《孫真人備急千金要方》Vol. 53

“Prescriptions for the Stomach Viscera: Difficulty Swallowing and Obstruction, Chapter Six: Discussion of Prescriptions” concerns disorders involving difficulty swallowing and their remedies.

Revised by Lin Yi and others, who held the Song-dynasty posts of Court Gentleman for Court Audiences, Acting Vice Minister of the Court of Imperial Sacrifices, and Collator at the Institute for the Advancement of Literature.

Five Obstructions Pills are used for long-term cold in the chest, vomiting, rebellious Qi, difficulty swallowing food and drink, and Qi binding that does not disperse.

The Records of Proven Formulas, Ancient and Modern says that the “five obstructions” are Qi obstruction, grief obstruction, overexertion obstruction, food obstruction, and rumination obstruction. With Qi obstruction, the patient experiences palpitations and an impeded flow of breath, with belching and hiccups that do not ease, and pain in the chest and flanks. With grief obstruction, cold, overcast weather brings rebellious Qi, fluttering beneath the heart, and cold hands and feet. With overexertion obstruction, the movement of Qi is blocked, the area beneath the flanks feels distended and full, the chest feels obstructed, and the hands and feet are cold and difficult to warm. With food obstruction, no matter how much the patient eats, the chest feels blocked and often painful; breathing may even become difficult. With rumination obstruction, the patient has palpitations, is prone to forgetfulness, and sees unclearly. These symptoms all arise from grief, resentment, anger, or cold Qi surging upward into the chest and flanks.

The ingredients are dried ginger, Sichuan pepper, Sichuan evodia, cinnamon bark, and ginseng (five fen each); asarum, atractylodes, poria, and aconite (four fen each); and dried tangerine peel (six fen). Grind the ten ingredients into a fine powder and mix with honey to form pills the size of Chinese parasol tree seeds. Take three pills with wine three times a day. If the symptoms do not ease, gradually increase the dose to ten pills each time.

Another formula is used for the five kinds of Qi obstruction.

The ingredients are ginseng, pinellia, cinnamon bark, saposhnikovia (some versions say siler), polygala, aconite, asarum, and licorice (two liang each); aster, dried ginger, Sichuan evodia, peony, and monkshood (six fen each); and immature bitter orange (one liang). Grind the fourteen ingredients into a fine powder and use honey to form pills the size of Chinese parasol tree seeds. Take five pills with wine three times a day. If the symptoms do not ease, increase the dose to fifteen pills each time. Monkshood and pinellia have opposing properties and should not be used together, so one of them should be removed when combining the ingredients.

Bamboo Skin Decoction is used for obstruction that causes loss of voice.

The ingredients are bamboo skin (bamboo leaves may also be used) and asarum (two liang each); licorice, fresh ginger, tetrapanax pith, ginseng, poria, ephedra, schisandra, and cinnamon bark (one liang each).

Chop the ten ingredients. Boil the bamboo bark in one dou of water until the liquid has reduced by two sheng. Remove the bark, add the medicines, and continue boiling until three sheng of decoction remain. Divide into three doses.

Dried Ginger Decoction: A prescription for food sticking in the throat when swallowed. (The Collected Prescriptions calls it “Pinellia Decoction.”)

Four liang each of dried ginger and gypsum; two liang each of trichosanthes root (identified as “platycodon root” in the Collected Prescriptions), ginseng, and cassia bark; one sheng each of pinellia and wheat; two sheng of evodia; one liang of licorice; and thirty red azuki beans.

Chop the ten ingredients. Boil twenty jujubes in five sheng of wine and one dou of water. Strain out the solids, add the medicines, and continue boiling until three sheng of decoction remain. Divide into three doses.

Qi-Opening Decoction: A prescription for fullness and distention in the chest, impaired breathing, and food sticking in the throat.

Eight liang of pinellia, six liang of fresh ginger, three liang of cassia bark, and thirty jujubes.

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

Antelope Horn Decoction: A prescription for obstructed breathing and inability to eat.

Two liang each of antelope horn, tetrapanax pith, and tangerine peel; three liang each of magnolia bark, evodia, and dried ginger; and five aconite tubers.

Chop the seven ingredients. Boil them in nine sheng of water until three sheng of decoction remain. Divide into three doses, taking them three times a day.

Another prescription:

Three liang each of apricot kernels and cassia bark.

Grind the two ingredients into a fine powder and mix with honey to make pills the size of jujubes. Swallow them slowly. For best results, hold one in the mouth for a while just before eating.

