寶鑑Bogam

Formulas · Text · Donguibogam 東醫寶鑑

Sudden Turmoil

Gwallan

한글 곽란  ·  Pinyin Huo Luan

Violent vomiting and diarrhoea together — the dry kind and the wet kind, and why the dry kind kills

霍亂

霍亂 means a sudden overturning, and the chapter takes the name literally: 揮霍變亂, a whirl and a disordering. What it describes is explosive vomiting and diarrhoea coming on together, with abdominal pain, cramping of the legs, cold hands and feet and a pulse that may disappear altogether. The Bogam divides it into the wet kind, where everything comes up and out, and the dry kind, where nothing will move in either direction — and says plainly that the dry kind is the one that kills, because the patient cannot empty what is poisoning him.

Much of the chapter is good acute medicine working with the wrong tools. The signs it watches are the right ones: how cold the limbs are and how far up the cold has reached, whether the pulse can be found, whether the tongue has curled and the scrotum drawn up, whether the patient is still thirsty. The judgments it draws are mostly sound — cramping after violent vomiting and diarrhoea as a sign of what has been lost, thirst as the thing to treat next, food as the thing to withhold until the vomiting has stopped. The 禁忌法 section's rule that not a mouthful of grain is to be given while the vomiting lasts, and then only thin gruel, is close to modern advice.

What it lacks is any way of putting fluid back. Everything it has — salty sour drinks, honey water, rice water, powders stirred into cold water — is an attempt at it, and 1.15's list of untreatable signs is a list of patients who died of dehydration. The illness the chapter is largely describing, in its epidemic form, is cholera; a patient presenting this way today needs rehydration before anything else, and the chapter's own prognosis for those it could not rehydrate is the measure of why.

1.1 The Causes of Sudden Turmoil 霍亂之因

1.1.1
Source원문

內經曰, 土鬱之發, 民病嘔吐霍亂注下. 又曰, 太陰所至爲中滿ㆍ霍亂吐下. 又曰, 歲土不及, 風乃大行, 民病飱泄霍亂ㆍ體重腹痛ㆍ筋骨搖倂.

Translation영역
The Inner Classic says: when earth depression breaks out, the people fall ill with retching, vomiting, sudden turmoil and pouring diarrhoea. It says again: where greater yin arrives there is fullness in the centre and sudden turmoil with vomiting and diarrhoea. It says again: when the year's earth is insufficient, wind travels in abundance, and the people fall ill with food-shot diarrhoea and sudden turmoil, heaviness of the body, abdominal pain, and sinews and bones shaking and giving way.
Clinical note임상 주석
The third quotation is the chronogram of the 己 years, given in full at 天地運氣 1.41, where the same phrase 筋骨搖倂 appears. The chapter opens by placing sudden turmoil in the cosmological scheme and then, in the next passage, drops that frame entirely.

Naegyeong 內經

1.1.2
Source원문

霍亂之病, 皆因飮食, 非關鬼邪. 《千金》

Translation영역
The illness of sudden turmoil is in every case caused by food and drink; it has nothing to do with demons or evil spirits.
Clinical note임상 주석
非關鬼邪 — nothing to do with demons — is a seventh-century statement and the Bogam puts it second in the chapter, before anything else. Explosive vomiting and diarrhoea striking a household at once is exactly the kind of event that invites a supernatural explanation, and both the Cheongeum and the Dansim passage following refuse it. The attribution to food and drink is also, in the case of the illness they were mostly seeing, correct.

Cheongeum 千金

1.1.3
Source원문

內有所積, 外有所感, 陽不升陰不降, 乖隔而成. 非因鬼邪, 皆飮食所致, 此先哲確論也. 《丹心》

Translation영역
There is something accumulated within and something contracted without; the yang does not rise and the yin does not descend; they are sundered and set apart, and so it comes about. It is not caused by demons or evil spirits but is in every case brought on by food and drink — this is the settled judgment of the wise men before us.

Dansim 丹心

1.1.4
Source원문

霍亂者, 揮霍變亂也. 凡人內素有鬱熱, 外又感寒, 一時陰陽錯亂. 然病本因飮食失節ㆍ生冷過度, 以致濕熱內甚, 中焦失運, 不能升降, 是以上吐下瀉. 《入門》

Translation영역
Sudden turmoil means a whirling and a disordering. Where a person has had depressed heat within and then contracts cold without, yin and yang are thrown into confusion all at once. But the root of the illness is in failing to moderate food and drink and in taking too much raw and cold food, so that damp heat becomes severe within, the middle burner loses its movement and cannot raise or lower — and hence vomiting above and diarrhoea below.
Clinical note임상 주석
揮霍變亂 is the gloss that gives the illness its name, and it is a description of the tempo: everything happening at once. 生冷過度, too much raw and cold food, is the cause the chapter settles on, and in a hot climate without refrigeration it is as close to food-borne infection as the vocabulary allowed.

Immun 入門

1.1.5
Source원문

霍亂, 或因飮冷, 或冒寒, 或失飢, 或大怒, 或乘舟車傷動胃氣, 令人吐瀉倂作, 用藥遲緩, 須臾不救. 《華佗》

Translation영역
Sudden turmoil may come of drinking cold things, of braving cold, of going hungry past the hour, of great anger, or of riding in a boat or carriage so that the stomach qi is shaken and injured; it makes the patient vomit and have diarrhoea at once, and if medicine is used slowly there is no saving him in the little while that is left.
Clinical note임상 주석
用藥遲緩, 須臾不救 — treat slowly and there is no saving him in the little while that is left — is the chapter's working premise, and it is correct. Severe cholera can kill within hours, and the interval between presentation and treatment is what decides the outcome.

Hwata 華佗

1.1.6
Source원문

霍亂多責於熱, 故夏秋爲盛. 《入門》

Translation영역
Sudden turmoil is mostly to be laid to heat, and so it is at its height in summer and autumn.
Clinical note임상 주석
The seasonal observation is the chapter's strongest piece of evidence and it is right: epidemic diarrhoeal illness peaks in the hot months. The inference drawn from it — that the cause is heat — is the one a modern reader would replace, but the association is real and it is why the chapter's formulas are shared with the 暑 summerheat chapter.

Immun 入門

1.1.7
Source원문

霍亂之病, 由風ㆍ濕ㆍ暍三氣之合成也. 風者肝木也, 濕者脾土也, 暍者心火也. 肝主筋, 故風急甚則轉筋也. 吐者暍也, 心火炎上故嘔吐也. 泄者脾土也, 脾濕下流故泄瀉也. 啓玄子曰, 皆脾熱所生也. 斯言爲正. 《子和》

Translation영역
The illness of sudden turmoil is made up of three qi together — wind, damp and sunstroke-heat. Wind is the liver's wood, damp the spleen's earth, sunstroke-heat the heart's fire. The liver governs the sinews, and so when the wind is urgent and severe there is cramping of the sinews. The vomiting is the sunstroke-heat: the heart's fire blazes upward, and so there is retching and vomiting. The diarrhoea is the spleen's earth: the spleen's damp flows downward, and so there is outflow. Gyehyeonja says they are all engendered by heat in the spleen; and this saying is the right one.
Clinical note임상 주석
Jahwa's analysis takes the three cardinal signs — cramps, vomiting, diarrhoea — and assigns each to a qi, which is the clearest instance in the chapter of a symptom-by-symptom aetiology. 啓玄子 is Wang Bing, the Inner Classic's commentator, and the judgment quoted from him locates the whole thing in the spleen, which is where the chapter's treatment goes.

