Can’t Sleep? Should Your Feet Stick Out of the Blanket? Doctor Luo Dalun Presents Doctor Ni Haixia’s Sixteenth Lecture on the Huang Di Nei Jing — Blood Returns to the Liver for Sleep, Why Sleeping in a Draft Gives You Varicose Veins, Reading Vision From the Liver, and the Five Decisive Pulses That Diagnose Heart Block and Lung Block

Patient search terms: can’t fall asleep at night / what causes insomnia? / should your feet stick out of the blanket when you sleep? / blue veins on the calves / how to get rid of varicose veins / seeing things crooked / blurry vision / eyes can’t see clearly / severe headache / epilepsy / can’t hear clearly / bloated stomach / drum-like swollen belly / swollen hands and feet / coughing / restlessness / red face / pale face / what do you look for when feeling the pulse? / pulse diagnosis

Corresponding medical names: Su Wen · Wu Zang Sheng Cheng Pian (On the Generation of the Five Viscera, chapter ten) · the liver receives blood and the eyes can see (gan shou xue er neng shi) · the feet receive blood and can walk (zu shou xue er neng bu) · the palms receive blood and can grasp (zhang shou xue er neng wo) · the fingers receive blood and can hold (zhi shou xue er neng she) · sleeping and going out into the wind (wo chu er feng chui zhi) · blood congealing in the skin is bi (xue ning yu fu wei bi) · congealing in the vessels is qi (ning yu mai wei qi) · congealing in the feet is jue (ning yu zu wei jue) · the liver stores the hun (gan cang hun) · the liver channel at its peak hour (chou shi, 1-3 a.m.) · insomnia · the liver opens into the eyes (gan kai qiao yu mu) · left blood, right qi (zuo xue you qi) · stereoscopic vision · the heart hates heat (xin wu re) · the chief of the six yang channels (liu yang zhi shou) · varicose veins · He Gu (LI4) and Tai Chong (LR3) open the four gates (kai si guan) · twelve great valleys (da gu shi er fen) · three hundred fifty-four small streams (xiao xi san bai wu shi si) · twelve shu points (shao shi er shu) · defensive qi (wei qi) · the five decisions are the guide (wu jue wei ji) · first build its mother (xian jian qi mu) · liver wiry, heart full, spleen relaxed, lung floating, kidney deep (gan xian xin hong pi huan fei fu shen chen) · headache of the crown (tou tong dian ji) · lower deficiency with upper excess (xia xu shang shi) · epilepsy (dian xian) · rigidity seizures, both kinds (gang jing rou jing) · dim vision and deafness (xun meng zhao you, mu ming er long) · abdominal distension (fu man chen zhang) · the spleen governs the belly (pi zhu fu) · the small intestine, the official of receiving (xiao chang shou sheng zhi guan) · draining the south and tonifying the north (xie nan bu bei) · Nan Jing (Classic of Difficulties), difficulty seventy-five · coughing with qi rushing upward (ke sou shang qi) · the lung models the sky (fei fa xiang tian) · heart fire warms the lung (xin huo wen fei) · restlessness with headache (xin fan tou tong) · disease in the diaphragm (bing zai ge zhong) · the triple burner (san jiao) · the pulse: small-large, slippery-rough, floating-deep (mai zhi xiao da hua se fu chen) · slippery and floating are yang, rough and deep are yin (hua fu wei yang, se chen wei yin) · cun-guan-chi (inch-bar-cubit) · stomach qi (wei qi) · matching color and pulse (he se mai) · the solar terms (jie qi) · the red pulse arrives (chi mai zhi zhi) · heart block (xin bi) · the white pulse arrives (bai mai zhi zhi) · lung block (fei bi)

Opening: when you sleep, the blood all goes home

Last lecture finished the generation of the five viscera and the injuries of the five flavors. This time Doctor Ni continues from page 81 — and opens with a sentence everyone can use: while you sleep, the blood returns to the liver:

💬 Note from Doctor Ni: When a person sleeps, the blood returns to the liver — the liver receives blood and the eyes can see, the feet receive blood and can walk, the palms receive blood and can grasp, the fingers receive blood and can hold. The eyes can see because the blood has arrived; the feet can walk because the blood has arrived; the palms can grasp and the fingers can grip because the blood has arrived.

