Blood in Stool or Urine? Kidney Cancer Destroyed by Chemotherapy? Stroke and Paralysis? — Doctor Ni Haixia on the Mai Jie Pian (Resolving the Pulse, Part One) of the Huang Di Nei Jing

Patient search terms: blood in stool / bloody stool / bleeding from the anus / twenty bloody stools a day / blood in the stool / blood in urine / hematuria / kidney cancer / kidney cancer chemotherapy / no strength after chemotherapy / chemotherapy not working / can’t eat / no appetite / gastric ptosis / stomach drooping / stomach bloating / stroke / stroke paralysis / hemiplegia / one side of the body weak / stroke with loss of speech / slurred speech after stroke / stroke aftereffects / heart racing after a fright / easily startled / timid / lower back pain / lumbar pain / kidney-deficiency back pain / tinnitus / ringing in the ears / elderly person talking to himself / talking nonsense / mania / diarrhea / enteritis / Crohn’s disease / Lyme disease / feeling the pulse / pulse diagnosis / stomach qi / Huang Di Nei Jing / Mai Jie Pian

Corresponding medical names: the end of the Su Wen chapter Ping Ren Qi Xiang Lun (The Pulses of a Healthy Person), covering the pulse of stomach qi, intestinal bleeding (chang pi) and hemiplegia (pian ku), plus Chapter Forty-Nine, the Mai Jie Pian (Resolving the Pulse), part one · mai zheng he (pulse and symptoms agree) as the master key to judging life and death: a person losing blood should look pale, feel cold and be weak — small, thin, deep pulse agrees and is curable; blood warm, body hot, pulse floating, large and racing — pulse and symptoms disagree, interior yang about to expire · chang pi xia xue (intestinal bleeding): a small and relaxed liver pulse — easy to cure; a small, forceful, deep kidney pulse with bleeding — blood warm and body hot, death; cold organs bleeding, both organs diseased together — curable; a small, wiry, urgent pulse means cold inside; body hot, death within seven days (stomach qi sustains seven days without food) · real cases: single-kidney 5.5-cm tumor, five chemotherapy sessions, nearly dead — small thin pulse, cold body, afraid of cold, one dose cured overnight; a seventeen-year-old with twenty bloody stools a day (Crohn’s + Lyme) — stool color normal the next day; both because pulse and symptoms agreed; forget the Western disease name, prescribe by the pattern · the stomach pulse deep, drum-like and rough, or enlarged beyond its position: all pulses root in stomach qi; stomach qi blocked, the pulse grows large; a large Cun pulse with a small hard urgent heart pulse — ge you pian ku (one-sided paralysis); the heart pulse gone — stomach qi sinking, gastric ptosis, classical formulas need only two herbs · pian ku: men on the left, women on the right (right hand qi pulse, left hand blood pulse; men ruled by qi, women by blood); can still speak — curable, thirty days, provided within two weeks of onset; cannot speak — heart, lung and kidney all injured, three years; under twenty years old — at most three years · the pulse like panting, bao jue (sudden reversal) from fright, qi disturbed, self-cures in three or four days · the pulse like floating planks, ten-plus beats per breath — essence qi exhausted, death · five strange pulses, each dying in the season that conquers it: ru huo xin ran (like a burning flame, heart essence seized, dies when the grass dries in winter); ru san ye (like scattered leaves, liver qi failing, dies when leaves fall in autumn); ru sheng ke (like an unexpected guest, kidney qi insufficient, dies when jujube leaves come in late spring and early summer); ru ni wan (like a clay pellet, stomach essence insufficient, prayer-bead pulse that flattens when pressed, dies when elm seeds fall in spring); ru heng ge (like a crosswise bar, gallbladder qi insufficient, dies when the grain ripens in autumn); ru jiao qi, left and right both beating — thirty days · judgment by stomach qi: no stomach qi — no strength to speak, no appetite; bowel disease — hungry at noon the next day; organ disease — waking hungry at midnight (liver, lung, pancreatic and kidney cancer saved when the patient wakes hungry at midnight) · the ‘good talker’ who talks to himself — yin and yang separating, dies with the frost in late autumn; weak yang protects itself by silence · cold and heat entering the kidney: the kidney is the focus of cold and heat; ming men fire in the middle, water on both sides (one fire against two waters); yang must dwell hidden in yin — yang is never feared for being too much, only for failing to hide; diarrhea with a cold body — yang hidden, curable; with a hot body — yang floating, dangerous · the five organs pair with the six bowels: stomach with spleen, liver with gallbladder, heart with small intestine, kidney with bladder · the taiyang month of the first lunar month: taiyang is the meeting of the three yang and governs the lumbar spine; in the first month yang qi rises while yin qi is abundant, yang has not taken its proper place, hence lumbar swelling and pain; the kidney governs the lumbar spine (kidney position beside the fourteenth vertebra), lumbar pain not from injury means kidney trouble; pian xu (one side deficient) — half the body unmoving, one side without sweat (sweat is yin, pore opening and closing belong to yang), the limp; qiang shang yin bei (strong rising pulling the back), tinnitus (yang qi surging upward), mania (all the yang above, yin below)