A prescription for sudden choking:

Take a mouthful of honey. The blockage will clear.

Another prescription: Pick up a grain of leftover rice from the rim of a rice bowl and eat it. The blockage will clear.

Another prescription: Scrape the fine bran from the head of a rice-pounding pestle, hold it in the mouth, and the blockage will clear. This is said to be very effective.

A prescription for various kinds of choking:

Regularly eat dry cooked non-glutinous rice, and you will not choke.

Another prescription: Grind charcoal into powder, mix it with honey to make pills the size of a pellet, then hold a little in the mouth and swallow slowly. The blockage will clear.

Another prescription: Take an amount of an old ox’s saliva about the size of a jujube pit and swallow it with water. You will never choke again.

Discussion: Treatment should always be chosen according to the cause and symptoms of the illness. For example, when treating something lodged in the throat, how could one use a cormorant to treat a bone stuck there simply because it is said to help with bones in the throat? Or use a wildcat or tiger to treat a fish bone simply because they are said to help with fish bones? As for bamboo strips…

“Chop” here means cutting or pounding the medicinal ingredients to make them easier to decoct. The units “sheng,” “liang,” and “piece,” among others, are ancient measures.

After chewed Chinese chive bulb (the bulb of the chive, shaped like a small garlic clove) has been crushed, it can be used with tendon, cotton, honey, and similar materials to treat all kinds of blockages in the throat.

Methods for treating various blockages

Soften deer tendon in water, bring it together, and twist it into a cord. Shape it into a pellet. Tie a thread to one end of the tendon. Holding the end, swallow the tendon and guide it to the blockage in the throat, then slowly pull it out. The lodged object will stick to the tendon and come out with it.

Another method: Scrape a bamboo strip until it is smooth and clean, wrap it in cotton, and insert it into the throat, guiding it to the blockage. Move it back and forth and pull it out; the lodged object will come out with it.

Another method: Take two liang of cotton and heat it in honey. Apply the hot cotton externally over the site of the blockage, then press a warmed gourd against the cotton to heat it. If the object still has not been removed, boil another piece of cotton and replace the first. At the same time, blow a small amount of powdered Chinese honey locust into the nose to induce sneezing; the lodged object will then come out. The Zhouhou Fang says this method can treat blockages that have remained for a hundred days without being expelled.

Another method: Boil a Chinese chive bulb until half cooked and chew it lightly. Tie a thread around its middle. Holding the thread, swallow the bulb and guide it to the blockage, then pull on the thread; the lodged object will come out.

Methods for treating throat blockages

Take one square-spoon measure of powdered tiger bone or powdered raccoon-dog bone.

Another method: Take one square-spoon measure of powdered fringed pink.

Methods for treating fish bones stuck in the throat

Take one square-spoon measure of cormorant droppings.

Another method: Say aloud, “Cormorant, cormorant,” and the fish bone will go down.

Another method: Drink tangerine-peel decoction.

Another method: Drink brown-sugar water.

Another method: Burn a fishing net to ash and take one square-spoon measure. The Bixiao Fang says that if you cover your head with a fishing net, the fish bone will go down.

Treatment for a bone stuck in the throat when many methods have failed

Roll maltose into a ball the size of an egg yolk and swallow it. If the bone has not come out, swallow another, larger ball, gradually increasing the size, up to ten balls at most.

Another method: Burn tiger or wolf dung and take it.

Another method: Swallow a piece of pork fat the size of an egg. If that does not work, keep swallowing more until the condition is cured.

Method for when hair is swallowed with food, becomes tangled in the throat, and cannot be swallowed down

Burn the tangled hair to ash, grind it to powder, and take one qian-spoon measure with wine.

Method for treating swallowed coins

Take five liang of mugwort, add five sheng of water, and boil until one sheng remains. Drink it all at once; the coin will be expelled.

Another method: Drink two sheng of honey, and the coin will come out.

Another method: Grind charcoal to powder and take one square-spoon measure with wine. Water may also be used.

Method for treating swallowed gold or silver earrings or hairpins

Take two jin of white sugar and eat it all slowly at one time; the more you eat, the better.

Another method: Swallow one liang of mercury, then take another dose afterward.

Accidental swallowing of earrings or door-pivot pins

(The text provides only the heading here and gives no specific treatment.)

Burn fourteen goose feathers to ash, grind them into powder, and take it; goose down may also be used.

Remedy for accidentally swallowing a hairpin

Let the chives wilt, steam them until cooked, and eat the whole bunch without cutting it up. The hairpin will then come out. Raw chives may also be used.

