《孫真人備急千金要方》Vol. 36

People receive the Qi of Heaven and Earth and come into being. Within the body are the five zang organs and six fu organs, as well as Jing, Qi, bones and marrow, sinews, and vessels. Outside the body are the limbs, the nine openings—the eyes, ears, nose, mouth, and other apertures—skin and hair, fingernails, teeth, throat, lips, tongue, anus, and reproductive organs. Together, these make up the human body.

When properly cared for, the body’s many vessels can remain settled and harmonious. If we work or use the body inappropriately, we may suffer from the five kinds of overstrain and seven kinds of injury—various forms of damage from overexertion—as well as the six extremes, conditions of profound bodily depletion. Even if we fall ill, without a reliable method of treatment, we may die suddenly. For this reason, each volume of this section of the book describes the origins, circulation, and flow of blood through the five zang organs and six fu organs, and the points where they correspond to the nine openings. It also discusses the organs’ weight, size, length, width, and capacity, and sets out methods of treatment, including pills, powders, medicinal wine, decoctions, plasters, massage, hot compresses, acupuncture, and moxibustion. Those who study the art of healing can use this account to guide their examination and practice. By choosing medicines according to their properties and to the presence of Cold or Heat, deficiency or excess, and pathogenic Wind, one can address diseases both inside and outside the body.

In Heaven, the five zang organs correspond to the Five Planets; on Earth, they correspond to the Five Sacred Mountains; in the cycle of time, they correspond to the Five Phases (Wood, Fire, Earth, Metal, and Water); and in the human body, they are the five zang organs themselves. These organs are also linked with the spirit, Hun and Po souls, and thought. To discuss Yin-Yang, distinguish deficiency from excess, understand the causes of illness, and apply tonifying and draining methods, one must also take into account the body’s 365 joints and trace the connections of the twelve channels.

The liver stores the Hun soul. The Hun moves to and fro with the activity of the spirit, like an attendant following its lord; hence it is called the “Hun.” The liver is where the Hun is stored. The eyes are the liver’s sensory orifices, and liver Qi communicates with them. When the eyes are in harmony, they can distinguish the five colors. The left eye belongs to Jia and the right to Yi; their circulation moves through the Purple Palace, here referring to a related part within the body, and their vital essence nourishes the nails. Externally, the liver governs the sinews; internally, it governs the blood.

The liver weighs four jin and four liang. It has three lobes on the left and four on the right, seven in all. The text says that six youths and three jade maidens guard the liver. Its spirit is named Lanlan and is in charge of storing the Hun, which is why the liver is also called the “Hun organ.” As liver Qi responds to the seasons and to the various parts of the body, it is said that the liver stores blood; blood is where the Hun resides. Liver Qi manifests in the voice as speech and in bodily fluids as tears. When liver Qi is weak, a person feels fear; when it is full, a person becomes angry. When liver Qi is weak, one may dream of flowers and plants growing in a garden; when the corresponding season arrives, the dreams…

When a person lies beneath a tree and is afraid to get up, this is a sign that the Liver Qi is flourishing, and they will dream of becoming angry. If the deviant Qi of reversal—disordered, rebellious Qi—invades the Liver, they will dream of mountains, forests, and trees.

When a person lies down to sleep, the blood returns to the Liver. When the Liver is nourished by blood, the eyes can see; when the feet receive blood, they can walk; when the palms receive blood, they can grasp objects; and when the fingers receive blood, they can seize things.

In the Five Phases, the Liver corresponds to Wood and is paired with the Gallbladder, which is its fu organ. The Liver channel is the Foot Jueyin channel; it is interiorly and exteriorly paired with the Foot Shaoyang channel, the Gallbladder channel. The Liver’s pulse is the wiry pulse—straight and long, like a taut string. In winter it is secondary in strength; in spring it is flourishing. In spring, all things begin to grow. When the Liver pulse arrives, it is soft and fine, relaxed and empty, and thus has the quality of a wiry pulse. A soft pulse should not be treated by inducing sweat; a fine, weak pulse should not be treated with purgation. “Relaxed” means open, and open means unobstructed; unobstructed means free-flowing. This is why it is called “relaxed and empty.”

The pulse in spring is like a taut string: this is the Liver pulse, associated with Wood in the East, the season when all things begin to grow. So when the pulse arrives, it is soft, fine, light, and empty, yet also smooth, even, firm, and long; for this reason it is called wiry. A pulse that is the opposite of this is diseased. What counts as the opposite? If the pulse arrives full and hard, it is called excessive, and the illness is in the exterior. If it arrives insubstantial and faint, it is called deficient, and the illness is within. Excessiveness may make a person prone to anger (one version reads “forgetfulness”), feel dazed and dizzy, and even develop dian illness—mania or episodes of collapse. Deficiency causes chest pain that reaches through to the back, with distension and fullness in the flanks.

The Liver pulse arrives soft and fine, swaying gently like the tip of a long bamboo pole being lifted; this is a normal, harmonious pulse. In spring, Stomach Qi—the calm, even quality felt in the pulse—is its foundation. If the Liver pulse arrives full, substantial, and slippery, like touching a long bamboo pole, this indicates Liver disease. If it arrives urgent and even stronger, like a bowstring drawn tight, it is a death pulse showing that the Liver Qi is about to be exhausted.

When the true-organ pulse appears in the Liver—that is, when the organ’s Qi is exposed in the pulse and Stomach Qi is absent—the pulse is tight and urgent both inside and out, sharp as a blade under the fingers, and like pressing a stringed instrument’s strings (one version reads, “like a newly strung bow”). The complexion is blue-white and dull, and the body hair is dry and brittle. Death will follow.

