《孫真人備急千金要方》Vol. 54

Essential Prescriptions Worth a Thousand Gold Pieces for Emergencies by Sun Simiao, Volume Fifty-Four

Formulas for the Lung Viscera

First Treatise on the Lung Viscera and Its Pulse

The lungs govern the storage of the Po (corporeal soul). The Po is the vital essence through which a person senses external things and responds to them. Within the body, the lungs are like a senior general: they reside in the upper part of the body and direct the movement of Qi. Thus, the lungs are like a canopy over the Five Viscera, covering and protecting them, and they also govern the coming and going of vital essence.

The Po is stored in the lungs, and the nose is the lungs’ external aperture. Lung Qi reaches the nose; when the nose functions normally, one can distinguish fragrant from foul odors. Lung Qi travels through the body, rising to the Purple Palace—a term here for an upper palace-like region used in traditional medicine to describe the movement of Qi—passing through the cheeks and reaching the nose before flowing back into the lungs. It gives the hair its luster. At the body’s surface, the lungs govern Qi; internally, they correspond to the chest, roughly at the level of the breasts. The left breast corresponds to Geng, and the right to Xin.

The lungs weigh three jin and three liang. They have six lobes and two ears, making eight lobes in all. Tradition says that fourteen boys and seven girls guard the lungs. Their spirit is named Hong; it governs the storage of the Po and is called “the Storehouse of the Po.” The lungs respond to the body as the seasonal qi changes. Hence the saying: “The lungs store Qi, and Qi houses the Po.” Changes in lung Qi appear as coughing in the voice and as nasal discharge among the body’s fluids.

When lung Qi is weak, breathing through the nose is unobstructed, but the breath is short. When lung Qi is excessive, breathing becomes labored and noisy, the chest feels distended, and one can breathe only with the head raised. When lung Qi is deficient, one may dream of white things, or of people being beheaded and blood covering the ground. In the season corresponding to the lungs, one may dream of battle. When lung Qi is flourishing, one may dream of being frightened or weeping. If disordered Qi lodges in the lungs, one may dream of soaring through the air and seeing metal weapons and strange things.

In the Five Phases, the lungs belong to Metal and are paired with the large intestine, which is their fu organ. The lung channel is Hand Taiyin, and the large intestine channel is Hand Yangming; the two are interiorly and exteriorly related. The lung pulse is floating and is associated with late summer and autumn. In autumn, all things decline: leaves fall and branches grow bare. The lung pulse likewise takes on a light, floating quality in response to the season.

Defensive Qi moves relatively slowly, while Nutritive Qi moves relatively quickly. The faster-moving Qi is more prominent above, and the slower-moving Qi below; hence the lung pulse is called the “Mao pulse,” meaning that it is light and superficial. When Yang Qi should descend but fails to do so, and Yin Qi should rise but fails to do so, the body is vulnerable to pathogenic influences. (As Yin and Yang Qi contend with each other, the body is exposed to wind and cold.) When a pathogen injures Yang, the pulse becomes contracted; when it injures Yin, the pulse becomes tense. A contracted pulse brings a fear of cold, while a tense pulse brings shivering. When cold and shivering occur together, this is called malaria.

A weak pulse brings fever. When the pulse is floating and the pathogen moves outward, an attack that begins in the morning will occur in the morning, and one that begins in the evening will occur in the evening. The organs and bowels lie at different distances, the pulse has different speeds, and the body’s movements each follow their own measure, like time measured by a water clock. A slow pulse in the upper part of the body injures the skin and hair; a rapid pulse in the lower part injures the lower burner. As for pathogenic Qi in the middle burner…

When a healthy, harmonious pulse is observed, Yang Qi lies hidden and sinks downward. Yin Qi warms Yang Qi, yet comes to reside in the lower part of the body. Yin Qi thus occupies the crown of the head, which is why this is called “long and lingering”—the pulse is long and sustained.

The autumn pulse resembles a floating pulse. Autumn corresponds to the lungs; the lungs are associated with the west and belong to Metal among the Five Phases. It is the season when all things are gathered in. When Lung Qi arrives, it is light, empty, and floating; it comes on rapidly and disperses as it departs, which is why it is called “floating.” What does it indicate when the pulse is the opposite of this?

If the pulse Qi floats like hair, yet is firm in the center and weak at the sides, this is excess, and the illness is on the body’s exterior. If the pulse Qi floats like hair but is faint and weak, this is deficiency, and the illness is within. Excess causes Qi to rebel upward, pain in the back, and oppressive discomfort in the chest. Deficiency causes panting, shortness of breath, coughing, and Qi surging upward; the patient may even cough up blood, and the sound of the patient’s breathing can be heard from below.

When the Lung pulse arrives gently and subtly, like an elm seedpod drifting down, it is called a harmonious Lung pulse. In autumn, the pulse takes Stomach Qi as its foundation. Stomach Qi here means a pulse that is even, forceful, and not excessively rapid. When the Lung pulse arrives neither floating nor deep, like the touch of a chicken’s feather, this is the pulse of Lung disease. (The text Chaoyuan omits the word “not.”)

When the Lung pulse arrives as if something were floating on water, or as if wind were stirring feathers, this is the pulse of a Lung organ nearing death.

When the true Lung pulse appears, it is large and empty, like a feather lightly brushing the skin. The patient’s complexion is white with a reddish tinge but lacks luster; the hair is dry and brittle. Death will follow.

In autumn, a pulse with Stomach Qi and a slight hairlike quality is a normal pulse. A pronounced hairlike pulse with little Stomach Qi indicates Lung disease. A hairlike pulse without Stomach Qi is a death pulse. If the pulse is hairlike but also has a wiry quality, illness may arise in spring; if the wiry quality is pronounced, illness is present now.

The lungs store Qi, and the ethereal soul (Po) resides in them. Excessive joy damages the Po. When the Po is damaged, a person may become delirious and mentally unsettled; the skin grows dry and rough, the hair becomes withered, and the complexion turns dull. Death may occur in summer.

