《孫真人備急千金要方》Vol. 22

The Essential Formulas Worth a Thousand in Gold for Emergencies by Master Sun, Volume 22: Beriberi, Part Three

(Edited by Lin Yi and others, Court Gentleman for Attending the Emperor, Acting Junior Vice Minister of the Court of Imperial Sacrifices, and Proofreader at the Library Pavilion)

Formulas for Beriberi Caused by Wind Toxin

On the symptoms of wind toxin (first section, chapter sixteen)

The discussion says: A review of the medical books and formula collections shows frequent mention of “weakness of the feet,” yet in ancient times few people suffered from this illness. Since the Yongjia era, when people crossed south at the end of the Western Jin, it became increasingly common among scholar-officials. In the Lingnan and Jiangdong regions, people such as Zhi Facun and the Daoist Yang devoted themselves to studying medical texts and were especially skilled at treating this illness. Many officials and scholars of the Jin dynasty owed their lives to these two physicians.

Between the Song and Qi dynasties, there was also the Buddhist monk Shenshi. Daoist Shenshi compiled old formulas passed down by Zhi Facun and others into thirty volumes, including more than a hundred formulas for treating weakness of the feet. The illness seems not to have occurred during the Wei and Zhou periods, so when Lord Yao compiled the Collected Proven Formulas, he gave it little attention, and when Prince Xu compiled medical prescriptions, he likewise paid it no particular notice.

This was probably because political rule was divided at the time, customs and education were not unified, and the climates of different regions varied in warmth and cold. People in Guanzhong and Hebei therefore knew little about the illness. Since the Tang dynasty unified the realm, its borders have been open in every direction, and even remote regions in the south have become important strongholds of the court, where officials and soldiers are often stationed. People from elsewhere, unaccustomed to the local conditions, often contract this illness. In recent times, even scholar-officials from the Central Plains who have never traveled south of the Yangtze have suffered from it. This is probably because customs across the regions have gradually grown more alike, and people of all kinds now live in increasingly similar conditions.

When the illness first takes hold, it begins in the feet, then the lower legs swell. People at the time called it “beriberi.” The “weakness of the feet” described by Shenshi refers to this same illness. Shenshi recorded more than eighty formulas for weakness of the feet used by Zhi Facun, Yongpingshan Fu, Shilian, Fan Zuyao, Huang Su, and others. These formulas are all essential, but physicians consulting them often find the material extensive. They are merely collections of formulas, and when urgent treatment is needed, it can be difficult to find the right remedy quickly. Here I select only those formulas that have been tried and found effective, for use in emergencies, and omit the rest.

Why this illness affects the feet

Question: Wind toxin can enter the body and cause illness anywhere. Why does it so readily attack the feet?

Answer: The body has five viscera. The channels of the heart and lungs begin at the tips of the five fingers, while the channels of the liver, kidneys, and spleen begin at the tips of the ten toes.

The pathogenic wind toxin comes entirely from the ground. Cold, heat, wind, and dampness at ground level all give rise to vapor that rises upward. People often walk barefoot on the ground, so when wind toxin enters the body, it must first attack the feet. If the illness is not cured for a long time, it spreads to the limbs, abdomen and back, and head and neck. When the illness is mild, people often do not notice it. Only after the pathogenic influence has remained for a long time do they realize that something is wrong. The medical classics’ terms “successive transmission” and “intervening transmission” refer to this gradual progression of illness. Once the illness has become pronounced, it makes itself apparent.

All cases of beriberi arise from exposure to wind toxin. After falling ill, people often do not notice it right away. Beriberi may flare up along with another illness, or a person may suddenly feel extremely distressed and, two or three days later, become bedridden before realizing it is beriberi. Doctors with limited skill often fail to recognize the disease and mistake it for something else. As a result, many patients die. Beriberi is therefore often difficult to identify.

When beriberi first appears, its symptoms are mild. Eating, recreation, and physical strength remain as usual; the only difference is that the feet suddenly become weak and slack, unable to move. This is what the Yellow Emperor called “flaccid wind-damp impediment”: wind and dampness invade, leaving the limbs slack and paralyzed.

