《孫真人備急千金要方》Vol. 40

The heart governs the spirit and awareness. “Spirit” is the foundation of the vital essences and Qi of the five organs, just as an emperor rules over the four quarters. In summer, the heart governs for seventy-two days and occupies the Southern Palace of Li, associated with Fire among the Five Phases. The vital essence received at birth is called “Jing”; when the Yin and Yang essences combine, they are called “spirit.” Spirit governs how a person perceives and responds to things in the outside world. This function is called the “heart,” and spirit is stored within it.

The tongue is the heart’s external sensory opening. Heart Qi reaches the tongue, and only when the tongue functions properly can the five flavors be distinguished. The heart’s connection through the body’s sensory openings is also related to the ears. The heart belongs to Fire and the kidneys to Water; when Water and Fire support one another, heart Qi can reach the tongue. The tongue itself is not an opening, so its connection with the sensory openings is associated with the ears. The left ear belongs to Bing and the right to Ding. Heart Fire circulates through the heart palace and rises to the lips and mouth, enabling the perception of flavor; the heart’s essence is also visible in the ears. Externally, the heart governs blood; internally, it governs the five tones.

The heart weighs twelve liang. It contains three hairs and seven openings, and holds three he of essence fluid. The heart spirit is called “Xuxu” and governs the storage of spirit; it is also called the “Five Spirits,” moves with the seasonal qi, and corresponds to the various parts of the body. Thus it is said that the heart stores the vessels, and spirit resides within them. The expression of heart Qi is swallowing, and its fluid is sweat. When heart Qi is weak, a person grieves continually; when it is excessive, the person laughs without stopping. When heart Qi is deficient, one dreams of putting out fires or of things associated with Yang. When Yang Qi is in its corresponding season, one dreams of burning and intense heat. When heart Qi is excessive, one dreams of laughter and may also dream of fear. If rebellious Qi disturbs the heart, one dreams of hills, mountains, or smoke and fire.

Among the organs, the heart belongs to Fire and is paired with the small intestine, which is its associated bowel. The heart’s channel is the Hand Shaoyin channel, which is paired externally and internally with the small intestine’s Hand Taiyang channel. The heart pulse has a surging quality: it corresponds to spring and is at its strongest in summer. In summer, all things flourish, their branches and leaves drooping and bending; for this reason, this pulse quality is also called the “hook pulse.”

When the heart pulse is surging, large, and long, its surging quality indicates that Defensive Qi is abundant. When Defensive Qi is abundant, Qi has no outlet; the pulse’s large size indicates that Nutritive Qi is strong and full. The surging and large qualities combine and may bring on sweating, hence the name “long pulse.” When the long pulse combines with the surging pulse, it can direct fluids to fill the channels, body fluids, and skin. If the Hand Taiyang channel also has a surging, large pulse, this indicates that the Qi of the mother organ is strong. Fortunately, the Spleen and Stomach (Earth, represented by Wu and Ji) can secure the foundation, allowing Yang Qi to rise and sweat to emerge from the head.

At this time, the five organs within the body are depleted and dry, and the womb is empty. If a physician instead administers purgative treatment, the body will be weakened further. A floating pulse indicates that the illness is on the exterior, with no interior signs. Yang Qi has lost its support for normal circulation; this not only endangers the patient but also harms the mother organ that generates the heart.

The pulse in summer resembles a hook. The summer pulse corresponds to the heart, which belongs to Fire in the south. At this time, all things grow vigorously, so the pulse Qi arrives full and strong, then gradually weakens as it withdraws. This is called the “hook pulse.” A pulse that departs from this pattern is a pathological pulse.

What does it mean for the pulse to depart from this pattern? If the pulse Qi arrives full and strong and remains just as strong as it withdraws, this is called “excess,” and the illness is in the body’s exterior. If the pulse Qi does not arrive full and strong but becomes stronger as it withdraws, this is called “deficiency,” and the illness is in the body’s interior. Excess may cause fever and skin pain, which may gradually spread. Deficiency may cause vexation and discomfort in the chest, with coughing and phlegm above and Qi leakage below.

When the heart pulse arrives, it flows continuously, like a string of beads or as though gliding over langgan, a fine jade. This is a normal pulse. The pulse in summer takes Stomach Qi—its calm, balanced quality—as its foundation. If the heart pulse arrives rapidly and continuously, with a slight curve, the heart is diseased. If its first part curves and its latter part lingers, like a hand gripping a hook, this is a sign that the heart is about to fail.

In a true critical heart pulse, the pulse is hard and forceful, like distinct grains of coix seed beneath the fingers, linked together but uneven. The complexion is a dull, dark red, almost black, without luster; the body hair falls out. Death will follow.

A pulse in summer with a slight hook quality is normal. A pronounced hook quality with insufficient Stomach Qi indicates heart disease. A hook quality without any Stomach Qi is a death pulse. If Stomach Qi is present but the pulse also shows the quality of a stone pulse—a deep, firm, hard pulse—illness is foretold for winter. If the stone quality is pronounced, illness will occur in the near future.

The heart governs the storing of the pulse, and Shen (spirit) is lodged within it. Fear and anxiety, or excessive thought, can injure the heart’s Shen. When Shen is injured, a person may become unnaturally fearful; the muscles waste away, the body grows thin, the hair becomes dry and brittle, and the complexion turns dull. Death may occur in winter.

When the Qi of the Hand Shaoyin channel is cut off, the vessels become blocked. The Hand Shaoyin channel corresponds to the heart pulse. When the vessels are blocked, blood cannot circulate; the hair loses its luster, and the complexion turns black, like lacquered leaves. These are signs that the Blood and Qi have begun to fail. If the illness worsens on a Ren day and death occurs on a Gui day, it is because Water overcomes Fire in the Five Phases.

