《孫真人備急千金要方》Vol. 1

Sun Zhenren's Essential Prescriptions Worth a Thousand in Gold for Emergencies, Volume One

(Edited by Lin Yi, Court Gentleman of the Song Dynasty, Acting Vice Minister of the Court of Imperial Sacrifices, and Editor in the Secretariat Library)

On the Training Required of the Great Physician (Lun Da Yi Xi Ye), Chapter One

Anyone who wishes to become an accomplished physician must be thoroughly familiar with the medical classics Basic Questions (Suwen), Compendium of Acupuncture and Moxibustion (Jiayi Jing), The Yellow Emperor's Needling Classic (Huangdi Zhenjing), Mingtang (the Illustrious Hall), and Liuzhu (Flowing Pour). He must understand the twelve channels, the Three Positions and Nine Indicators (sanbu jiuhou, the methods of examining the pulse), the five zang and six fu organs and their interior-exterior relationships, the channel points and acupoints, and the Materia Medica along with the principles of compounding medicinals. He must also know the classical formulas (jingfang) transmitted by Zhang Zhongjing, Wang Shuhe, Ruan Henan, Fan Dongyang, Zhang Miao, Jin Shao, and others.

Beyond this, he must master Yin-Yang (yinyang), lu ming (the methods of calculating a person's fate), physiognomy, tortoise-shell divination, the wu zhao (cracks in the tortoise shell read as omens during divination), the Book of Changes (Zhou Yi), and the Six Ren divination arts. Only when he has achieved this may he be considered an accomplished physician. Without such knowledge, he is like a blind person walking at night, who will stumble and perish at every turn.

Next, he must thoroughly study this prescription collection, reflect repeatedly on its subtle principles, and apply himself diligently, for only then may he speak of the art of medicine.

He must also read widely. Why? Without reading the Five Classics (wu jing), one does not understand the Way of humaneness and righteousness. Without reading the Three Histories (the three great ancient historical works), one does not know the affairs of past and present. Without reading the many schools of philosophers, one cannot calmly discern matters when they arise. Without reading the Inner Classic, one does not comprehend the virtues of compassion, kindness, joy, and equanimity. Without reading Zhuangzi and Laozi, one cannot accord with what is authentic and apply the natural Dao, and so one is constrained at every turn by taboos of fortune and misfortune.

As for the waxing and waning of the Five Phases (wuxing), the Seven Luminaries (the sun, the moon, and the five major planets), and astronomical knowledge, these too must be investigated deeply. If one masters all of these, then one's practice of medicine will meet no obstruction, and one's skill will reach perfection.

On the Great Physician's Precision and Sincerity (Lun Da Yi Jing Cheng), Chapter Two

Zhang Zhan said: The study of classical formulas is difficult to master, and it has always been so. Some illnesses share the same inner pattern yet display different outward signs, while others have different inner patterns yet present the same outward signs. Therefore, the excess or deficiency of the five zang and six fu organs, and the smoothness or obstruction of the blood and the ying-wei qi (the qi and blood circulating within and outside the vessels), cannot be perceived merely by ear and eye. One must first examine the patient carefully and discern the condition with precision.

The pulse at the cunkou (the radial pulse site) and at the guan and chi positions displays complex changes of floating, sinking, wiry, and tight qualities. The distribution of acupoints and the flow of channel qi also differ in depth and height, and the thickness and firmness of the skin, flesh, sinews, and bones likewise vary. Only one who is attentive and examines with subtlety can claim to grasp these principles.

Now, to use coarse and shallow reasoning to probe such subtle principles, is this not perilous? If a patient is already weak yet is tonified, if already full yet is drained, if the channels are already open yet are forcibly unblocked, if already obstructed yet made more stagnant, if the condition is cold yet treated with cold remedies, or if it is hot yet treated with warming methods, this only aggravates the illness...

Patients long eagerly for their recovery, yet I can see that some are about to die. This shows how difficult it is to master arts such as medicine and divination. These arts are not transmitted directly by spirits, so how can one grasp the profound principles within them?

Some shallow people, after reading medical books for three years, assume there is no illness they cannot cure. Yet once they have practiced medicine for three years, they realize that no single prescription can address every disease. Therefore, those who study medicine must broadly and deeply investigate its fundamental principles and persevere without rest. They must not rely on hearsay and assume they have mastered the art. To do so only deeply misleads oneself.

Every physician of superior skill, when treating illness, should keep the mind calm and the will upright, free of selfish desire and not seeking reward. First, they must cultivate profound compassion and pity, and vow to relieve the suffering of all beings. When someone comes for help because of illness or calamity, the physician should treat them equally, as they would their own kin, regardless of rank or wealth, age or appearance, whether the person is an enemy or a friend, a member of the Huaxia (Chinese) civilization or of a foreign people, or clever or dull.

Nor should the physician hesitate, weighing fortune against misfortune or guarding their own life. On seeing a patient's suffering, they should feel as if they themselves were in pain and be deeply moved with pity. Even if the road is treacherous, they should not shrink back. Whether by day or night, in cold or heat, hungry or thirsty, or weary, they should hasten with full dedication to the cure and not adopt a posture of mere display or perfunctory response. Only such a physician is worthy of being a good doctor who saves all beings. To violate these principles is to become a calamity that harms living beings.

Since ancient times, many renowned worthy men, in order to treat patients in critical condition, have often used their own lives as medicinal materials. Although people say animals are lowly and humans noble, when it comes to cherishing life, humans and animals are no different. To harm other lives in order to preserve one's own causes suffering to any sentient being, let alone a human. To kill in order to seek survival only moves one further from the way of survival. For this reason, the prescriptions I have compiled do not use living creatures as medicine. For medicinal materials such as gadflies and leeches, one may use those already dead that are bought at the market; this restriction does not apply to them. As for chicken eggs, because the life within has not yet formed, one may painfully use them in an extremely urgent situation when there is no alternative. Those who can refrain from using them are extremely enlightened, though this is not something ordinary people can easily accomplish.

When encountering patients with sores or dysentery, whose conditions are so filthy and foul that they are unbearable to look upon, the physician should feel only shame, pity, and concern, and never the slightest trace of disgust. This is the aspiration I have established.

A good physician should have a clear and serene mind and a focused heart, a dignified yet gentle bearing, and an open, unbiased breadth of mind, neither obstinate nor muddled. When visiting patients and examining their conditions, one must concentrate fully and be meticulous, observing every symptom closely and omitting not even the most minute detail. When deciding on acupuncture and medication, one must likewise be cautious and thorough……

Although the conditions of illness differ, treatment must always be prompt. In the clinic, however, one must remain composed and never flustered. One must examine carefully and reflect deeply, and must not treat a person's life as a game, rashly showing off to win a reputation. This is a serious lack of benevolence.

On entering a patient's home, even if the furnishings are splendid, one should not gaze about. Even if music sounds in the ears, one should not show a look of delight. When the host serves one delicacy and fine wine after another, one should regard them with indifference, eating as though tasting nothing and drinking as though drinking no wine. The reason is that when one person sits alone in a corner, brooding with sorrow, everyone in the hall is made unhappy by it. How much more so when the patient suffers every moment, yet the physician is at ease, pleased with himself and self-satisfied. This is something that both humans and spirits regard as shameful, and it is something a person of virtue (De) would never do. This is the fundamental intent of practicing medicine.

When practicing medicine, one should not talk idly, laugh noisily, gossip about right and wrong, or pass judgment on others. Nor should one boast of one's reputation, disparage other physicians, or flaunt one's own skill. If one happens to cure a patient and then holds one's head high in self-satisfaction, thinking no one under heaven can compare, this is the physician's gravest taboo. Lord Lao (Laojun) said: "When a person does open good deeds, others will repay them; when a person does hidden good deeds, ghosts and spirits will reward them. When a person does open evil deeds, others will retaliate; when a person does hidden evil deeds, ghosts and spirits will bring calamity upon them." Considering these two aspects, the hidden virtue (yin De) and the visible virtue (yang De), good and evil each meet with their own recompense. Could this be empty falsehood?

Therefore, a physician must not rely on his own skill and devote his mind to calculating wealth. He should single-mindedly relieve suffering, and blessings will naturally come in the unseen realm. Nor should he, because a patient is wealthy and noble, prescribe rare and costly medicines to display his own ability. This is truly contrary to the way of loyalty, generosity, and forgiveness. The author, sincerely intending to aid the sick, has therefore set down even these trivial matters. Students should not think that something is not worth hearing merely because it is stated plainly and in petty detail.

On the Brief Examples of Treating Illness, Chapter Three

Heaven arranged the Five Phases (Wuxing: Metal, Wood, Water, Fire, Earth) to give birth to and nourish the myriad things, and humans received the qi of the Five Constants to form the Five Viscera. The distribution of the channels and the viscera, and the interaction and circulation of Yin-Yang, contain profundities and subtleties whose changes can never be exhausted. The Book of Changes says: "Unless one is among the most subtle and profound things under heaven, who could take part in them?"

Looking at the physicians of today, some are unwilling to exert their minds to ponder the meaning of the classics or to broaden their knowledge. They merely inherit their family arts and follow old methods from beginning to end. In examining conditions and inquiring about ailments, they seek only to answer quickly with their mouths, and after speaking with a patient for a few words, they immediately prescribe decoctions. When taking the pulse, they attend only to the inch pulse and disregard the cubit pulse; they grasp only the patient's wrist and do not examine the feet. As for the pulse positions such as Renying and Fuyang, and the three positional pulses…

When diagnosing a patient, if one does not carefully observe the number of breaths, or reaches a conclusion before counting fifty breaths, the illness often remains uncertain. If one also cannot discern the signs at the facial regions of the Mingtang (Bright Hall) and Queting (Courtyard), yet believes the condition has been fully determined, this is like peering through a tube, seeing only a narrow view. Distinguishing life from death is difficult by nature. Physicians should be especially careful in their examinations, and patients should also attend to their condition and take precautions.

Since ancient times, physicians have sometimes envied and harmed one another. Bian Que was himself killed by Li Xi, the Chief Imperial Physician of the state of Qin. A prescription written by one physician should not be compounded by others without authorization. Otherwise, someone may secretly add poison, worsening the illness and gradually endangering life. Such cases are not unique, and great caution is necessary. Rather than taking medicine of unknown origin that may have been tampered with, it is better to abstain for the time being and let nature take its course. One must never allow an ignorant physician, driven by jealousy, to take a life. This is truly lamentable.

The roots of the various diseases broadly include: stroke, cold damage (shanghan), chills and fever, warm malaria, invasion by pathogenic qi, cholera, abdominal dropsy, intestinal disorders and dysentery, urinary and fecal obstruction, benzhun (qi rushing upward from the lower abdomen), counterflow qi with cough, vomiting, jaundice, wasting-thirst (xiaoke), retained fluid, accumulations, hardened masses, abdominal lumps (zhengjia, masses within the abdomen), emaciation, fright-induced disorders, epilepsy, ghost-stricken disorders (guzhu, which the ancients attributed to invasion by ghostly forces), throat obstruction (houbi), toothache, deafness, blindness, metal wounds, sprains and bone fractures, carbuncles and malignant sores, hemorrhoids and fistulas, tumors, and goiters. In men, there are the five exhaustions and seven injuries, weakness and emaciation. In women, there are leukorrhea, flooding and spotting, amenorrhea, ulceration of the genitals, and injuries caused by venomous insects, snakes, and gu poison. These are only the general categories and roots of disease. The many manifestations that arise as illnesses change must still be examined one by one according to their specific causes.

Furthermore, chills and fever, exhaustion, overeating, excessive sexual activity, fright and terror, worry and anger, and restless apprehension can all cause illness. Blood stasis arising from childbirth, miscarriage, or falls, and the indulgence in Wushi San (a prescription made from mineral drugs), taken in pursuit of pleasure in the bedchamber, are also roots of disease and give rise to a variety of symptoms. Physicians cannot fail to understand the root and branch of illness.

Yet some physicians, relying only on the statements in medical books, rigidly match the conditions of men, women, young, and old to their supposed sources, prescribing medicine to anyone who shows even a slight resemblance. Men are often considered to have a greater abundance of yang qi, so their bodies tend toward dryness. Because yang qi moves vigorously, excessive exertion or loss of semen through sexual activity easily leads to exhaustion, and thus men suffer many exhaustion disorders. Compared with women, the illnesses of men are generally much easier to treat.

