Always Angry, Laughing Nonstop, Easily Frightened, Too Weak to Talk, Bloated, Cold Hands and Feet, or a Sudden Faint? — Doctor Ni Haixia on the Tiao Jing Lun of the Huang Di Nei Jing, Lecture 66

Patient search terms: prone to anger / flying off the handle at the slightest thing / always afraid and fearful / laughing nonstop / always wanting to cry, low mood / no strength to speak / short of breath / panting and coughing / pale face / too fat / too thin / weak hands and feet / lower-abdominal fullness / diarrhea / cold hands and feet / fainting / tumors / cancer / feeling cold and chilly / hot palms and soles / vexation / forgetfulness / acupuncture / bloodletting / massage / Huang Di Nei Jing / Tiao Jing Lun

Corresponding medical names (Tiao Jing Lun, chapter 62 of the Su Wen, continued): the acupuncture supplement-drain methods for the five excesses and five deficiencies of spirit, qi, blood, form and will. Spirit (heart): excess means laughing without stopping, deficiency means sadness; at the very start a slight chill (qi and blood not yet ill — do not treat recklessly); needle the tiny collaterals lightly / merely touch the skin; showing the patient the needle makes him tense and his spirit returns. Qi (lungs): excess means panting, coughing and qi rushing upward; deficiency means short weak breaths; in the mildest disorder the skin pales (white qi leaks slightly); for excess drain the channel qi (do not injure the sinews or let blood), for deficiency supplement the channel. Blood (liver): excess means anger, deficiency means fear; for excess drain the liver channel (Ququan LR8 mother point / Taichong LR3 shu and source point) and let blood; for deficiency retain the needle in the vessel; verify effect by pulse before and after needling (red needle hole; small pulse turning large); squeeze one or two drops for mild stasis, use the cupping jar only for pus-filled blood. Form (spleen): excess means abdominal distension and difficult urination and defecation (body shape altered, too fat), deficiency means the four limbs cannot function; twitching muscles signal mild wind; for excess drain the stomach channel, for deficiency supplement the luo channel, needling between the flesh, no higher than elbows and knees. Will (kidneys): excess means abdominal distension and undigested-food diarrhea, deficiency means reversal (fainting or cold hands and feet); joints move with sound; for excess let blood from the blue-green vein beside Rangu (KI2), for deficiency supplement Fuliu (KI7), the mother point. General rule: for mild illness needle shallowly in the collaterals and between the flesh; to treat an organ illness you must needle the main channels. Qi and blood combining: blood combining with yin and qi with yang gives fright and mania (let blood at Baihui GV20, drain Yongquan KI1); blood combining with yang and qi with yin gives heat in the middle; blood combining above and qi below gives vexation and ready anger; blood combining below and qi above gives confusion and forgetfulness. Qi and blood like warmth and dislike cold — cold stops qi and congeals blood; where qi combines there is blood vacuity, where blood combines there is qi vacuity; what is present is repletion, what is absent is vacuity; when qi and blood are both blocked it is repletion (tumors and cancer — move qi plus invigorate blood and resolve stasis). When qi and blood both rush upward it is the great reversal (coma) — let blood at Baihui, Yongquan and the ten fingertips; if qi returns, life; if not, death. The Three Regions and Nine Indicators: three regions on head, chest-body and feet, plus the wrist cun-guan-chi positions each pressed at three depths (skin/heaven, middle/human, bone edge/earth). Illness born of yang (external wind-cold-summerheat-dampness-dryness-fire), illness born of yin (diet, dwelling, emotions). Wind and rain injure: skin → minute collaterals → collaterals → great channels; repletion is hard, full and painful to pressure. Cold-damp injures: skin slack, muscles tight, nutritive blood sluggish, defensive qi gone → vacuity. Liking pressure is vacuity, resisting pressure is repletion. Yin repletion: irregular joy and anger make yin qi rise, emptying the lower body so yang scatters; yin may be full but never replete. Yin vacuity: grief dissolves qi, empties the blood vessels, then cold food is eaten on top — heavy cold creates yin vacuity. Yang deficiency produces external cold (yang receives qi from the upper burner and warms the flesh between skin and muscles; cold outside blocks the upper burner); yin deficiency produces internal heat (overwork, grain qi not flourishing, upper burner not moving, lower stomach not open, stomach qi hot and fumigating the chest; ‘stomach’ also means the small intestine, the heart transferring heat to the small intestine); yang excess produces external heat; yin excess produces internal cold. In prescribing, distinguish exterior cold from interior cold, and know which herbs enter the qi level and which enter the blood level.