Wheat leaves and the fibrous strands on wheat stalks, which resemble chive leaves, can be used in the same way, but eat as much as possible.

The hairpin will then pass out on its own.

Remedy for accidentally swallowing copper or iron that becomes lodged in the throat

Heat the copper trigger of a crossbow until red hot, put it into wine, and then drink the wine. It is said to cure the condition immediately.

Remedy for accidentally swallowing a nail, needle, arrowhead, or similar object

Eat plenty of fatty meat until full, so that the object is enclosed and passes out.

Remedy for accidentally swallowing a needle

Take a sewing needle and use a lodestone, a naturally magnetic mineral, to attract it. Grind the lodestone into powder and take one square-inch spoonful each time; the needle will pass down and out. (From Collected Proven Remedies from Past and Present.)

Collected Proven Remedies from Past and Present also says: if the swallowed needle is still in the throat, taking lodestone powder will cause it to enter the abdomen. If the lodestone is held in the mouth or used to attract the needle, the needle can be drawn out.

Distention and Fullness, Seventh (On abdominal distention and fullness: discussion, formulas, and moxibustion)

The discussion says: When a patient’s abdomen is distended and full but does not hurt when pressed, the condition is deficient; if it hurts when pressed, the condition is excess. When abdominal distention persists without easing and does not clearly worsen, it should be treated with purgation. If the tongue coating is yellow and the bowels have not yet been purged, purgation is also indicated; afterward, the yellow coating will fade on its own.

When abdominal distention comes and goes, then returns to its usual state, this is a cold condition and should be treated with warming medicines. If distention occurs together with a bitter, dry mouth and fluid accumulating in the abdomen, and the Fuyang pulse at the top of the foot is weak and somewhat wiry, abdominal distention would ordinarily be expected. If there is no distention, the lower passage may be obstructed, making the stool difficult to pass. Pain beneath both sides of the ribs indicates deficient cold Qi rising from below and should be treated with warming medicines. If abdominal distention turns to pain and moves toward the lower abdomen, this may mean that spontaneous diarrhea is imminent. (Another version says: if there is abdominal pain and Qi shifts downward toward the lower abdomen, spontaneous diarrhea may be imminent.)

Warming Stomach Decoction

Treats disharmony of Stomach Qi, frequent abdominal distention, coughing, and inability to eat.

Aconite, Chinese angelica, magnolia bark, ginseng, tangerine peel, peony, and licorice, one liang each; dried ginger, five fen; Sichuan pepper, three he.

Cut the nine ingredients into pieces. Decoct them in nine sheng of water until three sheng remain, and take the decoction in three doses.

Major Pinellia Decoction

Treats deficient cold in the Stomach, abdominal distention and blockage, and directs Qi downward.

One sheng of pinellia and twenty jujubes; licorice, aconite, Chinese angelica, ginseng, magnolia bark, poria, and immature bitter orange, two liang each.

Cinnamon bark (five liang), fresh ginger (eight liang), and Sichuan pepper (two hundred peppercorns).

Chop the ingredients and boil them in one dou of water. Reduce the liquid to three sheng, then divide it into three doses.

Aconite and Polished Rice Decoction: Used to treat cold in the abdomen, with fullness and distension, rumbling intestines and intermittent pain, counterflow of Qi with distension and fullness in the chest and flanks, and vomiting.

Aconite (one piece), pinellia and polished rice (half a sheng each), licorice (one liang), and jujubes (ten).

Chop the five ingredients and boil them in eight sheng of water until the rice is cooked. Strain out the dregs. Take one sheng per dose, three times a day. The Jiyan Fang records that two liang of dried ginger may be added.

Magnolia Bark Seven-Ingredient Decoction: Used to treat abdominal fullness and distension from Qi. Zhongjing says this formula is for cases of abdominal fullness accompanied by fever for several dozen days, with a floating and rapid pulse and normal appetite.

Magnolia bark (half a jin), licorice and rhubarb (three liang each), jujubes (ten), immature bitter oranges (five), cinnamon bark (two liang), and fresh ginger (five liang).

Chop the ingredients and boil them in one dou of water. Reduce the liquid to five sheng, strain out the dregs, add the rhubarb, and continue boiling until the liquid is reduced to four sheng. Take eight he per dose, three times a day. If there is retching, add five he of pinellia. If there is diarrhea, omit the rhubarb. If cold signs are pronounced, increase the fresh ginger to half a jin.

Magnolia Bark Three-Ingredient Decoction: Used to treat abdominal fullness and fever lasting several dozen days, with a floating and rapid pulse and normal appetite.

