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A Chinese Medieval Treatment for Angina

Anthony Butler and John Moffett

For the treatment of angina give your patient a dose of saltpetre, says a Dunhuang medical manuscript. But modern medicine has shown that such a treatment would have no effect whatsoever. Looking more carefully at the instructions in the manuscript and we see that the patient is told to keep the saltpetre under his tongue for as long as possible and to swallow the saliva. Under even the healthiest tongue there are bacteria that convert saltpetre (potassium nitrate) into potassium nitrite and very recent medical research has shown that potassium nitrite can relieve the symptoms of angina.

In September 2007 experts will convene at an international conference at the National Institutes of Health to discuss this, showing how we can still learn from an unknown Chinese physician who lived over a thousand years ago.

The text reads as follows:

Putting under the tongue to cause heart qi to flow freely

For treating symptoms such as struck by evil, acute heart pains and cold in the hands and feet, which can kill a patient in an instant.

Look at the patient's fingers and those with greenish-black nails are such cases.

Saltpetre [xiaoshi, potassium nitrate] (5 measures of a bi spoon) and realgar [xionghuang, arsenic sulphide] (1 measure of a bi spoon).
硝石五錢匕 雄黃一錢匕

Combine these two into a fine powder. Lift the patient's tongue and sprinkle 1 measure of a bi spoon under the tongue. If saliva is produced, have the patient swallow it.

This is a certain cure.

From: Fuxingjue zangfu yongyao fayao 輔行訣臟腑用藥法要
(Secret Instructions for Assisting the Body: Essential Methods for the Application of Drugs to the Viscera and Bowels).1

This is the only example of such a prescription in extant literature used in exactly this way. The text is attributed to the famous Daoist alchemist and physician Tao Hongjing 陶弘景 (AD 456–536). Although clearly not in his hand, it contains many indications of drawing on early medical traditions of pharmacy between the Han and Sui periods. It is certainly pre-Song and may well come from the early period of the Tang dynasty (perhaps the seventh century), incorporating some even earlier material. The original was decorated with images of the Three Daoist Lords and the Twelve Constellations, indicating links with Daoist traditions.

1. Note on the text
The manuscript on which this text is found was acquired at Dunhuang in the early twentieth century by a Chinese family and handed down a family of Chinese physicians living in Hebei Province. The original was destroyed in the Cultural Revolution, but two copies had been made and were used to reconstruct the text.

Anthony R. Butler is Honorary reader in Medical Science at the Bute Medical School of the University of St. Andrews, UK.
John Moffet is Librarian of the East Asian History of Science Library at the Needham Research Institute , Cambridge, UK.

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