A normal spring pulse has a slight wiry quality together with Stomach Qi. If the wiry quality is pronounced and Stomach Qi is weak, this indicates Liver disease. If the pulse is only wiry, with no Stomach Qi, it is a death pulse. If Stomach Qi is present along with the rough, floating quality of the autumn pulse, illness will arise in autumn. If that rough quality is especially pronounced, illness caused by Metal Qi overcoming Wood will arise at once.

The Liver stores blood, and blood is the dwelling place of the Hun. Excessive grief disturbs the heart and harms the Hun. When the Hun is injured, a person becomes wild and reckless, and the spirit cannot remain settled (one version reads: “wild and disordered, the spirit becomes unsteady, and the person dares not face others”). The genitals contract, the sinews spasm, and the ribs on both sides are difficult to raise (one version reads: “cannot be raised”). The hair becomes dry and brittle, and the complexion grows dull. The person will die in autumn, when Metal Qi governs and overcomes Liver Wood.

When the Qi of the Foot Jueyin Channel (Liver Channel) is exhausted, the sinews contract, pulling on the testicles and tongue. The Foot Jueyin Channel belongs to the Liver pulse. The Liver is associated with the sinews, which converge at the external genitalia and connect through the channels to the root of the tongue. When the pulse Qi can no longer nourish the sinews and channels, the sinews contract sharply, pulling on the testicles and tongue. Bluish-purple lips, a curled tongue, and contracted testicles indicate that the sinews and channels are about to fail. The condition worsens on a Geng day and ends in death on a Xin day because Metal Qi overcomes Wood Qi.

When the Liver is about to fail, the pulse feels faint when taken lightly; under firm pressure, it feels like a cord in the middle, but gives no rebound when pressed down. Or it may be crooked in shape, like a crawling snake. Both are dangerous, fatal pulses.

In spring, Wood governs and the Liver is in season. The normal pulse should be wiry, fine, and long. If instead it is deep, soft, and slippery, Kidney Water is overpowering Liver Wood. This is a “deficiency pathogen,” in which the mother Qi transmits to the child Qi; although illness occurs, it is relatively easy to treat. If the pulse is floating, large, and surging, Heart Fire is overpowering Liver Wood. This is an “excess pathogen,” in which the child Qi affects the mother Qi; although illness occurs, it will also resolve on its own. If the pulse is faint, rough, and short (the Qianjin Yifang reads “slightly floating, short, and rough”), Lung Metal is overcoming Liver Wood. This is a “thief pathogen,” and the illness is severe: in eight or nine cases out of ten, it is difficult to save the patient. If the pulse is large and moderate, Spleen Earth is encroaching on Liver Wood. This is a “slight pathogen,” and even if illness occurs, it will soon improve. Heart Qi overpowering the Liver causes vomiting and diarrhea; Lung Qi overpowering the Liver causes abscesses and swellings.

If the Yin pulse at the left Guan position—the pulse position on the cubit side of the Guan—is absent, it means the Liver pulse cannot be felt. The patient may be unable to urinate or may lose control of urination, have difficulty speaking, and have pathogenic Qi below the ribs, often accompanied by vomiting. The Foot Shaoyang Channel may be needled to treat a disorder of the Yang aspect.

If the Yin pulse at the left Guan position is firm and full, it indicates excessive Liver Qi. The patient feels pain deep in the muscles and often has cramping or spasms of the sinews and channels, as well as vomiting. The Foot Jueyin Channel may be needled to treat a disorder of the Yin aspect.

When the Liver pulse arrives, its rise and fall are pronounced, like a bamboo stalk or a zither string. Two beats for each coming and going of the pulse Qi are normal. Three are called “departing from the channel” and indicate an abnormal pulse; four indicate loss of essence and Qi, five indicate impending death, and six indicate that life is about to end. This describes the pulse of the Foot Jueyin Channel.

If the Liver pulse is extremely tight, speech may become confused; if it is only slightly tight, there may be “accumulated Qi,” a mass beneath the ribs shaped like an overturned cup. If the pulse is extremely moderate, vomiting may occur; if it is only slightly moderate and weak, there may be water masses or impediment syndromes, in which fluids accumulate inside the body and obstruct Qi and Blood. If the pulse is extremely large, there may be an internal abscess, often accompanied by vomiting and nosebleeds; if it is only slightly large, there may be Liver impediment, with coughing and sinew tension pulling on the lower abdomen. If the pulse is extremely small, there may be excessive thirst; if it is only slightly small, there may be wasting-thirst disease. If the pulse is extremely slippery, there may be a hernia with sagging, swollen scrotum; if it is only slightly slippery, there may be involuntary urination. If the pulse is extremely rough, there may be thin-fluid retention; if it is only slightly rough, spasms and sinew contractions may occur.

If the Liver pulse is forceful, hard, and long, but the complexion is not greenish, the illness is likely due to a fall or similar injury. A hard, forceful pulse may indicate stagnant Blood accumulated below the ribs, causing panting and rebellious Qi. If the pulse is soft and scattered and the complexion is lustrous, there may be overflowing fluid retention, in which fluids remain in the body and spread to the surface or the limbs.

“Overflowing fluid” (yiyin) refers to a sudden thirst followed by drinking large amounts of water, so that fluids overflow into the flesh and beyond the stomach and intestines. According to the Basic Questions, the variant reading “overflowing into” is also written as “entering readily.”

When a blue-green pulse appears, the pulse is long, with pronounced movement on both sides. This indicates an accumulation of Qi below the heart, pressing outward until it fills both flanks. This condition is called “Liver impediment” (ganbi), an illness caused by obstruction of Liver Qi. It arises from Cold and Dampness. It is treated in the same way as a hernia and commonly involves lower back pain, cold feet, and headache.