When the heart is about to die, the pulse feels firm when felt lightly, like beans or hemp seeds striking the fingers. When pressed, it becomes even more restless and rapid; death will follow. In summer, when the heart’s Fire is in season, the normal pulse is floating, large, and scattered; some versions read “wiry” instead of “scattered.” If the pulse is instead wiry, fine, and long, Liver Qi is overpowering the heart. This is a deficiency pathogen, in which the mother disease affects the child; though there is illness, it is easily treated. If the pulse is instead large and slow, Spleen Qi is overpowering the heart. This is an excess pathogen, in which the child disease affects the mother; though there is illness, it may resolve on its own. If the pulse is instead deep, soft, and slippery, Kidney Water is overcoming heart Fire. This is a robbing pathogen, and the illness is severe; in eight or nine cases out of ten, it cannot be cured. When Kidney Qi overpowers the heart, urination may also become obstructed.

If the pulse at the left wrist’s cun position—the site before the guan position—is absent in its Yin aspect, this indicates that the heart pulse has ceased. The patient will feel heat beneath the heart.

When the palms feel hot, vomiting occurs frequently, and painful ulcers develop in the mouth, the condition can be treated by needling the Hand Shaoyang channel.

If a Yin Excess pulse appears before the guan position at the left wrist, this indicates an Excess condition of the heart. If fluid gathers below the heart and symptoms flare up with worry or anger, the condition can be treated by needling the Hand Heart-Master channel (the Hand Jueyin Pericardium channel).

When the Heart pulse is continuous and smooth, like round beads strung together, and comes twice with each breath, it is called a normal pulse. If it comes three times, it is called a pulse departing from the channel and indicates illness; four times indicates the loss of Jing and Qi; five times indicates critical illness; and six times means life is nearing its end. This describes the pulse of the Hand Shaoyin Heart channel.

If the Heart pulse is extremely rapid and tense, convulsions may occur. If it is only slightly rapid and tense, there may be heart pain extending to the back and an inability to eat. If the pulse is excessively relaxed, there may be uncontrollable laughter. If it is only slightly relaxed, there may be a fuliang (a condition involving a mass below the heart that moves up and down), sometimes accompanied by vomiting blood. If the pulse is excessively forceful and surging, there may be an obstruction in the throat. If it is only slightly forceful and surging, there may be Heart impediment (obstruction of the Heart vessels), with pain extending to the back and frequent tearing. If the pulse is excessively fine and small, hiccups may occur often. If it is only slightly fine and small, there may be xiaodan (a wasting-thirst disorder). If the pulse is excessively slippery and flowing, there may be frequent thirst. If it is only slightly slippery and flowing, there may be a Heart shan (a disorder caused by stagnation of Qi and blood in the heart and abdomen), with pain extending to the navel and rumbling in the lower abdomen. If the pulse is excessively rough and sluggish, the voice may be lost. If it is only slightly rough and sluggish, there may be blood overflowing, cold and numb limbs, ringing in the ears, and mania.

If the Heart pulse is hard and long, the tongue may curl and speech may become impossible. If the pulse is soft and scattered, there may be wasting thirst, which may later resolve on its own. (Some editions read “huan” instead of “thirst.”)

When a red pulse appears, accompanied by rapid breathing and a hard pulse, the diagnosis is a buildup of Qi inside the body, which often interferes with eating. This is called Heart impediment. It arises when an external pathogen invades: excessive worry weakens Heart Qi, allowing the pathogen to take advantage of that weakness and enter. Bian Que said: When the Heart is diseased, sores and ulcers appear in the mouth.

The sound associated with the Heart is laughter; its emotional change is worry, and the emotion it governs is joy. Joy harms the Heart. When Jing and Qi gather in the Heart, joy is expressed; when Heart Qi is deficient, there is sorrow. Sorrow leads to worry; when Heart Qi is full, there is laughter, and laughter in turn expresses joy.

Heart disease often flares up during summer, when that season is in command. As the illness sometimes eases and sometimes worsens, use these changes to investigate its source, select the corresponding transport points (acupuncture points where the Qi and blood of the channels flow), observe the response to needling, and assess how the illness progresses.

When illness first begins in the Heart, heart pain comes first. After one day it passes to the Lungs, causing shortness of breath and coughing; after three days it passes to the Liver, causing pain and fullness in the ribs and flanks; after five days it passes to the Spleen, causing obstruction and a heavy ache throughout the body. If there is still no improvement after a further three days, death will follow: in winter, at midnight; in summer, at noon.

Heart disease is milder at noon, worsens at midnight, and settles at dawn.

If a person with Heart disease walks north, or falls ill after eating pork or fish, and neither of these is the cause, the illness should occur in winter and may worsen on a Ren or Gui day.

In all cases of Heart disease, symptoms include pain in the chest, fullness in the flanks, pain beneath both sides of the ribs, pain in the front of the chest, back, and between the shoulder blades, as well as pain along the inner sides of both arms. When Heart Qi is deficient, the chest and abdomen become distended, and beneath the ribs and around the waist…

When pain is drawn toward the back, treat the Hand Shaoyin and Hand Taiyang channels, and prick beneath the tongue to let blood. If the condition changes, bloodletting may be performed at Xizhong, the name of an acupuncture point.

The Heart pulse feels fine and tight when pressed deeply, with no panting or shortness of breath when felt superficially. The patient has painful Qi accumulation below the heart, cannot eat, and often wants to swallow saliva. At times the hands and feet feel hot and the heart feels vexed and distended; at other times the patient is forgetful and low in spirits, and likes to sigh. This is caused by worry and excessive thought.

