《孫真人備急千金要方》Vol. 33

Treating Formulas for Cold Damage: Chapter Two, Relapse from Overexertion (on Dietary Restrictions and Prescriptions)

When a febrile illness has only just subsided, or after a serious illness, eating pork, sheep’s blood, fatty fish, rich or oily foods, and the like will inevitably cause severe diarrhea. Even a physician may find it difficult to treat, and the patient may die as a result.

If the patient eats cakes and pastries, millet, maltose, dried meat, grilled or roasted foods, dates, chestnuts, various fruits, cured or dried meat, or other hard-to-digest foods, the Stomach Qi (the digestive function of the stomach) may still be too weak to digest them. Heat pathogens will then accumulate again. If purgatives are used to force them out, the Stomach Qi will become even more weak and cold, and severe diarrhea may follow that is difficult to stop. If purgatives are not used, the patient may die. Either course is dangerous and difficult to treat. Many people have died this way after febrile or serious illness, so great caution is necessary.

Just after recovery, the patient should eat only thin rice porridge. It is better to eat too little and feel slightly hungry than to eat one’s fill. Be careful not to overeat, and do not give the patient any other foods, even if they are strongly desired. After some time, as the body gradually recovers, the patient may slowly begin eating mutton and thicker rice porridge. Broths are also suitable, as are pheasant, rabbit, and venison, but pork and dog meat should be avoided.

After an illness has just passed, the patient should lie quietly and rest with care, and should not get up too soon to comb their hair or wash their face. These activities can tire the body. The patient should also avoid talking too much, exerting the mind, or exhausting the spirit. Any such exertion may cause the illness to return; this is called “relapse from overexertion.”

In the past, Gu Zixian, a district inspector, believed he had recovered after an illness, though his body had not yet regained its strength. He went to Hua Fu to have his pulse examined. Hua Fu said, “Although the illness has passed, your body is still weak and your Yang Qi has not recovered. Do not exert yourself. Other forms of exertion may be bearable, but the exertion of sexual intercourse can be fatal. You may vomit your tongue out several inches.” When his wife heard that he was well, she traveled more than a hundred li to visit him. They spent the night together and had sex. Three days later, he developed a fever and his jaw clenched. As he was dying, his tongue protruded several inches, and he died.

If a person has sex before a hundred days have passed since recovery, while their strength has not yet fully returned, they almost never survive. A scholar named Gai Zheng was able to go out hunting sixty days after recovering, but after having sex he vomited saliva and died. Sexual intercourse during a febrile illness is called “Yin-Yang Exchange” (a category of illness in which sexual activity during or after illness causes the condition to be transmitted or relapse). This condition is also difficult to treat, and many people die from it.

More recently, a senior official had a mild case of Cold Damage. A little over ten days after recovering, he was able to ride out on horseback and believed himself well again. After having sex, he suddenly developed severe pain in the lower abdomen, and his hands and feet cramped. He eventually died.

After recovering from a seasonal illness, eating various kinds of meat and wheat-based foods before five full days have passed may cause the illness to return and leave the person extremely weak.

Just after recovering from a seasonal illness, drinking alcohol or eating chives as soon as the body has resumed normal activity may cause the illness to return.

Just after recovering from a seasonal illness, eating raw or salted fish may cause persistent diarrhea.

Just after recovering from a seasonal illness, eating raw lettuce may keep the complexion from returning to normal for a long time.

Just after the fever has subsided and the illness pathogen has been dispelled, drinking cold water may injure the pericardial system (here referring to the functions of the organs surrounding the heart) and leave the person weak. Even with restorative care, recovery may be difficult.

Just after recovering from a seasonal illness, eating raw jujubes and lamb may cause heat to rise above the chest and diaphragm, as if hot vapors were steaming upward.

Just after recovering from a seasonal illness, eating dog meat, lamb, or similar foods may cause a steaming sensation of heat in the bones.

Just after recovering from a seasonal illness, eating fish and then eating melons and raw lettuce may cause the body to become hot. (Another text records this as “swelling of the body.”)

Just after recovering from a seasonal illness, eating garlic and kuai (finely chopped raw meat) may cause the illness to return and leave the person extremely weak.

Yellow Dragon Decoction (also called Minor Bupleurum Decoction): A formula for treating headache, high fever, and agitation that recur after recovery from cold damage. This formula comes from Zhongjing (Zhang Zhongjing).

Half a jin of bupleurum, half a sheng of pinellia, three liang of skullcap, two liang of ginseng, two liang of licorice, four liang of fresh ginger, and eleven jujubes.

