Why Isn’t My Medicine Working? When a Patient Doesn’t Believe, Even the Best Medicine Is Wasted — Doctor Luo Dalun Presents Doctor Ni Haixia’s Nineteenth Lecture on the Huang Di Nei Jing: the Tang Ye Liao Li Lun (On Soups, Wines and Fermented Drinks) and the Yu Ban Lun Yao (On the Essentials of the Jade Tablet)
Patient search terms: medicine is not working / why is the medicine not helping? / a patient who refuses to take medicine / patients who do not believe in Chinese medicine / an old person who does not trust the doctor / vomiting or diarrhea after taking herbs / is the medicine poison? / keeps losing weight / wasting away with no diagnosis / insomnia / depression / bipolar disorder / anxiety / dark complexion / a gray face as if unwashed / dry, puffed-up hair / itchy skin / muscle and joint pain / stiff neck / headache and fever / scorching thirst but no desire to drink water / cannot feel the pulse / very weak pulse / what disease does a short pulse indicate?
Corresponding medical names: Su Wen · Tang Ye Liao Li Lun (On Soups, Wines and Fermented Drinks, chapter fourteen) · tang ye liao li (soups, wines and fermented drinks) · wine as medicine · rice wine, glutinous rice wine, millet wine · the sages of high antiquity made soups as preparation (shang gu sheng ren zuo tang ye yi wei bei er) · in middle antiquity virtue declined, pathogens arrived with the seasons, drinking them brought complete recovery (zhong gu zhi shi dao de shao shuai, xie qi shi zhi, fu zhi wan quan) · tranquility and emptiness (tian dan xu wu) · one must attack internally with medicines and treat externally with needles and moxa (bi qi du yao gong qi zhong, chan shi zhen ai zhi qi wai) · when the form is worn out and the blood exhausted yet no result is achieved (xing bi xue jin er gong bu li zhe) · the spirit not following (shen bu shi) · the spirit does not advance, the will is not ordered (jing shen bu jin, zhi yi bu zhi) · endless desires and ceaseless worry, the essence-qi ruined and loosened (shi yu wu qiong, you huan bu zhi, jing qi chi huai) · the disease is the root, the physician is the branch; when root and branch do not meet, the pathogen does not submit (bing wei ben, gong wei biao, biao ben bu de, xie qi bu fu) · disease in its inception is extremely fine and subtle, first knotting in the skin (bing zhi shi sheng ji wei ji jing, xian ru jie yu pi fu) · the twelve back-shu points (shi er shu xue) · the superior physician saves it at the sprout (shang gong jiu qi meng ya) · when the disease is formed it is called contrary (bing cheng ming yue ni) · some are not born from the fine hairs but knot together from the yang of the five viscera (bu cong hao mao er sheng, cong wu zang yang yi jie) · essence-fluids filling the cul-de-sac, the po dwelling alone, lonely essence within and qi consumed without (jing ye chong guo, po du ju, gu jing yu nei, qi hao yu wai) · the po men (anus) and the lung (po men yu fei) · level and treat by the balance, remove the stagnant and old, gently move the four limbs, keep warm (ping zhi yu quan heng, qu wan chen cuo, wei dong si ji, wen yi) · needling the collateral at the place to restore the form (miao ci qi chu, yi fu qi xing) · open the ghost gate and cleanse the mansion (kai gui men, jie jing fu) · the essence taken in its season, the five yang spread, dredging and cleansing the five viscera (jing yi shi fu, wu yang yi bu, shu di wu zang) · bone and flesh protect each other, the great qi becomes level (gu rou xiang bao, ju qi nai ping) · bloodletting at the jing-well points (jing xue fang xue) · miao ci for emotional diseases — depression, insomnia, bipolar disorder, anxiety · Su Wen · Yu Ban Lun Yao (On the Essentials of the Jade Tablet, chapter fifteen) · kui du (assessing) and qi heng (extraordinary) · kui du measures the shallowness and depth of disease, qi heng speaks of extraordinary diseases (kui du zhe du bing zhi qian shen, qi heng zhe yan qi bing) · the changes of the five colors and pulses, the Way lies in the One (wu se mai bian, dao zai yu yi) · the spirit turns and does not turn back; turning back it does not turn, then the opportunity is lost (shen zhuan bu hui, hui ze bu zhuan, nai shi qi ji) · the essentials of the numbers, pressing close yet subtle, inscribed on the jade tablet, named ‘joining the jade mechanism’ (zhi shu zhi yao, po jin yi wei, zhu zhi yu ban, ming yue he yu ji) · the luopan compass (luo pan / luo jing) · the twenty-eight constellations (tian gang er shi ba xiu) · twenty-four solar terms, twelve months, twelve channels · the yin month (jian yue) · the hand taiyin lung channel (shou tai yin fei jing) · the complexion appears above, below, left and right, each in its essential place (rong se jian shang xia zuo you, ge zai qi yao) · soups govern ten days (tang ye zhu zhi shi ri) · medicines govern twenty-one days (bi qi zhu zhi er shi yi ri) · fermented wine governs one hundred days (lao jiu zhu zhi bai ri) · the color falling away, the face shedding (se yao mian tuo) · the luster gone · pulse short, qi exhausted, death (mai duan qi jue si) · yang pulse and yin pulse (yang mai yin mai) · yin and yang reversed (yin yang fan ni) · warming disease with extreme deficiency dies (bing wen xu shen si) · pulse and symptoms corresponding versus not corresponding (mai zheng xiang fu yu mai zheng bu fu) · the true visceral pulse, floating, big and surging (zhen zang mai fu da hong da) · upward is contrary, downward is following (shang wei ni, xia wei cong) · for men the left is contrary, for women the right is contrary (nan zuo wei ni, nü you wei ni) · at the extreme of yang, yin is generated (yang ji sheng yin) · water conquers fire, kidney disease black qi descending (shui ke huo, shen bing hei qi xia xing)
Opening scene: choosing the right wine for boiling medicine
This lecture continues where the previous one left off. Doctor Ni first adds a note on the art of brewing:
💬 Note from Doctor Ni: In the past we used water to boil medicine, but some people, some places, used wine to boil it. The wine cannot be red wine — no red wine of any kind. It must be rice wine, glutinous rice wine, or brewed millet wine — those are all fine.
Why does he insist on this? Because this lecture is about the Tang Ye Liao Li Lun — and liao li means wine. When the ancients matched medicine with wine, they had a deep purpose in mind.
The ancients made medicinal wine and left it sitting there — what were they planning?
The Yellow Emperor asks: they made the soups, wines and fermented drinks — why did they make them and then not use them?
💬 Note from Doctor Ni: Qi Bo says: the sages of high antiquity made these soups, wines and fermented drinks as preparation — to be ready for unexpected need (yi bei bu shi zhi xu). They were not meant to be used. They made them but did not drink them. By the time of middle antiquity, people’s virtue had begun to decline and pathogens arrived with the seasons — evil qi would come and invade — and at that point drinking them brought complete recovery; drink and be safe. The most important thing is that the people of high antiquity were tranquil in their emotions, very indifferent to desire. They did not need soups and medicines, and they did not need these alcoholic preparations either — by themselves, they simply did not fall ill.
Doctor Ni brings out the key point: medicine is prepared for “those who need it.” The ancients were tranquil and free of desire, so they had no use for it; by middle antiquity, human virtue had begun to decline and pathogens could slip in on weakness — and only then did the soups, wines and fermented drinks become useful.
Why do people today need needles, medicines and moxa all at once?
The Yellow Emperor asks again: today’s people take the soups and medicines, but not all of them are cured — why?
💬 Note from Doctor Ni: Qi Bo says: in the present age, one must attack internally with medicines and treat externally with needles and moxa — inside, use medicines to attack; outside, use needles and moxibustion; the inside and outside must be attacked together. Why must it be this way? Because the human heart is disordered, we have air pollution, and labor is less — everywhere you go you ride in a car. Obtaining food is also very cheap: we do not need to go out in the morning to plant vegetables, and then go to work after planting, do we? Buying is very convenient. So our labor is less, our exercise is less, and the environment is polluted. That is why we must use needles, moxa and medicinal soups together.
Set against today, this passage reads as if it were written for modern people: riding in cars, ordering takeout, little exercise, polluted environment — Doctor Ni says this is exactly why people today cannot be cured by a single herb alone: needles, medicine and moxa must all come into play.
