《孫真人備急千金要方》Vol. 47

Volume 47, “Admonitions 7,” of the Perfected Sun’s Essential Prescriptions Worth a Thousand in Emergencies

(Edited by Lin Yi and others, including Court Gentleman for Court Audiences, Acting Junior Minister of the Court of Imperial Sacrifices, and Proofreader of the Imperial Library)

Prescriptions for the Spleen

The Spleen: Deficiency and Excess, Part Two (On Pulse Diagnosis, Prescriptions, and Moxibustion)

Excess Heat in the Spleen

If the pulse at the right wrist’s middle position is predominantly Yin and forceful, this indicates excess heat in the Foot Taiyin Spleen Channel. The patient may feel cold in the feet and heat in the calves, with abdominal fullness and distention, restlessness, and difficulty sleeping. This condition is called “excess heat in the Spleen.”

Heat-draining decoction: For stiffness at the root of the tongue, or singing and playing music in one’s dreams, accompanied by heaviness in the body and difficulty walking.

Qianhu, Poria, gentian, asarum, and mirabilite (three liang each); apricot kernels (four liang); xuanshen and daqing (two liang each); and chopped bitter bamboo leaves (one sheng).

Coarsely cut the nine ingredients. Decoction in nine sheng of water until three sheng remain. Divide into three doses and take after meals.

Prescription for spleen heat with a yellow complexion, red eyes, and distending pain along the ribs:

Pinellia, mother ginger (eight liang each); immature bitter orange, gardenia, Poria, and mirabilite (three liang each); asarum (five liang); atractylodes and apricot kernels (four liang each); and fresh rehmannia root and chopped light bamboo leaves (one sheng each).

Coarsely cut the eleven ingredients. Decoction in nine sheng of water until three sheng remain, then strain out the dregs. Add the mirabilite and divide into three doses.

Treatment for “spleen crosswise”:

If red-black patches about the size of a fingernail appear on the skin, warm sheep fat and rub it onto the affected area.

Another prescription: Grind red adzuki beans into powder, mix with egg white, and apply to the affected area.

If the limbs alternately become hot and cold, the lower back aches, the body cannot bend forward or backward, the complexion turns yellow, the abdomen becomes distended, food is vomited after eating, and the root of the tongue becomes stiff, apply moxibustion above the eleventh vertebra (counting down the spine from the top) and at points one cun and five fen to either side, for three points in all. Apply seven cones of moxa at each point, each cone burned once.

Excess in Both the Spleen and Stomach

If both Yin and Yang pulses at the right wrist’s middle position are forceful, this indicates excess conditions in both the Foot Taiyin Spleen Channel and the Foot Yangming Stomach Channel. The patient may experience distention in the Spleen and hardness in the abdomen, with pain pulling from beneath the ribs. Stomach Qi fails to move freely, and bowel movements become difficult, though diarrhea may also occur at times. Pain in the abdomen may surge upward and disturb the Lungs and Liver, setting the Qi of the five viscera in motion. This is followed by panting and rumbling sounds; the patient is easily startled, feels feverish but does not sweat, and may also develop a sore, swollen throat and diminished Jing Qi. This condition is called “excess in both the Spleen and Stomach.”

Heat-draining prescription:

Rhubarb, ephedra, and baical skullcap (four liang each).

Almonds, red poria, licorice, tangerine peel, mirabilite, and Alisma rhizome, three liang each.

Chop all nine ingredients. Boil them in nine sheng of water and reduce the liquid to three sheng. Strain out the dregs. Add the rhubarb and decoct it twice more, then strain out the dregs. Add the mirabilite and divide the medicine into three doses.

Rhubarb Heat-Draining Decoction treats disorders caused by reversal in the Spleen pulse: heat in the abdomen, severe pain, a stiff tongue, abdominal distension and heaviness of the body, inability to eat, and acute pain caused when Heart Qi descends into the Spleen.