Opening: Last lecture opened the Tiao Jing Lun; this lecture explains the five excesses and five deficiencies one by one

Last lecture we reached the beginning of the Tiao Jing Lun: spirit, qi, blood, form and will each have their excess and their deficiency. In this lecture Doctor Ni Haixia continues, going through all five — heart, lungs, liver, spleen and kidneys — showing how to tell each “excess or deficiency” apart and how to needle it, and at the end reaches the great principles of qi-blood repletion and vacuity, yang deficiency with external cold, and yin deficiency with internal heat.

💬 Note from Doctor Ni Haixia: The principle of acupuncture is “drain what is in excess, supplement what is deficient” — we already know this principle. So now let us go organ by organ.

Spirit in excess means laughing nonstop; spirit deficient means wanting to cry — but without feeling cold, do not needle recklessly

First, spirit (the heart). A person whose spirit is in excess laughs without stopping; a person whose spirit is deficient is sad.

💬 Note from Doctor Ni Haixia: If the spirit is in excess, the person laughs without stopping; if the spirit is deficient, the person is sad. So when you see a person who is sad, that is spirit deficiency; when you see a person laughing, rolling on the floor still laughing, that is spirit excess. But you must combine it with the symptoms — if a person laughs without stopping, or is sad, yet has no chilly, miserable aversion to cold, does not feel the least bit cold, that means there is nothing wrong with him. You should not come over and say, “Little Luo, let me let some of your blood out” — that is going too far; he has no illness.

In other words, emotional change alone is not enough — it must be combined with a mild “feeling of cold,” a beginning exterior sign, to show that the disease qi has started to stir. And when the illness is at its very beginning, the needling technique should be unbelievably light:

💬 Note from Doctor Ni Haixia: When the illness is very mild, we stroke the needle over the surface of the skin, over the channel qi, really just touching the surface — touch it and it is done, sometimes you truly do not need to insert. When you touch it slightly, the patient forgets his “sadness” — he is concentrating: “you are going to needle me” — and the voice comes back. This tells you: Chinese medicine can cure disease at its very beginning; touching the skin at the start heals it. This is where Chinese medicine is powerful.

Show the patient the needle: when the illness is mild, one gesture can cure it

Speaking of when the lung qi first shows a tiny problem, Doctor Ni Haixia also teaches a bit of “psychological therapy”:

💬 Note from Doctor Ni Haixia: Hold the needle in your hand, take it out and show the patient, then say, “I am going to needle you now” — the patient gets very tense, resists, and in that moment of resistance and tension, his fine qi immediately recovers, his fear runs away, because the spirit has come back. The meaning is: when the illness is very mild, a few gestures from you can cure it. We doctors have many methods.

💬 Note from Doctor Ni Haixia: When the illness is at its start, at its mildest, we begin adjusting it — if there is excess, let a little blood, just a few drops; if there is deficiency, insert the needle and that is all, do not let it bleed. So at the onset of illness, do not go too far.

