Is a Red or Dark Palm a Sign of Liver Disease? Doctor Ni Haixia on Palm Diagnosis and the Pulses of Life and Death, from the Huang Di Nei Jing

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Corresponding medical names: the Yin Yang Bie Lun (Discourse on the Separate Discourses of Yin and Yang), from the Su Wen · the pulses of the five organs (the feather, taut, stone, hook and slipping pulses) · the mutual rooting of yin and yang · palm diagnosis · yin zhi suo sheng, he ben yue he · death yin and generating yang · the organs can be full but not replete, the bowels can be replete but not full · replete liver · the middle number five of xiang shu · the spleen earth governs water · insecurity of kidney yang · bound yang and bound yin · blood in the stool in one, two and three sheng · stone water (shi shui) · the binding of the two yang is called wasting · the binding of the three yang is called obstruction · the binding of the three yin is called water · throat impediment (hou bi) · yin surging and yang separated · the pregnancy pulse · yang added to yin is called sweating · yin deficient and yang surging is called flooding · the all-surging pulses of the three yin and three yang · the periods of life and death

Opening: first, review the pulses of the five organs — each has its own face

In the previous lecture Doctor Ni Haixia carried the pulse teaching of the Yin Yang Bie Lun as far as the qi transformation of the bladder. In this lecture he continues. Right at the start, he lays out the pulse image that belongs to each of the five organs — these five “name cards” you should hold in your mind whenever you feel a pulse:

💬 Note from Doctor Ni Haixia: The feather pulse (mao mai) is the lung pulse. If the taut pulse (xian mai) is very urgent and very hard, like a guitar string, that is the liver. And when the taut pulse has exhausted itself — the pulse stands straight over there, standing straight and not moving, like a stone — that is the kidney’s pulse. What does it mean that yin and yang cross each other? Above the guan position is yang, below the guan position is yin. This pulse sometimes runs up, sometimes runs down, wavering back and forth — when you feel the pulse you sense it now large, now small, sometimes large and small in the yang position, sometimes large and small in the yin position — this is yin and yang crossing each other; it is the slipping pulse (liu mai), slipping back and forth, crossing over the spleen’s position. So the hook is the heart, the feather is the lung, the taut is the liver, the stone pulse like a rock is the kidney, and the pulse that feels now large, now small, walking up and down between yin and yang — that is the spleen’s pulse.

Yin stored within, yang guarding outside: two people helping each other — that is normal

Once the pulses of the five organs are recognized, Doctor Ni explains how yin and yang live together in the body — not fighting, but supporting each other:

💬 Note from Doctor Ni Haixia: Yin stores the essence within; yang guards the exterior. On the very surface of the skin, yang is at the exterior — because yang is at the exterior, yang can close the pores. The reason yang is so obedient and closes the pores is that yin is inside — yin and yang in the body help each other and support each other.

But what if the yin organs inside start fighting each other and the five organs lose their balance? Normally the liver generates the heart, the heart generates the spleen, the spleen generates the lung, the lung generates the kidney, and the kidney generates the liver — but instead the liver wood attacks the spleen earth and the heart fire attacks the lung metal. When they fight, the pulses pull and tug at each other. Once the struggle begins, yang is no longer stable and runs outward:

💬 Note from Doctor Ni Haixia: Yang qi runs outward, the po sweat is not concealed, the fluids scatter outward — and then the four counterflows (si ni): the hands and feet turn cold. Because the fluids have been lost, the lungs become dry, and that creates wheezing and crowing (chuan ming). This is the phenomenon that appears when the body turns diseased.

