Source원문
凡得病反能飮水, 此欲愈也. 《仲景》
Translation영역
Wherever one has got the disease and is able to drink water instead, he is about to heal.
Junggyeong 仲景
Formulas · Text · Donguibogam 東醫寶鑑
Cold Damage (Part Two)
Han
한글 한 · Pinyin Han
Thirst, the chest binds, the ruined patterns and the relapses — then Li Zijian's ten admonitions, the gravest list of prohibitions in the book
寒
The lower part of the Cold Damage chapter abandons the six-channel frame of the upper part and arranges itself by what the patient presents with. Seventy-one sections run from thirst and tidal fever through the chest binds and the blood patterns to the long sequence on what has gone wrong: the ruined pattern, the pattern that will not resolve past its season, the relapse from exertion, the relapse from eating, the exchange pattern passed between a convalescent and a partner. Nearly a third of the chapter is about convalescence and its failures, which is unusual in this literature and reflects how long these illnesses took to let go.
Its centre is a sequence of sections on method — when to sweat and when not, when to purge and when not, when to harmonize — followed by Li Zijian's ten admonitions, ten numbered prohibitions each stating one thing not to do and why. They are the most emphatic writing in the Donguibogam: 多致殺人, it often kills people, appears twice; 犯房室者必死, one who transgresses in the bedchamber will certainly die, closes the tenth. Every one of the ten warns against the comfortable error — giving a warming drug, feeding the patient, moxaing the painful place, letting them drink their fill — and together they make the case that in this disease the kindly instinct is the dangerous one.
The pharmacology at the end of the chapter runs to the extremes. 痼冷, entrenched cold, is treated with mercury and sulphur elixirs whose synthesis the Bogam records in full; the mania and exchange-pattern sections carry faecal, rat-dung and burnt-garment preparations. These are kept in the registry with the warnings they require, because a chapter this influential should be read whole and because the procedures themselves are documents — Golden Liquid Elixir's seven days over a buried water jar is a water bath, and someone understood why. Against them stand formulas still in daily use: the five Heart-Draining Decoctions, the six Lily formulas, Bamboo Leaf and Gypsum, Agastache Qi-Rectifying, and the twenty simples of the 單方 section, several of which are ordinary kitchen foods.
1.1 Vexing Thirst in Cold Damage 傷寒煩渴
Translation영역
In cold damage where sweating has not resolved it and the pulse is floating, Atractylodes Lancea White Tiger Decoction governs it; where after vomiting, sweating and purging the mouth is dry, the tongue parched and the pulse surging and large, Ginseng White Tiger Decoction governs it.
Dansim 丹心
Source원문
凡得病五六日而渴欲飮水ㆍ不能多者, 不當與之. 何者? 以腹中熱尙少ㆍ不能消故也. 至七八日大渴欲飮水, 惟當少與之, 常令不足ㆍ勿極意也: 言能飮一斗, 只與五升. 若腹滿ㆍ小便不利ㆍ若喘ㆍ若噦者, 不可與之. 若小渴ㆍ咽乾者, 少少嚥潤之, 令胃氣和則愈. 《仲景》
Translation영역
Wherever one has had the disease five or six days and is thirsty with a wish to drink water but cannot take much, it should not be given him. Why? Because the heat within the abdomen is still slight and he cannot consume it. By the seventh or eighth day there is great thirst with a wish to drink water, and then only a little should be given, always leaving him short and never satisfying him to the full: that is, if he can drink a mal, give only five seung. If there is abdominal fullness, inhibited urination, panting or hiccough, it may not be given him. If the thirst is slight and the throat dry, let him swallow a very little to moisten it, and when the stomach qi is harmonized he heals.
Junggyeong 仲景
Source원문
渴欲飮水ㆍ水入卽吐, 名曰水逆, 五苓散主之. 《仲景》
Translation영역
Thirst with a wish to drink water and the water vomited as soon as it goes in is named water counterflow, and Five-Ingredient Poria Powder governs it.
Junggyeong 仲景
Source원문
厥陰病渴欲飮水者, 少少與之愈. 《活人》
Translation영역
In jueyin disease, where there is thirst with a wish to drink water, give him a very little and he heals.
Hwarinseo 活人
Source원문
熱在表則不渴, 熱入裏則渴, 耗奪津液而然也. 然有渴必有煩者: 腎主水, 熱深則水竭而渴; 肝木挾心火以生煩. 故厥陰六七日飮水多而小便少者, 謂之消渴. 渴欲水爲欲愈者, 傳經已盡也. 脉浮而渴屬太陽, 宜白虎湯; 汗多而渴屬陽明, 宜竹葉石膏湯; 自利而渴屬少陰, 宜猪苓湯. 《入門》
Translation영역
Where the heat is in the exterior there is no thirst, and where the heat enters the interior there is thirst, because the fluids are consumed and carried off. Yet where there is thirst there must be vexation: the kidney governs water, and where the heat is deep the water is exhausted and there is thirst; and the liver wood takes up the heart fire to generate vexation. Thus in the jueyin on the sixth or seventh day, where much water is drunk and little urine passed, it is called wasting thirst. That thirst with a wish for water means he is about to heal is because the passage through the channels is already complete. A floating pulse with thirst belongs to the taiyang, and White Tiger Decoction is apt; much sweating with thirst belongs to the yangming, and Bamboo Leaf and Gypsum Decoction is apt; spontaneous diarrhoea with thirst belongs to the shaoyin, and Polyporus Decoction is apt.
Uihak Immun 入門
Source원문
凡渴欲飮水, 常令不足爲善. 經云: 若還不飮非其治, 强飮須敎別病生. 《醫鑑》
Translation영역
Wherever there is thirst with a wish to drink water, it is best always to leave him short. The classic says: yet if he is given nothing to drink that is no treatment either, and forcing him to drink will surely make another disease.
Gogeum Uigam 醫鑑
Source원문
渴欲飮水而不能飮者, 丹田有熱ㆍ胸中有寒也. 《仲景》
Translation영역
Where there is thirst with a wish to drink water and he cannot drink, the cinnabar field has heat and the chest has cold.
Junggyeong 仲景
Source원문
陰盛隔陽之證, 口燥渴而漱水不嚥; 蓄血之證亦漱水不欲嚥. 《入門》
Translation영역
In the pattern of yin exuberance screening off the yang, the mouth is parched and thirsty and he rinses with water and does not swallow; and in the pattern of accumulated blood he also rinses with water and does not wish to swallow.
Clinical note임상 주석
常令不足 — always leave him short — is the most-quoted instruction in the lower part of the chapter and the hardest for a modern reader to accept, since the first thing one would do for a dehydrated febrile patient is replace the fluid. The Bogam's reasoning is in the third passage: a patient who cannot take much on day five or six has a stomach that cannot handle it, and water poured in faster than it is absorbed is vomited back, which loses more than it gains. 若能飮一斗, 只與五升 is a measured compromise rather than a refusal.
The Uigam's correction two passages later is what rescues the rule from becoming a dogma: 若還不飮非其治 — giving him nothing is no treatment either. Little and often, which is in fact how oral rehydration is given.
The three thirst patterns and their three formulas is a clean piece of sorting: floating pulse with thirst is taiyang and takes White Tiger, much sweating with thirst is yangming and takes Bamboo Leaf and Gypsum, diarrhoea with thirst is shaoyin and takes Polyporus. Against them stand the two cases where thirst is not thirst at all — rinsing without swallowing, which the upper part used at 2.63 and 2.29 for false heat and for blood.
Uihak Immun 入門
1.2 Tidal Fever in Cold Damage 傷寒潮熱
Source원문
潮熱者, 若潮水之潮ㆍ其來不失時也. 一日一發ㆍ指時而發者, 謂之潮熱; 若日三五發者, 是卽發熱ㆍ非潮熱也. 潮熱屬陽明, 必於日晡時發者乃爲潮熱也. 陽明之爲病, 胃家實也; 胃實則譫語. 《明理》
Translation영역
Tidal fever is like the tide of tidal water, in that its coming does not miss its time. Where it arises once a day, breaking out at the appointed hour, it is called tidal fever; where it arises three or five times a day, that is simply fever and not tidal fever. Tidal fever belongs to the yangming, and it is tidal fever only when it breaks out towards sunset. The yangming becoming diseased is the stomach being replete, and where the stomach is replete there is delirious speech.
Myeongni 明理
Source원문
潮熱者, 似潮水之有信, 一日一發謂之潮, 必日晡而作. 陽明旺於未申故耳. 諸承氣湯選用下之. 或潮於寅卯者屬少陽, 或潮於巳午者屬太陽, 爲邪未入胃, 俱宜小柴胡湯和解之. 《入門》
Translation영역
Tidal fever is like the tidal water in having its appointed term; arising once a day it is called tidal, and it must come on towards sunset. It is because the yangming is at its height in the hours of the goat and the monkey. Choose among the Order the Qi Decoctions to purge it. But where the tide comes in the hours of the tiger or the hare it belongs to the shaoyang, and where it comes in the hours of the snake or the horse it belongs to the taiyang, the evil not yet having entered the stomach, and in both Minor Bupleurum Decoction is apt to harmonize and resolve it.
Uihak Immun 入門
Source원문
吐下後不大便ㆍ潮熱, 若劇則不識人ㆍ循衣摸床ㆍ微喘ㆍ直視, 脉弦者生, 脉濇者死. 《仲景》
Translation영역
Where after vomiting and purging the bowels do not open and there is tidal fever, and in the severe case he does not recognize people, picks at his clothes and gropes at the bed, pants slightly and stares fixedly: if the pulse is stringlike he lives, and if the pulse is rough he dies.
Clinical note임상 주석
The hour of onset is used as a localizing sign, which is unusual and more useful than it sounds. Late afternoon — the hours of the goat and monkey, roughly one to five o'clock — is yangming and takes a purgative; early morning or late morning is shaoyang or taiyang and takes Minor Bupleurum. The Myeongni's qualification is the operative one: once a day at the appointed hour is tidal fever, and three or five times a day is simply fever. A regularly recurring late-afternoon fever spike is a real pattern, and whether or not it localizes to the stomach, the observation that its timing is diagnostic is sound.
The third passage repeats the carphologia case of the upper part's 2.23 verbatim, with the same prognostic rule. The chapter's willingness to print the same material twice under two headings is how it accommodates both its organizing schemes.
Junggyeong 仲景
1.3 Mania in Cold Damage 傷寒發狂
Source원문
發狂者, 熱毒在胃ㆍ倂入於心, 使神昏不定ㆍ言動急速ㆍ妄語妄笑, 甚則登高而歌ㆍ棄衣而走ㆍ踰垣上屋ㆍ不食不卧. 非大吐下不止. 表裏俱熱, 宜三黃石膏湯; 裏熱盛, 宜大承氣湯加黃連; 狂言譫語, 宜辰砂五苓散. 《入門》
Translation영역
In mania the heat toxin is in the stomach and presses into the heart, so that the spirit is clouded and unsettled, speech and movement are hurried, and there is wild talking and wild laughing; and in the severe case he climbs up high and sings, throws off his clothes and runs, leaps walls and goes up on the roof, neither eating nor lying down. It does not stop short of a great vomiting or purging. Where exterior and interior are both hot, Three Yellows and Gypsum Decoction is apt; where the interior heat is exuberant, Major Order the Qi Decoction with coptis added; for wild and delirious speech, Cinnabar Five-Ingredient Poria Powder.
Uihak Immun 入門
Source원문
如狂者, 但睡中忽欲起行ㆍ錯言妄語, 非若發狂莫能制也. 《入門》
Translation영역
One who is as though mad only wishes suddenly to get up and walk in the midst of sleep, with confused and wild speech; he is not like the maniac, whom nobody can restrain.
Uihak Immun 入門
Translation영역
For mania in yang toxin, Yang Toxin Cimicifuga Decoction and Yang Toxin Gardenia Decoction are apt. The formulas appear above.
Uihak Immun 入門
Translation영역
For mania, Wondrous Fragrance Pill the formula appears in the Fire chapter, Three Whites Drink, Live Dragon Powder, Coffin-Breaking Decoction, the Water-Soaking Method and the Fire-Robbing Method should be used.
Uihak Immun 入門
Source원문
喜忘如狂, 蓄血證也. 《活人》
Translation영역
Forgetfulness with being as though mad is the pattern of accumulated blood.
Hwarinseo 活人
Source원문
凡發狂見陽證陽脉者順, 見陰證陰脉ㆍ舌卷ㆍ囊縮者死. 《入門》
Translation영역
Wherever mania shows yang signs and a yang pulse it goes with the current; where it shows yin signs and a yin pulse, with the tongue curled and the scrotum retracted, he dies.
Clinical note임상 주석
登高而歌ㆍ棄衣而走ㆍ踰垣上屋 — climbing up high and singing, throwing off the clothes and running, leaping walls and going up on the roof — is quoted from the Neijing and is the classical description of mania, and it is accurate for an agitated hyperthermic delirium. The distinction from 如狂 in the second passage turns on restraint: the maniac cannot be held, while the one who is merely as though mad gets up confused in the night and can be. That is a usable triage.
喜忘如狂 — forgetfulness with being as though mad — points to accumulated blood, which connects this section to the Resistance Decoction and Pill of 1.10 and to 2.16 of the upper part. Forgetfulness in an agitated patient was consistently read as blood static below, and the pairing is worth remembering because it sends the prescriber somewhere quite different from the cooling purgatives of this section.
Of the six remedies in the fourth passage, three — Coffin-Breaking Decoction, the Fire-Robbing Method and Live Dragon Powder — are to be read and not made; their entries carry the reasons. The Water-Soaking Method is physical cooling and is the one here a modern clinician would recognize without qualification.
Uihak Immun 入門
1.4 Delirious Speech and the Faint Repeating Voice in Cold Damage 傷寒譫語鄭聲
Source원문
實則譫語, 虛則鄭聲. 譫語者, 謂亂語無次第ㆍ數數更端也; 鄭聲者, 謂鄭重頻煩也, 只將一句舊言重疊頻言之也. 《明理》
Translation영역
Where there is repletion there is delirious speech, and where there is depletion there is the faint repeating voice. Delirious speech means disordered speech without order, changing its subject over and over; the faint repeating voice means a grave and frequent repetition, taking only one phrase already said and saying it over and over again.
Myeongni 明理
Source원문
陽明病胃實則譫語. 《仲景》
Translation영역
In yangming disease, where the stomach is replete there is delirious speech.
Junggyeong 仲景
Translation영역
Where the stool and urine pass freely, the hands and feet are cold and the pulse is faint and fine, there will certainly be the faint repeating voice, and White Through-Flow Decoction should be used; where the stool is stopped, the urine dark, the hands and feet warm and the pulse surging and rapid, there will certainly be delirious speech, and Regulate the Stomach and Order the Qi Decoction should be used.
Hwarinseo 活人
Source원문
譫語有實有虛: 實則可下, 虛不可爲實者. 胃實有燥屎, 可下之; 虛者腸胃自利也, 難治. 《入門》
Translation영역
Delirious speech may be of repletion or of depletion: where there is repletion it may be purged, and the depleted may not be taken for the replete. Where the stomach is replete and there are dry faeces, it may be purged; the depleted has the intestines and stomach passing freely of themselves, and is hard to treat.
Uihak Immun 入門
Source원문
傷寒大熱ㆍ呻吟ㆍ錯語ㆍ不得眠, 黃連解毒湯主之. 《活人》
Translation영역
In cold damage with great heat, groaning, confused speech and inability to sleep, Coptis Resolve Toxicity Decoction governs it.
Hwarinseo 活人
Source원문
晝日明了ㆍ夜則譫語如見鬼, 乃婦人熱入血室證也. 《活人》
Translation영역
Clear by day and delirious at night as though he saw ghosts: this is the pattern of heat entering the blood chamber in a woman.
Hwarinseo 活人
Source원문
傷寒發熱ㆍ譫語, 宜柴胡連翹湯. 《醫鑑》
Translation영역
In cold damage with fever and delirious speech, Bupleurum and Forsythia Decoction is apt.
Clinical note임상 주석
The definitions are as careful as any in the chapter and both are recognizable. Delirious speech is disordered and changes subject; the faint repeating voice says one phrase over and over. The second is perseveration, and in a patient with cold extremities, a faint pulse and free urine it marks exhaustion rather than agitation. Two sounds, heard from the doorway, and they take opposite treatments — aconite for the one, rhubarb and mirabilite for the other.
晝日明了, 夜則譫語 — clear by day and delirious at night — is sundowning, and the Bogam attributes it specifically to heat entering the blood chamber in a woman, which is taken up at 1.21. The diurnal pattern as a diagnostic feature of delirium is still used.
Gogeum Uigam 醫鑑
1.5 Chest Bind in Cold Damage 傷寒結胸
Source원문
傷寒若脉浮緊ㆍ下之, 必結胸. 《海藏》
Translation영역
In cold damage, if the pulse is floating and tight and he is purged, there will certainly be a chest bind.
Haejang 海藏
Source원문
病發於陽而反下之, 熱入因作結胸. 《仲景》
Translation영역
Where the disease arises in the yang and he is purged instead, the heat enters and thereby a chest bind is made.
Junggyeong 仲景
Source원문
傷寒表未解ㆍ醫反下之ㆍ膈內拒痛ㆍ手不可近, 一云心下滿而硬痛, 此爲結胸, 宜大陷胸湯. 《仲景》
Translation영역
In cold damage where the exterior is not yet resolved and the physician has purged instead, with a resisting pain within the diaphragm that the hand may not come near — one account says fullness below the heart with hard pain — this is a chest bind, and Major Chest-Draining Decoction is apt.
Junggyeong 仲景
Source원문
若按心下硬痛ㆍ手不可近ㆍ燥渴ㆍ譫語ㆍ大便實ㆍ脉沉實有力, 爲大結胸, 急以大陷胸湯加枳殼ㆍ桔梗下之. 反加煩躁者死. 《醫鑑》
Translation영역
If on pressing below the heart it is hard and painful and the hand may not come near, with parched thirst, delirious speech, replete stool and a pulse deep, replete and forceful, it is a major chest bind, and Major Chest-Draining Decoction with bitter orange and platycodon added should be used urgently to purge it. If vexing agitation is added instead, he dies.
Gogeum Uigam 醫鑑
Source원문
小結胸者, 正在心下ㆍ按之則痛ㆍ脉浮滑, 宜小陷胸湯. 《醫鑑》
Translation영역
A minor chest bind is right below the heart, pains on being pressed, and the pulse is floating and slippery; Minor Chest-Draining Decoction is apt.
Gogeum Uigam 醫鑑
Translation영역
For a cold-repletion chest bind with no heat signs, Three Substances White Powder and Minor Chest-Draining Decoction are apt.
Gogeum Uigam 醫鑑
Source원문
熱實結胸及寒實結胸, 活人書不拘寒熱ㆍ但用陷胸湯; 不差, 用枳實理中丸, 應手而愈. 《綱目》
Translation영역
For both the heat-repletion chest bind and the cold-repletion chest bind, the Hwarinseo does not hold to cold or heat but uses only a Chest-Draining Decoction; and if it does not resolve, Bitter Orange Regulate the Centre Pill is used, and it heals under the hand.
Uihak Gangmok 綱目
Source원문
但結胸ㆍ無大熱者, 此爲水結在胸脇, 但頭汗出, 名曰水結胸, 小半夏湯加茯苓主之. 方見入門
Translation영역
Where there is only a chest bind without great heat, this is water bound in the chest and rib-side, and only the head sweats; it is named a water chest bind, and Minor Pinellia Decoction with Poria governs it. The formula appears in the Immun.
Uihak Gangmok 綱目
Source원문
熱實結胸, 宜用大陷胸丸. 《綱目》
Translation영역
For a heat-repletion chest bind, Major Chest-Draining Pill should be used.
Uihak Gangmok 綱目
Translation영역
For a chest bind the moxibustion method and the ironing method should be used. Where there has been no purging and the chest is full, it is not a chest bind, and only Minor Bupleurum combined with Minor Chest-Draining, with bitter orange and platycodon added, one dose and it is marvellous.
Clinical note임상 주석
Every one of the first three passages names purging as the cause, and the chapter does not soften it: a chest bind is what happens when a patient with an unresolved exterior is purged. 病發於陽而反下之 is Zhongjing's formulation and it makes this the most purely iatrogenic condition in the book.
手不可近 — the hand may not come near — is guarding, and with hard pain below the heart, replete stool and a forceful deep pulse the picture is a peritoneal or pleural collection. The Uigam's prognostic line is worth noting: if vexing agitation is added, he dies. That is the same reading of agitation as a terminal sign that the upper part gave at 2.74.
未經下而胸滿, 非結胸也 is the differential that saves the patient from the violent formulas: chest fullness in someone who has never been purged is something else, and takes a combination of two mild formulas instead. Given that Major Chest-Draining Decoction contains kansui and Three Substances White Powder contains croton, getting this distinction right matters a great deal.
Gogeum Uigam 醫鑑
1.5.1 The Moxibustion Method 灸法
Source원문
詳見胸部
Translation영역
Treated in detail in the Chest chapter.
Clinical note임상 주석
A cross-reference heading. The Bogam gives moxibustion for chest bind its own place in the sequence here and sends the reader to the Chest chapter of the External Form division for the points and the method.
Donguibogam 東醫寶鑑
1.5.2 The Ironing Method 熨法
Source원문
詳見胸部
Translation영역
Treated in detail in the Chest chapter.
Clinical note임상 주석
The companion cross-reference. Ironing — a hot compress applied over the bound area — is the gentler of the two physical measures and the Bogam's 熨臍法 in the upper part at 2.61 shows what the procedure looks like in full.
Donguibogam 東醫寶鑑
1.6 Visceral Bind in Cold Damage 傷寒藏結
Source원문
病有結胸ㆍ有藏結, 其狀何如? 答曰: 按之痛ㆍ寸脉浮ㆍ關脉沉, 名曰結胸也. 何謂藏結? 答曰: 如結胸狀ㆍ飮食如故ㆍ時時下利ㆍ寸脉浮ㆍ關脉細小沉緊, 名曰藏結; 舌上白胎滑者難治. 《仲景》
Translation영역
The disease has a chest bind and a visceral bind; what are their forms? The answer: pain on pressing, the inch pulse floating and the bar pulse deep, is named a chest bind. What is meant by a visceral bind? The answer: a form like a chest bind, with food and drink as usual, diarrhoea from time to time, the inch pulse floating and the bar pulse fine, small, deep and tight, is named a visceral bind; and where there is a white slippery coating on the tongue it is hard to treat.
Junggyeong 仲景
Source원문
病人胸中素有痞ㆍ連在臍傍ㆍ引入小腹ㆍ入陰筋者, 此名藏結, 死. 《仲景》
Translation영역
Where the sick man has long had a stuffiness in the chest, continuing beside the navel, drawing into the lower abdomen and entering the genital sinew, this is named a visceral bind, and he dies.
Junggyeong 仲景
Source원문
歌曰: 飮食如常時下利, 更加舌上白胎時, 連臍痛引陰筋者, 藏結元來死不醫.
Translation영역
A song says: food and drink as usual with diarrhoea from time to time, and a white coating on the tongue added to it; where the pain continues from the navel and draws into the genital sinew, a visceral bind is from the first a death and no treating.
Junggyeong 仲景
Source원문
狀如結胸ㆍ飮食如故ㆍ時時下利而舌上白胎. 《活人》
Translation영역
A form like a chest bind, with food and drink as before, diarrhoea from time to time, and a white coating on the tongue.
Hwarinseo 活人
Source원문
病人素有痞氣ㆍ再加傷寒, 與宿積相合, 使眞藏之氣閉結不通, 亦名藏結. 愼不可下, 止宜小柴胡加生薑以和表, 灸關元以回陽ㆍ解陰結. 危哉! 《入門》
Translation영역
Where the sick man has long had a stuffy qi and cold damage is added to it, joining with the long-standing accumulation so that the qi of the true viscus is shut and bound and does not flow, this too is named a visceral bind. With care it may not be purged; only Minor Bupleurum with fresh ginger added is apt, to harmonize the exterior, and moxa at Guanyuan to return the yang and loosen the yin bind. It is perilous!
Uihak Immun 入門
Source원문
藏結與結胸相似, 皆下後邪氣入裏ㆍ與陽相結. 結在胸者爲結胸, 與陰相結ㆍ結在藏者爲藏結. 惟其陰結, 故藏結無陽證ㆍ不往來寒熱, 或但寒不熱, 其人反靜ㆍ飮食如常ㆍ時時下利ㆍ舌上白胎ㆍ脇肋臍腹引入陰筋俱痛者, 丹田有熱ㆍ胸中有寒, 所以難治. 《入門》
Translation영역
The visceral bind resembles the chest bind, for in both the evil qi has entered the interior after purging and bound with the yang. Where the binding is in the chest it is a chest bind; where it has bound with the yin and the binding is in the viscus it is a visceral bind. Precisely because it is a yin binding, the visceral bind has no yang signs and no chill and fever coming and going, or there is cold without heat; the man is quiet instead, food and drink as usual, diarrhoea from time to time, a white coating on the tongue, and the rib-sides, navel and abdomen drawing into the genital sinew all in pain. The cinnabar field has heat and the chest has cold, and this is why it is hard to treat.
Clinical note임상 주석
飮食如常 is the whole of the differential and the most unsettling thing about this section: the patient eats normally. A chest bind cannot eat; a visceral bind can, and yet is the graver condition. Add to it diarrhoea from time to time, a white slippery tongue coating and a pain that runs from the navel down into the groin, and the Bogam pronounces it fatal four times over.
A chronic abdominal mass continuing into the groin in a patient who is eating and passing loose stool, with no fever, in whom an acute febrile illness has supervened — the picture is of an advanced intra-abdominal malignancy with an intercurrent infection, and the prognosis the chapter gives it is not wrong. 其人反靜, he is quiet instead, is the detail that completes it: the absence of the distress one would expect.
愼不可下 — with care it may not be purged — matters because everything the surface appearance suggests points to purging. The Immun's answer, Minor Bupleurum with extra ginger and moxa at Guanyuan CV-4, is palliative and says so with its closing exclamation.
Uihak Immun 入門
1.7 Stuffy Qi in Cold Damage 傷寒痞氣
Source원문
病發於陰而反下之, 因作痞. 《仲景》
Translation영역
Where the disease arises in the yin and he is purged instead, a stuffiness is thereby made.
Junggyeong 仲景
Source원문
傷寒嘔而發熱者, 若心下滿而不痛, 此爲痞, 半夏瀉心湯主之; 胃虛氣逆者亦主之. 《仲景》
Translation영역
In cold damage with retching and fever, if there is fullness below the heart without pain, this is a stuffiness, and Pinellia Heart-Draining Decoction governs it; it also governs the case where the stomach is depleted and the qi counterflows.
