《孫真人備急千金要方》Vol. 59

The kidneys govern the storage of essence and are the foundation of the vital energy received at birth. If the body is compared to a palace court, the kidneys are like the inner officials of the harem, overseeing its affairs. Heaven bestows De (Virtue) on human beings, and Earth bestows their vital energy. When De and Qi (vital energy) blend, life comes into being. The original foundation of life is called “essence,” which the kidneys store.

The ears are the kidneys’ sensory orifices, and kidney Qi connects with them. When kidney Qi is balanced and abundant, the ears can hear all kinds of sounds. The kidneys open into the ears: kidney Qi rises to connect with the ears and descends to the genital region. The left kidney belongs to Ren, and the right to Gui. Kidney Qi circulates along pathways within the body: it rises through the ear passages, enabling a person to hear distant sounds; then it descends and curves around the “Jade Sea” (a term for a related area of the lower abdomen), runs along both sides of the spine opposite the navel, and passes through the Upper, Middle, and Lower Burners (the three functional regions of the body in Chinese medicine), where it nourishes and protects. The kidneys govern the bones externally and are connected internally with the urinary bladder.

The two kidneys together weigh one jin and one liang. Their spirit is called “Piaopiao,” and it governs the storage of essence and Qi, which is why the kidneys are also called the “essence storehouse.” Kidney essence responds to the body’s seasonal rhythms; this is why it is said that the kidneys store essence. Essence resides in the kidneys, and intent is also associated with them. The bodily expression of kidney Qi is yawning, and the fluid produced by the kidneys is saliva.

When kidney Qi is weak, a person may experience a disorderly flow of Qi; when it is excessive, there may be distension and fullness. A dark color in the limbs is also associated with the kidneys. When kidney Qi is deficient, a person may dream of boats, people drowning, or lying face down in water and feeling afraid. When kidney Qi is abundant, a person may dream that the two sides of the lower back seem separated and disconnected. If rebellious Qi invades the kidneys, a person may dream of standing at the edge of a deep abyss or sinking beneath the water.

In the system of organ correspondences, the kidneys belong to Water and are paired with the urinary bladder, which is their associated bowel organ. The Kidney channel is the Foot Shaoyin channel and is paired internally and externally with the Taiyang Bladder channel. The kidney pulse is deep, corresponds to autumn, and is at its strongest in winter. In winter, all things store themselves away and insects lie dormant; Yang Qi sinks while Yin Qi rises. Yang Qi is hidden within, and Yin Qi grows cold and congeals into frost, no longer rising and eventually turning to frost and snow. Fierce animals lie dormant and insects conceal themselves, so the pulse too becomes deep and hidden. A deep pulse indicates that the illness is internal and Yin in nature; at such a time, one must not induce sweating. To force sweating would be like driving dormant insects out into frost and snow.

When Yin Qi is at the body’s surface and Yang Qi is concealed within, caution is needed: purgation must not be used. Purgation can injure the Spleen, weakening Spleen Earth, and causing Water Qi to move erratically. This is like a fish leaving the water or a moth plunging into boiling liquid. When pathogenic Qi is deeply lodged inside, treatment by steaming is also inadvisable; steaming may drive the Qi into disorder and cause panting. The final sentence is incomplete in the original, so its meaning cannot be fully determined.

When the mouth is ulcerated and the Yin vessels become lax, the blood is scattered and does not flow smoothly. The Qi of Upright Yang then declines, and the Qi of Jueyin cannot circulate. External pathogenic heat takes the opportunity to enter the body and become congested in the chest. The Spleen Qi also weakens, leading to clear, watery urine and dysentery. The thread of this passage is not very complete, so its original meaning is difficult to determine precisely.

The pulse in winter should lie deep, like the nutritive Qi hidden within. The winter pulse belongs to the Kidneys, which correspond to Water in the north. In winter, all things draw inward and lie in concealment. Thus, a normal winter pulse comes deep and forceful; this is called “nutritive.” What happens when the pulse is the opposite? If the pulse Qi comes on as hard and rapid as a stone being struck, it is called excessive, and the illness is on the body’s exterior. If the pulse Qi departs quickly, it is called deficient, and the illness is within. An excessive pulse can cause the sinews and vessels to contract, pain beside the spine, shortness of breath, and reluctance to speak. A deficient pulse can make the heart feel unsettled, as though one were starving, with coldness between the ribs, pain in the spine, fullness in the lower abdomen, and urine that turns reddish yellow.

When the Kidney pulse comes continuously and gently, like a curved hook, and remains firm under pressure, it is a normal pulse. In winter, the Stomach Qi is the foundation for pulse diagnosis. If the Kidney pulse is like a vine being pulled, growing harder under pressure, this indicates Kidney disease. If the Kidney pulse is like a taut cord suddenly snapping, with rapid beats like a stone being struck, it is a death pulse showing that Kidney Qi is about to be exhausted.

The true death pulse of the Kidneys beats hard and sometimes stops. Its rapid throbs feel like a finger flicking a stone. The complexion is yellowish black and dull, and the body hair falls out. These are signs of impending death.

A winter pulse with a slight quality of the stone pulse and Stomach Qi is normal. A pronounced stone pulse with weak Stomach Qi indicates Kidney disease. A stone pulse alone, without Stomach Qi, is a death pulse. A pulse with the quality of the hook pulse indicates that illness may arise in summer; if the hook pulse is especially pronounced, it indicates illness in the present. People depend on Water and the five grains for life; if Water and grain are cut off, they die. Likewise, if there is no Stomach Qi in the pulse, they die. To have no Stomach Qi means that only the pulse of the organ itself is present, without the Stomach Qi that harmonizes it. A pulse that lacks Stomach Qi means that the Liver pulse shows no wiry quality, or the Kidney pulse no stone-like quality.

The Kidneys store Jing, and Jing is where a person’s will is lodged. Unchecked rage harms the will. When the will is damaged, a person may easily forget what they have just said, and may also suffer pain in the lower back and spine and be unable to bend or straighten. The body hair withers and the complexion grows dull; death may occur in the last month of summer.

When the Qi of the Foot Shaoyin Kidney Channel is cut off, the bones wither. Foot Shaoyin corresponds to the winter pulse. Kidney Qi lies deep and circulates, nourishing the bone marrow. When the marrow is not nourished, the muscles can no longer attach to the bones. Unable to support one another, the muscles loosen and recede. As a result, the teeth appear longer and accumulate grime, while the hair loses its luster. Dull hair indicates that the bones have begun to decay. The illness worsens on a Wu day and death comes on a Ji day, because Earth overcomes Water.

When the Kidneys are about to be exhausted, the pulse feels hard under light pressure but scattered under heavy pressure, like a pellet rolling beneath the fingers. It sinks deeper the harder it is pressed, all the way to the cubit position. This is a death pulse.

In winter, Kidney Water is in season. The normal pulse should be deep, gentle, and slippery. If instead the pulse is slightly rough…

If the Kidney pulse feels short and hurried, this means Lung Qi is attacking Kidney Qi. The parent organ is affecting its child organ, so this is a Vacuity pathogen. Even if illness develops, it is relatively easy to treat.

If the pulse is instead wiry, fine, and long, this means Liver Qi is attacking Kidney Qi. The child organ is affecting its parent organ, so this is a Repletion pathogen. Even if illness develops, it will improve on its own.

If the pulse is instead large and moderate, this means Spleen Earth is restraining Kidney Water. This is a Thief pathogen and a severe counterflow pattern; in eight or nine cases out of ten, it cannot be treated successfully.

If the pulse is instead floating, large, and surging, this means Heart Fire is encroaching on Kidney Water. This is a Slight pathogen. Even if illness develops, it will quickly resolve.

If the Yin pulse at the Chi position, beyond the left-hand Guan position, is absent, this indicates that the Kidney pulse has declined and failed. The patient often feels heat on the soles of the feet and tightness along the inner thighs. This is caused by depletion of Jing and Qi, and can be brought on by even slight exertion. Needling the Foot Taiyang channel can regulate Yang Qi.

If the Yin pulse at the Chi position, beyond the left-hand Guan position, is full and forceful, this indicates Kidney repletion. The patient may feel dazed, become forgetful, see dimly, or be deaf; they may feel distressed and often hear ringing in the ears. Needling the Foot Shaoyin channel can regulate Yin Qi.

If the Yin pulse at the Chi position, beyond the right-hand Guan position, is absent, this indicates that the Kidney pulse has declined and failed. The patient often has coldness rising in the feet, with Qi surging upward into the chest and causing pain. They may also dream of entering water or seeing ghosts and strange beings, or be startled by nightmares in their sleep and dream of something black covering them. Needling the Foot Taiyang channel can regulate Yang Qi.

