SUN SIMIAO

Autore della prima Enciclopedia Cinese per la Pratica Clinica

by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon

Sun Simiao is one of the most, if not the most, interesting figures in the history of Chinese medicine. It is not too difficult to support this judgment, even though biographical details of this Tang physician are only fragmentary. In his lifetime, Sun Simiao was a famous clinician and alchemist; to posterity, he left voluminous formularies that have been influential until the present.

- Paul Unschuld, 2000

Medicine in China: Historical Artifacts and Images

Sun Simiao was born in the 6th Century, around 581 A.D., at the beginning of the short-lived Sui Dynasty (581-618 A.D.) and just prior to the unification of north and south China (589 A.D.). He carried out his medical work and writing during the Tang Dynasty (618-907 A.D.) and died in 682 A.D., having completed two 30-volume works on medical practice that would establish his place as a central figure in the field of herbal medicine.

Sun Simiao has been worshipped as the "Medicine God" (actually, the Medicine Buddha, a deity invoked during healing practices) or, more commonly, as the "King of Medicine" (yaowang; referring to herb medicines, yao). During the Ming Dynasty, in 1527 A.D., eight stone tablets engraved with quotations from his works were erected in his birthplace (Huayuan, in Yaoxian County, Shanxi Province) and to this day there are activities each year in his hometown celebrating his memory. In Beijing, a Temple to the King of Medicine was constructed; another temple to Sun Simiao was built in Kiangxi.

His life story is relayed in numerous modern texts (2, 5, 6) and articles (1), with the primary facts derived from the Tang Dynasty history by Wei Zheng and its retellings and embellishments that have survived to the present. Portions of his works have been translated to English (see Appendix 1 for samples), including an entire work on Daoist alchemical longevity prescriptions (11). Catherine Despeux, professor at the National Institute of Oriental Language and Civilization in Paris, has translated portions of his books on acupuncture and Taoism into French. Paul Unschuld, head of the Institute for the History of Medicine at Munich University, devoted considerable attention to Sun's position on medical ethics (3) and the iconography of Sun's legend (16; see Figures 1-4).

It is said that Sun studied very hard and mastered various Chinese classics by the age of 20. He had been sickly as a child and took up medicine as an adult, strengthening his own health (though still suffering various ailments), treating relatives and neighbors, and then practicing in the countryside of Huguan, not far from the capital city of Chang'an. He traveled great distances, perhaps as far as Sichuan province, to learn about useful prescriptions. After gaining a great reputation and completing his first book, he lived mostly in seclusion on Wubai Mountain (later to be known as Medicine King Mountain, Yaowang Shan), where he followed Taoist principles (Taoism was strongly supported during the Tang Dynasty) and integrated them with Buddhism and Confucianism. Noblemen would come to him to learn from his vast knowledge and experience. A cave where Sun lived in Taoist retreat and received such visitors has long been the destination of pilgrims; a pool where he is said to have washed herbs is located nearby.

Sun refused at least three official court positions offered to him: by the Emperor Wendi of the Sui Dynasty and by the Emperors Taizong and Gaozong of the Tang Dynasty. He preferred to provide treatment for ordinary people in the rural setting, though he accompanied Emperor Gaozong for a time. His medical orientation was described in an official history of the Tang Dynasty, as relayed by Paul Unschuld (3): "His biography describes him as an extraordinarily talented man, who devoted himself to the teachings of the Yi Jing [I-Ching], of Lao Zi [Lao-tzu; author of the Dao De Jing], and of the yin-yang philosophers, and he also took an interest in the magical calculation of numbers." His work emphasized the five elements and yin-yang systems of influences that are based on correspondences between features of the external environment and the internal structures and workings of the body. He is considered the first to have presented issues related to ethics of medical treatment, depicting the characteristics of a great physician and cautioning physicians about behavior that was inappropriate to their profession. He was especially concerned, as emphasized in Taoist philosophy, about physicians being influenced by a desire for rewards, including financial rewards, fame, or favors granted to them: they should not have these as their goal. Patients should be treated equally, regardless of rank, wealth, age, or beauty.