When Qi in the Hand Taiyin channel—that is, the Lung channel—is exhausted, the skin and hair become dry and scorched. The Hand Taiyin channel circulates Qi and blood and nourishes the skin and hair with warmth. When Qi can no longer moisten them, the skin and hair dry and scorch. As they dry, fluids are depleted; when fluids are depleted, the skin and flesh are damaged. When the skin and flesh are damaged, the nails (another version reads “skin”) wither and the hair breaks. Broken hair shows that Qi was exhausted first. The condition becomes critical on a Bing day and death follows on a Ding day, because Fire overcomes Metal in the Five Phases.

When the Lung organ is nearing death, the pulse feels empty to a light touch and faint under firm pressure, like an onion leaf, with no root Qi in the middle.

Autumn belongs to Metal, and the lungs govern the season. A slightly rough and short pulse is normal. If instead the pulse is large and slow, this means Spleen Qi is acting on the lungs: the mother returns to the child, a pattern of vacuity malign influence. Although there is illness, it is easy to treat. If instead the pulse is deep, soft, and slippery, this means Kidney Qi is acting on the lungs: the child encroaches upon the mother, a pattern of replete malign influence. Although there is illness, it will recover on its own. If instead the pulse is floating, large, and surging, this means Heart Qi is acting on the lungs…

Lung Fire overcomes Metal and is classified as a destructive, severely adverse pathogen. The illness is dangerous, and in eight or nine cases out of ten it cannot be cured. If, instead, the pulse is wiry, fine, and long, this indicates Liver Wood encroaching upon Lung Metal. This is a mild pathogenic influence: although illness develops, recovery is easy. When Liver Qi encroaches upon the Lungs, it inevitably weakens Lung Qi.

If the Yin pulse at the cun position before the bar on the right wrist—the right wrist’s cun pulse—is absent, this indicates that there is no Lung pulse. If the patient has shortness of breath, coughing with rebellious Qi, a blockage in the throat, or hiccups, needle the Hand Yangming channel to treat the Yang.

If the Yin pulse at the cun position before the bar on the right wrist is firm and forceful, this indicates that the Lungs are replete. The patient may feel short of breath and fullness in the chest, with pain extending to the shoulders. Needle the Hand Taiyin channel to treat the Yin.

When the Lung pulse arrives, it is floating, light, and soft, like a gentle breeze passing over the feathers on a bird’s back. Two beats with each breath in and out are called a normal pulse; three beats indicate illness of the channel; four indicate depletion of essence; five portend death; and six indicate that life is ending. This describes the pulse of the Hand Taiyin Lung channel.

If the Lung pulse is excessively rapid, severe illness may bring on epilepsy. If it is somewhat rapid, there may be alternating cold and heat in the Lungs, fatigue, coughing up blood, and pain extending through the lower back, back, and chest. A nasal polyp may also block the nostril. If the pulse is excessively slow, there may be profuse sweating; if somewhat slow, there may be flaccid weakness and “leaking wind” (some versions read “one-sided wind”), with unceasing sweating below the head. If the pulse is excessively large, the calves may swell; if somewhat large, there may be Lung impediment, with pain in the chest and back extending to the lower back. If the pulse is excessively small, there may be diarrhea; if somewhat small, wasting-thirst disease. If the pulse is excessively slippery, Qi may surge upward; if somewhat slippery, there may be bleeding from above and below. If the pulse is excessively rough, there may be vomiting of blood; if somewhat rough, tubercular swellings may develop in the neck, limbs, or armpits. Qi and blood in the lower body are then insufficient to support the upper body, and the patient may also have a preference for sour flavors.

If the Lung pulse beats firm and long, the patient is likely to cough up blood. If it is soft and scattered, sweating may continue without stopping (some versions read “pouring” instead of “leaking”), and the illness has still not resolved.

When the white pulse arrives, the patient is short of breath, the pulse floats in the upper region, and the body is deficient above and replete below, with palpitations. Qi has accumulated in the chest, and the breathing is labored and weak; this is called Lung impediment. The condition is caused by cold and heat and is commonly seen in people who have sexual intercourse after drinking alcohol.

The Yellow Emperor asked: “Of the twelve channels, why is it only the Hand Taiyin Lung pulse that beats without ceasing? The Hand Taiyin pulse is originally located at the cun position.”

Qibo replied: “This is because it is connected to the Foot Yangming Stomach pulse. The Stomach is the source from which the five Zang organs and six Fu organs receive nourishing essence and Qi. (The Stomach pulse is located on the top of the foot, between the great toe and the second toe, about three cun upward, at the cleft between the bones.) The Stomach’s essence and Qi rise and clear upward, carrying nourishment to the Lungs; Lung Qi then circulates along the Hand Taiyin channel. It moves with the breath, so the pulse beats twice with each exhalation and twice with each inhalation. As long as breathing continues, the pulse continues to beat.”

The Yellow Emperor asked, “Why is the qi opening able to govern all five Zang organs?” Qibo replied, “The stomach is where food and drink gather, and it holds the greatest place among the six Fu organs. The five flavors enter the stomach through the mouth and are then used to nourish the Qi of the five Zang organs. The ‘qi opening’ refers to the pulse opening of the Greater Yin channel—here, the Hand Greater Yin Lung channel. Qi from the Zang and Fu organs, along with the refined essence of food and drink, comes from the stomach and is revealed in the pulse at the qi opening. The qi opening belongs to the Fu pulse. Since the Qi of the Zang and Fu organs is reflected there, the qi opening is also called the ‘inch opening.’”

Bian Que said, “When the Lungs are diseased, the nostrils and mouth flare open. With excess heat, there may be panting, rebellious Qi, a lifted chest, and breathing with the head thrown back. When Yang Qi is excessive, one may feel fear in dreams, among other things. With deficiency and cold, there may be coughing, obstructed breathing, diarrhea, and shortness of breath. When Yin Qi is excessive, dreams may include scenes such as wading through water. In terms of sound, the Lungs correspond to weeping; in bodily symptoms, they correspond to coughing; and in the emotions, they correspond to sorrow. Sorrow harms the Lungs; when Jing Qi gathers in the Lungs, it makes a person feel grief.”

