Never Sweated a Day in Your Life, and Overheat the Moment You Exercise? Doctor Ni Haixia on Yang Excess Creating Exterior Heat, Blocked Sweat Pores, Yin Excess Creating Interior Cold and the Miao Ci (Opposite-Side) Bloodletting Method, from the Huang Di Nei Jing

Patient search terms: I don’t sweat / I have never sweated since I was a child / sweat will not come out / my skin is hot and burning / I overheat and gasp the moment I exercise / hot palms and soles / cold hands and feet / sudden heart pain / sudden stabbing pain in the chest / belly suddenly bloats / sore throat and dry tongue / anger and temper / headache and shoulder pain / fell from a height / urine and stool blocked / bloodletting / acupuncture / Huang Di Nei Jing / Miao Ci Lun

Corresponding medical names: the Su Wen · Tiao Jing Lun (Discourse on Regulating the Channels), Chapter 62, continued — yin deficiency creates interior heat · yang excess creates exterior heat · yin excess creates interior cold · needling when qi and blood are conjoined · acupuncture tonification and draining · plus the Su Wen · Miao Ci Lun (Discourse on Opposite-Side Needling), Chapter 63, in full — the definition of miao ci · the difference between ju ci and miao ci · the collateral disease patterns and needling methods of the fourteen channels · needling by the waxing and waning of the moon · the Tao He Cheng Qi Tang and Ran Gu bloodletting for injuries from falls · the San Mao emergency

Opening: continuing from the last lecture — first, how to treat “yin deficiency with interior heat”

In the previous lecture, Doctor Ni Haixia taught that yang deficiency creates exterior cold, and yin deficiency creates interior heat. Right at the start of this lecture, he goes straight on to teach how to deal with yin deficiency and interior heat.

💬 Note from Doctor Ni Haixia: In a person with yin deficiency, the yang qi tends to run upward, so a yin-deficient person shows the phenomenon of interior heat. When we see this yin deficiency with interior heat, we know to use herbs that nourish yin and herbs that tonify deficiency, and put the heat-clearing herbs in together with them. If you only see the heat and don’t realize it comes from yin deficiency, and you just clear the heat — clearing the heat only treats the branch. The real root is in the yin deficiency; if you don’t include herbs that nourish yin and tonify deficiency, the heat will not go away.

In clinical practice it is very simple: generally speaking, people who have been ill for a long time all show the pattern of yin deficiency with interior heat.

Yang excess creates exterior heat: sweat will not come out, and the skin burns

Then the Yellow Emperor asks: why does yang excess create exterior heat?

💬 Note from Doctor Ni Haixia: The yang qi of the upper burner should circulate ceaselessly — the qi in the lungs goes out to the four limbs and muscles, then spreads to the skin. If the upper burner is blocked, the skin becomes very tight, sweat cannot come out, the interstices are sealed, the mysterious pores (xuan fu) do not open, and the defensive qi cannot travel — then you feel hot on the outside: the skin surface is very hot, because the sweat cannot get out.

Bonus: why do some people go their whole lives without sweating?

At this point, Doctor Ni shares a common and very interesting clinical phenomenon: some people never sweat a drop from childhood to old age. There are three reasons:

💬 Note from Doctor Ni Haixia: The first: the child may have a problem in the lungs — for example, pneumonia when young; or when it came out of its mother’s belly, the amniotic fluid was not fully expelled. In the old days of childbirth, they took the baby out, held it up by the two legs upside down, and gave it a pat on the bottom — the baby cried, and all the amniotic fluid came out. That is the best method. Doctors nowadays don’t want to pat (in America they would be sued for abusing a child), so they put the baby on a table and use a suction tube to suck around the nose, mouth and ears a little, then toss it aside — the baby still has a lot of milk fluid and amniotic fluid in its chest that was never expelled. And before it even reaches its parents’ arms, they jab in the triple vaccine — adding frost to snow. This creates a huge number of pediatric cases. The polio vaccine is also pretty useless.

