Brain Heat and Nasal Abyss
Yè Tiānshì’s Sinus Cases
I’ve been long interested in treating what are sometimes known as “head diseases”, which is to say things like headache, dizziness, and diseases of the sensory orifices. I’ve been working on material in that vein, and I figured I would mulch some of it for my readers out there.
First up is a chapter from Yè Tiānshì (1667–1747), genius physician of the Qīng era. This is from his Lín Zhèng Zhǐnán Yī Àn (Clinical Guidelines And Medical Cases), published in 1746. The cases were compiled by his students, such as Huá Yùtáng, who offers a summary and commentary at the end of the chapter. As usual, my additions, comments and likely misapprehensions appear in brackets. The translation is my own, flubs and all.
鼻
Nose [diseases]
鮑（十七） 兩三年鼻塞不聞。清涕由口嗆出。而氣窒仍然。大凡頭面諸竅。皆清陽交會通行之所。就外邪來乘。亦必霧露無質清邪。邪郁既久。氣血失其流暢。進藥攻治。必不效驗。欲治其疴。須查手太陰自少商穴起。施針刺以泄邪流氣。乃一法也。（清邪郁久肺氣窒塞無方）
Bào (17): For three years he has had nasal congestion and inability to smell. He chokes on the drainage of clear snivel passing through his mouth, and his breathing (qì) remains obstructed. Generally all the orifices in the head and face are the place where the clear yáng converges and passes through. Exterior evils can exploit them to invade. It is also necessary for the insubstantial mist and dew to clear the evil or the evil will stagnate and become chronic. Qì and blood lose their free flow. I introduced medicinals for attacking therapy, but there was bound to be no effect. I want to treat the disease. I must examine hand tàiyīn beginning from shǎoshāng point (LU11), and use acupuncture needling to drain evil and get the qì to flow. This is the only method (clear evil chronic stagnant lung qì obstruction, there is no formula).
[I must say, off the bat, that this case is awesome if only because the master himself gave up on using medicinals here and resorted to acupuncture to treat the patient.]
徐（四十） 頭面諸竅。皆清陽遊行之所。邪處於中。則為堵塞。陽氣不司流行。必畏寒形頹。內痹必鬱而成熱有鼻柱鼽衄。矣論理當用通聖散。遠處江外倉猝就診。不可輕投。用輕可去實。
苦丁茶 乾荷葉邊 蔓荊子 連翹心 飛滑石 白芷
Xú (40): All the various orifices on the head and face are places where the clear yáng passes through. Evil can reside within, which results in blockage. Yáng qì is unable to spread. There will be a fear of cold and dispirited appearance. Interior impediment constrains and turns into heat, and there is snivel and bleeding at the nose pillar (columella). In theory, one should use Tōng Shèng Sàn (Powder that Sagely Unblocks). From a place distant to Jiangnan they hurried to see a doctor. Don’t just lightly toss this off. Use light [-natured medicinals] to allow the repletion to be eliminated.
Kǔ Dīng Chá (Fm Ilicis), Gān Hé Yè Biān (Fm Nelumbinis Marginatae Exsiccatum), Màn Jīng Zi (Fr Viticis), Lián Qiáo Xīn (Sm Forsythiae), Fēi Huá Shí (Pulvus Talci), Bái Zhǐ (Rx Angelicae Dahuricae)
[In this prescription, he uses mostly cooling medicinals with the exception of Bái Zhǐ. This is quite different from Fáng Fēng Tōng Shèng Sàn. I’ve long admired Yè’s use of light and nimble substances. Fēi Huá Shí is aqueous trituration of talc; the powder is repeatedly placed in water and only that which floats to the surface each is collected, making for extremely fine and light powder which is better suited to ingestion.]
毛（十四） 熱壅。肺氣失降。鼻柱窒痹。（熱壅肺氣）
知母 水梨肉 川貝母 水熬膏
Máo (14) Heat congestion. Lung qì fails to downbear. Nose pillar impediment obstruction. (Heat congesting lung qì)
Zhī Mǔ (Rz Anemarrhenae), Shuǐ Lí Ròu (Fr Pyri), Chuān Bèi Mǔ (Blb Fritillariae Cirrhosae), add water and boil into a paste
[Here he uses medicinals to nourish yīn and clear heat from the upper burner.]
楊 咸降滋填。鼻淵止。得寐。用虎潛法。減當歸陳皮。加天冬淡菜膠脊筋丸。（腦熱鼻淵）
Yáng
Salty downbears, enriches, and replenishes. Stops nasal abyss*, and allows one to sleep. Use the Hidden Tiger (Hǔ Qián)** method, minus Dāng Guī (Rx Angelicae Sinensis) and Chén Pí (Pc Citri Reticulatae), adding Tiān Dōng (Rx Asparagi), Dàn Cài Jiāo (Caro Gelatinum Mytili), Jí Jīn Wán. (Brain heat, nasal abyss)
*[The term in Chinese is 鼻淵, bí yuān. Wiseman’s term for it is “deep-source nasal congestion,” which is a bit of a mouthful. The term yuān can be translated as “abyss,” in the sense of a bottomless ocean of water, which I think accurately represents the seemingly inexhaustible supply of snot that characterizes this particular condition. Therefore, I decided to use the term in place of Wiseman’s.]
