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The “Huangdi Neijing” is one of the four classic texts of Traditional Chinese Medicine (TCM) (“Huangdi Neijing”, “Nanjing”, “Shanghan Zabing Lun”, “Shennong Bencao Jing”), and it is the earliest existing medical classic in our medical treasury. Theoretically, it established the “Yin-Yang and Five Elements Theory”, “Pulse Theory”, and “Zangxiang Theory” in TCM. It is divided into two parts: “Lingshu” and “Suwen”, traditionally attributed to the Yellow Emperor, passed down orally through generations, and later supplemented and developed by physicians and medical theorists, culminating in a written form during the Spring and Autumn and Warring States periods. It elucidates the mechanisms and pathology of diseases through dialogues and Q&A between the Yellow Emperor, Qi Bo, and Lei Gong, advocating for the treatment of diseases before they manifest, as well as promoting health preservation, longevity, and vitality. It is indeed the outline of TCM!
[Summary]
For any issues related to tendons, treating the liver is appropriate.
For any issues related to bones, treating the kidneys is appropriate.
For any issues related to muscles, treating the spleen and stomach is appropriate.
For any issues related to blood vessels, treating the heart is appropriate.
For any issues related to skin diseases and hair, treating the lungs is appropriate.
[Five Organs]
1. Heart: The heart is the residence of the spirit, the master of blood, and the root of the pulse. It belongs to fire in the Five Elements; physiological functions include: ① governing blood vessels; ② governing consciousness; the heart opens to the tongue, connects with the pulse in the body, manifests on the face, corresponds to joy in emotions, and sweat in fluids. The heart is interrelated with the small intestine.
2. Lung: The lung is the place of the corporeal soul and the master of qi, belonging to metal in the Five Elements; physiological functions include: ① governing qi and controlling respiration; ② governing the dispersing and descending of qi; ③ regulating the water pathways; ④ governing the hundred vessels and treating stagnation (congestion); assisting the heart in regulating the circulation of qi and blood; the lung connects to the throat, manifests on the skin, corresponds to hair, opens to the nose, relates to worry in emotions, and mucus in fluids, and is interrelated with the large intestine.
3. Spleen: The spleen is the source of qi and blood transformation, the foundation of postnatal life, and stores intention, belonging to earth in the Five Elements. Physiological functions include: ① governing transportation and transformation; ② governing the raising of clear qi; ③ governing blood regulation; it opens to the mouth, connects with the flesh, governs the limbs, manifests on the lips, corresponds to thought in emotions, and saliva in fluids; the spleen is interrelated with the stomach.
4. Liver: The liver is the place of the ethereal soul, the storehouse of blood, and the root of tendons. It belongs to wood in the Five Elements, governing upward movement. Physiological functions include: ① governing the smooth flow of qi; ② storing blood; it opens to the eyes, connects with the tendons, manifests on the nails, corresponds to anger in emotions, and tears in fluids, and is interrelated with the gallbladder.
5. Kidney: The kidney is the foundation of pre-natal essence, stores will, and the waist is the organ of the kidneys, belonging to water in the Five Elements; physiological functions include: ① storing essence, governing growth, development, and reproduction; ② governing water; ③ governing the reception of qi; in the body, it corresponds to bones, governs the production of marrow, manifests on hair, opens to the ears and the two yin (anus and perineum), corresponds to fear in emotions, and saliva in fluids, and is interrelated with the bladder.
[Six Fu Organs]
1. Gallbladder: Physiological function: stores and excretes bile, the gallbladder governs decision-making.
2. Stomach: Physiological function: receives and digests food and drink, the stomach descends to harmonize.
3. Small Intestine: Physiological function: governs the reception and transformation of substances, separating the clear from the turbid, “the small intestine governs fluids”.
4. Large Intestine: Physiological function: transmits and transforms waste, the large intestine governs fluids.
5. Bladder: Physiological function: stores and excretes urine, relying on the kidney’s qi transformation function.
6. San Jiao: Physiological function: facilitates the flow of original qi, governs the qi mechanism and transformation, serving as the pathway for the movement of water and fluids.
[Twelve Meridians Flow]
In a day, there are twelve time periods, each corresponding to a meridian, connecting end to end, like a loop without end. Mastering your own body means mastering the secrets of longevity and health!
Zi Hour: 23:00 – 1:00 Gallbladder Meridian: Deep sleep! The gallbladder needs metabolism; if a person sleeps at this hour, the gallbladder can complete its metabolism. At this time, the heart function is weakest; if there are heart patients, prepare the emergency heart pill.