A patient with Heart disease has a red complexion, heart pain, shortness of breath, and vexing heat in the palms. At times the patient laughs or cries unpredictably, speaks inappropriately, feels sorrow and grief, and has a red face and a hot body. The pulse is forceful, large, and rapid; this condition can be treated. The patient should take a certain medicine. In spring, prick Zhongchong; in summer, Laogong; and in late summer, Daling, using reinforcing methods at each point. In autumn, prick Jianshi; in winter, Quze, using reducing methods at both points. These points are all on the hand and belong to the Hand Jueyin Heart Protector channel. Moxibustion should also be applied for fifty cones at Juque and one hundred cones beside the fifth vertebra on the back. When pathogenic Qi is in the Heart, symptoms include heart pain, a tendency to sadness, and sometimes dizziness and collapse. Treat the corresponding transport points—the places where channel Qi gathers—according to whether the signs indicate excess or deficiency.

Grief and excessive worry or thought injure the Heart. When the Heart is injured, a person is easily startled, may become excessively joyful, is forgetful, and is also prone to anger.

A person with Wind in the Heart has bouts of fever and cannot get up. The person feels hungry inside the Heart, but vomits after eating.

A person with Cold in the Heart feels as though they have swallowed garlic paste. In severe cases, heart pain pulls through to the back, and back pain pulls through to the heart, as if poison from a worm had entered. If the pulse is floating, the patient will recover after vomiting spontaneously.

When the Heart is injured, exertion can bring redness to the head and face and a heavy feeling in the lower body. Heart pain pulls through to the back; the Heart feels vexed and hot, and the area around the navel throbs. The pulse is wiry. This is caused by injury to the Heart.

Crying for no apparent reason and unsettled Hun and Po are due to insufficient Blood and Qi; insufficiency of Blood and Qi is related to the Heart. A person with deficient Heart Qi is easily frightened, closes their eyes and wants to sleep, dreams of traveling far away, and feels mentally scattered. When Yin Qi declines, this leads to dian; when Yang Qi declines, this leads to kuang. The Five Zang organs are where the Hun and Po dwell and the spirit finds support. If the Hun and Po drift about restlessly, this shows that the Five Zang are empty, allowing malign spirits to take advantage of the deficiency and enter. A short and faint pulse indicates that the Qi of the Zang organs is insufficient and the Hun and Po cannot settle. The Hun belongs to the Liver, and the Po to the Lung. The Lung governs fluids; when Lung Qi is deficient, there is a runny nose and crying. When Liver Qi is deficient, the Hun and Po are unsettled. The Liver governs anger, so its sound is expressed as shouting.

Those with “Heart Water” have swelling of the body (some editions read “a heavy body”), shortness of breath, an inability to lie flat, and agitation within the heart. If the genital region also swells (the original text has a variant reading here), and true heart pain appears, with the hands and feet cold up to the joints and the pain severe, an attack in the morning may lead to death by evening, while an attack in the evening may lead to death by the following morning.

If there is pain in the heart and abdomen, discomfort and oppression in the heart, and, during an attack, the abdomen swells into a lump that shifts from side to side and darts up and down, with pain that comes and goes; if there is heat inside the heart and abdomen, thirst comes easily, and saliva dribbles from the mouth, this is pain caused by roundworms biting. Press down on the lump with the hand to keep it from moving, then insert a large needle and hold it in place for a while. Once the worm stops moving, the needle may be withdrawn. Pain caused by roundworms in the intestines must never be treated with a small needle.

Those with “Heart Distention” feel oppressed within the heart, are short of breath, and cannot lie down comfortably.

A rapid Heart pulse is called “Heart Hernia.” The lower abdomen should show a change in shape. The heart is a “male organ” (an organ of Yang), and the small intestine is its “envoy,” the paired organ governed by the heart; this is why a corresponding change in the shape of the lower abdomen occurs.

When the pulse of a Heart accumulation is examined, it is deep and hollow, and the illness shifts up and down, with no fixed location. The patient feels distention in the chest and palpitations; there is heat in the abdomen, a flushed complexion, a dry throat, agitation within the heart, and heat in the palms. In severe cases, the patient vomits blood and the body convulses and spasms. This illness belongs to “Blood Reversal,” a condition caused by the disordered counterflow of blood and Qi. It eases in summer and worsens in winter, and the complexion is flushed.

A Heart accumulation is called “Fu Liang” (“Crouching Beam”), a type of mass formation. It begins above the navel and extends upward to the heart, its size like an arm. If it persists without healing, agitation and heart pain develop. Why does it arise on a Geng or Xin day in autumn? Kidney disease passes to the heart, and the heart should then pass it on to the lungs. But in autumn the lungs are in season and flourishing, so an organ at its peak does not receive pathogenic influences. The heart disease then seeks to return to the kidneys, but the kidneys refuse to receive it. The pathogenic influence therefore remains and congeals, forming an accumulation. This is why Fu Liang arises in autumn.

A person with heart disease feels oppressed within the heart and short of breath, has intense internal heat, and experiences heat surging upward, with vomiting, coughing, retching, delirious speech, and sweat pouring out in beads, while the limbs are cold and withdrawn. The pulse should be floating, but instead it is deep, soft, and slippery; the complexion should be flushed, but instead it is dark. This is Water overcoming Fire, a severe pattern of reversal. In eight or nine cases out of ten, the patient will die, and there is no way to save them.

