Formulas · Text · Donguibogam 東醫寶鑑

Emergencies

Gugeup

한글 구급 · Pinyin Jiu Ji

The emergencies — the hanged, the drowned, the frozen, and the heart still warm

救急

The sections of this chapter are not diseases but states, and most of them are a person found down. 十件危病 opens with ten critical conditions; then 中惡 and 鬼撃鬼打鬼排, collapse read as a strike by something unseen; 尸厥, the faint that looks like death; 鬼魘, the thing that holds you down in sleep; 鬱冒; 客忤卒厥諸證; 卒死; 脫陽證. Then four rescues — the hanged, the drowned, the frozen, the starved — and 攪腸沙, 入井塚卒死, 蛇入七竅, and the needling that closes the chapter. One phrase runs through it: 心頭溫, the region of the heart still warm. It is the book's test for whether a person found down can be brought back, and it is applied to the hanged man, to the one pulled from the water, to 尸厥 and to 卒死 alike. It is the right question asked with the wrong instrument, and it is asked again and again. Some of what follows it is recognizable. 救自縊死 says to hold the body up and cut it down rather than let it drop, to keep the throat straight, to rub and warm, to have people work the limbs and the chest in turn, and above all to keep at it a long time and not conclude too early — which is continuous resuscitation, and the instruction not to let the body fall is correct care of a neck that may be broken. 入井塚卒死 is confined-space asphyxia, and if a lamp is lowered first and the flame goes out, nobody goes down: that test is still taught in principle, and the commonest death in such a place is the second person, going in after the first. 救凍死 rewarms slowly, which is closer to modern practice than heat would be, and a profoundly cold patient can look dead and still recover. And some of it is the opposite. 救溺水死 inverts the body and drains it, and rolls it over the back of an ox — none of which empties a lung, all of which costs the minutes that decide a hypoxic arrest. Most of all, this chapter pours liquids into the mouth and blows powders into the nose of people who are unconscious, over and over, in almost every section. A person with no gag reflex aspirates what you pour into them. That is the one modern note this chapter needs more than any other, and the notes make it wherever the text gives the instruction: the airway comes first.

3.1 Ten Critical Conditions 十件危病

3.1.1

Source원문

華佗云, 人有急病疾如風雨, 命醫不及, 須臾不救, 視其橫夭, 實可哀怜. 予選十件危病ㆍ三十妙方以救之, 不可不知.

Translation영역

Hwata says: when a man has an acute illness, the sickness comes on like wind and rain. There is no time to send for a physician, and if he is not rescued within moments he is lost; to look on so untimely a death is truly pitiable. I have therefore selected ten critical conditions and thirty excellent formulas with which to rescue them, and these must be known.

Clinical note임상 주석

The chapter opens by stating its own purpose, and the purpose is unusual for the Bogam: this is a manual for the interval before a physician arrives. Everything that follows is organised around that interval — ten named states, each with remedies that a household could reach for without a diagnosis. The premise is sound and is the premise of emergency medicine still. What determines survival in the conditions listed below is almost entirely what is done in the first minutes, by whoever is present, and almost nothing of what is done later by a specialist. The modern form of this preface is bystander training: recognise collapse, call for help, start compressions.

Hwata 華佗

3.1.2

Source원문

又云, 人有急病疾如風雨, 須臾不救, 命在頃刻. 世人纔見一時氣絶, 便以爲死, 更不知有可救之理ㆍ可救之方. 故以所歷經驗數方鋟𨫃, 以廣其傳, 便可對證尋方, 服藥急救, 庶幾倉卒無夭橫之患矣.

Translation영역

He also says: when a man has an acute illness the sickness comes on like wind and rain, and if he is not rescued within moments his life hangs on an instant. People, the moment they see the breath cut off, take him at once for dead, and do not know further that there is a principle by which he may be saved and a method by which he may be saved. I have therefore had cut into printing blocks a number of formulas I have tried in practice, so as to spread them widely; then one may match the formula to the presentation, give the medicine and rescue him urgently, and so, it is to be hoped, a sudden emergency will not bring the misfortune of an untimely death.

Clinical note임상 주석

This is the most important sentence in the chapter. People seeing the breath stop once take the person for dead, and do not know that there is a principle and a method by which he may still be saved. That is the whole of resuscitation stated as a proposition: apparent death is not death, and what is done in the interval decides the outcome. The modern expression of the same idea is that cardiac arrest is a treatable state rather than an event, and that the interval in which it is treatable is measured in minutes. Chest compressions begun by a bystander roughly double survival; every minute of delay before defibrillation costs about ten per cent of it. The Bogam has the concept and none of the tools.

Hwata 華佗

3.1.3

Source원문

一, 霍亂吐瀉. 詳見霍亂門

Translation영역

First, cholera with vomiting and diarrhoea — described in full in the chapter on Cholera.

Clinical note임상 주석

Acute profuse vomiting and diarrhoea, which kills by volume loss. This is still a first-rank emergency: in cholera itself an adult can lose many litres in hours and die of hypovolaemic shock with no other pathology at all. Oral rehydration solution and intravenous fluid bring mortality from around half to under one per cent, which makes it one of the few conditions on this list where a single simple measure accounts for nearly the whole of the modern gain.

Hwata 華佗

3.1.4

Source원문

二, 纏喉風閉塞. 方見咽喉門

Translation영역

Second, throat-binding wind with obstruction — formulas given in the chapter on the Throat.

Clinical note임상 주석

Obstruction of the upper airway. The presentations behind 纏喉風 are peritonsillar and retropharyngeal abscess, epiglottitis, diphtheria and angioedema, and all of them are still among the most urgent emergencies there are, because the time from obstruction to hypoxic brain injury is a few minutes. The modern answer is to secure the airway — intubation, or a surgical airway if intubation fails — and nothing a formula can do substitutes for it.

Hwata 華佗

3.1.5

Source원문

三, 吐血下血. 方見血門

Translation영역

Third, vomiting of blood and bleeding below — formulas given in the chapter on Blood.

Clinical note임상 주석

Gastrointestinal haemorrhage, upper and lower. Still a genuine emergency, and still one with high mortality when the source is a varix. It is managed by resuscitation with blood, acid suppression or vasoactive drugs, and endoscopy to find and close the bleeding point — none of which this tradition could do, and the chapter's haemostatics do not reach a bleeding vessel in the stomach.

Hwata 華佗

3.1.6

Source원문

四, 中砒礵毒. 方見解毒門

Translation영역

Fourth, poisoning by arsenic — formulas given in the chapter on Antidotes.

Clinical note임상 주석

Arsenic poisoning, which is real, was common when arsenic was a household rat poison and a homicidal one, and presents with exactly the violent vomiting and diarrhoea, collapse and shock the older texts describe. It remains a medical emergency; treatment is supportive with chelation by succimer or dimercaprol. That this item sits in a list otherwise made of collapse states says the compiler grouped by urgency, not by cause.

Hwata 華佗

3.1.7

Source원문

五, 尸厥.

Translation영역

Fifth, corpse reversal.

Clinical note임상 주석

Unresponsiveness so complete that the person appears dead while the pulse still moves — the state given its own section at 3.4. The presentations behind it are deep syncope, the postictal state after a seizure, and the first minutes of cardiac arrest. As a category it is recognisable; the chapter's own criterion for salvability, that the heart region is still warm, recurs throughout this chapter.

Hwata 華佗

3.1.8

Source원문

六, 中惡客忤.

Translation영역

Sixth, malign strike and hostile affront.

Clinical note임상 주석

Sudden collapse in a lonely or unfamiliar place, read as a strike by something unseen; the subject of the next section. Not a modern entity, and the attributed cause does not exist — but the presentations collected under it do, and several of them are surgical emergencies.

Hwata 華佗

3.1.9

Source원문

七, 脫陽.

Translation영역

Seventh, yang collapse.

Clinical note임상 주석

Collapse after sexual exhaustion, given its own section at 3.9. Not a modern entity either; the picture is most plausibly syncope, and where it is fatal, a cardiac event in someone with unsuspected coronary disease.

Hwata 華佗

3.1.10

Source원문

八, 鬼魘鬼打.

Translation영역

Eighth, ghost oppression and ghost blow.

Clinical note임상 주석

Two quite different things joined by their attributed cause. 鬼魘 is sleep paralysis — the normal atonia of REM sleep persisting into wakefulness, with hypnagogic hallucination and a sense of weight on the chest. It is common, benign, and not an emergency at all, which makes it the one item on this list that does not belong here. 鬼打 is the sudden stabbing pain of 3.2.1, which belongs here very much.

Hwata 華佗

3.1.11

Source원문

九, 孕婦橫逆産. 方見婦人門

Translation영역

Ninth, transverse and breech delivery in a pregnant woman — formulas given in the chapter on Women.

Clinical note임상 주석

Malpresentation in labour, and still a true obstetric emergency. A transverse lie cannot deliver vaginally at term, and obstructed labour ends in uterine rupture and the death of mother and child unless the obstruction is relieved. The modern answer is caesarean section, and it is the reason this item has almost vanished from mortality statistics where theatres exist and still accounts for a large share of maternal deaths where they do not.

Hwata 華佗

3.1.12

Source원문

十, 胎衣不下. 方見婦人門

Translation영역

Tenth, the afterbirth not coming down — formulas given in the chapter on Women.

Clinical note임상 주석

Retained placenta, which causes postpartum haemorrhage. Still one of the leading causes of maternal death worldwide, and still an emergency: the uterus cannot contract down on an open placental bed while placenta remains in it, and blood loss is rapid. Treatment is uterotonics, controlled cord traction and manual removal under anaesthesia. Seven of the ten — cholera, airway obstruction, gastrointestinal bleeding, arsenic, obstructed labour, retained placenta, and the arrest and syncope behind 尸厥 — are conditions a modern emergency department would recognise and act on within minutes. Three are not: 中惡客忤, 脫陽 and the 鬼魘 half of the eighth item name causes that do not exist. The list's hit rate is high for 1613, and its failures are failures of aetiology rather than of triage.

Hwata 華佗

3.2 Malign Strike 中惡

3.2.1

Source원문

凡中惡客忤鬼氣之證, 凡人暮夜, 或登厠, 或出郊野, 或遊空冷屋室, 或行人所不知之地, 忽見眼見鬼物, 口鼻吸着惡鬼氣, 驀然倒地, 四肢厥冷, 兩手握拳, 口鼻出淸血, 性命逡巡, 須臾不救. 此證與尸厥同, 但腹不鳴, 心腹俱煖. 切勿移動其屍, 卽令親戚衆人圍繞, 打鼓燒火, 或燒麝香ㆍ安息香, 直候記醒人事, 方可移歸. 《華佗》

Translation영역

In general, in the presentations of malign strike, hostile affront and ghost qi: when a person at dusk or in the night goes up to the privy, or goes out into open country, or wanders into an empty cold building, or walks in ground that people do not know, and suddenly sees — the eyes see — a ghostly thing, and the mouth and nose breathe in the qi of a malign ghost, then he falls abruptly to the ground, the four limbs are reverted and cold, the two hands are clenched into fists, clear blood comes from the mouth and nose, and his life hangs in the balance: unless he is rescued within moments he is lost. This presentation is the same as corpse reversal, except that the abdomen does not rumble and the heart region and abdomen are both warm. On no account move the body. Have his relatives and a number of people surround him at once, beat drums and light a fire, or burn musk and benzoin, and only when he has come to and knows what is happening may he be carried home.

Clinical note임상 주석

The setting is given in unusual detail and it is worth reading literally: dusk or night, going up to the privy, out in open country, in an empty cold building, in unfamiliar ground. Two of those are the classic settings of recognised faints. Micturition and defecation syncope are real, well-described entities — straining and then standing, often at night, in an older man, with a vagal surge and a drop in venous return — and the privy at night is exactly where they happen. An empty, cold, closed room with a fire in it is where carbon monoxide poisoning happens. The rest of the picture — abrupt fall, cold reverted limbs, clenched fists — fits syncope with a brief convulsive component, which is common and frightening and routinely mistaken for something worse. The clinical criterion is the interesting part. What separates this from 尸厥 is that the abdomen is silent and the heart region and abdomen are both still warm. A warm chest as the test of whether a collapsed person can still be saved recurs through this whole chapter, and it is a crude surrogate for perfusion. Modern practice makes the same judgement, better and in two seconds: is the person responsive, and is there a pulse. The management is not treatment. Drums, fire and incense do nothing, and burning musk at the face of someone who is unconscious is at best inert. The one instruction with any merit is not to move him, which is right for a different reason than the one given — an unnecessary move risks injury and delays assessment. But it is wrong if he is in arrest, because compressions need a firm flat surface, and it is wrong if the room is the cause, because the first step in suspected carbon monoxide or confined-space poisoning is to get the patient into clean air. **麝香 is musk from a CITES-listed deer; it cannot lawfully be traded or used.**

Hwata 華佗

3.2.2

Source원문

先用蘇合香元方見氣門, 薑湯或溫酒化下三丸, 蘇省後用他藥. 太乙神精丹尤好. 方見邪祟且用朱犀散ㆍ備急丸. 方見救急

Translation영역

First use Sohaphyang-won 蘇合香元 — formula given in the chapter on Qi — dissolving three pills down in ginger decoction or warm wine; once he has revived, use the other medicines. Taeeulsinjeong-dan 太乙神精丹 is better still — formula given in the chapter on Malign Possession. Also use Juseo-san 朱犀散 and Bigeup-hwan 備急丸 — formulas given in Emergencies.

Clinical note임상 주석

The sequence is pills dissolved in warm liquid and poured down, then other medicines once the patient has revived. The order matters and is backwards. In a person who has collapsed and is not responding, putting anything in the mouth is the one thing that must not be done: the gag and cough reflexes are depressed, the fluid goes into the lungs rather than the stomach, and aspiration pneumonitis turns a faint that would have resolved by itself into a lung injury. The airway comes first. This is the single most important modern note in the chapter, and it applies again in 3.4, 3.8, 3.10 and 3.11. **太乙神精丹 is made of cinnabar, malachite, orpiment, realgar and magnetite — mercuric sulfide and two arsenic sulfides. It is a mercury and arsenic preparation and must not be prepared or taken.** That it is recommended here as better still than the first formula is a reminder of how the mineral elixirs were ranked: potency was read from the violence of the material.

Deukhyo 得效

3.2.3

Source원문

急取半夏末, 或皂角末, 吹兩鼻中卽活. 心頭溫者, 一日亦可活. 《得效》

Translation영역

Urgently take powdered pinellia, or powdered gleditsia pod, and blow it into both nostrils; he revives. Where the heart region is warm, he may still be revived even after a day.

Clinical note임상 주석

Blowing an irritant powder into the nose is meant to provoke sneezing and with it a return of breath. It is not harmless. Both drugs are mucosal irritants, and in a person who is not protecting his own airway, powder blown into the nasopharynx goes where the next breath takes it. **Raw 半夏 is toxic and strongly irritant to mucous membranes; 皂角 is a saponin-bearing irritant.** The second clause is the chapter's recurring criterion, extended generously: a warm heart region means a day may still be within reach. Warmth of the trunk does mean the circulation has not long stopped, and a profoundly hypothermic patient genuinely can be dead-looking and recoverable — but a day is far outside any real window, and the sentence would license effort on someone long beyond it.

Deukhyo 得效

3.2.4

Source원문

又取故汗衣, 須用內衣久遭汗者佳, 男用女衣, 女用男衣, 燒灰爲末, 每二錢, 百沸湯調下. 《得效》

Translation영역

Also take an old sweat-soaked garment — an undergarment long subjected to sweat is best — a woman's garment for a man and a man's garment for a woman, burn it to ash and powder it, and give 2 don each time, stirred into water brought to a hundred boils.

Clinical note임상 주석

Burnt cloth ash is carbon and mineral residue with no pharmacological action, and the cross-sexing of the garment is sympathetic reasoning about yin and yang rather than any observation. The passage is included here because it shows what the emergency repertoire reached for once the plausible remedies were exhausted: something to hand, in every household, that could be given immediately. Given to an unresponsive person it carries the same aspiration risk as everything else in this section.