Attacking with fierce medicines only wounds the patient — the spirit not following (shen bu shi)
At the last line of page 104, Qi Bo speaks of a strange thing that every doctor will meet:
💬 Note from Doctor Ni: “When the form is worn out and the blood is exhausted, yet no result is achieved” — when we attack the disease with very strong fierce medicines, the pathogen does not retreat; instead the patient’s qi and blood decline and fail, and the patient is wounded. Why is this? You will all meet it later. Qi Bo says: it is because the spirit is not following (shen bu shi). Because the patient still does not believe. If the patient himself does not believe in you, prescribing medicine for him is useless — he does not believe. When he does not believe, even if he gets good symptoms, he takes them for bad ones; but they are actually good symptoms.
In one sentence: no matter how good the medicine, if the patient does not believe, the spirit will not obey orders and the medicinal power cannot enter at all.
Vomiting and diarrhea after taking herbs — the disease is actually leaving the body
Doctor Ni gives a wonderfully vivid example that explains shen bu shi completely:
💬 Note from Doctor Ni: The human being has a neck and a lower belly — the navel is here. The disease sits in the chest cavity — the lung is here. If we cut the lung in two, when the disease is in the upper part, if the phlegm-water is too high, the patient will vomit it out; when the disease is in the lower part, it will go downward and come out in the stool. So your prescription is excellent, the patient takes it — but he does not believe in Chinese medicine at all, so when he takes it and vomits, he says: “This doctor gave me some rotten medicine, I am not taking it!” And he goes home and lies down to sleep.
Then he tells the second half of this little play:
💬 Note from Doctor Ni: You ask him: “Weren’t you unable to lie down yesterday? The moment you lay down you vomited and had diarrhea.” And that very night he lay down and slept — the disease was already cured! But during the day he had quarreled with you and called you a rotten doctor. In the evening he came home, lay down, and slept — and he forgot all about it. He does not know the Chinese medicine was that good; he simply does not believe. When shen bu shi is in a person — when someone does not believe in Chinese medicine, however compassionate you are, he will still not get better.
To vomit it out, to purge it out — that is the pathogen finding its way out, a sign of recovery; but the patient does not believe, mistakes good medicine for poison, and mistakes recovery for poisoning. That is shen bu shi. Doctor Ni says a physician must often swallow this injustice.
The second cause of shen bu shi: the emotions are not ordered
The Yellow Emperor presses on: why is the spirit not following? Qi Bo’s answer lies half in the patient’s unbelief and half in the patient’s own emotions:
💬 Note from Doctor Ni: Qi Bo says: the spirit does not advance and the will is not ordered, therefore the disease cannot be cured. His spirit is already damaged; the essence-qi is about to leave, and the nutritive and defensive (rong wei) can no longer be gathered back. There is also endless desire — too many desires — and ceaseless worry; the essence-qi is ruined and loosened, and the nutritive qi is insufficient. So the spirit cannot be moved, and the disease is not cured. On the one hand he does not believe; on the other hand his own emotions have a great influence — your power simply cannot reach that stage.
Too many desires and unceasing worry dry up the essence-qi, the spirit has nothing left, and the medicine naturally loses its power. This is the shen bu shi at the level of the emotions — a different matter from believing or not believing in the doctor.
While the disease is still on the skin nobody cares; once it is formed, it gets a name
On page 106, Qi Bo speaks of how disease arises and how today’s physicians treat it:
💬 Note from Doctor Ni: When disease first arises, it is extremely fine and subtle — at the very beginning, it always first knots in the skin. Today’s fine physicians, however, all wait for the disease to be “formed and named” — they wait until the disease is fully formed, until there is actually a disease, and only then start explaining what the name of the disease is, and talk at great length. At its beginning, they did not notice it. As we discussed before, we have twelve back-shu points — the twelve back-shu points of the five viscera and six bowels — and three hundred sixty-five points altogether. At the start, the disease is entirely on these superficial points — you feel some soreness and pain, and the moment you treat it with acupuncture, the disease has not yet formed. This is the superior physician (shang gong). But today it is not so: they wait until the disease is very deep, until it is fully formed, and then give it a name — “when the disease is formed it is called contrary” (bing cheng ming yue ni). At that point true qi can no longer govern it, and fine medicine can no longer reach it.
Doctor Ni adds a jibe: you see, even in Qi Bo’s era they already knew the Western-medicine way of doing things — form the disease, name the disease; wait until it is fully formed, then name it and treat it. The superior physician of Chinese medicine, by contrast, intercepts the disease with a few needles while it is still on the skin, still on the points.
