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Food Stagnation

Food stagnation diseases are differentiated by whether symptoms occur in the upper or lower jiao, and further assessed for cold or heat nature, observing for vomiting or diarrhea. If accompanied by chest and epigastric fullness (feeling of obstruction), dysphagia and belching, pain in the heart and abdomen, as well as fever (due to latent fire in the stomach, or symptoms resembling malaria or dysentery), these are all caused by indigestion of food.

If food stagnates in the upper jiao (upper part of the stomach), causing qi stagnation and abundant phlegm-dampness, emesis is appropriate. For example, if injured by cold food, presenting with abdominal distension, rebellious qi, hiccups with acid regurgitation, nausea, and a desire to vomit without success, use Pingwei San (Calm the Stomach Powder) with a small amount of salt to induce emesis; if injured by hot-natured food or excessive alcohol and wheat products, presenting with fever, stabbing pain in the heart region, retained phlegm, retained fluid, and latent fire, use Erchen Tang (Two-Cured Decoction) added with Huanglian (Coptis Rhizome) and Zhishi (Immature Bitter Orange) to induce emesis; if the injury is severe, with food blocking the chest, absence of pulse in the lower body, and the patient is robust and young, only then dare one use Goudi San (Melon Pedicle Powder) to induce emesis; for ordinary overeating remaining in the diaphragm, manual induction of emesis is good. If food stagnates in the middle or lower jiao, purgation is appropriate to drive it out. For example, if injured by cold food, presenting with abdominal distension and painful fullness, use Muxiang Jian Wan (Aucklandia Pill), Dingxiang Pi Ji Wan (Clove Spleen Accumulation Pill), or Yinggan Wan (Responsive Pill); if injured by hot-natured food, presenting with stuffiness and fullness, use Erhuang Wan (Two-Yellows Pill); if tidal fever is severe at Shen hour (3-5 PM), use Xiao Chengqi Tang (Minor Order the Qi Decoction); if injured by both cold and heat, use Dahuang Beijii Wan (Rhubarb Emergency Pill) or Chuyuan San (Remove Origin Powder); if the constitution is weak, combine purgatives with tonics, or use Baohe Wan (Preserve Harmony Pill). All food stagnations belong to blood-level pathology in the middle jiao; drugs like Qianniu (Pharbitis Seed) are fierce and damage qi, and all harsh purgatives will instead damage stomach qi. If vomiting is currently present, use Erchen Tang added with Sharen (Amomum Fruit), Huanglian, Qingpi (Green Tangerina Peel), and Zhishi; if diarrhea is currently present, use Weiling Tang (Stomach and Five Decoction) added with Shanzha (Hawthorn Fruit) and Maiya (Sprouted Barley), or Sanbai Tang (Three Whites Decoction), selected according to seasonal cold or heat. If the body has contracted cold qi and consumed cold food, initially it is best to use acrid-warm herbs to regulate the middle; after a while, stagnation transforms into heat, so one should simultaneously use acrid-cool herbs to disperse.

After emesis and purgation, if digestion is not complete, use digestive methods: Hongwanzi (Red Pill), Zhizhu Wan (Atractylodes and Immature Bitter Orange Pill), Baohe Wan, Daan Wan (Great Peace Pill), Pingbu Zhizhu Wan (Neutralizing Atractylodes and Immature Bitter Orange Pill), or Dan Shanzha Wan (Single Hawthorn Pill).
After emesis and purgation, if deficiency exists, rely on tonification: Sijunzi Tang (Four Gentlemen Decoction), Liujunzi Tang (Six Gentlemen Decoction), Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction).

For habitual drinkers, separate and eliminate dampness while regulating the middle. Those who drink excessively or consume too much water should induce sweating and promote urination to separate and eliminate dampness; Gegua Jieying Tang (Pueraria Flower Decoction to Relieve Intoxication) cures with mild sweating; for diuretic agents, use Wuling San (Five-Ingredient Powder with Poria) or Tiaozhong Erchen Tang (Regulate Middle Two-Cured Decoction). If long-term alcohol confinement occurs, or accumulation forms from inferior wine, presenting with abdominal pain and urgent defecation, use Jiu Zheng Huanglian Wan (Wine-Steamed Coptis Pill) or Xianglian Wan (Costus and Coptis Pill). If alcohol injury causes vomiting and rebellion, vertigo, and headache as if breaking, use Buzhong Yiqi Tang removing Baizhu, added with Banxia (Pinellia Tuber), Shaoyao (Peony Root), Huangqin (Scutellaria Root), Huangbai (Phellodendron Bark), Ge Gen (Kudzu Root), and Chuanxiong (Sichuan Lovage Rhizome); if masses exist, add Ezhu (Curcuma Zedoary Rhizome) and Muxiang (Vladimiria Root). If one enjoys drinking, experiencing long belching every morning without vomiting, Xiaotiaozhong Tang (Minor Regulate Middle Decoction) is best, taken three to five times a month, or made into pills. If sexual intercourse after drunkenness leads to blood stasis and occasional stomach pain, use Datiaozhong Tang (Major Regulate Middle Decoction) or Babatu Tang (Eight Substances Decoction) added with Sharen. If heavy drinking without intoxication suddenly results in feces-like matter exiting the anterior orifice and urine exiting the posterior orifice, use Siwu Tang (Four Substances Decoction) added with Haijinsha (Lygodium Spore), Muxiang, Binglang (Areca Seed), Mutong (Akebia Stem), and Taoren (Peach Kernel); several doses can bring peace. Tea addiction is treated with Xingcai Wan.

