There Will Be Aversion To Food
The Morning After the Year Before
Another year is coming to a close, and it is the season for, among other things, lots of eating and drinking in celebration of the holidays and new year. So, I thought I’d close the year out with a few excerpts from the late imperial literature on how to treat our patients’ (or our own) overindulgences.
A Few Words from Wáng Xùgāo
First up from our ongoing work on Wáng Xùgāo’s Yī Xué Chú Yán (Medical Ruminations, 1862), here are a couple of relevant chapters in Wáng’s brief style, which display his pragmatic attitude toward diagnosis and prescriptions.
第四章 勞倦、飲食、色欲傷
勞倦內傷 勞倦內傷為不足，其證凜凜微惡寒，又微微內熱，稍行動則氣短不足以息，四肢倦怠無力。宜東垣補中益氣湯：參、耆、草、升、柴為要藥，血加當歸，氣加陳皮，食不易運加神麯。
飲食傷 飲食傷為有餘，脘脹不舒，或吞酸噯腐，反飽不思食，古法以香砂枳朮丸為主，今時以二陳湯加神麯、山楂、砂仁、枳實。
色欲傷 色欲傷腎為下虛，如二地、杞子、萸肉、沙苑、菟絲，古以六味丸為主方。
Chapter IV: Damage by Taxation Fatigue, Food and Drink, and Sexual Desire
Taxation Fatigue Internal Damage: Taxation fatigue internal damage is caused by insufficiency, it manifests with shivering and slight aversion to cold, also very slight internal heat, activity results in shortness of breath with panting from insufficiency, the four limbs are fatigued and without strength. Suitable is Dōng Yuán’s Bǔ Zhōng Yì Qì Tāng [Suppement the Center and Boost the Qì Decoction]: Rén Shēn [Rx Ginseng] , [Huáng] Qí [Rx Astragali], [Gān] Cǎo [Rx Glycyrrhizae], Shēng [Má] [Rz Cimicifugae], Chái [Hú] [Rx Bupleuri] are the main medicinals, for the blood add Dāng Guī [Rx Angelicae Sinensis], for the qì add Chén Pí [Pc Citri Reticulatae], if food does not transport easily add Shén Qū [Massa Fermentata Medicinalis] .
Damage by Food and Drink: Damage by food and drink is caused by superabundance, with gastric bloating and discomfort, possibly acid swallowing and putrid belching, instead there is satiety with no thought of food. The old method is to use Xiāng Shā Zhǐ Zhú Wán [Aucklandia, Amomum, Aurantium, and Atractylodes Pill]. Nowadays we use Èr Chén Tāng [Two Aged Decoction] with Shén Qū, Shān Zhā [Fr Crataegi], Shā Rén [Fr Amomi], and Zhǐ Shí [Fr Aurantii Immaturus] added.
Sexual Desire: Sexual desire injures the kidney making the lower burner empty; use agents such as Èr Dì [Rx Rehmanniae and Rx Rehmanniae Praeparata], [Gǒu] Qǐ Zĭ (Fr Lycii), [Shān] Yú Ròu [Fr Corni], Shā Yuàn [Sm Astragali], Tú Sī [Zĭ] [Sm Cuscutae]; the ancients used Liù Wèi Wán [Six-Flavor Pills] as the main prescription.
Chapter 18 of the book is a brief recap with a heads-up:
第十八章 傷食
傷食證，必見胸悶吞酸噯腐，腹脹痛等證。自宜以山楂、神麯、萊菔子、檳榔、枳實等。若不噯腐胸滿，但見頭痛，惡寒發熱，是外感證，切不可使用消食藥，反致表邪陷入，切記切記。脈滑而實者，食積也。病初起，舌上苔厚而黃白色者，必有食也。
Chapter XVIII: Food Damage
Food Damage Pattern: This pattern will present with thoracic oppression, acid swallowing, putrid belching, abdominal distension and pain, and so on. It is appropriate to freely use Shān Zhā, Shén Qū, Lái Fú Zĭ [Sm Raphani], Bīng Láng [Sm Arecae], Zhǐ Shí, and so forth. If there is no putrid belching or thoracic oppression, but the presentation includes headache, aversion to cold and heat effusion, this is an external contraction pattern; one must not use food-dispersing medicinals, which will cause the evils at the surface to sink inward, remember this, remember this. If the pulse is slippery and replete, it is food accumulation. In the early stages of the illness, if the coating on top of the tongue is thick and yellow-white in color, there must be food [damage].
