Formulas · Text · Donguibogam 東醫寶鑑

Strange Diseases

Goejil

한글 괴질 · Pinyin Guai Ji

The strange diseases — twenty-seven cases that fitted nothing the physician knew

怪疾

The shortest chapter of the volume and the one that admits the most. 怪證異於常患之病, 故謂之怪疾: a strange sign differs from the illnesses commonly suffered, and so it is called a strange disease. What follows is twenty-seven entries of two or three lines each — a mass in the belly named for the creature it was thought to be, seeing things upside down, the body becoming two, blood issuing from the pores, flesh standing up like an awl, the fingers rotting off, a sound of waves through the whole body, a man whose head and face gave off a light that burned the hand brought near it. Some of them are now namable, and the notes name them. 髮瘕 is a trichobezoar, a cast of swallowed hair in the stomach, and it is the one entry in the chapter that is simply correct — the Worm chapter carries the same thing twice as case records, once with a mass whose head had become a snake, and the decisive observation in both places is the smell of burnt hair. 身生猫眼瘡, the cat's-eye sore, is erythema multiforme, and the name is a good description of a target lesion. 人身作兩 is autoscopy, seeing a double of oneself, reported with temporoparietal lesions, with epilepsy and with migraine. 視物倒植 is a real vestibular and brainstem phenomenon, not a disease of the eye. 毛竅血出 is haematohidrosis, documented and very rare. Most of them are not namable, and the notes say so. That is the harder and the more honest half of the work here: the record is two lines long, it describes something nobody has seen since, and a confident label would be an invention. What the chapter preserves is not a nosology but a posture — the physician met a case that fitted nothing he knew, wrote down what he saw, wrote down what he tried, and put it in a chapter whose title says plainly that he could not place it. There are not many medical books of 1613 with such a chapter in them.

4.1 Strange Diseases Unlike the Ordinary 怪疾異常

4.1.1

Source원문

怪證異於常患之病, 故謂之怪疾.

Translation영역

A strange pattern is one that differs from the diseases ordinarily suffered, and for that reason it is called a strange disease.

Clinical note임상 주석

怪疾 is not a disease category but a residual one. The line defines it by exclusion — a pattern unlike the illnesses ordinarily met with — and the chapter that follows is simply what was left over once everything else in the book had been given a chapter of its own. It is the shortest chapter in the volume, and the only one the catalogue leaves undivided. What makes it worth reading is that it is a record of what a physician did when the case in front of him fitted nothing he knew. He looked, he named the thing after whatever he supposed had caused it, and he treated — most often by making the patient vomit, because expelling what should not be there was the one move that covered an unknown. A few of the cases are recognizable today: the hair mass of 4.1.3 is a real entity with a modern name, and the inverted vision of 4.1.10 and the coloured shapes of 4.1.9 are real phenomena with real causes. Most are not. A good number of these sections give two or three lines, one strange appearance and a remedy, and that is not enough to settle what the patient had. Where the notes below say we cannot know, that is the finding and not an evasion: a confident modern label fastened to twenty characters of description would be an invention. The chapter is more useful as evidence of how an unclassifiable case was handled than as a set of puzzles waiting to be solved.

Donguibogam · Goejil

4.1.1 Flesh Mass 肉癥

4.1.1.1

Source원문

肉癥者, 思肉不已, 食訖復思. 白馬尿三升, 空心飮, 當吐肉. 不吐者死. 《本草》

Translation영역

In flesh mass, the patient craves meat without end, and when he has finished eating he craves it again. Give 3 seung of white horse's urine, drunk on an empty stomach, and he should vomit flesh. One who does not vomit dies.

Clinical note임상 주석

癥 in the book's vocabulary is a fixed abdominal mass, but the thing named here is a behaviour rather than a palpable lump: an unending appetite for meat, renewed the moment a meal ends. No examination is described and no mass is reported felt. The only diagnostic criterion offered is the response to the remedy — vomit flesh and live, fail to vomit and die — which tests nothing and guarantees that every fatal case confirms the diagnosis. What this patient had cannot be determined. Insatiable hunger has real causes, among them thyrotoxicosis, poorly controlled diabetes, hypothalamic lesions and several psychiatric conditions, but nothing in these twenty-odd characters distinguishes between them, and nothing establishes that there was any mass at all. The honest answer is that we do not know what was in front of the physician. **White horse's urine is a raw animal excretion. Swallowing it carries a real risk of bacterial infection, it has no therapeutic action, and it will not produce the vomiting of flesh. This must not be prepared.**

Boncho 本草

4.1.2 Drink Mass 酒癥

4.1.2.1

Source원문

一人病心痛. 此人好酒, 初飮二三盃, 必奔走三五十次, 其酒稍散, 方復飮至前量. 至明朝, 嘔靑黃水數口, 夜變魚腥臭, 六七日始安. 戴人張子和也以藥吐之, 乃吐蟲一條, 靑黃色, 長六七寸, 口目鼻俱全, 狀如蛇. 醃乾以視人, 乃酒癥也. 《綱目》

Translation영역

A man suffered pain at the heart. He was fond of wine: after the first two or three cups he would always run about some thirty to fifty times, and once the wine had dispersed a little he would drink again up to his former measure. By the next morning he would bring up several mouthfuls of blue-yellow water, which by night had turned to a rank, fishy stench, and only after six or seven days did he settle. Master Dai — that is, Zhang Zihe — made him vomit with a drug, and he vomited a single worm, blue-yellow in colour, six or seven chon long, with mouth, eyes and nose all complete, shaped like a snake. It was salted and dried and shown to people. This was a drink mass.

Clinical note임상 주석

The illness here is alcohol, and the clinical picture is consistent with it. 心痛 in the Bogam's usage is pain at the epigastrium rather than in the heart, and a heavy drinker with epigastric pain who vomits bile-stained fluid in the morning, turns foul by evening and settles over six or seven days is describing repeated bouts of alcoholic gastritis; the same cycle would cover alcoholic pancreatitis, which is the more dangerous reading of recurrent attacks that take the better part of a week to subside. What chronic heavy drinking actually does is well established: erosive gastritis and gastric ulceration, Mallory-Weiss tears from retching, oesophageal and gastric varices once portal pressure rises, fatty liver progressing through alcoholic hepatitis to cirrhosis, acute and chronic pancreatitis, and the thiamine deficiency behind Wernicke's encephalopathy. An emetic addresses none of it and in a patient with varices is frankly dangerous. The worm is not a worm. What comes up when a heavy drinker is made to vomit is gastric content, mucus, altered blood and sloughed mucosa, and a long rope of mucus can take a cylindrical form with openings at one end that invite the reading given here. That the specimen was then salted, dried and shown about is the significant detail: it made visible a diagnosis the physician had already reached, and nobody examined it further.

Gangmok 綱目

4.1.2.2

Source원문

一男自幼喜飮酒, 日飮一二斗, 無酒呌呼不絶, 全不進食, 日就瘦弱. 家中設策, 令人用手巾縛住手足, 却取生酒一壜, 於口邊打開, 其酒氣衝入口中, 病者必欲就飮, 堅不與之. 須臾口中忽吐物一塊, 直下壜中, 以物盖覆, 猛火燒滾, 約乾一半, 却開取之. 其物如猪肝狀, 約三兩重, 周回有小孔如鍼眼, 不可數計. 棄之於江, 自後雖滴酒不能飮矣. 《得效》

Translation영역

A man had loved wine from childhood and drank one or two mal a day; without wine he shouted and cried without stopping, took no food at all, and grew thinner and weaker by the day. His household laid a plan. They had men bind his hands and feet with a cloth, then took a jar of raw wine and opened it beside his mouth, so that the fumes of the wine rushed into his mouth. The patient was desperate to get at it and drink, and they firmly refused him. In a short while he suddenly vomited a lump of something out of his mouth, straight down into the jar. They covered it over, boiled it hard on a fierce fire until about half had dried away, then opened it and took the thing out. It was shaped like a pig's liver, about 3 nyang in weight, and all round it were small holes like needle-eyes, beyond counting. They threw it into the river, and after that he could not drink so much as a drop of wine.

