《孫真人備急千金要方》Vol. 38

The gallbladder corresponds to the Liver, and the Liver’s Qi is paired with the gallbladder. The gallbladder is a pure and clear organ, meaning that it stores pure essence and fluid. The Classic of Difficulties calls it the “pure and clear organ,” while the Classic of Acupuncture and Moxibustion calls it the “organ of central essence.” Its position is like that of a general, or an official responsible for making decisions. The gallbladder weighs three liang and three zhu, is three cun and three fen long, and lies between the short lobes of the Liver. It stores two he of essence and fluid; the Classic of Difficulties records three he. The gallbladder is associated with a person’s emotions: it can be angry or joyful, firm or yielding. When the area below the eyes appears broad, the gallbladder grows laterally.

The gallbladder, brain, marrow, bones, vessels, and uterus are six organs born from the Earth Qi. They store within Yin and have forms resembling the earth; therefore, they can store without discharging and are called the “extraordinary organs.” The stomach, large intestine, small intestine, Triple Burner, and bladder are five organs born from Heaven Qi. Their forms resemble heaven, so they discharge rather than store. They receive turbid Qi passed on from the five zang organs and are called the “organs of transmission and transformation.” Food and fluids must not remain in them for long.

The five zang organs store essence and Qi (the Classic of Acupuncture and Moxibustion reads “spirit”) and do not discharge them outward. Thus, they can be full, but cannot be filled with food as the six fu organs can. The six fu organs transport and transform food without storing it; thus, they can be filled with food, but do not remain distended. After food and drink enter the mouth, the stomach fills while the intestines are empty. Once the food moves downward, the intestines fill and the stomach empties. Hence it is said that the six fu organs are “substantial but not full,” while the five zang organs are “full but not substantial.”

When the Yang pulse at the left wrist’s guan position is extremely weak, it indicates that the gallbladder pulse is failing. The patient may have knee pain, a bitter taste in the mouth, and a sensation as though something were obscuring the eyes. They may be easily frightened, as if seeing ghosts, and often startled and fatigued. Needling may be applied to the Yin position of the Foot Jueyin channel, between the toes of the big toe, or at the three hairs beside the big toenail.

When the Yang pulse at the left wrist’s guan position is forceful, it indicates gallbladder excess. The patient may have abdominal discomfort and feel lightheaded, as though swaying unsteadily. Needling may be applied to the Yang position of the Foot Shaoyang channel, one cun behind the joint of the second toe.

When the gallbladder is diseased, the patient often sighs, has a bitter taste in the mouth, and vomits bitter fluid from the previous night. They feel anxious and afraid, as though someone were coming to seize them; they may sense a foreign object in the throat and often spit saliva. During examination, observe the course of the Foot Shaoyang channel and its endpoint, and note whether there are depressions along the channel. Moxibustion may be applied to any depressions found. If chills and fever alternate, needle Yanglingquan. If the patient vomits easily, has a bitter taste in the mouth, sighs repeatedly, and feels anxious, often with sadness and fear…

When pathogenic Qi invades the Gallbladder and Stomach Qi also counterflows upward, bile rises into the mouth and causes a bitter taste. When Stomach Qi counterflows upward, the person vomits bitter fluid; this is called “vomiting bile.” Needling Zusanli on the foot can bring the counterflowing Stomach Qi downward. Needling the blood vessels along the Foot Shaoyang channel can unblock the Gallbladder channel and calm Gallbladder Qi. Treatment is then adjusted according to whether the condition is deficient or excessive, to dispel the pathogenic Qi.

Gallbladder distension is marked by pain and fullness below the ribs, a bitter taste in the mouth, and frequent sighing.

The Liver is affected first, and the illness then passes to the Gallbladder. If a Liver cough continues without stopping, the person will vomit bile.

Rebellious Qi lodged in the Gallbladder may cause dreams of fighting and lawsuits. (The Jia Yi Jing says that one may dream of fighting and lawsuits, or even of cutting open one’s own abdomen.)

The Liver corresponds to the sinews and nails. Thick, yellow nails indicate a thick Gallbladder; thin, reddish nails indicate a thin Gallbladder. Hard, bluish-green nails indicate tense Gallbladder Qi; soft, reddish nails indicate relaxed Gallbladder Qi. Flat, straight, white nails without ridges indicate even, straightforward Gallbladder Qi. Misshapen, blackened nails that break easily indicate stagnant Gallbladder Qi.

Bian Que said: The Foot Jueyin Liver channel and the Foot Shaoyang Gallbladder channel are interiorly and exteriorly related. The exterior pertains to clear Qi, and the interior to turbid Qi. When illness is extremely excessive, the person is injured by pathogenic Heat. Intense Heat unsettles the spirit, leaving the person unable to rest; sleep and waking become irregular. When illness is deficient, the person is injured by pathogenic Cold. Intense Cold brings fear and alarm, dizziness, and an inability to sleep alone. If illness arises from Xuanshui (a disease name for a type of water disorder), its source is in the Gallbladder. At first, swelling begins in the head and face, then extends down to the feet. (For treatment, see the “Treating Water” chapter.)

When the Gallbladder is diseased, the eyebrows become slanted. If a patient’s eyebrows are slanted, the patient will certainly die within seven days.

Abnormal Qi in the Foot Shaoyang Gallbladder channel can cause a bitter taste in the mouth, frequent sighing, and pain in the heart and ribs, to the point that the person cannot turn over. In severe cases, the complexion becomes slightly ashen and the body loses its luster, while the outer side of the foot grows hot. This is called “Yang Reversal.” The Gallbladder channel governs the bones. Illness arising from Qi in this channel may also cause headache; pain at the temples, jaw, and outer corners of the eyes; swelling and pain in the supraclavicular hollow and armpit; and “sword-shaped swelling” and “goiter-like swellings”—masses along the sides of the neck and in the armpits. The patient may also sweat, shiver with cold, or develop intermittent fever. Pain may occur in the chest, ribs, outer thigh, outer knee, lower leg, lower end of the fibula, in front of the outer ankle, and in the joints. The fourth toe may also be difficult to move. When the channel Qi is excessive, the Renying pulse (at the Renying point on the neck) is twice as large as the Cunkou pulse. When the channel Qi is deficient, the Renying pulse is smaller than the Cunkou pulse. (For the pulse patterns, channel sinews, and branches of this channel, see the related chapters on the Liver.)