Medicines for worry, thought, and depression should not be overly harsh.
Worry and thought damage the spleen, leading to loss of appetite; use Qingliu Wan (Clear Six Pill) added with Xiangfu (Cyperus Rhizome), fried Huanglian, and Shaoyao, formed into pills with ginger juice and steamed biscuit paste; for total anorexia, Wendan Tang (Warm Gallbladder Decoction) is miraculous; for worry/thought combined with food stagnation, use Muxiang Huazhi Tang (Aucklandia Transform Stagnation Decoction). For those who are thin, fatigued, breathless, and not eating, use Erchao Cangbai San (Double-Fried Atractylodes and Phellodendron Powder) added with Xiangfu, Shaoyao, Chenpi (Aged Tangerina Peel), Banxia, Huanglian, Bianbo (Flattened Biota Seed) in equal parts, with Baizhu as the sovereign herb, formed into pills with ginger juice and flour; for damp-phlegm and qi stagnation causing anorexia, use Sanbu Wan (Three Tonify Pill) added with Cangzhu (Atractylodes Rhizome), doubling the amount of Xiangfu.

Accumulations and Masses

Five Accumulations and Six Gatherings all belong to the spleen.
The classics state: Accumulations (Ji), Gatherings (Ju), Pin (Distention), and Man (Fullness) all stem from the qi of Taiyin damp-earth. Initially due to external contraction, internal injury, or qi stagnation, mistaken tonification by physicians leaves them to form accumulations. Ji (Accumulation) is yin qi, governed by the five zang organs, with a deep and hidden pulse, located left or right, having a root upon onset, and pain in a fixed location. Liver accumulation under the left hypochondrium is called Feiqi (Fat Qi), meaning excess wind qi and blood failing to move with qi, causing hypochondriac pain and malaria; Heart accumulation above the umbilicus is called Fuliang (Hidden Beam), meaning like a beam橫ly placed under the heart, causing vexation, which is fire stagnation; hot herbs and moxibustion are contraindicated. Intestinal abscess is similar but presents with swelling of thighs, back, and pain around the umbilicus. Spleen accumulation slightly to the right of the epigastrium is called Piqi (Pi Qi), meaning yang qi accumulated by dampness, causing jaundice, fatigue, and food failing to nourish flesh; hot herbs are still contraindicated. Lung accumulation under the right hypochondrium is called Xiben (Gasp), meaning gasping and rushing upward, causing cough and lung abscess. Kidney accumulation originating in the lower abdomen or rushing to the heart is called Bentun (Running Piglet), meaning rushing up and down unpredictably like a piglet, causing panting and bone萎 (withering), most difficult to treat. Do not lightly use emesis or purgation for various accumulations; it only depletes true qi and does not remove the accumulation; Bentun especially must not be emetic. The ancient Five Accumulations have five formulas; the modified Wujii Wan (Five Accumulations Pill) today is better. Ju (Gathering) is yang qi, formed by the six fu organs, with a deep and knotted pulse, appearing and disappearing, having no root, and pain in variable locations; use Sanju Tang (Disperse Gathering Decoction), Qi Qi Tang (Seven Qi Decoction), Xiangleng Wan (Aucklandia Prismatic Pill), Daawei Wan (Great Asafoetida Pill), or Daan Wan added with Ren Shen (Ginseng Root).

Movement in the left, right, and center;
Qi cannot form blocks or gatherings; blocks are formed by有形 (formative) substances like phlegm, food stagnation, and dead blood. Ji, Ju, and Xia are essentially one. Accumulations that form blocks and cannot move are called "Ji" (Accumulation), meaning hard and firm; those that appear and disappear, move up and down, left and right, are called "Xia" (Mass), meaning formed by false blood, with moving shapes and activity.

