Coughing Up Blood? Don’t Rush to Stop the Bleeding. And a Ruptured Aorta Is Really a Case of Freezing? Doctor Luo Dalun Presents Doctor Ni Haixia’s Twenty-Eighth Lecture on the Huang Di Nei Jing: The Four-Season Five-Organ Pulses and Five-Element Transmission in the Yu Ji Zhen Zang Lun

Patient search terms: how to regulate excessive heart fire / what to do about coughing or vomiting blood / why does a weak heart get treated through the stomach and intestines / why does an aorta rupture / how Chinese medicine treats uremia / sore back, aching loins, low energy and no spirit / urine that dribbles and will not stop / what are the symptoms of spleen deficiency / what disease is blockage of the nine orifices / what does long summer mean / is a green or black face a sign of illness / why do heart attacks spike in winter / how Chinese medicine reads the face to judge life and death

Corresponding medical names: Su Wen · Yu Ji Zhen Zang Lun (On the True Organ Pulses and the Jade Engine, the nineteenth chapter) · in excess drain the child, in deficiency tonify the mother (Nan Jing, the Classic of Difficult Issues) · the child can make the mother full, the mother can make the child empty · the four-season five-organ pulses (summer hook / autumn floating / winter deep; liver wiry, heart full, spleen relaxed, lung floating, kidney deep) · excess means disease on the outside, deficiency means disease in the middle · creeping sores (jin yin chuang) · the lung faces the hundred vessels / the lung is the canopy · there is no method of stopping blood (warming yang to gather blood) · aortic aneurysm (rupture from interior cold) · shao yin syndrome (a very thin, fine pulse) · uremia (kidney failure: strengthen the liver, warm the kidney, earth controls water, guard the heart against transmission) · the spleen is the solitary organ irrigating the four sides · the spleen governs the four limbs · zhong qiang, double-strength obstruction (blockage of the nine orifices) · spirit turns and does not turn back; turning back means it no longer turns · the five organs receive qi from what they generate and die at what they cannot conquer · five-element generation and conquest in transmission · five-color inspection · the day and night divided into five parts · the twelve earthly branches assigned to the five elements · long summer · the five organs communicate and move in order · when the liver is diseased, first firm the spleen · to distinguish by yang is to know where the disease comes from; to distinguish by yin is to know the time of death or life

Opening: first nail down the great principle — in excess, drain the child; in deficiency, tonify the mother

The previous lecture opened the Yu Ji Zhen Zang Lun and finished with the spring pulse being wiry. In this lecture Doctor Ni first puts the master principle of treatment on the table — it comes from the Nan Jing (Classic of Difficult Issues), and you will use it for the rest of your life in practice:

💬 Note from Doctor Ni: When we treat patients at the bedside, the great principle is — in excess, drain the child; in deficiency, tonify the mother. The child can make the mother full; the mother can make the child empty. This is the great principle of treatment, and it comes from the Nan Jing. The liver channel spreads through the ribs and flanks, and that is where evil heat settles. So when the liver is deficient, the two flanks and chest feel full and uncomfortable, and it can give you chest pain pulling to the back — because the chest is yang, yang dwells in the chest, right? When liver yin is deficient, the chest yang becomes insufficient, and that produces the chest pain pulling to the back.

Why is summer the hook pulse? — One family of five pulses: wiry, full, relaxed, floating, deep

The Yellow Emperor asks: the summer pulse is like a hook — in what way? Qi Bo answers: the summer pulse presides over the southern fire. In the world, the south is hot, all things grow very large, so its qi comes vigorous and leaves declining — therefore it is called a hook. Doctor Ni then strings together the five pulses of the five organs in one pass:

💬 Note from Doctor Ni: Actually, when we talk about the hook pulse, we are talking about the pulse we call the full, surging pulse. The five organs match five pulses: the liver is the wiry pulse, the heart is the full pulse, the spleen is the relaxed pulse, the lung is the floating pulse, the kidney is the deep pulse — wiry, full, relaxed, floating, deep; these five pulses are counterparts. Here he does not use the word “full”; he uses the word “hook” to describe it, but it is really the same thing. Turn it around, and the person is sick.