Jahwa 子和

1.2 The Form and Signs of Sudden Turmoil 霍亂形證

1.2.1
Source원문

霍亂證, 心腹卒痛ㆍ嘔吐下利ㆍ增寒壯熱ㆍ頭痛眩暈. 先心痛則先吐, 先腹痛則先利, 心腹俱痛, 吐利並作. 甚則轉筋入腹卽死. 《正傳》

Translation영역
In the pattern of sudden turmoil there is sudden pain in the heart region and abdomen, retching and vomiting with diarrhoea below, mounting chills and vigorous fever, headache and dizziness. If the pain in the heart region comes first the vomiting comes first; if the abdominal pain comes first the diarrhoea comes first; if both ache together, vomiting and diarrhoea break out together. In a severe case the cramping enters the abdomen and death is immediate.
Clinical note임상 주석
The order of the two pains predicting the order of the two evacuations is the kind of observation 辨證 3.5 makes a rule of — which came first decides where the trouble is. The last clause, cramping that reaches the abdomen, is the chapter's recurring terminal sign; generalized muscle cramping extending to the abdominal wall in a patient losing fluid at this rate marks severe electrolyte depletion.

Jeongjeon 正傳

1.2.2
Source원문

三焦爲水糓之道路. 邪在上焦則吐而不利, 邪在下焦則利而不吐, 邪在中焦則吐利並作. 病因飮食不節ㆍ淸濁相干ㆍ陰陽乖隔. 輕者只曰吐利, 重者揮霍變亂, 乃曰霍亂. 因邪入脾胃, 故發爲吐利. 《入門》

Translation영역
The three burners are the road of water and grain. When the evil is in the upper burner there is vomiting without diarrhoea; when it is in the lower burner, diarrhoea without vomiting; when it is in the middle burner, vomiting and diarrhoea break out together. The illness is caused by immoderate food and drink, by the clear and the turbid interfering with each other, and by yin and yang being sundered. In a light case it is called simply vomiting and diarrhoea; in a grave one it is a whirling and a disordering, and that is called sudden turmoil. It is because the evil has entered the spleen and stomach that it breaks out as vomiting and diarrhoea.
Clinical note임상 주석
A localizing rule: vomiting alone means the upper gut, diarrhoea alone the lower, both together the middle. It also gives the chapter its definition — 霍亂 is not vomiting or diarrhoea but the two together and violently, which is what distinguishes it from the 嘔吐 and 下痢 chapters.

Immun 入門

1.2.3
Source원문

霍亂一證, 夏秋爲多, 寒月亦有之, 盖有伏暑而作. 《入門》

Translation영역
The pattern of sudden turmoil is commonest in summer and autumn, though it occurs in the cold months too, there being a latent summerheat that breaks out.

Immun 入門

1.2.4
Source원문

人之藏府冷熱不調, 或飮食不節ㆍ生冷過多, 或起居失宜ㆍ露卧當風, 使風冷之氣歸於三焦, 傳於脾胃. 脾胃得冷, 不能消化水糓, 致令眞邪相干, 飮食變亂於腸胃之間, 心腹疼痛, 發作吐利. 有心痛而先吐者, 有腹痛而先利者, 有吐利俱發者, 有發熱頭痛體疼而復吐利虛煩者, 或但吐利心腹剌痛者, 或轉筋拘急疼痛者, 或但嘔而無物出者, 或四肢逆冷煩悶昏塞而欲死者. 隨證治之. 《得效》

Translation영역
When a person's viscera and bowels are out of balance between cold and heat, or when food and drink are immoderate and too much is taken raw and cold, or when the daily round is unsuitable and one lies out exposed to the wind, the wind-cold qi makes its way to the three burners and is passed on to the spleen and stomach. The spleen and stomach taking cold cannot digest water and grain, so that the true qi and the evil interfere with each other, food and drink are thrown into disorder between stomach and intestines, the heart region and abdomen ache, and vomiting and diarrhoea break out. There are those in whom the heart region aches and the vomiting comes first; those in whom the abdomen aches and the diarrhoea comes first; those in whom vomiting and diarrhoea break out together; those with fever, headache and aching of the body who then have vomiting, diarrhoea and vacuity vexation; some with only vomiting and diarrhoea and stabbing pain in the heart region and abdomen; some with cramping, tension and pain; some who only retch with nothing coming up; and some with cold reversal of the four limbs, vexed oppression, clouding and obstruction, at the point of death. Treat according to the pattern.
Clinical note임상 주석
Eight presentations, graded from the mildest to the worst, and the last is the one to read twice: cold reversal of the limbs with clouding of consciousness in a patient at the point of death. **That presentation is hypovolaemic shock. A patient with profuse vomiting and diarrhoea whose limbs are cold and who is becoming confused needs immediate rehydration and emergency care.** 或但嘔而無物出者 — retching with nothing coming up — is the 乾霍亂 of 1.4, singled out here among the eight as a presentation in its own right.

Deukhyo 得效

1.3 Pulse Method 脉法

1.3.1
Source원문

霍亂脉浮洪可救, 脉微遲而不語ㆍ氣少則難差. 《得效》

Translation영역
In sudden turmoil a floating surging pulse can be rescued; a faint slow pulse with loss of speech and scant qi is hard to bring right.

Deukhyo 得效

1.3.2
Source원문

脉多伏或絶. 《丹心》

Translation영역
The pulse is mostly hidden, or cut off altogether.

Dansim 丹心

1.3.3
Source원문

脉代者霍亂, 代而亂者亦霍亂. 又關脉滑爲霍亂吐瀉; 又滑而不勻, 必是霍亂吐瀉之候. 脉代勿訝. 《醫鑑》

Translation영역
An intermittent pulse means sudden turmoil, and one intermittent and disordered likewise. Again, a slippery pulse at the bar means sudden turmoil with vomiting and diarrhoea; and one slippery and uneven is certainly a sign of sudden turmoil with vomiting and diarrhoea. Do not be alarmed at an intermittent pulse.

Uigam 醫鑑

1.3.4
Source원문

滑數爲嘔, 代者霍亂, 微滑者生, 澁數凶斷. 《脉訣》

Translation영역
Slippery and rapid means retching; intermittent means sudden turmoil; faint and slippery means the patient lives; rough and rapid is judged ill.

Maekgyeol 脉訣

1.3.5
Source원문

脉微而澁, 或代而散, 或隱而伏, 或大而虛, 或結或促或代, 皆不可斷以死, 脉亂故也. 《正傳》

Translation영역
A pulse faint and rough, or intermittent and scattered, or hidden and buried, or large and empty, or bound, or hurried, or intermittent — none of these is to be judged fatal, because the pulse is in disorder.
Clinical note임상 주석
The most sensible pulse passage in the Bogam, and it tells the examiner to disregard his own method. In sudden turmoil the pulse is wrecked by the fluid loss itself, so every finding that would be grave in another illness — hidden, scattered, intermittent, empty — means only that the circulation is empty. 皆不可斷以死 — none of these is to be judged fatal — is a warning against giving up on a patient who is in fact salvageable, and with rehydration almost all of them were.

Jeongjeon 正傳

1.3.6
Source원문

脉浮大而洪可救, 微弱而遲難救. 《正傳》

Translation영역
A pulse floating, large and surging can be rescued; faint, weak and slow is hard to rescue.

