Formulas · Text · Donguibogam 東醫寶鑑

Cold Damage (Part One)

Han

한글 한 · Pinyin Han

The six channels in order, from the first day of taiyang to the retracted scrotum of jueyin — and the formulas that made Zhang Zhongjing the most quoted physician in East Asia

寒

The Cold Damage chapter is the Donguibogam's longest treatment of a single disease and the only one that runs across two volumes, eighty-three sections here and seventy-one in the next. It is also the chapter least of the Bogam's own making: what Heo Jun assembled is the Shanghanlun as it had been read, argued over and corrected for fourteen centuries, with Zhu Gong and Wang Haejang and Tao Hua and Li Dongyuan all answering Zhang Zhongjing in the margins and each other across them. The organizing frame is the six channels, taken in strict order — taiyang, yangming, shaoyang, taiyin, shaoyin, jueyin — and each gets a 形證用藥 section that names its signs and its drugs before the chapter goes on to the particular presentations. That structure is why this chapter has been the standard teaching text in Korea for four hundred years: it can be read straight through as a course.

What the chapter argues about is not the diagnosis but the timing. The great prohibitions run through it like a refrain — do not sweat the shaoyang, do not purge before the exterior resolves, do not warm what only looks cold — and the sections on 壞證, the ruined pattern, are a catalogue of what happens when they are ignored. Zhu Gong's warning stands at the front: a hundred kinds of disease and a thousand kinds of error, and a spoonful of medicine with a life hanging on it. The three Dragon formulas, the three Order the Qi formulas and the five Heart-Draining formulas are each presented as a graded set rather than as separate prescriptions, and reading each set together is how the chapter teaches dosing. Against that, the sections on 兩感傷寒 — both channels struck at once — concede that some patients die whatever is done, which Zhongjing said plainly and the Bogam does not soften.

Modern readers will recognize most of what is described. The six-channel progression maps onto the course of an untreated febrile illness with reasonable fidelity; 懊憹, the gnawing unlocatable distress of the chest, is a real symptom with no good English name; the chest binds are pleural and peritoneal collections; 動氣, the throbbing the patient can feel, is the pulsation of a thin, dehydrated abdomen. What has not survived is the pharmacology at the extremes — the mercury and sulphur elixirs for entrenched cold, the faecal and rat-dung preparations for mania and relapse — and those are kept in the registry with the warnings they require, because a chapter this influential should be read whole.

2.1 Winter Gives Cold Damage 冬爲傷寒

2.1.1

Source원문

從霜降以後至春分前, 凡有觸冒霜露ㆍ體中寒邪, 卽病者, 謂之傷寒. 《活人》

Translation영역

From after Frost Descent until before the Spring Equinox, wherever a person meets with frost and dew and the body is struck by cold evil, and falls ill at once, this is called cold damage.

Hwarinseo 活人

2.1.2

Source원문

春氣溫和, 夏氣暑熱, 秋氣淸凉, 冬氣冷冽, 此四時之正氣也. 冬時嚴寒, 萬類深藏, 君子固密則不傷於寒; 夫觸冒之者, 乃名傷寒. 其傷於四時之氣, 皆能爲病, 而惟傷寒最毒者, 以其有殺厲之氣也. 中而卽病者爲傷寒, 不卽病者, 其寒毒藏於肌膚中, 至春變爲溫病, 至夏變爲暑病. 暑者, 熱重於溫也. 是以辛苦之人, 春夏多溫熱病者, 皆由冬時觸寒所致, 非時行之氣也. 《活人》

Translation영역

The spring qi is warm and mild, the summer qi is hot with summerheat, the autumn qi is clear and cool, the winter qi is cold and biting: these are the upright qi of the four seasons. In winter, when the cold is severe and all the kinds of things are deep in hiding, the gentleman who keeps himself sealed and secure takes no damage from cold; it is he who goes out and meets with it who is said to have cold damage. Damage by the qi of any of the four seasons can produce disease, yet cold damage alone is the most toxic, because it carries a killing and cruel qi. He who is struck and falls ill at once has cold damage; he who does not fall ill at once has the cold toxin stored within his flesh and skin, and when spring comes it turns into warm disease, and when summer comes it turns into summerheat disease. Summerheat means the heat is heavier than in warmth. For this reason, among people who labour and toil, those who have many warm and hot diseases in spring and summer owe them all to meeting cold in winter, and not to the qi going round at that season.

Clinical note임상 주석

The second passage is the whole latent-cold doctrine in one paragraph, and it is worth reading carefully because it is both wrong and useful. Wrong, because cold does not lie dormant in the flesh for months and emerge as a different disease in spring. Useful, because the observation behind it is sound: people who work outdoors in winter do get more febrile illness the following spring and summer, and the Bogam is distinguishing that pattern from the epidemics that sweep through a season — 非時行之氣也, not the qi going round at that season. The distinction between endemic and epidemic illness is a real one, and this is a pre-modern attempt to make it. 君子固密則不傷於寒 is a quotation of attitude rather than medicine. The gentleman who keeps himself sealed does not take cold — meaning dress warmly and stay in — and it sits oddly beside 辛苦之人, those who labour and toil, two passages later. The chapter is aware that the disease falls on those who cannot stay indoors.

Hwarinseo 活人

2.2 Cold Damage Is Called the Great Disease 傷寒號爲大病

2.2.1

Source원문

傷寒世號爲大病. 《得效》

Translation영역

Cold damage is called by the world the great disease.

Deukhyobang 得效

2.2.2

Source원문

傷寒一證, 與雜病不同. 若不對證妄投藥餌, 罪犯非輕, 誤人多矣. 《局方》

Translation영역

The single pattern of cold damage is not like the miscellaneous disorders. If the medicine is thrown at it recklessly without matching the pattern, the offence committed is no light one, and many have been wronged by it.

Gukbang 局方

2.2.3

Source원문

傷寒證候, 頃刻傳變; 傷寒治法, 繩尺謹嚴, 非可以輕心視之也. 其間種類不一, 條例浩繁, 是固難矣. 至於陰極發躁ㆍ熱極發厥ㆍ陰證如陽ㆍ陽證如陰ㆍ脚氣似乎傷寒ㆍ中暑似乎熱病, 凡此等類, 尤當審思而明辨之. 若疑似未別ㆍ體認未明, 切不可妄投決病之劑. 方匕雖微, 死生係焉, 可不謹歟. 《得效》

Translation영역

The signs of cold damage pass over and change in an instant; the method of treating cold damage is strict as plumb-line and foot-rule, and is not a thing to be looked at with a light heart. Its kinds are not of one sort and its clauses are vast and many, and that in itself is hard. And then there is agitation arising at the extreme of yin, reversal arising at the extreme of heat, a yin pattern that looks like yang, a yang pattern that looks like yin, leg qi that resembles cold damage, and summerheat stroke that resembles heat disease — all such kinds as these must be considered with especial care and plainly distinguished. Where the resemblances are not yet separated and the recognition is not yet clear, on no account may one recklessly administer an agent that will decide the case. The spoonful of a formula is a small thing, and life and death hang upon it; may one not be careful?

Clinical note임상 주석

方匕雖微, 死生係焉 — the spoonful of a formula is a small thing and life and death hang upon it — is the best sentence in the chapter and the reason this section exists at all. It says nothing about any particular disease. It is a statement about the ethics of prescribing, placed second in an eighty-three-section chapter, before any pattern has been described. The six confusions the passage lists are not rhetorical. Agitation at the extreme of yin and reversal at the extreme of heat are both real: a patient in circulatory collapse becomes restless, and a patient with very high fever develops cold extremities through vasoconstriction. Each would be made worse by the treatment the surface appearance suggests. The chapter returns to all six in sections 2.63 through 2.66.

Deukhyobang 得效

2.3 Cold Damage Striking Both Channels Is a Fatal Pattern 兩感傷寒爲死證

2.3.1

Source원문

帝曰: 其兩感於寒而病者, 必不免於死. 《內經》

Translation영역

The Emperor said: he who is struck in both channels by cold and falls ill will surely not escape death.

Naegyeong 內經

2.3.2

Source원문

兩感於寒者, 病一日, 巨陽與少陰俱病, 則頭痛ㆍ口乾而煩滿; 二日則陽明與太陰俱病, 腹滿ㆍ身熱ㆍ不欲食ㆍ譫言; 三日則少陽與厥陰俱病, 則耳聾ㆍ囊縮而厥, 水漿不入ㆍ不知人, 六日死. 《內經》

Translation영역

In one struck in both channels by cold: on the first day of the disease the great yang and the shaoyin are ill together, and there is headache, dry mouth and vexing fullness; on the second day the yangming and the taiyin are ill together, with abdominal fullness, generalized fever, no desire for food and delirious speech; on the third day the shaoyang and the jueyin are ill together, and there is deafness, the scrotum retracted and reversal, with no water or gruel taken and no recognition of people; on the sixth day he dies.

Naegyeong 內經

2.3.3

Source원문

兩感傷寒, 古無治法. 仲景云: 兩病俱作, 治有先後. 如下利不止ㆍ身體疼痛, 急先救裏; 如不下利ㆍ身體疼痛, 急當救表. 救裏固宜急, 而表亦不可緩也. 救裏宜四逆湯, 救表宜桂枝湯. 二方見下《活人》

Translation영역

For cold damage striking both channels, antiquity had no method of treatment. Zhongjing says: when two diseases arise together, the treatment has a first and a second. Thus where the diarrhoea will not stop and the body aches and pains, urgently rescue the interior first; where there is no diarrhoea and the body aches and pains, urgently rescue the exterior. Rescuing the interior is certainly to be done urgently, but the exterior may not be left to wait either. To rescue the interior, Frigid Extremities Decoction is apt; to rescue the exterior, Cinnamon Twig Decoction. Both formulas appear below.

Hwarinseo 活人

2.3.4

Source원문

此必死之證, 然所稟有虛實, 所感有淺深. 實而感淺者, 猶或可治. 予嘗用大羌活湯, 十活二三. 《東垣》

Translation영역

This is a pattern of certain death; yet what a man is endowed with may be depleted or replete, and what he is struck by may be shallow or deep. Where he is replete and the strike is shallow, it may still perhaps be treated. I have used Major Notopterygium Decoction, and of ten I have brought two or three through.

Dongwon 東垣

2.3.5

Source원문

一云: 表裏俱急者, 大羌活湯; 陰陽未分者, 陶氏衝和湯探之. 《入門》

Translation영역

One account says: where exterior and interior are both urgent, Major Notopterygium Decoction; where yin and yang are not yet divided, probe with Tao's Harmonizing Decoction.

Uihak Immun 入門

2.3.6

Source원문

兩感傷寒者, 日傳二經之候也. 仲景無治法, 惟東垣有治兩感大羌活湯, 云十可救其一二, 未知是否. 《正傳》

Translation영역

Cold damage striking both channels is the case in which two channels are passed through in a day. Zhongjing has no method of treatment; only Dongwon has Major Notopterygium Decoction for a double strike, and says that of ten he can save one or two — whether this is so is not known.

Clinical note임상 주석

Three voices and three positions, printed in order and not reconciled. The Neijing says the patient dies on the sixth day. Zhu Gong says antiquity had no treatment but Zhongjing at least gave a rule of priority. Li Dongyuan claims two or three in ten. The Jeongjeon then says plainly that it does not know whether Dongyuan's claim is true. That last sentence is the Bogam at its best — it prints the hopeful formula and the doubt about it side by side, and leaves the prescriber to weigh them. The sequencing rule Zhu Gong attributes to Zhongjing is sound and still taught: unstoppable diarrhoea means the interior goes first, because a patient losing fluid that fast will not survive long enough for the exterior to matter. Without the diarrhoea, treat the exterior while there is still an exterior to treat. 表亦不可緩也 — but the exterior may not be left to wait either — is the qualification that keeps it from becoming a licence to ignore one half. Described clinically, 兩感傷寒 is a fulminant febrile illness presenting simultaneously with high fever, obtundation, oliguria and circulatory failure. The Neijing's six days and its catalogue of signs — deafness, retracted scrotum, nothing taken by mouth, no recognition of people — are a recognizable picture of septic shock, and the prognosis it gives is not far wrong for an untreated case.

Uihak Jeongjeon 正傳

2.4 Pulse Method 脉法

2.4.1

Source원문

凡治傷寒, 以脉爲先, 以證爲後; 凡治雜病, 以證爲先, 以脉爲後. 大抵治傷寒, 見證未見脉, 未可投藥; 見脉未見證, 雖小投藥亦無害也. 《祗和》

Translation영역

In treating cold damage, take the pulse first and the signs after; in treating the miscellaneous disorders, take the signs first and the pulse after. Broadly, in treating cold damage, where the signs are seen but the pulse is not yet seen, medicine may not yet be given; where the pulse is seen but the signs are not yet seen, even a small administration of medicine does no harm.

Jihwa 祗和

2.4.2

Source원문

緊脉爲傷寒. 《脉經》

Translation영역

A tight pulse is cold damage.

Maekgyeong 脉經

2.4.3

Source원문

傷寒之脉, 陰陽俱盛而緊濇. 《脉經》

Translation영역

The pulse of cold damage is exuberant in both yin and yang, and tight and rough.

Maekgyeong 脉經

2.4.4

Source원문

脉盛身寒, 得之傷寒. 《內經》

Translation영역

An exuberant pulse with a cold body is got from cold damage.

Naegyeong 內經

2.4.5

Source원문

弦緊爲寒脉. 《脉經》

Translation영역

Stringlike and tight is a cold pulse.

Maekgyeong 脉經

2.4.6

Source원문

傷寒脉大ㆍ浮ㆍ數ㆍ動ㆍ滑, 此名陽也; 沉ㆍ濇ㆍ弱ㆍ弦ㆍ微, 此名陰也. 凡陰病見陽脉者生, 陽病見陰脉者死. 《脉經》

Translation영역

In cold damage a pulse that is large, floating, rapid, stirring or slippery is named yang; deep, rough, weak, stringlike or faint is named yin. Wherever a yin disease shows a yang pulse the patient lives; wherever a yang disease shows a yin pulse the patient dies.

Maekgyeong 脉經

2.4.7

Source원문

熱病須得脉浮洪, 細小徒費用神功. 汗後脉靜當便瘥, 喘熱脉亂命應終. 《脉訣》

Translation영역

In heat disease the pulse must be got floating and surging; fine and small, and one spends divine skill in vain. After sweating, a quiet pulse means recovery is at hand; with panting and heat and a disordered pulse, the life must end.

Maekgyeol 脉訣

2.4.8

Source원문

寒傷太陽, 脉浮而濇; 及傳而變, 名狀難悉. 陽明則長, 少陽則弦; 太陰入裏, 遲沉必兼; 及入少陰, 其脉遂緊; 厥陰熱甚, 脉伏厥冷.

Translation영역

When cold damages the taiyang, the pulse is floating and rough; and once it has passed over and changed, its names and forms are hard to set out in full. In the yangming it is long, in the shaoyang stringlike; when the taiyin enters the interior, slow and deep must come together; and when it enters the shaoyin, the pulse becomes tight; in the jueyin, where the heat is severe, the pulse is hidden and the reversal cold.

Maekgyeol 脉訣

2.4.9

Source원문

在陽當汗, 次利小便; 表解裏病, 其脉實堅. 此其大略治法之正, 至於大法, 自有仲景.

Translation영역

While it is in the yang it should be sweated, and next the urine disinhibited; when the exterior resolves and the interior is diseased, the pulse is replete and hard. This is the broad outline of correct treatment; as for the great method, Zhongjing has it of his own.

Maekgyeol 脉訣

2.4.10

Source원문

傷寒有五, 脉非一端. 陰陽俱盛ㆍ緊澁者, 寒; 陽浮而滑ㆍ陰濡而弱, 此名傷風, 勿用寒藥.

Translation영역

Cold damage has five kinds and the pulse is not of one sort. Exuberant in both yin and yang, tight and rough: cold. Yang floating and slippery, yin soggy and weak: this is named wind damage, and cold medicines are not to be used.

Maekgyeol 脉訣

2.4.11

Source원문

陽濡而弱ㆍ陰小而急, 此非風寒, 乃濕溫脉.

Translation영역

Yang soggy and weak, yin small and urgent: this is not wind-cold but the pulse of damp warmth.

Maekgyeol 脉訣

2.4.12

Source원문

陽脉浮滑ㆍ陰脉濡弱, 或遇於風, 變成風溫.

Translation영역

Yang pulse floating and slippery, yin pulse soggy and weak, and if it then meets with wind, it turns into wind warmth.

Maekgyeol 脉訣

2.4.13

Source원문

陽脉洪數ㆍ陰脉實大, 更遇溫熱, 變成溫毒.

Translation영역

Yang pulse surging and rapid, yin pulse replete and large, and if it further meets with warm heat, it turns into warm toxin.

Maekgyeol 脉訣

2.4.14

Source원문

陽脉濡弱ㆍ陰脉弦緊, 更遇濕氣, 變爲濕溫.

Translation영역

Yang pulse soggy and weak, yin pulse stringlike and tight, and if it further meets with damp qi, it turns into damp warmth.

Maekgyeol 脉訣

2.4.15

Source원문

陰陽俱盛, 重感於寒, 變爲溫瘧, 同病異名.

Translation영역

Exuberant in both yin and yang, and struck by cold a second time, it turns into warm malaria — the same disease under a different name.

Maekgyeol 脉訣

2.4.16

Source원문

陰陽俱盛ㆍ病熱之極, 浮之而滑, 沉之散澁. 《脉訣》

Translation영역

Exuberant in both yin and yang at the extreme of the disease heat: floating it is slippery, and deep it is scattered and rough.

Maekgyeol 脉訣

2.4.17

Source원문

中寒緊澁, 陰陽俱盛, 法當無汗, 有汗傷命. 《回春》

Translation영역

Direct cold strike is tight and rough, exuberant in both yin and yang; by rule there should be no sweat, and if there is sweat it damages the life.

Manbyeong Hoechun 回春

2.4.18

Source원문

傷寒熱病, 脉宜洪大, 忌沉細. 《醫鑑》

Translation영역

In cold damage and heat disease the pulse should be surging and large; deep and fine is to be shunned.

Gogeum Uigam 醫鑑

2.4.19

Source원문

中寒之脉, 虛而微細. 《醫鑑》

Translation영역

The pulse of direct cold strike is depleted, faint and fine.

Clinical note임상 주석

The opening rule inverts the usual order of diagnosis and is worth taking seriously: in cold damage the pulse leads and the signs follow. The reason is given in the second half — signs without a pulse forbid prescribing, but a pulse without signs permits a small dose. In a disease that changes within hours, the pulse is the earlier indicator, and the Bogam is willing to treat on it alone. 陰病見陽脉者生, 陽病見陰脉者死 is the single most useful line in the section. A yin pattern — cold, collapsed, deep pulse — that develops a yang pulse is recovering, because the circulation is coming back up. A yang pattern that loses its pulse volume is decompensating. Read as a statement about perfusion rather than about yin and yang, it is simply correct, and it is still how a febrile patient is assessed at the bedside. The Maekgyeol passages in the middle are a mnemonic poem rather than clinical prose, and they are doing something specific: enumerating the five kinds the tradition grouped under cold damage — cold, wind, damp warmth, wind warmth, warm toxin, damp warmth and warm malaria — by pulse rather than by symptom. 傷寒有五 is the Nanjing's category and the poem is an aid to holding it in memory. 勿用寒藥 in the second line is the clinically operative instruction: a floating slippery yang pulse means wind, not cold, and cooling it is an error. The last two entries distinguish 傷寒 from 中寒, cold damage from direct cold strike, by pulse volume alone — surging and large against depleted and faint — and that distinction governs the whole of sections 2.70 onward and the 痼冷 formulas in the lower part.

Gogeum Uigam 醫鑑

2.5 Cold Damage Turning to Heat 傷寒變熱

2.5.1

Source원문

內經曰: 寒傷形. 註曰: 寒則衛氣不利, 故傷形也.

Translation영역

The Neijing says: cold damages the form. The commentary says: when there is cold, the defensive qi does not flow freely, and so the form is damaged.

Naegyeong 內經

2.5.2

Source원문

人傷於寒而傳爲熱, 何也? 曰: 夫寒盛則生熱也. 寒氣外凝, 陽氣內鬱, 腠理堅緻, 六府閉封. 緻則氣不宣通, 封則濕氣內結; 中外相薄, 寒盛熱生. 故人傷於寒, 轉而爲熱也. 汗之而愈, 則外凝內鬱之理可知矣. 斯乃雜病數日者也.

Translation영역

A man is damaged by cold and it passes over into heat — why? It is said: where cold is exuberant, heat is generated. The cold qi congeals outside and the yang qi is depressed within; the interstices are firm and close-knit and the six bowels are shut and sealed. Being close-knit, the qi does not diffuse and flow; being sealed, the damp qi binds within. Inside and outside press against each other, cold is exuberant and heat is generated. Therefore a man damaged by cold turns over into heat. That he is cured by being sweated makes the principle of congealing outside and depression within knowable. This then is the case of several days in the miscellaneous disorders.

Clinical note임상 주석

The mechanism offered here is the best piece of physiological reasoning in the first ten sections, and the argument is from treatment back to cause: sweating cures it, therefore the problem must have been that heat could not get out. 汗之而愈, 則外凝內鬱之理可知矣 — that it is cured by sweating makes the principle knowable — is inference from therapeutic response, which is a legitimate move and not a common one in this literature. The physiology is also not far off. Cutaneous vasoconstriction in response to cold does reduce heat loss, and a patient who cannot dissipate heat will run a higher core temperature. Where the passage goes wrong is in treating the retained heat as the whole of the fever rather than as one contribution to it; the pyrogenic response to infection is not in view and could not have been. But as an account of why a disease that begins with chills ends with fever, it is coherent and it earned its place.

Naegyeong 內經

2.6 Cold Damage Passing Through the Channels 傷寒傳經

2.6.1

Source원문

內經曰: 巨陽者, 諸陽之屬也. 其脉連於風府, 故爲諸陽主氣也. 人之傷於寒也, 則爲病熱; 熱雖甚不死. 其兩感於寒者, 必不免於死.

Translation영역

The Neijing says: the great yang is that to which all the yang belong. Its vessel joins at Fengfu, and so it governs the qi of all the yang. When a man is damaged by cold, he becomes ill with heat; and though the heat be severe he does not die. But he who is struck in both channels by cold will surely not escape death.

Naegyeong 內經

2.6.2

Source원문

帝曰: 願聞其狀. 歧伯曰: 傷寒一日, 巨陽受之, 故頭項痛ㆍ腰脊强. 二日陽明受之, 陽明主肉, 其脉挾鼻絡於目, 故身熱ㆍ目疼而鼻乾ㆍ不得卧也. 三日少陽受之, 少陽主膽, 其脉循脇絡於耳, 故胸脇痛而耳聾. 三陽經絡皆受其病而未入於藏, 故可汗而已. 四日太陰受之, 太陰脉布胃中絡於嗌, 故腹滿而嗌乾. 五日少陰受之, 少陰脉貫腎絡於肺ㆍ繫舌本, 故口燥ㆍ舌乾而渴. 六日厥陰受之, 厥陰脉循陰器而絡於肝, 故煩滿而囊縮. 三陰三陽ㆍ五藏六府皆受病, 榮衛不行ㆍ五藏不通, 則死矣.

Translation영역

The Emperor said: I should like to hear its form. Qibo said: on the first day of cold damage the great yang receives it, and so there is pain of the head and nape and stiffness of the lumbus and spine. On the second day the yangming receives it; the yangming governs the flesh and its vessel flanks the nose and nets the eyes, and so there is generalized fever, pain of the eyes, dryness of the nose and inability to lie down. On the third day the shaoyang receives it; the shaoyang governs the gallbladder and its vessel runs along the rib-side and nets the ear, and so there is pain of the chest and rib-side and deafness. The channels and network vessels of the three yang have all received the disease and it has not yet entered the viscera, and so it can be merely sweated. On the fourth day the taiyin receives it; the taiyin vessel spreads within the stomach and nets the throat, and so there is abdominal fullness and dryness of the throat. On the fifth day the shaoyin receives it; the shaoyin vessel passes through the kidney, nets the lung and ties to the root of the tongue, and so the mouth is parched, the tongue dry and there is thirst. On the sixth day the jueyin receives it; the jueyin vessel runs along the yin organ and nets the liver, and so there is vexing fullness and the scrotum retracted. The three yin and three yang and the five viscera and six bowels have all received the disease; the nutritive and defensive do not move and the five viscera are not free, and then he dies.

Naegyeong 內經

2.6.3

Source원문

其不兩感於寒者: 七日巨陽病衰, 頭痛少愈; 八日陽明病衰, 身熱少愈; 九日少陽病衰, 耳聾微聞; 十日太陰病衰, 腹減如故, 則思飮食; 十一日少陰病衰, 渴止ㆍ不滿ㆍ舌乾已而嚏; 十二日厥陰病衰, 囊縱ㆍ少腹微下, 大氣皆去, 病日已矣.

Translation영역

In him who is not struck in both channels by cold: on the seventh day the great yang disease declines and the headache somewhat heals; on the eighth the yangming disease declines and the generalized fever somewhat heals; on the ninth the shaoyang disease declines and the deaf ear hears faintly; on the tenth the taiyin disease declines, the abdomen subsides as before and he thinks of food and drink; on the eleventh the shaoyin disease declines, the thirst stops, the fullness is gone, the dry tongue is finished and he sneezes; on the twelfth the jueyin disease declines, the scrotum loosens, the lower abdomen comes slightly down, the great qi has all departed and day by day the disease is finished.

Naegyeong 內經

2.6.4

Source원문

煩滿者, 小腹煩滿也. 下云小腹微下者, 謂此也. 大氣皆去, 則病人精神爽慧也. 《活人》

Translation영역

Vexing fullness means vexing fullness of the lower abdomen. Where it says below that the lower abdomen comes slightly down, this is what is meant. When the great qi has all departed, the sick man's spirit is fresh and clear.

Hwarinseo 活人

2.6.5

Source원문

若過十三日不間, 尺寸陷者, 大危. 間謂瘳也. 《仲景》

Translation영역

If the thirteenth day passes without respite and the cubit and inch pulses are sunken, he is in great danger. Respite means recovery.

Clinical note임상 주석

The six-day progression and the six-day resolution are the structural backbone of the whole chapter, and the sections that follow are organized by it. What is remarkable is how much of the symptom list is correct for each level, given that the sequence is derived from channel pathways rather than from observation. Headache and stiff neck first, then eye pain and dry nose, then rib-side pain and reduced hearing, then abdominal fullness, then thirst and dry tongue, then prostration: that is a recognizable course for an untreated severe febrile illness, and the twelve-day resolution is roughly the natural history of a typhoid-like fever. 故可汗而已 — it can be merely sweated — marks the therapeutic window. While the disease is in the three yang it has not entered the viscera and the exterior treatments will reach it; after the fourth day they will not. That single clause is the origin of the whole timing doctrine that the chapter spends eighty sections elaborating. The sneeze on the eleventh day is the detail most worth keeping. It appears again in the Wind chapter as a prognostic sign, and in both places it is read the same way: the returning ability to mount a sneeze means the defensive qi has come back. A sneeze is a reflex requiring an intact afferent and motor arc, and a patient too ill to sneeze who begins to do so again has in fact turned a corner.

Junggyeong 仲景

2.7 The Days on Which Cold Damage Heals or Kills 傷寒或愈或死日期

2.7.1

Source원문

黃帝曰: 今夫熱病者, 皆傷寒之類也. 或愈或死, 其死皆以六七日之間, 其愈皆以十日已上者, 何也? 不知其解, 願聞其故. 歧伯對曰: 兩感於寒而病者, 到六七日, 三陰三陽ㆍ五藏六府皆受病, 榮衛不行ㆍ水漿不入, 六日死. 帝曰: 兩感者三日當死, 而六日乃死, 何也? 歧伯曰: 陽明者, 十二經脉之長也, 其血氣盛, 故不知人三日, 其氣乃盡, 故死矣. 其不兩感於寒者, 到十二日六經再傳, 故愈矣. 《內經》

Translation영역

The Yellow Emperor said: now these heat diseases are all of the cold damage kind. Some heal and some kill, and those that kill do so always within six or seven days, while those that heal do so always after ten days or more. Why is this? I do not know its explanation, and should like to hear the reason. Qibo replied: in him who is struck in both channels by cold and falls ill, by the sixth or seventh day the three yin and three yang and the five viscera and six bowels have all received the disease, the nutritive and defensive do not move and no water or gruel is taken, and on the sixth day he dies. The Emperor said: one struck in both channels ought to die on the third day, yet he dies on the sixth — why? Qibo said: the yangming is the longest of the twelve channel vessels and its blood and qi are exuberant; therefore he does not recognize people for three days, and only then is its qi exhausted, and so he dies. In him who is not struck in both channels by cold, by the twelfth day the six channels have been passed through twice, and so he heals.