Magnolia bark (half a jin), rhubarb (four liang), and mature bitter oranges (five large ones).

Chop the ingredients and boil them in one dou and two sheng of water. Reduce the liquid to five sheng, add the rhubarb, and boil until reduced to three sheng. Strain out the dregs and take one sheng per dose. If there is a rolling sensation in the abdomen, stop taking it; if there is no rolling sensation, continue. Another version adds two liang of mirabilite.

Evodia Decoction: Used to treat counterflow of Qi with distension and fullness in the chest and flanks, and inability to eat, caused by long-standing cold.

Evodia, pinellia, and wheat (one sheng each), licorice, ginseng, and cinnamon bark (one liang each), jujubes (twenty), and fresh ginger (eight liang).

Chop the eight ingredients and boil them in five sheng of wine and three sheng of water. Reduce the liquid to three sheng, then divide it into three doses.

This passage records medicinal formulas and moxibustion therapies for treating chest and abdominal distension from Sun Simiao's Essential Prescriptions Worth a Thousand Gold (Qianjin Yaofang) of the Tang Dynasty. The first part presents two herbal formulas:

The first formula, called Great Cinnamon Decoction (Da Gui Tang), treats physical weakness with emaciation and chest distension. It combines one jin each of cinnamon bark (rougui) and fresh ginger, one sheng of pinellia rhizome (banxia), and four liang of astragalus root (huangqi). After chopping these four ingredients, boil them in 1.5 dou of water until reduced to five sheng. Divide into five doses—three taken during daytime and two at night.

The second formula addresses sudden exhaustion-induced internal injury in men, presenting with abdominal distension after wind exposure with sweating, loss of appetite, heart pain, dark yellow or clear urine, and difficult bowel movements. Equal parts of rhubarb root (dahuang), lepidium seed (tinglizi), gypsum (hanshuishi), sophora root (kushen), coptis root (huanglian), and trichosanthes root (gualougen) are ground into powder, mixed with honey to form pills, and taken with fermented soybean juice. Begin with two wutong seed-sized pills three times daily, gradually increasing to ten pills.

Detailed moxibustion methods for different types of distension follow:

• For abdominal fullness: Apply 100 moxa cones (zhuang) at Geshu (BL17, 1.5 cun lateral to the seventh thoracic vertebra), divided into three sessions
• For chest and abdominal distension with pain: Apply 100 cones at Ganshu (BL18, below ninth thoracic vertebra) similarly in three sessions
• For edema with distension: Moxibustion at Pishu (BL20, below eleventh thoracic vertebra), with cone count adjusted by patient's age
• Special mention goes to "food stagnation" disorder (shihui): abdominal distension radiating to spinal pain despite voracious eating with emaciation—first moxa Pishu, then the lateral abdomen
• Specific techniques and contraindications are recorded for moxibustion at Dachangshu (BL25), Zhongwan (CV12, three cun below xiphoid), Qihai (CV6, one cun below navel), Bladder Mu (Zhongji CV3), and Tianshu (ST25, two cun lateral to navel)

The conclusion describes cold syndrome diagnostics: frequent yawning with clear nasal discharge, normal complexion but sneezing indicates cold invasion; accompanying diarrhea reveals internal deficiency-cold. All these conditions can be treated with the above methods.

Anyone who cannot sneeze will have pain in the abdomen. A deep, wiry pulse in a person with a cold condition, or a wiry pulse in both hands, indicates a cold pattern. The wiry pulse feels like a tightly drawn bowstring and does not shift when pressed. If the pulse is rapid and wiry, cold pathogens should be purged downward. If the pulses in both hands are wiry and slow, the area below the heart, at the pit of the stomach, will be hard. A large, tight pulse indicates that a Yin pathogen is present within the Yang aspect and may be treated with purgation.

A wiry pulse at the right wrist’s cun position—the section nearest the hand among the wrist’s cun, guan, and chi positions—will cause cramping pain below the ribs, and the patient will often feel cold. The physician says: a slow pulse indicates cold, while a choppy pulse indicates insufficient blood. If the pulse at the cun position is faint and weak, while that at the chi position is tight and choppy, tightness indicates cold, faintness indicates deficiency, and choppiness indicates insufficient blood. This shows that first inducing sweating and then purging will make a person even more deficient.

The Great Cold-Exposure Pill treats various illnesses caused by cold. The prescription appears in Volume Seventeen.

Xiongnu Cold-Exposure Pill: a prescription for treating accumulations of cold

Alum, cassia bark, aconite, and dried ginger, two liang each.

