Edema That Starts From the Feet, Body Heavier After Drinking Water, Wheezing So You Can’t Lie Down? — Doctor Ni Haixia on the Shui Re Xue Lun (Water-Heat Acupoints), Four-Season Needling, the Fifty-Nine Points for Heat Disease, and the Tiao Jing Lun (Regulating the Channels)

Patient search terms: edema / swollen feet / swollen face / swollen legs / body heavier after drinking water / distended belly / can’t catch your breath / can’t lie down / shortness of breath / wasting-thirst / constant thirst no matter how much you drink / always hungry / sweating in the wind / caught in the rain / high fever / pneumonia / chest heat like hot water pouring over you / fainting / stroke coma / headache with fever / nosebleed / acupuncture / blood-letting / Baihui / Zusanli / Yinlingquan / Sanyinjiao / Shenshu / Huang Di Nei Jing / Shui Re Xue Lun / Tiao Jing Lun

Corresponding topics (medical terms): the Su Wen chapters Shui Re Xue Lun (Water-Heat Acupoints, Chapter Sixty-One, continued) plus the four-season needling methods, the fifty-nine points for heat disease, and the Tiao Jing Lun (Regulating the Channels, Chapter Sixty-Two). The circulation of water-fluid: earth qi rising belongs to the kidney and generates water-fluid — the large intestine and lung are interior-exterior paired, the small intestine’s fire steams the water essence of the large intestine upward, the lung’s fluids descend (the lung models heaven and rains down), the lung water returns to the kidney, and the kidney water enters the bones (the kidney governs the bones, and the bones contain water); the brain is the sea of marrow, and the water goes into the marrow all the way to the head. Kidney sweat: ‘when one labors bravely, kidney sweat comes out’ (laboring makes you sweat, and the kidney governs the bones — only when the bones are strong can you labor); when sweat meets wind, the wind closes the xuan fu (sweat pores), so the sweat can neither enter the organs nor cross the skin, and it stops between skin and muscle — producing fu zhong with the feet swelling first, rooted in the kidney and named wind-water; Zhang Zhongjing later divided water disease more finely (wind-water, skin-water and so on) and established formulas. Water is yin and cold, so it sinks — edema begins at the lowest point of the body, the feet. The fifty-seven water points = the kidney’s fifty-seven points, the gathering of accumulated yin, where water enters and exits: on the back, starting at the coccyx/ming men, Shenshu BL23 one and a half cun lateral, one point per joint, skipping every other joint, twenty-five points in total; on the abdomen, the kidney street = Shenque CV8 (navel) to Qugu CV2, half a cun lateral to the Conception Vessel (the kidney channel points Zhongzhu KI15, Siman KI14, Qixue KI13, Dahe KI12, Henggu KI11); the stomach street = the stomach channel points Wailing ST26, Daju ST27, Shuidao ST28, Guilai ST29, Qichong ST30 (two cun lateral to the Conception Vessel); the lower-limb water-draining points = Sanyinjiao SP6, Zhaohai KI6, Fuliu KI7, Yinlingquan SP9, Lougu SP7 and Diji SP8 (the Three Sovereign points of the Spleen Channel). Any water accumulation is related to the kidney; the kidney-street and stomach-street points may be needled as the pattern indicates (the steaming-needle technique) to drain water; white soybean milk boiled with sweet rice wine is an edema food remedy. In water disease, below there is fu zhong and a great distended belly (the kidney governs the abdomen), above there is wheezing and an inability to lie down (the lung’s inhaled heavenly yang wants to enter the kidney but meets water and rebounds, so the breath shortens) — branch and root: the branch is the lung and the root is the kidney (the lung itself has no disease; it suffers because of the kidney). Treating water is like an empty tube in a cup: the top must be opened — either induce sweating with exterior-releasing herbs, or open the lung and make the person vomit, and the lower-burner water drains with it; Western diuretics cannot match this. Four-season needling: spring takes the collaterals and intermuscular spaces (wood: the liver qi is just born, the lesser yang is just arising, wind qi is urgent, the channels are deep with little qi, disease stops in the collaterals — do not needle the main channels); summer takes the interstices, skin and superficial channels (fire: the heart qi begins to grow, blood is abundant and qi weak, yang qi floats outward — all on the yang channels); autumn takes the shu-transport points of the channels (metal: yang qi begins to decline, yin qi rises, like seeks like, cold-damp is in the channels; shu means dredging, autumn is governed by the lung which governs qi), and when yang is exuberant, drain the yang channels’ he-sea points; winter