Clinical note임상 주석

The question the Emperor asks is a good one and the answer is honest about its own arithmetic: if both channels are struck on each of three days, death ought to come on the third, so why the sixth? Qibo's answer is that the yangming has the largest reserve of blood and qi and takes three days to exhaust. That is a reserve argument, and it is the same reasoning a modern clinician uses about physiological reserve determining how long a patient survives an overwhelming insult. The mechanism attributed to it is wrong; the shape of the explanation is not. The two outcomes — death within a week, recovery after ten days — describe the bimodal course of severe untreated febrile illness accurately enough to be worth noting. What the passage cannot see is that the difference lies mostly in the organism and the host rather than in a channel's qi reserve.

Naegyeong 內經

2.8 The Great Method of Cold Damage 傷寒大法

2.8.1

Source원문

傷寒大法有四: 曰傳經, 曰專經, 曰卽病, 曰鬱病. 夫卽病者多爲專經, 鬱病者多爲傳經. 蓋寒邪之中人, 無有定體: 或中於陽, 或中於陰, 或但中於太陽, 未及鬱熱而卽發, 首尾只在本經而不傳變者, 宜發散表邪而愈. 或有從太陽未及鬱熱, 不從陽明ㆍ少陽, 過而遂入於三陰之經者; 亦有不曾入於陽經, 而直傷於三陰之經而卽病者, 宜溫中通脉而愈. 若夫始從太陽鬱熱, 以次而傳至於陽明ㆍ少陽, 次第傳變於三陰之經者, 則爲傳經之熱證明矣. 《正傳》

Translation영역

The great method of cold damage has four heads: passing through the channels, staying in one channel, falling ill at once, and depressed disease. Now those who fall ill at once mostly stay in one channel, and those with depressed disease mostly pass through the channels. For the cold evil striking a man has no fixed body: it may strike in the yang, or strike in the yin, or strike only in the taiyang and break out at once before it comes to depressed heat, so that from first to last it stays only in its own channel and does not pass over and change — and that should be dispersed outward from the exterior, and heals. Or it may come from the taiyang without reaching depressed heat, and not follow the yangming and shaoyang but pass them by and enter straight into the channels of the three yin; and there are also those who have never entered a yang channel but are damaged directly in the channels of the three yin and fall ill at once — and that should be warmed in the middle and the vessels freed, and heals. But where it begins from depressed heat in the taiyang and passes in order to the yangming and shaoyang and then in sequence passes over and changes into the channels of the three yin, then it is plainly a heat pattern of passing through the channels.

Clinical note임상 주석

This section is the Jeongjeon's correction of the Neijing's tidy six-day scheme, and it is a necessary one: 寒邪之中人, 無有定體 — the cold evil striking a man has no fixed body — concedes that the orderly progression of the previous section is a model and not a law. Three courses are allowed. It may stay in one channel and resolve there. It may skip the yang channels and go straight to the yin. Or it may pass through in order. The therapeutic consequence is the point. A disease that stays in the taiyang is sweated. A disease that goes straight to the three yin is warmed and the vessels freed — not sweated, because there is no exterior pattern to release. Only the third course produces the heat pattern that the purgative formulas address. Getting this wrong is how the ruined patterns of the later sections arise, and the Jeongjeon is at pains to say that the day count is not a reliable guide to which course a given patient is on.

Uihak Jeongjeon 正傳

2.9 The Six Transmissions of the Taiyang 太陽六傳

2.9.1

Source원문

太陽者, 巨陽也, 爲三陽之首. 膀胱經病, 若渴者, 自入于本, 名曰傳本.

Translation영역

The taiyang is the great yang and is the head of the three yang. In disease of the bladder channel, if there is thirst, it has entered its own root of itself, and this is called transmission to the root.

Haejang 海藏

2.9.2

Source원문

太陽傳陽明胃土者, 名曰巡經傳, 爲發汗不盡ㆍ利小便餘邪不盡透入于裏也.

Translation영역

Where the taiyang transmits to the yangming stomach earth, this is called transmission along the channel; it comes of sweating that was not carried through, or of disinhibiting the urine so that the remaining evil was not exhausted and penetrated into the interior.

Haejang 海藏

2.9.3

Source원문

太陽傳少陽膽木者, 名曰越經傳, 爲元受病脉浮無汗, 宜用麻黃湯而不用故也.

Translation영역

Where the taiyang transmits to the shaoyang gallbladder wood, this is called transmission leaping the channel; it comes because at the first receiving of the disease the pulse was floating and there was no sweat, so that Ephedra Decoction ought to have been used and was not.

Haejang 海藏

2.9.4

Source원문

太陽傳太陰脾土者, 名曰誤下傳, 爲元受病脉緩有汗, 當用桂枝而反下之故也. 病當腹痛ㆍ四肢沉重.

Translation영역

Where the taiyang transmits to the taiyin spleen earth, this is called transmission by purging in error; it comes because at the first receiving of the disease the pulse was moderate and there was sweat, so that cinnamon twig ought to have been used and instead he was purged. The disease then has abdominal pain and heaviness of the four limbs.

Haejang 海藏

2.9.5

Source원문

太陽傳少陰腎水者, 名曰表裏傳, 爲表病急, 當汗而反不汗ㆍ不發, 所以傳裏也.

Translation영역

Where the taiyang transmits to the shaoyin kidney water, this is called exterior-to-interior transmission; it comes because the exterior disease was urgent and he ought to have been sweated, yet instead he was not sweated and it was not brought out, and this is why it transmitted to the interior.

Haejang 海藏

2.9.6

Source원문

太陽傳厥陰肝木者, 爲三陰不至於首, 惟厥陰與督脉上行, 與太陽相接, 名曰巡經得度傳. 《海藏》

Translation영역

Where the taiyang transmits to the jueyin liver wood: the three yin do not reach the head, and only the jueyin ascends with the governing vessel and joins with the taiyang; this is called transmission along the channel by crossing over.

Clinical note임상 주석

Wang Haejang's six transmissions are an iatrogenic taxonomy, and that is what makes the section valuable: four of the six are named for the mistake that caused them. Transmission along the channel is sweating not carried through. Transmission leaping the channel is failing to give Ephedra Decoction when the pulse called for it. Transmission by purging in error is purging a patient who should have had cinnamon twig. Exterior-to-interior transmission is failing to sweat at all. Only the first and the last are attributed to the disease itself rather than to the physician. The implication is one the chapter never states outright but repeats structurally: most progression past the taiyang is the prescriber's fault. Whether that is fair is another matter — a great deal of febrile illness worsens whatever is done — but as a teaching device for a trainee it is effective, and it explains why the chapter is so preoccupied with prohibitions.

Haejang 海藏

2.10 Branch and Root of the Six Channels 六經標本

2.10.1

Source원문

經絡爲標, 藏府爲本. 如太陽經爲標, 膀胱爲本, 餘倣此. 《入門》

Translation영역

The channels and network vessels are the branch and the viscera and bowels are the root. Thus the taiyang channel is the branch and the bladder is the root, and the rest are like this.

Clinical note임상 주석

One sentence, and it governs the reading of the six 形證用藥 sections that follow. Each channel has two levels, and a disease in the channel is not the same as a disease in its organ: taiyang in the branch is headache and stiff neck, taiyang in the root is thirst and dark urine. The next section applies the distinction immediately, and the formula choice turns on it — Ephedra and Cinnamon Twig for the branch, Five-Ingredient Poria Powder for the root.

Uihak Immun 入門

2.11 The Taiyang — Signs and Medicines 太陽形證用藥

2.11.1

Source원문

太陽膀胱本病, 頭疼ㆍ脊强. 小腸爲標, 與心爲表裏, 故發熱. 冬月麻黃桂枝湯, 餘月九味羌活湯.

Translation영역

In the root disease of the taiyang bladder there is headache and stiffness of the spine. The small intestine is its branch and stands as exterior and interior with the heart, and so there is fever. In the winter months, Ephedra and Cinnamon Twig Decoction; in the other months, Nine-Ingredient Notopterygium Decoction.

Uihak Immun 入門

2.11.2

Source원문

太陽以皮膚爲表, 以膀胱爲裏. 熱在皮膚, 則頭疼ㆍ項强, 宜麻黃桂枝湯ㆍ九味羌活湯; 熱在膀胱, 則口渴ㆍ尿赤, 宜五苓散. 《入門》

Translation영역

For the taiyang, the skin is the exterior and the bladder the interior. Where the heat is in the skin there is headache and stiffness of the nape, and Ephedra and Cinnamon Twig Decoction or Nine-Ingredient Notopterygium Decoction is apt; where the heat is in the bladder there is thirst and dark urine, and Five-Ingredient Poria Powder is apt.

Uihak Immun 入門

2.11.3

Source원문

發熱ㆍ惡寒ㆍ脉浮者, 屬表, 卽太陽證也. 《仲景》

Translation영역

Fever, aversion to cold and a floating pulse belong to the exterior; this is the taiyang pattern.

Clinical note임상 주석

The seasonal rule in the first passage is the practical heart of this section and is followed throughout Korean practice: ephedra and cinnamon twig in winter, Nine-Ingredient Notopterygium the rest of the year. The reasoning is in the formula's own entry — ephedra is unsafe in a patient already sweating, and in the warm months the patient usually is. Zhongjing's three signs in the last passage are the whole taiyang diagnosis compressed: fever, aversion to cold, floating pulse. All three must be present. Aversion to cold distinguishes it from the yangming, which averts heat instead; the floating pulse distinguishes it from the yin patterns. Everything in this chapter's first thirty sections is an elaboration of that triad.

Junggyeong 仲景

2.12 Taiyang Wind Damage 太陽傷風

2.12.1

Source원문

太陽傷風, 脉陽浮而陰弱. 陽浮者, 熱自發; 陰弱者, 汗自出. 嗇嗇惡寒ㆍ淅淅惡風ㆍ翕翕發熱ㆍ鼻鳴ㆍ乾嘔, 桂枝湯主之. 《仲景》

Translation영역

In taiyang wind damage the pulse is floating in the yang and weak in the yin. Floating in the yang, the heat issues of itself; weak in the yin, the sweat comes out of itself. Shrinkingly averse to cold, shiveringly averse to wind, feverish as though covered over, with the nose whistling and dry retching — Cinnamon Twig Decoction governs it.

Clinical note임상 주석

The four reduplicated binomes — 嗇嗇, 淅淅, 翕翕, and the whistling nose — are the most carefully observed description of a common cold in the classical literature, and they are doing diagnostic work rather than decoration. 嗇嗇 is the shrinking, drawn-in posture of someone cold. 淅淅 is the shiver that a draught of air provokes, which is what distinguishes aversion to wind from aversion to cold. 翕翕 is the feeling of being feverish under a covering rather than burning. Together they describe a low-grade febrile illness with the patient sweating, which is exactly the Cinnamon Twig pattern and exactly what must not be given ephedra.

Junggyeong 仲景

2.13 Taiyang Cold Damage 太陽傷寒

2.13.1

Source원문

太陽傷寒, 頭痛ㆍ發熱ㆍ身疼ㆍ腰痛ㆍ骨節皆痛ㆍ惡風ㆍ無汗而喘, 麻黃湯主之.

Translation영역

In taiyang cold damage there is headache, fever, body ache, lumbar pain, pain of all the bones and joints, aversion to wind, no sweating and panting — Ephedra Decoction governs it.

Junggyeong 仲景

2.13.2

Source원문

註曰: 頭痛ㆍ身疼ㆍ腹痛, 以至牽連百骨節俱痛者, 此大陽傷寒, 榮血不利故也. 《仲景》

Translation영역

The commentary says: headache, body ache and abdominal pain, going so far as to draw in all the hundred bones and joints so that they all hurt — this is taiyang cold damage, and it is because the nutritive blood does not flow freely.

Clinical note임상 주석

No sweat is the whole of the difference from the preceding section, and the two together make the chapter's first and most important fork. Cinnamon Twig for the sweating patient, Ephedra for the dry one; give either to the other's patient and the formula's own entries say what follows. 榮血不利 as the explanation for generalized myalgia is a reasonable piece of classical physiology and matches what the symptom feels like — a deep aching in the muscles and joints rather than a surface soreness. The Bogam offers no better account anywhere, and the commentary's instinct that the pain is vascular rather than cutaneous is not a bad guess at what the inflammatory myalgia of influenza actually is.

Junggyeong 仲景

2.14 Taiyang Doubly Damaged by Wind and Cold 太陽兩傷風寒

2.14.1

Source원문

脉浮緊ㆍ發熱ㆍ惡寒ㆍ身痛ㆍ不汗出而煩躁者, 大靑龍湯主之.

Translation영역

Where the pulse is floating and tight with fever, aversion to cold, body pain, no sweat coming out and vexing agitation — Major Blue-Green Dragon Decoction governs it.

Junggyeong 仲景

2.14.2

Source원문

發熱ㆍ惡風ㆍ煩躁ㆍ手足溫, 爲傷風候; 脉浮緊, 爲傷寒脉, 是傷風見寒脉也. 寒多熱少ㆍ不煩躁ㆍ手足微厥, 爲傷寒候; 脉浮緩, 爲傷風脉, 是傷寒見風脉也. 蓋脉似桂枝反無汗, 病似麻黃反煩躁, 是也. 《活人》

Translation영역

Fever, aversion to wind, vexing agitation and warm hands and feet are the signs of wind damage; a floating tight pulse is the pulse of cold damage — this is wind damage showing a cold pulse. Much cold and little heat, no vexing agitation and the hands and feet slightly reversed are the signs of cold damage; a floating moderate pulse is the pulse of wind damage — this is cold damage showing a wind pulse. In short, the pulse resembles the cinnamon twig case yet there is no sweat, and the disease resembles the ephedra case yet there is vexing agitation. This is it.

Clinical note임상 주석

The third fork, and the one that completes the set. Where pulse and symptoms agree, the two preceding sections decide. Where they disagree — and Zhu Gong sets out both ways they can disagree — neither formula fits, and the Dragon is the answer. Its entry explains why: the gypsum in it handles the vexing agitation that neither of the others can. Zhu Gong's summary in the last sentence is the version to remember: the pulse looks like Cinnamon Twig but there is no sweat, or the disease looks like Ephedra but there is agitation. Either mismatch sends you to the Dragon. This is a differential diagnosis built entirely on the discrepancy between two findings, which is unusual and rather sophisticated.

Hwarinseo 活人

2.15 Taiyang Disease Resembling Malaria 太陽病似瘧

2.15.1

Source원문

太陽病似瘧, 發熱ㆍ惡寒ㆍ熱多寒少ㆍ脉微弱者, 此無陽也. 身不痒, 不可發汗, 宜桂婢各半湯.

Translation영역

Taiyang disease resembling malaria, with fever and aversion to cold, much heat and little cold, and a faint weak pulse: this is an absence of yang. If the body does not itch, sweating may not be induced, and Cinnamon Twig and Maidservant Half-and-Half Decoction is apt.

Junggyeong 仲景

2.15.2

Source원문

太陽病八九日如瘧狀, 發熱ㆍ惡寒ㆍ熱多寒少ㆍ脉微而惡寒者, 此陰陽俱虛, 不可更發汗ㆍ更下ㆍ更吐. 面色反有熱色者, 未欲解也; 以其不能得小汗出, 身必痒, 宜桂麻各半湯. 《仲景》

Translation영역

Taiyang disease on the eighth or ninth day in a malarial form, with fever and aversion to cold, much heat and little cold, a faint pulse and aversion to cold: this is depletion of both yin and yang, and there may be no further sweating, no further purging and no further vomiting. If the colour of the face instead has a heat colour in it, it is not yet about to resolve; and because he cannot get even a small sweat out, the body must itch, and Cinnamon Twig and Ephedra Half-and-Half Decoction is apt.

Clinical note임상 주석

The itch is the discriminator, and it is a fine piece of observation. Both patients have a malaria-like alternation and a faint pulse. In the one whose body itches, a sweat is trying to come out and cannot — so give the formula with ephedra in it and let it out. In the one whose body does not itch, there is no sweat trying to come and forcing one would empty a patient already short of yang — so give the formula with gypsum instead. Two half-and-half formulas, distinguished by a single symptom that costs nothing to ask about. 無陽 in the first passage and 陰陽俱虛 in the second both mean the same practical thing: this patient has no reserve, and the ordinary prohibitions bind more tightly than usual. 不可更發汗ㆍ更下ㆍ更吐 — no further sweating, purging or vomiting — is the triple prohibition that reappears as the name of Minor Bupleurum Decoction later in the chapter.

Junggyeong 仲景

2.16 Taiyang Blood Accumulation 太陽畜血

2.16.1

Source원문

太陽病六七日, 表證因在, 脉微而沉, 反不結胸, 其人如狂者, 以熱在下焦, 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

2.16.2

Source원문

太陽證俱在而脉反沉, 兼發狂ㆍ小腹硬者, 宜用此藥. 方見下

Translation영역

Where the taiyang signs are all present and yet the pulse is deep, with mania arising and the lower abdomen hard, this medicine should be used. The formula appears below.

Clinical note임상 주석

Free-flowing urine is the sign the whole diagnosis turns on, and it appears again in the Resistance Pill's entry. A full hard lower abdomen could be retained urine or accumulated blood; if the urine is passing freely it is not the bladder, and what is left is blood. The test costs nothing and settles the question. 其人如狂 — the man is as though mad — with the qualifier 如 doing real work: not mad, but like it. The classical tradition consistently attributes an agitated confusion with a full lower abdomen to static blood below, and the association of pelvic or retroperitoneal haemorrhage with delirium is not fanciful. The absence of a chest bind is specified because that is the other condition that produces this picture, and it is treated quite differently.

Junggyeong 仲景

2.17 The Yangming — Signs and Medicines 陽明形證用藥

2.17.1

Source원문

陽明者, 大腸爲標, 與肺爲表裏, 故微惡寒ㆍ發熱, 爲經病, 宜葛根解肌湯. 渴而有汗者, 宜白虎湯. 胃爲本, 目疼ㆍ鼻乾ㆍ潮汗ㆍ閉澁ㆍ滿渴ㆍ狂譫, 宜調胃承氣湯. 《入門》

Translation영역

For the yangming, the large intestine is the branch and stands as exterior and interior with the lung, and so there is slight aversion to cold and fever; this is channel disease, and Pueraria Flesh-Resolving Decoction is apt. Where there is thirst with sweating, White Tiger Decoction is apt. The stomach is the root, and there is pain of the eyes, dryness of the nose, tidal sweating, blocked and rough stool, fullness and thirst, mania and delirium, for which Regulate the Stomach and Order the Qi Decoction is apt.

Uihak Immun 入門

2.17.2

Source원문

陽明以肌肉之間爲表, 胃府爲裏. 熱在表則目疼ㆍ不眠, 宜葛根解肌湯; 熱入裏則狂譫, 宜調胃承氣湯. 《入門》

Translation영역

For the yangming, the space within the flesh is the exterior and the stomach bowel is the interior. Where the heat is in the exterior there is pain of the eyes and sleeplessness, and Pueraria Flesh-Resolving Decoction is apt; where the heat enters the interior there is mania and delirium, and Regulate the Stomach and Order the Qi Decoction is apt.

Clinical note임상 주석

The branch-and-root distinction from 2.10 applied a second time, and here the therapeutic gap between the two levels is much wider than it was in the taiyang: a surface-releasing decoction for the branch, a purgative for the root. Choosing wrongly between them is one of the two or three most consequential errors the chapter warns against. Three formulas for three depths: pueraria for heat still in the flesh, gypsum for heat at the qi level with thirst and sweat, rhubarb and mirabilite for heat bound in the bowel. The sign that separates the second from the third is the stool, which is why 閉澁 appears in the first passage's list and not in the second's.

Uihak Immun 入門

2.18 Yangming Disease Has Three Kinds 陽明病有三

2.18.1

Source원문

病有太陽陽明, 有正陽陽明, 有少陽陽明, 何謂也? 答曰: 太陽陽明者, 脾約是也; 正陽陽明者, 胃家實是也; 少陽陽明者, 發汗ㆍ利小便, 胃中燥煩實ㆍ大便難是也. 《仲景》

Translation영역

There is a taiyang-yangming disease, an upright-yang yangming and a shaoyang-yangming — what is meant by this? The answer: taiyang-yangming is the spleen-bound case; upright-yang yangming is the case of the stomach being replete; shaoyang-yangming is the case where sweating and disinhibiting the urine have left the stomach dry, vexed and replete with difficult stool.

Junggyeong 仲景

2.18.2

Source원문

陽明之爲病, 胃家實也. 問曰: 緣何得陽明病? 答曰: 太陽病發汗ㆍ若下ㆍ若利小便者, 此亡津液ㆍ胃中乾燥, 因轉屬陽明, 不更衣ㆍ內實ㆍ大便難者, 此名陽明病也. 《仲景》

Translation영역

The yangming becoming diseased is the stomach being replete. It is asked: by what cause is yangming disease got? The answer: where a taiyang disease has been sweated, or purged, or the urine disinhibited, the fluids are lost and the stomach is dry, and thereby it turns over and belongs to the yangming; and where there is no change of clothes, repletion within and difficult stool, this is named yangming disease.

Clinical note임상 주석

Two of the three kinds are iatrogenic, and the second passage says so outright: sweating, purging or disinhibiting the urine in a taiyang patient loses fluid, dries the stomach, and makes a yangming disease out of a taiyang one. That is the same argument as Haejang's 六傳 in 2.9, arrived at from the other direction. 不更衣 — no change of clothes — is a classical euphemism for not having opened the bowels, and it is worth knowing because it recurs. The 脾約 case named first is the one with frequent urination and hard stool, treated with Spleen-Bound Pill rather than a 承氣 formula; the Bogam takes it up again in 2.28.

Junggyeong 仲景

2.19 Yin and Yang Binding in Yangming Disease 陽明病陰陽結

2.19.1

Source원문

脉浮而數ㆍ能食ㆍ不大便者, 此爲實, 名曰陽結也, 期十七日當劇. 脉沉而遲ㆍ不能食ㆍ身體重ㆍ大便硬, 名曰陰結也, 期十四日當劇. 《仲景》

Translation영역

Where the pulse is floating and rapid, the patient can eat and does not open the bowels, this is repletion and is named a yang bind; it is due to become severe on the seventeenth day. Where the pulse is deep and slow, the patient cannot eat, the body is heavy and the stool is hard, this is named a yin bind; it is due to become severe on the fourteenth day.

Clinical note임상 주석

Both patients are constipated, and appetite with pulse tells them apart: a floating rapid pulse in a patient who still eats is heat binding the bowel, while a deep slow pulse in a patient who cannot eat is cold doing it. The two take opposite treatment, and the next few sections are organized around the first while the taiyin sections address the second. The day counts are the least useful part and should be read as the tradition's habit of giving a disease a calendar rather than as prognosis. The clinically live content is the pairing of appetite with pulse quality, which is a quick and reliable way to separate hot from cold constipation at the bedside.

Junggyeong 仲景

2.20 The External Signs of Yangming 陽明外證

2.20.1

Source원문

陽明外證云何? 答曰: 身熱ㆍ汗自出ㆍ不惡寒ㆍ反惡熱也.

Translation영역

What are the external signs of the yangming? The answer: generalized fever, sweat coming out of itself, no aversion to cold but rather aversion to heat.

Junggyeong 仲景

2.20.2

Source원문

傷寒轉屬陽明者, 其人濈然微汗出也.

Translation영역

Where cold damage turns over and belongs to the yangming, the man sweats slightly and continuously.

Junggyeong 仲景

2.20.3

Source원문

陽明病發熱ㆍ汗多者, 急下之, 宜大承氣湯. 《仲景》

Translation영역

In yangming disease with fever and much sweating, purge it urgently; Major Order the Qi Decoction is apt.

Clinical note임상 주석

不惡寒ㆍ反惡熱 is the single most useful sign in this part of the chapter and the one to check at every visit: a patient who was averse to cold and has become averse to heat has crossed from the taiyang into the yangming, and the treatment reverses accordingly. It is also easy to elicit — ask whether they want the blanket on or off. The instruction to purge urgently a patient who is sweating heavily looks alarming and is the Shanghanlun's own reading: profuse sweating in a yangming fever is losing the fluid that would otherwise soften the stool, so waiting makes the bind worse. The logic is sound within the system; a modern clinician would be replacing the fluid rather than purging, and the two are not in fact incompatible.

Junggyeong 仲景

2.21 Tidal Fever in the Yangming Pattern 陽明證潮熱

2.21.1

Source원문

詳見下

Translation영역

Treated in detail below.

Clinical note임상 주석

A cross-reference heading with no content of its own, kept because the Bogam gives it its own place in the sequence of yangming signs. The material is at 2.70, where tidal fever is taken up alongside aversion to cold and aversion to heat.

Donguibogam 東醫寶鑑

2.22 Delirious Speech in the Yangming Pattern 陽明證譫語

2.22.1

Source원문

詳見下

Translation영역

Treated in detail below.

Clinical note임상 주석

A second cross-reference heading. The material is in the lower part of the chapter, where delirious speech and faint voice are treated together in their own section with Bupleurum and Forsythia Decoction.

Donguibogam 東醫寶鑑

2.23 The Malign Signs of Yangming Disease 陽明病惡候

2.23.1

Source원문

傷寒若吐ㆍ若下後不解, 不大便五六日至十餘日, 日晡所發潮熱ㆍ不惡寒ㆍ狂言如見鬼狀; 若劇者, 發則不識人ㆍ循衣模床ㆍ惕而不安ㆍ微喘ㆍ直視. 脉弦者生, 脉濇者死. 《仲景》

Translation영역

In cold damage, where after vomiting or purging it has not resolved, the bowels have not opened for five or six days up to ten days and more, and towards sunset tidal fever arises with no aversion to cold and wild speech as though he saw ghosts; and in the severe case, when it comes on he does not recognize people, picks at his clothes and gropes at the bed, is startled and not at ease, pants slightly and stares fixedly. If the pulse is stringlike he lives; if the pulse is rough he dies.

Junggyeong 仲景

2.23.2

Source원문

微者但發熱ㆍ譫語, 宜大承氣湯下之. 一服利則止後服. 脉弦者生, 脉濇者死. 《得效》

Translation영역

In the milder case there is only fever and delirious speech, and Major Order the Qi Decoction should be used to purge it. If one dose opens the bowels, stop and do not take the rest. If the pulse is stringlike he lives; if the pulse is rough he dies.

Deukhyobang 得效

2.23.3

Source원문

一人病傷寒, 大便不利ㆍ日晡發潮熱ㆍ手循衣縫ㆍ兩手撮空ㆍ直視ㆍ喘急, 諸醫皆走. 此誠惡候, 仲景雖有證而無法, 但云脉弦者生ㆍ脉濇者死. 謾且救之, 與小承氣湯一服而大便利, 諸疾漸退, 脉且微弦, 半月愈. 或問曰: 脉弦者生, 何也? 予曰: 錢仲陽云, 手尋衣領及捻物者, 肝熱也. 此證在玉函列於陽明部. 蓋陽明者胃也, 肝有熱邪淫于胃經, 故以承氣瀉之; 且得弦脉則肝平而胃不受剋, 此有生之理也. 《本事》

Translation영역

A man had cold damage with the bowels not opening, tidal fever towards sunset, the hands picking at the seams of his clothes, both hands snatching at the air, a fixed stare and urgent panting, and all the physicians ran away. This is indeed a malign sign, and though Zhongjing has the pattern he has no method for it, saying only that if the pulse is stringlike he lives and if rough he dies. I rescued him at a venture, giving him one dose of Minor Order the Qi Decoction, and the bowels opened, all the ailments gradually retreated, the pulse became slightly stringlike, and in half a month he was cured. Someone asked: why does a stringlike pulse mean he lives? I said: Qian Zhongyang says that picking at the collar and twisting at things is liver heat. This pattern is placed in the yangming section in the Jade Case. Now the yangming is the stomach, and the liver has a heat evil overrunning the stomach channel, so the Order the Qi is used to drain it; and once a stringlike pulse is got, the liver is level and the stomach is not overwhelmed — this is the principle by which he lives.

