Coughing and Farting at the Same Time, or Leaking Urine When You Cough? Belly Pain That Feels Better When Pressed vs. Pain That Cannot Be Touched — Doctor Luo Dalun Presents Doctor Ni Haixia’s Forty-Sixth Lecture on the Huang Di Nei Jing: the End of the Ke Lun (Cough Treatise, Chapter 38) and the Ju Tong Lun (Comprehensive Pain Treatise, Chapter 39) — Lung Cough Moves to the Large Intestine, Small Intestine Cough Farts, Kidney Cough Moves to the Bladder, Chronic Cough Enters the San Jiao; Needling the Shu and Ying Points for Cough, the He Points When Cough Moves to a Fu Organ, the Jing Points for Edema; Ten Kinds of Pain All Caused by Cold — Cold Outside the Vessels Hurts the Limbs, Cold Inside the Vessels Hurts So Much You Cannot Be Touched, Pain Between the Intestines Feels Better When Pressed, Cold at the Jiaji Points Pressing Does No Good, the Chong Vessel Palpates Under the Hand, Blood-Deficient Back Shu Pain Loves Massage, the Jue Yin Vessel Draws Pain to the Lower Abdomen, Cold in the Upper Inner Thigh; the Origin of the Four Examinations, Reading the Five Zang by Palpating Around the Navel, PSA Numbers That Lie, and the Twin Dantians of Qihai and Guanyuan

Patient search words: cough / coughing and farting at the same time / leaking a little stool when coughing / leaking urine when coughing / cough with a distended belly and no appetite / belly pain / belly pain that feels better when pressed / belly pain that cannot be pressed / pain that hurts even when clothing touches it / gout / back pain that feels better after a massage / jumping around the navel / a blood vessel jumping in the belly / belly pain that draws to the genitals / cold hands and feet / frostbite / high PSA index / PSA / sitting in meditation guarding the Dantian / Qihai / Guanyuan / Hua Tuo Jiaji / the four examinations (inspection, listening, inquiry, pulse-taking)

Corresponding topics (medical terms): Su Wen · Ke Lun (Cough Treatise, chapter 38) — closing section: lung cough persisting is received by the large intestine (cough with leaking stool); small intestine cough is cough with loss of qi (farting); kidney cough persisting is received by the bladder (cough with leaking urine); chronic cough is received by the san jiao (cough with a distended belly and no desire for food or drink); the six fu receive qi from the stomach; the five-zang coughs originate from the lungs · the needling rules for cough (for a zang, needle its Shu and Ying points; for a fu, needle its He point; with edema, needle the Jing point — with Doctor Ni’s additions of the Ying points and the Back Shu points) · constipation differentiated by position (large intestine / small intestine / the head of the bowel / the bends of the bowel) · disease always has a cause; AIDS is all yang ming pattern with no fatal patterns (Bai Hu Tang, White Tiger Decoction) · Su Wen · Ju Tong Lun (Comprehensive Pain Treatise, chapter 39): ‘one who speaks well of Heaven must have proof among humans’ (a famous doctor is a doctor who understands) · the origin of the four examinations (‘what is spoken can be known, what is seen can be observed, what is felt can be obtained’) · the channels and vessels flow without stopping and circle without end; cold qi entering the channels slows and stagnates · cold lodging outside the vessels reduces the blood; cold lodging inside the vessels blocks the qi — hence sudden pain · cold outside the vessels (contraction, urgent pulse, pain in the limbs, stops with heat, the character jiong) · severe cold and frostbite · cold inside the vessels (cold and heat clash, pain that refuses pressure, gout) · cold between the intestines beneath the membranes (pressing stops the pain — likes pressure) · cold in the vessels beside the spine (too deep to reach by pressing — pressing does no good) · cold in the Chong Vessel (starts at Guanyuan CV4, runs straight up the abdomen, palpates under the hand) · palpating around the navel to locate the five zang (left of navel — liver, below — heart, at — spleen, beside — lungs, above — kidneys) · cold in the Back Shu vessels (blood congeals, blood deficiency breeds pain, warm qi from pressing stops it) · cold in the Jue Yin vessel (ties the genitals, belongs to the liver; pain draws between flanks, ribs and lower abdomen) · cold in the upper inner thigh (belly pain drawing to the genitals — lower jiao too cold) · pain is all cold pattern — treat with hot-natured herbs · PSA numbers that lie (female hormones only dilute the index in the blood) · American Chinese doctors who cannot prescribe decoctions; sixty pounds of decoction a day · a doctor first asks whether his own prescription is wrong · cold between the membranes of the small intestine (the membranes reach the ming men; the san jiao’s membranes begin at Qihai; Guanyuan CV4 is the Front-Mu point of the small intestine, paired internally with the pericardium; Qihai CV6 and Guanyuan are both called Dantian)