First: Gallbladder Deficiency and Excess (Pulse Diagnosis, Prescriptions, and Moxibustion)

Excess Heat in the Gallbladder

A pulse that is Yang-excess in the left guan position indicates illness in the Foot Shaoyang Gallbladder channel. Symptoms include abdominal fullness, difficulty swallowing food, a dry throat, headache, chills that come in waves, and pain in the ribs. This is called “Gallbladder Excess Heat.”

Pinellia Decoction, a formula for treating excess heat in the Gallbladder organ and mental restlessness.

Pinellia, aged ginger, three liang each; Scutellaria root, one liang; raw Rehmannia, five liang; Polygala root and Poria, two liang each; glutinous millet, one dou; and sour jujube kernel, five ge.

Chop the eight ingredients. Take five dou of flowing water from a long river, and cook the millet in it until tiny bubbles like crab eyes appear on the surface. Then repeatedly scoop up and pour back the water more than a thousand times. Let it settle, take nine sheng, and use this to decoct the ingredients until three sheng remain. Divide into three doses.

The Jiyan Fang records that this formula is also used for deficiency vexation, chest oppression, and sleeplessness. In that version, omit raw Rehmannia and Polygala, and add Ophiopogon and cinnamon bark, three liang each, and licorice and ginseng, two liang each.

A formula for treating Gallbladder disorders in the chest:

Apply moxibustion at the Zhuoyu point, using a number of cones corresponding to the patient’s age. The point is beside the Gallbladder Shu point, about five cun outward.

Gallbladder deficiency-cold

A weak Yang pulse at the left guan position indicates the Foot Shaoyang Gallbladder channel. The patient may experience dizziness or fainting, weakness in the muscles of the feet, inability to move the toes, bodily stiffness and falling, yellowing of the eyes, seminal emission, and mental confusion or disorientation. This is called “Gallbladder deficiency-cold.”

Warming the Gallbladder Decoction, used to treat deficiency vexation and sleeplessness after a serious illness. These symptoms are due to cold in the Gallbladder, and this formula is suitable.

Pinellia, bamboo shavings, and immature bitter orange, two liang each; tangerine peel, three liang; fresh ginger, four liang; and licorice, one liang.

Chop the six ingredients, add eight sheng of water, and decoct until two sheng remain. Divide into three doses.

A formula for treating Gallbladder deficiency:

Apply moxibustion at the Sanyinjiao point, twenty cones on each side. Sanyinjiao is about one fu above the inner ankle, approximately the width of four joined fingers by ancient measurements.

Thousand-Mile Flowing Water Decoction, used to treat deficiency vexation and sleeplessness.

Ophiopogon and Pinellia, three liang each; Poria, four liang; sour jujube kernel, two sheng; licorice, cinnamon bark, Scutellaria root, Polygala root, Tokoro yam, ginseng, and fresh ginger, two liang each; and glutinous millet, one dou.

Chop the twelve ingredients. Take one hu of thousand-mile flowing water and cook the millet in it until tiny bubbles like crab eyes appear on the surface, repeatedly scooping up and pouring back the water ten thousand times. Let it settle, take one dou, and use this to decoct the ingredients until two and a half sheng remain. Divide into three doses.

Sour Jujube Decoction, used to treat agitation and restlessness caused by deficiency taxation, Qi surging up into the chest, and inability to fall asleep.

Sour jujube kernel, five sheng; ginseng and cinnamon bark…

Use two ounces each of fresh ginger; four ounces of gypsum; three ounces each of poria and anemarrhena; and one and a half ounces of licorice. Together with the medicines listed earlier, these make eight ingredients. Crush them into coarse pieces. First, boil the sour jujube kernels in one dou of water until seven sheng remain, then strain out the dregs. Add the remaining medicines and boil until three sheng remain. Divide into three doses and take all three in one day.

Another prescription treats deficiency taxation (physical depletion and weakness), vexation and oppression in the chest, and inability to fall asleep. Take fourteen jujubes and seven scallions, using only the white parts. Boil the two ingredients in three sheng of water until one sheng remains. Strain out the dregs and drink the full amount at once.

Gardenia Decoction treats deficiency taxation and insomnia that occur after purging. In severe cases, the patient tosses and turns, feeling so distressed and agitated that it seems they are about to die. Zhang Zhongjing says: “After sweating, vomiting, or purging, deficiency vexation may prevent sleep. In severe cases, the patient will certainly toss and turn, troubled and distressed in heart and mind. Gardenia Decoction is the treatment.” Take fourteen large gardenia fruits and seven he of fermented soybeans. First boil the gardenias in four sheng of water until two and a half sheng remain. Add the fermented soybeans and bring to a boil three times, then strain out the dregs. Take one sheng per dose. Stop taking it once the patient is settled. If there is rebellious Qi, vomiting, or hiccups, add two ounces of tangerine peel, or two ounces of fresh ginger.

Another prescription treats vexation and oppression in the chest and inability to fall asleep. Take five ounces each of goji bark and raw rehmannia; three ounces each of ophiopogon, licorice, and Chinese thorowax; four ounces each of poria and anemarrhena; two ounces of ginseng; and five he each of millet and fermented soybeans. Crush the ten ingredients into coarse pieces. Boil them in eight sheng of water until three sheng and seven he remain, then divide into four doses.

A prescription for deficiency-taxation insomnia: take equal parts sour jujube kernels and elm leaves, grind them into a fine powder, and mix with honey to make pills the size of a Chinese parasol tree seed. Take fifteen pills per dose, twice a day.

Another prescription: grind four ounces of dried ginger into powder and mix it with hot water. Drink the full dose at once, cover yourself with a quilt, and induce sweating; the illness will then resolve.

“Treatise on the Throat Passage,” Chapter Three. The treatise says: The throat passage is the part that corresponds to the five viscera and six bowels. It is the channel through which Shen Qi and Yin-Yang Qi circulate, and it determines whether their passage is open or blocked. The throat, the “womb sac” (said by some to refer to the epiglottis and surrounding tissues), and the tongue jointly govern the distribution of fluids and the harmonizing of the Qi of the five flavors. They are the foundation of these functions and must be studied. The throat passage is where disorders of the liver and gallbladder manifest externally. It weighs ten ounces, is two cun and five fen wide, connects downward to the stomach tube, and is one chi and six cun long. This is a basic description of its form and function.