A “Zhi-tone person”—one associated with the heart among the correspondences of the Five Tones—has the heart as their governing organ. The heart’s sound is laughter; its corresponding instrument is the yu mouth organ, and its corresponding emotion is joy. If the Qi activity of the Hand Shaoyin Heart channel and the Taiyang channel becomes disordered, the Qi of the nutritive and defensive systems can no longer flow freely, and Yin and Yang also fall into disorder. Yang Qi surges outward, while Yin Qi is injured within. Injury brings on cold; cold brings on weakness; weakness leads to fright, convulsions, and unsettled palpitations. “Heart-Calming Decoction” may be used to treat this (the prescription is in another volume).

When speaking, the voice is broad and slow in the first half of a sentence, then hurried in the second half. The second half cannot follow on from the first: the beginning is indistinct, the end muddled, and the mouth (the original text is damaged at this character) is confused and unclear. The person also likes to laugh to themselves. This is…

If a wind pathogen enters the heart, treat it with Jingli Decoction (see the formula in another volume). When the heart Qi is deficient and the person is also affected by wind and cold, symptoms may include paralysis on one side of the body, joints that feel as though they are coming apart, slack and powerless limbs that cannot be controlled, irregular bowel and bladder function, and abnormalities of the mouth and face. Xie Jiangfu Decoction may be used (see the formula in another volume). If the illness began less than ten days ago, treatment should be given promptly.

If the patient laughs while groaning, then becomes sorrowful after groaning, this shows Water overcoming Fire, with Yin Qi invading Yang Qi. As Yin Qi rises, Yang Qi lies hidden. When Yang Qi is hidden, the body becomes congested and replete; this congestion causes injury and generates heat. When heat becomes excessive, the person grows agitated, feels oppression in the chest, and becomes confused. They may speak at length but incoherently, so their words should not be trusted too readily. At this point, the heart has already been injured. If the patient’s lips are bright red, the condition may still be treated; if they are blue-green, yellow, white, or black, recovery is unlikely.

When heart disease flares up like malaria, it can make a person feel restless inside and crave cold water, while also fearing cold; the cold symptoms are pronounced, but fever is not (see the formula in another volume). If someone who is usually mild-mannered and refined suddenly becomes irritable and violent, unlike their usual self, treat them with Baizhu Wine (see the formula in another volume). There is also a sign in which a person stops speaking before finishing a sentence and then picks at their toenails with their hand. Such a person will surely die. Though calamity has not yet become apparent, this condition is called “walking corpse”: the body remains, but life is about to end. These are signs of heart disease expressed through sound and behavior. Deficiency should be tonified and repletion should be drained; carefully distinguish the cases that cannot be treated.

Red corresponds to the heart, and the heart is associated with the vessels. A complexion as red as a cockscomb is an auspicious sign. The heart governs the tongue, which is its outward expression. People whose bodily constitution belongs to Fire commonly have a red complexion, a broad forehead, a tapered face, a small head, and well-formed shoulders and back, with small hips and abdomen. Their hands and feet move steadily; when they walk quickly, their shoulders and back sway. They have full, strong muscles, do not value money, are not very dependable, think a great deal, see things clearly, like to look back, and are quick-tempered. Such people do not live long and may die suddenly. They endure spring and summer relatively well but not autumn and winter; when affected by pathogenic factors in autumn or winter, they are prone to illness. Their illnesses often manifest in the Hand Shaoyin channel, the Heart channel.

The length, slant, or straightness of the breastbone area can be used to assess the heart. A bright red complexion and fine, dense lines in this area indicate a small heart. A small heart is less easily harmed by pathogenic influences, but is more easily injured by sorrow. Coarse, sparse lines indicate a large heart. A large heart is prone to deficiency, and deficiency makes it susceptible to cold. After being affected by cold, it is less easily injured by sorrow but more easily invaded by pathogenic influences. If the breastbone area has no distinct prominence, the heart is positioned high. A high-positioned heart is prone to repletion; repletion generates heat, and heat fills the lungs, causing chest oppression and forgetfulness and making it difficult to speak. If the breastbone area is short and turned upward, the heart is positioned low. A low-positioned heart leaves the organs exposed, making them susceptible to cold and fear. A long breastbone area indicates a firm heart. A firm heart keeps the organs stable and securely guarded. A weak breastbone area indicates a fragile heart; a fragile heart is prone to illness and wasting…

The heart corresponds to summer, belongs to Fire among the Five Phases, has a red pulse color, and is associated with the Hand Taiyang channel. For needling in summer, select channels where Qi and blood are abundant, as well as points between the muscles and in the spaces beneath the skin.

When the area directly over the heart rises in the center and is well formed, the heart Qi is harmonious and unobstructed, and is less easily harmed by pathogenic influences. If the raised area leans to one side, this indicates that the heart region is askew; a person may then be prone to losing consistency in their conduct. If the area over the heart is sunken, small, and weak, this indicates that the heart lies low and its Qi is deficient. The person may be prone to cold damage, internal injury from grief or anger, sudden pain in the chest, and frequent spitting of clear saliva. Bad breath and toothache may also occur, as the pathogenic influence reaches the lips and teeth. If the area over the heart rises prominently, this indicates that the heart lies high and its Qi is excessive. Excess generates heat; when heat is severe, it may cause distress in the chest, forgetfulness, palpitations, a dry throat, pain in the mouth, swollen and painful gums, and injury to the tongue. Children may also develop constipation, a swollen tongue, oral thrush, or hoarseness. Relevant formulas can be found in “The Chapter on the Head and Face.”

