High Fever with No Bowel Movement for Seven Days? Clear the Bowels First and the Fever Breaks on Its Own — Doctor Ni Haixia on the Discourse on Root and Branch and the Transmission of Disease, from the Huang Di Nei Jing

Patient search terms: high fever with constipation / no bowel movement for days / bloated belly / stomach bloating / jaundice / vomiting blood / blood in the stool / low back pain so bad I can’t bend / can’t get urine out / appendicitis belly pain / appendix / food stuck in the stomach / restless heart and poor sleep / acupuncture / Huang Di Nei Jing

Corresponding medical names: the Su Wen · Si Shi Ci Ni Cong Lun (Discourse on Counter-Order Needling in the Four Seasons), Chapter 64, closing section (the four seasons’ qi in the channels, collaterals, muscles, skin and marrow, the harm of wrong-season needling, needling depth, and death from piercing the five organs) + the Su Wen · Biao Ben Bing Chuan Lun (Discourse on Root and Branch and the Transmission of Disease), Chapter 65 (the root-and-branch method, treating the branch when urgent and the root when slow, the order of organ-to-organ transmission and death times, and the five-element restraining principle of treatment).

Opening: the pathogen runs with the seasons — spring, summer, autumn and winter each have their own territory

The first half of this lecture finishes the Discourse on Counter-Order Needling in the Four Seasons. It opens with the Shao Yang channel: when Shao Yang is deficient, the gallbladder qi weakens and the liver follows into trouble; if the pulse is slippery, a wind illness is on the move — often sinew-channel numbness and eye pain, because the Shao Yang channel runs past the sides of the eyes. When pathogenic qi accumulates, in general it means deficiency — the blood vessels simply lack strength.

Then Qi Bo lays down the master principle of the four seasons’ qi:

💬 Note from Doctor Ni Haixia: In spring the qi is in the channels, in summer in the minute collaterals (sun luo), in long summer in the muscles, in autumn in the skin, and in winter in the bone marrow. In summer, because the blood and heat inside the body are very hot, when a pathogen enters it stays on the collaterals — it cannot get into the sinews. Long summer is the season of the spleen; during the transition the qi is in the muscles. In autumn it is in the skin, and in winter it is in the bone marrow.

Why does disease lodge in a different place each season?

The Yellow Emperor then asks: I want to know why the pathogen rests in a different place in spring, summer, autumn and winter.

💬 Note from Doctor Ni Haixia: Qi Bo says: in spring the weather opens, the earth’s qi begins to release, the ice thaws and melts; at this time the waters flow and the channels run free, so the human qi is on the channels — this is the most basic theory of Chinese medicine: superimposing the human body onto the seasons, onto the four seasons of heaven. In summer it is hot and the water overflows — in Taiwan we have mudslides and floods every summer; the water spills into the little streams. People are the same: qi and blood run to the outside, and the skin fills out. In long summer the channels all flourish, it is even hotter, and things spill inward into the muscles — the muscles accumulate a lot. In autumn the weather begins to close, the interstitial spaces (cou li) shut, the skin contracts and draws tight. In winter the blood and qi hide in the bones, clinging to the marrow and connecting with the five organs.

Because the seasons move this way, we humans follow the same rhythm — and so the pathogen always takes advantage of the moment when the qi and blood are changing to slip into the body. But once it is inside, its transformations are endless; it is very hard to measure exactly where it sits.

💬 Note from Doctor Ni Haixia: But there is one great principle: no matter how the illness changes, you must follow the course of its channels and qi to expel the pathogen. Remove the pathogen and no disorderly qi is generated. Being a doctor is simple — I told you before, why do we learn the twelve channels? If disease breaks out on a collateral (luo), even if you are too late to treat it, it will not enter the organs; it will only enter the channel (jing). When it reaches the channel, if you remove it there, it still will not enter the fu organs or the zang organs. So follow the channels — that is what Qi Bo is emphasizing.

