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Huangdi Neijing · The Yellow Emperor’s Inner Canon
Suwen 35 · Intermittent Fevers
Read in English. Switch to Original for word notes, or select text to ask a question.
The Yellow Emperor asked: “Intermittent fevers all arise from Wind. Why do they accumulate and then attack at fixed times?”
Qi Bo replied: “At the beginning, the disturbance first rises in the fine body hair. Stretching and yawning precede the attack, then shivering cold and chattering jaws, with pain in waist and spine. When cold passes, inside and outside become hot; the head hurts as though splitting, and thirst brings a wish for cold drinks.”
The Emperor asked: “What qi causes this? I wish to hear its Way.”
Qi Bo said: “Yin and yang contend above and below, deficiency and repletion alternate, and yin and yang shift into one another. Yang merging into yin makes yin replete and yang deficient. Deficient Yangming causes shivering and chattering jaws; deficient Greater Yang causes pain in waist, back, head and nape. When all three yang are deficient, yin qi prevails, making the bones cold and painful. Cold arises within, so inside and outside are both cold. Flourishing yang produces external heat; deficient yin internal heat. Heat both inside and outside brings panting and thirst, hence the wish for cold drinks.
These conditions arise from injury by summer heat. Abundant heat qi is stored within the skin, outside intestines and Stomach, where nutritive qi lodges. This loosens the sweat openings and opens the interstices. Autumn qi then arrives: wind is encountered while sweating, or water qi acquired through bathing lodges inside the skin together with defensive qi.
Defensive qi moves in yang by day and yin by night. This lodged qi moves outward on meeting yang and presses inward on meeting yin. Inside and outside press against one another; thus an attack occurs each day.”
The Emperor asked: “Why do attacks sometimes occur on alternate days?”
Qi Bo said: “The qi lodges deeply and presses inward upon yin. Yang qi emerges alone, while harmful yin remains lodged within. Yin contends with yang and cannot come out. Thus attacks occur on alternate days.”
The Emperor said: “Good. What qi makes attacks come later each day or earlier each day?”
Qi Bo said: “Harmful qi lodges at the Wind Palace and descends along the spinal muscles. Defensive qi gathers greatly at the Wind Palace once each day and night. On the following day the harmful qi descends one section, so the attack comes later. This is initial lodging in spine and back. Whenever defensive qi reaches the Wind Palace, the interstices open; harmful qi enters through them and illness attacks. Thus each daily attack comes slightly later.
After leaving the Wind Palace, it descends one section daily, reaching the sacral bone in twenty-five days. On the twenty-sixth it enters within the spine and pours into the vessel hidden along the spinal muscles. Its qi rises, emerging after nine days within the Quepen hollow above the chest. As qi rises higher each day, attacks come progressively earlier.
Alternate-day attacks occur when harmful qi presses inward upon the five zang organs and connects across their membrane-source regions. Its route is long, its qi deep and its movement slow. It cannot travel together with defensive qi or emerge entirely, so an attack occurs only on alternate days.
Reading note: The supplied 焔骨 is read as sacral bone in the same contextual 骶 reading used previously; the twenty-five, twenty-six and nine-day sequence is preserved.”
The Emperor asked: “You say that whenever defensive qi reaches the Wind Palace the interstices open, harmful qi enters and illness attacks. But if the qi descends one section daily, its emergence no longer coincides with the Wind Palace. How can attacks still occur each day?”
Qi Bo said: “That account concerns harmful qi lodging in head and nape and descending along the spine. Deficiency and repletion differ; harmful influence strikes different places, so it need not coincide with the Wind Palace.
If it strikes head and nape, illness attacks when defensive qi reaches head and nape; if the back, when qi reaches the back; if waist and spine, when qi reaches them; if hands and feet, when qi reaches them. Wherever defensive qi is, its meeting with harmful qi brings the attack.
Thus Wind has no fixed receptacle. Wherever defensive qi emerges, it must open the interstices. The place where harmful qi joins it becomes its receptacle.”
The Emperor said: “Good. Wind and intermittent fever resemble one another and belong to the same class. Why does Wind remain constantly, while intermittent fever has times of rest?”
Qi Bo said: “Wind qi remains in its place, so it is constantly present. Intermittent-fever qi follows channels and networks, sinks and presses inward. Only when defensive qi responds does an attack occur.”
The Emperor asked: “Why does intermittent fever bring cold first and heat afterward?”
Qi Bo said: “Injury by great summer heat brings copious sweat and opens the interstices. Encountering chilling water during summer then stores cold within interstices and skin. Injury by autumn Wind completes the illness. Cold is yin qi; Wind is yang qi. Injury by cold comes first and injury by Wind later, so cold precedes heat. The illness attacks at fixed times and is called cold intermittent fever.”
The Emperor asked: “Why does heat sometimes precede cold?”
