《孫真人備急千金要方》Vol. 58

The Daoist physician Sun the Perfected classifies pathogenic fluid retention into four types in Essential Formulas Worth a Thousand in Gold for Emergencies: phlegm-fluid, hanging fluid, overflowing fluid, and fluid lodged in the hypochondrium.

A person who was originally robust but gradually becomes thin, with sounds of fluid moving in the intestines, is said to have phlegm-fluid. After drinking, if fluid collects beneath the ribs and coughing or spitting up phlegm pulls at the area and causes pain, this is called hanging fluid. If someone drinks too much and fluid flows into the limbs, it should be expelled through sweating; when there is no sweating, the body becomes painful and heavy. This is called overflowing fluid. If coughing and counterflowing breath force a person to lean on something to breathe, with such shortness of breath that they cannot lie flat, and the body appears swollen, this is called fluid lodged in the hypochondrium.

People with fluid retention below the heart, near the pit of the stomach, often feel restless throbbing there, palpitations, and shortness of breath. They may feel afraid, become dizzy, or even experience disturbances of consciousness. If chills come first, the condition is usually one of deficiency; if fever comes first, it is usually one of excess. Fluid retention in different organs produces different signs. When it is in the heart, the area below the heart feels hard and throbs, breathing is short, and the person dislikes drinking. When it is in the lungs, the person spits up saliva but wants to drink. When it is in the spleen, there is little energy, fatigue, and heaviness throughout the body. When it is in the liver, the area beneath the ribs feels distended and full, and sneezing causes pain. When it is in the kidneys, there is throbbing below the heart.

If a patient suddenly drinks too much water, they may immediately develop labored breathing and distension in the chest and abdomen. Eating little but drinking much can cause fluid to collect below the heart: in severe cases there are palpitations, and in milder cases shortness of breath. A wiry pulse on both sides usually indicates cold. This is commonly seen after severe diarrhea, when the body is weak. A wiry pulse on only one side is more often due to pathogenic fluid. Fluid in the lungs does not necessarily produce a wiry pulse, but often causes labored breathing and shortness of breath. Fluid lodged in the hypochondrium can also cause wheezing, inability to sleep peacefully, and shortness of breath, even when the pulse sometimes remains normal.

When retained fluid flares up, there may be no obvious outward signs or fever, but the person feels mildly oppressed and distended and cannot eat. A deep, slippery pulse may also indicate retained fluid. Retained fluid can cause pain beneath the ribs that extends to the supraclavicular fossa, the hollow above the collarbone. The pain worsens with coughing; in severe cases, coughing makes it impossible to lie flat, and the pain extends to the neck. The body may also jerk with each cough, like a child having spasms.

People with retained fluid in the chest may have shortness of breath, thirst, and pain in the joints of the limbs. A deep pulse also points to retained fluid. Those with retained fluid below the heart often have a palm-sized patch of coldness on the back. Their shoulders rise and fall noticeably as they breathe, and their breath seems to pull upward. These may all be signs of overflowing fluid lodged in the chest. If it remains for a long time, the area above the collarbone may become distended, and a swelling known as “horse saber” may appear along the side of the neck…

When the illness is severe, it is caused by Qi-fluid retention (water and fluid that have accumulated in the body). Illness above the diaphragm causes fullness and oppression in the chest and diaphragm, shortness of breath, coughing, and vomiting.

During an attack, chills and fever alternate; the back aches, the patient feels cold, and tears flow involuntarily. The body trembles, and the muscles twitch on their own. In severe cases, there must be hidden fluid retention (water and fluid concealed in the body and unable to drain). One arm becomes unable to move, then after some time the condition shifts to the other arm. The pulse is deep and thready. This is not a wind disorder; there must be water and fluid in the upper burner (the chest and the regions above it). A weak pulse results when even slight exertion prevents the Qi of the nutritive and defensive systems (Qi that protects the body and maintains its normal functioning) from circulating freely. The condition will improve on its own in winter. Another version reads, “After a long time, it will improve on its own.”

For phlegm-fluid retention (a disorder caused by the accumulation of phlegm and retained fluids), treatment should use warm-natured medicines to restore balance.

Minor Pinellia Decoction: Treats deficiency-cold in the chest and abdomen, with roaming phlegm Qi surging upward and causing distention and fullness in the chest and hypochondria, inability to eat, and vomiting with reflux.

One sheng of Pinellia, one jin of fresh ginger, and four liang of dried tangerine peel.

Cut the three ingredients into pieces, decoct them in one dou of water, and reduce the liquid to three sheng. Divide it into three doses. For tightness in the chest or heart pain, add four liang of cassia twig. For abdominal distention and pain, add three liang of Chinese angelica. This decoction is especially suitable for people who are physically weak and for the elderly. Another version adds two liang of ginseng. Zhang Zhongjing’s formula contains neither dried tangerine peel nor ginseng.

Another formula: One sheng of Pinellia, one jin of fresh ginger, three liang of cassia twig, and one liang of licorice.

Cut the four ingredients into pieces, decoct them in seven sheng of water, and reduce the liquid to two and a half sheng. Divide it into three doses.

Licorice Decoction: Treats phlegm-fluid retention below the heart, with distention and fullness in the chest and hypochondria, dizziness, and blurred vision.

Two liang of licorice, three liang each of cassia twig and white atractylodes, and four liang of poria.

Cut the four ingredients into pieces, soak them overnight in six sheng of water, then decoct them and reduce the liquid to three sheng. Strain out the dregs. Take one sheng per dose, three times a day; urination should increase after taking it.

Ten Jujube Decoction: Treats suspended fluid retention (a disorder in which pathogenic fluids accumulate in places such as the chest and hypochondria). If purgation has already been used, this formula must not be used again. Upward surging Qi accompanied by sweating and coughing is generally caused by water and fluid retention. The formula is given in the “Coughing” chapter.

Minor Bluegreen Dragon Decoction: Treats overflowing fluid retention (a disorder in which pathogenic fluids spread to the body surface and limbs); it should be expelled by inducing sweating. The formula is given in the “Coughing” chapter. Fan Wang used Major Bluegreen Dragon Decoction.

