《孫真人備急千金要方》Vol. 41

Diseases of the pulse, when they reach a severe stage, are mainly associated with the heart. The heart corresponds to the pulse, and the heart and pulse are joined. A heart disorder may also begin in the vessels.

It is also said that illness arising in summer is called “pulse impediment” (obstruction of the vessels). If pulse impediment persists for a long time, and the person is then exposed to pathogenic influences that invade the heart, symptoms may appear: food fails to nourish the flesh, coughing, bleeding, a pale and dull complexion, and a vacuous pulse. The lips may become red.

If Qi in the pulse is weak and the blood is depleted, the hair falls out, and the illness begins on a bing or ding day in summer, this is due to wind-cold injuring the vessels and is called “heart wind.” Its signs are profuse sweating and aversion to wind. If Qi in the pulse is replete, fever develops. Heat damages the heart, making the person prone to anger and turning the complexion red. In severe cases, speech becomes difficult. If blood is lost, the complexion becomes dry and dull, and food can no longer nourish the flesh.

If Qi in the pulse is weak, chills develop. Cold causes coughing, and the coughing in turn brings on heart pain. The throat feels as if something is lodged in it; in severe cases, the throat becomes swollen and painful, and the larynx feels obstructed. These are signs of deficiency and excess in heart wind.

If the vessels of the Yang channels are diseased, treatment should be applied through the Yin vessels; if the Yin vessels are diseased, treatment should be applied through the Yang channels. Determine whether the Qi and blood are deficient or excessive, and restore each to its proper place. If Qi in the pulse is excessive, drain it; if deficient, supplement it. A skilled healer first distinguishes deficiency from excess, then treats accordingly. When illness remains in the body hair, skin, flesh, or sinews, it should be treated thoroughly. If it has penetrated deep into the six Fu organs and five Zang organs, there is a fifty percent chance the patient cannot be saved.

Bian Que said, “When Qi in the pulse is cut off, it cannot be treated; death will follow within three days.” How can this be recognized? The pulse is vacuous, the complexion withered, and the hair has fallen out. The pulse corresponds to the Hand Shaoyin channel. When the Qi of the Hand Shaoyin channel is cut off, the pulse no longer flows, and the blood is the first to be depleted.

“Decoction of Fresh Rehmannia” is used to treat severe heat in the pulse and the depletion of Qi and blood. Symptoms include a pale, dry, dull complexion and food that fails to nourish the flesh. This formula can clear heat, halt the progression of the illness, and strengthen Stomach Qi.

The ingredients are: one sheng each of fresh Rehmannia juice, fresh Ophiopogon, and red honey; one sheng of water shield heart (some say fermented soybean); two sheng of polygala; two liang of licorice; three liang each of ginseng, poria, dried Rehmannia, peony, and atractylodes; six liang of gypsum; and four liang of fresh Solomon’s seal.

Of these thirteen ingredients, chop the eleven other than the fresh Rehmannia juice and red honey. Boil them in one dou and two sheng of water… The source text ends here, unfinished.

Take two sheng and seven ge of the liquid, strain out the dregs, add Rehmannia juice and honey, then decoct again until reduced to three sheng and five ge. Divide into four doses.

Moxibustion Method

For pain in the chest that extends to the lower back, rebellious Qi with vomiting in the area below the heart (the upper abdomen), and a dull complexion, moxibustion may be applied to the Shangmen point. The number of moxa cones depends on the patient’s age. The point lies half a cun from each side of the Juque point; another account gives the distance as one cun.

For a sallow, withered complexion, fatigue and Qi deficiency, seminal emission, or pain in the shoulder and arm that prevents raising the arm, apply one hundred moxa cones to the Jianyu point. The Jianyu point is near the outer, rear end of the bone at the shoulder. Pressing with the hand will reveal a depression.

Chapter Five: Deficiency and Excess of the Pulse (Discussion, Prescriptions, and Acupuncture and Moxibustion Methods)

The discussion says: A person with a deficient pulse is easily startled, and the pulse beats irregularly. A person with an excessive pulse has a broad, forceful, full pulse. Deficiency and excess of the pulse correspond chiefly to the heart and small intestine. When the organs and bowels are diseased, a disorder arising from heat manifests in an organ, while one arising from cold manifests in a bowel.