Sun Simiao recorded his experience with herb formulas and his knowledge of medicine in his famous 30 volume work, printed in 652 A.D.: Prescriptions for Emergencies Worth a Thousand Gold (Beiji Qianjin Yaofang), the title usually shortened to Prescriptions Worth a Thousand Gold (Qianjin Yaofang). The book presented life saving remedies, hence the title reflecting their great value (i.e., a life is worth more than a thousand gold coins). A mystical origin was attributed to some of the formulas, as with this story from the Song Dynasty (660-1279 A.D.): Sun Simiao once saved the dragon of the Kunming Lake (in Yunnan Province) and, as a reward, got 30 magical recipes from the Dragon Palace.

The Qianjin Yaofang was not merely a collection of formulas (of which there were an astonishing 4,500), but a treatise on medical practice that reviewed the work since the Han Dynasty, starting with the concepts of the Neijing (ca. 100 B.C.). He included treatises on acupuncture, moxibustion, massage, diet, and exercises. So comprehensive in scope was this treatise that later authorities declared it the first encyclopedia of clinical practice.

Sun Simiao is probably best known for his intense interest in the identification and preparation of herbs and his definitive work with formulation principles. He emphasized the importance of gathering herbs at the right time, saying: "If you do not know the proper seasons when they should be placed in the shade or in the sun to dry, the result will be that you know their names but do not obtain their intended effects. If you gather them at an improper time, they will be good for nothing just like rotten wood, and you will have made a futile effort." Further, he insisted that the herbs must be from the genuine source, saying: "Without knowing where the medicines are from, and whether or not they are genuine and fresh, they cannot cure five or six patients out of ten." He described 519 different genuine medicinal materials that could be found in 133 counties (prefectures). The formulas he collected came from both famous physicians of the past and from numerous contemporary physicians, including those of minority groups and even foreigners. He paired down formulas to get rid of extraneous ingredients, with most of his published formulas having only 4-12 ingredients.

His book gave special attention to treatment of women and children, with the first three volumes devoted to woman's disorders (including pregnancy and post-partum disorders) and the next two about diseases of infants and about breast-feeding. His work was relied upon as a basis by the famous Song Dynasty specialists in gynecology, obstetrics, and pediatrics who influenced all subsequent work on these subjects.

A second book by Sun Simiao is a supplement to his early one: it is called Qianjin Yifang. The content is based on 30 years of subsequent experience with special attention to folk remedies; it was printed at the end of his life in 682 A.D. This work of 30 volumes also serves as a Materia Medica with 800 medicinal materials, providing details about the collection and preparation of 200 of them. He presented some new herbs, especially ones from foreign countries, notably from India (the source of the Buddhist tradition that he pursued), from whence came Terminalia chebula (hezi). Two volumes were devoted to study of the formulas and treatment strategies of the Shanghan Lun (ca. 220 A.D.). In addition, the supplement presented about 2000 more formulas, though these have not been studied and retained by future generations to the extent of the formulas from the earlier text. Sun's second book also included considerable reference to mystical and magical practices, such as exorcisms. He mentioned 32 drugs that were said to be effective against demons, and he carefully described the 13 acupuncture points that were known as demon-releasing points. The last two volumes included talismans, amulets, and incantations. Both of Sun's books are still reprinted today, compiled as one: the Qianjin Fang.

Although the information about medical practice that he recorded influenced all subsequent generations of Chinese scholar-physicians, today, the main legacy is a small number of his formulations (see Appendix 2). The formula best known to Western practitioners, and still widely used in China, is Duhuo Jisheng Tang (Tu-hou and Loranthus Combination), a prescription used for pain syndromes affecting the lower back and legs (see: Chinese herb therapies for sciatica and lumbago). A formula frequently referenced in China and used as a basis of numerous formulations used in modern times is Xijiao Dihuang Tang (Rhino and Rehmannia Combination), a prescription for blood-heat syndrome causing bleeding from the nose and mouth or causing severe mental distress.