Opening: picking up last lecture’s cough — when you cough long enough, it “moves house”

Last lecture’s Ke Lun (Cough Treatise) covered the five-zang coughs and the six-fu coughs. At the start of this lecture, Qi Bo finishes the transmission of cough: when a cough lasts long enough, the disease moves from a zang organ to a fu organ. Which fu it moves to completely changes the symptom — and this is precisely the key to tracing the root of the disease in clinical practice.

💬 Note from Doctor Ni: If you have a chronic cough, you can reason backward from the surface symptoms to what kind of cough it originally was and which zang organ it came from. When lung cough persists, the large intestine receives it — large intestine cough: with each cough a little stool comes out; small intestine cough: with each cough the person farts. Why is that? When you do pattern differentiation later, you can read it from here. The large intestine wraps around the small intestine, so when the small intestine is blocked and the large intestine is empty, what comes out with the cough is qi — farts; when the large intestine is blocked, with a cough a little stool leaks out.

Constipation also needs to be located: blocked in the large intestine, blocked in the small intestine, or blocked at the bend of the bowel?

One cough is not enough — Doctor Ni also teaches the positional differentiation of constipation along the way: constipation may be the same word, but where the blockage sits changes the prescription.

💬 Note from Doctor Ni: Take constipation: blocked inside the large intestine, blocked inside the small intestine, blocked at the head of the bowel, blocked at a bend of the bowel, blocked at the head or the tail of the bowel — the prescriptions are all different. How do you know which? Very simple — if it is blocked inside the small intestine, that means there is nothing inside the large intestine, so with a cough the fart comes right out; that is why small intestine cough farts. If the large intestine is entirely blocked, then when you cough a little stool comes out — that is large intestine cough. Hold on to this concept for now; when we teach the Jin Gui (Essentials from the Golden Cabinet) we will go into it in detail. Basically, once you have the concept — the Huang Di Nei Jing records every cause of disease, the whole course of the disease, right up to death, in great detail; when we actually treat, our symptoms and our prescriptions all come from the Huang Di Nei Jing.

Kidney cough moves to the bladder: urine leaks out with each cough — the root is in the kidney

There is one more crucial route for cough moving to a fu organ — the interior-exterior pair of kidney and bladder.

💬 Note from Doctor Ni: If a cough of the kidney organ itself goes on for a long time without healing, the kidney cough will transfer to the bladder — the kidney is cold, and the bladder is its paired organ, so with each cough urine comes out. So when someone tells you: “I find it strange — every time I cough, urine comes out” — that is a long-standing cough, the disease is about to pass from the zang organs onto the fu organs. You often hear people say “urine comes out when I cough” — the real cause is only in the kidney.

Chronic cough enters the san jiao: cough with a distended belly, unable to eat

At the very end of the cough journey there is one more receiving station — the san jiao.

💬 Note from Doctor Ni: When chronic cough persists, the san jiao receives it. The symptom of san jiao cough is cough with a distended belly and no desire to eat. The san jiao itself sits between the organs — it is the bridge that connects the zang and fu organs; the san jiao reaches into the muscles and channels of the whole body, a place it goes everywhere. As for the six fu receiving qi — all our fu organs receive qi from the stomach; and the five-zang coughs all respond from the lungs — the origin is in the lungs. From the lungs it transfers out; all the fu organs gather their qi in the stomach. The earliest cough is a lung cough, which is why cough makes a person produce more phlegm, with a puffy face and short breathing.

