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Suwen 14, Treatise on Fermented Medicinal Brews

黃帝內經素問

《湯液醪醴論篇第十四》

Plain Questions, Chapter 14

Treatise on Decoctions and Medicinal Liquors

 

Note: This translation is a draft version, prepared by Sabine Wilms for the purpose of teaching this chapter in the Classical Texts series at the School of Classical Chinese Medicine, National College of Natural Medicine. It is currently being taught by Long Rihui and Sabine Wilms. Please do not cite or share this translation without expressed written permission by Dr. Wilms, since it is just a draft.

SECTION ONE

(一)黃帝問曰︰為五穀湯液及醪醴奈何?

(二)岐伯對曰︰必以稻米,炊之稻薪,稻米者完,稻薪者堅。

(三)帝曰︰何以然?

(四)岐伯曰︰此得天地之和,高下之宜,故能至完,伐取得時,故能至堅也。

1) The Yellow Emperor asked: “How do you make fermented medicinal brews out of the Five Grains?”

2) Qí Bó answered: “You must use rice and cook it over a fire made with rice stalks as fuel, with the rice grains being complete and the rice stalks being firm.”

3) The Emperor said: “Why is that so?”

4) Qí Bó said: “The reason for this is as follows: Because [the grains] have obtained the harmony of Heaven and Earth and the appropriate measure of above and below, they have been able to reach completion. Because the cutting and harvesting [of the stalks] was done after giving them the necessary time to grow, they have been able to reach firmness.”

Notes

·       五穀: The “five grains” is a standard expression to refer to all varieties of grains, but specifically to barley, rice, glutinous and non-glutinous millet, and sesame or soybean (or sometimes sorghum, depending on the author or commentator). The Five Grains are associated with the Five Phases 五行 and thereby nurture the Five Zàng Organs. According to Zhang Zhicong, it is significant that Qí Bó responds by emphasizing the need for liquor that is made out of rice, the grain that is associated with the center, which is hence able to irrigate and nurture all the other organs in the body.

·       According to most commentators, the phrase 湯液及醪醴 (lit. “soup decoctions and fluids and unstrained and strained ales”) refers to two types of fermented medicinal brews, namely clear liquors and richer and sweeter yale- or mead-like brews, in other words to all varieties of fermented medicinal wines.

·       I have chosen to translate the phrase得天地之和,高下之宜 literally as “obtained the harmony of Heaven and Earth and the appropriate measure of above and below,” to preserve the wide range of possible readings in the original. Most likely, “harmony of Heaven and Earth” refers to the fact that the rice must have experienced a perfect balance of the four seasons and fluctuations of yin and yang throughout the year (birth/sprouting in spring, growth in summer, harvest in fall, and storage in winter) in order to form complete grains, which are therefore imbued with this balance. The “appropriate measure of above and below” may refer to the fact that rice is a grain that must be grown at mid-level elevations that are neither too high nor too low.

·       Zhang Zhicong points out that in comparison to the previous chapter, which talked about engendering shén qì 神氣 by means of pre-natal essence 先天之精, in order to connect this shén qì to Heaven, the present chapter also discusses essence qì 精氣, but from the perspective of Later Heaven, via enrichment through Later Heaven water and grains. The liquids derived from the Five Grains nurture the qì, which in turn allows for the spontaneous generation of the shén.

 

SECTION TWO

(一)帝曰︰上古聖人作湯液醪醴,為而不用何也?

(二)岐伯曰︰自古聖人之作湯液醪醴者,以為備耳。夫上古作湯液,故為而弗服也。中古之世,道德稍衰,邪氣時至,服之萬全。

(三)帝曰︰今之世不必已何也?

(四)岐伯曰︰當今之世,必齊毒藥攻其中,鑱石針艾治其外也。

1) The Emperor said: “The sages in ancient antiquity made fermented medicinal brews and yet they did not use them. Why is that?”

2) Qí Bó said: “The reason why from ancient times the sages made fermented medicinal brews was as a precaution, and nothing else. Thus in ancient antiquity [the sages] did make these liquors and yet they did not ingest them. In the age of mid-antiquity, [people’s] inherent power () as a manifestation of their Dào had gradually declined and evil qì reached them from time to time. When they did ingest [the medicinal brews in cases of harm from evil qì], they were a hundred percent effective.”

