Library

Jingjing Yihua (Medical Conversations from Jingjing)

--------------------------------------------------------------------------------

Intestinal Abscess (Chang Yong)

My clan nephew, Qin Wen, courtesy name Pei Shan, whose great-grandfather migrated from Suzhou to Changzhou, was the grandson of Ti Shen Shu Er Zhao. Upon returning from his studies in Japan, he came to see me and said: "After attending a general school in the East for one year and graduating, I contracted an intestinal abscess (a suppurative inflammation of the intestine) and was hospitalized. The Japanese doctor said, 'This is not difficult; it can be cured by surgical incision and excision.' Within ten days, my condition had resolved. Astonished by what I considered a miraculous effect, I subsequently took the Japanese doctor as my master and studied at the Chiba Prefecture Special Medical School. After two more years of study, I graduated and returned with my diploma. When I asked him in detail about his condition, I was also amazed. Later, when he went to Changzhou and Nanjing, I suddenly heard that he had rushed back to Japan urgently, though I did not know why. Less than a month later, I received a letter from his family stating that his old illness had relapsed, he could not treat himself, and he had hurried to Japan to seek treatment from his former teacher. The teacher still said, 'This is not difficult; incision and excision will suffice.' However, unexpectedly, after the surgery, he passed away suddenly without regaining consciousness. I pondered silently on the reason: the previous effectiveness was because his Qi and Blood were not yet depleted; the failure to recover fully was due to improper post-recovery regulation, where the Yuan Qi (Original Qi) had not recovered while the root of the disease remained. The ineffectiveness this time was because his Qi and Blood had already declined, leading to sudden death. Thus, I realized that although it was the same disease, the deficiency or excess of the body constitution must be distinguished; how can they be treated indiscriminately?"

Acute Consumption (Ji Lao)

Jiang Jianxia, named Biao, was a close friend of mine. One night at a banquet, hearing him cough, I said: "Your cough is not smooth, indicating external pathogens obstructing the Lung Meridian; you should take herbs that open and disperse." Mr. Jiang replied: "A Western doctor advised taking antitussive syrup." He intended to take it immediately. I said: "I am not well-versed in the properties of Western medicines, but judging by the name, it seems to be a restrictive agent (Jie Ji). As the ancients said, 'If a common cold is not resolved, it becomes consumption'; thus, it seems inappropriate to take it." He did not agree. Mr. Jiang and I both took the provincial examinations under the guidance of Mr. Wang Yaoting. At that time, Mr. Wang served as the magistrate of Changyi. The next day was the birthday of the teacher's wife, and we had agreed to meet again to congratulate her. On that day, Mr. Jiang did not appear. During the evening banquet, Teacher Wang said: "The servant from the Jiang household came and said Jianxia was ill and could not attend." I assumed it was a minor ailment and did not visit him. Over a month later, I received the news of his death and was shocked; I never expected that parting at the banquet would become our eternal farewell. Later, meeting his elder brother Xiao Wei, I learned that when his illness was severe, he had consulted Dr. Cao Zhihan. Dr. Cao strongly warned of the danger, but Jianxia remained unconvinced. Dr. Cao told his family: "The Chi pulse (Radial pulse at the deep level) is extremely weak; Kidney Essence is severely depleted." I reflected carefully: this was still pathogenic factors lingering in the Lung. Lung disease leads to Metal failing to generate Water. The harm was caused by the antitussive syrup forcibly stopping the cough. Generally, those with chronic Yin deficiency of the Kidney suffer from Lung heat drying up fluids, leaving the Kidney without a source, often resulting in fatality. In Phthisis (Lao Zhai, e.g., tuberculosis), there is a type called 'Seven-Day Acute Consumption,' half of which arises from this mechanism. People generally think the duration is short and do not suspect it to be a consumptive disease.

Rampant Gum Disease (Zou Ma Ya Gan)

My friend Mr. Fan, whose father-in-law was a traveling physician, possessed a herb that, when ground into a paste and applied in small amounts to the Shangen (root of the nose) to induce blistering and then punctured, was extremely effective for treating Rampant Gum Disease (an acute necrotizing gingivitis). Mr. Fan recognized the herb, which grew everywhere, but did not know its name. I once instructed him to find some and plant it in pots, but it withered shortly thereafter. Subsequently, my niece contracted this disease, and her brother came to request the herb. Unable to provide it, I relied on my understanding and instructed him to use a small amount of Yigong San (Extraordinary Efficacy Powder) from throat medicine, mixed with crushed garlic, and applied to the Shangen to induce blistering. It proved effective. I recall a prescription transmitted by Zhang Shunqin using Mylabris (Ban Mao), Moschus (She Xiang), and white pepper, mixed with peppermint oil, applied to the Taiyang acupoints (both temples) to induce blistering, used for treating headaches like being split by a knife. This follows the same principle. Different meridians involve different diseases, so the acupoints for application vary accordingly. By analogy, this method could likely be applied to other diseases suitable for drawing out toxins externally.