After a woman reaches the age of fourteen, she begins to menstruate. If, during menstruation, she is afflicted by wind, cold, dampness, or heat, or suffers from seasonal illnesses at the same time, she should truthfully inform the physician. If she does not explain clearly, the treatment may be mistaken and the illness worsened. The physician who writes the prescription should also...

Someone asked whether the choice of medicines should always be based on the local climate and a person's constitution. In Jiangnan and Lingnan, the summers are hot and humid and the local people have thin skin and loose couli (the texture of the skin and its pores), so medicines should be light and used sparingly. In Guanzhong and Hebei, the land is dry, the people's skin is firm, and their couli are closed, so somewhat stronger medicines are appropriate.

Some young and robust people disregard wind and damp, break taboos, and excessively deplete their Jing (essence), Qi, and body fluids. Even when they fall ill with only a mild condition, purgative medicines should not be used lightly. A single purgation may greatly damage their Jing, Qi, and fluids, leaving them weakened and bedridden for months or even years.

For those with a long-standing illness, when a purgative decoction is suitable, it is not necessary to take the entire dose. Once the purging is sufficient, the medicine should be stopped. If the root of the illness has not been removed, a further prescription can be given afterward. If the patient has some strength and can withstand the full dose, this rule need not be strictly followed. If the root of the illness must be cleared with a purgative decoction, pills or powders should be used from time to time afterward to support the recovery.

Those who recover after taking a purgative decoction should be cautious thereafter and avoid tonifying decoctions, or the illness may relapse. Heavy use of purgatives again will cause even greater harm to the patient. If the patient has only just recovered and their strength has not fully returned, they need only be observed and nourished. When medicine is truly needed, herbs of gentle nature should be used to harmonize the body.

For those who frequently fall ill, as long as they can still walk and their strength has not declined, they may take tonifying pills or powders chosen according to cold or heat patterns. Before doing so, they may first take a purgative decoction to clear the phlegm-fullness (tanshi) accumulated in the chest and abdomen, and then take the tonic. Those who are extremely weak and debilitated, and who need tonifying decoctions, should take no more than three doses. When treating wind disorders, the wind-dispelling decoctions required often cannot take effect within three or five doses. Some people have lingering wind pathogens and a weakened body, and they need more than a dozen doses, or even a course of over one hundred days, before they recover. Therefore it is said: "Where there is excess, purge; where there is deficiency, supplement."

Between Heaven and Earth, within Yin-Yang, the most precious thing is the human being. Humans receive the harmonious Qi of Heaven and Earth at birth, and laws, rites, and music are likewise established by humans. When a person is first born, Jing forms first, and once the Jing is formed, the marrow of the brain grows along with it. The round head corresponds to Heaven, and the square feet correspond to Earth. The eyes correspond to the sun and moon, the five zang organs to the five planets, and the six fu organs to the six pitch-pipes (lüshi). The heart lies at the center of the body. The large intestine is one zhang and two chi long, corresponding to the twelve periods of the day, and the small intestine is two zhang and four chi long, corresponding to the twenty-four solar terms. The human body has three hundred and sixty...

The fifteen collateral vessels correspond to the cycle of the year. The human body has nine orifices, corresponding to the nine regions (Jiuzhou). Heaven has the changes of cold and heat, and the human body has differences of deficiency and fullness. Heaven has punishment and grace, and humans have likes and dislikes. Heaven has Yin-Yang, and humans have male and female. The moon waxes and wanes, and humans differ in stature, tall or short. Therefore, if the eating of the five grains is not regulated with care, and foods of differing natures, cold, hot, salty, and bitter, come into conflict within the body, they will act upon one another and give rise to disease.

Doctors find it no easy matter to examine illness. One must also question the patient to understand how deep the illness lies, and this is called the refinement of medical skill. Zhang Zhongjing said that whenever decoctions are to be prepared or acupuncture and moxibustion applied, one must reflect with care. One must thoroughly understand the Twelve Channels, distinguish the three hundred and sixty acupoints, comprehend the movement of the ying and wei qi (the qi that circulates through the vessels and sustains the body's defense and nourishment), and know where the illness lies and the corresponding method of treatment.

The skilled physicians of antiquity observed the complexion, so that the pulse and the bodily appearance corroborated one another and did not contradict. Black appearing above red foretells danger, while red appearing above green portends the presence of life-giving vitality. Physicians of middling skill listened to the voice, matching the sound to the five tones. A person of the Fire phase who hears the sound of the Water phase will be vexed and frightened, and a person of the Wood phase who hears the sound of the Metal phase will be terrified, for among the Five Phases (wuxing) there exists a relationship of mutual overcoming.

The Spleen belongs to Earth. It nourishes and sustains all things and assists the other viscera. When the spleen qi is vigorous, this may not be outwardly visible, but when it declines, the body tends toward death. When spleen qi is excessive, the limbs become clumsy. When it is insufficient, the nine orifices are obstructed, the sense organs close off, and a person becomes as if intoxicated. The four seasons circulate and return in cycles. Physicians of a lower grade diagnose the cause through the pulse, observe how the illness changes over time, and note the orderly and adverse movements of the four seasons along with their patterns of mutual generation and overcoming. To discern the subtle changes of the viscera is what is called high medical skill.

Chapter Four: On the Examination of Symptoms

In treating disease, one must first investigate its cause and distinguish the course of its changes. If the five viscera have not yet weakened, the six bowels have not yet been exhausted, the blood vessels have not yet been disordered, and the spirit has not yet scattered, then administering medicine will allow the patient to survive. If the disease has already formed, treatment may still improve the condition by half. But if the illness has progressed to its extreme, life can hardly be preserved.

Examination of the illness should generally be carried out in the early morning. At that time Yin has not yet been stirred, Yang has not yet dispersed, the patient has not yet eaten, and the channels and the qi and blood have not yet been filled by food. The collateral vessels are relatively calm, and the qi and blood are undisturbed. At this time one judges through the pulse whether the circulation of qi and blood is smooth or adverse. If the time is not suitable, one should not rashly make a diagnosis. One must also carefully examine the Three Regions and Nine Indicators (a method of examining the pulse by position and level) and state the findings clearly to the patient.

Those skilled in healing in antiquity said that the superior physician governs the state, the middling physician treats people, and the inferior physician treats illness. They also said that the superior physician listens to sounds, the middling physician observes complexion, and the inferior physician takes the pulse. And they said that the superior physician treats what has not yet arisen, the middling physician treats what is about to arise, and the inferior physician treats what has already erupted. If one does not devote one's full attention to...

When the pulse becomes disordered, a patient becomes very difficult to treat. What are the "three sections of cun, guan, and chi" (sanbu cunguanchi)? The upper section belongs to Heaven and corresponds to the lungs; the middle section belongs to humanity and corresponds to the spleen; the lower section belongs to Earth and corresponds to the kidneys.

What are the "nine indicators" (jiuhou)? Each of the three sections is divided into three indicators, which together make nine. The Heaven indicator of the upper section is the artery on each side of the forehead, which reflects the Qi (vital energy) on the two sides of the head. The Earth indicator of the upper section is the artery on each cheek, which reflects the Qi of the mouth and teeth. The Human indicator of the upper section is the artery in front of the ear, which reflects the Qi of the ears and eyes. The Heaven indicator of the middle section reflects the Qi of the Hand Taiyin (Lung) channel; the Earth indicator of the middle section reflects the Qi of the Hand Yangming channel and the chest; the Human indicator of the middle section reflects the Qi of the Hand Shaoyin (Heart) channel. The Heaven indicator of the lower section reflects the Qi of the Foot Jueyin (Liver) channel; the Earth indicator of the lower section reflects the Qi of the Foot Shaoyin (Kidney) channel; the Human indicator of the lower section reflects the Qi of the Foot Taiyin (Spleen) channel. Together these form the nine indicators.

Those whose bodies are robust but whose pulse is fine and weak, with insufficient breath, will die; those whose bodies are emaciated but whose pulse is surging and whose chest Qi is excessive will also die. Those whose physical form and breath are in accord will live; when the various pulse patterns and bodily conditions are out of harmony, there is illness. If the pulses of the three sections and nine indicators are all disordered, death follows.

Physicians of shallow skill do not understand the three sections and nine indicators, or how the pulse changes across the four seasons. Sometimes they use the wrong decoctions, or apply acupuncture and moxibustion improperly. Intending to treat illness according to the prescription, they instead add other diseases and ultimately cause people to lose their lives. How lamentable! Among the common people, nearly half die needlessly, perhaps simply because there are too few good physicians in the world.

Here the text explains how the four elements of earth, water, fire, and wind in the human body are harmonized to form the body. When fire Qi is disordered, the whole body becomes hot; when wind Qi is disordered, the body stiffens and the pores close; when water Qi is disordered, the body swells, the abdomen becomes distended, and breathing grows rapid; when earth Qi is disordered, the limbs cannot move and one cannot speak. When fire Qi is exhausted, the body grows cold; when wind Qi ceases, breathing stops; when the body's fluids are depleted, the blood is exhausted; when earth Qi disperses, the body collapses.

Yet physicians of shallow skill do not consider the patterns by which the pulse and the body's inner movements operate. Instead they apply wrong methods, so that the Five Phases (wuxing) within the five viscera overcome one another, and the illness worsens like fuel added to a raging fire. One cannot be too cautious.

When the four kinds of Qi move in harmony and the four kinds of Shen (spirit) Qi are settled, the body is at peace. If any one of them falls out of balance, a hundred diseases may arise. When the four kinds of Shen (spirit) Qi become disordered, four hundred and four diseases may break out at once. Another account holds that one hundred and one diseases heal on their own even without treatment; one hundred and one diseases recover only with treatment; one hundred and one diseases remain hard to cure even with treatment; and one hundred and one diseases truly cause death and cannot be saved.

Zhang Zhongjing said: "In treating all diseases, one should first use decoctions to wash out the five viscera and six..."

When the fu organs (liu fu, the Six Bowels) are unobstructed, they can regulate the circulation of the meridians, restore the disrupted balance of yin and yang, expel pathogenic qi, and nourish a withered and weakened body.

Decoctions can make the skin glossy and augment qi and blood. Water cleanses all things, which is why decoctions are used in treatment.

If an illness of the limbs has lingered for a long time and wind or cold pathogens strike again, powders should be used next. Powders can drive out the pathogenic qi.

When wind and damp pathogens cause bi (painful obstruction), the pathogen wanders between the exterior and interior, and its lodging place is not fixed. Powders should then be used to level it.

Next, pills should be used. Pills can expel wind and cold, dissolve accumulations, resolve hard masses and pi (chronic stagnant conditions formed by long-term accumulation), promote the transformation of food and drink, and harmonize ying and wei (the nutritive and defensive qi that maintain the body's protective and nourishing functions). A physician who can combine these methods according to the situation may be called an accomplished doctor. Thus it is said: "The physician is one of yi (intention)." That is, practicing medicine requires examining the condition closely and judging flexibly.

Moreover, if a patient should not be made to sweat but is forced to sweat, the body fluids will be exhausted, and the patient may even die. If a patient needs to sweat but is not given a method to induce sweating, the pores will be blocked, causing suffocation and collapse, and the patient may die.

If a patient should not be purged but is forcibly purged, the intestines will be opened excessively and diarrhea will not stop, and the patient may even die. If a patient needs to be purged but is not given a purging method, the patient will suffer vexation in the heart, fullness and distension of the abdomen, and agitation, and may die of swelling.

If a patient should not receive moxibustion but is forced to undergo it, fire pathogens will invade the abdomen, disturb the five zang organs, aggravate agitation, and may even cause death. If a patient needs moxibustion but is not given it, cold pathogens will congeal more heavily and more firmly, becoming difficult to disperse over time. Qi will surge upward into the chest with no way to resolve it, and the condition becomes critical, leading to death.

The Yellow Emperor asked: "What is the situation when pathogenic qi spreads and wanders?" Qi Bo replied: "The zheng (correct) and xie (pathogenic) qi enter the body from outside, but they still have no fixed place to stay. Once they invade the zang-fu organs, they likewise have no fixed location. They travel together with the ying and wei qi and also disturb the hun and po (the ethereal and corporeal souls), causing restless sleep and frequent dreams.

"When pathogenic qi lodges in the fu organs, the fu become relatively excessive while the exterior becomes relatively deficient. When it lodges in the zang organs, the zang become relatively excessive while the exterior becomes relatively deficient."

