寶鑑Bogam

Formulas · Text · Donguibogam 東醫寶鑑

Injuries

Jesang

한글 제상  ·  Pinyin Zhu Shang

The injuries — blades, falls, broken bones, the rod, and what bites

諸傷

The surgical chapter. Everywhere else the Donguibogam treats illness that arrives from inside; here the body has been opened by something outside it, and the physician has to work with his hands. It is the one chapter with an operative sequence in it, and the sequence is recognizable: 草烏散 — the text says flatly 卽麻藥也, this is the anaesthetic — is given in wine until the patient is 麻倒不識痛處, insensible and past feeling the place, and then the surgeon cuts the joint open if he must, trims off the spur of bone, works the joint back into its socket, splints it with 夾骨法, and brings the patient round with salt broth. An arrowhead fast in bone is taken out the same way, with pincers or a chisel, under the same drug. The opening sections are abdominal. A belly laid open with the gut protruding is triaged by how much of the bowel shows — one end only and it cannot be joined, both ends and it can be sewn at once — and the join is made with hemp or mulberry-bark thread, sealed with cockscomb blood, the gut washed with barley gruel and pressed back in, the patient kept on thin gruel twenty days and off solid food for a hundred. 大腸一日半死, 小腸三日死: the prognosis is read from the level of the injury. None of this could have been done safely — not without anaesthesia it could not control, asepsis it had no concept of, or any way to govern what leaked into the peritoneum — and the chapter's own ten untreatable wounds say as much, since they are the ones still lethal today without a theatre. Two things here say more about the world outside the clinic than about medicine. 杖傷 is the treatment of flogging wounds, a judicial punishment, with its own formulas and its own single remedies; and the sub-section beside them is 打着不痛方, a dose of white wax in hot wine taken before the beating so that the blows will not be felt. The book names it 寄杖散. And the animal bites run from tiger and bear down to the cat and the rat, which is the measure of what a seventeenth-century country physician was actually called out to. The dog sections are the hardest reading. 狂犬 is a rabid dog, and the chapter has seen the disease properly: a latent period, with the poison breaking out again later; then barking, foam at the mouth, a man calling out in a dog's voice. Those are real signs, observed. What follows them is cantharides in warm wine, the patient told to pass water into a jar and watch for a cloudy mass in the shape of a dog, and to repeat it seven times if no dog appears — and burnt human skullcap, and tiger bone, once the poison has reached the heart. Rabies is effectively always fatal once symptoms begin, and none of this worked. What the chapter gets right is what it does first: wash the wound, and make it bleed. The notes say so where it matters, because a bite from a suspect animal is still an emergency, and what saves a life now is prophylaxis begun before the first symptom.

1.1 Wounds from Blades 金刃傷

1.1.1
Source원문

金瘡腸斷者, 視病淺深, 各有生死. 腸一頭見者, 不可連也. 若腹痛短氣, 不得飮食者, 大腸一日半死, 小腸三日死. 腸兩頭見者, 可速續之. 先以鍼縷如法連續之, 斷腸便取雞冠血塗其際, 勿令氣泄, 卽推納之. 但出不斷者, 作大麥粥取汁洗腸, 以漬納之, 且作粥淸, 稍稍飮之. 二十餘日乃喫糜粥, 百日後乃可進飯. 《病源》

Translation영역
Where a blade wound has severed the bowel, look at how shallow or deep the injury is: in each case there is life or death. Where only one end of the bowel shows, it cannot be joined. If there is abdominal pain and short breath and the patient cannot eat or drink, then with the large intestine death comes in a day and a half, and with the small intestine in three days. Where both ends of the bowel show, join them quickly. First join them continuously with needle and thread according to the method; then, for the severed bowel, take cockscomb blood at once and smear it over the join, so that no air escapes, and push it straight back in. Where the bowel has come out but is not severed, make a barley gruel, take the liquid and wash the bowel, steep it in that and put it back. Also make a thin gruel and have him drink it little by little. After twenty days or so he may eat congee, and only after a hundred days may he be given rice.
Clinical note임상 주석
This is abdominal surgery, and the procedure is recognizable throughout. The bowel is sutured end to end with needle and thread, the anastomosis sealed with cockscomb blood, the exposed gut irrigated with barley gruel and reduced into the abdomen, and the patient then kept on fluids and thin gruel for twenty days and off solid food for a hundred. The long period of gut rest is the right instinct: an anastomosis needs weeks before it will bear a food bolus. The staging is a real surgical distinction and not a rhetorical one. One end of the bowel showing means the other end has retracted into the abdomen and cannot be found through the wound, so no anastomosis is possible; both ends showing means the two can be brought together. 大腸一日半死, 小腸三日死 is a prognosis by level of injury, and the direction is right — a colonic injury spills faecal flora and kills faster than a small-bowel injury. The accompanying signs, pain in the belly and short breath with inability to take food, are peritonitis. All of this was done without anaesthesia, without asepsis, and with no means whatever of controlling peritoneal contamination — no lavage beyond the barley water, no drainage, no antibiotic. **Cockscomb blood smeared into an open abdomen is raw animal tissue introduced into the peritoneal cavity, and carries a severe risk of wound infection and tetanus. This must not be done.** Modern management of a penetrating bowel injury is resuscitation, laparotomy, repair or resection with controlled anastomosis or stoma, peritoneal lavage, antibiotics and tetanus cover.

Byeongwon 病源

1.1.2
Source원문

金瘡失血, 其人當苦渴, 然須忍之, 常令乾食, 可與肥脂之物, 以止其渴. 又不得多飮粥, 則血溢出殺人也. 又忌嗔怒及大言笑, 動作勞力, 及食醎酸, 熱酒, 熱羹輩, 皆使瘡痛衝發, 甚者卽死. 《聖惠》

Translation영역
Where a blade wound has lost blood, the patient is bound to suffer thirst; but he must endure it. Keep him always on dry food, and fatty things may be given him to stop the thirst. He must also not drink much gruel, for then the blood overflows and comes out, and that kills him. He must further avoid anger and loud talk and laughter, movement and exertion, and eating salty or sour things, hot wine and hot broth and the like — all of these make the wound pain surge and break out, and in a severe case he dies at once.
Clinical note임상 주석
Thirst after a blade wound is hypovolaemia, and the instruction to make the patient endure it is the one place in the chapter that is flatly dangerous: a patient who has lost blood needs volume, and withholding fluid from him is the opposite of resuscitation. **Fluid must not be withheld from a bleeding patient. Haemorrhagic shock is treated with volume replacement and control of the bleeding point.** The observation behind the prohibition is nevertheless a real one. 多飮粥則血溢出 — drink much and the blood overflows and comes out — is the clinical fact that restoring circulating volume and pressure in a patient whose bleeding has not been controlled dislodges the clot and restarts the haemorrhage. Modern trauma care accepts the same fact and answers it differently, with permissive hypotension and early surgical control rather than with thirst. The bans on exertion, anger and loud laughter are the same observation applied to anything that raises pressure in the wound. Fatty food and hot broth to a patient who may have a perforated bowel is its own hazard, and nothing should be given by mouth where an abdominal injury is suspected.

Seonghye 聖惠

1.1.3
Source원문

凡金瘡及折傷, 不可飮冷水, 血見寒則凝, 入心卽死. 《丹心》

Translation영역
In blade wounds and fractures generally, cold water must not be drunk: the blood on meeting cold congeals, and when it enters the heart death follows at once.
Clinical note임상 주석
The mechanism given is wrong — congealed blood does not travel to the heart — but the rule itself is sound, and for a reason the text could not have known. Hypothermia in a bleeding patient impairs platelet function and the clotting cascade directly, and together with acidosis and coagulopathy makes up the triad that kills in major trauma. Keeping a trauma patient warm and off cold fluid is current practice.

Dansim 丹心

1.1.1 Signs That Cannot Be Treated 不治證

1.1.1.1
Source원문

十不治證. 凡被傷入於肺者, 縱未卽死, 二七難過.

Translation영역
The ten signs that cannot be treated. In general, where the injury has entered the lung, even if he does not die at once he will hardly pass fourteen days.
Clinical note임상 주석
A triage list, and it works as one. The ten items pick out penetration of the lung, penetration of the left side of the chest, a bowel completely divided, penetration of the lower abdomen, a crowd of signs, a pulse that is not full, a crushed thigh in an old man, destroyed testicles, blood wholly run out, and penetration inward at the shoulder or behind the ear. Most of these are still lethal or near-lethal without an operating theatre. Penetration of the lung is an open pneumothorax or haemothorax. The fourteen-day limit is about right for the natural history: the patient who survives the first bleed and the first collapse of the lung dies in the second week of empyema. With a chest drain, closure of the chest wall and antibiotics, most such patients now live. The list ends with 皆不必用藥 — in all of them there is no need to use medicine. That is a refusal to treat, and it is a clinical judgement rather than a prohibition: the chapter is telling the practitioner where his treatment will not reach.

Deukhyo 得效

1.1.1.2
Source원문

左脇下傷透內者.

Translation영역
Where a wound under the left flank has pierced through to the inside.
Clinical note임상 주석
The left side of the chest and the left hypochondrium are the heart, the great vessels and the spleen. A penetrating injury there is cardiac tamponade or splenic haemorrhage, and both kill quickly; both are now routinely survivable with thoracotomy or splenectomy.

Deukhyo 得效

1.1.1.3
Source원문

腸傷斷一半可醫, 全斷不可治.

Translation영역
Where the bowel is injured and half divided it can be doctored; completely divided, it cannot be treated.
Clinical note임상 주석
The same staging as 1.1, stated the other way round. A partial tear can be oversewn where it lies; a complete transection means the proximal end retracts and must be found and resected before anything can be joined, which is beyond what this chapter's technique can reach.

Deukhyo 得效

1.1.1.4
Source원문

小腹下傷內者.

Translation영역
Where a wound below the lower abdomen has gone inside.

Deukhyo 得效

1.1.1.5
Source원문

證候繁多者.

Translation영역
Where the signs and symptoms are many.

Deukhyo 得效

1.1.1.6
Source원문

脉不實重者.

Translation영역
Where the pulse is not full and firm.
Clinical note임상 주석
A pulse that has lost its fullness and weight is a pulse that has lost volume. This is the one physiological sign in the list, and it is the right one: tachycardia with a thready, low-volume pulse is the cardinal finding of haemorrhagic shock, and it appears before blood pressure falls. 1.2 makes the same point at length.

Deukhyo 得效

1.1.1.7
Source원문

老人左股壓碎者.

Translation영역
Where an old man's left thigh has been crushed.
Clinical note임상 주석
A crushed femur in an old patient. The femoral shaft can hold two to three units of blood in the thigh alone, and such an injury brings with it fat embolism, rhabdomyolysis with renal failure, and the immobility that kills the elderly afterwards. It remains a high-mortality injury today, which is why the chapter's instinct here is sound even though the specification of the left side is not.

Deukhyo 得效

1.1.1.8
Source원문

傷破陰子者.

Translation영역
Where the wound has destroyed the testicles.

Deukhyo 得效

1.1.1.9
Source원문

血出盡者.

Translation영역
Where the blood has wholly run out.

Deukhyo 得效

1.1.1.10
Source원문

肩內耳後傷透於內者. 皆不必用藥. 《得效》

Translation영역
Where a wound inside the shoulder or behind the ear has pierced through to the inside. In all of these there is no need to use medicine.
Clinical note임상 주석
Behind the ear and inside the shoulder are the mastoid and the root of the neck, and a penetrating wound at either reaches the great vessels of the neck and the apex of the lung. The subclavian and carotid territory is still among the hardest of all penetrating injuries to control surgically.

Deukhyo 得效

1.1.1.11
Source원문

凡金瘡傷天窓穴名ㆍ眉角ㆍ腦後ㆍ臂裏跳脉ㆍ髀內陰股ㆍ兩乳上下ㆍ心鳩尾ㆍ小腸及五藏六府兪, 皆死處. 又破腦出髓而不能語, 戴眼直視, 喉中沸聲, 口急唾出, 兩手妄擧, 皆不治. 《聖惠》

Translation영역
In general, a blade wound injuring Cheonchang (天窓, SI16) — the name of a point — the corner of the eyebrow, the back of the head, the throbbing vessel on the inner arm, the inner thigh and yin of the groin, above and below the two breasts, the heart at Gumi (鳩尾, CV15), the small intestine, or the transport points of the five viscera and six bowels: these are all fatal places. Further, where the skull is broken open and the marrow comes out and he cannot speak, where the eyes are fixed upward in a straight stare, where there is a bubbling sound in the throat, the mouth clamped and saliva running out, and the two hands thrown about at random — none of these can be treated.
Clinical note임상 주석
The list of fatal sites is a map of the places where a blade reaches a great vessel or a body cavity: the carotid at the neck, the temporal artery at the brow, the occiput, the brachial artery where the pulse is felt on the inner arm, the femoral artery in the groin, the heart and lungs across the chest, and the abdomen at the midline. The second half is a description of severe traumatic brain injury with the skull open and brain tissue extruding. Every sign in it is a recognized neurological finding: loss of speech, upward deviation of the eyes with a fixed stare, the noisy wet breathing of an unprotected airway, trismus with drooling, and the aimless flinging of the arms that is decerebrate posturing or an early seizure. Taken together they are an end-stage picture, and before neurosurgery and ventilation they were indeed untreatable. Today an open skull fracture with extruding brain is a surgical emergency and a proportion of such patients survive, so the prognosis is no longer absolute — but the chapter's reading of the signs is accurate.

Seonghye 聖惠

1.2 Pulse Signs in a Blade Wound 金瘡脉候

1.2.1
Source원문

金瘡出血太多, 其脉虛細者生, 數實者死.

Translation영역
Where a blade wound has bled too much, if the pulse is vacuous and thready he lives; if it is rapid and full he dies.
Clinical note임상 주석
The expectation is that a patient who has lost a great deal of blood will have an empty, thin pulse, and that this is what he ought to have; a rapid, full pulse after such a loss means something else is driving the circulation. Read in modern terms the pairing is sound. A rising heart rate is the earliest and the most reliable sign of continuing haemorrhage, and tachycardia that persists after bleeding has stopped marks the patient who is still losing blood or is becoming septic.

Maekgyeong 脉經

1.2.2
Source원문

金瘡出血, 脉沈小者生, 浮大者死. 斫刺出血不止, 脉來大者七日死, 滑細者生. 《脉經》

Translation영역
Where a blade wound bleeds, if the pulse is deep and small he lives; floating and large, he dies. Where a cut or stab bleeds without stopping, if the pulse comes large he dies in seven days; slippery and thready, he lives.
Clinical note임상 주석
A large, floating pulse in an exsanguinated patient is the wide pulse pressure and bounding character of the high-output, low-resistance state — the picture of advancing shock or of sepsis, not of recovery. The seven-day limit for it fits wound sepsis rather than bleeding.

Maekgyeong 脉經

1.2.3
Source원문

金瘡出血, 虛細則宜, 實大則傾. 《得效》

Translation영역
Where a blade wound bleeds, vacuous and thready is as it should be; full and large and he is overturned.

Deukhyo 得效

1.2.4
Source원문

傷雖淺, 命脉虛促可慮; 傷至重, 命脉和緩永無慮也.

Translation영역
Though the wound be shallow, if the life-pulse is vacuous and hurried there is cause for concern; though the wound be of the gravest, if the life-pulse is harmonious and unhurried there is no concern at all.
Clinical note임상 주석
This is the most useful sentence in the section. It says that the pulse, not the appearance of the wound, predicts the outcome — that a small wound with a fast weak pulse is the dangerous patient and a frightening wound with a settled pulse is not. That is exactly the principle behind modern trauma triage, where occult haemorrhage from an unimpressive entry wound kills patients whose injury looked trivial, and where heart rate and pulse character are used to find them.

Deukhyo 得效

1.2.5
Source원문

血出甚者, 脉不要洪大, 只要平正重實. 《得效》

Translation영역
Where the bleeding is severe, the pulse should not be surging and large; it should only be even, upright, weighty and full.

Deukhyo 得效

1.2.1 Treatment of Wounds to the Belly and Bowel 腸肚傷治法

1.2.1.1
Source원문

肚破腸出在外. 若腸全斷難醫, 不斷者可治.

Translation영역
The belly is torn open and the bowel is out on the outside. If the bowel is completely divided it is hard to doctor; if it is not divided it can be treated.
Clinical note임상 주석
Evisceration through an abdominal wound. The distinction repeated from 1.1 is the operative one: a bowel still in continuity can be washed and returned, while a transected bowel has to be resected and joined, and that was the limit of the technique.

Deukhyo 得效

1.2.1.2
Source원문

腸及肚皮破者, 麻縷爲線, 或桑白皮尖茸爲線, 以花蘂石散付線上, 從裏縫之. 腸子則以淸油撚活放入肚內, 乃縫肚皮. 不可縫外重皮, 留皮開, 用藥糝, 待生肉. 《得效》

Translation영역
Where the bowel and the skin of the belly are torn: make a thread of hemp fibre, or make a thread of the fine fibre at the tip of mulberry root bark, put Flower Stamen Stone Powder on the thread, and sew from the inside. The bowel itself is worked loose with clear oil and let back into the belly, and then the belly skin is sewn. The outer layer of skin must not be sewn: leave the skin open, dust it with the medicine, and wait for the flesh to grow.
Clinical note임상 주석
A complete operative account. Hemp fibre and the fine fibre from the tip of mulberry root bark are the suture material — both are strong plant fibres, and mulberry bast in particular was the standard cordage of the region. 從裏縫之, sewing from the inside, is the inverting stitch that turns the mucosa in and brings serosa to serosa, which is what makes a bowel repair hold. Clear oil on the gut is lubrication for reduction, and it also eases the adhesions that make a prolapsed loop impossible to push back. The most striking instruction is the last. The abdominal wall is closed but the outer layer of skin is deliberately left open, dusted with powder, and allowed to granulate. That is delayed primary closure, and it is current practice in a contaminated abdominal wound: closing the skin over a dirty wound buries the infection, while leaving it open lets it drain and heal from the base. The chapter arrived at the right answer for a reason it states only as 待生肉, waiting for the flesh to grow. **Mineral powder placed on a suture that will lie inside the abdomen is a foreign body in the peritoneal cavity and a direct route to infection. This must not be done.** Nor can any of this be done as described without anaesthesia, sterile instruments or control of contamination.

Deukhyo 得效

1.2.1.3
Source원문

傷破肚皮, 腸與脂膏俱出, 先用湯藥如活血散ㆍ佛手散卽芎歸湯與服. 用手擘去膏不妨, 此是閑肉, 放心去之. 然後推腸入內, 用線縫之, 仍服通利藥, 勿令二便秘澁. 《得效》

Translation영역
Where the wound has torn the belly skin and the bowel and the fat have both come out: first use a decoction such as Quicken the Blood Powder or Buddha's Hand Powder that is, Cnidium and Angelica Decoction and give it to him to take. It does no harm to tear the fat away with the hand — this is idle flesh, and it may be taken off with an easy mind. Then push the bowel back inside and sew it with thread, and have him go on taking a freeing and draining medicine, so that stool and urine are not blocked and rough.
Clinical note임상 주석
脂膏 coming out with the bowel is the greater omentum, which lies over the gut and prolapses first through any abdominal wound. 此是閑肉 — this is idle flesh — is a judgement that the omentum may be sacrificed, and a surgeon would say the same: prolapsed omentum is contaminated and devitalized and is resected rather than returned. Tearing it off with the hand is not how it is done, because the omentum carries sizeable vessels that must be ligated, but the decision to remove it is correct. 仍服通利藥, 勿令二便秘澁 is postoperative care, and the aim — getting the bowel and bladder working again — is the aim of modern enhanced recovery after a laparotomy. The means is the problem. **A purgative given to a patient with a fresh bowel repair raises intraluminal pressure across the anastomosis and risks blowing it open. This must not be done.** Return of bowel function after abdominal surgery is now encouraged by early feeding and mobilization, not by cathartics.

Deukhyo 得效

1.2.2 Regulating the Blood First in a Blade Wound 金瘡先宜調血

1.2.2.1
Source원문

大凡金瘡及折傷墜墮內損者, 必有瘀血停積, 先宜逐去瘀血. 若亡血過多, 則調養氣血爲主. 《正傳》

Translation영역
In general, in blade wounds and in fractures and internal injury from a fall, there is always stagnant blood lodged and gathered, and it should first be driven out. If the loss of blood has been too great, then regulating and nourishing the qi and blood is the main thing.
Clinical note임상 주석
The chapter's whole frame for internal injury is 瘀血 — blood that has left the vessels and is lying in the tissues — and the first move is to expel it by purging. The reasoning is anatomically literal and not unreasonable: a haematoma does have to be resorbed or drained before the part will heal. The second sentence is the part that matters. 若亡血過多則調養氣血爲主 draws the distinction the chapter needs: the patient who has bled out is not to be purged but supported. That is the difference between a contusion and haemorrhagic shock, and getting it the right way round is what keeps the purging formulas of 1.2.5 from being given to the wrong patient. Whether the distinction can be made at the bedside without a blood count is another matter, and in practice the formulas that follow were given on the appearance of the injury.

Jeongjeon 正傳

1.2.2.2
Source원문

花蘂石散ㆍ奪命散ㆍ雞鳴散ㆍ導滯散ㆍ破血消痛湯ㆍ復元活血湯, 皆可選用. 《諸方》

Translation영역
Flower Stamen Stone Powder, Snatch Back Life Powder, Cockcrow Powder, Guide Out Stagnation Powder, Break the Blood and Disperse Pain Decoction and Restore the Origin and Quicken the Blood Decoction may all be chosen and used.
Clinical note임상 주석
The six formulas are set out in full at 1.2.5. Four of the six are built on rhubarb and one on leech, so the list is a list of purgatives and blood-breakers; the cautions belong with the formulas themselves.

Jebang 諸方

1.2.3 Drugs to Stop Bleeding, Grow Flesh and Close a Wound 止血生肌合瘡藥

1.2.3.1
Source원문

傷至重者, 海味中醎白鰾成片, 鋪在傷處, 以帛札定, 血立止. 《得效》

Translation영역
For the gravest injuries: take the salted white swim bladder from among sea foods, make it into a sheet, spread it over the wound and bind it fast with cloth, and the bleeding stops at once.
Clinical note임상 주석
This one is worth taking seriously. Fish swim bladder is isinglass, which is almost pure collagen, and collagen is a haemostat: it activates platelets on contact and gives the clot a scaffold. Collagen sheets and sponges are in current surgical use for exactly this purpose, and on a broad bleeding surface they work. The other half of the mechanism is in 以帛札定 — bound fast with cloth. Direct pressure is the first and best haemostatic measure there is, and a collagen sheet held under a firm dressing is a recognizable pressure dressing. Of everything in this section it is the one method a modern clinician would not change much. Salt-cured fish bladder is not sterile, so a wound dressed this way needs cleaning and tetanus cover.

Deukhyo 得效

1.2.3.2
Source원문

止血收口方. 白膠香ㆍ老松皮ㆍ白芷ㆍ血竭爲末付之. 單血竭末付之尤妙.

Translation영역
Formula to stop bleeding and close the mouth of a wound. Storax resin, old pine bark, angelica dahurica and dragon's blood, powdered and applied. Dragon's blood powder applied alone is still better.
Clinical note임상 주석
All four are resins or barks heavy in tannins and gums, which precipitate protein on contact and will stop capillary ooze from a raw surface. 單血竭末付之尤妙 — dragon's blood alone is better — picks out the one of the four with the most to it: the resin of Daemonorops has documented haemostatic and wound-contracting activity and is still sold for this use. None of these will stop arterial bleeding, and a powder packed into a deep wound becomes a foreign body. The method belongs to grazes and bleeding from a broad shallow surface.

Deukhyo 得效

1.2.3.3
Source원문

黃丹ㆍ滑石末付之. 夏月以薄荷葉貼之, 一日一次, 以藥水湯洗. 《得效》

Translation영역
Minium and talc, powdered and applied. In the summer months stick a mint leaf over it, once a day, and wash it with a decoction of the medicine in water.
Clinical note임상 주석
**黃丹 is minium, red lead oxide. Lead applied to an open wound is absorbed into the circulation and causes lead poisoning, and a raw surface absorbs it far faster than intact skin. This must not be prepared or applied.** Lead salts were used for centuries as astringent wound powders, and they do dry a weeping surface; the price is systemic lead. The rest of the instruction is better than the drug. Daily dressing changes, washing the wound at each change, and a leaf laid over it as a non-adherent cover are the elements of ordinary wound care.

Deukhyo 得效

1.2.3.4
Source원문

金傷散糝付神效. 《集要》

Translation영역
Metal Wound Powder, dusted on and applied, has a divine effect.
Clinical note임상 주석
The formula is given at the end of 1.2.5.

Jipyo 集要

1.2.3.5
Source원문

金瘡血不止, 黃丹ㆍ白礬爲末糝之. 又下子蚕蛾燒灰付之. 《聖惠》

Translation영역
Where a blade wound bleeds without stopping, minium and alum powdered and dusted on. Also, the silkworm moth that has laid its eggs, burnt to ash and applied.
Clinical note임상 주석
**Contains minium, which is lead. Lead applied to an open wound is absorbed and causes poisoning. This must not be prepared.** Alum on its own is a genuine astringent haemostat and was the active half of the pair. A wound that bleeds without stopping is bleeding from a vessel, and no powder will close it. The treatment is pressure, elevation and ligation or repair of the bleeding point, with tranexamic acid early where the bleeding is major.

Seonghye 聖惠

1.2.3.6
Source원문

下蚕室瘡不合, 取所割勢火煆爲末, 酒調服. 昔有一人自割其勢, 瘡久不合, 用此方不數日而愈. 《入門》

Translation영역
Where the wound in the silkworm chamber will not close, take the severed member that was cut off, calcine it in fire, powder it, and give it stirred into wine. Formerly there was a man who cut off his own member; the wound would not close for a long time, and with this formula he was healed in a few days.
Clinical note임상 주석
下蚕室, the silkworm chamber, is the room in which castration was performed, and the passage is about a castration wound that will not heal. The case appended to it is of a self-castration. **The remedy is calcined human tissue taken by mouth. Human materials must not be used as medicine, and nothing swallowed closes a wound. This must not be prepared.** A castration wound that fails to close is a scrotal or perineal wound with a urinary fistula, dead tissue or infection in it, and it is treated by debridement, urinary diversion where needed, and closure once the bed is clean. The passage is kept because of what it records rather than what it recommends: that the compilers expected to meet this wound, and knew it as one that characteristically failed to heal.

Immun 入門

1.2.4 Arrowheads and Blades Lodged in Bone and Vessel 箭鏃及金刃中骨脉不出

1.2.4.1
Source원문

白斂ㆍ半夏等分爲末, 每取一錢, 淡薑湯調服, 日三, 至二十日自出. 《入門》

Translation영역
Ampelopsis root and pinellia in equal parts, powdered; take 1 don each time, stirred into a weak ginger decoction, three times a day, and by the twentieth day it comes out of itself.
Clinical note임상 주석
**Contains raw pinellia, which is toxic. The raw tuber is a severe mucosal irritant and must not be taken; this must not be prepared.** Ginger in the vehicle is the traditional corrective for exactly that toxicity, which is why it appears here. No drug taken by mouth moves a foreign body out of bone. What the twenty days describe is the natural history: a retained arrowhead sets up suppuration around itself, and the abscess that forms either discharges through the skin and carries the metal out with it, or it does not. The medicine is incidental to that process. A retained metallic foreign body is now located by radiograph and removed under anaesthesia, with tetanus prophylaxis. A fragment that is deep, inert and causing nothing may sometimes be left, but that is a decision made on imaging, not on waiting.

Immun 入門

1.2.4.2
Source원문

箭鏃及鍼入肉不出, 象牙屑和水塗其上. 又螻蛄取汁頻塗. 又鼠腦塗之. 又好磁石着其上自出. 《聖惠》

Translation영역
Where an arrowhead or a needle has gone into the flesh and will not come out: ivory shavings mixed with water and smeared over it. Also, take the juice of the mole cricket and smear it on repeatedly. Also, rat brain smeared on it. Also, put a good magnet on it and it comes out of itself.
Clinical note임상 주석
The magnet is the one method here with a mechanism. A ferrous arrowhead or a steel needle lying just under the skin can be drawn out by a strong magnet, and magnetic extraction of superficial ferrous foreign bodies was standard practice in eye surgery well into the twentieth century. It does nothing for an object held in bone or for anything non-ferrous. **Rat brain and mole-cricket juice smeared into an open wound are raw animal materials introduced into broken skin, and carry a severe risk of wound infection and tetanus. These must not be used. Ivory is from a CITES Appendix I species and its trade is prohibited.** A penetrating wound from an arrow or a needle needs radiography to find the object, removal where it is reachable, wound cleaning and tetanus cover. Delay is what turns a small puncture into a deep infection.

Seonghye 聖惠

1.2.5 Emergency Formulas 救急方

1.2.5.1
Source원문

金瘡及諸傷重痛悶欲死, 取牛一隻剖腹, 納其人于牛腹, 浸熱血中可甦. 如傷腹, 用血竭末醋湯調飮, 出血而愈. 或戰陣砲矢所傷, 血流滿體, 氣貫胸膈悶絶者亦甦. 《入門》

Translation영역
Where a blade wound or any grave injury gives such pain and oppression that he is about to die: take an ox, cut open its belly, put the man inside the ox's belly, and steeping him in the hot blood can revive him. If the injury is to the belly, give dragon's blood powder stirred into a vinegar decoction to drink, and he recovers once the blood comes out. Or where a man is wounded in battle by gun or arrow, with blood running over his whole body and the qi driven through the chest and diaphragm so that he is oppressed to the point of collapse, this too revives him.
Clinical note임상 주석
The ox is a warming measure, and the instinct is right even though the method cannot be defended. A patient in haemorrhagic shock is cold, and hypothermia is one of the three things that kill him; immersion in a body at forty degrees is effective external rewarming, which is why the method survived in military medicine for so long. **It is also immersion of open wounds in unsterile blood and viscera, a near-certain route to wound infection, tetanus and zoonotic infection. This must not be done.** Warming is now done with blankets, warmed fluids and forced-air devices. 戰陣砲矢 — wounded in battle by gun and arrow — places the passage after the arrival of firearms, and the chapter is describing battlefield casualties. 氣貫胸膈悶絶 is a chest wound with the patient unable to breathe, which is a tension pneumothorax or a haemothorax and needs decompression, not a drink. The second instruction, dragon's blood in vinegar for an abdominal wound, is harmless and useless; 出血而愈, recovering once the blood comes out, is the chapter's expectation that the stagnant blood will be passed.

Immun 入門

1.2.5.2
Source원문

傷重暈絶不省人, 熱尿多灌卽甦, 童尿尤好. 《丹心》

Translation영역
Where the injury is grave and he has fainted away and does not know anyone, pour in a quantity of hot urine and he revives at once; a boy's urine is still better.
Clinical note임상 주석
Fainting and unresponsiveness after a grave injury is shock or head injury, and the method could hardly be worse chosen. **Human urine must not be used as medicine. Pouring any fluid into the mouth of an unconscious patient will be aspirated into the lungs. This must not be done.** An unresponsive injured patient needs the airway opened and protected, oxygen, control of bleeding and volume replacement. Nothing is given by mouth. Whatever revival was observed came from the handling and the stimulus, not from the urine.

Dansim 丹心

1.2.5.3
Source원문

活血散, 治刀鎗傷腹裂腸出者. 黃芪ㆍ當歸ㆍ川芎ㆍ白芷ㆍ續斷ㆍ赤芍藥ㆍ鹿茸ㆍ黃芩ㆍ細辛ㆍ乾薑ㆍ附子(炮) 各等分. 右爲末, 每三錢, 溫酒調服, 日三, 立驗. 《入門》

Translation영역
Hwalhyeol-san 活血散, Quicken the Blood Powder. Treats wounds from knife or spear where the belly is split open and the bowel is out. Astragalus, Korean angelica, cnidium, angelica dahurica, dipsacus, red peony, deer antler velvet, scutellaria, asarum, dried ginger and prepared aconite, equal parts of each. Powder them; 3 don each time, stirred into warm wine, three times a day, with immediate effect.
Clinical note임상 주석
**Contains aconite, which is toxic. Aconitine is cardiotoxic and the margin between a therapeutic and a lethal dose is narrow. This must not be prepared.** 炮, roasting, reduces but does not abolish the alkaloid content. The dose here is substantial, repeated three times a day, and given in wine, which speeds absorption. This is the systemic support given alongside the operation described at 1.2.1 — the indication, 腹裂腸出, is the same evisceration. The composition is coherent on its own terms: astragalus and the two angelicas and peony to fill and move the blood, dipsacus and antler velvet to knit the breach, dried ginger and aconite to hold up a patient who is cold and collapsing. The last pair is in effect a vasopressor, and a patient in haemorrhagic shock does need his circulation supported — but with blood, not with alkaloids given by mouth to someone who may not be absorbing anything. Deer antler velvet is a deer product; its supply and trade are regulated in many jurisdictions.

Immun 入門

1.2.5.4
Source원문

花蘂石散, 治一切金刃斫傷及打撲損傷ㆍ牛馬咬踼, 或至死者. 急於傷處糝藥, 其血化爲黃水. 再服藥便活, 更不疼痛. 如藏府有瘀血內損, 煩悶欲死, 服此藥則化爲黃水, 或吐出, 或下泄出. 花蘂石 四兩, 硫黃 一兩. 爲末, 入瓦罐內, 鹽泥固濟, 曬乾, 安四方塼上, 以炭火從巳午時煆至經宿, 候冷取出, 硏細. 每取一大匙, 童尿入酒煎熱調服. 《入門》

Translation영역
Hwaeseseok-san 花蘂石散, Flower Stamen Stone Powder. Treats all cutting wounds from blades, and injury from blows and falls, and bites and kicks from cattle and horses, even where the man is at the point of death. Dust the medicine on the wound at once and the blood turns to yellow water. Take the medicine again and he lives, and there is no more pain. Where there is stagnant blood and internal injury in the viscera and bowels, with vexation and oppression to the point of death, taking this medicine turns it to yellow water and it comes out either vomited up or passed below. Ophicalcite 4 nyang, sulphur 1 nyang. Powder them, put them into an earthenware jar, lute it fast with salt and clay, dry it in the sun, set it on four square bricks, and calcine over a charcoal fire from the hours of the serpent and the horse until the night is past; when it has cooled, take it out and grind it fine. Take one large spoonful each time, stirred into a boy's urine boiled hot with wine.
Clinical note임상 주석
The chapter's principal haemostatic, and the one named in the suture instruction at 1.2.1. Ophicalcite is a serpentine-calcite rock; calcined with sulphur in a luted jar overnight it yields a fine alkaline mineral powder, and such a powder dusted on a bleeding surface does stop capillary ooze by drying it and precipitating protein. 其血化爲黃水 — the blood turning to yellow water — is what is actually seen: the clot and the powder together make a yellowish serous crust. The internal claim is a different matter. Nothing swallowed converts a haematoma into fluid to be vomited or passed, and a patient with internal bleeding severe enough to produce 煩悶欲死 needs a surgeon. **Taken internally this is a calcined mineral powder in a vehicle of human urine. Human materials must not be used as medicine, and the powder must not be taken. Dusted into an open wound, a calcined mineral is a foreign body and a contaminant — a wound so treated needs cleaning and tetanus cover.**

Immun 入門

1.2.5.5
Source원문

奪命散, 治金刃所傷及從高墮落ㆍ木石壓損, 瘀血瘀積, 心腹痛, 二便不通. 水蛭(以石灰拌炒焦) 五錢, 大黃ㆍ黑牽牛頭末 各二兩. 右爲末, 每取二錢, 熱酒調下. 過數時無效, 再用一服, 以下惡血爲度. 《得效》

Translation영역
Talmyeong-san 奪命散, Snatch Back Life Powder. Treats wounds from blades, falls from a height and crush injury from timber and stone, with stagnant blood gathered, pain in the heart and belly, and stool and urine not passing. Leech, stir-fried to a char with lime, 5 don; rhubarb and the first-milled powder of black pharbitis seed, 2 nyang each. Powder them; take 2 don each time, stirred down in hot wine. If after some hours there is no effect, use another dose, taking the passing of the malign blood as the measure.
Clinical note임상 주석
Rhubarb and black pharbitis seed are both drastic cathartics, and pharbitis is the harsher of the two; the dose is driven upward until the bowels open. The patient this is written for has been crushed under timber and stone and has stopped passing urine and stool. That combination is dangerous. Retention of urine after a crush injury is usually a pelvic fracture with a urethral tear or it is acute kidney injury from rhabdomyolysis, and a silent distended abdomen with heart and belly pain is ileus or intra-abdominal haemorrhage. Purging such a patient strips him of the fluid and electrolytes he has least to spare, and in the presence of continuing internal bleeding it accelerates the collapse. **Contains violent purgatives. Drastic purging of a patient with internal bleeding or crush injury is dangerous and must not be done.** The leech is charred with lime before powdering, which destroys the hirudin that is the only pharmacologically interesting thing in it.