So what does “turned around” mean? The Yellow Emperor asks: if the qi comes vigorous and leaves vigorous too, is that turned around? Doctor Ni explains it in plain language:

💬 Note from Doctor Ni: If the heart pulse is full, but it comes fast and leaves fast, with great speed, that is excess — the disease is on the outside. If the qi comes without vigor, not hurried, and the pulse is comparatively weak and faint, the disease is in the middle. What we call excess — for example, we have said that any pulse of the heart must carry stomach qi. You know stomach qi: the pulse is full, but it beats five times per breath. Now it comes beating six or seven times — that is excess. Excess means exactly this.

What happens when heart fire is too strong? — Hot body, painful skin, skin that festers and swells

What are the symptoms when the summer pulse is in excess or in deficiency?

💬 Note from Doctor Ni: If the heart pulse is in excess, the heart too much, it makes the person’s body hot, with abdominal pain, and the skin hurts. Why? Because the inside is very hot, so it feels as if fire is burning inside the skin — the skin burns from the inside out. This kind of skin pain is extremely severe, and it becomes creeping sores (jin yin chuang) — at this point the skin easily festers and swells red. If it is not hurried (deficient), it makes the person vexed in the mind, with coughing and spitting above, and qi leaking below.

When the heart is weak, why treat the stomach and intestines?

The treatment in this passage, Doctor Ni explains with a stroke of genius — to treat heart disease, he prescribes medicines for the stomach and intestines:

💬 Note from Doctor Ni: In excess, we speak of the mother being able to make the child empty, so when we treat the liver, we can bring down a heart that is too full, too hot and too blazing. If it is deficiency, we call it the child making the mother full — when a person’s heart is weak, you see vexation of the mind, sometimes coughing and spitting, spitting saliva, coughing up a lot of phlegm and water; below, qi leaking; some people also have diarrhea or bleeding — blood in the stool. When heart qi is insufficient, we treat the stomach and intestines. When the stomach and intestines are regulated, the heart gets better. So sometimes the medicines we prescribe for heart disease are fundamentally medicines for the stomach and intestines — because the heart is deficient.

Why is autumn the floating pulse? — When the killing qi arrives, all the leaves change color

Around page 153, it explains why the autumn pulse floats. The lung matches the autumn pulse; in the west, metal, all things are gathered in:

💬 Note from Doctor Ni: Because all things are gathered in, its qi is light, empty and floating; it comes hurried and leaves scattered. What “floating” really describes is the killing, the gathering-in — because the lung governs the skin and body hair, so it is at the pores of the skin surface. When autumn qi arrives, all the leaves change color at once. In Taipei you do not see much of it; you have to go to the mountains. In North America it is truly beautiful — overnight, in an instant, you get up in the morning and everything is golden yellow and red; the red is really gorgeous!

For the normal and excessive conditions of the downy feather pulse, Doctor Ni uses a feather as the image:

💬 Note from Doctor Ni: The downy feather pulse is solid in the center and empty on both sides — look at a feather: the hard shaft in the middle feels very firm and solid, while the two sides are empty. That is excess, and the disease of excess is on the outside — for example, the nose, the skin, the exterior. If the qi comes feathery and faint — a very slight pulse — that is deficiency, the disease is in the middle, in the viscera of the body.

The symptoms of the autumn pulse in excess and deficiency:

💬 Note from Doctor Ni: In excess it makes the person’s qi rebellious with back pain, yun yun ran — a general malaise. Why back pain? Because the back is where yang qi dwells. The lung itself is the meeting of the yang of the middle; the lung presides over the canopy image, and can communicate with the hundred vessels. When yang is excessive it causes back pain. Yun yun ran means the person is uncomfortable and wants to vomit — because in a normal person the lung qi must purify and descend, go downward, pressing the qi down normally; when yang is excessive, yang rushes upward, so of course there is discomfort, a desire to vomit, and back pain. If the lung qi is deficient and the pulse comparatively weak, when the lung qi is not enough the patient shows wheezing, breathing with shortage of qi, and coughing; above, qi appears with blood; below, the sound of illness is heard — meaning the cough brings blood out.