Grind the four ingredients into a fine powder and use honey to form pills the size of Chinese parasol-tree seeds. Take ten pills three times a day, gradually increasing the dose.

Cold-Exposure Pill: for tightness and hardness below the heart after exposure to cold, vomiting, and cold food that does not digest; also for cold pathogens encountered in the morning and evening during a cold-damage illness

Aconite, monkshood, cassia bark, and alum, four liang each.

Grind the four ingredients into a fine powder and use honey to form pills the size of broad beans. Take three pills with wine three times a day, gradually increasing to ten pills. After taking the medicine, the body should be able to withstand cold. Avoid hot food and keep away from fire; cold food and cold drinks are suitable.

A prescription for treating longstanding cold, wind-induced dizziness, invasion by cold pathogens, icy hands and feet, coldness in the stomach area and below the navel, as well as various illnesses and the five strains and seven injuries

This prescription is said to have miraculous effects: it can increase appetite, strengthen the body, replenish strength, and aid fertility.

Three sheng of soybeans, fifteen jin of fresh Rehmannia root (take the juice), and one hundred and fifty aconite roots.

Prepare the three ingredients on a “chu-ri,” a day designated by traditional date-selection methods. Chop the aconite, then soak it in one dou and five sheng of wine together with the fresh Rehmannia juice. Leave it until a “po-ri,” another day designated by traditional date-selection methods, then strain out the medicinal residue. Put the soybeans into the medicinal liquid and remove them on the next chu-ri, then dry them in the sun. If any liquid remains, continue soaking and drying the beans until it has all been used up; the medicine is then ready.

Begin with a dose the size of two soybeans and gradually increase it to twenty beans’ worth, taken with wine. When ill, take it on an empty stomach; when well, take it after meals. It can be prepared in any season, though the second and third lunar months are most suitable. This medicine is said to increase appetite, replenish strength, strengthen the body, and…

The hair turns white and then black again, and lost teeth grow back. Anyone who has previously suffered from a febrile illness must not take this medicine.

A formula for long-standing coldness in the heart and abdomen that has not improved with any treatment

Three sheng of Qu powder, five liang of white atractylodes, three liang of dried ginger, three liang of cassia bark, two liang of Sichuan pepper, and two liang of Wu zhuyu.

Grind the six ingredients into a fine powder and sift it. Take it with rice water, one square-inch spoonful of powder at a time, twice daily. Take no more than five doses; the various symptoms of coldness should then quickly resolve. There are no special restrictions on taking it. Take it on an empty stomach.

A formula for cold illness lasting many years

Two liang of Sichuan pepper and one sheng of fermented black beans.

First pound the Sichuan pepper into powder, mix it with the fermented black beans, and pound the mixture repeatedly, three thousand times, until it can be formed into pills the size of a pellet. Take it with wine before meals, twice daily.

A formula for various severe cold syndromes that even doctors cannot treat

Nine sheng of iris seeds, washed to remove the soil. Take one he of the seeds on an empty stomach, three times daily, with water or wine. Wait a little while after taking it, then eat something to settle the medicine. Stop taking it once the illness has resolved.

Chiyuan: A formula for cold Qi rising counterflow and icy-cold limbs

Four liang of poria, four liang of cassia bark, one liang of asarum, two liang of aconite, two liang of prepared aconite, and one liang of aconite poison, about the size of a Chinese date.

Grind the six ingredients into a fine powder, add pearl powder to adjust the color, and use honey to make pills the size of hemp seeds. Take one pill with wine on an empty stomach, twice daily, and once more at night. If there is still no effect, increase the dose to two pills at a time, stopping when the symptoms cease. An alternative version uses four liang of pinellia and omits the cassia bark.

Pinellia Decoction: A formula for fullness in the chest, stagnant Qi, and coldness in the heart and abdomen

One sheng of pinellia, four liang of cassia bark, and eight liang of fresh ginger.

Cut the three ingredients into pieces and decoct them in seven sheng of water until two sheng remain. Take seven he at a time, three times daily.

Fresh Ginger Decoction: A formula for warming the middle burner and directing Qi downward

One jin of fresh ginger, three liang of licorice, and four liang of cassia bark.

Cut the three ingredients into pieces and decoct them in six sheng of water until one and a half sheng remain. Take five he at a time, three times daily.

Licorice Decoction: A formula for physical weakness and wasting, with faint breathing as if life were about to ebb away

Two liang each of licorice, schisandra, and fresh ginger; one sheng of Wu zhuyu; and one liang of ginseng.