3) The Emperor said: “Why is it that this is no longer invariably the case in our current age?”

4) Qí Bó said: “The reason for this that in our current age, we must line up toxic medicinals, to attack the patient’s center, and apply lancing stones, needles, and moxa, to treat their outside.”

Notes

·       The ancient sages are said to have been able to keep their true nature (or spirit) complete and therefore had no need to take medicinal brews. They merely prepared these decoctions as a precaution, in case evil qì should penetrate into their body and cause harm, but never had a need to actually use them.

·       In mid-antiquity, by contrast, people’s (“virtue” or “inherent power” that is the outward manifestation of being aligned with the Dào of the universe, if you have to translate this concept) had declined to the point where external evils might be able to do harm to the body but their jīng shén 精神 was still so strong and healthy that the medicinal brews were always effective.

·       不必已: I have translated 必 as most people do, as “invariably” or “must.” It is, however, also possible to read it in the rarely occurring earlier sense as a post that delineates the border of a territory. In that sense, the phrase could here mean that people “fail to delineate [and protect] the border of the territory” of their body, and thereby allow evil to invade.”

·       : This character poses a problem here. Zhang Zhicong reads it as 疾 “to get hit by disease,” but does not offer an explanation for this reading. Zhang Jiebin suggests a meaning of 劑 “medicinal preparation” instead. Others suggest reading 必 “must” here as 火 “fire,” based on the similarity in the early forms of these characters, emphasizing the parallelism between the two phrases 必齊毒藥 (which would then be “fire preparations and toxic medicinals”), to attack the center, and 鑱石針艾 (“lancing stones, needles, and moxa”), to treat the outside. Nevertheless, this parallelism can still exist when we read 必 as “invariably” and 齊 as “prepare” (劑) or “get hit by disease” (疾). I personally like to think of 齊 more in terms of its etymological origin, as perfectly lined up ears of grain of proper proportions, so perhaps in the sense of composing balanced formulas from toxic drugs.

·       毒藥: The notion of “toxic medicinals” is perhaps best understood by referencing the use of 毒 “toxicity” in the Divine Farmer’s Classic of Materia Medica  神農本草經: As the Preface explains, all substances in the book are classified as either toxic or not. The substances in the highest category of medicinals, associated with Heaven, are non-toxic and can be taken for extended periods of time, nurture the mìng 命 “destiny” , and are used to lighten the body, boost qì, and promote longevity or even immortality. Substances in the middle and lower categories are mostly classified as “toxic,” are associated with Humanity and Earth, and are in charge of supplementing the body, treating weakness and vacuity, and expelling disease. Based on this usage, it seems more appropriate to think of the concept of 毒 (“toxicity”) as “effective” from the perspective of a modern biomedical treatment of symptoms, or as “imbalanced” and hence in need of being given only for short periods of time to counteract conditions of extreme physical imbalance, under careful supervision of a skilled physician, and paired with other substances to balance out their aggressive actions.

 

SECTION THREE

(一)帝曰︰形弊血盡而功不立者何?

(二)岐伯曰︰神不使也。

(三)帝曰︰何謂神不使?

(四)岐伯曰︰針石,道也。精神不進,志意不治,故病不可愈。今精壞神去,榮衛不可複收。

(五)何者?嗜欲無窮,而憂患不止,精氣弛壞,榮泣衛除,故神去之而病不愈也。

1) The Emperor said: “Why is it that the physical body is ruined and the blood all used up and that success cannot be established?”

2) Qí Bó said: “It is because the spirit is failing to act as a messenger.”

3) The Emperor said:  “What do you mean by ‘the spirit is failing to act as a messenger’?”

4) Qí Bó said: “Needles and stones are [only] the path. Because the jīngshén fails to go forth and the will and intention are not well-ordered, the disease cannot be cured. In the present case, the jīng essence is ruined and the shén spirit has left, and yíng provisioning and wèi defense cannot be restored [to their healthy state].

5) Why is this? Cravings and desires are boundless, and worries and troubles do not stop. The essence qì becomes slack and ruined, yíng provisioning is trickling and wèi defense lost. For this reason, the spirit leaves the patient and the diseases cannot be cured.”