If the Yin pulse at the Chi position, beyond the right-hand Guan position, is full and forceful, this indicates Kidney repletion. The patient may have bone pain and pain in the lower back and spine, along with sensations of heat and cold within the body. Needling the Foot Shaoyin channel can regulate Yin Qi.

The Kidney pulse is deep, fine, and tight. If there are two rises and falls for each beat, the pulse is normal; three indicate a pulse departing from the channel; four indicate loss of Jing and Qi; five indicate imminent death; six indicate that life is about to end. This is the pulse of the Foot Shaoyin channel.

If the Kidney pulse is excessively rapid, it can readily cause bone flaccidity or epilepsy. If it is somewhat rapid, there may be running-piglet Qi—a disorder in which Qi surges upward from the lower abdomen—coldness in the hands and feet, and inability to bend or straighten the legs. If the pulse is excessively deep and slow, it can readily lead to spinal fracture. If it is somewhat slow, there may be severe diarrhea, with food undigested and vomited back up after swallowing. If the pulse is excessively surging and large, it can readily cause impotence. If it is somewhat large, there may be stone-water disease, a disorder like abdominal dropsy, with swelling extending from below the navel into the lower abdomen. The abdomen hangs heavily downward, and the swelling then spreads upward to the stomach region. This is difficult to treat successfully. If the pulse is excessively fine and small, it can readily cause severe diarrhea. If it is somewhat fine and small, it may lead to wasting-thirst disease. If the pulse is excessively slippery, it can readily cause urinary retention or dribbling urination. If it is somewhat slippery, it may cause bone flaccidity, inability to rise from a seated position, blindness, or dark spots before the eyes. If the pulse is excessively rough and choppy, it can readily cause a large abscess. If it is somewhat rough, it may lead to absent menstruation or deep-seated hemorrhoids.

If the Kidney pulse beats firm and long and the complexion is yellow tinged with red, there may be wrenching pain in the lower back. If the Kidney pulse is weak and scattered, this may indicate a deficiency of blood. When a black Kidney pulse appears, with the upper part of the pulse firm and large, this indicates a gathering of Qi in the lower abdomen and genital region. This is called “Kidney impediment.” The condition may result from exposure to cold water while bathing, followed by lying down to sleep.

Bian Que said: “When the Kidney is diseased, the ears become deaf. The Kidney’s corresponding orifice is the ear.”

Qi (vital energy) is connected with the ears. When the Five Viscera are out of balance, the nine orifices become obstructed. If Yin and Yang Qi are both excessive and cannot harmonize or circulate together, this is called “Guan’ge” (obstruction and rejection). Guan’ge means that the movement of Qi is blocked and Yin and Yang cannot support one another. The patient dies before reaching the normal span of life.

The kidneys correspond to groaning in the voice, trembling in abnormal bodily changes, and fear in the emotions. Fear damages the kidneys; when Jing Qi gathers in the kidneys, it can also cause fear.

The kidneys govern winter. When disease arises in the kidneys themselves, it should be treated by needling the Jing-Well points.

When illness first begins in the kidneys, there is pain in the lower abdomen, waist, and back, along with aching in the lower legs. On the second day, the pathogenic influence passes to the bladder, causing pain in the back and the sinews beside the spine, as well as difficulty urinating. On the third day, it travels upward to the heart, causing heart pain. On the fourth day, it reaches the small intestine, causing distension there. If there is no improvement by the fourth day, the patient may die. In winter, the illness usually begins in the early morning; in summer, it begins in the evening.

For a patient with kidney disease, symptoms are milder at midnight, worsen during the transitions between seasons, and are calmer in the evening.

For example, if kidney disease is related to diet, it may have been caused by eating beef or other foods that grow in the soil. Otherwise, the illness should flare up in late summer, perhaps on a day associated with Wu or Ji.

Common symptoms of kidney disease include abdominal distension, swelling and pain in the lower legs, shortness of breath and coughing, heaviness of the body, sweating during sleep, and aversion to wind. When the condition is deficient, there is pain in the chest, pain in both the upper and lower abdomen, cold hands and feet, and low spirits. Points may be needled along the Foot Shaoyin Kidney Channel and the Foot Taiyang Bladder Channel, or blood may be drawn along the channels. On examination, the kidney pulse is deep and large; when felt superficially, it is also large and tight. There may be swelling and coldness in the joints of the hands and feet, deficiency of Yin Qi, pain in the waist and spine, swelling of the lower abdomen, and fluid in the area below the heart, causing intermittent distension and obstruction or diarrhea. Such illness may be caused by sexual activity before drying the body after bathing, or by excessive exertion.

A patient with kidney disease may have a dark complexion, weak Qi, shortness of breath, a frequent sense of impaired hearing, back pain, frequent seminal emissions, reduced appetite, and coldness below the knees. If the pulse is deep, slippery, and slow, the condition can still be treated. Remedies include Neibu Powder, Jianzhong Decoction, Kidney Qi Pill, or Rehmannia Decoction. In spring, needle Yongquan; in autumn, Fuliu; and in winter, Yingu, using reinforcing methods. In summer, needle Rangu, and in late summer, Taixi, using reducing methods. Moxibustion should also be applied at Jingmen for fifty cones and at the point on the back at the fourteenth vertebra for one hundred cones. (“Cone” is a unit of moxibustion, referring to the number or intensity of applications.)

When pathogenic Qi attacks the kidneys, it causes bone pain and Yin Bi. Yin Bi refers to a condition in which the affected area is difficult to detect by pressing. Other symptoms may include abdominal distension, back pain, difficulty passing stool, stiffness and pain in the shoulders, back, neck, and nape, and occasional dizziness. Treatment may use Yongquan and Kunlun; if visible blood vessels are found, puncture them to let out blood. Excessive exertion, lifting heavy objects, or sweating heavily after excessive sexual activity, until the body is as wet as after bathing, may all damage the kidneys.

Kidney Wind, kidney Cold…

The kidneys correspond to Water. When Kidney Water is out of balance, the abdomen becomes distended, the navel swells, the lower back aches, urination becomes difficult, and the genital area grows damp. Sweat appears on the tip of the nose, like a cow’s nose; the feet turn cold, while the stool becomes dry and hard. (Another version reads, “the face becomes gaunt.”)

Kidney distention presents as a full, swollen abdomen, discomfort that pulls toward the back, and pain in the lower back and thighs.

People with Kidney Attachment (a disorder in which cold and dampness remain in the lower back and lower burner) feel heavy, and their lower back feels cold, as though immersed in water. They are not thirsty, urinate freely, and eat as usual. These are its symptoms. The disorder is located in the lower burner, the lower part of the body, including the abdomen and the urinary and reproductive systems. After strenuous exertion, a person sweats, while the inner layer of clothing becomes cold and damp. If this continues for a long time, the disorder develops. In Kidney Attachment, the body is cold below the waist, and the lower back feels so heavy it is as if five thousand coins were hanging from it.

Examination reveals a Kidney Accumulation, a disorder involving a mass in the kidney region, with a deep and rapid pulse. The patient often feels pain pulling through the back and lower back; the symptoms become pronounced when hungry and ease after eating. Other symptoms include tightness and pain in the lower abdomen, dry mouth, a sore and ulcerated throat, dim vision, coldness in the bones, impaired marrow, forgetfulness, and a dark complexion. Kidney Accumulation is also called Running Piglet. During an attack, Qi surges upward from the lower abdomen to the area below the heart, darting up and down like a piglet running about. The attacks occur at irregular times. If the disorder persists, symptoms such as panting with Qi surging upward, weakened bones, and scant Qi may arise.

Why does Running Piglet begin during the summer on a Bing or Ding day? According to the Five Phases cycle of transmission, when Spleen disease passes to the kidneys, Kidney disease should then pass to the heart. But in summer, Heart Qi is strong, so the heart does not receive the pathogenic influence. Kidney Qi then tries to pass back to the spleen, but the spleen does not accept it either. The pathogenic influence therefore stagnates and congeals, forming an accumulation. This is why Running Piglet arises in summer.

If a person with Kidney disease has cold hands and feet, a flushed face, yellow eyes, urinary incontinence, pain in the joints and bones, knotted pain in the lower abdomen, and Qi surging upward to the heart, the pulse should be deep, fine, and slippery, but is instead floating and large. The complexion should be dark, but is instead yellow. This shows a severe, abnormal reversal in which Earth overcomes Water—Spleen corresponds to Earth and the kidneys to Water. The illness is extremely serious and difficult to treat.

