《孫真人備急千金要方》Vol. 43

Formulas for the Small Intestine

First Treatise on the Small Intestine’s Pulse

The treatise says that the small intestine and the heart are interiorly and exteriorly related, and that the tongue can serve as a sign for observing disorders of the small intestine. The small intestine receives and holds food and drink; the ancients called it the “storehouse official.” According to the text, it weighs two jin and fourteen liang, is two zhang and four chi long, and is two cun and four fen wide. The Classic of Difficulties (Nanjing), the A-B Classic of Acupuncture and Moxibustion (Zhenjiu Jiayi Jing), and other works give slightly different measurements. The small intestine lies against the spine, loops around to the left in successive coils, and ends at the ileum. It encircles the navel and winds through sixteen bends, ordinarily holding two dou and four sheng of food and drink. The text also explains that water and grain each make up half its contents, relating this to the twenty-four solar terms. Other ancient books give different accounts.

Thick lips and a long philtrum can serve as outward signs of the small intestine. When it is diseased, there may be pain in the lower abdomen that draws toward the lower back and testicles. At times, there may be a distressing tightness in the abdomen and heat in front of the ears. In severe cases, heat may occur only in the shoulders, or between the little finger and ring finger. A slippery pulse, one that flows smoothly beneath the fingers, is another associated sign.

If pain in the lower abdomen draws toward the testicles and lower back and surges upward into the chest and heart area, the ancients considered this to be caused by pathogenic Qi invading the small intestine. In the theory of the channels, the small intestine connects with the testicles, runs upward to the spine, passes through the liver and lungs, and connects with the heart system. When its Qi becomes excessive, it surges upward in counterflow, disturbing the stomach and intestines, scattering the Qi of the liver and lungs, and stagnating below the diaphragm around the navel. Treatment may use “Huangyuan,” an ancient acupuncture point, to disperse the stagnation; needle the Hand Taiyin channel to regulate the movement of Qi; take the Foot Jueyin channel to guide Qi downward; and use Shangjuxu, on the Foot Yangming Stomach channel, to dispel pathogenic influences. Treatment should also follow the channels traversed by the pathogen, restoring their harmony.

If the Yang pulse before the guan position at the left wrist pulse site is depleted and absent, so that the small intestine pulse cannot be felt, the patient may experience numb discomfort around the navel, a hernia or mass in the lower abdomen, and chilliness during the corresponding seasonal month, with cold Qi surging upward into the chest and heart area. One may needle the “Zhiyin” point on the Hand Jueyin Pericardium channel. It lies in the middle of the transverse crease at the back of the palm; the needle is inserted one fen.

If the Yang pulse before the guan position at the left wrist is forceful and full, this is considered an excess pattern of the small intestine. The patient may experience tightness below the heart and fever, or internal heat in the small intestine and reddish-yellow urine. One may needle the “Zhiyang” point on the Hand Taiyang Small Intestine channel.

The Taiyang Meridian of the hand runs along the outer side of the little finger, at the hollow near the base joint.

When the small intestine is affected by Cold, a person feels heaviness and sagging in the lower abdomen, and the stool may contain pus and blood. When the small intestine has Heat, hemorrhoids are more likely to develop.

When undigested food accumulates in the small intestine, fever often comes on in the evening and subsides the next day.

Distension and fullness in the small intestine can enlarge the lower abdomen and cause pain that pulls across the abdomen.

Pathogenic influence first affects the heart, then passes to the small intestine. If a heart-related cough continues without stopping, Qi also rises in counterflow and comes out with the coughing.

Rebellious Qi—Qi that surges upward in disorder—invading the small intestine may cause a person to dream of crowds gathering in streets and lanes.

The heart corresponds to the skin. People with thick skin also have thick pulses; those with thick pulses have a thick small intestine. People with thin skin also have thin pulses; those with thin pulses have a thin small intestine. People with loose, relaxed skin also have loose, relaxed pulses; those with loose, relaxed pulses have a larger small intestine. People with thin skin and fine, small pulses have a small and short small intestine. If the vessels of the various Yang meridians are numerous and winding, the small intestine will have accumulations.