Chou Hour: 1:00 – 3:00 Liver Meridian: Deep sleep! This is the best time for liver repair; the waste blood needs to be eliminated, and fresh blood needs to be produced, completed during this hour. One must enter deep sleep to provide the liver with sufficient energy. If one does not sleep, the liver continues to output energy to support thinking and actions, failing to complete metabolism, leading to liver disease.
Yin Hour: 3:00 – 5:00 Corresponding Meridian: Lung Meridian: The transformation of yin and yang begins at this moment, transitioning from yin to yang. The human body also enters a time of yang flourishing and yin declining. At this moment, the lung meridian is most active. The liver provides blood to the lungs, which then distributes it throughout the body. At this time, the body requires a large amount of oxygen. Patients with lung diseases such as asthma should take their medication during this hour for better efficacy than during the day.
Yin Hour: 5:00 – 7:00 Large Intestine Meridian: Bowel movement! Drink a cup of warm water before defecation. At this moment, the large intestine meridian is vigorous, absorbing moisture and nutrients from food and expelling waste.
Chen Hour: 7:00 – 9:00 Stomach Meridian: Don’t forget breakfast! At this time, gastric acid is continuously secreted; if one goes hungry for too long, there is a risk of gastric ulcers, gastritis, duodenitis, and cholecystitis!
Si Hour: 9:00 – 11:00 Spleen Meridian: Drink water! (Drink more water at this time) The spleen is the overall coordinator of digestion, absorption, and excretion. The spleen is the foundation of postnatal life. To nourish the spleen: barley, red bean, and yam porridge. Throughout the day, drink about 2000ml of water, approximately five bottles of mineral water, and continue to drink; do not drink any beverages.
Wu Hour: 11:00 – 13:00 Heart Meridian: Take a short rest. The heart drives blood circulation, nourishing the spirit, qi, and tendons. A short nap is greatly beneficial for heart health, allowing one to be energetic in the afternoon and evening. *Napping should not exceed 30 minutes, as it may disrupt sleep and lead to insomnia at night.
Wei Hour: 13:00 – 15:00 Small Intestine Meridian: The small intestine meridian adjusts the nutrition of the body during this time. If there is heat in the small intestine, the body will experience belching and gas. Therefore, lunch should be eaten before 1:00 PM to ensure that nutrients are absorbed into the body.
Shen Hour: 15:00 – 17:00 Bladder Meridian: Urination! The bladder expels fluids from the body. If there is heat in the bladder, it can lead to bladder cough, which is coughing and involuntary urination. The bladder is most active, and it is suitable to drink more water. At this time, do not hold urine, as it can lead to “urinary retention”.
You Hour: 17:00 – 19:00 Kidney Meridian: The kidneys are the essence of reproduction and the essence of the five organs and six fu. The kidneys are the root of pre-natal essence. After the Shen hour, the body expels fire and detoxifies, and the kidneys enter the time of storing essence. This is a time for men. For those with kidney function issues, massaging the kidney meridian at this time is most effective.
Xu Hour: 19:00 – 21:00 Pericardium Meridian: The pericardium meridian. This moment creates conditions for peaceful sleep. Maintain a calm mindset.
Hai Hour: 21:00 – 23:00 San Jiao Meridian: Time to sleep! This is when the body’s largest fu, the San Jiao meridian, operates, governing all qi and unblocking the water pathways. During the Hai hour, the San Jiao connects with the hundred vessels. One can rest and recuperate.
Pathological Mechanism Analysis
1. Adhere to the pathological mechanism, each organ has its own role
When studying diseases, it is essential to grasp the mechanism of onset—whether it belongs to a specific organ or is due to cold or heat.
The nineteen pathological mechanisms can generally be categorized into the five organ mechanisms (heart, liver, spleen, lung, kidney, upper, lower) and the six qi mechanisms (fire, heat, wind, cold, dampness). The five organ mechanisms are defined by their location of disease, while the six qi mechanisms are defined by their nature of disease. The location of disease must have a corresponding nature, and the nature of disease cannot be separated from the location. Therefore, the five organ mechanisms are essentially variations of the six qi, and the variations of the six qi are pathological responses resulting from the imbalance of qi, blood, yin, and yang in the organs.
For example, “all types of syncope belong to the lower”.
Syncope can be divided into two types: one refers to the reversal of the four limbs due to the imbalance of yin, yang, qi, and blood. The other refers to fainting, where one loses consciousness. This is often related to liver and kidney disorders. “Solid” refers to the inability to pass urine and stool. “Diarrhea” refers to the inability to hold urine and stool (some believe that solid and diarrhea refer specifically to bowel movements). Solid and diarrhea are primarily related to disorders of the large intestine, bladder, and kidneys, thus also belonging to the lower jiao.
