《孫真人備急千金要方》Vol. 70

Essential Prescriptions Worth a Thousand in Gold for Emergencies by Master Sun, Scroll Seventy

(Edited by Lin Yi and others, Court Gentleman for Court Service, Acting Junior Minister of the Court of Imperial Sacrifices, and Proofreader of the Palace Library)

Intestinal Abscess, Part Two (Three discussions, thirty-three prescriptions, two moxibustion methods)

Discussion: Intestinal abscess can arise suddenly, yet people may not recognize its symptoms. If a doctor with limited skill treats it incorrectly, the patient may die. When intestinal abscess develops, the lower abdomen feels heavy and tight, and is painful when pressed. Urination is frequent, as in strangury; the patient often sweats and feels cold. The skin over the whole body feels rough, as though covered by a shell. The abdominal skin is taut, as if swollen. A rapid, frequent pulse indicates that there is little pus. (The Origins and Symptoms of Diseases says that a frequent pulse indicates pus is already present.) A slow, tight pulse indicates that there is no pus yet. In severe cases, the abdomen swells, and a sound of water can be heard inside when the patient turns over. Sometimes sores appear around the navel; sometimes pus flows from the navel; sometimes the stool contains pus and blood.

Someone asked: “When the Lady of the Palace Guards fell ill, how could the doctor tell from her pulse that there was pus in her intestines? Would purging cure her?” The answer was: “The pulse at the cun position on the wrist is slippery and frequent. A slippery pulse indicates an excess pathogen, while a frequent pulse indicates heat. The slippery pulse corresponds to nutritive Qi, and the frequent pulse to defensive Qi. Defensive Qi moves downward too quickly, while nutritive Qi moves upward with ease. When nutritive and defensive Qi are out of balance, the blood becomes corrupted and turbid. The lower abdomen then becomes blocked and hard; urination may be difficult, and the patient may sweat or feel cold. These signs show that pus has formed. A slow, tight pulse indicates blood stasis. If the stasis is purged, the illness will resolve.”

Prescription of Dahuang and Mudan Decoction: For treating intestinal abscess.

Four liang of da huang, three liang of mudan, two liang of mang xiao, one sheng of guazi, and fifty tao ren.

Cut the five ingredients into pieces. Add five sheng of water and decoct until one sheng remains. Take the whole dose at once; pus and blood should be discharged afterward. (The Prescription for Removing Complications uses half a ge of mang xiao and five ge of guazi. Liu Juanzi uses three ge of xiaoshi. He says that in patients with intestinal abscess, the lower abdomen becomes blocked and hard, and a mass may be located to either side of the bladder. It may be pale in color and hard in texture, about the size of a palm, and hot to the touch. Urination is generally unimpeded, and sometimes the patient has a white sweat. A slow, firm, tight pulse indicates that pus has not yet formed, so purging may be used; blood will be discharged after taking the medicine. A frequent pulse indicates that pus has formed, and purging should no longer be used. The Handbook of Prescriptions for Emergencies calls this the “Guazi Decoction.”)

Intestinal Abscess Decoction:

Two liang each of mudan, gancao, baijiang, shengjiang, and fuling; jiegeng…

Use three liang each of coix seed (yìyǐrén) and ophiopogon root, four liang each of red-rooted salvia and peony root, and five liang of raw rehmannia root. Chop all the ingredients, boil them in one dou of water, and reduce the liquid to three sheng. Take it in three portions, three times a day.

Another prescription: Use one sheng of coix seed, three liang each of tree peony bark and peach kernels, and two sheng of melon seeds. Chop the four ingredients, boil them in six sheng of water, and reduce the liquid to two sheng. Take it in two portions.

Yao’s version omits peach kernels and uses apricot kernels instead. Cui’s version adds two liang of mirabilite. It is said that severe abdominal pain and distress, a swollen, full abdomen with inability to eat, or difficulty urinating are often signs of intestinal carbuncle—an abscess inside the intestines. This illness is often overlooked. Women weakened and feverish after childbirth are also prone to it. Even if there is no abscess, taking this decoction will cause no other harm.

Another prescription: Take the crest feathers and droppings of a rooster, burn them to ash, and swallow the powder with wine on an empty stomach.

Another prescription: Cut off a small piece from the tip of a roof eave, burn it to ash, mix it with water, and drink it. It is said that this will open an outlet at the affected site; once pus and blood drain out, the patient will recover.

