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บทที่ 32 จาก 78
黄帝内经·素问
Overall meaning and interpretation
1. Liver heat disease
Those with liver heat disease first experience yellow urine, abdominal pain, liking to lie down, and body heat. When pathogenic heat contends with healthy qi, there may be delirious speech, easy startling, fullness and pain in the flanks and ribcage, restlessness of hands and feet, and inability to sleep well. On gengxin days (associated with metal; metal controls wood), the condition worsens; on jiayi days (associated with wood; wood qi is at its height), healthy qi returns and there may be profuse sweating all over with abatement of heat; if heat rebounds upward and the condition deteriorates, there is risk of death on gengxin days. Ancient acupuncture methods needled the foot jueyin liver channel and foot shaoyang gallbladder channel. If heat rebounds upward, there may be headache and dizziness, caused by channel qi rushing upward to the head.
2. Heart heat disease
Those with heart heat disease first feel unhappy at heart, and only after several days does fever appear. When pathogenic and healthy qi contend, there may be sudden heart pain, oppression, nausea with vomiting tendency, headache, red facial complexion, and absence of sweating. On rengui days (associated with water; water controls fire), the condition worsens; on bingding days (associated with fire; fire qi is at its height), there may be profuse sweating with abatement of heat; if heat rebounds upward, there is risk of death on rengui days. Ancient acupuncture methods needled the hand jueyin? Actually the text says hand shaoyin heart channel and hand taiyang small intestine channel.
3. Spleen heat disease
Those with spleen heat disease first experience heaviness of the head, pain in the cheeks, vexation at heart, greenish facial complexion, nausea with vomiting tendency, and body heat. When pathogenic and healthy qi contend, there may be lumbar pain with inability to bend or extend, abdominal distension with diarrhea, and pain in both lower jaw areas. On jiayi days (associated with wood; wood controls earth), the condition worsens; on wuji days (associated with earth; earth qi is at its height), there may be profuse sweating with abatement of heat; if heat rebounds upward, there is risk of death on jiayi days. Ancient acupuncture methods needled the foot taiyin spleen channel and foot yangming stomach channel.
4. Lung heat disease
Those with lung heat disease first experience chills, piloerection, aversion to wind and cold, yellowish tongue coating, and body heat. When pathogenic and healthy qi contend, there may be wheezing and coughing, pain that moves through the chest, breast, and back, inability to take deep breaths, severe headache, and sweating followed by chilling again. On bingding days (associated with fire; fire controls metal), the condition worsens; on gengxin days (associated with metal; metal qi is at its height), there may be profuse sweating with abatement of heat; if heat rebounds upward, there is risk of death on bingding days. Ancient acupuncture methods needled the hand taiyin lung channel and hand yangming large intestine channel, with a small amount of bloodletting about the size of a soybean; the original text holds that heat can resolve quickly this way.
5. Kidney heat disease
Those with kidney heat disease first experience lumbar pain, soreness in the calves, thirst with frequent drinking of water, and body heat. When pathogenic and healthy qi contend, there may be stiffness and pain in the nape, cold and sore calves, hot soles of the feet, and unwillingness to speak; if heat rebounds upward, there is nape pain accompanied by dizziness and a sensation of instability. On wuji days (associated with earth; earth controls water), the condition worsens; on rengui days (associated with water; water qi is at its height), there may be profuse sweating with abatement of heat; if heat rebounds upward, there is risk of death on wuji days. Ancient acupuncture methods needled the foot shaoyin kidney channel and foot taiyang bladder channel.
Regarding the pattern of sweating in the above visceral heat diseases, the ancients held that on the corresponding flourishing days, healthy qi prevails over pathogen, profuse sweating occurs, and heat abates.
6. Facial redness first and “treating before disease”
For liver heat disease, the left cheek becomes red first; for heart heat disease, the forehead becomes red first; for spleen heat disease, the nose becomes red first; for lung heat disease, the right cheek becomes red first; for kidney heat disease, the chin becomes red first. Although the disease has not yet fully broken out, as long as redness is seen in the corresponding region, acupuncture may be applied; this is called “treating before disease” — intervening before the disease fully takes shape. When heat disease begins in its corresponding region, it may resolve on the corresponding date; if acupuncture methods are used incorrectly, resolution may be delayed for three cycles; if erroneous treatment is repeated and healthy qi is disturbed, there may be risk of death. Whenever heat disease should resolve through sweating, at the corresponding flourishing day, profuse sweating will occur.
7. Care and regulation in heat disease
In ancient treatment of heat disease, the patient was first given cool water to drink, then acupuncture was applied; thin clothing was required, and the patient was placed in a cool place, so that the body became cool and treatment stopped. This reflects the ancient principle of “cooling for heat” in regulating heat disease.
