The Secret of Medicine Lies in Dosage

As the saying went, the secret of medicine lay in the dosage, which was not passed on.

Almost everyone who studied traditional Chinese medicine had heard that saying.

Yet apparently no one had ever paid it any attention.

As the saying went, without studying the Book of Changes, one could not presume to speak of being an imperial physician.

When it came to prescribing medicine, the dosage required a great deal of care.

This chapter might be a little dry to read. But for enthusiasts of traditional Chinese medicine, it might be a little helpful.

In Systematic Differentiation of Warm Diseases, there was a prescription called the Mass-Resolving Life-Restoring Pill.

Mass-Resolving Life-Restoring Pill prescription

Ginseng (six liang), Annam cinnamon (two liang), Radix Aconiti Agrestis (two liang), musk (two liang), turmeric slices (two liang), cloves (three liang), charred Sichuan pepper (two liang), horseflies (two liang), bur reed rhizome (two liang), charred cattail pollen (one liang), saffron (two liang), sappanwood (three liang), peach kernels (three liang), defatted perilla seed powder (two liang), flying squirrel feces (two liang), Dalbergia wood (two liang), dried lacquer (two liang), angelica root tips (four liang), myrrh (two liang), white peony root (four liang), apricot kernels (three liang), prepared cyperus rhizome (two liang), evodia fruit (two liang), corydalis rhizome (two liang), leeches (two liang), asafoetida (two liang), charred fennel seed (three liang), Sichuan lovage rhizome (two liang), frankincense (two liang), galangal (two liang), charred mugwort (two liang), motherwort extract (eight liang), prepared rehmannia root (four liang), turtle shell gelatin (one jin), rhubarb (eight liang; grind it all into a fine powder, simmer with one and a half jin of high-quality rice vinegar until concentrated, dry in the sun and grind into powder, then add vinegar and simmer again; repeat three times, dry in the sun and grind into powder).

Grind all the ingredients into a fine powder and mix evenly with the three extracts of turtle shell, motherwort and rhubarb. Add refined honey and form into pills weighing one qian and five fen each, sealing them in wax. When taking a pill, dissolve it in warm boiled water and take it on an empty stomach; for severe blood stasis, take it with yellow wine.

-Treats masses that do not disperse and cause no pain.

-Treats masses that flare up and cause severe pain.

-Treats blood impediment.

-Treats cases of dry blood consumption in women that belong to the excess pattern.

-Treats malarial masses accompanied by pain in the left flank, chills and fever.

-Treats pain in women before menstruation, which the ancients called menstrual pain.

-Treats chills and fever in women who are about to menstruate.

-Treats abdominal pain in women who accidentally eat raw or cold foods when about to menstruate.

-Treats absence of menstruation in women.

-Treats menstrual blood that is purple-black, or even forms clots.

-Treats lower back pain caused by stagnant blood from falls and blows.

-Treats postpartum blood stasis with lower abdominal pain that cannot bear pressure.

-Treats those rendered unconscious and near death by falls or blows.

-Treats blade and cudgel wounds accompanied by blood stasis.

This prescription was uncommon. It could even be called a miraculous prescription from Systematic Differentiation of Warm Diseases.

It treated a great many conditions.

One could not say it cured every disease, but it could treat any disease caused by blood stasis.

"The Turtle Shell Decoction Pill from the Golden Cabinet evolved from the Life-Restoring Pill. In this prescription, ginseng, cinnamon, pepper and ginger open and supplement yang Qi; white peony and prepared rehmannia preserve and replenish yin fluids; motherwort extract opens and supplements yin Qi while dispelling water Qi; turtle shell gelatin opens and supplements liver Qi while dispersing abdominal masses. The remaining ingredients are aromatic, entering the collaterals and transforming turbidity. Blood-feeding creatures are also used: those that fly travel through the Qi aspect of the collaterals, while those that crawl travel through the blood aspect. They may be said to leave no minute place unentered and no hardness unbroken. Rhubarb is also simmered three times with vinegar to guide it to the site of illness without harming the other organs. For long-standing illness with hard masses that will not disperse, nothing else will do. Some may fault the prescription for containing too many ingredients, not understanding the way of using medicines: when few are used, or one alone, their force is great and swift; when many are used together, their effects are divided and gradual. All the ancients' prescriptions for gradual resolution followed this principle. As the saying goes, a disciplined army need not fear great numbers; an undisciplined army is chaotic even when small. This prescription contains thirty-six ingredients in all, including vinegar and honey, arriving at the numbers four and nine, the numbers by which metal Qi is generated and completed."