The Lungs correspond to autumn. Related disorders may present with fullness and tightness in the chest, coughing up blood, and similar symptoms. If the illness arises from a lack of restraint in eating, treat it at the He point, where the Qi and blood of the channel converge. This is why it is said, “Flavor governs the He point.”

When an illness first begins in the Lungs, it causes panting and coughing. After three days, it passes to the Liver, causing pain and fullness in the ribs and flanks. A day later, it passes to the Spleen, causing Qi to become blocked and obstructed, and the whole body to feel painful and heavy. After five days, it passes to the Stomach, causing abdominal distension. If the person is still unable to eat after ten days, death will follow. In winter, the illness worsens at sunset; in summer, it worsens at sunrise. When the illness is in the Lungs, it eases in the evening, worsens at midday, and is relatively quiet at midnight.

If the Lung illness was caused by traveling south or eating horse or muntjac meat, but did not arise in this way, it will flare up in summer, on a Bing or Ding day. Red medicines are suitable for treatment.

Typical symptoms of Lung disease include panting, coughing, rebellious Qi, breathing with the shoulders raised, back pain, sweating, and stiffness or pain in the buttocks, genitals, thighs, knees, calves, and feet. When the Lungs are deficient, there may be shortness of breath, difficulty catching one’s breath, deafness, and a dry throat. For treatment, take blood at points on the Hand Greater Yin and Foot Greater Yang channels, as well as on the outer side of the Foot Reverting Yin channel and the inner side of the Foot Lesser Yin channel.

When the Lung pulse feels deep and rapid under pressure, panting may appear when it is taken superficially. There may also be shivering with cold, alternating chills and fever, abdominal distension, heat in the intestines, dark yellow urine, shoulder and back pain, and sweating above the waist. This illness may result from exposure to wind after sweating during sexual activity.

A person with Lung disease has a pale complexion, feels cold without developing a fever, and often coughs. If the pulse is faint and slow, the condition can still be treated. The person should take the Five-Flavor Great Lung-Tonifying Decoction and the Lung-Draining Powder. In spring, prick the Shaoshang point; in summer, prick the Yuji point, using the draining method for both. In late summer, prick the Taiyuan point; in autumn, the Jingqu point; and in winter, the Chize point, using the tonifying method for all three. Moxibustion should also be applied one hundred times at the Shanzhong point and twenty-five times at the third vertebra on the back.

When pathogenic Qi invades the lungs, the skin may become painful, and the person may feel cold, experience Qi surging upward, have shortness of breath, sweat, and cough. The cough may also cause pain that pulls at the shoulders and back. Points beside the center of the chest and alongside the third vertebra on the back can be pressed by hand. When pressing reaches a painful spot and brings relief, acupuncture can then be applied. The Quepen point, in the hollow above the clavicle, may also be used to disperse and drain the pathogenic Qi.

If the body is chilled and the person also drinks cold beverages, the two forms of cold influence one another and harm both the interior and exterior, causing Qi to rebel upward. Once the lungs are injured, exertion may bring on coughing and blood in the sputum. A pulse that is thin, tight, floating, and rapid may also be accompanied by vomiting blood. This results when the lungs are damaged by agitation and anger, causing Qi to stagnate.

A person with Wind in the lungs has a dry mouth, shortness of breath, dizziness and heaviness in the body, a dull head, and swelling. A person with Cold in the lungs may spit out turbid mucus. In Lung Water, water Qi accumulates in the lungs, causing swelling and difficulty urinating; at times the stool is loose and soft, like duck droppings. In Lung Distention, the body is weak but the chest feels full, with wheezing and coughing, and the eyes seem as though they might protrude.

When the Fuyang pulse at the top of the foot is floating and moderate, and the Shaoyang pulse is faint and tight, the faint pulse indicates blood deficiency, while the tight pulse indicates mild Cold. This is a pattern called “mouse nipple.” In examining a Lung accumulation, the pulse floats like a feather and recedes when pressed. There is frequent pain below the ribs, drawing upward into the back, along with shortness of breath, forgetfulness, and closed eyes. An abscess may also form, and the skin may feel cold. The condition eases in autumn and worsens in summer. The skin may sometimes hurt as though lice were crawling over it; in severe cases the pain feels like stabbing, and there may also be itching and a pale complexion.

The Lung accumulation is called “Xiben” (“Rushing Breath”). It lies below the right ribs and is about the size of a cup. If it persists despite prolonged treatment, chills and fever, rebellious Qi, wheezing, and coughing may develop, and it may progress to a lung abscess. Why does it arise on a Jia or Yi day in spring? A Heart illness passes to the lungs, which should then pass it on to the liver. But in spring the liver Qi is flourishing, and a flourishing organ Qi does not accept pathogenic Qi. The lung Qi therefore tries to pass the illness back to the Heart, but the Heart does not accept it. The pathogenic influence then remains and congeals into an accumulation. This is why Xiben may arise in spring.

A person with lung disease generally has a fever, cough, and shortness of breath, and may cough up pus and blood. The pulse should be short and rough. If instead it is floating and large, and the complexion, which should be pale, is red, this is a severe counteracting pattern in which Fire overcomes Metal, Metal corresponding to the lungs; the prognosis is extremely poor. For a person associated with the Shang tone, which corresponds to the lungs, the lung sound is like weeping, with a tone like a stone chime. The person’s emotion is joy, and the associated channel is the Hand Taiyin Lung channel. When Qi in the Hand Taiyin and Yangming channels runs counter to its proper course, the movement of nutritive Qi and defensive Qi becomes obstructed and Yin-Yang falls out of balance: Yang Qi attacks inward, while Yin Qi is harmed outwardly. The resulting injury brings on chills, weakness of the righteous Qi, and vulnerability to fierce pathogenic Winds, with shivering and trembling between each inhalation and exhalation.