**[This refers to Hǔ Qián Wán (Hidden Tiger Pill), which is made up of Shú Dì Huáng (Radix Rehmanniae Praeparata), Guī Bǎn (Plastrum Testudinis), Huáng Bǎi (Cx Phellodendri), Zhī Mǔ (Rhizoma Anemarrhenae), Hǔ Gǔ (Os Tigris), Suǒ Yáng (Herba Cynomorii), Niú Xī (Radix Achyranthis Bidentatae), Dāng Guī, Bái Sháo Yào (Radix Paeoniae Alba), Chén Pí, Gān Jiāng (Rhizoma Zingiberis). Dàn Cài Jiāo would appear to be gelatin from mussel flesh. I was unable to find Jí Jīn Wán.]
沈（氏） 素有痰火氣逆。春令地中陽升。木火化風上引巔頂。腦熱由清竅以泄越。耳鳴鼻淵。甚於左者。春應肝膽。氣火自左而升也。宜清熱散郁。辛涼達於頭而主治。
羚羊角 黑山梔 苦丁茶 青菊葉 飛滑石 夏枯草花
又 照方去滑石加乾荷葉生石膏。
又 性情躁急。陽動太過。氣火上升。鬱於隧竅。由春深病加。失其條達之性。經言春氣病在頭也。考五行六氣。迅速變化。莫若火風。腦熱暗泄而為鼻淵。隧道失和。結成癭核。夫東垣升陽散火。丹溪總治諸郁。咸取苦辛為法。然藥乃片時之效。欲得久安。以怡悅心志為要旨耳。
連翹心 土貝母 海藻 昆布 黑山梔 川芎 小生香附 鬱金 羚羊角 夏枯草 乾荷葉邊
生研末青菊葉汁法丸苦丁茶煎湯送二錢五分。
Chén (clan) has always had phlegm fire and qì counterflow. Springtime causes earth’s central yáng to rise. Wood and fire transform to wind which rises and pulls at the vertex of the head. Brain heat causes excessive discharge from the clear orifices. There is ringing in the ears and nasal abyss, more on the left. Spring should pertain to the liver and gallbladder. Qì and fire naturally rise on the left. It is appropriate to clear heat and disperse stagnation. The main treatment is acrid and cool [medicinals] to reach the head. Líng Yáng Jiǎo (Cornu Saigae Tataricae), Hēi Shān Zhī (Fr Gardeniae Carbonisatus), Kǔ Dīng Chá, Qīng Jú Yè (Fm Chrysanthemi Viride), Fēi Huá Shí, Xià Kū Cǎo Huā (Fl Prunellae).
Also to the prescription accordingly remove Huá Shí and add Gān Hé Yè (Fm Nelumbinis Exsiccatum), Shēng Shí Gāo (Gypsum Crudum)
Furthermore, his natural disposition is restless and impatient. Yáng stirs excessively. Qì and fire rise upward, constraining the orifice passages. Springtime profoundly increases the illness. The natural quality of orderly reaching is lost. The classic says that spring qì illness is located in the head. Study the five phases and six qi. For rapid changes there is nothing like fire and wind. Brain heat forms a cloudy discharge that produces nasal abyss. The passageways lose their harmony, and swellings and nodulations form. Doctor Dōngyuán would raise yáng and disperse fire, Dānxī summarized the treatment of various types of depression*. Select salty, bitter, and acrid as the method. However the medicinals are only effective for a short time. The gist is the desire for long-term peace, and a joyous heart-will.
Lián Qiáo Xīn, Tǔ Bèi Mǔ (Tuber Bolbostemmatis), Hǎi Zǎo (Sargassum), Kūn Bù (Thallus Laminariae), Hēi Shān Zhī, Chuān Xiōng (Radix Ligusticum Chuanxiong), Xiǎo Shēng Xiāng Fù (Rz Cyperi Crudum), Yù Jīn (Rx Curcumae), Líng Yáng Jiǎo, Xià Kū Cǎo (Spica Prunellae), Gān Hé Yè Biān.
Raw, grind to a powder, make pills with Qīng Jú Yè Zhī (Succus Fm Chrysanthemi Viride), decoct Kǔ Dīng Chá, 2 qián 5 fēn in boiling water.
*[This refers to two of the four great masters of the Sòng-Jīn-Yuán period, Lǐ Dōngyuán and Zhū Dānxī]
[The first prescription is largely medicinals which clear heat from the liver. The second includes cold, bitter and salty substances to scatter nodulation and remove stuck phlegm, like Tǔ Bèi Mǔ, Hǎi Zǎo, and Kūn Bù.]