Depressions or protrusions in different parts of the body often indicate illness in the corresponding region. The small intestine belongs to the Taiyang channel and is the surface counterpart of the heart; a depression or protrusion in that area may therefore indicate illness. Changes in the internal organs and their surface manifestations can also be assessed by the body’s shape: heavy, turbid pathogenic influences belong to the interior, while light, superficial, and clear ones are external. When an external illness enters the interior, it may cause distension and fullness in the lower abdomen. When an internal illness manifests outwardly, a corresponding area may become sunken or depressed. In treatment, when a pathogenic influence moves from the exterior to the interior, first treat the Yang aspect, then tonify the Yin aspect. When illness moves from the interior to the exterior, first tonify the Yin aspect, then drain the Yang aspect. The Yang aspect is replete and hot, while the Yin aspect is deficient and cold; Yang governs the exterior, and Yin governs the interior.

Signs of life, death, good fortune, and misfortune may appear on the face as the spirits and Qi of the organs change. Before an attack of heart disease, the mouth may open; when the heart Qi is about to give out, the complexion becomes withered and black, and speech becomes halting. If a deathly, dusky color appears at the center of the forehead or other corresponding areas, and coincides with the Mao day, the condition is difficult to treat. Changes in these signs should be considered when judging whether the illness is progressing slowly or rapidly: in a slow-moving illness, death may come within four hundred days; in a rapid one, within ten or fifteen days.

How can one foresee sudden death when heart disease seems to have improved somewhat? If dark red-black spots appear on the face, especially in the facial diagnostic region and the upper bridge of the nose, sudden death may follow. When the heart Qi is severed, death comes within a day. If both eyes roll upward and stare, and the shoulders rise and fall with the breath, these are signs that death is near. If the face is red and the whites of the eyes are prominent, the heart Qi may be depleted internally by grief, anger, and excessive thought. Even if the complexion appears better, preparations for death should be made promptly, as death may come within ten days. If the face is yellow and the eyes are red, death is generally not imminent; but if the redness resembles clotted, decayed blood, death may follow. If a dusky red-black color appears in the corresponding facial region and extends to the mouth, the person may not live beyond the year. This condition is called “walking corpse.” If no corresponding sign appears at the upper bridge of the nose, the illness may still prove fatal within three years.

Summer corresponds to Fire. Fire Qi begins to flourish, and the Qi of the heart grows with it. At this time the pulse is relatively thin and the body’s strength is weak, while Yang Qi remains within the body and fills it. Heat steams the spaces between the muscles and skin, then penetrates inward into the channels. Thus, if acupuncture is applied where the channels are flourishing and the spaces between the skin are open, allowing pathogenic Qi to leave through the skin, the illness can be cured. This is because the pathogenic influence has lodged only superficially. The “flourishing channel” mentioned here is a Yang channel.

The root of this channel lies behind the outer ankle, corresponding to “Mingmen” (here an ancient term for locating a channel, not the lumbar Mingmen point as understood today). Mingmen is one inch above the heart. The channel’s root is also at Shaoze, the point at the tip of the little finger.

Its sinew channel begins above the little finger and binds at the wrist. It travels upward along the inner forearm to a point behind the bony prominence on the inner elbow. Plucking this spot produces a sensation above the little finger. The sinew channel enters and binds in the armpit. Another branch runs upward and backward from the rear edge of the armpit, passes around the shoulder blade, and ascends along the neck. It binds at Wangu, the bony prominence behind the ear, in front of the sinew channel of the Foot Taiyang. One branch enters the ear, emerges directly above it, binds at the jaw, and connects to the outer corner of the eye.

This channel begins at the tip of the little finger and runs upward along the outer side of the hand to the wrist, passing between the bony prominences there. It then ascends along the lower edge of the forearm bones, passes between the two bones at the inner elbow, and follows the rear outer edge of the upper arm to the shoulder. It winds around the shoulder blade, crosses the top of the shoulder, and enters the supraclavicular fossa. From there it descends to the armpit, connects with the heart, runs down along the throat, passes through the diaphragm, reaches the stomach, and pertains to the small intestine. One branch runs from the supraclavicular fossa up the neck and across the cheek to the outer corner of the eye, then turns back and enters the ear. Another branch separates from the cheek, passes over the bridge of the nose to the inner corner of the eye, and runs diagonally to connect with the cheekbone. It joins the Hand Shaoyin channel, with the two serving as exterior and interior to one another. The root of the Hand Shaoyin channel lies at the end of the bony prominence at the ulna, corresponding to the back. The two channels meet with the Hand Taiyin channel.

The collateral channel of the Hand Taiyang is called Zhizheng. It lies five inches above the wrist and flows inward into the Hand Shaoyin channel. Another branch ascends to the elbow, connects with the shoulder, and governs disorders related to the heart. When pathogenic Qi is excessive, the small intestine becomes hot. Excess heat loosens the joints, followed by signs of illness in the Yang channel. If the Yang pulse at the cun position is twice its usual size, or even twice that, symptoms may include a sore throat, swelling of the jaw, deafness, yellowing of the eyes, and being unable to speak while lying down. When the chest feels constricted, the person will urgently try to sit up.

When the channel is deficient, the small intestine becomes cold. Cold can cause warts, followed by signs of illness in the Yin channel. If the Yin pulse at the cun position is more than half its usual size below normal, symptoms may include shortness of breath, pain in the joints throughout the body, spasms in the sinews, neck pain, and inability to turn the head to look around.

(The above describes the disorders governed by the sinew channel, channel, and branches of the Hand Taiyang Small Intestine channel. The following section appends material on the Hand Jueyin Pericardium collateral and the Hand Shaoyin Heart channel.)

The collateral vessel of the Hand Jueyin Pericardium channel is called Neiguan. It lies five cun above the wrist; the Jia Yi Jing gives the location as two cun. The vessel branches off between the two tendons at the wrist, follows the channel upward, and connects with the pericardial network and the heart network—the vessels linked to the heart. When Qi and blood are congested, there is heart pain; when they are deficient, there is distress and oppression in the heart. Treatment uses the Neiguan point between the two tendons.