Fangfeng Pills

This prescription supplements deficiency and regulates the central Qi. It treats a deficient pulse, frequent startled and unsettled beats, and symptoms that come and go. It is indicated for cold in the small intestine.

Fangfeng, cinnamon heartwood, tongcao, poria spirit, polygala root, mai men dong, licorice, ginseng, and white quartz, three liang each.

Grind the nine ingredients into a fine powder and mix with white honey to form pills the size of wutong seeds. Take thirty pills with wine twice a day, gradually increasing to forty pills.

Shengma Decoction

This prescription treats a broad, full, excessive pulse and is indicated for heart heat.

Shengma, scutellaria root, alisma, gardenia seed, light bamboo leaves, and mirabilite, three liang each; sliced fresh Rehmannia, one sheng.

Coarsely cut the seven ingredients and decoct them in nine sheng of water. Reduce to three sheng and strain out the dregs. Add the mirabilite and divide into three doses.

Mahuang Decoction

This prescription regulates the heart pulse and clears heat. It treats a chaotic, surging heart pulse, an unusually large cun-mouth pulse, and tooth decay pain and sore throat caused by heat in the small intestine.

Mahuang and fresh ginger, four liang each; asarum, scutellaria root, poria, and peony, three liang each; atractylodes, two liang; cinnamon heartwood, one liang; sliced fresh Rehmannia, one sheng.

Coarsely cut the nine ingredients and decoct them in nine sheng of water. Reduce to three sheng, strain out the dregs, and divide into three doses. To promote bowel movement, add three liang of mirabilite; this works better.

Acupuncture and Moxibustion Method

When the pulse is difficult to detect, needle the Burong point. It lies one cun and five fen from each side of the Youmen point.

A feeling of pressure and pain in the chest, with Qi surging upward and pain extending to the small intestine: moxa the Juque point (near the lower end of the sternum in the upper abdomen) for two sets of seven moxa cones, or fourteen in all. Here, “cone” is a unit of moxibustion, referring to the amount burned in one moxa-cone treatment.

Heart and Abdominal Pain, Chapter Six (Discussion, Prescriptions, Steaming and Hot Compresses, and Moxibustion)

The discussion says: when Cold Qi suddenly invades the five viscera and six bowels, it can cause sudden heart pain or chest obstruction (a condition involving tightness and pain in the chest).

Mild Cold Evil can cause coughing; in more severe cases, it causes pain, diarrhea, or reversal cold. When heart pain extends to the back and the body is prone to spasms, as if something were striking the heart from behind, with the body bending and curling up, this is called “Kidney heart pain.”

When heart pain comes with abdominal distension and fullness, and the pain is severe, it is called “Stomach heart pain.” Pain as intense as a needle or awl stabbing the heart is called “Spleen heart pain.” A grayish-blue complexion, like dead ashes, and an inability to breathe freely throughout the day are called “Liver heart pain.” Pain around the heart when lying down that worsens with movement, without any change in complexion, is called “Lung heart pain.”

“True heart pain” is marked by cold hands and feet, with the cold reaching the joints, and severe heart pain. If it begins in the morning, death may come by evening; if it begins in the evening, death may come by morning.

“Roundworm heart pain” is pain in the heart and abdomen caused by roundworms, which were called hui in ancient times. When the abdomen hurts, a lump gathers and disperses unpredictably, moving up and down, while the pain comes and goes. The abdomen feels hot, and saliva often flows from the mouth: these are signs of pain from roundworms biting. Hold the painful area with the hand to keep the lump from moving, then treat it with a large needle while continuing to press for a time. Remove the needle once the worms have stopped moving. When needling below the heart, do not pierce an already formed accumulation. If there are worms in the intestines or pain from roundworms biting, do not treat it with a small needle.