汪 形瘦尖長。稟乎木火。陰精不足。腦髓不固。鼻淵淋下。並不腥穢。暖天稍止。遇冷更甚。其為虛證顯然明白。醫者愈以風寒中腦主治。發散滲泄。愈耗正氣。豈但欲愈。勞怯是憂。用天真丸。（精虛鼻淵）
人參 黃耆 白朮 山藥 蓯蓉 當歸 天冬 羊肉
Wāng: His form is lean, sharp and long. Endowed with a wood and fire constitution, and insufficient yīn essence. The brain-marrow is not secured. Nasal abyss dribbling downward, not at all fishy-smelling or foul. The warm weather has let up a bit. When it turns cold it is still worse. This is clearly and unequivocally a vacuity pattern. The doctor attempts to cure it with wind-cold in the brain as the main treatment. Effuse, disperse, seep and drain. This “cure” is consuming the upright qi. Not only do we want to cure, but vacuity taxation is a concern here. Use Tiān Zhēn Wán. (Essence vacuity nasal abyss)
Rén Shēn (Radix Ginseng), Huáng Qí (Radix Astragali), Bái Zhú (Rhizoma Atractylodis Macrocephalae), Shān Yào (Rhizoma Dioscoreae), Cōng Róng (Hb Cistanches), Dāng Guī, Tiān Dōng, Yáng Ròu (Caro Caprae Seu Ovis).
[Pure warm supplementation. One of the things I find really interesting about these cases is the variety of approaches. With the exception of the Xú case, which included Bái Zhǐ, you don’t see any of the usual suspects for clearing sinuses – no Cāng Ěr Zĭ (Fr Xanthii), no Xīn Yí Huā (Fl Magnoliae). Those are mentioned in the commentary below, but they don’t actually appear in the cases.]
經云。肺和則鼻能知香臭矣。又云。膽移熱於腦。令人辛頞鼻淵。傳為衄衊瞑目。是知初感風寒之邪。久則化熱。熱鬱則氣痹而塞矣。治法利於開上宣郁。如蒼耳散。防風通聖散。川芎茶調散。菊花茶調散等類。先生則佐以荷葉邊苦丁茶蔓荊連翹之屬以治之。此外感宜辛散也。內熱宜清涼者。如腦熱鼻淵。用羚羊山梔石膏滑石夏枯草青菊葉苦丁茶等類。苦辛涼散郁之法也。久則當用咸降滋填。如虎潛減辛。再加鎮攝之品。其有精氣不足。腦髓不固。淋下無腥穢之氣者。此勞怯根萌。以天真丸主之。此就案中大概而言之也。然症候錯雜。再當考前賢之法而治之。（華玉堂）
徐評 此等病皆有專治之方。大概以清火驅風保肺為治。於理無害。而藥不中窾。往往無效。所以醫貴博極群書也。
The classic says: If the lung is in harmony, the nose is able to distinguish the fragrant from the putrid. Another says: The gallbladder transmits heat to the brain, causing one to have an acrid sensation at the bridge of the nose, [a symptom of] nasal abyss. The transmission can turn into nosebleeds or closing one’s eyes in death. It is common knowledge that early stage is contraction of wind-cold evil. After a while, it transforms into heat. Heat depression is followed by qì obstruction and blockage. The most beneficial treatment strategy is to open the upper burner and vent the pathogen, such as with Cāng Ěr Sàn (Xanthium Decoction), Fáng Fēng Tōng Shèng Sàn (Ledebouriella Powder That Sagely Unblocks), Chuān Xiōng Chá Tiáo Sǎn (Tea-Blended Ligusticum Powder), Jú Huā Chá Tiáo Sǎn (Tea-Blended Chrysanthemum Powder), and the like. The physician can follow with assistant herbs of the category of Hé Yè Biān, Kǔ Dīng Chá, Màn Jīng, and Lián Qiáo to treat. For external contraction it is appropriate to use acrid dispersion. For internal heat it is appropriate to clear and cool, in cases such as brain heat and nasal abyss. Use Líng Yáng, Shān Zhī, Shí Gāo, Huá Shí, Xià Kū Cǎo, Qīng Jú Yè, Kǔ Dīng Chá and the like. There is the method of using bitter, acrid and cool to disperse depression. In chronic cases the rule is one should use salty downbearing, enriching and replenishing, such as Hǔ Qián (Hidden Tiger) without the acrid ingredients. Besides that, use settling and conserving products if there is insufficiency of essence-qi. Insecurity of brain-marrow has dribbling down without fishy-smelling or foul qi. This is vacuity taxation, root and sprout. Tiān Zhēn Wán is the main [remedy for this]. These cases are just speaking in rough approximations, however the disease conditions can be all mixed up. Then we must study the principles and treatments of the previous generations. (Huá Yùtáng)
Comment: All of these sorts of diseases have their specific treatments and prescriptions. Roughly speaking, use treatments that clear fire, expel wind, and preserve the lung. The rule is not to do harm. Yet the medicinals may not be able to crack things open and often have no effect. Consequently medicine is expensive, to be extremely well-versed one needs a multitude of books.
Okay, there you have it. If you are still reading, thanks for sticking with this long post. I am planning some followup articles as we move into the autumn. Thanks again for your support.
Note: this post is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.
References
Yè, T. (1746). Lín zhèng zhǐnán yī àn. https://jicheng.tw/tcm/book/%E8%87%A8%E8%AD%89%E6%8C%87%E5%8D%97%E9%86%AB%E6%A1%88/index.html
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