The Yellow Emperor further asked: "Can excess and deficiency be perceived from dreams?" Qi Bo replied: "When yin qi is predominant, one dreams of crossing great waters and feels fear. When yang qi is predominant, one dreams of walking through great fire and being burned. When yin and yang are both predominant, one dreams of fighting and being wounded by one another. When qi is excessive in the upper body, one dreams of flying upward. When qi is excessive in the lower body, one dreams of falling. When one eats to excess, one dreams of walking (another record says one dreams of moving about). When one is excessively hungry, one dreams of seeking things (another record says one dreams of lying down).

"When liver qi is predominant, one dreams of anger. When lung qi is predominant, one dreams of fear and weeping. When heart qi is predominant, one dreams of laughing, and also of fear. When spleen qi is predominant, one dreams of singing and playing music, of a heavy body, and of hands and feet..."

On Prescriptions, Chapter Five

When kidney Qi is vigorous, one dreams that the waist and spine seem to have come apart, no longer connected to each other. For these dream images, if they arise from an excess of pathogenic Qi, the draining method (xiefa) should be applied when that excess appears, and the illness will quickly ease.

When pathogenic Qi invades the heart, one dreams of hills and smoke and fire. When it invades the lungs, one dreams of soaring and flying aloft, or of metal implements and strange objects. When it invades the liver, one dreams of mountain forests and trees. When it invades the spleen, one dreams of hills, great marshes, collapsed houses, and wind and rain. When it invades the kidneys, one dreams of standing at the edge of an abyss or sinking underwater. When it invades the bladder, one dreams of wandering everywhere. When it invades the stomach, one dreams of eating and drinking. When it invades the large intestine, one dreams of open fields. When it invades the small intestine, one dreams of gathered cities and streets. When it invades the gallbladder, one dreams of fighting and lawsuits, and even of harming oneself. When it invades the genitals, one dreams of intercourse or conflict. When it invades the neck, one dreams of being beheaded. When it invades the groin, one dreams of walking yet being unable to advance, or of being in ponds, ditches, pits, or low-lying places. When it invades the thigh, one dreams of performing ritual bows and kneeling prostrations. When it invades the bao (the uterus or bladder) or the rectum, one dreams of urinating or defecating. These are all cases of insufficient pathogenic Qi, and when the insufficiency appears, it should be supplemented and tonified, after which the illness will quickly ease. Those skilled at observing disease signs should also grasp this principle deeply, so that their treatment is thorough.

The Shiji (Records of the Grand Historian) states that there are six circumstances in which disease is difficult to treat. The first is arrogance and willfulness, with a refusal to listen to reason. The second is neglecting one's body while valuing wealth. The third is an inability to regulate diet, clothing, and daily routine. The fourth is disharmony of yin and yang and unstable Qi in the viscera. The fifth is a body so weakened that it cannot take medicine. The sixth is a belief in sorcery alongside a distrust of physicians. If the patient still has vitality, with complexion and bodily form not yet changed, and the pathogen has not penetrated deeply into the tissues, then illness can be cured without fail, provided that needle and medicinal treatment is given promptly, that recuperation is carefully managed, and that the patient is entrusted to a skilled physician.

In treating cold patterns, warming medicines should be used, and in treating heat patterns, cooling medicines. Where food stagnation does not dissipate, emetic or purgative medicines are called for. Illnesses such as ghost invasion (guizhu) and gu poisoning require medicines suited to them, and carbuncles, swellings, ulcers, and tumors require medicines directed at such conditions. Wind-damp disorders are treated with medicines for wind-damp, while wind disorders, consumptive exhaustion (xulao), and cold-Qi conditions should each be treated by their own appropriate methods.

Lei Gong said that medicinal substances come in three grades and that diseases also have different levels. The sweet, bitter, light, and heavy properties of medicines differ, and diseases likewise differ in being new or chronic and in being cold or warm in nature. Heavy, hot, greasy, slippery, salty, and sour substances, including mineral drugs and foods of this kind, are suitable for wind disorders, but when applied to other diseases they may not match the pattern. Light, cold, coarse, astringent, sweet, and bitter substances, including herbs and foods of this kind, are suitable for heat disorders, but when applied to other diseases they too may not match the pattern.

Pungent, bitter, and bland medicines and foods are suited to treating cold disorders; when applied to other conditions, they are not necessarily appropriate.

What follows is only a brief outline of the principles and origins of differentiating patterns and selecting medicines. Other situations may be inferred from the conditions themselves, and in clinical practice one must respond flexibly. One should understand this essential point.

The Yao Dui (Paired Medicines) states: Diseases and accumulations (ji ju) mostly arise from deficiency, and deficiency in turn gives rise to a hundred illnesses. Ji refers to what accumulates in the five zang organs, and ju refers to what gathers in the six fu organs. For conditions of this kind, old formulas are often followed without addition or subtraction. However, the changes produced by deficiency-exhaustion (xu lao) are endlessly varied, so medicines should be adjusted according to the state of the illness.

Skilled physicians of old all gathered herbs themselves, understanding the nature and efficacy of each, and they collected them according to the season and the time of day. Gathered too early, the medicine's potency had not yet matured; gathered too late, its peak potency had already passed. Today's practitioners neither gather herbs themselves nor understand the solar terms and the proper timing for harvest. They simply pick whatever is at hand and use it. Nor do they understand the shifts in the cold and hot properties of medicines, or whether dosages should be increased or reduced. Such practitioners, though they wish to heal, can hardly ensure results. This is truly superficial and mistaken. Here, for the time being, the key points for distinguishing cold and heat and for adding or removing medicines are explained.

For deficiency-exhaustion (physical weakness and long-standing illness with strain) accompanied by headache and fever, add Chinese wolfberry (gouqi) and Solomon's seal (yuzhu). For deficiency with vomiting, add ginseng (renshen). For deficiency with restlessness of the mind-spirit (shen), ginseng may also be added. For deficiency with frequent, disordered dreams, add dragon bone (longgu). For deficiency with marked fever, add rehmannia (dihuang), oyster shell (muli), kochia fruit (difuzi), and licorice (gancao). For deficiency that leans toward cold, add angelica (danggui), ligusticum (chuanxiong), and dried ginger (ganjiang).

For deficiency with depletion of the body, add stalactite (zhongru), gleditsia thorn (jici), cistanche (rou congrong), and morinda root (bajitian). For deficiency with intense heat, add scutellaria (huangqin) and asparagus root (tianmendong). For deficiency with forgetfulness, add poria mycelium (fushen) and polygala root (yuanzhi). For deficiency with fright, palpitations, and unease, add dragon's teeth (longchi), purple fluorite (zishiying), glehnia (shashen), and small grass (xiaocao). When the condition leans cold, use purple fluorite and small grass; when external heat evils are present, use glehnia and dragon's teeth. When the condition is neither predominantly cold nor hot, these medicines are unnecessary.

For deficiency with dry mouth, add ophiopogon (maimendong) and anemarrhena (zhimu). For shortness of breath, add sesame (huma), rubus fruit (fupenzi), and platycladus seed (baiziren). For excess qi accompanied by a mild cough, add schisandra (wuweizi) and jujube (dazao). For deficiency with stiffness of the body and discomfort in the lower back, add magnetite (cishi) and eucommia (duzhong). For deficiency with marked aversion to cold, add cinnamon bark (guixin), evodia (wuzhuyu), and aconite (fuzi).

For deficiency with head discomfort and reddish urine, add scutellaria (huangqin). For deficiency with external heat evils, add lycium root bark (digupi), baishui, and astragalus (huangqi). For deficiency that leans cold, use Longxi astragalus (Longxi huangqi). For deficiency with phlegm and counterflow qi, add fresh ginger (shengjiang), pinellia (banxia), and immature bitter orange (zhishi). For deficiency with small-intestinal looseness (incontinence of stool or urine), add mantis egg case (sangpiaoxiao), dragon bone, and chicken gizzard lining (jipichi).

The text continues with material on the "small intestine," but the passage is incomplete at this point, so the translation can only proceed up to this point.

On the Use of Substances (Chapter Six)

The upper-grade substances total one hundred and twenty kinds and serve as the chief (jun) substances. They are used mainly to nourish life in accordance with the Way of Heaven (tiandao), and none are poisonous. Those who wish to lighten the body, increase vital energy, slow aging, and prolong life may select from them according to the Upper Scripture of the Classic of Materia Medica (Benjing).

The middle-grade substances also total one hundred and twenty kinds and serve as the minister (chen) substances. They are used mainly to regulate the nature and constitution in accordance with human needs. Some are poisonous and some are not, so they should be chosen with discretion. Those who wish to suppress illness and strengthen deficiency may select from them according to the Middle Scripture of the Benjing.

The lower-grade substances total one hundred and twenty-five kinds and serve as the assistant and envoy (zuoshi) substances. They are used mainly to respond to disease in accordance with the Way of Earth (didao). Most are poisonous and should not be taken over a long period. Those who wish to dispel cold and heat pathogens, disperse accumulations, and cure disease may select from them according to the Lower Scripture of the Benjing.

Together, the three grades comprise three hundred and sixty-five substances, corresponding to the three hundred and sixty-five days of the year, with each substance matched to one day so that together they form a year. Doubling this number yields seven hundred and thirty names.

In every prescription, the chief, minister, assistant, and envoy substances stand in a relation of mutual ordering. To make the substances cooperate and harmonize, one may combine one chief substance with two minister substances, three assistant substances, and five envoy substances, or one chief substance with three minister substances and nine assistant and envoy substances.

Substances also have relations of yin and yang, of mother and child, and of brothers. Medicinal materials come in different kinds, such as roots, stems, flowers, and fruits, or herbs, stones, bones, and flesh. In compounding, some substances are used alone, some must be combined with others, some assist one another, and some restrain, oppose, conflict with, or neutralize one another. These are called the "seven relations" (qiqing) of compounding. In preparation, one must distinguish these carefully: substances that are mutually necessary (xiangxu) or mutually aiding (xiangshi) should be used together, while those that are mutually antagonistic (xiangwu) or mutually opposing (xiangfan) should not be combined. If a substance is poisonous, it may be used in combinations of mutual counteraction (xiangwei) or mutual subduing (xiangsha) once its toxicity has been restrained; otherwise it should not be paired.

Beyond this, substances are classified by their five flavors (sour, salty, sweet, bitter, and pungent) and four natures (cold, hot, warm, and cool), and by whether they are toxic or non-toxic. Each also has its own requirements for drying in the shade or the sun, for the seasons of harvest and processing, for raw or prepared form, for place of origin, for authenticity, and for freshness. The mutual relations of aiding, counteracting, and so on are listed below, and anyone prescribing should study these points thoroughly.

Jade and Stone, Upper Section (the upper-grade category of jade and stone substances)

Jade Spring (the following names may refer to corresponding medicinals or substances used in combination): Coltsfoot flower. Jade Dust: deer antler. Cinnabar: lodestone and brackish water. Zeng Qing (azurite or blue vitriol): dodder seed.

Shi dan (chalcanthite) pairs well with ying shui; mugui, junggui, yuanhua, xinyi, and baiwei should not be combined with it. Yunmu (mica) pairs well with zexie; tuoyu and flowing water should not be combined with it.

Xu Changqing; puxiao (refined mirabilite) pairs well with maiju ginger; zhongru (stalactite) pairs well with shechuangzi and tusizi, and should not be combined with mudan, xuanshi, mengmu, or zishiying.

Yingrang grass; xiaoshi (saltpeter) is suitable when processed with fire, and should not be combined with kushen, bitter greens, or nüwan; mangxiao pairs well with shiwei and should not be combined with maiju ginger; fanshi (alum) pairs well with licorice and should not be combined with muli oyster shell.

Huashi (talc) pairs well with shiwei and should not be combined with zengqing; baishiying (white quartz) pairs well with mamu and should not be combined with dugong.

Zishiying (purple quartz) pairs well with changshi and should not be combined with bianqing or fuzi, nor with tuojia, huanglian, or maiju ginger; chishizhi (red halloysite) should not be combined with rhubarb.

Yuanhua; huangshizhi (yellow halloysite) pairs well with zengqing and should not be combined with xixin, feilian, bianqing, or fuzi; baishizhi (white halloysite) pairs well with yanfen and should not be combined with songzhi or huangqin.