Chinese Aristolochia Root Decoction: Treats branch fluid retention (water and fluid lodged between the chest and diaphragm). The patient has shortness of breath, fullness in the chest, focal distention and hardness below the heart, a dark complexion, and a deep, tight pulse. Use this formula when the illness has persisted for several dozen days and treatment by induced vomiting and purgation has failed to bring improvement.

Mu Fangji Decoction: Mu fangji, three liang; cassia bark, two liang; ginseng, four liang; and one piece of gypsum, about the size of an egg. Coarsely chop the four ingredients, add six sheng of water, and decoct until two sheng of liquid remain. Divide into two doses.

People with a weak constitution will recover after taking it. Those with a robust constitution may have a recurrence three days later; take another dose when this happens. If they still have not recovered, remove the gypsum and add four liang of poria and three ge of mirabilite. Add six sheng of water and decoct until two sheng of liquid remain. Strain out the herbs, then add the mirabilite and let it dissolve. Divide into two doses. A slight bout of diarrhea after taking it signals recovery. Another version omits the poria.

Houpo Dahuang Decoction: People who have drunk alcohol for a long time may develop a cough that progresses to coughing up blood. This is caused by excessive drinking over an extended period. If the pulse is weak, they may feel dizzy; if there is already retained fluid in the chest, they may feel tightness there. The prescription is: houpo, one chi; rhubarb, six liang; and immature bitter orange, four liang. Coarsely chop the three ingredients, add five sheng of water, and decoct until two sheng of liquid remain. Divide into two doses and take warm.

Tingli Dazao Xiefei Decoction: Used to treat shortness of breath caused by retained fluid in the chest. See the prescription in “The Lung Abscess Chapter.”

Minor Pinellia Decoction with Poria: When someone who is vomiting is not thirsty but later becomes thirsty, this indicates that the illness is about to improve. If they were thirsty at first but later become unthirsty, there may be retained fluid in the epigastrium; Minor Pinellia Decoction may be used. In another case, thirst followed by vomiting indicates water collecting in the epigastrium; use Minor Pinellia Decoction with Poria. This prescription treats sudden vomiting, fullness and oppression in the epigastrium, retained fluid between the chest and diaphragm, blurred vision, and palpitations. Use one sheng of pinellia, three liang of poria, and half a jin of fresh ginger. Coarsely chop the ingredients, add seven sheng of water, and decoct until one sheng and five ge of liquid remain. Strain out the herbs and divide into two warm doses. The Hu Qia Fang omits the poria and uses four liang of cassia bark instead.

Five-Ingredient Powder: This prescription may be used when a thin person feels a throbbing below the navel and brings up frothy saliva, accompanied by dizziness and blurred vision; these symptoms are caused by retained fluid. See the prescription in Volume Nine above.

Pepper-Seed Pill: Abdominal distension and dry mouth indicate water accumulating between the intestines; this prescription may be used. Use three liang each of pepper seeds, Mu fangji, and rhubarb, and two liang of tingli seeds. Grind the four ingredients into a fine powder and mix with honey to form pills the size of parasol-tree seeds. Take several pills before meals with a liquid.

If thirst persists after taking the pills, add half a liang of mirabilite to the pills. After taking the medicine for three days, gradually increase the dose. If saliva returns to the mouth and the thirst stops, stop increasing the dose.

Gansui and Pinellia Decoction: Used when the patient’s pulse is deep and hidden and they feel an urge to induce diarrhea. Although the condition eases somewhat after diarrhea, the area below the heart, around the stomach, remains hard and distended. This indicates that retained fluids are trying to leave the body, so this formula is used.

Three large pieces of kansui; twelve pieces of pinellia, boiled in one sheng of water until reduced to half a sheng; three pieces of peony; and one piece of licorice, about as thick as a finger, boiled in one sheng of water until reduced to half a sheng. Coarsely cut the four ingredients. Mix the pinellia and licorice decoctions with half a sheng of honey, making one and a half sheng in total. Boil down to eight ge and take as a single dose.

Major Poria Decoction: Treats phlegm and fluids congealed in the chest, tension and distension below the navel, nausea and vomiting, and inability to eat. It is also used for Wind-Water patterns, or edema caused by Wind pathogen and retained dampness.

Poria and atractylodes, three liang each; Chinese angelica, tangerine peel, and aconite, two liang each; fresh ginger, pinellia, and cinnamon bark, four liang each; and asarum, four liang (another version gives ginseng). Coarsely cut the nine ingredients. Add one dou of water and boil down to three sheng. Strain out the dregs and divide into three doses. Three courses of the medicine should bring improvement.

Poria Decoction: Treats distension from phlegm and fluids between the chest and diaphragm.

Poria, four liang; pinellia, one sheng; fresh ginger, one jin; cinnamon bark, eight liang. Coarsely cut the four ingredients. Add eight sheng of water and boil down to two and a half sheng. Divide into four doses and take the decoction after it has cooled. If cold symptoms are severe, add four liang of aconite. If there is distension from Qi, add twenty-one pieces of betel nut. This is the same formula as the one in the “Vomiting” section of the previous volume, but the ingredient quantities and adjustments differ.

Major Pinellia Decoction: Treats symptoms of cold phlegm and retained fluids that make the chest and diaphragm feel constricted.

Pinellia, one sheng; atractylodes, three liang; fresh ginger, eight liang; and poria, ginseng, cinnamon bark, licorice, and aconite, two liang each. Coarsely cut the eight ingredients. Add eight sheng of water and boil down to three sheng. Divide into three doses.

Pinellia Decoction: Treats phlegm and retained fluids, stagnant Qi, and acid regurgitation, in which stomach acid rises into the mouth.

Pinellia and evodia, three liang each; fresh ginger, six liang; and one piece of aconite.

Add water to the four ingredients above and simmer until five sheng have been reduced to two and a half. Divide into three doses. Elderly people and young children should each take half a dose at a time, three times daily.

Jujube Decoction: A formula for treating edema, fullness and distension in the chest and abdomen, and retained fluid.