Prescription for Heart Pain Caused by Cold and Heat Qi Suddenly Invading the Five Viscera and Six Bowels

Rhubarb, peony root, and bupleurum, four liang each; cimicifuga, baical skullcap root, platycodon root, and cinnabar, three liang each; winged euonymus twig, ghost’s knee, cinnamon bark, and mirabilite, two liang each.

Cut the eleven ingredients into small pieces. Add nine sheng of water and boil until two sheng and seven ge remain. Divide into three doses. First, divide the cinnabar into three portions; add one portion to each dose, stir well, and take. If the medicine brings about a smooth bowel movement but the pain has not stopped, take the following prescription.

Red peony root, six liang; platycodon root and apricot kernel, five liang each.

Cut the three ingredients into small pieces. Add six sheng of water and boil until three sheng remain. Divide into three doses.

Nine-Pain Pill

The Nine-Pain Pill treats nine kinds of heart pain, as well as conditions caused by Cold Qi surging upward and injuries from falling off a horse or falling from a height… The original text ends here, incomplete.

Formula for Treating Heart Pain and Related Ailments

Heart pain is divided into nine types: worm-related heart pain, chronic transmitted heart pain, wind-related heart pain, palpitation-related heart pain, food-related heart pain, fluid-related heart pain, cold-related heart pain, heat-related heart pain, and heart pain that comes and goes.

Two liang each of aconite and dried ginger; one liang each of Evodia, ginseng, and croton; four liang of fresh langdu.

Grind these six ingredients into a fine powder, mix with honey, and form pills the size of parasol tree seeds. Take one pill on an empty stomach. For a sudden invasion by pathogenic Qi accompanied by abdominal distension and pain and inability to speak, take two pills once a day. The pills may also be taken for long-standing accumulations of cold, when cold Qi has spread into the heart and chest. Take good care of yourself during treatment; this remedy is said to have miraculous effects.

Formula for Treating the Nine Types of Heart Pain

Take a handful of newly grown sophora branches from the direction associated with the year’s Tai Sui. Trim off both ends and chop the branches. Add three sheng of water and boil until one sheng remains; drink the whole amount at once.

Cinnamon, Ginger, and Maltose Decoction: Formula for Treating Stifling Fullness in the Heart, Rebellious Qi, and Pain That Radiates

Two liang each of cinnamon bark and ginger; half a jin of maltose.

Chop the first two ingredients, add six sheng of water, and boil until three sheng remain. Strain out the dregs, add the maltose, and divide into three doses. Zhang Zhongjing’s formula uses five pieces of immature bitter orange instead of maltose. The Handbook of Prescriptions for Emergencies uses five pieces of immature bitter orange and two liang of atractylodes, making five ingredients in all.

Aconite Pills: Formula for Treating Heart Pain That Radiates to the Back, or Back Pain That Radiates to the Heart

Six zhu of aconite; half a liang each of prepared aconite and Sichuan pepper; one liang each of dried ginger and red halloysite.

Grind these five ingredients into powder, mix with honey, and form pills the size of hemp seeds. Take three pills before meals, three times a day. If there is no response, gradually increase the dose. The Fan Wang Formula omits prepared aconite and makes pills the size of parasol tree seeds, taking three each time. The Cui Family Formula adds half a liang of cinnamon bark, making six ingredients in all.

Formula for Treating Heart Pain

Decoct the white bark of a peach tree and take an appropriate amount on an empty stomach. The Cui Family Formula uses this to treat chronic transmitted heart pain.

Formula for Treating Sudden Heart Pain That Feels Like an Attack by Pathogenic Qi, with Saliva Constantly Rising in the Mouth and Frequent Urges to Vomit

Ten jin of bitter sophora.

Chop the bitter sophora, add one shi of water, and boil until two dou remain. Strain out the dregs, add two dou of vinegar, and boil again until five sheng remain. Add the powder of roasted yellow soybeans and mix it into the liquid...

Boil the medicines down until they are thick enough to form pills, then roll them by hand into pills about the size of a paulownia seed. Take thirty or forty pills at a time with one sheng of wine, once a day. They should cause diarrhea. If they do not, soak two jin of bitter sophora root in wine; the longer it soaks, the better. This formula is used not only for sudden, severe pain, but also for pain around the shin and lower leg bones. It can treat any illness of the abdomen.