Bian Que said: When the Liver is diseased, the eyes lose their vitality; when the Liver is deficient, a person fears the cold. When Cold is severe, Yin Qi flourishes, and the person may dream of mountains, forests, trees, and similar scenes. When the Liver is replete, there is fever; as Yang Qi flourishes, the person may dream of becoming angry.

The sound associated with the Liver is shouting; its abnormal bodily movement is clenching the fists, and its emotional expression is anger. Anger harms the Liver. When Jing Qi gathers in the Liver, a person is prone to sorrow; Liver deficiency brings fear, while Liver repletion brings anger. Anger that does not subside can also give rise to sorrow.

The Liver corresponds to the color blue-green and to spring among the four seasons. When illness is reflected in the complexion, treatment should select an “Ying point,” one of the Five Transport points along the meridians, often used to treat heat disorders of the corresponding meridian.

When illness first arises in the Liver, it causes dizziness and blurred vision, pain in the flanks and ribs, and distension and fullness across the chest and flanks. After one day, the illness passes to the Spleen: the Spleen Qi becomes blocked, and the body feels painful and heavy. After two days, it passes to the Stomach, causing abdominal distension and fullness. After three days, it passes to the Kidneys, causing pain in the lower abdomen, lower back, and back, along with aching in the calves. If there is no improvement after ten days, the patient will die. If the illness begins in winter, it worsens at sunset; if it begins in summer, it worsens after the morning meal.

Liver disease is milder in the early morning, more severe in the evening, and calmer around midnight.

If a person with Liver disease travels westward or becomes ill after eating chicken, the illness may flare up in autumn, or on a Geng or Xin day. Bloodstained objects in the home, or the presence of a woman, may also be signs of impending misfortune. Otherwise, the illness may have resulted from contact with gold or silver.

Liver disease usually presents as pain below the ribs on both sides, extending down to the lower abdomen and making the person prone to anger. When the Liver is deficient, vision becomes dim and unclear, hearing is lost, and the person is easily frightened, as though someone were coming to seize them. Treatment should select points on the Foot Jueyin Liver Meridian and the Foot Shaoyang Gallbladder Meridian. If Qi counterflows upward, it can cause headache, eye pain, deafness or ringing in the ears, unclear hearing, and swelling of the cheeks. When bloodletting is needed, the blood vessels in the corresponding area should be selected.

The Liver pulse feels deep and rapid under pressure, and has the same quality when felt superficially. The patient often has flank pain, stagnation and distension of Qi, and pain extending to the lower abdomen. Urination may be difficult, and the patient may also experience dizziness, blurred vision, headache, lower back pain, and cold feet. At times, urination may be completely obstructed. In women, menstruation may cease or come and go irregularly. This kind of illness may result from a fall or other injury sustained in youth.

A patient with Liver disease has a blue-green complexion, stiff hands and feet, fullness below the ribs, and sometimes dizziness or blurred vision. If the pulse is wiry and long, the condition can be treated. Fangfeng Zhuli Decoction or Qinjiao Powder is suitable. In spring, acupuncture may be applied to Dadun; in summer, to Xingjian; and in winter, to Ququan. Use the reinforcing method at each point.

In the final month of summer (late summer), needle Taichong; in autumn, needle Zhongxi. Use the reducing method for both. Also apply one hundred cones of moxa at Qimen, and fifty cones at the point on the ninth vertebra of the back.

When pathogenic Qi enters the Liver, it causes pain between the ribs. If cold and blood stasis are present within the body, the calves are prone to cramping and the joints often swell. Needle Xingjian to guide the pathogenic Qi beneath the ribs outward; reinforce Zusanli to warm the Stomach Qi. Needle a blood vessel in the middle of the body to release the stagnant blood and disperse the harmful blood, then needle the bluish vessels beside the ears to relieve the cramping.

Blood stasis may remain in the body after a fall or other injury. It can also arise when intense anger drives Qi upward so that it cannot descend, causing it to accumulate beneath the left ribs. Either condition can injure the Liver.

When the Liver is attacked by wind, symptoms include dizziness, pain between the ribs, and a tendency to walk with the body bent. The person may also crave sweet foods and look like a woman whose pregnancy has been obstructed.

When the Liver is affected by cold, there may be recurring chills and fever, a flushed face with slight sweating, and heat and agitation in the chest.

Another pattern of Liver cold makes it difficult to raise the arms. The root of the tongue (another version reads “the large tongue”) becomes dry, and the person often sighs, has chest pain, and cannot turn over or lie on the side. Night sweats and coughing may occur, and after eating, the person may bring up stomach fluid.

The Liver governs the Qi in the chest. A person with Liver disease may pant, become angry, and curse. The pulse is deep, the chest feels blocked, and the person wants someone to press and rub it. The body feels hot, and the nose is congested.

A person with Liver injury becomes thin and lies with the mouth open. The hands and feet are often bluish; when the eyes are closed, the area around them becomes swollen and painful. These are all signs caused by injury to the Liver.

Liver water causes the abdomen to swell and prevents the person from turning over unaided. There is pain beneath the ribs and in the abdomen. Body fluids may occasionally be produced in small amounts, while urination continues without interruption.

Liver distension presents as fullness and pain beneath the ribs. The pain pulls toward the lower abdomen and leaves the person restless.

People with Liver congestion often want someone to tread on their chest. Before the illness becomes clearly manifest, they may feel an urge only to drink hot water.

On examination, the pulse of Liver accumulation is taut and fine. There is pain beneath both sides of the ribs, and the pathogenic Qi moves toward the area below the heart. The feet and shins feel cold, and the pain beneath the ribs pulls toward the lower abdomen. Men may develop accumulations and hernias; women may develop abdominal masses and painful, difficult urination. The body loses its luster, cramps occur easily, and the nails become dry and bluish-black. The illness improves in spring and worsens in autumn, and the complexion turns blue-green.

