Fever After a Cold: Why Does It Come Back Days After It Breaks? Doctor Luo Dalun Presents Doctor Ni Haixia’s 40th Lecture on the Huang Di Nei Jing — the Re Lun (Discussion of Heat): All Heat Diseases Come from Cold, Six-Day Cycles of the Six Channels, Sun-Channel Cold Water, Yang Ming Intestinal-Heat Constipation Must Never Be Sweated, Twofold Cold Invasion Dies in Six Days, the Food Taboos of Heat Relapse, Winter Cold and Spring Warmth, and the Ci Re Pian: Needling Heat Diseases

Patient search words: fever after a cold, what to do / how many days does a fever last / fever breaks then comes back / can you eat meat with a fever / how a cold changes from day one to day six / cold with headache and stiff neck / can you sweat a fever with constipation / is yellow urine with fever heat or cold / fever with restlessness and sleeplessness / fever with no appetite and nausea / liver fire with a bad temper / irritability, sweating and a racing heart

Corresponding topics (medical terms): Su Wen · Re Lun (chapter 31): all heat diseases are injuries from cold · Ju Yang is the chief of all the yang (tai yang governs the qi of all the yang) · twofold invasion of cold is certain death · the origin of warm disease (cold damage developing into warm disease; criticism of the warm-disease school for clearing heat as soon as it appears) · one day equals six days (the six-channel transmission counted by hou, five days to one hou) · tai yang cold water (head and nape pain, stiff back; cold water as the body’s insulating layer) · yang ming governs the flesh, its vessels flank the nose and connect to the eyes (body heat, eye pain, dry nose, inability to lie down; Chengqi ST1, Sibai ST2, Juliao ST3; channel heat vs bowel heat; Bai Hu Tang; bowel-heat constipation must not be sweated) · shao yang half-exterior half-interior (chest and rib pain, deafness; governs opening and closing; not entered the organs, sweating cures it) · tai yin abdominal fullness and dry throat · shao yin dry mouth, dry tongue and thirst (the tongue maps the five organs: coating the lungs, body the heart, root the spleen, Jin Jin and Yu Ye under the tongue the kidneys, sinews the liver) · jue yin vexation, fullness and scrotal retraction · all three yin and three yang diseased, nutritive and defensive qi cannot move — a death sign, yet still fight · the order of decline (day seven tai yang headache eases … day twelve jue yin scrotum relaxes) · the governing rule of treating each through its organ and channel (before three days can sweat, after three days can drain — the source of the Shang Han Lun sweating methods) · heat relapse (eating forcefully while heat is severe; grain qi and heat clash, two heats combine; relapse from eating) · taboos of heat disease (no meat during recovery; eating more causes relapse) · the three stages of twofold cold invasion (tai yang + shao yin diseased together → yang ming + tai yin → shao yang + jue yin; no water or gruel entering, unconsciousness, death on day six) · needle to reverse the crisis and hot rice gruel (rice as the essence of heaven and earth) · death in three days (the yang ming stomach qi is the longest of the twelve channels, rich in qi and blood, sustaining life only three days) · winter cold injury, spring warm disease (before the summer solstice warm disease, after it summer-heat disease; summer-heat disease is cured by sweating) · the difference between the cold-damage prescription and the warm-disease prescription (releasing herbs combined with nourishing herbs); Su Wen · Ci Re (chapter 32): liver heat turns urine yellow first (the liver channel encircles the genitals; ask about urine to tell cold from heat; the eight principles; cold-constipation and heat-constipation) · geng-xin days worsen, jia-yi days great sweating (metal conquers wood) · needle foot jue yin and foot shao yang at the yuan-source points (Taichong LR3, Qiuxu GB40) · heart heat takes days to appear (the heart governs joy; sudden heart pain, vexation, vomiting, headache, red face, no sweating; ren-gui days death; needle hand shao yin and hand tai yang at the yuan-luo points) · the difference between heat and fire (heat-clearing medicines and fire-descending medicines are two different things) · spleen heat makes the head heavy first (the spleen governs dampness; both cheeks ache; bluish face; desire to vomit)

Opening: the Yellow Emperor asks a frightening question — do all diseases come from cold injury?

Page 263 of the Nei Jing: the Re Lun, chapter 31 of the Huang Di Nei Jing. The Yellow Emperor opens with a great question: are all diseases injuries from cold? Some people recover, some recover slowly, some die — the dead do not last six or seven days, while those who recover drag on for ten days or more. Why?

