《孫真人備急千金要方》Vol. 44

Formulas for Diseases of the Small Intestine

Fifth: Wind and Epilepsy (Discussion, Formulas and Medicinal Substances, and Acupuncture Methods)

The Yellow Emperor asked Qibo, “When someone suffers from epilepsy from birth, where does it come from?”

Qibo replied, “It is acquired in the womb. If the mother is repeatedly frightened, her Qi rises in counterflow and cannot descend. Her essence and Qi gather together, so after birth the child develops attacks of epilepsy.

“When the illness affects the Yang channels, their separate regions may be cold at one time and hot at another. This is called mania. Needle the weakened channels and examine each region. When the signs of heat have subsided, the illness is considered cured, and needling should stop.

“When epilepsy first begins, attacks once a year are difficult to cure; attacks once a month are also difficult to cure. Attacks every four or five days are called epilepsy. Needle the various regions. Where the pulse is especially cold, use the tonifying method to support the body’s righteous Qi. Stop when the illness is cured.

“At the onset of epilepsy, the patient may first feel depressed, with a heavy head and a fixed gaze; when raising the eyes, the whites turn red. During a severe attack, the patient feels agitated. Observe the complexion and bleed the Hand Taiyang, Hand Yangming, and Hand Taiyin channels. Stop treatment when the complexion changes.

“At the onset of an epileptic attack, if the body instead becomes rigid, causing pain in the back, observe changes in the Qi and blood of the Foot Taiyang, Foot Yangming, Foot Taiyin, and Hand Taiyang channels. Stop treatment when the signs of Qi and blood change.

“During an epileptic attack, if the corners of the mouth are drawn to one side and the patient cries out, pants, or experiences palpitations (the Jia Yi Jing reads ‘panting and palpitations’), examine the Hand Yangming and Hand Taiyang channels. If the right side is rigid, treat the left; if the left side is rigid, treat the right. Stop treatment when the signs of Qi and blood change.

“When treating epilepsy, keep the patient under constant observation and watch for the places that should be treated. During an attack, look for anything abnormal and immediately use the reducing method to disperse pathogenic Qi with the needle. Collect the blood drawn by needling in a gourd. When the patient has another attack, if the blood in the gourd surges of its own accord, use this to assess the illness. If the blood does not move, apply twenty moxa cones to the ‘poor bone,’ which is the sacrum.”

Bone epilepsy: The jaw, teeth, transport points, and regions of the muscles all become distended and full; the bones become rigid and extended; and the patient sweats, feels agitated and oppressed in the chest, vomits copious saliva and mucus, and has Qi discharge downward. This illness cannot be cured.

Tendon epilepsy: The body curls up, the sinews and channels contract tightly, and the pulse is surging and large. Needle the Shu point, the root point of the major channel in the neck. If the patient vomits copious saliva and mucus and has Qi discharge downward, this illness cannot be cured.

Pulse epilepsy: The patient suddenly collapses, and the pulses in all four limbs become distended and full. Bleed all the distended pulses. If they still do not subside, apply moxa at the Taiyang point beside the neck, then apply moxa to the Dai Mai in the lower back; the two points are three cun apart. If the regions of the muscles and the source points become distended and full, and the patient vomits copious saliva and mucus and has Qi discharge downward, this illness cannot be cured.

When treating dian disorder (seizures involving altered awareness and frenzy): if an attack brings on agitation and the skin of the face is thick and swollen, the condition is usually critical and difficult to treat.

During an attack, the patient may collapse to the ground, foam at the mouth, and lose consciousness. If forced to stand, the patient may behave as if deranged. Loss of bowel control also makes the condition difficult to cure.

In dian disorder, a large, slippery pulse in a patient whose illness has lasted a long time may indicate that the condition will ease on its own. A deep, small, rapid, and forceful pulse signals a critical condition that is difficult to treat. A fine, small, and rapid pulse is also difficult to treat. A deficient pulse may be treated, but a replete pulse carries a grave prognosis. When counterflow develops into dian disorder, it is caused by disharmony in the Five Viscera and blockage in the Six Bowels. For this reason, counterflow disorders are also discussed here, after dian disorder. When Yin Qi declines, heat counterflow arises; when Yang Qi declines, cold counterflow arises.

The treatise says: The Yellow Emperor asked, “Why can counterflow disorders be either cold or hot?” Qibo replied, “When Yang Qi is weak in the lower body, cold counterflow develops. When Yin Qi is weak in the lower body, heat counterflow develops.”

The Yellow Emperor asked again, “Why does heat counterflow always begin on the soles of the feet?” Qibo replied, “Yang Qi rises along the feet and the backs of the five toes, gathers on the soles, and then collects at the centers of the feet. So when Yang Qi is excessive, the soles become hot.”

The Yellow Emperor asked, “Why does cold counterflow always begin in the five toes and spread upward to the knees?” Qibo replied, “Yin Qi rises along the inner sides of the five toes, gathers at the knees, and collects above them. So when Yin Qi is excessive, the cold spreads from the toes to above the knees. This cold does not enter from the body’s surface; it arises within the body.”

Counterflow may sometimes cause abdominal distension, and at other times make a person suddenly faint and lose consciousness. Some people regain consciousness after half a day; in severe cases, it may take until the following day. Why does this happen? When Yin Qi is excessive in the upper body, the lower body becomes deficient. This deficiency causes abdominal fullness, which in turn drives Qi upward in counterflow. As pathogenic Qi rises with it, Yang Qi becomes disordered, and the person loses consciousness.