Blood is the source of strength. Wherever the blood reaches, there is strength.

Why does the blood returning to the liver put you to sleep?

Then comes the age-old riddle of sleep. Why can a person fall asleep? Doctor Ni says the key is the liver:

💬 Note from Doctor Ni: A person can sleep because at night our blood goes back inside the liver. Between 1 and 3 a.m. the liver is busiest, and during those two hours we are in deep sleep. The liver stores the hun (ethereal soul), and the hun belongs to yang — yang represents strength. At night the hun returns to the liver, the eyes close, and sleep comes. This part agrees with Western medicine, which also holds that at night the liver is busy metabolizing toxins for you — the Huang Di Nei Jing said this first, long ago.

Blood returns to the liver, the hun returns to the liver — and the person sleeps. Turn it around: when the blood cannot return to its root, the hun cannot return to its root, and of course there is insomnia. Doctor Ni divides the blood failing to return to the liver into two kinds:

💬 Note from Doctor Ni: One kind is that something has grown inside the liver — an excess condition. Something occupies the liver, and when the blood goes back in it bounces back out again, and the person wakes up. The other kind is a deficiency — the force pulling the blood back is not strong enough, and that also causes insomnia and poor sleep.

So insomnia is not simply a matter of “nerves” and done. First determine whether the liver has something blocking it (excess) or the strength to pull the blood back is insufficient (deficiency) — the two directions are completely different.

Yang ming dryness-heat: so hot you kick off the covers, and couples sleep in separate rooms

Before talking about sleep, Doctor Ni slips in something he sees in the clinic every single day — yang ming dryness-heat. Note carefully: this is not the Western “bipolar disorder”:

💬 Note from Doctor Ni: We talk about the yang ming syndrome — the yang ming syndrome is very hot. If it is not treated, then at night, because of the heat, you cannot sleep under the covers. Many patients not only refuse the blanket, they turn on the electric fan, turn on the air conditioner, and still find it too hot. Some couples — the wife has yang ming dryness-heat and is burning up; the husband has no illness. The husband says, our temperatures are different, I’ll go sleep in the other room — No! You don’t love me anymore!

In the clinic Doctor Ni constantly hears patients say: I kick the blanket off, in summer I only cover a sliver. People with dryness-heat are blowing in the wind — and the liver governs wind — so when at night the blood returns to the liver and yang withdraws inward, and the wind blows on you, that is where the trouble that follows comes from.

Sleeping in a draft congeals the blood — the truth about varicose veins

When you sleep, the blood returns to the liver and yang returns to the interior. At this time the body should be well covered. If you do not cover up — feet sticking out, the wind blowing on them — the wind wounds the channels. What does the classic say?

💬 Note from Doctor Ni: Sleep and go out into the wind — blood congealed in the skin is bi, the skin goes numb; congealed in the vessels is qi, the blood flows sluggishly; congealed in the feet is jue, the feet turn icy. All three are the blood’s movement injured by wind, and together they are called bi jue (blockage-reversal).

Here comes the crucial point. Doctor Ni tells every beauty-conscious lady the plain truth:

💬 Note from Doctor Ni: Many ladies and misses think that because they work standing up, their feet get varicose veins and a lot of stagnant blood. In fact it is because they themselves have heat, and at night they sleep in a draft. Chinese medicine holds that even in summer, when it is very hot, you should still cover yourself with a thin sheet — with the feet outside. If you keep that habit year after year, your legs will certainly be beautiful legs, and you will never see blue veins or varicose veins.