Taiyi yuliang (a residual grain stone) pairs well with duzhong and should not be combined with tieluo, changpu, or beimu.

Jade and Stone, Middle Grade

Mercury (cishi, lodestone, should not be combined with it); yinnie (a mineral residue) should not be combined with fangji or zhu; kong gong nie (a mineral residue) pairs well with magnolia bark and should not be combined with xixin; ningshui shi (ice-like stone) pairs well with dilü and is harmed by badou.

Yangqi shi (actinolite) pairs well with sangpiaoxiao and should not be combined with tusizi, zexie, junggui, leiwan, or snake sloughs; shigao (gypsum) pairs well with eggs and should not be combined with mangcao or dugong; cishi (lodestone) pairs well with chaihu and should not be combined with huangshizhi, mudan, or mangcao.

Xuanshi (dark stone) pairs well with pine resin, cypress seeds, and junggui; lishi (a veined stone) pairs well with talc and should not be combined with mahuang.

Jade and Stone, Lower Grade

Qinglanggan (a green gem) works well with mercury and is harmed by chicken bone and tin; lei shi (a stone used in ancient medicine) works well when heated with fire, pairs well with jicizhen, and should not be combined with hu zhang, dugong, luck duck droppings, xixin, or water; teshengleishi works well when heated with fire and should not be combined with water; fangjie shi (calcite) should not be combined with badou; daizhe (red ochre); tianxiong (aconite); and da yan (coarse salt) pairs well with louzi.

Herbs, Upper Grade

Liuzhi (a fungus) pairs well with shuyu and works well with hair, but should not be combined with hengshan, bianqing, or yinchen; tianmendong (asparagus root) pairs well with yuanyi and dihuang and should not be combined with zengqing.

In the text, "weishi" refers to substances that suit combined use, "buyu" indicates that two substances should not be used together, and "de huo liang" means that the effect is better after fire processing. The original contains several line breaks, bracketed annotations, and apparently missing characters, so some drug names and pairings can only be organized as they appear on the surviving text.

Ophiopogon root (maimendong, also called maidong) pairs well with rehmannia (dihuang) and plantago seed (cheqianzi), but should not be combined with tussilago flower (kuandonghua), bitter gourd (kuhu), sophora root (kushen), or green cucumber (qingrang). Atractylodes-type herbs (zhu) pair well with saposhnikovia root (fangfeng) and sanguisorba root (dilü). Fu wei (nüwei) is a medicinal name.

Polygonatum (weirui, the same as yuzhu, or Solomon's seal) should not be combined with salty drugs (lu xian). Dried rehmannia (gan dihuang) pairs well with ophiopogon root and clear rice wine, but should not be combined with fritillaria (beimu) or wuyi (wuyi). Calamus (changpu) pairs well with gentiana macrophylla (qinjiao) and cork tree bark (qinpi), but should not be combined with mylabris beetle (digu) or ephedra (mahuang). Alisma (zexie) should not be combined with sea clam (haige) or ark shell (wenge). Chinese yam (shuyu, also called shanyao) pairs well with purple fungus (zizhi), but should not be combined with kansui (gansui).

Polygala root (yuanzhi) pairs well with poria (fuling), cold-green seed (dongkuizi), and dragon bone (longgu), but should not be combined with aconite (tianxiong), prepared aconite (fuzi), pearl (zhenzhu), cockroach (feilian), veratrum (lilu), or qi clam (qige). Chrysanthemum (juhua) pairs well with atractylodes (zhu), and also with lycium root (gouqi gen) and mulberry root bark (sangen baipi). Ginseng (renshen) pairs well with poria (fuling), but should not be combined with shaosou (shaosou) or veratrum (lilu). Licorice (gancao) pairs well with atractylodes (zhu), dried lacquer (ganqi), and sophora root (kushen), but should not be combined with polygala root (yuanzhi), kansui (gansui), greater euphorbia (daji), daphne flower (yuanhua), or sea algae (haizao).

Dendrobium (shihu) pairs well with lu ying, but should not be combined with ningshuishi, croton seed (badou), white silkworm (baijiangcan), or thunder fungus (leiwan). Achyranthes root (niuxi) pairs well with firefly (yinghuo) and turtle shell (guijia), but should not be combined with lu ying or baiqian. Angelica pubescens (duhuo) pairs well with ligustrum fruit (lishi). Bupleurum root (chaihu) pairs well with pinellia (banxia), but should not be combined with gleditsia pod (zaojia), aster (ziwan), or veratrum (lilu). Asarum (xixin) pairs well with zengqing and jujube root (zaogen), but should not be combined with wolfsbane (langdu), cornus fruit (shanzhuyu), astragalus (huangqi), talc (huashi), saltpeter (xiaoshi), or veratrum (lilu).

Cassia seed (ancai, also written aiqi) pairs well with chaste tree seed (jingzi) and coix seed (yiyiren), but should not be combined with asarum (xixin) or dried ginger (ganjiang). Cassia seed (ximing, also called jueming) pairs well with chaste tree seed (jingzi) and asarum (xixin), but should not be combined with dried ginger (ganjiang) or sophora root (kushen). Gentian (longdan) pairs well with cinnamon fern rhizome (guanzhong), but should not be combined with fangkui or rehmannia (dihuang). Dodder seed (tusizi) is best taken mixed with wine. It pairs well with Chinese yam (shuyu) and pine resin (songzhi), but should not be combined with fungus (guan jun). Morinda root (bajitian) pairs well with raspberry (fupenzi), but should not be combined with a plant listed as chaosheng, thunder fungus (leiwan), and salvia (danshen).

Tribulus fruit (jilizi) pairs well with aconite (wutou). Saposhnikovia root (fangfeng) pairs well with dried ginger (ganjiang), but should not be combined with veratrum (lilu), ampelopsis (bailian), daphne flower (yuanhua), or prepared aconite (fuzi). Adenophora root (shashen) pairs well with stephania (fangji), but should not be combined with veratrum (lilu). Trachelospermum (luoshi) pairs well with eucommia (duzhong) and peony (mudan), but should not be combined with iron filings (tieluo), calamus (changpu), or fritillaria (beimu). Salvia (danshen) pairs well with salt water, but should not be combined with veratrum (lilu). Tianmingjing pairs well with yuan yi (a wall moss). Cassia seed (juemingzi) pairs well with cassia seed (shishi), but should not be combined with hemp seed (damazi).

Coptis (huanglian) pairs well with scutellaria (huangqin), dragon bone (longgu), and li stone, but should not be combined with chrysanthemum (juhua), daphne flower (yuanhua), scrophularia (xuanshen), or dictamnus bark (baixianpi). It has a restraining relationship with tussilago (kuandong), aconite (wutou), and croton seed (badou).

This paragraph mainly lists the relationships in which medicinals should be used together or avoided when combined. Shi refers to an auxiliary drug in a formula, de ... liang means the combination with the listed drug is beneficial, and characters such as wei ("fear") and du ("toxicity") indicate interactions that require attention. Because the original text has missing characters, unclear punctuation, and variant drug names, some individual names and relationships can only be rendered based on the surviving text.

Ligusticum (possibly referring to chuanxiong), which uses baizhi as its adjuvant. Xuduan, which uses dihuang as its adjuvant and should not be used together with leiwan. Huangqi, which should not be used together with guijia. Duruo, which pairs well with xinyi.

Shechuangzi should not be used together with mudan, badou, or beimu. Qiangen should not be used together with shugu. Feilian pairs well with wutou and should not be used together with mahuang. Weixian pairs well with qinpi. Wuweizi uses roujungrong as its adjuvant and should not be used together with weirui or wutou.

Middle Herbs

Danggui should not be used together with jianru, changpu, haizao, or mumeng. Qinjiao uses changpu as its adjuvant. Huangqin uses shanzhuyu and longgu as adjuvants and should not be used together with congshi, danshi, mudan, or lilu.

Gaoben should not be used together with jianru. Mahuang uses houpu as its adjuvant and should not be used together with xinyi or shiwei. Ganjiang uses qinjiao as its adjuvant and should not be used together with huanglian, huangqin, tianshufen, banxia, or langdang, which are toxic when combined with ganjiang.

Gegen should not be used together with yegen, badou, or any of the poisons of the hundred herbs. Qianhu uses banxia as its adjuvant and should not be used together with zaojia or lilu. Shaoyao uses leiwan as its adjuvant and should not be used together with shihu, mangxiao, xiaoshi, bieijia, xiaoji, or lilu.

Beimu uses houpu and baiwei as adjuvants and should not be used together with taohua, qincai, langshi, mangcao, or wutou. Xuanshen should not be used together with huangqi, ganjiang, dazao, shanzhuyu, or lilu. Shiwei pairs well with huacai and should not be used together with huashi.

Kuolou uses gouqi as its adjuvant and should not be used together with ganjiang, niuxi, ganqi, or wutou. Gouji uses bixie as its adjuvant and should not be used together with baijiang. Kushen uses xuanshen as its adjuvant and should not be used together with beimu, loulu, tusizi, or lilu.

Qumai uses bangcao and mudan as adjuvants and should not be used together with sangpiaoxiao. Baizhi uses danggui as its adjuvant and should not be used together with xuanfuhua. Shiluorui is antagonized by snake slough and should not be used together with wuzhuyu. Baixianpi should not be used together with sangpiaoxiao, jiegeng, fuling, or bixie.

Bixie uses yiyi as its adjuvant and should not be used together with kuijiagen, dahuang, chaihu, muli, or qianhu. Ziseng should not be used together with xinyi. Xianlingpi should not be used together with shuyu.

The phrase "as adjuvant" (wei shi) indicates use as a supporting herb in a formula. "Pairs well with" (de…liang) indicates good compatibility with a given herb. "Is antagonized by" (wei) indicates mutual antagonism of properties. "Should not be used together with" (bu yi tong yong) indicates incompatibilities as listed in the source. The original contains line breaks and apparent textual errors, and some herb names and bracketed relationships cannot be determined from this passage alone, so this translation follows the surviving text.

Zi Wan (aster root) uses coltsfoot flower (kuandonghua) as its envoy herb (shiyao). Aster is incompatible (xiang'e) with tianxiong (aconite) and qumai (dianthus), but is constrained by (xiangwei) leiwan (omphalia) and yuanzhi (polygala root), and yinchen (artemisia) can restrain it. Fangji (stephania root) uses yinnie as its envoy herb and is incompatible with xixin (asarum).

Tree peony is incompatible with tusizi (dodder seed). Baiwei (cynanchum) is incompatible with huangqi (astragalus), dahuang (rhubarb), daji (euphorbia root), ganjiang (dried ginger), ganqi (lacquer resin), and dazao (jujube). Cornus fruit is incompatible with coltsfoot flower.

Coltsfoot flower uses apricot kernel as its envoy herb and pairs well with aster. It is incompatible with zaojia (gleditsia pod), xiaoshi (saltpeter), xuanshen (scrophularia), beimu (fritillaria), xinyi (magnolia flower), mahuang (ephedra), huangqin (scutellaria), huanglian (coptis), huangqi (astragalus), and qingxiang (celosia seed). Nüwan (aster) is incompatible with luxian (bittern). Zelan (eupatorium) uses fangji as its envoy herb. Diyu (burnet root) pairs well with human hair but is incompatible with maidong (ophiopogon). Haizao (seaweed) is incompatible with licorice.

Lower Herbs

Rhubarb uses huangqin as its envoy herb. Jiegeng (platycodon) uses its nodes and bark as its envoy, and is incompatible with baiji (bletilla), longdan (gentian), and longyan (longan). Tingli (draba seed) uses elm bark as its envoy and pairs well with wine, but is incompatible with jiangcan (silkworm) and shilongrui (ranunculus).

Gansui (kansui) uses melon stalk as its envoy and is incompatible with yuanzhi and licorice. Yuanhua (daphne flower) uses jueming (cassia seed) as its envoy and is incompatible with licorice. Zeqi (euphorbia herb) uses adzuki bean as its envoy and is incompatible with shuyu (yam). Daji is incompatible with licorice. Gouwen (gelsemium) uses banxia (pinellia) as its envoy and is incompatible with huangqin.

Lilu (veratrum) uses huanglian as its envoy and is incompatible with xixin, peony root, wushen (five-leaf ginseng), and rhubarb. Tianxiong uses yuanzhi as its envoy and is incompatible with fubei (rotten maid herb). Wutou and wuhui (aconite) use mangcao (illicium) as their envoy and are incompatible with banxia, gualou (trichosanthes), beimu, bailian (ampelopsis), baiji, and lilu.

