Gout Swollen Red and Hurting Bad, Joint Pain That Travels or Stays in One Spot, Muscle Wasting? — Doctor Ni Haixia’s Fifty-First Lecture on the Huang Di Nei Jing: the Bi Lun (Bi-Syndrome Treatise, Part 2) and the Wei Lun (Atrophy Treatise, Part 1) — Gout Pain That Hurts Most Is Cold, Not Heat; When Fu Zi Fails, Use Wu Tou; Migrating Pain Is Wind, Fixed Severe Pain Is Cold, Fixed Heavy Pain Is Damp; Painkillers Chill the Kidneys and Injure the Liver; the Four-Season Bi and the Five-Zang Bi — Bone Bi Enters the Kidney, Sinew Bi the Liver, Vessel Bi the Heart; Lung Bi, Heart Bi, Kidney Bi, Intestinal Bi and Bladder Bi; Overeating Injures the Stomach and Intestines; the Shu Points of the Five Zang and the He Points of the Six Fu; Ying and Wei Do Not Form Bi; the Five Kinds of Painless Bi; Wei Means Atrophy — Wei Disease Arises in Heat; Lung Heat Scorches the Leaves; the Liver Generates the Sinews, the Sinews Generate the Heart, and the Kidney Is the Root of the Prenatal

Patient search words: gout / high uric acid / red swollen joints / joint pain that hurts terribly / migratory joint pain / joint pain that moves around / joint pain fixed in one place / rheumatic arthritis / rheumatoid arthritis / painkillers damage the kidneys / kidney problems from painkillers / knee pain / ankle pain / swollen legs and feet / swelling in the lower body / cannot pass urine / lower abdominal bladder pain / frequent and urgent urination / bed-wetting / muscle wasting / arm muscle atrophy / legs without strength / wei syndrome / muscle weakness / lung-heat cough / palpitations and racing heart / irritability / no appetite / vomiting right after eating / bloated belly / diarrhea / sore lower back / how is rheumatic disease treated / acupuncture for rheumatism / wind-dispelling herbs / cold-dispelling herbs / damp-dispelling herbs

