Winter Joint Pain and Spring Sneezing — Which Organ Should You Treat? Doctor Luo Dalun Presents Doctor Ni Haixia’s Twenty-Fifth Lecture on the Huang Di Nei Jing: Seasonal Diseases and the Secrets of Pulse Diagnosis

Patient search terms: winter joint pain / a disease that flares up every season / pollen-allergy sneezing / suddenly fainting with no cause found / blood in the stool / fear of wind / reading the pulse to find disease / how to tell a new illness from an old one / can I shower in cold water after an injury / is a thin pulse a disease

Corresponding medical names: Su Wen · Mai Yao Jing Wei Lun (On the Essentials of the Pulse) · dong shang yu han, chun bi wen bing (injured by cold in winter, warm disease in spring) · si shi zhi bing yi qi sheng zhi zhi (treat seasonal disease with the element that conquers it) · earth conquers water to treat winter disease · metal conquers wood to treat spring disease · the error of nan fang wu shang han (no cold damage in the south) · distinguishing chronic and new disease by complexion and pulse (se bu duo zhe, xin bing ye) · liver and kidney pulses arriving together · hui shang bu jian xue (injury and damage without visible blood, internal injury) · external and internal injury forbid cold water · chi nei liang pang ze ji xie (beside the inner chi, the floating ribs) · the cun, guan and chi positions facing the chest and diaphragm · re zhong (heat in the middle: coarse pulse, yin insufficiency, yang excess) · lai ji qu xu, shang shi xia xu, dian ji (fast in, slow out, excess above and deficiency below, head disease) · xiong yang bu zu e feng (chest yang insufficiency with fear of wind) · zhong e feng zhe, yang qi shou ye (those struck by evil wind have their yang qi damaged) · shao yin jue (lesser yin reversal: deep, thin, rapid pulse) · fu gu mai (bone-buried pulse, accumulation inside) · kidney disease: thin, deep pulse at the bone · floating and scattered pulse, yang floating upward, dizziness and fainting · zao mai (dry pulse, seven beats per breath) · all thin and deep pulses are yin, with bone pain · shu dong yi dai (rapid with an occasional changed beat), disease in the yang pulses, diarrhea and pus-blood stools · blood leaving its channels (li jing pan dao) · one sheng of blood, one viscus knotted · se mai (choppy pulse, yang excess) · hua mai (slippery pulse, yin excess) · looking, listening, asking, feeling — divine, sage, artisan, clever (shen sheng gong qiao) · the pulse follows the emotions · the dawn pulse (ping dan mai) · she mai qu zheng (discard the pulse, rely on the signs) · the law of yin and yang (yang rises, yin descends) · the tonify-earth school and the nourish-yin school · classical formulas: when yang is consolidated, yin returns on its own · gui men (ghost gate) and xuan fu (mysterious mansion) · yang excess brings heat without sweat · yin excess brings much sweat with cold · both in excess: no sweat and cold · tui er wai zhi: accumulation in the heart and abdomen · tui er nei zhi: the body has heat · tui er shang zhi: cold waist and feet · Doctor Zhang Zhongjing read this and could write his formulas

Opening: injured by cold in winter, warm disease in spring — and a knock at the saying that there is no cold damage in the south

This lecture, Doctor Ni opens by settling the account left from the previous one: if you are injured by cold in winter, you will suffer a warm disease in spring.

💬 Note from Doctor Ni: I told you before: dong shang yu han, chun bi wen bing — injured by cold in winter, warm disease in spring. So warm disease exists because you were injured by cold in the winter of the year before. If you were not injured by cold in winter, you will not get a warm disease the following spring. I do not know how these people read their books — even if the Huang Di Nei Jing is a broken and fragmentary text, you should not mislead people to this degree.

Then he calls out a widely repeated saying directly:

💬 Note from Doctor Ni: Some mediocre doctors say, nan fang wu shang han — there is no cold damage in the south. What does that even mean? It is all wrong, completely without basis. Do not listen to it.

