素问·热论 Discourse on Heat Disease

Huangdi asked: Now, heat diseases are all of the category of cold damage; some patients recover, others die. Those who die all do so within six or seven days, while those who recover all take more than ten days. I do not understand the reason for this and wish to hear its explanation. Qibo replied: The Greater Yang is the chief of all the yang; its vessel connects with the Wind Mansion point, and therefore it governs the qi of all the yang channels. When a person is injured by cold, heat disease results; though the heat may be severe, the patient does not die. But one who is doubly stricken by cold, affected in both yin and yang at once, cannot escape death.

Huangdi said: I wish to hear what this looks like. Qibo said: On the first day of cold damage, the Greater Yang receives it, and so there is pain in the head and neck and stiffness of the lumbar spine. On the second day, Yang Brightness receives it; Yang Brightness governs the flesh, and its vessel flanks the nose and connects with the eyes, and so the body becomes hot, the eyes ache, the nose grows dry, and the patient cannot rest. On the third day, Lesser Yang receives it; Lesser Yang governs the gallbladder, and its vessel follows the flanks and connects with the ears, and so there is pain in the chest and flanks and deafness. When all three yang channels and their network vessels have received the disease, but it has not yet entered the viscera, the disease may be resolved by inducing sweat. On the fourth day, Greater Yin receives it; the Greater Yin vessel spreads through the stomach and connects with the gullet, and so there is abdominal fullness and dryness of the throat. On the fifth day, Lesser Yin receives it; the Lesser Yin vessel penetrates the kidney and connects with the lung, and links with the root of the tongue, and so the mouth parches, the tongue dries, and there is thirst. On the sixth day, Reverting Yin receives it; the Reverting Yin vessel follows the genitals and connects with the liver, and so there is vexation and fullness and contraction of the scrotum. When the three yin and three yang, and the five viscera and six bowels, have all received the disease, so that the nutritive and defensive qi no longer circulate and the five viscera no longer communicate, then the patient dies.

In one who is not doubly stricken by cold, on the seventh day the Greater Yang disease wanes and the headache somewhat improves; on the eighth day, the Yang Brightness disease wanes and the bodily heat somewhat improves; on the ninth day, the Lesser Yang disease wanes and hearing is faintly restored; on the tenth day, the Greater Yin disease wanes, the abdomen returns to its normal size, and the patient begins to think of food and drink; on the eleventh day, the Lesser Yin disease wanes, the thirst stops, the fullness subsides, the tongue's dryness ends, and the patient sneezes; on the twelfth day, the Reverting Yin disease wanes, the scrotum relaxes and the lower abdomen slightly descends, the pathogenic great qi departs entirely, and the disease resolves day by day. Huangdi said: How is this treated? Qibo said: In treating it, one opens and frees the vessel corresponding to each viscus in turn, and the disease will wane and resolve day by day. In cases not yet past three days, one may resolve the disease by inducing sweat; in cases past three days, one may resolve it by purgation.

Huangdi said: When heat disease has already resolved, there are cases in which some residue lingers on — why is this? Qibo said: In all such cases of residue, the heat was still severe when the patient was forced to eat, and so a residue was left behind. In such cases the disease has already waned, yet heat still remains stored within; because the qi of the food clashes with it, the two heats combine, and so a residue remains. Huangdi said: Good. How is this residue treated? Qibo said: Examine whether it is deficiency or excess, and regulate what is rebellious and what is compliant, and the disease can certainly be made to resolve. Huangdi said: In heat disease, what should be forbidden? Qibo said: When heat disease has only somewhat improved, eating meat will cause relapse, and eating too much will leave a residue — these are the things to be forbidden.

Huangdi said: In cases doubly stricken by cold, what are the corresponding pulse and clinical signs? Qibo said: In double stricken by cold, on the first day of disease, both the Greater Yang and Lesser Yin are diseased together, causing headache, dry mouth, and vexatious fullness; on the second day, both Yang Brightness and Greater Yin are diseased together, causing abdominal fullness, bodily heat, disinclination to eat, and delirious speech; on the third day, both Lesser Yang and Reverting Yin are diseased together, causing deafness, contraction of the scrotum, and reversal, so that the patient can take neither water nor gruel and no longer recognizes those around him; on the sixth day he dies. Huangdi said: If the five viscera are already injured, the six bowels no longer communicate, and the nutritive and defensive qi no longer circulate, why does death then follow only after a further three days? Qibo said: Yang Brightness is the chief of the twelve channels and vessels, abundant in blood and qi; hence though the patient no longer recognizes others, it takes three more days for its qi to be entirely exhausted, and only then does death follow. In general, when cold damage disease transforms into warm disease: if it occurs before the Summer Solstice, it is called warm disease; if it occurs after the Summer Solstice, it is called summerheat disease. In summerheat disease, sweat should be allowed to flow out freely together with the heat, and should not be checked.