On the Symptoms of Wind Toxin

Sometimes the feet show no clear discomfort, while the head, neck, or arms are already painful. Sometimes there are no obvious symptoms anywhere, yet the heart, abdomen, and five viscera have already been affected. After wind toxin enters the body, a person may vomit after eating or feel repelled by the smell of food; there may be abdominal pain or diarrhea, or difficulty passing urine or stool. The chest may pound with unease; the person may dislike light, feel mentally clouded, or become confused and speak incoherently. Other signs include high fever and headache; unusual coldness throughout the body, pain, and distress; cramping and twitching of the sinews; swelling; or numbness and loss of control in the thighs. The limbs may become limp and weak, unable to move at will, or the joints throughout the body may contract, with loss of sensation in the lower abdomen. All these are manifestations of beriberi, also known as signs of wind toxin beriberi.

The symptoms of beriberi are difficult to recognize and must be observed carefully. Otherwise, the crucial moment for diagnosis and treatment may be missed, and once the illness takes hold it becomes difficult to manage. Women can also contract this disease. After childbirth, women who seek relief from the heat in spring or summer are also prone to exposure to wind toxin and should take particular care. Fever and distress, twitching limbs, palpitations, agitation, vomiting, and Qi surging upward may all be signs of beriberi. Even if a person feels only coldness and distension below the navel, along with difficulty passing urine, and this is unlike their usual state, it is also a sign of beriberi. Numbness and weakness in the limbs are called “flaccid wind”; pain is called “damp impediment.”

On the Causes of the Illness

In every season, do not stand or sit for long periods in damp, cold places. Nor should you take off your clothes, shoes, and socks to cool down in the wind after drinking heavily and sweating. These conditions may all bring on foot qi disease. In ancient usage, “foot qi” usually referred to disorders of the lower limbs caused by wind, damp, cold, or heat invading the channels and collaterals; it is not the same as the fungal infection known by that name today.

In summer, sitting or standing for a long time in a damp place allows hot, damp qi to enter the channels and collaterals. When the illness develops, common symptoms include fever, aching limbs, and a feeling of agitation. In winter, sitting or standing for a long time in a damp, cold place allows cold, damp qi to enter the channels and collaterals; when the illness develops, the limbs become cold and cramped. If the illness results from cooling off in the wind, the skin and flesh may become numb, and twitching may occur in various parts of the body, with the symptoms gradually spreading toward the head.

In daily life, when the weather suddenly becomes unbearably hot, people often find it hard to endure. Even then, they should not immediately seek relief from the heat. If the weather then suddenly turns cold and they cannot adapt, they may also easily fall ill.

Some people who diligently study or work become so absorbed that they sit, stand, or walk for a long time in damp places without moving their bodies. When cold wind enters the channels and collaterals, they may fall ill without realizing it. Wind toxin can invade the body, sometimes beginning in the fingers or toes: when a person is sweating, the pores open and the skin’s protective texture loosens, allowing wind pathogen to enter like a swift arrow. At other times, it first attacks the soles or tops of the feet, or the inner and outer sides of the lower legs below the knees.

To keep the illness from worsening, apply moxibustion as soon as anything unusual is noticed, at the area that feels weak or uncomfortable. Twenty or thirty moxa cones—each cone being one measure of moxibustion, burned once—can often bring a cure and prevent recurrence. The Yellow Emperor’s Inner Canon says that cooling off in the wind, as well as having sexual intercourse after drinking heavily, can bring on this illness.

Why cold and heat symptoms differ

Question: Why are some people with this illness afraid of cold, while others have a fever?

Answer: The feet have three Yin channels and three Yang channels. When cold pathogen invades the three Yang channels, the resulting illness tends to be cold in nature; when summer heat invades the three Yin channels, it tends to be hot. The illness therefore differs according to whether it affects the exterior or interior, and whether it is cold or hot. Hot conditions should be treated with cooling medicines, and cold conditions with warming medicines; treatment must be determined according to the specific case. When the Spleen is invaded by Yang toxin, heat symptoms and persistent numbness may occur. When the Kidneys are invaded by Yin dampness, cold symptoms and paralysis may occur.

Other illnesses that arise after foot qi

Even a person with foot qi may experience reactions such as the effects of mineral medicines becoming active after taking them. In such cases, treatment should use prescriptions that can counteract the action of those medicines.