Western Laboratory Testing

A newspaper reported that someone fell ill, and a neighbor provided a single prescription of two herbs, which were highly pungent, warm, diaphoretic, and Qi-dispersing. After ingestion, the patient died immediately. Someone sued in court, ordering Western doctors to test the herbs, which showed no toxicity. I analyze: For diseases not located in the Exterior, or in those with inherent Exterior deficiency, exterior-releasing methods are contraindicated. For diseases not located in the Interior, or in the Interior but deficient rather than excess, purgative methods are contraindicated. Therefore, Ephedrae Herba (Mahuang), Asari Radix et Rhizoma (Xixin), Rheum Palmatum (Dahuang), and Mirabilite (Mangxiao) can all be fatal. Even mild herbs, if not indicated, can turn a light disease serious or a serious disease fatal. Testing these herbs would not necessarily show toxicity.

Inverted Vision (Dao Shi)

The Minli Bao reported that in Awamuya City, USA, a youth named Geberudela had a strange sensory function: objects seen appeared inverted. For example, descending stairs, he saw upward movements and fell repeatedly; carriages coming from the right appeared to come from the left, causing him to rush and fall repeatedly. He consulted Dr. Simon at a specialized medical institution in New York, who attributed it to abnormalities in the optic nerve. I privately examined the *Classified Cases of Famous Doctors*, which records a case by Lu Cangzhou where vision was completely inverted, termed as 'inverting the Gallbladder Fu'; and a case by Chen Jilao where upright objects appeared slanted, termed as 'dislocating a lobe of the Liver onto the Lung'. Another medical text states that flat tables and chairs appear tilted, and tilted ones appear flat, attributing this to latent phlegm in the chest and diaphragm. Wei Yuhuang refuted Chen's case, arguing that the Liver is far from the Lung and cannot physically overlap. I believe the visual system connects internally to the Liver and Gallbladder; this is phlegm stagnation in the Gallbladder collaterals. Treatment with Pinelliae Tuber (Ban Xia), Flos Trichosanthis (Gualou Shi), and Red Peony Root (Chishao) should avoid error. Qian Zhongyang used Prunus japonica seed (Yuliren) to treat eyes wide open unable to close; this herb moistens and resolves nodules, so it could be adapted. Sun Simiao stated that wind entering the brain causes diplopia (seeing one object as two). Li Dongyuan stated that excessive consumption of pungent and hot foods, where pungency disperses and heat aids fire, rising to the brain, causes blurred vision, seeing small as large and short as long. Zhang Zihe stated that in phlegm-heat diseases, the walls appear covered with red lotus flowers. Although slightly different from the above symptoms, they can be cross-referenced. Only seeing one as two or small as large occurs in phlegm disorders, but also frequently in deficiency disorders due to the scattering of Essence. Detailed differentiation of pulse and symptoms is required.

Sha Toxins Require Sneezing; Overeating Requires Vomiting

Wu Shangxian's *Li Yue Pian Wen* states: "Upper applications require sneezing; self-note: sneezing is equivalent to vomiting. For upper locations, sneezing is appropriate; pathogens entering via mouth and nose require sneezing." Analysis: Sneezing and vomiting methods differ. For Six Excesses entering via the nose, sneezing is appropriate to expel pathogens from the site of entry. Thus, during the humid and turbid seasons of May and June, if Sha syndrome (a type of febrile disease) has not entered the Ying (Nutrient) level, sneezing can cure it because the pathogen is in the clear pathways. This corresponds to the Classic saying: "From Tianping comes the way, returning to its journey, Qi emerges from the brain, thus not interfering with pathogens." If dietary indiscretion, overeating, or inhaling turbid qi mixes with retained food and phlegm-fluids in the stomach, filling the chest and diaphragm, vomiting is appropriate. Vomiting expels pathogens that entered via the mouth from the site of entry. Both sneezing and vomiting treat pathogens in the Upper Jiao; one must not equate sneezing with vomiting. Extending this logic: Wind-Cold requires sweating, Wind-Heat requires cooling the exterior, and sexually transmitted diseases require unblocking the essence orifices—all expelling pathogens from their site of entry. This adheres to the principle: if the disease is in the Upper Jiao, do not attack the Middle and Lower; if in the Lower Jiao, do not attack the Upper and Middle.