Deukhyo 得效

3.2.5

Source원문

又麝香一錢硏, 和醋二合服之便差. 又取葱黃心刺鼻中, 入深四五寸, 令目中出血卽活. 又生薑汁ㆍ醇酒各半盞, 同煎百沸, 灌服之. 又白犬斷頭, 取熱血一升灌之. 又韭汁灌口鼻中. 又菖蒲擣取汁灌之. 又桃梟酒磨服之. 又黃丹一錢, 蜜三合和服, 口噤者折齒灌之. 《本草》

Translation영역

Also grind musk, 1 don, mix it with 2 hop of vinegar and have him take it; he recovers. Also take the yellow heart of a scallion and thrust it into the nostril, entering to a depth of four or five chi, so as to make blood come from the eyes; he revives. Also fresh ginger juice and unmixed wine, half a cup each, decocted together to a hundred boils, poured into him. Also behead a white dog, take a seung of the hot blood and pour it into him. Also pour chive juice into the mouth and nose. Also pound acorus and take the juice and pour it into him. Also grind a withered peach in wine and have him take it. Also lead oxide, 1 don, mixed with 3 hop of honey and taken; where the mouth is clenched shut, break the teeth and pour it in.

Clinical note임상 주석

A string of last resorts, and several of them would do harm. Thrusting a scallion stem four or five chi into the nose to make the eyes bleed is a described injury, not a treatment, and nothing is gained by it. Pouring chive juice into the mouth **and nose** of an unconscious person is close to a description of how to drown him; pouring a seung of fresh dog's blood into him adds a zoonotic inoculum to the same aspiration. Breaking the teeth of a patient whose jaw is clenched to get medicine in is a real practice recorded without comment, and it produces an airway full of tooth fragments and blood. **黃丹 is lead tetroxide; it causes lead poisoning and must not be taken. 麝香 is musk from a CITES-listed species. Fresh animal blood given by mouth to an unresponsive patient carries both infection and aspiration risk.** The pattern across the whole passage is that every remedy is delivered into the mouth of someone who cannot swallow or protect his airway. The modern response to this presentation is to check for responsiveness and a pulse, call emergency services, start chest compressions if there is no pulse, and put nothing in the mouth at all.

Boncho 本草

3.2.1 Ghost Strike, Ghost Blow and Ghost Thrust 鬼擊鬼打鬼排

3.2.1.1

Source원문

此等病皆得之無漸, 卒着人如刀刺狀, 胸腹㽲痛, 不可按抑, 或吐衄下血. 治法同中惡. 《本草》

Translation영역

These illnesses are all contracted without any gradual onset. They strike a person suddenly, in the manner of a knife stab, with griping pain in the chest and abdomen that cannot bear being pressed down on, and sometimes with vomiting of blood, nosebleed or bleeding below. The method of treatment is the same as for malign strike.

Clinical note임상 주석

Strip the attributed cause away and this is a clean description of a catastrophic intrathoracic or intra-abdominal event. Abrupt onset with no prodrome, pain likened to a stab, and an abdomen that cannot tolerate pressure: 不可按抑 is guarding and rebound tenderness, and it is a genuine clinical observation, made by pressing, that still separates peritonitis from almost everything else. Blood vomited or passed points to the gut. The presentations that fit are perforated peptic ulcer, aortic dissection or rupture, mesenteric ischaemia, ruptured ectopic pregnancy and acute pancreatitis — the list of conditions where the patient is well one minute and dying the next. All of them need an operating theatre or an interventional suite within hours. None of them is improved by the remedies of the previous section, and the purging and pouring that 治法同中惡 refers back to would hasten the deterioration of a perforation. What the section shows is a category built on suddenness. The book had no way to look inside the chest or abdomen, so a group of lethal internal catastrophes with nothing visible to account for them was named by the only common feature available: the patient was struck by something that could not be seen.

Boncho 本草

3.2.1.2

Source원문

朱犀散犀角五錢, 朱砂ㆍ麝香各二錢半. 右爲末, 每二錢, 新汲水調灌. 《入門》

Translation영역

Juseo-san. Rhinoceros horn 5 don; cinnabar and musk 2 don 5 fun each. Powder the above, and pour in 2 don each time, stirred into newly drawn water.

Clinical note임상 주석

A three-ingredient mineral and animal powder, poured rather than swallowed — 灌 is the verb used throughout this chapter for getting medicine into someone who cannot drink. **This formula must not be prepared. 犀角 is rhinoceros horn, from CITES Appendix I species; all trade is banned, and the horn is keratin — the same protein as hair and nail — with no pharmacological action whatever. The demand this tradition created for it is the reason the species are endangered. 朱砂 is cinnabar, mercuric sulfide, and is a cause of mercury poisoning. 麝香 is musk, also CITES-listed.** Two of the three ingredients are unlawful and the third is a heavy-metal poison. Pouring a mineral suspension into the mouth of an unconscious patient is the aspiration hazard of this chapter in its most concentrated form. There is nothing here to salvage.

Immun 入門

3.3 Pulse Signs 脉候

3.3.1

Source원문

中惡之脉, 緊細易治, 浮大難痊. 《得效》

Translation영역

As to the pulse in malign strike: tight and thin is easy to treat, floating and large is hard to cure.

Clinical note임상 주석

This is the chapter's prognostic rule for the collapse states, and it is where its pulse reading parts company with modern observation. A tight, thin pulse is a small-volume, high-resistance pulse — the pulse of a patient who is clamped down and underperfused — and in shock it is the bad sign, not the good one. The text reads it favourably because within its own frame a tight pulse means the qi is still contained, while a floating large pulse means it has scattered outward. What is true, and worth not losing in the disagreement, is the underlying claim: the character of the pulse in a collapsed patient carries prognostic information independent of whether a pulse is present. Modern practice makes the same reading through volume and rate rather than through tension and depth.

Deukhyo 得效

3.3.2

Source원문

脉至如喘, 名曰暴厥. 暴厥者, 不知與人言. 《內經》

Translation영역

A pulse arriving as though panting is called sudden reversal. One in sudden reversal does not know how to speak with people.

Clinical note임상 주석

A pulse that comes like panting is a fast, shallow, hurried pulse — the Naegyeong's image is auditory, of breath rather than of beat. Taken with loss of speech and awareness, the picture is a tachyarrhythmia fast enough to drop cerebral perfusion: ventricular tachycardia or a rapid supraventricular tachycardia in someone who cannot sustain it. The pairing is the real observation here. A very rapid pulse together with loss of the ability to interact is still, in a sentence, the definition of an unstable tachycardia, and it is still the finding that decides treatment — an unstable patient with a fast rhythm is cardioverted rather than medicated.

Naegyeong 內經

3.3.3

Source원문

寸口脉沈大而滑, 沈則爲實, 滑則爲氣, 實氣相搏, 血氣入藏卽死, 入府卽愈, 此爲卒厥. 不知人何謂也? 師曰, 唇靑身冷爲入藏卽死, 身溫和汗自出爲入府卽愈. 《仲景》

Translation영역

When the pulse at the inch opening is deep, large and slippery — deep indicates repletion, slippery indicates qi — repletion and qi strike against each other, and when blood and qi enter the viscera there is death at once, while when they enter the bowels there is recovery. This is sudden reversal. What is meant by his not knowing people? The master said: blue lips and a cold body are entering the viscera, and there is death at once; a body warm and harmonious with sweat coming of itself is entering the bowels, and there is recovery.

Clinical note임상 주석

The 入藏 and 入府 framework is wrong as an explanation and precise as an observation, and the two should be separated. What the master is actually asked for is how to tell, at the bedside, which unconscious patient will die and which will wake, and the answer he gives is two clinical pictures. Blue lips with a cold body is central cyanosis together with peripheral shutdown — hypoxaemia and a failing circulation, the shunting of blood away from the skin to defend the central organs. It is still taught as a sign of imminent arrest, and the prognosis attached to it here is correct. A body that is warm and sweating of itself is the picture of a vasovagal faint in its recovery phase: perfusion restored, the autonomic surge resolving, the patient about to come round. The prognosis attached to that is correct too. Two reliably distinguishable outcomes, sorted by skin temperature, colour and sweating, with no instrument. The mechanism supplied to account for them is of no use; the discrimination is excellent.

Junggyeong 仲景

3.3.4

Source원문

厥逆連藏則死, 連經則生. 註云, 連藏死者, 神去故也. 《內經》

Translation영역

When reversal and counterflow link to the viscera there is death; when they link to the channels there is life. The commentary says: that one dies when it links to the viscera is because the spirit has departed.

Clinical note임상 주석

A rule of depth: collapse that has reached the organs kills, collapse confined to the channels does not. Stated this way it is unfalsifiable — whether the viscera were reached is known from whether the patient died — and the commentary's gloss, that the spirit has departed, closes the circle rather than opening it. It is worth saying plainly where this differs from the passage just before it. The Junggyeong text named findings that could be checked before the outcome was known. This one names a category that can only be assigned afterwards. Both sit in the same section, and the difference between them is the difference between a clinical sign and an explanation.

Naegyeong 內經

3.3.5

Source원문

尸厥呼之不應, 脉伏者死, 脉大反小者死.

Translation영역

In corpse reversal, where he is called to and does not respond, a hidden pulse means death, and a pulse that was large and turns small instead means death.

Clinical note임상 주석

This is the one place in the section where the text's prognosis is simply right, and right for the reason we would now give. A patient who does not respond when called and in whom no pulse can be felt is in cardiac arrest. Before chest compressions and defibrillation existed, that was uniformly fatal, and the Maekgyeong records it as such. The second sign is equally sound: a pulse that was full and becomes small is a falling cardiac output, and a patient going that way is deteriorating rather than stabilising. Serial observation of the same pulse, rather than a single reading, is what makes it informative, and the text has evidently done that. The modern response to the first finding is the whole of what has changed since. Unresponsive, no pulse: call for help, start chest compressions, get a defibrillator on the chest. Roughly one in ten such patients now survives to leave hospital, and rather more when the arrest is witnessed and compressions begin at once.

Maekgyeong 脉經

3.3.6

Source원문

卒中惡, 腹大四肢滿, 脉大而緩者生, 緊大而浮者死, 緊細而微者亦生. 《脉經》

Translation영역

In sudden malign strike, with a large abdomen and the four limbs full: a pulse large and relaxed means he lives, tight, large and floating means he dies, and tight, thin and faint also means he lives.

Clinical note임상 주석

The presenting signs are a distended abdomen and fullness of the limbs, which in a patient who has collapsed suddenly is the picture of either an acute abdomen with ileus or a rapidly accumulating intra-abdominal fluid — blood, in a rupture. Either way the abdomen is the clue, and the chapter is right to record it. The three pulses repeat the rule of 3.1 of this section and repeat its error. Large and relaxed is a good pulse in any reading, and the text and modern practice agree on it. But tight, thin and faint, called survivable here, is the pulse of a patient in compensated shock: peripherally constricted, low in volume, running fast and barely palpable, and that patient is the one who will decompensate in the next hour. A faint thready pulse in a collapsed patient with a distended abdomen should be read as internal haemorrhage until proved otherwise. Across the whole section the pattern is consistent and instructive. Where the Bogam's pulse lore rests on things that can be seen and felt alongside the pulse — colour, temperature, sweating, responsiveness, change over time — it is accurate. Where it rests on the tension and depth of the pulse read as a sign of where the qi has gone, it inverts the prognosis.

Maekgyeong 脉經

3.4 Corpse Reversal 尸厥

3.4.1

Source원문

尸厥者, 脉動而無氣, 氣閉不通, 故靜如死也. 還魂湯主之. 《仲景》

Translation영역

In corpse reversal the vessels beat but there is no qi; the qi is shut in and does not pass through, and so the man is still as though dead. Hwanhon-tang 還魂湯 governs it.

Clinical note임상 주석

尸厥 is the corpse-like faint: a person found apparently dead who is in fact alive and may be recoverable. The definition given here is exact about what makes the state what it is — 脉動而無氣, the vessels still beating while there is no breath — and that pairing is the whole of the diagnosis. A pulse without respiration is what we would now call respiratory arrest, and it is the narrow window in which a person can still be saved. The sections that follow are the chapter at its most useful and its most dangerous at once. The judgement that such a person is not dead is correct and was not universally made. The methods offered for reviving him are, with one exception, things poured or blown into the mouth and nose of someone who cannot protect his own airway.

Junggyeong 仲景

3.4.2

Source원문

卒然不省人事, 全如死尸, 但氣不絶, 脉動如故. 或脉無倫序, 或乍大乍小, 或微細不見, 而心胸煖者是也. 《仲景》

Translation영역

He suddenly knows nothing of the human world and is altogether like a dead corpse, except that the qi is not cut off and the vessels beat as before. Or the vessels have no order to them, or they are now large and now small, or they are so faint and fine as not to be found — and the region of the heart is still warm: this is it.

Clinical note임상 주석

心頭溫, the heart region still warm, is this volume's criterion for a body still worth working on, and it recurs in 3.8 卒死, 3.10 救自縊死 and 3.11 救溺水死. As a test it is crude but not foolish: central warmth means the trunk has been perfused recently, and it fails in the one direction that matters most, since a profoundly cold patient may be cold and still salvageable. Modern practice makes the same judgement faster and better — look for responsiveness and normal breathing, feel for a central pulse for no more than ten seconds, and if either is absent begin chest compressions and call for help. The pulse descriptions are worth reading literally. 脉無倫序 is an irregularly irregular pulse, 乍大乍小 a varying pulse volume, and 微細不見 a pulse too thready to palpate. Together they describe atrial fibrillation or another malignant arrhythmia, or simply profound shock, and all three are compatible with a patient who looks dead and is not.

Junggyeong 仲景

3.4.3

Source원문

尸厥者, 卽中惡之類. 凡弔死問疾, 或入墓登塚, 卒中邪惡, 與藏氣相忤, 忽然手足逆冷, 頭面靑黑, 牙關緊急, 頭旋暈倒, 昏不知人, 或錯言妄語. 急取蘇合香丸三丸, 溫酒或薑湯灌下. 又煎還魂湯灌之. 又故汗衣燒灰末二錢, 百沸湯調灌. 又菖蒲汁灌口中. 《丹心》

Translation영역

Corpse reversal is of the same kind as malign stroke. Whenever a man condoles at a death or visits the sick, or enters a tomb or climbs a burial mound, and is suddenly struck by an evil malignity that comes into conflict with the qi of his viscera, then all at once his hands and feet turn cold in reversal, his head and face are green-black, his jaws are clenched tight, his head spins and he falls in a faint, and he lies darkened and knowing no one, or else talks at cross purposes and raves. Quickly take three pills of Sohaphyang-won 蘇合香丸 and pour them down in warm wine or in a ginger decoction. Also decoct Hwanhon-tang 還魂湯 and pour that in. Also 2 don of the ash of an old sweat-soaked garment, burnt and powdered, stirred into water boiled a hundred times and poured in. Also acorus juice poured into the mouth.

Clinical note임상 주석

The settings are the informative part. Condoling at a funeral, sitting with the sick, going down into a tomb or up onto a burial mound — these are the circumstances of standing a long time in heat and crowding, of infectious exposure, and of entering an unventilated space. The first produces ordinary vasovagal syncope, the second accounts for how a collapse at a sickbed could be attributed to the illness in the room, and the third is confined-space asphyxia, which this chapter treats properly in 3.15 入井塚卒死. 頭面靑黑 is cyanosis and 牙關緊急 is trismus, and both fit a hypoxic collapse better than a faint. **Every remedy here is poured into the mouth of an unconscious person. That must not be done: an obtunded patient has no gag or cough reflex, and liquid poured in goes into the lungs. The airway comes first — position the patient, open the airway, check for breathing, and give nothing by mouth to anyone who is not fully awake.** This is the single most important modern correction to the whole chapter, and it applies again in 3.8, 3.10 and 3.11. Of the four, 蘇合香丸 is an aromatic resin pill whose rationale is that strong odours rouse; burnt sweat-soaked cloth is ash and carries no action at all; and acorus juice, 菖蒲, is a pungent irritant. 石菖蒲 contains asarone, which is hepatotoxic and genotoxic in animal studies, so the juice is not a harmless placebo even leaving the route aside.

Dansim 丹心

3.4.4

Source원문

血之與氣幷走於上, 則爲大厥, 厥則暴死. 氣復反則生, 不反則死.

Translation영역

When the blood together with the qi runs upward, this makes great reversal, and in reversal a man dies suddenly. If the qi returns again he lives; if it does not return he dies.

Clinical note임상 주석

This is the Inner Canon's own account of sudden collapse, and the last clause is the part that has held up. 氣復反則生, 不反則死 — if the qi comes back he lives, and if it does not he dies — is a statement that the same presentation has two outcomes and that the difference lies in whether the state reverses. That is the distinction between syncope and cardiac arrest, and it is the reason a chapter like this one exists at all. The mechanism offered, blood and qi rushing upward together, is wrong in its own terms but describes something real in reverse: a faint is a failure of perfusion of the head, not a flooding of it. 大厥 in the source text is given as the cause of hemiplegia as well as of sudden death, which suggests the compilers had stroke and syncope filed under one heading.

