《孫真人備急千金要方》Vol. 61

Treatise on the Pulse of the Bladder Fu Organ, Chapter One

The treatise says: The Bladder and the Kidneys are interiorly and exteriorly related, and the Bladder is governed by the Kidneys. The ears are external signs that reflect the condition of the Kidneys and Bladder. Kidney Qi combines with the Bladder. The Bladder is a Fu organ that stores fluids; it is also called the “Waterway Officer,” the official in charge of water channels, and the “Jade Sea.” It weighs nine liang and two zhu, winds and folds upon itself, and measures nine cun both vertically and horizontally. It can hold nine sheng and nine ge of fluids, and its two sides correspond to the twenty-four solar terms. The nostrils lie externally; if the Bladder leaks, corresponding disorders arise.

The Yellow Emperor asked: “All the other Zang organs have one name and one form. Why alone do the Kidneys have two?” Qibo replied: “The Bladder, as a Fu organ, has two parts, and the Kidneys likewise correspond to it in having two forms. There is one name for the Zang organs and two names for the Fu organs; this is why they are counted as the ‘Five Zang and Six Fu.’” Another account says that the Kidneys are divided into left and right, while the Bladder is singular. The principle adopted here is that the left Kidney corresponds to the Bladder, and the right Kidney corresponds to the Sanjiao, the body’s pathways for fluids and Qi transformation.

When Yang is absent from the chi position behind the bar on the left wrist, meaning no pulse can be felt in the Fu-organ pulse position, the Bladder pulse is absent. The patient suffers from cold reversal in the hands and feet. In women, menstruation becomes irregular and may cease in the month when it is due; in men, there is seminal emission and dribbling after urination. Treatment should use needling of the Foot Shaoyin channel, the Kidney channel, to treat Yin, at the artery below the inner ankle.

When Yang is absent from the chi position behind the bar on the right wrist, the pulse of the Zi Hu, or womb, is absent. The patient suffers from cold reversal and chill in the feet. Women may be infertile, have vaginal discharge, and experience coldness in the vagina. The Foot Shaoyin channel should likewise be needled to treat Yin.

When Yang is excessive at the chi position behind the bar on the left wrist, this indicates excess in the Bladder. The patient suffers from cold reversal and pain as pathogenic Qi pulls beneath the ribs. Treatment should use needling of the Foot Taiyang channel, the Bladder channel, to treat Yang, at the hollow behind the joint on the outer side of the little toe.

When Yang is excessive at the chi position behind the bar on the right wrist, this also indicates excess in the Bladder. The patient suffers from fullness and distention in the lower abdomen, with pain that pulls into the lower back. The Foot Taiyang channel should likewise be needled to treat Yang.

If an illness first arises in the Bladder, it causes pain in the sinews on both sides of the spine and difficulty urinating. After five days, it passes to the Kidneys, causing pain in the lower abdomen and along the lower back, as well as weakness in the lower legs. One day later it passes to the Small Intestine, causing distention and fullness. Another day later it passes to the Spleen, causing blockage, pain throughout the body, and heaviness. If there is still no improvement after a further two days, the patient will die: in winter, at cockcrow; in summer, in the hour of Shen in the afternoon—some accounts say at dusk.

Signs of Bladder disease include swelling and pain on one side of the lower abdomen. When pressed by hand, the patient feels the urge to urinate.

When urination is difficult, if there is heat in the shoulder, or heat along the outer side of the little toe, the shinbone, or behind the ankle, and the pulse at the corresponding area feels sunken, treatment may be given by needling Weizhong, at the center of the hollow behind the knee.

When the bladder is distended and full, the lower abdomen feels swollen and urination becomes difficult. If the kidneys fall ill first, the illness may pass to the bladder. A kidney cough that persists despite prolonged treatment may cause involuntary urination during coughing. When rebellious Qi (disordered vital energy) remains in the bladder, one may dream of wandering from place to place.

The kidneys correspond to the bones. If the skin’s texture is dense and the skin is thick, the Triple Burner and bladder are also thick; if the texture is coarse and the skin is thin, they too are thin. Loose skin indicates that the Triple Burner and bladder are slack; taut skin without body hair indicates that they are firm. Fine, coarse body hair indicates that they are open and unobstructed, while sparse body hair indicates that they are prone to stagnation.

Bian Que said that illness in the six bowels reveals itself in the face. The kidneys and bladder, and the Foot Shaoyin channel (Kidney Channel) and Foot Taiyang channel (Bladder Channel), are paired as interior and exterior. The bladder’s Qi channels also connect with the five viscera. Thus, illness in the five viscera often manifests in the bladder, while bladder illness can also affect the urinary bladder. Heat pathogen damaging the bladder may obstruct urination and make it difficult to pass urine; cold pathogen damaging it may cause frequent urination of clear, pale urine. A condition known as “stone water” may also occur. It originates in the bladder and is marked by wasting of the limbs and swelling confined to the lower abdomen. (For the treatment prescription, see “Treatise on Water.”) When the Qi of the bones is exhausted and severed, the condition cannot be cured. If the teeth turn yellow and fall out, death will occur within ten days.