takes the jing-well points (‘take jing and ying in winter, and in spring there will be no nosebleeds’ — the well points are shallow and only discharge the pathogen without moving yang; if you move the yang so that it cannot hide in winter, the next spring the person bleeds from the nose). Distinguishing deficiency and excess: new disease is excess and is drained, chronic disease is deficiency and is tonified; the complexion of new disease is unchanged, chronic disease damages the complexion; new disease has continuous pain, chronic disease has dull vague pain that is comfortable under pressure; interior pain is yin, exterior pain is yang. The fifty-nine points for heat disease: the five rows on the head (Shangxing GV23, Xinhui GV22, Qianding GV21, Baihui GV20, Houding GV19 on the Governor Vessel plus the Bladder Channel one cun lateral) drain the heat of all the yang meetings; the most commonly used is blood-letting Baihui GV20 (when heat rushes upward and the person faints, blood-let it and the yang qi descends). Heat in the chest (pneumonia with high fever, heart problems — the patient describes a torrent of hot water pouring down over the body) is treated at Feishu BL13 (back shu), Quepen ST12, Yingchuang ST16, Ruzhong ST17 and Rugen ST18; locate the points by pressing for tenderness (heat points always have tender points — needle directly there). The qi street and the Three Li points (Futu ST32, Zusanli ST36, Shangjuxu ST37, Xiajuxu ST39) drain stomach-intestine heat — for example wasting-thirst, where drinking cannot stop the thirst and eating cannot stop the hunger. Yunmen LU2, Jianyu LI15, Weizhong BL40 and Huantiao GB30 drain the heat of the four limbs (all around the joints); the five-zang heat is drained at Ganshu BL18, Pishu BL20, Xinshu BL15, Feishu BL13 and Shenshu BL23 (ten points left and right). ‘In winter one is injured by cold, in spring one inevitably suffers warm disease’: cold excess generates heat, and when an epidemic sweeps through, some people fall ill and some do not — those who were injured by cold the previous winter have insufficient strength; read the Huang Di Nei Jing and then the Shang Han Lun, and you will know the Shang Han Lun is right — the warm-disease practitioners never carefully read the Nei Jing. The Tiao Jing Lun: excess is drained, deficiency is tonified; the five zang each store something — the heart stores spirit, the liver stores blood, the lung stores qi, the spleen stores flesh (form), the kidney stores will; there are five excesses and five deficiencies (spirit, qi, blood, form, will), ten states that are five excesses and five deficiencies — all of them originate in the five zang, each zang sends a channel out to the body surface to move qi and blood, so regulating the channels (guarding the sinews and marrow) balances deficiency and excess; spirit excess makes one laugh without stopping, spirit deficiency makes one sorrowful (without fear of cold, the zang organs are not yet injured — do not treat); in the normal state qi walks ahead of blood (about six cun ahead), and when qi and blood merge, disease arises; disease begins at the level of the downy hairs (the subtle beginning of spirit disease) with slight aversion to cold; for spirit excess, drain the small collaterals by letting a few drops of blood out; for spirit deficiency, needle without drawing blood.

Opening: picking up where the last lecture left off, understanding water disease completely

The last lecture ended with “the kidney is the gate of the stomach” — but why does water disease start from the kidney? In this lecture Doctor Ni Haixia continues with the Shui Re Xue Lun, and right at the opening he fills in how water actually circulates through the body:

💬 Note from Doctor Ni Haixia: The earth qi that rises belongs to the kidney and generates water-fluid. The reason our earth qi keeps rising, and the water-fluid above — it says it belongs to the kidney and generates water-fluid. The water above was originally meant to supply what is below; the kidney’s water actually travels like this — the large intestine and the lung are interior-exterior paired, and the small intestine sits below the large intestine; the small intestine’s fire sends the water essence of the large intestine upward, that is the ascent. After it ascends, the fluids in the lung descend — the lung models heaven, and when heaven rains, that is the lung’s water descending. The lung’s water has to return to the kidney; this water seeps down into the kidney, and when the kidney’s water meets the small intestine, the small intestine qi-transforms it again, then it enters the kidney governing the bones — the bones contain water. The brain is the sea of marrow; this water enters the marrow and travels all the way up to our head.