Bian Que said: The Hand Shaoyin Meridian (Heart Meridian) and the Hand Taiyang Meridian (Small Intestine Meridian) are interiorly and exteriorly paired. The exterior pertains to clarity, the interior to turbidity; when clear Qi is abundant, turbid Qi is deficient. Thus, after food descends, the small intestine becomes full while the stomach is empty. The bowel may therefore be full without becoming distended. When the small intestine is replete, it is harmed by pathogenic Heat. Heat causes the mouth to hang open and sores to appear inside it. When the small intestine is deficient, it is harmed by pathogenic Cold. Cold causes diarrhea with pus and blood in the stool and may sometimes bring on internal water retention—fluid collecting within the abdomen. The root of the illness lies in the small intestine. Treatment should begin with the abdomen; for the specific method, see “Treating Water.”

When the small intestine’s Qi is exhausted, the condition cannot be saved, and the person will die after six days. How can this be recognized? The hair stands stiff and straight, like dry, withered hemp fibers, and cannot bend or lie smooth; cold sweat flows without stopping.

Abnormalities in the Hand Taiyang Meridian may cause pain in the throat, swelling of the jaw, and an inability to turn the head. The shoulder feels as though it is being pulled out, and the arm as though it is about to break. This meridian governs fluids. The disorders it governs include deafness, yellowing of the whites of the eyes, swelling of the cheeks and jaw, and pain in the neck, shoulder, arm, elbow, and along the outer rear edge of the upper arm. (The branches and connections of the meridian are described in “The Heart.”)

Deficiency and Excess of the Small Intestine, Part Two (Pulse Diagnosis and Moxibustion)

Excess Heat in the Small Intestine

A firm, forceful pulse at the left cun position—the pulse at the wrist—before the Renying position, in the Yang location, indicates disease of the Hand Taiyang Meridian. Symptoms include alternating bouts of fever and its subsiding, inability to sweat, agitation and fullness in the heart, heaviness of the body, and sores in the mouth. This is called excess Heat in the small intestine.

Bupleurum and Alisma Decoction, used to treat Heat and distension in the small intestine and sores in the mouth.

Ingredients: three liang each of bupleurum, alisma, tangerine peel (another version gives platycodon), scutellaria, inula flower, immature bitter orange, cimicifuga, and mirabilite; and one sheng of fresh rehmannia, sliced.

Chop the nine ingredients. Boil them in one dou of water until three sheng of decoction remain, then strain out the dregs and add…

Take the mirabilite in three divided doses.

Rhubarb Pills: A Formula for Treating Heat Pathogenic Factors Accumulating in the Small Intestine, with Abdominal Distension and Obstruction

Rhubarb, peony, and draba seed, two liang each; kansui and mirabilite, three liang each; fifty apricot kernels; seven croton seeds.

Grind the seven ingredients into a fine powder, mix with honey, and form pills the size of Chinese parasol tree seeds. Adults should take seven pills per dose; children should take two or three pills per dose, twice a day. Once the heat pathogenic factors have subsided, reduce the dosage to once a day.

Moxibustion

For distension caused by heat pathogenic factors in the small intestine, apply moxibustion to the Yindu point, using one moxa cone for each year of age. Yindu is beside the Zhongwan point, one cun to either side.

For small-intestine diarrhea or dysentery with pus and blood, apply one hundred moxa cones to the Hun She point, reducing the number as appropriate for children. Hun She is beside the navel, one cun to either side. Also apply seven moxa cones to the Xiaochangshu point.

Small-Intestine Deficiency-Cold

If the pulse at the left wrist, at the cun position, is deficient in Yang compared with the Renying pulse, this indicates disease in the Hand Taiyang channel, which is internally and externally paired with the Small Intestine channel. The patient may have pain on one side along the edge of the skull, as well as pain in the ear and cheek. This is called “small-intestine deficiency-cold.”

A Tonifying Formula for Pain from Small-Intestine Deficiency-Cold, Red-and-White Dysentery, Intestinal Leakage, and Distress and Discomfort in the Intestines

Dried ginger, three liang; Chinese angelica, phellodendron bark, and Chinese herbal knotweed, four liang each; coptis and donkey-hide gelatin, two liang each; three pomegranates.

Cut the seven ingredients into pieces and decoct them in seven sheng of water. Reduce the liquid to two sheng and five ge, then strain out the dregs and add the donkey-hide gelatin. Continue boiling until the gelatin has fully dissolved. Take in three divided doses.

Third Discussion: The Tongue

The discussion says: The tongue is an outward sign of the heart and can also reflect the condition of the small intestine. The text records that the tongue weighs ten liang, is seven cun long and two and a half cun wide. It moves freely like a pivot and balance beam, and can distinguish and regulate the five flavors.