Counterflow in the Taiyang channel may cause swelling and heaviness of the head and an inability to walk; during an attack, the person may become dizzy and fall. Counterflow in the Yangming channel may cause dian disorder, an urge to run about and shout, abdominal fullness that makes it impossible to lie comfortably, a flushed and feverish face, seeing things that are not there, or speaking incoherently. Counterflow in the Shaoyang channel may cause sudden deafness, swollen and feverish cheeks, pain along the ribs, and inability to move the thighs. Counterflow in the Taiyin channel may cause severe abdominal distension, constipation, loss of appetite, vomiting after eating, and inability to lie comfortably. Counterflow in the Shaoyin channel may cause a dry tongue, red urine, abdominal fullness, and heart pain. Counterflow in the Jueyin channel may cause swelling and pain in the lower abdomen, abdominal distension, difficulty passing urine or stool, a preference for lying down with the knees bent, contraction or swelling of the genital region, and heat along the inner or outer sides of the lower legs.

In treatment, drain when pathogenic Qi is excessive and supplement when upright Qi is deficient. When neither is excessive nor deficient, treat by selecting the corresponding channel.

If cold pathogens are present below and heat pathogens above, first needle the Taiyang channel points on the neck and nape, leaving the needles in for a relatively long time. After removing them, apply a heated compress to the neck, nape, and shoulder blades until the area feels warm. Stop once the cold sensation in the lower part of the body has subsided. This is what is meant by “pushing it upward.”

If the upper part of the body is hot and the lower part cold, examine the weakened channels and locate depressions along the meridians for needling. This makes Qi flow downward; continue until the symptoms ease. This is what is meant by “drawing it downward.”

When needling heat reversal—coldness of the limbs caused by heat pathogens—leave the needles in so that the patient feels cool afterward. When needling cold reversal—coldness of the limbs caused by cold pathogens—leave the needles in so that the patient feels warm afterward. To treat heat reversal, use points on two Yin channels and one Yang channel; to treat cold reversal, use points on two Yang channels and one Yin channel. “Two Yin” means needling points on two Yin channels; “two Yang” means needling points on two Yang channels.

The treatise says that when the heat pathogen of a warm disease penetrates deep into the kidneys, it can also cause convulsions. Children with epilepsy may likewise develop convulsions when their fever is severe. Wind aphonia (loss of speech caused by wind pathogens), sudden fainting that resembles death, and a spirit pressing on someone and leaving them unconscious and unable to wake can all present with similar symptoms, so they must be carefully distinguished. Hence the scripture says, “Reversal illness that persists for a long time becomes dian illness,” showing that these conditions have similarities.

The treatise also describes five kinds of dian illness:

The first is Yang dian. During an attack, the patient looks as if dead and may urinate involuntarily; the episode eases after a while.

The second is Yin dian. The patient is an infant whose navel wound has not yet healed; the illness is said to result from being bathed repeatedly.

The third is wind dian. During an attack, the eyes are pulled askew, the body convulses and stiffens, and the patient may even bleat like a sheep. The episode eases after roughly the time it takes to eat a meal. Some say it is caused by being exposed to wind after sweating from exertion, or by sexual activity after excessive intercourse, drunkenness, or a full meal. These conditions constrain the Heart Qi, causing shortness of breath and palpitations in the Heart pulse, and bring on the illness.

The fourth is damp dian, marked by pain between the eyebrows and a heavy feeling in the body. Some say it results from washing the hair in hot water and leaving it wet and matted, or from exposure to dampness while sweat on the head has not yet stopped.

The fifth is horse dian. During an attack, the eyes roll upward, the mouth cannot open, the hands and feet are pulled into convulsions, and the whole body becomes hot. Some say it results from a disharmony between the fat and Qi of the brain in early childhood.

Formula for treating the five kinds of dian illness

One liang each of copper verdigris, realgar, azurite, “chicken head from above the eastern gate,” and mercury; two liang each of poria, polyporus, ginseng, dahurian angelica, bai lian, bai wei, and shi chang sheng; half a liang each of juan bai and wu shan; and one and a half liang of sulfur.

Grind these fifteen ingredients into a fine powder and mix with the bile of a blue-green ox. Place the mixture in a copper vessel and steam it on a bamboo steamer containing five dou of soybeans. Once prepared, roll it into pills the size of hemp seeds. Take thirty pills twice a day before meals, and take another dose at night.

“Tiger-Eye Pills” are used to treat wind dian, with symptoms including bodily convulsions, the mouth and eyes held wide open, and white foam at the mouth, or …

A prescription for treating abnormal vocalizations, fainting, and loss of consciousness (called the “Great Tranquilizing Heart Pill” in Qianjin Yifang, where it is used for various forms of epilepsy that are difficult to cure by other methods).

One tiger’s eye, soaked in wine overnight and then roasted dry; two fen each of ghost arrow feather and wasp nest; three liang each of pubescent angelica, polygala, asarum, cyrtomium, musk, white clover (also given as white peony), cimicifuga, and dictamnus bark; four fen each of ox bezoar, fangfeng, gentian root, fangKui, dragon bone, scutellaria, realgar, cornus fruit, dried rehmannia (another version uses dried ginger), fangji, poria, iron essence, ghost-head root, ginseng, rhubarb, and silver filings; five fen each of poria spirit, gypsum, and aconite; six fen of cold-water stone; and one chi of snake slough.

Grind all thirty-two ingredients into a fine powder, mix with honey, and form pills the size of parasol tree seeds. Take with wine, fifteen pills per dose, twice daily; gradually increase to twenty-five pills. The original calls this a “divine prescription,” meaning one with remarkable efficacy.

