1 Essential Prescriptions of the Golden CabinetJin Gui Yao Lue - 金匱要略 Essential Prescriptions of the Golden Cabinet
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3 Introduction Together with the Shang Han Lun (On Cold Damage-傷 寒論) and Jin Gui Yao Lue (Essential Prescriptions of the Golden Cabinet-金櫃要略) is widely studied and used by Chinese Medicine practitioners. As the earliest extant classics on medicinal formulas, they were originally rendered as a single text of sixteen scrolls called the Shang Han Za Bing Lun (On Cold Damage and Miscellaneous Diseases傷寒雜病論) by Zhang Ji (Zhang Zhong- Jing 張仲景) during the Eastern Han period, around the second century CE.
4 Introduction Zhang integrated these two relatively new theories of systematic correspondence laid down in the “Huang Di Nei Jing” and the “Nan Jing”. By combining theoretical etiologies with detailed diagnosis and treatment. The Jin Gui Yao Lue covers diseases other than external contractions, including lung diseases, water swelling, phlegm diseases, dispersion-thirst, impediment (Bi Syndrome), summer stroke, mounting diseases, and gynecological disorders.
5 Introduction As the title suggests, “Shang Han Lun” discusses the diagnosis and treatment of cold damage conditions, which are conditions related to external contraction, especially of wind and cold. “Jin Gui Yao Lue” is thought to reflect that section of the original “Shang Han Za Bing Lun” that was called “miscellaneous diseases”, basically a catch-all phrase for any conditions which could not be traced to externally contracted evils.
6 Jin Gui Yao Lue (Essential Prescriptions and Discussion from the Golden Cabinet)1. it’s an indication of the value that the author placed on the book’s content. It refer to a cabinet-like storage box made of gold, hence a place where to store the most valuable items. 2. the text is characterized as containing both “prescriptions” and “discussions”, or same as “clinical” and “theoretical” information. This book includes detailed diagnostic guidelines and etiological reasoning in addition to instructions for the treatment primary with medicinal formulas.
7 Textual History This import text was lost in the war –related upheavals that accompanied the collapse of the Han dynasty. In the following Western Jin period, Wang Shu-He 王 叔和( CE), who also left a mark in the history of Chinese medicine as the compiler of the Mai Jing (The pulse Canon-脈經), collected the Zhang’s work and arrange them into two separate books: the Shan Han Lun in ten scrolls, and another text on “miscellaneous diseases” in six scrolls, which is known as the “Jin Gui Yao Lue”.
8 Textual History Song Imperial court in the11th century form a large editorial team to collate, annotate and reissue in woodblock print. They recreate the Jin Gui Yao Lue on the basis of quotation found in other medical classics like the Mai Jing (pause Canon-脈經); Zhu Bing Yuan Hou Lun ( Origin and Indictors of Disease-諸病源侯論 ) and Qian Jin Fang (Thousand Gold Pieces Prescriptions- 千金方) as well as Jin Gui Yu Han Yao Lue Fang( Essential Prescriptions from the Golden Cabinet and Jade Sheath-金櫃玉函要略方). The Song editors matched the prescription with the descriptions of symptoms, arranged the text by disease categories into 25 chapters in three parts. The Song revision has been the standard version of the text ever since.
9 Author Zhang Zhong-Jing 張仲景Zhang Ji or Zhang Zhong Jing, lived during the Eastern Han Dynasty (150 to 219 CE). Born in Nan Yang 南陽 in He-Nan Province 河南 As losing two thirds of his family in less than 10 years, most of them due to externally contracted diseases, motivated him to immerse himself in the medical literature available at the time and collect the most efficacious treatments he could find into the work he titled Shang Han Za Bing Lun (On Cold Damage and Miscellaneous Diseases傷寒雜病論). While he knew that his book will assist reader to discerning the origins of disease.
10 Descriptions and Outline of the TextConsists of 25 chapters that deal with various conditions of internal medicine, but also contains sections on gynecology, some external medicine, emergency treatments and advice on the prevention.
11 1st Chapter It serves as a preface, presenting Zhang Zhong-Jing’s general guidelines on diagnosis, treatment and prevention. It emphasizes the cosmic interrelations between cycles inside and out side the human body in accordance with 5 phase correspondences through the vehicle of Qi. It define health as the result of a free flow of internal Qi in the five viscera, and disease as a state of disharmony or lack of flow, cause by an invasion of external evil Qi, mostly notably abnormal climatic influences. As a result, prevention is primarily the recommended curse of action for a life free from disease.