Eating too much of any one flavor also affects the tongue and other parts of the body. Too much salt makes the tongue’s vessels congeal and change color. Too much bitterness dries the tongue’s surface and scorches the hair outside the tongue. Too much pungency constricts the tongue’s sinews and dries the nails. Too much sourness makes the tongue’s flesh swell and the lips turn up. Too much sweetness causes pain at the root of the tongue and makes the body hair fall out.

Another account says that the heart favors bitterness, the lungs favor pungency, the liver favors sourness, the spleen favors sweetness, and the kidneys favor saltiness. These five flavors each correspond to the Qi of one of the five viscera.

When the viscera and bowels have heat, sores appear on the tongue, accompanied by raised, reddened lips. When a bowel is cold, the root of the tongue contracts, the jaws clamp shut, and the lips turn blue. Cold conditions call for tonification; hot conditions call for draining. When there is neither cold nor heat, treatment should follow…

After regulating the internal organs, if the tongue draws back, the jaws clench shut, and the lips turn bluish purple, Shengma Decoction may be used. The formula appears earlier in the text.

Separate Scroll

Wind Dizziness, Fourth (Discussion, Formulas, and Restrictions on Acupuncture and Moxibustion)

The previous scroll has already included formulas for treating wind disorders of the head and face. Wind dizziness need not have a separate category, but Sun Simiao believed that the formula recorded here belonged to Xu Sibai and should not be combined with the others. He therefore created a separate entry on “Wind Dizziness” specifically to include Xu’s formulas.

Xu Sibai said: “When I was young, I inherited my family’s medical practice. I became quite familiar with medical books and formulas, and I also heard of the important methods used by many renowned physicians. I believed that wind dizziness had many causes and that the methods used by different schools were not necessarily all effective. I devoted particular care to studying this art—that is, the diagnosis and treatment of wind dizziness. Since I was young, I have used these methods and have rarely failed. Now that I am nearing old age, I fear I may die suddenly before I have time to pass on this experience. So I have set out the diagnoses and methods of treatment clearly for future generations.”

Wind dizziness arises when the heart Qi is unsettled and pathogenic excess accumulates in the chest. It therefore produces symptoms such as wind affecting the head and heat in the face. Phlegm and heat interact, stirring up pathogenic wind; when the wind disturbs the heart spirit, the mind becomes confused and the chest feels oppressed. Hence the name “wind dizziness.” In adults, an episode is called dian; in children, it is called xian. In fact, they belong to the same category of illness. These formulas should, in principle, be effective in treatment, but errors may occur if the pattern is not correctly identified. In general, one should avoid eating the meat of animals corresponding to the twelve zodiac signs, and especially guard against an episode of “Running Piglet” (a disease term in classical medical texts). Episodes commonly involve shortness of breath; if the breathlessness becomes severe, death may follow and rescue is difficult. This decoction should therefore be used according to the severity of the illness. Do not assume it is unsuitable simply because the patient’s symptoms are mild.

There are ten formulas for treating wind dizziness, including decoctions, powders, pills, and boiled preparations. At the first onset of illness, an ordinary patient should take Life-Sustaining Decoction immediately. In an emergency, if the appropriate moxibustion points can be found, they should be needled with a heated needle; this can often bring a cure. Applying moxibustion immediately after needling is best. The moxibustion methods are listed below. In more than thirty years of practicing this art, I have treated hundreds and thousands of people, all of whom recovered. If later generations master these formulas, I hope they will not mix in other methods.”

Life-Sustaining Decoction: Treats episodes of wind dizziness marked by agitation, confusion, drooling, limbs rigidly arched like a drawn bow, eyes rolled upward, clenched jaws, and inability to speak.

Ingredients: bamboo sap (1 sheng and 2 ge); fresh rehmannia juice (1 sheng); dragon bone (4 liang); fresh ginger, Saposhnikovia root, and ephedra (4 liang each); Stephania root (3 liang); aconite (3 fen); and gypsum (7 liang).

Cinnamon bark (two liang).

Chop the ten ingredients listed above. Boil them in one dou of water until three sheng of liquid remain. Divide into three doses.

If there is upward surging of Qi, add one liang of Aconite, five ge of Perilla seeds, and half a liang of Tangerine peel. After taking the Life-Sustaining Decoction, if the mouth remains open, the limbs have not yet regained stability, and the discomfort in the heart has not gone away, treat with the Purple Stone Decoction. Its recipe appears later; it is the “Purple Stone Powder Decoction.”