Clinical note임상 주석

The best case record in the chapter, and the only place in it where a physician says that all his colleagues ran away. 循衣模床 and 兩手撮空 — picking at the clothes, groping at the bed, snatching at the air — is carphologia, the terminal restless picking of a severely delirious patient, and it is still regarded as an ominous sign. The Bogam's authors knew it as one too. What makes the entry remarkable is the reasoning afterwards. Zhongjing named the sign and gave no treatment. Xu Shuwei treated it anyway with the milder of the two purgatives, succeeded, and was then asked to explain why the stringlike pulse had predicted survival. His answer runs through three steps: Qian Yi's observation that picking at things is liver heat, the placement of this pattern in the yangming section of the Jinkui Yuhan, and the five-phase relation by which a level liver spares the stomach. That is a reconstruction after the fact rather than the reason he chose the formula, and it is honest about being one — 謾且救之, I rescued him at a venture.

Bonsa 本事

2.24 The Yangming Repletion Pattern Should Be Purged 陽明實證宜下

2.24.1

Source원문

自汗出ㆍ大便秘ㆍ小便赤ㆍ手足溫ㆍ脉洪數ㆍ譫語者, 必有燥糞在胃中, 調胃承氣湯下之. 《活人》

Translation영역

Where there is sweat coming out of itself, the stool stopped, the urine dark, the hands and feet warm, the pulse surging and rapid, and delirious speech, there must be dry faeces in the stomach, and Regulate the Stomach and Order the Qi Decoction should be used to purge it.

Hwarinseo 活人

2.24.2

Source원문

手足濈然汗出者, 此大便已硬也. 譫語ㆍ有潮熱, 承氣湯下之; 熱不潮者, 勿服. 《明理》

Translation영역

Where the hands and feet sweat continuously, the stool has already hardened. With delirious speech and tidal fever, an Order the Qi Decoction should be used to purge; where the heat is not tidal, do not give it.

Clinical note임상 주석

熱不潮者勿服 — if the heat is not tidal, do not give it — is the prohibition that makes this section usable. Delirium alone does not license a purgative; the fever must have the tidal pattern, rising towards late afternoon, which is what marks it as bowel heat rather than something else. Without that, the purge is being given to a patient whose delirium has another cause. Sweating of the hands and feet specifically, rather than generally, as a sign that the stool has hardened is a small and genuine observation. The classical reading is that the yangming's heat has concentrated and is venting at the extremities of its own channel; what a modern eye sees is a febrile, dehydrated patient with a sympathetic palmar sweat. Either way the inference about the bowel holds up well enough to act on.

Myeongni 明理

2.25 The Yangming Depletion Pattern Should Be Supplemented 陽明虛證宜補

2.25.1

Source원문

一人傷寒發狂ㆍ欲走ㆍ脉虛數, 用柴胡湯反劇. 以參ㆍ芪ㆍ歸ㆍ朮ㆍ陳皮ㆍ甘草煎湯, 一服狂定, 再服安睡而愈. 《海藏》

Translation영역

A man had cold damage with mania arising and a wish to run about, and a depleted rapid pulse; Bupleurum Decoction was used and it grew worse instead. A decoction was made of ginseng, astragalus, tangkuei, atractylodes, tangerine peel and licorice; one dose settled the mania, a second brought quiet sleep, and he was cured.

Haejang 海藏

2.25.2

Source원문

嘗治循衣模床者數人, 皆用大補氣血之劑. 惟一人兼瞤振ㆍ脉代, 遂於補劑中略加桂, 亦振止ㆍ脉和而愈. 《綱目》

Translation영역

I have treated several who picked at their clothes and groped at the bed, and in every case used an agent that greatly supplements the qi and blood. Only one of them also had twitching and trembling with an intermittent pulse, and to the supplementing agent I added a little cinnamon; the trembling then stopped, the pulse harmonized and he was cured.

Clinical note임상 주석

This section exists to contradict the one before it, and the pairing is the Bogam at its most useful. The same signs — mania, picking at the clothes, groping at the bed — that called for a purgative two sections ago here call for ginseng and astragalus, and the discriminator is the pulse: 脉洪數 there, 脉虛數 here. Surging and rapid is repletion; depleted and rapid is a patient running on nothing. Haejang's case is instructive about error as well as about treatment: Bupleurum Decoction made the patient worse, and only then was the depletion recognized. The Gangmok's single qualification — one patient among several also had twitching and an intermittent pulse, and needed a little cinnamon — is the kind of detail that only comes from having treated the series. 脉代, an intermittent pulse, in a trembling patient is a genuine sign of failing circulation and the cinnamon is being used as a cardiotonic.

Uihak Gangmok 綱目

2.26 Sweating and Thirst in the Yangming Pattern 陽明證汗渴

2.26.1

Source원문

治汗後脉洪大而煩渴, 宜用白虎湯和解之.

Translation영역

To treat a surging large pulse with vexing thirst after sweating, White Tiger Decoction should be used to harmonize and resolve it.

Junggyeong 仲景

2.26.2

Source원문

三陽合病, 頭痛ㆍ面垢ㆍ譫語ㆍ遺尿ㆍ中外俱熱ㆍ自汗ㆍ煩渴, 亦宜此藥. 《仲景》

Translation영역

In a combined disease of the three yang, with headache, a grimy face, delirious speech, involuntary urination, heat both inside and out, spontaneous sweating and vexing thirst, this medicine is also apt.

Junggyeong 仲景

2.26.3

Source원문

汗下後表裏俱熱ㆍ舌上乾燥而大渴ㆍ脉洪大者, 人參白虎湯主之.

Translation영역

Where after sweating and purging there is heat in both exterior and interior, the tongue is dry and parched with great thirst, and the pulse is surging and large, Ginseng White Tiger Decoction governs it.

Junggyeong 仲景

2.26.4

Source원문

汗而不解ㆍ脉浮者, 蒼朮白虎湯主之. 《仲景》

Translation영역

Where sweating has not resolved it and the pulse is floating, Atractylodes Lancea White Tiger Decoction governs it.

Junggyeong 仲景

2.26.5

Source원문

無汗而渴者, 不可服.

Translation영역

One who is thirsty without sweating may not be given it.

Junggyeong 仲景

2.26.6

Source원문

陽明證汗渴, 竹葉石膏湯最妙. 方見下

Translation영역

For sweating and thirst in the yangming pattern, Bamboo Leaf and Gypsum Decoction is best of all. The formula appears below.

Clinical note임상 주석

無汗而渴者不可服 is the gate on the whole White Tiger family and the most-ignored prohibition in this chapter. Thirst alone is not enough; the patient must also be sweating, because sweating is what shows the heat is at the qi level and venting. Thirst without sweat means the exterior is still closed, and a cold heavy mineral formula will shut it further. 面垢 — a grimy face — in the three-yang combined disease is a detail worth keeping. It describes the dulled, unwashed-looking complexion of a patient in a severe systemic fever, and it appears in the Summerheat chapter for the same reason. With involuntary urination beside it, the picture is of a patient too ill to attend to themselves, which is what the Shanghanlun means by all three yang being involved at once.

Junggyeong 仲景

2.27 The Three Yangming Patterns 陽明三證

2.27.1

Source원문

陽明證: 上焦熱, 脉浮ㆍ發熱; 中焦熱, 渴欲飮水; 下焦熱, 小便不利. 是乃三焦俱熱, 宜使熱邪從小便而出, 是用猪苓湯. 惟汗多而渴者, 不可服. 《入門》

Translation영역

In the yangming pattern: heat in the upper burner gives a floating pulse and fever; heat in the middle burner gives thirst with a wish to drink water; heat in the lower burner gives inhibited urination. This then is heat in all three burners, and the heat evil should be made to leave by way of the urine, so Polyporus Decoction is used. Only one who sweats much and is thirsty may not be given it.

Clinical note임상 주석

A clean piece of localization: one sign for each burner, and when all three are present the heat is everywhere and needs a single exit. The urine is chosen as that exit because it costs the least — sweating a patient this hot loses more fluid, and purging requires a bowel bind that is not described here. The exclusion at the end mirrors the one in the previous section from the other side. Much sweating with thirst sends you to White Tiger; thirst with inhibited urination sends you to Polyporus. The two prohibitions together make a usable pair of rules, and the formula entries explain why each is right.

Uihak Immun 入門

2.28 The Yangming Spleen-Bound Pattern 陽明脾約證

2.28.1

Source원문

趺陽脉浮而濇, 浮則胃氣强, 濇則小便數; 浮濇相搏, 大便必難, 其脾爲約, 麻仁丸主之. 一名脾約丸. 方見大便《仲景》

Translation영역

Where the instep yang pulse is floating and rough — floating meaning the stomach qi is strong, rough meaning the urine is frequent — and the floating and the rough beat against each other, the stool must be difficult and the spleen is bound; Hemp Seed Pill governs it. It is also called Spleen-Bound Pill. The formula appears in the Stool chapter.

Clinical note임상 주석

The 脾約 pattern is constipation with frequent urination and no fever, in a patient who is otherwise well — the fluid is going out through the bladder instead of into the bowel. It is the one yangming pattern that does not call for a 承氣 formula, and the Bogam is careful to say so: a moistening pill, taken over days, rather than a purgative taken once. The instep yang pulse at the dorsum of the foot is rarely used in later practice, and the two qualities read here are doing the same work the appetite did in 2.19 — separating a bind that is about heat and strength from one that is about dryness. Still a recognizable and common pattern, and the formula is still the right answer to it.

Junggyeong 仲景

2.29 The Prohibitions in Yangming Disease 陽明病禁忌

2.29.1

Source원문

陽明病不能食, 攻其熱必噦. 所以然者, 胃氣虛冷故也.

Translation영역

In yangming disease where the patient cannot eat, attacking the heat will certainly bring on hiccough. The reason is that the stomach qi is depleted and cold.

Junggyeong 仲景

2.29.2

Source원문

傷寒嘔多, 雖有陽明證, 不可攻也.

Translation영역

In cold damage with much retching, although there be a yangming pattern, it may not be attacked.

Junggyeong 仲景

2.29.3

Source원문

胃家實ㆍ不大便, 若表未解及有半表者, 先用桂枝ㆍ柴胡和解之, 乃可下也.

Translation영역

Where the stomach is replete and the bowels do not open, if the exterior is not yet resolved or there is a half-exterior present, first use cinnamon twig or bupleurum to harmonize and resolve it, and only then may it be purged.

Junggyeong 仲景

2.29.4

Source원문

陽明病自汗出ㆍ小便自利者, 此爲津液內竭, 大便雖硬, 不可攻之, 宜用蜜導法通之. 方見大便

Translation영역

In yangming disease with sweat coming out of itself and the urine passing freely of itself, this is the fluids being exhausted within; though the stool be hard, it may not be attacked, and the honey suppository method should be used to free it. The method appears in the Stool chapter.

Junggyeong 仲景

2.29.5

Source원문

陽明病口燥ㆍ但欲漱水ㆍ不欲嚥, 此必衂, 不可下, 宜用犀角地黃湯. 《仲景》

Translation영역

In yangming disease with a parched mouth where the patient wishes only to rinse with water and does not wish to swallow, he will certainly have a nosebleed; he may not be purged, and Rhinoceros Horn and Rehmannia Decoction should be used.

Clinical note임상 주석

Five prohibitions, and each names the sign that forbids the purge. Cannot eat: the stomach is cold, not hot. Much retching: the qi is already going the wrong way. Exterior not resolved: purging drags the evil inward. Sweating with free urine: there is no fluid left to purge with. Rinsing without swallowing: the problem is blood, not stool. The last of the five is the most useful piece of bedside observation in the section and appears again in the Resistance Decoction's entry. A patient who wants water in the mouth but will not swallow it has a dry mouth without true thirst, and the classical reading is that heat has gone into the blood rather than consumed the fluids — hence the predicted nosebleed and the blood-cooling formula. The distinction between wanting to drink and wanting only to rinse is one of the sharpest in the whole tradition and takes one question to establish. 蜜導法, the honey suppository, is the alternative offered where the stool is hard but the patient cannot be purged: a local measure instead of a systemic one. It is a sensible answer and the Bogam gives it its own place in the Stool chapter.

Junggyeong 仲景

2.30 The Shaoyang — Signs and Medicines 少陽形證用藥

2.30.1

Source원문

少陽之爲病, 口苦ㆍ咽乾ㆍ目眩. 《仲景》

Translation영역

The shaoyang becoming diseased is a bitter mouth, a dry throat and dizziness of the eyes.

Junggyeong 仲景

2.30.2

Source원문

眩而口苦ㆍ舌乾者, 屬少陽. 《仲景》

Translation영역

Dizziness with a bitter mouth and a dry tongue belongs to the shaoyang.

Junggyeong 仲景

2.30.3

Source원문

脇滿ㆍ乾嘔ㆍ往來寒熱者, 屬少陽. 《仲景》

Translation영역

Rib-side fullness, dry retching and chill and fever coming and going belong to the shaoyang.

Junggyeong 仲景

2.30.4

Source원문

胸脇痛ㆍ耳聾ㆍ尺寸脉俱弦者, 少陽受病也. 《仲景》

Translation영역

Chest and rib-side pain, deafness, and both the cubit and inch pulses stringlike: the shaoyang has received the disease.

Junggyeong 仲景

2.30.5

Source원문

口苦ㆍ耳聾ㆍ胸滿者, 少陽傷風也. 《仲景》

Translation영역

A bitter mouth, deafness and chest fullness: this is shaoyang wind damage.

Junggyeong 仲景

2.30.6

Source원문

少陽三焦相火爲本, 故微熱; 膽爲標, 故耳聾ㆍ脇痛ㆍ寒熱ㆍ嘔而口苦. 宜從中治, 俱宜小柴胡湯. 《入門》

Translation영역

For the shaoyang, the ministerial fire of the triple burner is the root, and so there is slight fever; the gallbladder is the branch, and so there is deafness, rib-side pain, chill and fever, retching and a bitter mouth. It should be treated from the middle, and for all of these Minor Bupleurum Decoction is apt.

Clinical note임상 주석

The three cardinal signs — bitter mouth, dry throat, dizziness — are among the most durable diagnostic triads in the tradition and are still used unchanged. A bitter taste in the mouth with a febrile illness is a real and specific complaint, and the association with gallbladder and biliary disease that the classical reading implies is not a bad one. 宜從中治 — it should be treated from the middle — is the whole therapeutic principle of the shaoyang in four characters, and the next section spells out what it rules out. Note that unlike the taiyang and yangming, the branch and root here do not take different formulas: both get Minor Bupleurum, because what is wrong is the position rather than the depth.

Uihak Immun 入門

2.31 The Shaoyang Pattern Is Half Exterior and Half Interior 少陽證爲半表半裏

2.31.1

Source원문

少陽居太陽ㆍ陽明之中, 半表半裏也. 禁汗, 恐犯太陽; 禁下, 恐犯陽明; 禁利小便, 恐生發之氣陷入陰中. 故只用小柴胡湯和之. 《入門》

Translation영역

The shaoyang lies between the taiyang and the yangming, half in the exterior and half in the interior. Sweating is forbidden, for fear of transgressing against the taiyang; purging is forbidden, for fear of transgressing against the yangming; disinhibiting the urine is forbidden, for fear the generating and issuing qi will fall inward into the yin. Therefore only Minor Bupleurum Decoction is used, to harmonize it.

Uihak Immun 入門

2.31.2

Source원문

少陽以胸脇之間爲半表半裏. 表多則小柴胡湯, 裏多則黃芩湯. 已上發熱太陽ㆍ惡寒陽明ㆍ自汗少陽多嘔, 皆三陽證也. 《入門》

Translation영역

For the shaoyang, the space between the chest and rib-side is the half-exterior and half-interior. Where the exterior predominates, Minor Bupleurum Decoction; where the interior predominates, Scutellaria Decoction. The above — fever in the taiyang, aversion to cold in the yangming, spontaneous sweating in the shaoyang with much retching — are all three-yang patterns.

Clinical note임상 주석

The three prohibitions are what give Minor Bupleurum its alternative name 三禁湯, and the reasons given for each are worth reading: sweating would act on the taiyang, which is no longer where the disease is; purging would act on the yangming, which it has not yet reached; disinhibiting the urine would drain downward the very qi that needs to rise and vent. Three wrong directions, which leaves harmonizing as the only move available. The second passage's 表多 / 裏多 refinement is the practical qualification. Scutellaria Decoction has no bupleurum and no ginseng and works from the interior; where the picture has tipped inward it is the better choice. The closing summary of the three yang by their cardinal sign — fever, aversion to cold, retching — is a useful mnemonic, though it simplifies the aversion to cold of 2.20, which the yangming loses rather than keeps.

Uihak Immun 入門

2.32 Shaoyang Disease May Not Be Sweated 少陽病不可發汗

2.32.1

Source원문

傷寒脉弦細ㆍ頭痛ㆍ發熱者, 屬少陽, 不可發汗; 發汗則譫語. 《仲景》

Translation영역

In cold damage with a stringlike fine pulse, headache and fever, it belongs to the shaoyang and may not be sweated; if it is sweated, there will be delirious speech.

Clinical note임상 주석

Headache and fever look like a taiyang pattern and would ordinarily be sweated; the stringlike fine pulse is what forbids it. The named consequence — delirium — is specific and is the chapter's way of saying that sweating a shaoyang patient drives the illness into the yangming. Section 2.34 describes what is left afterwards.

Junggyeong 仲景

2.33 Chill and Fever Coming and Going in the Shaoyang Pattern 少陽證往來寒熱

2.33.1

Source원문

血氣虛ㆍ腠理開, 邪氣因入, 與正氣相搏, 結於脇下. 邪正分爭, 往來寒熱, 休作無時, 不欲飮食而嘔, 宜用小柴胡湯. 《仲景》

Translation영역

The blood and qi being depleted and the interstices open, the evil qi thereby enters, beats against the upright qi and binds below the rib-side. Evil and upright contend apart from one another, so chill and fever come and go, resting and arising at no set time, with no desire for food and drink, and retching; Minor Bupleurum Decoction should be used.

Clinical note임상 주석

邪正分爭 — evil and upright contending apart from one another — is the classical account of the alternating fever, and it is a good metaphor whatever one makes of the entities: the chill and the fever alternate because neither side holds the field. 休作無時, resting and arising at no set time, is the detail that separates this from malaria, where the periods are regular, and the Bogam is careful about the distinction in the Malaria chapter. The precondition given at the start matters for prescribing: the blood and qi are already depleted, the interstices already open. That is why Minor Bupleurum has ginseng, licorice and dates in it, and why this pattern is not treated by driving anything out.

Junggyeong 仲景

2.34 The Ruined Pattern of Shaoyang Disease 少陽病壞證

2.34.1

Source원문

太陽病不解, 轉入少陽者, 脇下硬滿ㆍ乾嘔ㆍ不能食ㆍ往來寒熱, 尙未吐下ㆍ脉沉緊者, 與小柴胡湯. 若已吐下ㆍ發汗ㆍ譫語, 柴胡證罷, 此爲壞病, 依壞法治之. 《仲景》

Translation영역

Where a taiyang disease has not resolved and turns inward into the shaoyang, with hard fullness below the rib-side, dry retching, inability to eat and chill and fever coming and going: if vomiting and purging have not yet been done and the pulse is deep and tight, give Minor Bupleurum Decoction. But if vomiting, purging and sweating have already been done and there is delirious speech, the bupleurum pattern is finished; this is a ruined disease, and it is to be treated by the method for the ruined.

Clinical note임상 주석

柴胡證罷 — the bupleurum pattern is finished — is the most important three characters in this part of the chapter. A ruined pattern is not a worse version of the original; it is a different disease, and the formula that was right before is now wrong. The chapter takes up the ruined patterns at 2.52 and again in the lower part, with Anemarrhena and Ephedra Decoction and Ginseng, Bupleurum and Peony Decoction. The condition attached to the first half is the useful part: 尙未吐下, vomiting and purging not yet done. Minor Bupleurum still works on a shaoyang patient who has not been mistreated. Once they have been, the formula has nothing to harmonize.

Junggyeong 仲景

2.35 Rib-Side Pain in Shaoyang Disease 少陽病脇痛

2.35.1

Source원문

少陽證漐漐汗出ㆍ頭痛ㆍ心下痞硬滿ㆍ引脇下痛ㆍ乾嘔ㆍ短氣ㆍ不惡寒, 此表解裏未和也, 宜十棗湯. 若合下不下, 則令人脹滿ㆍ遍身浮腫也. 《仲景》

Translation영역

In the shaoyang pattern with sweat coming out in a fine moisture, headache, stuffy hard fullness below the heart drawing a pain below the rib-side, dry retching, shortness of breath and no aversion to cold: this is the exterior resolved and the interior not yet harmonized, and Ten Jujubes Decoction is apt. If it ought to be purged and is not, it will give the man distending fullness and oedema over the whole body.

Junggyeong 仲景

2.35.2

Source원문

杜壬曰: 裏未和者, 蓋痰與燥氣壅於中焦, 故頭痛ㆍ乾嘔ㆍ短氣ㆍ汗出, 是痰隔也, 非十棗湯不治. 《綱目》

Translation영역

Du Ren says: in the case where the interior is not yet harmonized, phlegm and dry qi are congesting the middle burner, and so there is headache, dry retching, shortness of breath and sweating; this is a phlegm partition, and nothing but Ten Jujubes Decoction will cure it.

Clinical note임상 주석

A pleural effusion described from the outside: hard fullness below the heart that pulls into a rib-side pain, breathlessness, dry retching, and the exterior already resolved so the fever is no longer the problem. Ten Jujubes Decoction is a violent water-expelling formula built on three toxic drugs, and the consequence the text gives for not using it — distension and generalized oedema — is what happens when a large effusion is left to accumulate. 非十棗湯不治 is unusually emphatic for this literature, and the formula's own entry shows why the compilers were willing to say it: Liu Wansu's gloss there explains the division of labour among the three purgatives and then warns that they are toxic and not to be used lightly. Both statements stand in the Bogam without being reconciled, which is the honest position for a drug of this kind.

Uihak Gangmok 綱目

2.36 The Taiyin — Signs and Medicines 太陰形證用藥

2.36.1

Source원문

太陰之爲病, 腹滿而吐ㆍ食不下ㆍ自利益甚ㆍ時腹自痛. 《仲景》

Translation영역

The taiyin becoming diseased is abdominal fullness with vomiting, food not going down, spontaneous diarrhoea growing ever worse, and the abdomen paining of itself from time to time.

Junggyeong 仲景

2.36.2

Source원문

太陰肺爲標, 故咽乾ㆍ身目黃; 脾爲本, 故腹滿痛, 宜大柴胡湯. 方見下身黃者, 茵蔯蒿湯. 如自利不渴, 屬藏病, 宜理中湯ㆍ丸. 《入門》

Translation영역

For the taiyin, the lung is the branch, and so there is a dry throat and yellowing of the body and eyes; the spleen is the root, and so there is abdominal fullness and pain, for which Major Bupleurum Decoction is apt. The formula appears below. Where the body is yellow, Capillaris Decoction. Where there is spontaneous diarrhoea without thirst, it belongs to visceral disease, and Regulate the Middle Decoction or Pill is apt.

Uihak Immun 入門

2.36.3

Source원문

太陰證腹痛ㆍ自利ㆍ不渴, 宜理中湯ㆍ理中丸; 四順理中湯ㆍ丸亦主之. 《仲景》

Translation영역

In the taiyin pattern with abdominal pain, spontaneous diarrhoea and no thirst, Regulate the Middle Decoction or Regulate the Middle Pill is apt; Four Obediences Regulate the Middle Decoction or Pill also governs it.

Junggyeong 仲景

2.36.4

Source원문

腹滿時痛ㆍ吐利ㆍ不渴者爲太陰, 宜四逆湯方見下ㆍ理中湯. 腹滿不減, 減不足言, 宜大承氣湯. 方見下《仲景》

Translation영역

Abdominal fullness with pain from time to time, vomiting and diarrhoea, and no thirst, is taiyin, and Frigid Extremities Decoction the formula appears below or Regulate the Middle Decoction is apt. Where the abdominal fullness does not lessen, or lessens too little to speak of, Major Order the Qi Decoction is apt. The formula appears below.

Junggyeong 仲景

2.36.5

Source원문

腹滿時痛ㆍ復如故, 此虛寒從下而上也, 當以溫藥和之, 宜理中湯. 《仲景》

Translation영역

Abdominal fullness paining from time to time and then returning as it was: this is depletion cold coming up from below, and it should be harmonized with warming medicines; Regulate the Middle Decoction is apt.

Junggyeong 仲景

2.36.6

Source원문

飮食不節ㆍ寒中陰經ㆍ腹滿閉塞ㆍ唇靑ㆍ手足冷ㆍ脉沉細, 宜治中湯. 《仲景》

Translation영역

Where food and drink have been taken without moderation and cold has struck the yin channels, with abdominal fullness and blockage, blue lips, cold hands and feet and a deep fine pulse, Govern the Middle Decoction is apt.

Junggyeong 仲景

2.36.7

Source원문

傷寒自利ㆍ不渴者屬太陰, 以其藏有寒故也, 當溫之, 宜用四逆湯. 《仲景》

Translation영역

In cold damage, spontaneous diarrhoea without thirst belongs to the taiyin, because its viscus has cold; it should be warmed, and Frigid Extremities Decoction should be used.

Clinical note임상 주석

自利不渴 — spontaneous diarrhoea without thirst — is repeated three times in this one section and is the taiyin's defining sign. Thirst with diarrhoea sends you to Pulsatilla Decoction and the heat formulas; its absence sends you to Regulate the Middle and the warm ones. One question, and the whole treatment turns on it. 腹滿不減, 減不足言 — the fullness does not lessen, or lessens too little to speak of — is the exception that admits a purgative into a cold chapter, and it is Zhongjing being careful: taiyin fullness that genuinely does not move with warming is not cold at all, and needs Major Order the Qi. The section prints the warming formulas and that exception side by side without comment, which is characteristic. The section is also where the whole Regulate the Middle family is introduced in one breath — decoction, pill, Four Obediences in both forms, Govern the Middle — and the variants are differentiated by small things: doubled licorice for pain with diarrhoea, added tangerine and green tangerine peel for pain from dietary excess.

Junggyeong 仲景

2.37 Abdominal Pain in Taiyin Disease 太陰病腹痛

2.37.1

Source원문

傷寒陽脉濇ㆍ陰脉弦, 法當腹中急痛, 先與小建中湯方見虛勞; 不差, 再與小柴胡湯. 《仲景》

Translation영역

In cold damage with the yang pulse rough and the yin pulse stringlike, by rule there should be urgent pain within the abdomen; first give Minor Construct the Middle Decoction the formula appears in the Taxation chapter, and if it does not resolve, then give Minor Bupleurum Decoction.

Junggyeong 仲景

2.37.2

Source원문

太陽病, 醫反下之, 因而腹滿時痛者, 屬太陰, 桂枝湯加芍藥主之. 凡言加者, 謂倍入也. 大便實痛者, 桂枝湯加大黃主之. 《仲景》

Translation영역

In a taiyang disease where the physician has purged instead, and thereby there is abdominal fullness paining from time to time, it belongs to the taiyin, and Cinnamon Twig Decoction with peony added governs it. Wherever adding is spoken of, doubling is meant. Where the stool is replete and there is pain, Cinnamon Twig Decoction with rhubarb added governs it.

Junggyeong 仲景

2.37.3

Source원문

傷寒邪在三陰, 內不得交通, 故爲腹痛. 手足之經皆會於腹故也. 《仲景》

Translation영역

In cold damage, where the evil is in the three yin and cannot communicate within, there is abdominal pain. It is because the channels of the hands and feet all meet in the abdomen.

Clinical note임상 주석

凡言加者, 謂倍入也 — wherever adding is spoken of, doubling is meant — is a note on how to read the whole literature and is worth more than the section it sits in. When a source says a formula is given "with peony added", the peony was already in it and the instruction is to double the dose. Misreading that as a new ingredient changes a great many formulas. The second passage is another iatrogenic case: a taiyang patient purged by mistake, now with taiyin abdominal pain. The answer is not to abandon the original formula but to modify it, which is a more conservative move than the chapter usually allows and reflects that the exterior pattern has not actually gone away.