The source text ends here and gives no further instructions for preparation or administration.

Coarsely cut the five ingredients above. Boil the Evodia fruit in four sheng of water. Once the water begins to simmer, strain out the dregs, then add the remaining ingredients and simmer until one sheng and six ge remain. Divide into two doses. The results are better after several consecutive doses.

Evodia and Niter Decoction: Treats prolonged exposure to cold, loss of appetite, and pi yin, a disorder in which fluid accumulates in the body and persists for decades.

Ingredients: Eight ge of Evodia fruit, one sheng of niter, and one jin of fresh ginger.

Put the three ingredients in one dou of wine, then add water to bring the total volume to two dou. Boil down to four sheng and divide into two doses of two sheng each. Stop taking it once the pathogenic matter has been discharged; do not continue the treatment. At first, the discharge resembles rice-rinsing water; later, it resembles mud. If you vomit something frothy or the medicinal dregs, you may take another dose. During treatment, recuperate as carefully as one would care for a nursing mother.

Major Constructing the Middle Decoction: Treats severe pain caused by cold in the chest, heart region, and sides of the ribs, accompanied by vomiting and inability to eat. After swallowing food, one can feel it pass down more on one side, with a gurgling sound. If cold in the abdomen surges upward, the skin bulges as though a head and feet could be seen moving up and down inside the abdomen, accompanied by pain, and the bulge is too tender to touch, this prescription is appropriate.

Ingredients: Two ge of Sichuan pepper, four liang of dried ginger, two liang of ginseng, and one sheng of maltose.

Coarsely cut the first three ingredients and boil them in four sheng of water. When two sheng remain, strain out the dregs, add the maltose, and simmer over low heat until one and a half sheng remain. Divide into three doses. After drinking the decoction, wait about as long as it takes to steam three sheng of rice, then drink roughly two sheng of thin rice porridge before taking the next dose. Eat thin porridge that day and keep warm under the covers.

Major Rhubarb and Aconite Decoction: Treats pain on one side beneath the ribs, fever, and a pulse that is tight and wiry. This is diagnosed as a cold condition and should be treated by purging with warming medicines.

Ingredients: Three liang of rhubarb, three aconite tubers, and two liang of asarum.

Coarsely cut the three ingredients and boil them in five sheng of water until two sheng remain. Divide into two doses.

Discussion: A wiry and tight pulse at the cun kou (the wrist pulse) indicates that the Defensive Qi is not circulating freely; when it is impeded, the person feels cold. A tight pulse indicates loss of appetite. When wiry and tight qualities occur together, they form cold shan, a condition of abdominal pain and related symptoms caused by cold. A floating and slow pulse at the fu yang (the pulse on the top of the foot) indicates wind and deficiency of upright Qi; a slow pulse indicates cold shan.

In a thin and weak person, pain around the navel necessarily indicates wind and cold, which prevent the vital essence of grain from circulating normally. If the condition is instead treated with purging, the cold will surge upward; if it does not surge upward, focal distention will develop below the heart.

Major Aconite Decoction: Treats severe cold shan pain encircling the navel, with cold sweats during attacks …

A Formula for Cold in the Foot Jueyin Channel, with a Deep and Wiry Pulse (which Zhang Zhongjing calls the “Two-Ingredient Aconite Decoction”)

Fifteen aconite roots, stir-fried until black and left whole. Add three sheng of water and boil until one sheng remains. Strain out the herbs, then add two jin of white honey and simmer until the steam has dispersed and about two sheng of liquid remain. A person of strong constitution should take seven ge at a time; someone frail should take five ge. If one dose brings no improvement, take another the next day. Take no more than one dose per day.

Aconite and Cinnamon Twig Decoction: Used to treat hernia caused by severe cold, with symptoms including abdominal pain, coldness and reversal in the hands and feet, numbness and loss of sensation, or pain throughout the body. It is used when moxibustion, acupuncture, and medicines of every kind have failed.

Five dried aconite roots harvested in autumn, full and firm, with their tips removed; one jin of white honey.

Simmer the aconite in the honey until the liquid has reduced by half, then strain out the herbs. Mix the remaining liquid with five ge of Cinnamon Twig Decoction and simmer until about one sheng remains. Take two ge for the first dose. If the pain continues, take three ge more; if it still does not stop, the dose may be increased to five ge. As the condition eases, the person will appear as if drunk. Vomiting indicates that the medicine has taken effect. The formula for Cinnamon Twig Decoction is given in the middle volume of the Treatise on Cold Damage.

