Weak Legs and No Strength from Spleen Deficiency — What to Do? When Exactly Is Long Summer? Should You Sweat Out a Winter Cold? Doctor Luo Dalun Presents Doctor Ni Haixia's Thirty-Ninth Lecture on the Huang Di Nei Jing: The Tai Yin Yang Ming Lun (Part 2) — The Spleen Governs the Four Limbs, the Eighteen Days of Long Summer and the Timing of Treatment, Sweat and Urine Share the Same Origin, Wounded by Cold in Winter Means Warm Disease in Spring, the Spleen Moves Fluids for the Stomach; The Yang Ming Pulse Explanation (Chapter 30): Loathe People, Loathe Fire, Startled by the Sound of Wood, Throwing Off Clothes and Singing on High, Da Cheng Qi Tang

Patient search terms: weak legs and no strength from spleen deficiency / when exactly is long summer / why do I get sick every time the season changes / how do I choose the timing of treatment / should I sweat out a winter cold / child runs a fever in winter but never sweats / can constipation affect my brain / irritable, hate the sight of fire / suddenly stripping off clothes and running down the street / climbing onto rooftops and singing — what illness is that / manic cursing at everyone / Da Cheng Qi Tang

Corresponding medical names: Su Wen · Tai Yin Yang Ming Lun (Chapter 29) closing: yang receives wind, yin receives dampness (wind injures the upper body first, dampness injures the lower body first) · the Shaoyang governs opening and closing (the pivot of half-exterior half-interior; food entering the windpipe) · spleen disease leaves the four limbs useless (the limbs receive qi from the stomach but must rely on the spleen; the small intestine in the lower abdomen is governed by the spleen; the spleen moves fluids for the stomach) · the reading key for the classics (stomach = small intestine; below the heart = stomach) · the spleen does not govern a season alone (the spleen is earth, governing the center; eighteen days at the end of each of the four seasons; long summer = nine days before and after each seasonal transition, or the two-week solar term) · the timing of treatment (liver disease arises in spring, heals in summer, holds steady in winter, dies in autumn; when evil is strong and upright qi weak, first secure the spleen; attack when spleen qi is at its peak in long summer) · exterior excess can be attacked at any time (sweat and urine share the same origin; wounded by cold in winter, warm disease in spring) · the spleen and stomach are connected by membranes (the San Jiao collaterals; the Foot-Taiyin is where the three yin gather, piercing the stomach and connecting to the throat; Yang Ming moves qi to the three yang) · fire engenders earth, the spleen presides over yin and yang; Su Wen · Yang Ming Pulse Explanation (Chapter 30): Yang Ming channel disease loathes people and fire (heat but no cold; abundant channel qi and blood) · startled by the sound of wood but unafraid of bells and drums (wood overcomes earth, earth engenders metal; diagnosis by sound) · panting that kills versus panting that survives (reverse flow cutting off the viscera versus connecting to channels) · throwing off clothes and running, climbing high and singing (the diaphragm separates clear from turbid; yang ming dry-heat turbid qi rushing up to meet yang qi disorders the mind; pure yang hyperactivity in the head is mania; turbid qi entering the brain causes unconsciousness) · yang ming fu heat is the Da Cheng Qi Tang pattern (worse heat at dusk, raving and cursing, no appetite) · the warm-disease school would not use rhubarb and mirabilite · the case of running naked at dusk cured with one dose of Cheng Qi Tang · six-channel pattern differentiation and the Shen Nong Ben Cao Jing (Zhi Shi, Hou Po, Da Huang, Mang Xiao)

Opening: when dampness is too heavy, the body cannot hold it — a swollen belly and diarrhea

This lecture continues from the previous one on the spleen and stomach. What do you do when dampness is overwhelming? Doctor Ni says: the body cannot hold this dampness, so the damp runs downward, and the patient begins to have loose stools, diarrhea, and a swollen belly.

💬 Note from Doctor Ni: When dampness is very heavy, the body cannot stay put — the damp goes down and becomes diarrhea, with a swollen belly. So underneath this is the saying: the throat governs heavenly qi, the pharynx governs earthly qi — yang receives wind, yin receives dampness. Heavenly qi means the breath, the windpipe; the pharynx is for swallowing food. Eating goes into the esophagus and the breath goes into the windpipe — they are two separate passages, with a membrane in between.