Back to the Míng
The next excerpt is from Shén Nóng Běn Cǎo Jīng Shū (Clarification of the Divine Farmer’s Materia Medica Classic, 1625) by Miào Xīyōng (1546-1627) a physician from the Míng era. Miào was an admirer of Lǐ Dōngyuán, and though I’ve just started cracking into the book, his applications of Lǐ’s theories on supplementing earth are found throughout the text. It is a fascinating work with a lot of useful and well-organized discussion. Here are some excerpts, relevant to our inquiry here:
飲食勞倦傷脾發熱
【忌】破氣，發散，下，苦寒。
諸藥俱見前。
【宜】補中益氣，甘溫，升，酸。
人參 黃耆 術 炙甘草 大棗 柴胡 升麻 石斛 麥門冬 橘紅 白芍藥 酸棗仁
Food and Drink Taxation Fatigue, with Damage to the Spleen and Heat Effusion
【Contraindicated】Breaking qì, effusing and dissipating, downward draining, bitter cold.
All medicinals discussed previously*.
【Appropriate】Supplement the center and boost the qì [bǔ zhōng yì qì], sweet and warm, ascending, sour.
Rén Shēn, Huáng Qí, [Bái] Zhú [Rz Atractylodis Macrocephalae], Zhì Gān Cǎo [Rx Glycyrrhizae Praeparata ], Dà Zǎo [Fr Jujubae], Chái Hú, Shēng Má, Shí Hú [Hb Dendrobii], Mài Mén Dōng [Rx Ophiopogonis], Jú Hóng [Pc Citri Reticulatae Rubra], Bái Sháo Yào [Rx Paeoniae Alba], Suān Zǎo Rén [Sm Zizyphi Spinosae].
Mulch comments: *Some examples of qì-breaking medicinals, given in an earlier chapter of the text: Qīng Pí [Pc Citri Reticulatae Viride], Zhǐ Shí, Bīng Láng, Hòu Pò [Cx Magnoliae];
Some examples of effusing and dissipating medicinals: Má Huáng [Hb Ephedrae], Qiāng Huó [Rx Notopterygii], Bái Zhǐ [Rx Angelicae Dahuricae], Xì Xīn [Hb Asari];
Some examples of downward draining medicinals: Dà Huáng [Rx Et Rz Rhei], Máng Xiāo [Natrii Sulfas];
Some examples of bitter cold medicinals: Shān Zhī [Fr Gardeniae], Huáng Qín [Rx Scutellariae Baicalensis], Huáng Lián [Rz Coptidis].
飲食不消化 屬脾氣虛。
【忌】破氣，消導克伐，苦寒；復忌燥。
草果 枳實 檳榔 蓬荗 三稜 綠礬（以上消導） 余忌藥見前。
【宜】益真氣，香，甘溫，甘辛。
同脾虛，加穀芽、麥芽、肉豆蔻。
Non-Transformation of Food and Drink: Categorized as spleen qì vacuity
【Contraindicated】Breaking qì, abductive dispersion, vanquishing and quelling, bitter cold; resume contraindications for dryness.
Cǎo Guǒ [Fr Amomi Tsaoko], Zhǐ Shí, Bīng Láng, Péng Zhú [Rz Curcumae Zedoariae], Sān Léng [Rz Sparganii], Lǜ Fán [Melanteritum] (the above is for abductive dispersion). The remaining contraindicated medicinals are discussed previously**
【Appropriate】Boost the true qì, aromatic, sweet and warm, sweet and acrid.
Together with [medicinals for] spleen vacuity, add Gǔ Yá [Fr Oryzae Germinatus], Mài Yá [Fr Hordei Germinatus], and Ròu Dòu Kòu [Sm Myristicae].
Mulch comments: **Vanquishing and quelling medicinals are cathartic in nature, such as Qiān Niú Zi [Sm Pharbitidis]; while dryness would seem to be a desirable quality in treating spleen qi vacuity, Miào emphasizes sweet medicinals which moisten and moderate the spleen.
傷食 必惡食。
【忌】潤濕，苦寒。
當歸 肉蓯蓉 鎖陽 天門冬 地黃 知母 玄參 豬脂 茄子 酒糟 麵食（以上濕潤） 苦寒諸藥見前。
【宜】健脾消導，甘溫，辛香。
橘皮 薯蕷 蓮肉 白扁豆 白芍藥 白茯苓 草果 山楂
如腹痛大便不通，宜下之，枳實、檳榔、厚朴、大黃。元氣虛人不可下，宜加參朮。
傷肉食，輕者宜蒜、山楂，兼黃連；重者宜礬紅，棗肉為丸。服二錢，不可過，終身忌蕎麥。
傷麵食，宜炒萊菔子。
Food Damage: There will be aversion to food.
【Contraindicated】Moistening and damp, bitter and cold.