12 1st Chapter Next, the preface offers basic diagnostic rules to predict the course of the disease, related to the inspection of the face, quality of the voice and breath, and the nature of the pulse. The chapter concludes by describing a number of disease patterns and pathomechanisms to demonstrate general rules in the progression of disease, related to Yin and Yang, the difference between internal and external and chronic and sudden conditions, the type of invading evil, and which viscera or bowel maybe affected first.
13 General Rules the following chapters each discuss a disease or category of diseases in terms of causes, main symptoms and pulses, pattern identification, treatment principles, and prognosis, with occasional reference to adverse or contraindicated treatments or transmuted variations or stage of the disease covered in that chapter.
14 Chapter 1 Pulses, Signs, and Sequence of Bowel and Viscera, and Channel and Collateral Disease
15 Pulses, Signs, and Sequence of Bowel and Viscera, and Channel and Collateral Disease
16 Overview Pathological passage and transmutation of diseases involving the bowels and viscera, and of the channels and collaterals. The pulses and signs by which these conditions are identified are discussed here along with the sequence in which they occur.
17 Overview Holistic interdependence between the body and the outside environment, as well the interrelationships of the viscera and bowels, and channels and collaterals within human body. “Prevention” 上工治未病 “Superior practitioners treat diseases before they arise”
18 Question (Q):” Superior practitioners treat diseases before they ariseAnswer (A): Treating a disease before it arises means that when one sees a Liver condition, for example, one knows that the LIV condition will pass to the SP and that the SP must first be firmed. Ordinary practitioners do not know about the progression of disease. When they see the LIV condition, they do not understand the need to firm the SP and they simply treat the LIV.
19 Tx method for Liver deficiency:“For Liver conditions, supplement with sourness. Assist with burnt or bitter flavors, and benefit and regulate with sweet-flavored medicinals.” Tx method for Liver deficiency: Sourness enters the LIV, so LIV deficiency should be supplemented with sour flavors. Burnt and bitter flavors enter the HT; the HT and LIV stand in a mother-son relationship. Sweet flavors act to fortify the SP and harmonize the Middle Jiao.
20 Sour, sweet, burnt and bitter flavors can be applied “Treating the Liver through supplementation of the Spleen (for deficiency only).” Sour, sweet, burnt and bitter flavors can be applied in the Tx of LIV deficiency. LIV Yin deficiency: Bai Shao, Wu Wei Zi, Suan Zao Ren and Shan Zhu Yu Nourish HT Blood: Dan Shen, Dang Gui and Di Huang Boost SP Qi: Zhi Gan Cao, Bai Zhu and Da Burnt: stir-fried (Suan Zao Ren, Dang Gui, Bai Zhu)
21 “Do not drain deficiency or replenish excess“Do not drain deficiency or replenish excess. Supplement the insufficiency and reduce the super-abundance.” Insufficiency should be treated with supplementation, and excess should be treated with drainage. Xiao Yao San (sooth Qi and nourish SP) Bai Zhu, Zhi Gan Cao
22 Three positions of examination:“The movement of the pulse at the inch opening should manifest in accordance with the effulgent time period of the viscera.” Exclusive examination of the inch opening: includes inch, bar and cubit pulse of the wrist. Three positions of examination: Wrist pulse FayYang (ST42) pulse ShaoYin (KD3) pulse
23 “The color of Liver effulgence is green-blue, and each of the four seasons also has a corresponding color. When the associated color of the Liver is supposed to be green-blue, but it is white instead, this is not the correct color; nor does the pulse reflect the corresponding time.” Corresponding color: Spring is associated with a green-blue color Summer is associated with red Autumn is associated with white Winter is associated with black Corresponding time: the Liver is effulgent in the Spring, its corresponding facial complexion is green- blue, and the pulse is wiry.
24 Corresponding time & color:HT: summer/red, and the pulse is surging. LU: autumn/ white, and the pulse is floating. KD: winter/black, and the pulse is sunken. In the winter, for example, if someone has a red facial complexion and a rapid pulse, the color and pulse image do not match with the seasonal correspondences. This indicates an unfavorable health condition.
25 “The pulses at the inch opening are sunken, large and slippery“The pulses at the inch opening are sunken, large and slippery. Sunken reflects excess, and slippery reflects Qi; the excess contents with Qi. Blood and Qi entering the viscera will result in death, and entering the bowels will result in resolution. This is called sudden reversal.” The inch opening reflects the condition of the HT and LU. The sunken quality reflects HT blood excess. The large and slippery qualities reflect LU Qi congestion. When excess Qi & Blood combine internally, normal circulation becomes chaotic and sudden reversal may result.
