Lingshu: Cold and Heat Diseases, Chapter 21

Lingshu·Cold and Heat Diseases, Chapter 21 — Vernacular Interpretation

Overall Paraphrase

⚠️ The following content is an academic interpretation of classical Chinese medicine texts. The acupuncture, acupoints, and syndrome determinations mentioned are for study purposes only and do not constitute any treatment advice.

Cold-Heat Diseases of the Skin, Flesh, and Bones

• Cold-Heat of the Skin: When pathogenic qi resides in the skin and hair, the body feels hot and the patient cannot lie close to the mat. The hair becomes dry and brittle, the nose is parched without moisture, and there is no sweating. The ancient treatment was to select the collateral points of the three Yang channels and supplement the Hand Taiyin Lung channel 🌿.
• Cold-Heat of the Flesh: When pathogenic qi resides in the flesh, there is muscle pain, dry and brittle hair, a parched nose, and also no sweating. The treatment is to select the lower collateral vessels of the three Yang channels of the foot, remove stagnant blood, and then supplement the Foot Taiyang channel to induce sweating 💨.
• Cold-Heat of the Bones: When pathogenic qi resides in the bones, the patient experiences restlessness and irritability with incessant sweating. If the teeth have not yet withered, one may select the collateral vessels of the Foot Shaoyin channel on the inner thigh. If the teeth have already withered, it indicates exhaustion of essential qi, and the ancients considered the prognosis poor. Bone reversal (gu jue) is similar to this condition.
• Bone Bi (arthropathy): Joints are stiff and painful upon movement, accompanied by sweating and restlessness. One may select the Jing-river points of the three Yin channels for supplementation.
• Body Fatigue (ti duo): When the body is wounded with excessive bleeding, and then exposed to wind-cold, or after falling from a height, the limbs become lax, weak, and unable to move — this is called "body fatigue." One may select the Three Junctions (san jiao jie) in the lower abdomen below the navel, which is the Guanyuan point three cun below the navel.

Reversal Bi and the Five Regions of Tianyou

• Reversal Bi: Reversed qi rushes upward to the abdomen. In treatment, one may select the collateral vessels of the Yin and Yang channels, observe which channel is primarily affected, and use draining methods on the Yang channels and supplementation on the Yin channels.
• The pulsating artery on the side of the neck is the Renying point, belonging to the Foot Yangming channel, located in front of the large muscle beside the throat. Behind the large muscle is the Futu point, belonging to the Hand Yangming channel. Further back is the Tianyou point — the channel attribution in the original text is a transmission error; according to the standard edition, it belongs to the Hand Shaoyang channel. Further back still is the Tianzhu point, belonging to the Foot Taiyang channel. The pulsating artery in the axilla is the Tianfu point, belonging to the Hand Taiyin channel.
• When Yang heat rebels upward causing headache and chest oppression with difficulty breathing, select Renying. For sudden loss of voice and throat qi blockage, select Futu and bleed the root of the tongue. For sudden deafness, clouded qi, and blurred vision in the ears and eyes, select Tianyou. For sudden cramping, dizziness, and inability of the feet to support the body, select Tianzhu. For sudden heat disease with internal rebellion, where Liver and Lung qi clash causing bleeding from the mouth and nose, select Tianfu. These are the Five Regions of Tianyou.

Facial and Dental Acupoints, and the Qiao Vessels

• The Yangming channel has a branch that enters the cheekbone and spreads through the teeth. The corresponding point is called Daying, used for dental caries of the lower teeth. If the patient fears cold, use supplementation; if not, use draining.
• The Taiyang channel has a branch that enters the vertex and spreads through the teeth. The corresponding point is called Jiaosun, used for dental caries of the upper teeth. It is located in front of the nose and the neck. The channel attribution in this passage is also a transmission error; Jiaosun belongs to the Hand Shaoyang channel in the standard edition.
• When the disease is active, the local vessels are replete. For replete vessels, use draining; for deficient vessels, use supplementation. Another version says to select the point lateral to the nose.
• The Foot Yangming channel has a branch that flanks the nose and enters the face, called Xuanlu, connecting to the mouth and internally linking to the eye system. Examine its abnormalities and select accordingly. For excess patterns, drain the surplus; for deficiency patterns, supplement the insufficiency. Using the opposite approach will worsen the condition.
• The Foot Taiyang channel has a branch that enters the brain from the nape, directly connecting to the root of the eye, called the Eye System. For painful conditions of the head and eyes, one may select the point between the two sinews at the nape; the channel divides only after entering the brain.
• The Yin Qiao vessel and Yang Qiao vessel intersect with Yin and Yang. Yang enters Yin, and Yin emerges from Yang, meeting at the outer canthus of the eye. When Yang qi is predominant, the eyes open; when Yin qi is predominant, the eyes close.