Cut the seven ingredients into pieces. Boil them in one dou of water until five sheng of liquid remain, then strain out the dregs. Take five ge per dose, three times a day. If there is no vomiting but the mouth is thirsty, omit the pinellia and add four liang of trichosanthes root.

Formula to replenish deficiency and debility after severe illness (also suitable for various kinds of deficiency and debility): Take one sheng of milk from a yellow cow that has given birth at least seven years and is more than five years old. Add four sheng of water and boil until one sheng remains. Let it cool to near body temperature, then drink it slowly; do not drink too much. Continue taking it for ten days for better results.

Formula for recurrence after cold damage or warm disease, brought on by exertion or food: Thirty-seven seeds of gardenia, five liang of gypsum, one sheng of fermented soybeans, and twenty mouse droppings with pointed ends. Cut the four ingredients into pieces. Boil them in seven sheng of water until three sheng remain, then divide into three doses.

Method for treating a recurrence after illness brought on by exertion such as washing the hands or feet, combing the hair, or eating: Take one ge of the water used to wash the hands and feet and drink it. Then take a piece of scalp grime about the size of a jujube pit and swallow it.

Phragmites and Gardenia Decoction: A formula for relapse caused by exertion after recovery from a serious illness.

Three immature bitter orange fruits, fourteen gardenia fruits, and one sheng of fermented soybeans, wrapped in cotton cloth.

Cut the three ingredients into small pieces. First boil them in seven sheng of vinegar water until four sheng remain. Add the immature bitter orange and gardenia, and boil until two sheng remain. Then add the fermented soybeans and boil for another five or six rolling boils. Strain out the herbs and take the liquid in two doses. Cover yourself with a quilt to bring on slight sweating. If undigested food still remains in the abdomen, add five or six slices of rhubarb, each about the size of a game piece.

A formula for relapse after recovery from an illness caused by eating too much of especially appetizing food:

Burn the leftover food to ash and take two qian mixed into a drink. Take it in three doses over seven days.

A formula for relapse after recovery from an illness caused by getting up too soon, eating too much, or exertion:

Five ge of fermented soybeans and twenty-one pointed mouse droppings.

Boil these two ingredients in two sheng of water until one sheng remains, and drink it all. Then lie down in a warm bed and rest, allowing the body to sweat slightly; the illness will resolve. Cui’s formula adds seven gardenia fruits and is said to work better. The Zhouhou Fang records that one sheng of hemp seeds may also be added, along with an extra sheng of water. Three immature bitter orange fruits and a handful of scallion whites may also be added.

A formula for a life-threatening relapse after recovery from a serious illness, caused by getting up too soon, exertion, or eating too much:

Burn softshell turtle shell to ash and take one square-inch spoonful mixed into a drink. (A square-inch spoonful was the amount held by an ancient measuring spoon.)

A formula for relapse caused by overeating, undigested food, and exertion, with a forceful pulse:

One sheng of fermented soybeans, twenty mouse droppings, seven gardenia fruits, and three liang of rhubarb.

Cut these four ingredients into small pieces. Boil them in six sheng of water until two sheng remain, then take in three doses. Stop when slight sweating occurs. If the stool becomes loose, like the droppings of a duckling, stop taking the medicine; if this does not occur, take another dose.

A formula for severe relapse caused by exertion:

Take three ge of warm broth, use it to wash the genitals of a girl aged four or five, and drink the wash water. This is said to bring recovery; it may also be used for a boy.

Ophiopogon Decoction: A formula for relapse caused by exertion when the breath is nearly gone, said to bring the dying back to life.

One liang of Ophiopogon, two liang of licorice, twenty Chinese dates, and one sheng of chopped bamboo leaves.

Cut these four ingredients into small pieces. First boil one sheng of polished rice in seven sheng of water. When the rice is cooked, remove it, then add the herbs and boil until three sheng remain. Take in three doses. If the patient cannot swallow, dip cotton wool into the decoction and drip it into the mouth; this is said to be effective.

A formula for relapse caused by exertion related to eating:

Boil two sheng of flour and drink the resulting liquid.

Another prescription: Boil fifty apricot kernels in two sheng of vinegar. When the liquid has boiled down to one sheng, take it.

Promoting sweating

Another prescription: Burn human feces to ash, mix it with water, and take one fangcun bi (a measure used with an ancient medicine spoon). Take this amount.

A prescription to prevent the illness from recurring

Burn the grime from the head to ash. Take a lump about the size of a parasol tree seed and swallow it.