The price of needling against the season: pricking collaterals in spring drains the qi

On page 522, the Yellow Emperor asks: what happens if you violate the four seasons, needling wildly and throwing the qi and blood into disorder?

Qi Bo answers: in spring you should needle the channels; if instead you prick the collaterals, the qi and blood become restless and spill outward, making a person short of qi. Needling the muscles in spring is also excessive — it makes the qi and blood circle back against their proper course and causes panting (qi rushing upward). Needling sinew and bone in spring is excessive too — the qi and blood lodge inside and cause abdominal distension. In summer the disease is on the collaterals, so you should prick collaterals; if you needle the channels instead, it weakens the qi and makes a person weary and limp. Needling the muscles in summer makes the qi and blood excessive.

💬 Note from Doctor Ni Haixia: You can read through these symptoms yourself. The main principle is: needle shallowly in spring and summer, and needle deeper in autumn and winter — that is the simplest rule; you don’t need to memorize which qi goes up or down. Because our needles today are very fine, you only need to hold the principle: in spring and summer the needles go in shallow. Especially in winter — the needle must go in very deep. Winter is the season of storing, and winter disease sits at the bone, very deep — that needle must go right down to the bone.

Why must stroke needling reach the bone?

Speaking of depth, Doctor Ni uses stroke as an example:

💬 Note from Doctor Ni Haixia: For instance, when a person has a stroke, why do we always needle down to the bone? Because no matter the season, he lies there on one side — the disease is already very deep, so it must be at the bone. Don’t you start from the bone? If you needle a stroke patient but don’t reach the bone, he won’t recover. Now, if there is a kind of stroke patient who lies down in winter but can get up and move around in summer — that kind you don’t need to needle to the bone. Very rare, very rare — at least I have never seen one.

Never pierce an organ: pierce the heart and death comes in one day

Page 524 sets down a great rule: when needling the region of the five organs, you must absolutely never pierce the organs themselves. That is why, when we needle the back Shu points (the points on the back aligned with each organ), there is a set depth — not too deep, not too shallow.

💬 Note from Doctor Ni Haixia: I often tell everyone about the Governor Vessel (Du Mai): from Da Zhui (GV14) all the way down to the fourteenth vertebra, Ming Men (GV4), we needle obliquely, never straight down. If you go straight in — a one-cun needle — with a fat person it’s fine, but with a skinny person even a one-cun needle will reach an organ. Try your best not to pierce an organ. If you do pierce one, what symptoms appear? The text defines them here: pierce the heart and death comes in one day — how do you know? The throat produces eructation (burping). Pierce the liver and death comes in five days — that person talks and talks without stopping. Pierce the lung — coughing that never stops. If you pierce the kidney, its movement is sneezing — he sneezes, and also yawns and stretches. Pierce the spleen and death comes in ten days — the patient keeps swallowing saliva. Wounding the five organs means certain death. So we absolutely must not needle too deep and injure a person’s organs — that is the fundamental rule.

Transition: Chapter 65 of the Huang Di Nei Jing — the Discourse on Root and Branch

With the four-seasons needling complete, the main subject of this lecture arrives: Chapter 65, the Discourse on Root and Branch and the Transmission of Disease (Biao Ben Bing Chuan Lun).

The Yellow Emperor asks: disease has a root and a branch; needling has its compliant and its contrary order. How do you distinguish root from branch? The root (ben) is where the disease originally began — the primary site. The branch (biao) is where it has transmitted and spread to the surface.

💬 Note from Doctor Ni Haixia: How do you tell what is the root and what is the branch? When should you treat the branch first and when the root first? Qi Bo says: your needling must first distinguish yin from yang — we speak of yin channels and yang channels. When you know the channels thoroughly, it becomes: my hand hurts here — that’s a yang channel; it hurts here — a yin channel. Yin and yang must be separated. It hurts here — can you see whether it is on the yang channel, on the stomach channel, on the kidney channel, or on the Conception Vessel? Why do we learn the twelve channels and the eight extraordinary vessels until they are familiar? Precisely so we can separate yin and yang.