It is also used to treat chronic cold, stagnant blood, and Yin accumulations—a category of disorders involving masses within the abdomen. Repeated use is said to be effective, with very good results.

Formula for Sudden Pain in the Chest and Abdomen

Three liang of bitter sophora root.

Chop the root and boil it in one and a half sheng of good vinegar until the liquid is reduced to eight ge. A robust person should take it all at once; an elderly person or child should divide it into two doses.

Another formula: one liang of cassia bark.

Chop the cassia bark and boil it in four sheng of water until the liquid is reduced to one and a half sheng. Divide it into three doses.

Treating Heart and Abdominal Pain Caused by Worm Accumulation

Grind false daisy seeds into powder, mix with honey, and make pills about the size of a paulownia seed. Take forty pills at a time with honey water, once a day, gradually increasing the dose to fifty pills. Avoid wine and meat while taking the medicine.

Another formula: one liang of false daisy seeds, ground into powder and mixed with one cup of warm vinegar. Take on an empty stomach. The original text says the worms will be vomited out.

Another formula: take one ge of lacquer. For details, see the “Treatise on Nourishing Life Through Ingested Preparations.” The original text says lacquer can treat all heart and abdominal pain caused by worm accumulation.

Five-Pungent Ingredients Decoction: Treating Pain from Cold in the Chest and Abdomen

One liang each of asarum, Sichuan pepper, cassia bark, dried ginger, evodia, peony, fangfeng, bitter sophora root, licorice, dried rehmannia root, and Chinese angelica; twenty-seven fruits each of gardenia, smoked plum, and jujube.

Chop the fourteen ingredients and boil them in nine sheng of water until the liquid is reduced to three sheng. Divide into four doses.

Rhinoceros Horn Pills: Treating Pain in the Chest and Abdomen That Has Recurred for Years

This pain persists for years and often returns at intervals of less than one shichen. In severe cases, the patient may be unable to eat for several days and may pass dried blood. Even searching everywhere under Heaven for a remedy does not cure it. Zhen Liyan once used this formula, and it is said that the patient recovered within a few days.

One and a half liang each of rhinoceros horn, musk, realgar, balloon flower root, Chinese lizard’s tail, ghost drumstick, cassia bark, and genkwa; one and a half liang of kansui; six zhu each of cinnabar and aconite; five shell teeth; twenty ba dou seeds; and two red-legged centipedes.

The note at the end of the previous prescription: Grind the fourteen ingredients listed above into powder, mix with honey, and form pills the size of wutong seeds. Take with a drink, one pill each time, twice daily, gradually increasing to three pills. A mild loosening of the bowels is the appropriate effect. (The version of this prescription recorded in Gujin Lu Yan does not include realgar.)

Galangal Decoction: Treats sudden, gripping pain in the heart and abdomen, as if pierced by needles, with distension and fullness in both flanks and unbearable agitation. Use five liang of lesser galangal, two liang of magnolia bark, and three liang each of angelica and cassia bark. Cut the four ingredients into pieces, decoct in eight sheng of water until reduced to one sheng and eight ge, and divide into three doses, taking them at intervals. If the pain stops after one dose, there is no need to take more. People of robust constitution should divide it into two doses; those of weaker constitution should divide it into three.

Angelica Decoction: Treats gripping pain in the heart and abdomen, as well as distension and pain caused by various forms of deficiency-cold Qi. Use two liang each of angelica, peony, magnolia bark, and pinellia; three liang each of cassia bark, licorice, astragalus (also called huangqi), and ginseng; four liang of dried ginger; and one liang of Sichuan pepper (also called prickly ash). Cut the ten ingredients into pieces, decoct in one dou of water until reduced to three sheng and two ge, and divide into four doses. People who are thin and weak should divide it into six doses. (Xiaopin Fang says that if the cold is severe, adding one aconite tuber works well.)

