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Chapter 5 of 27
金匮要略
Overall Paraphrase
This chapter is devoted exclusively to three categories of disease: Lily Disease (bǎi hé bìng), Fox-Corruption Disease (hú huò bìng), and Yin-Yang Toxin (yīn yáng dú). The entire chapter comprises one general discussion, three passages on pattern differentiation, and twelve formulas. The ancients grouped these three conditions together because they all involve heat pathogen, vacuity heat, and dampness-turbidity toxin disturbing the qi and blood, throat, orifices, and skin.
The so-called "Lily Disease" refers to the notion that the hundred vessels of the body all arise from a single source — the heart governs the blood vessels, and the lungs face the hundred vessels. Therefore, when the yin fluids of the heart and lungs are insufficient and vacuity heat harasses internally, the blood vessels throughout the body and the spirit are all affected. The patient desires to eat but cannot, and often remains silent and withdrawn; wishes to lie down but cannot rest peacefully; wishes to walk but cannot move about; food sometimes tastes delicious, and at other times the patient loathes the smell of food; the patient seems afraid of cold, yet there is no true cold; seems to have fever, yet there is no true heat; the mouth feels bitter, and the urine is red. Many medications prove ineffective, and some even cause severe vomiting and diarrhea after administration, as if haunted by "spirits"; yet the physical appearance remains relatively normal, with a slightly rapid pulse.
Regarding prognosis, the text records: if the patient develops headache at each urination, recovery may occur in about sixty days; if there is no headache at urination but only a creeping chill sensation, recovery may occur in about forty days; if urination is free-flowing and only slight dizziness is perceived, recovery may occur in about twenty days. The symptoms may appear before the illness manifests, or gradually emerge four to five days, twenty days, or one month after the onset of illness — treatment should be adjusted according to the specific presenting pattern.
Regarding formulas, the original text records them in sequence:
The concluding treatment principle states: when Lily Disease manifests with a preponderance of yin pattern, rescue it by proceeding from yang; when it manifests with a preponderance of yang pattern, rescue it by proceeding from yin. If in a yang pattern one instead attacks the yin aspect and additionally promotes sweating, this is counter-treatment; if in a yin pattern one instead attacks the yang aspect and additionally employs purgation, this too is counter-treatment. The core principle is to protect body fluids, yin and yang, and never rashly employ sweating or purgation methods again.
Fox-Corruption Disease initially resembles cold damage. The patient is silent and desires sleep but cannot close the eyes, restlessly sitting or lying. Erosion and ulceration in the throat is called "corruption" (huò); in the anterior and posterior yin orifices, it is called "fox" (hú). The patient has no desire for food and loathes the smell of food; the facial complexion suddenly turns red, then black, then white.
Another variation is recorded: the patient has a rapid pulse, no pronounced high fever, mild vexation, silence with desire to lie down, and sweating. In the first three to four days, the eyes become red like those of a turtledove; by the seventh to eighth day, the canthi turn black. If the patient can eat, it indicates that pus has already formed; use Red Adzuki Bean and Tangkuei Powder (Chì Xiǎo Dòu Dāng Guī Sǎn): red adzuki bean disinhibits dampness and expels pus, tangkuei harmonizes the blood, manifesting the approach of clearing heat, disinhibiting dampness, quickening the blood, and expelling pus.
Yang Toxin manifests as facial erythema patterned like brocade, sore throat, and coughing up pus and blood. Yin Toxin manifests as a bluish facial complexion, body pain as if beaten with a club, and sore throat. Both are acute and severe conditions. The text states, "Curable within five days; incurable after seven days," emphasizing the rapid progression of the disease and the critical importance of timely treatment.
The post-formula notes on decoction and administration methods — such as "take in one draught," "promote sweating," as well as washing lily, soaking it overnight, removing the froth, and decocting in spring water — are all ancient Han dynasty methods, provided here solely for understanding the pharmaceutical approaches of that era and cannot be directly adopted as modern usage.
1. Lily Disease — The "Hundred Vessels One Origin" View of Vacuity Heat Disturbing the Spirit
The core of Lily Disease lies not in organic damage to a specific viscus, but in insufficiency of heart and lung yin fluids with vacuity heat harassing internally, affecting the "hundred vessels" and the spirit. This explains a group of seemingly contradictory, widespread, and unfixed symptoms: yin fluid depletion with vacuity heat circulating wildly, leading to instability of the ethereal soul and disharmony of constructive and defensive qi. The treatment principle consistently revolves around nourishing yin fluids and clearing heat to quiet the spirit, scrupulously avoiding sweating, vomiting, and purgation methods that would further damage fluids and yang. The chapter flexibly adjusts the formula compositions according to erroneous treatments and transformed patterns: after erroneous sweating, add anemarrhena to clear heat; after erroneous purgation, add talc and hematite to disinhibit dampness and descend counterflow; after erroneous vomiting, add egg yolk to settle the center; for the primary disease, add rehmannia to cool the blood and nourish yin; when transformed to thirst, add trichosanthes and oyster to engender fluids and astringe descent; when transformed to fever, add talc to clear and disinhibit. This approach of "treating according to the presenting pattern" is the core principle.
