Vexed By Unnecessary Tasks
Xuē Jǐ’s Treatment of the Senses
Readers who have been following Clinical mulch for some time may have noticed a particular focus on the head, brain and sensory orifices (ears, nose, and eyes). I also have an online continuing education class on treating headaches, and I have contributed articles to the Journal of Chinese Medicine on acupuncture treatment for vertigo and (coming soon) eye diseases. So it is an ongoing interest of mine.
This week, I’ve been looking at a chapter on the orifices in Nèi Kē Zhāi Yào (Summary of Internal Medicine, 內科摘要, 1529) by Xuē Jǐ 薛己. Xuē Jǐ, it may be recalled, was previously mentioned as the doctor who gave us the most commonly used modfication of Xiāo Yáo Sӑn (Free Wanderer Powder). He was also a forerunner of the warm supplementation current of thought in the Ming era. Two of his major influences were Lǐ Dōngyuán as well as Qián Yǐ钱乙 , best known as a pediatrician and the formulator of Liù Wèi Dì Huáng Wán (Six-Flavor Rehmannia Pill). Lǐ Dōngyuán emphasized the role of the spleen and stomach and Qián Yǐ paid special attention to the importance of kidney water; Xuē Jǐ took both views and fused them (“薛己”, n.d.). The results are very apparent here, in this chapter.
五、肝脾腎虧損頭目耳鼻等症
5, Liver, Spleen, and Kidney Depletion Diseases of the Head, Eyes, Ears, Nose, Etcetera
給事張禹功，目赤不明，服祛風散熱藥，反畏明重聽，脈大而虛，此因勞心過度，飲食失節，以補中益氣加茯神、棗仁、山藥、山茱、五味頓愈。又勞役復甚，用十全大補兼以前藥漸愈，卻用補中益氣加前藥而痊。
Supervising secretary Zhāng Yǔgōng’s eyes were red and his vision was poor. He took medicinals to dispel wind and disperse heat, but he instead developed aversion to light and deafness. His pulse was large and empty. This condition was caused by taxation from excessive mental work and loss of restraint in eating and drinking. I used Bǔ Zhōng Yì Qì [Center-Supplementing Qi-Boosting Decoction] plus Fú Shén [Poria Pararadicis], Zǎo Rén [Sm Zizyphi Spinosae], Shān Yào [Rz Dioscoreae], Shān Zhū [Fr Corni], Wǔ Wèi [Fr Schisandrae], and he was cured at once. Later when his physical taxation returned even worse, I used Shí Quán Dà Bǔ [Perfect Major Supplementation Decoction] together with the previous medicinals and he was soon cured. Then he went back to using Bǔ Zhōng Yì Qì plus the previous modifications for his recovery.
[Comment: Bǔ Zhōng Yì Qì Tāng is referenced something like 113 times in the text of the Nèi Kē Zhāi Yào, indicating that it was a formula Xuē Jǐ frequently relied on. Here the modifications are to nourish the heart and calm the spirit, bank up and preserve essence. Shí Quán Dà Bǔ Tāng supplements qì and blood and boosts the gate of vitality. Xuē Jǐ explains his reasoning in the next paragraph.]
東垣云：諸經脈絡，皆走於面而行空竅，其清氣散於目而為精，走於耳而為聽，若心煩事冗，飲食失節，脾胃虧損，心火太盛，百脈沸騰，邪害孔竅而失明矣。況脾為諸陰之首，目為血脈之宗，脾虛則五臟之精氣皆為失所，若不理脾胃，不養神血，乃治標而不治本也。
Dōngyuán said: Every channel, vessel and network, all travel to the face and go to the empty orifices. The clear qí disperses into the eyes and becomes essence, and travels to the ears and makes one hear. If the heart is vexed by unnecessary tasks and unrestrained eating and drinking, then the spleen and stomach are depleted, and heart fire is greatly exuberant; the hundred vessels are agitated, and evil harms the orifice openings and there is loss of sight. Moreover, the spleen is the chief of all yīn, and the eyes are the ancestral blood vessels, so spleen vacuity results in the essence of the five viscera losing its office. If spleen and stomach are not regulated and the spirit and blood are not nourished, then one is treating the branches rather than the root.
[Comment: Lǐ Dōngyuán tended to downplay the importance of the liver as regards the eyes, and instead linked eyesight directly with the blood (Kovacs & Unschuld, 1999). Since the spleen is responsible for the generation of blood, it is also crucial for eyesight. Many of the medicinals that brighten the eyes are cool and acrid and enter the liver. In Xuē Jǐ’s view, though, these herbs only made things worse in this case.]