Where does the water in the body go? Fire descends, fluids rise

What does a normal person look like? Doctor Ni draws the whole “logistics map” of the heart, the lungs, the small intestine, the large intestine and the liver — this is the foundation of all his reasoning from here on:

💬 Note from Doctor Ni Haixia: In a normal person, the fire of the heart beats; because the lung is here, fire controls metal, and these two have that mutual relationship. When the amounts are balanced, the fire force of the heart comes down and enters directly into the small intestine. As for the fluids in the lung — if you have not been exercising, these fluids return from the lung into the kidney: metal generates water. So the yang of the upper jiao, whether it is the heat of the heart or the fluids of the lung, all sinks downward; and normal yin always rises upward. The fluids of the lung come from the large intestine. Because the large intestine surrounds the small intestine, and the small intestine is fire, after the fire vaporizes the water in the large intestine, the water of the large intestine returns to the lung and becomes the lung’s fluids. And the liver? The liver is wood generating fire; the source of the blood in the heart comes from the liver — so everything is mutually generating and sinking downward.

The color of the palm is faster than feeling the pulse: pink is normal, dark red is liver disease

This passage is Doctor Ni’s proudest “deduction show” — he says that once he understood physiology, he often reached conclusions he could not find in any book, and his speed at the clinic became very fast:

💬 Note from Doctor Ni Haixia: Let me give you an example. Look at your hand — what did it originally look like? After I finish, I guarantee that tomorrow at the office you will grab everyone’s hand and look at it. What is normal? Normal is pink. In kindergarten you all learned to paint — the teacher says, how do you mix pink? White and red mixed together, right? The Huang Di Nei Jing has already told you: the lung is the western metal — is it not white? The heart is red. Right? The heart is very small, the lung is very big — is there not a lot of white and very little red? So when it reaches the hand — the palm is yin, yin within yang and yang within yin — you can see white mixed with a little red, that color is normal.

The deduction does not stop there. What happens the day the liver goes wrong?

💬 Note from Doctor Ni Haixia: When the liver is normal, it sends fine blood to the heart — wood generates fire — and this bit of blood is very beautiful, very bright red, and it turns pink. One day a large part of the liver has been occupied — it may be cirrhosis or liver cancer. The blood still has to go back; it returns to the liver and discovers: it is over — it has already been occupied. The blood has no time to be transformed, has not been detoxified; a whole pile of blood rushes into the heart. The heart normally receives one drop of blood, and now it receives a basketful — there is too much red, so the white becomes less, right? Then when it reaches the hand, the palm turns red — and darker and darker. A normal person’s red is bright red; in liver disease it is dark red. So people with liver problems — their palms start out dark red.

Doctor Ni says that every time he feels the pulse, he is also looking at the palm — inspection is sometimes faster than pulse diagnosis:

💬 Note from Doctor Ni Haixia: When I see a patient, I do not even need to look at his fingers for liver disease — before the hand is even touched, the liver pulse no longer needs to be felt. And if he takes medicine for a week and the palm gets redder and darker — it is over, the direction is wrong; if the pink appears more and more and the color fades, the disease is receding, making progress. You can see it right there. So we emphasize inspection — in many places you can find the clues.

Yin zhi suo sheng, he ben yue he: when yin is excessive, a person sweats unceasingly and loses control of stool and urine

On page 57, the text reads “yin zhi suo sheng, he ben yue he” — where yin is born, harmony is its root:

💬 Note from Doctor Ni Haixia: Yin governs the five organs; it all must be harmonious, peaceful, without wind and waves — that is yin. If one day yin becomes excessive, too mighty — the reason yin can be harmonious is that there is yang inside it. Take water for example: there is yang in the middle of it, so yin and yang combine, and there will be no problem. All things come from water; without water, nothing can survive — just remember this great principle: without water, nothing can survive.

Following along, Doctor Ni points out the biggest difference between Chinese and Western medicine — one looks at blood, the other at water:

💬 Note from Doctor Ni Haixia: The biggest difference between Chinese and Western medicine is that Western medicine only looks at blood, while Chinese medicine must look at water. Everyone knows the body is more than 70 percent water and only 25 percent blood. We cannot take 25 percent of the information and make a judgment on it — you will be wrong. It is like the American jury: the evidence is utterly insufficient, they look at two pieces of evidence and declare guilt — are you not killing people? You have to see everything clearly before you pass judgment. That is why Western medicine so often misdiagnoses.