Opening: before you feel a pulse, remember what “the pulse of stomach qi” means

This lecture picks up where the previous one left off. The last lecture taught the normal pulse; this one begins by reviewing the “pulse of stomach qi”:

💬 Note from Doctor Ni Haixia: The speed is one breath — the doctor’s own breath in and out. You feel the patient’s pulse, and between one breath in and out the pulse beats five times. That is the most standard — this is the pulse with stomach qi.

Then Doctor Ni immediately throws out a frightening-sounding name — intestinal bleeding (chang pi):

💬 Note from Doctor Ni Haixia: If there is cold inside the bones (chronic diarrhea), the patient will have intestinal bleeding. This kind of disease heals by itself. So sometimes when you have diarrhea, there is a kind that gets better on its own. Now which kind is dangerous? As it says later: if the liver pulse is small and relaxed, that is intestinal bleeding, also easy to cure. Look at this: the kidney pulse small, forceful and deep is intestinal bleeding with blood — if the blood is warm and the body hot, the patient dies.

Three characters solve all pattern differentiation — pulse and symptoms agree

A student asks: Teacher, with so many pulses, how do we differentiate the pattern? Doctor Ni says: very simple, three characters solve it for you, and you will never, ever be wrong — pulse and symptoms agree (mai zheng he).

💬 Note from Doctor Ni Haixia: This is exactly what pulse-and-symptoms-agree means. Use common sense: a person is losing blood — not from snow outside in winter, but blood in the stool, blood constantly coming out with diarrhea, or blood in the urine, or vomiting blood, or nosebleeds — it doesn’t matter. In this state of blood loss, use common sense: should he not have a rather pale face, be rather weak? And cold — he has lost that much blood. In the movies, the Westerns show it best: “So cold!” and he pulls the cowboy jacket over himself — you see, blood loss!

A person who has lost blood is pale, cold and weak — that is the “symptom.” Feel the pulse: small, thin, deep — that is “agreement.” Pulse and symptoms agreeing means easy to cure.

💬 Note from Doctor Ni Haixia: Pulse and symptoms agree — bring him back, easy to cure. What you fear is pulse and symptoms disagreeing. What does disagreement look like? This person is already bleeding, so by reason he should be cold — because blood carries the body’s warmth. But this patient feels hot, and the pulse is floating, large and racing — that is disagreement. This disagreement means the interior yang is about to expire. It is like the flame of a candle, an oil lamp, at its very last moment — boom, one flare up — and then it is nearly over.

The accountant’s wife nearly killed by chemotherapy — one dose, out of bed overnight

Theory done, Doctor Ni tells a case he treated with his own hands — one dose of decoction that brought a woman felled by chemotherapy back to her feet the next day:

💬 Note from Doctor Ni Haixia: We were treating a patient — this gentleman is my patient. His wife, forty-one years old — nineteen years earlier she had kidney cancer, one kidney removed, only one left. Nineteen years later, in 2000, it struck: when she went to the toilet, the urine came out entirely as blood. Western medicine examined her — on that one remaining kidney another tumor had grown, 5.5 centimeters big. This time you can’t take it out, can you? Right, you can take one, but this time you can’t. Since they couldn’t take it, they only gave her chemotherapy — five rounds — and it nearly killed her. She told her husband: “I will definitely die from the chemotherapy. Before it, yes, I had blood in the urine, but nothing else. After it, I still have blood in the urine, but I truly can’t go on — I have no strength to stand at all, I can’t do any housework. Oh, and I’m an accountant…”

The wife said: I have a client who is a Chinese doctor — do you want to try him? “I do anything!” — at that point, what else could they do? Nothing mattered anymore; she was only forty-one!