少宰李蒲汀，耳如蟬鳴，服四物湯，耳鳴益甚，此元氣虧損之症，五更服六味地黃丸，食前服補中益氣湯頓愈。此症若血虛而有火，用八珍加山梔、柴胡。氣虛而有火，四君加山梔、柴胡。若因怒就聾或鳴，實，用小柴胡加芎、歸、山梔，虛，用補中益氣加山梔。午前甚，用四物加白朮、茯苓，久，須用補中益氣，午後甚，用地黃丸。
Junior minister Lǐ Pútīng heard a sound like the chirping of cicadas in his ears. He took Sì Wù Tāng [Four Substance Decoction] and the tinnitus became much worse. This illness was due to depletion of the original [yuán] qì. At 5th watch [just before sunrise] he took Liù Wèi Dì Huáng Wán, and before eating he took Bǔ Zhōng Yì Qì Tāng and he was summarily cured. For this illness, if it is due to blood vacuity and there is fire, use Bā Zhēn [Eight Treasures Decoction] plus Shān Zhī [Fr Gardeniae] and Chái Hú [Rx Bupleuri]. For qì vacuity with fire, use Sì Jūn [Four Gentlemen Decoction] plus Shān Zhī and Chái Hú. If the cause is anger which then causes deafness or ringing, [if due to] repletion, use Xiǎo Chái Hú [Minor Bupleurum Decoction] plus Qiōng [Rz Chuanxiong], Guī [Rx Angelicae Sinensis] and Shān Zhī; [if it is] vacuity, use Bǔ Zhōng Yì Qì plus Shān Zhī. [If it is] more severe before noon, use Sì Wù plus Bái Zhú [Rz Atractylodis Macrocephalae], Fú Líng [Poria]; if chronic, one must use Bǔ Zhōng Yì Qì; if it is more severe in the afternoon, use Dì Huáng Wán.
[Comment: Xuē Jǐ’s modification of adding a combination of Shān Zhī and Chái Hú to tonic formulas can also be found in what has become known as Jiā Wèi Guī Pí Tāng. It is, of course a combination also found in Jiā Wèi Xiāo Yáo Sӑn, and gives whatever formula it is added to the capacity to clear depressive heat from the liver. Bǔ Zhōng Yì Qì Tāng already contains Chái Hú, so the only sole addition of Shān Zhī is needed. The modification to Xiǎo Chái Hú Tāng brings it a little closer to the functions of Jiā Wèi Xiāo Yáo Sӑn, with the addition of Chuān Xiōng and Dāng Guī to nourish and quicken blood. The additions to Sì Wù Tāng make it a little closer to Bā Zhēn Tāng. ]
少司馬黎仰之，南銀臺時，因怒耳鳴，吐痰，作嘔，不食，寒熱，脅痛，用小柴胡合四物加山梔、茯神、陳皮而瘥。
Junior war minister Lí Yǎng, in south Yíntái at the time, had tinnitus caused by anger; [also he] was spitting up phlegm, became nauseous, was not eating, had chills and fever, and ribside pain. I used Xiǎo Chái Hú together with Sì Wù plus Shān Zhī, Fú Shén, Chén Pí [Pc Citri Reticulatae] and he recovered.
[Comment: The formula here is better known as Chái Hú Sì Wù Tāng. The modifications add Chén Pí to downbear the stomach and improve the appetite.]
劉毅齋，怒則太陽作痛，用小柴胡加茯苓、山梔以清肝火，更用六味丸以生腎水，後不再發。
Shàngbǎo secretary Liú Yìzhāi’s anger resulted in aching pain in the tàiyáng. I used Xiǎo Chái Hú plus Fú Líng and Shān Zhī to clear liver fire, then changed to Liù Wèi Wán to engender kidney water, after which he did not relapse.
[Comment: We’ve seen a similar strategy before in which a harmonizing formula like Xiāo Yáo Sǎn is followed up with Liù Wèi Dì Huáng Wán to consolidate the effects of the treatment.]
一儒者，日晡兩目緊澀，不能瞻視，此元氣下陷，用補中益氣倍加參、耆，數劑痊愈。
A scholar, at sunset both his eyes became tense and dry, and he couldn’t stand to look at anything. This was [due to] sinking of the original qì; I used Bǔ Zhōng Yì Qì with extra added Rén Shēn [Rx Ginseng] and Huáng Qí [Rx Astragali], and after a number of doses he was completely cured.
[Comment: It is important to remember that the pathomechanisms for dryness in the upper body include qì vacuity, when there is not enough qì to push the fluids to the upper body. This is a job for something like Bǔ Zhōng Yì Qì Tāng to raise the clear fluids along with the qì.]
一男子，亦患前症，服黃柏、知母之類，更加便血，此脾虛不能統血，肝虛不能藏血也，用補中益氣、六味地黃而愈。
A man also suffered from the above-mentioned disease. He took medicines of the type of Huáng Bǎi (Cx Phellodendri) and Zhī Mǔ (Rx Anemarrhenae), and it changed to include bloody stool. This was liver vacuity with inability to store blood; I used Bǔ Zhōng Yì Qì and Liù Wèi Dì Huáng and he was cured.