A person of the Yu tone type, classified according to the Five Tones and associated with the kidneys, has a voice that corresponds to the kidneys: the kidney sound is a groan, with a tone like that of the se. The associated emotion is fear. If the Qi mechanism of the Foot Shaoyin Kidney channel and the Taiyang channel becomes counterflowing, Nutritive Qi and Defensive Qi can no longer circulate freely, and Yin-Yang falls out of balance: Yang Qi becomes trapped inside, while Yin Qi rises outward. As Yin Qi rises, the person feels cold; the cold weakens the body, and the weakened person becomes more vulnerable to fierce wind. The patient may stammer, speak with a broken voice, develop partial paralysis, and drag one leg. If the left side is affected, the left kidney is injured; if the right side is affected, the right kidney is injured. Wind illness spreads from one side of the nose down one side of the body to the foot, making the limbs sluggish, weak, and unable to move. The mouth may also become crooked, the voice thick and unclear, and urination and bowel movements irregular. When lying on the back, hearing in one ear may become dull or blocked, and the lower back and back may hurt as though pulling on each other. In severe cases…

A condition may be treated with Shenli Tang (the formula appears in the Separate Volume). There is also another condition in which the patient groans, becomes angry easily, and is forgetful; the spirit is unsettled, as though the patient has something weighing on the mind. This is a case of “Earth overcoming Water” (in the Five Phases, Earth overcomes Water): Yang Qi disturbs Yin Qi, Yin Qi lies dormant, and Yang Qi rises. When Yang Qi rises, it produces heat; heat leads to internal excess, and internal excess makes the patient prone to anger and forgetfulness. The patient cannot hear sounds, and the limbs feel distended and tense. The urine is reddish yellow. The lips move when the patient speaks, but no sound comes out; the patient smiles at others. These are signs that pathogenic heat has damaged the Kidneys. When the condition is severe, it is difficult to treat. If the complexion is dark yellow and the ears do not respond to sounds, the condition can still be treated.

When Kidney disease breaks out as malaria, the patient feels cold, has pain in the lower back and spine, tosses restlessly, has difficulty passing stool, cannot move the eyes freely, sways unsteadily, and has cold hands and feet. It may be treated with Hengshan Tang (the formula appears in the Separate Volume).

If a patient who did not previously stutter suddenly begins to speak haltingly, becomes easily angered, and behaves contrary to their usual temperament, this indicates that the Kidneys have been damaged. Even if the illness has not yet clearly manifested, these are already warning signs. If the patient opens their mouth to laugh before anyone has spoken, then closes it without making a sound, and raises a hand to press the abdomen (another reading says “cover the eyes”), these are signs of Kidney disease expressed in the voice and behavior. The condition should be assessed for deficiency or excess, exterior or interior, floating or sinking, and clear or turbid, and treatment should be based on that assessment.

Black corresponds to the Kidneys, which are associated with the bones. A black complexion with the sheen of a crow’s feathers is an auspicious sign. The Kidneys govern the ears, which manifest Kidney Qi externally. A person with a Water constitution (a body type classified according to the Five Phases) usually has a large head, curved facial contours, a broad chin, narrow shoulders, a large abdomen, and small hands and feet. When walking, the body sways; the buttocks are long, and the back is elongated. Such people are not respectful or cautious and are prone to deceiving others. They are more likely to suffer punishment or violent death, adapt better to autumn and winter, and tolerate spring and summer poorly. If they contract a pathogenic influence in spring or summer and fall ill, the illness is often in the Foot Shaoyin Kidney Channel.

The ears’ size, height, thickness, and degree of roundness correspond to the condition of the Kidneys. A uniformly dark complexion and fine skin texture indicate small Kidneys. Small Kidneys are more stable and less susceptible to pathogenic influences. Coarse skin texture indicates large Kidneys. Large Kidneys are prone to deficiency; deficiency makes the Kidneys cold and may lead to deafness or ringing in the ears, sweating, lower back pain, and difficulty bending or straightening the body. Such people are also more susceptible to pathogenic influences.

Ears set high indicate that the Kidneys are positioned high. High-positioned Kidneys are in excess; excess makes them hot and may cause stiffness and pulling pain in the back, pus and blood to flow from the ears, or polyps to grow and block the ear canal. A hollow behind the ear indicates that the Kidneys are positioned low. Low-positioned Kidneys may cause pain in the lower back and buttocks, difficulty bending or straightening the body, and may also lead to fox-hernia (a hernia in the groin). Firm ears indicate firm Kidneys. Firm Kidneys are less prone to illness and lower back pain. Thin ears indicate fragile Kidneys. Fragile Kidneys are easily damaged by pathogenic heat; when the heat is severe, there may be a clamor in the ears, and the person is also prone to wasting-thirst (a disorder marked by thirst, excessive drinking, and frequent urination). If the ears are positioned close to the teeth… The original text breaks off here.

When the kidneys are properly shaped, Kidney Qi flows in harmony and is less likely to be damaged. If one ear sits higher than the other, this indicates that a kidney is tilted. People with a tilted kidney often have pain on one side of the lower back and buttocks.

When the bones in any part of the body are sunken, this is often a grave sign, and death is difficult to avert. The bladder and the Foot Taiyang channel (Bladder channel) both correspond to the kidneys; a depression in the bones at the corresponding location therefore indicates an abnormality there. The Qi of the internal organs connects with the inside and outside of the body, so changes in the organs are reflected in external parts as well. A dark, murky complexion indicates an internal illness; a bright, clear complexion indicates an external illness. If the color changes from the outside inward, the illness began externally, and the corresponding part will develop a disorder. If the color appears from the inside outward, the illness began internally, and the corresponding part will become sunken.

For internal illness, treat Yin first and Yang afterward; for external illness, treat Yang first and Yin afterward. Yang governs the exterior, while Yin governs the interior. Changes in the Shen Qi of the internal organs often appear externally first, foreshadowing a person’s life or death and good or ill fortune. When kidney disease is about to develop, the ears become withered and dry. When Kidney Qi is about to expire, the ears turn scorched and black, and become dry. A dusky color at the center of the forehead and other areas is a grave sign that cannot be treated. Only by observing the severity of changes in complexion can one judge how quickly the illness will progress: in a slow-moving illness, death will occur within four hundred days; in an urgent one, death will come within ten days to a month.

What signs indicate that a person with kidney disease is about to die? Yellow-black spots the size of a thumb on the ears may signal sudden death. Once Kidney Qi is cut off, death follows in four days. How can one tell that Kidney Qi has been cut off? The teeth suddenly turn black; the face becomes entirely dark; the eyes turn yellow; the lower back feels as though it will break; cold sweat pours out like water; and the face is black while the eyes are blue-green (some versions read “white”). These are signs that the kidneys have been injured internally and pathogenic influences have accumulated; death follows after eight days. Such signs show that the illness has turned into a fatal condition.

A yellow face and black eyes do not necessarily mean death; but if the blackness resembles the soot on the bottom of a pot, death will follow. Abnormal coloring at the center of the forehead and on either side reflects the corresponding positions of Yin and Yang. Even without becoming involved in a lawsuit or similar trouble, a person may still meet with death. If a person’s face and the area around the eyes are tinged yellow-black, with the color extending to the ears, someone over forty may die within a hundred days. If the color appears on only one side, the omen is most inauspicious and death is certain. If it appears on both sides but not on the upper forehead, disaster will surely come within three years.

Winter belongs to Water and corresponds to the kidneys. The kidneys are associated with the color black and govern the Foot Shaoyin channel (Kidney channel). Why does the Foot Shaoyin channel govern the kidneys? Because the kidneys govern Yin, Yin belongs to Water, and Water Qi is generated by the kidneys. This channel is called “Taichong” and has fifty-seven acupuncture points. In winter, treatment uses the Jing-Well and Ying-Spring points, the first two categories among the Five Transporting points. In winter, Water Qi is in season and Kidney Qi is stored away; Yang Qi is diminished, Shaoyin Qi is strong, Taiyang Qi lies hidden and deep, and the Yang channels withdraw into storage. Therefore, the Jing-Well points are used to disperse and lower the rebellious Yin Qi, followed by the Ying-Spring points to make Yin Qi flow freely (the Suwen reads “enrich”).

The pathways of Yang Qi have their root point two inches below the inner ankle, corresponding to the two vessels beneath the tongue. The root of this channel is at Yongquan (Bubbling Spring), an acupoint on the sole of the foot, around the center of the sole.

Its sinew channel begins beneath the little toe, enters the center of the sole, and joins the sinew channel of the Foot Taiyin meridian. It then runs obliquely toward the area below the inner ankle and binds at the heel, where it joins the sinew channel of the Foot Taiyang meridian. It ascends to bind below the inner side of the knee, then joins the sinew channel of the Foot Taiyin meridian. Continuing upward along the inner thigh, it binds at the genital region, runs along the inner side of the spine and upward beside the back, and reaches the neck, where it binds at the occipital bone and joins the sinew channel of the Foot Taiyang meridian.

