寶鑑Bogam

Formulas · Text · Donguibogam 東醫寶鑑

The Posterior Yin

Hueum

한글 후음  ·  Pinyin Hou Yin

The corporeal-soul gate — why a pile is called a hill, the bright blood and the dark, twenty-four named shapes, and the one rule the whole chapter rests on

後陰

The anus has three names and each carries an argument. 廣腸, the broad intestine, because it is wider than what comes before it. 魄門, the corporeal-soul gate, because the large intestine is the lung's bowel and the lung stores the corporeal soul — and the Suwen adds the functional point: this gate is the servant of all five viscera, and its business is to send out and not to take in. And 痔 itself, which the Samin explains by the graph: 峙, a small hill standing out of a marsh, so that any small flesh standing out at any of the nine orifices is a 痔 — there are nose piles and eye piles and tooth piles too. The chapter's causes are eating to fullness, wine, and sex, and its best distinction is the blood: bright blood before the stool is intestinal wind, an evil newly come in; dark blood after it is visceral toxin, a heat long accumulated. Then five named piles, then twenty-four shapes in a mnemonic verse — lotus, chestnut, water caltrop, cock's comb, mouse nipple — and a long apparatus of washes, fumigations, caustics and suppositories for burning a pile off. Much of that is dangerous and some of it lethal. What survives is at the two ends: Dongwon's whole-chapter rule that one treats from inside and outside together, the sitz bath, and the chapter's own closing counsel — supplement the depleted patient, keep the stool soft, and moderate the appetites, or nothing here will hold.

5.1 The Measure of the Anus 肛門重數

5.1.1
Source원문

靈樞曰, 肛門重十二兩, 大八寸, 徑二寸太半, 長二尺八寸, 受穀九升三合八分合之一.

Translation영역
The Lingshu says: the anus weighs twelve nyang, is eight chon around and two and a half chon across, two cheok eight chon long, and holds nine seung three hop and an eighth of a hop of grain.

Yeongchu 靈樞

5.2 The Other Names of the Anus 肛門別名

5.2.1
Source원문

肛門者大腸之下截也. 一曰廣腸, 言其廣闊於大小腸也. 又曰魄門, 言大腸爲肺之府, 肺藏魄, 故曰魄門也. 肛者, 言其處似車釭形也. 《入門》

Translation영역
The anus is the lower cutting of the large intestine. One name is the broad intestine, meaning that it is broader than the large and small intestines. Another is the corporeal-soul gate, meaning that the large intestine is the lung's bowel and the lung stores the corporeal soul. 肛 refers to its being shaped like the hub-ring of a cartwheel.

Immun 入門

5.2.2
Source원문

內經曰, 魄門亦爲五藏使, 水穀不得久留, 主出而不納, 以傳送也. 《內經》

Translation영역
The Neijing says: the corporeal-soul gate is also the servant of the five viscera; water and grain cannot stay long there, and its business is to send out and not to take in, and so to pass things on.
Clinical note임상 주석
主出而不納 — its business is to send out and not take in. The one functional statement in the chapter's opening, and 5.25's suppositories and 5.23's washes all run against it, which may be why 5.21's treatment rule insists on treating from inside as well.

Naegyeong 內經

5.3 The Causes of Pile Disease 痔病之因

5.3.1
Source원문

小腸有熱必痔, 大腸有熱必便血. 《仲景》

Translation영역
Where the small intestine has heat there will be piles; where the large intestine has heat there will be blood in the stool.

Junggyeong 仲景

5.3.2
Source원문

內經曰, 因而飽食, 筋脉橫解, 腸澼爲痔. 又曰, 飮食不節, 起居不時者, 陰受之; 陰受之則入五藏; 入五藏則䐜滿閉塞, 下爲飱泄, 久爲腸澼. 腸澼者, 大便下血, 卽腸風藏毒也. 澼者, 腸間積水也. 《類聚》

Translation영역
The Neijing says: eating to fullness, the sinews and vessels slacken crosswise, and intestinal afflux becomes piles. It also says: where food and drink are without measure and rising and resting are out of season, the yin receives it; receiving it, it enters the five viscera; entering them there is fullness and blockage, below there is swill diarrhoea, and in time intestinal afflux. Intestinal afflux is blood passed with the stool — that is, intestinal wind and visceral toxin. 澼 means water accumulated between the intestines.

Naegyeong 內經 · Yuchwi 類聚

5.3.3
Source원문

盖飽食則脾不能運, 食積停聚大腸. 脾土一虛, 肺金失養, 則肝木寡畏, 風邪乘虛下流, 輕則腸風下血, 重則變爲痔漏. 或醉飽入房, 精氣脫泄, 熱毒乘虛下注. 或淫極入房, 致傷膀胱與腎肝筋脉. 盖膀胱筋脉抵腰絡腎貫臀走肝, 環前後二陰, 故痔乃筋脉病也. 《入門》

Translation영역
Eating to fullness, the spleen cannot move it and the food accumulates and gathers in the large intestine. Once the spleen earth is vacuous the lung metal loses its nourishment, the liver wood has little to fear, and a wind evil takes advantage of the vacuity and flows downward — lightly, intestinal wind with blood below; heavily, it turns into fistulous piles. Or one goes to the bedchamber drunk and full, the essential qi is deserted and the heat toxin pours down into the vacancy. Or excess in the bedchamber damages the bladder and the sinews and vessels of kidney and liver. The bladder's vessel reaches the waist, networks the kidney, threads the buttock and runs to the liver, circling the two yin before and behind — so piles are a disease of the sinews and vessels.
Clinical note임상 주석
醉飽入房 — going to bed drunk and full. The three causes the chapter names throughout are overeating, wine and sex, and it returns to them in 5.26's list of what to avoid.

Immun 入門

5.3.4
Source원문

痔非外邪, 乃藏內濕熱風燥四氣相合而成. 其腸頭成塊者濕也; 腸頭墮腫者濕兼熱也; 出膿血水者熱勝血也; 作大痛者火熱也; 痒者風熱也; 大便秘者燥熱也; 小便澁者肝藏濕熱也. 《入門》

Translation영역
Piles are not an outer evil but the four qi within the viscera — damp, heat, wind and dryness — combining. Where the bowel head forms a lump, it is damp; where the bowel head sags and swells, damp with heat; where pus, blood and water come out, heat overcoming the blood; where there is great pain, fire heat; where there is itching, wind heat; where the stool is bound, dry heat; where the urine is rough, damp heat in the liver viscus.
Clinical note임상 주석
Seven features, each assigned a cause. The list is worth having at the bedside whatever one makes of the causes, because it names what to ask about: lump, swelling, discharge, pain, itch, stool, urine.

Immun 入門

5.4 A Pile Is a Standing Hill 痔者峙也

5.4.1
Source원문

內經曰, 腸澼爲痔. 如大澤中有小山突出爲峙. 人於九竅中凡有小肉突出皆曰痔, 不特於肛門邊者; 有鼻痔ㆍ眼痔ㆍ牙痔等類, 其狀不一. 《三因》

Translation영역
The Neijing says: intestinal afflux becomes piles. It is as when in a great marsh a small hill stands out, which is a 峙. In a person, any small flesh standing out at any of the nine orifices is called a pile, not only one at the edge of the anus: there are nose piles, eye piles, tooth piles and the like, and their shapes are not alike.
Clinical note임상 주석
The Nose chapter's 2.14 polyp and the Teeth chapter's 4.21 proud flesh are both 痔 by this definition, and the Samin's point is that the word names a shape rather than a place.

Samin 三因

5.4.2
Source원문

漢避呂后諱, 號痔疾爲野鷄病. 《類聚》

Translation영역
Under the Han, to avoid the taboo on Empress Lü's name, pile disease was called the wild-fowl disease.

Yuchwi 類聚

5.5 The Pulse 脉法

5.5.1
Source원문

䘌蝕肛陰, 其脉虛小者生, 緊急者死. 《脉經》 凡痔脉沈小實者易治, 浮洪而軟弱者難愈. 《正傳》 便血則芤數, 則赤黃實脉, 癃閉熱在膀胱. 《醫鑑》

Translation영역
Where gan erosion eats into the anus and genitals, a vacuous small pulse means life and a tight urgent one death. In any pile, a sunken small replete pulse is easy to treat and a floating surging soft weak one hard to heal. Where there is blood in the stool the pulse is scallion-stalk and rapid; a red-yellow replete pulse with dribbling blockage means heat in the bladder.

Maekgyeong 脉經 · Jeongjeon 正傳 · Uigam 醫鑑

5.6 The Names of the Piles 諸痔名目

5.6.1
Source원문

方書有五種: 一曰牡痔, 二曰牝痔, 三曰脉痔, 四曰腸痔, 五曰氣痔. 又有酒痔ㆍ血痔ㆍ瘻痔. 《三因》

Translation영역
The formularies have five kinds: first the male pile, second the female pile, third the vessel pile, fourth the intestinal pile, fifth the qi pile. There are also the wine pile, the blood pile and the fistulous pile.
Clinical note임상 주석
Five named as a set, then three more added — which is why the chapter's heading for the group is 五痔, the five piles, while the sections that follow run to eight.

Samin 三因

5.6.2
Source원문

凡痔毒甚者大如鷄冠ㆍ蓮花ㆍ核桃, 毒淺者小如松子ㆍ牛乳ㆍ鷄心ㆍ鼠乳ㆍ櫻桃. 雖種種不同, 皆三陰虛也. 《入門》

Translation영역
Where the pile's toxin is severe it is as large as a cockscomb, a lotus flower or a walnut; where the toxin is shallow it is as small as a pine nut, a cow's teat, a fowl's heart, a mouse's teat or a cherry. Though they differ kind by kind, all of them are a vacuity of the three yin.
Clinical note임상 주석
皆三陰虛也 — the Immun's one sentence of theory for the whole chapter. Size grades the toxin, but the ground beneath every grade is the same vacuity, which is the argument for the supplementing formulas that follow rather than the cooling ones.

Immun 入門

5.6.3
Source원문

凡痔因酒ㆍ色ㆍ風ㆍ氣ㆍ食五事過度而變成二十四證. 歌曰, 痔證分三八, 憑君子細看, 莫敎年月久, 見者膽心寒. 菱角看形怪, 蓮花不可觀, 穿腸幷鼠嬭, 酒色兩相干. 莫願翻花怨, 蜂窠亦不寬, 雌雄同氣血, 子母及腸盤. 玄珠尤可怪, 鉤腸痛若鑽, 核桃與流氣, 見者便心酸. 栗子於中大, 鷄心在外安, 珊瑚形可惡, 那更脫肛難. 內痔紅不出, 搭腸裏內蟠, 垂珠更難治, 日久有鷄冠. 切莫輕刀火, 令君性命殘, 用功無半月, 去病更除根. 《醫鑑》

Translation영역
Piles come of excess in five things — wine, sex, wind, qi and food — and turn into twenty-four signs. The song says: The pile's signs divide three times eight; I beg you look at them closely. Do not let the months and years run long, or the sight of them chills heart and gall. The water-caltrop is strange in shape; the lotus flower cannot be looked at. Through-the-bowel and the mouse's teat come of wine and sex together. Do not wish for the turned-flower's grudge; the wasp's nest gives no more room. Male and female share one blood and qi; mother-and-child and the coiled bowel are of a kind. The dark pearl is stranger still; the hooked bowel pains as if bored through. The walnut and the flowing qi — the sight of them turns the heart sour. The chestnut is the largest of the inner sort; the fowl's heart sits quietly outside. The coral is hateful in form, and worse than it is the prolapse. The inner pile is red and does not come out; it clings to the bowel and coils within. The hanging pearl is harder yet to treat, and in time the cockscomb comes. Do not lightly take to knife and cautery, or you will leave a man's life in ruins. Work at it and in half a month the disease is gone and the root removed with it.
Clinical note임상 주석
Twenty-four names, and the song is how they were memorised — three times eight, each a form the physician was to recognise by eye. Most are shapes (water-caltrop, lotus, walnut, chestnut, cockscomb, coral), a few are behaviours (through-the-bowel, the hooked bowel that bores, the inner pile that never shows). 切莫輕刀火 is the line worth keeping: the Uigam's advice against reaching for the knife or the cautery first, written four centuries before the same caution was argued on the evidence.