Sun Simiao is credited with recognizing that goiter occurred in mountainous regions and could be cured by prescribing both seaweeds (which contain iodine) and thyroid glands (which contain thyroid hormone) from deer and sheep. He successfully treated night blindness with livers from oxen and sheep, which contain vitamin A, and treated beriberi (leg edema due to vitamin B₁ deficiency) by using unpolished rice (the outer layer of rice and other grains are rich in B vitamins), based on Buddhist practices from India. Sun also contributed to the utilization of placenta for treatment of weakness as well as for regulating menstruation and relieving difficult labor. He presented 25 formulas for treatment of malaria, 17 of them containing changshan (dichroa). Some Chinese authorities have suggested that Sun Simiao authored the ophthalmology classic Yinhai Jingwei, but the evidence supports a much later date for the work, at least during the Song Dynasty, perhaps afterward (7). Nonetheless, Sun devoted an entire volume of his work to ophthalmology and is credited with being the first to elaborate the causes and treatments for ophthalmic disorders.

As to his general philosophy of health, he believed people should keep moving, saying that "running water is never stale and a door hinge does not become worm-eaten because they never stop moving." But, he thought it was damaging to do too much hard labor, saying: "The way to keep in good health lies in doing light work frequently without fatiguing yourself doing what you cannot." He was an advocate of good nutrition, having noted that many diseases were curable by consuming the proper foods and that diseases could be caused by eating food that was uncooked, unclean, or poisonous, or by overeating or not chewing one's food well. He advocated the use of massage therapies, physical exercises, and breathing exercises. Sun suggested that travelers should take with them some remedies and a guidebook to formulas so that they could deal with emergencies that might crop up, such as injuries, bites, skin sores, etc.

Taoist alchemists considered Sun the source of several works on alchemy, and he is believed to have practiced alchemy on himself, contributing to his lifespan of 101 years. The primary alchemical text attributed to Sun is the Taiqing Danjing Yaojue (Essentials of the Elixir Manuals for Oral Transmission; ca. 640 A.D.), which has been translated by Nathan Sivin and presented along with an extensive analysis of the historical records of Sun Simiao's life (11). Many of Sun's alchemical formulas involved ingestion of metallic substances, such as realgar and cinnabar.

According to the Taoist writer Shen Fen, in his book Xu Xian Chuan (Further Biographies of the Immortals, ca. 930 A.D.), when Sun Simiao died, his body remained without decay for many weeks. "After more than a month had passed, there was no change in his appearance, and when the corpse was raised to be placed in the coffin, it was light as a bundle of empty clothes. Truly, this was release from the mortal part." Needham has speculated that Sun had been taking the mercury and arsenic elixirs he had described in his last book, resulting in the preservation of this body at death (14).

Only a few decades after his death, Sun's first book had a strong influence on the Japanese practice of Chinese medicine, which had become popular in the 8^th Century. In the 10th century, a Japanese physician compiled a book, the Ishimpo, largely based on the Qianjin Fang, selecting 481 formulas from it. It became a required textbook for the study of medicine in Japan.