So what happens when the yin qi is excessive?

💬 Note from Doctor Ni Haixia: When steel meets steel, the yang qi breaks and scatters. If yin qi is excessive, it creates yang deficiency; once yang deficiency scatters, when there is nothing left to control yin — it is over, the yin scatters too. Yin scatters in many ways — the sun opens, so there is unceasing sweating and the fluids scatter; also incontinence of urine and stool, the stool and urine cannot be held together — that is also yin going outward, the yang is deficient and cannot hold it closed. “When the fluids are turbid, hardness and softness lose harmony, and the channel qi is exhausted” — all of this is because yang deficiency creates yin excess.

The death yin types die within three days; the generating yang types within four

Next comes a string of sentences that sound like sentencing — generating yang and death yin, each with its own span of life:

💬 Note from Doctor Ni Haixia: The death yin types die within no more than three days; the generating yang types within no more than four days. What are the generating yang and death yin? Liver-to-heart is called generating yang (sheng yang) — liver wood generates heart fire; it is originally mutual generation, so it is called generating yang. But this generating yang is yang hyperactivity gone too far: when the liver is replete, yang has no way to stay inside and runs outward; the liver wood comes out and meets fire, and the heart beats extremely fast. Heart-to-lung is called death yin (si yin) — the heart and the lung mutually check and balance each other; the two overcome each other, and that is death yin. Lung-to-kidney is called double yin (chong yin) — the kidney normally receives nourishment and fluids from the lung; now the kidney is diseased, but the lung still pours in plenty of nourishment and fluids regardless, adding to its pressure — that is called double yin. Kidney-to-spleen? The spleen is earth, the kidney is water; in a normal person earth comes to overcome water, to govern water — now it is reversed, and that is called open yin (pi yin) — death yin.

The organs can be full but not replete; the bowels can be replete but not full: eating with a seven-day constipation is “full”

The organs and the bowels follow different rules, and Doctor Ni explains it with eating — you understand it at once:

💬 Note from Doctor Ni Haixia: The organs (zang) are for storing — they can be full (man) but cannot be replete (shi); the bowels (fu) can be replete but cannot be full. Why? Take the stomach for example: you eat a lot of food — the food does not matter, because once you digest it, it runs into the small intestine. The small intestine is replete, but the space is empty — so the bowels can be replete but cannot be full. What is “full”? I have been constipated for seven days without a bowel movement, the stool is blocked right here, and you keep feeding him — it is already full to here and you are still feeding — that is overfull; that is not allowed. The organs are different: the organs are filled with a great deal of yin, a great deal of fluids, a great deal of yang inside — they can be full, but they cannot be replete — replete means there is a real, solid thing inside. Full only means filled up; replete means a real solid thing. That is the basic principle.

When the liver is replete, the heart beats eight or nine times to one breath — the middle number five of xiang shu is the standard

If the liver has a replete condition, Doctor Ni uses the images and numbers (xiang shu) of the Book of Changes to explain just how dangerous it is:

💬 Note from Doctor Ni Haixia: When the liver is replete, wood generates fire, and it speeds up the heart. When the liver yang is very hyperactive, the yang inside the liver cannot stay inside and runs outward, and the heart beats extremely fast — eight or nine times to one breath, even ten, almost dead; normal is five times to one breath. Chinese medicine is connected to the Book of Changes. We speak of images and numbers: in the numbers one to ten, the exact middle is five — five is the most standard; too much or too little are both wrong. The closer to one, the more dangerous; the closer to nine, the more dangerous. If it was originally seven and you treat it down to five; if it was originally three and you treat it up to five — you are a master. If it was originally five or six and you make it ten — then your direction is completely wrong, you have mixed up the direction. The speed of the pulse can be felt out too.