Its meridian begins beneath the little toe and runs obliquely toward the center of the sole. Passing beneath Rangu (the bony area below and in front of the inner ankle), it follows the back of the inner ankle into the heel, then ascends along the inner side of the lower leg. It rises along the inner side of the hollow behind the knee, follows the rear edge of the inner thigh, penetrates the spine, and connects with the kidneys and the bladder. A branch runs directly upward from the kidney, passes through the liver and diaphragm, enters the lungs, ascends along the throat, and runs beside the root of the tongue. Another branch emerges from the lungs, connects with the heart, and flows into the chest. This meridian is paired with the Foot Taiyang meridian as its exterior-interior counterpart. The Foot Taiyang meridian’s root point lies five inches above the heel, and the two meridians also meet the Hand Taiyin meridian.

The collateral of the Foot Shaoyin meridian is called Dazhong (Great Bell). It lies behind the inner ankle, curves around the heel, and sends a separate branch to the Foot Taiyang meridian. Another branch runs upward alongside the main meridian, reaches the Pericardium, then descends through the lumbar spine to govern the kidneys.

When the kidney meridian is in excess, the bladder becomes hot. If the heat becomes severe, urination may be obstructed; this condition is called long (urinary retention). If the Yang pulse runs counter to its proper course and is twice as large as the pulse at the cun position, the condition may worsen, producing heat in the mouth, a dry tongue, swelling of the throat, Qi surging upward, dryness and pain in the throat, agitation and heart pain, jaundice, diarrhea, pain in the back and along the rear edge of the inner thigh, weakness or coldness in the limbs, a desire to lie down, and heat and pain on the soles of the feet. Applying moxibustion in these circumstances may instead force the person to eat and cause the condition to change. The belt should be loosened, the hair let down, and the person should walk slowly with a large staff and heavy shoes.

When the kidney meridian is deficient, the bladder becomes cold. If the cold becomes severe, the lower back will hurt. If the Yin pulse is instead smaller than the pulse at the cun position, symptoms may include feeling hungry but not wanting to eat, a complexion black as charcoal, coughing and bringing up phlegm tinged with blood, a rattling sound in the throat and shortness of breath, wanting to stand when seated, dim vision, and a fearful, unsettled feeling, like the desperate hunger experienced during illness. When Qi is insufficient, the person is prone to fear and feels apprehensive, as though someone were coming to seize them. This condition is called “Bone Reversal.”

The three months of winter correspond chiefly to the kidneys and bladder. They belong to the Water phase, are associated with the color black, and correspond to the bones. If a warm disease develops, its source is the Foot Taiyang and Foot Shaoyin meridians contending with one another. Pathogenic Qi accumulates, obstructing the Triple Burner—the functional regions of the upper, middle, and lower body—and preventing movement between them. Yin pathogens circulate within the body, and the organs are invaded by external pathogens, causing illness. Its manifestations vary; for example, in the fu organs…

When the body is weak, it is easily invaded by cold Yin pathogens. This may cause internal heat alongside chills on the surface of the body, a desire to warm oneself by a fire, and a desire for hot drinks. Sometimes the lower back hurts as though it were about to break. When the internal organs are replete, they are injured by hot Yang pathogens, causing severe pain in the chest and flanks, like knife thrusts; the person cannot turn, and heat surges within the body. Taking too much cold medicine causes severe diarrhea. This illness is therefore called “Black-Bone Warm Disease.” In ancient times, “warm disease” was a term for a category of febrile illnesses.

Bian Que said that moxibustion may be applied to the transport points of the spleen, liver, and kidneys—the points on the body’s surface where channel Qi flows and gathers—to treat erysipelas, metal toxin, and Black Warm Disease. Treatment should address the cause and regulate the internal organs. When the organs and bowels are in harmony, and clear and turbid Qi circulate normally, illness will not arise.

Deficiency and Repletion of the Kidneys, Part Two (Pulse Signs, Prescriptions, and Moxibustion)

Repletion-Heat of the Kidneys

At the chi position of the left hand, behind the Shenmen point, the pulse is Yin-replete. This belongs to the Foot Shaoyin channel (the Kidney channel). The patient may have a dry tongue, a swollen throat, distress in the heart, a dry throat, frequent pain in the chest and flanks, panting and coughing, sweating, fullness and distention in the lower abdomen, stiffness and tightness in the lower back, a heavy body, heat in the joints, reddish-yellow urine, irritability, forgetfulness, burning pain on the soles of the feet, darkened limbs, and deafness. This is called “Repletion-Heat of the Kidneys.” The Mai Jing says that when the kidneys have repletion-heat, the patient feels fullness in the bladder and cannot urinate; the lower abdomen and the lumbar spine and back are drawn into pain.

At the chi position of the right hand, behind the Shenmen point, the pulse is also Yin-replete and belongs to the Foot Shaoyin channel. The patient may have numbness and paralysis, fever, heart pain, pain drawn through the back and ribs, Qi surging upward into the feet with heat, and agitation in the heart. This too is called “Repletion-Heat of the Kidneys.”

Kidney-Draining Decoction treats Repletion-Heat of the Kidneys, with symptoms including fullness and distention in the lower abdomen, darkened limbs, deafness, dreams in which the lumbar spine seems to come apart and break, and acute breathing difficulty associated with hidden water. The ingredients are three liang each of mirabilite, poria, and scutellaria; five liang each of fresh rehmannia juice and sweetflag; eight liang of magnetite, crushed into pieces the size of sparrow heads; one sheng of rhubarb, sliced and soaked in water overnight; four liang each of scrophularia and asarum; and two liang of licorice.

Coarsely cut seven of the ten ingredients, add nine sheng of water, and decoct until two and a half sheng remain. Strain out the dregs. Add the rhubarb to the liquid and continue decocting until it has reduced by two or three ge. Remove the rhubarb, add the fresh rehmannia juice, and simmer briefly for one or two boils. Then add the mirabilite and divide the decoction into three doses.

Another prescription treats irritability, forgetfulness, inability to hear sounds, fullness and tightness in the limbs, and difficulty turning the lower back and back, with stiffness and rigidity, when these symptoms arise from Kidney heat. Its listed ingredients are bupleurum, tuckahoe with spirit (listed as poria in the Waitai Miyao), and scutellaria.

Alisma, cimicifuga, apricot kernels, Isatis leaf, and mirabilite (three liang each); bamboo leaf and prepared rehmannia root (one sheng each, chopped); magnetite (four liang); and antelope horn (one liang).

Coarsely chop the twelve ingredients listed above. Boil them in one dou of water until three sheng of liquid remain, then strain out the dregs. Add the mirabilite and divide the liquid into three doses.

For kidney heat, the urine is yellow or red and difficult to pass, or resembles the juice of gardenia or phellodendron. Each time the person feels the urge to urinate, the opening of the urethra hurts. Use this formula:

Elm bark (chopped) and winter-melon seeds (one sheng each); plantain seeds (chopped, two sheng); talc (crushed, eight liang); Scutellaria root, akebia stem, and dianthus (three liang each); and pyrrosia leaf (four liang).

Coarsely chop the eight ingredients listed above. First boil the plantain in two dou of water until one dou of liquid remains. Strain out the dregs and let the liquid settle; take nine sheng of the clear liquid. Add the remaining ingredients and continue boiling until three sheng and five he remain. Strain out the dregs and divide the liquid into four doses.

Kidney and Bladder Both Excessive

If the pulse at the left wrist’s Chi position, just behind the Shenmen point, is forceful in both its Yin and Yang aspects, this indicates excess in both the Foot Shaoyin channel (the Kidney channel) and the Foot Taiyang channel (the Bladder channel). The patient may feel stiffness in the back, arch backward, roll their eyes upward, and experience Qi surging into the chest and heart area. They may have back pain and be unable to turn over without help. This is called “Kidney and Bladder Both Excessive.”

If the pulse at the right wrist’s Chi position, just behind the Shenmen point, is forceful in both its Yin and Yang aspects, this likewise indicates excess in both the Foot Shaoyin and Foot Taiyang channels. The patient may have seizure-like episodes, heaviness in the head, headache extending to the eyes, cold hands and feet, agitation and an urge to run, and upward-rolling eyes. Symptoms resembling severe wind disease and excessive sweating may also occur. This is called “Kidney and Bladder Both Excessive.”

“Chi position” and “Shenmen” are names for pulse-taking locations in ancient practice. “Yin and Yang both excessive” describes the diagnosis of excess in the channels based on the pulse.

Kidney Deficiency and Cold

If the pulse at the left wrist’s Chi position, just behind the Shenmen point, is weak in its Yin aspect, this indicates disease in the Foot Shaoyin channel (the Kidney channel). The patient may feel distress in the heart area and heaviness in the lower limbs. The feet may swell and be unable to bear the body’s weight. This is called “Kidney Deficiency and Cold.”