Jeongjeon 正傳

1.4 Sudden Turmoil Is Either Dry or Wet 霍亂有乾有濕

1.4.1
Source원문

此病有乾霍亂ㆍ濕霍亂. 乾霍亂死者多, 濕霍亂死者少. 盖吐利則所傷之物得以泄出, 雖甚重, 胃中水糓泄盡則止矣, 所以死者少也. 乾霍亂死者多者, 以其上不得吐ㆍ下不得利, 則所傷之物不得出泄, 壅閉正氣, 隔絶陰陽, 煩擾悶躁ㆍ喘脹而死矣. 《明理》

Translation영역
This illness is of two kinds, dry sudden turmoil and wet. In the dry kind many die, in the wet kind few. For where there is vomiting and diarrhoea, what has done the injury gets discharged, and however grave the case, once the water and grain in the stomach have all been passed it stops — and that is why few die. In the dry kind many die because nothing can be vomited above and nothing passed below, so that what has done the injury cannot get out; it blocks and shuts in the true qi, cuts yin and yang off from each other, and the patient dies in vexed distress, oppression and agitation, with panting and distension.
Clinical note임상 주석
The chapter's central distinction and the reasoning behind it is explicit: vomiting and diarrhoea are the cure as much as the disease, because they empty what caused the trouble. It follows that the dangerous patient is the one who cannot empty, and the whole of 1.5 is about making him. A modern reading reverses the prognosis. 濕霍亂 — profuse vomiting and diarrhoea, which the chapter calls the survivable kind — is what kills in cholera, by dehydration; 乾霍亂, with its distension, panting and inability to pass anything, is intestinal obstruction or ileus, serious but slower. The Bogam has the two mechanisms exactly inverted, and the reason is that it could do something for the dry case and nothing for the wet one. Its death rates are a record of what it could treat.

Myeongni 明理

1.5 Treatment of Dry Sudden Turmoil 乾霍亂治法

1.5.1
Source원문

吐利不得, 謂之乾霍亂.

Translation영역
Where neither vomiting nor diarrhoea is possible, this is called dry sudden turmoil.

Deukhyo 得效

1.5.2
Source원문

乾霍亂者, 忽然心腹脹滿ㆍ剌痛, 狀若神靈所附, 吐利不得, 頃刻之間便致悶絶. 急用塩湯吐之, 續以理中湯方見寒門倍加橘紅與之, 或藿香正氣散方見寒門加官桂ㆍ赤茯苓ㆍ枳殼ㆍ木瓜煎服, 或呑下蘇合香元尤妙. 《得效》

Translation영역
In dry sudden turmoil the heart region and abdomen suddenly swell up full and stab with pain, the look of it as though a spirit had taken possession, nothing can be vomited or passed, and in a moment the patient is brought to oppression and collapse. Urgently make him vomit with salt water, and follow it with Regulate the Centre Decoctionthe formula is given in the Cold chapter with the tangerine peel doubled; or with Patchouli Correct the Qi Powderthe formula is given in the Cold chapter with official cinnamon, red poria, bitter orange peel and quince added and decocted; or it is better still to have him swallow down Storax Pill.
Clinical note임상 주석
狀若神靈所附 — the look of it as though a spirit had taken possession — is the chapter's one concession to the appearance it denied at 1.1, and it is a description of the patient's distress rather than an explanation. Sudden abdominal distension with stabbing pain, retching that produces nothing, and rapid collapse is an acute abdomen. **A patient in this state needs urgent surgical assessment; inducing vomiting is dangerous and the salt water of 1.10 is not to be used.**

Deukhyo 得效

1.5.3
Source원문

乾霍亂最難治, 死在須臾, 升降不通故也. 當先吐以提其氣之橫格, 不可用凉藥. 宜二陳湯方見痰門加解散藥川芎ㆍ蒼朮ㆍ防風ㆍ白芷之類, 兼用薑塩湯. 《丹心》

Translation영역
Dry sudden turmoil is the hardest of all to treat and death comes in a moment, because rising and falling have stopped passing. One should first induce vomiting, to lift the qi that has been blocked crosswise, and cooling medicines must not be used. Two Matured Ingredients Decoctionthe formula is given in the Phlegm chapter is appropriate, with dispersing drugs such as chuanxiong, black atractylodes, siler and angelica added, together with Ginger and Salt Decoction.

Dansim 丹心

1.5.4
Source원문

絞腸沙者, 乃乾霍亂一名也. 腹痛不可忍, 或手足厥冷, 乃腸胃絞縮在腹也. 急用塩湯吐之. 《入門》

Translation영역
Wrung-bowel sand is another name for dry sudden turmoil. The abdominal pain is unbearable and the hands and feet may be cold in reversal; this is the stomach and intestines wringing and shrinking within the abdomen. Urgently make the patient vomit with salt water.
Clinical note임상 주석
絞腸沙, wrung-bowel sand, is the name under which the illness appears in the 救急 chapter and in popular use. 腸胃絞縮在腹 — the bowel wringing and shrinking inside the abdomen — is as direct a description of colic as the literature has, and the picture given, unbearable colicky pain with cold extremities and nothing passing, is an obstructed or strangulated bowel. **This is a surgical emergency.**

Immun 入門

1.5.5
Source원문

乾霍亂者, 氣痞於中, 吐利不得, 所傷之物壅閉正氣, 關格陰陽, 煩躁喘脹者必死. 急用吐法, 鍼委中穴名出血, 兼服治中湯方見寒門, 或藿香正氣散必效. 《入門》

Translation영역
In dry sudden turmoil the qi is stopped up in the centre, nothing can be vomited or passed, what has done the injury blocks and shuts in the true qi and bars yin and yang apart; and where there is agitation with panting and distension the patient must die. Urgently use the method of inducing vomiting, needle wijungthe name of a point to let blood, and together with it give Govern the Centre Decoctionthe formula is given in the Cold chapter, or Patchouli Correct the Qi Powder, which is certain to work.
Clinical note임상 주석
Wijung is BL-40, in the popliteal crease. Bleeding it was the standard emergency measure for this illness and appears again at 1.12; the chapter's own assessment of why it works is given there, in the Dansim passage that prefers moving the blood to letting it out.

Immun 入門

1.6 Treatment of Wet Sudden Turmoil 濕霍亂治法

1.6.1
Source원문

上吐下瀉, 謂之濕霍亂.

Translation영역
Vomiting above and diarrhoea below: this is called wet sudden turmoil.

Haejang 海藏

1.6.2
Source원문

凡霍亂吐瀉, 渴爲熱, 不渴爲寒. 《海藏》

Translation영역
In any sudden turmoil with vomiting and diarrhoea, thirst means heat and absence of thirst means cold.
Clinical note임상 주석
The single question the chapter uses to choose between its two lines of treatment, and it is the same test as 辨證 3.14's 問所便. A patient losing fluid will be thirsty whatever the cause, so the discrimination is weaker than it looks; what it is really distinguishing is the patient who wants cold drink from the one who cannot face it.