Why think of the Shaoyang when food goes down the windpipe?

Doctor Ni throws out an amusing question: Teacher, when I eat and some food slips into my windpipe, what should I think about?

💬 Note from Doctor Ni: The Shaoyang! Because the Shaoyang governs opening and closing. The Taiyang governs opening, the Yangming governs closing — what is the pivot in between? The Shaoyang. So all half-exterior, half-interior problems are simultaneously Shaoyang problems. The Huang Di Nei Jing simplified it: yang receives wind disease, yin receives dampness — the Yangming (stomach) receives wind disease, and yin receives the dampness of the earth, which travels up from the ground, from the feet upward.

Why does wind injure the upper body first and dampness the lower body first?

The spleen and stomach are the same pair — why do they receive evil from opposite directions? Doctor Ni explains it clearly through the courses of the channels:

💬 Note from Doctor Ni: Is the Foot-Taiyin Spleen channel not Yin Bai (SP1), Da Du (SP2), Tai Bai (SP3), Gongsun (SP4) coming up all the way? The Stomach channel comes down from the head — Tou Wei (ST8), Xia Guan (ST7), flanking Cheng Qi (ST1), Si Bai (ST2), Ju Liao (ST3) — all the way down. So the upper body receives wind and the lower body receives dampness — these two are not the same, understand — this is talking about the spleen and stomach. So “wounded by wind, the upper body is affected first; wounded by dampness, the lower body is affected first” — this is talking about the spleen.

When the spleen is diseased, the four limbs become useless — why?

The Yellow Emperor asks: when the spleen is diseased, the four limbs become useless — why? Doctor Ni says: we have already said the spleen governs the four limbs; besides the sinews, it is the spleen that manages the limbs. The theory is right on this page — the four limbs all receive qi from the stomach, but this qi cannot reach the channels by itself; it must rely on the spleen:

💬 Note from Doctor Ni: The four limbs all receive qi from the stomach — but without the spleen, the food you eat goes into the small intestine (think of the “stomach” as the small intestine; if you only read “stomach” you will not understand). Food is ground up in the stomach, then enters the small intestine, where absorption and digestion begin. Now the small intestine sits in the lower abdomen, and it is managed by the spleen — because the spleen is there, it can carry the nourishment of food out to the four limbs, and only then do the limbs have strength. So when the spleen is diseased and cannot move the fluids for the small intestine, the limbs fail to receive the qi of grain and water, and in the end the limbs lose their strength.

Understand the single word “stomach” and you have read half the Nei Jing

Doctor Ni casually teaches a key for reading the Huang Di Nei Jing — this one is extremely valuable:

💬 Note from Doctor Ni: If you read the Huang Di Nei Jing and see the word “stomach,” and you take it literally as the stomach, you will have trouble understanding. Drop the “stomach” down two levels and think of it as the small intestine; and when you see “below the heart” (xin xia), that means the stomach — then you will understand. The spleen governs the lower abdomen — the lower abdomen is managed by the spleen — and what is inside the lower abdomen? The small intestine. The spleen helps the small intestine move fluids, move the fluids. These are all connected.

When exactly is long summer? Arguing for thousands of years, settled in one sentence

Page 256 settles the question of long summer. Everyone has been arguing: when is long summer? Is it tied to a fixed solar term? The Yellow Emperor asks: the spleen does not govern a season — but is there not a long summer? Qi Bo says:

💬 Note from Doctor Ni: The spleen is earth; it governs the center. When the seasons of spring, summer, autumn and winter change, they must all pass through the earth qi in the middle to make the transition. We nourish the four viscera with the four seasons — our spring, summer, autumn and winter nourish the liver, heart, lung and kidney — and each of them is attended to for eighteen days at the season’s end; the spleen does not govern a season alone. For example: when winter begins at Start of Winter (Li Dong), the nine days before and the nine days after — together eighteen days. That is how the Nei Jing puts it. For stability, in fortune-telling we treat two weeks as one solar term — twenty-four solar terms, two weeks each, the most standard. Nine days before and nine days after adds up to eighteen days; every season has its eighteen days in the middle, and these together are long summer. Shortened to two weeks, this is the absolute long summer.