Another prescription: Treats abdominal pain caused by deficiency-cold, inability to eat, difficulty digesting food, and abdominal distension. Use five fen each of angelica and poria; four fen each of astragalus and aster; six fen each of lesser galangal and dried ginger; three fen each of deer antler, cassia bark, kelp, cistanche, and tangerine peel; two liang of licorice; one liang of aconite; forty jujubes; one hundred peach kernels; and one sheng each of lycium bark, fermented Shenqu (used to aid digestion), and barley malt. Cut the eighteen ingredients into pieces, decoct in one dou and five sheng of water until reduced to four sheng and two ge, and divide into five doses. For diarrhea, add three fen each of red halloysite and dragon bone; for thirst, add one sheng of ophiopogon.

Another prescription: Treats abdominal pain caused by cold. (Xiaopin Fang calls it the Evodia Decoction.) Use two liang of angelica; one liang each of cassia bark, licorice, and ginseng; five liang of fresh ginger; and pinellia.

One sheng each of wheat and Evodia fruit. Coarsely chop the ingredients, simmer them in one dou and five sheng of water, and reduce the liquid to three sheng. Divide it into three portions and drink warm, three times a day. This prescription also treats postpartum weakness and feeling cold.

Another prescription treats cold lodged beneath the ribs that moves back and forth, surges upward to the chest and diaphragm, and causes pain that extends to the ribs and back, accompanied by oppression in the chest.

Two liang each of Chinese angelica, cinnamon bark, ginseng, licorice, Evodia fruit, peony, and rhubarb; one liang each of poria and immature bitter orange; and three liang of dried ginger. Coarsely chop the ten ingredients, simmer them in eight sheng of water, and reduce the liquid to two and a half sheng. Divide it into three portions and drink warm, three times a day. This prescription is also well suited to treating “corpse infestation” (shizhu), a category of contagious or persistent illnesses that ancient people attributed to corpse qi. The prescription attributed to Zhang Zhongjing and quoted in the Waitai miyao does not include poria or immature bitter orange.

Another prescription treats chronic illness caused by cold that has remained in the body, with chest and abdominal pain and occasional diarrhea.

Three liang of Chinese angelica; two liang each of licorice and tangerine peel; one liang of aconite; and four liang of dried ginger. Coarsely chop the five ingredients, simmer them in eight sheng of water, and reduce the liquid to two sheng. Divide it into three portions and take them three times a day.

Another prescription treats recurring chronic illness caused by cold that has remained in the body, with chest and abdominal pain, shortness of breath, and sometimes persistent diarrhea.

Three liang each of Chinese angelica and cinnamon bark; four liang of dried ginger; and one liang of aconite. Coarsely chop the four ingredients, simmer them in eight sheng of water, and reduce the liquid to two sheng. Divide it into three portions and take them three times a day. The Fang Wang prescription omits aconite and uses two liang of licorice instead. It also says that for severe pain caused by deficiency-cold, two liang each of astragalus root and peony may be added.

Warming-the-Middle Decoction with Chinese Angelica treats pain in the heart and abdomen. During an attack, a lump-like knot forms in the abdomen; the pain moves up and down and comes and goes. If there is also a sensation of internal heat and a tendency to spit up saliva, the pain is attributed to roundworms biting. If two or three doses bring no relief, or the condition changes, switch to another prescription and adjust the ingredients as appropriate.

Two liang each of Chinese angelica, ginseng, dried ginger, poria, magnolia bark, aucklandia root, cinnamon bark, platycodon root, peony, and licorice. Coarsely chop the ten ingredients, simmer them in eight sheng of water, and reduce the liquid to three sheng. Divide it into five portions and drink warm, three times a day. If aucklandia root is not tolerated, replace it with one liang of rhinoceros horn.

Lamb and Chinese Angelica Decoction treats cramping pain caused by cold in the abdomen.

Half a jin of lamb; four fen of Chinese angelica; and three fen each of dried ginger, tangerine peel, astragalus, peony root, chuanxiong (also called Sichuan lovage), cinnamon bark, pubescent angelica, and saposhnikovia root; one fen each of evodia, ginseng, licorice, dried rehmannia, and poria; six fen of fresh ginger; and thirty jujubes.

