Coughing Thick Phlegm After Sweating at Work and Getting Blown by the Wind? Doctor Luo Dalun Presents Doctor Ni Haixia’s Forty-Second Lecture on the Huang Di Nei Jing — the Ping Re Bing Lun (Assessing Heat Disease) Concluded: Labor Wind and the ‘Yi Jiu Fu Yang’ Breathing Method, Kidney Wind and Wind-Water, Where the Pathogen Gathers the Qi Must Be Deficient, the Sorrowful and the Four-Limbs-Hot; the Ni Tiao Lun (Rebellion and Regulation): Bone Bi, Flesh Numbness, and the Wheezing Distinction; and the Opening of the Nue Lun (Malaria Treatise): All Malaria Is Born from Wind
Patient search words: coughing after sweating at work and getting blown by the wind / caught cold after sweating / cough with thick yellow phlegm / swollen face / swollen eyelids and eyes / puffy eye bags / period stopped / coughing when lying flat / cannot lie flat to sleep / cold all year round / cold hands and feet / always cold but never shivering / rheumatoid arthritis / swollen painful joints / numb hands and feet / arms and legs too weak to lift / muscle wasting / panting and short of breath / hard to breathe in / hard to breathe out / the shaking chills / alternating chills and fever / malaria
Corresponding topics (medical terms): Su Wen · Ping Re Bing Lun (Assessing Heat Disease, chapter 33), continued: the five organs’ transformed fluids put to work (the liver transforms into tears, the heart into sweat, the spleen into drool, the lungs into nasal discharge, the kidneys into saliva — see the symptom, know the organ) · labor wind, lao feng (wind-cold caught while sweating at labor; the cure ‘yi jiu fu yang’ — stand straight, breathe in deep and rise, breathe out and bend down, the yang of heaven enters the kidneys; three days for the young, five for the middle-aged, seven for ‘bu jing zhe’, the past-their-prime; cough up green-yellow pus-like phlegm as big as an egg, from mouth or nose; phlegm out and the disease is over; phlegm stuck, the lungs are injured and death follows; expel the phlegm by needling the lung or with formulas that attack phlegm) · kidney wind, shen feng (the face is swollen and speech unclear; can it be needled? Qi Bo’s rule — the deficient should not be needled; needling when you should not brings the disease back in five days; the deficient: use needles as little as possible, use herbs when too deficient) · the disease returning after wrong needling (breathing very short — the fluids are hurt; heat rises from the chest and back to the head — chest yang should sink, in kidney wind the yang cannot go down and runs upward; sweating with hot hands; dry mouth, bitter thirst; yellow urine; eyelid bags swollen like sleeping silkworms, shiny — retained water; rumbling intestines — all water; a heavy body; in women the period stops; vexation without appetite; cannot lie flat — lying flat brings coughing; the disease name is wind-water, feng shui) · the normal-state view of the breast milk (lung yang, the yang within yang, should descend swiftly; when cold-damp sits below the yang cannot descend, it rebels, the breast milk comes down and freezes, the Chong and Ren vessels are blocked — so the period stops; Chinese medicine says menstruation is breast milk; Western medicine injects progesterone to force the period, not knowing the interior cold is the cause; lying flat lets the rebellious yang rush straight into the lungs — cough; lying on the side lets the light qi float aside) · xie zhi suo cou, qi qi bi xu (where the pathogen gathers, the upright qi must be deficient; the body has no empty spaces; where evil flourishes, righteousness is weak) · scanty qi, periodic heat, and sweating (yin deficiency lets yang flood in — the blood is the yin, when the blood is insufficient yang squeezes in and the surface shows a yang pattern; when the fluids are hurt the yang rushes in to fill the gap; if yin and yang were harmonized in the lungs, you would sweat only with exercise; yellow urine reveals heat in the belly — ask about urine in every clinic visit) · Su Wen · Ni Tiao Lun (Rebellion and Regulation, chapter 34): the sorrowful type (yang deficient with yin in excess; exterior deficiency — yang guards the surface, no yang means unstoppable sweating; catching wind-cold, the cold is felt from inside the body out) · the four-limbs-hot type (yin qi deficient, yang qi in excess; wind-cold touches them like fire roasting; the hands and feet belong to yang; one water cannot overcome two fires, only solitary yang remains; solitary yang cannot grow — unexplained muscle wasting with scorching hands and feet means yin deficiency and yang excess; harmonize the two) · bone bi, gu bi (always cold, still cold in hot water, an oven, thick clothes, yet never shivering; the