《孫真人備急千金要方》Vol. 31

The Essential Prescriptions for Emergencies of the True Person Sun, Scroll 31

Collated and edited by Lin Yi and others, Court Gentleman for Service, Acting Junior Director of the Court of Imperial Sacrifices, and Assistant Collator of the Secret Pavilion, of the Song dynasty.

Prescriptions for Cold Damage

Section Six: Pills for Inducing Perspiration

Divine Elixir Pill: A prescription for cold damage with aversion to cold, fever, and bodily pain.

Four liang each of aconite and crow-dipper; five liang each of ginseng, poria, and pinellia; and one liang of cinnabar.

Grind these six ingredients into a fine powder and form it into pills with honey. Then coat the pills with cinnabar to make them red. Take two pills before meals, each about the size of a soybean, with ginger decoction, three times a day. Soon after taking them, drink about two sheng of hot rice porridge and cover yourself with bedding until you sweat. If you do not sweat, or sweat only a little and the illness has not eased, take another dose in the same way. If you have sweated sufficiently and the symptoms should have eased but have not, switch to Cinnamon Twig Decoction.

This medicine is highly toxic. If signs of heat appear, have the patient drink water; if signs of cold appear, give warm water to relieve them. To treat malaria, take two pills before an attack.

The Essentials from the Golden Cabinet uses asarum instead of ginseng and adds a piece of belamcanda and one jujube. This formula is called Red Pill and treats reversal caused by cold, in which cold pathogen disrupts the flow of Qi and leaves the limbs cold and withdrawn.

Wheat Slave Pill: Used in severe cases when cold damage has not resolved after five or six days or more, heat pathogen has lodged in the chest, and the patient’s jaws are clenched so that they cannot speak, while longing only to drink water. This condition is called “deteriorated cold damage.” Physicians of the time considered it difficult to save: the patient’s Jing, Qi, and Shen had been exhausted, and only a faint warmth remained below the heart. A stick may be used to gently pry open the patient’s mouth and pour in the medicine. If the patient can swallow it, recovery may be possible. Wheat Slave Pill is also called Black Slave Pill or Water-Relief Pill.

One liang each of soot from the bottom of a cooking pot, soot from the kitchen flue, soot from a roof beam, wheat slave, scutellaria, rhubarb, and mirabilite; two liang of ephedra.

Grind these eight ingredients into a fine powder and form it with honey into pills about the size of a marble. Take five he of freshly drawn water, crush one pill into it, and let it soak until fully dissolved before administering. If the patient is thirsty and wants water, let them drink as much as they wish, without limit. When they no longer want to drink, encourage them to drink more; the more, the better. If they do not want water after taking the medicine, they should still be made to drink.

A short while after taking the medicine, the patient will feel cold. When that feeling passes, sweating will follow, and the illness will ease. If the patient has not sweated after roughly the time it takes the sun’s shadow to move five chi, give another dose in the same way, up to two or three doses at most. The black fungus-like growth that appears on wheat is called “wheat slave.”

Section Seven: Cases in Which Induced Vomiting Is Appropriate (Indications and Prescriptions)

The general principle is that spring is suitable for the emetic method. After taking an emetic, as soon as its effect has been achieved, one should stop the medicine immediately; there is no need to finish the entire dose.

If the patient’s symptoms resemble Guizhi Tang syndrome (a category of externally contracted disease patterns), but there is no headache and no stiff neck, and the cunkou pulse is floating; if the chest is hard and full, qi rushes upward to the throat, making the patient breathless, this is accumulated phlegm in the chest, and emesis should be used.

When cold pathogen is in the chest, with oppressive pain in the chest, inability to eat, and a desire to have someone press on the chest; if pressing instead causes saliva or fluid to gush out, and there is diarrhea more than ten times a day. The patient’s pulse is slow, and the cun pulse is weak and slightly slippery. This condition is suitable for emesis. After vomiting, the diarrhea will stop.

For patients with Shaoyin disease who vomit as soon as they eat, with vexation and oppression in the heart, wanting to vomit but unable to do so, emesis is suitable. When food stagnates in the upper part of the gastric cavity, emesis is also suitable.