Sha Syndrome and Plague

Furthermore, Sha syndrome is formed by seasonal turbid qi mixed with pathogens; it is a type of plague, albeit milder. When seasonal prevalence is extreme and contagious among neighbors, it becomes a plague. The disease progresses from Exterior to Interior, from Wei (Defensive) Qi to Ying (Nutrient) and Xue (Blood). If entering via the nose initially, sneezing cures it; if entering via the mouth, drinking Ye Tianshi's stir-fried Loquat Leaf decoction works; if entering via skin and hair, scraping (Sha therapy) is best, with aromatic herbs to dispel turbidity as the main treatment, adjusted for accompanying symptoms. If the disease has deeply entered the Ying level, pricking the Weizhong acupoint is appropriate; if only in the Qi level, pricking is not suitable.

When I traveled to Fujian, plague was prevalent. Investigating the disease, it arose from damp-heat transforming into toxin, deeply entering the Blood level, blocking meridians, causing obstruction and stasis, forming nodules where blocked. Clearly a heat disease, but cooling agents suppress it further, while warming agents exacerbate the toxin. Only urgent pricking of Weizhong to bleed, followed by warming herbs like Safflower (Honghua), Ligusticum Wallichii (Chuanxiong), and Aristolochia Vine (Tianxianteng) to unblock collaterals and invigorate blood, followed by cooling herbs like Rhinoceros Horn (Xijiao, now substituted), Arnebia Root (Zicao), Moutan Bark (Danpi), fresh Rehmannia Root (Shengdi), and Luffa Rind (Sigualuo) to cool blood and unblock collaterals, alternating between the two formulas within a short time, offers hope. Otherwise, the initial warming formula may aggravate the heat. I have used this with verified results.

Cold Wrapping Summer Heat

Using warming and cooling herbs together, or sequentially, treats the disease based on its nature. It is not that warming precludes cooling or vice versa. Previously in Hunan, serving in the staff of Vice Minister Xiang, one day the Vice Minister went out, accompanied by Commander Ruan. Amidst sultry summer heat, upon return, heavy rain brought sudden cold. As they approached the office, Ruan's clothes and shoes were soaked, he suddenly fell from his horse into unconsciousness, was carried in, muttering deliriously, claiming someone grabbed him and demanded gambling debts. The crowd thought it was demonic possession. I diagnosed his pulse: deep, surging, rapid, and forceless, with no sweat, skin burning hot, pulling covers to hide, yet still aversion to cold. I said: "This is summer heat accumulated over days constrained by sudden cold-dampness. First, use pungent-warm herbs to induce sweating. Once the exterior cold-dampness is removed, then use pungent-cool herbs to resolve it." I prescribed Notopterygium Root (Qianghuo), Elsholtzia Herb (Xiangru), Perilla Leaf (Suye), and Tangerine Peel (Chenpi), instructing him to take them first. I also prepared Baihu Tang (White Tiger Decoction), removing Coix Seed (Jingmi) and Licorice (Gancao), adding Watermelon Rind (Xiguacuiyi) and Coix Seed Husk (Bian Douyi), instructing to brew it, saying: "When the pulse floats and sweating increases, take this immediately." Indeed, after the first formula, he sweated profusely, not only losing aversion to cold but becoming extremely averse to heat, even stripping naked. Taking the second formula, within an hour, sweating ceased, heat receded, consciousness cleared, and by dinner, he was completely recovered. Such symptoms, where one catches summer heat by day and greed for coolness by night, are common. The treatment is not extraordinary, nor worth recording, but mentioned here by association with the discussion on plague requiring warming then cooling.

Chronic Cough, Wind-Warmth Cough, Wind-Cold Cough

If physicians understand the principles and the properties of substances, even ordinary items can serve as medicines. Formerly, in Anxi, Fujian, customs were simple, viewing officials as divine. One day, someone holding incense came to the door. The clerk said: "His family has a sick person seeking medicine." There was no need to ask the disease or insist on medicine; food was given casually according to custom, as if seeking an immortal prescription, truly foolish. I asked briefly what the disease was; he said chronic cough, preferring drinks. Thinking chronic cough does not require opening and dispersing, and finding pears at the table, I gave him two, instructing him to boil and drink them, curing the cough. Cooked pear moistens Lung dryness.