Naegyeong 內經

3.4.5

Source원문

邪客於手足少陰ㆍ太陰ㆍ足陽明之絡, 此五絡皆會於耳中, 上絡左角. 五絡俱竭, 令人身脉皆動而形無知也, 其狀若尸, 名曰尸厥. 以竹管吹其兩耳, 卽甦. 《內經》

Translation영역

An evil lodges in the connecting vessels of the hand and foot Shaoyin and Taiyin and of the foot Yangming. These five connecting vessels all meet within the ear and ascend to connect at the left corner of the head. When all five connecting vessels are exhausted together, the vessels of the man's body all beat and yet the form knows nothing; his aspect is as of a corpse, and it is named corpse reversal. Blow into both his ears with a bamboo tube, and he revives at once.

Clinical note임상 주석

The anatomy is the Inner Canon's, not ours: five connecting vessels meeting inside the ear and running up to the left temple is a scheme of channels, and nothing in the ear connects to the viscera in the way described. Blowing air down a bamboo tube into both ear canals has no mechanism by which it could restore circulation or breathing. It is, however, the only method in this section that is not poured into the mouth, and so the only one that does not risk drowning the patient. What it amounts to is a vigorous stimulus applied to an unresponsive person, which is a reasonable thing to try and a reasonable thing to observe: a response tells you the patient is rousable. Its real cost is the time it takes, because in the state the section describes the treatment that works is ventilation and, if there is no pulse, compressions.

Naegyeong 內經

3.4.6

Source원문

尸厥之證, 卒死, 脉猶動, 四肢逆冷, 腹中氣走如雷鳴, 聽其耳中如微語聲者是也. 急用硫黃散ㆍ朱犀散方見上. 又附子(泡) 一枚爲末, 分二服, 酒煎灌之. 如無, 則薑汁半盞ㆍ酒一盞, 煎百沸灌下. 《入門》

Translation영역

The signs of corpse reversal: he dies suddenly, yet the vessels still beat, the four limbs are cold in reversal, the qi runs about within the belly like thunder rumbling, and on listening at his ear there is as it were the sound of faint speech — this is it. Use at once Yuhwang-san 硫黃散 or Juseo-san 朱犀散 — the formula is given above. Also one aconite accessory root, dry-roasted, powdered and divided into two doses, decocted in wine and poured in. If there is none, then half a ja of ginger juice and 1 ja of wine, boiled a hundred times and poured down.

Clinical note임상 주석

The triad of a persisting pulse, cold limbs and loud borborygmi is again the picture of shock with a preserved circulation. 聽其耳中如微語聲 — a faint speaking heard on listening at the ear — is more interesting than it looks: an examiner with his head against a collapsed patient hears shallow, irregular agonal respiration and transmitted breath sounds, and that is a sign of a very unwell patient rather than of anything occult. **Contains aconite, which is toxic. Aconitine is a cardiac sodium-channel poison and causes exactly the ventricular arrhythmias that kill a collapsed patient; the roasting reduces the alkaloid content but does not make the dose safe, and a whole root divided into two doses is a large one. This must not be prepared.** Of all the things to give someone whose pulse is already irregular, this is close to the worst. **The wine decoction and the ginger-juice substitute are both poured into the mouth of an unconscious person and will be aspirated. Give nothing by mouth; open the airway, check for breathing, and start resuscitation.**

Immun 入門

3.4.7

Source원문

還魂湯, 一名追魂湯. 主中惡ㆍ尸厥ㆍ暴死ㆍ客忤ㆍ鬼擊ㆍ飛尸, 奄忽口噤氣絶. 麻黃三錢, 杏仁二十五粒, 桂心ㆍ甘草各一錢. 右剉作一貼, 水煎灌服. 口噤者, 斡開口灌之, 藥下立甦. 《仲景》

Translation영역

Hwanhon-tang 還魂湯, also called Chuhon-tang 追魂湯. It governs malign stroke, corpse reversal, sudden death, guest-affront, demon-strike and flying corpse — the sudden clenching of the mouth and cutting off of the qi. Ephedra, 3 don; apricot kernels, twenty-five; cinnamon heartwood and licorice, 1 don each. Cut the above up to make one packet, decoct in water and pour it in to be taken. Where the mouth is clenched shut, pry the mouth open and pour it in; as soon as the drug goes down he revives.

Clinical note임상 주석

The composition is the old 麻黃湯 line with ephedra, apricot kernel, cinnamon and licorice, and it is the one remedy in this section with a pharmacological argument behind it. Ephedra yields ephedrine and pseudoephedrine, which are sympathomimetics: they raise blood pressure and heart rate and dilate the bronchi. For a hypotensive, poorly breathing patient that is at least the right direction, and 3 don is a substantial dose. Apricot kernel contains amygdalin, which releases cyanide on hydrolysis, and is the ingredient that makes the formula dangerous rather than merely useless. **Contains ephedra, a sympathomimetic that can precipitate arrhythmia, hypertensive crisis and stroke, and apricot kernel, which is cyanogenic. This must not be prepared.** **口噤者, 斡開口灌之 — prying the clenched mouth open and pouring the decoction in — is the most dangerous instruction in the section. Trismus in an unresponsive patient is a sign of hypoxia or of seizure, and forcing fluid past it fills the lungs. Nothing given by mouth can be absorbed quickly enough to matter in an arrest. The airway comes first: open it, support ventilation, and get emergency help.**

Junggyeong 仲景

3.4.8

Source원문

凡尸厥ㆍ鬱冒ㆍ卒死ㆍ卒中之類, 皆當發表. 仲景云, 鬱冒欲解, 必大汗出是也. 《綱目》

Translation영역

In all of the kinds of corpse reversal, muffled collapse, sudden death and sudden stroke, the exterior should be released. This is what Junggyeong means when he says that when a muffled collapse is about to resolve, a great sweat must come out.

Clinical note임상 주석

A unifying rule laid over four of this chapter's sections, and it is the chapter's clearest mistake of reasoning. Junggyeong's remark is an observation that recovery from 鬱冒 is accompanied by sweating; 綱目 turns it round and makes the sweating the means of recovery. That a sign accompanies resolution does not make producing the sign curative. In practice the error is harmful. 發表 means diaphoresis — hot drinks, covering, ephedra-type drugs — and sweating a collapsed patient vasodilates him and loses him fluid, which lowers an already low blood pressure. The sweat seen at the end of a faint is the autonomic discharge that accompanies recovery of perfusion, not its cause.

Gangmok 綱目

3.4.9

Source원문

硫黃散, 治尸厥奄然死去, 不省人事, 命在頃刻. 硫黃一兩, 焰硝半兩. 右細硏如粉, 分作三服. 每用好酒一盞同煎, 覺焰起, 傾於盞內, 盖着候溫灌服之. 如人行五里, 又進一服, 不過三服卽甦. 《得效》

Translation영역

Yuhwang-san 硫黃散 treats corpse reversal where the man has suddenly died away, knows nothing of the human world, and his life hangs on a moment. Sulfur, 1 nyang; saltpetre, half a nyang. Grind the above fine as flour and divide it into three doses. For each dose simmer it together with 1 ja of good wine; when you see the flame rise, pour it out into a cup, cover it, wait until it is warm, and pour it in to be taken. In the time a man walks 5 ri give another dose; within three doses he revives.

Clinical note임상 주석

**Sulfur and saltpetre ground together are a fuel and an oxidiser: this is gunpowder without the charcoal. 覺焰起, waiting until the flame rises, means the mixture is deliberately ignited, and heating a sulfur-nitrate mixture deflagrates and gives off sulfur dioxide. It must not be prepared, and it must not be heated.** The text knows the mixture burns and treats the flame as the sign the drug is ready. What remains after burning is largely sulfate and sulfite in hot wine. Oral sulfur is a gastrointestinal irritant and laxative, releasing hydrogen sulfide in the gut; saltpetre, potassium nitrate, is absorbed and reduced to nitrite, which oxidises haemoglobin to methaemoglobin. Neither has any action that could restore breathing or circulation, and methaemoglobinaemia reduces the oxygen the blood can carry, which is the exact opposite of what a hypoxic patient needs. **The hot wine is poured into the mouth of a person described as insensible, and three doses are given over the time it takes to walk 10 ri. That is a prolonged aspiration risk and a long delay before anything effective is done.**

Deukhyo 得效

3.5 Demon Oppression in Sleep 鬼魘

3.5.1

Source원문

人眠睡, 則魂魄外遊, 爲鬼邪所魘屈. 其精神弱者, 則久不得寤, 乃至氣絶. 所以須傍人助喚, 幷以方術治之. 《千金》

Translation영역

When a man sleeps, his hun and baek souls wander outside him, and he is oppressed and bent down by a demonic evil. One whose spirit is weak then cannot wake for a long time, and it goes as far as the cutting off of the qi. For this reason someone at his side must help by calling to him, and together with that it is treated by method and art.

Clinical note임상 주석

鬼魘 is sleep paralysis with hypnagogic or hypnopompic hallucination. The muscle atonia of REM sleep persists for a few seconds to a couple of minutes after consciousness returns, so the sleeper is awake, aware of the room, and unable to move or speak; the dream imagery carries over, which is why the experience is so consistently reported as a presence in the room pressing down on the chest. It is common — something like one person in five has had at least one episode — and it is benign. Episodes end on their own. 魂魄外遊 is a precise description of what the state feels like from inside, and the text has the sequence right: the sleeper is in some sense present and in some sense not. 乃至氣絶, that it can go as far as death, is the one claim that is simply false. Sleep paralysis does not kill, and the fear that it might is the main reason it causes distress. 須傍人助喚, that a bystander should call to the sleeper, happens to be right. External stimulus shortens an episode, and being spoken to is the gentlest form of it. Recurrent episodes are managed by regularising sleep, treating sleep deprivation and screening for narcolepsy where they are frequent and accompanied by daytime sleep attacks.

Cheongeum 千金

3.5.2

Source원문

鬼魘ㆍ鬼打之證, 人到客舍館驛, 及久無人居冷房睡中, 爲鬼物所魘, 但聞其人吃吃作聲, 便令人呌喚. 如不醒, 乃鬼魘也. 不急救則死, 宜用雄朱散. 《丹心》

Translation영역

The signs of demon oppression and demon beating: a man comes to a guest house or a posting station, or sleeps in a cold room long unlived in, and while asleep is oppressed by a demonic thing. One hears only that the man makes a choking, gasping sound, and then someone is set to call out to him. If he does not come round, this is demon oppression. If he is not rescued at once he dies. Ungju-san 雄朱散 should be used.

Clinical note임상 주석

The settings are the best observation in the section. Inns, posting stations and cold rooms long unoccupied are the circumstances of travel, and sleep paralysis is strongly associated with disrupted and insufficient sleep, irregular hours, an unfamiliar bed and the supine position — in other words with exactly the night the passage describes. The association is real even though the agent assigned to it is not. 吃吃作聲, the choking or gasping noise, is worth separating out, because it belongs to a different set of conditions and some of them are emergencies. Obstructive sleep apnoea gives precisely this, and so does a nocturnal seizure. In a cold, closed, long-unused room with a brazier, an unrousable sleeper is carbon monoxide poisoning until proved otherwise, and the rescuer is at the same risk — which is the subject of 3.15 入井塚卒死. A sleeper who genuinely cannot be roused is not having sleep paralysis, and needs emergency assessment.

Dansim 丹心

3.5.3

Source원문

人爲鬼魘卒死, 不得着燈火照, 亦不得近前急喚, 多殺人. 但痛咬其足跟及大拇指甲邊, 幷多唾其面, 卽活. 如不醒者, 移動處些子, 徐喚之. 若元有燈, 卽存, 不可吹滅. 如無燈, 切不可用燈照. 仍用筆管吹兩耳. 又取半夏末或皂角末, 吹兩鼻中. 《得效》

Translation영역

Where a man has suddenly died of demon oppression, you may not bring a lamp flame up to shine on him, nor may you go close and call to him urgently: that kills many. Only bite hard on his heel and on the edge of the nail of his big toe, and spit much upon his face, and he comes to life. If he does not come round, move him a little from the place and call him slowly. If there was a lamp there to begin with, leave it, and do not blow it out. If there is no lamp, on no account use a lamp to shine on him. Then use a brush-tube to blow into both ears. Also take pinellia powder or gleditsia-pod powder and blow it into both nostrils.

Clinical note임상 주석

The prohibitions are the part to keep. Do not thrust a light into the sleeper's face, do not rush up and shout at him, and if a lamp was already burning leave it burning rather than plunging the room into dark — this is sound handling of someone in a frightening, half-conscious state, and it is close to what is advised now. An episode of sleep paralysis is made worse by abrupt, alarming arousal and better by calm speech and a familiar room. 多殺人, that it kills many, is an overstatement of a real point. What follows is painful stimulation: biting the heel and the nail bed of the great toe, and spitting on the face. Nail-bed pressure is still used as a peripheral painful stimulus when assessing an unresponsive patient, so the instinct is recognisable, but it is a test of responsiveness and not a treatment. **Blowing pinellia or gleditsia powder into the nostrils of an unresponsive person must not be done. Raw pinellia is irritant and toxic — its calcium oxalate needles cause intense mucosal irritation and swelling — and gleditsia pod is rich in irritant saponins. Insufflated into the nose of someone who is not protecting his airway, either can provoke laryngospasm, and powder drawn into the lungs cannot be removed. The airway comes first.**

Deukhyo 得效

3.5.4

Source원문

鬼魘卒死, 及卒中鬼擊, 血漏腹中, 煩滿欲死. 雄黃末吹入鼻中. 又酒調一錢服, 日三, 能化血爲水. 《本草》

Translation영역

For sudden death from demon oppression, and for sudden demon-strike with blood leaking into the belly, vexing fullness and the man at the point of death: blow realgar powder into the nose. Also give 1 don stirred into wine, three times a day; it can turn the blood to water.

Clinical note임상 주석

**Contains realgar, which is arsenic disulfide. Blowing arsenic powder into the nose puts it onto absorptive mucosa, and 1 don three times a day is repeated arsenic dosing; arsenic causes vomiting and diarrhoea, cardiac arrhythmia and multi-organ failure acutely, and peripheral neuropathy, skin lesions and cancer with continued exposure. This must not be prepared.** 能化血爲水, that it can turn blood to water, is not an action realgar or any other substance has. 血漏腹中, 煩滿欲死 — blood leaking inside the belly, with vexing fullness, and the patient dying — is not sleep paralysis at all. It is the picture of intra-abdominal haemorrhage: a ruptured organ or ectopic pregnancy or a bleeding ulcer, with distension, agitation and shock. That is a surgical emergency needing resuscitation and an operating theatre, and the agitation the text reads as 煩 is hypovolaemia.

Boncho 本草

3.5.5

Source원문

又生韭汁灌口中及耳鼻中, 薤白汁亦可. 又東向桃ㆍ柳枝各七寸, 煎湯灌下. 又伏龍肝末二錢, 井水調灌服, 更吹入鼻中. 又羊糞燒烟熏鼻中, 卽甦. 《諸方》

Translation영역

Also pour the juice of fresh Chinese chives into the mouth and into the ears and nose; the juice of Chinese shallot bulbs will do as well. Also an east-facing peach twig and willow twig, 7 chon each, decocted and the decoction poured down. Also 2 don of hearth-centre earth powdered, stirred into well water and poured in to be taken, and blown into the nose besides. Also burn sheep dung and smoke the fumes into the nose, and he revives at once.

Clinical note임상 주석

All four of these are sternutatories — things put into the nose to force a sneeze. A sneeze is a brainstem reflex that requires an intact airway and some respiratory effort, so producing one does tell you something about the patient; the tradition read it as the spirit returning, and it is closer to a reflex test than to a treatment. Chive and shallot juice are allium irritants, hearth earth is baked clay, and the east-facing peach and willow twigs are chosen for their direction rather than for anything in them. **Pouring juice into the ears and nose of an unconscious person, and blowing smoke or powdered earth into the nose, risk aspiration and airway obstruction and must not be done. Sheep-dung smoke carries faecal bacteria and the irritant products of combustion directly into the lower airway of someone who cannot cough.** The warm-smoke methods in this chapter read as attempts to supply something to the breath, and they supply the wrong thing; what a non-breathing patient needs is ventilation with air.