Epileptic seizures often present in many different ways. If there is white foam around the mouth and the body moves irregularly, the following prescription may be used:

Two liang each of gentian root, ginseng, fangKui (also given as fangfeng), poria spirit (also given as moutan), and licorice; one liang of lead oxide; and one piece of cyrtomium.

Cut the seven ingredients into pieces. Boil them in nine sheng of water until three and a half sheng remain, then divide into three doses.

Male-and-Female Pill: for wind epilepsy, disordered consciousness, reversed behavior, critical illness, and the “Five Epilepsies” and convulsive seizures.

One liang each of realgar, orpiment, and pearl; two liang of lead, melted and ground into powder; two fen of cinnabar; and eight fen of mercury.

Grind all six ingredients into a fine powder and pound with honey thirty thousand times. Form pills the size of broad beans. Take two pills twice daily before meals, gradually increasing the dose according to the body’s response.

Records of Verified Prescriptions from Ancient and Modern Times says this prescription treats the “Five Epilepsies”: ox epilepsy, during which the patient bellows like an ox; horse epilepsy, with neighing like a horse; dog epilepsy, with barking like a dog; sheep epilepsy, with bleating like a sheep; and chicken epilepsy, with crowing like a chicken. Ancient practitioners believed that the Five Epilepsies and manic illness arose when the organs became entangled with one another, Qi became congested and exuberant, and cold reversal occurred, causing symptoms such as cold limbs. The patient might be confused and speak incoherently, sometimes spit white foam, and then regain consciousness after a time.

Note: Lead, lead oxide, realgar, orpiment, cinnabar, mercury, and other substances named in the original are toxic medicinal materials. This is an interpretation of an ancient text and must not be used as practical guidance for treatment.

Xuming Fengyin Decoction is used to treat fainting and dizziness after a stroke, loss of consciousness, delirious speech, and a swollen tongue.

Prescription

Ephedra, Chuanxiong, and gypsum; ginseng and saposhnikovia root (three liang each); cinnamon bark, licorice, and pubescent angelica root (two liang each); Stephania root, aconite, and angelica (one liang each); thirty apricot kernels; and five liang of aged ginger (one version omits the word “aged”).

Cut the thirteen ingredients into small pieces. Simmer them together in three sheng of wine and one dou of water until four sheng remain. Divide the decoction into four doses: take three during the day and one at night.

Zishi Powder is used for symptoms in adults brought on by pathogenic wind, and for infantile convulsions and seizures in children. It is also used when attacks occur dozens of times a day and physicians consider the condition difficult to cure.

Prescription

Amethyst, talc, white kaolin, water-hardening stone, red kaolin, and gypsum (six liang each); licorice, cinnamon bark, and oyster shell (five liang each); rhubarb, dragon bone, and dried ginger (four liang each).

Grind the twelve ingredients and sift them into a coarse powder. Put the powder in a leather pouch and hang it in a cool, elevated place. For each dose, take an amount that can be pinched between three fingers and simmer it in three sheng of freshly drawn well water until one sheng and two he remain. Adults should take the entire dose at once. For infants younger than one hundred days, give one he. If an infant cannot swallow, soak cotton wool in the liquid and place it in the mouth. If the fever is severe, give four or five doses a day, adjusting the amount as needed. (The Shenshi Formula uses only five ingredients: dragon bone, dried ginger, oyster shell, talc, and white kaolin.)

A formula for treating 120 kinds of wind disorders, epilepsy, and episodes of frenzied convulsions, during which the patient froths at the mouth and fails to recognize others. It should be taken in the fourth or fifth month.

Prescription

Amethyst, peony, and dragon bone (another edition uses skullcap instead); blue kaolin, dittany bark, ephedra, angelica, licorice, trichosanthes root, cinnamon bark, and ginseng (two liang each); oyster shell (three liang); and rhubarb (five liang).

Grind the thirteen ingredients and sift them into a coarse powder, then divide it into seven packets. For each dose, take one packet, add ten jujubes and three sheng of water, and simmer until two sheng and five he remain. Strain out the dregs. Then add the contents of the packet to the jujube liquid and continue simmering until one sheng remains. Strain out the dregs and drink the entire amount at once. Take one dose every seven days; the condition will then be cured.

A formula for treating epilepsy and fainting attacks:

Daphne root, hematite, and ginseng.

Red lead, white stiff silkworm, and fresh pig teeth; uncaria, poria with hostwood, and thunder ball; tiger bone, polygala root, and cassia bark; saposhnikovia (six fen each), spikemoss, and henbane seed; cinnabar, cohosh, and aconite; peony and dragon teeth (one fen each), and bezoar (two fen); Chinese aster (four fen), fourteen cicadas, snake slough, and the eyes of a white horse (one of each).

Grind these twenty-five ingredients into a coarse powder and take with wine, one square-inch spoonful at a time (an ancient measure for medicines, roughly a spoonful), twice a day. They may also be made into pills, which are highly effective.

Chuanxiong Decoction: Treats wind-induced epilepsy with pain that pulls at the ribs and flanks, vomiting during an episode, and ringing in the ears like the sound of cicadas.

Chuanxiong, angelica dahurica, and lüru, five liang each.

Cut up these three ingredients, boil them in one dou of wine, and reduce the liquid to three sheng. Take it all at once. Those who are weak should divide the dose in two. After taking it, sweat profusely.

A formula for treating wind-induced epilepsy (called “Owl Head Pill” in the Jingxin Lu):

Draba seed, red lead, tiger palm, monkshood, and trichosanthes root, three fen each; kansui, Chinese aconite, Sichuan pepper, and kansui root, two fen each; atractylodes, one fen; iron essence and lüru, one liang each; one owl’s head.