How does labor sweat, blown by wind, become edema?

So where does water disease come from? The original text says, “when one labors bravely, kidney sweat comes out” — Doctor Ni explains the concept of “kidney sweat” vividly:

💬 Note from Doctor Ni Haixia: When a person labors — doing physical work — and the workload is very heavy, he sweats while working. Then, as he sweats, he faces the wind, and the body inside is very hot. This sweat is what we call kidney sweat — because the kidney governs the bones, and only then do the bones have strength; so when you can labor with strength, it means the kidney is strong enough to labor. When the kidney fails, there is no strength.

💬 Note from Doctor Ni Haixia: When you are sweating profusely and the wind outside is strong, the wind dries the sweat at once. As the wind blows, the pores of the skin contract. But inside, you are still working hard and sweating; the sweat comes out but cannot exit through the pores, so it stops between the skin and the muscle — this “xuan fu” is the sweat pore. This causes abdominal swelling, and the feet swell first; the root is in the kidney, and it is called wind-water.

So “kidney sweat meets the wind; inside it cannot enter the organs, outside it cannot cross the skin; it lodges in the xuan fu and is transmitted into fu swelling.” Doctor Ni says that later we will introduce how Zhang Zhongjing divided this more finely — wind-water, skin-water, and so on — each with a different formula, and this passage is the earliest source:

💬 Note from Doctor Ni Haixia: When Zhang Zhongjing divided it more finely, he not only analyzed it, he also wrote out the formulas — that is why he is our doctor. And why does it begin at the fu (the shin)? Think about this water: in a normal person, the water in the body is qi-transformed and very hot, so the qi rises; but now the qi is cold, and cold water sinks — it truly starts from the feet, because the feet are the lowest place on the body.

The fifty-seven water points: through which gate does water enter and leave?

The Yellow Emperor asks: the water points — the places where water is transported — number fifty-seven acupoints; what function do they preside over? Qi Bo answers: the kidney’s fifty-seven water points are the gathering of accumulated yin, and they are where water enters and exits:

💬 Note from Doctor Ni Haixia: The kidney’s fifty-seven points are the gathering of accumulated yin — all the yin and all the water accumulate in this place, and it is where water enters and exits. Count from the back — starting from the coccyx and going up. Actually, when we look from above, it is the ming men; one and a half cun lateral to the ming men is our Shenshu BL23. From the center line, going down, each joint is about one and a half cun; one point at each joint, skipping every other joint, coming down one and a half cun, one and a half cun — that gives exactly 25 points on the back.

Why does water disease both swell the belly and make you unable to catch your breath?

In water disease, below there is fu zhong and a great distended belly — the belly is pushed up big, because the front is the abdomen, and the abdomen is governed by the kidney; above there is wheezing:

💬 Note from Doctor Ni Haixia: Because when water accumulates below, the heavenly yang your lung qi inhales wants to descend and enter the kidney, but it cannot — it reaches this place, meets the water, and rebounds against the water, so the breathing becomes very short and you cannot lie down. Treating the branch and the root — here the branch refers to the lung, and the root refers to the kidney. When the kidney has a problem, the disease originates in the kidney, but it affects its branch (its surface), and it affects the lung; the lung itself originally had no problem — it is because the kidney developed a problem. So we say the lung makes one wheeze and the kidney makes one edematous — because the water is blocked below and cannot be eliminated, the lung qi becomes very short.

Doctor Ni adds that a later chapter, the Biao Ben Lun (Branch and Root), will explain this in even more detail.