Uigam 醫鑑

5.6.4
Source원문

痔之名, 曰牛嬭, 曰鼠嬭, 曰鷄心, 曰鷄冠, 曰蓮花, 曰翻花, 曰蜂窠, 曰穿腸, 曰外痔, 曰內痔. 爲狀不一, 而其因則同焉. 《正傳》

Translation영역
The names of the piles: the cow's teat, the mouse's teat, the fowl's heart, the cockscomb, the lotus flower, the turned flower, the wasp's nest, through-the-bowel, the outer pile and the inner pile. Their forms are not one, but their cause is the same.
Clinical note임상 주석
爲狀不一而其因則同焉 — the Jeongjeon's reply to the twenty-four names: the taxonomy is of appearances, and treating it as a taxonomy of diseases is a mistake. Ten names here against twenty-four in the song, with no attempt to reconcile them, which is the Bogam's habit of printing its sources against each other rather than harmonising them.

Jeongjeon 正傳

5.6.5
Source원문

五痔宜五痔散ㆍ神應散ㆍ槐角元ㆍ神應黑玉丹.

Translation영역
For the five piles, Five Piles Powder, Divine Response Powder, Sophora Fruit Pill and Divine Response Black Jade Elixir are appropriate.
Clinical note임상 주석
The four formulas for the group as a whole, before the eight sections divide it. 五痔散 is built of five animal medicinals, one named in the source for each of the five piles.

Donguibogam · Hueum

5.7 Piles Have an Inner and an Outer Kind 痔有內外

5.7.1
Source원문

脉痔ㆍ腸痔ㆍ氣痔ㆍ血痔ㆍ酒痔屬內; 牡痔ㆍ牝痔ㆍ瘻痔屬外.

Translation영역
The vessel pile, intestinal pile, qi pile, blood pile and wine pile belong to the inner kind; the male pile, female pile and fistulous pile belong to the outer.
Clinical note임상 주석
Internal and external haemorrhoids are still the first division made, and for the same reason: the inner kind bleeds and the outer kind is seen and felt.

Donguibogam · Hueum

5.7.1 The Vessel Pile 脉痔

5.7.1.1
Source원문

腸口顆顆發㿔, 且痛且痒. 宜槐角元ㆍ釣腸丸ㆍ神應黑玉丹ㆍ神應散ㆍ逐瘀湯. 《綱目》

Translation영역
The mouth of the bowel breaks out in lump upon lump of swelling, and it both pains and itches. Sophora Fruit Pill, Draw Up the Bowel Pill, Divine Response Black Jade Elixir, Divine Response Powder and Expel Stasis Decoction are appropriate.
Clinical note임상 주석
顆顆, grain upon grain. The vessel pile is named for the vessels, but the sign that identifies it here is the form — many small separate swellings round the anal verge rather than one mass — together with the pairing of pain and itch. In modern terms this is the picture of thrombosed external haemorrhoids or of a crop of perianal skin tags.

Gangmok 綱目

5.7.2 The Intestinal Pile 腸痔

5.7.2.1
Source원문

肛內結核, 寒熱往來, 登溷脫肛, 卽下脫肛條同治. 《三因》

Translation영역
Nodules bind within the anus, cold and heat come and go, and at the privy the rectum falls out: treat it as in the Prolapse of the Rectum section below.
Clinical note임상 주석
登溷, going to the privy. What distinguishes the intestinal pile is that it is internal — nodules felt within rather than seen at the verge — and that it brings the alternating cold and heat of a systemic process. The Bogam does not give it a formula of its own but sends the reader to 脫肛, since the prolapse is what the patient presents with.

Samin 三因

5.7.3 The Qi Pile 氣痔

5.7.3.1
Source원문

憂恐恚怒適臨乎前, 立見腫痛, 氣散則愈. 宜加味香蘇散ㆍ橘皮湯. 《綱目》

Translation영역
When grief, fear, vexation or anger comes right upon a man, the swelling and pain appear at once, and when the qi disperses it heals. Supplemented Cyperus and Perilla Powder and Tangerine Peel Decoction are appropriate.
Clinical note임상 주석
適臨乎前 — arriving right in front of one. The qi pile is defined by its timing: it flares with the emotion and goes when the emotion goes, which is why the treatment moves qi rather than cools blood. 加味香蘇散 carries a second name, 橘皮湯, so the two names in this list are one formula.

Gangmok 綱目

5.7.4 The Blood Pile 血痔

5.7.4.1
Source원문

每遇大便淸血隨下而不止, 與下腸風藏毒同治. 《綱目》

Translation영역
Each time at stool clear blood comes down with it and will not stop: treat it as in Intestinal Wind and Visceral Toxin below.
Clinical note임상 주석
淸血, clear blood — bright red and unmixed, the near blood of 5.8. The blood pile is referred wholesale to the next section but one, where the Bogam separates bright blood before the stool from dark blood after it.

Gangmok 綱目

5.7.5 The Wine Pile 酒痔

5.7.5.1
Source원문

每遇飮酒輒發腫痛, 或下血. 宜乾葛湯. 《綱目》

Translation영역
Each time wine is drunk it breaks out in swelling and pain, or blood comes down. Pueraria Decoction is appropriate.
Clinical note임상 주석
The one pile named for its cause rather than its form. 乾葛湯 is built on pueraria, the Bogam's standing medicinal for wine damage, and the reasoning is the same as in 酒傷: resolve the wine and the swelling follows it out.

Gangmok 綱目

5.7.6 The Male Pile 牡痔

5.7.6.1
Source원문

肛邊發露肉珠, 狀如鼠嬭, 時時滴漬膿血. 宜加味槐角丸ㆍ秦芃蒼朮湯. 《綱目》

Translation영역
At the rim of the anus a bead of flesh is thrust out, shaped like a mouse's teat, and from time to time it drips and seeps pus and blood.
Clinical note임상 주석
鼠嬭, the mouse's teat — a small pedunculated lump at the verge, which with its discharge of pus and blood is the sentinel tag or the external opening of a low fistula. 牡 and 牝, male and female, divide the two external piles by form alone: the male juts out as one bead, the female breaks out as several sores.

Gangmok 綱目

5.7.7 The Female Pile 牝痔

5.7.7.1
Source원문

肛邊生瘡腫突出, 一日數枚, 膿潰且散. 治藥同上. 《綱目》

Translation영역
At the rim of the anus sores arise, swell and jut out, several in a day, and they suppurate, burst and scatter. The medicines are the same as above.
Clinical note임상 주석
治藥同上 — the same two formulas as the male pile. 一日數枚, several in a day, and 膿潰且散, suppurating and then dispersing, describe a crop of small perianal abscesses that come and go rather than one lasting mass.

Gangmok 綱目

5.7.8 The Fistulous Pile 瘻痔

5.7.8.1
Source원문

浸淫濕爛, 歲積月累, 虫生其間, 蝕腸穿穴, 與下痔漏同治法. 《綱目》

Translation영역
It spreads and seeps, damp and rotting; year on year and month on month worms breed within it, eating into the bowel and boring a hole through: treat it by the method of Pile Fistula below.
Clinical note임상 주석
穿穴, boring a hole through — the fistulous tract itself, which is what 瘻 names. 虫生其間 is the Bogam's account of a chronically discharging sinus; the worms are what the discharge was taken to prove, and the treatment it sends the reader to is surgical in everything but name.

Gangmok 綱目

5.8 Intestinal Wind and Visceral Toxin 腸風臟毒

5.8.1
Source원문

卽血痔也. 腸澼者, 大便下血, 所謂腸風藏毒也. 《醫鑑》

Translation영역
This is the blood pile. Intestinal afflux is blood passed with the stool — what is called intestinal wind and visceral toxin.

Uigam 醫鑑

5.8.2
Source원문

如下淸血色鮮者, 腸風也; 血濁而色黯者, 臟毒也. 《本事》 腸風者, 邪氣外入, 隨感隨見, 所以其色淸也; 臟毒者, 蘊積熱毒, 久而始見, 所以其色濁也. 治腸風以散風行濕, 治臟毒以淸熱凉血. 《丹心》

Translation영역
Where the blood that comes down is clear and bright in colour, it is intestinal wind; where it is turbid and dark, it is visceral toxin. Intestinal wind is an evil qi entering from without, seen as soon as it is felt, and so its colour is clear; visceral toxin is heat toxin gathered and accumulated, seen only after long, and so its colour is turbid. Intestinal wind is treated by scattering wind and moving damp, visceral toxin by clearing heat and cooling blood.
Clinical note임상 주석
The chapter's best distinction, and it holds up: bright blood on the surface of the stool comes from near the anus, and dark blood mixed through it from higher up. Dark blood in the stool is the one finding in this chapter that still needs looking into rather than treating.

Bonsa 本事 · Dansim 丹心

5.8.3
Source원문

腸風下血必在糞前, 是名近血, 色淸而鮮, 宜用敗毒散方見寒門; 臟毒下血必在糞後, 是名遠血, 色黯而濁, 宜用香連丸方見大便. 藏寒下血無痛, 宜用薑桂之屬; 積熱下血純下鮮血, 甚則兼痛, 宜用三黃湯丸方見火門. 《醫鑑》

Translation영역
In intestinal wind the blood comes before the stool and is named near blood, clear and bright in colour: Vanquish Toxin Powder formula in the Cold Damage chapter. In visceral toxin it comes after the stool and is named far blood, turbid and dark: Costus and Coptis Pill formula in the Stool chapter. Where visceral cold brings blood down without pain, ginger and cinnamon and their kind; where accumulated heat brings down pure bright blood, with pain in a severe case, Three Yellows Decoction or Pill formula in the Fire chapter.

Uigam 醫鑑

5.8.4
Source원문

大便下血曰腸風, 切勿止澁, 究其本末證狀, 先淸其表, 後攻其裏, 其血自止. 如脉洪大, 四物湯方見血門合黃連解毒湯方見寒門調治. 《綱目》

Translation영역
Blood passed with the stool is called intestinal wind, and on no account is it to be stopped and astringed: look into the root and branch of the pattern, first clear the surface and afterwards attack the interior, and the blood stops of itself. Where the pulse is surging and large, Four Substances Decoction formula in the Blood chapter combined with Coptis Resolve Toxin Decoction formula in the Cold Damage chapter to regulate it.
Clinical note임상 주석
切勿止澁 — on no account stop and astringe it. The chapter's warning against treating the bleeding rather than the cause, which is also why 5.26's advice is to supplement the patient and leave the blood alone.