BIBLIOGRAPHY AND REFERENCES

1. Zheng Bocheng, The King of Medicine: Sun Simiao, Journal of Traditional Chinese Medicine 1986; 6(4): 210-211.
2. Hsu HY and Peacher WG, Chen's History of Chinese Medical Science, 1977 Modern Drug Publishers, Co. Taipei, Taiwan.
3. Unschuld PU, Medical Ethics in Imperial China, A Study in Historical Anthropology, 1979 University of California Press, Berkeley, CA.
4. Furth C., A Flourishing Yin: Gender in China's Medical History, 960-1665, 1999 University of California Press, Berkeley, CA.
5. Chen Ping (editor in chief), History and Development of Traditional Chinese Medicine, 1999 Science Press, Beijing.
6. State Administration of Traditional Chinese Medicine, Advanced Textbook on Traditional Chinese Medicine and Pharmacology, volume 1, 1995 New World Press, Beijing.
7. Kovacs J and Unschuld PU (translators, annotators), Essential Subtleties on the Silver Sea: The Yinhai Jingwei; A Chinese Classic on Ophthalmology, 1998 University of California Press, Berkeley, CA.
8. Unschuld PU, Medicine in China: A History of Pharmaceutics, 1986 University of California Press, Berkeley, CA.
9. Unschuld PU, Medicine in China: A History of Ideas, 1985 University of California Press, Berkeley, CA.
10. Wong KC and Wu LT, History of Chinese Medicine: Being a Chronicle of Medical Happenings in China from Ancient Times to the Present Period, 1936 National Quarantine Service, Shanghai.
11. Sivin N, Chinese Alchemy: Preliminary Studies, 1968 Harvard University Press, Cambridge, MA.
12. Hsu HY and Hsu CS, Commonly Used Chinese Herbal Formulas Companion Handbook, 2^nd revised edition, 1997 Oriental Healing Arts Institute, Long Beach, CA.
13. Huang Binshan and Wang Yuxia (chief compilers), Thousand Formulas and Thousand Herbs of Traditional Chinese Medicine, 1993 Heilongjiang Education Press, Harbin.
14. Needham J, Science and Civilization in China, volume 5, number 2, 1974 Cambridge University Press, London.
15. Kohn L, The Taoist Experience, 1993 State University of New York Press, Albany, NY.
16. Unschuld PU, Medicine in China: Historical Artifacts and Images, 2000 Prestel Verlag, Munich.

APPENDIX 1: Writings of Sun Simiao

The following is from a translation provided by Paul Unschuld (3). The words are as valuable today as when they were written, some 13 centuries ago.

The saying goes back to Chang Chan [4^th Century]: The difficult parts and the fine points in the [medical] classics and the literature on the prescriptions date back to the distant past.

Nowadays, we have diseases that take a similar course with different patients, yet from the outside they appear to be different; and there are others that take a different course with different persons, yet from the outside they appear to be similar. For this reason, it will never suffice to examine exclusively with ears and eyes the symptoms of excess or deficiency in the five zang and the six fu as well as the flow or the blocking of the blood and the pulses, and the constructive and protective qi [ying and wei]. In the first place, one has to examine the symptoms of an illness, which can be felt in the pulses to determine the specific ailment. Only someone who gives his undivided mental attention can begin to elaborate on these symptoms. This undivided attention must be given even to the last details which are related to the irregularities in the depth and the marking of the various kinds of pulsations, which condition the variations in the position of the acupuncture points and which are responsible for the deviations in the thickness and strength of the flesh and bones. Today, however, the prevailing effort is to grasp the most subtle details with the crudest and most superficial thought. This is truly dangerous!

If there is an excess and we still increase it; if there exists a deficiency and even more is taken away; if a congestion prevails and is further intensified; if there is a flow and still more is drained; if there is a chill and further cooling is applied; and if in the case of heat an increase in temperature is brought about, then the specific illness has to deteriorate exceedingly. When there is still hope for life, I then see the approach of death!

It has indeed never happened that spirits distributed the understanding for the difficult aspects and the details which are necessary for physicians, people versed in prescriptions, soothsayers, and magicians. But how else can a person gain access to these secrets? At all times, fools could be found who studied the prescriptions for three years and then they simply maintained that there was no disease in the world which could not be cured. Thereafter they treated diseases for three years and reached the conclusion that there was no useful prescription in the world. Thence ensues that it is absolutely necessary for the student to master the foundations of medicine in its most general significance, and to work energetically and unceasingly. He is not to gossip, but has to devote his words exclusively to the medical teachings. Only then will he avoid errors.

Whenever a great physician treats diseases, he has to be mentally calm and his disposition firm. He should not give way to wishes and desires, but has to develop first a marked attitude of compassion. He should commit himself firmly to the willingness to take the effort to save every living creature.

If someone seeks help because of illness, or on the ground of another difficulty, a great physician should not pay attention to status, wealth, or age; neither should he question whether the particular person is attractive or unattractive, whether he is an enemy or a friend, whether he is Chinese or a foreigner, or finally, whether he is uneducated or educated. He should meet everyone on equal ground; he should always act as if he were thinking of himself. He should not desire anything and should ignore all consequences; he is not to ponder over his own fortune or misfortune and thus preserve life and have compassion for it. He should look upon those who have come to grief as if he himself had been struck, and he should sympathize with them deep in his heart. Neither dangerous mountain passes nor the time of day, neither weather conditions nor hunger, thirst nor fatigue should keep him from helping whole-heartedly. Whoever acts in this manner is a great physician for the living. Whoever acts contrary to these demands is a great thief for those who still have their spirits!

