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Huangdi Neijing · The Yellow Emperor’s Inner Canon
Suwen 33 · Assessing Heat Illness
Read in English. Switch to Original for word notes, or select text to ask a question.
The Yellow Emperor asked: “In warm illness, sweating is immediately followed by renewed heat, with an agitated, rapid pulse that does not subside after sweating, wild speech and inability to eat. What is this illness called?”
Qi Bo replied: “It is called crossing of yin and yang. Such crossing means death.”
The Emperor said: “I wish to hear the explanation.”
Qi Bo said: “Sweat is generated from grain, and grain arises from essence. When harmful qi contends in bone and flesh and sweat is obtained, harmful qi retreats and essence prevails. When essence prevails, the person should be able to eat and heat should not return. Returning heat is harmful qi; sweat is essential qi. Sweating followed immediately by returning heat therefore means harmful qi has prevailed. Inability to eat means essence has no support. If the illness remains, life can be overturned in a moment.
The Discourse on Heat also says that sweating with a still agitated, abundant pulse means death. Here the pulse does not respond to sweating: the body has not overcome its illness, so death is clear. Wild speech means loss of resolve; loss of resolve means death. Three signs of death now appear, without one sign of life. Even if the illness eases, death is certain.”
Reading note: The supplied 穀生於精 is kept as grain arising from essence, without reversing its stated relationship.
The Emperor asked: “What illness causes bodily heat, sweating, vexation and fullness, when sweating does not relieve the vexation and fullness?”
Qi Bo said: “Sweating with bodily heat is Wind. Sweating without relief of vexation and fullness is counterflow. The illness is called Wind counterflow.”
The Emperor said: “I wish to hear it fully.”
Qi Bo said: “Greater Yang governs qi and therefore receives harmful influence first. Shaoyin forms its exterior–interior pair. On obtaining heat, Shaoyin follows it upward; following upward produces counterflow.”
The Emperor asked: “How is it treated?”
Qi Bo said: “Needle exterior and interior and give a decoction to drink.”
The Emperor asked: “What is the illness of Wind from toil like?”
Qi Bo said: “Wind from toil is characteristically below Lung. It makes the upper body or nape stiff and vision dim. Sputum comes out like nasal mucus; there is aversion to wind and shivering cold. This is the illness of Wind from toil.”
The Emperor asked: “How is it treated?”
Qi Bo said: “Restrict bending and straightening. For those whose Greater Yang draws essence, three days are required; for the middle-aged, five; for those lacking essence, seven. Blue-green and yellow mucus is coughed out, like pus, as large as a pellet. It leaves through mouth or nose. If it does not leave, Lung is injured; injury to Lung means death.
Reading note: Wang Bing glosses 救 here as stopping, applied to bending and straightening; it is not silently changed to moxibustion. The supplied Greater Yang, essence and three/five/seven-day distinctions remain.”
The Emperor asked: “With Kidney Wind, the face is swollen and distended and obstruction impairs speech. May this be needled?”
Qi Bo said: “This is deficiency and should not be needled. If needled when it should not be, its qi will certainly arrive five days later.”
The Emperor asked: “What is its arrival like?”
Qi Bo said: “Its arrival necessarily brings scant qi and periodic heat. Heat rises from chest and back to the head, with sweating, hot hands, dry mouth, bitterness and thirst, yellow urine, swelling below the eyes, abdominal rumbling, a heavy body and difficulty walking. Menstruation does not come; vexation prevents eating. The person cannot lie flat on the back; doing so brings cough. The illness is called Wind Water, discussed in the Needling Methods.”
The Emperor said: “I wish to hear the explanation.”
Qi Bo said: “Where harmful influence gathers, the local qi must be deficient. When yin is deficient, yang necessarily gathers there. Thus qi is scant and heat periodically appears with sweat. Yellow urine means heat in the lower abdomen. Inability to lie flat means disharmony within Stomach. Lying flat intensifies cough because pressure rises against Lung. In every case of water qi, slight swelling first appears below the eyes.”
The Emperor asked: “Why is this said?”
Qi Bo said: “Water is yin, and below the eyes is also yin. The abdomen is where utmost yin resides. Thus water in the abdomen must cause swelling below the eyes. True qi rises contrary, making the mouth bitter and tongue dry and preventing flat lying. Lying flat brings a cough with clear water. Thus those with water illness cannot lie down; lying down brings startlement, which worsens cough.
Abdominal rumbling means the illness is rooted in Stomach. When it presses on Spleen there is vexation and inability to eat. Food failing to descend means obstruction at the Stomach cavity. A heavy body and difficulty walking occur because Stomach’s vessel is at the foot. Menstruation fails because the uterine vessel is closed. This vessel belongs to Heart and networks within the uterus. Qi now presses upward against Lung; Heart qi cannot communicate downward. Thus menstruation does not come.”
The Emperor said: “Good.”
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