Gangmok 綱目

5.8.5
Source원문

大便後下血, 腹中不痛者, 謂之濕毒下血, 黃連湯主之; 腹中痛者, 謂之熱毒下血, 芍藥黃連湯主之. 《易老》

Translation영역
Where blood comes after the stool and the belly does not pain, it is damp toxin bleeding, and Coptis Decoction governs it; where the belly pains, it is heat toxin bleeding, and Peony and Coptis Decoction governs it.

Yeongno 易老

5.8.6
Source원문

腸澼者, 爲水穀與血另作一派, 如喞桶涌出也. 長夏濕熱太甚, 正當客氣盛而主氣弱, 故腸澼之病甚也. 宜凉血地黃湯ㆍ當歸和血散ㆍ升陽除濕和血湯. 《東垣》

Translation영역
Intestinal afflux is water and grain making a stream of their own along with the blood, spurting out as from a squirt-tube. In the long summer when damp heat is at its height, the visitor qi is exuberant and the host qi weak, and so the disease of intestinal afflux is severe. Cool the Blood Rehmannia Decoction, Angelica Harmonize the Blood Powder and Upbear Yang, Remove Damp and Harmonize the Blood Decoction are appropriate.
Clinical note임상 주석
另作一派, 如喞桶涌出 — the blood making a stream of its own, spurting as from a squirt-tube. Dongwon's phrase for brisk rectal bleeding, and the point of 另作一派 is that the blood is not merely mixed through the stool but comes separately, which is how he tells this from the dysenteric flux. His three formulas are all built on upbearing rather than astringing.

Dongwon 東垣

5.8.7
Source원문

腸澼下血宜香殼丸ㆍ加味香連丸方見大便ㆍ升麻補胃湯ㆍ益智和中湯. 腸風宜香附散ㆍ止血散ㆍ栢葉湯ㆍ斷紅元. 臟毒宜解毒湯ㆍ槐花散ㆍ枳殼散ㆍ絲瓜散. 腸風臟毒通用玉屑丸ㆍ剪紅元ㆍ芎歸丸ㆍ槐黃丸ㆍ槐花散ㆍ腸風黑散ㆍ槐黃湯ㆍ淸榮槐花飮.

Translation영역
For intestinal afflux with bleeding: Fragrant Bitter Orange Pill, Supplemented Costus and Coptis Pill formula in the Stool chapter, Upbear Yang and Supplement the Stomach Decoction and Alpinia Harmonize the Centre Decoction. For intestinal wind: Cyperus Powder, Stop Bleeding Powder, Arborvitae Leaf Decoction and Cut Off the Red Pill. For visceral toxin: Resolve Toxin Decoction, Sophora Flower Powder, Bitter Orange Powder and Loofah Powder. For both together: Jade Shavings Pill, Cut Off the Red Pill, Chuanxiong and Angelica Pill, Sophora and Coptis Pill, Sophora Flower Powder, Intestinal Wind Black Powder, Sophora and Ailanthus Decoction and Clear the Construction Sophora Flower Drink.

Donguibogam · Hueum

5.9 Fistulous Piles 痔漏

5.9.1
Source원문

卽瘻痔也. 痔核已破謂之痔漏. 《東垣》

Translation영역
This is the fistulous pile. Where the pile's kernel has already broken it is called a fistulous pile.

Dongwon 東垣

5.9.2
Source원문

瘻痔亦謂之蟲痔. 歲月積久, 蟲蝕其間, 痒痛不堪, 或肛門間射血如線, 乃蟲痔也. 蟲痔宜熏, 千金用蝟皮ㆍ艾者佳方見下. 《本事》

Translation영역
The fistulous pile is also called the worm pile: with months and years accumulating, worms eat within it, the itching and pain are past bearing, and at times blood spurts from the anus like a thread — this is the worm pile. The worm pile should be fumigated, and the Cheongeumbang's method with hedgehog skin and mugwort is good formula below.
Clinical note임상 주석
射血如線 — blood spurting like a thread. Arterial bleeding from an eroded vessel, described exactly, and it is the finding in this chapter that most needs a surgeon.

Bonsa 本事

5.9.3
Source원문

痔漏之源由乎酒色. 痔久成瘻, 痔輕而瘻重, 痔實而瘻虛. 治痔之法不過凉血淸熱而已; 治瘻則初宜凉血淸熱燥濕, 久則宜澁竅殺蟲而兼乎溫散. 盖初作則腸胃氣實爲熱, 久則腸胃氣虛而爲寒矣. 《丹心》

Translation영역
The source of fistulous piles is wine and sex. A pile long continued becomes a fistula; the pile is light and the fistula heavy, the pile is repletion and the fistula vacuity. The method of treating a pile is no more than cooling the blood and clearing heat; in treating a fistula, at first one should cool the blood, clear heat and dry damp, but when it is long-standing one should astringe the opening and kill the worms, together with warming and dispersing. For at first the qi of intestines and stomach is replete and makes heat, and in time it is vacuous and makes cold.
Clinical note임상 주석
痔實而瘻虛 — the pile is repletion and the fistula vacuity. Danxi's rule reverses the treatment as the disease ages, and it is the same shape as the Chest chapter's warning that an old cold pain is no longer cold.

Dansim 丹心

5.9.4
Source원문

痔瘻先須服補藥生氣血, 用參ㆍ朮ㆍ芪ㆍ芎ㆍ歸爲主, 大劑服之; 外用附子灸法方見下鍼灸條. 《丹心》 痔漏專以凉血爲主, 宜用凉血飮, 外用澁藥塞竅. 《丹心》

Translation영역
In fistulous piles one must first take supplementing medicines to engender qi and blood, using ginseng, atractylodes, astragalus, chuanxiong and angelica as the chief and taking them in large doses; outwardly use the aconite moxa method in the acupuncture section below. Fistulous piles are treated above all by cooling the blood: Cool the Blood Drink is appropriate, with astringent medicines used outwardly to plug the opening.

Dansim 丹心

5.9.5
Source원문

痔漏宜黑玉丹ㆍ蝟皮丸ㆍ活龜丸ㆍ加味槐角丸方見上ㆍ豚胃丸ㆍ秘傳神應膏ㆍ蓮花蘂散ㆍ釣腸丸方見上ㆍ取漏膿方ㆍ取蟲方ㆍ塞漏孔方. ○狐惑亦是蟲蝕肛詳見傷寒.

Translation영역
For fistulous piles: Black Jade Elixir, Hedgehog Skin Pill, Live Tortoise Pill, Supplemented Sophora Fruit Pill formula above, Pig's Stomach Pill, Secretly Transmitted Divine Response Paste, Lotus Stamen Powder, Hook the Bowel Pill formula above, the Method of Drawing Out Fistula Pus, the Formula for Drawing Out the Pile Worm and the Formula for Plugging the Fistula Opening. Fox-delusion is likewise worms eroding the anus treated in the Cold Damage chapter.

Donguibogam · Hueum

5.9.6
Source원문

治內痔久漏, 取膿最妙. 焰硝 三兩ㆍ苦參 一兩半, 右爲末, 用布四寸長ㆍ三寸闊, 縫一袋, 入藥半袋, 以砒三分放藥末中間, 方入全藥裝滿, 縫袋中兩頭安帶子, 如𩣔馬繫住. 《入門》

Translation영역
To treat an internal haemorrhoid with a long-standing fistula, this is best of all for drawing out the pus. Saltpetre 3 nyang and sophora root 1½ nyang, powdered together; take a cloth four chon long and three chon wide and sew it into a bag, put half a bagful of the powder in, lay 3 pun of arsenic in the middle of the powder, then put in the rest of the powder to fill the bag, sew it up, and fasten a tie at each end of the bag, binding it on as one harnesses a horse.
Clinical note임상 주석
**This must not be prepared.** 砒 is arsenic trioxide, and the method is a medicated pack held against a fistula with ties so that the arsenic stays in contact and destroys the tissue. Arsenical escharotic pastes were used on fistulas and tumours into the twentieth century and they do destroy what they touch; they also absorb, and systemic arsenic poisoning from topical application is documented. A fistula-in-ano is laid open surgically.

Immun 入門

5.9.7
Source원문

蟲蝕痒痛下膿血, 槐白皮濃煎湯盛盆中, 坐其上熏穀道, 冷則易煖湯, 良久欲大便, 當有蟲出, 三度愈. 《本草》

Translation영역
Where worms erode with itching, pain and a discharge of pus and blood, decoct sophora root bark thick, put it in a basin and sit over it to fumigate the grain path, changing it for warm when it cools; after a good while one wishes to go to stool and worms should come out, and three times over heals it.

Boncho 本草

5.9.8
Source원문

蠡魚腸以五味灸, 貼痔漏上, 良久蟲出, 卽去之, 三次盡出. 《本草》

Translation영역
Take the gut of the snakehead fish, roast it with the five flavours, lay it on the fistulous pile, and after a good while the worms come out; remove it at once, and in three applications they are all out.
Clinical note임상 주석
The first of five single-drug items the chapter prints after the formula bodies of this section. What they share is the premise that a fistula is a worm burrow and that the worm can be drawn out with bait — roasted fish gut, a dung-beetle plug, a honeyed date — which is why they are all applied at the opening rather than swallowed.

Boncho 本草

5.9.9
Source원문

蜣蜋生擣爲丸, 塞肛門孔中, 引痔蟲出盡, 永差. 《本草》

Translation영역
Pound a live dung beetle into a pill and plug it into the opening of the anus; it draws the pile worms out to the last and the cure is lasting.

Boncho 本草

5.9.10
Source원문

痔漏決洞者, 桃皮葉杵爛, 水漬令濃, 去滓, 盛盆中漬之, 蟲自出. 《本草》

Translation영역
Where the fistulous pile has broken right through, pound peach bark and leaf to a mash, steep it in water till it is strong, strain off the dregs, put it in a basin and soak in it, and the worms come out of themselves.

Boncho 本草

5.9.11
Source원문

痔漏濕䘌, 猪膽一枚ㆍ苦酒一合, 同煎三兩沸, 滿口飮之, 蟲立死出, 卽愈. 或灌肛內, 亦下蟲及惡物. 《本草》

Translation영역
For a damp, eroding fistulous pile, boil one pig's gallbladder with 1 hop of vinegar to three or four bubblings, drink it down at a mouthful, and the worms die and come out at once and it heals. Or pour it into the anus, and that too brings down the worms and the foul matter.

Boncho 本草

5.9.12
Source원문

痔漏蟲痒, 蒸棗取肉, 入水銀和勻, 撚如棗核, 長三寸許, 臨臥綿裹納肛內, 明日蟲盡出. 若痛, 加甘草末. 《本草》

Translation영역
For a fistulous pile with worms and itching, steam dates and take the flesh, mix mercury into it evenly, roll it like a date stone some 3 chi long, wrap it in cotton wool at bedtime and put it into the anus, and by the next day the worms are all out. If it is painful, add powdered licorice.
Clinical note임상 주석
**This must not be prepared.** Mercury inserted into the rectum overnight is absorbed through the mucosa, and the dose here is not small. The last and worst of the five, and the one place in the section where the worm premise leads somewhere dangerous.

Boncho 本草

5.9.13
Source원문

澁藥塞竅, 用童便煆爐甘石ㆍ牡蠣粉ㆍ龍骨ㆍ密陀僧. 《丹心》

Translation영역
For astringent medicines to plug the opening, use calamine calcined in boys' urine, oyster shell powder, dragon bone and litharge.