Junggyeong 仲景
Source원문
心下痞硬ㆍ按之濡ㆍ其脉關上浮者, 三黃瀉心湯主之. 凡結胸與痞, 關脉須沉; 若關脉浮者, 宜此湯. 《仲景》
Translation영역
Where there is stuffy hardness below the heart that is soft on pressing and the pulse is floating at the bar, Three Yellows Heart-Draining Decoction governs it. In chest bind and in stuffiness generally, the bar pulse must be deep; if the bar pulse is floating, this decoction is apt.
Junggyeong 仲景
Source원문
心下痞而復惡寒ㆍ汗出者, 附子瀉心湯主之. 《仲景》
Translation영역
Where there is stuffiness below the heart with aversion to cold as well and sweating, Aconite Heart-Draining Decoction governs it.
Junggyeong 仲景
Source원문
下後下利日數十行ㆍ糓不化ㆍ腹雷鳴ㆍ心下痞硬ㆍ乾嘔ㆍ心煩, 此乃結熱, 乃胃中虛ㆍ客氣上逆故也, 甘草瀉心湯主之. 《仲景》
Translation영역
Where after purging the diarrhoea goes to several tens of times a day with the grain undigested, the abdomen rumbles like thunder, there is stuffy hardness below the heart, dry retching and vexation of the heart, this is a bound heat, and it is because the stomach is depleted and a guest qi counterflows upward; Licorice Heart-Draining Decoction governs it.
Junggyeong 仲景
Source원문
汗解後胃不和ㆍ心下痞硬ㆍ脇下有水氣ㆍ腹中雷鳴ㆍ下利者, 生薑瀉心湯主之. 《仲景》
Translation영역
Where after resolution by sweating the stomach is not harmonized, there is stuffy hardness below the heart, water qi below the rib-side, thunderous rumbling within the abdomen and diarrhoea, Fresh Ginger Heart-Draining Decoction governs it.
Junggyeong 仲景
Source원문
太陽病外證未除而數下之, 遂下利不止ㆍ心下痞硬ㆍ表裏不解, 桂枝人參湯主之. 《仲景》
Translation영역
In taiyang disease where the external signs are not yet removed and he is purged repeatedly, so that the diarrhoea does not stop, there is stuffy hardness below the heart, and neither exterior nor interior resolves, Cinnamon Twig and Ginseng Decoction governs it.
Junggyeong 仲景
Source원문
痞氣通用桔梗枳殼湯方見胸部.
Translation영역
For stuffy qi, Platycodon and Bitter Orange Decoction formula in the Chest chapter serves generally.
Clinical note임상 주석
心下滿而不痛 is the whole difference from the chest bind of the previous two sections: fullness without pain, and soft to the pressing finger. A chest bind resists the hand; a stuffiness does not. One sign, and it separates the kansui and croton formulas from the mild harmonizing ones.
All five Heart-Draining Decoctions appear here in sequence, and read together they are the best demonstration in the Bogam of how one formula is adapted by small changes. Pinellia for the base case with retching; Three Yellows where the bar pulse is floating, steeped not decocted; Aconite where there is sweating and chill as well; Licorice where repeated purging has emptied the middle; Fresh Ginger where water has pooled and the belly rumbles. Five patterns, one architecture, and each formula's own entry sets out the mechanism.
病發於陰而反下之 pairs with 病發於陽而反下之 at 1.5. Purging the wrong patient makes a chest bind if the disease was in the yang and a stuffiness if it was in the yin. Both are the physician's doing, and the Shanghanlun says so in parallel sentences.
Uihak Immun 入門
1.8 Twitching Sinews and Fasciculating Flesh in Cold Damage 傷寒筋惕肉瞤
Source원문
動氣在左而發汗, 則筋惕肉瞤. 《明理》
Translation영역
Where the stirred qi is on the left and a sweat is induced, there is twitching of the sinews and fasciculation of the flesh.
Myeongni 明理
Source원문
傷寒筋惕ㆍ身瞤, 發汗太過所致也. 古人以眞武湯主之; 然眞武湯能止其汗而不能定其瞤. 瞤者, 動也. 蓋汗多則傷血, 血虛無以榮筋, 筋愈急而四體百骸俱爲之瞤動. 宜以四物湯去地黃, 加人參ㆍ半夏ㆍ茯苓ㆍ甘草作劑, 以五靈脂爲佐, 入生薑ㆍ烏梅煎服, 自有神效. 此專主生血, 生血乃所以收汗也. 《直指》
Translation영역
Twitching sinews and fasciculating body in cold damage are brought about by excessive sweating. The ancients governed it with True Warrior Decoction; yet True Warrior Decoction can stop the sweating and cannot settle the fasciculation. Fasciculation means movement. Now where there is much sweating the blood is damaged, and the blood being depleted has nothing with which to nourish the sinews, so the sinews grow more hypertonic and all four limbs and the hundred bones fasciculate with it. Four Substances Decoction with the rehmannia removed and ginseng, pinellia, poria and licorice added should be made into an agent, with flying-squirrel droppings as assistant, and fresh ginger and mume plum put in and decocted; it has a marvellous effect of itself. This governs the generating of blood above all, and generating the blood is the way to gather in the sweat.
Clinical note임상 주석
然眞武湯能止其汗而不能定其瞤 — True Warrior Decoction can stop the sweating and cannot settle the fasciculation — is a correction of the received treatment on the ground that it treats only half the problem, and it is the best piece of independent reasoning in this part of the chapter. The Jikji's argument is that the twitching is a consequence of the blood lost with the sweat, so stopping the sweat does not undo what the sweat has already taken; something must replace it.
生血乃所以收汗也 — generating the blood is the way to gather in the sweat — inverts the usual order of treatment and is a defensible piece of physiology: restore the circulating volume and the compensatory sweating settles. The prescription is Four Substances with rehmannia dropped and four qi drugs put in, which is a blood-and-qi formula rather than a blood one, and the mume plum at the end is sour, to hold the fluid in.
筋惕肉瞤 is the sign that Channel-Warming Original-Qi Boosting Decoction treats at 1.35 of this part, and it appears again at 2.79.2 of the upper part as the consequence of sweating a patient with left-sided stirred qi. The chapter states three times that it is iatrogenic.
Injae Jikji 直指
1.9 The Pattern of the Middle Removed in Cold Damage 傷寒除中證
Source원문
厥而下利ㆍ反能食者, 曰除中, 不治. 《得效》
Translation영역
Where there is reversal with diarrhoea and he is able to eat instead, it is called the middle removed, and it is not treatable.
Deukhyobang 得效
Source원문
厥而利ㆍ反能食, 曰除中, 其死也可立待也. 《入門》
Translation영역
Reversal with diarrhoea and able to eat instead is called the middle removed, and his death may be awaited standing.
Uihak Immun 入門
Source원문
邪在表則能食, 邪在裏則不能食. 今傷寒厥深ㆍ下利ㆍ脉遲, 當不能食而反能食者, 名曰除中: 中之胃氣旣除, 豈可再復? 《入門》
Translation영역
Where the evil is in the exterior he can eat, and where the evil is in the interior he cannot eat. Now in cold damage with deep reversal, diarrhoea and a slow pulse, he ought not to be able to eat, and if he can eat instead it is named the middle removed: the stomach qi of the middle having already been removed, how shall it be restored again?
Uihak Immun 入門
Source원문
厥利當不能食, 今反能食, 恐爲除中. 試食以索餠: 發熱者, 除中也; 不發熱者, 非除中, 知胃氣尙在, 必愈也. 《仲景》
Translation영역
With reversal and diarrhoea he ought not to be able to eat, and now he can eat instead; it may be the middle removed. Test him by feeding him noodle cake: if fever arises, it is the middle removed; if no fever arises, it is not the middle removed, and one knows the stomach qi is still there and he will certainly heal.
Clinical note임상 주석
試食以索餠 — test him by feeding him noodle cake — is a genuine clinical test with a clear endpoint, and it is the only one of its kind in the Bogam. A gravely ill patient with cold extremities and diarrhoea who suddenly eats is either recovering or is exhibiting the terminal ravenous appetite the tradition called 除中; feed him and watch. Fever after eating means the first, no fever means the second.
Whether the test discriminates what it claims to is unknowable, but the structure is sound: a cheap, harmless intervention with a binary outcome used to settle a prognosis that nothing else can. 其死也可立待 — his death may be awaited standing — is as blunt as the chapter gets, and the test exists because the Bogam's authors wanted some way not to pronounce it on a patient who was in fact improving.
Junggyeong 仲景
1.10 Blood Patterns in Cold Damage 傷寒血證
Source원문
太陽病六七日ㆍ表證因在ㆍ脉微而沉ㆍ反不結胸ㆍ其人如狂者, 以熱在下焦ㆍ小腹當滿. 小便自利者, 下血乃愈, 抵當湯主之. 《仲景》
Translation영역
In taiyang disease on the sixth or seventh day, the exterior signs still being present, the pulse faint and deep, and yet there is no chest bind, and the man is as though mad: it is because the heat is in the lower burner, and the lower abdomen should be full. Where the urine passes freely of itself, bringing the blood down cures it, and Resistance Decoction governs it.
Junggyeong 仲景
Source원문
太陽證身黃ㆍ發狂ㆍ小腹硬滿ㆍ自利者, 血證諦也, 宜抵當湯. 《仲景》
Translation영역
In the taiyang pattern with a yellow body, mania arising, hard fullness of the lower abdomen and spontaneous diarrhoea, the blood pattern is certain, and Resistance Decoction is apt.
Junggyeong 仲景
Source원문
傷寒小腹滿ㆍ應小便不利, 今反利者, 爲有血也, 當下之, 宜抵當丸. 《仲景》
Translation영역
In cold damage with lower abdominal fullness, the urine ought to be inhibited, and if it passes freely instead there is blood; it should be brought down, and Resistance Pill is apt.
Junggyeong 仲景
Source원문
太陽病不解ㆍ熱結膀胱ㆍ其人似狂, 若血自下者自愈; 但小腹急結者宜攻之, 宜桃仁承氣湯. 《仲景》
Translation영역
In taiyang disease that has not resolved, with heat bound in the bladder and the man seeming mad: if the blood comes down of itself he heals of himself; but where the lower abdomen alone is urgently bound it should be attacked, and Peach Kernel Qi-Coordinating Decoction is apt.
Junggyeong 仲景
Translation영역
That nosebleed forbids sweating is because there is no pulse or the pulse is faint. If the pulse is floating and tight with body ache, aversion to cold and fever, then sweating is permissible, and Ephedra Decoction or Cinnamon Twig Decoction is apt. Both formulas appear above. If the pulse is faint and sweating is not permissible, Rhinoceros Horn and Rehmannia Decoction governs it. The formula appears in the Blood chapter.
Haejang 海藏
Source원문
少陰病强發汗ㆍ血出九竅, 是名下厥上竭, 不治. 《仲景》
Translation영역
In shaoyin disease where a sweat is forced and blood comes out of the nine orifices, this is named reversal below and exhaustion above, and it is not treatable.
Junggyeong 仲景
Source원문
太陽病脉浮緊ㆍ發熱ㆍ無汗而衂者, 自愈也. 《仲景》
Translation영역
In taiyang disease with a floating tight pulse, fever, no sweat and a nosebleed, he heals of himself.
Junggyeong 仲景
Translation영역
In cold damage with headache, fever, a dry mouth, blood coming from the mouth and nose, clouding in the afternoon, deafness and rib-side pain, commonly named the blood-sweat disease, Rhinoceros Horn and Rehmannia Decoction combined with Minor Bupleurum Decoction governs it.
Clinical note임상 주석
The nosebleed is read two opposite ways in two passages and the difference is the pulse. With a floating tight pulse and fever, a nosebleed in taiyang disease resolves the illness — 自愈也, he heals of himself — because the exterior has opened and the pressure has found a way out; the tradition called this 紅汗, a red sweat. With no pulse or a faint one, the same bleeding is a sign of collapse and sweating is forbidden.
血出九竅 — blood from the nine orifices — and the name 下厥上竭 repeat 2.46 of the upper part verbatim, which means the chapter states twice that forcing a sweat in a shaoyin patient can produce diffuse mucosal bleeding. For a condition that it classes as untreatable, that repetition is the strongest form of warning available to it.
Free-flowing urine as the sign that a full lower abdomen is blood rather than retained urine appears three times in this section and in both Resistance formulas' own entries. It is the chapter's most reliable piece of abdominal differential diagnosis and costs one question.
Gogeum Uigam 醫鑑
1.11 Spontaneous Diarrhoea in Cold Damage 傷寒自利
Source원문
傷寒陰證ㆍ身痛ㆍ脉沉ㆍ大便自利ㆍ或嘔ㆍ或咳, 宜玄武湯. 方見上
Translation영역
In the yin pattern of cold damage with body ache, a deep pulse, the stool passing freely of itself, and either retching or cough, Black Warrior Decoction is apt. The formula appears above.
Dansim 丹心
Source원문
傷寒陽證ㆍ身熱ㆍ脉數ㆍ煩渴引飮ㆍ大便自利, 宜柴苓湯. 《丹心》
Translation영역
In the yang pattern of cold damage with generalized fever, a rapid pulse, vexing thirst drawing at drink, and the stool passing freely of itself, Bupleurum and Poria Decoction is apt.
Dansim 丹心
Source원문
益元散亦佳. 方見暑門
Translation영역
Benefit the Origin Powder is also good. The formula appears in the Summerheat chapter.
Dansim 丹心
Source원문
太陰證自利, 宜理中湯. 《丹心》
Translation영역
For spontaneous diarrhoea in the taiyin pattern, Regulate the Middle Decoction is apt.
Clinical note임상 주석
Four lines, and together they put the three diarrhoeas of this chapter in order: yin pattern with body ache and a deep pulse takes True Warrior; yang pattern with fever, thirst and a rapid pulse takes Bupleurum and Poria; taiyin pattern takes Regulate the Middle. The discriminator each time is the thirst and the pulse rate, as it was at 2.43 of the upper part.
The use of the old name 玄武湯 here where the upper part used 眞武湯 is a small sign that the Bogam's compilers took their passages from their sources without normalizing the formula names, which is why the registry needs the cross-reference.
Dansim 丹心
1.12 Chest and Abdominal Pain in Cold Damage 傷寒胸腹痛
Source원문
傷寒腹痛: 中脘痛, 太陰也; 臍腹痛, 少陰也; 小腹痛, 厥陰也. 《仲景》
Translation영역
Abdominal pain in cold damage: pain at the middle stomach duct is taiyin; pain of the navel and abdomen is shaoyin; pain of the lower abdomen is jueyin.
Junggyeong 仲景
Translation영역
Hard pain of the heart and chest that the hand may not come near is a chest bind; but if there has been no purging it is not a chest bind, and the evil qi is stopping up the chest, and only Minor Bupleurum with bitter orange and platycodon added treats it. If that has no effect, Minor Bupleurum combined with Minor Chest-Draining with bitter orange and platycodon added, one dose and it is marvellous.
Gogeum Uigam 醫鑑
Source원문
若心下脹滿而不痛者, 乃痞氣也, 宜瀉心湯加枳ㆍ桔. 《醫鑑》
Translation영역
If there is distending fullness below the heart without pain, it is stuffy qi, and a Heart-Draining Decoction with bitter orange and platycodon added is apt.
Gogeum Uigam 醫鑑
Translation영역
If the lower abdomen is hard and painful and the urine passes freely, it is the pattern of accumulated blood, and Peach Kernel Qi-Coordinating Decoction should purge it; if the urine is inhibited, it is the pattern of rough urination, and Five-Ingredient Poria Powder should disinhibit it; if the lower abdomen is hard and painful round about the navel with rough urination and replete stool, there are dry faeces, and Major Order the Qi Decoction should purge it.
Clinical note임상 주석
The last passage is the best piece of abdominal localization in the chapter and resolves three causes of the same finding by two questions about the urine and the stool. Hard painful lower abdomen with free urine is blood; with inhibited urine it is the bladder; with inhibited urine and replete stool it is the bowel. Three formulas, and the sorting is done before any of them is reached for.
The three levels of abdominal pain in the first passage — middle duct, periumbilical, lower — map onto taiyin, shaoyin and jueyin, which is a channel-based reading of what is really anatomical localization. Taken as topography rather than as channel theory it is reasonable: upper abdominal pain, periumbilical pain and suprapubic pain do have different differential lists.
Gogeum Uigam 醫鑑
1.13 Vomiting Roundworms in Cold Damage 傷寒吐蛔
Source원문
傷寒有吐蛔者, 雖有大熱, 忌下凉藥, 犯之必死. 蓋胃中有寒則蛔不安其所而上膈, 大凶之兆也. 急用理中湯方見上加烏梅 二箇ㆍ紅椒 十粒, 煎服. 待蛔定, 却以小柴胡湯退熱. 《醫鑑》
Translation영역
In cold damage where there is vomiting of roundworms, although there be great heat, cooling and purging medicines are to be shunned, and to transgress is certain death. For where the stomach has cold the roundworms are not at ease in their place and come up through the diaphragm, which is a sign of great ill omen. Urgently use Regulate the Middle Decoction the formula appears above with two mume plums and ten red peppercorns added, decocted and taken. Wait until the roundworms are settled, and then use Minor Bupleurum Decoction to make the heat retreat.
Gogeum Uigam 醫鑑
Source원문
傷寒吐蛔者, 手足冷ㆍ胃虛空也. 《回春》
Translation영역
In cold damage where roundworms are vomited, the hands and feet are cold and the stomach is depleted and empty.
Clinical note임상 주석
犯之必死 — to transgress is certain death — is the strongest warning in the lower part, and it is directed against the obvious treatment: the patient has great heat, so cool him. The Bogam's reading is that the worms have come up because the stomach has gone cold beneath the fever, and cooling it further drives them higher. Ascaris does migrate upward in a host whose gut has become inhospitable, and vomiting a worm in a febrile illness is a sign of a very sick patient.
The staging is as careful as at 2.75 of the upper part: warm the middle first with mume plum and peppercorn added to Regulate the Middle, wait until the worms are settled, and only then treat the fever. 待蛔定, 却以小柴胡湯退熱 — the order is the prescription. Mume plum is the classical anti-ascarid drug and is the chief of Mume Pill, which is where the Worms chapter takes this up properly.
Manbyeong Hoechun 回春
1.14 The Pattern of Yin and Yang Crossing 陰陽交證
Source원문
黃帝問曰: 有病溫者, 汗出輒復熱ㆍ而脉躁疾不爲汗衰ㆍ狂言ㆍ不能食, 病名爲何? 歧伯曰: 病名陰陽交, 交者死也. 帝曰: 願聞其說. 歧伯曰: 人所以汗出者, 皆生於糓, 糓生於精. 今邪氣交爭於骨肉而得汗者, 是邪却而精勝也; 精勝則當能食而不復熱. 復熱者, 邪氣也; 汗者, 精氣也. 今汗出而輒復熱者, 是邪勝也; 不能食者, 精無俾也. 病而留者, 其壽可立而傾也. 且夫熱論曰: 汗出而脉尙躁盛者死. 狂言者, 是失志; 失志者死. 《內經》
Translation영역
The Yellow Emperor asked: there is one with warm disease in whom, sweat having come out, the fever returns at once, the pulse is agitated and swift and does not decline with the sweat, there is wild speech and he cannot eat — what is the name of the disease? Qibo said: the disease is named yin and yang crossing, and where they cross he dies. The Emperor said: I should like to hear the explanation. Qibo said: the reason a man sweats is that it all arises from grain, and grain arises from essence. Now where the evil qi has contended in the bones and flesh and a sweat is got, it is that the evil has retreated and the essence prevails; and where the essence prevails he ought to be able to eat and the fever should not return. That the fever returns is the evil qi; the sweat is the essence qi. Now where sweat has come out and the fever returns at once, it is that the evil prevails; and that he cannot eat is that the essence has nothing to help it. Where the disease lodges, his lifespan may topple while one stands. Moreover the Discourse on Heat says: where sweat has come out and the pulse is still agitated and exuberant, he dies. Wild speech is the loss of the mind, and one who loses his mind dies.
Naegyeong 內經
Source원문
發汗後脉躁疾ㆍ狂言ㆍ不能食, 謂之陰陽交. 言交合陰陽之氣不可分別, 此死證也. 《入門》
Translation영역
Where after sweating the pulse is agitated and swift, there is wild speech and he cannot eat, it is called yin and yang crossing. It means that the crossing and joining of the yin and yang qi can no longer be distinguished, and this is a fatal pattern.
Clinical note임상 주석
Three findings after a sweat, and all three are bad: the fever returns immediately, the pulse stays fast, and the patient cannot eat. Qibo's argument is a piece of reasoning from response to treatment, which is the best kind this literature produces. A sweat that works means the body has prevailed, so the fever should fall and appetite return; a sweat that changes nothing means it has not, and the fluid is gone for nothing.
汗出而脉尙躁盛者死 is the operative line and it is clinically sound: a febrile patient whose tachycardia does not settle after the temperature breaks has not turned the corner. Together with the inability to eat and the delirium, the picture is of a severe infection progressing despite the body's response, and the Neijing's prognosis for it in the absence of antimicrobials is accurate.
其壽可立而傾 — his lifespan may topple while one stands — is the same image as 其死也可立待 at 1.9, and both are the Neijing's way of saying hours rather than days.
Uihak Immun 入門
1.15 The Ruined Pattern 壞證
Source원문
傷寒病未退ㆍ重感寒, 變爲溫瘧; 重感風, 變爲風溫; 再感濕熱, 變爲溫毒; 重感疫氣, 變爲溫疫. 又太陽病經汗ㆍ吐ㆍ下ㆍ溫鍼不解, 及過經不解, 皆名壞證. 或醫者不辨陰陽ㆍ錯謬汗下, 使病不解ㆍ壞證亂經ㆍ久而不差, 視其犯何逆以治之: 表證多者知母麻黃湯, 半表者小柴胡湯, 餘熱不解者參胡芍藥湯, 危急者奪命散, 諸藥不效者鼈甲散. 《入門》
Translation영역
Where the cold damage disease has not retreated and cold is contracted a second time, it turns into warm malaria; where wind is contracted a second time, into wind warmth; where damp heat is contracted again, into warm toxin; where epidemic qi is contracted a second time, into warm epidemic. And a taiyang disease that has been through sweating, vomiting, purging and warm needling without resolving, and one that has passed its season without resolving, are both named the ruined pattern. Or the physician may fail to distinguish yin from yang and mistake sweating for purging, so that the disease does not resolve, the ruined pattern throws the channels into disorder and it long goes uncured; then look at which contrary act was committed and treat accordingly. Where the exterior signs predominate, Anemarrhena and Ephedra Decoction; where it is half in the exterior, Minor Bupleurum Decoction; where the residual heat will not resolve, Ginseng, Bupleurum and Peony Decoction; where it is urgent, Snatch Back Life Powder; where no medicine has had effect, Soft-Shelled Turtle Shell Powder.
Clinical note임상 주석
視其犯何逆以治之 — look at which contrary act was committed and treat accordingly — is the whole method for the ruined pattern, and it is a diagnosis made from the treatment history rather than from the patient. What has been done to them determines what is wrong with them now.
The five formulas form a ladder with the last two rungs defined by failure rather than by signs: urgent cases get a nyang of ginseng alone, and cases where nothing has worked get turtle shell. Both entries say as much. That a chapter should organize its most difficult section by how far other treatments have already failed is a candid arrangement and an unusual one.
The four transformations at the start — into warm malaria, wind warmth, warm toxin, warm epidemic — are the Nanjing's five kinds of cold damage reached by second contraction, and the pulse poem of the upper part's 2.4 enumerates them the same way. They explain why the chapter's name covers so much more than cold.
Uihak Immun 入門
1.16 The Lily Pattern 百合證
Source원문
大病後未平復ㆍ失於調理, 餘證在陽ㆍ醫反下之, 餘證在陰ㆍ醫反汗之, 以此百脉一宗ㆍ悉致其病ㆍ無復經絡, 故謂之百合傷寒. 其證常黙黙然ㆍ欲食不能食ㆍ欲卧不能卧ㆍ欲行不能行, 或有時聞食臭, 或時如寒無寒ㆍ如熱無熱ㆍ口苦ㆍ小便赤, 諸藥不能治ㆍ藥入口卽吐利ㆍ如有神靈, 身形雖似和ㆍ其脉微數. 每尿時輒頭痛者, 六十日乃愈; 若尿時頭不痛ㆍ淅淅然者, 四十日愈; 若尿時快然ㆍ但頭眩者, 二十日愈. 宜用陶氏柴胡百合湯ㆍ百合知母湯ㆍ百合滑石代赭湯ㆍ百合雞子湯ㆍ百合地黃湯ㆍ百合滑石散ㆍ百合洗方. 《仲景》
Translation영역
After a great illness, before he has levelled out and recovered, the regulating care may fail: the residual signs being in the yang, the physician purges instead; the residual signs being in the yin, the physician sweats instead. By this the hundred vessels, which have one ancestor, are all brought to disease and there is no longer any channel or network vessel, and so it is called lily cold damage. Its signs are that he is constantly silent and withdrawn, wishes to eat and cannot eat, wishes to lie down and cannot lie down, wishes to walk and cannot walk; at times he smells the smell of food; at times he is as though cold with no cold and as though hot with no heat, the mouth bitter and the urine dark; no medicine can treat him and the medicine entering his mouth is at once vomited or purged, as though a spirit were at work; and though the body's form seems harmonious, the pulse is faint and rapid. Where the head aches every time he passes water, he heals in sixty days; where the head does not ache on passing water but he shivers, he heals in forty days; where passing water is a relief and only the head is dizzy, he heals in twenty days. Tao's Bupleurum and Lily Decoction, Lily Bulb and Anemarrhena Decoction, Lily Bulb, Talc and Hematite Decoction, Lily Bulb and Egg Yolk Decoction, Lily Bulb and Rehmannia Decoction, Lily Bulb and Talc Powder and the Lily Bulb Wash should be used.
Junggyeong 仲景
Source원문
百合者, 百脉合病也. 治以百合爲主者, 以其能和合百脉也. 《入門》
Translation영역
Lily means the hundred vessels diseased together. That it is treated with lily bulb as the chief is because the bulb can harmonize and join the hundred vessels.
Clinical note임상 주석
欲食不能食ㆍ欲卧不能卧ㆍ欲行不能行 — wishes to eat and cannot, wishes to lie down and cannot, wishes to walk and cannot — is the finest description in the Bogam of a condition with no physical findings and complete incapacity. The patient is silent and withdrawn, cold without being cold and hot without being hot, and 身形雖似和 — the body's form seems harmonious — meaning there is nothing to see. Only the pulse, faint and rapid, is abnormal.
Post-infectious fatigue with autonomic instability is the obvious modern reading, and the chapter attributes it squarely to mismanaged convalescence: the residual signs were in the yang and the patient was purged, or they were in the yin and the patient was sweated. That is as good an account of iatrogenic harm in convalescence as the period produced.
The prognosis by headache on micturition — sixty days, forty days, twenty days — is the strangest piece of staging in the chapter and has no physiological reading that holds up. What it shows is that someone followed these patients long enough to count the weeks, and twenty to sixty days is a realistic range for this kind of recovery.