Grind these thirteen ingredients into powder and mix with honey to make pills the size of Chinese parasol-tree seeds. Take two pills at a time with decoction or wine, three times a day.

Another formula:

Thirty jin of rehmannia root and ten jin of asparagus root.

Pound these two ingredients to extract their juice, simmer it down to a thick liquid, and take it. It can cure the condition.

Another formula:

Three sheng of henbane seed. Pound and sift it, then soak it in one dou of wine for half a day. Strain out the dregs, put the liquid into a decoction, and simmer until it can be formed into pills. Take before meals, beginning with two pills the size of adzuki beans and gradually increasing to two pills the size of Chinese parasol-tree seeds, stopping when the medicine takes effect. Redness between the lines on the forehead and palms indicates that it has taken effect. If this does not appear, continue taking it.

If the illness occurs once a day, it can be cured in three days; if it occurs every other day, in ten days; if it occurs once every five days, in twenty days; if it occurs once every six months, in one month.

A formula for treating epilepsy and convulsions:

One jin of red lead and two flying owl heads.

Grind these two ingredients into powder and mix with honey to make pills. Take three pills before meals, three times a day. For severe cases…

Each night, gradually increase the amount you take.

Asparagus wine can treat wind disorders affecting the five viscera and six bowels, severe diarrhea, and weakness. It can also be used for the five strains and seven injuries, accumulations and stagnation of Qi, chills and fever, various wind disorders, epilepsy, deafness, headaches caused by wind, spasms of the limbs, joint pain, and many other illnesses. Taken over a long period, it can prolong life and make the body feel light and nimble. Even after teeth fall out, they may grow back, and white hair may turn black again.

Asparagus resembles Bai Bu, but asparagus tastes sweet and its root is squarer at both ends. Bai Bu is slender and long, tastes bitter, and has a draining effect. Pound the asparagus, squeeze out its juice, and take two dou of juice. Add two sheng of wine starter. Once the starter has fermented, use two dou of glutinous rice and brew the wine according to your household method. When brewing in spring or summer, let the cooked rice cool completely; in autumn or winter, let it cool until it is warm, close to body temperature. Once the wine has fermented, draw off the clear wine. Drink one cup at a time, keeping a steady amount of wine in the body, but do not drink until you become drunk and vomit. While taking it, avoid raw or cold foods, sour foods, slippery or greasy foods, chicken, pork, fish, and garlic. Be especially careful to avoid carp, and also avoid fatty foods. This recipe uses one dou of asparagus juice; for one shi or two shi, brew in the same proportions.

After ten days of taking the medicine, you will feel a faint rash and itching over the body. After twenty days, the itching will become more intense; only after thirty days will it gradually stop. The text says this happens because wind Qi is being expelled. By the fortieth day, you will feel clear and refreshed in both body and mind. By the fiftieth day, you will feel even more refreshed, and sitting or lying in the wind will no longer seem to let wind disorders invade the body. It will seem that all the wind disorders within you have been eliminated.

To brew the wine with rice, first wash the rice and dry it in the sun or by heating it. When ready to use it, soak the rice in a separate portion of asparagus juice, drain it, and steam it. Mix the remaining juice into the cooked rice, then seal it for fermentation. To obtain the asparagus juice, first wash the asparagus and remove its core and outer skin. Drain off the water, chop it, and squeeze out the juice. Press the pulp repeatedly three or four times, until the residue is as dry as grass.

When newly brewed, this wine tastes sour and has a rank smell like wastewater. If you follow the recipe and let it stand for a while, it becomes fragrant and delicious; the text says no other wine can compare with it. Sealing it for four seven-day periods—twenty-eight days, since in ancient times seven days made a period—produces a good result. Usually, brew a small amount in the eighth or ninth month, then a larger amount in the tenth month, preparing to begin taking it regularly around the thirtieth day of the fifth month of the following year. It can also be brewed in the third month of spring, but should not be brewed once the fourth month begins.

The text says that taking a powder at the same time as the wine makes the effects stronger and faster. To prepare the powder, remove the asparagus core and outer skin, dry it in the sun, and pound it into a fine powder. Wash it down with the wine brewed as described above. Take one square-inch spoonful at a time, three times a day, gradually increasing to three square-inch spoonfuls. The recipe says that long-term use can prolong life and bring immortality.

Moxibustion

To treat mania in adults and convulsive seizures in children, apply moxibustion at two places: the second vertebra of the back and the lower end of the coccyx. Measure a length of cord, then fold it in half. The points where the ends of the cord fall mark the acupoints along the spine. After measuring these three points, cut the cord into three equal lengths and overlap them to form a “ム” shape. Place one corner at the center and the other two against either side of the spine, then apply moxibustion. This gives five points in all. The scripture says to draw a diagram marking their positions and apply one hundred cones at each of the five points (one burned moxa cone is called one zhuang). Thinly shaved bamboo skin is more suitable for measuring than cord.

For a sudden epileptic seizure, apply three moxa cones to the hollow above the penis. Once urination flows freely, the illness will improve. The Qianjin Yifang says the acupoint is above the urethral opening. One can also apply three cones to the glans, seven to the tuft of hair above the big toe, fourteen to the groove beneath the scrotum, and three to each nipple. Moxibustion may also be applied to the Governing Vessel for thirty cones, in three sessions; this point lies at the midline of the bridge of the nose, above it and within the hairline. At the Tianchuang and Baihui points, the number of cones may be increased gradually to three hundred each, using small cones. Apply fifty cones on each side at the hairline above the ears.

