Formulas · Text · Donguibogam 東醫寶鑑
Two chapters bound as one, and the join is at 2.9.
The first eight sections are about 蠱. The character is its own definition — 蠱字從蟲從皿, worms over a vessel — and the book gives the recipe as hearsay: three creatures put in one pot, a toad, a centipede and a snake, left to eat each other until one is left, and that survivor is the poison. You can tell which it was by the face: green-yellow for the snake, red-yellow for the lizard, green-white with tadpoles in the vomit for the toad. Everything the victim eats turns to worms and eats the organs, and when he dies the disease-qi flows out and fastens on the people standing near, which is why it is also called 蠱疰. None of this exists. What does exist is in 2.1.1, and it is not medicine at all but table manners: in a district with a reputation, palm a piece of your food and bury it at a crossroads afterwards; or let your host lift his chopsticks first; or simply ask him, straight out, whether there is 蠱 in the house, and rap the table with your chopsticks before you eat. That is a protocol for eating in a home you suspect, written down by a physician. The notes keep the fear and the etiquette and decline the mechanism.
Then 2.9 救諸中毒方 begins, and the chapter changes character completely. It is a poisons index, one section per substance, minerals first and then plants, animals, and food: arsenic, mushrooms, pufferfish, Sichuan pepper, apricot kernel, chinaberry, veratrum, croton, aconite, alum, the metals, cantharides, borax, sulphur, realgar, mercury, euphorbia, wolfsbane, rhododendron, gansui, raw pinellia, daphne, henbane, bitter gourd, the mineral drugs, mugwort, seaweed, horses, the meat of beasts, rhinoceros horn, the meat of birds, fish and crab, melons, vegetables, distilled spirit, bean curd, wheat flour, an overdose of one's own medicine, all poisons in general, and water. The substances are named, so they can be checked, and many of them are exactly what the names say — the pufferfish section is about tetrodotoxin, the apricot-kernel section about cyanide, the henbane section about an anticholinergic delirium, and the aconite section about the same drug the Injuries chapter gives deliberately as an anaesthetic.
The index's opening paragraph is the most striking line in the chapter. 人遇事急智盡術窮, 或爲人 所陷, 始自服毒, 宜急救之 — a person at the end of his wits, or cornered by someone, swallows poison, and he is to be saved at once. The book names self-poisoning as a thing that happens, puts it first, and treats rescue as the obvious duty. Then it gives the rule it trusts most: liquorice and mung bean resolve a hundred poisons; failing that, pour in oil and empty the stomach. Emptying the stomach early is the one principle here that modern practice still shares, and only early; everything after that belongs to poison control, antidotes and supportive care. The notes say so for each poison, and say where the remedy could not have worked.
2.1 Households That Keep Gu Poison 蠱毒畜養家
譯 2.1.1 Source원문
凡有蠱之鄕, 見人家門限屋梁無灰塵潔淨者, 其家必畜蠱, 當用心防之. 《易簡》
Translation영역
In a district where there is gu, if you see a household whose door-sill and roof-beams are without dust or ash and are clean, that household is certainly keeping gu, and you should take care to guard against it.
Clinical note임상 주석
There is no such thing as gu. 蠱 is the belief that a poison can be bred, kept and fed to a person, and the sections that follow describe a practice that never existed; what the patients had was ordinary poisoning, dysentery, parasitic infection or gastrointestinal haemorrhage.
This first passage is not about any of that. It is a rule for identifying a suspect household, and the sign it offers — an unusually clean door-sill and roof-beam — identifies a tidy house. The reasoning is that the gu keeps its own dwelling swept; the effect is that fastidiousness becomes evidence. Gu accusations fell, in both the Chinese and the Korean record, on households that were already marginal — incomers, widows, the unusually prosperous or the unusually withdrawn — and keeping gu was a capital offence in statute. The fear was real, the illnesses were real, and the mechanism was invented; all three things have to be held at once to read this group of sections honestly.
譯 2.1.2 Source원문
蠱者, 人取三蟲之類蝦蟆ㆍ蜈蚣ㆍ蛇虺也, 以器皿盛之蠱字從蟲從皿, 使其自相啖食, 餘一存者名爲蠱, 而能變化. 人有造作敬事, 以酒肉祭之, 取出放毒於飮食中. 人中其毒, 心悶腹痛, 面目靑黃, 或吐唾鮮血, 或下膿血. 病人所食之物皆化爲蟲, 侵蝕藏府, 蝕盡則死. 急者十數日便死, 緩者延引歲月. 死後病氣流注, 染着傍人, 故謂之蠱疰. 《千金》
Translation영역
As for gu: a man takes creatures of the three vermin kinds — that is, toad, centipede and viper — and puts them into a vessel — the character 蠱 is made of 蟲, vermin, over 皿, a vessel. He lets them devour one another, and the one that is left over is called gu, and it can transform itself. There are those who make it and serve it with reverence, offering it wine and meat in sacrifice, and who then take it out and loose its poison into food and drink. When a man is struck by that poison, his heart is oppressed and his belly pains him, his face and eyes are green-yellow, and he either vomits and spits fresh blood or passes pus and blood below. Everything the sick man eats turns into vermin, which eat into the viscera and bowels, and when they have eaten them through he dies. In an acute case he is dead in ten days or so; in a slow one it drags on for months and years. After his death the disease qi flows on and fastens itself on those beside him, and for this it is called gu-ju, gu infestation.
Clinical note임상 주석
The gloss 蠱字從蟲從皿 — the character is vermin over a vessel — is the text reasoning from the written graph to the thing itself, and it is worth noticing that the whole account of the breeding is an unpacking of that graph. The belief was built out of the writing, not out of any observation.
The clinical picture, by contrast, is drawn from life. Epigastric oppression with abdominal pain, a sallow green-yellow face, vomiting of fresh blood or the passage of pus and blood below, and a course that runs either to death within a fortnight or on for years, is a recognizable composite: upper gastrointestinal bleeding in the acute form, and in the chronic form dysentery or chronic intestinal parasitosis with the anaemia that gives the complexion its colour. 病人所食之物皆化爲蟲 — everything he eats turns into vermin — is what a heavy worm burden looks like to an observer who finds worms in the stool of a wasting patient.
The last clause is the most interesting and the one part of the account with a genuine basis. 死後病氣流注, 染着傍人, the disease qi passing after death to those beside the patient, is a description of contagion, and a household illness that spreads to attendants and then kills them is how an infectious disease behaves, not how a poison does. Dysentery, typhoid and tuberculosis all do exactly this. The observation was sound; the agent assigned to it was not.
譯 2.1.3 Source원문
中蠱者, 面色靑黃是蛇蠱, 面色赤黃是𧋍蜴蠱, 面色靑白若內脹滿吐出成科斗形者是蝦蟆蠱, 面色多靑或吐出如蜣蜋形者是蜣蜋蠱. 《病源》
Translation영역
In one struck by gu, a green-yellow facial colour means snake gu; a red-yellow facial colour means lizard gu; a green-white facial colour, with distension and fullness within and matter vomited up in the shape of tadpoles, means toad gu; and a facial colour mostly green, or matter vomited up in the shape of dung beetles, means dung beetle gu.
Clinical note임상 주석
A four-way typing of the poison by the patient's complexion and by the shape of what he brings up. Neither can do the work asked of it: facial colour in a sick man reflects anaemia, jaundice, cyanosis and circulatory state, and none of those names an agent, while vomited matter in the shape of tadpoles or beetles is food debris, clotted blood and mucus, or — where the shapes were real — the parasites themselves.
The green-white face with inner distension and fullness is the one combination that carries information: pallor with abdominal distension is the picture of bleeding into the gut or of obstruction, and either is urgent.
2.1.1 Warding Off Gu Poison 辟蠱毒法
譯 2.1.1.1 Source원문
如入蠱鄕飮食, 卽潛於初下筯時收藏一塊在手, 儘喫不妨. 少頃却將所藏一塊, 潛埋於人行十字路下, 卽蠱於其家作閙, 蠱主必反來求救. 或食時讓主家先動筯, 或明問主家云, 莫有蠱麽, 以筯築卓而後食. 如是則蠱不能爲害. 《易簡》
Translation영역
If you go into a gu district and eat there, then at the moment you first set down your chopsticks secretly keep back one morsel and hold it in your hand; after that you may eat your fill with no harm. A little later take the morsel you kept and secretly bury it under a crossroads where people walk, and the gu will at once make an uproar in its own house, and the gu's master will be bound to come back to you and beg for relief. Or else at the meal let the household's own people move their chopsticks first; or ask the household plainly, saying, there is surely no gu here?, and tap your chopsticks on the table before you eat. Do it in this way and the gu cannot do you harm.
Clinical note임상 주석
This is a ritual and not a treatment, and it should be read as one. Three devices are offered: palming a morsel and burying it at a crossroads so that the gu is tormented and its owner has to come and ask for it back; letting the hosts eat first; and challenging them aloud while striking the chopsticks on the table. None of them has any effect on a poison. The first is sympathetic magic with a hostage, the second and third are social manoeuvres that put the host on notice.
There is one sound thing buried in it, which is the second device. Letting the host family take the first mouthful from a shared dish is a real precaution against deliberate poisoning, and it is the only part of the section that could protect anyone. The rest tells us about the atmosphere of a journey through a district under suspicion — a traveller eating at a stranger's table and conducting a small defensive ceremony over it — more than about any illness.
2.1.2 Testing for Gu Poison 驗蠱毒法
譯 2.1.2.1 Source원문
令病人朝起, 取井華水唾水中, 唾如柱脚直下沉者是蠱也, 浮者非蠱也. 《三因》
Translation영역
Have the patient rise in the morning, take first-drawn well water, and spit into the water. If the spittle goes straight down like the foot of a pillar and sinks, it is gu; if it floats, it is not gu.
Clinical note임상 주석
Spittle sinks or floats according to how much air is entrained in it and how much mucin it carries, and both of those vary with the hour, with hydration and with whether the person has just cleared his throat. Thick morning saliva from a dehydrated mouth will sink in anyone. The test cannot distinguish a poisoned man from a thirsty one.
It is nevertheless worth saying what the test is trying to be. It specifies the time (on rising), the medium (water newly drawn from the well, so uncontaminated) and a binary read-out, and that is the shape of a laboratory test. The design is not foolish; the thing it claims to measure does not exist.
譯 2.1.2.2 Source원문
嚼生黑豆不腥, 嚼白礬味甘, 皆中蠱無疑. 《三因》
Translation영역
If he chews a raw black soybean and it is not rank, and chews alum and the taste is sweet, then in both cases he has been struck by gu beyond doubt.
Clinical note임상 주석
These two are the cleverest tests in the chapter, and they deserve the credit before the correction. Each uses a substance with a strong, reliable and unmistakable taste — raw soybean, which is rank and green from its own lipoxygenase, and alum, which is harshly astringent and sour — and asks whether the patient still perceives it. A reference substance with a known value, applied to the subject, with a deviation taken as the signal: that is the reasoning of a control, and it is being used here several centuries before anyone wrote it down as a principle.
It still cannot work. Loss or distortion of taste is real and is sometimes a sign of poisoning — heavy metals do it — but it is one of the least specific findings in medicine. Dry mouth, a head cold, smoking, zinc deficiency, oral thrush, radiotherapy and dozens of ordinary drugs all blunt the same perception, and a sick man with a furred tongue will fail both tests. A negative result is no reassurance either, since most poisons leave taste intact. The test can register that something is wrong with the tongue; it can never name an agent.
**Alum should not be chewed or swallowed. Aluminium salts are mucosal irritants and are not safe as an oral test substance.**
譯 2.1.2.3 Source원문
入蠱鄕遇飮食, 以犀角攪之, 白沫竦起者是蠱也, 否則非也. 《綱目》
Translation영역
When you come upon food or drink in a gu district, stir it with rhinoceros horn; if a white froth rises up, it is gu, and if not, it is not.
Clinical note임상 주석
Rhinoceros horn is keratin — the same protein as hair and nail — and it has no pharmacological action and no chemistry that would make one liquid froth and another not. Stirring any dish vigorously with a smooth horn will raise foam where there is protein or saponin in it, which is to say in a great many ordinary soups.
**All rhinoceros species are listed on CITES Appendix I and international trade in the horn is banned. It must not be bought, sold or used.** Belief in exactly this kind of detecting and antidotal power is what has driven the poaching; the chapter returns to the horn as an antidote at 2.9.30.
譯 2.1.2.4 Source원문
又煮一雞卵去皮, 日夕含口中, 勿令破, 夜吐出着霜露中, 朝看色大靑者是蠱也. 《得效》
Translation영역
Again: boil one hen's egg, take off the shell, and at dusk hold it in the mouth without letting it break; at night spit it out and set it in the frost and dew, and in the morning look at it — if its colour is a deep green, it is gu.
Clinical note임상 주석
A boiled egg white held in the mouth and then left out overnight will discolour, and the greenish-grey it takes on comes from sulfur compounds in the albumen reacting with iron and with the air, helped along by whatever oral bacteria it has picked up. It will do this in a healthy mouth. The result is a property of eggs, not of the patient.
Holding an unbroken peeled egg in the mouth from dusk until night is itself an aspiration risk, and it should not be done to a sick or drowsy person.
譯 2.1.2.5 Source원문
中蠱者大便黑如漆, 或堅或薄或微赤者是蠱也. 《千金》
Translation영역
In one struck by gu the stool is black as lacquer; and whether it is firm or thin or faintly red, it is gu.
Clinical note임상 주석
This is the one sign in the section with real diagnostic weight, and the text has it right as an observation even though it has the cause wrong. A stool black as lacquer is melaena — blood that has been digested on its way through the gut — and it means bleeding somewhere above the small intestine. Faintly red means fresher blood from lower down. Either, in a patient who is also vomiting blood and wasting, is the picture of a bleeding ulcer, a varix or a tumour.
Melaena is a medical emergency today and is investigated by endoscopy, with resuscitation, acid suppression and treatment of the bleeding point. It is worth noticing that the chapter's single reliable test for gu is in fact a reliable test for something else entirely, and something treatable.
2.1.3 Pulse in Gu Poisoning 蠱毒中毒脉候
譯 2.1.3.1 Source원문
凡中蠱毒, 脉類如釵股. 《直指》
Translation영역
Whenever a man is struck by gu poison, the pulse is like the shanks of a hairpin.
Clinical note임상 주석
釵股, the shanks of a hairpin, is the tradition's image for a pulse felt as a thin, taut, wiry double line under the finger rather than a rounded wave. In modern terms that is a narrow pulse pressure with high peripheral resistance — a vasoconstricted, underfilled circulation, which is what shock feels like before the blood pressure falls.
譯 2.1.3.2 Source원문
人爲百藥所中傷, 脉浮洪而疾者生, 微細者死.
Translation영역
Where a man has been struck and harmed by any of the hundred drugs, if the pulse is floating, surging and racing he lives; if it is faint and thready he dies.
Clinical note임상 주석
This is a prognostic rule for poisoning in general, not for gu, and it is substantially correct. A full, easily felt, fast pulse in a poisoned patient means the heart is still ejecting a good stroke volume; a faint thready pulse means it is not, and that is circulatory shock, which carries most of the mortality in acute poisoning whatever the agent.
A thready, barely palpable pulse in anyone who may have been poisoned is a resuscitation emergency — airway, oxygen, intravenous volume, and the specific antidote where one exists.
譯 2.1.3.3 Source원문
又脉洪大而遲者生, 微細而數者死. 《脉經》
Translation영역
Again: if the pulse is surging and large but slow he lives; if it is faint and thready and rapid he dies.
Clinical note임상 주석
Set beside the passage before it, this one is more informative than it looks. There a racing pulse was compatible with life and here a slow one is, so the rate is carrying no weight in either rule; what both have in common is amplitude — surging and large means life, faint and thready means death. The text has independently landed on the right variable, because amplitude reflects stroke volume and rate does not.
微細而數, faint and rapid, is the classical bedside signature of compensated shock: the heart speeding up to defend a cardiac output it can no longer fill. It is the most ominous pulse in the section and the text says so.
2.1.4 Sending the Gu Back 送蠱法
譯 2.1.4.1 Source원문
人中蠱毒, 當服藥. 如知蠱主姓名, 便呼取以去也. 《本草》
Translation영역
When a man has been struck by gu poison he should take medicine. If the surname and given name of the gu's master are known, then call on him to take it away and be rid of it.
Clinical note임상 주석
The section's title, 送蠱法, means sending the gu back, and that is what it is: a set of procedures for finding out who is supposed to have sent the poison and making him recall it. It is a ritual, not a treatment, and nothing in the four passages is addressed to the patient's body at all. 當服藥, he should take medicine, is the whole of the medical content, and it points away to 2.1.5.
譯 2.1.4.2 Source원문
欲知蠱主姓名, 取敗鼓皮燒爲末, 飮調服一錢, 病人須臾自呼蠱主姓名, 令取蠱去卽愈. 《本草》
Translation영역
If you wish to know the name of the gu's master, take the skin of a worn-out drum, burn it and make it into a powder, and give 1 don stirred into a drink; in a short while the sick man himself calls out the name of the gu's master, and when the master is made to take the gu away he recovers at once.
Clinical note임상 주석
Burnt drum-hide is charred collagen, and a don of it has no pharmacological action whatever. The reason it is the drug for this and for nothing else is a pun: a drum is a thing that is beaten, so its skin will beat out the gu and beat out the name. The tradition's materia medica does this often, and it is useful to recognise when a substance has been chosen by its name rather than its effect.
What the passage actually describes is a sick, frightened and possibly delirious person being induced to name a neighbour. Keeping gu was a capital offence, and the danger in this procedure runs away from the patient and towards whoever is named.
譯 2.1.4.3 Source원문
中蠱毒, 下血如猪肝, 藏府敗壞, 惟待死. 蘘荷葉密安病人卧席下, 勿令知, 病者自呼蠱主姓名, 令取去卽愈. 《本草》
Translation영역
Where a man struck by gu poison passes blood below like pig's liver, with the viscera and bowels broken down and nothing to do but wait for death: place mioga ginger leaves secretly under the sick man's sleeping mat without letting him know, and the sick man will himself call out the name of the gu's master; and when the master is made to take it away he recovers at once.
Clinical note임상 주석
下血如猪肝, passing blood below like pig's liver, with the organs broken down and nothing left but to wait for death, is a massive lower gastrointestinal haemorrhage in a patient who is dying of it. For that patient this section offers leaves hidden under the mat.
蘘荷 is mioga ginger, *Zingiber mioga*, a culinary plant with no relevant activity; it is here because the concealment is the point. The leaves are hidden so that the name, when it comes, cannot be said to have been suggested, which is a recognisable attempt to make the divination unprompted and therefore trustworthy. The method is sound reasoning applied to a question that has no answer.
A patient bleeding at this rate needs resuscitation, transfusion and urgent endoscopy or surgery, and in 1613 he had none of those. It is worth saying that the ritual was not offered in place of a treatment that was being withheld; there was nothing else to offer.
譯 2.1.4.4 Source원문
蔣士先得疾下血, 言中蠱. 家人密以蘘荷置卧席下, 忽大笑曰, 蠱我者張小也. 乃收小, 小走. 《本草》
Translation영역
Jang Saseon 蔣士先 took ill and passed blood below, and said he had been struck by gu. His household secretly put mioga ginger under his sleeping mat, and he suddenly laughed aloud and said, the one who gu'd me is Jang So 張小. They then went to seize So, and So had fled.
Clinical note임상 주석
The case is given as proof that the method works, and what it records is the method's actual outcome: a man passing blood names a neighbour from his sickbed, and the household goes to arrest him. The sudden loud laughing before he speaks is the detail worth keeping — a dying man with that much blood loss may be hypotensive, hypoxic and delirious, and an abrupt change in manner is a sign of that rather than of revelation.
Nothing is said about whether the patient recovered. The story ends with the flight of the accused, which is the end the procedure was built to produce, and it is as clear a statement as the chapter gives of what the gu complex was for.
2.1.5 Treatment of Gu Poisoning 蠱毒治法
譯 2.1.5.1 Translation영역
When a man has been struck by gu poison, there is cutting pain in the heart and belly as though something were biting him, the facial colour is green-yellow, and he either vomits blood or passes blood below. If he is not treated at once, then when the five viscera have been eaten quite through he dies. He should be given Taeeul jageum-dan 太乙紫金丹, Okchu-dan 玉樞丹, Manbyeong haedok-won 萬病解毒元, Ungban-hwan 雄礬丸, Ungsa-san 雄麝散, Jinsa-hwan 辰砂丸, Boryeong-dan 保靈丹, Dokseung-san 獨勝散 or Gungno-eum 國老飮, and either made to vomit or purged, and he recovers.
Clinical note임상 주석
The presentation is consistent across the whole gu group: cutting epigastric and abdominal pain, a sallow green-yellow face, and haematemesis or the passage of blood below, running to death. Read without the gu, it is acute gastrointestinal bleeding, or a corrosive or irritant poisoning, or severe dysentery, and the as-though-bitten quality of the pain is colic.
The strategy for all nine formulas is stated in four characters — 或吐或下, make him vomit or purge him — and that is the only therapeutic principle in the section that modern practice shares at all. Emptying the stomach after a swallowed poison is a real measure, but it is now used rarely and only within about the first hour, because after that little is recovered and the risk of aspirating gastric contents into the lungs outweighs the benefit. Activated charcoal, specific antidotes and supportive care have replaced it. Where the illness has been running for days or months, as the gu cases are described as doing, emesis and purging cannot help and will worsen the dehydration of a patient who is already losing blood and fluid.
The nine formulas themselves are set out below. Six of the nine are built on cinnabar, realgar, red lead or the violent purgatives, which is to say that the chapter's antidotes for poisoning are mercury, arsenic, lead and croton oil. That is not an accident or an inconsistency: 以毒攻毒, attacking poison with poison, was the explicit rationale, and it is the same reasoning that puts arsenic trioxide into the modern treatment of acute promyelocytic leukaemia. The difference is that the modern use rests on a known mechanism, a measured dose and a monitored patient, and this one rests on none of the three.
譯 2.1.5.2 Source원문
太乙紫金丹, 一名紫金錠, 一名萬病解毒丹. 治蠱毒ㆍ挑生毒ㆍ狐狸ㆍ鼠莽ㆍ惡菌ㆍ河豚ㆍ死牛馬肉毒ㆍ山嵐瘴氣毒ㆍ諸藥ㆍ金石ㆍ草木ㆍ鳥獸ㆍ百蟲一切諸毒. 蚊蛤(去蟲土) 三兩, 山茨茗(去皮焙) 二兩, 紅芽大戟(洗焙) 一兩半, 續隨子(去皮油) 一兩, 麝香 三錢. 右爲末, 糯米粥和勻, 擣千餘杵, 每一料分作四十錠. 每服半錠, 重者一錠, 並用薄荷湯化下. ○修合時宜端午ㆍ七夕ㆍ重陽日, 或遇天德ㆍ月德日, 在淨室焚香齋戒, 勿令婦人ㆍ孝服人ㆍ雞犬見之. ○自縊ㆍ落水ㆍ鬼迷ㆍ驚死心頭溫者, 並冷水磨灌卽醒. 蛇犬諸惡蟲傷, 以酒化服, 水磨塗傷處. 《入門》
Translation영역
Taeeul jageum-dan 太乙紫金丹, also called Jageum-jeong 紫金錠 and also called Manbyeong haedok-dan 萬病解毒丹. It treats gu poison, dosaeng poison, fox and badger poison, rat-bane poison, poisonous mushrooms, pufferfish, the poison of the flesh of oxen and horses that have died, the poison of mountain mist and miasmal vapours, and every poison whatever of drugs, metals and minerals, plants and trees, birds and beasts and the hundred insects. Gallnut (the insects and dirt removed), 3 nyang; sanjago 山茨茗 (the skin removed, dry-roasted), 2 nyang; red-sprout Peking spurge (washed and dry-roasted), 1 nyang 5 don; caper spurge seed (the husk and oil removed), 1 nyang; musk, 3 don. Powder the above, mix evenly with glutinous rice gruel and pound it a thousand strokes and more, and divide each batch into forty lozenges. Half a lozenge a dose, a whole one in a severe case, in each case dissolved down in a mint decoction. ○For the time of compounding, the Dano, Chilseok or Jungyang day is suitable, or a day falling on the Heavenly Virtue or Monthly Virtue; do it in a clean room with incense burning and under fasting observance, and do not let a woman, a person in mourning dress, a chicken or a dog see it. ○For one who has hanged himself, fallen into water, been bewildered by a ghost or died of fright, so long as there is still warmth at the heart, in every case grind it in cold water and pour it in, and he wakes at once. For bites from snakes, dogs and any of the noxious insects, dissolve it in wine and give it, and grind it in water and smear it on the bitten place.
Clinical note임상 주석
**Contains red-sprout Peking spurge and caper spurge seed, both violent purgatives, and sanjago (山茨菰, *Iphigenia indica*), which carries colchicine-type alkaloids whose toxic dose is close to the active one. It also contains musk, and all musk deer are CITES-listed. This must not be prepared.** Of the five ingredients only the gallnut is inert; it is tannin, and tannins do in fact precipitate some alkaloids in the stomach, which is the one plausible antidotal action in the formula.
The indication list is the widest in the chapter and amounts to a universal antidote, which is the first warning that it is not an antidote to anything in particular. The pharmacologically honest description is that this is a purgative: the two spurges and the colchicine-bearing bulb between them empty the bowel violently, and the strategy of 2.1.5 is 或吐或下. That gives it some footing within the first hour of a swallowed poison and none at all for mushroom or pufferfish poisoning, both named here, where the latent period is already past by the time the patient presents.
The compounding instructions are pharmacy as liturgy — festival days, auspicious calendar days, a clean room, incense, fasting, and the exclusion of women, mourners, chickens and dogs. The one rational kernel in it is the clean dedicated room; the rest is a guarantee of potency written in the only vocabulary available. The resuscitation uses in the last clause are the dangerous part: **pouring a liquid into the mouth of an unconscious or non-breathing person will be aspirated into the lungs and must not be done.** Hanging and drowning are treated now by opening the airway, rescue breaths and chest compressions. The formula survives as 紫金錠, still sold across East Asia, and modern commercial versions have had the most toxic ingredients reduced or removed.
譯 2.1.5.3 Source원문
玉樞丹, 一名追毒丹. 治病服法同上. ○卽上太乙紫金丹加入雄黃 一兩ㆍ朱砂 五錢也, 製法同上. ○入蠱鄕, 纔覺意思不快, 卽服一錠, 或吐或利而愈, 誠濟世衛生之寶也. 《入門》
Translation영역
Okchu-dan 玉樞丹, also called Chudok-dan 追毒丹. The diseases it treats and the way it is taken are the same as above. ○That is, it is the Taeeul jageum-dan above with realgar 1 nyang and cinnabar 5 don added, and the method of preparation is the same as above. ○On entering a gu district, the moment one feels at all out of sorts, take one lozenge at once, and he either vomits or is purged and recovers. Truly a treasure for succouring the world and guarding health.
Clinical note임상 주석
**Contains realgar (arsenic sulfide) and cinnabar (mercuric sulfide), on top of the two violent purgatives and the colchicine-bearing bulb of the parent formula. This must not be prepared.** The remedy for poisoning is here made stronger by the addition of arsenic and mercury, which states the chapter's logic as plainly as it can be stated: poison is driven out by poison.
Realgar is arsenic disulfide and cinnabar is mercuric sulfide. Both are relatively insoluble, which is why they were tolerated in single doses and why the tradition regarded them as safe, but neither is inert: heating or long grinding converts realgar towards the far more toxic arsenic trioxide, gastric acid mobilises a fraction of both, and repeated use accumulates arsenic and mercury in the body. Arsenic poisoning is treated by chelation and mercury poisoning by chelation and supportive care; the chapter's own section on arsenic is at 2.9.1 and on mercury at 2.9.16.