A prescription for fluid accumulation below the heart and inability to eat, one year after recovering from cold damage

Use five jin of fresh Rehmannia root, one jin of white atractylodes, and two jin of fine flour. Pound the three ingredients together until evenly mixed, dry them in the sun, and sift them into a fine powder. Take one fangcun bi with wine. After seven days, increase the dose to two fangcun bi.

Discussion

When a woman contracts a warm disease, she may recover from the illness without fully regaining her strength. Her Qi and Blood channels have not yet returned to harmony, and heat toxins remain in her body. If a man has intercourse with her at this time and contracts the illness, this is called “Yin Exchange.” The patient’s body becomes heavy and feverish; heat surges into the chest; the head feels too heavy to lift; eye discharge forms (some versions say a film forms over the eyes); the limbs stiffen and contract (another account says the knees and calves contract); the lower abdomen cramps, and the hands and feet curl inward. Some patients die immediately.

Others do not die at once. They suffer cramping pain in the lower abdomen, heat surging into the chest, and heaviness in the head that makes them reluctant to lift it. Their joints feel as if they have come apart; their channels grow slack and weak; Qi and Blood are depleted, the marrow is exhausted, and their breathing becomes rapid and faint. Their strength steadily diminishes until they lie motionless in bed, needing help to sit up or lie down. Some linger for years before dying. The physician Zhang Miao said that a maidservant, just days after recovering from an illness, was assaulted by six men, all of whom died.

A prescription for illness passed from a woman to her husband, or from a husband to his wife

Take a woman’s trousers that have been worn close against her private parts. Burn them to ash and take one fangcun bi for three consecutive days. When urination flows freely and the penis swells slightly, the patient is considered cured. If the woman is ill, the same method may be used with a man’s trousers.

A prescription for relapse after intercourse, with swollen or retracted testicles, cramping pain in the lower abdomen, and a critical condition

Cover the man with clothing worn by the woman with whom he had intercourse. The text says this will bring immediate recovery.

A prescription to prevent the illness from recurring

Take a total of twenty of a woman’s fingernails and toenails, along with one chi of her close-fitting sash. Burn them, then mix the ashes with wine or rice drink and take them.

A prescription for relapse when a man, just recovered from illness, goes near a woman

Burn to ash a piece of red cloth stained with menstrual blood and take one fangcun bi. The text says this method can also treat swollen or retracted testicles that have drawn up into the abdomen, accompanied by cramping pain and a critical condition.

A method for hair that becomes tousled and difficult to comb after illness

Only the heading remains in the source; no prescription is recorded.

Take two sheng of raw sesame oil (unprocessed sesame oil). Untie the hair and place it in a copper sieve, soaking it thoroughly with the oil. Then slowly comb through and separate the hair with a hairpin. After a while, it will come apart on its own.

The Third Discussion and Prescriptions on Lily Disease

The discussion says: “Lily disease” means that the illness has affected the body’s channels and vessels throughout, gathering in the person as a whole. It often develops after a cold-damage illness, depletion and fatigue, or a serious illness, when the body has not yet returned to balance.

If the patient fears cold and vomits, the illness is in the upper burner—the upper part of the body, mainly above the diaphragm—and should resolve in about twenty-three days. If the abdomen is distended and full, breathing is slightly labored, and the stools are dry and hard, occurring only once every three or four days, though at times they are somewhat loose, the illness is in the middle burner—the middle part of the body, mainly where the Spleen and Stomach are located—and should resolve in about sixty-three days. If urination is dribbling and difficult, the illness is in the lower burner—the lower part of the body, mainly below the abdomen—and should resolve in about thirty-three days. Treat each case according to its specific signs.

The signs of lily disease are these: the patient wants to eat but cannot; at times food seems appealing, while at other times even its smell is unwelcome. The patient may seem afraid of cold, though there is no actual cold pattern, or seem feverish, though there is no actual heat pattern. The patient is often quiet and sparing of words, wants to lie down but cannot sleep. In the morning, the mouth feels bitter, and the urine is reddish and difficult to pass. The patient wants to move but cannot. No medicines seem to cure the illness; after taking them, the condition worsens, with vomiting and diarrhea, as though spirits were causing trouble.

A person with lily disease appears calm on the outside, while the pulse is faint and slightly rapid. If the patient has a headache each time they urinate, recovery takes sixty days. If urination brings no headache but is accompanied by bouts of chills, recovery takes forty days. If urination feels comfortable and the only symptom is dizziness, recovery takes twenty days.