Guanzhong (cyrtomium fern) uses guanjun (a fungus) as its envoy. Huzhang (tiger's paw) uses shuqi (dichroa) as its envoy and is incompatible with mangcao. Fuzi (aconite root) uses didan (blister beetle) as its envoy and is incompatible with wugong (centipede), fangfeng (saposhnikovia), licorice, huangqi, ginseng, wujiu (fern), and soybean. Shuqi uses gualou as its envoy and is incompatible with guanzhong. Hengshan is incompatible with yuzha.

Banxia uses shegan (belamcanda) as its envoy and is incompatible with zaojia, xiongheng (realgar), fresh and dried ginger, qinpi (ash bark), turtle shell, and wutou. Lang'ya (wild rice) uses wuyi (elm seed) as its envoy and is incompatible with qinjiao (gentiana) and diyu. Bailian (ampelopsis) uses daizhe (red ochre) as its envoy and is incompatible with wutou. Baiji uses zishiying (purple fluorite) as its envoy and is incompatible with lishi (a mineral), plum kernel, and apricot kernel. Guanjun pairs well with wine and is incompatible with chicken egg. Xiaoru is incompatible with licorice.

Here "envoy" (shiyao) refers to a herb that assists the principal herb in a traditional formula. "Incompatible" (xiang'e) means that combining the herbs may weaken their effect, while "constrained by" (xiangwei) means that one herb may be restrained by another. "Pairs well with wine" means the herb works better when taken with wine. Some herb names and annotations in the original are incomplete, so the above follows the surviving text as it reads.

Upper Section of Wood-Category Drugs (listed as superior grade)

Fuling (Poria) and fushen (Poria with pine root) are paired with maling (Iris lactea) as envoy (shi), and are compatible with bailian (Ampelopsis), mumeng, diyu (burnet root), xionghuang (realgar), qinjiao (gentian root), and guijia (tortoise shell). Baiziren (cypress seed kernel) is also listed here.

Duzhong (eucommia bark) is paired with muli (oyster shell), guixin (cinnamon bark), and guazi (melon seed) as envoy; it is compatible with juhua (chrysanthemum), yangti (sorrel), and the various mineral drugs, as well as with flour and yeast. Xuanshen (scrophularia) is paired with shetui (snake slough), and ganqi (dried lacquer) with banxia (pinellia).

Manjingzi (vitex fruit) is paired with jizi (egg) as envoy and is incompatible with wutou (aconite). Muojing shi (chaste tree fruit) is paired with fangfeng (saposhnikovia) as envoy and is compatible with shigao (gypsum). Wujiapi (acanthopanax bark) is paired with yuanzhi (polygala) as envoy; shetui and xuanshen constrain it. Huangbai (phellodendron) is paired with ganqi. Xinyi (magnolia flower) is paired with chuanxiong (ligusticum) as envoy and is compatible with the five mineral fats (wushizhi). Huanglian (coptis), shigao, and huanghuan are paired with changpu (acorus) and pujhuang (cattail pollen). Suanzaoren (sour jujube seed) is paired with fangji (stephania). Huaizi (sophora seed) is paired with tianxiong (ephedra root) and jingtian (sedum) as envoys.

Middle Section of Wood-Category Drugs (listed as medium grade)

Houpo (magnolia bark) is paired with ganjiang (dried ginger) as envoy and is compatible with zexie (alisma), hanshuishi (cold water stone), and xiaoshi (mirabilite). Shanzhuyu (cornus fruit) is paired with liaoshi (polygonum fruit) as envoy and is compatible with jiegeng (platycodon), fangfeng, and fangji. Wuzhuyu (evodia fruit) is paired with liaoshi as envoy and is compatible with danshen (salvia), xiaoshi, baiyue (chalk), and zishiying (purple fluorite). Qinpi (ash bark) is paired with dagi (euphorbia root) as envoy and is compatible with wuzhuyu. Zhanssi is paired with langdu (aconite root). Zhizi (gardenia) is paired with zhuchuo (rhododendron). Qinjiao (Sichuan pepper) is compatible with gualou (trichosanthes), fangkui (saposhnikovia root), and xiongqing (realgar), and it is paired with them. Sangen baipi (mulberry root bark) is paired with xuduan (dipsacus), guixin, and mazi (hemp seed) as envoys.

Lower Section of Wood-Category Drugs (listed as inferior grade)

Huanghuan is paired with yuanwei (iris) as envoy and is compatible with fuling and fangji. Shinan is paired with wujiapi as envoy. Badou is paired with yuanhua (daphne flower) as envoy and is incompatible with ranghui (a plant name), dahuang (rhubarb), huanglian, lilu (veratrum), and banmao (blister beetle). Shujiao is paired with xingren (apricot kernel) as envoy and is compatible with kuandong (tussilago). [One drug name in the original is illegible; its envoy is listed as louhua.] Luanhua is paired with juemingzi (cassia seed) as envoy. Leiwan (lei pill fungus) is paired with lizhi (litchi) and houpo as envoys and is compatible with gegen (kudzu). Zaojia (gleditsia pod) is paired with baiziren as envoy; it is compatible with maimendong (ophiopogon) and with kongqing (azurite), renshen (ginseng), and kushen (sophora root).

Upper Section of Animal-Category Drugs

The original text ends here, with only this heading listed. No entries follow.

Longgu (dragon bone, fossils of dragon-type animals or bone-based medicinals) pairs well with ginseng and cattle bezoar (niuhuang), and suits gypsum. Longjiao (dragon horn, a class of dragon-derived medicinals) is paired with dried lacquer, Sichuan pepper, and lishi. Cattle bezoar pairs with ginseng, which serves as the shiyao (assistant drug, a substance that supports the action of the principal drug).

Longgu pairs with rehmannia, gentian, cockroach, and achyranthes. Baijiao (animal hide glue, a class of skin-derived medicinals) is best prepared by heating and is paired with rhubarb. Ejiao (donkey-hide glue) is likewise best prepared by heating and is paired with rhubarb.

Beast Class, Middle Grade

Rhinoceros horn uses pine resin as its shiyao and is paired with guanjun and thunder fungus (leiwan). Goat horn (the horn of a male goat) uses dodder seed as its shiyao. Deer antler (the young antler of a deer) uses hemp flower buds (mabo) as its shiyao.

Deer horn uses eucommia bark as its shiyao.

Beast Class, Lower Grade

Musk deer fat (fat from the musk deer) is paired with rhubarb and licorice.

Insect and Fish Class, Upper Grade

Beeswax is paired with daphne flower. The name qigé ("equal clam") is also a related drug name in this pairing. Bee larva (the larva or pupa of bees) is paired with scutellaria, peony root, and oyster shell. Oyster shell uses fritillary bulb as its shiyao and is paired with licorice and achyranthes.

Polygala root and cnidium seed pair well with these drugs. Ephedra, evodia fruit, and magnolia flower are also listed among the pairing relationships. Mantis egg case (the egg sac of the praying mantis) is paired with inula flower. Sea clam (a clam-type medicinal) uses dichroa leaf as its shiyao, and is also associated with the drugs listed after the character "dog."

Gallbladder, Gansui (kansui root), and daphne flower form one pairing group. Tortoise shell (the dorsal shell of the turtle) is paired with glehnia root and cockroach.

Insect and Fish Class, Middle Grade

Bat (the flying mouse) uses amaranth seed and cloudy-fruit (yunshi) as its shiyao. Hedgehog skin (the skin of the hedgehog) works best prepared with wine and is paired with platycodon and ophiopogon. Skink (lizard) is paired with sulfur and is listed alongside spotted beetle and wutou.

Lu feng fang (wasp nest, the nest of bees) is paired with dried ginger, salvia, scutellaria, peony root, and oyster shell. Ground beetle (the ground-dwelling beetle) is paired with gleditsia pod and acorus. Grub (the larva of the scarab beetle) uses cockroach as its shiyao and is paired with aconite.

Turtle-like fish shell (the shell of a fish) uses dichroa leaf as its shiyao and is listed alongside dog gallbladder, Gansui, and daphne flower. Turtle shell (the soft-shelled turtle's plastron) is paired with alum stone.

Cuttlefish bone is paired with ampelopsis and bletilla. Crab is paired with henbane and toxic lacquer. Heavenly rat droppings (bat droppings) are paired with ampelopsis and cynanchum.

Insect and Fish Class, Lower Grade

Snake slough (the skin shed by a snake) is paired with magnetite and is also listed with wine. Mantis (the praying mantis) is paired with goat horn and gypsum. Spotted beetle uses horse-blade (madao) as its shiyao and is paired with croton seed, salvia, azurite, and fuqing.

Ground beetle (didan) is paired with licorice. Horse-blade (a shellfish medicinal) works best with water.

Fruit Class, Upper Grade

Jujube is toxic when used together with aconite.

Fruit Class, Lower Grade

Apricot kernel works best when prepared by heating. It is paired with astragalus, scutellaria, and kudzu root, and is also used to counteract the toxicity of tin and white powder, and is listed alongside mamaku.

Vegetable Class, Upper Grade

Winter mallow seed uses scutellaria as its shiyao.

Vegetable Class, Middle Grade

This passage mainly lists the pairing relationships among various medicinals and which drugs may serve as shiyao. Some drug names in parentheses are unclear because of copying errors, punctuation, or layout problems in the original text, so their relationships cannot be fully determined. The above follows the existing text as closely as possible, preserving the original order of the listings.

Scallion seed (the seed of the scallion), which can counteract the poison of veratrum (lilu).

Listed under the "upper section of grains" are hemp seed (mafen) and hemp kernel (mazi), which relate to oyster shell (muli), Baiwei, and Poria (fuling).

Listed under the "middle section of grains" are soybean and yellowed soybean sprouts (dadou ji huangjuan), which may be paired with the five shen herbs and gentian for Qianhu and Wuhui, and apricot kernel and oyster shell are highly effective against aconite (wutou) poison, as well as barley. Honey may serve as an shi (envoy), a substance that guides or assists the action of other medicines. Soy paste (jiang) can counteract medicinal and fire toxins.

In all, these 197 items record the substances that have restraining or complementary relationships with one another. Those without such relationships are not recorded one by one.

Someone asked: "The ancients used few medicines and light dosages, yet they cured many illnesses. Your prescriptions are not simple, and your doses are large, yet the results are inferior to those of the ancients. Why is this?"

The answer was: "The ancient era lies far in the past, so medicinals had a long time to grow and mature in the soil, and their natures were genuine. The common people had few desires and received balanced vital energy (yuan qi), so when they fell ill, the illness was mild and easy to treat. Today the times are short, the potency of medicines is thin and weak, and people are mostly clever and deceitful, so the pathogenic influences they suffer are deep and difficult to treat. When the illness is light, medicine should be used sparingly; when it is heavy, medicine must be used in greater amounts. This is only one aspect of the medical art. What is there to find strange in it?

"Furthermore, the physicians of antiquity gathered their own herbs, and both shade-drying and sun-drying were carried out according to proper procedure. They also always followed local conditions in using medicines, so that of ten patients treated, nine might respond. Today's physicians merely know how to take the pulse and write prescriptions, but they do not understand the seasons for gathering herbs. As for the places of origin, the qualities of the soil, the freshness or age of the materials, and their genuine or deficient qualities, they know nothing. Hence, of ten patients treated, five or six cannot be cured at all. This is indeed the reason. Those who write prescriptions ought to apply their minds constantly, weighing and reconsidering the use of each medicine, so that the medicines can exert their power. If one merely imitates the methods of the ancients, one will instead harm oneself. Later learners must carefully understand and commit these principles to memory."

Purple fluorite (zi shiying), white fluorite (bai shiying), cinnabar (zhusha), realgar (xiongzhuang), sulfur (liuhuang), and similar minerals should all be chosen for being bright and translucent, with clear, vivid coloration, distinct texture, and clean surfaces. If they are not like this, taking them will cause the body to become dry, feverish, and thirsty, and may even lead to death.

Both herbal and mineral medicines should be chosen from places with firm soil and with strong, pungent aroma. Otherwise, the treatment will not be effective.

For langdu (Stellera), zhishi (immature bitter orange), orange peel, banxia (pinellia), mahuang (ephedra), and wuzhuyu (evodia), aged storage is preferred. For the remaining medicines, fine and fresh material should be selected.