Junggyeong 仲景

2.38 Abdominal Distending Fullness in Taiyin Disease 太陰病腹脹滿

2.38.1

Source원문

太陰證下利淸穀, 若發汗則必脹滿. 《仲景》

Translation영역

In the taiyin pattern with diarrhoea of clear undigested grain, if sweating is induced there will certainly be distending fullness.

Junggyeong 仲景

2.38.2

Source원문

發汗後腹脹滿, 宜用厚朴半夏湯. 《仲景》

Translation영역

For abdominal distending fullness after sweating has been induced, Magnolia Bark and Pinellia Decoction should be used.

Clinical note임상 주석

下利淸穀 — diarrhoea of clear undigested grain — is the sign that absolutely forbids sweating, and the pairing of prohibition and remedy in two short passages is the chapter's most economical teaching. Food passing undigested means the middle burner has no warmth left to transform it; take more fluid out through the skin and the abdomen distends. Magnolia Bark and Pinellia Decoction is the repair, and its composition shows what is being repaired: magnolia bark at triple dose to break the distension, with ginseng and licorice to put back what the sweat took. An iatrogenic complication with its own named formula is a sign of how often it happened.

Junggyeong 仲景

2.39 Jaundice in Taiyin Disease 太陰病發黃

2.39.1

Source원문

傷寒七八日ㆍ身黃如橘子色ㆍ小便不利ㆍ腹微滿, 屬太陰, 宜茵蔯蒿湯. 《仲景》

Translation영역

In cold damage on the seventh or eighth day, with the body yellow as the colour of a tangerine, inhibited urination and slight abdominal fullness, it belongs to the taiyin, and Capillaris Decoction is apt.

Junggyeong 仲景

2.39.2

Source원문

傷寒但頭汗出ㆍ餘無汗ㆍ劑頸而還ㆍ小便不利, 身必發黃. 《仲景》

Translation영역

In cold damage where only the head sweats and the rest does not, the sweat stopping level at the neck and turning back, and the urine is inhibited, the body will certainly turn yellow.

Junggyeong 仲景

2.39.3

Source원문

問曰: 白虎證亦有身熱ㆍ煩渴ㆍ引飮ㆍ小便不利, 何以不發黃? 答曰: 白虎與發黃證相近, 但遍身汗出, 此爲熱越, 白虎證也; 頭面汗出ㆍ頸以下無汗, 發黃證也. 《活人》

Translation영역

It is asked: the White Tiger pattern also has generalized fever, vexing thirst, drawing at drink and inhibited urination — why does it not turn yellow? The answer: White Tiger and the jaundice pattern are close to one another, but where the sweat comes out over the whole body, this is heat leaping out, and is the White Tiger pattern; where the head and face sweat and there is no sweat below the neck, it is the jaundice pattern.

Clinical note임상 주석

Zhu Gong's question is the kind that makes this chapter worth reading whole: two patterns share fever, thirst and scanty urine, so what distinguishes them? His answer is the distribution of the sweat. Over the whole body, the heat has a way out and the patient has a White Tiger pattern. Confined to the head and face, stopping level at the neck, the heat is trapped with the damp and the patient will turn yellow. 劑頸而還 — stopping level at the neck and turning back — is precise observation, and head-and-neck sweating with an anicteric trunk is a real clinical finding. The inference drawn from it is that the obstruction is in the middle rather than the surface, which for a cholestatic jaundice is approximately right. Two sections of the chapter and one question settle a diagnosis that the shared symptoms would otherwise confuse.

Hwarinseo 活人

2.40 The Shaoyin — Signs and Medicines 少陰形證用藥

2.40.1

Source원문

少陰之爲病, 脉微細ㆍ但欲寐. 蓋氣寤則行陽, 寐則行陰, 必從足少陰始, 故少陰病但欲寐也. 《仲景》

Translation영역

The shaoyin becoming diseased is a faint fine pulse and wanting only to sleep. For the qi, when a man is awake, moves in the yang, and when he sleeps moves in the yin, and it must begin from the foot shaoyin; therefore in shaoyin disease he wants only to sleep.

Junggyeong 仲景

2.40.2

Source원문

少陰心爲本, 故舌乾ㆍ口燥, 或下利淸水ㆍ譫語ㆍ便閉, 宜小承氣湯; 腎爲標, 故面寒ㆍ唇靑ㆍ四肢厥冷ㆍ指甲靑黑, 宜薑附湯. 《入門》

Translation영역

For the shaoyin, the heart is the root, and so there is a dry tongue and parched mouth, or diarrhoea of clear water, delirious speech and blocked stool, for which Minor Order the Qi Decoction is apt; the kidney is the branch, and so there is a cold face, blue lips, reversal cold of the four limbs and the nails blue-black, for which Ginger and Aconite Decoction is apt.

Uihak Immun 入門

2.40.3

Source원문

少陰病始得之, 反發熱ㆍ脉沉者, 麻黃附子細辛湯主之. 《仲景》

Translation영역

Where shaoyin disease is newly got and there is fever instead with a deep pulse, Ephedra, Aconite and Asarum Decoction governs it.

Junggyeong 仲景

2.40.4

Source원문

少陰病二三日, 用麻黃附子甘草湯微發之, 以二三日無證故微發汗也. 無證謂無吐利厥證也. 《仲景》

Translation영역

In shaoyin disease on the second or third day, Ephedra, Aconite and Licorice Decoction is used to bring it out slightly, for at two or three days there are no signs and so the sweat is raised only slightly. No signs means no vomiting, diarrhoea or reversal pattern.

Junggyeong 仲景

2.40.5

Source원문

少陰病一二日ㆍ口中和ㆍ背惡寒, 當灸之, 宜附子湯. 《仲景》

Translation영역

In shaoyin disease on the first or second day, with the mouth harmonious and the back averse to cold, it should be moxaed, and Aconite Decoction is apt.

Junggyeong 仲景

2.40.6

Source원문

少陰病二三日ㆍ心中煩ㆍ不得卧, 黃連阿膠湯主之. 《仲景》

Translation영역

In shaoyin disease on the second or third day with vexation in the heart and inability to lie down, Coptis and Donkey-Hide Gelatin Decoction governs it.

Junggyeong 仲景

2.40.7

Source원문

少陰病身體痛ㆍ手足寒ㆍ骨節痛ㆍ脉沉者, 附子湯主之. 《仲景》

Translation영역

In shaoyin disease with pain of the body, cold hands and feet, pain of the bones and joints and a deep pulse, Aconite Decoction governs it.

Junggyeong 仲景

2.40.8

Source원문

傷寒欲吐不吐ㆍ心煩ㆍ但欲寐, 五六日自利而渴者, 屬少陰也. 虛故引水自救. 若小便色白者, 以下焦有寒ㆍ不能制水, 故色白, 宜四逆湯. 《仲景》

Translation영역

In cold damage where he wishes to vomit and does not, with vexation of the heart and wanting only to sleep, and on the fifth or sixth day spontaneous diarrhoea with thirst, it belongs to the shaoyin. Being depleted, he draws at water to rescue himself. If the urine is white in colour, it is because the lower burner has cold and cannot govern the water, and so the colour is white; Frigid Extremities Decoction is apt.

Junggyeong 仲景

2.40.9

Source원문

下痢ㆍ脉沉而遲, 其人面少赤ㆍ身有微汗ㆍ下利淸穀, 必鬱冒ㆍ汗出而解, 病人必微厥. 所以然者, 其面戴陽ㆍ下虛故也. 《仲景》

Translation영역

In diarrhoea with a deep slow pulse, where the man's face is slightly red, the body has a slight sweat and the diarrhoea is of clear undigested grain, he will certainly have a depressed fogging, and sweat will come out and it will resolve; and the sick man will certainly be slightly reversed. The reason is that his face wears the yang while below he is depleted.

Junggyeong 仲景

2.40.10

Source원문

下利ㆍ腹脹滿ㆍ身體疼痛, 先溫其裏, 乃攻其表. 溫裏宜四逆湯, 攻表宜桂枝湯. 《仲景》

Translation영역

In diarrhoea with abdominal distending fullness and aching of the body, first warm the interior and only then attack the exterior. To warm the interior, Frigid Extremities Decoction is apt; to attack the exterior, Cinnamon Twig Decoction.

Junggyeong 仲景

2.40.11

Source원문

少陰病吐利ㆍ手足厥冷ㆍ煩燥欲死, 吳茱萸湯主之. 方見下

Translation영역

In shaoyin disease with vomiting and diarrhoea, reversal cold of the hands and feet, and vexing agitation to the point of wishing to die, Evodia Decoction governs it. The formula appears below.

Junggyeong 仲景

2.40.12

Source원문

少陰證口中辨: 口中和者當溫, 口乾燥者當下. 《東垣》

Translation영역

Distinguishing the shaoyin pattern by the mouth: where the mouth is harmonious it should be warmed; where the mouth is dry and parched it should be purged.

Clinical note임상 주석

The longest 形證用藥 section in the chapter, and the one where the branch-and-root split does the most work: the heart as root gives a dry mouth and a purgative, the kidney as branch gives blue nails and aconite. Those are opposite treatments for the same named channel, and Li Dongyuan's closing rule is the shortcut — look in the mouth. A harmonious mouth means warm it, a dry mouth means purge it. One look, and it settles which of the two halves of the section applies. 但欲寐, wanting only to sleep, is the shaoyin's cardinal sign and it describes obtundation rather than sleepiness. The explanation offered — the qi moves in the yang when awake and the yin when asleep — is a theoretical gloss, but the sign itself is one of the most reliable indicators of severity in this chapter. 面戴陽 — the face wears the yang — is the best phrase in the section and names a real and dangerous appearance: a flushed face in a patient who is cold, with a deep slow pulse and undigested stool. The flush is not heat but the last of the yang displaced upward, and treating it as heat kills the patient. The chapter returns to this at 2.63 under 陰盛隔陽.

Dongwon 東垣

2.41 The Deep Pulse in Shaoyin Disease 少陰病脉沉

2.41.1

Source원문

少陰證口燥ㆍ舌乾而渴ㆍ尺寸脉俱沉: 沉而疾則大承氣湯, 沉而遲則四逆湯. 《東垣》

Translation영역

In the shaoyin pattern with a parched mouth, a dry tongue and thirst, and both the cubit and inch pulses deep: deep and swift, then Major Order the Qi Decoction; deep and slow, then Frigid Extremities Decoction.

Clinical note임상 주석

One sentence, two opposite formulas, and the only thing separating them is the rate. The same deep pulse with the same dry mouth takes the strongest purgative in the book or the strongest warming one, according to whether it is fast or slow. That is as stark a demonstration of why this chapter puts the pulse before the signs as anything in it.

Dongwon 東垣

2.42 The Severed Pulse in Shaoyin Disease 少陰病脉絶

2.42.1

Source원문

少陰病下利ㆍ脉絶或無脉者, 宜通脉四逆湯. 《仲景》

Translation영역

In shaoyin disease with diarrhoea and the pulse severed, or with no pulse, Free the Vessels Frigid Extremities Decoction is apt.

Junggyeong 仲景

2.42.2

Source원문

少陰病下利淸穀ㆍ手足厥逆ㆍ脉微欲絶ㆍ身反不惡寒ㆍ面赤色者, 通脉四逆湯加葱白主之. 《入門》

Translation영역

In shaoyin disease with diarrhoea of clear undigested grain, reversal cold of the hands and feet, a faint pulse on the point of being severed, the body instead not averse to cold and the face red in colour, Free the Vessels Frigid Extremities Decoction with scallion white added governs it.

Uihak Immun 入門

2.42.3

Source원문

傷寒吐下後汗出而厥ㆍ四肢拘急不解ㆍ脉微欲絶, 通脉四逆湯加猪膽汁下之. 《仲景》

Translation영역

In cold damage where after vomiting and purging there is sweating with reversal, the four limbs hypertonic and unresolving, and a faint pulse on the point of being severed, Free the Vessels Frigid Extremities Decoction with pig's bile added should be used to bring it down.

Junggyeong 仲景

2.42.4

Source원문

少陰病下利ㆍ脉微, 與白通湯; 利不止ㆍ厥逆ㆍ無脉ㆍ乾嘔ㆍ煩者, 白通加猪膽汁湯主之. 服湯後脉暴出者死, 微續者生. 《仲景》

Translation영역

In shaoyin disease with diarrhoea and a faint pulse, give White Through-Flow Decoction; where the diarrhoea does not stop, with reversal, no pulse, dry retching and vexation, White Through-Flow Decoction with Pig's Bile Added governs it. After taking the decoction, if the pulse comes out violently he dies; if it continues faintly he lives.

Clinical note임상 주석

脉暴出者死, 微續者生 is the single most clinically acute observation in the chapter. After a powerful warming formula in a pulseless patient, a pulse that returns suddenly and strongly is a terminal sign, while one that returns faintly and continues is recovery. That is exactly right about circulatory collapse: a brief surge before failure is the agonal pattern, and genuine recovery of perfusion is gradual. Four centuries before any understanding of cardiac output, someone watched enough patients die to notice the difference. Pig's bile added to a warming formula looks strange and is deliberate: bitter and cold in a cup of aconite and dried ginger, it is there to keep the formula from being rejected by a stomach that has been vomiting, and the classical reasoning is that a touch of the opposite nature lets the whole be accepted. The same logic as the cold-steeped drugs in Aconite Heart-Draining Decoction.

Junggyeong 仲景

2.43 Spontaneous Diarrhoea in Shaoyin Disease 少陰病自利

2.43.1

Source원문

傷寒下利ㆍ心下痞硬, 服瀉心湯後以他藥下之, 利不止; 與理中湯, 利益甚. 理中者, 理中焦; 此利在下焦, 赤石脂禹餘粮湯主之. 《仲景》

Translation영역

In cold damage with diarrhoea and stuffy hardness below the heart: after taking a Heart-Draining Decoction he was purged with another medicine and the diarrhoea would not stop; Regulate the Middle Decoction was given and the diarrhoea grew still worse. Regulating the middle regulates the middle burner; this diarrhoea is in the lower burner, and Halloysite and Limonite Decoction governs it.

Junggyeong 仲景

2.43.2

Source원문

少陰病下利便膿血, 桃花湯主之. 《仲景》

Translation영역

In shaoyin disease with diarrhoea passing pus and blood, Peach Blossom Decoction governs it.

Junggyeong 仲景

2.43.3

Source원문

少陰病至四五日ㆍ腹滿痛ㆍ小便利ㆍ或下利ㆍ或嘔者, 宜眞武湯. 《仲景》

Translation영역

In shaoyin disease reaching the fourth or fifth day, with abdominal fullness and pain, the urine passing freely, and either diarrhoea or retching, True Warrior Decoction is apt.

Junggyeong 仲景

2.43.4

Source원문

下利欲飮水者, 以有熱故也, 宜白頭翁湯. 《仲景》

Translation영역

Where there is diarrhoea with a wish to drink water, it is because heat is present, and Pulsatilla Decoction is apt.

Junggyeong 仲景

2.43.5

Source원문

少陰病熱利不止, 三黃熟艾湯及薤白湯主之. 《仲景》

Translation영역

In shaoyin disease where heat diarrhoea will not stop, Three Yellows and Cooked Mugwort Decoction and Allium Decoction govern it.

Junggyeong 仲景

2.43.6

Source원문

少陰病自利純靑水ㆍ心下痛ㆍ口燥乾者, 宜大承氣湯. 《仲景》

Translation영역

In shaoyin disease with spontaneous diarrhoea of pure green water, pain below the heart and a dry parched mouth, Major Order the Qi Decoction is apt.

Junggyeong 仲景

2.43.7

Source원문

少陰證下利辨色: 靑者當下, 色不靑者當溫. 《東垣》

Translation영역

Distinguishing the shaoyin pattern by the colour of the diarrhoea: where it is green it should be purged; where the colour is not green it should be warmed.

Clinical note임상 주석

The first passage is a case of two successive errors corrected by localization, and the reasoning is admirably plain: 理中者, 理中焦 — regulating the middle regulates the middle burner, and this diarrhoea is not there. Halloysite and limonite are both mineral astringents that act low in the bowel, and they are given because the problem has been correctly placed rather than because they are stronger. Li Dongyuan's colour rule at the end pairs with his mouth rule in 2.40 and does the same job: a single quick observation that settles whether to warm or to purge in a situation where both are plausible. Green watery stool with a dry mouth he reads as heat driving fluid through, and the Bogam prints Major Order the Qi for it in a section otherwise full of warming and astringing formulas. That juxtaposition is characteristic of the shaoyin, where the same channel produces both the coldest and the hottest patterns in the chapter.

Dongwon 東垣

2.44 The Shaoyin Frigid Extremities Pattern Has Two Kinds 少陰四逆證有二

2.44.1

Source원문

少陰病四逆, 或咳ㆍ或悸ㆍ或小便不利ㆍ或腹中痛ㆍ或泄利下重, 宜四逆散.

Translation영역

In shaoyin disease with frigid extremities, and either cough, or palpitation, or inhibited urination, or pain within the abdomen, or diarrhoea with a heavy sensation below, Frigid Extremities Powder is apt.

Uihak Immun 入門

2.44.2

Source원문

邪熱入深則手足漸冷, 此熱厥似陰之證, 宜服四逆散. 《入門》

Translation영역

Where the evil heat enters deep, the hands and feet grow cold by degrees; this is a heat reversal resembling a yin pattern, and Frigid Extremities Powder should be taken.

Uihak Immun 入門

2.44.3

Source원문

傷寒直中陰經, 初來無頭痛ㆍ無身熱ㆍ無渴ㆍ怕寒ㆍ踡卧ㆍ沉重欲眠ㆍ唇靑ㆍ厥冷ㆍ脉微而欲絶或脉伏, 宜四逆湯. 四逆者, 四肢逆冷也. 《仲景》

Translation영역

Where cold damage strikes straight into a yin channel, at its first coming there is no headache, no generalized fever, no thirst, but fear of cold, lying curled up, heaviness with a wish to sleep, blue lips, reversal cold, and a faint pulse on the point of being severed or a hidden pulse; Frigid Extremities Decoction is apt. Frigid extremities means reversal cold of the four limbs.

Clinical note임상 주석

Two patients with cold hands and feet and opposite causes, and the section exists to keep them apart. In the first, heat has gone deep and the cold extremities are peripheral vasoconstriction in a febrile patient — a heat reversal resembling a yin pattern, as the Immun says plainly — and the formula is a cooling, freeing one. In the second, cold has struck a yin channel directly and there was never any fever at all. The discriminating signs for the second are all negatives: no headache, no fever, no thirst. 初來, at its first coming, is the key qualifier — this patient was never hot, so there is no heat to have gone inward. Together with the entries for the three Frigid Extremities formulas, this is the chapter's most sustained piece of differential reasoning, and it is built on asking what the patient looked like at the start rather than on what they look like now.

Junggyeong 仲景

2.45 Latent Qi with Throat Pain in Shaoyin Disease 少陰病伏氣咽痛

2.45.1

Source원문

伏氣之病, 謂非時有暴寒中人, 伏氣於少陰經, 始不覺病, 旬月乃發. 脉更微弱, 先發咽痛, 似傷寒非喉痺之病, 必下痢, 宜服半夏桂甘湯方見咽喉便差. 古方謂之腎傷寒. 《活人》

Translation영역

The disease of latent qi means that out of season a sudden cold strikes a man and the qi lies latent in the shaoyin channel; at first he does not notice the illness, and after ten days or a month it breaks out. The pulse is further faint and weak, throat pain comes first, and it resembles cold damage but is not the throat-impediment disease; he will certainly have diarrhoea. Pinellia, Cinnamon Twig and Licorice Decoction should be taken the formula appears in the Throat chapter and he recovers. The old formularies call it kidney cold damage.

Hwarinseo 活人

2.45.2

Source원문

少陰下利ㆍ咽痛ㆍ胸滿ㆍ心煩, 猪膚湯主之. 《仲景》

Translation영역

In shaoyin disease with diarrhoea, throat pain, chest fullness and vexation of the heart, Pig's Skin Decoction governs it.

Junggyeong 仲景

2.45.3

Source원문

少陰病二三日咽痛, 可與甘草湯; 不差, 與桔梗湯. 《仲景》

Translation영역

In shaoyin disease on the second or third day with throat pain, Licorice Decoction may be given; if it does not resolve, give Platycodon Decoction.

Junggyeong 仲景

2.45.4

Source원문

少陰病咽中痛, 宜半夏散. 《仲景》

Translation영역

In shaoyin disease with pain within the throat, Pinellia Powder is apt.

Clinical note임상 주석

腎傷寒 — kidney cold damage — is the old name, and the pattern it describes is specific and recognizable: a sore throat with diarrhoea and a weak pulse, in a patient who was chilled weeks earlier and thought nothing of it. 似傷寒非喉痺之病 distinguishes it from the acute throat obstruction of the Throat chapter, which has none of the systemic features. A pharyngitis with diarrhoea in a run-down patient is still a picture one meets. The escalation through the last three passages is worth noting for its restraint: licorice alone first, then licorice with platycodon, then pinellia. A single-drug decoction as a first measure for a sore throat is not a gesture — licorice has real demulcent and anti-inflammatory activity — and the willingness to start there and escalate only on failure is better practice than the chapter usually shows.

Junggyeong 仲景

2.46 The Prohibitions in Shaoyin Disease 少陰病禁忌

2.46.1

Source원문

少陰病脉細沉數, 病爲在裏, 不可發汗. 《仲景》

Translation영역

In shaoyin disease with a fine, deep and rapid pulse, the disease is in the interior and may not be sweated.

Junggyeong 仲景

2.46.2

Source원문

少陰病但厥ㆍ無汗而强發之, 必動其血, 未知從何道來: 或從口鼻, 或從目出, 是名下厥上竭, 爲難治也. 《仲景》

Translation영역

In shaoyin disease with only reversal and no sweat, if a sweat is forced, it will certainly stir the blood, and there is no knowing by which road it will come: either from the mouth and nose, or out of the eyes. This is named reversal below and exhaustion above, and it is hard to treat.

Clinical note임상 주석

下厥上竭 — reversal below and exhaustion above — is the name for what happens when a shaoyin patient is sweated, and the description is of bleeding from the mucous membranes at sites the physician cannot predict. 未知從何道來, no knowing by which road it will come, is the honest part: the bleeding is diffuse and not localizable, which is what disseminated coagulopathy looks like. Whether forced sweating causes it is another question, and the mechanism the passage implies — fluid driven out of a depleted patient until the vessels fail — is at least the right shape. 爲難治也, hard to treat, is the chapter's standard phrase for a complication it has no answer to, and it is used sparingly enough to mean something.

Junggyeong 仲景

2.47 The Jueyin — Signs and Medicines 厥陰形證用藥

2.47.1

Source원문

厥陰心包絡爲標, 故舌卷ㆍ厥逆ㆍ冷過肘膝ㆍ小腹絞痛, 三味參萸湯ㆍ四順湯主之; 肝爲本, 故男則囊縮ㆍ女則乳縮ㆍ手足乍冷乍溫ㆍ煩滿者, 大承氣湯主之. 《入門》

Translation영역

For the jueyin, the pericardium is the branch, and so there is a curled tongue, reversal, cold passing beyond the elbows and knees, and gripping pain of the lower abdomen, which Three Flavours Ginseng and Evodia Decoction and Four Obediences Decoction govern; the liver is the root, and so in a man the scrotum retracts and in a woman the breasts retract, the hands and feet are now cold and now warm, and there is vexing fullness, which Major Order the Qi Decoction governs.

Uihak Immun 入門

2.47.2

Source원문

厥陰之爲病, 消渴ㆍ氣上衝心ㆍ心中疼熱ㆍ飢不欲食ㆍ食則吐蚘. 《活人》

Translation영역

The jueyin becoming diseased is wasting thirst, qi surging up against the heart, pain and heat within the heart, hunger with no wish to eat, and vomiting roundworms on eating.

Hwarinseo 活人

2.47.3

Source원문

傷寒六七日ㆍ煩滿ㆍ囊縮, 其脉尺寸俱微緩者, 足厥陰肝經受病也. 其脉微浮爲欲愈, 不浮爲難愈. 脉浮緩者必囊不縮, 外證必發熱ㆍ惡寒似瘧, 爲欲愈, 宜桂枝麻黃各半湯. 方見上若尺寸俱沉短者, 必是囊縮ㆍ毒氣入腹, 宜承氣湯下之. 《活人》

Translation영역

In cold damage on the sixth or seventh day with vexing fullness and the scrotum retracted, and both the cubit and inch pulses faint and moderate, the foot jueyin liver channel has received the disease. If the pulse is faintly floating he is about to heal; if it is not floating he will heal with difficulty. Where the pulse is floating and moderate the scrotum will certainly not be retracted, and the external signs will certainly be fever and aversion to cold resembling malaria — he is about to heal, and Cinnamon Twig and Ephedra Half-and-Half Decoction is apt. The formula appears above. But if both cubit and inch are deep and short, the scrotum is certainly retracted and the toxic qi has entered the abdomen, and an Order the Qi Decoction should be used to purge it.

Hwarinseo 活人

2.47.4

Source원문

大抵傷寒病藏府傳變, 陽經先受病, 故次傳入陰經. 以陽主生, 故太陽水傳足陽明土, 土傳足少陽木, 爲微邪也; 陰主殺, 故木傳足太陰土, 土傳足少陰水, 水傳足厥陰木. 至六七日當傳厥陰肝木, 必移氣剋於脾土; 脾再受邪, 則五藏六府皆因而危殆, 榮衛不通ㆍ耳聾ㆍ囊縮ㆍ不知人而死. 速用承氣湯下之, 可保五生一死. 《活人》

Translation영역

Broadly, in the passing over and changing of cold damage disease through the viscera and bowels, the yang channels receive the disease first and so it passes next into the yin channels. Since the yang governs generation, the taiyang water passes to the foot yangming earth and the earth to the foot shaoyang wood, and the evil is slight; since the yin governs killing, the wood passes to the foot taiyin earth, the earth to the foot shaoyin water, and the water to the foot jueyin wood. By the sixth or seventh day it should pass to the jueyin liver wood, and it will certainly shift its qi to overwhelm the spleen earth; and once the spleen receives the evil a second time, the five viscera and six bowels are all thereby imperilled, the nutritive and defensive do not communicate, there is deafness, the scrotum retracted, no recognition of people, and he dies. Use an Order the Qi Decoction quickly to purge it, and five may be preserved alive to one dead.

Hwarinseo 活人

2.47.5

Source원문

若第六七日傳厥陰, 脉得微緩ㆍ微浮, 爲脾胃脉也, 故知脾氣全不受剋, 邪無所容. 否極泰來, 榮衛將復, 水升火降, 則寒熱作而大汗解矣. 《活人》

Translation영역

But if on the sixth or seventh day it passes to the jueyin and the pulse is got faintly moderate and faintly floating, this is a spleen and stomach pulse, and so one knows the spleen qi is wholly unoverwhelmed and the evil has nowhere to lodge. Obstruction at its height gives way to peace, the nutritive and defensive are about to recover, water ascends and fire descends, and then chill and fever arise and a great sweat resolves it.

Clinical note임상 주석

Zhu Gong's long argument in the last three passages rests on a single prognostic reading: at day six or seven, a faintly floating or moderate pulse is a spleen-and-stomach pulse and means the middle burner has held, while a deep short pulse means it has not. Everything else — the five-phase chain of transmissions, the claim of five saved to one lost — is built on that one observation, and the observation is a reasonable one: a patient a week into a severe fever whose pulse has body left is in a different position from one whose pulse has gone deep and short. 囊縮, the retracted scrotum, is the jueyin's signature sign and appears in the Neijing's day-six description in 2.6. Scrotal retraction in a severely dehydrated, cold, shocked patient is a real finding, and the Bogam treats it throughout as a near-terminal one. The parallel sign in women, retracted breasts, is the Immun's addition and is less convincing. 食則吐蚘 — vomiting roundworms on eating — in the second passage is the jueyin's other classic sign and the origin of the whole 蚘厥 discussion at 2.60. Ascaris was endemic and vomiting a worm in a febrile illness was a common enough event to become a diagnostic criterion.