The heart fears heat, not cold: feet outside the blanket actually nourish the heart

Wait — the passage above says the feet may stick out? Won’t that let the cold in? Doctor Ni says that is precisely what nourishes the heart:

💬 Note from Doctor Ni: The heart itself hates heat and delights in cool. When we treat the heart, we must keep the patient slightly cool. In winter some people say, “My heart is bad, I should wear more clothes to stay warm” — that is actually wrong. To treat the lung we keep warm; to treat the heart — the heart does not like being too hot. The feet are the farthest place from the heart. Let them take a little cold; use cold to stimulate the heart, and at the same time strengthen it.

So the correct sleeping arrangement is: the quilt comes up to the ankles, and from the ankles down the feet are out; the neck is out, and the head is out in the open.

The head is the chief of the six yang channels: why the head never feels cold

Why can the head stay uncovered? Doctor Ni explains with some channel basics:

💬 Note from Doctor Ni: The head is the chief of the six yang channels. The liver channel, gallbladder channel, stomach channel, bladder channel, triple burner channel and small intestine channel — all the yang channels run over the head. The yin channels end at the neck; yin does not go up onto the head, so the head is purely yang. However cold the weather, however many layers you wear, your scalp stays exposed and the head does not feel cold. Of course in a great cold the ears cannot take it and you cover the ears — but the head has never had a yin channel coming up. The main channels are great rivers, the collaterals are little streams; the six great channels truly reaching the head make it the hottest, most cold-resistant place on the body.

The liver opens into the eyes: seeing things crooked or shaky is all under the liver’s jurisdiction

Sleep done, the lecture moves to the eyes. The liver opens into the eyes, because the liver channel lands behind the eyes — liver blood reaches the eyes and only then can we see. So vision problems are treated from the liver:

💬 Note from Doctor Ni: Vision problems also have yin and yang. Yin: the vision goes blurry, the eyes degenerate. Yang: the strength itself is fine, no degeneration — but how come what you see comes out reversed? That is a problem of qi.

What does a qi problem look like? A patient once told Doctor Ni: “Doctor, my illness is strange. I see things crooked, so I have to walk sideways like this to feel straight.”

💬 Note from Doctor Ni: When qi is unbalanced, one angle is fixed and does not move; when blood is unbalanced, this side shakes — when it shakes, everything you look at wavers, and the person is forever adjusting his posture. Understand the cause and you know where to start. So vision that does not shake but comes out tilted — problems of that sort all belong to yin.

Left blood, right qi: two eyes together give you depth

Why can the eyes judge near and far, front and back? Doctor Ni uses the Chinese medicine principle of “left blood, right qi” to explain stereoscopic vision:

💬 Note from Doctor Ni: Chinese medicine holds that the left side is blood and the right side is qi. Blood comes from water — water can aid the heart, and only then is blood generated. Kidney water controls the heart; with water coming to aid fire, the heart’s momentum can last a whole lifetime, a hundred years, no problem. Around the heart is what is called the pericardium — between the pericardium and the heart is a layer of clear water. Water on the outside, and the fire cannot overheat. The blood vessel on the left — when it sends blood out, it goes at a horizontal angle; qi rises, generates yang, and travels the vertical angle. The left eye and right eye put together become three-dimensional space — we see near and far. Close one eye and it becomes flat — like a point-and-shoot camera is flat, while a single-lens camera sees depth. The principle is the same.

Weakening grip? Check the liver first

The next line — “the feet receive blood and can walk, the palms receive blood and can grasp” — prompts Doctor Ni to point out a very practical diagnostic clue:

💬 Note from Doctor Ni: The palms receive blood and can grasp — blood brings strength. Sinews and bones are connected, and the liver governs the sinews, so the strength of the grip lives in the liver. When the liver has a problem, patients discover their grip strength weakens. So whether the eyes can see, the feet can walk with strength, the palms can hold things — all of that belongs to the liver.

Bonus: why Tai Chong for opening the four gates?