Reversal Syndromes, Four-Season Needling Methods, and Needling Hazards

• For Heat reversal, select the Foot Taiyin channel and Foot Shaoyang channel with retained needles. For Cold reversal, select the Foot Yangming channel and Foot Shaoyin channel at points on the foot with retained needles.
• For a flaccid tongue, drooling from the corner of the mouth, and restlessness in the chest, select the Foot Shaoyin channel. For shivering with chills, teeth chattering, absence of sweating, abdominal distension, and restlessness, select the Hand Taiyin channel.
• When needling deficiency, follow the direction of qi flow to use supplementation; when needling excess, meet the direction of qi coming to use draining.
• In spring, mostly select the collateral vessels; in summer, mostly select the intermuscular spaces (fen cou); in autumn, mostly select the qi opening (qikou); in winter, mostly select the jing-shu points. Each season has corresponding needling standards. The collateral vessels govern the skin, the intermuscular spaces govern the flesh, the qi opening governs the sinews and vessels, and the jing-shu points govern the bone marrow and the five zang organs.
• The body has five important regions: the first is Futu (the thigh muscle), the second is the calf (fei) , the third is the back, the fourth is the Back-Shu points of the five zang organs, and the fifth is the nape. The ancients believed that if ulcers or carbuncles arise in these five regions, the prognosis is dangerous.
• If the disease begins in the arms and hands, first select the Hand Yangming and Hand Taiyang channels to induce sweating. If the disease begins in the head, first select the Foot Taiyang channel at the nape to induce sweating. If the disease begins in the foot and lower leg, first select the Foot Yangming channel to induce sweating. Both the Hand Taiyang and Foot Yangming channels can induce sweating.
• Therefore, if excessive sweating occurs after needling Yin channels, one may needle Yang channels to stop the sweating. If excessive sweating occurs after needling Yang channels, one may needle Yin channels to stop the sweating.
• Hazards of improper needling: If the needle hits the affected area but is left in too long, it will drain essential qi. If the needle is withdrawn without hitting the affected area, it may allow pathogenic qi to accumulate. Depletion of essential qi worsens the condition and causes deficiency; accumulation of pathogenic qi may lead to the formation of ulcers and carbuncles.

🧠 In-Depth Understanding

Core Principles 💡

The core of this chapter lies in layered differentiation and treatment based on the depth of the disease location. Cold-heat diseases of the skin, flesh, and bones correspond to pathogenic qi residing at the levels of skin/hair, flesh/muscle, and bone/marrow, respectively. The symptoms progress from mild to severe, and the treatments shift from superficial collateral points to deeper channel points, embodying the Neijing principle of "where the pathogen is, there select the channel."

The Five Regions of Tianyou demonstrates the ancient acupuncture concept of "using key acupoints of the neck and nape to treat acute conditions of the head, face, and sense organs." Renying, Futu, Tianyou, Tianzhu, and Tianfu are all located near the pulsating arteries of the neck, nape, and axilla. The ancients believed these areas had channel connections to the clear orifices of the head and face, and thus could treat acute conditions such as sudden deafness, sudden muteness, and dizziness.

Additionally, this chapter emphasizes four-season needling methods and deficiency-excess supplementation and draining. Needling collaterals in spring, intermuscular spaces in summer, qi opening in autumn, and jing-shu points in winter reflects the philosophy of "correspondence between man and heaven-earth" applied to acupuncture. Using "following" for deficiency and "meeting" for excess is the fundamental principle of acupuncture supplementation and draining.

Modern Perspectives 🌟

From a modern perspective, the layer-by-layer progression of cold-heat diseases in the skin, flesh, and bones roughly corresponds to the process of certain infections or inflammations spreading from the body surface to deeper layers, though the ancients had no concepts of microorganisms or immunity and could not be equated directly with modern disease classifications. The value lies in providing a "from shallow to deep" observational framework.

The acupoints in the Five Regions of Tianyou are mostly located in the neck and bear certain anatomical correlations with the nerves and blood vessels of the head and face. For instance, Renying is near the carotid artery, Futu and Tianyou are adjacent to the sternocleidomastoid muscle, and Tianzhu is at the nape. Needling these areas may influence local neural reflexes, but the channel connections described by the ancients cannot be fully validated by modern anatomy.

"The five regions with ulcers and carbuncles result in death" is the ancients' simple empirical summary regarding dangerous suppurative infections in critical areas. With modern surgical and anti-infection capabilities, the prognosis for such diseases has vastly improved, and the ancient judgments should not be applied literally. When reading, note that some channel names and acupoint attributions in this chapter contain transmission errors and should be cross-checked with the Jiayi Jing, Taisu, and other classical texts.

Health Insights ⚡

• In daily life, pay attention to adapting to cold and warmth and avoiding external injuries to prevent pathogenic factors from penetrating from the exterior to the interior and from the shallow to the deep.
• Sudden discomfort in the head, face, or sense organs — such as sudden hearing loss or sudden hoarseness — warrants prompt medical attention. The ancients emphasized early intervention for sudden illnesses, and modern medicine likewise advocates timely diagnosis and treatment.
• Maintain regular routines and avoid prolonged sleep deprivation. This chapter discusses the Yin Qiao and Yang Qiao vessels in relation to the opening and closing of the eyes and sleep rhythm; proper rest supports the orderly alternation of Yin and Yang.
• Keep emotions stable and avoid qi reversals such as "Liver and Lung clashing." Practice regular emotional疏导 and stress relief.

📚 Related Knowledge

• Related Concepts: Cold-heat of the skin, cold-heat of the flesh, cold-heat of the bones, body fatigue, reversal Bi, the Five Regions of Tianyou, Yin Qiao vessel, Yang Qiao vessel, four-season needling methods, following-meeting supplementation and draining, carbuncles in the five regions.
• Further Reading: Lingshu·Jingmai, Lingshu·Jiu Zhen Shi Er Yuan, Suwen·Ci Yao Lun, Suwen·Si Shi Ci Ni Cong Lun, and related chapters of the Zhenjiu Jiayi Jing.

This content is based on classical Chinese medicine texts and is provided for traditional cultural study and research only. It does not constitute any medical diagnosis, medication, or treatment advice. If you feel unwell, please seek medical attention promptly.