The channels of the Foot Taiyang begin at the inner corner of the eye, ascend across the forehead, and meet at the crown. One branch runs from the crown to the upper corner of the ear. The main channel descends from the crown into the brain, connects with the back of the head, then emerges and runs down through the neck and the inner side of the shoulder. It follows both sides of the spine to the lower back, enters and connects with the kidneys, and belongs to the bladder. Another branch descends from the lower back, meets at the anus, passes through the buttocks, and enters the hollow behind the knee. A further branch leaves the inner side of the shoulder, descends through the shoulder blade area (some versions read “hip”), passes the hip joint, and runs down the outer back of the thigh. It meets the channel described above at the hollow behind the knee, then continues down past the calf, circles behind the outer ankle, follows the Jinggu bone—a bony landmark on the outer side of the foot—and reaches the outer side of the little toe.

When this channel is affected, symptoms may include a swollen, painful head; eyes that feel as if they might protrude; a neck that feels tightly drawn; back pain; a lower back that feels as if it might break; inability to bend or extend the thigh; tightness behind the knee; and a calf that feels as if it might split open. This is called “ankle reversal.” The Foot Taiyang channel governs the sinews and is also associated with hemorrhoids, malaria, mania, epilepsy, pain in the head and neck, yellowing and tearing of the eyes, nasal congestion or nosebleeds, and pain in the neck and back, lower back, buttocks, hollow behind the knee, calves, and feet. The little toe may also become immobile. The final phrase in this passage, “when it is excessive, then the Renying…,” is unfinished and its meaning is incomplete.

When the pulse is more than twice as strong as the Cun Kou pulse, while the Cun Kou pulse itself appears weak, the Renying pulse will be weaker than the Cun Kou pulse.

The Second Section: Deficiency and Excess of the Bladder

(Four pulse signs, six prescriptions, and one moxibustion method concerning deficiency and excess of the Bladder)

Excess Heat in the Bladder

The pulse at the left wrist, in the Chi position behind the Shenmen point, is predominantly Yang and forceful. It belongs to the Foot Taiyang channel. The patient often feels Qi surging upward and fullness in the chest and abdomen, has pain in the lower back, and cannot bend forward or lean back. Fatigue makes the symptoms especially uncomfortable. This is called excess heat in the Bladder.

The pulse at the right wrist, in the Chi position behind the Shenmen point, is also predominantly Yang and forceful, and belongs to the Foot Taiyang channel. The patient often feels that Qi is obstructed in the lower abdomen and cannot urinate. They may also experience dizziness and headache, restlessness and abdominal distension, and stiffness in the back. This is called excess heat in the Bladder.

Here, “Chi position” refers to the section of the Cun Kou pulse closest to the wrist. “Shenmen” is an acupoint on the wrist, used in this text as a reference for locating the pulse.

Prescription for Treating Excess Heat in the Bladder

Eight liang of gypsum; three liang each of gardenia seed (also written as melon seed), poria, and anemarrhena; five ge of honey; and one sheng each of fresh bamboo leaves and rehmannia root.

Cut the seven ingredients into small pieces. Add seven sheng of water and decoct until two sheng remain. Strain out the dregs, add the honey, and boil twice more. Take in three portions.

Prescription for Bladder Heat That Does Not Resolve, with Dry Tongue and Swollen Throat

Seven ge of honey; three liang each of cimicifuga and isatis leaf; and four liang each of belamcanda, fresh scrophularia root, phellodendron bark, and the white bark of rose root.

Add seven sheng of water to the seven ingredients and decoct until one sheng remains. Strain out the dregs, add the honey, and boil twice more. Hold small amounts in the mouth repeatedly.

Cold from Bladder Deficiency

The pulse at the left wrist, in the Chi position behind the Shenmen point, is predominantly Yang but weak. It belongs to the Foot Taiyang channel. The patient often has tight, cramping tendons in the calves and abdominal pain that extends to the lower back. The body cannot bend, stretch, or turn. There may also be cramping, aversion to wind, paralysis on one side of the body, lower back pain, and pain behind the outer ankle. This is called cold from Bladder deficiency.

The pulse at the right wrist, in the Chi position behind the Shenmen point, is also predominantly Yang but weak, and belongs to the Foot Taiyang channel. The patient often has muscle tremors, tight, cramping tendons in the calves, and deafness, with sudden loss of hearing. They may also have an aversion to wind and hear a whistling sound like wind in the ears. This is called cold from Bladder deficiency.

Prescription for Cold from Bladder Deficiency, Hunger Without Desire to Eat, a Face Black as Charcoal, and Pain in the Lower Back and Sides

Six liang of magnetite; three liang each of astragalus and poria; four liang each of schisandra and eucommia; and white atractylodes…

The source text ends at “white atractylodes”; it does not give the dosage or subsequent decoction and administration instructions.