Ten large jujubes; one liang each of kansui, rhubarb, scutellaria root, licorice, and euphorbia root; half a liang each of genkwa and sweet-scented genkwa.

Cut the eight ingredients into pieces. Add five sheng of water and simmer until one sheng and six ge remain. Divide into four doses and take on an empty stomach. Adjust the amount so that the bowels move readily after taking it.

Angelica Decoction: A formula for treating retained fluid, undigested food, and abdominal accumulations accompanied by diarrhea.

Two liang each of angelica root, ginseng, cinnamon bark, scutellaria root, licorice, peony root, and mirabilite; four liang of rhubarb; three liang each of fresh ginger and oriental waterplantain rhizome.

Cut the ten ingredients into pieces. Add one dou of water and simmer until three sheng remain. Divide into three doses.

Formula for Treating Phlegm and Fluid Retention, Undigested Food, and Dry Heaving

One liang each of ginseng, inula flower, tangerine peel, and asarum; two liang each of oriental waterplantain rhizome, atractylodes rhizome, apricot kernel, and immature bitter orange; three liang each of poria, bupleurum, fresh ginger, pinellia, and peony root.

Cut the thirteen ingredients into pieces. Add nine sheng of water and simmer until two sheng and seven ge remain. Divide into three doses and take three times daily.

Formula for Treating Phlegm and Fluid Retention in the Chest, Rumbling Fluid in the Intestines, Undigested Food, and Vomiting of Clear Fluid

Twelve betel nuts; four liang each of fresh ginger, apricot kernel, and atractylodes rhizome; eight liang of pinellia; five liang of poria; three liang of tangerine peel.

Cut the seven ingredients into pieces. Add one dou of water and simmer until three sheng remain. Strain out the dregs and divide into three doses.

Evodia Decoction: A formula for treating cold accumulation in the chest, vexation in the heart, fullness and distension in the chest and abdomen, churning fluid in the stomach that prevents eating, and pain extending from the heart and chest to the back.

Three liang of evodia fruit; four liang of pinellia; two liang each of cinnamon bark and ginseng; one liang of licorice; five liang of fresh ginger; twenty jujubes.

Cut the seven ingredients into pieces. Add nine sheng of water and simmer until three sheng remain. Strain out the dregs and divide into three doses, taken three times daily.

Note: Sheng, ge, and liang in the original are ancient units of measurement. The names, quantities, and preparation and administration instructions for the medicines in Daoist Canon formulas are retained as they appear in the original.

Phlegm, retained fluid, and cold accumulate between the chest and diaphragm and around the heart and abdomen. The area below the heart feels unsettled, as if water were sloshing there, causing a churning, oppressive discomfort. Sometimes there are rumbling sounds of fluid in the abdomen, excessive saliva, and clear fluid that flows from the mouth on its own. The ribs feel tense, swollen, and painful, and there is no desire to eat. These symptoms are all caused by weakness of Stomach Qi and invasion by cold pathogens. The pulse is often deep, wiry, fine, or slow; any of these patterns may be treated with the following formula.

Pinellia and ginger, five liang each; peony, three liang; poria, four liang; inula flower, asarum, tangerine peel, cinnamon bark, ginseng, licorice, and platycodon, two liang each.

Chop the eleven ingredients, add one dou of water, and decoct until three sheng of liquid remain. Divide into three doses. If the patient usually sometimes likes to drink water, use three liang of white atractylodes and omit inula flower. To promote bowel movements, add two liang of rhubarb; for a gentler harmonizing effect, use prepared rehmannia.

Formula for treating mixed cold and heat with long-standing accumulation: For a protracted illness with stagnation in the Stomach, inability to eat, and distention below the heart that feels as if there were water there.

Bupleurum, ginger, poria, and Pinellia, four liang each; licorice, immature bitter orange, and white atractylodes, three liang each; cinnamon bark, two liang.

Chop the eight ingredients, add eight sheng of water, and decoct until three sheng of liquid remain. Divide into three doses.

Bupleurum Decoction: Treats long-standing cold and accumulation in the chest that will not disperse, obstruction between the chest and diaphragm, chest pain, and impaired flow of Qi. It is used when cold and heat are out of balance in the Triple Burner—the functional system governing the upper, middle, and lower regions—and when appetite is diminished and food tastes bland. It is also suitable for aversion to cold with fever, a heavy feeling in the body, and reluctance to get out of bed.

Bupleurum, ginseng, Chinese angelica, licorice, and Pinellia, three liang each; rhubarb, saposhnikovia root, dwarf lilyturf, evodia, and baical skullcap, one liang each; ginger, four liang; forty apricot kernels.

Chop the twelve ingredients, add one dou of water, and decoct. Strain out the dregs and take three sheng of liquid in three doses. The Shenshi Formula records that twelve jujubes may be added if there is distention and fullness below the ribs. This formula is also suitable for promoting urination.

Inula Flower Decoction: Treats phlegm bound between the chest and diaphragm, with thick, glue-like saliva that cannot be swallowed and consequently prevents eating.

Inula flower, asarum, bupleurum, licorice, and poria, two liang each; ginger, eight liang; cinnamon bark, four liang; Pinellia, one sheng; five aconite tubers.

The nine ingredients above should be coarsely chopped. Add nine sheng of water and boil down to three sheng. Strain out the dregs and take in three divided doses.

Ginger and Sichuan Pepper Decoction: Treats accumulations in the chest, stagnant phlegm and fluid retention, reduced appetite, insufficient Stomach Qi, coughing with counterflow of Qi, and vomiting.

Seven he of ginger juice; three he of Sichuan pepper; one liang each of cinnamon heart, aconite, and licorice; two liang each of tangerine peel, platycodon root, and poria; and three liang of pinellia.

Coarsely chop the nine ingredients above. Add nine sheng of water and boil down to two and a half sheng. Strain out the dregs, then add the ginger juice and boil down to two sheng. Take in three divided doses. Three successive doses of the decoction are more effective. If taking a strong powder or any of the various Five Mineral Pills, it is best to take this decoction first, followed by Astragalus Pills. Another version omits licorice.