Jebang 諸方

3.5.6

Source원문

夢中被刺殺, 或被打, 諸般不祥, 忽然吐衄下血, 甚者九竅皆出血. 宜以升麻ㆍ獨活ㆍ續斷ㆍ地黃各五錢, 桂皮一錢. 右爲末, 每二錢白湯調下, 日三. 《入門》

Translation영역

Where in a dream a man is stabbed and killed, or is beaten, with all manner of ill omen, and then suddenly vomits blood, bleeds from the nose and passes blood below — in severe cases bleeding from all nine orifices — use bugbane root, pubescent angelica, teasel root and rehmannia, 5 don each, and cinnamon bark, 1 don. Powder the above and give 2 don at a time stirred into plain hot water, three times a day.

Clinical note임상 주석

Bleeding from several sites at once — haematemesis, epistaxis and rectal bleeding together, and in the severe case from every orifice — is a coagulopathy, and the modern differential is short and serious: disseminated intravascular coagulation, severe thrombocytopenia, acute leukaemia, liver failure, or envenomation. Every item on that list is a medical emergency requiring blood counts, clotting studies, transfusion and treatment of the cause. The dream is not the cause; where there is a connection it runs the other way, since a patient who is bleeding and hypoxic sleeps badly and dreams violently. The formula is a blood-moving and exterior-releasing group with rehmannia as the only blood-related ingredient, and nothing in it is haemostatic in any modern sense. Cinnamon bark is a warming vasodilator and is the wrong direction entirely for someone who is bleeding.

Immun 入門

3.5.7

Source원문

雄朱散, 治鬼魘. 牛黃ㆍ雄黃各一錢, 朱砂五分. 右爲末, 每挑一錢於床下燒之, 次挑一錢以酒調灌. 《入門》

Translation영역

Ungju-san 雄朱散 treats demon oppression. Ox bezoar and realgar, 1 don each; cinnabar, 5 fun. Powder the above; scoop out 1 don and burn it under the bed, then scoop out a further 1 don and pour it in stirred into wine.

Clinical note임상 주석

**Contains realgar, which is arsenic disulfide, and cinnabar, which is mercuric sulfide. This must not be prepared.** The two routes are both bad and the first is worse. Burning realgar under the bed oxidises it towards arsenic trioxide and releases sulfur dioxide into a closed sleeping room, so the patient and everyone attending him inhale it; inhaled arsenic is absorbed efficiently and is a recognised cause of lung cancer. The second don is swallowed in wine, adding mercury, which accumulates in kidney and nervous tissue. **It is also poured into the mouth of a person who has been described as unrousable, which risks aspiration. Nothing is given by mouth to someone who is not fully awake.** 牛黃 is a gallstone from cattle, largely bilirubin and calcium salts, and is pharmacologically inert at this dose. Set against the condition being treated, the arithmetic is worth stating plainly: sleep paralysis resolves by itself in under two minutes and harms no one, and the remedy offered for it is arsenic and mercury given by two routes.

Immun 入門

3.6 Oppressive Clouding 鬱冒

3.6.1

Source원문

人平居無疾, 忽如死人, 身不動搖, 黙黙不知人, 目閉不能開, 口啞不能言, 或微知人, 惡聞人聲, 但如眩冒, 移時方寤. 此由汗出過多, 血少, 氣并于血, 陽獨上而不下, 氣壅塞而不行, 故身如死. 氣過血還, 陰陽復通, 故移時方寤, 名曰鬱冒, 亦名血厥, 婦人多有之. 宜白薇湯ㆍ倉公散, 卽甦. 《本事》

Translation영역

A person going about ordinarily and without illness is suddenly as one dead. The body does not stir, he is silent and does not know anyone, the eyes are shut and cannot be opened, the mouth is mute and cannot speak; or he knows people faintly but hates to hear a human voice, and is only as though dizzy and clouded over. After a while he wakes. This comes of sweating having been too profuse, so that the blood is diminished and the qi is merged into the blood; the yang goes up alone and does not come down, the qi is blocked up and does not move, and so the body is as one dead. When the qi has passed and the blood returns, yin and yang are once more in communication, and so after a while he wakes. It is called oppressive clouding, and also called blood reversal; women have it often. White Swallowwort Decoction or Changgong's Powder is appropriate, and he revives at once.

Clinical note임상 주석

This is a faint. The whole picture — a well person who abruptly becomes unresponsive with the eyes shut, breathing but still, perhaps dimly aware and unable to bear noise, and then waking spontaneously after a short interval with nothing left behind — is syncope, a transient loss of consciousness from a transient drop in cerebral perfusion. The commonest kind by far is reflex, or vasovagal, syncope, and the next commonest is orthostatic syncope from a low circulating volume. 移時方寤, recovery after a little while, is the clinical hallmark that separates it from a seizure and from a stroke. What is striking is that the text's own aetiology points the right way. 汗出過多, 血少 — sweating too profuse and the blood thereby diminished — is a volume-loss account, and heavy sweating with dehydration is a standard precipitant of orthostatic and reflex syncope. The observation that women have it often also matches the epidemiology: reflex syncope is commonest in younger women. The 陽獨上而不下 mechanism is not how circulation works, but the precipitant and the course were read off the patient correctly. The one place where the benign reading becomes dangerous is a faint that happens during exertion, or with chest pain, palpitation or a family history of sudden death. That is cardiac syncope and it needs an electrocardiogram, not a decoction. A collapse that does not resolve within minutes, or that leaves confusion, weakness or a one-sided deficit, is not this condition at all.

Bonsa 本事

3.6.2

Source원문

白薇湯白薇ㆍ當歸各一兩, 人參半兩, 甘草二錢半. 右爲麄末, 每五錢, 水煎溫服. 《本事》

Translation영역

White Swallowwort Decoction. White swallowwort root and Chinese angelica, 1 nyang each; ginseng, half a nyang; licorice, 2 don 5 fun. Make the above into a coarse powder; for each dose take 5 don, boil it in water and give it warm.

Clinical note임상 주석

A qi-and-blood supplementing decoction for a condition that resolves by itself. For a simple faint nothing needs to be given at all: the patient should be laid flat with the legs raised until consciousness returns, and then given fluid and salt by mouth, which is the specific treatment for the volume depletion the text itself identifies. Licorice in any quantity and over any length of time is not inert — glycyrrhizin inhibits renal 11-beta-hydroxysteroid dehydrogenase, causing potassium loss, sodium retention and hypertension — and potassium loss is itself a cause of arrhythmia. A decoction poured into someone not yet fully awake risks aspiration; nothing should be given by mouth until the patient can swallow on command.

Bonsa 本事

3.6.3

Source원문

倉公散藜蘆ㆍ瓜蔕ㆍ雄黃ㆍ白礬各等分. 右爲末, 取少許, 吹入鼻中. 《本事》

Translation영역

Changgong's Powder. Veratrum root, melon pedicle, realgar and alum, equal parts of each. Powder the above, take a small quantity and blow it into the nostrils.

Clinical note임상 주석

**Contains Veratrum, a violent emetic that is also cardiotoxic and causes bradycardia and hypotension, and realgar, which is arsenic sulfide. This must not be prepared.** Alum is strongly irritant to mucosa, and melon pedicle is an emetic in its own right. **The powder is blown into the nostrils, and here the patient is by definition not fully conscious. Powder blown into the nose of an unresponsive person can be drawn into the airway, and the airway comes first: nothing is put into the nose or mouth of someone who cannot protect it.** The underlying idea — a violent nasal stimulus to rouse the patient — does provoke a sneeze and a brief sympathetic surge, which is why sternutatories survived so long in emergency practice; but it is being used on a condition that recovers on its own within minutes, so the risk is all on one side.

Bonsa 本事

3.7 The Various Patterns of Guest Offence and Sudden Reversal 客忤卒厥諸證

3.7.1

Source원문

客忤者, 中惡之類也, 多於道間ㆍ門外得之. 令人心腹絞痛, 脹滿, 氣衝心胸, 不卽治亦殺人. 取百草霜五錢, 鹽一錢, 和硏, 溫水調下. 《本草》

Translation영역

Guest offence is of the same kind as being struck by something malign. It is most often contracted on the road or outside the gate. It makes a man suffer griping pain in the heart and abdomen with distension and fullness, and the qi surges up into the heart and chest; if it is not treated at once it kills him too. Take soot from the hundred grasses, 5 don, and salt, 1 don, grind them together, stir into warm water and give it.

Clinical note임상 주석

客忤 — guest offence — is collapse laid to the account of something met with outside: on the road, beyond the gate, away from home. The section groups it with 中惡, and the explanatory frame is the same, an outside agency striking a person down. What is described in the body of the passage, however, is a recognizable clinical picture: sudden griping abdominal and chest pain with distension and a sense of pressure rising into the chest, fatal within hours if nothing is done. That is an acute abdomen. Sudden severe abdominal pain with distension in a previously well person is perforation of a viscus, bowel obstruction, mesenteric ischaemia, a ruptured aortic aneurysm or a ruptured ectopic pregnancy, and every one of those does kill within hours. 不卽治亦殺人 is correct about the urgency and correct that the clock is what matters. It can equally be the presentation of a myocardial infarction, which often presents as epigastric pain rather than chest pain. Soot from the cooking hearth is carbon, and a crude adsorbent — it is the distant ancestor of activated charcoal, which still has a place in poisoning. Neither carbon nor salt touches a surgical abdomen. What this patient needs is an emergency service, examination and imaging, and in most of these diagnoses an operating theatre.

Boncho 本草

3.7.2

Source원문

又取鹽雞子大, 靑布裹, 燒赤硏, 納酒中頓服, 當吐惡物. 又取細辛ㆍ桂心, 爲細末, 納口中. 又銅器或瓦器盛熱湯, 用厚衣襯腹上, 於衣上熨之, 冷則易, 便愈. 又至寶丹方見風門ㆍ蘇合香元, 以薑汁或溫酒或童尿調灌. 《諸方》

Translation영역

Again: take salt the size of a hen's egg, wrap it in blue cloth, burn it red, grind it, put it into wine and have it drunk off at one draught; he should vomit up the foul matter. Again: take wild ginger and inner cinnamon bark, make them into a fine powder and put it into the mouth. Again: fill a copper or earthenware vessel with hot water, lay a thick garment over the abdomen, press and iron over the garment with the vessel, and change it when it goes cold; he recovers thereupon. Again: Supreme Treasure Elixir — the formula is found in the Wind chapter — or Storax Pill, stirred into ginger juice, warm wine or child's urine and poured in.

Clinical note임상 주석

The hot vessel over the abdomen under a thick cloth is local heat applied for pain. It is harmless in itself and genuinely eases colic, but in a surgical abdomen it relieves the pain that is the diagnosis and buys nothing. Burnt salt in wine to provoke vomiting is the worst move available here: induced emesis has been abandoned everywhere because it empties little, delays what works and risks aspiration, and in a perforation or an obstruction forced vomiting is actively harmful. **Wild ginger is Asarum, a plant of the Aristolochiaceae whose aerial parts carry aristolochic acid — nephrotoxic and carcinogenic — along with safrole; it should not be put into anyone's mouth. Supreme Treasure Elixir is built on rhinoceros horn, hawksbill turtle shell, cinnabar, realgar and musk — two CITES Appendix I animals, mercury sulfide, arsenic sulfide and a third protected species — and Storax Pill likewise contains rhinoceros horn, cinnabar and musk. Neither must be prepared.** Rhinoceros horn is keratin, with no pharmacological action of any kind, and the demand this tradition created is why the species are now endangered. Child's urine is human material and has no place in treatment. And the instruction to pour a liquid in applies to a patient who may be only half conscious: that risks aspiration, and the airway comes before any remedy.

Jebang 諸方

3.7.3

Source원문

又熟艾一兩, 水煎取汁, 頓服卽差. 《本草》

Translation영역

Again: processed mugwort, 1 nyang, boiled in water; take the liquid and drink it off at one draught, and he is cured.

Clinical note임상 주석

Mugwort decoction. Artemisia is aromatic and mildly antispasmodic, and a warm aromatic drink will take the edge off a cramping gut, which is probably the whole of the observed effect. It does nothing for the conditions this section's presentation actually represents.

Boncho 本草

3.7.4

Source원문

帝曰, 厥令人腹滿, 或令人暴不知人, 或至半日, 遠至一日乃知人者, 何也? 歧伯曰, 陰氣盛於上則下虛, 下虛則腹脹滿. 陽氣盛於上則下氣重上而邪氣逆, 逆則陽氣亂, 陽氣亂則不知人. 《內經》

Translation영역

The Emperor said: reversal makes a man's abdomen full, or makes him abruptly not know anyone, in some cases for as long as half a day and at the furthest a whole day before he knows people again. Why is this? Qi Bo said: when yin qi is abundant above, then below is vacuous, and when below is vacuous the abdomen is distended and full. When yang qi is abundant above, then the qi below presses doubly upward and the evil qi counterflows; when it counterflows the yang qi is thrown into disorder, and when the yang qi is in disorder he does not know anyone.

Clinical note임상 주석

The clinical fact recorded here is the duration, and it is worth attending to. A loss of consciousness lasting half a day or a whole day and then resolving is not syncope; nothing that brief and self-limiting lasts that long. That duration points instead to a structural or metabolic cause — hypoglycaemia, a prolonged post-ictal state, sepsis, a drug or poison, hyponatraemia, hepatic or uraemic encephalopathy, or an intracranial event with partial recovery. The text has grouped together, under the single word 厥, states that run from a few seconds to a full day, and the long end of that range is the dangerous end. The 陰氣盛於上 / 下虛 mechanism is a positional account of qi and does not correspond to anything in physiology. The pairing of abdominal distension with impaired consciousness, though, is a real association: it is what obstruction with sepsis, or hepatic failure with ascites, looks like from the outside.

Naegyeong 內經

3.7.5

Source원문

凡卒急之證, 有氣厥ㆍ血厥ㆍ痰厥ㆍ食厥ㆍ中風ㆍ中寒ㆍ中暑ㆍ中濕之類, 皆詳見各門, 隨證治之. 《回春》

Translation영역

In general the patterns of sudden urgency include qi reversal, blood reversal, phlegm reversal and food reversal, and wind stroke, cold stroke, summerheat stroke and damp stroke and the like. All of these are set out in detail in their several chapters; treat according to the pattern.

Clinical note임상 주석

This is the book being systematic about collapse, and the principle is the right one: sudden loss of consciousness is not one disease but a final common presentation, and the first job is to sort it by precipitant. Modern emergency practice does exactly this, with a different set of bins — cardiac, neurological, metabolic, toxicological, environmental, haemorrhagic. Two of the categories named here map directly onto conditions still treated as emergencies. 中暑 is heat illness, and heat stroke with altered consciousness requires immediate aggressive cooling; 中寒 covers hypothermia, where a profoundly cold patient can appear dead and still recover. 中風 is stroke, where the treatment is time-critical imaging and reperfusion. The cross-referencing is a strength of the book; what is missing is any way of telling the categories apart at the bedside in the first minutes, which is what an airway check, a pulse, a glucose stick and an electrocardiogram now do.

Hoechun 回春

3.7.6

Source원문

至聖來復丹方見寒門, 通治諸厥危急之疾. 《得效》

Translation영역

Most Holy Return-of-Life Elixir — the formula is found in the Cold chapter — treats all the critical and urgent illnesses of the several reversals.

Clinical note임상 주석

A general-purpose emergency pill. **Its two leading ingredients are saltpetre and sulfur, roasted together; the formula also uses flying-squirrel droppings. It must not be prepared.** Nitrate and sulfur taken by mouth are gastric irritants, nitrite reduction causes methaemoglobinaemia, and neither has any resuscitative action. A single remedy offered for every kind of collapse is the opposite of the triage the previous passage recommends, and the gap between the two passages is the gap between the book's best instinct and its practice.

Deukhyo 得效

3.8 Sudden Death 卒死

3.8.1

Source원문

帝曰, 人有卒然暴死ㆍ暴病者, 何也? 少師答曰, 三虛者, 其死暴疾也. 得三實者, 邪不能傷人也. 所謂三虛者, 乘年之衰, 逢月之空, 失時之和, 因爲賊風所傷, 是爲三虛. 逢年之盛, 遇月之滿, 得時之和, 雖有賊風邪氣, 不能危之, 是爲三實.