From early times famous persons frequently used certain living creatures for the treatment of diseases, in order to thus help others in situations of need. To be sure, it is said: "Little esteem for the beast and high esteem for man," but when love of life is concerned, man and animal are equal. If one's cattle are mistreated, no use can be expected from it; object and sentiments suffer equally. How much more applicable is this to man!

Whoever destroys life in order to save life places life at an even greater distance. This is my good reason for the fact that I do not suggest the use of any living creature as medicament in the present collection of prescriptions. This does not concern the gadflies and the leeches. They have already perished when they reach the market, and it is therefore permissible to use them. As to the hen's eggs, we have to say the following: before their content has been hatched out, they can be used in very urgent cases. Otherwise, one should not burden oneself with this. To avoid their use is a sign of great wisdom, but this will never be attained.

Whoever suffers from abominable things, such as ulcers or diarrhea, will be looked upon with contempt by people. Yet even in such cases, this is my view, an attitude of compassion, of sympathy, and of care should develop; by no means should there arise an attitude of rejection.

Therefore, a great physician should possess a clear mind in order to look at himself; he should make a dignified appearance, neither luminous nor somber. It is his duty to reduce diseases and to diagnose sufferings and for this purpose to examine carefully the external indications and the symptoms appearing in the pulse. He has to include all the details, and should not overlook anything. In the decision over the subsequent treatment with acupuncture or with medicaments, nothing should occur that is contrary to regulations. The saying goes: "In case of a disease, one has to help quickly," yet it is nevertheless indispensable to acquaint oneself fully with the particular situation so that there remain no doubts. It is important that the examination be carried out with perseverance. Wherever someone's life is at stake, one should neither act hastily, nor rely on one's own superiority and ability, and least of all keep one's own reputation in mind. This would not correspond to the demands of humaneness!

In visiting the sick, whatever beautiful silks and fabrics fill the eye, the physician is not allowed to look out for them either to the left or to the right. Where the sounds of string instruments and instruments of bamboo fill the ear, he should not evoke the impression that he delights in them. Where delicious food is offered in stunning succession, he is to eat as if he experienced no taste. Finally, where liquors are placed one next to the other, he will look at them as if they did not exist. Such manners have their origin in the assumption that if one single guest is not contented, the whole party cannot be merry. A patient's aches and pains release one from this obligation less than ever! However, if a physician is tranquil and engrossed in merry thoughts, in addition to being conceited and complacent, this is shameful for any human frame of mind. Such conduct is not suitable to man and conceals the true meaning of medicine.

According to the reputations of medicine, it is not permissible to be talkative and make provocative speeches, to make fun of others and raise one's voice, to decide over right and wrong, and to discuss other people and their business. Finally, it is inappropriate to emphasize one's reputation, to belittle the rest of the physicians, and to praise one's own virtue. Indeed, in actual life someone who has accidentally healed a disease then strides around with his head raised, shows conceit, and announces that no one in the entire world could measure up to him. In this respect, all physicians are evidently incurable!

Lao Zi has said: When the conduct of men visibly reveals virtue, the humans themselves will reward it. If, however, men commit virtues secretly, the spirits will reward them. When the conduct of men visibly reveals misdeeds, the humans themselves will take retribution. If, however, men commit their misdeeds secretly, the spirits will take retribution. When comparing these alternatives and the respective rewards that will be given in the time after this life and still during this life, how could one ever make a wrong decision?

Consequently, physicians should not rely on their own excellence, neither should they strive with their whole heart for material goods. On the contrary, they should develop an attitude of good will. If they move on the right path, concealed from the eyes of their contemporaries, they will receive great happiness as a reward without asking for it. The wealth of others should not be the reason to prescribe precious and expensive drugs, and thus make the access to help more difficult and underscore one's own merits and abilities. Such conduct has to be regarded as contrary to the teaching of magnanimity. The object is help. Therefore, I enter into all the problems in such detail here. Who ever studies medicine should not consider these problems insignificant!