The last clause is the one worth marking for what it reveals: take it the instant you feel out of sorts anywhere in a gu district. A strong purgative with arsenic and mercury in it, taken prophylactically on a vague unease, is the formula being used on well people, and that is where this kind of remedy did most of its harm.
譯 2.1.5.4 Source원문
萬病解毒元, 治蠱毒ㆍ挑生毒ㆍ藥毒ㆍ草毒ㆍ畜獸毒. 蚊蛤 一兩半, 山茨菰 一兩, 大戟 七錢半, 山豆根ㆍ續隨子(去皮油) 各五錢, 朱砂ㆍ雄黃 各二錢, 麝香 一錢, 全蝎 五枚. 右爲末, 糯米糊丸, 分作三十五丸. 每服一丸, 薑汁ㆍ蜜水磨下, 井水硏付所傷處. 《得效》
Translation영역
Manbyeong haedok-won 萬病解毒元 treats gu poison, dosaeng poison, drug poison, plant poison and the poison of domestic animals and beasts. Gallnut, 1 nyang 5 don; sanjago 山茨菰, 1 nyang; Peking spurge, 7 don 5 fun; sophora root and caper spurge seed (the husk and oil removed), 5 don each; cinnabar and realgar, 2 don each; musk, 1 don; whole scorpions, five. Powder the above and make pills with glutinous rice paste, dividing them into thirty-five pills. One pill a dose, ground down in ginger juice or honey water; and ground in well water it is applied to the injured place.
Clinical note임상 주석
**Contains cinnabar (mercury), realgar (arsenic), Peking spurge and caper spurge seed (violent purgatives), sanjago (colchicine-type alkaloids), scorpion and musk (CITES). This must not be prepared.** It is the same formula family as the two above with sophora root and scorpion added.
山豆根, *Sophora tonkinensis*, deserves separate mention because it is the one ingredient here with a well-documented modern toxicity. It contains matrine and related quinolizidine alkaloids, and overdose causes vomiting, tremor, convulsions and liver injury; clinical reports of hepatotoxicity and of neurological damage from it are not rare in the East Asian literature, and 5 don is a substantial dose. The tradition used it chiefly for the throat, as the corpus notes elsewhere.
The topical use in the last clause — the pill ground in well water and smeared on a bite or wound — puts mercury, arsenic and cantharidin-free but still irritant material on broken skin, from which some is absorbed. It should not be done.
譯 2.1.5.5 Source원문
雄礬丸, 治蠱毒及蟲蛇毒. 卽蠟礬丸方見癰疽加雄黃等分, 作丸梧子大, 每七丸熟水呑下. 《入門》
Translation영역
Ungban-hwan 雄礬丸 treats gu poison and the poison of insects and snakes. That is, it is Napban-hwan 蠟礬丸 — the formula is given in the chapter on Abscesses and Sores — with realgar added in equal part; make pills the size of a paulownia seed, and seven pills a dose swallowed down with boiled water.
Clinical note임상 주석
**Contains realgar (arsenic sulfide) and alum. This must not be prepared.** Napban-hwan is beeswax and alum, the tradition's standing remedy for suppuration, which is why the cross-reference goes to the chapter on abscesses; adding realgar in equal part turns it into an arsenic preparation at a third of the pill by weight.
Taken as directed, seven pills of paulownia-seed size, the arsenic dose is small but not negligible, and the alum load is enough to irritate the stomach on its own. The beeswax is the binder and is inert. There is nothing here that would treat a snakebite: venomous snakebite is managed by immobilisation, rapid transport and antivenom where indicated, and the Bogam's own snakebite material is at 諸傷門 1.15.1.
譯 2.1.5.6 Source원문
雄麝散, 治五種蠱毒. 雄黃ㆍ麝香 等分爲末, 取生羊肺如指大, 以刀開裹藥呑之. 《丹心》
Translation영역
Ungsa-san 雄麝散 treats the five kinds of gu poison. Realgar and musk, equal parts, powdered; take a piece of raw sheep's lung the size of a finger, open it with a knife, wrap the powder in it and swallow it.
Clinical note임상 주석
**Contains realgar (arsenic sulfide) and musk (CITES-listed). Swallowing raw sheep lung carries a risk of foodborne bacterial and parasitic infection, including hydatid disease, which is endemic in sheep-rearing regions. This must not be prepared.**
The raw lung is not a drug but a delivery vehicle, and a shrewd one: realgar is gritty and musk is overpoweringly acrid, and wrapping them in a piece of spongy tissue the size of a fingertip gets the powder past the tongue in one swallow. Enteric coating solves the same problem now.
The five kinds of gu are those of 2.1, typed by complexion and vomitus, so a formula said to cover all five is a formula not matched to anything.
譯 2.1.5.7 Source원문
辰砂丸, 治蠱毒從酒食中着者. 辰砂ㆍ雄黃ㆍ赤足蜈蚣ㆍ續隨子 各一兩, 麝香 二錢半. 右爲末, 糯米飯和丸芡實大, 每一丸以酒化下, 端午日合. ○一名丹砂元. 《三因》
Translation영역
Jinsa-hwan 辰砂丸 treats gu poison contracted by way of wine or food. Cinnabar, realgar, red-footed centipede and caper spurge seed, 1 nyang each; musk, 2 don 5 fun. Powder the above and make pills with boiled glutinous rice the size of a gorgon-nut; one pill a dose dissolved down in wine; compound it on the Dano day. ○Also called Dansa-won 丹砂元.
Clinical note임상 주석
**Contains cinnabar (mercuric sulfide), realgar (arsenic sulfide), centipede, caper spurge seed (a violent purgative) and musk (CITES-listed). This must not be prepared.** A nyang each of cinnabar and realgar is the heaviest mineral loading of the nine formulas relative to its size, and the vehicle is wine, which increases absorption from the stomach.
蜈蚣, centipede, is used for its venom and the tradition classed it as a toxic, wind-extinguishing drug; centipede venom is a mixture of peptides and histamine-releasing compounds, and it is a cardiotoxin. 赤足, red-footed, specifies *Scolopendra* with the reddish legs.
從酒食中着者, contracted by way of wine or food, is the one clause with a plain reading: the patients were people who fell ill after eating or drinking at someone else's table, which covers both deliberate poisoning and ordinary foodborne illness and needs no gu at all to explain it.
譯 2.1.5.8 Source원문
保靈丹, 治蠱毒ㆍ諸毒ㆍ一切藥毒神效. 朱砂 一兩, 山豆根 五錢, 雄黃ㆍ黃丹ㆍ麝香ㆍ黃藥子ㆍ續隨子(去皮, 另硏)ㆍ巴豆(去皮, 不去油)ㆍ斑猫(去頭足翅) 各二錢半, 赤足蜈蚣 二條(一生一灸), 糯米(半生半炒)爲末作糊. 右於端午ㆍ重陽ㆍ臘日修合爲末, 不令雞犬ㆍ婦人見之. 用糯米稀糊和丸芡實大, 陰乾, 磁盒收貯. 每一丸茶淸呑下, 不得嚼破. 須臾將毒物或吐或利, 藥丸凝血並下, 以水洗淨收之. 一丸可救三人. 若急則擇吉日精潔修合. 《得效》
Translation영역
Boryeong-dan 保靈丹 treats gu poison, the various poisons and every drug poison, with divine effect. Cinnabar, 1 nyang; sophora root, 5 don; realgar, red lead, musk, hwangyakja 黃藥子, caper spurge seed (the husk removed, ground separately), croton seed (the husk removed, the oil not removed) and blister beetle (head, feet and wings removed), 2 don 5 fun each; red-footed centipede, two of them, one raw and one roasted; glutinous rice, half raw and half parched, powdered and made into a paste. Compound the above on the Dano, Jungyang or Napil day and powder it, not letting a chicken, a dog or a woman see it. Make pills with a thin glutinous rice paste the size of a gorgon-nut, dry them in the shade, and store them in a porcelain box. One pill a dose swallowed down with clear tea; it must not be chewed and broken. In a short while the poisonous matter is either vomited or purged out, and the pill comes down together with clotted blood; wash it clean with water and keep it. One pill can save three people. If the case is urgent, then choose an auspicious day and compound it with scrupulous cleanliness.
Clinical note임상 주석
**This is among the most dangerous preparations in the Bogam and must not be prepared under any circumstances. It contains cinnabar (mercuric sulfide), realgar (arsenic sulfide), red lead (lead tetroxide), croton seed with the oil deliberately retained, blister beetle (cantharidin), centipede, caper spurge seed, sophora root and hwangyakja (*Dioscorea bulbifera*), together with musk, which is CITES-listed.** Four heavy-metal and mineral poisons, two drastic purgative oils, a vesicant insect toxin and two hepatotoxins are in a single pill.
Three ingredients should be named individually. 黃丹 is lead tetroxide: lead has no safe dose, accumulates in bone, and causes anaemia, peripheral neuropathy, renal injury and, in children, permanent cognitive impairment. 巴豆去皮不去油 — croton seed with the oil left in — is a deliberate choice of the most violent form; croton oil is a drastic purgative and a vesicant that blisters skin on contact, and the tradition itself normally de-oiled it. 斑猫 is the blister beetle, and cantharidin is a potent vesicant that causes gastrointestinal haemorrhage, acute tubular necrosis and renal failure. 黃藥子 is air-potato yam, now a recognised cause of herb-induced liver injury. Any one of these could kill the patient the formula is meant to save.
The last instructions are the ones to read closely. The pill is not to be chewed, it is expected to come through intact in the stool along with clotted blood, and it is then to be washed and kept, because one pill can save three people. That is a reusable dose-form, and the economics behind it are obvious — a pill of cinnabar, musk and lead was expensive. It is also a direct faecal-oral route between patients, and everything the first patient carried, including the dysenteries that presented as gu in the first place, would travel with it. The clotted blood passed alongside it is evidence that the pill was itself causing gastrointestinal haemorrhage.
譯 2.1.5.9 Source원문
獨勝散, 治蠱毒及藥毒ㆍ蟲蛇諸毒. 大甘草節麻油浸, 年歲愈多愈妙. 右取甘草嚼下, 或以水煎服, 神效. 《得效》
Translation영역
Dokseung-san 獨勝散 treats gu poison and drug poison and the various poisons of insects and snakes. Large liquorice root-nodes steeped in sesame oil, and the more years it has stood the better. Take the liquorice and chew and swallow it, or else decoct it in water and take it; divine effect.
Clinical note임상 주석
The one formula of the nine with nothing acutely dangerous in it, and the plainest: liquorice root-nodes kept in sesame oil, the older the better, chewed or decocted. Liquorice was the tradition's general antidote — the by-name 國老, the state elder, belongs to it, and the next formula is named for it — and a liquorice-and-bean decoction (甘豆湯) was the standard counter-poison across the whole corpus.
It is not inert. Glycyrrhizin inhibits the enzyme that inactivates cortisol in the kidney, so liquorice in quantity or over time produces a pseudohyperaldosteronism — sodium retention, potassium loss, oedema and hypertension — and the hypokalaemia can cause arrhythmia and muscle weakness. It also interacts with diuretics, corticosteroids and digoxin. **Liquorice should not be taken in quantity or for long periods, and should be avoided altogether in hypertension, heart failure, kidney disease or pregnancy.**
Glycyrrhizin does have some documented activity against a few toxins and a mild hepatoprotective effect, which is probably how the reputation arose, but nothing in it would treat a poisoning or a snakebite. The corpus holds two other formulas of the same name, in 諸傷門 and in the chapter on abscesses, and they are different medicines.
譯 2.1.5.10 Source원문
國老飮, 治蠱毒. 白礬ㆍ甘草 等分爲末, 淸水調下, 或吐黑涎, 或瀉下卽安. 《得效》
Translation영역
Gungno-eum 國老飮 treats gu poison. Alum and liquorice, equal parts, powdered and stirred down in clear water; he either vomits black drool or is purged below, and is at once at ease.
Clinical note임상 주석
國老, the state elder, is liquorice's by-name, so the formula is named after half its contents. The other half is what makes it work: alum, potassium aluminium sulfate, is a mucosal irritant, and a powdered dose of it in water is a crude emetic. 或吐黑涎或瀉下 — he vomits black drool or is purged — is the irritant acting, and the black drool is mucus, bile and possibly digested blood.
This makes it the most mechanistically honest of the nine: it does the one thing the section set out to do, which is to empty the patient. Gastric emptying is also the one principle here that modern practice ever shared. It is no longer recommended as first aid, because little is recovered after the first hour, because vomiting in a drowsy or convulsing patient leads to aspiration pneumonia, and because activated charcoal and specific antidotes do the job better. It is actively dangerous after a corrosive or a petroleum product, which are brought back up through an already burnt oesophagus.
**Alum should not be taken orally; aluminium salts are mucosal irritants. Vomiting should not be induced in a poisoned person. Suspected poisoning is a medical emergency — call emergency services or a poison centre.**
2.2 Gold-Silkworm Sorcery Poison 金蚕蠱毒
譯 2.2.1 Source원문
南方畜金蚕, 其蚕金色, 食以蜀錦, 取其遺糞, 置飮食中, 以毒人. 人死, 蚕喜, 能致他財, 使人暴富, 而遣之極難. 水火兵刃所不能害. 必多以金銀置蚕其中, 投諸路隅, 人或收之, 蚕隨以往, 謂之嫁金蚕. 《𤨏言》
Translation영역
In the south they keep the gold silkworm. The worm is gold in colour. It is fed on Shu brocade, and its droppings are taken and put into food and drink to poison people. When the person dies the worm is pleased; it can draw in other people's wealth and make its keeper suddenly rich — and it is extremely hard to send away. Water, fire, weapon and blade cannot harm it. One must put a good quantity of gold and silver together with the worm, and set the whole down at a corner of the road; if someone picks it up, the worm goes along with him. This is called marrying off the gold silkworm.
Clinical note임상 주석
There is no gold silkworm. No insect is gold-coloured because it was fed brocade, no insect's droppings are a poison of this kind, and nothing survives water, fire and the blade. The passage is not a description of an organism but of a belief, and it is worth reading for what the belief did rather than for what it claims.
The two things the text says about the creature are social, not medical. It makes its keeper suddenly rich: that is an explanation for a neighbour's unaccountable prosperity, and it puts the suspicion of murder on the household that has it. And it cannot be got rid of except by leaving it at a roadside with silver, so that whoever takes the money takes the worm: that is a rule for transferring blame from one house to another, with a purse as the vehicle. A village that believed this had a ready mechanism for accusing the wealthy and for explaining away a death from ordinary poisoning, dysentery or parasitic disease.
The word 嫁, marrying off, is the word used of sending a daughter out of the house. The ritual is built on the same logic as a dowry.
譯 2.2.2 Source원문
人中金蚕蠱毒, 先嚼白礬, 味甘不澁, 次嚼黑生豆, 不腥者是也. 石榴根皮濃煎汁飮之, 吐出活蟲卽愈. 《得效》
Translation영역
Where a person has been struck by gold-silkworm sorcery poison: first have him chew white alum — if the taste is sweet and not astringent; then have him chew raw black soybean — if it has no raw smell, this is it. Decoct pomegranate root bark thick and have him drink the liquid; he vomits out live worms and is at once cured.
Clinical note임상 주석
The test is the same device as the one at 2.1.2 — a substance with a strong and unmistakable taste is given, and a reversal of that taste is read as proof. Alum is sour and sharply astringent and raw soybean smells green and raw, so the reasoning has a shape: the known quantity is the control, and the poison is inferred from the deviation. It cannot work. Nothing in any poisoning alters taste in the direction described, and a frightened patient asked whether the alum tastes sweet is being asked to confirm a diagnosis that has already been announced to him.
The treatment is a different matter. Pomegranate root bark is a genuine anthelmintic — it contains pelletierine and isopelletierine, and it was a standard taeniacide in Western pharmacy into the twentieth century. A patient with intestinal worms given a thick decoction of it may well pass or vomit visible worms, which is exactly what the text reports. The observation is real; the gold silkworm is the explanation laid over it.
**Pomegranate root bark contains pelletierine alkaloids, which are toxic — they cause vertigo, visual disturbance, cramp, weakness and collapse, and the margin between an effective and a dangerous dose is narrow. This must not be prepared.** Suspected intestinal parasitosis is diagnosed on stool examination and treated with albendazole or praziquantel according to the organism.
2.3 Life-Raising Poison 挑生毒
譯 2.3.1 Source원문
嶺南有挑生毒, 乃挑毒於飮食中, 以害於人. 其候初覺胸腹作痛, 次則漸漸攪刺, 滿十日則物生能動. 在上則胸痛, 在下則腹痛. 在上者, 膽礬末五分, 投熱茶內化服, 探吐之; 在下者, 鬱金末二錢, 米飮調服, 瀉下惡物, 後以四君子湯去甘草, 煎服調理. 《得效》
Translation영역
In Lingnan there is life-raising poison. It is poison stirred into food and drink to harm a person. Its signs: at first he feels pain arising in the chest and abdomen; next it churns and stabs, little by little; and when ten days are full, the thing comes to life and can move. If it is above, there is chest pain; if below, abdominal pain. For the one in which it is above: powdered chalcanthite, 5 fun, dropped into hot tea to dissolve and swallowed, then probe to make him vomit. For the one in which it is below: powdered curcuma, 2 don, mixed into rice decoction and swallowed, to flush the foul matter downward; afterwards give Four Gentlemen Decoction with the licorice removed, decocted and taken, to set him right.
Clinical note임상 주석
挑生 is the belief that something swallowed takes life inside the body and grows there. Nothing swallowed does that, but the belief is not arbitrary: in the subtropical south, food- and water-borne parasites are endemic, and a patient with ascariasis, clonorchiasis, fasciolopsiasis or taeniasis has abdominal pain that churns and shifts, and will at some point pass a living worm that he did not swallow in that form. From seeing the worm, the inference that it grew from something eaten is a short step. The ten-day latency is the one detail that argues the observation was real rather than imagined — it is roughly the interval over which a food-borne illness declares itself.
The treatment is staged by level, and the staging is the sound part: vomit what is high, purge what is low. That is gastric emptying, and it is the one principle in the 蠱毒 sections that modern practice still shares — but only within the first hour or so after ingestion, and now with gastric lavage or activated charcoal rather than an emetic. At ten days nothing is left in the stomach to bring up.
**Chalcanthite is copper sulfate. It was once used precisely as an emetic, and was abandoned because it is absorbed: copper poisoning causes haemolysis, acute kidney injury and liver failure, and deaths from emetic doses are on record. This must not be prepared.** Curcuma and Four Gentlemen Decoction minus licorice are the benign end of the sequence.
譯 2.3.2 Source원문
有人忽肋下腫起, 頃刻間大如椀, 此中挑生毒也. 竢五更, 菉豆細嚼試之, 若香甜則是也. 升麻爲細末, 取冷熟水調二大錢連服之, 洞泄出葱數莖, 根鬚皆具, 腫則消縮. 仍服平胃散調補. 《得效》
Translation영역
There was a man in whom a swelling suddenly rose below the ribs, and in a moment it was as big as a bowl. This was a case of life-raising poison. Wait for the fifth watch and test him by having him chew mung bean fine: if it is fragrant and sweet, this is it. Make cimicifuga into a fine powder, take cold boiled water and mix in 2 large don, and have him take it repeatedly. He flooded downward, and out came several stalks of scallion, roots and rootlets all complete, and the swelling shrank away. Then give Stomach-Calming Powder to regulate and supplement him.
Clinical note임상 주석
A swelling below the ribs that reaches the size of a bowl in moments is not a swelling that grew; it is one that was noticed. The plausible candidates are an enlarged spleen or liver edge coming under the hand, a tense subcostal hernia, an abscess, or a distended loop of bowel. None of them would resolve from a purge, though an obstructed loop decompressing would feel exactly like a swelling shrinking away.
The mung-bean test fails for the same reason the alum test in 2.2 fails. The scallion stalks with roots and rootlets complete did not come out of him. What a thorough purge does produce is undigested vegetable fibre, and a stool inspected by people certain they would find the poison in it will yield whatever they are looking for. This is the chapter's weakest kind of evidence: the cure is confirmed by an object produced after the event, and the object is reported, not kept.
Cimicifuga in quantity causes nausea, vomiting, headache and slowing of the pulse, so the violent purge the text describes is within its reach. Stomach-Calming Powder afterwards is the sensible part — the patient has been emptied and needs feeding.
2.4 Prohibitions 禁忌法
譯 2.4.1 Source원문
凡中蠱之人, 用藥已差, 自後飮食永不得喫冷. 若飮食帶冷, 則鬼氣乘之, 毒蟲復生, 竟不能救. 《入門》
Translation영역
In general, for a person who has been struck by sorcery poison: once medicine has been used and he is well, from then on he must never eat anything cold in his food or drink. If food or drink carries cold, then the ghost qi rides it, the toxic worms are born again, and in the end he cannot be saved.
Clinical note임상 주석
The stated mechanism is the ghost qi riding in on cold food, and that is not a mechanism. No prohibition can prevent a disease attributed to 蠱, because the disease so attributed does not have the cause the text gives it.
There is nevertheless a reason this rule would have looked as though it worked. The illnesses gathered under 蠱毒 are in large part food-borne — bacterial and parasitic — and the foods that carry them are the raw and the cold ones. A household that kept a convalescent off cold food was also keeping him off uncooked food, and so off reinfection. The prohibition is useful by accident, for a reason the text does not know, and the fatal weight it puts on a single lapse — in the end he cannot be saved — is the part to discount.
Clinically the sentence is also doing social work: it hands the patient a rule he can break, so that a relapse has an explanation that is nobody's fault but his own.
2.5 Moxibustion 灸法
譯 2.5.1 Source원문
灸蠱毒法, 於足小指尖上灸三壯, 卽有物出. 酒飯得之, 隨酒飯出; 肉菜得之, 隨肉菜出, 卽愈神驗. 皆於灸瘡上出. 《千金》
Translation영역
The method of moxing sorcery poison: on the tip of the little toe of the foot, moxa three cones, and at once a thing comes out. If it was got by way of wine and rice, it comes out with wine and rice; if it was got by way of meat and vegetables, it comes out with meat and vegetables, and he is cured at once — a marvellous proof. In every case it comes out at the moxa sore.
Clinical note임상 주석
Three cones of direct moxa on the tip of the little toe is a small deep burn. Nothing comes out of a burn but serum and, if it is infected, pus. The claim that the poison emerges at the moxa sore in the company of whatever food carried it in — wine and rice if wine and rice, meat and vegetables if meat and vegetables — is sympathetic logic, the thing leaving by the same form it entered by. It is the least defensible promise in the 蠱毒 sections, and it is stated as 神驗, a marvellous proof, which is how the chapter marks the claims it has least evidence for.
**Direct moxibustion burnt down to the skin raises a blister and leaves an open wound. On the toe of a patient with diabetes or any peripheral neuropathy or arterial disease, a burn of this kind is a limb-threatening injury: it will not be felt, it will not heal, and it is a common route to osteomyelitis and amputation. This must not be done.** Where moxa is used at all today it is held off the skin or insulated.
2.6 Medicines That Eject Sorcery Poison 吐蠱藥
譯 2.6.1 Source원문
凡中蠱, 煮甘草湯服之, 當吐出. 《本草》
Translation영역
In general, where a person has been struck by sorcery poison, boil licorice decoction and have him take it; he should vomit it out.
Clinical note임상 주석
This section and the next are the emetics and the purges, and they deserve one point said plainly at the head of them. Emptying the stomach soon after a poison has been swallowed is the single principle in this chapter that modern practice shares. It shares it narrowly: induced vomiting has been abandoned altogether — syrup of ipecac was withdrawn because it delayed better treatment and changed no outcome — and gastric lavage is now reserved for a life-threatening ingestion seen within the hour. Activated charcoal, specific antidotes and supportive care replaced all of it. A drink given days after the event, which is what most of these remedies are, cannot remove anything.
Licorice itself is not an emetic. It is here as the all-purpose detoxicant of the materia medica, the same role it plays in 獨勝散 and 國老飮 in the section before this one. Prolonged or high-dose licorice causes a pseudoaldosteronism — sodium retention, potassium loss, hypertension — which matters in anyone already vomiting or purging.
譯 2.6.2 Source원문
又升麻 一兩, 水煮取濃汁服, 入口卽吐蠱出. 《本草》
Translation영역
Again: cimicifuga, 1 nyang, boiled in water, the thick liquid taken off and drunk; the moment it enters the mouth it brings the sorcery poison up.
Clinical note임상 주석
One nyang of cimicifuga is a large dose, and at that size the drug does cause nausea, vomiting, headache and a slowed pulse. Of the emetics in this section it is among the ones that would do what is claimed of it. The claim that it acts the moment it enters the mouth is rhetoric, not observation; a gastric irritant takes some minutes.
譯 2.6.3 Source원문
中蠱下血如雞肝, 四藏悉壞, 惟心未毁, 只待死. 馬藺根爲末, 水和服一二錢, 卽吐出極神. 《本草》
Translation영역
Struck by sorcery poison and passing blood below like chicken liver, the four viscera all ruined and only the heart not yet destroyed, so that he is merely waiting to die: powder the root of Chinese iris, mix it with water and give 1 or 2 don; he vomits it out at once — most marvellous.
Clinical note임상 주석
The clinical picture is real and is an emergency. Passing blood below in clots like chicken liver, in a patient collapsed to the point of being thought dying, is a major gastrointestinal bleed or a fulminant dysentery — amoebic or bacillary — and either kills by volume loss. The reasoning about the viscera is pre-mortem reasoning: the four are already destroyed, the heart is not yet, and so there is still an interval in which to act. It is a way of saying that the patient is moribund but not dead.
What the patient needs is intravenous fluid and blood, and then the source found — endoscopy for a bleed, stool studies and metronidazole for amoebic colitis. An emetic is the opposite of what he can tolerate: Chinese iris root is an irritant emeto-cathartic, and vomiting on top of a large bleed risks aspiration and makes the loss worse. **This must not be prepared.**
譯 2.6.4 Source원문
又王瓜, 取根葉擣汁服, 當吐下. 《本草》
Translation영역
Again: wild cucumber — take the root and leaves, pound out the juice and have him drink it; he should vomit and purge.
Clinical note임상 주석
A cucurbit, and the bitterness that makes it medicinal is cucurbitacin. Cucurbitacins are genuinely and violently emetic and purgative, so the drug does what the text says. They are also cytotoxic, and raw juice is an uncontrolled dose. **This must not be prepared.**
譯 2.6.5 Source원문
又治五種蠱毒, 馬兜鈴根爲末一兩, 水煎頓服, 當吐蠱出. 未快, 再服. 《本草》
Translation영역
Again, for treating the five kinds of sorcery poison: powder the root of birthwort, 1 nyang, decoct in water and take at a draught; he should vomit the sorcery poison out. If he is not relieved, give it again.
Clinical note임상 주석
**This is the most dangerous item in the section. 馬兜鈴 is Aristolochia, and it contains aristolochic acid, which is nephrotoxic and carcinogenic. It causes an irreversible interstitial nephritis progressing to end-stage renal failure, and urothelial carcinoma of the upper urinary tract; the association was established in Belgian slimming-clinic patients and in Balkan endemic nephropathy, and the damage is cumulative and permanent. Aristolochia is banned or restricted in most jurisdictions. This must not be prepared, and the instruction to repeat the dose must not be followed.**
A nyang at a draught, repeated until relief, is a very large exposure. Nothing is gained against it: the drug has no antidotal action, and whatever vomiting it produces could be had from safer agents or, properly, not at all.