Notes

·       神不使也: According to Zhang Jiebin, “attacking the evil lies in the hands of needles and medicinals, but moving the medicinals lies in the hands of the shénqì 神氣. Thus you may apply treatment on the outside, but the spirit has to respond on the inside and “act as a messenger” to deliver the medicinals up or down.” When a condition is so advanced that the patient’s spirit is already gone, no treatment, whether with needles and stones or with medicinals, can do anything.

·       As Zhang Zhicong explains, qì is engendered by essence, and this qì in turn then transform the subtle essences from “water and grain” (i.e., food and drink) to produce yíng and wèi (provisioning and defense). Boundless desires ruin the essence, whileincessant worrying damages the qì. Spirit shén has two aspects: the Earlier Heaven shén is engendered by essence and qì, while the Later Heaven shén is the one that is engendered by “water and grain” and by yíng and wèi.

·       róng and 營 yíng are common synonyms. I have used the pronunciation yíng in my translation above because that is the pinyin pronunciation that is most familiar to contemporary practitioners of Chinese medicine. A more modern rendering would be “nutritive” or “constructive” [qì].

·       泣: Literally, “to shed tears,” it could here mean either that the flow of yíng qì has been reduced to a trickle, like a drop of tears here and there, or that it is halting 澀, which is another reading of 泣. Either way, themeaning is clear.

 

SECTION FOUR

(一)帝曰︰夫病之始生也,極微極精,必先入結於皮膚。

(二)今良工皆稱曰︰病成名曰逆,則針石不能治,良藥不能及也。

(三)今良工皆得其法,守其數,親戚兄弟遠近音聲日聞於耳,五色日見於目,而病不愈者,亦何暇不早乎?

(四)岐伯曰︰病為本,工為標,標本不得,邪氣不服,此之謂也。

1) The Emperor said: “Now when a disease is in the initial stage of being formed, it is extremely minute and extremely subtle, and invariably first enters through and binds in the skin.

2)  The excellent physicians of today all say that a disease that has matured is called a bad prognosis. This is because in such cases needles and lancing stones are unable to restore good order and even excellent medicinals are unable to reach it.

3) The excellent physicians of today all possess their set procedures and abide by their computations. [In addition,] close relatives and siblings distant and close daily listen to the [patient’s] sounds with their ears and observe [the patient’s] five colors with their eyes. And yet the disease is not cured. Is this also [a case where one should ask] why did people stand by in idleness and fail to interfere early enough?”

4) Qí Bó said: “The disease is the trunk [of the tree], the physician is the tip of a twig. The tip of the twig and the trunk do not match, and evil qì does not surrender. This is what I am talking about.”

Notes

·       五色: The “five colors” here refers to the variation in the patient’s complexion, especially in the face, which is one of the key diagnostic indicators in the Nèijīng since a physician skilled in facial diagnosis can clearly read the internal progression of illness in the patient by its reflection in the change of skin color in the face.

·       In Line Four, 病 “disease” can be read literally, as I have done, or can be read as 病者 “the patient.” According to Dr. Long, this line emphasizes the need to tailor treatment carefully to the specific situation at hand. In contrast to biomedical intervention where an active drug or surgery is performed on a passive body with no or little power of its own, this line emphasizes the key idea in Chinese medicine that healing is always a process where the patient is in the driver’s seat. The physician’s role is merely to help the patient tap into her or his body’s inherent healing powers and resurrect the right qì 正氣.

·       While Qí Bó’s response in Line Four might seem a bit out of place and not directly answering to the Yellow Emperor’s sincere inquiry, the metaphor of the trunk and the tip of the twig is in fact quite insightful. My reading of it is that the trunk is the foundation, the core element in this situation, while the physician, regardless of her or his level of skill, training, experience, and attentiveness to the patient, is only the tip of an outlying branch, in other words a very insignificant part of the whole tree. You can have the most beautiful resplendent flower or fruit at the end of a branch but if you cut the trunk or there is rot in the trunk, the tree will die.

 

SECTION FIVE

(一)帝曰︰其有不從毫毛而生,五臟陽以竭也,津液充郭,其魄獨居,精孤於內,氣耗於外,形不可與衣相保,此四極急而動中,是氣拒於內,而形施於外,治之奈何?