The channel of the Hand Jueyin Pericardium begins in the chest, connects with the pericardium, passes downward through the diaphragm, and links with the upper, middle, and lower Triple Burners. One branch emerges from the chest, passes below the ribs and three cun beneath the armpit, then rises to the armpit. It continues down the inner upper arm, between the Hand Taiyin Lung channel and the Hand Shaoyin Heart channel, enters the elbow, and travels between the two tendons of the forearm into the palm. From there it follows the middle finger to its tip. Another branch separates from the palm and follows the ring finger to its tip.

When this channel is disordered, symptoms may include heat in the palm, cramping of the elbow and arm, and swelling beneath the armpit. In severe cases, there may be fullness in the chest and flanks, agitation and forceful pounding in the heart, a flushed face, yellowing of the eyes, and frequent uncontrollable laughter. These are conditions governed by the Pericardium channel. Related organ conditions also include distress in the heart, heart pain, and heat in the palm. To treat them, drain when Qi is abundant and tonify when Qi is deficient. For heat, insert the needle shallowly and withdraw it quickly; for cold, retain the needle. When Qi and blood have sunk, use moxibustion. If there is neither excess nor deficiency, treat according to the channel. When Qi is abundant, the cun-mouth pulse is twice as large as the Renying pulse; when Qi is deficient, the cun-mouth pulse is smaller than the Renying pulse.

The collateral vessel of the Hand Shaoyin Heart channel is called Tongli. It lies one cun behind the wrist. The vessel branches off here, travels upward along the Heart channel into the throat, and connects with the root of the tongue and the eye network—the vessels linked to the eyes. When Qi and blood in the collateral vessel are congested, there is distending fullness in the chest and diaphragm; when they are deficient, the person is unable to speak. Treatment uses the Tongli point one cun behind the palm; this is where the collateral vessel connects with the Hand Taiyang channel.

The channel of the Hand Shaoyin Heart begins in the heart, connects with the heart network, passes upward through the diaphragm, and links with the small intestine. One branch rises from the heart network, runs along both sides of the throat, and connects with the eye network. (Another version reads, “It travels along the chest and emerges below the ribs.”) The main channel turns back upward from the heart network, enters the lungs, then emerges beneath the armpit. It descends along the inner rear edge of the upper arm, behind the Hand Taiyin Lung channel and the Hand Jueyin Pericardium channel, passes the inner elbow, and follows the inner rear edge of the forearm to the bony prominence on the little-finger side of the wrist. It then enters the inner side of the palm and follows the inner side of the little finger to its tip.

When this channel is disordered, symptoms may include a dry throat, heart pain, and thirst with a desire to drink water. This is called “Arm Reversal,” a condition caused by the disruption and reversal of Qi and blood in the arm channels. Conditions governed by the Heart channel also include yellowing of the eyes, distending fullness and pain in the flanks, pain along the inner rear side of the upper and lower arm, coldness and reversal in the arm, and heat or pain in the palm. To treat these conditions, drain when Qi is abundant and tonify when it is deficient. When Qi in the channel is abundant, the cun-mouth pulse is twice as large as the Renying pulse; when Qi is deficient, the cun-mouth pulse...

Therefore, the pulse at the cunkou is smaller than the pulse at the renying.

Someone asked, “Why does the pulse of the Hand Shaoyin channel alone have no Shu point?” The answer was, “Shaoyin is the Heart channel. The Heart governs the five zang and six fu organs and is where the spirit resides. When the Heart is firm, pathogenic Qi cannot enter. If it does enter, it will damage the Heart. When the Heart is damaged, Shen departs; when Shen departs, the person dies. Therefore, pathogenic Qi that attacks the Heart is confined to the Heart’s envelope. The envelope is the channel of the Heart Master, which is why the Shaoyin channel has no Shu point.”

Someone asked again, “If the Shaoyin channel has no Shu point, can the Heart not become ill?” The answer was, “The Heart’s external channel and fu organ can become ill, but the Heart itself cannot. So treatment uses its channel, selecting a point behind the palm, at the end of the wrist’s ulnar prominence.”

The three summer months correspond to the Heart and Small Intestine, and are prone to a disorder called “Red Pulse Collapse,” a disease associated with the summer season. Its root lies in the Qi of Shaoyin and Taiyang binding against each other and stagnating, so that the movement of nutritive Qi and defensive Qi is impeded, causing pain in the flesh and skin. When Taiyang Qi stirs, the pathogenic Qi of Shaoyin follows and invades; the zang and fu organs then respond to the season by contracting summer epidemic illness. These illnesses have similar symptoms. When the Qi of the fu organs is weak, it is invaded by Yin pathogens, causing shivering, abnormal pulsation, and involuntary movements. When the Qi of the zang organs is excessive, it is invaded by Yang toxins, causing heat in the muscles, an open mouth, sores on the tongue, obstruction of the throat, and hoarseness. This is why the disorder is called “Red Pulse Collapse.” (See the treatment in the middle volume of Treatise on Cold Damage.)

Bian Que said: Moxibustion at the Shu points of the Kidney, Liver, and Heart channels can treat cinnabar toxin (the original text also reads “impediment toxin”). Treatment should follow the cause of the illness and take account of the exterior and interior, Yin and Yang, so that the zang and fu organs are harmonized and illness does not arise.

The Second Section on Heart Deficiency and Excess (Pulse Signs, Prescriptions, and Moxibustion)

Heart Excess Heat

The pulse at the left cun position, before the renying, is Yin-excess. This indicates illness of the Hand Shaoyin Heart channel. The patient often has constipation, abdominal distension, heaviness in the limbs, and fever. This is called Heart excess heat.

