灵枢经·热病 Heat Disease

In hemiplegia, one side of the body is disabled and painful, yet speech is unaffected and the mind remains unclouded; the disease lies between the interstices of the flesh. One should select points with the large needle, supplementing what is deficient and draining what is in excess, and recovery can then be achieved.

In the disease called fei (flaccid wind-strike), the body is without pain, yet the four limbs cannot be controlled. If the mind is not gravely disturbed and speech remains faintly intelligible, it can be treated; but if it is severe and the patient cannot speak at all, it cannot be treated. When the disease first arises in the yang and then enters the yin, one should first select the yang, and afterward the yin, needling shallowly to reach them.

When heat disease has lasted three days and the qi opening (the wrist pulse) is calm while the renying pulse (at the neck) is agitated, one should select the yang channels, applying the fifty-nine punctures to drain the heat and bring out sweat, while making the yin replete so as to supplement what is deficient. When body heat is severe and both yin and yang pulses are calm, one must not needle; where needling is permissible, one should apply it urgently — if sweat does not appear, the patient will suffer a discharging flux. The cases in which needling is forbidden are those bearing signs of impending death.

When heat disease has lasted seven or eight days and the pulse at the wrist is agitated, with panting and shortness of breath, one should needle urgently, and sweat will then appear of itself; needle shallowly between the thumb and the hand.

When heat disease has lasted seven or eight days and the pulse is faint and small, and the patient passes blood in the urine with a dry mouth, death will come within a day and a half. If the pulse is intermittent (dai), death will come within a day.

When heat disease has already produced sweating, yet the pulse remains agitated, with panting and a return of heat, one must not needle the skin; if the panting is severe, the patient will die.

When heat disease has lasted seven or eight days, if the pulse is not agitated, or if agitated it is not scattered and rapid, then within the following three days sweat should appear; if after three days there is still no sweat, death will come on the fourth day. In one who has not yet sweated, do not needle the interstices of the flesh.

When in heat disease the skin aches first, with the nose obstructed and the face swollen and full, select points at the skin level, using the first needle, applying the fifty-nine punctures. If harsh rashes appear about the nose, seek the disorder of the skin in the lung; if this fails, seek it in fire, for fire is the heart.

When in heat disease the body first feels rough and heavy, leaning and feverish, with vexation and a bowed head, and the lips are dry with excess saliva at the mouth, select points at the skin level, using the first needle, applying the fifty-nine punctures. If the skin becomes swollen, the mouth dry, and cold sweat appears, seek the disorder of the vessels in the heart; if this fails, seek it in water, for water is the kidney.

When in heat disease there is welling dryness and excessive drinking, frequent fright, and lying down unable to rise, select points at the flesh, using the sixth needle, applying the fifty-nine punctures; when the canthi of the eyes turn blue-green, seek the disorder of the flesh in the spleen; if this fails, seek it in wood, for wood is the liver.

When in heat disease the face turns blue-green, with pain in the brain and agitation of the hands and feet, select points between the sinews, using the fourth needle for the four reversals (coldness in the four limbs). When the sinews become lame and the eyes water, seek the disorder of the sinews in the liver; if this fails, seek it in metal, for metal is the lung.

When in heat disease there is frequent fright, convulsions and mania, select points at the vessels, using the fourth needle, urgently draining what is in excess; when epilepsy has caused the hair to fall out, seek the disorder of the blood in the heart; if this fails, seek it in water, for water is the kidney.

When in heat disease the body feels heavy with pain in the bones, deafness, and a tendency to keep the eyes closed, select points at the bones, using the fourth needle, applying the fifty-nine punctures to needle the bones. When the patient cannot eat, gnashes the teeth, and the ears turn blue-green, seek the disorder of the bones in the kidney; if this fails, seek it in earth, for earth is the spleen.

When in heat disease the patient does not know where the pain is, is deaf, unable to control the body, with a dry mouth, severe yang heat, yet the yin shows some degree of cold — the heat lies in the marrow, and death is inevitable; it cannot be treated.