Corresponding topics (medical terms): Su Wen · Bi Lun (Bi-Syndrome Treatise, chapter 43), concluded — gout with red swelling is not heat; cold bi uses Fu Zi (aconite), and when that cannot move it, Wu Tou (stronger aconite); the three-qi differentiation of xing bi (migrating bi), tong bi (painful bi) and zhuo bi (fixed bi) — wind prevailing is xing bi, cold prevailing is tong bi, damp prevailing is zhuo bi; the prescription combines wind-, damp- and cold-dispelling herbs; Zhang Zhongjing treated rheumatic joint pain with only a few herbs; a critique of Western painkillers that do not distinguish cold from heat — they chill the kidney, kidney cold moves to the liver, and kidney failure leads to dialysis; the four-season bi — winter bone bi, spring sinew bi, summer vessel bi, long-summer (zhi yin) muscle bi, autumn skin bi — bi aggravated by re-exposure in its own season; the five zang each have their correspondence (lung governs skin and hair, kidney bone, spleen muscle, liver sinews), and long-lasting disease lodges inward in the corresponding organ — bone bi not resolved, re-infected, enters the kidney; damp tends downward and easily injures the lower limbs (ankle, knee, hip); sinew bi enters the liver, vessel bi the heart, muscle bi the spleen, skin bi the lung; the five-zang bi symptoms — lung bi fullness, panting and vomiting; heart bi vessels blocked, vexation with palpitation under the heart, sudden upward qi with panting, dry throat, much belching, and fear when reversed qi rises; liver bi startled at night, drinking much, urinating often, upper abdomen drawing up as if pregnant; kidney bi good at bloating, the buttocks replacing the heels and the spine replacing the head; spleen bi four limbs lax and weary, coughing and vomiting fluid, great blockage above; intestinal bi drinking much but unable to void, qi struggling in the middle, sometimes undigested diarrhea; bladder bi pressing the lower abdomen hurts inside like boiling water poured on, rough urination, clear snivel above; the female uterus and male seminal palace sit with the pericardium network; yin qi — in stillness the spirit is stored, in agitation it is lost; overeating injures the stomach and intestines; restraining appetite, eating only when hungry, stopping at seventy percent full is the way of longevity; bi gathering in the five zang — lung panting, heart worry and brooding, kidney bed-wetting, liver weariness, spleen muscle weakness; where wind prevails it is easy to cure; entering the viscera means death, between skin and muscle it heals quickly, between sinew and bone the pain lasts long; the bi of the six fu has food, drink and daily living as its root — wind, cold and damp strike the Shu points and diet answers; to treat bi take the Shu points of the five zang (Liver Shu BL18, Heart Shu BL15, Spleen Shu BL20, Lung Shu BL13, Kidney Shu BL23) and the He points of the six fu (e.g., Zusanli ST36 for the stomach, Weizhong BL40 for the bladder, Yanglingquan GB34 for the gallbladder); each following where the excess lies, and it heals — chou means recovery; the definitions of ying and wei — ying is the essential qi of water and grain that enters the vessels, harmonizes the five zang and spreads through the six fu; wei is the fierce qi of water and grain, swift and slippery, that does not enter the vessels but moves between skin and flesh, warming the huang membranes (the san jiao) and spreading through chest and abdomen; going against the qi brings disease, following it brings recovery; ying and wei do not combine with wind, cold and damp, so they do not form bi; why bi may hurt or not, be cold or hot, dry or damp — pain means much cold (heat pain comes only from overwork); painless numbness means the disease has gone deep and the movement of ying and wei is rough; those constitutionally hot (fat, fond of rich food) and those constitutionally cold (thin, plain diet); bi-heat arises when yang meets yin; profuse sweating and clamminess means damp prevails — sticky skin felt on the pulse; yang guards the exterior and when yang is deficient the fluids leak; the eight principles of yin-yang, exterior-interior, deficiency-excess, cold-heat as the master key of all prescribing — the Huang Di Nei Jing does not discuss herb properties; the five kinds of painless bi — in the bone it is heavy, in the vessels the blood congeals and stops flowing, in the sinews it cannot bend and stretch, in the flesh it is numb, in the skin it feels cold; in cold it cramps, in heat it relaxes (a stroke hand curled up is cold, stretched open is wind-heat)) · Su Wen · Wei Lun (Atrophy Treatise, chapter 44), opened (wei means atrophy; compared with the Ke Lun (Cough Treatise) — cough first attacks the lung and returns to the lung even when it transmits, so treat at the beginning; wei disease arises in heat; treating atrophy takes a long time, so prevent it early; the five zang each cause atrophy — lung governs skin and body hair, heart blood and vessels, liver sinews and membranes, spleen muscles, kidney bone and marrow; qi refines into body hair and blood refines into head hair; the sinew meeting point Yanglingquan GB34 sits at the knee and yin cold stops at the knee; the liver generates the sinews and the sinews generate the heart — in the womb the baby is water first (true water), grows sinews in two weeks, then the sinews jump and become the heart; liver is water generating wood and wood generating fire; Western medicine sees the heart as the first organ, Chinese medicine sees water first — the kidney is the root of the prenatal, so kidney water is treasured; the white membranes in muscle are the surplus of sinews; gao is fat and rou is lean meat, both governed by the spleen; lung heat scorches the leaves and the skin and hair become weak; the normal state — the lung models heaven like a canopy, the heart is the heat inside the earth, cold and heat meeting produce a normal temperature, the car radiator analogy)

Opening: gout swollen red — must be heat? Doctor Ni says: wrong — the pain that hurts most is cold

Continuing from the last lecture, the Bi Treatise moves on. Doctor Ni starts with the disease everyone knows best — gout. Many people see a red, swollen joint and immediately decide it is a heat pattern. Doctor Ni pours cold water on that idea on the spot.

💬 Note from Doctor Ni: This gout — it swells badly, right? Always that red swelling — is it heat? No! Pain that hurts very heavily is cold. If you see swelling and think it is heat, you prescribe cold, cooling herbs — useless! You need to prescribe cold-dispelling medicine. That is why we have Fu Zi and Wu Tou. When Fu Zi is prescribed but cannot move it, Wu Tou works even better — Wu Tou is stronger than Fu Zi and removes the cold. And how does the ordinary doctor treat it? He does not even dare to use Fu Zi or Wu Tou, so how can he treat it? That rheumatic disease will never be cured. People with heavy dampness stay stuck and still — the patient comes to you: “Doctor, my joints hurt. Where does it hurt? This joint of mine is strange — today it hurts here, tomorrow it hurts over there.”