💬 Note from Doctor Ni: In other words, the ones who recover on their own are slower, while the ones who die are quicker. Qi Bo answers: what we call ju yang is tai yang — the three yang gathered together, the chief of all the yang. Tai yang governs qi. When a person is injured by cold, it becomes heat disease. So every heat syndrome begins as cold injury — this is the origin of warm disease. But the warm-disease school does not understand this: the moment heat appears they treat it, only clearing heat, never using warm medicines — they do not know it began as cold injury.

Qi Bo then speaks the most important sentence in the whole book: injury by cold produces fever — heat, however severe, will not kill — but the person who is diseased by twofold invasion of cold will surely die.

Why “twofold invasion of cold”? — how cold burrows into the body step by step

Doctor Ni draws a figure to explain: outside the skin, Chinese medicine calls it the “exterior.” If your body is good — you don’t drink recklessly, don’t stay up late misbehaving, your mind is calm and you don’t haggle over trifles, you have no ambition, and you understand how to regulate the five flavors — you recover gradually. But if you are injured by cold and don’t know how to protect yourself, the cold moves inward.

💬 Note from Doctor Ni: When cold enters the body there are two possibilities: first it enters shao yang, second it enters yang ming. When it enters shao yang, it has the chance to transmit to the yin — tai yin, shao yin, jue yin. When it reaches yang ming it stops — at most the person runs wild in a frenzy, climbs high and sings, throws off his clothes and walks naked. But after the cold has entered, if you are hit by another old cold again, this is called “twofold invasion of cold,” and this is more dangerous.

First get this straight: here “one day” is not one day — it’s six days!

The Yellow Emperor asks Qi Bo to explain in detail, and this passage is the source of the fundamental theory of the entire Shang Han Lun.

💬 Note from Doctor Ni: Qi Bo says “one day of cold injury.” This “one day” — because of the nature of Chinese writing, the definition is not always the same — the “one day” spoken of here should be six days. Transmission is one hou per five days; on the fifth day the seasonal node breaks, the body breaks, and on the sixth day there is a change. One cycle of cold injury is also six days.

First cycle: tai yang — if you touch the back and it’s cool, that’s correct!

At the start, tai yang receives it. The tai yang channel is the foot tai yang bladder channel, running from the head and face down the back and down the back of the legs — so there is headache at the top of the head, and the back and spine feel stiff.

💬 Note from Doctor Ni: Tai yang we call “cold water.” Why cold water? Touch the skin, the back is all cold — cold is correct! If you touch it and it’s boiling hot, first, you’ve been in the sun too long; second, you have a fever. So when you sweat, even the sweat is still cold to the touch. Tai yang itself is cold water — water is cold, and that is what protects us: it is an insulating layer between us and the environment. Otherwise our body would change with the environment at once and we could never adapt. You are naturally cold water, with a normal amount of cold water inside; add another cold on top and it becomes hard like ice, causing stiffness.

Second cycle: yang ming — body heat, sore eyes, dry nose, can’t lie down

If it doesn’t resolve within six days, roughly six or seven days, a week, yang ming receives it. Yang ming governs the flesh; its vessels flank the nose and connect to the eyes — Chengqi (ST1), Sibai (ST2), Juliao (ST3) are precisely these.

💬 Note from Doctor Ni: So there is body heat, eye pain and dry nose, and the inability to lie down. A person’s inability to lie down and sleep has a great deal to do with the stomach and intestines. The yang ming qi flows from above downward — memorizing the points is simple, you don’t have to memorize by rote: when we begin the points, Touwei (ST8), Xiaguan (ST7), Jiache (ST6), Chengqi (ST1), Sibai (ST2), Juliao (ST3) — they follow the flow of qi. The hand yang ming large intestine channel: Shangyang (LI1), Erjian (LI2), Sanjian (LI3), Hegu (LI4), Yangxi (LI5), Pianli (LI6), Wenliu (LI7), Xialian (LI8), Shanglian (LI9), Shousanli (LI10), Quchi (LI11), Zhouliao (LI12), Wuli (LI13), Binao (LI14) — this is the direction of qi. Introducing acupuncture and the points is introducing the movement of qi.

The yang ming channel qi naturally descends from the head. When disease enters yang ming, the qi no longer descends but reverses upward — yang ming is dry and hot — so the nose dries, the eyes are both hot and painful, the body heats up, and you cannot sleep either, because the qi rushes upward.