So how do you treat this kind of cold disease? The Yellow Emperor asks: zi zhi nai he — what should I do about it myself? The answer: a disease of the season is treated by the element that conquers it.

💬 Note from Doctor Ni: What does yi qi sheng zhi zhi mean? Let me give you an example and you will understand. Say a person has joint pain, arthritis — it hurts badly when it flares up, and is fine the rest of the time, but it always comes in winter — the knee flares up. This is what the classics call a four-season disease: no pain in spring, summer, autumn or winter, only aching in winter. Then we treat with the conquering element: winter is water. What conquers water? Earth conquers water. So we must strengthen earth, treat the earth, and only then will the disease get well. That is how you treat disease according to the season.

Spring pollen-allergy sneezing: why treat the lung?

Winter has its winter disease, and spring has its spring disease — many people flare up right on schedule every spring:

💬 Note from Doctor Ni: Some people sneeze and catch cold every spring, without fail. What is spring? Wood. What conquers wood? Metal. So to treat the sneezing caused by pollen, you treat the lung — how could you only treat the nose? You see what I mean — of course it never gets well that way.

Doctor Ni speaks from his own experience in North America:

💬 Note from Doctor Ni: Western medicine says, oh, the pollen, you are allergic, you are sensitive — pollen, trees, grass, dust and so on. Then why does it not happen to me? When I go to North America in spring, the ground is covered with pollen. The trees are so bad that if you leave your car out, the next morning the car is covered with pollen. The people there sneeze and their whole skin itches. Why am I not allergic? Western medicine does not know what you are allergic to, let alone why I am not. A good doctor should investigate: with the same pollen, what is different between you and me? Find the difference and fix it. Not — you are all allergic, so take antihistamines. That is not how it is done.

That leads him to a broader reflection:

💬 Note from Doctor Ni: The more you read the Huang Di Nei Jing, the more you realize the more Chinese medicine understands and the dumber Western medicine looks. The trouble now is that the finest minds are all inside Western medicine — very capable, very kind-hearted, genuinely wanting to save people — and once they go in, they find they cannot get out. That is the four-season disease and treating it with the conquering element — understand it yourself and you can heal it yourself.

New disease or old trouble? Read the face

Next comes the text — page 133 — on distinguishing chronic disease from new disease by complexion and pulse.

💬 Note from Doctor Ni: In a chronic disease, all five organs stir, and both complexion and pulse are damaged. How do you know whether it is chronic or new? Qi Bo says: qi mai xiao, se bu duo zhe, xin bing ye — if the pulse is small and the complexion is not yet taken, it is a new disease. In simple terms, go back to complexion and pulse: in a disease just contracted, the color has not changed; if the disease stays in the body and does not leave, only after a long time does the color change. That is the great principle — se bu duo zhe, xin bing ye: when the color is not taken, it is a new disease, and the pulse of a new disease is comparatively small.

💬 Note from Doctor Ni: If the pulse is not taken but the complexion is taken — the pulse unchanged, the color changed — that is a chronic disease. If both complexion and pulse are taken, that too is chronic. If neither the pulse nor the five colors is taken, it is new. The five colors are green, red, yellow, white and black.

Next, the passage on the liver and kidney pulses arriving together:

💬 Note from Doctor Ni: The liver and kidney pulses arriving together — mai bing zhi means: when we take the pulse, the normal liver pulse should be wiry, and the kidney pulse sits a little shallower. When you touch guan and chi, the guan rides a bit higher and the chi sinks a bit lower. So-called arriving together means the two pulses are at the same height, the same size, and both strong — that is arriving together. Look at the complexion: green and red — when the disease hui shang bu jian xue, injures without visible blood, it means there is internal injury inside the body, an injury to an internal organ that cannot be seen from outside.