Zhongjing's seven formulas are organized by what was done to the patient before — sweating, purging, vomiting, or nothing — and each entry sets out the reasoning. Read together they are the most systematic set in the chapter.
Uihak Immun 入門
1.17 Passing the Season Without Resolving 過經不解
Translation영역
In cold damage, in six days it passes through the channels once and on the seventh it should resolve; and where it passes through a second time and goes to the thirteenth day and beyond without healing, it is called passing the season without resolving. It comes of the sweating or purging having been unfitting, so that the evil qi lingers on. One may follow the lighter course and sweat or purge again, and Ginseng, Bupleurum and Peony Decoction or Minor Bupleurum Decoction is apt to regulate it. Both formulas appear above.
Hwarinseo 活人
Source원문
餘熱不退, 皆宜小柴胡湯. 《活人》
Translation영역
Where the residual heat does not retreat, Minor Bupleurum Decoction is apt in every case.
Clinical note임상 주석
Thirteen days is the threshold, taken from the two six-day passages of the upper part's 2.6 with one day over. Beyond it the illness is no longer running its course but lingering, and the cause given is again that the sweating or purging was unfitting.
從輕 — follow the lighter course — is the operative instruction. A patient two weeks into an illness that has been treated twice already cannot take a third full-strength intervention, so the formulas named are both mild and both convalescent. The chapter's repeated answer for anything that will not clear is Minor Bupleurum, which is less a specific than an admission that harmonizing is what is left.
Hwarinseo 活人
1.18 Relapse from Exertion and Relapse from Eating 勞復食復證
Source원문
勞者, 動也. 動非一種, 有內外血氣之異. 若見外證, 則謂之復病ㆍ非爲勞也, 如再感風寒是已. 《海藏》
Translation영역
Exertion means movement. Movement is not of one kind, and there is a difference between inner and outer, blood and qi. If external signs appear, it is called a relapse disease and not exertion — as when wind-cold is contracted a second time.
Haejang 海藏
Source원문
復者, 其病如初也. 傷寒新差ㆍ津液未復ㆍ血氣尙虛, 或梳洗ㆍ言動太早, 或思爲太過, 則成勞復. 蓋勞則生熱, 熱氣乘虛還入經絡, 未免再復, 謂之勞復. 宜小柴胡湯ㆍ麥門冬湯和之; 熱氣浮者, 梔豉枳實湯ㆍ鼠屎豉湯. 《入門》
Translation영역
Relapse means the disease as it was at first. Where cold damage is newly recovered, the fluids not yet restored and the blood and qi still depleted, and he combs and washes or speaks and moves too soon, or thinks and plans too much, then relapse from exertion comes about. For exertion generates heat, and the heat qi, taking advantage of the depletion, returns into the channels and network vessels, and a second relapse cannot be avoided: this is called relapse from exertion. Minor Bupleurum Decoction and Ophiopogon Decoction are apt to harmonize it; where the heat qi floats, Gardenia, Fermented Soybean and Bitter Orange Decoction and Rat Dung and Fermented Soybean Decoction.
Uihak Immun 入門
Source원문
食復者, 傷寒新差ㆍ胃氣尙弱, 若恣食飮ㆍ不能剋化, 依前發熱. 若用補藥則胃熱轉增, 治須淸熱消食. 輕者胸中微滿, 損糓自愈; 重者必須吐下, 宜梔豉枳黃湯; 胸痞者生薑瀉心湯方見上; 飮酒復劇者宜黃連解毒湯. 方見上 《入門》
Translation영역
Relapse from eating is where cold damage is newly recovered and the stomach qi is still weak, and he eats and drinks without restraint and cannot digest it, so that the fever arises as before. If supplementing medicines are used the stomach heat turns and increases, and the treatment must clear the heat and disperse the food. In the light case the chest is slightly full and reducing the grain cures it of itself; in the heavy case there must be vomiting or purging, and Gardenia, Fermented Soybean and Rhubarb Decoction is apt; where the chest is stuffy, Fresh Ginger Heart-Draining Decoction the formula appears above; where it grows severe again from drinking wine, Coptis Resolve Toxicity Decoction is apt. The formula appears above.
Uihak Immun 入門
Translation영역
For relapse from exertion and relapse from eating, Seven-Ingredient Scallion White Powder is apt; for relapse from exertion in the depleted, Qi-Boosting Spirit-Nourishing Decoction.
Uihak Immun 入門
Source원문
凡復證: 先病七日出汗而解, 今復擧亦必七日而解; 先病十四日出汗而解, 今復擧亦必十四日而解. 雖三四次復擧, 亦必三四次戰汗而解. 但勞復證久不愈, 恐成勞瘵. 《入門》
Translation영역
In all relapse patterns: where the first illness resolved by sweating on the seventh day, the present recurrence too will certainly resolve on the seventh; where the first illness resolved by sweating on the fourteenth, the present recurrence too will certainly resolve on the fourteenth. And though it recur three or four times, it will certainly resolve by a shivering sweat three or four times. Only, where the relapse from exertion long goes uncured, it may become consumptive taxation.
Clinical note임상 주석
或梳洗ㆍ言動太早 — combing and washing or speaking and moving too soon — is the most humane detail in the chapter and shows how low the threshold for relapse was taken to be. A convalescent who sat up to have their hair combed was thought to risk the illness returning, and 或思爲太過, thinking and planning too much, is put in the same list. Modern practice would call it graded return to activity.
The two relapses take opposite treatments and the text is explicit about it: relapse from exertion is harmonized and supplemented; relapse from eating must not be given supplementing medicines, because 用補藥則胃熱轉增. 損糓自愈 — reduce the grain and he heals of himself — is the mild version, and the same instruction appears in the upper part at 2.73.
The claim that a relapse resolves on the same day of its course as the first illness is not credible, but the closing warning is: a relapse from exertion that goes on too long becomes 勞瘵, consumptive taxation. That is the chapter conceding that some of these patients never recover, and it is the route by which an acute febrile illness enters the Taxation chapter.
Uihak Immun 入門
1.19 The Remaining Pattern of Cold Damage 傷寒遺證
Source원문
帝曰: 熱病已愈ㆍ時有所遺者, 何也? 歧伯曰: 諸遺者, 熱甚而强食之, 故有所遺也. 帝曰: 治遺柰何? 歧伯曰: 視其虛實ㆍ調其逆從, 可使必已矣. 帝曰: 病熱當何禁之? 歧伯曰: 病熱少愈ㆍ食肉則復ㆍ多食則遺, 此其禁也. 《內經》
Translation영역
The Emperor said: where the heat disease has already healed and yet at times something remains, why is this? Qibo said: in all cases of something remaining, it is because the heat was severe and he was pressed to eat, and so something remains. The Emperor said: how is what remains to be treated? Qibo said: look to whether he is depleted or replete and regulate the contrary and the compliant, and it may certainly be brought to an end. The Emperor said: in a heat disease, what should be prohibited? Qibo said: where the heat disease is a little healed, eating meat brings it back and eating much leaves something remaining; this is the prohibition.
Naegyeong 內經
Source원문
遺謂遺熱. 內經註曰: 如遺之在人也. 所謂遺者, 大小便不禁也. 嘗見病差後善飮食而大小便不禁, 故知之. 《活人》
Translation영역
What remains means remaining heat. The commentary to the Neijing says: it is like something left behind in a man. What is called remaining is the stool and urine not being held. I have seen a case where after the disease had recovered he ate and drank well and the stool and urine were not held, and from this I know it.
Hwarinseo 活人
Source원문
當與食復參看.
Translation영역
It should be read together with relapse from eating.
Clinical note임상 주석
食肉則復ㆍ多食則遺 — eating meat brings it back, eating much leaves something remaining — is the Neijing's dietary prohibition for convalescence and it distinguishes two outcomes: a frank relapse from rich food, and a residue from too much of any food. The Bogam's cross-reference to the relapse section is the right one.
Zhu Gong's reading of 遺 as incontinence rather than as residual heat is a minority one and he gives his evidence: a patient who recovered, ate well and could not hold stool or urine. Post-infectious incontinence in a debilitated patient is real, and the honesty of 嘗見 — I have seen a case — is worth more than the etymology.
Hwarinseo 活人
1.20 The Yin-Yang Exchange Pattern 陰陽易證
Source원문
傷寒病新差ㆍ陰陽未和, 因合房室, 則令人陰腫入腹ㆍ絞痛; 婦人則裏急ㆍ腰胯連腹內痛, 名爲陰陽易也. 其男子病新差ㆍ婦人與之交得病, 名曰陽易; 婦人病新差ㆍ男子與之交得病, 名曰陰易. 若二男二女, 幷不相易. 所以呼爲易者, 以陰陽相感動ㆍ其毒着於人ㆍ如換易然. 其病之狀: 身熱ㆍ衝胸ㆍ頭重不能擧ㆍ眼中生火ㆍ四肢拘急ㆍ小腹絞痛ㆍ手足拳, 卽死. 亦有不卽死者, 病苦小腹裏急ㆍ熱上衝胸ㆍ頭重不能擧ㆍ百節解離ㆍ經脉緩弱ㆍ血氣虛ㆍ骨髓乾, 便恍恍翕翕ㆍ氣力轉少ㆍ着床不能動搖ㆍ起止須人, 或牽引歲月方死. 《活人》
Translation영역
Where the cold damage disease is newly recovered and the yin and yang are not yet harmonized, and he thereupon joins in the bedchamber, it gives a man a swelling of the genitals entering the abdomen with gripping pain; and in a woman urgency within, with pain of the lumbus and hips continuing into the abdomen. This is named the yin-yang exchange. Where a man's disease is newly recovered and a woman has intercourse with him and gets the disease, it is called a yang exchange; where a woman's disease is newly recovered and a man has intercourse with her and gets the disease, it is called a yin exchange. Between two men or two women there is no exchanging at all. The reason it is called an exchange is that the yin and yang are stirred by feeling for one another, and the toxin attaches to the person as though it were being traded. The form of the disease is generalized fever, a surging against the chest, the head too heavy to lift, fire arising within the eyes, the four limbs hypertonic, gripping pain of the lower abdomen and the hands and feet clenched; and he dies at once. There are also those who do not die at once, whose illness distresses them with urgency within the lower abdomen, heat surging up against the chest, the head too heavy to lift, all the hundred joints loosened and coming apart, the channel vessels slack and weak, the blood and qi depleted and the marrow of the bones dried; he becomes vague and faint, his strength of qi turns to little, he takes to his bed and cannot stir, and must have someone to help him rise and settle, and may be drawn out over months and years before he dies.
Hwarinseo 活人
Translation영역
For the yin-yang exchange, Burnt Undergarment Powder, Red Garment Powder, Rat Dung Decoction, Green Bamboo Shavings Decoction, Bamboo Skin Decoction and Dried Ginger Decoction are apt; where the scrotum is retracted, there is pain and the qi is about to be severed, Bamboo Skin Free Wanderer Powder is apt.
Uihak Immun 入門
Source원문
女勞復者, 不因易而自病復也, 治亦相同; 但多憎寒ㆍ發熱ㆍ虛弱者, 人參逍遙散. 《入門》
Translation영역
Relapse from intercourse is a relapse of his own disease and not through an exchange, and the treatment is likewise the same; only where there is much loathing of cold, fever and depletion, Ginseng Free Wanderer Powder.
Uihak Immun 入門
Source원문
陰陽易病見舌吐出者, 必死. 《寶鑑》
Translation영역
In the yin-yang exchange disease, where the tongue is seen to be thrust out, he will certainly die.
Bogam 寶鑑
Source원문
顧子獻病傷寒新差, 華佗診脉曰: 尙虛未復ㆍ陽氣不足, 勿爲勞事. 餘勞尙可, 女勞卽死, 死當吐舌數寸. 其妻聞病差ㆍ從百里來省之, 住數宿, 果爲勞事, 遂吐舌數寸而死. 《活人》
Translation영역
Gu Zixian's cold damage was newly recovered, and Hua Tuo examined his pulse and said: he is still depleted and not recovered, the yang qi is insufficient, let him do no laborious thing. Other labour would still pass, but labour with a woman means death at once, and in dying he will thrust out his tongue some inches. His wife heard that the illness had recovered and came a hundred li to visit him, stayed several nights, and he did indeed labour; and he thrust out his tongue some inches and died.
Hwarinseo 活人
Source원문
有婦人病傷寒, 賊來不能走, 其賊六七人姦之, 皆得婦人病而死. 此陰陽易也. 《外臺》
Translation영역
There was a woman ill with cold damage who, when robbers came, could not run; six or seven of the robbers violated her, and all got the woman's disease and died. This is the yin-yang exchange.
Clinical note임상 주석
陰陽易 is the Bogam's name for an illness passed between a convalescent and a sexual partner, and the chapter treats it as a distinct disease with its own signs and prognosis. The signs it describes in the surviving case — the hundred joints loosened, the channels slack, strength gone, bedbound and needing help to rise, drawn out over months or years — are a protracted post-infectious debility, and that part of the account is clinically recognizable whatever one makes of the transmission theory.
若二男二女, 幷不相易 is the theory's own limit, and it is the clearest sign that the mechanism being proposed is one of yin-yang complementarity rather than of contagion. The Bogam is reasoning from the polarity, not from observation, and it follows that the remedies at 1.20's second passage work the same way: the partners use each other's burnt garment. Those entries carry the warnings they require and are not to be made.
The two case records are of a different character. Hua Tuo's is a prognosis given and fulfilled, with a specific predicted sign; the Oedae's is a report of multiple transmissions from one patient with no treatment and no survivors. Neither can be verified. Both were kept because they were the strongest evidence the compilers had for a prohibition they wanted obeyed, and the tenth of Li Zijian's admonitions at 1.44.10 puts it in a single line: 犯房室者必死.
Oedae 外臺
1.21 The Pattern of Heat Entering the Blood Chamber 熱入血室證
Source원문
婦人傷寒與男子無異, 惟熱入血室及姙娠傷寒則不同也. 《雲歧》
Translation영역
Cold damage in a woman is no different from in a man; only heat entering the blood chamber and cold damage in pregnancy are not the same.
Ungi 雲歧
Source원문
婦人以血爲主, 血室卽衝脉血海也. 婦人傷寒發熱ㆍ經水適來適斷ㆍ晝日明了ㆍ夜則譫語如見鬼狀, 此爲熱入血室. 無犯胃氣及上二焦, 必自愈. 活人書云: 小柴胡湯加生地黃主之. 犯胃氣謂下之, 犯上二焦謂發汗也. 《仲景》
Translation영역
A woman takes the blood as her governing principle, and the blood chamber is the thoroughfare vessel, the sea of blood. In a woman with cold damage and fever, where the menstrual water has just come or just stopped, who is clear by day and delirious at night as though she saw ghosts, this is heat entering the blood chamber. Do not transgress against the stomach qi or against the upper two burners, and she will certainly heal of herself. The Hwarinseo says: Minor Bupleurum Decoction with fresh rehmannia added governs it. Transgressing against the stomach qi means purging her, and transgressing against the upper two burners means raising a sweat.
Junggyeong 仲景
Translation영역
In a woman with cold damage, chill and fever like malaria, quiet by day and agitated at night, as though she saw ghosts, this is heat entering the blood chamber. Where there is no repletion and fullness, Minor Bupleurum Decoction with moutan bark added; where there is great repletion and fullness, Peach Kernel Qi-Coordinating Decoction governs it.
Ungi 雲歧
Translation영역
Where heat has entered the blood chamber, the blood must bind and not move, and Minor Bupleurum with moutan bark and peach kernel added, or Minor Bupleurum combined with Four Substances Decoction, governs it; Ox Bezoar Paste also governs it. The formula appears in the Women's chapter.
Uihak Immun 入門
Source원문
婦人傷寒發熱ㆍ經水適來, 經行盡則熱隨血散ㆍ不治自愈. 如熱除而脉遲ㆍ身涼ㆍ胸脇下滿ㆍ按之痛者, 謂之血結胸, 當刺期門穴名ㆍ隨其實而瀉之, 宜服桂枝紅花湯. 《入門》
Translation영역
In a woman with cold damage and fever where the menstrual water has just come, once the menses have run their course the heat disperses along with the blood and she heals of herself without treatment. But if the heat is removed and the pulse is slow, the body cool, with fullness below the chest and rib-side that pains on pressing, it is called a blood chest bind; Qimen the name of a point should be needled and drained according to its repletion, and Cinnamon Twig and Safflower Decoction should be taken.
Clinical note임상 주석
無犯胃氣及上二焦 — do not transgress against the stomach qi or the upper two burners — with its gloss naming purging and sweating as the two transgressions, is the whole treatment: leave this patient alone and she heals. That is an unusual instruction for this chapter and the Bogam repeats it in the last passage: once the menses have run their course the heat goes with the blood, 不治自愈, she heals of herself without treatment.
晝日明了ㆍ夜則譫語 — clear by day and delirious at night — is the same diurnal pattern as at 1.4, and here the Bogam attaches it specifically to a febrile illness coinciding with menstruation. A fever at the onset or end of a period, with nocturnal confusion, is a real enough conjunction, and treating it as a recognized pattern rather than as two unrelated events is reasonable.
The escalation is graded by abdominal findings: no repletion and fullness takes Minor Bupleurum with moutan bark, great repletion takes Peach Kernel Qi-Coordinating Decoction. Needling Qimen LR-14 for the blood chest bind is one of the few places in this chapter where acupuncture is prescribed for a specific point and a specific finding, and the next section explains the reasoning behind it.
Uihak Immun 入門
1.22 Blood Chest Bind 血結胸
Source원문
或問: 熱入血室, 何爲而成結胸也? 予曰: 邪氣傳入經絡ㆍ與正氣相搏ㆍ上下流行, 或遇經水適來適斷, 邪氣乘虛而入血室; 血爲邪迫ㆍ上入肝經, 肝受邪則譫語而見鬼; 復入膻中, 則血結於胸也. 何以言之? 婦人平居, 水當養於木ㆍ血當養於肝: 方未受孕, 則下行之以爲月水; 旣姙, 則中畜之以養胎; 及已産, 則上壅之以爲乳汁. 皆此血也. 今邪氣蓄血ㆍ倂歸肝經ㆍ聚於膻中ㆍ結於乳下, 故手觸之則痛, 非湯劑可及, 故當刺期門也. 《本事》
Translation영역
Someone asked: when heat enters the blood chamber, how does it come to make a chest bind? I said: the evil qi passes into the channels and network vessels, beats against the upright qi and flows up and down, and should it meet the menstrual water just coming or just stopping, the evil qi takes advantage of the depletion and enters the blood chamber; the blood, pressed by the evil, goes up into the liver channel, and the liver receiving the evil there is delirious speech and the seeing of ghosts; and entering the chest centre again, the blood binds in the chest. How is this to be put? In a woman's ordinary state, the water should nourish the wood and the blood should nourish the liver: before she has conceived it goes downward and becomes the monthly water; once pregnant it is stored in the middle to nourish the foetus; and after she has given birth it is dammed upward and becomes milk. It is all this same blood. Now the evil qi and the stored blood go together into the liver channel, gather in the chest centre and bind below the breast, and so it pains when the hand touches it; and it is not within the reach of a decoction, and therefore Qimen should be needled.
Clinical note임상 주석
A single long answer to a single question, and the reasoning is as sustained as anything in the chapter. Xu Shuwei is asked why heat in the blood chamber should produce a chest bind, and his answer traces a route: evil qi enters the blood chamber at the vulnerable moment of the menses, drives the blood up into the liver channel, which gives the delirium, and then into the chest, where it binds.
The physiological frame is the identity of menstrual blood, foetal blood and milk — downward before conception, stored in the middle in pregnancy, dammed upward after birth, all the same blood. That is a coherent account and it is the reason the chest is the place the displaced blood is expected to go.
非湯劑可及 — not within the reach of a decoction — is the conclusion and the justification for needling. A tender mass below the breast is a local finding, and the argument is that a drug taken by mouth cannot reach what a needle at Qimen can. Whether or not that is so, it is a reasoned preference for one modality over another on anatomical grounds, which is rare in this literature.
Bonsa 本事
1.23 Absence of Pulse in Cold Damage Means a Sweat Is Coming 傷寒無脉爲欲汗
Source원문
傷寒兩手無脉曰雙伏, 一手無脉曰單伏.
Translation영역
In cold damage, no pulse in both hands is called a double hiding, and no pulse in one hand a single hiding.
Hwarinseo 活人
Source원문
若病人寒熱而厥ㆍ面色不澤ㆍ冒昧ㆍ而兩手忽無脉ㆍ或一手無脉者, 必是有正汗也. 如天之欲雨ㆍ六合昏昧. 多用綿衣褁手足令溫煖, 急服五味子湯, 晬時必有大汗而解矣. 《活人》
Translation영역
If the sick man has chill and fever with reversal, the colour of the face without lustre, and is fogged and dull, and the pulse is suddenly absent in both hands or in one, there is certainly a proper sweat coming. It is as when the heavens are about to rain and the six directions are dark and dull. Use plenty of cotton clothing to wrap the hands and feet and make them warm, give Schisandra Decoction urgently, and in a full day there will certainly be a great sweat and it will resolve.
Hwarinseo 活人
Source원문
傷寒病六七日來ㆍ別無刑克證ㆍ忽昏迷不省ㆍ脉靜或無, 此欲作正汗, 如久旱將雨之兆. 喘促無脉者加味生脉散, 陰躁無脉者回陽返本湯, 下利脉不至白通加猪膽汁湯二方見上, 脉結者灸甘草湯方見脉部, 寒熱鬱閉者兩手俱無脉ㆍ亦是好汗相逼ㆍ汗出自愈, 宜麻黃附子細辛湯方見上加人參ㆍ五味子. 以汗出ㆍ脉續出則生; 服藥而仍前無汗ㆍ脉不至者死. 《入門》
Translation영역
Where the cold damage disease has come to the sixth or seventh day with no sign of punishing overwhelming, and he suddenly falls into a clouded stupor and is not aware, with the pulse quiet or absent, this is a proper sweat about to be made, like the sign of rain after a long drought. Where there is hurried panting with no pulse, Supplemented Generate the Pulse Powder; where there is yin agitation with no pulse, Restore the Yang and Return to the Root Decoction; where there is diarrhoea and the pulse does not arrive, White Through-Flow Decoction with Pig's Bile Added both formulas appear above; where the pulse is bound, Honey-Fried Licorice Decoction the formula appears in the Pulse chapter; where chill and fever are depressed and shut in, the pulse is absent in both hands and this too is a good sweat pressing to come out, and sweat coming he heals of himself, for which Ephedra, Aconite and Asarum Decoction the formula appears above with ginseng and schisandra added is apt. Where sweat comes out and the pulse comes out after it, he lives; where he takes the medicine and there is still no sweat as before and the pulse does not arrive, he dies.
Clinical note임상 주석
The whole section rests on a hopeful reading of a frightening finding: a pulseless, obtunded patient on day six or seven is about to break into a sweat, 如久旱將雨之兆, like the sign of rain after a long drought. The image is honest about being a hope.
What saves it from wishful thinking is the decision rule at the end: 以汗出脉續出則生, 服藥而仍前無汗脉不至者死. Sweat followed by a returning pulse means recovery; medicine given with neither means death. The prognosis is made on the response rather than on the presentation, which is the most reliable kind.
綿衣褁手足令溫煖 — wrap the hands and feet in cotton clothing to warm them — is simple external warming and is the right first move in a shut-down, vasoconstricted patient. The five formulas that follow are sorted by what accompanies the missing pulse: panting, agitation, diarrhoea, a bound pulse, or nothing but the chill and fever.
Uihak Immun 入門
1.24 Clouding and Sinking After Recovery 差後昏沉
Source원문
傷寒差後, 或十數日ㆍ或二十日, 終不惺惺ㆍ常昏沉似失精神ㆍ言語錯謬, 又無寒熱. 醫或作鬼祟ㆍ或作風疾, 多般治不差. 或朝夕潮熱往來ㆍ頰赤, 或有寒熱似瘧, 都是發汗不盡ㆍ餘毒在心胞間所致. 知母麻黃湯主之. 方見上 《得效》
Translation영역
After recovery from cold damage, for ten days and more or for twenty days, he is never alert, is constantly clouded and sunken as though he had lost his spirit, and his speech is confused, and yet there is no chill or fever. The physician may take it for a haunting by ghosts, or for a wind ailment, and many kinds of treatment do not cure it. Or there is tidal fever coming and going morning and evening with flushed cheeks, or there is chill and fever like malaria; and all of it is brought about because the sweating was not carried through and a residual toxin remains in the pericardial space. Anemarrhena and Ephedra Decoction governs it. The formula appears above.
Deukhyobang 得效
Source원문
陶氏導赤各半湯極妙. 《入門》
Translation영역
Tao's Half-and-Half Red-Guiding Decoction is most excellent.
Uihak Immun 入門
Source원문
傷寒後無寒熱雜證ㆍ但漸變神昏不語, 或睡中獨語一二句ㆍ目赤ㆍ唇焦ㆍ舌乾ㆍ不飮水, 稀粥與之則嚥ㆍ不與則不思, 心下無痞ㆍ腹中不滿ㆍ大小便如常ㆍ形貌如醉人, 此熱傳手少陰心經也. 心火熏肺, 所以神昏, 名曰越經證, 宜陶氏導赤各半湯. 《入門》
Translation영역
After cold damage, with no chill and fever and no other pattern, he only changes by degrees to a clouded spirit and does not speak, or in his sleep says one or two sentences alone; the eyes are red, the lips scorched, the tongue dry and he does not drink water; given thin gruel he swallows it and if it is not given he does not think of it; there is no stuffiness below the heart, no fullness within the abdomen, the stool and urine are as usual, and his form and look are those of a drunken man. This is the heat passing into the hand shaoyin heart channel. The heart fire fumes the lung, and this is why the spirit is clouded; it is named the channel-leaping pattern, and Tao's Half-and-Half Red-Guiding Decoction is apt.
Clinical note임상 주석
形貌如醉人 — his form and look are those of a drunken man — is the best phrase in the section and names an appearance that has no clinical term: a patient neither asleep nor awake, speaking a sentence or two and then silent, eating when fed and not asking to be fed. Post-infectious encephalopathy is the modern reading and the description is exact.
The negatives are what make it diagnostic: no fever, no stuffiness below the heart, no abdominal fullness, stool and urine normal. Everything that would point elsewhere is absent, and what remains is a clouded mind after an illness that has otherwise resolved. 醫或作鬼祟 — the physician may take it for a haunting — records what actually happened to these patients, and the chapter's insistence that it is residual heat rather than possession is a real advance.
餘毒在心胞間 — residual toxin in the pericardial space — is the same explanation Anemarrhena and Ephedra Decoction's entry gives, and it attributes the whole condition to sweating that was not carried through. The chapter is consistent: nearly every convalescent complication in it is traced back to incomplete or mistaken treatment.
Uihak Immun 入門
1.25 Residual Heat That Will Not Retreat 餘熱不退
Translation영역
Where the residual heat of cold damage does not retreat, Minor Bupleurum Decoction serves generally to regulate it; where the urine is dark and rough, Bupleurum and Poria Decoction. Both formulas appear above.