First separate yin and yang, then speak of tonifying and draining

“Counter-order and compliant order are applied, and root and branch shift places accordingly” — that is, tonify what should be tonified and drain what should be drained, according to the excess and deficiency of the channels.

💬 Note from Doctor Ni Haixia: Follow the rules of our acupuncture and you will never go wrong. Sometimes the disease is on the branch and you seek it on the branch; sometimes it is on the root and you seek it on the root; sometimes the disease is on the root but you seek it on the branch, and sometimes it is on the branch but you seek it on the root. Some treatments succeed by taking the branch, some by taking the root, some by contrary taking, some by compliant taking. Everything you do hits the mark — but if you do not understand root and branch, your practice is reckless. The most important thing is yin-yang counter-order — that is the way of root and branch. From the small you see the great; from one you know the harm of a hundred diseases. From little you reach much, from shallow you reach broad, from shallow you know deep. What is all this saying? It says: when you are a doctor, there is root and there is branch — treat the branch when the branch is urgent, treat the root when the root is urgent. That’s the whole thing in plain words.

The first case: high fever with no bowel movement for seven days — clear the bowels and the fever breaks

Theory done, Doctor Ni goes straight to cases:

💬 Note from Doctor Ni Haixia: A patient comes in. You ask: high fever, eh? How are your bowels? Constipated? How many days have you been constipated? Seven days! Terrifying — no bowel movement for seven days. At this point do you still care about the fever? Once you get the bowels moving, the fever breaks. The bowels are the root; that heat is false heat — Yangming dry-heat produces a raging fever.

How do you judge? Here is the contrast case:

💬 Note from Doctor Ni Haixia: You say: how many days have you had the fever? Three or four days. How are the bowels? I haven’t had a movement today; yesterday I did; I was supposed to have one this morning but it hasn’t come yet. Then we know you’re fine — we can still use some exterior-releasing herbs, some heat-clearing herbs. That is root and branch.

When the branch is urgent, treat the branch: twenty-four hours without urine — open the urine first

💬 Note from Doctor Ni Haixia: So when there is urgency, we treat the urgent thing first; when things are slow, and an urgent condition arises, we treat that extreme first. Someone runs in and tells you: I haven’t urinated in twenty-four hours! You open his urine first, before anything else — would you still be worrying about other things? You’d be scared half to death, right? Can we open it with needles? Of course we can — why not? Shui Fen (REN9), Shui Dao (ST28), Zhong Ji (CV3), the Mu point of the Bladder, Yin Ling Quan (SP9), the San Jiao Mu point — things like that. Get the urine out first! Are you still asking other questions: hey, do you sleep at night? Do you sleep well? Too slow! That’s the whole thing in plain words.

Illness first, then a counter-flow symptom: treat the root — the appendicitis case

The original text says “when there is a prior disease and afterward a counter-flow (ni) arises, treat the root” — after the original disease, other rebellious symptoms develop; in that case treat the original disease. Doctor Ni gives a vivid example:

💬 Note from Doctor Ni Haixia: A man has appendicitis, blocked up. We know this area (the right lower abdomen) is hot, and at the same time there is no bowel movement and abdominal pain. He tells you: my belly hurts. You check the Foot Yang Ming channel — one to two cun below Zu San Li (ST36), in the middle, you press for the tender point; we call it the Lan Wei point (the appendix point). You find the tender spot and confirm it is appendicitis. Then the patient says: Doctor, my hand is injured here, it hasn’t closed up in two days. And you ignore his appendix and start closing up the wound — that is terrible doctoring! Do you see the sense of it? His appendix is swollen over there, and you’re stitching up his hand.

The correct move is to needle it out, to attack the blockage out.