Deukhyo 得效

1.2.5.6
Source원문

雞鳴散, 治金刃傷ㆍ打撲傷, 血瘀凝積, 煩悶欲絶. 大黃(酒蒸) 五錢, 當歸尾 三錢, 桃仁 二七粒(硏). 右剉作一貼, 酒煎, 雞鳴時服, 次日下瘀血卽愈. 治折傷亦妙. 《三因》

Translation영역
Gyemyeong-san 雞鳴散, Cockcrow Powder. Treats blade wounds and injury from blows, with the blood stagnant and congealed and gathered, and vexation and oppression to the point of collapse. Rhubarb, steamed in wine, 5 don; the tails of Korean angelica root 3 don; peach kernel, fourteen pieces, ground. Cut them up for one packet, decoct in wine, and take it at cockcrow; the next day the stagnant blood descends and he recovers. It is excellent for fractures too.
Clinical note임상 주석
Rhubarb steamed in wine with peach kernel and the tails of the angelica root — the fine root ends, taken as the part that moves blood rather than fills it. It is a purgative given to make 瘀血 descend, and the dose at cockcrow with the result expected the next day is a bowel movement timed for the morning. **Contains a purgative given for internal bleeding. Purging a patient who is bleeding internally does not remove the extravasated blood; it dehydrates him and worsens the shock. This must not be relied on.** A patient with 煩悶欲絶 after a blunt injury is a patient with occult haemorrhage and belongs in a trauma unit.

Samin 三因

1.2.5.7
Source원문

導滯散, 治傷損內有瘀血, 大便不通, 壅鬱欲死. 大黃 一兩, 當歸 二錢半, 麝香 少許. 右爲末, 每三錢, 熱酒調下. 《聖惠》

Translation영역
Doche-san 導滯散, Guide Out Stagnation Powder. Treats injury with stagnant blood inside, the stool not passing, and such blockage and depression that he is about to die. Rhubarb 1 nyang, Korean angelica 2 don 5 fun, musk a little. Powder them; 3 don each time, stirred down in hot wine.
Clinical note임상 주석
The simplest of the purging formulas: rhubarb with angelica to soften the move and musk to carry it. **Musk is from the musk deer, a CITES-listed species whose trade is prohibited; it must not be used.** Obstipation after a blunt abdominal injury is most often ileus, and ileus is not relieved by a cathartic. Where the cause is instead a haematoma or an injured bowel, purging is actively harmful.

Seonghye 聖惠

1.2.5.8
Source원문

破血消痛湯, 治傷損墮落, 惡血流於脇下, 痛楚不能轉側. 水蛭(炒烟盡, 另硏) 三錢, 柴胡ㆍ連翹ㆍ當歸梢 各二錢, 蘇木 一錢半, 羌活ㆍ防風ㆍ桂皮 各一錢, 麝香 少許. 右除水蛭ㆍ麝香外, 餘藥剉作一貼, 酒水相半煎, 去滓, 入蛭ㆍ麝調服, 空心兩貼立愈. 《東垣》

Translation영역
Pahyeol-sotong-tang 破血消痛湯, Break the Blood and Disperse Pain Decoction. Treats injury from a fall with malign blood running down below the flank, and pain so bitter that he cannot turn on his side. Leech, stir-fried until the smoke is gone and ground separately, 3 don; bupleurum, forsythia and the tips of Korean angelica root, 2 don each; sappanwood 1 don 5 fun; notopterygium, saposhnikovia and cassia bark, 1 don each; musk a little. Of these, set the leech and the musk aside; cut up the remaining drugs for one packet, decoct in half wine and half water, strain off the dregs, stir in the leech and musk, and take it on an empty stomach. Two packets and he recovers at once.
Clinical note임상 주석
Li Dongyuan's formula for traumatic pain in the flank, and the leech is the point of it. Living leech saliva does contain hirudin, a direct thrombin inhibitor, and it is a real anticoagulant — but hirudin is a protein, and the instruction here is to dry-fry the leech until the smoke stops, which destroys it. Grinding it separately and stirring it into the strained decoction at the end does preserve whatever survives the frying, and the compiler clearly understood that the leech should not be boiled; the frying has already done the damage. **Musk is from a CITES-listed species and must not be used. Blood-moving treatment given for malign blood collected below the flank may be given to a patient with a ruptured spleen or liver, where anything that discourages clotting is dangerous.** Pain on turning, after a fall, with the injury localized below the flank, is the presentation of splenic or renal injury and of lower rib fractures, and it is assessed by imaging.

Dongwon 東垣

1.2.5.9
Source원문

復元活血湯, 治同上. 大黃 二錢半, 當歸 一錢七分, 柴胡 一錢半, 穿山甲(炒硏)ㆍ瓜蔞根ㆍ甘草 各一錢, 桃仁 十箇(爲泥), 紅花 五分. 右剉作一貼, 酒水相半煎服. 《寶鑑》

Translation영역
Bogwon-hwalhyeol-tang 復元活血湯, Restore the Origin and Quicken the Blood Decoction. Treats the same as the above. Rhubarb 2 don 5 fun, Korean angelica 1 don 7 fun, bupleurum 1 don 5 fun, pangolin scale stir-fried and ground, trichosanthes root and licorice 1 don each, peach kernel ten pieces pounded to a paste, safflower 5 fun. Cut up for one packet and decoct in half wine and half water.
Clinical note임상 주석
Also Li Dongyuan's, and still one of the standard prescriptions in East Asian practice for pain in the hypochondrium after blunt injury — bupleurum to reach the flank, rhubarb and peach kernel and safflower to break the blood, licorice to hold the whole together. Of the chapter's six emergency formulas it is the one most likely to be met in a clinic today. **Pangolin scale is from a CITES Appendix I species; its trade is prohibited and it must not be used.** It is keratin, the same material as hair and nail, and has no demonstrated action; contemporary practice substitutes or omits it. Rhubarb in this dose is a mild purgative rather than a drastic one, and the formula is the gentlest of the six.

Bogam 寶鑑

1.2.5.10
Source원문

金傷散, 治一切金瘡. 重午日早朝, 使四人各出四方, 採草木莖葉各半把, 至日午時, 入石灰一斤同擣極爛. 鑿大桑木三兩株作孔, 納藥實築, 以桑皮蔽之, 油調石灰密塗之, 勿令泄氣. 更以桑皮塡固, 至九月九日午時取出, 陰乾百日, 擣羅爲末. 如遇傷糝之神效. 《鄕藥》

Translation영역
Geumsang-san 金傷散, Metal Wound Powder. Treats all blade wounds. On the morning of the Double Fifth send four men out to the four quarters, and let each gather half a handful of the stems and leaves of plants and trees; at the noon hour put in 1 geun of lime and pound it all together to a thorough mash. Cut holes in two or three large mulberry trunks, put the medicine in and tamp it firm, cover it with mulberry bark, mix lime with oil and seal it over tightly so that no air escapes, and pack it fast again with mulberry bark. At the noon hour of the ninth day of the ninth month take it out, dry it in the shade for a hundred days, and pound and sift it to a powder. When an injury is met with, dust it on, with divine effect.
Clinical note임상 주석
The one Korean entry in the section, and the most calendrical thing in the chapter: herbs gathered at the four quarters on the Double Fifth, sealed into a living mulberry trunk with lime and oil, opened at the noon of the Double Ninth, and shade-dried a hundred days. The dates are the two great herb-gathering festivals of the year, and the four quarters and four gatherers make the powder a compendium of the whole vegetable world rather than a prescription of named drugs — which is why no drug is named. **Contains quicklime, which is caustic. Lime on broken skin causes chemical burns, and burns from lime go on deepening as long as it is in contact. This must not be applied to a wound.** Four months sealed in a tree trunk is also four months of uncontrolled fermentation, and the product is neither sterile nor of known composition — on an open wound it carries a real risk of tetanus. The section ends on this because it is the practical Korean substitute for everything above it: a powder a household could make once a year and keep by for the cuts that would come.

Hyangyak 鄕藥

1.3 Simple Medicinals 單方

1.3.1
Source원문

凡二十四種.

Translation영역
Twenty-four kinds in all.
Clinical note임상 주석
The head is a true count: twenty-four drug entries follow, from newly drawn water to axle grease, and the number is right. The section is the dispensary behind the blade-wound sections that precede it — haemostatics, granulating agents, and a group of drugs for drawing out an arrowhead or a broken needle.

Donguibogam · Jesang

1.3.2
Source원문

新汲水 人被金瘡及損傷腸出, 以新汲泉水噴之, 令身噤, 腸自入也. 《本草》

Translation영역
Newly drawn water (新汲水): Where a man has taken a blade wound or an injury and the bowel has come out, spray him with newly drawn spring water; it makes the body clench, and the bowel goes back in of itself.
Clinical note임상 주석
The mechanism described is real as far as it goes: a shock of cold water makes a man gasp and tighten the abdominal wall, and a loop of gut lying on the skin can be carried back through the defect by that movement. It is the same observation that 小麥 below is built on. What it does not do is close the wound or clean it. An eviscerated bowel is a surgical emergency: the gut is covered moist, not pushed back by a bystander, and the patient goes to theatre. Reduction without repair leaves a defect that will obstruct or strangulate, and spring water is not sterile.

Boncho 本草

1.3.3
Source원문

石灰 療金瘡甚良. 人爲金刃所傷, 以石灰末裹之, 定痛止血神效. ○又石灰和雞子白, 火煆爲末, 付瘡立差. 《本草》

Translation영역
Lime (石灰): Very good for treating blade wounds. Where a man has been wounded by a blade, wrap it in powdered lime — it settles the pain and stanches the blood with miraculous effect. ○ Again: lime mixed with egg white, calcined in the fire and powdered, applied to the wound, and it heals at once.
Clinical note임상 주석
Quicklime packed into a cut does stop bleeding, by cauterizing it. Calcium oxide takes up water and releases a great deal of heat, and the hydroxide it becomes is strongly alkaline, so the bleeding surface is burnt and sealed. The haemostasis is genuine; the price is a chemical burn and a layer of dead tissue that must slough before anything can granulate under it. 定痛, settling the pain, is the one claim that is simply wrong. The second method is the gentler of the two. Lime slaked in egg white and then calcined is largely carbonate by the time it reaches the wound, and the albumin leaves a film. **Contains lime, which is caustic and burns skin and eye. This must not be prepared or applied to a wound.**

Boncho 本草

1.3.4
Source원문

葛根 療金瘡止痛. 爲末付之, 又濃煎取汁服之. 《本草》

Translation영역
Kudzu root (葛根): Treats blade wounds and stops pain. Powder it and apply it; or decoct it thick, take the liquid and drink it.

Boncho 本草

1.3.5
Source원문

桑白皮 可以縫金瘡. 取生皮作線, 縫腹破腸出者. 唐安金藏剖腹, 用此法便愈. ○神仙刀箭藥, 妙不可言. 桑葉爲末, 乾糝之. ○金瘡止痛, 桑柴灰付之佳. 《本草》

Translation영역
Mulberry root bark (桑白皮): It can be used to sew up a blade wound. Take the fresh bark, make thread of it, and sew up a man whose belly is split and whose bowel has come out. When An Geumjang of the Tang cut open his own belly, this method was used and he recovered. ○ A divine drug for sword and arrow wounds, marvellous beyond telling: mulberry leaf powdered and dusted on dry. ○ To stop the pain of a blade wound, mulberry-wood ash applied is good.
Clinical note임상 주석
This is the suture material of the abdominal repair in 1.2.1, and it is a sensible choice. Mulberry bast fibre is long, strong and wets without going slack, and it is the only thread the chapter names besides hemp. It is not absorbable and it is not sterile, so it is a suture that closes a wound and then has to be got out again. The story of An Geumjang is a historical anecdote, not a case record: he opened his own abdomen before the court to prove a point, and survived. The chapter cites it as precedent that the belly can be opened and closed. Mulberry-wood ash is alkaline. Like lime it will stop a small bleed and like lime it does it by burning.

Boncho 本草

1.3.6
Source원문

螻蛄 箭鏃在咽喉胸膈不出, 螻蛄擣取汁, 滴上三五度自出. ○鍼入肉不出, 螻蛄腦同硫黃硏付, 覺痒鍼自出. 《本草》

Translation영역
Mole cricket (螻蛄): Where an arrowhead lodged in the throat or in the chest and diaphragm will not come out, pound mole crickets, take the juice and drip it on three or five times, and it comes out of itself. ○ Where a needle has gone into the flesh and will not come out, grind mole-cricket brain together with sulphur and apply it; when itching is felt the needle comes out of itself.
Clinical note임상 주석
Four of this section's twenty-four entries are for extracting a foreign body — mole cricket, dung beetle, ivory and axle grease — and they share one logic: a drug that bores or burrows will draw out what has bored in. The drawing itself is magical. What is observed correctly is that a retained metal fragment suppurates and is eventually extruded by the abscess that forms around it, which is why an irritant poultice appears to work and why the text speaks of itching first. An arrowhead in the throat or mediastinum is not a case for a poultice. It needs imaging and operative removal. **Crushed insect juice dripped into an open wound carries a real risk of wound infection and of tetanus. This must not be applied.**

Boncho 本草

1.3.7
Source원문

蜣蜋 箭鏃入骨不可拔. 微熬巴豆與蜣蜋同硏勻, 塗傷處, 待極痒, 便撼動拔之立出. 後以生肌膏貼之. ○出箭鏃方, 蜣蜋 全者ㆍ麝香 少許, 同爲末, 撥動箭頭, 糝藥瘡內自出. 《本草》

Translation영역
Dung beetle (蜣蜋): Where an arrowhead has gone into bone and cannot be drawn out: lightly parch croton seed, grind it evenly together with dung beetle, smear it on the injured place, wait until the itching is extreme, then work the head loose and pull — it comes out at once. Afterwards apply flesh-growing paste. ○ A formula for bringing out an arrowhead: whole dung beetles and a little musk powdered together; work the arrowhead loose, dust the drug inside the wound, and it comes out of itself.
Clinical note임상 주석
The method has two halves and only one of them is drug work. 撥動 and 撼動 — working the head loose before pulling — is what actually extracts a barbed point from cancellous bone, and it is what a surgeon does. The paste supplies the interval and the inflammation. Croton seed is the active part of the first preparation, and it is a vesicant: applied to skin it raises blisters and a weeping surface. That is the 極痒 the text waits for. **Contains croton seed, a violent purgative and a severe skin irritant, and musk, which comes from a CITES-protected animal. This must not be prepared. Insect material dusted inside a wound carries a risk of infection and tetanus.**

Boncho 本草

1.3.8
Source원문

旋葍根 卽旋花根也. 合金瘡, 續斷筋. 取根擣汁, 滴瘡中, 滓封瘡上妙. 《本草》

Translation영역
Bindweed root (旋葍根): That is, the root of the bindweed. It closes blade wounds and joins severed sinews. Take the root, pound out the juice, drip it into the wound, and seal the dregs over it — marvellous.
Clinical note임상 주석
續斷筋, joining a severed sinew, is a claim no poultice can meet. A completely divided tendon retracts and will not reappose itself; it needs operative repair and then immobilization in the position of least tension. The chapter says as much in 1.7, which describes reduction and splinting rather than a drug.

Boncho 本草

1.3.9
Source원문

象牙 主箭鏃及鍼入肉不出. 爲末和水, 付瘡上卽出. 舊牙梳尤佳. 《本草》

Translation영역
Ivory (象牙): Governs an arrowhead or a needle that has gone into the flesh and will not come out. Powder it, mix with water and apply to the wound, and it comes out at once. An old ivory comb is especially good.
Clinical note임상 주석
The reasoning is sympathetic rather than pharmacological: ivory is the hard point that is drawn out of the living animal, so it draws out what is embedded. An old comb is recommended because it has already been worked thin and is easy to scrape. **Ivory comes from a CITES Appendix I species and its trade is prohibited. This must not be obtained or used.**

Boncho 本草

1.3.10
Source원문

蝙蝠 主金瘡出血內漏. 取二枚燒爲末, 每一錢和水服, 令一日服盡. 當下如水, 乃血消也. 《本草》

Translation영역
Bat (蝙蝠): Governs bleeding and internal leakage from a blade wound. Take two, burn them and powder them; 1 don at a time mixed with water, to be finished within one day. What is passed will be like water, and that is the blood dispersing.
Clinical note임상 주석
內漏 is blood that has leaked inside the body rather than out of the wound — a haemothorax or a haemoperitoneum. The text reads the watery stool that follows as the extravasated blood leaving, which is a misreading of what is in fact a drug effect on the gut; blood in a body cavity is resorbed through the serosa or it is drained. **Bats are a reservoir for rabies and for several other zoonoses, and handling or preparing one is a genuine exposure risk. This must not be prepared.**

Boncho 本草

1.3.11
Source원문

黑虱 主箭頭入肉不出. 取頭上黑虱及人牙齒, 同硏塗之卽出. 《本草》

Translation영역
Black louse (黑虱): Governs an arrowhead in the flesh that will not come out. Take black lice from the head and human teeth, grind them together and smear it on, and it comes out.
Clinical note임상 주석
The same drawing logic again, with the teeth standing in for the hard embedded thing. Head lice are vectors of relapsing fever and of trench fever. **Contains human teeth and body parasites. Human material must not be used, and smearing either into an open wound carries a risk of infection and tetanus. This must not be prepared.**

Boncho 本草

1.3.12
Source원문

葱 治金瘡因驚出血不止. 取葱灸熱, 挼取汁付之, 血卽止. ○金瘡中風, 水腫痛, 葱莖葉煨硏, 罯付立愈. 《本草》

Translation영역
Scallion (葱): Treats a blade wound bleeding without stop from fright. Take scallion, roast it hot, rub out the juice and apply it, and the blood stops at once. ○ Where a blade wound has been struck by wind, with watery swelling and pain, roast scallion stem and leaf in the embers, grind and lay it on as a compress — cured at once.
Clinical note임상 주석
金瘡中風 is tetanus. The chapter uses the phrase throughout for a wound that has taken wind, and the clinical picture it describes elsewhere — trismus, arched spasm, death — is unmistakable. A roasted scallion compress does nothing against it. Tetanus is prevented by immunization and by wound toilet, and once established it needs antitoxin and intensive care. The first half is more modest and not unreasonable as first aid: a warm poultice held firmly on a bleeding cut applies pressure, which is what stops it.

Boncho 本草

1.3.13
Source원문

小麥 主腸出不入. 小麥 五升, 水 九升, 煮取四升, 去滓, 令極冷, 使人含噀瘡上, 又噀其背, 腸漸自入. 勿令衆人見. 《本草》

Translation영역
Wheat (小麥): Governs a bowel that has come out and will not go back. Wheat 5 seung, water 9 seung, boiled down to 4 seung; remove the dregs and let it get very cold. Have someone hold it in the mouth and spray it over the wound, and spray his back as well; the bowel goes back in little by little of itself. Do not let a crowd watch.
Clinical note임상 주석
This is the barley-gruel irrigation of 1.2.1 in its single-drug form, and it is the most competent entry in the section. Cold wheat decoction sprayed on exposed bowel does three useful things: it keeps the serosa wet, it makes the abdominal wall contract so that the loop can be reduced, and the starch leaves a film that reduces adhesion to dry air. 勿令衆人見 is sound too — the operator needs the patient calm and still. Spraying from the mouth is the part that cannot stand. It inoculates the peritoneum with oral flora, and peritonitis is what kills in this injury. Modern management is to cover the eviscerated bowel in warm saline-soaked gauze and to move the patient to theatre.

Boncho 本草

1.3.14
Source원문

石榴花 治金瘡血流不止. 石榴花和石灰, 擣爲末糝之, 血便斷. 《本草》

Translation영역
Pomegranate flower (石榴花): Treats a blade wound whose blood runs without stopping. Pomegranate flower with lime, pounded to a powder and dusted on, and the blood is cut off at once.
Clinical note임상 주석
Pomegranate flower is heavily tannin-bearing, and tannins precipitate protein, so the powder does form a coagulum on a raw surface. It is the one plant haemostatic in the section with a plausible mechanism of its own. **Contains lime, which is caustic. This must not be prepared or applied to a wound.**

Boncho 本草

1.3.15
Source원문

壁錢 主金瘡血不止. 取汁點瘡上良. 《本草》

Translation영역
Wall-spider nest (壁錢): Governs a blade wound whose blood will not stop. Take the juice and dab it on the wound — good.

Boncho 本草

1.3.16
Source원문

鼠腦肝 治箭鏃及鍼刀在咽喉胸膈諸隱處不出. 取生鼠腦及肝, 擣付之卽出. 《本草》

Translation영역
Rat brain and liver (鼠腦肝): Treats an arrowhead, or a needle or blade, lodged in the throat, in the chest and diaphragm, or in any hidden place, that will not come out. Take fresh rat brain and liver, pound them and apply, and it comes out.
Clinical note임상 주석
Another of the drawing remedies, and the most hazardous of them. Rats carry leptospirosis, hantavirus, rat-bite fever and salmonella, and fresh brain and liver are the tissues in which those organisms are concentrated. **Raw rodent tissue laid on an open wound is a serious infection risk, including leptospirosis and tetanus. This must not be prepared or applied.**

Boncho 本草

1.3.17
Source원문

紫檀香 治金瘡. 急刮紫檀末付之, 止血止痛至妙. 《本草》

Translation영역
Red sandalwood (紫檀香): Treats blade wounds. Quickly scrape red sandalwood to a powder and apply it; it stops bleeding and stops pain most marvellously.

Boncho 本草

1.3.18
Source원문

血竭 療金瘡, 止血止痛生肌最妙. 刮屑付之. 但性急, 不可多用. 《入門》

Translation영역
Dragon's blood resin (血竭): Treats blade wounds; best of all for stopping bleeding, stopping pain and growing flesh. Scrape off the shavings and apply. But its nature is hasty, and it must not be used in quantity.
Clinical note임상 주석
Dragon's blood is the dark resin of Daemonorops or Dracaena, and it is the closest thing in the section to a modern wound powder: a resin dressing that dries to an adherent film over a raw surface. 性急, a hasty nature, with the caution not to use much, is the text noticing that a thick layer of resin seals a wound before it has drained — which is exactly how an occlusive dressing turns a contaminated wound into an abscess.

Immun 入門

1.3.19
Source원문

琥珀 止血生肌, 合金瘡. 作末付之. ○中弩箭悶絶, 琥珀末 一錢, 童尿調服妙. 《本草》

Translation영역
Amber (琥珀): Stops bleeding, grows flesh and closes blade wounds. Powder it and apply. ○ Where a man struck by a crossbow bolt is stifled to the point of collapse: amber powder 1 don, mixed in child's urine and taken — marvellous.
Clinical note임상 주석
中弩箭悶絶 is a penetrating missile injury with collapse — most often a tension pneumothorax or exsanguination from a crossbow bolt in the chest. Neither answers to a powder. The first needs decompression, the second needs blood and an operation. **Contains child's urine, a human material. This must not be prepared.**

Boncho 本草

1.3.20
Source원문

蛇含草 主金瘡. 擣付之佳. ○又云, 蛇含膏連已斷之指. 《本草》

Translation영역
Snake-holding herb (蛇含草): Governs blade wounds. Pounded and applied — good. ○ It is also said that snake-holding paste joins a finger already severed.
Clinical note임상 주석
A completely amputated digit does not reattach to a paste. Replantation requires microvascular anastomosis of the digital arteries within a few hours of cold-ischaemic storage, and even then it is not always attempted. The same claim is made more fully in 1.9 for a severed ear or nose, and the chapter is wrong about both.

Boncho 本草

1.3.21
Source원문

靑蒿 生挼付金瘡, 止血止痛生肌最妙. 《本草》

Translation영역
Sweet wormwood (靑蒿): Rubbed fresh and applied to a blade wound; best of all for stopping bleeding, stopping pain and growing flesh.

Boncho 本草

1.3.22
Source원문

熟艾 搨金瘡, 止血止痛易合. 或煎湯, 或熏烟亦好. 《俗方》

Translation영역
Cured mugwort (熟艾): Pressed on a blade wound; it stops bleeding, stops pain and makes it close easily. Decocted as a wash, or smoked over it, is also good.
Clinical note임상 주석
Cured mugwort is moxa floss, and as a wound dressing it works as a dressing: a mass of soft absorbent fibre pressed on a cut applies pressure and takes up blood. The 《俗方》 label marks this as a Korean household practice rather than a Chinese citation, and it is the most sensible of the three methods here. Smoking the wound is the one to leave alone — smoke does not sterilize, and it dries the surface.

Sokbang 俗方

1.3.23
Source원문

小薊 主金瘡血不止. 挼葉封之. 《本草》

Translation영역
Field thistle (小薊): Governs a blade wound whose blood will not stop. Rub the leaves and seal the wound with them.

Boncho 本草

1.3.24
Source원문

藍葉汁 金瘡血悶, 取藍汁飮之. 《本草》

Translation영역
Indigo leaf juice (藍葉汁): Where a blade wound brings stifling from blood, take indigo juice and drink it.

Boncho 本草

1.3.25
Source원문

車脂 鍼入肉不出. 取車𨊧脂, 攤紙上罨之, 二日一換, 三五次自出. 《本草》

Translation영역
Axle grease (車脂): Where a needle has gone into the flesh and will not come out, take the grease from a cart axle, spread it on paper and lay it on as a compress, changing it once in two days; in three or five changes it comes out of itself.
Clinical note임상 주석
The last of the drawing remedies, and the one whose apparent success is easiest to account for. An occlusive greasy dressing left on for days macerates the skin and keeps a track open, and a superficial needle fragment is often extruded by the low-grade suppuration that follows. That is also why it should not be done: the method works by letting a foreign-body infection take hold. A retained needle is located by imaging and removed. **Cart-axle grease laid on a puncture wound is a classic tetanus exposure. This must not be applied.**

Boncho 本草

1.4 Falls, Blows and Crush Injuries 攧撲墮落壓倒傷

1.4.1
Source원문

凡墮壓死者, 急安好處, 以袖掩其口鼻上一食頃, 候眼開, 先與熱小便飮之. 若初覺氣絶, 急擘開口, 以熱小便灌之, 利去瘀血. 《得效》

Translation영역
In all cases of death from a fall or a crushing, lay the man quickly in a good place and cover his mouth and nose with a sleeve for about the time of a meal. When the eyes open, first give him hot urine to drink. If he is found just at the moment the breath has stopped, force the mouth open at once and pour hot urine in, to drain off the stagnant blood.
Clinical note임상 주석
攧撲墮落壓倒傷 is blunt and crush trauma — falls from height, blows, and being pinned under a load. 墮壓死 is not death but what we would call unconsciousness after injury, and the first instruction is right for the wrong reason: laying the patient flat in a safe place and leaving him undisturbed for a few minutes is what a bystander should do. Covering the mouth and nose is the opposite of what is needed. In an unconscious trauma patient the airway is the first priority, and the two things that must happen are a protected airway and spinal immobilization before the patient is moved at all. Pouring anything into the mouth of a patient who is not awake risks aspiration, and in this chapter the thing poured is urine, chosen because 瘀血, stagnant blood, is held to be the whole pathology of blunt injury and urine is held to move it. **Hot urine is a human material and is not a medicine. This must not be given, and nothing should be poured into the mouth of an unconscious patient.**

Deukhyo 得效

1.4.2
Source원문

卒墮攧壓倒打死, 心頭溫者皆可救. 將本人如僧打坐, 令一人將其頭髮控放低, 以半夏末或皂角末吹入鼻內. 如活, 却以薑汁ㆍ香油打勻灌之. 《綱目》

Translation영역
Where a man has suddenly fallen, been thrown down, crushed or beaten to death, he can still be rescued so long as the region of the heart is warm. Set him up as a monk sits in meditation, have one person take hold of his hair and draw the head down low, and blow pinellia powder or gleditsia-pod powder into the nostrils. If he revives, then pour in ginger juice and sesame oil beaten together.
Clinical note임상 주석
心頭溫者皆可救 — while the chest is still warm he can be saved — is a workable field triage rule, and it is the text recognizing that apparent death after blunt injury is often survivable. What follows undoes it. Sitting a patient up after a fall, and then pulling the head down by the hair, is precisely the handling that converts an unstable cervical fracture into a cord transection. Blowing an irritant powder up the nose of an unresponsive patient provokes laryngospasm and aspiration. The underlying idea is a sternutatory arousal test, the same one the book uses in 救急. Modern practice is chest compressions if there is no pulse, in-line stabilization of the neck, and nothing in the airway that was not put there to protect it. **Contains raw pinellia, which is toxic and strongly irritant to mucous membrane. This must not be prepared or insufflated.**

Gangmok 綱目

1.4.3
Source원문

若取藥不及, 急抭開口, 以熱小便多灌之. 《入門》

Translation영역
If there is no time to fetch a drug, force the mouth open at once and pour in a quantity of hot urine.
Clinical note임상 주석
The emergency fallback for the same purging-the-stagnant-blood logic, with the dose simply increased. **Hot urine is a human material and is not a medicine; pouring any fluid into the mouth of a patient who cannot swallow causes aspiration. This must not be done.**

Immun 入門

1.4.4
Source원문

人爲刀斧所傷, 或墮落險地, 或撲身體損傷筋骨皮肉, 皆出血不止, 或瘀血停積. 若去之不早, 則有入腹攻心之患. 《醫鑑》

Translation영역
Where a man is wounded by knife or axe, or falls from a dangerous place, or is struck so that sinew, bone, skin and flesh are injured, in every case either the bleeding does not stop or stagnant blood settles and collects. If it is not got rid of early, there is the danger of its entering the belly and assaulting the heart.
Clinical note임상 주석
This is the chapter's own statement of the pathology of blunt trauma, and it is the hinge of the whole section: either the blood runs out, or it collects inside, and the collected blood is what kills by reaching the belly and the heart. 入腹攻心 is a recognizable clinical observation — abdominal distension, restlessness and collapse some hours after a blow — and what is being described is haemoperitoneum from a ruptured spleen or liver, or a retroperitoneal bleed, ending in haemorrhagic shock. The observation is right and the inference from it is dangerous. Because the collected blood is read as something to be expelled, the treatment prescribed is purgation. A patient bleeding into the abdomen needs volume, imaging and an operation, and 若去之不早 — the warning not to delay — is in modern terms a warning not to delay transport.

Uigam 醫鑑

1.4.5
Source원문

跌撲傷損, 須用蘇木活血, 黃連降火, 白朮和中, 以童便煎服妙. 傷在上, 宜飮韭汁. 《丹心》

Translation영역
For injury from a fall or a blow one must use sappan wood to quicken the blood, coptis to bring down fire, and white atractylodes to harmonize the centre, decocted in child's urine and taken — marvellous. Where the injury is in the upper body, Chinese chive juice should be drunk.
Clinical note임상 주석
A three-drug skeleton of the chapter's approach: move the blood, cool the heat of injury, protect the stomach against the drugs that do the first two. **Contains child's urine, a human material. This must not be prepared.**

Dansim 丹心

1.4.6
Source원문

凡攧打壓傷, 或從高墮落, 皆驚動四肢五藏, 必有惡血在內, 專怕惡心. 先用通二便藥和童便服之立效. 大小腸俱通利, 則自無煩悶攻心之患矣. 《得效》

Translation영역
In all injuries from a throw, a blow or a crushing, and in falls from a height, the four limbs and the five viscera are shaken and startled, and there is certainly bad blood inside; what is most to be feared is that it reaches the heart. First use a drug that opens both passages, mixed in child's urine — the effect is immediate. Once large and small intestine are both freely open, there is of itself no danger of oppression and of the blood assaulting the heart.
Clinical note임상 주석
通二便藥, a drug that opens both passages, means a purgative and a diuretic given together, and this passage is the clearest statement of the strategy that 通導散 below carries out. The logic is internally consistent: bad blood is collecting inside, so open the bowels and the bladder and let it out. In a patient who has fallen from a height the thing collecting inside is blood from a torn spleen, liver, kidney or mesentery, and purging it is not possible — the peritoneum does not drain into the colon. What a vigorous purge does instead is produce fluid loss and hypotension in someone who is already losing circulating volume, and it empties the bowel of a patient who may need an urgent laparotomy. 專怕惡心, that the danger is the blood reaching the heart, is a fair description of shock; the response to shock is resuscitation, not catharsis. **A purgative given after blunt abdominal trauma can hasten circulatory collapse. Contains child's urine, a human material. This must not be prepared or given.**

Deukhyo 得效

1.4.7
Source원문

凡傷損, 專主血論. 肝主血, 不問何經所傷, 惡血必歸於肝, 流於脇, 鬱於腹而作脹痛. 實者下之, 宜通導散ㆍ桃仁承氣湯方見寒門ㆍ奪命散方見上. 虛者, 復元活血湯方見上ㆍ當歸鬚散調之. 《入門》

Translation영역
In injury the discussion is governed entirely by the blood. The liver governs the blood, and whatever channel is injured the bad blood invariably returns to the liver, runs into the flanks and binds in the belly, making distension and pain. Where the patient is replete, purge him: Tongdo-san, Doinseunggi-tang — the formula is given in the Cold Damage chapter — or Talmyeong-san — the formula is given above. Where he is depleted, regulate him with Bogwonhwalhyeol-tang — the formula is given above — or Dangguisu-san.
Clinical note임상 주석
The replete-and-depleted division is the chapter's own safeguard, and it is doing the work that a modern assessment of circulatory status does: a patient who is distended, firm and still robust is purged, a patient who is weak is not. The distinction is sound in intent. It is far too coarse in practice, because the patient who is about to die of a splenic rupture looks replete before he looks depleted, with abdominal distension, guarding and pain in the flank — exactly the 流於脇, 鬱於腹而作脹痛 described here, and exactly the picture that is read as an indication to purge. 惡血必歸於肝 has an anatomical shadow behind it: blunt upper-abdominal trauma does cause liver and splenic injury with blood tracking into the flanks, and right-sided flank pain after a blow is a liver sign. The text has the organ right and the direction of flow backwards. **Purging a patient who may be bleeding internally is dangerous. Blunt abdominal injury with distension and flank pain is a surgical emergency and needs imaging and resuscitation, not a purgative.**

Immun 入門

1.4.8
Source원문

凡出血已多, 而又嘔血不止者難治. 宜用蘇木煎湯, 調蚌霜散服之. 《入門》

Translation영역
Where much blood has already been lost and the patient vomits blood without stopping, it is hard to treat. Sappan wood should be decocted and Bangsang-san mixed into it and taken.
Clinical note임상 주석
難治, hard to treat, is an honest prognosis. Continuing haematemesis after blunt trauma, in a patient who has already lost a great deal of blood, is an upper gastrointestinal bleed or a ruptured viscus, and the mortality of it before transfusion and endoscopy was close to total. The treatment offered is an astringent powder of calcined mussel shell and stove soot, which cannot reach the bleeding point.

Immun 入門

1.4.9
Source원문

諸傷疼痛, 宜乳香定痛散ㆍ乳香散ㆍ雙烏散ㆍ尋痛元ㆍ陣王丹ㆍ補損當歸散. 《諸方》

Translation영역
For the pain of all injuries: Yuhyang-jeongtong-san, Yuhyang-san, Ssangoh-san, Simtong-won, Jinwang-dan or Boson-dangwi-san.
Clinical note임상 주석
The section's analgesic list, and three of the six are aconite preparations. Before anaesthesia this was the only way to blunt the pain of a fracture or a crush, and the chapter is frank that the dose is pushed until numbness is felt — 如覺麻痺無害 in Ssangoh-san below. The 《諸方》 label marks this as the compiler's own gathering of formulas rather than a single citation.