譯 2.6.6 Source원문
又槲木北陰白皮, 濃煎取一升, 空心服, 卽吐蠱出. 《本草》
Translation영역
Again: the white bark from the north, shaded side of the oak — decoct it thick, take off 1 seung, and have him drink it on an empty stomach; he at once vomits the sorcery poison out.
Clinical note임상 주석
Oak bark is tannin, and tannin is astringent — it binds protein and tightens mucosa. If anything it works against vomiting rather than causing it, and a seung of a thick tannin decoction on an empty stomach would more likely produce nausea from sheer irritation than any emesis worth the name.
The specification of the north, shaded side is worth noticing: it is a yin-yang prescription for how to gather the drug, not a botanical distinction, and it does not alter what is in the bark.
譯 2.6.7 Source원문
又蝟皮燒爲末, 水和服一錢, 當吐蠱. 《本草》
Translation영역
Again: hedgehog skin, burnt and powdered, mixed with water, 1 don taken; he should vomit the sorcery poison.
Clinical note임상 주석
Burnt hedgehog skin is charred keratin and bone ash. It has no emetic action and no pharmacology of any kind beyond that of charcoal. **Hedgehogs are protected in most jurisdictions and this material should not be obtained or used.**
譯 2.6.8 Source원문
又苦瓠一枚, 水煮取汁服, 立吐卽愈. 《本草》
Translation영역
Again: one bitter bottle gourd, boiled in water, the liquid taken off and drunk; he vomits immediately and is cured.
Clinical note임상 주석
This one works and that is the problem with it. The bitterness of a bitter bottle gourd is cucurbitacin, and the dose in a whole fruit is not controllable. **Cucurbitacin poisoning from bitter gourd or bottle-gourd juice causes violent vomiting, bloody diarrhoea, gastrointestinal haemorrhage, shock and death; fatalities are documented from a single glass of juice from a bitter fruit, and the characteristic warning is the taste itself. This must not be prepared.**
A gourd that tastes bitter is the one that should be thrown away, which is the exact reverse of the instruction here.
譯 2.6.9 Source원문
又人頭垢, 米飮或酒化服, 卽吐蠱. 《本草》
Translation영역
Again: scurf from a human head, dissolved in rice decoction or in wine and taken; he at once vomits the sorcery poison.
Clinical note임상 주석
This is a disgust emetic, and that is the whole of its action: the thought of what has been put in the cup is what brings the stomach up. The chapter uses human materials this way more than once.
**Human scurf and scalp debris carry staphylococci and dermatophytes and should not be swallowed or handled as a medicine. This must not be prepared.**
譯 2.6.10 Source원문
又猯胞, 湯摩如雞卵許服之, 卽吐蠱. 《本草》
Translation영역
Again: the bladder of a raccoon dog — rub it up in hot water to the amount of a hen's egg and have him take it; he at once vomits the sorcery poison.
Clinical note임상 주석
Animal bladder tissue rubbed up in hot water is protein suspension with no emetic action. **Raw viscera from a wild carnivore carry Trichinella, Echinococcus and enteric bacteria, and handling them carries a rabies exposure risk. This must not be prepared.**
2.7 Medicines That Purge Sorcery Poison 下蠱藥
譯 2.7.1 Source원문
凡中蠱毒, 商陸末和水服, 卽下蠱. 《本草》
Translation영역
In general, where a person has been struck by sorcery poison: powdered pokeweed root mixed with water and taken, and the sorcery poison comes down at once.
Clinical note임상 주석
The purges carry the same single caveat as the emetics before them, and it is worth repeating here because this section is the more hazardous of the two. Emptying the gut early after an ingestion is the one principle modern practice shares with this chapter, and it has narrowed almost to nothing: cathartics have been dropped from poisoning management entirely, because they were never shown to change an outcome and they add fluid and electrolyte loss to a patient who is already compromised. A purge given days after the event removes nothing but water.
**Pokeweed root is toxic. Phytolaccatoxin and the related saponins cause protracted vomiting, bloody diarrhoea, hypotension, and in reported cases convulsions and respiratory depression; children have died. This must not be prepared.**
譯 2.7.2 Source원문
又續隨子去皮, 硏爲末, 和水服一錢, 卽下利蠱蟲. 《本草》
Translation영역
Again: caper spurge seed, husked, ground to powder, mixed with water, 1 don taken; it purges down the sorcery worms at once.
Clinical note임상 주석
**Caper spurge seed is a drastic purgative of the Euphorbia group. The diterpene esters in it are severe mucosal irritants: taken by mouth they cause burning of the mouth and throat, violent bloody diarrhoea and dehydration, and on the skin and in the eye they are vesicant. This must not be prepared.** A don of the powder is a large dose of an agent with no safe one.
譯 2.7.3 Source원문
牽牛子取頭末二錢, 和水服, 當瀉出毒蟲. 《本草》
Translation영역
Pharbitis seed — take 2 don of the first-drawn powder, mix with water and have him take it; it should flush the toxic worms out.
Clinical note임상 주석
頭末 is the fine powder that comes off first in grinding, and it is the most concentrated part of the seed; the specification shows the drug was dosed with care. Pharbitis resin is a drastic cathartic of the same family as jalap, and 2 don of the head powder produces copious watery diarrhoea with cramping.
**This is a violent purgative. It causes dehydration and electrolyte loss, and it is contraindicated in pregnancy and in anyone already depleted by vomiting or diarrhoea. This must not be prepared.**
譯 2.7.4 Source원문
斑猫一枚, 去頭足翅, 硏爲末, 和飮服, 當下蠱. 《本草》
Translation영역
Blister beetle, one insect, head, feet and wings removed, ground to powder, mixed into a drink and taken; it should bring the sorcery poison down.
Clinical note임상 주석
**Blister beetle is cantharidin, and this is the most acutely lethal substance in either of these two sections. Cantharidin is a protein phosphatase inhibitor and a potent vesicant: swallowed, it blisters the mouth, oesophagus and stomach, causes haematemesis and bloody diarrhoea, and then acute tubular necrosis, haematuria and priapism, followed by cardiovascular collapse. The adult lethal dose is of the order of tens of milligrams, which is within the content of a very small number of beetles, and there is no antidote — treatment is supportive only. This must not be prepared.**
Removing the head, feet and wings is a real preparation step found throughout the materia medica, but it does nothing about the toxin: cantharidin is in the haemolymph and the body, and the trimming only removes the parts that would be mechanically irritating.
譯 2.7.5 Source원문
又斑猫去足翅熬ㆍ大戟ㆍ桃白皮東引者, 三物等分爲末, 冷水調服半錢, 其毒卽下. 若未出, 更一服奇效. 只單服大戟亦好. 《本草》
Translation영역
Again: blister beetle with feet and wings removed and dry-roasted, euphorbia root, and the white bark of a peach from an east-running branch — the three substances in equal parts, powdered, half a don mixed in cold water and taken, and the poison comes down at once. If it has not come out, one further dose has a remarkable effect. Taking euphorbia root alone is also good.
Clinical note임상 주석
Two of the three ingredients are among the most toxic drugs in the book and they are given together. **Blister beetle is cantharidin — vesicant, nephrotoxic, lethal in tens of milligrams, no antidote. Euphorbia root is a drastic purgative whose diterpene esters cause violent bloody diarrhoea and dehydration. Half a don of a powder in which cantharidin is one part in three is a potentially fatal dose, and the instruction to repeat it if nothing comes out is the most dangerous sentence in this section. This must not be prepared, and the repeat dose must not be given.**
The concession at the end — that euphorbia root alone also serves — is the text's own admission that the beetle is not what is doing the work. Only the peach bark is harmless, and the east-running specification is directional symbolism, not botany.
譯 2.7.6 Source원문
又燕屎三合(熬)ㆍ獨頭蒜十枚, 和擣爲丸梧子大, 服三丸, 蠱當隨利下而出. 《本草》
Translation영역
Again: swallow droppings, 3 hop, dry-roasted, and single-clove garlic, ten heads — pounded together and made into pills the size of a paulownia seed; three pills taken, and the sorcery poison should come out with the purge.
Clinical note임상 주석
Garlic is harmless and roasting the droppings would kill much of what is in them, but the material is still bird faeces taken by mouth. **Dried bird droppings carry Salmonella, Chlamydia psittaci and Histoplasma capsulatum; pounding them raises a dust that is itself the usual route of histoplasmosis infection. This must not be prepared or handled.** Three pills is a trivial dose of anything purgative, so the stated action is not likely to be observed at all.
2.8 Simple Medicinals for General Use 通治單方
譯 2.8.1 Source원문
中蠱毒, 蚕退紙不拘多少, 以麻油紙撚燒存性爲末, 新汲水調一錢頻服. 雖面靑脉絶, 昏迷口噤, 吐血者, 服之卽甦. 《得效》
Translation영역
Struck by sorcery poison: silkworm moulting paper, any amount, twisted into a spill with hemp oil and burnt with its nature preserved, then powdered; 1 don mixed in newly drawn water and taken frequently. Even where the face is blue and the pulse cut off, where he is unconscious with the jaw clenched and vomiting blood, he takes it and revives at once.
Clinical note임상 주석
This section carries no 凡…種 counting line, unlike the other 單方 heads in these volumes; it runs straight into its first remedy and is divided only by the ○ marks. Thirteen remedies follow.
The signs listed in the second sentence are shock: central cyanosis, an impalpable pulse, loss of consciousness, and haematemesis. They describe a patient in the last minutes of a major haemorrhage or a profound circulatory collapse, whatever the cause, and nothing about them is vague — this is a good clinical description.
What follows it is not possible. A patient with a clenched jaw and no palpable pulse cannot swallow, and nothing given by mouth would be absorbed if he could. Charred paper is activated charcoal of a sort, and charcoal does bind many ingested poisons — but it is given early, to a conscious patient with a protected airway, and never to one who is obtunded without intubation, because the real risk is aspiration. The patient described here needs an airway, intravenous volume and the bleeding source controlled.
譯 2.8.2 Source원문
凡中蠱毒, 藍葉汁飮之良. 《本草》
Translation영역
In general, where a person has been struck by sorcery poison, the juice of indigo leaf drunk is good.
Clinical note임상 주석
Indigo-plant leaf is the chapter's standard cooling detoxicant, and it is harmless. It has no antidotal action against any identified poison; its constituents are indican and indirubin, with some anti-inflammatory activity in the laboratory and nothing that bears on poisoning.
譯 2.8.3 Source원문
又茜根濃煎服之. 又與蘘荷同煎, 飮數升卽愈. 《本草》
Translation영역
Again: madder root decocted thick and taken. Again: decocted together with mioga ginger, several seung drunk, and he is cured.
Clinical note임상 주석
Madder root pairs with mioga ginger here because mioga is the leading anti-蠱 drug of 2.1.1, where it is laid under the sleeping mat; the two carry the same reputation rather than any shared pharmacology.
Madder is worth one caution. **Madder root contains lucidin and ruberythric acid; lucidin is genotoxic and madder was withdrawn as a permitted food colouring on that ground. Several seung of a thick decoction is a large and repeated exposure, and it is not advisable.**
譯 2.8.4 Source원문
又薺苨擣取汁飮之, 末服煎服並佳. 《本草》
Translation영역
Again: adenophora pounded, the juice taken off and drunk; taken as a powder or as a decoction, both are good.
Clinical note임상 주석
Adenophora is the materia medica's general antidote — the drug reached for when the poison is unknown, as licorice is in the section before. It is a benign root with saponins and no identified antidotal action. The chapter's willingness to offer it in any form, juice, powder or decoction, is itself a sign that no specific effect was expected of it.
譯 2.8.5 Source원문
又桔梗擣汁飮之, 危重者亦甦. 《本草》
Translation영역
Again: platycodon pounded, the juice drunk; even those in grave danger revive.
Clinical note임상 주석
Platycodon saponins are irritant to the stomach and in quantity they do cause nausea and vomiting, which is probably the observed effect being reported as a revival. The drug is otherwise benign and is used today as an expectorant on the same saponin action.
譯 2.8.6 Source원문
又鮫魚皮燒爲末, 和水服, 治中蠱吐血. 《本草》
Translation영역
Again: shark skin burnt and powdered, mixed with water and taken; it treats vomiting of blood from sorcery poison.
Clinical note임상 주석
Burnt shark skin is charred collagen and the mineralised denticles of the hide — effectively bone ash and charcoal, with no haemostatic action on a bleeding stomach. Haematemesis is an emergency needing endoscopy, acid suppression and transfusion where indicated.
**Many shark species are CITES-listed and in decline; shark products should not be sourced.**
譯 2.8.7 Source원문
中蠱吐血下血如爛肝, 蚯蚓十四枚, 醋一升漬之, 蚓死, 但飮其汁, 已死者皆可活. 《本草》
Translation영역
Struck by sorcery poison, vomiting blood and passing blood below like rotted liver: fourteen earthworms steeped in 1 seung of vinegar until the worms die; drink only the liquid, and even those already dead can all be brought back to life.
Clinical note임상 주석
Bleeding from above and below together, with clots described as rotted liver, is severe gastrointestinal haemorrhage. It is the same presentation as the iris-root passage in 2.6, and it needs the same thing: volume, blood and the source found.
**Raw earthworm preparations are a real infection risk. Earthworms are the intermediate host of Angiostrongylus cantonensis, the rat lungworm, which causes eosinophilic meningitis in humans, and they carry enteric bacteria from the soil they live in. Vinegar steeping does not sterilise them. This must not be prepared.** The closing claim — that the already dead can be brought back — is the formula the chapter uses where it has no case to cite.
譯 2.8.8 Source원문
又蜈蚣灸爲末, 和飮服亦佳. 《本草》
Translation영역
Again: centipede roasted and powdered, mixed into a drink and taken; this too is good.
Clinical note임상 주석
**Centipede is one of the chapter's venomous animal drugs. The venom contains cardiotoxic and haemolytic peptides and histamine-releasing components, and the dried whole insect is also a recognised cause of allergic reaction including anaphylaxis in sensitised people. This must not be prepared.** Roasting denatures much of the protein venom, which is why the drug was used at all, but nothing in it acts against a poison.
譯 2.8.9 Source원문
又治蠱毒, 胡荽根擣汁半升, 和酒服, 蠱立下. 又取胡荽子硏, 水煮取汁, 冷服半升, 日二. 《本草》
Translation영역
Again, for treating sorcery poison: coriander root pounded, half a seung of the juice, mixed with wine and taken, and the sorcery poison comes down at once. Again: take coriander seed, grind it, boil it in water, take off the liquid and drink half a seung cold, twice a day.
Clinical note임상 주석
Coriander root and seed are food, and this is the gentlest remedy in the section. Coriander seed has a mild carminative action and will settle a griping abdomen; it does nothing against a poison. The wine in the first form is the only part worth a second look — alcohol increases the absorption of several ingested toxins and is best not given to anyone who has been poisoned.
譯 2.8.10 Source원문
又大蒜或小蒜, 並常食之, 治蠱毒. 《本草》
Translation영역
Again: garlic, or scallion-garlic — eat either of them regularly, and it treats sorcery poison.
Clinical note임상 주석
Garlic eaten regularly is harmless and mildly useful, and the reasoning behind it is not foolish: allicin has demonstrable antibacterial, antifungal and anthelmintic activity in the laboratory. The step the text cannot make is from that to systemic antidotal action. Given that much of what is gathered under 蠱毒 is food-borne infection, a diet heavy in raw garlic may genuinely have reduced some of it — not as an antidote, but as a seasoning that happened to be antimicrobial.
譯 2.8.11 Source원문
又狐五藏及腸, 治如食法, 和五味煮作羹食之, 去蠱毒, 灸食亦良. 有人病蠱, 夢道人示頌云, 似犬非犬, 似猫非猫, 烹而食之, 其病自消. 覺而有狐入其室, 殺而烹食, 遂差. 白氏六帖云, 靑丘狐食之令人不蠱. 《夷堅》
Translation영역
Again: the five viscera and the intestine of a fox, dressed as for food, cooked with the five flavours into a soup and eaten — it removes sorcery poison; roasted and eaten is also good. There was a man ill with sorcery poison who dreamt that a Daoist showed him a verse, saying: like a dog but not a dog, like a cat but not a cat — boil it and eat it, and your illness will dissolve of itself. He woke, and a fox came into his room; he killed it, boiled and ate it, and recovered. The Bai Clan Six Tablets says that a fox of Qingqiu, eaten, keeps a man free of sorcery poison.
Clinical note임상 주석
The source is the only one of its kind in this section. 夷堅 is the 夷堅志, Hong Mai's Song collection of anomaly accounts — a book of strange tales, not a medical text — and the Donguibogam has reproduced its evidence intact: a dream, a riddle, an animal arriving on cue, and a recovery. As a case record it is worthless, and it is useful for exactly that reason: it shows what counted as proof when the disease itself was a belief. The riddle's answer is the fox, and the fox walks in because the story needs it to.
**Eating the viscera of a wild canid is genuinely dangerous. Foxes are the definitive host of Echinococcus multilocularis, whose eggs cause alveolar echinococcosis — a slow-growing, liver-based parasitic disease that behaves like a malignancy and is often fatal untreated. They also carry Trichinella, and killing and butchering a fox is a rabies exposure. This must not be prepared.**
譯 2.8.12 Source원문
又獺肝主蠱毒, 燒服之. 《本草》
Translation영역
Again: otter liver governs sorcery poison; burn it and take it.
Clinical note임상 주석
Burnt liver is ash and has no action. **Otters are CITES-listed and protected throughout their range; this material must not be obtained or used.**
譯 2.8.13 Source원문
中蠱人, 常服燒酒與大蒜最妙. 《俗方》
Translation영역
For a person struck by sorcery poison, regularly taking distilled liquor with garlic is best of all.
Clinical note임상 주석
A 俗方 entry — the domestic practice of the compilers' own country, recorded as such, and the last word the chapter gives on 蠱毒 is a folk remedy rather than a prescription from a book.
Garlic is defensible on the grounds given in the entry above. The liquor is not. **Alcohol is not an antidote to anything. It increases the absorption of several ingested toxins, adds its own hepatic and gastric injury, impairs the airway reflexes of a patient who may vomit, and makes assessment of a poisoned or bleeding patient harder. Regular distilled spirits as a prophylactic is advice to drink daily, and should not be followed.**
2.9 Formulas for Rescue in the Various Poisonings 救諸中毒方
譯 2.9.1 Source원문
抑論中毒之證, 辨其自成被害何物之中, 審其遠近, 久則不救. 又手足面靑過時者亦不救. 治法, 上宜吐之, 急以香油多灌一作桐油, 鵝翎探吐之. 下以解毒丸ㆍ靛漿利之. 緊急只以芒硝煎甘草湯調服利之亦可. 《入門》
Translation영역
To consider the signs of poisoning: distinguish whether it came about of itself or was inflicted by another, and which substance it was that struck him; and examine whether it is recent or long standing. If it is long standing he cannot be saved. Again, where the hands, the feet and the face have gone blue and the time has passed, he also cannot be saved. As for the method of treatment: above, it should be vomited out — quickly pour in a quantity of sesame oilone text has tung oil and probe for vomiting with a goose quill; below, drain it out with Toxin-Resolving Pills and indigo liquid. In an urgent case it is also permissible merely to boil mirabilite, stir it into licorice decoction, give it and so drain him.
Clinical note임상 주석
This is the chapter's general protocol, and what it does first is take a history: which substance, how long ago, and whether the patient poisoned himself or was poisoned. Those are still the three questions asked at the door of an emergency department, and time since ingestion is still the single fact that decides what can be done. The late sign the text calls hopeless — blue hands, feet and face with time elapsed — is central cyanosis with circulatory failure, and reading it as beyond rescue was correct in 1613, when there was no oxygen, no fluid line and no ventilator.
Gastric emptying is the one principle here that modern practice still shares, and it has narrowed almost out of existence. Induced emesis was abandoned because it empties little, delays the treatments that work, and risks aspiration; where decontamination is used at all it is activated charcoal within about an hour of a dangerous ingestion, and lavage only in rare cases with the airway protected. Mirabilite is sodium sulfate, an osmotic cathartic, and routine purging is no longer recommended — it changes no outcome and costs fluid and electrolytes.
**Pouring oil into a drowsy poisoned patient and provoking vomiting with a quill down the throat is an aspiration hazard, and aspirated oil causes lipoid pneumonia. This must not be done.** The modern first move is a call to a poison centre or emergency service while airway, breathing and circulation are supported, and then the specific antidote where one exists.
譯 2.9.2 Source원문
人遇事急, 智盡術窮, 或爲人所陷, 始自服毒, 宜急救之. 大法, 甘草ㆍ菉豆能解百毒. 又法, 不問何毒, 多灌香油, 吐利卽安. 《醫鑑》
Translation영역
When a man meets some pressing affair, his wits exhausted and his resources at an end, or when he has been entrapped by another, and so comes to take poison himself, he must be rescued quickly. The great rule is that licorice and mung bean can resolve the hundred poisons. Another method: whatever the poison may be, pour in a quantity of sesame oil, and once he has vomited and been purged he is at ease.
Clinical note임상 주석
This passage is the chapter admitting what its cases actually are. After eight sections on bred and administered 蠱 poison, the 救諸中毒方 opens by naming the two ordinary routes: a man cornered by circumstance who swallows poison himself, and a man poisoned by someone else. Deliberate self-poisoning was then, as it is now, the commonest way these substances reach a patient, and 宜急救之 — rescue him quickly — is the right instinct even though the means were not there. Acute self-poisoning is a medical emergency; the care is airway, decontamination where it is still useful, the specific antidote, and afterwards assessment and support for the person, not only the poison.
**There is no universal antidote, and the licorice-and-mung-bean pair that this chapter repeats as 解百毒 is not one.** Mung bean is a food and does nothing; licorice taken in quantity is not inert — glycyrrhizin inhibits renal 11-beta-hydroxysteroid dehydrogenase and produces potassium loss, sodium retention and hypertension, which is the last thing wanted in someone already vomiting and losing fluid. Sesame oil in quantity likewise has no antidotal action, and in a patient with a dulled gag reflex it is a hazard rather than a remedy.
譯 2.9.3 Source원문
解毒丸 治飮食中毒, 幷百物毒, 救人於必死. 板藍根 四兩, 貫衆(去毛)ㆍ靑黛ㆍ甘草 各一兩. 右爲末, 蜜丸梧子大, 以靑黛另爲衣. 稍覺精神恍惚, 是中諸毒, 急取十五丸, 爛嚼, 新水送下卽解. 《三因》
Translation영역
Toxin-Resolving Pills. Treats poisoning from food and drink, and the poisons of the hundred substances; it rescues a man from certain death. Isatis root, 4 nyang; Dryopteris root with the hairs removed, natural indigo and licorice, 1 nyang each. Powder the above, make honey pills the size of a firmiana seed, and coat them separately with natural indigo. As soon as he feels his spirit somewhat clouded and bewildered, this is poisoning by one of the various toxins: quickly take 15 pills, chew them to a pulp and send them down with newly drawn water, and it resolves at once.
Clinical note임상 주석
The one formula the general section carries, and the thing to notice is its stated indication. 飮食中毒, poisoning from food and drink, is bacterial or toxin-mediated gastroenteritis, which is self-limiting and whose whole treatment is fluid and electrolyte replacement — oral rehydration solution, which costs nothing and saves lives. 百物毒, the poisons of the hundred substances, is a claim no single pill can meet; the poisons named in the forty sections that follow act by entirely different mechanisms and have entirely different antidotes, where they have any at all.
Isatis root, natural indigo and licorice are the chapter's standard cooling antitoxic trio and are relatively benign. The fourth drug is not. **Dryopteris root (貫衆) is the male-fern group of anthelmintics; its filicin and flavaspidic acid are hepatotoxic and toxic to the optic nerve, and overdose of fern extracts caused permanent blindness often enough that the drugs were withdrawn. This must not be prepared.** Taking fifteen pills of it at the first clouding of consciousness, which is exactly when absorption is at its height, adds a second poisoning to the first.
2.9.1 Arsenic Poisoning 砒礵毒
譯 2.9.1.1 Source원문
人中砒礵毒, 其證煩燥如狂, 心腹攪痛, 頭旋欲吐, 面口靑黑, 四肢逆冷, 須臾不救. 此毒於肉飯中得之則易治, 於酒中得之則其毒散歸百脉, 故難治. 在膈上則瓜蔕散吐之方見吐門, 在腹中則萬病解毒丹下之. 《入門》
Translation영역
When a man is struck by arsenic poison, the signs are vexation and agitation to the point of madness, churning pain in the heart and abdomen, the head spinning with an urge to vomit, the face and mouth blue-black, and the four limbs cold and reversed; in a little while he cannot be saved. If he got this poison in meat or rice it is easy to treat; if he got it in wine, then the poison scatters and goes into the hundred vessels, and so it is hard to treat. If it is above the diaphragm, vomit it out with Melon Stalk Powderthe formula is given in the Vomiting chapter; if it is in the abdomen, drain it down with Hundred Diseases Toxin-Resolving Elixir.
Clinical note임상 주석
砒礵 is arsenic trioxide, the drug the Korean pharmacopoeia calls bisang, and the classic poison of the pre-modern world — cheap, tasteless in food, and sold as a rodenticide. The clinical picture given here is accurate and complete: agitation verging on delirium, violent griping abdominal pain, vertigo with vomiting, cyanosis of the face and mouth, cold extremities, death within hours. What it describes is hypovolaemic shock produced by a massive haemorrhagic gastroenteritis — arsenic strips the gut mucosa, the patient loses litres into the bowel, and the circulation fails.
The distinction between arsenic taken in food and arsenic taken in wine is a real observation dressed in the language of channels. Alcohol on an empty stomach speeds gastric emptying and absorption; a full meal delays both. The text had no way to say that, but 散歸百脉 — scattered into the hundred vessels — is what systemic absorption looks like from the outside, and the prognosis attached to it is right.
**Acute arsenic poisoning is a medical emergency, and nothing in this section treats it. The modern management is chelation — dimercaprol first, then succimer or DMPS — together with aggressive intravenous fluid resuscitation, electrolyte correction, and cardiac monitoring for QT prolongation and torsades de pointes.** Emesis inside the first hour is the only measure here with any footing, and Melon Stalk Powder is a genuine emetic; but by the time the limbs are cold the arsenic is no longer in the stomach, and purging a patient who is already losing his circulating volume into the gut makes the shock worse.
譯 2.9.1.2 Source원문
急取黑鉛四兩, 磨水一椀, 灌服卽解.
Translation영역
Quickly take 4 nyang of black lead, grind it in water to make 1 bowl, and pour it in to drink; it resolves at once.
Clinical note임상 주석
**This is lead given as the antidote to arsenic. Lead has no antidotal action against arsenic whatever, and it is itself a cumulative neurotoxin with no safe level of intake; in a child it costs cognitive development permanently. This must not be prepared.** Four nyang is a very large quantity of metal to grind into a bowl of water, and metallic lead is poorly absorbed, which is the only reason the draught did not reliably add a second poisoning to the first.
The grain of sense buried in it is the bowl of liquid. An arsenic-poisoned patient is dying of fluid loss, and anything drinkable helps a little; what he actually needs is intravenous crystalloid in volume, and the chelator that follows it.
譯 2.9.1.3 Source원문
如無黑鉛, 急取靑藍汁一椀灌服.
Translation영역
If there is no black lead, quickly take 1 bowl of blue indigo juice and pour it in to drink.
譯 2.9.1.4 Source원문
或香油一二升灌服. 又取地漿三椀, 和鉛粉頻灌服. 旋刺猪ㆍ狗ㆍ羊ㆍ雞ㆍ鴨熱血飮之. 又人糞汁灌之. 《諸方》
Translation영역
Or pour in 1 to 2 seung of sesame oil to drink. Again, take 3 bowls of earth water, mix in lead powder and pour it in to drink repeatedly. Or stab a pig, a dog, a sheep, a chicken or a duck on the spot and have him drink the hot blood. Again, pour in the liquor of human faeces.