Speech becomes disordered, the voice hoarse, blocked, and weak; breathing is short, and the person feels exhausted and feeble. The limbs are weak, the complexion is bluish-white, and control of urination and bowel movements is lost. In severe cases, the condition cannot be treated. When the cause matches, use Ephedra Life-Sustaining Decoction (Mahua Xuming Tang; see the formula in Volume Eight).

There is another condition in which speaking brings on rapid, labored breathing and shortness of breath, along with a tendency to spit saliva. This is a sign that Fire is overcoming Metal—the Five Phases relationship in which Fire restrains Metal; here, the Lungs belong to Metal and Heart Fire overcomes Lung Metal—and that Yang Qi is invading Yin Qi. Yin Qi sinks while Yang Qi rises. When Yang Qi rises, it becomes congested; congestion produces heat, and heat leads to mania. The patient keeps their eyes closed, experiences palpitations, speaks irrationally, and has red lips and an open mouth. They drink water without restraint. This results from pathogenic heat damaging the Lungs and altering the blood within them, and is usually incurable. If only the complexion is red and the nose is not crooked, however, the condition can still be treated.

When Lung disease gives rise to malaria, the person feels cold within the chest; when the chill becomes severe, fever follows. During the alternation of chills and fever, the person is easily startled, as though seeing something. This condition can be treated with Changshan Decoction (Hengshan Tang; see the formula in Volume Ten). If someone who ordinarily speaks in a loud, powerful voice suddenly loses its clarity and must draw out the breath and struggle to make a sound, speaking in a way entirely unlike their usual manner, the illness will soon become apparent. If asked to join in speaking, the person stares straight ahead without responding. These are all signs that Lung disease is affecting the voice, even before there are clear symptoms. When examining an illness, one should determine whether it lies on the exterior or interior of the body, then treat it cautiously in light of its cause to avoid treating it incorrectly.

White corresponds to the Lungs, which are associated with the skin. Skin that is white and lustrous like pork fat is an auspicious sign. The Lungs govern the nose, which manifests Lung Qi on the body’s surface. A person with a Metal constitution generally has the physical traits described above: they correspond to the Shang note, associated with Metal among the Five Notes; have a white complexion, a small, square-shaped head, and a small face, shoulders, back, abdomen, and hands and feet. They move nimbly and are physically light and fit. They are discerning and upright, with a temperament that is impatient yet composed and strong-willed. They like serving as officials, tolerate autumn and winter, but do not tolerate spring and summer; when exposed to pathogenic influences in spring and summer, they easily fall ill. Their principal meridian is Hand Taiyin, the Lung Meridian.

The condition of the Lungs can also be assessed by observing the thickness of the shoulders and chest and whether the posture is upright. People with a uniformly white complexion and fine skin texture have small Lungs. Those with small Lungs drink little water and are less likely to suffer from labored, coarse breathing. People with coarse skin texture have large Lungs. Large Lungs are prone to deficiency; deficiency makes a person susceptible to cold, leading to wheezing and increased thirst. They are also prone to obstruction in the chest or throat and to counterflow of Qi.

People with very broad shoulders, an outwardly protruding chest, and a hollow at the throat have high-positioned Lungs. High-positioned Lungs are prone to congestion, which generates heat and leads to Qi surging upward, raised shoulders and labored breathing, coughing, and counterflow of Qi. People with spread-out armpits and broad ribs have low-positioned Lungs. Low-positioned Lungs compress the diaphragm and impede the Liver, making pain beneath the ribs, nasal congestion or blockage, a runny nose, and even nasal polyps more likely.

People with thick shoulders and backs have firm Lungs. Firm Lungs make a person less prone to coughing or Qi surging upward. People with thin shoulders and backs have fragile Lungs. Fragile Lungs are easily damaged by pathogenic heat, leading to labored breathing and nosebleeds. When the shoulders and chest are evenly proportioned and upright, the Lungs are also well formed; well-formed Lungs allow Qi to flow in harmony and without obstruction.

When the chest is injured and one side becomes tilted, the lung also shifts to one side, causing pain on that side of the chest. The corresponding side of the nose may also develop a disorder. If the regions of the face—the areas used in ancient times to observe signs of illness in the internal organs—are sunken or raised, this often indicates illness in the corresponding organ.

The nose belongs to Yangming and corresponds to the lung on the face. Qi in the lung connects the inside and outside of the body, so the corresponding area of the face changes with it. When pathogenic Qi is heavy and turbid, the illness is internal; when it is superficial and clear, the illness is external. If an external illness enters the body, the corresponding area will become raised; if an internal illness manifests outwardly, that area will become sunken. When pathogenic influences invade from outside, treat the Yang channels first, then the Yin channels. When illness moves from within outward, treat the Yin channels first, then the Yang channels. For excess patterns, use reducing methods; for deficiency patterns, use tonifying methods. Yang governs the exterior, and Yin governs the interior.

A person’s prospects for life, death, good fortune, or misfortune first appear outwardly through changes in the spirits of the internal organs. When lung disease is about to develop, the nostrils flare and the nose becomes dry, scorched, and withered. When the lung Qi is about to be exhausted, the bridge of the nose collapses, the nostrils close, and the color turns blue-black. If a dark, dull color corresponding to the illness appears in facial regions such as the center of the forehead, this is a dangerous sign and is difficult to treat. Physicians should judge the duration of the illness by the depth of the discoloration: a long-running illness will last no more than a year, while an acute, severe one may not last even a month.

How can one foresee sudden death when lung disease seems to have improved somewhat? If spots the size of a thumb, black tinged with red, appear on both cheeks, sudden death may follow. When lung Qi is cut off, death comes within three days. How can this be recognized? The patient’s mouth remains open, with exhalation but no inhalation; the face is pale and the eyes are blue. This is called a disorder of Qi and blood in the channels. If someone drinks alcohol and then is exposed to wind and cold, wind pathogens enter the lung channel and gallbladder Qi runs amok and leaks outward, causing the eyes to turn blue. Even if Heaven wished to save the person, they could not be brought back to life. A yellow face and white eyes, like those of a withered corpse, are also signs of death.

