L I D O N G - Y U A N ’ S Treatise On The Spleen & Stomach A TRANSLATION OF THE PI WEI LUN NEW EDITION Translated & Annotated by Bob Flaws BLUE POPPY PRESS Published by: BLUE POPPY PRESS A Division ofBlue Poppy Enterprises,Inc. 5441 Western Avenue #2 BOULDER,CO 80301 SECOND EDITION OCTOBER 2004 ISBN 0-936185-41-4 Library ofCongress #92-75135 COPYRIGHT 2004 © BLUE POPPY PRESS All rights reserved.No part ofthis book may be reproduced,stored in a retrieval system, or transcribed in any form or by any means,electronic,mechanical,photocopy, recording,or any other means,or translated into any other language without the prior written permission ofthe publisher. Printed at Johnson Printing,Boulder,Colorado COMP Designation:Denotative translation Printed on recycled paper products with soy-based ink. 10 9 8 7 6 5 4 3 2 Table of Contents Translator’s Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .v BOOK ONE 1 Treatise on the Transmutation ofVacuity & Repletion ofthe Spleen & Stomach . .3 2 Diagram ofUpbearing & Downbearing,Floating & Sinking,Supplementing & Draining ofthe Visceral Qi in Different Seasons . . . . . . . . . . . . . . . . . . . . . . . . . . .13 3 Treatise on the Waxing & Waning ofthe Spleen & Stomach . . . . . . . . . . . . . . . . . .17 4 Treatise on the Lungs in Relation to Spleen-stomach Vacuity . . . . . . . . . . . . . . . . .37 5 Rules Concerning Sovereign,Minister,Assistant,& Envoy . . . . . . . . . . . . . . . . . . .47 6 Composing Formulas [Based on] the Division ofChannels and Following the Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53 7 Treatise on Medicinal Indications & Prohibitions . . . . . . . . . . . . . . . . . . . . . . . . . .59 Seasonal Prohibitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59 Channel Prohibitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60 Disease Prohibitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .61 Medicinal Prohibitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62 8 The Spleen & Stomach According to [Zhang] Zhong-jing’s Quotations from the Nei Jing (Inner Classic) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65 BOOK TWO 1 Diagrams & Explanations on the Waxing & Waning ofthe Movement ofQi . . . .77 2 Treatise on the Initiation ofHeat in the Center Due to Damage by Food & Drink and Taxation Fatigue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .81 3 Diseases in the Different Seasons Due to Spleen & Stomach Vacuity Weakness and Formula Composing According to Different Diseases . . . . . . . . . . . . . . . . . . . . . .155 4 Treatise on the Use ofQing Shu Yi Qi Tang (Clear Summerheat & Boost the Qi Decoction)in Case ofthe Stomach Troubled Particularly Profoundly by Damp Heat in Long Summer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .169 5 Rules for Adding & Subtracting in the Use ofMedicinals Following the Seasons . .179 6 Treatise on Intestinal Afflux with Blood in the Stools . . . . . . . . . . . . . . . . . . . . . .185 7 Treatise on the Prohibition ofUnwarranted Use ofEjecting Medicinals in Spleen & Stomach Vacuity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .189 8 Treatise on Quieting & Nurturing the Heart Spirit [by] Regulating & Treating the Spleen & Stomach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .193 9 The Necessity ofInquiring About Inclinations Before Treating Any Disease . . . .195 10 Treatise on the Downward Pouring ofStomach Qi,Chaos ofAll the Five Viscera Qi & the Consequent Simultaneous Manifestation ofVarious Diseases . . . . . . . . . .197 11 Yin Disease Treated [Through] Yang,Yang Disease Treated [Through} Yin . . . . .201 12 Debility & Effulgence ofthe Original Qi ofthe Triple Heater . . . . . . . . . . . . . . . .205 BOOK THREE 1 Treatise on Ascription ofthe Large Intestine,Small Intestine,& All Five Viscera to the Stomach and Stomach Vacuity Leading to Disease ofThem All . . . . . . . . . . .209 2 Treatise on Stomach Vacuity’s Leading to Non-free Flow ofthe Nine Orifices . . . .211 3 Treatise on the Viscera & Bowels,Channels & Network Vessels Having Nowhere from Which to Receive Qi and [thus] Contracting Disease When the Stomach is Vacuous . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .215 4 Treatise on the Engenderment ofVarious Diseases Due to Stomach Vacuity [&] Insufficient Original Qi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .219 5 Treatise on Suddenly [Becoming] Fat & Suddenly [Becoming] Thin . . . . . . . . . .221 6 Treatise on the Laws ofEngendering & Killing ofYin & Yang in Heaven & Earth Consisting ofUpbearing & Downbearing,Floating & Sinking . . . . . . . . . . . . . . .223 7 Treatise on Yin & Yang,Longevity & Premature Death . . . . . . . . . . . . . . . . . . . . .227 8 Treatise on the Intricate Changes ofthe Qi ofthe Five Viscera . . . . . . . . . . . . . . .229 9 Treatise on the Upbearing & Downbearing ofYin & Yang . . . . . . . . . . . . . . . . . . .233 10 Experiences in Regulating & Rectifying the Spleen & Stomach:Treatise on Inadvertent Detriment Due to Mistakes Out ofIgnorance in the Use ofUpbearing & Downbearing,Floating & Sinking Treatment Methods in Medication . . . . . . .237 11 Treatise on the Yang MingDisease ofOverwhelming Dampness & Spontaneous Perspiration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .253 12 Treatise on Damp Heat Producing Wilting and Lung Metal Suffering Evils . . . . .255 13 Treatise on Drinking & Eating Damaging the Spleen . . . . . . . . . . . . . . . . . . . . . . .263 14 Treatise on Damage Due to Excessive Drinking ofAlcohol . . . . . . . . . . . . . . . . . .265 15 Spleen-stomach Detriment Warrants Regulated Drinking & Eating and Suitable Cold & Hot [Foods] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .279 16 Methods for Supporting & Rectifying the Spleen & Stomach . . . . . . . . . . . . . . . .291 17 Nursing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .293 18 Distancing Desires [i.e.,Keeping Desires at a Distance] . . . . . . . . . . . . . . . . . . . . .295 19 Admonition on Economy ofSpeech . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .297 Appendix: Representative Dong-yuan Yin Fire Formulas . . . . . . . . . . . . . . . . . . . . . . . .299 Formula Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .313 General Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .315 Translator’s Preface This book is a translation ofand commentary on Li Gao’s Pi Wei Lun (Treatise on the Spleen & Stomach).Li Gao,a.k.a.Li Dong-yuan and Li Ming-zhi,was arguably the greatest ofthe four great masters ofthe Jin-Yuan dynasties (1115- 1386 CE).The other three of these four great masters of this time were Liu He-jian,a.k.a.,Liu Wan-su,Zhang Cong-zheng,a.k.a.Zhang Zi-he,and Zhu Zhen-heng,a.k.a.Zhu Dan-xi.Li Dong-yuan was the founder of the school ofsupplementing earth,and the Pi Wei Lun is regarded as Li’s final book and greatest masterpiece. The Jin-Yuan dynasties are considered the renaissance of Chinese medicine. Most of the seminal theories of Chinese medicine were set down in the Han dynasty (206 BCE-220 CE) in such classics as the Nei Jing (Inner Classic),Nan Jing (Classic of Difficulties),and Shang Han Lun/Jin Gui Yao Lue (Treatise on Damage [Due to] Cold/Essentials from the Golden Cabinet).For the next thou- sand years,there was little radical development in these theories.However,dur- ing the Song dynasty (960-1279 CE),the development of Neoconfucianism allowed Chinese thinkers the freedom to posit entirely new ideas,and the four great schools ofthe Jin-Yuan that followed grew directly out ofthis philosophical revolution.Although many Chinese medical histories present the four great schools ofthe Jin-Yuan as four separate theoretical approaches to the practice ofChinese medicine,in fact,three out offour were a clear progression or evo- lution from one to the next.In this case,Liu Wan-su’s school ofcool and cold (medicines) emphasized the role of heat evils in disease.Li Dong-yuan then further refined this observation with his development ofthe theory ofyin fire which explains where these heat evils frequently come from when engendered internally.And finally,Zhu Dan-xi further refined Li’s praxis by routinely adding moist,yin-enriching medicinals to Li’s commonly sweet,acrid,and warm for- mulas.Therefore,we can now speak ofLi-Zhu medicine,meaning the theories and practices ofLi Dong-yuan and Zhu Dan-xi as a single school ofor approach to the practice ofChinese medicine. Recently,many Chinese doctors in Asia and abroad have realized that the theo- ries and prescriptive methodology of Li-Zhu medicine are