Clinical note임상 주석
Earth water is a suspension of clay settled out of water, and of everything in this section it is the nearest thing to a rational measure: an adsorbent slurry given by mouth is the distant ancestor of activated charcoal. The resemblance ends there. Clay binds arsenic poorly, charcoal binds it poorly too, and neither is the treatment.
**Lead powder (鉛粉) is basic lead carbonate, and giving it repeatedly is lead poisoning administered as a remedy. This must not be prepared.** **Hot blood drawn from an animal at the moment of slaughter and the liquor of human faeces, taken by mouth, carry bacterial and parasitic infection and have no antidotal action. These must not be prepared.** Forcing a litre or two of oil into a patient who is vomiting is an aspiration risk as well.
譯 2.9.1.5 Source원문
又白扁豆ㆍ靑黛ㆍ甘草 各一錢, 巴豆(去殼)一箇一云半箇, 爲末. 砂糖大一塊水化, 調一盞飮之, 毒隨利下. 《得效》
Translation영역
Again: white hyacinth bean, natural indigo and licorice, 1 don each, and one croton seed with the husk removedone text says half a seed, powdered together. Dissolve a large lump of sugar in water, stir in 1 jan of the powder and have him drink it; the poison follows the purge down.
Clinical note임상 주석
毒隨利下 — the poison goes out with the stool — is the theory of the whole purgative half of this chapter, and in arsenic poisoning it is precisely the wrong move. The patient is already purging himself to death: arsenic causes a cholera-like outpouring into the bowel, and what kills in the first day is the loss of volume, not the retention of poison.
**Croton seed is a drastic irritant cathartic, so violent that half a husked seed is given here as a dose, and it adds fluid loss to a patient who has none to spare. It must not be prepared.** The care of the diarrhoea in arsenic poisoning runs the other way: replace the fluid and the electrolytes, chelate the metal, and watch the heart.
譯 2.9.1.6 Source원문
又臘月猪膽, 水和服之立解. 《種杏》
Translation영역
Again, mix a pig's gall taken in the twelfth month with water and give it; it resolves at once.
Clinical note임상 주석
Pig gall is bile salts and bile pigment. It is a mild irritant laxative and emetic in quantity, it has no action on arsenic, and raw animal bile taken by mouth is an infection risk. The twelfth-month collection date is a pharmacy convention about when the drug was gathered, not a statement about potency.
譯 2.9.1.7 Source원문
又稻稈灰和水淋, 取汁冷服一椀, 毒隨利下. 《醫鑑》
Translation영역
Again, mix rice-straw ash with water and strain it; take the liquid and give 1 bowl of it cold, and the poison follows the purge down.
Clinical note임상 주석
Ash leached with water yields a solution of potassium and sodium carbonate — lye. **A bowl of straw-ash lye is a caustic alkali and will burn the mouth, throat and oesophagus of a patient whose gut lining arsenic has already stripped; alkaline corrosive injury is worse than acid in the oesophagus, and it is one of the few injuries in this chapter that could kill by itself. This must not be prepared.**
譯 2.9.1.8 Source원문
又冷水硏菉豆, 取汁飮而解之. 《本草》
Translation영역
Again, grind mung beans in cold water, take the juice and have him drink it; this resolves it.
Clinical note임상 주석
Mung bean juice is the chapter's universal antidote and appears in nearly every section of it. It is a harmless food drink with no demonstrated action against arsenic or against any other poison named here; what it supplies is water, a little salt and a little sugar, which in a dehydrated patient is not nothing. Given as the treatment for arsenic poisoning it is a way of losing hours.
譯 2.9.1.9 Source원문
又藍根ㆍ砂糖擂爛, 和水服. 《綱目》
Translation영역
Again, grind indigo root and sugar to a pulp, mix with water and give it.
2.9.2 Mushroom Poisoning 菌蕈毒
譯 2.9.2.1 Source원문
山中有毒菌, 人煮食無不死. 地生者爲菌, 木生者爲檽, 江東人呼爲蕈.
Translation영역
In the mountains there are poisonous fungi, and of those who boil and eat them there is none who does not die. Those that grow from the ground are called gyun 菌, those that grow on wood are called nu 檽, and the people of Gangdong call them sim 蕈.
Clinical note임상 주석
The nomenclature is botanical geography, not toxicology — ground-growing against wood-growing tells you nothing about whether a mushroom will kill, since the deadliest genus, *Amanita*, grows from the ground and the deadly *Galerina* grows on wood. But 人煮食無不死, boiled and eaten and none survives, records something important and correct: **cooking does not detoxify a deadly mushroom.** Amatoxins are heat-stable cyclic peptides; boiling, drying, salting and frying leave them intact, and that single fact defeats most of the folk reasoning about mushrooms.
譯 2.9.2.2 Source원문
夜中光者, 煮不熟者, 煮訖照人無影者, 欲爛無蟲者, 皆有毒, 不可食.
Translation영역
Those that shine at night, those that will not cook through, those that cast no shadow of a man when held to the light after boiling, and those that rot without worms in them — all of these have poison and must not be eaten.
Clinical note임상 주석
**None of these four tests distinguishes a lethal mushroom from an edible one, and relying on any of them is how people die.** The first has a thread of truth: bioluminescence does mark *Omphalotus* species, which are toxic, though far from the worst. The fourth is the most dangerous, because it is the most widely believed — insects and slugs eat death caps readily, and "the worms won't touch it" has killed foragers in every century. The third is pure sympathetic reasoning.
Mushroom identification is by species, by an expert, on the whole fruiting body including the base of the stem, and no kitchen test substitutes for it. The one rule that holds is that an unidentified wild mushroom is not eaten.
譯 2.9.2.3 Source원문
冬春則無毒, 秋夏有毒者, 因蛇蟲毒氣熏蒸所致也.
Translation영역
In winter and spring they have no poison; those that have poison in autumn and summer get it because the toxic vapours of snakes and insects have steamed and fumed upon them.
Clinical note임상 주석
The seasonal pattern is a genuine observation with an invented mechanism. Amatoxin-bearing *Amanita* species fruit in late summer and autumn, so poisonings cluster exactly where the text puts them, and a winter forager meets far fewer of them. But the toxin is the fungus's own synthesis; nothing is deposited on it by snakes or insects, and a mushroom gathered in spring can be just as lethal if it is the wrong species.
譯 2.9.2.4 Source원문
人中其毒, 地漿飮之. 又人糞汁飮之. 又馬藺根葉擣取汁服之. 又人頭垢和水服, 以吐爲度. 又六畜及鵝鴨之屬, 刺取熱血飮之. 又油煎甘草冷飮, 只多飮香油亦好. 《本草》
Translation영역
When a man is struck by this poison, give him earth water to drink. Again, give him the liquor of human faeces to drink. Again, pound iris root and leaf, take the juice and give it. Again, mix scurf from a person's head with water and give it, taking vomiting as the measure. Again, from the six domestic animals and the goose and duck kind, stab and draw hot blood and have him drink it. Again, fry licorice in oil and give it cold; or simply drinking a quantity of sesame oil is also good.
Clinical note임상 주석
以吐爲度 — vomiting as the endpoint — is the one measure in the section with any footing, and it has a window. Emptying the stomach can matter within the first hour of eating a suspect mushroom, before absorption; by the time symptoms declare themselves it is useless, and in amatoxin poisoning symptoms do not begin for six to twelve hours. That latency is the central fact about this poisoning and the reason it kills: the patient vomits violently through the night, feels better the next day, and is already in liver failure.
**The lethal species — *Amanita phalloides*, *A. verna*, *A. virosa*, and the amatoxin-bearing *Galerina* and *Lepiota* — give six to twenty-four hours of nothing, then violent gastroenteritis, then an apparent recovery of a day or two, then fulminant hepatic failure. An early recovery means nothing at all.** Modern care is supportive and time-critical: fluids, repeated activated charcoal, intravenous silibinin, N-acetylcysteine, and transfer to a liver unit, with transplantation for those who progress.
**Scurf from a person's head and the liquor of human faeces taken by mouth, and blood drunk hot from a freshly stabbed animal, are infection hazards with no antidotal action. These must not be prepared.**
譯 2.9.2.5 Source원문
中蕈毒吐下不止, 細菜芽卽雀舌茶爲末, 新汲水調服神效. 又荷葉擣爛, 和水服. 《綱目》
Translation영역
Where a man struck by mushroom poison vomits and purges without stopping: powder fine leaf shootsthat is, sparrow-tongue tea, stir the powder into newly drawn water and give it — divinely effective. Again, pound lotus leaf to a pulp, mix with water and give it.
Clinical note임상 주석
吐下不止 is the phase of amatoxin poisoning that comes six to twelve hours after the meal, and it is what kills first — a cholera-like loss of fluid that produces shock and pre-renal failure before the liver has finished dying. The need is volume: oral rehydration if it can be kept down, intravenous crystalloid if it cannot, with potassium and glucose replaced and the liver enzymes and coagulation watched.
A draught of tea powder and lotus leaf in cold water cannot stop it, and 神效 is the wrong confidence to bring to this hour. What the draught does contribute, by accident, is fluid.
譯 2.9.2.6 Translation영역
Boil the head of a dried fish, drink the liquid, and he recovers at once.
譯 2.9.2.7 Source원문
楓樹菌食之, 令人笑不止而死. 飮地漿最妙, 人糞汁次之, 餘藥不能救. 《本草》
Translation영역
The fungus of the maple tree, if eaten, makes a man laugh without stopping until he dies. Drinking earth water is best for it, the liquor of human faeces next; the other drugs cannot rescue him.
Clinical note임상 주석
Uncontrollable laughter after eating a wood-growing mushroom is a recognizable syndrome. *Gymnopilus junonius* and the psilocybin-bearing species growing on stumps and fallen timber produce euphoria, hallucination and helpless laughing — the 笑菌 of the Chinese and Japanese literature, the laughing mushroom — and that intoxication, frightening as it is, is rarely fatal in itself. The danger is injury during it and, in a frail patient, agitation and hyperthermia; the management is a quiet room, reassurance, fluids, and benzodiazepines if agitation threatens.
The deaths the passage reports more likely belong to the lethal wood-growing species that look like these and were eaten alongside them — *Galerina marginata* carries the same amatoxins as the death cap and grows on exactly the same rotting wood. That is the real hazard of this entry: the laughing mushroom and the liver-destroying mushroom share a habitat. **Earth water and faeces liquor cannot treat either, and the second must not be prepared.**
2.9.3 Pufferfish Poisoning 河㹠毒
譯 2.9.3.1 Source원문
諸魚中, 河㹠最毒, 其卵尤毒, 人中其毒必死. 急取蘆葦根擣取汁飮之.
Translation영역
Among all the fishes the pufferfish is the most poisonous, and its eggs are more poisonous still. A man struck by this poison must die. Quickly take reed rhizome, pound it, take the juice and give it to drink.
Clinical note임상 주석
河㹠 is the pufferfish, and its poison is tetrodotoxin — not a fish product at all but a bacterial toxin the fish concentrates, held above all in the liver, the ovaries and roe, the skin and the intestine. 其卵尤毒, the eggs are more poisonous still, is exactly right and is the reason the roe is the part that kills: a gram of ovary can carry a lethal dose. Tetrodotoxin blocks voltage-gated sodium channels, so the sequence is numbness and tingling of the lips and tongue within minutes to hours, then ascending weakness, then paralysis of the respiratory muscles — with the patient awake and aware throughout, because the toxin does not cross into the brain.
**There is no antidote to tetrodotoxin and there never has been. The treatment is airway protection and mechanical ventilation until the toxin is cleared, usually within twenty-four hours, after which recovery is complete and without sequelae.** The section's own prognosis, 人中其毒必死 — he must die — is the accurate part of the text, and it was accurate for a reason: the patient dies of asphyxia with a working heart, and the only thing that saves him is breathing for him. Reed rhizome juice cannot work; nothing swallowed can.
譯 2.9.3.2 Source원문
或人糞汁, 或香油多灌, 吐出卽愈. 又白礬末, 白湯調下. 又白扁豆末, 和水服. 又羊蹄葉擣取汁飮之. 《本草》
Translation영역
Or pour in a quantity of the liquor of human faeces, or of sesame oil, and when he has vomited it out he recovers. Again, stir alum powder into hot water and send it down. Again, mix white hyacinth bean powder with water and give it. Again, pound rumex leaf, take the juice and give it.
Clinical note임상 주석
Emesis inside the first hour is defensible in principle — some of the fish may still be in the stomach — but in this particular poisoning it is actively dangerous, and the reason is the mechanism. Tetrodotoxin paralyses the bulbar muscles early: the patient cannot swallow or protect his airway while remaining fully conscious. **Pouring faeces liquor, oil or alum solution into such a patient and provoking vomiting is near-certain aspiration, and aspiration is what converts a survivable poisoning into a fatal one. Nothing should be given by mouth; these must not be prepared.**
What this patient needs is to be got to a ventilator before his breathing fails — oxygen, assisted ventilation, bag-valve-mask or intubation, and monitoring for the bradycardia and hypotension that accompany severe cases. Alum, hyacinth bean and rumex have no action on the toxin.
2.9.4 Sichuan Pepper Poisoning 川椒毒
譯 2.9.4.1 Source원문
人誤食椒, 戟人咽喉, 氣閉欲絶, 喫大棗三枚解之.
Translation영역
When a man eats Sichuan pepper by mistake it pricks his throat, the breath closes and he seems about to expire; have him chew three jujubes and it resolves.
Clinical note임상 주석
Sichuan pepper is *Zanthoxylum*, and what it does to the throat is a sensory trick rather than a poisoning. Hydroxy-alpha-sanshool acts on the touch and tingle receptors directly, producing the buzzing numbness the pepper is prized for; a mouthful of it feels like the throat closing without the airway narrowing at all, and the sensation passes. Three jujubes chewed are a sweet demulcent, and they would genuinely help — sugar and saliva dilute and displace the compound.
The distinction worth holding is between this and a real airway emergency. **Breathing that is actually obstructed — stridor, drooling, an inability to speak, a swelling lip or tongue, hives — is anaphylaxis or a lodged foreign body, and it needs adrenaline or the Heimlich manoeuvre and an ambulance, not jujubes.** A whole peppercorn inhaled by a child is the one way this entry's complaint becomes lethal.
譯 2.9.4.2 Source원문
川椒閉口者有毒, 人誤呑之, 便氣欲絶, 或下白沫, 身體冷痺, 宜急治之. 飮井水一二升便差.
Translation영역
Sichuan pepper whose mouth is closed has poison in it; if a man swallows it by mistake, his breath at once seems about to expire, or white froth comes down, and his body goes cold and numb. It should be treated quickly: have him drink 1 to 2 seung of well water and he recovers.
Clinical note임상 주석
閉口者 — the fruit that has not split open — is a selection rule found across the old materia medica, and the pharmacies discarded such fruits as 椒目. There is no modern evidence that unopened *Zanthoxylum* fruits are more toxic; the rule probably sorted unripe or mouldy fruit from sound, which is not a bad proxy.
Sichuan pepper is not a significant systemic poison. A very large ingestion gives vomiting, abdominal pain, diarrhoea and widespread paraesthesia — which is close enough to 身體冷痺, the body cold and numb — and it settles with time and fluid. A seung or two of water does no harm and may dilute the irritant. The froth and the sense of closing breath are the parts to take seriously only if they persist, because they also belong to aspiration.
譯 2.9.4.3 Source원문
又桂皮煎湯飮之. 又地漿飮之. 又濃煎黑豆汁飮之. 又人尿飮之. 《本草》
Translation영역
Again, boil cinnamon bark into a decoction and give it. Again, give earth water. Again, boil black soybean down into a thick liquid and give it. Again, give human urine.
Clinical note임상 주석
Cinnamon decoction, earth water and black soybean broth are warm fluids and no more; for a self-limiting irritant exposure that is adequate treatment, which is why the section reads as successful. **Human urine taken by mouth has no therapeutic action and carries infection risk. This must not be prepared.**
2.9.5 Apricot Kernel Poisoning 杏仁毒
譯 2.9.5.1 Source원문
杏子雙仁者有毒, 人誤食必死. 若中其毒, 藍葉汁飮之. 又藍實水硏取汁飮之. 又地漿飮二三椀. 又香油多灌之妙. 《本草》
Translation영역
Apricots with twin kernels have poison in them, and a man who eats one by mistake must die. If he is struck by that poison, give him indigo leaf juice to drink. Again, grind indigo seed in water, take the juice and give it. Again, give 2 or 3 bowls of earth water. Again, pouring in a quantity of sesame oil is excellent.
Clinical note임상 주석
The twin-kernel rule is folklore, but the chapter is right that the kernel kills, and this is one of the few sections in it where the poison has a name and a real antidote. Apricot kernel contains amygdalin, a cyanogenic glycoside; the kernel's own beta-glucosidase and the bacteria of the gut split it and release hydrogen cyanide. A bitter kernel carries roughly one to four milligrams of releasable cyanide, so a few dozen can kill an adult and a handful can kill a child — and chewing, which breaks the cells, makes it far worse than swallowing whole.
Cyanide binds cytochrome c oxidase and stops oxidative phosphorylation: headache, nausea and dizziness first, then rapid deep breathing, confusion, seizures, bradycardia and collapse, with a severe lactic acidosis and venous blood that stays bright because the tissues cannot extract the oxygen in it.
**Cyanide poisoning is treatable and the treatment is time-critical: high-flow oxygen with intravenous hydroxocobalamin, or sodium nitrite followed by sodium thiosulfate where hydroxocobalamin is not available. Nothing in this passage substitutes for it, and indigo leaf, indigo seed, earth water and sesame oil have no action on cyanide whatever.** The same chemistry is sold today as laetrile or "vitamin B17" for cancer; it does not treat cancer and it has killed people who took it by mouth.
2.9.6 Chinaberry Poisoning 苦練毒
譯 2.9.6.1 Source원문
服苦練根, 瀉不止, 飮冷粥止之. 《本草》
Translation영역
Where chinaberry root has been taken and the purging will not stop, give cold gruel to drink and it stops.
Clinical note임상 주석
苦練根 is the root bark of chinaberry, *Melia azedarach*, and this is an iatrogenic poisoning: the drug was given as an anthelmintic for roundworm, and the section records what happens when the dose is too large. Its limonoid toosendanin is a gut irritant and a neuromuscular blocker, and overdose produces exactly what the text names — diarrhoea that will not stop — along with vomiting, abdominal pain, and in serious cases hepatic injury, hypotension, respiratory depression, convulsions and death. The fruit is the part that kills children who eat it from the tree.
Cold gruel is a bland, cooling, rehydrating food, and as a response to drug-induced diarrhoea it is sensible and harmless; it is also all the chapter has. **There is no antidote to melia poisoning. The management is fluid and electrolyte replacement with monitoring of liver function and of the airway in severe cases, and chinaberry must not be used as a vermifuge — single-dose albendazole, mebendazole and praziquantel replaced it entirely and safely.**
2.9.7 Veratrum Poisoning 藜蘆毒
譯 2.9.7.1 Source원문
人中此毒, 令吐逆不止, 葱白煎湯飮之. 又雄黃末和水服. 又香油灌之. 又溫湯飮之. 《本草》
Translation영역
When a man is struck by this poison it makes him retch and vomit without stopping. Boil scallion white into a decoction and give it. Again, mix realgar powder with water and give it. Again, pour in sesame oil. Again, give warm water to drink.
Clinical note임상 주석
藜蘆 is *Veratrum*, and the Bogam gives it deliberately elsewhere as its strongest emetic; this section is its overdose, which is the same action carried past the point of use. Veratrum alkaloids — protoveratrine, veratridine, germine — hold sodium channels open, and the clinical course has two halves. The first is the one the text sees: intractable retching and vomiting, and 吐逆不止 is the correct and characteristic sign. The second is the one that kills and the text does not mention: bradycardia and hypotension by way of the Bezold-Jarisch reflex, which can be profound and comes on while the patient is still vomiting.
**Veratrum poisoning is cardiotoxic. The treatment is atropine for the bradycardia, intravenous fluid and vasopressors for the hypotension, continuous cardiac monitoring, and antiemetics; there is no antidote.** Anyone who has taken veratrum and cannot stop vomiting needs an ECG and a blood pressure, not a decoction.
Scallion white and warm water are harmless and supply a little fluid. **Realgar is arsenic sulfide, and giving it as the remedy adds arsenic poisoning to veratrum poisoning; it must not be prepared.** Sesame oil poured into a patient vomiting uncontrollably is an aspiration hazard.
2.9.8 Croton Seed Poisoning 巴豆毒
譯 2.9.8.1 Source원문
人中毒則令大瀉, 或吐, 煩渴發熱. 急用黃連ㆍ黃栢煎湯冷服.
Translation영역
When a man is struck by this poison it makes him purge greatly, or vomit, with vexing thirst and fever. Quickly boil coptis and phellodendron into a decoction and give it cold.
Clinical note임상 주석
巴豆 is *Croton tiglium*, and like veratrum it is a drug this book prescribes on purpose — the most violent purgative in its cabinet, which is why the previous section's arsenic pill contained half a seed. Its phorbol esters are both a drastic cathartic and a potent irritant: burning of the mouth and throat, vomiting, profuse watery diarrhoea with colic and tenesmus, and on the skin and in the eye a chemical burn. 大瀉, 煩渴, 發熱 — great purging, vexing thirst, fever — is dehydration described from the outside; the thirst and the fever are the fluid loss, not an added heat.
Coptis and phellodendron given cold follow the logic of clearing toxic heat. They are harmless at this dose and do nothing for the problem, which is volume. **Croton seed has no safe therapeutic window and should never be taken; its phorbol esters are also laboratory tumour promoters, and most poisonings by it — this one included — are caused by the prescriber.**
譯 2.9.8.2 Source원문
又黑豆煮取汁飮之. 又寒水石磨水服之. 又菖蒲或葛根擣取汁飮之. 更以冷水浸手足, 忌食熱物. 《本草》
Translation영역
Again, boil black soybean, take the liquid and give it. Again, grind glauberite in water and give it. Again, pound acorus or pueraria, take the juice and give it. Further, soak the hands and feet in cold water, and forbid the eating of hot things.
Clinical note임상 주석
This is symptomatic nursing and most of it is harmless. Cold water on the hands and feet and a ban on hot food are comfort measures; glauberite ground in water is an inert mineral at this dose; pueraria is at best mildly antiemetic. The black soybean broth is the most useful thing in the passage and for a reason the text could not have known — boiled bean water is a salted, slightly sugared fluid, which is the shape of an oral rehydration solution, and replacing fluid and electrolytes is the whole treatment of a cathartic overdose.
What should be added today is the measurement: a croton-poisoned patient needs his hydration, his urine output and his potassium followed, and intravenous fluid if he cannot keep oral fluid down.
譯 2.9.8.3 Source원문
又藍根ㆍ砂糖擂爛, 和水服. 《綱目》
Translation영역
Again, grind indigo root and sugar to a pulp, mix with water and give it.
2.9.9 Poisoning by Aconite Roots 草烏川烏天雄附子毒
譯 2.9.9.1 Source원문
人中用烏天雄附子毒則心煩躁悶, 甚則頭岑岑然, 遍身皆黑必死. 煎菉豆ㆍ黑豆汁冷服之.
Translation영역
When a man is struck by the poison of the aconite roots, the heart is vexed and agitated and oppressed; in a severe case the head grows heavy and swimming, the whole body turns black, and he must die. Boil mung bean and black soybean, and give the liquid cold.
Clinical note임상 주석
The four names in the heading are one drug in four pharmacy grades: 草烏 is *Aconitum kusnezoffii* or *A. ciliare*, 川烏 the mother root of *A. carmichaelii*, 附子 its lateral daughter root, and 天雄 the long root that has grown no daughters. All of them carry aconitine and its congeners, which bind voltage-gated sodium channels in the open state. The sequence the passage describes is the real one: oppression and agitation about the heart, then the head heavy and swimming, then the mottled dusky cyanosis it calls 遍身皆黑 — and in between, which the text does not record, numbness and tingling of the mouth and limbs, vomiting, and then ventricular tachyarrhythmia and cardiogenic shock. Death comes within one to six hours. The margin is narrow: one or two milligrams of pure aconitine, or a few grams of unprocessed root.
**The same book gives this drug on purpose. 諸傷門 1.7 骨折筋斷傷 prescribes 草烏散 as an anaesthetic before a fracture is reduced, and gives it until the patient is insensible — 昏沈不省 is the stated endpoint there, and the dose is titrated to it.** 解毒門 describes what happens when that dose is a little larger. The two sections are the same substance read from either side of a therapeutic index so narrow that the anaesthetic and the poison are separated only by the hand holding the spoon, and this is the place in the book to say it plainly: aconite's usefulness and its lethality are the same property.
**Aconitine poisoning has no antidote. The management is continuous cardiac monitoring, activated charcoal if the patient presents early, magnesium and an antiarrhythmic — amiodarone or flecainide — for the ventricular arrhythmia, vasopressors for shock, and extracorporeal life support in refractory cases; mortality remains substantial even with all of it. Aconite must not be prepared or taken.** Mung bean and black soybean liquid have no action against absorbed aconitine.
譯 2.9.9.2 Source원문
又甘草ㆍ黑豆濃煎飮汁. 又防風ㆍ甘草煎湯冷飮之. 又甘草ㆍ黑豆濃煎服, 入口卽定. 又棗肉ㆍ飴糖服之幷解. 又乾薑煮汁冷飮之. 又多飮井水, 大吐瀉卽愈.
Translation영역
Again, boil licorice and black soybean down thick and drink the liquid. Again, boil saposhnikovia and licorice into a decoction and give it cold. Again, boil licorice and black soybean down thick and give it — it settles as soon as it enters the mouth. Again, jujube flesh and malt sugar taken together also resolve it. Again, boil dried ginger, take the liquid and give it cold. Again, have him drink a quantity of well water, and when he has vomited and purged greatly he recovers.
Clinical note임상 주석
The licorice-and-black-bean pair that runs through this passage is not arbitrary, and it has a real basis — in the pot rather than in the patient. Co-decoction with licorice and with dried ginger measurably lowers the diester alkaloid content of aconite root, which is why 附子 is classically boiled with 甘草 and 乾薑 in 四逆湯 and why the processing methods 炮 and 製 exist at all. The pharmacy knew how to make the drug safer to give.
But reducing alkaloid in a decoction is a different operation from reversing aconitine already absorbed in a man's bloodstream, and nothing drunk after the fact does the second. 入口卽定 — it settles as soon as it enters the mouth — is not achievable, and the confidence of that phrase is what makes this passage dangerous: it would keep a patient at home through the hour in which his rhythm fails. Drinking well water to provoke vomiting and purging is the gastric-emptying principle again, worth something only inside the first hour and only if the airway is safe.
譯 2.9.9.3 Source원문
中草烏毒則令人麻痺暈悶, 甘豆湯飮之, 生薑汁飮之. 又童尿飮之. 又黃連湯飮之. 《本草》
Translation영역
Where a man is struck by the poison of 草烏 aconite it makes him numb and paralysed, dizzy and oppressed. Give Licorice and Bean Decoction to drink, and ginger juice to drink. Again, give a boy's urine to drink. Again, give coptis decoction to drink.