Cut the rhubarb finely and soak it separately overnight in one and a half sheng of water. Licorice, three liang. Alisma rhizome, poria, scutellaria root, asarum, mirabilite, and tangerine peel, two liang each.

Chop all eight ingredients. Boil them in seven sheng of water and reduce the liquid to three sheng and three ge. Strain out the dregs, add the rhubarb, and decoct twice more. Strain out the dregs, add the mirabilite, and divide the medicine into three doses.

Formula for Spleen heat with pain in the sides, persistent heat and distension, unrelenting redness of the eyes, and cracked, dry lips:

Gypsum, one jin, broken into pieces; fresh Rehmannia juice and red honey, one sheng each; five sheng of chopped bamboo leaves.

Boil the bamboo leaves first in one dou and two sheng of water, reducing the liquid to seven sheng. Strain out the dregs and let it settle until clear. Then decoct the gypsum, reducing the liquid to one sheng and five ge, and strain out the dregs. Add the fresh Rehmannia juice and bring it to a boil twice. Then add the red honey and simmer until the liquid is reduced to three sheng. Take in small amounts over several doses.

Formula for Spleen heat concentrated on one side, fullness and oppression in the chest, and distension on one side of the ribs:

Poria, tangerine peel, and Alisma rhizome, three liang each; peony root and Atractylodes rhizome, four liang each; ginseng and cinnamon bark, two liang each; gypsum, eight liang; pinellia, six liang; sliced fresh ginger, one sheng; and one sheng of white mulberry root bark.

Chop all eleven ingredients. Boil them in one dou and two sheng of water, reducing the liquid to three sheng. Strain out the dregs and divide the medicine into three doses. If stronger purgation is needed to promote evacuation, add two liang of mirabilite.

Spleen Deficiency-Cold

When the right guan pulse, the pulse position on the right side of the wrist, is deficient in Yin, this indicates the Foot Taiyin Spleen channel. The patient may have diarrhea, abdominal distension, rebellious Qi, cholera-like vomiting and diarrhea, vomiting, jaundice, restlessness, inability to sleep peacefully, or intestinal rumbling. This is called “Spleen Deficiency-Cold.”

Formula for deficiency distension, pain in the sides, and shortness of breath that occurs in episodes:

Wujia root bark, Salvia miltiorrhiza, and tangerine peel, one jin each; Chinese wolfberry root bark, dried ginger, and white atractylodes, eight liang each; pig-pepper root bark, two jin; dried Rehmannia root, Ligusticum chuanxiong (also called Sichuan lovage), and aconite, five liang each; cassia bark and balloonflower root, four liang each; fifty jujubes; and three liang of licorice.

Cut the fourteen ingredients into pieces and soak them in four dou of wine for five to seven days. Take seven or eight he each time, gradually increasing to one sheng. Take twice daily.

Areca Powder: Used to treat weakness and coldness of the Spleen and Stomach, poor digestion, fatigue and drowsiness, abdominal distention and belching, tightness and fullness in the chest and abdomen, and distress or irritability accompanied by a low mood.

Eight areca nuts, using both the husks and kernels; two liang each of ginseng, poria, aged fermented grain (old wine starter), magnolia bark, malted wheat, Evodia fruit, and white atractylodes.

Grind the eight ingredients into a fine powder. After meals, take it with wine, one square-inch spoonful each time. Take twice daily for seven days. Another formula adds one and a half liang of tangerine peel.

Warming Spleen Pill: Used to treat weakness and emaciation after a prolonged illness, Spleen Qi deficiency, poor digestion, and frequent belching.

One liang each of phellodendron bark, malted barley, Evodia fruit, cassia bark, dried ginger, asarum, aconite, Chinese angelica, rhubarb, fermented grain (wine starter), and coptis.

Grind the eleven ingredients into powder and make pills with honey, each the size of a parasol tree seed. Take fifteen pills on an empty stomach with wine, three times daily.

Hemp and Bean Powder: Used to treat Spleen Qi deficiency and inability to eat. It may be taken with meals.