First, let’s discuss syncope.
1. Reversal Syndrome
Cold limbs, pale complexion, cold sweat, lethargy, and a weak pulse. This can be divided into cold reversal and heat reversal.
1. Cold Reversal
Due to excessive internal cold, the yang qi is weak below, and the cold impedes blood flow. The treatment should warm the center and disperse cold. Use Si Tong Decoction with modifications for treatment.
2. Heat Reversal
Common in high fever illnesses, excessive heat burns and injures fluids, leading to a decline in yin qi below and an excess of yang qi. Extreme yang can lead to cold, with internal heat and external cold, resulting in sudden cold limbs and sweating. As stated in the “Shanghan Lun”, “if there is heat in the front, there must be reversal in the back; if the reversal is deep, the heat is also deep”. Symptoms include chest and abdominal heat, delirium, thirst, and a red tongue with a rapid or deep and slow pulse. The treatment should revive yang urgently and clear heat and detoxify. Use Shenfu Decoction with Huanglian, Huangqin, Muli, and Longgu for treatment.
2. Fainting Syndrome
Refers to sudden loss of consciousness, cold limbs, but with a gradual chance of recovery. The causes of this syndrome are numerous, as recorded in the “Huangdi Neijing” including violent fainting, boiling fainting, thin fainting, and corpse fainting. There are also qi fainting, blood fainting, pale fainting, and worm fainting. All are caused by the disorder of qi and blood, divided into deficiency and excess types.
1. Excess Type
① Liver Yang Excess: Violent anger harms the liver, causing liver qi to reverse, blood follows qi upward, qi and blood become obstructed, obscuring the clear yang. As stated in the “Suwen: Theory of Vitality”, “great anger leads to the cessation of qi, and blood accumulates above, causing fainting”. Clinical symptoms include sudden fainting, loss of consciousness, clenched teeth, purple lips, and a red face, with a wiry pulse. The initial treatment should be to open the orifices with acrid and cool herbs, using An Gong Niu Huang Wan, followed by blood-activating and qi-regulating methods, using Tong Yu Decoction (from “Jingyue Quanshu”) with Tianma, Gouteng, and Shijue Ming for treatment.
② Phlegm Turbidity Obstruction: Usually due to excessive phlegm, combined with anger causing qi to reverse, phlegm rises with qi, obstructing the clear orifices, leading to sudden fainting, accompanied by phlegm sounds in the throat, foaming at the mouth, cold limbs, white and slippery tongue coating, and a submerged and slippery pulse. The treatment should promote qi and resolve phlegm, using Guo Phlegm Decoction with Baijiezi and Shichangpu.
③ Heat and Dampness: Usually due to yin deficiency and yang excess, combined with heat and dampness, disturbing the clear yang, leading to sudden fainting. As stated in the “Suwen: Theory of Vitality”, “yang qi, when overworked, becomes exhausted, accumulating in summer, causing fainting”. The initial treatment should be An Gong Niu Huang Wan with acrid and cool herbs, and after recovery, use San Wu Xiangru Decoction with Dan Nanxing, Shichangpu, and Huangqin to clear heat and benefit qi.
2. Deficiency Type
① Blood Deficiency Fainting: Seen in cases of excessive blood loss, where qi follows blood loss, unable to ascend to the head, leading to fainting. Clinical symptoms include loss of consciousness, pale complexion, pale tongue, and a submerged and weak pulse. The treatment should be Ren Shen Yang Rong Decoction to tonify qi and blood.
② Qi Deficiency Fainting: Due to deficiency of the source qi, insufficient vital energy, or qi sinking, leading to sudden fainting, pale complexion, sweating, and cold limbs, with a submerged and weak pulse. The initial treatment should be Shenfu Decoction to tonify qi and revive yang, followed by Ba Zhen Decoction to tonify both qi and blood.
3. Constipation Analysis
Constipation primarily occurs in the large intestine. As stated in the “Suwen: Linglan Secret Classic”, “the large intestine is the official of transmission and transformation”. It is also related to the spleen, stomach, and small intestine. The food and drink undergo fermentation in the stomach, transformation in the spleen, and separation of clear and turbid in the small intestine, with the waste transmitted to the large intestine, where water is absorbed to form stool. Therefore, the “Lingshu: Nutritional Health” states, “food and drink reside in the stomach, forming waste, and descend to the large intestine”. If there is cold or heat in the large intestine, its function may be either excessive or deficient, affecting stool formation. Additionally, during the process of food and drink transformation, the spleen, stomach, and small intestine are involved, and any dysfunction or invasion of external pathogens can affect stool formation.