Qi in excess means panting and coughing; qi deficient means short of breath — one listen tells you whether the voice is loud or not

Next, qi (the lungs). The Yellow Emperor asks: how does one treat qi in excess and qi deficiency? Doctor Ni Haixia says — qi means the lungs:

💬 Note from Doctor Ni Haixia: If the lung qi is in excess, has surplus qi, it becomes panting, coughing, qi rushing upward. If deficient, then breathing is smooth but short — the breaths are short and weak. When qi and blood are only slightly ill and the five organs are stable — this tells you that qi and blood themselves divide the work and cooperate; they do not fall ill together. When the five organs are stable and the skin has a slight disorder, it is called “the white qi leaks slightly” — when the lung qi has a tiny problem, you can see a little pallor on the skin and face. Pallor is only a color; it is the sign of the illness at its beginning.

How do you tell excess from deficiency? Doctor Ni Haixia gives the most direct method:

💬 Note from Doctor Ni Haixia: Excess you can see at a glance; deficiency is even more obvious — when the person has no strength to speak, that is deficiency; when you hear a loud voice on the phone, that is excess, you hear it immediately. Chinese medicine may look messy from beginning to end, but when we use it there are great principles — the great principles of the five elements. Later I will give some cases: with listening, smelling and looking, you know at once.

The supplement-drain technique? For excess we drain, for deficiency we supplement:

💬 Note from Doctor Ni Haixia: If there is excess, we drain the channel qi — do not injure the sinews, do not let it bleed, do not drain the spleen qi. “Do not drain its qi” here means you may drain a little of its qi. If deficient, supplement its channel — do not let its qi leak out. For a lung problem: if deficient, do not let its qi leak; if in excess, let a little of its qi leak out.

Blood in excess makes you prone to anger; blood deficient makes you fearful — how to tell false anger from true anger?

Next, blood (the liver). What are the symptoms of blood in excess? Doctor Ni Haixia says: when a person’s blood is in excess, he is prone to anger, loses his temper easily; when deficient, he is fearful. Along the way he shares a trick for reading people:

💬 Note from Doctor Ni Haixia: Sometimes anger is false anger — I often feign anger myself. Look at the teacher losing his temper — it is fake; I am testing the person’s character. When anger is real, the face turns red — that is great anger. When deficient, there is fear. When we have a blood disorder, both excess and deficiency can create stasis on the channels, and blood vessels appear.

For treatment, blood in excess is a liver problem:

💬 Note from Doctor Ni Haixia: For blood in excess, drain its channel (the liver channel) — a patient who angers easily: let blood. For deficiency, at the entry point, insert the needle into the vessel qi and retain the needle, letting him recover slowly. When we do supplement and drain, for example on the liver channel, we insert at Ququan — Ququan is the mother point, right? Or Taichong — Taichong is the earth point, the shu point; it can serve as the source point.

How do you know after needling whether it worked? Doctor Ni Haixia teaches two concrete checks:

💬 Note from Doctor Ni Haixia: When judging the result of supplement and drain, first, you can see the needle hole is red; second, you can feel the pulse — the pulse was small before, after needling it becomes large. If you insert the needle, you can feel the patient’s pulse before needling and again after needling. The pulse changes — you can feel it very clearly if you feel carefully.

And what about stasis in the veins? Doctor Ni Haixia stresses the measure of bloodletting:

💬 Note from Doctor Ni Haixia: Just let the stasis out. When we let blood, two drops, squeeze out one or two drops, that is enough. Only when there is pus do we let it out in earnest — when you see pus, let it flow freely; use the cupping jar to suck it out. Some is just a little blood on a collateral — no cupping jar needed; prick with the bloodletting needle and squeeze out one or two drops, enough to let qi and blood become even again.

Form in excess: abdominal distension and blocked urine and stool; form deficient: weak hands and feet

Next, form (the spleen). When a person is too fat, or too thin, or the body shape has changed, that is excess:

💬 Note from Doctor Ni Haixia: A person with form in excess will surely have abdominal distension, a big belly, lower-abdominal fullness, and jing sou bu li — urination and defecation will not flow smoothly. Form deficient: the four limbs cannot function — the hands and feet have no strength and cannot be controlled. Because this is at the onset, qi and blood are not yet ill and the five organs are stable; the movement of the muscles is called “mild wind” — the skin may twitch, or you may feel a little itch inside the skin.

