Why Do You Pee All Night? Why Is Your Urine Stream Weak? Doctor Ni Haixia on Bladder Qi Transformation and the Pulses of Life and Death, from the Huang Di Nei Jing

Patient search terms: what to do about frequent urination at night / I keep getting up in the night / my urine stream is weak / frequent urination / how to care for rough skin / how to treat gallstones / hemiplegia and weak limbs / what is the true organ pulse? / how do you feel the pulse? / how many pulse beats per breath is normal? / why do liver patients have a bad temper? / is sweating in winter bad?

Corresponding medical names: the Yin Yang Bie Lun (Discourse on the Separate Discourses of Yin and Yang), from the Su Wen · the true organ pulses · the covering and overflowing pulses · taiyang opens, shaoyang is the pivot, yangming closes · disease of the two yang starts in the heart and spleen · bu de yin qu · wind wasting and xi ben · disease of the three yang brings cold and heat · bladder qi transformation · the hot-air balloon theory · Zhongji and Guanyuan · disease of one yang · xin che · the gallbladder and the pericardium · sour enters the liver · anger injures the liver · wind reversal (feng jue) · hemiplegia and withering (pian ku wei yi) · the spleen governs the four limbs · the hook, feather and scallion-stalk pulses

Opening: last time we spoke of the true organ pulses — the “covering pulse” still needs finishing

In the previous lecture Doctor Ni Haixia explained the “overflowing pulse” (yi mai) — yang qi shooting outward, rushing right past the cun position. At the start of this lecture he completes the other true organ pulse:

💬 Note from Doctor Ni Haixia: The covering pulse (fu mai) is this: normally the chi position is only allowed to occupy one cun of length, but now it stretches very long, covering over and pressing down from the yang position — we call that the covering pulse. In simple terms, when you feel the pulse and find that the chi pulse is very long, far beyond the normal range, that is the covering pulse. If the pulse instead rises above, past the cun position, hard and straight, that is the overflowing pulse. These two are what we call the true organ pulses.

💬 Note from Doctor Ni Haixia: Generally when a true organ pulse appears, yin and yang have already separated — because the guan position has lost its function. This is a very dangerous pulse. When we know this pulse image has appeared, we can know when the person will die.

When a true organ pulse appears, how many days are left? Eighteen for the liver, nine for the heart

The Yellow Emperor asks: how long can a person hold on with a true organ pulse? Qi Bo gives the numbers, and Doctor Ni says you only need to keep these figures in the back of your mind:

💬 Note from Doctor Ni Haixia: In holding the true organ pulse, when the liver pulse is absolutely taut and exhausted, eighteen days; for the heart pulse, nine days. Should you memorize these numbers if you meet this situation? It is a matter of opinion — because you can hardly feel the true organ pulse on day one by coincidence; you might only feel it a week later. So you will never be that lucky. But you only need to know these numbers — they are all death pulses, differing only in how soon.

Three yin in the hand, three yang in the head: only one theory, and it is all in the hand

Before teaching the pulse, Qi Bo sets up the general principle — all this talk of three yin and three yang is really one thing:

💬 Note from Doctor Ni Haixia: The three yin are in the hand, the three yang are in the head — the three yin in the hand, that is what is meant by “one.” Whether three yin or three yang, there is only one theory — the pulse of our palm is primary. “Distinguish it from the yang, and you know the taboo times of the disease; distinguish it from the yin, and you know the qi of life and death.” You must become thoroughly familiar with yin and yang — “do not consult the multitude” — when you are thoroughly familiar with yin and yang, you do not need a crowd of doctors to confer with; you can decide on your own.