Clinical note임상 주석
麻痺 — numbness and loss of feeling — is the earliest reliable sign of aconite poisoning, and this passage is the one in the section that names it. It begins at the lips and tongue, spreads to the fingers and then the whole body, and arrives before the heart declares itself. **Numbness and tingling after taking any aconite-containing preparation is a medical emergency: it means absorbed aconitine, and the ventricular arrhythmia can follow within the hour. It needs an ECG, cardiac monitoring and an emergency department, not a decoction.**
Licorice and Bean Decoction and ginger juice are the pharmacy's traditional pairing for this, and the laboratory basis for it belongs to the decoction pot rather than to the poisoned patient; coptis decoction is inert here. **A boy's urine has no therapeutic action and carries infection risk; it must not be prepared.**
2.9.10 Alum Stone Poisoning 礬石毒
譯 2.9.10.1 Source원문
礬石毒, 黑豆煎汁飮之. 《本草》
Translation영역
For alum-stone poisoning, decoct black soybean and drink the liquor.
Clinical note임상 주석
礬石 is alum — hydrated potassium aluminium sulphate, the same substance as the 白礬 the corpus uses as an astringent and a haemostatic. Swallowed in quantity it is not a systemic poison in the way arsenic or mercury is; it is a gastrointestinal irritant and, at strength, a corrosive. The picture is burning in the mouth and throat, vomiting, abdominal pain and gastritis, with mucosal erosion and fluid loss in a large dose, and aluminium accumulation only where the kidneys are already failing.
Black soybean decoction is this chapter's reflex antidote and recurs for kansui, for the mineral drugs and, with licorice, as Gamdu-tang throughout the neighbouring sections. It has no neutralising or binding action on aluminium sulphate. But as a bland, starchy, protein-rich drink given by mouth it dilutes a corrosive and coats the mucosa, and that is close to what first aid for a corrosive ingestion actually is — small volumes of water or milk, no induced vomiting, no attempt at neutralisation. This is one of the few entries in the chapter that is both harmless and pointed in the right direction.
2.9.11 Gold, Silver, Copper, Tin and Iron Poisoning 金銀銅錫鐵毒
譯 2.9.11.1 Source원문
金銀銅錫鐵毒, 人服金銀中毒, 服水銀卽出. 盖水銀能解金銀銅錫毒也.
Translation영역
Poisoning by gold, silver, copper, tin or iron. Where a man has taken gold or silver and been poisoned, give him quicksilver and it comes straight out; for quicksilver can resolve the toxins of gold, silver, copper and tin.
Clinical note임상 주석
Swallowed metal does less than the chapter supposes, and what it does is mostly mechanical. Metallic gold and silver are inert and pass through; so does a swallowed iron or tin object, and the dangers are perforation by something sharp, obstruction by something long, and — in the modern household — a button battery or a pair of magnets, either of which is a surgical emergency. What actually poisoned people was never the metal but its soluble salts: verdigris from a copper vessel causes vomiting, haemolysis and hepatic and renal injury; an iron salt gives corrosive gastritis, then shock and hepatotoxicity, and is the one metal here with a clean antidote in deferoxamine; lead in the forms this book calls 胡粉 and 黃丹 gives chronic plumbism.
The Bogam does not hold one view of these metals. 諸傷門 1.8, among the single remedies for fractures, gives 赤銅屑 — copper filings calcined and quenched in vinegar seven or nine times, ground fine and taken in warm wine — on the reasoning that it goes straight to the broken place and solders it; and the entry closes with a case, a man who fell from a horse and broke his leg, took copper in wine and recovered, and whose shin bone, when the grave was reopened more than ten years later, was found with the copper binding the fracture. That story is offered as evidence. The same book that files copper under the poisons here has a patient swallowing it deliberately there, two chapters away.
The remedy is the chapter at its most dangerous. Giving quicksilver to bring out swallowed gold is amalgamation reasoning, and the chemistry behind it is real — mercury does take up gold, silver and tin into an amalgam. It is still one toxic heavy metal given for another, and it did not routinely kill only because elemental mercury is poorly absorbed from an intact gut. Where the gut is ulcerated, or where the patient aspirates it, or where it is heated and the vapour inhaled, it is a serious exposure. See 2.9.16 for what mercury does. **Contains mercury, which is a cumulative neurotoxin and nephrotoxin with no safe dose. This must not be prepared.**
譯 2.9.11.2 Source원문
取鴨血飮之. 又白鴨屎淋取汁飮之. 又生雞卵呑之. 又黑豆汁或藍葉汁ㆍ水芹汁飮之.
Translation영역
Take duck's blood and drink it. Also pour water over white duck droppings, take the liquid and drink it. Also swallow a raw hen's egg. Also drink black soybean juice, or indigo-plant leaf juice or water dropwort juice.
Clinical note임상 주석
The raw egg is the one item with a mechanism: egg white binds heavy-metal ions, and raw egg white and milk were the standard demulcent antidote for metallic-salt ingestion in Western practice into the twentieth century, before activated charcoal and chelation displaced them. It is of no use once the metal has been absorbed.
**Raw duck blood and the lye of dried duck droppings taken internally are routes to *Salmonella*, *Campylobacter*, *Chlamydia psittaci* and avian influenza, and must not be used; a raw hen's egg carries *Salmonella*.**
譯 2.9.11.3 Translation영역
Boil ginseng and take the liquor.
譯 2.9.11.4 Translation영역
For iron poisoning, boil magnetite and drink it.
Clinical note임상 주석
Treating iron with magnetite is sympathetic reasoning — the stone that draws iron is given to draw iron out — and magnetite is itself an iron oxide, so the remedy adds iron to an iron poisoning. In the form given it is almost wholly insoluble and will do nothing either way.
Iron is the one metal in this section with a genuine antidote. Acute iron-salt overdose runs a recognised course — corrosive vomiting and diarrhoea, an apparent recovery, then metabolic acidosis, shock and hepatic necrosis — and is treated with fluid resuscitation and intravenous deferoxamine, which chelates free iron and is given on the basis of serum iron and the clinical state.
譯 2.9.11.5 Translation영역
For poisoning by tin or white lead, take apricot kernels, grind them for the juice and take it.
Clinical note임상 주석
胡粉 is white lead, basic lead carbonate, used as a cosmetic and a pigment as much as a drug, and swallowed lead is the most consequential poisoning in this section. Lead has no safe exposure: an acute load gives abdominal colic, vomiting, anaemia and encephalopathy, and chronic absorption gives anaemia with basophilic stippling, peripheral motor neuropathy, nephropathy, and in children an irreversible loss of cognitive development. Treatment is removal of the source, and chelation with succimer or calcium disodium EDTA, with dimercaprol added in encephalopathy.
Apricot kernel is itself a poison in this chapter — 2.9.5 杏仁毒 is four sections earlier — because amygdalin is hydrolysed in the gut to hydrogen cyanide. Ground kernel juice given for a lead poisoning is one poison for another, and the Bogam files the same drug as poison and antidote within two leaves. **Contains apricot kernel, which is cyanogenic, for a lead poisoning. This must not be prepared.**
譯 2.9.11.6 Source원문
金石藥毒, 取黑鉛一斤, 鍋內熔成汁, 投酒一升, 如此十數遍, 候酒至半升, 去鉛頓服之. 《本草》
Translation영역
For poisoning by the metal and mineral drugs, take 1 geun of black lead, melt it in a pan to a liquid, pour in 1 seung of wine, and do this a dozen times or more; when the wine has come down to half a seung, remove the lead and drink it off at one draught.
Clinical note임상 주석
This is the worst instruction in the batch. Molten lead quenched repeatedly in wine, reduced to half volume and drunk, is a method for making a concentrated solution of lead salts: wine is acidic, and hot lead in acid gives soluble lead acetate and lead tartrate — the *sapa* and *sugar of lead* with which the Romans sweetened wine and poisoned themselves. The preparation is deliberate and the dose is a full draught.
It is also the chapter contradicting itself at close range. 2.9.25 石藥毒 treats mineral-drug poisoning with ginseng and fat, and this clause treats the same heading with a heavy metal; 2.9.14 gives decocted black lead for sulphur. **Contains lead, for which there is no safe dose. This must not be prepared or taken under any circumstances.**
2.9.12 Blister Beetle Poisoning 斑猫芫靑毒
譯 2.9.12.1 Source원문
斑猫芫靑毒, 中此毒令人吐逆不止, 急用菉豆或黑豆或糯米, 和水硏取汁服之.
Translation영역
Blister beetle and green blister beetle poisoning. Being poisoned by these makes a man retch and vomit without ceasing; at once take mung bean, or black soybean, or glutinous rice, grind it with water, take the juice and give it.
Clinical note임상 주석
斑猫 and 芫靑 are blister beetles — *Mylabris* and *Lytta* species — and the active principle of both is **cantharidin**, a protein-phosphatase inhibitor and one of the most potent vesicants known. Taken by mouth it blisters the mouth, oesophagus and stomach, giving burning pain, haematemesis and the unremitting retching the text describes; it is then excreted by the kidney, where it causes acute tubular necrosis, haematuria and dysuria, with priapism as a classic sign. Doses of the order of 10 mg have killed, and death is from circulatory collapse and renal failure.
**There is no antidote to cantharidin.** Management is supportive — airway, aggressive fluids to protect the kidneys, analgesia, correction of electrolytes, and renal replacement if the kidneys fail. Mung bean, black soybean and glutinous rice juice are demulcents and may soothe a burned oesophagus; they do nothing to the toxin. **Contains cantharidin, a vesicant and renal toxin. This must not be prepared.**
譯 2.9.12.2 Source원문
又藍汁飮之. 又猪肪服之. 又澤蘭葉挼取汁飮. 《本草》
Translation영역
Also drink indigo juice. Also take pork fat. Also rub lycopus leaves between the hands, take the juice and drink it.
Clinical note임상 주석
Pork fat is the wrong vehicle, and not harmlessly so: cantharidin is lipid-soluble, and oils and fats were recognised in the nineteenth-century toxicologies as increasing its absorption. The same caution applies to the lard of 2.9.16.
The section's standing is settled by a cross-reference inside this book. At 諸傷門 1.13.6 犬咬毒防再發 the Bogam has the patient swallow seven blister beetles, heads, wings and feet removed, in warm wine, so that "the toxin must come out in the urine", and has him pass water into a jar and watch for a shape like a dog; if no dog appears, the dose is repeated up to seven times. The haematuria and dysuria that follow are cantharidin nephritis, and they were read as proof that the method worked. The same book that has no antidote here administers the poison deliberately there — and does it for a dog bite, where the disease at issue is rabies and nothing in either section alters its course.
2.9.13 Sal Ammoniac Poisoning 䃃砂毒
譯 2.9.13.1 Source원문
䃃砂毒, 生菉豆水硏取汁一二升飮之. 《本草》
Translation영역
For sal ammoniac poisoning, grind raw mung bean with water, take 1 or 2 seung of the juice and drink it.
Clinical note임상 주석
䃃砂 is the corpus's spelling of 硇砂, sal ammoniac — ammonium chloride, as the crude mineral, which in trade also carried arsenical and chloride impurities. The corpus uses it as a corrosive to eat away nasal polyps and flesh, and that is what it does when swallowed in bulk: nausea, vomiting and abdominal pain from local irritation, and then a systemic effect that the text could not see. Ammonium chloride is an acidifying salt; a large load produces hyperchloraemic metabolic acidosis, and the ammonium is a hazard in liver disease, where hyperammonaemia brings confusion, tremor and, at the extreme, seizures and coma.
Treatment is supportive, with attention to the acid–base state and to electrolytes — the acidosis, not the salt, is what needs correcting. One to two seung of mung bean water is a large volume of fluid, and for an irritant salt load dilution and gastric protection are not without value; nothing in it addresses the acidosis.
2.9.14 Sulphur Poisoning 硫黃毒
譯 2.9.14.1 Source원문
硫黃毒, 令人心悶, 取猪羊熱血飮之. 又宿冷猪肉及鴨肉羹, 冷食之. 又黑錫煎取汁飮之. 又生羊血飮之. 《本草》
Translation영역
Sulphur poisoning makes a man oppressed at the heart. Take the hot blood of a pig or a sheep and drink it. Also pork left overnight to grow cold, and duck-meat broth, eaten cold. Also decoct black lead, take the liquid and drink it. Also drink raw sheep's blood.
Clinical note임상 주석
Elemental sulphur is the mildest of the chapter's minerals. It is poorly absorbed, and most of what it does is confined to the gut, where colonic bacteria reduce it to hydrogen sulphide: the result is belching, flatus, abdominal pain and diarrhoea, and the epigastric distress the text calls 心悶 is a fair description. Large doses have produced hydrogen sulphide toxicity with metabolic acidosis and depressed consciousness, and sulphur heated with other minerals is a route to sulphur dioxide. What was sold as 硫黃 was also not reliably pure; the sublimed and processed sulphurs of the materia medica carried arsenic.
The remedies are humoral rather than chemical — sulphur is a hot drug, so cooling blood, cold meat and cold broth are given against it — and two of them are hazardous. **Raw or fresh-drawn blood from a pig or a sheep is a route to brucellosis, salmonellosis, *E. coli* and tapeworm infection and must not be taken; pork kept overnight unrefrigerated is a route to staphylococcal and clostridial foodborne illness.**
黑錫 is metallic lead, not tin. **Decocting lead and drinking the liquor gives an antidote more dangerous than the poisoning it treats: lead has no safe dose, and the same preparation appears at 2.9.11. It must not be prepared.**
2.9.15 Realgar Poisoning 雄黃毒
譯 2.9.15.1 Source원문
雄黃毒, 防己煎取汁飮之. 《本草》
Translation영역
For realgar poisoning, decoct stephania, take the liquor and drink it.
Clinical note임상 주석
雄黃 is realgar, arsenic sulphide — the same element as the 砒礵 of 2.9.1 in a less soluble form. The sulphide is absorbed far more poorly than arsenic trioxide, which is why realgar was tolerated in doses that white arsenic would not have survived, but it is still arsenic: it oxidises on roasting or in gastric acid to soluble arsenite, and long use accumulates, giving the skin pigmentation and keratoses, the hepatic injury and the peripheral neuropathy of chronic arsenicalism. Acute poisoning gives the arsenic picture — vomiting, rice-water diarrhoea, hypovolaemia, QT prolongation and ventricular arrhythmia, then encephalopathy. The modern treatment is resuscitation with cardiac monitoring and chelation with dimercaprol or DMSA, and nothing in this section supplies it.
The whole antidote is a decoction of 防己. **Material sold as 防己 includes *Aristolochia fangchi*, which contains aristolochic acid — a proven nephrotoxin and urothelial carcinogen responsible for an epidemic of renal failure and urinary-tract cancer. It must not be prepared.** So the section answers an arsenic poisoning with a nephrotoxin, at a moment when the kidneys are already the organ at risk.
2.9.16 Quicksilver Poisoning 水銀毒
譯 2.9.16.1 Source원문
水銀毒, 肥猪肉煮冷食之. 又猪脂服之. 《本草》
Translation영역
For quicksilver poisoning, boil fat pork and eat it cold. Also take lard.
Clinical note임상 주석
Mercury is the most consequential poison in this batch and the Bogam gives it the shortest entry. The toxicity depends entirely on the form. Elemental mercury swallowed is poorly absorbed from an intact gut and often passes through; the dangerous exposures are its vapour, which causes an acute chemical pneumonitis and then tremor, erethism and gingivostomatitis; the inorganic salts — calomel and corrosive sublimate — which are corrosive to the gut and cause acute tubular necrosis; and organic methylmercury, which crosses the blood–brain barrier and the placenta and gives the Minamata picture of ataxia, paraesthesia and constricted visual fields. Modern management is decontamination, supportive care, and chelation with DMSA or DMPS. Boiled fat pork and lard do nothing, and fat is the wrong vehicle, since it favours the absorption of lipid-soluble organic mercury.
**The same book poisons and antidotes with the same metal, and this is the place to say so.** At 諸瘡門 2.2 天疱瘡 — the Heavenly Blister Sore, which is syphilis — the Bogam's central treatment is 輕粉, calomel: given internally, smeared on the sores at 2.2.3, burned under the nose as a fumigation at 2.2.4, blown into the throat at 2.2.5, held in a lamp at 2.2.6. It then records the consequences in four further sections, and one of them, 2.2.1 取輕粉法, is an entire protocol for *drawing the calomel back out* of a patient the book has just dosed with it, with 2.2.8 禁忌法 carrying the avoidances. That section is the clearest record of iatrogenic mercurialism in the corpus, written by the physicians who caused it — and it stands two chapters away from this one, which calls mercury a poison and offers pork fat. The first clause of 2.9.11 makes mercury an antidote a second time, given to bring out swallowed gold.
**Contains mercury, a cumulative neurotoxin and nephrotoxin with no safe dose. This must not be prepared.**
2.9.17 Peking Spurge Poisoning 大戟毒
譯 2.9.17.1 Source원문
大戟毒, 中此毒令人冷泄不禁, 煎薺苨汁飮之. 又菖蒲擣取汁飮之. 《本草》
Translation영역
Peking spurge poisoning. Being poisoned by it makes a man pass a cold diarrhoea he cannot hold; decoct deodeok root and drink the juice. Also pound acorus, take the juice and drink it.
Clinical note임상 주석
大戟 is the root of *Euphorbia pekinensis*, the first of the four violent purgatives this chapter devotes a section to apiece — with 甘遂 at 2.9.20, 芫花 at 2.9.22 and 巴豆 at 2.9.8. Their active principles are diterpene esters of the ingenane and daphnane types, direct mucosal irritants that activate protein kinase C; the latex is also a severe skin and eye irritant, and splashes into the eye have caused keratitis and lasting visual loss. Swallowed, it burns the mouth and throat and then produces violent vomiting and watery diarrhoea. 冷泄不禁 — a cold diarrhoea he cannot hold — is exact.
What kills is not the toxin but the emptying: hypovolaemia, hypokalaemia, metabolic acidosis, prerenal failure and circulatory collapse. Management is fluid and electrolyte resuscitation and nothing more; there is no antidote, and no further purging. Deodeok root is this chapter's standing remedy for drug toxins, recurring at 2.9.9 and 2.9.23, and acorus is an aromatic carminative; neither acts on a diterpene ester, and neither can do harm.
**Contains Peking spurge, a violent purgative which is toxic. This must not be prepared.**
2.9.18 Fischer Euphorbia Poisoning 狼毒毒
譯 2.9.18.1 Source원문
狼毒毒, 杏仁硏水和取汁服之. 又藍葉汁飮之. 又白斂爲末, 和水服. 又占斯取汁飮. 《本草》
Translation영역
For Fischer euphorbia poisoning, grind apricot kernels, mix them with water, take the juice and give it. Also drink indigo-plant leaf juice. Also powder ampelopsis root and take it mixed with water. Also take the juice of jeomsa 占斯 and drink it.
Clinical note임상 주석
狼毒 is the root of *Euphorbia fischeriana*, with *Stellera chamaejasme* sold under the same name in some markets. Both carry diterpene esters, and the profile is that of its neighbours in this group: burning of the mouth and gullet, vomiting, bloody diarrhoea, abdominal pain, then dehydration and electrolyte loss. Applied to the skin it blisters. The management is resuscitation; there is no antidote.
The first remedy is the problem. **Apricot kernel is itself a poison in this chapter — 2.9.5 杏仁毒 — because its amygdalin is hydrolysed in the gut to hydrogen cyanide, and cyanide poisoning does have real antidotes in hydroxocobalamin and the nitrite–thiosulphate sequence.** Giving ground kernel in water to a patient already vomiting and dehydrated is giving a cyanogenic drug for a purgative, and the book files the same material as poison and antidote four leaves apart. 占斯 is an obscure *Bencao* item — the bark of a tree already unidentifiable to the Tang commentators — and cannot be sourced or verified today; the translation leaves it romanised for that reason.
**Contains a violent purgative and a cyanogenic kernel. This must not be prepared.**
2.9.19 Rhododendron Poisoning 躑躅毒
譯 2.9.19.1 Source원문
躑躅毒, 梔子煎取汁飮之. 又甘豆湯煎湯服之. 《本草》
Translation영역
For rhododendron poisoning, decoct gardenia, take the liquor and drink it. Also decoct Gamdu-tang 甘豆湯 and take the decoction.
Clinical note임상 주석
躑躅 is rhododendron — in the materia medica chiefly 羊躑躅, *Rhododendron molle*, the yellow azalea, with the Korean royal azalea *R. schlippenbachii* carried under the same name. The toxins are **grayanotoxins**, diterpenes that bind voltage-gated sodium channels in the open state and prevent inactivation. Poisoning gives salivation, vomiting, perioral paraesthesia and dizziness, then sinus bradycardia, atrioventricular block and hypotension, with seizures and respiratory depression in severe cases. It is the toxin of *mad honey*, honey made from rhododendron nectar, which still fills hospital beds in the eastern Black Sea region and in Nepal, and the patient arriving bradycardic, hypotensive and nauseated is routinely mistaken for an inferior myocardial infarction.
This matters because grayanotoxin poisoning is one of the few in the chapter with a reliably effective modern treatment, and it is not an antidote: atropine for the bradycardia, intravenous fluids for the hypotension, and cardiac monitoring, after which almost every patient is well within a day. Gardenia decoction and Gamdu-tang — black soybean, licorice and ginger — do not treat a heart block. The one point of contact is that the text, like modern practice, treats the poisoning as something to be sat out with fluids rather than purged.
2.9.20 Kansui Poisoning 甘遂毒
譯 2.9.20.1 Source원문
甘遂毒, 黑豆煎汁飮之. 《本草》
Translation영역
For kansui poisoning, decoct black soybean and drink the liquor.
Clinical note임상 주석
甘遂 is the root of *Euphorbia kansui*, the third of the violent purgatives, with the same diterpene esters and the same course as 大戟 and 芫花 — oral and gastric burning, then profuse watery diarrhoea and vomiting, then hypovolaemia, hypokalaemia and collapse. It was used classically for 水腫 and 結胸, oedema and pleural effusion, precisely because it empties a patient of fluid, and the deaths came from the emptying rather than from any specific organ toxicity.
Black soybean decoction, identical to the remedy at 2.9.10 and the base of the Gamdu-tang of the sections on either side, is fluid given by mouth. For a patient losing litres from both ends that is the right direction and the whole of the merit; what such a patient needs is measured fluid and potassium replacement, and no further purging.
**Contains kansui, a violent purgative which is toxic. This must not be prepared.**
2.9.21 Pinellia Poisoning 半夏毒
譯 2.9.21.1 Source원문
半夏毒, 生薑汁飮之. 又乾薑煮汁服. 《本草》
Translation영역
For pinellia poisoning, drink fresh ginger juice. Also boil dried ginger and take the liquor.
Clinical note임상 주석
半夏 is the tuber of *Pinellia ternata*, and this is the one section in the group whose toxicity explains a practice that is still universal. Raw pinellia carries needle-shaped calcium oxalate raphides together with an irritant lectin, and chewing or swallowing the raw tuber gives immediate, intense burning and numbness of the tongue, mouth and throat, profuse salivation and loss of speech, and in quantity swelling of the tongue and glottis. The mechanism is mechanical and inflammatory, the same as raw *Arisaema* (天南星) and the household dieffenbachia. The danger is airway obstruction; the treatment is airway assessment, cold fluids, analgesia and observation, and there is nothing to neutralise.
The antidote is ginger, and the pairing is not humoral reasoning — it is the record of an actual detoxification method. **This is why the corpus never uses raw pinellia:** the drug is processed with ginger juice, or with ginger and alum, or soaked and boiled repeatedly (薑製半夏, 法製半夏), and the processing is the control for the very toxicity this section describes. Ginger does not dissolve oxalate crystals, but prolonged soaking and boiling leach and degrade much of the irritant fraction, and the processed drug is tolerated where the raw is not.
**Contains raw pinellia, which is toxic. This must not be prepared.**
2.9.22 Genkwa Poisoning 芫花毒
譯 2.9.22.1 Source원문
芫花毒, 桂皮煮汁飮. 又甘草或防風煎汁服. 《本草》
Translation영역
For genkwa poisoning, boil cassia bark and drink the liquor. Also decoct licorice, or siler, and take the liquor.
Clinical note임상 주석
芫花 is the flower bud of *Daphne genkwa*, the fourth of the violent purgatives. Its daphnane diterpene esters are mucosal irritants and vesicants; ingestion gives burning pain, vomiting, bloody diarrhoea and colic, then dehydration and electrolyte loss, with hepatic and renal injury reported in severe cases. It was also used as an abortifacient, and a share of the historical poisonings arose that way. Management is resuscitation; there is no antidote.
Cassia bark, licorice and siler do not counteract a diterpene ester. Licorice is this chapter's reflex antidote and appears in nearly every section of the group, usually as Gamdu-tang; it is worth saying that licorice is not inert in volume. Glycyrrhizin inhibits 11β-hydroxysteroid dehydrogenase and produces an apparent mineralocorticoid excess — sodium retention, hypertension and hypokalaemia — and the patient in these sections is already potassium-depleted from the purging, which is the one situation in which a licorice load could do measurable harm.
**Contains genkwa, a violent purgative which is toxic. This must not be prepared.**
2.9.23 Henbane Poisoning 莨菪毒
譯 2.9.23.1 Source원문
莨菪毒, 人中此毒則衝心大煩悶, 眼生星火, 狂亂奔走, 見鬼拾鍼. 水硏菉豆汁飮之. 甘草ㆍ薺苨煎汁飮之. 又犀角磨水服之. 又蟹汁服之. 又甘豆湯濃煎服之. 《本草》
Translation영역
Henbane poisoning. Where a man is poisoned by it, it surges against the heart with great vexation and oppression, sparks and fire arise before the eyes, he runs about in mania and derangement, he sees ghosts and picks up needles. Grind mung bean with water and drink the juice. Decoct licorice and deodeok root and drink the liquor. Also grind rhinoceros horn in water and take it. Also take crab juice. Also decoct Gamdu-tang 甘豆湯 thick and take it.
Clinical note임상 주석
莨菪 is henbane, *Hyoscyamus niger*, whose seed the corpus calls 天仙子 and uses for toothache. Its tropane alkaloids — hyoscine, hyoscyamine and atropine — are competitive antagonists at muscarinic acetylcholine receptors, peripherally and in the brain. The syndrome is the one taught as a jingle: hot, dry, red, blind and mad — hyperthermia, dry mouth and skin, flushing, dilated unreactive pupils and blurred vision, urinary retention, tachycardia, and an agitated delirium with visual hallucinations.
**The description here is clinically exact, and it is the best piece of observation in the chapter.** 衝心大煩悶 is the tachycardia with agitation; 眼生星火 is mydriasis and cycloplegia with photophobia; 狂亂奔走 is the agitated delirium; 見鬼 is the visual hallucination that distinguishes anticholinergic delirium from most others, in which patients see and converse with people and animals that are not there. And 拾鍼 — picking up needles — is **carphologia**, the plucking at invisible objects and at the bedclothes that is characteristic enough to be used diagnostically at the bedside. A physician writing in Korea in 1613 recorded the sign in the same terms the modern texts use.
This is also one of the very few sections in the chapter with a real counterpart. Central anticholinergic toxicity is **reversed by physostigmine**, a carbamate cholinesterase inhibitor that crosses the blood–brain barrier and restores synaptic acetylcholine, ending the delirium within minutes; it is given slowly with atropine and a benzodiazepine to hand. Otherwise care is benzodiazepines for agitation — not antipsychotics, which are themselves anticholinergic — with cooling, fluids and bladder drainage. Mung bean, licorice, deodeok, crab juice and Gamdu-tang do none of this. **Rhinoceros horn is keratin with no pharmacological action; the rhinoceros is CITES Appendix I, all trade is banned, and it must not be used or sourced** — see 2.9.30, where this chapter files it among the poisons as its universal antidote.