Liver accumulation is called “Fertilized Qi.” It lies beneath the left ribs and is shaped like an inverted cup, with a head and feet, like a turtle or tortoise. If it persists without recovery, coughing, counterflow Qi, and intermittent fever may develop and continue year after year. According to the theory of transmission through the Five Phases, this illness arises on the Earthly Stems Wu and Ji in late summer: Lung disease is transmitted to the Liver, and the Liver should then transmit it to the Spleen. But late summer is precisely when Spleen Qi is vigorous, and a vigorous organ Qi is not vulnerable to pathogenic invasion. The Liver disease therefore tries to return…

The Lung Qi refused to receive it, so the pathogenic Qi remained and congealed, forming a mass. We can therefore tell that this is “fatty accumulation,” an ancient term for a kind of mass in the liver, and that the illness arose in late summer.

Liver disease can make a person feel tightness in the chest and fullness in the ribs, become irritable and prone to shouting, and develop a fever while also feeling cold. The limbs may be unable to move, the face may turn pale, and the body may feel slick and damp. In principle, the pulse should be taut, long, and rapid; instead, it is short and rough. The complexion should be green, but instead it is white. This is a severe reversal of the pattern in which Metal overcomes Wood, and in eight or nine cases out of ten it is difficult to treat.

Duke Xiang asked Bian Que, “I would like to judge an illness and whether the patient will live or die without taking the pulse—only by listening to the voice and observing the complexion. Can I learn this method?” Bian Que replied, “This is an essential part of the Way of the sages, and teachers do not usually pass it on. The Yellow Emperor valued it greatly, considering it more precious than gold or jade. When a patient enters, observe the complexion and listen to the breathing; from these you can judge whether the coming and going of the breath is favorable or adverse, and whether the outcome is auspicious or ominous.

“The human voice corresponds to the liver. The liver’s sound is shouting, with a tone like that of a zither; the emotion corresponding to the liver is anger. The liver’s channel is Foot Jueyin. When the Qi of Jueyin and Shaoyang becomes disordered, the Qi of the nutritive and defensive systems cannot flow freely, and Yin and Yang fall into disorder. Yin is injured on the outside, while Yang is struck on the inside. When Yang is struck, cold arises; cold brings deficiency, and when the deficiency becomes extreme, the voice may suddenly disappear. This is a fierce wind pathogen entering the liver, and it can be treated with Continuation-of-Life Decoction.

“If the patient squats and cannot lower the head, has a blue-black complexion, and has limp, weak limbs, together with involuntary and incessant defecation, the illness is severe and cannot be treated. If it is less severe, Cinnamon Twig Decoction may be used over a period of ten days to a month.

“If the patient cries after shouting, then makes groaning sounds after crying, this shows Metal overcoming Wood and Yin suppressing Yang. Yin rises while Yang lies hidden. When Yang lies hidden, an excess pattern develops; excess generates heat, heat causes panting, and panting disrupts the movement of Qi. This disruption causes chest tightness, and chest tightness brings fear. The patient will see unclearly and speak in a hurried, confused way. This is pathogenic heat injuring the liver; in severe cases, it cannot be treated. If the lips are blue but their color corresponds with that of the eyes, the patient can still be saved and may be treated with Rehmannia Decoction.

“When liver disease develops into malaria, the patient’s complexion becomes dusky green, and they often sigh, appearing close to death. Mume Pill may be used. If someone who is usually seldom sad or angry suddenly becomes irritable and speaks abnormally, sometimes slowly and sometimes rapidly, then covers their eyes with a hand before finishing what they were saying, as though afraid of something, disaster is near even if the illness does not strike at once. These are all signs of liver disease in the voice. If the patient’s Zheng Qi is weak, they will be invaded by cold wind; if their Zheng Qi is strong…”

For this reason, it is harmed by pathogenic Heat. When the Yang aspect is diseased, use draining; when the Yin aspect is diseased, use supplementation. Green corresponds to the Liver.

The Liver is associated with the sinews. A Liver color as green as a kingfisher’s feathers is an auspicious sign. The Liver governs the eyes; the eyes are where Liver Qi manifests outwardly.

People of the Wood constitution (one of the Five Phases body types) correspond to the Shangjiao pitch. They have a blue-green complexion, a small head, a long face, broad shoulders, a straight back, and an upright build. Their hands and feet are small, with prominent sinews and bones. They enjoy mental exertion, have limited physical strength, worry often, and can endure hard work. They do well in spring and summer, but poorly in autumn and winter. If they encounter pathogenic influences in autumn or winter, they are prone to illness in the Foot Jueyin channel (the Liver channel), with symptoms described as “tata-ran.” The width of the flanks, the strength or fragility of the ribs, and whether the body is upright or crooked all correspond to the state of the Liver.

A true blue-green complexion and fine skin texture indicate a small Liver. A small Liver stores its contents securely, and illness is less likely to arise beneath the flanks. Coarse skin texture indicates a large Liver. A large Liver is prone to deficiency; when deficient, it is approached by Cold, which presses upward from the stomach toward the throat. Discomfort in the diaphragm is common, along with pain beneath the flanks in the morning. Broad flanks and ribs that flare outward indicate that the Liver is positioned high. A high Liver tends toward excess; in excess, it becomes hot and pushes upward against the diaphragm, causing tightness beneath the flanks and possibly Xiben, a disorder marked by upward-surging breath and distension and tightness in the chest and flanks. Closely joined flanks and ribs indicate that the Liver is positioned low. A low Liver presses on the stomach, leaving the area beneath the flanks feeling hollow; hollowness makes it easy for pathogenic influences to enter.