[Comment: Huáng Bǎi and Zhī Mǔ are cooling medicinals of the sort employed often by Zhū Dānxī, the last of the four great masters of the Sòng-Jīn-Yuán period. Sometimes one hears of people practicing “Lǐ-Zhū medicine” as if the two styles of Dōngyuán and Dānxī formed a coherent whole, but Xuē Jǐ clearly made a distinction between them here.]
一儒者，兩目作痛，服降火祛風之藥，兩目如緋，熱倦殊甚，余用十全大補湯數劑，諸症悉退，服補中益氣兼六味丸而愈。復因勞役，午後目澀、體倦，服十全大補而痊。
A scholar had aching pain in both eyes. He took medicinals to downbear fire and eliminate wind, and both eyes became bright red, and the fever and fatigue grew especially severe. I used shí quán dà bǔ tāng for a number of doses, and when all symptoms completely remitted, he took Bǔ Zhōng Yì Qì with Liù Wèi Wán at the same time and was cured. Later when again the cause was physical taxation, in the afternoon his eyes would be dry and his body would be weary, he would take Shí Quán Dà Bǔ and recover.
[Comment: As above, bitter and acrid medicinals were seen to aggravate the patient’s symptoms, and supplementation was the correct course of action.]
一男子，房勞兼怒，風府脹悶，兩脅脹痛，余作色欲損腎，怒氣傷肝，用六味地黃丸料加柴胡、當歸，一劑而安。
A man suffered from bedroom taxation along with anger, distension and oppression in the wind palace, and painful distension in both ribsides. Excessive lust had depleted the kidney, and anger injured the liver; I used a prescription of Liù Wèi Dì Huáng Wán plus Chái Hú and Dāng Guī, one dose and he was calm.
[Comment: Wind palace is the name for GV16. The prescription here recalls the combination of Liù Wèi Dì Huáng Wán with Xiāo Yáo Sǎn above.]
一儒者，酒色過度，頭腦兩脅作痛，余以為腎虛而肝病，亦用前藥頓安。
A scholar, indulged in excessive drinking and licentiousness; his head, brain, and both ribsides ached. I diagnosed kidney vacuity and liver disease, and also used the previously-mentioned medicinals which immediately calmed the illness.
[Comment: Apparently a significant demographic of Xuē Jǐ’s practice was officials and scholars who were more subject to mental stress and lifestyles of dissipation.]
一男子，面白鼻流清涕，不聞馨穢，三年矣，用補中益氣加麥門、山梔而愈。
A man’s face was white with clear mucus streaming from his nose; he could not smell fragrant or filthy for three years. I used Bǔ Zhōng Yì Qì plus Mài Mén [Rz Ophiopogonis] and Shān Zhī and he was cured.
一男子，年二十，素嗜酒色，兩目赤痛，或作或止，兩尺洪大，按之微弱。余謂少年得此，目當失明。翌早索途而行，不辨天日，眾皆驚異。余與六味地黃料加麥門、五味，一劑頓明。
A man 20 years of age, was habitually addicted to drinking and sex, both eyes were red and painful, sometimes on and sometimes off. Both chǐ [proximal] pulses were flooding and big, and on pressure they would be faint and weak. I told him that if a young man keeps doing this [behavior], he will become blind. The next morning, he searched for the road so he could walk, but he was unable to distinguish the sky and sun, everyone around him was astonished. I offered a prescription of Liù Wèi Dì Huáng plus Mài Mén and Wǔ Wèi; one dose promptly restored sight.
[Comment: The formula mentioned is now more commonly referred to at Bā Xiān Cháng Shòu Wán (Eight Imortals Longevity Pill) or Mài Wèi Dì Huáng Wán (Ophiopogon, Schizandra, and Rehmannia Pill).]
Conclusion
This chapter is a good example of the application of a consistent set of core formulas with modifications. The cases given are largely lifestyle-driven, which gives some relevance to many of the people we see today – occupational stress, overindulgence in food and drink, etc. I personally lean more toward harmonizing and regulating formulas but many of the modifications given here do strike a certain balance between straight supplementation and regulation of qì and blood.
Okay, that’s all for now. Thanks for reading.
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
薛己. (n.d.). Retrieved June 13, 2024 from https://baike.baidu.com/item/%E8%96%9B%E5%B7%B1/1011836
Kovacs, J., & Unschuld, P.U. (1999). Essential subtleties on the silver sea: The yin-hai jing-wei: A Chinese classic on ophthalmology. University of California Press: Berkeley.
Xuē, J. (1529). Nèi kē zhāi yào. Retrieved November 18, 2023 from https://jicheng.tw/tcm/book/%E5%85%A7%E7%A7%91%E6%91%98%E8%A6%81/index.html