Dansim 丹心

5.9.14
Source원문

秘方用煉蜜半盞, 入熊膽一分, 再煉入水成珠不散, 將猪鬃綿裹撚成撚子, 將蜜塗在撚子上, 仍用片腦ㆍ熊膽各半分硏細搽在撚子上, 揷入漏眼內, 底至盡頭則止. 如眼多, 醫得一箇又醫一箇, 不可一齊上藥. 如外皮潰爛, 用黃蠟ㆍ黃丹ㆍ麻油煎膏貼瘡上, 縳緊, 一七日效. 《醫鑑》

Translation영역
A secret method: half a jan of refined honey with 1 pun of bear bile, refined again until it beads in water without dispersing; wrap a pig's bristle in cotton wool and twist it into a wick, smear the honey on the wick, grind borneol and bear bile 5 ri each and rub them on it, and insert it into the fistula's eye, stopping when it reaches the end. Where there are many eyes, treat one and then another and do not dress them all at once. Where the outer skin is ulcerated, boil beeswax, red lead and sesame oil into a paste, stick it on the sore and bind it tight, and in seven days it answers.
Clinical note임상 주석
A bristle wrapped in cotton, waxed and medicated, passed into the track until it reaches the end — and the instruction not to dress more than one track at a time. That is a seton and a staged dressing, and the handling is careful. **Red lead is toxic; the external paste should not be prepared.** Bear bile is from a CITES-listed species.

Uigam 醫鑑

5.9.15
Source원문

塞竅宜辰砂膏ㆍ生肌散ㆍ上品錠子ㆍ寸金錠子.

Translation영역
For plugging the opening: Cinnabar Paste, Engender the Flesh Powder, Superior Grade Pellet and Inch of Gold Pellet.

Donguibogam · Hueum

5.10 Prolapse of the Rectum 脫肛

5.10.1
Source원문

卽腸痔也. 脫肛者, 肛門飜出也. 肺與大腸爲表裏, 腎主大便, 肺腎虛者多有此證, 參芪湯升之. 《回春》

Translation영역
This is the intestinal pile. Prolapse of the rectum is the anus turning itself out. The lung and large intestine are outer and inner to each other and the kidney governs the stool, so those vacuous in lung and kidney mostly have this pattern: Ginseng and Astragalus Decoction raises it.

Hoechun 回春

5.10.2
Source원문

脫肛一證, 氣聚不散也. 裏急而不得出, 外脹而不得入. 先以枳殼散糝付則氣散腫消矣. 《直指》

Translation영역
Prolapse of the rectum is the qi gathered and not scattering: within there is urgency and it cannot come out, without there is distension and it cannot go in. First apply Bitter Orange Powder, and the qi scatters and the swelling goes down.

Jikji 直指

5.10.3
Source원문

難經曰, 病之虛實, 出者爲虛, 入者爲實. 肛門之脫非虛無故然哉. 其有産婦用力過多, 及小兒叫號努氣, 幷久痢不止, 風邪襲虛, 亦有此證. 《直指》

Translation영역
The Nanjing says: in the vacuity and repletion of disease, what comes out is vacuity and what goes in is repletion. Could the anus prolapse without vacuity? There are also cases from a woman in childbirth using too much force, from a child crying and straining, from long diarrhoea that does not stop, and from a wind evil falling on vacuity.
Clinical note임상 주석
小兒叫號努氣 — a child crying and straining. Three of the four causes named here are simply straining, and prolapse in a child after prolonged diarrhoea or crying is exactly what the chapter describes.

Jikji 直指

5.10.4
Source원문

脫肛者氣下陷也. 肺主魄門, 肺熱則肛門縮入, 肺寒則肛門脫出, 必須溫肺補胃, 補中益氣湯方見內傷加訶子ㆍ樗根白皮少許; 或蝟皮散ㆍ釣腸丸方見上. 血熱者四物湯加黃栢ㆍ升麻; 虛熱者縮砂散. 《入門》

Translation영역
Prolapse of the rectum is the qi fallen downward. The lung governs the corporeal-soul gate: where the lung is hot the anus draws in, where the lung is cold the anus prolapses, and one must warm the lung and supplement the stomach — Supplement the Centre and Boost the Qi Decoction formula in the Internal Damage chapter with a little chebula and ailanthus root bark added; or Hedgehog Skin Powder and Hook the Bowel Pill formula above. Where the blood is hot, Four Substances Decoction with phellodendron and cimicifuga; where the heat is vacuous, Amomum Powder.

Immun 入門

5.10.5
Source원문

脫肛宜龍骨散ㆍ二槐丹ㆍ獨虎散ㆍ蚊蛤散ㆍ浮萍散ㆍ孩兒散ㆍ熏鼈法.

Translation영역
For prolapse of the rectum: Dragon Bone Powder, Two Sophoras Elixir, Lone Tiger Powder, Gallnut Powder, Duckweed Powder, Cutch Powder and the turtle fumigation method.

Donguibogam · Hueum

5.10.6
Source원문

治脫肛不收, 五倍子末入白礬ㆍ蛇床子煎湯熏洗, 後以赤石脂末糝芭蕉葉上托入. 或長尺餘者, 以兩床相接中空, 以器盛藥水滿, 架起與床平, 令病者仰臥浸器中, 逐日如此, 縮盡爲度. 《得效》

Translation영역
To treat an anus that will not draw in: powdered gallnut with alum and cnidium seed decocted, fumigated and washed with; then dust powdered halloysite on a plantain leaf and push it back in with that. Where it hangs a cheok or more, set two couches together with a space between, fill a vessel with the medicinal water, raise it level with the couches and have the patient lie on their back soaking in it; do this daily until it has drawn wholly in.
Clinical note임상 주석
A vessel of warm medicated water set level between two couches so the patient can lie back and soak the part. It is a contrivance for a long prolapse, and the daily soaking is the same measure as 5.23's sitz bath.

Deukhyo 得效

5.10.1 The Soft-Shelled Turtle Fumigation Method 熏鼈法

5.10.1.1
Source원문

治脫肛, 取鼈一箇放罈內, 入麝香一二分, 將滾水傾入罈內泡鼈, 坐其上熏之, 良久將水洗痔. 後將肉作羹食之, 將鼈頭作末糝肛上. 《醫鑑》

Translation영역
To treat rectal prolapse: take a soft-shelled turtle and put it in a jar with 1 or 2 pun of musk; pour boiling water into the jar to steep the turtle, sit over it and let it fumigate the part, and after a good while wash the haemorrhoid with the water. Afterwards make a soup of the flesh and eat it, and powder the turtle's head and sprinkle it on the anus.
Clinical note임상 주석
Musk is prohibited and the turtle contributes nothing but the broth. What the patient gets is a steam sitz bath followed by a warm wash, which is the one part of the method that helps a prolapse back and eases the pain. The turtle's head powdered and sprinkled on is the organ-for-organ reasoning of the 鼈頭 entry in the simples below.

Uigam 醫鑑

5.10.2 Another Method 一方

5.10.2.1
Source원문

治久痢脫肛, 黑色生殼者, 巴豆殼燒灰, 芭蕉自然汁煮, 入朴硝少許, 洗軟, 用淸油點三滴, 放三角, 取白礬煆過ㆍ龍骨少許爲末, 乾糝肛頭, 以芭蕉葉托上便臥, 勿令出入. 《入門》

Translation영역
To treat rectal prolapse from a long dysentery, where it is black in colour and the coat is raw: croton husks burnt to ash and boiled in the natural juice of plantain, with a little crude mirabilite put in; wash the part soft with it, drop three drops of clear oil on, and set it in three places. Then take calcined alum with a little dragon bone, powdered, sprinkle the powder dry on the head of the bowel, push it back up on a plantain leaf and have the patient lie down at once, and let it not come out and in again.
Clinical note임상 주석
黑色生殼者 — black in colour with the coat raw — is a prolapse that has been out long enough to become congested and to have lost its surface, which is the point at which it can strangulate. The treatment described is careful and well staged: soften and clean the mucosa, lubricate it, dust it with an astringent, reduce it on a leaf rather than with the bare hand, and keep the patient lying down afterwards so that it stays in. That last instruction is the one still given.

Immun 入門

5.10.3 A Further Method 又方

5.10.3.1
Source원문

一女子脫肛, 以糯米濃煎汁洗肛, 却取塼燒紅沃醋, 靑布鋪其上, 令溫坐布上, 肛自吸入. 《綱目》

Translation영역
A girl had a prolapse of the rectum: the part was washed with a thick decoction of glutinous rice, then a brick was heated red and quenched with vinegar, a blue cloth spread over it, and when it was warm she was made to sit on the cloth, and the bowel drew itself in.

Gangmok 綱目

5.11 Itching and Pain of the Anus 肛門痒痛

5.11.1
Source원문

蟲痔多痒. 肛門作痒, 乃腸中有蟲. 生艾ㆍ苦練根煎湯熏洗, 仍以乾艾ㆍ生薑煎服. 《直指》

Translation영역
The worm pile mostly itches. Where the anus itches, there are worms in the bowel: decoct fresh mugwort and chinaberry root, fumigate and wash with it, and take dried mugwort and fresh ginger decocted.

Jikji 直指

5.11.2
Source원문

肛痒宜黑玉丹方見上ㆍ秦艽羌活湯, 又宜熏法見下. 治痒, 槐白皮或五加皮濃煎湯熏洗肛門. 《本草》 蟲蝕肛痒, 萹蓄葉一握, 水一升煮取五合, 去滓, 隔夜不食, 明晨空腹飮之, 蟲卽下. 小兒同法. 《丹心》

Translation영역
For an itching anus: Black Jade Elixir formula above, Gentiana Macrophylla and Notopterygium Decoction, and the fumigation method below. For the itching, decoct sophora root bark or acanthopanax bark thick and fumigate and wash the anus. For worms eroding with itching, a handful of knotgrass leaves boiled in a seung of water down to five hop and strained; eat nothing overnight and drink it next morning on an empty stomach, and the worms come down. The same method serves for a child.
Clinical note임상 주석
An anal itch that is worse at night and answers to a fast and a morning dose is pinworm, and this is the one place in the chapter where the worms are real.

Donguibogam · Hueum · Boncho 本草 · Dansim 丹心

5.11.3
Source원문

肛頭作大痛者, 火也. 又大便秘澁亦作大痛. 凡人醉飽行房, 忍泄前陰之氣歸於大腸, 木乘火熱而侮燥金, 故火就燥也, 大便必閉. 其疾甚者, 當以苦寒瀉火, 以辛溫和血潤燥, 踈風止痛, 是其治也. 宜秦芃白朮丸ㆍ七聖丸ㆍ秦芃當歸湯ㆍ當歸郁李仁湯ㆍ逐瘀湯方見上ㆍ寬腸丸ㆍ血竭散ㆍ淸心丸ㆍ枯礬散.

Translation영역
Where the head of the anus gives great pain, it is fire. Constipation also gives great pain. When a man lies with a woman drunk and full and holds back the discharge, the qi of the anterior yin turns back into the large intestine; wood mounts the fire's heat and slights the dry metal, and so the fire goes over to dryness, and the stool is certain to be blocked. Where the disease is severe, the treatment is to drain the fire with the bitter and cold, to harmonize the blood and moisten the dryness with the acrid and warm, and to dredge the wind and stop the pain. Gentiana Macrophylla and Atractylodes Pill, Seven Sages Pill, Gentiana Macrophylla and Angelica Decoction, Angelica and Bush-Cherry Seed Decoction, Expel Stasis Decoction formula above, Loosen the Intestine Pill, Dragon's Blood Powder, Clear the Heart Pill and Calcined Alum Powder are appropriate.
Clinical note임상 주석
The 痛 half of the section, and the one place in the chapter that explains anal pain rather than describing it. 火就燥 — fire going over to dryness — is the mechanism, and the clinical content survives the five-phase language intact: a hard stool and a fissure are what make a pile hurt, so the treatment both cools and moistens, and every formula in the list but one moves the bowel. 忍泄, holding back the discharge, is the Bogam's recurring caution against coitus reservatus, which it blames for pelvic congestion throughout the 前陰 and 後陰 chapters.