If the pulse at the right wrist’s Chi position, just behind the Shenmen point, is weak in its Yin aspect, this also indicates disease in the Foot Shaoyin channel. The patient may have weak, thin calves and feel cold. The pulse may come and go, or even become temporarily imperceptible. The feet may be cold; the upper body may feel heavy and the lower body light; and the feet may be unable to support the body when walking. The lower abdomen may also feel distended, with Qi surging up into the chest and pain extending to the area beneath the ribs. This is called “Kidney Deficiency and Cold.”

Formula for Kidney Qi Deficiency and Cold

This formula is used for Kidney Qi deficiency and cold, weakness of the penis, pain in the lower back and spine, heaviness and fatigue in the body, indistinct speech, and sudden collapse of Yang energy. It contains:

Cistanche, atractylodes, and morinda root.

Ophiopogon root, poria, licorice, achyranthes root, schisandra fruit, and eucommia bark (eight liang each); plantain seed and dried ginger (five liang each); and fresh dried rehmannia root (five jin).

Grind these nine ingredients into a fine powder. After meals, take one square-inch spoonful with wine, three times a day.

A Formula for Treating Kidney Wind with Deficiency and Cold

Moxa the Shenshu points one hundred times. The Shenshu points are on the back, opposite the navel, one cun and five fen on either side of the spine. “Time” is a unit used in moxibustion, referring to each moxa cone that is lit and applied.

Deficiency of Both the Kidneys and Bladder

If the pulses at the chi position of the left hand, behind the Shenmen point, are weak in both their Yin and Yang aspects, this indicates weakness of both the Foot Shaoyin Kidney channel and the Foot Taiyang Bladder channel. Symptoms include frequent urination, heart pain, coldness in the back, and sometimes distention and fullness in the lower abdomen. This is called “deficiency of both the kidneys and bladder.”

If the pulses at the chi position of the right hand, behind the Shenmen point, are weak in both their Yin and Yang aspects, this also indicates weakness of both the Foot Shaoyin Kidney channel and the Foot Taiyang Bladder channel. Symptoms include heart pain, or a sinking sensation in the bowels with inability to control them, sometimes with recurrent diarrhea. At times, cold in the middle burner may also cause diarrhea, accompanied by pain in both the kidneys and the heart. This too is called “deficiency of both the kidneys and bladder.”

Kidney Taxation, Part Three (Discussion and Formulas)

The treatise says: For kidney taxation, nourish the Liver Qi to support the kidneys. When Liver Qi is flourishing, the kidneys too can respond and receive nourishment. If a person acts against the regimen for nurturing life in winter, the Foot Shaoyin Kidney channel cannot store essence, and Kidney Qi becomes stagnant and turbid. Following the proper course allows one to live; going against it brings harm. Following it regulates illness; going against it disorders the body. Reversing the proper course is called “obstruction and rejection,” and illness then arises.

Gardenia Decoction: Treats excess heat from kidney taxation, with symptoms including distention and fullness in the lower abdomen, yellow-red urine, lingering dribbling after urination, frequent urination in small amounts, pain in the urethra, and sores on the scrotum.

Gardenia seed, peony, akebia stem, and pyrrosia leaf (three liang each); gypsum (five liang); talc (eight liang); Scutellaria root (four liang); fresh rehmannia root, elm bark, and fresh bamboo leaves (chopped, one sheng each).

Chop these ten ingredients. Boil them in one dou of water until three sheng of liquid remain. Strain out the dregs and divide the decoction into three doses.

Ephedra Root Powder: Treats fever from kidney taxation and sores on the scrotum.

Ephedra root and sulfur (three liang each), and rice flour (five he).

Grind these three ingredients into a fine powder and sift it. Using cotton, apply the powder to the sores as one normally applies body powder. When the powder becomes damp, apply more.

A decoction powder for treating fever caused by Kidney exhaustion, irritability, and pain in the lower back and spine so severe that bending or straightening is impossible:

Salvia root, achyranthes root, kudzu root, eucommia bark, dried rehmannia root, licorice root, and polyporus (two and a half liang each); poria, polygala root, and scutellaria root (one liang and eighteen zhu each); Siberian ginseng bark and gypsum (three liang each); antelope horn, fresh ginger, and tangerine peel (two liang each); and bamboo leaves, about the size of a duck egg.

Grind these sixteen ingredients coarsely and decoct them in three sheng of water. Wrap the powdered herbs in silk and take eight he of the liquid each time, twice daily. The text is damaged at this point, and phrases such as “decoct in three sheng…” are incomplete.

A formula for treating deficiency taxation and disharmony between Yin and Yang, resulting in injury to the sinews and vessels, shortness of breath, incontinence or diarrhea, dark yellow urine, dampness and itching in the genital area, pain in the lower back and spine as if they had been broken, and a face that grows increasingly haggard:

Tokoro vine, jujube flesh, fresh rehmannia root, cassia bark, eucommia bark, and mai men dong (one jin each).

Cut these six ingredients into pieces and soak them for three nights in one dou and five sheng of wine. Remove them and dry them in the sun, then return them to the wine and soak them again. Repeat this until all the wine has been used. When the herbs are dry, grind them into a fine powder. After meals, take the powder with wine, one square-inch spoonful at a time, three times daily.

A formula for treating Kidney exhaustion with deficiency and cold, emaciation, internal injury caused by sorrow and anger, and damage to Kidney Qi from sitting for a long time on damp ground:

Chinese gentian root, achyranthes root, Sichuan lovage root, saposhnikovia root, cassia bark, pubescent angelica root, and poria (four liang each); dried Chinese yam, mai men dong, and lycium root bark (three liang each); poria with spirit (fu shen) and schisandra fruit (five liang each); dendrobium stem (six liang); powdered agarwood (one liang); Siberian ginseng bark (ten liang); coix seed (one liang); and hemp seeds (two sheng).

Cut these seventeen ingredients into pieces and soak them in four dou of wine for seven days. Take seven he each time, twice daily.

Fourth: Exhaustion of Essence (discussion, formulas, and moxibustion methods)

The discussion says: “Exhaustion of Essence,” broadly speaking, refers to a group of manifestations associated with illnesses of the five viscera and six bowels. When the five viscera and six bowels grow weak, all aspects of the body are severely affected: vision becomes dim, the teeth become dry and withered, the hair falls out, and the body feels heavy. When Kidney Water is insufficient, deafness and unsteady walking may follow… The text is incomplete at this point.

Yang pathogens damage the five viscera, while Yin pathogens injure the six bowels. When Yang Qi is excessive, it should be drawn and regulated through the Yin aspect; when Yin Qi is deficient, Yin Qi should be drawn and regulated through the Yang aspect.

Yang illness chiefly manifests in the upper body: congestion and excess in the upper body cause fever. Fever may be accompanied by blurred vision, parched teeth, hair loss, and abdominal distention. When the abdomen is distended, the joints are often painful; when there is pain, it is appropriate to purge pathogenic heat from within.

Yin illness chiefly manifests in the lower body: weakness in the lower body causes chills and a feeling of heaviness. Damage to Kidney Water—the Yin fluids associated with the kidneys in Chinese medicine—can cause deafness and unsteady walking. When pathogenic Qi enters the body and reaches the five viscera, it causes coughing. Coughing is often accompanied by increased nasal discharge and saliva, facial swelling, and rebellious Qi rising upward. When pathogenic Qi travels counter to its proper course through the six bowels and then disrupts the five viscera, it causes weakness and coldness in the hands and feet. This condition is therefore called “Jing Extremity,” a disorder of severe depletion of Jing Qi.

When the body is deficient, it should be warmed and nourished with Qi; when Jing Qi is deficient, it should be replenished with food. Those skilled at treating depletion of Jing Qi first regulate the skin and sinews, then the six bowels. If pathogenic Qi has already invaded the five viscera, the illness is extremely serious.

Bian Que said: “When the Yin Qi of all five viscera has been severed, the condition cannot be treated. When Yin Qi is severed, the ocular connections—the tissues linking the eyes with the brain—begin to turn. When they turn, the eyes lose their luster, and the person’s spirit and awareness begin to fail first. The illness may worsen rapidly within a day or half a day; at that point, it is beyond a physician’s power to save the patient.” Physicians should therefore study diagnosis and treatment diligently: infer internal conditions from external signs, infer the right side from the left, and the left from the right. If one can infer the condition in one place from signs elsewhere, the illness can be cured.

Bamboo Leaf and Scutellaria Decoction: Used to treat Jing Extremity with excess heat, marked by blurred vision, parched teeth, hair loss, bodily weakness, pain throughout the body, and deficient heat.

Prescription: two sheng of bamboo leaves, chopped; three liang each of Scutellaria and Poria; two liang each of licorice, Ophiopogon, and rhubarb; six liang of fresh ginger; four liang of peony; and one sheng of fresh Rehmannia, chopped.