Clinical note임상 주석

This is an aversion cure, and its machinery is laid out in the open: the patient is tied, the wine is opened under his nose, and he is refused it. Aversive conditioning for alcohol dependence is a real technique and works on the same principle, pairing the stimulus with a strongly unpleasant experience; its measured effect is modest and poorly sustained. The claim that he could not afterwards swallow a drop is the outcome the method was designed to produce, and should be read as the family's report of success rather than as an observation. The detail worth taking seriously is the clinical description of dependence: drinking from childhood, one or two mal a day, ceaseless shouting when deprived, no food at all, and progressive wasting. Craving, withdrawal agitation and the displacement of food by alcohol are the features by which dependence is still recognized, and the wasting is partly starvation and partly the malabsorption and muscle loss that go with it. What the account does not know is that abrupt deprivation in a drinker of this severity is itself dangerous: withdrawal seizures and delirium tremens carry real mortality, and tying such a patient up and withholding alcohol without cover is the one part of the procedure that could have killed him. The object vomited into the jar — liver-coloured, some 3 nyang in weight, pitted all round with uncountable pinholes — is not an organism, and nothing answering that description lives in a human stomach. A cast of mucus and fibrin boiled down to half its bulk over a fierce fire would be unidentifiable by the time it was examined. Alcohol dependence is managed now with supervised withdrawal, thiamine, the medications that have evidence behind them (naltrexone, acamprosate, disulfiram) and sustained psychosocial support.

Deukhyo 得效

4.1.3 Hair Mass 髮瘕

4.1.3.1

Source원문

一人有飮油五升以來方始快意, 常喫則安, 不飮則病. 此是髮入胃化爲央. 雄黃半兩爲末, 水調服, 蟲自出, 投沸油中, 棄之江中, 病卽愈. 《得效》

Translation영역

There was a man who had to drink 5 seung of oil before he first felt at ease; while he kept drinking it he was well, and when he did not drink it he fell ill. This was hair that had entered the stomach and turned into a worm. Powder half a nyang of realgar and give it stirred into water; the worm comes out of itself. Throw it into boiling oil, discard it in a river, and the illness is cured at once.

Clinical note임상 주석

This is the one section of the chapter that is closer to fact than to theory. A mass of swallowed hair in the stomach is a **trichobezoar**, and it is entirely real: hair is keratin and is not digested, so repeatedly swallowed hair mats into a felted cast that takes the shape of the stomach. Where a tail of the mass extends through the pylorus into the small bowel the eponym is Rapunzel syndrome. It is associated with trichotillomania and trichophagia — hair-pulling and hair-eating — and so is found most often in adolescent girls and in patients with intellectual disability or an eating disorder. The presentation the text gives fits as well. A gastric bezoar causes early satiety, epigastric fullness, nausea and vomiting, and oil would genuinely ease matters for a time by lubricating a partly obstructed outlet, which is why the man felt well only while he kept drinking it. Complications are gastric ulceration and bleeding from pressure on the mucosa, perforation, and small-bowel obstruction from a migrating fragment. The treatment is removal — endoscopic where the mass is small enough, surgical where it is not, with attention to the underlying hair-eating afterwards, since bezoars recur. Realgar does not dissolve keratin and nothing taken by mouth will. **Realgar (雄黃) is arsenic sulfide and is poisonous. This must not be prepared.** The two case records that follow, and the chicken mass of 4.1.4, are also carried in 蟲門 14.7 諸物變蟲, where the same stories are collected as things that turn into worms.

Deukhyo 得效

4.1.3.2

Source원문

一道人心腹煩滿, 彌二歲. 甄立言診曰, 腹有蠱, 誤食髮而然. 令餌雄黃一劑, 少頃吐一蛇, 無目, 燒之有髮氣, 乃愈. 《入門》

Translation영역

A Daoist had vexing fullness in the heart and belly which went on for two full years. Zhen Liyan examined him and said: there is a gu in the belly, and it comes of having swallowed hair by mistake. He had him take a single dose of realgar, and after a little while he vomited a snake with no eyes; when it was burnt it smelt of hair, and he was cured.

Clinical note임상 주석

The decisive observation is in the last clause: burnt, the thing smelt of hair. Keratin burns with a characteristic acrid smell quite unlike burning flesh, and the physician who made that test and recorded the result had, by his own evidence, a mass of hair in his hands and not a snake. That the thing had no eyes points the same way. This is a trichobezoar, correctly attributed to swallowed hair and correctly treated by getting it out, and the two-year history of epigastric fullness is what a long-standing gastric bezoar does. The same case is recorded in 蟲門 14.7 諸物變蟲, there attributed to 醫說. Zhen Liyan was a Tang physician, brother of Zhen Quan. **Realgar (雄黃) is arsenic sulfide and is poisonous. This must not be prepared.** Expulsion was the right aim and the wrong means; a gastric bezoar is removed endoscopically or surgically.

Immun 入門

4.1.3.3

Source원문

一人患腰痛牽心, 每發輒氣欲絶, 衆以爲肉癥. 徐文伯視之曰, 此髮瘕也. 以油投之, 卽吐物如髮, 稍引之長三尺, 頭已成蛇能動. 掛門上滴盡, 惟一髮而已. 《入門》

Translation영역

A man suffered lumbar pain that dragged at the heart, and at every attack his breath seemed about to fail. Everyone took it for a flesh mass. Xu Wenbo examined him and said: this is a hair mass. He gave him oil, and he at once vomited a thing like hair; drawn out a little it was 3 ja long, and its head had already become a snake and could move. Hung up on a door until it had finished dripping, it was nothing but a single hair.

Clinical note임상 주석

The ending is the point, and the physician states it himself: hung up and allowed to drain, the thing was 惟一髮而已 — nothing but a hair. The snake-like head is how a felted hair mass looks when it is drawn out of the mouth, with the bulk of the cast leading and a tapering tail behind, and the apparent movement is the oil-soaked mass settling as it hangs. A trichobezoar 3 ja long is large but not impossible; a Rapunzel-type mass can occupy the whole stomach and trail through the duodenum into the jejunum. Note that the correct diagnosis was made against the room: 衆以爲肉癥 — everyone else called it a flesh mass, the entity of 4.1.1 — and Xu Wenbo named it from the history of hair-eating. The pain in the loin dragging at the heart is less easy to place, and may belong to a separate complaint. This case is also in 蟲門 14.7 諸物變蟲 (there in a shorter form, with 掛門下 for 掛門上 and no attribution) and again in 胸門 among the simple medicinals under 脂麻油, attributed to 本草. Oil by mouth will not clear a bezoar, and giving it to a patient who is retching risks aspiration; the treatment is removal.

Immun 入門

4.1.3.4

Source원문

一婦人病胸膈不利, 口流涎沫, 自言咽下胃中常有雷聲, 心膈微痛, 時復發昏. 鍼灸藥餌三載不愈. 戴人用痰藥, 一涌而出雪白蟲一條, 長五六寸, 有口鼻牙齒, 走於涎中. 病者惡而斷之, 中有白髮一莖, 此髮瘕也. 《子和》

Translation영역

A woman was ill with the chest and diaphragm not free, with drool and foam running from the mouth. She said herself that below the throat, in the stomach, there was always a sound like thunder, with slight pain at the heart and diaphragm, and from time to time she would faint. Needling, moxa and medicines over three years did not cure her. Master Dai used a phlegm drug, and at one heave out came a snow-white worm, five or six chon long, with mouth, nose and teeth, moving about in the drool. The patient, disgusted, cut it in two, and inside it was a single white hair. This was a hair mass.

Clinical note임상 주석

The hair is inside the thing, and that is what settles it for the compiler: cut open, the white worm turns out to have a hair at its core. On the modern reading the relation is the other way round — the hair is the nucleus and the rest is the mucus and food debris felted around it, which is exactly how a small bezoar forms and why the cut surface shows a hair running through the middle. Three features of the history are worth having. The rumbling in the stomach that the patient could hear herself is the succussion sound of fluid and gas held above a narrowed gastric outlet; the drooling and foaming is the hypersalivation that goes with chronic nausea and with anything held at the oesophagogastric junction; and the three years of failed needling, moxa and medicines is the natural history of an unrecognized mechanical obstruction, which does not respond to anything except removal. The fainting may be vasovagal, from retching, or from the anaemia that gastric erosion over a bezoar can produce. Compare 4.1.14 遍身波浪聲, where a fluid sound in the body is treated as its own disease. Here the sound is incidental to the obstruction, and the right answer to both is to look for the fluid and the thing holding it up.