White quartz, five liang of each; this passage appears to give the medicinal dosages for the preceding prescription, which was not fully recorded above.

Cut the seven ingredients into pieces. Boil them in nine sheng of water until three sheng remain. Divide into three doses and take them.

Prescription for treating deficiency-cold of the bladder, coughing up blood, a rattling sound in the throat, and labored breathing:

One sheep kidney; three liang each of ginseng, Scrophularia root, astragalus root, cinnamon bark, Chuanxiong rhizome, and licorice; four liang of poria; five liang each of Chinese wolfberry root bark and fresh ginger; six liang of largehead atractylodes rhizome.

Cut the eleven ingredients into pieces. First boil the sheep kidney in one dou and two sheng of water until the volume has decreased by three sheng. Remove the kidney, then add the other ingredients and continue boiling until three sheng of liquid remain. Strain out the dregs and divide into three doses.

Dragon Bone Pills: A prescription for treating deficiency-cold of the bladder and kidneys, a sensation of nearly falling when sitting up or standing, blurred vision, lack of strength, and weak, powerless bones:

Five fen each of dragon bone, arborvitae seeds, dried rehmannia root, licorice, and saposhnikovia root; seven fen each of astragalus root, limonite, white quartz, cinnamon bark, and poria; six fen each of Schisandra fruit, notopterygium root, ginseng, and aconite; four fen each of Asiatic cornelian cherry fruit, Scrophularia root, and Chuanxiong rhizome; eight fen each of magnetite, eucommia bark, and dried ginger.

Grind the twenty ingredients into a fine powder and mix with honey to form pills the size of Chinese parasol tree seeds. Take thirty pills on an empty stomach with wine, twice daily, gradually increasing the dose to forty pills.

Prescription for treating cold in the bladder, frequent urination with leakage, and semen thick like rice-washing water:

Five fen each of red halloysite and white halloysite; three fen of dried rehmannia root; six fen of cistanche; two red rooster intestines and two gizzards; four fen each of mantis egg cases, oyster shell, dragon bone, and coptis.

Grind the ten ingredients into a fine powder and sift. Stuff the rooster intestines and gizzards into the intestines, sew them closed, steam them until cooked, then dry them in the sun. Pound them together with the powdered medicine to make a medicinal powder. Take one square-inch spoonful each time, mixed with wine, three times daily.

Moxibustion for treating the bladder:

Apply moxibustion according to the method for treating kidney deficiency.

Treatise on the Urinary Bladder, Third (one treatise, sixteen prescriptions, eight moxibustion methods)

The treatise says: The urinary bladder is the site by which the condition of the kidneys and bladder is assessed. It stores fluids and urine. If heat disease arises within the organs and bowels, the bladder becomes obstructed, urination stops, and the urine turns yellow-red. If there is cold in the bowels…

The patient may develop an inability of the bladder to retain urine, with frequent, copious urination and cloudy white urine. Urine is especially abundant at night. As Yin Qi gradually arises at night, use a draining method if the condition is due to heat, and a tonifying method if it is due to cold. If there is neither cold nor heat, regulate treatment according to the meridians and the condition, and the illness will not arise.

Sometimes urine cannot flow freely into the bladder because the bladder is compressed or displaced, obstructing the passage of fluids. Take an onion leaf, remove its tip, and insert it about three inches into the urethra. Then blow gently to inflate the bladder and restore the flow of fluids; the condition will resolve.

Elm bark helps lubricate the passage and drain heat. The following formula is used when Kidney heat affects the bladder, causing painful, difficult urination and yellow-red urine:

One sheng each of elm bark, red honey, and winter-melon seeds; three liang each of talc and tongcao; five sheng of plantain seeds.

Chop the six ingredients, add three dou of water, and decoct until seven sheng remain. Strain out the herbs, add honey, and decoct again until three sheng remain. Divide into three doses. This formula is also used for difficult childbirth in women.

Talc Decoction, for urgent bladder symptoms with internal heat and yellow-red urine:

Eight liang of talc; three liang of scutellaria root; one sheng each of plantain seeds and winter-melon seeds; four liang of elm bark.

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

For cloudy white urine caused by deficiency taxation:

Take two jin of elm bark, chop it, add two dou of water, and decoct until five sheng remain. Divide into five doses.

Another formula: Pound dried sheep bone into powder. Take one square-inch spoonful at a time, twice daily.

There is also a moxibustion method: apply one hundred cones of moxa each to Pishu, Sanjiaoshu, and Shenshu, and one hundred cones to Zhangmen. Zhangmen is located at the tip of the lower rib. A “cone” is a unit of moxibustion, indicating the amount used in one treatment.

Eating to fullness, holding in urine, riding a horse at speed, running vigorously after holding in urine, or sexual activity may all cause “bladder twisting” (blockage of the bladder’s Qi movement). Symptoms include urgent fullness and distension below the navel and inability to urinate. The treatment is as follows:

Twist loose hair tightly into two fist-sized bundles and burn them to ash. Mix the ash with four he of vinegar, then add two square-inch spoonfuls of medicinal powder and take it. Afterward, spread stir-fried black bean leaves on the ground and squat on them.