Translation영역

The Emperor said: there are men who die suddenly and violently, or fall suddenly ill. Why is this? The Lesser Teacher answered: in those who have the three vacuities, their death is sudden and swift. In those who have obtained the three repletions, evil cannot injure them. What are called the three vacuities are these: riding on a year of decline, meeting a month of emptiness, losing the harmony of the season, and thereby being injured by brigand wind — this is the three vacuities. Meeting a year of abundance, encountering a month of fullness, obtaining the harmony of the season — then though there be brigand wind and evil qi, they cannot endanger him; this is the three repletions.

Clinical note임상 주석

The question the section opens with is the right question — why do some people drop dead and others take the same insult and live — and the answer is a calendrical and constitutional one, framed in the years, the months and the seasons. Sudden death in adults is overwhelmingly cardiac. The great majority of out-of-hospital sudden deaths are ventricular fibrillation or pulseless ventricular tachycardia arising on a substrate of coronary artery disease, with cardiomyopathy and the inherited arrhythmia syndromes making up most of the rest. There is a real sense in which susceptibility and timing both matter: an ischaemic substrate, electrolyte state, autonomic tone and circadian rhythm all bear on whether a given moment turns into an arrest, and that is the kernel the three-vacuities scheme is reaching for with no means of measuring any of it. The modern answer to the question is not constitutional but procedural, and it is the one thing in this section that saves lives: recognize the arrest, call for help, start chest compressions immediately, and get a defibrillator onto the chest as fast as possible. Survival falls by roughly ten percent for every minute that defibrillation is delayed.

Yeongchu 靈樞

3.8.2

Source원문

三虛相搏, 則爲暴病卒死.

Translation영역

When the three vacuities strike together, there is sudden illness and sudden death.

Yeongchu 靈樞

3.8.3

Source원문

雷公問曰, 人不病而卒死, 何以知之? 帝曰, 火氣入於藏府者, 不病而卒死矣. 雷公曰, 病小愈而卒死者, 何以知之? 帝曰, 赤色出兩觀, 大如拇指者, 病雖小愈, 必卒死. 黑色出於庭庭謂額也, 大如拇指, 必不病而卒死. 《靈樞》

Translation영역

Lei Gong asked: when a man dies suddenly without having been ill, how is it to be known? The Emperor said: in those where fire qi has entered the viscera and bowels, there is sudden death without illness. Lei Gong said: when a man dies suddenly after a slight recovery from illness, how is it to be known? The Emperor said: when a red colour comes out on the two cheekbones, as large as a thumb, then though the illness has slightly abated he will certainly die suddenly. When a black colour comes out on the courtyard — the courtyard means the forehead — as large as a thumb, he will certainly die suddenly without having been ill.

Clinical note임상 주석

A prognostic sign read off the face, with the interlinear gloss identifying 庭 as the forehead. Facial colour does not predict sudden cardiac death; what predicts it is the history, the electrocardiogram and the ejection fraction, and even with those the prediction is poor at the level of the individual. The attention to colour in a sick face is not empty observation, though. Central cyanosis, mottling and the grey pallor of low cardiac output are real signs of circulatory failure and do carry prognosis. What the passage has done is take a correct clinical habit — looking hard at the face of a patient who has taken a turn — and fix it into a sign with a location and a size, which is how a useful observation becomes an unfalsifiable rule.

Yeongchu 靈樞

3.8.4

Source원문

凡卒死者, 口張ㆍ目開ㆍ手散ㆍ遺尿, 爲虛, 宜補氣. 目閉ㆍ口噤ㆍ手拳, 爲實, 宜發表. 《綱目》

Translation영역

In all cases of sudden death, where the mouth hangs open, the eyes are open, the hands are slack and there is incontinence of urine, it is vacuity, and the qi should be supplemented. Where the eyes are shut, the jaw is clamped and the hands are fisted, it is repletion, and the exterior should be released.

Clinical note임상 주석

The division itself is a real clinical discrimination, and a good one. Flaccidity with an open mouth, open fixed eyes, loose hands and incontinence is deep coma or death; a clamped jaw with fisted hands and closed eyes is a hypertonic state. Those are two genuinely different patients, and the second group is what a convulsion, tetanus, a dystonic reaction or decerebrate posturing looks like from the bedside. The treatments that follow from the vacuity–repletion reading are wrong — nothing is supplemented or released in a person without a pulse — but the observation deserves credit. Modern practice makes the same split with better consequences: the flaccid, unresponsive patient is checked for breathing and a pulse and, if absent, receives compressions; the clenched, posturing patient is treated for seizure, raised intracranial pressure or poisoning, which are different problems with different answers.

Gangmok 綱目

3.8.5

Source원문

人見五色非常之鬼, 遂令暴亡者, 皆自己精神不守, 神光不聚故耳, 非外所侮, 乃元氣極虛之候也. 《正傳》

Translation영역

Where a man sees demons of the five colours, strange and not ordinary, and thereupon dies abruptly, it is in every case because his own essence-spirit is not kept in and the light of his spirit is not gathered; it is not an offence from outside, but a sign of the original qi being utterly vacuous.

Clinical note임상 주석

This is the most interesting passage in the section, because it is the book arguing against itself. Two sections earlier the same collapse was read as a strike by something unseen; here 正傳 states flatly that it is 非外所侮 — not an offence from outside — and locates it in the patient's own exhausted vitality. That instinct is correct. Visual hallucination immediately before collapse is a sign of a brain being deprived: hypoxia, hypoglycaemia, hypoperfusion in the moments before a faint or an arrest, or the visual phenomena of delirium in a patient already failing. The apparition is a symptom of the illness, not its cause, and that is exactly what this passage says.

Jeongjeon 正傳

3.8.6

Source원문

凡暴亡不出一時, 可救之. 雖氣閉絶, 四肢冷, 若心腹溫, 鼻微溫, 目中神彩不轉, 口中無涎, 舌與陰卵不縮者, 皆可活也. 《遺篇》

Translation영역

In any abrupt death, where not a full watch has passed, he may be rescued. Though the breath be stopped and cut off and the four limbs cold, yet if the heart region and abdomen are warm, the nose faintly warm, the lustre of the spirit in the eyes not turned away, no froth in the mouth, and the tongue and the testicles not retracted, in all such cases he can be brought back to life.

Clinical note임상 주석

This is the chapter's criterion for a death that is not yet final, and the same judgement recurs across this volume as 心頭溫, the heart region still warm. What the passage is actually doing is asking two questions: is there any residual perfusion, and how long has there been none. 不出一時 — within a single watch — is a time limit, and warmth over the chest and at the nose is a crude proxy for how recently circulation stopped. The eyes not fixed, no froth at the mouth, no retraction of tongue or scrotum are further signs read against the appearance of established death. Those are the right questions, asked with the only instruments available: a hand and an eye. Modern practice asks them better — the presence of a shockable rhythm, end-tidal carbon dioxide, the witnessed downtime and the circumstances of the arrest — and it also knows the one situation in which body warmth reverses the conclusion entirely. In hypothermia a profoundly cold patient can look dead and still recover, and resuscitation continues until rewarming; cold is a reason to keep going, not to stop. What follows from the criterion in this chapter is the problem. Having judged the patient savable, the text's next move is to pour things into the mouth and blow powders into the nose of a person who is not breathing. That order is exactly reversed.

Yupyeon 遺篇

3.8.7

Source원문

救卒死, 或常居寢卧奄忽而絶, 急割取雄雞冠血, 頻塗其面, 乾復塗之, 并以灰營死人一周. 《本草》

Translation영역

To rescue sudden death, or where a man lying down in his usual place is abruptly cut off: quickly cut and take the blood of a cock's comb and smear it repeatedly on his face, smearing again when it dries; and also draw a circle of ashes once round the dead man.

Clinical note임상 주석

Neither measure does anything. The circle of ashes is ritual, not treatment. **Raw poultry blood smeared on the face and around the mouth and nose of an unconscious patient is an infection hazard — Campylobacter, Salmonella and avian influenza are all carried in fresh poultry tissue — and it is being applied exactly where it can be inhaled.** A person found collapsed and pulseless in bed is in cardiac arrest, and the minutes spent cutting a cockerel are the minutes in which the outcome is decided. The response is to call for help, begin chest compressions and get a defibrillator.

Boncho 本草

3.8.8

Source원문

狐膽主暴亡, 臘月取者尤佳. 若有人卒死未移時者, 溫水硏灌入口中, 卽活. 《本草》

Translation영역

Fox gallbladder governs abrupt death; those taken in the twelfth month are the best. If a man has died suddenly and no time has yet passed, grind it in warm water and pour it into his mouth, and he lives at once.

Clinical note임상 주석

**This is the central hazard of the whole chapter. Pouring a liquid into the mouth of a person who is unconscious and has no gag reflex does not deliver a remedy; it fills the airway. Aspiration kills, and it kills people who were otherwise recoverable. The airway comes first, before anything is given by any route.** In a patient who is not breathing the first acts are to open the airway, check for breathing and a pulse, and begin chest compressions — not to administer a medicine. Fox gall is bile, with no resuscitative action, and a wild-animal material carrying the usual parasitic and viral risks. The seasonal refinement about the twelfth month tells us the remedy was collected and traded with care; it tells us nothing about whether it worked.

Boncho 本草

3.8.9

Source원문

淸心元ㆍ至寶丹方見風門ㆍ蘇合香元方見氣門ㆍ至聖來復丹方見寒門ㆍ備急丸, 皆主卒死. 以薑汁或溫酒或童尿調和灌服. 《諸方》

Translation영역

Heart-Clearing Pill, Supreme Treasure Elixir — the formula is found in the Wind chapter — Storax Pill — the formula is found in the Qi chapter — Most Holy Return-of-Life Elixir — the formula is found in the Cold chapter — and Emergency Preparedness Pill all govern sudden death. Stir them into ginger juice, warm wine or child's urine and pour them in.

Clinical note임상 주석

**None of these may be prepared. Supreme Treasure Elixir and Storax Pill are both built on rhinoceros horn and cinnabar; Supreme Treasure adds hawksbill turtle shell, realgar and musk, and Storax Pill also contains musk. That is mercury sulfide, arsenic sulfide, and three CITES Appendix I species.** Rhinoceros horn is keratin, pharmacologically inert, and the demand this tradition created is the reason the species are now endangered. Most Holy Return-of-Life Elixir is saltpetre and sulfur, and Emergency Preparedness Pill is a croton purgative, dealt with below. **The delivery is the greater danger. Every one of these is to be poured into the mouth of a person who by hypothesis has just died suddenly, in ginger juice, wine or urine. That is aspiration, and alcohol poured into an unresponsive patient adds respiratory depression and vasodilatation to it. Child's urine is human material with no therapeutic role.** The airway comes first, and in an arrest the correct sequence is compressions and defibrillation with nothing given by mouth at all.

Jebang 諸方

3.8.10

Source원문

救卒死, 急取半夏末或皂角末, 吹入鼻中. 又雄雞冠血滴入鼻中. 又牛黃或麝香一錢, 溫酒調灌, 卽甦. 《諸方》

Translation영역

To rescue sudden death: quickly take powdered pinellia or powdered gleditsia pod and blow it into the nostrils. Again: drip the blood of a cock's comb into the nostrils. Again: bezoar or musk, 1 don, stirred into warm wine and poured in, and he revives.

Clinical note임상 주석

**Raw pinellia is toxic and violently irritant to mucosa, and gleditsia pod saponins are haemolytic and strongly irritant; neither should be blown into the nose, and musk is from a CITES-listed species. These must not be prepared.** Bezoar is a ruminant gallstone with no action here. **Powder blown into the nostrils of someone who is not breathing does not stay in the nose. Blood dripped into the nostrils runs into the pharynx. Wine poured into an unresponsive mouth goes into the lungs. All three of these instructions put material into an unprotected airway, and the airway is the one thing that must be secured before anything else is attempted.** The idea behind the sternutatory is not foolish: a violent nasal stimulus in a fainting patient provokes a sneeze and a sympathetic surge, and that will rouse someone who was going to rouse anyway. It is useless in a patient whose heart has stopped, which is what this section is about.

Jebang 諸方

3.8.11

Source원문

驚怖卒死者, 以溫酒灌之, 卽活. 《綱目》

Translation영역

Where a man dies suddenly from fright and terror, pour warm wine into him and he lives at once.

Clinical note임상 주석

Death from acute fright is not a fiction. A sudden intense emotional stressor produces a catecholamine surge that can precipitate ventricular arrhythmia in a susceptible heart, and stress cardiomyopathy — transient severe left ventricular dysfunction after emotional shock — is a described and sometimes fatal entity. So the category the passage names corresponds to something real. **The treatment does not. Warm wine poured into an unresponsive person is both an aspiration hazard and a vasodilator and respiratory depressant in someone whose circulation has already failed.** If the patient is unresponsive and not breathing normally, the response is compressions and a defibrillator; if they have fainted and are breathing, they need to be laid flat and left alone until they wake.

Gangmok 綱目

3.8.12

Source원문

備急丸主諸卒死ㆍ暴疾ㆍ百病, 及中惡ㆍ客忤ㆍ鬼擊ㆍ鬼打, 面靑ㆍ口噤ㆍ奄忽氣絶. 大黃ㆍ乾薑ㆍ巴豆霜各一兩. 右爲末, 蜜和擣千杵, 作丸小豆大. 卒死者取三丸, 熱酒呑下. 口噤則以酒化灌之, 下咽卽活. 或溫水下亦得. 《仲景》

Translation영역

Emergency Preparedness Pill. Governs the several sudden deaths, violent illnesses and the hundred diseases, and being struck by something malign, guest offence, demon strike and demon blow, with a blue face, a clamped jaw and the breath abruptly cut off. Rhubarb, dry ginger and croton seed frost, 1 nyang each. Powder the above, blend with honey and pound a thousand strokes with the pestle, and make pills the size of an adzuki bean. For one who has died suddenly, take three pills and swallow them down with hot wine. If the jaw is clamped, dissolve them in wine and pour it in; once it has gone down the throat he lives. Giving them down with warm water will also do.

Clinical note임상 주석

**Contains croton seed frost, which is a violent purgative and a severe irritant; croton oil is a vesicant on skin and mucosa and is toxic by mouth, and the therapeutic dose sits very close to the harmful one. This must not be prepared.** Rhubarb is a stimulant laxative and dry ginger a warming carminative; the formula as a whole is a drastic purge. **Two instructions here are specifically dangerous. A purge given to a person whose circulation has failed does nothing for the arrest and strips fluid and electrolytes from a patient who can spare neither. And 口噤則以酒化灌之 — if the jaw is clamped, dissolve the pills in wine and pour it in — directs a liquid down the throat of someone who cannot swallow and cannot protect their airway. A clamped jaw is a reason to give nothing by mouth at all.** The signs the formula is offered for, a blue face and breath abruptly cut off, are cyanosis and respiratory arrest, and what those call for is an open airway, ventilation and compressions.

Junggyeong 仲景

3.8.13

Source원문

張易老又名獨行丸, 乃急劑也. 《丹心》

Translation영역

Zhang Yilao also called it Solitary Walker Pill; it is an urgent preparation.

Clinical note임상 주석

The alternative name records how the formula was regarded — a single-purpose drug kept for emergencies, to be used alone and at once. That reputation is a reason for extra caution rather than less: a preparation reserved for desperate cases is the one most likely to be given to a patient with no reserve, and croton is the least forgiving ingredient in the chapter.

Dansim 丹心

3.9 Yang Collapse 脫陽證

3.9.1

Source원문

凡人因大吐大瀉之後, 元氣不接, 四肢逆冷, 面黑, 氣喘, 冷汗自出, 外腎縮搐, 不省人事, 須臾不救, 與傷寒陰陽易同證. 宜急服大固陽湯.

Translation영역

In general, after a man has had great vomiting and great diarrhoea, the original qi does not connect: the four limbs turn cold with counterflow, the face is black, the breath is panting, cold sweat comes out of itself, the external genitals retract and twitch, and he is insensible and does not know anything. In a short while he is beyond rescue. It is the same pattern as the yin-yang exchange in cold damage. Great Yang-Securing Decoction should be given quickly.