Jebang 諸方

1.4.10
Source원문

蘇合香元方見氣門治打撲墮落, 挾驚悸, 氣血錯亂, 昏迷不省. 急取三五丸, 溫酒ㆍ童便調灌卽甦. 《得效》

Translation영역
Sohaphyang-won — the formula is given in the Qi chapter — treats a blow or a fall attended by fright and palpitation, with qi and blood thrown into disorder and the patient dazed and insensible. Take three or five pills at once, mixed in warm wine and child's urine and poured in, and he revives.
Clinical note임상 주석
昏迷不省 after a blow to the head is concussion or a developing intracranial haemorrhage, and it is the one presentation in this section where the modern answer is unambiguous: urgent imaging, because an extradural haematoma is operable and is fatal if missed. **Pouring wine and urine into the mouth of an insensible patient causes aspiration, and alcohol in a head injury obscures the very signs that are being watched for. Sohaphyang-won contains musk and other restricted animal materials. This must not be given.**

Deukhyo 得效

1.4.11
Source원문

頭上有傷, 或打破, 或金刃傷, 用藥糊角縛, 不使傷風, 愼之. 《得效》

Translation영역
Where there is an injury on the head, whether a break from a blow or a blade wound, apply the drug, paste it, bind the corners, and do not let it be struck by wind. Be careful of this.
Clinical note임상 주석
傷風 in this chapter is 破傷風, tetanus, and the instruction to dress and bind a scalp wound rather than leave it open is the chapter's own tetanus precaution. The reasoning is wrong — tetanus comes from Clostridium tetani spores in the wound, not from draught — but the practice that follows from it, covering the wound promptly, is right. A scalp wound over a blow heavy enough to break bone is also a depressed skull fracture until proved otherwise, and the modern sequence is wound irrigation, tetanus prophylaxis and imaging of the skull.

Deukhyo 得效

1.4.12
Source원문

通導散 治傷損極重, 大小便不通, 心腹脹悶. 宜用此下瘀血. 大黃ㆍ芒硝 各二錢, 當歸ㆍ蘇木ㆍ紅花ㆍ桃仁 各一錢, 厚朴ㆍ陳皮ㆍ木通ㆍ枳殼ㆍ甘草 各五分. 右剉作一貼, 水煎空心服. 《醫鑑》 ○一名大成湯. 《醫林》

Translation영역
Tongdo-san. Treats injury of the gravest degree, with neither stool nor urine passing and distension and oppression of the heart and belly. This should be used to bring the stagnant blood down. Rhubarb and mirabilite 2 don each; Korean angelica, sappan wood, safflower and peach kernel 1 don each; magnolia bark, tangerine peel, akebia, bitter orange and licorice 5 fun each. Cut them up to make one packet, decoct in water and take on an empty stomach. ○ Also called Daeseong-tang.
Clinical note임상 주석
Structurally this is Daeseunggi-tang — rhubarb, mirabilite, magnolia bark, with bitter orange for 枳實 — with a blood-moving group laid on top of it: sappan wood, safflower, peach kernel and angelica. Rhubarb and mirabilite together are an anthraquinone stimulant plus an osmotic salt, and the combination is a drastic purge; the indication given, 大小便不通 with 心腹脹悶, is severe abdominal distension with retention after a crush or a fall. That presentation is almost never constipation. It is a paralytic ileus from retroperitoneal or intraperitoneal bleeding, or an obstructing haematoma, or peritonitis from a ruptured viscus. Giving a brisk purge into it adds large fluid losses to a patient who is already volume-depleted, raises intraluminal pressure against a possible perforation, and can turn a contained bleed into frank decompensation. There is no route by which blood in the peritoneal cavity leaves through the bowel, so the thing the formula is given for cannot happen. **Contains rhubarb and mirabilite, a drastic purgative combination. Purging a patient who may be bleeding internally can precipitate circulatory collapse, and abdominal distension with retention after blunt trauma is a surgical emergency. This must not be prepared or given.**

Uigam 醫鑑 · Uirim 醫林

1.4.13
Source원문

當歸鬚散 治打撲損傷, 致氣凝血結, 胸腹脇痛. 當歸尾 一錢半, 赤芍藥ㆍ烏藥ㆍ香附子ㆍ蘇木 各一錢, 紅花 八分, 桃仁 七分, 桂皮 六分, 甘草 五分. 右剉作一貼, 酒水相半煎服. 《入門》

Translation영역
Dangguisu-san. Treats injury from a blow, where qi has congealed and blood bound, with pain in the chest, belly and flanks. Angelica tails 1 don 5 fun; red peony, lindera, cyperus and sappan wood 1 don each; safflower 8 fun; peach kernel 7 fun; cinnamon bark 6 fun; licorice 5 fun. Cut them up to make one packet and decoct in half wine, half water.
Clinical note임상 주석
This is the formula that survived into ordinary Korean practice, and it is the one in the section a clinician still reaches for: the standard prescription after a contusion or a sprain, and the usual internal counterpart to needling in personal-injury work. Unlike Tongdo-san it does not purge. It is a blood-moving and qi-moving formula with no cathartic in it, which is why it is safe in the cases that matter — the bruised, aching, non-haemorrhaging patient a week after the accident. 氣凝血結 with chest, belly and flank pain is rib and chest-wall injury with soft-tissue haematoma. The caution is the same as for any trauma presentation: flank and chest pain after a blow has to be cleared of pneumothorax, rib fracture and solid-organ injury before it is treated as a bruise.

Immun 入門

1.4.14
Source원문

蚌霜散 治傷損大吐血. 蚌粉ㆍ百草霜 各等分. 右爲末, 每二錢, 糯米飮調服. 《入門》

Translation영역
Bangsang-san. Treats great vomiting of blood from injury. Mussel-shell powder and stove soot in equal parts. Powder them; 2 don at a time, mixed in a glutinous-rice drink and taken.
Clinical note임상 주석
Two inert powders — calcined mussel shell is calcium carbonate, stove soot is carbon — in a rice vehicle. Calcium carbonate is an antacid, and raising gastric pH does in fact favour clot stability in an upper gastrointestinal bleed, which is the nearest this formula comes to a mechanism. It will not stop a significant haematemesis. That needs endoscopy and transfusion.

Immun 入門

1.4.15
Source원문

乳香定痛散 治諸傷損疼痛. 白芷ㆍ當歸ㆍ生芐ㆍ牡丹皮ㆍ赤芍藥ㆍ川芎ㆍ乳香ㆍ沒藥ㆍ白朮ㆍ甘草 各等分. 右爲末, 每二錢, 溫酒ㆍ童便各半調勻服之. 《入門》 ○一名活血止痛散. 《醫鑑》

Translation영역
Yuhyang-jeongtong-san. Treats the pain of all injuries. Dahurian angelica, Korean angelica, fresh rehmannia, moutan bark, red peony, cnidium, frankincense, myrrh, white atractylodes and licorice in equal parts. Powder them; 2 don at a time, mixed evenly in half warm wine and half child's urine and taken. ○ Also called Hwalhyeol-jitong-san.

Immun 入門 · Uigam 醫鑑

1.4.16
Source원문

乳香散 治打撲傷損, 痛不可忍. 白朮(炒)ㆍ當歸(炒)ㆍ白芷ㆍ桂皮ㆍ乳香ㆍ沒藥ㆍ甘草 各等分. 右爲末, 每二錢, 溫酒調下. 《得效》

Translation영역
Yuhyang-san. Treats injury from a blow with pain that cannot be borne. White atractylodes (parched), Korean angelica (parched), dahurian angelica, cinnamon bark, frankincense, myrrh and licorice in equal parts. Powder them; 2 don at a time, taken down in warm wine.
Clinical note임상 주석
Frankincense and myrrh are the pair that carries every analgesic formula in this section, and this is the mildest of the six — no aconite, no purgative, no mineral. Boswellic acids and the sesquiterpenes of myrrh have measurable anti-inflammatory activity, which is a modest but real basis for the pair.

Deukhyo 得效

1.4.17
Source원문

雙烏散 治諸傷百損, 久後時常疼痛者, 及新被傷作痛亦宜. 川烏ㆍ草烏(略炮) 各三錢, 當歸ㆍ白芍藥ㆍ蘇木ㆍ大黃ㆍ生乾地黃ㆍ紅麴(炒) 各五錢, 麝香 少許. 右爲末, 入瓦甁, 以酒煮, 放冷服. 如覺麻痺無害. 但草烏生用恐太猛, 所以略炮. 《入門》

Translation영역
Ssangoh-san. Treats all injuries and the hundred hurts, both where pain recurs constantly long afterwards and in a fresh injury that is painful. Aconite main root and wild aconite (lightly blast-fried) 3 don each; Korean angelica, white peony, sappan wood, rhubarb, dried fresh rehmannia and red yeast rice (parched) 5 don each; a little musk. Powder them, put them in an earthenware bottle, boil in wine, let it cool and take it. If numbness is felt there is no harm. But raw wild aconite is feared to be too fierce, and so it is lightly blast-fried.
Clinical note임상 주석
The dose is six don of aconite in one preparation, and 如覺麻痺無害 — if numbness is felt there is no harm — is the text's own endpoint for it. That is not a side effect. Perioral and limb numbness is the first sign of aconitine toxicity, and it is being used deliberately as the mark that enough has been given. The note that raw 草烏 is 太猛, too fierce, and so is blast-fried first, shows the compiler knew the margin was narrow; blast-frying hydrolyses some of the diester alkaloids and does reduce toxicity, but not predictably. Aconitine blocks voltage-gated sodium channels and the next thing after numbness is ventricular arrhythmia. There is no antidote; treatment is supportive, with antiarrhythmics and sometimes cardiopulmonary bypass. Deaths from exactly this kind of preparation are still reported. **Contains aconite in large amount, which is toxic and can cause fatal cardiac arrhythmia, and musk from a CITES-protected animal. This must not be prepared.**

Immun 入門

1.4.18
Source원문

尋痛元 治諸傷止痛, 淸心行氣活血如神. 草烏(生用)ㆍ乳香(火熨)ㆍ沒藥(火熨)ㆍ五靈脂 各三錢, 生麝香 少許. 右爲末, 酒糊丸如指頭大, 朱砂爲衣. 每一丸, 薄荷湯ㆍ薑汁磨化服. 《得效》

Translation영역
Simtong-won. Treats all injuries and stops pain; it clears the heart, moves the qi and quickens the blood like a spirit. Wild aconite (used raw), frankincense (heat-pressed), myrrh (heat-pressed) and flying-squirrel faeces 3 don each; a little fresh musk. Powder them, make pills with wine paste the size of a fingertip and coat them with cinnabar. One pill at a time, ground up in mint decoction with ginger juice and taken.
Clinical note임상 주석
Here the aconite is used raw and undetoxified, 草烏生用, which is the most dangerous preparation of it in the whole chapter — Ssangoh-san above explicitly blast-fries it for that reason. A pill the size of a fingertip is a substantial single dose and there is no titration against effect. **Contains raw wild aconite, which is highly toxic and can cause fatal cardiac arrhythmia, cinnabar, which is a mercury compound, and musk from a CITES-protected animal. This must not be prepared.**

Deukhyo 得效

1.4.19
Source원문

陣王丹 治諸折傷止血定痛. 大黃 一兩, 石灰 六兩. 右同炒紫色爲度, 去火毒, 擣篩爲末, 敷傷處妙. 《入門》

Translation영역
Jinwang-dan. Treats all fractures; it stanches blood and settles pain. Rhubarb 1 nyang, lime 6 nyang. Parch them together until the colour is purple, drive off the fire toxin, pound and sift to a powder, and apply it to the injured place — marvellous.
Clinical note임상 주석
Six parts lime to one of rhubarb, parched together, is an external haemostatic powder and it works the way the 石灰 entry in 1.3 works — by cauterizing the bleeding surface. 去火毒, driving off the fire toxin, means letting the calcined mixture stand until it has cooled and taken up moisture, which converts some of the oxide to the less violent carbonate. For 折傷, a fracture, the useful intervention is reduction and immobilization, which the chapter describes properly in 1.7. A caustic powder on the skin over a closed fracture does nothing for the bone, and on an open fracture it burns tissue that has to heal over exposed bone. **Contains lime, which is caustic and burns skin and eye. This must not be prepared or applied to a wound.**

Immun 入門

1.4.20
Source원문

補損當歸散 治墮撲折傷疼痛呌號. 服此藥不復大痛, 三日筋骨相連. 川芎 一兩半, 桂心ㆍ川椒ㆍ當歸ㆍ甘草 各七錢半, 附子(炮)ㆍ澤蘭 各二錢半. 右爲末, 每二錢, 溫酒調服, 效如神. 《局方》

Translation영역
Boson-dangwi-san. Treats a fracture from a fall or a blow, with pain that makes the patient cry out. Take this drug and the great pain does not return; in three days sinew and bone are joined again. Cnidium 1 nyang 5 don; cinnamon heart, Sichuan pepper, Korean angelica and licorice 7 don 5 fun each; prepared aconite (blast-fried) and bugleweed 2 don 5 fun each. Powder them; 2 don at a time, mixed in warm wine and taken — the effect is like a spirit.
Clinical note임상 주석
疼痛呌號, pain that makes the patient cry out, is the honest description of an unsplinted long-bone fracture, and this is an analgesic powder for it. 三日筋骨相連, sinew and bone joined in three days, is not: bony union takes weeks to months, and nothing taken by mouth shortens it. What can be relieved in three days is the pain, once the fracture stops moving. **Contains aconite, which is toxic. This must not be prepared.**

Gukbang 局方

1.4.1 Reducing Swelling and Removing Scars in Blow Injury 打撲傷消腫滅瘢

1.4.1.1
Source원문

凡鬪毆被打成破傷風, 頭面腫大發熱, 以九味羌活湯方見寒門熱服取汗. 外用杏仁擣爛, 入白麪少許, 新汲水調付瘡上, 腫卽消. 《回春》

Translation영역
Where a man has been struck in a brawl and lockjaw wind has formed, the head and face swollen large and fever arising: give Nine Ingredient Decoction with Notopterygiumthe formula is given in the Cold chapter hot, to obtain sweat. Outwardly, pound apricot kernels to a pulp, put in a little white wheat flour, stir it up with newly drawn water and apply it over the wound; the swelling subsides at once.
Clinical note임상 주석
破傷風 is tetanus, and the text has the aetiology right — it ties the disease to the blow that broke the skin. The trismus that gives the Korean and the English name their shape is the first sign; the swelling and fever of the head and face described here are what a contaminated facial wound looks like in the days before the spasm generalises. **Tetanus is a medical emergency and nothing in this passage treats it.** It kills by sustained spasm of the respiratory and laryngeal muscles, and the modern management is wound debridement, tetanus immunoglobulin, metronidazole, muscle relaxation and ventilatory support; prevention is a tetanus-toxoid booster given at the time of any dirty or penetrating wound. Nine Ingredient Decoction with Notopterygium is a wind-dispersing diaphoretic for the early stage of an exterior cold pattern, and sweating a man whose airway is about to close is a loss of the hours that matter. The apricot-flour poultice is a harmless cooling dressing; apricot kernel is cyanogenic and must not be eaten in quantity, but laid on the skin it does nothing either way.

Hoechun 回春

1.4.1.2
Source원문

治傷損腫痛, 瘀血流注紫黑, 或傷眼上靑黑不散. 大黃爲末, 生薑汁調付患處, 卽消. 名將軍膏. 《醫鑑》

Translation영역
Treats swelling and pain from an injury, where stagnant blood has flowed down and settled purple-black, or where the eye has been injured and the blue-black above it will not disperse. Powder rhubarb, stir it with ginger juice and apply it to the affected place; it subsides at once. It is called General's Paste.
Clinical note임상 주석
將軍 — the General — is rhubarb's by-name, and the paste is named for the drug. The picture is an ordinary contusion with gravitational tracking of blood under the skin, and the second indication, blue-black above the eye that will not clear, is a black eye. Rhubarb's anthraquinones have some topical anti-inflammatory action and the cold paste itself eases the ache, but a closed bruise resolves on its own in one to three weeks whatever is laid on it. What the passage cannot do is tell a bruise from the injury underneath it. Periorbital discoloration after a blow needs the eye itself looked at — for hyphaema, for a blown pupil, for the restricted upgaze of an orbital floor fracture, and for the tense, proptosed, painful eye of retrobulbar haemorrhage, which blinds within hours unless the orbit is decompressed. Ginger juice is an irritant and should not go on broken skin or near the eye.

Uigam 醫鑑

1.4.1.3
Source원문

散被毆瘢痕, 亦治跌撲. 麻油ㆍ淸酒各一椀, 同煎數沸服之. 服了卧火燒熱地上一夜, 痛止腫消無痕. 有被傷者, 仇家陰令術士以此治之, 次日驗審, 了無一毫傷痕. 《回春》

Translation영역
Disperses the scars and marks of a beating, and also treats falls and blows. Sesame oil and clear wine, 1 bowl each, are boiled together through several risings of the boil and drunk. When it has been taken, let him lie a whole night on ground heated by fire; the pain stops, the swelling goes down, and no mark is left. There was a man who had been injured, and the enemy household secretly had a practitioner treat him with this; when the examination was made the next day, there was not one hair's breadth of injury to be found.
Clinical note임상 주석
This is not a healing method but a method for defeating one. The anecdote turns on the 驗審, the official inspection of the injury, and the enemy household pays a practitioner to clear the marks before the examiner arrives, so that no assault can be proved. Its presence in a medical book is evidence that injuries were legally examined in Chosŏn and that the examination rested on visible marks, which is exactly why they were worth removing. As treatment it is implausible and not harmless. A bowl of sesame oil with a bowl of wine is a large load of fat and ethanol, and alcohol in a man who may be bleeding internally vasodilates, impairs platelet function and masks the drowsiness that is the first sign of a head injury. Lying all night on fire-heated ground is a contact-burn risk, and most of all in someone who has been drinking or whose sensation is dulled. Bruises fade in days to weeks; nothing clears one overnight.

Hoechun 回春

1.4.1.4
Source원문

打撲傷肌膚靑腫, 茄子種通黃極大者, 切作片, 瓦上焙乾爲末, 臨卧酒調 二錢服, 一夜消盡無痕. 《聖惠》

Translation영역
For a blow injury where the flesh and skin are blue and swollen: take an aubergine of the seed kind, yellow all through and extremely large, cut it into slices, dry it on a tile over the fire and powder it; at bedtime stir 2 don into wine and take it, and in one night it disperses entirely without a mark.
Clinical note임상 주석
A ripe aubergine dried and powdered is a harmless food, and 2 don of it in wine at night will do nothing good or bad. The claim that a contusion clears in a single night is the one part worth marking: ecchymosis follows the breakdown of extravasated haemoglobin and runs its colour sequence over one to three weeks no matter what is given. The repeated 無痕 of this section — no mark left — is the promise that drew the recipes together, and none of them keeps it.

Seonghye 聖惠

1.5 Pulse Signs and the Signs That Cannot Be Treated 脉候及不治證

1.5.1
Source원문

凡打撲損傷, 內有瘀血, 其脉堅强者生, 小弱者死. 《脉經》

Translation영역
In any injury from a blow or a fall where there is stagnant blood within, if the pulse is firm and strong he lives; if it is small and weak he dies.
Clinical note임상 주석
Strip the 瘀血 framing and this is a statement about circulatory failure, and it is correct. A firm, well-filled pulse after blunt trauma means the circulating volume is holding; a small, weak, thready pulse means it is not, and a thready pulse in a man with internal bleeding is class III haemorrhagic shock. In 1613 that was a death sentence because there was nothing to give; today it is the point at which blood products, tranexamic acid and a surgeon are called for, and the window is measured in minutes.

Maekgyeong 脉經

1.5.2
Source원문

打撲傷損, 去血過多, 脉當虛細. 若得急疾大數者死. 《醫鑑》

Translation영역
In injury from a blow or a fall where too much blood has been lost, the pulse ought to be vacuous and fine. If one finds it urgent, rapid, large and frequent, he dies.
Clinical note임상 주석
The sharper of the two pulse rules. It says that after heavy blood loss a weak thin pulse is to be expected, and that a racing one is the ominous finding — which is the recognition that tachycardia is not reassurance but compensation. A rising rate in a man who has bled is the earliest reliable sign that the loss is continuing, and it rises before the blood pressure falls; the pre-transfusion observer saw the same thing and read it as fatal because it was.

Uigam 醫鑑

1.5.3
Source원문

凡折傷, 外損筋骨者可治. 內損藏府裏膜, 及破陰子ㆍ耳後者, 並不治. 與上十不治證參看 《入門》

Translation영역
In any fracture injury, where the damage is outside, to sinew and bone, it can be treated. Where the damage is inside — to the viscera and the lining membrane — and where the testicles are ruptured or the injury is behind the ear, none of these can be treated.to be read together with the ten untreatable signs above
Clinical note임상 주석
A triage list, and a shrewd one. 裏膜 is the lining membrane — peritoneum and pleura — and what the text is separating is the injury that stops at the musculoskeletal shell from the injury that has opened a body cavity. Closed visceral trauma is still what kills in blunt injury: splenic and hepatic laceration, bowel rupture with peritonitis, haemothorax, cardiac tamponade. 破陰子, a ruptured testis, is correctly singled out, and the injury behind the ear is the mastoid — the thin squamous and petrous temporal bone over the sigmoid sinus, the classic site of a basal skull fracture, whose retroauricular bruise is still taught as Battle's sign. Every site on the list was effectively fatal in 1613 and none of them need be now. Visceral haemorrhage is a laparotomy or an angiographic embolisation; a ruptured testis is salvageable by exploration and repair within a few hours; a basal skull fracture needs imaging, airway protection and watching for a rising intracranial pressure. The text's own contribution is the distinction, which is sound, and the cross-reference back to the ten untreatable signs of the blade-wound section shows the author treating prognosis as a single subject across the chapter.

Immun 入門

1.5.4
Source원문

如傷藏府致命處, 一觀其脉虛促, 危矣. 《得效》

Translation영역
If the injury is to the viscera, to a place that decides life, then as soon as one finds the pulse vacuous and hurried, it is grave.
Clinical note임상 주석
虛促 — empty and hurried — is the same finding as the preceding passage's urgent rapid pulse, read at the bedside rather than as a rule. An empty, fast pulse with a known visceral injury is decompensated shock, and the chapter is consistent on it: the pulse, not the wound, tells whether the man will live.

Deukhyo 得效

1.6 Simple Medicinals 單方

1.6.1
Source원문

凡十七種.

Translation영역
Seventeen kinds in all.
Clinical note임상 주석
Seventeen entries follow and seventeen are printed, so the head's count is sound. Hot or warm wine is the vehicle in eight of them. It is worth saying once, for the whole section: ethanol vasodilates, inhibits platelet aggregation and blunts the level of consciousness that is the thing being watched, so in a man with stagnant blood — which in modern terms means a man who is bleeding inside — the standard vehicle of this section works against him.

Donguibogam · Jesang

1.6.2
Source원문

蒲黃 治撲損瘀血在內煩悶. 蒲黃末 三錢, 熱酒調下. 《得效》

Translation영역
Cattail Pollen (蒲黃): Treats a blow injury with stagnant blood within and vexation and oppression. Cattail pollen powder 3 don, stirred into hot wine and taken down.
Clinical note임상 주석
煩悶 — vexation and oppression in the chest — after blunt injury is restlessness and air hunger, and in a man who has been struck that is a sign of blood loss or of blood in the chest, not of an obstruction to be moved. Cattail pollen is classed as a blood-moving and blood-stopping drug depending on whether it is used raw or charred, which is as much as to say its action was never settled; there is no evidence it does either in a human.

Deukhyo 得效

1.6.3
Source원문

白楊樹皮 治撲損瘀血, 痛不可忍. 取樹皮, 酒漬服之. 《本草》

Translation영역
White Poplar Bark (白楊樹皮): Treats a blow injury with stagnant blood and pain beyond bearing. Take the bark, steep it in wine and take it.
Clinical note임상 주석
The one entry in the section with real pharmacology behind it. Poplar bark is rich in salicin, the glycoside that yields salicylic acid in the body and from which aspirin was made; willow and poplar bark steeped in alcohol give a genuine analgesic and anti-inflammatory dose, and a sufferer who found the pain unbearable would have felt the difference. The irony is that it is the wrong drug for the indication as the text understands it. Salicylates inhibit platelet cyclo-oxygenase irreversibly and prolong bleeding for days, so in a man with real internal haemorrhage this relieves the pain and worsens the bleeding. For a closed contusion with no cavity injury it is a reasonable analgesic, and essentially what is still done.

Boncho 本草

1.6.4
Source원문

生龜 治撲損踒折. 取血和酒飮之. 肉生硏厚塗傷處, 立效. 《本草》

Translation영역
Live Turtle (生龜): Treats a blow injury with sprain and fracture. Take its blood, mix it with wine and drink it. Grind the flesh raw and spread it thickly over the injured place; the effect is immediate.
Clinical note임상 주석
**Raw reptile blood and tissue carry Salmonella and other enteric organisms, and laying raw flesh thickly on an injured limb invites wound infection and tetanus. This must not be prepared.** Freshwater turtles are a known reservoir of reptile-associated salmonellosis, and drinking the blood of a live one is the most direct route of exposure there is. Many turtle and tortoise species are now protected under CITES and under national wildlife law, so the material is also one that cannot lawfully be obtained in most places. A sprain or fracture needs reduction, immobilisation and imaging, which the chapter itself describes well in 骨折筋斷傷 — this entry adds nothing to that but a hazard.

Boncho 本草

1.6.5
Source원문

蠐螬 主打撲踠折, 血在脇下堅滿痛. 取汁和酒服. 又硏付傷處. 《本草》

Translation영역
Beetle Grub (蠐螬): Governs blows and sprains where blood lies below the rib-side, hard, full and painful. Take its juice, mix it with wine and take it. Also grind it and apply it to the injured place.
Clinical note임상 주석
血在脇下堅滿痛 — blood below the rib-side, hard, full and painful — is a good description of what is now read as a subcapsular or perisplenic haematoma after a blow to the left flank, or a hepatic injury on the right. The sign is observed accurately and the inference, that blood has collected there, is correct. **The juice of a raw insect larva taken internally and applied to an injury carries a clear infection risk and must not be prepared.** More importantly, the condition named is one of the true emergencies of blunt trauma: a delayed splenic rupture can bleed out hours or days after the blow, and it is diagnosed by imaging and managed by embolisation or splenectomy.

Boncho 本草

1.6.6
Source원문

鼠屎 治落傷筋骨, 痛不可忍. 取屎燒爲末, 猪脂調, 急裹之, 不過半日愈. 《本草》

Translation영역
Rat Droppings (鼠屎): Treats a fall injury to the sinews and bones with pain beyond bearing. Take the droppings, burn them to a powder, stir them with lard, bind it on tightly, and in not more than half a day it is healed.
Clinical note임상 주석
**Rodent droppings carry leptospirosis, hantavirus, Salmonella and Clostridium tetani, and must never be put on injured tissue. This must not be prepared.** Burning reduces the load but the preparation is then stirred into lard and bound tightly on, which is a warm, occluded, anaerobic dressing — the condition under which tetanus and clostridial infection flourish. The 急裹之, bind it on tightly, is the only part with any merit, and only by accident: firm compression and immobilisation do relieve the pain of a sprain or a closed fracture. Use a clean bandage and nothing else.

Boncho 本草

1.6.7
Source원문

荷葉 治打撲落傷, 惡血攻心悶亂. 乾葉燒爲末, 熱童尿調下 二錢, 日三. ○未展荷葉爲末, 童便調服, 利下惡物. 《綱目》

Translation영역
Lotus Leaf (荷葉): Treats blows and falls where malign blood assails the heart with oppression and disorder. Burn the dried leaf to a powder and take 2 don stirred into hot boy's urine, three times a day. ○ Powder an unopened lotus leaf and take it stirred into boy's urine; it drains down the malign matter.
Clinical note임상 주석
惡血攻心悶亂 — malign blood assailing the heart, with oppression and disorder — is the confusion and agitation of a man who is losing blood or has had his head struck, and the doctrine reads the agitation as something the blood is doing to the heart. **Boy's urine is a human material; urine is not sterile, and drinking it in volume adds a bacterial and solute load to a patient who is already compromised.** It appears here and in the 人尿 entry below as the standard vehicle for trauma in this chapter. Lotus leaf ash itself is inert charcoal. A man confused after a blow needs his conscious level tracked and his head imaged, because the one diagnosis that behaves exactly like this and is reversible is an extradural haematoma.

Gangmok 綱目

1.6.8
Source원문

胡桃 壓撲傷損. 胡桃肉擣爛, 和溫酒頓服便差. 《本草》

Translation영역
Walnut (胡桃): For injury from crushing and blows. Pound walnut flesh to a pulp, mix it with warm wine and take it all at once; he recovers directly.
Clinical note임상 주석
A food in wine, harmless in itself. 壓撲 is crush injury, and the entry is worth reading against what crush injury actually does: muscle breakdown releases myoglobin and potassium, and the kidney fails days later from rhabdomyolysis unless the patient is given large volumes of fluid early. That is the treatment, and it is the opposite of a single draught of wine.

Boncho 本草

1.6.9
Source원문

麻根 主打撲落傷踠折, 有瘀血痛不可忍. 取根及葉, 擣取汁飮, 或煮服之. 非時則取乾麻煮汁飮. 《本草》

Translation영역
Hemp Root (麻根): Governs blows, falls and sprains where there is stagnant blood and pain beyond bearing. Take the root and the leaves, pound them, press out the juice and drink it, or boil them and take it. Out of season, take dried hemp, boil it and drink the liquor.
Clinical note임상 주석
麻 here is 大麻, Cannabis sativa, grown throughout Korea as a fibre crop, and the drug is its root with the leaves. The root contains almost none of the cannabinoids; the leaf carries a little, far less than the flowering tops, and a water decoction extracts them poorly because they are lipophilic. So a plausible analgesic plant is being used in the two parts and by the one method least likely to deliver anything. Cannabis is a controlled plant in Korea and in most jurisdictions, including its leaf and root, so the preparation cannot lawfully be made whatever its merits.

Boncho 本草

1.6.10
Source원문

稻稈灰 治墮落撲損痛楚. 稻稈燒灰, 和糟酒淋灰取汁, 乘溫淋洗痛處, 立差. 《本草》

Translation영역
Rice Straw Ash (稻稈灰): Treats the pain and distress of falls and blows. Burn rice straw to ash, mix it with lees-wine, pour it over the ash and take the liquor; while it is still warm pour it over and wash the painful place, and he recovers at once.
Clinical note임상 주석
The method is lye-making: water poured through plant ash dissolves potassium carbonate, and the liquor that runs off is strongly alkaline, with a pH well above 11 from straw ash. **An alkaline lye wash will cause chemical burns, and poured on broken skin it will deepen the wound; alkalis saponify tissue and keep burning after the liquid is wiped away. This must not be prepared.** A warm wash does ease the ache of a contusion, and warm water alone does it without the alkali. There is no good reason to put ash liquor on injured skin.

Boncho 本草

1.6.11
Source원문

芥子 撲損瘀血作痛. 芥子和生薑硏, 微煖塗貼患處, 卽效. 《本草》

Translation영역
Brown Mustard Seed (芥子): For a blow injury where stagnant blood makes pain. Grind mustard seed with fresh ginger, warm it slightly, spread it on and apply it to the affected place; the effect is immediate.
Clinical note임상 주석
A mustard plaster, and it works the way the text says it does — the allyl isothiocyanate released when ground mustard is wetted is a rubefacient, and the warmth and counter-irritation genuinely mask a deep ache. Ginger adds gingerols to the same effect. **Mustard left on the skin blisters it. A mustard plaster causes full-thickness chemical burns within fifteen to thirty minutes on thin or already injured skin, and the text gives no time limit at all.** It must never go on broken skin, and the burns it causes are slow to heal in precisely the sort of bruised, poorly perfused tissue this entry is meant for.

Boncho 本草

1.6.12
Source원문

葱白 治打撲傷損, 痛不可忍. 取葱白入煻火煨, 乘熱擘開, 其中有涕, 便將罨損處, 冷則易熱者, 須臾痛定. 《本草》 ○又葱白ㆍ砂糖等分, 爛硏付之, 痛立止, 且無瘢痕. 《丹心》

Translation영역
Scallion White (葱白): Treats blows and injuries with pain beyond bearing. Take scallion white, put it into the embers and roast it, split it open while it is hot — there is a slime inside it — and at once lay it as a compress on the injured place; when it cools, change it for a hot one. In a short while the pain settles. ○ Also, scallion white and granulated sugar in equal parts, ground to a pulp and applied: the pain stops at once, and no scar is left.
Clinical note임상 주석
The least objectionable entry in the section and the only one whose mechanism is honest. A hot, moist compress changed as it cools relieves the pain of a closed contusion, and the mucilage of a roasted scallion holds the heat and keeps the dressing from sticking. The second recipe is a sugar paste, which is hygroscopic and mildly antibacterial — sugar dressings are still used on some wounds for that reason. 無瘢痕, no scar left, is the section's standing promise and is not kept. Scarring is determined by the depth of the original injury; nothing applied afterwards changes it, and the roasting embers are a burn risk if the scallion goes on too hot.

Boncho 本草 · Dansim 丹心

1.6.13
Source원문

人尿 主撲損落傷, 瘀血攻心暈絶. 熱尿頓服一二升卽甦. 童子尿尤佳. 《本草》

Translation영역
Human Urine (人尿): Governs blows and falls where stagnant blood assails the heart with fainting and loss of consciousness. Take 1 to 2 seung of hot urine at one draught and he revives. A boy's urine is better still.
Clinical note임상 주석
**A human material, and it must not be prepared.** Urine is not sterile at the point of voiding, and one to two seung — well over a litre — poured into a patient at a single draught adds a solute and bacterial load for no benefit at all. The real danger is the indication. 暈絶 after a fall is syncope or a reduced level of consciousness — from blood loss, from a vasovagal response, or from a head injury — and pouring a litre of fluid into the mouth of someone who is not fully conscious is how people aspirate and die of it. Nobody with an impaired conscious level should be given anything by mouth. What this patient needs is to be laid flat, assessed for the source of the bleeding, and moved.

Boncho 本草

1.6.14
Source원문

烏雞 被壓窄ㆍ墮舟船ㆍ車轢ㆍ馬踼ㆍ牛觸, 胸腹破陷, 四肢摧折, 氣悶欲死. 烏雞 一隻, 合毛杵一千下, 和苦酒一升得所. 以新布搨病處, 取藥塗布上罨定, 乾則易. 覺寒振欲吐, 不可去藥. 須臾復上一雞, 神效. 《本草》

Translation영역
Black-Boned Fowl (烏雞): For one who has been crushed in a narrow place, fallen from a boat, run over by a cart, kicked by a horse or gored by an ox, the chest and abdomen broken in and sunken, the four limbs shattered and broken, the breath stifled and death near. One black-boned fowl, feathers and all, pounded a thousand strokes and mixed with 1 seung of vinegar to the right consistency. Lay a new cloth over the affected place, take the medicine and spread it on the cloth, cover it and fix it there, and change it when it dries. If he feels cold, shivers and wants to vomit, the medicine must not be taken off. In a short while put on a second fowl; the effect is miraculous.
Clinical note임상 주석
Read the indication rather than the remedy. Crushed in a confined space, fallen from a boat, run over by a cart, kicked by a horse, gored by an ox — chest and abdomen caved in, all four limbs broken, air hunger and death near. That is a trauma bay, and it is as good a casualty list as the pre-modern literature gives. 胸腹破陷 with 氣悶 is a flail chest with respiratory failure, and the limb fractures and visceral injury make it a polytrauma with a mortality that was effectively total. **A whole raw fowl pounded with its feathers and bound on broken skin is as direct an inoculation of Campylobacter, Salmonella and Clostridium tetani as could be devised, and it must not be prepared.** The instruction not to remove the dressing when the patient turns cold, shivers and retches is the most dangerous line in the section: those are the signs of sepsis or of continued haemorrhage, and they are the signs that should bring the dressing off and help in.