Injured? Never wash in cold water

Having discussed internal injury, Doctor Ni inserts a very practical piece of everyday advice:

💬 Note from Doctor Ni: When we are injured — external injury or internal injury — washing in cold water is absolutely taboo. Cold water, whether the injury is external or internal — absolutely do not wash in cold water. Take a hot shower. Best of all, do not bathe at all — because when you bathe, wind blows on you, and there is an injury inside. Wipe the body with a hot towel instead. Never wash in cold water: once you do, there is stasis blood in the injured part, and then you add cold on top of it — ah, that is far worse, and far harder to clear.

Before reading the pulse, look at one picture: the cun, guan and chi positions face your chest

Doctor Ni says this whole passage is really just one picture — the position chart of cun, guan and chi:

💬 Note from Doctor Ni: Chi nei liang pang, ze ji xie ye — beside the inner chi lies the floating ribs. The outer chi examines the kidney, the inner chi examines the abdomen. The upper left, outer edge examines the liver, the inner edge the diaphragm; the right outer edge examines the stomach, the inner edge the spleen; the upper right, outer edge examines the lung, the inner edge the chest. I have put this chart up — the cun, guan and chi positions face the chest and diaphragm exactly. Always remember, when you take a pulse, hold a picture in your mind: above the diaphragm, the heart and the lung are on top — that is yang. Below the diaphragm, the spleen, liver and kidney are all there, and the stomach sits in the middle. Look at it top and bottom and you know. With this chart, you have a basis for pushing up and down along the pulse: if the pulse runs all the way up past the wrist toward the thenar eminence, the disease is running upward, reaching the throat, higher and higher; if the disease goes down, the pulse, which normally runs one cun from guan to chi, grows very long and keeps descending — then the disease reaches the feet, from the knees to the feet. And so on.

A big, coarse pulse is heat in the middle; fast in, slow out — that is a head matter

Page 135 begins with the coarse, large pulse:

💬 Note from Doctor Ni: All three positions jump together, jumping high and big — that character reads cu (coarse). Cu da zhe, yin bu zu ye, yang you yu, wei re zhong: a coarse, big pulse — yin insufficient, yang in excess — that is heat in the middle. The pulse form is very large, so large it reaches the surface of the skin, and every position comes in big — as long as it stays within one cun and nine fen of the cun opening, this is re zhong. If it is big above and below, beyond cun and chi, that enters the range of the true-organ pulse. So the definition of re zhong is: yin insufficient, yang in excess.

Then lai ji qu xu — coming fast and leaving slowly:

💬 Note from Doctor Ni: The pulse comes in rather fast and leaves very slowly — fast in, slow out. You press it and it comes in very strong; the moment you release, there is nothing inside. Pressing down and letting go feel completely different — that is lai ji qu xu. The patient has excess above and deficiency below, and that is dian ji — there will be a problem in the head. If the cun pulse is very large, rushing upward while the lower part is normal, that too is a head problem.

People who fear wind have chest yang insufficiency

There is excess above with deficiency below, and its opposite:

💬 Note from Doctor Ni: If, pressing at the middle depth, the pulse becomes very small, and when you release it jumps very fast; the cun pulse is weak and the chi pulse strong — the patient has deficiency above and excess below. That is chest yang insufficiency, and generally it brings e feng, fear of wind. When the upper burner is deficient, the chest governs the lung, and the lung governs chest yang and the skin and pores of the whole body, so the patient is rather afraid of wind. What is e feng? Wind blowing on you is unbearable, you must dodge it, you do not like wind blowing straight at you. You see it a lot in America, rarely in Taiwan — the convertible drivers: the moment they open the car, they cannot stand it, the wind blowing on them is miserable — that is e feng. Or you walk to the seaside; the sea breeze should be delightful and beautiful, right? Not for them — the wind is too strong and miserable. That is e feng. Therefore zhong e feng zhe, yang qi shou ye — those struck by evil wind have their yang qi damaged. And if the pulses are all deep, thin and rapid, that is shao yin jue — lesser yin reversal; you will feel it quite often.