Why must you know where the cough comes from? — the prescription is the same, the root is different

This passage is the key to the whole lecture: the cough prescription may be identical, but the herbs that remove the root are different.

💬 Note from Doctor Ni: Later you will meet many prescriptions — say this prescription treats cough; you take it and the coughing decreases, but it never fully heals. Why? Because you did not treat its root. So when stool comes out with a cough, when farts come out with a cough, when urine comes out with a cough — the cough prescription is the same, but we add some things to it, things that go to the root. This is why we must understand the Huang Di Nei Jing. Otherwise, when I teach the Jin Gui and finish with cough, you will go into clinical practice and be unable to completely cure cough.

💬 Note from Doctor Ni: There is a funny saying in our local dialect: “medical books stink of nose sweat.” Both Chinese and Western medicine are afraid of treating cough, because cough is very hard to treat. But once you grasp its spirit — its root — cough is very easy to treat, not difficult at all.

The Yellow Emperor asks: for treating this cough, how does acupuncture work? Qi Bo gives three rules for treating cough with needles.

💬 Note from Doctor Ni: The Huang Di Nei Jing is 99% related to acupuncture; it contains very few prescriptions — later we will introduce a few prescriptions, but only a few is not enough; with acupuncture, almost every passage relates to it. Qi Bo says: if the cough is in a zang organ and has not yet moved to a fu organ — a pure zang cough — we treat its Shu point — among the five Shu points (Jing, Ying, Shu, Jing, He), the Ying point, and you can also use the Back Shu point on the back; treating the Shu point of that zang is enough. If you are treating a fu organ, treat its He point — a cough that has lasted a long time without healing, once it turns to a fu organ — for example urine leaks out with each cough — we treat the He point of the bladder channel, right? That is all. If there is edema, that means the stomach qi has been hurt; then treat its Jing point — we can take the essence-blood of that Jing point. That concludes the treatise on cough.

Disease always has a cause — Western medicine only knows the outbreak, not how the disease came

Having finished cough, Doctor Ni turns his spear at Western medicine: the Huang Di Nei Jing is pathology and physiology — what the cause of a disease is, Western medicine still cannot figure out to this day.

💬 Note from Doctor Ni: Every patient comes and says, “the doctor told me I have such-and-such a disease.” I ask: “did the doctor tell you how it came about?” No. Then your doctor is wrong — let me tell you how it came about. I often say, “doctor, you are so capable” — I say, yes, I tell you where it comes from, and I explain it to him. Western medicine is all after the fact — when the disease breaks out they see it, but ask them where the cause came from and they still do not know. So after enough clinical practice you will hear me often telling patients: your doctor does not know where you came from. If he knew where you came from, he would have cured you long ago. So he piles up a bunch of terms — useless. If the name were correct, you would already be well. You talk a lot about “red-white herpes sores” — if your doctor really knew what red-white herpes sores are, he would have cured you long ago, knowing how the disease came. Disease always has a cause; when you know the Huang Di Nei Jing well, you trace the cause and find it.

At this point Doctor Ni drags in the topic he is most often scolded for — AIDS:

💬 Note from Doctor Ni: Let me emphasize here why I have said from the very beginning, all along: AIDS does not kill people. Because every AIDS patient I have seen is entirely in the yang ming — and the yang ming has no fatal patterns, so they cannot die. In other words, not taking medicine is better than taking medicine. But Western medicine disagrees — Western medicine wants everyone to be sick so they can make money, right? So they insist it is fatal, and they kill the patients — kill them with Western drugs. Later you will see some cases; basically when we teach the Shang Han Lun and the Jin Gui we will cover many symptoms, then pattern differentiation and our treatment methods; in clinical practice I will introduce some cases for you. So when an AIDS patient comes, I give one dose of Bai Hu Tang (White Tiger Decoction); he drinks it and feels better on the spot than he has in over a decade — that is Bai Hu Tang.

Chapter 39, the Ju Tong Lun: the Yellow Emperor asks — sudden pain in the five zang, what is the real cause?