People with constipation must never be sweated — the story of the mayor who ran every morning

Speaking of yang ming, Doctor Ni separates channel heat from bowel heat crystal-clearly, and tells a story that makes you laugh:

💬 Note from Doctor Ni: Yang ming divides into bowel heat and channel heat. Bowel heat means heat has entered the stomach and intestines — the hand yang ming large intestine — the stool becomes dry, constipation. If you take a constipated person and release the exterior and sweat him, the sweating makes the constipation drier and drier! If it is channel heat — the disease is on the channel, not entered the bowel — you give Bai Hu Tang (White Tiger Decoction) and the patient sweats and the disease resolves — it is still resolved by sweating. So if a yang ming constipated person goes running — running in the morning makes him sweat more, and the fluids are injured, right? The first day or two of running is fine, but add constipation, and after a week of running the fluids are injured and dryness rises — in the morning he runs with the mayor, in the afternoon he goes off by himself, throws off his clothes and runs, climbing to a high place, because the dryness reverses upward. So that’s wrong. Just walking is fine.

So you cannot release the exterior. The moment you see constipation and release the exterior on top of it, you are piling dryness on dryness — it works on your enemies, but never use it on people you care about! If you use it on them, they will hate you for life. The stool is blocked inside; you cannot. So of the three [treatable situations] that can be sweated, yang ming bowel heat cannot be sweated.

Third cycle: shao yang — “knocking at the door” is half-exterior half-interior

💬 Note from Doctor Ni: When it reaches shao yang, we call shao yang “half-exterior half-interior.” When someone comes to your house, first he must knock at the door — that door is half-exterior half-interior, governing opening and closing. When you knock on the outside you are still exterior; when the door opens and the guest enters, only then are you inside. Shao yang governs the gallbladder; the gallbladder channel runs along the chest and ribs all the way to above the ears. Earlier we introduced that beside the ear there are three: san jiao, gallbladder, small intestine — Ermen (TE21), Tinggong (SI19), Tinghui (GB2). So there is chest and rib pain with ringing in the ears — when qi is blocked by wind-cold, deafness appears. If the disease is in shao yang and has not entered the organs, we can generally cure it by sweating, as long as the patient’s urination and defecation are normal.

Cycles four, five and six: tai yin, shao yin, jue yin — from abdominal fullness to dry tongue to scrotal retraction

The disease transmits deeper day by day:

💬 Note from Doctor Ni: The fourth cycle — if after twenty-one days the disease is still not better, it enters tai yin. Tai yin is the spleen and stomach; the spleen channel is distributed around the stomach — around the small intestine and stomach are all spleen channels. When the spleen is injured by cold it causes abdominal distension and fullness — hence “abdominal fullness and dry throat.”

The fifth cycle: the shao yin channel passes through the kidney and then enters the lungs — the lungs and kidneys are connected, metal generates water. It lands on the root of the tongue:

💬 Note from Doctor Ni: Remember the picture I drew the other day? A tongue — the coating on top of the tongue is the lungs, the tongue body itself is the heart, the root of the tongue is the spleen, Jinjin and Yuye, the two spots under the tongue, are the kidneys, and the sinews inside the tongue are the liver. One tongue shows you the condition of all five organs. Someone comes and tells me “I have cramps” — tongue cramps belong to the liver, the liver sinews attach here. Shao yin is buried under the tongue; the kidney governs saliva. When cold enters the kidney, it causes dry mouth, dry tongue and thirst.

The sixth cycle enters jue yin. The jue yin channel, by its course, is the only one that passes through the genitals and connects to the liver:

💬 Note from Doctor Ni: So it causes vexation, fullness and scrotal retraction — the scrotum draws inward. What about women? Disease in jue yin is not only about the scrotum; most importantly the chest and ribs become distended and full, so uncomfortable that it is vexing, irritating, and the emotions easily turn to anger, because the liver sinews attach to the chest and ribs. You only need to know this much — but if a patient comes and tells you “my scrotum has drawn up, what happened, after my cold it drew up,” you know: the cold of jue yin has entered jue yin.

Even when the death sign appears, still fight with everything you have

When all three yin and three yang, all five organs and six bowels are diseased — the nutritive and defensive qi cannot move, qi and blood are blocked, the five organs cannot communicate with one another and cannot check one another — this is a death sign.