Supplement and drain? Form belongs to the spleen:

💬 Note from Doctor Ni Haixia: For form in excess, we drain its yang channel (the stomach channel); for deficiency, supplement its luo (connecting) channel. Because the illness has just begun — between the spleen channel and the stomach channel, is there a weak luo point? The focus between the weak points is the luo. So for excess, needle the yang channel; for deficiency, needle the luo channel, that is enough.

Where to needle? At the onset of illness, the location is shallow:

💬 Note from Doctor Ni Haixia: For a mild illness we take the point between the flesh — for example, between the stomach channel and the spleen channel, find the gap between two muscle bellies and insert there. Because this is a shallow illness, the hand does not go above the elbow and the foot does not go above the knee — below the knees and below the elbows, on the spleen and stomach channels.

Will in excess: diarrhea; will deficient: cold hands and feet — supplement and drain for the kidneys

Next, will (the kidneys). The main symptom of will in excess is abdominal distension and sun xie (undigested-food diarrhea); deficiency means jue — either fainting away or ice-cold hands and feet, both called jue:

💬 Note from Doctor Ni Haixia: At the very beginning of the change, the person does not faint; rather the hands and feet become cold. At this time the patient’s joints will move — sound arises within the bones and joints, with a slight tremor.

For supplement and drain, Doctor Ni Haixia mentions two very useful points:

💬 Note from Doctor Ni Haixia: On the kidney channel I often introduce Rangu (KI2) — remember? Rangu is a very useful place. When there is excess, on the channel beside Rangu you see a blue-green vein bulging out — let blood. When deficient, we know we can supplement Fuliu (KI7) — when the kidney qi is slightly deficient, supplement Fuliu; Fuliu is its mother point.

Why needle the collaterals at the onset — and why you must needle the main channels to treat an organ illness

After finishing the five excesses and five deficiencies, Doctor Ni Haixia points out the general rule of needling. When qi and blood are not ill, the circulation is excellent and the pulse is normal; when a slight abnormality arises:

💬 Note from Doctor Ni Haixia: We needle shallowly at the location — let a little blood on the collaterals, insert between the flesh, that is enough; there is no need to go to the main channels. For example, when we needle Fuliu or Sanyinjiao (SP6), we are not needling on the main channels. We insert on the main channels only when the main channel itself has a problem. The channels run directly to the organs, so to treat an illness of the organs we must needle on the channels. Needling the collaterals is useless — because the collaterals pass through the vessels, and the vessels reach the organs; there is still a stage in between. To treat an internal-organ illness, insert directly on the great channel.

Qi and blood combining: blood in yin and qi in yang makes a person manic — let blood at Baihui (GV20)

Next the Yellow Emperor asks: we know the patterns of repletion and vacuity — where does illness come from? Qi Bo answers — from qi and blood combining:

💬 Note from Doctor Ni Haixia: Qi and blood themselves do not fight each other. When qi and blood fall ill and fight each other, yin and yang clash and struggle — qi becomes chaotic in the defensive (exterior qi) and blood runs against the channels. At this point qi and blood separate — one replete, one vacuous: blood combines with yin, qi combines with yang, producing fright and mania. When blood combines with yin and qi with yang, the qi rushes entirely toward the six yang channels, toward the head, and the patient becomes manic. Problems like this we must drain immediately — we learned in acupuncture: let blood at Baihui (GV20); if qi is too exuberant, yang qi too strong, Yongquan (KI1) can also bring it down.

And blood combining with yang, qi combining with yin? That is heat in the middle:

💬 Note from Doctor Ni Haixia: Blood is by nature very hot; combine it with yang and it is even hotter — so it becomes “heat in the middle.” Blood combining above and qi combining below causes vexation and readiness to anger; blood combining below and qi combining above — when qi merges together and is overfull — causes confusion and forgetfulness.