kidney-strong person who works in water — divers, men standing in water, the dishwashing housewife; sweating while the body sits in cold water lets cold water enter the kidneys; one water cannot overcome the two fires, the heart and small-intestine fire; the kidneys govern the bones and the marrow — the cold comes out of the marrow, bone cold born from the bone; the liver is one yang, the heart two yang, the kidney a solitary organ — one water cannot overcome two fires, so no trembling; the disease is bone bi; the joints swell — the source of rheumatoid arthritis; swollen joints mean cold inside, prescribe herbs that expel interior cold; ‘yi shui wei shi’ includes the housewife whose hands go hot and cold in the kitchen — the sweat enters the bones) · flesh numbness, rou ke (extreme numbness and heaviness even in thick clothes; rong qi deficiency causes bu ren, numbness — rong is the blood; wei qi deficiency causes bu yong, weakness — wei is the qi; both deficient, numb and useless; the warm-disease school differentiates by qi, blood, rong and wei; the cold-damage school by the six channels; the classical formulas school takes the Nei Jing as the supreme guide in physiology and pathology — nine times out of ten correct; limbs that drop onto the bed — the yang and the kinetic power are gone; look at the eyes — loss of spirit means death, the walking corpse with bright eyes can be saved, the intact body with no spirit is dangerous; spirit matters more than form) · the wheezing distinction (cannot lie down, loud breath sounds — stomach qi rebelling upward; the stomach is the sea of the six bowels, its qi descends; yang ming rebellion disturbs sleep — ‘stomach disharmony makes sleep uneasy’; normal daily life with breath sounds — the lung collaterals are rebelling; can lie down but wheezes on walking — lung qi cannot descend; cannot lie down, cannot walk, and wheezes, or wheezes on lying down — mostly the lung; hard to breathe in — the kidneys, hard to breathe out — the lungs; ask the patient which is harder; inhaling descends from the back straight to the dantian; exhaling returns to Guan Yuan (CV4), runs up the Conception Vessel to the chest, out by nose and mouth; the kidneys must be good to grasp the inhaled qi) · Su Wen · Nue Lun (Malaria Treatise, chapter 35), the opening: malaria, the alternating fever-and-chills shaking, existed in ancient times; such seasonal epidemics are like SARS or avian flu; in World War II China malaria ran everywhere — acupuncture could completely cure it; all malaria is born from wind, the external pathogen, and strikes at set intervals (once a day, every other day, every few days); the attack begins in the body hair, then yawning and stretching (the kidneys govern yawning and stretching; tai yang and the kidneys are interior-exterior), then shivering with chattering teeth (the yang ming channel enters the teeth — bone cold, the teeth chatter) and pain in the loins and spine (tai yang); the cold leaves, inside and outside are both hot — headache as if split open, thirst craving cold drinks; yin and yang contend above and below, deficiency and excess take turns — the upright qi and the pathogen fighting; yang diseased within yin — yin excess and yang deficiency; yang ming deficiency — shivering and chattering teeth; tai yang deficiency — back, head and neck pain (tai yang is a channel of much blood and little qi; yang weak, the blood stagnates); all three yang deficient — yin qi prevails and, the deepest home of yin being the bone, bone-cold pain; the cold of malaria is born from within; yang excess — external heat, yin excess — internal heat, both hot — panting and thirst; yang excess scatters the fluids, hence craving cold drinks; watch the alternation of cold and heat — that is how to read malaria
Opening: tears, thirst, unstoppable sweating — the five organs’ “liquids” each tell their own story
Last lecture set out the five organs’ transformed fluids: the liver transforms into tears, the heart into sweat, the spleen into drool, the lungs into nasal discharge, and the kidneys into saliva. In this lecture Doctor Ni Haixia immediately puts the map to work: a patient walks in complaining, and one sentence points straight to an organ.
💬 Note from Doctor Ni: If a patient runs in and tells you, “Doctor, why do I have so many tears?” — that’s it, the answer is done: tears are the liver. “Why is my mouth so dry?” — thirst, fluids and saliva insufficient: the kidneys. “I can’t stop sweating” — the heart; sweat is the fluid of the heart. This is the five organs transforming into five fluids. Chinese medicine works this way — you have to look at both sides of the coin: see the symptom, and you know which organ is out of order.