To interpret the favorable or ominous colors seen in the facial regions, one must see whether they match the area corresponding to the affected internal organ. If red or white appears and spreads into the nose, illness will follow, and the person will usually not live beyond that year. If the sign does not come to pass that year, calamity will certainly befall them within three years.

Autumn belongs to Metal; the lung pulse corresponds to the color white and governs the Hand Taiyin channel, the lung channel. In autumn, the Shu and He points of the channels are used for treatment. As Metal begins to govern in autumn, lung Qi starts to contract and become austere; Metal is about to overcome Fire. Yang Qi is still at the He points, while Yin Qi is only beginning to strengthen. Dampness also affects the body, but Yin Qi is not yet strong enough to penetrate deeply. Therefore, the Shu points are used to drain Yin pathogens, and the He points to weaken Yang pathogens. As Yang Qi begins to decline, the He points are also used.

The pulse Qi of the lung channel originates at the Cun Kou pulse, between the two tendons behind the wrist, about two cun from the wrist crease; it corresponds to the pulsation in the armpit. The root of the lung channel is in the Great Granary, the stomach, which lies three cun above the navel, about the length of one forearm.

The sinew channel of the lung begins on the back of the thumb, runs up along the thumb, and gathers behind the thenar eminence. It then travels upward along the outer side of the Cun Kou, runs along the forearm, and binds at the center of the elbow before ascending along the inner side of the upper arm and entering the armpit…

The Qi vessels descend from the upper part of the supraclavicular hollow (the depression above the collarbone), pass in front of Jianyu (a shoulder acupuncture point), then rise back to connect with the supraclavicular hollow before descending into the chest. They branch out, pass through the diaphragm, and descend to the lower ribs on either side.

This channel begins in the Middle Burner (the region of the spleen and stomach in the center of the body), descends to connect with the large intestine, then follows the entrance to the stomach upward through the diaphragm and belongs to the lungs. It extends sideways from the lung system (the trachea and other structures connected with the lungs) beneath the armpit, travels down the inner side of the upper arm, passing in front of the Hand Shaoyin Heart Channel and the Hand Jueyin Pericardium Channel, and reaches the center of the elbow. It then runs along the inner forearm near the lower edge of the ulna, enters Cunkou (the wrist pulse-taking point), passes through the thenar eminence (the raised area at the base of the thumb) and Yuji, and ends at the tip of the thumb. A branch separates behind the wrist and runs straight along the inner side of the index finger to its tip, where it connects with the Hand Yangming Large Intestine Channel. The Hand Taiyin Lung Channel and the Hand Yangming Large Intestine Channel are interiorly and exteriorly related; the two channels meet beside the elbow bone.

The connecting vessel of the Hand Taiyin Channel is called Lieque. It begins between the muscles beneath the armpit, descends along the Hand Taiyin Channel, enters the palm, and spreads through Yuji. A branch then extends toward the Hand Yangming Channel. It treats disorders related to the lungs.

When the Lung Channel has excess heat, the large intestine also becomes heated, and the palms and fingers may grow hot. If the pulse of the Yang channel is abnormal and the pulse at Cunkou is three times stronger than usual, this indicates a Yang pattern. Symptoms may include coughing, Qi surging upward, wheezing, thirst, restlessness, chest tightness, pain along the inner upper arm and forearm, and heat in the center of the palm. When Lung Qi is excessive, there may also be pain in the shoulders and back, sweating, and sensitivity to drafts.

When the large intestine is deficient and cold, the palms and fingers become cold. If the pulse of the Yin channel is abnormal and the pulse at Cunkou is half its usual strength, this indicates a Yin pattern. Symptoms may include yawning, coughing, frequent urination or incontinence. The shoulders and back may also feel cold and painful, with shortness of breath and fatigue, hollow pain beneath the lower ribs, changes in urine color, and sudden loss of bowel control.

The lungs and large intestine govern the three months of autumn. The condition called “White Qi Tan disease” is associated with this season. Pathogenic influence may pass from the Taiyang Channel to the Hand Taiyin Channel. When excessive pathogenic influence attacks the Hand Taiyin Channel, the channels become obstructed and the skin and body hair tighten. As the pathogenic influence vents outward, it may also damage the internal organs. After exposure to epidemic Qi in autumn, the illness may take one of two opposite forms: when the Qi of the bowel organs is weak, the person is readily attacked by Yin pathogens and may experience alternating chills and fever, impaired Lung Qi, sudden coughing fits, and retching; when the Qi of the solid organs is excessive, the person may be harmed by Yang toxicity and develop fever, skin spots, wheezing, and intense thirst. This is why it is called “White Qi Tan disease.”

Bian Que said that needling the transport points of the Heart and Lungs can treat erysipelas and White Qi Tan disease. Treatment should address the cause: harmonize Yang Qi and regulate Yin Qi, so that disorders of the organs are less likely to arise.

The Lung’s Deficiency and Excess Patterns, Part Two (Pulse Signs, Prescriptions, and Moxibustion)

Excess Heat in the Lungs

If the pulse at the right Cunkou is forceful on the proximal side of the Qi Gate (the pulse position used to assess Lung Qi), this indicates illness in the Hand Taiyin Lung Channel.

When the lungs feel distended and full, sweat appears like dew, Qi surges upward and breathing becomes labored, the throat feels blocked, and one feels as though one is about to vomit, this condition is called “excess heat in the lungs.”

A formula for treating excess heat in the lungs, fullness in the chest, and difficulty breathing while lying on one’s back; it clears heat by expelling the breath:

Eight liang of gypsum; three liang each of baiqian and apricot kernels; five liang each of tangerine peel and atractylodes; seven ge of red honey; and two sheng of chopped wolfberry root bark.

Coarsely cut the seven ingredients. Boil them in seven sheng of water until two sheng of liquid remain, then strain out the dregs, add honey, and bring to a boil three times. Divide into three doses.