There is no method of stopping blood! — Coughing or vomiting blood: do not rush to stop it

Coming to coughing blood, Doctor Ni pauses to explain the Chinese medical view of blood — this is an iron rule at the bedside:

💬 Note from Doctor Ni: What does Chinese medicine call a normal person? When yang can move and can guard, blood returns to its channels and does not flow backward in the vessels; if yang does not guard, blood rebels. So yang must be present. Now the lung yang is deficient — yang deficient — of course the vessels inside the lung have no yang guarding them; they have no strength, so at one cough they rupture and blood comes out. When you see coughing of blood or vomiting of blood, very often it is deficiency. In the Chinese medical view, there is no method of stopping blood — do not think about stopping the bleeding; you do not need to. Once you bring the yang back, the blood stops naturally. So when there is bleeding, the last thing to do is stop the bleeding — especially internal bleeding. We bring the yang back and the blood stops.

A ruptured aorta — is it “frozen” apart? The story of the water pipe bursting in winter

Next Doctor Ni tells a real clinical story — what Western medicine regards as major surgery, for him becomes a lesson in cold:

💬 Note from Doctor Ni: There is a patient now — in the abdomen, the abdominal cavity — Western medicine says the aorta suddenly ruptured. After it ruptured, the blood clotted into a big air-bubble-like mass, and the peritoneum wrapped around it. For Western medicine this is major surgery, and it occurs mostly in people between about fifty-five and sixty. Once it bursts, the Western doctor says the patient must not move — they have to wait for the whole team. Say it happens to you and you are taken to Ren’ai Hospital; Ren’ai is a second-level hospital, not a first-level hospital. Only the doctor there can perform the surgery, but the patient cannot be moved, so they must bring a surgeon from another hospital — two hospitals perform the surgery together, because if it expands any further, it is terrible; the person dies. Western medicine cuts the vessel out and replaces it with a plastic blood vessel. The patient learns that the vessel in the middle of his body has ruptured, and he is scared to death — he dares not lean forward, dares not lean back, afraid that it will tear open further. Why did it rupture? Why does it rupture? Western medicine does not know. Cold! In the north in winter, if you use the water pipe at night and forget to drain the water out, by the next morning the pipe is burst, and you have to buy a new one — only cold makes a water pipe burst. So you must remove the interior cold. We have many medicines that remove interior cold, medicines that can make the inside warm. You say, teacher, once it is warm more blood will flow in — on the contrary, that stops the bleeding. That is the idea of warming yang to stop blood. Oh — if there is bleeding and you use cold, cooling medicines to stop it, you are wrong; you will never stop it that way.

Why is winter the deep pulse? — A kidney pulse like flicking a stone is excess; a thread-fine pulse is deficiency

Around page 155, it discusses the winter pulse being like a deep, sinking (ying) pulse:

💬 Note from Doctor Ni: The reason the winter pulse is deep is that the kidney governs it. The kidney presides over the northern water — the place where all things are stored — so the qi comes sinking and striking: “striking” means forceful, sinking right by the bone, but very forceful — four or five beats per breath, very strong. Forceful is fine, but it must not be like stone; like stone is no good, too hard. If it becomes a diseased pulse — we only need the middle to be normal; excess and deficiency are both disease. In excess, the qi comes like flicking a stone, and the disease is on the outside; if it comes rapid in count, the disease is in the middle — the pulse is extremely thin and fine. This is called shao yin syndrome. Later, when I introduce Zhang Zhongjing, I will speak of the shao yin syndrome: the pulse is extremely thin and fine, and the patient really has that pulse — extremely thin and fine.

Speaking of feeling the pulse, Doctor Ni suddenly pokes fun at himself, and incidentally teaches a lesson about being a doctor:

💬 Note from Doctor Ni: Sometimes when I see a patient I cannot be bothered to talk much. With many patients I just feel the pulse, and by the time the prescription is written the patient has not yet spoken, and I say, “I haven’t talked with you yet.” But in fact you still have to let the patient finish talking — otherwise he thinks you do not understand what is wrong with him. So a doctor must have patience. That is why I am not suited to be a doctor — do not scold me for saying so (laughs).