① Heat Constipation: Due to heat accumulation in the stomach and intestines, or residual heat after an illness, drying out the fluids and leading to constipation. Symptoms may include fever, red face, bad breath, dry throat, yellow and dry tongue coating, and a rapid and forceful pulse. The treatment should be Ma Zi Ren Wan to clear heat and moisten the intestines.
② Cold Constipation: Due to yang deficiency or cold in the organs, leading to stagnation of qi, internal cold, and inability to move fluids, resulting in dry and hard stools, with clear and long urine, pale tongue, and a submerged and slow pulse. The treatment should warm the intestines and expel cold, using Wen Pi Decoction with Da Huang, adding Dang Gui, Rou Cong Rong, and Xing Ren for warming and moistening.
③ Deficiency Constipation: Due to dryness of blood and fluids or prolonged illness leading to qi deficiency, resulting in weak transmission. Those with blood deficiency often present with a pale complexion and occasional dizziness and palpitations. Those with qi deficiency may present with a pale complexion, shortness of breath, and sweating. For blood deficiency, use Run Chang Wan to nourish blood and moisten the intestines (see “Shen’s Book of Respect for Life”). For qi deficiency, use Huang Qi Decoction to tonify qi and moisten the intestines (see “Jinkui Yiyi”).
Analysis: Due to obstruction in the intestines, clear qi cannot ascend, turbid qi cannot descend, and clear and turbid mix, leading to abdominal distension, constipation, hardness, and pain, accompanied by loss of appetite, vomiting, white and greasy tongue coating, and a tight pulse. The treatment should be Mang Xiao Tong Jie Decoction to open the blockage.
4. Diarrhea Analysis
Diarrhea is like water flowing out, while loose stools are more urgent. Clinically, both are referred to as diarrhea. Diarrhea is primarily due to dysfunction of the spleen, stomach, large intestine, and small intestine, or due to invasion of wind, cold, and dampness, affecting digestive function, with dampness being particularly significant. As stated in the “Huangdi Neijing”, “excess dampness leads to diarrhea”, where excessive dampness harms the spleen, and if the spleen yang is insufficient, it can also lead to diarrhea.
① Food Diarrhea: Due to spleen deficiency and liver excess, where the spleen governs transformation and the liver governs smooth flow. If the liver is excessive, it can invade the spleen, and if the spleen is deficient, it cannot transform properly, leading to undigested food and diarrhea. Clinical symptoms often include watery stools, undigested food, abdominal distension, and intermittent pain. The treatment should be Tongxie Yaofang with modifications, adding Gegen and Shengma to support the spleen and suppress the liver.
② Damp-Heat Diarrhea: Often due to overeating or consuming spoiled food, damaging the spleen and stomach, leading to spleen deficiency and dampness accumulation, resulting in diarrhea. Clinical symptoms include loose stools, foul-smelling, intermittent pain, and burning sensation in the anus. Accompanied by fever, yellow and thick tongue coating, and a rapid pulse. The treatment should be Qinlian Gegen Decoction to clear heat and drain dampness.
③ Cold-Damp Diarrhea: Due to cold dampness invading the spleen and stomach, obstructing the spleen’s function, leading to undifferentiated clear and turbid, resulting in diarrhea. Clinical symptoms include watery stools, dark and clear like water, with some formed stools resembling duck droppings, accompanied by clear and long urine, and cold limbs. The treatment should be Fuzi Lizhong Decoction combined with Pingwei San to warm the center, dispel cold, strengthen the spleen, and drain dampness.
④ Deficiency Diarrhea: Due to spleen deficiency, leading to internal dampness, resulting in diarrhea. Clinical symptoms include watery stools, shooting out like water, pale complexion, heaviness in the body, and scanty yellow urine. The treatment should be Weiling Decoction to warm the spleen, dry dampness, and promote urination.
⑤ Slippery Diarrhea: Due to qi deficiency leading to downward movement of the large intestine, resulting in loose stools. Clinical symptoms include watery stools, with intermittent episodes, and abdominal pain. The treatment should be Buzhong Yiqi Decoction with Hezi and Rou Dou Kou to tonify the center and stabilize the descent.
⑥ Early Morning Diarrhea: Due to deficiency of the Mingmen fire, leading to insufficient warmth for the earth, resulting in diarrhea at dawn. Clinical symptoms include early morning bowel sounds, relief after defecation, cold limbs, pale tongue, and a submerged and thin pulse. The treatment should be Si Shen Wan to warm and tonify the Mingmen fire.