That was a fairly classic explanation of the prescription by Wu Tang.

The final sentence was especially interesting. Wu Tang said the prescription contained thirty-six ingredients, arriving at the numbers four and nine, the numbers by which metal Qi was generated and completed.

Why did Wu Tang say that? To explain it, one had to go back to the roots of traditional culture: the Yellow River Chart and the Luo River Book.

The Yellow River Chart concerned the numbers of the former heaven and governed generation.

The Luo River Book concerned the numbers of the latter heaven and governed killing.

The numbers four and nine Wu Tang spoke of were the numbers of the west on the Yellow River Chart.

As the saying went, heaven's one generated water, and earth's six completed it; earth's two generated fire, and heaven's seven completed it; heaven's three generated wood, and earth's eight completed it; earth's four generated metal, and heaven's nine completed it; earth's five generated earth, and heaven's ten completed it.

The numbers four and nine occupied the west and were both metal numbers. Metal had the power to break things apart, so it could break through Qi and open up blood stasis.

Personally, I felt that Wu Tang had revealed a little of the true essence here, though one could not call it a heavenly secret.

But many people might miss it if they did not pay close attention.

Some might say, "Isn't that nonsense? How could there be any connection?"

I could tell you straight: there had to be a connection! And a very big one at that!

That prescription might have been too unfamiliar to most people.

So let me name one everyone knew.

The Six-Ingredient Rehmannia Pill.

At the mention of it, everyone remembered the advertising slogan.

"Jiuzhitang Six-Ingredient Rehmannia Pills: treat kidney deficiency, with no sugar."

The Six-Ingredient Rehmannia Pill could replenish kidney yin. It was a yin-nourishing prescription for treating kidney yin deficiency.

Originally, the Six-Ingredient Rehmannia Pill was a pediatric medicine, used mainly to treat delayed development in children.

The medicine did indeed have the effect of replenishing essence and filling the marrow.

But why did it have six ingredients?

Because heaven's one generated water, and earth's six completed it.

Traditional Chinese medicine held that, among the five elements, the kidneys belonged to water.

Thus, six ingredients were used to correspond to the kidneys and replenish them, achieving twice the result with half the effort.

Moreover, the Six-Ingredient Rehmannia Pill was taken with lightly salted water. The kidneys belonged to water, and their associated flavor was salty. Taking it with salt water therefore achieved twice the result with half the effort.

Then there was Cui's Eight-Ingredient Pill, recorded in Zhongjing's writings and used to replenish kidney Qi.

The Eight-Ingredient Kidney Qi Pill was what people later commonly called the Cinnamon and Aconite Rehmannia Pill.

It was made by adding cinnamon and aconite to the Six-Ingredient Rehmannia Pill.

Both ingredients were pungent and hot.

In this way, the prescription went from six ingredients to eight.

Its medicinal nature changed completely: what had originally nourished kidney yin became a medicine that assisted kidney Qi.

Why?

Because heaven's three generated wood, and earth's eight completed it.

Eight was the number of wood, and wood was said to bend and straighten.

Luxuriant trees and plants represented abundant yang Qi.

Thus, eight ingredients were used to assist kidney Qi.

Now, turning back to the Kidney Qi Pill, how was it taken?

It was taken with clear wine.

Wine was pungent and could greatly increase the body's yang Qi. Using it this way achieved twice the result with half the effort.