On Compounding and Harmonizing, Seventh (a treatise on the preparation of medicines, seventh chapter)

Someone asked: "When preparing decoctions to treat various illnesses, how much water should be used for herbal, mineral, insect, and animal medicines, how should they be simmered and processed, and what methods should be followed?"

The answer was: "Herbal medicines have roots, stems, branches, leaves, bark……"

Some medicinal substances use flowers, fruits, or insects, including those that are hairy, winged, or shelled, and those with heads, legs, tails, or bones. These materials must be roasted and processed according to prescribed methods, and whether they are used raw or prepared also follows set rules. Following the formula in preparing a remedy brings benefit, while departing from it may bring harm. Some materials require the skin to be removed and the flesh kept, while others require the flesh to be taken. Some call for the rhizome, and others for the flowers or fruit. Each should be handled according to the formula so that it is clean, then measured accurately in sheng, ge, weight, and liang, with no errors.

Medicinal substances can generate or overcome one another, and their potency varies in strength. Sovereign, minister, assistant, and envoy substances each have roles of coordination and restraint. Without broad familiarity with the various medical classics, one cannot know which substances are suitable and which are contraindicated. If a physician adds to or subtracts from the doses on personal judgment, disregarding the quantities specified in the formula, the strengths of herbal and mineral substances may come into conflict. Once taken, such substances may not cure the illness but may instead struggle against and overcome one another, causing confusion of the mind. When their natures conflict severely, they may be as harmful as a blade. If the combination is appropriate, then even if the illness is not cured, at least the five viscera will be harmonized and the condition will not worsen.

In general, the formulas in the medical classics explain the methods of decocting and preparing the substances in their commentaries. This chapter does not follow that approach. Instead, it sets out the relevant rules together and does not separately annotate them under each formula. Substances must first be selected, then processed through decocting, roasting, and similar treatments, and only afterward weighed for medicinal use. They must not be weighed without processing.

For all mineral substances and jade, they should be crushed to the size of grains of rice, wrapped in fine cloth, and placed into decoctions or wine. Minerals such as stalactite must be ground with water in a jade pestle for three days and three nights, then washed, refined, and ground until extremely fine.

Silver filings must be mixed with mercury into a paste. Arsenopyrite must be wrapped in red clay, placed in a fire, and roasted for half a day. It may be used only after roasting, but it must not be roasted excessively. Unrefined arsenopyrite taken directly as medicine will injure the heart and liver.

Raw mirabilite and alum stone must be roasted until all their liquid is completely exhausted before they are used in pills or powders. When mangxiao and raw mirabilite are used in decoctions, first extract their liquid, then add that liquid to the medicinal broth and heat it, bringing it to a boil two or three times, and take it only after the substances have dissolved.

When cinnabar or realgar is used in a decoction, these should first be ground into a fine powder, and then stirred into the broth just before it is taken and swallowed.

When whole pieces of medicinal material are used in a decoction, they should first be broken apart, as with dried jujube and gardenia. Materials with small kernels should also be crushed, such as cornus fruit, schisandra, rui kernels, and cassia seed. Materials with small flowers or seeds may be used whole, such as inula flower, chrysanthemum, kochia fruit, and mallow seed. Grains, wheat, and beans are likewise used whole.

Tangerine peel, evodia fruit, and Sichuan pepper, when added to a decoction, are not cut finely or pounded. (Jufu refers to cutting medicinal materials into coarse pieces or roughly pounding them.)

All kinds of fruits and seed kernels used in medicine should have their tips and any double kernels removed. Rub them with hot water to strip the outer skin, then chop them finely. When using gardenia (zhizi), peel it first. When using cattail pollen (puhuang), add it only after the decoction has been brewed.

When ophiopogon root (maimendong) and fresh ginger are used in decoctions, chop both finely, pound them three times, and squeeze out the juice. After the decoction is ready, remove the dregs first, then pour the liquid back in and boil it five or six times. Measure the amount of liquid as originally specified, and do not boil these with the other herbs. Alternatively, they may be cut into thin slices and used.

Ophiopogon root should be lightly moistened, and then its central core removed.

Ephedra (mahuang) must have its nodes removed. Boil it alone for two or three rolling boils, skimming off the foam. Then add water to the originally specified volume and put in the other herbs. If this is not done, taking the preparation will cause restlessness. Herbs must be cut into pieces: Polygala root (xiaocao) and dianthus (qumai) should be cut to about five fen in size, and asarum (xixin) and cynanchum (baiqian) to about three fen. Herbs used in paste preparations must be ground very fine.

Achyranthes (niuxi), dendrobium (shihu), and other herbs used in decoctions or medicinal wines should be crushed before use. When dendrobium is made into pills or powders, first pound it vigorously with a pestle until broken, then grind it in a mortar. Otherwise it is difficult to pulverize. The same applies when it is processed with wine.

For cinnamon bark, magnolia bark (houpo), eucommia (duzhong), phellodendron bark (qinpi), and magnolia flower (mulan), shave off the soft, coarse outer layers and weigh only the inner portion that carries the medicinal flavor. Poria (fuling) and Polyporus (zhuling) should have their black skin scraped off. Peony root bark (mudan), morinda root (bajitian), polygala root (yuanzhi), and wild aconite-like root (yege) should be crushed and have their cores removed. Aster root (ziwan) should be washed free of soil, dried in the sun, and then weighed. The white part of allium bulbs (xiebai) and the green part of scallion (congbai) should be removed. For mangrove-like herb (mangcao), stone yew (shinan), and flowering rush (yinyu), and lycopus (zelan), use only the leaves and tender stems, and discard the coarse branches. For the rhizome of mayapple (guijiu) and coptis (huanglian), remove all the root hairs. For the fern Pyrrosia (shiwei) and magnolia flower, rub off the fuzz; magnolia flower must also have its core removed. Sichuan pepper (shujiao) should have its closed fruits and fruit stalks removed. Jujubes and smoked plums (wumei) should both be pitted. For the "ghost arrow" (guijian), shave off the feathery bark.

For tonifying herbs such as poria and peony root, choose the white varieties; for purgative herbs, choose the red varieties.

Dodder seed (tusizi) should be rinsed in warm water to remove sand and grit, drained, and then soaked in warm wine overnight. After it is taken out, dry it in the sun until it is slightly whitened, then pound it. If some of it remains unbroken, soak it again in wine for three to five days, remove it, dry it lightly, and pound it once more. In this way it will soon be fully crushed and will break up easily.

Licorice, magnolia bark, bitter orange (zhishi), stone yew, flowering rush, veratrum (lilu), and honey locust pod (zaojiao) should all be prepared by roasting. For bitter orange, remove the pith; for veratrum, remove the head; for honey locust pod, remove the skin and seeds.

Sichuan pepper should be stir-fried lightly until it sweats, so that its medicinal potency is released.

When Chinese monkshood (tianxiong), aconite (fuzi), wolfsbane (wutou), wuhui, or lateral aconite (ceze) are used in decoctions, pills, or powders, they must be treated with hot ash (yan)... [The original text breaks off here at this point, and the complete procedure is not given.]

Process the medicinal materials over low ash-fire (huihuo) until they begin to crack slightly, then scrape off the black skin and weigh them. Only the materials in the ginger-aconite decoction (jiangfu tang, a formula built mainly on fresh ginger and aconite) and in ointments and wine may be used raw. Even these must have their outer skin removed and be weighed, then sliced along the grain into seven or eight pieces.

Banxia (pinellia) should be washed in hot water to remove the slippery film on its surface, washed ten times (some texts say four), cut into four pieces, and then weighed. When banxia is used in decoctions, it is prepared this way. When it is used in ointments, wine, pills, or powders, it is processed over ash-fire instead.

Croton seeds (badou) should have their skins, hearts, and membranes removed, then be simmered until purple. Ingredients rich in oil, such as peach kernels, apricot kernels, tingli (Descurainia seed), and sesame, should be simmered until yellowish-black, then each pounded into a paste. Spread the paste with the fingers until it is smooth and fine-grained with no visible particles. Then gradually add the powders prepared earlier into a mortar, grinding as you add them so they blend together. Afterward, sift everything through a thin silk sieve, making sure nothing is left behind. Return the material to the mortar and pound it several hundred times. Even if some ingredients in decoctions, ointments, or wines are meant to be used raw, they should still be crushed beforehand.

Wheat malt, leaven powder (qu mo), sprouted soybean (dadou huangjuan), Eupatorium (zelan), and elm seed (wuyi) should all be lightly stir-fried until dry. Dried lacquer (ganqi) should be stir-fried until it no longer smokes. Smoked plums (wumei), when used in pills or powders, must be simmered. Processed mugwort (shu ai) should be stir-fried first, then finely separated and pounded together with the other ingredients into a fine powder. Materials that cannot be sieved should be mixed evenly into the powder.

Feathers, hair, teeth, tusks, hooves, and shells, as well as the shells, skins, flesh, bones, horns, and sinews of turtles, soft-shelled turtles, and pangolins, along with deer antler and similar items, should all be roasted. Snake slough should be lightly roasted.

Insects such as blister beetles (banmao) should have their wings and legs removed, then be lightly simmered. Mantis egg cases (sangpiaoxiao) should be split open and roasted. Oyster shell should be simmered until yellow. Silkworms that died of white muscardine (jiangcan) and wasp nests (fengfang) should be lightly stir-fried.

When musk, rhinoceros horn, deer antler, antelope horn, or bezoar (niuhuang) is used in a decoction, each must first be ground into powder. Just before taking the medicine, stir the powder into the decoction until evenly mixed, then drink it.

When glue is used in pills or powders, it must first be roasted until it bubbles all over and dries, and only then pounded into pieces. If any part fails to bubble, roast it again. Glue used in decoctions is used directly without roasting. When ejiao (donkey-hide gelatin) is used in a decoction, first cook the decoction, then add the ejiao to the liquid and reheat it until it boils two or three times so that it dissolves.

When making pills with honey, first heat the honey and skim off the foam, then simmer it until it turns faintly yellow. Pills made this way keep longer and are less likely to spoil. How much foam to skim depends on the quality of the honey, and the thicker the honey is cooked, the better it suits pill-making.

When wax is used in pills, first melt the wax, then pour it into a small amount of honey and stir until blended, and use this mixture to bind the medicine.

When maltose syrup (yitang) is used in a decoction, add it only after the decoction has been fully cooked. When wine is used in a decoction, add it only when the medicine is nearly finished cooking.

Medicinals are suited to different preparations. Some are made into pills (wanji), some ground into powders (sanji), some decocted into soups (tangji), some steeped in wine (jiu), and some boiled into pastes (gaoji). Some can be prepared in several ways, while others cannot go into decoctions or wine infusions. Each should be handled according to its nature, and this must not be violated. Below are the substances that should not be made into decoctions or steeped in wine. Those marked "ru jiu" (enters wine) may be processed with wine.

Minerals, seventeen in all: zhusha (cinnabar, ru jiu after preparation), cihuang (orpiment), yunmu (mica), yangqishi (actinolite, ru jiu), fanshi (alum, ru jiu), liuhuang (sulfur, ru jiu), zhongru (stalactite, ru jiu), kong gong nie (ru jiu), yushi (arsenic-bearing stone, ru jiu), yinxie (silver filings), baie (chalk), tongjingbi, hufen (lead white), qiandan (red lead), luxian (brine salt, ru jiu), shihui (lime, ru jiu), and lihui (goosefoot ash).

Plants, forty-eight in all: yege (wild kudzu), langdu (wolfsbane), gonggong, guijiu (mayapple rhizome), mangcao, shuodiao (ru jiu), badou (croton seed), zhizhu (azalea, ru jiu), zaojia (honey locust pod, ru jiu), guanjun, lilu (false hellebore), a rare herb whose name I cannot reliably romanize, guanzhong (shieldfern rhizome, ru jiu), wuyi, leiwan, langya, yuanwei (iris), jili (caltrop, ru jiu), nüwan, xier, ziwei (ru jiu), weixian (ru jiu), baiji, mumeng, feilian, shexian, zhansi, xinyi (magnolia flower), shinan (ru jiu), lianshi (chinaberry fruit), huzhang (only steeped alone in wine), huzhang (tuber of Arisaema), xugen, yangtao (ru jiu), mabo (hemp flower tops), kuhu (bitter gourd), guadi (melon stem), zhili, langbazi (ru jiu), yunshi, huaizi (pagoda tree seed, ru jiu), difuzi, shechuangzi (cnidium seed, ru jiu), qingxiangzi, chongweizi, wangbuliuxing, ximingzi, and tusizi (dodder seed, ru jiu).