Hwarinseo 活人

2.48 Reversal Cold of the Hands and Feet in Jueyin Disease 厥陰病手足厥冷

2.48.1

Source원문

凡厥者, 陰陽氣不相順接, 便爲厥. 厥者, 手足逆冷是也. 《仲景》

Translation영역

In all reversal, the yin and yang qi do not join smoothly one to the other, and that is reversal. Reversal means reversal cold of the hands and feet.

Junggyeong 仲景

2.48.2

Source원문

若始得之手足便厥冷不溫者, 是陰經受邪, 可用四逆湯溫之. 若手足自熱而至溫ㆍ從四逆而至厥者, 傳經之邪也, 可用四逆散. 方並見上必須識此, 勿令誤也. 《明理》

Translation영역

If from the first getting of it the hands and feet are at once cold with reversal and not warm, the yin channel has received the evil, and Frigid Extremities Decoction may be used to warm it. If the hands and feet pass of themselves from hot to warm, and from frigid to reversal, it is an evil that has passed through the channels, and Frigid Extremities Powder may be used. Both formulas appear above. This must be recognized, and no error allowed.

Myeongni 明理

2.48.3

Source원문

諸手足逆冷皆屬厥陰, 不可汗下. 然有須汗ㆍ須下者, 謂手足雖逆冷ㆍ時有溫時ㆍ手足掌心必煖, 非正厥逆, 當消息之. 《活人》

Translation영역

All reversal cold of the hands and feet belongs to the jueyin and may not be sweated or purged. Yet there are cases that must be sweated or must be purged, namely where the hands and feet, though cold with reversal, have times of warmth and the palms and soles are certainly warm; this is not true reversal, and it should be weighed out.

Clinical note임상 주석

The palms and soles are the test, and it is a good one. In true reversal the whole extremity is cold; where the palm still feels warm under a cold hand, the circulation has not failed and the cold is a sign of heat trapped deep rather than yang lost. 非正厥逆, not true reversal, licenses the sweating or purging that the blanket prohibition forbids. 必須識此, 勿令誤也 — this must be recognized, and no error allowed — is the Myeongni being as emphatic as this literature gets, and with reason: the two patterns look identical at the bedside and take opposite treatment. The history is what separates them, which is why the passage asks what the hands were like at the start.

Hwarinseo 活人

2.49 Vexing Fullness and Retracted Scrotum in Jueyin Disease 厥陰病煩滿囊縮

2.49.1

Source원문

厥陰證手足厥冷ㆍ小腹痛ㆍ煩滿ㆍ囊縮ㆍ脉微欲絶, 宜當歸四逆湯. 《仲景》

Translation영역

In the jueyin pattern with reversal cold of the hands and feet, lower abdominal pain, vexing fullness, the scrotum retracted and a faint pulse on the point of being severed, Tangkuei Frigid Extremities Decoction is apt.

Junggyeong 仲景

2.49.2

Source원문

傷寒六七日ㆍ尺寸脉微緩者, 厥陰受病也. 其證小腹煩滿而囊縮, 宜用承氣湯下之. 《仲景》

Translation영역

In cold damage on the sixth or seventh day with the cubit and inch pulses faint and moderate, the jueyin has received the disease. Its signs are vexing fullness of the lower abdomen with the scrotum retracted, and an Order the Qi Decoction should be used to purge it.

Clinical note임상 주석

Two passages and two opposite formulas for the same named signs, printed without comment — one of the places where the Bogam's method of gathering rather than adjudicating leaves real work for the reader. The difference has to be the pulse: faint and on the point of being severed takes the warming formula, faint and moderate takes the purgative. 微緩 has body to it where 微欲絶 does not, and 2.47 has already established that a moderate pulse at day six or seven means the middle burner has held. Read together with 2.47's last passage, the logic becomes clear enough to act on: the retracted scrotum is a sign of the jueyin and not by itself a sign of collapse, and whether to warm or to purge depends on whether there is any reserve left to purge with.

Junggyeong 仲景

2.50 The Yang Pattern of Cold Damage 傷寒陽證

2.50.1

Source원문

凡仲景稱太陽病者, 皆表證發熱ㆍ惡寒ㆍ頭項痛也. 若脉大則與證相應, 宜發汗; 若脉反微ㆍ不與證相應, 則不可發汗, 但用一二各半湯和之可也. 《綱目》

Translation영역

Wherever Zhongjing speaks of taiyang disease, it is in every case the exterior signs of fever, aversion to cold and pain of the head and nape. If the pulse is large it corresponds with the signs and sweating is apt; but if the pulse is faint instead and does not correspond with the signs, sweating may not be induced, and one or other of the half-and-half decoctions may be used to harmonize it.

Uihak Gangmok 綱目

2.50.2

Source원문

少陰身雖有熱而無頭痛; 厥陰有頭痛而無身熱. 若身熱而又頭痛, 屬陽證無疑矣. 《活人》

Translation영역

In the shaoyin, though the body has heat there is no headache; in the jueyin there is headache but no generalized fever. If there is generalized fever and headache as well, it belongs to a yang pattern beyond doubt.

Hwarinseo 活人

2.50.3

Source원문

陽證似陰, 糞黑而脉滑. 《得效》

Translation영역

A yang pattern resembling a yin one: the stool is black and the pulse slippery.

Deukhyobang 得效

2.50.4

Source원문

身大熱ㆍ反不欲近衣, 此爲表寒裏熱, 屬陽證, 宜陽旦湯. 《入門》

Translation영역

The body greatly hot and yet not wishing to come near clothing: this is cold in the exterior and heat in the interior, belongs to a yang pattern, and Yang Daybreak Decoction is apt.

Uihak Immun 入門

2.50.5

Source원문

陽證宜汗: 冬月麻黃湯ㆍ桂枝湯, 虛者人參順氣散方見風門, 三時羌活衝和湯. 《入門》

Translation영역

A yang pattern should be sweated: in the winter months Ephedra Decoction or Cinnamon Twig Decoction, for the depleted Ginseng Normalize Qi Powder the formula appears in the Wind chapter, and in the other three seasons Notopterygium Harmonizing Decoction.

Uihak Immun 入門

2.50.6

Source원문

陽證頭痛ㆍ身熱ㆍ脉浮數, 宜香蘇散ㆍ芎芷香蘇散ㆍ人參羌活散方見風門ㆍ參蘇飮ㆍ十神湯. 方見瘟疫

Translation영역

For a yang pattern with headache, generalized fever and a floating rapid pulse, Cyperus and Perilla Powder, Chuanxiong, Angelica and Cyperus and Perilla Powder, Ginseng and Notopterygium Powder the formula appears in the Wind chapter, Ginseng and Perilla Drink and Ten Spirits Decoction are apt. The formula appears in the Epidemics chapter.

Clinical note임상 주석

Zhu Gong's two-line differential in the second passage is as compact as the chapter gets and worth memorizing: shaoyin has fever without headache, jueyin has headache without fever, and both together mean a yang pattern. Three signs, two questions, and the whole six-channel location is narrowed. 身大熱反不欲近衣 — greatly hot and yet unwilling to come near clothing — is a patient who feels cold while running a high temperature, and the Immun reads it as cold outside with heat inside. Yang Daybreak Decoction is Cinnamon Twig with scutellaria added, which treats exactly that split. The companion case, hot and wanting the covers on, appears in the next section with the mirror formula. The pulse-signs mismatch in the first passage is the same problem the Major Dragon answered in 2.14, and the Gangmok's answer is the same: when the pulse does not corroborate the symptoms, neither of the two main formulas fits and a half-and-half is the safer move.

Uihak Immun 入門

2.51 The Yin Pattern of Cold Damage 傷寒陰證

2.51.1

Source원문

凡傷寒四肢厥冷ㆍ吐利ㆍ不渴ㆍ靜踡, 此陰證之常也. 須察其脉有力無力: 如重按無力或無脉, 便是伏陰, 急與五積散加附子; 如脉有力, 是陽證也, 不可不辨. 《入門》

Translation영역

In cold damage with reversal cold of the four limbs, vomiting and diarrhoea, no thirst and lying quietly curled up, this is the ordinary form of a yin pattern. One must examine whether the pulse has strength or not: if on pressing hard it has no strength, or there is no pulse, this is latent yin, and Five Accumulations Powder with aconite added should be given urgently; if the pulse has strength, it is a yang pattern, and the distinction must be made.

Uihak Immun 入門

2.51.2

Source원문

三陰經血分自受寒, 謂之陰證傷寒. 微者, 寒邪外襲ㆍ漸入經絡, 宜麻黃附子細辛湯或辛黃三白湯; 甚者, 卒中陰經ㆍ初起無頭痛ㆍ身熱ㆍ便惡寒ㆍ厥冷, 或胸腹痛ㆍ嘔吐ㆍ下利: 太陰用附子理中湯, 少陰用附子湯, 厥陰用當歸四逆湯. 《入門》

Translation영역

Where the blood aspect of the three yin channels receives cold of itself, this is called yin-pattern cold damage. In the mild case the cold evil assails from outside and gradually enters the channels and network vessels, and Ephedra, Aconite and Asarum Decoction or Asarum, Ephedra and Three Whites Decoction is apt. In the severe case it strikes the yin channel suddenly: at its first arising there is no headache and no generalized fever but at once aversion to cold and reversal cold, or chest and abdominal pain, vomiting and diarrhoea. For the taiyin use Aconite Regulate the Middle Decoction; for the shaoyin, Aconite Decoction; for the jueyin, Tangkuei Frigid Extremities Decoction.

Uihak Immun 入門

2.51.3

Source원문

傷寒有口沃白沫ㆍ或唾多ㆍ流冷涎, 俱是寒證, 宜吳茱萸湯ㆍ理中湯, 切忌冷藥. 《醫鑑》

Translation영역

In cold damage, where the mouth brims with white froth, or there is much spitting, or cold drool runs out, these are all cold patterns, and Evodia Decoction or Regulate the Middle Decoction is apt; cold medicines are strictly to be shunned.

Gogeum Uigam 醫鑑

2.51.4

Source원문

傷寒陰證, 宜陰旦湯ㆍ人參養胃湯ㆍ藿香正氣散ㆍ不換金正氣散ㆍ正陽散.

Translation영역

For the yin pattern of cold damage, Yin Daybreak Decoction, Ginseng Nourish the Stomach Decoction, Agastache Qi-Rectifying Powder, Priceless Rectify the Qi Powder and Upright Yang Powder are apt.

Uihak Immun 入門

2.51.5

Source원문

陰證似陽, 面赤而脉微. 《入門》

Translation영역

A yin pattern resembling a yang one: the face is red and the pulse faint.

Clinical note임상 주석

須察其脉有力無力 — one must examine whether the pulse has strength or not — with the instruction to press hard, is the most practical sentence in the section. Cold limbs, vomiting, diarrhoea and no thirst look like a yin pattern, and usually are; but the same picture occurs in a heat reversal, and the only reliable discriminator is whether there is force under the finger. The chapter has said this in several ways by now and says it again because it is the error that kills people here. The two 似 lines are the matched pair that the chapter builds four sections on at 2.65 through 2.67. A yang pattern resembling a yin one has black stool and a slippery pulse; a yin pattern resembling a yang one has a red face and a faint pulse. In both the pulse is the arbiter and the appearance is the trap. 口沃白沫 — the mouth brimming with white froth — is a good observation and belongs with cold rather than heat: thin clear saliva in quantity, as against the thick yellow sputum of a heat pattern. 切忌冷藥, cold medicines strictly to be shunned, is the Uigam being blunt about a case that will be made worse by the obvious treatment.

Uihak Immun 入門

2.52 The Exterior Pattern of Cold Damage 傷寒表證

2.52.1

Source원문

凡傷寒初得病二三日ㆍ頭痛ㆍ身體痛ㆍ惡寒ㆍ發熱, 皆表證也. 《局方》

Translation영역

Wherever cold damage is newly got, on the second or third day, with headache, aching of the body, aversion to cold and fever, these are all exterior signs.

Gukbang 局方

2.52.2

Source원문

凡仲景稱太陽病者, 皆表證發熱ㆍ惡寒ㆍ頭項痛也. 《綱目》

Translation영역

Wherever Zhongjing speaks of taiyang disease, it is in every case the exterior signs of fever, aversion to cold and pain of the head and nape.

Uihak Gangmok 綱目

2.52.3

Source원문

發熱ㆍ惡寒ㆍ身體痛而脉浮者, 表證也. 表證者, 惡寒是也. 惡寒屬太陽, 宜汗之. 《活人》

Translation영역

Fever, aversion to cold, aching of the body and a floating pulse: this is an exterior pattern. The exterior pattern is aversion to cold. Aversion to cold belongs to the taiyang, and it should be sweated.

Hwarinseo 活人

2.52.4

Source원문

項强几几, 爲太陽表證. 几音殊, 如短羽鳥不能飛騰, 動先伸引其頭也; 項背强者, 動亦如之. 一云無翅鳥欲飛貌. 《明理》

Translation영역

The nape stiff and drawn up is a taiyang exterior sign. Gi 几 is pronounced su, and is like a short-feathered bird that cannot fly up: when it moves it first stretches out its head. One whose nape and back are stiff moves in the same way. Another account says it is the look of a wingless bird trying to fly.

Myeongni 明理

2.52.5

Source원문

傷寒表證通用麻黃杏仁飮; 寒傷榮宜麻黃湯, 風傷衛宜桂枝湯, 三時發表宜九味羌活湯. 《入門》

Translation영역

For the exterior pattern of cold damage, Ephedra and Apricot Kernel Drink serves generally; where cold has damaged the nutritive, Ephedra Decoction is apt; where wind has damaged the defensive, Cinnamon Twig Decoction; and for bringing out the exterior in the other three seasons, Nine-Ingredient Notopterygium Decoction.

Uihak Immun 入門

2.52.6

Source원문

表證宜香蘇散ㆍ十神湯ㆍ人參敗毒散ㆍ香葛湯ㆍ葱白散ㆍ參蘇飮ㆍ芎芷香蘇散ㆍ小靑龍湯ㆍ神朮散ㆍ消風百解散.

Translation영역

For an exterior pattern, Cyperus and Perilla Powder, Ten Spirits Decoction, Ginseng Overcome Toxin Powder, Cyperus and Pueraria Decoction, Scallion White Powder, Ginseng and Perilla Drink, Chuanxiong, Angelica and Cyperus and Perilla Powder, Minor Blue-Green Dragon Decoction, Spirit Atractylodes Powder and Disperse Wind and Resolve a Hundred Powder are apt.

Uihak Immun 入門

2.52.7

Source원문

表證無汗宜羌活衝和湯, 有汗宜防風衝和湯. 方見下表裏不解宜雙解散. 《河間》

Translation영역

For an exterior pattern with no sweat, Notopterygium Harmonizing Decoction is apt; with sweat, Saposhnikovia Harmonizing Decoction. The formula appears below. Where neither exterior nor interior resolves, Double Resolution Powder is apt.

Clinical note임상 주석

表證者, 惡寒是也 — the exterior pattern is aversion to cold — reduces the diagnosis to one sign, and it is the right one to choose: fever occurs at every level, body ache at several, but aversion to cold is specific to the exterior and is lost the moment the disease crosses into the yangming, as 2.20 says. 项强几几 and the gloss on it are the most charming passage in the chapter and also useful. The Myeongni explains a rare graph by describing a short-feathered bird that stretches its neck out before it can move, and a patient with a stiff neck and back who moves the same way. That is meningism, or at least the guarded head-forward posture of severe neck stiffness, and the image conveys it better than a clinical term would. The last passage gives the practical rule the whole section exists for: no sweat takes Notopterygium Harmonizing, sweat takes Saposhnikovia Harmonizing. Both are Nine-Ingredient Notopterygium under different names or with small adjustments, and the choice between them turns on the same question as the Ephedra and Cinnamon Twig fork.

Hagan 河間

2.53 The Interior Pattern of Cold Damage 傷寒裏證

2.53.1

Source원문

傷寒裏熱者, 若火熏蒸ㆍ自內達表, 惟下之一法而已. 《入門》

Translation영역

Where there is interior heat in cold damage, it is as though fire were fuming and steaming from within outward to the exterior, and there is only the one method of purging.

Uihak Immun 入門

2.53.2

Source원문

發熱ㆍ汗出ㆍ不惡寒ㆍ反惡熱, 乃陽明裏證也, 宜下之.

Translation영역

Fever, sweating, no aversion to cold but rather aversion to heat: this is the yangming interior pattern, and it should be purged.

Myeongni 明理

2.53.3

Source원문

陽明爲病, 胃家實也. 胃實則潮熱ㆍ譫語, 承氣湯下之. 《明理》

Translation영역

The yangming becoming diseased is the stomach being replete. Where the stomach is replete there is tidal fever and delirious speech, and an Order the Qi Decoction should be used to purge it.

Myeongni 明理

2.53.4

Source원문

陽明病潮熱ㆍ不大便六七日, 恐有燥屎. 欲知之法, 少與小承氣湯: 轉屎氣者, 有燥屎, 可攻; 若不轉屎氣者, 無燥屎, 愼不可攻也. 若攻之, 必脹滿ㆍ不能食. 《仲景》

Translation영역

In yangming disease with tidal fever and no stool for six or seven days, there may be dry faeces. The method of finding out is to give a little Minor Order the Qi Decoction: if the wind of the stool turns, there are dry faeces and it may be attacked; but if the wind of the stool does not turn, there are no dry faeces, and with care it may not be attacked. If it is attacked, there will certainly be distending fullness and inability to eat.

Junggyeong 仲景

2.53.5

Source원문

發熱ㆍ汗出ㆍ不惡寒ㆍ反惡熱者屬裏, 卽陽明證也. 發汗後不惡寒ㆍ但惡熱者, 胃實也, 宜調胃承氣湯. 《仲景》

Translation영역

Fever, sweating, no aversion to cold but rather aversion to heat belongs to the interior; this is the yangming pattern. Where after sweating there is no aversion to cold but only aversion to heat, the stomach is replete, and Regulate the Stomach and Order the Qi Decoction is apt.

Junggyeong 仲景

2.53.6

Source원문

大柴胡ㆍ三承氣, 攻熱邪傳裏. 《丹心》

Translation영역

Major Bupleurum and the three Order the Qi formulas attack a heat evil that has passed into the interior.

Dansim 丹心

2.53.7

Source원문

下藥: 大承氣最緊, 小承氣次之, 調胃承氣又次之, 大柴胡湯又次之. 《東垣》

Translation영역

Among the purging medicines, Major Order the Qi is the most urgent, Minor Order the Qi next, Regulate the Stomach and Order the Qi next again, and Major Bupleurum Decoction next after that.

Dongwon 東垣

2.53.8

Source원문

如不惡寒ㆍ反惡熱ㆍ發渴ㆍ譫語ㆍ腹滿而喘ㆍ手足濈然汗出, 急下之, 宜大承氣湯. 如邪未深ㆍ恐有燥屎ㆍ小腹痛, 宜用小承氣微和胃氣, 勿令大泄. 如不惡寒但實者, 當和胃氣, 調胃承氣主之. 《東垣》

Translation영역

Where there is no aversion to cold but rather aversion to heat, thirst arising, delirious speech, abdominal fullness with panting, and the hands and feet sweating continuously, purge it urgently, and Major Order the Qi Decoction is apt. Where the evil is not yet deep, there may be dry faeces and the lower abdomen pains, Minor Order the Qi should be used to harmonize the stomach qi slightly and not allowed to cause a great outpouring. Where there is no aversion to cold but only repletion, the stomach qi should be harmonized, and Regulate the Stomach and Order the Qi governs it.

Dongwon 東垣

2.53.9

Source원문

已上三法不可差, 差則無者生之ㆍ有者遺之. 假令調胃承氣證用大承氣, 則愈後元氣不復, 以其氣藥犯之; 若大承氣證用調胃承氣, 則愈後神痴不淸, 以其無氣藥也; 小承氣湯證用大承氣, 則下利不止ㆍ變而成虛. 後人合三藥爲一方, 號爲三一承氣, 殊失仲景本意. 《綱目》

Translation영역

In the above three methods there may be no mistaking, for if there is, what is absent is generated and what is present is left behind. Suppose that in a Regulate the Stomach and Order the Qi case Major Order the Qi is used: then after recovery the original qi does not return, because the qi-moving drugs have transgressed against him. If in a Major Order the Qi case Regulate the Stomach and Order the Qi is used, then after recovery the spirit is dulled and unclear, because it has no qi-moving drugs. If in a Minor Order the Qi case Major Order the Qi is used, the diarrhoea does not stop and it turns into a depletion. Later men combined the three medicines into one formula and called it Three-in-One Order the Qi, which quite loses Zhongjing's original intent.

Uihak Gangmok 綱目

2.53.10

Source원문

裏證宜下, 通用三一承氣湯ㆍ六一順氣湯ㆍ陶氏黃龍湯.

Translation영역

An interior pattern should be purged, and Three-in-One Order the Qi Decoction, Six-to-One Normalize the Qi Decoction and Tao's Yellow Dragon Decoction serve generally.

Clinical note임상 주석

The test in the fourth passage is the best thing in this section and one of the few genuine diagnostic trials in classical practice: give a small dose of the milder purgative and see whether the patient passes wind. 轉屎氣 — the wind of the stool turning — means there is something to move and the stronger formula is justified; no wind means there is not, and the stronger formula would cause harm. A therapeutic trial used as a diagnostic, with a clear endpoint and a clear decision rule, is a sophisticated piece of method. The Gangmok's passage on mismatching the three formulas names a specific sequela for each error, and the specificity is what makes it worth reading. Too strong a purgative leaves the patient's qi unrecovered after cure; too weak a one leaves the spirit dull; using Major where Minor was indicated turns a repletion into a depletion. Whether those are the actual consequences is unverifiable; that someone tried to track the long-term outcome of getting the dose wrong is not nothing. 殊失仲景本意 — quite loses Zhongjing's original intent — is the Gangmok's verdict on Three-in-One Order the Qi, and the Bogam then prints Three-in-One among the general purgatives two passages later. The compilers record the criticism and the practice both, which is their method, and a reader should take the criticism seriously: a formula that merges three graded prescriptions discards the grading the section has just spent a page establishing.

Uihak Immun 入門

2.54 The Half-Exterior Half-Interior Pattern of Cold Damage 傷寒半表半裏證

2.54.1

Source원문

半表裏極難識. 有言身前後者, 有言身上下者, 有言太陽ㆍ陽明之間者. 身後爲太陽, 身前爲陽明, 少陽居中, 寒熱莫定, 此以身之前後而言也, 小柴胡湯主少陽之半表裏也. 膀胱寒水近陽明燥金, 水多則寒ㆍ燥多則熱, 亦往來寒熱, 五苓散分利膀胱之半表裏也. 理中湯治吐瀉不定, 上下之半表裏也. 《入門》

Translation영역

The half-exterior and half-interior is extremely hard to recognize. Some speak of the front and back of the body, some of above and below, some of the space between the taiyang and the yangming. The back of the body is taiyang and the front is yangming, with the shaoyang lying in the middle and the chill and fever not fixed: this is speaking of the front and back of the body, and Minor Bupleurum Decoction governs the half-exterior and half-interior of the shaoyang. The bladder's cold water lies near the yangming's dry metal, and where the water predominates there is cold and where the dryness predominates there is heat, so that here too chill and fever come and go; Five-Ingredient Poria Powder separates and disinhibits the half-exterior and half-interior of the bladder. Regulate the Middle Decoction treats vomiting and diarrhoea that are not fixed, the half-exterior and half-interior of above and below.

Uihak Immun 入門

2.54.2

Source원문

發熱ㆍ脉弦細ㆍ頭痛者, 屬半表半裏, 卽少陽證也. 《仲景》

Translation영역

Fever with a stringlike fine pulse and headache belongs to the half-exterior and half-interior; this is the shaoyang pattern.

Junggyeong 仲景

2.54.3

Source원문

傷寒表證當汗ㆍ裏證當下, 不易之法也. 然而假令脉浮而大, 是表證當汗; 又發熱ㆍ煩渴ㆍ小便赤, 却當下. 此表裏俱見, 雙解散主之. 《河間》

Translation영역

In cold damage an exterior pattern should be sweated and an interior pattern purged; this is an unchanging rule. Yet suppose the pulse is floating and large — that is an exterior pattern and should be sweated; and there is also fever, vexing thirst and dark urine, which instead should be purged. Here exterior and interior appear together, and Double Resolution Powder governs it.

Hagan 河間

2.54.4

Source원문

假令不大便六七日ㆍ頭痛ㆍ身熱, 是裏證; 又小便淸, 知不在裏ㆍ因在表, 須當發汗. 此兩證俱見, 宜桂枝湯. 《河間》

Translation영역

Suppose there is no stool for six or seven days with headache and generalized fever — that is an interior pattern; and yet the urine is clear, from which one knows it is not in the interior but in the exterior, and a sweat must be raised. Here the two patterns appear together, and Cinnamon Twig Decoction is apt.

Hagan 河間

2.54.5

Source원문

假令心下滿ㆍ口不欲食ㆍ大便硬ㆍ脉沉數, 是裏證當下; 又頭汗出ㆍ微惡寒ㆍ手足冷, 却當汗. 此半在表半在裏也, 小柴胡湯主之. 《河間》

Translation영역

Suppose there is fullness below the heart, no wish for food, hard stool and a deep rapid pulse — that is an interior pattern and should be purged; and yet the head sweats, there is slight aversion to cold and the hands and feet are cold, which instead should be sweated. This is half in the exterior and half in the interior, and Minor Bupleurum Decoction governs it.

Hagan 河間

2.54.6

Source원문

治表裏內外俱熱之證: 表者或脉浮ㆍ或頭痛ㆍ或惡風ㆍ或惡寒; 裏者或譫言妄語ㆍ或揚手擲足. 欲汗則裏證已急, 欲下則表證尙存, 通宜大柴胡湯. 《海藏》

Translation영역

To treat the pattern in which exterior and interior, inside and outside, are all hot: for the exterior there may be a floating pulse, or headache, or aversion to wind, or aversion to cold; for the interior there may be delirious and wild speech, or flinging up the hands and throwing out the feet. If one would sweat, the interior pattern is already urgent; if one would purge, the exterior pattern is still present; and Major Bupleurum Decoction serves generally.

Haejang 海藏

2.54.7

Source원문

傷寒須分表裏. 若表裏不分ㆍ汗下差誤, 豈爲上工. 且如均是發熱: 身熱不渴, 爲表有熱, 小柴胡加桂枝主之; 厥而脉滑, 爲裏有熱, 白虎湯加人參主之.

Translation영역

In cold damage the exterior and interior must be distinguished. If exterior and interior are not distinguished and sweating and purging are mistaken for each other, how shall one be a superior workman? Thus where the fever is the same in both: generalized fever without thirst is heat in the exterior, and Minor Bupleurum with cinnamon twig added governs it; reversal with a slippery pulse is heat in the interior, and White Tiger Decoction with ginseng added governs it.

Haejang 海藏

2.54.8

Source원문

均是水氣: 乾嘔ㆍ微利ㆍ發熱而咳, 爲表有水, 小靑龍湯主之; 身凉ㆍ表證罷ㆍ咳而脇下痛, 爲裏有水, 十棗湯主之.

Translation영역

Where the water qi is the same in both: dry retching, slight diarrhoea, fever and cough is water in the exterior, and Minor Blue-Green Dragon Decoction governs it; the body cool, the exterior pattern finished, cough with pain below the rib-side is water in the interior, and Ten Jujubes Decoction governs it.

Haejang 海藏

2.54.9

Source원문

均是惡寒: 有熱而惡寒者, 發於陽也, 麻黃ㆍ桂枝ㆍ小柴胡主之; 無熱而惡寒者, 發於陰也, 附子湯ㆍ四逆湯主之.

Translation영역

Where the aversion to cold is the same in both: aversion to cold with heat arises from the yang, and Ephedra, Cinnamon Twig and Minor Bupleurum govern it; aversion to cold without heat arises from the yin, and Aconite Decoction and Frigid Extremities Decoction govern it.