Ginger and Aconite Decoction: Treats cold phlegm and fluid retention, Qi stagnation with fullness in the chest, shortness of breath, vomiting of frothy saliva, headache, and inability to digest food.

Eight liang of fresh ginger and four liang of raw aconite, cut into four pieces.

Coarsely chop the two ingredients above. Add eight sheng of water and boil down to two sheng. Take in four divided doses. It is also used to treat sudden-onset wind disease.

Chest-Opening Powder: Treats phlegm and fluid retention lodged above the pit of the stomach, with internal excess cold causing distress in the chest.

Twenty-eight melon stalks, twenty-seven red beans, and one fen each of ginseng and licorice.

Grind the four ingredients above into a fine powder and sift. Take with wine, one square-inch spoonful per dose (an ancient measure for powdered medicine), twice a day. It also treats various forms of jaundice.

Diaphragm-Draining Decoction: Treats phlegm and fluid retention lodged in the chest.

Three liang of Dichroa root; one liang each of licorice and Usnea; and twenty-one melon stalks.

Coarsely chop the four ingredients above. Add one and a half sheng each of water and wine, and boil down to one and a half sheng. Take in three divided doses, gradually reducing the amount thereafter. If vomiting occurs readily after taking it, follow with the Pinellia Decoction (formula in the preceding chapter).

Usnea Decoction: Treats phlegm accumulation and heat patterns in the chest.

Two liang of Usnea; fourteen black plums and fourteen gardenia fruits; one liang of licorice; and three liang of Dichroa root.

Coarsely chop the five ingredients above and soak them overnight in three sheng of wine. The next morning, add three sheng of water and boil down to one and a half sheng. Strain out the dregs and take all at once, or divide into two doses. If vomiting occurs readily after taking it, stop taking the decoction.

Duheng Decoction: A Formula for Inducing Vomiting in Various Illnesses

Three liang each of Duheng and songluo, and thirty-seven guadi fruits.

Chop these three ingredients, soak them in one sheng and two ge of wine for two nights, then strain out the herbs. Take in two doses. If one dose induces vomiting, stop taking it. If there is no vomiting, take the second dose. Leave enough time between the two doses to walk about ten li. Once the medicine has taken effect and passed, drink one sheng of thin rice porridge, and the patient will settle down. This may also be used for the elderly and children.

Honey Decoction: A Formula for Cold and Heat Disorders

Five ge of honey, and two liang each of Changshan and licorice.

Chop the Changshan and licorice, add one dou of water, and boil until reduced to two sheng. Strain out the herbs, then add five ge of honey. Take seven ge warm; if vomiting begins, stop. If there is no vomiting, take another seven ge. Do not let the patient drink cold water. Another version of the formula uses half a liang of licorice.

Another Formula

Two ge of honey and eight ge of vinegar.

Mix the two ingredients thoroughly and take the whole dose at once in the early morning. After a while, waves of nausea will arise; at that point, induce vomiting. If the vomiting seems incomplete, take another dose the following morning. The patient will invariably vomit profusely and then settle down.

A Formula for Sudden, Splitting Headache

If a headache comes on suddenly and feels as though the head is splitting, and is caused neither by exposure to cold nor by windstroke, but by phlegm-fluid and rebellious Qi surging upward from the chest and diaphragm, it is called “Jue Headache.” Inducing vomiting can bring relief. The formula is:

Use only tea leaves, decocted as a tea drink, about two or three sheng in all. Let it cool until lukewarm, then drink two sheng first. After a while, induce vomiting. Once the vomiting is over, drink more and repeat this process several times. In severe cases, vomiting will continue until bile is brought up. The original text says this will not harm the body; if thirst arises, the symptoms will ease.

Scallion-White Decoction: A Formula for Headache, Chest Tightness, Restlessness, and Inability to Vomit During an Attack of Cold or Heat Phlegm-Fluid Between the Chest and Diaphragm

Twenty-eight stalks of scallion white, a handful of peach leaves (another account says to use loquat leaves), and half a liang each of pearl, Changshan, aconite, and licorice.

Chop these six ingredients, combine four sheng of water and four sheng of wine, and boil until reduced to three sheng. Strain out the herbs and add the pearl. Take one sheng at a time; stop once vomiting begins.

Large Five-Fluid Pill: For the Five Types of Fluid Retention

The first is called “retained fluid”: water remains below the heart. The second is called “congested fluid”: water accumulates beneath the two flanks. The third is called “phlegm-fluid”: water remains in the stomach. The fourth is called “overflowing fluid”: water overflows above the diaphragm and among the five viscera. The fifth is called “flowing fluid”: water remains in the intestines, where the intestines churn and rumble.

The five types of fluid retention arise after drinking alcohol and…

Formula for treating disorders caused by drinking too much cold water during an episode of cold damage

Cistanche, Polygala, Sophora root, Veratrum, cuttlebone, Atractylodes, Euphorbia kansui, rhubarb, gypsum, trichosanthes root, platycodon, pinellia, aster, peucedanum, schisandra, mirabilite, cinnamon bark, Daphne genkwa, Chinese angelica, ginseng, fritillaria, poria, peony, Euphorbia pekinensis, pepperweed, and scutellaria (one liang each); licorice, Dichroa, Chinese yam, magnolia bark, asarum, and aconite (three fen each); croton seeds (thirty).

Grind these thirty-three ingredients into a fine powder, mix with honey, and form pills the size of parasol tree seeds. Take three pills each time, three times a day. Gradually increase the dose until the body responds and the intended effect is achieved.

Inula Flower Pills

For disorders in which phlegm-fluid accumulates and becomes lodged along both sides of the ribs. The patient may have abdominal distension and fullness, become thin, lose the ability to eat, and have difficulty digesting food. They may often spit saliva and retch without vomiting. Urination and bowel movements may at times be obstructed and at other times loose. The abdomen may feel as though something is sloshing inside, with watery sounds. There may be heat within the abdomen, a dry mouth, and a desire to drink. The patient may also suddenly become dizzy, as if about to fall, and feel pain below the ribs.