Left is dead blood, right is qi accumulation.
Treating the left focuses on breaking blood: use Haishi Wan (Calcium Carbonate Pill) or Danggui Longhui Wan (Angelica and Scutellaria Pill) base 5 qian, added with Tao Ren (Peach Kernel) and Jianghuang (Turmeric Rhizome) 1 liang each, honey-pill. Treating the right focuses on regulating qi: use Qingpi Tang (Green Tangerina Peel Decoction) or Muxiang Fenqi Wan (Aucklandia Separating Qi Pill). For existing accumulations, use Xiaoji Zhengyuan San (Eliminate Accumulation Correct Origin Powder), Hongwanzi, Xiaoawei Wan (Little Asafoetida Pill), or Danggui Longhui Wan, Baohe Wan, all added with Bobojiu Shi (Pigeon Droppings).

Center is phlegm knotting in one mass.
The center is the pathway for food and water; dietary and emotional stagnation forms phlegm; use Shichangpu Wan (Acorus Pill) or Baijie Wan (White Mustard Seed Pill). Any Pi (distention) masses in the subcutaneous or membranous layers should use Erchen Tang added with qi-tonifying and qi-moving herbs.

Excess requires digestion, distinguishing new and old.
New accumulations are cold; use acrid-warm digestion: Da Qi Qi Tang (Great Seven Qi Decoction), Wu Bai Wan (Black and White Pill), Da Wen Zhong Wan (Great Warm Middle Pill), Xiao Wen Zhong Wan, Tuihuang Wan (Retreat Jaundice Pill),awei Zhuangqi Wan (Asafoetida Striking Qi Pill). Old accumulations become heat; use acrid-cold pushing: Muxiang Binglang Wan (Aucklandia and Areca Pill), Tongxuan Erba Dan (Penetrating Mystery Two-Eight Elixir), Xiaokuai Wan (Reduce Mass Pill). General formulas include Zuanji Dan (Gather Accumulation Elixir) and Shengqi Gao (Raw Lacquer Ointment). For worms, use Miaoying Wan. External treatments: Sansheng Gao (Three Sages Ointment), Sanleng Jian (Polygonatum Decoction), Shenxiaoawei San (Miraculous Asafoetida Powder).

Deficiency requires neutral tonification; this is the superior physician.
Yang deficiency with accumulation is easy to treat; yin deficiency is difficult to tonify harshly. Pi accumulations also avoid cloying herbs; best to take tonics early in the day added with Biejia (Turtle Shell), Guiban (Tortoise Plastron), Qiushi Dan (Mineral Salt Elixir); take Zhizhu Wan, Daan Wan, or Cu Bie Wan (Vinegar Turtle Pill) at noon, which excellently dissolve and transform. If Pi accumulation cold pain penetrates the umbilicus, mistakenly diagnosed as chronic cold, using Ginger and Aconite hot herbs may seem suitable initially, but later worsens the accumulation, damaging true qi and scorching yin blood. Liu Huang (Sulfur) and Fu Zi (Prepared Aconite Root) must absolutely not be used; Zhi Mu (Anemarrhena Rhizome), Huang Bai, and Dong Quai (Ophiopogon Tuber) are cold and damage spleen/stagnate qi, also unsuitable. Ancient saying: "Stop when half the disease is gone." Another: "Nourish righteousness, and the accumulation removes itself." These refer to deficiency with accumulation. Besides neutral tonification, cut rich flavors, restrain lust, guard against rage, correct thoughts, for ultimate safety.

Gu Poison and Miasma

Gu poison and miasma are acquired through diet and lifestyle, hence attached here.
Folk customs of Gu poisoning are not elegant.
According to medical texts, there are several types of Gu, all bewitching and confusing qi, strangely so. Some create it deliberately, collecting insects and snakes in a jar to let them eat each other. The sole survivor is sacrificed with wine and meat, then put into food/drink to harm people. Poison onset causes blue-yellow face, weakness, body pain, spitting fresh blood, dribbling urine, pus-blood stool, dry lips/mouth, chest/hypochondriac fullness, abdominal pain like insect bites or crawling. Food eaten turns into insects, eroding viscera; death follows erosion. After death, disease qi flows and infects others. Dead souls serve families for wealth; whether true is unknown. Treat with Wanbing Jiedu Dan (Ten Thousand Disease Detoxifying Elixir) or Dongpo Xiongfan Wan (Dongpo Realgar Alum Pill); or moxa three grains on the tip of the little toe, expelling objects. Poison from wine/rice exits with them; from meat/veg, exits with them. For any Gu poisoning, regardless of time, boil one egg, peel, insert silver needle, hold in mouth for a meal time, remove; black needle/egg indicates poisoning. Method: spit saliva into water; sinking is Gu, floating is not. Method: hold soybean in mouth; swollen/rotten/shed skin is Gu, otherwise not. When traveling, keep Yuzhizi (Premonition Seed) in collar; sounds when poisoned. After Gu poisoning heals, never eat cold food again. Cold food allows ghost qi to enter,毒虫 (poison insects) regenerate, incurable.