The Essential Secrets from Beyond the Realm records another method: boil cinnamon twig in two and a half sheng of water until one sheng remains. Then simmer the cinnamon twig liquid with honey until about one sheng remains, and take it. It also says that the Fan Wang Formula uses Cinnamon Twig Decoction to mix with the aconite decoction given above.

Discussion: Anyone suffering from a severe heat condition should first have their pulse examined. If the pulse is large and forceful and the heat is intense, the medicine should not be given at a fixed dose in every case; the amount should be adjusted to the condition. For an ordinary severe heat condition, the dose may be doubled or tripled. If the heat is especially fierce, it may even be increased tenfold to bring the illness under control.

Some people suffer from heat conditions for a long time because they have taken medicines refined from minerals. No combination of medicines or nourishing treatments can control the condition; only the “Glauber’s Salt Decoction” can bring it to rest. During the Wude era, a nobleman’s teacher called a certain medicine “Metal and Stone Frost,” but that is not what it is. This formula can be made directly from mirabilite, Glauber’s salt, cold-water stone, and gypsum; there is no need to use gold. The nobleman himself added the gold.

Glauber’s Salt Decoction

One jin of mirabilite, eight liang of Glauber’s salt, four liang of cold-water stone, two liang of gypsum, and two liang of gold.

Put the two kinds of salt into eight sheng of hot water and stir until dissolved. Seal the vessel tightly with paper and leave it overnight. Once the sediment has settled, decant the clear liquid into a copper vessel. Separately, pound the cold-water stone…

Break the gypsum (a mineral medicine) into pieces about the size of beans and place them in a silk bag. Put the bag into the medicinal decoction and simmer over low heat. When foam rises to the surface, insert a chopstick. If the foam clings to it and sets like white frost, immediately pour the decoction into a basin. Once it has solidified, remove it and dry it in strong sunlight.

When accumulated heat causes fatigue and distress that are hard to bear, take one square-inch spoonful of white honey (an ancient small spoon, holding about one spoonful of powdered medicine), mix it with one he of honey and five he of cold water, and drink it all at once after it dissolves. Take it three times a day, and stop once the heat has subsided.

Five-Mineral Decoction: Treats heat in the stomach, heat that persists after a febrile illness, restlessness and tightness in the chest, and dry mouth and thirst.

Five fen each of cold-water stone, saltpeter, red stone powder, dragon bone, trichosanthes root, oyster shell, licorice, and baical skullcap; three fen each of anemarrhena, cinnamon twig, and gypsum; two fen of rhubarb.

Coarsely chop the twelve ingredients (the term “fuju” means cutting medicinal materials into coarse pieces suitable for decoction). Boil them in seven sheng of water until three sheng of liquid remain. Divide into four doses: take three doses during the day and one at night. Some versions list only four of the “stone” medicines.

Bamboo Leaf Decoction: Treats heat in the palms and soles, aching and irritation in the hands and feet, dry mouth and lips, and heat in the chest.

One sheng each of bamboo leaves and wheat; three liang each of anemarrhena and gypsum; two liang each of poria, baical skullcap, and ophiopogon; one and a half liang of ginseng; five liang of fresh ginger; one liang each of trichosanthes root, licorice, and pinellia.

Coarsely chop the twelve ingredients. First boil the bamboo leaves and wheat in one dou and two sheng of water until eight sheng remain, then strain out the solids. Add the remaining ingredients and boil until three sheng of liquid remain. Divide into three doses. For elderly people who are frail and for children, divide into five doses.

Pinellia Decoction: Treats constrained heat in the chest, distress and fullness in the heart, Qi surging upward, and difficulty passing urine or stool.

One sheng of pinellia; eight liang of fresh ginger; four liang of peucedanum; five liang each of poria and white atractylodes; one liang of licorice; two liang each of baical skullcap and ginseng; three liang each of apricot kernel and immature bitter orange.

Coarsely chop the ten ingredients. Boil them in nine sheng of water until three sheng of liquid remain, then divide into three doses. When heat in the chest is severe, let the decoction cool before drinking. If urination or bowel movements are difficult and sluggish, add two liang of rhubarb. Another version adds two liang of gardenia seed, making eleven ingredients.

Chengqi Decoction is used to treat Qi bound and gathered in the chest, with heat in the stomach area, causing vomiting after eating, nausea, thirst, and other symptoms.

Formula: Qianhu, Zhishi, cinnamon bark, rhubarb, cold-water stone, Zhimu, and licorice (one liang each); saltpeter, Trichosanthes root, and gypsum (two liang each).