💬 Note from Doctor Ni Haixia: So she came. The accountant (was very familiar to me). I said, take Chinese medicine, I’ll prescribe a decoction — it’s bitter. “No problem!” He went home, stayed up half the night, boiled the herbs and fed her. I examined her: the pulse was small and thin; her face was pale, her whole body without strength, and when I touched her body it was cold — this is very easy to cure! I asked: are you afraid of cold or heat? “I’m so, so cold — at night I pile on several quilts and I’m still cold.” The medicine went down, and the next morning she jumped out of bed, made breakfast, and cleaned the kitchen. He called me: “My wife is a completely different person!” — in just one night (overnight)! That fast.

Doctor Ni adds the most crucial line: why so fast? Because pulse and symptoms agreed. If they disagreed, it would have been dangerous.

💬 Note from Doctor Ni Haixia: So you don’t need to care what Western medicine says is inside. When you become doctors, you may read the Western reports, but at the moment you treat, you must forget the disease name in that report. We treat by pattern differentiation, not by prescribing according to a name. We only look at his signs, and according to the signs one dose is enough.

Intestinal bleeding: hot body — seven days; cold body — hope

Back to intestinal bleeding — blood in the stool. Which kind dies, and which kind lives?

💬 Note from Doctor Ni Haixia: If there is diarrhea — whether it is intestinal bleeding, blood in the stool — the blood is warm and the body hot. By reason it should be cold, but it is hot — certain death; this is yang reversal. Bleeding from the heart, liver and spleen — if the heart or liver has cold-dampness inside (it must be cold-damp inside), and it also bleeds, with both organs diseased together, that can all be cured. As long as pulse and symptoms agree, it is easy. The pulse small, wiry and urgent is intestinal bleeding — very cold inside. If the patient’s body is cold, there is hope; if the body is hot, at most seven days, one week, and he is gone.

Why seven days? Doctor Ni gives a very practical reason:

💬 Note from Doctor Ni Haixia: Why? Remember, seven days — because below the stomach there is still a little food stored there, which allows you to live seven days without eating or drinking. This is the last seat of stomach qi. Suppose you meet him on the third or fourth of those seven days, right? You see the body warm, the pulse racing — a racing pulse means death. “Teacher, how many days does he have left at most?” “How many days have you been like this?” “Three days.” “Oh, then only four days remain.” Then your diagnosis is very accurate — because you can count when he will die. But a doctor cannot do that. You must always fight for the patient! One strike — and it is either a full turnaround or both eyes staring. The medicine we truly use is strong — the classical formulas (jing fang) are the strong ones. The ordinary “current formulas,” the warm-disease school herbs, are not that strong. Still, you can fight — is there a chance to save him? Of course there is!

A seventeen-year-old with twenty bloody stools a day — one dose, normal color the next day

Then comes the second real case — again bleeding, again “pulse and symptoms agree”:

💬 Note from Doctor Ni Haixia: I have a patient with diarrhea and blood — a young boy, only seventeen, still in high school, about twenty bloody stools a day. How does he even go to school? Western medicine gave him two names: one is Lyme disease, one is Crohn’s disease — they put both together: this test says Crohn’s, that test says Lyme. They fussed around for a year, and still the blood kept coming. One dose of our decoction, and the next day the stool color changed right back! Why? Because pulse and symptoms agreed. If they had disagreed, it would not have been that fast.

💬 Note from Doctor Ni Haixia: Later I will teach you how to treat it — when we reach the Jin Gui Yao Lue I will teach the treatment; here we don’t discuss the main formula. So you must all hold this concept: pulse and symptoms must agree. And this is not only for intestinal bleeding — any critical condition, as long as pulse and symptoms agree, is easy to treat.