5. Urinary Retention Analysis
Retention also includes urinary retention. Retention refers to difficulty urinating, while closure refers to the desire to urinate but being unable to do so, with bladder distension and urgency. These are often referred to together. The occurrence of urinary retention primarily involves the kidneys and bladder.
As stated in the “Suwen: Linglan Secret Classic”, “the bladder is the official of the state, storing fluids, and can release them when qi transforms”. Due to damp-heat in the bladder or obstruction in the bladder, the function of storing fluids is impaired, leading to urinary retention. However, the fundamental qi transformation relies on the kidneys, which govern the two yin and control the opening and closing. When kidney yang is deficient, qi transformation fails, leading to urinary retention. Additionally, urinary difficulties are closely related to the spleen and lungs; the lungs are the upper source of water. If heat obstructs the lungs, the lungs cannot regulate fluids, leading to urinary retention.
① Lung Heat Qi Obstruction: Clinical symptoms include dripping urination, yellow and red color, accompanied by fever, shortness of breath, dry throat, thin yellow tongue coating, and a rapid pulse. The treatment should be Qingfei Decoction to clear lung heat and promote urination.
② Damp-Heat Accumulation in the Middle Jiao: Due to damp-heat accumulation in the middle jiao, the San Jiao water pathways are obstructed, leading to difficulty urinating. Often accompanied by abdominal distension and thirst. Damp-heat steaming the skin may lead to yellowing of the face, thick yellow tongue coating, and a slippery and rapid pulse. The treatment should be Yinchen Wuling San to clear heat, strengthen the spleen, and drain dampness.
③ Damp-Heat Accumulation in the Bladder: Due to damp-heat accumulation in the bladder, obstructing qi transformation, clinical symptoms include difficulty urinating, abdominal distension, bladder urgency, thirst, red tongue, thick yellow tongue coating, and a rapid pulse. The treatment should be Ba Zheng San to clear heat, drain dampness, and promote urination.
④ Kidney Yang Deficiency: Due to insufficient Mingmen fire, leading to failure of qi transformation, clear fluids cannot ascend, and turbid fluids cannot descend to the bladder, resulting in oliguria and urinary retention. Often accompanied by lower back pain and weakness, and if water overflows the skin, it leads to edema, pale tongue, and a submerged and thin pulse. The treatment should be Ba Wei Wan or You Gui Wan to warm yang and promote urination.
⑤ Bladder Obstruction: Due to blood stasis and dampness accumulation in the lower jiao, obstructing the bladder, leading to difficulty urinating, or urination in a thin stream, or sand-like particles in the urine, often accompanied by urinary pain and lower abdominal distension. The treatment should be Ba Zheng San combined with Shihui San with modifications (Jinqian Cao, Bian Xu, Qu Mai, Shihui, Dong Kui Zi, Haijinsuo, Huai Niu Xi, and Jineijin) to clear heat, drain dampness, and promote urination. If there is blood in the urine, add Xiaoci and Hailian Cao.
2. Those who have it seek it, and those who do not have it seek it
After the original text of the nineteen pathological mechanisms in the “Suwen: Essential Discussion of True Principles”, there is a passage stating, “Adhere to the pathological mechanism, each organ has its own role, those who have it seek it, and those who do not have it seek it”. The first two sentences have been analyzed above, and it is not difficult to understand what “those who have it seek it, and those who do not have it seek it” means. I believe this sentence is a further summary and extension of the nineteen pathological mechanisms. Clinical analysis must grasp the mechanism of onset—whether the disease is cold or heat, and whether the location is upper or lower, and also study the symptoms that have appeared and those that are about to appear.
Here, we can take a few examples from the nineteen pathological mechanisms related to fire as an illustration.
1. All types of heat and dizziness belong to fire
Dizziness refers to unclear vision, and severe dizziness leads to a feeling of heaviness in the heart, accompanied by varying degrees of mental disturbance. This refers to symptoms such as high fever, mental confusion, and muscle spasms, which are mostly related to the mechanism of fire heat. Zhang Jingyue believes that “heat evil harms the spirit, leading to dizziness, and excessive yang harms the blood, leading to spasms”, all caused by excessive heat.