Cough is finished. Turn to page 326 — we enter the thirty-ninth chapter of the Huang Di Nei Jing: the Ju Tong Lun (Comprehensive Pain Treatise). Doctor Ni says: all pain patterns — how to differentiate them — now we go through them treatise by treatise: cough, pain, cold, heat, all of them. At the opening of this passage, the Yellow Emperor first says something very amusing.

💬 Note from Doctor Ni: “One who speaks well of Heaven must have proof among humans” — if you talk about heaven, earth, yin and yang among people, you will be tested among people; if you specialize in the ancient, constantly quoting the classics — what the Records of the Grand Historian said, what the Warring States said — there must be an ancient principle, and it must match the present; “one who speaks well of benevolence (people) must have suffered from people.” That is why our history books are important. Understanding people too well will surely make people hate you — so many people hate me, because I understand them too well. But we do not make personal attacks; basically I always believe people are good, their starting intention is good. That they went to study Western medicine is not their fault — it is a problem of the medical theory. Why do we want to overturn Western medical theory now? Because we need to save people — knowing enough to act on it.

💬 Note from Doctor Ni: This passage speaks of “ming” — brightness, clarity. We want to become famous doctors — doctors who understand clearly. You do not have to have the “fame” (ming), but you must have the “clarity” (ming) — being clear in your mind, clear about what you can do, clear about the process of the disease. The biggest problem now is that Western medicine is not clear, so they must keep researching and developing new things. The Yellow Emperor finished this several thousand years ago — the Nei Jing was already complete; and they are still researching, still following this very law: the cause of disease, the course of disease, the treatment rules, the end of disease — all written out clearly. We do not need to invent anything new — that proves it is the truth. Western medicine is wrong; it keeps inventing new things, keeps inventing new things — that means it has hit a dead end, no road left. We do not need to invent; we have already finished. They are still at the start.

The four examinations — inspection, listening, inquiry, pulse-taking — were first defined right in this passage

Right after this, Doctor Ni points out a great origin in Chinese medical history — the source of the four diagnostic methods is here.

💬 Note from Doctor Ni: This passage speaks of “what is spoken can be known” — when making a diagnosis, the patient speaks, you converse with him and listen — that is inquiry; “what is seen can be observed” — what the eyes see — inspection; “what is felt can be obtained” — you take the pulse. The four examinations — inspection, listening, inquiry, pulse-taking — were first defined from this passage. Our teacher’s “deng xiong chu” (leisure moments) — the four examinations are known to everyone; they first came from this passage of the Huang Di Nei Jing: the eyes look, the ears listen, the mouth asks, the hand feels the pulse.

The general mechanism of pain: the channels circulate without stopping — cold qi comes in and trouble starts

The Yellow Emperor asks: when the five zang suddenly develop pain, what causes it? Qi Bo’s answer is the outline of the entire Ju Tong Lun.

💬 Note from Doctor Ni: The channels and vessels flow without stopping, circulate without end — that is normal. The normal state of a human being is continuous circulation — only forward, never backward, circulating like this all the time. So from birth to old age we never go backward. Your personality might go backward — at eighty you return to childhood, your personality goes backward — but the body keeps aging, keeps moving forward. If it moves against the current, that is a disease state; qi reversal is a disease state. So unceasing circulation is the norm; when cold qi runs into the channels, it slows the circulation. “Mai” (vessel) has two meanings: one is the channel, the other is the blood vessel. Outside the vessel — the outside of the blood vessel: if cold qi comes in, it slows the circulation of qi and blood, or stops it altogether — outside the blood vessel, this cold contracts the blood vessel. So the colder it is, the tighter the pulse, the smaller the vessel gets, the less blood there is, the slower the blood moves. If it lodges inside the vessel — cold inside the vessel, not outside — then pain arises, and it is instantaneous pain: sudden pain. Everything was fine, then suddenly a burst of pain. When you find sudden, instantaneous pain, you know the cold is inside the vessel.

The Yellow Emperor asks so many questions: pain that stops and starts, pain that never stops, pain that likes pressure, pain that refuses pressure — how do you tell them apart?

The Yellow Emperor asks about every clinical situation of pain at once: some pain suddenly stops, some never stops, some cannot be pressed, some likes pressing — pressing feels good; with some, pressing or not makes no difference; and there is also the “palpating response” (palpitations).