Formula for treating bladder twisting:

One liang of shiwei; two liang each of winter-melon seeds, tongcao, and licorice; three liang of ghost arrow; four liang of talc; one sheng of elm bark.

The original text ends here and does not record how to decoct or take this formula.

Coarsely chop the seven ingredients above. Boil them in one dou of water, reduce the liquid to three sheng, and divide it into three doses.

Formula for treating urinary retention caused by bladder displacement in men or women, with inability to urinate for eight or nine days:

One sheng of sunflower seeds; one jin each of talc and cold-water stone.

Coarsely chop the three ingredients above. Boil them in one dou of water, reduce the liquid to five sheng, and divide it into three doses.

Formula for treating bladder displacement and inability to urinate:

Forty-seven stalks of scallion whites, one liang of donkey-hide gelatin, three liang of amber, and one sheng of plantain seeds.

Coarsely chop the four ingredients above. Boil them in one dou of water, reduce the liquid to three sheng, and divide it into three doses.

Another formula: Boil three liang of donkey-hide gelatin in two sheng of water, reduce the liquid to seven ge, and drink it all at once.

Another formula: Boil five ge of fermented soybeans in three sheng of water until it bubbles several times, then drink it all at once.

Another formula: Boil hemp seeds to make a decoction, and drink it all at once.

Another formula: Burn a section of a flail handle to ash, and swallow it with water.

Another formula: Burn a brush tip to ash, and swallow it with water.

Another formula: Grind two scarab beetles that have died in a fire into powder, and swallow it with water.

Another formula: Place the eggs of a white fish into the urethral opening.

Another formula: Mix a lump of pork fat the size of an egg with wine, and swallow it all at once.

Formula for treating lower back pain, inability to urinate, and distress caused by bladder displacement:

Apply seven moxa cones at the Yuguan point. Yuguan is one cun below the Guanyuan point. For adults, locate it by measuring eight cun downward from the pit of the stomach; for children, adjust the location as appropriate. Also apply fifty moxa cones at the fifteenth vertebra, then moxibustion below the navel at one cun and four cun; determine the number of cones at both sites according to age.

Chapter Four: “Treatise on the Pulse of the Three Burners”

The treatise says: The Three Burners are also called the “Three Passes.” The upper burner is called “Three-Pipe Reflux,” the middle burner “Sudden Turmoil,” and the lower burner “Running Feed.” Together, the Three Burners are considered a single fu-organ. They have a name but no visible form. They govern the movement between the five zang-organs and six fu-organs and form a spiritual pathway that runs throughout the body: their functions can be heard of, but their substance cannot be seen. They harmonize and circulate Jing and Qi, open the pathways through which fluids move, and sustain the flow of Qi between the intestines and stomach. For this reason, their workings must be understood.

The Three Burners are also called the “fu-organ of inner clarity,” and are known by another name, “Jade Sea.” The pathways for fluids lead to the bladder. Although the Three Burners are collectively called one fu-organ, in practice they are divided into upper, middle, and lower parts; together, these are called the “solitary fu-organ.” Nutritive Qi emerges from the middle burner, and defensive Qi from the upper burner: nutritive Qi is the Qi that travels through the network vessels, while defensive Qi travels through the channel vessels. The Three Burners are said to have the same shape, thickness, and size as the bladder.

When the Triple Burner (the upper, middle, and lower burners in Chinese medicine) is diseased, the abdomen becomes distended and full, with particular hardness in the lower abdomen. The person feels an urge to urinate but cannot pass urine, and is distressed and uncomfortable.

When Qi in the Triple Burner becomes constricted and its movement obstructed, fluids accumulate. If they remain stagnant and do not disperse, distention and fullness result. The symptoms may appear along the great collateral of the Foot Taiyang channel and between the Taiyang and Shaoyang channels. To examine the channel vessels, one may select Weiyang. If the lower abdomen is swollen and painful and urination is blocked, the pathogen is in the Triple Burner and Qi movement is obstructed. One may select the great collateral of the Foot Taiyang channel and examine the vessels where stagnation has formed. If the small collateral of the Jueyin channel is also congested and contains stagnant blood, and the swelling extends upward to the epigastrium, one may select Zusanli.

When the Triple Burner is distended and full, Qi fills the skin, causing it to bulge. Some accounts say that the skin does not feel hard to the touch; others say that it does.

If a chronic cough persists and the disease reaches the Triple Burner, the person coughs, develops abdominal distention and fullness, and loses the desire to eat.

The Hand Shaoyang channel (the Hand Shaoyang Triple Burner channel) begins at the tip of the ring finger. It travels upward between the ring and little fingers, along the back of the hand to the wrist, then up between the two bones on the outer forearm. It passes through the elbow and follows the outer upper arm to the shoulder, where it meets the Foot Shaoyang channel. It enters the supraclavicular fossa, meets at Shanzhong (between the breasts), spreads through and connects with the Pericardium, then descends through the diaphragm and extends throughout the Triple Burner.