Speaking of liver blood, Doctor Ni takes a moment to correct his own slip of the tongue — and in doing so explains exactly why the four gates are opened where they are:

💬 Note from Doctor Ni: In acupuncture we use He Gu (LI4) and Tai Chong (LR3) to open the four gates — I misspoke just now; it is not He Gu and Wai Guan, it is He Gu and Tai Chong. Tai Chong is the blood point on the liver channel, and that is why we choose Tai Chong for this job.

The twelve shu points and the three hundred sixty-six points: where defensive qi lodges

Page 82 counts the body’s points:

💬 Note from Doctor Ni: A person has twelve great valleys, three hundred fifty-four small streams, and twelve shu points — the twelve shu points: liver, gallbladder, spleen, stomach, triple burner, kidney, bladder, small intestine, large intestine, pericardium — twelve in all. The body’s points add up to three hundred sixty-six. All of them are places where defensive qi (wei qi) stops, where yang qi stops, and also places where external pathogens — wind, cold, summer heat, dampness, dryness, heat — stop.

So in the clinic, when a patient complains that a particular point hurts, that means the pathogen is at the surface, lodged in that position — and acupuncture can cure it. See where the problem sits, and that is how you choose the point; that is where points come from. Doctor Ni adds: the true pattern diagnosis, the causes and mechanisms, are all in the Huang Di Nei Jing.

The five decisions are the guide: five pulses, five organs at a glance

The last line of page 82 is the master key to diagnosis:

💬 Note from Doctor Ni: “The beginning of diagnosing disease is the five decisions as guide; to know its beginning, first build its mother.” The five decisions are the five pulses, the pulses of the five viscera — the liver pulse is wiry (xian), the heart pulse is full (hong), the spleen pulse is relaxed (huan), the lung pulse is floating (fu), the kidney pulse is deep (chen). Why? The liver is wood; feeling the liver pulse is like a thin branch of a tree, like a lute string — that is wiry. The heart is a full pulse, thicker and more forceful to the touch. The spleen is very soft and relaxed. The lung is a floating pulse, because the lung governs the skin and body hair — your finger just lightly touches the skin, just makes contact, and you can feel the pulse; that is floating. The kidney is water — you must press down to the bone before you feel the pulse; that is the kidney pulse. What does a normal floating pulse look like? A piece of wood floating on water: you touch it lightly and it is there; press slightly and it sinks down — that is the normal pulse. If you feel a floating pulse and pressing it down does not make it sink, it stays there — then the disease is in the skin and body hair.

Headache and epilepsy: lower deficiency with upper excess, fault in the kidney and tai yang channels

Page 83 enters the long section that assigns diseases to channels. The first disease — excess conditions of the head and face:

💬 Note from Doctor Ni: Headache of the crown and epilepsy are lower deficiency with upper excess, the fault lying in the foot shao yin (kidney) and ju yang (tai yang, bladder) channels; in severe cases it enters the kidney. A person is balanced between yin and yang, between deficiency and excess. Now an excess condition is presenting, so below it must be deficient — the upper part is excess because the lower part is deficient. Generally speaking, excess headaches are fierce headaches. All epilepsy is excess; the rigidity seizures of both kinds — gang jing and rou jing — are also excess. The cause sits on the kidney channel and the tai yang channel, because both go up to the head; in severe cases it enters the kidney — from the channels it penetrates deeper, into the internal organs, depending on how solid the excess is.

Eyes dim, ears deaf: this time it is deficiency

The second disease is the deficiency condition of the head and face:

💬 Note from Doctor Ni: Xun meng zhao you — the ears cannot hear, the eyes are dim and cannot see clearly, the vision is poor — this is deficiency, and it is also lower excess with upper deficiency. The cause is in the foot shao yang and jue yin — the gallbladder channel and the liver channel. When the deficiency worsens, it goes from the channels into the liver.