Jahwa 子和

4.1.4 Chicken Mass 雞瘕

4.1.4.1

Source원문

褚澄爲吳郡太守, 李道念到郡, 澄見謂曰, 汝有重病. 荅曰, 舊有冷病, 今五年矣. 澄爲診曰, 汝病非冷非熱, 當是食白瀹雞子過多所致. 令取蒜一升煮服之, 乃吐一物如升大, 有涎裹之, 開看則是雞雛, 翅羽爪距悉具, 能行走. 澄曰, 此未盡. 令更服藥, 又吐如向者十三頭而安. 《醫說》

Translation영역

Chu Cheng was Governor of Wu commandery. When Li Daonian came to the commandery, Cheng saw him and said: you have a grave illness. He answered: I have had a cold illness for a long while, five years now. Cheng examined him and said: your illness is neither cold nor heat; it must come of eating too many plain-boiled hen's eggs. He had him take 1 seung of garlic, boiled, and drink it, whereupon he vomited a thing the size of a seung measure, wrapped about with slime. Opened and looked at, it was a chick, with wings, feathers, claws and spurs all complete, and able to walk about. Cheng said: this is not all of it. He had him take the medicine again, and he vomited thirteen more of the same as before, and then was well.

Clinical note임상 주석

瘕 is an abdominal mass, and in this group of four sections (4.1.4 to 4.1.7) the names are aetiological, not descriptive. The reasoning in each is the same: the patient ate a particular thing, the thing is held to have taken root and grown inside him, and the mass is then named after it. What the physician could actually establish was a history of eating and a lump in the abdomen; the chick, the dragon spawn, the snake and the turtle are the theory of cause, not an observation of a creature. An abdominal mass is, in fact, a tumour (benign or malignant), an organ enlarged (liver, spleen, kidney), a cyst, an aneurysm, a loaded or obstructed bowel, a collection of pus, or a pregnancy. None of these is produced by eating eggs, and a live chick with feathers, claws and spurs cannot be vomited by a human being; thirteen more after it removes any remaining question about what kind of record this is. What survives scrutiny is the clinician's move, which is a good one: he rejected the label the patient had carried for five years (舊有冷病 — a cold illness), said the illness was neither cold nor heat, and went back to the dietary history. Chu Cheng was a fifth-century physician of the Southern Qi. The same case stands in 蟲門 14.7 諸物變蟲 in a shorter form attributed to 本草, and the chapter there collects it with the hair masses of 4.1.3. A seung of boiled garlic is a large dose of an irritant on an empty stomach and will cause vomiting and epigastric burning, which is the whole of its action here.

Uiseol 醫說

4.1.5 Dragon Mass 蛟龍瘕

4.1.5.1

Source원문

春秋二時, 龍帶精入芹菜中, 人偶食之得病, 發則似癎, 面色靑黃, 腹滿痛不可忍, 名爲蛟龍病. 取飴糖二三升, 日兩度服, 吐出如𧋍蜴三五枚卽差.

Translation영역

In the two seasons of spring and autumn, dragons carry their essence into the water-celery, and a man who happens to eat it contracts the disease. When it breaks out it resembles epilepsy: the face is blue-yellow, and the belly is full with pain beyond bearing. It is called dragon disease. Take 2 or 3 seung of malt sugar twice a day, and when he has vomited up three or five things like lizards he is cured.

Clinical note임상 주석

Of the four creature-named masses this is the one that may have something behind it, and the reason is the route of infection the text gives. 芹菜 is water-celery, a plant of ditches and standing water, and eating raw water-plants gathered from still water is exactly how human **fascioliasis** is acquired: the liver fluke Fasciola hepatica encysts as metacercariae on watercress and similar plants, and the cysts are swallowed with the leaves. The acute phase, as the immature flukes migrate through the liver, gives fever, right upper abdominal pain, tender hepatomegaly and marked eosinophilia; the later biliary phase gives obstructive jaundice and colic. Severe, unbearable abdominal pain in someone who has eaten raw water-plants is therefore a real clinical association. This has to be offered as a possibility and not as a fact. Nothing in the passage names the liver, reports fever or describes jaundice, and the seasonal story about dragons is a seasonal story about dragons; it is also true that the time of year given, spring and autumn, is when the plants are gathered and when metacercarial contamination is highest. If the identification is right, the things vomited are not the parasite — adult Fasciola live in the bile ducts and are not vomited — and the treatment is triclabendazole, with praziquantel ineffective against this fluke. Malt sugar is harmless and inert here. The resemblance to epilepsy (發則似癎) is more likely the writhing and collapse of severe visceral colic than a true seizure.

Junggyeong 仲景

4.1.5.2

Source원문

蛟龍子生在芹菜中, 食之入腹變成龍子. 用餳糖ㆍ粳米ㆍ杏仁ㆍ乳餠煮粥, 食之三升, 日三服, 吐出蛟龍子, 有兩頭可驗. 《伸景》

Translation영역

Dragon spawn lives in the water-celery, and when eaten it goes into the belly and turns into young dragons. Boil a gruel of malt sugar, polished rice, apricot kernel and milk curd, and have him eat 3 seung of it, three doses a day. When the dragon spawn is vomited up, it can be recognized by its having two heads.

Clinical note임상 주석

The two-headed appearance offered as the confirming sign is worth noting for what it shows about the method. The diagnosis was to be verified by inspecting what came up, and a criterion was fixed in advance; it is the same procedure as the salted specimen in 4.1.2 and the burnt mass in 4.1.3, and it is recognizably an attempt at evidence. The difficulty is that the criterion was chosen to fit the name rather than the other way round, so anything with a thickening at both ends would satisfy it. Apricot kernel (杏仁) contains amygdalin, which releases cyanide on hydrolysis. **Bitter apricot kernel is toxic in quantity and has caused fatal cyanide poisoning; it must not be taken in bulk, and this preparation must not be prepared.** The rest of the gruel is food. If the condition behind this section is fascioliasis, nothing in either passage treats it, and the modern treatment is triclabendazole.

Junggyeong 仲景

4.1.6 Snake Mass 蛇瘕

4.1.6.1

Source원문

華佗行道, 見車載一人, 病噎塞, 食不下, 呻吟. 佗曰, 餠店家蒜虀大酢三升, 飮之當自痊. 如言服之, 果吐大蛇一枚而愈. 《本草》

Translation영역

Hua Tuo, travelling on the road, saw a man being carried in a cart, ill with choking blockage so that food would not go down, and groaning. Tuo said: 3 seung of the garlic-pickle vinegar from the cake shop; drink it and he will recover of himself. He took it as directed, and sure enough vomited a great snake and was cured.

Clinical note임상 주석

The complaint is described precisely and is not strange at all. 噎塞, 食不下 is dysphagia — food will not pass — and a patient too ill to walk, carried in a cart and groaning, has had it long enough to be exhausted by it. In a middle-aged or older adult, progressive dysphagia for solids is oesophageal carcinoma until proved otherwise; the other substantial causes are a benign stricture (usually peptic), achalasia, and an impacted foreign body or food bolus. Only the last of those can be cured by what is described. A bolus impacted above a narrowing can be dislodged by vomiting, and a large volume of strong vinegar on an empty stomach will certainly provoke that, so a one-off cure of this kind is possible where the obstruction was a bolus. Whatever came up was not a snake. **Three seung of strong vinegar is a large volume of acid; in a patient with an obstructed oesophagus, provoking vomiting against a blockage risks oesophageal perforation (Boerhaave syndrome) and aspiration, both of which can kill. This must not be prepared.** Dysphagia is investigated now by endoscopy, and a food bolus is removed endoscopically.

Boncho 本草

4.1.6.2

Source원문

一人常飢, 呑食則下至胸便卽吐出. 醫作噎膈治不效. 任度曰, 此因食蛇肉不消而致斯病, 但揣心腹土有蛇形也. 視之果然. 遂用硝黃合而服之, 微利卽愈. 《入門》

Translation영역

A man was always hungry; when he swallowed food it went down as far as the chest and was at once brought back up. A physician treated it as choking blockage, without effect. Ren Du said: this illness comes of eating snake flesh that was not digested; only palpate over the heart and belly, and there is the shape of a snake. They looked, and so it was. He then used mirabilite and rhubarb combined and gave it, and with a mild purge the man was cured.

