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Huangdi Neijing · The Yellow Emperor’s Inner Canon
Lingshu 23 · Heat Illness
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In one-sided withering, one side of the body is painful and unusable, but speech is unchanged and awareness unconfused. Illness is in the divisions and interstices. Address it with the great needle, increasing insufficiency and diminishing excess; recovery may then occur.
In the illness called fei, the body has no pain but the four limbs cannot gather themselves. If confusion is not severe and speech remains slightly intelligible, it can be treated. If severe, so that speech is impossible, it cannot. When illness begins in yang and later enters yin, first address yang and then yin, taking them superficially.
The historical categories “one-sided withering” and fei are retained without equating them with a particular modern neurological diagnosis.
On the third day of heat illness, if Qikou is quiet and Renying agitated, address the yang channels with fifty-nine punctures to drain heat and bring out sweat, making yin replete to supplement its insufficiency. If bodily heat is extreme but both yin and yang are quiet, do not needle. Where needling is possible, address it urgently; if sweat does not emerge, release it. The instruction not to needle refers to signs of death.
On the seventh or eighth day of heat illness, if the pulse at the mouth moves and breathing is panting and short, needle urgently and sweat will emerge of itself; needle superficially between the hand’s great digits. On the seventh or eighth day, a faint, small pulse, bloody urine and a dry mouth are said to bring death in one and a half days. An intermittent pulse is said to bring death in one day. If sweat has already emerged but the pulse remains agitated, panting occurs and heat returns, do not needle the skin; severe panting is declared fatal.
On the seventh or eighth day, if the pulse is not agitated—or is agitated but not scattered and rapid—sweat should emerge within the next three days. Without sweat in three days, death is said to occur on the fourth. If sweat has never emerged, do not needle the interstices.
If heat illness begins with skin pain, blocked nose and a suffused face, address the skin with the first needle, at fifty-nine sites. For troublesome eruptions at the nose, seek the skin’s disorder in the Lung; if it cannot be found, seek it in Fire, which is the Heart.
If heat illness begins with bodily roughness or stiffness, heat, vexed oppression and dry lips, mouth and throat, address the skin with the first needle at fifty-nine sites. For swollen skin, dry mouth and cold sweat, seek the vessels’ disorder in the Heart; if it cannot be found, seek it in Water, which is the Kidney.
For heat illness with dry throat, much drinking, easy fright and inability to rise from bed, address skin and flesh with the sixth needle at fifty-nine sites. With blue-green eye corners, seek the flesh’s disorder in the Spleen; if it cannot be found, seek it in Wood, which is the Liver.
For heat illness with a blue-green face, brain pain and restless hands and feet, address the spaces between sinews with the fourth needle at the four reversals. With disabled sinews and watering eyes, seek the sinews’ disorder in the Liver; if it cannot be found, seek it in Metal, which is the Lung.
For heat illness with frequent fright, contraction and relaxation of the limbs and kuang, address the vessels with the fourth needle and urgently drain excess. With dian illness and loss of hair, seek the blood’s disorder in the Heart; if it cannot be found, seek it in Water, which is the Kidney.
For heat illness with bodily heaviness, bone pain, deafness and a wish to keep the eyes closed, address the bones with the fourth needle at fifty-nine sites. In bone illness with inability to eat, grinding teeth and blue-green ears, seek the bones’ disorder in the Kidney; if it cannot be found, seek it in Earth, which is the Spleen.
In heat illness where the patient cannot identify the pain, is deaf, cannot control the body and has a dry mouth, with extreme yang heat and some cold in yin, heat is in the marrow: the text declares death beyond treatment.
Heat illness with headache, tightness at the temples and eyes, painful vessels and frequent nosebleeds is reversal heat illness. Address it with the third needle, inspecting excess and insufficiency. For cold and heat, piles and heat illness with bodily heaviness and heat in the intestines, use the fourth needle at the transporting sites and below between the digits; seek qi in the Stomach networks and obtain qi. For heat illness with urgent pain beside the navel and fullness in the chest spaces, address Yongquan and Yinlingquan with the fourth needle; the text then says to needle “inside the throat.”
When sweat is about to emerge and a favorable pulse permits sweating, address Yuji, Dayuan, Dadu and Dabai. Draining removes heat; supplementation brings out sweat. If sweat is excessive, address the transverse vessel above the inner ankle to stop it.
If sweat has emerged but the pulse remains agitated and abundant, this is the extreme of the yin pulse and is declared fatal. Sweat with a quiet pulse means life. An abundant, agitated pulse with no sweat is the extreme of the yang pulse and is declared fatal. If an abundant, agitated pulse becomes quiet after sweating, it means life.
There are nine heat-illness patterns that must not be needled, each declared fatal:
1. No sweat, reddening of the large cheekbones and retching.
2. Diarrhea with extreme abdominal fullness.
3. Unclear vision and unceasing heat.
4. Heat and abdominal fullness in an old person or infant.
5. No sweat, with vomiting and passage of blood below.
6. Ulceration at the root of the tongue and unceasing heat.
7. Cough and nosebleed, with no sweat or sweat not reaching the feet.
8. Heat in the marrow.
9. Heat with rigid spasms: the waist bends backward, the limbs contract and relax, and the teeth clamp and grind.
None of these nine is to be needled.
The so-called fifty-nine punctures are: three on each inner and outer side of both hands, twelve punctures in all; one in each interval between the five fingers, eight in all, and the feet likewise; three on each side one cun into the hairline and three fen to the side, six in all; five on either side three cun farther into the hairline, ten in all; one each before and behind the ears and below the mouth, and one at the middle of the nape, six in all; one at the crown, one at Nihui, one at the hairline, one at Lianquan, two at Fengchi and two at Tianzhu.
All counts, needle numbers, stated times and prognoses are preserved as historical assertions. Several phrases are compressed or graphically damaged, including the temples and eyes, the “cold and heat, piles” grouping and “inside the throat”; they are not silently replaced with a reconstructed treatment. The enumerated sites are retained without recalculating them to force a total of fifty-nine. Point-name spellings follow the supplied text.
For qi filling the chest with panting, address Foot Taiyin at the tip of the great toe, a leek leaf’s width from the nail. If cold, retain; if hot, act swiftly. Stop when qi descends. For sudden painful heart shan, address Foot Taiyin and Jueyin, needling all blood networks to remove blood.
For throat obstruction with a curled tongue, dry mouth, vexation, heart pain and pain along the inner arm preventing it from reaching the head, address below the nail of the finger next to the little finger, a leek leaf’s width from the tip. For redness and pain beginning at the inner canthus, address Yin Qiao.
For wind spasms bending the body backward, first address Foot Taiyang, the hollow behind the knee and the blood networks to draw blood. If there is internal cold, address Sanli. For blocked urination, address Yin Qiao, above the three hairs and the blood networks to draw blood. If a man seems afflicted by gu or a woman by the named ju disorder, and the body, waist and spine seem to come apart with no wish for food or drink, first draw blood at Yongquan, then inspect abundant sites on the foot’s upper surface and draw blood from them all.
Shan, gu and the anomalously written ju remain historical labels. The unnamed finger site and “three hairs” are not replaced with additional modern point codes or locations.
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