Hard ribs indicate a firm Liver, with the visceral Qi stable and less likely to be harmed. Weak ribs indicate a fragile Liver, making the person prone to Xiaodan, a wasting-thirst disorder, and to injury. Evenly balanced sides of the flank and abdomen indicate that the Liver is properly positioned. When it is properly positioned, the flow of Qi is harmonious and unobstructed, and it is less likely to be harmed. If the ribs are raised on one side, the Liver is crookedly positioned, and pain is more likely to occur on that side beneath the flanks.

Depressions or raised areas on any part of the body may foretell illness in the corresponding part. The Gallbladder belongs to Shaoyang and corresponds to the Liver. The Qi of the organs and bowels connects with the inside and outside of the body, and changes therefore appear on the corresponding areas of the body’s surface. A dark, murky color indicates illness within; a bright, clear color indicates illness on the exterior. If the color progresses from the outside inward, the illness originates externally and the corresponding area will bulge. If it appears from the inside outward, the illness originates internally and the corresponding area will be sunken. For internal illness, treat the Yin first and the Yang afterward; for external illness, treat the Yang first and the Yin afterward. Yang governs the exterior, and Yin governs the interior.

A person’s death or survival, and the course of an illness, often first become visible in the body through changes in the spirit of the organs and bowels. When Liver disease is about to arise, the eyes lose their luster. When Liver Qi is about to expire, shortly before death, the eyes lose their vital essence. If a color corresponding to the color of a tomb appears in areas such as the Tianting, death is certain and treatment cannot save the person. One must also observe how the illness changes and estimate how long it will last: a gradual illness will not exceed four hundred days, while an acute one will allow the person to live no more than ten days to a month.

If Liver disease seems to improve slightly, yet the person suddenly dies, how can this be foreseen? The answer: if a bluish-white spot the size of a thumb appears on the cheek, sudden death is certain. After Liver Qi is severed, death comes on the eighth day.

From this we can see that a patient whose face is blue-green and eyes are red, who only wants to lie down and sleep, and who looks at people without recognizing them, will sweat as if drenched in water, with no relief; death will follow within a day or two. A patient with a black face and blue-green eyes, by contrast, will not die. A blue-green color as bright and lustrous as fresh grass is an auspicious sign. To judge good or ill fortune, one must consider which region of the face the color appears in and whether it accords with that region’s usual color. If a blue-green and white color enters the eyes, illness is certain, and the person will not live through the year. If no corresponding sign appears at the center of the forehead (the “Year Above” point), disaster will still befall them within three years.

Spring corresponds to Wood; the color of the Liver pulse is blue-green, and it governs the Foot Shaoyang channel. In spring, treatment is applied to the collaterals and the spaces between the flesh. As Wood Qi begins to govern in spring, Liver Qi begins to sprout and rise. Liver Qi moves rapidly, and wind pathogens can invade just as swiftly. At this time the channels are usually deep, while Qi is insufficient to penetrate deeply, so treatment should be applied to the collaterals and the spaces between the flesh. The root of the Foot Shaoyang channel lies near the Qiaoyin point; its corresponding site is the Window Cage in front of the ear. The “Window Cage” refers to the pulse that beats up and down in front of the ear: press it with your hand, and you can feel it pulsate.

The sinew channel of Foot Shaoyang begins above the fourth toe, the toe next to the little toe, and binds above the outer ankle. It ascends along the outside of the lower leg and binds at the outer side of the knee. One branch emerges from the upper end of the fibula, ascends across the front of the thigh, and binds above the Futu point; another branch runs backward and binds at the buttock. The direct course ascends along the flank, follows the lowest rib upward, reaches the front of the armpit, passes alongside the chest and breast, and binds in the supraclavicular fossa. Another section ascends directly from beneath the armpit, passes through the supraclavicular fossa, reaches the front of the Hand Taiyang channel, and travels upward behind the ear to the corner of the forehead. It meets at the crown, then descends to the lower jaw and binds beside the nose. A branch binds at the outer corner of the eye, forming the restraint on the outer side of the eye.

The channel of Foot Shaoyang begins at the outer corner of the eye, ascends to the corner of the head, then descends behind the ear. It follows the neck in front of the Hand Shaoyang channel, reaches the shoulder, turns back, crosses behind the Hand Shaoyang channel, and enters the supraclavicular fossa. One branch enters the ear behind it, then emerges and travels in front of the ear to a point behind the outer corner of the eye. Another branch separates from the outer corner of the eye and descends to the Daying point, where it meets the Hand Shaoyang channel. It passes beneath the cheekbone and through the Jiache point, then follows the neck to rejoin the main channel in the supraclavicular fossa. From there it descends into the chest, passes through the diaphragm, connects with the Liver, and belongs to the Gallbladder. It descends along the inner side of the ribs, emerges at the Qijie point, skirts the edge of the pubic hair, and runs horizontally into the hip hollow—the depression on the outer side of the root of the thigh.

The main channel descends from the supraclavicular fossa to the armpit, travels along the chest past the lower flank, and meets the branch described above at the hip hollow. It then descends along the outer side of the thigh, passes down the outer side of the knee and in front of the fibula, and reaches Juegu—the fibula above the outer ankle. It emerges in front of the outer ankle and travels along the top of the foot to the tip of the fourth toe. Another branch separates from the top of the foot, enters the space between the big toe and second toe, and follows…

The vessel branching from the inner side of the thumb runs back along this end and enters the fingernail. It emerges at the Three Hairs point and joins with the foot.

Jueyin is paired with another channel as the interior and exterior. The root of the Jueyin channel lies five cun above the Xingjian point, corresponds to the transport points on the back, and joins with the Hand Taiyin channel.

The collateral of the Foot Shaoyang channel is called Guangming. It lies half a cun above the outer ankle. After branching off, it runs toward the Jueyin channel and descends to connect with the top of the foot; it governs the liver. When the liver and gallbladder are ill, an excess pattern brings heat in the gallbladder. If the heat becomes intense, counterflow and reversal may occur. This is a Yang pattern, in which the Yang pulse is twice as large as the cun-kou pulse. When the illness arises, there is heat in the chest, pain in the chest, flanks, head, and jaw, and swelling in the supraclavicular hollow and armpit.