💬 Note from Doctor Ni: The Huang Di Nei Jing is fun — it reads like a dialogue between two people, like a script; it does not write itself stiffly with endless classical citations, so it is easy to read. If you have no clinical experience, reading the Huang Di Nei Jing feels very metaphysical; after you have seen clinical cases and then read it again — wow, this really makes sense.

Palpating around the navel reads the five zang: left of the navel is the liver, below is the heart, at the navel is the spleen

What is “palpating response”? It is when you feel the pulse beating very fast under your hand — Doctor Ni teaches everyone on the spot how to palpate the belly for location.

💬 Note from Doctor Ni: “Palpitating and moving” — palpitation. Left of the navel is the liver; below the navel is the heart; palpitation at the navel itself is the spleen; beside the navel is the lungs; palpitation above the navel is the kidney. This comes from arranging things by east, south, west, north — the human body naturally sits at the center of the eight directions. The small intestine’s fire is hot, so the heart is placed in the south; we put the east over here — because the human body, within the natural world’s east-south-west-north, wood matching the left sinews, develops its diseases according to the same arrangement. You must understand that the Huang Di Nei Jing is telling you the early cause of disease is right here; so to treat disease, you must understand the principles of heaven and earth. Western medicine is not like this — a few chemists sit in a lab, heads down, working hard; they do not know the waxing and waning of the moon outside, do not know the sun, do not know east from west — they just make a drug.

The story of the lying PSA number: 243 down to 3, and the tumor is still right there

At this point Doctor Ni brings up a real case from one of his lectures — how Western indices lie.

💬 Note from Doctor Ni: Look at this patient — prostate enlargement (cancer); their code name is the PSA index. When I gave a lecture in Florida, after the medical talk, in the clinical session there was a man whose prostate cancer index was 243 — normal is below three or four, very low; 243 is that high. So they gave him a female hormone; he took it and the next day it became 3. Have you ever thought — is the thing they did still as big as before? People today are very ignorant — they only look at the index; if the index is normal they are delighted. In reality, that Western drug only dilutes the index in your blood; the disease is still in the body, never removed. So many people have a good index yet still develop the disease. Those who trust Chinese medicine, when they meet a good doctor, live long and healthy; those who trust the Western index — they are finished. This patient himself knew: “I took it and the next day it became 3, but my tumor is still a big lump.” So what do you do? Look — this thing is not accurate. If you study chemistry, what is so hard about finding something to neutralize it? The water is too concentrated — add some water and it is diluted; what is so hard about that? The hard part is removing the root.

Pain differentiation (one): cold outside the vessels — put your hand in ice and it hurts; soak it in hot water and it is fine

Back to the main topic of pain. Qi Bo lists one by one where the cold lodges and what the pain looks like; Doctor Ni pairs each one with a clinical picture. First: cold lodging outside the vessels.

💬 Note from Doctor Ni: If the cold qi lodges outside the blood vessels — when the area outside the vessel is attacked by cold, the patient curls up — cold contracts, so the patient curls up; the pulse is very tight, and it also affects the outer small collaterals — the fine vessels, the small places. Then pain suddenly breaks out. Because it is outside the vessel, in a looser area, closer to the periphery of the limbs. For example, put your hand in a freezer, or in ice and ice water — it hurts after a moment of freezing — that is cold outside the vessel. This pain — as soon as you put it in hot water it is fine, or roast it with heat and it recovers — sudden pain, pain where it should not hurt. That character “jiong” — the sun radical plus fire; we cannot find how to pronounce it either; whatever — it means adding heat. Do not fuss over the characters of ancient Chinese; just know the meaning — once it receives heat, it heals.

Pain differentiation (two): severe cold — frostbite cannot be cured by roasting at a fire; only the Northern-school shang han physicians can do it

Cold has light and heavy degrees; when it reaches a certain severity, the treatment is completely different.