Coarsely cut the ten ingredients. Boil them in one dou of water until three sheng of liquid remain. Divide into three doses.

Formula for heat causing the palms and soles to feel feverishly hot, as if on fire:

Bamboo leaves (two sheng), Zhishi (three liang), Qingxiangzi and Baqian (one liang each), Wuzhuyu and Huangqin (two fen each), Trichosanthes root and Maidong (two liang each), fresh ginger (six liang), Qianhu (another version gives “Shaoyao”), and Banxia (five liang each).

Coarsely cut the eleven ingredients. Boil them in eight sheng of water until two sheng of liquid remain. Divide into three doses.

Rehmannia Decoction, used to treat heat syndromes:

Rehmannia juice (four sheng and three he), Fushen, Zhimu, and Yuzhu (four liang each), Trichosanthes root (five liang), bamboo sap (three he; another formula uses bamboo leaves), ginger juice, fresh Rehmannia root bark, fresh Maidong juice, and white honey (two sheng each), and gypsum (eight liang).

Coarsely cut the eleven ingredients. First boil the herbs in one dou and two sheng of water until three sheng of liquid remain, then strain out the dregs. Add the bamboo sap, Rehmannia juice, and Maidong juice, and simmer until the mixture has boiled gently four or five times. Add the honey and ginger juice, then simmer until six sheng remain. Take four he for the first dose, three times during the day and once at night; gradually increase the dose to six or seven he each time. In the fourth or fifth lunar month, this may be prepared as a powder for use.

Formula for accumulated heat:

Zhishi, Huangqin, rhubarb, Huanglian, and mirabilite (two liang each).

Grind the five ingredients into a fine powder and mix with honey to form pills the size of Chinese parasol tree seeds. Take thirty pills on an empty stomach with wine. The dose may gradually be increased to forty pills, taken once daily.

Formula for heat above the diaphragm:

Kushen (ten liang), Xuanshen (five liang), Maidong (three liang), and Cheqianzi (two liang).

Grind the four ingredients into a fine powder and mix with honey to form pills the size of Chinese parasol tree seeds. Take fifteen pills twice daily.

“Coarsely cut” means cutting the medicinal materials into rough pieces to make them easier to decoct. The dou, sheng, he, liang, and fen in the source are units of volume or weight; their precise modern equivalents vary according to the period and system used.

Fine, Round Pills (small medicinal pills): These are used to treat externally contracted Heat Evil that has gathered and obstructed the smooth flow of Qi. Grind three liang each of rhubarb and garden cress seed, three ge of fermented soybean, and five fen each of apricot kernels and croton seeds into a fine powder. Form the powder with honey into pills the size of the seeds of the Chinese parasol tree. Take two pills daily with water, enough to induce a bowel movement.

A Formula for Treating Bone Steaming Heat (a condition described as heat steaming up from within the bones, often accompanied by wasting): For cases involving emaciation, irritability and chest oppression, shortness of breath and panting, flaring nostrils, and symptoms that occur each evening. Grind four fen each of gentian, coptis, and snakegourd root; two fen of mirabilite; ten gardenia fruits; and two liang each of sophora root, rhubarb, baical skullcap root, peony, and Celosia seed into a powder. Form it with honey into pills the size of the seeds of the Chinese parasol tree. Take two pills with water twice daily, until the symptoms ease. Another version omits sophora root. A further record says to grind only the five ingredients beginning with sophora root into a powder and take one fangcunbi (an ancient measure for powdered medicine, approximately a spoonful) per dose. This last formula is attributed to Zhang Wen Zhong.

A Formula for Treating Bone Steaming: Take a piece of the Heavenly Spirit Cover (a medicinal substance named in ancient formularies) about the size of a comb. Roast it until yellow, then crush it. Add five sheng of water and boil down to two sheng; divide into three doses. The source says this formula “raises the dead,” an exaggerated expression of miraculous efficacy. Another formula: grind mirabilite into a powder and take one fangcunbi per dose, twice daily. A third formula: burn human feces to ash and take one fangcunbi with wine, twice daily.

A Formula for Treating Heat in the Five Viscera, Generalized Fever, and a Wiry, Rapid Pulse: Apply fifty cones of moxa at the fourteenth vertebra, opposite the navel (“cone” is the unit used to measure moxibustion, referring to one burning moxa cone). For older adults and children, adjust the number as appropriate. If the condition is due to deficiency and cold, apply up to one hundred cones, and apply moxa transversely at a point three cun to the side.