Why Doesn’t Anyone Have a Heart Attack in Summer? Doctor Luo Dalun Presents Doctor Ni Haixia’s Fourteenth Lecture on the Huang Di Nei Jing — Solar Terms in Excess and Insufficiency, the Five Viscera and Their Manifestations, and the Renying-Cunkou Pulse Method

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Corresponding medical names: the Su Wen · Liu Jie Cang Xiang Lun (Treatise on the Six-Six Festivals and Visceral Manifestations) · solar terms in excess and insufficiency · zhi er zhi (arriving when it should arrive) is excess · zhi er bu zhi (not arriving when it should) is insufficiency · qi yin (lewd qi) and qi po (pressed qi) · winter running spring’s program · spring running winter’s program · the five movements and six qi · zheng xie, xu xie, shi xie, zei xie, wei xie (the five pathogenic influences) · the number of five · Heaven feeds people with the five qi, Earth feeds them with the five flavors · the five qi enter the nose and lodge in the heart and lung · the five flavors enter the mouth and lodge in the stomach and intestines · the heart is the root of life, the seat of spirit, its bloom on the face, its fullness in the blood vessels, the great yang within yang, communicating with summer qi · the lung is the root of qi, the residence of the po, its bloom in the body hair, its fullness in the skin, the great yin within yang, communicating with autumn qi · the kidney is the root of hibernation, sealing and storage, the residence of essence, its bloom in the hair, its fullness in the bones, the lesser yin within yin, communicating with winter qi · the liver is the root of endurance, the residence of the hun, its bloom in the nails, its fullness in the sinews, generating blood and qi, its flavor sour, its color cang, the lesser yang within yang, communicating with spring qi · the spleen, stomach, small intestine, large intestine, bladder and san jiao are the root of the granaries, the residence of the nutritive, their bloom on the lips and the flesh around the mouth · surplus of blood · surplus of bone · the kidney generates marrow · the brain is the sea of marrow · the miao ci method · sun luo (fine collateral vessels) · the five flavors sour, bitter, sweet, pungent, salty · sour injures the spleen · salty injures the heart and kidney · bitter injures the lung · pungent injures the liver · all eleven organs depend on the gallbladder · Renying one time greater is shaoyang disease, two times greater taiyang, three times greater yangming, four times greater or more is ge yang · Cunkou one time greater is jueyin, two times greater shaoyin, three times greater taiyin, four times greater or more is guan yin · guan ge · the overflowing and covering pulses · Difficulty Three of the Nan Jing · Chengqi ST1, Sibai ST2, Juliao ST3

Opening: the Beginning of Spring has passed, so why is it still so cold?

This lecture continues where the previous one left off, still in the Liu Jie Cang Xiang Lun. Doctor Ni first corrects a mistake he made last time — he had said the Beginning of Spring (li chun), but after the Beginning of Spring comes Rain Water (yu shui):

💬 Note from Doctor Ni: After the Beginning of Spring comes Rain Water. The two weeks between the Beginning of Spring and Rain Water form one solar term. When this term is changing over, it is still fairly cold. Only after Rain Water does the weather start walking toward spring, and it is about to turn warm. But what happened? While it was still winter, spring’s program was already running — winter should have been very cold, yet this winter was very warm. That is “zhi er zhi” — it arrived when it arrived — what we call excess.

“Zhi er zhi” — arriving when it should arrive — is normal. But when spring runs ahead and shows up in the middle of winter, that is a big problem. Doctor Ni peels the reasoning behind it apart, layer by layer.

Winter running spring’s program: excess, called “qi yin” (lewd qi)

💬 Note from Doctor Ni: When qi is excessive, it thins what it cannot conquer and rides roughshod over what it conquers. When wood qi is overabundant, wood goes to overcome earth — earth is what wood conquers, and it gets badly beaten; originally metal is what overcomes wood, but now wood turns around and bullies metal instead, harming it. This kind of excessive qi of the seasons, we call “qi yin” — lewd, flooding qi. It arises from within without distinguishing right from wrong, and it cannot be attacked head-on — if we doctors cannot detect it, in the end we will not be able to control it.