Uihak Immun 入門
Source원문
吐ㆍ汗ㆍ下三法之後, 別無異證者, 涼膈散方見火門調之. 《宣明》
Translation영역
After the three methods of vomiting, sweating and purging, where there is no other unusual pattern, Cool the Diaphragm Powder the formula appears in the Fire chapter regulates it.
Seonmyeong 宣明
Source원문
餘熱盛ㆍ或發狂言, 辰砂益元散最妙. 方見下 《入門》
Translation영역
Where the residual heat is exuberant or wild speech arises, Cinnabar Benefit the Origin Powder is best of all. The formula appears below.
Uihak Immun 入門
Source원문
發熱之後熱不解ㆍ脉尙浮者, 白虎湯加蒼朮再解之. 方見上
Translation영역
After the fever, where the heat does not resolve and the pulse is still floating, White Tiger Decoction with atractylodes lancea added resolves it a second time. The formula appears above.
Hagan 河間
Translation영역
After cold damage, where the depletion heat will not cease, White Tiger with atractylodes lancea and ginseng added, one dose and it is marvellous: the sweating stops and the body cools. This is a method that goes through to the spirits. Thus where the heat does not retreat after sweating or purging, whether there is sweating or no sweating, White Tiger with atractylodes lancea and ginseng added is best of all to resolve it.
Hagan 河間
Source원문
傷寒後六經餘熱不退, 宜加減凉膈散. 方見火門 《正傳》
Translation영역
After cold damage, where the residual heat of the six channels does not retreat, Adjusted Cool the Diaphragm Powder is apt. The formula appears in the Fire chapter.
Clinical note임상 주석
Liu Wansu's recommendation in the fifth passage overrides a prohibition the upper part stated twice: 不問有汗無汗 — whether there is sweating or no sweating — give White Tiger with atractylodes lancea and ginseng. At 2.26 the chapter said plainly that one who is thirsty without sweating may not be given it. Here, in the convalescent case, Liu sets that aside.
The reason is implied by the two additions. Ginseng replaces what the illness spent and atractylodes lancea handles the damp, so the formula is no longer the cold mineral purgative the prohibition was written against. 此通神之法也 is enthusiasm rather than evidence, but the clinical situation — a patient whose fever broke and whose low-grade heat will not clear — is common and the formula is a reasonable answer to it.
Uihak Jeongjeon 正傳
1.26 The Fox-Delusion Pattern 狐惑證
Source원문
虫證也. 如狐聽氷ㆍ猶豫不決之義. 其候四肢沉重ㆍ黙黙欲眠ㆍ目不得閉ㆍ惡聞食臭ㆍ舌白ㆍ齒晦ㆍ面目乍赤乍白乍黑ㆍ變異無常. 此因大病後腸胃空虛ㆍ三虫求食ㆍ食人五藏: 蝕其喉則爲惑ㆍ其聲啞; 蝕其肛則爲狐ㆍ其咽乾. 殺人甚急. 當看上唇有瘡ㆍ虫蝕其藏; 下唇有瘡ㆍ虫蝕其肛. 蝕上部者三黃瀉心湯主之方見上; 蝕下部者苦參湯熏洗之; 蝕肛門者生艾汁調雄黃末ㆍ燒烟熏之. 通用黃連犀角湯ㆍ治惑桃仁湯ㆍ雄黃銳散. 《入門》
Translation영역
It is a worm pattern. The sense of it is that of a fox listening to the ice, hesitating and undecided. Its signs are heaviness of the four limbs, silence and a wish to sleep with the eyes unable to close, loathing the smell of food, a white tongue, dull teeth, and the face and eyes now red, now white, now black, changing without constancy. This comes about because after a great illness the intestines and stomach are empty, the three worms seek food and eat the man's five viscera: where they gnaw his throat it is delusion and his voice is hoarse; where they gnaw his anus it is fox and his throat is dry. It kills a man very quickly. One should look for a sore on the upper lip, where the worms have gnawed his viscera, and on the lower lip, where the worms have gnawed his anus. Where the upper part is gnawed, Three Yellows Heart-Draining Decoction governs it the formula appears above; where the lower part is gnawed, fumigate and wash it with sophora decoction; where the anus is gnawed, mix realgar powder with fresh mugwort juice and fumigate it with the smoke of its burning. In general, Coptis and Rhinoceros Horn Decoction, Peach Kernel Decoction for the Delusion Pattern and Realgar Sharp Suppository are used.
Clinical note임상 주석
狐惑 maps closely onto what is now called Behçet's disease, and the correspondence is one of the most striking in the whole Bogam: ulceration of the mouth and throat together with ulceration of the genitals or anus, in a patient who is exhausted, cannot sleep though the eyes will not close, and whose colour changes. All of that is recognizable, and the relation to a preceding illness that the chapter asserts is a reasonable guess at a post-infectious trigger.
如狐聽氷ㆍ猶豫不決 — a fox listening to the ice, hesitating and undecided — is the gloss on the name, and the image is of something that cannot settle. Whether the disease was named for the patient's restlessness or for the shifting of the signs, the compilers thought the indecision worth explaining.
三虫求食ㆍ食人五藏 is the aetiology and it is wrong, but the treatment it produces is not foolish: local washes and fumigations for the lower sores, a cold bitter formula for the upper ones, and the staged inspection of the upper and lower lip as a guide to where the ulceration is. Realgar is arsenic sulphide and the suppository is not to be made; the two decoctions are, with water buffalo horn in place of the rhinoceros.
Uihak Immun 入門
1.27 Miscellaneous Patterns After Recovery from Cold Damage 傷寒差後雜證
Translation영역
After recovery from cold damage, with depletion vexation and inability to sleep, Sour Jujube Seed Decoction and Mume Plum Decoction are apt.
Hwarinseo 活人
Translation영역
After recovery, where he does not eat, Ginseng, Poria and Atractylodes Powder and Concentrate the Spirit Powder are apt. Both formulas appear in the Internal Damage chapter.
Uihak Immun 入門
Translation영역
After recovery, with heat and wild speech, Cinnabar Five-Ingredient Poria Powder and Cinnabar Benefit the Origin Powder are apt.
Uihak Immun 入門
Source원문
差後虛煩欲嘔, 宜竹葉石膏湯. 方見上 《入門》
Translation영역
After recovery, with depletion vexation and a wish to retch, Bamboo Leaf and Gypsum Decoction is apt.
Clinical note임상 주석
Four lines for four convalescent complaints — sleeplessness, loss of appetite, residual heat with confusion, and nausea — and between them they cover most of what a patient actually brings in the weeks after a severe febrile illness. The chapter's long attention to convalescence ends here in a plain list.
Both cinnabar formulas in the third line are mercuric sulphide and their entries carry the warnings they require; the pattern they treat is addressed by the settling and clearing formulas elsewhere in the chapter. The other five are all still usable, and Bamboo Leaf and Gypsum is the one most often reached for.
Uihak Immun 入門
1.28 The Method of Treating Cold Damage 傷寒治法
Source원문
張仲景傷寒論載三百九十七法ㆍ一百一十有三方. 惜乎! 其書一變於王叔和之撰次, 再變於成無己之詮註, 傳之愈久而愈失其眞也. 《正傳》
Translation영역
Zhang Zhongjing's Treatise on Cold Damage sets down three hundred and ninety-seven methods and one hundred and thirteen formulas. What a pity! His book was altered once by Wang Shuhe's arranging of it and altered again by Cheng Wuji's annotating of it, and the longer it has been transmitted the further it has lost its true form.
Uihak Jeongjeon 正傳
Source원문
帝曰: 治之柰何? 歧伯曰: 治之各通其藏脉ㆍ病日衰已矣. 其未滿三日者可汗而已, 其滿三日者可泄而已. 《內經》
Translation영역
The Emperor said: how is it to be treated? Qibo said: treat it by freeing each one's visceral vessel, and day by day the disease declines and is finished. Where three days are not yet full it may be merely sweated; where three days are full it may be merely drained.
Naegyeong 內經
Source원문
陽盛陰虛, 下之則愈ㆍ汗之則死; 陰盛陽虛, 汗之則愈ㆍ下之則死. 此陰陽指表裏而言之也. 《難經》
Translation영역
Where yang is exuberant and yin depleted, purging cures and sweating kills; where yin is exuberant and yang depleted, sweating cures and purging kills. Here yin and yang are spoken of as pointing to exterior and interior.
Nangyeong 難經
Translation영역
Cinnamon twig passing the throat, and the yang being exuberant, he perishes; an Order the Qi entering the stomach, and the yin being exuberant, he is lost.
Junggyeong 仲景
Source원문
傷寒五法者, 汗ㆍ吐ㆍ下ㆍ溫ㆍ解也, 各有不同: 汗有大汗發表ㆍ微汗解肌之異; 下有急下ㆍ少與微和ㆍ滲利之殊; 溫有兼補者; 吐有宣涌ㆍ探引者; 和解則一而已. 《入門》
Translation영역
The five methods of cold damage are sweating, vomiting, purging, warming and resolving, and each is not the same as the others: in sweating there is the difference between a great sweat to bring out the exterior and a slight sweat to resolve the flesh; in purging there is the distinction between urgent purging, giving a little to harmonize slightly, and percolating and disinhibiting; in warming there is the kind that supplements as well; in vomiting there is the diffusing and welling up and the probing and drawing out; and in harmonizing and resolving there is only the one.
Uihak Immun 入門
Source원문
汗ㆍ吐ㆍ下三法, 毫釐不可差誤. 在表宜汗, 在裏宜下, 在胸宜吐, 在半表半裏宜和解, 表裏俱見ㆍ隨證滲泄. 《得效》
Translation영역
In the three methods of sweating, vomiting and purging there may be no error of a hair's breadth. Where it is in the exterior, sweating is apt; in the interior, purging; in the chest, vomiting; in the half-exterior and half-interior, harmonizing and resolving; and where exterior and interior appear together, percolate and drain according to the pattern.
Deukhyobang 得效
Source원문
傷寒之病: 太陽屬膀胱, 非發汗則不愈, 必用麻黃之類, 蓋其性能通陽氣ㆍ却外寒也; 陽明屬胃, 非通泄則不愈, 須用大黃ㆍ芒硝以利之; 少陽屬膽ㆍ無出入道, 柴胡ㆍ半夏能利能汗ㆍ佐以黃芩則能解矣; 太陰屬脾ㆍ性惡寒濕, 非乾薑ㆍ白朮則不能燥; 少陰屬腎ㆍ性畏寒燥, 非附子不能溫; 厥陰屬肝ㆍ藏血養筋, 非溫中之藥不能潤. 《得效》
Translation영역
In the disease of cold damage: the taiyang belongs to the bladder, and nothing but sweating cures it, and the ephedra class must be used, for its nature can free the yang qi and drive off the external cold; the yangming belongs to the stomach, and nothing but freeing and draining cures it, and rhubarb and mirabilite must be used to disinhibit it; the shaoyang belongs to the gallbladder and has no road in or out, and bupleurum and pinellia can disinhibit and can sweat, and assisted by scutellaria can resolve it; the taiyin belongs to the spleen, whose nature loathes cold and damp, and nothing but dried ginger and atractylodes can dry it; the shaoyin belongs to the kidney, whose nature fears cold and dryness, and nothing but aconite can warm it; the jueyin belongs to the liver, which stores blood and nourishes the sinews, and nothing but a medicine that warms the middle can moisten it.
Deukhyobang 得效
Translation영역
For the taiyang-yangming, Major Order the Qi; for the shaoyang-yangming, Minor Order the Qi; for the upright-yang yangming, Regulate the Stomach and Order the Qi: these are for the three yang having already entered the viscera, and drain them. For the taiyin, Cinnamon Twig Decoction; for the shaoyin, Ephedra, Aconite and Asarum Decoction; for the jueyin, Tangkuei Frigid Extremities Decoction: these are for the three yin not yet having entered the viscera, and sweat them.
Dongwon 東垣
Source원문
傷寒三日前可汗ㆍ三日後可下, 此大略言之耳. 凡病人有虛實ㆍ邪氣有淺深, 豈可拘以日數? 仲景云: 日數雖多, 但有表證而脉浮者, 猶宜發汗; 日數雖少, 有裏證而脉沉者, 卽宜下之. 此活法也. 《活人》
Translation영역
That in cold damage before the third day it may be sweated and after the third day purged is spoken only as a broad outline. Sick men are depleted or replete and the evil qi shallow or deep; how shall one be bound by the count of days? Zhongjing says: though the days be many, if there are exterior signs and the pulse is floating, sweating is still apt; though the days be few, if there are interior signs and the pulse is deep, it should be purged at once. This is the living method.
Hwarinseo 活人
Source원문
九味羌活湯發三時之表春夏秋; 六神通解散方見正傳理晩發之邪; 香蘇散ㆍ十神湯ㆍ參蘇飮發表調中; 葛根湯ㆍ解肌湯; 小柴胡和解半表; 大柴胡ㆍ三承氣攻熱邪傳裏; 理中湯ㆍ四逆湯散寒中陰經; 柴苓湯ㆍ益元散治泄瀉身熱. 《丹心》
Translation영역
Nine-Ingredient Notopterygium Decoction brings out the exterior in the three seasons spring, summer and autumn; Six Spirits Freeing and Resolving Powder the formula appears in the Jeongjeon regulates a late-breaking evil; Cyperus and Perilla Powder, Ten Spirits Decoction and Ginseng and Perilla Drink bring out the exterior and regulate the middle; Pueraria Decoction and Flesh-Resolving Decoction resolve the flesh; Minor Bupleurum harmonizes and resolves the half-exterior; Major Bupleurum and the three Order the Qi formulas attack a heat evil passed into the interior; Regulate the Middle Decoction and Frigid Extremities Decoction scatter cold struck into a yin channel; Bupleurum and Poria Decoction and Benefit the Origin Powder treat diarrhoea with generalized fever.
Dansim 丹心
Source원문
傷寒宜用湯以盪滌邪熱, 不宜用丸藥也. 《本事》
Translation영역
In cold damage, decoctions should be used to sluice out the evil heat, and pills are not apt.
Clinical note임상 주석
桂枝下咽ㆍ陽盛則斃; 承氣入胃ㆍ陰盛乃亡 is the most quoted sentence in the cold damage literature and is the chapter's whole argument in twelve characters. The two commonest formulas, each lethal in the other's patient. Everything in the two parts of this chapter is in service of telling them apart.
豈可拘以日數 — how shall one be bound by the count of days — is the Hwarinseo setting aside the Neijing's three-day rule two passages earlier, and the ground it gives is the right one: the pulse and the signs, not the calendar. 此活法也, this is the living method, is the phrase this literature uses for a rule that bends to the case.
The Deukhyobang's channel-by-channel assignment of drugs is the most compressed materia medica in the chapter and worth learning as it stands: ephedra for the bladder, rhubarb and mirabilite for the stomach, bupleurum and pinellia for the gallbladder, dried ginger and atractylodes for the spleen, aconite for the kidney, warming drugs for the liver. Six channels, six drug classes, and the Bogam's whole pharmacology for this disease.
The closing preference for decoctions over pills is practical: a decoction acts within hours and can be stopped, and in a disease that changes within hours that matters more than convenience.
Bonsa 本事
1.29 Cold Damage About to Resolve 傷寒欲解
Source원문
傷寒三日ㆍ脉浮數而微ㆍ身溫和者, 此爲欲解也. 脉浮而解者, 濈然汗出也; 脉浮而解者, 必能食也; 脉不浮而解, 必大汗出也. 《仲景》
Translation영역
In cold damage on the third day, where the pulse is floating, rapid and faint and the body warm and harmonious, this is about to resolve. Where it resolves with a floating pulse, sweat comes out continuously; where it resolves with a floating pulse, he will certainly be able to eat; where it resolves without the pulse floating, there will certainly be a great sweat.
Junggyeong 仲景
Source원문
六七日脉至皆大ㆍ煩而口噤不能言ㆍ躁擾者, 必欲解也. 《仲景》
Translation영역
On the sixth or seventh day, where the pulses all arrive large, and he is vexed with the mouth clenched and unable to speak and restlessly agitated, it is certainly about to resolve.
Junggyeong 仲景
Source원문
必當先煩ㆍ乃有汗而解. 何以知之? 脉浮故知汗出解也. 《脉經》
Translation영역
There must first be vexation, and then there is sweat and it resolves. How is this known? Because the pulse is floating, one knows the sweat will come out and resolve it.
Maekgyeong 脉經
Source원문
若脉平和ㆍ其人大煩ㆍ目重瞼內際黃者, 皆欲解也. 《脉經》
Translation영역
If the pulse is level and harmonious, the man greatly vexed and the eyes heavy with the inner edges of the lids yellow, all these are about to resolve.
Maekgyeong 脉經
Source원문
脉浮數而微ㆍ身溫和者, 欲解也. 《脉經》
Translation영역
A floating, rapid and faint pulse with the body warm and harmonious is about to resolve.
Maekgyeong 脉經
Source원문
凡病反能飮水者爲欲愈. 《脉經》
Translation영역
Wherever in a disease he is able to drink water instead, he is about to heal.
Maekgyeong 脉經
Source원문
問曰: 脉病欲知愈未愈, 何以別之? 答曰: 寸口ㆍ關上ㆍ尺中三處, 大小ㆍ浮沉ㆍ遲數同等, 雖有寒熱不調者, 此脉爲陰陽和平, 雖劇當愈. 《脉經》
Translation영역
It is asked: to know from the pulse whether the disease will heal or not, how is it distinguished? The answer: where at the three places — the inch opening, the bar and the cubit — the largeness and smallness, the floating and deepness, the slowness and rapidity are all equal, then although there be chill and fever unregulated, this pulse is yin and yang in harmony and level, and though the case be severe he should heal.
Maekgyeong 脉經
Source원문
問曰: 病有戰而汗出ㆍ因得解者, 何也? 答曰: 脉浮而緊ㆍ按之反芤, 此爲本虛, 故當戰而汗出也. 其人本虛, 是以發戰也; 若浮而數ㆍ按之不芤, 此人本不虛, 故但出汗ㆍ不發戰也. 《脉經》
Translation영역
It is asked: there is a disease with shivering and sweat coming out and thereby resolving — why? The answer: where the pulse is floating and tight and on pressing is scallion-hollow instead, this is an original depletion, and so he must shiver and the sweat come out. The man is originally depleted, and that is why the shivering arises; but if it is floating and rapid and on pressing is not scallion-hollow, this man is not originally depleted, and so the sweat merely comes out and no shivering arises.
Maekgyeong 脉經
Source원문
問曰: 有不戰不汗出而解者, 何也? 答曰: 其脉自微, 此以曾經發汗ㆍ若吐ㆍ若下ㆍ若亡血, 以內無津液, 待陰陽自和ㆍ必自愈, 故不戰不汗出而解也. 《脉經》
Translation영역
It is asked: there is one who resolves with neither shivering nor sweating — why? The answer: his pulse is faint of itself, and this is because he has already been sweated, or vomited, or purged, or has lost blood, so that within there are no fluids; one waits for the yin and yang to harmonize of themselves and he will certainly heal of himself, and so he resolves with neither shivering nor sweating.
Maekgyeong 脉經
Source원문
太陽病無汗而衂者自愈. 《仲景》
Translation영역
In taiyang disease with no sweat and a nosebleed, he heals of himself.
Junggyeong 仲景
Source원문
問曰: 凡病何時得ㆍ何時愈? 答曰: 日中得病ㆍ夜半愈者, 以陽得陰則解也; 夜半得病ㆍ日中愈者, 以陰得陽則解也. 《脉經》
Translation영역
It is asked: in all diseases, at what hour are they got and at what hour do they heal? The answer: where the disease is got at midday and heals at midnight, it is because the yang getting the yin resolves it; where the disease is got at midnight and heals at midday, it is because the yin getting the yang resolves it.
Maekgyeong 脉經
Source원문
太陽知可解者, 爲頭不痛ㆍ項不强ㆍ肢節不痛, 則知表易解也; 陽明證知可解者, 爲無發熱惡熱, 則知裏易解也; 少陽知可解者, 寒熱亂作ㆍ失其早晩, 知可解也. 《海藏》
Translation영역
That the taiyang may be known to be resolvable is that the head does not ache, the nape is not stiff and the limbs and joints do not hurt, and so one knows the exterior resolves easily; that the yangming pattern may be known to be resolvable is that there is no fever and no aversion to heat, and so one knows the interior resolves easily; that the shaoyang may be known to be resolvable is that the chill and fever come on in disorder and lose their morning and evening, and from this one knows it may be resolved.
Clinical note임상 주석
The section collects every sign the tradition read as improvement, and the good ones are the ones that describe a returning function: able to eat, able to drink water, a pulse equal at all three positions, chill and fever losing their regular hour. Each of those is something a patient does rather than something they have, and that is why they are better indicators than any symptom.
The two 問曰 passages on shivering are the most interesting. A patient who shivers before sweating was originally depleted; one who sweats without shivering was not; one who resolves with neither has already been sweated or purged or has lost blood, and simply has nothing left to mount a response with. Three mechanisms for the same recovery, sorted by reserve, and the third — 待陰陽自和ㆍ必自愈, wait for the yin and yang to harmonize of themselves — is an instruction to do nothing, which the chapter rarely gives.
Haejang's closing differential inverts the chapter's usual method: instead of asking what signs are present, he asks which are absent. No headache, no stiff nape, no joint pain: the taiyang is going. No fever, no aversion to heat: the yangming is going. That is discharge planning, and it is as practical as anything in the chapter.
Haejang 海藏
1.30 The Pattern in Cold Damage That May Be Vomited 傷寒可吐證
Source원문
傷寒三四日ㆍ邪氣未傳裏, 瓜蔕散吐之.
Translation영역
In cold damage on the third or fourth day, where the evil qi has not yet passed into the interior, Melon Stalk Powder vomits it out.
Junggyeong 仲景
Source원문
六七日胸煩懊憹, 梔子湯吐之. 方並見吐門 《仲景》
Translation영역
On the sixth or seventh day, with vexation of the chest and a gnawing distress, Gardenia Decoction vomits it out. Both formulas appear in the Vomiting chapter.
Clinical note임상 주석
The shortest section in the chapter, and vomiting is the least used of the five methods in it. Both indications are narrow: a very early case where the evil is still high and reachable, and the gnawing chest distress of 2.76 in the upper part. Gardenia and Fermented Soybean Decoction's own entry gives the dose rule that governs the second — if vomiting is obtained, stop.
Junggyeong 仲景
1.31 Patterns That May and May Not Be Sweated 可汗不可汗證
Source원문
傷寒寸口脉浮而緊: 浮則爲風ㆍ緊則爲寒; 風則傷衛ㆍ寒則傷榮. 榮衛俱病ㆍ骨節煩疼, 當發其汗. 《仲景》
Translation영역
In cold damage, where the inch-opening pulse is floating and tight: floating is wind and tight is cold; wind damages the defensive and cold damages the nutritive. Where the nutritive and defensive are both diseased and the bones and joints vexingly ache, the sweat should be raised.
Junggyeong 仲景
Source원문
傷寒前三日法當汗, 可用雙解散連進數服, 必愈. 《丹心》
Translation영역
In cold damage, in the first three days it should by rule be sweated, and Double Resolution Powder may be given in several doses in succession, and it will certainly heal.
Dansim 丹心
Translation영역
Where cold has damaged the nutritive, Ephedra Decoction is apt; where wind has damaged the defensive, Cinnamon Twig Decoction. The formulas appear above.
Junggyeong 仲景
Source원문
內經曰: 體若燔炭ㆍ汗出而解.
Translation영역
The Neijing says: the body as though it were burning charcoal, and the sweat comes out and it resolves.
Naegyeong 內經
Source원문
服藥而不得汗, 當用蒸法, 陶氏再造散主之. 《入門》
Translation영역
Where the medicine is taken and no sweat is got, the steaming method should be used, and Tao's Remaking Powder governs it.
Uihak Immun 入門
Source원문
太陽證非頭痛項强不可發汗; 非身熱惡寒不可汗; 非脉浮不可汗; 脉微弱或尺脉遲者不可汗; 衂血不可汗, 汗出則必額上陷ㆍ脉急緊ㆍ直視不能瞬ㆍ不得眠; 諸亡血不可汗, 汗出則寒慄而振; 風溫ㆍ濕溫並不可汗; 虛煩不可汗; 臍間左右上下有動氣不可汗; 太陽病者咽乾ㆍ鼻衂ㆍ小便淋幷不可汗; 咽喉乾燥者不可汗; 婦人經來不可汗. 《活人》
Translation영역
In the taiyang pattern, without headache and a stiff nape a sweat may not be induced; without generalized fever and aversion to cold it may not be sweated; without a floating pulse it may not be sweated; where the pulse is faint and weak or the cubit pulse slow it may not be sweated; with nosebleed it may not be sweated, for if sweat comes out the forehead will certainly sink in, the pulse be urgent and tight, he will stare fixedly unable to blink and be unable to sleep; in all loss of blood it may not be sweated, for if sweat comes out he will tremble with cold and shiver; in wind warmth and damp warmth alike it may not be sweated; in depletion vexation it may not be sweated; where there is stirred qi to the left, right, above or below the navel it may not be sweated; in taiyang disease with a dry throat, nosebleed or dribbling urination it may not be sweated; where the throat is dry and parched it may not be sweated; and in a woman whose menses have come it may not be sweated.
Hwarinseo 活人
Source원문
當汗不汗則生黃; 當利小便而不利則亦生黃; 不當汗而汗則爲蓄血; 當汗而過多則爲亡陽. 《活人》
Translation영역
Where it should be sweated and is not, jaundice is generated; where the urine should be disinhibited and is not, jaundice is likewise generated; where it should not be sweated and is, accumulated blood comes about; and where it should be sweated and too much is raised, yang collapse comes about.
Clinical note임상 주석
Twelve prohibitions in one passage, each naming the finding that forbids the sweat, and the four consequences in the next. Three of the twelve are negatives — not sweating a patient who lacks the positive signs for it — and the remaining nine are conditions in which the patient has no fluid to spare: a weak pulse, bleeding, blood loss, menstruation, a dry throat, dribbling urine.
額上陷 — the forehead sinking in — as the named consequence of sweating a patient with a nosebleed is a severe dehydration sign, and it belongs with 眼胞忽陷 at 2.70 of the upper part. The staring without blinking beside it completes a picture that nobody who had seen it would forget.
The last passage is the chapter's most economical statement of the four-way error: not sweating when you should, not freeing the urine when you should, sweating when you should not, and sweating too much. Each has its own consequence, and jaundice arriving from two different omissions explains why the Jaundice chapter sits where it does in this volume.
Hwarinseo 活人
1.32 The Method of Inducing Sweat 發汗法
Source원문
凡發汗, 欲令手足皆周至漐漐然ㆍ一時間許益佳, 不可令如水淋漓耳. 若病不解, 當重發汗; 汗多則亡陽, 亡陽不得重發汗也. 《仲景》
Translation영역
In inducing sweat, it is best to bring it all round to the hands and feet in a fine moisture, and about the space of one double hour is better still; it may not be allowed to pour like water. If the disease does not resolve, the sweat should be induced again; but where the sweat is much there is yang collapse, and in yang collapse the sweat may not be induced again.