Bloating: the spleen is in charge; swollen limbs: yang is insufficient

The third disease — the belly:

💬 Note from Doctor Ni: Abdominal distension — the belly full, the lower abdomen bloated, the chest and flanks uncomfortable — the fault lies in the foot tai yin (spleen) and yang ming (stomach) channels. The spleen governs the belly and the lower abdomen, so this whole region is the spleen’s to manage. The small intestine is the official of receiving; the small intestine is fire, and fire generates earth — earth is the spleen. The whole lower-abdominal region, with the stomach in the middle, all belongs to the spleen. So when someone’s belly is drum-distended, you can see it at once.

But not all swelling is alike, and Doctor Ni draws the line clearly:

💬 Note from Doctor Ni: If the belly is not distended but the four limbs are swollen — hands and feet puffy — that is yang. The four limbs are yang; when yang is insufficient they swell, because yang cannot vaporize the water. That is why, when we introduce medicinals, certain herbs that move yang, strengthen yang, or move qi can eliminate edema. If a person has both a swollen belly and swollen hands and feet, you do both together. Generally, abdominal distension and drum-belly are excess conditions — excess has a visible shape. The whole belly is hard and rigid — that is excess, stone-like. When the spleen is over-full, this phenomenon appears. How to treat it? The seventy-fifth difficulty of the Nan Jing, which I have explained: drain the south and tonify the north — the child can make the mother full, the mother can make the child empty — use that method to treat it.

Coughing with qi rushing upward: the lung is too cold

The fourth disease — coughing:

💬 Note from Doctor Ni: Coughing with qi rushing upward — the reversal is in the chest, the fault lying in the hand yang ming (large intestine) and hand tai yin (lung). Why coughing with qi rushing upward? Because cold qi is in the chest. In the Chinese medical view, the lung models the sky — the canopy covers the whole globe; the lung sits high and is cold. But a normal lung is warmed because heart fire is below it — the lung wraps the heart fire, and that fire ceaselessly warms the lung, giving the lung itself a very mild, gentle temperature. If the lung grows too cold, the patient coughs, because the lung does not like cold — it likes heat.

Restlessness and headache: heart fire cannot descend, so it rushes upward

The fifth disease — restlessness and headache:

💬 Note from Doctor Ni: Restlessness and headache — the disease is in the diaphragm, the fault lying in the hand ju yang (small intestine) and shao yin (heart channel). The heart and the small intestine are themselves both fire. The heat the heart produces is pushed downward by the lung above it, so heart fire travels down; heart fire descends to the small intestine, and between the two there is a certain speed, temperature and pressure that make the small intestine peristalse and digest food — the small intestine’s heat steams and transforms food. Now the heart fire cannot get through on its way down and turns back — because directly below the heart is the diaphragm — and the heat rushes upward, giving the person headache and restlessness. The heart should be mild, its fire should travel down; now the fire goes up instead, and the heart grows agitated.

When this kind of disease sits between the organs, it belongs to the triple burner (san jiao) — we have the transverse diaphragm and the longitudinal mediastinum; those will be introduced gradually later.

Slippery and floating are yang, rough and deep are yin: it all comes back to yin and yang

Page 84 brings the essentials of diagnosis:

💬 Note from Doctor Ni: “The pulse in its small-large, slippery-rough, floating-deep can be distinguished by the fingers; the images of the five viscera can be inferred by analogy; the notes of the five viscera can be recognized by the mind; the five colors in diagnosis can be examined by the eyes. Combine color and pulse, and you can be perfectly safe.” These are the essentials of diagnosis. The slippery pulse and the floating pulse are yang pulses; the rough pulse and the deep pulse are yin pulses. Four characters to divide yin and yang — the entire system of Chinese medicine is nothing but dividing yin and yang; after all the talk, it is still yin and yang. How is the pulse divided by region? In the chest, the lung and heart belong to the upper part — the upper is yang, the lower is yin. In pulse diagnosis, above the guan (bar) is yang, below the guan is yin. In the very middle sits the stomach, so the center is spleen earth — the meeting place of yin qi and yang qi. Yin and yang combine into the center; the center is where stomach qi lives. When you feel the pulse, its shape may be wiry like the liver pulse, but if its force and speed are gentle and soft, that always means stomach qi is present.