It can unblock the fluids and Shen-Qi of the five zang organs and six fu organs, bringing them into alignment with the twelve double-hours. If the organs are overheated, the throat passage becomes obstructed and breathing is impeded. If they are cold, the throat passage is damaged and the voice becomes hoarse. Mother ginger wine can be used as treatment (see the prescription in another volume). Heat should be cleared to restore free passage; cold should be warmed and supplemented. When cold and heat are in balance, illness is less likely to occur.

Deficiency and Excess of the Marrow, Fourth (Discussion and Prescriptions)

The treatise says: When the marrow is deficient, the head and brain ache and the spirit is unsettled; when the marrow is excessive, a person becomes bold and forceful. Changes in the marrow’s deficiency or excess are chiefly associated with the liver and gallbladder. When the organs are diseased, heat pathogens arising from the marrow produce patterns of illness in the zang organs; cold pathogens produce patterns of illness in the fu organs.

Qianghuo Marrow-Supplementing Pill: Treats head and brain pain and an unsettled spirit caused by marrow deficiency, as well as cold patterns of the gallbladder.

Three liang each of qianghuo, chuanxiong, and angelica; two liang of cinnamon bark; four liang of ginseng; one sheng each of jujube flesh, pounded into a paste, sheep marrow, and ghee; two sheng each of beef marrow and hemp seeds, roasted and pounded into a paste.

Use these ten ingredients. First pound the five dry ingredients into powder. Add the jujube paste and hemp seeds, and pound everything together until blended. Then add the sheep marrow, beef marrow, and ghee. Place the mixture in a copper bowl and heat it in a water bath. Form pills the size of parasol tree seeds. Take thirty pills with wine twice daily, gradually increasing the dose to forty pills.

Bupleurum Heat-Dispersing Decoction: Treats heat patterns, such as boldness and agitation with fever, caused by marrow excess.

Three liang each of bupleurum, cimicifuga, Scutellaria root, asarum, immature bitter orange, gardenia seed, and mirabilite; one sheng each of indocalamus leaves and raw rehmannia; four liang of Alisma rhizome.

Cut up these ten ingredients. Add nine sheng of water and decoct until three sheng of liquid remain. Strain out the dregs, add the mirabilite, and divide into three doses.

Wine Decoctions for Wind-Related Deficiency and Miscellaneous Supplementation, Fifth (Prescriptions)

Morinda Root Wine: Used to treat patterns of deficiency and debility, including bodily weakness and emaciation, impaired erectile function, and the Five Taxations and Seven Injuries. It also helps stimulate appetite and regulate the movement of Qi.

Three jin each of morinda root and Achyranthes root; two jin each of the white root bark of goji, Ophiopogon root, rehmannia, and Saposhnikovia root.

Use all six ingredients fresh; if fresh ingredients are temporarily unavailable, dried ones may be used. Cut them up and soak them in one shi and four dou of wine. After seven days, strain out the dregs and drink warm. Take enough to maintain the presence of wine in the body, but do not drink until you become drunk and vomit. Avoid raw or cold foods, pork, fish, greasy foods, and garlic. In spring…

In autumn and winter, take it for seven consecutive days; in summer, take it for fourteen consecutive days. Those who previously suffered from cold disorders may add one jin each of dried ginger and cinnamon bark. Those who are prone to forgetfulness may add one jin of polygala root. Those who are extremely weak and debilitated may add one jin each of schisandra berries and cistanche. Those with dampness in the genital area may add one jin of the root bark of Siberian ginseng. If dendrobium is available, adding one jin will make the effects better. For every additional jin of medicinal ingredients, add seven sheng of wine.

Prepare this medicinal wine in the middle of the ninth lunar month each year, and begin taking it in early October. If you are also taking other medicines, take them with this wine; it works very well. Dry the medicinal residue in the sun and pound it into powder. Each time, take one square-inch spoonful (an ancient measure of medicine, approximately the amount held by a square-inch spoon), washed down with this wine, three times a day; this works even better. It is also beneficial to add ten liang of licorice regularly. Those who are weak and debilitated may add one jin of astragalus root.

Another formula:

Three jin each of ba ji tian and fresh achyranthes root.

Chop these two ingredients, soak them in five dou of wine, and take the preparation as described above.

Siberian Ginseng Wine Formula for Treating Deficiency and Debility:

One dou each of Siberian ginseng bark and the white bark of the goji root.

Chop these two ingredients and boil them in one shi and five dou of water, reducing the liquid to seven dou. Use four dou of this liquid to soak one dou of wine starter, and use the remaining three dou to mix with the rice. Then add the rice according to the usual brewing method. Once fermentation is complete, press the mixture to extract the wine. Decide how much to take according to your own needs. Follow the restrictions and regimen for taking medicinal wine, and rest twice as much.

Major Decoction of Chinese Asparagus Root Formula: Treats the five forms of exhaustion, seven injuries, eight pathogenic winds, twelve impediments, and conditions such as injury to the middle and the six extremes in men.

First, the extreme of Qi: marked by pronounced chills, impediment pain, abdominal pain, shortness of breath, fear, and headache.

Second, the extreme of the Lungs: marked by cold impediment, lower back pain, hardness and accumulations below the heart, difficulty urinating, and numbness of the hands and feet.

Third, the extreme of the vessels: marked by a dark, bluish complexion, abnormal moods, and a dazed, absent state, as if overcome with grief and weeping. The tongue may later become stiff and the throat dry; the person may fear both cold and heat, dislike the wind, be unable to move, lose their appetite, and be prone to dizziness, anger, and incoherent speech.

Fourth, the extreme of the sinews: marked by tightness and spasms of the sinews, a hard and distended lower abdomen, heart pain, cold knees, and pain in the joints and bones of the limbs.

Fifth, the extreme of the bones: marked by coldness in the joints of the limbs, jaundice, wasting thirst, and the sudden onset of conditions such as carbuncles and ulcers. The illness is severe, and the body swells as in edema.

Sixth, the extreme of the flesh: an attack feels like being struck; afterward, the person cannot speak. In severe cases, they seem to die and then revive, and many doctors are unable to cure them.

These conditions are caused by the six extremes and seven injuries, and do not result solely from excessive sexual activity. Grief, anger, accumulated worry and thought, and shifts among joy, anger, sorrow, and delight, together with the congealing of wind and dampness, may also cause coughing and sometimes vomiting.