Labor wind: you finish the work drenched in sweat, the wind blows, and you cough up thick phlegm — the four characters “yi jiu fu yang” are the prescription
The lecture continues with labor wind (lao feng) from last session. Labor wind is wind-cold caught in the middle of laboring and sweating. How is it treated? Qi Bo, on page 283, gives a very simple method.
💬 Note from Doctor Ni: Qi Bo says “yi jiu fu yang” — what does that mean? It means: when you don’t need to use your body for work anymore, stand up straight, and breathe deeply. You breathe in, and the body rises; you breathe out, and the body bends down; breathe in, the body rises; breathe out, bend down. In this way the yang of heaven enters the kidneys. So doing deep breathing while bending the body is all it takes.
How fast you recover depends on age — Doctor Ni gives an account reckoned by years:
💬 Note from Doctor Ni: “Tai yang, ju yang and the meridian drinkers — three days and they’re better; the middle-aged — five days; bu jing zhe — seven days.” What does this mean? A young person doing the “yi jiu fu yang” exercise — deep breath, bend down, breathe out, rise up — is better in three days; a middle-aged person takes five days; “bu jing zhe” — literally, those who no longer have essence, no longer have semen — the elderly, whose strength is poor, need a full week.
Coughing up green-yellow phlegm as big as an egg — spit it out and you’re well; hold it in and you injure the lungs
Labor wind has a signature symptom: coughing phlegm.
💬 Note from Doctor Ni: If a symptom appears — coughing up green-yellow discharge — the phlegm you cough is deep yellow, deep green, like pus, extremely thick, as big as an egg. It may come out through the mouth, it may come out through the nose, not always the same way. And if this phlegm does not come out, it will injure the lungs — and lung injury means death.
So the treatment principle of labor wind is one sentence: find a way to spit that phlegm out of the lungs.
💬 Note from Doctor Ni: When you have labor wind, you must find a way to get the phlegm out of the lungs. Get it out and there’s no problem. As for the method of getting it out — this is Qi Bo’s method: when we first introduced acupuncture, we spoke of “needling the lung”; needling the lung can make the phlegm in the lungs come out. And we also have many formulas that can attack and expel the phlegm from the lungs. Either way works.
Kidney wind: the face is so swollen you can’t speak clearly — can we needle? Qi Bo lays down a rule first
The Yellow Emperor asks: there is a person with kidney wind whose face is so swollen that speech is unclear — can we use acupuncture and moxibustion?
💬 Note from Doctor Ni: Qi Bo here defines the rule for acupuncture — “xu bu dang ci, bu dang ci er ci”: the deficient should not be needled; if you needle when you should not, five days later the disease breaks out again. So in our acupuncture practice, when we meet a deficiency pattern, we use the needle as little as possible; when the patient is too deficient, we don’t needle at all — we use herbs.
Needled wrongly, the disease returns in five days — the fluids are hurt through and through
So what happens when kidney wind is needled when it should not be, and the disease qi returns? Page 284 continues.
💬 Note from Doctor Ni: The breathing becomes very short — because the fluids (jin ye) are insufficient, the fluids have been hurt. Sometimes heat rises from the chest and back up to the head — why from the chest and back up to the head? The chest is chest yang; yang should sink downward and yin rise upward — that is the normal state. But now it is kidney wind: wind-cold has injured it, the yang cannot go down, so it runs upward — from the chest and back all the way to the head, with sweating and hot hands.
💬 Note from Doctor Ni: This is the fluids hurt reaching the kidneys — swelling and saliva; the fluids hurt, causing dry mouth and bitter thirst — very thirsty; the urine is yellow; the bags under the eyes are swollen. When we look at the eye bags, swollen like sleeping silkworms — very big, like a silkworm, and very glossy — this is water swelling, retained water. Inside the belly there are also intestinal sounds — it’s all water; and the whole body feels heavy.
Plus a symptom exclusive to women:
💬 Note from Doctor Ni: In women, the period stops; there is vexation without appetite; and she cannot lie flat — lying normally flat brings coughing. The name of this disease is “wind-water” (feng shui).
Why does the period stop? Chinese medicine says: menstruation is breast milk
Why does wind-water stop the period and forbid lying flat? Doctor Ni brings out the concept of the “normal state” and explains it again.