There are also "Tiao Sheng" (Lifting Life) poisons and toxic springs.
Lingnan has many "Tiao Sheng" poisoners, injecting poison into fish, meat, vegetables, fruits, wine, vinegar to harm people. Symptoms: initial chest/abdominal pain, gradually stabbing, after ten days object grows and moves, upper chest pain, lower abdominal pain. In upper diaphragm, use Danfan (Alum) powder 5 fen, dissolved in hot tea, drunk to induce emesis; in lower jiao, use Yujin (Curcuma Aromatica Rhizome) powder 2 qian, mixed with rice soup, purging evil matter, then regulate with Sijunzi Tang removing Gancao (Licorice Root). If sudden hypochondriac swelling, abscess forming instantly like a bowl, use Shengma (Cimicifuga Rhizome) powder 2 qian, mixed with cold/hot water, taken continuously, purging onion-root-like matter, swelling subsides. Then use Pingwei San, advance white porridge.

In Jiangnan streams, there is She Gong (Shooting Worker) poison, entering homes via rain/flood, shooting sand at shadows causing chills/heat, confusion, head/eye pain, similar to corpse possession, sudden muteness. There is also Water Poison Insect, named Xiwen (Stream Warmth). Same disease as She Gong, but with rotting ulcers is She Gong, without ulcers is Xiwen. There is also Shali (Sand Louse), fine as scabies mites, emerging in grass during rain, entering skin, stinging pain. These three cause morning light/evening heavy disease, cold hands/feet to elbows/knees, worms in abdomen after 2-3 days eating lower body, ulcers at umbilicus, painless/itchless. Urgently check lower body: red ulcer like cut meat is Yang Du (Yang Poison), most urgent; like carp teeth is Yin Du (Yin Poison), slower; all kill within 20 days. Wash with crushed garlic thick juice, warm decoction. This is water poison, body should have red spots, otherwise not. Treat as other diseases, Xiao Shuidu Yinzi (Eliminate Water Poison Drink)主治 (main treatment).

Miasma cold/heat differentiate internal/external.
Southeast Guangdong/Guangxi, steep mountains, bad waters, damp/steamy earth. In spring/autumn, external frost poison causes chills/heat, chest fullness, anorexia; poison enters mouth/nose, clear upper heat, resolve internal toxin, descend qi, move phlegm; do not induce sweat. Use Pingwei San added with Huangqin, Huanglian, Shengma, Chaihu, Jiegeng (Platycodon Root), Zhike (Bitter Orange Peel), Muxiang, Mutong, decocted with ginger. In cold months, external wind-cold causes qi closure, fever/headache, spontaneous sweating like malaria, southern person's qi rising, or chest fullness/phlegm obstruction, anorexia; different from north where only exterior is injured and interior harmonizes; resolve exterior, clear heat, move phlegm, descend qi. Use Erchen Tang added with Chaihu, Huangqin, Cangzhu, Qianghuo (Notopterygium Rhizome), Chuanxiong, water decocted, mild sweat stops. If internal injury from diet, use Lipi Quezhang Tang (Regulate Spleen Remove Miasma Decoction), Buzhong Yiqi Tang, Buhuanjin Zhengqi San (Non-Exchanging Metal Upright Qi Powder), Zhizhu Wan; severe deficiency or with sexual exhaustion, use Yili Jin Dan (One Grain Golden Elixir); heat, use Chai Ling Tang (Bupleurum and Poria Decoction), Chengqi Tang, Sanhuang Tang (Three Yellows Decoction) combined with Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction), or Sanhuang Zhizhu Wan.

Acclimatization failure shares origin with miasma.
Flatlands have firm soil/hot water, valleys have moist soil/cold water; all use Pingwei San as main, adjusting for soil/wind/cold/heat. Or transforming into malaria, dysentery, jaundice, sores/boils, seek in respective categories, but focus on supporting spleen/stomach. Indulgence in alcohol/lust, eating fish/meat, seasonal fruits/veg, bamboo shoots/fiddleheads raw, sticky rice/spiced wine, oil-fried/sauce-braised, chicken/duck/wheat noodles, hunger/fullness extremes, sleeping in foul air, uncovering at midnight, walking dew-covered early, empty stomach going out, all can trigger miasma. Officials/merchants traveling should regulate diet, caution routine to prevent.