Why does excessive heat lead to mental disturbances and spasms? The head is the meeting place of all yang and the residence of the six spirits; when the clear yang rises to the head, the spirit is clear and the vision is bright. If excessive heat rushes upward, disturbing the clear yang, it leads to mental confusion and dizziness. This is commonly seen in severe heat conditions. In warm diseases, it is often due to heat entering the nutrient blood and disturbing the heart. The pericardium has a role in replacing the heart in governing the spirit, and the heart governs clarity; thus, when the evil disturbs the pericardium, it can lead to mental confusion and disturbances. Excessive heat burns and injures yin, depleting blood and fluids, leading to insufficient nourishment of the tendons, resulting in spasms.
Clinical manifestations include:
① Excess Heat Yang: External invasion of summer heat or prolonged external evil transforming into fire, leading to excessive heat rushing upward, resulting in irritability, delirium, and other mental symptoms. Accompanied by high fever, red tongue, yellow and dry tongue coating, and a rapid and forceful pulse. Excessive heat injures blood, leading to spasms. The treatment should be Huanglian Jiedu Decoction to clear the heart and drain fire. If jaundice appears due to damp-heat, add Yinchen, Baijiao, Niubang, Xuan Shen, and Mudan Pi to clear heat, drain dampness, and reduce jaundice.
② Qi and Nutrient Heat: Evil invading the heart during warm disease, clinical symptoms include high fever and delirium, red tongue, and spasms. Heat injures blood vessels and leads to rashes; the treatment should be Qingying Decoction with modifications to clear the heart and open the orifices, cooling the nutrient and detoxifying.
③ Heat Generating Liver Wind: High fever leads to excessive heat, which generates wind; when wind and fire assist each other, they disturb the clear yang, leading to mental confusion. Excessive heat and wind lead to spasms, and in severe cases, it can lead to opisthotonos, red tongue, and wiry and rapid pulse. The treatment should be Qingwen Baidu San with modifications to clear heat, drain fire, and pacify wind.
2. All types of restrictions and tremors belong to fire
“Restriction” refers to the inability to open the mouth, with clenched teeth and inability to speak clearly. “Tremor” refers to shivering and trembling. “Drumming” refers to the inability to open the jaw. “Loss of spirit” refers to anxiety and restlessness, with the spirit not being in control. This indicates that if symptoms such as inability to open the mouth, shivering, inability to open the jaw, anxiety, and restlessness appear, the pathological mechanism is mostly related to fire.
These symptoms often manifest before high fever, during the stage of conflict between righteousness and evil, when the evil invades the body, and the evil desires to penetrate deeply while the righteousness resists the evil. Yin and yang are in conflict, with yin evil prevailing, yang qi being obstructed, and yang wanting to expand while yin wants to contract. When yang is obstructed internally and yin disturbs externally, symptoms such as inability to open the mouth, shivering, and inability to open the jaw appear. When the heat prevails, the spirit becomes disturbed, leading to feelings of anxiety and restlessness. Clinically, this is often seen in the stage of conflict between righteousness and evil before high fever.
3. All types of upward counterflow belong to fire
Various symptoms of upward counterflow are often related to fire heat. “Counterflow” refers to the qi moving in the opposite direction, while “upward counterflow” refers to a sudden upward movement. The organs and functions of the body have specific directions of movement, known as “qi mechanism”. If the qi mechanism is disordered, it leads to “qi counterflow”; for example, if the stomach qi counterflows, it leads to vomiting, belching, and hiccups; if the liver qi counterflows, it leads to liver fire rising and liver yang hyperactivity; if the lung qi counterflows, it leads to coughing and wheezing… Among the symptoms listed above, only some are caused by fire heat. However, “excess qi is fire”; fire is a yang evil, characterized by heat, and its nature is to rise. Fire evil can break the counterflow, causing qi to rise and counterflow as a disease. For example, under physiological conditions, the qi of the lung and stomach descends smoothly; if subjected to fire evil, it can lead to upward counterflow and disease.
Clinical analysis:
① Vomiting: The mechanism is generally due to stomach qi counterflow, divided into excess heat and deficiency cold types. If the fire evil rises, it belongs to excess heat, and vomiting often occurs suddenly or immediately after eating, with a strong force and loud sound, yellow tongue coating, and a large pulse. The treatment should clear heat, descend counterflow, and stop vomiting.
② Belching: The disease belongs to stomach qi deficiency and cold, with qi stagnation and poor movement. If it is related to fire, phlegm-heat may be excessive, leading to foul-smelling belching, accompanied by abdominal distension. The treatment should be Erchen Decoction with Chuan Huanglian to clear heat, descend counterflow, and eliminate phlegm; it may also be seen in cases of overeating, often occurring after meals, accompanied by sour belching and noisy stomach sounds. The treatment should tonify the spleen and harmonize the stomach, aiding digestion and descending counterflow.