Gypsum Decoction treats excess heat in the Heart, as well as retching without being able to vomit, vexation in the chest, rapid breathing, and headache.

One jin of gypsum; one sheng each of bland bamboo leaves and fermented soybean; three sheng of wheat; five liang of Chinese wolfberry root bark; three liang of poria; and thirty-seven gardenia seeds.

Chop the seven ingredients. First boil the wheat and bamboo leaves in one dou and five sheng of water. When the liquid has reduced to eight sheng, strain it clear. Add the remaining ingredients and decoct until two sheng of liquid remain. Filter out the dregs and take in three portions. (In Essential Secrets from the Outer Tower, this prescription is called “Lung-Purging Decoction.”)

Xiexin Tang (Drain the Heart Decoction): Treats diarrhea in the elderly and children, undigested food and drink, rumbling in the intestines, oppression and fullness below the heart (around the pit of the stomach), persistent dry heaving, and an unsettled spirit.

Ingredients: Ginseng, Scutellaria root, and licorice, one liang each; dried ginger, one and a half liang; Coptis rhizome, two liang; pinellia, three liang; and twelve jujubes.

Chop the seven ingredients. Simmer them in eight sheng of water until two and a half sheng remain. Divide into three doses. This formula also treats cholera. If the patient feels cold, add one aconite root. For thirst, add two liang of trichosanthes root. For vomiting, add one liang of tangerine peel. For abdominal pain, add one liang of Chinese angelica root. If the condition is due to an external heat pathogen, use fresh ginger instead of dried ginger.

Heart and Small Intestine Both Excessive: If the pulses at the left cun position and at the point before the renying position are both strong and full in their Yin and Yang aspects, this indicates excess in both the Hand Shaoyin channel (Heart channel) and the Great Yang channel (Taiyang channel). The patient will have a headache, fever, constipation, oppression and fullness in the chest and abdomen, and difficulty sleeping. This results from the Stomach Qi failing to circulate, causing water and grain to stagnate. It is called “Heart and Small Intestine Both Excessive.”

Zhuli Tang (Bamboo Sap Decoction): Treats startling dreams, a tendency to laugh easily, fear, palpitations, and an unsettled spirit caused by excess heat in the Heart.

Ingredients: Fresh bamboo sap and fresh rehmannia juice, one sheng each; gypsum, eight liang; peony, atractylodes, ginseng, and gardenia seed, two liang each; red halloysite, aster root, anemarrhena, and poria spirit, two liang each.

Chop the eleven ingredients. Set the bamboo sap aside and simmer the other ten ingredients in nine sheng of water until two sheng and seven ge remain. Strain out the herbs, then add the bamboo sap and continue simmering until three sheng remain. To strengthen the laxative effect, add two liang of mirabilite and omit the peony. Divide into three doses.

Fushen San (Poria Spirit Powder): Treats dry mouth, intense thirst, and restless sleep caused by excess heat in the Heart.

Ingredients: Poria spirit and ophiopogon tuber, thirty-six zhu each; tetrapanax pith and cimicifuga, thirty zhu each; aster root and cassia bark, eighteen zhu each; anemarrhena, one liang; red halloysite, forty-two zhu; ten jujubes; and one piece of fresh bamboo shavings, about the size of a chicken egg.

Grind the ten ingredients into a coarse powder. Take one square-inch spoonful of powder, wrap it in cloth, and simmer it in two and a half sheng of well water until nine ge remain. Stir the herb bundle from time to time as it simmers. Take one dose each time, twice daily.

Xiexin Tang (Drain the Heart Decoction): Treats unsettled Heart Qi, vomiting blood, and nosebleeds.

Two liang of rhubarb, one liang of coptis, and one liang of scutellaria.

Chop the three ingredients. Simmer them in three sheng of water until one sheng remains, then drink the whole amount at once. This prescription is also used to treat cholera, meaning an acute illness involving vomiting and diarrhea.

Calming the Heart Powder: A prescription for heat in the Heart, fullness and distension in the chest, distress, and fear.

Two liang each of white peony, polygala, and aged ginger; forty-two zhu each of poria, red halloysite, ophiopogon, anemarrhena, aster, and gypsum; twenty-four zhu of ginseng; thirty zhu each of cinnamon heartwood, ephedra, and scutellaria; thirty-six zhu of fragrant Solomon’s seal; and twelve zhu of licorice.

Grind the fifteen ingredients into a coarse powder and sift. First simmer one sheng of fresh bamboo leaves in five sheng of water until three sheng remain, then strain out the solids. Add one and a half fangcun spoonfuls of the powder, wrapped in silk, and stir the sachet as it simmers. Reduce the liquid to eight he. This is one dose. Take it twice a day.

A prescription for inability to eat, fullness and distension in the chest, rebellious Qi above the diaphragm, distress, and fever:

Apply fourteen moxa cones at the Heart Shu point. Use fewer for children, as appropriate. Heart Shu is the point on the back corresponding to the Heart; “cone” is a unit for counting moxibustion applications.

Heart Deficiency-Cold

When the pulse at the left wrist, before the renying position, is deficient and Yin in quality, this indicates illness in the Hand Shaoyin Heart channel. The patient often feels palpitations, fear, and low spirits, with pain in the Heart and abdomen that is difficult to describe. The Heart seems cold, and the patient feels dazed and unsettled. This condition is called “Heart Deficiency-Cold.”