Animals: fengzi (bee larvae), mila (beeswax), baimajing (white horse penis), gouyin (dog genitalia), queluan (sparrow eggs), jizi (hen's eggs), xiongque (male magpie), fuyi (bat), shufu (woodlouse), chuji, yinghuo (firefly), yeweng (in some old editions the first character of this name appears as a blank), jiangcan (silkworm dried after death from fungus), wugong (centipede), xiyi (lizard), banmao (blister beetle), yuanqing (blister beetle), tingzhang, shedan (snake gall), mengchong (gadfly larva), and feilian (cockroach).

Earthworm mole cricket (gegu), ma dao clam (madao, a shellfish), and zhe kui tuber (zhekui, a tuberous medicinal); toad (hama), hedgehog skin (weipi), and live mice; live turtles (steeped in wine), snails, and various birds and beasts (steeped in wine).

Fats extracted from insects and fishes (gaozhi), as well as bones, marrow, gall, blood, feces, and urine.

Altogether, there are twenty-nine kinds of insect and animal medicines listed above.

In ancient times, the balance scale had only the zhu and the liang as units, with no unit called fen. Today, ten shu (millet grains) make one zhu, six zhu make one fen, four fen make one liang, and sixteen liang make one jin. This is the Shennong system of weights. People of the Wu region treated two liang as one liang, while people of the Sui dynasty treated three liang as one liang. The current standard, which takes four fen as one liang, is adopted for prescriptions.

Prescription books use the term "equal portions" (dengfen). When making pills or powders, this means that the amount of each ingredient is determined by the severity of the illness, and there is no fixed weight in zhu or liang. To say that three or five ingredients are used in "equal portions" means that each has the same quantity as the others. When pill and powder formulas list a number of fen or liang, they indicate how much of each ingredient to use, but the medicine need not be measured strictly by those figures. For example, a formula may direct taking three square-inch spoonfuls (fangcun bi, a dose measured with a spoon one inch square) per day until the illness is cured, and the total amount of medicine used may be no more than three to five liang.

Powder formulas mention the "one daogui," which is roughly one-tenth of a fangcun bi and about the size of one wutong seed (Chinese parasol tree seed). A fangcun bi is a one-inch square spoon, and the dose is judged by whether the powder stays on the spoon without falling off. A "coin spoon" (qian bi) is a dose taken by filling a spoon level with a large coin. A "half-coin spoon" (ban qian bi) is taken with a single coin, scooping only the portion on one side, and the coin used is a five-zhu coin. A "five-coin spoon" (qian wu bi) is taken using the edge of a five-zhu coin marked with the character for "five," again judged by whether the powder stays on the spoon.

One cuo equals four daogui. Ten cuo make one shao (ladle), and two shao make one ge (a unit of volume). When powdered medicine is measured by volume using a sheng (a unit of volume), it is because the ingredients differ in weight and density, making weighing by jin and liang inconvenient, so measuring by volume is used instead. The medicine sheng has an opening one inch in diameter, a base six fen in diameter, and a depth of eight fen. Place the powder into the sheng without pressing it down; simply shake it gently so the surface is level. Once the doses have been measured in this way, it is no longer necessary to use this measuring vessel.

When pills are described as "like fine hemp," this means they should be about the size of a sesame seed. They do not need to be flattened; it is enough that their size is roughly consistent. "Like millet or foxtail millet" has the same meaning. Sixteen millet grains together roughly equal one soybean. "Like hemp seed" refers to today's hemp seed, which is about the size of three fine hemp grains. "Like broad bean" refers to today's mottled broad bean, and by two grains of the large……

Using hemp seeds (the seeds of the hemp plant) as a comparison: those about the size of small beans are what is now called red adzuki beans, and they vary in size. Three hemp seeds are roughly the size of one soybean, and two small beans are roughly the size of one soybean. Those about the size of wutong seeds are compared with two soybeans.

A fangcun spoon (an ancient measure for powdered medicines, in which one bi held about one fangcun of volume) is filled with powdered medicine and mixed with honey into pills the size of wutong seeds, with ten pills as the standard. If the pills are the size of a pellet or an egg yolk, ten wutong seeds serve as the comparison.

Where a formula calls for a certain number of croton seeds (ba dou), the count must be adjusted for differences in size: the seeds should first have their hearts and skins removed before weighing, and one fen corresponds to about sixteen seeds. Where a formula calls for a certain number of aconite roots (fuzi) or wutou, the roots are weighed after peeling, with half a liang taken as roughly one root. For a given number of immature bitter oranges (zhishi), after removing the pulp, one fen corresponds to about two fruits. One fen of dried tangerine peel corresponds to about three pieces. Jujubes vary in size, and three are taken as about one liang. Where a formula calls for "one lei" of dried ginger, it is reckoned at half a liang, whereas the Materia Medica (Bencao) reckons it at one liang.

Where a formula calls for one sheng of pinellia (banxia), it is measured at five liang after washing; one sheng of Sichuan pepper (huajiao) is reckoned at three liang; one sheng of evodia fruit (wuzhuyu) at five liang; one sheng of dodder seed (tusizi) at nine liang; one sheng of anlu seed at four liang; one sheng of cnidium fruit (chuangsheng zi) at three and a half liang; and one sheng of kochia fruit (difu zi) at four liang. The weights of different medicinals are not the same. When a formula gives only a volume of seeds in sheng, the seeds differ in density and weight, so they cannot be converted uniformly by weight; the measure should be a level sheng.

Where a formula calls for one chi of cinnamon, the standard is half a liang after the outer bark is removed; one chi of licorice is reckoned at two liang. A bundle of a certain herb is reckoned at three liang, and a handful at two liang.

Where a formula calls for one jin of honey, it is about seven ge; one jin of lard is about one sheng and two ge.

In earlier decoctions, tinctures, and plasters, it was often instructed that medicinals be "fuzu" (cut into small pieces). This meant that after weighing the medicinals, they were pounded to about the size of soybeans and then the fine powder was blown away. This practice was not appropriate: some medicinals break easily and others do not, and the amount of fine powder varies, so weighing by the liang would give uneven doses. Today the practice is to cut the medicinals finely, roughly to the size described by fuzu. This leaves no fine powder, and the pieces are more even in size. Where a formula says "mo zhi" (grind it), it means to pound the medicine according to the standard procedure and then sieve it.

When making pills or powders, the medicinals should first be finely cut and dried in the sun, and then pounded. Some medicinals should be pounded separately, while others should be pounded together...

When pounding medicinals, follow the methods described in the formula. For ingredients with high water content, such as Asparagus Root (tianmendong) and Dried Rehmannia Root (gan dihuang), first slice and sun-dry them, then pound them separately. Afterward, take them out, tease apart the larger pieces finely, and dry them again. On rainy days, they may be lightly dried over a low fire. Once the medicinals are thoroughly dry, set them aside to cool before pounding. Water-rich medicinals always lose much of their weight when dried, so the quantity should be increased somewhat before weighing. Weigh them only after they have been pounded into fine powder, to ensure accuracy. Medicinals to be decocted or steeped in wine need not be processed this way.

When sieving pills, use a fine silk sieve so that the powder is finer, which makes the honey pills made from it easier to cook through. When sieving herbal powders (san), use a looser silk sieve. Because powders are taken with wine, overly fine sieving may cause them to clump like mud. Mineral medicinals should also be sieved through a fine silk sieve, to the same fineness as the powder for pills.

After pills and powders have been sieved, place them in a mortar and pound them several hundred more times with a pestle. Only when the color and texture of the powder are uniform and consistent is it considered proper.

When decocting, use clean well water and measure it precisely using the volume units specified in the formula, such as the sheng and dou. Do not add or reduce it arbitrarily. During decoction, attend to the fire and follow the prescribed method. Generally, simmer over a low flame until the liquid just begins to bubble gently. The amount of water depends on the formula. In general, for every twenty liang of medicinals, use one dou of water and reduce it to four sheng. Other cases can be calculated by this proportion. After decocting, always filter out the dregs, then measure out the liquid as needed.

However, for decoctions that move and clear (tongli), the illness requires rapid clearing, so less water should be added and more liquid extracted. For tonifying decoctions, the medicinals must be cooked thoroughly, so more water is added and less liquid extracted. One should carefully distinguish the purpose of the formula and not confuse the amount of water with the amount of liquid to be extracted.

Once the decoction is ready, have two people hold wooden rulers and use a clean new cloth to press and squeeze the dregs, filtering out sediment and turbidity. If the liquid is to be taken in two or three doses, cover the second and third portions with paper to keep the medicinal aroma from escaping. Before taking, one may warm the liquid by placing a bronze vessel in hot water, but take care that no water enters the vessel.

When steeping medicinals in wine, cut them finely, place them in a raw silk bag, and seal the bag in the wine. The number of days for soaking should be determined by the warmth or coolness of the weather. Attend to the strength of the wine, and once it reaches an appropriate level, it may be filtered out without waiting for the medicinal potency to be fully exhausted. The filtered dregs may be dried, lightly pounded, and steeped again for drinking, or ground into powder for taking.

For tonifying decoctions such as Jianzhong Decoction (Jianzhong Tang) and Shenli Decoction (Shenli Tang), the dregs of two doses may be combined. Add water and decoct until the water is fully consumed, then take the result. Its efficacy will match that of one fresh dose. People of poor families may adopt this method. Before use, all dregs should first be dried in the sun.

Whenever an ointment is prepared, first soak the medicinal materials in bitter wine (cu jiu, vinegar) so that every piece is thoroughly saturated. Do not use much liquid. Then seal the vessel tightly so the aroma does not escape. The term zuishi (a full day) in the text means one full day, from one morning to the next. Some also soak the materials for just one night.

When decocting the ointment, bring the liquid to a boil three times and remove it from the heat three times, to dispel the excess heat and fully extract the potency of the drugs. After each reheating, boil until bubbles rise throughout the liquid, then move it off the fire and let it stand for a long time until the boiling subsides. The materials should not be cooked until they are overly soft. If the formula includes xiebai (the bulb of Allium macrostemon), simmer both ends until they turn slightly yellow. Baizhi (angelica root) and fuzi (aconite) should also be decocted until they are faintly yellowed. The pork fat must not touch water, and fat rendered in the twelfth lunar month is best. Use new cloth when straining the ointment.

If an ointment is meant for internal use, the strained residue may be boiled in wine and drunk. If it is meant for external application, the residue is best spread on the affected area. Both methods aim to draw out as much of the medicinal power of the materials as possible.

If the ointment contains xiongh uang (realgar), zhusha (cinnabar), or similar substances, pound and grind each one separately until it is as fine as flour. Add them only after the ointment has been strained, and stir quickly until it sets, so that the powder does not sink to the bottom and mix unevenly. If the formula contains shuiyin (mercury), grind it while the ointment is setting so that it disperses evenly. Hufen (white lead powder) is treated in the same way.

When pounding medicines, burn incense, sweep the area, and keep everything clean. Avoid conversation and noise. Have a boy do the pounding, and grind the materials as finely and evenly as possible. The pestle may strike thousands or even tens of thousands of times, and more strikes are better.

When making shenqi wan (Kidney Qi Pills), shuyu wan (Yam Pills), other strong tonic preparations, mineral-based formulas (the "five minerals" class), the large shexiang dawan (Large Musk Pills), jinya san (Golden Tooth Powder), and wine-decocted ointments, no woman, child, woman who has recently given birth, person in mourning, long-term invalid, person with a physical or sensory impairment, or domestic animal such as a chicken or dog may see any part of the process, from the measuring of ingredients to the final decoction. This is a strict prohibition and must be carefully observed. General small formulas, such as xuming tang (Life-Prolonging Decoction) and those using mahuang (ephedra), are not subject to these restrictions.

Recently, rural households that buy medicines often hire whoever is available in the market to pound them. The results usually do not follow proper method. When the materials are hard to pound, such as shihu (dendrobium) or tusizi (dodder seed), the hired workers may secretly throw them away to save effort, and the employer never knows. Dust and foul air also get mixed in, the sieving is coarse, and the powder blows away in the wind. When people then taste it with their mouths and smell it with their noses, the essential qi of the materials is lost, and the medicine becomes no better than rotten wood. Patients also fail to finish the course as prescribed, so they grow weaker after taking it and blame the physician.