Treating water like an empty tube in a cup: the key is opening the top

The most important thing in treating water is the concept:

💬 Note from Doctor Ni Haixia: If we take an empty tube and put it in a cup of water, and you hold the top of the empty tube and lift it, the water stays right there, doesn’t it? So to make the water come out, you open the top — the moment the top opens, the water goes out. Sometimes we use sweating — go in with exterior-releasing herbs, and once the patient sweats, the water is eliminated; and sometimes, when the water is all on the surface, we open the lung and make the patient vomit, and once he vomits, the water below is also eliminated — this is the Chinese medicine concept.

💬 Note from Doctor Ni Haixia: What about Western medicine? Diuretics are exactly this — so they push and push and cannot push it out, the person just swells up right there, and there is nothing more they can do. Chinese medicine has many ways to drain water.

Page 473: the kidney street and the stomach street, the abdomen’s two “waterways”

The original text continues, “above the fu there are two rows, five in each row — these are the kidney’s street.” Doctor Ni turns to page 473 of the book:

💬 Note from Doctor Ni Haixia: This is the kidney street — the kidney’s roadway. From the navel (Shenque CV8) to the Qugu CV2 point, flanking the midline is the kidney channel — Zhongzhu KI15, Siman KI14, Qixue KI13, Dahe KI12, Henggu KI11 — these run along the abdomen following the Conception Vessel, from Qugu to the navel, half a cun lateral, following the Conception Vessel. These points we call the kidney street — the kidney’s roadway.

And the stomach qi’s street? It is on the stomach channel:

💬 Note from Doctor Ni Haixia: The stomach’s street is on the stomach channel: Wailing ST26, Daju ST27, Shuidao ST28, Guilai ST29, Qichong ST30 — these are also lateral to the Conception Vessel, two cun out is the stomach channel. So right between Shenque and Qugu, the kidney channel is beside it (half a cun lateral), and two cun further out is the stomach channel — that is the stomach street; beside the Conception Vessel is the kidney street. We keep these two distinct.

The Three Sovereign points on the feet: the places that drain water

Besides the abdomen, the feet carry a batch of places where water “passes through and pours off”:

💬 Note from Doctor Ni Haixia: On the feet — Sanyinjiao SP6, Zhaohai KI6, Fuliu KI7, Yinlingquan SP9, Lougu SP7, Diji SP8 — these are on the Spleen Channel, and these are the places where we can drain water. These are all our Three Sovereign points, the places where water passes through and pours off. When you needle these places, the urine comes out in great quantity.

Doctor Ni then states the great principle that anyone treating water disease must remember:

💬 Note from Doctor Ni Haixia: Everyone should hold one concept — any water accumulation anywhere is related to the kidney. I don’t care how big the belly is; as long as there is accumulated water, it is related to the kidney — that is a great principle. As for these kidney-street and stomach-street points, you can needle them as the pattern indicates, you can needle directly without hesitation, and it will drain the water — this is the steaming-needle technique.

At this point Doctor Ni throws in a food remedy:

💬 Note from Doctor Ni Haixia: If you see it swelled up very big, all white like dead chicken — a big pale patch — then white soybean milk boiled with sweet rice wine, boiled down, that also works. This is how we can do it with acupuncture and moxibustion.

Why spring needling takes the collaterals, summer the skin, autumn the shu points, and winter the jing-well points?

Page 474 moves into the four-season needling methods. The Yellow Emperor asks: why do we take the collaterals and intermuscular spaces in spring? Qi Bo answers that spring belongs to wood:

💬 Note from Doctor Ni Haixia: Chinese medicine must know the four seasons, must know the five phases, must know yin and yang. Spring is wood; the liver qi is just born, the lesser yang is just starting to emerge. At this time the wind qi is urgent and the liver qi is urgent — the liver is wind. Because yang is only just beginning to rise, the channels have not yet fully come to the surface; the channels are very deep and their qi is little, so when disease qi comes in from outside it cannot penetrate deeply; most of it stops on the collaterals and in the intermuscular spaces. So we should not needle the main channels; we can needle the collaterals, the weak places between the channels and sinews, and the gaps inside the muscles.