2.9.24 Bitter Bottle Gourd Poisoning 苦瓠毒
譯 2.9.24.1 Source원문
苦瓠毒, 食苦瓠吐利不止, 飮黍穰灰汁解之. 《本草》
Translation영역
Bitter bottle gourd poisoning. Where eating bitter bottle gourd brings vomiting and diarrhoea that will not stop, drink the lye of millet-straw ash to resolve it.
Clinical note임상 주석
苦瓠 is the bitter bottle gourd, *Lagenaria siceraria*. The gourd is ordinarily a vegetable; the bitter fruits carry **cucurbitacins**, highly oxygenated triterpenes among the most bitter compounds known, and eating them produces precisely what the text records — vomiting and diarrhoea that will not stop, with cramping pain, and in severe cases haematemesis, upper gastrointestinal bleeding, hypovolaemic shock and death. This is not a historical curiosity: bitter bottle gourd juice drunk as a health tonic causes clusters of poisoning and deaths in India every year, and the national food authority's advice is the practical safeguard the text lacks — taste a little before swallowing, and discard anything bitter.
There is no antidote. Treatment is fluid and electrolyte resuscitation, antiemetics, proton-pump inhibition and endoscopy where there is bleeding. Millet-straw ash lye is a weak potash solution, that is, a dilute alkali. **Drinking an alkali into a gut already eroded and bleeding adds a caustic injury to a corrosive one and must not be done.** The only useful thing in the instruction is the fluid, and plain water supplies that without the alkali.
2.9.25 Mineral Drug Poisoning 石藥毒
譯 2.9.25.1 Source원문
石藥毒, 人服諸石藥中毒, 人參煮汁服. 又鴈肪服之. 又白鴨屎爲末, 和水服之. 《本草》
Translation영역
Mineral drug poisoning. Where a man has taken any of the mineral drugs and been poisoned, boil ginseng and take the liquor. Also take wild goose fat. Also powder white duck droppings and take it mixed with water.
Clinical note임상 주석
This is the chapter's catch-all for 金石藥, the mineral wing of the materia medica — the arsenicals, the mercurials, the lead compounds, sulphur, alum, cinnabar, sal ammoniac and magnetite that fill the ten sections before it. Its existence is an admission: these drugs poisoned patients often enough to need a general heading, and the Bogam places the general heading immediately after the particular ones rather than hiding it.
But there is no general treatment for mineral poisoning, then or now, because the metal determines the antidote and the antidotes are not interchangeable. Dimercaprol or DMSA for arsenic and inorganic mercury, succimer or calcium disodium EDTA for lead, deferoxamine for iron, penicillamine or trientine for copper — and the wrong chelator can redistribute a metal into the brain rather than remove it. A single remedy for all the mineral drugs is a category error, however reasonable it looked from inside the system.
Ginseng decoction and wild goose fat are inert here. **Dried bird droppings taken internally are a route to *Salmonella*, *Chlamydia psittaci* and *Histoplasma* and must not be used.** Note also what the neighbouring section does with the same heading: 2.9.11's last clause treats 金石藥毒 with lead melted and quenched in wine. The chapter's two answers to mineral poisoning are an inert fat and a heavy metal.
2.9.26 Mugwort Poisoning 艾毒
譯 2.9.26.1 Source원문
艾毒, 艾葉久服亦有毒, 毒發則熱氣衝上, 狂躁不能禁, 至攻眼有瘡出血者, 甘豆湯冷服之. 藍葉汁ㆍ菉豆汁飮之. 《本草》
Translation영역
Mugwort poisoning. Mugwort leaf taken over a long time also has toxin; when the toxin breaks out, hot qi surges upward and there is mania and agitation that cannot be restrained, and where it goes so far as to attack the eyes, with sores and bleeding, give Gamdu-tang 甘豆湯 cold. Drink indigo-plant leaf juice and mung bean juice.
Clinical note임상 주석
艾葉 is mugwort leaf, *Artemisia argyi* and *A. princeps* — the moxa herb, which the corpus also gives internally for cold in the womb and for bleeding. Its volatile oil contains **thujone** and camphor; thujone is a GABA-A antagonist, which is why agitation and seizures travel together in its poisoning. Large or prolonged doses give restlessness, tremor, agitation and convulsions, with gastrointestinal upset and hepatic injury, and that is a fair reading of 熱氣衝上, 狂躁不能禁. The same compound made wormwood and absinthe notorious. The eye involvement is harder to place and may be conjunctival injection and subconjunctival haemorrhage from repeated retching or from a fit, rather than a direct action.
What is worth noticing is the premise: 久服亦有毒 — taken long, it also has toxin. This is the Bogam stating plainly that a drug it recommends elsewhere poisons people with cumulative use, which is a correct statement about dose-dependent toxicity and a rare one in a materia medica.
Gamdu-tang given cold, indigo leaf juice and mung bean juice have no anticonvulsant action. A thujone seizure is treated with a benzodiazepine, with airway support and cooling, and the drug is stopped.
2.9.27 Sea Vegetable Poisoning 海菜毒
譯 2.9.27.1 Source원문
海菜毒, 凡海中菜多食損人, 令腹痛發氣, 吐白沫. 飮熱醋卽安. 凡海菜傷皆同此法. 《本草》
Translation영역
Sea vegetable poisoning. Eating much of the vegetables of the sea harms a man, bringing abdominal pain and a rising of qi, and vomiting of white froth. Drink hot vinegar and he is at once at ease. For injury from any sea vegetable the method is the same throughout.
Clinical note임상 주석
海菜 covers the sea vegetables — 海藻, 昆布, 海帶, 甘藿 and the rest — and this is the one "poison" in the group that is a staple food. The text says so: 多食損人, eating *much* of it harms a man. That is a dose complaint, not a toxin. Seaweed in bulk is a large load of soluble fibre — alginates, fucoidan, agar — with salt, which draws water into the lumen and gels; the result is colic, distension and vomiting, and swallowed dried kelp has swelled to obstruct the oesophagus and the stomach.
The real hazards of sea vegetables are two the text could not see. The first is **iodine**: kelp carries enormous and highly variable amounts, a single gram often exceeding the daily requirement many times over, and heavy loads cause both hypothyroidism and thyrotoxicosis — a live clinical problem in Korea and Japan, and one that matters in pregnancy and in anyone with thyroid disease. The second is **arsenic**: *Hizikia fusiforme*, the hijiki of Korean and Japanese tables, concentrates inorganic arsenic to levels that have led several countries to advise against eating it.
Hot vinegar is not unreasonable for a gelled fibre load. It will not dissolve alginate, but a warm acidic drink stimulates gastric emptying and relieves distension, and this is one of the few entries in the chapter that could not harm anyone.
2.9.28 Horse Toxin 馬毒
譯 2.9.28.1 Source원문
馬毒, 開剝死牛馬中毒, 遍身生紫疱俱潰, 呌痛. 急服紫金錠, 吐瀉卽愈. 《入門》
Translation영역
Horse toxin. Where a man has been poisoned in cutting open and flaying a dead ox or horse, purple blisters break out over the whole body and all of them ulcerate, and he cries out with the pain. Give Jageumjeong 紫金錠 at once; he vomits and purges and is cured.
Clinical note임상 주석
Read this section against 癰疽門 下 1.10.8 食疫死牛馬禽獸肉生疔, where the Bogam records that of those lately seen to suffer the clove-sore, all got it from eating the flesh of cattle, horses and beasts that had died of themselves, and that 十患十死 — of ten who suffer it, ten die. That is **anthrax**. *Bacillus anthracis* sporulates and survives for decades in soil, in carcasses and in hides; cutaneous anthrax is contracted exactly as this clause describes, by handling the carcass, hide, hair or wool of an animal dead of the disease, through a cut or an abrasion. The modern Korean and Chinese name, 炭疽, is literally the charcoal 疽 of this book's own vocabulary, after the black eschar. The two sections are halves of one observation filed in different chapters — 癰疽門 has the ingestion route and the mortality, 解毒門 has the contact route and the remedies — and the Bogam reaches for the same 紫金錠 in both.
Blisters over the whole body all ulcerating, with severe pain, is not localised cutaneous anthrax but a disseminated eruption, and septicaemic anthrax or one of the other carcass-handling zoonoses fits better. Untreated cutaneous anthrax kills about one in five; with ciprofloxacin or doxycycline, almost none. Inhalational and systemic disease needs combination antibiotics with an antitoxin, and both are medical emergencies.
**Jageumjeong 紫金錠, the Bogam's universal antidote, is also called 萬病解毒丹 and contains 大戟 and 續隨子 — two violent purgatives — with musk. Purging a patient with a systemic bacterial infection removes fluid he needs and treats nothing; musk is taken from the musk deer, which is CITES-listed. It must not be prepared.**
譯 2.9.28.2 Source원문
凡人體有瘡, 馬汗ㆍ馬氣ㆍ馬毛並能爲害.
Translation영역
Wherever there is a sore on a man's body, horse sweat, horse emanation and horse hair are all able to do harm.
Clinical note임상 주석
This one clause is the section's whole principle, and as epidemiology it is right: a break in the skin plus material from a horse equals disease. The text has the route without the organism.
馬氣 — the horse's qi, its breath or emanation — is the premodern name for an airborne route, and the disease that gave it substance is woolsorter's disease, inhalational anthrax from spores in hide and fleece. The other organisms of the same route deserve naming because the text cannot distinguish them: *Burkholderia mallei* (glanders, the horse disease above all others, passing to men who handle horses and producing ulcerating nodules and lymphangitis), *Streptococcus equi*, *Rhodococcus equi*, *Clostridium tetani* from a soil-contaminated puncture, and the ordinary staphylococcal and streptococcal cellulitis of any dirty wound. All of them are consistent with what this section describes, and all of them are treatable with antibiotics the book had no access to.
譯 2.9.28.3 Source원문
馬汗入人瘡, 毒氣攻作心悶欲絶, 燒粟稈灰, 濃淋作汁, 熱煮, 蘸瘡於灰汁中, 須臾白沫出盡卽差. 白沫是毒氣也.
Translation영역
Where horse sweat has got into a man's sore, the toxic qi attacks and brings on an oppression at the heart as though he would expire. Burn millet stalks to ash, pour water over them for a strong lye, boil it hot, and dip the sore in the lye; in a moment the white froth comes out to the last and he recovers. The white froth is the toxic qi.
Clinical note임상 주석
The white froth is soap. Wood and straw ash is potash, a strong alkali; poured over and concentrated it makes lye, and lye on the fats of skin and on wound exudate saponifies them and foams. The text read the foam as the toxin leaving the wound, and it is in fact the lye destroying the tissue it touches.
**A hot concentrated alkali applied to an open wound is a chemical burn, and must not be done.** The burn is full-thickness and progressive, since alkalis continue to penetrate after contact, and on an infected wound it adds necrotic tissue to the problem. What a contaminated wound needs is copious irrigation with clean water or saline, debridement, and systemic antibiotics; the only element of this instruction with any footing is the washing, and it is undone by what is in the water.
譯 2.9.28.4 Source원문
凡生馬血入人肉中, 三兩日便腫, 連心則死. 有人剝馬, 被骨傷手指, 血入肉中, 一夜卽死. 《本草》
Translation영역
Whenever the fresh blood of a horse gets into a man's flesh, in two or three days it swells, and if it reaches the heart he dies. There was a man who, flaying a horse, had his finger wounded by a bone; the blood entered the flesh and in one night he died.
Clinical note임상 주석
A case record, and a plausible one. A finger laid open on the bone of a carcass, with the animal's blood driven into the wound, is a textbook inoculation injury, and the outcome described — swelling that progresses toward the trunk over two or three days, or an overnight death — covers both courses such an injury takes: spreading necrotising infection with sepsis, and fulminant septicaemia.
連心則死, reaching the heart means death, is the chapter's idiom for what is now called sepsis, and the staging by time is sound: the infection that is still local at day one and at the shoulder by day three is the one that kills. A death within a single night from a hand wound suggests a clostridial or group A streptococcal infection rather than anthrax.
The clause carries no treatment, which is honest. Modern management of such a wound is immediate: irrigation and exploration, broad-spectrum antibiotics, tetanus prophylaxis, and surgical review of any spreading swelling within hours rather than days.
譯 2.9.28.5 Source원문
馬汗入肉, 毒氣引入如紅線, 先以鍼刺瘡口出血, 烏梅和核爛硏, 醋調塗之. 《綱目》
Translation영역
Where horse sweat has got into the flesh and the toxic qi is drawn inward like a red thread, first prick the mouth of the sore with a needle to let out blood; then grind mume plums, stones and all, to a mash, mix with vinegar and smear it on.
Clinical note임상 주석
毒氣引入如紅線 — the toxic qi drawn inward like a red thread — is **lymphangitis**, and this is the finest observation in the section. The red streak tracking from an infected wound up the limb along the lymphatic channels is described in English in the same words, a red line or streak, and in the vernacular as blood poisoning. The text's inference is correct in its own terms: the thing in the wound is travelling toward the trunk, which is why the previous clause has 連心則死.
It is also the one point in the section where modern practice would act at once. A red streak from a wound, with or without fever and tender nodes, means ascending bacterial infection — usually group A streptococcus or *Staphylococcus aureus* — and needs systemic antibiotics the same day, with the limb elevated and the wound reassessed; delay is how it becomes sepsis.
Pricking the wound to bleed it is the one mechanically defensible act here, though for a reason the text does not give: it opens and drains. **Mashed mume plum in vinegar laid on an open wound is of no antibacterial value and will not stop an ascending infection; relying on it is what makes this entry dangerous.**
譯 2.9.28.6 Translation영역
Also take the juice of purslane and drink it.
譯 2.9.28.7 Source원문
馬汗及毛入瘡腫痛, 以冷水浸瘡數易, 飮好酒立愈. 《本草》
Translation영역
Where horse sweat or hair has got into a sore with swelling and pain, steep the sore in cold water, changing the water several times, and give good wine to drink; it heals at once.
Clinical note임상 주석
This is the best-judged instruction in the section and nearly the only harmless one. Steeping a contaminated wound in clean cold water and changing the water repeatedly is irrigation, which is the first and most important step in the care of a dirty wound in any century; the water carries away the inoculum mechanically, and nothing about the method damages tissue. Cold also relieves the pain of a swollen wound.
The wine is for the patient rather than the wound, and as an analgesic and anxiolytic it is not nothing, though it clouds the assessment of a man who may be becoming septic. What this entry lacks is the second step: a wound containing animal hair needs that hair removed under direct vision, since retained hair acts as a foreign body and seeds a chronic sinus.
譯 2.9.28.8 Source원문
驢涎馬汗入瘡腫痛, 生烏頭末付瘡上, 良久黃水出立安. 又白礬(枯)ㆍ黃丹(炒) 等分, 調貼瘡上. 《本草》
Translation영역
Where a donkey's slaver or horse sweat has got into a sore with swelling and pain, apply raw aconite main root in powder on the sore; after a good while yellow water comes out and he is at ease. Also calcined alum and roasted red lead in equal parts, mixed and pasted on the sore.
Clinical note임상 주석
Both applications are hazardous, and both are laid on broken skin, which removes the barrier that usually makes a topical safe.
**Raw aconite root (烏頭) contains aconitine, which is absorbed through damaged skin and mucosa and is cardiotoxic: it holds sodium channels open and produces paraesthesia, vomiting, and ventricular arrhythmias that are refractory to ordinary treatment and often fatal. 諸傷門 1.7 uses the same drug deliberately, as the anaesthetic 草烏散 given before a fracture is set, which is how large a dose the corpus was willing to administer. It must not be prepared or applied.** The yellow exudate the text takes for the toxin leaving is wound serum from a surface that has been chemically irritated.
**黃丹 is red lead, lead tetroxide. Lead is absorbed from an open wound and has no safe dose; a lead-containing paste on an ulcerated surface, renewed over days, is a route to systemic plumbism. It must not be prepared or applied.** Calcined alum alone is an astringent and the least of the three.
譯 2.9.28.9 Source원문
馬毒瘡, 婦人月經血塗之. 又生栗及馬齒莧擣付之. 《本草》
Translation영역
For the horse-toxin sore, smear a woman's menstrual blood on it. Also pound raw chestnut and purslane and lay them on.
Clinical note임상 주석
**Menstrual blood smeared on an open wound is human blood applied to broken skin, and carries hepatitis B, hepatitis C and HIV risk along with bacterial contamination. It must not be used.** The corpus reaches for human materials — 童便, 人中白, 人屎, menstrual blood — wherever a toxin is to be countered by something equally potent in its own logic, and in a chapter on wounds this is the most hazardous of the family.
Pounded raw chestnut and purslane as a poultice are inert by comparison. Purslane recurs three times in this section and is the chapter's standing cooling application for a hot, swollen sore; it will not treat the infection, and a sore of this kind needs cleaning, debridement and systemic antibiotics rather than anything laid over the top of it.
2.9.29 Poisoning from the Flesh of Beasts 諸獸肉毒
譯 2.9.29.1 Source원문
解六畜肉毒, 犀角濃磨汁一椀, 服之. 《本草》
Translation영역
To resolve poisoning from the flesh of the six domestic animals: rhinoceros horn ground thick in water to make one bowl of the liquid; drink it.
Clinical note임상 주석
Rhinoceros horn is the chapter's standing antidote, and it recurs within a few leaves of here — at 2.9.23 for henbane, at 2.9.31 for pheasant, and on its own account at 2.9.30. **Rhinoceros horn is prohibited under CITES, which lists all five rhinoceros species on Appendix I, and the horn is keratin with no pharmacological action whatever. This cannot be prepared, and no substitute claim should be made for it.**
What this section is about is bacterial foodborne illness. 六畜肉毒, poisoning from the flesh of the six domestic animals, covers meat that was spoiled, diseased, or taken from an animal that was never properly slaughtered, and the picture the clauses describe — vomiting, purging, blood in the stool, griping pain coming on within hours of a meal — is that of salmonellosis, campylobacter, Clostridium perfringens, staphylococcal enterotoxin and their relatives. The Bogam has no means of telling them apart and so treats the whole class as a single poison with a single antidote. The treatment that matters in all of them is fluid and electrolyte replacement, which no clause in the section provides.
譯 2.9.29.2 Source원문
食馬獸六畜肉中毒, 水浸豆豉, 絞取汁數升, 服之. 《綱目》
Translation영역
For poisoning from eating the flesh of horse, beast or the six domestic animals: steep fermented soybean in water, wring out several seung of the liquid and drink it.
譯 2.9.29.3 Source원문
食自死六畜肉中毒, 黃栢末 二三錢, 水調服. 不解, 再服. 《入門》
Translation영역
For poisoning from eating the flesh of a domestic animal that died of itself: phellodendron bark powder 2 or 3 don, mixed in water and taken. If it does not resolve, take it again.
Clinical note임상 주석
食自死 — the flesh of an animal that died of itself — is the one category in this section that names a real and specific danger, because an animal found dead has died of something. The Abscesses chapter puts it at its sharpest: 癰疽 下 1.10.8 食疫死牛馬禽獸肉生疔 says that of those lately seen with the clove abscess, all of them got it from eating the flesh of cattle, horses, fowl and beasts that had died of themselves, and that 十患十死 — of ten who suffer it, ten die.
That is anthrax. Bacillus anthracis is a disease of grazing livestock; it kills them in the field, and skinning, butchering or eating the carcass transmits it to people — cutaneous anthrax through the hands, which is the clove abscess of that section, and gastrointestinal anthrax through the meat. The near-total mortality the Abscesses chapter records for the ingested form is not an exaggeration for an age without antibiotics; gastrointestinal anthrax still kills a large share of those who get it. The observation is one of the best in the book, and it was made by watching who fell ill after which meal.
Phellodendron bark powder does nothing against it, nor against the botulinum and clostridial toxins that the same carcass may carry. Anthrax is treated with ciprofloxacin or doxycycline, with antitoxin in severe disease, and the standing rule is that livestock dead of unknown cause are neither opened nor eaten.
譯 2.9.29.4 Source원문
食自死鳥獸肝中毒, 取人頭垢 一錢, 熱湯化服. 《本草》
Translation영역
For poisoning from eating the liver of a bird or beast that died of itself: take scurf from a person's head 1 don, dissolve it in hot water and take it.
Clinical note임상 주석
**人頭垢, the scurf scraped from a person's scalp, is human material taken by mouth. It must not be used.**
The liver is a reasonable thing to single out. In an animal dead of infection it carries a heavy bacterial load, and liver is also the one meat with a dose-related poisoning of its own: it concentrates vitamin A, and a large meal of the liver of a large carnivore or sea mammal causes acute hypervitaminosis A, with headache, vomiting, drowsiness and later peeling of the skin. Neither hazard is touched by anything in the clause.
譯 2.9.29.5 Source원문
食諸肉中毒, 或吐下血, 胡荽子 一升, 煮取汁, 停冷, 每服半升, 日二. 又胡葱 一升, 煮取汁, 冷服半升. 又生韭汁飮之. 又燒猪骨末, 和水服. 又犬屎燒灰, 和酒服. 《本草》
Translation영역
For poisoning from eating any kind of flesh, with vomiting or the passing of blood below: coriander seed 1 seung, boiled and the liquid taken, left to go cold; half a seung at each dose, twice a day. Also shallot 1 seung, boiled and the liquid taken, half a seung drunk cold. Also fresh Chinese chive juice, drunk. Also pig bone burnt and powdered, mixed with water and taken. Also dog dung burnt to ash, mixed with wine and taken.
Clinical note임상 주석
吐下血 — vomiting, and blood passed below — marks out the invasive enteric infections from the merely watery ones: shigella, campylobacter, invasive salmonella, and in modern terms Shiga-toxin-producing E. coli, whose source is undercooked beef. Bloody diarrhoea after a meat meal is still a reason to seek care rather than to wait, both for the fluid loss and because of the haemolytic uraemic syndrome that can follow in children.
Coriander seed, shallot and chive juice are foods and will neither help nor harm. **Burnt dog dung taken in wine is faecal material by mouth; it must not be used, and in a patient already dysenteric it can only add a second enteric infection to the first.**
譯 2.9.29.6 Source원문
凡肉盛密器, 盖之隔宿者, 名爲鬱肉. 又茅屋漏水沾濕脯, 名爲漏脯. 皆有毒害人. 黑豆濃煎汁, 飮數升. 又燒犬屎末, 和酒服. 又擣韭取汁, 服一二升. 又多飮人乳汁. 又燒人屎, 和酒服. 《本草》
Translation영역
Whenever meat is packed into a tight vessel, covered and left overnight, it is called stifled meat. And dried meat soaked by water leaking through a thatched roof is called leaked meat. Both carry poison and harm people. Black soybean decocted thick, and several seung of the liquid drunk. Also dog dung burnt and powdered, mixed with wine and taken. Also chive pounded and the juice taken, one or two seung. Also human milk drunk in quantity. Also human faeces burnt, mixed with wine and taken.
Clinical note임상 주석
These two named categories are the best part of the section, because both of them track real spoilage. 鬱肉, meat sealed in a tight covered vessel and left overnight, is exactly the anaerobic, unrefrigerated condition in which Clostridium perfringens multiplies and in which Clostridium botulinum produces toxin; home-preserved meat in a sealed container is still the classical source of botulism. 漏脯, cured meat that has been wetted, has had its one preservative removed — dried meat keeps because its water activity is too low for growth — and once damp it supports bacteria and moulds, with their toxins. The Bogam could not see the mechanism, but the two conditions it chose to name are the two that matter: an airless container, and water in a cured food.
Of the remedies, black soybean decoction and chive juice are inert. **Burnt dog dung in wine and burnt human faeces in wine are faecal material taken by mouth, and human milk is human material; none of them may be used.** Botulism, if that is what the sealed vessel produced, declares itself as a descending paralysis with double vision, drooping lids and difficulty swallowing, and it is treated with antitoxin and mechanical ventilation; the paralysis of the breathing muscles is what kills.
譯 2.9.29.7 Source원문
食牛馬肉及肝中毒, 先剉頭髮令寸長, 拌好土作溏泥二升, 合和飮之, 須臾髮皆貫所食肝出, 卽愈. 又人乳汁飮一二升, 亦立愈. 《本草》
Translation영역
For poisoning from eating the flesh or liver of cattle or horse: first chop head hair so that it is an inch long, mix it with good earth to make two seung of thin mud, blend them together and drink it. In a short while the hairs will all have threaded through the liver that was eaten and bring it out, and he recovers at once. Also human milk, one or two seung drunk, likewise cures him on the spot.
Clinical note임상 주석
The mechanism here is sympathetic rather than physiological: the hairs are imagined to thread themselves through the offending liver like stitches and draw it out whole. Hair is keratin, indigestible, and passes unchanged; swallowed in quantity it does the opposite of what is wanted and mats into a trichobezoar, which obstructs the stomach and may need endoscopic or surgical removal. **Chopped hair and earth taken by mouth, and human milk, should not be given.**
譯 2.9.29.8 Source원문
食馬肉中毒欲死, 香豉 二兩, 杏仁 三兩, 和蒸一炊久, 熟杵服, 日二. 又蘆根煮取汁, 飮一二升. 又多飮淸酒卽解, 濁酒卽加. 《本草》
Translation영역
For poisoning from eating horse flesh, where he is at the point of death: fragrant fermented soybean 2 nyang and apricot kernel 3 nyang, mixed and steamed for as long as it takes to cook a pot of rice; when done, pound them and take, twice a day. Also reed root boiled and the liquid taken, one or two seung drunk. Also clear wine drunk in quantity resolves it at once, while unstrained wine makes it worse.
Clinical note임상 주석
**Apricot kernel contains amygdalin, which gut bacteria and the kernel's own enzyme convert to hydrogen cyanide. Three nyang of kernels, steamed and eaten over a day, is a potentially lethal dose for an adult and far more so for a child. This must not be prepared.** The chapter is here at odds with itself: 2.9.5 杏仁毒 is a section devoted to apricot-kernel poisoning, and this clause prescribes the same kernel by the handful as the remedy for spoiled horse meat.
Cyanide blocks cytochrome oxidase, so the tissues cannot use the oxygen the blood is carrying; the onset is minutes, with headache, breathlessness, collapse and seizure. There is a real antidote — hydroxocobalamin, or sodium nitrite with sodium thiosulfate — which is why recognising the kernel matters. The distinction drawn between clear and unstrained wine is of no consequence; alcohol in a vomiting, dehydrated patient is harmful either way.
譯 2.9.29.9 Source원문
食馬肝中毒, 人頭垢和水服. 又雄鼠屎 三七枚, 硏和水服. 《本草》
Translation영역
For poisoning from eating horse liver: scurf from a person's head mixed with water and taken. Also male rat droppings 21 pieces, ground, mixed with water and taken.
Clinical note임상 주석
**Human head scurf and rat droppings taken by mouth must not be used.** Rodent droppings are a vehicle for salmonella, leptospirosis and hantavirus, so this remedy carries a specific infectious risk of its own rather than a merely theoretical one. 三七枚, three sevens, is a counted number of the kind used to make a remedy efficacious rather than to measure a dose.
譯 2.9.29.10 Source원문
食狗肉不消, 心下堅脹, 口乾發熱妄語, 煮蘆根取汁飮之. 又杏仁 一升, 去皮硏, 水三升, 煎去滓, 分三服, 利下血片爲效. 《本草》
Translation영역
Where dog flesh eaten will not digest, with hardness and distension below the heart, a dry mouth, fever and raving: boil reed root, take the liquid and drink it. Also apricot kernel 1 seung, skinned and ground, with three seung of water, decocted and the dregs removed, divided into three doses; when fragments of blood are passed below, it has taken effect.
Clinical note임상 주석
Fever, a dry mouth, delirium and a hard distended epigastrium after a meat meal is not indigestion; it is a severe bacterial gastroenteritis with dehydration, and the raving is the delirium of fever and volume loss. The patient needs fluid, and in this state purgation is the one thing that will finish him.