Clinical note임상 주석

The description is accurate and the diagnosis follows from it directly. Great vomiting and great diarrhoea, then cold extremities, a dark face, rapid breathing, spontaneous cold sweat and loss of consciousness, with death within a short time, is hypovolaemic shock from gastrointestinal fluid loss. Every element is a recognizable sign: the cold limbs and clammy sweat are peripheral vasoconstriction, the tachypnoea is respiratory compensation for metabolic acidosis, the darkened face is poor perfusion, and the clouded consciousness is the brain losing its share of a failing circulation. This is what cholera and severe gastroenteritis look like, and it does kill within hours. The treatment is volume. Intravenous fluid, or oral rehydration solution where the patient can still drink, reverses this condition, and oral rehydration is among the cheapest and most effective interventions in all of medicine. Warming decoctions do not replace salt and water. The section's title and its cross-reference to 陰陽易 place it in the tradition's category of yang deserting the body, which elsewhere covers collapse during or after sexual exertion. That physiology — yang escaping with the semen — is not how the body works. Collapse at such a moment is most often reflex syncope, and where it proves fatal it is a cardiac event or a subarachnoid haemorrhage, both of which are precipitated by exertion and straining rather than by any loss of substance.

Deukhyo 得效

3.9.2

Source원문

又桂枝二兩, 剉, 好酒煎取升服. 又連鬚葱白三七莖, 以酒濃煎服, 陽氣卽回. 又生薑一兩, 硏, 酒煎服亦效. 又葱ㆍ鹽爛擣, 炒熱, 熨臍下氣海, 卽愈. 《得效》

Translation영역

Again: cinnamon twig, 2 nyang, chopped, boiled in good wine; take a seung of it and drink it. Again: scallion white with the rootlets left on, twenty-one stalks, boiled strongly in wine and drunk, and the yang qi returns at once. Again: fresh ginger, 1 nyang, ground and boiled in wine and drunk, is also effective. Again: scallion and salt pounded to a pulp, dry-fried hot, and ironed over Gihae (氣海, CV6) below the navel; he recovers thereupon.

Clinical note임상 주석

Three of the four remedies are given in wine, and that is the wrong direction for this patient. **Alcohol is a vasodilator and a respiratory depressant, and giving it to someone who is already hypotensive and only half conscious deepens the shock and adds an aspiration risk.** Cinnamon twig and fresh ginger are warming aromatics with no effect on circulating volume. The hot scallion-and-salt compress below the navel is the one harmless item, and external warming of a cold, shocked patient is reasonable as far as it goes. The salt is the only substance named in the whole section with a genuine claim on this illness — but it has to go in by mouth or by vein, dissolved in water, not be fried and laid on the abdomen. A patient who can still swallow should be drinking oral rehydration solution; one who cannot needs intravenous fluid without delay.

Deukhyo 得效

3.9.3

Source원문

大固陽湯大附子一枚(炮, 切作八片), 白朮ㆍ乾薑(炮) 各五錢, 木香二錢半. 右剉, 作一貼, 水煎去滓, 放冷灌服. 須臾又進一服, 神效. 《得效》

Translation영역

Great Yang-Securing Decoction. A large aconite tuber, one piece, blast-fried and cut into eight slices; white atractylodes and dry ginger, blast-fried, 5 don each; costus root, 2 don 5 fun. Chop the above and make one packet; boil in water, strain off the dregs, let it go cold and pour it in. After a short while give a second dose; the effect is marvellous.

Clinical note임상 주석

**Contains aconite, which is cardiotoxic. Aconitine opens voltage-gated sodium channels and causes refractory ventricular arrhythmia, and fatal poisonings follow quite small errors in processing or dose. A whole large tuber, repeated after a short interval, is a substantial quantity. This must not be prepared.** It is worth saying what the formula is trying to do, because unlike most of this chapter it is aiming at the right target. Aconite is given here precisely for its cardiovascular action, and processed aconite does have positive inotropic and vasoconstrictor effects at low dose — it is the tradition's nearest thing to a pressor agent, used in exactly the situation where a pressor is wanted. But the therapeutic window is narrow at the best of times, and in a shocked, acidotic, electrolyte-depleted patient there is no margin at all; an arrhythmic death from the remedy is at least as likely as a rescue. **The instruction 放冷灌服 — let it cool and pour it in — applies to a patient already described as 不省人事, insensible. Pouring liquid into an unconscious person risks aspiration, and the airway comes before any drug.** The treatment this patient actually needs is fluid: intravenous crystalloid, or oral rehydration if they can swallow, with the cause of the vomiting and diarrhoea addressed alongside.

Deukhyo 得效

3.10 Rescue from Death by Hanging 救自縊死

3.10.1

Source원문

自縊死者, 自旦至暮, 雖已冷, 必可活. 自暮至旦, 則難治. 心下若微溫者, 一日已上猶可活. 當徐徐抱下解之, 不可截斷繩子. 令安卧被中, 急須按定其心, 却撚正喉嚨. 令一人以手掌掩其口鼻, 勿令透氣, 氣急卽活. 又令一人以脚踏其兩肩, 以手挽其髮, 常令弦急, 勿使縱緩. 一人以手據按胸上, 數摩動之. 一人摩捋臂脛, 屈伸之. 若已強直, 漸漸強屈之. 如此一炊頃, 雖得氣從口出, 呼吸眼開, 仍引按勿止. 《仲景》

Translation영역

In one dead by hanging: if it happened between dawn and dusk, then though the body is already cold he can certainly be brought back; if between dusk and dawn, it is hard to treat. If below the heart there is still a faint warmth, he may be brought back even after a day and more. He should be taken down slowly, held in the arms, and then loosened; the rope must not be cut through. Lay him quietly under the bedding, press and steady the heart region at once, and then turn the throat straight. Have one person cover his mouth and nose with the palm of the hand so that the breath cannot pass through; when the breath grows urgent he revives. Have another person tread on both his shoulders with the feet and pull his hair with the hands, keeping it always taut like a bowstring and never letting it slacken. One person presses down on the chest with the hands and rubs and works it repeatedly. One person rubs and strokes the arms and the shins and flexes and extends them; if they are already stiff and rigid, force the flexion little by little. Do this for the time it takes to cook a meal. Even when the breath has come from the mouth, when he breathes and the eyes open, go on drawing and pressing and do not stop.

Clinical note임상 주석

This is the most recognizable passage in the chapter. Hanging kills by occluding the airway and the vessels of the neck, so the arrest is hypoxic, and a person cut down early can be recoverable — which is exactly what the text asserts against the appearance of death, including against a body that has gone cold. The instruction to hold the body and take it down slowly rather than cut the rope and let it drop is correct cervical-spine care, and it is given for the right reason in practice even if not for the stated one. Straightening the throat is an airway-positioning manoeuvre. Pressing and working over the chest, rubbing and flexing the limbs, several people taking the work in turn, keeping it up for the time it takes to cook a meal, and not stopping even after breathing and eye opening return — that is the principle of continuous resuscitation and of post-arrest care, and it is stated plainly. What is absent is as clear. There is no airway control: no way to open or protect the airway, no means of ventilation. There are no chest compressions as we understand them — pressing and rubbing over the chest is not compression at a depth and rate that generates circulation. There is no defibrillation. And one instruction is actively harmful: covering the mouth and nose with the palm so that air cannot pass is occlusion of the airway in a person who may not be breathing. The reasoning behind it, that obstructing the breath provokes an urgent effort to breathe, is wrong, and the manoeuvre does the opposite of what is needed. The modern response to a person found hanged is to call emergency services, support the body while releasing it, and begin CPR with the airway opened and the cervical spine protected. The warmth below the heart that the text uses as its criterion for who is still savable is the same judgement modern practice makes, and makes differently and better.

Junggyeong 仲景

3.10.2

Source원문

又法, 用手厚裹衣物, 緊填穀道, 抱起解繩放下, 揉其項痕, 仍搐藥入鼻, 及以竹管吹其兩耳. 待其氣回, 方可放手. 若便後分泄氣, 則不可救矣. 《山居》

Translation영역

Another method: wrap the hand thickly in clothing and pack the anus tight; take him up in the arms, loosen the rope and set him down; knead the mark on the neck; then insufflate a drug into the nose, and blow into both ears with a bamboo tube. Wait until his breath returns — only then may the hands be let go. If afterwards the air escapes by the stool, he cannot be saved.

Clinical note임상 주석

The physiology here is the folk idea that the breath is a quantity of air held in the body which can leak away at the lower end, so that plugging the anus retains it and escaping bowel gas is the sign that it has gone. There is nothing in this. Blowing into the ears does nothing: the ear is closed off from the airway at the tympanic membrane. Insufflating a powder into the nose of an unconscious person risks aspiration, and the airway comes first. Taking the body up and releasing the rope rather than letting it fall is, again, correct; so is the patience of waiting for breathing to return before stopping. The modern response remains CPR with the airway opened and the spine protected while emergency services are called.

Sangeo 山居

3.10.3

Source원문

急刺雞冠血, 滴口中卽活, 男雌女雄. 又取雞屎白如棗大, 酒和灌鼻中尤妙. 《本草》

Translation영역

Quickly prick a cockscomb and drip the blood into the mouth; he revives at once — for a man a hen, for a woman a cock. Also take dried white chicken dropping the size of a jujube, blend it with wine and pour it into the nose; this is better still.

Clinical note임상 주석

**Fresh cockscomb blood dripped into the mouth and chicken dropping blended with wine poured into the nose of an unconscious person. This must not be prepared or administered.** Either one is liquid delivered into the airway of someone who cannot protect it, and the second is faecal material; the risks are aspiration and contamination, and both can kill a patient who had been salvageable. The male-female pairing of hen and cock is yin-yang correspondence, not observation. Nothing in this passage has any effect on a hypoxic cardiac arrest, and the time spent on it is time not spent ventilating.

Boncho 本草

3.10.4

Source원문

又以藍汁灌之. 又取梁上塵如大豆許, 納竹管中, 四人各一管, 同時極力吹兩耳鼻中卽活. 又取半夏末, 或皂角末, 或細辛末, 吹入鼻中, 得嚏卽甦. 須臾少與溫粥淸, 令喉潤, 漸漸嚥下乃止. 《本草》

Translation영역

Also pour indigo juice into him. Also take dust from the roof beams, about the bulk of a large bean, put it into bamboo tubes, one tube each to four people, and have them blow with all their force into both ears and into the nose at the same time; he revives at once. Also take powdered pinellia, or powdered soap-bean, or powdered asarum, and blow it into the nose; when he sneezes he comes round. After a short while give him a little of the clear part of warm gruel to moisten the throat, and let him swallow it down little by little, then stop.

Clinical note임상 주석

**Contains pinellia, which is toxic in the raw state and severely irritant to mucous membrane; soap-bean is a saponin irritant. These must not be prepared or insufflated.** Blowing any powder into the nose of an unconscious person risks aspiration into the lungs, and dust from the roof beams adds an inhaled foreign body and its organisms to that. Blowing into the ears does nothing. One observation in the passage is sound. A sneeze requires an intact brainstem reflex arc, so a person who sneezes has a functioning brainstem and is not dead; the text is right to treat it as the sign that he has come round. Provoking it is not a treatment, but reading it as a sign of life is a real piece of clinical observation. Giving the clear part of warm gruel a little at a time once the throat is moist is reasonable in a patient who is awake and swallowing, and dangerous in one who is not. The modern response in this situation is emergency services, CPR with the airway opened and the cervical spine protected, and nothing by mouth or nose until the patient is conscious and able to swallow.

Boncho 本草

3.10.5

Source원문

五絶者, 一曰自縊, 二曰墻壁壓, 三曰溺水, 四曰鬼魘, 五曰産乳. 皆取半夏末吹鼻中, 心頭溫者, 雖一日皆可活. 《本草》

Translation영역

The five severings: the first is hanging, the second being crushed by a wall, the third drowning, the fourth ghost oppression, the fifth childbirth. In all of them take powdered pinellia and blow it into the nose; where the heart region is warm, all may be brought back even after a day.

Clinical note임상 주석

The five severings are a single category built on a single criterion — warmth at the heart region — and treated with a single remedy. The criterion is the chapter's recurring test for who is still savable, and the grouping is not foolish: four of the five are states in which a person can look dead and not be, which is the one thing they have in common. But their physiology is quite different. Hanging and drowning are hypoxic arrests; crush injury under a wall brings traumatic asphyxia, haemorrhage and crush syndrome; childbirth brings haemorrhage, embolism and eclampsia. Each needs a different intervention, and none of them needs the same one. Ghost oppression does not belong on the list at all: it is sleep paralysis, a benign and common phenomenon of REM atonia persisting into waking, from which the sleeper recovers on his own. **Contains pinellia, which is toxic raw and irritant to mucous membrane. This must not be prepared or insufflated**, least of all into the nose of someone who cannot protect the airway.

Boncho 本草

3.11 Rescue from Death by Drowning 救溺水死

3.11.1

Source원문

凡溺水死者, 一宿尙可救. 急急拯出, 先以刀抭開口, 放筯一枚含之, 使可出水. 然後解去衣服, 多灸臍中二三百壯. 令兩人以筆管吹其兩耳. 又取皂角末, 綿裹納下部, 須臾出水卽活. 又取鴨血灌入口中. 又將醋半盞灌鼻中. 又用蘇合香元三丸, 薑湯調灌. 又萬病解毒丹一錠, 冷水磨化灌下卽甦. 溺死ㆍ縊死皆效. 《入門》

Translation영역

In all who have died by drowning, even after a night they may still be saved. Get them out with all haste. First force the mouth open with a knife and put in a single chopstick for him to hold, so that the water can come out. Then take off the clothes and give much moxa at the navel, two or three hundred cones. Have two people blow into both his ears with brush tubes. Also take powdered soap-bean, wrap it in cotton wool and put it into the lower part; after a short while the water comes out and he revives. Also take duck's blood and pour it into the mouth. Also take half a small cup of vinegar and pour it into the nose. Also use three pills of Sohaphyang-won 蘇合香元, stirred into ginger decoction and poured in. Also one tablet of Manbyeonghaedok-dan 萬病解毒丹, ground down and dissolved in cold water and poured down; he comes round at once. For drowning and for hanging alike it is effective.

Clinical note임상 주석

The whole design of this passage is to get water out, and that is the wrong target. Water in the lungs is not drained — the volume that reaches the alveoli in drowning is small, it is absorbed, and no posture or manoeuvre removes it. What does come up when a drowned person is tipped or pressed is stomach contents, and bringing those into the pharynx of someone who cannot protect the airway causes aspiration. Drowning arrest is hypoxic, so ventilation comes first: delay to rescue breathing is what kills. Every step here that aims at drainage delays it. Two elements are right. Undressing the wet patient and warming him is correct, because a drowned person is usually also hypothermic. And the chapter's insistence that someone brought out after a long immersion may still be savable is correct in principle — drowning survival after prolonged submersion, especially in cold water, is documented. **Two or three hundred moxa cones at the navel will burn the patient, on skin that may be cold and insensate.** Soap-bean put into the rectum is an irritant with no effect on the lungs. **Sohaphyang-won 蘇合香元 contains cinnabar (mercury) and rhinoceros horn and musk, both CITES-listed; rhinoceros horn is keratin with no pharmacological action, and the demand this tradition created is why the species are endangered. 萬病解毒丹 here is the Bogam's alternate name for Taeeuljageum-dan 太乙紫金丹, which contains musk, also CITES-listed, together with two violent purgatives — red-sprout euphorbia and caper spurge, the latter *Euphorbia lathyris*, whose seed is a drastic cathartic and whose latex is a skin and mucosal irritant. Neither formula must be prepared.** Pouring either of them, or duck's blood, or vinegar, into the mouth or nose of an unconscious person risks aspiration; the airway comes first, and this is the single most important modern correction to the chapter. One name needs disentangling, because the two formulas are a single character apart. The Bogam uses 萬病解毒丹 as an alternate name for 太乙紫金丹 — the Antidotes chapter's leaf heads itself 太乙紫金丹一名紫金錠一名萬病解毒丹, and that formula's own text prescribes it ground in cold water and poured in for hanging, for falling into water and for fright-death where the heart region is still warm, which is precisely the indication cited here. A separate and differently composed 萬病解毒元 stands one leaf below it in the same chapter, adding cinnabar, realgar, sophora root and scorpion. They are not the same prescription, and the hazards named above are those of 太乙紫金丹, the formula this passage actually means. The modern response is to get the person out of the water, call emergency services, and start rescue breathing immediately, then CPR, with no attempt to drain water and no delay for anything else.

Immun 入門

3.11.2

Source원문

又法, 取竈中熱灰熱沙亦可一二石, 埋其身, 只出頭面, 水出七孔卽活. 《仲景》

Translation영역

Another method: take one or two seok of hot ash from the stove — hot sand will also do — bury his body in it with only the head and face left out, and when the water comes out of the seven orifices he revives.