Inula flower, cinnamon bark, immature bitter orange, and ginseng (five liang each); Euphorbia kansui (three fen); evodia, asarum, rhubarb, scutellaria, pepperweed, magnolia bark, Daphne genkwa, and tangerine peel (four fen each); dried ginger, peony, and Atractylodes (six fen each); poria, langdu, monkshood, and arsenolite (eight fen each).

Grind these twenty ingredients into a fine powder, mix with honey, and form pills the size of parasol tree seeds. Take five pills with wine each time, twice a day. Gradually increase the dose until the body responds and the intended effect is achieved.

The formula recorded in the Yan Nian Fang omits Atractylodes, langdu, monkshood, arsenolite, asarum, scutellaria, magnolia bark, evodia, Daphne genkwa, tangerine peel, and Euphorbia kansui. It adds soapberry and aconite, two fen each; Sichuan pepper, siler, and apricot kernels, three liang each; and dried Rehmannia, four fen.

Central Army Marquis Black Pills (another version has “li” instead of “black”)

For disorders in which phlegm-fluid accumulates and becomes lodged without dispersing, causing fullness and oppression in the chest and abdomen, and dimmed vision.

Daphne genkwa (three liang), croton seeds (eight fen), apricot kernels (five fen), cinnamon bark and platycodon (four fen each).

The original text ends here; the remaining ingredients and instructions for use have not been copied.

Grind the five ingredients above into a fine powder and mix with honey to make pills the size of broad beans. Take three pills daily, gradually increasing the dose until bowel movements become easy.

Flow-Following Purple Pills: Used to treat accumulations in the chest and abdomen, distension and fullness in the flanks, retained fluids and phlegm-fluid, difficulty urinating or defecating, severe pain in the lower abdomen, and blockage between the chest and diaphragm.

Ingredients: gypsum, five fen; ochre (hematite) and cuttlebone, three fen each; pinellia, three fen; cassia bark, four fen; and seven croton seeds.

Grind the six ingredients above into a fine powder and mix with honey to make pills the size of broad beans. Take one pill at dawn, increasing to two. Hu Qia’s version also includes three fen each of veratrum, cistanche, and Chinese angelica. Fan Wang’s version omits gypsum and pinellia, and instead includes one fen of Chinese angelica, three fen of poria, two fen of cistanche, and five fen of veratrum.

A formula for treating phlegm-fluid that has stagnated and congealed in the flanks, abdominal distension, emaciation, inability to eat, difficulty digesting food, frequent spitting, dry retching, and bowel movements that are sometimes obstructed and sometimes free:

Inula flowers, rhubarb, aconite, poria, prickly ash seeds, cassia bark, genkwa, langdu, dried ginger, peony, immature bitter orange, and asarum, eight fen each.

Grind the twelve ingredients above into a fine powder and mix with honey to make pills the size of parasol tree seeds. Take three pills with water, three times daily, gradually increasing the dose thereafter.

A formula for wind-qi and phlegm-fluid above the chest and diaphragm:

Take an unopened bitter gourd, boil it in water for three to five boils, then wrap it in cloth. While hot, apply it to the chest and diaphragm.

A formula for treating accumulations, retained fluids and phlegm-fluid, fullness in the chest, and food that does not digest:

Apply fifty moxa cones at the Tonggu acupoint. A “cone” is a unit of moxibustion measurement, referring to the amount of moxa burned in one application.

Seventh: The Nine Worms (an ancient classification of intestinal parasites)

The treatise says: A person’s abdomen contains a corpse worm, which is born together with the person and causes great harm. It is shaped like a thick horse’s tail, sometimes like a slender tendon. It dwells near the spleen, has a head and tail, and is three cun long.

There are also nine kinds of worms. The first is called the hidden worm, four fen long. The second is the roundworm, one chi long. The third is the white worm, one cun long. The fourth is the flesh worm, shaped like a rotting apricot. The fifth is the lung worm, shaped like a silkworm. The sixth is the stomach worm, shaped like a toad. The seventh is the weak worm, shaped like a melon segment. The eighth is the red worm, shaped like raw meat. The ninth is the pinworm, extremely small and shaped like a vegetable caterpillar. The hidden worm is the leader of the other worms. When a roundworm travels to the heart, it causes death…

The worms continue to multiply, and their offspring grow more numerous. The mother worm also gradually grows larger, reaching up to four or five zhang in length, and can even kill a person. The flesh worm causes oppressive discomfort and distension; the lung worm causes coughing; and the stomach worm causes vomiting, upward reversal of stomach Qi, and frequent retching. The weak worm, also called the diaphragm worm, causes excessive phlegm; the red worm causes rumbling in the intestines. Pinworms dwell in the intestines. When they become numerous, they can cause hemorrhoids, and in severe cases may bring on leprosy. If worms encounter sores on the body, they can give rise to all kinds of abscesses, ulcers, ringworm, fistulas, scabies, tooth decay, and other illnesses—there is almost nothing they cannot cause.

Not everyone necessarily has all these worms in their body. Even when they are present, they are not always numerous: some people have more, some have few, and some have none. Women often have more worms in their bodies. These worms are fierce and pose a grave threat to human health. It is beneficial to bathe regularly with baidian grass, an aromatic herb; both its roots and leaves may be used. The herb is fragrant, and corpse worms fear it.

Commentary: Whenever one intends to take tonifying medicines or treat any kind of illness, one must first clear the body of worms, phlegm-fluid, accumulated stagnant matter, and the like, so that these pathogenic factors are completely eliminated. Only then should tonifying medicines be taken. Otherwise, the medicines will not be effective.

Prescription for treating liver taxation and worms growing in the liver: In this condition, worms grow in the liver, causing fear and agitation.

Wax; the east-facing root bark of Wu Zhuyu (two liang each); dry lacquer, four liang; five eggs, yolks removed; and half a jin of nonglutinous rice flour.

Pound the Wu Zhuyu root bark into powder. Combine it with the other ingredients in a copper vessel and boil them together, then form pills the size of small beans. Fast the night before, then take one hundred pills with water early the next morning; children should take fifty. The worms will decay and be expelled. (The Jiyan Fang omits Wu Zhuyu root bark and calls the prescription “Egg Pill.”)