Qi Bo said: “Wind injures first and cold afterward, so heat comes first and cold afterward. This too attacks at fixed times and is called warm intermittent fever. If there is heat alone without cold, yin qi has first become cut off and yang qi emerges alone. This brings scant qi, vexation and distress, hot hands and feet and a wish to vomit. It is called heat-only intermittent fever, dan nüe.”
The Emperor asked: “The canon says to drain excess and supplement insufficiency. Heat now is excess and cold insufficiency. Yet the cold of intermittent fever cannot be warmed by hot water or fire, and its heat cannot be cooled by ice water. These belong to excess and insufficiency. Why can even a good practitioner not stop them at their height, but must wait for the attack to decline before needling? I wish to hear the explanation.”
Qi Bo said: “The canon says: do not needle blazing heat, a surging, turbid pulse, or streaming sweat. At such times the illness runs contrary and cannot yet be treated.
As intermittent fever begins, yang qi merges into yin. Yang is then deficient and yin abundant; the exterior has no qi, so shivering cold comes first. When contrary yin qi reaches its extreme, it returns outward into yang. Yang and yin again combine outside; yin is deficient and yang replete, so heat and thirst arise.
Intermittent-fever qi combining with yang makes yang prevail; combining with yin makes yin prevail. Prevailing yin brings cold and prevailing yang heat. The Wind and cold qi of this illness do not stay constant: at the extreme they turn back. When an attack begins, it is like blazing fire or unopposable wind and rain.
Thus the canon says: confronting its flourishing time necessarily brings damage; working with its decline makes the undertaking prosper greatly. This is the meaning. Before an attack, yin has not merged with yang and yang not with yin. Regulate it then: true qi finds peace and harmful qi disappears. Practitioners cannot treat an attack already underway because its qi is moving contrary.”
The Emperor said: “Good. How is it attacked, and what of earlier and later timing?”
Qi Bo said: “As an attack is about to occur and yin and yang about to shift, it must begin at the four extremities. Yang is already injured and yin follows. Before its time, bind the relevant region firmly, preventing harmful qi from entering and yin qi from escaping. Carefully observe the fine network vessels: treat all that are abundant, firm and filled with blood. This catches the movement before the influences have been able to merge.
Reading note: The supplied 四未 is read contextually as the four extremities, 四末.”
The Emperor asked: “What are the responses when the fever is not attacking?”
Qi Bo said: “Intermittent-fever qi necessarily alternates between fullness and deficiency. Its current site determines the signs. In yang there is heat and an agitated pulse; in yin cold and a quiet pulse. At the extreme, yin and yang both decline and defensive qi separates, allowing the illness to rest. When defensive qi gathers again, illness returns.”
The Emperor asked: “Why do some attacks have two-day intervals or even several days, and why is thirst sometimes present and sometimes absent?”
Qi Bo said: “In intermittent attacks, harmful qi and defensive qi lodge in the six fu organs but sometimes miss one another and cannot meet. Thus several days of rest precede another attack. Intermittent fever alternates the ascendancy of yin and yang, sometimes severely and sometimes mildly; therefore thirst may be present or absent.”
The Emperor asked: “The discourse says injury by summer heat necessarily brings intermittent fever in autumn. Why does fever not always follow this correspondence?”
Qi Bo said: “That describes correspondence with the four seasons. Differently formed illness runs contrary to the seasons. Onset in autumn brings severe cold; in winter, less severe cold; in spring, aversion to wind; in summer, much sweat.”
The Emperor asked: “Where do warm and cold intermittent fevers settle, and in which zang organs?”
Qi Bo said: “Warm intermittent fever comes from Wind striking in winter, with cold qi stored within bone and marrow. In spring yang qi emerges greatly, but harmful qi cannot leave by itself. Great summer heat then consumes brain and marrow and diminishes flesh; the interstices open and discharge. Or exertion makes harmful qi leave together with sweat.
This illness is stored in Kidney. Its qi first moves from inside to outside: yin is deficient and yang abundant, and abundant yang brings heat. As this declines, qi returns inward; entry makes yang deficient, and deficient yang brings cold. Thus heat precedes cold, and it is called warm intermittent fever.”
The Emperor asked: “What is heat-only intermittent fever like?”
Qi Bo said: “In heat-only intermittent fever, Lung already has heat qi abundant through the body. Counterflow rushes upward; central qi is replete and does not discharge outward. Exertion opens the interstices, and wind and cold lodge inside skin and between the divisions of flesh, setting off the illness. The attack makes yang qi abundant; if it does not decline, illness persists.
Its qi does not reach yin, so there is heat alone without cold. Internally the qi is stored in Heart; externally it lodges between the divisions of flesh, consuming the person and stripping away flesh. Thus it is named heat-only intermittent fever.”
The Emperor said: “Good.”
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