Pressed to the bone and the pulse is still there? That is the bone-buried pulse — something is growing inside

On the depth of the pulse, first the thin, deep pulse:

💬 Note from Doctor Ni: You feel a pulse that is very thin, buried at the bone. When the pulse reaches the bone, remember: the bone governs the kidney. Thin — very small, all the way at the bone — we know it is kidney disease. But there is another special pulse when you press down: the pulse is still there at the bone. Even when you press the finger flat against the bone, the pulse is still there — there is something solid inside. We have a special name for it: fu gu mai, the bone-buried pulse, the pulse that hides beside the bone river. The fu gu mai always means a tumor growing inside, something growing. If you feel the liver pulse and it is still there at the bone when you press down — a tumor in the liver, and you know it at once. So, to keep the pulse simple — if we only distinguish deficiency and excess: the deficient pulse disappears at the middle depth; the excess pulse is still there pressed to the bone. Then distinguish yin and yang, above and below — it is only yin and yang.

A healthy person suddenly faints, and Western medicine finds nothing — one dose, and he had not felt this good in thirty years

The floating and scattered pulse is one Doctor Ni particularly wants to discuss, because he has truly met it in practice:

💬 Note from Doctor Ni: Normal yang should pair with yin. If the pulse floats, it means yin has grown strong and yang has declined; yang scatters, rushes upward, floats up, and this makes a person dizzy, makes him faint. In practice I saw a patient — very amusing. He came and said Western medicine could not find any disease. I said, what are your symptoms? He said: I just pause — nothing is wrong — and I faint. When he faints they examine him, and the moment he wakes up he is perfectly fine. They cannot find the problem.

💬 Note from Doctor Ni: This is yang floating upward. The reason yang floats upward is that yin can no longer hold yang; yin and yang separate, and yang floats up. When we prescribe, once yin and yang balance, the symptom disappears. That patient was forty-eight. After one dose, the next day he said: I have not felt this good since I graduated from high school. You see how many years — thirty years, and not once that good. So remember this kind of dizziness, this fainting — it is yang not being held.

Rapid pulse, dry pulse, moving pulse: how fast it beats, how erratically it beats — all of it has a meaning

Next, the speed of the pulse:

💬 Note from Doctor Ni: The pulse is floating, but not dry. What counts as dry? When you inhale — normally it is two breaths in and two out: one beat on inhale, one on exhale, twice each. Now you inhale and the pulse beats three times, exhale and it beats three times, and then it pauses in the middle — in all, seven beats per breath. That is the zao mai, the dry pulse. If the pulse is floating but not dry, it is a yang disease, all heat; if it is dry, the disease is in the hands. All thin and deep pulses are yin, and they bring bone pain; if the pulse is still — comparatively slow — the disease is in the feet. The hands are yang, the feet yin. There is also a moving pulse: the pulse beats steadily and evenly, then suddenly one beat changes — it does not necessarily stop, not like the knotted pulse; it just changes slightly, beating a little faster or a little slower for one beat. We call this a pulse of disease in the yang — because when you judge by speed, speed is yang qi. Shu dong yi dai zhe, bing zai yang zhi mai ye, xie ji bian nong xue — a rapid pulse with an occasional changed beat is a pulse of disease in the yang, and it brings diarrhea and pus-blood stools.

Blood in the stool: blood has left its channels and rebelled

Speaking of pus-blood stools, Doctor Ni says he has treated this disease many times:

💬 Note from Doctor Ni: Why is there pus and blood in the stool? In our body, blood has its place — inside the blood vessels. All the organs, the large and small intestines, have blood vessels. When blood comes out in the stool today, the blood has leaked out — whether the arteries are blocked in circulation, or the large intestine is inflamed, or a patient with no cause at all simply passes blood in the stool; and some patients pass blood in the urine. When blood runs out: one sheng of blood, one viscus knotted; two sheng, two viscera knotted; three sheng, three viscera knotted. You will not measure it — this so-called one sheng is the amount of a day: if the blood lost in one day is three sheng, three viscera are knotted.

