素问：厥论篇第四十五

Plain Questions: Treatise on Syncope, Chapter 45

Holistic Paraphrase

This chapter discusses syncope (a category of disorders involving reversed flow of qi, imbalance of yin and yang, manifested as cold or heat in the extremities, fainting, and related symptoms). The Yellow Emperor asked: Syncope can be distinguished as cold-type or heat-type—what is the reason for this? Qi Bo answered: When yang qi in the lower burner is deficient, cold syncope occurs; when yin qi in the lower burner is deficient, heat syncope occurs.

The Yellow Emperor asked: In heat syncope, why does the fever always begin from the soles of the feet? Qi Bo said: The qi of the three yang channels of the foot originates from the lateral side of the five toes, while the qi of the three yin channels of the foot gathers at the sole and center of the foot. Therefore, when yang qi predominates, the soles become hot first. The Yellow Emperor further asked: In cold syncope, why does the coldness spread upward from the five toes to the knees? Qi Bo said: The qi of the three yin channels of the foot originates from the medial side of the five toes and gathers below and above the knees. Therefore, when yin qi predominates, coldness spreads from the toes up to above the knees. This cold is not contracted from external factors but generated from within the body.

The Yellow Emperor asked: How does cold syncope arise? Qi Bo said: The external genitalia are where the ancestral sinews (the convergence point of all sinews and vessels in the body) converge and where the spleen channel of foot-taiyin and the stomach channel of foot-yangming meet. In spring and summer, yang qi is abundant and yin qi is scarce; in autumn and winter, yin qi is exuberant and yang qi declines. If a person with a normally robust constitution overexerts (such as through excessive sexual activity) during autumn and winter, the essential qi of the lower burner struggles upward but cannot recover, and essence is drained downward while pathogenic qi takes advantage of the deficiency to rebel upward. When yang qi in the middle burner declines, it can no longer infiltrate and nourish the channels and collaterals, leading to a daily depletion of yang qi and the solitary retention of cold yin internally, hence cold hands and feet.

The Yellow Emperor asked: How does heat syncope arise? Qi Bo said: When wine enters the stomach, it causes the collateral vessels to become full while the primary channels become empty. The spleen is responsible for transporting fluids for the stomach. If yin qi is deficient, yang-heat enters internally, and stomach qi becomes disharmonized. When the stomach is disharmonized, essential qi becomes exhausted; when essential qi is exhausted, it can no longer nourish the four limbs. Such persons often engage in sexual intercourse after repeated intoxication or heavy meals. The qi of wine and food accumulates in the spleen without being dispersed, and the qi of wine and the qi of grains bind and struggle with each other, generating exuberant heat internally—hence the body becomes hot and urine becomes yellow-red. Since the qi of wine is fierce and swift, and kidney qi is already declining, yang qi becomes hyperactive in isolation, and the hands and feet become hot.

The Yellow Emperor asked: Some syncope disorders cause abdominal distension, while others cause sudden loss of consciousness from which the person awakens only after half a day or even a full day—why is this? Qi Bo said: When yin qi predominates above, the lower burner becomes empty, and emptiness below leads to abdominal distension; when yang qi predominates above, the lower qi rebels upward, pathogenic qi becomes rebellious and chaotic, and when yang qi is deranged, consciousness is lost.

The Yellow Emperor said: Well spoken. I would like to hear about the symptoms when the six channels manifest reversed flow. Qi Bo said:

• Syncope of the bladder channel of foot-taiyang: Swelling of the head and face, heaviness of the head, inability of the feet to walk, and during episodes dizziness and falling down.
• Syncope of the stomach channel of foot-yangming: Manic agitation, desire to run and shout, abdominal fullness with inability to lie down peacefully, red face with fever, visual hallucinations, and delirious speech.
• Syncope of the gallbladder channel of foot-shaoyang: Sudden deafness, swelling and heat of the cheeks, rib pain, and inability of the calves to move.
• Syncope of the spleen channel of foot-taiyin: Abdominal distension, difficult defecation, no desire to eat, vomiting after eating, and inability to sleep peacefully.
• Syncope of the kidney channel of foot-shaoyin: Dry mouth, yellow-red urine, abdominal distension, and heart pain.
• Syncope of the liver channel of foot-jueyin: Pain and swelling in the lower abdomen, abdominal distension, difficult urination, preference for curling up with bent knees, contraction and swelling of the genitals, and heat on the medial side of the calves.

