素问·评热病论 Discourse Evaluating Heat Disease

Huangdi asked: There is a disease of warmth in which, whenever sweat comes out, the fever promptly returns, the pulse remains agitated and rapid without abating along with the sweat, and the patient raves and cannot eat — what is this disease called? Qibo replied: This disease is called yin-yang crossing; crossing means death. Huangdi said: I wish to hear the explanation. Qibo said: The reason a person sweats is that sweat is always generated from grain, and grain in turn generates essence. Now when the evil qi contends with the essence within the bones and flesh and sweat is thereby obtained, this signifies that the evil has retreated and the essence has prevailed; when the essence prevails, the patient ought to be able to eat and the fever ought not to return. A return of fever indicates the evil qi; sweat indicates the essential qi. Now if sweat comes out and the fever promptly returns, this signifies that the evil has prevailed. Inability to eat means the essence has nothing to replenish it. When the disease lingers on in this way, the patient's life may be overturned in an instant. Moreover, the Discourse on Heat states: if sweat comes out while the pulse remains agitated and exuberant, the patient dies. Now since the pulse fails to correspond to the sweating, this shows the patient cannot overcome the disease, and death is certain. Raving speech signifies the loss of the will; loss of the will means death. Since here we see three signs of death and not a single sign of life, even should the patient seem to improve, he will certainly die.

Huangdi said: There is a disease in which the body is hot, sweat comes out, and there is vexation and fullness, yet the vexation and fullness are not relieved by the sweating — what disease is this? Qibo said: Sweating together with bodily heat is due to wind; sweating with vexation and fullness that is not relieved is due to reversal — this disease is called wind reversal. Huangdi said: I wish to hear the whole of it. Qibo said: The Greater Yang governs the qi and therefore receives the evil first; the Lesser Yin stands with it in exterior-interior relation, and when it encounters this heat, it follows the Greater Yang's qi upward, and this following-upward constitutes the reversal. Huangdi said: How is this treated? Qibo said: Needle both the exterior and interior channels, and give the patient decoctions to drink.

Huangdi said: What manner of disease is taxation-wind? Qibo said: Taxation-wind, as a rule, lodges beneath the lung; as a disease it causes stiffness in the upper back and dimness of vision, with spittle coming forth like mucus, aversion to wind, and shivering with cold — this is the disease of taxation-wind. Huangdi said: How is it treated? Qibo said: Treatment aims to restore the ability to bend and stretch. In one whose Greater Yang still draws upon sufficient essence, it resolves in three days; in a person of middle years, in five days; in one deficient in essence, in seven days, when the patient coughs up greenish-yellow mucus resembling pus, as large as a pellet, coming out through the mouth or nose. If it fails to come out, it will injure the lung, and injury to the lung brings death.

Huangdi said: There is a disease called kidney wind, in which the face becomes puffy and swollen, and speech is impaired — may this be treated with needling? Qibo said: When it is due to deficiency, needling is not appropriate; if one needles when it is not appropriate, then after five days the pathogenic qi is certain to arrive in force. Huangdi said: What is it like when it arrives? Qibo said: When it arrives, the patient certainly suffers shortness of breath and intermittent fever, the fever rising from the chest and back up to the head, with sweating, hot hands, dry mouth, bitter and distressing thirst, yellow urine, swelling beneath the eyes, rumbling in the abdomen, heaviness of the body making walking difficult, cessation of the menses, vexation with inability to eat, and inability to lie flat on the back — for lying flat brings on coughing. This disease is called wind water, and its treatment is discussed among the needling methods. Huangdi said: I wish to hear the explanation. Qibo said: Wherever evil qi gathers, the correct qi there is certainly deficient; when yin is deficient, yang is bound to gather there — hence the shortness of breath, intermittent fever, and sweating. Yellow urine indicates heat within the lower abdomen. Inability to lie flat indicates disharmony within the stomach; when the patient does lie flat, the coughing grows severe, because the qi presses upward upon the lung. In all cases of water qi, a slight swelling appears first beneath the eyes. Huangdi said: On what basis is this said? Qibo said: Water belongs to yin, and the region beneath the eyes likewise belongs to yin; the abdomen is where utmost yin resides. Hence when water lodges in the abdomen, it necessarily causes swelling beneath the eyes as well. When the true qi rebels upward, the mouth turns bitter and the tongue dry, and the patient cannot lie flat; when he does lie flat, he coughs up clear water. In all water diseases, the patient therefore cannot rest lying down; if he does lie down, he startles, and starting brings on severe coughing. Rumbling in the abdomen indicates the disease is rooted in the stomach. When it presses upon the spleen, there is vexation and inability to eat; when food fails to descend, this is obstruction at the stomach duct. Heaviness of the body making walking difficult is because the stomach vessel runs through the feet. Cessation of the menses is due to closure of the uterine vessel; the uterine vessel belongs to the heart and connects with the interior of the uterus. Now, since the qi presses upward upon the lung, the heart qi cannot communicate downward, and so the menses fail to come. Huangdi said: Good.