So you cannot watch the weather just for entertainment: a winter that is abnormally warm is not merely “saving money on the padded coat.” It is a signal that wood qi is overabundant, and next it will overcome earth and insult metal in turn — the five organs and six bowels will all suffer the consequences.

Spring running winter’s program: insufficiency, called “qi po” (pressed qi)

The reverse also holds: when spring arrives but the cold refuses to leave, that too is disease:

💬 Note from Doctor Ni: We enter spring, but it is still very cold. The Beginning of Spring has passed, Rain Water has passed, it should long since have been spring — yet it is still as cold as winter. That is insufficiency: it should have arrived but has not, and we call it “qi po” — pressed, oppressed qi. So spring is running winter’s program — how can spring still be running winter’s program? Then the summer floods will be huge. In summer there will be great floods.

The water is still the same amount: how the court astronomers foretold drought and flood

Why must a doctor keep an eye on the solar terms? Doctor Ni offers a homely analogy: the earth is fixed, and so is the amount of water. When this region is dry, the water is over there; when this region floods, that one dries up — the water is always just that much.

💬 Note from Doctor Ni: Winter is supposed to be very cold, and in the cold the water vapor stays up in the sky. But suddenly winter runs spring’s program — it turns warm and rains, and when winter has a lot of rain, then summer does not have much rain. So when winter runs spring’s program, the following summer tends to be dry. Conversely, when spring is still cold — spring running winter’s program — the summer floods will be huge. In the old days, many court astronomers used exactly this excess and insufficiency of the solar terms to quickly predict what the next summer would be like and make preparations in advance.

This is wisdom on the level of Yu the Great taming the floods: read today’s abnormality, calculate next year’s drought or flood.

The five movements thrown into disorder: no change unless it must — when it changes, great illness

The Yellow Emperor asks: the five movements of Heaven and Earth — wood, fire, earth, metal, water, cycling through spring, summer, late summer, autumn and winter — what happens if they no longer follow this sequence, this season? Qi Bo answers: the qi of the vast sky cannot be without constancy; when qi does not keep circulating as it should, great change is certain.

💬 Note from Doctor Ni: For example, now winter turns as hot as summer, or autumn turns into spring — inconstant, not following the normal round of spring, summer, autumn and winter, and great change is certain. Change means disease. When what conquers is conquered in turn, disease follows. We spoke earlier of the so-called upright pathogenic influence (zheng xie): take the heart as the master — when the heart itself falls ill, that is zheng xie; what the heart generates, earth, is called shi xie (excess pathogenic influence); what generates the heart, wood, is called xu xie (deficient pathogenic influence); water is what overcomes the heart, and when the heart has a problem the water comes even harder — that is zei xie (thief pathogenic influence); fire can overcome metal, so when the heart has a problem it affects metal and the lung gets a little disorder — which is why in heart patients, the lung problem is never very big.

Zheng xie, xu xie, shi xie, zei xie, wei xie — a complete genealogy of pathogenic influences, all derived from the mother–child generation and conquest cycles of the five elements.

Cold never lasts more than five days, heat never more than five: the marvel of the number five

Before page 74, Doctor Ni introduces a little astronomy — “the number of five”:

💬 Note from Doctor Ni: The number of the five qi is only five — wood, fire, earth, metal, water. We often say, “these days it is so cold” — cold never lasts more than five; on the sixth day it will turn. Heat likewise never lasts more than five; after five days of extreme heat, it will not go further — on the sixth day it will certainly rain, and the weather will be cooler. This number five is very interesting. From now on, use it as a point of observation and you will see — it is truly marvelous.

The same rhythm applies to an apple: when you first pick it, it is sour — that is wood. Leave it for no more than five days, and when you eat it, it has turned sweet — it has been transforming all along, and the qi has changed. Five days: the time it takes the qi of Heaven and Earth to turn around once.