Matching color and pulse: before feeling the pulse, know the season

Qi Bo here raises “matching color and pulse,” and Doctor Ni turns the sentence into a clinical operating manual:

💬 Note from Doctor Ni: When diagnosing a patient, look at the complexion with your eyes, feel the pulse with your hand, and at the same time know what solar season it is — you do not need to divide it down to all twenty-four terms, but at least know spring, summer, autumn, winter. In winter, think: it is winter now, all the normal pulses should be somewhat deeper, and the complexion somewhat darker — hidden, the concealed color is darker; that is normal. Now in walks someone with a red face; you feel the pulse and it is large and floating — you know the heart has a problem. The same illness: in summer, when the weather is very hot, a person runs in with a red face and a large, floating pulse — that is pulse and color in accord with the season, and you would make a different diagnosis. So to be a good doctor, you must be able to match color and pulse.

Red face, hard pulse: heart block — eating without attention also makes you sick

The second paragraph of page 84 gives two concrete examples of “matching color and pulse.” The first, the heart:

💬 Note from Doctor Ni: “The red pulse arrives — rapid and hard.” A person with a red face, a pulse that comes large and hard, with panting — the diagnosis: accumulated qi in the middle, at times harming the appetite, called the heart block (xin bi). Eating too much has two flavors: one is that you simply eat too much food, but you are happy, and this can still happen; the other is that when you eat, you never eat attentively — all day long you are thinking of a thousand things, worries and vexations troubling you. When you eat and the heart’s strength is not good, the food is not digested, as if you had eaten too much. If the stomach is fine and digestion is good, the heart’s red will not leak out; the complexion of the face is governed by stomach qi. Now the food is stuck inside, heart yang cannot come down and goes up instead, and the face reflects the red.

Pale face, floating pulse: lung block — upper deficiency, lower excess

The second, the lung:

💬 Note from Doctor Ni: “The pulse arrives — white.” A pale complexion — the pulse comes floating, panting and floating — this is upper deficiency and lower excess. The face is white; the lung color is white. This patient has upper deficiency and lower excess — this is the lung block (fei bi), and there will be chills and fever. Our earlier five colors — blue-green, red, yellow, white, black — correspond to the liver, heart, spleen, lung and kidney.

Closing: from sleeping to feeling the pulse, one thread runs through

This lecture opened with “when you sleep, the blood returns to the liver” and walked all the way to the end of the Wu Zang Sheng Cheng Pian: the liver receives blood and the eyes can see, the feet receive blood and can walk, the palms receive blood and can grasp, the fingers receive blood and can hold — blood is the source of strength; sleep and go out into the wind, blood congeals in the skin as bi, in the vessels as qi, in the feet as jue; insomnia divides into excess and deficiency; the heart hates heat, and feet outside the blanket nourish the heart; the head is the chief of the six yang channels; vision is treated from the liver, left blood and right qi create three-dimensional space; the twelve shu points and three hundred sixty-six points are where defensive qi and external pathogens lodge; the five decisions are the guide — liver wiry, heart full, spleen relaxed, lung floating, kidney deep; headache and epilepsy, dim eyes and deaf ears, bloating, coughing and restlessness each have their channel; slippery and floating are yang, rough and deep are yin, and matching color and pulse means knowing the season — finally landing on two real diagnoses, the heart block and the lung block. Doctor Ni’s classes are always like this: one line of the classic yields the fine points of sleeping, the secret of beautiful legs, the essentials of pulse diagnosis, and diagnosis by season. Next lecture, the Huang Di Nei Jing continues.

Arranged from Doctor Ni Haixia’s Ren Ji (Human Records) lecture series on the Huang Di Nei Jing (Sixteenth lecture)