The symptoms of intestinal carbuncle are coarse, jagged ridges on the outer rims of both ears, like a rasp. At the onset, there is severe abdominal pain, sometimes circling the navel. Pimple-like sores the size of millet grains appear on the skin, which becomes hot; pus and blood then pass, resembling dysentery with red and white discharge. Without treatment, the patient will certainly die. Burn a horse’s hoof to ash, mix it with egg white, and apply it to the affected area. It is said to draw out the pathogenic influence; no more than two applications are needed.

Another prescription: Take three sheng of melon seeds, pound them into powder, boil them in three sheng of water, and reduce the liquid to one sheng and five ge. Take it in three portions.

Another prescription: Mix soil from a grave with water to make a paste, and apply it to the affected area.

For treating an internal abscess before a head of pus has formed: Take the droppings of a brooding hen, and the illness will be cured.

Another prescription: Burn a horse’s tooth to ash, mix it with egg, and apply it. Replace the application when it dries.

Moxibustion for intestinal carbuncle: Bend both elbows and apply one hundred cones of moxa to the bony tip of each elbow. Pus and blood will then be discharged, and the illness will be cured. (One cone usually means one burning of a moxa stick.)

A treatise says: After giving birth, women should make sure their infants nurse frequently and should not allow milk to accumulate. If milk remains undischarged for a long time, it congeals. The stagnant, harmful fluid then builds up in the body and brings on fever, hard lumps in the breasts, pulling pain, and thirst. The breasts become painfully engorged, and even touching them is impossible. This is called “jealous breast” and is not an abscess. Immediately apply twenty-seven cones of moxa to the fish-border points on both hands, at the base of the thumbs on the palm side, to block the abscess channel. Afterward, touching the breasts will no longer cause pain, and the milk will flow on its own. At that point, the hands may be used to help express and clear the milk.

When large amounts of milk flow out and look like pus, take Forsythia Decoction internally and apply a thin layer of small red beans externally. This will cure the condition.

Women and girls may develop small, superficial, hot sores on the nipples. They itch, and scratching causes yellow fluid to seep out. The sores gradually spread and enlarge, resisting treatment for a long time and sometimes persisting for years. This condition is called “jealous breast.” When a nursing woman develops it, she often wants to wean her baby. This is the condition people refer to as “gouchaoru.”

The breasts should be washed with Red Dragon Bark Decoction or Gastrodia Decoction, then treated with Flying Crow Ointment or Flying Crow Powder; these work well. At the very onset, either Scutellaria and Rupturewort Powder or Coptis and Lead Powder may be applied. Both formulas are suitable.

Red Dragon Bark Decoction

Take three sheng of chopped oak bark and add one dou of water. Boil until five sheng remain. In summer, let it cool before use; in winter, use it warm. Wash the breasts in several applications. This decoction can also be used to wash deep, ulcerated sores that have resisted treatment for a long time. After washing, apply an ointment or powder.

Gastrodia Decoction

Take five sheng of chopped gastrodia herb and add one and a half dou of water. Boil until one dou remains. Wash the breasts in several applications, adjusting the temperature to the patient’s comfort, to relieve itching. The text says that this plant’s leaves resemble hemp leaves; it grows in winter and flowers in summer. Its flowers are red and shaped like a mouse’s tail. The decoction can also be used to wash spreading, weeping sores; yellow, ulcerated hot sores; itchy carbuncles; moist sores of the genitals; ulcerated sores; and sores on children’s heads. After washing, apply an ointment or powder.

Flying Crow Ointment

Three liang each of powdered soot (the black residue produced when cinnabar is heated to obtain mercury; another name for it is “Xiang powder”) and alum.

Grind the two ingredients into a fine powder, then blend them with a prepared oil used as an ointment base. Apply to breast sores three times a day. To make a powder, do not add any liquid: the medicinal powder will adhere on its own and can be applied directly. This formula is also used for various hot sores, yellow, ulcerated sores, spreading, weeping, itchy sores, itchy and moist sores of the male genitals, sores on children’s heads, “moon-eating” sores that gradually enlarge, fleshy sores around the mouth, and guo sores, a type of skin lesion.

Coptis and Lead Powder

Two liang of coptis, ten parts of lead powder, and one liang of mercury.