How do people stay alive? Heaven feeds people with the five qi, Earth feeds them with the five flavors

On page 74, the Yellow Emperor asks: qi combines to give form, and responses manifest as evidence — in the transformations of Heaven and Earth, of yin and yang, which is greater for the myriad things, which is lesser? Qi Bo answers: Heaven is too vast to be measured, Earth too great to be weighed. And here the nature of medicines comes out — plants are divided into five colors, blue-green, red, yellow, white and black; and besides color, into five flavors, sour, bitter, sweet, pungent and salty. The changes of the five colors cannot all be seen; the beauties of the five flavors cannot all be exhausted.

💬 Note from Doctor Ni: Heaven feeds people with the five qi, and Earth feeds them with the five flavors. We humans can exist between Heaven and Earth because we absorb the five qi — the changes of the solar terms, the growth, harvest and storage of spring, summer, autumn and winter — and also because we eat the five flavors, the five tastes within the five grains. The five qi enter through the nose and lodge in the heart and lung — the qi is in the heart and lung, and from above it makes the five colors bright and the voice clear: you see sharply, you hear sharply. The five flavors enter through the mouth and lodge in the stomach and intestines — all flavored food is stored in the stomach and intestines. When flavor is stored, it nourishes the five qi; qi harmonizes and gives form; fluids combine — and then spirit arises of itself.

So in the Chinese medical view, a person is Heaven qi and Earth qi joined together: if you only have the Earth qi of eating the five flavors, without Heaven qi it will not work — after all, you must breathe; and if you only breathe, that will not do either — the Earth qi must cooperate with it.

💬 Note from Doctor Ni: Of course there are exceptions — the True Persons of high antiquity did not need to eat; they could just sit there every day. But that would be terribly dull — no friends. You watch your whole generation pass away together, and you alone live to two hundred; nobody you know is left, and you have no idea how to talk to these people. That is no fun either — that is just my personal opinion.

The visceral manifestation doctrine begins: the heart is the root of life, and summer is its protective umbrella

On page 75, the visceral manifestation doctrine (cang xiang) proper begins. Qi Bo takes the five organs one by one, and the first is the heart:

💬 Note from Doctor Ni: The heart is the root of life, the seat of spirit. Its bloom is on the face, its fullness is in the blood vessels; it is the great yang within yang and communicates with summer qi. The complexion on the face tells you about the heart; from the cheeks up to the cheekbones — Chengqi (ST1), Sibai (ST2), Juliao (ST3) — is where the stomach qi lives; the heart sits right in the middle of that region.

The heart’s fullness is in the blood vessels — every vessel in the body is governed by the heart. And Doctor Ni points to the clinic at once:

💬 Note from Doctor Ni: Look at the blood vessels, look at the skin. When the vessels are normal, you cannot see them. If you see many blue-green vessels on the legs — like varicose veins — or small blood vessels showing, that is not normal. In the miao ci method, we prick the places where blood is congested and let the blood out, so that it can flow freely again. When the blood vessels have a problem, we are talking about the heart. So when we see a patient with varicose veins or vascular problems, we usually prescribe heart medicines.

Those four characters — “communicates with summer qi” (tong yu xia qi) — get a startling reading from Doctor Ni:

💬 Note from Doctor Ni: Why “communicates with summer qi”? It means the qi of your heart communicates with the qi of summer — the heart is protected by the season. In summer, the heart itself is not subject to disease. So a normal person should not die of a heart attack in summer. Chinese medicine stands outside and looks inside — the Yellow Emperor’s Classic laid down this definition first. If in Taipei, in summer, the emergency room never has anyone dying of a heart attack, then Taipei’s medicine is correct; if people still die of heart disease in summer, then that medicine is wrong. The Yellow Emperor’s Classic does not talk about treatment here — according to the discipline between Heaven, humans and the body, Heaven and humans are connected, and no one should die of a heart attack in summer. Go and investigate — count how many people die of heart disease in summer, and you will know whether this is right or wrong.

