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Chapter 34 of 78
黄帝内经·素问
The Yellow Emperor asked: When a person has not dressed too warmly and has not been exposed to external pathogenic heat, why do they nonetheless develop fever, irritability, and fullness in the chest and abdomen? Qi Bo replied: This is because the Yin qi (the aspect that is still, cool, and nourishing) is deficient and diminished, while Yang qi (the aspect that is dynamic, hot, and propelling) is preponderant and exuberant—hence the fever, irritability, and fullness.
The Yellow Emperor asked: When the body has not been chilled by inadequate clothing, and there is no external cold pathogenic factor, yet coldness feels as though it arises from within the body, why is this? Qi Bo replied: Such people typically have an excess of Bi qi (obstructed and stagnant qi). Their yang qi is deficient and yin qi is excessive, and therefore the body feels cold, as if emerging from water.
The Yellow Emperor asked: Some people have heat in the four limbs; when they encounter wind and cold, it paradoxically feels like being scorched by fire. Why is this? Qi Bo replied: Such people have deficient yin qi and exuberant yang qi. The four limbs pertain to yang, and external wind also pertains to yang; when two yangs meet—and since yin qi is already deficient and scanty—a small amount of 💧water cannot extinguish the blazing 🔥fire. Thus yang qi acts alone and dominates exclusively. When yang qi dominates exclusively, it cannot carry out normal transformation and generation; it merely reaches an extreme of excess. Therefore, those who feel as if scorched by fire when encountering wind will gradually experience wasting of the flesh.
The Yellow Emperor asked: Some people have a cold body—neither hot water nor fire can warm them; thick clothing cannot make them warm—yet they do not shiver from cold. What disease is this? Qi Bo replied: Such people usually have an overabundant renal (kidney) qi in their constitution and frequently come into contact with dampness and water. The qi of the Taiyang (Bladder) channel declines, and the fatty essence (marrow fat) of the kidney becomes exhausted and can no longer grow. One viscus—the kidney (water)—cannot restrain the yang qi of the liver and heart (wood and fire). The kidney pertains to water and governs the bones; when kidney essence can no longer be transformed and generated, the bone marrow cannot be replenished. Therefore, the coldness penetrates deep into the bones. The reason they do not shiver from cold is that the liver is the lesser yang (shaoyang) within yin, and the heart is the greater yang (taiyang) within yang; the kidney is the solitary viscus—one water cannot overcome two fires—and therefore there is no shivering. This disease is called bone bi (bone impediment), and the patient will present with joint contracture.
The Yellow Emperor asked: Some people have numb and insensate flesh—even when wearing thick clothing and padded with cotton wadding, they still feel dull and unresponsive. What disease is this? Qi Bo replied: This is nutritive qi (ying qi, which travels within the vessels and governs nourishment) deficiency, combined with defensive qi (wei qi, which travels outside the vessels and governs warming and protection) deficiency—although the original text reads "defensive qi in excess," later commentators generally hold that it should be "defensive qi deficiency." When nutritive qi is deficient, the flesh and skin become numb and insensate; when defensive qi is deficient, the limbs become heavy and difficult to move; when both nutritive and defensive qi are deficient, the person is both numb and immobile, yet the outward appearance of the flesh is normal. When the physical body and the spirit cannot respond to one another, the prognosis is poor—the ancients called this "death."
The Yellow Emperor asked: There are people who suffer from adverse counterflow of qi, who cannot lie flat and breathe with sound; others cannot lie flat but breathe without sound; still others go about their daily activities normally yet breathe with sound; others can lie flat but become breathless when walking; others can neither lie flat nor walk without breathlessness; and yet others cannot lie flat—the moment they lie down, they pant. Which viscus is responsible for each of these conditions? I would like to hear the reasons.