A formula for treating lung heat, abnormal voice, rapid, shallow breathing, and frequent coughing up of pus and blood:

Two sheng of chopped raw rehmannia root; eight liang of gypsum; five liang of ephedra; four liang of apricot kernels; three liang each of cimicifuga, antelope horn, and mirabilite; one piece of bamboo shavings, about the size of an egg; and one sheng of red honey.

Coarsely cut the nine ingredients. Boil them in seven sheng of water until two sheng of liquid remain, then strain out the dregs, add honey, and bring to a boil twice. Divide into three doses.

A formula for persistent chest oppression from lung heat, tightness and labored breathing in the chest, palpitations, and an external heat pathogen that comes and goes, when the condition is critical and taking medicine is difficult. Apply it to the chest to ease labored breathing:

One sheng each of peach bark and genkwa.

Coarsely cut the two ingredients. Boil them in four dou of water until one dou and five sheng of liquid remain, then strain out the dregs. Soak an old cloth towel in the liquid and apply it to the chest, while keeping the limbs warm. Use it for several days, and the symptoms will ease.

Tangerine Peel Decoction: A formula for lung heat, upward-surging Qi, coughing, and rapid, gasping breaths:

Three liang each of tangerine peel and ephedra; four liang each of bupleurum, dried purple perilla (the Shanfan text gives “dried indigo plant”), and aged ginger; and eight liang of gypsum.

Coarsely cut the seven ingredients. First boil the ephedra in nine sheng of water. After it has boiled twice, skim off the foam, then add the remaining ingredients and simmer until three sheng remain. Strain out the dregs and divide into three doses. If the condition does not improve, take two more doses.

A formula for lung heat with wheezing and nosebleeds:

Three liang each of antelope horn, scrophularia, blackberry lily, cockscomb herb, peony, cimicifuga, and arborvitae bark; one sheng of chopped raw rehmannia root; and four liang of gardenia seeds.

The original text does not include instructions for preparing or taking this medicine.

Light bamboo shavings (one egg)

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

If a laxative effect is needed, add three liang of mirabilite and bring the mixture to a boil three times.

A formula for treating Lung Heat and wind exposure after drinking, when wind pathogen enters the Lung and Gallbladder Qi discharges recklessly, causing bluish eyes and panting

Four liang of ephedra; three liang each of licorice and Schisandra fruit; fifty apricot kernels; five liang of mother ginger; and one sheng of fresh bamboo leaves, chopped.

Chop the six ingredients above. Boil seven sheng of water with the ephedra first, skimming off the foam. Add the remaining ingredients and simmer until three sheng remain. Strain out the herbs and divide into three doses.

Lung-Draining Powder

Treats people who drink alcohol and become exhausted and drowsy, or who are exposed to wind while outdoors. Emotional shifts such as joy or anger may cause the pathogen to lodge in the Lung, bringing yellowing and swelling of the face and eyes, followed by dizziness, coughing with rebellious Qi, and Qi surging upward. At times, the person suddenly feels as though their breath is about to stop. There is tightness below the heart and inability to eat. Sometimes pus and blood are vomited; chest pain extends to the back, the chest and flanks feel distended and full, and there is an urge to vomit.

Two and a half liang each of Schisandra fruit and Stemona root; one liang each of Poria, aconite, Cistanche, Chinese angelica, Dendrobium, Polygala, and teasel root; seven fen each of Asarum and licorice; one and a half liang each of Saposhnikovia root, Sichuan pepper, aster root, cassia bark, coltsfoot flower, and dried ginger; sixty peach kernels and thirty apricot kernels.

Grind the nineteen ingredients above into a fine powder and sift. Take one square-inch spoonful (an ancient measure for powdered medicine) with wine three times a day, gradually increasing to two spoonfuls each time.

Moxibustion

For Lung distention with Qi surging beneath the flanks and heat and pain, apply moxibustion to the Yin Du point, using one moxa cone for each year of age. Yin Du lies on both sides of the upper abdomen, one cun apart from the midline on each side. The upper abdomen is three cun below the area beneath the heart.

For Lung distention, fullness in the flanks, vomiting, and Qi surging upward, apply moxibustion to the Dazhui point and to the space above the third rib between the breasts, using no more than seven cones at each site. One burning moxa cone constitutes one treatment.

When the Lung and Large Intestine are both Excess

If the pulse at the Qi-gate position of the right wrist is Excess both when lightly and deeply palpated, this indicates that the Hand Taiyin Lung channel and the Hand Yangming Large Intestine channel are both Excess. The patient often has headache, dizziness, fright, manic agitation, painful throat obstruction, arms that are tense and curled inward, and lips that cannot close properly. This is called “the Lung and Large Intestine both being Excess.”

A decoction-powder formula for treating Excess in both the Lung and Large Intestine, causing Qi to become congested and full in the chest

Poria and ephedra, six fen each; astragalus root; isatis leaf and cinnamon bark, three fen each; asarum; apricot kernels, five fen each; gypsum, two liang; red sage root, half a liang; Schisandra berries, licorice root, fritillaria bulb, tangerine peel, and Szechuan lovage root, one liang each; and three immature bitter oranges.

Grind these fifteen ingredients into a coarse powder and wrap it in cloth. Take one square-inch spoonful at a time. Decoction it in one sheng and five ge of water drawn from a well at dawn, reducing the liquid to seven ge. Divide into one dose. Take twice a day.

Lung Deficiency and Cold

When the pulse at the cun position on the right wrist—the qi-gate side—is weak, this indicates the Hand Taiyin Lung Channel. The patient often feels short of breath, with inadequate breathing, a dry throat, and insufficient body fluids. This condition is called “lung deficiency and cold.”