Boncho 本草

1.6.15
Source원문

烏鴉羽 治墮落損傷, 瘀血脹心, 面靑氣短. 取右翅羽七枚燒灰, 和酒服, 當吐血便差. 《本草》

Translation영역
Crow Feather (烏鴉羽): Treats injury from a fall where stagnant blood distends the heart, the face is blue-green and the breath is short. Take seven feathers from the right wing, burn them to ash, mix with wine and take it; he should vomit blood and then recover.
Clinical note임상 주석
面靑氣短 after a fall is cyanosis with dyspnoea, and with it the sense of something distending the chest. The modern reading is not stagnant blood but air or blood in the pleural space, or fluid in the pericardium: tension pneumothorax, massive haemothorax, cardiac tamponade. Each of them kills within minutes to hours and each is relieved by a needle or a drain. A cyanosed, breathless patient after a fall is the single most time-critical presentation in this chapter. **Burnt feather ash in wine does nothing, and inducing vomiting in a man with chest trauma and respiratory distress risks aspiration and raises intrathoracic pressure in the one patient who can least afford it.** Crows are protected birds under wildlife law in many jurisdictions. The count of seven and the choice of the right wing are numerological, not pharmacological.

Boncho 本草

1.6.16
Source원문

犬膽 治撲損刀箭傷, 內有瘀血. 取膽熱酒調服, 瘀血盡下. 《本草》 ○犬屎燒存性爲末, 熱酒調下二三錢, 亦有奇效. 《俗方》

Translation영역
Dog Gall (犬膽): Treats blow injuries and wounds from blade and arrow where there is stagnant blood within. Take the gall, stir it into hot wine and take it, and the stagnant blood all comes down. ○ Dog faeces burnt with its nature preserved and powdered, 2 to 3 don stirred into hot wine and taken down, also has a remarkable effect.
Clinical note임상 주석
**Both parts are animal materials taken internally and must not be prepared.** Dog bile and dog faeces carry Echinococcus granulosus, Toxocara canis, Campylobacter and Salmonella; the eggs of Echinococcus survive heating poorly but the preparation 燒存性 — burnt only until the nature is preserved — is deliberately incomplete combustion, which is to say it is designed not to sterilise the material. Obtaining gall from a dog also means killing it. 瘀血盡下, the stagnant blood all comes down, describes a purge. Purging a man with internal bleeding from a blade or arrow wound loses him fluid he cannot spare and is among the more harmful of the chapter's standing manoeuvres.

Boncho 本草 · Sokbang 俗方

1.6.17
Source원문

酒糟 主打撲墮落損傷, 瘀血腫痛. 酒糟和醋滓, 蒸溫熨之, 妙. 《俗方》

Translation영역
Wine Lees (酒糟): Governs injury from blows and falls with stagnant blood, swelling and pain. Mix wine lees with vinegar dregs, steam them warm and iron the place with it; this is excellent.
Clinical note임상 주석
A warm moist poultice ironed over a bruise, and of all the entries in the section this is the one a modern reader would recognise. Heat applied after the first day or two of a closed contusion increases local blood flow, relaxes the overlying muscle and genuinely eases pain; the lees and dregs are simply a warm, retentive medium. Ice in the first twenty-four hours and heat after is still the advice. The caution is burns. Steamed mash holds heat well and is applied to skin that may be numb from the injury, so it should be warm to the back of the hand and no hotter, and not laid on broken skin.

Sokbang 俗方

1.6.18
Source원문

水蛭 主墮撲落傷ㆍ折傷, 內有瘀血. 水蛭炒焦爲末, 入麝香少許, 每一錢熱酒調服, 當下瘀血. 《本草》

Translation영역
Leech (水蛭): Governs falls, blows and fracture injuries where there is stagnant blood within. Stir-fry leeches until scorched and powder them, put in a little musk, and take 1 don at a time stirred into hot wine; the stagnant blood should come down.
Clinical note임상 주석
Leech is the classical blood-breaking drug and the reasoning is consistent: the animal keeps blood from clotting, so the drug should break blood that has clotted. The agent behind the observation is real — hirudin, a direct thrombin inhibitor from leech salivary glands, and the model for the recombinant anticoagulants bivalirudin and desirudin. But hirudin is a 65-residue peptide. Dried, scorched to powder and swallowed, it is denatured by the frying and digested in the stomach, so an oral leech preparation has no anticoagulant action at all. That is as well, because if it did work it would be exactly wrong. **Contains musk, a CITES-listed material from a protected species that cannot lawfully be traded; and an anticoagulant given for internal bleeding would make the bleeding worse. This must not be prepared.**

Boncho 本草

1.7 Fractures and Torn Sinews 骨折筋斷傷

1.7.1
Source원문

凡脚手各有六出臼ㆍ四折骨. 每手有三處出臼, 脚亦三處出臼. 手掌根出臼, 其骨交互相鎖, 或出臼則是挫出鎖骨之外, 須是搦骨於鎖骨下歸窠. 若出外則須搦入內, 若出內則須搦入外, 方入窠臼. 只用手拽, 斷難入窠, 十有八九成痼疾也. 《得效》

Translation영역
In the leg and the arm there are each six places that come out of the socket and four bones that break. Each hand has three places that come out of the socket, and the leg likewise has three. When the root of the palm comes out of the socket — its bones interlock one with another — then being out of the socket means it has been wrenched out past the locking bone, and the bone must be pressed in beneath the locking bone to return it to its hollow. If it has come out to the outside it must be pressed inward; if it has come out to the inside it must be pressed outward, and only then does it enter the socket. If the hand is used only to pull on it, it is decidedly hard to get back into the hollow, and in eight or nine cases out of ten it becomes a lasting disability.
Clinical note임상 주석
The section opens with a count of the limb: six joints that dislocate and four bones that break in each. 鎖骨 here is not the clavicle but the interlocking bone — the text says so itself, 其骨交互相鎖, its bones lock across one another, which is the carpus. 手掌根出臼 is therefore injury at the wrist, where a dislocation sits outside and above the row of locked carpal bones and has to be pushed back under them rather than simply pulled on. The clinical content is in the last clause, and it is correct. Reduction is a matter of reversing the direction of displacement — out means press in, in means press out — and axial traction alone does not do it. A dislocation or a displaced fracture left unreduced goes on to stiffness, deformity and permanent loss of function, and 十有八九成痼疾 is not far from what happens. The Bogam is describing closed reduction as a directed manoeuvre, which is what it is.

Deukhyo 得效

1.7.2
Source원문

骨節損折, 肘臂腰膝出臼蹉跌, 須用法整頓歸元. 先用麻藥與服, 使不知痛, 然後可用手法. 《得效》

Translation영역
Where a bone joint is damaged and broken, or the elbow, arm, lumbus or knee has come out of the socket and slipped awry, the method must be used to set it and return it to where it began. First give the numbing medicine to drink, so that he does not feel the pain, and only then may the hand technique be used.
Clinical note임상 주석
One sentence, and it states the order of operations that modern fracture care also uses: analgesia first, manipulation second. Reduction of a displaced fracture or a dislocation is not possible against muscle spasm, and spasm is driven by pain; a patient who can feel the joint being moved will guard it hard enough to prevent reduction and to make the attempt itself injurious. Today that is solved with a haematoma block, a regional block or procedural sedation, with monitoring. The principle the Bogam states here is sound. What follows in this section is the drug it used to achieve it, and that is where the problem lies.

Deukhyo 得效

1.7.3
Source원문

搦骨歸窠, 用竹一片生柳木板片尤佳夾定一邊, 一邊不用夾, 須存屈直處, 時時拽屈拽直. 不然則愈後曲直一得. 《得效》

Translation영역
To press a bone back into its hollow: take a slip of bamboo — a slip of board of green willow wood is better still — and splint it fast on one side, the other side left unsplinted. The place where it bends and straightens must be left free, and from time to time it is to be pulled into flexion and pulled into extension. If this is not done, then after it has healed only one of the two, the bending or the straightening, will be got.
Clinical note임상 주석
This is the most advanced paragraph in the chapter. A splint on one side only, the joint line deliberately left out of the splint, and repeated passive flexion and extension during the healing period — that is functional bracing with early controlled motion, and it is current practice. The reason given is also the right one: a joint immobilised across its full arc for the weeks a bone takes to unite will not recover that arc, because the capsule and the gliding planes adhere. 曲直一得, only one of bending and straightening obtained, is a precise description of a contracture. Modern orthopaedics arrived at the same conclusion the long way round, after a century of rigid plaster, and the phrase for it now is that a fracture is immobilised but a joint is not. The Bogam has it in 1613, with a bamboo slip.

Deukhyo 得效

1.7.4
Source원문

凡骨碎者, 須用麻藥卽草烏散與服, 或用刀割開, 甚者用剪剪去骨鋒, 使不衝破肉. 或有粉碎者, 與去細骨, 免膿血之禍. 且以藥水一日一洗, 莫令臭穢. 《得效》

Translation영역
In every case of a crushed bone the numbing medicine — that is Choo-san 草烏散 — must be given to drink. Then either open it up with a knife, or, in severe cases, use shears to cut away the points of bone so that they do not thrust through and break the flesh. Where there are fragments ground small, take the little pieces of bone away, so as to avoid the calamity of pus and blood. And wash it once a day with medicinal water, letting it not turn foul-smelling.
Clinical note임상 주석
An open comminuted fracture, and four steps of management: anaesthetise, incise to expose, trim the protruding bone ends so they stop tenting and tearing the soft tissue, excise the loose small fragments, and irrigate daily with the wound kept from smelling. That is debridement, and in modern open-fracture care debridement and lavage are the single intervention that decides whether the limb survives. Loose devitalised fragments have no blood supply, cannot unite, and become the culture medium — which is exactly what 免膿血之禍 says. Keeping watch on the smell is infection surveillance with the only instrument available. What is missing is everything that makes it survivable: antibiotics, tetanus prophylaxis, and any means of sterilising the field or the instruments. **Contains aconite, which is toxic. This must not be prepared.** The 麻藥 named here is 草烏散, the aconite powder of the next passage, and it was given to the point of insensibility before the knife was used.

Deukhyo 得效

1.7.5
Source원문

凡骨碎者, 用接骨藥火上化開, 糊骨上, 然後夾定. 外用夾骨法ㆍ活血散ㆍ接骨丹ㆍ二生膏ㆍ糯米膏, 內服麥斗散ㆍ沒藥降聖丹ㆍ接骨散ㆍ自然銅散ㆍ接骨紫金丹.

Translation영역
In every case of a crushed bone, take a bone-knitting medicine, melt it open over the fire, smear it over the bone, and then splint it fast. Externally use Hyeopgol-beop 夾骨法, Hwalhyeol-san 活血散, Jeopgol-dan 接骨丹, Isaeng-go 二生膏 or Nami-go 糯米膏; internally take Maekdu-san 麥斗散, Moryakgangseong-dan 沒藥降聖丹, Jeopgol-san 接骨散, Jayeondong-san 自然銅散 or Jeopgoljageum-dan 接骨紫金丹.
Clinical note임상 주석
The index to the twelve formulas that follow, divided the way the section uses them — five laid on the limb, five swallowed, and the wash kept separate in the next clause. 糊骨上, smeared over the bone, means the plaster went onto exposed bone in an open fracture, which is how every one of the external preparations in this section should be read.

Donguibogam · Jesang

1.7.6
Source원문

淋洗用蔓荊散. 《諸方》

Translation영역
For the pouring wash use Manhyeong-san 蔓荊散.

Jebang 諸方

1.7.7
Source원문

草烏散, 卽麻藥也. 凡骨節出臼, 用此麻之, 然後用手整頓. 皂角ㆍ木鼈子ㆍ紫金皮ㆍ白芷ㆍ半夏ㆍ烏藥ㆍ當歸ㆍ川芎ㆍ川烏各一兩二錢半, 草烏ㆍ茴香ㆍ坐拏草各二錢半, 木香一錢, 並無煆製. 右爲末, 諸樣骨節出臼窠者, 每服二錢, 好紅酒調下, 麻倒不識痛處. 然後或用刀割開, 或剪去骨鋒, 以手整頓骨節歸原, 用夾夾定. 然後醫治. 如箭鏃入骨不出, 亦用此藥麻後, 或鉗出, 或鑿開取出, 然後取鹽湯或鹽水與服, 立醒. 《得效》

Translation영역
Choo-san 草烏散. This is the numbing medicine. Whenever a bone joint has come out of the socket, use this to numb him, and then set it by hand. Gleditsia pod, momordica seed, jageum-pi bark 紫金皮, dahurian angelica, pinellia, lindera, Korean angelica, cnidium and aconite main root, 1 nyang 2 don 5 fun each; wild aconite, fennel fruit and janacho 坐拏草, 2 don 5 fun each; costus root, 1 don — and none of them calcined or processed. Powder the above. For any kind of bone joint out of its socket, 2 don a dose, stirred down in good red wine, until he is numbed and falls over and cannot tell where the pain is. Then either open it up with a knife or cut away the points of bone with shears, set the bone joint by hand back to where it began, and splint it fast with splints. Only then treat it. If an arrowhead has entered the bone and will not come out, this medicine is likewise used to numb him, and then it is either drawn out with pincers or chiselled open and taken out; after which salt broth or salt water is given to drink and he wakes at once.
Clinical note임상 주석
**Contains aconite, which is toxic. This must not be prepared.** This is a surgical general anaesthetic, and it is the clearest statement of one in the Bogam. Two aconites are in it — 川烏, the main root of Aconitum, at 1 nyang 2 don 5 fun, and 草烏, wild aconite, at 2 don 5 fun — and the instruction 並無煆製, none of them calcined or processed, removes the one step the tradition itself used to reduce their toxicity. Raw aconite root is where the diester alkaloids, aconitine and its relatives, are at their highest. The dosing instruction is 麻倒不識痛處: give it until he collapses numbed and cannot locate the pain. Aconitine works by holding voltage-gated sodium channels open, which is why it produces numbness and then paralysis — and the same action on cardiac muscle produces ventricular tachycardia and fibrillation. The two effects are not separable by dose in any usable way: the gap between the amount that abolishes sensation and the amount that stops the heart is essentially nil, and it moves with the individual root, the season, the processing and the patient. There was no pulse oximeter, no ECG, no airway, no defibrillator and no way to tell a deepening anaesthetic from a developing arrhythmia until the patient died. The salt broth said to wake him at once has no antidotal action on aconitine whatever. What deserves respect is the operative sequence, which is unchanged: anaesthetise, incise, trim the bone ends, reduce by hand, splint, then treat. The same powder is used for an arrowhead embedded in bone, drawn with pincers or cut out with a chisel. Anaesthesia for orthopaedic surgery is being practised here two centuries before ether, with the only drug available and at a cost that cannot be measured from the text.

Deukhyo 得效

1.7.8
Source원문

夾骨法, 小蝦蟆四五箇ㆍ皮硝三分ㆍ生薑一兩ㆍ酒糟一椀, 腫者加紅內消卽紅何首烏也同擣, 敷折傷之處. 《入門》

Translation영역
Hyeopgol-beop 夾骨法, the bone-splinting method. Small toads, four or five; crude mirabilite, 3 fun; fresh ginger, 1 nyang; wine lees, one bowl. Where there is swelling, add hong-naeso 紅內消 — that is red fleeceflower root. Pound them together and apply to the place of the fracture.
Clinical note임상 주석
The name says splinting but the formula is a poultice, and it is meant to go under the splint of the passage above. The one component with a defensible mechanism is 皮硝, crude mirabilite — sodium sulfate, strongly hyperosmolar, which does draw fluid out of swollen tissue when laid on intact skin. Four or five whole toads pounded into wine lees and spread on a fracture site is another matter. Toad skin secretes bufadienolides, which act on the sodium-potassium pump much as digoxin does, and are absorbed through broken skin; this section's fractures are frequently open. Raw amphibian tissue and fermented lees packed into a wound are also a direct inoculation of soil and gut organisms, including Clostridium tetani, into exactly the kind of deep devitalised wound in which tetanus develops. **This must not be prepared or applied.**

Immun 入門

1.7.9
Source원문

活血散, 治折傷. 菉豆粉炒紫色, 新汲水調成膏, 厚付折傷處, 以桑皮夾定, 其效如神. 一方, 熱酒醋調付. 《得效》

Translation영역
Hwalhyeol-san 活血散 treats fractures. Mung bean flour parched to a purple colour, stirred into newly drawn water to make a paste, is laid on thickly over the fractured place and splinted fast with mulberry bark; the effect is as though divine. Another formula stirs it with hot wine and vinegar and applies it.
Clinical note임상 주석
A starch paste and a bark splint. The paste is pharmacologically inert; parched mung bean flour in water is a stiffening poultice and nothing more. The mulberry bark binding it on, however, is a splint — and the clause 其效如神 should be credited to the immobilisation, not to the bean flour. This is the least hazardous of the external preparations in the section, which also makes it the most useful: a moulded paste that sets around a limb and is held by a circumferential bark wrap is, in function, a cast.

Deukhyo 得效

1.7.10
Source원문

接骨丹, 當歸七錢半, 川芎ㆍ沒藥ㆍ骨碎補各五錢, 川烏煨四錢, 古文錢三箇火煆醋淬七次, 乳香二錢半, 木香一錢, 黃香松脂也六兩, 香油一兩半. 右爲末, 和油成膏, 攤油紙貼患處. 如骨碎筋斷, 用此復續如初. 《回春》

Translation영역
Jeopgol-dan 接骨丹. Korean angelica, 7 don 5 fun; cnidium, myrrh and drynaria, 5 don each; aconite main root roasted in ashes, 4 don; three old cash coins, calcined in fire and quenched in vinegar seven times; frankincense, 2 don 5 fun; costus root, 1 don; hwang-hyang 黃香 — that is pine resin — 6 nyang; sesame oil, 1 nyang 5 fun. Powder the above, blend it with the oil into a paste, spread it on oiled paper and stick it on the affected place. Where the bone is crushed and the sinew torn, use this and it will knit together again as at first.
Clinical note임상 주석
A resin plaster: six nyang of pine resin and a nyang and a half of sesame oil make the vehicle, and the drugs are suspended in it on oiled paper. As a dressing that adheres, seals and can be lifted off whole, it is a reasonable piece of craft, and the frankincense and myrrh in it are mildly antimicrobial resins. **Contains aconite, which is toxic. This must not be prepared.** The 川烏 is 煨, roasted in hot ashes, which does hydrolyse some of the diester alkaloids, and this is a plaster rather than a draught — but aconitine is absorbed through broken skin, and in this section the plaster is being laid directly on exposed bone. The three 古文錢, old cash coins calcined and vinegar-quenched seven times, are also not inert: Joseon and Ming cash are copper alloys that commonly carry lead and tin, and the vinegar quench is designed to make the metal soluble. The closing promise, that crushed bone and torn sinew will knit as at first, belongs to the splint underneath.

Hoechun 回春

1.7.11
Source원문

二生膏, 治折傷手足. 生地黃一斤ㆍ生薑四兩. 右擣爛, 入酒糟一斤, 炒熱, 布裹罨傷處熨之. 傷筋損骨, 痛不可忍, 神效. 《醫鑑》

Translation영역
Isaeng-go 二生膏, the paste of the two raw things, treats fractures of the hand and foot. Raw rehmannia, 1 geun; fresh ginger, 4 nyang. Pound the above to a mash, add 1 geun of wine lees, parch them hot, wrap them in cloth, lay the compress over the injured place and iron it in. For damaged sinew and injured bone with pain that cannot be borne, divinely effective.
Clinical note임상 주석
The two raw things of the name are the raw rehmannia and the fresh ginger, and the preparation is a hot moist fomentation held against the limb in a cloth. For the pain of a closed injury that is defensible — heat and pressure are still what people reach for — though it belongs after the first day or two, since heat applied to fresh trauma increases bleeding and swelling rather than reducing it. Over an open fracture a hot poultice of fermented wine lees is contamination of the wound and nothing else. Note that this formula contains no aconite, despite the company it keeps in this section; its three components are rehmannia, ginger and lees. The hazard here is bacterial, not alkaloid.

Uigam 醫鑑

1.7.12
Source원문

傷損臂臼脫出腫痛, 生地黃擣爛, 攤油紙上, 次糝木香末一層, 又攤地黃, 貼患處, 明日痛卽止. 《得效》

Translation영역
For injury with the socket of the arm slipped out, swollen and painful: pound raw rehmannia to a mash, spread it on oiled paper, sprinkle a layer of powdered costus root over it, spread rehmannia over that again, and stick it on the affected place; by the next day the pain stops at once.
Clinical note임상 주석
A layered dressing — rehmannia, a dusting of costus root, rehmannia again — on oiled paper, which keeps the paste wet and off the skin. The construction is more interesting than the contents: oiled paper is an occlusive backing, and a moist occluded dressing is still the standard for a healing surface. The indication, 臂臼脫出, the socket of the arm slipped out, is a shoulder or elbow dislocation, and a poultice does not treat one. A dislocation that is left unreduced does not stop hurting by the next day; it needs reduction, which the section has already described, and this plaster is for the swelling that follows it.

Deukhyo 得效

1.7.13
Source원문

治折傷斷筋損骨, 生地黃擣取汁, 好酒和服, 日二三次, 最妙. 又擣爛蒸熱, 封傷處, 一月筋骨連續. 蓋地黃屬骨. 《種杏》

Translation영역
To treat fractures with the sinew severed and the bone injured: pound raw rehmannia and take the juice, blend it with good wine and drink it two or three times a day — most excellent. Also pound it to a mash, steam it hot and seal it over the injured place; in a month the sinew and bone will have joined up. For rehmannia belongs to the bone.
Clinical note임상 주석
蓋地黃屬骨, rehmannia belongs to the bone, is the doctrinal justification rather than an observation — rehmannia is a kidney drug, the kidney governs the bone, therefore rehmannia reaches the bone. There is no evidence that Rehmannia glutinosa, by mouth or on the skin, affects the rate at which a fracture unites. What unites a fracture is reduction, mechanical stability, an intact blood supply, and enough calcium, vitamin D and protein; nothing in this passage supplies any of those. The one figure worth keeping is 一月筋骨連續, union in a month. For a metacarpal or a distal radius in a young adult that is about right, and the number reads as something counted rather than inferred. For a femur or a tibia it is wrong by half. Taking the juice in wine two or three times a day adds alcohol to a patient in pain, which is how the analgesia in this section was largely achieved.

Jonghaeng 種杏

1.7.14
Source원문

糯米膏, 治撲傷筋斷骨折. 糯米一升ㆍ皂角切碎半升ㆍ銅錢百箇, 同炒至焦黑, 去錢. 右爲末, 酒調膏, 貼患處, 神效. 《綱目》

Translation영역
Nami-go 糯米膏 treats blunt injury with the sinew torn and the bone broken. Glutinous rice, 1 seung; gleditsia pod cut up small, half a seung; copper coins, a hundred. Parch them together until scorched black, and take out the coins. Powder the above, stir it into wine as a paste, and stick it on the affected place — divinely effective.
Clinical note임상 주석
A hundred copper coins parched with the rice and then removed: they are there as a heat sink, to hold an even high temperature in the pan while the rice and gleditsia char without burning, and the recipe says to take them out. What remains is a charred starch-and-saponin powder stirred into wine, which sets into a stiff adherent paste — again a moulded dressing whose value is mechanical. The gleditsia pod is the only active component, and it is a saponin: surface-active, mildly detergent, and irritant on raw tissue. On intact skin over a closed injury this is harmless. Note that a formula of the same name, 糯米膏, is registered in this corpus from the abscess chapter with an entirely different composition — a single-ingredient rice paste — and the two should not be confused.

Gangmok 綱目

1.7.15
Source원문

麥斗散, 治跌傷骨節. 土鼈一箇瓦上焙ㆍ巴豆一箇去殼ㆍ半夏一箇生ㆍ乳香ㆍ沒藥各半分, 自然銅火煆醋淬七次用些少. 右爲細末, 溫淸酒調服一釐, 如重車行十里之久, 其骨接之有聲. 初跌之時, 須整理如舊, 以綿衣蓋覆, 方服藥, 勿轉動. 端午日製尤妙. 《回春》

Translation영역
Maekdu-san 麥斗散 treats fall injury to the bone joints. Ground beetle, one, baked on a tile; croton seed, one, husked; pinellia, one, raw; frankincense and myrrh, half a fun each; pyrite calcined in fire and quenched in vinegar seven times, a very little of it. Powder the above finely and take 1 ri stirred into warm clear wine; in the time a heavy cart takes to go ten li, the bone will join with an audible sound. At the moment of the fall it must be set as it was before, covered over with a padded garment, and only then is the medicine taken; and he is not to be moved about. Made on the day of Dano it is still better.
Clinical note임상 주석
**Contains croton seed and raw pinellia, which are toxic. This must not be prepared.** One croton seed goes into the batch, and croton is a violent purgative whose oil is also a skin and mucosal vesicant; raw pinellia is an oral and pharyngeal irritant. The dose, 1 ri, is about four hundredths of a gram of the finished powder, so the per-dose quantity of croton is a trace — but the hazard lies in the preparation, in the handling, and in the fact that a trace is also, by the same arithmetic, pharmacologically nothing. 自然銅 is the question this formula raises, and it recurs twice more in this section. It is iron pyrite, FeS2, calcined and quenched in vinegar seven times, which converts the sulfide to iron oxides and partly soluble iron salts — so the preparation does make iron bioavailable, and the processing is chemically purposeful rather than magical. But no mineral taken by mouth accelerates fracture union. Union is determined by reduction, mechanical stability and blood supply, with calcium, vitamin D and protein as the substrate; iron matters only to the extent that the patient is anaemic, and natural pyrite also commonly carries arsenic. The bone joining with an audible sound in the time a cart takes to go ten li cannot be observed and did not happen. What is sound here is the last three instructions, and they are the whole treatment: set it immediately as it was, pad it, and do not move it. The powder is incidental to them.

Hoechun 回春

1.7.16
Source원문

沒藥降聖丹, 治打撲閃肭ㆍ筋斷骨折, 痛不可忍. 生乾地黃ㆍ川芎各一錢半, 自然銅火煆醋淬十二次另硏ㆍ川烏生ㆍ骨碎補ㆍ白芍藥ㆍ當歸ㆍ乳香ㆍ沒藥各一錢. 右爲末, 薑汁與蜜等分和勻, 每一兩作四丸. 每服一丸, 水酒各半盞, 入蘇木一錢同煎, 去蘇木調藥, 空心熱服. 《丹心》

Translation영역
Moryakgangseong-dan 沒藥降聖丹 treats blunt injury and wrenching, with the sinew torn and the bone broken and pain that cannot be borne. Raw dried rehmannia and cnidium, 1 don 5 fun each; pyrite calcined in fire and quenched in vinegar twelve times then ground separately, raw aconite main root, drynaria, white peony, Korean angelica, frankincense and myrrh, 1 don each. Powder the above and blend it evenly with equal parts ginger juice and honey; from each nyang make four pills. One pill a dose, with half a jan of water and half a jan of wine and 1 don of sappan wood decocted together; remove the sappan wood, stir the medicine into the liquid, and take it hot on an empty stomach.
Clinical note임상 주석
**Contains aconite, which is toxic. This must not be prepared.** The 川烏 here is specified 生, raw — not roasted as in 接骨丹, not boiled, not paired with a long decoction that would hydrolyse it. It is powdered raw, bound in honey, made into pills, and swallowed on an empty stomach, which is the condition of fastest absorption. A nyang of the powder makes four pills, so a single pill carries roughly 2 don 5 fun of mixed powder of which raw aconite is about a tenth: an unmeasured oral dose of the most dangerous preparation of the drug. Aconite poisoning begins with perioral and limb paraesthesia and proceeds to ventricular arrhythmia, and it is not reliably survivable outside a critical care unit even now. Stripped of the aconite, the formula is a sensible analgesic and blood-moving prescription for the days after a fracture — rehmannia, cnidium, peony, angelica, frankincense and myrrh, with sappan wood decocted into the vehicle. The twelve vinegar quenches of the pyrite are the longest processing of it in this section, which suggests the compilers knew that the mineral needed work to become anything at all.

Dansim 丹心

1.7.17
Source원문

接骨散, 治骨折. 乳香ㆍ沒藥各二錢半, 自然銅煆淬另硏五錢, 滑石一兩, 龍骨ㆍ赤石脂各一錢半, 麝香少許. 右爲末, 好醋浸潤, 煮乾炒燥爲末, 臨睡服時, 入麝香和勻, 溫酒調下一錢. 若骨已接, 去龍骨ㆍ赤石脂而服, 極效. 《丹心》

Translation영역
Jeopgol-san 接骨散 treats a broken bone. Frankincense and myrrh, 2 don 5 fun each; pyrite calcined and quenched and ground separately, 5 don; talc, 1 nyang; dragon bone and red halloysite, 1 don 5 fun each; musk, a little. Powder the above, soak and moisten it in good vinegar, boil it dry, parch it dry and powder it again; at the time of taking it, just before sleep, put in the musk and blend evenly, and take 1 don stirred down in warm wine. If the bone has already knitted, leave out the dragon bone and red halloysite and take it so — extremely effective.
Clinical note임상 주석
The most interesting line is the last: once the bone has united, drop the 龍骨 and 赤石脂 and continue with the rest. That is staged prescribing, the composition changed according to the phase of healing, and it implies that those two astringent minerals — fossil bone and red halloysite clay — were understood as consolidating agents for the acute phase rather than as tonics. **Contains musk, which comes from a protected species and may not be traded or prepared.** Musk is a CITES Appendix I material taken from the musk deer, and there is no circumstance in which it should be obtained. The mineral bulk of the formula — talc, fossil bone, clay, pyrite — passes through the gut largely unabsorbed and has no effect on bone union; the frankincense and myrrh resins are the only components with any plausible analgesic or anti-inflammatory action.

Dansim 丹心

1.7.18
Source원문

一方, 將藥除麝香, 浸酒煮乾爲末, 黃蠟五錢熔化, 乃入麝和勻, 作丸彈子大. 每一丸酒煎, 以東南柳枝攪散, 空心熱服, 名曰接骨丹. 《入門》

Translation영역
Another formula: take the medicine without the musk, steep it in wine, boil it dry and powder it; melt 5 don of beeswax, then put in the musk, blend evenly and make pills the size of a bullet. One pill a dose, decocted in wine and broken up by stirring with a willow twig from the south-east side, taken hot on an empty stomach. It is called Jeopgol-dan 接骨丹.
Clinical note임상 주석
A beeswax pill made from the same powder, which is a delayed-release form: wax resists gastric dissolution, so the pill is broken up in hot wine before swallowing — which is what the stirring does. The specification of a willow twig from the south-east side of the tree is directional cosmology, not pharmacy; the stirring itself is the functional step. Note also that this formula shares its name with the 接骨丹 plaster earlier in the section, which has a different composition and a different route, and the two are distinct preparations.

Immun 入門

1.7.19
Source원문

自然銅散, 治打撲筋骨折傷. 乳香ㆍ沒藥ㆍ蘇木ㆍ降眞香無則紫檀代之ㆍ川烏ㆍ松明節ㆍ自然銅火煆醋淬七次各五錢, 地龍油炒ㆍ龍骨ㆍ生水蛭油炒焦各二錢半, 血竭一錢半, 土狗五箇油浸焙. 右爲末, 每五錢好酒調下, 自頂心尋病至下, 兩手兩足周遍一身. 病人自覺藥力習習往來, 遇病處則颯颯有聲. 《得效》

Translation영역
Jayeondong-san 自然銅散 treats blunt injury with fracture of sinew and bone. Frankincense, myrrh, sappan wood, rosewood 降眞香 — if there is none, red sandalwood is used in its place — aconite main root, resinous pine knot, and pyrite calcined in fire and quenched in vinegar seven times, 5 don each; earthworm parched in oil, dragon bone, and raw leech parched in oil until scorched, 2 don 5 fun each; dragon's blood resin, 1 don 5 fun; mole cricket, five, steeped in oil and baked. Powder the above and take 5 don a dose stirred down in good wine. It goes from the crown of the head seeking the illness downward, through both hands and both feet, going right round the whole body; the sick man himself feels the force of the medicine passing to and fro, and where it meets the diseased place there is a rustling sound.
Clinical note임상 주석
**Contains aconite, which is toxic. This must not be prepared.** Five don of 川烏 in the batch and five don of the finished powder to a dose: this is the largest single oral dose in the section, and it is taken in wine, which increases absorption. The closing clause is the most revealing sentence in the section, because it tells us how the remedy was judged. The drug is described as descending from the crown, searching out the lesion, and announcing itself at the injury with a rustling sound that the patient hears. Nothing taken by mouth does any of that. What the passage is recording is the sensation a patient reports after a strong dose of aconite and alcohol — the spreading paraesthesia and tingling that are the first signs of aconitine toxicity — reinterpreted as the medicine locating the fracture. The verification standard is the patient's own report of a sensation, and the sensation is the poison.

Deukhyo 得效

1.7.20
Source원문

接骨紫金丹, 治跌打骨折, 瘀血攻心, 發熱昏暈. 土鼈一方用土狗ㆍ自然銅火煆醋淬七次另硏ㆍ骨碎補ㆍ大黃ㆍ血竭ㆍ當歸尾ㆍ乳香ㆍ沒藥ㆍ鵬砂各一錢. 右爲末, 每取八釐, 熱酒調服, 其骨自接. 《入門》

Translation영역
Jeopgoljageum-dan 接骨紫金丹 treats a fall or a blow with the bone broken, and static blood assaulting the heart, with fever and clouded faintness. Ground beetle — one formula uses mole cricket — pyrite calcined in fire and quenched in vinegar seven times then ground separately, drynaria, rhubarb, dragon's blood resin, the tails of Korean angelica, frankincense, myrrh and borax, 1 don each. Powder the above and take 8 ri at a time stirred into hot wine; the bone will knit of itself.
Clinical note임상 주석
The indication is worth reading closely. 瘀血攻心, 發熱昏暈 — static blood assaulting the heart, with fever and clouded consciousness, in the days after a fracture — is a real and recognisable syndrome, and in modern terms it is the group of post-fracture emergencies: fat embolism from a long-bone fracture, haemorrhagic shock from the fracture haematoma, and early wound sepsis. All three present with fever, tachycardia and a clouding of consciousness. All three are hospital emergencies in which the patient needs oxygen, fluid or blood, and source control, within hours. **Contains borax, which is toxic when swallowed, and rhubarb, a purgative. This must not be prepared.** Borax causes vomiting, diarrhoea, renal injury and seizures, and the dose here is not small relative to its margin. Giving a purgative in hot wine to a patient who is febrile, faint and possibly bleeding into a thigh is the same error the chapter makes with 通導散 in the blunt-trauma section: it moves fluid out of a circulation that is already failing. 其骨自接, the bone knits of itself, is the one honest phrase in the passage — it does, and not because of this.

Immun 入門

1.7.21
Source원문

蔓荊散, 治打落筋骨折傷, 瘀血結痛. 頑荊葉無則荊芥代之ㆍ蔓荊子ㆍ白芷ㆍ細辛ㆍ防風ㆍ川芎ㆍ桂皮ㆍ丁香皮ㆍ羌活各一兩. 右爲麄末, 每一兩入鹽一匙ㆍ連鬚葱白五莖, 漿水五升, 煎七沸, 淋洗痛處, 冷則易. 《丹心》

Translation영역
Manhyeong-san 蔓荊散 treats a fall with fracture of sinew and bone, and binding pain from static blood. Wanhyeong leaf 頑荊葉 — if there is none, schizonepeta is used in its place — vitex fruit, dahurian angelica, asarum, siler, cnidium, cinnamon bark, clove bark and notopterygium, 1 nyang each. Make the above into a coarse powder; to each nyang put in a spoonful of salt and five stalks of scallion white with the root hairs, and 5 seung of fermented millet water; decoct to seven boilings and pour-wash the painful place, replacing it when it goes cold.
Clinical note임상 주석
The gentlest preparation in the section and the one with no serious hazard: a hot aromatic decoction poured over the limb and renewed as it cools. As warmth and salt water on intact skin over a healing closed fracture it is comfortable and harmless, and the instruction to replace it when cold is simply how to keep a fomentation at temperature. It does nothing to the bone. Two cautions. It is a wash, not a draught, and it should not be swallowed: 細辛, asarum, carries aristolochic acid, which is nephrotoxic and carcinogenic by mouth. And a pour-wash does not belong on an open fracture, where a non-sterile decoction poured into the wound is contamination — the passage is for the closed injury and the 打落 bruising that goes with it.