Stomach pulse drum-like and enlarged, heart pulse small and hard — a partition, one-sided paralysis

Turning to page 408, Doctor Ni explains “the stomach pulse deep, drum-like and rough; the stomach pulse enlarged, pushing outside its position”:

💬 Note from Doctor Ni Haixia: Look — the stomach pulse should normally be the spleen-stomach pulse, relaxed yet forceful, right? Now it has sunk down, and it is drum-like — as if something were pushing up in the middle, that is “drum.” And the stomach pulse is very large, pushing over into the spleen pulse’s position, going outside the pulse. Why? Because the stomach itself holds this concept: all our pulses take stomach qi as their root. The stomach’s own yang qi is very great, so it can receive the five grains and moisten our five organs and six bowels. Therefore our pulses are ruled by stomach qi. The moment your stomach qi is blocked, the first thing you discover is the stomach pulse becomes very large, no longer relaxed — “relaxed” means yin and yang harmonized; suddenly it becomes very large, and the stomach qi, the yang qi, is obstructed.

💬 Note from Doctor Ni Haixia: So if you feel the Cun pulse — when yang qi is blocked, the Cun pulse will certainly become very large. The stomach pulse drum-like and enlarged, while the heart pulse (the Cun pulse) becomes small and hard and urgent — this is “ge you pian ku”: there is a partition, and one-sided paralysis may appear in the body — a person might have one side paralyzed or something of the sort.

Doctor Ni also teaches everyone to compare the two hands — the right-hand Guan pulse (the stomach pulse position) very drum-like and large, the left-hand Cun pulse (the heart pulse position) small, thin and racing: the stomach is blocked, and the stomach’s yang qi cannot moisten the four limbs.

And the reverse? Doctor Ni teaches everyone to reason:

💬 Note from Doctor Ni Haixia: If it is reversed — the stomach pulse still large, but the left heart pulse gone — it means stomach qi sinks downward. In a normal person the stomach pulse is relaxed, and the heart pulse can be faintly felt, slightly floating and relaxed. So when we feel the pulse we often do both hands at once — feel the heart pulse and the spleen-stomach pulse, and you know the relation between the two. When the relation is good, the stomach pulse is relaxed and the heart pulse is relaxed yet forceful, slightly floating. When your stomach pulse becomes very large, the heart pulse has two structures: one is the heart pulse large and hard and urgent — meaning stomach qi keeps rising upward, which makes the heart pulse (the heart is above, after all) flutter very fast; the other is the heart pulse gone — meaning the stomach is blocked here, qi can neither rise nor descend, and just sits there. So in practice you look at the patient: gastric ptosis — the stomach sinks, and the heart qi goes downward with it.

💬 Note from Doctor Ni Haixia: So in many places we can reason it out. Ask the classical formulas: who? Two herbs! The “current formulas,” I don’t know — they prescribe big piles of medicine and the stomach still sinks. Two herbs are enough for us. So although we are both Chinese medicine, the prescriptions we write are different.

Hemiplegia: men on the left, women on the right

“The heart pulse small, hard and urgent — all are ge you pian ku.” Pian ku — one side paralyzed. There is a famous rule here, and Doctor Ni defines it first:

💬 Note from Doctor Ni Haixia: If the pulse is small, hard and urgent, you speak of pian ku — men on the left, women on the right. Why men on the left? Because men are ruled by qi. On the pulse of the human hand: the right-hand pulse is the qi pulse, the left-hand pulse the blood pulse — the same for men and women; that is the first definition. The second definition: men are ruled by qi transformation, women by blood transformation. So a man is strongest on the right, a woman strongest on the left. When pian ku occurs, it strikes on the weaker side — a man’s left side is weaker; a woman’s right side is weaker, so it reverses.

Can pian ku be cured? Look at the tongue and the speech:

💬 Note from Doctor Ni Haixia: If the voice can still speak and the tongue can still turn — as long as the mouth can speak. Speaking is an action. Now you are going deeper: speaking strings three things together — the kidney pulse pours into the lung, the lung pours into the throat, the throat reaches under the tongue; when it pours into the lung it also passes the heart, so the heart and kidney are joined, all the way into the tongue. The kidney sends out its yang, the heart sends out the pitch and volume of the voice, the lung sends out the breath. So when a person speaks, you form the thought in your mind, the spirit moves within — these three together send it to the tongue, and only then does the tongue move — the tongue is the outward display of the heart. So the moment a person has a stroke with hemiplegia, ask him to speak: if he can still speak, no big problem, very easy to cure, the tongue can still turn.