If the hands and feet are cold, the pulse is sometimes knotted and sluggish, exogenous pathogenic qi is in the chest, there is fullness and oppression below the heart, and the patient is hungry but cannot eat, this is disease in the chest, and emesis should be used.

Guadi San (Melon Stalk Powder): The patient’s symptoms resemble Guizhi Tang syndrome, but there is no headache and no stiff neck, and the cun pulse is slightly floating; the chest is stuffy, blocked, and hard, and qi rushes upward to the throat, making the patient breathless. This is cold in the chest, and emesis should be used.

Melon stalk and adzuki bean, one liang each.

Grind the above two ingredients into a fine powder and take one qian and seven fen; then take one ge of fermented soybean, cook it with seven ge of boiled water into a thin gruel, strain off the residue, take the liquid and mix it with the powder, and take it warm in a single dose. If there is no vomiting, small amounts may be added successively; stop after vomiting freely. Zhang Wenzhong’s method is to mix and take it with three ge of plain boiled water.

Shuidao San: Used for seasonal qi disease (epidemic externally contracted febrile illness), with symptoms of feverish heat like fire, delirious speech, and a desire to run about.

Gansui half a liang, Baizhi two liang, Dahuang four liang, Houpo eight liang, Zhishi five pieces, Mangxiao three ge.

Cut the above six ingredients. First boil Houpo and Zhishi in one dou of water until five sheng remain, then strain off the residue; add Dahuang and decoct until two sheng remain, then strain again; add Mangxiao and bring to one or two boils. Divide into two doses; stop after free purgation.

Didang Wan (Blood-Discharging Formula):

Leech and gadfly, twenty pieces each; peach kernel, twenty-two pieces; rhubarb, three liang.

Grind the above four ingredients into a fine powder, mix with honey, and divide into four pills. With one sheng of water…

Note: no further text is provided after the final phrase “with one sheng of water…,” so the translation can only proceed to this point.

Decoct the pills and take seven he of the medicinal liquid in one dose. After a day and night, stagnant blood should be discharged. If it is not, take another dose.

Dicheng Decoction (for the same condition as above)

Leeches, gadflies (30 of each), 23 peach kernels, and 3 liang of rhubarb.

Coarsely chop the four ingredients, add five sheng of water, and boil until three sheng of liquid remain. Strain out the dregs. Take one sheng; if there is still no discharge, take another dose.

Chengqi Decoction

Five bitter orange fruits, half a sheng of mirabilite, 4 liang of rhubarb, and 2 liang of licorice.

Coarsely chop the four ingredients, add five sheng of water, and boil until two sheng of liquid remain. Strain out the dregs and let the liquid cool to a suitable temperature. Divide it into three doses, taking one dose in the time it takes to walk five li each time, until the bowels move. If they still have not moved, finish the remaining liquid.

Fresh Rehmannia Decoction: For febrile illness with emaciation and weakness, shortness of breath, fullness below the heart, food stagnation in the stomach, and constipation.

Three jin of fresh rehmannia root, 4 liang of rhubarb, 1 liang of licorice, two he of mirabilite, and 20 jujubes.

Pound the five ingredients together until evenly mixed. Place them over five sheng of cooked rice and steam until done. Squeeze out the medicinal liquid and divide it into two doses.

Major Bupleurum, Solomon’s Seal, and Anemarrhena Decoction: For febrile illness that has not resolved after seven or eight days, with a withdrawn demeanor, inner restlessness, dry, bound stool in the abdomen, and delirious speech.

Half a jin of bupleurum; 2 liang each of Solomon’s seal, anemarrhena, rhubarb, and licorice; 3 liang each of ginseng, baical skullcap, and peony; 5 liang of fresh ginger; and half a sheng of pinellia.

Coarsely chop the ten ingredients, add one dou of water, and boil until three sheng of liquid remain. Strain out the dregs. Take one sheng per dose, three times a day, until the bowels move. The Jiyan Fang records a variation: add four bitter orange fruits and omit the peony.

Formula for Headache, High Fever, and Pain Throughout the Joints in Febrile Illness

Four liang each of bupleurum, gardenia seed, peony, and anemarrhena; 3 liang each of cimicifuga, baical skullcap, isatis leaf, and apricot kernel; 8 liang of gypsum; and one sheng of fermented soybeans.

