寶鑑Bogam

Formulas · Tonify Blood 補血 · Uihak Gangmok (醫學綱目)

Boiled Liver Pill

Jagan-hwan

한글 자간환  ·  Pinyin Zhu Gan Wan

煮肝丸

Called a 丸 but there are no pills in it — the dosage-form syllable names the stuffed and boiled liver, which is eaten whole. This leaf is the one place in the round that gives a dose by weight for a child and scales it by age (小兒一錢, 七歲以上三錢); it is the exception to the chapter's silence on dosing, and it is a powder dose, not a dose of the liver. 靑蛤粉 has no herb entry of its own and is registered against 蛤粉, the same clamshell powder with the species named; the alias should be added. The transcription writes 糓精草, the form the corpus prints for this drug, and 椀 and 訖 are kept as written. The procedure is the same as 雀盲散 of the Eye chapter, where a pig liver is split, bat droppings are put inside, it is tied and boiled in rice-washing water, and the liver is chewed and the broth drunk.

Composition 構成

Total 0 g per packet (첩) · representative dosage — verify against source texts. Excludes 5 ingredients measured by count or used as a vehicle, shown as —.

Received this formula from your practitioner? Amounts shown here are classical reference values — granule and prepared products differ. Always follow your prescribed dosage and directions.

Actions 效能

Indications 主治

Pattern-based

  • 疳眼 — gan eye, with 雀目 night blindness, a membrane over the eye and loss of sight, or discharge of pus
  • 雀目 — sparrow blindness, sight failing as the light goes

Biomedical correlates

  • Vitamin A deficiency — xerophthalmia, from night blindness through Bitot's spots and corneal xerosis to corneal ulceration and keratomalacia
  • Nutritional blindness in a malnourished child

Source text 原文

Donguibogam 東醫寶鑑

治疳眼盲膜不見物. 夜明砂ㆍ靑蛤粉ㆍ糓精草 各等分. 右細末, 小兒一錢, 七歲以上三錢. 猪肝 一大片, 批開糝藥, 麻線縛定, 米泔半椀煮肝熟, 取出. 肝湯則傾椀內熏眼, 取肝分三次嚼訖, 却以肝湯下, 一日三服, 十日必退. 如大人雀目, 空心服, 至夜便見物. 《綱目》

Translation

Treats gan eye with a blinding membrane and loss of sight. Bat droppings, powdered green clamshell and pipewort flower, equal parts of each. Grind the above fine — 1 don for a small child, 3 don for one over seven years. Take one large slab of pig liver, split it open, strew the powder inside, and tie it fast with hemp thread; boil the liver in half a bowl of rice-washing water until done, then take it out. Pour the liver broth into a bowl and fume the eyes over it; take the liver and chew it down in three mouthfuls, then wash it down with the liver broth. Three doses a day, and in ten days it will certainly go. For night blindness in an adult, take it on an empty stomach and by nightfall he will see. — Gangmok 綱目 (Donguibogam · Soa)

Clinical commentary 臨床

疳眼 is vitamin A deficiency, and this formula works. The sequence the section describes is the textbook one: night blindness first (雀目, the 疳眼 line's own first symptom), then a drying of the conjunctiva, Bitot's spots, corneal xerosis, corneal ulceration, keratomalacia, and irreversible blindness. It is still the leading cause of childhood blindness wherever children are malnourished, and it kills as well as blinds, because vitamin A deficiency is also immune failure — measles and diarrhoea become lethal in a deficient child. **煮肝丸 turns on the liver, and animal liver is the richest dietary source of vitamin A there is.** A slab of pig liver is split, a bitter powder is strewn inside, it is tied with hemp thread, boiled in rice-washing water, and eaten whole in three mouthfuls with the broth drunk after it — three times a day for ten days. That is a real dose of retinol, repeated, by mouth, and the claim the text attaches to it is the right claim: in ten days it will certainly go, and for an adult with night blindness, take it on an empty stomach and by nightfall he will see. Night blindness from vitamin A deficiency does reverse in a day or two once retinol is given. **This is one of the clearest true positives in the book — the remedy works, and for the reason the modern account gives.** The powder is incidental: the bat droppings, the clamshell and the pipewort flower are not what cured the child. The liver is. What follows from that is not a reason to make this formula, but a reason it is no longer needed. **Two 200,000 IU capsules of retinyl palmitate, given a day apart, now cost a few cents and prevent the blindness outright** — the same two doses treat established xerophthalmia, with a third at two weeks, and they cut all-cause child mortality in deficient populations as well. There is no reason to boil a liver when the capsule exists, and there is every reason to give the capsule before the cornea goes, because once it ulcerates and melts, nothing restores the eye. **The patient is a small child, and even here the caution holds.** The dose by weight on this leaf is for the powder, not the liver, and the bat droppings in it are raw animal faeces, which in a child this sick is an infection risk and not a medicine. Liver itself can be overdone — retinol is fat-soluble and accumulates, and liver is why pregnant women are told to limit it — but a child with xerophthalmia is nowhere near that problem. On 疳 as childhood malnutrition and why the rest of this chapter's formulas are not food, see 五疳保童元; this one is food, and it is the right food. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.

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