In a deficient pattern, the gallbladder Qi is weak and cold, causing withering weakness and a limp. This is a Yin pattern, in which the Yin pulse is smaller than the cun-kou pulse. When the illness arises, there is cold in the chest, scant Qi, a bitter taste in the mouth, and a lack of moisture in the body. Pain may extend from the outer side of the shin to the Juegu point, the area in front of the outer ankle, and the joints throughout the body. If the pulses on both the Yin and Yang sides are quiet, or both are agitated like taut cords, and their force suddenly stops, this indicates illness. (The above describes the branch of the sinew channel of the Foot Shaoyang Gallbladder channel and the disorders it governs. The following adds material on the Foot Jueyin Liver channel.)

The Foot Jueyin channel begins at the cluster of hairs on the big toe. It runs along the upper edge of the foot, passes the inner ankle one cun above it, then ascends eight cun and crosses behind the Foot Taiyin channel. It continues up the inner side of the knee hollow and thigh, enters the pubic hair, circles the external genitals, and reaches the lower abdomen. It passes alongside the stomach, belongs to the liver and connects with the gallbladder. It then rises through the diaphragm, spreads through the flanks, travels up behind the throat, enters the depths of the nasopharynx, connects with the eye system, and emerges at the forehead, joining the Governing Vessel at the crown of the head. (Another version records that a branch emerges from the lower abdomen and connects with the Foot Taiyin and Foot Shaoyang channels. It lies in the space between the third and fourth bones below the hip, at the waist.)

One branch descends from the eye system, passes along the inner side of the cheek, and circles the inside of the lips. Another branch emerges from the liver, passes through the diaphragm, and flows upward into the lungs. When the channel Qi moves abnormally, there is lower back pain and an inability to bend forward or lean back. Men may develop a hernia, while women may have swelling in the lower abdomen. In severe cases, the throat becomes dry and the face turns dull and loses its luster. These are the disorders that arise when the Qi of the Foot Jueyin channel moves abnormally.

Other disorders governed by the Foot Jueyin channel include fullness in the chest, vomiting, severe diarrhea, fox hernia, involuntary urination, or inability to urinate. In an excess pattern, the cun-kou pulse is twice as large as the renying pulse; in a deficient pattern, the cun-kou pulse is smaller than the renying pulse.

The collateral of the Foot Jueyin channel is called Ligou. It lies five cun above the inner ankle and branches toward the Foot Shaoyang channel. Another branch runs upward along the channel to the testicles and gathers at the penis. If the Qi of this collateral becomes disordered and flows counter to its proper course, then…

Swelling of the testicles (the male reproductive organs) and sudden onset of a hernia: in an excess pattern, the penis becomes erect and elongated, with a sensation of heat; in a deficiency pattern, sudden itching occurs. Treatment may be chosen at the points along the channels corresponding to these symptoms.

The sinew channel of Foot Jueyin (the Liver channel of Foot Jueyin) begins above the big toe and ascends to gather in front of the inner ankle. It then runs up the lower leg and gathers above the inner side of the knee. Continuing up the inner thigh, it joins at the genitals and connects with the sinews throughout the body.

During the three months of spring, the Liver and Gallbladder are in season, and illnesses involving taut blue-green sinews and pulling pain often arise. The pathogenic influence shifts from Shaoyin (a channel system in which Yin is relatively abundant) to Foot Shaoyang (the Gallbladder channel). When the Qi of Shaoyang begins to stir, the Qi of Shaoyin begins to decline. Yin and Yang Qi become bound in the skin and interstices, so symptoms appear both on the surface and inside the body. The illness begins with Shaoyang but disrupts the Qi of Shaoyin in reverse, causing the Zang-Fu organs to be invaded and fall ill. The symptoms are opposite depending on whether the organs are deficient or excessive.

When the Qi of the Fu organs is deficient, they are easily harmed by Yin pathogens. Symptoms include stiffness and tightness in the lower back, curled feet that cannot be straightened, calves that feel as if they might break, and seeming flower-like patterns before the eyes. When the Qi of the Zang organs is excessive, they are easily harmed by Yang toxins. Symptoms include waves of chills followed by fever; pulling pain in the sinews on both sides of the neck, with inability to bend or extend; a rigid neck and stiff back; and red-yellow eyes. To turn, the whole body must rotate together. This is therefore called “illness of taut blue-green sinews.” (See the formula in the Treatise on Cold Damage, juan 1.)

Moxibustion

Bian Que said: Moxibustion at the Shu points of the Liver and Lungs (back points connected with the Zang-Fu organs) can be used to treat erysipelas and illnesses involving pulling tension in the sinews and channels. Treatment should be guided by the cause and location of the illness, harmonizing Yang Qi and regulating Yin Qi; in this way, illness of the Zang-Fu organs will not arise.

The Liver: Deficiency and Excess, Part Two (Pulse Diagnosis, Formulas, and Moxibustion)

Excess Heat in the Liver

At the left guan position (the location in the cun-kou pulse corresponding to the Liver and Gallbladder), the pulse is Yin-leaning and full. This belongs to the Foot Jueyin Liver channel. The patient often feels hardness and distension below the heart, pain in both flanks, and hurried, labored breathing, as if enraged. This is called “excess heat in the Liver.”

Bamboo Shavings Decoction to Drain Heat: This treats excess heat in the Liver, when Yang Qi is obstructed and trapped by a latent pathogenic influence, producing heat. Symptoms include panting, rebellious Qi, vexation in the chest, fear in the heart, blurred vision, deranged consciousness, palpitations, and speaking in ways that are out of keeping with the situation.