The second reason: the lungs have been injured, and the pores don’t sweat. The third reason happens most often in girls:

💬 Note from Doctor Ni Haixia: A girl goes to school, sees the public toilet is dirty, and won’t use it; she also loves cleanliness and doesn’t like exercise, because when she exercises, sweat pours all over her and she thinks she smells bad — she would rather hide away; no matter how hot the weather, she won’t sweat. In the Chinese medical view: sweat soaks the clothes, and if the wet clothes are left on the body without changing, day after day the sweat and dampness combine, and the skin produces oil — that is where the oil comes from. If from childhood she doesn’t like to sweat, by seventeen or eighteen the pores have already degenerated — when she exercises, her whole body is hot, but not one drop of sweat comes out; her face is bright red and she is panting, because she only has two nostrils breathing while all 36,000 pores are blocked.

When such patients come to Doctor Ni, he says he has “collapsed” on them many times:

💬 Note from Doctor Ni Haixia: I look at them and collapse many times — I give sweating herbs, and after taking them they get even hotter, and the sweat still won’t come out. What to do? Go home and take a shower — take a cold shower, and cold collects and produces great heat: when yin reaches its extreme it generates cold, when cold reaches its extreme it generates heat. When the cold water hits you, on the contrary you break out in a flood of sweat. Do it while they are well — don’t wait until they have a high fever. When everything is normal, let the mother give the child a cold shower. Try it at home: at first you think it must be freezing — you’re wrong. After washing, when you lie down and come out, you’re hot inside and out, and immediately you sweat profusely. When we were soldiers outside, there was no hot water — one shower was like ascending to heaven, and we still sweated profusely.

So when you meet a patient whose pores won’t open, you must find every way to open them. If they can’t be opened, the mysterious pores don’t communicate, and a person easily accumulates interior heat.

Yin excess creates interior cold: cold qi stuck in the chest, even the heart beats slower

The Yellow Emperor asks again: what about yin excess? Is it interior cold?

💬 Note from Doctor Ni Haixia: Rebellious cold qi rises upward, and cold qi accumulates in the chest without being discharged; if it is not discharged, the warming qi leaves. When there is cold in the body that cannot be discharged, and it stays inside for a long time, the warming qi of the chest is gone — the temperature of the heart drops. Originally the heart went bang-bang-bang, beating very strongly; now with cold inside, the strength of the heartbeat slows down. Because of the cold, the blood congeals and solidifies, the speed of blood flow is affected, and the pulse becomes large but choppy (mai sheng da er se). So yin excess is the whole body being internally cold — that is the source of interior cold.

There is another situation: yin should stay below. If a person overworks, the yin keeps rising upward and stays in the chest, unable to be expelled. If this happens in winter — in winter you should conserve, it is not the season for sweating — and you keep exercising and working outside in winter, the yin qi in the belly keeps rising, the exterior sweat comes out, it is too cold above, and the air you breathe in is cold — then interior cold is born.

When qi and blood are conjoined into one disease, how does acupuncture needle it? The heart is blood, the lungs are qi

The Yellow Emperor then asks: if yin and yang, qi and blood conjoin with each other and create disease, how do we needle it?

💬 Note from Doctor Ni Haixia: When needling this kind of disease, just do it on the channel where the abnormality occurs. If it is blood, we needle on the blood and qi; if it is qi, we needle on the defensive (wei). Taking the chest cavity as an example: the heart is blood and the lungs are qi — so when disease breaks out in the chest cavity, if it is blood we put the needle on the heart channel, and if it is qi we put the needle on the lung channel.

So when the deviation of qi and blood causes yin and yang to contend, how do we tonify and drain?

💬 Note from Doctor Ni Haixia: To drain excess, when the qi is full, insert the needle — the needle enters together with the qi, to open its gate, to benefit its door (yi kai qi men, ru li qi hu). We insert the needle into the point, and when withdrawing the needle, we shake the needle hole wide open so the qi flows out — this is the great draining method: the draining technique for excess patterns is called the Green Dragon Swings Its Tail (cang long bai wei). To tonify deficiency, insert the needle as the patient exhales: when the breath is fully exhaled, the qi is flat, and inserting at that moment does not easily injure the qi; inhale and push the needle deeper, and when withdrawing, press the needle hole shut. These are all tonification and draining techniques.