The signs of lily disease may appear before the illness itself begins, after four or five days of illness, or even after twenty days or a month. It is easy to misjudge the condition in treatment, so diagnosis and treatment must follow the signs.

The discussion further says: If the illness is in the Yin aspect but treatment attacks the Yang aspect, the illness in the Yin aspect will not be resolved; inducing sweating afterward is treatment in reverse. If the illness is in the Yang aspect but treatment attacks the Yin aspect, the illness in the Yang aspect will not be resolved; purging afterward will not cure it either. (The Essential Prescriptions from the Golden Cabinet says: When the illness is in the Yin aspect, use methods that harmonize the Yang aspect to rescue the patient; when it is in the Yang aspect, use methods that harmonize the Yin aspect to resolve it. If the illness is in the Yang aspect but one attacks the Yin aspect and then induces sweating, this is treatment in reverse and the illness will be difficult to treat. If the illness is in the Yin aspect but one attacks the Yang aspect and then purges, this too is treatment in reverse, and the illness will likewise be difficult to treat.)

Lily Bulb and Anemarrhena Decoction: Used when Lily Bulb Disease recurs after sweating treatment.

Take seven lily bulbs and separate them into petals; use three liang of Anemarrhena. First soak the lily bulbs overnight in spring water, until foam appears on the water. The next morning, discard the soaking water, add two sheng of spring water, and boil the lily bulbs until one sheng of liquid remains. Set it aside. Slice the Anemarrhena separately, add two sheng of spring water, and boil until one sheng of liquid remains. Combine this with the lily bulb liquid, then simmer until one and a half sheng remains. Divide into two doses. If the condition does not improve, prepare and take another course in the same way.

Lily Bulb, Talc, and Hematite Decoction: Used when Lily Bulb Disease recurs after purgation.

Take seven lily bulbs and separate them into petals; use three liang of talc and one liang of hematite. First soak the lily bulbs overnight in spring water. The next morning, discard the soaking water, add two sheng of spring water, and boil the lily bulbs until one sheng remains. Strain out the herbs. Separately, boil the talc and hematite in two sheng of water until one sheng remains. Pour this liquid into the lily bulb liquid, then simmer them together as before until one and a half sheng remains. Divide into two doses.

Lily Bulb and Egg Yolk Decoction: Used when Lily Bulb Disease recurs after induced vomiting.

Take seven lily bulbs, separate them into petals, and soak them overnight. Discard the soaking water, add two sheng of spring water, and boil until one sheng remains. Add the yolk of one chicken egg and stir well. Divide into two doses.

Lily Bulb and Rehmannia Decoction: Used when Lily Bulb Disease has not initially been treated with sweating, induced vomiting, or purgation, and the condition remains as it was at the outset.

Take seven lily bulbs, separate them into petals, and soak them overnight. Discard the soaking water, add two sheng of spring water, and boil until one sheng remains. Add one sheng of fresh Rehmannia juice, then simmer until one and a half sheng remains. Divide into two doses. The appearance of unusual foam in the stool is taken as an indication of the medicine’s effect.

When Lily Bulb Disease has persisted for a month without recovery and has developed into thirst:

Take one sheng of lily bulb root and soak it overnight in one dou of water. First wash the patient’s body with the soaking liquid. After washing, have the patient eat plain boiled wheat cakes without salt or fermented black beans. If the thirst is still not relieved, prepare a powder using equal amounts of Trichosanthes root and oyster shell. Take one square-inch spoonful three times a day.

When Lily Bulb Disease develops into fever:

Take one liang of dried lily bulb root and three liang of talc. Grind them into a fine powder and sift. Take one square-inch spoonful three times a day. Mild diarrhea should occur after taking it.

“Lily Bulb Disease” is the name of an illness in ancient medical texts. A “square-inch spoonful” is a set dose measured with an ancient implement for scooping medicinal powders.

If diarrhea occurs after taking the medicine, stop taking it and do not resume. If you develop a fever, the symptoms will subside. Another text records this as “treating lily disease.” People with lily disease may also have dark yellow urine, painful or difficult urination, and tightness, hardness, and pain below the navel.

A prescription for treating lily disease that has developed into abdominal distension and pain: Take an appropriate amount of lily bulb, stir-fry until yellow, then pound it and sift it into a fine powder. Take one square-inch spoonful (an ancient small measuring spoon for medicines) three times a day. When the abdominal distension subsides, the pain will stop.

— Essential Prescriptions Worth a Thousand in Emergencies by Master Sun, volume 33