Coarsely chop the ten ingredients, add nine sheng of water, and boil until two sheng and seven he of liquid remain. Divide into three doses and take warm. If the fever is severe, add 4 liang of rhubarb.

The units sheng, he, liang, and mei are measures used in ancient China. “Coarsely chop” refers to cutting the medicinal ingredients into rough pieces. These are prescriptions recorded in an ancient medical text and should not be used as modern medical guidance.

The Dou-chi Pill is used to treat lingering pathogenic fluid and food stagnation that remain after a cold damage illness. Take one sheng of fermented soybeans, three hundred seeds of oil-removed croton (two hundred seeds in current practice), sixty apricot kernels, and four liang each of Scutellaria root, Coptis root, rhubarb, and ephedra, plus three liang each of mirabilite and kansui root. Grind the nine ingredients into a fine powder, mix with honey, and form pills the size of soybeans. Take two pills at a time; if they do not produce a bowel movement, the dose may be increased as appropriate. Cui says this is the Huang Su formula.

The ninth chapter on sweating, inducing vomiting, and purging discusses the related pulse patterns, signs, formulas, and moxibustion methods.

If cold damage has resolved for about half a day, but restlessness in the chest and fever then appear, with a floating, rapid pulse, sweating may be induced again. Gui Zhi Tang is appropriate.

Drinking water after sweating may cause panting, so caution is needed.

Zhu Ye Tang is used when, after sweating, both the exterior and interior are deficient, there is vexing heat in the chest, and purging is unsuitable. Take two handfuls of bamboo leaves, half a sheng of pinellia, one sheng of Ophiopogon, two liang each of ginseng and licorice, four liang of ginger, and one jin of gypsum. Cut the seven ingredients into pieces. Boil them in one dou of water until six sheng remain, then strain out the dregs. Add half a sheng of polished rice and cook until the rice is done. Remove the rice and take the decoction in divided doses of one sheng, three times a day. Zhang Wenzhong’s version omits ginger.

If profuse sweating occurs after taking Gui Zhi Tang and the pulse is surging and large, continue using Gui Zhi Tang. If the illness resembles malaria, occurring twice a day and easing after sweating, Gui Zhi Er Ma Huang Yi Tang is appropriate. Take one liang and seventeen zhu of cinnamon twig, sixteen zhu of ephedra, one liang and six zhu each of peony and ginger, one liang and two zhu of licorice, sixteen apricot kernels, and five jujubes. Cut the seven ingredients into pieces. Boil the ephedra in five sheng of water; after it boils twice, skim off the foam. Add the other ingredients and boil until two sheng remain. Let the decoction cool to a suitable temperature, then take it in two doses. A slight sweat is enough.

Xiao Qing Long Tang is used to treat cold damage when the exterior condition has not yet resolved and water is lodged below the heart. Symptoms may include dry retching, fever, and coughing, and may also be accompanied by thirst, diarrhea, a sensation of obstruction in the throat, difficulty urinating, fullness in the lower abdomen, or panting. The formula lists cinnamon bark, ephedra, licorice…

Dried ginger, peony root, and asarum, three liang each; schisandra berries and pinellia, half a sheng each.

Chop the eight ingredients. First decoct the ephedra in one dou of water until the water has reduced by two sheng, then skim off the foam. Add the remaining ingredients and decoct until three sheng remain. Divide into three doses, taking them at intervals equivalent to the time it takes to travel about ten li. If thirsty, omit pinellia and add three liang of trichosanthes root. For mild diarrhea, omit ephedra and add one egg-sized piece of erycibe, stir-fried until red. For obstruction in the throat, add one aconite. For difficulty urinating and fullness in the lower abdomen, omit ephedra and add four liang of poria. For panting, omit ephedra and add half a sheng of apricot kernels. Used repeatedly, this remedy is highly effective.

Four-Ingredient Licorice Decoction is used for cases in which sweating persists after diaphoresis for Cold Damage, with panting but no marked fever.

Licorice, two liang; ephedra, four liang; gypsum, half a jin; apricot kernels, fifty.