And summer? Summer belongs to fire:

💬 Note from Doctor Ni Haixia: In summer the heart qi begins to grow, the blood vessels receive qi, the blood is extremely abundant, and the qi is comparatively weak. At this time the yang qi moves outward; because the blood qi is very exuberant, the heat steams the intermuscular spaces and governs within the channels. People fall ill in summer because of heat (summer-heat) injury — it is very hot, and the heat runs into the body; so when it comes in, the disease enters the channels — because in summer the pores of the whole skin are wide open and the channels float at the surface. So in acupuncture we also needle the skin and the superficial channels; we do not need to use the yin channels, everything is on the yang channels.

Why does autumn take the shu-transport points on the channels?

💬 Note from Doctor Ni Haixia: In autumn, yang qi begins to decline at the he-sea points, and yin qi begins to rise. In this condition, if you are struck by cold or dampness, inside there is like seeking like — when the outside is yin qi, it must match the yin qi inside; only double yin can resist yang and make yang develop problems. So when the yin qi first begins to rise, the external cold-damp cannot penetrate deeply; it stays on the channels. At this point we take the shu-transport points on the channels, because they only manage qi. Well, ying, shu, jing, he — “shu” means dredging. Autumn is governed by the lung channel, and the lung governs qi, so needling on the qi-blood level is enough.

💬 Note from Doctor Ni Haixia: Everyone should just remember — when we speak of the Lung Channel of Hand-Tai Yin, the Large Intestine Channel of Hand-Yang Ming, and many other channels, those are positions of qi, not positions of blood vessels; they have nothing to do with the blood vessels. The position of a channel includes the blood vessels around it; when the qi moves, the blood vessels inside, and the blood inside the vessels, follow the qi outside in moving — so the lung governs qi. When yang is very exuberant, we can use the he-sea points of the yang channels to drain the yang pathogen.

New disease is drained, chronic disease is tonified: how do you tell? Look at the complexion and look at the pain

Speaking of tonification and drainage, Doctor Ni lays out plainly how to distinguish deficiency and excess in clinical practice:

💬 Note from Doctor Ni Haixia: Short-term patients are all excess patterns, and we use the draining technique; chronic disease is deficiency, and with chronic disease we use the tonifying technique. “Teacher, how do I know if it is chronic or new?” Some people cannot tell you — a person who just got sick, his complexion certainly has not changed; a person with chronic disease, the complexion is certainly damaged. So you can tell by the complexion too. And the pain of a new disease is continuous; the pain of a chronic disease is dull, vague, aching dully — when you press it, it feels comparatively comfortable. New-disease pain is uncomfortable when pressed.

💬 Note from Doctor Ni Haixia: So when you see which channel has a problem, the channel itself tells you whether the disease is in yin or in yang, and you distinguish yin from yang — interior pain is yin, exterior pain is yang; the back is yang, the front is yin — simply put, that is it. You do not need to be confused by this; just remember to select points according to our channels and you will be right.

Winter takes the jing-well points: why does moving yang qi make you bleed from the nose in spring?

In winter we take the jing-well points. “Take jing and ying in winter, and in spring there will be no nosebleeds” — Doctor Ni explains this line with a bear:

💬 Note from Doctor Ni Haixia: In winter our yang qi is very deep — normally the yang qi is deep, the outside is yin qi, and the yang must hide. If you move other points — say you move the sinew-channel points, the well, shu, jing or he points — that will draw the yang qi out. If you move the well and ying points, which are comparatively shallow, it will only discharge the pathogen without moving the yang qi. But if you do move the yang qi — in winter, as it should be, the yang must hide; when the yang floats outward, when the winter yang does not hide, then the following spring the person starts bleeding from the nose. If this bear does not hibernate, then next spring it will keep bleeding from the nose.

So in spring, summer, autumn and winter, we treat according to the qi of the season, following the season’s qi — that is the correct way.

Page 477: the fifty-nine points for heat disease — blood-letting Baihui GV20 is the most commonly used

The “fifty-nine points for heat disease” are the points that drain heat. Doctor Ni explains: the five rows on the head, in five places — all the heat generated by the meetings of yang can be treated here:

💬 Note from Doctor Ni Haixia: On top of the head, Shangxing GV23 at the front, then Xinhui GV22, Qianding GV21, Baihui GV20, Houding GV19 — all on the Governor Vessel; one cun lateral to the Governor Vessel is the Bladder Channel. These run continuously like the scar on the head; you can blood-let along these channels — and the most commonly used is blood-letting at Baihui GV20. When heat rushes upward and the person faints, blood-let Baihui — the moment the blood comes out, the yang qi descends.