③ Hiccups: If the condition is heat-related, it is often due to internal heat of the yangming, with constipation and stomach qi counterflow. Clinical symptoms include strong hiccups. The treatment should be Zhuye Shigao Decoction to clear the stomach and descend counterflow. If the condition is deficiency cold-related, it is often seen in spleen and kidney yang deficiency, with counterflow qi, leading to weak hiccups, and the condition is often severe. The treatment should tonify the spleen and kidneys, harmonize the stomach, and descend counterflow, using Xuanfu Daizhe Decoction with Fuzi, Ganjiang, and Wuzhuyu.
4. All types of agitation and mania belong to fire
“Agitation” refers to restlessness, with hands and feet moving about, and internal and external unrest. It differs from “irritation”, which refers to anger without external manifestation, but both involve abnormal mental states. “Mania” refers to wild and unrestrained behavior, with little sleep and unrest, often caused by phlegm-heat disturbance and unsettled spirit.
Clinical analysis:
① Phlegm-Heat Disturbing the Heart: Due to emotional distress, phlegm transforms into heat, burning fluids and generating phlegm, leading to obstruction of the heart orifices, resulting in mania. Clinical symptoms include unpredictable laughter and crying, incoherent speech, singing loudly, and running away, often seen in schizophrenia or manic-depressive disorders. The treatment should be Longshi Guo Phlegm Pill combined with Qingxin Pill to clear the heart, resolve phlegm, and open the orifices.
② Heat Disturbing the Spirit: Often seen during the course of warm diseases, with excess heat disturbing the spirit, leading to symptoms such as irritability, delirium, and even restlessness. The treatment should be Dachengqi Decoction with modifications to drain heat and preserve yin. If the warm evil reverses and disturbs the heart, leading to mental symptoms, accompanied by thirst, red tongue, yellow coating, and rapid pulse, the treatment should be Qingying Decoction to clear the heart and open the orifices, cooling the blood and detoxifying.
5. All types of swelling, pain, and fright belong to fire
“Swelling” has two interpretations:
① Edema, ② Swelling of the dorsum of the foot. The “Ciyuan” records: “Swelling refers to the foot.” “Pain” refers to pain that is not severe but difficult to describe. This clause is more appropriate for swelling of the dorsum of the foot, as “edema” has already been discussed in “All types of damp swelling belong to the spleen”, and should not be repeated, and swelling due to edema is rare. Therefore, it can be interpreted as swelling of the dorsum of the foot accompanied by pain and fever, even fright.
Unexplained swelling and pain of the dorsum of the foot, even with fever and fright, are often caused by internal fire heat and stagnation of qi and blood, mostly belonging to surgical diseases.
In the pathological mechanism of “all types of restrictions and tremors belong to fire”, the appearance of symptoms such as inability to open the mouth and shivering is due to the conflict between yin and yang, where yang desires to expand and yin desires to contract, leading to a temporary phenomenon where yang cannot overcome yin, and yin dominates. However, as the disease progresses, what symptoms will appear? The fire evil disturbing the spirit will lead to feelings of heaviness and dizziness. Or due to heat damaging fluids, leading to dryness and spasms. Additionally, it is also possible that fire heat will lead to symptoms of agitation and mania.
Therefore, Zhang Ji believes that each of the nineteen pathological mechanisms only illustrates one aspect of symptoms, rather than a comprehensive discussion of the mechanism of “fire”. Thus, it is necessary to study why this symptom appears and what other symptoms may arise, hence the phrase “those who have it seek it, and those who do not have it seek it”. This encourages a comprehensive analysis and understanding of the symptoms, rather than isolating one aspect, but rather analyzing it as a whole, which is the essence of the nineteen mechanisms.
This article is excerpted from “Needles and Medicine for the World: Zhang Ji”
[Conclusion]
The basic spirit and main content of the “Huangdi Neijing” include: holistic concepts, yin-yang and five elements, zangxiang and meridians, etiology and pathogenesis, diagnostic methods and treatment principles, prevention and health preservation, and the theory of qi and climate. The “holistic concept” emphasizes that the human body and nature are a whole, and that the structure of the body and its various parts are interconnected. The “yin-yang and five elements” theory explains the relationship of opposition and unity between things. The “zangxiang and meridians” study the physiological functions, pathological changes, and interrelationships of the five organs and six fu, twelve meridians, and eight extraordinary meridians.