💬 Note from Doctor Ni: If you are hit by severe cold — this cold enters very seriously — say you put your hand in ice water for fifteen minutes and it hurts; twenty minutes it hurts; leave it two hours, keep adding ice — that is different; very strong cold is different. Take frostbite — frostbite: does roasting at a fire help? He has been frozen all night; the whole thing has already necrosed. Of course we can heal it with our hand medicines (ointments) — cutting off a toe for frostbite is not a good doctor; frostbite can all be cured by Chinese medicine. Of course, only the Northern-school shang han physicians can do it — shang han, cold damage; the warm-disease school — we in the South have no shang han, so frostbite victims just die — plenty of people in the South get frostbite and die. When you finish studying all these diseases I teach you, treating them will be that simple for you — cured in a flash, not difficult at all. So pain that has lasted a long time means the cold is very heavy — cold qi lodged inside the channels.

Pain differentiation (three): cold inside the vessels — cold and heat clash, pain so bad clothing cannot touch it

Inside the vessel and outside the vessel — the nature of the pain is worlds apart.

💬 Note from Doctor Ni: Just now was outside the vessel; now inside the vessel — inside the vessel there is originally blood, which is hot; now cold runs in; when cold and heat clash, the vessel swells full. When it swells full, the pain refuses pressure — pressing makes it worse; the more you press, the more it hurts. Like gout — never mind pressing with your hand; even clothing touching it hurts. Next time you meet this, you know: this person has cold and heat clashing inside the blood vessels. Then you know — inside the blood vessels we prescribe herbs that enter the blood, herbs that expel cold; inside the vessel it is hot, so you do not need anything else; if it is deficient and cold inside, add a little hot herb and the pain is gone in a moment. Why do I lay this out? To help you write prescriptions later — you must know the cause before you know how to prescribe. If the cold stagnates and hot qi rushes up, the vessel becomes large and the blood deficient and chaotic — the pain is even worse — even more unpressable. Think about that person — pain so bad it cannot be touched; he will suffer terribly.

Pain differentiation (four): cold between the intestines beneath the membranes — the pain likes pressure, but the hand must be warm

Some pain likes pressure — pressing makes it better; this pattern is the most common in clinical practice.

💬 Note from Doctor Ni: Look at page 329, first line: if this cold qi lodges between the intestines, beneath the membranes — the Huang Di Nei Jing told you long ago: the mo yuan (membranes) are the membranes of the san jiao; between the organs everything is connected by this network of membranes. The blood cannot scatter, but when you press, the blood qi scatters — hence pressing stops the pain — it is because this cold is only shallow, between the intestines, so when my hand presses down, my hand is warm; press down and the blood qi scatters, the pain stops. If your hand is colder than his belly, pressing makes it hurt more. Many girls have cold hands and feet, right? We should treat their hands and feet first. So if you hold your wife’s hand, your girlfriend’s hand, and the hand is cold — treat it quickly! Otherwise, someday when she has pain, your pressing will make it colder and more painful. So better to put a hot towel on it. Because it is cold pain, on the surface of the intestines, our hand pressing can heal it. But be sure to use a warm hand — a cold hand must not press. A cold hand does not mean the heart is bad — the body just has not been fixed yet.

Pain differentiation (five): cold in the vessels beside the spine — too deep, pressing or not makes no difference

Doctor Ni teaches everyone to number the pains one by one: the above can be numbered 1, 2, 3, 4, 5, 6, 7. Second: cold lodging in the vessels beside the spine — Hua Tuo’s Jiaji.

💬 Note from Doctor Ni: Second, cold qi can lodge in the vessels beside the spine — Hua Tuo Jiaji (EX-B2), next to the Du (governing) vessel. See — the cold is beside it; the Jiaji points are very deep; when they are very deep, you press and cannot reach them; of course pressing does no good — you press for a long time; pressing or not makes no difference to it — it neither fears nor likes pressure; it just stays there. In clinical life we know it sits on the Jiaji points.

Pain differentiation (six): cold in the Chong Vessel — a blood vessel jumping in the belly; diagnosis by palpating the belly

The third entry is the most interesting: cold lodging in the Chong Vessel — the pulsation of the abdominal aorta — “palpitating and moving under the hand.”