What about excessive heat in the chest? For example pneumonia with high fever — many such surface patterns:

💬 Note from Doctor Ni Haixia: When the chest is too hot, we use Feishu BL13 (the back shu), Quepen ST12, and the points on the chest — Yingchuang ST16, Ruzhong ST17, Rugen ST18. In clinical practice, do not be afraid: if we now have a patient with epidemic pneumonia, heat great in the chest, or a heart problem with the chest very hot — how would the patient describe it? Like a torrent of hot water; some describe it as hot water pouring down over the body, scalding everywhere.

With so many points, how do you find the right one? Doctor Ni gives the single most practical clinical trick:

💬 Note from Doctor Ni Haixia: Press these heat points — the points that are “self-heated” always have a tender point. So you know roughly where they are, you press and find the tender point. Generally when we truly treat a pattern, we go by the tender point — the tender point is where the disease qi is blocked, so needle directly there. The tender point is extremely useful; otherwise, with so many points, how would you find them?

Stomach-intestine heat, wasting-thirst, limb heat, five-zang heat: each goes to its own road

“The qi street and the Three Li” — these refer to the points on the stomach channel line:

💬 Note from Doctor Ni Haixia: The qi street refers to Futu ST32 — Futu, Zusanli ST36, Shangjuxu ST37, Xiajuxu ST39 — four points on each side, and these drain the heat in the stomach, the heat in the stomach and intestines. For example wasting-thirst — that is heat in the stomach and intestines: you keep drinking and drinking and it cannot stop the thirst; you eat and eat and it does no good, the belly is still hungry.

And the heat of the four limbs?

💬 Note from Doctor Ni Haixia: Points like Yunmen LU2, Jianyu LI15, Weizhong BL40 and Huantiao GB30 — these can drain the heat of the four limbs, and they all sit right around the joints — around the hand joints and the legs. The heat of the five zang? Ganshu BL18, Pishu BL20, Xinshu BL15, Feishu BL13, Shenshu BL23 — ten points left and right — these are the points that can drain the heat of the five zang.

Page 478: cold excess generates heat — where does warm disease really come from?

On page 478 the original text says, “when a person is injured by cold, the injury changes and becomes heat.” Doctor Ni cannot resist criticizing the warm-disease school once more — a point he stresses again and again:

💬 Note from Doctor Ni Haixia: Why does cold excess generate heat? Look at the whole passage — heat is generated now because one was injured by cold. So if you truly read the Huang Di Nei Jing and then look at the Shang Han Lun, you will know the Shang Han Lun is right. The later warm-disease school really did not — those people did not read the Huang Di Nei Jing, did not carefully read it. Everyone only looks at “in spring one inevitably suffers warm disease” — what is the sentence before that? “In winter one is injured by cold.” So heat patterns and warm patterns are diseases that come over from winter.

💬 Note from Doctor Ni Haixia: In the past they talked about epidemics, many epidemics and so on. But actually, when an epidemic comes, some people are fine and some people catch it — why? Those who were injured by cold last winter — it erupts, their strength was insufficient. When we introduce the Shang Han Lun we will go deeper into this — where the formulas are, why they are written that way.

Page 479: the Tiao Jing Lun — why do only “five excesses and five deficiencies” sum up all diseases?

Page 479 enters the Tiao Jing Lun. In needling, excess is drained and deficiency is tonified. The Yellow Emperor asks: we speak of excess and deficiency — how is that framed? What are the five?

💬 Note from Doctor Ni Haixia: The five zang are divided into five kinds — the liver stores blood, the heart stores spirit, the lung stores qi, the spleen stores flesh (a change in a person’s outward form is managed by this spleen), and the kidney stores will. So there are spirit, blood, qi, form, and will. And five excesses and five deficiencies: some people have spirit excess, some have spirit deficiency; some have qi excess, some qi deficiency; some blood excess, some blood deficiency; some form excess (too fat), some form deficiency (too thin); some will excess, some will deficiency — these ten states have five excesses and five deficiencies.