How many pulse beats is normal? Four beats to one breath

Before the true organ pulse, you must first know the normal pulse. Doctor Ni starts from the cooperation of breath and pulse:

💬 Note from Doctor Ni Haixia: When feeling the pulse, the pulse going out is yin, the pulse coming in is yang — think of something leaving you: its shadow grows smaller and smaller, the pulse feels smaller and smaller, that is yin; the pulse stimulated to grow larger and larger, the more you feel it the bigger it is, that is a yang pulse. A quiet pulse — very calm, very slow, very gentle — is yin; a moving, strong one is yang. Normally, with one inhale and one exhale, the pulse beats four times: two beats on the exhale, two beats on the inhale. If it drops to one beat, that is too slow; sometimes eight to nine beats — a single breath with eight or nine beats, far too fast — these are all abnormal.

The opening, pivoting and closing of the three yang: look at the eyes and you know which channel is sick

Doctor Ni brings out the three yang concept from the previous lecture, the Yin Yang Li He Lun — taiyang governs opening, shaoyang is the pivot, yangming governs closing — and teaches a very down-to-earth way to observe it:

💬 Note from Doctor Ni Haixia: For example, you treat someone’s facial paralysis, and you treat for a long time and it is almost better, except the eye will not close — the yangming cannot close, right? Yangming governs closing; if it cannot close, the yangming channel qi is not yet sufficient. If the eyes can blink, blink, blink, then the shaoyang is excellent — a girl gives you a wink, that is good shaoyang. But if you meet someone with taiyang disease, the eyes are open, and when they want to close them, they cannot — taiyang governs opening, it opened and cannot close. Some people close on the inside and cannot open — the eye stays mostly closed and cannot open — that is a taiyang problem.

The skin works the same way: opening the pores is taiyang, closing them is yangming. When the pathogen is on the exterior, its first stop is always taiyang:

💬 Note from Doctor Ni Haixia: The largest taiyang channel in the body runs from the sole of the foot all the way up the back, from the Zhiyin point (BL67) on the foot up to the Jingming point (BL1) at the inner corner of the eye — that enormous a channel. So when taiyang is affected, it always shows in the back and the nape of the neck. When the disease is on the exterior and our strength fights the external pathogen, alternating cold and heat appear — that is taiyang disease.

Once a pathogen enters the body, it has two roads: yangming is the “terminal station,” shaoyang is the “fork in the road”

If taiyang disease is not cured and the pathogen moves inward, Doctor Ni says there are only two choices:

💬 Note from Doctor Ni Haixia: One road leads into shaoyang, one into yangming. If it enters yangming, the disease stops there and goes no further — yangming is heat, and only heat, so everything you see is heat syndrome. Taiyang has fever, and yangming has fever too, but taiyang has cold and heat while yangming has no cold, only heat. So many people say: that lady is fifty-five years old, you ask her how her bowels are — constipated for how long? “Ever since I was a child!” Right? So yangming can hold on for a very long time without trouble, because it does not transmit; it stops right there.

💬 Note from Doctor Ni Haixia: The second road — if unfortunately it does not enter yangming but runs into shaoyang. Shaoyang is the pivot — turn right and it goes toward yangming; turn left and it enters our yin channels, and yin syndromes appear. That is the basic concept.

Disease of the two yang starts in the heart and spleen: when yangming is sick, people become anemic and wasted

Now the main text begins. Doctor Ni takes “disease of the two yang starts in the heart and spleen” apart sentence by sentence:

💬 Note from Doctor Ni Haixia: The two yang refers to yangming. When it starts in the heart and spleen, note that the heart and spleen both govern blood. “There is that which cannot be spoken of” (bu de yin qu) — some people get this disease and it is awkward to talk about: in a man, the semen becomes scant; in a woman, menstruation stalls — this is a kind of anemia. Because yangming refers to the stomach and intestines: after the stomach and intestines digest food, if they cannot transform the food into blood, the patient develops blood deficiency.

And when blood deficiency keeps transmitting, Doctor Ni says, things get serious:

💬 Note from Doctor Ni Haixia: When it transmits on, because this person’s blood is insufficient, wind wasting (feng xiao) develops — the person wastes away day by day. It transmits further into xi ben: breathing that has to use the neck. Think of it — normally breathing is simple, inhale and exhale. But this person cannot; he has to force the breath, and the neck and shoulders all come to help him breathe — this is very dangerous. This is what anemia looks like in the end.