Clinical note임상 주석

Constant hunger with immediate regurgitation of everything swallowed, the food reaching only as far as the chest, is the picture of an obstruction at the level of the oesophagus or the oesophagogastric junction: the patient is starving because nothing gets through. Achalasia produces exactly this, including the hunger and the regurgitation of undigested food shortly after swallowing, and so does a stricture or a tumour at the cardia. The first physician's label, 噎膈, was in fact the right one, and the second opinion recorded here as a success replaced a correct diagnosis with a story about snake flesh. The palpable 蛇形 is not a snake. A firm, elongated mass felt in the epigastrium is a real finding and a serious one — a gastric or pancreatic tumour, an enlarged left lobe of liver, a loaded colon — and naming it after what the patient was supposed to have eaten closes off the question. That the onlookers then confirmed it (視之果然) shows how the naming worked: once told what to feel for, they felt it. **硝黃 is mirabilite (芒硝) with rhubarb (大黃), a saline and stimulant purgative combination. Purging a patient who cannot swallow and is already starved risks dangerous dehydration and electrolyte loss, and it does nothing to an obstruction above the stomach. This must not be prepared.** Oesophageal obstruction is investigated by endoscopy and treated according to cause.

Immun 入門

4.1.7 Turtle Mass 鼈瘕

4.1.7.1

Source원문

人食鼈肉不消成瘕, 伏在心下, 揣見頭足, 時時轉動作痛. 白馬尿飮之卽消. 昔有人與奴俱得此病, 奴先死, 剖其腹得鼈, 置庭中. 有乗白馬客來看, 其馬放尿鼈上, 卽便消化. 其主知其奇效, 取飮之卽愈.

Translation영역

When a man eats soft-shelled turtle flesh and it is not digested, it forms a mass that lies hidden below the heart; on palpation its head and feet can be made out, and from time to time it turns about and causes pain. Give white horse's urine to drink and it dissolves at once. Formerly a man and his servant both contracted this illness. The servant died first, and when his belly was opened a turtle was found and set down in the courtyard. A visitor came on a white horse to look at it, and the horse made water on the turtle, which immediately dissolved away. The master, learning of this remarkable effect, took the urine and drank it, and was cured at once.

Clinical note임상 주석

The anecdote is an aetiological story told backwards from the remedy: the cure is known first, and the dissection and the horse are supplied to explain why it works. The one detail that reports an observation is the autopsy — a mass was found in the abdomen of a man who had died of it — and that is consistent with any solid abdominal tumour. A mass below the heart in which a head and limbs can be felt, and which moves and causes intermittent pain, is also how a large, mobile intra-abdominal mass behaves on examination: a bosselated or lobulated surface gives the impression of parts, and transmitted intestinal movement gives the impression of life. An abdominal mass is a tumour, an enlarged organ, a cyst, an aneurysm, a loaded or obstructed bowel, an abscess or a pregnancy. Eating turtle does not produce one, and nothing dissolves a mass from the inside. The mass that killed the servant was almost certainly a malignancy or an obstruction, and the master's recovery, if it happened, says nothing about the urine. **White horse's urine is a raw animal excretion. Swallowing it carries a real risk of bacterial infection and it has no therapeutic action. This must not be prepared.** A palpable abdominal mass today calls for imaging and tissue diagnosis, not for a remedy aimed at dissolving it.

Jonghaeng 種杏

4.1.7.2

Source원문

白雌雞一隻, 勿與食令飢, 過一宿. 明日以猪脂煎飯喂之, 取其屎熬乾爲末, 白湯調下一錢, 日三服. 須消盡乃止, 好了殺雞食之. 《種杏》

Translation영역

Take one white hen, give her nothing to eat so that she goes hungry, and leave her overnight. The next day feed her rice fried in pig fat; take her droppings, parch them dry and powder them, and give 1 don at a dose stirred into plain hot water, three doses a day. Continue until the mass has entirely dissolved, then stop; when he is well, kill the hen and eat her.

Clinical note임상 주석

The procedure is elaborate and its logic is sympathetic rather than pharmacological — the hen is starved and then fed fat so that her droppings will carry the power to consume flesh — and the last instruction, to kill and eat the hen once the patient is well, belongs to the same reasoning. **Chicken droppings are faecal material. Swallowing them carries a serious risk of Salmonella, Campylobacter and other enteric infection, and parching does not reliably sterilize them. This must not be prepared.** There is no mechanism by which any oral powder dissolves an abdominal mass; the instruction to continue until the mass is gone means in practice continuing indefinitely.

Jonghaeng 種杏

4.1.8 Clam-Essence Disease 蛤精疾

4.1.8.1

Source원문

一人患脚跟腫痛, 諸醫莫識. 徐之才曰, 蛤精疾也, 由乗舩入海, 垂脚水中而得. 爲剖出二蛤而愈. 《入門》

Translation영역

A man suffered swelling and pain of the heel, and no physician could identify it. Xu Zhicai said: this is clam-essence disease; he got it from going out to sea in a boat and letting his legs hang down in the water. He cut it open, took out two clams, and the man recovered.

Clinical note임상 주석

What this was cannot be determined, and it is better to say so than to choose among the candidates. Swelling and pain of the heel has a long differential — plantar fasciitis, retrocalcaneal or Achilles bursitis, a calcaneal stress fracture, gout, osteomyelitis, an abscess, a foreign-body granuloma, and in a patient who has been in warm sea water a marine-organism puncture or a Mycobacterium marinum infection — and the record gives a single sign, a travel history and an outcome. Nothing in it chooses. The one part of the account that is mechanically plausible is the operation. Incising a swollen, painful heel and removing something releases pus or a foreign body, and relief follows; that is how an abscess or a retained fragment behaves, and it is the standard treatment for both. Two clams did not grow in a man's heel. If anything solid really was taken out, a foreign body driven in while his feet trailed in the water is the reading that fits the history the physician himself elicited, and it may be that he was right about the cause and wrong about what he removed. Xu Zhicai was a sixth-century Northern Qi physician, and the chapter quotes him twice more (4.1.9 and, in the same vein, the case he names there). The method on display in both — take a history, find the exposure, act on it — is better than the diagnosis it produced.

Immun 入門

4.1.9 Seeing Things of Five Colours 眼見五色物

4.1.9.1

Source원문

一人酒色過度, 眼見空中有五色物, 稍近變成一美婦人, 亭亭而立. 徐之才曰, 此色慾多, 大虛所致. 乃處補藥飮之, 數劑而愈. 《入門》

Translation영역

A man was excessive in wine and in sex, and his eyes saw things of five colours in the air; as they drew nearer they turned into a beautiful woman, standing there slender and erect. Xu Zhicai said: this comes of too much sexual desire, and of great depletion. He accordingly prescribed a supplementing medicine for him to drink, and after several doses he was cured.

Clinical note임상 주석

Two different things are described, and they should be separated. Seeing colours — **chromatopsia** — is a real symptom with real causes: retinal disease, optic neuritis and other optic-nerve disease, occipital lesions, migraine aura, and drugs, of which digitalis is the classic, giving xanthopsia, a yellow cast to vision. Sildenafil-type drugs give a blue tinge, and so do some antibiotics and antiepileptics. Colour vision that goes wrong is a sign to be investigated, not a curiosity. The formed figure is a different phenomenon. A complex, fully realized visual hallucination of a person is not a disorder of the eye at all; in a heavy drinker it points first to alcohol withdrawal — alcoholic hallucinosis, or the visual hallucinations of delirium tremens, which can be detailed and are often of people or animals — and otherwise to delirium from any cause, to Lewy body disease, to seizures arising in the temporal or occipital lobe, and to Charles Bonnet syndrome, where vivid formed hallucinations occur in people with poor sight and an intact mind. The sequence the text reports, coloured shapes resolving into a figure as they approach, would fit a migraine aura evolving, or an evolving withdrawal state. Given 酒色過度, withdrawal in a heavy drinker is the reading to take most seriously, and it is the one that matters clinically: untreated delirium tremens has significant mortality and is a medical emergency treated with benzodiazepines and thiamine. The physician's own analysis is not far off in form — he attributed it to depletion from excess and treated by supplementation, which is at least aimed at the patient rather than at the eye — but a supplementing decoction is not a treatment for any of the above.

Immun 入門

4.1.10 Seeing Things Upside Down 視物倒植

4.1.10.1

Source원문

一人因大醉極吐, 熟睡至次早, 眼中視物皆倒植. 醫者診其脉, 左關浮促, 遂用瓜蔕ㆍ藜蘆, 平旦吐之, 視物如常. 盖傷酒吐時, 上焦反覆, 致倒膽府, 故視物皆倒, 法當復吐, 以正其膽, 則自愈. 《入門》

Translation영역

A man, from being heavily drunk, vomited violently, then slept soundly until the next morning, when everything his eyes saw was upside down. The physician examined his pulse and found the left bar position floating and hurried, and accordingly used melon pedicle and veratrum to make him vomit at daybreak, after which he saw things as usual. The explanation is that when he was injured by wine and vomited, the upper burner was turned over, and this overturned the Gallbladder; hence everything he saw was inverted. The method is to make him vomit again, so as to set his Gallbladder upright, and then he recovers of himself.

