Discussion on Contrary Conditions
The Yellow Emperor asked: When the body is not ordinarily warm, nor ordinarily feverish, yet fever and a sensation of stuffiness and fullness arise—why is this? Qi Bo replied: This is because yin qi is insufficient and yang qi is excessive, hence fever and stuffiness and fullness.
The Yellow Emperor said: When the body does not feel cold because of thin clothing, nor is there cold qi invading internally, yet cold is generated from within—why is this? Qi Bo said: Such persons mostly have bi-qi (obstructive qi), with yang qi insufficient and yin qi excessive, so the body feels cold as if just emerged from water.
The Yellow Emperor said: Some people have heat in the four limbs, and when encountering wind-cold, they feel scorching as if roasted by fire—why is this? Qi Bo said: Such persons have yin qi deficiency and atrophy, with yang qi hyperactive. The four limbs pertain to yang; two yang combine (the yang of the limbs and the yang within the body), while yin qi is sparse and insufficient. A small amount of water cannot extinguish a raging fire, so yang qi acts alone. When yang qi acts alone, it cannot foster the growth of the ten thousand things; it merely flourishes on its own. When encountering wind-cold, it feels like being roasted by fire. Such persons will experience muscle wasting.
The Yellow Emperor said: Some people have a cold body, and neither hot water nor fire can warm them, nor can thick clothing make them warm, yet they do not shiver from cold—what disease is this? Qi Bo said: Such persons ordinarily have an excess of kidney qi, engaging in water-damp activities (such as wading through water or dwelling in dampness), causing the taiyang channel qi to decline and the kidney's fatty essence to wither and fail to grow. One water (kidney) cannot overcome two fires (liver and heart). The kidney pertains to water and governs the growth of marrow; if kidney qi cannot transform, then marrow cannot be filled, so cold qi even penetrates deep into the marrow. The reason they do not shiver from cold is that the liver is one yang (shaoyang), the heart is two yang (sovereign fire), and the kidney is a solitary viscus—one water cannot overcome two fires, hence no shivering. This disease is called bone bi (bone obstruction), and such persons will develop symptoms of joint contracture.
The Yellow Emperor said: Some people have numbness and loss of sensation in the muscles; even when wearing padded cotton garments, they still feel numbness—what disease is this? Qi Bo said: This is because nutritive qi is deficient and defensive qi is replete. When nutritive qi is deficient, muscle sensation is dull; when defensive qi is deficient, limb movement is impaired; when both nutritive and defensive qi are deficient, then there is both dull sensation and impaired movement, yet the muscle form remains as usual. When the person's body and spirit do not coordinate, this is called a death sign.
The Yellow Emperor said: Some people have rebellious qi, cannot lie flat, and have audible breathing; some cannot lie flat but have inaudible breathing; some carry on as usual but have audible breathing; some can lie flat but become short of breath when walking; some cannot lie flat nor walk and also have shortness of breath; some cannot lie flat and become short of breath when lying down. Which viscera cause these conditions? I wish to hear the reasons. Qi Bo said: In those who cannot lie flat and have audible breathing, this is reversal and upward rebellion of the yangming channel qi. The three yang channels of the foot have qi that descends; now it moves upward rebelliously, so breathing is audible. The yangming is the channel of the stomach; the stomach is the sea of the six fu organs, and its qi should also descend. When yangming channel qi rebels upward and cannot follow its normal pathway, the person cannot lie flat. The Xia Jing (Lower Classic) says: When the stomach is not harmonious, lying down is restless—this refers to that principle. As for those who carry on as usual yet have audible breathing, this is rebellion of the lung collateral qi. The collaterals cannot follow the channels to move upward and downward, so they stagnate within the channels and cannot flow freely. Diseases of the collaterals are relatively mild, hence the person carries on as usual yet has audible breathing. As for those who cannot lie flat and become short of breath when lying down, this is due to invasion by water qi. Water qi follows the movement of fluids. The kidney is the water viscus and governs fluids; it also governs lying down and shortness of breath. The Yellow Emperor said: Well spoken.