Disease of the three yang brings cold and heat: the cold water of taiyang and abscesses

The third yang — the outermost taiyang — when diseased, brings cold and heat, and also breeds abscesses and swelling. Why? Doctor Ni lays out the body’s water-heat map:

💬 Note from Doctor Ni Haixia: The taiyang channel itself is on the outside of the body — feel a person’s body, the back is cool — so our taiyang is cold water. The kidneys are here, this is the Governing Vessel, and in the middle is the fourteenth vertebra. The kidneys sit behind the small intestine; the small intestine is fire, and its fire comes from the heart. The fire burns below, and the kidney water above is boiled. The water inside the kidneys originates from the lungs — the lung is the mother of the kidney, metal generates water. The water in the lungs keeps leaking down into the kidneys, and once in the kidneys it is vaporized and steamed up: the clean water enters the bladder channel in our back and ascends all the way to the brain, where the nourishment enters the marrow and the brain, moistening our mind and strengthening our memory; the seminal fluid enters our channels. The residual, waste water then goes from the kidneys into the bladder.

The body’s distillery: the bladder performs a “second qi transformation”

At this point Doctor Ni grows animated — the human body is the most precise machine, and even waste water is recycled twice:

💬 Note from Doctor Ni Haixia: From the kidneys to the bladder, it has already undergone one qi transformation. It is like a distillery: the first distillation produces the finest wine; the second time is “er guo tou” (second-run spirits), not as good as the first pot. The second time — when it reaches the bladder, Heaven says the human body is the most precise thing, let us recycle once more, nothing may be wasted. The urine in the bladder, because the bladder leans on the small intestine, is gasified a second time. The good vapor and steam return to the liver — using water to generate wood: the bladder’s water generates the liver’s wood, and then helps clean the liver a little. And this residue is finally discharged as urine.

The 400 CC hot-air balloon: why you pee all night and your stream is weak

Why is the bladder designed in a “gasified” state? Doctor Ni explains with a hot-air balloon and the whole room understands at once:

💬 Note from Doctor Ni Haixia: Because it is in the gasified state, the bladder is like a balloon — the hot air rises, and the bladder holds a full 400 CC. That amount is enough for you to sleep the whole night through and not get up for the toilet until morning. But if you are old and your qi is failing — you sleep eight hours and get up eight times, meaning you rise every hour — the bladder was 400 CC, how did you turn it into 40 CC? Because there is no qi transformation. When it expands into a hot-air balloon and the hot air rises, the ejection force is very strong, so your urine stream should be powerful. That is how it should be.

When the stream is weak, Doctor Ni says you do not even need to feel the pulse — you can hear it. And he takes the chance to correct a word:

💬 Note from Doctor Ni Haixia: An old man gets up to pee at night — listen to the sound: drip, drip, drip, like water leaking — that is lacking force. Would you be stupid enough to go check whether the urine is cold or hot? No one is that foolish; you know by listening. So we do not say “cong ming” (sharp-eyed and bright); we say “ting ming” (sharp-eared and bright) — look at the character ting (listen, 聽): an ear with a king beneath it, the ear as king, the ear does the listening. “Cong ming” is not as good as “ting ming” — one listen and you know. That is why we do not like people coming before us and talking: the moment they speak I understand everything — one listen and I know. Better not to listen at all.