Dāng Guī, Ròu Cōng Róng [Hb Cistanches], Suǒ Yáng [Hb Cynomorii], Tiān Mén Dōng [Rx Asparagi], Dì Huáng [Rx Rehmanniae], Zhī Mǔ [Rz Anemarrhenae], Xuán Shēn [Rx Scrophulariae], Zhū Zhī [Adeps Suis Ferae, wild hog fat], Qié Zĭ [Fr Solani, eggplant], Jiǔ Zāo [Residuum Vini, wine dregs], Miàn Shí [Farina Tritici, wheat flour] (the above are moistening), Bitter and cold medicinals are previously discussed.
【Appropriate】Strengthen the spleen, abduct and disperse, sweet and warm, acrid and aromatic.
Jú Pí [Pc Citri Reticulatae], Shǔ Yù [Rz Dioscoreae Zingiberensis], Lián Ròu [Sm Nelumbinis], Bái Biǎn Dòu [Sm Lablab Alba], Bái Sháo Yào, Bái Fú Líng [Poria], Cǎo Guǒ, Shān Zhā.
If there is abdominal pain and difficult defecation, it is appropriate to purge, with Zhǐ Shí, Bīng Láng, Hòu Pò, Dà Huáng. One cannot use purging in people with original qì vacuity, it is appropriate to add [Rén] Shēn and [Bái] Zhú.
For damage from eating meat, in mild cases it is suitable to use Suàn [Blb Allii, garlic], Shān Zhā, along with Huáng Lián; for severe cases take Fán Hóng [Alumen Rubrum] and Zǎo Ròu [Pc Jujubae] made into pills. Take 2 qián, not more than that, and avoid buckwheat for good.
For damage from eating flour, fried Lái Fú Zĭ is appropriate.
Mulch comments: According to Wiseman & Brand (2020), wine dregs are sweet, acrid and warm; warm the center, disperse food, disperse stasis and relieve pain; used for wind-damp as well as traumatic injury. Even so, it is listed here as something to avoid, which is probably not a big stretch for someone who is hung over. Hog fat here is basically lard/manteca, sweet and cool, mostly used to moisten dryness. Eggplant is sweet and cool, enters the spleen, stomach, and large intestine channels; it clears heat, quickens blood, disperses swelling and relieves pain, so medicinally it is used mainly for ulcerations. Wheat flour is mostly used to supplement the spleen, heart and kidney, so its prohibition here is one of supplementing repletion.
停飲 為恣飲湯水，或冷茶、冷酒所致。
【忌】下，酸斂，濕潤，滯膩。
諸藥俱見前，加栝樓根及仁 桃仁 郁李仁
【宜】健脾利水，淡滲，兼辛散。
人參 白朮 半夏 茯苓 橘皮 澤瀉 豬苓 木通 桑白皮 旋覆花 紫蘇 白豆蔻
Collecting Rheum: Caused by unrestrained drinking of watery soup, cold tea, or cold wine.
【Contraindicated】: Downward draining, sour restraining, damp and moistening, stagnating and slimy.
All medicinals discussed previously, add Guā Lóu Gēn [Rx Trichosanthis] as well as Rén [Sm Trichosanthis], Táo Rén [Sm Persicae], Yù Lǐ Rén [Sm Pruni].
【Appropriate】Strengthen the spleen and disinhibit water, use bland percolation concurrent with acrid dispersion
Rén Shēn, Bái Zhú, Bàn Xià [Rz Pinelliae], Fú Líng, Jú Pí, Zé Xiè [Rz Alismatis], Zhū Líng [Polyporus], Mù Tōng [Caulis Akebiae], Sāng Bái Pí [Cx Mori], Xuán Fù Huā [Fl Inulae], Zǐ Sū [Fm Perillae], Bái Dòu Kòu [Fr Amomi Kravanh].
Mulch comments: Here you see a sort of modified Six Gentlemen Decoction. It is interesting that there is not a lot of warming used here; Bái Dòu Kòu is probably the warmest medicinal in the bunch, and there are some cold ones mixed in among the list. From what I can tell, Miào was not an adherent to the warm supplementation school of thought which was influential during the Míng period, and here is a little bit of evidence to that effect.
Okay, that’s enough from me this year...
Thanks for reading
In closing, I want to thank all of the folks who have been reading this crazy project of mine all year. I really appreciate you all. Happy New Year to everyone!
Note: this publication 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
Miào, X. (1625). Shén Nóng běn cǎo jīng shū. https://jicheng.tw/tcm/book/%E7%A5%9E%E8%BE%B2%E6%9C%AC%E8%8D%89%E7%B6%93%E7%96%8F/index.html
Wáng, X. (1862). Yī xué chú yán. https://jicheng.tw/tcm/book/%E9%86%AB%E5%AD%B8%E8%8A%BB%E8%A8%80/index.html
Wiseman, N., & Brand, E. (2020). Comprehensive Chinese materia medica. Paradigm Publications.