After eating, food fails to transform properly, and bowel movements and urination become difficult. At times, there is persistent diarrhea, which may become severe, or bloody urine and shortness of breath.

Vomiting and diarrhea alternate with chills and fever, and it is difficult to lie still. The urine is reddish or yellow, and there are frequent nightmares: dreams of eating and drinking with the dead, or entering a tomb or a spirit chamber—a room for the worship of deities. On waking, the hun and po seem to have scattered, leaving the mind unsettled.

Exhaustion of the sinews and Qi damages the liver. When the liver is damaged, pain pulls through the lower back and spine, making it difficult to bend or straighten the body. Exhaustion of Qi damages the lungs. When the lungs are damaged, there may be blood in the urine and blurred vision. Exhaustion of Jing and marrow can cause the penis to become limp and fail to rise, making intercourse impossible. Exhaustion of bone Qi damages the kidneys. When the kidneys are damaged, there may be shortness of breath and an inability to stand for long; pain and cold in the genital area, with the testicles drawing up in severe cases; and sores beneath the genitals that are damp and itchy, with itching so persistent that scratching cannot be stopped and fluid seeping from the sores. These are all signs of kidney disease.

When the condition is severe, wind toxins often invade, causing numbness in the limbs and swelling of the hands and feet. This illness is called “weak feet,” also known as “foot Qi,” an ancient term for disorders chiefly marked by numbness and swelling in the lower limbs. The following prescription treats all the symptoms described above.

Ingredients:

Cut and pound three and a half dou of each of the following: Tianmen Dong and raw Rehmannia root; press out their juices. Prepare three sheng of refined white honey and three sheng of refined butter. Cut three dou of goji root into pieces and wash it; add two shi and five dou of water, boil, and collect one dou and three sheng of juice, then let it settle until clear. Pound one whole deer bone, add one shi of water, and boil; collect five dou of juice and let it settle until clear.

First put the Tianmen Dong juice and raw Rehmannia juice into a large copper vessel and simmer over a low flame until reduced by half. Add the remaining liquids and continue simmering until two dou remain. Then add the powdered ingredients listed below and cook until reduced to one dou. Transfer to a copper vessel and heat it in a water bath until thick enough to be gently pressed and rolled into pills.

Make pills the size of parasol tree seeds. Each morning, take twenty pills on an empty stomach with wine, twice a day, gradually increasing the dose to fifty pills. While taking the medicine, avoid raw or cold foods, vinegar, greasy or slippery foods, pork, chicken, fish, garlic, oil, and foods made from flour.

Choose a suitable “Wangxiang day” from among the four seasons—a term from traditional date selection for days considered auspicious for undertaking an activity—and prepare the medicine then. Follow the method of combining the ingredients described in the “On Combining and Preparing” section of the first volume of the Essential Prescriptions Worth a Thousand Gold Pieces. The powdered ingredients are:

Poria, cinnamon heartwood, white atractylodes, fragrant solomon’s seal, five-flavor bark, sweet flag, polygala root, alisma, Chinese yam, arborvitae seeds, ginseng, dendrobium, Chinese teasel root, eucommia bark, Chinese raspberry, asarum, angelica pubescens, immature bitter orange, ligusticum, fermented soybean sprouts, astragalus, cistanche, teasel root, Chinese spleenwort rhizome, sesame seeds, tokoro yam, angelica dahurica, tangerine peel, poria with hostwood, and morinda root, two liang each; donkey-hide gelatin, ten liang; licorice, six liang.

One sheng each of Sichuan pepper (a medicinal type of prickly ash) and coix seed; one hundred jujubes, boiled and made into a paste. Five liang of deer antler glue and three liang of Vitex fruit.

Sift the thirty-eight ingredients above into a coarse powder and place them in a decoction vessel. Add three sheng each of ox marrow and deer marrow; this works very well.

If urination is difficult, remove biota seeds and add two liang of gentian root and six liang of dried rehmannia root. For impotence or seminal emission, remove fragrant Solomon’s seal and add two liang of schisandra berries. For head-wind, remove biota seeds and add two liang each of chrysanthemum and saposhnikovia root. For frequent urination and weakness of Yin qi, remove asarum and saposhnikovia root and add two liang of cornus fruit. For cold in the abdomen, remove saposhnikovia root and add two liang of dried ginger. If there are no other symptoms, prepare the original formula.

Gather the ingredients for this decoction in the latter part of the ninth lunar month, prepare it at the Start of Winter, and take it until the first ten days of the fifth lunar month the following year. If it is prepared on the La Day in the twelfth lunar month, take it until the latter part of the seventh lunar month, after the Summer Solstice. To store the medicine through the summer, bury it in a shaded place on the north side of the house. Dig six chi into the ground, lay down sand, place the medicine on it, and cover it with more sand. This keeps the medicine from spoiling over the summer.

Women who previously had heat conditions may take it; those with cold conditions should not.

Marrow-Filling Ten-Thousand-Gold Decoction: Used to treat internal exhaustion, scant qi, cold shan (abdominal pain or pulling pain caused by cold), abdominal cramping, counterflow qi in the abdomen with panting, and pain in the lower back and spine.

Thirty jin of fresh rehmannia root, juiced; one jin each of cistanche, licorice, and donkey-hide gelatin; two jin each of ophiopogon and dried rehmannia root; eight liang each of dried ginger, poria, mulberry root bark, and cassia bark; five liang each of ginseng, platycodon, schisandra berries, and aconite; one jin and five liang of dendrobium; three jin of ox marrow; ten jin of white honey; four dou of clear wine; three sheng of hemp seeds; one hundred and fifty jujubes; fourteen liang of Chinese angelica; twenty liang of dried lacquer; four liang of Sichuan pepper.

First place the twenty-three ingredients above, together with two dou and six sheng of clear wine, mulberry root bark, hemp seeds, jujubes, and donkey-hide gelatin, in a pot, marking a level inside the vessel. Then add one dou and four sheng of wine and boil until the liquid falls to the marked level. Strain out the solids. Next add the honey, ox marrow, and fresh rehmannia juice, and heat them in a water bath in a copper vessel. Add the remaining ingredients in powder form and simmer for about half a day, until the mixture can be made into pills…

Put the medicinal liquid in an earthenware jar. Take one pill about the size of a pellet each time, three times a day. If taking it during the heat of summer, you may boil the medicine to mellow its flavor. Alternatively, mix the medicinal powders with honey and fresh Rehmannia juice, and form pills the size of parasol tree seeds. Take fifteen pills each time. If the medicine seems too weak, gradually increase the dose to thirty pills.