The lung is the root of qi: hair is the surplus of blood, teeth are the surplus of bone

💬 Note from Doctor Ni: The lung is the root of qi, the residence of the po. Its bloom is in the body hair, its fullness is in the skin; it is the great yin within yang and communicates with autumn qi. The heart is yang, the lung is yin, and yin and yang interlock — that is why the po is hidden inside the lung. The lung governs the skin and body hair — every pore of the skin is managed by the lung. The lung governs qi, the heart governs blood, and both are in the upper burner.

So how does hair grow? Doctor Ni explains the exquisite principle of the “surplus of blood”:

💬 Note from Doctor Ni: The lung governs the skin and body hair. This form generates blood, so all the hair grows where blood is in surplus — it is the surplus of blood. It is the same as the teeth: the kidney manages all the bones of the body, and the teeth are connected to the bones — the teeth are where the bone is in surplus, called the “surplus of bone.” The hair is the surplus of blood: when the blood of the heart arrives here and meets the lung’s qi, the blood and qi transform, and hair grows out. If you want to get rid of your hair, just do the reverse.

The lung communicates with autumn qi — in autumn the lung is on duty, and it rules killing and descending:

💬 Note from Doctor Ni: In autumn, go up into the mountains and look — in a single night, nature turns every leaf yellow. If you tried to use human strength to artificially roast a tree yellow, imagine how much effort that would take. Yet Heaven and Earth change the entire tree in one night, that fast — the power of Heaven and Earth is beyond anything you can match. Why? Because the lung rules dry metal, and metal rules killing and descending. The qi of the lung is extremely sharp — metal overcomes wood — so in a single night, every tree changes color.

The kidney is the root of sealing and storage: hair color belongs to the kidney, hair growth belongs to the liver

💬 Note from Doctor Ni: The kidney is the root of hibernation, sealing and storage, the residence of essence. Its bloom is in the hair, its fullness is in the bones; it is the lesser yin within yin and communicates with winter qi. The diaphragm is like the surface of the ground, and the kidneys are like two tree roots anchored underneath — which is why the kidneys are black. Black is the color of winter, the season of storage — all plants and hibernating animals hide themselves underground, seeds hide underground. Winter is the nature of the kidney.

Why are the bones governed by the kidney? Doctor Ni lays out the chain clearly:

💬 Note from Doctor Ni: Among muscles, skin, channels and blood vessels, what is the innermost layer? Bone. Bone is at the very bottom, and its nature is the same as the kidney’s — so when the bones have a problem, we all treat the kidney. Why? Because the kidney can generate marrow — the marrow born inside the bone marrow is the essence of the kidney, an extremely fine nourishing fluid. Marrow is born, bone comes from marrow, marrow comes from the kidney — that is the process. What about the brain? The brain is the sea of marrow: the marrow concentrates and rises to the head, accumulates there like an ocean — so the brain is also connected to the kidney.

The kidney’s bloom is in the hair, and the hair is managed by two masters:

💬 Note from Doctor Ni: The color of the hair is managed by the kidney — black, the hair color is the kidney. The growth of the hair — that is water generating wood, managed by the liver. The liver is wood; when wood begins to grow it sends out many tendrils. Originally it was only a seed, and when the seed first sprouts, what grows out first are all tendrils. So the kidney manages the quality and color of the hair, and the liver manages the growth of the hair.

And speaking of hair, Doctor Ni cannot resist a jab at chemotherapy:

💬 Note from Doctor Ni: If you do not believe me, go to the hospital. A cancer patient’s first chemotherapy — he lies there three or four hours unable to move, and two hours later you can pull his hair out. It falls out on the spot, on the spot — because the liver has been injured. Give that to the enemy, but do not take it yourself.