The skill of pulse diagnosis: one touch and I know you will get frostbite this winter

Speaking of “listening,” Doctor Ni goes on to talk about his mastery of pulse diagnosis — with the four examinations, actually “one examination” is enough:

💬 Note from Doctor Ni Haixia: Pulse diagnosis — if you came with me and I felt your pulse, I would immediately tell you what is going on. Three patients, three different answers — I immediately tell you: this is a taiyang exterior syndrome, this is a yangming excess syndrome, this is a shaoyin syndrome. Why? Feel the pulse and you know. Now it is summer, and I feel this pulse and say: you will get frostbite this winter. How do I know? That is how you learn. Chinese medicine sounds very simple — we have four examinations: look, listen, ask, feel. In reality, if you understand physiology and human anatomy thoroughly, one examination is enough. So an old gentleman comes and says: I get up eight times a night, my feet are cold, my lower burner is cold — that is the end of it, right? Then we need warmth to go down. That is the principle of heaven and earth. If you take a balloon, will it rise by itself? No — you must heat the air before it rises. In balloon competitions all over the world they are hot-air balloons. Is there a cold-air balloon? Some fool made a cold-air balloon — laughable. So this one idea is very important: Chinese medicine is the principle of heaven, the principle of earth.

💬 Note from Doctor Ni Haixia: Western medicine does not care about the principle of heaven and earth — one look: “bladder sphincter relaxation — operate!” You have the operation, and you are still cold! Surgery has nothing to do with cold and heat. Do not operate. Moxibustion is better — burn a little mugwort, is that not good?

Cold water blocked under the skin: leg problems and rough skin

The bladder channel contains water — the cold water normally waits there to preserve body temperature: cold outside, hot inside. Doctor Ni says once this water is blocked, trouble begins:

💬 Note from Doctor Ni Haixia: When the cold water meets a pathogen and cannot be released, it stops under the skin. Water is heavy, so it sinks below — the lower legs develop problems, the feet develop problems. Why do we say a normal person’s feet are warm? Because when hot water gasifies, it rises quickly. If cold water is blocked here — in ordinary exercise, taiyang governs opening; when you exercise, the water is discharged and new water immediately takes its place — it keeps exchanging, never sitting still. Now the exterior is injured, the external pathogen arrives, taiyang should open but cannot, the water is blocked inside and cannot come out. Left stagnant for a long time, it breeds pus and calluses, and the muscles cramp.

💬 Note from Doctor Ni Haixia: When it transmits to suo ze, the skin becomes very rough. A girl says: “Teacher, I want my skin to be fine and delicate, what should I do?” You must sweat often — the fresh sweat replaces the old sweat. If you insist on staying in the air-conditioned room and never going out, your skin grows rougher and rougher, because there is metabolism inside, but the sweat never comes out. True cleansing must reach the very deepest part of the pores — not cleaned from the outside in, but cleared from the inside out. You have to sweat to clear it out.

Sweating has its season: sweat in winter, and get warm disease in spring

The skin needs to sweat, but Doctor Ni stresses — sweating has its season; you cannot sweat recklessly:

💬 Note from Doctor Ni Haixia: Sweating has its season! You cannot keep sweating in winter; summer is the best time to sweat. Follow the proper seasons and solar terms to sweat. You go out and sweat in winter, always saying “my skin is so good” — now it is winter, you do not look at the season and run out to sweat, you are asking for trouble. Once the sweat is let out (xie), “injury by cold in winter brings warm disease in spring” — in spring everyone has febrile disease. And when you ask about febrile disease and go to the warm-disease school, taking their medicine does not work: because your warm disease came from cold in winter — you had cold, you had sweat, your pores were open; in winter your pores opened and the cold ran very deep inside. The cold must be dispersed before it can be completely cured. Otherwise you take the warm-disease school’s medicine, the cold, cool herbs — ah, the first day or two you feel fine, and on the third day it comes back.

Doctor Ni also points out a very common phenomenon — why children’s fevers come and go:

💬 Note from Doctor Ni Haixia: We see a child with a fever; we give Chinese medicine for a while. Why is it fine on the day of taking, a little back on the second day, and back to square one on the third? Because the cold has not been removed yet — it is still there. Now you can see it clearly.