A Formula for Men with Wind-Deficiency, Debility, and Seasonal Illness

One jin of licorice; four liang each of dendrobium, saposhnikovia root, cistanche, Asiatic cornelian cherry, poria, ginseng, and Chinese yam; three liang each of cassia bark, achyranthes root, schisandra, dodder seed, morinda root, and Sichuan lovage. Grind these ingredients into powder. Also, one sheng each of finely cut fresh rehmannia bark and fresh Rehmannia juice; two liang of red-rooted salvia; two sheng each of ginger juice and sesame; and three sheng each of ox marrow, white honey, and fresh ophiopogon juice.

There are twenty-two ingredients in all. First, boil the Rehmannia, Rehmannia bark, and sesame in two dou of water until the liquid has reduced by half. Strain out the solids. Add the ox marrow, honey, ginger juice, and ophiopogon juice, then simmer over low heat until eight sheng remain. Add the powdered ingredients and stir well. Transfer to a copper bowl and heat in a water bath until the paste is firm enough to form into pills. Make pills the size of parasol tree seeds. Take thirty pills with wine each time, twice a day, gradually increasing to fifty pills.

Young Deer-Bone Decoction, also called Roe Deer-Bone Decoction

This may be taken for any kind of weakness and wasting.

One deer skeleton, broken into pieces; two sheng of sliced goji root.

Place the two ingredients in separate vessels, add one dou of water to each, and boil until five sheng of liquid remain in each. Strain out the solids and let the liquids settle and clear. Combine the two liquids and boil them down to five sheng. Take twice daily until it is finished. Take care to regulate and nourish the body while using this medicine. All measures given are in large dou.

Rehmannia Paste

For the Five Taxations and Seven Injuries—a general term for various forms of overexertion and debility—as well as emaciation and wasted muscles.

One sheng of dried Rehmannia powder, half a sheng of sesame oil, two sheng of honey, and one jin of pork fat.

Place all four ingredients in a copper vessel and boil until the mixture is firm enough to form into pills. Make pills the size of parasol tree seeds. Take three pills each time, three times a day, gradually increasing to ten pills. Long-term use is said to be highly beneficial and to restore fullness to those who are thin and dark.

Lu Kang Paste

For deficiency-cold, wasting, lack of luster in the body, and all forms of deficiency and debility.

Two sheng each of ox marrow and mutton fat; butter, a dairy product (identified as pork fat in the Jingxin lu).

Three sheng each of fresh ginger juice and white honey.

First, heat the butter until cooked. Add the fresh ginger juice, then the honey, and finally the sheep fat and ox marrow. Simmer over low heat, heating and removing from the fire three times, until all the moisture from the ginger juice has evaporated and the paste is ready. Stir until it sets. Take with warm wine, in whatever amount one can tolerate; no specific limit is given. It is said to make a person plump, strong, and warm. The Jingxin lu says this remedy treats many ailments, is suitable for exhaustion and rheumatism, has a nourishing effect, and works remarkably well. It is suitable for both men and women.

A Miraculous Goji Berry Decoction for Nourishing Deficiency and Emaciation, and for Becoming Light and Ageless with Long-Term Use

On the tenth day of the ninth month, take one sheng of fresh, moist goji berries. Boil them in six sheng of clear wine until the mixture bubbles five or six times, then remove the berries and pound them to a pulp. Strain out the juice. Squeeze the pulp as dry as possible, dry it in the sun, and pound it into powder. Mix the powder with the juice set aside earlier, and simmer over low heat until the mixture can be rolled into pills. Take with wine: two square-inch spoonfuls each time, increasing to three after seven days. Alternatively, make pills and take thirty each time.

Xia Ji’s Apricot Kernel Decoction

Boil three sheng of apricot kernels in water. Remove their skins, tips, and double kernels. Once cooked, pound them in a basin, grind with water, and extract seven or eight sheng of juice. Set an iron pot over charcoal and add four jin of sheep fat. Once it has melted, add the apricot kernel juice and simmer gently for four or five days, until the mixture is golden in color. Take an amount the size of a pellet from a slingshot three times a day. After one hundred days, it is said to make a person plump and fair, changing their appearance so much that others can no longer recognize them.

Another formula: Dry-fry apricot kernels until yellow, remove the skins and tips, then pound them and form pills the size of Chinese parasol tree seeds. Take three times a day. This remedy treats emaciation and moistens the body. It is also used for coughing, upward surging of Qi, various throat ailments, and distress beneath the heart that makes swallowing difficult. Its medicinal effect is stronger when combined with poria, coltsfoot, and aster root. The text says that the herb is hot when used raw and cool when cooked. It can also be taken for a throat condition that feels as though a polyp has grown there.

Peach Kernel Decoction

One jin each of peach kernels, ground into powder, and honey; half a jin of butter; one sheng of sesame seeds, ground into powder; five sheng of cow’s milk; and ten jin of rehmannia root, from which the juice is extracted. Combine all six ingredients and boil until thick like malt syrup. Take at any time.

Formula for Treating the Five Taxations and Seven Injuries

One white sheep’s head and all four hooves. Clean and prepare them, then roast them over a grass fire until yellowish red. Tightly plug the nostrils and openings in the head with clean cotton cloth. One liang each of pepper, long pepper, and dried ginger; one sheng of scallion whites; and two sheng of fermented soybeans.

(The source text ends here; the remaining preparation instructions for the formula are not recorded.)

First, boil a sheep’s head and hooves in water until half cooked. Add the seven medicinal ingredients and continue boiling until everything is very tender. Remove the herbs and, once the broth and meat have cooled to a suitable temperature, eat as desired. Eat one portion each day for seven consecutive days, for a total of seven portions. Avoid raw or cold foods, sour foods, greasy or slippery foods, the Five Pungent Plants (such as scallions, garlic, chives, Chinese chives, and asafoetida, along with other pungent, stimulating foods), and stale or foul-smelling foods.

A nourishing formula for treating deficiency taxation

One sheep’s stomach, chopped; one sheng of white atractylodes.

Add two dou of water to these ingredients and boil until six sheng remain. Take two sheng per dose, three times a day.

Another formula

One sheng of fermented soybeans, steamed three times; one jin of Chinese chives, chopped.