Chop the four ingredients. First decoct the ephedra in seven sheng of water until the water has reduced by two sheng. Add the remaining ingredients and decoct until three sheng remain. Divide into three doses.

Gardenia Decoction is used for vexing heat, oppression in the chest, and rebellious Qi surging up toward the heart after diaphoresis or purgation.

Gardenia fruit, fourteen; fermented soybeans, four he, wrapped in cotton cloth.

First decoct the gardenia fruit in four sheng of water until two and a half sheng remain. Add the fermented soybeans and decoct until one and a half sheng remain. Divide into two doses and drink warm. If vomiting occurs readily after the first dose, stop taking the decoction and do not take the second dose.

Magnolia Bark Decoction is used to treat abdominal distention after diaphoresis.

Magnolia bark, half a liang; ginseng, one liang; licorice, two liang; fresh ginger, eight liang; pinellia, half a sheng.

Chop the five ingredients and decoct them in one dou of water until three sheng remain. Divide into three doses.

Black Tortoise Decoction is used for Taiyang disease when diaphoresis has been given but the illness has not resolved: fever persists, accompanied by palpitations below the heart, dizziness, twitching muscles, and a sensation of swaying as if about to fall.

Poria, peony root, and fresh ginger, three liang each; white atractylodes, two liang; one aconite.

Chop the five ingredients and decoct them in eight sheng of water until three sheng remain. Drink seven ge warm per dose.

Kudzu Root and Coptis Decoction is used when purgation has been mistakenly used for Taiyang disease and diarrhea continues without stopping, with a pulse…

When the pulse is rapid, the exterior pattern (with the pathogenic influence still at the body’s surface) has not yet resolved, and there is wheezing and sweating, use the following prescription:

Half a jin of Gegen (kudzu root), three liang each of Huanglian (Coptis) and Huangqin (Scutellaria), and two liang of Gancao (licorice).

Cut the four ingredients into pieces. Add eight sheng of water and decoct the Gegen first, reducing the liquid by two sheng. Then add the remaining ingredients and decoct until two sheng remain. Strain out the dregs and take in two doses.

Fuling Tang (Poria Decoction): This is used after sweating, inducing vomiting, or purging for a cold-damage illness, when fullness develops below the heart (in the pit of the stomach), Qi surges upward into the chest, and dizziness follows. The pulse is deep and tight. If sweating is induced again at this point, the channels will be damaged, causing the body to tremble and sway. Use the following prescription:

Four liang of Fuling (poria), three liang each of Baizhu (white atractylodes) and Guixin (cinnamon bark), and two liang of Gancao (licorice).

Cut the four ingredients into pieces. Add six sheng of water and decoct until three sheng remain. Strain out the dregs and take in three doses.

When the cun position of the Cunkou pulse is floating while the guan position is instead deep, this is called a chest bind (a condition in which pathogenic heat, fluids, and other factors become bound in the chest and abdomen, causing distension and pain; the Chaoyuan text records “deep and fine”).

In a cold-damage illness, if the pathogen moves from the exterior into the interior and purging is mistakenly used, pathogenic heat sinks inward and a chest bind forms.

Daxianxiong Wan (Major Chest-Draining Pill): This treats a chest bind accompanied by stiffness in the neck, resembling roujing (a condition marked by bodily rigidity and a stiff neck). After taking it, the pathogen is expelled downward. Use the following prescription:

Eight liang of Dahuang (rhubarb), and five ge each of Mangxiao (mirabilite), Xingren (apricot kernels), and Tingli (pepperweed seeds).

Pound and sift the Dahuang and Tingli. Grind the Xingren and Mangxiao separately until smooth and oily, then mix them with the powdered herbs. Form one pill from the powder, about the size of a pellet. Add one qian and seven fen of Gansui powder, two he of white honey, and one sheng of water. Decoction until eight he remain, then take one warm dose. If there is no bowel movement, take another dose. A bowel movement indicates that it has worked.

On the sixth or seventh day of a cold-damage illness, if pathogenic heat is firmly bound inside a chest bind, the pulse is deep and tight, and there is pain below the pit of the stomach with marked hardness on pressure, Daxianxiong Tang is appropriate.