The next quotation is derived from the section of Sun's book that was devoted to women's disorders (there were a total of three chapters on this subject, all presented at the beginning of his book). According to Charlotte Furth (4), "almost every important writer on the subject [of women's disorders] quoted some or all of Sun's compelling account of the female medical body." Here is Furth's translation:

It is said that the reason there are separate prescriptions for women is because they get pregnant, give birth, and suffer form uterine damage. This is why women's disorders are ten times more difficult to cure than those of males. The Classic [Neijing] says: "women are a gathering place for yin influences, swelling in dampness." From the age of fourteen on, their yin qi wells up and a hundred thoughts run through their minds, damaging their organ systems within and ruining their beauty without. Their monthly courses flow out or are retained within, now early, now late, stagnating and congesting blood, and interrupting the function of the central pathways. The injuries from this cannot be enumerated in words. Internal organs are now cold, now hot, now replete, now depleted. Bad blood within leaks out, and meridians are used up and drained empty. Sometimes immoderate diet causes damage, sometimes they have sexual intercourse before their [vaginal] itching sores have healed. Sometimes as they relieve themselves at the privy, wind from below enters, causing the twelve chronic illnesses. All of this is why women have separate prescriptions. If an illness is due to the qi of the four seasons, or to the divisions of day and night, or to imbalance of cold and heat, or of repletion or depletion, it is no different from that of men; only potent medicines are to be avoided if they fall ill when pregnant. For miscellaneous disorders that are the same in women and men, one should consult the main chapters of this work. Nonetheless, females' longings and desires are more intense than those of their husbands, and they are more frequently stimulated to become ill. Add to this that in women envy and dislike, compassion and love, grief and sorrow, attachments and aversions are all especially stubborn and deep-seated. They cannot themselves control these emotions and from this the roots of their illnesses are deep, and their cure is difficult.

Following is a portion of Sun's Taoist text Cunshen Lianqi Ming (Visualization of Spirit and Refinement of Qi), translated by Kohn (15):

The body is the habitation of spirit [shen] and qi. As long as spirit and qi are there, the body is healthy and strong. As soon as spirit and qi scatter, the body dies. Therefore, if you wish to preserve yourself whole, first calm spirit and qi. Understand: qi is the mother of spirit; spirit is the son of qi. Only when qi and spirit are together can you live long and not die.

If you, therefore, wish to calm spirit, first refine primordial qi. When this refined qi resides in the body, spirit is calm and qi is like an ocean. With the sea of qi full to overflowing, the mind [heart] is calm and the spirit stable. When this stability is not disturbed, body and mind are gathered in tranquility. Tranquility then attains to concentration, and the body continues to exist for years eternal.

Just stay all the time with the deep source of the Tao, and you will naturally become a sage. Then qi pervades spirit and all mental projections; spirit pervades all insight and destiny. With destiny established and the body preserved, you can unite both with your true inner nature. Then you will reach an age as old as the sun and moon. Your Tao is perfected.

This introductory section follows the typical Taoist description of cultivating qi in order to calm spirit, and in tranquility gaining longevity. It is followed by instructions for meditation (persistent focus of the mind, especially on the cinnabar field, dantian, just below the naval). Five phases of the mind are described by Sun, starting with the agitated mind, and then progressing to greater degrees of tranquility. Having attained tranquility, there are then seven phases of the body that one can pass through. These begin with the healing of diseases, followed by recovery of youth, extension of the life span, refining the physical form to a radiant body, further refinement to pure spirit, unification of spirit with the world, and, finally, going beyond all beings to reside in the numinous realm. As to how these refinements of the body are to be accomplished, nothing is said, but the practitioner is warned to diligently study the Tao and follow the orally transmitted teachings, which are never written down.