Haejang 海藏

1.6.3
Source원문

熱多欲飮水, 宜五苓散; 寒多不飮水, 宜理中湯二方並見寒門○仲景

Translation영역
Where heat predominates and the patient wants to drink water, Five Ingredient Powder with Poria is appropriate; where cold predominates and he will not drink, Regulate the Centre Decoctionboth formulas are given in the Cold chapter ○ Junggyeong

Junggyeong 仲景

1.6.4
Source원문

霍亂乃濕熱兼風木爲害, 治宜散風寒ㆍ利濕ㆍ降火. 四時通用藿香正氣散方見寒門, 寒月虛冷用理中湯方見寒門, 暑月煩渴宜黃連香薷散方見暑門, 俱宜合五苓散方見寒門以分消上下, 更合益元散方見暑門降火尤妙. 《入門》

Translation영역
Sudden turmoil is damp heat together with wind wood doing harm, and the treatment should disperse wind cold, disinhibit damp and bring fire down. For use in all four seasons there is Patchouli Correct the Qi Powderthe formula is given in the Cold chapter; in the cold months with vacuity cold use Regulate the Centre Decoctionthe formula is given in the Cold chapter; in the summer months with vexing thirst, Coptis and Elsholtzia Powderthe formula is given in the Summerheat chapter is appropriate. With any of them it is well to combine Five Ingredient Powder with Poriathe formula is given in the Cold chapter to disperse above and below separately, and better still to combine Benefit the Origin Powderthe formula is given in the Summerheat chapter to bring the fire down.

Immun 入門

1.6.5
Source원문

霍亂吐瀉, 宜用木萸散ㆍ二香黃連散ㆍ加味薑附湯ㆍ回生散ㆍ加減正氣散.

Translation영역
For sudden turmoil with vomiting and diarrhoea, Quince and Evodia Powder, Two Aromatics and Coptis Powder, Supplemented Ginger and Aconite Decoction, Return to Life Powder and Modified Correct Qi Powder are appropriate.

Donguibogam · Gwallan

1.6.6
Source원문

中暑霍亂, 宜香薷散方見暑門ㆍ桂苓白朮散方見下○丹心

Translation영역
For sudden turmoil from summerheat stroke, Elsholtzia Powderthe formula is given in the Summerheat chapter and Cinnamon, Poria and White Atractylodes Powderthe formula is given below ○ Dansim are appropriate

Dansim 丹心

1.6.7
Source원문

吐瀉過多, 四肢逆冷, 不省人事, 南星末 三錢ㆍ棗 三枚ㆍ薑 五片煎極熱服, 一服可效. 或半夏末薑汁點服, 或白礬末 一大錢沸湯點服亦效. 《得效》

Translation영역
Where there has been excessive vomiting and diarrhoea, with cold reversal of the four limbs and the patient unaware of his surroundings: decoct 3 don of arisaema powder with three jujubes and five slices of ginger and give it as hot as may be, and one dose should answer. Or give pinellia powder dripped in ginger juice, or 1 large don of alum powder dripped in boiling water, which also works.
Clinical note임상 주석
**This is a record of the text, not a treatment. Arisaema and pinellia are both toxic in the raw state and are here given as powders to an obtunded patient, who is at serious risk of aspirating them; neither should be prepared. A patient with cold limbs and reduced consciousness after profuse vomiting and diarrhoea is in shock and needs intravenous fluids immediately.**

Deukhyo 得效

1.7 Cramping Sinews After Sudden Turmoil 霍亂後轉筋

1.7.1
Source원문

陽明屬胃與大腸, 以養宗筋. 暴吐暴瀉, 津液驟亡, 宗筋失其所養, 故輕者兩脚轉筋而已, 重者遍體轉筋入腹, 手足厥冷, 危甚風燭矣. 倉卒之際, 以鹽填臍中, 灼艾不計壯數, 雖已死而胸中有煖氣者立甦. 急用木萸散方見上加茴香ㆍ甘草ㆍ紫蘇葉煎服, 再硏大蒜塗兩脚掌心, 則雖昏危入腹者亦效. 《入門》

Translation영역
Yang brightness belongs to the stomach and large intestine, and it nourishes the ancestral sinews. In violent vomiting and violent diarrhoea the fluids are lost all at once, the ancestral sinews lose their nourishment, and so in a light case there is cramping of the two legs only, while in a grave one the cramping is all over the body and enters the abdomen, the hands and feet are cold in reversal, and the danger is worse than a candle in the wind. In such a sudden crisis, fill the navel with salt and burn moxa there without counting the cones; even a patient already dead, if there is warm qi in the chest, will revive on the spot. Urgently give Quince and Evodia Powderthe formula is given above with fennel, licorice and perilla leaf added and decocted, and grind garlic and smear it on the soles of both feet; then even one clouded and in danger with the cramping into the abdomen will be helped.
Clinical note임상 주석
津液驟亡 — the fluids lost all at once — is the chapter's own explanation of the cramps and it is essentially correct: generalized cramping after violent vomiting and diarrhoea is loss of salt and water. 宗筋 is the great sinew mass of the trunk and thighs, and the progression described, from calf cramps to cramping all over and into the abdominal wall, with cold extremities, is what severe hypovolaemia with electrolyte depletion looks like. **Severe generalized cramping with cold extremities after profuse vomiting and diarrhoea needs urgent rehydration and electrolyte correction. The moxa on salt at the navel is recorded as the text gives it; direct burning over the abdomen causes burns.**

Immun 入門

1.7.2
Source원문

霍亂吐瀉過多, 遍體轉筋, 手足厥冷, 氣欲絶者, 急灸臍中. 又取蓼一把煎湯泡洗, 次投附子理中湯方見寒門卽效. 《綱目》

Translation영역
Where sudden turmoil with excessive vomiting and diarrhoea brings cramping all over the body, cold reversal of the hands and feet, and the qi at the point of being cut off, urgently give moxa at the navel. Also take a handful of knotweed, decoct it and soak and wash with the liquid, and then give Aconite Regulate the Centre Decoctionthe formula is given in the Cold chapter, which works at once.

Gangmok 綱目

1.7.3
Source원문

霍亂後轉筋, 理中湯方見寒門加石膏 一兩煎服. 《海藏》

Translation영역
For cramping sinews after sudden turmoil, give Regulate the Centre Decoctionthe formula is given in the Cold chapter with 1 nyang of gypsum added, decocted.

Haejang 海藏

1.7.4
Source원문

一法, 理中湯去白朮, 加生附子 一箇. 《活人》

Translation영역
One method: Regulate the Centre Decoction with the white atractylodes removed and one whole raw aconite added.
Clinical note임상 주석
**Raw aconite — 生附子, unprocessed — is highly toxic and has caused fatal poisoning. This must not be prepared.** Processed aconite is dangerous enough; the raw root used whole is the most hazardous preparation in the Bogam.

Hwarinseo 活人

1.7.5
Source원문

轉筋屬血熱, 四物湯方見血門加酒芩ㆍ酒花ㆍ蒼朮ㆍ南星煎服. 《丹心》

Translation영역
Cramping sinews belong to heat in the blood: give Four Substances Decoctionthe formula is given in the Blood chapter with wine-treated scutellaria, wine-treated hwa, black atractylodes and arisaema added, decocted.

Dansim 丹心

1.7.6
Source원문

吐瀉脇痛轉筋, 脉弦者, 木剋土也. 平胃散方見內傷加木瓜 五錢煎服. 《入門》

Translation영역
Vomiting and diarrhoea with pain in the flanks and cramping sinews, and a stringlike pulse: this is wood restraining earth. Give Level the Stomach Powderthe formula is given in the Inward Damage chapter with 5 don of quince added, decocted.

Immun 入門

1.7.7
Source원문

吐瀉後轉筋不止, 宜用木瓜湯. 《直指》

Translation영역
Where the cramping will not stop after the vomiting and diarrhoea, Quince Decoction is appropriate.