The kidney pulse in excess and deficiency — that string of deficiency symptoms is uremia

💬 Note from Doctor Ni: A kidney pulse in excess makes the person jie yi — weary, without strength, always feeling fatigued. The spine is painful, qi is short, and the person does not want to speak — the whole spine aches severely, and the patient does not like talking. In deficiency, it makes the heart hang as if hungry — the heart hangs there, the person feels hungry, as if the heart were empty and suspended in the air, like a hungry feeling, yet not really hunger; the loins feel cold, the spine aches, the lower abdomen is full, and urination is dribbling and obstructed.

Doctor Ni points out the modern name for those deficiency symptoms:

💬 Note from Doctor Ni: This coldness of the loins and spine, bone pain, distension of the lower abdomen, urination that dribbles without stopping — what this describes is uremia; the kidney has failed, and the modern term is uremia. With uremia, what do we do? The child can make the mother full — so we strengthen the liver; strengthening the liver is making the child fill the mother. Of course this is a great principle; you can also prescribe medicines that warm the kidney — that is essential. “The child makes the mother full” is only one move; it does not mean the job is done with that one move — the strength of that medicine alone is not enough. We must also use earth to control water — the spleen earth controls the kidney water. And we must also fear the kidney water going on to conquer the heart — after kidney failure, heart failure follows; you still have to guard the heart first. Things like this — that is the principle.

The spleen pulse: the solitary organ irrigating the four sides — the relaxed pulse is the spleen pulse; a normal person cannot feel it

Around page 157, the spleen pulse. The pulses of spring, summer, autumn and winter have all been discussed; only the spleen pulse is special:

💬 Note from Doctor Ni: The spleen pulse is earth; it is the solitary organ irrigating the four sides — the spleen is the central earth, the center of the four organs, so it can pour stomach qi into all the other four. In a normal person you cannot feel the spleen; it exists everywhere. When you feel a relaxed pulse, that relaxed pulse is the spleen; when there is stomach qi, that is the spleen pulse. In a normal person it is invisible; you only see it when the person is sick. The Chinese language is wonderful — “only bad people can be seen”: bad people never have good luck, right? It is the same — you only see it when the person is sick.

How does one feel the diseased spleen pulse? The Yellow Emperor asks what counts as disease:

💬 Note from Doctor Ni: If its coming is like water flowing — that is excess, the disease on the outside. If it comes like a bird pecking — that is deficiency, the disease in the middle. This one is rather elusive; you have to grasp it by intuition.

The spleen governs the four limbs and the lower abdomen — in deficiency the nine orifices are blocked, called zhong qiang

The Yellow Emperor asks: the spleen is the solitary organ, central earth irrigating the four sides — what are the diseases of excess and deficiency? Doctor Ni says that from this one sentence alone you can already know:

💬 Note from Doctor Ni: The spleen governs the four limbs. The spleen also governs the lower abdomen — everything in the belly is managed by the spleen. The spleen stands in the center irrigating the four sides. In excess and deficiency: in excess it makes the four limbs unable to lift — you see, the spleen governs the four limbs. In deficiency it makes the nine orifices blocked, called zhong qiang. The spleen is the organ in the middle; when the nine orifices are blocked — for example, urine and stool are obstructed, the patient’s voice also fails — because the spleen manages the five organs; all the other organs are affected, and the functions of urination and defecation become blocked and closed. The meaning of zhong qiang is very interesting. Write the character zhong: our basic idea — the liver, spleen, lung and so on are arranged in their places, and we usually put the spleen off to one side; but the position it should truly occupy is the center; the spleen is the center. The five organs support each other in harmony — that is normal; they pull on each other and check each other, and only then can they live in peace. If the spleen becomes deficient, all four organs press down together — because the spleen is earth; it is like a dam: when it is about to collapse suddenly, all four organs press down together, and this makes the nine orifices blocked. Zhong qiang — several layers of pressure added together: that is zhong qiang.