A formula for lung deficiency and cold, hoarseness and difficulty speaking, or bodily trembling, sluggishness and weakness, frailty and wasting, as well as invasion of the lungs by pathogenic wind:

Saposhnikovia root, pubescent angelica root, Szechuan lovage root, prickly ash, dried ginger, and astragalus root, forty-two zhu each; monkshood, ephedra, Schisandra berries, Asiatic cornelian cherry fruit, and licorice root, thirty-six zhu each; gentian root, cinnamon bark, Chinese yam, eucommia bark, ginseng, asarum, and fangji root, thirty zhu each; chrysanthemum and aster root, twenty-four zhu each; two rhizomes of Chinese knotweed; and monkshood, seven fen.

Grind these twenty-two ingredients into a fine powder. Take one square-inch spoonful with wine, twice a day. Another version adds six fen of gypsum and five fen of Chinese angelica root.

Butter, Honey, and Syrup Paste with Wine

This formula is for hoarseness or blocked voice, breathlessness and fatigue, coughing, and phlegm, caused by lung deficiency and cold or injury from pathogenic wind. It is said to help stop coughing and clear the voice.

Butter, cliff honey (honey produced among mountain cliffs), malt syrup, fresh ginger juice, fresh Stemona root juice, jujube flesh, and apricot kernels, one sheng each; crush the apricot kernels. Five pieces of citrus peel, ground into powder.

Mix these eight ingredients and simmer over low heat, stirring from time to time, for about the time it takes to eat a meal. When preparing the formula, use half the stated amount of the liquids such as ginger juice. Mix one square-inch spoonful of the medicinal paste with one sheng of warm wine and swallow slowly. Take twice a day, with an additional dose at night.

Another formula:

Three pig pancreases and one hundred jujubes.

Soak the two ingredients in five sheng of wine: for seven days in autumn and winter, and five days in spring and summer. Remove them and strain the liquid through cloth, discarding the dregs. Finish the medicinal wine within seven days. While taking it, avoid salt and mutton. This prescription can also treat cough, fullness and distension in the chest and flanks, severe wheezing, and Qi surging upward; it is especially effective for these symptoms.

The Elbow-Backup Prescriptions (Zhouhou fang) records that this prescription is used for persistent cough and Qi surging upward, including cases in which someone has coughed for twenty years and has not been cured by any of the usual methods.

Prescription for treating cold damage to the lungs, cough, runny nose, phlegm, and nasal congestion

Jujube pulp (two sheng, ground into a paste), apricot kernels (one sheng, roasted and ground into a paste), butter, ginger juice, white sugar, white honey, and fresh Bai Bu juice (one sheng each of the last four ingredients).

Combine the seven ingredients and simmer over low heat, stirring constantly. Remove from the heat after about the time it takes to cook a meal. Take a small amount each time, with two he of warm clear wine, twice daily.

Lung-Tonifying Decoction: Used to treat insufficiency of lung Qi (weak lung Qi), Qi counterflow with fullness in the chest, Qi surging upward, tightness and blockage in the throat, shortness of breath, and cold in the back. The mouth feels as cold as if it held frost or snow. In severe cases, the voice is lost and blood is coughed up.

Schisandra fruit (three liang); dried ginger, cinnamon heart (the inner bark of the cinnamon tree), and coltsfoot flower (two liang each); Ophiopogon root (one sheng); jujubes (one hundred); nonglutinous rice (two he); and white mulberry root bark (one jin).

Cut the eight ingredients into pieces. First boil the mulberry root bark in one dou of water for five boils, then add the remaining ingredients. Boil until three sheng of liquid remain, and divide into three doses.

Another prescription

Astragalus root (five liang); licorice and stalactite (two liang each); ginseng, dried Rehmannia root, cinnamon heart, poria, white quartz, mulberry root bark, magnolia bark, dried ginger, aster root, tangerine peel, Chinese angelica, schisandra fruit, polygala root, and Ophiopogon root (three liang each); jujubes (twenty).

Cut the eighteen ingredients into pieces. Boil them in one dou and four sheng of water until four sheng of liquid remain. Divide into five doses: take three during the day and two at night.

Another prescription: Used to treat insufficiency of lung Qi, cough with Qi counterflow, and Qi surging upward. The coughing feels as if the person is being pulled by a rope; they can only sit upright, bring up frothy saliva or blood, and cannot eat.

Perilla seeds (one sheng), mulberry root bark (five liang), pinellia tuber (six liang), aster root, ginseng, licorice, schisandra fruit, and apricot kernels (two liang each), and coltsfoot flower.

The source text breaks off here; the remaining quantities and instructions for decoction and administration are missing.

Use one liang each of blackberry lily rhizome, ephedra, and dried ginger; three liang of cinnamon bark; and half a liang of asarum. Chop the five ingredients. Add one dou and two sheng of water and boil down to three sheng of decoction. Divide the decoction into five portions. Take three portions during the day and two at night.

Another prescription treats cough, counterflow of Qi, and shortness of breath caused by Lung Qi deficiency, along with a cold back, a mouth that feels as cold as if holding frost or snow, loss of voice, thirst, and dryness at the root of the tongue:

One sheng each of Schisandra fruit and perilla seed; three liang each of white quartz and stalactite; two liang each of coltsfoot flower, bamboo leaf, tangerine peel, cinnamon bark, mulberry root bark, poria, and aster root; two he of polished rice; four liang of ophiopogon root; five liang of fresh ginger; fifty apricot kernels; and ten jujubes.

Chop the sixteen ingredients. Add one dou and three sheng of water. First boil the mulberry root bark, polished rice, and jujubes until the rice is cooked, then strain out the dregs. Add the remaining ingredients and boil down to five sheng of decoction. Divide into six doses and take three times a day.

Another prescription treats fullness and distension in the chest and abdomen caused by Lung Qi deficiency, cough, wheezing and counterflow of Qi, Qi surging upward, coughing up pus and blood, pain in the chest and back, heat and restlessness in the hands and feet, being easily startled and mentally unsettled, and raised bumps on the skin. The person may also alternate between crying, singing, and becoming angry; retch dryly and feel agitated; hear what seems like wind and rain in the ears; and appear pale:

Two liang each of coltsfoot flower and cinnamon bark; one jin of mulberry root bark; three liang each of fresh ginger, Schisandra fruit, and stalactite; five he of polished rice; ten jujubes; and four liang of ophiopogon root.