some of the most vi Treatise on the Spleen & Stomach effective and appropriate for treating the knotty,difficult-to-treat diseases which have become the stock in trade ofcontemporary Chinese medicine.As I hope to show in this book,the theories and treatments ofLi Dong-yuan and Zhu Dan- xi are especially appropriate for chronic diseases with multi-pattern presenta- tions,such as allergies,endocrine disorders,chronic viral disorders,immune deficiencies,autoimmune diseases,and cancers.However,till now,these theo- ries have not been generally well known,and Blue Poppy Press’s first translation ofthis work appeared without commentary,making it difficult for most read- ers to extract the clinical gist ofwhat Li was trying to say.Therefore,I have retrans- lated this important Chinese medical text and added commentaries and case histories in order to make its wisdom more accessible to modern readers.There is no way I would have attempted this new edition ofthe Pi Wei Lunwere it not for the pioneering translation ofYang Shou-zhong and Li Jian-yong,Blue Poppy’s first translators ofthis important text.Thus I am grateful and indebted for their ground-breaking work. Li Gao (1180-1251 CE) was one ofthe most eminent Chinese medical scholars ofhis time.He was born in Zhending (present day Baoding in Hebei province) into a very wealthy family which owned thousands ofacres ofland and enjoyed the company ofthe highest officials and most distinguished scholars oftheir day. From his childhood,Li received an excellent education in the Confucian clas- sics,and,rolling in wealth,he did not need to learn a profession to earn his liv- ing.At that time,the practice ofmedicine,though a respectable profession,was inferior to official position in the Confucian bureaucracy,and most intellectu- als preferred to spend their lives climbing the bureaucratic ladder.However,one year while Li was still young,his mother fell ill.One after another doctor was sent for,but none was able to even diagnose Li’s mother let alone help her even a little.When Li’s mother eventually died,Li blamed himselffor a lack offilial piety.As his mother’s son,he reproached himselfthat should have known enough medicine to take care ofher himself.Therefore,similar to Zhang Zhong-jing in the Han dynasty,Li determined to learn medicine.Money being no object,Li did not hesitate to pay a small fortune in silver in order to study directly under Zhang Yuan-su,one ofthe greatest doctors and teachers ofmedicine ofhis time. At the outbreak ofwar against the Mongols,Li moved to Henan where he lived among a number ofhighranking officials.Being from a rich family,Li did not practice medicine as a livelihood.Instead,Li practiced medicine as an expres- sion ofConfucian benevolence.Over the years,Li became a distinguished prac- titioner in nearly all the specialties of Chinese medicine,including internal medicine,acupuncture,pathology,pharmacology,gynecology,and pediatrics. In fact,Li so distinguished himselfabove and beyond simply being a disciple of Treatise on the Spleen & Stomach vii Zhang that Wang Hang-gu,also an outstanding student ofZhang’s and a famous medical scholar in his own right,formally acknowledged Li as his master.Within Chinese culture,such an acknowledgment by a classmate who might otherwise claim equal status has profound implications.Wang said: I have been studying medicine for scores ofyears...but I am eager to have an excellent teacher for a guide...This desire has been occupying my mind day and night,but I have yet thought ofno suitable candidate except for Elder-born Li. According to one ofLi’s biographies,there was a famine in the area in which he was living from 1201-1208 CE and the people were also suffering from various epidemics.Other doctors in the area relied on either the sweating or precipita- tion (i.e.,purgation) methods for any and every patient,and,therefore,many of these died.Among the local doctors,it is said that only Li Dong-yuan traced the disease causes and mechanisms,reviewed the signs and symptoms,conducted physical examinations,and then prescribed appropriate medicinals. In terms ofthe evolution ofChinese medicine,it was Li Dong-yuan who empha- sized internal damage as opposed to external contraction as the main cause of chronic,enduring diseases and