**One seung of apricot kernels, decocted and drunk in three doses, is a cyanide dose and a larger one than the preceding clause gives. This must not be prepared.** The sign the text takes for success — fragments of blood passed below — is the mucosal damage of the illness and of the purge, read as the poison leaving. That inversion, where the harm done by the remedy is counted as proof it worked, is worth noticing wherever it appears in this chapter.
譯 2.9.29.11 Source원문
食牛羊肉中毒, 煮甘草汁, 服一二升. 《本草》
Translation영역
For poisoning from eating beef or mutton: boil licorice, and take one or two seung of the liquid.
Clinical note임상 주석
Licorice is the chapter's general antidote — the head of 2.9 states the great rule as 甘草菉豆能解百毒, licorice and mung bean resolve the hundred poisons — and it is the one such drug with real pharmacology, though not of the kind claimed. Glycyrrhizin inhibits 11-beta-hydroxysteroid dehydrogenase and so produces a mineralocorticoid effect: taken in quantity or for long, it causes potassium loss, sodium retention, hypertension and sometimes muscle weakness or arrhythmia. One or two seung of the decoction is a large dose, and in a patient already losing potassium through vomiting and diarrhoea the direction of that effect is the wrong one.
譯 2.9.29.12 Source원문
食生肉中毒, 地漿飮之. 《本草》
Translation영역
For poisoning from eating raw flesh: drink earth broth.
Clinical note임상 주석
Earth broth is made by digging a hole, stirring yellow earth into water and taking the clear liquid off the top, and it is this chapter's universal remedy. Clay minerals do adsorb some toxins, which is why kaolin was once a standard antidiarrhoeal, so the choice is not quite arbitrary — but adsorption is a distant and far weaker relative of activated charcoal, and **earth taken by mouth also introduces soil organisms, Clostridium tetani among them; it should not be given.**
Raw flesh is the right thing to worry about. It carries salmonella and campylobacter, Toxoplasma in undercooked pork and mutton, Trichinella in pork and game, and tapeworm cysts in beef and pork. All of them are prevented by cooking, which is the measure the chapter never names.
2.9.30 Rhinoceros Horn 犀角
譯 2.9.30.1 Source원문
犀角多服, 則令人煩. 麝香 一字, 調水飮之. 《入門》
Translation영역
Rhinoceros horn, taken in quantity, makes a person vexed and oppressed. Musk 1 ja, mixed in water and drunk.
Clinical note임상 주석
This is the only head in the forty of 2.9 that names no poison. It is here because the chapter's own antidote has a dose above which it harms: rhinoceros horn is prescribed three times within a few leaves of this one — 2.9.23 for henbane, 2.9.29 for the flesh of the six domestic animals, 2.9.31 for pheasant — and the entry records what happens when too much of it is given. The tradition also used the horn as a detector, a cup or stirrer supposed to reveal poison in a drink, so the same material served as test and as remedy. Neither use has any foundation.
**Rhinoceros horn is keratin — the same protein as hair, hoof and fingernail — and it has no pharmacological action of any kind. All five rhinoceros species are listed on CITES Appendix I and international commercial trade in the horn is banned. Demand created by exactly this tradition is the principal reason the animals are endangered and are still being killed for it. It must not be obtained, prescribed or used, and no substitute claim should be made for it — buffalo horn, the usual replacement, is also keratin and equally inert.** **Musk is likewise prohibited: all musk deer species are listed on CITES Appendix I or II and trade in the gland is banned.**
As for the complaint itself, 煩 — restless oppression — after a large dose of ground keratin is most plausibly the mechanical effect of a mass of indigestible protein sitting in the stomach, if it is anything at all. The section is therefore a small piece of honest self-correction by the book: the antidote is recorded as having a ceiling, even though it never had a floor.
2.9.31 Poisoning from the Flesh of Birds 諸禽肉毒
譯 2.9.31.1 Source원문
食鵝鴨肉中毒, 糯米泔或溫酒飮之. 又秣米水硏取汁, 飮一盞. 《本草》
Translation영역
For poisoning from eating goose or duck flesh: water from washing glutinous rice, or warm wine, drunk. Also glutinous millet ground in water, the liquid taken and one jan drunk.
Clinical note임상 주석
Waterfowl are the reservoir of Campylobacter and of Salmonella, and duck and goose are both commonly served underdone because the flesh is dark and looks cooked before it is. Vomiting and diarrhoea two to five days after a poultry meal is campylobacter; within twelve hours it is more likely salmonella or a preformed staphylococcal toxin. Both are managed with fluid replacement, and antibiotics only in severe or invasive disease. Rice water and millet gruel are, at least, oral fluids with some salt and starch in them, which is the one thing in this whole group of sections that points in the right direction. **Warm wine is not: alcohol worsens the fluid loss and irritates an already inflamed gut.**
譯 2.9.31.2 Source원문
食雉肉中毒吐下, 犀角末和水服 一錢, 或以水濃磨取汁飮.
Translation영역
For poisoning from eating pheasant flesh, with vomiting and purging: rhinoceros horn powder mixed with water and taken, 1 don; or ground thick in water and the liquid taken and drunk.
Clinical note임상 주석
**Rhinoceros horn is prohibited under CITES and all five species are endangered; the horn is keratin and inert. This cannot be prepared.** See 2.9.30.
Game birds carry the same enteric organisms as domestic poultry and are more often hung for days before being drawn, so the spoilage risk is higher, not lower. Vomiting with purging is how the body empties itself of such a meal, and the useful response is to replace what is lost.
譯 2.9.31.3 Source원문
食中毒箭死鳥獸肉及野鳥肉中毒, 狸骨燒灰, 和水服. 又黑豆汁ㆍ藍汁飮之. 《本草》
Translation영역
For poisoning from eating the flesh of a bird or beast killed by a poisoned arrow, and for poisoning from the flesh of wild birds: wildcat bone burnt to ash, mixed with water and taken. Also black soybean juice and indigo juice, drunk.
Clinical note임상 주석
This clause is not about spoilage at all, and it is the sharpest observation in the section: the poison is the hunter's, not the carcass's. Hunting arrows in this region were tipped with aconite, and the alkaloid remains in the tissue around the wound after the animal is killed — so the meat poisons the eater at second hand. The chapter's own section on it is 2.9.9 草烏川烏天雄附子毒, and the same drug is given as an anaesthetic in 諸傷門 1.7 for setting broken bones.
**Aconitine opens cardiac sodium channels and kills by ventricular arrhythmia, usually within a few hours; there is no antidote.** Treatment is cardiac monitoring, antiarrhythmics and, where available, extracorporeal support until the drug clears. The one measure that would actually have helped — cutting away and discarding the flesh around the arrow wound — is not mentioned; wildcat bone ash, black soybean and indigo cannot touch it.
2.9.32 Fish Poisoning and Crab Poisoning 諸魚毒及蟹毒
譯 2.9.32.1 Source원문
食魚中毒, 飮冬瓜汁最驗. 又海獺皮煮汁飮之. 又濃煮橘皮汁飮之. 又鮫魚皮燒灰, 和水服之. 《本草》
Translation영역
For poisoning from eating fish: drinking winter melon juice is the most proven. Also otter skin boiled and the liquid drunk. Also tangerine peel boiled thick and the liquid drunk. Also shark skin burnt to ash, mixed with water and taken.
Clinical note임상 주석
食魚中毒 covers at least four illnesses that look alike at the table. The commonest by far is scombroid, which is histamine poisoning: tuna, mackerel, bonito, sardine and the other dark-fleshed oily fish are rich in free histidine, and bacteria growing on a fish that was not kept cold decarboxylate it to histamine. Cooking destroys the bacteria but not the histamine. Flushing of the face and neck, headache, palpitations, a peppery or metallic taste in the mouth, cramps and diarrhoea come on within minutes to an hour of the meal and pass off in a few hours; an antihistamine is the treatment, and the prevention is cold storage from the moment the fish is landed.
The others are ciguatera from large reef fish, which gives the characteristic reversal of hot and cold sensation and can last months; ordinary bacterial gastroenteritis from spoiled fish, including Vibrio species; and tetrodotoxin, which the chapter gives its own section at 2.9.3 and names again in the third clause below.
**Otter skin and shark skin must not be used: otters are protected under CITES — the Eurasian otter on Appendix I — and a number of shark species are CITES-listed, with the trade in their parts restricted.** Winter melon juice and tangerine peel are harmless and do nothing for any of the four.
譯 2.9.32.2 Source원문
食蟹中毒, 生藕汁ㆍ冬瓜汁ㆍ煮蒜汁飮之, 並佳. 又紫蘇葉煮汁飮之, 子汁飮之亦良. 又黑豆汁ㆍ豉汁, 並解之. 《本草》
Translation영역
For poisoning from eating crab: fresh lotus root juice, winter melon juice and the juice of boiled garlic, drunk — all are good. Also perilla leaf boiled and the liquid drunk, and the juice of the seed drunk is likewise good. Also black soybean juice and fermented soybean liquid both resolve it.
Clinical note임상 주석
Crab is one of the great food allergens, and shellfish allergy — to tropomyosin, shared across crab, shrimp and lobster — is the commonest cause of food-induced anaphylaxis in adults. A reaction within minutes of a crab meal, with hives, swelling of the lips or throat, wheeze or faintness, is an emergency and the treatment is intramuscular adrenaline; nothing taken by mouth will reach it in time. That is the most likely explanation for a sudden violent illness in one diner while the rest of the table is well, which is the pattern the term 食蟹中毒 would most often have covered.
The others are infective and toxic. Crustaceans concentrate Vibrio parahaemolyticus, which is the usual cause of diarrhoea after undercooked shellfish, and bivalves and some crabs accumulate algal-bloom toxins — saxitoxin in paralytic shellfish poisoning, domoic acid in the amnesic form, okadaic acid in the diarrhetic. These are not destroyed by cooking; paralytic shellfish poisoning begins as numbness of the lips and spreads to the breathing muscles, has no antidote, and is survived on ventilation. Perilla, lotus root and garlic are foods and will do nothing against any of it.
譯 2.9.32.3 Source원문
食鱸魚ㆍ鯸鮧魚中毒, 蘆根煮汁飮一二升, 生汁亦可.
Translation영역
For poisoning from eating perch or globefish: reed root boiled and the liquid drunk, one or two seung; the raw juice will do as well.
Clinical note임상 주석
鯸鮧魚 is an old name for the globefish, the same fish the chapter treats at 2.9.3 河㹠毒. **Pufferfish carries tetrodotoxin in its liver, ovaries, skin and gut; the toxin blocks the voltage-gated sodium channel, is not destroyed by cooking, and has no antidote at all.** Numbness begins about the lips and tongue within twenty minutes to a few hours, ascends to the limbs, and in a fatal case ends in paralysis of the breathing muscles while the patient remains conscious. Survival turns entirely on getting to mechanical ventilation and staying there until the toxin clears, which it does completely within a day or two. Reed root cannot touch it, and the time spent on it is the time that matters.
譯 2.9.32.4 Source원문
食鱔中毒, 食蟹解之. 食鱔鼈中毒, 豉 一合, 投新汲水半椀, 取濃汁頓服, 卽愈.
Translation영역
For poisoning from eating eel: eat crab and it is resolved. For poisoning from eating eel or soft-shelled turtle: fermented soybean 1 hop thrown into half a bowl of newly drawn water, the thick liquid taken and swallowed at one draught, and he recovers.
Clinical note임상 주석
Eel is one of the few cases where the old category holds up. The blood and serum of eels contain a genuine ichthyohaemotoxin, which causes vomiting, diarrhoea and cramp if the fish is eaten raw or its blood swallowed; the toxin is heat-labile, which is why eel is cooked everywhere it is eaten and never served as sashimi. Soft-shelled turtle carries salmonella, as all reptiles do, and the trade in several turtle species is now restricted.
Curing eel poisoning by eating crab belongs to the opposing-category reasoning that runs through this chapter — one aquatic food set against another — and the clause immediately above gives remedies for crab poisoning, so the two antidotes are each other's poisons. Neither direction works.
譯 2.9.32.5 Source원문
多食生膾不消, 胸膈不快, 瓜蔕散方見吐門吐之. 若日久成癥病, 大黃ㆍ朴硝ㆍ陳皮 各三錢, 水煮頓服下之. 《綱目》
Translation영역
Where much raw sliced fish has been eaten and will not digest, with discomfort in the chest and diaphragm, use Gwache-san 瓜蔕散 — the formula is given in the Vomiting chapter — to make him vomit. If days pass and it becomes a lump disease, rhubarb, mirabilite and tangerine peel 3 don each, boiled in water and swallowed at one draught, to drive it down.
Clinical note임상 주석
Epigastric pain and oppression some hours after a meal of raw fish, not settling, is the presentation of anisakiasis: the larva of Anisakis, taken in with raw marine fish, burrows into the stomach wall and causes violent pain, nausea and sometimes an allergic reaction. The diagnosis is made at endoscopy and the treatment is to pick the worm off, after which the pain stops. Freezing fish before it is served raw kills the larva, which is why this is now a rarity where that is done. The chapter's complaint — raw fish that will not digest — is a fair description of the illness, and vomiting would occasionally even have brought up a gastric larva.
This is nevertheless the one place in these sections where the method and modern practice touch: emptying the stomach soon after a bad meal is a real principle. It has been narrowed almost out of existence. Induced emesis is no longer used at all in poisoning, because of the risk of aspiration and because it empties the stomach incompletely; where decontamination is indicated it is activated charcoal within the first hour, and otherwise the treatment is the antidote and supportive care. **瓜蔕 — melon pedicle — owes its emetic force to cucurbitacins, which are violent gastrointestinal irritants and toxic in their own right, and 朴硝 is a saline purgative; forcing vomiting and purging on a patient who is already dehydrated must not be done.** A mass that has formed over days is not undigested fish, and purging it will not remove it.
譯 2.9.32.6 Source원문
又方, 取水中石子數十枚, 燒赤, 投五升水中七次, 卽熱飮之, 三五度當利出瘕.
Translation영역
Another formula: take several dozen pebbles from water, burn them red, plunge them into five seung of water seven times, and drink it hot at once; after three to five rounds the lump should pass out below.
Clinical note임상 주석
Quenching red-hot stones is a way of heating water, and little else: river pebbles are silicates and give nothing up to the water, so what the patient drinks is hot water with a trace of ash and grit. Hot fluid taken in quantity is mildly useful for a cramping abdomen and nothing more, and there is a real risk of scalding both in the making and in the drinking. The count of seven quenchings and three to five rounds is ritual rather than dose.
譯 2.9.32.7 Source원문
凡食魚肉過度, 還飮肉汁卽消, 食腦立消. 萬物腦能消身, 所以食膾飡魚頭羹也. 《本草》
Translation영역
Whenever fish or flesh has been eaten to excess, drinking the broth of that same flesh digests it at once, and eating its brain digests it on the spot. The brains of all creatures can dissolve the body, which is why with raw sliced fish one eats fish-head soup.
Clinical note임상 주석
The reasoning is of the sympathetic kind — the part dissolves the whole, so brain dissolves flesh — and it is also a piece of observed custom given a theory: fish-head soup is eaten with raw fish across the region, and the Bogam explains a table practice rather than prescribing a treatment. Brain tissue is fat, cholesterol and phospholipid, and contains no digestive enzyme; eating it adds to the load it is supposed to clear. Nor does eating more of the same thing help, which is the first clause's claim.
**Brain is the one organ meat with a hazard of a different order: it is the tissue in which prions concentrate, and eating the brain of an affected animal transmits spongiform encephalopathy — variant CJD from cattle, and kuru where human brain was eaten. Brain should not be eaten.** Fish brain carries no prion risk, but the general instruction here is to eat the brains of all creatures.
譯 2.9.32.8 Source원문
食膾不消, 飮薑汁卽消. 《本草》
Translation영역
Where raw sliced fish will not digest, drink ginger juice and it digests at once.
Clinical note임상 주석
This is among the small number of remedies in the chapter with genuine pharmacology behind it. Ginger's gingerols and shogaols accelerate gastric emptying and have a real antiemetic effect, well enough established to be used for nausea in pregnancy and after surgery. It will not kill an organism or neutralise a toxin, so it treats the symptom rather than the cause — but for the complaint as stated, a heavy raw-fish meal sitting in the stomach, ginger is a reasonable thing to reach for, and the pairing of ginger with raw fish is kept at the table for the same reason.
譯 2.9.32.9 Source원문
食魚肉不消, 成癥結, 狗糞燒存性爲末, 和酒服二錢, 日三, 癥結卽出. 《本草》
Translation영역
Where fish or flesh will not digest and forms a lump-bind: dog dung burnt with its nature preserved and powdered, mixed with wine and taken 2 don, three times a day, and the lump-bind comes out.
Clinical note임상 주석
**Dog faeces taken by mouth must not be used under any preparation.** The method is nevertheless an accidental near-miss: 燒存性, burning a substance so that its form is kept but it is charred through, produces carbon, and charcoal is the modern adsorbent of first resort in poisoning. The route to it here could hardly be worse chosen, and charring does not reliably destroy bacterial spores or parasite eggs.
A 癥結 — a fixed lump felt in the abdomen — that has formed over days or weeks is not retained food. It is more likely a tumour, an inflammatory mass or an enlarged organ, and an abdominal mass of unknown cause needs imaging, not an adsorbent.
2.9.33 Poisoning from Melons and Fruit 苽果毒
譯 2.9.33.1 Source원문
食菓中毒, 猪骨燒灰, 和水服. 又桂皮濃煎取汁飮之. 又服瓜蔕散吐之, 卽愈.
Translation영역
For poisoning from eating fruit: pig bone burnt to ash, mixed with water and taken. Also cinnamon bark decocted thick and the liquid taken and drunk. Also take Gwache-san 瓜蔕散 to make him vomit, and he recovers.
Clinical note임상 주석
What makes plant food dangerous is specific compounds, not a class called fruit poison. The gourds are the real hazard in this family: bottle gourd, and occasionally a cucumber, courgette or squash, can carry high concentrations of cucurbitacins, and toxic squash syndrome — violent vomiting, cramping and bloody diarrhoea, with collapse and deaths recorded — follows within hours. The warning sign is reliable and simple: the flesh tastes intensely bitter, and the rule is to spit it out and eat no more. The chapter has a whole section on this at 2.9.24 苦瓠毒, the bitter gourd.
The others are the cyanogenic glycosides in the kernels and stones of apricot, peach, plum, cherry and bitter almond, which 2.9.5 杏仁毒 treats; the enteric organisms carried on skins and in the water fruit is washed in, which is what most illness after a fruit meal actually is; and the simple osmotic diarrhoea of too much unripe fruit, which is not poisoning at all. None of this is visible from where the Bogam stands, so it reaches for an emetic and a warming drug.
**瓜蔕 is a cucurbitacin-bearing emetic and a gastrointestinal irritant in its own right; forced vomiting is not used today. Bone ash taken by mouth should not be given.** Cinnamon bark is harmless in this quantity, though cassia carries coumarin and is not for sustained use.
譯 2.9.33.2 Source원문
食雜苽果子過多, 腹脹氣急, 桂心爲末, 飯丸菉豆大, 以水呑下十丸. 未愈, 再服. 《本草》
Translation영역
Where too many mixed melons and fruits and their seeds have been eaten, with abdominal distension and hurried breathing: cinnamon heart powdered, made into rice pills the size of a mung bean, ten swallowed down with water. If he does not recover, take it again.
Clinical note임상 주석
This is not poisoning. A large volume of fruit delivers fermentable sugars — fructose and sorbitol in particular — to the colon, where gas production distends the abdomen; the hurried breathing is a splinted diaphragm, not a lung or heart complaint. It settles by itself. Cinnamon heart is given on the reasoning that raw fruit is cold and what it leaves behind should be met with warmth, and it has no effect on the gas; the registered formula for the same complaint stands in the Accumulations chapter at 1.13.22.
譯 2.9.33.3 Source원문
又桂心末 五錢, 麝香 一錢, 飯丸菉豆大, 白湯下十五丸, 卽效. 名曰桂香丸. 《入門》
Translation영역
Also cinnamon heart powder 5 don and musk 1 don, made into rice pills the size of a mung bean, fifteen taken down with plain hot water, and it takes effect at once. It is called Gyehyang-hwan 桂香丸.
Clinical note임상 주석
**Musk is prohibited: all musk deer species are listed on CITES Appendix I or II and trade in the gland is banned. This formula cannot be prepared as written.** The formula is registered from the Accumulations chapter, where the same two medicinals are given for fruit and gourd accumulation, so the entry here is a cross-chapter duplicate rather than a new prescription. Two aromatics against colonic gas is a harmless intervention pharmacologically and an unobtainable one legally.
譯 2.9.33.4 Source원문
食銀杏中毒, 香油多飮吐之. 又地漿ㆍ藍汁ㆍ甘草汁飮之.
Translation영역
For poisoning from eating ginkgo nuts: sesame oil drunk in quantity to make him vomit. Also earth broth, indigo juice and licorice decoction, drunk.
Clinical note임상 주석
This is a real, specific and well-characterised poisoning, and one of the few in the chapter with an exact modern counterpart. Ginkgo seed contains 4'-O-methylpyridoxine — ginkgotoxin — which antagonises vitamin B6 and so blocks the synthesis of GABA, the brain's main inhibitory transmitter. One to twelve hours after a large helping of roasted nuts there is vomiting, irritability and then convulsions, with loss of consciousness in severe cases. Children are far more susceptible than adults: a few dozen nuts can be enough, and deaths have been recorded. Any seizure in a child after a ginkgo meal should be treated as this until shown otherwise.
**The antidote is pyridoxine, vitamin B6, given intravenously, with a benzodiazepine for the seizures.** It works, and it is cheap and widely available, which makes recognising the cause the whole task. Of the measures given here, sesame oil in quantity to empty the stomach is the only one with a principle behind it, and only within the first hour; **inducing vomiting in a patient who may convulse risks aspiration and is not done today.** Earth broth, indigo and licorice cannot reach it.
譯 2.9.33.5 Source원문
治苽毒, 石首魚灸食, 或煮汁服, 自消. 《本草》
Translation영역
To treat melon poisoning: yellow croaker roasted and eaten, or boiled and the liquid taken, and it dissolves of itself.
Clinical note임상 주석
The same opposing-category logic as the fish and crab clauses at 2.9.32: a sea food is set against a garden food. 石首魚, the yellow croaker, is named for the two stones in its head, and 2.9.2 uses a dried fish head against mushroom poisoning in the same way. There is no mechanism, and if the melon was bitter — the one thing that would make it genuinely poisonous — then what is needed is fluid replacement, since cucurbitacin poisoning kills through volume loss.
譯 2.9.33.6 Source원문
食桃得病, 取桃梟燒爲末, 和水服之, 卽愈. 《本草》
Translation영역
Where eating a peach has caused illness: take a withered peach left hanging on the tree, burn it to a powder, mix with water and take it, and he recovers.
Clinical note임상 주석
桃梟 is the peach that dries on the branch and hangs there through the winter instead of falling, and the remedy is sympathetic in the plainest way: the fruit that caused the illness, in its shrivelled form, cures it. A peach that mummifies on the tree has done so because of brown rot, a fungal infection of the fruit, so what is being burnt is a fungal mummy; the ash of it is inert, which is the most that can be said. If the illness came from the stone rather than the flesh, the agent is amygdalin and the problem is cyanide — see 2.9.5 and the apricot-kernel clauses at 2.9.29.
2.9.34 Poisoning from Vegetables 菜蔬毒
譯 2.9.34.1 Source원문
食諸菜中毒, 發狂煩悶, 或吐下, 葛根濃煎汁服, 生汁尤佳. 又烏雞屎燒爲末, 和水服. 又香油多飮之. 又甘草湯飮之. 又人乳汁或小兒尿服二升, 卽愈. 《本草》
Translation영역
For poisoning from eating any kind of vegetable, with raving, oppression and restlessness, or vomiting and purging: kudzu root decocted thick and the liquid taken; the raw juice is better still. Also black chicken droppings burnt and powdered, mixed with water and taken. Also sesame oil drunk in quantity. Also licorice decoction drunk. Also human milk, or a child's urine, two seung taken, and he recovers.
Clinical note임상 주석
發狂 — raving — is the clinically useful word in this clause, because it separates two quite different illnesses. Vomiting and purging after a vegetable meal is almost always infective: leaves are grown in soil manured with animal dung, washed in whatever water was at hand, and eaten raw, and salmonella, E. coli and norovirus all travel that way. Delirium is not part of that picture at low severity, and when it appears the likeliest cause is that something inedible was gathered among the greens. An anticholinergic plant — henbane, which the chapter treats at 2.9.23 莨菪毒, or datura — gives precisely this syndrome of agitated delirium with a dry mouth, wide pupils, hot dry skin and retention of urine, and it has a real antidote in physostigmine. Water hemlock, taken for a root vegetable, gives violent seizures instead and is often fatal. Aconite roots have been mistaken for wild greens more than once.
The dose-related plant poisons of the vegetable garden are worth naming since the chapter cannot: solanine and chaconine in sprouted, green or blighted potato and in green tomato, which give gastrointestinal upset first and headache and confusion in quantity; cyanogenic glycosides in cassava, bamboo shoots and lima beans, which boiling drives off; and phytohaemagglutinin in undercooked kidney beans, which causes violent vomiting from as few as four or five raw beans. In every one of these, cooking or discarding the affected part is the whole of the prevention.
Kudzu root, sesame oil and licorice decoction are inert here or close to it. **Chicken droppings, human milk and a child's urine taken by mouth are faecal and human materials and must not be used — two seung of urine is a substantial volume of a potentially infected fluid.** A patient who is raving cannot safely be given two seung of anything to swallow.
譯 2.9.34.2 Source원문
菜蔬魚肉毒, 苦參剉 三兩, 苦酒一升, 煎服, 吐出卽愈. 《本草》
Translation영역
For poisoning from vegetables, fish or flesh: sophora root cut up, 3 nyang, with one seung of vinegar, decocted and taken; he vomits it out and recovers.
Clinical note임상 주석
**Sophora flavescens root contains matrine and oxymatrine. In small doses it is bitter and emetic, which is what is wanted here, but in quantity it is a nerve and heart poison — salivation, vomiting, unsteadiness, slowed breathing, convulsions and arrhythmia are all recorded, and three nyang is a very large dose. This must not be prepared.** The remedy is a poison given to expel a poison, and the chapter's own 2.9.38 服藥過劑 is the section that admits what happens when that goes wrong.
The underlying principle — empty the stomach soon after a bad meal — is the one this chapter shares with modern practice, and it has been narrowed to almost nothing: induced emesis is no longer used in poisoning at all, because it is incomplete and risks aspiration, and decontamination now means activated charcoal within the first hour where it is indicated at all. Vinegar adds nothing but the sourness; acid does not neutralise anything relevant in a plant or bacterial poisoning.
2.9.35 Distilled Spirit Poisoning 燒酒毒
譯 2.9.35.1 Source원문
過飮燒酒中毒, 則面靑, 口噤, 昏迷不省. 甚則腐腸穿脇, 遍身靑黑, 或吐下血, 死在須臾. 初覺便脫衣, 推身袞轉之無數, 吐之卽甦. 又以溫湯裸體浸灌, 常令溫煖, 若灌冷水卽死. 又取生苽及蔓擣取汁, 斡開口灌之不住. 又碎氷頻納口中及肛門. 又葛根擣取汁灌口中, 漸醒而愈. 《俗方》
Translation영역
When a person drinks too much distilled spirit and is poisoned by it, the face turns blue-green, the jaw clenches shut, and he sinks into a stupor and knows nothing. In severe cases the bowel rots and the flanks are pierced through, the whole body goes blue-black, there may be vomiting of blood or blood passed below, and death comes within moments. As soon as it is noticed, strip off his clothes and push the body and roll it over and over, times without number; when he vomits he revives at once. Again, with warm water bathe and douse the naked body, keeping it always warm — if cold water is poured over him he dies at once. Again, take fresh melon and its vine, pound them and take the juice, prise the mouth open and pour it in without stopping. Again, crush ice and put it repeatedly into the mouth and into the anus. Again, pound kudzu root, take the juice and pour it into the mouth; he gradually comes round and recovers.