Treating illness is like going to war: strike only when the skylight opens

Why do we need to know long summer? Because of the timing of treatment. Doctor Ni says: when the spleen is diseased, the illness arises in long summer; once long summer passes and the solar term changes, in the next term it will heal. It does not say it must be autumn, must be winter — between the four seasons there is long summer: the spring-summer junction, the autumn-winter junction, the spring-autumn junction, the summer-autumn junction — these four corners are all long summer. He gives the most striking example — liver cancer:

💬 Note from Doctor Ni: Take a liver cancer or cirrhosis patient. We know his illness arises in spring, heals in summer, holds steady in winter, and in autumn it is dangerous — it is the season of death. You cannot schedule when a liver patient happens to come see you — it is not that convenient. So you must look at the season: if he comes in autumn, we know it is very dangerous — the solar term is not right, evil qi is very strong, and original qi is very weak. At this time we must adopt a defensive posture, because if we attack now, the original qi will be gone. Wait a little, and attend to his root — attend to his spleen and stomach, secure the spleen, make his spleen strong. When the long summer season arrives, we can intensify the attack on the evil. In winter it holds steady — and when it holds steady you may make your move — because yin qi and upright qi are in balance with evil qi. Once you strike, if you find his appetite is gone and his body is failing again, stop quickly — because it is still winter. Then at the spring-summer junction, when the spleen qi is at its most flourishing, we no longer need to secure the spleen — the season itself is the spleen’s season — this is when we attack it.

💬 Note from Doctor Ni: Treating illness is just like going to war: when the season opens, when the skylight of qi opens, you strike; when it closes, we defend. Treating severe illness is like this. But this kind of severe illness we are talking about is interior excess; if it is exterior excess — an excess pattern on the surface — then no matter what time of year it is, one dose of medicine settles it.

From the attack method for exterior excess, Doctor Ni naturally moves on to the key concept of “sweat and urine sharing the same origin,” and brings out the lesson of “wounded by cold in winter, warm disease in spring”:

💬 Note from Doctor Ni: Exterior excess can be attacked at any time — for example, releasing the exterior and inducing sweat: in summer, ephedra makes you sweat; in winter, take it and you do not sweat — it goes out in the urine instead. Sweat and urine share the same origin. “How come I urinate a lot after taking it?” — because it is winter, that is normal! In summer, ephedra should make you sweat. So if a child runs a fever in winter and you give the medicine, and the fever breaks, and you wonder: the medicine did not make him sweat — no good, give more? You have gone too far! He did not sweat because in winter he will not sweat — eliminating through urine is normal, so you should watch his urine.

💬 Note from Doctor Ni: Some people do not understand this. They say: this cold damage — we must induce sweat; but in winter sweat is hard to produce, so you induce sweat, it will not come, and you get angry and induce it again — but in winter the skin and pores are supposed to be sealed and stored, and once you tear them open, even more wind-cold enters, and then — warm disease in spring, right? Wounded by cold in winter — he was already wounded by cold, and you open him up to be wounded by cold even more. So once the exterior is released, as long as the patient sweats and urinates normally, that is good enough. For generations the Chinese have calculated by solar terms — solar terms are better.

The spleen and stomach are connected by membranes — all five viscera and six bowels rely on stomach qi

Next comes “the spleen and stomach are connected by membranes”: the spleen and stomach are joined by fascial membranes, with the San Jiao collaterals forming a network between them, and so the spleen can move fluids for the stomach.

💬 Note from Doctor Ni: Foot-Taiyin is Taiyin — Taiyin is where the three yin gather, just as Taiyang is where the three yang gather. The Taiyin channel pierces the stomach, belongs to the spleen, and connects to the throat — also connecting to the larynx — and so Taiyin moves qi to the three yin for the stomach, because the three yin all gather in Taiyin. Yangming is a fu (bowel) — the division of the five viscera and six bowels — and Yangming also moves qi to the three yang. Each viscus and bowel has its own channel connections, so they receive qi from the Yangming; the stomach moves fluids for (the spleen). Because the spleen has fascial membranes connecting it to the small intestine, when the small intestine receives nourishment and digests it, it can infuse that nourishment through the whole body — and only then can the four limbs, five viscera and six bowels function — the two support each other.

This is “fire engenders earth”:

💬 Note from Doctor Ni: What the small intestine absorbs is handed over to the spleen, and the spleen presides over yin and yang — this is why the spleen governs the great connecting vessel Da Bao (SP21) — it presides over yin and yang, distributing them to the five viscera and six bowels, to the extremities, and into the muscles.