Jikji 直指

1.7.8
Source원문

治轉筋不止欲死, 男子以手挽其陰牽之, 女子則挽其乳近兩傍牽之. 此千金方妙法也. 《丹心》

Translation영역
To treat cramping that will not stop, with the patient at the point of death: in a man, take hold of the genitals with the hand and draw them; in a woman, take hold of the breasts near their two sides and draw them. This is a fine method of the Cheongeumbang.
Clinical note임상 주석
A counter-stimulation manoeuvre, and the reasoning behind it is the one that still underlies pressing hard on a cramping muscle: a strong sensory input elsewhere breaks the cramp. The sites chosen are the most sensitive available, and the Bogam records the method from the Cheongeumbang without comment. It is not something to do to a patient now, and what the cramping needs is fluid and salt.

Dansim 丹心

1.8 Vexing Thirst After Sudden Turmoil 霍亂後煩渴

1.8.1
Source원문

吐瀉旣多, 津液暴亡, 以致煩渴引飮不止, 宜桂苓白朮散ㆍ五苓散方見寒門ㆍ椒豆散ㆍ麥門冬湯ㆍ加減薷苓湯ㆍ止渴湯. 《諸方》

Translation영역
Where the vomiting and diarrhoea have been profuse and the fluids suddenly lost, so that there is vexing thirst and unceasing drinking, Cinnamon, Poria and White Atractylodes Powder, Five Ingredient Powder with Poriathe formula is given in the Cold chapter, Pepper and Mung Bean Powder, Ophiopogon Decoction, Modified Elsholtzia and Poria Decoction and Stop Thirst Decoction are appropriate.
Clinical note임상 주석
津液暴亡 with 引飮不止 — the fluids suddenly gone and the patient drinking without stopping — is the rehydration phase, and the six formulas offered for it are all drinks: two powders stirred into cold water, a sweet decoction, a honey-water powder. The chapter has identified the right problem and is treating it by the only route available, by mouth, which is also the route that works for all but the most severe cases. What none of them contains is salt, and that is the one addition that would have changed the outcomes in 1.15. An oral rehydration solution is sugar, salt and water; the chapter has the sugar and the water.

Jebang 諸方

1.9 Vacuity Vexation After Sudden Turmoil 霍亂後虛煩

1.9.1
Source원문

霍亂後虛煩不得眠, 或熱渴, 宜竹葉石膏湯方見寒門ㆍ參胡三白湯ㆍ旣濟湯. 《諸方》

Translation영역
For vacuity vexation after sudden turmoil with inability to sleep, or heat thirst, Bamboo Leaf and Gypsum Decoctionthe formula is given in the Cold chapter, Ginseng, Bupleurum and Three Whites Decoction and Already Fording Decoction are appropriate.
Clinical note임상 주석
虛煩不得眠 — a vexed restlessness that will not let the patient sleep — is the state after the acute illness has passed, and the three formulas for it are graded by how cold they are: Jukyeopseokgo-tang for the patient still hot, Samhosambaek-tang for the one running a low fever while depleted, Gije-tang — the same formula with the gypsum out and aconite in — for the one who has gone cold.

Jebang 諸方

1.10 The Method of Inducing Vomiting in Sudden Turmoil 霍亂吐法

1.10.1
Source원문

治乾霍亂, 心腹剌痛ㆍ煩寃, 吐利不得, 氣欲絶者. 極鹹鹽湯熱飮一升, 剌口令吐; 不吐則再飮一升, 須三吐, 使宿食盡乃止. 此法大勝諸治. 吐訖, 以理中湯ㆍ藿香正氣散款緩調治. 《得效》

Translation영역
To treat dry sudden turmoil with stabbing pain in the heart region and abdomen and vexed distress, where nothing can be vomited or passed and the qi is at the point of being cut off: have the patient drink a seung of extremely salty water hot, and tickle the mouth to make him vomit; if he does not vomit, let him drink another seung, and he should vomit three times, until the old food is all gone, and then stop. This method far surpasses all other treatments. When the vomiting is done, treat gently with Regulate the Centre Decoction and Patchouli Correct the Qi Powder.
Clinical note임상 주석
**This must not be done.** Drinking a seung of saturated salt water — roughly 600 ml — has caused fatal hypernatraemia, and deliberately inducing vomiting in a patient with abdominal pain and distension risks aspiration and oesophageal rupture. The chapter's own reasoning, that what cannot get out must be brought out, led it to the most dangerous treatment in the whole book. The condition it is for, 乾霍亂 with stabbing pain and nothing passing, is an acute abdomen and needs surgical assessment.

Deukhyo 得效

1.10.2
Source원문

又法, 急以鹽湯一盞入童便ㆍ薑汁頓服, 探吐令透; 未透再服. 吐後續用熨法. 《入門》

Translation영역
Another method: quickly give a cup of salt water with a boy's urine and ginger juice in it, all at once, and probe to make him vomit thoroughly; if it is not thorough, give it again. After the vomiting, go on to the method of ironing.

Immun 入門

1.11 The Method of Ironing in Sudden Turmoil 霍亂熨法

1.11.1
Source원문

霍亂吐瀉, 心腹痛不可忍. 炒鹽二椀, 紙包紗護, 頓其胸前幷腹肚上, 以熨斗火熨之. 氣透則甦. 續以炒鹽熨其背, 則十分無事. 《得效》

Translation영역
In sudden turmoil with vomiting and diarrhoea and unbearable pain in the heart region and abdomen: take two bowls of dry-fried salt, wrap it in paper and cover it with gauze, set it on the front of the chest and over the belly, and iron it with a hot flatiron. When the qi passes through, the patient revives. Follow by ironing the back with dry-fried salt, and all will be perfectly well.
Clinical note임상 주석
Hot salt packs to the abdomen and back, which is the chapter's one treatment that is both safe enough and likely to have helped: local heat relieves cramping colic, and the ritual of it gave something to do for a patient who could not take anything by mouth. **The risk is burns — the salt is fried and then pressed with a hot iron — and in a shocked patient with reduced consciousness, scalding is easy.**

Deukhyo 得效

1.11.2
Source원문

又法, 鹽炒吳茱萸, 熨臍下亦效. 《入門》

Translation영역
Another method: dry-fry evodia with salt and iron below the navel, which also works.

Immun 入門

1.12 The Needling Method in Sudden Turmoil 霍亂鍼法

1.12.1
Source원문

乾霍亂, 剌委中穴名出血, 或十指頭諸經井穴出血, 皆是良法. 《正傳》

Translation영역
In dry sudden turmoil, prick wijungthe name of a point to let blood, or the tips of the ten fingersthe well points of the channels to let blood; both are good methods.

Jeongjeon 正傳

1.12.2
Source원문

絞腸沙證, 手足厥冷, 腹痛不可忍者, 以手蘸溫水於病者膝腕上拍打, 有紫黑點處以鍼剌去惡血, 卽愈. 《經驗》

Translation영역
In the pattern of wrung-bowel sand, with cold reversal of the hands and feet and unbearable abdominal pain: dip the hand in warm water and slap the patient above the knee and the wrist, and where purple-black spots appear, prick with a needle to let out the foul blood, and he is cured at once.