The spleen earth governs water: kidney yang must be guarded by the spleen earth

The heading of this passage is “governing water,” but Doctor Ni says — the truly inspired idea is different from what is written on the page:

💬 Note from Doctor Ni Haixia: The spleen is earth, the kidney is water. On the page, everyone knows the literal explanation: you have water retention, a water problem — we strengthen the spleen and slowly drain the water — that is the most basic idea. The truly inspired idea is not like that: the kidney itself has yang inside, so we call it kidney yang — that is the motive force. Because yang is inside, we have the strength to lift heavy things, we can have wisdom, we can have memory. For yang to be guarded and held inside, it needs earth. So we just said: yang is not afraid of being much; yang must be able to hide below, to stay put inside — the kidney holds water, and this yang hides in the water and behaves itself. Who does it depend on? The spleen — because the spleen can govern water.

What are the symptoms when kidney yang cannot hold? Doctor Ni takes the opportunity to explain “yang governs opening and closing,” and reveals how the classical formula doctors prescribe:

💬 Note from Doctor Ni Haixia: Does yang not govern opening and closing? Today you have intercourse: it rises, and then it secretes the fluids and lets them out — opening and closing — that is kidney yang. When yang is gone, it can no longer open and close. So some people use essence-securing herbs — but the classical formula doctors of the northern school do not; they strengthen the spleen earth. Once the spleen earth is strong, the urine no longer leaks and the essence no longer spills. Why? The spleen earth — earth can govern water; this is the root. So with classical formulas we rarely need many of the herbs in the Ben Cao (the Materia Medica) — because this is one hundred percent Huang Di Nei Jing. If you ask an ordinary Chinese medicine doctor or professor at school, “the spleen governs water — when there is water retention we treat the spleen,” everyone knows that; but that when kidney yang cannot hold, you treat the spleen — that they do not understand. It is this principle: earth can govern water.

Why is death yin “heart-to-lung”? When the car’s radiator runs dry, the engine burns out

💬 Note from Doctor Ni Haixia: Why is death yin heart-to-lung? Heart-to-lung is fire overcoming metal. When the fluids in metal are insufficient — when the fluids in the lung are insufficient — and the fire keeps steaming and vaporizing, the lung develops problems. It is like a car engine: the heart is the engine, the lung is the radiator. When the radiator has too little water, the car overheats and burns out. That is death yin.

Bound yang swells the four limbs; bound yin bleeds from the stool: one sheng, two sheng, three sheng — each matches one organ

On page 58 the text speaks of “bound yang” (jie yang) and “bound yin” (jie yin). Doctor Ni explains the character jie (bound) with a very vivid image:

💬 Note from Doctor Ni Haixia: What is called bound yang means yang has been sealed up, has met resistance — like a rope tied around it, cut off. When yang meets resistance — “when yang is bound, the four limbs swell”: a person’s four limbs are yang, the body is yin. When yang is cut off, yin flourishes, and at that point the four limbs become edematous. What about bound yin? Yin has been cut off — say the liver, the heart, the lung, the spleen, the kidney, even below; the organs store blood. If an organ is cut off, like a rope tied around it and sealed, the blood cannot enter the spleen; the blood cannot be delivered, so it flows back and comes out in reverse. When it comes out in reverse, how do we know which organ is bound? The Huang Di Nei Jing defines it: blood in the stool, one sheng — bound again, two sheng — bound a third time, three sheng. If one organ is cut off, one sheng comes out; if the blood discharged reaches two sheng, two organs are bound; at three sheng, three organs are bound. This blood may be passed with the stool, may be passed with the urine, and sometimes it is vomited out.

All the “bindings” strung together become a set of diagnostic formulas:

💬 Note from Doctor Ni Haixia: When yin and yang are both bound by evil — mostly yin, little yang — when yin and yang are simultaneously blocked and yin flourishes while yang weakens, we call it stone water (shi shui) — the main symptom of stone water is a swollen lower abdomen. “The binding of the two yang is called wasting” (xiao): the two yang are the stomach qi of yangming. The stomach qi is cut off, cannot spread downward, and keeps rising — why is it called wasting? Because when we drink water and it enters the stomach, it is dispersed right there and absorbed by the body; the water we drink does not enter the small intestine and then the large intestine. If the water you drink entered the small intestine and the large intestine, the person would have diarrhea — because it can only get in there when it is too cold. The water in food is different from the water we drink; the water mixed in food can come down and enter the small intestine. Now the yang of the stomach is cut off, the heat has no way to go down, it rises upward, the stomach is extremely hot — the moment you drink water it is vaporized — this is wasting-thirst (xiao ke); diabetes is something like this. “The binding of the three yang is called obstruction” (ge): the three yang is taiyang — we mean the small intestine and the bladder. When the small intestine and the bladder are cut off, the urine stops — it will not come out, it is too hot. “The binding of the three yin is called water”: the three yin is taiyin — the spleen and the lung. Cold binds inside; the water qi transforms and then turns back into cold water, blocked inside the body — that is water (edema). “The binding of one yin and one yang”: one yin is the liver, the jueyin channel; one yang is shaoyang. This produces throat impediment (hou bi) — there will be problems in the throat.

The pregnancy pulse: yin surging and yang separated — a boy on the left, a girl on the right

The highlight moment of pulse diagnosis — when a woman is pregnant, the pulse will tell you, and even the sex of the child is written in it:

💬 Note from Doctor Ni Haixia: “Yin surging and yang separated” — this is about the pulse. Here is the guan position, here the cun position — yang is on this side, yin on that side. When you feel the pulse, the yin pulse is extremely large and keeps beating very strongly. What does “separated” mean? Originally it is one pulse, right? Now it divides into two — it jumps left and right, also divided into two jumping. This means pregnancy — there is a child. The Chinese are amusing — boy left, girl right: if you feel the pulse on the left hand, it is a boy; on the right hand, a girl. This is the pregnancy pulse. In fact, Shenmen (HT7) is on the hand shaoyin heart channel. Beside Shenmen there is a big tendon, and between the two tendons of the pericardium channel — Shenmen is on the inner side, and on the inner side here there is another pulse, the shaoyin pulse — that is the child’s heart pulse.

Both yin and yang deficient with unceasing diarrhea: a death syndrome, but the doctor must fight with all his strength

💬 Note from Doctor Ni Haixia: The cun pulse is yang, the chi pulse is yin. When both the yin pulse and the yang pulse are deficient, and at the same time the patient has diarrhea, intestinal afflux (chang pi) that will not stop — this is very dangerous. Why? Yin and yang are already deficient — deficient to what degree? Still having diarrhea, diarrhea that will not stop — that means it has already reached the extreme of exhaustion. Because yang is what controls it; yang is gone too, and yin keeps scattering outward. And when you feel the pulse and it is also deficient, that means yang will not come back — this is very dangerous; these are all death syndromes. But as doctors, we cannot say, “I learned in the medical arts that this is a death syndrome, so the patient dies” — no, that is not allowed; we must fight with all our strength. So we keep fighting — and when we fight, among all the schools only the classical formulas (jing fang) have a way to fight.

Yang added to yin is called sweating: sweating while sitting still, or night sweats while asleep — all excessive

💬 Note from Doctor Ni Haixia: “Yang added to yin is called sweating.” When the yang pulse of the cun position rides on top of the yin pulse, when you feel it, it means the patient is sweating, sweating without stop — yang is going outward. This chi pulse, the yin pulse, should normally be deep and slow down below; now the yin pulse comes up and becomes a yang pulse — that means the yin inside — the fluids, everything visible is yin — is coming out; that means the patient has night sweats. Normal people all sweat — but we sweat after movement, after exercise, not sitting still at any moment, and not sweating while sleeping at night — that is excessive.

And conversely, a deficient chi pulse with a strong yang pulse is the warning sign of massive bleeding:

💬 Note from Doctor Ni Haixia: If the chi pulse is deficient and the yang pulse at the cun position is strong, this is flooding (beng) — uterine bleeding with massive blood loss. What is a deficient pulse? When it is deficient, if you touch it lightly you can feel the pulse, but press down to the bone and there is no pulse at all — a normal yin pulse, the chi pulse, reaches the bone; once it is deficient, the yin pulse floats up; it floats up and you feel a little pulse, but press down and it completely disappears — that is a yin deficient pulse. With a deficient pulse, if the yang pulse at the cun position is very forceful, it means yang keeps going outward — that is the phenomenon of flooding, massive blood loss.