One branch rises from Shanzhong, emerges at the supraclavicular fossa, and travels up along the neck and nape, passing behind the ear to the upper corner of the ear before curving downward toward the forehead and the side of the nose. Another branch enters the ear from behind, emerges in front of it, passes before Kezhuren (Shangguan, in front of the ear), meets the cheek, and reaches the outer corner of the eye.

When this channel is affected, symptoms may include deafness, a dull or unclear sensation in the ears, swelling and pain in the throat, and a sensation of blockage in the larynx. The channel governs disorders of Qi. Other disorders along its course include sweating; pain at the outer corner of the eye; swelling of the cheek; pain behind the ear, in the shoulder, upper arm, elbow, and outer forearm; and difficulty moving the ring and little fingers.

To treat these disorders, drain when pathogenic Qi is excessive and tonify when genuine Qi is deficient. For heat, needle quickly; for cold, retain the needles longer. When Qi and blood are deficient and sunk, use moxibustion. If the condition involves neither excess pathogen nor deficiency of genuine Qi, select points according to the channel’s usual method. When pathogenic Qi is excessive, the Renying pulse (felt at the carotid artery) is twice as large as the Cunkou pulse (felt at the wrist). When genuine Qi is deficient, the Renying pulse is smaller than the Cunkou pulse.

Chapter Five: Deficiency and Excess of the Triple Burner (three discussions, eighteen prescriptions, seven moxibustion methods)

The treatise says: “The Upper Burner is like mist.” Here, “mist” describes Qi that is gentle and diffuse as it rises. The Qi of the Upper Burner begins at the upper opening of the stomach, travels up along the throat, passes through the diaphragm, and spreads through the chest. It then moves toward the armpits, follows the course of the Foot Taiyin channel, and flows back to enter the Hand Yangming channel. It rises to the tongue and descends into the Foot Yangming channel. It normally travels together with nutritive Qi and defensive Qi along the front of the body, circulating twenty-five times in each direction over the course of a day and night.

When Qi and blood circulate through the Yin aspect twenty-five times, this counts as one day and night. Over the full day and night, they circulate fifty times, traveling through the whole body before beginning again, and ultimately converging at Hand Taiyin (the name of a channel, referring to the Lung channel). Illnesses governed by channels such as Hand Shaoyang, the Heart, and the Lung are generally internal and do not manifest externally.

A person may develop a fever. Food and drink enter the stomach, but before the stomach Qi has settled, sweat begins to flow. Sometimes it appears on the face, sometimes on the back, and the whole body also grows hot. Why does this sweat fail to emerge along the normal route followed by defensive Qi? Because Wind evil has invaded from outside, opening the interstices (the tissues between skin and muscle, including the pores). The skin grows hot and the interstices leak, so defensive Qi escapes through the opening. Defensive Qi moves swiftly and flows out wherever it finds an opening, making it unable to follow its normal course. This condition is called “leaking Qi.”

A person with this condition may suffer painful cramping in the elbows. Food is first vomited, then passes downward. The breath cannot flow continuously, and there is oppressive discomfort between the chest and diaphragm; for this reason, food is vomited before it passes downward. When the condition tends toward cold, the spirit cannot settle, diarrhea and dysentery occur, and the person may even lose the ability to speak. When the condition is excess, Qi surges upward and obstructs the Heart region; when it is deficient, it draws on Lung Qi.

Alisma Decoction: Unblocks the channels and drains Heat evil. It is used when there is Heat in the upper burner (the region above the chest, including the Heart and Lungs), and sweat appears before the stomach Qi has settled after food enters the stomach, with heat in the face, back, and throughout the body. This condition is called “leaking Qi.”

Alisma, Pinellia, Bupleurum, and Ginger (three liang each); cinnamon bark and licorice (one liang each); Poria and ginseng (two liang each); Cortex Lycii Radicis (five liang); gypsum (eight liang); bamboo leaves (five ge); and water shield pith (one sheng).

Cut the twelve ingredients into pieces. Add two dou of water and decoct until six sheng remain. Divide into five doses and take them. Another version says to add one dou of water, decoct until three sheng remain, and divide into three doses.

Ophiopogon Regulate-the-Middle Decoction: Used for Heat in the upper burner, abdominal fullness, loss of appetite, food that is vomited before passing downward, or painful cramping in the elbows.

Ophiopogon, fresh reed root, bamboo shavings, and polished rice (one sheng each); water shield pith (five ge); licorice and Poria (two liang each); tangerine peel, ginseng, and Solomon’s seal (three liang each); fresh Ginger (four liang); and Atractylodes (five liang).

Cut the twelve ingredients into pieces. Add one dou and five sheng of water and decoct until three sheng remain. Divide into three doses and take them.

Formula for treating Qi that gathers and binds in the chest, causing pain and a tendency to vomit:

Moxibustion at the Jueyinshu point, located on the back: the point lies on either side of the fourth vertebra, one cun and five fen from the spine. The number of moxibustion cones is determined by age.

