Suwen: Treatise on Qi Reversal, Chapter 37
Overall Paraphrase
This chapter discusses how cold and heat pathogenic qi of the five viscera and six bowels mutually transfer and transform. Huangdi asks: When cold and heat pathogenic qi of the five viscera and six bowels mutually transfer, what diseases arise? Qibo replies:
Regarding cold pathogen transfer: Cold from the kidneys transferring to the liver may produce swellings (carbuncles), qi deficiency, and shortness of breath; cold from the spleen transferring to the liver may produce swellings and sinew/vessel spasms; cold from the liver transferring to the heart may produce mania and chest/diaphragm blockage; cold from the heart transferring to the lungs forms lung wasting (feixiao), manifested as "drinking one measure but urinating two"—drinking one portion of water yet excreting two portions of urine. The ancients considered this a fatal condition, difficult to treat; cold from the lungs transferring to the kidneys forms welling water (yongshui) disease—pressing the abdomen shows no hardness, water qi lodges in the large intestine, and when walking quickly, a "zhuo-zhuo" sound arises from the intestines, like a leather bag filled with water 🌊—this is caused by water qi.
Regarding heat pathogen transfer 🔥: Heat from the spleen transferring to the liver may produce fright and nosebleeds; heat from the liver transferring to the heart was deemed by the ancients to have an ominous prognosis; heat from the heart transferring to the lungs transforms into diaphragm wasting (ge xiao—diaphragm heat with wasting thirst, dry mouth, and excessive drinking); heat from the lungs transferring to the kidneys transforms into flaccidity with rigidity (rouchi, an ancient disease name, a type of convulsive disorder with sinew spasms); heat from the kidneys transferring to the spleen transforms into depletion-wasting and intestinal dysentery (chang pi—sundered intestines with purulent, bloody stools), which the ancients considered fatal and difficult to treat; heat from the uterus (here referring to the female womb or the essence chamber) transferring to the bladder manifests as difficult urination and blood in the urine; heat from the bladder transferring to the small intestine causes intestinal blockage and difficult defecation, with heat steaming upward producing erosion of the mouth; heat from the small intestine transferring to the large intestine forms hidden masses (fu jia—latent abdominal conglomerations) or sinking (some say a type of hemorrhoids with prolapse); heat from the large intestine transferring to the stomach allows eating but with progressive emaciation, called food counterflow (shi yi); heat from the stomach transferring to the gallbladder is also called food counterflow; heat from the gallbladder transferring to the brain produces a pungent discomfort at the base of the nose, developing into nasal abyss (bi yuan—nasal discharge of turbid fluid flowing incessantly), which may further transform into nosebleeds and blurred vision. All these conditions arise because qi mechanism reversal 💨 causes cold and heat pathogenic qi to transmit abnormally beyond their regular pathways.
🧠 Deep Understanding
Core Principles 💡
- Viscera interconnected, pathogenic transmission: Traditional Chinese medicine holds that the five viscera and six bowels are interconnected through channel networks, exterior-interior relationships, and the five-phase generation/control cycles. When one viscus is affected by pathogens, others may be involved. The "transfer of cold" and "transfer of heat" in this text are not anatomical transfers but pathomechanism transmissions akin to a domino effect, based on physiological and pathological relationships among the viscera.
- Cold-heat determination shapes pathological tendencies: Cold pathogens tend to damage yang, congeal, and constrict, hence presentations of shortness of breath, sinew spasms, and water retention; heat pathogens tend to damage yin, flare upward, and move blood, hence presentations of nosebleeds, wasting-thirst, oral erosion, and blurred vision. This classification of cold versus heat as the guiding principle embodies the diagnostic approach of "examining syndromes to seek the cause."
- Qi mechanism derangement is the root of transmission: The title "Qi Reversal" emphasizes that abnormal ascending, descending, exiting, and entering of qi is the internal precondition enabling cold and heat pathogens to "transfer" among viscera. When qi does not follow its regular pathways, pathogens follow the derangement.
Modern Perspectives 🌟
- This text constitutes a systematic explanation—under the ancients' limited observational conditions—linking multi-system symptoms with visceral correspondences, holding significant value in medical history and theory. Descriptions such as "drinking one, urinating two" and "eating well yet becoming thin" bear resemblance to typical presentations of certain modern endocrine-metabolic disorders (e.g., diabetes insipidus, diabetes mellitus, hyperthyroidism); the description of "nasal abyss" is also close to chronic sinusitis. However, these are only phenomenological similarities and should not equate ancient disease names with modern diagnoses.
- "Transfer of cold" and "transfer of heat" belong to speculative pathomechanistic models lacking modern pathological evidence; judgments such as "liver heat transferring to the heart results in death" or "kidney heat transferring to the spleen... fatal and untreatable" reflect prognostic assessments of critical conditions under the medical capabilities of that era and should not be taken as absolute determinations today. In critical situations, prompt medical attention is necessary 🩺.
- Several ancient disease names in the text (e.g., soft rigidity, hidden masses, food counterflow) have received divergent interpretations from later commentators; readers should consult annotated editions and avoid mechanically mapping them to modern diseases.
Wellness Insights ⚡
- Harmonize cold and heat: In daily diet, avoid chronically excessive consumption of raw, cold, pungent, or scorching foods to reduce stimulation of internal qi by cold-heat excess.
- Regulate emotions: Excessive emotional agitation can induce qi reversal, such as anger harming the liver and fright harming the heart; maintaining emotional calm helps prevent "qi-reversal" transmissions.
- Prevent disease before onset: Address minor imbalances promptly—e.g., nasal congestion with turbid discharge, recurrent mouth ulcers, or urinary abnormalities—seek professional pattern differentiation rather than self-applying ancient disease names.
- Follow the four seasons: Maintain regular routines to support the ascending, descending, exiting, and entering of qi, avoid staying up late or overexertion that depletes upright qi, thereby reducing the foundation for external pathogens to invade and transmit.
📚 Related Knowledge
- Related Concepts: Qi mechanism ascending-descending-exiting-entering, viscera-bowel exterior-interior correspondence, five-phase generation and control, six-channel transmission, defense-qi-nutrient-blood transmission, treating disease before onset
- Further Reading: Suwen·Jade Engine Treatise on Visceral Vessels (Yuji Zhenzang Lun) on disease transmission among the five viscera; Lingshu·Disease Transmission (Bing Chuan); Suwen·Treatise on Cough (Ke Lun) — "all five viscera and six bowels can cause cough"; Suwen·Treatise on Yin-Yang Correspondences (Yinyang Yingxiang Da Lun) on cold-heat and yin-yang.
Bugua's note: This content is based on classic traditional Chinese medicine texts and is provided solely for traditional cultural study and research. It does not constitute any medical diagnosis, medication recommendations, or therapeutic advice; please consult a qualified professional for any health concerns.