Qi and blood like warmth and dislike cold: when cold stops them, qi and blood split apart

On page 492, the Yellow Emperor asks: blood combines with yin, qi combines with yang — what is repletion, what is vacuity? Qi Bo gives the definitions, and Doctor Ni Haixia expands the key point — the nature of qi and blood:

💬 Note from Doctor Ni Haixia: The qi and blood in the body are by nature fond of warmth and averse to cold — they do not like cold. The moment they meet cold, qi cannot flow, and blood cannot flow either; qi is affected as well. Warmth dissolves — when the temperature returns, qi and blood come back into balance. Therefore “where qi combines there is blood vacuity, where blood combines there is qi vacuity” — when blood is too much, qi becomes little; when qi is too much, blood becomes little. Qi and blood must exist in a state of balance.

Why does cold create vacuity? Doctor Ni Haixia explains it clearly with “qi moves, blood follows”:

💬 Note from Doctor Ni Haixia: Qi and blood, in one sentence — qi moves and blood follows. Qi and blood never turn back; they circulate constantly and must not stop or accumulate. The moment they meet cold and stop, they accumulate. When qi is injured by cold, as qi moves in its channels it stops and accumulates; once qi accumulates in one place, blood cannot pass — because blood waits for qi to move; qi moves six cun first, then blood follows. Now qi congeals and stays, blood does not pass, so qi and blood falling ill together creates blood vacuity. When blood meets cold and stagnates, water stops and qi does not move; qi is affected, creating qi vacuity. That is the simple version.

Why must clinical practice distinguish so finely? Because the medicines differ:

💬 Note from Doctor Ni Haixia: In pattern identification we understand qi and blood — we have herbs that move qi, herbs that enter the qi level, herbs that enter the blood level; this is how we distinguish them. Everything in the Shang Han Lun and Jin Gui Yao Lue later originates here. Here it is piece by piece; Zhang Zhongjing combined it and reorganized it.

What is present is repletion, what is absent is vacuity: why are tumors and cancer repletion patterns?

On page 493, the Yellow Emperor asks: you say blood illness is vacuity and qi illness is vacuity — so are all patterns vacuity, with no repletion? Qi Bo defines repletion and vacuity:

💬 Note from Doctor Ni Haixia: What is present is repletion, what is absent is vacuity — what you can see and touch is repletion; what is not there is vacuity. So when qi combines, there is no blood (qi falls ill together, blood cannot pass, and blood is injured); when blood combines, there is no qi. The qi and blood of the collaterals and minute collaterals all pour into the great channels, so when qi and blood combine together it creates a vacuity pattern. If only simple qi is blocked, the qi stagnation creates blood vacuity; if only blood is congealed and slowed by cold, it creates qi vacuity. A repletion pattern arises when qi and blood are blocked simultaneously — when qi and blood combine, it is repletion.

Here Doctor Ni Haixia even points out the treatment of tumors and cancer:

💬 Note from Doctor Ni Haixia: So when we attack repletion, we often say, “Teacher, this person has a tumor, cancer” — we know inside it is qi and blood combined together; that is why it is repletion. So we must add herbs that move qi, and also herbs that invigorate blood and resolve stasis. If it is vacuity, it is either qi vacuity or blood vacuity — qi vacuity because blood is blocked there, blood vacuity because qi does not move. A vacuity pattern has only one thing blocked; a repletion pattern has both qi and blood blocked. To treat repletion — what is present is repletion — we need herbs that move qi, plus herbs that invigorate blood and resolve stasis; only then can the illness be cured.