Astragalus and Regulate-the-Center Decoction: Treats deficiency cold in the upper burner, shortness of breath that cannot be drawn in fully, and a voice too weak to speak.

Astragalus and cinnamon bark, two liang each; schisandra fruit, platycodon root, dried ginger, poria, licorice, and ligusticum, three liang each; salvia root and apricot kernel, four liang each.

Coarsely cut the ten ingredients, add nine sheng of water, and decoct until three sheng of liquid remain. Divide into three doses.

Coptis Pills: Treats cold in the upper burner, diarrhea, abdominal discomfort, and a tendency to have diarrhea after eating.

Coptis, eight liang; mume fruit flesh, eight liang; cinnamon bark, two liang; dried ginger, aconite, and donkey-hide gelatin, four liang each; zelkova bark, ligusticum, and phellodendron bark, three liang each.

Grind the nine ingredients into powder and use honey to form pills the size of Chinese parasol tree seeds. Take twenty pills with water per dose, gradually increasing to thirty.

Magnolia Bark Decoction: Treats obstruction in the upper burner, dry retching without being able to vomit, a body with little heat but much cold, and frequent vomiting of white foam and thin, clear saliva, with a sour taste in the mouth.

Magnolia bark, poria, ligusticum, atractylodes, and scrophularia, four liang each; platycodon root, aconite, ginseng, and tangerine peel, three liang each; fresh ginger, eight liang; evodia fruit, eight he.

Coarsely cut the eleven ingredients, add two dou of water, and decoct until five sheng of liquid remain. Divide into five doses.

Discussion: The middle burner, one of the body’s upper, middle, and lower burners and chiefly the region where the spleen and stomach are located, is like bubbles in boiling water. The term “ou” refers to bubbles surging in the stomach. The Qi of the middle burner arises at the “guan” in the stomach, called the “middle opening” in the Classic of Difficulties and the “stomach opening” in the A-B Classic of Acupuncture and Moxibustion and Treatise on the Origins and Symptoms of Various Diseases. It lies behind the upper burner. The middle burner receives the Qi of food and drink, transforms it into their refined essence, separates out the waste, and steams and transforms fluids. It then conveys the refined substances to the lung vessels, where they are further transformed into blood to nourish the body. Nothing is more important than this. Thus, it moves through the channels and is called “nutritive Qi,” the Qi that nourishes the body.

The branch collateral of the Foot Yangming channel is called Fenglong. It lies eight cun above the outer ankle, branches off to connect with the Foot Taiyin channel, communicates with the various channels above and below, and connects with the stomach. The stomach governs the digestion of the five grains: when stomach Qi is strong, food is neither vomited nor passed in diarrhea. If this strength generates heat, the pathogenic heat causes obstruction, separating the upper and lower parts. If stomach Qi is weak… The original text ends here.

Cold pathogens can invade and cause abdominal pain, severe diarrhea, and dysentery with blood in the stool. These conditions all concern the Spleen and Stomach.

Blood and Qi differ in form but are similar in nature. Defensive Qi (the Qi that circulates at the body’s surface and provides protection) is formed from Jing and blood, while Qi is the manifestation of Shen (the activity of life and the functions of the mind).

Thus, blood and Qi have different names but similar natures. A person who loses blood does not sweat; this indicates damage to Shen and Qi. A person who sweats excessively has insufficient blood; this indicates damage to Jing and Qi. A person may therefore die in either of two ways, but cannot have two sources of vitality at once, just as spirit and breath may become separated from each other. When there is deficiency, tonify Stomach Qi; when there is excess, drain Spleen Qi. Harmonizing the middle burner and treating the source of illness can bring the treatment to completion.

Rhubarb Heat-Draining Decoction: This formula opens obstruction and restores communication when the upper and lower parts are blocked off from each other. It treats excess Heat in the middle burner with obstruction between the upper and lower parts, when the patient can neither vomit nor pass stool and has abdominal distension and rapid, labored breathing.

Ingredients: Sichuan rhubarb (sliced and soaked in one sheng of water), Scutellaria root, Alisma, Cimicifuga, and mirabilite (three liang each); antelope horn and gardenia (four liang each); fresh Scrophularia root (eight liang); and fresh Rehmannia juice (one sheng).

Coarsely cut the nine ingredients. Boil them in seven sheng of water until two sheng and three ge remain. Add the rhubarb and boil twice more, then strain out the dregs. Add the mirabilite and divide into three doses.

Blue-Green Pill: Treats water-and-grain diarrhea caused by Heat in the middle burner, in which food passes out soon after it is eaten.

Ingredients: blue-green plant juice (three sheng), Coptis (eight liang), Phellodendron bark (four liang), dark plum flesh, kochia fruit, Sanguisorba root, and Atractylodes (two liang each), and donkey-hide gelatin (five liang).