Earlier, when discussing deficiency and excess, we spoke of the five organs and five pulses — the five organs and the five pulses all have connections. Now the twelve channels are all linked, connecting to the 365 joints of the body. When a joint has disease, it can spread to the channels, and the channels also have deficiency and excess — when deficient, tonify the mother; when excess, drain the child. All of this was taught in the acupuncture classes.

Transition: Chapter 63, the Miao Ci Lun — needling methods specifically for the “collaterals”

After finishing the Tiao Jing Lun, the next chapter is Chapter 63 of the Huang Di Nei Jing, the Miao Ci Lun (Discourse on Opposite-Side Needling), which is entirely about miao ci.

💬 Note from Doctor Ni Haixia: The Yellow Emperor says, I have heard of miao ci but do not know its meaning — tell me, what is miao ci? Qi Bo says: when a pathogenic qi invades the exterior form of the body rather than the internal organs, and evil comes in from outside, it will certainly first lodge in the skin and hair; if it stays in the skin and hair without healing, it enters and lodges in the sun (minute) collaterals; if it remains in the sun collaterals without leaving, it next enters and lodges in the collaterals; if it remains in the collaterals without leaving, it next enters and lodges in the channels — for example, on the foot taiyang or yangming channels; if the yangming channel illness does not heal, it follows the yangming collateral and runs to the lung channel, enters the lung channel, the lung channel enters the organ, internally connecting the five organs; then it disperses into the stomach and intestines. When both yin and yang are affected, the five organs are injured — this is the order by which evil enters from the skin and hair all the way to the five organs. When it reaches this level, you treat its channel.

In simple terms: when the disease is in the skin and hair, you can see it in the skin and hair, so we needle the skin and hair; when evil qi comes in from the skin and hair, enters the sun collaterals, flows and does not leave, blocked and uncommunicating, and cannot enter the main channel (the main channel’s qi and blood are very vigorous), it has nowhere to stay, so it runs to the collaterals and waits there:

💬 Note from Doctor Ni Haixia: If the disease on the sun collaterals does not heal and cannot enter the main channel, it runs to the great collaterals. We have fifteen great collaterals, and they all converge at the Da Bao point of the spleen channel — Da Bao manages all the collaterals. When evil qi stays in the great collaterals, then all sorts of strange and peculiar ailments are born.

Ju ci and miao ci: both treat “the left for disease on the right” — one needles the channel, the other needles the collaterals

What is it like when evil is in the great collaterals? The original text says: it pours from the left into the right, from the right into the left; up, down, left and right it interferes with the channels, and spreads through the four extremities; its qi has no fixed residence and does not enter the channel points — therefore it is called miao ci.

💬 Note from Doctor Ni Haixia: Miao ci is what we use as symmetrical treatment — also treating the left for disease on the right, and the right for disease on the left — but you do not select points according to the channel rule of “when deficient, tonify the mother; when excess, drain the child” — because that applies to deficiency and excess arising on the channels themselves. When we need the channel’s deficiency and excess, we take the mother-child points on the opposite side — that is called ju ci. Everything on the collaterals is miao ci. The common point of the two: both treat the left for disease on the right and the right for disease on the left. The difference: ju ci is on the channel, miao ci is on the collaterals.

For example:

💬 Note from Doctor Ni Haixia: Say you see a deficiency pattern of the hand taiyin lung channel — you needle the mother point on the opposite side, Tai Yuan (LU9), and this is ju ci, because it is on the channel. If the pain is not on the main channel but on a collateral beside the channel, then needling the opposite-side collateral is enough — that is miao ci. So clinical work is very fast: I see a patient who hurts here — I don’t even think about whether it is the hand taiyang small intestine channel. I see the pain here, and the needle goes into the opposite side and it’s done. If it hurts at the small foot joint, around Shen Mai, a needle into the opposite Shen Mai and it’s done — that is miao ci.

When evil lodges in the channel and the left is full, the right is diseased; when the right is full, the left is diseased — this kind must use ju ci: it must hit the channel, not the collaterals. In collateral disease, the pain is interlaced (miao) with the channels, so it is called miao ci.