Cut the seventeen ingredients into pieces. First boil the lamb in one dou and a half of water until twelve sheng remain. Remove the lamb, add the other ingredients, and simmer until three sheng of liquid remain. Divide into three doses and take them over the course of the day. After taking each dose, cover yourself with a quilt to keep warm.

Warming the Spleen Decoction: Treats abdominal pain, cramping below the navel, and persistent pain caused by accumulations around the navel.

Two liang each of licorice, aconite, ginseng, and mirabilite; three liang each of Chinese angelica and dried ginger; and five liang of rhubarb.

Cut the seven ingredients into pieces. Boil them in seven sheng of water until three sheng remain. Take in divided doses, three times a day.

Fresh Ginger Decoction: Treats sudden pain in the chest and abdomen.

One jin of fresh ginger, juiced; eight liang of honey; and four liang of clarified butter.

Warm the three ingredients over low heat until thoroughly blended. When the mixture has cooled to a suitable temperature, take three he (a measure of volume), three times a day.

Fomentation and Steaming Method: For cold pain in the chest or abdomen, heat one dou of salt in a pan and apply it as a hot compress. Alternatively, heat silkworm droppings, or warm bricks or stones and apply them as a compress or use them to steam the affected area, drawing on their internal warmth. Steaming and fomenting with hot earth is also very effective.

Acupuncture and Moxibustion Method

When pathogenic Qi affects the Heart, symptoms may include heart pain, a tendency to feel sorrow, and occasional dizziness or collapse. Assess whether the pulse indicates excess or deficiency, then treat the corresponding transport points along the meridians.

For heart pain caused by the Kidney meridian, first needle Jinggu and Kunlun. If the pain does not ease, needle Rangu.

For heart pain caused by the Stomach meridian, needle Dadu and Taibai.

For heart pain caused by the Spleen meridian, needle Rangu and Taixi.

For heart pain caused by the Liver meridian, needle Xingjian and Taichong.

For heart pain caused by the Lung meridian, needle Yuji and Taiyuan.

If heart pain extends to the lower back and spine and is accompanied by an urge to vomit, needle the Foot Shaoyin meridian.

If heart pain extends to the back and makes breathing difficult, needle the Foot Shaoyin meridian. If the pain does not ease, needle the Hand Shaoyin meridian.

If heart pain is accompanied by abdominal distension and difficult, obstructed bowel movements, needle the Foot Taiyin meridian.

If heart pain is accompanied by fullness in the lower abdomen, with pain shifting up and down and difficulty urinating or defecating, needle the Foot Jueyin meridian.

If heart pain is accompanied by shortness of breath and insufficient breathing, needle the Hand Taiyin meridian.

If heart pain is so severe that the area cannot be touched, and the Heart feels agitated and unsettled, treat it by needling Juque.

Heart pain occurs in three forms. When it is caused by the “three worms” (an explanation of disease found in ancient medical texts), with excessive saliva and an inability to turn over, the principal treatment is the Shangguan point.

For heart pain accompanied by chills and difficulty bending forward or backward, with an attack of “heart protrusion” (a type of heart and abdominal pain described in ancient medicine) surging upward, even to the point of unconsciousness, the principal treatment is the Zhongguan point.

For heart pain like a needle or awl stabbing, treat the Rangu and Taixi points.

For sudden pain in the heart and abdomen, treat the Shimen point.

For sudden, severe pain from heart protrusion, treat the Foot Taiyin channel.

For vexation and oppression in the chest, a dull ache, and Qi surging upward, apply one hundred moxa cones at the Xinshu point.

For heart pain like a cone or knife stabbing, with Qi bound and unable to move freely, apply seven moxa cones at the Geshu point.

For heart pain with cold Qi surging upward, apply one hundred moxa cones at the Longhan point. This point is one and a half inches above the Jiuwei point. Do not needle it.

For heart pain with foul Qi surging upward and tight, severe pain in the ribs, apply fifty moxa cones at the Tonggu point. This point is two inches below the nipple.

For sudden, severe, cramping heart pain that feels almost fatal, apply one hundred moxa cones at the Shenfu point. This point is at the center of the Jiuwei point.