The sick relative seen every day — why can’t he be cured?
Qi Bo then raises a question that cuts deep: the fine physicians of today have obtained the methods and keep the arts and numbers; relatives, brothers, people near and far all come to them — their voices are heard in the ear every day, their five colors are seen by the eye every day; they see the patient’s complexion every single day. Why is the disease still not cured?
💬 Note from Doctor Ni: Qi Bo says: the disease is the root (ben), the physician is the branch (biao). Root and branch must correspond to each other, and only then is one a true physician. If the art of medicine and the disease do not meet, the pathogen does not submit. One situation: your own relative does not believe in Chinese medicine — he would rather believe in Western medicine. How do you handle that? You see him every day and you see his decline and wasting day by day; he does not believe you, and there is truly no way. There is another meaning: the physician’s skill is insufficient and he cannot grasp the disease well — even if the patient is by your side and you see him every day, you still cannot cure him.
“The disease is the root, the physician is the branch; when root and branch do not meet, the pathogen does not submit” — this one sentence reduces the reasons for failure to cure to two kinds: the patient does not believe, or the physician is not good enough. Seeing each other every day changes nothing.
Some diseases do not come through the skin — they come from the decline of the five viscera’ yang
Midway through page 107, Qi Bo shifts direction: “There are those that are not born from the fine hairs, but knot together from the yang of the five viscera” (bu cong hao mao er sheng, cong wu zang yang yi jie) —
💬 Note from Doctor Ni: Some diseases do not enter through the skin; they arise because the yang qi inside the five viscera has declined. When we read the Huang Di Nei Jing, we must read every sentence from both sides: when the yang qi of the five viscera is insufficient, disease arises; when the yang qi declines, disease arises. In other words, if we always keep the yang qi of the five viscera vigorous, we will not fall ill, right?
This is the “way of reading the classics” that Doctor Ni repeats again and again: every sentence must be unlocked from both sides. When yang is vigorous, no disease; when yang declines, disease — the direction of care is completely clear.
Wasting away: the fluids are blocking the path of the lung qi
Qi Bo then describes a symptom — why a person keeps growing thinner:
💬 Note from Doctor Ni: In a normal person the lung qi covers the whole body like a balloon. The lung qi governs purifying and descending (su jiang), and normally it descends. If there is a great deal of essence-fluid inside — a great deal of essence-fluid in the lower abdomen (below the navel, in the middle of the belly) — the lung qi is blocked and cannot descend, and so it returns to the four limbs. The reason is that the dampness in the middle, the excess fluid in the middle, is too much, and the lung dwells alone — the lung is the po (corporeal soul); when we see the po, the po is the lung; the po men is the anus, so the po men, the anus, and the lung are all related. This is what causes “lonely essence within, qi consumed without, the form unable to keep its clothes on” — the clothes gradually grow looser, and this person will keep wasting away.
The five viscera are out of balance, yet no single viscus can be found “sick” — the clothes grow wider and wider while the person grows thinner and thinner. In clinical practice, this is exactly the portrait of many cases of unexplained wasting and mental-emotional disorders.
The miao ci method: open the ghost gate, cleanse the mansion
So how is it treated? Qi Bo gives a great principle of treatment, which Doctor Ni calls “the great principle for treating visceral disease”:
💬 Note from Doctor Ni: Qi Bo says: “Level and treat by the balance; remove the stagnant and the old (qu wan chen cuo); gently move the four limbs; keep warm; needle the collaterals (miao ci) at the place to restore the form. Open the ghost gate (kai gui men), cleanse the mansion (jie jing fu); let the essence be taken in its season, the five yang spread, dredging and cleansing the five viscera. Therefore the essence is born of itself, the form fills of itself, bone and flesh protect each other, and the great qi becomes level.” The “miao” of miao ci means the jing-well points at the tips of our four limbs — prick them and let a few drops of blood. Also, on the ends of the limbs — the legs, the arms, the calves — wherever you see blue-green veins: the blue-green veins are the blood vessels; where the veins are varicose, twisted and bent, we prick that vein to let a little blood. Doing this can open the ghost gate — the ghost gate is our pores, the pores of the skin all open — and then cleanse the mansion — making the intestines, the stomach and the bladder all pass freely.