The next quotes come from the section of Sun's book on eye disorders, presented by Kovacs and Unschuld (7):

All people older than 45 years have the feeling of a gradual decrease in vision. After the age of sixty, vision gradually brightens up again. Therapeutic patterns are such that prior to age fifty it is advisable to take the 'decoction to drain the liver' [Xiegan Tang]. After age fifty, one should no longer drain the liver. If an illness is in the eyes, one can apply such medication as the 'powder with shidan' [Shidan San]. In case there is no illness, this powder must not be applied recklessly; rather, one should simply supplement the liver. If someone's vision is obscured or blinded because of wind-heat in the liver, one should moxa the liver transportation points and take several tens of doses of decoctions, pill, or powders eliminating wind. This should bring relief.

Pathogenic causes of eye disorders listed by Sun Simiao were these:

In modern terms, summarizing these causes, there is: eye strain due to too much use of the eyes, especially in dim light; overexposure to bright light (we can be reminded of how bright the moon and stars appeared when the sky was completely dark at night); exposure to smoke or to wind; consumption of hot and spicy foods; and poor lifestyle (including smoking, drinking, excessive sexual activity, and not enough rest).

The next section comes from Sun's volume on dietary therapy, translated by Paul Unschuld (8):

Zhang Zhongjing has said: For the human body to remain in a healthy and balanced state, nothing else is required but to care about its nourishment. By no means should drugs be consumed recklessly. The strength of drugs is one-sided, and there are occasions where they are of help. But, they can lead to an imbalance of the qi in man's zang organs, and, consequently, an affliction will easily be acquired form outside sources. Living beings have always depended on food to maintain their life. But, at the same time, they are unaware of the fact that even food has positive and negative aspects. Food is in daily use with all the people, but one knows little about it. Water and fire are very near but difficult to comprehend! I regretted this and have, therefore-when I had spare time from my other writings-compiled a treatise on dietetic therapy emphasizing harms and benefits that can result form the five tastes, in order to inform our youth….Now, those who practice medicine must first recognize the origin of an illness; they must know which violations have caused the suffering. Then they must treat it with dietary means. If dietary therapy does not cure the illness, only then can they employ drugs. The nature of drugs is violent, just like that of the imperial soldiers. Because the soldiers are so wild, how could anybody deploy them recklessly? If they are deployed inappropriately, harm and destruction will result everywhere. Similarly, excessive calamities are the consequence if drugs are thrown against illnesses carelessly.

The alarmist language about use of herbs may seem strange given the very large number of herbs and formulas described in his books. However, if one examines his formulas (especially those that are no longer relied upon today), it is evident that he tended to rely on herbs of somewhat extreme nature: very cold, very hot, purging herbs, diaphoretic herbs, etc. Thus, he aimed at having highly effective drugs that must be given with great care, and usually used for emergency situations or when dietary therapies have failed.

APPENDIX 2: Some Formulas of Sun Simiao Referenced in Modern Texts

Following are formulas from Sun Simiao's Qianjin Yaofang (and two formulas from Qianjin Yifang), from texts on traditional Chinese medicine published in recent times. Formulas that have an English common name in parentheses are from Commonly Used Chinese Herb Formulas will Illustrations Companion Guide (12) and the others are from Thousand Formulas and Thousand Herbs of Traditional Chinese Medicine (13). In a few cases, the formulas are presented in both books. They have been organized here by therapeutic pattern.

Purgative Formulas

• Zi Yuan (Croton and Hematite Formula) with croton, hematite, apricot seed, and kaolin; used for abdominal edematous distention in persons who suffer damage from improper eating. This formula alleviates constipation, purges fluids, and lowers rising qi.
• Wenpi Tang with rhubarb, mirabilitum, aconite, dry ginger, ginseng licorice, tang-kuei; for spleen yang deficiency with abdominal pain and constipation.
• Sanhuang Tang, with rhubarb, scute, gardenia, and licorice; used for heat in the lower warmer with constipation.