💬 Note from Doctor Ni: When we see a death sign, we must still do our utmost to fight! You cannot say “ah, it’s doomed, doomed” — that’s not good. We do our best. For those not twofold invaded by cold — that is, cold was already present before and outside cold entered again to add fuel — generally from the seventh day: on day seven tai yang disease declines, the headache eases; on day eight yang ming disease declines, the body heat eases; on day nine shao yang disease declines, the deafness improves slightly — the ears are still deaf but can hear sounds; on day ten tai yin disease declines, the abdomen reduces as before and the appetite begins to return; on day eleven shao yin disease declines, the symptoms gradually recede; on day twelve jue yin disease declines, the scrotum relaxes and the lower abdomen settles slightly — the disease is cured. So one is disease advancing, getting worse and worse; one is disease retreating, coming out slowly.

When seeing a patient you must also ask about timing carefully:

If the disease is still in shao yang and you treat it and it turns into a tai yin pattern, it means your treatment was not right; there is a second possibility — when it entered shao yin you wrote the correct prescription, but the patient went home and didn’t boil it right away, went off to do other things, and boiled it two days later when the disease had already transmitted to shao yang — and you prescribed the shao yang formula again, wrong! So many things can happen in between; you must ask clearly. Sometimes you have to tell the patient: how many days have you had these symptoms? A week? Then go home and boil it and drink it immediately — don’t wait until tomorrow.

The governing rule: within three days it can be sweated, after three days it can be drained — this is the source of the Shang Han Lun’s sweating methods

The Yellow Emperor asks: how is it treated? Qi Bo says: treat each by opening its organ and channel.

💬 Note from Doctor Ni: We must know his organs and his channels. When the twelve-channel diseases decline: before three days are full — that is, three hou, twenty-one days — the disease is in the yang, and it can all be resolved by sweating. After three days are full, we can drain — promoting urination counts, promoting defecation counts, and so on. A rule is fixed here, which is why when we study the Shang Han Lun there are so many sweating methods. We have many sweating methods.

Bonus one: the fever breaks, then days later it returns — “heat relapse,” caused by forcing food during the fever!

The Yellow Emperor asks: some people recover, then a few days later the heat returns, fever again. Why?

💬 Note from Doctor Ni: Qi Bo says, retained heat — the reason this heat returns is “eating forcefully while the heat is severe”: forcing yourself to eat during a high fever, hence something is retained. Grain qi and heat clash, two heats combine, hence retention. So generally when treating exterior patterns you must tell the patient: even if you’re hungry, eat something very light, some rice gruel is enough — or if you can, don’t eat at all, it doesn’t matter — a person can go seven days without food and not die! Eat after the disease is cured. Otherwise you clear the heat, and a few days later it returns — he thinks “I’m sick, I should eat more,” and this creates a lot of heat in the stomach.

Page 268 gives the taboos: when a heat disease just begins to recover, you absolutely must not eat meat — meat leaves residual heat stuck inside, unable to fully disperse; eating more causes relapse.

💬 Note from Doctor Ni: So eat grains — rice, wheat, these are best. Congee with a little pickled vegetable is fine; meat is not. A little boiled green vegetable is fine. These are the taboos of heat disease.

The most dangerous twofold cold invasion: three cycles, heart-stopping at every step, death on day six

The Yellow Emperor asks again: in the patient with twofold invasion of cold, what are the pulse and disease signs? Qi Bo explains — at the start one cold syndrome has already entered the yin, and while it was entering, another cold comes in behind it:

💬 Note from Doctor Ni: The first cycle shows tai yang and shao yin diseased together — headache is a tai yang sign, dry mouth and vexation are shao yin signs. Teacher, this patient has tai yang signs but also shao yin signs? This is twofold invasion of cold — yin signs and yang signs appearing together. The second cycle: yang ming and tai yin diseased together — abdominal fullness is a tai yin sign, body heat is a yang ming sign; no appetite and delirium — not wanting to eat and talking nonsense, speaking without passing through the brain, already clouded in spirit (not the same as a petty man’s slander). The third cycle: shao yang and jue yin meet, diseased together — deafness is shao yang’s cold, scrotal retraction is jue yin’s cold; hands and feet ice-cold, no water or gruel entering, unconscious — death on day six. So sometimes this “day” means one day, sometimes one hou, one cycle.