Discussion

The Yellow Emperor asked, “When someone becomes angry and mad after falling ill, how does this illness arise?” Qibo replied, “It is caused by an irregularity in Yang Qi.” The Yellow Emperor asked, “Why does Yang Qi make a person go mad?” Qibo said, “Yang Qi suddenly becomes obstructed, as though it were difficult to break through; the person therefore becomes prone to anger. This illness is called ‘Yang reversal.’”

The Yellow Emperor then asked, “How can this illness be recognized?” Qibo replied, “The pulse of the Yangming channel is always agitated, while the pulses of the Taiyang and Shaoyang channels are normally still. If they too begin to move, and do so rapidly, this is a sign of the illness.” The Yellow Emperor asked, “How should it be treated?” Qibo replied, “Reducing food intake will bring improvement. Food entering the body can increase Yin Qi and also strengthen Yang Qi. Therefore, food should be reduced, and the patient may also take iron filings—scraped from iron implements—after meals. Iron filings can bring Qi that surges upward back down.”

The discussion also says that anyone who goes mad and wants to run, or claims to be exceptionally wise, virtuous, or divine, should be treated with various forms of moxibustion; only then may the illness be cured for a long time. If the patient weeps and moans, the condition is an illness caused by pathogenic influences, not the madness described here, and it should be treated according to the methods for that kind of illness. When pathogenic Qi enters the Yang aspect, it makes a person go mad; when it enters the Yin aspect, it causes obstruction of the blood vessels. When pathogenic Qi transforms in the Yang aspect, it becomes epilepsy or convulsive illness; in the Yin aspect, it causes pain and loss of voice. When Yang pathogens enter the Yin aspect, the illness appears quiet; when Yin pathogens enter the Yang aspect, the illness appears as anger.

Alligator Turtle Shell Decoction: Used to treat conditions caused by pathogenic influences in which a person weeps and cries in sleep or upon waking, and does not want to hear people’s voices.

The symptoms include aching and weakness, alternating chills and fever, stiffness and pain in the lower back and spine, abdominal cramping, and loss of appetite. They may result from overexertion after an illness, breaking prohibitions, or living without restraint. In women after childbirth, the symptoms may include obstructed menstruation, with menstrual blood that is sometimes greenish, red, or white; physical weakness and wasting; difficulty urinating; or heat in the head and body that later comes and goes. This also includes becoming drowsy and exhausted for the whole day after having intercourse once. This prescription can be used to treat all of these symptoms.

Softshell turtle (the “softshell turtle” here refers to the shell of an animal like the Chinese alligator; seven pieces), licorice, Baiwei (some versions give “Baizhi”), fritillaria bulb, and Scutellaria root (two liang each); ephedra, peony, and atractylodes (two and a half liang each); Saposhnikovia root (three liang); calcite, cinnamon bark, poria, and Anemarrhena rhizome (four liang each); gypsum (six liang).

Cut the fourteen ingredients into small pieces. Boil them in two dou of water until four sheng of liquid remain. Take one sheng warm three times a day, with one dose at night.

Nine-Ingredient Ox-Bezoar Pill: Treats men afflicted by ghosts or spirits and in critical condition, who see things that terrify them and make them want to flee, with symptoms that come and go. The original text attributes this to malign influences, from which the patient cannot free himself.

Ox bezoar (essence of Earth; some say essence of Fire), Vitex fruit (essence of humans), copper carbonate (essence of the Azure Dragon), powdered jade (essence of the White Tiger), azurite (essence of Heaven), realgar (essence of Earth), Scrophularia root (essence of the Black Tortoise), dragon bone (essence of Water), and red halloysite (essence of the Vermilion).

These nine ingredients are called the “Nine Essences.” They are said to reach upward to the nine heavens and downward to the nine earths. Take one liang of each, grind them into a fine powder, sift, and mix with honey to form pills the size of small beans. Take one pill before meals three times a day, gradually increasing the dose until the condition improves. The Qianjin Yifang says that for illnesses caused by malign influences, one should take the “Five-Malign-Influence Decoction” and the “Nine-Essence Pill” until cured.

Ten-Yellow Powder: Treats insufficiency of Qi and blood in the five viscera and six bowels, mental confusion, a sense that the soul is unsettled, sudden and changeable sadness or joy, persistent fear, and the feeling that ghosts or other beings are appearing. The original text holds that these conditions are often caused by severe fright, falling from a height while exposed to the wind, or falling into water.

Realgar and ginseng (five fen each); Scutellaria root, rhubarb, phellodendron bark, astragalus root, Asarum, and cinnamon bark (three fen each); Coptis root.

“Pollen of cattail, ephedra, and scutellaria, one part each; yellow-berried spindle tree, Asian water plantain, and Cornelian cherry, two parts each.”

Grind the fifteen ingredients above into a fine powder. Before eating, take one square-inch spoonful (an ancient small measuring spoon) with warm wine. If there is no improvement after three days, increase the dose to two spoonfuls. For those who are weak, add five parts of ginseng. The total amount of the ingredients is ten parts. Another version says to add two parts of raw huang; Cui’s version uses five parts of Sichuan pepper and four parts of dried ginger.

Separation Powder: Treats conditions attributed to “wind evils” in men and women, such as men dreaming of women, women dreaming of men, or shifting emotions including sadness, worry, anger, and joy. These symptoms may recur once every six months or several months. “Wind evils” is an ancient medical term for a category of disease-causing factors.

Cinnamon bark, Japanese skimmia, monkshood, sweet flag, Chinese wild ginger, madder root, aconite, and dried ginger, one liang each; atractylodes and Chinese taxillus, three liang each.