💬 Note from Doctor Ni Haixia: For example, you see a person whose mouth corner is pulled to one side. You look and the disease appears on the left, but actually the right is full — needle the right and it’s done. That is the distinction between ju ci and miao ci. Ju ci takes points on the channels, miao ci takes points on the collaterals — it’s only a difference of names. If you truly forget the names, it doesn’t matter. In clinical treatment, respond according to the way I taught you, put the needle in, and it’s done.

The miao ci chart: for each collateral disease, where to needle and where to let blood?

Later in the Miao Ci Lun, Qi Bo goes through the collaterals one by one: when a collateral gets sick, what are the main symptoms, and how to let blood.

💬 Note from Doctor Ni Haixia: Disease on the collateral of the foot shaoyin (kidney) channel causes a person to suddenly develop heart pain, while the abdomen suddenly swells enormously and the chest feels full and distended. In a person with no previous accumulation who suddenly gets this disease (wu ji zhe), needle in front of Ran Gu — on the blue vein in front of the Blazing Valley bone, find the blood vessel and let a little blood, and the disease is cured. So when a person falls from the air, or has heart pain of some kind that causes evil heat pain, we can all use this point.

Next is the collateral of the shaoyang channel:

💬 Note from Doctor Ni Haixia: Disease of the collateral of the hand shaoyang (san jiao) channel makes a person’s throat blocked with the tongue rolled up, dry mouth and vexed heart, pain on the outer side of the arm, and the hand unable to reach the head — let blood at the well point. Generally in collateral disease we let a little blood around the well points at the tips of the four limbs. The well point is beside the nail, in the flesh-division area behind the nail; when you see a blue vein you can let it. Collateral disease is easy to treat — it is always at the extremities, never on the main channel. If it is the collateral disease of the jueyin liver channel, it makes a person’s foot suddenly burst into severe pain (sudden hernia pain, zu shan bao tong) — it comes very fast. Needle Da Dun (LR1): in a boy it resolves immediately; in a girl you wait a moment. Treat the left for disease on the right, and the right for disease on the left — collateral disease is always relatively shallow when it comes.

What about the foot taiyang collateral?

💬 Note from Doctor Ni Haixia: The collateral of the foot taiyang channel is on the back side of the body and makes a person’s shoulder hurt — needle Zhi Yin (BL67) and let a little blood beside the nail, and it is cured on the spot. Disease of the hand yangming collateral makes a person’s qi full in the chest, panting with the flanks propped up, and heat in the chest — needle Shang Yang (LI1), the point beside the nail of the index finger, left for right and right for left.

How do you tell apart so many chest-fullness and shortness-of-breath diseases? Doctor Ni gives a master rule:

💬 Note from Doctor Ni Haixia: All collateral diseases are new diseases — things that never happened before and suddenly break out. For example, a patient recently caught a cold with fever, and when the fever rises the chest is full, the breathing is short, the fever is very high — would you needle Shang Yang and let blood? Of course you would; this is an exterior pattern — that is exactly what the text is talking about: fever. If a person has asthma, that is an internal organ disease, and we would not needle Shang Yang to let blood. Just remember: collateral diseases are all new diseases, and many of them are exterior pathogens coming in from outside. Diseases of the internal organs will not run to the collaterals — they must be external: external means wind, cold, summer heat, dampness, dryness and fire. Remember it that way. Chinese medicine talks about symptoms, not disease names. Once you confuse the disease names you are finished — you insist on seeing what the bacteria look like before you use antibiotics.

Closing: antibiotics are cold — Doctor Ni’s sharp critique

Speaking of disease names and bacteria, Doctor Ni takes the opportunity to deliver a sharp critique of antibiotics:

💬 Note from Doctor Ni Haixia: He says, I want to see what the bacteria look like, and use this antibiotic. How many kinds of bacteria are there really? How many kinds of antibiotics do you have? It’s all deception. Bacteria with three legs, bacteria with four legs — he uses the same antibiotic for all of them. Believe me. Not using antibiotics is fine; once you use them, the interior cold gets even worse — because the nature of antibiotics is all cold. Don’t believe me? It’s simple: I give you one pill to swallow, and for twenty-four hours your impotence will not stop. Your wife will think you have another woman outside — but no, it’s that the medicine is too cold.