Dansim 丹心

1.8 Simple Medicinals 單方

1.8.1
Source원문

凡十四種.

Translation영역
Fourteen kinds in all.
Clinical note임상 주석
The single remedies that answer to the section before them, 骨折筋斷傷 — fractures and torn sinews. Almost every item is a bone-knitter: two coppers, two barks, a resin wax, crab, grub, rat, chestnut, lettuce seed and a black cock. 接骨 and 續筋, to join bone and to continue sinew, are the two phrases that recur, and the logic behind most of the choices is sympathetic rather than pharmacological — a metal that can be soldered will solder bone, a crab's limb that regrows will regrow a limb, a tree bark called 合歡 will make parts agree. Nothing here sets a fracture. What determines whether a broken bone knits is reduction and immobilisation, which the chapter does describe, in 1.7, with splinting under aconite. These fourteen are what was given alongside that, and the useful ones are useful for other reasons: beeswax as an occlusive dressing, steamed rehmannia as a moist poultice, dipsacus and myrrh for pain.

Donguibogam · Jesang

1.8.2
Source원문

赤銅屑 治打撲墮落骨折傷. 取赤銅, 火煆醋淬七次或九次, 細硏, 溫酒調一字或半錢服, 直入骨損處銲之. ○有人墮馬折足, 取銅末和酒服, 遂痊. 亡後十餘年改葬, 視脛骨折處, 有銅束之. 《本草》

Translation영역
Copper filings (赤銅屑): Treat injury from a blow, a fall or a broken bone. Take red copper, calcine it in the fire and quench it in vinegar seven times or nine times, grind it fine, and give 1 ja or half a don stirred into warm wine; it goes straight to the broken place in the bone and solders it. ○ There was a man who fell from a horse and broke his leg. He took powdered copper in wine and recovered. More than ten years after his death the grave was moved, and when they looked at the break in the shin bone there was copper binding it.
Clinical note임상 주석
The reasoning is in the verb: 銲, to solder. Copper is the metal a craftsman joins metal with, so powdered copper will join bone. The exhumation story is the proof offered, and it is a proof that cannot be had — copper swallowed in wine is absorbed as ionic copper, distributed and excreted, and does not travel to a healed fracture and deposit itself as a band of metal around it. What a reopened grave ten years on would show at an old fracture is callus, denser and paler than the shaft, which is what the story is almost certainly describing. **Copper filings taken internally are not safe. Copper salts irritate the gut and cause vomiting, and in quantity damage the liver and cause haemolysis; repeated dosing in wine, which increases absorption, has no therapeutic margin here. This must not be prepared.**

Boncho 本草

1.8.3
Source원문

自然銅 療傷損骨折. 火煆醋淬七次, 硏細水飛, 同當歸ㆍ沒藥 各半錢, 溫酒調服, 仍以手摩痛處. 《本草》 ○此藥新火煆者有毒, 若不折骨不碎骨, 則不可用自然銅. 《丹心》

Translation영역
Pyrite (自然銅): Treats injury and broken bone. Calcine it in the fire and quench it in vinegar seven times, grind it fine and levigate it in water, and give it with Chinese angelica and myrrh, half a don of each, stirred into warm wine; then rub the painful place with the hand. ○ This drug is poisonous when newly calcined. If the bone is not broken and not shattered, pyrite is not to be used.
Clinical note임상 주석
自然銅, "the copper that occurs of itself", is iron pyrite or chalcopyrite — iron and copper sulphide, not copper metal. The preparation is the interesting part and it is real chemistry: calcining a sulphide and quenching it in vinegar seven times roasts off sulphur as sulphur dioxide and leaves an oxide that the acetic acid then partly dissolves, so the repeated cycle genuinely changes the substance. 水飛, levigation, then floats off the finest fraction. The 丹心 restriction is the sharpest piece of pharmacovigilance in the section. Newly calcined pyrite is said to be poisonous, and the drug is confined to a bone that is actually broken — a dose-and-indication limit set because harm had been seen. That is worth more than any of the knitting claims around it. **Pyrite often carries arsenic, and roasting it releases sulphur dioxide and arsenic oxides; the calcined product is not a defined substance. This must not be prepared.** The two plant drugs in the formula, angelica and myrrh, are the parts with any standing, and the hand rubbed over the painful place is the one instruction that would have helped.

Boncho 本草 · Dansim 丹心

1.8.4
Source원문

合歡皮 主骨折, 專能接骨. 取皮炒黑色 四兩ㆍ芥子炒 一兩, 右末, 酒調二錢服, 以滓罨傷處. 《丹心》

Translation영역
Albizia bark (合歡皮): Governs broken bone and is especially able to join bone. Take the bark roasted to a black colour, 4 nyang, and roasted mustard seed, 1 nyang; powder the above and give 2 don stirred into wine, and lay the dregs on the injured place.
Clinical note임상 주석
合歡, the tree whose name means "joined joy", is chosen for its name as much as for anything else — a bark that makes things agree will make bone ends agree. The mustard seed is a counter-irritant and the dregs laid on the skin would redden and warm it, which is the whole of the local effect. Albizia bark has mild sedative use in the tradition and no action on fracture healing. The preparation is harmless, which in this section is worth saying.

Dansim 丹心

1.8.5
Source원문

生地黃 主屬骨. 若傷損骨碎, 生地黃爛擣, 蒸熱, 裹傷處, 日再易. 《本草》

Translation영역
Fresh rehmannia (生地黃): Governs the joining of bone. Where there is injury and the bone is shattered, pound fresh rehmannia to a pulp, steam it hot, and wrap it round the injured place, changing it twice a day.
Clinical note임상 주석
A hot moist poultice, changed twice daily, over a closed fracture. It will not knit bone, but warmth and compression over a fresh fracture are comforting and the twice-daily change keeps the dressing from souring. Of the external applications in the section this is the one with nothing to object to.

Boncho 本草

1.8.6
Source원문

續斷 治撲損瘀血, 能續筋骨. 煮汁內服, 外擣付之. 《本草》

Translation영역
Dipsacus root (續斷): Treats stagnant blood from a blow and is able to continue sinew and bone. Boil it for its juice and take it internally; pound it and apply it outside.
Clinical note임상 주석
續斷 means "continues what is severed", and the drug is named for the indication rather than the reverse. It remains one of the standard trauma drugs in Korean practice, given for sprain and fracture pain, and there is nothing hazardous in it. The claim that it continues bone is a claim about the name.

Boncho 本草

1.8.7
Source원문

旋葍根 卽旋花根也. 療被斫筋斷. 取根擣汁, 瀝瘡中, 以滓封瘡上, 日二三易, 筋便續. 《本草》

Translation영역
Bindweed root (旋葍根): That is, the root of the field bindweed. Treats a sinew cut through by a blade. Take the root, pound it for its juice, drip it into the wound, and seal the wound over with the dregs, changing it two or three times a day; the sinew then continues.
Clinical note임상 주석
A severed tendon does not reunite because juice has been dripped into the wound. It reunites when the two ends are brought together and held — tendon repair is a suture technique, and the gap, once the muscle has retracted, is beyond anything a dressing can close. **Plant juice and pounded root pressed into an open wound carry soil organisms, and a deep blade wound sealed under a poultice is the classic setting for tetanus.** What the chapter itself calls 破傷風 is tetanus, and it is the reason this instruction should not be followed.

Boncho 本草

1.8.8
Source원문

白蠟 屬金, 稟收歛堅凝之氣, 外科之要藥. 生肌止血, 定痛, 接骨續筋, 補虛. 與合歡皮同用, 極神效. 《丹心》

Translation영역
White wax (白蠟): It belongs to metal and takes on the qi of gathering in, hardening and setting; it is the essential drug of external medicine. It breeds flesh and stops bleeding, settles pain, joins bone and continues sinew, and supplements depletion. Used together with albizia bark it is extremely effective.
Clinical note임상 주석
白蠟 is insect wax — the hard, high-melting wax of the scale insect Ericerus pela, not beeswax, though the chapter also uses 黃蠟 for the latter. 稟收歛堅凝之氣, taking on the qi of gathering in and setting hard, is a description of what the substance physically does: it sets. The tradition then reads that property as an action on the body. As 外科之要藥, the essential drug of external medicine, it is right. A wax base is the vehicle for every plaster in the surgical chapters, it holds a dressing on, and it keeps a wound moist and covered, which is exactly how a modern occlusive dressing works and why a covered wound granulates faster than a dry one. 生肌, breeding flesh, is a fair name for that. 接骨續筋 is not — wax does nothing to bone. This is also the drug of 打着不痛方 further down the chapter, where a nyang of it is swallowed in hot wine before a flogging. Insect wax is inert and indigestible, and that dose would have done nothing at all.

Dansim 丹心

1.8.9
Source원문

蟹 脚中髓及腦, 幷殼中黃, 並能續斷折筋骨. 取碎之微熬, 納瘡中, 筋卽連. ○筋骨折傷, 生擣炒罨良. 《本草》

Translation영역
Crab (蟹): The marrow in the legs and the brain, together with the yellow inside the shell, are all able to continue sinew and bone that have been severed or broken. Take them, crush them and roast them a little, and put them into the wound; the sinew then joins. ○ For a broken or injured sinew and bone, pounding them raw and roasting them as a poultice is good.
Clinical note임상 주석
The crab regrows a lost limb, so the crab will regrow yours — the clearest piece of sympathetic reasoning in the section. The soft tissue inside a crab is also, in fact, a medium that bacteria grow in readily. **Crushed raw crab flesh put into an open wound is a direct inoculation. Marine invertebrates carry Vibrio species, and a Vibrio vulnificus wound infection is fulminant and frequently fatal; Aeromonas and Clostridium tetani are the other risks. This must not be prepared.**

Boncho 本草

1.8.10
Source원문

蠐螬 療踒折骨, 破血結. 取汁和酒服, 又擣付傷處. 《本草》

Translation영역
Beetle grub (蠐螬): Treats a sprained or broken bone and breaks up binding of blood. Take its juice, mix it with wine and drink it; also pound it and apply it to the injured place.
Clinical note임상 주석
The grub of a chafer beetle, dug out of dung or rotten wood. 破血結, breaking the binding of blood, is the standing indication for the insect drugs in trauma, and the chapter uses several of them this way. **A soil- and dung-dwelling larva crushed onto a broken skin surface is a tetanus and clostridial risk, and swallowed raw it carries parasites. This must not be prepared.**

Boncho 本草

1.8.11
Source원문

人中白 治閃挫跌撲傷骨極重. 人中白煆爲末, 溫酒調五分服. 《入門》

Translation영역
Urine sediment (人中白): Treats a wrench, a sprain, a fall or a blow where the bone is very severely injured. Calcine urine sediment, powder it, and give 5 fun stirred into warm wine.
Clinical note임상 주석
人中白 is the crust that dries on the inside of a urine vessel — mostly urates, phosphates and urea salts. Calcining it drives off the organic matter and leaves an alkaline mineral ash, which is why the tradition treats it as a cooling, descending drug. **This is a human material. It is not used in practice, there is no modern basis for it in fracture injury, and a preparation made from stored urine is a contamination risk whatever the calcining is supposed to achieve. This must not be prepared.**

Immun 入門

1.8.12
Source원문

牡鼠 療折傷筋骨. 生擣付傷處, 三日一易新, 能續筋骨. 《本草》

Translation영역
Male rat (牡鼠): Treats broken and injured sinew and bone. Pound it raw and apply it to the injured place, changing it for a fresh one every three days; it is able to continue sinew and bone.
Clinical note임상 주석
**A rat pounded raw and bound over an injury for three days at a time is the most dangerous dressing in the section. Rats carry Leptospira, Streptobacillus moniliformis, Seoul hantavirus and Salmonella, and a warm animal-tissue poultice left undisturbed for three days over broken skin is an incubator. This must not be prepared.** The rat appears twice in this chapter — here and again among the single remedies for flogging wounds, where it is fried in oil until charred. Charring at least sterilises; this preparation does not.

Boncho 本草

1.8.13
Source원문

生栗 主筋骨折碎, 血瘀腫痛. 細嚼生栗塗付之. 栗楔尤好, 三箇共一窠居中者. 《本草》

Translation영역
Raw chestnut (生栗): Governs broken and shattered sinew and bone, with stagnant blood, swelling and pain. Chew raw chestnut fine and smear it on. The wedge chestnut is better still — the one that sits in the middle where three share a single burr.
Clinical note임상 주석
栗楔, the wedge chestnut, is the flat-sided middle nut of a three-nut burr. Singling it out is a doctrine-of-signatures choice: the nut that is pressed between two others, and comes out shaped like a wedge, is the one for a bone that must be wedged back into place. Chewed chestnut is a starch paste. It has no action on a fracture, and chewing it first puts oral flora into a dressing that may go onto broken skin, so keep it to intact skin if at all.

Boncho 本草

1.8.14
Source원문

萵苣子 主打落折傷. 取子微炒爲末, 酒服二三錢, 能接續筋骨, 名接骨散. 《回春》

Translation영역
Lettuce seed (萵苣子): Governs injury from being struck down or from a break. Take the seed, roast it a little, powder it, and give 2 or 3 don in wine; it is able to join and continue sinew and bone. It is named Bone-Joining Powder 接骨散.
Clinical note임상 주석
A one-drug powder with a formula name, which is how 單方 and 方 shade into each other in this book. Lettuce seed is bland and harmless and has no effect on bone. What the 2 or 3 don of wine would have done is take the edge off the pain, which is probably why the vehicle is wine in two-thirds of this section.

Hoechun 回春

1.8.15
Source원문

烏雄雞 主踒折骨傷, 骨痛. 取血和酒服, 仍破腹罨傷處妙. 《本草》 ○又取骨末 一兩ㆍ自然銅末 四錢, 和勻, 溫酒調下二錢, 空心. 《綱目》

Translation영역
Black cock (烏雄雞): Governs a sprained or broken bone and injury, with bone pain. Take its blood, mix it with wine and drink it; then split the belly open and lay the bird on the injured place as a poultice — excellent. ○ Also take 1 nyang of the powdered bone and 4 don of powdered pyrite, mix them evenly, and give 2 don stirred into warm wine on an empty stomach.
Clinical note임상 주석
The black cock split open and laid still warm over the injury is the same operation as the cockscomb blood used to seal a bowel anastomosis earlier in the chapter: fresh avian tissue applied directly to a human wound. **Raw poultry blood drunk, and a freshly opened carcass bound onto an injury, are a direct route for Salmonella and Campylobacter and, where the skin is broken, for clostridial wound infection. This must not be prepared.** The second method adds calcined pyrite, which carries its own warning above.

Boncho 本草 · Gangmok 綱目

1.9 Formulas for Treating a Severed Ear, Nose or Tongue 療傷斷耳鼻舌方

1.9.1
Source원문

治擦落耳鼻. 用油髮灰末, 乘急以所落耳鼻蘸髮灰, 綴定, 以軟帛縛定. 有人爲驢所咬下鼻, 一僧用此綴之, 神效. 《綱目》

Translation영역
Treats an ear or nose scraped off. Use the ash of oiled hair, powdered; while the urgency is on, dip the fallen ear or nose in the hair ash, fasten it on, and bind it fast with soft silk. There was a man whose nose was bitten off by a donkey, and a monk fastened it on by this method with miraculous effect.
Clinical note임상 주석
This is a free composite graft — a wholly detached piece of ear or nose, with no blood supply of its own, put back and bandaged. **Without vascular anastomosis a free graft of that size does not take.** A composite graft survives only by imbibition from the wound bed and then revascularisation from its edges, which limits it to about a centimetre across and only at its thinnest; a whole nose or the greater part of an ear is far beyond that and will become necrotic over the following days. Modern replantation of an avulsed nose or ear is a microsurgical operation — the artery and vein are sutured under magnification — and without it the standard course is to discard the amputated part and reconstruct with a flap. What the method does have is the right reflex: 乘急, while the urgency is on. Cold ischaemia time decides everything in replantation, and the instruction to act at once is correct even though nothing follows from it here. Fastening and binding the part in good position is also correct in principle — a graft must be immobilised against its bed. **油髮灰, the ash of human hair, is a human material and is not used; char pressed into a fresh avulsion is a contamination and tetanus risk.** The hair ash here is doing the work of a surgical adhesive, and it is the one place in the chapter where a dressing is asked to hold tissue together mechanically.

Gangmok 綱目

1.9.2
Source원문

自行顚仆, 穿斷舌心, 血出不止. 取米醋, 以雞翎刷所斷處, 其血卽止. 仍用蒲黃ㆍ杏仁ㆍ鵬砂少許爲末, 蜜調噙化而愈. 《綱目》

Translation영역
A man walking fell flat and pierced through the middle of his tongue, and the bleeding would not stop. Rice vinegar was taken and brushed over the severed place with a chicken feather, and the bleeding stopped at once. Then typha pollen, apricot kernel and a little borax were powdered, mixed with honey, and held in the mouth to dissolve, and he was cured.
Clinical note임상 주석
A through-and-through tongue laceration from a fall onto the chin, with bleeding that will not stop. The tongue has a rich dual blood supply and bleeds heavily, and a deep laceration through it is one of the few mouth injuries that genuinely needs suturing; a gaping or actively bleeding wound is repaired under anaesthesia, with attention to the airway, since a swelling tongue can obstruct it. The vinegar brushed on is not useless. Dilute acetic acid is mildly astringent and causes local vasoconstriction, and firm application of anything over a bleeding mucosal surface supplies pressure, which is what actually stops it. Typha pollen is the tradition's haemostatic for exactly this, and honey held in the mouth is a reasonable mucosal dressing with real antibacterial activity. Borax is the item to drop — swallowed boron compounds are toxic and have no place in the mouth. **The chicken feather used as a brush is a contaminated applicator and should not be used on an open wound.**

Gangmok 綱目

1.9.3
Source원문

接指方, 蘇木爲末, 敷斷指間, 接定, 外用蚕繭包縛完固, 數日如故. 《入門》

Translation영역
A formula for joining a finger. Powder sappanwood, dust it between the severed parts of the finger, fasten them together, and bind the outside up firm and complete with silkworm cocoon; in a few days it is as it was.
Clinical note임상 주석
A severed finger is a replantation, and replantation is microsurgery: the bone is fixed, the tendons repaired, and at least one artery and one vein anastomosed under the microscope. A powder dusted between the ends and a cocoon wrapped round the outside cannot revascularise the part, and 數日如故, as it was in a few days, did not happen. The dressing itself is intelligently chosen. Silkworm cocoon is sericin-coated fibroin — the material surgical silk is made from — and wrapping a digit in it gives a firm, conforming splint. Sappanwood is the tradition's blood-moving dye wood, used throughout this chapter for trauma. If the finger was in fact partly attached rather than off, the method amounts to cleaning, apposing and splinting, which is the right thing to do.

Immun 入門

1.9.4
Source원문

一人落馬, 被所佩鎖匙傷破陰囊, 二丸脫落懸掛未斷, 痛苦無任, 諸藥不效. 予敎人漫漫托上, 多取壁錢敷貼傷處, 日漸就安, 其囊如故. 《醫鑑》

Translation영역
A man fell from a horse and tore his scrotum open on the lock key he was carrying. Both testicles had dropped out and hung there, not severed, and the pain was past bearing; no medicine answered. I taught someone to push them back up slowly and gently, and to take a quantity of spider egg-case and lay it over the injured place. Day by day it came to rest, and his scrotum was as it had been.
Clinical note임상 주석
The one case in this section that was managed correctly. 懸掛未斷, hanging but not severed: the testicles were still on their cords, which means their blood supply was intact, and the injury was a scrotal degloving rather than an amputation. Pushing them back into the sac slowly and gently, and dressing the wound, is in substance what is done now — reduce the contents, debride and irrigate, close the scrotum, which heals well because it is richly vascularised and elastic. 其囊如故, the scrotum as it had been, is a believable outcome. What the case needed and did not get was tetanus prophylaxis and antibiotics, and ideally an ultrasound to exclude rupture of the testis itself, which is repairable and is salvaged only if found early. **壁錢, the papery egg-case of the wall spider, laid on an open wound is a contamination risk and has no haemostatic or antiseptic action.** The dressing is the weakest part of a sound piece of management.

Uigam 醫鑑

1.10 Flogging Wounds 杖傷

1.10.1
Source원문

凡杖畢, 卽用童便ㆍ好酒 各一鍾, 合而溫服, 免血攻心, 甚妙. 實者, 雞鳴散方見上下之. 虛者, 當歸鬚散方見上加柴胡ㆍ羌活煎服. 仍用葱白擣爛炒熱, 搭杖處, 冷則易, 止痛散瘀如神. 《種杏》

Translation영역
Whenever the flogging is over, at once take a boy's urine and good wine, 1 jong of each, combine them and give them warm; this averts the blood attacking the heart and is most excellent. For the repleted, purge with Cock-Crow Powder 雞鳴散 — formula given above. For the depleted, give Dangguisu-san 當歸鬚散 — formula given above — with bupleurum and pubescent angelica added, decocted. Then pound scallion white to a pulp, fry it hot and lay it over the flogged place, changing it when it goes cold; it stops pain and disperses stagnation miraculously.
Clinical note임상 주석
杖 is the heavy bamboo rod of the Chosŏn penal code, laid across the buttocks and the backs of the thighs. The injury is a closed crush of large muscle groups with extensive bruising, and 血攻心 — blood attacking the heart — is the name the text gives to what happens when a flogging kills. The modern reading is good: crush of that much muscle releases myoglobin and potassium, and the result is rhabdomyolysis with acute kidney injury and hyperkalaemic cardiac arrest, on top of hypovolaemia from blood lost into the tissues. Someone struck hard enough across the back and buttocks can die days later with dark urine and failing kidneys, and the text has correctly identified the moment immediately after the beating as the one that decides it. What that patient needs is fluid — aggressive intravenous volume, which is the single intervention that prevents myoglobinuric renal failure. 一鍾 of urine and wine is about a cupful, and the wine is a diuretic working the wrong way. Purging a man who has just bled into his own muscles, which is what 雞鳴散 does, is actively harmful; 當歸鬚散 for the depleted is at least not a purge. The scallion poultice, fried hot and renewed as it cools, is a warm compress, and warm compresses over deep bruising are still used. **童便, a boy's urine, is a human material and is not used.**

Jonghaeng 種杏

1.10.2
Source원문

又片豆腐鹽水煮熱, 鋪杖處, 其氣如蒸, 其腐卽紫, 復換貼, 以色淡爲度. 潰爛者亦宜. 《種杏》

Translation영역
Also, slice bean curd, boil it hot in salt water and spread it over the flogged place; the steam of it is as though steaming, and the curd at once turns purple. Change and reapply it until the colour comes out pale. This suits an ulcerated and festering wound too.
Clinical note임상 주석
The purpling of the bean curd is read as the bruise being drawn out into it, and the endpoint — keep going until the curd comes away pale — is a tidy piece of clinical bookkeeping built on a false premise. What actually stains the curd is serous exudate and blood from the surface of the wound, and it will keep staining as long as the wound weeps. As a dressing it is better than most in this chapter. Hot bean curd in brine is a warm, wet, mildly saline compress, renewed repeatedly, and over bruised or sloughing skin that is a reasonable way to keep a wound moist and lift debris. It is not sterile, which is the reservation, and 潰爛者亦宜 — suitable for the ulcerated and festering — is where that matters most.

Jonghaeng 種杏

1.10.3
Source원문

痛甚者, 內服乳香定痛散方見上, 隨以熱酒盡量而飮, 外貼黃蠟膏方見諸瘡. 有血瘀壅腫, 先刺出惡血, 然後乃貼膏藥. 《入門》

Translation영역
Where the pain is severe, give Yuhyang Jeongtong-san 乳香定痛散 — formula given above — internally, following it with as much hot wine as he can drink; outside, lay on Hwangrap-go 黃蠟膏 — formula given in the Sores chapter. Where there is stagnant blood and congested swelling, first lance it to let out the bad blood, and only then lay the plaster on.
Clinical note임상 주석
盡量而飮, as much as he can drink: alcohol to the limit of tolerance, as an analgesic. It is the most honest analgesia in the section and it is the wrong drug — ethanol is a poor analgesic, it worsens the hypovolaemia and the acidosis of a crush injury, and it clouds the assessment of a patient who may be bleeding. 先刺出惡血, lance it first and let the bad blood out, is a real procedure and the indication is correctly drawn: 血瘀壅腫, a tense collection under the skin. That is a haematoma, and a large tense haematoma over a flogged buttock is drained now as well, because the alternative is that it liquefies and becomes infected. **Lancing without asepsis is how that wound becomes a deep soft-tissue infection, and the sequence here — open it, then seal it under a wax plaster — closes contaminated tissue under an occlusive dressing, which is the one thing not to do.**

Immun 入門

1.10.4
Source원문

杖瘡只是血熱作痛, 用凉藥去瘀血爲先, 須服雞鳴散之類, 外貼以五黃散, 或大黃ㆍ黃栢爲末, 生地黃汁調付之.

Translation영역
A flogging sore is nothing but heat in the blood making pain. Using cooling drugs to take away the stagnant blood comes first, and formulas of the Cock-Crow Powder 雞鳴散 kind should be given. Outside, lay on Five Yellows Powder 五黃散, or powder rhubarb and amur cork bark and apply them stirred into fresh rehmannia juice.
Clinical note임상 주석
血熱作痛 is the whole pathology of flogging in this chapter: a beating drives heat into the blood, and the treatment is to cool and to move. It produces a consistent therapeutics — cold bitter drugs inside and out, purging to clear the stasis — and the error in it is the purging, for the reasons given above. The topical alternative offered here is sound in its own terms and almost benign: rhubarb and amur cork bark powdered into fresh rehmannia juice is a cool, astringent, tannin-rich wet dressing over bruised skin. It is a better choice than the 五黃散 beside it, which carries lead.

Dansim 丹心

1.10.5
Source원문

又野苧根嫩者洗淨, 同鹽擣付, 神妙. 《丹心》

Translation영역
Also, wash clean the tender root of wild ramie, pound it together with salt and apply it; miraculous.

Dansim 丹心

1.10.6
Source원문

又鳳仙花科連根葉擣爛, 貼患處, 乾則易, 一夜血散卽愈. 《醫鑑》

Translation영역
Also, take the whole balsam plant with its root and leaves together, pound it to a pulp and lay it on the affected place, changing it when it dries; in one night the blood disperses and it is cured.
Clinical note임상 주석
Garden balsam, Impatiens balsamina, used whole. The tradition's name for it is 透骨草, "pierce-the-bone herb", and it is still a common external drug for bruising and joint pain. A pulped fresh plant under a dressing is a cool wet compress; the one-night cure is the usual overstatement.

Uigam 醫鑑

1.10.7
Source원문

又菉豆粉微炒, 雞子淸調付之. 《醫鑑》

Translation영역
Also, roast mung bean flour a little and apply it stirred into egg white.
Clinical note임상 주석
Mung bean flour in egg white sets to a smooth, cooling film that dries and contracts over the skin — the structure of a cosmetic mask, and a plausible soothing dressing over intact bruised skin. **Raw egg white should not be put on broken skin; it carries Salmonella.**

Uigam 醫鑑

1.10.8
Source원문

杖瘡宜服乳香散ㆍ化瘀散ㆍ補氣坐血湯ㆍ烏龍解毒散. 《諸方》

Translation영역
For a flogging sore it is right to give Yuhyang-san 乳香散, Hwaeo-san 化瘀散, Bogi Saenghyeol-tang 補氣生血湯 and Oryong Haedok-san 烏龍解毒散.
Clinical note임상 주석
The four formulas that follow, in the order the text lists them. They divide by stage: 乳香散 and 化瘀散 for the fresh injury, 補氣生血湯 for the wound that has ulcerated and will not close, and 烏龍解毒散 for the sloughing scab that has to be lifted. That is a sensible sequence for a wound that will be weeks in healing, and it is the only place in the chapter where a course of treatment is laid out over time.

Jebang 諸方

1.10.9
Source원문

大槩通滯血, 皆以酒化服. 盖血滯則氣壅淤, 氣壅淤則經絡滿急, 經絡滿急故腫且痛. 凡打撲着肌肉須腫痛者, 以經絡傷氣血不行故如是. 《本草》

Translation영역
In general, to open up stagnant blood, all of these are dissolved in wine and taken. For when the blood is stagnant the qi is congested and silted; when the qi is congested and silted the channels and network vessels are full and tense; and because the channels and network vessels are full and tense there is both swelling and pain. Whenever a blow or a fall strikes the flesh and swelling and pain must follow, it is because the channels and network vessels are injured and the qi and blood are not moving, and so it is thus.
Clinical note임상 주석
A causal chain set out step by step — stasis, then congestion, then tense fullness of the vessels, then swelling and pain. Strip the vocabulary and it is close to right: blunt injury tears small vessels, blood and fluid accumulate in the tissue, interstitial pressure rises, and the rise in pressure is what produces the swelling and the pain. Where the compartment is closed, that rise is itself the emergency, and the chapter has no concept of that. The therapeutic conclusion — dissolve everything in wine, because wine moves blood — is where it goes wrong. Alcohol is a vasodilator and interferes with platelet function, and in a patient bleeding into his muscles it makes the bleeding worse.

Boncho 本草

1.10.10
Source원문

凡杖瘡忽乾黑陷, 毒氣攻心, 恍惚煩悶嘔吐者死. 《入門》

Translation영역
Whenever a flogging sore suddenly goes dry, black and sunken, and the poisonous qi attacks the heart with dazed confusion, vexation, oppression and vomiting, the patient dies.
Clinical note임상 주석
The best piece of observation in the section. A wound that suddenly dries, blackens and sinks is a wound whose tissue has died, and a patient who then becomes confused, agitated and vomiting is a patient who is septic. Taken together that is necrotising soft-tissue infection — necrotising fasciitis or clostridial myonecrosis — presenting with septic shock, and the chapter's prognosis is correct: untreated, it kills. 毒氣攻心, the poisonous qi attacking the heart, is as good a name for septic shock as a system without microbiology could produce, and the chapter has got the sequence right — local change first, systemic collapse after. What it could not know is that the treatment is immediate surgical debridement, intravenous antibiotics and resuscitation, and that hours decide the outcome. Nothing in these pages alters it.

Immun 入門

1.10.11
Source원문

五黃散 治杖瘡止痛. 黃丹ㆍ黃連ㆍ黃芩ㆍ黃栢ㆍ大黃ㆍ乳香 各等分. 右爲末, 新水調成膏, 以緋絹攤貼傷處, 日三易. 《精要》

Translation영역
Ohwang-san 五黃散 treats a flogging sore and stops pain. Minium, coptis, scutellaria, amur cork bark, rhubarb and frankincense, equal parts of each. Powder the above, stir it into fresh water to make a paste, spread it on scarlet silk and lay it on the injured place, changing it three times a day.
Clinical note임상 주석
**Contains minium, which is lead tetroxide. Spread on silk and bound onto a broken, weeping flogging wound three times a day, it is absorbed through the wound surface, and there is no safe topical dose. This must not be prepared.** The five yellows are counted with 黃丹 as one of them, so the lead is not an adjunct here but a quarter of the name. Take the minium out and the remainder is a defensible cooling dressing: coptis, scutellaria, amur cork bark and rhubarb are all berberine- or tannin-bearing bitters with real antibacterial activity, and frankincense is the chapter's analgesic resin. The handling is good too — a thin paste spread on cloth, applied over the wound, renewed three times a day, which is a frequent-change wet dressing.

Jeongyo 精要

1.10.12
Source원문

乳香散 治杖瘡腫痛. 自然銅(火煆醋淬七次)ㆍ當歸 各五錢, 茴香 四錢, 乳香ㆍ沒藥 各三錢. 右末, 每三錢, 溫酒調下. 《精要》

Translation영역
Yuhyang-san 乳香散 treats swelling and pain in a flogging sore. Pyrite (calcined in the fire and quenched in vinegar seven times) and Chinese angelica, 5 don of each; fennel, 4 don; frankincense and myrrh, 3 don of each. Powder the above and give 3 don each time, stirred into warm wine.
Clinical note임상 주석
An internal powder for the bruised and swollen flogging wound, built on the two resins — frankincense and myrrh — that the chapter uses whenever pain is the complaint. Boswellic acids and the sesquiterpenes of myrrh do have measurable anti-inflammatory activity, and angelica and fennel are warm, moving and harmless. As trauma powders go this is one of the more reasonable. **The pyrite is the problem. Calcined iron-copper sulphide is not a defined substance, it may carry arsenic, and it is here in the largest share of the formula. This must not be prepared as written.**

Jeongyo 精要

1.10.13
Source원문

化瘀散 治杖打重, 血上攻心, 煩悶. 蘇木ㆍ當歸尾 各三錢, 大黃ㆍ紅花 各二錢. 右爲末, 每三錢, 溫酒ㆍ童便調和服. 《醫鑑》

Translation영역
Hwaeo-san 化瘀散 treats a heavy flogging where the blood rises and attacks the heart with vexation and oppression. Sappanwood and angelica tails, 3 don of each; rhubarb and safflower, 2 don of each. Powder the above and give 3 don each time, stirred together into warm wine and a boy's urine.
Clinical note임상 주석
Given for the gravest presentation in the section — 血上攻心 with vexation and oppression, which is the crush-injury syndrome described above. Four blood-movers and a purgative, in wine: sappanwood, angelica tails, safflower and rhubarb. **In a patient who is bleeding into crushed muscle, rhubarb purges fluid he cannot spare and the wine and blood-movers work against haemostasis; this is the wrong direction of treatment for the condition it names, and the condition it names needs intravenous fluid.** **童便, a boy's urine, is a human material and is not used.**

Uigam 醫鑑

1.10.14
Source원문

補氣生血湯 治杖瘡潰爛久不愈. 人參ㆍ白朮ㆍ白茯苓ㆍ白芍藥ㆍ當歸ㆍ陳皮ㆍ香附子ㆍ貝母ㆍ桔梗ㆍ熟地黃ㆍ甘草 各一錢. 右剉作一貼, 酒水相半煎服. 《醫鑑》

Translation영역
Bogi Saenghyeol-tang 補氣生血湯 treats a flogging sore that has ulcerated and festered and has long failed to heal. Ginseng, white atractylodes, poria, white peony, Chinese angelica, aged tangerine peel, cyperus, fritillary, platycodon, prepared rehmannia and liquorice, 1 don of each. Cut the above up to make one packet and decoct it in half wine and half water.
Clinical note임상 주석
The one formula in the section that is unobjectionable and the one with the best claim to working. It is 八物湯 — the four qi drugs and the four blood drugs — with cyperus and tangerine peel to move qi and fritillary and platycodon to open and drain the sore. The indication is a flogging wound that has broken down and will not close after weeks. A chronic non-healing wound in a prisoner or a flogged labourer is in most cases a wound in a malnourished patient, and the two things that decide whether it closes are nutrition and perfusion. A warm decoction of ginseng, atractylodes, poria, angelica and rehmannia, taken daily, is a tonic given to someone depleted, and the tradition's 補氣生血 — supplement the qi and breed the blood — is not a bad description of what a wound in that state actually needs. Protein, calories, iron, vitamin C and zinc are the modern names for it.