Clinical note임상 주석

This is a real phenomenon and it is not a disease of the eye. Inversion or reversal of the visual scene — the **room-tilt illusion** when it is partial, reversal of vision when the image is turned through 180 degrees — is a disorder of the brain's internal reference for which way is up, built from vestibular, visual and proprioceptive input. It is reported with lesions of the brainstem and the vestibular pathways, with posterior circulation stroke and vestibular neuritis, with multiple sclerosis plaques in the brainstem, with parietal lesions, and with migraine; episodes are usually brief, lasting seconds to minutes, though they can persist for hours or days. The setting the text gives is the right setting to be alarmed by. Heavy alcohol intake followed by violent vomiting and then a new neurological sign on waking raises three things in particular: Wernicke's encephalopathy, which classically follows vomiting in a thiamine-depleted drinker and presents with eye-movement abnormalities, ataxia and confusion, and which is an emergency treated with parenteral thiamine; posterior circulation ischaemia, since the brainstem is where the gravitational reference lives; and acute vestibular dysfunction, which alcohol itself produces. The one reassuring feature is that it resolved by the following morning. The physician's reasoning is internally consistent and wholly mistaken — the upper burner is held to have been turned over by the vomiting, inverting the Gallbladder, so a second vomit is used to turn it back — and the treatment is actively harmful. **Veratrum (藜蘆) is a violent emetic and is cardiotoxic, causing bradycardia, hypotension and arrhythmia; melon pedicle (瓜蔕) is also a harsh emetic. Deliberately inducing vomiting in a patient who has just vomited to exhaustion, and who may be thiamine-depleted or bleeding from a Mallory-Weiss tear, is dangerous. This must not be prepared.**

Immun 入門

4.1.11 Limbs Hard as Stone 四肢堅如石

4.1.11.1

Source원문

寒熱不止, 經日後四肢堅如石, 以物撃之一似鍾磬聲, 日漸瘦弱. 吳茱萸ㆍ木香等分, 剉煎湯飮之自愈. 《得效》

Translation영역

Cold and heat that do not cease; after some days the four limbs become hard as stone, and when struck with something they give out a sound like a bell or a chime-stone. Day by day the patient grows thin and weak. Evodia and costus root in equal parts, cut up and decocted and drunk, and he recovers of himself.

Clinical note임상 주석

We cannot know what this was. The components of the description are each ordinary — persisting fever with chills, hardening of the limbs, and progressive wasting — but the one that would fix the diagnosis, limbs that ring like a bell when struck, is not something any disease does, and it is the sign the section is named for. Generalized hardening of the limbs is a real finding, and the conditions that cause it include systemic sclerosis, scleromyxoedema, eosinophilic fasciitis, chronic lymphoedema with fibrosis, and the heterotopic bone of fibrodysplasia ossificans progressiva; calcinosis and calciphylaxis can make tissue genuinely stony to the touch. Several of these come with constitutional illness and weight loss, so a febrile, wasting patient with hardening limbs is not an impossible case. But a single sentence does not distinguish between them, and the resonant note turns the whole account into something nobody can now examine. Forcing a label onto it would be an invention. Evodia and costus root are warming, aromatic, qi-moving drugs — the standard answer for cold pain in the abdomen — and the prescription appears to be reasoning from 寒 in the presenting line rather than from anything in the limbs. Neither drug affects fibrosis, calcification or heterotopic bone.

Deukhyo 得效

4.1.12 Shrimp-Fish Coming to Life 化生鰕魚

4.1.12.1

Source원문

口鼻腥臭水流, 以椀盛之, 有鐵色鰕魚如粳米大, 走躍不住, 以手捉卽化爲水. 此肉壞也. 任意飡食雞肉自愈. 《得效》

Translation영역

Rank, fishy-smelling water runs from the mouth and nose; caught in a bowl, there are iron-coloured shrimp-fish the size of grains of polished rice, darting and leaping without stopping, and when taken in the hand they turn at once into water. This is the flesh decaying. Let him eat chicken freely as he pleases, and he recovers of himself.

Clinical note임상 주석

We cannot know what this was, and here the reason is in the description itself: creatures that move until touched and then become water are not creatures, so the central observation cannot be taken at face value and there is nothing left to diagnose from. The part that may be an observation is the discharge — foul, fishy-smelling fluid running from the mouth and nose. That is a real and recognizable complaint, and the things that produce it are chronic purulent rhinosinusitis, a nasal foreign body or a nasal tumour, atrophic rhinitis with ozaena, an oroantral or palatal fistula, bronchiectasis or a lung abscess with foul sputum, and in children a retained foreign body. Any of these could put a bowlful of malodorous fluid in front of an observer. What was then seen in the bowl — iron-coloured, rice-grain-sized, mobile — is more likely to have been debris, clots, casts or sediment moving in disturbed liquid than anything alive. The compiler's own reading, 此肉壞也 — this is the flesh decaying — is at least an attempt to account for the smell, and foul discharge genuinely does signal tissue breakdown and anaerobic infection. Eating chicken freely is not a treatment for it. The honest conclusion is that a patient with a foul discharge was described in terms that make his illness unrecoverable.

Deukhyo 得效

4.1.13 Belly Hard as Iron and Stone 腹如鐵石

4.1.13.1

Source원문

腹中如鐵石, 臍中水出, 旋變作蟲行之狀, 遶身咂啄, 痒痛難忍, 撥掃不盡. 用濃煎蒼朮湯浴之, 以蒼朮末入麝香少許, 水調服之而痊. 《得效》

Translation영역

The inside of the belly is like iron and stone, and water comes out from the navel, which presently turns into the appearance of crawling worms that go round the body sucking and pecking, with itching and pain beyond bearing, and they cannot be brushed or swept away. Bathe him in a strong decoction of atractylodes, and give atractylodes powder with a little musk added, stirred into water, and he recovers.

Clinical note임상 주석

We cannot know what this was, but two of the three findings are real and serious, and they belong together. A belly hard as iron and stone is a rigid or grossly distended abdomen — tense ascites, a large tumour or mass, or the board-like rigidity of peritonitis. Water issuing from the navel is also a genuine sign: in tense ascites the umbilicus is the weakest point of the abdominal wall, and fluid can leak or frankly rupture through it, which is a recognized complication of cirrhotic ascites and a medical emergency because of the risk of peritonitis. An umbilical discharge can also come from a patent urachus or vitelline duct remnant, or from an infected umbilical hernia or sinus. A hard belly with fluid leaking at the navel is therefore a coherent and ominous picture. The third finding is not interpretable. Sensations of things crawling and biting over the skin, with unbearable itching and nothing to be found or brushed off, is formication, and it occurs in delirium, in alcohol and drug withdrawal, in uraemia and liver failure, in diabetic and other neuropathies, in thyroid disease, and in delusional infestation. In a patient with decompensated liver disease — which the first two findings would fit — hepatic encephalopathy with tactile hallucinations would tie the whole picture together, but that is a reconstruction and not something the record establishes. The treatment does not address any of it. **Musk (麝香) comes from the musk deer, a CITES-listed protected species; its trade is restricted and it must not be used.** Atractylodes, internally and as a bath, has no action on ascites or on an abdominal mass. Leaking ascites at the navel is treated by draining the fluid under controlled conditions, treating the underlying liver disease, and covering for peritonitis.

Deukhyo 得效

4.1.14 Sound of Waves Through the Body 遍身波浪聲

4.1.14.1

Source원문

遍身忽皮底渾渾如波浪聲, 痒不可忍, 搔之血出, 謂之氣奔. 人參ㆍ苦杖ㆍ靑鹽ㆍ細辛各一兩. 剉作兩貼, 每一貼水煎服, 便愈. 《得效》

Translation영역

All over the body, suddenly, beneath the skin there is a confused rushing like the sound of waves; the itch cannot be endured, and scratching it draws blood. This is called qi racing (氣奔). Ginseng, bushy knotweed, blue rock salt and asarum, 1 nyang each. Cut them up and make two packets; for each packet decoct in water and take it, and it is cured at once.