Add seven dou of water to these ingredients and boil until three sheng remain. Divide into three doses and take them, allowing a slight sweat to break.

A lard decoction for treating weakness and emaciation

Take pork fat that has not come into contact with water and render one sheng. Add a handful of scallion whites and fry until they turn yellow, then remove them and pour the fat into a basin. Take it on an empty stomach at dawn, then cover yourself warmly and lie down to rest. In the afternoon, eat plain rice porridge, but do not make it too thin. After taking this for three days, take the restorative medicine prepared as follows.

One sheep’s liver; one strip of meat from a sheep’s back; half a jin of powdered fermented grain; ten jin of goji root.

First, boil the goji root in three dou of water until one dou remains, then strain out the solids. Finely chop the sheep’s liver and the other ingredients, put them into the strained liquid, and add scallions, fermented soybeans, and salt. Cook as you would a soup, then continue simmering until it thickens to the consistency of syrup. Eat this for seven days, observing the same dietary restrictions as for the previous formula.

A formula for replenishing deficiency

One pig’s stomach; five liang of ginseng; one liang of Sichuan pepper; two and a half liang of dried ginger; seven liang of scallion whites; half a sheng of white millet (the Qianjin Yifang uses non-glutinous rice).

Chop and mix the six ingredients, then put them together with the rice inside the pig’s stomach and sew it closed, taking care not to let the air inside escape. Add four and a half dou of water and simmer over low heat until tender. It works well when eaten on an empty stomach, and may also be served with a little rice.

Spitting Blood, Sixth (Discussion, Formulas, and Moxibustion)

The discussion says that Bingqiu believed spitting blood had three forms: internal bleeding, lung abscess, and stomach injury. In internal bleeding, the blood appears as it does in nosebleeds, but instead of flowing from the nostrils, it comes from the fluids between the heart and lungs and then flows into the stomach. The blood may resemble the liquid from a bean soup, or it may clot like finely chopped meat and remain in the stomach. This causes a feeling of distension and oppression in the chest and abdomen, after which the person vomits it, or…

A single episode may produce several dou of blood, or even a shi. This is usually caused by overexertion or an improper diet. People with lung carbuncle, a type of abscess in the lungs, may sometimes feel that toxic Qi is congested and their chest is troubled after drinking alcohol, followed by vomiting. At times they vomit blood afterward, in amounts ranging from one ge or half a sheng to one sheng.

Stomach injury occurs when someone overeats and the stomach is also exposed to cold, preventing the food from digesting. The person then feels distressed and forces themself to vomit. Food and Qi surge upward together, pressing against and tearing the stomach opening, so the vomited blood is bright red. The patient has gripping abdominal pain, cold sweats, and a tight, rapid pulse. This condition is difficult to treat.

Someone asked: “What is the name of an illness in which the chest and flanks feel distended and full, making it difficult to eat; at the onset, one first smells a rank, fishy odor, then brings up clear fluid and afterward spits blood; the limbs grow cold, the vision blurs, and blood sometimes appears in the urine or stool? How does this illness arise?”

The answer: “It is called ‘Blood Exhaustion.’ It occurs when someone has lost a great deal of blood in youth, or has sexual relations after becoming drunk, exhausting their strength and damaging the liver. As a result, menstrual flow becomes scant or stops altogether. To treat it, combine cuttlebone (cuttlebone shell) and lǘrú, an ancient medicinal substance, and make pills the size of sparrow eggs or small beans. Take five pills at a time after meals with abalone broth. This helps the bowels move and regulates the liver.”

After vomiting blood, someone who feels only physically tired, without distress in the heart, will often recover on their own. If they are agitated and troubled in the heart, vomit repeatedly, and cannot sit or lie at ease, a physician may give them Yellow Earth Decoction or Donkey-Hide Gelatin Powder, making the agitation worse and potentially endangering their life. When this distress in the chest occurs, vomiting should be induced promptly. The prescription is as follows:

Two fen of melon-stalk powder, and one fen each of duheng and ginseng. Grind these three ingredients into a fine powder and sift. Take one qianbi measure at a time, using the ancient measuring spoon for medicines. Even without water, it is enough to swallow the powder. Reduce the dose as appropriate for someone who is weak. After taking it, the person may vomit a blue-yellow fluid or one or two sheng of blood; there is no need to be alarmed.

Yellow Earth Decoction, for treating vomiting of blood:

Two pieces of fulonggan (stove-hearth earth), each about the size of an egg; one liang each of cinnamon heart, dried ginger, Chinese angelica, peony, angelica dahurica, licorice, donkey-hide gelatin, and Sichuan lovage; eight liang of fresh rehmannia; half a liang of asarum; and two sheng of medicinal evodia.

Cut the twelve ingredients into pieces. Combine seven sheng of wine with three sheng of water and decoct until three and a half sheng remain. Strain out the dregs, then add the donkey-hide gelatin and cook until three sheng remain. Divide into three doses. This prescription also treats nosebleeds.

Another formula treats sudden vomiting of blood or nosebleeds: hearth earth (the soil from the center of a stove), half a jin; licorice, dried ginger (Zhongjing’s version uses rehmannia instead), white atractylodes, donkey-hide gelatin, and scutellaria, three liang each. Chop the six ingredients, decoct them in one dou of water until three sheng remain, and strain out the dregs. Add the donkey-hide gelatin, then take the decoction in three portions. Zhongjing’s version adds three liang of aconite, making seven ingredients.

Rehmannia Decoction treats vomiting blood due to grief and resentment, accompanied by distress in the heart, shortness of breath, and chest pain: one jin of fresh rehmannia, fifty jujubes, and three liang each of donkey-hide gelatin and licorice. Chop the four ingredients, decoct them in one dou of water until four sheng remain, and take in four portions: three during the day and one at night.

Jianzhong Decoction treats alternating chills and fever, vomiting, and vomiting blood caused by deficiency taxation and internal injury: three jin of maltose; three liang each of peony, pinellia, ginger, and licorice; two liang of cinnamon bark; and fifty jujubes. Chop the seven ingredients, decoct them in two dou of water until seven sheng remain, and take in seven portions: five during the day and two at night. The Supplement to the Essential Prescriptions omits licorice and cinnamon bark and adds fresh rehmannia.