Chill-dispelling Formulas

• Qianjin Danggui Tang (Tang-kuei Combination): with tang-kuei, cinnamon, zanthoxylum, dry ginger, licorice, pinellia, magnolia bark, ginseng, astragalus, and peony; used for cold spleen/stomach with pain in the chest and/or abdomen.
• Jianzhong Tang (Hoelen and Jujube Combination) with hoelen, dried ginger, cinnamon, licorice, peony, jujube, and pinellia; used for cold in the spleen and stomach causing belching, vomiting, and/or stomach pain.
• Duzhong Jiu, with eucommia, photinia, chiang-huo, and aconite, prepared as a wine; for rheumatic pain in lower back and/or knees in persons with cold of spleen and kidney.

Wind-dispelling Formulas

• Xiao Xuming Tang (Ma-huang and Peony Combination) with ma-huang, apricot seed, cinnamon, peony, fresh ginger, ginseng, licorice, cnidium, siler, stephania, aconite, and scute; used for invasion of wind-cold that causes paralysis, unconsciousness, mental confusion, and/or spasms.
• Duhuo Jisheng Tang (Tu-huo and Loranthus Combination) with tu-huo, loranthus, chin-chiu, siler, asarum, cinnamon bark, eucommia, rehmannia, achyranthes, tang-kuei, peony, cnidium, ginseng, hoelen, and licorice; used for bi syndrome (specifically wind-damp-cold affecting the lower back and legs) in persons with deficiency of liver and kidney.

Treatments for Diarrhea

• Zhujiu Wan with coptis, dry ginger, tang-kuei, and gelatin, prepared as a pill; for diarrhea due to damp-heat.
• Zhuchi Baili Fang with kaolin, dragon bone, dry ginger, and coptis; for diarrhea of all types.

Pregnancy and Post-partum Formulas

• Zhuli Tang with bamboo sap, siler, scute, ophiopogon, and hoelen; for restlessness and irritability during pregnancy.
• Neibu Danggui Jianzhong Tang with tang-kuei, peony, fresh ginger, licorice, cinnamon bark, and jujube (this is Cinnamon Combination from the Shanghan Lun with cinnamon bark substituted for cinnamon twig and tang-kuei added); used for post-partum deficiency with abdominal pain.
• Anxin Tang with polygala, licorice, ginseng hoelen, tang-kuei, peony, ophiopogon, and jujube; used for postpartum mental distress accompanied by shortness of breath.
• Dahuang Tang with rhubarb, tang-kuei, licorice, fresh ginger, moutan, peony, evodia; used for post-partum leukorrhea.

Cough-relieving Formulas

• Weijing Tang with coix, persica, benincasa, and phragmites; used for cough with pulmonary abscess.
• Feishang Tang with ginseng, dry ginger, cinnamon bark, gelatin aster, maltose, rehmannia, and morus; used to treat lung insufficiency with shortness of breath and coughing. [from Qianjin Yifang]

Miscellaneous Other Formulas

• Xijiao Dihuang Tang (Rhino and Rehmannia Formula) with rhino horn (substituted today by buffalo horn), raw rehmannia, red peony, and moutan; used for heat in the blood causing bleeding, especially hemoptysis and nose bleeds; also for febrile diseases causing mental disturbance.
• Changyong Tang (Coix and Persica Combination) with coix, persica, moutan, and benincasa; used for hot mass in the abdomen (infection with abscess).
• Huanshao Dan with rehmannia, cistanche, altaica, eucommia, morus, cornus, lycium, schizandra, achyranthes, morinda, dioscorea, hoelen, polygala, and fennel, made as honey pills; used for kidney deficiency syndrome with symptoms such as lumbar pain, dizziness, blurred vision, hair loss, poor memory, and heart palpitation.
• Danggui Jianzhong Tang with tang-kuei, cinnamon, peony, baked licorice, fresh ginger, jujube and maltose (this is Cinnamon Combination from the Shanghan Lun with tang-kuei and maltose added); for abdominal cramps dues to deficiency syndrome of spleen and stomach with blood deficiency. [from Qianjin Yifang]

The following figures are from books by Paul Unschuld (8, 16). Most often, Sun Simiao is depicted with a tiger below, representing yin, and a dragon above, representing yang. His Taoist skills are illustrated by this command of the yin and yang forces.