With that said, we could explain the prescriptions in the Treatise on Cold Damage.

Take the Cinnamon Twig Decoction and the Ephedra Decoction, for example. Why did the Cinnamon Twig Decoction use three liang of cinnamon twig, and the Ephedra Decoction three liang of ephedra?

Three liang: three was the number of wood.

These sweat-inducing medicines worked by raising yang Qi and opening the Qi channels blocked by the pathogenic influence of wind-cold. Thus, three represented the position and numerical principle for raising yang Qi.

Three was wood, and among heaven and earth, wood had another attribute: wind. It therefore also corresponded to the pathogenic influence of wind-cold.

There was also a modern school called the Three Liang Three Medical School. Many of its medicinal dosages were three liang and three qian.

At this point, some people might argue, "That's not right. If I get some gypsum and use three liang, can you make it induce sweating? Drive out wind? Or if I get three liang of ice, can you make it induce sweating?"

That brought us back to the nature of medicines.

The numerical principles discussed above had to be based on the nature of the medicine.

The rules of numbers and the laws governing their operation could only be applied on a basis that already conformed more closely to the rules.

To give a rather imperfect example:

Suppose I had a particularly good recipe for hot pot base and told you its proportions.

Then you made it too, only to come back and say, "Your dumbass hot pot base is garbage."

Why did you say that?

Because I discovered that when we cooked hot pot, we cooked meat and vegetables, but you used it to cook shit.

Whether my base was good or bad, at the very least what you cooked in it had to be edible, didn't it? Weren't you being a little unreasonable, judging the quality of a seasoning by using something inedible?

By the same principle, if you wanted to induce sweating, you had to use a sweat-inducing medicine. All I was saying was that, with such a medicine, three liang was just the right amount, producing twice the result with half the effort.

I was not saying that you could take three liang of just anything and make someone sweat.

All right, back to the subject.

In ancient times, there were actually many such prescriptions and methods, but everyone understood them without speaking and left them unmentioned.

It was just like today's traditional Chinese medicine detractors, who always said its methods were not standardized, varied too much and could not be unified.

But that was not true. Our prescriptions also had strict dosage requirements, and we naturally had our own rules. Otherwise, how could we prescribe three or five liang on a whim?

It was just that our rules were not recognized by modern science. Perhaps one day our culture would truly flourish, and our rules would become standards too.

Writing this, I suddenly remembered a passage.

The July 2003 issue of China Geography published another article by Zhu Tong and Zhu Shizhong, with the striking headline "Traditional Chinese Medicine-A Civilization Being Lost." It featured a large color photograph of Cheng Xinnong, an eighty-two-year-old traditional Chinese physician with a full head of white hair, holding a silver needle. Beneath it was this passage: "Beneath the halo of science, people cannot sense its existence. In people's minds, it is far removed from human reason. For a hundred years, through wind and rain, it has stood silently yet aloof above the human world. But suddenly it appears beside us again, and as we quietly and deeply experience it, we discover that, deep in our souls and blood, our very lifeblood is connected to it. It is traditional Chinese medicine! A great civilization that may soon be lost from our hands, leaving perhaps only a beautiful empty shell for those who come after us."

Whenever I read that passage in the middle of the night, I wanted to cry. Perhaps only those who truly loved traditional culture, or those who worked in traditional industries, could understand that feeling.

The China Journal of Traditional Chinese Medicine once published a report about a traditional Chinese medicine delegation from Europe. After touring China, its members offered this reflection: the whole world needs traditional Chinese medicine, but it does not need "Westernized" traditional Chinese medicine!

In recent years, with the development of the media, the blending and collision of traditional Chinese and Western medicine had attracted increasing attention.

In a society where Western medicine held the dominant position, traditional Chinese medicine had also begun a gradual revival.

Yet even so, detractors of traditional Chinese medicine kept appearing online. Some might have been acting for profit, while others might simply have been doing it for fun.

But no matter what, I hoped traditional Chinese medicine would only get better.