The worst thing? He no longer speaks. Doctor Ni gives the timetable:

💬 Note from Doctor Ni Haixia: The worst is when he doesn’t speak at all, and the tongue cannot turn either — then we know the heart, lung and kidney are all three injured at once. If he can speak and has hemiplegia, and we begin treatment, thirty days — within a month he will be better. But “within a month” has a condition: you must treat within one or two weeks of the stroke, no more than two weeks. Beyond two weeks it becomes hard to handle, and the time stretches out. If he cannot speak — the heart, lung and kidney are all injured — it takes three years to cure. If a young person, under twenty, develops hemiplegia, one side not working — he lives at most three years. Because under twenty yang qi is at its strongest; you should not have pian ku. Once pian ku hits, the person is finished — you missed the most precious time for treatment. So it is absolutely most dangerous when contracted young.

The pulse coming like panting — a frightened pulse, don’t panic

The text reads: “When the pulse comes forceful, and there is bleeding with a hot body, death; a pulse hanging like a hook and floating is the normal pulse.”

💬 Note from Doctor Ni Haixia: Whenever you bleed, the body must be cold; a hot body, or a racing pulse — that is pulse and symptoms disagreeing. A pulse hanging like a hook and floating is the normal pulse. The pulse coming like panting is called bao jue (sudden reversal) — one in sudden reversal does not know people, does not know how to speak with people. This pulse is extremely rapid and startles people. There is a situation like this: right after a fright — you walk on the road and something scares you, or you walk into your stairwell and something scares you. The moment you are frightened, the pulse beats very fast and you pant heavily, but when you feel the pulse, it beats rapidly and chaotically — this is the qi disturbed. But look at him: he was frightened, the spirit is still there, the complexion has not changed. It will heal by itself — he was just scared. At most three or four days. If it hasn’t healed in three or four days, then he is truly timid as a mouse! One scare and it lasts three or four days.

The floating-planks pulse: ten or more beats per breath — essence qi insufficient

💬 Note from Doctor Ni Haixia: If the pulse comes like floating planks joined, counting like a rapid pulse, ten or more beats per breath — essence qi insufficient — this kind dies. “Floating planks” means the pulse floats to the surface. A blood-loss pulse is always deep and deficient. When it walks up to the surface, that is yang about to expire. So when you feel the pulse, there is a lot of differentiation in the middle — I have said this before, we have the twenty-eight pulses and so on; after all that talk your head spins. You don’t need it! You only need to know what the normal pulse is, and then whether the person’s pulse and symptoms disagree — that is a critical condition. Basically that is the principle; it just takes experience.

The five strange pulses: burning flame, scattered leaves, unexpected guest, clay pellet, crosswise bar — death in the conquering season

The text then runs through a string of “pulses coming like so-and-so,” each corresponding to the essence of an organ about to expire — and each dies in the season that conquers it. Doctor Ni takes them one by one:

💬 Note from Doctor Ni Haixia: The pulse coming like a burning flame — a very large pulse — the heart essence is about to be seized, and he dies when the grass dries. Not grass outside drying — that is winter. The grass dries in winter. If your heart is like this, you meet the season that conquers the organ — so you die in winter (heart is fire; in winter water conquers fire). The pulse coming like scattered leaves — the liver qi scattered. The liver governs wood, is the wood of trees, so it is like scattered falling leaves. Actually when you feel it, the liver pulse should be wiry; now it is spread open, not a single wiry string — the stomach qi is gone. With this pulse, when the leaves fall — autumn — he dies (liver is wood; in autumn metal conquers wood).