Chop the nine ingredients. Boil them in nine sheng of water until three sheng remain. Strain out the dregs and take the decoction in three portions.

Another prescription: Used to treat Jing Extremity, in which the five viscera and six bowels are all damaged, deficient heat spreads throughout the body, the bones ache, and the chest feels oppressed and agitated.

Prescription: two sheng of fresh Rehmannia juice; one sheng each of Ophiopogon juice and red honey; one he of bamboo sap; eight liang of gypsum; three liang each of ginseng, Chuanxiong, cinnamon bark, licorice, Scutellaria, and ephedra; and four liang of Chinese angelica.

Chop the twelve ingredients. First boil eight of them in seven sheng of water until two sheng remain, then strain out the dregs. Add the juices and other ingredients, including the fresh Rehmannia, and continue boiling until four sheng remain. Take in four portions. The source text breaks off after the character “day.”

Three Nights, One

Decoction for treating the five taxations and six debilitations, bodily weakness, palpitations, emaciation, and frequent dreams

Four liang of poria; three liang each of licorice, peony root, cinnamon bark, and dried ginger; five jujubes; and two liang each of polygala root and ginseng.

Chop the eight ingredients. Simmer them in eight sheng of water until three sheng remain. Divide into three doses and take them over the course of the day.

Prescription for treating deficiency taxation and depleted Jing and Qi

Grind deer antler into a fine powder, mix it with white honey, and form pills the size of parasol tree seeds. Take seven pills each time, three times a day. After ten days, the effect will be pronounced.

Another prescription: simmer tribulus seeds in rice-washing water. Once cooked, strain off the liquid and use it to wash the genital area. Continue for twenty days, and the effect will be pronounced.

Thorn Pill: prescription for treating deficiency taxation, insufficiency of the various Qi, and nocturnal emission during dreams

Two liang each of thorn, dried ginger, and dodder seed; one liang each of asparagus root, monkshood, small grass, peucedanum, Chinese yam, smilax, asarum, buttercup, goji berry, morinda root, fragrant Solomon’s seal, dendrobium, magnolia bark, achyranthes root, and cinnamon bark.

Grind the eighteen ingredients into a fine powder and use honey to form pills the size of parasol tree seeds. Take five pills with wine, twice a day.

The Shen Shi Fang records that the pills may instead be made by mixing equal parts honey and egg white. For wind invasion, weakness, numbness, restricted movement, vexing heat and a stuffy chest, shortness of breath, or thirst, add fragrant Solomon’s seal, asparagus root, or dodder seed as appropriate. For yellowing of the body, profuse sweating, or dark yellow urine that is difficult to pass, add buttercup or goji berry. For pain in the joints, lower back, or back, add smilax or achyranthes root. For abdominal cold, distention, frequent diarrhea, excess saliva, nausea, or vomiting, add magnolia bark, dried ginger, or cinnamon bark. For dampness of the scrotum, scanty semen, or dribbling urine, add dendrobium; the amounts may also be adjusted as needed.

The Gu Jin Lu Yan records that dried rehmannia may be substituted for dried ginger, dwarf lilyturf root for asparagus root, eucommia bark for Chinese yam, arborvitae seed for goji berry, and cistanche for fragrant Solomon’s seal. It states that this prescription may be used for a range of ailments in men, as well as excessive urination and seminal emission.

Prescription for treating nocturnal emission during dreams, lingering dribbling after urination, or semen in the urine

One liang and a half each of ginseng, dwarf lilyturf root, red halloysite, polygala root, teasel root, and deer antler; one liang and six zhu each of arborvitae seed, salvia root, and Chinese chive seed.

Poria, dragon teeth, lodestone, and cistanche (two liang each); dried Rehmannia root (three liang).

Grind the fourteen ingredients above into powder and mix with honey to form pills the size of parasol tree seeds. Take with wine, twenty pills per dose, twice daily, gradually increasing to thirty pills per dose.

A formula for treating debility, cloudy white urine, and nocturnal seminal emission

Chinese dodder seed, plantain seed, and Chinese chive seed (one sheng each); alum and Chinese angelica root (two liang each); aconite and Sichuan lovage root (three liang each); cassia bark (one liang).

Grind the eight ingredients above into powder and mix with honey to form pills the size of parasol tree seeds. Take with wine, five pills per dose, three times daily.

Another formula

Jujubes (fifty); Chinese chive seed (five he); astragalus, ginseng, licorice, dried ginger, Chinese angelica root, dragon bone, pinellia, and peony root (two liang each).

Grind the ten ingredients above into powder and mix with honey to form pills the size of parasol tree seeds. Take with wine, five pills per dose, three times daily.

Chinese Chive Seed Pills: for treating uncontrolled seminal leakage after excessive sexual activity, inability to bend or straighten the lower back, lack of hunger after eating, and aching, weak legs

Chinese chive seed (one sheng); licorice, cassia bark, purple fluorite, Limonite, polygala root, Asiatic cornelian cherry fruit, Chinese angelica root, Aconitum root, aster root, Chinese yam, Chinese wild ginger, poria, stiff silkworm, sweet flag, ginseng, Eucommia bark, white atractylodes, dried ginger, Sichuan lovage root, aconite, dendrobium, and asparagus root (one and a half liang each); cistanche, astragalus, Chinese dodder seed, dried Rehmannia root, and cnidium seed (two liang each); jujubes (fifty), ox marrow, and dried lacquer (four liang each).

Grind the thirty-one ingredients above into powder. Mix with ox marrow, white honey, and jujube paste, then pound repeatedly three thousand times to form pills the size of parasol tree seeds. Take on an empty stomach, fifteen pills per dose, twice daily; the dose may be gradually increased to twenty pills.

Chinese Chive Seed Powder: for treating seminal emission during urination and nocturnal seminal emission

Chinese chive seed and ophiopogon root (one sheng each); Chinese dodder seed and plantain seed (two he each); Sichuan lovage root (two liang); white dragon bone (three liang).

Here, “pill” is an ancient unit for taking medicine, and “the size of a parasol tree seed” describes the pill’s size. “Sheng,” “he,” and “liang” are ancient units of measurement. The original text breaks off at “white dragon bone (three liang).”

Grind the following six ingredients into a fine powder and sift it. Take one square-inch spoonful—a traditional measure for powdered medicine—with wine, three times a day. If the condition does not improve and instead gradually worsens, take one more dose at night. The prescription recorded in the Emergency Formulas to Keep Up One’s Sleeve uses one and a half liang of Alisma.

Sour Jujube Kernel Decoction is used to treat severe depletion and debility, nocturnal emissions during dreams, weakness of the penis and testicles, and exhaustion of Qi and blood. It is also used when drinking or overeating before sexual intercourse leads to palpitations and unease in the heart, along with cramping pain in the lower abdomen. The prescription is as follows:

Two ge of sour jujube kernels; one liang each of Alisma, ginseng, peony, and cinnamon bark; two liang each of astragalus, licorice, poria, white dragon bone, and oyster shell; two jin of fresh ginger; and one jin of pinellia.

Cut the twelve ingredients into pieces. Add nine sheng of water and decoct until four sheng remain. Take seven ge per dose, three times a day. If the patient cannot eat and has cramping in the lower abdomen, add six liang of cinnamon bark.

A prescription for treating nocturnal emissions during dreams:

One sheng of Chinese chive seeds, ground into a fine powder and sifted. Take one square-inch spoonful with wine twice a day. It takes effect immediately.

A prescription for treating seminal leakage due to depletion and debility:

One sheng of Chinese chive seeds and two sheng of rice. Add one dou and seven sheng of water and cook into a rice porridge. Strain off six sheng of liquid and divide it into three doses. This prescription is also used to treat seminal discharge.

Another prescription:

Five ge each of pomegranate peel (identified as white mulberry bark in the Arcane Essentials from the Imperial Library) and mulberry root bark, cut into pieces. Add five sheng of wine and decoct until three sheng remain. Divide into three doses.

Another prescription:

Three liang of dried gelatin, ground into powder and mixed with two sheng of wine. Divide into three doses and drink warm. Stop taking it once cured. Another account specifies deer antler gelatin.

Another prescription:

Two sheng of fresh Chinese chive seeds, gathered after the first frost in the tenth month. Soak them overnight in eight ge of fine wine. The next morning, in clear weather, have a boy face south and pound the medicine ten thousand times. At dawn, take one square-inch spoonful with five ge of warm wine, twice a day.

Essence-Sealing Decoction is used to treat seminal emissions, wasting and weakness of the body, diminished muscle strength accompanied by soreness, shortness of breath, blurred vision, and aversion to hearing people’s voices. The prescription is as follows:

Two sheng of Chinese chive seeds and one sheng of polished rice. Fry both ingredients together in a bronze vessel until the rice turns yellow-black and the medicine is hot. Pour in one dou of fine wine and strain off seven sheng of liquid. Take one sheng per dose, three times a day, and finish two batches.