Donguibogam · Hueum

5.12 Piles Together with Other Diseases 痔兼諸病

5.12.1
Source원문

痔疾有兼下疳瘡者, 有莖中出白津者, 有兼瘦者. 皆肝腎不足變出, 勿專服寒凉藥. 《入門》

Translation영역
Pile disease is sometimes accompanied by chancre sores, sometimes by a white discharge from the stalk, sometimes by wasting. All of these come of liver and kidney insufficiency, and cold and cooling medicines must not be taken by themselves.
Clinical note임상 주석
勿專服寒凉藥 — do not take cold medicines alone. The caution the chapter keeps returning to: where piles come with wasting or with a genital complaint, the patient is depleted and cooling alone will make it worse.

Immun 入門

5.13 The Method of Treating Pile Disease 痔病治法

5.13.1
Source원문

痔以凉血爲主. 盖熱則傷血, 血滯則氣亦不運, 而大腸下墜作痛. 大要以槐花ㆍ槐角ㆍ生地黃凉血, 川芎ㆍ當歸ㆍ桃仁和血生血, 枳殼行氣寬腸, 黃芩ㆍ黃連ㆍ梔子淸熱, 黃栢ㆍ防己ㆍ澤瀉去濕, 麻仁ㆍ大黃潤燥, 秦艽ㆍ荊芥疎風. 《入門》

Translation영역
Piles are treated above all by cooling the blood: heat damages the blood, the blood stagnating the qi too does not move, and the large intestine bears down and pains. The essentials are sophora flower, sophora husk and fresh rehmannia to cool the blood; chuanxiong, angelica and peach kernel to harmonize and engender it; bitter orange to move the qi and loosen the intestine; scutellaria, coptis and gardenia to clear heat; phellodendron, stephania and alisma to remove damp; hemp seed and rhubarb to moisten dryness; gentiana macrophylla and schizonepeta to course wind.
Clinical note임상 주석
Seven jobs with the medicinals for each, in one sentence. It is the chapter's whole pharmacology set out as a checklist, and every decoction in it is built from this list.

Immun 入門

5.13.2
Source원문

治法以苦寒瀉火, 芩連梔子槐花之類; 以辛溫和血, 當歸川芎桃仁之類. 風邪在下, 秦艽防風升麻之類提之; 燥熱怫鬱, 大黃枳殼麻仁之類潤之. 《正傳》

Translation영역
The method is to drain fire with the bitter and cold — scutellaria, coptis, gardenia and sophora flower and their kind; and to harmonize the blood with the acrid and warm — angelica, chuanxiong and peach kernel and their kind. Where a wind evil is below, gentiana macrophylla, saposhnikovia and cimicifuga and their kind raise it; where dry heat is pent up, rhubarb, bitter orange and hemp seed and their kind moisten it.

Jeongjeon 正傳

5.13.3
Source원문

諸痔皆由房酒過度, 久嗜甘肥, 不愼醉飽以合陰陽, 勞擾血脉, 腸澼滲漏, 衝注下部, 肛邊生瘡, 變爲痔疾. 初發便服槐角丸; 熱實服湯藥疎利藏府, 及浴洗熏熨以取內消. 若變成痔瘻, 須用寸金錠子三五次痊愈. 《東垣》

Translation영역
All piles come of bedchamber and wine beyond measure, a long liking for sweet and fat things, and not taking care but joining yin and yang while drunk and full, so that the blood vessels are taxed and disturbed, the intestine seeps and leaks, it surges down into the lower part, sores arise at the edge of the anus and it turns into pile disease. At the first outbreak take Sophora Fruit Pill; where there is repletion heat take decoctions to free the viscera and bowels, with bathing, washing, fumigating and ironing to disperse it from within. If it turns into a fistulous pile, Inch of Gold Pellet used three to five times heals it.
Clinical note임상 주석
浴洗熏熨以取內消 — bathing, washing, fumigating and ironing, to disperse it from within. The chapter's organizing idea: medicine by mouth and treatment at the part, working toward each other, and the four external sections that follow are all this one clause expanded.

Dongwon 東垣

5.14 The General Treatment of Pile Disease 痔病通治

5.14.1
Source원문

一切痔病通治, 宜槐膽丸方見身形ㆍ槐角丸ㆍ加味槐角丸ㆍ秦艽蒼朮湯ㆍ蝟皮丸ㆍ釣腸丸ㆍ黑玉丹ㆍ五痔散ㆍ神應散八方皆見上ㆍ水馬散ㆍ三神丸. 久痔宜用黑地黃丸ㆍ蓮花蘂散方見上.

Translation영역
For the general treatment of any pile disease: Sophora and Gall Pill formula in the Body chapter, Sophora Fruit Pill, Supplemented Sophora Fruit Pill, Gentiana Macrophylla and Atractylodes Decoction, Hedgehog Skin Pill, Hook the Bowel Pill, Black Jade Elixir, Five Piles Powder and Divine Response Powder all eight above, Water Strider Powder and Three Spirits Pill. For long-standing piles, Black Rehmannia Pill and Lotus Stamen Powder formula above.

Donguibogam · Hueum

5.15 The Method of Washing Piles 洗痔法

5.15.1
Source원문

凡痔疾內服湯丸疎利藏府, 外用藥水洗浴以取內消. 《東垣》 凡痔漏脫肛腸風者, 登溷後須用溫湯一洗, 江河水尤妙. 《直指》

Translation영역
In any pile disease, decoctions and pills are taken inwardly to free the viscera and bowels, and a medicinal water is used outwardly to bathe with and so disperse it from within. Anyone with fistulous piles, prolapse or intestinal wind should wash once with warm water after going to the privy, and river water is better still.
Clinical note임상 주석
登溷後須用溫湯一洗 — wash with warm water after every visit to the privy. One line, and it is the single most useful thing in this chapter. The Jikji gives it as a standing instruction rather than a treatment.

Dongwon 東垣 · Jikji 直指

5.15.2
Source원문

腸虛熱湊, 脫肛紅腫, 荊芥穗ㆍ朴硝泡湯溫洗. 《直指》 治痔腫痒痛, 威靈仙ㆍ枳殼 各一兩麤末, 煎湯先熏後洗, 冷則易; 枳實亦好. 《綱目》 洗痔方, 槐花ㆍ荊芥ㆍ枳殼ㆍ艾葉煎湯入白礬, 先熏後洗. 《得效》 無花果葉煮水熏洗亦可. 《丹心》

Translation영역
Where the intestine is vacuous and heat gathers with the prolapse red and swollen, steep schizonepeta spike and mirabilite in hot water and wash warm with it. To treat piles swollen, itching and painful, grind clematis and bitter orange 1 nyang each coarse, decoct, fumigate first and wash after, changing it as it cools; immature bitter orange serves too. A washing formula: sophora flower, schizonepeta, bitter orange and mugwort leaf decocted with alum added, fumigated with first and washed with after. Fig leaves boiled in water to fumigate and wash with will also do.

Jikji 直指 · Gangmok 綱目 · Deukhyo 得效 · Dansim 丹心

5.15.3
Source원문

洗痔瘻方, 川椒ㆍ艾葉ㆍ葱白ㆍ五倍子ㆍ焰硝ㆍ馬齒莧ㆍ茄子根, 右剉水煎, 先熏後洗. 《醫鑑》 翻花痔, 荊芥ㆍ防風ㆍ焰硝煎湯熏洗, 次用木鼈子ㆍ鬱金硏末, 入龍腦少許, 水調塗之. 《丹心》 洗痔漏神效, 隨河柳根上鬚一把ㆍ花椒ㆍ芥菜子不拘多少, 煎水先熏後洗, 其虫頭黑身白俱從漏瘡而出, 立愈. 《回春》 痔痛不可忍, 木綿花煎湯入焰硝熏洗, 單用硝水極妙. 《綱目》 痔痒, 取河水頻洗, 硏蝸牛塗之. 《綱目》 脫肛, 苦參ㆍ五倍子ㆍ東壁土煎湯熏洗; 又熱童尿和白礬末熏洗, 以烘熱鞋底搽入. 《回春》 痔漏宜用却毒湯.

Translation영역
A formula for washing fistulous piles: Sichuan pepper, mugwort leaf, scallion white, gallnut, saltpetre, purslane and aubergine root, cut up and decocted in water, fumigated with first and washed with after. For the turned-flower pile, decoct schizonepeta, saposhnikovia and saltpetre to fumigate and wash with, then grind momordica seed and curcuma to powder, add a little borneol, mix with water and apply it. Of excellent effect for washing a pile fistula: a handful of the beard from a riverside willow's root, with Sichuan pepper and mustard seed in any quantity, boiled in water to fumigate with first and wash with after — the worms, black-headed and white-bodied, all come out of the fistula sore, and it heals at once. Where the pain of piles is past bearing, decoct cotton flower with saltpetre added and fumigate and wash; saltpetre water alone is excellent. For itching piles, wash often with river water and apply ground snail. For prolapse, decoct flavescent sophora, gallnut and east-wall earth to fumigate and wash with; or mix hot boys' urine with powdered alum to fumigate and wash, and push the bowel in with a warmed shoe sole. For fistulous piles, Drive Off Toxin Decoction.

Uigam 醫鑑 · Dansim 丹心 · Hoechun 回春 · Gangmok 綱目 · Donguibogam · Hueum

5.16 The Method of Fumigating Piles 熏痔法

5.16.1
Source원문

治五痔及瘻漏蟲蝕下膿血. 蝟皮三指大(剉), 雄黃如棗子大, 熟艾鷄子大. 右麤末, 入瓦缸內火燒, 坐其上熏之, 取烟氣從口中出爲佳. 三日將息, 更熏之, 三度永差. 忌鷄猪魚生冷毒物. 《三因》

Translation영역
Treats the five piles and seeping fistula with worms eroding and a discharge of pus and blood. Hedgehog skin three fingers' breadth, cut up; realgar the size of a jujube; prepared mugwort the size of a hen's egg. Grind coarse, put into an earthen jar and set alight, and sit over it to be fumigated; it is best when the smoke is felt coming out at the mouth. Rest three days and fumigate again, and three times over cures it for good. Avoid chicken, pork, fish and raw, cold and toxic things. — Samin 三因 (Donguibogam · Hueum)
Clinical note임상 주석
取烟氣從口中出爲佳 — best when the smoke comes out at the mouth. The endpoint is nonsense as anatomy and the realgar makes the smoke arsenical. **Burning realgar produces arsenic trioxide fumes. This must not be prepared.**

Samin 三因

5.16.2
Source원문

治五痔痔漏, 鰻鱺魚火燒熏肛門, 痔蟲盡死; 蠡魚亦佳. 《本草》 又法, 死蛇一條, 掘地作坑, 盤屈置其中, 火燒, 以有孔板子覆坑, 坐板孔上熏之, 瘻蟲出盡大效. 《本草》

Translation영역
Treats the five piles and fistulous piles: burn an eel and fumigate the anus with it, and the pile worms all die; the snakehead serves too. Another method: take a dead snake, dig a pit, coil it in and set it alight; cover the pit with a board that has a hole in it and sit over the hole to be fumigated, and the fistula worms all come out — greatly effective.