Clinical note임상 주석

Two different observations are run together under one name. A fluid sound that can genuinely be heard or felt belongs to a collection of fluid, and there are two bedside signs that produce exactly this: ascites, where a tap on one flank sends a palpable thrill across to the other hand, and gastric outlet obstruction, where shaking the trunk produces a succussion splash from stomach contents still retained hours after a meal. Both are real, both are still taught, and neither itches. The other half of the description — an itch that cannot be endured, with bleeding where the patient has scratched — is the commonest complaint in dermatology and carries no single cause. What the text has done is to bind a sound it could not account for to an itch it could, under the one heading 氣奔, qi racing. Whether one patient had both, or whether the two halves come from separate reports, cannot be recovered from three lines. **Asarum (細辛) contains aristolochic acid, a nephrotoxin and a Group 1 carcinogen that causes irreversible kidney failure and urothelial cancer. It must not be taken internally.** The decoction as written is to be swallowed, and this one is not a matter of dose.

Deukhyo 得效

4.1.15 Mottled Hair Coming Out on the Body 身出斑毛

4.1.15.1

Source원문

眼赤鼻張大喘, 渾身出斑毛, 髮如銅鐵, 乃目中熱毒氣結於下焦. 白礬ㆍ滑石各一兩. 爲末, 水煎服, 不住乃安. 《得效》

Translation영역

The eyes are red, the nostrils flared and the breathing greatly laboured; mottled hairs come out over the whole body and the hair is like bronze or iron. This is heat toxin qi in the eye binding in the lower burner. Alum and talc, 1 nyang each. Powder them, decoct in water and take without stopping, and it settles.

Clinical note임상 주석

The first clause is the one part of this that a clinician would recognize at once. Red eyes, flaring of the nostrils and laboured breathing are the signs of respiratory distress, and nasal flaring in particular is still used as a marker of increased work of breathing. Someone was seriously short of breath. What follows cannot be placed. 渾身出斑毛髮如銅鐵 can be read two ways — mottled hairs coming out with the hair hard as metal, or blotches coming out with the body hair hard as metal — and neither reading corresponds to anything described since. Hair does not become metallic, and no disease makes new mottled hair erupt over the body in the course of an acute illness. We cannot tell what this was. The honest position is that a breathless patient was seen, something about his skin and hair struck the observer as extraordinary, and the record of it is too compressed to interpret. The aetiology offered — heat toxin in the eye binding in the lower burner — is reasoning from the red eyes outward, not an observation. Alum and talc by mouth have no action on breathlessness; alum is an astringent irritant that provokes vomiting in quantity, and neither should be swallowed as prescribed here.

Deukhyo 得效

4.1.16 Breaking Down of the Ten Fingers 十指斷壞

4.1.16.1

Source원문

手十指節斷壞, 惟有筋連, 無節肉, 蟲出如燈心, 長數尺餘, 遍身綠色, 名曰血餘. 赤茯苓ㆍ胡黃連煎湯飮之, 自愈. 《得效》

Translation영역

The joints of the ten fingers of the hand break down, only the sinews remaining to join them, and there is no flesh at the joints; worms come out like lamp-wick, several ja and more in length, and the whole body is green in colour. It is called blood remainder (血餘). Decoct red poria and Picrorhiza and drink the decoction, and it heals of itself.

Clinical note임상 주석

The first half of this is a real clinical picture, and a terrible one. Fingers that break down joint by joint, with the soft tissue gone and only sinew holding the digit on, is the end point of either of two processes. One is critical ischaemia: digital gangrene from vasculitis, embolism, severe Raynaud phenomenon or frostbite, in which the tissue dies from the tip back. The other is an advanced neuropathic process, where a hand that cannot feel is injured and reinjured without the patient noticing, and the joints destroy themselves — leprosy is the classic cause of fingers lost in exactly this way, and diabetes and syringomyelia do it too. These are possibilities to hold open, not labels to attach; the text gives no duration, no pain, no mention of sensation, and without those the choice cannot be made. The rest does not belong to either. Worms like lamp-wick several ja long coming from the fingers, and a whole body turned green, have no counterpart, and they read like what the physician was told rather than what he examined. The name given, 血餘 — blood remainder — records the theory, not a finding. Red poria and Picrorhiza are a mild diuretic and a bitter heat-clearing drug. Against gangrene or a destroyed hand they do nothing, and the claim that it heals of itself is the formula of this chapter rather than an outcome.

Deukhyo 得效

4.1.17 Worms Like Crabs 有蟲如蟹

4.1.17.1

Source원문

有蟲如蟹走於皮下, 作聲如小兒啼, 爲筋肉之化. 雷丸ㆍ雄黃各一兩. 爲末, 糝於猪肉片, 火上灸熟食之, 自安. 《得效》

Translation영역

There are worms like crabs running beneath the skin, making a sound like an infant crying. It is a transformation of the sinews and flesh. Omphalia and realgar, 1 nyang each. Powder them, sprinkle the powder over slices of pork, roast them over the fire until done and eat them, and it settles.

Clinical note임상 주석

The sensation of something moving under the skin is a genuine symptom with a name — formication — and it has real causes: peripheral neuropathy, stimulant and alcohol withdrawal, drug effects, and delusional infestation, in which the conviction that creatures are present is itself the condition and is held with complete certainty. A patient describing crabs running beneath his skin would not have been inventing the feeling. The crying sound is another matter, and nothing accounts for it. We cannot tell what this was, and the two-line record does not allow a choice between a sensory symptom, a belief about its cause, and an account that has already passed through several mouths before it reached the page. The explanation offered — that the sinews and flesh have transformed into the creature — is the chapter's habitual move when a complaint fits nothing known. **Realgar is arsenic sulphide. It must not be prepared or taken, and heating it, as this recipe does over an open fire, drives off arsenic oxides that are then inhaled.** One nyang of it eaten on roast pork is a poisoning dose, not a remedy. Omphalia is an anthelmintic fungus and was chosen because the complaint was read as worms; it has no bearing on a sensation arising in the skin or the nerves.

Deukhyo 得效

4.1.18 Flesh Coming Out Like Awls 肉出如錐

4.1.18.1

Source원문

遍身忽然肉出如錐, 旣痒且痛, 不能飮食, 此名血壅. 若不速治, 潰而膿出. 赤皮葱燒灰, 和水淋洗, 喫豉湯, 自安. 《得效》

Translation영역

All over the body the flesh suddenly comes out like awls; it both itches and hurts, and he cannot eat or drink. This is called blood damming (血壅). If it is not treated quickly, it breaks down and pus comes out. Burn red-skinned scallion to ash, mix it with water and pour it over to wash the parts, and drink fermented soybean decoction; it settles.

Clinical note임상 주석

Sharp, projecting lesions over the whole body that itch, hurt and go on to suppurate could be any of a dozen things, and the text gives nothing to separate them — no distribution, no duration, no description of the skin between the lesions. Keratotic spines, a follicular eruption and a crop of early abscesses would all have looked like this to an observer reaching for a simile. We cannot tell what this was. What the passage does get right is the prognosis. A raised, painful skin lesion that is not dealt with and then breaks down with pus is the ordinary course of a skin infection becoming an abscess, and saying so — 若不速治, 潰而膿出 — is an accurate observation about timing, independent of whatever the eruption was. The treatment is a wash and a drink, and both are harmless. Scallion ash in water is alkaline and would sting on broken skin without doing much else; fermented soybean decoction is food. Neither drains an abscess, which is what the text's own prognosis calls for.

Deukhyo 得效

4.1.19 Blood Issuing from the Pores 毛竅血出

4.1.19.1

Source원문

遍身毛竅節次血出, 若不出, 皮膨脹如鼓, 須臾眼鼻口被氣脹合, 此名脉溢. 飮生薑汁一盞, 卽安. 《得效》

Translation영역

All over the body, blood issues from the pores one after another. If it does not come out, the skin swells and distends like a drum, and in a moment the eyes, nose and mouth are closed up by the swelling of the qi. This is called vessel overflow (脉溢). Drink 1 jan of fresh ginger juice and it settles at once.