Junggyeong 仲景
Source원문
凡發汗, 腰以上則如常覆之, 腰以下則厚衣覆之. 腰以上雖淋漓而腰以下至足微潤, 則病終不解. 《活人》
Translation영역
In inducing sweat, cover from the waist up as usual and from the waist down cover thickly with clothing. Though it pour from the waist up, if from the waist down to the feet it is only faintly moist, the disease will in the end not resolve.
Hwarinseo 活人
Source원문
凡發汗服湯, 其方雖言日一二服, 若病劇不解, 當促其服, 可半日間盡一二服; 連服三劑乃解. 若汗不出者, 死病也. 《仲景》
Translation영역
In taking a decoction to induce sweat, though the formula say one or two doses a day, if the disease is severe and does not resolve the doses should be hurried, and one or two doses may be finished within half a day; three agents taken in succession and it resolves. If the sweat does not come out, it is a fatal disease.
Junggyeong 仲景
Source원문
凡發汗病證仍在者, 三日內可二三汗之, 周遍爲度. 若未汗, 可作熱粥投之, 粥內加葱白甚妙. 《仲景》
Translation영역
Where after inducing sweat the disease signs are still present, within three days it may be sweated two or three times, taking an all-round sweat as the measure. If no sweat has come, hot gruel may be made and given him, and adding scallion white to the gruel is excellent.
Junggyeong 仲景
Source원문
凡服藥發汗, 中病卽止ㆍ不必盡劑, 恐汗大過ㆍ作亡陽證也. 吐下亦如之. 《仲景》
Translation영역
In taking medicine to induce sweat, stop as soon as the disease is struck and do not finish the agent, for fear the sweat go greatly too far and a yang collapse pattern come about. In vomiting and purging it is likewise.
Clinical note임상 주석
腰以下至足微潤則病終不解 — if from the waist down to the feet it is only faintly moist, the disease will not resolve — is the most practical instruction in the chapter and is routinely ignored. A sweat that reaches only the head and trunk is not the sweat the formulas are aiming at, and the remedy given is simply to cover the legs more thickly than the chest.
The whole section is about dose and endpoint rather than about drugs. A fine moisture all over for about two hours; never pouring; stop as soon as it is achieved; do not finish the packet. 中病卽止ㆍ不必盡劑 is the sentence to take from it, and it applies to vomiting and purging too.
Hot gruel with scallion white if the sweat will not come is the simplest intervention in the chapter, and it is the same move as the cup of thin gruel after Cinnamon Twig Decoction at 2.12 of the upper part: give the formula something to work with.
Junggyeong 仲景
1.33 The Yang Collapse Pattern 亡陽證
Translation영역
Wherever the sweat induced is excessive and leaks without stopping, it is named yang collapse, and Channel-Warming Original-Qi Boosting Decoction governs it. There is also the case where the yang is depleted and the medicine is taken and no sweat is got, which is likewise named yang collapse, and Tao's Remaking Powder governs it, with the steaming method used as well. Treated in detail in the Sweating chapter.
Uihak Immun 入門
Source원문
太陽證惡寒ㆍ脉當浮而緊, 今反脉浮而遲; 遲爲亡陽ㆍ不能作汗, 其身必痒, 桂麻各半湯主之. 方見上 《入門》
Translation영역
In the taiyang pattern with aversion to cold the pulse should be floating and tight, and here it is floating and slow instead; slow is yang collapse and he cannot make a sweat, so his body must itch, and Cinnamon Twig and Ephedra Half-and-Half Decoction governs it. The formula appears above.
Clinical note임상 주석
Two opposite presentations under one name, and the Immun prints both without apology: the patient who cannot stop sweating, and the patient who cannot be made to sweat at all. What they share is the absence of yang — in the first it has gone out with the sweat, in the second there was never enough to raise one. Both take warming and supplementing formulas, and Tao's Remaking Powder's entry sets out the argument that a patient with no yang cannot be sweated until the yang is supplied.
The itch is the sign again, as it was at 2.15 of the upper part, and it means the same thing: a sweat is trying to come out and cannot. A slow pulse where a tight one was expected is what tells you why.
Uihak Immun 入門
1.34 Where the Kidney Qi Is Insufficient, a Sweat Is Hard to Get 腎氣不足難得汗
Source원문
太陽病脉浮緊ㆍ身疼痛, 宜以汗解之; 假令尺脉遲者, 不可發汗. 何以知之? 以榮血不足ㆍ血少故也. 小建中湯方見虛勞加黃芪服之, 尺脉有力, 乃服汗藥. 《脉經》
Translation영역
In taiyang disease with a floating tight pulse and aching pain of the body, it should be resolved by sweating; but suppose the cubit pulse is slow, then a sweat may not be induced. How is this known? Because the nutritive blood is insufficient and the blood is scant. Minor Construct the Middle Decoction the formula appears in the Taxation chapter with astragalus added should be taken, and when the cubit pulse has strength, then the sweating medicine may be taken.
Maekgyeong 脉經
Source원문
一人患傷寒ㆍ發汗多ㆍ驚悸ㆍ目眩ㆍ身戰. 孫曰: 太陽經病得汗早, 因太陽經欲解復作汗ㆍ腎氣不足ㆍ故汗不來, 所以心悸ㆍ目眩ㆍ身戰. 遂作眞武湯三服, 微汗而解. 蓋附子ㆍ白朮和其腎氣, 腎氣得行ㆍ故汗得來也. 若但責太陽, 惟能乾涸血液爾. 仲景云: 尺脉遲者榮血不足ㆍ不可以汗. 以此知腎氣怯則難得汗也. 《孫兆》
Translation영역
A man suffered cold damage, was sweated much, and had fright palpitations, dizziness of the eyes and trembling of the body. Sun said: the taiyang channel disease got its sweat early, and because the taiyang channel was about to resolve a sweat was raised again while the kidney qi was insufficient, and so the sweat would not come, and this is why there was palpitation of the heart, dizziness of the eyes and trembling of the body. He then made True Warrior Decoction, three doses, and a slight sweat resolved it. For the aconite and atractylodes harmonize the kidney qi, and the kidney qi being able to move, the sweat can come. If one had held only the taiyang to account, one could only have dried up the blood and fluids. Zhongjing says: where the cubit pulse is slow the nutritive blood is insufficient and it may not be sweated. From this one knows that where the kidney qi is timid a sweat is hard to get.
Clinical note임상 주석
尺脉遲者不可發汗 is a specific prohibition tied to a specific position: the cubit pulse, read as the kidney and the blood, and slow in a patient who otherwise has every sign for sweating. The remedy is not to abandon the sweat but to earn it — Minor Construct the Middle with astragalus until the cubit pulse has strength, and only then the sweating formula. 尺脉有力ㆍ乃服汗藥 is a staged protocol with a measurable gate, and that is rare.
Sun Zhao's case is the same principle applied after the error. The patient was sweated twice, developed palpitations, dizziness and trembling, and could not sweat again; the answer was True Warrior Decoction, not another sweating formula. 若但責太陽ㆍ惟能乾涸血液爾 — if one had held only the taiyang to account, one could only have dried up the blood and fluids — is Sun explaining why the obvious treatment would have killed him.
Sonjo 孫兆
1.35 Hurrying the Sweat Shortens Life 促汗夭壽
Source원문
凡傷寒發汗, 須顧其表裏虛實ㆍ待其時日. 若不循次第, 則暫時得安ㆍ虧損五藏ㆍ以促壽限, 何足貴哉. 昔南朝范雲爲陳武帝屬官, 適得傷寒, 恐不得預九錫之慶, 召徐文伯懇求促汗. 文伯曰: 便差甚易, 只恐二年不復起耳. 雲曰: 朝聞道ㆍ夕死可矣, 何待二年! 遂以火燒地ㆍ鋪桃葉ㆍ設席ㆍ置雲於其上, 須臾大汗, 撲以溫粉, 翌日便愈. 雲甚喜, 文伯曰: 不足喜也. 後二年果卒. 《本事》
Translation영역
In inducing sweat in cold damage, one must have regard to whether the exterior and interior are depleted or replete, and wait for its proper day. If the order is not followed, then he gets ease for a moment, the five viscera are diminished and damaged, and the limit of his life is hurried on; what is there in that to prize? Formerly, in the Southern dynasty, Fan Yun was an officer attached to Emperor Wu of Chen, and happening to get cold damage and fearing he would not share in the celebration of the nine gifts, he summoned Xu Wenbo and earnestly begged him to hurry the sweat. Wenbo said: to cure you at once is easy enough; I only fear you will not rise again in two years. Yun said: to hear the Way in the morning and die in the evening is enough — why wait two years! So the ground was burnt with fire, peach leaves spread, a mat laid out, and Yun placed upon it; in a moment there was a great sweat, he was dusted with warm powder, and the next day he was cured. Yun was greatly pleased, and Wenbo said: there is nothing to be pleased at. Two years later he died as foretold.
Clinical note임상 주석
The only anecdote in the Bogam where a physician states the cost of a treatment in advance, the patient accepts it knowingly, and the outcome is recorded. Xu Wenbo told Fan Yun that curing him at once was easy and that he would not rise again in two years; Fan Yun quoted the Analects at him and took it anyway; two years later he died.
What the method actually was is worth noting as a piece of technique: ground burnt with fire, peach leaves spread over it, a mat on top, and the patient laid down to sweat — a heated bed, the most forcible sweating method in the book, finished with a dusting of warm powder to close the pores. 以促壽限 — the limit of his life hurried on — is the chapter's judgment on it.
Placed as it is, immediately after two sections on patients who could not be sweated, the story is an argument about method: a sweat can always be forced, and the question is never whether it can be got but what it costs.
Bonsa 本事
1.36 Patterns That May and May Not Be Purged 可下不可下證
Source원문
不惡寒ㆍ反惡熱ㆍ手掌心幷腋下濈濈汗出, 乃胃中乾燥ㆍ結聚ㆍ潮熱ㆍ大便硬ㆍ小便如常ㆍ腹滿而喘ㆍ或譫語ㆍ脉沉而滑者, 裏證也. 裏證內熱是也; 內熱屬陽明, 宜下. 《活人》
Translation영역
No aversion to cold but rather aversion to heat, with continuous sweating of the palms and the armpits: this is the stomach being dry and parched, with binding and gathering, tidal fever, hard stool, urine as usual, abdominal fullness with panting, or delirious speech, and a pulse deep and slippery — it is an interior pattern. An interior pattern is interior heat; interior heat belongs to the yangming, and purging is apt.
Hwarinseo 活人
Translation영역
For the three Order the Qi formulas — Major, Minor and Regulate the Stomach — the exterior signs of a floating pulse, headache, aversion to wind and aversion to cold must all have finished, and there must instead be fever, aversion to heat, delirious speech and no stool, and only then may they be used. If the pulse is floating and he is purged there will certainly be a chest bind; if the pulse is moderate and he is purged there will certainly be a stuffy qi.
Haejang 海藏
Translation영역
In cold damage, after the third day it should by rule be purged; and if it is purged too early it will certainly change into some other pattern, the light case will certainly become perilous and the perilous certainly die. Medicines of a level and harmonious kind should be used, and Minor Bupleurum, Cool the Diaphragm and Heavenly Water that is, Benefit the Origin Powder taken combined.
Seonmyeong 宣明
Translation영역
If the interior heat is slight, it should be purged slightly, and Major Bupleurum combined with Resolve Toxicity Decoction should purge it; where the force of the heat has not retreated, Major Bupleurum combined with the three Order the Qi should purge it, removing the heat of exterior and interior together.
Seonmyeong 宣明
Source원문
凡轉下之藥, 與裏證藥參考選用. 《丹心》
Translation영역
In all the purging medicines, choose and use them with reference to the medicines for the interior pattern.
Dansim 丹心
Source원문
脉浮不可下; 脉虛不可下; 惡寒不可下; 嘔吐不可下; 不轉矢氣者不可下; 小便淸不可下. 《活人》
Translation영역
A floating pulse may not be purged; a depleted pulse may not be purged; aversion to cold may not be purged; vomiting may not be purged; one in whom the wind of the stool does not turn may not be purged; clear urine may not be purged.
Hwarinseo 活人
Source원문
非陽明本病不可下; 非痞ㆍ滿ㆍ燥ㆍ實不可下; 非脉沉實不可下; 非發狂不可下. 《雲歧》
Translation영역
What is not a root disease of the yangming may not be purged; what has not stuffiness, fullness, dryness and repletion may not be purged; what has not a deep replete pulse may not be purged; what has not mania may not be purged.
Clinical note임상 주석
Ten prohibitions across the last two passages, and six of the ten are findings a trainee could check in a minute: floating pulse, weak pulse, aversion to cold, vomiting, no wind of the stool, clear urine. The seventh — 不轉矢氣 — is the test from the upper part's 2.53 put in the negative, and the clear urine is the counterpart of the dark urine in the first passage.
手掌心幷腋下濈濈汗出 — continuous sweating of the palms and the armpits — is a more precise observation than the general sweating of the yangming, and it marks the same thing the hands and feet did at 2.24: heat concentrating and venting at particular surfaces while the stool hardens.
下之太早則必變他證ㆍ輕者必危ㆍ危者必死 is the Seonmyeong at its most emphatic, and its alternative is interesting: three mild formulas taken combined rather than one strong one. Heavenly Water Powder is Six-to-One Powder under another name, and the gloss identifying it is the Bogam's own.
Ungi 雲歧
1.37 The Two Patterns to Be Purged Urgently 急下兩證
Source원문
少陰主腎ㆍ繫舌本. 熱氣入藏ㆍ留於少陰之經, 腎汁乾ㆍ咽路焦, 故口燥ㆍ咽乾而渴, 宜急下之, 非若陽明宜下而可緩也. 雖然陽明一證發熱ㆍ汗多, 亦急下之, 以胃汁乾故也. 《活人》
Translation영역
The shaoyin governs the kidney and ties to the root of the tongue. Where the heat qi enters the viscera and lodges in the channel of the shaoyin, the kidney's liquor dries and the road of the throat is scorched, and so the mouth is parched, the throat dry and there is thirst; it should be purged urgently, and not as in the yangming, where purging is apt and may be done slowly. Yet there is one yangming pattern, with fever and much sweating, which should also be purged urgently, because the stomach's liquor is dry.
Hwarinseo 活人
Source원문
少陰證口燥ㆍ咽乾, 謂之腎汁乾, 宜急下之; 陽明證發熱ㆍ汗多, 謂之胃汁乾, 亦急下之. 《活人》
Translation영역
The shaoyin pattern with a parched mouth and dry throat is called the kidney's liquor being dry, and should be purged urgently; the yangming pattern with fever and much sweating is called the stomach's liquor being dry, and should also be purged urgently.
Clinical note임상 주석
Two exceptions to the chapter's general preference for delay, and both are about fluid. The reasoning is that the dryness itself is the emergency: once the kidney's or the stomach's liquor has gone, waiting makes the bind harder and the patient worse, so the purge cannot be deferred. 腎汁乾 and 胃汁乾 are the two names, and the signs that distinguish them are the parched mouth with dry throat for the one and the fever with heavy sweating for the other.
A modern clinician looking at the same two patients would replace the fluid rather than purge, and the two courses are not as opposed as they look: both recognize that the critical variable is the fluid and that time is against the patient.
Hwarinseo 活人
1.38 Where the Pulse Does Not Beat Against the Finger It May Not Be Purged 脉不鼓擊不可下
Source원문
一少年傷寒ㆍ目赤ㆍ煩渴ㆍ脉七八至, 醫欲用承氣湯下之. 東垣偶來診之, 大駭曰: 幾殺此兒! 彼以脉數爲熱, 今脉七至是極熱也, 殊不知內經云: 病有脉從而病反者, 何也? 歧伯曰: 脉至而從ㆍ按之不鼓, 諸陽皆然. 此陰盛隔陽於外ㆍ非熱也. 取薑ㆍ附來, 吾以熱因寒用之法治之. 藥未就而病者爪甲已靑, 遂頓服八兩, 汗漸出而愈. 《東垣》
Translation영역
A youth had cold damage with red eyes, vexing thirst and a pulse at seven or eight beats to a breath, and the physician wished to use an Order the Qi Decoction to purge him. Dongwon happening to come and examine him was greatly startled and said: you nearly killed this boy! He has taken the rapid pulse for heat, and that a pulse at seven beats is an extreme of heat; and he does not know at all that the Neijing says: there are diseases in which the pulse is compliant and the disease the contrary of it — why? Qibo said: where the pulse arrives compliant and on pressing does not beat against the finger, it is so for all the yang. This is yin exuberance screening the yang off to the outside, and is not heat. Fetch ginger and aconite; I shall treat him by the method of using the hot by reason of the cold. The medicine was not yet ready and the patient's nails had already turned blue; eight nyang was then taken at one draught, the sweat gradually came out, and he was cured.
Clinical note임상 주석
A pulse at seven or eight beats to a breath is a rate above 120, with red eyes and thirst, and the first physician read it the obvious way. 按之不鼓 — on pressing it does not beat against the finger — is what Li Dongyuan found, and it is the sign the upper part's 2.63 and 2.64 are built on: rate without force. The nails turning blue while the medicine was being prepared confirmed it.
熱因寒用 — using the hot by reason of the cold — is the name for the principle, and eight nyang of ginger and aconite in one draught is among the largest single doses in the Bogam. For a patient in that state the dose is not reckless; the formulas of 2.61 are in the same range.
幾殺此兒 is the most human line in the chapter and worth keeping. Whatever the theoretical framing, what Li Dongyuan did was feel the pulse under pressure rather than count it, and that is the lesson the section exists to teach.
Dongwon 東垣
1.39 Where the Heat Does Not Retreat After Purging It Should Be Purged Again 下後熱不退宜再下
Source원문
下後熱不退ㆍ再三下之ㆍ熱愈盛ㆍ脉微ㆍ氣虛ㆍ力弱, 不加以法則無可生之理; 若輟而不下, 則邪熱極盛ㆍ陰氣極衰ㆍ脉息斷絶ㆍ必不可救. 如此之證, 是下之亦死ㆍ不下亦死. 醫者到此, 殺人活人一彈指間耳. 《河間》
Translation영역
Where the heat does not retreat after purging and he is purged again and a third time and the heat grows more exuberant still, with a faint pulse, depleted qi and weak strength, then unless a method is applied there is no principle by which he can live; and if one leaves off and does not purge, the evil heat becomes utterly exuberant, the yin qi utterly declined, the pulse and breath cut off, and he certainly cannot be rescued. In a pattern such as this, purging kills him and not purging kills him. A physician come to this point has the killing and the saving of a man in the space of a finger-snap.
Hagan 河間
Translation영역
The classic says: where after three purgings the heat does not retreat, he dies. Later men have purged three or four times, going up to ten and more passages, and the patient has lived; but this is merely chancing to hit the mark by accident. Those who come after must on no account take it for a method, but should only regulate him with Resolve Toxicity Decoction combined with Cool the Diaphragm Powder, and so they may not lose a man's life.
Hagan 河間
Source원문
汗下後熱不退, 不問有汗無汗, 宜白虎湯加人參ㆍ蒼朮解之, 妙. 《河間》
Translation영역
Where the heat does not retreat after sweating or purging, whether there is sweating or no sweating, White Tiger Decoction with ginseng and atractylodes lancea added is apt to resolve it, and is excellent.
Clinical note임상 주석
殺人活人一彈指間 — the killing and the saving of a man in the space of a finger-snap — is the sentence the whole chapter has been working towards. Liu Wansu sets out a situation in which both available courses kill, and then, instead of choosing one, says in the next passage what to do: do not purge again, and give two mild cooling formulas combined.
此乃偶然誤中耳 — merely chancing to hit the mark by accident — is the best piece of critical reasoning in the Bogam. Liu knows that some patients purged ten times have survived, and he refuses to treat survival as evidence that the method was right. 後學切不 可以爲法, those who come after must on no account take it for a method, is an argument about inference from outcomes that would not be out of place in a modern discussion of anecdote.
The title promises a second purge and the content refuses it, which is characteristic of how this chapter was assembled: the heading records the received position and the passages beneath it record the argument against.
Hagan 河間
1.40 The Pattern of Yin Consumed and Yang Exhausted 陰耗陽竭證
Source원문
裏熱內盛ㆍ陽厥極甚, 皆因失下而成此證, 以致身冷ㆍ脉微ㆍ昏懵將死. 殊不知此證乃陰耗陽竭: 陰氣極弱謂之耗, 陽厥極甚謂之竭. 但進凉膈ㆍ解毒合以服之, 以養陰退陽, 脉氣漸生ㆍ得大汗而愈. 若未愈, 解毒合承氣下之; 次以解毒ㆍ凉膈ㆍ天水合而爲一ㆍ洗滌藏府, 則自愈矣. 《河間》
Translation영역
Where the interior heat is exuberant within and the yang reversal utterly severe, in every case it is because the purge was missed that this pattern came about, bringing the body to coldness, the pulse to faintness, and him to a clouded stupor on the point of death. And it is not at all understood that this pattern is the yin consumed and the yang exhausted: the yin qi utterly weak is called consumed, and the yang reversal utterly severe is called exhausted. Only give Cool the Diaphragm and Resolve Toxicity combined and let him take them, to nourish the yin and make the yang retreat, and the pulse qi will gradually be generated, a great sweat got, and he will be cured. If he is not cured, Resolve Toxicity combined with an Order the Qi should purge him; and next Resolve Toxicity, Cool the Diaphragm and Heavenly Water combined into one will sluice out the viscera and bowels, and he will heal of himself.
Clinical note임상 주석
A cold body, a faint pulse and a clouded patient, and the diagnosis is heat. That is the most counter-intuitive reading in the chapter and it rests entirely on the history: 皆因 失下而成此證 — in every case it is because the purge was missed. The patient looks like the yin collapse of 2.61 and has arrived there by the opposite route.
養陰退陽 — nourish the yin and make the yang retreat — is the therapeutic aim and it is why Liu Wansu will not simply purge again: the yin is already consumed, and another purge would spend what is left. Two mild cooling formulas first, a purge only if they fail, and then three combined to flush the system. A staged escalation starting from the mildest option, which is the pattern of all Liu's writing in this chapter.
Hagan 河間
1.41 Patterns That May and May Not Be Harmonized 可和不可和證
Source원문
傷寒熱邪半在表半在裏, 宜小柴胡湯和之. 《活人》
Translation영역
In cold damage where the heat evil is half in the exterior and half in the interior, Minor Bupleurum Decoction is apt to harmonize it.
Hwarinseo 活人
Source원문
口苦ㆍ咽乾ㆍ目眩ㆍ耳聾ㆍ胸脇滿ㆍ或往來寒熱而嘔, 屬少陽, 忌吐下, 宜小柴胡湯和之. 《仲景》
Translation영역
A bitter mouth, dry throat, dizziness of the eyes, deafness, fullness of the chest and rib-side, or chill and fever coming and going with retching, belongs to the shaoyang; vomiting and purging are to be shunned, and Minor Bupleurum Decoction is apt to harmonize it.
Junggyeong 仲景
Translation영역
Minor Bupleurum Decoction is also called Harmonize and Resolve Powder. If a pinch of black soybean is added and decocted with it, it is called Fire Evil Decoction.
Uihak Immun 入門
Translation영역
If the disease is half in the exterior and half in the interior, by rule it should be harmonized and resolved, and Minor Bupleurum combined with Cool the Diaphragm Powder the formula appears in the Fire chapter governs it.
Hagan 河間
Source원문
非往來寒熱不可和; 非脇肋急痛不可和; 非胸滿而嘔不可和. 《雲歧》
Translation영역
What has not chill and fever coming and going may not be harmonized; what has not urgent pain of the rib-side may not be harmonized; what has not chest fullness with retching may not be harmonized.
Clinical note임상 주석
The three prohibitions in the last passage complete the set begun in 1.31 and 1.36, and the symmetry is the point: sweating, purging and harmonizing each have their own list of what forbids them, and Yunqi's lists are all of the same form — without this sign, not this method. Three signs here, and all three are the shaoyang's own.
忌吐下 is the three prohibitions of Minor Bupleurum's alternative name, and the formula's own entry explains why harmonizing is what remains when the other three routes are shut. The three sections together are the chapter's method stated as a set of gates rather than as a sequence.
Ungi 雲歧
1.42 The Ill-Omened Signs of Cold Damage 傷寒凶證
Source원문
傷寒病唇吻反靑ㆍ四肢多汗, 肝絶也.
Translation영역
In cold damage disease, where the lips and mouth turn blue and the four limbs sweat much, the liver is severed.
Junggyeong 仲景
Source원문
形如烟熏ㆍ搖頭直視, 心絶也.
Translation영역
A form as though smoke-blackened, with the head shaking and a fixed stare: the heart is severed.
Junggyeong 仲景
Source원문
環口黧黑ㆍ柔汗發黃, 脾絶也.
Translation영역
A dark sallow ring about the mouth, with a limp sweat and yellowing: the spleen is severed.
Junggyeong 仲景
Source원문
汗出髮潤ㆍ喘而不休, 肺絶也.
Translation영역
Sweat coming out with the hair damp, and panting without cease: the lung is severed.
Junggyeong 仲景
Source원문
狂言ㆍ直視ㆍ溲便遺失, 腎絶也.
Translation영역
Wild speech, a fixed stare, and urine and stool passed without control: the kidney is severed.
Junggyeong 仲景
Source원문
汗出如油ㆍ喘促不休ㆍ水漿不入ㆍ形體不仁, 命絶也. 《仲景》
Translation영역
Sweat coming out like oil, hurried panting without cease, no water or gruel taken, and the body's form without feeling: the life is severed.
Clinical note임상 주석
Six terminal pictures, one for each of the five viscera and one for life itself, and the descriptions are of a kind that only direct observation produces. 形如烟熏, a form as though smoke-blackened, is the grey mottling of profound shock. 環口黧黑, a dark sallow ring about the mouth, is circumoral cyanosis. 汗出如油, sweat like oil, is the thick cold diaphoresis of a dying patient, and 柔汗, a limp sweat, is the same thing named differently. 形體不仁, the body without feeling, is unresponsiveness.
The assignment of each to a particular viscus is the organizing device and need not be taken literally; what the section is, read plainly, is a list of signs of imminent death compiled by people who had watched a great many. Every one of the six is still recognized.
Junggyeong 仲景
1.43 The Untreatable Patterns of Cold Damage 傷寒不治證
Source원문
脉陰陽俱虛ㆍ熱不止者死. 脉陰陽俱盛ㆍ大汗出不解者死. 少陰病六七日息高者死. 少陰病吐利ㆍ煩躁ㆍ四逆者死.