Spirit turns and does not turn back; turning back means it no longer turns — the five elements only move forward, never backward

Around page 159, the Yellow Emperor is delighted and speaks a very important sentence. Doctor Ni says this is the definition of the five elements:

💬 Note from Doctor Ni: “The ultimate numbers of heaven, the transformations of the five colors and pulses, the strange constants and the measuring rod — the Way lies in the One. Spirit turns and does not turn back; turning back means it no longer turns, and the opportunity is lost.” This sentence is very important. Wood generates fire, fire generates earth, earth generates metal, metal generates water — generation continues all around this cycle. The direction of the cycle: through your whole life, growth and harvest, you keep producing new things and keep metabolizing the old away; this cycle keeps moving in one direction, unceasing, never stopping — it not only cannot stop, it cannot turn back. For example, how old am I now? I am fifty. To turn back to twenty is impossible — you can wear twenty-year-old clothes, but you are still this old man, right? It cannot be changed. So we humans only move forward, never backward. If it goes against this, problems arise. Therefore the Way lies in the One: spirit turns and does not turn back; turning back means it no longer turns — once something turns back and stops, it affects the other problems.

The qi of the five organs dies at what it cannot conquer — the heart’s greatest fear is water

Around page 160, it discusses the rebellious movement of qi — this is the key to judging transmission and life and death:

💬 Note from Doctor Ni: “The five organs receive qi from what they generate, transmit it to what they conquer, lodge qi in what they generate, and die at what they cannot conquer. When disease approaches death, it must first transmit, and when it reaches what the organ cannot conquer, the disease is fatal.” What does this mean? Very simple: it is called going against. For example, the heart is fire; fire generates earth, earth generates metal — that is the constant, the normal person. If the heart fire turns back and reverses to the liver, going backward against the direction, and finally returns to the kidney — the kidney itself is water, and water conquers fire — so when the heart has a problem, the moment it meets water is the most dangerous moment, because its qi is moving rebelliously. So if it reverses to the liver and comes back here, we know the next step is the kidney.

The five-color inspection comes from this cycle:

💬 Note from Doctor Ni: The liver is blue-green, the spleen yellow, the lung white, the kidney black. Someone comes to you for treatment, and his face is blue-green. As you treat him it slowly turns red, then red turns yellow, slowly, slowly it moves, between yellow and white — that kind of change is recovery. But instead, after you treat him the blue-green stays, and a week later it turns black, and another week later white, and he dies — why? Metal conquers wood; the lung conquers the liver. This is inspection — colors must not walk backward. Every year, the four seasons move forward; if you go against them, it will not work. So in winter I do not see many ruddy, glowing faces here in the south — very good; the moment you see a ruddy, glowing face, there is a problem; keep an eye on it.

The heart dies at what it cannot conquer, which is the kidney — in winter, most heart disease deaths occur:

💬 Note from Doctor Ni: It dies at what it cannot conquer — what the heart cannot conquer is the kidney. In winter, the most heart-attack deaths occur. So “when disease approaches death, it must first transmit to what it cannot conquer, and then the disease is fatal” — this speaks of the rebellious movement of qi; that is all it means. You see many words, but this is the meaning. The liver receives qi from the heart and transmits it to the spleen — that is the normal course. But if the qi reverses, lodges in the kidney, and then reverses to the lung — the lung is metal; metal conquers wood, the liver’s wood — that is death. The heart receives qi from the spleen and transmits it to the lung; wood generates fire, fire generates earth, earth generates metal. If the moving qi reverses, shoots back to the liver, and then transmits to the kidney, death follows — water and fire cannot tolerate each other. The spleen receives qi from the lung and transmits it to the kidney; if the spleen’s qi reverses back into the heart, and then returns to the liver — wood conquers earth — that is death.

The day and night divided into five parts — the twelve earthly branches assigned to the five elements, and what long summer really is

This passage ends with “the day and night divided into five parts — this is how one divines whether death comes early or late.” Twelve hours in a day — how do you divide them into five parts? Doctor Ni draws a diagram:

💬 Note from Doctor Ni: Some people hate seeing the stems and branches when they study Chinese medicine, but there is no way around it; I still have to give you a view of the stems and branches. The twelve earthly branches: yin-mao, chen-si-wu-wei, shen-you, xu-hai-zi-chou — yin-mao is wood, si-wu is fire, shen-you is metal, hai-zi is water, and the four characters chen, xu, chou, wei are earth, presiding over the four seasons. So chen, xu, chou and wei sit between the four seasons, right? The branches are also divided this way; the twelve hours of the day match the movement of earth qi like this. Why must you know this for life and death — you must have this concept. That is the branches. The heavenly stems are simpler: jia-yi, bing-ding, wu-ji, geng-xin, ren-gui — wood, fire, earth, metal, water. The stems carry the five elements; the branches are what we use to count the twelve hours. Divide the twelve branches into five parts: wood, fire, earth, metal, water — one part, two parts, three parts, four parts, five parts.