Ingredients: ten sheng of bamboo juice; three fen each of ephedra, Chinese woad, gardenia seed, Chinese cimicifuga, poria, Scrophularia root, and anemarrhena; eight fen each of fresh kudzu root and gypsum; and four fen each of fresh ginger and peony.

Cut the twelve ingredients into pieces and decoct them in nine sheng of water until two and a half sheng remain. Strain out the dregs, add the bamboo juice, and boil two or three more times. Take in three portions. If a purgative effect is needed, add three fen of mirabilite, omit the peony, and add five fen of fresh Rehmannia root. (The Formulae for Miscellaneous Disorders omits gypsum, fresh ginger, peony, and fresh kudzu root, and instead uses three fen of ginseng.)

Qianhu Decoction, used to treat eye pain, fullness in the chest, shortness of breath, and other symptoms caused by excess heat in the Liver. It is a formula for draining the Liver.

Qianhu, mirabilite, Qinpi bark, gardenia seed, cassia seed, Huangqin, Cimicifuga rhizome, Ruinen kernel, and Asarum root, three liang of each; bitter bamboo leaves and Plantago leaves, one sheng of each. Cut the eleven ingredients into pieces and decoct them in nine sheng of water until three sheng of liquid remain. Strain out the dregs, add the mirabilite, and divide the dose into three servings. Another version adds three liang of Chaihu, making twelve ingredients in all.

Fangfeng Powder for Decoction, used to treat anger in dreams, being easily startled, and other symptoms caused by excess heat in the Liver.

Fangfeng, Poria, Yuzhu, Atractylodes rhizome, tangerine peel, and Danshen, one liang and three fen of each; Asarum root, two liang; licorice and Belamcanda rhizome, one liang of each; Cimicifuga rhizome and Huangqin, one liang and five fen of each; thirty-seven jujubes; and sour jujube seed, three fen. Grind the thirteen ingredients into a coarse powder. Take two square-inch spoonfuls of the powder, wrap it in cloth, and decoct it in two sheng of freshly drawn well water, stirring the packet from time to time. Reduce the liquid to one sheng and divide it into two servings, taken twice daily.

Yuanzhi Powder, used to treat abnormal speech after pathogenic heat has affected the Liver, with speech alternating between slow and hurried.

Yuanzhi, Belamcanda rhizome, apricot kernel, and Daqing, one liang and five fen of each; Fushen, Ophiopogon root, kudzu root, and licorice, one liang of each; peony root, one liang and three fen; cinnamon bark, three fen; Anemarrhena rhizome and Cimicifuga rhizome, five fen of each; and gypsum, two liang. Grind the thirteen ingredients into a coarse powder. Boil one sheng of bamboo leaves in two sheng and five he of water. Add the strained liquid to one qi-and-a-half of the powder and simmer until eight he remain; this is one dose, taken once daily. Wrap the powder in cotton cloth while decocting.

Rehmannia Decoction, used to treat a tendency toward sadness and anger, unsettled emotions and behavior, and frequent fright and fear after pathogenic heat has damaged the Liver.

Fresh rehmannia root, light bamboo leaves, ginger, Plantago herb, and dried indigo plant, one sheng of each; red honey, one sheng; Danshen and Scrophularia root, four liang of each; Poria, two liang; and gypsum, five liang. Cut the ten ingredients into pieces and decoct them in nine sheng of water until three sheng of liquid remain. Strain out the dregs and let the liquid cool, then add the honey. Bring it back to a boil two or three times and divide it into three servings.

Excess in both the Liver and Gallbladder refers to the simultaneous presence of excess patterns in the Liver and Gallbladder.

When both the yin and yang pulses feel full at the left wrist’s Guan position, this indicates excess pathogenic factors in both the Foot Jueyin Liver Meridian and the Foot Shaoyang Gallbladder Meridian. The patient may experience fullness and distension in the upper abdomen, vomiting, and difficulty digesting food. This condition is called “excess in both the Liver and Gallbladder.”

Liver Deficiency Cold

A weak yin pulse at the left Guan position indicates illness in the Foot Jueyin Liver Meridian. The patient may feel hardness and discomfort below the ribs, alternate between feeling cold and hot, experience abdominal fullness and distension, lose their appetite, and feel low in spirits. Women may also have obstructed menstruation and pain in the lower back and abdomen. This condition is called “Liver deficiency cold.”

Liver-Tonifying Decoction

The Liver-Tonifying Decoction is used to treat insufficiency of Liver Qi, with symptoms including fullness and distension on both sides of the ribs, tightness and spasms in the sinews and vessels, difficulty taking a deep breath, cold limbs, Qi surging upward toward the heart, abdominal pain, and blurred vision. The original text also lists heart pain in women, breast abscesses, heat in the knees, wasting-thirst, dry and withered nails, and a bluish tinge to the lips and complexion.

Ingredients: three liang each of Cornus fruit (the Yifang version reads “as the principal ingredient”), licorice, and cassia bark; two liang each of peach kernel (the Yifang version reads “rui ren”), arborvitae seed, asarum, poria, and saposhnikovia root; and twenty-four jujubes.

Cut the nine ingredients into pieces. Add nine sheng of water and boil until five sheng of liquid remain. Strain out the dregs and divide the decoction into three doses.

Liver-Tonifying Powder

The Liver-Tonifying Powder is used for pain concentrated on the left side beneath the ribs, retained undigested food, dim or blurred vision, tearing in the wind, and unclear sight. The formula is also said to help with related symptoms that worsen when facing the wind, and to aid digestion, regulate Qi, and stop tearing.