If other illnesses arise after foot qi develops, use medicines suited to each particular condition. For example, if urination is obstructed, diuretic medicines such as Zhuling and Fuling may be used. If the stool is extremely dry and hard, medicines such as the Five Softening Pill or Hemp Seed Pill may be used.

When the whole body is swollen and fluid has accumulated internally to cause illness, treat it with the prescriptions and medicines for water disorders in the “Water Treatment Formulas.” Apply the same principle to other conditions; there is no need to cling to a single method.

On the Urgency of Illness

As soon as you notice anything unusual about an illness, be highly alert and resolve to treat it as soon as possible.

If treatment is delayed and the pathogenic Qi surges upward into the abdomen, symptoms may include swelling or no swelling, fullness in the chest and sides, Qi counterflowing upward, and being able to breathe only by lifting the shoulders. Death may come quickly. Even when the illness progresses more slowly, death often follows within a few days, so treatment must not be delayed.

A feeling of urgent pressure below the heart, continuous panting, frequent spontaneous sweating, alternating chills and fever, short and rapid breathing, or persistent vomiting are all critical symptoms.

On Deficiency, Excess, and Whether Medicine Can Be Taken

People with beriberi—a disease described in ancient times, marked mainly by symptoms in the legs and feet and sometimes accompanied by symptoms throughout the body—often die because the illness is severe and excessive. No one has ever died because taking medicine made the body deficient. Therefore, patients with beriberi should neither be greatly tonified nor greatly purged. But one should not stop taking decoctions in advance for fear of becoming weak; those who do so ultimately die because they receive no treatment.

On Those Who Visit and Inquire About the Sick

It is common for a patient’s relatives, old acquaintances, and friends to come and visit. They have neither experienced medical practice firsthand nor read medical books, yet imagine they know a great deal and pretend to understand, voicing all kinds of conflicting opinions. Some say the illness is deficient, others that it is excessive; some say it is caused by wind, others by gu (a kind of pernicious illness as understood in ancient times), water, or phlegm. These contradictory opinions confuse the patient and leave them unable to decide what to do. Treatment is delayed, and the illness often suddenly worsens. By then, those who offered their opinions have all gone away.

A reliable person and a reputable, skilled physician must therefore be asked to diagnose and treat the patient. The physician should understand the severity of the illness, examine medical books closely, read widely in case histories from both past and present, and be familiar with the relevant medical principles. Otherwise, it is easy to delay treatment and harm the patient. I privately grieve over this, for it happens so often. I have therefore set out the causes and symptoms one by one, so that patients in later generations may read them and be prepared. Whenever a symptom pattern accords with a particular illness, treatment should promptly follow the appropriate prescription. Do not listen to the opinions of bystanders and leave yourself with worry and regret. A patient may die very soon; do not trust what others say and thereby lose the chance to save yourself. I once prepared a formula called “Mendong Decoction,” made with mendong-type medicinal herbs. It is very effective for treating beriberi and may be used by those who suffer from it.

On Methods for Examining the Pulse

Although the pulse in beriberi must be assessed from several aspects, the pulses at the cun, guan, and chi positions must always …

People who go against the seasonal rhythms are more likely to recover from illness, while those who follow them are not suitable for treatment. For the rest, see the Mai Jing (Pulse Classic); the details are not repeated here.

People naturally dark in complexion and lean in build are easier to treat. Those who are stout, heavily muscled, and ruddy or fair in complexion are harder to cure. Dark-skinned people are more able to withstand wind and dampness, while those with ruddy or fair complexions are less able to do so. Lean people have firmer muscles, while stout people have softer muscles. Pathogenic influences can penetrate more deeply into people with soft muscles, making them harder to cure.

On whether beriberi causes swelling

Some people suffer from beriberi for a long time without realizing it. Later, after another illness strikes and is cured through treatment, they suddenly develop vomiting and weakness in both legs. I examined one such person and told him he had beriberi. He said, “My feet have never been swollen in my life. How can this be called beriberi?” So he refused to take medicine. Other doctors thought the illness had been caused by mineral medicines, but they too were uncertain. Before ten days of indecision had passed, he died.