Two sheng of yellow soybeans and three sheng of hemp seeds, dry-fried until fragrant.

Grind the two ingredients into a fine powder and mix with a drink. Take one he each time, four or five times daily; adjust the amount as needed.

Deficiency of Both Spleen and Stomach

If the pulse at the right guan position is deficient under both light and deep pressure, this indicates deficiency of the Foot Taiyin Spleen channel and the Foot Yangming Stomach channel. The patient may feel as if the stomach is empty, have shortness of breath and inadequate respiration, cold and numb limbs, and persistent diarrhea. This is called “deficiency of both Spleen and Stomach.”

Formula for treating abdominal distention, belching, nausea after eating, loose watery stools, dry mouth, heavy limbs, irritability, unwillingness to listen to others, poor memory, and obstruction in the throat:

One liang of coptis, two liang of limonite, and white atractylodes...

Use fresh ginger, hemp seeds, and mulberry root bark in doses of three, five, and eight liang respectively, along with twenty jujubes. Cut the seven ingredients into small pieces, boil them in one dou and two sheng of water until three sheng of liquid remain, and take in four portions.

Remedy for Deficiency of Both Spleen and Stomach, with Frequent Hunger and Cold Pain

Use three liang each of ginseng, angelica, cinnamon bark, poria, platycodon root, and chuanxiong; two liang each of magnolia bark, licorice, tangerine peel, and evodia; five liang of atractylodes; and one sheng of malted wheat. Cut the twelve ingredients into small pieces, boil them in one dou and two sheng of water until three sheng of liquid remain, and take in three portions.

Atractylodes Powder: Remedy for Deficiency and Coldness of Both Spleen and Stomach

Use three liang each of atractylodes, magnolia bark, ginseng, evodia, poria, malted wheat, fermented grain, and chuanxiong. Grind the eight ingredients into a fine powder. Take it with wine, one fangcun spoonful (an ancient measure for powdered medicine, roughly a spoonful), after meals, three times a day. Another version adds areca peel and tangerine peel.

Pingwei Pills

People who feel heavy in the body, cannot eat, cannot taste their food, feel emptiness and distension below the heart, often feel the urge to defecate, and like to lie down may receive acupuncture at the stomach tube (the epigastric region, also called the Great Granary) and take Jianzhong Decoction together with this remedy. The recipe for Jianzhong Decoction appears in another volume.

Use fifty almonds, three liang of red sage, two liang each of bitter ginseng, pepperweed seed, and scrophularia, and one liang each of chuanxiong and cinnamon bark. Grind the seven ingredients into a fine powder and mix with honey to make pills the size of parasol tree seeds. Take five pills with wine, three times a day, until the symptoms improve.

Another Remedy

For adults and children with food stagnation, indigestion, or disharmony of Stomach Qi, as well as fever, heat bind, or difficulty passing stool and urine. For cold-pattern conditions, take Lusu Pills. After taking warming medicines, follow with these pills to regulate Stomach Qi.

Use two liang of rhubarb, one liang each of small herb, licorice, peony, chuanxiong, and pepperweed seed, and fifty almonds. Grind the seven ingredients into a fine powder and mix with honey to make pills the size of parasol tree seeds. Take five pills with a drink, three times a day. A one-year-old child should take two pills, with the dose gradually increased. The version recorded in the Qianjin Yifang adds calamus, angelica, dried ginger, poria, dwarf lilyturf root, and asarum, making thirteen ingredients in all, and omits the almonds.

Discussion: When food remains in the upper stomach, it should be expelled by inducing vomiting. A rapid, slippery pulse indicates that the condition is predominantly excess. If undigested food has accumulated, purging it downward should bring improvement.

When pi (a pathogenic accumulation of fluids or food) is present in the stomach, eating cold food causes pain, while eating hot food makes one want to eat. People with abdominal distension and undigested food may develop chills and fever, like an attack of malaria. When undigested food remains in the lower abdomen, fever often appears in the evening and subsides the following morning.