If the prescription has no effect, as described above, the fault does not lie with the physician. It means the initial diagnosis was seriously mistaken, and the reasons should be examined carefully.

On Taking Medicine, Chapter Eight

When treating illness with strongly toxic medicines, begin with a very small dose, about the size of a millet grain. If the condition improves, stop taking the medicine. If it does not improve, double the dose. If it is still ineffective, increase the dose gradually until the illness is eliminated.

When the illness lies above the chest and diaphragm, eat first and then take the medicine. When it lies below the heart and abdomen, take the medicine first and then eat. When the illness affects the limbs and blood vessels, it is suitable to take the medicine on an empty stomach, usually in the morning. When it affects the marrow of the bones, it is suitable to take the medicine after a full meal, usually at night.

When taking pills or powders, if the prescription does not specify whether to take them with wine or water, follow the requirements of the prescription itself. Either method of taking them is acceptable.

Decoctions meant to move the bowels are best taken early in the morning. A decoction should be slightly warm, since this helps it move downward and makes vomiting less likely. If it is too cold, it may cause vomiting and will also struggle to move downward. If it is too hot, it will injure the throat, so the temperature must be watched. A decoction should also be clear. If it is turbid, it may cause discomfort and oppression in the heart.

Leave an interval between two doses, roughly the time it takes to walk ten li. If the interval is too short, the earlier dose has not yet been digested when the next one is swallowed, and the two potencies clash, which may cause vomiting. Ask the patient and confirm that the medicine in the abdomen has dispersed before continuing.

Decoctions are usually taken in three doses. The amount of each dose may be adjusted according to the patient's appetite and strength. The first dose should be the largest, and the doses that follow should gradually decrease. This is the safer course, because the patient's strength will weaken over time, so the amount should be reduced accordingly.

For tonifying decoctions, the total quantity is generally three and a half sheng. Take it three times during the day and once at night. While taking the medicine, one may eat moderately, so that the medicinal power moves with the qi and blood and works more readily. Do not drink a decoction too quickly, nor spread it out over too long a time. After drinking, one may lie on the left side, the right side, on the back, and on the front, keeping each position for about the time of a meal, so that the medicine spreads through the abdomen. One may also walk about a hundred paces indoors. Do not go out that day, as this benefits recuperation.

For three days during a course of decoction, avoid alcohol, because wine and decoctions are mutually incompatible.

When taking a decoction for wind illness, cover yourself with more bedding after the first dose so as to induce sweating. If you are already sweating, cover yourself less, to avoid profuse perspiration. While taking the medicine, eat moderately as well. Otherwise, one will feel weak and the body will grow even frailer and thinner.

Pills are generally made to the size of a wutong seed. For tonifying pills, begin with ten pills and increase gradually, to no more than forty at most, since taking more than this may also harm the body. The original text continues: take them three times a day.

Medicine should be taken continuously over a long period without interruption, so that its qi gradually permeates and nourishes the five zang organs (what Chinese medicine calls the heart, liver, spleen, lungs, and kidneys). Long-term use is better, and one need not hurry to finish a course. If one is only eager to finish early, costly medicines are wasted and little benefit is gained.

In general, people under forty who are ill may take purgatives, and if there is no obvious depletion, tonics are unnecessary. Where there is genuine depletion, this restriction does not apply. People over forty should not take purgatives but should take tonics, and people over fifty should be nourished with tonics continuously through all four seasons. Only in this way can one help prolong life and regulate the body. Specific formulas are given in volume twenty-seven. The Suwen (Basic Questions) says: "For excess patterns, purge; for deficiency patterns, supplement; where there is neither deficiency nor excess, regulate according to the meridians and the condition of the disease." These are only broad principles. If the viscera harbor stagnation, one should purge regardless of age. If the body is depleted and weakened, one should supplement regardless of age. The choice should be weighed according to circumstances.

When taking medicines for hemorrhoids, fistulas, infantile malnutrition (gan disease), or worm-eaten sores, avoid pork, chicken, fish, and greasy foods until the illness is cured.

When taking a purgative, stop once bowel movements are smooth. Never take an excessive dose, lest diarrhea that will not stop seriously damage the body.

After all kinds of malignant sores have healed, one must avoid certain foods for one hundred days, otherwise the sores may recur.

When taking medicines prepared with wine, the effect of the wine should be kept up continuously without interruption, because if it is broken, the potency of the medicine cannot be fully realized. The amount should be what the body can tolerate. One must not drink to intoxication or vomiting, which would seriously harm the body.

During medication, one should generally avoid raw or cold foods, sour foods, and glutinous foods, as well as pork, dog meat, chicken, fish, greasy foods, noodles, garlic, and certain fruits. When taking large pills or powders in particular, one must strictly avoid stale food, foul-smelling food, and food that is difficult to digest. Individual medicines also carry their own taboos. While taking azurite (kongqing), avoid raw-blood foods. While taking asparagus root (tianmendong), avoid carp. While taking atractylodes (baizhu), avoid peaches, plums, sparrow meat, coriander, garlic, black carp, and vinegar. While taking rehmannia (dihuang), avoid elm seed (wuyi). While taking licorice (gancao), avoid cabbage and seaweed. While taking asarum (xixin), avoid raw vegetables. While taking dodder seed (tusizi), avoid rabbit meat. While taking achyranthes (niuxi), avoid beef. While taking coptis (huanglian) or platycodon (jiegeng), avoid pork. While taking peony (mudan), avoid coriander. While taking veratrum (lilu), avoid civet meat. While taking pinellia (banxia) or acorus (changpu), avoid malt sugar and mutton. While taking dichroa (henshan) or cinnamon bark (guixin), avoid raw scallions and raw vegetables. While taking phytolacca (shanglu), avoid dog meat. While taking poria (fuling), avoid vinegary foods. While taking arborvitae seed (baiziren), avoid wet noodles. While taking croton (badou), avoid asparagus soup and pork. While taking turtle shell (biejia), avoid amaranth.

During medication, one should also avoid seeing corpses and avoid contact with the impure matter of women after childbirth. If one is contaminated by such impurities, one should also avoid becoming angry……

Anger, Worry, and Toil

When taking decoctions, the porridge, rice, meat, and vegetables one eats should all be cooked thoroughly. Well-cooked food is easier to digest and is better suited to being taken alongside medicine, whereas raw food is hard to digest and can impair the medicine's efficacy. While taking medicine, one should eat few vegetables and tough foods, and use little salt and vinegar. One should also avoid overexertion, sexual activity, and great joy or great anger. Therefore, when treating illness with medicine, proper diet and rest often contribute more to recovery than the medicine itself. Patients must be attentive to rest and moderation, and being careful and thorough not only helps them recover from illness but also benefits their longevity.

When taking purgative decoctions, or pills, powders, medicinal wines, and the like, if one needs to eat at mealtime during the course of treatment, it is best first to drink a mouthful of cold vinegar, wait a short while, and then eat.

If someone suddenly suffers a stroke, with the body and spirit both declining at once and even the inability to speak, one should take prescriptions such as the Great and Small Life-Prolonging Decoctions, the Xizhou Life-Prolonging Decoction, the Wind-Dispelling Decoction, and the Yuepi Decoction. The medicine should be taken in a sealed, draft-free chamber, four or five times a day and night, without concern for the quantity of the dose or for the patient's weakness. The aim is sustained sweating from the head, face, hands, feet, abdomen, and back. After taking the decoction, once it has been digested one may eat porridge, and once the porridge has been digested, take the medicine again. A small amount of lamb broth may also be taken to nourish the body. If the wind affliction is severe, the decoction should be taken continuously for five days and five nights, then stopped for two days while the body is nourished with broth and the breath is regulated. Once the condition shows slight improvement, the medicine should be discontinued and the patient should gradually rest. If there is no improvement, treatment should continue until the illness is cured.

When treating wind affliction with decoctions, if no great sweat is produced, the wind will not dissipate. For this reason, ephedra (má huáng) appears in every formula for treating wind. For example, the Xizhou Life-Prolonging Decoction uses eight liang of ephedra, the Yuepi Decoction uses six liang, and the Great and Small Life-Prolonging Decoctions use one, three, or four liang in various versions. From this it can be seen that the author held that wind must be treated by inducing sweating in order to be effective. Therefore, these decoctions must be taken in a sealed chamber; otherwise, taking the medicine rashly may instead cause harm. The author also states that dosages often need to be increased continually, and that there are no cases where they needed to be reduced.

For those over fifty years of age and of very frail constitution, when taking the "Three-Stone Regeneration" formula, one must never use the "Five-Stone" formula. It should be taken every morning in all four seasons, drunk warm in quantities of one to two sheng, and continued over the long term. At the same time, one should avoid garlic, oil, fish, pork, beef, horse meat, chicken, goose, and duck. The author holds that by doing so one will be free of illness.

On the Storage of Medicines, Ninth Chapter

The ancients taught that one should keep the possible dangers in mind at all times, and not forget to guard against calamity even in peaceful times. This is the sages' essential instruction for relieving the people's suffering. To attend to the people's hidden troubles is the mindset of the worthy. Shennong gathered all manner of medicinals, and the Yellow Emperor compiled the classics of acupuncture and moxibustion, both in order to prepare in advance.

Human illness often strikes suddenly and makes no appointment beforehand. If one falls ill in the morning, where is there time to seek a remedy? I therefore hope that those inclined to do good will store medicines in advance against unforeseen needs. This requires only a single resolve, yet it may save a great many lives. I have seen families who have enjoyed hereditary stipends and who are skilled at raising horses keep several dozen jin of horse medicine, yet I have never seen a household devoted to nurturing life keep even a little medicine for treating people. Seen in this light, it is truly shameful: to treasure livestock while esteeming oneself lightly is indeed disgraceful. The ancient saying, "Was anyone hurt?" and not "What of the horses?" means that when people are injured, one should first attend to the person and need not first attend to the horse. If one does not cherish human life, what meaning would such a saying have?

Some people travel on official or private business to distant frontier regions, where the land is barren and medicines are hard to obtain. If they suddenly encounter miasma (pestilential vapors, or diseases common in remote, damp, and hot regions) and have no medicines stored, they have no means of treatment and can only wait helplessly for death. Such cases result from failing to prepare in advance and cannot be counted as misfortune arising without cause. Since one has not cared for oneself in ordinary times, sighing with regret only in a crisis comes too late. Therefore, the methods of storing medicines are set out here to guard against emergencies.

The medicines that should be stored include mineral substances; ash and earth from plants; water; the roots, stems, leaves, flowers, bark, fruits, and seeds of herbs and trees; the five grains, five fruits, and five vegetables; the teeth, bones, horns, hooves, shells, hides, and fur of various animals, as well as their urine and dung; and also su (clarified butter), sui (marrow), milk, lao (curds), ti hu (a rich dairy preparation), shi mi (rock honey), sha tang (cane sugar), yi tang (malt sugar), wine, vinegar, glue, yeast cakes, nie (grain sprouts used to ferment wine), and dou shi (fermented soybeans).

These medicines should be gathered and stored at their proper seasons. Insect-derived medicines need not be collected personally.

The implements needed for preparing medicines should likewise be readied in advance: scales, and the dou, sheng, and he measures; iron and wooden mortars; silk, gauze, and horsehair sieves for straining powders; knives, chopping boards, jade mallets, and porcelain bowls; and large and small copper and iron pots, along with copper and iron spoons.

Medicines should not be taken out and sunned frequently. Constant exposure to wind and sun weakens their potency, a point one should know well. Medicines not needed for the time being should be dried thoroughly under the blazing sun on a very clear day, then placed in new earthenware jars and sealed with clay. When a medicine is needed, the jar should be resealed immediately after opening, so that wind and moisture do not enter. In this way, even after many years of storage, the medicines can remain as fresh as new. Pills and powders should be placed in porcelain vessels, sealed, and then wrapped in wax……

Allow air to circulate around the containers so that their contents will not spoil even after thirty years in storage. Medicinal ingredients such as apricot kernels and herb seeds should be kept in earthenware vessels, where mice cannot reach them. All medicines should be stored three or four feet above the ground to keep damp rising from the earth from seeping in.