The “etiology and pathogenesis” elucidates the internal mechanisms of disease occurrence and change after various pathogenic factors act on the human body. The “diagnostic methods and treatment principles” are the basic principles of TCM in understanding and treating diseases. The “prevention and health preservation” systematically expounds the health preservation theories of TCM, summarizing important experiences in health preservation and disease prevention. The “theory of qi and climate” studies the impact of natural climate on human physiology and pathology, using this as a basis to guide people in seeking benefits and avoiding harm.
Highlights from previous articles
The secret to growing younger – Huangdi Neijing
Distinguishing syndromes in the six meridians and the origins of the “Neijing”
Folk experts explain the “Neijing”: a detailed interpretation of the Yin-Yang Correspondence Theory
Comprehensive explanation of the “Neijing” on diabetes
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The magical secrets of TCM: what do the “Huangdi Neijing” and “Shanghan Lun” really say?
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Ni Haixia: The true words of the “Jinkui” – Huangdi Neijing
Ni Haixia: The theory of vitality in the “Huangdi Neijing”
Ni Haixia: The theory of regulating the spirit in the “Huangdi Neijing”
Ni Haixia: The theory of ancient celestial truth
The “Huangdi Neijing”: the key to longevity lies in following five major principles
The “Huangdi Neijing”: the overcrowding in hospitals is due to forgetting the health preservation methods of our ancestors
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Ni Haixia – The “Huangdi Neijing” is the highest guiding principle of TCM
The diagnostic methods of the “Neijing”: a comprehensive display of the eighteen diagnostic methods of the “Neijing” (including rapid clinical diagnosis and treatment methods)
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A new interpretation of the essence of the “I Ching” and the “Huangdi Neijing” | Dong Caoyuan
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Exploring the fourteenth formula in the “Neijing”
The medical ethics section: ten medical ethics principles as shown in the “Neijing”
Pulse diagnosis method – restoring the comprehensive diagnostic method of the “Huangdi Neijing”
Essential health principles from the “Huangdi Neijing” that everyone must know
The “Huangdi Neijing” and the unity of heaven and man
The “Huangdi Neijing” states that diseases arise from either “yin” or “yang”
Rational dietary structure and appropriate organ function – exploring dietary health in the “Huangdi Neijing” | Ma Zuofeng
The “Huangdi Neijing”: these seventeen words are enough to ensure physical and mental health and bring peace to the world | Xu Wenbing
The essence of the “I Ching” and the “Huangdi Neijing” | Dong Caoyuan [Essence]
The concepts of essence, qi, body fluids, blood, and pulse in TCM | Huangdi Neijing
Little-known: thirteen formulas in the “Neijing” (thirteen formulas in the Huangdi Neijing)
The “Huangdi Neijing”: the heart governs the spirit, thus maintaining health leads to longevity
The “Huangdi Neijing”: the four levels of life (distinguishing between true people, wise people, saints, and virtuous people)
How Daoist thought influenced the “Huangdi Neijing”? This in-depth article is worth reading
[Huangdi Neijing] 50 essential phrases for health preservation (with explanations)
The “Huangdi Neijing”: why do people get cancer in middle age? What is the meaning of “returning light”?
Lecture | Wang Qingqi: The health preservation concepts and philosophical wisdom of the “Neijing”
TCM: The five movements and six qi health preservation methods in the “Huangdi Neijing” (with audio)
100 phrases to understand TCM from the “Neijing” (extracting 100 essential phrases from the Neijing)
The “Huangdi Neijing”: regarding these seven diseases, how does TCM analyze them? (headache, dizziness, forgetfulness, hypertension, stroke, depression)
The charm of the yin-yang theory, interpreted by the “Huangdi Neijing”
The “Dao De Jing” and the “Huangdi Neijing” are the manuals for practitioners
The “Huangdi Neijing”: why should we tonify yang qi? How to do it? | Zhai Shuangqing
Cultivation is like farming (Xuan Yuan Huangdi visits Dao)
The “Huangdi Neijing” in an easy-to-understand vernacular version (Volume 1)
The “Huangdi Neijing” in an easy-to-understand vernacular version (Volume 2)
The “Huangdi Neijing”: without understanding “essence and qi”, it is difficult to diagnose diseases and prolong life! (Explaining the mysteries of yin and yang)
What is a true immortal? | Xiao Yan Huangdi Neijing | Nan Huai Jin
The application of the nineteen pathological mechanisms in the “Huangdi Neijing” (Liu Lihong) [including discussion on hypertension]
Have you ever wondered why the “Huangdi Neijing” mainly discusses acupuncture and not herbal medicine?
The “Huangdi Neijing”: the key to longevity lies in following five major principles!
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