Uigam 醫鑑

1.10.15
Source원문

烏龍解毒散 治人受杖責後, 疔甲爛肉, 疼痛難忍, 不能起動, 服此痛止, 便能動履, 其效如神. 木耳 四兩, 入砂鍋內炒焦存性爲末. 右每服五錢, 熱酒一椀調服. 服後少頃, 其藥力行至杖瘡上, 從肉裏透如鍼刺, 痒甚, 不時流血水, 卽以藥水洗淨, 貼膏藥. 《回春》 ○去疔甲, 取雞子淸入麝香少許, 以銀簪打成稀水, 用簪尖輕輕點上, 不多時其疔甲化爛, 取去, 一日一換, 貼膏藥, 化盡死肉, 數日如故矣. 《回春》

Translation영역
Oryong Haedok-san 烏龍解毒散 treats a man after he has undergone a flogging, with a hard scab and festering flesh, pain hard to bear, and inability to get up and move; take this and the pain stops, he can at once walk about, and the effect is miraculous. Wood ear fungus, 4 nyang, put into an earthenware pan and roasted to a char with its nature kept, then powdered. Give 5 don of the above each time, stirred into 1 jar of hot wine. A little while after taking it, the strength of the drug travels to the flogging sore and pierces up out of the flesh like a needle prick, with severe itching, and from time to time blood and water run out; wash it clean at once with medicinal water and lay on the plaster. ○ To remove the hard scab, take egg white, put in a little musk, beat it to a thin liquid with a silver pin, and dab it on lightly with the pin's point. In a short while the hard scab dissolves and festers; take it away, change it once a day, and lay the plaster on. When the dead flesh has all been dissolved away, in a few days it is as it was.
Clinical note임상 주석
疔甲 is the hard, horny eschar that forms over a flogged wound, and the leaf is about getting it off. That is debridement, and the aim is exactly right: dead tissue has to come away before a wound can close, and the text says so plainly — 化盡死肉, dissolve the dead flesh away entirely, and then it heals. Lifting it progressively with a daily application, rather than cutting it off at once, is enzymatic or autolytic debridement in all but name. The agent chosen cannot do it. Egg white with a trace of musk, beaten thin, has no proteolytic activity; what softens an eschar is moisture, and the wet daily dressing is probably what was doing the work. The 烏龍解毒散 itself is charred wood ear in a jar of hot wine, and the sensation it is credited with — the drug travelling to the wound and pricking up through the flesh — belongs to the wine. 便能動履, he can walk at once, is what a jar of strong drink does for a man who has been beaten. **麝香 is musk from the musk deer, a CITES-protected animal, and is not used. Raw egg white dabbed into an open wound carries Salmonella, and the silver pin used as both whisk and applicator is not sterile. This must not be prepared.**

Hoechun 回春

1.10.1 Formula for Not Feeling the Blows 打着不痛方

1.10.1.1
Source원문

未打之前, 先取白蠟 一兩, 細切, 入椀內, 滾酒泡服, 則雖打着不痛, 名寄杖散. 《醫鑑》

Translation영역
Before the beating, first take white wax, 1 nyang, cut it up fine, put it in a bowl, steep it in boiling wine and drink it; then though the blows strike there will be no pain. It is named Entrust-the-Rod Powder 寄杖散.
Clinical note임상 주석
Insect wax has no analgesic action of any kind. It is a hard, high-melting ester wax, it is not digested, it is not absorbed, and a nyang of it swallowed in hot wine will pass through unchanged. Whatever dulling the dose produced came from the 滾酒 — the wine it was steeped in, drunk hot and on an empty stomach before a flogging. The name 寄杖散, entrusting the rod, says what was being bought: not a cure but courage. The formula is worth pausing over for what it implies about the patients. Someone had to know in advance that he was to be beaten, have time to send for a physician, and be able to pay for a nyang of imported insect wax — which means the flogged men a physician prescribed for were not the ones dragged in off the street. A judicial sentence of 杖 was anticipated, and the anticipation was long enough and the means sufficient for a prescription to be bought beforehand. Set beside 杖傷 itself, with its formulas, its single remedies and its course of treatment running over weeks, the section documents corporal punishment as something routine enough to have a medicine for it on both sides of the event — one dose before, a regimen after — and clientele with the standing to ask. **This cannot prevent the injury. Flogging across the buttocks and back is a crush injury to large muscle, and the dangerous sequelae — rhabdomyolysis, acute kidney injury, deep infection — follow from the tissue damage whether or not the blows were felt. Nothing taken beforehand changes that.**

Uigam 醫鑑

1.11 Simple Medicinals 單方

1.11.1
Source원문

凡五種.

Translation영역
Five kinds in all.
Clinical note임상 주석
The shortest of the chapter's five Single Remedies sections, and the only one attached to an injury with a legal rather than an accidental cause. All five are for the flogging wound: a radish for the bruise that has not broken the skin, dung as a hot compress, myrrh for pain past bearing, a rat charred in oil, and malt sugar to bring the stagnant blood down.

Donguibogam · Jesang

1.11.2
Source원문

蘿蔔根 治杖瘡, 皮不破而內損者. 蘿葍根擣爛, 罨傷處良. 《種杏》

Translation영역
Radish root (蘿蔔根): Treats a flogging sore where the skin is not broken but there is injury within. Pound radish root to a pulp and lay it on the injured place as a poultice — good.
Clinical note임상 주석
The indication is carefully drawn and it is the right one — 皮不破而內損, the skin unbroken but injury within, which is a contusion. A cool wet pulp bound over a closed bruise is a reasonable dressing and carries none of the infection risk that the other four in this section do, precisely because the skin is intact. It is the only item here that could be used as written.

Jonghaeng 種杏

1.11.3
Source원문

馬糞 治杖瘡入風疼痛. 馬或驢濕糞, 替換熱熨, 日五十遍, 極效. 《本草》

Translation영역
Horse dung (馬糞): Treats a flogging sore into which wind has entered, with pain. Take the moist dung of a horse or a donkey and iron the place with it hot, changing it over and over, fifty times a day; extremely effective.
Clinical note임상 주석
杖瘡入風, wind entering the flogging sore, is the chapter's own category for a wound that turns bad, and where it goes on to rigidity and spasm the book calls it 破傷風 — which is tetanus. **This remedy is the means of causing the disease it is given for. Clostridium tetani lives in the gut of horses and donkeys and is shed in their dung; moist equine dung pressed repeatedly into an open wound is the single most reliable way to inoculate a human being with tetanus, and the same dung carries Clostridium perfringens, the organism of gas gangrene. This must not be prepared under any circumstances.** A wound of this kind needs cleaning, debridement and tetanus immunoprophylaxis, and tetanus once established has a mortality of tens of percent even in an intensive care unit.

Boncho 本草

1.11.4
Source원문

沒藥 主杖瘡腫痛不可忍. 細硏, 取一錢, 熱酒調服妙. 《本草》

Translation영역
Myrrh (沒藥): Governs swelling and pain in a flogging sore that cannot be borne. Grind it fine, take 1 don and give it stirred into hot wine — excellent.
Clinical note임상 주석
Myrrh on its own, a don at a time, for pain past bearing. The resin's sesquiterpenes have documented anti-inflammatory and mild analgesic activity, and myrrh is the drug the chapter reaches for whenever pain is the whole complaint, appearing in three of the four flogging formulas as well. A don is a modest dose and the preparation is safe, which makes this the most defensible single remedy in the section — though not enough to touch the pain it names, and the hot wine is again carrying part of the effect.

Boncho 本草

1.11.5
Source원문

鼠 治打傷瘡. 生鼠一枚, 和腸肚剉, 油半斤煎令焦黑, 收之, 以雞羽蘸付瘡上妙. 《本草》

Translation영역
Rat (鼠): Treats a sore from a beating. Take one live rat, chop it up guts and all, fry it in half a geun of oil until it is charred black, and keep it; dip a chicken feather in it and apply it to the sore — excellent.
Clinical note임상 주석
Frying the animal in oil until it is charred black does at least sterilise it, which the raw rat poultice in the fractures section does not, and what is left is a char-and-oil liniment of the kind used across East Asia as a wound dressing. **It remains a preparation of a rat applied to an open wound. Rats carry Leptospira, Streptobacillus moniliformis, hantavirus and Salmonella; the oil is not sterile once stored, and the chicken feather applicator is itself contaminated. This must not be prepared.**

Boncho 本草

1.11.6
Source원문

飴糖 治打損瘀血. 飴糖熬和酒服, 能下惡血. 《本草》

Translation영역
Malt sugar (飴糖): Treats stagnant blood from a blow. Boil malt sugar down, mix it with wine and drink it; it is able to bring the bad blood down.
Clinical note임상 주석
Maltose syrup in wine. It is a sweetened drink and nothing more — there is no mechanism by which sugar moves a haematoma — but of all the things in this chapter given to a man who has just been flogged, sugar and fluid is among the least harmful, and a hypovolaemic patient with crushed muscle needs calories and volume more than he needs a purge.

Boncho 本草

1.12 Human Bites 人咬傷

1.12.1
Source원문

人咬傷成瘡, 龜板或鼈甲燒灰, 油調付. 《綱目》

Translation영역
Where a human bite has wounded a man and become a sore, burn tortoise plastron or soft-shelled turtle shell to ash and apply it mixed with oil.
Clinical note임상 주석
A human bite that breaks the skin is one of the dirtiest wounds in surgery. The mouth carries *Eikenella corrodens* along with streptococci, staphylococci and mouth anaerobes, and a bite over a knuckle or a joint drives that flora under the skin as the hand opens again. Infection rates are high enough that a bite breaching the dermis is treated as infected from the outset: irrigation, exploration, no primary closure of a hand bite, amoxicillin-clavulanate, tetanus cover, and a review of bloodborne-virus exposure where the biter's status is unknown. **Ash from a burned shell, worked into oil and laid on an open wound, adds contamination to a wound already seeded with mouth flora and should not be used.** Charred shell has no antiseptic action; the only part of this entry with any mechanical sense is the oil, which keeps a dressing from adhering. The chapter opens its bite series with the human bite rather than the animal one, which follows the materia medica logic of working from man outward rather than any clinical ordering.

Gangmok 綱目

1.13 Animal Bites 諸獸傷

1.13.1
Source원문

諸獸傷.

Translation영역
Wounds from the various beasts.
Clinical note임상 주석
A division heading with no text of its own. What follows under it is organised by the animal — tiger, bear, horse and donkey and mule, ox, dog — and the dog occupies five sub-sections out of nine because the dog is the one animal whose bite carries rabies. The cat and the rat, which belong here by subject, are printed after the Single Remedies section instead, and keep their place in the numbering.

Donguibogam · Jesang

1.13.1 Tiger Wounds 虎傷

1.13.1.1
Source원문

人被虎咬, 先飮淸油 一椀. 又白礬爲末, 納傷處. 又砂糖水調服 一二椀, 幷塗傷處. 《入門》

Translation영역
Where a man has been bitten by a tiger, first have him drink 1 ja of clear oil. Also powder alum and pack it into the wound. Also give 1 or 2 ja of sugar water to drink, and smear it over the wound as well.
Clinical note임상 주석
A large-cat bite is a crush and avulsion injury with deep inoculation: the canines penetrate to bone and the carnassials strip tissue, so the wound is a cavity rather than a puncture. The immediate problems are haemorrhage, devitalised tissue and a polymicrobial inoculum — *Pasteurella multocida*, streptococci, staphylococci, *Capnocytophaga* and mouth anaerobes. Treatment is surgical: exploration under anaesthesia, debridement, copious irrigation, delayed closure, broad-spectrum antibiotics, tetanus cover and rabies post-exposure prophylaxis, since any carnivore bite in a rabies-endemic area is treated as an exposure. Nothing here addresses any of that. Alum is an astringent and will not stop bleeding from a vessel of any size; swallowed oil and sugar water are supportive at best. The one instruction with incidental merit is that the wound is to be irrigated with something rather than closed over.

Immun 入門

1.13.1.2
Source원문

虎傷人瘡, 取靑布緊捲, 燒一頭, 納竹筒中, 向瘡口令烟熏之佳. 《本草》

Translation영역
For the sore where a tiger has wounded a man: take blue cloth, roll it up tightly, set one end alight, put it inside a bamboo tube and direct it at the mouth of the sore so that the smoke fumigates it — this is good.
Clinical note임상 주석
Smoke fumigation of a wound through a bamboo tube recurs for bear wounds in the next sub-section and is the chapter's standard method for driving out what it takes to be the beast's toxin. Smoke from burning dyed cloth deposits soot and combustion products on the wound surface and has no antimicrobial value at the temperatures involved; the hot gas can burn granulating tissue. It should not be done.

Boncho 本草

1.13.1.3
Source원문

虎傷人, 但飮酒常令大醉, 當吐毛出良. 《本草》

Translation영역
Where a tiger has wounded a man, simply give him wine to drink so that he is kept very drunk; he should vomit out hair, which is good.
Clinical note임상 주석
The sign being looked for — hair vomited up — is the same magical endpoint as the dog hair expected in the bean-paste ball under 1.13.7. The idea is that the animal's substance has entered the body and must be expelled in its own visible form, so a particle of fur or fluff is read as proof of cure. It proves nothing. Deliberate intoxication after a mauling is actively harmful: alcohol worsens hypovolaemia, impairs clotting, suppresses the cough reflex in a patient who is being made to vomit, and masks the deterioration that a head or abdominal injury from a large animal would otherwise show.

Boncho 本草

1.13.1.4
Source원문

虎犬咬人, 杵薤取汁, 飮 一升, 日三, 滓付傷處. 《本草》

Translation영역
Where a tiger or a dog has bitten a man, pound Chinese scallion and take the juice; have him drink 1 seung of it three times a day, and apply the dregs to the wound.

Boncho 本草

1.13.1.5
Source원문

虎狼傷人, 生雞肉食之. 又生葛汁飮之, 又洗瘡. 又婦人月經赤衣燒爲灰, 和酒服. 《本草》

Translation영역
Where a tiger or a wolf has wounded a man, have him eat raw chicken flesh. Also have him drink the juice of fresh pueraria, and wash the sore with it too. Also burn a woman's menstrual cloth to ash and give it in wine.
Clinical note임상 주석
**Raw chicken flesh given to a mauled patient is a salmonella and campylobacter exposure in someone already facing wound sepsis, and must not be used. Menstrual cloth is a human material and a bloodborne-virus exposure; it must not be prepared or given.** The red cloth is here for its sympathetic logic — blood answering blood — not for any property it has. The fresh pueraria juice used as a wound wash is the only part of the entry that would do no harm, and copious irrigation with a clean fluid is in fact the first step in modern bite care; the text has the action right and the agent wrong.

Boncho 本草

1.13.1.6
Source원문

乾薑末納瘡妙. 《本草》

Translation영역
Packing dried ginger powder into the sore is excellent.

Boncho 本草

1.13.2 Bear Wounds 熊傷

1.13.2.1
Source원문

熊傷人, 燒靑布取烟熏瘡口, 令毒出. 《本草》

Translation영역
Where a bear has wounded a man, burn blue cloth, take the smoke and fumigate the mouth of the sore so that the toxin comes out.

Boncho 本草

1.13.2.2
Source원문

又煮葛根取濃汁以洗瘡十度, 幷擣葛根爲末, 調葛根汁服, 日五. 《本草》

Translation영역
Also boil pueraria root, take the thick decoction and wash the sore with it ten times over; and pound pueraria root to powder, stir it into pueraria juice and give it, five times a day.
Clinical note임상 주석
Washing the wound ten times over with a boiled decoction is the soundest instruction in the two beast-wound sub-sections. Repeated high-volume irrigation is what reduces the bacterial load in a contaminated bite, and the fluid here has at least been boiled. Modern practice is the same action with saline or clean running water, and the decoction would be a reasonable substitute where nothing else existed. A bear mauling, though, is a surgical injury — deep lacerations, crush, degloving, skull and facial fractures — and irrigation is the first step of a procedure, not the whole of it. The wound needs exploration and debridement, antibiotic cover against *Pasteurella* and anaerobes, tetanus prophylaxis and rabies post-exposure prophylaxis.

Boncho 本草

1.13.2.3
Source원문

熊傷人, 蒴藋剉, 水漬取汁飮, 滓付瘡上.

Translation영역
Where a bear has wounded a man, chop elder, steep it in water, take the liquid and have him drink it, and apply the dregs on top of the sore.

Boncho 本草

1.13.2.4
Source원문

熊虎傷, 煮生鐵令有味洗之.

Translation영역
For bear and tiger wounds, boil raw iron until the water takes a taste from it, and wash with that.
Clinical note임상 주석
Iron-boiled water is a dilute solution of iron salts, mildly astringent and no more. The interest of the entry is that it belongs to a family of mineral washes used across this chapter where the aim is to tighten and dry a wound surface; it does not disinfect, and a deep bear wound will not be helped by surface astringency.

Boncho 本草

1.13.2.5
Source원문

熊虎瓜甲傷, 嚼生栗付之. 《本草》

Translation영역
For a wound from the claws of a bear or a tiger, chew raw chestnut and apply it.
Clinical note임상 주석
A claw wound from a large carnivore is a contaminated laceration, often with embedded debris, and carries the same infection profile as the bite. Chewed chestnut is a poultice applied with the practitioner's own mouth flora; it should not be put on an open wound. This is also the point at which to say that tiger-derived materials appear later in this chapter — tiger skull, tooth and shin bone under 1.13.8, tiger bone and tiger hair under 1.14.2. **The tiger is listed on CITES Appendix I and every tiger-derived material is prohibited in trade and in practice. These must not be sourced, prepared or dispensed.** Bear bile, which does not appear here but belongs to the same group, is under the same restriction.

Boncho 本草

1.13.3 Bites and Kicks from Horse, Donkey and Mule 馬驢騾咬踢傷

1.13.3.1
Source원문

馬咬踢傷, 益母草擣爛, 和醋炒付. 《本草》

Translation영역
For a bite or a kick wound from a horse, pound leonurus to a mash, mix it with vinegar, stir-fry it and apply.
Clinical note임상 주석
A horse kick and a horse bite are different injuries and this sub-section treats them together. The kick is blunt trauma from a mass moving fast: closed fractures of the ribs, forearm, femur or facial bones, splenic and hepatic injury, and in a kick to the head or chest a lethal injury with little to see on the skin. The bite is a crush with wide, shallow tissue damage. The kick needs imaging and the bite needs irrigation, and neither needs a poultice.

Boncho 本草

1.13.3.2
Source원문

又馬鞭梢燒灰塗之.

Translation영역
Also burn the tip of a horsewhip to ash and smear it on.

Deukhyo 得效

1.13.3.3
Source원문

獨顆栗子燒灰貼亦妙. 《得效》

Translation영역
Burning a single-kernel chestnut to ash and sticking it on is excellent as well.

Deukhyo 得效

1.13.3.4
Source원문

又鼠屎 二七枚ㆍ故馬鞭梢 五寸同燒灰, 猪脂調付. 《本草》

Translation영역
Also burn fourteen rat droppings together with 5 chi of the tip of an old horsewhip to ash, mix with lard and apply.
Clinical note임상 주석
**Rat droppings must not be prepared or applied.** Rodent faeces carry *Leptospira*, *Salmonella*, hantavirus and *Streptobacillus*, and burning to ash is not a reliable sterilisation of a material handled and compounded afterwards into lard. On an open wound it is an inoculation. The horsewhip tip is a sympathetic ingredient: the instrument that touched the horse is taken to hold something of the horse, and burning it is held to undo the injury. It is worth recognising as magic rather than reading it as pharmacy.

Boncho 本草

1.13.3.5
Source원문

又用艾灸傷處, 取人屎或馬屎燒灰爲末付之. 《入門》

Translation영역
Also apply moxa to the wound, then take human or horse dung, burn it to ash, powder it and apply.
Clinical note임상 주석
**Human and horse dung must not be prepared or applied to a wound.** Horse manure in particular is the classical reservoir of *Clostridium tetani*, and the combination described here — a burn made by moxa, then manure ash packed into it — reproduces almost exactly the conditions tetanus requires: devitalised tissue, a deep anaerobic pocket and soil or gut organisms introduced directly. 破傷風, the tetanus of this chapter, is the predictable outcome. A horse-associated wound today is a tetanus-prone wound by definition: it is irrigated and debrided, tetanus immunoglobulin and vaccine are given where immunity is uncertain, and antibiotics cover the mixed flora.

Immun 入門

1.13.3.6
Source원문

嚼生栗付之. 《綱目》

Translation영역
Chew raw chestnut and apply it.

Gangmok 綱目

1.13.3.7
Source원문

又取雞冠熱血塗瘡中, 或浸之. 《本草》

Translation영역
Also take warm blood from a cockscomb and smear it into the sore, or soak the part in it.
Clinical note임상 주석
**Fresh cockscomb blood must not be put into an open wound.** Raw poultry blood carries *Salmonella* and *Campylobacter* and, poured into a contaminated puncture, is a culture medium laid into an anaerobic space. Cockscomb blood is used elsewhere in this chapter to seal a bowel anastomosis, and the same objection holds there: it is being used because it clots, and it does clot, but what it also does is seed the wound.

Boncho 本草

1.13.3.8
Source원문

驢或馬咬人, 或骨刺傷, 取其尿洗瘡, 以糞塗之, 又飮糞汁佳. 《本草》

Translation영역
Where a donkey or a horse has bitten a man, or a bone has pierced and wounded him, take the animal's urine and wash the sore with it, smear the dung on it, and drinking the dung liquor is good as well.
Clinical note임상 주석
**Animal urine and dung must not be used as a wound wash, a dressing or a drink.** This is the single most hazardous instruction in the sub-section: it washes a fresh wound with urine, packs it with manure, and gives manure liquor by mouth. Each step adds tetanus, clostridial and enteric risk to an injury that already carries it. The underlying reasoning is the same sympathetic principle as the horsewhip — the animal that caused the harm supplies the cure. Where the text reaches for the right action, which is to flush the wound with volume, the fluid it chooses is the worst available.

Boncho 本草

1.13.4 Ox Wounds 牛傷

1.13.4.1
Source원문

牛觸腸出不損者, 急送入, 以桑白皮尖或生白麻爲線, 縫合肚皮, 縫上糝血竭末或百草霜末, 血止立活. 勿封罨, 恐內作膿. 《入門》

Translation영역
Where an ox has gored a man and the bowel is out but not damaged, push it back in at once; make thread of pointed mulberry bark or of raw white hemp, suture the belly wall closed, sprinkle dragon's blood powder or hearth-soot powder over the suture line, and when the bleeding stops he lives on the spot. Do not seal and bandage it over, for fear that pus will form within.
Clinical note임상 주석
This is the same operation as the blade-wound laparotomy of 1.1 and 1.2.1, arriving here by way of a goring. The staging is real and clinically correct: eviscerated bowel that is not perforated has a far better prognosis than bowel that is torn, and the text sorts on exactly that. Reduction of the eviscerated loop, closure of the abdominal wall with a natural suture material, and a haemostatic dusted along the closure are recognisable steps, and mulberry-bark fibre as suture is a real surgical thread with usable tensile strength. `勿封罨, 恐內作膿` is the best observation in the sub-section. Leaving a contaminated wound open rather than sealing it, specifically so that pus does not collect inside, is the principle behind delayed primary closure and open drainage of dirty wounds, and it was arrived at here by watching what happened when the wound was closed. What the procedure lacked was everything that makes it survivable: no anaesthesia, no asepsis, no way to irrigate the peritoneal cavity, no means of recognising or managing the faecal contamination a goring usually carries, and no fluid resuscitation. A goring with evisceration today is a laparotomy with lavage, bowel repair or resection, broad-spectrum antibiotics and tetanus cover. **Dragon's blood and hearth soot dusted into a laparotomy wound are particulate foreign bodies and should not be used; soot in particular carries soil organisms into the peritoneum.**

Immun 入門

1.13.4.2
Source원문

脇破腸出臭穢, 急以香油摸腸, 用手送入, 煎人參地骨皮湯淋之, 皮自合, 喫羊肉羹, 十日愈. 《入門》

Translation영역
Where the flank is torn open and the bowel is out and foul-smelling, at once smear the bowel with fragrant oil, push it back in by hand, decoct a ginseng and lycium bark decoction and pour it over, and the wall closes of itself; have him eat mutton broth, and in ten days he is healed.
Clinical note임상 주석
A foul smell from eviscerated bowel means the bowel has been perforated and its contents are outside it. That is faecal peritonitis, and the ten-day recovery promised here did not happen; the previous passage's own staging, where damaged bowel is the bad outcome, contradicts it. The two instructions are nonetheless worth reading as technique. Oiling the loop before reduction is sound — a dried serosal surface will not slide back through a tight defect — and pouring a warm decoction over the exposed bowel is peritoneal lavage in all but name. The chapter irrigates with barley gruel in 1.2.1 and with a ginseng decoction here; the action is right and the fluid is not sterile. Mutton broth as the refeeding diet matches the thin-gruel convalescence prescribed after the blade-wound repair, and the instinct to feed lightly after an abdominal injury is sound.

Immun 入門

1.13.5 Dog Bites 犬傷

1.13.5.1
Source원문

凡春夏初交, 犬多發狂, 但見其尾直下不捲, 口中流涎, 舌黑者, 卽是狂犬. 若被其傷, 乃九死一生之患. 急用鍼刺去血, 以人小便洗淨, 用胡桃殼半邊, 以人糞塡滿, 掩其瘡上, 着艾灸之, 殼焦糞乾則易之, 灸至百壯, 次日又灸百壯, 灸至三五百壯爲佳. 《千金》

Translation영역
Generally at the turn of spring into summer dogs often go mad. Simply look: where the tail hangs straight down and is not curled, saliva runs from the mouth, and the tongue is black, that is a mad dog. If a man is wounded by one, it is an affliction in which nine die and one lives. Urgently needle the wound and let the blood out, wash it clean with human urine, take half a walnut shell, fill it with human dung, cover the sore with it, set moxa on it and burn; when the shell is charred and the dung dry, replace it. Burn to a hundred cones, and the next day another hundred cones; burning to three or five hundred cones is best.
Clinical note임상 주석
**Rabies is essentially 100% fatal once symptoms begin, and nothing in this section or in the four that follow changes that. A bite, scratch or mucosal exposure from a suspect animal today is a medical emergency: wash the wound with soap and running water for at least fifteen minutes, then seek immediate post-exposure prophylaxis — rabies vaccine together with rabies immunoglobulin infiltrated into the wound. Prophylaxis is close to completely effective when begun before symptoms appear, and useless once they have. Delay is what kills.** The clinical description is accurate and deserves to be said so. A tail carried straight and uncurled, hypersalivation and a change in the tongue are the signs of a dog in the furious or early paralytic phase of rabies, and the seasonal note matches the spring peak in dog-bite exposures. `九死一生之患` — nine die and one lives — is the chapter's own prognosis, and it is the most honest statement about rabies anywhere in the premodern literature. The text has also noticed that the disease is in the dog's saliva, which is why it goes after the wound rather than the constitution. Of the treatment, the bleeding and washing have real footing: making a fresh bite bleed and flushing it with volume reduces the viral inoculum, and wound washing remains the first and most important step of post-exposure care. **Human urine and human dung must not be used — urine is not sterile and dung packed into a fresh wound is a tetanus and clostridial inoculation.** The moxa regimen — three to five hundred cones burned over two days through a shell held against the wound — is a deliberate full-thickness burn of the bite site, and cautery of this kind does not prevent rabies; the virus reaches the nerve endings long before the burning is finished, and the burn itself adds a large infected wound to the problem.

Cheongeum 千金

1.13.5.2
Source원문

風狗咬傷, 卽先口噙漿水洗淨, 或以熱人尿淋咬處, 嚼生薑擦之. 又用葱白嚼爛塗之. 又杏仁嚼爛付之, 以帛繫定. 或同馬藺根硏細, 葱湯洗後塗之尤妙. 《綱目》

Translation영역
For a bite wound from a mad dog, first hold fermented millet water in the mouth and wash the wound clean with it, or pour warm human urine over the bitten place, and chew fresh ginger and rub it on. Also chew scallion white to a mash and smear it on. Also chew apricot kernel to a mash, apply it and tie it in place with a cloth. Or grind the apricot kernel together with iris root, wash with a scallion decoction and then smear it on — this is better still.
Clinical note임상 주석
**Rabies is essentially 100% fatal once symptoms begin, and none of this prevents it. A bite from a suspect animal needs immediate wound washing and post-exposure prophylaxis — vaccine plus immunoglobulin — which works only if begun before symptoms.** The washing instruction is the right instinct and is put first, which matters. Fermented millet water held in the mouth and spat over the wound, and a scallion decoction used as a wash, are both irrigation; the modern equivalent is soap and running water for fifteen minutes, which mechanically removes and inactivates virus at the inoculation site and is the single most effective thing a person can do unaided. **Human urine must not be used as a wound wash**, and chewing a drug and applying it from the mouth puts oral flora into the bite. Apricot kernel and iris root laid on the skin have no antiviral action.

Gangmok 綱目

1.13.5.3
Source원문

於患人頂心中有一紅髮, 卽當拔去, 後服藥快效. 《十三方》

Translation영역
In the crown of the patient's head there is a single red hair; it should be pulled out at once, and the medicine taken afterwards then works quickly.
Clinical note임상 주석
A diagnostic sign with nothing behind it. A single red hair at the vertex is being read as the mark the toxin has left on the body, and its removal as the removal of a channel. It is harmless in itself; what makes it dangerous is the time it occupies. **Rabies is essentially 100% fatal once symptoms begin. Any delay between a suspect bite and post-exposure prophylaxis — vaccine and immunoglobulin — is the only variable that decides the outcome, and searching the scalp is time spent not going for the vaccine.**

Sipsambang 十三方

1.13.5.4
Source원문

一方, 斑猫 二十一箇(去頭翅足), 以糯米 一勺, 先將猫七箇同炒, 不令米赤, 去猫, 再入七箇同炒, 猫色變去之, 又入七箇同炒, 米出靑烟, 去猫, 取米硏爲粉, 冷水入淸油少許, 空心調服一勺分三服. 少頃又進一服, 以小便利下惡物爲度. 否則再用一服. 利後腹痛, 急以冷水調靑靛服, 或服黃連湯以解其毒. 否則有傷, 不可便食熱物. 《綱目》

Translation영역
Another method: twenty-one cantharides beetles, heads, wings and feet removed, with 1 hop of glutinous rice. First take seven of the beetles and stir-fry them with the rice, without letting the rice redden; discard the beetles, put in another seven and stir-fry, and when the beetles change colour discard them; put in another seven and stir-fry, and when the rice gives off a blue smoke discard the beetles. Take the rice, grind it to powder, and give it on an empty stomach in cold water with a little clear oil added — the 1 hop is divided into three doses. After a short while give another dose, the measure being that the urine is disinhibited and the malign matter comes down. If it is not, use a further dose. If the belly aches after the disinhibition, urgently give indigo stirred in cold water, or Hwangryeon-tang, to resolve the toxin. Otherwise harm is done, and he must not eat hot food straight away.
Clinical note임상 주석
**This preparation contains cantharides, which is a severe poison, and must not be made or taken. Twenty-one blister beetles is many times a lethal oral dose.** Cantharidin is a vesicant absorbed through the gut; it blisters the mucosa, causes vomiting and haematemesis, haemorrhagic cystitis with bloody painful urination, and acute tubular necrosis, and death from renal and circulatory failure follows at doses in the tens of milligrams. The method here is careful to transfer cantharidin into the rice and then discard the beetles, which reduces but does not control the dose; the warning that the belly will ache afterwards and that indigo or a coptis decoction must be given is the text's own record of poisoning. The sign the preparation is driven towards — malign matter passed in disinhibited urine — is cantharidin's renal injury being read as the toxin leaving the body. The patient is being made to bleed into his bladder and told it is the cure working. **Rabies is essentially 100% fatal once symptoms begin, and nothing swallowed changes that. Today the answer to a suspect bite is immediate wound washing and post-exposure prophylaxis — vaccine plus immunoglobulin — effective only before symptoms appear, so any delay for an oral remedy is the fatal error.** 黃連湯 is left unlinked: two formulas of that name are registered and the text gives no cross-reference to tell them apart.

Gangmok 綱目

1.13.6 Preventing Recurrence of Dog-Bite Toxin 犬咬毒防再發

1.13.6.1
Source원문

風狗咬, 急用斑猫 七箇(去頭翅足)爲末, 溫酒調服, 其毒必從小便中出. 可將尿缸盛淸水, 令患人尿其中, 停半日, 見濁氣凝結如狗形, 則毒已出. 如不見狗形, 須服七次, 方可無狗形, 乃不再發, 極驗. 若小便澁, 益元散方見暑門水調服最妙. 《十三方》

Translation영역
For a mad-dog bite, urgently powder seven cantharides beetles with heads, wings and feet removed, give it stirred into warm wine, and the toxin will certainly come out in the urine. Fill a urine jar with clear water, have the patient urinate into it, let it stand half a day, and if a turbid matter is seen congealing in the shape of a dog, the toxin has come out. If no dog shape is seen, he must take it seven times; only then will there be no dog shape, and then it will not break out again — most reliable. If the urine is rough, giving Igwon-san — the formula is in the Summerheat chapter — stirred in water is best.
Clinical note임상 주석
**Rabies is essentially 100% fatal once symptoms begin, and nothing in this section changes that. A bite from a suspect animal today is a medical emergency: wash the wound at once with soap and running water for fifteen minutes, then get post-exposure prophylaxis — rabies vaccine plus rabies immunoglobulin. It is highly effective only if begun before symptoms appear.** The section's premise is the chapter's best observation about rabies and deserves to be named: the disease has a latent period, the bite can look healed, and the illness breaks out later. `防再發`, preventing the breaking-out again, is an incubation period correctly inferred from watching cases. The chapter has the natural history right and no means of acting on it. **This method must not be used. Cantharides is a severe poison and seven blister beetles taken in warm wine is a poisonous dose, repeated here up to seven times.** Cantharidin is a vesicant that is excreted by the kidney and blisters the urinary tract on its way out, and it is a severe renal toxin: haemorrhagic cystitis and acute tubular necrosis are its characteristic injuries, and death follows from renal and circulatory failure. The urine test is therefore worse than divination. The cloudy mass congealing in the jar is most plausibly blood and protein in the urine put there by the drug itself — the sign being read as proof that the toxin has left the body is a sign of kidney injury caused by the treatment. The instruction to repeat the dose until a dog shape appears, and the aside that Igwon-san should be given if the urine turns rough, mean dosing to renal failure and then treating the dysuria the poisoning has produced.

Sipsambang 十三方

1.13.6.2
Source원문

狂犬咬, 先口噙漿水洗淨, 用玉眞散方見風門乾貼之, 更不再發, 神效. 《丹心》

Translation영역
For a mad-dog bite, first hold fermented millet water in the mouth and wash the wound clean, then apply Okjin-san — the formula is in the Wind chapter — dry on the wound; it will not break out again, with miraculous effect.
Clinical note임상 주석
**Rabies is essentially 100% fatal once symptoms begin, and a dry powder on the wound does not prevent it. The modern treatment of a suspect bite is immediate wound washing and post-exposure prophylaxis — vaccine with immunoglobulin — and delay is what kills.** Okjin-san is the chapter's tetanus powder, arrowhead and typhonium, carried over from the Wind chapter where it treats 破傷風. Its presence here shows the two wound diseases being handled as one: a bite that later convulses the patient was not distinguished from a bite that later maddens him. Tetanus after a dog bite is a real risk and is genuinely preventable, by immunoglobulin and vaccine rather than by powder; rabies is not preventable by anything applied topically once the wound has been washed.

Dansim 丹心

1.13.6.3
Source원문

又仍殺所咬犬, 取腦付傷處, 後不復發. 《本草》

Translation영역
Also kill the dog that did the biting, take its brain and apply it to the wound, and it will not break out again afterwards.
Clinical note임상 주석
**This must never be done. It is the most dangerous instruction in the chapter.** Rabies virus is concentrated in the brain and spinal cord of an infected animal, and the brain of a rabid dog is the highest-titre material there is. Smearing it into a fresh open wound is a deliberate second inoculation, by the most efficient route available, with far more virus than the bite delivered. Handling and dissecting the head of a rabid animal without protection is itself an exposure, and laboratory and butchery transmissions of rabies from infected nervous tissue are documented. **Rabies is essentially 100% fatal once symptoms begin. A suspect bite needs the wound washed at once with soap and running water and post-exposure prophylaxis — vaccine and immunoglobulin — started immediately; it is near-completely effective before symptoms and useless after.** If the biting animal is to be dealt with at all, it is confined and observed, or its head is submitted to a laboratory for diagnosis by trained staff — never handled by the patient. The logic behind the entry is `以毒攻毒`, like driving out like, and it is the point at which that principle does the most harm.