💬 Note from Doctor Ni: You must remember what the normal state is. The lung sits in the chest yang; this chest yang is the yang within yang, and it sinks downward — sinking is its extreme, and in the normal person it goes down fast. When below there is cold-damp, the lung yang cannot descend; it rebels, and the whole lower body turns icy cold. The same thing: your breast milk comes down to this region, meets the cold, and stops; the Chong and Ren vessels are blocked — this is the rebellion. When it rebels, the lower body is cold, and so the period stops.
💬 Note from Doctor Ni: No period — in Chinese medicine we consider menstruation to be breast milk: your breast milk never came down, so of course the period never comes. Western medicine is different: the moment they see “your period isn’t coming,” they inject progesterone to force it. They don’t know that your cold is the cause — the interior cold caused it.
And what about the inability to lie flat?
💬 Note from Doctor Ni: Because when your yang qi is rebelling outside the qi, the moment you lie flat, the qi rushes upward, straight into the lungs, and you cough even harder. So you have to lie on your side — because qi is very light; if you lie on your side, the qi floats over to the side and doesn’t rush straight into the lungs — it goes off to the side. Side-lying works; lying flat does not.
Where the pathogen gathers, the qi must be deficient — there are no “empty” places in the body
On page 285, Qi Bo lays down another definition — one of the basic concepts of Chinese medicine:
💬 Note from Doctor Ni: Xie zhi suo cou, qi qi bi xu — when the pathogen gathers in a place, the upright qi there must be deficient. In the human body there is no empty space, no so-called vacant place — inside a normal person, the whole body is filled with normal upright qi. When the pathogen comes, the upright qi in that spot becomes deficient. There is certainly no such thing as a place left empty, with neither upright qi nor pathogen — no such thing. So where evil flourishes, the righteous qi is always deficient.
Pushing this concept forward explains “scanty qi, periodic heat, and sweating”:
💬 Note from Doctor Ni: If a person has yin deficiency, yang must rush in to fill it. For example, this “yin” refers to the blood: when the blood is insufficient, that is yin deficiency, and yang will squeeze in — on the surface it looks like a yang pattern. That is why the text says “you have scanty qi, periodic heat, and sweating” — it matches the passage on page 284: when the disease qi returns, there is always scanty qi together with fever — because the fluids are hurt; when the yin channels are damaged, yang qi rushes in to fill the gap.
💬 Note from Doctor Ni: At this time the breathing is very short; you see heat with sweating — if yin and yang were harmonized in the lungs, you would sweat only when you exercise. Otherwise — yin and yang at peace in the lungs — there should be no sweating without exertion. Yellow urine tells us there is heat in the belly. In clinical practice, to know whether there is heat in the belly, we often just ask: how is your urine? What color is it? Yellow urine — heat in the belly.
The sorrowful type: yang deficient, yin in excess — the cold seeps out from inside the body
Next Doctor Ni discusses a certain kind of person — one who is often sorrowful. The Huang Di Nei Jing has a specific discussion of this character type.
💬 Note from Doctor Ni: Such a person usually has less yang qi and more yin qi, which produces a chronic exterior deficiency. Because the yang is insufficient — yang itself guards the surface; the pores of our skin can contract because we have yang there. If there were no yang, you would sweat without stopping. So because this person’s yang is insufficient and yin qi is more abundant, this is his everyday state. This type of person is already yang-deficient to begin with; now if wind-cold attacks, he feels that cold seeping out from inside the body — the cold comes out from within. That is Qi Bo’s explanation to him.
Four limbs hot: hands and feet scorching like fire, while the body wastes away — solitary yang cannot grow
On page 289, the Yellow Emperor asks again: some people have hot hands and feet; when wind-cold touches them, the skin feels like it’s being roasted — what’s going on?
💬 Note from Doctor Ni: This discusses four-limbs heat. When we speak of warm hands and feet, that’s the normal person — the palms and soles are warm, the backs of the hands and feet are cool. Now we’re talking about four-limbs heat: the whole hand is hot, the whole foot is hot. When wind-cold blows on them, it feels like fire roasting. This type of person has yin qi deficient and yang qi in excess. The cold-feeling person just before was yang deficient with yin in excess; now it’s reversed. Because the four limbs are yang — the hands and feet usually belong to yang. The person’s own yang qi is already in excess; now wind-cold arrives, yin and yang clash, the yin becomes even less, and at this point water cannot overcome fire — only solitary yang remains, yang standing alone. So the hands and feet feel scorching hot, burning like fire.
What are the consequences of solitary yang?
