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Chapter 25 of 27
金匮要略
Overall Paraphrase
This chapter, from the Synopsis of the Golden Chamber · Miscellaneous Remedies, Chapter 23, primarily contains ancient emergency remedies and miscellaneous treatment formulas. Some entries in the original text are annotated with "suspected not to be Zhang Zhongjing's formula," suggesting these contents may not be from Zhang Zhongjing's original work but rather added by later generations. The following is a complete explanation in modern vernacular, following the original order:
An ancient formula for resolving deficiency-heat in the five viscera, with modifications according to the seasons:
Cut the above medicinals into small pieces and divide into three doses. For each dose, use three sheng of water and decoct to obtain two sheng. Take warm in three divided portions; approximately one dose should be taken at intervals equivalent to walking four to five li. If there is a sensation of stagnation and discomfort in the limbs, slightly increase the Gancao. Each dose may also be further divided into three smaller doses; for each small dose, use one sheng of water, decoct to obtain seven he, and take warm. The dregs can be combined and decocted once more as a single serving, totaling four servings. The original text expresses doubt that this is Zhang Zhongjing's formula.
The original text also notes "suspected not to be Zhang Zhongjing's formula." Ingredients: He Li Le (Chebula) (roasted), Chenpi (Tangerine peel), Houpo (Magnolia bark) — 3 liang each. Grind the three ingredients into powder, mix with refined honey to form pills the size of wutong seeds. Take 20 pills with wine, gradually increasing to 30 pills. This formula tends to warm the middle burner, regulate qi, and astringe the intestines.
This formula can also be found in the Qian Jin Fang (Essential Prescriptions Worth a Thousand Gold), and it may also be prepared as a powder. The original text states that the powder can first be mixed into a liquid and poured between the teeth, with very good results. Ingredients: Dahuang (Rhubarb) 1 liang, Ganjiang (Dried ginger) 1 liang, Badou (Croton seed) 1 liang (remove skin and core, after dry-heating, grind externally to a paste-like consistency). All three ingredients must be fresh and of fine quality. First pound the Dahuang and Ganjiang into powder, then grind the Badou into it, pound together for one thousand strokes. Use as a powder, or mix with honey to form pills. Store in an airtight container, not allowing the qi to escape. Ancient records state this formula treats various sudden acute conditions of the heart and abdomen: such as attack by evil qi (zhong e), sudden intrusion of foreign qi (ke wu), heart and abdominal distension and fullness, sudden severe stabbing pain, rapid breathing with clenched jaw, or even sudden collapse like a corpse. At the time of use, take 3–4 pills the size of soybeans with warm water or vinegar. If the patient cannot swallow, lift the head and pour in to make it go down. A response should occur shortly afterward. If ineffective, give another three pills. When bowel sounds are heard, vomiting and diarrhea will occur and the patient will recover. If the jaw is tightly locked, it may even be necessary to break a tooth to administer the medicine. Note: This formula contains croton seed, which is highly toxic and drastic. It is for ancient literature study only; strictly forbidden to prepare or consume on one's own.
The original text notes "see the Qian Jin Yi Fang," used to prevent relapse after recovery from febrile disease (typhoid). Ingredients: Zishiying (Purple quartz), Baishiying (White quartz), Chishizhi (Red halloysite), Zhongru (Stalactite) (ground and refined), Gualougen (Trichosanthes root), Fangfeng (Saposhnikovia root), Jiegeng (Platycodon), Wenge (Meretrix shell), Guijiu (Dysosma versipellis) — 10 fen each; Taiyi Yuliang (Limonite) 10 fen (calcined); Ganjiang (Dried ginger) 4 fen, Fuzi (Aconite) (processed, skin removed) 4 fen, Guizhi (Cinnamon twig) (skin removed) 4 fen. The thirteen ingredients are pounded into a powder and taken with wine, one fangcunbi (spoon) each time. This formula contains many mineral medicinals and belongs to the category of ancient "cold food powder" (hanshi san). Later generations generally considered it to carry toxicity risks and not to be used lightly.
Ancient records document several methods for treating sudden collapse:
Use alum (fanshi) half a jin, add one dou and a half of water, boil until dissolved. Soak both feet in this solution, with the water covering the ankles.
Ancient records prescribe having the patient ride a water buffalo facing its head, pounding Xie (chive) juice to pour into the ears, and blowing Zaojia (honey locust) powder into the nostrils.
Moxibustion applied to the nails of hands and feet for fourteen zhuang (moxa cones); then administer the "Wu Du Zhu Gao San" (Five Poisons Various Ointment Powder) containing croton seed.
Use horse manure one sheng ( may be undigested material), three dou of water, decoct to two dou for washing the body; also take liquid cow manure one sheng, warm with wine and pour into the mouth; then moxibustion at one cun below the heart, three cun above the navel, and four cun below the navel, each for 100 zhuang.
When the disease is unknown, use dog feces — knead one pellet and squeeze the juice to administer; if dry, boil in water to extract the juice.
In "corpse syncope," the pulse is still present but breathing has stopped; it is due to blockage of qi, so the person appears as if dead. Treatment: blow Acorus (Changpu) powder into both nostrils, and have someone place Cinnamomum (Guì) powder under the tongue. Another formula: Take hair from the left corner of the head, one fangcun measure, burn it to ashes, mix with wine and pour into the throat.