Haejang 海藏

2.54.10

Source원문

均是身體痛: 脉浮ㆍ發熱ㆍ頭痛ㆍ身體痛者, 爲表未解, 麻黃湯主之; 脉沉ㆍ自利ㆍ身體痛者, 爲裏不和, 四逆湯主之. 《海藏》

Translation영역

Where the body ache is the same in both: a floating pulse with fever, headache and aching of the body is the exterior not yet resolved, and Ephedra Decoction governs it; a deep pulse with spontaneous diarrhoea and aching of the body is the interior not harmonized, and Frigid Extremities Decoction governs it.

Clinical note임상 주석

Haejang's four 均是 pairs are the best piece of teaching in the whole chapter and deserve to be read as a set. Each takes a symptom that occurs at both levels — fever, water, aversion to cold, body ache — and gives the one additional finding that locates it. Fever without thirst is exterior; fever with reversal and a slippery pulse is interior. Water with cough and fever is exterior; water with cough and a cool body is interior. Aversion to cold with heat is yang; without heat is yin. Body ache with a floating pulse is exterior; with a deep pulse and diarrhoea is interior. Four symptoms, eight patterns, and in every case the discriminator is a second finding rather than a refinement of the first. 豈爲上工 — how shall one be a superior workman — is the challenge, and the method he offers to meet it is simply never to act on one sign alone. Liu Wansu's three 假令 cases in the middle do something different and equally valuable: each presents a patient whose findings point both ways, and names the formula that treats both. The third is the subtlest — hard stool and a deep rapid pulse pulling one way, head sweating and cold extremities pulling the other — and the answer is Minor Bupleurum, which commits to neither. That is the shaoyang principle arrived at from the clinic rather than from the channel theory.

Haejang 海藏

2.55 Yin Reversal in Cold Damage 傷寒陰厥

2.55.1

Source원문

厥者, 手足逆冷是也. 其手足指頭微寒者, 謂之淸, 此疾爲輕. 《活人》

Translation영역

Reversal means reversal cold of the hands and feet. Where only the tips of the fingers and toes are slightly cold, this is called coolness, and the ailment is light.

Hwarinseo 活人

2.55.2

Source원문

陰厥者, 初得病便四肢逆冷ㆍ脉沉微而不數ㆍ足多攣ㆍ卧時惡寒ㆍ或引衣自覆ㆍ不飮水ㆍ或下利淸穀ㆍ或淸便自調, 外證多惺惺而靜, 宜四逆湯ㆍ通脉四逆湯ㆍ當歸四逆湯. 《活人》

Translation영역

In yin reversal, from the first getting of the disease the four limbs are at once cold with reversal, the pulse deep and faint and not rapid, the feet often hypertonic, there is aversion to cold when lying down, or he draws the clothes over himself, does not drink water, or has diarrhoea of clear undigested grain, or the stool is clear and regular of itself; and in the external signs he is mostly alert and quiet. Frigid Extremities Decoction, Free the Vessels Frigid Extremities Decoction and Tangkuei Frigid Extremities Decoction are apt.

Hwarinseo 活人

2.55.3

Source원문

陰厥者, 無頭痛ㆍ無身熱ㆍ吐利ㆍ不渴ㆍ靜踡而卧ㆍ手足盡冷, 乃厥陰所主, 陰陽之氣不相接連而然. 太陰厥, 手足指頭微冷者, 理中湯; 少陰厥, 脛寒ㆍ足冷, 甚則手至臂ㆍ足至膝者, 四逆湯; 厥陰厥, 一身盡冷者, 當歸四逆湯. 厥逆ㆍ煩燥者不治. 《入門》

Translation영역

In yin reversal there is no headache, no generalized fever, vomiting and diarrhoea, no thirst, lying quietly curled up, and the hands and feet wholly cold; this is governed by the jueyin, and it is because the yin and yang qi do not join one to the other. In taiyin reversal, where only the tips of the fingers and toes are slightly cold, Regulate the Middle Decoction; in shaoyin reversal, with the shins cold and the feet cold, and in the severe case the hands cold up to the forearm and the feet up to the knee, Frigid Extremities Decoction; in jueyin reversal, with the whole body wholly cold, Tangkuei Frigid Extremities Decoction. Reversal with vexing agitation is not treatable.

Uihak Immun 入門

2.55.4

Source원문

小便數ㆍ微惡寒者, 陽氣不足也; 心煩ㆍ足踡者, 陰氣不足也. 《入門》

Translation영역

Frequent urination with slight aversion to cold is insufficiency of the yang qi; vexation of the heart with the feet drawn up is insufficiency of the yin qi.

Uihak Immun 入門

2.55.5

Source원문

厥陰證四肢厥冷ㆍ脉沉遲ㆍ按之無力, 則爲陰, 當溫之, 宜四逆湯. 《海藏》

Translation영역

In the jueyin pattern with reversal cold of the four limbs and a deep slow pulse that has no strength when pressed, it is yin and should be warmed; Frigid Extremities Decoction is apt.

Haejang 海藏

2.55.6

Source원문

陰厥, 指爪常冷ㆍ足踡卧ㆍ不渴ㆍ淸便如常, 外證惺惺. 《得效》

Translation영역

In yin reversal the fingernails are constantly cold, the feet drawn up in lying, there is no thirst, the stool is clear as usual, and in the external signs he is alert.

Clinical note임상 주석

The staged reading of how far up the cold has gone — fingertips only, hands to the forearm and feet to the knee, the whole body — maps directly onto three levels and three formulas, and it is a usable bedside grading of severity. In a patient losing peripheral perfusion, the level at which the skin turns cold does track how far the circulation has failed, and treating the extent of the coldness as a measure of depth is sound. 外證惺惺 — alert in the external signs — is repeated in two of the passages and is the single best discriminator from the heat reversal of the next section, where the patient is clouded. A cold, curled-up, quiet but mentally clear patient is in yin reversal; a cold patient who is confused has heat trapped inside. One look at the face settles it. 厥逆煩燥者不治 is the chapter's blunt prognosis: reversal with agitation means both the circulation and the mind have gone, and the Immun offers nothing. Section 2.59 names the same picture 藏厥 and says Zhongjing had no method for it either.

Deukhyobang 得效

2.56 Yang Reversal in Cold Damage 傷寒陽厥

2.56.1

Source원문

陽厥者, 初得病必身熱ㆍ頭痛ㆍ外有陽證, 至四五日方發厥. 厥至半日却身熱, 蓋熱氣深方能發厥; 若微厥却發熱者, 熱深故也. 其脉雖伏, 按之滑者爲裏熱, 或飮水ㆍ或揚手擲足ㆍ或煩燥不得眠ㆍ大便秘ㆍ小便赤, 外證多昏憒; 承氣湯ㆍ白虎湯隨證用之. 《活人》

Translation영역

In yang reversal, at the first getting of the disease there is certainly generalized fever, headache and yang signs outside, and only on the fourth or fifth day does the reversal arise. The reversal lasts half a day and then the body is hot again, for only when the heat qi is deep can reversal arise; and where the reversal is slight and fever follows, it is because the heat is deep. Though the pulse is hidden, if it is slippery on pressing it is interior heat; and there may be drinking of water, or flinging up the hands and throwing out the feet, or vexing agitation with sleeplessness, the stool stopped and the urine dark, and in the external signs he is mostly clouded and confused. An Order the Qi Decoction or White Tiger Decoction is used according to the pattern.

Hwarinseo 活人

2.56.2

Source원문

下證悉具而見四逆者, 是因失下ㆍ血氣不通ㆍ四肢便厥. 醫不識, 疑爲陰厥, 便進熱藥, 禍如反掌. 大抵熱厥須脉沉伏而滑者, 手雖冷ㆍ時復指爪溫, 須承氣湯下之. 《活人》

Translation영역

Where all the signs for purging are present and frigid extremities appear as well, it is because the purge was missed, the blood and qi do not flow freely, and the four limbs are thereby reversed. The physician does not recognize it, suspects a yin reversal and gives hot medicines at once, and the disaster is as quick as turning the hand. Broadly, in heat reversal the pulse must be deep and hidden and slippery, and although the hand is cold, from time to time the fingernails are warm again; an Order the Qi Decoction must be used to purge it.

Hwarinseo 活人

2.56.3

Source원문

厥陰證四肢逆冷ㆍ爪甲靑ㆍ脉沉疾ㆍ按之有力, 則爲陽, 當下之, 宜大承氣. 《海藏》

Translation영역

In the jueyin pattern with reversal cold of the four limbs, blue nails, and a deep swift pulse that has strength when pressed, it is yang and should be purged; Major Order the Qi is apt.

Haejang 海藏

2.56.4

Source원문

陽厥者, 未厥前有頭痛ㆍ有身熱, 陽邪深入ㆍ陷伏於內而後發厥; 微厥半日間却又發熱. 熱氣下行則腹痛ㆍ下利ㆍ或便膿血; 若不便血, 則熱氣上行, 必爲喉痺. 《入門》

Translation영역

In yang reversal, before the reversal there is headache and generalized fever; the yang evil enters deep and falls hidden within, and only then does the reversal arise, and after half a day of slight reversal there is fever again. If the heat qi moves downward there is abdominal pain, diarrhoea or the passing of pus and blood; and if the blood is not passed, the heat qi moves upward and there will certainly be throat impediment.

Uihak Immun 入門

2.56.5

Source원문

傷寒邪在三陽, 則四肢熱; 半表裏及太陰, 則邪漸入內, 故四肢溫; 至少陰ㆍ厥陰, 邪入深而陷伏於內, 則四肢厥冷. 然先由熱後厥者, 傳經熱厥也: 輕則四逆散, 重則大柴胡ㆍ承氣湯下之. 《入門》

Translation영역

In cold damage, while the evil is in the three yang the four limbs are hot; in the half-exterior half-interior and reaching the taiyin, the evil gradually enters within and so the four limbs are warm; reaching the shaoyin and jueyin, the evil enters deep and falls hidden within, and then the four limbs are cold with reversal. But where heat comes first and reversal after, it is a channel-passing heat reversal: in the light case Frigid Extremities Powder, in the heavy case Major Bupleurum or an Order the Qi Decoction to purge it.

Uihak Immun 入門

2.56.6

Source원문

熱厥脉沉伏而滑ㆍ頭上有汗ㆍ手掌溫ㆍ指梢亦溫, 便宜下. 《入門》

Translation영역

In heat reversal the pulse is deep and hidden and slippery, there is sweat on the head, the palm is warm and the fingertips also warm; it should be purged at once.

Clinical note임상 주석

禍如反掌 — the disaster is as quick as turning the hand — is Zhu Gong on what happens when a heat reversal is given aconite, and the whole section is built around preventing that error. Four discriminators are offered and all four are easy to check: the history (was there fever first?), the pulse on pressure (slippery and forceful, not weak), the palm and fingertips (warm under cold skin), and the mental state (clouded, not alert). The sequence described is physiologically coherent. A patient with high fever and deep infection develops peripheral vasoconstriction, so the extremities go cold while the core stays hot; the cold lasts hours and the fever reasserts itself. 熱氣深方能發厥 — only when the heat qi is deep can reversal arise — is a correct inference drawn backwards from the observation that the sickest patients are the ones whose hands go cold. 失下 in the second passage is the specific error: the purge was indicated and was not given, and the reversal is the consequence. That makes this a section about an iatrogenic complication as much as a diagnostic one, which is consistent with the rest of the chapter.

Uihak Immun 入門

2.57 The Severity of Yin and Yang Reversal 陰陽厥輕重

2.57.1

Source원문

傷寒至四五日而厥者, 必發熱. 前熱者後必厥; 厥深者熱亦深, 厥微者熱亦微. 《仲景》

Translation영역

In cold damage, one who reverses by the fourth or fifth day will certainly have fever. Where heat comes first, reversal must follow after; where the reversal is deep the heat is also deep, and where the reversal is slight the heat is also slight.

Junggyeong 仲景

2.57.2

Source원문

傷寒厥四日ㆍ熱反三日ㆍ復厥五日, 其病爲進. 厥多熱少, 陽氣退, 故爲進也. 《仲景》

Translation영역

In cold damage with four days of reversal, then three days of fever instead, then five days of reversal again, the disease is advancing. Much reversal and little heat means the yang qi is retreating, and so it is advancing.

Junggyeong 仲景

2.57.3

Source원문

傷寒發熱四日ㆍ厥反三日, 厥少熱多, 其病當自愈. 《仲景》

Translation영역

In cold damage with four days of fever and then three days of reversal instead, the reversal being little and the heat much, the disease should heal of itself.

Junggyeong 仲景

2.57.4

Source원문

傷寒病厥五日ㆍ熱亦五日, 設六日當復厥; 不厥者自愈. 厥終不過五日, 以熱五日, 故知自愈. 《仲景》

Translation영역

In cold damage disease with five days of reversal and five days of fever as well, on the sixth day the reversal ought to return; if it does not, he heals of himself. The reversal in the end does not exceed five days, and because the heat was five days, one knows he heals of himself.

Junggyeong 仲景

2.57.5

Source원문

熱多厥少者易愈, 厥多熱少者難已. 《入門》

Translation영역

Where the heat is much and the reversal little he heals easily; where the reversal is much and the heat little it is hard to bring to an end.

Clinical note임상 주석

Counting the days of reversal against the days of fever is the simplest prognostic instrument in the chapter, and the principle behind it is sound: whether a patient is improving or deteriorating is better judged from the trend than from any single day's findings. More fever than cold means the body is still mounting a response; more cold than fever means it is not. 厥深者熱亦深 inverts the intuitive reading and is the reason the whole heat-reversal concept hangs together. Deeper coldness of the extremities means deeper heat inside, not less of it. Anyone who has felt the ice-cold hands of a patient in septic shock while the core temperature climbs will recognize what is being described, and the inference the Shanghanlun draws from it — that the cold hands are a measure of the heat and not a contradiction of it — is correct.

Uihak Immun 入門

2.58 The Method of Distinguishing Yin and Yang Reversal 辨陰陽厥法

2.58.1

Source원문

陰陽二厥, 脉皆沉, 所以使人疑之. 然陰厥脉沉遲而弱, 陽厥脉沉伏而滑. 又陽厥指爪時一溫, 陰厥常冷. 《得效》

Translation영역

In the two reversals, yin and yang, the pulse is deep in both, and this is what makes people doubtful of them. Yet in yin reversal the pulse is deep, slow and weak, and in yang reversal deep, hidden and slippery. And further, in yang reversal the fingernails are warm from time to time, while in yin reversal they are constantly cold.

Deukhyobang 得效

2.58.2

Source원문

若未辨陰陽, 且與理中湯試之: 陽厥則便熱, 陰厥則不熱. 《得效》

Translation영역

If yin and yang are not yet distinguished, give Regulate the Middle Decoction as a trial: in yang reversal he will at once become hot, and in yin reversal he will not.

Clinical note임상 주석

The second passage is a therapeutic trial used as a diagnostic test, like the small dose of Minor Order the Qi in 2.53, and it is the better of the two: Regulate the Middle is a warming formula with no aconite in it, so giving it to a heat reversal produces an immediate flush of heat that reveals the error without doing great harm, while giving Frigid Extremities Decoction to the same patient would be the disaster of 2.56. Choosing the mild warming formula as the probe rather than the strong one is the whole point, and the Deukhyobang does not spell it out. The three discriminators in the first passage — slow and weak against hidden and slippery, and the intermittently warm nail — are the same ones the previous two sections gave. The chapter has now stated this differential four times in four sections, which is a fair measure of how often it was got wrong.

Deukhyobang 得效

2.59 Reversal Includes Visceral Reversal and Roundworm Reversal 厥有藏厥蚘厥

2.59.1

Source원문

躁無暫定而厥者, 爲藏厥. 《活人》

Translation영역

Where there is agitation with no moment of settling, together with reversal, it is visceral reversal.

Hwarinseo 活人

2.59.2

Source원문

藏厥者, 發躁無休息時, 且發熱七八日ㆍ脉微ㆍ膚冷而躁, 或吐或瀉ㆍ無時暫安者, 乃厥陰眞藏氣盡, 故曰藏厥. 仲景無治法, 四逆湯冷飮救之. 又少陰厥而吐利ㆍ發躁亦不治, 三味參萸湯救之. 《入門》

Translation영역

In visceral reversal the agitation arises with no time of rest, and there is fever for seven or eight days, a faint pulse, cold skin with agitation, and either vomiting or diarrhoea with no moment of ease; this is the true visceral qi of the jueyin exhausted, and so it is called visceral reversal. Zhongjing has no method of treatment; Frigid Extremities Decoction taken cold may rescue it. Again, shaoyin reversal with vomiting and diarrhoea and agitation arising is also not treatable, and Three Flavours Ginseng and Evodia Decoction may rescue it.

Uihak Immun 入門

2.59.3

Source원문

靜而復煩ㆍ吐虫而厥者, 爲蚘厥. 詳見虫門《活人》

Translation영역

Where the patient is quiet and then vexed again, vomits worms and reverses, it is roundworm reversal. Treated in detail in the Worms chapter.

Clinical note임상 주석

四逆湯冷飮 — Frigid Extremities Decoction taken cold — is the strangest instruction in the chapter and the most interesting. A hot, warming formula given cold to a patient who is cold and agitated. The classical reasoning is that a patient this far gone will reject anything hot, so the drug must be disguised as its opposite to get past the stomach; the same principle as the pig's bile in 2.42. Whether or not that is how it works, giving a vomiting patient a cold drink is more likely to stay down than a hot one. 仲景無治法 and 亦不治, printed twice in one short section, are the chapter admitting defeat. Visceral reversal — a week of fever, faint pulse, cold skin, ceaseless agitation, vomiting or diarrhoea without respite — is multi-organ failure, and the Bogam's two rescue formulas are offered as attempts rather than treatments. The honesty is worth more than a confident prescription would be. Roundworm reversal gets one line and a cross-reference, which is proportionate: it is the one reversal in this group with a treatable cause, and the Worms chapter has the formulas.

Hwarinseo 活人

2.60 Reversal and Frigid Extremities Are Not the Same 厥與四逆不同

2.60.1

Source원문

四逆者, 四肢不溫也; 厥者, 手足逆冷也. 傷寒邪在三陽則手足必熱; 傳到太陰, 手足自溫; 至少陰則邪熱漸深, 故四肢逆而不溫; 及至厥陰, 則手足厥冷, 是又甚於逆. 其四逆散凉藥, 以治四肢不溫; 其四逆湯熱藥, 以治寒極而成逆厥者也. 四肢通冷, 比之手足獨冷則有間. 夫死者以四逆言之, 可治者以厥冷言, 則亦可見四逆與手足厥冷之有輕重淺深矣. 蓋四肢通冷, 其病爲重; 手足獨冷, 其病爲輕也. 四肢與手足却有所分: 以四字加於逆字之上, 是通指手足ㆍ臂脛以上言也; 以手足二字加於厥逆ㆍ厥冷之上, 是獨指手足言也. 蓋以四逆爲四肢通冷, 厥爲手足獨冷也. 《東垣》

Translation영역

Frigid extremities means the four limbs are not warm; reversal means reversal cold of the hands and feet. In cold damage, while the evil is in the three yang the hands and feet are certainly hot; when it passes to the taiyin the hands and feet are warm of themselves; reaching the shaoyin the evil heat grows gradually deeper, and so the four limbs are reversed and not warm; and reaching the jueyin the hands and feet are cold with reversal, which is more severe again than reversal. Frigid Extremities Powder, being a cooling medicine, treats the four limbs not being warm; Frigid Extremities Decoction, being a hot medicine, treats the one in whom cold at its extreme has made a reversal. The four limbs cold throughout, compared with the hands and feet cold alone, has a space between them. Now where the patient dies it is spoken of as frigid extremities, and where he can be treated it is spoken of as reversal cold, from which too one may see that frigid extremities and reversal cold of the hands and feet have their light and heavy, shallow and deep. For the four limbs cold throughout is a heavy disease, and the hands and feet cold alone a light one. The four limbs and the hands and feet are moreover to be divided: putting the character for four above the character for reversal refers to the hands and feet together with the forearms and shins and above; putting the two characters for hands and feet above reversal or reversal cold refers to the hands and feet alone. For frigid extremities is the four limbs cold throughout, and reversal is the hands and feet cold alone.

Clinical note임상 주석

A whole section on the meaning of two terms, and it is not pedantry: the two words name different extents of the same finding, and the formulas named after them do opposite things. 四逆 is cold up the forearm and shin and is the graver; 厥 is cold of the hands and feet alone and is the lighter. That is a real distinction and it corresponds to how far proximally the perfusion has failed. The complication is that the names of the formulas do not follow the rule. Frigid Extremities Powder is a cooling formula for the lighter finding, and Frigid Extremities Decoction a hot one for the graver — so the shared name 四逆 attaches to two opposite treatments, which is precisely why the chapter keeps returning to this differential. Li Dongyuan's point is that the terminology is unreliable and the extent of the coldness is not, so one should measure how far up the limb the cold reaches rather than trust the word a source happens to use.

Dongwon 東垣

2.61 Yin Toxin in Cold Damage 傷寒陰毒

2.61.1

Source원문

傷寒三陰病深, 必變爲陰毒. 其證四肢厥冷ㆍ吐利ㆍ不渴ㆍ靜踡而卧, 甚則咽痛ㆍ鄭聲, 加以頭痛ㆍ頭汗ㆍ眼睛內痛ㆍ不欲見光ㆍ面唇指甲靑黑ㆍ手背冷汗ㆍ心下結梗ㆍ臍腹築痛ㆍ身如被杖ㆍ外腎氷冷, 其脉附骨取之則有ㆍ按之則無. 宜甘草湯ㆍ正陽散; 陽氣乍復或生煩躁者, 返陰丹ㆍ復陽丹用之. 不可凉藥. 《入門》

Translation영역

In cold damage, where the three yin disease is deep, it must turn into yin toxin. Its signs are reversal cold of the four limbs, vomiting and diarrhoea, no thirst and lying quietly curled up; and in the severe case throat pain and a faint repeating voice, with headache, sweating of the head, pain within the eyeballs, no wish to see the light, the face and lips and nails blue-black, cold sweat on the backs of the hands, a bound hardness below the heart, a pounding pain of the navel and abdomen, the body as though beaten with a stick, and the external genitals ice-cold; and as for the pulse, taken right against the bone it is there, and on pressing it is not. Licorice Decoction and Upright Yang Powder are apt; where the yang qi suddenly returns and vexing agitation arises, Returning Yin Elixir and Restore the Yang Elixir are used. Cooling medicines may not be given.

Uihak Immun 入門

2.61.2

Source원문

又此證面靑ㆍ舌黑ㆍ四肢厥冷ㆍ多睡. 《入門》

Translation영역

Again, in this pattern the face is blue, the tongue black, the four limbs cold with reversal, and there is much sleeping.

Uihak Immun 入門

2.61.3

Source원문

積陰感於下則微陽消於上, 故其候四肢沉重ㆍ逆冷ㆍ腹痛ㆍ咽喉不利, 或心下脹滿結硬ㆍ燥渴ㆍ虛汗不止, 或時狂言ㆍ爪甲面色靑黑ㆍ六脉沉細而一息七至以來. 速於氣海ㆍ關元各灸二三百壯, 以手足溫煖爲效, 仍服還陽散ㆍ退陰散. 《本事》

Translation영역

Where accumulated yin is contracted below, the slight yang is extinguished above, and so the signs are heaviness of the four limbs, reversal cold, abdominal pain and difficulty of the throat; or distending fullness below the heart with a bound hardness, parched thirst and depletion sweating that will not stop; or at times wild speech, with the nails and the colour of the face blue-black and all six pulses deep and fine at seven beats to a breath and more. Moxa quickly at Qihai and Guanyuan, two or three hundred cones at each, taking the hands and feet growing warm as the effect, and then give Return the Yang Powder and Retreat the Yin Powder.

Bonsa 本事

2.61.4

Source원문

陰毒沉困之候, 六脉附骨取之方有ㆍ按之卽無, 一息八至已上ㆍ或不可數. 至此則藥餌難爲功矣, 宜灸臍下二三百壯, 更以還陽散等熱藥助之. 如手足不和煖者, 不可治. 《本事》

Translation영역

In the signs of yin toxin with sinking exhaustion, all six pulses are there only when taken right against the bone and are gone the moment they are pressed, at eight beats to a breath and above, or beyond counting. Once it has come to this, medicines can hardly be made to work; moxa below the navel, two or three hundred cones, and further assist it with hot medicines such as Return the Yang Powder. If the hands and feet do not become warm, it is not treatable.

Bonsa 本事

2.61.5

Source원문

傷寒陰毒之病, 面靑ㆍ身痛如被杖ㆍ咽喉痛, 五日可治, 七日不可治, 甘草湯主之. 《仲景》

Translation영역

In the disease of yin toxin in cold damage, with a blue face, the body aching as though beaten with a stick, and throat pain, at five days it may be treated and at seven days it may not; Licorice Decoction governs it.

Junggyeong 仲景

2.61.6

Source원문

陰毒宜用正陽散ㆍ附子散ㆍ白朮散ㆍ回陽救急湯ㆍ熨臍法.

Translation영역

For yin toxin, Upright Yang Powder, Aconite Powder, Atractylodes Powder, Restore the Yang and Rescue the Urgent Decoction and the Navel-Ironing Method should be used.

Uihak Immun 入門

2.61.7

Source원문

一人傷寒四肢逆冷ㆍ臍下築痛ㆍ身疼如被杖, 蓋陰毒也. 急服金液丹ㆍ來復丹方並見下等藥, 其脉遂沉而滑. 證雖陰而有陽脉, 可生; 仍灸臍下百壯, 乃手足溫ㆍ陽回ㆍ得汗而解. 《本事》

Translation영역

A man had cold damage with reversal cold of the four limbs, a pounding pain below the navel and the body aching as though beaten with a stick — this was yin toxin. Golden Liquid Elixir and Come-Again Elixir both formulas appear below and such medicines were given urgently, and his pulse then became deep and slippery. Though the pattern was yin, there was a yang pulse, and he could live; moxa was then given below the navel, a hundred cones, and the hands and feet grew warm, the yang returned, sweat was got and it resolved.

Clinical note임상 주석

The pulse description is the most precise in the chapter and the most useful: 附骨取之則有, 按之則無 — taken right against the bone it is there, and on pressing it is gone. That is a thready, barely palpable pulse that disappears under any pressure, which is what one feels in profound hypotension. With a rate of seven or eight to a breath, that is a rate above 120 with almost no volume, and the Bonsa's judgment that medicines can hardly be made to work at that point is correct. 身如被杖 — the body as though beaten with a stick — is the phrase the whole yin toxin description turns on and it recurs three times. Deep generalized aching with blue-black extremities and an ice-cold scrotum is a recognizable picture of peripheral circulatory failure, and the Bogam treats it as the gravest condition in the chapter. The treatment is moxibustion first and medicine second, which is unusual: two or three hundred cones at Qihai CV-6 and Guanyuan CV-4, with the hands and feet growing warm as the endpoint. That is a measurable endpoint for a physical intervention and a more honest instruction than any of the mineral elixirs offered alongside it. Golden Liquid Elixir and Come-Again Elixir are sulphur and mercury preparations and their entries carry the warnings they require; they are not to be made. 如手足不和煖者不可治 — if the hands and feet do not grow warm, it is not treatable — is the chapter's prognostic rule for this condition, and it is a response-to-treatment criterion rather than a presenting sign, which makes it the better kind of prognosis.

Bonsa 本事

2.62 Yang Toxin in Cold Damage 傷寒陽毒

2.62.1

Source원문

傷寒三陽病深, 必變爲陽毒; 或有失於汗下, 或本陽證誤投熱藥, 使熱毒入深, 發爲狂亂ㆍ面赤ㆍ眼紅ㆍ身發斑黃, 或下利黃赤ㆍ六脉洪大, 名曰陽毒發斑. 宜黑奴丸ㆍ白虎湯ㆍ三黃石膏湯ㆍ消斑靑黛飮. 方見皮部《醫鑑》

Translation영역

In cold damage, where the three yang disease is deep, it must turn into yang toxin; or the sweating or purging may have been missed, or hot medicines given in error in what was from the first a yang pattern, so that the heat toxin enters deep and breaks out as mania and disorder, a red face, red eyes, yellow macules erupting on the body, or diarrhoea of yellow and red, with all six pulses surging and large. This is named yang toxin with macules erupting. Black Slave Pill, White Tiger Decoction, Three Yellows and Gypsum Decoction and Disperse the Macules Indigo Drink are apt. The formula appears in the Skin chapter.