26 Huang Di Nei Jing Su Wen (The Yellow Emperor's Inner Classic: Basic Questions) “Blood and Qi moving to the upper together, resulting in great reversal.” Text note: Pulse diagnosis should be combined with the “Four Diagnoses Method”. It is common in Zhang ZhongJing’s book to describe and explain the character of disease by using pulse diagnosis.
27 “A patient with a floating pulse in the front position indicates disease of the exterior.”Floating inch pulses reflect upright Qi deficiency with an externally-contracted disease, and also that the upright Qi is contending with the evil. Floating pulses at the cubit position also reflect an insufficiency of KD yin which results in deficient yang floating upward.
28 “A floating quality in the rear indicates disease of the interior that manifests with lumbar pain, back rigidity, and an inability to walk. There will be shortness of breath and exhaustion.” The cubit pulse reflects the state of the KD, which stores essence and governs bones. KD deficiency with failure to nourish essence and marrow manifests with lumbar pain, back rigidity and withering of the feet. The KD also governs Qi absorption; severe KD deficiency leads to shortness of breath and rapid breathing at the slightest exertion, referred to here as “exhaustion.”
29 DUAL DISEASE OF THE EXTERIOR AND INTERIOR(Q)“Among diseases there are those which require urgent rescue of the interior and those which require urgent rescue of the exterior. What does this mean?”
30 DUAL DISEASE OF THE EXTERIOR AND INTERIOR(A) For diseases that follow purgation where incessant clear-food diarrhea and generalized pain occur, urgently rescue the interior. For diseases that follow treatment with generalized pain and regular elimination, urgently rescue the exterior.” In conditions involving both the interior and exterior, the priority of Tx is to treat the exterior first in order to prevent the condition from entering internally.
31 DUAL DISEASE OF THE EXTERIOR AND INTERIORIf purgation is applied improperly when the condition is exterior, or even when it is both exterior and interior, middle yang can become damaged and incessant clear- food diarrhea will appear. In this case, even though exterior signs may be present, treating the interior pattern is most important. After the interior has been treated and both urination and defecation have returned to normal, then the exterior pattern can be addressed.
32 INTRACTABLE DISEASE AND SUDDEN ONSET“For intractable diseases accompanied by a sudden illness, one should primarily treat the sudden illness, then the intractable disease.” The principle of priority Tx for chronic diseases when complicated by the sudden onset of a new condition.
33 INTRACTABLE DISEASE AND SUDDEN ONSETIf chronic and new diseases are simultaneously present, the more acute condition should be treated first. In this case, the manifestations of the chronic condition seem to be less severe than those of the recently acquired disease, so the new condition is the priority of Tx. In many cases, a new condition is easier to resolve because it has not yet fully developed, whereas chronic diseases are more deeply rooted in the body and so take a longer period of time to cure.
34 INCLINATIONS AND AVERSIONSDiseases of the five viscera can be cured by their appropriate correspondences. Diseases of the five viscera have their own aversions; each follows their corresponding disinclinations and so become affected.
35 INCLINATIONS AND AVERSIONSHT favors bitterness, LU favors acridity, LIV favors sourness, SP favors sweetness, and KD favors saltiness. When the viscera receive these beneficial flavors, their associated conditions also improve. The five viscera also have corresponding aversions that can result in disease. HT is averse to heat, LU is averse to coldness, SP is averse to dampness, LIV is averse to wind, and KD is averse to dryness.
36 Principles of Treatment as Associated with Causative Factors“For all diseases of the viscera, when attacking, attack according to their reliance. If there is thirst, apply Zhu Ling Tang (Polyporus Decoction). This principle can be applied to other diseases.” Understanding the etiology of the disease is essential for correct diagnosis and treatment. All internal diseases are associated with pathological substances within the body such as fluids, static blood, phlegm, or abiding foods. In this case, the sign of thirst is attributed to heat binding with water, constraint heat damaging yin, and fluids failing to move upwards.
37 Principles of Treatment as Associated with Causative Factors.Zhu Ling Tang: Clear heat, foster yin, and dis-inhibit water As the internal heat is drained through urination, the excessive thirst will also resolve Another example: Internal heat binding with abiding food can be treated with Da Cheng Qi Tang, which acts to drain heat and also disperse binding.
38 SUMMARY Holistic Prevention Diagnosis 4 Dx Method Treatment8 Principle