Let blood, open the pores, free the intestines and bladder, let the yang qi spread through the whole body and cleanse the five viscera by itself — that is the thinking of the miao ci method. Doctor Ni especially stresses its range of application:
💬 Note from Doctor Ni: What this passage is about: of the five viscera, the lung sits on top; the lung is the official of the prime minister (xiang fu zhi guan) and governs qi. When the viscera are out of balance, the person keeps growing thinner — but if you ask which viscus is truly diseased, none of them really is. Clinically I truly do this, and I have cured many patients with depression and insomnia — the internal organs have no problem; for fear, bipolar disorder, anxiety, all of these can use this method to let the qi of the five viscera come back into balance. The method is miao ci — bloodletting at the jing-well points of the twelve channels, and bloodletting where you see bruising and stagnant blood vessels on the limbs, especially many on the legs; a little blood lets out, and it can open the ghost gate and make the intestines and stomach very clean. This only treats diseases of the spirit — diseases where yin and yang are separated and obstructed. If your internal organs are truly diseased — liver disease or the like — miao ci is useless; it must be a spiritual-emotional condition.
The miao ci method is not a panacea: for emotional imbalances of yin and yang, for depression, insomnia, bipolar disorder and anxiety, it is superb; for genuine organic disease of the viscera, it does not treat. Doctor Ni draws this boundary very clearly.
Kui du and qi heng: two lost ancient books
On page 109, we enter the Yu Ban Lun Yao. The Yellow Emperor says: I have heard of kui du and qi heng — they refer to different things; how are they used?
💬 Note from Doctor Ni: Kui du and qi heng are two books, spoken of in the Yu Ban Lun Yao. Qi Bo says: one who can kui du measures the shallowness and depth of disease; qi heng speaks of the disease. Let me speak of the ultimate numbers of the Way: “The changes of the five colors and pulses, kui du and qi heng — the Way lies in the One. The spirit turns and does not turn back; turning back, it does not turn — then the opportunity is lost. The essentials of the numbers press close yet are subtle; inscribe them on the jade tablet and call it ‘joining the jade mechanism.’”
Fearing that everyone will not understand the two characters kui du, Doctor Ni borrows a feng shui comparison:
💬 Note from Doctor Ni: Take the luopan — when you open a luopan to read feng shui, inside it are the twenty-eight tian gang (the twenty-eight constellations) and three hundred sixty degrees. The “heavenly degrees” we speak of are the luo jing (the compass). The reason the Yellow Emperor mentions kui du here — think about it, none of you have a foundation in astronomy and geography. Let me put it this way: at the coarsest level, there is growth, harvest, storage — spring, summer, autumn, winter, the four seasons; at the finest level, we can begin from the “gradual month” (jian yue) — the first lunar month of the calendar is the yin month, beginning from yin. On the human body, the qi and blood first begin their journey in the hand taiyin lung channel. That is why, when we introduce the twelve channels, we begin with the lung channel — because it is the beginning of heavenly qi: the year begins with yin, the body begins with the lung — both are yin.
The year starts from the yin month, the qi and blood start from the lung channel — the calendar of heaven and the channels of the human body are drawn from the same blueprint.
The complexion of the face: upward is contrary, downward is following
Page 111: “The complexion appears above, below, left and right, each in its essential place” — the abnormal changes of the human body all show on the face, and the different colors above, below, left and right each have their fixed position.
💬 Note from Doctor Ni: We put the face together with the four seasons of heaven and earth: zi (midnight/north) is below, wu (noon/south) is above. Placed on the human body, it corresponds to the liver, heart, spleen, lung and kidney; you can also go around the shenque (the navel, CV8) — the liver, heart, spleen, lung and kidney can be arranged there too. When you see a color that is not right, if it is very shallow, soups (tang ye) govern it — it can be cured in ten days; if the color is deeper, it is governed in twenty-one days — not that you must count from some solar term (for example, if today happens to be Beginning of Spring, then you count ten days from Beginning of Spring — no), it is ten days, twenty-one days from the day you begin treatment. If the color is very deep (da shen), you must use wine to boil the medicinal soup, and treat for one hundred days or more.
Shallow color, ten days; deep color, twenty-one days; very deep color, one hundred days and more — the timetable of treatment is written on the patient’s face.