Clinical note임상 주석

Rewarming a drowned patient is the right instinct, since immersion makes him hypothermic, but hot ash is not the way to do it. Heat of that kind burns, and it burns worst on cold skin that cannot feel it or vasodilate away from it; a hypothermic patient scalds easily and will not report pain. Burying the trunk also puts weight on the chest and takes away access to it, so ventilation and chest compressions become impossible during the very minutes that decide the outcome. Water coming out of the orifices is not a sign of recovery and not the mechanism of rescue. Modern rewarming is gentle, external, and secondary to the airway and ventilation.

Junggyeong 仲景

3.11.3

Source원문

又法, 將牛一頭, 將死者腹橫覆在牛背上, 兩邊用人扶策, 徐徐而行, 則水自下亦活. 《得效》

Translation영역

Another method: take an ox, lay the dead man belly-down across its back, have people steady him on either side, walk the ox slowly, and the water comes down of itself; he too revives.

Clinical note임상 주석

This is contraindicated. Rolling a drowned person face-down over the back of a walking animal is a postural-drainage manoeuvre aimed at water that is not there to be drained. What it actually produces is regurgitation of stomach contents into the pharynx of a patient who cannot protect the airway, and the aspiration that follows. It also makes ventilation and chest compressions impossible and costs the minutes in which a hypoxic arrest is still reversible. The chapter is consistent and consistently wrong on this point: every one of its drowning manoeuvres treats the lungs as a vessel of water to be emptied. Ventilation comes first, and nothing should delay it.

Deukhyo 得效

3.11.4

Source원문

又法, 以生人倒䭾死人, 卽負持走, 吐水便活.

Translation영역

Another method: have a living person carry the dead one upside down on his back, and run at once with him on his back; he vomits the water and revives.

Clinical note임상 주석

The same objection, in its most direct form: inverting the patient and running with him is drainage by gravity, and it achieves vomiting rather than drainage. Vomiting in an unconscious person is the mechanism of aspiration, not of recovery. Nothing is gained, ventilation is delayed, and any neck injury is aggravated. The modern response is rescue breathing without delay, on firm ground, with the airway opened, while emergency services are called.

Immun 入門

3.11.5

Source원문

又法, 以酒壜一箇, 以紙錢一把燒壜中, 𢙣以壜口覆死人面上, 或臍上, 冷則再換, 水出卽活. 《入門》

Translation영역

Another method: take a wine jar, burn a handful of paper money inside it, and quickly invert the mouth of the jar over the dead man's face, or over the navel; when it goes cold, change it again, and when the water comes out he revives.

Clinical note임상 주석

Placing a vessel in which paper has just been burned over the face of a person who may not be breathing puts combustion products — smoke, carbon monoxide, hot gas — directly over the airway, and covers the mouth and nose besides. It is harmful on both counts. The intended mechanism is suction: the cooling jar is meant to draw water out through the skin. It does not, and there is no water in the lungs to be drawn. Applied over the navel the manoeuvre is inert rather than dangerous; over the face it must not be done. The modern response is rescue breathing first, then CPR, with the face and airway kept clear.

Immun 入門

3.12 Rescue from Death by Freezing 救凍死

3.12.1

Source원문

人遇寒凍死, 四肢強直, 口噤, 只有微氣者, 用大釜炒灰令煖, 囊盛熨心上, 冷則易. 口開氣出, 然後以溫粥淸稍稍灌之, 或溫酒, 或薑湯灌之卽甦. 若不先溫其心, 便將火灸, 則冷氣與火淨, 必死矣. 《綱目》

Translation영역

Where a person has met with cold and frozen to death, with the four limbs stiff and rigid, the mouth clenched shut, and only a faint breath remaining: in a large cauldron parch ash until it is warm, put it in a bag and iron it over the heart region, changing it when it goes cold. When the mouth opens and the breath comes out, then pour in a little at a time the clear part of warm gruel, or warm wine, or ginger decoction, and he comes round. If the heart is not warmed first and fire and moxa are applied straight away, then the cold qi and the fire contend, and he will certainly die.

Clinical note임상 주석

This is hypothermia, and the clinical picture is accurate: rigidity of the limbs, a clenched jaw, and respiration so slight that it is barely detectable. A profoundly cold patient can look dead and still recover — the working rule is that he is not dead until he is warm and dead — and the chapter's refusal to write such a person off is the right instinct. The central instruction is better than it looks. Warming the trunk over the heart region, slowly, with a bag of parched ash changed as it cools, and explicitly *not* putting fire or moxa to the patient first, is closer to modern practice than fast heat is. Rewarming the periphery before the core opens up cold peripheral vessels, returns cold blood to the heart and drops the core temperature further — rewarming collapse — and the text's warning that fire applied too early will kill is an observation of exactly that, explained in its own terms as cold and fire contending. Modern rewarming likewise works from the core outward and avoids direct heat to the limbs. What is wrong is what goes into the mouth. A patient with a clenched jaw and a faint breath cannot protect his airway, and warm gruel, wine or ginger decoction poured in will be aspirated; alcohol also vasodilates, which is the opposite of what is wanted. Nothing by mouth until the patient is awake and swallowing. The modern response is to call emergency services, handle the patient gently and horizontally, remove wet clothing, insulate, and rewarm the core — with CPR if there are no signs of life, and rewarming continued during it.

Gangmok 綱目

3.12.2

Source원문

又法, 用氊或蒿薦裹死人, 以索繋定, 放平穩處, 令兩人對面輕輕袞轉往來, 如捍氊法. 四肢溫和卽活. 《得效》

Translation영역

Another method: wrap the dead man in felt or in a straw mat, tie him fast with rope, lay him in a level and steady place, and have two people face each other and gently roll him to and fro, as in the method of beating felt. When the four limbs are warm he revives.

Clinical note임상 주석

Wrapping the patient in felt or matting and laying him flat and steady is sound: insulation and a horizontal position are the first measures in hypothermia, and the text names both. The word for gently is important and the text is right to use it. But the manoeuvre itself is the known hazard of this condition. A profoundly cold heart is electrically unstable, and rough or repeated movement can precipitate ventricular fibrillation — which is why modern handling of a severely hypothermic patient is kept to the minimum necessary, with no rolling, no rubbing of the limbs and no unnecessary transfers. Rolling the body to and fro to generate warmth is more handling than such a patient can safely take, and warmth returning to the limbs is in any case not the measure of recovery; the core temperature is. The modern response is emergency services, minimal gentle movement, horizontal position, dry insulation, and transport to a centre able to rewarm the core.

Deukhyo 得效

3.13 Rescue from Death by Starvation 救餓死

3.13.1

Source원문

凶荒之歲, 人多餓死. 若累日不得食, 飢困將死者, 頓喫飯及肉物則必死. 宜先以稀粥淸稍稍嚥下, 令咽腸滋潤. 過一日, 漸與稀粥頻啜之. 過數日, 乃與稠粥軟飯, 則自然生活. 《類聚》

Translation영역

In years of blight and famine many people die of hunger. If a man has gone days without food and is starving and near death, then eating rice and meat all at once will certainly kill him. He should first be given the clear part of thin gruel, swallowed a little at a time, so as to moisten the throat and the bowels. After a day has passed, give him thin gruel by degrees, sipped often. After several days have passed, then give him thick gruel and soft-cooked rice, and he will come back to life of himself.

Clinical note임상 주석

The chapter is right, and right for a reason it could not have known. Feeding a starved person too much too fast is itself lethal: this is refeeding syndrome. Prolonged starvation depletes intracellular phosphate, potassium and magnesium while serum levels stay near normal, and a sudden carbohydrate load drives insulin, which pushes those electrolytes and glucose into the cells. Serum phosphate can collapse within a day or two, and the consequences are cardiac arrhythmia, heart failure, respiratory failure, seizures and death. The observation that a starving man who eats a full meal of rice and meat will certainly die is correct, and it was not generally understood in Western medicine until the twentieth century, when it was described in people liberated from famine and from the camps. The management the text gives happens to follow the right shape. The clear liquid off thin gruel, taken a little at a time; thin gruel more frequently over the next day; thick gruel and soft rice only after several days — that is a low-volume, low-energy start with a graded increase over days, which is the principle behind modern refeeding protocols. The stated purpose, moistening the throat and the bowels, is wrong; the caution is right. What is missing is what makes refeeding safe today: thiamine before any carbohydrate, to prevent Wernicke's encephalopathy; measurement and replacement of phosphate, potassium and magnesium before and during feeding; a calculated energy target started low and advanced against daily bloods. Severe starvation is a hospital problem, and the danger is in the feeding, not only in the hunger.

Yuchwi 類聚

3.14 Churned-Intestine Sand 攪腸沙

3.14.1

Source원문

此證心腹絞痛, 冷汗出, 脹悶欲絶, 俗謂之攪腸沙, 與乾霍亂同. 由山嵐瘴氣, 或因飢飽失時, 陰陽暴亂而致也.

Translation영역

In this condition there is wringing pain in the heart region and the belly, cold sweat breaks out, and there is distension and oppression to the point of expiring. Commonly it is called the churned-intestine sand, and it is the same as dry cholera. It comes of mountain mist and miasmic vapour, or else of eating and fasting out of season, so that yin and yang are thrown into sudden disorder.

Clinical note임상 주석

The picture is an acute abdominal catastrophe: pain severe enough to be called wringing, cold sweat, abdominal distension, and collapse within a short time. That combination — severe constant abdominal pain, distension, diaphoresis and shock — is the surgical abdomen, and the differential is a short one. Volvulus or closed-loop obstruction, perforation of a viscus with peritonitis, and acute mesenteric ischaemia all present this way and all kill quickly. Severe secretory diarrhoeal illness with hypovolaemic shock belongs on the list too, which is why the chapter equates the state with dry cholera. What the text has got right is that this is one syndrome defined by its speed and its circulatory failure rather than by any organ. What it cannot do is separate the causes, and the separation is the whole of the management: obstruction and perforation need a theatre, ischaemia needs revascularisation, and dehydration needs fluid. Today this is an emergency-department presentation — intravenous access and resuscitation, imaging, and a surgeon.

Deukhyo 得效

3.14.2

Source원문

所感如傷寒, 頭痛嘔惡, 渾身壯熱, 手足指末微厥, 或腹痛悶亂, 須臾能殺人. 先濃煎艾湯試之, 如吐卽是也. 《得效》

Translation영역

What is felt is like cold damage: headache, retching and nausea, the whole body in strong fever, the tips of the fingers and toes slightly cold and reversed, or belly pain with oppression and agitation. It can kill a man in a moment. First decoct mugwort strongly and test him with it; if he vomits, this is it.

Clinical note임상 주석

`手足指末微厥` is a good observation. Cold fingers and toes in a patient who is otherwise febrile is peripheral vasoconstriction — the body shutting down the skin to defend central pressure — and it is one of the earliest bedside signs of shock. Modern practice looks for the same thing in the same place, as cool peripheries and delayed capillary refill, and in a child it is part of every sepsis screen. The chapter has noticed that the state announces itself at the fingertips before the pulse fails. The diagnostic test is of a kind the book uses elsewhere: give something and read the response. Here vomiting after mugwort decoction is taken as confirmation. It confirms nothing — a patient with obstruction, peritonitis or gastroenteritis will vomit after anything given by mouth — and in a patient with a distended, obstructed bowel or a clouding level of consciousness it adds the risk of aspiration. The honest part of the passage is `須臾能殺人`, that it can kill in a moment, which is the one thing a reader most needed to be told.

Deukhyo 得效

3.14.3

Source원문

治法, 蚕退紙燒爲末, 熱酒調服, 立效. 又多飮鹽湯吐之亦愈. 《得效》

Translation영역

Method of treatment: burn silkworm-moulting paper, grind it to powder, and give it stirred into hot wine — it answers at once. Also, drinking much salt decoction and vomiting it up likewise cures.

Clinical note임상 주석

Burnt silkworm paper is charred protein and has no action. Hot wine given to someone with a surgical abdomen is alcohol on an empty stomach in a shocked patient, and it also obscures the abdominal signs on which the diagnosis turns. **Salt water drunk in quantity to force vomiting must not be used. Forced salt-water emesis has killed by acute hypernatraemia, and induced vomiting is no longer part of any emergency protocol — it risks aspiration in a drowsy patient and, where the bowel is obstructed, raises intraluminal pressure in a loop that may already be at the point of perforating.**

Deukhyo 得效

3.14.4

Source원문

有陰陽二證. 陰沙腹痛而手足冷, 看其身上有小紅點, 以香油燈點火, 燒於紅點上, 令其煖爆. 或服葱豉湯, 汗出卽愈. 陽沙腹痛而手足煖, 以鍼刺其十指背近爪甲半分許, 血出卽安. 先自兩臂按摩下其惡血, 令聚指頭, 血出爲好. 《入門》

Translation영역

There are two patterns, yin and yang. In yin sand there is belly pain with cold hands and feet; look over the body for small red spots, take fire from a sesame-oil lamp and burn it over the red spots so that they are warmed until they crackle. Or give Chongsi-tang 葱豉湯, and when sweat comes out it is cured. In yang sand there is belly pain with warm hands and feet; needle the backs of the ten fingers about 5 fun from the nail, and when blood comes out he is at ease. First knead the malign blood downward from both arms so that it gathers at the fingertips, for it is better when the blood comes out.

Clinical note임상 주석

The division is made on the temperature of the hands and feet, which is the one piece of bedside information in the section that carries real weight: cold extremities mark the worse-perfused patient. The chapter then draws the wrong conclusion from it, treating the cold patient with surface burning and a diaphoretic rather than recognising that he is the one in circulatory failure. The small red spots are worth naming. Petechiae appearing on the trunk of a patient with abdominal pain and shock suggest a coagulopathy — meningococcal or other fulminant sepsis, or disseminated intravascular coagulation — and they are a sign to move faster, not a target. **Burning them with a lamp flame inflicts small full-thickness burns on skin that is already failing, and in a coagulopathic patient every burn is a bleeding point.** Pricking the fingertips to bleed is the ancestor of a practice still alive in Korean households, where a needle to the thumb is the usual first response to sudden abdominal pain. It does nothing for the abdomen. The puncture is unsterile, which in this chapter's world means tetanus and cellulitis, and the time spent on it is time not spent getting the patient to help.

Immun 入門

3.14.5

Source원문

又法, 以手蘸溫水, 於病者膝灣內打拍, 有紫黑點處, 以鍼刺去惡血卽愈. 《丹心》

Translation영역

Another method: dip the hand in warm water and slap the inner hollow of the patient's knee; where purple-black spots appear, needle them, let out the malign blood, and he is cured.

Clinical note임상 주석

The procedure manufactures its own sign. Slapping the popliteal fossa ruptures surface capillaries and raises exactly the purple-black marks that are then read as proof of malign blood and chosen as the site to puncture. It is a closed loop, and it is the mechanism behind the whole family of scraping and slapping therapies: the bruise is the treatment's effect, not the disease's.

Dansim 丹心

3.14.6

Source원문

患痛之人, 兩臂腕中有筋, 必致黑色, 用砂鍼擊刺, 出紫黑血, 痛卽止, 神效. 《十三方》

Translation영역

In a man suffering this pain there is a sinew within both arms at the wrist which will have turned black; strike and prick it with a stone needle to let out purple-black blood, and the pain stops at once — divinely effective.

Clinical note임상 주석

A dark vessel at the wrist is a vein, and the dark blood drawn from it is venous blood, not a toxin. Striking and pricking a vein with an unsterilised stone or porcelain point produces a contaminated puncture over a site with tendon sheaths running beneath it — a route to tenosynovitis and, in a pre-antibiotic setting, to a hand that is lost. Taken together, the three bleeding methods of this section tell us what the chapter could actually offer for an acute abdomen: counter-stimulation, and the appearance of having acted. Neither relieves obstruction nor perfuses an ischaemic gut. The claim `痛卽止`, that the pain stops at once, is the kind of report that a self-limiting colic will generate reliably and a volvulus never will.

Sipsambang 十三方

3.15 Sudden Death on Entering a Well or a Tomb 入井塚卒死

3.15.1

Source원문

凡入井塚, 須先以雞鴨毛投之, 直下則無毒, 若徘徊不下則有毒. 當先以酒數升灑其中, 停久乃入. 《本草》

Translation영역

Whenever entering a well or a tomb, one must first throw in a chicken or duck feather. If it goes straight down there is no poison; if it hovers and will not descend, there is poison. One should first sprinkle several seung of wine inside, wait a good while, and only then go in.