Gyeongheombang 經驗

1.12.3
Source원문

又法, 用麻弦ㆍ小竹弓蘸香油或熱水, 刮手足ㆍ胸背ㆍ額項卽愈. 《經驗》

Translation영역
Another method: take a hempen bowstring or a small bamboo bow, dip it in sesame oil or hot water, and scrape the hands and feet, the chest and back, the forehead and nape, and he is cured at once.
Clinical note임상 주석
This is 刮法, scraping — the practice known in Chinese as guasha and still current in Korean clinics — and here it is described with its original implement, a bowstring or a bent bamboo, oiled. The purple-black spots raised by slapping in the previous passage are the same phenomenon, and the chapter treats both as ways of bringing the stagnation to the surface.

Gyeongheombang 經驗

1.12.4
Source원문

乾霍亂者, 乃寒濕太甚, 脾被絆而不能動, 氣被鬱而不能行, 所以卒痛而手足厥冷. 俗名絞腸沙者, 盖言痛之甚也. 北方剌靑筋以出氣血, 南方刮胸背手足以行氣血, 俱能散病; 然出氣血不如行氣血之爲愈也. 《丹心》

Translation영역
In dry sudden turmoil the cold damp is excessive, the spleen is tethered and cannot move, the qi is depressed and cannot travel, and that is why there is sudden pain with cold reversal of the hands and feet. What is commonly called wrung-bowel sand is so called from the severity of the pain. In the north they prick the blue veins to let out qi and blood; in the south they scrape the chest, back, hands and feet to move the qi and blood. Both can disperse the illness; but letting out qi and blood is not as good as moving it.
Clinical note임상 주석
A comparison of two regional practices with a judgment between them, and the judgment goes against bloodletting: 出氣血不如行氣血 — letting out the qi and blood is not as good as moving it. In a patient already losing fluid, declining to bleed him is the right call, and Dansim reaches it on his own reasoning.

Dansim 丹心

1.12.5
Source원문

又治絞腸沙剌血法, 詳見救急門. 《入門》

Translation영역
The method of pricking for blood in wrung-bowel sand is also treated in full in the Emergencies chapter.

Immun 入門

1.13 The Moxa Method in Sudden Turmoil 霍亂灸法

1.13.1
Source원문

霍亂轉筋入腹, 手足厥冷, 氣欲絶, 以鹽填臍中, 大艾炷灸之, 不計壯數, 立效. 《得效》

Translation영역
Where sudden turmoil brings cramping into the abdomen, cold reversal of the hands and feet and the qi at the point of being cut off: fill the navel with salt and burn large moxa cones on it without counting the cones; it works on the spot.

Deukhyo 得效

1.13.2
Source원문

霍亂已死而腹中有煖氣者, 依上法灸之亦甦. 《醫鑑》

Translation영역
Where the patient has already died of sudden turmoil but there is warm qi in the abdomen, moxa by the method above will revive him too.

Uigam 醫鑑

1.13.3
Source원문

又法, 灸氣海二七壯妙. 《得效》

Translation영역
Another method: fourteen cones of moxa at the sea of qi, which is excellent.

Deukhyo 得效

1.13.4
Source원문

霍亂吐瀉不止垂死, 灸天樞ㆍ氣海ㆍ中脘立愈. 《正傳》

Translation영역
Where sudden turmoil with unceasing vomiting and diarrhoea has brought the patient to the point of death, moxa at cheonchu, the sea of qi and the middle duct cures him on the spot.

Jeongjeon 正傳

1.13.5
Source원문

霍亂諸法不效, 灸大椎卽效. 《綱目》

Translation영역
Where none of the methods for sudden turmoil has worked, moxa at the great vertebra works at once.

Gangmok 綱目

1.13.6
Source원문

霍亂已死, 但有煖氣者, 灸承筋七壯立甦. 《綱目》

Translation영역
Where the patient has already died of sudden turmoil but is still warm, seven cones of moxa at seunggeun revive him on the spot.
Clinical note임상 주석
The points are ST-25 cheonchu beside the navel, CV-6 gihae below it, CV-12 jungwan above it, GV-14 daechu at the base of the neck, and BL-56 seunggeun in the calf — the last chosen because it is the muscle that cramps. The repeated 已死 … 立甦, already dead and revived on the spot, describes a patient profoundly shocked rather than one actually dead, and the chapter's willingness to go on treating such a patient is the counterpart of 1.3's refusal to read the pulse as fatal.

Gangmok 綱目

1.14 What Is Forbidden 禁忌法

1.14.1
Source원문

霍亂吐瀉之時, 切勿與糓食. 雖米湯一呷下咽立死. 必待吐瀉止過半日, 飢甚, 方可與稀粥, 以漸而將息. 《正傳》

Translation영역
While the vomiting and diarrhoea of sudden turmoil are going on, on no account give grain food. Even one mouthful of rice water swallowed down brings instant death. One must wait until half a day has passed since the vomiting and diarrhoea stopped and the patient is very hungry; only then may thin gruel be given, and he is to be brought back by degrees.
Clinical note임상 주석
The rule is right and the reason given is not. Withholding solid food during active vomiting, then reintroducing thin gruel gradually, is still the advice; 立死, instant death, from a mouthful of rice water is not what happens, and modern practice is the opposite on fluids — a patient in this state must be given fluid continuously, by mouth if he can keep it down and intravenously if he cannot. The chapter's instinct was to rest the gut, and in doing so it forbade the one thing that would have saved the patients in 1.15. That is the single most consequential error in the chapter.

Jeongjeon 正傳

1.14.2
Source원문

霍亂吐瀉時, 愼勿與粟米粥湯, 入胃必死矣. 《綱目》

Translation영역
At the time of the vomiting and diarrhoea of sudden turmoil, take care not to give millet gruel or its water; once in the stomach it means certain death.

Gangmok 綱目

1.14.3
Source원문

霍亂不可遽與米飮粥飯, 以助邪氣. 必所傷物盡, 然後稀粥漸漸養之. 《入門》

Translation영역
In sudden turmoil one must not hastily give rice water, gruel or cooked rice, for they aid the evil qi. Only when what did the injury is all gone may the patient be nourished little by little with thin gruel.

Immun 入門

1.14.4
Source원문

霍亂時大忌飮食. 入腹則死. 只喫氷水不妨. 不可飮熱湯, 切不可飮熱酒ㆍ燒酒. 《山居》

Translation영역
At the time of sudden turmoil food and drink are strictly forbidden; once in the belly they mean death. Only iced water may be drunk without harm. Hot soup must not be drunk, and hot wine and distilled spirits least of all.
Clinical note임상 주석
只喫氷水不妨 — only iced water may be drunk without harm — is the one permission in the section, and it is the useful one. Cold water is better tolerated than warm by a vomiting patient, and the chapter arrives at that by observation while forbidding everything else. The prohibition on spirits is sound for a dehydrated patient on any account.

Sangeo 山居

1.15 Signs That Cannot Be Treated 不治證

1.15.1
Source원문

霍亂轉筋ㆍ腹痛ㆍ四肢厥冷ㆍ氣欲絶, 其脉洪大可治; 如脉微而囊縮ㆍ舌卷者不治. 《綱目》

Translation영역
In sudden turmoil with cramping sinews, abdominal pain, cold reversal of the four limbs and the qi at the point of being cut off, a surging large pulse can be treated; but where the pulse is faint and the scrotum has drawn up and the tongue curled, the case cannot be treated.
Clinical note임상 주석
囊縮 and 舌卷 — the scrotum drawn up and the tongue curled — are the two signs the chapter treats as final, and both are signs of extreme fluid loss: the scrotal skin contracted and the tongue shrunken and furled in a profoundly dehydrated patient. The judgment that these mark the point past rescue was accurate for medicine without intravenous fluids, and is not accurate now.