A formula for treating belching and stopping the spitting of blood: four liang of gypsum; three liang of magnolia bark; two liang each of ephedra, ginger, schisandra, pinellia, and apricot kernels; and one sheng of wheat. Chop the eight ingredients. First decoct the ephedra in one dou of water, skim off the froth, and let the liquid settle. Add the remaining ingredients and decoct until two and a half sheng remain. Take in two portions.

A formula for treating vomiting blood accompanied by a blockage and pain in the chest: three liang each of peony, dried ginger, poria, cinnamon bark, Chinese angelica, rhubarb, and mirabilite; two liang each of donkey-hide gelatin, licorice, and ginseng; one liang of ephedra; four liang of dried rehmannia; eighty gadflies and eighty leeches; twenty jujubes; and one hundred peach kernels. Chop the sixteen ingredients, decoct them in one dou and seven sheng of water until four sheng remain, and take in five portions: three during the day and two at night.

A formula for treating vomiting blood, internal bleeding, upward surging of Qi, and an ashen complexion: two liang each of dried ginger, donkey-hide gelatin, and arborvitae leaves, and one handful of mugwort.

Take the four ingredients listed above, chop them and pound them coarsely, then boil them in five sheng of water until one sheng remains. Add one sheng of horse dung juice and continue boiling until one sheng remains; drink the whole amount at once. Zhang Zhongjing calls this the “Cypress Leaf Decoction” and omits donkey-hide gelatin; the Xiaopin Fang also omits it. The use of cypress leaves is the same as in the Zhouhou Fang.

A formula for vomiting blood due to epidemic febrile illness and heat toxins in people who drink alcohol, accompanied by dry retching and distress in the chest:

Pollen of cattail (Puhuang), rhinoceros horn, trichosanthes root, and licorice (two liang each); kudzu root and Chinese taxillus (three liang each).

Chop and pound the six ingredients coarsely. Boil them in seven sheng of water until three sheng remain, and take in three doses.

Zelan Decoction: For abdominal spasms and cramping pain in the chest and flanks due to internal injury, with nausea or vomiting of blood, alternating chills and fever, and reddish-yellow urine. The text attributes these symptoms to excessive sexual activity.

Zelan, maltose (one jin each); cinnamon bark, white bark of the mulberry root, ginseng, and polygala root (two liang each); fresh ginger (five liang); hemp seeds (one sheng).

Chop and pound the eight ingredients coarsely. Boil them in one dou and five sheng of strong wine until seven sheng remain, then strain out the herbs and add the maltose. Take one sheng before meals, three times during the day and once at night. While taking the medicine, avoid exertion and excessive activity.

A formula for suddenly vomiting one or two mouthfuls of blood, or for bleeding from the heart or elsewhere inside the body:

Grubs (five); Chinese teasel root, moutan bark, cowherb seed, and dwarf lilyturf root (two liang each); shanyao vine, peony root, dried rehmannia root, Japanese teasel root, and donkey-hide gelatin (three liang each).

Chop and pound the ten ingredients coarsely. Boil them in five sheng of fresh rehmannia juice and three sheng of red horse dung juice until three sheng remain, and take in three doses. If the illness has not resolved, prepare several more batches and continue until recovery.

Another formula: Take about three egg-sized portions of processed mugwort. Boil them in five sheng of water until two sheng remain, and drink the whole amount at once.

Another formula: Burn disheveled hair to ash. Take one square-inch spoonful at a time with water, twice daily. The Jiyan Fang says this also treats sudden bleeding from the tongue, with a blood opening as small as a hairpin’s tip, and blood in the urine.

A formula for vomiting blood due to deficiency taxation:

Take five sheng of fresh, thick rehmannia root and pound it to a pulp. Add one sheng of wine, bring it to a boil three times, then strain out the residue and drink the whole amount at once.

Another formula: When vomiting blood, take powdered cinnamon bark, one square-inch spoonful at a time, up to twenty doses over the course of the day and night. The Zhouhou Fang says this is also suitable for blood in the stool.

Another formula: Take five jin of fresh Rehmannia root and squeeze out the juice. Simmer gently until it has boiled three times, then add one sheng of white honey and continue simmering until reduced to three sheng. Take half a sheng each time, three times daily. It may be used for chest pain and various illnesses; prolonged use is beneficial.

Another formula: Take one jin of arborvitae leaves and boil them in six sheng of water until reduced to three sheng. Divide into three doses.

Another formula: Take half a sheng of fresh Rehmannia juice and one square-inch spoonful (about a teaspoon) of Sichuan rhubarb powder. First warm the Rehmannia juice until it boils, then stir in the rhubarb powder. Take the mixture once on an empty stomach, three times daily, and stop when the illness is cured.

Rhinoceros Horn and Rehmannia Decoction, a formula made with rhinoceros horn, fresh Rehmannia root, and other ingredients: Used for patients with cold damage or warm disease who should have been made to sweat but were not, causing stagnant blood to accumulate within the body. It is also used when stagnant blood remains in the body after nosebleeds or vomiting blood, and for symptoms such as black stools and a yellow complexion, to disperse the stagnant blood.

One liang of rhinoceros horn, eight liang of fresh Rehmannia root, three liang of peony root, and two liang of moutan bark. Cut the four ingredients into pieces, add nine sheng of water, and simmer until reduced to three sheng. Divide into three doses. If the patient becomes confused and restless, as if delirious, add two liang of rhubarb and three liang of Scutellaria root. If the pulse is large and slow, the abdomen is not distended, and the patient merely reports abdominal bloating, this indicates there is no heat pattern. Use the original formula without adding anything.

A formula for treating heat bound in the Five Zang, vomiting blood, and nosebleeds:

A chicken-egg-sized piece of Fulonggan (the earth from the heart of a stove), one sheng of fresh bamboo shavings, two liang each of peony root, Chinese angelica, Scutellaria root, Ligusticum rhizome, and licorice, and one jin of fresh Rehmannia root. Cut the eight ingredients into pieces and add one dou and three sheng of water. First boil the bamboo shavings, reducing the liquid by three sheng; then add the remaining ingredients and simmer until reduced to three sheng. Divide into three doses. The Essential Supplements from a Thousand Gold Pieces records that cinnamon heart is also added to this formula.

Angelica Decoction: Used for nosebleeds and vomiting blood. Take two liang each of Chinese angelica, dried ginger, peony root, and donkey-hide gelatin, and three liang of Scutellaria root. Cut the five ingredients into pieces, add six sheng of water, and simmer until reduced to two sheng. Divide into three doses.