Prescription for treating heart taxation and heat pathogens damaging the heart: A long worm called “Gu” lives in the heart. It is one chi long and pierces through the heart, causing illness.

Leiwan, dried tangerine peel, peach kernels (one account says peach bark), and stone silkworm (five fen each); langya, six fen; two pieces of guanzhong; thirty-seven stiff silkworms; Wu Zhuyu root bark, seven fen; wuhuang, qingxiang, and dry lacquer (four fen each); and a mass of tangled hair, burned to ash, equal in size to an egg.

Grind the twelve ingredients into powder and use honey to form pills the size of wutong seeds. Take seven pills on an empty stomach with bitter wine, gradually increasing to fourteen pills, twice a day. Another version of the prescription omits stone silkworm.

Prescription for treating spleen taxation and illness caused by heat pathogens: White worms live in the spleen, causing a person to vomit frequently and expel the worms.

Large hemp seeds (eight sheng), the root of east-growing Evodia (one large root, one chi), and tangerine peel (two liang).

Coarsely chop these three ingredients and simmer them in water. Take an appropriate amount when using. Keep quiet while preparing the medicine and do not discuss how it is made. It is said that if the worms hear, they will not be expelled; this must be strictly avoided.

A prescription for treating heat from lung taxation and worms in the lungs:

Wolf’s teeth (three liang), the white bark of the root of an east-growing mulberry (chopped, one sheng), and the white bark of the root of an east-growing Evodia (five he).

Coarsely chop these three ingredients and simmer them in seven sheng of wine until one sheng remains. Take the entire dose in the early morning.

A prescription for treating heat from kidney taxation, severe swelling in the limbs, and disorders caused by pinworms in the kidneys that resemble vegetable worms:

Ulmoides seed, lead powder, and pagoda-tree bark (one liang each); dried lacquer (two liang); cyrtomium (three pieces); apricot kernels (forty); and Evodia (fifty).

Grind these seven ingredients into a fine powder and sift. In the early morning, take one fangcun spoonful—the ancient measure for powdered medicine, approximately one spoonful—with freshly drawn well water. Gradually increase the dose to one and a half spoonfuls. Stop taking it once the illness is cured.

A prescription for treating pinworms:

Take two liang of fine, high-quality salt and half a sheng of bitter wine (vinegar). Boil them for several boils in a bronze vessel. Fast from the previous evening, then take the entire dose on an empty stomach the next morning.

Another prescription:

Pearls (two liang) and a quantity of tangled hair about the size of an egg, burned to ash.

Grind these two ingredients into a fine powder and sift. Mix with bitter wine and take it in the early morning after getting up. The Emergency Formulas to Keep Up One’s Sleeve records this prescription as a treatment for the three worms.

Miwu Pills: A prescription for children with roundworms in the abdomen, recurring abdominal pain, mild diarrhea with white discharge, vomiting, chest oppression, alternating chills and fever, undigested food, easy hunger, thin, yellowed skin and flesh, and weakness in the limbs:

Miwu, cyrtomium, thunder ball, Chinese cornel, asparagus root, and wolf’s teeth (eight fen each); reed rhizome and wild chrysanthemum flowers (four fen each).

Grind these eight ingredients into powder and form pills with honey, each about the size of a soybean. Give children aged three five pills per dose; for children over five, adjust the amount as appropriate, gradually increasing to ten pills. If six fen of reed rhizome is added, the prescription is called “Reed Rhizome Pills.” It is said to treat various disorders in older people, children, and women, including irregular cold and heat in the abdomen, obstructed Qi flow, sudden abdominal distension and pain, tightness and fullness in the chest and diaphragm, and irritability with heat in the hands and feet.

Note: The original text breaks off at the word “above”; the following text is not included.

These remedies can treat impaired Qi circulation, inability to eat, swelling of the body, stiffness in the lower back and legs, sounds in the abdomen like the croaking of a water frog, and irregular menstruation in women.

Formula for treating roundworms

Grind guanlu into a powder and mix it with rice broth or meat soup. Take one fangcun bi (an ancient measuring spoon for medicines, holding about a spoonful). If you notice no effect, gradually increase the dose.

The Beiji Fang records that this formula is used to treat pinworms.

Formula for treating fever and restlessness caused by roundworms

Guanlu, ten parts; dry lacquer, two parts; bianxu, two parts.

Grind these three ingredients into a fine powder and sift it. Mix with rice broth and take one he per dose, three times a day.

Formula for treating roundworms in the stomach that cause progressive weight loss

Strong wine, top-quality dry lacquer, and white honey, one sheng of each.

Put these three ingredients in a bronze vessel and simmer over low heat until the mixture can be rolled into pills. Make one pill about the size of a peach pit. Swallow it with warm wine, then do not eat for the rest of the night. Take it the next morning, and the worms will be expelled. If they are not expelled, take another dose. The Waitai Miyao records that this formula is used to treat pinworms.

Another formula

Take lian shi and soak it in pure vinegar for two nights. Wrap it in cotton cloth and insert it about three cun into the anus. Replace it once a day. The Jiyan Fang records that this method is used to treat long worms.

Formula for treating roundworms that attack the heart and cause abdominal pain

Chop two jin of yiyi root. Boil it in seven sheng of water until three sheng remain. Take it before eating; the worms will die and be expelled.

Another formula

Take heshi on an empty stomach, mixed with vinegar to the amount of one fangcun bi. It is quite effective.

Another formula

Gather jili seeds on the seventh day of the seventh month, dry them in the shade, and burn them to ash. Before meals, take one fangcun bi each time, three times a day, and the condition will be cured.

Formula for treating cunbai worms (tapeworms)

Take a handful of the fine roots of Wu zhuyu and crush them. Take three sheng of hemp seeds, roast them, and grind them into a powder.

Add three sheng of water to these two ingredients. Rub and knead them, then strain out the juice. Drink it all at dawn. At the hour of Si (between nine and eleven in the morning), give the patient a good meal and let them eat until full. The worms will soon be expelled. If the condition is not cured, prepare and take the medicine again the next morning. If it is still not cured, continue taking it for three days. The Zhouhou Fang records that soaking the ingredients in this formula in wine and drinking the strained liquid can treat three kinds of worm disease.