💬 Note from Doctor Ni: Solitary yang cannot grow. When yang stands alone, the muscles do not grow. So if you see a person coming in with muscles wasting away — unexplained wasting — and hands and feet hot and dry, this is what the text describes: yin qi deficient, yang qi in excess. We must harmonize yin and yang and bring them back into balance.
Bone bi: cold all year round, still cold in hot water, and yet — strangely — never shivering
On page 290, the Yellow Emperor asks about a very strange kind of person: cold all year round, forever feeling cold — thrown into hot water, still cold; put in an oven, still cold; wrapped in the thickest clothes, still cold — nothing can warm him. And yet, oddly, he never shakes.
💬 Note from Doctor Ni: You’d think that being cold, he would shiver. He doesn’t. What disease is this? Qi Bo analyzes it: different people get different symptoms. This type of person usually has strong kidney qi and “works in water” — people who work in water: those who stand in water, divers — many of them work in water all the time. While working, the tai yang qi declines, because the sweat comes out while he is in the water — he sweats and his body sits in the water at the same time. This allows cold water to enter the kidneys. When the yin fluids are excessive, the kidney yang becomes insufficient.
💬 Note from Doctor Ni: One water cannot overcome two fires — the cold keeps coming in; the two fires are the fire of the heart and the fire of the small intestine. When it cannot overcome them, the interior yin-cold becomes heavy. The kidneys govern the bones, and the bones generate the marrow; when it is too cold, even the marrow is cold — that cold comes out from the marrow itself: bone cold born from the bone, cold seeping out of the bone.
And why, being this cold, does he not shiver? Qi Bo’s explanation is wonderful:
💬 Note from Doctor Ni: When we are cold, our hands shake, our hands and feet tremble — why? The liver is one yang, the heart is two yang, and the kidney is a solitary organ — one water cannot overcome two fires, so the body cannot tremble in battle. The name of the disease is “bone bi” (gu bi). Such people’s joints all swell — and this is the source of rheumatoid arthritis.
Bone bi is the root of rheumatoid arthritis — dishwashing mothers know it best
Doctor Ni then gives a very everyday example, pointing out that “working in water” is not only a profession:
💬 Note from Doctor Ni: Let me give you an example of rheumatoid arthritis: why do so many wives get rheumatoid arthritis? She stands in the kitchen; after the meal, she has to wash the dishes — no dishwasher, in the old days everything was washed by hand — her hands go into cold water for a while; then she has to stir-fry, so she runs over to the wok and her hands get hot; a moment later she’s back washing, and her hands are in cold water again. Hot, then cold, then hot, then cold — and this sweat goes into the bones.
💬 Note from Doctor Ni: The cold that enters the bones is not the true externally-contracted cold, so she still doesn’t shiver. Real cold makes you tremble — go outside underdressed and shiver a little; that’s normal. Not shivering is what’s abnormal. People with bone bi, because the interior is already very cold and deep, don’t even feel the external wind-cold, so they don’t tremble. So when we see joints swollen, we know the cold is inside, and when prescribing we simply open the herbs that expel interior cold. So “working in water” doesn’t only mean working in water — it also includes the housewife with her hands soaking in cold water. Many mothers with rheumatoid hands, swollen joints — this is how it started.
Flesh numbness: hands and feet numb, heavy, too weak to lift — rong qi deficiency brings numbness, wei qi deficiency brings weakness
Page 291 discusses “flesh numbness” (rou ke): a person is extremely numb and heavy; even wearing very thick clothes, he still feels numb and numb.
💬 Note from Doctor Ni: Qi Bo says this phenomenon is rong qi deficient with wei qi in excess. Rong refers to the blood; wei refers to the qi. The warm-disease school uses qi, blood, rong and wei for differentiation; the cold-damage school does not — the cold-damage school differentiates by the six channels, so our differentiation is extremely precise. If you rely only on qi, blood, rong and wei, you simply cannot differentiate — their method is wrong, so of course the prescriptions they write are wrong. Compared with such coarseness, we of the classical formulas school take the Huang Di Nei Jing as our supreme guiding principle, as our physiology and pathology, and working from that angle, our differentiation is right nine times out of ten.
💬 Note from Doctor Ni: Rong qi deficient brings bu ren — when the blood qi is insufficient, there is numbness; wei qi deficient brings bu yong — when yang qi is deficient, one cannot exert strength, cannot use the limb; when both are deficient, it is numb and useless. So some people look like their muscles are perfectly fine, but they are numb, heavy, and cannot use them.