A tight pulse at the cun position may indicate headache, exposure to wind and cold, or undigested food in the abdomen. A tight pulse at the cun kou position, feeling like a cord turning beneath the fingers and shifting from side to side, indicates undigested food in the Spleen and stomach. A floating, large pulse at the cun kou position that becomes rough under deeper pressure, together with a fine, faint, rough pulse at the chi position, indicates undigested food.

Great Qu and Nie Pill: This formula aids the digestion of grains and stops diarrhea; its nature is mild and warm. People with a cold constitution may also take it long term; it is said to prevent cholera. The ingredients are:

Barley malt and qu (fermented grain starter), one sheng each; aconite, dried ginger, Chinese angelica, and ginseng, three liang each; red halloysite, one liang; platycodon and nüwei, two liang each; Chinese evodia and zhu jia, five liang each; Sichuan pepper, two and a half liang; and fifty Chinese plums.

Grind the thirteen ingredients into a fine powder. Soak the plums overnight in a mixture of equal parts honey and vinegar, then steam them on three dou of cooked rice. Remove the pits and mash the plums into a paste. Combine the paste with the medicinal powder and honey, and pound the mixture three thousand times to make pills. Take ten pills three times a day. For a more severe condition, add three liang each of dragon bone, donkey-hide gelatin, and mugwort leaf.

Food-Digesting, Diarrhea-Stopping Pill: People with a cold constitution may take this regularly to aid digestion and stop diarrhea. The ingredients are:

Qu and barley malt, one sheng each; Chinese evodia, four liang.

Grind the three ingredients into a fine powder and mix with honey to form pills. Take fifteen pills, each about the size of a wutong seed, three times a day.

Dried Ginger Powder: For inability to eat, with mental confusion and forgetting to eat. The ingredients are:

Dried ginger, prepared qu, Sichuan pepper, fermented soybeans, and barley malt, one sheng each.

Combine the five ingredients, grind them finely, and sift. After meals, take three fangcun spoonfuls (about three square inches of powder) three times a day, until the ability to eat returns.

Food-Digesting Pill: For inability to eat lasting many years. The ingredients are:

Wheat malt and qu, one sheng each; dried ginger and Chinese plums, four liang each.

Grind the four ingredients into a fine powder and mix with honey to form pills. Take fifteen pills twice a day, gradually increasing the dose to four…

Take ten pills. Those with cold in the chest, retching, or nausea and churning in the heart will recover after taking them.

Qu and Nie Powder (Qu and Nie are fermented grain starter and malt): This formula aids digestion and appetite, and dispels fluid in the intestines and abdominal distension.

Ingredients: five liang each of Shenqu, malt, and almonds.

Grind the three ingredients into a fine powder. After meals, take one he of the powder with wine, three times a day.

The Third: Spleen Taxation (Discussion and Formulas)

Discussion: In cases of spleen taxation, the Lung Qi should be strengthened to support the Spleen. When Lung Qi is vigorous, it can respond to and support the Spleen. Thus, the sages nourished Yang Qi in spring and summer, and Yin Qi in autumn and winter, so that the practice of nurturing life followed its proper foundation. The Liver and Heart belong to Yang; the Spleen, Lungs, and Kidneys belong to Yin. Going against the foundations of Yin and Yang damages the foundation of life. Yin-Yang and the four seasons are the fundamental pattern by which all things pass from ending to beginning.

Pinellia Decoction: Used for excess patterns of spleen taxation, marked by weakness in the limbs, disordered function of the five organs, abdominal distension, rapid and labored breathing, and short, uneasy breaths. This formula promotes bowel movements and expels excess Heat.

Ingredients: eight liang each of pinellia and dried ginger; three liang each of poria, atractylodes, and almonds; twenty jujubes; one sheng of chopped bamboo leaves; and four liang each of tangerine peel and peony.