The color falling away, the hair dry and puffed — a danger signal
More frightening than the depth of the color is “se yao mian tuo” — the color falling away and the face shedding:
💬 Note from Doctor Ni: When the color has entirely fallen away — soaked through and gone — the face has shed; this is extremely dangerous, death may come at any time. What is meant by “the face sheds” (mian tuo)? The oil and luster are all gone: when you look at the patient, all the oil has come out and scattered, there is much dust on the face, as if he has not washed his face. There are two situations: when we doctors examine a patient and the face is gray, dark, as if covered with dust — that is the complexion falling away. But if you sit on the bench as a judge and see a man whose face is black, just out of prison — the misfortune of jail, the face black, gray, as if unwashed — these two are not quite the same: for the man out of prison it is gray, but the complexion is still there; for the truly shed complexion, the entire color has fallen away — the disease is very dangerous.
How do you tell a true shedding of color? Doctor Ni teaches a special trick — look at the hair:
💬 Note from Doctor Ni: The most obvious sign of shedding: after the complexion of the face has fallen away, look at his hair — the whole head of hair stands up puffed and dry — when you touch the hair it is completely dry, no oil at all, sparse. Our hair has oil if we do not wash it for a day; now there is no oil left, it all stands up puffed, and the qi has fallen away. Because the hair is the very topmost place of yang qi; when the whole yang qi falls away, it is roughly the next day — if you see it today, he may die tomorrow, very fast. Generally, once the complexion has shed, death comes within one hundred days.
Luster gone, hair dry and puffed — yang qi shed at the top; this is the danger sign of “when the face sheds, it is finished within one hundred days.” Doctor Ni says, when it is fast, the person is gone the very next day.
Pulse short, qi exhausted, death: yin and yang have turned upside down
Next, the pulse. Here the short pulse is discussed — cun, guan and chi:
💬 Note from Doctor Ni: The cun pulse is one cun, and this is nine fen. The meaning of a short pulse (duan mai) is that the pulse is very short, only a little, unable to be that long; exceeding this is what is called a long pulse (chang mai). The yang pulse must always be longer, the yin pulse must always be shorter. In form, the yang pulse is nine fen — when you touch it, the yang pulse is comparatively floating, the qi comparatively long; the yin pulse has a longer form, but when you touch the surface of the skin, press down a little and you cannot feel the pulse — the qi is comparatively short. This is the normal pulse. If today the pulse, on heavy pressure, is found to have the yang pulse very short below while the yin pulse floats up — the yang pulse should float on top, with the guan in the middle; when you touch it the form is correct; now it is reversed and slanted, the yin pulse floats up and the yang pulse sinks down — this is yin and yang reversed (yin yang fan ni) — the qi is exhausted.
“Pulse short, qi exhausted, death” — when the positions of yin and yang are inverted, the qi is finished. Doctor Ni uses the normal structure of “yang floating, yin sinking” to infer, by contrast, what is abnormal.
Warming disease with extreme deficiency dies: scorching thirst without drinking
💬 Note from Doctor Ni: “Warming disease with extreme deficiency dies” (bing wen xu shen si). Wen — the patient’s symptoms are scorching heat and thirst. But the patient is scorching and thirsty, and he does not want to drink water — “I am scorching and thirsty right now, naturally I would go drink water”; he is very thirsty from disease, yet he does not drink. This symptom is entirely an inconsistent phenomenon — pulse and symptoms do not match.
Thirsty yet not drinking, scorching yet without sweat — symptoms contradicting the natural physiology of the body — that is the bad omen of “extreme deficiency.” Doctor Ni says, simply summarized, this phenomenon is “pulse and symptoms not corresponding.”
Pulse and symptoms corresponding are easy to treat; not corresponding is a death sign
Doctor Ni condenses this whole section on pulse diagnosis into one easy-to-remember yardstick:
💬 Note from Doctor Ni: If pulse and symptoms correspond — for example, when we feel the pulse and it is floating on the surface of the skin, and the patient tells you of skin pain, neck pain stiff as a wall (xiang qiang), shoulder pain — all exterior symptoms; pulse and symptoms correspond, all easy to treat. Those whose pulse and symptoms do not correspond are harder: the patient’s pulse, felt clearly, is very deep, yet exterior symptoms appear; or the patient has a very floating pulse, a very big pulse, on the floating surface — you touch a floating pulse, so big, and you ask him: “Do you have a cold or a fever?” He says no. That is the yang qi, the yang of the internal organs, floating outward. When we feel a true visceral pulse (zhen zang mai) — whether it is the liver pulse, heart pulse, spleen pulse, lung pulse or kidney pulse, whether it is a yin pulse or a floating pulse — they are all floating, big and surging, the pulse beating very fast and very large. You say this is the pulse of an exterior pattern? No — pulse and symptoms do not correspond. If it were an exterior pulse, the patient would surely have exterior symptoms: the exterior pathogen on the skin — some have itchy skin, skin pain, muscle and joint pain, fever, stiff neck, rigid neck, headache. If pulse and symptoms do not correspond, all are death signs, very dangerous conditions.