Needle and formula together: the doctor who can both needle and use classical formulas is a super doctor

💬 Note from Doctor Ni Haixia: In the future I hope you will all be doctors of both needle and formula — when you can do acupuncture and use classical formulas (jing fang) at the same time, you are truly a super Chinese physician: from the disease at its very start, sitting on a collateral, all the way to the disease deep in an organ, you can handle it all. Otherwise, take a man with low back pain — do you know how long he would have to take herbs? A low back injury that has hurt for a long time — one needle and it’s done, cured on the spot.

And for those who understand neither root nor branch:

💬 Note from Doctor Ni Haixia: Now there’s a man with terrible low back pain, can’t even bend over, and he has a bit of fever. You tell him: no problem, let’s treat the fever first, forget about the back — he can’t even move, right? That is understanding neither root nor branch.

The jaundice case: symptoms first, then a major illness — still treat the root

The original text: when many symptoms appear first and afterward a serious illness develops, we still treat the root. Jaundice as the example:

💬 Note from Doctor Ni Haixia: A man comes in, jaundiced all over. You ask: how many days have you had the jaundice? It only started yesterday. And before the jaundice, were you sleeping well? No, not well. Appetite? No — poor appetite, and the stools weren’t very smooth either, and the urine was yellow — all of it running along until yesterday, when the jaundice suddenly exploded. In this case, treat the jaundice first. Why? Because the gallbladder is blocked — only then do the other secondary symptoms appear; only when the blockage is complete does jaundice form.

Cold first or heat first, treat the root; constipation beyond two days must be cleared out

If cold comes first and then illness arises, treat the cold first; if illness comes first and then cold arises, treat the illness; if heat comes first and then illness arises, treat the heat illness.

💬 Note from Doctor Ni Haixia: What does “heat first” mean? A person’s large intestine is blocked with stool, and that causes fever. Another kind: the large intestine isn’t blocked at all, it is simply dry-heat; because the heat hasn’t been removed, it eventually causes the bowel to clog. That is seeing the order of events. Generally, if you’re blocked one or two days, no problem; beyond two days we must clear it out.

The rule of the Shang Han Lun: release the exterior first, then attack the interior

Here Doctor Ni previews the principle that will govern the later Shang Han Lun lectures:

💬 Note from Doctor Ni Haixia: Later, when we study the Shang Han Lun, there it is: if you have a Taiyang exterior pattern and you see constipation, release the exterior first and then attack the interior — that is the rule in the classical method. Otherwise, if you attack the interior first, the exterior pathogen sinks down, and when it sinks it creates xin xia pi (epigastric stuffiness), and the pi (accumulated fluid) spills out — that’s when your angle of judgment was off. Don’t worry, I’m teaching you; you won’t give your patients xin xia pi. Of course, if you deliberately want to give your enemy xin xia pi, that’s also possible — when you should release the exterior and instead you purge him, he gets pi!

Zhong man is treated as the branch: food stuck in the stomach

The original text: “when illness comes first and afterward zhong man (midsection fullness) arises, treat the branch.” What is zhong man?

💬 Note from Doctor Ni Haixia: Zhong man — we eat food into the stomach and it gets stuck there. When does it appear? Often you see someone who has eaten spoiled food, and it gets blocked right here: the good food can’t go down because the bad food is blocking it. Why does the bad food stay there? Because your body won’t accept it — this food doesn’t belong here. Blocked there, that is zhong man. At that point we clear out the zhong man — we have many excellent medicines for it, and needles work too.