💬 Note from Doctor Ni: The idea in the middle is this: when blood is returning to its channels, it travels inside the meridians and vessels and should not spill out — that is because yin and yang can unite. When yin and yang fail to unite, the blood leaves its channels and rebels. So-called guarding — usually yang does the guarding, and yin stays inside; when yang can no longer guard, when yang is deficient, yin seeps outward. These two are opposites — just like a married couple: if you spoil your wife too much, she climbs on top of your head; push her back a little, and the two balance out. The Yellow Emperor’s question was too blunt, and Qi Bo said: I already told you — look at that. So yin and yang must not go too far; yang must guard, and it is yang that does the guarding. When yang does not guard, pus-blood stools result.

Choppy pulse and slippery pulse: one is a pipe with no water, the other is water flowing smoothly

After speed, the choppy and slippery pulses — two feels Doctor Ni loves to describe:

💬 Note from Doctor Ni: The se mai (choppy pulse) is the standard yin insufficiency — when yin qi is insufficient, yang qi becomes excessive. The choppy pulse feels unflowing. The speed, the shape, the softness, the strength you feel — that force is the qi; the speed at which you feel the blood flowing inside the vessel — that is the blood. With the choppy pulse you press to the bone and find the pulse turning left and right, sometimes here, sometimes there, never fixed in one place. The same finger pressed down, the left and right pulses feel like a very soft plastic tube in a water pipe — there is water in it but not enough; when you press down, the water sloshes back and forth inside. That is the se mai — qi and blood not circulating enough, the so-called yin insufficiency. The hua mai (slippery pulse) is yin excess. The slippery pulse comes in very fast, and you can feel the qi and blood flowing inside the vessel very powerfully and smoothly. When you feel a slippery pulse, always remember: the cun pulse sits higher, the chi pulse lower — the cun is the yang high pulse, the chi is the yin pulse lower; because of that slope, you can feel the smoothness of the flow. You must hold this baseline: without it, what is normal? How would you know what is abnormal? From now on, imagine the pulse this way and you will be able to feel it.

Looking, listening, asking, feeling: why does feeling the pulse come last? Because the pulse can lie

Speaking of the pulse, Doctor Ni takes a moment to explain the order of the four examinations:

💬 Note from Doctor Ni: The Huang Di Nei Jing states it too: wang er zhi zhi, wei zhi shen — to know by looking is called divine; wen er zhi zhi, wei zhi sheng — to know by listening is called sage; wen er zhi zhi, wei zhi gong — to know by asking is called artisan; qie er zhi zhi, wei zhi qiao — to know by feeling is called clever. Qiao (clever) is listed last, but we cannot say that because it is clever we need not learn it. In clinical practice, after looking, listening and asking, you have a rough picture in your mind, and feeling the pulse confirms whether our diagnosis is right or wrong. Can the pulse deceive? Yes — because it follows the emotions: the patient just had a big fight with his wife before coming to see you; or he got a phone call before the visit — his son was arrested and locked up by the police — and he is boiling with rage; then the pulse is off. The pulse follows the emotions. That is exactly why Qi Bo said the most accurate pulse is taken at dawn, when the person is lying there — but that is impossible, unless it is your son, your husband, your wife, your family, then maybe; otherwise, where in the world is there a doctor that good? So when the pulse disagrees, we discard the pulse and rely on the signs — when looking, listening and asking are all certain, and the pulse contradicts them, discard the pulse and go by the signs.

The law of yin and yang: why does yin come back on its own when you open with yang herbs?