Gangmok 綱目

1.15.2
Source원문

霍亂喘脹ㆍ煩躁者不治. 《得效》

Translation영역
Sudden turmoil with panting, distension and agitation cannot be treated.

Deukhyo 得效

1.15.3
Source원문

乾霍亂吐瀉不得ㆍ胸腹脹硬ㆍ面唇靑黑ㆍ手足冷過肘膝ㆍ六脉伏絶ㆍ氣喘急ㆍ舌短囊縮者死. 《回春》

Translation영역
In dry sudden turmoil, where nothing can be vomited or passed, the chest and abdomen are distended and hard, the face and lips a dark blue-black, the hands and feet cold past the elbows and knees, all six pulses buried and cut off, the breathing hurried and panting, the tongue shortened and the scrotum drawn up, the patient dies.
Clinical note임상 주석
The most precise prognostic description in the chapter, and the detail that makes it so is 手足冷過肘膝 — the cold reaching past the elbows and knees. How far up the body the coldness has climbed is a measure of how far the circulation has shut down, and it is still assessed the same way at a modern bedside. With central cyanosis, an unrecordable pulse and a rigid distended abdomen, this is a patient in the last stage of shock.

Hoechun 回春

1.15.4
Source원문

脉微遲ㆍ氣少不語爲難治. 《得效》

Translation영역
A faint slow pulse with scant qi and loss of speech is hard to treat.

Deukhyo 得效

1.15.5
Source원문

大渴ㆍ大躁ㆍ大汗ㆍ遺尿者死. 回生散救之. 方見上○入門

Translation영역
Great thirst, great agitation, great sweating and incontinence of urine mean death; rescue with Return to Life Powder. the formula is given above ○ Immun
Clinical note임상 주석
The one place in the Bogam where a formula is offered after the verdict of death has been given, which is worth noticing: the chapter does not treat its own prognosis as final. The four signs together — unquenchable thirst, agitation, profuse sweating and the passing of urine without control — describe a patient whose fluid is pouring out by every route at once, and the two aromatic drugs of Hoesaeng-san could do nothing about it. **The modern treatment is immediate intravenous rehydration, and with it this patient recovers.**

Immun 入門

1.16 Vomiting and Diarrhoea of the Water Sickness 水疾吐瀉

1.16.1
Source원문

乘舩大吐瀉, 渴飮水者卽死. 飮童尿最好, 自己尿亦好. 《丹心》

Translation영역
Where riding in a boat brings on violent vomiting and diarrhoea, a patient who is thirsty and drinks water dies at once. It is best to drink a boy's urine, and one's own urine will do as well.
Clinical note임상 주석
水疾 is seasickness, and the chapter gives it a section of its own because the vomiting looks like sudden turmoil. The advice is the worst in the chapter — that a thirsty, vomiting patient who drinks water dies, and should drink urine instead — and the reasoning is 1.14's carried to its conclusion. **A seasick patient who is vomiting should be given water, in small frequent sips.**

Dansim 丹心

1.16.2
Source원문

枯白礬末 一錢百沸湯點服亦好. 《入門》

Translation영역
One don of calcined alum powder dripped into boiling water and taken is also good.

Immun 入門

1.16.3
Source원문

舩暈嘔吐, 大半夏湯方見痰門煎服效. 《入門》

Translation영역
For the dizziness of sea travel with retching and vomiting, Major Pinellia Decoctionthe formula is given in the Phlegm chapter decocted and taken works.
Clinical note임상 주석
Pinellia for motion sickness is the chapter's one reasonable prescription here: the drug is the tradition's principal antiemetic, and nausea of vestibular origin is what it is best at. **Pinellia is toxic in the raw state and must be properly processed.**

Immun 入門

1.17 Simple Medicinals 單方

1.17.1
Source원문

凡二十一種.

Translation영역
Twenty-one kinds in all.
Clinical note임상 주석
The simple medicinals of this chapter divide into three groups by what they are for. Four are emetics for the dry kind — salt, pot-bottom soot, soapberry, smoked deerskin water. Five or six are for the cramps — quince, knotweed, sorghum leaf, millet water, vinegar. The rest are for thirst and for the vomiting itself. Almost all of them are kitchen or household materials, which is the point of a 單方 list: these are what is to hand when the illness strikes at night in a village.

Donguibogam · Gwallan

1.17.2
Source원문

鹽 治乾霍亂. 鹽 一大匙熬黃, 取童尿一升溫和攪服, 吐下卽愈. 《本草》

Translation영역
Salt (鹽): Treats dry sudden turmoil. Dry-roast one large spoonful of salt until yellow, take a seung of a boy's urine warmed, stir the salt into it and give it; the patient vomits and passes below and is cured at once.

Boncho 本草

1.17.3
Source원문

鍋底墨 治霍亂. 取二錢, 百沸湯一盞投其中, 急攪服, 吐瀉立止. 《本草》

Translation영역
Pot-bottom soot (鍋底墨): Treats sudden turmoil. Take 2 don, throw it into a cup of thoroughly boiled water, stir quickly and give it; the vomiting and diarrhoea stop on the spot.

Boncho 本草

1.17.4
Source원문

甘爛水 治霍亂. 入藥煎用甚妙. 詳見水部

Translation영역
Sweet-stirred water (甘爛水): Treats sudden turmoil. Excellent for decocting the medicines in. treated in full in the Water section

Boncho 本草

1.17.5
Source원문

生熟湯 一名陰陽湯. 治乾霍亂, 能吐宿食惡毒之物, 和鹽服之尤妙. 卽百沸湯合新汲水也. 《本草》

Translation영역
Raw and cooked water (生熟湯), also called yin-and-yang water: treats dry sudden turmoil, and can bring up old food and foul poisonous matter; better still taken with salt stirred in. It is thoroughly boiled water mixed with newly drawn water.
Clinical note임상 주석
Boiled water mixed with fresh-drawn — the yin and the yang of water — and given as an emetic. The mixture would be about blood heat, which is why it is easier to drink in quantity than either; drinking a large volume quickly is what makes a person vomit.

Boncho 本草

1.17.6
Source원문

生薑 治霍亂欲死. 生薑 五兩切, 取牛屎一升同煎取汁服, 卽效. 《本草》

Translation영역
Fresh ginger (生薑): Treats sudden turmoil at the point of death. Slice 5 nyang of fresh ginger, decoct it with a seung of cow dung, strain and give the liquid; it works at once.
Clinical note임상 주석
**Not to be prepared. Cow dung carries Escherichia coli, Salmonella, Clostridium and Cryptosporidium among others, and giving it by mouth to a patient already losing fluid from the gut would make the illness worse.** The ginger is sound; the vehicle is why the entry is here only as a record.

Boncho 本草

1.17.7
Source원문

天南星 治吐瀉不止, 四肢逆冷, 不省人事. 南星爲末, 每三錢入大棗三枚同煎服, 四肢漸煖, 神識便省, 神妙. 《本草》

Translation영역
Arisaema (天南星): Treats unceasing vomiting and diarrhoea with cold reversal of the four limbs and the patient unaware of his surroundings. Powder the arisaema and decoct 3 don each time with three large jujubes and give it; the four limbs grow warm by degrees and awareness returns — wonderfully effective.
Clinical note임상 주석
**Arisaema is toxic in the raw state — it causes severe irritation and swelling of the mouth and throat — and must not be prepared. Giving a powder to a patient with reduced consciousness also risks aspiration.**

Boncho 本草

1.17.8
Source원문

蘆花 一名蓬蕽. 治霍亂氣息危急者, 取一把濃煎取汁頓服, 卽差. 《本草》

Translation영역
Reed flower (蘆花), also called bongnong: treats sudden turmoil where the breathing is in crisis. Take a handful, decoct it strong, strain and give it all at once, and the patient mends.