If, in a Taiyang disease (a type of cold-damage pattern in which the pathogen is at the exterior), sweating is induced repeatedly and purging is then used, and after five or six days there has been no bowel movement, the tongue is dry and the mouth thirsty, mild tidal fever appears in the afternoon, there is severe agitation in the chest, and the area from the pit of the stomach to the lower abdomen is hard, distended, and painful, with even approaching it unbearable, Daxianxiong Tang is appropriate.

Daxianxiong Tang (Major Chest-Draining Decoction) prescription:

One qian and seven fen of Gansui powder, six liang of sliced Dahuang (rhubarb), and one sheng of Mangxiao (mirabilite).

Add six sheng of water to the three ingredients and decoct the Dahuang first, reducing the liquid to two sheng. Strain out the dregs, add the Mangxiao, and bring it to a boil once. Then add the Gansui. Take in two doses. If one dose produces a satisfactory bowel movement, omit the second dose.

Gancao Xiexin Tang (Licorice Heart-Drainage Decoction): In patients with cold-damage or wind-strike illness, the physician mistakenly uses purging, causing the patient to develop diarrhea...

If a person has bowel movements dozens of times a day, the grains they eat remain undigested, their abdomen gurgles, and the area below the heart feels blocked, hard, and distended, they may also retch dryly, feel agitated, and be unable to settle. If this is taken to mean that the pathogenic influence has not yet been cleared, and purging is used again, the blockage below the heart will become worse. This is not heat pathogen bound in the interior; it is caused by weak Stomach Qi, with an external pathogenic influence moving upward in counterflow. The following formula should be used to regulate the condition:

Four liang of licorice, three liang of Scutellaria root, three liang of dried ginger, one liang of Coptis rhizome, half a sheng of Pinellia tuber, and twelve jujubes.

Cut the six ingredients into pieces. Boil them in one dou of water until six sheng remain, then strain out the dregs. Divide the decoction into doses of one sheng each, taken three times a day. (A note says that three liang of ginseng should be added.)

Fresh Ginger Drain the Epigastrium Decoction (Shengjiang Xiexin Tang), a formula centered on fresh ginger, treats disharmony in the Stomach after sweating for cold damage: a hard blockage below the heart, frequent belching with a foul, spoiled-food smell, water-fluid below the ribs, and abdominal rumbling with diarrhea. The ingredients are:

Four liang of fresh ginger, three liang of licorice, three liang of ginseng, three liang of Scutellaria root, one liang of dried ginger, one liang of Coptis rhizome, half a sheng of Pinellia tuber, and twelve jujubes.

Cut the eight ingredients into pieces. Boil them in one dou of water until six sheng remain, then strain out the dregs. Divide the decoction into doses of one sheng each, taken three times a day.

White Tiger Decoction (Baihu Tang) treats a condition in which, after vomiting and purging for cold damage, the illness remains unresolved after seven or eight days. Heat pathogen is bound in the interior, with heat both on the exterior and in the interior. The person often fears wind, is extremely thirsty, has a dry tongue and agitation, and wants to drink several sheng of water. The ingredients are:

One sheng of gypsum, six liang of Anemarrhena rhizome, two liang of licorice, and six ge of non-glutinous rice.

Cut the four ingredients into pieces and boil them together in one dou of water. When the rice is cooked, strain out the dregs. Divide the decoction into doses of one sheng each, taken three times a day. Anyone with bleeding symptoms or physical weakness must not take White Tiger Decoction.

From the beginning of summer until before the beginning of autumn, this formula may be used when the condition is appropriate. It must not be taken after the beginning of autumn. It must also not be used during the three spring months, when the weather is still cold. Taking it by mistake at these times may cause vomiting, diarrhea, and abdominal pain.

In cold damage, if there is no marked high fever but the mouth is dry and thirsty, the person feels agitated, and the back is slightly sensitive to cold, White Tiger Decoction may be taken.

In cold damage, if the pulse is floating, there is fever and no sweating, and the exterior condition has not yet resolved, White Tiger Decoction must not be taken. If the person is thirsty and wants to drink but has no exterior condition, the decoction may be taken. If the person is thirsty and wants to drink, with a dry mouth and tongue, the decoction is also appropriate.