Clinical note임상 주석
This is acute alcohol poisoning, and the section exists because the poison was new. Everywhere else the Bogam says 酒 it means fermented grain wine of perhaps five to fifteen per cent; 燒酒 is the distilled spirit that reached Korea by way of the Mongols and spread through the fifteenth and sixteenth centuries, four to ten times as strong, so that a dose which would take a bellyful of rice wine now fits in a cup. A physician who had never seen a drinker die suddenly began to, and 俗方 — the local, uncited practice — is where that new emergency was first written down.
The clinical picture is observed and accurate. Loss of consciousness, a jaw locked shut, and a face and body turning blue-black are stupor and cyanosis: ethanol depresses the brainstem, breathing slows and shallows, and the blood desaturates. Death 在須臾 is real, and the mechanism is respiratory depression and the inhaling of vomit, not the rotted bowel and pierced flanks the text supplies as explanation. The modern treatment is airway protection and observation and nothing more — lay the person on his side, keep the airway clear, give oxygen, intubate and ventilate if the gag reflex has gone, check and correct the blood sugar, and wait, because ethanol is cleared at a fixed rate and there is no antidote. Alcohol also hides head injury, hypoglycaemia and hypothermia, each of which kills the same patient independently.
Of the measures here, one is right, most are useless, and one is lethal. **Forcing vomiting in a person who is already stuporous and cannot protect his airway is how aspiration pneumonia and asphyxia happen, and it must not be done** — and the same objection applies to pouring melon juice or kudzu juice down the throat of someone 昏迷不省. Rolling the body and the ice in the mouth and rectum do nothing, and the ice contradicts the warming the same passage insists on. The warm bath, though, is correct and for the correct reason: alcohol dilates the skin vessels and a drunk left lying loses heat fast, so hypothermia is a genuine cause of death here, and the flat warning that pouring on cold water kills is a clinical observation worth keeping.
2.9.36 Bean Curd Poisoning 豆腐毒
譯 2.9.36.1 Source원문
過食豆腐, 腹脹氣塞欲死, 新汲水多飮卽安, 若飮酒卽死. 《俗方》
Translation영역
When one eats too much bean curd, the belly distends and the qi is blocked so that one is at the point of death. Drink plenty of freshly drawn water and it settles at once. If wine is drunk, death follows at once.
Clinical note임상 주석
Bean curd is not poisonous, and the chapter is mistaken in listing it among the poisons. Two ordinary things lie behind the complaint. The first is simple gas: soybean carries the oligosaccharides raffinose and stachyose, which the human small intestine has no enzyme for, so they pass to the colon and are fermented there, and a large helping produces exactly the distended, blocked, frightening belly described. The second is spoilage, and bean curd is one of the most perishable foods in a kitchen without refrigeration — moist, near-neutral in pH, almost pure protein, and left in a warm room it supports Bacillus cereus, Staphylococcus aureus and the coliforms within hours. Acute illness after a plate of it is bacterial foodborne illness or a preformed toxin, not a property of the curd.
Drinking a lot of cold water will do nothing for either, though it will do no harm. The claim that wine kills is simply wrong; there is no interaction between ethanol and soy protein, and the sentence is the kind of absolute prohibition that attaches itself to a food once the food has been named a poison.
譯 2.9.36.2 Source원문
中豆腐毒, 令人生瘡, 噫氣, 遺精, 白濁. 蘿葍煎湯飮之. 又杏仁水硏取汁飮之. 《入門》
Translation영역
Poisoning by bean curd makes a person break out in sores, belch, suffer seminal emission and pass white turbid urine. Decoct radish and drink it. Again, grind apricot kernel in water, take the juice and drink that.
Clinical note임상 주석
The second passage is not describing food poisoning at all. Sores, belching, involuntary seminal emission and turbid white urine are the complaints the tradition files under damp-heat in the lower burner, and they have been attached here because bean curd was classed as a cooling, damp food; the reasoning runs from the category to the symptom list, not from any patient. Nothing in that group follows a meal.
Radish decoction is harmless and is the tradition's standard digestive, which makes it the one sensible item in the section. The apricot kernel is another matter. **Apricot kernel contains amygdalin, which releases hydrogen cyanide on digestion; it is the very substance 2.9.5 杏仁毒 treats as a poison a few pages earlier in this same chapter, and it must not be prepared.** A formulary that carries a section on apricot-kernel poisoning and then prescribes apricot kernel as the antidote to a food that is not poisonous is at odds with itself, and this is the clearest instance of it in the 解毒門.
2.9.37 Wheat Flour Poisoning 麪毒
譯 2.9.37.1 Source원문
人食熱麪, 多中毒. 蘿葍擣取汁飮之, 無生者, 則取子水硏取汁飮之. 又地骨皮煮取汁飮之. 又赤小豆末和水服, 卽愈. 《本草》
Translation영역
People who eat hot wheat noodles are often poisoned by them. Pound radish, take the juice and drink it; if there is none fresh, then take the seed, grind it in water, take the juice and drink that. Again, boil lycium root bark, take the liquor and drink it. Again, mix powdered adzuki bean with water and take it; it heals at once.
Clinical note임상 주석
麪 is wheat flour and the noodles made from it, and 熱麪 is a bowl of them freshly boiled. Sound wheat flour is not toxic and the heat of the noodles has nothing to do with anything, so the section is wrong as stated — but two real things could produce the observation it records.
The first is the grain itself. Wheat and rye stored damp carry Claviceps purpurea, whose ergot alkaloids cause the burning extremities, vasoconstrictive gangrene and convulsive delirium of ergotism, and Aspergillus and Fusarium growing on stored grain produce aflatoxins and trichothecenes that cause vomiting and gastrointestinal illness. Flour from a bad harvest or a damp granary genuinely poisons people, in numbers, and the mediaeval European outbreaks are the proof of it. The second, and the likelier cause of one person falling ill after one bowl, is coeliac disease or non-coeliac wheat sensitivity — an immune reaction to gluten that produces bloating, cramping pain and diarrhoea after wheat and after nothing else, so that to the sufferer and to his physician the flour looks exactly like a poison that happens to be selective.
None of the four remedies touches either. Radish, radish seed and adzuki are harmless, and radish is again the tradition's digestive; lycium root bark is a cooling drug with no bearing on the case. A mould toxin is dealt with by not eating the grain, and coeliac disease by lifelong exclusion of wheat, barley and rye — the first measure the section could have given and the one it does not reach.
2.9.38 Overdose of Medicine, or Poisoning with Oppression Near Death 服藥過劑或中毒煩悶欲死
譯 2.9.38.1 Source원문
犀角以水濃磨取汁服. 又葛根擣取汁飮之, 或水煮取汁服之. 又靑藍汁飮之. 又生雞卵取黃呑之. 又地漿飮之. 又胡粉水和服之. 又粳米粉和水服. 又豉汁飮之. 《本草》
Translation영역
Rhinoceros horn, ground thick in water, the liquor taken. Again, pound kudzu root, take the juice and drink it, or boil it in water, take the liquor and take that. Again, drink the juice of the indigo plant. Again, take a raw hen's egg, take the yolk and swallow it. Again, drink earth-broth. Again, mix white lead with water and take it. Again, mix powdered non-glutinous rice with water and take it. Again, drink the liquor of fermented soybeans.
Clinical note임상 주석
This is the iatrogenic section — 服藥過劑, the dose of the medicine was too great — and it deserves to be read as the admission it is. Together with 諸瘡門 2.2's four records of harm from mercury, this is one of only two places where the Bogam registers its own medicine as the cause of the illness it then sets out to treat. A formulary that carries a general antidote section for its own overdoses is being honest about an everyday hazard rather than concealing it, and the hazard was real: the book's own materia medica includes aconite, arsenic trioxide, mercury, cantharides, croton seed and henbane, doses them by the don and the nyang, and in places tells the reader to push the dose until the patient vomits. Sections 2.9.1, 2.9.8, 2.9.9, 2.9.12, 2.9.16 and 2.9.23 are the single-poison entries for exactly those drugs. This section is what one reaches for when the drug is unknown, or when the patient has taken several.
The remedies cannot do the work. **胡粉 is white lead — lead carbonate — and is itself a cumulative poison; offered here as an antidote it adds a second poisoning to the first, and it must not be prepared.** **犀角, rhinoceros horn, is from a CITES Appendix I species; trade in it is banned, and the horn is keratin with no pharmacological action of any kind.** Of the rest, 地漿 — the clear water settled over yellow earth dug into a pit — is the only item with a mechanism worth noticing, because a clay suspension does adsorb some alkaloids, which is the principle activated charcoal works on, though weaker by orders of magnitude and not reliable at any dose. Egg yolk, rice flour and fermented-bean liquor are demulcents: they coat and dilute, which matters for a caustic swallowed and not at all for a poison already absorbed. Kudzu and indigo do nothing.
A suspected overdose or poisoning today is managed by telephoning a poisons centre, supporting airway, breathing and circulation, and giving activated charcoal within the first hour where the substance binds to it. There are specific antidotes for a short list of poisons — N-acetylcysteine, naloxone, atropine, physostigmine, digoxin-specific antibodies, chelators for the heavy metals — and nothing general. The universal antidote this section is reaching for does not exist, and it is worth saying that the reaching itself was the right instinct.
2.9.39 General Treatment for the Hundred Poisons 通治百物毒
譯 2.9.39.1 Source원문
人中諸物毒, 服萬病解毒丹最妙.
Translation영역
When a person is poisoned by any of the various substances, to take Manbyeong Haedok-dan is best of all.
Clinical note임상 주석
萬病解毒丹 is the alternate name 太乙紫金丹 carries at 2.1.5 — the chapter's own leaf there opens 一名紫金錠, 一名萬病解毒丹 — and the section lists it ahead of everything else as the universal remedy. Its drugs are worth recalling before accepting the recommendation: 山茨菰, 紅芽大戟, 續隨子 and 麝香, which is to say a toxic corm, a violent purgative, a second violent purgative, and musk. **紅芽大戟 and 續隨子 are drastic cathartics; 大戟 is itself the subject of 2.9.17 大戟毒 in this same chapter, and 麝香 is taken from a CITES Appendix I species. This must not be prepared.**
So the chapter's first-line universal antidote is a purgative compounded partly from substances the chapter elsewhere treats as poisons. That is not incoherence so much as the logic of the whole section made visible: a universal antidote was understood to work by emptying the patient, and the strongest emptying drugs available were the toxic ones.
譯 2.9.39.2 Source원문
又細茶ㆍ白礬, 每取三錢末, 新水調服卽效. 名礬茶散. 《丹心》
Translation영역
Again, fine tea and alum: take 3 don of each as a powder, mix it with fresh water and take it; it works at once. It is called Banda-san.
譯 2.9.39.3 Source원문
又五倍子爲末, 好酒調下三錢. 在上卽吐, 在下卽瀉. 《丹心》
Translation영역
Again, powder Chinese gall and send down 3 don mixed in good wine. If the poison is above it is vomited, if below it is purged out.
Clinical note임상 주석
The clause states the operating principle of the entire section: if the poison is still in the stomach bring it up, if it has passed on drive it down. Gastric emptying soon after ingestion is the one idea here that modern practice shares, and the sharing is partial — induced vomiting has been abandoned altogether, gastric lavage survives only for a life-threatening ingestion seen within the first hour, and activated charcoal with specific antidotes replaced both. The division of poisons into those 在上 and those 在下 is also a real distinction, roughly the distinction between a poison still recoverable and one already absorbed, and the text draws it for the right reason even though it has no way to tell which is which. Chinese gall is tannin-rich and astringent and will precipitate some alkaloids in the stomach, which is a faint echo of adsorption and nothing to rely on.
譯 2.9.39.4 Source원문
又大甘草爲極細末微炒, 量病人酒量多少, 好酒調服, 須臾大吐瀉. 雖渴不可飮水, 飮水則難救. 《丹心》
Translation영역
Again, take thick licorice, make it into an extremely fine powder and roast it lightly; judge how much wine the patient can hold, mix the powder into good wine and give it. In a short while there is violent vomiting and purging. Though he be thirsty he must not drink water; if he drinks water he will be hard to save.
Clinical note임상 주석
Two things here are actively dangerous and should be said plainly. **Withholding water from a patient who has just vomited and purged violently and is thirsty is the opposite of what he needs; thirst after fluid loss on that scale is the body asking for the one thing that will keep him alive, and dehydration with electrolyte loss is what kills after a severe purge.** The instruction is the most harmful sentence in the section. And giving spirits, in quantity gauged to what the patient can hold, to someone already poisoned adds ethanol to the problem, depresses the airway reflexes before deliberate vomiting is induced, and makes aspiration likely.
**Licorice in the doses implied here is not inert either: glycyrrhizin inhibits 11β-hydroxysteroid dehydrogenase and produces a pseudohyperaldosteronism — sodium and water retention, potassium loss, hypertension and arrhythmia — which is precisely the wrong physiology to add to a patient losing potassium through both ends.**
譯 2.9.39.5 Source원문
臘雪水解一切毒, 取飮之. 《本草》
Translation영역
Water from the snow of the twelfth month resolves every poison; take it and drink it.
譯 2.9.39.6 Source원문
又甘草ㆍ薺苨煎湯服之, 入口便活. 《本草》
Translation영역
Again, decoct licorice and deodeok root and take it; the moment it enters the mouth he lives.
譯 2.9.39.7 Source원문
解諸藥毒, 殺諸蟲毒. 靑黛ㆍ雄黃等分爲末, 新水調下二錢. 《得效》
Translation영역
To resolve the poison of all drugs and kill the poison of all worms and insects: powder natural indigo and realgar in equal parts and send 2 don down mixed with fresh water.
Clinical note임상 주석
**Realgar 雄黃 is arsenic sulphide. Giving 1 don of arsenic sulphide by mouth to a poisoned patient is poisoning him again, and this must not be prepared.** The chapter's own 2.9.15 雄黃毒 is the section for undoing what this passage does, and 2.9.1 砒礵毒 is the section for arsenic in its other form.
The reasoning is not arbitrary even so. Realgar was held to kill worms and insects, and a poison from a worm or an insect was therefore to be met with the thing that kills worms and insects — the same sympathetic figure that governs much of the materia medica for bites. Natural indigo is harmless and inert.
譯 2.9.39.8 Source원문
又蚕退紙燒灰, 新水調下一錢, 神效. 《直指》
Translation영역
Again, burn to ash the paper on which silkworms laid their eggs and send 1 don down mixed with fresh water; it works wonderfully.
譯 2.9.39.9 Source원문
又白扁豆爲末, 新水調下二三錢, 得利卽安. 《得效》
Translation영역
Again, powder white hyacinth bean and send two or three don down mixed with fresh water; once the bowels move, the patient settles.
譯 2.9.39.10 Source원문
又犀角以水濃磨取汁服, 能解百毒. 《本草》
Translation영역
Again, grind rhinoceros horn thick in water, take the liquor and take it; it can resolve the hundred poisons.
Clinical note임상 주석
**Rhinoceros horn is from a CITES Appendix I species, all trade in it is banned, and the horn is keratin — the same protein as hair and fingernail — with no pharmacological action.** It appears four times in this chapter, as the opening item of 2.9.38, as an antidote here, as a formula ingredient at 2.9.40, and as the subject of 2.9.30, where it is the one thing in the sequence of named poisons that is not a poison at all. Its reputation as the universal antidote is the oldest and most consequential error in the chapter, and it is still killing rhinoceroses.
譯 2.9.39.11 Source원문
又葛根汁, 又藍葉汁, 又人糞汁, 又地漿飮之. 《本草》
Translation영역
Again, the juice of kudzu root; again, the juice of indigo leaf; again, the liquor of human faeces; again, earth-broth — drink any of these.
Clinical note임상 주석
**The liquor of human faeces must not be prepared or swallowed. It carries the whole enteric flora — Salmonella, Shigella, pathogenic E. coli, hepatitis A and E, and the helminth ova — and giving it by mouth to a patient whose gut is already inflamed by a poison is as direct a route to severe infection as exists.**
地漿, the clear water settled over dug yellow earth, is the one item in this list with any footing, for the reason given at 2.9.38: a clay suspension adsorbs some alkaloids, which is the principle behind activated charcoal. Kudzu and indigo leaf are harmless and do nothing.
譯 2.9.39.12 Source원문
又香油多飮之, 或吐或下, 神效. 《本草》
Translation영역
Again, drink sesame oil in quantity; it either brings on vomiting or moves the bowels, and works wonderfully.
Clinical note임상 주석
A large volume of oil will indeed loosen the bowel and may provoke vomiting, so the passage is at least describing what happens. The difficulty is that it works against itself. For a fat-soluble poison — and aconitine, the pyrethrins, many plant alkaloids and most of the pesticides are fat-soluble — oil in the stomach increases absorption rather than preventing it. And oil aspirated into the lung during the vomiting the passage is counting on causes a chemical pneumonitis that is harder to treat than the poisoning. Oily cathartics were dropped from poisons practice for exactly these two reasons.
譯 2.9.39.13 Source원문
又黑豆汁飮之. 又白狗屎絞汁服, 或燒灰和水服. 《本草》
Translation영역
Again, drink the juice of black soybean. Again, wring out the juice of white dog's dung and take it, or burn it to ash, mix it with water and take it.
Clinical note임상 주석
**Dog faeces, wrung out or burned, must not be given. Fresh canine faeces carry Toxocara canis and Echinococcus ova, Campylobacter and Salmonella, and the ash is not sterile in the sense that matters, since the preparation described would not reliably reach a temperature that destroys helminth ova.** Black soybean juice is harmless and is the second drug of 甘豆湯, which the next clause names as first among antidotes.
譯 2.9.39.14 Translation영역
Gamdu-tang is first among the remedies that resolve poison.
譯 2.9.39.15 Source원문
甘豆湯 甘草ㆍ黑豆, 皆解百藥百物毒. 各取五錢, 作一貼, 水煎取汁, 溫冷任意服之, 神效. 或加竹葉, 或加薺苨, 尤效. 《本草》
Translation영역
Gamdu-tang. Licorice and black soybean both resolve the poison of the hundred drugs and the hundred substances. Take 5 don of each, make one packet, decoct in water, take the liquor and take it warm or cool as one pleases; it works wonderfully. Adding bamboo leaf, or adding deodeok root, makes it more effective still.
Clinical note임상 주석
Two drugs, bland, cheap and available in any household, named first among antidotes — this is the tradition's universal remedy, and the nearest thing the chapter has to a general measure. Something can be said for it. Glycyrrhizin and the soybean proteins and phospholipids do bind and dilute what is in the stomach, licorice is genuinely demulcent and will soothe a gut irritated by a caustic, and a warm drink taken freely rehydrates a patient who has been vomiting. None of that is an antidote to anything, and the formula has no effect whatever on a poison already absorbed.
**At 5 don a day, and taken repeatedly as a general antidote would be, licorice is a drug with a dose-limiting toxicity of its own: glycyrrhizin causes sodium retention, potassium loss, hypertension and arrhythmia, and it interacts with diuretics, digoxin and corticosteroids. It should not be taken in quantity, and least of all by someone already losing potassium.** The chapter does not notice this, which is the more striking because the passage four clauses earlier uses licorice in quantity precisely to produce violent vomiting and purging — the same drug is first among gentle antidotes here and a drastic emetic there, and neither passage mentions the other.
2.9.40 Water Poison 水毒
譯 2.9.40.1 Source원문
江南溪澗中有蟲, 名爲短狐, 亦名射工, 一名蜮. 其蟲無目利耳, 能聽在水中附人聲, 輒以口中毒射人, 故謂之射工. 又含沙射人之影, 故謂之射工. 人中其毒, 寒熱悶亂, 頭目俱痛, 亦如中尸, 卒不能語. 又有水毒蟲, 一名溪溫, 其病與射工相似, 但有瘡爲射工, 無瘡爲溪溫.
Translation영역
In the brooks and streams of Gangnam there is a creature called the short fox, also called the shooting artisan, and by another name 蜮. The creature has no eyes but keen ears, and can hear a human voice carried in the water; thereupon it shoots the poison in its mouth at the person, and for that reason it is called the shooting artisan. It also holds sand in its mouth and shoots at a person's reflection, and for that reason too it is called the shooting artisan. When a person takes its poison there is alternating cold and heat, oppression and confusion, pain in both head and eyes, and, as in corpse-strike, he is suddenly unable to speak. There is also a water-poison creature, by another name the brook-warm, and its disease resembles the shooting artisan's; but where there is a sore it is the shooting artisan, and where there is no sore it is the brook-warm.
Clinical note임상 주석
There is no such animal. What the section describes is illness caught from standing or slow fresh water in the south, attributed to a blind, sharp-eared insect that shoots poison at a person by sound or at his reflection — which is a mechanism invented to explain how someone could be struck down by water he had merely stood in without being bitten by anything he could see. The explanation is false and the observation behind it is sound: the water was the right place to look.
The symptoms are those of an acute febrile illness, and the candidates for a Jiangnan river valley are specific. Schistosomiasis fits the striking part of the account best, since Schistosoma japonicum cercariae leave freshwater snails and penetrate unbroken skin — invisible attack from within the water, which is exactly what 射工 names — and the acute phase, Katayama fever, is fever, chills, headache and malaise. Leptospirosis fits as well: it enters through skin abrasions and mucous membranes from water contaminated with rodent urine, and produces high fever, severe headache and conjunctival suffusion, which is the 頭目俱痛 of this passage. The faecal-oral enteric fevers, typhoid among them, account for the rest.
The distinction the text draws at the end is a genuine clinical sign, and better than it has any right to be. 有瘡爲射工, 無瘡爲溪溫 — with a sore it is one disease, without a sore the other — separates waterborne illness acquired through the skin, which leaves a mark at the entry point, from waterborne illness acquired by swallowing, which does not. That is the correct axis on which to divide these infections, arrived at by observation and attached to the wrong cause.
譯 2.9.40.2 Source원문
又有沙虱, 乃毒蛇鱗中蟲也. 夏月蛇爲虱所苦, 倒身江灘刷其虱, 虱入沙中. 行人中其毒, 如瘡如鍼孔粟粒, 四面有五色文, 須剜去小肉卽愈, 不然三兩日死.
Translation영역
There is also the sand louse, which is a creature living among the scales of venomous snakes. In the summer months the snake is troubled by the lice, and turns its body over on the river shoal to brush them off, and the lice go into the sand. A traveller takes their poison; it is like a sore, like a needle-hole, like a millet grain, with markings of five colours around it. One must gouge out the small piece of flesh and it heals; if not, death comes in two or three days.
Clinical note임상 주석
This one can be named. The lesion described — small as a needle-hole or a millet grain, crusted like a sore, with a ring of discoloration around it — is an eschar, and an eschar at the bite of a larval trombiculid mite, caught in summer in grass and scrub near water, is scrub typhus, caused by Orientia tsutsugamushi. The mite is the chigger, the 恙蟲 of the later Chinese literature, and it is so small as to be effectively invisible, which is why an unexplained fever with a single odd little sore was attributed to something shaken out of a snake's scales. The eschar with its surrounding reaction is close to diagnostic, and the text has it exactly.
The prognosis is nearly right as well. Untreated scrub typhus carried a case fatality running into the tens of per cent before antibiotics, so 三兩日死 is hurried but not fanciful. It is now treated with doxycycline or azithromycin, and the response is fast enough to be diagnostic in itself. 剜去小肉, gouging out the small piece of flesh, does nothing at all: by the time the eschar is visible the organism has disseminated through the bloodstream, and cutting out the entry site is a week too late. **Cutting out a piece of flesh over a febrile infection adds a wound, bleeding and a tetanus risk and achieves nothing; it must not be done.**
What is historically remarkable is that the section locates the disease in a creature in the river sand. That is correct. The snake is the explanatory fiction attached to a real vector.
譯 2.9.40.3 Source원문
射工ㆍ溪溫皆能殺人. 治法, 取湯數斛, 以蒜五升投湯中溫浴之, 身體發赤癍者水毒. 又消水毒飮子並主之. 《入門》
Translation영역
The shooting artisan and the brook-warm can both kill a person. The method of treatment: take several seok of hot water, put 5 seung of garlic into it and bathe the patient warm in it; if red blotches come out on the body, it is water poison. Soso-dok eumja also governs these.
Clinical note임상 주석
The garlic bath is doing two jobs at once, as a treatment and as a diagnostic test, and it fails at the second for an obvious reason: hot water reddens everyone. A test whose positive result is produced by the test itself cannot distinguish the sick from the well, and this is the same difficulty as the spittle and soybean tests of 2.1.2 at the other end of the chapter. As a treatment the bath is harmless — garlic in bathwater does nothing, warmth is comforting, and a febrile patient being looked after is better off than one who is not.
The measure that would have worked is in the chapter already, recommended elsewhere and for other reasons: boiling the water. Boiling destroys the leptospires, the typhoid and the dysentery organisms, and keeping drinking water separate from the shoal where people wash would have cut the rest. Nothing in this section touches schistosomiasis or scrub typhus, which need praziquantel and doxycycline respectively, but the enteric half of 水毒 was preventable with a fire and a pot.
譯 2.9.40.4 Source원문
消水毒飮子 吳茱萸半升, 生薑ㆍ犀角ㆍ升麻ㆍ陳皮各一兩, 烏梅七箇. 右剉, 水七椀, 煎至二椀, 分二服. 《入門》
Translation영역
Soso-dok eumja. Evodia half a seung; fresh ginger, rhinoceros horn, cimicifuga and tangerine peel 1 nyang each; mume 7 pieces. Chop the above, take 7 bowls of water and decoct down to 2 bowls; divide into two doses.
Clinical note임상 주석
A warming, aromatic, acrid-and-sour decoction — evodia and ginger to warm, cimicifuga to lift and release, tangerine peel and mume for the oppression and the nausea. It is the shape of a formula for a cold, damp illness taken in from water, and it treats the account of the disease rather than the disease. **犀角 is rhinoceros horn, from a CITES Appendix I species; trade is banned, the material is keratin, and the formula cannot lawfully or usefully be made as written.** Evodia is also not a trivial drug — it is hepatotoxic in quantity and carries alkaloids with cardiovascular activity — and half a seung is a large measure of it.
With this formula the 解毒門 closes, and the chapter's arc is worth naming at the end of it. It opened on 蠱, a poison believed to be bred in a household and fed to a victim, which does not exist; it ran through forty sections of named poisons — arsenic, aconite, mercury, cantharides, pufferfish, henbane, cyanide from apricot kernel — most of which do exist and do exactly what the chapter says they do; and it ends on water that makes people ill, which is the commonest poisoning in the world and the one the chapter understands least. Its one durable principle is that a poison should be got out of the stomach before it is absorbed. Its one durable insight is that a named poison requires a named antidote rather than a general one, which is why the chapter is organised one poison per section at all. Its great omission is clean water.
About this translation 凡例
Base text: Donguibogam (東醫寶鑑, 1613 first edition), Miscellaneous Disorders, Volume 9, Resolving Toxins chapter, leaves 019a to 029a. 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 nine sections; the text itself stands up fifty-four, so forty-five are given here as numbered sub-sections in source order, leaving the table of contents' numbering untouched. Forty of those forty-five sit under 2.9 救諸中毒方, where the chapter works through the poisons one at a time. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.