When in heat disease there is headache, throbbing at the temples, and the eyes feel as though pulled, with pain in the vessels and frequent nosebleeds — this is a reversal-heat disease. Treat it with the third needle, observing whether there is excess or deficiency, and whether there is cold, heat, or hemorrhoids.

When in heat disease the body feels heavy and there is heat in the intestines, treat with the fourth needle at the transport points, and between the toes below, seeking the qi at the network vessel of the stomach until qi is obtained.

When in heat disease there is acute pain flanking the navel, with fullness in the chest and rib-sides, select Yongquan and Yinlingquan, using the fourth needle, and needle within the throat.

When in heat disease sweat is about to appear, and the pulse is favorable for sweating, select Yuji, Taiyuan, Dadu, and Taibai. Draining these points causes the heat to leave; supplementing them causes sweat to appear. If sweating becomes excessive, select the transverse vessel above the medial malleolus to stop it.

When heat disease has already produced sweating yet the pulse remains agitated and forceful, this is the extreme of the yin vessels, and the patient will die. If, having sweated, the pulse becomes calm, the patient will live.

In heat disease, if the pulse remains forceful and agitated and sweat cannot be obtained, this is the extreme of the yang vessels, and the patient will die. If the pulse is forceful and agitated but becomes calm once sweat is obtained, the patient will live.

There are nine conditions of heat disease in which needling is forbidden: first, when sweat does not appear, and the great cheekbones flush red with hiccupping, the patient will die; second, when there is diarrhea with severe abdominal fullness, the patient will die; third, when the eyes are dim and the heat does not abate, the patient will die; fourth, when the elderly or infants have heat with abdominal fullness, the patient will die; fifth, when sweat does not appear and there is vomiting of blood from below, the patient will die; sixth, when the root of the tongue rots and the heat does not abate, the patient will die; seventh, when there is coughing with nosebleed, and sweat does not appear, or appears but does not reach the feet, the patient will die; eighth, when the marrow is heated, the patient will die; ninth, when there is heat with tetany, the patient will die — the lower back snaps, there are convulsions, and the teeth are clenched and grinding. In all these nine conditions, needling is forbidden.

What is called the fifty-nine punctures is this: on the outer and inner sides of both hands, three points each, making twelve punctures in all. Between each of the five fingers, one point each, making eight punctures in all, and likewise on the feet. On the head, one cun within the hairline, three fen to each side, three points each, making six punctures in all. Further in, three cun within the hairline, five points to each side, making ten punctures in all. In front of and behind the ears, and below the mouth, one point each; at the nape of the neck, one point — making six punctures in all. On the crown of the head, one point; at Conghui, one point; at the hairline, one point; at Lianquan, one point; at Fengchi, two points; at Tianzhu, two points.

When qi fills the chest with panting breath, select the tip of the big toe on the Foot Taiyin channel, at a distance from the nail like the width of a scallion leaf; if there is cold, retain the needle, if there is heat, withdraw it quickly — stop once the qi descends.

For sudden pain of cardiac mounting-disorder (xin shan), select the Foot Taiyin and Jueyin channels, needling thoroughly to remove blood from the network vessels.

For throat impediment with the tongue curling, dryness of the mouth, vexation of the heart, heart pain, and pain along the inner border of the arm such that the hand cannot reach the head, select the point below the nail of the fourth finger, at a distance from the tip like the width of a chive leaf.

For redness and pain in the eye beginning from the inner canthus, select the Yinqiao (Yin Heel Vessel).

For wind-tetany with the body arched backward, first select the Foot Taiyang channel, the popliteal fossa, and the network vessels, letting blood; if there is cold within, select Zusanli.

For dribbling urinary block, select the Yinqiao, the point above the three hairs (of the great toe), and the network vessels, letting blood.

When a man's condition resembles gu-toxin disorder, or a woman's resembles ju-disorder, with the body, lower back, and spine feeling as though coming apart, and no desire for food or drink, first select Yongquan until blood appears; observe where the vessels on the instep are full and let blood from all of them.