Boncho 本草

1.13.6.4
Source원문

猘犬傷, 或經久復發, 無藥可療, 雄黃(明者) 五錢ㆍ麝香 五分. 右爲末, 酒調二錢服. 服後必使得睡, 切勿驚動, 任其自醒, 須利下惡物乃效. 《綱目》

Translation영역
For a wound from a rabid dog, or where it breaks out again after a long interval and no medicine can cure it: clear realgar 5 don and musk 5 fun. Powder the above and give 2 don stirred in wine. After he takes it he must be allowed to sleep; on no account disturb or startle him, let him wake of himself, and it works when the malign matter has been disinhibited downward.
Clinical note임상 주석
**Contains realgar, which is arsenic sulfide, and must not be prepared or taken.** Two don of a powder that is four-fifths realgar is a substantial arsenic dose; in wine, and repeated, it produces gastrointestinal haemorrhage, hepatic and renal injury and peripheral neuropathy. **Musk is taken from the musk deer, a CITES-listed species, and must not be sourced or dispensed.** `或經久復發, 無藥可療` is the chapter speaking plainly: where the bite has long healed and the illness has now broken out, no medicine can cure it. That is correct. What is described next — letting the patient sleep, keeping the room quiet, not startling him — is not pharmacology but the management of a patient in whom any stimulus provokes spasm, and it is the same instinct behind modern palliative care in clinical rabies: a dark quiet room, sedation, and no noise or draught. **Rabies is essentially 100% fatal once symptoms begin. Once a patient is at this stage nothing alters the outcome, and care is comfort care. The disease is prevented, not treated: immediate wound washing after a suspect bite, then vaccine and immunoglobulin before symptoms appear.**

Gangmok 綱目

1.13.7 Drawing Out the Toxin of a Mad-Dog Bite 狂犬傷出毒法

1.13.7.1
Source원문

宜用扶危散.

Translation영역
Buwi-san 扶危散 is appropriate.
Clinical note임상 주석
The sub-section's heading instruction, naming the formula whose composition is given at the foot of the leaf. 扶危散 is not yet registered on this site, so the name is left as plain text. The whole of this sub-section is addressed to a mad-dog bite. **Rabies is essentially 100% fatal once symptoms begin, and nothing in these methods changes that; the cantharides formulas below are themselves lethal and must not be prepared. A bite from a suspect animal is a medical emergency treated by immediate wound washing with soap and running water and post-exposure prophylaxis — rabies vaccine plus rabies immunoglobulin — which is highly effective only if begun before symptoms appear.**

Donguibogam · Jesang

1.13.7.2
Source원문

防風 五錢, 大黃ㆍ黑丑(頭末) 各三錢, 斑猫 一錢, 麝香 三分, 雄黃 二錢半. 右爲末, 每二錢, 滾水調服, 惡物從小便而出. 《入門》

Translation영역
Saposhnikovia 5 don; rhubarb and black pharbitis, first powder, 3 don each; cantharides 1 don; musk 3 fun; realgar 2 don 5 fun. Powder the above and give 2 don at a time stirred in boiling water, and the malign matter comes out in the urine.
Clinical note임상 주석
**This formula must not be prepared or taken. It contains cantharides, a severe vesicant poison; realgar, which is arsenic sulfide; black pharbitis, a drastic purgative; and musk, which comes from a CITES-listed species.** Arsenic and cantharidin given together, with a purgative to drive them through, is a combination that injures gut, kidney and liver at once. The endpoint sought — malign matter out in the urine — is again the haemorrhagic cystitis cantharidin causes, read as the toxin leaving. **Rabies is essentially 100% fatal once symptoms begin, and nothing swallowed draws the virus out of a wound. Rabies virus travels from the bite along peripheral nerves to the central nervous system; it is not in the blood or the urine, and there is no route by which a purgative or a diuretic could reach it. The modern treatment of a suspect bite is immediate washing of the wound and post-exposure prophylaxis — vaccine plus immunoglobulin — highly effective only if begun before symptoms.**

Immun 入門

1.13.7.3
Source원문

狂犬傷, 蚯蚓糞封之, 出犬毛, 神效. 《本草》

Translation영역
For a mad-dog wound, seal it with earthworm castings and dog hair comes out — miraculous effect.
Clinical note임상 주석
**Earthworm castings are soil and must not be sealed into a wound.** Soil packed into a bite and covered over is the textbook route to tetanus and to clostridial infection: the organisms are in the earth, the wound is deep and the dressing makes it anaerobic. A dog bite is a tetanus-prone wound and this converts it into a tetanus-certain one. The dog hair said to emerge is the same imagined sign as the hair vomited up in 1.13.1 and the fuzz looked for in the bean paste below. **Rabies is essentially 100% fatal once symptoms begin; a dressing that produces a satisfying sign does not prevent it, and the only effective response to a suspect bite is wound washing followed at once by vaccine and immunoglobulin.**

Boncho 本草

1.13.7.4
Source원문

又生麻油硏豆豉爲膏, 丸如彈子大, 常常揩拭所咬處, 却搯開看豉丸內, 若有狗毛茸茸然, 此毒氣已出. 揩至無茸毛, 方乃痊可. 《十三方》

Translation영역
Also grind fermented soybean with raw sesame oil into a paste, roll it into pills the size of a pellet, and rub the bitten place with one again and again; then break the bean pill open and look inside, and if there is dog hair in it, downy, the toxic qi has come out. Rub until there is no down, and only then is he fully cured.
Clinical note임상 주석
The fuzz found inside the broken pill is the bean paste's own fibre, drawn out and separated by the rubbing. It is a self-fulfilling endpoint: a soybean paste rolled and rubbed will always yield something that looks like down, so the sign appears whenever it is looked for and then disappears when the practitioner decides it has. That matters because of what the sign licenses. The patient is told that the toxin has come out and that he is cured. **Rabies is essentially 100% fatal once symptoms begin, and rubbing a bite with a bean pill does nothing to it. The correct response to a bite from a suspect animal is immediate washing of the wound with soap and running water for fifteen minutes and urgent post-exposure prophylaxis — rabies vaccine with rabies immunoglobulin — which is highly effective before symptoms and of no use after. A method that supplies false reassurance during the incubation period is worse than no method, because the one thing that decides the outcome is not waiting.**

Sipsambang 十三方

1.13.7.5
Source원문

扶危散 治風狗咬. 斑猫(七日內用七箇, 七日外每日加一箇, 十日十箇, 百日百箇. 去翅足, 糯米同炒)ㆍ滑石 一兩ㆍ雄黃 一錢ㆍ麝香 一字. 右爲末, 溫酒調服. 不飮酒者, 米飮下. 毒從大小便出卽愈. 《醫鑑》

Translation영역
Buwi-san 扶危散. It treats mad-dog bite. Cantharides — within seven days use seven beetles; beyond seven days add one for each day, so ten at ten days and a hundred at a hundred days; remove the wings and feet and stir-fry them with glutinous rice — talc 1 nyang, realgar 1 don, musk 1 ja. Powder the above and give it stirred in warm wine; for one who does not drink wine, send it down with rice water. The toxin comes out in the stool and urine and he is cured at once.
Clinical note임상 주석
**This formula must not be prepared or taken under any circumstances. The dose schedule is lethal.** Cantharidin's oral lethal dose in an adult is on the order of tens of milligrams, which a handful of blister beetles supplies. One beetle per day of delay, so a hundred beetles at a hundred days, is a dose scaled not to the patient but to the practitioner's anxiety, and at the upper end it is certain fatal poisoning: blistering of the whole gastrointestinal mucosa, haematemesis, haemorrhagic cystitis, acute tubular necrosis and circulatory collapse. **It also contains realgar, which is arsenic sulfide, and musk, from a CITES-listed species.** The escalating schedule shows, unintentionally, that the chapter understood the incubation period: the longer since the bite, the nearer the disease, so the more drug. That reading of the natural history is correct and the response to it kills faster than the disease would. **Rabies is essentially 100% fatal once symptoms begin, and nothing here alters that. A bite from a suspect animal is a medical emergency treated by immediate wound washing and post-exposure prophylaxis — vaccine plus immunoglobulin — which is highly effective only while the patient is still symptom-free.**

Uigam 醫鑑

1.13.8 Mad-Dog Toxin Entering the Heart 狂犬毒入心

1.13.8.1
Source원문

狂犬咬, 衆治不差, 毒攻心, 煩亂, 喚已作犬聲, 天靈盖燒灰爲末, 水服一錢, 以活止. 《本草》

Translation영역
Where a mad dog has bitten and the many treatments have not cured it, the toxin assails the heart, there is vexation and disorder, and his crying has already become the voice of a dog: burn a human skull vault to ash, powder it, and give 1 don in water, continuing until he lives.
Clinical note임상 주석
This sub-section is clinical rabies, and the signs are described from life. `毒攻心` with vexation and disorder is the agitated encephalitic phase; `喚已作犬聲`, the cry become a dog's voice, is the hoarse, barking, spasmodic vocalisation of a patient whose pharyngeal and laryngeal muscles are in spasm. Classical observers read it as the dog's nature emerging in the man; it is hydrophobic spasm. **Rabies is essentially 100% fatal once symptoms begin. A patient at this stage will die, and nothing in this sub-section or anywhere in the chapter changes that. The disease is prevented and not treated: after a bite from a suspect animal, wash the wound immediately with soap and running water and begin post-exposure prophylaxis — rabies vaccine with rabies immunoglobulin — which is highly effective only before symptoms appear.** Care after onset is palliative: a quiet darkened room, sedation and analgesia. **Human skull bone is a human material and must not be sourced, prepared or dispensed.** Beyond the ethical and legal prohibition there are two specific hazards: a skull taken from someone who died of rabies is infectious nervous tissue, and human central nervous system material carries prion risk that no burning reliably removes.

Boncho 本草

1.13.8.2
Source원문

犬咬人久不差, 口吐白沫者, 爲犬毒入心, 呌喚似犬聲, 天靈盖燒灰, 東流水調服一錢. 《本草》

Translation영역
Where a dog has bitten a man and it has long failed to heal, and he spits white froth from the mouth, this is dog toxin entering the heart; his crying out is like the voice of a dog. Burn a human skull vault to ash and give 1 don stirred in eastward-flowing water.
Clinical note임상 주석
`口吐白沫` is hypersalivation with an inability to swallow — the froth at the mouth that gave rabies its popular name — and `久不差`, long failing to heal, is the incubation period again, here understood as a wound that never truly closed. Taken with the previous passage, the chapter has assembled a correct clinical picture of human rabies: a bite, a silent interval, then agitation, barking vocalisation and foaming. **Rabies is essentially 100% fatal once symptoms begin, and nothing here affects the outcome. The only effective intervention is before symptoms: immediate wound washing after the bite and post-exposure prophylaxis with vaccine and immunoglobulin. Human skull bone must not be used.** Eastward-flowing water is a ritual specification, not a pharmacological one.

Boncho 本草

1.13.8.3
Source원문

狂犬咬人發狂如犬呌, 蝦蟆膾食之. 又虎頭骨ㆍ虎牙ㆍ虎脛骨爲末, 酒調二錢服之. 《本草》

Translation영역
Where a mad dog has bitten a man and he goes mad and cries like a dog, give him toad prepared as raw slices to eat. Also powder tiger skull, tiger tooth and tiger shin bone and give 2 don stirred in wine.
Clinical note임상 주석
**Raw toad must not be eaten. Toad skin and parotoid glands contain bufadienolides, cardiac-glycoside poisons that cause vomiting, arrhythmia and cardiac arrest; deaths from eating toad are well documented, and raw amphibian flesh also carries salmonella and parasites.** The chapter uses the same animal again in the Single Remedies section below, with the instruction to serve it without telling the patient what it is. **Tiger skull, tooth and shin bone are materials from a CITES Appendix I species. They are prohibited in trade and in clinical use and must not be sourced, prepared or dispensed.** There is in any case no pharmacological basis for them here; the tiger is being invoked as the one animal that outranks the dog. **Rabies is essentially 100% fatal once symptoms begin. A patient who has gone mad and is barking is dying of encephalitis and no drug reverses it; what can be done is to keep him comfortable and quiet. Prevention is the whole of rabies medicine: wash a suspect bite immediately with soap and running water, then vaccine and immunoglobulin, before symptoms appear.**

Boncho 本草

1.13.9 Prohibitions 禁忌法

1.13.9.1
Source원문

被狂犬咬人, 終身禁食犬肉及蚕蛹. 此毒再發則不可救. 三年之內, 亦忌食一切毒物及房事. 常食杏仁以防其毒. 《十三方》

Translation영역
A man bitten by a mad dog is forbidden dog meat and silkworm pupae for life. If this toxin breaks out again he cannot be saved. Within three years he must also avoid all toxic foods and sexual activity. He should eat apricot kernel regularly to guard against the toxin.
Clinical note임상 주석
**None of these prohibitions can prevent rabies.** Diet, abstinence and avoidance have no bearing on a virus already travelling along a peripheral nerve, and a lifelong restriction offers the patient a task to perform in place of the one intervention that works. **Rabies is essentially 100% fatal once symptoms begin, and nothing in this section alters that. A bite from a suspect animal is a medical emergency: wash the wound at once with soap and running water for fifteen minutes, then get post-exposure prophylaxis — rabies vaccine together with rabies immunoglobulin. It is highly effective only if begun before symptoms appear, and delay is what kills.** The three-year window and the lifelong ban are nonetheless worth reading closely, because they are an incubation period written as a rule of life. `此毒再發則不可救` — if this toxin breaks out again he cannot be saved — is accurate, and it is the chapter stating that the disease, once declared, is untreatable. The prohibition on dog meat is sympathetic logic: the substance that caused the harm must not be reintroduced. **Habitually eating apricot kernel is itself unsafe. Bitter apricot kernel contains amygdalin, which releases cyanide on digestion; regular consumption as a prophylactic has caused cyanide poisoning, and it should not be taken this way.**

Sipsambang 十三方

1.13.9.2
Source원문

犬咬傷人, 忌飮酒. 《丹心》

Translation영역
A man wounded by a dog bite should avoid drinking wine.
Clinical note임상 주석
The one prohibition here with something behind it, though not for the reason given. Alcohol after any significant wound impairs clotting and immune response and clouds the assessment of a head injury, and a patient who is drinking is a patient who does not present for care. It is also a striking contrast with 1.13.1, where a man mauled by a tiger is to be kept very drunk. **It does not protect against rabies. Rabies is essentially 100% fatal once symptoms begin; a suspect bite needs immediate wound washing and post-exposure prophylaxis with vaccine and immunoglobulin, begun before symptoms.**

Dansim 丹心

1.14 Single Remedies 單方

1.14.1
Source원문

凡六種.

Translation영역
Six kinds in all.
Clinical note임상 주석
The count is correct: alum, pueraria root, apricot kernel, wild chrysanthemum, castor seed and toad — six drug heads on leaves 015a and 015b. Every one of the six is for dog bite or mad-dog bite, so this Single Remedies section serves the rabies sub-sections rather than the animal bites as a whole; the cat and the rat are handled separately after it.

Donguibogam · Jesang

1.14.2
Source원문

白礬 猘犬咬, 白礬末納瘡中, 止痛速愈. 《本草》

Translation영역
Alum (白礬): For a rabid dog bite, pack powdered alum into the wound; it stops the pain and it heals quickly.
Clinical note임상 주석
Alum is an astringent aluminium salt with weak antibacterial action, and of the six single remedies here it is the least objectionable — it is at least a mineral powder rather than a raw animal tissue. Packed dry into a deep puncture, though, it is a foreign body in a wound that needs to drain, and it will not stop pain from a crush injury. **It has no effect on rabies. Rabies is essentially 100% fatal once symptoms begin; a suspect bite requires immediate wound washing and post-exposure prophylaxis — vaccine with immunoglobulin — before symptoms appear.**

Boncho 本草

1.14.3
Source원문

葛根 狂犬咬, 葛根擣取汁服之, 洗之, 滓付傷處. 《本草》

Translation영역
Pueraria root (葛根): For a mad-dog bite, pound pueraria root, take the juice and give it to drink, wash with it, and apply the dregs to the wound.
Clinical note임상 주석
Pueraria runs through the beast-wound sub-sections as the general wound drug of this chapter — it appears for bear wounds, tiger wounds and dog bites alike. Used as a wash it is irrigation, which is the one genuinely useful action available without a clinic; nothing in the root is antiviral.

Boncho 本草

1.14.4
Source원문

杏仁 殺狗毒, 作粥常食之. 又擣爛貼傷處最佳. 《本草》

Translation영역
Apricot kernel (杏仁): It kills dog toxin. Make it into a gruel and eat it regularly. Also pounding it to a mash and sticking it on the wound is best of all.
Clinical note임상 주석
**Bitter apricot kernel contains amygdalin, which releases hydrogen cyanide on digestion. Eaten as a gruel regularly, as this entry and the Prohibitions section both direct, it has caused cyanide poisoning, and it should not be taken this way.** Children are at particular risk, and the margin between a culinary quantity and a toxic one is small. **It does not kill dog toxin and it does not prevent rabies, which is essentially 100% fatal once symptoms begin. A suspect bite needs the wound washed at once and post-exposure prophylaxis — vaccine and immunoglobulin — started before symptoms.**

Boncho 本草

1.14.5
Source원문

野菊 主風狗咬, 硏細酒調服, 盡醉止效. 《綱目》

Translation영역
Wild chrysanthemum (野菊): It governs mad-dog bite. Grind it fine and give it stirred in wine, stopping when he is thoroughly drunk; effective.
Clinical note임상 주석
Dosing to intoxication is a recurring instruction in this chapter — the tiger-wound entry does the same — and the endpoint is the patient's drunkenness rather than any measured quantity of drug. Deliberate intoxication after a bite delays presentation for prophylaxis and impairs the assessment of the wound. **Rabies is essentially 100% fatal once symptoms begin. Immediate wound washing and post-exposure prophylaxis with vaccine and immunoglobulin, before symptoms, are the only effective response to a suspect bite.**

Gangmok 綱目

1.14.6
Source원문

萆麻子 主犬咬傷, 取五十粒去殼, 硏爲膏付之. 《綱目》

Translation영역
Castor seed (萆麻子): It governs dog-bite wounds. Take fifty seeds, remove the husks, grind them to a paste and apply.
Clinical note임상 주석
**Castor seed contains ricin, one of the most toxic substances of plant origin, and must not be prepared or applied. Fifty crushed seeds is well above a lethal oral dose, and grinding them raw to a paste is exactly the preparation that liberates the toxin — the commercial oil is safe only because ricin is destroyed in processing.** Applied to an open wound, where the skin barrier is gone, systemic absorption cannot be assumed to be negligible; and a paste within a patient's reach is a poisoning risk by mouth. **It has no effect on rabies, which is essentially 100% fatal once symptoms begin. The response to a suspect bite is wound washing and post-exposure prophylaxis — vaccine plus immunoglobulin — before symptoms appear.**

Gangmok 綱目

1.14.7
Source원문

蟾蜍 卽蝦蟆也. 主狂犬咬發狂欲死, 作膾食之, 勿令知. 又取後兩腿擣爛, 酒調服亦佳. 《本草》

Translation영역
Toad (蟾蜍): That is to say, the toad. It governs the case where a mad dog has bitten and the man has gone mad and is near death. Prepare it as raw slices and have him eat it, without letting him know what it is. Also take the two hind legs, pound them to a mash and give it stirred in wine — good as well.
Clinical note임상 주석
**Raw toad must not be eaten or prepared. Toad skin and parotoid secretion contain bufadienolides — cardiac glycosides that cause vomiting, bradycardia, ventricular arrhythmia and cardiac arrest — and fatal poisonings from eating toad or toad eggs are documented. Raw amphibian flesh additionally carries salmonella and parasitic infection.** Serving a cardiotoxic animal raw to a patient who is already encephalitic is likely to kill him before the disease does. `勿令知`, without letting him know, deserves to be marked. Deceiving a dying patient about what he is being given has no place in practice, and the instruction exists because the practitioner knew the patient would refuse. **Rabies is essentially 100% fatal once symptoms begin, and a patient described as mad and near death cannot be saved by anything. Care at that point is palliative. Prevention is the whole of it: wash a suspect bite immediately with soap and running water, then vaccine and immunoglobulin, before symptoms appear.**

Boncho 本草

1.14.1 Needling and Moxibustion 鍼灸法

1.14.1.1
Source원문

狂犬咬人, 當先鍼刺去惡血, 仍灸瘡中十壯, 自後日灸一壯, 至百日乃止. 忌飮酒. 《資生》

Translation영역
Where a mad dog has bitten a man, one should first needle the wound and let the malign blood out, then burn ten cones of moxa in the middle of the sore, and from then on burn one cone a day until a hundred days, when it stops. He should avoid drinking wine.
Clinical note임상 주석
Making a fresh bite bleed is the one part of this sub-section with modern footing. Encouraging a puncture to bleed, and above all flushing it with volume, reduces the viral inoculum at the inoculation site, and wound care of this kind is the first step of post-exposure management. **Burning moxa in the wound, however, is cautery, and cautery does not prevent rabies — the virus has entered the nerve endings long before, and the burn adds a deep infected wound to a bite that is already tetanus-prone.** The hundred-day course is worth noticing. Daily moxa for a hundred days, and in the next passage a hundred and twenty, is a treatment scaled to the incubation period: the chapter has inferred the latent interval from observation and is treating across the whole of it. The inference is right and the method is not. **Rabies is essentially 100% fatal once symptoms begin. After a bite from a suspect animal, wash the wound with soap and running water for fifteen minutes and get post-exposure prophylaxis at once — rabies vaccine with rabies immunoglobulin infiltrated into the wound. It is highly effective before symptoms and of no use after, so the hundred days matter only as time in which to be vaccinated.**

Jasaeng 資生

1.14.1.2
Source원문

被狂犬咬者, 無出於灸, 只就咬牙跡上灸之, 一日三壯, 灸至一百二十日乃止. 常食韭菜, 永不再發. 《千金》

Translation영역
For one bitten by a mad dog nothing surpasses moxibustion: burn directly on the marks left by the teeth, three cones a day, continuing to a hundred and twenty days, when it stops. If he eats Chinese chive regularly it will never break out again.
Clinical note임상 주석
Three cones a day on the tooth marks for a hundred and twenty days is three hundred and sixty burns on the same small area of skin. That is a chronic non-healing wound, and in a patient with no antibiotics it is a serious injury in its own right. **Moxibustion does not prevent rabies, and neither does Chinese chive. Rabies is essentially 100% fatal once symptoms begin; the correct response to a suspect bite is immediate washing of the wound and post-exposure prophylaxis — vaccine and immunoglobulin — begun before symptoms appear.** The confidence of `無出於灸`, nothing surpasses moxibustion, is the measure of how little the tradition had.

Cheongeum 千金

1.14.1.3
Source원문

常飮韭菜自然汁, 以滓封灸瘡, 永不再發. 《資生》

Translation영역
Drinking the natural juice of Chinese chive regularly and sealing the moxa sore with the dregs means it will never break out again.
Clinical note임상 주석
Sealing a burn with vegetable pulp occludes a wound that needs to drain. **It has no effect on rabies, which is essentially 100% fatal once symptoms begin. A suspect bite needs the wound washed immediately and post-exposure prophylaxis — vaccine plus immunoglobulin — before symptoms.**

Jasaeng 資生

1.14.1.4
Source원문

猘犬傷, 毒不出, 發寒熱, 速以艾灸外丘穴三壯, 又灸所咬之處七壯, 立愈. 《銅人》

Translation영역
For a rabid-dog wound where the toxin does not come out and there is chill and fever, burn three cones of moxa at Oegu 外丘 without delay, and seven cones at the bitten place as well; it heals at once.
Clinical note임상 주석
Oegu 外丘, GB36 on the gall bladder channel of the lower leg, is the classical point for mad-dog bite and is cited for it across the needling literature; the Dongin's entry here is one of the sources of that tradition. The point has no action on the disease. The sign that prompts it — chill and fever where the toxin has not come out — is probably bacterial infection of the bite rather than rabies, and that is treatable: irrigation, debridement and antibiotics against *Pasteurella*, staphylococci, streptococci and anaerobes. **If it is rabies, nothing helps. Rabies is essentially 100% fatal once symptoms begin, and fever and malaise in the prodrome mean the window has closed. The window is before symptoms: wash the wound at once with soap and running water, then vaccine and immunoglobulin.**

Dongin 銅人

1.14.2 Cat Bites 猫傷

1.14.2.1
Source원문

人爲猫所傷, 取薄荷葉細嚼付之.

Translation영역
Where a man has been wounded by a cat, take mint leaf, chew it fine and apply it.
Clinical note임상 주석
A cat bite is a narrow deep puncture made by fine canines, and it is the bite with the highest infection rate in surgery — around half become infected, chiefly with *Pasteurella multocida*, which can declare itself within twelve hours as a hot, rapidly spreading cellulitis. A cat bite over a hand or a joint is referred, not dressed: irrigation, exploration, no primary closure, prophylactic amoxicillin-clavulanate and tetanus cover. Cat scratch disease, from *Bartonella henselae*, follows days to weeks later with regional lymphadenopathy. Cats are also a rabies vector, so a bite from an unvaccinated or unknown cat is assessed for post-exposure prophylaxis in the same way as a dog bite. Mint chewed and applied adds oral flora to a puncture that is already the worst-case inoculation, and seals it rather than letting it drain.

Japbang 雜方

1.14.2.2
Source원문

又虎骨ㆍ虎毛燒爲末塗之. 《雜方》

Translation영역
Also burn tiger bone and tiger hair, powder them and smear on.
Clinical note임상 주석
**Tiger bone and tiger hair are materials from a CITES Appendix I species. They are prohibited in international trade and in clinical use and must not be sourced, prepared or dispensed under any circumstances.** Substitute materia medica is used for the indications tiger bone once carried, and none of those indications is a cat bite. The reasoning is purely sympathetic — the great cat subdues the small one — and the entry is a good example of how the chapter's animal logic generates prescriptions that have no pharmacology behind them at all.

Japbang 雜方

1.14.3 Rat Bites 䑕咬傷

1.14.3.1
Source원문

取猫毛燒灰, 入麝香少許, 津唾調付. 《入門》

Translation영역
Take cat hair, burn it to ash, add a little musk, mix with saliva and apply.
Clinical note임상 주석
A rat bite carries its own infections, and they are worth naming because the chapter has filed this with the dog bites. Rat-bite fever follows from *Streptobacillus moniliformis* or *Spirillum minus* days to weeks later with fever, rash and migratory joint pain and is treated with penicillin; leptospirosis, salmonella and tetanus are the other considerations. Rodents are not a practical rabies reservoir and a rat bite is not normally a rabies exposure — which is the one way in which this sub-section's position after the mad-dog material is misleading. Treatment is irrigation, tetanus cover and antibiotic prophylaxis. **Musk comes from the musk deer, a CITES-listed species, and must not be sourced or dispensed.** Mixing ash with the practitioner's own saliva and applying it to a fresh bite introduces human oral flora into the wound and should not be done; cat hair is being used here for the same sympathetic reason that tiger hair was used against the cat.

Immun 入門

1.14.3.2
Source원문

又麝香塗之差. 《本草》

Translation영역
Also smearing musk on it cures it.
Clinical note임상 주석
**Musk is taken from the musk deer, a CITES-listed species, and must not be sourced, prepared or dispensed.** Synthetic musk is a fragrance compound and is not a substitute for any claimed action here.

Boncho 本草

1.15 Bites and Stings from Vermin 諸蟲傷

1.15.1
Source원문

諸蟲傷

Translation영역
Bites and stings from the various vermin.
Clinical note임상 주석
The heading stands alone, and what follows it is the chapter's last large block: snake, scorpion, centipede, spider, earthworm, earwig, wasp, silkworm, snail, mole cricket and house spider, each with its own subsection. 蟲 here covers everything small that bites or stings, insects and reptiles together. The whole block reasons from one model. A creature's 毒 enters the flesh, and the work of treatment is to draw it out, wash it out, burn it out or neutralise it with a drug that masters that particular creature. That single pathology is then laid over things of completely different weight — a viper envenomation that can kill in hours, a scorpion sting that hurts for a day, and conditions that are not bites at all. The sections below are best read with that difference in mind, because the text does not make it.

Donguibogam · Jesang

1.15.1 Snakebite 蛇咬傷

1.15.1.1
Source원문

中蛇咬毒昏困, 五靈脂五錢ㆍ雄黃二錢半, 爲末, 酒調二錢灌之, 以滓付患處, 卽甦. 《綱目》

Translation영역
For one struck by the poison of a snakebite, clouded and prostrate: flying squirrel droppings 5 don and realgar 2 don 5 fun, made into a powder; mix 2 don with wine and pour it in, and put the dregs on the affected place. He revives at once.
Clinical note임상 주석
中蛇咬毒 with 昏困 is systemic envenomation — a bite that has gone beyond the limb. On the Korean peninsula the snakes that can do this are the pit vipers of the genus *Gloydius* (*G. brevicaudus*, *G. ussuriensis* and *G. saxatilis*) and the colubrid *Rhabdophis tigrinus*; everything else that bites here is harmless. The vipers give local swelling, blistering and tissue necrosis with a consumptive coagulopathy; *Rhabdophis* gives a defibrination syndrome from the secretion of its Duvernoy's gland, which is why a bite from a snake that looks unthreatening can still bleed a patient out. **The whole apparatus of this section is contraindicated today.** Incision of the bite, suction by mouth, cautery with molten alum or moxa, tight bands above the wound, and poultices said to draw the poison out as water do not remove venom. Venom is distributed through lymphatics within minutes and cannot be recovered from the skin; every one of these methods adds tissue injury, bleeding into an already coagulopathic patient, or infection, and a tourniquet adds limb ischaemia to an injury that is itself destroying tissue. The modern treatment is to immobilise and splint the bitten limb at about heart level, keep the patient still, and move him to a hospital quickly; antivenom is given where envenomation is confirmed, with supportive care for the coagulopathy, and tetanus cover for the wound. Delay is what kills, not the absence of a poultice. **Contains realgar (arsenic sulfide), which is toxic. This must not be prepared.** Nothing swallowed alters the course of an envenomation.

Gangmok 綱目

1.15.1.2
Source원문

又五靈脂ㆍ雄黃ㆍ貝母ㆍ白芷等分, 爲末, 熱酒調二錢服, 亦良. 《丹心》

Translation영역
Again: flying squirrel droppings, realgar, fritillary and dahurian angelica in equal parts, made into a powder; take 2 don mixed with hot wine. This is also good.
Clinical note임상 주석
**Contains realgar (arsenic sulfide), which is toxic. This must not be prepared.** Hot wine is the wrong vehicle for this injury in particular. Alcohol dilates the peripheral vessels and raises cardiac output, hastening systemic spread, and an intoxicated patient cannot be assessed for the neurological and bleeding signs on which the decision to give antivenom turns.

Dansim 丹心

1.15.1.3
Source원문

治蛇毒無如雄黃, 若被諸蛇咬, 取雄黃細末貼瘡口, 立效. 《綱目》

Translation영역
For treating snake poison nothing equals realgar. If bitten by any snake, take finely powdered realgar and stick it on the mouth of the wound; the effect is immediate.
Clinical note임상 주석
Realgar is the section's sovereign drug, named in six of its entries, and the claim that nothing equals it is the strongest statement of the chapter's belief that one mineral masters a whole class of poison. **Contains realgar (arsenic sulfide), which is toxic. This must not be prepared.** Laid on broken skin it is worse than taken by mouth: arsenic is absorbed through an open wound, and the wound in a viper bite is a bed of damaged, permeable tissue.

Gangmok 綱目

1.15.1.4
Source원문

又萵苣取汁, 和雄黃作餠子, 候乾爲末, 貼瘡口, 毒水流出, 腫痛卽消. 《綱目》

Translation영역
Again: take the juice of lettuce, mix it with realgar and make it into cakes; when they have dried, powder them and stick the powder on the mouth of the wound. The poisonous water flows out, and the swelling and pain resolve at once.
Clinical note임상 주석
毒水流出 is an observation read backwards. A viper bite does weep — blood-stained serum oozes from the puncture for hours as the envenomated tissue breaks down — but that fluid is the patient's own plasma leaving damaged capillaries, not venom being pulled out by the dressing. Taking the ooze for success is what kept drawing poultices in use for centuries. **Contains realgar (arsenic sulfide), which is toxic. This must not be prepared.**

Gangmok 綱目

1.15.1.5
Source원문

卒被蛇傷, 白礬火上熔汁, 滴咬處, 立差. 無白礬則速作艾炷, 灸五壯良. 《綱目》

Translation영역
For one suddenly bitten by a snake: melt alum over a fire until it runs, and drip it on the bitten place; he recovers at once. If there is no alum, quickly make moxa cones and burn five cones — this is good.
Clinical note임상 주석
This is cautery, stated plainly, and it is the clearest instance in the section of a method now firmly abandoned. Alum melts and dehydrates well above the temperature of boiling water, and dripping it on a bite gives a deep contact burn; five moxa cones burnt directly on the puncture do the same more slowly. Heat does not denature venom that is already in the tissue — by the time the fire is lit it has gone into the lymphatics — and a full-thickness burn laid over a viper bite that is itself causing necrosis produces a wound that will need debridement and may need grafting. Immobilise the limb and transport the patient instead.

Gangmok 綱目

1.15.1.6
Source원문

毒蛇螫欲死, 雄黃ㆍ乾薑等分, 爲末, 付傷處. 《本草》

Translation영역
When one stung by a venomous snake is near death: realgar and dried ginger in equal parts, made into a powder, and put on the wound.
Clinical note임상 주석
欲死 names the one situation in this section where a specific treatment exists and time decides the outcome. A patient collapsing after a bite needs airway and circulatory support and antivenom, and nothing applied to the skin will reach him. **Contains realgar (arsenic sulfide), which is toxic. This must not be prepared.**

Boncho 本草

1.15.1.7
Source원문

中蛇毒, 眼黑口噤欲死, 蒼耳嫩葉一握, 擣取汁, 溫酒和灌之, 滓付瘡上. 《本草》

Translation영역
For one struck by snake poison, with blackness before the eyes and the jaw clenched, near death: one handful of tender cocklebur leaves, pounded for the juice, mixed with warm wine and poured in; put the dregs on the sore.
Clinical note임상 주석
眼黑 is a reasonable description of the dimming vision of shock or of bleeding, and either can follow a viper bite. 口噤 is the harder sign. A clenched jaw is not a feature of *Gloydius* envenomation, which is haemotoxic rather than neurotoxic; trismus appearing some days after a puncture wound is the opening sign of tetanus, which this chapter knows elsewhere as 破傷風. A snakebite is a deep, dirty puncture and therefore a tetanus-prone wound — tetanus cover belongs with the care of every bite, and tetanus itself is treated with immunoglobulin, wound care and intensive support, not with a draught.

Boncho 本草

1.15.1.8
Source원문

又白芷末, 麥門冬湯調服, 滓付傷處. 《綱目》

Translation영역
Again: powdered dahurian angelica, taken mixed with a decoction of ophiopogon; put the dregs on the wound.

Gangmok 綱目

1.15.1.9
Source원문

又細辛ㆍ白芷各五錢ㆍ雄黃二錢ㆍ麝香少許, 爲末, 每二錢, 溫酒調服. 《綱目》

Translation영역
Again: asarum and dahurian angelica 5 don each, realgar 2 don, and a little musk, made into a powder; take 2 don each time, mixed with warm wine.
Clinical note임상 주석
**Contains realgar (arsenic sulfide), which is toxic, and musk, taken from the musk deer, a species protected under CITES. This must not be prepared.**

Gangmok 綱目

1.15.1.10
Source원문

又貝母爲末, 酒調, 令病人盡量飮之, 少頃酒自傷處爲水流出, 却以滓付患處, 卽甦. 《綱目》

Translation영역
Again: powder fritillary and mix it with wine; have the patient drink as much as he can hold. After a little while the wine runs out of the wound itself as water; then put the dregs on the affected place, and he revives at once.
Clinical note임상 주석
The claim that the wine itself comes out of the wound is the drawing theory in its boldest form, and it rests on the same ooze described three entries above: what leaves a viper bite is blood-stained serum from the envenomated tissue, and it would leave whether or not the patient had drunk anything. Drinking to capacity is the most harmful instruction in the section. It dilates the peripheral vessels and speeds systemic spread, it compounds the hypotension of envenomation, it raises the risk of aspiration in a patient who may collapse, and it makes the neurological assessment on which treatment depends impossible.