💬 Note from Doctor Ni Haixia: The pulse coming like an unexpected guest — “guest” means the pulse is blocked very strongly, blocked inside, and jumps upward — kidney qi insufficient. This is late spring, early summer, when the big dates, the red jujubes ripen — he dies then (kidney is water; earth conquers water). The pulse coming like a clay pellet — stomach essence insufficient. As for “clay pellet,” I have met many patients at the moment of stiffening death who showed this: when you feel the pulse it seems to rotate, and inside you feel bead after bead — like a string of prayer beads. You press on one bead, pull it beneath your finger, and you feel bead after bead passing. Why use clay to describe it? Because when you touch the bead and press, it flattens. If you pinch a clay pellet, it flattens, right? But a prayer bead pressed stays hard. This one is truly a clay pellet — press and it is gone; release and you feel many beads moving underneath, one by one passing by. Because the pulse qi does not run — not continuous, broken and intermittent. He dies when the elm seeds fall — in spring! Wood conquers earth (stomach is earth; in spring wood conquers earth). The pulse coming like a crosswise bar — the pulse on the hand should run up and down; how can it meet a crosswise pulse? A crosswise pulse here, or a crosswise pulse there — neither is good. Most crosswise pulses we see run across the hand, some crossing over to this side. That is the crosswise pulse, very bad. When you feel the crosswise-bar pulse, the gallbladder qi is insufficient — the gallbladder will have problems. “When the grain ripens” means autumn — wood and metal conquer each other, metal conquers wood; in autumn, when the grain ripens, trouble arrives.

💬 Note from Doctor Ni Haixia: That is what you (must remember): this passage speaks of the conquering seasons. When you feel this pulse, he will inevitably leave in the conquering season — that is danger. Basically, when we judge life and death by pulse and signs, we always look at stomach qi — when there is no stomach qi, then look at when he will go.

And one even more urgent — the pulse like lacquer being poured:

💬 Note from Doctor Ni Haixia: The pulse coming like lacquer poured, beating on the left and the right — one pulse, both sides beating together, about a month (slightly seen, death in thirty days). This also comes from reading the pulse qi; the book roughly records it.

No stomach qi — see it at a glance: no strength in the voice, no desire to eat

So what does “no stomach qi” look like? No need to feel the pulse:

💬 Note from Doctor Ni Haixia: When a patient has the surface signs of no stomach qi, you don’t need to feel the pulse: the voice has no strength, he doesn’t want to eat, food won’t go down, no appetite at all, no desire for food — no stomach qi. When we treat bowel diseases — gallbladder, small intestine, stomach, bladder, and some exterior cold-damage patterns, common cold exterior patterns — in most cases the stomach qi returns around noon of the next day. It is amusing: at noon his appetite opens, at noon he gets hungry.

Treating organ diseases? The signal comes at midnight:

💬 Note from Doctor Ni Haixia: When treating organ diseases — liver, heart, spleen, lung, kidney, any of them — the patient wakes up at midnight, hungry, wanting to eat: the stomach qi has returned. So when you treat a serious illness, after the patient takes medicine for a while — if it is a very heavy organ disease, liver cancer, lung cancer, pancreatic cancer, kidney disease — and he starts saying “I wake up at midnight, hungry,” he is saved — the stomach qi has returned! So even if you cannot feel the pulse, listen to his symptoms and you know he is saved. In a seriously ill person, as long as he feels hungry, that is good.

A person talking to himself — the yang is about to scatter

The text speaks of “the good talker dies when the frost comes.” Doctor Ni first distinguishes: this is not an old lady’s chattering.

💬 Note from Doctor Ni Haixia: This kind of “good talker” is not the same as an old lady’s good talking. Old ladies chatter — that is another kind, a chattering personality. This “good talker” is yin and yang not harmonized: a person sits alone and talks to himself. The yang is about to scatter; when the frost begins in late autumn, he will go. People have a self-protecting action: when his yang qi is weak, while life force is still there, his mind naturally adjusts and he does not want to talk much — because he can store the yuan yang in his heart for a while. Because the yang can still protect itself, he does not want to speak. When the yang is about to scatter, he cannot control it: with nobody talking to him, he talks to the air, sits there alone talking to himself. This is one of the most subtle, most subtle places of the body’s yin and yang.