Grind the coptis into powder and combine all three ingredients. Wrap them in soft leather and rub repeatedly until they mix together. Even if they do not blend completely, the mercury will disperse finely through the lead powder. Apply to breast sores and to various moist sores, yellow, ulcerated sores, and fleshy sores. If the medicine dries and hardens on the skin, blend it into an ointment with prepared oil.

Formula for treating jealous breast and breast sores

Equal amounts of wasp nest, soil from inside a pig’s hoof, and mud from a wheel rut.

Grind the above three ingredients into a fine powder, mix with bitter wine (vinegar), and apply to the affected area.

Deer Antler Powder: Treats sores on the breasts of women, with fluid draining from the sores and unbearable pain.

Three parts deer antler, one part licorice root.

Crush the two ingredients and sift them into a powder. Mix with egg yolk, place in a bronze vessel, and warm it in a warm place before applying. Apply twice a day, and the condition will heal. This prescription is highly effective and is not readily shared.

A Prescription for Treating Blocked Breast Milk

Blocked breast milk refers to conditions in which milk stagnates, causing breast swelling, pain, and lumps. Burn sunflower stalks to ash, crush and sift them, then take one square-inch spoonful at a time—a measure of medicinal powder in ancient times, roughly the amount held on the tip of a dagger—three times a day. The condition will heal.

The Collection of Proven Prescriptions says: Crush the sunflower stalks directly into powder; there is no need to burn them to ash.

Another prescription: Burn a snake that has died naturally to ash, mix it with lard, and apply it to the affected area. It works very well.

Moxibustion Method

Use a strip of cattail to measure the width of the mouth. Starting above the nipple, measure upward by that length, then apply fourteen moxa cones at the point reached. “Cone” is the unit used to count moxibustion; one cone usually refers to burning a single moxa cone.

Discussion

After childbirth, if the mother does not nurse her baby, or if the baby dies or there is no baby to nurse, accumulated milk can readily develop into an abscess. If the mother does not nurse and her breasts become swollen, mix red bean powder with egg white and apply it to the breasts to disperse the lumps.

If milk remains after the baby has nursed, gently squeeze the breasts several times to express it. Alternatively, have an older child take a mouthful of water to cool the mouth, then suck out the stagnant milk and spit it out. If the child sucks without first taking water, the mouth will be warm, which can easily cause sores on the nipple and block the milk ducts.

Breast abscesses are common among women. Those under forty mostly recover with treatment. Treatment should be approached cautiously in those over fifty, since many die after treatment; without treatment, they may instead live out their natural span.

Forsythia Decoction: Treats blocked breast milk and breast abscesses.

Two liang each of forsythia fruit and mirabilite; three liang each of peony root, blackberry lily, cohosh, tetrandrine, apricot kernels, baical skullcap root, rhubarb, bupleurum, and licorice root.

Cut the eleven ingredients into pieces. Boil them in nine sheng of water until two sheng and five ge remain. Divide into three doses.

A Prescription for Treating Breast Abscesses

One sheng of ophiopogon tuber; two liang each of baical skullcap root, peony root, and poria; three liang each of mulberry mistletoe, ginseng, astragalus root, saposhnikovia root, and licorice root; eight liang of maltose syrup; five jujubes.

Cut the eleven ingredients into pieces and boil them in one dou of water until three sheng remain. Strain out the medicinal residue, add the maltose syrup, bring to a boil once, and divide into four doses.

Take the decoction described above for five days, then take this pill formula, and you will recover.

Five liang of asparagus root; five fen of Chinese motherwort; ten fen of rhubarb; six fen of cimicifuga; two fen each of notopterygium root, mulberry mistletoe, siler root, ginseng, astragalus root, dried rehmannia root, angelica dahurica, and tetrapanax pith; and one liang each of Scutellaria root, immature bitter orange, schisandra, poria with hostwood, Aconitum root, Ligusticum, and Chinese angelica.

Grind the nineteen ingredients into a fine powder and form pills with honey. Take twenty pills with wine each day, gradually increasing the dose to forty pills.

Formula for treating breast abscess at its onset (a breast abscess is a suppurating swelling of the breast. The Guangji Fang says this formula is for a hard breast lump that is red-purple in color, so painful that even clothing touching it is unbearable):

Equal parts rhubarb, chinaberry fruit, peony, and water chestnut.