Grind the ten ingredients above into a fine powder and take one square-inch spoonful with wine three times a day. During preparation, do not let women, chickens, dogs, or anyone in the patient’s household see or know about it. The text says that observing this restriction keeps the evil Qi from dispersing, and treats compliance as proof that the prescription is effective.

Four-Ingredient Kitehead Powder: Treats conditions attributed to “ghosts and spirits.”

Kitehead from the Eastern Sea (the root of youba), yellow-toothed stone (also called golden tooth), henbane seeds, and euphorbia root, one part each.

Grind the four ingredients above into a fine powder and take one square-inch spoonful with wine. To make the patient see a ghost, add one part of euphorbia root. To learn who rules the ghost, add another part; this is said to produce an effect quickly. Euphorbia root and henbane can both cause confusion and disorientation, making a person appear to be insane, so they should not be taken in large quantities.

Five-Evils Decoction: Treats crying, singing, or shouting attributed to “evil Qi.”

Limonite, saposhnikovia, cinnamon bark, peony, polygala, angelica pubescens, licorice, atractylodes, ginseng, gypsum, oyster shell, and large-leaved gentian, two liang each; ledebouriella, sweet flag, poria with hostwood, realgar (the version by Shenshi says lead tetroxide), and snake slough, one liang each.

Cut the seventeen ingredients into pieces, add two dou of water, and boil down to four sheng. Divide into four doses. It may also be taken using the method for decoctions made from sliced herbs.

Poria Decoction: Treats symptoms said to arise when the “Qi of the five evils” enters the body, such as seeing ghosts, speaking incoherently, thinking one sees or hears things, palpitations, and an unsettled, disoriented spirit.

Poria with hostwood, ginseng, sweet flag…

Three liang each of poria and the other ingredients; forty red beans.

Chop the five ingredients. Boil them in one dou of water until two and a half sheng remain. Divide into three doses.

Ginseng Decoction: A prescription for treating attacks by wind malignity and demonic influences, when the illness sometimes recurs at regular intervals and sometimes without any pattern.

Five fen each of ginseng, saposhnikovia root, monkshood, dried ginger, alisma, trichosanthes root (listed as “platycodon root” in the Qianjin Yifang), dog ridge, polygala root, aconite, scutellaria root, and angelica pubescens root; eighteen zhu each of gentian root, oyster shell, schisandra fruit, Cornus fruit, hogfennel root, asarum, gypsum, Sichuan lovage root, Sichuan pepper, achyranthes root, licorice, Chinese photinia, mulberry root bark, cassia bark, ephedra, bamboo skin, atractylodes, and tangerine peel; twelve zhu each of Japanese arrowwood (listed as “sweetflag” in the Qianjin Yifang) and poria; sixteen jujubes.

Chop the thirty-two ingredients. Combine six sheng of water and six sheng of wine, and boil until four sheng remain. Divide into five doses: take three during the day and two at night.

Tiger-Eye Decoction: A prescription for sudden, irregular outbreaks of madness caused by malign influences, in which the hair is disheveled and the person shouts loudly, even wanting to kill and showing no fear of water or fire.

One tiger eye, one hornet’s nest, and one owl’s head; five fen of mistletoe from a maple tree; ten fen of Shichangsheng; three liang each of poria, cassia bark, and saposhnikovia root; one liang each of angelica pubescens root, licorice, ginseng, and Tianxiong.

Chop the twelve ingredients. Boil them in one dou and two sheng of water until three sheng remain. Divide into four doses: take three during the day and one at night.

Another prescription:

Five liang each of Fangkui, ginseng, and Guanzhong; three liang each of saposhnikovia root and cassia bark.

Chop the five ingredients. Boil them in one dou of water until three sheng remain. Divide into four doses, or take small amounts gradually.

Another prescription:

Mix five jin of bitter sophora with honey and form pills the size of a sour jujube. Take ten pills at a time.

A prescription for sudden madness:

Have the patient lie on their back on the ground. Keep pouring cold water over their face throughout the day. This is said to work well.

A prescription for various malign spirits and ghosts:

Take scalp grime, an amount about the size of a red bean.

A prescription for attacks by ghosts and spirits:

Take deer antler powder with water, one fangcun bi spoonful (an ancient measure for powdered medicine) at a time, three times daily for seven consecutive days.

Another prescription: Grind otter liver into powder and take it with water three times a day.

Prescriptions for treating fox spirits and other supernatural entities that cause trouble, making people afraid, deranged, or epileptic

Six jin of realgar and one dou and two sheng of oil.

Break the realgar into pieces about the size of game pieces and put them in a pot. Cover the pot by turning a basin upside down over it. Set up a separate stove and simmer over a low flame for nine days and nine nights. The fire must not go out for even a moment, nor be allowed to grow cold; it must remain warm and unbroken throughout. This is said to be highly effective.

A prescription for treating wind affliction

Take thirty jin of poke root, peel it, and slice it finely. Add eight dou of water and boil it on a stove facing east. When the water has reduced by half, strain out the herbs and continue boiling until the mixture can be made into pills the size of parasol tree seeds. Take one pill each time. Do not let anyone watch while preparing the medicine. The henbane prescription and the purple soybean decoction may also be taken; sweating is beneficial. (The henbane prescription appears earlier in this chapter, and the purple decoction is in another volume.)

Another prescription: Burn a toad, grind it into powder, and take it with water, one square-inch spoonful each time, three times a day.

Another prescription: Burn human feces to ash and take it with wine. While taking the medicine, avoid raw or cold foods, vinegar, sticky or slippery foods, pork, chicken, fish, and garlic.

Another prescription: Take Fulonggan (hearth-earth) with water, one square-inch spoonful each time, three times a day.