Pill of Celosia Seeds, used to treat lingering internal heat and constraint after an attack of Cold Damage, accompanied by restlessness and thirst. Grind the following eight ingredients into powder: five liang of celosia seeds; one liang each of Scutellaria root, trichosanthes root, and sophora root; two liang of phellodendron bark; and three liang each of gentian, gardenia seed, and coptis root. Mix the powder with honey and form pills the size of wutong seeds. Take seven pills before meals, three times a day. If they have no effect, gradually increase the dose. Another version in the original text says to mix the powder with maltose syrup to make the pills.

Great Green Decoction, used to treat Cold Damage or a heat illness lasting more than ten days when the illness persists after sweating has been induced, or when heat does not subside after vomiting or diarrhea, diarrhea continues, or a rash appears on the body. Take four liang of great green, two liang each of licorice and donkey-hide gelatin, and one sheng of fermented soybeans. Cut the ingredients into pieces, add eight sheng of water, and decoct until two sheng remain. Strain out the dregs, then bring the liquid to a boil three times. Remove the soybeans and add the gelatin, stirring until it melts. Take one sheng per dose, three times a day. When the decoction is nearly finished, prepare another batch so that some is always left over. Drink water when thirsty. This formula clears heat and stops vomiting and diarrhea; the text says it is nontoxic. The version recorded by Shenshi is used to treat relapse caused by overexertion during recovery. The Elbow Reserve Formulas adds three liang of red halloysite. The Hu Qia Ji Yan Fang gives the same formula.

A formula for treating a lingering illness after Cold Damage, with fever in the morning and evening like bouts of malaria: two liang of anemarrhena; and one liang each of ephedra, licorice, peony, Scutellaria root, and cassia bark. Cut the six ingredients into pieces, add seven sheng of water, and decoct until two and a half sheng remain. Take five he of the warm decoction per dose, three times a day, and cover yourself with a quilt so that you sweat lightly. If you feel restless, cannot sleep, and want to drink water, sip it a little at a time. This will harmonize the Stomach Qi, and you will improve.

Physicians in the Jiangnan region secretly passed down Zhongjing’s important formulas, but did not make them publicly available.

Acupuncture and moxibustion treatment: At the onset of illness, the first symptoms may include headache, chills and fever, feeling cold and wanting to warm yourself by a fire, stiffness in the lower back and back, or a flushed face as if drunk. These are signs of the first day or two of Cold Damage. At this point, apply strong moxibustion at three points below the heart (in the upper abdomen). The first is one cun below the pit of the stomach, called “Great Palace Gate”; the second is two cun below it, called “Upper Tube”; the third is three cun below it, called “Stomach Tube.” Apply fifty moxa cones at each point, with each cone constituting one application of moxibustion. However, people’s body sizes differ, so the cun measurements between points may vary. It is best to measure according to each person’s body length using a cord. The original text breaks off at “take a cord from the breastbone”; the rest of the method is not recorded.

The location of Jiuwei is determined as follows: measure with a cord from the center of the navel to Jiuwei on the chest, then fold the cord in half. The point reached by the end of the cord marks Jiuwei.

The location of Weiguan, an acupoint on the upper abdomen, is also measured with a cord. First fold the cord in half, then divide that folded length into two equal parts. Measure one part upward from Weiguan to find Shangguan, then measure another part upward to find Juque. Adults may receive fifty cones of moxibustion (each burning of moxa counts as one cone); children may receive three cones, with the number adjusted as appropriate for their age. The precise number should be determined according to the illness and the person’s constitution.

If the patient has been ill for three or four days or longer, first apply twenty cones of moxibustion to the upper chest. Measure with a cord from the tip of the nose up to the midpoint of the hairline, then fold the cord in half and cut off one half. From the hairline, measure inward beneath the hair to the point reached by the cord’s end; this point is called Tiansong. Next, apply moxibustion to the temples on both sides, then to Fengchi on both sides, points at the back of the neck. Then apply one hundred cones to Ganshu, the back point corresponding to the liver, and twenty cones to each of the remaining points, followed by thirty cones to Taichong. The text calls this method “miraculously effective.”

Sun the Immortal’s Essential Prescriptions for Emergencies, juan 31