Boncho 本草

5.17 Medicines Smeared on Piles 塗痔藥

5.17.1
Source원문

治諸痔, 宜塗熊氷膏ㆍ痔藥膏子ㆍ蝸牛散ㆍ田螺膏ㆍ蜈蚣油ㆍ枯痔方ㆍ黑聖散.

Translation영역
To treat piles of every kind, smear on: Bear Bile and Borneol Paste, the Pile Medicine Paste, Snail Powder, River Snail Paste, Centipede Oil, the Withering the Pile Formula and Black Sage Powder.

Donguibogam · Hueum

5.17.2
Source원문

脫肛不收, 蝸牛燒爲末, 猪脂和付之立縮; 緣桑蝸牛尤妙. 《直指》 治痔瘻, 田螺一箇, 挑開靨入片腦少許, 過一宿, 先以冬瓜煎湯洗, 後取藥塗之. 《丹心》

Translation영역
Where a prolapse will not draw in, burn snails to a powder, mix with lard and apply, and it draws in at once; snails taken from a mulberry tree are better still. To treat fistulous piles, prick open the lid of one river snail, put in a little borneol and leave overnight; first wash with a decoction of winter melon, then apply the medicine.

Jikji 直指 · Dansim 丹心

5.17.3
Source원문

治痔, 活蜈蚣一條浸香油內, 候生黴略熬, 塗痔上, 累驗, 陳久愈妙. 《綱目》 枯痔方, 赤足蜈蚣一條香油煎酥, 挹乾, 加乳香ㆍ沒藥 各二錢, 麝香ㆍ粉霜 各五分, 人指爪甲 五錢泥裹煨乾, 爲末, 以鵝翎管吹上患處, 如有水卽時出盡不疼. 《綱目》

Translation영역
To treat piles: steep one live centipede in sesame oil, and when mould has formed boil it a little and smear it on the piles — proved over and over, and the longer it has stood the better. A withering formula: fry one red-footed centipede crisp in sesame oil and drain it; add frankincense and myrrh 2 don each, musk and sublimed calomel 5 pun each, and 5 don of human nail parings wrapped in clay and roasted dry; powder them and blow onto the affected place through a goose quill, and if there is fluid it all comes out at once without pain.
Clinical note임상 주석
**Contains sublimed calomel, a mercury compound, blown onto a raw surface; centipede is toxic. This must not be prepared.**

Gangmok 綱目

5.18 What Is Forbidden in Pile Disease 痔病禁忌

5.18.1
Source원문

久痔虛者當服補藥, 如黑地黃丸方見上ㆍ腎氣丸方見虛勞, 以滋化源; 更節嗜慾, 謹起居, 方可斷根. 《入門》

Translation영역
One with long-standing piles who is vacuous should take supplementing medicines — Black Rehmannia Pill formula above and Kidney Qi Pill formula in the Vacuity Taxation chapter — to enrich the source of transformation; and he must moderate his appetites and be careful in rising and resting before the root can be cut off.

Immun 入門

5.18.2
Source원문

治痔忌喫生冷硬物ㆍ冷藥之類, 及酒ㆍ濕麪ㆍ五辢ㆍ辛熱大料物及薑桂之類, 犯之則服藥無效. 此東垣格言也. 《綱目》

Translation영역
In treating piles, avoid raw, cold and hard foods and cold medicines, and wine, damp wheat food, the five pungents, acrid hot spices and ginger and cinnamon and their kind; offend in this and the medicine taken has no effect. This is Dongwon's maxim.

Gangmok 綱目

5.18.3
Source원문

痔根本是冷, 愼冷飮食及房勞. 鷄肉最毒, 而房勞爲尤甚. 蕎麥麪亦須忌之. 《綱目》 宜常服茯苓麪. 《入門》

Translation영역
Piles are at root a cold thing: be careful of cold food and drink and of bedchamber taxation. Chicken is the most harmful, and bedchamber taxation worse still; buckwheat noodles must also be avoided. Poria Flour should be taken regularly.
Clinical note임상 주석
房勞爲尤甚 — bedchamber taxation worse still. 5.3 named wine, food and sex as the three causes, and this section closes by naming the same three as what will undo the treatment.

Gangmok 綱目 · Immun 入門

5.19 Ominous Signs in Pile Disease 痔病凶證

5.19.1
Source원문

久痔與陰相通者死. 《甲乙》

Translation영역
Where a long-standing pile has come to communicate with the genitals, death.
Clinical note임상 주석
與陰相通 — a track opening through to the genitals. A recto-vaginal or recto-urethral fistula, which before surgery was indeed what the Gabeul says it was.

Gabeul 甲乙經

5.19.2
Source원문

痔漏成穴, 大小便相通者亦死. 《甲乙》

Translation영역
Where a haemorrhoidal fistula has formed a hole and the stool and the urine pass by a single way, this too is fatal.
Clinical note임상 주석
The same judgement carried one step further: the first passage is a track into the genitals, this one a track that lets stool and urine out by one road. Faecal matter entering the bladder gives an ascending infection that was not survivable, and the Gabeul is right for its time. Both are repaired surgically now.

Gabeul 甲乙經

5.20 Simple Medicinals 單方

5.20.1
Source원문

凡三十三種. 有槐花散ㆍ猪甲散.

Translation영역
Thirty-three kinds in all. There are Goehwa-san 槐花散, Sophora Flower Powder, and Jeogap-san 猪甲散, Pig's Dewclaw Powder.

Donguibogam · Hueum

5.20.2
Source원문

生鐵汁 治痔瘻脫肛. 生鐵三斤ㆍ水一斗, 煮取五升, 日再洗. 《本草》

Translation영역
Raw iron water (生鐵汁): Treats haemorrhoidal fistula and rectal prolapse. Raw iron 3 geun and water 1 mal, boiled down to 5 seung, and the part washed with it twice a day.

Boncho 本草

5.20.3
Source원문

東壁土 治脫肛. 取土湯泡, 先熏後洗. 亦治小兒脫肛. 《丹心》

Translation영역
Earth from the east wall (東壁土): Treats rectal prolapse. Take the earth, infuse it in hot water, fumigate the part first and then wash it. It also treats rectal prolapse in children.
Clinical note임상 주석
先熏後洗 — fumigate first, then wash — is the standing order for everything applied to the anus in this chapter, and the sequence is sensible: the steam relaxes the sphincter and eases the prolapse back, and the wash cleans. Rectal prolapse in a child is usually managed conservatively and often resolves; in an adult it needs surgical assessment.

Dansim 丹心

5.20.4
Source원문

車前草 治藏毒下血. 車前草連根一握ㆍ生薑一小塊, 新水硏碎取汁, 候血欲下時腰間必覺重, 便服一盞, 血卽止. 甚者不過再服. 《丹心》

Translation영역
Plantain herb (車前草): Treats visceral toxin with blood descending. Plantain herb with its root, a handful, and a small piece of fresh ginger, ground up in fresh water and the juice taken; when the blood is about to come down the loins are bound to feel heavy, and at that point take 1 jan and the blood stops at once. In severe cases no more than a second dose is needed.
Clinical note임상 주석
候血欲下時腰間必覺重 — when the blood is about to come down the loins feel heavy — is a prodrome, and the entry tells the patient to take the medicine at that moment rather than on a schedule. That is unusual in this literature and it is good practice: the patient is taught to recognize their own warning sign.

Dansim 丹心

5.20.5
Source원문

白芷 治痔. 以白芷煮白苧作線, 快手緊繫痔上, 微疼不妨, 其痔自然乾萎而落. 《得效》

Translation영역
Dahurian angelica (白芷): Treats haemorrhoids. Boil white ramie thread in dahurian angelica and make a ligature of it; tie it tightly round the haemorrhoid with a quick hand. A slight pain does no harm, and the haemorrhoid dries, withers and falls away of itself.
Clinical note임상 주석
This is ligation, and it is the ancestor of a procedure still in use: a band tied round the base of an internal haemorrhoid cuts off its blood supply so that it necroses and sloughs, which is exactly what rubber-band ligation does. The description of the mechanism — 乾萎而落, it dries, withers and falls — is correct. Done with a thread and no anoscope it risks banding sensate skin below the dentate line, which is agonizing, and causing bleeding or sepsis when the stump separates. The modern procedure is the same idea done safely.

Deukhyo 得效

5.20.6
Source원문

艾葉 治痔漏蟲蝕肛門. 熟艾一團ㆍ雄黃少許, 同燒火, 以竹筒納下部, 引烟熏之, 良. 《本草》

Translation영역
Mugwort leaf (艾葉): Treats haemorrhoidal fistula with worms eating at the anus. A ball of matured mugwort with a little realgar, burnt together; put a bamboo tube into the lower part and draw the smoke in to fumigate it — good.
Clinical note임상 주석
**Realgar is not to be used.** It is arsenic sulphide, and burning it gives off arsenic trioxide fumes which are being directed into the rectum through a tube. Mugwort smoke alone is harmless. 蟲蝕肛門, worms eating at the anus, is pinworm, which causes the perianal itching this is given for and is cured with a single dose of mebendazole.

Boncho 本草

5.20.7
Source원문

雞冠花 治血痔. 取花不拘多少, 濃煎湯, 空心服一盞. 《綱目》

Translation영역
Cockscomb flower (雞冠花): Treats bleeding haemorrhoids. Take the flowers, any amount, decoct them strongly and take 1 jan on an empty stomach.

Gangmok 綱目

5.20.8
Source원문

木賊 主腸風ㆍ血痔及脫肛. 同槐花及桑耳水煎. 脫肛爲末, 糝肛托入. 《得效》

Translation영역
Horsetail (木賊): Governs intestinal wind, bleeding haemorrhoids and rectal prolapse. Decoct it in water with pagoda tree flower and mulberry tree ear. For prolapse, powder it, sprinkle it on the anus and push it back in.

Deukhyo 得效

5.20.9
Source원문

槐花 主五痔及腸風藏毒. 槐花炒, 水煎服. 或同荊芥ㆍ側栢葉爲末, 米飮下二錢, 名曰槐花散. 《丹心》 ○腸風, 槐花炒爲末, 塡入猪腸內, 縛扎兩頭, 醋煮爛, 硏爲丸, 酒下三十丸. 《得效》

Translation영역
Pagoda tree flower (槐花): Governs the five haemorrhoids, intestinal wind and visceral toxin. Pagoda tree flower parched, decocted in water and taken. Or powdered with schizonepeta and biota leaf, 2 don taken down with rice water; it is called Goehwa-san 槐花散, Pagoda Tree Flower Powder. ○ For intestinal wind: pagoda tree flower parched and powdered, stuffed into a pig's intestine, both ends tied off, boiled soft in vinegar, ground and made into pills, 30 taken down with wine.
Clinical note임상 주석
The pig's intestine is a delivery vehicle chosen by organ: the drug for the bowel is carried in a bowel. 槐花散 is the one formula this section names, and pagoda tree flower with biota leaf is still the standard pair for rectal bleeding in Korean practice. 腸風 and 藏毒 are the chapter's two names for blood in the stool — bright and sudden for the first, dark and mixed in for the second — and that distinction is the clinically useful part: dark blood mixed with stool is from higher up and needs investigating.