8. Channel-specific acupuncture for heat disease
For heat disease beginning with chest and flank pain and restlessness of hands and feet, needle the foot shaoyang gallbladder channel and supplement the foot taiyin spleen channel; for severe cases use the fifty-nine punctures (an ancient set of fifty-nine acupuncture points dedicated to heat disease). For heat disease beginning with arm pain, needle the hand yangming and hand taiyin channels, stopping when sweating appears and heat abates. For heat disease beginning with the head, needle the taiyang channel of the nape, stopping when sweating appears and heat abates. For heat disease beginning with the lower legs and shins, needle the foot yangming channel, stopping when sweating appears and heat abates. For heat disease first presenting with heavy body, bone pain, deafness, and somnolence, needle the foot shaoyin channel; for severe cases use the fifty-nine punctures. For heat disease first presenting with dizziness, fever, and fullness in chest and flanks, needle the foot shaoyin and foot shaoyang channels.
9. Integrating color and pulse examination
The color of the taiyang channel appears on the cheekbone; this indicates heat disease. If ying qi (nutritive qi, the refined substances moving within the vessels) has not yet bound with pathogenic qi, one may still say sweating is forthcoming, and resolution may occur on the corresponding day within the relevant time frame. If it contends with jueyin pulse color and both appear, death will occur within no more than three days. If heat disease internally connects with the kidney, color appears in the region of the shaoyang channel. When shaoyang channel color appears in front of the cheek, this indicates heat disease; if ying qi has not yet bound, sweating will occur, with resolution at the proper time; if it contends with shaoyin pulse color and both appear, death will occur within no more than three days.
10. Back acupoints and facial color diagnosis
For heat disease back acupoints: below the third vertebra governs heat in the chest, below the fourth vertebra governs heat in the diaphragm, below the fifth vertebra governs liver heat, below the sixth vertebra governs spleen heat, below the seventh vertebra governs kidney heat; ying qi is at the sacrum, and the hollow above the nape thirds? [Revised:] Ying qi is at the sacrum, and above the nape in the depression of the third vertebra. Facial color diagnosis: when color rising from below the cheek reaches the cheekbone, it indicates major abdominal masses; the lower jaw region governs abdominal fullness; behind the cheekbone governs flank pain; the upper cheek region governs the area above the diaphragm.
Heat disease classified by the five viscera: This chapter classifies heat disease according to the five viscera – liver, heart, spleen, lung, and kidney – each with prodromal symptoms, typical manifestations during the contention of pathogenic and healthy qi, corresponding acupuncture channels, and prognostic days. This reflects the application of the visceral manifestation doctrine of the Neijing to heat disease.
Five-element ten heavenly stems rise-decline model: The ten heavenly stems are matched to the five elements to explain changes in illness: the condition worsens on “controlling me” days, on the “own qi” flourishing day sweating occurs and recovery proceeds, and if healthy qi is disturbed, death may occur on the “controlling me” day. This is a specific deduction of ancient “correspondence between heaven and humanity” and “contention between healthy and pathogenic qi” thought.
“Treating before disease” thought: The five visceral heat diseases each have their own facial region that reddens first; before the disease has manifested fully, early detection and early intervention can be carried out through color diagnosis. This is a classic expression of preventive medicine thought in Chinese medicine.
Combining color and pulse, treatment by channel: Facial color diagnosis determines which viscus and channel is affected; combining this with whether the pulse color has bound determines prognosis; appropriate channels are selected for acupuncture according to the site of onset and symptoms of heat disease. The core is “treatment based on syndrome differentiation” and “guiding according to the situation.”
Cooling for heat as a basic care principle: Methods such as drinking cool water, wearing thin clothing, and staying in cool places for heat disease embody the basic direction of care for heat conditions.
The descriptions of heat disease symptoms in this chapter – such as fever, restlessness, flank pain, cough, yellow urine, thirst, and headache – represent careful ancient observation of infectious fevers and associated systemic manifestations, some of which broadly overlap with nonspecific manifestations in feverish illnesses in modern medicine.
The ten-heavenly-stem deduction of days for “worsening,” “sweating,” and “death” belongs to theoretical speculation under the ancient five-element model and is not a reliable modern prognostic tool. The outcome of heat disease depends on cause, constitution, treatment, and many other factors; life and death cannot be judged on the basis of heavenly stem dates.
Facial color diagnostic regions and back acupoint correlations have a certain value of ancient empirical observation but lack specific evidence in modern anatomy, physiology, or pathology. They should be regarded rationally and not used as diagnostic basis.
Methods such as acupuncture to drain heat and minor bloodletting reflect the ancients’ physical intervention approach to heat disease. Acupuncture must be performed by professionals and must not be self-attempted; its clinical efficacy still requires modern evidence-based research.
“Drinking cool water, thin clothing, staying in a cool place, stopping when the body becomes cool” is an ancient method of heat disease care. Mechanisms of fever in modern conditions are complex, and the excessive cooling method of “stop when the body becomes cool” should not be blindly adopted; one should maintain comfort, allow appropriate heat dissipation, supplement fluids adequately, and treat the underlying cause.
Related concepts
Further reading
This content is based on classic Chinese medical texts and is provided only for cultural heritage study and reading. It does not constitute any medical diagnosis, medication, or treatment advice; if you are unwell, please seek medical attention in a timely manner.