When qi and blood both rush upward it is the great reversal — let blood at Baihui, Yongquan and the ten fingertips; if qi returns, life

What if qi and blood both rush upward? The person faints at once:

💬 Note from Doctor Ni Haixia: When qi and blood both rush upward, this creates the great reversal (da jue) — the person falls unconscious — and a reversal can mean sudden death. If the qi is able to turn back, there is a chance of life. So when qi and blood both rush up into the head and the person faints — right? We let blood at Baihui; the blood is removed. And the qi? At Yongquan (KI1), and bloodletting at the ten fingertips (Shixuan, EX-UE11) — letting blood at the extremities makes the qi move. If qi returns, life; if it does not return, death.

The Three Regions and Nine Indicators: you can feel nine indicators on the wrist too

On page 494, discussing where repletion and vacuity come from, Qi Bo begins with the yin-yang transport points. Doctor Ni Haixia takes the chance to review the Three Regions and Nine Indicators:

💬 Note from Doctor Ni Haixia: All the yin refers to the organs; yang refers to the bowels, to qi. All yin and yang have their transport points, their gathering places; yang pours into the yin channels — from the yang channels it pours into the yin channels, because we have transport points; transport points are where the channels guide and regulate the qi vessels. When yin and yang are even and level, they fill the body — a normal body is propped up by yin and yang together.

💬 Note from Doctor Ni Haixia: “When the nine indicators are as one, he is called a normal person.” We have three regions — three steps on the head, three on the chest and body, three on the feet; the pulses together make a normal person. Our hand pulse can also be divided into nine indicators: the palm side here is guan, this is cun, this is chi — the hand also has three regions and nine indicators. Cun, guan and chi are three steps, and each step is pressed at three depths: pressing at the skin is heaven, pressing at the middle is human, pressing at the bone edge is earth. One part has three steps; three parts make nine indicators. As for the pulse positions: from before the guan to the wrist it is a little over nine fen, without touching the wrist bone; behind it is one cun — the pulse slants down from above, so the upper yang pulse is a little higher and the lower yin pulse a little lower. Press at the skin surface and feel the pulse — the illness is in the skin; press at the middle, the illness is in the blood vessels; press deep at the bone edge, the illness is in the organs.

Where does illness come from? Yang illness comes from outside; yin illness comes from yourself

Next, illness born of yin or born of yang:

💬 Note from Doctor Ni Haixia: Illness that emerges from yang is all wind-cold — the external seasonal qi: wind, cold, summer heat, dampness, dryness, heat. If it is born of yin, emerging from the yin organs, most of it comes from unregulated diet, from dwelling places that do not follow the seasons, and from irregular joy and anger — the emotions: joy, anger, worry, sorrow, fear. All of these can cause it. So we must follow the seasons — when the solar terms change, know how to protect yourself. At the same time diet must be watched: do not eat too much, do not eat too richly. And the emotions must stay stable: do not be overjoyed, over-angry, over-worried, over-sad, over-fearful.

In one sentence: yang illness all comes from outside (wind, cold, summer heat, dampness), and yin illness comes from within — you did not take care of yourself and protect yourself.

Wind and rain injure with pain on pressure; cold-damp injures with comfort on pressure — liking pressure is vacuity, resisting pressure is repletion

On page 495, the Yellow Emperor asks about the symptoms of wind and rain injuring a person. Qi Bo says wind and rain first injure at the skin surface; if not cured, they enter the minute collaterals; when full, they pass to the collaterals, then to the great channels:

💬 Note from Doctor Ni Haixia: When they reach the great channels, qi and blood gather in the muscles; at that point when you feel the pulse it is very hard and large — “the replete one is hard and full on the outside, cannot be pressed; pressing it hurts” — that is repletion. In plain terms, when we see a person in continuous pain, we know it is repletion. If the pain is dull and hidden and likes pressure — pressing feels comfortable — it is vacuity pain.