💬 Note from Doctor Ni: Third, cold lodges in the Chong Vessel. The Chong Vessel starts at Guanyuan CV4 and runs straight up the abdomen; when cold qi lodges inside the Chong Vessel, the vessel cannot pass; when the vessel cannot pass, the qi follows and therefore palpitates under the hand. When cold qi enters the Chong Vessel — the Chong Vessel is a blood vessel, a vessel with very strong blood power; when it is attacked by cold here and blocked, it starts to palpitate. So remember: palpitation on the left affects the liver; palpitation below affects the heart; this side is the lungs; palpitation around the navel is the spleen palpitation — you can feel the artery jumping when you touch it, or pull the skin open and see the skin and flesh jumping. Palpitation has its own prescriptions introduced in the Shang Han Lun and the Jin Gui. So “palpitating and moving under the hand” means exactly this — it is not the patient panting; it is that the moment you touch, you feel the pulse beating very fast. So a good doctor grabs the belly like this, palpates it, feels which side moves — the diagnosis of the abdomen is already done. Our abdominal diagnosis — the belly diagnosis.

Pain differentiation (seven): cold in the Back Shu vessels — blood deficiency breeds pain; a warm hand massaging slowly relieves it

Why does a back massage feel good? The mechanism is in this entry: cold lodging in the Back Shu vessels.

💬 Note from Doctor Ni: Fourth, cold qi lodges in the vessels of the Back Shu points — the ones on the back. The blood and qi stagnate — the vessel weeps (se) — blood deficiency; the blood cannot get through; the blood becomes deficient, and blood deficiency can also breed pain. This blood-deficiency pain — because our blood is governed by the heart, the heart governs the blood, so the pain responds accordingly. If it is blood-deficiency pain, when you massage his blood passage (blood vessels), the pain slowly eases. So when an elderly person is sick and you massage him, pat his back slowly, the pain gets much better — why? Because originally it was blood deficiency, and your hand is warm. So girls with cold hands — soak them in hot water before pressing, or use a hot towel. Our hands are warm; the heat felt from touching is the best — because the heat of the human body is fixed; I am not running a fever, the person is normal; what you feel is the body’s heat, in communication with your body heat — neither too hot nor too cold — otherwise how could I have survived all this time? So my heat must suit his heat — it is the best temperature. If you use artificial temperature adjustment, is it not either too high or too low? Adjust it too hot and you burn him; too cold and it does not work — the human body’s temperature is best. Of course, this kind of massage you can only do for your own family — if you massaged every patient like this, you would collapse the moment you lay down at night; overwork, chronic strain, too much fatigue. Every patient needs such tiring massage — impossible; only your own family can do it. I often see a couple where the wife has back pain; I tell the husband: massage her for an hour every night before bed — and the pain heals. What is wrong with massaging your wife? Of course I say this to him, and I did not do it well myself at home — right, everyone does it that way; we are all human. So you often have back pain and a massage feels wonderful — that is the meaning.

Pain differentiation (eight): cold in the Jue Yin vessel — belly pain drawing to the genitals; the lower jiao is too cold

The last two entries — one connects to the liver channel, one to the groin.

💬 Note from Doctor Ni: If cold qi lodges in the Jue Yin vessel — the Jue Yin vessel ties to the genitals; the Jue Yin liver channel falls upon the genitals, its qi belonging to the liver. If the cold lodges inside the vessel, in the vessel rather than outside it — lodged in the vessel, then the blood qi and vessel become urgent, the blood weeps and cannot pass, and this draws the evil qi to the lower abdomen — pain: we know the cold is inside the blood vessels, on the liver channel. If cold qi lodges in the yin gu (the upper inner thigh) — at the groin, down below — the cold rises to the lower abdomen; the blood qi below responds accordingly, so the belly pain draws to the genitals — the pain is drawn and pulled to the perineal area. Then we know: the cold in the lower jiao is too severe.

The whole page is cold — how could you prescribe cold-natured herbs for pain?

After laying out the ten pain patterns, Doctor Ni makes the loudest summary of the session: look — it is all cold qi. Did you see any pain caused by heat?