Clinical note임상 주석

Haematohidrosis — blood appearing on intact skin, apparently through the sweat ducts — is a documented condition, with case reports in the modern literature, and it is extraordinarily rare. For almost any account of blood coming from the pores, a different explanation is more likely: blood tracking onto the skin from a source elsewhere, or a bleeding tendency showing itself at the skin. Scurvy produces perifollicular haemorrhage, bleeding around each hair follicle, which looks precisely like blood issuing from the pores and was common wherever fresh food was scarce. A platelet disorder, liver disease or disseminated intravascular coagulation will all bleed into the skin in a way an observer would describe this way. The second sentence has nothing behind it. Blood does not have to come out to prevent the skin inflating like a drum, and the face does not swell shut because blood was retained; that is the chapter's own physiology, reasoning backwards from the name it has given the case, 脉溢, vessel overflow. If a patient did swell and close up about the eyes, nose and mouth within minutes, that is angioedema or anaphylaxis, which is an emergency and is not related to bleeding at all. A cup of ginger juice does nothing for either half of the description. Where there is bleeding into the skin the question is what is causing it — which means a clotting screen, a platelet count and a look for scurvy or liver disease — and where there is rapid facial swelling with airway involvement the answer is adrenaline.

Deukhyo 得效

4.1.20 Cat's-Eye Sores on the Body 身生猫眼瘡

4.1.20.1

Source원문

面上及遍身生瘡, 似猫兒眼, 有光彩, 無膿血, 但痛痒不常, 久則透脛, 名曰寒瘡. 多喫魚ㆍ雞ㆍ韭ㆍ葱等物, 則自愈. 《得效》

Translation영역

On the face and over the whole body sores arise, resembling a cat's eye, with a lustre to them and without pus or blood, only hurting and itching inconstantly; after a long time they penetrate to the shin. It is called cold sore (寒瘡). Eat plenty of fish, fowl, garlic chives, scallion and the like, and it heals of itself.

Clinical note임상 주석

This one can be named with some confidence. A lesion with concentric rings — a dark or dusky centre, a pale ring around it and a red rim — is the target or iris lesion of erythema multiforme, and "cat's eye" is as good a description of it as the English "bullseye". The accompanying details fit: the face and the limbs are where erythema multiforme favours, the lesions are not pustular, so 無膿血 is correct, and the symptoms are more often burning or itching than pain. 有光彩, a lustre to them, is what a central blister on a target lesion looks like. Erythema multiforme is a hypersensitivity reaction rather than a disease in its own right, and the triggers matter clinically. Infection accounts for most of it, and herpes simplex is far and away the commonest — recurrent target lesions following cold sores are the classic pattern — with *Mycoplasma pneumoniae* next, especially in children. Drugs account for a minority. Most cases settle on their own in two to four weeks, which is why a text that recommended nothing in particular could record that it heals of itself. The thing to separate it from is Stevens-Johnson syndrome and toxic epidermal necrolysis, where mucosal involvement and skin detachment make it a medical emergency. The advice — eat plenty of fish, fowl, garlic chives and scallion — is dietary encouragement rather than treatment, and in a self-limiting eruption it would have done no harm and taken the credit. 久則透脛, that in time they penetrate to the shin, does not belong to erythema multiforme and may be a different case folded into the same entry.

Deukhyo 得效

4.1.21 Breath from the Mouth and Nose That Does Not Disperse 口鼻氣出不散

4.1.21.1

Source원문

口鼻中氣出, 盤旋不散, 凝如黑盖色, 過十日漸至肩胸, 與肉相連, 堅勝金鐵, 多因瘧後得之. 煎澤瀉湯, 日飮三盃, 五日乃愈. 《得效》

Translation영역

Breath issues from the mouth and nose, whirls about without dispersing, and congeals, black as the colour of a canopy. After ten days it reaches gradually to the shoulders and chest, joins with the flesh, and is harder than metal or iron. It is mostly contracted after a malarial fever. Decoct Alisma decoction and drink three cups a day; in five days it is cured.

Clinical note임상 주석

We cannot tell what this was, and it is worth saying so without hedging. Breath does not become visible, does not congeal, and does not harden onto the shoulders and chest. Something was seen or reported, but no part of the description can be matched to a finding — not a skin change, not a swelling, not a discharge. Attempts to turn it into a diagnosis require supplying every clinically useful detail from outside the text, which is the opposite of reading it. The one clause with any purchase is 多因瘧後得之 — that it mostly comes on after a malarial fever. That is an aetiological observation of the kind physicians actually make, and malaria was endemic and familiar, so a run of cases following it would have been noticed. What follows a severe malarial illness in fact is anaemia, an enlarged spleen and prolonged debility; none of that is what is described here, but the association tells us the physician was placing a baffling case after a recognized one, which is how this chapter works. 澤瀉湯 is left unlinked. The only 澤瀉湯 in the corpus is 正傳's formula for 子淋 in 婦人門, a quite different prescription for painful urination in pregnancy, and linking 得效's decoction to it would assert an identity the texts do not support. Here it is almost certainly nothing more elaborate than a decoction of Alisma, a diuretic.

Deukhyo 得效

4.1.22 Blisters Breaking Out Over the Whole Body 渾身生燎疱

4.1.22.1

Source원문

渾身生燎疱如甘棠梨, 每箇破出水, 內有石一片如指甲大. 疱復生, 抽盡肌膚肉, 不可治. 三稜ㆍ蓬朮各五兩. 爲末, 分三貼, 酒調服, 自愈. 《得效》

Translation영역

Over the whole body blisters break out like sweet crab-pears. Each one, when broken, lets out water, and within there is a stone, one piece the size of a fingernail. The blisters arise again and draw away the whole of the skin and flesh; this cannot be treated. Sparganium and zedoary, 5 nyang each. Powder them, divide into three packets, stir into wine and take; it heals of itself.

Clinical note임상 주석

The first part is consistent with a severe blistering eruption, and the details are the ones that matter in such a case. Blisters the size of a small pear are large — that is the scale of the bullae in bullous pemphigoid or in a severe drug reaction, rather than the small vesicles of eczema or chickenpox. That they fill with clear fluid, break, and then crop again is the course of an autoimmune blistering disease. 抽盡肌膚肉, the skin and flesh being drawn entirely away, is how extensive skin loss would be described by someone without a word for it, and extensive skin loss is exactly what makes toxic epidermal necrolysis and pemphigus lethal: the barrier goes, fluid and protein are lost, and infection follows. The text's verdict, 不可治, is not pessimism. It is what was true before fluid replacement, barrier care and immunosuppression existed. This is offered as a possibility and not as a label. The stone the size of a fingernail inside each blister cannot be accommodated by it, or by anything else; blisters do not contain stones. Either it is a mineral-looking crust being described from the inside of a dried bulla, or it is an addition the case acquired in transmission. The entry cannot be settled. Note what the passage does to itself. It declares the condition untreatable and then gives a prescription that heals of itself, in the same breath. Sparganium and zedoary are blood-breaking and mass-dispersing drugs, and 5 nyang of each divided into three doses is a large quantity of both; they have no action on a blistering eruption, and in a patient already losing fluid through denuded skin a strong purgative-adjacent preparation taken in wine is the wrong direction. The real treatment of extensive skin loss is fluid, temperature control, wound care and withdrawal of any drug that may have triggered it.

Deukhyo 得效

4.1.23 Doubling of the Body 人身作兩

4.1.23.1

Source원문

人自覺其形作兩人, 並卧, 不辨眞假, 不語, 問亦無對, 乃是離魂. 辰砂ㆍ人參ㆍ白茯苓濃煎湯服之, 眞者氣爽, 假者化也. 《得效》

Translation영역

A man perceives of himself that his form has become two persons, lying side by side, and he cannot tell the true one from the false. He does not speak, and when questioned makes no reply. This is the soul departing. Decoct cinnabar, ginseng and white poria into a thick decoction and give it; the true one's qi becomes clear and the false one dissolves.

Clinical note임상 주석

This is autoscopy, and it is one of the better-attested oddities in the whole chapter. Seeing a double of oneself is a recognized disorder of body representation, and it comes in degrees: autoscopy proper, in which the double is seen from one's ordinary position; heautoscopy, in which the patient cannot say which body he occupies; and out-of-body experience, in which the self is felt to be located outside the body altogether. The text's 不辨眞假 — not being able to distinguish the true from the false — is a precise description of the middle form, and it is the detail that makes this entry worth taking seriously. The lesions associated with it cluster at the temporoparietal junction, where visual, vestibular and proprioceptive information are integrated into a sense of where the body is; focal epilepsy arising there can produce it as a seizure phenomenon, and it is also reported with migraine, with stroke and tumour at that site, and with vestibular disturbance. The accompanying mutism and failure to answer questions are consistent with a seizure or a post-ictal state, which would also explain why the episode was discrete enough to be reported as a case. None of that is a diagnosis for this patient — the record gives no duration, no recurrence and no other neurological finding — but the phenomenon itself is real and has a known anatomy, and it does not need to be treated as a marvel. Today it would be investigated with a careful history, an EEG and imaging. The name 離魂, the soul departing, is the period's reading of it, and the prescription follows from the name rather than from the patient. **Cinnabar is mercuric sulphide. It must not be prepared or taken; mercury accumulates and damages the kidneys and the nervous system, and giving it to someone with a neurological disturbance makes that disturbance worse.** Ginseng and white poria are inert in this setting. The closing sentence, that the true one's qi clears and the false one dissolves, is a statement about the theory rather than about an outcome.