Translation영역
Where the pulse is depleted in both yin and yang and the heat does not stop, he dies. Where the pulse is exuberant in both yin and yang and a great sweat comes out without resolving, he dies. In shaoyin disease on the sixth or seventh day, where the breath is high, he dies. In shaoyin disease with vomiting and diarrhoea, vexing agitation and frigid extremities, he dies.
Junggyeong 仲景
Source원문
汗後嘔吐ㆍ水藥不入口者逆. 下利後脉絶ㆍ手足厥冷, 晬時脉還ㆍ手足溫者生, 脉不還者死. 發熱下利至甚ㆍ厥不止者死. 汗下後復發熱ㆍ脉躁疾ㆍ下利不止者死.
Translation영역
Where after sweating there is vomiting and no water or medicine goes into the mouth, it is contrary. Where after diarrhoea the pulse is severed and the hands and feet cold with reversal, if in a full day the pulse returns and the hands and feet become warm he lives, and if the pulse does not return he dies. Where there is fever and the diarrhoea goes to its worst and the reversal does not stop, he dies. Where after sweating or purging the fever returns, the pulse is agitated and swift and the diarrhoea does not stop, he dies.
Junggyeong 仲景
Source원문
下利ㆍ厥逆ㆍ無脉, 灸之脉不還ㆍ身不溫ㆍ反微喘者死. 直視ㆍ譫語ㆍ或喘滿ㆍ或下利者死. 服麻黃湯二三劑ㆍ汗不出者死. 熱病脉躁盛而不得汗者死.
Translation영역
Where there is diarrhoea, reversal and no pulse, and on moxaing him the pulse does not return, the body does not grow warm and he pants slightly instead, he dies. A fixed stare with delirious speech, or panting fullness, or diarrhoea: he dies. Where two or three agents of Ephedra Decoction are taken and no sweat comes out, he dies. In heat disease, where the pulse is agitated and exuberant and no sweat can be got, he dies.
Junggyeong 仲景
Source원문
發汗不至足者逆. 汗出如珠不流者死. 忽冒昧ㆍ無脉, 服藥後汗解則生; 若無汗ㆍ脉不至者死. 七八日以上發大熱ㆍ難治.
Translation영역
Where the sweat induced does not reach the feet, it is contrary. Where the sweat comes out like beads and does not run, he dies. Where he is suddenly fogged and dull with no pulse, and after taking medicine resolves by sweating, he lives; but if there is no sweat and the pulse does not arrive, he dies. Where after the seventh or eighth day great heat arises, it is hard to treat.
Junggyeong 仲景
Source원문
傷寒脉乍踈乍數者不治. 脉代者不治. 口乾ㆍ舌黑不治. 口張ㆍ目陷不治. 尋衣摸空者逆. 厥陰證唇靑ㆍ舌卷ㆍ耳聾ㆍ囊縮不治.
Translation영역
In cold damage, where the pulse is now sparse and now rapid, it is not treatable. An intermittent pulse is not treatable. A dry mouth with a black tongue is not treatable. A gaping mouth with sunken eyes is not treatable. Picking at the clothes and groping at the air is contrary. In the jueyin pattern, blue lips, a curled tongue, deafness and a retracted scrotum are not treatable.
Junggyeong 仲景
Source원문
陰陽易過六七日不治. 大發濕家汗則成痓ㆍ熱而痓難治. 發風濕ㆍ中濕汗並逆. 發風溫汗必譫語ㆍ不治. 《仲景》
Translation영역
The yin-yang exchange past the sixth or seventh day is not treatable. Where a damp case is greatly sweated it becomes tetany, and heat with tetany is hard to treat. Inducing sweat in wind-damp and in damp strike is contrary in both. Inducing sweat in wind warmth will certainly bring delirious speech, and is not treatable.
Clinical note임상 주석
Twenty-six items, and they fall into three groups. Some are presenting signs: a gaping mouth with sunken eyes, a dry mouth with a black tongue, blue lips with a curled tongue. Some are failures of response: no sweat after two or three doses of Ephedra Decoction, no pulse after moxibustion, a pulse that does not return within a day. And four are iatrogenic — sweating a damp case, a wind-damp case, a damp strike or a warm disease.
息高 — the breath high — in the first group deserves notice: shallow rapid breathing high in the chest, which is a well-recognized terminal sign and is still described in almost those words. 汗出如珠不流 — sweat coming out like beads and not running — is the thick cold sweat of 1.42's 汗出如油 seen more closely, and 脉乍踈乍數 is an irregularly irregular pulse.
The group defined by failure of response is the most useful. A prognosis made after a treatment has been given and has not worked is worth more than one made from the presentation, and the chapter's willingness to state those thresholds — two or three doses, one full day — is what makes this list something other than a counsel of despair.
Junggyeong 仲景
1.44 The Ten Admonitions on Cold Damage 傷寒十勸
Source원문
李子建所撰, 不可不察.
Translation영역
Composed by Li Zijian; it must be examined.
Clinical note임상 주석
Ten numbered prohibitions, each one sentence of warning and one of reasoning, and together they are the most emphatic writing in the Donguibogam. 多致殺人 — it often kills people — appears twice; the last ends 必死. What unites them is their target: every one warns against the kindly instinct. Give a warming drug to a patient who feels cold, feed one who has not eaten, moxa the place that hurts, let the thirsty drink their fill, let the recovered get up and resume their life. Each is the obvious thing to do and each, Li Zijian says, is the error.
不可不察 — it must be examined — is the Gukbang's whole introduction, and the ten stand on their own below.
Gukbang 局方
1.44.1 Headache and Fever in Cold Damage Are at Once a Yang Pattern, and Hot Medicines May Not Be Taken 傷寒頭痛身熱便是陽證不可服熱藥
Source원문
傷寒六經內: 太陰病頭不痛ㆍ身不熱; 少陰病反發熱而無頭痛; 厥陰病有頭痛而無發熱. 卽是陽證, 不可妄投熱藥. 《局方》
Translation영역
Within the six channels of cold damage: in taiyin disease the head does not ache and the body is not hot; in shaoyin disease there is fever instead but no headache; in jueyin disease there is headache but no fever. So it is at once a yang pattern, and hot medicines may not be recklessly administered.
Clinical note임상 주석
The first admonition and the one everything else rests on, and the argument is by elimination across the three yin: the taiyin has neither sign, the shaoyin has fever without headache, the jueyin headache without fever. Both together therefore cannot be a yin pattern. Zhu Gong's version of the same reasoning stands at 2.50 of the upper part.
Gukbang 局方
1.44.2 In Cold Damage the Toxic Qi Should Be Attacked Directly, and Supplementing May Not Be Done 傷寒當直攻毒氣不可補益
Source원문
邪氣在經絡中, 當隨證攻之. 或醫者却行補益, 使毒氣流藏, 多致殺人. 《局方》
Translation영역
Where the evil qi is within the channels and network vessels, it should be attacked according to the pattern. But the physician may instead proceed to supplement, so that the toxic qi flows into the viscera, and it often kills people.
Clinical note임상 주석
多致殺人 — it often kills people — and the mechanism named is that supplementing closes the patient round the evil and drives it inward. This is the most contestable of the ten, since the chapter itself prescribes Ginseng Overcome Toxin Powder, Tao's Remaking Powder and Snatch Back Life Powder, all of which supplement. The reconciliation is in those entries: they supplement in order to make an attack possible, not in place of one. Li Zijian is warning against supplementing as the whole treatment.
Gukbang 局方
1.44.3 In Cold Damage, Where There Is No Desire for Food, Medicines That Warm the Spleen and Stomach May Not Be Taken 傷寒不思飮食不可服溫脾胃藥
Source원문
傷寒不思飮食, 自是常事, 終無餓死之理. 如理中元之類, 不可輕服; 若熱氣增重, 或至不救. 《局方》
Translation영역
That in cold damage there is no desire for food is in itself an ordinary matter, and there is no principle by which he will starve to death in the end. The Regulate the Middle Pill class must not be taken lightly; for if the heat qi is increased and made heavier, it may come to his not being saved.
Clinical note임상 주석
終無餓死之理 — there is no principle by which he will starve to death — is the whole of the argument and it is correct: a few days without eating does not kill a febrile patient, and warming the stomach to restore an appetite adds heat to a disease made of heat. The counterpart from the other side is the Neijing's 損穀則愈 at 1.19 and 2.73, where the danger is feeding a convalescent too much.
Gukbang 局方
1.44.4 Abdominal Pain in Cold Damage May Also Be a Heat Pattern, and Warming Medicines May Not Be Taken Lightly 傷寒腹痛亦有熱證不可輕服溫煖藥
Source원문
傷寒腹痛多是熱毒. 仲景方痛甚者加大黃, 則意可見也. 惟身冷ㆍ厥逆ㆍ腹痛, 方是陰證, 當消息之. 《局方》
Translation영역
Abdominal pain in cold damage is mostly a heat toxin. That Zhongjing's formulas add rhubarb where the pain is severe makes the intention plain enough. Only where the body is cold and there is reversal with abdominal pain is it a yin pattern, and it should be weighed out.
Clinical note임상 주석
The evidence offered is a pharmacological argument rather than an assertion: Zhongjing adds rhubarb when the pain gets worse, therefore Zhongjing thought the pain was heat. 則意可見也 — the intention is plain enough — is reasoning from what a predecessor prescribed to what he believed, which is a legitimate move and not a common one here. The exception is given precisely: body cold and limbs reversed, both, not pain alone.
Gukbang 局方
1.44.5 In Cold Damage with Spontaneous Diarrhoea the Yin or Yang Pattern Must Be Looked To, and Warming and Diarrhoea-Stopping Medicines May Not Be Given as a Rule 傷寒自利當看陰陽證不可例服溫煖及止瀉藥
Source원문
自利惟身不熱ㆍ手足溫者屬太陰, 身冷ㆍ四逆者屬少陰ㆍ厥陰. 外其餘身熱下利皆是陽證, 不可用熱藥. 《局方》
Translation영역
In spontaneous diarrhoea, only where the body is not hot and the hands and feet are warm does it belong to the taiyin, and where the body is cold with frigid extremities it belongs to the shaoyin and jueyin. Apart from these, all the rest with a hot body and diarrhoea are yang patterns, and hot medicines may not be used.
Clinical note임상 주석
Two narrow exceptions and everything else a yang pattern, which inverts the usual assumption that diarrhoea means cold. 身熱下利皆是陽證 is the operative clause, and the formulas for it are at 1.11 — Bupleurum and Poria Decoction and Benefit the Origin Powder. Note that the prohibition covers diarrhoea-stopping drugs as well as warming ones: in a heat diarrhoea, holding the bowel is as wrong as warming it.
Gukbang 局方
1.44.6 In Cold Damage with Chest and Rib-Side Pain and with Abdominal Pain, Moxibustion May Not Be Recklessly Used 傷寒胸脇痛及腹痛不可妄用艾灸
Source원문
傷寒胸脇痛屬少陽, 腹脹痛屬太陰, 切不可便用艾灸, 多致殺人. 《局方》
Translation영역
Chest and rib-side pain in cold damage belongs to the shaoyang, and distending abdominal pain belongs to the taiyin; on no account may moxibustion be used at once, for it often kills people.
Clinical note임상 주석
The second 多致殺人, and the only one of the ten directed at a physical treatment rather than a drug. Moxa over a painful chest or abdomen is the obvious comfort measure, and in a shaoyang or taiyin pattern with heat behind it, applying heat is the same error as giving a warming drug. The chapter does prescribe moxibustion elsewhere — at Guanyuan for the visceral bind at 1.6, at Qihai and Guanyuan for yin toxin at 2.61 — and in every one of those cases the patient is cold.
Gukbang 局方
1.44.7 In Cold Damage with Reversal Cold of the Hands and Feet the Yin or Yang Must Be Looked To, and It May Not Be Taken for a Yin Pattern as a Rule 傷寒手足厥冷當看陰陽不可一例作陰證
Source원문
傷寒有陰厥ㆍ有陽厥, 當仔細分辨, 不可例用熱藥. 《局方》
Translation영역
Cold damage has a yin reversal and a yang reversal, and they should be minutely distinguished; hot medicines may not be used as a rule.
Clinical note임상 주석
The shortest of the ten and the one the upper part spends four sections on — 2.55 through 2.58 — with four discriminators: the history, the pulse under pressure, the palms and fingertips, and whether the patient is alert or clouded. 當仔細分辨 is all Li Zijian says here, and he can afford to be brief because Zhu Gong's 禍如反掌 at 2.56 has said the rest.
Gukbang 局方
1.44.8 Where the Cold Damage Disease Is Already in the Interior, Medicine May Not Be Used to Induce Sweat 傷寒病已在裏卽不可用藥發汗
Source원문
傷寒須看表裏. 若一例發汗, 則邪氣未除ㆍ眞氣先涸, 死者多矣. 《局方》
Translation영역
In cold damage the exterior and interior must be looked to. If a sweat is induced as a rule, then the evil qi is not yet removed and the true qi dries up first, and many have died of it.
Clinical note임상 주석
邪氣未除ㆍ眞氣先涸 — the evil not yet removed and the true qi dried up first — is the mechanism of every over-sweating injury in the chapter, from the yang collapse of 1.33 to the twitching sinews of 1.8 to the ruined patterns of 1.15. Stated in six characters, it is the best summary of them.
Gukbang 局方
1.44.9 That in Cold Damage He Drinks Water Means He Is About to Heal, and the Sick Man May Not Be Allowed to Drink Without Restraint 傷寒飮水爲欲愈不可令病人恣飮過度
Source원문
病人發渴, 當與水以消熱氣; 然不可過多, 常令不足爲善. 《局方》
Translation영역
Where the sick man grows thirsty, water should be given him to consume the heat qi; yet it may not be too much, and it is best always to leave him short.
Clinical note임상 주석
The mildest of the ten and the only one that permits as well as forbids: give him water, but not too much. 常令不足爲善 is the same instruction as at 1.1, where the Uigam's qualification — giving him nothing is no treatment either — keeps it from becoming a refusal. Little and often is what both amount to.
Gukbang 局方
1.44.10 Where the Cold Damage Disease Is Newly Recovered, He May Not Eat to Excess, Drink Wine, Eat Mutton or Go to the Bedchamber 傷寒病初差不可過飽及飮酒食羊肉行房事
Source원문
病方愈ㆍ飮食過飽ㆍ病卽再來, 謂之食復; 勞動太早ㆍ病卽再來, 謂之勞復; 犯房室者必死. 《局方》
Translation영역
Where the disease is just healed and he eats and drinks to excess, the disease comes again at once, and it is called relapse from eating; where he labours and moves too soon, the disease comes again at once, and it is called relapse from exertion; and one who transgresses in the bedchamber will certainly die.
Clinical note임상 주석
The tenth and the one the chapter has built most apparatus around: 1.18 for the two relapses, 1.20 for the exchange pattern, and the two case records there — Hua Tuo's prognosis and the Oedae's report. 犯房室者必死 is the only absolute in the ten, and it closes them.
Read as a set, the ten are a convalescence protocol as much as a treatment doctrine, and the last is the one that the chapter's own evidence supports least and asserts most. What is clinically sound in it is the general principle the three clauses share: a patient whose fever has broken is not yet a well patient, and the demands that a well body meets without noticing will put this one back.
Gukbang 局方
1.45 The Interdictions in Cold Damage 傷寒戒忌
Source원문
傷寒新差後, 但少喫糜粥ㆍ常令稍飢ㆍ不得飽食; 反此則復.
Translation영역
After cold damage is newly recovered, let him eat only a little thin gruel, always keeping him somewhat hungry, and he may not eat his fill; do the contrary of this and it relapses.
Gukbang 局方
Source원문
不得早起ㆍ不得梳頭洗面ㆍ不得多言ㆍ不得勞心費力; 反此則復.
Translation영역
He may not rise early, may not comb his head or wash his face, may not talk much, and may not labour his mind or spend his strength; do the contrary of this and it relapses.
Gukbang 局方
Source원문
差後百日內ㆍ氣體未復, 犯房室者死.
Translation영역
Within a hundred days of recovery the qi and body are not yet restored, and one who transgresses in the bedchamber dies.
Gukbang 局方
Source원문
忌食羊ㆍ雞ㆍ狗肉ㆍ肥魚ㆍ油膩ㆍ諸骨汁ㆍ及醎藏ㆍ鮓ㆍ脯ㆍ油餠ㆍ麪等物; 病則再發. 《局方》
Translation영역
He should shun eating mutton, fowl, dog's flesh, fatty fish, oily and greasy things, all bone broths, and salted preserves, fermented fish, dried meat, oily cakes, noodles and the like; for then the disease breaks out again.
Clinical note임상 주석
Four prohibitions, and three of them are about doing less rather than taking anything. 常令稍飢 — always keep him somewhat hungry — is the same instruction as 常令不足 for water at 1.1 and 1.44.9, applied to food, and 不得梳頭洗面 repeats the threshold set at 1.18 and 1.44.10.
百日內 is the longest convalescent period named anywhere in the chapter, and the hundred days are for the sexual prohibition specifically. The chapter's evidence for that particular rule is the two case records at 1.20 and the tenth admonition, and it is the claim in this whole chapter that is asserted most and supported least.
The food list overlaps the Hwarinseo's at 1.44 and adds bone broths, salted preserves and fermented fish. Behind all of it is one principle, stated at 1.44.3 from the other side: a convalescent stomach cannot digest what a well one can, and the risk of feeding it is greater than the risk of not.
Gukbang 局方
1.46 The Pattern of Direct Cold Strike 中寒證
Source원문
仲景論傷寒矣, 未及乎中寒. 先哲治冒大寒而昏中者, 用附子理中湯, 其議藥則得之; 然曰傷ㆍ曰中, 未有議其異同者. 夫傷寒有卽病ㆍ有不卽病, 必大發熱, 病邪循經而入ㆍ以漸而深; 中寒則倉卒感受ㆍ其病卽發而暴ㆍ一身受邪ㆍ難分經絡ㆍ無熱可發ㆍ溫補自解, 此氣太虛也, 不急治則死矣. 《東垣》
Translation영역
Zhongjing discoursed on cold damage and did not come to direct cold strike. Earlier worthies treated one struck into stupor by braving a great cold with Aconite Regulate the Middle Decoction, and in their reckoning of the medicine they had it right; yet though they said damage and said strike, none of them discussed how the two differ. Now cold damage may fall ill at once or not at once, and there must be a great fever, the disease evil following the channel inward and deepening by degrees; in direct cold strike it is contracted all in a moment, the disease breaks out at once and suddenly, the whole body receives the evil and the channels and network vessels can hardly be distinguished, there is no fever to be brought out, and warming and supplementing resolve it of themselves. Here the qi is utterly depleted, and unless it is treated urgently he dies.
Dongwon 東垣
Translation영역
In direct cold strike the cold evil strikes straight into the three yin, and he is suddenly clouded and does not know people, the mouth clenched, the four limbs rigid and stiff, hypertonic and painful. If it is not treated urgently, death is within a morning or an evening. First use hot wine and ginger juice, half a cup of each, poured in and swallowed; and next use Restore the Yang and Rescue the Urgent Decoction the formula appears above, Aconite Regulate the Middle Decoction, Atractylodes and Aconite Decoction and Yang-Returning Decoction.
Gogeum Uigam 醫鑑
Source원문
中寒雖燥熱ㆍ煩渴, 可煎附子理中湯ㆍ浸水中冷服之, 不可熱服. 《醫鑑》
Translation영역
In direct cold strike, although there be parched heat and vexing thirst, Aconite Regulate the Middle Decoction may be decocted, steeped in water to cool and taken cold; it may not be taken hot.
Gogeum Uigam 醫鑑
Source원문
冷極ㆍ唇靑ㆍ厥逆ㆍ無脉ㆍ陰囊縮者, 急用吳茱萸熨法方見積聚ㆍ葱熨法見下, 幷艾灸臍中與氣海ㆍ關元各三五十壯. 而脉不出ㆍ手足不溫者死. 《入門》
Translation영역
Where the cold is at its extreme, the lips blue, the limbs reversed, there is no pulse and the scrotum is retracted, urgently use the Evodia Ironing Method the method appears in the Accumulations chapter and the Scallion Ironing Method see below, together with moxibustion at the centre of the navel and at Qihai and Guanyuan, thirty to fifty cones at each. And where the pulse does not come out and the hands and feet do not grow warm, he dies.
Uihak Immun 入門
Source원문
中寒則口噤ㆍ四肢强直ㆍ卒然暈倒. 《得效》
Translation영역
In direct cold strike the mouth is clenched, the four limbs rigid and stiff, and he falls down suddenly in a faint.
Clinical note임상 주석
Li Dongyuan's opening passage is the clearest statement in the Bogam of why 中寒 needed a section of its own: Zhongjing wrote about 傷寒 and never came to this, and the physicians who treated it had the right formula without having thought about how the two differ. His differential is in four clauses — cold damage has a febrile phase, travels channel by channel and deepens by degrees; direct cold strike is contracted in a moment, breaks out at once, takes the whole body, and has no fever to bring out.
無熱可發ㆍ溫補自解 settles the treatment: there is nothing to sweat out, so warming and supplementing is the whole of it. A sudden collapse with a rigid body, clenched jaw and no pulse in a patient who was never hot is hypothermia, and 不急治則死矣 is accurate.
The hot wine and ginger juice poured in before any decoction can be prepared is active rewarming by the only available route, and the sequence — warm him first, then the formula — is right. The last passage's prognostic rule is the familiar one: no pulse and no warmth after rewarming means death. Yang-Returning Decoction's entry carries the warning its two raw aconites require.
Deukhyobang 得效
1.47 Sudden Death from Cold Reversal 寒厥暴亡
Source원문
一婦人病傷寒ㆍ暴亡ㆍ脉絶. 有一道人見之曰: 是寒厥爾ㆍ不死也. 令人速掘地作坑ㆍ以薪炭燒之, 竢極煖ㆍ施薦覆坑ㆍ舁病人卧其上ㆍ厚被覆之. 少頃大汗沾衣ㆍ卽甦. 《類聚》
Translation영역
A woman was ill with cold damage, died suddenly, and her pulse was severed. A certain Daoist, seeing her, said: this is only cold reversal, she is not dead. He had men quickly dig the ground into a pit and burn firewood and charcoal in it; when he had waited for it to become extremely warm, he spread matting over the pit, carried the sick woman and laid her upon it, and covered her thickly with bedding. In a little while a great sweat soaked her clothes and she revived.
Clinical note임상 주석
A pulseless, apparently dead patient revived by being laid on matting over a pit of burnt-out charcoal and covered thickly. 是寒厥爾ㆍ不死也 — this is only cold reversal, she is not dead — is the whole diagnosis, made against everyone else's judgment, and the treatment is active external rewarming carried out with what was to hand.
Profound hypothermia does produce a state in which the pulse cannot be found and the patient appears dead, and recovery on rewarming is well documented. The method is the same as the heated bed used to force a sweat at 1.35, put to a far better use: there it shortened a life, here it saved one.
Uibang Yuchwi 類聚
1.48 The Scallion Ironing Method 葱熨法
Source원문
治中寒ㆍ身冷ㆍ脉微ㆍ面靑黑. 葱白(連根, 切)ㆍ小麥麩 各三升, 鹽 二升. 右以水和勻, 分二包, 炒令極熱, 絹包之, 互熨臍上. 冷則用水拌濕, 更炒熨之. 《醫鑑》
Translation영역
Treats direct cold strike with a cold body, a faint pulse and a blue-black face. Scallion white with the roots left on, cut up, and wheat bran, 3 seung of each; salt, 2 seung. Mix them evenly with water, divide into two parcels, dry-fry them until extremely hot, wrap them in silk, and iron the navel with them alternately. When one grows cold, sprinkle it with water to dampen it, fry it again and iron with it.
Clinical note임상 주석
Registered here as the Bogam gives it its own section. It is a hot salt-and-bran compress with scallion in it, made in two parcels so that one is always heating while the other is applied — a detail that matters, because a compress that is allowed to cool on the patient draws heat rather than giving it. 互熨 is the whole technique.
Salt and bran hold heat far longer than a cloth, which is why they are the filling, and damping the parcel before re-frying restores the steam. For the condition named — cold body, faint pulse, blue-black face — this is the right intervention, and the chapter pairs it with moxibustion and the aconite formulas at 1.46.
Gogeum Uigam 醫鑑
1.49 Contracting Cold and the Cold Damage of the Four Seasons 感寒及四時傷寒
Source원문
寒溫不節ㆍ將理失宜, 乍煖脫衣ㆍ甚熱飮冷ㆍ坐卧當風ㆍ居處暴露ㆍ衝冒霜雪ㆍ凌晨朝起呼吸冷氣ㆍ久晴暴煖忽變陰寒ㆍ久雨積寒致生陰濕. 如此之候, 皆爲邪厲侵傷肌膚ㆍ入于腠理, 使人身體沉重ㆍ肢節痠疼ㆍ項背拘急ㆍ頭目不淸ㆍ鼻塞ㆍ聲重ㆍ淚出ㆍ氣壅胸膈凝滯ㆍ飮食不入. 凡此之證, 若不便行解利, 伏留經絡ㆍ傳變無已. 《得效》
Translation영역
Cold and warmth not moderated and the nursing of the body ill managed: taking off clothes at a sudden warmth, drinking cold things in great heat, sitting or lying in a draught, dwelling exposed to the weather, going out into frost and snow, rising at dawn and breathing the cold air, a long clear spell turning suddenly from heat to a dark cold, long rain and accumulated cold giving rise to a yin damp. In all such circumstances the evil pestilence invades and damages the flesh and skin and enters the interstices, and it gives a man a heavy body, aching of the limbs and joints, hypertonic nape and back, head and eyes unclear, a blocked nose, a heavy voice, running tears, qi congested and the chest and diaphragm stagnant, and food and drink not going in. In all these patterns, if resolving and disinhibiting is not set about at once, it lodges hidden in the channels and network vessels and passes over and changes without end.
Deukhyobang 得效
Translation영역
For an ordinary cold with exterior signs, Notopterygium Harmonizing Decoction, Saposhnikovia Harmonizing Decoction and Chuanxiong, Angelica and Cyperus and Perilla Powder are apt the formulas appear above; where the cold toxin has entered the interior with vomiting and diarrhoea, Agastache Qi-Rectifying; where food is held and phlegm lodged, Ginseng Nourish the Stomach Decoction both formulas appear above; for a seasonal cold, Cimicifuga and Pueraria Decoction is apt.
Deukhyobang 得效
Source원문
大抵感冒, 古人不敢輕發汗者, 正由麻黃能開腠理, 用或不得其宜, 則導泄眞氣ㆍ因而致虛ㆍ變生他證. 此藥乃平和之劑人參養胃湯也, 止能溫中解表而已, 不致妄擾也. 《局方》
Translation영역
Broadly, that the ancients did not dare lightly to induce sweat in a cold is precisely because ephedra can open the interstices, and if it is used and not fittingly, then the true qi is led out and drained, depletion is thereby brought on, and some other pattern arises by change. This medicine is an agent of a level and harmonious kind that is, Ginseng Nourish the Stomach Decoction, able only to warm the middle and resolve the exterior, and does not go so far as to disturb recklessly.