Dansim 丹心 · Deukhyo 得效

5.20.10
Source원문

槐實 治五痔及腸風藏毒. 剉擣爲末, 米飮下一錢. 或蜜丸服亦佳. 《本草》

Translation영역
Pagoda tree fruit (槐實): Treats the five haemorrhoids, intestinal wind and visceral toxin. Cut it up, pound it to a powder, and take 1 don down with rice water. Or made into honey pills and taken, which is also good.

Boncho 本草

5.20.11
Source원문

槐木上耳 治諸痔及腸風藏毒. 取耳爲末, 米飮下一錢, 日三. 《本草》

Translation영역
Wood ear from the pagoda tree (槐木上耳): Treats all haemorrhoids, intestinal wind and visceral toxin. Take the ear, powder it, and take 1 don down with rice water, three times a day.

Boncho 本草

5.20.12
Source원문

桑木耳 治五痔及腸風下血ㆍ痔漏. 桑耳 二兩ㆍ粳米 三合, 煮粥, 空心食之. 《入門》

Translation영역
Mulberry tree ear (桑木耳): Treats the five haemorrhoids, intestinal wind with blood descending, and haemorrhoidal fistula. Mulberry tree ear 2 nyang and polished rice 3 hop, boiled into a gruel and eaten on an empty stomach.

Immun 入門

5.20.13
Source원문

大樹木上寄生 治腸風痔漏如神. 取葉乾爲末, 水ㆍ酒ㆍ米飮任下一錢. 或爲丸服亦佳. 《丹心》

Translation영역
Mistletoe from a great tree (大樹木上寄生): Treats intestinal wind and haemorrhoidal fistula as if by a spirit. Take the leaves, dry them and powder them, and take 1 don down with water, wine or rice water as you please. Or made into pills and taken, which is also good.

Dansim 丹心

5.20.14
Source원문

馬藺根 治痔漏. 取根硏細付上, 片時看肉平, 去藥. 稍遲恐肉反出, 以爐甘石煆ㆍ牡蠣粉末塞之. 《丹心》

Translation영역
Iris root (馬藺根): Treats haemorrhoidal fistula. Take the root, grind it fine and apply it; after a short while look, and when the flesh is level take the medicine off. If it is left too long the flesh may be driven out instead, and then calcined calamine and oyster shell powder should be packed in.
Clinical note임상 주석
稍遲恐肉反出 — if left too long the flesh may be driven out instead — is a caution written by someone who had seen it happen, and it is what an escharotic does when applied beyond its endpoint. This is a chemical destruction of fistula tissue, and a fistula-in-ano needs surgical assessment: an incompletely treated one recurs, and a fistula with Crohn's disease behind it is a different problem entirely.

Dansim 丹心

5.20.15
Source원문

五倍子 主五痔及腸風脫肛. 五倍子ㆍ白礬 各五錢, 爲末, 順流水丸如梧子, 米飮下七丸. 《綱目》 ○脫肛, 五倍子末三錢ㆍ白礬一塊, 同煎湯, 先熏後洗. 又取末糝肛托入. 《綱目》

Translation영역
Chinese gall (五倍子): Governs the five haemorrhoids, intestinal wind and rectal prolapse. Chinese gall and alum, 5 don each, powdered, made into pills the size of a paulownia seed with downstream water, and 7 taken down with rice water. ○ For rectal prolapse: Chinese gall powder 3 don and a lump of alum, decocted together; fumigate first and then wash. Or take the powder, sprinkle it on the anus and push it back in.
Clinical note임상 주석
Gallnut and alum are the two strongest astringents in the materia medica and this is the combination the chapter relies on for a prolapse. The action is real — a tannin and an aluminium salt on prolapsed mucosa shrink and toughen it — and the same principle is behind the astringent suppositories still sold for piles.

Gangmok 綱目

5.20.16
Source원문

樗根白皮 主血痔ㆍ腸風藏毒. 取皮切, 酒浸蜜炒, 爲末, 棗肉和丸, 酒下三五十丸. 《丹心》 ○又取皮ㆍ人參 等分爲末, 空心米飮下二錢亦佳. 《丹心》

Translation영역
Ailanthus root bark (樗根白皮): Governs bleeding haemorrhoids, intestinal wind and visceral toxin. Take the bark, cut it up, steep it in wine and parch it with honey, powder it, make pills with jujube flesh, and take 30 to 50 down with wine. ○ Or take the bark with ginseng in equal parts, powdered, and take 2 don on an empty stomach down with rice water, which is also good.

Dansim 丹心

5.20.17
Source원문

蠡魚 主五痔及腸痔下血. 作膾和薑虀食之. 又和五味作羹食之亦佳. 《本草》

Translation영역
Snakehead fish (蠡魚): Governs the five haemorrhoids and intestinal haemorrhoids with blood descending. Dress it raw and eat it with ginger and pickle. Or make a soup of it dressed with the five flavours and eat it, which is also good.

Boncho 本草

5.20.18
Source원문

鯽魚 治五痔及血痔. 作膾和薑ㆍ醋ㆍ芥ㆍ醬食之, 又作羹飽食良. 《本草》 ○痔漏, 鯽魚一箇, 去腸, 入白礬令滿, 合之, 於瓦上燒過爲末, 以雞羽掃藥付之, 立效. 《綱目》

Translation영역
Crucian carp (鯽魚): Treats the five haemorrhoids and bleeding haemorrhoids. Dress it raw and eat it with ginger, vinegar, mustard and soy; or make a soup of it and eat your fill, which is good. ○ For haemorrhoidal fistula: one crucian carp, gutted, filled with alum and closed up, burnt through on a tile and powdered; brush the medicine on with a chicken feather and it takes effect at once.

Boncho 本草 · Gangmok 綱目

5.20.19
Source원문

猬皮 主五痔ㆍ痔漏ㆍ腸風ㆍ脫肛一切痔病. 取皮燒爲末, 米飮下一錢, 空心. 《本草》 ○氣痔, 猬皮ㆍ穿山甲 等分ㆍ肉豆蔲減半, 爲末, 米飮下一錢. 《本草》 ○痔漏, 猬膽一箇汁ㆍ膩粉ㆍ麝香 各少許, 和入一箇牛膽內, 懸簷前四十九日, 旋取如大麥許, 揷入瘡口內, 追出惡物是驗. 《本草》

Translation영역
Hedgehog skin (猬皮): Governs the five haemorrhoids, haemorrhoidal fistula, intestinal wind, rectal prolapse and every haemorrhoidal disease. Take the skin, burn it, powder it, and take 1 don down with rice water on an empty stomach. ○ For qi haemorrhoids: hedgehog skin and pangolin scale in equal parts with half as much nutmeg, powdered, 1 don taken down with rice water. ○ For haemorrhoidal fistula: the bile of one hedgehog's gall with a little calomel and a little musk, mixed and put inside an ox gall bladder, hung under the eaves for forty-nine days; then take out a piece the size of a barley grain and insert it into the mouth of the sore, and when the malign matter is drawn out, that is the proof.
Clinical note임상 주석
**The third method is not to be prepared.** 膩粉 is calomel, mercurous chloride, packed into a fistula tract, and musk is prohibited. Pangolins in the second method are listed on CITES Appendix I and trade in their scales is banned outright; hedgehogs are protected in Korea. Nothing in this entry can lawfully be obtained, and the fistula it treats needs surgery.

Boncho 本草

5.20.20
Source원문

露蜂房 主腸痔及痔漏. 有子蜂房焙乾爲末, 麪糊和丸梧子大, 空心酒下二三十丸. 《回春》

Translation영역
Hornet's nest (露蜂房): Governs intestinal haemorrhoids and haemorrhoidal fistula. A nest with grubs in it, dried over a fire and powdered, made into pills the size of a paulownia seed with wheat-flour paste, and 20 to 30 taken on an empty stomach down with wine.

Hoechun 回春

5.20.21
Source원문

鼈頭 治脫肛不收. 灸作末, 米飮調下一錢. 又取末油調付肛托入. 《本草》

Translation영역
Turtle's head (鼈頭): Treats a rectal prolapse that will not go back. Roast it, powder it, and take 1 don stirred into rice water. Or take the powder, mix it with oil, apply it to the anus and push it back in.

Boncho 本草

5.20.22
Source원문

鰻鱺魚 治五痔瘻瘡. 取魚治如食法, 煮熟, 入椒ㆍ鹽ㆍ醬調和食之. 《本草》

Translation영역
Japanese eel (鰻鱺魚): Treats the five haemorrhoids and fistulous sores. Take the fish, dress it as for food, boil it through, and eat it seasoned with pepper, salt and soy.

Boncho 本草

5.20.23
Source원문

蛙 蟲蝕肛腸穿者, 取金線蛙一枚ㆍ雞骨二錢半, 燒爲灰, 合吹下部, 令深入, 數用大驗. 《本草》

Translation영역
Frog (蛙): Where worms have eaten at the anus and the bowel is perforated: take one gold-thread frog and 2½ don of chicken bone, burn them to ash, and blow the mixture into the lower part so that it goes deep in; used repeatedly it is greatly proven.
Clinical note임상 주석
腸穿, the bowel perforated, is either a perforation — which is a surgical emergency with a high mortality — or, more likely here, a fistula opening through to the skin. Either way blowing ash into it does nothing for it.

Boncho 本草

5.20.24
Source원문

蘿蔔 治酒痔下血. 取二十枚, 留葉寸許及根, 入罐內水煮極爛, 以薑ㆍ鹽ㆍ醋同淹, 空心食之, 立止. 《入門》

Translation영역
Radish (蘿蔔): Treats wine haemorrhoids with blood descending. Take twenty radishes, leaving about a chon of leaf and the root, put them in a jar and boil them in water until very soft, pickle them with ginger, salt and vinegar, and eat them on an empty stomach; the bleeding stops at once.

Immun 入門

5.20.25
Source원문

胡荽子 治五痔. 水煮取汁, 冷服半升, 日二. ○腸頭出, 取子燒烟熏, 卽入. 又醋煮熨之亦效. 《本草》

Translation영역
Coriander seed (胡荽子): Treats the five haemorrhoids. Boil it in water, take the liquid and drink half a seung cold, twice a day. ○ Where the head of the bowel protrudes: burn the seed and fumigate with the smoke, and it goes back in. Or boil it in vinegar and iron the part with it, which is also effective.

Boncho 本草

5.20.26
Source원문

葱白 治腸痔下血. 多取濃煮作湯, 盛盆熏之, 立差. ○肛熱腫, 取靑葉刮取涎, 對停入蜜, 調勻, 先以藥水洗, 後付痔上, 其冷如氷. 《得效》

Translation영역
Scallion white (葱白): Treats intestinal haemorrhoids with blood descending. Take a quantity, boil it strongly into a decoction, put it in a basin and fumigate the part over it, and it is cured at once. ○ For the anus hot and swollen: take the green leaves, scrape off the mucilage, add an equal measure of honey and mix it evenly; wash first with medicinal water and then apply it on the haemorrhoid, and it is as cold as ice.
Clinical note임상 주석
其冷如氷, as cold as ice, is a description of sensation rather than temperature — the scallion mucilage with honey is a cooling gel on inflamed anoderm, and that is as sound a piece of symptomatic treatment as this chapter offers. A sitz bath and a soothing application remain the first thing for an acutely painful pile.

Deukhyo 得效

5.20.27
Source원문

冬瓜藤 主痔瘻. 取藤濃煮湯, 熏洗卽愈. 《丹心》

Translation영역
Wax gourd vine (冬瓜藤): Governs haemorrhoidal fistula. Take the vine, boil it strongly, and fumigate and wash with it, and it heals.