Grind the four ingredients into a fine powder and sift it. Take one square-inch spoonful at a time, washed down with wine, to promote drainage and improve the condition. The Guangji Fang also says: after taking one square-inch spoonful with wine, cover yourself with a blanket and sweat. When you wake after sleeping, the swelling will have subsided and the pain will be gone; it should disappear within a night.

Pus-draining powder: a formula for treating breast abscess and removing necrotic tissue

Three fen each of cistanche, iron essence, cassia bark, asarum, Scutellaria root, peony, ginseng, Stephania root (another account gives siler root), dried ginger, Ligusticum, and Chinese angelica; and five fen of licorice.

Grind the twelve ingredients into a fine powder and sift it. Take one square-inch spoonful with wine three times a day, then take another dose at night. After ten days of taking the medicine, do not be alarmed if a large amount of pus and blood drains out.

Another formula: three sheng of fresh rehmannia root, three he of mirabilite, and one sheng of fermented soybean.

Pound the three ingredients together and apply them to the affected area. Replace the poultice when it becomes hot, and continue until recovery. This method can be used for all kinds of abscesses and swellings. Another account says to apply fresh rehmannia root alone.

Formula for treating swelling from a breast abscess:

Heat two rice-pounders and cover the breast with cotton wadding and old cloth. Alternately press the hot rice-pounders against the breast until the condition improves. This method is said to have been used before, with rapid results.

Formula for treating a hard breast lump:

Pour vinegar and rice-rinsing water into a water jar. Heat stones and put them in; when the water stops boiling, heat the stones again as before, let them cool slightly, then put them into the water. Soak the breast in it. When the water cools, heat more stones and continue.

The internal soaking should not be done more than three times. Heat the stone before use, and the illness will be cured. (This sentence follows the preceding text, but the original does not specify how to soak or use the stone.)

Another prescription: Scutellaria root, amur cork-tree bark, and peony root, in equal parts.

Grind these three ingredients into powder and take half a banbi (a small unit of measure in antiquity) with fermented rice water, three times a day for seven days.

If milk has collected in the left breast, express the milk from the right breast; if it has collected in the right breast, express the milk from the left. (The Xiaopin Fang says this method treats “jealous milk,” an ancient term for conditions involving a lump or swelling and pain in the breast.)

Prescription for treating breast abscess

Rhubarb and fresh mouse droppings, one part each; Chinese goldthread, two parts.

Pound these three ingredients into powder, mix with the clear liquid from millet porridge, and apply around the breast. When the pain stops, the illness will be cured. If millet is unavailable, foxtail millet or polished rice may be used.

Another prescription: Rhubarb, Chinese wolfsbane, and ginger, two parts each; fulonggan (the ancient name for the clay lining of a stove), twelve parts.

Pound these four ingredients into powder, mix with vinegar, and apply to the breast to relieve pain. It is said to be effective.

Another prescription: Grind antler into powder and sift it. Mix with the clear fat skimmed from pork fat and take one fangcunbi (a small ancient measuring spoon) at a time, no more than twice. It may also be taken with vinegar-fermented rice water.

Another prescription: Pound the white part of a scallion and apply it to the affected area. At the same time, squeeze out one sheng of scallion juice and drink it all at once. The illness will then be cured.

Willow-root fomentation for breast abscess lasting two or three hundred days, unresponsive to all treatments, with a hard, purple-blue breast

Shave off the outer bark of a willow root and pound it. Stir-fry it until hot, place it in a silk bag, and apply it to the breast as a hot compress. Replace it when the medicine cools. After applying it overnight, the illness will be cured.

Tribulus Pill: for breast swelling and pain in women, and to clear pathogenic heat

Tribulus seeds and rhubarb, one liang each; patrinia herb, one part; cassia bark, ginseng, coix seeds, aconite, Chinese goldthread, astragalus root, chicken bone, Chinese angelica, immature bitter orange, peony root, and rice-paper plant pith, two parts each.

Grind these fourteen ingredients into powder and form pills with honey, each the size of a wutong seed. Before meals, take three pills with a drink. If they have no effect, increase the dose to five pills. Take them three times a day; there are no dietary restrictions.

Another version omits rhubarb, patrinia herb, Chinese goldthread, and rice-paper plant pith. Grind the remaining ingredients into a powder and take one fangcunbi with wine.