When the bladder channel is weak: the intestines sag, hernias form

When the bladder channel has problems, even the intestines are affected. Doctor Ni lays out the points of the lower abdomen:

💬 Note from Doctor Ni Haixia: The front-mu point of the bladder is at Zhongji — one cun above the pubic bone is Zhongji (CV3), one cun above Zhongji is Guanyuan (CV4), Zhongji lies below Guanyuan. With Zhongji here, the intestines press up against it. When the bladder channel is diseased, when the strength of the channel is not great, the intestines sag down — hernias, intestinal hernias, all of these.

Disease of one yang: when shaoyang is sick — shortage of qi, cough, diarrhea, and the heart is dragged in

“One yang” refers to shaoyang. What does shaoyang disease look like?

💬 Note from Doctor Ni Haixia: Disease of one yang brings shortage of qi (shao qi), frequent coughing (shan ke), and frequent diarrhea (shan xie). Why? Because the bile is expelled too much or too little, and that affects the blood. When it transmits to xin che — if it affects other places, the first organ affected is the heart, because the heart and the gallbladder are connected; it returns to the heart. When it transmits to ge — when there is a problem here and it swells and blocks, the gallbladder stone swells up, and you cannot swallow anything.

Bile is ejected at the same speed as the heartbeat

Why does gallbladder disease affect the heart? Doctor Ni explains the pericardium–gallbladder relationship, and the whole room goes “oh——”:

💬 Note from Doctor Ni Haixia: The heat generated by the heart’s beating enters the small intestine. But there is one more thing we have missed — we have the pericardium. The pericardium is like the outer membrane of the heart, wrapping it, and between the pericardium and the heart there is much clear fluid that keeps the heart from overheating. When the heart beats, the kinetic energy it generates affects the pericardium, and the pericardium is connected to the gallbladder by one channel. So why is the bile ejected? If you could see the gallbladder, the bile comes out in a jet — bang! The heart beats once, and the bile comes out once; the bile’s speed is the same as the heart’s speed. Once you understand this deep physiological process, treating a gallstone patient becomes very simple.

To treat gallstones, Doctor Ni uses a famous comparison — the perfume bottle:

💬 Note from Doctor Ni Haixia: How do we prescribe shaoyang herbs to open the bile duct, to unblock it? Second, strengthen the heart’s bang-bang ejection — just like a perfume bottle: when the head is blocked, you press and it sprays out. Now something is stuck at the head. You go to the Western doctor, and he wants to repair it — fine: he cuts the head off and seals you up. Then can the perfume still be used? No! Chinese medicine is not like that — very simple: press a couple more times and it sprays clean. But who is pressing? The pericardium is pressing. So we prescribe liver-soothing herbs to open the bile duct, strengthen the heart’s pumping force, and add some stone-dissolving herbs — and the gallstones come out. So in the future, writing a prescription becomes natural — I have not even taught the Shen Nong Ben Cao Jing yet; once you understand this, you will know how to prescribe.

Anger injures the liver: a person with liver disease is not bad-tempered

“Disease of two yang and one yin” — yangming plus jueyin. Doctor Ni takes the opportunity to correct a widespread misunderstanding:

💬 Note from Doctor Ni Haixia: The liver itself governs fright (jing hai); the kidneys govern fear. When disease breaks out, it is what we call anger injuring the liver — anger can injure the liver; it is the angry qi that damages the liver. But when the liver itself is diseased, it does not manifest as anger; it manifests as fright. A person with liver disease is not angry all day long — it is not that a damaged liver makes you lose your temper; it is that losing your temper easily damages the liver. Do not get it backwards. So, gentlemen — quarrel with your wife four times, and that is enough; that is good, no more. The liver is just right. You must grasp this great principle.

💬 Note from Doctor Ni Haixia: The exterior signs are: back pain, frequent sighing (shan yi), frequent yawning (shan qian) — this is called wind reversal (feng jue), because the liver is the wind organ.

