寶鑑Bogam

Formulas · Clear Heat 淸熱 · Uihak Gangmok (醫學綱目)

Gentian Draught

Yongdam-eumja

한글 용담음자  ·  Pinyin Long Dan Yin Zi

龍膽飮子

蛇脫皮 is registered against 蛇蛻, following the corpus's own handling of the same spelling at 神應散. 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 欝金, normalized to 鬱金, and 糓精草, the form the corpus prints for this drug. The name is hyphenated before the 飮子 as the corpus does at 當歸飮子. Not to be confused with 龍膽元 or 龍膽丸 of 1.38, two separate leaves of this same chapter, nor with 連膽丸 of 1.37, whose name differs from 龍膽丸 only in the first character.

Composition 構成

Total 114 g per packet (첩) · representative dosage — verify against source texts. Excludes 1 ingredient 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

  • 疳眼流膿 — gan eye with purulent discharge
  • 疳眼 with 盲膜不見物 — a membrane over the eye and loss of sight

Biomedical correlates

  • Vitamin A deficiency — corneal ulceration and keratomalacia, the suppurating stage of xerophthalmia
  • Secondary bacterial keratitis or endophthalmitis in a malnourished child

Source text 原文

Donguibogam 東醫寶鑑

治疳眼流膿神效. 靑蛤粉ㆍ蛇脫皮ㆍ糓精草 各五錢, 羌活ㆍ草龍膽 各三錢, 麻黃 二錢半, 黃芩(炒)ㆍ升麻 各二錢, 鬱金ㆍ甘草 各半錢. 右末, 每二錢, 茶淸調下. 《綱目》

Translation

Treats gan eye running with pus, with marked effect. Powdered green clamshell, snake slough and pipewort flower, 5 don each; notopterygium and gentian root, 3 don each; ephedra, 2 don 5 fun; scutellaria (stir-fried) and cimicifuga, 2 don each; curcuma and licorice, 5 fun each. Powder the above; 2 don a dose, stirred into clear tea. — Gangmok 綱目 (Donguibogam · Soa)

Clinical commentary 臨床

Pipewort flower and gentian root carry it, with clamshell powder and snake slough, notopterygium, ephedra, cimicifuga and stir-fried scutellaria to disperse and cool, and a little curcuma and licorice. A powder, 2 don at a time in clear tea. Pipewort flower and gentian root are the Eye chapter's standard pair for a clouded or ulcerated cornea, and the dispersing drugs follow the classical reading of an eye disease as wind-heat in the liver channel. This is the second of the two 疳眼 formulas, and the honest reading is different from the first. **疳眼 is vitamin A deficiency**, and 煮肝丸, the formula directly above it, works — it feeds the child pig liver, the richest dietary source of vitamin A there is, and the deficiency reverses. This one does not contain liver, or anything else that carries retinol. It is bitters and dispersing drugs for a cornea that is already suppurating, and nothing in it reaches the cause. See 煮肝丸 for the full statement, and for the fact that two 200,000 IU capsules now cost a few cents and prevent the blindness outright. **流膿 — the eye running with pus — is the late stage, and it is an emergency.** By the time a xerophthalmic cornea discharges, it is ulcerating or melting (keratomalacia), often with bacterial infection on top, and it is hours to days from perforation and permanent blindness. What that child needs is vitamin A immediately, at the dosing above, plus antibiotic cover and an ophthalmologist; and the underlying malnutrition treated, because xerophthalmia at this stage carries a high mortality quite apart from the eye. A powder in tea does not buy that time. The text's 神效 — marked effect — cannot be taken at face value here. **The patient is a small child and the text gives no dose by weight for the child anywhere** — 2 don a dose, with no age or size attached. **It contains ephedra at 2 don 5 fun, which is ephedrine-bearing**: a sympathomimetic, raising heart rate and blood pressure, in an undernourished infant whose circulation is already strained. The snake slough is a dried animal product laid into a powder for the mouth. On 疳 as childhood malnutrition and why bitters are not a treatment for it, see 五疳保童元. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.

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