The liver is the root of endurance: look at the nails to know the liver

💬 Note from Doctor Ni: The liver is the root of endurance, the residence of the hun. Its bloom is in the nails, its fullness is in the sinews; it generates blood and qi; its flavor is sour, its color is cang. The liver is yin and the hun is the yang soul; yin and yang support each other, and the hun lives in the liver. The liver gives birth to many sinews, and the sinews run to the tips of the four limbs — the surplus of the sinews is the nails. The nails are the outermost place of the sinews. So by looking at the symptoms of the nails, you can judge whether the liver has a problem.

And what is the proper color of the liver? Doctor Ni casually teaches the complexion of all four seasons:

💬 Note from Doctor Ni: Cang is actually the proper color — the healthy green, a green with a tiny bit of yellow in it; that is normal. Why must we look at this color? Winter is black, autumn is white, summer is red, spring is green. When spring comes, if this person’s face carries a little green and a little yellow — not strongly green, not strongly yellow — then he is sick; a touch of green and a touch of yellow is the normal color, the color a healthy person should have. In winter a person’s complexion should be a bit darker, a bit blacker, a bit more subdued — because the body must store, just like a farmer after the harvest hurrying to get the rice into the granary; the essence and qi must be drawn inward.

The spleen and stomach are the root of the granaries: where does blood come from? From the five grains

💬 Note from Doctor Ni: The spleen, stomach, small intestine, large intestine, bladder and san jiao are all the places that digest food; the place of accumulation is the root of the granaries, the residence of the nutritive. When we speak of the nutritive (ying), we are speaking of blood — and where does blood actually come from? The five grains, food. The qi stored in this food — while the spleen, stomach, small intestine, large intestine, bladder and san jiao are on duty — can transform the dregs and turn flavor into intake and output: pushing out the waste of food and hoarding the essence of food. The spleen’s bloom is on the lips and the flesh around the mouth — the area around the lips is managed by the spleen. Whether the spleen functions well, look at whether the muscles are strong. The flavor of the spleen is sweet, its color is yellow, and it communicates with earth qi. So the liver communicates with wood qi, the kidney with water qi, the spleen with earth qi, the heart with fire qi — each has its own different place.

The five flavors go directly into the five organs: eat too much, and you injure the organ it conquers

Sour, bitter, sweet, pungent and salty go directly into the five organs; too much and too little are both bad, and in the middle amount they are best for the five organs. But Doctor Ni punctures a common misunderstanding:

💬 Note from Doctor Ni: If you eat too much sour, it does not harm the liver — rather, when there is too much sour in the liver, it affects the spleen. Because wood overcomes earth, it affects the earth qi. So when the earth has too much sour in it, that is not allowed. The salty flavor enters the kidney — we add a little sea salt, and the salty flavor enters the kidney. But if you eat too much salt, the excess salt injures the kidney and also injures the bone, and above all it injures the heart — because the salty flavor manages the water in our blood. The water in the blood is managed by the kidney; when the water decreases, the blood becomes thicker and stickier, and that affects the heart.

What about bitter? Too much bitter affects the lung; too much pungent injures the liver:

💬 Note from Doctor Ni: In normal amounts the pungent flavor is very good for the lung — the lung is white, and garlic is white and pungent — is that not exactly the fruit of the lung? You can see it at a glance. Eating a few cloves is fine; eating too much injures the liver — it disperses too much.

But then Doctor Ni adds a dose of common sense — food and medicine are two different things:

💬 Note from Doctor Ni: If we are talking about food, there is really nothing to fear. You eat twenty dumplings, one clove of garlic per dumpling — it will not hurt you much, because it is food. But if you do it the Sichuan way — boil a huge pile of chili peppers down into a dense, concentrated oil — try that oil, now that is excess. With raw food you could never eat that much — how many raw chilis can you eat? But boil a crowd of little bird’s-eye chilis down into one small pot — wow, that is truly excessive, and it will affect the liver. Still, we cannot do without them either — we must have all five flavors, mixed evenly.

