Formulas · Warm the Interior 溫裏 · Seui Deukhyobang (世醫得效方)

Four Generals Drink

Sajanggun-eum

한글 사장군음 · Pinyin Si Jiang Jun Yin

四將軍飮

撼腋 in the transcription is hard to construe — literally the armpit shaking — and the sense wanted is plainly the whole body shaking in the collapse; the reading is printed as the transcription has it. The four drugs are the four generals of the name, and only the aconite carries a weight: chebula and tangerine peel are counted by the piece and licorice by length.

Composition 構成

Buja Fu Zi
附子 부자 · Prepared Aconite

40 g
Chief 君

炮, blast-fried — aconite, toxic
Gaja He Zi
訶子 가자 · Chebula

—
Deputy 臣

四箇, four fruits, roasted in ash and the stones removed
Jinpi Chen Pi
陳皮 진피 · Aged Tangerine Peel

—
Assistant 佐

四箇(全者), four whole peels
Gamcho Gan Cao
甘草 감초 · Licorice

—
Envoy 使

四寸(灸), four chon, roasted
Saenggang Sheng Jiang
生薑 생강 · Fresh Ginger

—
Envoy 使

薑七, seven slices to each packet
Daejo Da Zao
大棗 대조 · Jujube

—
Envoy 使

棗七, seven jujubes to each packet

Total 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

Revives a patient who collapses insensible at the onset of a paroxysm
Warms and rescues the yang where cold and heat are at war in the middle

Indications 主治

Pattern-based

Collapse and reversal at the onset of malaria with loss of awareness
Repression bound in the centre of the chest with yin and yang in open battle
Malaria with syncope

Biomedical correlates

Syncope or collapse during a malarial paroxysm
Cerebral malaria — historical description
Febrile collapse with shock

Source text 原文

Donguibogam 東醫寶鑑

治瘧作時, 仆厥撼腋不省. 是中心抑鬱, 陰陽交戰所致, 宜服此. 附子一兩(炮)ㆍ訶子四箇(煨去核)ㆍ陳皮四箇(全者)ㆍ甘草四寸(灸). 右剉, 分作二貼, 每貼入薑棗各七, 水煎, 漸漸灌下, 四服頓甦. 《得效》

Translation

Treats the case where, at the moment the malaria breaks out, the patient falls in reversal with the body shaking and knows nothing. This comes of repression bound in the centre and of yin and yang at war with each other, and this is the one to take. Blast-fried aconite, 1 nyang; chebula, four fruits, roasted in ash with the stones removed; aged tangerine peel, four whole peels; roasted licorice, four chon. Cut them up and divide into two packets; to each packet add seven slices of ginger and seven jujubes, decoct in water, and pour it down little by little — at the fourth dose the patient revives at once. — Deukhyo 得效 (Donguibogam · Haehak)

Clinical commentary 臨床

Four drugs, four generals, and a formula for an emergency rather than for a malaria. What it describes is the patient who goes down at the moment the paroxysm starts and cannot be roused — 仆厥不省 — and the answer is a whole nyang of blast-fried aconite divided over two packets, poured in slowly, four doses to bring the patient back. The chebula binds, the tangerine peel and licorice hold the stomach, and the aconite is the whole of the intention. The explanation offered, 中心抑鬱 with 陰陽交戰, is the chapter's own vocabulary for the paroxysm turned violent. Collapse with loss of consciousness in the middle of a malarial fever is cerebral malaria or septic shock, and it is a medical emergency; nothing poured down the throat of an unconscious patient is safe, least of all this. **Contains aconite, which is toxic. This must not be prepared. Collapse with loss of consciousness during a fever needs emergency medical care.** — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.