One sentence breaks it open: redness and swelling do not equal heat; severe pain is cold. Whether you dare to use Fu Zi and Wu Tou is the dividing line between curing rheumatism and not curing it.

Joint pain that “runs around” or is “nailed to one spot”? The three-qi differentiation, easy once you see it

With one sentence from the patient, Doctor Ni hears the whole story — of wind, cold and damp, who is more and who is less is all written in the “temperament” of the pain.

💬 Note from Doctor Ni: We know the three qi — wind, cold and damp. If wind is more, the pain migrates; open the wind herbs bigger. Some people say: “Ouch, I hurt very badly — sometimes it hurts over there, sometimes it is gone” — cold prevails! Right? Cold prevails here, so the cold-dispelling herbs must be prescribed heavier. If the pain is fixed in one joint, and the joint hurts very badly and feels very heavy — damp prevails! The damp-dispelling herbs must be prescribed heavier. So when you write the prescription, wind herbs, damp herbs and cold herbs — prescribe them together. If you know the cause is these three qi mixed together, your prescription is very simple.

This is the practical differentiation of xing bi (migrating bi), tong bi (painful bi) and zhuo bi (fixed bi). Doctor Ni even brings up Zhang Zhongjing as the model: in treating rheumatic joint pain, the herbs number only a few — simplify it down, and from then on gout and rheumatism all have a cure, no matter what Western medicine calls it, even rheumatoid arthritis.

💬 Note from Doctor Ni: This patient is pitiful. When gout and arthritis hurt, people around who have never suffered do not understand — it really is extremely painful. Some patients are lazy and like convenience: “Taking herbal medicine is so troublesome — taking a painkiller pill is better.” He finds it troublesome — and shortens his life. He takes them until the kidneys are damaged; by his fifties or sixties the kidneys fail, and he still has to go on dialysis; when dialysis cannot wash it out, the person dies. You find it troublesome — and your life is gone! So in the end, what is it? Not believing in Chinese medicine! If he truly wants to live and trusts you, tell him to take five months of medicine and he will take it.

A critique thrown in: once the painkiller goes down, the kidney turns cold

Why do painkillers injure the body so much? Doctor Ni gives an explanation that still rings loud and clear today — cold and heat.

💬 Note from Doctor Ni: Every painkiller that goes down injures the kidneys and makes the kidney cold. Because Western medicine does not distinguish cold from heat — it stops the pain as it goes down, and strangely, the kidney turns cold, because it has no concept of cold and heat. Once the kidney is cold, kidney function fails. Does kidney cold transfer to the liver? Absolutely! It moves to the liver and becomes liver cold. So when people take painkillers, many injure the kidney and the liver — this is the reason. It is not only painkillers; many Western drugs injure the kidney and liver, all because — Westerners do not understand cold and heat — everything they make is a cold medicine. Chinese medicine treats this very quickly.

Bi by season: winter bone bi, spring sinew bi, summer vessel bi, long-summer muscle bi, autumn skin bi

Having finished treatment and critique, Bo Qi puts bi back into the coordinates of the four seasons.

💬 Note from Doctor Ni: All diseases — whether internal medicine or surgery — actually relate to the solar terms. Disease arising in winter we call bone bi; arising in spring, sinew bi; in summer, vessel bi; in long summer (zhi yin), muscle bi; in autumn, skin bi. The symptoms differ, but no matter how they differ, they are all wind, cold and damp. So when you are struck again in the season of that disease, it is aggravated — this is what the text means: bi is bi re-struck by wind, cold and damp in its own season.

The five zang each have their correspondence: when the disease drags on, it “lodges inward” into the organs

Bi staying on the body surface is nothing to fear — the fear is dragging. Bo Qi says: the five zang each have what they correspond to.

💬 Note from Doctor Ni: The five zang all have places they correspond to: the lung governs skin and body hair, the kidney governs bone, the spleen governs muscle, the liver governs sinews. When the disease lasts long and does not leave, it lodges inward in its corresponding place — when the disease is long-lasting, it stops where it corresponds. So if bone bi does not resolve and just stays there, and is then infected again, it runs into the kidney. When you first catch wind, cold and damp, the damp descends — it most easily injures the lower limbs: the ankle, the knee joint, and the hip are all places easily injured by damp. If you have bone bi disease and do not cure it, and it stays long without leaving, the disease enters the internal organs. Bone bi entering the internal organs — the first thing injured is the kidney.