The vomiting-blood case: the blood isn’t even stopped and you want to treat his melancholy? That’s apples and oranges

On page 527, the passage “treat the branch through the root, treat the root through the branch” — Doctor Ni is afraid you won’t remember it, so he speaks plainly:

💬 Note from Doctor Ni Haixia: In plain words — a man is already vomiting blood, passing pus and blood below. His secondary symptoms will be many: I’m exhausted all over, I have no strength to speak, I can’t sleep, I just had a fight with my wife, I’m angry and weak and miserable inside. Can you say: oh, depression — let’s treat the depression first? No! You look at which is more urgent — that’s the principle: whichever is more urgent, treat that one first. The moment you remove the bleeding in his intestines and stomach, all his spirits recover; once he’s back to normal, then he can start worrying about whether his son is gay or whatever — we’ll deal with that then. But as it is now, you’ve mixed up root and branch: he’s over there vomiting blood and you ignore him, running off to solve his son’s sexuality problem — that’s apples and oranges, the method is wrong!

Organ disease transmits: the illness marches along, the five-element restraints line up in order

Page 529 enters the hardest core of the Discourse on Root and Branch and the Transmission of Disease — the transmission of organ disease and its death times.

💬 Note from Doctor Ni Haixia: When a disease transmits and first reaches the heart, the heart is the first to hurt. After one day of heart pain, coughing begins — because fire overcomes metal: when the heart is in trouble, fire (heart) overcomes metal (lung), producing cough. On the third day the pathogen reaches the chest and ribs with distending pain — metal overcomes wood: the liver wood is entirely in the flanks, and Shao Yang is entirely in the flanks. On the fifth day it causes blockage and obstruction — because wood overcomes earth: earth (spleen and stomach) governs the bowels and urine, and the body feels heavy; the kidneys also govern urine, and the spleen also governs urine, so the symptoms differ. If it is not cured by three days, then in winter death comes at midnight, and in summer death comes at noon.

The five-part method for death times: midnight in winter, noon in summer

How do we know midnight versus noon? Doctor Ni says: this is what I call the five-part method — the five elements matched to the hours:

💬 Note from Doctor Ni Haixia: We know the root illness is in the heart. The heart is fire; noon is the height of fire — same qi, so the illness flares. Midnight is water, and water overcomes fire, so death comes at midnight. In winter, death comes at midnight — winter is water; night is water, midnight is water. In summer, death comes at the end of the day (noon), because that is when the illness flares. That is why heart disease death times differ between summer and winter. If you want the five-part method, forget things like “winter, at sunset; summer, at sunrise” — the five-part method tells you clearly when the trouble will come.

The transmission of lung disease and liver disease

Organ disease transmits along its own routes:

💬 Note from Doctor Ni Haixia: Lung disease — wheezing cough, shortness of breath with coughing. In three days the pathogen creates chest and rib oppression and distension — that is metal overcoming wood: lung trouble affects the liver. If it isn’t cured and keeps transmitting, that’s wood overcoming earth — the spleen: heavy body, body pain, distension. If it isn’t cured in ten days, the patient is doomed — the death hour differs between winter and summer.

Liver disease? The liver governs the eyes and the chest and ribs, so when the liver is ill there is blurry vision and distension of the chest and ribs. On the third day, heavy body and painful joints — wood overcomes earth: liver disease transmits to the spleen; the spleen governs the lower abdomen, so the belly swells; then low back and lower abdominal pain, and neck soreness — that is earth overcoming water. If it isn’t cured in three days, in winter death comes as the sun goes down, and in summer death comes at breakfast time (sunrise).

From days to hou: Zhang Zhongjing’s one hou is seven days

Speaking of death times, Doctor Ni inserts a note on converting “days” (ri) to “hou” (periods) — a seed for the later Shang Han Lun:

💬 Note from Doctor Ni Haixia: Later, in the Shang Han Lun, Zhang Zhongjing uses hou — one hou is seven days: about six days, and on the seventh day the pattern changes. That is why I often say “six” — because on the seventh day it changes over. If here you convert “day” to “hou,” three days becomes twenty-one days. Personally I think converting days to hou is more important — in the old definition, one day equals one hou; in the old books, one hou is about six days.