Beriberi therefore cannot be diagnosed by swelling alone: some cases involve swelling and some do not. When the lower abdomen becomes numb and loses sensation, the feet often do not swell. If vomiting begins within three to five days of the onset of numbness in the lower abdomen, this is called “beriberi attacking the heart.” This condition is often fatal within a short time. Once beriberi has progressed to “attacking the heart,” it is difficult to treat. The original text explains the danger through the Five Phases’ cycle of overcoming, saying that Kidney Water overcomes Heart Fire.

On taking care with diet and daily life

When suffering from beriberi, one must especially limit sexual activity and strictly avoid mutton, beef, fish, garlic, houttuynia, Chinese cabbage, turnips, bottle gourd, alcohol, wheat-flour foods, butter, milk porridge, pork, chicken, goose, and duck. Some prescriptions use carp head, but all the other foods listed should be avoided. One should also avoid becoming extremely angry.

One may eat rice, millet, glutinous millet, bean paste, fermented soybeans, scallions, Chinese chives, Chinese chive bulbs, pepper, ginger, and tangerine peel. All raw fruit, as well as sour foods and foods flavored with vinegar, must also be avoided; breaking these prohibitions makes the illness difficult to cure. The original text also specifically recommends raw cow’s milk and raw chestnuts.

On how quickly a skilled practitioner can cure the illness

Many people who suffer from beriberi die needlessly. There are, broadly speaking, three reasons: they recognize the illness too late; they are arrogant and stubborn, indulging their own wishes; or they hesitate and cannot decide. These things readily lead to deaths that need not occur. Even when good doctors are available in the world, they rarely encounter patients who understand and accept treatment, and are willing to follow the prescribed regimen. It is like having a fine horse without encountering Bo Le, or having Confucius with no one willing to study under him. Needless deaths arise in much the same way.

Today, some patients are able to understand and accept treatment, and to follow the prescribed regimen…

I treat this illness, and recovery usually takes no more than ten days. If a patient’s constitution is not suited to treatment, there is no need to force it; even if treatment is given, they may never recover. This is true not only of beriberi but of all kinds of illness. When patients see a good medicine or hear beneficial advice, they may choose to follow it; they should not be forced to take medicine. Treat those who have faith, and do not try to persuade those who remain doubtful.

On moxibustion

When beriberi first appears and both legs feel weak, apply moxibustion promptly and take Bamboo Sap Decoction at the same time. After moxibustion, you may take Eight Winds Powder. If treatment is given in time, everyone can recover. If you use moxibustion without medicine, or medicine without moxibustion, the results will be poorer: some may recover, while others may die. Even if the illness seems to have passed, it may return one or two years later. At the first sign of recurrence, apply moxibustion and take the medicine as before. Following this method, all ten out of ten patients will recover.

When the illness is mild, it may not seem serious at first. But if treatment does not eliminate its root, the illness may become fatal over time, so it must be taken seriously.

Apply moxibustion in this order: first to Fengshi (Wind Market), a point on the outer thigh; then to Futu (Crouching Rabbit), on the front of the thigh; Dubi (Calf’s Nose), below and outside the knee; and Xiyan (Knee Eye), in the hollows on either side below the kneecap. Next, apply it to Sanli (Three Miles, or Zusanli), Shanglian (Upper Ridge), Xialian (Lower Ridge), and Juegu (Suspended Bell).

To locate the first of these eight points, Fengshi, have the patient stand upright with both arms hanging naturally and fingers extended against the outer thighs. The point lies on the thigh muscle opposite the tip of the middle finger. Apply one hundred cones of moxa. Even in mild cases, do not use fewer than one hundred; in severe cases, a single point may receive five or six hundred. Do not apply them all at once; it is better to divide the treatment into three sessions.

To locate the second point, Futu, have the patient sit upright and place a hand across the knee. The lower edge of the palm should align with the kneecap when the knee is bent. The point lies at the midpoint of the side edge of the palm. Apply one hundred cones, or fifty.

The third point, Dubi, lies on the outer side of the upper edge of the kneecap, on the flat area beside the bone. Press with a finger to find the hollow between the joints. Another account places it below the kneecap on the outer side, where three bones meet in a shape like the bottom of a winnowing basket. Move the foot and press with a finger to find the hollow. Apply fifty cones, up to one hundred at most.

The fourth point, Xiyan, lies in the hollows on either side below the kneecap.