Sinew bi unresolved runs into the liver, vessel bi into the heart, muscle bi into the spleen, skin bi into the lung — the longer the disease drags, the deeper it goes. This is “lodging inward.”

What does wind, cold and damp look like once inside the organs? Each organ has its own face

This section is the densest in useful detail: when wind, cold and damp enter the five zang, each has its own set of symptoms.

💬 Note from Doctor Ni: When wind, cold and damp enter the lung, the patient gets vexed fullness, panting and vomiting. Because the lung itself is where the qi mechanism lives, where yang qi lives, like a canopy covering the whole body — suddenly wind, cold and damp go in, the great qi is blocked and congested, and what the congestion produces is fullness, panting and vomiting. Heart bi: the vessels are blocked; with vexation there is palpitation under the heart — distension under the heart, sudden upward qi with panting, dry throat, much belching, and fear when reversed qi rises. Why fear? The heart is damaged — water comes to overcome fire! We have said again and again that the five zang generate and overcome each other; when the heart has a problem, water immediately moves in, without a moment’s pause. Normally a healthy person must keep the five zang in balance — the moment there is a problem, it comes in; it will not say “wait a minute, let me think about it” — it does not wait for you! So we say, the moment the heart develops a problem, first pay attention to the kidney and see whether water has injured its way in.

💬 Note from Doctor Ni: Liver bi: at night lying down, startled; drinks much; urinates often — running to the toilet all day; above, drawing up as if pregnant — because the liver channel lands between the ribs of the chest and diaphragm, and lands at the genitals, so these phenomena appear. Kidney bi: good at bloating — the buttocks replace the heels and the spine replaces the head: a person normally walks on his feet; when they swell he cannot walk and has to sit; the lower body fills with edema. When the kidney catches wind, cold and damp, it forms accumulated water. Spleen bi: the four limbs are lax and weary, coughing and vomiting fluid, a great blockage above — the spleen is earth, itself damp; now wind, cold and damp all three come in, the spleen is already very damp, and you add wind, add cold, add damp — is the damp not even worse? The middle diaphragm is blocked; when we eat, the middle is full of damp and the food cannot go down. This kind of vomiting, we know, is caused by very heavy damp — if you only prescribe anti-vomiting herbs but do not know the vomiting comes from heavy damp and do not prescribe damp-dispelling herbs, the vomiting stays right there. So when you write a prescription, you must know where the nausea comes from. We have many prescriptions specially for vomiting, and their contents are all different. Reading the Huang Di Nei Jing from here, later when I lecture on the Shang Han Lun and Jin Gui Yao Lue, it will be very simple — the moment you see a prescription you know what Zhang Zhongjing was thinking.

Intestinal bi and bladder bi: one drains from behind, the other feels like boiling water poured on the lower abdomen

Wind, cold and damp can also burrow into the intestines and into the bao (the female uterus and the male seminal palace).

💬 Note from Doctor Ni: Intestinal bi: drinking much but unable to void, qi struggling in the middle, sometimes undigested diarrhea — wind, cold and damp run into the intestines; he drinks a lot of water because the damp is very heavy, blocking things inside; sometimes urine cannot come out, sometimes it suddenly comes out as diarrhea: when it cannot be discharged from the front, it is discharged from the back. Bladder bi: pressing the lower abdomen hurts inside, like boiling water poured on — the urine is rough, and above there is clear snivel. The bao — the female uterus sits between the small intestine and the bladder; a man has the seminal palace here. This bao is attached to the pericardium network. When you see something very exciting, you get excited and stand up — this is the reason, because the pericardium and the bao channels are connected. When wind, cold and damp run into the bao, this is what results: clear snivel running above and urine unable to come out below.