Poria Heart-Supplementing Decoction: A prescription for insufficient Heart Qi, with a tendency toward sadness, worry, anger, nosebleeds, a yellowish complexion, distress, and heat in the palms, soles, and chest. It may also be used when someone sometimes speaks aloud without realizing it, has a sore throat, a stiff tongue root, cold drooling (another version reads “sweating”), forgetfulness, or unease and fear. It is also used for women with uterine bleeding or a flushed complexion.

Four liang of poria; two liang each of cinnamon heartwood and licorice; one liang each of purple fluorite and ginseng; twenty jujubes; three liang of ophiopogon; and twenty-four red adzuki beans.

Chop the eight ingredients. Simmer them in seven sheng of water until two sheng remain, then divide into three doses.

Pinellia Heart-Supplementing Decoction: A prescription for Heart Deficiency-Cold, fullness and distension in the Heart, sadness and worry, or dreams of hills, plains, lakes, and marshes.

Six liang of pinellia; five liang of aged ginger; three liang each of poria, cinnamon heartwood, immature bitter orange, and tangerine peel; four liang of white atractylodes; and two liang each of saposhnikovia and polygala.

The nine ingredients listed above should be roughly chopped and boiled in one dou of water. Reduce the liquid to three sheng, then divide it into three doses.

Ox Marrow Pills: A General Remedy for All Diseases, Weakness, Emaciation, and Related Conditions

The formula consists of ox marrow, sheep marrow, jujube paste, white honey, and butter (one sheng each); Ophiopogon root, chuanxiong (also called Sichuan lovage), cinnamon heartwood, Chinese angelica, poria (some versions specify spirit poria), licorice root, and notopterygium (thirty zhu each); dried rehmannia and dried ginger (thirty-six zhu each); schisandra fruit, ginseng, and saposhnikovia root (one liang each); asarum (eighteen zhu); and atractylodes (forty-two zhu).

Roughly chop, pound finely, and sift fourteen of the nineteen ingredients. Separately grind the jujube paste, then mix it thoroughly with the powdered herbs. Add the various kinds of marrow and the honey, and stir well. Place the mixture in a copper bowl, then set the bowl in a pot of boiling water and cook it over the water. Form pills the size of parasol tree seeds. Take thirty-nine pills at a time with wine, gradually increasing the dose to forty-nine pills. After taking the pills for forty-nine days, take one more dose.

Deficiency of Both the Heart and Small Intestine

If the Yin and Yang pulses at the left wrist, before the Renying pulse, are both weak, this indicates simultaneous deficiency of the Hand Shaoyin channel (the Heart channel) and the Hand Taiyang channel (the Small Intestine channel). Symptoms may include watery diarrhea, aversion to cold, shortness of breath, cold and numb limbs, and intestinal flux. This condition is called “deficiency of both the Heart and Small Intestine.”

Major Heart-Tonifying Decoction

This is used for weakness of Heart Qi, palpitations, occasional confused speech, decline in the function of the limbs, lack of strength, and a dull complexion.

The formula consists of scutellaria root and aconite (one liang each); licorice root, poria, Ophiopogon root, dried rehmannia, cinnamon heartwood, and donkey-hide gelatin (three liang each); pinellia, polygala root, and gypsum (four liang each); fresh ginger (six liang); maltose (one jin); and twenty jujubes.

Roughly chop the thirteen ingredients and boil them in one dou and five sheng of water. Reduce the liquid to five sheng. Once the decoction is ready, add the maltose and divide it into four doses.

Heart-Tonifying Pills

These are used for weakness of the organs and bowels, a tendency to be easily frightened, and the feeling of being tormented by nightmares. They are also used for lingering discomfort after childbirth and irregular menstruation.

The formula consists of Chinese angelica, saposhnikovia root, chuanxiong, aconite, peony root, licorice root, Sichuan pepper, dried ginger, asarum, cinnamon heartwood, pinellia, magnolia bark, rhubarb, and poria (one liang each; one version gives spirit poria).

There are sixteen ingredients in all, including Polygala root (yuanzhi); the original text does not record the full list of ingredients or their dosages. Grind them into a fine powder and use honey to form pills the size of firmiana seeds. Take with wine, five pills per dose, three times a day. If they have no effect, gradually increase the dose to ten pills each time. If the body is severely cold, warm-natured medicines may also be added.

Third: Heart Taxation (Discussion and Formula)

The discussion says: For heart-taxation illness, the Spleen Qi should be strengthened to help nourish the Heart. When Spleen Qi is vigorous, it can respond to and support the Heart.

If one goes against the growth Qi of summer, the Hand Taiyang channel cannot develop fully, and Heart Qi becomes inwardly depleted and exhausted. Following this seasonal influence allows life to continue; going against it causes harm. Following it brings bodily stability; going against it throws Qi activity into disorder. Treating what should be followed as something to resist obstructs the flow of Qi and thereby brings on illness.

Rhubarb Heat-Draining Decoction: Used to treat sores in the mouth, difficult and bound stools, and inability to pass stool caused by heat arising from heart taxation, as well as distension and pain in the chest and heat in the small intestine.

Ingredients: rhubarb, Alisma, Scutellaria, mirabilite, gardenia seed, cassia bark, Tetrapanax pith, gypsum, licorice, and jujubes. Gardenia seed, three liang; Tetrapanax pith, two liang; gypsum, eight liang; licorice, one liang; jujubes, twenty. The original text does not specify the dosages of the other ingredients.

Coarsely cut the ten ingredients. First, soak the rhubarb separately overnight in one sheng of water. Then boil the remaining ingredients in eight sheng of water until two sheng and five he remain, and strain out the dregs. Add the soaked rhubarb and boil twice more. Strain out the dregs, then add the mirabilite. Once it has dissolved, divide the decoction into three doses.

Sun Simiao’s Essential Formulas Worth a Thousand in Gold for Emergencies, juan 40