Chop the nine ingredients. Add one dou and two sheng of water. First boil the polished rice and jujubes until cooked, then remove them. Add the medicinal ingredients and boil down to two sheng of decoction. Divide into three portions and take warm. Another version adds two liang of white quartz. The Guangji Formula uses two liang each of aster root and ginseng and calls the prescription “Aster Decoction.”

Hemp Seed Decoction treats Lung Qi deficiency, cough with coughing up of pus and blood, shortness of breath, and inability to lie flat:

One sheng of hemp seed; one jin each of mulberry root bark and maltose; two liang each of cinnamon bark and ginseng; and donkey-hide gelatin.

Aster (one liang each), fresh ginger (three liang), and dried Rehmannia root (four liang).

Chop the nine herbs listed above. Combine one dou and five sheng of wine with one dou and five sheng of water, and boil until four sheng remain. Strain out the dregs and divide into five doses.

Malt-Sugar Decoction: A formula for insufficient Lung Qi and uncomfortable dryness of the throat.

Use any amount of malt sugar. Take one sheng of dried dates, remove the pits, steam until soft, and mash. Add five sheng of water and mix, then strain out the dregs. Let the liquid settle until clear, take the cloudy liquid from the bottom, and stir it into the malt sugar. Simmer over a fire; do not cook it until it becomes overly thick and hard. Take an amount about the size of an egg each time, swallowing it slowly: three times during the day and twice at night.

A formula for Wind invading the Lung, weakened breathing, swelling and fullness in the limbs, labored breathing with rebellious Qi, and oppression and fullness in the chest.

Apply moxibustion to Feishu, the back points corresponding to the Lung, two cones on each side. To locate the points, stretch a cord from the nipple to the area below the third vertebra on the back. Feishu lies on either side, one cun and five fen from the center.

Lung and Large Intestine Both Deficient

At the right wrist’s cun-kou position, the pulse at the Qi gate, which reflects Lung Qi, is deficient in both its Yin and Yang aspects. This indicates deficiency of both the Hand Taiyin Lung channel and the Hand Yangming Large Intestine channel. The patient may hear noisy ringing in the ears, sometimes see illusory flashes of light, feel unhappy, or experience fear. This condition is called “Lung and Large Intestine Both Deficient.”

Minor Construct the Middle Decoction: A formula for deficiency of both the Lung and Large Intestine, weakness and debility from deficiency-cold, lower abdominal tension, lower back pain, emaciation, and various other disorders.

Twelve jujubes, three liang of ginger, three liang of cassia bark, two liang of licorice, and six liang of peony.

Chop the five ingredients listed above. Add eight sheng of water and boil until three sheng remain, then strain out the dregs. Add eight liang of sugar and bring to a boil three times. Divide into three doses. The Zhouhou Fang adds two liang each of astragalus and ginseng and calls the formula “Astragalus Construct the Middle Decoction.”

Lung Taxation, Third (Discussion, Formulas, and Moxibustion)

Discussion: In all cases of Lung taxation, Kidney Qi should be replenished to support Lung Qi. When Kidney Qi is abundant, it will resonate with the Lung. If a person goes against the seasonal regimen for autumn, the contracting function of the Hand Taiyin Lung channel will become disordered, and Lung Qi will burn and swell with fullness. Following its natural course allows life; going against it leads to death. When followed, the illness can be treated; when opposed, the Qi mechanism becomes disordered. Reversing the principles of following the natural course causes Yin and Yang Qi to become blocked and fail to flow freely, and illness will arise.

Ephedra Guide-Qi Decoction: A formula for excess-type Lung taxation, panting, flaring nostrils, and swelling of the face and eyes.

Ephedra, apricot kernel, ginger…

The ingredients of the Banxia Decoction are Banxia and gypsum, five fen each; purple perilla, four fen; Asarum and cinnamon bark, three fen each; and tangerine peel, two fen. Also use one sheng of bamboo leaves, chopped. Chop all eleven ingredients, add one dou of water, and boil until three sheng remain. Strain out the dregs and divide the decoction into three doses.

Another Banxia Decoction is used to treat lung taxation (weakness and damage to Lung Qi), deficiency cold, and cold Qi in the chest and abdomen, counterflow Qi, and Qi that wanders without a fixed location. Symptoms include fullness and distension in the chest and flanks; pain extending from the chest to the back; a troubled, depressed Qi that comes and goes unpredictably; vomiting; bringing food back up immediately after eating; and weakness, fatigue, and deficiency of Qi and blood.

This formula uses one sheng of Banxia, one jin of fresh ginger, four liang of cinnamon bark, two liang each of licorice and Magnolia bark, and three liang each of ginseng, tangerine peel, and Ophiopogon. Chop the eight ingredients, add one dou of water, and boil until four sheng remain. Divide into four doses. If there is abdominal pain, add two liang of Chinese angelica.

The Houpo Decoction treats wind deficiency and cold phlegm, along with water accumulation, arising from lung taxation. The patient cannot rest lying down by day or night, cannot bring the head near the pillow, and has fullness in the chest, wheezing, and even difficulty breathing. The text attributes these symptoms to an excess of phlegm and fluid surging upward.

The formula contains two liang each of Magnolia bark, ephedra, cinnamon bark, Scutellaria, gypsum, Euphorbia, and tangerine peel; three liang each of bitter orange, licorice, Gentiana macrophylla, apricot kernels, and Poria; one liang of Asarum; one sheng of Banxia; one liang of fresh ginger; and fifteen jujubes. Chop the sixteen ingredients, add one dou and three sheng of water, and boil until four sheng remain. Divide into five doses.

For throat obstruction (swelling and blockage of the throat), counterflow Qi, coughing, and excessive saliva in the mouth, moxibustion may be applied at Feishu, the back point corresponding to the Lungs, for seven cones. Alternatively, apply one cone for each year of age, increasing gradually, up to a maximum of one hundred cones.