For heart pain accompanied by a severe aversion to wind, apply one hundred moxa cones at the Juque point.

For hard, oppressive heart pain with Qi bound and unable to disperse, apply one hundred moxa cones at the Taicang point.

To treat heart pain, apply twenty-one moxa cones at the wrist crease of the arm. Alternatively, apply seven moxa cones on each hand at the junction of the white flesh on the inner side of the web between the thumb and index finger.

Chest Bi, Chapter Seven (Discussion, Formulas, and Moxibustion)

The discussion says: Chest Bi (a condition in which the chest feels obstructed and blocked) causes a sense of blockage and fullness in the chest, oppressive tightness and pain, numbness and discomfort in the muscles, and cramping pain like a stab. The person cannot bend forward or backward. The skin over the chest also hurts, and the person cannot bear to touch the chest. The chest feels full and oppressed, breathing is short, and coughing or expectorating phlegm draws out pain. The throat feels obstructed, with an itch as if insects were crawling inside it, and it becomes dry. At times the person feels like vomiting, is vexed and agitated, and breaks into a cold sweat. The pain may extend all the way to the back. Without prompt treatment, the condition may be fatal within a few days.

The discussion further says: In examining the pulse, note whether it is excessive or deficient. When the Yang pulse is faint and the Yin pulse is taut and tight, chest Bi pain occurs. The cause is extreme deficiency of upright Qi. The Yang Qi is deficient in the Upper Burner (the functional region of the upper body); thus chest Bi and heart pain arise when the patient’s pulse is Yin and taut. A person who normally has no signs of cold or heat, but is short of breath and unable to draw enough breath, has an excess condition.

Zhi Shi, Xie Bai, and Gui Zhi Decoction

This formula treats chest Bi, oppression in the chest, Qi bound in the chest, chest fullness, and Qi surging from beneath the ribs upward into the chest and heart.

Ingredients: four Zhi Shi fruits, one jin of Xie Bai, one liang of Gui Zhi, three liang of Hou Po, and one Gua Lou fruit.

Cut the five ingredients into pieces. Add seven sheng of water and decoct until two and a half sheng of liquid remain. Divide into two doses.

Use Zhang Zhongjing’s formula: four liang of magnolia bark and half a jin of Chinese chives. Add five sheng of water and boil down to two and a half sheng, then take.

Trichosanthes Decoction treats chest impediment (a condition in which the chest feels obstructed and blocked). Symptoms include labored breathing, coughing, coughing up phlegm and saliva, pain in the chest and back, and shortness of breath. The pulse at the cun position is deep and slow; at the guan position it is small, tight, and rapid.

One trichosanthes fruit, half a sheng of pinellia, one jin of Chinese chives, two liang of immature bitter orange, and four liang of fresh ginger.

Chop the five ingredients, add one dou of fermented rice liquid, and boil down to four sheng. Take one sheng per dose, three times a day. The version in Zhang Zhongjing’s Zhouhou Fang omits fresh ginger, immature bitter orange, and pinellia.

For chest impediment marked by fullness and discomfort in the chest, as if something were choking or blocking it; a slight itching sensation in the chest; a dry, rough throat; and spitting saliva, take this formula:

One jin of tangerine peel, half a jin of fresh ginger, and five immature bitter oranges.

Chop the three ingredients, add five sheng of water, and boil down to two sheng. Strain out the herbs and take in two divided doses.

Center-Regulating Decoction is a formula for treating chest impediment.

Poria Decoction treats obstructed Qi in the chest and shortness of breath:

Three liang of poria, one liang of licorice, and fifty apricot kernels.

Chop the three ingredients, add one dou and three sheng of water, and boil down to six sheng. Strain out the herbs and take in six divided doses, three times a day. If the condition has not resolved, prepare and take another batch according to this formula.

Qi-Flowing Decoction treats chest fullness, shortness of breath, and choking obstruction:

Eight liang of pinellia, six liang of fresh ginger, three liang of tangerine peel, and forty fruits of Evodia.

Chop the four ingredients, add eight sheng of water, and boil down to three sheng. Divide into three doses. Another version of the formula uses two liang of cinnamon and omits the tangerine peel.