💬 Note from Doctor Ni: Look — it is all cold, right? If even a single pain is all cold, then how could you prescribe cold-natured herbs? Because prescribing them will not cure it — you know at a glance it will not heal. When a patient comes to you, it is not that he demands your medicine taste good — “oh, this doctor’s medicine tastes good” — he did not come for good taste; he wants the disease to recover. Your medicine tastes terrible, but if the disease heals, he will drink it even through the bitterness. Do you know what my patients tell me? “This medicine of yours — I have liver cancer now; if you can make me well, even if you tell me to eat excrement, I will eat it!”

💬 Note from Doctor Ni: But the mainland Chinese doctors in America are not like that — because their decoctions do not work, patients cannot get well drinking them, so they tell us Chinese people: “Americans do not like decoctions, so we do not prescribe decoctions.” In truth, they do not know how to prescribe them! They cannot write a good prescription. How much decoction do I write? Every day it goes out in bags — a bag of sixty pounds goes out. So they cannot prescribe — that is all. They say Americans do not like it and blame everyone else. When we truly act as doctors — especially learning medicine — when a medical problem occurs, first consider whether you yourself were right or wrong. So I am very strict in evaluating myself; I see things clearly, and I absolutely must not err. Second, every time you write a prescription and the medicine is wrong, the patient shows no response — the first thing to consider is whether my prescription is wrong; then, if the prescription is not wrong and the patient side is not wrong either, I think: did this person omit something in what he told me? That is how I work.

Cold between the membranes of the small intestine: the story of Qihai and Guanyuan, the two Dantians

The last entry — Qi Bo speaks of “cold qi lodging between the membranes of the small intestine” — and Doctor Ni uses it to explain the location of the Dantian clearly, bringing in the meditation practices of both Daoism and Buddhism.

💬 Note from Doctor Ni: If cold qi lodges between the membranes of the small intestine — the small intestine is full of membranes; the san jiao begins here, connecting back to the ming men (life gate). So he especially speaks of the small intestine’s membranes: the membranes outside the small intestine fall straight to the ming men behind, pass through the small intestine in the middle, and go directly to Guanyuan CV4. Above Guanyuan is where the Chong Vessel begins. The place where the membranes truly make contact is at Qihai CV6 and Shimen CV5. So the Daoists raised a question — some Daoists guard their intention at Qihai; Qihai is the Dantian; some Buddhist monks say, “I guard Guanyuan, three cun below the navel”; some say one and a half cun below — that is guarding the membranes. Truly, when we speak of the san jiao’s membranes, they begin at Qihai. But why do we so often speak of Guanyuan? Because Guanyuan is the Front-Mu point of the small intestine, paired internally with the pericardium — extremely important. So remember heart and small intestine — Guanyuan and Qihai are not far apart. When you sit in meditation, no one points a finger at Qihai and tells you to guard it — there is no such gesture, right? This kind of intention is imagined; roughly this area is enough; do not fuss over it. You have never seen a person meditating with a finger pointing inside, right — no one has attained the Way that way. But we should know: Qihai is the place of the san jiao (membranes); the small intestine is the place of Guanyuan; and both are each called the Dantian.

Closing: one page of text strings cough and pain together

This lecture is just as information-dense: the Ke Lun teaches that cough must be traced from zang to fu to find the root; the Ju Tong Lun teaches that nine times out of ten, pain is cold — cold outside the vessels hurts the limbs, cold inside the vessels refuses pressure, cold between the intestines likes pressure, cold at the Jiaji points makes pressing useless, cold in the Chong Vessel palpitates under the hand, cold in the Back Shu vessels makes blood deficiency love massage, cold in the Jue Yin vessel draws pain to the lower abdomen, cold in the upper inner thigh means the lower jiao is too cold. Doctor Ni says: these are all the foundation for writing prescriptions later — know the cause, and you know how to write the prescription.

💬 Note from Doctor Ni: Next time we continue with the treatment of pain patterns. Today, first hold this concept: disease always has a cause; when you know the Huang Di Nei Jing well, you trace the cause and find it. Everyone remember — pain is all cold. Then when you write prescriptions, you have a foundation in your heart: for cold we prescribe hot-natured herbs — that can never be wrong. That is what the Ju Tong Lun gives us first.

Based on Doctor Ni Haixia’s Ren Ji (Human Records) lecture series on the Huang Di Nei Jing (Lecture 46)