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The Master said: There are diseases of Ben Tun (Rushing Pig), vomiting of pus, fright and terror, and fire pathogen. These four categories of diseases all arise from fright and alarm.

[Commentary] This chapter only contains the syndrome of Ben Tun, while vomiting of pus, fright/terror, and fire pathogen are abbreviated or missing; there must be lacunae in the text.

The Master said: The disease of Ben Tun starts from the lower abdomen, rushes upward to the throat, causes extreme suffering during attacks, and subsides afterward. All such cases arise from fright and alarm.

[Annotation] Ben Tun is a kidney disease. It is named so because its pathological qi rushes from the lower abdomen to the throat, resembling the running and darting of a pig. During an attack, Kidney Qi ascends to overwhelm the Heart, causing extreme suffering; after the attack, the qi weakens and returns to the Kidney, thus stopping. Therefore, although the severity varies, these diseases invariably arise from fright and alarm. Fright injures the Heart, and fear injures the Kidney; both organs are affected. Since Water overcomes Fire, and Kidney Water overwhelms the Heart, the treatment method should involve draining the Kidney and tonifying the Heart.

[Collected Annotations] Zhang Congzheng said: Fright arises from ignorance of the cause; fear arises from awareness of the cause.

Zhou Yangjun said: The Shaoyin (Kidney) meridian runs along the throat; due to its connection with this meridian, the upward rush is facilitated.

After sweating therapy, if burning needles (warm needle moxibustion) were used to induce sweat, and the puncture sites became cold, resulting in nodules rising and turning red, Ben Tun will definitely occur, with qi rushing from the lower abdomen to the heart. Moxibustion should be applied once on each nodule, followed by Guizhi Jia Gui Tang (Cinnamon Twig Decoction plus Cinnamon).

[Annotation] This paragraph is identical to that in Shanghan Lun (Treatise on Cold Damage). Shanghan Lun lacks the three characters "after sweating" but includes the eleven characters "In Taiyang cold damage, adding warm needles will certainly cause fright." The Shanghan Lun version is likely correct. This clarifies that the cause of fright is not singular; even cold invading the needle site can cause this disease. "In Taiyang cold damage, adding warm needles will certainly cause fright" means that when a patient with cold damage is suddenly subjected to warm needles, their mind will be startled; it does not mean that warm needles will inevitably lead to a fright disorder. Burning needles refer to warm needles; inducing sweat via burning needles is also a sweating method. Needle sites should be protected from cold. If carelessness allows external cold invasion, fire becomes constrained within the vessels, blood circulation stagnates, leading to nodular swelling and redness. Warm needle sweating is a rapid and intense method. If the Ying (Nutritive) Qi fails to disperse the pathogen after needling, it indicates the person was originally deficient in Yang and abundant in Yin. Thus, despite the heat of the warm needles, only nodular redness appears. Combined with cold invasion, instead of resolving, it attracts Yin pathogens. At the time of needling, the Heart was already frightened and deficient, allowing Kidney Water and Yin pathogens to overwhelm Heart Yang, triggering Ben Tun. Ben Tun is the Qi of Kidney Water and Yin pathogens rushing from the lower abdomen to the Heart, like a running pig. Moxibustion on the nodules first dispels external cold; subsequently administering Guizhi Jia Gui Tang attacks internal Kidney pathogens.

[Collected Annotations] Zhou Yangjun said: Ben Tun is the pathogen of the North (Kidney). Burning needles to induce sweat, even if improper, how does it relate to Shaoyin to produce Ben Tun? Because Taiyang and Shaoyin are exterior-interior pairs. Cold at the needle site causes nodules and redness; I know the previous pathogen was not dispersed, and the new pathogen entered. Only Cinnamon can attack Kidney pathogens. Hence, Cinnamon is added to Guizhi Tang: one part to release exterior Wind pathogen externally, and one part to vent Yin internally. Moxibustion on the nodules is used because cold causes swelling, which only moxibustion can resolve.

Guizhi Jia Gui Tang (Cinnamon Twig Decoction Plus Cinnamon) Formula
Guizhi (Cinnamomi Ramulus) - 5 liang
Shaoyao (Paeoniae Radix Alba) - 3 liang
Gancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) - 2 liang (honey-fried)
Shengjiang (Zingiberis Rhizoma Recens) - 3 liang
Dazao (Ziziphi Jujubae Fructus) - 12 pieces

These five ingredients are boiled in 7 sheng of water, simmered until 3 sheng remain, strained, and taken warm, 1 sheng per dose.

Ben Tun with qi rushing to the chest, abdominal pain, and alternating chills and fever is treated with Bentong Tang (Rushing Pig Decoction).