Deukhyo 得效

4.1.24 Sores Like Cherries 生瘡如櫻桃

4.1.24.1

Source원문

項上生瘡如櫻桃大, 有五色, 瘡破則項皮斷. 但逐日飮牛乳, 自消. 《得效》

Translation영역

On the nape sores arise the size of cherries, having five colours; when the sore breaks, the skin of the nape parts. Simply drink cow's milk day after day and they disperse of themselves.

Clinical note임상 주석

We cannot tell what this was. A cherry-sized lesion on the back of the neck that breaks down and leaves the skin parted is a shape and a site, not a disease, and the only other descriptor given — 有五色, that it has five colours — is a formula from the five-phase vocabulary rather than an observation a dermatologist could use. The nape is a site where a great many things happen, from boils and carbuncles, which are common there, to lymphadenopathy and to tumours, and nothing here chooses between them. It is worth resisting the pull of the obvious guess. A suppurating nodule at the back of the neck that ruptures is what a carbuncle does, and the entry would read plausibly as one — but a carbuncle was entirely familiar to this medicine, has its own sections in 癰疽門, and would not have been filed among the strange diseases. That it is here is itself evidence that the physician did not recognize it, and his judgement on that point deserves more weight than our hindsight. Cow's milk daily is food, not treatment. It is harmless, and in an entry where the author had nothing to offer, prescribing nourishment and waiting is not the worst of the chapter's instincts.

Deukhyo 得效

4.1.25 Falling Apart of the Joints of the Limbs 四肢節脫

4.1.25.1

Source원문

四肢節脫, 但有皮連, 不能擧動, 名曰筋解. 用酒浸黃茋三兩, 經一宿, 焙乾爲末, 每三錢, 酒調下, 愈. 《得效》

Translation영역

The joints of the four limbs come apart, with only the skin holding them together, and he cannot lift or move them. It is called sinew loosening (筋解). Take 3 nyang of astragalus steeped in wine, leave it a night, dry it over a gentle fire and powder it; 3 don each time, stirred into wine and taken down. It heals.

Clinical note임상 주석

A severe arthropathy is a possibility worth holding, and the description points that way rather than at anything else on offer. Joints that have lost their integrity so that the limb feels held together only by skin, with movement impossible, is how gross joint destruction presents. Advanced rheumatoid disease does it, with the collapse of the small joints and rupture of the tendons that hold them in line; a Charcot joint — joint destruction in a limb that cannot feel pain — does it more dramatically still, and produces exactly the impression of a limb falling apart within an intact envelope of skin. Severe generalized joint hypermobility, with recurrent dislocation, would also look like this to an observer, and the text's own name for it, 筋解 — the sinews loosening — is closer to that reading than to a destructive arthritis. These are possibilities rather than a diagnosis. There is no account of pain, swelling, duration, fever or which joints were affected, and those are precisely the features that would separate an inflammatory arthritis from a neuropathic joint from a connective tissue disorder. The entry is too thin to settle, and it is better to say so than to pick one. Astragalus steeped in wine, dried and powdered, 3 don in wine, is a qi-supplementing tonic given for weakness, and the logic of prescribing it for a limb that cannot be lifted is consistent on its own terms. It has no effect on a destroyed joint. The flat closing 愈 — it heals — is the chapter's habit and should not be read as an outcome.

Deukhyo 得效

4.1.26 Swelling of the Body in the Shape of a Snake 身腫如蛇狀

4.1.26.1

Source원문

身上及頭面肉上浮腫如蛇狀. 取雨滴階塼上苔痕一錢, 水化開, 塗蛇頭, 立消. 《得效》

Translation영역

On the body, and on the flesh of the head and face, there is a puffy swelling in the shape of a snake. Take 1 don of the moss-stain on the paving brick of the steps where the rain drips, dissolve it in water, smear it on the snake's head, and it disperses at once.

Clinical note임상 주석

We cannot tell what this was. A swelling that takes a long, winding shape does have real causes — superficial thrombophlebitis runs along a vein as a tender cord, lymphangitis tracks as a red line from a wound towards the nodes, and cutaneous larva migrans leaves a serpentine trail that advances by the day — but the entry gives no site in any useful sense, no colour, no tenderness, no fever, and no course. "On the body and on the flesh of the head and face" is not a distribution. Choosing among those possibilities would be invention. What the entry does show clearly is how the naming works in this chapter and what follows from it. The swelling resembles a snake, so it is called a snake; because it is called a snake it is held to have a head; and because it has a head, the treatment is applied to the head, since killing a snake means striking its head. The reasoning is internally complete and entirely detached from the body. It is the clearest small example in these twenty-seven entries of what a physician does when a case fits nothing he knows. The material — moss and dirt scraped from the paving brick under a drip line, dissolved in water and smeared on the skin — is environmental matter of unknown composition applied topically, and carries a plain risk of introducing infection if the skin is broken. It has no therapeutic action. The claim 立消, that it disperses at once, is not credible for any of the conditions a serpentine swelling might actually be.

Deukhyo 得效

4.1.27 Luminous Colour on the Body 身有光色

4.1.27.1

Source원문

頭面發熱有光色, 他人手近之如火燒人. 用蒜汁半兩, 酒調服, 如蛇狀, 遂安. 《得效》

Translation영역

The head and face give out heat and have a luminous colour, and when another person's hand comes near, it is as though a fire were burning him. Use half a nyang of garlic juice, stirred into wine and taken — as for the snake shape above — and it settles.

Clinical note임상 주석

We cannot tell what this was, and the chapter closes on a case its author could not place. The one element with an ordinary explanation is the heat: a face hot enough that a bystander's hand feels it at a distance is how high fever and intense facial flushing are described from the outside, and either erysipelas of the face or a severe systemic fever would produce it. The luminous colour will not reduce to anything. Skin does not emit light, so either a high gloss on tense, flushed skin was read as luminosity, or the account had already been embellished before the physician wrote it down. The record is two lines, and two lines will not carry a diagnosis. 如蛇狀 in the final clause is best read as a back-reference to the preceding entry, 4.1.26 身腫如蛇狀 — treat as for the snake-shaped swelling — rather than as a new observation that the patient's own heat took a serpentine form. The transcription does not mark it as an interlinear note, so it is printed as base text, but the reading matters: on the reference reading, the author is grouping two cases he could not explain and handing the second the first's remedy, which is consistent with how the rest of these entries behave. Garlic juice in wine is harmless and has no effect on fever. This is the last of the twenty-seven, and it is a fitting end to them. 怪疾門 is the shortest section in the volume and the only one that exists to hold what the medicine could not classify: no pulse teaching, no pattern differentiation, no formulas of its own — a list of cases, each with a name coined for the occasion and a prescription reasoned from the name. Read as diagnosis it is mostly unusable. Read as a record of a physician's conduct at the limit of his knowledge — that he wrote the case down anyway, gave it a heading, and passed it on rather than discarding it — it is one of the more honest things in the book.

Deukhyo 得效

About this translation 凡例

Base text: Donguibogam (東醫寶鑑, 1613 first edition), Miscellaneous Disorders, Volume 9, Strange Diseases chapter, leaves 035b to 039a. The Chinese text is collated against the Kyujanggak transcription of the 1613 edition; collation notes are given on the passages they concern. The leaves run in order with no misbinding. The table of contents lists a single section, 怪疾異常, and the text stands up twenty-eight heads, so the other twenty-seven are given here as numbered sub-sections in source order. One count does not come out. A gloss on the chapter head reads 怪疾有二十六條 — the strange diseases number twenty-six items — and the text stands up twenty-seven sub-sections after the framing line. The discrepancy is recorded rather than resolved: no two of the twenty-seven read as one item, and the last of them, 身有光色, closes with 如蛇狀遂安, a back-reference to the snake-shape case before it, which makes the two adjacent but not one. Elsewhere in this volume a count of this kind has been load-bearing — the 凡三十七種 of Abscesses Part 2 checksummed a misbinding — so the mismatch is left on the page for a later reader rather than argued away. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.