Gogeum Uigam 醫鑑

2.62.2

Source원문

陽毒爲病, 面赤斑斑如錦紋ㆍ咽喉痛ㆍ唾膿血, 五日可治, 七日不可治. 宜陽毒升麻湯ㆍ陽毒梔子湯ㆍ葛根湯, 外用水漬法. 《活人》

Translation영역

Yang toxin becoming a disease is a red face mottled like brocade, throat pain and spitting of pus and blood; at five days it may be treated and at seven days it may not. Yang Toxin Cimicifuga Decoction, Yang Toxin Gardenia Decoction and Pueraria Decoction are apt, and externally the Water-Soaking Method is used.

Hwarinseo 活人

2.62.3

Source원문

傷寒先觀兩目, 或赤或黃: 赤爲陽毒, 六脉洪大有力ㆍ燥渴者, 輕則三黃石膏湯ㆍ三黃巨勝湯, 重則大承氣湯下之. 《醫鑑》

Translation영역

In cold damage, look first at the two eyes, whether they are red or yellow: red is yang toxin, and where all six pulses are surging, large and forceful with parched thirst, in the light case Three Yellows and Gypsum Decoction or Three Yellows Great Victory Decoction, and in the heavy case Major Order the Qi Decoction to purge it.

Clinical note임상 주석

面赤斑斑如錦紋 — a red face mottled like brocade — is the best description of a petechial or purpuric rash in the classical literature, and with throat pain and the spitting of pus and blood the picture is a fulminant septicaemia. The five-day and seven-day prognosis matches the yin toxin section's and is the Shanghanlun's standard formulation for a condition with a narrow window. 失於汗下 or 誤投熱藥 as the two routes into yang toxin makes this another iatrogenic section: either the purge was missed or hot drugs were given to a hot patient. Taken together with 2.61, the chapter is saying that both toxin patterns are usually the result of mismanagement rather than of the disease taking its own course. 先觀兩目 — look first at the two eyes — is a good first move and still is. Red for yang toxin and yellow for jaundice, which the chapter has already dealt with at 2.39, and both are visible from the doorway. The Water-Soaking Method appended to this section is physical cooling — wet cloth on the chest, changed scores of times a day — and is the one intervention here that a modern clinician would recognize without qualification.

Gogeum Uigam 醫鑑

2.63 Yin Exuberance Screening Off the Yang 陰盛隔陽

2.63.1

Source원문

傷寒陰盛隔陽, 其證身冷ㆍ反躁ㆍ欲投井中ㆍ唇靑ㆍ面黑ㆍ渴欲飮水復吐ㆍ大便自利黑水ㆍ六脉沉細而疾或無. 《入門》

Translation영역

In cold damage with yin exuberance screening off the yang, the signs are a cold body yet agitation, a wish to throw himself into a well, blue lips, a black face, thirst with a wish to drink water and then vomiting it back, spontaneous diarrhoea of black water, and all six pulses deep, fine and swift, or absent.

Uihak Immun 入門

2.63.2

Source원문

病人身冷ㆍ脉沉細而疾ㆍ煩躁而不飮水者, 陰盛隔陽也. 《活人》

Translation영역

Where the sick man's body is cold, the pulse deep, fine and swift, and he is vexed and agitated but does not drink water, it is yin exuberance screening off the yang.

Hwarinseo 活人

2.63.3

Source원문

陰盛隔陽, 大虛證也. 身熱而脉不鼓擊, 或身冷而欲坐井中, 欲漱水而不入口, 非眞熱也. 宜霹靂散ㆍ回陽返本湯. 《入門》

Translation영역

Yin exuberance screening off the yang is a great depletion pattern. The body is hot and yet the pulse does not beat against the finger, or the body is cold and he wishes to sit in a well, or he wishes to rinse with water and does not take it into the mouth: this is not true heat. Thunderclap Powder and Restore the Yang and Return to the Root Decoction are apt.

Uihak Immun 入門

2.63.4

Source원문

一人患傷寒, 六脉沉伏不見, 深按至骨則若有力ㆍ頭疼ㆍ身溫ㆍ煩躁ㆍ指末皆冷ㆍ胸中滿ㆍ惡心, 醫皆不識. 許學士診之曰: 此陰中伏陽也. 仲景法中無此證. 若用熱藥則爲陰所隔ㆍ不能導引眞陽ㆍ反生客熱; 若用冷藥則眞火愈消. 須用破散陰氣ㆍ導達眞火之藥, 用破陰丹二百粒作一服, 冷鹽湯下. 不時煩躁ㆍ狂熱ㆍ手足躁擾, 許曰: 俗所謂換陽也. 須臾稍定, 略睡ㆍ汗出ㆍ身冷矣. 《本事》

Translation영역

A man suffered cold damage with all six pulses deep and hidden and not to be found, yet on pressing deep to the bone they seemed to have strength; with headache, a warm body, vexing agitation, the fingertips all cold, fullness in the chest and nausea; and the physicians all failed to recognize it. Xu the Academician examined him and said: this is yang lying hidden within the yin. There is no such pattern in Zhongjing's methods. If hot medicines are used they will be screened off by the yin and cannot lead out the true yang, and will generate guest heat instead; if cold medicines are used the true fire will be further extinguished. Medicines must be used that break up and scatter the yin qi and lead the true fire through. Two hundred pellets of Break the Yin Elixir were used as one dose, taken down in cold salt water. Before long there was vexing agitation, maniacal heat and restless thrashing of the hands and feet, and Xu said: this is what is commonly called the changing of the yang. In a little while it somewhat settled, he slept a little, sweat came out, and the body was cool.

Bonsa 本事

2.63.5

Source원문

若飮水者, 非此證也. 《活人》

Translation영역

If he drinks the water, it is not this pattern.

Clinical note임상 주석

欲漱水而不入口 — wishing to rinse with water and not taking it into the mouth — is the discriminator, and it is the same sign the chapter used for blood heat at 2.29, put to a different use here. A patient who asks for water and then will not drink it is not truly thirsty, and if he is not truly thirsty the agitation is not from heat. Zhu Gong's closing line makes it a decision rule: if he drinks, this is not the pattern. Xu Shuwei's case is the most interesting narrative in the chapter and the only place where a physician says outright that the Shanghanlun has no pattern for what he is looking at: 仲景法中無此證. His reasoning about why neither hot nor cold medicines will serve — hot will be screened off and generate false heat, cold will put out the remaining fire — is a genuine piece of clinical thinking rather than a citation, and it leads him to a third category of drug. 換陽, the changing of the yang, is the name he gives to the violent agitation that follows the dose and precedes the recovery, and it is worth noting that he predicted it and told the family. A treatment that makes a patient temporarily much worse before improving is one where that warning matters, and the record preserves both the prediction and the outcome.

Hwarinseo 活人

2.64 Yang Exuberance Repelling the Yin 陽盛拒陰

2.64.1

Source원문

傷寒陽盛拒陰, 其證身體厥冷ㆍ其脉滑數ㆍ按之鼓擊於指下, 非眞寒也, 此大熱證也. 脉數而身反盡寒, 宜三黃巨勝湯. 方見上

Translation영역

In cold damage with yang exuberance repelling the yin, the signs are a body cold with reversal and a pulse slippery and rapid that beats against the finger when pressed: this is not true cold but a pattern of great heat. Where the pulse is rapid and the body is instead wholly cold, Three Yellows Great Victory Decoction is apt. The formula appears above.

Clinical note임상 주석

The mirror of the previous section, and the pulse is again the arbiter: here it beats against the finger under pressure, where in yin exuberance it does not. 按之鼓擊於指下 is as clear a description of a forceful pulse as the literature gives, and it is the one finding that cannot be faked by a cold body. This is the fourth time in six sections that the chapter has said the same thing — that the surface appearance of hot and cold reverses in severe illness and the pulse must decide. Three Yellows Great Victory Decoction, given to a patient whose body is cold all over, is the most counter-intuitive prescription in the chapter and the clearest demonstration of how much weight the tradition put on that single finding.

Uihak Immun 入門

2.65 Yin at Its Extreme Resembling Yang 陰極似陽

2.65.1

Source원문

陽邪不深, 不能至于厥逆; 陰邪不甚, 不能至於煩躁. 此水極似火ㆍ火極似水, 謂之反化, 亢極則害之之義也. 陰證之極, 火浮於外ㆍ發躁擾亂ㆍ狀若陽證; 然身雖煩躁而引衣自覆, 口雖燥渴而漱水不下, 脉必沉細無力, 此陰極似陽也. 宜通脉四逆湯. 《入門》

Translation영역

Where the yang evil is not deep it cannot reach to reversal; where the yin evil is not severe it cannot reach to vexing agitation. This is water at its extreme resembling fire and fire at its extreme resembling water, which is called turning into the opposite, and is the meaning of the saying that what is carried to excess does harm. At the extreme of a yin pattern the fire floats to the outside, agitation arises with restlessness and disorder, and the form is like a yang pattern; yet though the body is vexed and agitated he draws the clothes over himself, and though the mouth is parched and thirsty he rinses with water and does not swallow it, and the pulse must be deep, fine and without strength. This is yin at its extreme resembling yang, and Free the Vessels Frigid Extremities Decoction is apt.

Uihak Immun 入門

2.65.2

Source원문

煩極而反發厥, 乃陰所致, 言熱極則反與陰盛發躁一同, 必以四逆湯ㆍ理中湯治之. 《入門》

Translation영역

Where vexation at its extreme brings on reversal instead, it is brought about by the yin; which is to say that heat at its extreme is the same thing as the agitation arising from exuberant yin, and it must be treated with Frigid Extremities Decoction or Regulate the Middle Decoction.

Clinical note임상 주석

亢極則害 — what is carried to excess does harm — is the Neijing's principle, and this section is its clinical application: at the extremes the signs invert, so a reading taken from the surface will be exactly wrong. Three findings are offered against the misleading appearance, and all three are easy: he pulls the covers over himself despite the agitation, he rinses without swallowing despite the thirst, and the pulse has no strength. Taken with 2.66, this pair is the chapter's conclusion on a question it has been circling since 2.2, where the six confusions were first listed. The answer it arrives at is that agitation and reversal are both non-specific — either extreme produces either sign — and only the pulse and the patient's own behaviour distinguish them. What the patient does with the blanket and the cup of water is more reliable than what they say about feeling hot or cold.

Uihak Immun 入門

2.66 Yang at Its Extreme Resembling Yin 陽極似陰

2.66.1

Source원문

陽證之極, 熱伏於內, 故身凉ㆍ四肢厥逆ㆍ狀若陰證; 但身雖冷而不欲近衣, 神雖昏而氣色光潤, 脉必沉滑而有力, 此陽極似陰也. 宜大柴胡湯或白虎湯. 《入門》

Translation영역

At the extreme of a yang pattern the heat lies hidden within, and so the body is cool, the four limbs cold with reversal, and the form is like a yin pattern; but though the body is cold he does not wish to come near clothing, and though the spirit is clouded the colour of his qi is bright and lustrous, and the pulse must be deep and slippery and forceful. This is yang at its extreme resembling yin, and Major Bupleurum Decoction or White Tiger Decoction is apt.

Uihak Immun 入門

2.66.2

Source원문

陰陽錯雜之證, 宜用從治法. 從治者, 反治也: 熱藥冷飮ㆍ冷藥熱飮, 或熱藥爲君而佐以凉藥, 或冷藥爲君而佐以熱劑, 是也. 《入門》

Translation영역

For patterns in which yin and yang are mixed and tangled, the method of following treatment should be used. Following treatment is treating by the contrary: hot medicines drunk cold and cold medicines drunk hot, or hot medicines as sovereign with cooling medicines as assistants, or cold medicines as sovereign with hot agents as assistants — this is it.

Clinical note임상 주석

氣色光潤 — the colour of the qi bright and lustrous — is the best of the three discriminators and the hardest to describe: a clouded patient whose skin still has lustre, as against the dull grey of a patient in true collapse. It is a real difference and experienced clinicians still read it, without having a better word for it than this one. 從治 in the second passage is the chapter's synthesis and the principle behind several of its strangest instructions: Frigid Extremities Decoction drunk cold at 2.59, pig's bile added to a warming formula at 2.42, the cold-steeped yellows with separately decocted aconite in Aconite Heart-Draining Decoction. In every case a drug is given in the guise of its opposite so that a body refusing one will accept the other. It is stated here as a general method, which is where it belongs — at the end of six sections about appearances that contradict reality.

Uihak Immun 入門

2.67 Miscellaneous Patterns of Cold Damage 傷寒雜證

2.67.1

Source원문

有頭痛ㆍ身痛ㆍ百節痛ㆍ惡寒ㆍ惡熱ㆍ往來寒熱ㆍ看面目舌色ㆍ合病ㆍ倂病ㆍ煩躁ㆍ戰慄ㆍ動悸ㆍ動氣等證.

Translation영역

There are such patterns as headache, generalized pain, pain in all the joints, aversion to cold, aversion to heat, alternating cold and heat, inspection of the face and eyes and the colour of the tongue, combination disease, overlapping disease, vexation and agitation, shivering, palpitation and stirring qi.

Clinical note임상 주석

A division heading rather than a section with content of its own. It marks the end of the chapter's systematic treatment by channel and pattern, and everything from here to the close of the upper part is arranged by symptom instead — headache and body ache, aversion to cold and heat, the colour of the face and tongue, agitation, shivering, palpitation and stirred qi.

Donguibogam · Hansang

2.68 Headache, Body Ache and Pain of All the Hundred Joints in Cold Damage 傷寒頭痛身疼百節痛

2.68.1

Source원문

傷寒頭痛ㆍ身疼ㆍ腰痛, 以至牽連百骨節俱痛, 此太陽傷寒ㆍ榮血不利故也. 《仲景》

Translation영역

In cold damage, headache, body ache and lumbar pain, going so far as to draw in all the hundred bones and joints so that they all hurt: this is taiyang cold damage, and it is because the nutritive blood does not flow freely.

Junggyeong 仲景

2.68.2

Source원문

傷寒頭痛, 知邪在經也; 不頭痛, 則知邪不在經也. 《海藏》

Translation영역

In cold damage, where there is headache one knows the evil is in the channel; where there is no headache, one knows the evil is not in the channel.

Haejang 海藏

2.68.3

Source원문

太陽之證, 頭痛ㆍ身熱ㆍ脊强. 《入門》

Translation영역

The signs of the taiyang are headache, generalized fever and stiffness of the spine.

Uihak Immun 入門

2.68.4

Source원문

三陽之病有頭痛, 三陰無頭痛; 惟厥陰與督脉會於頭巔, 故有頭痛. 《入門》

Translation영역

The diseases of the three yang have headache and the three yin have none; only the jueyin meets with the governing vessel at the crown of the head, and so it has headache.

Uihak Immun 入門

2.68.5

Source원문

風寒入肌ㆍ血脉凝滯, 所以身痛. 太陽身痛, 拘急而已; 少陽身痛, 必脇硬ㆍ嘔ㆍ渴; 少陰身痛, 下利ㆍ煩滿; 陰毒身痛, 宛如被杖. 《入門》

Translation영역

Wind-cold entering the flesh and the blood vessels congealing and stagnating is the reason for body ache. Taiyang body ache is hypertonic and no more; shaoyang body ache must have hard rib-sides, retching and thirst; shaoyin body ache has diarrhoea and vexing fullness; and the body ache of yin toxin is exactly as though he had been beaten with a stick.

Clinical note임상 주석

Haejang's rule is the usable one and it works in both directions: headache means the evil is in a channel, no headache means it is not. With the next passage's qualification — the three yin have no headache except the jueyin, which reaches the crown through the governing vessel — it becomes a two-step localization that 2.50 already used. The last passage grades the same symptom across four levels by what accompanies it rather than by its character, which is the method the chapter settled on at 2.54. Body ache alone and hypertonic is taiyang; with hard rib-sides it is shaoyang; with diarrhoea it is shaoyin; and as though beaten with a stick it is yin toxin, the gravest. The phrase from 2.61 reappears here for the fourth time in the chapter, which is how the compilers mark what matters.

Uihak Immun 入門

2.69 Aversion to Cold, Aversion to Heat, and Chill and Fever Coming and Going 惡寒惡熱往來寒熱

2.69.1

Source원문

傷寒之病, 邪之客於表者爲寒, 邪與陽相爭則爲寒矣; 邪之入於裏者爲熱, 邪與陰相爭則爲熱矣. 邪在半表半裏, 外與陽爭而爲寒ㆍ內與陰爭而爲熱, 是以往來寒熱, 宜小柴胡湯和解之. 《活人》

Translation영역

In the disease of cold damage, where the evil lodges in the exterior there is cold, for when the evil contends with the yang there is cold; where the evil enters the interior there is heat, for when the evil contends with the yin there is heat. Where the evil is in the half-exterior and half-interior, outwardly it contends with the yang and there is cold and inwardly with the yin and there is heat, and this is why the chill and fever come and go; Minor Bupleurum Decoction is apt to harmonize and resolve it.

Hwarinseo 活人

2.69.2

Source원문

病有發熱ㆍ惡寒者, 發於陽也; 無熱ㆍ惡寒者, 發於陰也. 發於陽者七日愈, 發於陰者六日愈, 以陽數七ㆍ陰數六故也. 《仲景》

Translation영역

Where the disease has fever with aversion to cold, it arises from the yang; where there is no fever but aversion to cold, it arises from the yin. What arises from the yang heals in seven days and what arises from the yin in six, because the number of yang is seven and of yin six.

Junggyeong 仲景

2.69.3

Source원문

陽微惡寒ㆍ陰微發熱; 寒多易愈, 熱多難愈. 《入門》

Translation영역

Where the yang is faint there is aversion to cold, and where the yin is faint there is fever; where the cold predominates it heals easily, and where the heat predominates it heals with difficulty.

Uihak Immun 入門

2.69.4

Source원문

發汗後病不解ㆍ反惡寒者, 虛也, 芍藥甘草湯主之. 《仲景》

Translation영역

Where after sweating the disease does not resolve and there is aversion to cold instead, it is depletion, and Peony and Licorice Decoction governs it.

Junggyeong 仲景

2.69.5

Source원문

惡風者, 見風至則惡矣, 必居密室之內ㆍ幃帳之中則坦然自舒; 惡寒者, 則不待風而自寒, 雖身大熱而不欲去衣者是也. 活人云: 惡寒者不當風而自憎寒, 惡風者當風而憎寒. 《綱目》

Translation영역

One averse to wind is averse as soon as he sees the wind come, and in a sealed room or within the bed curtains he is at ease of himself; one averse to cold is cold of himself without waiting for wind, and though the body be greatly hot he does not wish to take off his clothes. The Hwarinseo says: one averse to cold loathes the cold of himself without facing the wind, and one averse to wind loathes the cold when facing the wind.

Uihak Gangmok 綱目

2.69.6

Source원문

病人脉微而澁者, 其人亡血ㆍ病當惡寒ㆍ後乃發熱ㆍ無休止時, 夏月盛暑欲着複衣ㆍ冬月盛寒欲裸其身. 所以然者, 陽微則惡寒ㆍ陰弱則發熱也. 此由醫者過爲汗ㆍ令陽氣微, 又大下ㆍ令陰氣弱. 夏月陽氣在表ㆍ胃中虛冷ㆍ陽氣內微ㆍ不能勝冷, 故欲着複衣; 冬月陽氣在裏ㆍ胃中煩熱ㆍ陰氣內弱ㆍ不能勝熱, 故欲裸其身也. 《仲景》

Translation영역

Where the sick man's pulse is faint and rough, he has lost blood, and the disease should be aversion to cold with fever following after, with no time of resting; in the height of summer heat he wishes to put on padded clothes, and in the depth of winter cold he wishes to go naked. The reason is that where the yang is faint there is aversion to cold and where the yin is weak there is fever. This comes of the physician having sweated him excessively, making the yang qi faint, and having also purged him greatly, making the yin qi weak. In summer the yang qi is in the exterior and the stomach is depleted and cold, the yang qi faint within and unable to overcome the cold, and so he wishes to put on padded clothes; in winter the yang qi is in the interior and the stomach is vexed and hot, the yin qi weak within and unable to overcome the heat, and so he wishes to go naked.

Junggyeong 仲景

2.69.7

Source원문

傷寒雖裏證悉具, 若有一毫惡寒者, 爲表邪未盡, 須先解表乃攻裏也. 《入門》

Translation영역

In cold damage, though all the interior signs be present, if there is a hair's breadth of aversion to cold, the exterior evil is not yet exhausted, and the exterior must be resolved first and only then the interior attacked.

Uihak Immun 入門

2.69.8

Source원문

發熱惡寒近似傷寒者有五種: 脉浮而緊ㆍ發熱惡寒者, 傷寒也; 脉浮而數ㆍ發熱惡寒ㆍ或有痛處, 是欲作癰疽也; 脉浮而澁ㆍ發熱惡寒ㆍ或膈滿嘔吐, 此傷食也; 脉浮而滑ㆍ發熱惡寒ㆍ或頭眩嘔吐, 是風痰也; 脉浮而弦ㆍ發熱惡寒ㆍ或欲思飮食, 此欲作瘧疾也. 《本事》

Translation영역

There are five kinds that resemble cold damage in having fever and aversion to cold. A pulse floating and tight with fever and aversion to cold is cold damage. A pulse floating and rapid with fever and aversion to cold, and perhaps a place that hurts, is an abscess about to form. A pulse floating and rough with fever and aversion to cold, and perhaps fullness of the diaphragm and vomiting, is food damage. A pulse floating and slippery with fever and aversion to cold, and perhaps dizziness and vomiting, is wind phlegm. A pulse floating and stringlike with fever and aversion to cold, and perhaps a thinking towards food and drink, is malaria about to form.

Clinical note임상 주석

The distinction between aversion to wind and aversion to cold is made twice, from two sources, and it is worth making: aversion to wind is relieved by shutting the door, and aversion to cold is not. 雖身大熱而不欲去衣 — though the body be greatly hot he does not wish to take off his clothes — is the test, and it takes no instrument. 一毫惡寒 — a hair's breadth of aversion to cold — forbidding the purge is the single most repeated prohibition in the chapter, stated here in its most absolute form. However complete the interior picture, any residual aversion to cold means the exterior is still open and must be closed first. Xu Shuwei's five look-alikes in the last passage are a genuine differential list and each is separated by one pulse quality plus one accompanying sign: tight for cold damage, rapid with a tender spot for an abscess, rough with vomiting for food damage, slippery with dizziness for wind phlegm, stringlike with returning appetite for incipient malaria. Fever with chills has many causes, and a list of the four commonest mimics is as useful now as it was then. The case in the sixth passage — a patient who wants padded clothes in high summer and to go naked in deep winter — is thermoregulatory instability after fluid and blood loss, and Zhongjing attributes it squarely to over-sweating and over-purging. The explanation by seasonal distribution of yang qi is of its time; the observation that an exsanguinated patient loses the ability to regulate temperature is not.

Bonsa 本事

2.70 Looking at the Colour of the Face, Eyes and Tongue in Cold Damage 傷寒看面目舌色

2.70.1

Source원문

少陰病下利ㆍ脉沉而遲ㆍ其人面少赤, 必鬱冒汗出而解. 所以然者, 其面戴陽ㆍ下虛故也. 《仲景》

Translation영역

In shaoyin disease with diarrhoea, a deep slow pulse and the man's face slightly red, there will certainly be a depressed fogging and then sweat comes out and it resolves. The reason is that his face wears the yang while below he is depleted.

Junggyeong 仲景

2.70.2

Source원문

太陽病發汗不徹ㆍ面色緣緣正赤色者, 陽氣怫鬱在表, 當解之. 《仲景》

Translation영역

In taiyang disease where the sweating was not carried through and the colour of the face is a continuous true red, the yang qi is pent and depressed in the exterior, and it should be resolved.

Junggyeong 仲景

2.70.3

Source원문

面戴陽者, 面雖赤而不紅活, 乃下虛也. 又曰: 陰盛者面赤而黯, 陽盛者面赤而光. 《入門》

Translation영역

In one whose face wears the yang, the face is red but not of a living redness, and this is depletion below. It is also said: where the yin is exuberant the face is red and dull, and where the yang is exuberant the face is red and lustrous.

Uihak Immun 入門

2.70.4

Source원문

傷寒陰證無頭痛ㆍ無身熱ㆍ躁悶ㆍ面赤ㆍ飮水不得入口, 乃氣弱無根ㆍ虛火泛上, 名曰戴陽證, 陶氏益元湯主之. 《入門》

Translation영역

In the yin pattern of cold damage with no headache, no generalized fever, agitated oppression, a red face and water that cannot be taken into the mouth, the qi is weak and rootless and a depletion fire floats upward; this is named the pattern of wearing the yang, and Tao's Benefit the Origin Decoction governs it.

Uihak Immun 入門

2.70.5

Source원문

欲愈之病, 目眥黃; 眼胞忽陷, 定知亡. 《脉訣》

Translation영역

In a disease about to heal, the corners of the eyes are yellow; where the eyelids suddenly sink in, know for certain he will die.

Maekgyeol 脉訣

2.70.6

Source원문

傷寒六七日, 若脉和平ㆍ其人大煩ㆍ目重瞼內際皆黃者, 爲欲解也. 《脉經》

Translation영역

In cold damage on the sixth or seventh day, if the pulse is harmonious and level, the man greatly vexed, and the eyes heavy with the inner edges of the lids all yellow, it is about to resolve.

Maekgyeong 脉經

2.70.7

Source원문

傷寒目赤爲陽毒, 目黃爲黃疸. 《入門》

Translation영역

In cold damage, red eyes are yang toxin and yellow eyes are jaundice.

Uihak Immun 入門

2.70.8

Source원문

傷寒熱病目不明, 謂神水已竭ㆍ不能照物, 病已篤矣, 急以六一順氣湯下之. 《醫鑑》

Translation영역

In cold damage and heat disease, where the eyes do not see clearly, it means the spirit water is already exhausted and cannot illuminate objects; the disease is already grave, and Six-to-One Normalize the Qi Decoction should be used urgently to purge it.

Gogeum Uigam 醫鑑

2.70.9

Source원문

熱病在腎, 令人渴ㆍ舌焦黃赤ㆍ飮水不止ㆍ目無精光者, 死不治. 《仲景》

Translation영역

Where the heat disease is in the kidney, it gives the man thirst, a tongue scorched yellow and red, drinking of water without stopping, and eyes without the light of essence: he dies and is not treatable.

Junggyeong 仲景

2.70.10

Source원문

舌上白胎者, 邪未入府ㆍ屬半表半裏, 以小柴胡湯和解之; 舌生黃胎者, 熱已入胃, 調胃承氣湯下之; 舌上黑胎或生芒刺者, 是腎水剋心火, 急以大承氣下之, 此熱已極也. 《醫鑑》

Translation영역

Where there is a white coating on the tongue, the evil has not yet entered the bowels and belongs to the half-exterior and half-interior, and Minor Bupleurum Decoction harmonizes and resolves it; where a yellow coating grows on the tongue, the heat has already entered the stomach, and Regulate the Stomach and Order the Qi Decoction purges it; where there is a black coating on the tongue or prickles growing on it, the kidney water is overwhelming the heart fire, and Major Order the Qi should be used urgently to purge it, for the heat is already at its extreme.

Gogeum Uigam 醫鑑

2.70.11

Source원문

治法: 取井水浸靑布片子, 淨洗舌上, 後以生薑片浸水, 時時刮舌, 黑胎自退. 《醫鑑》

Translation영역

Method of treatment: take a piece of blue cloth soaked in well water and wash the tongue clean, and afterwards take a slice of fresh ginger soaked in water and scrape the tongue from time to time, and the black coating retreats of itself.

Clinical note임상 주석

面雖赤而不紅活 — red but not of a living redness — and its companion, red and dull against red and lustrous, are the chapter's attempt to describe the difference between a flush of perfusion and a flush of displaced yang. It is a real distinction and a hard one to put into words; the Immun's two pairs of adjectives are as close as the literature comes, and the same quality of lustre served as a discriminator at 2.66. 眼胞忽陷, 定知亡 — eyelids suddenly sunken, know for certain he will die — is sunken orbits from severe dehydration, and as a terminal sign in an untreated diarrhoeal or febrile illness it is accurate. Against it, the yellow at the inner lid margins with a level pulse on day six or seven is given as a sign of impending recovery, which is harder to credit. The three tongue coatings and their three formulas are the most-copied passage in this part of the chapter and are still taught in nearly this form: white for a half-exterior pattern, yellow for heat in the stomach, black with prickles for heat at its extreme. A dry fissured black-coated tongue with filiform papillae standing up is a real appearance and does mark a severely dehydrated, gravely ill patient. The last passage is the only cosmetic instruction in the chapter and is worth reading for what it reveals: scraping the black coating off with ginger water removes the sign without touching the disease. The Uigam offers it immediately after naming the sign as indicating heat at its extreme, which leaves a reader to notice the contradiction for themselves.