Yin qi: in stillness the spirit is stored, in agitation it is lost — and the way of nourishing life along with it

💬 Note from Doctor Ni: Yin qi — in stillness the spirit is stored, in agitation it is lost. Yin governs stillness. When a person sits quietly, able to meditate, the spirit lives inside, yin is inside; when very agitated, the spirit is lost. Then Bo Qi suddenly says: overeating injures the stomach and intestines. If you meet wind, cold and damp and double your eating, the stomach and intestines are injured. So to read Chinese medicine you must read in reverse — the true way of nourishing life is to restrain your appetite, do not eat too much, let the stomach qi rise. Every meal, you must wait until you are hungry before eating; if you are not hungry, do not eat. After dinner, if you are not hungry by bedtime, do not eat again. Keeping a little hunger at all times is best, because the stomach qi is always there — what is called stomach qi is hunger. When too hungry, eat a little something, but not to fullness; when you finish eating, keep a little hunger and stop. Being able to control yourself — all this is the road to longevity, health and body maintenance.

When bi gathers in a zang, each has its own mark

💬 Note from Doctor Ni: If bi gathers on the lung, there is panting; gathering on the heart, worry and brooding; bi gathering on the kidney — bed-wetting; bi gathering on the liver — the patient is weary, the whole body without strength; bi gathering on the spleen — the muscles have no power. Any bi that lasts long unresolved affects that organ more and more severely. Later Bo Qi says one sentence: where wind prevails, it is easiest to cure! Because the disease sits at the shallowest place.

Why do some people die of bi, some hurt for a long time, and some recover quickly? Shallow and deep are not the same

The Yellow Emperor is also curious: bi sometimes kills, sometimes hurts long without dying, sometimes heals easily — why? Bo Qi’s answer is four words — shallow and deep are not the same.

💬 Note from Doctor Ni: If wind, cold and damp enter the viscera, death; lingering between sinew and bone, the pain lasts long; if it stays between skin and muscle, it heals quickly. Skin and muscle, blood vessels, sinew and bone — the deeper, the harder to heal, the longer the disease; entering the viscera is very dangerous, life-threatening. So we are very wary of bi entering the viscera.

The bi of the six fu: the root of the disease is “food, drink and daily living”

The Yellow Emperor asks again: what if bi runs into the fu? Into the digestive system?

💬 Note from Doctor Ni: Bo Qi says bi’s disease root is the patient’s food, drink and daily living. The gallbladder, small intestine, stomach, large intestine and bladder all have Shu points. When wind, cold and damp strike the Shu points of the digestive system, at this time diet answers — if you ordinarily do not know how to moderate your eating, eating recklessly, alternating great fullness and great hunger, without restraint, and wind, cold and damp run onto that fu’s Shu point, they likewise enter the fu. So no matter what, if you always keep your eating moderate, wind, cold and damp cannot easily get into your body. When the pathogen enters from the fu, it hides in the digestive system.

How to treat it? Shu points of the five zang, He points of the six fu — “chou” means recovery

The Yellow Emperor asks how acupuncture treats it, and Bo Qi gives the master rule of acupuncture for bi.

💬 Note from Doctor Ni: The five zang all have Shu points. When the five zang form bi and catch wind, cold and damp, we needle their Shu points; for the six fu, we needle their He points. Following the course of the vessels, each has its own origin; each following where the excess lies, and it heals — this character is pronounced “chou”; chou means the disease is cured. As I introduced when we did acupuncture: the Shu points treat zang diseases — that is, the back Shu points: Liver Shu BL18, Heart Shu BL15, Spleen Shu BL20, Lung Shu BL13, Kidney Shu BL23; the He points we use to treat fu diseases; for the other channels, take points according to the channel.

Can ying and wei catch bi? No — ying and wei do not combine with wind, cold and damp

The Yellow Emperor asks again: can rong and wei (nutritive and defensive qi) make a person catch bi? Can wind, cold and damp enter the blood and qi? Here Bo Qi defines ying and wei.

💬 Note from Doctor Ni: Ying is the essential qi of water and grain — when you eat rice, noodles and grains, you take their essential qi; this is ying. It enters the blood aspect, harmonizes the five zang, spreads through the six fu, and only then can enter the vessels — this is the source of blood, the blood vessels running up and down through the five zang and connecting the six fu. Wei is the fierce qi of water and grain — its qi is swift and slippery; it cannot enter the vessels; it is in the skin, between the flesh, warming the huang membranes — that is the san jiao, where qi travels — and spreading through the chest and abdomen. Blood and qi both come from water and grain: from the grain in food, the yin within creates blood, and the yang (all food has qi) creates qi, which does not enter the vessels but stays between skin and flesh. Go against its qi and there is disease; follow it and there is recovery. So this ying and wei — it does not combine with wind, cold and damp, therefore it does not form bi. The bi of wind, cold and damp will not enter the blood aspect, will not enter the qi aspect; it only sits among skin and muscle, between sinew and bone, in the zang, in the fu — but it will never run into the blood vessels.