raised the spleen and stomach to pivotal and pre- eminent importance among the five viscera and six bowels.It was also Li Dong- yuan who developed the theory ofyin fire and then designed a host ofbrilliant Chinese medicinal formulas to address so many ofthe clinical manifestations of this species ofinternally engendered heat.Li left behind a number ofimportant works in the literature of Chinese medicine.These include the Nei Wai Shang Bian Huo Lun (Treatise on Solving Confusion in Discriminating Internal & External Damages);the Lan Shi Mi Cang (Secret Collection ofthe Orchid Chamber);the Yi Xue Fa Ming (The Study ofMedicine Made Clear);the Yong Yao Fa Xiang (Methods & Approaches to Using Medicinals);and the Pi Wei Lun.Ofthese,the Pi Wei Lun is Li’s undisputed masterpiece and was probably the last work he wrote before he died at 71 years ofage. This translation is based on three editions ofthe Pi Wei Luncurrentlyavailable in the People’s Republic ofChina.The Gu Qin Yi Tong Zheng Mai Quan Shu (The Complete Book ofAll Collected Ancient & Modern Medicine & Orthodox Pulse [Lore]) is a photolithograph ofa Ming dynasty book published by the People’s Health & Hygiene Press in 1957 which includes several Jin-Yuan texts.In 1976, the People’s Health & Hygiene Press published an annotated version of the Pi Wei Lunwith commentaries developed by the Hunan Chinese Medical Research Institute.In 1995,another edition ofthe Pi Wei Lunwas included in Ye Chuan viii Treatise on the Spleen & Stomach and Jian Yi’s Jin Yuan Si Da Yi Xue Jia Ming Zhu Ji Cheng (A Compilation of Famous Texts from the Masters ofthe Four Great Schools ofMedicine ofthe Jin- Yuan) published by the Chinese National Chinese Medicine & Medicinals Publishing House in Beijing.This English version is a collation based on these three editions.Following ancient Chinese tradition,all commentaries and foot- notes added to the original text are printed in ink,while the original text is printed in black.Chapter numbers have been added for the sake ofconvenient reference. In addition,the table ofcontents reflects the title ofthe chapters as they appear in this English text,not as they appear in the source text.Materials within the text in parentheses were made by some previous editor(s).Materials in brackets have been inserted by the present translator to make the meaning more intelli- gible and readily understandable in English while yet preserving some ofthe fla- vor ofthe original for serious scholars. The English language Chinese medical terminology used in this book is based on Nigel Wiseman and Feng Ye’s A Practical Chinese Medical Dictionarypub- lished by Paradigm Publications (Brookline,MA,1998).Divergences from this standard are footnoted the first time they appear.Formulas are identified by their Chinese names in Pinyin romanization followed by my own English language translation in parentheses.Similarly,ingredients in these formulas are identified first in Chinese in Pinyin romanization followed by Latinate pharmacological nomenclature in parentheses.The main sources for the identifications ofthese medicinals in preparing this work were Bensky and Gamble’s Chinese Herbal Medicine: Materia Medica(Eastland Press,Seattle,1993),Hong-yen Hsu’s Oriental Materia Medica: A Concise Guide(Oriental Healing Arts Institute,Long Beach, CA,1986),Stuart and Read’s Chinese Materia Medica(Southern Materials Center, Inc.,Taipei,1979),and Jiangsu New Medical Academy’s Zhong Yao Da Ci Dian (Dictionary ofChinese Medicinals,Shanghai Science & Technology Press,Shanghai, 1991).All Chinese medicinal identifications have been translated into their stan- dard modern Chinese names.Thus Shao Yao has become Bai Shao,Ju Pi has become Chen Pi,Suo Sha Ren has simply become Sha Ren,etc.Acupuncture points are identified first in Chinese in Pinyin romanization followed by stan- dard channel-numeric notation in parentheses.And finally,the 10 heavenly stems and 12 earthly branches are identified in Chinese in Pinyin romanization first followed by an alpha-numeric code in parentheses.Hence (S1) refers to the first heavenly stem,while (B12) refers to the 12thearthly branch.These changes have been made in an attempt to make the text as easily approachable to modern read- ers as possible. Bob Flaws Summer,2004 Book One