Bentan Decoction: A prescription for Qi surging sharply upward, as if the person were about to stop breathing.

Evodia (one sheng); Gypsum, Ginseng, Pinellia, and Ligusticum chuanxiong (three fen each); Cinnamon bark, Peony, and Fresh Ginger (four fen each); Fresh Kudzu root and Poria (ten fen each); Angelica (four liang); and Plum root bark (one jin).

Chop the twelve ingredients listed above. Boil them in seven sheng of water and eight sheng of rice wine until three sheng of liquid remain. Divide into three doses.

Stephania and Rehmannia Decoction: A prescription for confused speech, darting eyes, occasional claims of seeing ghosts, and a dim, disordered state of mind.

Stephania and Licorice (two liang each); Cinnamon bark and Saposhnikovia (three liang each); and Fresh Rehmannia root (five jin, sliced separately and not soaked with the other ingredients; use two jin for milder illness).

Chop the five ingredients listed above. Soak them overnight in one sheng of water, then squeeze out the liquid and set it aside. Place the remaining herbs on a bamboo rack, spread the Fresh Rehmannia root over them, and steam everything over five dou of rice, collecting the liquid that condenses in a copper vessel. When the rice is cooked, combine the collected liquid with the liquid from the earlier soak, then squeeze out the medicinal juice. Divide into two doses.

Chinese Yam Decoction: A prescription for palpitations, limp and weak limbs, heat in the head and face, phlegm congested in the chest, and dizziness and blurred vision, as if the body were swaying.

Chinese yam, Ophiopogon, and Ginseng (four liang each); Fresh Rehmannia root, Peucedanum, and Peony (eight fen each); Immature Bitter Orange, Polygala, and Fresh Ginger (three fen each); Poria and Fu Shen (six fen each); Pinellia (five fen); Licorice, Scutellaria, and Bamboo leaves (two fen each); and glutinous millet (three ge).

Chop the sixteen ingredients listed above. Take river water and raise and pour it by hand 390 times. Measure out three dou and use it to cook the glutinous millet. When the water has reduced by one dou, add the Pinellia and continue boiling until the quantity of liquid has reduced…

Simmer in nine sheng of water, then strain out the dregs. Add the medicinal ingredients and simmer until four sheng remain. Divide into four doses. If river water is unavailable, water from a river flowing eastward far away may be used instead. In the collated edition, the passage beginning “shou ling shang tou ye Qin” is incomplete, and its meaning cannot be determined. When river water is unavailable in the Qin region, Jing River or Wei River water may be used. The wording “Zhuge guan jian you shang qu zhi” is also corrupt and cannot be reliably interpreted.

Fangfeng Decoction: After taking the previous decoction, if your limbs are still not cool and you feel dizzy or see things spinning, take this decoction. It is highly effective and suitable for long-term use; the dosage may be adjusted slightly according to whether the body feels hot or cold. If the illness has not yet resolved, take it according to this prescription.

Fangfeng, gypsum, ginseng, red halloysite, white halloysite, fresh ginger, dragon bone, cold water stone, and poria, three fen each; cinnamon heart, two fen; purple stone, one fen.

Cut the eleven ingredients into small pieces and simmer them in eight sheng of water until three sheng remain. Divide into three doses. Well-flower water—that is, water drawn from a well at dawn—is used for its purity. When using river water today, choose a source free of mud and contaminants: spring water flows from afar and follows its course into the sea, without flowing backward uphill. Its use for treating ailments of the head draws on the idea that water flows downward, guiding the illness downward as well.

Chinese Yam Decoction Recipe

Chinese yam, twenty fen; licorice, fourteen fen; alisma, ginseng, and baical skullcap, four fen each; Chinese angelica, Chinese radish, cinnamon heart, and fangfeng, two fen each; ophiopogon, three fen; Japanese cornel, platycodon, peony, aster, fermented soybean sprouts, dried rehmannia, white atractylodes, chuanxiong, dried ginger, and Sichuan pepper, two fen each. Pound all twenty ingredients together and sift them.

Separately, take eighteen jin of fresh rehmannia, pound it, and squeeze out the juice; simmer until only half remains. Take eight liang each of mixed deer marrow and deer antler glue; eighty jujubes; hemp seeds, pounded and ground; and three sheng each of honey and mulberry root bark. The mulberry root bark must not be taken from trees that grow wild on hillsides. The original text says this kind of medicinal material is highly toxic and must be strictly avoided. Bark from trees growing near fences, house walls, or ditches is also unsuitable.