Illustrated instructions for acupuncture and moxibustion to treat various malign influences, derangement, and mania

The treatise says: Illnesses caused by various malign influences have many different origins and manifestations, and may be signs of an attack of derangement. Some patients fall silent; others babble incoherently. Some sing, weep, chant, or laugh; some lie down or sit in ditches and eat filth. Some strip naked; some wander day and night; some rage and curse without end. Others seem to be tormented by flying insects, gu-type afflictions, or spirits, moving their hands and feet wildly and darting their eyes about. This chapter treats such patients with acupuncture and moxibustion together with medicinal prescriptions. Those who divine the cause of wind afflictions often judge such illnesses to be the work of ghosts.

Bian Que said that there are thirteen acupuncture points for illnesses caused by the hundred malign influences. Begin by needling “Ghost Palace,” then “Ghost Faith,” followed by “Ghost Fortress,” and then “Ghost Heart.” It is not necessary to needle every point; the situation may become clear after five or six. If malign gu, spirits, or other supernatural entities are at work, the patient will speak spontaneously and explain what happened. If inquiry confirms the account, the spirit can be identified. There is no need to kill it; instead, find a way to make it leave. For men, begin needling on the left; for women, on the right. If the patient still does not speak after several points have been needled, follow the instructions and needle all the points.

When administering treatments such as acupuncture, one should also work according to the zhangjue (hand formulas or finger techniques) and manipulate the area around the eyes. Treatment carried out in this way is said to be unfailingly effective. The Yellow Emperor’s hand formulas form a separate set, consisting of essential methods secretly transmitted among practitioners.

This method can be used to bind malevolent spirits, restrain calamities and baleful influences, and subdue spirits and ghosts inhabiting mountains and rivers. The human body has several sites for needling, including the areas between the joints of the ten fingers:

The first needle is inserted at Renzhong, known as “Ghost Palace.” Insert it from the left and withdraw it from the right.

The second needle is inserted beneath the nail of the thumb and is known as “Ghost Trust.” Insert it three fen into the flesh.

The third needle is inserted beneath the nail of the big toe and is known as “Ghost Rampart.” Insert it two fen into the flesh.

The fourth needle is inserted at the crease behind the palm and is known as “Ghost Heart.” Insert it half a cun into the flesh. This is the Taiyuan point.

The fifth needle is inserted below the outer ankle, at the boundary between the white and red flesh. It belongs to the Foot Taiyang channel and is known as “Ghost Path.” Apply a fire needle—a needle heated before insertion—seven times, three thrusts each time. This is the Shenmai point.

The sixth needle is inserted one cun within the hairline, above the Dazhui point, and is known as “Ghost Pillow.” Apply a fire needle seven times, three thrusts each time.

The seventh needle is inserted in the hollow just in front of the ear, five fen below the earlobe, and is known as “Ghost Bed.” Apply a fire needle seven times, three thrusts each time.

The eighth needle is inserted at the Chengjiang point and is known as “Ghost Market.” Insert it from the left and withdraw it from the right.

The ninth needle is inserted between the two tendons, three cun above the wrist crease, and is known as “Ghost Path.” This is the Laogong point.

The tenth needle is inserted one cun into the hairline, directly above the bridge of the nose, and is known as “Ghost Hall.” Apply a fire needle seven times, three thrusts each time. This is the Shangxing point.

The eleventh needle is inserted into the cleft beneath the genitals, followed by three moxa cones. For women, insert it at the head of the Jade Gate. This point is known as “Ghost Storehouse.”

The twelfth needle is inserted on the outer side of the elbow crease, at the boundary between the white and red flesh, and is known as “Ghost Minister.” Apply a fire needle seven times, three thrusts each time. This is the Quchi point.

The thirteenth needle is inserted into the center of the tongue, one cun from its tip. Pass it through the cleft underneath so that it emerges on the upper surface of the tongue. This is known as “Ghost Seal.” Then place a board crosswise at the corner of the mouth and press it against the needle’s head, preventing the tongue from moving.

For any of the points listed above that have corresponding sites on both the left and right sides, needle both sides. If there is only one site, needle that side alone.

If a person suffering from an affliction caused by spirits babbles incoherently, apply fourteen moxa cones to the Xuanming point. It lies on the tendon at the center of the inside of the lips and is also called “Ghost Reward.” Some say it is better to cut through this tendon with a sharp knife.

If the afflicted person lies unconscious and does not know what they are doing, treat the Fengfu point, also called “Ghost Cavity.”

When an evil illness flares up, with loud shouting, cursing, or running, moxibustion may be applied to the tips of all ten fingers, one fen from the nails. This point is called “Ghost Market.”

When an evil illness flares up, with loud shouting and wandering far away, needle the Sanli point. This point is called “Ghost Evil.”

When an evil illness flares up with symptoms resembling mania and heaviness in the limbs, needle the Shangxin point. This point is called “Ghost Gate.”

When an evil illness flares up with heaviness and pain in the limbs, or other varied symptoms, needle the Chize point. It lies over the artery at the elbow crease and is also called “Ghost Receiving.”

When an evil illness flares up with nonstop speech or other varied symptoms, needle the Renzhong point, also called “Ghost Reception Hall.” For anyone struck by a malign influence, first press below the nose; this is the spot meant.

Cang Gong’s method: For mania, epilepsy, failure to recognize people, or dizziness and confusion caused by manic illness, apply nine cones of moxa at the Baihui point. A “cone” is the unit used to measure the amount of moxibustion.

For running about wildly and convulsions, apply moxibustion three cun above the Yuzhen point. Another account says to apply one hundred cones one cun behind the crown of the head. For running about wildly and manic illness, one may also apply twelve cones two cun behind the crown.