Gukbang 局方
Source원문
雜病與傷寒相類者極多. 凡有感冒輕證, 不可便認爲傷寒而妄治之. 其或可者, 蓋亦因其不敢放肆ㆍ多用和解平和之藥散之爾. 《丹心》
Translation영역
The miscellaneous disorders that resemble cold damage are very many. Wherever there is a light case of a cold, it may not be taken at once for cold damage and treated recklessly. That some of them do turn out well is because the physician did not dare to be unrestrained and mostly used harmonizing and resolving medicines of a level kind to disperse it.
Dansim 丹心
Translation영역
Wherever wind-cold is contracted, it is generally called the cold damage of the four seasons, and Harmonizing Powder, Rectify the Qi Powder, Ginseng and Perilla Drink both formulas appear above, Snow-Drenching Decoction, Interchange Powder, Ten-Ingredient Chuanxiong and Perilla Powder the formula appears in the Epidemics chapter and Worth Its Weight in Gold Drink are apt. The formula appears in the Internal Damage chapter.
Clinical note임상 주석
The opening list of nine ways to catch cold is the most concrete passage of its kind in the Bogam, and it is observation rather than theory: taking off a coat on the first warm day, drinking something cold when overheated, sleeping in a draught, going out in snow, breathing cold air at dawn, a warm spell breaking suddenly, a long wet cold spell. 將理失宜 — the nursing of the body ill managed — is the common thread, and every one of the nine is recognizable now.
古人不敢輕發汗 — the ancients did not dare lightly to induce sweat — is the most useful statement in the chapter about ephedra, and it is a restraint argument rather than a pharmacological one: the drug works by opening the interstices, so used wrongly it drains the true qi and makes a new disease. Hence the preference for 平和之劑, an agent of a level kind.
雜病與傷寒相類者極多 and the Dansim's explanation of why mild cases do well — because the physician was cautious and used gentle formulas — is a piece of honest reasoning about why treatments appear to work. It belongs with Liu Wansu's 偶然誤中 at 1.39.
Deukhyobang 得效
1.50 External Contraction Compounded with Internal Damage 外感挾內傷證
Source원문
外感無內傷, 用仲景法. 《丹心》
Translation영역
Where there is external contraction without internal damage, Zhongjing's methods are used.
Dansim 丹心
Source원문
傷寒挾內傷者十居八九. 蓋邪之所湊ㆍ其氣必虛, 只用補中益氣湯出入加減; 氣虛甚者少加附子以行參ㆍ芪之功. 方見內傷 《丹心》
Translation영역
Of cold damage cases compounded with internal damage there are eight or nine in ten. For where the evil gathers, the qi there must be depleted; use only Center-Supplementing Qi-Boosting Decoction with additions and subtractions. Where the qi depletion is severe, add a little aconite to carry the work of the ginseng and astragalus. The formula appears in the Internal Damage chapter.
Dansim 丹心
Translation영역
In cold damage, Dangye used Center-Supplementing Qi-Boosting Decoction and Haejang used Nine-Ingredient Notopterygium Decoction, and both are in the sense of harmonizing and resolving, not letting the true qi be scattered and lost.
Uihak Gangmok 綱目
Source원문
丹溪ㆍ海藏諸賢治傷寒, 皆以補養兼發散之法. 此乃風雨寒熱不得虛ㆍ邪不能獨傷人之旨也. 俗醫謂傷寒無補法, 不分虛實ㆍ一例汗下而致夭橫, 實醫門之罪人也. 《綱目》
Translation영역
Dangye, Haejang and the other worthies all treated cold damage by a method that supplements and nourishes together with dispersing outward. This is the import of the saying that wind and rain and cold and heat, not finding a depletion, cannot of themselves damage a man. The common physicians say that cold damage has no supplementing method, and without distinguishing depletion from repletion they sweat and purge by one rule and so bring about untimely deaths; they are in truth the criminals of the medical gate.
Uihak Gangmok 綱目
Source원문
傷寒一證頭疼ㆍ身熱ㆍ惡寒ㆍ微渴ㆍ濈然汗出ㆍ沉困ㆍ身痛ㆍ脚痠ㆍ脉浮虛無力, 名曰勞力感寒, 不可誤作正傷寒大發汗, 宜加味益氣湯. 《回春》
Translation영역
There is one cold damage pattern with headache, generalized fever, aversion to cold, slight thirst, continuous sweating, heavy exhaustion, body ache, aching legs and a floating, depleted, forceless pulse; it is named cold contracted through labour, and it may not be mistaken for a true cold damage and greatly sweated. Supplemented Qi-Boosting Decoction is apt.
Manbyeong Hoechun 回春
Translation영역
For external contraction compounded with internal damage, Tao's Center-Supplementing Qi-Boosting Decoction and Ten-Ingredient Harmonizing and Resolving Powder are apt.
Clinical note임상 주석
十居八九 — eight or nine in ten — is the claim the whole section rests on, and it is a direct challenge to the chapter's own first principles: if nearly every cold damage case is compounded with internal damage, then the pure sweating and purging methods of the upper part apply to almost nobody. Zhu Dangye's answer is to make Center-Supplementing Qi-Boosting Decoction the base and adjust from there.
邪之所湊ㆍ其氣必虛 — where the evil gathers, the qi there must be depleted — is the Neijing line that licenses it, and 風雨寒熱不得虛ㆍ邪不能獨傷人 is its fuller form. Taken seriously, it makes depletion the precondition of every infection, which is too strong; but as a correction to treating every febrile patient as if they had reserves to spare, it is well aimed.
俗醫謂傷寒無補法…實醫門之罪人也 — they are the criminals of the medical gate — is the angriest sentence in the Bogam, and the target is a real position: that cold damage admits no supplementing, so sweat and purge regardless. The Gangmok's charge is not that the methods are wrong but that they are applied 不分虛實, without distinguishing.
勞力感寒, cold contracted through labour, is the specific pattern this reasoning was built for, and the formula's own entry sets out Gong Tingxian's version of it.
Uihak Immun 入門
1.51 The Depletion Pattern of External Contraction with Internal Damage Should Be Supplemented 外感內傷虛證宜補
Source원문
一婦年七十ㆍ患傷寒ㆍ發熱惡寒, 諸醫以藥發散ㆍ旬日不效, 飮食漸少ㆍ昏沉不省ㆍ口不能言ㆍ眼不能開ㆍ咽喉有微氣ㆍ有欲絶之候ㆍ六脉虛微若無. 以人參濃煎湯ㆍ徐徐灌之, 連用頓甦, 又歷十四年而卒. 夫人參回元氣於無何有之鄕, 果有起死回生之功. 醫說載一人傷寒成壞證, 只服人參湯ㆍ鼻梁出汗而愈, 與此同. 《回春》
Translation영역
A woman of seventy suffered cold damage with fever and aversion to cold, and the physicians all used medicines to disperse it outward, and for ten days it had no effect; her food and drink grew less by degrees, she was clouded and sunken and not aware, the mouth could not speak, the eyes could not open, there was a faint breath in the throat and the signs of one about to be cut off, and all six pulses were depleted and faint as though absent. A thick decoction of ginseng was made and poured into her slowly, and with its continued use she revived at once, and lived a further fourteen years before she died. Now ginseng brings the original qi back from the land where nothing is, and it does indeed have the power of raising the dying and bringing them back to life. The Uiseol records a man whose cold damage became a ruined pattern and who took only a ginseng decoction, and sweat came out on the bridge of his nose and he was cured; it is the same as this.
Clinical note임상 주석
A seventy-year-old woman sweated for ten days without effect, by then unresponsive and pulseless, revived on a thick ginseng decoction poured in slowly, and living fourteen more years. Whatever one makes of the pharmacology, the case is a record of a patient saved by stopping a treatment: the dispersing had been going on for ten days and was the reason she was in that state.
徐徐灌之 — poured into her slowly — is the detail that matters in an unresponsive patient, and it is the right instruction. The sweat on the bridge of the nose in the second case is the same sign Snatch Back Life Powder's entry gives, which identifies that formula as the ginseng decoction being described.
回元氣於無何有之鄕 — brings the original qi back from the land where nothing is — is rhetoric, but the clinical point under it is the one the previous section argued: in a depleted patient the supplementing is the treatment, not an adjunct to it.
Manbyeong Hoechun 回春
1.52 Cold Damage in a Pregnant Woman 孕婦傷寒
Translation영역
For cold damage in a pregnant woman, Chuanxiong and Perilla Powder, Yellow Dragon Decoction, Bupleurum and Bitter Orange Decoction and Fetus-Shielding Powder should be used.
Uihak Immun 入門
Source원문
傷寒熱病宜護胎: 井底泥及靑黛ㆍ伏龍肝, 井水調ㆍ塗臍腹上, 乾則再濕塗, 庶免傷胎. 《回春》
Translation영역
In cold damage and heat disease the foetus should be protected: mud from the bottom of a well, together with indigo and the earth from under a stove, mixed with well water and smeared over the navel and abdomen, and when it dries moistened and smeared again, so that damage to the foetus may be avoided.
Clinical note임상 주석
Four internal formulas and one external measure, and the external one is the interesting part: a cool wet poultice of well mud and indigo over the lower abdomen, kept damp. The reasoning is to keep the womb cool while the fever runs, and a cold compress over the lower abdomen in a hyperthermic pregnant patient is not a bad thing to do — the same principle as the Water-Soaking Method at 1.3 and the Chest-cloth method of the Yang Toxin section.
All four formulas are built around not purging and not forcing a sweat, and the entries for Fetus-Shielding Powder and Chuanxiong and Perilla Powder set out which drugs were chosen and which deliberately left out. 庶免傷胎 — so that damage to the foetus may be avoided — is the governing aim of the whole section.
Manbyeong Hoechun 回春
1.53 Entrenched Cold 痼冷
Source원문
痼冷者, 謂痼久而冷也. 痼者, 固也; 冷者, 寒之甚也. 《醫鑑》
Translation영역
Entrenched cold means that it has been entrenched a long time and is cold. Entrenched means fixed; cold means cold at its severest.
Gogeum Uigam 醫鑑
Translation영역
Cold lodged within the viscera and bowels and not dispersing is called deep cold; accumulated cold that will not resolve is called entrenched cold. Aconite Regulate the Middle Decoction the formula appears above, Four Pillars Powder the formula appears in the Stool chapter, Cold-Dispersing Powder, Modified White Through-Flow Decoction, Numinous Cinnabar, Golden Liquid Elixir, Most Holy Come-Again Elixir, Moxa-Replacing Navel Paste and Supplemented Regulate the Middle Decoction are apt.
Clinical note임상 주석
痼者固也 — entrenched means fixed — and the distinction from 沉寒, deep cold, is one of duration rather than of kind: cold that has stopped moving against cold that has accumulated past resolving. The patient is the one who is always cold, whose stool is always loose, and who has been so for years.
Nine remedies, and the two in the middle are the chapter's most dangerous: Numinous Cinnabar is mercuric sulphide made by direct synthesis and Golden Liquid Elixir is purified sulphur, and both entries carry the warnings they require and the reasons the procedures are worth reading. Of the rest, Aconite Regulate the Middle, Supplemented Regulate the Middle, Cold-Dispersing Powder and Four Pillars Powder are usable, and Moxa-Replacing Navel Paste is an external plaster.
The whole section is three lines in the Bogam and nine formulas, which is the proportion of a chapter that has said all it has to say about the mechanism and is simply listing what was used.
Uihak Immun 入門
1.54 Cold Damage Has Five Kinds 傷寒有五種
Source원문
有中風ㆍ有濕溫ㆍ有傷寒ㆍ有熱病ㆍ有溫病, 皆以脉理推之.
Translation영역
There is wind strike, there is damp warmth, there is cold damage, there is heat disease and there is warm disease, and all are inferred by the principle of the pulse.
Nangyeong 難經
Source원문
中風之脉, 陽浮而滑ㆍ陰濡而弱.
Translation영역
The pulse of wind strike is floating and slippery in the yang, soggy and weak in the yin.
Nangyeong 難經
Source원문
濕溫之脉, 陽濡而弱ㆍ陰少而急.
Translation영역
The pulse of damp warmth is soggy and weak in the yang, small and urgent in the yin.
Nangyeong 難經
Source원문
傷寒之脉, 陰陽俱盛而緊濇.
Translation영역
The pulse of cold damage is exuberant in both yin and yang, and tight and rough.
Nangyeong 難經
Source원문
熱病之脉, 陰陽俱浮, 浮之而滑ㆍ沉之散澁.
Translation영역
The pulse of heat disease is floating in both yin and yang; floating it is slippery and deep it is scattered and rough.
Nangyeong 難經
Source원문
溫病之脉, 行在諸經ㆍ不知何經之動也, 隨其經所在而取之. 《難經》
Translation영역
The pulse of warm disease moves in all the channels and one does not know which channel's stirring it is; take it according to the channel in which it lies.
Clinical note임상 주석
The Nanjing's five kinds, each defined by a pulse and nothing else, and the upper part's 2.4 sets them out in verse. The fifth is the interesting one: warm disease has no fixed pulse because it moves in all the channels, so the instruction is to find which channel it is in and read there. An admission that one of the five cannot be identified the way the other four can.
Nangyeong 難經
1.55 The Sixteen Names of Cold Damage 傷寒十六名
Source원문
一曰傷寒, 二曰傷風, 三曰傷寒見風, 四曰傷風見寒, 五曰風濕, 六曰中濕, 七曰風溫, 八曰濕溫, 九曰溫毒, 十曰中暍, 十一曰熱病, 十二曰溫病, 十三曰晩發, 十四曰痓病, 十五曰溫瘧, 十六曰疫癘. 《類聚》
Translation영역
The first is cold damage, the second wind damage, the third cold damage showing wind, the fourth wind damage showing cold, the fifth wind damp, the sixth damp strike, the seventh wind warmth, the eighth damp warmth, the ninth warm toxin, the tenth summerheat strike, the eleventh heat disease, the twelfth warm disease, the thirteenth late onset, the fourteenth tetany disease, the fifteenth warm malaria and the sixteenth epidemic pestilence.
Uibang Yuchwi 類聚
Source원문
濕病有五種, 乃風濕ㆍ濕溫ㆍ寒濕ㆍ中濕ㆍ濕痺也. 溫病有五種, 乃春溫ㆍ風溫ㆍ溫疫ㆍ溫瘧ㆍ溫毒也. 濕詳見濕門, 溫詳見瘟疫 《入門》
Translation영역
Damp disease has five kinds, namely wind damp, damp warmth, cold damp, damp strike and damp impediment. Warm disease has five kinds, namely spring warmth, wind warmth, warm epidemic, warm malaria and warm toxin. Damp is treated in detail in the Damp chapter, and warmth in the Epidemics chapter.
Clinical note임상 주석
Sixteen names under one heading, and the list is why this chapter had to cover so much ground: summerheat strike, tetany, epidemic pestilence and warm malaria are all counted as cold damage, and three of them have chapters of their own elsewhere in this volume. The third and fourth names — cold damage showing wind and wind damage showing cold — are the Major Dragon's indication at 2.14, given here as diseases in their own right.
The second passage's two sets of five are the Bogam's cross-references out of this chapter, and together with 1.56 they mark the boundary of what the compilers thought belonged here.
Uihak Immun 入門
1.56 The Four Patterns Resembling Cold Damage 傷寒相類四證
Source원문
一曰痰飮詳見痰門, 二曰虛煩詳見火門, 三曰脚氣詳見足部, 四曰食積. 詳見內傷 《入門》
Translation영역
The first is phlegm-rheum treated in detail in the Phlegm chapter, the second depletion vexation treated in detail in the Fire chapter, the third leg qi treated in detail in the Foot chapter, and the fourth food accumulation. Treated in detail in the Internal Damage chapter.
Clinical note임상 주석
Four conditions that present like cold damage and are not, each sent to its own chapter. They overlap Xu Shuwei's five look-alikes at 2.69 of the upper part — food damage and wind phlegm appear in both — and leg qi was named among the six confusions at 2.2. The list exists so that a reader working through this chapter knows when to stop and look elsewhere.
Uihak Immun 入門
1.57 Rhapsody on Cold Damage 傷寒賦
Source원문
傷寒爲病ㆍ反覆變遷, 賴先師究詳之遺旨ㆍ成後學診治之良詮. 太陽則頭痛ㆍ身熱ㆍ脊强, 陽明則目疼ㆍ鼻乾ㆍ不眠; 少陽耳聾ㆍ脇痛ㆍ寒熱嘔而口爲之苦, 太陰腹滿ㆍ自利ㆍ尺寸沉而津不到咽; 少陰舌乾ㆍ口燥, 厥陰煩滿ㆍ囊縮.
Translation영역
Cold damage as a disease turns over and over and shifts and changes; we lean on the former masters' bequeathed import, searched out in detail, and it becomes a good explication of diagnosis and treatment for those who come after. In the taiyang there is headache, generalized fever and a stiff spine; in the yangming, pain of the eyes, dryness of the nose and sleeplessness; in the shaoyang, deafness, rib-side pain, chill and fever with retching and a mouth made bitter by it; in the taiyin, abdominal fullness, spontaneous diarrhoea, the cubit and inch deep and the fluids not reaching the throat; in the shaoyin, a dry tongue and parched mouth; in the jueyin, vexing fullness and the scrotum retracted.
Donguibogam 東醫寶鑑
Source원문
一二日可發表而散, 三四日宜和解而痊; 五六日便實方可議下, 七八日不解又復再傳. 日傳二經ㆍ病名兩感, 經傳六日ㆍ應無一全.
Translation영역
On the first or second day it may be brought out at the exterior and dispersed; on the third or fourth it should be harmonized and resolved and healed; on the fifth or sixth, when the stool is replete, purging may then be discussed; on the seventh or eighth, if it has not resolved, it passes over again a second time. Where two channels are passed in a day the disease is named a double strike; where the channels are passed in six days, there should not be one who comes through whole.
Donguibogam 東醫寶鑑
Translation영역
In the taiyang without sweat, ephedra is best; in the taiyang with sweat, cinnamon twig may come first; Minor Bupleurum is the essential hold on the shaoyang, and Major Bupleurum moves the stopped hardness of the yangming. Coming to the three yin, a fixed method is hard to be bound by, and it may be warmed or it may be purged; one should change often so as to exhaust the intention of giving life, and it may be square or it may be round.
Donguibogam 東醫寶鑑
Source원문
且如陽證下之早者ㆍ乃爲結胸, 陰證下之早者ㆍ因成痞氣; 發狂爲血蓄于內ㆍ又大便之極實, 發黃爲熱積於中ㆍ兼小便之不利. 微喘緣表之未解, 微煩爲陽之相勝; 喘滿而不惡寒者當下而痊, 煩極而反發厥者乃陰所致.
Translation영역
And thus a yang pattern purged early becomes a chest bind, and a yin pattern purged early thereby makes a stuffy qi; mania is blood stored within, with the stool at its most replete; jaundice is heat accumulated in the middle, together with the urine inhibited. Slight panting follows from the exterior not resolved, and slight vexation is the yang prevailing; panting fullness without aversion to cold should be purged and healed, and vexation at its extreme turning instead to reversal is brought about by the yin.
Donguibogam 東醫寶鑑
Source원문
狐惑蓋緣失汗ㆍ虫蝕藏及蝕肛, 蛔厥却緣多飢ㆍ虫攻咽及攻胃; 渴乃煩多ㆍ斑爲熱熾. 陽明內實則爲寒熱往來, 太陽中風因作剛柔二痓.
Translation영역
The fox-delusion pattern follows from a sweat that was missed, the worms gnawing the viscera and gnawing the anus; roundworm reversal follows instead from much hunger, the worms attacking the throat and attacking the stomach; thirst is vexation in plenty, and macules are heat at its fiercest. Where the yangming is replete within there is chill and fever coming and going, and taiyang wind strike thereby makes the two tetanies, the hard and the soft.
Donguibogam 東醫寶鑑
Source원문
衂血雖爲欲解ㆍ動陰血者有厥竭之憂, 厥利雖若尋常ㆍ反能食者有除中之忌. 厥有二端ㆍ治非一類: 陰厥脉沉而細ㆍ初緣利過, 陽厥脉沉而滑ㆍ始因便秘; 治陽則芒硝ㆍ大黃, 治陰則附子ㆍ薑ㆍ桂. 死生係反掌之間ㆍ脉藥可折肱而治.
Translation영역
Though a nosebleed means it is about to resolve, one who has stirred the yin blood has the fear of reversal and exhaustion; and though reversal with diarrhoea seems an ordinary thing, one who is able to eat instead has the taboo of the middle removed. Reversal has two ends and its treatment is not of one kind: yin reversal has a pulse deep and fine and begins from excessive diarrhoea, and yang reversal has a pulse deep and slippery and begins from constipation; to treat the yang, mirabilite and rhubarb; to treat the yin, aconite, ginger and cinnamon. Life and death hang in the turning of a hand, and in pulse and medicine one may break an arm and so learn to treat.
Donguibogam 東醫寶鑑
Translation영역
And so one knows that where wind warmth sweats without cease, stephania of Han should be used, and where chest stuffiness with diarrhoea will not stop, limonite should be taken. A concurrent disease returns into one channel, and the evil not passing over, the exterior resolves and the ailment heals; the shivering sweat divides into four patterns, and the yang prevailing over the yin, the heat retreats and the body cools. For cough with counterflow, notopterygium and aconite; for abdominal pain, cinnamon twig and rhubarb.
Donguibogam 東醫寶鑑
Source원문
微虛相搏則爲短氣, 勞ㆍ食再復乃成內傷. 陽明背惡寒而唇口燥ㆍ懸知白虎爲最, 少陰身體痛而筋肉惕ㆍ乃聞眞武至强. 將欲發黃ㆍ先出頭汗ㆍ始因火迫ㆍ終至亡陽. 渴欲飮水ㆍ水入卽吐者五苓散, 燥欲漱水ㆍ水入不下者犀角湯.
Translation영역
Where slight depletion and the evil beat against each other there is shortness of breath, and relapse from exertion or from eating makes an internal damage. In the yangming, with the back averse to cold and the lips and mouth parched, one knows from afar that White Tiger is best; in the shaoyin, with the body aching and the sinews and flesh twitching, one hears that True Warrior is the strongest. Where jaundice is about to arise, sweat comes out on the head first; it begins from fire pressing and ends in yang collapse. Thirst with a wish to drink water and the water vomited as soon as it goes in: Five-Ingredient Poria Powder; parchedness with a wish to rinse with water and the water not going down: Rhinoceros Horn Decoction.
Donguibogam 東醫寶鑑
Source원문
況乃大靑龍兼理風寒, 小承氣正蠲潮熱. 不得眠而煩燥甚ㆍ雞子入於黃連, 但有熱而嘔噦頻ㆍ薑汁加於竹葉. 二匕瓜蔕散吐傷寒中脘痰涎, 三物桃花湯理少陰下利膿血. 厚朴半夏治腹脹爲偏宜, 葱白麻黃理頭疼爲至截.
Translation영역
How much more does the Major Blue-Green Dragon govern wind and cold together, and Minor Order the Qi precisely remove tidal fever. Where he cannot sleep and the vexing agitation is severe, egg goes into the coptis; where there is only heat and the retching and hiccough are frequent, ginger juice is added to the bamboo leaf. Two spoonfuls of Melon Stalk Powder vomits out the phlegm and drool at the middle duct in cold damage, and the three substances of Peach Blossom Decoction set right the shaoyin diarrhoea of pus and blood. Magnolia Bark and Pinellia treats abdominal distension and is particularly apt; scallion white and ephedra set right headache and is the most cutting of all.
Donguibogam 東醫寶鑑
Source원문
調溫毒可用黑膏散, 赤癍當行紫雪. 吐血者須煎黃連ㆍ蘗皮, 咽痛者通用猪膚ㆍ甘桔. 三物白雖云頗峻ㆍ散結胸寒實中焦, 十棗湯固非泛常ㆍ治痞滿痛連兩脇. 加以大熱ㆍ錯語ㆍ呻吟ㆍ乾嘔者黃連解毒, 脉遲ㆍ熱多寒少ㆍ血弱者黃芪建中.
Translation영역
To regulate warm toxin, Black Paste Powder may be used, and for red macules Purple Snow should be given. For one who vomits blood, coptis and phellodendron bark must be decocted, and for throat pain, pig's skin and licorice with platycodon serve generally. Though the Three Substances White be called rather harsh, it disperses a cold-repletion chest bind in the middle burner; and though Ten Jujubes Decoction be no common thing, it treats stuffy fullness with pain continuing into both rib-sides. Add to these: for great heat with confused speech, groaning and dry retching, Coptis Resolve Toxicity; for a slow pulse with much heat and little cold and weak blood, Astragalus Construct the Middle.
Donguibogam 東醫寶鑑
Source원문
汗之過多ㆍ動悸而惕, 下之先時ㆍ懊憹在胸. 旋覆代赭理心痞而噫不息, 桂枝各半療身痒而汗不通. 勞復身熱ㆍ湯名猳鼠糞, 腸垢臍熱ㆍ藥用白頭翁. 疫癘者春夏秋冬各有分ㆍ用須十全九證, 百合者行住坐卧皆不定ㆍ號爲百脉一宗.
Translation영역
Sweating him too much gives stirring palpitation and startling; purging him before the time gives a gnawing distress in the chest. Inula and Hematite sets right the heart stuffiness with belching that will not cease, and Cinnamon Twig Half-and-Half cures the itching body with the sweat not getting through. For relapse from exertion with generalized fever, the decoction is named Rat Dung; for intestinal filth and heat at the navel, the medicine used is pulsatilla. For epidemic pestilence, spring, summer, autumn and winter each have their division, and in using it one must have the nine patterns complete in ten; for the lily case, walking, standing, sitting and lying are all unsettled, and it is called the hundred vessels having one ancestor.
Donguibogam 東醫寶鑑
Source원문
常謂多眠ㆍ身猶灼熱ㆍ風溫可用萎蕤, 不眠ㆍ心蘊虛煩ㆍ斂汗必須酸棗. 手足攣搐ㆍ當末牛蒡根, 咳嗽生痰ㆍ宜行金沸草. 不可汗本有數種ㆍ動氣與風濕脉虛, 不可下自非一端ㆍ動氣與陽浮在表. 濕證不可汗ㆍ傷霍亂多緣熱惱; 溫病發於春夏ㆍ要須柴葛以解肌; 奔豚挾逐寒邪ㆍ多用桂苓爲可保.
Translation영역
It is commonly said that where there is much sleeping and the body is still scorching hot, wind warmth may use polygonatum; where there is no sleep and the heart harbours a depletion vexation, to gather in the sweat sour jujube is needed. For hypertonic twitching of the hands and feet, burdock root should be powdered; for cough generating phlegm, inula should be given. That it may not be sweated has from the first several kinds — stirred qi, and wind damp with a depleted pulse; that it may not be purged is of itself not of one sort — stirred qi, and the yang floating in the exterior. In a damp pattern it may not be sweated, and damage in cholera is mostly owing to heat vexation; a warm disease arising in spring or summer must have bupleurum and pueraria to resolve the flesh; the running piglet carrying off a cold evil mostly uses cinnamon and poria to be made safe.