Gogeum Uigam 醫鑑

2.71 Combined Disease in Cold Damage 傷寒合病

2.71.1

Source원문

合病者, 一陽先病ㆍ或一陽隨病, 或二陽同病ㆍ或三陽同病, 不傳者謂之合病. 通用羌活衝和湯. 《入門》

Translation영역

A combined disease is where one yang falls ill first and another yang falls ill along with it, or two yang are ill together, or three yang are ill together, and it does not pass over; this is called a combined disease. Notopterygium Harmonizing Decoction serves generally.

Uihak Immun 入門

2.71.2

Source원문

三陽合病, 頭痛ㆍ面垢ㆍ譫語ㆍ遺尿ㆍ中外俱熱ㆍ自汗ㆍ煩渴, 或腹滿ㆍ身重, 白虎湯主之. 《仲景》

Translation영역

Clinical note임상 주석

不傳 is the whole definition: a combined disease is one where two or three channels are involved at once and the illness is not moving through them in sequence. That matters for treatment, because the timing rules the chapter has spent fifty sections building all assume a progression, and here there is none to anticipate. The three-yang combined disease recurs from 2.26 with the same signs, and White Tiger is the answer in both places. 面垢 and 遺尿 together — a grimy face and urine passed without noticing — describe a patient too ill to attend to themselves, which is what involving all three yang at once amounts to.

Junggyeong 仲景

2.72 Concurrent Disease in Cold Damage 傷寒倂病

2.72.1

Source원문

倂者, 催倂逼迫之意. 始初二陽合病, 後一陽氣盛ㆍ一陽氣衰, 倂歸於一經獨重, 初證亦不解罷. 通用羌活衝和湯. 《入門》

Translation영역

Concurrence means pressing together and driving upon. At the outset two yang are ill in combination, and afterwards the qi of one yang is exuberant and the qi of the other declines, so that they press together and go over into one channel which alone is heavy, while the first signs also do not resolve and finish. Notopterygium Harmonizing Decoction serves generally.

Clinical note임상 주석

The distinction from the previous section is one of movement: in a combined disease the channels stay as they are, and in a concurrent disease the weight shifts from one to another while the original signs persist. 初證亦不解罷 is the diagnostic point — the first channel's signs have not gone away, so this is not a transmission but an accumulation. Both sections get the same formula, which is the Immun being candid about how little hangs on the distinction in practice. Nine-Ingredient Notopterygium covers several channels at once, which is exactly what a disease that will not stay in one requires.

Uihak Immun 入門

2.73 Vexation and Agitation in Cold Damage 傷寒煩躁

2.73.1

Source원문

煩, 乃心中懊憹欲吐之貌; 躁, 則手掉足動ㆍ起卧不安.

Translation영역

Vexation is the look of a gnawing distress in the heart with a wish to vomit; agitation is the hands shaking and the feet moving, with no ease in rising or lying.

Uihak Immun 入門

2.73.2

Source원문

心熱則煩, 腎熱則躁.

Translation영역

Where the heart is hot there is vexation; where the kidney is hot there is agitation.

Uihak Immun 入門

2.73.3

Source원문

煩爲輕, 躁爲重.

Translation영역

Vexation is light and agitation is heavy.

Uihak Immun 入門

2.73.4

Source원문

先煩而漸燥者爲陽證, 不煩而便發躁者爲陰證. 《入門》

Translation영역

Where vexation comes first and agitation gradually follows, it is a yang pattern; where there is no vexation and agitation breaks out at once, it is a yin pattern.

Uihak Immun 入門

2.73.5

Source원문

煩主氣ㆍ躁主血. 肺主皮毛, 氣熱則煩; 腎主津液, 血熱則躁. 故用梔子以治肺ㆍ豆豉以潤腎, 宜黃連雞子湯ㆍ甘草乾薑湯ㆍ芍藥甘草湯. 《入門》

Translation영역

Vexation governs the qi and agitation governs the blood. The lung governs the skin and hair, and where the qi is hot there is vexation; the kidney governs the fluids, and where the blood is hot there is agitation. Therefore gardenia is used to treat the lung and fermented soybean to moisten the kidney; and Coptis and Egg Decoction, Licorice and Dried Ginger Decoction and Peony and Licorice Decoction are apt.

Uihak Immun 入門

2.73.6

Source원문

煩躁者, 懊憹不得眠也. 懊憹者, 鬱悶不舒之貌. 煩者氣也, 火入於肺也; 燥者血也, 火入於腎也. 梔子豉湯主之. 《仲景》

Translation영역

Vexation and agitation is a gnawing distress with inability to sleep. The gnawing distress is the look of a depressed oppression that is not at ease. Vexation is of the qi, the fire having entered the lung; agitation is of the blood, the fire having entered the kidney. Gardenia and Fermented Soybean Decoction governs it.

Junggyeong 仲景

2.73.7

Source원문

煩者身熱也. 邪氣不爲汗解ㆍ蒸於經絡ㆍ鬱於肌表, 故生熱煩也. 《類聚》

Translation영역

Vexation is generalized fever. The evil qi has not been resolved by sweating, steams in the channels and network vessels and is depressed in the flesh and surface, and so heat vexation is generated.

Uibang Yuchwi 類聚

2.73.8

Source원문

傷寒下後心煩ㆍ腹滿, 宜梔子厚朴湯.

Translation영역

In cold damage after purging, with vexation of the heart and abdominal fullness, Gardenia and Magnolia Bark Decoction is apt.

Junggyeong 仲景

2.73.9

Source원문

煩躁ㆍ不大便ㆍ續臍痛ㆍ發作有時者, 有燥屎也, 宜下之. 《仲景》

Translation영역

Where there is vexation and agitation, no stool, a pain continuing round the navel that comes on at set times, there are dry faeces, and it should be purged.

Junggyeong 仲景

2.73.10

Source원문

病人脉已解而日暮微煩者, 以病新差ㆍ人强與穀ㆍ脾胃氣尙弱ㆍ不能消穀, 故令微煩熱. 損穀則愈. 《仲景》

Translation영역

Where the sick man's pulse has already resolved and towards evening he is slightly vexed, it is because the disease is newly recovered and people have pressed grain upon him while the spleen and stomach qi is still weak and cannot digest it, and so there is slight vexing heat. Reduce the grain and he heals.

Junggyeong 仲景

2.73.11

Source원문

煩躁者, 氣隨火升也. 《丹心》

Translation영역

Vexation and agitation is the qi rising along with the fire.

Clinical note임상 주석

The vexation-and-agitation pair is defined here more carefully than any other symptom in the chapter, and the definitions are behavioural rather than theoretical: vexation is the inward gnawing distress with nausea, agitation is the outward restlessness of hands and feet. 煩爲輕, 躁爲重 grades them, and the sequence in which they appear separates yang from yin — gradual from vexation into agitation is yang, agitation straight away is yin. 損穀則愈 — reduce the grain and he heals — is the gentlest prescription in the chapter and one of the best. A convalescent slightly feverish in the evening has been overfed by well-meaning relatives, and the treatment is to feed him less. That the Shanghanlun recorded it, and that the Bogam kept it among the vexation formulas rather than dropping it as trivial, says something about both.

Dansim 丹心

2.74 The Good and Ill Omen of Vexation and Agitation 煩躁吉凶

2.74.1

Source원문

內熱曰煩, 謂心中鬱煩也; 外熱曰躁, 謂氣外熱躁也. 內熱爲有根之火, 故但煩不躁ㆍ及先煩後躁者, 皆可治; 外熱爲無根之火, 故但躁不煩ㆍ及先躁後煩者, 皆不可治也. 《明理》

Translation영역

Interior heat is called vexation, meaning a depressed vexation within the heart; exterior heat is called agitation, meaning the qi outwardly hot and agitated. Interior heat is a fire with a root, and so one who is vexed but not agitated, and one in whom vexation comes first and agitation after, may both be treated; exterior heat is a fire without a root, and so one who is agitated but not vexed, and one in whom agitation comes first and vexation after, may neither be treated.

Myeongni 明理

2.74.2

Source원문

所謂煩躁者, 謂先煩ㆍ漸至躁也; 所謂躁煩者, 謂先發躁ㆍ迤𨓦復煩也. 從煩至躁爲熱, 未有不漸煩而躁者也. 先躁後煩, 謂怫怫然更作躁悶, 此爲陰盛隔陽也. 雖大躁ㆍ欲於泥水中卧, 但水不得入口是也. 此氣欲絶而爭, 譬如燈將滅而暴明. 《明理》

Translation영역

What is called vexation-agitation means vexation first, gradually reaching agitation; what is called agitation-vexation means agitation breaking out first and vexation following on by degrees. Going from vexation to agitation is heat, and there is none in whom agitation does not come gradually through vexation. Agitation first and vexation after means that pent and depressed he makes an agitated oppression again, and this is yin exuberance screening off the yang. Though he is greatly agitated and wishes to lie down in muddy water, yet the water cannot be taken into the mouth — this is it. It is the qi contending as it is about to be severed, like a lamp that blazes up suddenly as it is going out.

Clinical note임상 주석

譬如燈將滅而暴明 — like a lamp that blazes up suddenly as it is going out — is the best image in the chapter and names something every clinician has seen: the brief surge of energy or agitation that precedes death. The Myeongni uses it to explain why agitation arriving first is a terminal sign while agitation arriving after vexation is not, and the distinction is a prognostic one rather than a diagnostic one. 有根之火 and 無根之火 — fire with a root and fire without — is the whole of the reasoning. A fire with fuel under it burns in order and can be put out; a fire with nothing beneath it flares and goes. That the order of two symptoms should carry so much weight seems excessive until one notices what it is standing in for: whether the patient's reserve is being consumed gradually or has already gone. The muddy water detail connects this section to 2.63 and 2.65: the patient who wants to lie in water and will not take it in the mouth is the same patient, and the sign is the chapter's most reliable marker of false heat.

Myeongni 明理

2.75 Vexation and Agitation with Hypertonic Legs 煩躁脚攣

2.75.1

Source원문

傷寒脉浮ㆍ自汗出ㆍ小便數ㆍ心煩ㆍ微惡寒ㆍ脚攣急, 反與桂枝湯, 此誤也. 得之便厥ㆍ咽中乾ㆍ煩躁ㆍ吐逆, 作甘草乾薑湯與之以復其陽; 若厥愈ㆍ足溫者, 更作芍藥甘草湯與之, 其脚遂伸. 《仲景》

Translation영역

In cold damage with a floating pulse, sweat coming out of itself, frequent urination, vexation of the heart, slight aversion to cold and hypertonic urgency of the legs, Cinnamon Twig Decoction was given instead, and this was an error. On taking it he was at once reversed, with dryness in the throat, vexation and agitation, and vomiting counterflow; Licorice and Dried Ginger Decoction was made and given to restore his yang; and when the reversal was healed and the feet warm, Peony and Licorice Decoction was then made and given, and his legs straightened out.

Clinical note임상 주석

A complete iatrogenic sequence with its own two-stage repair, and the most instructive single passage in the last part of the chapter. The error is subtle: a floating pulse with slight aversion to cold looks like a Cinnamon Twig case, but the patient is already sweating and passing water frequently, so there is no fluid to spare and the hypertonic legs say as much. Sweating him produced reversal, throat dryness and vomiting. The repair is staged, and the staging is the lesson. Licorice and Dried Ginger first, to get the yang back and the feet warm — nothing else until that is achieved. Then, and only then, Peony and Licorice for the legs. Treating the cramp before the circulation would have been another error, and the text makes the sequence and its endpoint explicit: 若厥愈足溫者, 更作. Hypertonic legs with frequent urination and sweating is a fluid and electrolyte picture, and peony with licorice is still the standard formula for cramp in East Asian practice. The whole passage reads as a case followed through to the end, which is rare here.

Junggyeong 仲景

2.76 Gnawing Distress and Pent Depression 懊憹怫鬱

2.76.1

Source원문

有人傷寒八九日ㆍ身熱ㆍ無汗ㆍ時時譫語, 時因下後大便不通已三日矣. 非躁非煩ㆍ非寒非痛, 終夜不得卧, 但心中無曉會處. 許學士診之曰: 此懊憹ㆍ怫鬱二證俱作也, 胃中有燥屎. 服承氣湯下燥屎二十枚, 得利而解. 仲景云: 陽明病下之ㆍ心中懊憹ㆍ微煩, 胃中有燥屎也. 又云: 小便不利ㆍ大便難ㆍ時有微熱怫鬱, 有燥屎也. 內經曰: 胃不和則卧不安, 此夜所以不得眠也. 胃中燥ㆍ大便堅者必譫語也. 非煩非躁ㆍ非寒非痛, 所以心中懊憹也. 《本事》

Translation영역

There was a man with cold damage on the eighth or ninth day, with generalized fever, no sweat and delirious speech from time to time, and at that time, having been purged, the bowels had not opened for three days. He was neither agitated nor vexed, neither cold nor in pain, could not lie down the whole night through, and only had within his heart a place he could make nothing of. Xu the Academician examined him and said: here the two patterns of gnawing distress and pent depression have both arisen, and there are dry faeces in the stomach. He took an Order the Qi Decoction and passed down twenty dry faeces, and with the bowels opened it resolved. Zhongjing says: in yangming disease after purging, with a gnawing distress within the heart and slight vexation, there are dry faeces in the stomach. He also says: where the urine is inhibited, the stool difficult and there is slight heat pent and depressed from time to time, there are dry faeces. The Neijing says: where the stomach is not harmonized, lying down is not at ease — this is why he could not sleep at night. Where the stomach is dry and the stool hard, he must have delirious speech. Neither vexed nor agitated, neither cold nor in pain: this is why there was a gnawing distress within the heart.

Clinical note임상 주석

心中無曉會處 — within his heart a place he could make nothing of — is the finest phrase in the chapter for a symptom that resists description. The patient is not in pain, not cold, not vexed and not agitated, and cannot sleep; there is simply something wrong that he cannot locate or name. 懊憹 is the classical term for it and English has no equivalent. Xu Shuwei's diagnosis is arrived at by exclusion and then confirmed by the result — twenty dry faeces — which makes this one of the better-evidenced case records in the literature. The argument he assembles afterwards from three sources is the same retrospective style as his case at 2.23, and 胃不和則卧不安 from the Neijing is still the most-quoted line in East Asian medicine on the relation between the gut and sleep. Worth noting that the patient had already been purged once and the bowels had still not opened for three days. The first purge was insufficient rather than wrong, which is a different kind of error from the ones the chapter usually catalogues and one that only a follow-up reveals.

Bonsa 本事

2.77 Shivering and Trembling in Cold Damage 傷寒戰慄

2.77.1

Source원문

黃帝曰: 人之振寒者, 何氣使然? 歧伯曰: 寒氣客于皮膚ㆍ陰氣盛ㆍ陽氣虛, 故爲振寒ㆍ寒慄. 《靈樞》

Translation영역

The Yellow Emperor said: when a man shivers with cold, what qi brings it about? Qibo said: the cold qi lodges in the skin, the yin qi is exuberant and the yang qi depleted, and so there is shivering with cold and trembling with cold.

Yeongchu 靈樞

2.77.2

Source원문

戰者, 身爲之戰搖也; 慄者, 心戰是也. 正與邪爭則鼓慄而戰; 但虛而不至爭, 則心聳動而振也. 戰之與振, 振輕而戰重也. 《明論》

Translation영역

Shivering is the body shaking with it; trembling is the heart shivering. Where the upright contends with the evil, there is a drumming trembling and shivering; where there is only depletion and it does not come to contending, the heart starts up and moves and there is a quivering. Between shivering and quivering, the quivering is light and the shivering heavy.

Myeongnon 明論

2.77.3

Source원문

諸乗寒者則爲厥ㆍ鬱冒ㆍ不仁, 以胃無穀氣ㆍ脾澁不通ㆍ口急不能言ㆍ戰而慄也. 《仲景》

Translation영역

In all cases where cold prevails there is reversal, a depressed fogging and numbness, because the stomach has no grain qi, the spleen is rough and does not flow freely, the mouth is tight and cannot speak, and there is shivering and trembling.

Junggyeong 仲景

2.77.4

Source원문

戰者身振而動, 慄者心戰而惕. 邪正相爭: 正氣勝則戰, 邪氣勝則慄. 戰則病欲愈, 慄則病欲甚. 戰屬陽, 故大汗以解, 不必藥也; 慄屬陰, 陽爲陰所制, 故心寒ㆍ足踡ㆍ鼓頷ㆍ厥冷ㆍ便尿妄出ㆍ不知人事, 宜理中ㆍ四逆湯. 《入門》

Translation영역

Shivering is the body quivering and moving; trembling is the heart shivering and startled. Evil and upright contend with one another: where the upright qi prevails there is shivering, and where the evil qi prevails there is trembling. Shivering means the disease is about to heal; trembling means the disease is about to grow severe. Shivering belongs to the yang, and so a great sweat resolves it and no medicine is needed; trembling belongs to the yin, the yang being governed by the yin, and so there is cold in the heart, the feet drawn up, the jaw drumming, reversal cold, stool and urine passed without control and no knowledge of affairs, for which Regulate the Middle or Frigid Extremities Decoction is apt.

Uihak Immun 入門

2.77.5

Source원문

若原係熱邪表證慄者, 羌活衝和湯; 裏證慄者, 大柴胡湯. 《入門》

Translation영역

If it was originally a heat evil and the trembling is with an exterior pattern, Notopterygium Harmonizing Decoction; if the trembling is with an interior pattern, Major Bupleurum Decoction.

Uihak Immun 入門

2.77.6

Source원문

有戰而汗解者, 太陽也; 有不戰而汗解者, 陽明也; 有不戰不汗而解者, 少陽也. 老人虛弱ㆍ發戰而汗不行ㆍ隨卽昏悶者, 不治. 《入門》

Translation영역

There is a resolving by sweat with shivering, which is the taiyang; a resolving by sweat without shivering, which is the yangming; and a resolving with neither shivering nor sweat, which is the shaoyang. In an old and depleted person, where shivering arises and the sweat does not come and he at once falls into a clouded oppression, it is not treatable.

Clinical note임상 주석

戰則病欲愈, 慄則病欲甚 is a prognostic reading of the rigor, and it is better than it looks. A patient who mounts a vigorous shaking chill and then sweats has a working febrile response; one who merely trembles, with a cold trunk, drawn-up feet, chattering jaw, incontinence and clouded consciousness, does not. The first is a rigor and the second is decompensation, and the Immun has separated them correctly on behavioural grounds. 不必藥也 — no medicine is needed — is unusual and welcome. A shivering fit that resolves in a sweat requires nothing but to be left alone, and the chapter says so rather than prescribing for it. The last passage grades the resolution by channel and then names the one case that cannot be treated: an elderly depleted patient who shivers, fails to sweat and goes straight into obtundation. That is a febrile response begun and not completed in a patient without the reserve to complete it, and it remains an ominous sequence.

Uihak Immun 入門

2.78 Stirring and Palpitation in Cold Damage 傷寒動悸

2.78.1

Source원문

傷寒過多, 其人叉手自冒心ㆍ心下悸ㆍ欲得按, 甚則身振振欲擗地, 宜桂枝甘草湯. 《仲景》

Translation영역

Where the cold damage treatment has been excessive, the man crosses his hands and covers his heart of himself, with palpitation below the heart and a wish to have it pressed; and in the severe case the body quivers and he wishes to beat upon the ground. Cinnamon Twig and Licorice Decoction is apt.

Junggyeong 仲景

2.78.2

Source원문

發汗後臍下悸ㆍ欲作奔豚, 宜茯苓桂甘湯. 《仲景》

Translation영역

After sweating, where there is palpitation below the navel and a running piglet is about to arise, Poria, Cinnamon Twig and Licorice Decoction is apt.

Junggyeong 仲景

2.78.3

Source원문

脉結代ㆍ心動悸, 宜灸甘草湯. 方見脉部

Translation영역

Where the pulse is bound and intermittent and the heart stirs and palpitates, Honey-Fried Licorice Decoction is apt. The formula appears in the Pulse chapter.

Junggyeong 仲景

2.78.4

Source원문

撮空ㆍ神昏者, 陶氏升陽散火湯. 《入門》

Translation영역

Where he snatches at the air and the spirit is clouded, Tao's Raise the Yang and Disperse Fire Decoction.

Clinical note임상 주석

叉手自冒心 — crossing the hands and covering the heart of himself — is a gesture, and a patient who does it with palpitations below the heart and wants the chest pressed is giving a physical sign that costs nothing to observe. The Shanghanlun notes it as a consequence of excessive treatment, and Cinnamon Twig with licorice is as light an intervention as the chapter offers. 脉結代 with palpitation taking Honey-Fried Licorice Decoction is one of the most durable pairings in East Asian medicine: a bound and intermittent pulse is an irregular rhythm, and that formula is still the first thing considered for palpitations with arrhythmia. The chapter sends the reader to the Pulse chapter for the composition, which is where it belongs. 奔豚, the running piglet — a sensation of something surging up from below the navel — gets its own formula here and a chapter of its own in the Jin Gui. Poria with cinnamon twig and licorice, decocted in sweet-stirred water, is a deliberately gentle prescription for what is in part an anxiety symptom following over-sweating.

Uihak Immun 入門

2.79 Stirred Qi in Cold Damage 傷寒動氣

2.79.1

Source원문

動氣者, 爲築築然動跳於腹者是也. 《明理》

Translation영역

Stirred qi is that which moves and leaps in the abdomen with a pounding.

Myeongni 明理

2.79.2

Source원문

病人先有五積在腹中ㆍ或臍上下左右, 復因傷寒新邪與舊積相搏而痛ㆍ築築然跳動, 名曰動氣. 大槩虛者理中湯去白朮加肉桂, 熱者宜柴胡桂枝湯. 《入門》

Translation영역

Where the sick man already has one of the five accumulations within the abdomen, whether above, below, to the left or to the right of the navel, and then through cold damage the new evil beats against the old accumulation so that there is pain and a pounding leaping movement, this is named stirred qi. Broadly, for the depleted, Regulate the Middle Decoction with the atractylodes removed and cinnamon bark added; for the hot, Bupleurum and Cinnamon Twig Decoction is apt.

Uihak Immun 入門

2.79.3

Source원문

五積中惟臍下奔豚衝心最急, 桂枝湯加桂一倍. 《入門》

Translation영역

Among the five accumulations, only the running piglet below the navel surging up against the heart is the most urgent; Cinnamon Twig Decoction with the cinnamon doubled.

Clinical note임상 주석

築築然動跳 — moving and leaping with a pounding — is a palpable abdominal pulsation, and in a thin, dehydrated patient the aorta is readily felt and visible. That the Bogam treats it as a specific contraindication to both sweating and purging, and devotes four sub-sections to where exactly it is felt, suggests the finding was taken very seriously. The four sub-sections that follow are unusual in form: each names a location, then states what happens if the patient is sweated and what happens if he is purged, then gives a formula for the sweating error only. No formula is offered for the purging error in any of the four. Whether that is an accident of transmission or a judgment that the purging consequences are untreatable, the Bogam prints it as it stands. 加桂一倍 is the instruction glossed at 2.37 — doubling what is already there, not adding a new drug.

Uihak Immun 入門

2.79.1 Stirred Qi on the Right 動氣在右

2.79.1.1

Source원문

不可發汗. 發汗則衂而渴ㆍ心苦煩ㆍ飮水卽吐, 宜五苓散.

Translation영역

It may not be sweated. If it is sweated there will be nosebleed with thirst, the heart bitterly vexed, and water vomited as soon as it is drunk; Five-Ingredient Poria Powder is apt.

Myeongni 明理

2.79.1.2

Source원문

不可下. 下之則津液內竭ㆍ咽燥ㆍ鼻乾ㆍ頭眩ㆍ心悸. 《明理》

Translation영역

It may not be purged. If it is purged the fluids will be exhausted within, with a parched throat, a dry nose, dizziness and palpitation.

Clinical note임상 주석

Water vomited as soon as it is drunk is the water counterflow of 2.27, and Five-Ingredient Poria Powder is the formula for it there as here. The repair for the sweating error is the same formula whichever way the patient came to it.

Myeongni 明理

2.79.2 Stirred Qi on the Left 動氣在左

2.79.2.1

Source원문

不可發汗. 發汗則頭眩ㆍ汗不出ㆍ筋惕肉瞤, 宜防風白朮牡蠣湯.

Translation영역

It may not be sweated. If it is sweated there will be dizziness, the sweat not coming out, and twitching of the sinews and fasciculation of the flesh; Saposhnikovia, Atractylodes and Oyster Shell Decoction is apt.

Myeongni 明理

2.79.2.2

Source원문

不可下. 下之則腹內拘急ㆍ食不下ㆍ動氣更劇, 身雖有熱ㆍ卧則欲踡. 《明理》

Translation영역

It may not be purged. If it is purged there will be hypertonic urgency within the abdomen, food will not go down, the stirred qi will be worse again, and though the body has heat he will wish to curl up when lying down.

Clinical note임상 주석

筋惕肉瞤 — twitching sinews and fasciculating flesh — is the sign that Channel-Warming Original-Qi Boosting Decoction treats in the lower part of the chapter, and it is the classical marker of fluid and salt loss from over-sweating. Oyster shell here is doing what calcium does: settling the twitch.

Myeongni 明理

2.79.3 Stirred Qi Above 動氣在上

2.79.3.1

Source원문

不可發汗. 發汗則氣上衝ㆍ正在心端, 宜甘李根湯.

Translation영역

It may not be sweated. If it is sweated the qi will surge upward and stand right at the tip of the heart; Plum Root Bark Decoction is apt.

Myeongni 明理

2.79.3.2

Source원문

不可下. 下之則掌握熱煩ㆍ身上浮冷ㆍ熱汗自泄ㆍ欲得水自灌. 《明理》

Translation영역

It may not be purged. If it is purged the palms will be hot and vexed, there will be a floating coldness on the body, a hot sweat pouring out of itself, and a wish to pour water over himself.

Clinical note임상 주석

氣上衝正在心端 is the running piglet again, described from its endpoint rather than its origin. Plum root bark is a rarely used drug and this is one of the few formulas that employs it; the Jin Gui's running piglet formula uses it the same way.

Myeongni 明理

2.79.4 Stirred Qi Below 動氣在下

2.79.4.1

Source원문

不可發汗. 汗之則無汗ㆍ心中大煩ㆍ骨節苦疼ㆍ目暈ㆍ惡寒ㆍ食則反吐ㆍ穀不能進, 宜大橘皮湯.

Translation영역

It may not be sweated. If it is sweated there will be no sweat, great vexation within the heart, bitter pain of the bones and joints, dimness of the eyes, aversion to cold, food vomited back on eating and grain unable to go in; Major Tangerine Peel Decoction is apt.

Myeongni 明理

2.79.4.2

Source원문

不可下. 下之則腹脹滿ㆍ卒起頭眩ㆍ食則下淸穀ㆍ心下痞. 《明理》

Translation영역

It may not be purged. If it is purged there will be abdominal distending fullness, dizziness on rising suddenly, clear undigested grain passed below on eating, and stuffiness below the heart.

Clinical note임상 주석

卒起頭眩 — dizziness on rising suddenly — is postural hypotension, and it is the one sign among the sixteen in these four sub-sections that can be reproduced at will. It appears here as a consequence of purging a patient who should not have been purged, which is exactly when it would be found. Major Tangerine Peel Decoction, with tangerine peel at the top dose and bamboo shavings beside it, is the formula for the vomiting, and it closes the upper part of the chapter. The lower part opens with thirst and tidal fever and continues the same arrangement by symptom.

Myeongni 明理

About this translation 凡例

Base text: Donguibogam (東醫寶鑑, 1613 first edition), Miscellaneous Disorders, Volume 2, Cold Damage chapter, upper 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.