Why is bi sometimes painful, sometimes not; sometimes cold, sometimes hot; sometimes dry, sometimes damp?

The manifestations of bi are endlessly varied. Doctor Ni takes them apart one by one (page 368).

💬 Note from Doctor Ni: Pain — the vast majority comes from cold. The patient hurts; cold qi is much, because where there is cold there is pain. Of course there is also heat; heat has only one kind — overwork: only people who labor and wear themselves out get heat injury with fever. So we often meet patients with abdominal pain from cold; you only prescribe blood-moving, stasis-resolving herbs and it still hurts — because you did not prescribe cold-dispelling herbs! Then there are those who do not hurt, who are numb — this kind of disease has lasted long and gone deep; there is not much pain because the disease has run into a very deep place. This wind and cold do not enter the wei qi, but they slow and block the movement of blood and qi, blocking the channels — we call this numbness (bu ren): bu ren means the skin has a tingling, numb feeling, little sensation.

💬 Note from Doctor Ni: In cold, yang qi is little, yin qi is much, adding to the disease, so it is cold — cold and cold connect and aggravate each other. People ordinarily come in two kinds: one is constitutionally hot — the comparatively fat person, one who likes rich, heavy food, is constitutionally hot; another kind is thin, with a plain diet, himself cold — the constitutions differ. In heat, yang qi is much, yin qi is little; when the disease qi is strong, yang meets yin, so there is bi-heat — a constitutionally hot person meeting wind, cold and damp generally shows heat symptoms; only people ordinarily with more cold show this kind of acute pain. Profuse sweating and clamminess — people with heavy damp are amusing: it is not necessarily that the body sweats a lot. When you take the pulse, I touch the patient’s skin — strange, sticky, damp, a layer on the skin — this is a person with very heavy damp; clinically you meet it all the time. Such people have little yang qi and much yin qi; yin and yang interfere, so the sweat comes out clammy. Yin and yang are relative and should be balanced: if your yang is little, the yin qi will be much. Yang itself guards the exterior — our skin is here, with a lot of water inside; you do not lose the water, why? Because yang guards it, so the water is not lost. When yang is deficient and yin is abundant, of course you lose yin — yin is the body fluids, and they run out. When this kind of person catches wind and cold, it is aggravated; the cold is aggravated. Because yang is little and yin is much — these are two different kinds of people, and meeting this situation they produce different symptoms.

The eight principles take the stage: the Huang Di Nei Jing does not discuss herb properties, only yin-yang, exterior-interior, deficiency-excess, cold-heat

This section is the master key of study that Doctor Ni repeats again and again.

💬 Note from Doctor Ni: You must know this — our Chinese herbs are also divided into yin-yang, exterior-interior, deficiency-excess, cold-heat: some herbs walk the exterior, some walk the interior; some are yin herbs, some yang herbs; some are deficiency-tonifying, some excess-dispelling; some dispel cold, some dispel heat. Because the Huang Di Nei Jing does not discuss herb properties — it only speaks of yin-yang, exterior-interior, deficiency-excess, cold-heat, our eight principles. So later when you hold a herb — this is an exterior herb, this is an interior herb, this is a yin herb, this is a yang herb, and so on. In the later Shen Nong Ben Cao Jing, when we go looking for herbs, we always select which herbs treat which diseases according to the yin-yang, exterior-interior, deficiency-excess, cold-heat differentiation of the Huang Di Nei Jing.

The five kinds of painless bi: in the bone it is heavy, in the sinew it cannot stretch… in cold it cramps, in heat it relaxes

Turning to page 369, Bo Qi discusses the situations where bi does not hurt.

