Suwen · On Intermittent Heat

The text

The Yellow Emperor asked: Intermittent heat is all born of wind. Why does it store up and then issue on a schedule? Qi Bo answered: When intermittent heat first issues, it first rises in the fine hairs; stretching and yawning then begin; there is cold shivering and the jaws drum; low back and spine both ache. When the cold goes, inside and outside are both hot; the head aches as if splitting; there is thirst, and one wishes cold drink. The Emperor said: What qi makes it so? I wish to hear its Dao. Qi Bo said: Yin and yang contend across above and below; vacuity and repletion take turns issuing; yin and yang move into each other's place. When yang joins into yin, yin is replete and yang vacant. When Yangming is vacant, there is cold shivering and the jaws drum. When the Great Yang is vacant, low back, back, head, and nape ache. When the three yang are all vacant, yin qi prevails; when yin qi prevails, the bones are cold and ache. Cold is born within; therefore the center and the outside are both cold. When yang is abundant there is heat outside; when yin is vacant there is heat inside. When outside and inside are both hot, there is panting and thirst; therefore one wishes cold drink. These are all obtained from harm by summer-heat in summer. The heat-qi is abundant, stored within the skin, outside the intestines and stomach — this is where ying qi lodges. This makes a person's sweat-holes sparse, the skin interstices open. Then they obtain the qi of autumn; sweat goes out and they meet wind; or they obtain it by bathing. Water-qi lodges within the skin and dwells together with wei qi. Wei qi, in the daytime, travels in the yang; at night it travels in the yin. This qi, obtaining yang, goes out; obtaining yin, it presses inward. Inside and outside press each other; therefore it issues daily. The Emperor said: Why does it issue every other day? Qi Bo said: The lodging of its qi is deep; it presses inward upon yin. Yang qi issues alone; the yin pathogen lodges within. Yin and yang contend and it cannot come out; therefore it issues every other day. The Emperor said: Good. That it issues later in the day, or earlier in the day — what qi makes it so? Qi Bo said: Pathogenic qi lodges as a guest at the Wind Mansion and follows the spine downward. Wei qi, in one day and one night, has a great meeting at the Wind Mansion. The next day it descends one joint; therefore the issuing is later. This first lodged as a guest in the spine and back. Each time it reaches the Wind Mansion the skin interstices open; when the interstices open, pathogenic qi enters; when pathogenic qi enters, the illness issues. By this the daily issuing grows a little later. When it leaves the Wind Mansion, it descends one joint a day; on the twenty-fifth day it reaches the sacral bone; on the twenty-sixth day it enters within the spine and pours into the hidden spinal vessel. Its qi travels upward; on the ninth day it comes out in the midst of the Broken Basin. Its qi is higher day by day; therefore the issuing is earlier day by day. Those that issue every other day: pathogenic qi presses inward upon the five zang and joins across the membrane-origin. Its road is far; its qi is deep; its travel is slow; it cannot travel together with wei qi, and they cannot all come out; therefore it issues only every other day. The Emperor said: You say that each time wei qi reaches the Wind Mansion the skin interstices open; opening, pathogenic qi enters; entering, the illness issues. Now wei qi descends one joint a day; its issuing of qi is not at the Wind Mansion. How then does it still issue daily? Qi Bo said: This is pathogenic qi lodging as a guest in the head and nape and following the spine downward. Thus vacuity and repletion are not the same; the pathogen strikes different places, and so it need not be at the Wind Mansion. Thus when the pathogen strikes the head and nape, the qi arrives at the head and nape and there is illness. When it strikes the back, the qi arrives at the back and there is illness. When it strikes the low back and spine, the qi arrives at the low back and spine and there is illness. When it strikes the hands and feet, the qi arrives at the hands and feet and there is illness. Where wei qi is, joining with pathogenic qi — then the illness issues. Thus wind has no constant mansion. Wherever wei qi issues, it must open the skin interstices; wherever pathogenic qi joins — that is its mansion. The Emperor said: Good. Wind and intermittent heat are alike, of the same kind — yet wind alone is constantly there, while intermittent heat has times of rest. Why? Qi Bo said: Wind-qi stays in its place; therefore it is constantly there. The qi of intermittent heat follows the channels and collaterals, sinks, and presses inward; therefore only when wei qi answers does it issue. The Emperor said: Why does intermittent heat have cold first and heat after? Qi Bo said: In summer one is harmed by great summer-heat; the sweat goes out greatly; the skin interstices open and develop. Then one meets the bleak water-cold of summer qi, stored in the skin interstices. In autumn one is harmed by wind, and the illness is complete. Cold is yin qi; wind is yang qi. First harmed by cold, then harmed by wind — therefore cold first and heat after. The illness issues in its time; it is named cold intermittent heat. The Emperor said: Why heat first and cold after? Qi Bo said: This is first harmed by wind, then harmed by cold; therefore heat first and cold after. It also issues in its time; it is named warm intermittent heat. Those with only heat and no cold: yin qi is first cut off; yang qi issues alone; then there is little qi and vexed oppression, the hands and feet hot, and a wish to vomit. It is named wasting intermittent heat. The Emperor said: The classic says: what has surplus, drain it; what is insufficient, replenish it. Now heat is surplus, cold is insufficiency. The cold of one with intermittent heat — hot water and fire cannot warm it; and when the heat comes, ice-water cannot cool it. These are all of the kind of surplus and insufficiency. At such a time the good artisan cannot stop it; one must wait for it to decline of itself, then needle. Why is this? I wish to hear the account. Qi Bo said: The classic says: do not needle blazing, blazing heat; do not needle a pulse that is chaotic and turbid; do not needle sweat that drips and drips. Therefore, because the illness is going against, it cannot yet be treated. When intermittent heat first issues, yang qi joins into yin. At that time yang is vacant and yin abundant; outside there is no qi; therefore first there is cold shivering. When yin qi has gone against to the extreme, it comes out again into yang. Yang and yin join again on the outside; then yin is vacant and yang replete; therefore first there is heat and thirst. The qi of intermittent heat: joining into yang, yang prevails; joining into yin, yin prevails. Yin prevailing, there is cold; yang prevailing, there is heat. Intermittent heat is the inconstancy of wind-cold qi; when the illness reaches the extreme, it turns back. When the illness issues, it is hot as fire, like wind and rain that cannot be withstood. Therefore the classic says: just at its abundance you will surely be destroyed; because it is in decline, the work will surely greatly prosper. This is what is meant. Before intermittent heat has issued, yin has not yet joined yang, yang has not yet joined yin; regulate it then, and true qi obtains rest, pathogenic qi then perishes. Therefore the artisan cannot treat what has already issued, because its qi is going against. The Emperor said: Good. How does one attack it? What of early and late? Qi Bo said: When intermittent heat is about to issue, yin and yang are about to shift place. It must begin from the four extremities. Yang is already harmed, and yin follows it. Therefore, before its time, bind the place firmly, so pathogenic qi cannot enter and yin qi cannot go out. Watch carefully: when you see it in the fine collaterals, abundant, hard, and with blood, take them all. This is the true having gone, and not yet having joined. The Emperor said: When intermittent heat does not issue — what answers it? Qi Bo said: The qi of intermittent heat must take turns at abundance and vacuity, at the place where the qi is. When the illness is in yang, there is heat and the pulse is restless; when in yin, there is cold and the pulse is quiet. At the extreme, yin and yang both decline; wei qi parts from it; therefore the illness obtains rest. When wei qi gathers, the illness returns. The Emperor said: At times it skips two days, or issues only after several days; some have thirst, some do not. Why? Qi Bo said: Those that skip days: pathogenic qi and wei qi lodge as guests in the six fu, and at times miss each other; they cannot obtain each other; therefore it rests several days, then issues. Intermittent heat is yin and yang prevailing in turn; some extreme, some not extreme; therefore some have thirst, some do not. The Emperor said: The discourse says that harm by summer-heat in summer means intermittent heat in autumn of necessity. Now intermittent heat does not always answer this. Why? Qi Bo said: This is what answers the four seasons. Those whose illness has a different form are against the four seasons. Those ill in autumn have extreme cold; those ill in winter have cold that is not extreme; those ill in spring have aversion to wind; those ill in summer have much sweat. The Emperor said: Warm intermittent heat and cold intermittent heat — where do they both lodge in peace? In which zang do they lodge? Qi Bo said: Warm intermittent heat is obtained from being struck by wind in winter. Cold qi is stored in the midst of the bones and marrow. When spring comes, yang qi issues greatly; the pathogenic qi cannot come out of itself. Then one meets great summer-heat; the brain and marrow melt; the flesh wastes; the skin interstices discharge. Or there is exertion; pathogenic qi and sweat all go out. This illness is stored in the kidney; its qi first goes from the inside out to the outside. In such a one, yin is vacant and yang abundant; yang abundant, there is heat. When it declines, the qi turns back and enters; entering, yang is vacant; yang vacant, there is cold. Therefore heat first and cold after; it is named warm intermittent heat. The Emperor said: What of wasting intermittent heat? Qi Bo said: In wasting intermittent heat, the lung has, from the first, heat-qi abundant in the body; reversal against rushes upward; the central qi is replete and does not discharge outward. Then there is exertion; the skin interstices open; wind-cold lodges within the skin, between the divided flesh, and issues. Issuing, yang qi is abundant; yang qi abundant and not declining — then there is illness. Its qi does not reach yin; therefore there is only heat and no cold. The qi is stored within at the heart, and lodges without between the divided flesh; it makes a person melt and shed the flesh. Therefore it is named wasting intermittent heat. The Emperor said: Good.

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Qi Bo answered: When intermittent heat first issues, it first rises in the fine hairs; stretching and yawning then begin; there is cold shivering and the jaws drum; low back and spine both ache. When the cold goes, inside and outside are both hot; the head aches as if splitting; there is thirst, and one wishes cold drink.

The note

It rises on a schedule because it still walks with the days of wei qi. It starts in the fine hairs, then goes deep. Watching the time matters more than watching the name.