The Yellow Emperor is very sharp — he asks an excellent question. A person has so many fluids, the four limbs, nine orifices, five zang, three hundred sixty-five joints — so many places, so many joints, so many organs, from which all kinds of diseases arise; all the hundred diseases have deficiency and excess — why do you speak today only of five excesses and five deficiencies, only five?

💬 Note from Doctor Ni Haixia: Qi Bo says, because these five — spirit, blood, qi, form, will — originate in the five zang: the heart stores spirit, the lung stores qi, the liver stores blood, the spleen stores flesh, the kidney stores will. Only with the zang organs are there channels, and only then does a person become lively, only then is there blood, only then is there spirit. A person has will, has thoughts, has actions, and only then does he connect to the marrow and to the five zang. So the way of the five zang can all send out 5 channels to the outside of the body to move qi and blood — and only then can we have spirit, have outward form, have qi, have will.

💬 Note from Doctor Ni Haixia: And if the qi and blood are not harmonious, changes arise. So how do we balance these five excesses and five deficiencies? Qi Bo sets down the definition: make the channels balanced, and it will naturally be balanced — so you must guard the sinews and marrow. Acupuncture is extremely useful!

Spirit excess makes you laugh without stopping; spirit deficiency makes you sad

Page 481 goes through them one by one. First, spirit:

💬 Note from Doctor Ni Haixia: With spirit excess, the person laughs without stopping; with spirit deficiency, the person is sorrowful. So when you see someone sorrowful, that is spirit deficiency; when you see someone laughing — rolling on the ground even — that is spirit excess. At this point, if the qi and blood have not yet merged — remember, in the normal state qi walks ahead of blood, qi is faster than blood; measured by length it should be 6 cun, and blood runs behind qi. When qi and blood merge together, that is when disease arises.

💬 Note from Doctor Ni Haixia: “Teacher, how do I know whether a person has spirit excess or spirit deficiency?” You see the person sorrowful, you see the person overjoyed — right? Now, if the patient shows a little aversion to cold, a fear of cold, then the symptoms are just beginning to appear. But if some people laugh or weep without any fear of cold, that means their spirit excess or deficiency has not yet injured the internal organs; the qi and blood are not yet diseased, the disease has not yet been triggered — then you do not treat them. Once a little symptom is triggered, you can see it — it is a beginning surface pattern caused by spirit excess or deficiency: a slightly cold feeling at the downy hairs and skin.

Page 482: disease at the level of the downy hairs — how to tonify and drain?

How do you handle disease at its beginning, at a very superficial level?

💬 Note from Doctor Ni Haixia: With spirit excess, drain his small collaterals — the small collaterals are: we have the channels, then the collaterals, then the grandchild collaterals, then the small collaterals; the small collaterals run out to beside the fingertips — deficiency there, just let a little blood out and that is all; do not needle directly into the great sinews or onto the main channels, and the spirit qi will be calm. With spirit deficiency, you see the deficiency, press and treat it — needle it without letting blood out. For excess, let a tiny bit out, a few drops; for deficiency, needling without bleeding is enough — just adjust it. So when the disease is at the very beginning, at the mildest stage, we start adjusting it right there.

After this long passage, Doctor Ni says, “That is what this section is about. Let us take a break, and we will continue in a moment” — and the sixty-fifth lecture comes to a close here.

This lecture took us from how water runs through the body, kidney sweat and wind-water, the fifty-seven water points, and the kidney street and stomach street, through the four-season needling methods and the fifty-nine points for heat disease, and finally opened the Tiao Jing Lun with its five excesses and five deficiencies. As Doctor Ni says, read the Huang Di Nei Jing and then look back at the Shang Han Lun — and you will understand why the classical formulas are right: the way to treat water, the points that drain heat, and the method of distinguishing deficiency and excess are all in this one chapter.

Based on Doctor Ni Haixia’s Ren Ji (Human Records) Huang Di Nei Jing lecture series (Lecture 65)