Grind the eight ingredients into powder and mix with the blue-green juice. Simmer over a low flame to make pills the size of apricot kernels. Take three pills twice a day for seven days; the formula is said to work very well. Roll the pills between both palms to shape them.

Coptis Decoction: Treats severe diarrhea and dysentery caused by deficiency Cold in the middle burner, or diarrhea following cholera, with yellowish-white stools that pass repeatedly without stopping and empty abdominal pain.

Ingredients: Coptis, sour pomegranate peel, Sanguisorba root, and donkey-hide gelatin (four liang each); Phellodendron bark, Chinese angelica root, magnolia bark, and dried ginger (three liang each).

Coarsely cut the eight ingredients. Boil them in nine sheng of water until three sheng remain, then strain out the dregs. Add the donkey-hide gelatin and continue boiling until it melts. Divide into three doses.

A formula for treating inability to move the limbs, excessive sweating, and severe diarrhea.

The Great Horizontal point, one of the points on the Spleen Channel of Foot-Taiyin, lies two cun and five fen to either side of the navel. When applying moxibustion, use one moxa cone for each year of age.

Discussion: The lower burner, the part of the lower abdomen associated with the discharge of fluids, is like a network of canals that guides and carries off water. Its Qi rises from the lower opening of the stomach, branches into the ileum, and then flows into the bladder; fluids seep into the bladder along with it. Thus, fluids and food residue usually remain together in the stomach. Once transformed into waste, they descend together into the large intestine.

The lower burner is connected with the Foot-Taiyang Channel. It distributes and conveys fluids, joins with the bladder, governs discharge rather than intake, and distinguishes clear from turbid substances. It is also associated with patterns of illness involving the liver and kidneys. In an excess pattern of the lower burner, urination and defecation are obstructed, Qi rebels upward, food cannot descend, and vomiting continues without stopping. This condition is called “reversal of ingestion.” In a deficiency pattern, control of urination and defecation is lost, and both fluids and Qi are depleted.

Why is it that after someone drinks alcohol, the alcohol and food enter the stomach together, but before the food has finished digesting, the urine is already passed? Alcohol is the juice of grain that has already been fermented. It acts powerfully and moves freely, so the alcohol consumed earlier is discharged before the food eaten later has passed through. Therefore, when the lower burner has heat, treat it by draining the liver; when it has cold, treat it by supplementing the kidneys.

Bupleurum Decoction for Freeing Blockage: Treats heat in the lower burner with obstructed urination and defecation.

Ingredients: Bupleurum, antelope horn, Scutellaria root, tangerine peel, and Alisma, three liang each; fermented soybeans, one sheng, set aside separately; fresh Rehmannia root, one sheng; mirabilite, two liang; gardenia fruit, four liang; and gypsum, six liang.

Chop the ten ingredients. Boil them in one dou of water until three sheng of liquid remain. Strain out the dregs, add the mirabilite, and take the dose in three portions.

Red Halloysite Decoction: Treats heat in the lower burner, or dysentery with pus and blood, accompanied by distress and mental confusion.

Ingredients: red halloysite, eight liang; twenty Chinese plums; fourteen gardenia fruits; one sheng of stored rice; white atractylodes and cimicifuga, three liang each; and dried ginger, two liang.

Chop the seven ingredients. First boil the rice in one dou of water until cooked, then remove the rice and add the medicinal ingredients. Continue boiling until two and a half sheng of liquid remain. Take the dose in three portions.

Ginseng Decoction to Stop Vomiting: Treats heat in the lower burner with rebellious Qi, food that cannot descend, and unrelenting vomiting. This condition is called “reversal of ingestion.”

Ingredients: ginseng, Solomon’s seal, Scutellaria root, Anemarrhena, and Poria, three liang each; fresh reed root, gardenia seed, white atractylodes, and tangerine peel, four liang each; and gypsum, eight liang.

Cut the following ten ingredients into small pieces. Simmer them in nine sheng of water until three sheng of decoction remain. Strain out the dregs and divide the liquid into three doses.

Fragrant Fermented Soybean Decoction: Used to treat dysentery caused by heat toxins in the lower burner. Symptoms include stool resembling fish brains, streaked with red blood, severe cramping below the navel and in the lower abdomen, and an urge to defecate without being able to pass stool.

Fragrant fermented soybeans and Chinese chives, one sheng each; Coptis root, amur cork tree bark, white atractylodes, and madder root, three liang each; gardenia fruit, baical skullcap root, and great burnet root, four liang each.

Cut the following nine ingredients into small pieces. Simmer them in nine sheng of water until three sheng of decoction remain, then divide the liquid into three doses.

For disorders involving impaired fluid circulation in the bladder and Triple Burner, and cold or heat in the small and large intestines, with symptoms such as red-and-white dysentery, pain in the lower back and spine, difficulty urinating, and vaginal discharge in women: apply moxibustion to the Xiaochangshu point with fifty moxa cones.

Amur Cork Bark Decoction for Stopping Diarrhea: Used to treat deficiency-cold in the lower burner, with persistent watery diarrhea and urination.