The fifth point, Sanli, lies about one fu below the knee joint, near the outer side of the shinbone. Another account says it lies below the kneecap…

Moxibustion is applied three cun below the joint of the lower leg, with the exact position measured according to the patient’s finger length. Once the location is determined, apply moxibustion there for one hundred cones (one cone burned to completion counts as one application).

Sixth is Shanglian, a point below Zusanli, located one fu below Zusanli on the outer side of the tibia. Apply one hundred cones. Seventh is Xialian, one fu below Shanglian. Some accounts also place it on the outer side of the tibia. Apply one hundred cones. Eighth is Juegu, one fu above the outer ankle; some accounts place it four cun above the ankle.

The prescribed number of cones need not be applied in a single session. Moxibustion may be given daily, with the full number completed within three days. If the illness affects only one foot, treat that foot; if both feet are affected, treat both. Weakness of the feet usually affects both feet at once. Another method recommends moxibustion at Zusanli and Juegu when the feet feel unwell; if both feet are affected, treat all four points. The number of cones may be adjusted according to the severity of the illness, but even mild cases should receive no fewer than one hundred cones. If the condition does not improve, proceed promptly to moxibustion at the other points. The more cones applied, the better.

Some accounts say that Juegu is the most important point. If someone with weakness of the feet has not been treated in time and the condition progresses to the abdomen, causing abdominal distension and shortness of breath, extensive moxibustion is then required. Apply it along the shu points, where the Qi of the channels flows and gathers, as well as at the guan points, joints, abdomen, and back, and administer Bafeng San, the name of a formula. Some people have recovered through this treatment. The locations of the guan points, shu points, and joints are described in another volume.

If the illness seems to have progressed to the abdomen, but the patient is in too much pain to tolerate extensive moxibustion, treat only the points on the chest and in the area of the heart and abdomen, along with the points on both feet. Some patients have recovered well in this way.

To measure one fu, place the palm downward, extend the four fingers together, and use the transverse width across the middle joints of the four fingers as one fu. There are two ways to measure one fu: one uses the width of three fingers; for treating weakness of the feet, use the width of four fingers. One should also follow the point locations preserved in the older method of Zhi Fa, a traditional acupuncture method.

The points listed in the older method are Liangqiu, Dubi, Zusanli, Shanglian, Xialian, Jiexi, Taichong, Yanglingquan, Juegu, Kunlun, Yinlingquan, Sanyinjiao, Fuliu, Rangu, Yongquan, Chengshan, and Shugu, making eighteen points in all. The older method often applied moxibustion at Baihui and Fengfu, as well as at the shu and mu points of the five zang organs and six fu organs, where the Qi of the organs gathers. In recent times, moxibustion at these points often causes Qi to surge upward, so this method is not used; it may be used if the patient has no such upward surging of Qi. If the condition has become established and there is concern that it cannot be reversed, moxibustion should be applied at all of them. As for the ten toes of both feet…

The “Surprising Points” are taken at one point each, making eight points on both feet. Cao calls them the “Eight Chong” (the eight vital points on the feet), located at the very bottom. Moxibustion at these points is effective. The tips of the ten toes are called the “Qi Extremities”; apply three cones of moxa to them each day (each cone refers to one burning of moxa). The Essentials of the Great Spirit says that the Eight Chong points may be treated with seven cones of moxa each day. Stop moxibustion once the circulation of Qi and blood has become unobstructed. Never treat a patient with moxibustion unless they trust you deeply and place themselves entirely in your care; exercise the utmost caution. When treating the Eight Chong points, make the moxa cones small.

Key points for diagnosing and prescribing decoctions

After wind toxin Qi enters the body, the pulse generally falls into one of three patterns. The outward and inward symptoms may look similar, but the pulse differs.

If the pulse is floating, large, and moderate, the patient should take the Life-Sustaining Decoction; two doses are usually enough to bring improvement. If wind pathogen is predominant, use the Yuebi Decoction with four liang of Atractylodes. If the pulse is floating, large, tight, and rapid, use the Bamboo Sap Decoction.

If the patient’s pulse is faint and weak, they should take the Wind-Attracting Decoction. This pulse pattern is usually due to deficiency. If the patient is extremely weak, short of breath, and lacking strength, a tonic decoction may be given as appropriate during treatment, chosen according to whether the condition tends toward cold or heat. If the condition still does not improve, give the Bamboo Sap Decoction.