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

Digestive Paste Wine: Used for Spleen deficiency with Cold, taxation and damage, Qi distension, fullness after eating with belching, and difficulty swallowing food. It also helps belching to pass freely.

Ingredients: three sheng of pork fat, five sheng of dried ginger juice, one sheng of Evodia, and one jin of atractylodes.

Grind the Evodia and atractylodes into a fine powder. Gradually add them to the ginger juice and pork fat, and simmer until six sheng remain. Take one fangcunbi (an ancient measure for powdered medicine, approximately one spoonful) with one sheng of warm, clear wine, twice a day.

The Fourth: Flesh Exhaustion (Discussion and Formulas)

Discussion: Flesh exhaustion is primarily associated with the Spleen. The Spleen corresponds to the muscles; when the Spleen is ill, the muscles change color. It is also said that when the Qi of Ultimate Yin is afflicted, it gives rise to muscle impediment (numbness and aching pain in the muscles). If the impediment persists, and the person is then exposed to an external pathogen, the pathogen lodges in the Spleen. The person may feel itchy, as though mice were crawling over the body; body fluids are depleted, the skin’s interstices (its texture and pores) open, sweating becomes profuse, and the tip of the nose turns yellow. These are the corresponding symptoms. When Wind pathogen lodges in the skin, it causes the muscles to lose their proper color. Exposure to Wind on a Wu or Ji day in the last month of summer gives rise to Spleen Wind. Its manifestations include profuse sweating, Yin…

When attacked by cold pathogens, the cold can weaken the body. As the body weakens, one feels heavy and tired, does not want to lift the limbs, and loses the appetite. Eating brings on coughing; when coughing, there is pain below the right ribs that faintly pulls toward the shoulder and back, and the body cannot turn. This condition is called “Severe Wind.” It is a case of internal deficiency with an outward appearance of excess.

When Yang activity becomes excessive and generates heat, the heat can make the body tend toward an excess condition. The patient feels as though mice are crawling over the body; the lips and mouth become damaged, the skin changes color, the body’s fluids are depleted, the pores open, and profuse sweating occurs. This condition is called “Adverse Wind.” In treatment, one should identify the main features and course of the illness, as well as Yin and Yang, movement and stillness, and whether the muscles are deficient or excessive: use draining methods for excess and supplementing methods for deficiency. Those who can cure this illness treat it promptly, while the Wind pathogen has only just entered the spaces between the muscles, hair, skin, and sinews and vessels. If it has already entered the six bowels or five organs, the condition is dangerous.

Bian Que said, “When the vitality of the muscles is cut off, the condition cannot be treated, and the patient will die within five days. How can this be recognized? The skin is obstructed, and pathogenic influences on the body’s surface cannot be expelled. The muscles depend on the Qi of the Foot Taiyin channel—the channel associated with the Spleen—for nourishment. When the Qi of the Foot Taiyin channel is exhausted, it can no longer nourish the muscles. Inverted lips are a sign that Qi has been depleted and the muscles are about to decay first. Even with a renowned physician and excellent medicine, the condition cannot be cured.”

For treating excessive heat in the muscles, numbness of the skin, the sensation of mice crawling over the body, depletion of body fluids, open pores, profuse sweating, and Wind impediment—numbness, pain, and related disorders caused by Wind pathogens—the method is as follows: when a Wind pathogen is lodged in the skin, the muscles lose their healthy color and the nose turns yellow. Ma Huang can be used to stop sweating and open the muscles.

Decoction for Dispersing Wind Impediment

Ma Huang, Fang Ji (another text gives “Fang Feng”), Zhi Shi, Xi Xin, and Bai Zhu, three liang each; fresh ginger and Fu Zi, four liang each; Gan Cao and Gui Xin, two liang each; Shi Gao, eight liang.

Cut the ten ingredients into pieces. Boil Ma Huang in nine sheng of water and skim off the foam. Add the remaining ingredients and continue boiling until three sheng of liquid remain. Divide into three doses and take them.