Dansim 丹心

5.20.28
Source원문

啄木鳥 主痔漏. 燒爲末, 納孔中, 不過二三度差. 《本草》

Translation영역
Woodpecker (啄木鳥): Governs haemorrhoidal fistula. Burn it, powder it, and put it into the opening; in no more than two or three applications it is cured.
Clinical note임상 주석
The woodpecker is given because it bores holes and so, by reversal, closes them. The same bird appears in the Worm chapter against the consumption worm, where it is fed cinnabar first; here it is at least only burnt.

Boncho 本草

5.20.29
Source원문

牛脾 治諸痔. 臘月牛脾一具, 熟食之, 勿與鹽醬. 未差再喫. 《本草》

Translation영역
Ox spleen (牛脾): Treats all haemorrhoids. One ox spleen taken in the twelfth month, cooked through and eaten, with no salt or soy given with it. If it is not cured, eat it again.

Boncho 本草

5.20.30
Source원문

鼠狼皮 治痔瘻. 取皮缸內燒烟, 坐其上熏之, 三五度除根. 《綱目》

Translation영역
Weasel skin (鼠狼皮): Treats haemorrhoidal fistula. Burn the skin in a jar to make smoke, sit over it and let it fumigate the part; in three to five applications the root of it is removed.
Clinical note임상 주석
坐其上熏之, sitting over it to be fumigated — this is the smoke version of a sitz bath, and the chapter has four of them in this section alone. Whatever the material burnt, the warmth and the sitting are what the patient gets, and both help.

Gangmok 綱目

5.20.31
Source원문

狸肉 主五痔甚妙. 取肉作羹食之, 空心作脯食亦良. ○痔漏, 狸骨灸和麝香ㆍ雄黃爲丸服, 或爲末酒下二錢, 十服見效. 《綱目》

Translation영역
Wildcat flesh (狸肉): Governs the five haemorrhoids and is very excellent. Take the flesh, make a soup of it and eat it; dried into jerky and eaten on an empty stomach it is also good. ○ For haemorrhoidal fistula: wildcat bone roasted and made into pills with musk and realgar and taken, or powdered and 2 don taken down in wine; in ten doses it shows its effect.
Clinical note임상 주석
**The second method is not to be prepared.** Realgar is arsenic sulphide and musk is prohibited; the wildcat is protected in Korea.

Gangmok 綱目

5.20.32
Source원문

猪懸蹄 主五痔. 蹄甲不以多少, 燒爲末, 米飮下二錢, 名曰猪甲散. 《丹心》

Translation영역
Pig's dewclaw (猪懸蹄): Governs the five haemorrhoids. The hoof horn, any amount, burnt and powdered, 2 don taken down with rice water; it is called Jeogap-san 猪甲散, Pig Hoof Powder.
Clinical note임상 주석
猪甲散 is the second of this section's two named formulas, and it is one burnt ingredient. Hoof horn is keratin and pharmacologically inert; what it supplies is an absorbent powder.

Dansim 丹心

5.20.33
Source원문

野猪肉 主血痔ㆍ腸風瀉血. 取肉二斤切, 着五味灸熟, 空心食之. 作羹亦得. 又取外腎連皮燒作末, 米飮下, 空心, 卽止. 《本草》

Translation영역
Wild boar flesh (野猪肉): Governs bleeding haemorrhoids and intestinal wind pouring blood. Take 2 geun of the flesh, cut up, season it with the five flavours, roast it through and eat it on an empty stomach. Made into a soup it will also serve. Or take the testes with the skin on, burn them and powder them, and take the powder down with rice water on an empty stomach, and the bleeding stops at once.

Boncho 本草

5.20.34
Source원문

鼴鼠 主痔漏ㆍ陰蝕爛瘡. 燒爲灰, 空心米飮下二錢. 又取油塗之妙. 《本草》

Translation영역
Mole (鼴鼠): Governs haemorrhoidal fistula and the eroding ulcerated sore of the genitals. Burn it to ash and take 2 don on an empty stomach down with rice water. Or take the fat and smear it on — excellent.
Clinical note임상 주석
The section closes on the burrowing animal, as the woodpecker entry closed on the boring bird, and for the same reason: a fistula is a tunnel, so the creature that makes tunnels is given to unmake one. It is the chapter's organizing instinct in its plainest form, and it is the opposite of how a fistula is actually cured, which is by laying the tunnel open and letting it heal from the bottom.

Boncho 本草

5.21 Acupuncture and Moxibustion 鍼灸法

5.21.1
Source원문

痔疾, 取足太陽卽承山穴, 取督脉卽長强穴. 《靈樞》

Translation영역
For pile disease, take the foot greater yang — that is, Seungsan (承山, BL57) — and take the governing vessel, that is, Jangkang (長强, GV1).
Clinical note임상 주석
The two points the Lingshu gives for piles are the ones every later text keeps: the greater yang at the calf and the governing vessel at the tailbone. BL57 is still the first point taught for haemorrhoids in Korean practice.

Yeongchu 靈樞

5.21.2
Source원문

五痔便血, 灸脊中百壯, 又灸回氣百壯. 《得效》

Translation영역
For the five piles with blood in the stool, moxa Cheokjung (脊中, GV6) a hundred cones, and moxa Hoegi (回氣) a hundred cones.
Clinical note임상 주석
回氣 is not in the modern point lists; the Bogam's own 鍼灸篇 places it on the tip of the coccyx, which puts it where 長强 is taken. A hundred cones is the Deukhyobang's measure for a chronic bleeding pile, done over many sittings rather than one.

Deukhyo 得效

5.21.3
Source원문

治痔, 平立量脊與臍平處顀上灸七壯. 或年深, 更於顀骨兩傍各一寸灸七壯, 除根. 《得效》

Translation영역
To treat piles: have the patient stand straight, measure on the spine the place level with the navel, and moxa seven cones on the vertebra there. If it is of long standing, moxa seven more cones an inch to either side of that vertebra, and the root is removed.
Clinical note임상 주석
平立量脊與臍平處 — a landmark taken on the standing patient, which falls at the second lumbar vertebra and so at 命門 (GV4), with the two points an inch out being 腎兪 (BL23). 顀 is this transcription's graph for 椎, the vertebra.

Deukhyo 得效

5.21.4
Source원문

痔痛, 取承筋ㆍ飛揚ㆍ委中ㆍ承扶ㆍ攢竹ㆍ會陰ㆍ商丘. 《甲乙》

Translation영역
For pain of the piles, take Seunggeun (承筋, BL56), Biyang (飛揚, BL58), Wijung (委中, BL40), Seungbu (承扶, BL36), Chanjuk (攢竹, BL2), Hoeeum (會陰, CV1) and Sanggu (商丘, SP5).
Clinical note임상 주석
Six of the seven are on the foot greater yang, running the length of the channel from the brow to the calf; 商丘 on the spleen channel is the one exception. The Jiayi jing's list treats the pile as a disorder of that channel's whole course, not of the local tissue.

Gabeul 甲乙

5.21.5
Source원문

治諸痔及腸風, 取脊十四顀下各開一寸灸之, 久痔尤效. 《入門》

Translation영역
To treat all the piles and intestinal wind, moxa an inch out to either side below the fourteenth vertebra of the spine; it answers best in piles of long standing.
Clinical note임상 주석
十四顀下各開一寸 — below the fourteenth vertebra, an inch to each side, which is 腎兪 (BL23) again. The Immun reaches the same two points as the Deukhyobang above by counting vertebrae instead of measuring against the navel.

Immun 入門

5.21.6
Source원문

脫肛, 取大腸兪ㆍ百會ㆍ長强ㆍ肩井ㆍ合谷ㆍ氣衝. 《綱目》

Translation영역
For prolapse of the rectum, take Daejangyu (大腸兪, BL25), Baekhoe (百會, GV20), Jangkang (長强, GV1), Gyeongjeong (肩井, GB21), Hapgok (合谷, LI4) and Gichung (氣衝, ST30).
Clinical note임상 주석
百會 at the crown is the point that raises what has fallen, and it is the reason this list differs from the pile lists above: a prolapse is read as qi that has sunk, so the treatment is drawn upward from the vertex rather than cooled at the verge.

Gangmok 綱目

5.21.7
Source원문

脫肛, 灸臍中隨年壯, 又灸橫骨百壯, 又灸脊窮骨上七壯. 《得效》

Translation영역
For prolapse of the rectum, moxa Jejung (臍中, CV8) as many cones as the patient has years, moxa Hoenggol (橫骨, KI11) a hundred cones, and moxa seven cones on the end of the tailbone.
Clinical note임상 주석
隨年壯, a cone for each year of age — the Bogam's usual measure where the point is the navel. 脊窮骨, the spine's last bone, is the coccyx and so 長强 once more.

Deukhyo 得效

5.21.8
Source원문

痔瘡, 先取頭垢揑成餅子, 安痔頭上, 其上又安大蒜片, 以艾灸之. 《丹心》

Translation영역
For a pile sore, first take scalp grime, knead it into a small cake and set it on the head of the pile; set a slice of garlic on top of that, and moxa it with mugwort.
Clinical note임상 주석
Indirect moxibustion with garlic between the cone and the skin, which is still done for perianal lesions. The layer of 頭垢 beneath it is the Dangye xinfa's own addition and has nothing to recommend it on a broken surface.

Dansim 丹心

5.21.9
Source원문

痔漏, 以附子末津唾和作餅子如錢大, 安漏上, 以艾灸令微熱, 乾則易新餅再灸, 明日又灸, 直至肉平爲效. 《丹心》

Translation영역
For a pile fistula, mix powdered aconite with saliva, make a cake the size of a coin, set it over the fistula and moxa it with mugwort until it is slightly warm; when the cake dries, replace it with a fresh one and moxa again, and again the next day, until the flesh is level — that is the result.
Clinical note임상 주석
直至肉平 — until the flesh is level, which is to say until the tract has granulated shut, and the course is counted in days rather than sittings. **Aconite is a cardiotoxic poison.** Here it is applied to a discharging surface under heat, which is the route most likely to carry it into the blood, and it is not to be used.

Dansim 丹心

5.21.10
Source원문

一人行路得痔疾, 狀如胡瓜貫於腸頭, 熱如火, 僵什不能起. 有人敎之, 先以槐枝濃煎湯洗患處, 以艾炷灸其上三五壯, 忽覺一道熱氣入腸中, 因瀉鮮血, 雖一時暫痛, 其疾如失. 《本草》

Translation영역
A man on a journey got pile disease: it was shaped like a cucumber run through the head of the bowel, hot as fire, and he lay stiff and prostrate and could not rise. Someone taught him this: first wash the place with a strong decoction of pagoda-tree twigs, then moxa three or five cones on top of it. All at once he felt a thread of hot qi enter the bowel; bright blood poured out, and though it pained him for a moment the disease was gone as if lost.
Clinical note임상 주석
狀如胡瓜貫於腸頭 — the only case record in the chapter, and the lesion it describes, hot and protruding so far that the man could not stand, is an acutely thrombosed prolapsed pile. 因瀉鮮血 … 其疾如失 is the relief that follows when such a pile discharges, which the account credits to the moxa.

Boncho 本草

About this translation 凡例

Base text: Donguibogam (東醫寶鑑, 1613 first edition), Outer Form, Volume 4, Posterior Yin chapter. The Chinese text is collated against the public-domain Wikisource transcription and a printed edition; original character forms (脉, 人參) 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.