At this point Doctor Ni also settles the “long summer” (chang xia) that Chinese medicine has argued about for centuries:

💬 Note from Doctor Ni: I often say that many people in Chinese medicine used to argue over what long summer means — actually, whenever two solar terms hand over, that is one “summer.” Because the spleen sits in the middle, it can control the four organs; the four organs do not quarrel, so at every handover of work between organs, the spleen must step in for one summer. When spring is changing into summer, the spleen in the middle comes in, eases the transition, and then it becomes deep summer — spring cannot jump straight to summer; then the solar terms would not go smoothly. This will be introduced later; for now, just a mention. It says that a person with a history of heart disease — morning, noon, evening, night — when he dies, the time of death is all there; the Huang Di Nei Jing discusses it in great detail.

When the liver is diseased, first firm the spleen — block the conquering transmission halfway

Around page 161, the Yellow Emperor says: the five organs communicate, and their movements all have their order. When the five organs are diseased, each transmits to what it conquers. If untreated — in three months or six months, in three days or six days, it transmits through the five organs and death comes. Doctor Ni turns this system of conquering transmission into a road map of life and death:

💬 Note from Doctor Ni: In a normal person, generation runs this way. In disease, conquering runs: the liver conquers the spleen, the spleen conquers the kidney (earth conquers water), water conquers fire, fire conquers metal, and metal turns back to conquer the liver — and then the person dies. When conquering appears, if the liver has a problem, we first treat and firm the spleen — at that point the disease stops transmitting. Why? Because of the five-element conquering relationship. If the spleen was too late to hold the line — by the time we see the patient, the spleen has already been destroyed by the liver — then we have to treat what the liver conquers. If it has already reached the kidney, there is no way out; we hurry to strengthen the heart. When the heart, with its last breath, happens to meet us, that is very tiring — four organs are gone and only one is left. At that point you have only one chance; the prescription gets one chance. Miss it, and a life is lost. So patients must come earlier — since you trust me now, why did you not trust me at the beginning? When the disease starts is the time to treat it; cure it then and it is very simple.

Finally, the pulse-method formula that closes the whole passage:

💬 Note from Doctor Ni: “To distinguish by yang is to know where the disease comes from” — when we examine the changes of yang qi, we can know from where the disease arises. “To distinguish by yin is to know the time of death or life” — when we examine the changes of yin qi, we can know when death comes and when life is preserved. Because we know the time at which his internal organs’ disease will be conquered, we know when he will have trouble and when he will pass away — that is the conquering relationship. As for transmission, as said before: some people have three months, some six months, some three days, some six days — all different; later it will be subdivided gradually. That is how the Huang Di Nei Jing works: first it gives you the great principles, and then gradually it gives you the fine adjustments.

Closing: set up the great principles first; the fine skill comes with practice

This lecture establishes the core of the Yu Ji Zhen Zang Lun: the four-season five-organ pulses — summer hook, autumn floating, winter deep, plus the spleen pulse dwelling in the center. Excess means the disease is on the outside; deficiency means the disease is in the middle. In treatment: in excess, drain the child; in deficiency, tonify the mother — when the heart is weak, treat the stomach and intestines; for uremia, strengthen the liver, warm the kidney, and guard the heart first. There is no method of stopping blood — warming yang lets a ruptured vessel seal itself. The qi of the five elements only moves forward; spirit turns and does not turn back; turning back means it no longer turns. When the liver is diseased, first firm the spleen — stop the disease halfway along the path of conquering.

String this lecture into one sentence: when feeling the pulse, first distinguish excess from deficiency; in treatment, hold to the great principle of tonifying the mother and draining the child; in inspection, watch whether the five colors move forward or backward; in transmission, intercept the disease midway between the organs — the Huang Di Nei Jing first hands you a map, and everything after that is walking the terrain, over and over, at the bedside.

Based on Doctor Ni Haixia’s Ren Ji (Human Records) lecture series on the Huang Di Nei Jing, compiled by Doctor Luo Dalun (Twenty-Eighth lecture)