For mania and speaking of ghosts, apply nine cones of moxa at the Tianchuang point. For running about wildly and manic illness, apply one hundred cones at the Dayou point.

For manic speech and confusion, apply one hundred cones of moxa at the Tianshu point. For running about wildly and epilepsy, apply thirty cones at the tip of the lower ribs.

For manic illness and weeping, apply thirty cones of moxa at the Shounizhu point. There is one point on each side, six cun behind the wrist.

For running about wildly and fright epilepsy, apply fifty cones of moxa at the Hekou point. It lies in the hollow behind the wrist, where the pulse can be felt. (This point is the same as the Yangming point.)

For manic illness, wind epilepsy, and tongue protrusion, apply one hundred cones of moxa at the Weiguan point; do not use needling.

When a manic evil influence flares up unpredictably, with disheveled hair and loud shouting, or even an urge to kill, fearlessness around water and fire, or wild speech, apply thirty cones of moxa at the Jianshi point. It lies five cun behind the wrist, between the two bones of the forearm. (For fright, singing, or weeping, moxibustion may also be applied there.)

For running about wildly, or sudden shifts between joy and anger, sorrow, and weeping, apply moxibustion at the Chenjue point, using a number of cones equal to the person’s age. This point is also written “Jujiao.” It lies on the back, on the inner side of the shoulder blade, where it cannot be reached by reaching behind. Press along the bony ridge; the tender spot is the point.

For a manic evil influence and speaking of ghosts, apply one hundred cones of moxa at the Futu point. (An earlier passage gives nine cones at the Tianchuang point.)

For sorrowful weeping and speaking of ghosts, apply fifty cones of moxa at the Tianfu point. For sorrowful weeping, evil speech, and confusion, or singing and crying out, apply fifty cones at the Cimen point.

For manic evil influences and fright epilepsy, apply thirty cones of moxa at the Chengming point. It lies three cun above the inner ankle, over the artery. (For running about in a frightened, manic state, moxibustion may also be applied there.)

For manic illness, wind fright, coldness in the hands and feet, and agitation in the heart, apply moxibustion at Ju…

For mania associated with a Yang channel, one may apply fifty moxa cones. When a person is agitated, has seizures, and speaks as though repeating the words of ghosts, apply forty cones at points on the Foot Taiyang channel.

If fright causes someone to run about in a daze, apply thirty cones at points on the Foot Yangming channel. For recurrent episodes of agitation and seizures, apply moxa on the Foot Shaoyang channel, with the number of cones determined by the patient’s age. If someone runs about wildly and faints as though dead, apply nine cones at the three hairs beside the big toe. The Wings Formula says this is the Dadun point.

For wild running and a tendency to curse, apply moxa at the Eight Meeting points, using a number of cones equal to the patient’s age. This point is five fen below the Foot Yangming channel. If there is mania, fear-driven running, mental confusion, sudden shifts between anger and joy, cursing and laughter, singing and weeping, or speech as though repeating the words of ghosts, apply moxa at Naohu and Fengchi, as well as on the Hand Yangming, Hand Taiyang, Hand Taiyin, Foot Yangming, Yang Qiao, Shaoyang, Taiyin, Yin Qiao, and heel areas. In each case, the number of cones should be determined by the patient’s age.

For palpitations and weakness caused by fright, apply fifty cones at the Daheng point. An episode of agitation in which someone curses, strikes others, or even swings a weapon to injure them is called “Yang Heat Wind.” Apply one cone at each corner of the mouth, where the red and white parts meet.

One may also apply thirty cones along the midline of the scrotum. Have the patient stand and mark the centerline with a pen; then have him lie down and apply moxa above the testicles. Do not place it too far forward, lest the testicles be injured and Yang energy damaged.

If someone runs about wildly and injures others, tries to kill himself, curses without stopping, or claims to be possessed by a god or ghost, apply one cone where the red and white parts meet at the corners of the mouth. Then apply five cones on the inner side of each elbow and three cones on the back between the shoulder blades. The Cang Gong Method calls this highly effective.

To counter disturbances by ghosts and spirits, apply one hundred cones an inch inside the hairline. One may also apply fifty cones each at the Jianshi point on the inner wrist and at the center of the palm. If a fox spirit is thought to be responsible, bind the two thumbs tightly together and apply twenty-one cones where they meet. It is said that the person will recover upon hearing the fox cry out.

When someone suddenly speaks incoherently or as though repeating the words of ghosts, bind the thumbs tightly together with the strap of a rice steamer. Then apply seven cones simultaneously at the two points beneath the ribs, opposite one another at the ends of the curved ribs. After a short while, the ghost is said to announce its name and ask to leave. Once it has been questioned gently, untie the strap.

If someone is suddenly disturbed by an evil spirit and becomes dazed, trembles, or has locked jaws, apply moxa at Renzhong beneath the nose and at the roots of the nails on the big toes and thumbs. Place half of each moxa cone on the nail and half on the flesh, and apply seven cones at each point. If the symptoms do not stop, continue to fourteen cones. The cones should be as small as sparrow droppings.

If wind-evil is thought to be the cause, apply moxa at Jianshi, using a number of cones equal to the patient’s age; then apply seven cones each at Chengjiang, Xinshu, and Zusanli. For sudden agitation accompanied by speech as though repeating the words of ghosts, insert a needle shallowly just beneath the nail of the big toe. It is said that this will make the symptoms stop.

Volume 44 of Sun the Perfected One’s Essential Formulas Worth a Thousand in Gold for Emergencies