Taiyang and taiyin combined: hemiplegia and limbs that will not lift

“Disease of three yang and three yin” — taiyang and taiyin combined. Doctor Ni says this disease is serious:

💬 Note from Doctor Ni Haixia: When taiyang and taiyin combine, the patient develops hemiplegia, atrophy of the muscles on one side, and the four limbs cannot be lifted. Chinese medicine considers the four limbs yang, the body yin — the four limbs are yang exposed on the outside. Among the internal organs, the spleen governs the limbs: the spleen governs the four limbs. Remember, the character zhi (支) in “four limbs” (si zhi) is the same as the branch of a tree — the human limbs and tree branches are the same. The spleen is earth, and tree branches are all born from earth. That is the Chinese medicine view; do not overcomplicate it. The spleen governs the muscles; the four limbs have a great deal of muscle. Now there is a problem, the muscles atrophy, and the limbs cannot lift, have no strength.

One sentence that could easily cause a laugh — Doctor Ni quickly clarifies:

💬 Note from Doctor Ni Haixia: When we say the four limbs cannot lift (si zhi bu ju) — it is not “the fifth limb”! A man’s inability to rise (bu ju) has nothing to do with this bu ju. Do not misunderstand. Sometimes you can judge by the name, sometimes you cannot.

The hook pulse and the feather pulse: feeling the pulse is like touching a chicken feather

After the diseases, back to the pulse. At the end of this lecture, Doctor Ni teaches two special pulse images — the hook pulse and the feather pulse:

💬 Note from Doctor Ni Haixia: What is “hook”? Those who have personally felt it know — direct sensation is very important. This pulse on the hand, the left hand: this is the thumb, this is guan, this is cun. Originally it was nine fen, right? Now it becomes two or three fen — a round drum bulging right here. You touch it and the thing pushes up — bulging inside; the pulse is felt as a bulge. Normally when you feel the pulse on the wrist it is horizontal; a hook is when you touch it and it pushes up against you. One yang is the hook — the hook pulse is the pulse of the heart. One yin is the feather (mao) — at the yang position of the cun, we call it the feather pulse. There is also the scallion-stalk pulse (kou mai), which is not the hook pulse — one is the lung, one is the heart. The hook pulse is the proper pulse of the heart; the heart’s proper pulse is originally a surging (hong) pulse — when it becomes a hook, it means the heart has a problem, a serious problem.

How do you feel the feather pulse? Doctor Ni’s comparison is unforgettable for life:

💬 Note from Doctor Ni Haixia: You feel something very thin, like a hair, floating on the surface very lightly. Remember a chicken feather — flat on both sides, with a ridge down the middle. When you touch it, the middle ridge, flat on both sides — that is the feather pulse: you feel the middle, and on both sides you can feel the flat part, but in the very center there is a hard ridge — that is the feather pulse.

Closing: one thought on the pulse — the fork in the road between life and death

In this lecture Doctor Ni carried the pulse diagnosis of the Yin Yang Bie Lun to its depths: when a true organ pulse appears — eighteen days for the liver, nine for the heart — all are death pulses, differing only in how soon. The normal pulse is four beats to one breath. Taiyang opens, shaoyang pivots, yangming closes — look at the eyes, look at the skin, and you know which channel the disease sits in. Disease of the two yang starting in the heart and spleen leads to wind wasting and xi ben; disease of the three yang brings cold, heat and abscesses, rooted in the cold water of taiyang. The most life-flavored passage was the bladder qi transformation: the human body is like a distillery, the bladder is gasified a second time by the small intestine, and the 400 CC hot-air balloon carries you through a peaceful night — frequent night urination and a weak, dripping stream are not the bladder sphincter’s business; the qi transformation has failed, and moxibustion beats the knife. The gallstone perfume bottle, liver disease and anger, the tree branches of the spleen governing the limbs, the chicken feather of the hook and feather pulses — on the pulse hangs a single thought, and it is the fork in the road between life and death. In the next lecture, Doctor Ni will keep on feeling the pulse.

Based on Doctor Ni Haixia’s Ren Ji · Huang Di Nei Jing lecture series (Lecture Eleven)