Regarding treatment principles, the ancients held that: when pathogenic qi is exuberant, use purging methods; when righteous qi is deficient, use supplementing methods; when there is neither excess nor deficiency, select points along the affected channel for regulation. The following are syncope of various channels with reversed flow: Reversal of taiyin involves cramping and spasms of the calves, with heart pain radiating to the abdomen; reversal of shaoyin involves deficient fullness, nausea and vomiting, and loose stools with undigested food; reversal of jueyin involves contracture of the limbs, lower back pain, deficient fullness, urinary obstruction, and delirium; reverse flow of all three yin channels simultaneously manifests with obstruction of both bowels and urinary bladder, ice-cold hands and feet—the ancients considered this an extremely poor prognosis. Reversal of taiyang manifests with rigid stiffness and falling, vomiting blood, and epistaxis; reversal of shaoyang involves impaired joint mobility, inability to move the lower back, inability to turn the neck for looking back, and if intestinal abscess develops, it was deemed incurable in ancient times—convulsions accompanying it are critical; reversal of yangming involves wheezing, coughing, body heat, easy fright, epistaxis, and vomiting blood. Reversal of hand-taiyin involves deficient fullness with coughing and frequent spitting of saliva; reversal of hand-jueyin and hand-shaoyin involves heart pain radiating to the throat with body heat—the ancients considered this incurable; reversal of hand-taiyang involves deafness with tearing, inability of the neck to turn backward, and inability of the lower back to bend or extend; reversal of hand-yangming and hand-shaoyang manifests as throat obstruction and pharyngeal swelling.

🧠 Deep Understanding

Core Principles 💡

The core of this chapter is that imbalance of yin and yang with reversed derangement of qi movement leads to syncope disorders.

• The essence of cold syncope is yang qi deficiency in the lower burner with exuberant cold-yin internally, often caused by failure to store essence in autumn and winter, excessive depletion, leading to daily decline of yang qi and solitary predominance of yin qi.
• The essence of heat syncope is yin qi deficiency in the lower burner with hyperactive yang-heat, often caused by sexual intercourse after intoxication and heavy meals; the qi of wine and grains bind and generate heat while simultaneously damaging kidney yin, resulting in hot hands and feet.
• Syncope disorders are not limited to cold or heat of the extremities; the rebellion and derangement of yin and yang qi upward and downward may also cause abdominal distension or sudden loss of consciousness.
• The syncope manifestations of the six channels are summarized according to the pathways of channel circulation and associated viscera, reflecting the dialectical approach that "where the channels pass, there lie the treatment indications."

Modern Perspectives 🌟

From a modern point of view, syncope disorders correspond to varying degrees with autonomic nervous system dysfunction, peripheral circulatory disorders, metabolic abnormalities, acute infections, and neurological conditions.

• Cold syncope resembles hypothermia, pre-shock states, poor peripheral circulation, and hypothyroidism.
• Heat syncope resembles high fever, infection, vasodilation and metabolic hyperactivity induced by alcohol.
• Sudden loss of consciousness resembles syncope and impaired consciousness, which may be caused by insufficient cerebral or cardiac blood supply, severe arrhythmias, hypoglycemia, and other conditions.
• The manifestations described for six-channel syncope—such as head heaviness, deafness, rib pain, abdominal distension, and urinary difficulty—roughly correspond to neurological segments and visceral referred pain patterns, but are not anatomical concepts.
• Ancient statements such as "death in three days" or "incurable" reflect the clinical observations of the ancients regarding critical conditions, constrained by the medical capabilities of their era, and cannot serve as modern prognostic determinations; modern emergency medicine can provide effective interventions.

Health Preservation Insights ⚡

• Follow the four seasons, nourish yin in autumn and winter: In autumn and winter, one should reduce excessive consumption, moderate sexual activity, and avoid overexertion to protect essential qi.
• Drink alcohol in moderation; avoid sexual intercourse when drunk or full: The nature of alcohol is fierce and promotes heat; sexual intercourse after intoxication and heavy meals most easily damages yin and depletes qi—this should be avoided as much as possible.
• Eat with moderation: Avoid binge eating and heavy drinking, reduce accumulated heat in the spleen and stomach, and maintain smooth digestion.
• Maintain emotional stability: Avoid intense emotional fluctuations such as great anger and extreme fright, to prevent derangement of qi movement.
• Seek medical attention promptly: If sudden coldness of the extremities, fever, fainting, or severe abdominal pain occurs, seek medical care immediately rather than self-treating through channel regulation.

📚 Related Knowledge

• Related concepts: Syncope, imbalance of yin and yang, reversed derangement of qi movement, circulation pathways of the twelve channels, the spleen governing the transportation of fluids for the stomach, ancestral sinews, external genitalia.
• Further reading: Plain Questions: Discourse on the Correspondence of Vital Qi with Heaven, Plain Questions: Discourse on the Manifestations of Yin and Yang, Miraculous Pivot: Channel Pathways, Treatise on Cold Damage: Differentiation and Treatment of Jueyin Disease.

Bu Gua Reminder: This content is based on classical texts of traditional Chinese medicine and is provided solely for the study and research of traditional culture. It does not constitute any form of medical diagnosis, medication, or treatment advice. If you experience discomfort, please seek medical attention promptly.