Asarum Powder treats chest impediment that extends to pain in the back, along with shortness of breath:

Two liang each of asarum and licorice; three liang each of immature bitter orange, fresh ginger, trichosanthes fruit, dried rehmannia, and atractylodes; and five liang each of cinnamon bark and poria.

Grind the nine ingredients into a fine powder. Take with wine, one square-inch spoonful per dose, three times a day.

Sichuan Pepper Powder treats chest impediment that extends to pain in the back:

One liang each of Sichuan pepper and food-grade Evodia, cinnamon bark…

Platycodon root and aconite, three liang each; fermented soybeans, six zhu. Grind the ingredients into a coarse powder. After meals, take it with wine, three times a day.

Peucedanum Decoction

Peucedanum Decoction is used to treat rebellious Qi in the chest, heart pain extending to the back, shortness of breath, and loss of appetite.

Peucedanum root, licorice, pinellia, and peony, two liang each; skullcap, Chinese angelica, ginseng, and cinnamon bark, one liang each; fresh ginger, three liang; thirty jujubes; and one sheng of bamboo leaves.

Cut the eleven ingredients into small pieces. Boil them in nine sheng of water until three sheng of liquid remain, then divide into four doses.

Another Formula

Peucedanum root, ginseng, fresh ginger, pinellia, dwarf lilyturf root, licorice, peony, poria, and malt sugar, three liang each; cinnamon bark, skullcap, and Chinese angelica, one liang each; and thirty jujubes.

Cut the thirteen ingredients into small pieces. Boil them in one dou and four sheng of water until three sheng remain. Strain out the dregs and divide into three doses.

Back-Fomentation Powder

Back-Fomentation Powder is used for pain in the chest and back, and for tightness in the chest.

Aconite, asarum, aconite root, notopterygium, Sichuan pepper, and cinnamon bark, five liang each; chuanxiong, one liang and six zhu.

Grind the seven ingredients into a coarse powder and wrap it in cloth. Warm it over a low fire, then apply it to the back as a fomentation. Stop once the pain eases. In daily life, avoid cold and raw foods and continue your usual regimen.

Qi-Descending Decoction

Qi-Descending Decoction is used for obstruction and fullness in the chest, abdomen, and back, as well as Qi surging upward and rapid breathing.

Forty-seven apricot kernels and twenty-seven areca nuts. Cut the two ingredients into small pieces. Boil them in three sheng of a child’s urine until one and a half sheng remain, then divide into two doses. Anyone who has previously suffered such an episode of rebellious Qi may prepare and take this medicine whenever an attack occurs.

Areca Nut Decoction

Areca Nut Decoction is used to disperse obstructive, noxious Qi in the chest and back, and to treat a blocked voice that cannot be brought out.

Use four very large areca nuts, or eight small ones. Cut them into small pieces and boil them in two and a half sheng of a child’s urine until one sheng remains. Strain out the dregs and divide into three doses. The text says that after five consecutive doses, the condition should stabilize.

Moxibustion Methods

For chest impediment—a constricted, uncomfortable feeling in the chest—that extends to the back and is sometimes accompanied by chills, apply moxibustion at the “Jianshi” point.

For chest impediment and heart pain, apply moxibustion at the “Tianjing” point.

For chest impediment and heart pain so severe that breathing cannot be settled, with pain that shifts from place to place, apply moxibustion at the “Linqi” point.

For chest impediment and heart pain, apply one hundred moxa cones at the Danzhong point. The Danzhong point is one cun above the Jiuwei point. Needling this point is contraindicated.

For fullness and distention in the chest and flanks, and heart pain, apply moxa at the Qimen point, with the number of cones determined by the patient’s age. The Qimen point lies at the end of the second rib, one and a half cun directly below the nipple.

Here, “cone” is the unit used to count the burning of moxa cones during moxibustion; the cun in the text is a traditional measure used to locate acupuncture points. The above are the moxibustion methods and point locations recorded in the classical text.

Essential Prescriptions for Emergencies by Master Sun the Immortal, juan 41