Cold-damp injures a person in exactly the opposite way:

💬 Note from Doctor Ni Haixia: When cold-damp injures a person, the skin does not close, the muscles become tight, the nutritive blood (rong) becomes sluggish — the blood vessels do not flow smoothly — and the defensive qi (wei) leaves, so the patient shows a vacuity pattern. In a vacuity pattern the yang qi is insufficient. If you press with your hand, your yang qi passes over, and the patient says, “Ah, that feels comfortable” — because the warmth of your hand feels good; press a little more, right? That is vacuity. If it is repletion, yang repletion, and you touch him: “Don’t touch me, don’t touch me!” We said this earlier in acupuncture — liking pressure is vacuity, resisting pressure is repletion; this is where it comes from.

Yin may be full but never replete: when the emotions are chaotic, yin qi rises

On page 496, the Yellow Emperor asks about the life and death of yin repletion. Earlier we were told: yin may be full but never replete — the organs can be filled with much blood, but must not accumulate stasis within. How does yin repletion arise? Qi Bo says: irregular joy and anger — suddenly great joy, suddenly great anger, unstable emotions — drive yin qi upward:

💬 Note from Doctor Ni Haixia: A person’s chest cavity is originally yang; now yin qi rushes up — yin is originally below (below the navel), and above is originally yang. The emotions are very unstable — this is why we often sit in meditation. Emotional instability makes yin come up; once yin comes up, the lower part becomes vacuous — rising upward empties the lower body. Once the lower body is vacuous, only yang remains below; yang without yin scatters. Yin stops above and does not move, yin and yang separate — this is the cause of yin repletion. Yin by nature can be full and can circulate, but cannot be replete. So we must keep the emotions very stable, keep the mood good, and not casually over-joy or over-anger.

Grief dissolves qi: grieve too much and add cold food — that is how yin vacuity arises

On page 497, the origin of yin vacuity: Qi Bo says it is all related to the emotions:

💬 Note from Doctor Ni Haixia: Joy makes qi sink — when a person rejoices, qi goes down; anger makes qi rise. Grief dissolves qi — when grief is excessive it injures the lung qi; the lung qi dissolves and the blood vessels become empty. At this point, eating cold things on top of it — the lungs are yang, the chest cavity is all yang; when grief is excessive, yang qi is consumed, and as yang is consumed, yin enters. The patient already eats cold food and drinks cold drinks, and does not know to protect the body and keep it warm, and eats cold food on top of it — the cold is too heavy, and yin vacuity results.

Why must we know yin vacuity from yin repletion? Doctor Ni Haixia says it concerns prescribing:

💬 Note from Doctor Ni Haixia: We have herbs that enter the yin, herbs that attack repletion, and herbs that supplement vacuity — if you know it is yin vacuity, give the yin-supplementing herbs; if you know it is repletion, mix herbs that enter the yin with herbs that attack repletion. Why must we also know cold and heat? Because some of our herbs remove heat and some remove cold. If you can distinguish all this, the main prescription will not go wrong. Most vacuity patterns have heavy cold — heavy cold inside the body — so in vacuity patterns the yang qi scatters in all directions; basically there is cold.

Yang deficiency produces external cold, yin deficiency produces internal heat — exterior cold and interior cold must not be treated with the wrong herbs

On page 497, the classic says “yang deficiency produces external cold, yin deficiency produces internal heat.” Doctor Ni Haixia takes it apart:

💬 Note from Doctor Ni Haixia: Yang is originally at the skin surface. Now the yang qi is deficient, and the outside of the body feels cold — when we have a little yang qi on the surface, we are not easily afraid of cold. When yang is deficient and yin is exuberant inside, you feel cold on the outside and want to wear an extra layer of clothes — that is yang deficiency. A yin-deficient person generates heat inside the body — yang excess produces external heat, yin excess produces internal cold. Yin and yang must be balanced; yin is by nature cold and yang is by nature hot.