Boncho 本草

1.17.9
Source원문

皂角 乾霍亂, 鹽湯一椀入皂角末少許調服, 探吐卽效. 《本草》

Translation영역
Soapberry (皂角): For dry sudden turmoil, stir a little soapberry powder into a bowl of salt water and give it, then probe to induce vomiting; it works at once.

Boncho 本草

1.17.10
Source원문

木瓜 治霍亂吐瀉轉筋不止. 煮汁飮之. 枝葉功同. ○榠樝與木瓜同功. 《本草》

Translation영역
Quince (木瓜): Treats sudden turmoil with vomiting, diarrhoea and unceasing cramping. Boil it and drink the liquid. The twigs and leaves have the same power. ○ Chinese quince has the same power as quince.

Boncho 本草

1.17.11
Source원문

烏梅 治霍亂煩渴. 水漬和蜜飮之妙. 《本草》

Translation영역
Smoked plum (烏梅): Treats vexing thirst in sudden turmoil. Soak it in water, mix with honey and drink; excellent.
Clinical note임상 주석
Sour fruit soaked in water with honey, for a patient who cannot stop drinking. Of everything in the chapter this is the closest to an oral rehydration drink — it lacks only salt, which 生熟湯 above has and this does not.

Boncho 本草

1.17.12
Source원문

林檎 靑色者治霍亂吐瀉甚妙. 煮取汁飮, 或嚼食之. 《本草》

Translation영역
Crab apple (林檎): The green sort is excellent for sudden turmoil with vomiting and diarrhoea. Boil it, strain and drink the liquid, or chew and eat it.

Boncho 本草

1.17.13
Source원문

秫薥葉 治霍亂轉筋, 筋麄大如桃李, 攣搐不可忍. 取葉濃煎湯飮之. 《種杏》

Translation영역
Sorghum leaf (秫薥葉): Treats cramping sinews in sudden turmoil, where the sinews stand out as thick as a peach or a plum and the spasm is unbearable. Take the leaves, decoct them strong and drink.
Clinical note임상 주석
筋麄大如桃李 — the sinew standing out as thick as a peach or a plum — is the best description of a cramp in the Bogam, and anyone who has seen a calf in full cramp will recognize it.

Jonghaeng 種杏

1.17.14
Source원문

粟米泔 治霍亂煩渴, 飮數升立差. ○又硏米淸水和濾取汁服之, 主轉筋入腹. 《本草》

Translation영역
Millet washing-water (粟米泔): Treats vexing thirst in sudden turmoil; drinking several seung brings relief on the spot. ○ Again, grind the millet, mix it with clear water, strain and give the liquid; it governs cramping that has entered the abdomen.
Clinical note임상 주석
Rice or millet water, several seung of it, given for thirst — and it works for the reason an oral rehydration solution works, since the starch provides the carbohydrate that carries water across the gut wall. Rice-water rehydration is still used in cholera treatment, and this entry is the nearest the chapter comes to it. It sits two sections after 1.14 forbids exactly this.

Boncho 本草

1.17.15
Source원문

糯米 治霍亂煩渴. 水硏取汁, 任意飮之. 《本草》

Translation영역
Glutinous rice (糯米): Treats vexing thirst in sudden turmoil. Grind it with water, strain and let the patient drink as much as he likes.

Boncho 本草

1.17.16
Source원문

蓼 治霍亂轉筋. 濃煎乘熱熏洗, 因取飮一二盞卽愈. 《得效》

Translation영역
Knotweed (蓼): Treats cramping sinews in sudden turmoil. Decoct it strong and, while it is hot, steam and wash the part with it, then drink one or two cups of it and the patient is cured.

Deukhyo 得效

1.17.17
Source원문

香薷 治霍亂吐瀉轉筋. 濃煎飮之卽止. ○治霍亂不可闕也. 《本草》

Translation영역
Elsholtzia (香薷): Treats sudden turmoil with vomiting, diarrhoea and cramping. Decoct it strong and drink, and it stops at once. ○ In treating sudden turmoil it cannot be done without.

Boncho 本草

1.17.18
Source원문

小蒜 治霍亂吐瀉. 煮汁飮之. 《本草》

Translation영역
Small garlic (小蒜): Treats sudden turmoil with vomiting and diarrhoea. Boil it and drink the liquid.

Boncho 本草

1.17.19
Source원문

牛糞 治霍亂吐瀉, 四肢逆冷. 黃牛糞以水煮濾取淸汁, 頓服一升卽止. 《本草》

Translation영역
Cow dung (牛糞): Treats sudden turmoil with vomiting and diarrhoea and cold reversal of the four limbs. Boil the dung of a yellow ox in water, strain off the clear liquid, and give a seung of it all at once; it stops at once.
Clinical note임상 주석
**Not to be prepared, for the reasons given under fresh ginger above. Cow dung given by mouth to a patient with acute diarrhoea adds a second infection to the first.**

Boncho 本草

1.17.20
Source원문

烟鹿皮 或烟獐皮, 熏烟最多黃色者, 水浸揉取汁, 頓服, 治乾霍亂, 卽吐神效. 《俗方》

Translation영역
Smoked deerskin (烟鹿皮): Or smoked roe-deer skin — the most heavily smoked and yellowest sort. Soak it in water, knead it, strain the liquid and give it all at once; it treats dry sudden turmoil and brings on vomiting at once, with wonderful effect.
Clinical note임상 주석
A 俗方, a popular remedy, and the only one in the chapter from Korean domestic practice rather than a Chinese source: water wrung out of the smoked hide that hung in the chimney. What it would contain is tar and ash, and it was being used as an emetic.

Sokbang 俗方

1.17.21
Source원문

醋 治霍亂未得吐下, 飮一二升良. ○治轉筋, 取衣絮漬醋煮令溫, 裹患處, 冷則易, 卽愈. 《千金》

Translation영역
Vinegar (醋): Treats sudden turmoil where nothing can yet be vomited or passed; drinking one or two seung is good. ○ For cramping sinews, take wadding from a garment, soak it in vinegar, warm it by boiling, wrap the affected part in it, and change it when it cools; the patient is cured.

Cheongeum 千金

1.17.22
Source원문

牛涎 小兒霍亂, 牛涎 一合灌下立效. 《得效》

Translation영역
Cow's drool (牛涎): For sudden turmoil in a small child, pour down one hop of cow's drool; it works on the spot.
Clinical note임상 주석
**Not to be prepared.** An infant with profuse vomiting and diarrhoea is the patient most quickly killed by dehydration and least able to tolerate another infection. **A child in this state is a medical emergency and needs oral or intravenous rehydration at once.**

Deukhyo 得效

About this translation 凡例

Base text: Donguibogam (東醫寶鑑, 1613 first edition), Miscellaneous Disorders, Volume 5, Sudden Turmoil chapter. The Chinese text is collated against the Kyujanggak transcription of the 1613 edition; collation notes are given on the passages they concern. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.