Another formula

Yuyi, six parts; langya, four parts; bailian, two parts.

Grind these three ingredients into a fine powder and sift it. Add two he of vinegar and mix well. Let it soak overnight, then take it on an empty stomach the next morning.

Yet another formula

One sheng of sesame seeds and one liang of husai.

Grind the two ingredients above into a powder. The next morning, take it on an empty stomach with pork broth. After taking it, the patient should recover.

Another prescription: Take forty-nine peeled Chinese torreya seeds. On a morning during the first ten days of the lunar month, take seven on an empty stomach, continuing for seven days until they are all gone. The worms will dissolve into liquid, and the illness will be completely cured.

Another prescription: Take the roots of a northern, shaded-growing Chinese prickly ash tree. Dry them in the sun, remove the soil, and chop them. Measure out one sheng and soak it overnight in one sheng of wine. The next morning, take it in two doses. Choose fine roots; those that grow eastward in a northern, shaded place are best. Do not use roots thicker than a finger.

Another prescription: Use pomegranate root, prepared in the same way as Chinese prickly ash root. It may also be boiled in water and taken.

Another prescription: Grind hemp seeds and extract their juice, making a total of five sheng. Divide it into five doses. (This also treats roundworms in children.)

Another prescription: Take two sheng of good-quality sesame oil and heat it until cooked. Add a scallion white three cun long. When the scallion white turns black, the oil is ready. Let it cool, then take it all at once.

Another prescription: Cook maltose until very dry, then grind it into powder. Each time, take one square-inch spoonful—the capacity of an ancient small medicinal spoon—and mix it into mutton broth.

Another prescription: Chop three sheng of mulberry root bark. Add seven sheng of water and boil until two sheng remain. Do not eat the night before; take the full amount on an empty stomach the next morning. The Zhouhou Fang says that sudden diarrhea with worms visible in the stool means there are many worms in the abdomen, and they should be dealt with quickly.

Another prescription: Crush and sift twenty betel nuts. First, boil the betel nut husks in two and a half sheng of water until one and a half sheng remain, then strain out the dregs. Add the powdered betel nut and take it warm in several doses. Then lie down warmly; the worms will be expelled. If they are not all expelled, prepare and take another dose, continuing until cured. Do not eat the night before; take the medicine the next morning.

On the condition: During cold damage or seasonal febrile illness, there is heat in the abdomen. Because the patient eats little and the intestines and stomach are empty, the “three worms”—the ancient general term for parasites in the body—become active and seek food, gnawing at the Five Viscera and the lower body. If the gums look abnormal and the tongue is entirely white, and, in severe cases, sores appear inside the lips, the limbs feel heavy, and the patient is dazed and drowsy, carefully examine the inside of the upper lip for sores. Blood-tinged saliva, tiny millet-like sores inside the lips, and feelings of agitation, pain, and tightness in the chest indicate that the worms are in the upper body and are gnawing at the Five Viscera. Sores inside the lower lip and a tendency to fall asleep indicate that the worms are in the lower body and are gnawing at it. People often fail to notice these signs. They may take this kind of worm-killing medicine; otherwise, gu worms may cause death.

It is also said that people with shini, an ancient term for a kind of damp-heat parasitic illness, often develop it after a febrile illness. It may also result from prolonged diarrhea, external pathogenic heat becoming trapped in the abdomen, or moving to a different region and being unaccustomed to its local conditions.

Exposure to hot or cold-damp influences often brings on this illness. In some cases, there is no obvious diarrhea, but sores and itching develop around the anus. If the illness persists, it may become life-threatening. When Dampness meets cold and causes severe diarrhea, Coptis root may be boiled on its own, or medicines such as mugwort leaves and Sophora root may be used.

If the patient’s gums have lost their color, the tongue coating is white, they are constantly drowsy or mentally clouded, they cannot tell where they feel pain or itching, or they are having diarrhea, treat the lower-body illness at once. If this is not understood and treatment focuses only on the upper body, neglecting the lower body, worms may develop around the anus. They can eat away at the anus, and if the decay reaches deep into the five zang organs, the patient will die. Light mugwort leaves and place them in a bamboo tube to fumigate the affected area.

Prescription for treating worm illness associated with cold damage

Take one raw egg, crack open its narrow end, and pour out the white. Add one ge of lacquer and stir thoroughly until many bubbles form. Pour the mixture back into the eggshell, tilt the head back, and swallow it. After about the time it takes to eat a meal, or after half a day, worms will be vomited or passed in the stool. If the illness is severe, take the dose once more. Once the worms have been expelled and the fever has subsided, the illness will be cured.

Prescription for treating Dampness-related worm illness

Coptis root, ten liang; fresh ginger, ten liang; mugwort leaves, eight liang; Sophora root, four liang.

Chop the four ingredients, boil them in one dou of water, and reduce the liquid to three sheng. Divide it into three doses. If the illness has lasted a long time, take three courses.

Aonongsan: prescription for treating sores and decay caused by Dampness-related worm illness, and for killing and expelling worms

Bian bamboo, half a liang; Huanlu, Leizhu, Qingxiang, Nüqing, and peach kernels, three liang each.

Grind the six ingredients into a fine powder. Take one square-inch spoonful with rice gruel, three times daily for seven days; then increase the dose to two square-inch spoonfuls each time. It may also be taken with wine.

Qingxiang Powder: prescription for treating sores caused by worms in the lower body during a febrile illness

Qingxiang seeds, one liang; tangerine peel and Bian bamboo, two liang each; Huanlu, four liang; licorice, one fen; Langya, three fen.

Grind the six ingredients into a fine powder and mix with rice water. Take one ge per dose, three times daily. If the illness persists, gradually increase the dose. (The version recorded in the Xiaopin Fang does not include licorice.)

Ginger and Honey Decoction: prescription for treating Dampness-related worm illness

Fresh ginger juice, five ge; white honey, three ge; Coptis root, three liang.