First, simmer the mulberry root bark, hemp seeds, and jujubes in two dou and four sheng of clear wine until one dou remains, then strain out the dregs. Next, add the rehmannia juice, deer antler glue, deer marrow, and honey…

Boil the medicine until only half remains. Add the various medicinal powders ground earlier and boil them together until the mixture is suitable for making pills. Roll it into pills the size of an egg yolk. Take one pill each time with plenty of water, three times a day. Gradually increase the dose, up to a maximum of three pills at a time.

Chinese Yam Pills: Used to treat dizziness and vertigo, agitation and distress in the heart, palpitations and unease, as well as mania, epilepsy, and similar conditions.

Chinese yam (28 parts), licorice (20 parts), deer antler glue, soybean sprouts, and cassia bark (7 parts each); dried Rehmannia root, fermented medicated leaven, Chinese angelica, and ginseng (10 parts each); Ophiopogon root, fangfeng, skullcap, white peony, and white atractylodes (6 parts each); bupleurum, platycodon, poria, apricot kernel, and Sichuan lovage (5 parts each); white ampelopsis and dried ginger (3 parts each); and 100 jujubes, stewed into a paste.

Grind the 22 ingredients above into a fine powder. Mix thoroughly with white honey and the jujube paste, then make pills the size of a crossbow pellet. Take one pill before meals, three times a day.

Tianxiong Powder: Used to treat dizziness and vertigo, when the room seems to spin and one cannot stand steadily, sometimes to the point of falling.

Tianxiong, fangfeng, Sichuan lovage, ginseng, pubescent angelica, cassia bark, and kudzu root (3 parts each); Chinese alangium (4 parts); white atractylodes, polygala root, Chinese yam, poria with hostwood, and Japanese cornel (6 parts each).

Grind the 13 ingredients above into powder and sift. Before meals, take one fangcun bi measure with chrysanthemum wine. A fangcun bi was an ancient measuring implement for medicine, holding roughly a square inch of powder. After seven days, increase the dose to two measures each time, then gradually to three, according to the body’s response. The method for making chrysanthemum wine is given under the ninth day of the ninth month: take Danzhou chrysanthemums, dry them in the sun and grind them into powder, mix the powder into rice, and steam it to make wine.

Ginseng Pills: Used to treat frequent spells of mental confusion and unsettled consciousness.

Shangdang ginseng, ghost’s head, iron essence, ox bezoar, cinnabar, realgar, rhubarb, calamus, and fangfeng (one liang each); a lizard and a red-legged centipede.

Grind the 11 ingredients above into a fine powder and use honey to make pills the size of Chinese parasol tree seeds. Take seven pills with the chrysanthemum wine described above, three times during the day and once at night, gradually increasing the dose. Do not use blue paper when preparing the medicine. During preparation, keep away women, people wearing blue clothes, people still in mourning, people whose clothing or headwear is untidy, filth, and domestic animals such as chickens, dogs, and rats.

Moxibustion Method

Use a cord to measure horizontally from one side of the mouth to the other, then use that length as the unit of measurement.

Using a cord, measure the distance between the nostrils on either side of the nose. Use this length to measure the width of the nose. Fold the cord in half and compare one half with the full width of the mouth, then fold the cord in half again. First locate the whorl of hair at the crown of the head. From this point, measure in four directions—left and right, forward and backward—and apply moxibustion at the positions corresponding to the ends of the cord. Take the centerline of the face as the reference when measuring.

The number of moxa cones used each year is determined by the person’s age. Moxibustion is performed three times a year, each time only after the previous moxibustion sores have healed. Determine the number of cones according to the method described above. If moxibustion is performed continuously and the heat rises upward, apply it at the point closest to the nose among the several hair whorls on the head. If a whorl is close to the forehead, apply moxibustion there as well. If measuring by finger-width places a point on the face where it would leave a scar, omit that facial point; however, when the illness is severe, there is no need to be concerned about this.

Dietary Restrictions

Do not eat the meat of, or use as medicine, any of the animals corresponding to the twelve zodiac signs: tiger, rabbit, dragon, snake, ox, horse, pig, sheep, chicken, dog, monkey, and rat. However, bezoar from an ox, dragon bone, and dragon teeth may still be used and should not be discarded.