Clinical note임상 주석

This is confined-space entry, and the chapter opens it with a pre-entry atmosphere test. A well, a cellar or an opened tomb is a space where the air can be stripped of oxygen or loaded with carbon dioxide, and a man who climbs down into it has no warning: carbon dioxide at the concentrations that kill is odourless, and oxygen deficiency is felt as nothing at all until consciousness goes, often within a breath or two. The principle of testing before entry is correct and has never been abandoned. The flame that will not stay lit and the bird that dies are the historical instruments, and both were still formally in use into the twentieth century; the modern instrument is a four-gas meter read before entry and continuously during it, because the hazard changes as the space is disturbed. The feather itself does not measure anything — how a feather falls reports air currents, not oxygen — and sprinkling wine and waiting is a very weak gesture at the thing that actually works, which is forced mechanical ventilation of the space. The point the chapter cannot make, and the one that matters most, is this: **the commonest way to die in a confined space is as the rescuer going in after the first victim.** Modern practice is that nobody enters without the atmosphere tested and ventilated, without breathing apparatus, and without a trained attendant and a retrieval system outside the opening. An untrained rescuer who climbs in after a collapsed colleague becomes the second casualty.

Boncho 本草

3.15.2

Source원문

夏月淘井, 多致殺人, 五六月尤甚. 古塚中及深井中, 皆有伏氣, 若入則令人冒悶, 奄忽而死. 卽取井水噀其面, 幷冷水調雄黃末一二錢服之. 轉筋入腹痛欲死者, 使四人捉住手足, 灸臍左邊二寸十四壯. 又用生薑一兩剉, 酒五盞, 濃煎頓服. 又醋煮衣絮, 令熱徹, 濕裹轉筋處. 又濃煎鹽湯, 浸手足, 洗胸脇間, 卽甦. 《入門》

Translation영역

Dredging wells in the summer months often kills men, and the fifth and sixth months are the worst of all. In old tombs and in deep wells there is always a lurking vapour, and if one goes in it makes a man muffled and oppressed, and he dies in an instant. At once take well water and spurt it over his face, and give him 1 or 2 don of powdered realgar stirred into cold water. Where the sinews cramp and draw up into the belly with pain to the point of death, have four men hold the hands and feet fast and burn fourteen cones of moxa 2 chon to the left of the navel. Also take 1 nyang of fresh ginger, chop it, decoct it strongly in 5 jan of wine and give it all at once. Also boil cotton wadding in vinegar until the heat has gone right through it, and wrap it wet about the cramping place. Also decoct salt water strongly, steep the hands and feet in it and bathe between the chest and the flanks, and he revives.

Clinical note임상 주석

`伏氣`, the lurking vapour, is the chapter's name for a real and specific hazard, and the epidemiology attached to it is accurate. Stagnant water at the bottom of a deep well supports microbial activity that consumes oxygen and generates carbon dioxide, the process runs faster when it is warm, and disturbing the sediment during dredging releases what has accumulated. That the fifth and sixth months are the worst is an observation worth having. A sealed old tomb is the same chemistry with decomposition added, and the collapse `奄忽而死`, dying in an instant, is what severe hypoxia or a high carbon-dioxide atmosphere actually does. None of the remedies touch the cause. A man taken out of such a space is hypoxic, and the only treatments are removal from the atmosphere by rescuers who are themselves protected, high-flow oxygen, an open airway, assisted ventilation, and CPR if there is no pulse. **Pouring realgar in cold water into the mouth of an unconscious person risks aspiration; in anyone who is not fully awake the airway comes first and nothing is given by mouth at all.** The one measure with any sense in it is spurting cold water on the face, which is a stimulus applied to a patient whose breathing is being watched. **Realgar is arsenic sulfide and is toxic. This must not be prepared.** The cramps drawing into the belly look like a separate condition folded in here — heat cramps or the cramping of severe salt and water depletion — and four men holding a convulsing patient down while fourteen cones are burned beside his navel is a description of restraint and burn injury.

Immun 入門

3.15.3

Source원문

新城縣人家有枯井一口. 有客人兩者, 於五月間因失鈔袋, 疑在井中. 一人先下井中, 寂然無聲. 又一人繼下, 亦久不出. 傍人怪之, 與家主議, 用繩吊縛木板, 令人登▼(足+畓)下井看之, 其人亦無聲. 卽牽上井, 則其人昏迷不省, 用冷水救甦. 更用雞犬縛繩下試, 亦皆死焉. 遂拆毁井畔, 見兩人身尸, 用繩吊縛上來看審, 則身尸靑黑了無傷痕, 比其中毒而死也. 治法同上. 《類聚》

Translation영역

At a household in Sinseong county there was one dried-up well. Two travellers, in the fifth month, having lost a money-bag, suspected it was in the well. One man went down into the well first, and there was stillness and no sound. Another followed him down, and he too was long in not coming out. The bystanders thought it strange, and taking counsel with the householder they slung a wooden board on a rope and had a man stand on it and go down the well to look; and that man too made no sound. They drew him up out of the well at once, and he was in a stupor and senseless, and with cold water they brought him round. They tried again, lowering a chicken and a dog tied to the rope, and these too all died. So they broke down the side of the well and saw the bodies of the two men; they slung them on the rope, brought them up and examined them closely, and the bodies were blue-black with no wound upon them at all — this was dying of the poison. The method of treatment is as above.

Clinical note임상 주석

This is the best passage in the section and one of the most valuable case records in the chapter, because it is a reported multiple-fatality incident reasoned through to a correct conclusion. Three men went down in succession and each fell silent; a chicken and a dog were lowered on the rope as a deliberate test and both died; the well was broken open and the bodies recovered without a mark on them. From the absence of injury the account concludes that the air killed them, which is right, and the blue-black colour of the bodies is cyanosis described accurately. The lowered animals are the canary, used here as a test two and a half centuries before the practice was formalised in mining, and the logic is the same: send something that will show you the atmosphere before it shows you a man. The sequence is also the classic rescuer cascade. The first man went down for his own reasons; the second and third went down after him, and the only survivor is the one who was hauled out quickly. That pattern has not changed, and it is the reason modern confined-space rules forbid entry without ventilation, monitoring and breathing apparatus, and require the rescue to be made from outside the space wherever it can be. **Where someone has collapsed in a well, a tank, a silo or a cellar, the response is to call emergency services and not to go in.**

Yuchwi 類聚

3.16 A Snake Entering the Seven Orifices 蛇入七竅

3.16.1

Source원문

夏月因熱就凉時, 有蛇入人耳鼻口中, 挽不出, 急以刀傷蛇尾, 納川椒一云胡椒二三粒, 裹着卽出. 又以艾灸蛇尾卽出. 又割母猪尾頭, 瀝血入口中, 幷孔中亦出. 後取雄黃末, 調人參湯服, 制蛇毒. 《丹心》

Translation영역

In the summer months, when a man goes to the cool because of the heat, it happens that a snake enters his ear, nose or mouth and will not be pulled out. Quickly wound the snake's tail with a knife, put in two or three grains of Sichuan pepper — one text says black pepper — bind it on, and it comes out. Or burn moxa on the snake's tail and it comes out. Or cut the tip of a sow's tail and let the blood drip into the mouth, and into the opening as well, and it comes out too. Afterwards take powdered realgar, stir it into ginseng decoction and give it, to subdue the snake poison.

Clinical note임상 주석

A snake does not enter a sleeping person's ear, nose or mouth and lodge there with its tail protruding. The ear canal and the nostril are far too narrow for anything but a very small snake, the gag and cough reflexes are violent, and there is no credible case series behind the picture. What circulates is a story, and it has circulated widely and for a long time. The section is still worth having, because it shows how the book handled the extreme and the implausible. The *Donguibogam* is a compendium built for completeness: a reader confronted with anything at all should be able to find an entry, so an entry exists even where the compilers can only have been copying report. The internal signs of that are visible here — the gloss offering black pepper as an alternative reading, and the stacked `又…又…` remedies that mark a passage assembled from several sources rather than from practice. The book prints what it received and attributes it, which is also why a reader four centuries later can tell which sections rest on observation and which do not. **Realgar is arsenic sulfide and is toxic. This must not be prepared.**

Dansim 丹心

3.16.2

Source원문

人卒爲蛇繞不解, 以熱湯淋之, 無湯則令人尿之卽解. 《綱目》

Translation영역

Where a man is suddenly coiled about by a snake and it will not let go, pour hot water over it; if there is no hot water, have someone urinate on it and it lets go at once.

Clinical note임상 주석

Unlike the first passage this one describes something that can happen, though not in Korea: a large constrictor can take a hold that a person cannot break alone. Hot water and urine are not the answer, and scalding water poured over a coiled snake lands on the person inside the coils as well. A constrictor is released by unwrapping it from the tail forward, which takes more than one pair of hands. The clinically important snake emergency is the other one, envenomation, and this chapter treats it elsewhere. The modern management there is immobilisation of the limb, no cutting, no sucking and no tourniquet, transport, and antivenom where it is indicated.

Gangmok 綱目

3.17 Acupuncture and Moxibustion 鍼灸法

3.17.1

Source원문

邪客於手足少陰太陰足陽明之絡, 此五絡俱竭, 令人身脉皆動而形無知, 其狀若尸, 名曰尸厥. 先刺隱自, 後刺涌泉, 後刺厲兌, 後刺少商, 後刺神門. 《內經》

Translation영역

When evil lodges in the connecting vessels of the hand and foot shaoyin, the taiyin and the foot yangming, and these five connecting vessels are all exhausted, it makes all the vessels of a man's body move while his form knows nothing, and his appearance is like a corpse. This is called corpse reversal. First needle Eunbaek (隱白, SP1), then Yongcheon (涌泉, KI1), then Yeotae (厲兌, ST45), then Sosang (少商, LU11), then Sinmun (神門, HT7).

Clinical note임상 주석

The quotation is from the *Suwen*, and the state it defines is a precise one: every vessel in the body is still moving while the form knows nothing. That is an unresponsive patient who still has a pulse — and distinguishing him from a patient with no pulse is the single most consequential judgement in emergency medicine, because the two need entirely different things. The chapter has the distinction and makes it the basis of the name. Four of the five points are at the ends of the fingers and toes, with Sinmun at the wrist, so the method is distal noxious stimulation. It will sometimes appear to work, because the conditions that produce a brief unresponsive state with a preserved pulse — vasovagal syncope above all — resolve on their own within a minute or two of the patient being flat. Modern practice for an unresponsive patient with a pulse is to open the airway, confirm that breathing is normal, put him in the recovery position, give oxygen, and look for the cause: hypoglycaemia, stroke, seizure, intoxication, arrhythmia, head injury. For an unresponsive patient who is not breathing normally it is chest compressions at once.

Naegyeong 內經

3.17.2

Source원문

尸厥, 當刺期門ㆍ巨闕ㆍ中極ㆍ僕參ㆍ隱白ㆍ大敦ㆍ金門.

Translation영역

For corpse reversal one should needle Gimun (期門, LR14), Geogwol (巨闕, CV14), Junggeuk (中極, CV3), Boksam (僕參, BL61), Eunbaek, Daedon (大敦, LR1) and Geummun (金門, BL63).

Gangmok 綱目

3.17.3

Source원문

卒厥尸厥, 百會灸四十九壯, 氣海ㆍ丹田灸三百壯, 覺身體溫煖卽止.

Translation영역

For sudden reversal and corpse reversal, burn forty-nine cones at Baekhoe (百會, GV20), and three hundred cones at Gihae (氣海, CV6) and Danjeon (丹田); when the body is felt to be warm, stop.

Clinical note임상 주석

Three hundred cones at the lower abdomen is hours of continuous burning on one small area of skin, and what it produces is a deep burn. Nobody in circulatory collapse has that much time, and in a patient who is not perfusing the skin the burn is also the slowest to be noticed. The endpoint is the interesting part. `覺身體溫煖卽止` — stop when the body is felt to be warm — is the same criterion that runs through this chapter as 心頭溫, warmth over the heart, used to decide whether a person found collapsed is still worth working on. It is a crude proxy for perfusion, and it is the right variable approached the only way available. Modern practice reads the same thing far better and far earlier, from a central pulse, breathing, capillary refill, blood pressure and an ECG, and it does not wait for the skin.

Gangmok 綱目

3.17.4

Source원문

中惡ㆍ客忤ㆍ卒死, 灸臍中百壯.

Translation영역

For strike by malignity, offence by a visitant and sudden death, burn a hundred cones at Jejung (臍中).

Gangmok 綱目

3.17.5

Source원문

中惡, 取人中ㆍ中脘ㆍ氣海.

Translation영역

For strike by malignity, take Injung (人中, GV26), Jungwan (中脘, CV12) and Gihae.

Clinical note임상 주석

Injung, at the midpoint of the philtrum, is the point this chapter and every later popular tradition reaches for when someone has collapsed, and pressing, pinching or needling it is still ordinary first-response folk practice in Korea and across East Asia. **There is no evidence that stimulating the philtrum restores consciousness or circulation, and the harm is not in the pinch but in the delay. In cardiac arrest the chance of survival falls by roughly seven to ten per cent for every minute that passes without chest compressions, so a minute spent on the philtrum is a minute of no blood flow to the brain. For anyone found collapsed: check whether they respond and whether they are breathing normally, call emergency services, and if breathing is absent or abnormal start chest compressions immediately and use a defibrillator as soon as one can be brought.**

Gangmok 綱目

3.17.6

Source원문

卒死, 灸心下一寸ㆍ臍上三寸ㆍ臍下四寸各三壯卽差. 又灸手足兩瓜後二七壯.

Translation영역

For sudden death, burn three cones each 1 chon below the heart, 3 chon above the navel and 4 chon below the navel, and he recovers. Also burn fourteen cones behind the nails of both the hands and the feet.

Gangmok 綱目

3.17.7

Source원문

諸卒死及魘死, 急於人中及兩脚大拇指內離瓜一韭葉許, 各七壯卽活. 《綱目》

Translation영역

For all the sudden deaths and death by nightmare, urgently burn seven cones each at Injung and on the inner side of the great toes of both feet, about the breadth of a leek leaf from the nail, and he lives.

Clinical note임상 주석

Moxa to the philtrum and the toes for a person found apparently dead is cautery applied in place of resuscitation, and the measure of it is the time it takes. The two states the passage names are not comparable: `魘死` belongs with the night-terror section of this chapter and describes sleep paralysis, which is benign and ends on its own, while `卒死` includes true cardiac arrest, in which only compressions and defibrillation change the outcome. Treating the two with the same cones is the limit of what the chapter could distinguish.

Gangmok 綱目

3.17.8

Source원문

卒被鬼擊如中箭, 用桃皮一片安痛上, 取一匙頭安桃皮上, 用艾胡桃大安匙頭灸之卽差. 《入門》

Translation영역

Where a man is suddenly struck by a ghost, as though hit by an arrow, lay a piece of peach bark on the painful place, set the bowl of a spoon on the peach bark, put moxa the size of a walnut in the bowl of the spoon and burn it, and he recovers.

Clinical note임상 주석

The construction is a recognisable piece of indirect moxibustion: an insulating layer on the skin, a metal vessel above it, and the burning moxa in the vessel, so that heat reaches the site without the cone touching the body. Devices of this kind were a genuine technical refinement — they let a large charge of moxa be used without a burn — and the same principle is behind the moxa box and the warm-needle methods still in use. The peach bark is apotropaic rather than thermal; peach wood is the standard material against malign influence. With this passage 救急門 closes. It is the most clinically checkable chapter in the volume, and the reason is that its sections are states rather than diseases: a person found hanged, drowned, frozen, starved, or collapsed in a well is a presentation that modern emergency medicine also recognises, so the chapter's methods can be held against current practice item by item. Several hold up — cutting a hanged man down supported rather than letting him fall, rewarming the frozen slowly, refeeding the starved a little at a time, testing the air before entering a well, and above all the refusal to stop early. The needling and moxa gathered here are where the chapter is weakest, because they occupy the minutes that matter most. Where the base text would have a reader burning cones on a philtrum, the modern answer is to call emergency services, open the airway, and start chest compressions.

Immun 入門

About this translation 凡例

Base text: Donguibogam (東醫寶鑑, 1613 first edition), Miscellaneous Disorders, Volume 9, Emergencies chapter, leaves 029a to 035b. 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 seventeen sections and the text stands up eighteen, so one is given here as a numbered sub-section. Twenty-three collation notes bear on the chapter, two of which sit past its last section, on the leaf that opens the following chapter, and point back into 3.17. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.