When you meet this situation and no formula fits, what do you do? Doctor Ni says: we still cannot be doctors who just watch the show — we must act:

💬 Note from Doctor Ni: You can use acupuncture to reverse the crisis — we have the strength to reverse it. Also have the patient take some very hot rice gruel; the moment it reaches the stomach it receives the hot qi. Why is rice gruel good? Because rice is the essence of heaven and earth — the rice plant grows according to spring sprouting, summer growing, autumn harvesting, winter storing; it grows by the four seasons’ qi itself. So it is the essence of heaven and earth.

Doctor Ni also tells a little parable about enlightenment through rice:

I hope you don’t read stiffly; you’re all good students — and if a good student can’t learn Chinese medicine well, I’d criticize him. Think about it: rice grains, aren’t they small, one by one? Have you ever seen a rice grain as big as that? No, they’re all small grains. Why? Because when people get old, living to ninety, their teeth are gone — no Western dental implants available. You eat rice without chewing; you can just swallow it. So rice must be made small — does that make sense? Wonderful! Looking at this single grain, you see the form; I see the spirit — if rice were made that big, God would definitely have a problem. Extremely wise.

Why “death in three days”? — the stomach qi lasts at most three days

Page 269: the Yellow Emperor asks — when the five organs are already injured, the six bowels blocked, and the nutritive and defensive qi cannot move, why does death come in three days?

💬 Note from Doctor Ni: Qi Bo says, yang ming is the stomach qi, the longest of the twelve channels, the greatest of the twelve — yang ming is the channel rich in both qi and blood. When qi and blood are too abundant, the yang ming channel should normally flow from the head down to the feet, ending at Lidui (ST45). If the qi reverses, the yang ming channel qi flows backward — yang ming is the channel of much blood and much qi; ordinarily this causes unconsciousness. Because you cannot eat and the five organs are injured, the yang ming channel qi can sustain at most three days — the stomach qi can only last three days — then death.

The last passage on page 269 gives another definition:

💬 Note from Doctor Ni: All diseases injured by cold — injured by cold in winter, the disease breaks out in spring. Before the summer solstice it is warm disease; after the summer solstice it is summer-heat disease — here warm disease and summer-heat disease are cut apart. So when you say “injured by cold in winter,” this person gets warm disease in spring — it is not necessarily tied to the summer solstice: warm-heat disease contracted before the summer solstice belongs to winter cold injury, cold coming from winter; warm disease contracted after the summer solstice has nothing to do with winter cold — it is heatstroke, the weather being too hot. How is summer-heat disease resolved? It is resolved by sweating — these are all sweating methods. Don’t nourish yin for it. Sweat is yang; when sweat is released and yang is vented, we resolve by sweating. When yang reaches its extreme, yin turns back on its own.

💬 Note from Doctor Ni: So the cold-damage physician’s prescription and the warm-disease physician’s prescription are different. The warm-disease physician looks at heat and nourishes yin, nourishes yin, nourishes yin — to us that leaves residual heat inside. You nourish yin, and with residual heat inside it starts off nicely — the fever clears — but a few days later it comes back; and if you haven’t told the patient to stop eating meat, it will still come back. When we prescribe, we use some dispersing medicines — the moment you disperse, the yang qi turns back on its own. So in our prescriptions, besides the releasing herbs, we also put some nourishing, moistening herbs inside — both at the same time — and at the same time the patient must not eat meat, only grains and some vegetables. That’s all it takes.

Turning the page: chapter 32, the Ci Re — needling techniques for heat diseases

Page 271, we enter chapter 32, the Ci Re Lun, which teaches how to treat heat diseases and the needling techniques we use when encountering heat disease.

The first passage, liver heat disease — heat in the liver:

💬 Note from Doctor Ni: Liver heat disease: urine turns yellow first, abdominal pain, sleeping a lot, body heat — this is talking about hepatitis, acute hepatitis looks very similar. The first thing we see is that the urine immediately turns yellow, because the liver channel encircles the genitals; the moment there is heat, the urine turns yellow. We often ask about urine: are you constipated? How many days without stool? A week. Then we separate cold and heat — Chinese medicine distinguishes cold and heat, and distinguishes excess. We differentiate with the eight principles: yin and yang, exterior and interior, deficiency and excess, cold and heat. Constipation is excess, diarrhea is deficiency; excess divides into heat-excess and cold-excess. With the same constipation, the prescriptions divide into two kinds.