A floating, large, tight, and rapid pulse is the most dangerous of the three patterns. A deep, fine, and rapid pulse is equally dangerous: floating and large indicate that the illness is on the exterior, while deep and fine indicate that it is within. The treatment does not differ; judge according to the particular circumstances. Even if the patient’s appearance seems fairly good, their hands and feet may already have lost strength. If Qi surges upward within a few days, they may die suddenly. Such a pulse is often extremely dangerous; the text says that almost no one survives it. Give the Bamboo Sap Decoction immediately, one dose each day, and keep its medicinal effect continuous. Do not let the patient go half a day without a dose. This decoction should contain plenty of bamboo sap. If it is not hot enough, it may remain in the chest and cause harm. Make sure the decoction is sufficiently hot each time it is given. If the patient has a bowel movement after taking the Bamboo Sap Decoction, the condition will usually improve.

If the patient has taken three doses of the Bamboo Sap Decoction and the condition and pulse have not eased, and there is also distension and fullness, use the Great Softshell Turtle Shell Decoction to purge. If the decoction’s medicinal effect has worn off but the patient still cannot pass stool, a pill may be used to help the decoction work and promote evacuation. After a bowel movement, resume the Bamboo Sap Decoction until the pulse becomes moderate and the breathing steady; then stop the medicine. At this point, it is best to take the Thirty-Two-Ingredient Eight-Wind Powder.

At the very onset of illness, apply Wild Kudzu Ointment to the affected area by massage, twice daily. This can cure even stubborn numbness and paralysis with weakness in both legs.

The Bamboo Sap Decoction should then be discontinued. If the pulse has settled and is close to what it was before the illness, and strength is gradually returning, but the patient still cannot walk, this shows that the body’s strength is recovering. Once strength is sufficient, the patient can gradually practice walking. In severe cases, the patient may need to wait six months after recovery before walking with someone’s support.

Once improvement in the pulse and the body’s condition is apparent, the Eight Winds Powder, a formula for treating pathogenic wind, should be taken regularly. Do not hastily add other treatments simply because the patient still cannot walk. Other treatments may not work and could instead cause new problems or delay the original treatment. Even with someone nearby, do not use Wild Kudzu Ointment indiscriminately.

Some people, having heard of the Bamboo Sap Decoction, worry that it will harm the lower back and legs. Do not give it to them; this treatment must be understood. These formulas are not suitable for people who are unable to receive them, so they should not be taught indiscriminately. In other words, do not explain these methods to people who remain doubtful.

There are three formulas for the Bamboo Sap Decoction: those with milder illness should take the first formula, while those with more severe illness should take the later formulas in sequence. This kind of wind toxin is contagious. The patient should carry a small amount of Golden Tooth Powder and apply it to the nostrils and the ear openings. People who are critically ill, as well as those who have just died, can readily infect others. Even the robust should carry the medicine and apply it around the ears and nose before approaching someone near death or visiting a patient. A red sachet containing one square-inch spoonful of the powder may be tied to the arm: men should tie it on the left arm, women on the right. Begin taking the powder in small doses. The Golden Tooth Powder formula is given in another volume. Patients should drink only a red-bean beverage; in winter, they should take Side-Child Golden Tooth Wine.

The Continuation of Life Decoction is a formula for treating wind toxin. At the onset, the symptoms resemble an epidemic toxin disease, and the pulse is floating and moderate, remaining so throughout. Without prompt treatment, the patient may die within a few days or ten days. The patient may also suddenly become confused, or develop jaundice, eruptions, red eyes, or ulceration in the lower body. This illness is extremely dangerous. As soon as it occurs, give one dose of the Continuation of Life Decoction, followed by Kudzu Root Decoction and Ephedra Decoction to induce purgation. If the pulse still has not settled, give two or three more doses of the Continuation of Life Decoction; the illness will then surely improve. Because the illness is so dangerous, keep the decoction coming without interruption, even for half a day. Stopping the medicine may prove fatal. The formula for the Continuation of Life Decoction is given in another volume.

Essential Formulas for Emergencies Worth a Thousand Gold Pieces by the Perfected Sun, Volume Twenty-Two.