Bonus: needling according to the waxing and waning of the moon? And the Tao He Cheng Qi Tang emergency for injuries from falls

When evil lodges between the arm and palm and the joint cannot bend or extend — the elbow cannot bend, what to do?

💬 Note from Doctor Ni Haixia: We can needle behind the ankle; first press with the hand to find the tender point. This kind of needling uses the waxing and waning of the moon as its count (yi yue si sheng wei shu): on the first day of the moon’s growth, one prick (yi ri yi wei); the second day, two pricks; on the fifteenth, when the moon is full, fifteen pricks; after the sixteenth it counts back down — fourteen, thirteen, twelve — following the moon’s waxing and waning. Actually you don’t need to check the moon’s phases every day — that’s too fussy; as long as the disease is cured, it’s cured. There are many ways to treat an arm that cannot bend — injuries are wind and exterior pathogens, on the collaterals: wind, cold, summer heat, dampness, dryness and fire. If you catch wind-cold, soak in hot water and rub it — it will certainly be cured. Very simple.

What about disease of the yang qiao vessel?

💬 Note from Doctor Ni Haixia: When evil lodges in the yang qiao vessel, it makes a person’s eyes hurt, starting from the inner corner of the eye — the yang qiao vessel merges with the foot taiyang channel. We can needle half a cun below the outer ankle — that is the place of Shen Mai (BL62) — needle the left for disease on the right, the right for disease on the left, and retain the needle about one shichen (the time it takes to walk ten li, roughly two hours).

What about a person injured falling from a height? This is a great emergency method:

💬 Note from Doctor Ni Haixia: When a person falls from a height, evil blood is retained inside, the abdomen is distended and full, and they cannot pass urine or stool (bu de qian hou). Above, it injures the jueyin channel; below, it injures the shaoyin collateral. First drink a purging medicine — in the classical formulas there is one called Tao He Cheng Qi Tang (Peach Kernel Qi-Guiding Decoction), made precisely for injury from falling at high speed, or being kicked in the testicles causing blood stasis, swelling and blocked urine and stool — first drink the purging medicine. Then needle the blood vessel beneath the inner ankle, in front of the Blazing Valley bone, and let blood — the Blazing Valley point is Ran Gu (KI2). If you fall at high speed, tumble off a horse’s back, or are kicked, and the head is severely injured or struck — when you see the blood vessel at Ran Gu jumping up, it tells you there is blood stasis below. Let a little blood; the stasis disperses, the blood spurts out, and the person wakes up.

Speaking of bloodletting, Doctor Ni also tells a funny story about fire cupping:

💬 Note from Doctor Ni Haixia: Bloodletting requires common sense: aim your head at the wall when you spray, otherwise it sprays onto your face — that stasis blood stinks to high heaven. In the old days women had no common sense; they burned fire inside the cup. After much effort it finally suctioned on, but the fire inside burned all their hair — that is why this kind of direct vacuum cup was developed — all for the sake of some very nervous people. You can’t say: every time you cup with fire you burn off hair; before long the hair is all gone, and the patient says, “You’re a Chinese medicine doctor — how come you have no hair left?” Nowadays everyone uses vacuum cups.

When the yang qiao vessel is diseased, its symptoms are very close to those of the bladder channel, as introduced in the acupuncture classes. If needling Ran Gu to let blood does not work — the stasis blood has not left — and the condition is heavier, needle the place of Chong Yang (ST42) and let a little blood; if still not better, needle San Mao:

💬 Note from Doctor Ni Haixia: San Mao is behind the nail of the big toe. Don’t be rigid and insist on finding “three hairs” — when you see a blue vein there, let it out. For bloodletting on the foot, I recommend wearing gloves. This goes one level deeper than acupuncture: if Chong Yang doesn’t cure it, needle San Mao. When you let blood at San Mao at night, the person will wake up; when you can’t sleep, moxa San Mao and the person will sleep. If a person is startled all day long and gloomy and unhappy, you can also use the method just described to make him happier and more balanced — you can let blood — but you don’t need to go as far as Chong Yang; Chong Yang is too strong, that is for emergencies.

Recorded from Doctor Ni Haixia’s Ren Ji (Human Records) lecture series on the Huang Di Nei Jing (Lecture 67).