Qi Bo replied: Those who cannot lie flat and breathe with sound suffer from reversal of the Yangming channel qi. The three yang channels of the foot should normally descend, but now they ascend instead—hence the noisy breathing. The Yangming is the stomach channel; the stomach is the sea of the six bowels (fu organs), and stomach qi likewise should descend. When Yangming qi reverses its course and fails to follow its descending pathway, the person cannot lie flat. The Xia Jing (Lower Classic) says: When the stomach is not harmonious, lying down is unsettled. This is exactly what is meant. Those who go about their daily activities normally yet breathe with sound suffer from reversal of the lung collateral (luo mai) qi. When collateral vessels cannot follow the main channels in moving up and down, qi becomes trapped locally and cannot circulate freely. Since collateral disease is relatively mild, the person can maintain normal daily activities yet breathe with sound. Those who cannot lie flat and pant as soon as they lie down suffer from retention of water qi. Water fluids normally travel through the channels of body fluid transport; the kidney is the water viscus and governs body fluids, so when water qi attacks the lungs, it affects both lying flat and breathing—hence panting on lying down.
The Yellow Emperor said: Excellent.
This chapter is titled "Adverse Counterflow and Regulation," and its essence lies in the relationship between "counterflow" (逆) and "regulation" (调): the normal state of the human body is one of harmonious coordination among yin and yang, nutritive and defensive qi, and the ascending-descending movements of visceral qi. Once this harmony is disrupted, abnormal manifestations such as cold, heat, numbness, and panting arise.
Yin-yang imbalance produces cold and heat
Heat with irritability and fullness results from yin deficiency and yang exuberance; cold arising from within results from yang deficiency and yin exuberance. The ancients regarded cold and heat as the outcome of the relative balance of power between yin and yang—not merely as a consequence of external temperature.
Yin deficiency with yang exuberance can cause "wasting of the flesh" (rou shuo)
Heat in the four limbs that feels like scorching on exposure to wind arises from the conjunction of limb yang and external wind yang, with insufficient yin water to restrain the yang fire. This embodies the principle that "yang exuberance produces heat" and "solitary yang cannot generate": when yang qi loses the constraint of yin qi, it not only fails to carry out normal transformation and generation, but actually consumes the physical form.
Kidney, bone, marrow, and the manifestation of cold
Cold penetrating to the bones without shivering is named "bone bi" (bone impediment). The ancients held that the kidney governs water, governs the bones, and generates marrow. When renal fatty essence is depleted and marrow is no longer replenished, cold penetrates deeply to the bones. The statement that "one water cannot overcome two fires" belongs to the viscera-yin-yang model of the time, used to explain the internal mechanism of mixed cold and heat presentations.
The relationship between nutritive/defensive qi and body-spirit (xing-shen)
"Rou ke" (flesh torpor) results from deficiency of both nutritive and defensive qi, leading to numbness and immobility. Nutritive qi governs nourishment; defensive qi governs protection and motor activity. When both are deficient, the physical body and the spirit (conscious awareness, responsiveness) fail to correspond. This reflects the Neijing's concern with the unity of body and spirit.
Ascending-descending qi movement and its relation to panting and inability to lie flat
Stomach qi should normally descend; when the stomach is disharmonious, it reverses and moves upward, causing restless lying and noisy breathing. Lung collateral qi reversal is mild, so daily activities remain normal, though the breath is audible. Water retention—with loss of the kidney's regulatory function over water metabolism—causes panting on lying down. The common thread in all these discussions: when qi that should descend does not descend, or forward movement is blocked, corresponding symptoms arise.
These contents are theoretical formulations by the ancients of phenomena related to body temperature, sensation, movement, respiration, and sleep. They belong to the traditional medical model and cannot be directly equated with modern pathological diagnoses.
This chapter offers general insights for daily life and lifestyle, not directed at any specific disease:
This content is based on classical Chinese medical texts and is provided for cultural and scholarly study only. It does not constitute any medical diagnosis, medication recommendation, or treatment advice. If you are unwell, please consult a qualified healthcare provider in a timely manner.
— Pugua