How to use this clinically? Doctor Ni Haixia gives the most direct way to tell:

💬 Note from Doctor Ni Haixia: If you know it is yang deficiency, we supplement yang, use the vacuity-supplementing herbs, and the exterior cold will go away. The patient says, “My body is very cold.” You ask him: do you feel the skin surface cold, or the inside of the body cold? He says, “Really, my skin surface is colder” — from this symptom we know it is yang deficiency cold. If the person has yin deficiency with internal heat — when yin is deficient the body is very hot inside — we have yin-nourishing herbs and vacuity-supplementing herbs, and the heat will go away. Why must we know interior cold? Because we have herbs that can remove interior cold; some people have exterior cold, and we must remove the exterior cold. There are two kinds of cold-removal — one is interior cold, one is exterior cold — so the herbs cannot be used carelessly.

Page 498: Where does yang-deficiency external cold come from? Where does yin-deficiency internal heat come from?

The Yellow Emperor says: you have been talking about yin-deficiency internal heat and yang-deficiency external cold; I do not understand — explain again. Qi Bo gives the definitions once more, and Doctor Ni Haixia expands them sentence by sentence:

💬 Note from Doctor Ni Haixia: Yang receives qi from the upper burner — the chest cavity is basically yang; yang receives qi from the upper burner, and therefore can warm the gaps between the skin and the flesh. These parts are all protected by yang. Now cold is outside, affecting the upper burner — outside is too cold, the environment is too cold, the upper burner is blocked. When the upper burner is blocked, cold stays outside and yang qi cannot reach the skin surface, so the patient feels cold — thus yang deficiency produces external cold.

And yin deficiency with internal heat? Its root is “overwork and fatigue”:

💬 Note from Doctor Ni Haixia: A yin-deficient person has internal heat. “Overwork and fatigue” — doing a lot of physical labor, like moving workers, factory workers, farm workers — much physical output; frequent sexual activity also counts; that too can create yin deficiency. Physical exertion damages and depletes the form and qi. When the grain qi is not flourishing, the upper burner does not move, and the lower stomach is not open, at that point only the stomach qi remains hot — because after years of dissipation, yin has been consumed a great deal, and only the stomach heat is left. The heat keeps fumigating; the stomach itself is very hot.

Doctor Ni Haixia adds one particular note — this “stomach” is not only the stomach:

💬 Note from Doctor Ni Haixia: The “stomach” we speak of here, besides the stomach itself, also broadly includes the small intestine. The fire in the small intestine communicates with the fire in the heart — the heart transfers heat to the small intestine. Since you have consumed much yin through exertion, the heat fumigates the chest, and internal heat results.

Closing: the great principle of the Tiao Jing Lun all comes down to two words — qi and blood

This lecture went from the acupuncture supplement-drain methods for the five excesses and five deficiencies of spirit, qi, blood, form and will, to the repletion and vacuity of qi and blood combining, the Three Regions and Nine Indicators, illness born of yin and yang, wind-rain and cold-damp injury, yin repletion and yin vacuity, and finally landed on yang deficiency with external cold and yin deficiency with internal heat. It looks vast and scattered, but Doctor Ni Haixia sums it up in one sentence:

💬 Note from Doctor Ni Haixia: When you get to the bottom of it, it is just two words: qi and blood. When qi and blood are not ill, the five organs are stable and circulation is excellent; when qi and blood fall ill, it is either qi vacuity or blood vacuity, and when qi and blood combine together it is repletion. So in treating illness, first distinguish qi from blood, then distinguish repletion from vacuity and cold from heat — then the prescription will not go wrong.

When you read the Tiao Jing Lun of the Huang Di Nei Jing, and then see how Zhang Zhongjing reorganized the qi-blood passages into the Shang Han Lun and the Jin Gui Yao Lue, you can see that the classical formula school’s approach to repletion — “move qi plus invigorate blood and resolve stasis” — has its source right here.

Compiled from Doctor Ni Haixia’s 66th lecture of the Ren Ji series on the Huang Di Nei Jing, presented by Doctor Luo Dalun.