Mutton Bone Decoction is used to treat seminal emissions, excessive sleep, and dimness of vision. The prescription is as follows:

One complete set of mutton bones, half a jin of maltose, fresh rehmannia root…

The source text breaks off here; the remaining ingredients and directions are not recorded.

White atractylodes (2 jin), jujubes (20), mulberry root bark, magnolia bark, and donkey-hide gelatin (1 liang each); dwarf lilyturf, ginseng, peony, fresh ginger, and licorice (3 liang each); poria (4 liang); and cinnamon heartwood (8 liang).

Coarsely chop the fifteen ingredients. Boil sheep bones in five dou of water, then remove the bones and take three dou of broth. Add the herbs and boil until the liquid is reduced to eight sheng. When the decoction is ready, add malt syrup and stir until it dissolves. Take one sheng at dawn, then another one sheng at dawn the following day.

Moxibustion (a treatment that stimulates acupuncture points with burning mugwort)

For deficiency taxation and seminal leakage, apply thirty cones of moxa on each side of the seventh vertebra, then thirty on each side of the tenth vertebra, and twenty on each side of the nineteenth vertebra. Then apply moxa to Yanglingquan and Yinlingquan, using one cone for each year of the patient’s age.

For seminal emission during dreams, apply fourteen cones of moxa at Sanyinjiao. This can stop the emissions and is highly effective. Sanyinjiao is above the inner ankle, four finger-widths up along the large vessel.

For men with seminal emission during dreams, cloudy urine, or difficulty urinating, apply one hundred cones of moxa at Shenshu.

For men with genital pain, blood in the urine, or seminal emission, apply thirty cones of moxa at Lieque.

For seminal emission and severe weakness of the five viscera, apply fifty cones of moxa at the tip of Qugu. Qugu is at the center of the transverse bone above the genitals, where the bone curves like a crescent. This point is called Henggu.

For men with deficiency taxation and seminal emission, retraction of the genitals, and pain in the penile passage, apply thirty cones of moxa at Dahe. Dahe is three cun above the tip of Qugu.

For men with deficiency taxation and seminal emission accompanied by retraction of the genitals, apply fifty cones of moxa at Zhongfeng.

For men with cold pain in the lower back and spine, and abundant, clear, cloudy urine, apply one hundred cones of moxa at the Spleen Alarm point.

For men with seminal emission and pain and coldness in the knees and lower legs, apply one hundred cones of moxa at Ququan. Ququan is at the end of the crease on the inner side of the knee.

Fifth: Bone Exhaustion (discussion, prescriptions, and methods of treatment)

The discussion says: Bone exhaustion is chiefly associated with the kidneys. The kidneys correspond to the bones, and the bones are joined to the kidneys. It is also said that illness contracted in winter develops into bone impediment. If bone impediment persists without recovery and is then invaded by pathogenic Qi, the pathogen settles internally in the kidneys. Tinnitus and seeing blackness are signs of this illness. When the kidneys are diseased, bone exhaustion may develop, bringing toothache, aching in the hands and feet, inability to stand for long, difficulty bending and stretching, numbness of the body, and aching in the brain and marrow. If one is invaded by pathogenic influences on a Ren or Gui day in winter, or encounters wind pathogen, kidney wind will develop…

Bone Exhaustion refers to a category of disorders in which the bones and bone marrow are severely damaged. When Yin energy within the body is excessive, it weakens the body, and weakness brings on a fear of cold. When chilled, a person may develop facial swelling and a dull, dark complexion, pain in the lower back and spine, an inability to stand for long, and difficulty bending or stretching. As the pathogenic energy wanes, the hair may fall out and the teeth become brittle and dull; pain radiates through the lower back and back. When the pain is severe, coughing and expectoration may also occur.

When Yang energy within the body is excessive, it produces an excess condition, which brings on fever. During a fever, the complexion becomes as dark and dull as soot. The flow of Qi through the genitals and related areas, as well as the bladder, becomes obstructed; the teeth and brain marrow ache; the hands and feet are sore; the ears ring; and the complexion turns black. These are signs that Bone Exhaustion has reached a severe stage.

Yin and Yang, clear and turbid, must be carefully distinguished; the location of the disorder must be identified, and the patient’s breathing observed. A skilled healer treats pathogenic influences promptly while they remain in the skin and channels. Once they enter the internal organs, the patient is already in grave danger.

Bian Que said: “When the Qi of the bones is severed, there is no cure. If severe aching and pain make bending and stretching impossible, death will follow within ten days. The bones correspond to the Foot Shaoyin Kidney Channel. When the Qi of Foot Shaoyin is severed, the bones wither and the hair loses its luster. This shows that the bones are the first part to decline.”

Three Yellows Decoction

Three Yellows Decoction treats Bone Exhaustion, especially disorders marked by heat in the kidneys. Symptoms include obstructed Qi in the bladder, difficulty passing urine and stool, a withered, black complexion, ringing in the ears, and deficiency heat.

Prescription: three liang each of rhubarb, sliced and soaked separately in one sheng of water, and scutellaria root; fourteen gardenia fruits; one liang of licorice; and two liang of mirabilite.

Cut the first five ingredients into small pieces. First boil the scutellaria root, gardenia fruits, and licorice in four sheng of water until one sheng and five he remain, then strain out the herbs. Add the rhubarb and boil twice; finally, add the mirabilite. Divide into three doses.

Moxibustion

For difficulty moving the lower back and back, spasms of the sinews and channels, numbness and contraction of the limbs, together with deficiency heat and obstruction, apply moxibustion one cun and five fen to either side of the twenty-first vertebra. Determine the number of moxa cones according to the patient’s age. A “cone” is the unit used to measure moxibustion.

For difficulty urinating, fullness and distension in the lower abdomen, and bodily weakness, apply moxibustion at Xiaochangshu, the point on the back associated with the small intestine. Determine the number of moxa cones according to the patient’s age.

Chapter Six: Deficiency and Excess of the Bones

Discussion: People with bone deficiency experience aching and discomfort and tire easily; those with bone excess feel vexed and hot. The deficiency or excess of the bones is reflected in the kidneys and bladder: when an internal organ is diseased, heat manifests in the organ, while cold manifests in its paired bowel.

Tiger Bone Wine

Tiger Bone Wine treats aching and discomfort, and easy fatigue caused by bone deficiency. It is indicated for cold conditions of the bladder.

Take a complete tiger skeleton and roast it all until it is browned and all its juices have been dried out, then break it into pieces the size of sparrow heads. Brew wine in the usual way using three dan of rice, four dou of fermenting starter, and three dan of water. The recipe calls for extra water and starter because the tiger bones consume the starter and absorb water.

Add it to the wine. Once the wine has fermented, seal the jar and open it to drink after fifty days.

Prescription for solid heat in the bones, with aching pain and vexing heat

One sheng each of kudzu root juice, fresh rehmannia root juice, and red honey; five ge of ophiopogon juice.

Mix the four ingredients thoroughly and simmer over low heat. Bring it to a boil three or four times, then divide it into three doses.

Prescription for pain in the bone marrow

Four liang of tiger bone, one jin of peony, and five jin of dried rehmannia root.

Cut the three ingredients into small pieces and soak them in one dou of clear wine for three nights. Remove them and dry them in the sun, then soak them again in wine. Repeat this process until all the wine has been used. Pound and sift the medicinal ingredients. Take one square-inch spoonful at a time with wine, three times a day. A square-inch spoon was an ancient small measuring spoon, holding about one spoonful of powdered medicine.

Prescription for cold pain in the bone marrow

Take one shi of rehmannia root juice and two dou of wine. Mix them and simmer. Drink warm three times a day to nourish the bone marrow.

Another prescription: apply seventy moxa cones to the Shanglian point. Shanglian is three cun below the Zusanli point. In this moxibustion method, place a cone of mugwort on the point and light it, burning the prescribed number of cones.

Prescription for consumptive weakness, cold pain in the joints, and loss of strength

Two sheng of fermented black beans and eight jin of rehmannia root.

Steam and sun-dry the two ingredients twice, then grind them into powder. After meals, take two square-inch spoonfuls with one sheng of wine, twice a day. This can also treat deficiency heat.

Another prescription: grind asparagus root into powder. Take one square-inch spoonful with wine, three times a day. After taking it for one hundred days, recovery may be expected.