Turning the page: Yang Ming Pulse Explanation, Chapter 30 — annoyed by people, more annoyed by fire — that is a disease!

Page 258: the Yang Ming Pulse Explanation (Chapter 30) — a short chapter. When the Yangming channel is diseased, there are channel diseases and bowel diseases.

💬 Note from Doctor Ni: A channel disease is a disease of the channel and its vessels. He hates the sight of people, and hates the sight of fire too — because it is hot — too hot; he does not like seeing people, and hates fire even more, because fire is heat. “Startled by the sound of wood” — when wood is struck, wood overcomes earth, so he is frightened. But when bells and drums are banging — dang dang dang — he is not afraid. Why? Because earth engenders metal. So hearing the sound of wood frightens him instead. So to confirm whether he has a Yangming disease is very simple: tap on wood and he jumps — that is a Yangming channel disease; if tapping does not scare him, he does not have a Yangming channel disease. There are many methods — the Huang Di Nei Jing talks about the things of everyday life.

Diagnosis by sound: a child who refuses to talk — one tap and you know

Doctor Ni says he actually relies on this “diagnosis by sound” in clinical practice:

💬 Note from Doctor Ni: When we walk in, sometimes the patient stops talking — children sometimes will not speak. You ask him: are you hot? He will not say. “I will not tell you” — kids can be very stubborn. I have met this kind — he will not even show his hand. What do you do? In cases like this, make a sound and you will know. So to be a good doctor, you can use the people around you — and often use sound to diagnose.

Why loathe fire? Why loathe people?

Qi Bo explains to the Yellow Emperor: why does he loathe the sight of fire? Why does he loathe the sight of people?

💬 Note from Doctor Ni: Because Yangming is the stomach channel; the stomach is earth, and wood overcomes earth — that is why there is this phenomenon (being startled by the sound of wood). Why loathe fire? Yangming governs the flesh — the spleen governs the flesh, and Yangming also governs the flesh — its channel has abundant qi and blood, and when evil lodges there it becomes hot. You are already very hot — Yangming is a pure heat pattern, heat but never cold — and then you still have to look at fire, adding fire to fire, so he loathes fire. And why loathe people? When Yangming qi and blood surge upward, panting with distress, breathing out hot qi — he loathes the sight of people. When a Yangming pattern surges up — really — you will loathe even your own wife.

At this point Doctor Ni cracks his famous joke — what to do when your wife loses her temper:

💬 Note from Doctor Ni: The best thing — if you are too full of Yangming pattern, stay far away; you loathe the sight of them. When you are married and your wife gets angry, you cannot leave the house — hide in a corner at home, let her find you, and only then will her anger subside. If you run away, you add fuel to the fire — she will have to find you, and it will be worse. So when a Yangming pattern appears, quickly prepare the medicine and give it to her fast, to avoid disaster. Later, when we discuss astronomy and geography, I will teach you how to use the positions of things — not only can you make the household very harmonious, husband and wife respecting each other like guests, you can also avoid disasters.

Panting connected to distension is dangerous; connected to channels there is hope

The Yellow Emperor asks: some patients “die panting,” some “live panting” — why?

💬 Note from Doctor Ni: Panting connected to distension — when cold and distension connect, the patient becomes very dangerous: Yangming is overheated, and when it is too hot the cold cannot come out, and he dies. If it connects to the channels — viscera and bowels connected to the channels — that is life. If the fu and the channels are connected, there is life.

Why do some people strip off their clothes and run down the street, climb onto rooftops and sing?

The Yellow Emperor asks: in Yangming disease, why does the patient “throw off his clothes and run,” climb high and sing — not eating for days, yet still able to leap onto rooftops, run fast, and sing up there? Normally he cannot do this; when the disease attacks he can. Why? Qi Bo says: the four limbs are the root of all yang; when yang is abundant the four limbs are full, and when full one can climb high. Doctor Ni first explains the function of the diaphragm:

💬 Note from Doctor Ni: This is caused by fu heat. In a normal person, above the belly and abdomen there is a diaphragm — I have stressed to you again and again that the diaphragm’s chief function is to separate clear from turbid: above the diaphragm, the lung and heart area, is the clear part; below the diaphragm is the turbid part — that is the normal person. Now take a person with constipation, stool blocked up — the large intestine runs across, the navel is here, the small intestine is here — constipation blocks a lot of turbid qi, which normally can only rise as far as the diaphragm and stops there — that is completely normal; twenty years of constipation without running mad through the streets. But one day the Yangming dry qi surges past — turbid qi comes up and meets yang qi, and the mind loses its order. If it is pure yang hyperactivity in the head, it is mania (dian ji); if turbid qi rushes upward, it is not mania — it is this: climbing high and running and singing. The wall is very high — up he goes in one leap — he says “even a cat is not that fierce” — normally he could never do it; he climbs up — and at a glance you know it is a Yangming pattern.

The story of Da Cheng Qi Tang: running naked and singing at dusk every day, cured with one dose

Only a pure heat pattern shows this (throwing off clothes and running); in general this is a Da Cheng Qi Tang pattern. Doctor Ni says: when we speak of Da Cheng Qi Tang, Zhang Zhongjing used the same name in the Shang Han Lun (Treatise on Cold Damage), but the earliest mention is right here in the Huang Di Nei Jing:

💬 Note from Doctor Ni: Why throw off the clothes and run? The heat is in the body, and it is too hot — turbid qi comes up and meets yang qi, and only then does the mind lose its order — the clothes are too hot, so off they come — forget it — strip and run. It must be turbid qi coming up and meeting yang qi to produce this loss of mental order. If the turbid qi does not come up and only yang rushes upward — that is yang hyperactivity, mania (dian ji). If he curses wildly, cursing everyone he sees, without regard for kin or stranger, and sings — yang excess makes one rave and curse, without appetite, and therefore run wildly. Because the belly and large intestine are blocked, he stops eating, and at this time the turbid qi of the large intestine, the turbid qi of the stool, rushes upward and produces this phenomenon. This is Yangming — we have a special name for it: Yangming fu heat.

💬 Note from Doctor Ni: Yangming channel heat and Yangming fu heat are different. When Yangming fu heat is dry and scorching, the whole body gives off steaming heat, so he strips his clothes and runs off; singing brightly without regard for kin or stranger means turbid qi has entered the brain — the turbid qi of the stool rushed across the diaphragm up into the head, producing unconsciousness and mental confusion. So when you see this, Cheng Qi Tang solves it. But the warm-disease school will not use Cheng Qi Tang, will not use Da Cheng Qi Tang — rhubarb and mirabilite cannot be used — well then, the patient just keeps on running.

Doctor Ni then tells a classic “story” — also the clinical standard for recognizing a cold-damage physician:

💬 Note from Doctor Ni: At dusk (ri bu), Yangming channel heat flares most violently. Every dusk you see a man run out of the village, climb onto a rooftop, and sing up there, having thrown away his clothes, running naked — a year, two years, no one could cure him — that proves there is no cold-damage physician in this place. We gave one dose of Da Cheng Qi Tang, and from then on he was cured.

Closing: we are walking the very road Zhang Zhongjing walked

At this point Doctor Ni previews the road ahead — from the general to the refined six-channel pattern differentiation:

💬 Note from Doctor Ni: Sit here with me, and gradually we will enter six-channel pattern differentiation, getting finer and finer. You see, right now we are still quite general, quite broad principle — later we will slowly, slowly become detailed. The road I am taking you on is the very road Zhang Zhongjing walked. How did Zhang Zhongjing come to it? How did his formulas come about? We look at the Shen Nong Ben Cao Jing (Divine Farmer’s Classic of the Materia Medica), look at his formulas — oh, so Cheng Qi Tang uses Zhi Shi (bitter orange), Hou Po (magnolia bark), Da Huang (rhubarb), Mang Xiao (mirabilite) — why? The question of dosage is settled. By the time we reach the Shang Han Lun and Jin Gui Yao Lue (Essentials from the Golden Cabinet), your formulas will come out naturally; and before you have even seen the formulas — when you finish the Shen Nong Ben Cao Jing — you will be able to select the herbs yourself. The parts Zhang Zhongjing lost, or wrote incorrectly, you can restore — and you will not make mistakes either.

Compiled from Doctor Ni Haixia’s Ren Ji (Human Records) lecture series on the Huang Di Nei Jing (Lecture 39), presented by Doctor Luo Dalun.