A floating pulse should have exterior symptoms; a deep pulse should have interior symptoms — when pulse and symptoms do not match, Doctor Ni says, this is the most dangerous situation. A true visceral pulse, floating, big and surging, with no exterior symptoms at all, is the signal that the yang of the internal organs is leaking outward.
Facial diagnosis for men and women: exactly opposite
“The complexion appears above, below, left and right, each in its essential place: upward is contrary (ni), downward is following (cong).” Where the complexion of the face moves — auspicious or inauspicious — Doctor Ni explains it this way:
💬 Note from Doctor Ni: The reason the liver, heart, spleen, lung and kidney have their fixed positions is that spring, summer, autumn and winter, east, south, west and north fix them. Taking the whole complexion of the face by the stomach qi (wei qi): if the direction of the stomach qi is from below going up — for example, you see the color of the heart moving upward, the color of the spleen moving upward, the color of the kidney originally here, the black qi moving upward, spreading wider and wider — when it spreads upward, this is inauspicious. Because the head is the extreme of yang; yang does not exceed the head; at the extreme, yang generates yin (yang ji sheng yin), so the head, the face, the body are cool, and the normal qi descends. For it to move upward is contrary qi, and it represents inauspiciousness. So when the morbid color develops from above downward, that is benign — the disease retreating, easier and easier to treat. And women and men are exactly opposite: for a man, left is contrary and right is following; for a woman, right is contrary and left is following — men and women are exactly one positive, one negative.
The head is the extreme of yang; normal qi descends. For the complexion to rush upward against the current is inauspicious. Left for men, right for women — each yin and yang in its own place. In the art of reading the complexion, Doctor Ni explains it all plainly.
Closing: kui du and qi heng — one great luopan of yin-yang balance
Having finished all this, Doctor Ni gathers the theme of kui du and qi heng into a single sentence:
💬 Note from Doctor Ni: What this chapter speaks of is mainly the yin-yang balance of heaven and earth. We have twenty-four solar terms, divided into twelve months; on the human body there are twelve channels, and the twelve channels correspond to the twelve months. Traveling from spring, summer, autumn and winter all the way — growth, harvest, storage — it cycles forever; only when there is the balance of yin and yang is there the phenomenon of cycling. When it reaches the extreme — for example, at the winter solstice, at the extreme of yin, yang begins to be generated, and then it turns back and goes again. So yin and yang themselves keep cycling, forming one great circle (da zhou tian), as if there were a universe. When we look at the luo jing (compass), opening it to see the heavenly stars of tian gang, the earthly branches and the stems and branches in the luopan, there are three hundred sixty degrees turning — in fact we are looking for its yin-yang balance, and it is the same on the human body.
Finally he gives a small clinical example that puts “the complexion descending = the direction is right” into practice:
💬 Note from Doctor Ni: The head and face are themselves yang; when yang reaches its peak it generates yin and descends — this is normal. For a person’s complexion to move from below upward is reversed — reversed means inauspicious. Look: a patient comes to you with kidney disease. At first his lower part is black — water conquers fire, so in the position of fire, how do you see the color of water? The color of water is black. You treat him for a week; a week later the nose turns black — oh no, this means your direction is wrong. Conversely, a person comes to you with the whole face black; when you begin treating him, the black qi on the head slowly recedes, slowly retreats downward, retreating to the chin, where it is black — that means your direction is right.
Black qi spreading upward is inauspicious; black qi retreating downward is auspicious — whether the direction of your treatment is right or wrong, you can tell by where the complexion moves. A face is a luopan; kui du and qi heng measure the shallowness and depth of disease and seek the balance of yin and yang.
Based on Doctor Ni Haixia’s Ren Ji (Human Records) lecture series on the Huang Di Nei Jing (Nineteenth lecture)