(二)岐伯曰︰平治於權衡,去宛陳 ,微動四極,溫衣,繆刺其處,以複其形。

(三)開鬼門,潔淨府,精以時服,五陽已布,疏滌五臟,故精自生,形自盛,骨肉相保,巨氣乃平。

(四)帝曰︰善。

1) The Emperor said: “Concerning your statement above, there are also diseases that do not sprout forth from [the location of] the finest body hairs but are a case of yáng in the five zàng organs becoming exhausted. [As a result] fluids fill up the [body’s] outer ramparts, the patient’s pò soul subsists on its own, and the essence is orphaned on the inside while the qì is exhausted on the outside. The outer body and the clothes are unable to hold on to each other. This results in tension in the four extremities and stirring in the center. This means that qì is pushing out from the inside and that the body is altered on the outside. How do you go about treating [this condition]?”

2) Qí Bó said: “Restore balance and order by means of balance beam and weights, get rid of what is entangled and stale, and make the patient slightly move the four extremities and dress warmly. Needle the affected locations by the crosswise needling technique, and thereby restore the patient’s outer form.

3) Open the ghost gates and rinse the Pure Palace, and essence will recover in due time. When the five yáng are distributed throughout, open up and cleanse the five zàng organs. As a result, essence will sprout spontaneously, the physical body will spontaneously flourish again, and the bones and flesh will hold on to each other. The immense qì will return to a state of balance.”

4) The Emperor said: “Good!”

Notes

·       The “finest body hairs” here refers to the statement above in Section Four that disease invariably enters through the outer layer of the skin. This whole section thus discusses conditions that are not caused by external invasion but by internal causes, specifically the fluid metabolism.

·       郭: I have chosen to translate this character literally as the “outer rampart,” i.e., the outermost ring of protective barriers around a city and its suburbs (as opposed to 城, which refers to the walls around the inner city). According to Dr. Long, this term should here be read in the sense of the large cavities in the body, i.e. the chest and abdomen, which serve as the protective walls around the internal organs. Alternatively, it is possible to read it as referring to the outermost layer of defense in the body, or in other words the exterior layer, as in the case of superficial edema. Either reading is possible.

·       soul: The specific meaning of this term here is still disputed. One possibility is that it refers to the yīn essence, which depends on the presence of yang to transform qì and move water. In the present case, yáng is exhausted, and bodily fluids accumulate instead of being distributed throughout the body and eliminated through sweating and urination. As an alternative, Dr. Long advocates to read it here as referring to the physical body or even the limbs. In this case, this line would point towards external edema with swelling happening in the limbs and outer layers of the skin, instead of inside.

·       形不可與衣相保: I have translated this line very literally but awkwardly as “the outer body and the clothes are unable to hold on to each other.” What does this mean? Dr. Long suggests to interpret it as describing a body that has gained so much weight from edema and is so swollen that the normal clothes no longer fit the patient. Alternately, it could mean that the yang qi is so weakened that clothes can no longer protect and keep the body warm.

·       四極急 “tension in the four extremities”: I have again left this difficult phrase literal, to allow the reader to make their own choice. Most commentators agree that “four extremities” here refers to the four limbs, or even the hands and feet. The character 急 can be read either as “hectic,” i.e. here possibly describing hectic motions in the hands and feet, or as “tense” due to the edema, or in other words, as discomfort from taut skin, especially in the lower extremities. This is the reading preferred by Dr. Long, which also makes more sense to me, and fits well with the clinical picture described here.

·       施: This character is often read here as a textual error and mostly interpreted as meaning either 易 (“altered”) or 弛 (“flaccid”).

·       繆刺 “crosswise needling” refers to a needling technique where the doctor chooses points primarily on the network vessels that are located opposite of the affected location in the body. In the present case, as if often the case with this technique, the aim is to bleed the patient, to get rid of the pathological fluid that is trapped in the body. While some people translated “crosswise” as “contralateral,” it is important to note that you also needle the top to treat the bottom, and bottom to treat the top, not just the right side to treat the left, and left side to treat the right.

·       鬼門 “ghost gates” here most likely refers to the hair pores, which are controlled by the lung and through which the wèi (defense) qi is being distributed. Here, “opening the ghost gates” means to induce sweating, as one way of getting rid of the excess fluids in the body.

·       淨府 “pure palace” here refers to the urinary bladder. Thus the text tells you to promote urination by means of diuretics.

·       巨氣 “immense qì”: This phrase can be read as referring either to the great qì of the healthy physiological body, or as the xieqi, here water qi in particular, that became immense and therefore severely imbalance due to the deficiency of right qì.