[Annotation] Ben Tun with qi rushing to the throat and extreme suffering during attacks represents severe Ben Tun. Ben Tun with qi rushing to the chest, abdominal pain, and alternating chills and fever represents mild Ben Tun. Severe cases are treated with Guizhi Jia Gui Tang to drain Yin and direct rebellious Qi downward from the Kidney. Mild cases are treated with Bentong Tang to regulate Blood and dissipate rebellious Qi from the Heart.

Bentong Tang (Rushing Pig Decoction) Formula
Gancao (Glycyrrhizae Radix et Rhizoma)
Xiong (Ligustici Chuanxiong Rhizoma)
Danggui (Angelicae Sinensis Radix)
Each: 2 liang
Banxia (Pinelliae Rhizoma Praeparatum) - 4 liang
Huangqin (Scutellariae Radix) - 2 liang
Shengge (Puerariae Radix) - 5 liang
Shaoyao (Paeoniae Radix Alba) - 2 liang
Shengjiang (Zingiberis Rhizoma Recens) - 4 liang
Ganligen Baipi (Pruni Spinosae Cortex Albus) - 1 sheng

These nine ingredients are boiled in 2 dou of water until 5 sheng remain. Take 1 sheng warm, three times daily and once at night.

[Collected Exegesis] Shen Mingzong said: Xiong, Danggui, Baishao, and Gancao nourish the proper Blood and Qi of Jueyin and Shaoyang, allowing pathogens to exit outward. Shengge, Huangqin, Banxia, and Shengjiang assist Ligen to resolve half-exterior/half-interior chills and fever, dispersing rebellious Qi. Although Ben Tun belongs to Kidney disease, it sometimes occurs with concurrent Jueyin and Shaoyang pathogens. Zhongjing’s use of this formula clearly indicates that it is not caused solely by cold pathogens.

After sweating therapy, if palpitations occur below the umbilicus, indicating impending Ben Tun, Fuling Guizhi Gancao Dazao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction) is indicated.

[Annotation] After sweating, palpitations in the epigastrium indicate Heart Yang deficiency and disease of the primary meridian. Palpitations below the umbilicus indicate Kidney pathogens overwhelming the Heart due to deficiency. Ben Tun involves Qi moving below the umbilicus and rushing upward. Impending Ben Tun refers to symptoms resembling Ben Tun that are about to manifest but have not yet fully developed. Fuling Guizhi Gancao Dazao Tang tonifies Fire and Earth to attack Water pathogens. The previous paragraph explained that exterior cold pathogens can cause Ben Tun; this paragraph further clarifies that interior Water Qi can also cause Ben Tun.

[Collected Annotations] Xu Bin said: Zhongjing’s syndrome differentiation often combines several paragraphs to exhaust variations. He states Ben Tun arises from fright, then describes its rush from the lower abdomen to the throat, then mentions accompanying abdominal pain and alternating chills/fever, then nodules without other diseases, and finally post-sweating sub-umbilical palpitations indicating impending but unformed Ben Tun. Its depth and superficiality are clear. Using harmonizing methods, attacking Kidney methods, using Cinnamon vs. not using Cinnamon—treatment nuances are subtle. For Ben Tun, etiology, syndromes, and treatments leave no room for omission. If one does not understand Zhongjing’s intent in formulating prescriptions, one may fear potent drugs and find mild remedies ineffective. Is it that ancient formulas are unsuitable for modern times?

Zhou Yangjun said: Sweat is the fluid of the Heart. Post-sweating sub-umbilical palpitations indicate Heart Qi deficiency and Kidney Qi movement.

Fuling Guizhi Gancao Dazao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction) Formula
Fuling (Polyporus Umbellatus) - 8 jin
Guizhi (Cinnamomi Ramulus) - 4 liang
Gancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) - 2 liang (honey-fried)
Dazao (Ziziphi Jujubae Fructus) - 15 pieces

These four ingredients are boiled in 1 dou of Ganlan Shui (Gestating Water). First boil Fuling until reduced by 2 sheng, add remaining herbs, boil until 3 sheng remain, strain, and take 1 sheng warm, three times daily.

Method for preparing Gestating Water: Take 3 sheng of water, place in a large basin, and ladle it up and down thousands of times. When small bubbles (like pearls) appear on the surface, count them; take this water for use.

[Collected Exegesis] Cheng Lin said: Post-sweating sub-umbilical palpitations indicate Yang Qi deficiency and rebellious Kidney pathogens. The area below the umbilicus is the source of Kidney Qi. Fuling drains Water to attack Kidney pathogens; Guizhi promotes Yang to scatter rebellious Qi; Gancao and Dazao, being sweet and warm, strengthen Spleen Earth to control Kidney Water. Gestating water is used because the ladling process removes its natural water properties, preventing it from aiding Kidney pathogens.