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Huangdi Neijing · The Yellow Emperor’s Inner Canon
Suwen 45 · Counterflow
Read in English. Switch to Original for word notes, or select text to ask a question.
The Yellow Emperor asked: “Why does counterflow have cold and hot forms?”
Qi Bo replied: “Declining yang qi below produces cold counterflow; declining yin qi below produces hot counterflow.”
The Emperor asked: “Why must the heat of hot counterflow begin beneath the feet?”
Qi Bo said: “Yang qi begins at the outer surfaces of the five toes. The yin vessels gather beneath the feet and converge at the soles’ centers. Thus flourishing yang qi makes the soles hot.”
The Emperor asked: “Why must the cold of cold counterflow begin at the five toes and rise toward the knees?”
Qi Bo said: “Yin qi begins inside the five toes, gathers below the knees and converges above them. Thus flourishing yin qi brings cold from the toes to above the knees. This cold does not come from outside: it all comes from within.”
The Emperor asked: “What loss makes cold counterflow arise?”
Qi Bo said: “The front private parts are where the gathering sinews converge and Taiyin and Yangming join. In spring and summer yang qi is abundant and yin qi scant; in autumn and winter yin flourishes and yang declines. This person is robust in constitution, but in autumn and winter becomes depleted through use.
Lower qi contends upward and cannot return. Essential qi overflows downward, and harmful qi follows upward. Qi becomes lodged in the center; yang declines and cannot permeate and nourish its channels and networks. Yang qi diminishes daily and yin remains alone. Thus hands and feet become cold.”
The Emperor asked: “How does hot counterflow arise?”
Qi Bo said: “Liquor entering Stomach fills the networks and empties the channels. Spleen circulates Stomach’s fluids. When yin qi is deficient, yang enters; its entry makes Stomach disharmonious. Essential qi is then exhausted and cannot nourish the four limbs.
This person must repeatedly become drunk, or enter the bedchamber after eating to fullness. Qi gathers in Spleen and cannot disperse. Liquor qi and grain qi press against one another, making heat flourish in the center. Thus heat concentrates within the body and urine becomes red. Liquor qi is abundant, swift and fierce; Kidney qi declines while yang alone flourishes. Thus hands and feet become hot.”
The Emperor asked: “Why does counterflow sometimes cause abdominal fullness, and sometimes sudden inability to recognize people, with recognition returning only after half a day or as long as a day?”
Qi Bo said: “Yin qi flourishing above makes the lower part deficient; lower deficiency brings abdominal distention and fullness. When yang qi flourishes above, lower qi doubles upward and harmful qi moves contrary. This disorders yang qi; disordered yang qi prevents recognition of people.”
The Emperor said: “Good. I wish to hear the manifestations of counterflow in the six channel vessels.”
Qi Bo said: “Greater Yang counterflow brings a swollen, heavy head and feet unable to walk, developing into dizziness and collapse. Yangming counterflow brings dian illness, a wish to run and shout, abdominal fullness and inability to lie down, a red, hot face, and false visions and disordered speech.
Shaoyang counterflow brings sudden deafness, swollen hot cheeks, flank pain and inability to move the lower legs. Taiyin counterflow brings abdominal fullness and swelling distention, difficult passage from behind and no appetite; eating brings vomiting, and lying down is impossible.
Shaoyin counterflow brings dry mouth, red urine, abdominal fullness and Heart pain. Jueyin counterflow brings painful swelling of the lower abdomen, abdominal distention, difficult passage of excreta and urine, a preference for lying with knees bent, contracted swollen private parts and heat inside the shins. Drain abundance; supplement deficiency. With neither abundance nor deficiency, treat along the channel.”
Taiyin counterflow brings urgent contraction of the lower legs and Heart pain drawing into the abdomen: treat what governs the illness. Shaoyin counterflow brings empty fullness, vomiting with alteration and clear watery flux below: treat what governs the illness. Jueyin counterflow brings contraction and waist pain, empty fullness, closure of the front passage and delirious speech: treat what governs the illness.
When all three yin move contrary together, neither front nor rear passage functions. Hands and feet become cold; death comes in three days.
Reading note: The supplied 嘔變 is retained as vomiting with alteration; the text does not specify a separate new symptom for 變.
Taiyang counterflow brings rigid collapse, vomiting of blood and frequent nosebleed: treat what governs the illness. Shaoyang counterflow makes joints and pivots fail. The waist cannot move and the nape cannot turn; an intestinal abscess develops beyond treatment. Startlement means death. Yangming counterflow brings panting, cough, bodily heat, frequent startlement, nosebleed and vomiting of blood.
Hand Taiyin counterflow brings empty fullness and cough, with frequent vomiting of foam: treat what governs the illness. Counterflow of the Hand Heart Master and Shaoyin brings Heart pain drawing to the throat and bodily heat; death follows and treatment is impossible.
Hand Taiyang counterflow brings deafness and tears, inability to turn the nape or bend and straighten the waist: treat what governs the illness. Hand Yangming and Shaoyang counterflow bring painful throat obstruction, swelling and stiff contraction of the throat: treat what governs the illness.
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