Cold and heat entering the kidney: the ming men fire, water on both sides

The text has one more passage — cold and heat transmitted to the kidney. Doctor Ni draws the structure of the kidney:

💬 Note from Doctor Ni Haixia: When the organs bind with heat, heat transmits; cold transmits too. When cold and heat transmit into the kidney — the kidney itself is a focus of cold and heat. The normal kidney: in the middle is the ming men, and the ming men is fire; on both sides is water. So it holds the fire in the middle; in the normal state one fire faces two waters. Therefore below it is very warm. But if it is too hot or too cold, and both enter the kidney together — these are all very dangerous signs. Cold is yin, heat is yang — only when yin and yang are about to separate do you see cold and heat appear together. Normally, what we normal people see is warmth. This person cannot sit up — because the kidney governs the bones; a person can stand and can sit, all relying on the bones grown by the kidney. What this passage describes is when the organs fail, when death comes; when the bowels fail, when death comes. I have translated it all in great detail.

Chapter Forty-Nine, the Mai Jie Pian: yang must dwell hidden, never fear it being too much

Doctor Ni summarizes the theme of this lecture — Chapter Forty-Nine of the Huang Di Nei Jing, the Mai Jie Pian (Resolving the Pulse):

💬 Note from Doctor Ni Haixia: What does the Mai Jie Pian mainly teach? The first key point: it uses the weather and the seasonal nodes of heaven and earth to explain the correspondence between humans and nature. The second key point: what is the relation of our yin and yang? For example, from what I just said — here is the ming men, this is fire; on both sides of the ming men are the kidneys, this is water. So in our kidney, yang lies hidden inside, wrapped by two waters, yang dwelling in the middle. In the normal state we all should have yang, and the best yang is the yang that hides inside yin, not the yang that walks outward. The reason yang does not walk outward is that our yin is very even and holds yang in control.

Doctor Ni uses diarrhea as an example to show the gulf between “yang hidden” and “yang floating”:

💬 Note from Doctor Ni Haixia: For example, diarrhea. The first day or two you feel nothing special; if it gets heavier and heavier, the person loses vitality. Why? Because you have drained away the yin — yin, everything you can see, is yin. When yang (the physical strength in the body) has no yin to hold it, the body consumes itself. Yin keeps leaving; if it is not treated in time, yang floats up and the whole body is hot — because yang is heat; what results is: the body is hot, the stool is running (dangerous). If you keep having diarrhea but the body is still cold — yang is still hidden inside — this is very easy to cure. This is the concept: we never fear yang being too much; yang must hide. When we design a prescription, the yang will hide inside. When yang is absolutely hidden, yin and yang intersect and cooperate perfectly; when yin and yang are not harmonized, problems arise. This phenomenon exists not only in the kidney — it exists in every part of the body. So we have the stomach, and it has the spleen — the stomach is yang, and the spleen’s yin restrains it; the two control each other, so the stomach yang never becomes excessive and never runs away. The liver pairs with the gallbladder, the heart with the small intestine, the kidney with the bladder — the five organs paired with the six bowels, that is the basic concept.

The taiyang month of the first lunar month: why back pain makes you think of the kidney first

With the concept of yin and yang in hand, look at the first section of the Mai Jie Pian — the taiyang channel:

💬 Note from Doctor Ni Haixia: Taiyang is the meeting of the three yang, the chief of all — the place where the lumbar spine gathers. Because the first month is the yin month, and taiyang is the yin month — the first month of the year belongs to taiyang. Look at the almanac: every year’s first month is the yin month, and yin belongs to taiyang. In the first month yang qi comes out above, yang qi on top while yin qi is abundant — “yang has not yet taken its proper place,” hence swelling and lumbar pain. In a normal person, in the taiyang first month, the yang qi is about to come out; yin qi is below, and yang qi slowly floats up. Now the yang qi cannot fully come out — after the first month yang qi should come out, should emerge to the surface; that is the body’s circulation. Yin is still very abundant inside; yang wants to come out but cannot, so it pushes inside, swells, and produces lumbar pain. Therefore if our kidney has a problem, the first phenomenon is the lumbar spine — because the kidney governs the lumbar spine. Apart from a sprain or injury, if you have lumbar pain, otherwise the lumbar spine should not hurt — if it hurts, the kidney has a problem. Some people hurt at the fourteenth vertebra, beside the fourteenth vertebra — right at the kidney’s position, pain at the kidney’s position.