And how do you know whether it is cold or heat? Doctor Ni gives a trick that is extremely handy in practice — ask about the urine:

💬 Note from Doctor Ni: Urine that comes out clear and white is cold; urine that is yellow is itself heat — that’s the whole lecture! Sometimes the patient is on the phone and you can’t see his eyes; you see his face is pale — don’t even ask about urine: feel the pulse. Pulse slow, fine, small — an excess syndrome should have a big pulse; why is it fine and small? Right: cold! Cold means the small and large intestines have no peristalsis, stopped in place; because they don’t move, he doesn’t feel pain. Heat-excess is different — very painful! The intestines churn, the dry stool can’t get out, and the belly hurts. So looking at the urine tells us cold and heat.

When liver heat erupts (heat struggling): wild speech and fright, rib fullness and pain, restless hands and feet, unable to lie calmly — the liver governs anger; when it receives heat the emotions are very bad, hands and feet agitated, unable to sleep well. And there is a timing rule:

💬 Note from Doctor Ni: Geng-xin days worsen, jia-yi days bring great sweating. Jia-yi is wood, bing-ding is fire, wu-ji is earth, geng-xin is metal, ren-gui is water. The liver meets geng-xin days — metal conquers wood — the worst time; on jia-yi days the disease arises. If the qi is reversed (the feet are cold) and it meets a geng-xin day, it is a death day. So when you see a liver patient, flip through the almanac — if these are geng-xin days, watch what the Yellow Emperor said is right or wrong, wait for him to die. Truly correct.

The needling: needle the foot jue yin and foot shao yang (liver channel and gallbladder channel). When the qi is reversed, the headache comes in waves — the channel qi rushes to the head and face, surging up in waves.

💬 Note from Doctor Ni: When you needle, do you use the child point or the mother point? Find the yuan-source point! The yuan-source point governs the deficiency and excess of its own channel — both supplementation and draining can be treated. The liver channel is a yin channel without a yuan-source point (yin channels use the shu point in place of the yuan), so we use its shu point to represent it — thus Taichong (LR3) is the liver channel’s yuan point; for the gallbladder channel use Qiuxu (GB40, the yuan-source point).

Heart heat disease: the heart governs joy, the heat appears after several days — and the great difference between “heat” and “fire”

Page 271: if it is heart heat — inflammation of the heart — at the beginning there is no heat. The heart governs joy; people with a healthy heart are very happy. Shu ri nai re — only after several days does the heat appear.

💬 Note from Doctor Ni: When heat struggles, sudden heart pain — sudden heart pain, vexation and fullness, tendency to vomit, headache, red face. When the heart is injured, all the heart yang runs outward; what the heart governs is the color red — the patient has no sweat: the heart governs sweat fluid; when the heart is injured by too much dryness-heat, sweat disappears. Meeting ren-gui days is dangerous — ren-gui is water, the heart is fire, water conquers fire; on bing-ding days (fire days) the disease arises. If the qi is reversed and the feet are cold, death on a ren-gui day. The needling technique is hand shao yin and hand tai yang; when taking points on the four limbs we always use the yuan-luo points — the so-called yuan-luo treatment.

Speaking of the heart, Doctor Ni takes the opportunity to separate “heat” and “fire” once and for all — a pair of concepts that is absolutely key in Chinese medicine:

You say, teacher, I can’t figure out how to distinguish heat from fire. Very simple — the heavenly yang shining down from the sky is heat: you feel “it’s so hot,” that is heat. As for fire, that is seeing fire burning. These two are not the same! Heat and fire have different definitions in Chinese medicine. So we have medicines that clear heat and medicines that down fire — these are two different things; don’t lump heat and fire together. The heart is naturally like fire; now add heat on top — that’s all it is.

Spleen heat disease: when the patient says “my body feels heavy” — that’s the spleen

💬 Note from Doctor Ni: With spleen heat, the head feels heavy first — head heaviness. The spleen governs dampness; you only need to remember: the patient has no pain, he just feels the body is heavy — why is the body heavy and the head heavy too? The moment a patient tells you “heavy,” you say the spleen — because the spleen governs dampness, and dampness is a heavy thing, with volume and weight, extremely heavy. Both cheeks ache, vexation, bluish face — why does the face turn bluish? Spleen heat in excess insults the liver, and the liver’s bluish color shows on the face. Desire to vomit — if the spleen has a problem, there is certainly nausea and inability to eat. Because the spleen governs dampness; when dampness is very severe it presses up against the diaphragm — the spleen is swollen, the stomach is compressed, and nausea makes you vomit.

Compiled from Doctor Ni Haixia’s Ren Ji (Human Records) lecture series on the Huang Di Nei Jing (lecture 40)