The hand drops the moment you lift it, and the eyes have lost their spirit — spirit matters more than form
Next comes the differentiation of a critical case, and Doctor Ni speaks without hedging:
💬 Note from Doctor Ni: When the hands and feet no longer obey, you go to the patient, lift his hand — “thump,” it drops onto the bed; lift it again, “thump,” it drops again. The four limbs govern the yang of the whole body — in the classical formula view, the four limbs govern yang; the stomach and intestines govern the four limbs, so after a meal you have strength. Now the hand drops the moment you lift it, the foot drops the moment you pull it up — the yang is gone, the kinetic power is gone; this is exactly what the text describes. Then we look at the eyes: if the spirit is lost — not human anymore, the consciousness is gone — that person is dead for certain.
💬 Note from Doctor Ni: So in our classical formula practice, we see a walking corpse’s outer form — the muscles deformed, water accumulation, the hands without strength; the form is lost. Or the muscles wasting away. Can the walking corpse survive? If the eyes are bright and spirited, one look and you can save him. Another person has a fine form, no muscle wasting, but the eyes have no spirit — once the spirit is diseased, all is dangerous. So spirit matters more than form; that is the great principle.
And how do you judge whether the spirit is present?
💬 Note from Doctor Ni: Whether the spirit is there — I can talk about it all day and you still can’t see it, but the moment you meet the patient you know: sometimes the son walks in and the mother no longer recognizes her own son — that is the spirit gone. Eyes wide open, a glassy stare — the spirit is gone.
Wheezing: can’t get the breath in, or can’t get it out? — that is the division of labor between the kidneys and the lungs
On page 292, the Yellow Emperor runs through a string of wheezing differentials: cannot lie down, with loud breath sounds; cannot lie down, but no sound; living normally but breathing with sound; can lie down but wheezes when walking; cannot lie down, cannot walk, and wheezes — which organ causes each?
💬 Note from Doctor Ni: Qi Bo says this is simple: cannot lie down, with sound — this is stomach qi rebelling upward; stomach qi rebelling upward fills the chest with turbid qi, so the breathing sounds are very loud. Cannot lie down but the breathing sounds are fine — the qi has no strength; that is just ordinary insomnia. Living normally but with problems in the breathing — this is the collaterals of the lung. Some people can lie down, but when they walk, they wheeze — this is lung qi unable to descend: when we walk, we take deep breaths; in the normal person the lung qi descends, the clear qi keeps descending; with rebellious qi there is wheezing — the qi cannot get down, so you wheeze. As for those who cannot lie down, cannot walk, and wheeze, or those who wheeze the moment they lie down — most of these are the lung.
💬 Note from Doctor Ni: Look at Qi Bo’s explanation — he says: the stomach is the sea of the six bowels, and its qi descends. If the yang ming stomach qi rebels, one cannot lie down — so the Nei Jing says “stomach disharmony makes sleep uneasy,” and we also treat the stomach. Living normally, generally fine, but with sound — that is the collaterals.
Then Doctor Ni delivers the clinical question you must always ask:
💬 Note from Doctor Ni: When a person develops wheezing — if he can’t get the breath in, the disease is in the kidneys; if he can’t get the breath out, it is the lungs. So when you treat wheezing, you must be clear: is it hard to breathe in, or hard to breathe out? Ask the patient: “Do you find it harder to breathe in, or harder to breathe out?” — if he says “I feel like I want to breathe in,” that tells you the kidneys have a problem. So wheezing is not only the lungs — the lungs only handle breathing out; the kidneys must be good for us to grasp and hold the breath we take in.
Why does inhaling belong to the kidneys and exhaling to the lungs? Doctor Ni draws the path of the qi:
💬 Note from Doctor Ni: In the Chinese medical view, after the nose breathes in, the qi travels along the channels straight down to the dantian — that is the inhale. When you breathe out, the qi of the lungs returns to Guan Yuan (CV4), runs up the Conception Vessel, comes up to the chest, and leaves through the nose and mouth — that is the exhale. So inhaling descends from the back, exhaling rises from the front — this is the normal state. If the kidneys have a problem, the inhaled breath cannot come down; if exhaling is a problem, there is trouble in the lungs — this is the reason.