Pian xu: sweat on one side, no sweat on the other

Next comes “pian xu” (one side deficient) — why there is hemiplegia, and sweating on only one side:

💬 Note from Doctor Ni Haixia: “Pian xu” means one side is deficient. When spring arrives, our yang should come out, but yin is still abundant — because the yang cannot come out. As a result, on one side the yang comes out and on the other side it does not — one-sided — and this makes half the body unmoving. Where yang has not come out, it cannot sweat; where yang has come out, it can sweat. But in a normal person, when you exercise or walk you begin to sweat, and it is even, over the whole body — you cannot have sweat on one side and none on the other. For example, if I have no sweat on the left, then the yang on the left cannot come out; the yang on the right can come out, so the right has sweat. Simply put. Remember: what you can see is yin — before this sweat comes out, inside it is yang; but the water you see as sweat, that is yin. Why does it come out? Because the pores open — who opens the pores? Yang opens them! So the power of opening and closing belongs to yang, and yin comes out. In a normal person, yang reads the temperature; when the body’s temperature is adjusted properly, the pores close by themselves — yang is very automatic. “Those who are pian xu have some insufficiency of winter cold, therefore pian xu is a limp” — cold still sits on one side inside, and the yang cannot push it out.

Strong rising pulling the back, tinnitus, mania — yang qi surging upward

To close the lecture, the text speaks of “qiang shang yin bei” (strong rising pulling the back), “tinnitus,” and “mania” — all signs of yang qi rushing upward:

💬 Note from Doctor Ni Haixia: “Qiang shang yin bei” — the yang qi rises greatly and contends, therefore the back is pulled up strongly. “Tinnitus” — the yang qi of the myriad things surges upward and leaps, therefore the ears ring — yang qi surging up and leaping, so the ears ring. “Mania” — all the yang is exhausted above while yin qi is below — the yang is all on top, yin qi underneath (deficient below, excess above) — therefore mania.

And there the transcript of this lecture closes — the next lecture continues the Mai Jie Pian.

Compiled from Doctor Ni Haixia’s Ren Ji (Human Records) lectures on the Huang Di Nei Jing (Lecture 58)

What to take away

Pulse and symptoms must agree. A person losing blood should look pale, feel weak and cold, with a small, thin, deep pulse — that combination is curable. If someone is bleeding yet feels hot, with a floating, large, racing pulse, the interior yang is expiring — danger. This single rule applies to every critical condition, not just intestinal bleeding.
Forget the Western disease name when you treat. The accountant’s wife — single kidney, a 5.5-cm tumor, five rounds of chemotherapy, nearly dead — was brought back in one night because her pulse agreed with her symptoms. A seventeen-year-old with twenty bloody stools a day was labeled both Crohn’s and Lyme; one dose returned his stool color to normal the next day.
Body hot with intestinal bleeding means seven days; body cold means hope. The stomach stores enough below it to sustain a person for seven days without food — that is the last seat of stomach qi. A doctor never counts down the days; he fights for the patient. Classical formulas are strong; the weak “current formula” and warm-disease herbs are not.
Stomach qi is the root of every pulse — and the judge of life and death. No stomach qi: no strength to speak, no appetite. Bowel disease: stomach qi returns at noon the next day (hungry at noon). Organ disease: the signal is midnight — waking hungry at midnight means the stomach qi has returned. In liver, lung, pancreatic or kidney cancer, waking hungry at midnight means the patient has been saved. In any seriously ill person, feeling hungry is good.
Yang is never to be feared for being too much — only for failing to hide. The ming men fire sits wrapped between the two kidneys’ water; yang that stays hidden inside yin is the healthy state. Diarrhea with a cold body — yang hidden, curable; diarrhea with a hot body — yang floating, dangerous. Five organs pair with six bowels so each restrains the other: stomach with spleen, liver with gallbladder, heart with small intestine, kidney with bladder.
Lumbar pain that is not from injury means the kidney. Taiyang, the meeting of the three yang, governs the lumbar spine; the kidney position sits beside the fourteenth vertebra. One side unable to sweat, half the body unmoving — that side’s yang cannot come out, and cold is trapped inside.