The periods of life and death: each all-surging pulse has its own day of death

In the last long passage, Doctor Ni teaches the “all-surging” pulses — when several yin or yang pulses surge violently at the same time, each has its own deadline — and along the way he delivers a sharp attack on chemotherapy and surgery:

💬 Note from Doctor Ni Haixia: “The three yin all surge” — here the three yin means taiyin — it includes two organs, one is the spleen, one is the lung, the spleen earth and the lung metal — death comes twenty days later, at midnight. Why midnight? Because at midnight the wood qi is flourishing, and wood is the overcoming time. The seasons all have their overcoming relationships — why do we study the overcoming? So that we can know life and death. Take the liver: the liver is spring. Logically spring is the time when the liver flourishes, so at this node a liver patient has less chance of trouble — not that nothing will happen; things can still happen, because nowadays there are many causes. Take those who do hepatic vascular embolization — you give them chemotherapy, you operate on them — I have still never seen or heard of anyone cured by surgery. When we treat, the medicinal nature would arrive on its own; but after chemotherapy, a wall stands in front, yin and yang are separated — our medicine reaches the wall and is knocked back, knocked back by the chemotherapy. People feel bitter regret — a person who should not have died dies. According to the explanation of the Huang Di Nei Jing, you should think: this is something several thousand years old, with no Western medicine involved at all — this is how the human body originally works. He should not have died of liver disease in spring, but now he dies of liver disease in spring — who did it? You know who caused the disaster. So not only the seasons can be calculated — even the days, even the good hours of a day can be calculated. And look at the almanac: every day has its heavenly stem and earthly branch, and those characters can also calculate life and death.

💬 Note from Doctor Ni Haixia: “The two yin all surge” — the two yin means shaoyin — in the body that is the heart and the kidney — death comes thirteen days later, at sunset. “The one yin all surges” — one yin is jueyin — we have the liver and the pericardium — death in ten days. A normal yin pulse should be deep, drawn out, and slow; it should not surge too much, not be too strong — that is bad. “The three yang all surge” — the three yang means the bladder, taiyang, and the small intestine — not only is it very fast, it is hard like a bone standing up; when you feel it, it feels like one object after another poking at you, not like feeling a pulse as a line, but in a bone-like state — this one dies in three days. “The three yin and three yang all surge” — that is taiyin and taiyang — the taiyin spleen governs the heart and abdomen; the spleen itself governs the four limbs and the lower abdomen — death in five days. “The two yang all surge” — that is yangming; if the yangming pulse surges very strongly and very fast — that means the yin is gone.

Closing: stretch out the palm and the disease is before your eyes; feel the pulse and the day of life or death is known

This lecture carried an enormous amount of information, but strung together it is one line: yin and yang in the body help each other — yin stores the essence, yang guards the exterior; once the balance is lost, the five organs fight and the fluids scatter outward. Liver disease shows itself first in the palm — pink turning dark red, and the color fading with medicine means the direction is right. Then a complete set of diagnostic formulas: the organs can be full but not replete, the bowels replete but not full; a replete liver makes the heart beat fast; the spleen earth governs water and guards kidney yang; bound yang swells the four limbs; bound yin bleeds one, two or three sheng; the two yang bound is wasting-thirst; the three yang bound stops the urine; the three yin bound makes water; yin surging and yang separated is the pregnancy pulse; yang added to yin is called sweating; yin deficient and yang surging is flooding — and finally the all-surging pulses with their periods of life and death. Doctor Ni says a doctor must not abandon a patient just because he has learned a death syndrome — he must fight with all his strength, and the classical formulas are the only weapon that can fight. In the next lecture, he will continue with the pulse.

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