Life-Sustaining Decoction

Used to treat extreme muscle weakness with deficiency heat, numbness of the skin and the sensation of mice crawling over the body, leakage of body fluids, or numbness with impaired sensation and painful stiffness of the limbs.

Ma Huang and fresh ginger, three liang each; Dang Gui and Shi Gao, two liang each; Chuan Xiong, Gui Xin, Gan Cao, Huang Qin, Fang Feng, and Shao Yao, one liang each; forty Xing Ren.

Cut the eleven ingredients into pieces. First boil Ma Huang in nine sheng of water and skim off the foam. Add the remaining ingredients and continue boiling until three sheng of liquid remain. Strain out the dregs and divide into four doses. Take twice daily.

Lesser Maidservant Decoction (Yuebi Tang) is used to treat heat syndromes caused by “extreme flesh.” When heat is intense, the body’s fluids are depleted, the skin’s interstices—the texture of the skin and its pores—open, and sweat pours out in great quantities. A prescription for treating “great wind qi” entering the lower burner and causing weakness in both feet is found in another volume.

Southernwood Powder (Shinan San) is used to treat symptoms caused by an excess of heat in the flesh: a sensation on the body’s surface as if mice were crawling over it, or symptoms resembling wind impediment, in which wind evil invades, causing numbness, pain, and impaired movement in the limbs; damage to the lips and mouth; and changes in skin color. This prescription treats severe forms of various wind disorders.

Thirty zhu of southernwood; one liang each of Chinese yam, peony (another edition reads licorice), monkshood, peach blossom (one edition reads peach kernel), and wild chrysanthemum flower; eighteen zhu of astragalus; one liang and eighteen zhu of cornus fruit; eighteen zhu of genuine pearl; two liang of gypsum; and one and a half liang each of cimicifuga and fragrant Solomon’s seal. Grind these twelve ingredients into a coarse powder and sift. Take it with wine, one square-inch spoonful at a time—the ancient measure for medicines, roughly one spoonful—twice daily after meals.

Major Astragalus Wine (Da Huangqi Jiu) is used to treat deficiency-cold syndromes caused by extreme flesh. Symptoms include wind impediment, with numbness, pain, and impaired movement; Yin qi stirring and damaging the body; heaviness, fatigue and reluctance to move, unwillingness to lift the limbs, joint pain, and loss of appetite. These symptoms all arise from severe depletion.

Three liang each of astragalus, cassia bark, morinda root, dendrobium, alisma, poria, arborvitae seed, dried ginger, and Sichuan pepper; three liang each of saposhnikovia, angelica pubescens, and ginseng; and one liang each of monkshood, peony, aconite, Sichuan aconite, Japanese yew, trichosanthes root, cornus fruit, pinellia, asarum, atractylodes, and scutellaria. Cut these twenty-three ingredients into pieces and place them in a silk bag. Soak the bag in three dou of clear wine for seven days in autumn and winter, or three days in spring and summer. Take three he at first, then gradually increase the dose until the body feels slightly numb. Take twice daily.

Another prescription treats deficiency-cold of extreme flesh. After a sudden wind-stroke, the jaw may clamp shut and speech become impossible; the limbs may grow limp and weak, or one side of the body may become stiff and painful. The condition may also involve Qi affecting the five viscera, a dazed spirit, erratic changes between joy and anger, and hands and feet that will not obey.

Three liang each of angelica pubescens, Japanese yew, and scutellaria; two liang each of licorice, saposhnikovia, peony, ligusticum, ephedra, and kudzu root; one liang of ginseng; and three pieces of Sichuan aconite. Cut these eleven ingredients into pieces, add one dou of water and four sheng of bamboo sap, and decoct them together.

Take four sheng, divided into four doses: three during the day and one at night. Here, “four sheng” refers to an ancient unit of capacity; its precise modern equivalent varies according to the period and the measuring vessel used.

Essential Prescriptions Worth a Thousand in Emergencies by Sun Simiao, fascicle 47.