💬 Note from Doctor Ni: Bi in the bone — the body feels very heavy; in the vessels, the blood congeals and does not flow, the blood vessels congeal; in the sinews, it cannot bend and stretch — so when you see a foot that cannot straighten, we know it is a sinew problem; in the flesh, it is numb; in the skin, it feels cold. All kinds of bi: in cold, cramping — the whole thing contracts; cold contracts; in heat, relaxing — it stretches open. These two are the positive and the reverse. For example, we see a stroke patient: the hand hooked up, bent and unable to open — that is cold; stretched open — that is a heat pattern (wind-heat), and the prescription is a little different. The five kinds without pain are right here.

And with that, page 370, the Bi Treatise is finished.

Wrapping up: Bi Treatise done — the next essay, the Wei Lun: wei means atrophy

💬 Note from Doctor Ni: This essay finished, next time we begin to lecture on wei. See how we are now starting to divide into chapters — before we discussed the great principles; now it becomes more and more divided, more and more detailed; which symptoms will appear, slowly divided out. The Wei Lun introduced today is the forty-fourth chapter of the Huang Di Nei Jing. Wei, as the name implies, is atrophy — you look and this person’s leg has atrophied away; that arm’s muscle has atrophied away — that is wei. This essay discusses where wei comes from, how to treat it, and how to make the diagnosis.

The Wei Lun opens: first compare it with the Cough Treatise — wei disease arises in heat

Doctor Ni first uses the Cough Treatise from the previous essay as the frame of reference.

💬 Note from Doctor Ni: Before, we lectured on the Ke Lun, devoted to cough, and it opened the door straight away: cough first attacks the lung — if you have no lung, there is no cough at all. Cough keeps coughing inside; on the surface it is all lung; cough for a long time and only then it transmits to liver cough, spleen cough, kidney cough, transmitting all the way down; when the zang are done transmitting, it goes to the fu — but in the end, turning back, it is still the lung. So if you treat at the beginning — as soon as a cough starts, one strike and the cough is cured — it will not transmit. Wei disease, by contrast, arises in heat; the whole essay speaks of one heat — in the yin-yang, exterior-interior, deficiency-excess, cold-heat of Chinese medicine, the heat discussed in this essay is very special. Clinically, when we treat wei disease, it consumes a lot of time, because once the wei has set in, to build it back up really takes a period of time before it can recover — it is not incurable, it can be cured, but it is very time-consuming. If you understand the cause of wei disease and nip it in the bud — the moment the disease starts you strike — there will be no wei syndrome at all: this is the key point of the essay. The Yellow Emperor asks: the five zang cause a person to develop wei — why? Bo Qi answers: the lung governs the body’s skin and body hair; the heart governs blood and vessels; the liver governs sinews and membranes; the spleen governs the body’s muscles; the kidney governs the body’s bone and marrow — only inside the bone is there marrow, so bone and marrow both belong to the kidney. Why speak of sinews and membranes? Skin and hair must be separated — we read before: qi refines into body hair, blood refines into head hair. When the hair is all curled and twisted, it is dead — that is the end of the qi. Blood and vessels both belong to the heart; you cannot separate them. Why did the classical Chinese write so concisely? Because in the old days it was carved on bamboo slips — to write a book you carved bamboo slips; the simpler the better. You cannot blame him; in those days people carved by hand.

Why does yin cold stop at the knee? — the sinew meeting point Yanglingquan

💬 Note from Doctor Ni: The sinew meeting point Yanglingquan GB34 is at the knee. Why does the yin-cold pattern stop at the knee? Because the sinew meeting point Yanglingquan is there — the liver channel’s qi arrives here. So when all yin patterns appear, however ice-cold the feet get, it stops at the knee, because from there on it is the sinews’ jurisdiction — we will introduce that later. The liver has sinews; after these sinews are generated, they then create the heart.

A bonus on the origin of life: why does the baby have a heartbeat first? — the kidney is the root of the prenatal

Speaking of the liver governing sinews and the sinews generating the heart, Doctor Ni takes the opportunity to tell the story of the origin of life — the “easter egg” of the whole lecture.