Later, traveling to Beijing by boat, I met a friend suffering from unsmooth cough. He said: "Cough started upon boarding, suffering from having a doctor but no medicine." I said: "This is not difficult." Diagnosing floating and rapid pulse, thin yellow tongue coating, belonging to Wind-Warmth, I instructed him to take dried bamboo leaves (Ruoye) used for wrapping southern goods, boil a large bowl, and drink it, smoothing the cough, as the substance is pungent-cool and clears the Lung.

Another time, traveling to Beijing in summer, I met a new scholar who found the crowded cabin stuffy and slept on deck for air. At dawn, he developed fever, aversion to cold, no sweat, and extreme fatigue. The cabin attendant helped him into my cabin and asked if he wanted medicine. He said: "What can be done since there is no medicine on the ship?" I said: "This is not difficult." The syndrome belongs to Wind-Cold. I instructed him to take a large cup of Brandy mixed with a small cup of Mint Wine, warm and drink it, cover up to sweat, and he recovered promptly. Combining the two wines provides pungent-warm exterior release. These three incidents are akin to games, unworthy of record, but written down roughly to aid conversation.

Obstruction of Urination and Defecation

Mr. Gu Jiting introduced me as a friend of different generations; we exchanged poetry and wine, associating closely. After resigning from the China Merchants' Bureau, he lived in Mudu Town, Wu Township. Our meetings became less frequent, but whenever he came to the city, we met. Seeing his slow gait and confused speech, I knew he was aged and frail. At the beginning of the following year, I heard he suffered from obstruction of urination and defecation. When lying down, urine leaked involuntarily. There was a mass in the lower abdomen, heart palpitations with discomfort, hunger wanting to eat, but loss of appetite once eating began. Physicians used purgatives for bowel and bladder obstruction without effect. I said: "Examining the *Jingui Zhenyan Lun*: Northern black qi enters and communicates with the Kidney, opening into the two yin orifices. Zhao Xianke's *Yi Guan* states: Kidney Qi deficiency causes difficulty in urination and defecation. Use Rehmannia Root (Dihuang), Cistanche Stem (Rongrong), Plantago Seed (Cheqianzi), and Poria (Fuling) to tonify Yin and benefit water passages, with a little pungent herb to open pores, promote fluid production, and moisten dryness. Also, the *Nanjing* states: The accumulation of the Kidney is named Ben Tun, originating in the lower abdomen, rising to below the heart, resembling a pig, moving up and down unpredictably. The *Jingmai Pian* states: The Foot-Shaoyin Kidney Meridian, when moved, causes disease: hunger without desire to eat. The *Yuji Zhenzang Lun* states: Winter pulse deficiency causes the heart to hang as if hungry. Zhang's annotation says the Kidney is the source of generating Qi; deficiency prevents the interaction of Heart Fire and Kidney Water. Zhang Jiegu's *Huofa Jiyao* states: Vigorous people have no accumulations; deficient people do. If one abruptly uses harsh breaking drugs, the disease goes but the person declines; thus, treating accumulation requires first nourishing righteousness. Now, with obstruction of urination and defecation and a mass in the lower abdomen, is this not a Kidney disease? Kidney Qi deficiency causes stagnation, hence the mass; stagnation sinks downward, blocking the tunnels, causing urinary obstruction. When lying down, Qi rises, opening the blockage, causing involuntary urination. Frequent hunger is not related to the Stomach but to the non-interaction of Heart and Kidney. What is described as 'heart hanging as if hungry' is not true hunger." Treatment should tonify Kidney Qi to interact with the Heart, assisted by herbs that dissipate stagnation and lift sinking Qi. Prescribe Kanli Dan first to interact Heart and Kidney, then continue with Polygala Root (Yuanzhi), Poria (Fuling), Lotus Seed (Lianzi), Astragalus Complanatus Seed (Shayuanzi), Cistanche (Rongrong), Morinda Root (Bajitian), Goji Berry (Gouqi), Aurantium Fruit (Zhike), Cimicifuga Rhizome (Shengma), and Rehmannia Pill (Dihuang Wan). The prescription was sent via post to his hometown, but he died before taking it. Whether this prescription was correct is unknown; recorded here for evaluation by experts.

Confusion and Delirium