Lower Back Pain, Section Seven (Discussion, Prescriptions, Daoyin Methods, and Acupuncture and Moxibustion)

The discussion says that lower back pain generally has five causes. The first is called Shaoyin lower back pain; Shaoyin refers to the kidneys. In the tenth month, the Yang Qi of all things declines, and this can cause lower back pain. The second cause is wind impediment: wind and cold invade the lower back, causing pain. The third is kidney deficiency: overwork damages the kidneys and leads to pain. The fourth is an injury to the lower back from a fall. The fifth is exposure to cold: sleeping on the ground allows the Earth Qi to injure the body. If the pain persists and extends between the lower back and spine, the whole back often becomes painful.

Du Zhong wine prescription: For disordered flow in the kidney pulse, a fine and weak pulse at the wrist, deficiency cold in the bladder, and symptoms such as lower back pain and throbbing in the chest. It may be taken in any season.

Four liang each of eucommia bark and dried ginger (one account says the dried ginger should be dried rehmannia root); three liang each of tokoro, notopterygium root, Chinese aconite, Sichuan pepper, cassia bark, Sichuan lovage, siler root, gentian root, aconite, and asarum; five liang each of Siberian ginseng bark and dendrobium.

The source text ends here; the subsequent instructions for preparing the ingredients and taking the medicine have not been copied.

Snake gourd root, Chinese wolfberry bark, teasel root, platycodon root, and licorice (the last two ingredients, one liang each).

Chop the nineteen ingredients listed above and soak them in four dou of wine for four nights. Begin by taking five he of the infusion at a time, gradually increasing the dose to seven or eight he, twice daily. This prescription treats all five kinds of lower back pain.

(The original text lists only some of the ingredients here; the preceding ingredients have not been preserved.)

Another prescription:

Mulberry mistletoe, moutan bark, deer antler, and cinnamon bark.

Use equal amounts of the four ingredients and grind them into a fine powder. Take one square-inch spoonful at a time with wine, three times daily.

Another prescription: Taking deer antler alone, or deer horn, can also cure the condition.

Prescription for lower back pain caused by Kidney deficiency:

Tokoro rhizome, cinnamon bark, and white atractylodes, three fen each; moutan bark, two fen.

Grind the four ingredients into a fine powder. Take one square-inch spoonful at a time with wine, three times daily. They may also be decocted as a medicinal broth; this works very well.

Another prescription:

Aconite, two fen; cinnamon bark and moutan bark, one liang each.

Grind the three ingredients into a fine powder. Take one small knife-tip measure at a time, twice daily. The results are remarkable.

Kidney Attachment Decoction

In Kidney Attachment illness, the patient feels heavy, with coldness in the lower back as though it had been washed with cold water. There is no thirst, urination is normal, and appetite is unchanged. These are the symptoms. After physical labor, the patient sweats, while the inner layer of clothing remains cold and damp. Over time, this brings on illness, with cold pain below the waist and a heaviness in the abdomen, as though five thousand coins were tied around it. This prescription appears in the Records of Tested Formulas from Ancient and Modern Times under the name “Licorice Decoction.”

Licorice, two liang; dried ginger, three liang; poria and white atractylodes, four liang each.

Chop the four ingredients, add five sheng of water, and decoct until three sheng of liquid remain. Divide into three doses. The lower back will gradually grow warm.

Kidney Attachment Powder

Eucommia bark and cinnamon bark, three liang each; licorice, oriental waterplantain rhizome, Chinese teasel root, and dried ginger, two liang each; white atractylodes and poria, four liang each.

Grind the eight ingredients into a coarse powder. Take three square-inch spoonfuls at a time, add one sheng of wine, and boil until it has bubbled five or six times. Strain out the herbs and drink the liquid in one dose, twice daily.

Prescription for lower back pain so severe that the patient cannot stand:

Kansui root, cinnamon bark (some versions read “aconite”), eucommia bark, and ginseng, two liang each.

Grind the four ingredients into a fine powder. Put one square-inch spoonful of the powder inside a sheep’s kidney, roast it until cooked, and take it.

Prescription for lower back pain:

Take one jin each of Bixie, Eucommia bark, and wolfberry root. Coarsely chop the three ingredients, soak them in three dou of good wine, and seal them in an urn. Place the urn inside a copper vessel and boil it for one day. Take as much and as often as you like, until you are drunk.

Eucommia Pills: A Tonic Formula

One liang of Eucommia bark, two fen of dendrobium, and three fen each of dried ginger and dried rehmannia. Grind the four ingredients into a fine powder and mix with honey to form pills the size of parasol tree seeds. Take twenty pills at a time with wine, twice daily.

Salvia Pills: A Formula for Lower Back Pain Accompanied by Cold Bi

Two liang each of salvia, Eucommia bark, achyranthes, and teasel root, and two liang each of cassia bark and dried ginger. Grind the six ingredients into a fine powder and mix with honey to form pills the size of parasol tree seeds. Take twenty pills twice during the day and once at night. Follow the dietary restrictions prescribed for taking the medicine.

Pubescent Angelica and Mistletoe Decoction

Pain in the lower back and spine is often caused by weak Kidney Qi, sleeping in a cold, damp place, or exposure to wind. If left untreated, the condition can spread to the feet and knees, causing difficulty moving one side of the body, or coldness and numbness in the limbs, sluggishness, weakness, and heavy, aching pain. For lower back pain, cramping and heaviness in the legs and feet, or numbness and pain, take this formula promptly. (The formula is in another volume.)

A Formula for Severe Pain in the Lower Back and Spine That Makes Movement Difficult

Take three dou of soybeans. Roast them until reduced to one dou, boil them until reduced to one dou, then steam them until reduced to one dou. Set aside six dou of wine and an urn. Steam the beans until very hot, then put them, while still hot, into the urn and seal its mouth. In autumn or winter, leave them for fourteen days. Then make a hole in the urn’s mouth and draw off the medicinal wine. Take five he at a time, two or three times throughout the day and night.

Another formula: Grind rehmannia flowers into a fine powder and take one square-inch spoonful with wine three times daily.

Another formula: Scrape away the outer skin of deer antler and use the white part. Roast it until yellow, grind it into a fine powder, and take one square-inch spoonful with wine three times daily. Avoid raw fish strictly; other foods are permitted. Fresh antler is preferable; do not use old antler. Do not take the yellowish part at the center of the antler. This formula is highly effective.

Another formula: Grind sheep’s kidney into a fine powder and take two square-inch spoonfuls with wine three times daily.

Another formula: On the third day of the third month, gather one dou of peach blossoms. Combine them with three dou of well water drawn at the beginning of the third month, six sheng of fermentation starter, and six dou of rice. Steam and brew the mixture into wine. Once the wine is ready, strain out the lees. Take one sheng at a time, three times daily. If making it as food or drink, use river water. Follow the dietary restrictions prescribed for taking the medicine. This formula is highly effective.

A Formula for Men with Coldness in the Lower Back and Legs, Restricted Movement, and Inability to Walk

Take three dou of high-quality, well-aged wine and three dou of water. Mix them together in an urn, then soak both feet in the warm wine and water …

Treating Cold Pain and Hot, Oppressed Hands and Feet

If cold qi spreads upward from the lower limbs toward the knees, keep the patient warm for three consecutive days. Keep charcoal or ash fire under the bed at all times to maintain warmth, and do not let the body cool. If the hands and feet feel hot and oppressed, take three sheng (a traditional unit of volume) of urine, warm it in a basin, and soak the hands and feet in it.

Daoyin Method for Lumbar Pain (yaobi pain)

The patient sits facing due east with the hands gathered and held against the chest. One person in front presses down on both knees, and another person behind supports the head and slowly draws it back, so that the patient lies on his or her back with the crown of the head touching the ground. Repeat this sitting and lying down three times, and the pain will stop and the patient will recover.

Acupuncture Method

For lumbar and spinal pain, needle the hollow between the knee and the waist, at the point the original text calls Gouhuazhong. Let out bluish-purple collateral blood, and once the blood flows, the pain is cured.

Moxibustion for Lumbar Pain When Bending and Turning Are Impossible

Have the patient stand upright. Use a bamboo pole to measure from the ground up to the navel, then break the pole at that length. Use this length of bamboo to measure along the spine, and apply moxibustion at the point aligned with the upper end of the pole. The number of moxa cones (zhuang, the count of cones applied) depends on the patient's age. After the treatment, put the bamboo away and do not let others know about it.

Several other moxibustion points are also recommended. Moxibustion at the white flesh margin in the middle of the transverse crease just above the heel is considered especially effective, with ten cones. Seven cones may be applied at Zu Juyang, located below the outer ankle. Seven cones may be applied at Yaomuliao, near Baliao, located on each side above the tailbone (kao). Moxibustion may also be applied to Baliao and to the area between the bones above the outer ankle. Finally, if the lower back suddenly becomes severely painful, apply moxibustion one cun above the tailbone (qiong gu), one cun to each side, with seven cones at each point.