Spleen disease, kidney disease, stomach disease: transmitting on down the line

Spleen disease — when the spleen is troubled, the belly distends, the body feels heavy, joints ache, the body feels weighted down, the lower abdomen distends — you can hear at once that this is spleen distension. Earth overcomes water: if it isn’t cured — not cured within a week — the lower abdominal distension leads to urgent low back pain and neck soreness (earth overcomes water). If the hou are wounded, the back and spine all hurt, and the urine stops coming. If within ten hou (sixty days, two months) you haven’t cured him, the person is finished — when he dies in winter and when in summer are written in the book.

Kidney disease? Kidney disease always brings soreness of the lower abdomen, the back and spine, and the shinbones (the bones ache; the tibia on the foot is sore).

💬 Note from Doctor Ni Haixia: When the back cannot bear lifting, that is water overcoming fire. Kidney disease is a water disease — and the urine is the disease: the moment urination is blocked, the patient is in grave danger — Western medicine is the same. We must hurry and get it all out.

Stomach disease is the easiest to treat — Doctor Ni emphasizes this line specially:

💬 Note from Doctor Ni Haixia: Stomach disease is actually the easiest to treat — whether it’s stomach suppuration, inflammation, gastric ulcer with pus, any stomach inflammation — all very treatable. If stomach disease distends and fills, then at five hou the lower abdomen and low back ache urgently — that’s earth overcoming water, not cured; then cold hernia (han shan) — because cold follows the route of water. If it still isn’t cured, the urine becomes blocked — because water has been overcome, earth overcomes water, and water can no longer transform.

The true point comes at the very end: if it stops at one organ, it can be treated

At page 530, lines 2 and 6, under the third paragraph, Doctor Ni says “the real point of this whole passage is at the very end”:

💬 Note from Doctor Ni Haixia: All diseases transmit, and all have death times. But if it stops at one organ — it transmits to one organ and stops, transmitting no further — or even if it transmits to three or four organs, these can all be treated. This sentence is the point! Why do we need to know all those secondary symptoms earlier? Go read them; if you can’t memorize them, no matter — I don’t care whether you remember them. But you absolutely must hold this concept.

The great principle: protect the lung when the heart is ill, strengthen the spleen when the liver is ill, guard the heart when the kidney is ill

With this concept, the great principle of treatment emerges:

💬 Note from Doctor Ni Haixia: When the heart has a problem, if you first secure the lung, the heart disease will not transmit. When the liver has a problem, we first strengthen the spleen, and the disease will not transmit further. When the kidney has a problem — because the first organ involved is the heart — we guard the heart, and the disease will not transmit. As long as you trap the disease in a single organ so it does not transmit, this patient will not die — understand what I mean? Then however you regulate and treat him afterward, that is the great principle.

Closing: the next lecture enters the Discourse on the Great Origins of Heaven’s Mandate

On page 532, this lecture comes to a rest. Doctor Ni says: next chapter we will take up the Tian Yuan Ji Da Lun (Discourse on the Great Origins of Heaven’s Mandate) — starting with Chapter 66. Much of the original Huang Di Nei Jing was lost in transmission; the edition we have now comes from the Song-dynasty print (the Song edition), in which the Tang-dynasty Wang Bing restored and completed Chapters 66 through 74. Everything we discuss from here on is that restored content — we’ll continue tomorrow.

What this lecture is worth most is those two characters: root and branch. High fever with constipation — clear the bowels first; no urine for a day — open the urine first; vomiting blood — stop the bleeding first. Treat the branch when it is urgent, treat the root when it is slow. Add the great organ-guarding method — an illness that does not transmit will not kill: protect the lung when the heart is ill, strengthen the spleen when the liver is ill, guard the heart when the kidney is ill. Remember these two sentences, and they will serve you better than memorizing a hundred acupuncture points.

Compiled from Doctor Ni Haixia’s Ren Ji (Human Records) lecture series on the Huang Di Nei Jing (Lecture 69), presented by Doctor Luo Dalun.