All eleven organs depend on the gallbladder

💬 Note from Doctor Ni: Our five organs — liver, heart, spleen, lung, kidney — paired with the gallbladder, stomach, small intestine, large intestine and bladder, normally — all eleven organs depend on the gallbladder. This is a very famous line from the Liu Jie Cang Xiang Lun.

The Renying-Cunkou pulse method: one, two, three times greater — four times greater and something terrible happens

With the visceral manifestations complete, Qi Bo hands over the pulse method. The Renying pulse is at the Renying point (ST9) on the neck. The right Renying pulse governs the bowels — stomach, small intestine, large intestine, bladder, gallbladder; the left Renying pulse governs the organs — liver, heart, spleen, lung, kidney. In a normal person the right pulse is a little larger than the left:

💬 Note from Doctor Ni: Renying one time greater, disease is in the shaoyang; two times greater, in the taiyang; three times greater, in the yangming; four times greater or more is ge yang — repelled yang. Cunkou one time greater, disease is in the jueyin; two times greater, in the shaoyin; three times greater, in the taiyin; four times greater or more is guan yin — barred yin. When both Renying and Cunkou are four times greater or more, that is guan ge — barred and repelled; the guan ge pulse is surging full, and the person is about to pass away.

The right pulse a little larger: disease in the shaoyang. Twice as large: disease in the taiyang. Three times as large: disease in the yangming. Four times or more: ge yang. This pulse method, which locates the depth of disease by “how many times greater,” is the skeleton of diagnosis in the Nei Jing.

The overflowing pulse and the covering pulse: when cold water runs into the lung, yin usurps yang’s seat

When the discussion reaches guan ge, Doctor Ni deliberately pulls out Difficulty Three of the Nan Jing (Classic of Difficult Issues) for comparison:

💬 Note from Doctor Ni: You can all look at the third difficulty of the Nan Jing — this chapter of ours discusses guan ge. When the yang pulse is excessive and the pulse surges upward, that is yin mounting yang’s seat — yin has usurped the place of yang. An example: a person — the lung likes dryness, right? — suddenly cold water runs into it. Water is a cold, yin thing; water should be underground — groundwater, down in the kidney region, that is fine. But this water runs into the lung and accumulates there — yin mounting the seat of yang — none of that is good. That is the overflowing pulse (yi mai).

And the covering pulse? The reverse:

💬 Note from Doctor Ni: As for the covering pulse (fu mai), it is the yang pulse descending, pressing downward all the way, covering and lying on top of the yin pulse. That is fu mai — the interior barred and the exterior repelled. Originally yang was here; yang descends and runs into the seat of yin — the interior is barred from the exterior, and yang qi cannot come in.

The overflowing pulse is yin mounting yang’s seat; the covering pulse is yang mounting yin’s seat — both are pulses where yin and yang have left their proper places, the severe conditions of guan ge.

Closing: diagnose with excess and insufficiency — reading the sky and reading people is the same art

This lecture began with the solar terms in excess and insufficiency, moved through the visceral manifestations of the five organs, the five flavors for health, and the Renying-Cunkou pulse method, and at the end Doctor Ni loops back to the plain truth of the opening:

💬 Note from Doctor Ni: So we must always look at excess and insufficiency — use excess and insufficiency to make the diagnosis. A doctor treating patients and an astronomer reading the sky use the same logic: what should have come has not come, and what should not have come has come — both are disease.

With the Liu Jie Cang Xiang Lun discussed this far, the whole chessboard of “how the person corresponds to Heaven and Earth” is laid out: how the solar terms in excess or insufficiency will affect the drought and flood of the year; how each of the five organs has its bloom, its fullness and its season; how overeating the five flavors injures the organ the flavor conquers; how the “how many times greater” of Renying and Cunkou fixes the seat of disease; and how the guan ge pulse presages death. In the next lecture, Doctor Ni will keep walking forward with these rules in hand.

Compiled from Doctor Ni Haixia’s Ren Ji · Huang Di Nei Jing lecture series (Lecture Fourteen)