The Malaria Treatise opens: the shaking chills, the alternating cold and heat — this “seasonal epidemic” existed in ancient times
The wheezing discussion finished, the lecture enters the thirty-fifth chapter of the Huang Di Nei Jing — the Nue Lun (Malaria Treatise).
💬 Note from Doctor Ni: The definition of malaria: malaria comes and goes, it’s the “shaking bench” — people define it many ways, it doesn’t matter. Chinese medicine treats by pattern; when there is a pattern, we treat according to the pattern. This whole chapter describes something very much like malaria — which means this disease existed in ancient times; it is not modern. This kind of seasonal epidemic is like SARS or avian flu — all of the same family. During the Second World War, malaria was everywhere in China, rampant all over — and with acupuncture techniques, we could completely cure it.
The Yellow Emperor asks: all malaria is born from wind and strikes at set times — some people have an attack once a day, some every other day, some only every few days; during an attack there is alternating cold and heat; some get cold first then heat, some heat first then cold. With so many symptoms, why?
💬 Note from Doctor Ni: But it’s all wind — wind is external contraction, coming in from outside. Qi Bo on the beginning of the malarial attack: it first starts in the body hair, entering through the skin pores. Then yawning and stretching — yawning and stretching are governed by the kidneys, and tai yang and the kidneys are interior-exterior, so we often see this in exterior patterns. Then han li gu han — the shivering: the loins and spine ache severely, the back hurts — all pain on the tai yang channel. Then the cold leaves and inside and outside are both hot — headache as if split open, thirst craving cold drinks. Cold and heat keep exchanging — this alternating phenomenon.
The symptoms differ between the cold phase and the hot phase:
💬 Note from Doctor Ni: In the cold phase, the patient shakes, shaking continuously, all the teeth chattering — don’t the teeth pass through bone? Bone cold, bone cold — that’s the teeth chattering; the back and loins ache. In the hot phase, when the fever comes, there is headache and thirst. These are the different symptoms of the cold and hot phases.
Why the alternating chills and fever? Yin and yang contend above and below — the upright qi and the pathogen fight for ground
The Yellow Emperor asks: why does this happen? On page 295, Qi Bo answers.
💬 Note from Doctor Ni: Qi Bo says: yin and yang contend above and below, deficiency and excess take turns, yin and yang shift — yin and yang are fighting, deficiency and excess are scrambling; it’s like the upright qi of our body contending with the pathogen, and these are the phenomena produced by the contention. If yang is diseased within yin — the disease sits in the yin organs — this produces yin excess with yang deficiency; if yang ming is deficient, then han li gu han — shivering with chattering teeth — because the yang ming channel enters the teeth, the teeth chatter.
Doctor Ni also takes the opportunity to explain that “yin and yang are everywhere”:
💬 Note from Doctor Ni: What does “yang diseased within yin” mean? Our yang — inside every organ, in every muscle of the body, there is yin and yang. Divided by organs: the zang organs (liver, heart, spleen, lungs, kidneys) are yin; the fu organs (gallbladder, small intestine, stomach, large intestine, bladder) are yang. Divided by muscle: fat is yang, lean meat is yin. Divided by bone: bone is yin, flesh is yang. However you divide it, yin and yang are everywhere. Yin and yang should be harmonious — that is, a married couple that doesn’t quarrel; when they quarrel and fight, that is the contention.
💬 Note from Doctor Ni: When tai yang is deficient — the tai yang channel is a channel of much blood and little qi — if the yang is weak, the blood in the tai yang channel stagnates and stops; then along the channel you find back pain, headache, stiff neck. If all three yang are deficient, then yin qi prevails; and when yin qi is very strong, the yin sits on the bones — the deepest home of yin is the bone — so at that point the patient has this bone-cold pain.
And finally back to the heart of malaria’s cold and heat:
💬 Note from Doctor Ni: When malaria attacks, there is sometimes alternating cold and heat — the cold of malaria actually comes from within: because this yin-cold is born internally, cold is born inside, and both the exterior and the interior are very cold. If yang is in excess — when yang is very strong it produces external heat; yin in excess produces internal heat; when inside and outside are both hot, there is panting and thirst, craving cold drinks. Remember this key point: this yin is emitted from within. And when yang is in excess, the fluids are scattered too much, so the patient wants to drink. So with malaria — when we look at malaria, we watch this alternation of cold and heat.
Based on Doctor Ni Haixia’s Ren Ji (Human Records) Huang Di Nei Jing lecture series (Lecture 42)