A formula for heat in the upper burner, injury to the chest and diaphragm causing vomiting of blood or nosebleeds, or persistent bloody stools lasting several days in a critical condition:

One sheng each of mugwort leaves and bamboo shavings, one piece of donkey-hide gelatin about the size of a palm, and two liang of dried ginger. Cut the four ingredients into pieces, add three sheng of water, and simmer until reduced to one sheng. Strain out the ingredients, add half a sheng of horse-urine infusion (liquid extracted from horse dung), and simmer again until reduced to one sheng. Take as a single dose.

Another prescription: Take fresh horse dung, add a little water, mix well, and squeeze out the juice to drink. Another account says not to add water.

Add dried ginger to the Bamboo Shavings Decoction, using seven liang in all.

A prescription for treating deficiency taxation, uterine bleeding, vomiting blood, blood in the stool, upward surging of Qi, shortness of breath as if life were about to end, and a face black as lacquer:

Astragalus root, peony, Chuanxiong rhizome, and licorice, four liang each; fresh ginger, one jin.

Coarsely chop the five ingredients and soak them in five sheng of wine overnight. The next morning, add five sheng of water and boil until four sheng remain. Divide into four doses: take three during the day and one at night. Once the medicinal force reaches the Yin region, the pathogenic toxin will quickly dissipate, like hot water poured over snow. In summer, do not soak the medicine in wine overnight.

If hemorrhoids and blood in the stool arise from overwork and internal heat, with heat around the anus, omit the fresh ginger and use fresh Rehmannia root instead. Usually, take three doses in succession.

Bamboo Shavings Decoction: a prescription for treating vomiting blood, sweating blood, and bleeding from the bowels or urinary tract.

Bamboo shavings, two sheng; licorice, Chuanxiong rhizome, scutellaria root, and Chinese angelica root, six fen each; peony, white atractylodes, ginseng, and cinnamon heart, one liang each.

Coarsely chop the nine ingredients, add one dou of water, and boil until three sheng remain. Divide into four doses: take three during the day and one at night.

A prescription for treating bleeding from the nine orifices:

Pound jing leaves and squeeze out the juice. Take two he of it with wine. Another version gives the herb as “jingjie.”

A prescription for treating vomiting blood, Gu poison, bleeding hemorrhoids, and women’s lower back and abdominal pain with fresh blood passed after a bowel movement:

Take the root of east-facing miogeng, pound it and squeeze out the juice. Drink two sheng at once; it takes effect immediately.

Red Adzuki Bean Powder: for treating various kinds of blood in the stool.

If blood appears before the stool, this is “distant bleeding”; take Yellow Earth Decoction (the seven-ingredient prescription given earlier, attributed to Zhang Zhongjing in the Treatise on Cold Damage). If the stool comes first and blood appears afterward, this is “near bleeding”; take Red Adzuki Bean Powder:

Red adzuki beans, three sheng, dry-fried until they split; Chinese angelica root, three liang.

Grind the two ingredients into a fine powder and sift. Take one square-inch spoonful each time, three times a day.

Dried Rehmannia Pill: a prescription for nourishing and treating blood deficiency and taxation damage, vexing fullness and pain in the chest and abdomen, fluctuating stasis, weakness of the viscera and bowels that prevents food from being received, and Qi counterflow that makes eating impossible.

Dried Rehmannia root, three liang; Chinese angelica root, dried ginger, ophiopogon tuber, licorice, and scutellaria root, two liang each; magnolia bark, dried lacquer, immature bitter orange, saposhnikovia root, rhubarb, and asarum.

The text ends here; it gives no quantities for these remaining ingredients and no method of preparation.

Atractylodes (Bai Zhu, one liang), Poria (Fu Ling, five liang), hogfennel root (Qian Hu, six fen), ginseng (Ren Shen, five fen), horsefly insects and ground beetles (Meng Chong and Zhe Chong, fifty of each).

Grind the eighteen ingredients above into powder and use honey to form pills the size of Chinese parasol tree seeds. Take ten pills three times a day before meals, gradually increasing the dose.

Ophiopogon Decoction: A formula for extreme weakness caused by blood in the stool.

Ophiopogon (Mai Men Dong) and Atractylodes (Bai Zhu), four liang each; licorice (Gan Cao), one liang; oyster shell (Mu Li), peony root (Shao Yao), and donkey-hide gelatin (E Jiao), three liang each; and twenty jujubes (Da Zao).

Cut the seven ingredients above into pieces and decoct them in eight sheng of water. Reduce the liquid to two sheng and take it in two doses.

For blood stasis in the chest, with distension and pain in the ribs and chest, inability to stand for long, and weak, cold knees, needle Zusanli (ST36).

For vomiting blood accompanied by shoulder and rib pain, dry mouth, and heart pain that extends to the back; inability to cough without pain pulling into the kidneys, needle Burong (ST19).

For vomiting blood from beneath the heart, chest, and diaphragm, needle Shangwan (CV13). For vomiting blood, chills and shivering, and a dry throat, needle Taiyuan (LU9). For vomiting blood, needle Taoling (PC7) and Ximen (PC4). For vomiting blood with Qi surging upward, needle Shenmen (HT7). For internal injury with vomiting blood, bodily weakness, and a dull complexion, needle Diwuhui (GB42).

Moxibustion

To treat consumptive weakness with vomiting of blood, apply three hundred moxa cones at Weiguan (around Shangwan, CV13). One cone is counted each time a moxa stick burns completely down. This method is also used for vomiting after overexertion, vomiting blood, poor appetite with early fullness, and excessive salivation. (Another edition reads “excessive sleep” instead of “excessive salivation.”)

For vomiting or spitting blood, apply one hundred moxa cones at Xiongtang. Do not needle this point.

For vomiting blood with aching, soreness, and a wasting sensation, apply one hundred moxa cones at Ganshu (BL18).

For vomiting blood with abdominal pain and intestinal rumbling, apply one hundred moxa cones at Tianshu (ST25).

For vomiting or spitting blood, Qi surging upward, or coughing with rebellious Qi, apply moxa at Feishu (BL13). The number of cones depends on the patient’s age.

Persistent bleeding from the mouth or nose is called “brain bleeding.” Apply fifty moxa cones at Shangxing (GV23), located one cun inside the hairline.

For blood in the stool, apply moxa at the twentieth vertebra. The number of cones depends on the patient’s age.