For rescuing from sudden death or death from foreign qi intrusion (ke wu). Ingredients: Mahuang (Ephedra) 3 liang (remove nodes; one version uses 4 liang), Xingren (Apricot kernel) 70 pieces (remove skin and tips), Gancao (Licorice) 1 liang (honey-fried). The Qian Jin Fang adds Guixin (Cinnamon bark) 2 liang. The above three ingredients, decocted with 8 sheng of water to obtain 3 sheng. Strain and administer by pouring in divided portions. Ancient texts state this can broadly treat various types of qi cessation caused by "gan-wu" (being startled or affected by external influences). Another formula: Jiugen (Chive root) one handful, Wumei (Smoked plum) 27 pieces, Wuzhuyu (Evodia) half sheng (stir-fried). Decoct with one dou of water; place the sick person's comb into the medicinal liquid, boiling for three turns; if the comb floats, the person will live; if it sinks, the person will die. Boil down to 3 sheng, strain, and drink in portions.
Ancient texts state that if hanging occurred from morning to evening, even if the body is already cold, rescue is still possible; from evening to morning is somewhat more difficult, said to be due to the abundance of yin qi. However, in summer when nights are shorter than days and it is hot, rescue remains possible. It is also said: if the heart region is still slightly warm, even after more than a day, the person can still be treated. Method: Slowly embrace and untie the person; do not cut the rope. Spread bedding above and below and lay the patient flat. One person steps with both feet on the patient's two shoulders, with hands gently holding back the hair, keeping the head and neck stable. Another person presses a hand on the chest, alternately pressing and releasing. Another person massages and kneads the arms and calves, performing flexion and extension movements. If the limbs have become stiff, gradually and forcefully flex and extend, and press on the abdomen. Continue for approximately the time of one meal until qi comes out through the mouth, breathing resumes, and the eyes open; at this point, do not immediately stop pressing, but rather continue gently. Soon, a small amount of Guizhi Tang (Cinnamon Twig Decoction) and thin rice congee can be given, held in the mouth for moistening, gradually ensuring swallowing. If two people can blow into both ears with tubes at the same time, even better. Ancient texts call this the best method, with none who cannot be revived. Note: This is an ancient prototype of emergency resuscitation, containing reasonable elements such as chest compressions and limb movement, but it cannot replace modern CPR. In an emergency, professional help should be sought immediately.
Ancient texts believed that in cases of coma from heatstroke, the patient should not be exposed to cold, for exposure to cold means death. Method: use a straw belt coiled around the patient's umbilicus, have two or three people urinate on the straw belt to warm it. Alternatively, material such as hot mud mixed with bent straw, or warm objects such as the bottom of a clay bowl or wheel hub, may be placed against the body, and the urine allowed to run off even in the wild where hot water is absent, using multiple persons' urine for warmth is an expedient. If hot water can be found, it should be given. Cold objects like mud or wheel parts should not be used. Note: This passage contradicts modern heatstroke first-aid principles. Modern management of heatstroke requires rapid cooling, rehydration, and hospital care. Ancient methods must not be imitated.
Ancient records: take over two shi of ash from the stove and bury the person from head to toe; once water drains out through the seven orifices, the person revives. Note: This method lacks scientific basis and must not be used for drowning rescue. Drowning victims should immediately receive CPR and emergency services should be called.
Original annotation: "see the Zhou Hou Fang (Handbook of Prescriptions for Emergencies)." Ingredients: Dahuang (Rhubarb) 1 liang (sliced, added after steeping in liquid), Fei Bo (red silk fabric) the size of a palm (burned to ash), Luanfa (human hair) the size of a chicken egg (burned to ash), Jiu yong chui dan bu (long-used steaming cloth) 1 chi (burned to ash), Bai pu (worn cattail mat) one handful (3 cun pieces), Taoren (Peach kernel) 49 pieces (remove skin and tips, dry-heat), Gancao (Licorice) the length of a middle finger joint (honey-fried, cut). The above seven ingredients are decocted in an appropriate amount of boys' urine (tong bian) to form a soup; add one large cup of wine, then add the Dahuang. Strain and divide into three warm portions. First use a half mat of old cattail to boil into water for bathing, then cover with clothing and bedding. Ancient records report that after taking the medicine, the patient will have several purgative bowel movements shortly afterwards, and the pain will immediately diminish. The stool and washing water will be reddish, which is not surprising — it is said to be the discharge of stagnant blood. Note: This formula uses boys' urine and burnt ashes, reflecting ancient blood-activating and stasis-resolving approaches, but modern practice cannot emulate this. Fractures should be examined and treated by medical professionals.
This chapter collectively reflects the clinical thinking of the Han dynasty and earlier periods, emphasizing "treating the acute manifestation, opening the qi mechanism, warming and unblocking, and reversing collapse." Facing acute conditions such as sudden fainting, qi obstruction, or traumatic falls, the ancients often first used external methods to open the orifices and restore consciousness, then employed warming, purging, or blood-activating methods to restore the flow of qi. For example:
Blowing into nostrils, filling ears, administering under the tongue: The intention was to open the sensory orifices through local stimulation — an embryonic form of the ancient "resuscitation by opening orifices" (kai qiao) method.
San Wu Bei Ji Wan (Three Substance Emergency Pill): Rhubarb, only grounded components, provides vigorous dissipation, cold and hot combined, purgative downward movement, the classical framework uses purgatives to treat acute conditions. A warm-purgation strategy applies "urgency in the method of securing the root is through drying in the symptoms... exterior strategies are to deplete..." Other corrections can now lead directly to consolidation without a comprehensive intro...
Huan Hun Tang: Ephedra, Apricot kernel, Licorice to diffuse the lungs and open obstruction, targeting "the five messengers "Qi syncope.
Rescuing from Hanging: Includes chest pressure, movement of extremities, and retaining airway patency. Demonstrates the use of leading methods consistent with early concepts.
Treating injuries to bones and sinews with Rhubarb, Peach Kernel, and ashes: Reflects the functional relationship that if indigestible materials have "static blood is the gateway to the generation of new blood."
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