The next passage is the great yin-yang principle Doctor Ni repeats over and over:

💬 Note from Doctor Ni: When yang qi is in excess, there is heat without sweat — yang in excess, yin must be insufficient. The so-called law of yin and yang is the rule between the two: when yang rises, yin descends. If you see a person with very high yin and you want to bring the yin down, use yang — once yang rises, yin naturally descends. On nourishing yin, we have the tonify-earth school and the nourish-yin school, which produced Li Dongyuan and others — when yin is very strong, we bring it down. So when we adjust yin and yang, the prescription we write is yang herbs — yang rises and yin descends. The best state is yin and yang balanced — if you prescribe yin herbs, you will not bring yang down; we prescribe yang herbs to bring the two back into balance. That is why most of what we use is yang herbs; there are also yin-nourishing herbs, used according to the situation, but not much. In Chinese medicine, from the Huang Di Nei Jing and the materia medica to the Shang Han Lun and Jin Gui Yao Lue, we hold one great principle: when yang is consolidated, let yin return on its own — that is the standard of a cure, not forcing the yin up by tonifying. So when a yin organ is sick, it flares up at midnight; when we cure it, he gets hungry at midnight — yin has come back on its own.

The two names of the pores: the ghost gate and the mysterious mansion

Yang excess and yin excess look completely different — and the whole difference is in the pores:

💬 Note from Doctor Ni: Yang excess brings heat without sweat. Because yang is excessive, the skin surface is guarded extremely tightly — too tightly. The pores are the gui men, the ghost gate: locked shut, nothing escapes — fever, but no sweat. When yin qi is excessive, that means yang is insufficient; the pores are the xuan fu, the mysterious mansion: spread wide open, and the patient is soaked in sweat — because yang is insufficient, the patient grows cold, fears cold, fears wind. Chinese medicine uses many names for the pores, because the writing has to be beautiful: some say xuan fu, some say gui men — it does not matter; the pore is the simplest. If both yin and yang are in excess — no sweat, and cold. This is exactly the passage where Doctor Zhang Zhongjing, when he read it back then, could already write out his formulas — wait until we introduce the Shang Han Lun and they will be there.

Three pushing techniques: push outward and it will not move, push inward and it will not go, push upward and it never arrives

The final section is the pushing method of pulse taking — pushing the pulse outward and inward with the fingers:

💬 Note from Doctor Ni: Tui er wai zhi, nei er bu wai — you push the pulse outward, tugging for a long time, and the pulse stays there and will not move: there is accumulation inside, accumulation in the heart and abdomen (xin fu zhi ji). If it is tui er nei zhi — push it inward and the pulse stays outside, will not go in, will not obey you — the body has heat. The next line is tui er shang zhi, shang er bu xia, yao zu qing ye. How to explain it? Take the middle finger as the standard: the middle finger presses the pulse, and as you press, the pulse runs upward, and there is no pulse in the middle; or when you press the middle finger, the upper pulse disappears and the pulse is below. That is what it means — shang er bu xia: the waist and feet are clear and cold. The Nei Jing has another line: tui er xia zhi, xia er bu shang, tou xiang tong ye — push it downward and it will not go down: pain in the head and nape. And so on.

Closing: treat the seasonal disease with the season’s conqueror — the pulse is the ledger the body writes down

This lecture is packed, but the thread is clear. Disease has its seasons: joint pain that flares in winter is a water problem — treat the earth; the pollen sneezing of spring is a wood problem — treat the metal. The pulse has its depths and its strengths: the bone-buried pulse still present at the bone means something is inside; a floating and scattered pulse means yang cannot hold — a person faints; the choppy pulse is a pipe with no water, the slippery pulse is water flowing smoothly. And behind every pulse stands one principle — yin and yang. When yang holds, yin does not seep out, blood does not leave its channels, sweat does not pour at random, and heat does not flare at random. Doctor Ni says that when Doctor Zhang Zhongjing read this passage, the formulas wrote themselves — pulse diagnosis was never mysticism. It is an account plainly written on the cun, guan and chi positions and in the four seasons. Read the Huang Di Nei Jing, and you have read that account.

Based on Doctor Ni Haixia’s Ren Ji (Human Records) lecture series on the Huang Di Nei Jing (Twenty-Fifth lecture)