💬 Note from Doctor Ni: In the very beginning, the baby in the mother’s belly is water — there is true water; the fertilized egg attaches to the water and only then begins to grow. In the first two weeks it grows a piece of sinew; two weeks later, the sinew starts to jump — that is the heart! So the liver is water generating wood, and wood generating fire. Western medicine sees the heart start to jump and says this is life, so they think the first internal organ is the heart; Chinese medicine is not like that — Chinese medicine thinks the first organ is water — so the kidney is the root of the prenatal, and we treasure this kidney water — that is the reason. The sinews of the whole body are born from the liver; after the liver produces the heart, all the sinews fall onto the joints of the whole body, and every joint has sinews. And inside the muscle — take chicken meat: if you cut it open, inside there are layers of white membrane, right? That white membrane is also the surplus of sinews — that membrane also belongs to the sinews.

The spleen governs muscle: gao is fat, rou is lean; lung heat scorches the leaves and the skin and hair become weak

💬 Note from Doctor Ni: The spleen governs the body’s muscle — ji and rou are not the same: if we take gao as fat, then rou is lean meat; the white meat (gao) is fat, and lean meat is rou; both belong to the spleen. The kidney governs bone and marrow. Because the five zang face our five correspondences — lung pairs with skin and hair, heart with blood and vessels, liver with sinews and membranes, spleen with muscle, kidney with bone and marrow — below, the causes of disease begin to be explained. Because the lung governs skin and body hair, when the lung heat scorches the leaves, the skin and hair become weak. To read the Huang Di Nei Jing properly, you must know what the normal state (chang tai) is — what a normal person is.

Closing: what is the normal state? — the car radiator analogy

💬 Note from Doctor Ni: In the Nei Jing’s conception, the lung models heaven, like a canopy covering the whole body — the skin and hair cover the whole body; it covers everything, so the lung models heaven. Is heaven not very cold? Right! And we humans — heaven is in the middle, the earth is in the middle, surrounded by the atmosphere. Is the earth not very hot inside? Hot as fire — that is the heart. So if we compare heaven to the canopy, the heart is the heat inside the earth — these are cold and heat; the two meet and produce a normal temperature. It is like driving a car: if you have no radiator, the car overheats; if the radiator is too big and holds too much water, too cold and it will not run. Overheating is no good either — you must have the proper temperature — this is the normal state.

One sentence closes the whole lecture: cold and heat balancing, just right, is the healthy temperature. This lecture travels from gout to prescriptions, from the five-zang bi to ying and wei, and then lands on the origin of life in the Wei Lun — an enormous amount of information. But one main thread is enough to remember: disease lies in shallow or deep; treatment lies in pattern differentiation; and nourishing life lies in restraint.

What to take away

Red and swollen is not heat: gout pain that hurts most severely is cold — prescribe cold-dispelling herbs; if Fu Zi (aconite) cannot move it, Wu Tou is stronger.
Three qi, three temperaments of pain: migrating pain means wind prevails (dispel wind heavily), fixed severe pain means cold prevails (dispel cold heavily), fixed heavy pain means damp prevails (dispel damp heavily) — prescribe all three kinds of herbs together, as Zhang Zhongjing did.
Painkillers are cold medicine: they chill the kidney, kidney cold moves to the liver — this is why long-term painkiller use injures both organs and ends in dialysis.
Bi that drags on lodges inward: bone bi enters the kidney, sinew bi the liver, vessel bi the heart, muscle bi the spleen, skin bi the lung — treat it early; damp tends downward and easily injures the ankle, knee and hip.
Treatment rule for bi: Shu points of the five zang (Liver Shu BL18, Heart Shu BL15, Spleen Shu BL20, Lung Shu BL13, Kidney Shu BL23), He points of the six fu (Zusanli ST36, Weizhong BL40, Yanglingquan GB34…); where wind prevails it is easy to cure; entering the viscera is dangerous.
Nourishing life: yin qi in stillness stores the spirit; overeating injures the stomach and intestines — eat only when hungry, stop at seventy percent full, keep a little hunger.
Wei means atrophy: it arises in heat, is slow to treat, so prevent it early; the kidney is the root of the prenatal — in the womb life begins as water, then sinew, then the jumping sinew that becomes the heart; treasure kidney water.
Normal state: the lung is the canopy of heaven, the heart the heat of the earth; cold and heat balance into the right temperature — like a car radiator, neither too hot nor too cold.

Based on Doctor Ni Haixia’s Ren Ji (Human Records) Huang Di Nei Jing lecture series (Lecture 51), presented by Doctor Luo Dalun.