2. Fox-Corruption Disease — The Dampness-Toxin View of Upper and Lower Erosion
Fox-Corruption Disease links ulceration of the mouth, throat, anterior and posterior yin orifices together, viewing them as the same type of toxin invading different sites. The names "corruption" and "fox" reflect the recurrent, unpredictable nature of the symptoms and the concealment of the affected sites. Treatment combines internal and external approaches: internally, harmonize the center and resolve toxin; externally, apply sophora root and realgar. This embodies the holistic view of Chinese medicine: the relationship between upper and lower orifices and the spleen, stomach, dampness-heat, and filthy turbid toxin.
3. Yin-Yang Toxin — An Acute Heat-Toxin View Differentiated by Yin and Yang
Yin-Yang Toxin presents mainly with facial macule coloration, sore throat, spitting pus and blood, and body pain. The condition is acute and severe. Yang Toxin leans toward heat and the exterior, with red macules; Yin Toxin presents with a bluish face and body pain as if beaten, indicating deep-seated toxin with stasis and obstruction. Treatment employs cimicifuga to resolve toxin, tangkuei to harmonize the blood, and turtle shell to nourish yin and soften hardness, with acrid-warm medicinals adjusted according to yin or yang. This approach of different treatments for the same disease and the notion of "curable within five days, difficult after seven" reflects the ancients' emphasis on disease course and timing of intervention.
Lily Disease: This cannot be simply equated with any single modern disease entity. Its manifestations bear some resemblance to certain emotion-related conditions, autonomic nervous system dysfunction, anxiety-depressive states, chronic fatigue, or the convalescent phase of febrile illness — but it cannot be equated with these. The ancient notion of "hundred vessels one origin" may be understood as an early, rudimentary observation of psychosomatic whole-body regulation and dysregulation of the neuro-endocrine-immune network. Its features of "the physical body appears harmonious, with a slightly rapid pulse" resemble certain functional disorders, yet must be approached objectively without thereby overlooking organic disease.
Fox-Corruption Disease: Many scholars believe its description closely approximates Behçet's syndrome (the eye-mouth-genital triad); other conditions such as recurrent aphthous ulcers and certain autoimmune diseases may also present similarly. Among the external treatments using sophora root and realgar, realgar contains arsenic, and even topical application carries absorption risks; it is rarely used in modern practice and must never be blindly imitated.
Yin-Yang Toxin: This may partially resemble certain acute exanthematous diseases, streptococcal infection, septicemia-like states, or systemic lupus erythematosus in their superficial manifestations, but it does not correspond precisely. The text's "curable within five days, incurable after seven" is an empirical warning from the ancients about the dangerous nature of the condition and cannot serve as a basis for modern clinical judgment.
Formulas: The formulas in this chapter — such as Lily and Rehmannia Decoction, Licorice Heart-Draining Decoction, and Cimicifuga and Turtle Shell Decoction — remain subjects of scholarly discussion. Some formulas have seen exploratory research in modern studies, but their efficacy and safety must be judged on the basis of modern medical evidence; individuals must not self-prescribe according to the original text.
Associated Concepts: Hundred Vessels One Origin, Lily Disease, Fox-Corruption Disease, Yin-Yang Toxin, Lily and Rehmannia Decoction, Licorice Heart-Draining Decoction, Cimicifuga and Turtle Shell Decoction, Erroneous sweating/vomiting/purgation treatment, Rescue by yin method / rescue by yang method, Different treatments for the same disease, Combined internal and external treatment, External therapies.
Further Reading: Commentaries on Chapter 3 of the Synopsis of the Golden Chamber, such as You Zaijing's Essential Insights into the Synopsis of the Golden Chamber (Jīn Guì Yào Lüè Xīn Diǎn) and Chen Xiuyuan's Concise Commentary on the Synopsis of the Golden Chamber (Jīn Guì Yào Lüè Qiǎn Zhù); the relevant passages on Licorice Heart-Draining Decoction and Red Adzuki Bean and Tangkuei Powder in the Treatise on Cold Damage (Shāng Hán Lùn); the records concerning Fox-Corruption Disease patterns in the Treatise on the Origins and Manifestations of Various Diseases (Zhū Bìng Yuán Hóu Lùn); and supplementary discussions on Yin-Yang Toxin and Lily Disease in the Thousand Golden Formulas (Qiān Jīn Yào Fāng) and the Medical Secrets of an Official (Wài Tái Mì Yào).
This content is based on classical Chinese medicine texts and is provided solely for traditional cultural study and scholarly reading. It does not constitute any medical diagnosis, medication recommendation, or treatment advice. If you feel unwell, please seek prompt medical attention.