First boil the Coptis root separately in two sheng of water and reduce the liquid to one sheng. Strain out the herbs, then add the ginger juice and honey. Continue boiling until the liquid is reduced to one sheng and two ge. For a five-year-old child, give four ge on an empty stomach in the morning, twice daily.

A prescription for treating parasites that erode the lower part of the body, cause anal itching, or produce sores

Take two liang each of donkey-hide gelatin, Chinese angelica, and Celosia seeds, and one handful of mugwort leaves. Coarsely chop the four ingredients. Boil them in eight sheng of water until two and a half sheng of liquid remain. Strain out the dregs and divide the medicine into three doses.

Apricot Kernel Decoction: For parasitic disease

Take fifty apricot kernels, two sheng of bitter wine (vinegar), and one he of salt. Mix the three ingredients and boil them until five he of liquid remain. Drink the entire dose at once. Reduce the amount as appropriate for a child.

Peach Bark Decoction: For pinworms, roundworms, and parasites that invade hemorrhoids, erode the lower part of the body, and cause sores

Take one liang each of peach bark and mugwort leaves, three liang of sophora seeds, and thirty jujubes. Coarsely chop the four ingredients. Boil them in three sheng of water until half a sheng of liquid remains. Drink the entire dose at once. The book says this works very well.

Pig Bile and Bitter Wine Decoction: For parasites that wander up and down during a febrile illness and may prove fatal

Take one pig’s gallbladder and half a sheng of bitter wine. Mix them and heat over a flame until boiling; repeat this three times. Once the medicine is prepared, let it cool until warm. On an empty stomach, drink three large mouthfuls. The book says the illness will resolve once the parasites are dead.

A prescription for sores on the lower part of the body and parasites that erode the Five Viscera during a warm disease

Take one fen each of realgar and Chinese honeylocust fruit, and two fen each of musk and cinnabar. Grind the four ingredients into powder, mix with honey, and pound ten thousand times. At the onset of illness, take one pill with wine twice a day. Each pill should be about the size of a Chinese parasol tree seed. If sores appear on the lower part of the body, place powder the size of a parasol tree seed at the affected site twice a day.

A prescription for sores on the lower part of the body

Boil peach bark down until it becomes thick like syrup, then apply it to the lower part of the body. If sores appear in the mouth, it may also be held in the mouth.

A prescription for damp parasite disease

Take fresh ginger, scrape off the skin, chop it, and grind it thoroughly. Extract one and a half sheng of juice, then add one and a half sheng of water and mix well. Drink it in the morning on an empty stomach. Also cut two pieces of fresh ginger about the size of silkworm cocoons. Wrap them in several layers of Chinese catalpa leaves and bitter peach leaves, then place them in the ash of a hearth fire until very hot. Insert them into the lower part of the body and leave them there for the time it takes to eat a meal. If the dampness is severe, repeat this for three consecutive mornings and take the medicine frequently. The book says this method never fails to cure the condition.

Another prescription

Take two liang of indigo naturalis, one liang each of Chinese goldthread, Amur cork tree bark, and cloves, and two fen of musk. The original text ends here and gives no instructions for preparation or use.

Grind the five medicines listed earlier into a fine powder and roll it into pills about the size of small dates. Insert one into the anus once a day. For more severe cases, mix a date-sized portion of the powder with two or three he (a measure) of cart grease and administer it into the anus twice a day.

Realgar Powder: For anal worm infestation and sores caused by seasonal epidemic illness. Use half a liang of realgar, one liang of peach kernel, and three liang each of Celosia seed, Coptis, and Sophora root. Grind the five medicines into a fine powder, wrap it in cotton cloth to make a date-stone-sized packet, and insert it into the anus. Alternatively, take it with jujube juice: one square-inch spoonful each time, three times a day.

A remedy for worm disease: Burn horseshoe to ash and grind it into powder. Mix it with pig fat, smear it on a cotton cord, and insert the cord into the anus four or five times a day.

A remedy for itching caused by worms deep in the anus: Mash steamed jujubes into a paste and mix with mercury. Shape it into a strip three inches long, wrap it in cotton cloth, and insert it deep into the anus at night. The next morning, the worms are said to come out. The original text also warns that mercury can damage the intestines and should be used with caution.

A remedy for worms eating into the anus: Take equal parts white lead and realgar, grind them into a fine powder, and apply it at the anal opening. It may also be used for children.

A remedy for drowsiness following a febrile illness, progressing to dampness-related infestation (a condition the original calls a type of pathogenic dampness associated with worms), with aching and distress in the limbs and inability to eat: Take ten jin of Chinese bittersweet, chop and crush it, and soak it in three dou of warm water. At midday each day, have the patient sit in it for about the time it takes to eat a meal. The text says that no more than three treatments are needed for recovery.

When a febrile illness causes “gu poison” (a pathogenic toxin described in the original), the patient becomes drowsy, cannot tell where the pain is, has a flushed face like a drunkard, and suffers diarrhea with pus and blood. The patient’s anal openings should be examined repeatedly. If there are fine red marks there (another edition reads “sousou ran,” describing something similar), this indicates infestation sores; severe cases can be fatal. If medicine does not work, fumigation may be used: make a clay jar that holds one sheng, and take a bamboo tube about as thick as a finger. Pass one end through the side of the jar and insert the other end shallowly into the patient’s anus. Put a cooked mugwort ball about the size of an egg into the jar and light it. Blow through the mouth of the jar to direct the smoke into the patient’s body, stopping when the mugwort has burned away. The amount of mugwort may be increased somewhat for adults and reduced for children. Do not use too much on a frail patient, as an excessive amount can also cause harm. Fumigate twice a day, no more than three times in all; the text says this will kill the worms and stop the diarrhea. Realgar may also be ground into powder, burned, and used for fumigation in the same way.

These are ancient treatments recorded in volume 58 of Sun Zhenren’s Essential Prescriptions Worth a Thousand in Gold for Emergencies. Mercury, realgar, fumigation, and medicines administered into the anus all carry serious risks and should not be taken as modern medical advice.