Donguibogam 東醫寶鑑
Source원문
蓋聞乍寒微熱ㆍ名似瘧ㆍ不嘔淸便必自愈, 臍痛引陰ㆍ名藏結ㆍ下利白胎不可醫. 口燥咽乾ㆍ雖少陰下莫可緩, 肉瞤筋惕ㆍ發動氣汗以致羸. 陽明與少陽合病ㆍ脉弦者名曰負, 傷寒與熱病將痊ㆍ食多者號曰遺.
Translation영역
It is heard that a sudden cold with slight heat is named resembling malaria, and if there is no retching and the stool is clear he will certainly heal of himself; and that pain at the navel drawing into the genitals is named a visceral bind, and with diarrhoea and a white coating it may not be doctored. With a parched mouth and dry throat, though it be shaoyin the purge may not be delayed; with flesh fasciculating and sinews twitching, stirred qi has been raised and the sweat has brought him to wasting. In a combined disease of yangming and shaoyang, where the pulse is stringlike it is named a defeat; in cold damage and heat disease about to heal, one who eats much is called a remainder.
Donguibogam 東醫寶鑑
Source원문
自汗有風溫ㆍ濕溫, 若亡陽則朮ㆍ附可用; 身痛有表證ㆍ裏證, 若陰毒則四逆尤遲. 脾弱者大便難而小便數ㆍ治用大黃ㆍ枳殼, 協熱者小便澁而大便利ㆍ用須黃連ㆍ當歸. 嘔吐有寒有熱ㆍ寒則當溫ㆍ熱當以解, 譫語有虛有實ㆍ實則可下ㆍ虛不可爲.
Translation영역
Spontaneous sweating belongs to wind warmth and damp warmth, and if it is yang collapse, atractylodes and aconite may be used; body ache belongs to an exterior pattern and an interior pattern, and if it is yin toxin, Frigid Extremities is slower still. In the spleen-weak case the stool is difficult and the urine frequent, and the treatment uses rhubarb and bitter orange; in the heat-complicated case the urine is rough and the stool passes freely, and coptis and tangkuei must be used. Vomiting may be of cold or of heat: cold should be warmed and heat should be resolved; delirious speech may be of depletion or of repletion: repletion may be purged and depletion may not be acted on.
Donguibogam 東醫寶鑑
Source원문
陽毒則狂ㆍ斑ㆍ煩亂ㆍ以大靑ㆍ升麻可回困篤, 陰毒則唇靑ㆍ厥逆ㆍ以正陽ㆍ甘草或拯顚危. 發厥時胸煩尤甚ㆍ此藏氣絶而精神散, 大汗後身熱猶盛ㆍ此陰陽交而魂魄離. 嗟夫! 生死之關ㆍ陰陽是主. 陽脉見於陰經ㆍ其生也可知, 陰脉見於陽經ㆍ其死也可許. 土衰木旺則爲賊ㆍ能無剋制之災, 水升火降則爲和ㆍ會見歡欣之擧. 緣傷寒傳變之不常ㆍ非雜病徑直而可取, 是用潛篤心神ㆍ洞窺藏府. 推惻隱之端以濟乎今ㆍ拯疲癃之疾以遵乎古. 庶幾可登東垣之堂ㆍ不負乎諄諄之語.
Translation영역
In yang toxin there is mania, macules and vexed disorder, and with isatis and cimicifuga the gravest exhaustion may be brought back; in yin toxin there are blue lips and reversal, and with Upright Yang and licorice the utmost peril may perhaps be rescued. When the reversal arises and the chest vexation is at its worst, this is the visceral qi severed and the essence-spirit scattered; when after a great sweat the generalized fever is still exuberant, this is the yin and yang crossing and the ethereal and bodily souls parting. Alas! At the gate of life and death, the yin and yang are the governors. When a yang pulse appears in a yin channel, that he will live may be known; when a yin pulse appears in a yang channel, that he will die may be affirmed. Where earth declines and wood flourishes it becomes a robber — can the calamity of overwhelming restraint be escaped? Where water rises and fire descends it makes concord, and occasions of gladness will be seen. Because the transmissions and transformations of cold damage are never constant, and are not to be taken as straightforwardly as the miscellaneous diseases, one must therefore still the heart and spirit and peer deeply into the viscera and bowels. Carry out the impulse of compassion to relieve the present age; rescue the diseases of the worn and the crippled in accordance with the ancients. Then one may perhaps ascend to the hall of Dongwon, and not be unworthy of his earnest words.
Clinical note임상 주석
A verse summary of the whole chapter, and it is the most compressed teaching document in the Bogam: thirty-odd couplets, each pairing a sign with a drug or a prohibition with its reason, written to be memorized. Nearly every formula in both parts of the chapter appears in it by a two- or three-character tag — 雞子入於黃連 for Coptis and Donkey-Hide Gelatin, 薑汁加於竹葉 for Bamboo Leaf and Gypsum, 葱白麻黃 for Ephedra Decoction with the Bogam's scallion.
死生係反掌之間ㆍ脉藥可折肱而治 is the couplet to take from it. The first half is Liu Wansu's 一彈指間 at 1.39 in another form; the second alludes to the saying that a man who has broken his arm three times becomes a good doctor — experience bought by error, which is the chapter's own history.
嗟夫ㆍ生死之關ㆍ陰陽是主 closes the rhapsody and the chapter's argument: at the gate of life and death, yin and yang are what govern. After eighty-three sections in the upper part and fifty-seven here, the conclusion is the distinction the whole thing began with at 2.2 — a yin pattern that looks like yang, a yang pattern that looks like yin — and the insistence that getting it right is the whole of the art.
Donguibogam 東醫寶鑑
1.58 Simple Medicinals 單方
Source원문
凡二十種.
Translation영역
Twenty kinds in all.
Donguibogam · Han
Source원문
石膏 主傷寒熱病ㆍ汗後脉洪大ㆍ頭痛ㆍ口燥ㆍ大渴. 取石膏碎 一兩, 水煎服之. 《本草》
Translation영역
Gypsum (石膏): Governs cold damage and heat disease where after sweating the pulse is surging and large, with headache, a parched mouth and great thirst. Take 1 nyang of gypsum, crush it and decoct in water.
Boncho 本草
Source원문
硫黃 治傷寒陰證ㆍ身冷ㆍ脉微ㆍ手足厥而躁. 硫黃 五錢爲末, 艾湯調服, 卽時安卧ㆍ汗出而愈. 《入門》
Translation영역
Sulphur (硫黃): Treats the yin pattern of cold damage with a cold body, a faint pulse, the hands and feet reversed and agitation. Powder 5 don of sulphur and take it stirred into mugwort decoction; he lies down at ease at once, the sweat comes out and he is cured.
Clinical note임상 주석
Sulphur taken internally at 5 don is the most dangerous single item in this section and the same drug as Golden Liquid Elixir at 1.53, there given after seven days of purification. Here it is simply powdered. Sulphur causes hydrogen sulphide toxicity and severe gastrointestinal injury and is not to be taken; the pattern it addresses is the one the aconite formulas of 1.46 treat.
Uihak Immun 入門
Source원문
柴胡 療傷寒第一, 解肌ㆍ除煩熱. 剉 一兩, 水煎服之. 《本草》
Translation영역
Bupleurum (柴胡): First of all for curing cold damage; it resolves the flesh and removes vexing heat. Cut up 1 nyang and decoct in water.
Boncho 本草
Source원문
葛根 傷寒初患ㆍ頭痛ㆍ身熱. 葛根剉 一兩, 水煎服. ○生葛取汁飮 一升亦效. 《本草》
Translation영역
Pueraria (葛根): For the first onset of cold damage with headache and generalized fever. Cut up 1 nyang of pueraria and decoct in water. ○ Pressing the juice from fresh pueraria and drinking 1 seung is also effective.
Boncho 本草
Source원문
麻黃 療傷寒ㆍ解肌發汗爲第一. 去節, 取 五錢, 水煎服之. 《本草》
Translation영역
Ephedra (麻黃): For curing cold damage, it is first of all for resolving the flesh and inducing sweat. Remove the nodes, take 5 don and decoct in water.
Boncho 本草
Source원문
百合 傷寒陰毒. 煮百合濃汁ㆍ服 一升良. 《本草》
Translation영역
Lily bulb (百合): For yin toxin in cold damage. Boil lily bulb to a thick liquor and 1 seung taken is good.
Boncho 本草
Source원문
竹瀝 主傷寒勞復. 竹瀝小煎ㆍ數數飮之取汗. 《本草》
Translation영역
Bamboo sap (竹瀝): Governs relapse from exertion in cold damage. Decoct bamboo sap a little and drink it again and again to obtain a sweat.
Boncho 本草
Source원문
梔子 治傷寒熱病ㆍ勞復. 梔子 十枚碎, 水煎服, 微汗. 《本草》
Translation영역
Gardenia (梔子): Treats cold damage, heat disease and relapse from exertion. Crush ten gardenias and decoct in water; a slight sweat.
Boncho 本草
Source원문
皂莢 傷寒昏迷不省人事. 皂莢末ㆍ以紙撚燒烟入鼻, 有嚏可治ㆍ無則不治, 肺氣上絶也. 可治者, 隨用皂莢ㆍ半夏(生)ㆍ白礬共 一錢半爲末, 薑汁調服, 探吐痰ㆍ去卽甦. 《回春》
Translation영역
Gleditsia pod (皂莢): For cold damage with a clouded stupor and no awareness of affairs. Powder the gleditsia pod, twist paper about it and burn it so the smoke enters the nose; if there is a sneeze he may be treated, and if not he may not, for the lung qi is severed above. For one who may be treated, then use gleditsia pod, raw pinellia and white alum together, 1 don 5 fun, powdered and taken stirred into ginger juice; probe to make him vomit the phlegm, and once it is gone he revives.
Clinical note임상 주석
有嚏可治ㆍ無則不治 — if there is a sneeze he may be treated, and if not he may not — is a prognostic test and a good one. A sneeze requires an intact afferent and motor arc, so an unresponsive patient who can still mount one has reflexes left. The Wind chapter uses the same test and the Neijing's day-eleven sneeze at 2.6 of the upper part reads it the same way.
Manbyeong Hoechun 回春
Source원문
牡鼠糞 專主勞復. 入葱ㆍ豉水煎服. 《本草》
Translation영역
Male rat droppings (牡鼠糞): Governs relapse from exertion above all. Put in scallion and fermented soybean and decoct in water.
Clinical note임상 주석
Not to be used. Rat droppings carry leptospirosis, hantavirus and salmonella, and the two formulas built on them — Rat Dung and Fermented Soybean Decoction and Rat Dung Decoction — carry the same warning in their entries. The scallion and fermented soybean are doing the work, and Gardenia, Fermented Soybean and Bitter Orange Decoction treats the same relapse without them.
Boncho 本草
Source원문
葱白 傷寒初覺頭痛ㆍ身熱, 便服葱豉湯: 葱白 一握ㆍ豉 一合ㆍ生薑 五片, 水煎溫服取汗. 時疫亦用此. 《本草》
Translation영역
Scallion white (葱白): At the first sense of headache and generalized fever in cold damage, take Scallion and Fermented Soybean Decoction at once: a handful of scallion white, a hop of fermented soybean and five slices of fresh ginger, decocted in water and taken warm to obtain a sweat. It is used for seasonal epidemics too.
Boncho 本草
Source원문
生梨 主傷寒熱盛. 取食之. 《本草》
Translation영역
Fresh pear (生梨): Governs cold damage where the heat is exuberant. Take it and eat it.
Boncho 本草
Source원문
葱酒 治感寒初覺. 連鬚葱白細切, 投熱酒中飮之, 取汗差. 《俗方》
Translation영역
Scallion wine (葱酒): Treats the first sense of having caught cold. Cut scallion white with the roots left on finely, throw it into hot wine and drink it, and a sweat is obtained and he recovers.
Sokbang 俗方
Source원문
荊芥 主傷寒頭痛. 取穗 一兩, 濃煎服之. 《本草》
Translation영역
Schizonepeta (荊芥): Governs headache in cold damage. Take 1 nyang of the spikes and decoct thickly.
Boncho 本草
Source원문
紫蘇葉 治感傷風寒. 濃煎湯飮之, 取汗差. 《本草》
Translation영역
Perilla leaf (紫蘇葉): Treats contraction and damage by wind-cold. Decoct thickly and drink it, and a sweat is obtained and he recovers.
Boncho 本草
Source원문
忍冬藤 治同上. 濃煎湯溫服取汗. 《本草》
Translation영역
Honeysuckle vine (忍冬藤): Treats the same as the above. Decoct thickly and take warm to obtain a sweat.
Boncho 本草
Source원문
薄荷 療傷寒陰陽毒. 取葉煮汁ㆍ溫服取汗良. 《本草》
Translation영역
Mint (薄荷): Cures yin toxin and yang toxin in cold damage. Take the leaves, boil out the liquor and take warm to obtain a sweat; it is good.
Boncho 本草
Source원문
菉豆粥 治傷寒熱病ㆍ煩渴. 煮作粥ㆍ常服之. 《俗方》
Translation영역
Mung bean gruel (菉豆粥): Treats cold damage and heat disease with vexing thirst. Boil it into a gruel and take it regularly.
Sokbang 俗方
Source원문
人屎 卽野人乾糞也. 主傷寒發熱ㆍ發狂. 溫水漬ㆍ取汁飮之. 《本草》
Translation영역
Human faeces (人屎): That is, wild man's dried dung. Governs fever and mania in cold damage. Steep in warm water and drink the liquor.
Clinical note임상 주석
Not to be used. The same material as Coffin-Breaking Decoction at 1.3, whose entry explains the reasoning and the infectious risk. The gloss 野人乾糞 is the colloquial name the formula entry also records.
Boncho 本草
Source원문
婦人月水 解女勞復及陰經熱. 取月經衣ㆍ溫水漬ㆍ取汁飮之. 《本草》
Translation영역
A woman's menstrual flow (婦人月水): Resolves relapse from intercourse and heat in the yin channels. Take the menstrual garment, steep it in warm water and drink the liquor.
Clinical note임상 주석
Not to be used, and the same material as Red Garment Powder at 1.20, whose entry sets out the sympathetic reasoning behind the yin-yang exchange remedies. It closes the section, and the twenty simples between them run the whole range of this chapter: eight ordinary herbs that are still in use, three kitchen foods, and three items that are in the registry only because the Bogam records them.
The eight that work are worth naming together, because this is the most usable list in the chapter: gypsum for the sweating, thirsty, surging-pulse patient; bupleurum and pueraria for the early case; ephedra for the dry one; schizonepeta for the headache; perilla leaf and honeysuckle vine for a gentle sweat; mint for either toxin; gardenia for the relapse; lily bulb for the yin toxin; bamboo sap for the relapse with heat. And three foods — pear, mung bean gruel, scallion and fermented soybean decoction — of which the last is the one to remember: a handful of scallion white, a hop of fermented soybean and five slices of ginger, at the first sense of a headache coming on.
Boncho 本草
1.59 Acupuncture and Moxibustion 鍼灸法
Source원문
傷寒初得一二日ㆍ頭痛ㆍ寒熱, 宜灸巨闕ㆍ上脘ㆍ中脘各五十壯. 《得效》
Translation영역
In the first or second day of getting cold damage, with headache and chill and fever, moxa Jugwol CV-14, Sanggwan CV-13 and Junggwan CV-12, fifty cones at each.
Deukhyobang 得效
Source원문
傷寒大熱不止, 取曲池瀉ㆍ絶骨補ㆍ陷谷出血ㆍ八關大刺. 十指間出血 《易老》
Translation영역
In cold damage where the great heat will not stop, take Gokji LI-11, draining; Jeolgol GB-39, supplementing; Hamgok ST-43, letting blood; and the great needling of the eight passes. Letting blood between the ten fingers.
Yeokro 易老
Source원문
傷寒頭痛, 刺合谷ㆍ攢竹. 《綱目》
Translation영역
For headache in cold damage, needle Hapgok LI-4 and Chanjuk BL-2.
Uihak Gangmok 綱目
Source원문
傷寒汗不出, 取合谷鍼五分, 遍身汗出卽出鍼. 此穴發汗大妙ㆍ復溜瀉ㆍ商丘ㆍ腕骨ㆍ陽谷ㆍ俠谿ㆍ厲兌ㆍ勞宮ㆍ風池ㆍ魚際ㆍ經渠ㆍ內庭. 又十二經榮穴皆可刺. 《綱目》
Translation영역
In cold damage where the sweat does not come out, take Hapgok LI-4 needle to five fun, and when sweat comes out over the whole body withdraw the needle at once; this point is marvellous for inducing sweat, Bongnyu KI-7 draining, Sanggu SP-5, Wangol SI-4, Yanggok SI-5, Hyeopgye GB-43, Yeotae ST-45, Nogung PC-8, Pungji GB-20, Eoje LU-10, Gyeonggeo LU-8 and Naejeong ST-44. And the ying-spring points of the twelve channels may all be needled.
Uihak Gangmok 綱目
Source원문
傷寒汗多不止, 取內庭ㆍ合谷ㆍ復溜. 俱瀉 《綱目》
Translation영역
In cold damage where the sweating is profuse and will not stop, take Naejeong ST-44, Hapgok LI-4 and Bongnyu KI-7. All draining.
Uihak Gangmok 綱目
Source원문
傷寒頭痛: 太陽證刺完骨ㆍ京骨; 陽明證刺合谷ㆍ衝陽; 少陽證刺陽池ㆍ丘墟ㆍ風府ㆍ風池. 《雲歧》
Translation영역
For headache in cold damage: in a taiyang pattern needle Wangol GB-12 and Gyeonggol BL-64; in a yangming pattern, Hapgok LI-4 and Chungyang ST-42; in a shaoyang pattern, Yangji TE-4, Guheo GB-40, Pungbu GV-16 and Pungji GB-20.
Ungi 雲歧
Source원문
傷寒結胸, 先使人心蔽骨下正痛處左畔揉之, 以毫鍼刺左畔支溝穴, 次刺左間使穴, 名曰雙關刺; 次刺左行間穴, 左邊結胸立效. 右亦依上法刺之, 慢慢呼吸ㆍ停鍼立愈. 《綱目》
Translation영역
For chest bind in cold damage, first have someone knead the left side of the place that hurts exactly below the breastbone, and with a fine needle needle Jigu TE-6 on the left, next Gansa PC-5 on the left — this is called the double-pass needling — and next Haenggan LR-2 on the left, and a chest bind on the left side takes effect at once. For the right, needle it likewise by the above method; let him breathe slowly, and with the needle retained he is cured at once.
Uihak Gangmok 綱目
Source원문
傷寒胸痛, 取期門ㆍ大陵. 《綱目》
Translation영역
For chest pain in cold damage, take Gimun LR-14 and Daeneung PC-7.
Uihak Gangmok 綱目
Source원문
傷寒脇痛, 取支溝ㆍ陽陵泉. 《綱目》
Translation영역
For rib-side pain in cold damage, take Jigu TE-6 and Yangneungcheon GB-34.
Uihak Gangmok 綱目
Source원문
傷寒陰證腹痛, 灸足小指外側上紋尖, 灸三壯, 男左女右. 《回春》
Translation영역
For abdominal pain in the yin pattern of cold damage, moxa the tip of the upper crease on the outer side of the little toe, three cones, on the left in a man and the right in a woman.
Manbyeong Hoechun 回春
Source원문
傷寒陰毒危極ㆍ藥餌無功, 速灸臍中 三百壯; 又灸氣海ㆍ關元各二三百壯, 以手足溫煖爲效. 《本事》
Translation영역
In yin toxin of cold damage at its utmost peril, where medicines have had no effect, moxa quickly at the centre of the navel, three hundred cones; and moxa also at Gihae CV-6 and Gwanwon CV-4, two or three hundred cones at each, taking the hands and feet growing warm as the effect.
Bonsa 本事
Source원문
又法: 陰證已極ㆍ玉莖縮入, 速令人捉定, 急將艾丸菉豆大ㆍ放在陰莖口上灸 三壯, 其莖卽出. 《回春》
Translation영역
Another method: where the yin pattern is already at its extreme and the jade stalk has retracted inward, have someone quickly hold it steady, and urgently take a mugwort pellet the size of a mung bean, place it on the mouth of the penis and moxa three cones, and the stalk comes out at once.
Manbyeong Hoechun 回春
Source원문
傷寒手足厥冷, 取大都. 鍼一分
Translation영역
For reversal cold of the hands and feet in cold damage, take Daedo SP-2. Needle to one fun.
Uihak Gangmok 綱目
Source원문
傷寒六脉俱無, 取復溜補之, 大回六脉ㆍ合谷ㆍ中極ㆍ支溝一寸半, 此和脉絶穴ㆍ穴巨闕三寸三分ㆍ氣衝. 灸七壯 《綱目》
Translation영역
In cold damage where all six pulses are absent, take Bongnyu KI-7 supplementing it; it greatly brings back the six pulses, Hapgok LI-4, Junggeuk CV-3, Jigu TE-6 one chi five fun; this is the point that harmonizes a severed pulse, Jugwol CV-14 three chi three fun and Gichung ST-30. Moxa seven cones.
Uihak Gangmok 綱目
Source원문
傷寒熱退後再發熱, 取風門ㆍ合谷ㆍ行間ㆍ絶骨. 《雲歧》
Translation영역
In cold damage where the heat has retreated and fever arises again, take Pungmun BL-12, Hapgok LI-4, Haenggan LR-2 and Jeolgol GB-39.
Ungi 雲歧
Source원문
傷寒熱病五十九刺法: 頭上五行ㆍ行五者, 以越諸陽熱逆也, 謂頭中行上星ㆍ顖會ㆍ前頂ㆍ百會ㆍ後頂五穴也; 兩傍謂承光ㆍ通天ㆍ絡却ㆍ玉枕ㆍ天柱十穴也; 又兩傍謂臨泣ㆍ目窓ㆍ正營ㆍ承靈ㆍ腦空十穴也.
Translation영역
The fifty-nine needlings for cold damage and heat disease: five rows on the head, five in each row, to let out the heat counterflow of all the yang — that is, in the middle row of the head, the five points Sangseong GV-23, Sinhoe GV-22, Jeonjeong GV-21, Baekhoe GV-20 and Hujeong GV-19; on the two sides, the ten points Seunggwang BL-6, Tongcheon BL-7, Nakgak BL-8, Okchim BL-9 and Cheonju BL-10; and again on the two sides, the ten points Imneup GB-15, Mokchang GB-16, Jeongyeong GB-17, Seungnyeong GB-18 and Noegong GB-19.
Naegyeong 內經
Source원문
大杼ㆍ膺兪ㆍ缺盆ㆍ背兪, 此八者以瀉胸中之熱也. ○氣街ㆍ三里ㆍ巨虛上下廉, 此八者以瀉胃中之熱也. ○雲門ㆍ髃骨ㆍ委中ㆍ髓空, 此八者以瀉四肢之熱也. ○五藏兪傍五, 此十者以瀉五藏之熱也. 膺兪卽中府穴, 背兪卽風門穴, 髃骨卽肩髃穴, 髓空卽腰兪穴也 《內經》
Translation영역
Daejeo BL-11, Eungyu, Gyeolbun ST-12 and Baeyu: these eight drain the heat in the chest. ○ Gigai ST-30, Samni ST-36 and the upper and lower Geoheo ridges: these eight drain the heat in the stomach. ○ Unmun LU-2, Ugol, Wijung BL-40 and Sugong: these eight drain the heat of the four limbs. ○ The five beside the transport points of the five viscera: these ten drain the heat of the five viscera. Eungyu is the point Jungbu LU-1, Baeyu is the point Pungmun BL-12, Ugol is the point Gyeonu LI-15, and Sugong is the point Yoyu GV-2.
Naegyeong 內經
Source원문
熱病不可刺者有九: 一曰汗不出ㆍ大顴發赤ㆍ噦者死. ○二曰泄而腹滿甚者死. ○三曰目不明ㆍ熱不已者死. ○四曰老人嬰兒ㆍ熱而腹滿者死. ○五曰汗不出ㆍ嘔下血者死. ○六曰舌本爛ㆍ熱不已者死. ○七曰咳而衂ㆍ汗不出ㆍ出不至足者死. ○八曰髓熱者死. ○九曰熱而痙者死. 痙者, 腰折ㆍ瘈瘲ㆍ齒噤齘也. 《靈樞》
Translation영역
There are nine in heat disease that may not be needled. The first: no sweat coming out, the cheekbones flushed red, and hiccough — he dies. ○ The second: diarrhoea with severe abdominal fullness — he dies. ○ The third: the eyes not seeing clearly and the heat not ceasing — he dies. ○ The fourth: an old man or an infant, hot and with abdominal fullness — he dies. ○ The fifth: no sweat coming out, vomiting and passing blood below — he dies. ○ The sixth: the root of the tongue ulcerated and the heat not ceasing — he dies. ○ The seventh: cough with nosebleed, the sweat not coming out, or coming out but not reaching the feet — he dies. ○ The eighth: the marrow hot — he dies. ○ The ninth: hot with convulsion — he dies. Convulsion means the lumbus snapping back, tugging and slackening, and the teeth clenched and grinding.
Clinical note임상 주석
此穴發汗大妙 — this point is marvellous for inducing sweat — on Hapgok LI-4, with the instruction to withdraw the needle the moment sweat appears over the whole body, is the best-attested piece of acupuncture in the section and is still used that way. The same point appears in the list for stopping excessive sweating two passages later, drained instead, which is the kind of apparent contradiction this literature handles by the needling technique rather than the point.
The double-pass needling for chest bind is unusually specific: knead the painful spot on the left, then needle Jigu TE-6, Gansa PC-5 and Haenggan LR-2 on that side, with slow breathing and the needle retained. All three are on the left for a left-sided bind and mirrored for the right, which makes it one of the few side-specific protocols in the Bogam.
The Neijing's fifty-nine needlings are given in full and are a systematic heat-draining prescription — twenty-five on the head, eight for the chest, eight for the stomach, eight for the limbs, ten beside the visceral transport points — with the Bogam's own gloss identifying four of the older point names.
The nine that may not be needled close the chapter, and they are prognostic rather than technical: nine states in which the patient will die and needling will not change it. 老人嬰兒ㆍ熱而腹滿 — an old man or an infant, hot with abdominal fullness — is the one that names an age group rather than a sign, and the chapter ends on it.
Yeongchu 靈樞
About this translation 凡例
Base text: Donguibogam (東醫寶鑑, 1613 first edition), Miscellaneous Disorders, Volume 3, Cold Damage chapter, lower part. The Chinese text is collated against a transcription of the Kyujanggak printed edition carrying its leaf numbers and first-edition collation notes; original character forms (脉, 人參, 梔) are retained. Terminology follows Wiseman & Feng, A Practical Dictionary of Chinese Medicine. Translation and clinical notes are original to this site. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.