Ingredients: five fen each of Cornus fruit, cassia bark, Chinese yam, Aconitum, poria, and ginseng; seven fen each of Ligusticum, atractylodes, angelica pubescens, eleuthero bark, and rhubarb; three fen of tangerine peel; one and a half liang each of saposhnikovia root, dried ginger, red sage root, magnolia bark, asarum, and platycodon; one liang each of licorice and chrysanthemum; half a liang of Chinese fern; and one sheng each of aged wheat leaven and barley malt.

Grind the twenty-three ingredients into a fine powder and sift. Take one square-inch spoonful of the powder with wine, twice a day. For indigestion, take it after meals; for pain relief, take it before meals.

Pine Resin Paste Wine

Pine Resin Paste Wine is used to tonify the Liver and also for various conditions, including Liver deficiency cold and excessive wind pathogenic factors accompanied by tearing.

Take ten jin of pine resin, cut it into pieces, and soak it in water for a full day before boiling it. As it boils, slowly skim off the paste that rises to the surface. When the water has boiled away, add more water and continue boiling until the pine resin is exhausted. The original passage breaks off at the character “take”; the remainder of the preparation method is not preserved.

Brew the wine with one jin of rice for brewing, one shi of water, seven dou of water, and two dou of fine qu starter (a ferment used in brewing). Follow the usual brewing method: once the rice has cooled, put it into the fermentation jar and seal it for one hundred days. The rice and starter in the wine will both dissolve, and its aroma will fill the room. It can then be enjoyed slowly. When brewing this wine, use twice the usual amount of starter.

Goji Berry Wine has the same effects as the preceding recipe.

Crush one dou of goji berries and place them in a silk bag. Put the bag into two dou of wine to soak. Seal the wine jar tightly with clay so that no air can escape. Leave it in the sun to dry; do not take it outside on cloudy days. After soaking for twenty-one days, warm the wine in the morning and drink as much as you like. Avoid vinegar.

Saposhnikovia Decoction: Used to treat dim vision and blurred sight caused by Liver deficiency-cold, as well as the sensation of flower-like shadows before the eyes when staring.

Ingredients: three liang each of saposhnikovia root, asarum, Chuanxiong, angelica pubescens, Dictamnus bark, and licorice; two liang of tangerine peel; thirty-seven jujubes; five he of honey; and one sheng of fresh bamboo leaves, chopped.

Coarsely cut the ten ingredients. First decoct nine of them in one dou and two sheng of water. When the liquid has reduced to four sheng, strain out the herbs, add the honey, and bring the decoction to a boil twice. Divide it into four doses: take three during the day and one at night. If taking it in the fifth or sixth month, pour the decoction into a clean container and keep it in cold water.

Betel Nut Decoction: Used to treat pain and distension below the ribs, shortness of breath, dim vision, and blurred sight caused by Liver deficiency-cold.

Ingredients: twenty-four betel nuts, seven aconite roots, and seven liang of fresh ginger; three liang each of poria, tangerine peel, and cassia bark; four liang each of platycodon and atractylodes; and five liang of Evodia.

Coarsely cut the nine ingredients and decoct them in nine sheng of water until three sheng remain. Strain out the herbs and take warm, one sheng per dose. For wheezing, add three and a half liang of Chuanxiong, four liang of pinellia, and two liang of licorice.

Prescription for Liver Deficiency and Blurred Vision: Apply moxibustion at the Liver Shu point for two hundred cones (the unit used to count moxibustion applications). For children, adjust the treatment as appropriate, applying fourteen to twenty-one cones.

Deficiency of Both Liver and Gallbladder

If the pulse at the bar position of the left hand is weak in both its Yin and Yang aspects, this indicates deficiency of both the Foot Jueyin Liver Channel and the Foot Shaoyang Gallbladder Channel. The patient may experience disorientation, coma resembling corpse-like collapse, delusions, weak Qi that makes speaking difficult, and frequent fright. This condition is called “deficiency of both Liver and Gallbladder.”

Liver Taxation, Third Section (Discussion and Prescriptions)

The treatise says: Those suffering from Liver taxation should replenish the Heart Qi to support recovery. When the Heart Qi is abundant, it will resonate with…

When the liver fails to follow the springtime pattern of growth and flourishing, Qi in the Foot Shaoyang Gallbladder Channel cannot rise and flourish smoothly, and the liver Qi also changes within the body.

Following the natural pattern allows the body to grow; going against it causes harm. Following it brings the body into harmony; going against it throws the body into disorder. Treating what accords with the pattern as though it were contrary causes Qi to stagnate, leaving the upper and lower parts unable to communicate. This is called “Closure and Reversal” (guange), and illness can arise as a result.

Pork Fat and Ginger Wine: Used to treat deficiency-cold and Closure and Reversal caused by liver taxation, as well as impeded circulation of Qi and blood after overexertion, obstruction, dry and withered hair, and a dull, dark complexion.

Ingredients: two sheng each of pork fat and ginger juice.

Gently fry the pork fat and ginger juice over low heat until three sheng remain. Add five he of wine and continue cooking. Divide into three doses.

Tiger Bone Wine: Used to treat liver deficiency-cold and overexertion, as well as a bitter taste in the mouth, pain in the joints and bones, tightening and contraction of the sinews and channels, and vexation in the heart.

Ingredients: one sheng of tiger bone, roasted until charred, pounded into pieces about the size of a sparrow’s head; eight liang of salvia root; seven liang of dried rehmannia root; four liang each of goji root bark, dried ginger, and chuanxiong; and five liang each of prickly ash root, five-flavor bark, white atractylodes, and immature bitter orange.

Cut the ten ingredients into pieces and place them in a silk bag. Steep in four dou of wine for four days. Take six or seven he for the first dose, then gradually increase to one sheng. Take twice daily.

Essential Prescriptions for Emergencies Worth a Thousand Pieces of Gold by Sun Simiao, juan 36