Amur cork tree bark, ginseng, great burnet root, and donkey-hide gelatin, three liang each; Coptis root, five liang; poria and zelkova bark, four liang each; mugwort leaves, one sheng.

Cut the following eight ingredients into small pieces. Simmer them in one dou of water until three sheng of decoction remain, then strain out the dregs. Add the donkey-hide gelatin and stir until it dissolves. Divide into three doses.

Ginseng Decoction for Restoring Qi: Used to treat deficiency-cold in the lower burner, continuous loss of fluids, and shortness of breath so severe it seems about to cease.

Ginseng, tangerine peel, poria, smoked plum, dwarf lilyturf tuber, astragalus root, dried ginger, and Sichuan lovage rhizome, three liang each; evodia fruit, three ge; cinnamon bark, two liang; white atractylodes and magnolia bark, four liang each.

Cut the following twelve ingredients into small pieces. Simmer them in one dou and two sheng of water until three sheng of decoction remain, then divide into three doses.

Poria Pill: Used to treat deficiency-cold in the lower burner and blood stasis in the abdomen, with symptoms including forgetfulness, reluctance to listen to others, a sensation of obstruction in the chest, and shortness of breath.

Poria, dried rehmannia root, and Chinese angelica root, eight fen each; licorice, dried ginger, and ginseng, seven fen each; astragalus root, six fen; Sichuan lovage rhizome, five fen; cinnamon bark, four fen; magnolia bark, three fen; fifty apricot kernels.

Grind the following eleven ingredients into a fine powder and use honey to make pills the size of parasol tree seeds. Begin by taking twenty pills.

Gradually increase the pills to a maximum of thirty. Take them twice daily with clear, plain water.

Fulonggan Decoction: Used for damage caused by deficiency and cold in the lower burner, presenting as blood appearing before a bowel movement. This is called “proximate bleeding”: stool is passed first, followed by blood. The condition may or may not be accompanied by diarrhea.

The ingredients are: five he of Fulonggan (the earth from the center of a stove, ground to powder); five liang of dried Rehmannia root (one version uses Phellodendron bark instead); three liang each of donkey-hide gelatin, Achyranthes root (another text gives burdock root), licorice, dried ginger, Scutellaria root, and garden burnet root; and two he of hair ash.

Chop the nine ingredients. Simmer them in nine sheng of water until three sheng remain, then strain out the dregs. Add the donkey-hide gelatin and simmer until it melts, then add the hair ash. Divide into three doses.

Dipsacus Hemostatic Formula: Used for damage caused by deficiency and cold in the lower burner, presenting as stool passed before blood appears. This is called “distal bleeding”: blood appears after a bowel movement. The condition may or may not be accompanied by diarrhea, and often flares up after exertion or exposure to cold.

The ingredients are: one liang each of Dipsacus root, Chinese angelica root, cinnamon bark, cattail pollen, and donkey-hide gelatin; two liang of licorice; and four liang each of dried ginger and dried Rehmannia root.

Chop the eight ingredients. Simmer them in nine sheng of water until three and a half sheng remain, then strain out the dregs. Add the donkey-hide gelatin and simmer until it melts, then add the cattail pollen. Divide into three doses.

Chinese Angelica Decoction: Used for deficiency and damage of the three burners, which may cause bleeding from the upper or lower body, such as vomiting blood or spitting blood. The text holds that these symptoms are all related to the three burners and may be caused by damage from pathogenic heat or by drinking alcohol. This formula may be used for them.

The ingredients are: three liang each of Chinese angelica root, dried ginger, small thistle, donkey-hide gelatin, antelope horn, dried Rehmannia root, and arborvitae bark; four liang each of white peony root and white atractylodes; five he of cattail pollen; half a sheng of green bamboo shavings; and two liang each of Fulonggan, hair ash (an amount the size of an egg), Scutellaria root, and licorice.

Chop the fifteen ingredients. Simmer them in one dou and two sheng of water until three and a half sheng remain, then strain out the dregs. Add the donkey-hide gelatin and simmer until it melts, then add the hair ash and cattail pollen. Divide into three doses.

Moxibustion

For fullness and distension in the chest and abdomen, pain in the lower back and back, vomiting after eating, alternating chills and fever, difficulty urinating, wasting of the body, or shortness of breath, apply moxibustion to Sanjiaoshu, using one moxa cone for each year of age.

For abdominal disorders, lower back pain, cold and stagnation in the bladder, or diarrhea after drinking water, apply moxibustion to Xiajishu, using one moxa cone for each year of age.

For cold and heat in the three burners, apply moxibustion to Xiaochangshu, using one moxa cone for each year of age.

When there is heat in the Triple Burner, bladder, and kidneys, moxa can be applied to the Shuidao points. The number of moxa cones should be determined by age. The Shuidao points are located on either side of the upper edge of the pubic bone (the curved bone), each two and a half cun from the midline. The distance from the upper edge of the pubic bone to the navel is five cun.