Gangmok 綱目

1.15.1.11
Source원문

又白礬ㆍ甘草等分, 爲末, 每二錢, 冷水調下. 《綱目》

Translation영역
Again: alum and liquorice in equal parts, made into a powder; take 2 don each time, sent down with cold water.

Gangmok 綱目

1.15.1.12
Source원문

毒蛇螫, 急以熱人尿洗出血, 次取口中唾塗之, 又以牙垽封傷處, 又取人屎厚付, 布裹卽消. 《丹心》

Translation영역
For a venomous snake's sting: at once wash the blood out with hot human urine, then take saliva from the mouth and smear it on; also seal the wound with the scurf from the teeth; also take human faeces, lay it on thickly and wrap it with cloth — the swelling resolves at once.
Clinical note임상 주석
**Human urine, saliva, dental tartar and faeces laid on an open wound carry a serious risk of infection, including tetanus and clostridial infection. These must not be used.** Human faeces packed into a puncture and then occluded under cloth is close to the ideal conditions for tetanus, and this chapter's own 破傷風 is what results. The one defensible instinct in the entry is the washing. Cleaning a bite with clean running water, gently and without scrubbing, is current practice — but it is wound care, not venom removal, and it should not be allowed to delay transport.

Dansim 丹心

1.15.1.13
Source원문

急飮好醋二椀, 令毒氣不隨血走, 或淸油亦可. 《入門》

Translation영역
Quickly drink two bowls of good vinegar, so that the poisonous qi does not travel with the blood; or clear oil will do as well.
Clinical note임상 주석
The reasoning is right and the means wrong. Keeping the poison from travelling with the blood is precisely the aim of first aid in envenomation, and the fact that the text has identified it is to its credit. But nothing swallowed achieves it. What actually slows the lymphatic spread of venom is mechanical: splinting the limb, keeping it still, and not letting the patient walk. Two bowls of vinegar is a gastric irritant and may make him vomit.

Immun 入門

1.15.1.14
Source원문

凡蛇毒, 取獨頭蒜ㆍ或小蒜ㆍ或苦苣ㆍ或水蓼ㆍ或豆葉ㆍ或荏葉, 皆擣飮汁, 以滓付傷處. 《本草》

Translation영역
For snake poison in general, take single-clove garlic, or small garlic, or endive, or water pepper, or bean leaves, or perilla leaves — pound any of them, drink the juice, and put the dregs on the wound.
Clinical note임상 주석
A list of this kind, where six quite unrelated plants are interchangeable, says that the choice did not matter; what mattered was that something pungent and green be pounded and applied. All six are harmless, which makes this the safest entry in the section, and equally the one most likely to cost a patient the hour in which antivenom should have been reached.

Boncho 本草

1.15.1.15
Source원문

又絲瓜根洗淨, 擣硏生酒調吃, 一醉立已. 《海上》

Translation영역
Again: wash sponge gourd root clean, pound and grind it, mix it with unheated wine and swallow it; one bout of drunkenness and it stops at once.
Clinical note임상 주석
Deliberate intoxication appears three times in this section, and the reasoning behind it seems to be that the drunk man's warmth and flushing show the poison being dispersed. What is being seen is vasodilation, which in envenomation accelerates the spread of venom and deepens hypotension. It should not be done.

Haesang 海上

1.15.1.16
Source원문

又鸛觜及脚骨燒灰, 飮服, 滓付之. 《本草》

Translation영역
Again: burn a stork's beak and leg bones to ash, take it in drink, and put the dregs on the place.
Clinical note임상 주석
The stork is chosen because it eats snakes — the same natural-enemy reasoning that puts the centipede at the end of this section and the spider on the centipede bite in 1.15.3. **The Oriental stork, *Ciconia boyciana*, is an endangered species and legally protected in Korea; its parts must not be taken or used.**

Boncho 本草

1.15.1.17
Source원문

又蚯蚓或蝦蟆擣付之. 《本草》

Translation영역
Again: pound earthworms or a toad and put them on.
Clinical note임상 주석
**Raw earthworm and raw toad laid on an open wound carry a serious risk of infection, including tetanus; toad skin secretion contains bufadienolides, which are cardiotoxic and absorbed through broken skin. These must not be used.**

Boncho 本草

1.15.1.18
Source원문

牛耳中垢ㆍ猪耳中垢, 取付之, 猪齒燒灰付之. 《本草》

Translation영역
Take the wax from an ox's ear or from a pig's ear and put it on; or burn pig's teeth to ash and put that on.
Clinical note임상 주석
**Animal ear wax laid on an open wound carries a serious risk of infection, including tetanus. This must not be used.**

Boncho 本草

1.15.1.19
Source원문

被蛇咬人忌食酸物梅子, 犯之必大痛. 《綱目》

Translation영역
One who has been bitten by a snake must avoid sour things and plums; if he transgresses, there will certainly be great pain.
Clinical note임상 주석
A dietary prohibition of this kind has no bearing on the course of an envenomation, and it is worth saying so plainly because prohibitions like it are what a frightened patient and his family attend to. Pain after a viper bite tracks the swelling and the tissue damage, not the meal.

Gangmok 綱目

1.15.1.20
Source원문

蜈蚣制蛇毒, 爲末付. 《本草》

Translation영역
The centipede subdues snake poison; powder it and apply.
Clinical note임상 주석
制 states the logic of the whole section in two characters: the centipede was held to master the snake, so powdered centipede masters its poison. The same figure governs the stork's beak above and the spider laid on the centipede bite below. **Contains centipede, whose venom is cardiotoxic. This must not be prepared.**

Boncho 本草

1.15.1.21
Source원문

辟蛇法, 羖羊角燒之, 蛇卽遠去. 又小袋盛雄黃帶之, 蛇遠避. 又養鵝辟蛇. 《本草》

Translation영역
A method for warding off snakes: burn a black ram's horn and snakes go far off. Also, put realgar in a small bag and carry it, and snakes keep away. Also, keep geese and they ward off snakes.
Clinical note임상 주석
The goose is the one entry with any footing. Geese are loud, territorial and aggressive, they do mob and harass snakes, and a flock in a yard genuinely reduces the chance of a child meeting one. Burning horn and a sachet of mineral are apotropaic, and the real prevention — boots and long trousers in long grass, not reaching into woodpiles or stone walls, carrying a light at night — is not mentioned. **Realgar is arsenic sulfide and toxic; its dust should not be handled or carried against the skin.**

Boncho 本草

1.15.2 Scorpion Sting 蝎螫傷

1.15.2.1
Source원문

蝎有雌雄, 雄螫痛在一處, 井泥付之. 雌者痛牽諸處, 取瓦屋溝下泥付之. 無雨時, 新水從屋上淋下, 取泥用. 《本草》

Translation영역
Scorpions are male and female. When a male stings, the pain stays in one place; put well-mud on it. With a female, the pain draws out to many places; take the mud from beneath the gutter of a tiled roof and put that on. When there has been no rain, pour fresh water down from the roof and take the mud that comes.
Clinical note임상 주석
The scheme is sympathetic rather than observational: pain that stays put is matched with mud from the bottom of a well, which also stays put, and pain that travels with mud carried down by running water. The sex of the scorpion makes no difference to the sting, and the distinction being drawn is really between a sting that hurts locally and one that radiates up the limb, which is a matter of how close the sting fell to a nerve. Scorpion sting is in any case barely a Korean problem. The medically dangerous species — *Leiurus*, *Androctonus*, *Centruroides*, *Tityus* — are North African, Middle Eastern and American; the East Asian *Mesobuthus martensii*, which supplies the drug 全蝎, gives local pain and little else. The treatment of any scorpion sting in this region is cleaning, cold, and an analgesic. **Mud and gutter sediment pressed into a puncture wound carry a serious risk of infection, including tetanus. These must not be used.**

Boncho 本草

1.15.2.2
Source원문

蝎螫痛不可忍, 冷水漬之卽不痛, 水微煖復痛, 卽易新水. 《本草》

Translation영역
When the pain of a scorpion sting cannot be borne, steep the part in cold water and the pain stops at once; when the water grows slightly warm the pain returns, so change it for fresh water.
Clinical note임상 주석
This is the best entry in the section and it is still sound practice. Cold genuinely blunts the pain of a sting, and the detail that the pain returns as the water warms and goes again when the water is changed is an accurate observation of an effect that depends on temperature — the sort of thing that can only come from watching a patient rather than from a theory about male and female scorpions. Scorpion sting in this region is painful and self-limiting. Washing, a cold pack applied in spells rather than continuously, elevation and a simple analgesic are the whole of the treatment; the sting site should be left unbroken.

Boncho 本草

1.15.2.3
Source원문

蝎螫痛, 半夏生一字ㆍ雄黃一字ㆍ巴豆一箇, 右同硏付之. 《綱目》

Translation영역
For the pain of a scorpion sting: raw pinellia 1 ja, realgar 1 ja and one croton seed — grind the above together and apply.
Clinical note임상 주석
**Contains raw pinellia, which is toxic and an acrid irritant; realgar, which is arsenic sulfide; and croton seed, a violent purgative whose oil is one of the strongest known skin irritants. This must not be prepared.** The combination would work against its own purpose. Croton oil raises blisters and burns on intact skin within hours; ground into a paste and laid on a sting it would add a chemical burn to a wound that was going to settle by itself, and the arsenic would be absorbed through it.

Gangmok 綱目

1.15.2.4
Source원문

又白礬ㆍ半夏爲末, 醋調貼之, 痛止毒出. 《得效》

Translation영역
Again: powder alum and pinellia, mix with vinegar and stick it on; the pain stops and the poison comes out.
Clinical note임상 주석
**Contains raw pinellia, which is toxic and an acrid irritant. This must not be prepared.** 毒出 describes the serous blister fluid that a sting and an irritant dressing together produce; nothing is coming out of the patient but his own plasma.

Deukhyo 得效

1.15.2.5
Source원문

又驢耳中垢或猫屎塗之. 蜘蛛取汁付之. 又地上磨生薑塗之. 又薄荷細嚼付之. 又白礬熔汁滴傷處. 《本草》

Translation영역
Again: smear on the wax from a donkey's ear, or cat's faeces. Take the juice of a spider and put it on. Also grind fresh ginger on the ground and smear it on. Also chew peppermint fine and apply it. Also melt alum until it runs and drip it on the wound.
Clinical note임상 주석
**Cat faeces and animal ear wax laid on a break in the skin carry a serious risk of infection, including tetanus and toxoplasmosis. These must not be used.** The last instruction is cautery again: molten alum on a sting gives a contact burn for no benefit. Of the five, chewed peppermint is the only one that is both harmless and does anything — menthol is a genuine topical counter-irritant and takes the edge off sting pain, which is why it is in current over-the-counter preparations.

Boncho 本草

1.15.3 Centipede Bite 蜈蚣咬傷

1.15.3.1
Source원문

蜈蚣咬人傷痛, 取蜘蛛安咬處, 當自吸毒. 如死而痛未止, 更易生者. 如蜘蛛死, 卽投水中救活. 《綱目》

Translation영역
When a centipede has bitten a man and the wound is painful, take a spider and set it on the bitten place; it will of itself suck out the poison. If it dies and the pain has not stopped, replace it with a live one. If the spider dies, throw it into water at once to revive it.
Clinical note임상 주석
Natural-enemy reasoning carried to its logical end. The spider is the centipede's adversary, so it draws the centipede's poison; and because the poison must go somewhere, it goes into the spider, which dies of it. The dying spider is read as proof that the method worked, and the instruction to throw it in water and bring it round is a small piece of decency toward the creature doing the work. Nothing is drawn out: a spider placed on skin neither sucks nor absorbs, and if it dies it dies of being handled. Centipede bite in Korea means *Scolopendra subspinipes*. It is intensely painful for several hours, with local swelling, redness and sometimes lymphangitis or a small area of superficial necrosis at the punctures, and it is not dangerous to a healthy adult; deaths are vanishingly rare and come from anaphylaxis, not from the venom load. Washing, a cold pack, elevation, an analgesic and tetanus cover are the whole of it.

Gangmok 綱目

1.15.3.2
Source원문

蛇含草挼付之. 又蝸牛取汁滴入咬處. 又烏雞血及屎塗之.

Translation영역
Rub snake-hold herb and apply it. Also take the juice of a snail and drip it into the bitten place. Also smear on the blood and droppings of a black chicken.
Clinical note임상 주석
**Raw blood and chicken droppings laid on an open puncture wound carry a serious risk of infection, including tetanus. These must not be used.** Dripping snail juice into a puncture is the same hazard by a quieter route.

Boncho 本草

1.15.3.3
Source원문

桑白皮汁或獨頭蒜硏塗之. 又人頭垢塗之, 不痛不痒.

Translation영역
Smear on mulberry root-bark juice, or ground single-clove garlic. Also smear on the scurf from a man's head, and there will be neither pain nor itching.
Clinical note임상 주석
**Human scalp scurf laid on an open wound carries a serious risk of infection. This must not be used.** The promise 不痛不痒 would be met in any case: the pain of a centipede bite subsides over a few hours whatever is done to it, and that is the reason so many different applications could each be credited with stopping it.

Boncho 本草

1.15.3.4
Source원문

又淸油點燈, 取烟熏之. 又鹽湯漬之. 又黃蠟火上熔汁, 滴患處. 《本草》

Translation영역
Again: light a lamp with clear oil and fumigate the place with its smoke. Also steep it in salt water. Also melt yellow beeswax over a fire and drip the liquid on the affected place.
Clinical note임상 주석
Soaking in warm salt water is the one reasonable instruction here — it cleans the punctures and the warmth is comforting — and it is the ancestor of the saline soak still used for a dirty bite. Lamp smoke deposits soot in the wound, and molten beeswax, which runs at well above the temperature of boiling water, gives a contact burn.

Boncho 本草

1.15.4 Spider Bite 蜘蛛咬傷

1.15.4.1
Source원문

蜘蛛咬人, 腹大如孕, 一身生絲, 羊乳飮之, 未幾日而平. 《本草》

Translation영역
When a spider has bitten a man, his belly grows as large as a pregnant woman's and silk grows over his whole body; give him goat's milk to drink, and within a few days he is level again.
Clinical note임상 주석
This is a legend rather than a case, and it is built by reading the spider's own nature into the patient: the spider spins, so the bitten man sprouts silk; the spider's abdomen is swollen, so his belly swells. No spider bite anywhere produces abdominal distension, and none makes threads grow from the skin. The spiders that do matter medically are *Latrodectus*, whose bite gives systemic muscle cramping and abdominal rigidity that can be mistaken for a surgical abdomen, and *Loxosceles*, whose bite can give a slowly spreading necrotic ulcer. Neither is established in Korea. The great majority of lesions attributed to spiders anywhere turn out to be something else — most often a staphylococcal abscess or a cellulitis, which is why a "spider bite" that is worsening after two days should be examined for pus rather than treated as a poisoning. Goat's milk is harmless and does nothing.

Boncho 本草

1.15.4.2
Source원문

蜘蛛咬, 遍身成瘡, 取好酒飮令大醉, 須臾蟲於肉中小如米自出. 《本草》

Translation영역
For a spider bite that has made sores over the whole body: take good wine and drink until very drunk, and after a while the creatures come out of the flesh of themselves, small as grains of rice.
Clinical note임상 주석
The things like rice grains are not creatures. A widespread eruption that extrudes small white cores is folliculitis, milia, or the slough of small pustules, and a generalised rash is in any case not what a single spider bite does. Deliberate drunkenness is dangerous and alters nothing.

Boncho 本草

1.15.4.3
Source원문

又靑葱葉去光, 納蚯蚓一條, 緊捻頭勿通氣, 候化水點咬處, 卽差. 《本草》

Translation영역
Again: strip the sheen from a green scallion leaf, put one earthworm inside it, pinch the end tight so that no air passes, and when it has turned to water, dab it on the bitten place; he recovers at once.
Clinical note임상 주석
The liquefaction is real and has a prosaic cause: an earthworm sealed in an airless tube dies and autolyses within hours, and its own enzymes reduce it to fluid. That fluid is the celebrated 化水. It has no action against venom, and as a preparation of decomposing animal tissue dabbed on broken skin it is an infection risk.

Boncho 本草

1.15.4.4
Source원문

蜘蛛咬人, 瘡中出絲, 屢有死者, 惟飮羊乳可制其毒. 《本草》

Translation영역
When a spider has bitten a man and silk comes out of the sore, there have often been deaths; only drinking goat's milk can subdue the poison.
Clinical note임상 주석
A sore discharging fine threads is discharging fibrinous strands from a sinus, or stringy slough from a breaking-down abscess — an appearance that is common and that reads, to anyone expecting a spider, exactly as silk. 屢有死者 is probably true and is the important part of the entry. Deaths from such sores are deaths from the sepsis of an untreated deep infection, which is treatable now by incision and drainage with antibiotics, and which goat's milk does not touch. A spreading sore with fever after a presumed bite is a surgical problem.

Boncho 本草

1.15.4.5
Source원문

又藍汁一椀入雄黃ㆍ麝香末各一錢和之, 細飮其汁, 並點咬處. 有人被斑蜘蛛咬, 腫痛垂死, 得此方卽愈. 只服藍汁亦好. 《本草》

Translation영역
Again: into one bowl of indigo-plant juice put 1 don each of powdered realgar and musk, mix them, sip the juice slowly, and dab it on the bitten place at the same time. There was a man bitten by a spotted spider, swollen and in pain and close to death, who got this formula and was cured at once. Taking the indigo juice alone is also good.
Clinical note임상 주석
**Contains realgar (arsenic sulfide), which is toxic, and musk, taken from the musk deer, a species protected under CITES. This must not be prepared.** The case is the section's one piece of reporting, and the concession at the end — that the indigo juice alone does just as well — quietly removes the two expensive ingredients from the formula. A man swollen, in pain and apparently dying after a bite, who then recovers, is more likely to have had a cellulitis or a severe local reaction that turned the corner than an envenomation; that course is the usual one, and it is what makes single-case cures of this kind unreliable.

Boncho 本草

1.15.4.6
Source원문

蜘蛛傷, 土蜂燒末, 油和付之. 又取土蜂窠土, 醋調塗之. 穴土居赤黑色者是蜂也. 《本草》

Translation영역
For a spider's injury: burn a ground wasp, powder it, mix it with oil and apply. Also take the earth of a ground wasp's nest, mix it with vinegar and smear it on. The one that burrows and lives in the earth, red-black in colour, is this wasp.
Clinical note임상 주석
Natural-enemy reasoning again, and here the natural history behind it is accurate: the spider-hunting wasps do paralyse spiders and provision their burrows with them, so the wasp was taken to master the spider's poison. The identifying gloss at the end, down to the colour and the habit of burrowing, shows that whoever wrote it had looked at the insect. **Nest earth pressed onto broken skin carries a serious risk of infection, including tetanus. This must not be used.**

Boncho 本草

1.15.4.7
Source원문

又多取人尿, 灌瓮中, 坐浸其身, 防蛛毒入內. 《本草》

Translation영역
Again: collect a quantity of human urine, pour it into a jar, and sit soaking the body in it, to keep the spider poison from entering within.
Clinical note임상 주석
**Sitting immersed in human urine with a broken skin surface carries a serious risk of infection. This must not be done.** The intention — to stop the poison getting inward — is the right aim pursued by a means that cannot touch it; a toxin already in the tissue is carried off by the lymphatics, and only immobility slows that.

Boncho 本草

1.15.4.8
Source원문

又烏雞屎浸酒服. 又取冠血塗之. 《本草》

Translation영역
Again: steep black chicken droppings in wine and take it. Also take the blood of the comb and smear it on.
Clinical note임상 주석
**Chicken droppings taken internally and raw cockscomb blood laid on an open wound carry a serious risk of infection, including salmonellosis and tetanus. These must not be used.** Cockscomb blood appears in this chapter's abdominal surgery at 1.2.1 as a sealant for the sutured bowel; here it is the same material put to the same supposed purpose on a smaller wound, with the same consequence.

Boncho 本草

1.15.4.9
Source원문

薤白或韭白擣付之. 又雄黃末付之. 又桑白皮汁塗之. 又蔓菁子硏油調付之. 又小薊汁飮之. 《本草》

Translation영역
Pound the bulb of Chinese chive or of leek and apply it. Also apply powdered realgar. Also smear on mulberry root-bark juice. Also grind turnip seed, mix it with oil and apply. Also drink the juice of small thistle.
Clinical note임상 주석
**Contains realgar (arsenic sulfide), which is toxic and absorbed through broken skin. This must not be prepared.** The remaining four are harmless plant applications, and the fact that five such different things close the section confirms that none of them was doing much.

Boncho 本草

1.15.5 Injury from Earthworms 蚯蚓傷

1.15.5.1
Source원문

有人中此毒, 腹大, 夜聞蚯蚓鳴於身, 有人敎用鹽水浸之而愈.

Translation영역
There was a man struck by this poison whose belly grew large and who at night heard earthworms singing in his body; someone taught him to steep himself in salt water, and he recovered.
Clinical note임상 주석
Earthworms do not bite and cannot envenomate. They have no fangs, no sting and no venom apparatus of any kind; their mouth is a soft muscular opening for drawing in soil. So whatever this section is describing, it is not an earthworm's bite, and the title is a misattribution — the chapter had a model in which small creatures carry 毒 into the flesh, and it filed these cases under the creature that was present in the wet ground where they happened. What the case itself answers to is worth attending to, because the remedy is specific: soaking in brine, which is treatment for skin, not for a swollen abdomen. The noise of earthworms heard in the body at night belongs with the internal sensations — formication, borborygmus, tinnitus — that a patient explains to himself by the nearest available creature. This is the chapter at its most credulous, and it is the clearest case in the whole of 諸蟲傷 of a cause assigned backwards from a cure.

Boncho 本草

1.15.5.2
Source원문

有人跣立濕地中其毒, 先飮鹽湯一盃, 次以鹽湯浸其足, 卽愈. 《本草》

Translation영역
There was a man who stood barefoot on wet ground and was struck by its poison: first he drank a cup of salt water, then he steeped his feet in salt water, and recovered at once.
Clinical note임상 주석
The exposure named here is real and the treatment is reasonable, which makes this the most useful entry in the section. Standing barefoot on wet ground, followed by trouble with the feet, points to a condition of the skin acquired from damp soil or standing water: tinea pedis, an irritant or contact dermatitis, or — if the water was fresh and snail-bearing — cercarial dermatitis. Warm saline soaks are sound care for macerated, inflamed skin on the feet, and keeping them dry afterwards is the rest of it. Drinking salt water does nothing and in quantity is harmful.

Boncho 本草

1.15.5.3
Source원문

蚯蚓咬, 其形如大風, 眉鬚皆落, 以石灰水浸身愈. 《本草》

Translation영역
An earthworm's bite — its form is like great-wind disease, with the eyebrows and beard all falling out — is cured by steeping the body in limewater.
Clinical note임상 주석
大風 is leprosy, and loss of the eyebrows and beard is its classic sign: madarosis in lepromatous Hansen's disease, from the bacillus's preference for cool skin at the brow and the destruction of hair follicles in the infiltrated tissue. The text has met something that looks like leprosy and credited an earthworm with it. Hansen's disease is caused by *Mycobacterium leprae*, is not caught from worms or soil, and is curable with multidrug therapy — rifampicin, dapsone and clofazimine — which renders a patient non-infectious quickly and stops the nerve damage from progressing. What cannot be reversed is damage already done, which is why delay in diagnosis is the thing that disables. **Limewater is caustic calcium hydroxide. Bathing in it burns the skin and can blind; this must not be used.** On a patient with leprosy it is worse than useless: anaesthetic skin cannot feel a chemical burn, and unfelt burns are how such patients lose tissue.

Boncho 本草

1.15.5.4
Source원문

蚯蚓吹瘡, 雞屎付之.

Translation영역
For a sore raised by an earthworm's breath, apply chicken droppings.
Clinical note임상 주석
**Chicken droppings laid on an open sore carry a serious risk of infection, including tetanus and salmonellosis. This must not be used.** 吹 — the worm blowing on the skin — is the mechanism invented to let a creature with no bite be blamed for a sore.

Gangmok 綱目

1.15.5.5
Source원문

蛐蟮咬, 鴨屎付之. 又老茶葉細末油調付. 蛐蟮卽蚯蚓也. 《綱目》

Translation영역
For a gokseon's bite, apply duck droppings. Also powder old tea leaves fine, mix them with oil and apply. The gokseon 蛐蟮 is the earthworm.
Clinical note임상 주석
The closing gloss is the compiler reconciling two names for the same creature, 蛐蟮 being the ordinary word and 蚯蚓 the one used in the materia medica — the same housekeeping that the project's own disambiguation notes do. **Duck droppings laid on a break in the skin carry a serious risk of infection, including tetanus. This must not be used.** Powdered tea in oil is harmless, and tea polyphenols are mildly astringent and antibacterial, so it is the better of the two by a wide margin.

Gangmok 綱目

1.15.6 Injury from Earwigs 蠼螋傷

1.15.6.1
Source원문

此蟲又名八角蟲, 隱於壁間, 以尿射人, 遍身生瘡如湯火傷. 烏雞翎燒灰, 雞子淸調塗之. 《綱目》

Translation영역
This creature is also called the eight-horned insect. It hides in the walls and shoots its urine at a man, and sores arise over the whole body like a scald or a burn. Burn the feathers of a black chicken to ash, mix them with egg white and smear it on.
Clinical note임상 주석
蠼螋 is the earwig, and the account of urine shot at a man names a real phenomenon with the wrong insect. Earwigs have abdominal forceps and no spray that harms human skin. What does produce precisely this picture — a man who has been near a small insect on a wall at night, and some hours later has linear streaks of blisters where it was crushed or brushed off — is the rove beetle *Paederus*, whose body fluid contains pederin, one of the most potent blistering agents in nature. The insect does not bite or sting; the fluid is released when its body is damaged against the skin. 如湯火傷, like a scald, is the standard description of that eruption in modern dermatology too, which is a striking agreement. It is self-limiting, settling over one to three weeks, often with transient pigmentation. The treatment is to wash the area promptly with soap and water so the remaining toxin is removed, apply cool compresses, and leave the blisters intact; the insect should be blown off rather than crushed. **Burnt feather ash and raw egg white laid on broken blisters carry a serious risk of infection. These must not be used.**

Gangmok 綱目

1.15.6.2
Source원문

蠼螋尿瘡如熱疿而大, 繞腰匝不可療. 蟲如小蜈蚣, 色靑黑, 長足. 取扁豆葉挼付, 卽差. 《本草》

Translation영역
The sore from an earwig's urine is like heat prickle but larger; if it goes right round the waist in a closed ring, it cannot be treated. The creature is like a small centipede, blue-black in colour, with long legs. Take hyacinth bean leaves, rub them and apply them; he recovers at once.
Clinical note임상 주석
The description of the insect settles the identification: a small centipede-like creature, blue-black, long-legged, is a rove beetle rather than an earwig, and the elongated body with its short wing-cases is exactly what makes *Paederus* look like a tiny centipede to anyone who has met one on a wall. 繞腰匝不可療 is the girdling belief, recorded in many traditions and most often of the belted eruption of herpes zoster. It is a belief rather than an observation. A dermatomal eruption follows one nerve root and stops at the midline, so it does not close a ring, and even a true bilateral eruption carries no such prognosis. Zoster is treated with antivirals started within seventy-two hours of the rash, with analgesia; the real risk is post-herpetic neuralgia, not encirclement. Saying so matters, because a patient told his rash will kill him when it meets itself is being frightened to no purpose.

Boncho 本草

1.15.6.3
Source원문

又鹽湯淋漬瘡上數日愈. 又犀角水磨塗之. 又雞屎塗之. 又胡燕窠中土, 猪脂ㆍ苦酒和塗之. 又雞腸草挼付之. 又胡粉和醋付之. 又嚼梨汁付之. 《本草》

Translation영역
Again: pour salt water over the sores and steep them, and in a few days they heal. Also grind rhinoceros horn in water and smear it on. Also smear on chicken droppings. Also take the earth from a house martin's nest, mix it with lard and vinegar, and smear it on. Also rub chickweed and apply it. Also mix white lead with vinegar and apply. Also chew a pear and apply the juice.
Clinical note임상 주석
The first entry is the good one and it comes first. Bathing a blistering eruption in saline for a few days is close to what is done now, and 數日愈 is an honest prognosis rather than a boast — a pederin dermatitis does take days to weeks and resolves on its own. **Contains rhinoceros horn, from species protected under CITES, whose trade and use are prohibited; and white lead, which is toxic and absorbed through broken skin, with no safe dose. Neither must be used.** **Chicken droppings, nest earth and lard laid on open blisters carry a serious risk of infection, including tetanus. These must not be used.** Chewed pear and rubbed chickweed are harmless; cool water would do the same.

Boncho 本草

1.15.7 Bee and Wasp Stings 蜂叮傷

1.15.7.1
Source원문

蜂螫人, 嚼靑蒿付之.

Translation영역
When a bee stings a person, chew sweet wormwood and lay it on.
Clinical note임상 주석
A sting from a bee, wasp or hornet hurts out of all proportion to the wound, and the local reaction — a hot red weal that swells for a day or two — is what the whole of this section is treating. For that, almost anything cool and wet laid on the site will take the edge off it, and so will the one thing the text never mentions: ice. What the section does not address is the only way a sting kills. Anaphylaxis — airway swelling, wheeze, collapse of the blood pressure, within minutes of the sting — is treated with intramuscular adrenaline into the outer thigh and an ambulance, and nothing chewed and laid on the skin has any bearing on it. A person who has reacted that way once must carry an adrenaline auto-injector. Multiple stings, or any sting inside the mouth or throat, is also an emergency on its own.

Boncho 本草

1.15.7.2
Source원문

又薄荷挼貼之.

Translation영역
Again, rub mint between the hands and stick it on.

Boncho 本草

1.15.7.3
Source원문

蜂房爲末, 猪脂和付.

Translation영역
Powder hornet's nest, mix it with lard and apply.

Boncho 本草

1.15.7.4
Source원문

挼芋莖擦之, 卽愈.

Translation영역
Rub a taro stalk between the hands and chafe the place with it; it heals at once.

Boncho 本草

1.15.7.5
Source원문

醋磨雄黃塗之. 又淸油擦之.

Translation영역
Grind realgar in vinegar and smear it on. Again, rub with clear sesame oil.
Clinical note임상 주석
**Realgar 雄黃 is arsenic sulphide and is toxic by skin as well as by mouth. This must not be prepared.** The sesame oil in the same clause is harmless and mildly soothing, which is about as much as a sting site needs.

Boncho 本草

1.15.7.6
Source원문

人頭垢及鹽擦之. 又醬塗之. 又冬瓜葉挼付之. 《本草》

Translation영역
Rub with the scurf of a person's head and with salt. Again, smear soy paste on. Again, rub wax-gourd leaves between the hands and lay them on.
Clinical note임상 주석
**Scurf scraped from a person's head is a human material and carries skin flora onto a broken sting site; it must not be used.** Salt and fermented soy paste rubbed into an inflamed weal will sting sharply and add nothing. The one measure worth borrowing from this section is implied rather than stated — a honey bee leaves its sting and venom sac in the skin, and getting it out quickly, by scraping sideways rather than squeezing, limits how much venom goes in. Wasps and hornets do not leave a sting behind.

Boncho 本草

1.15.8 Silkworm Bites 蚕咬傷

1.15.8.1
Source원문

屋上爛茅, 和醬汁硏付.

Translation영역
Rotted thatch from the roof, ground up with the liquor of soy paste and applied.
Clinical note임상 주석
A silkworm does not bite. Bombyx mori has chewing mouthparts built for mulberry leaf and no capacity to break human skin, and it carries no venom. What a sericulture household actually suffered — and this section sits in a book written for one — is a contact reaction: the fine hairs and scales of the larvae and moths, and the dust of the rearing room, raise an itching weal-and-papule rash on the forearms, and in heavy exposure cause rhinitis and asthma. Silk-worker's dermatitis and silk-sericulture asthma are both recognised occupational diseases. So the complaint is real; the bite is not. **Rotted thatch ground into a paste and laid on broken skin is a tetanus and wound infection risk and must not be used.** Clostridium tetani lives in soil and decaying organic matter, and a contaminated poultice on an excoriated itch is exactly how it gets in. An itching contact rash is treated by getting away from the source, washing, and a topical corticosteroid with an oral antihistamine.

Boncho 本草

1.15.8.2
Source원문

麝香蜜調塗之.

Translation영역
Musk mixed with honey and smeared on.
Clinical note임상 주석
**Musk is taken from the gland of a musk deer, a CITES Appendix I species, and cannot lawfully be traded.** Honey alone is bland and will do no harm.

Boncho 本草

1.15.8.3
Source원문

苧汁飮之, 又塗之. 苧近蚕種, 則蚕不生. 《本草》

Translation영역
Drink ramie juice, and also smear it on. If ramie is brought near silkworm eggs, the silkworms will not hatch.
Clinical note임상 주석
The last clause gives away the reasoning. Ramie is held to be hostile to silkworms — brought near the eggs, the eggs do not hatch — and therefore ramie is held to be the antidote to a silkworm's bite. That is sympathetic logic, not pharmacology, and it is worth flagging because the same figure of reasoning governs a good part of the materia medica for bites and stings: the thing that destroys the creature is given against its poison. Where a remedy in these sections looks arbitrary, this is usually why.

Boncho 本草

1.15.9 Snail Bites 蝸牛傷

1.15.9.1
Source원문

人爲蝸牛蟲所咬, 毒遍身者, 蓼子汁浸之, 卽差. 《本草》

Translation영역
When a person has been bitten by the snail worm and the poison has spread over the whole body, steep the place in the juice of smartweed seed and it is cured at once.
Clinical note임상 주석
Snails have no venom and no apparatus for biting a person — the radula is a rasping ribbon that works on leaves and algae and cannot break human skin. Poison spreading over the whole body after handling one is not a snail bite; the likeliest reading is a generalised itching eruption in someone who had been in wet vegetation, attributed to the animal that was visibly there. The genuine hazard from snails and slugs is one the text could not have seen, and it is not from contact. Terrestrial molluscs are the intermediate host of Angiostrongylus cantonensis, the rat lungworm, and swallowing a raw or undercooked snail or slug — or unwashed greens a slug has crawled over — causes eosinophilic meningitis. Snails and slugs also carry Fasciola and the usual enteric organisms. So the risk lies in eating them, not in being touched by them, and a soak in smartweed juice has no bearing either way.

Boncho 本草

1.15.10 Mole Cricket Bites 螻蛄傷

1.15.10.1
Source원문

螻蛄咬人, 石灰醋和塗之.

Translation영역
When a mole cricket bites a person, mix lime with vinegar and smear it on.
Clinical note임상 주석
A mole cricket can in fact pinch. Gryllotalpa has heavy spade-like forelimbs and strong mandibles for cutting roots, and a large one gripped in the hand will nip hard enough to hurt and draw a spot of blood. It is not venomous, and the whole of the injury is the mechanical nip, which needs washing and nothing else. **Lime is caustic. Slaked lime stirred into vinegar and smeared on broken skin produces an alkaline burn on top of the nip, and this must not be prepared.** The treatment here is worse than the complaint it is for.

Boncho 本草

1.15.10.2
Source원문

槲葉燒灰, 以泔水和浸洗, 以滓付之. 《本草》

Translation영역
Burn oak leaves to ash, mix with rice-washing water, soak and wash the place, and lay the dregs on it.
Clinical note임상 주석
Wood and leaf ash in water is a weak lye, so this is a milder version of the first clause's error rather than a different idea. Rice-washing water is starchy and bland. Washing the nip is the only part of the clause that does anything, and plain water does it better.

Boncho 本草

1.15.11 Wall Spider Bites 壁鏡傷

1.15.11.1
Source원문

壁鏡咬毒, 人必死. 桑灰淋濃汁, 調白礬末塗之.

Translation영역
The poison of a wall spider's bite — the person is sure to die. Leach mulberry ash for a thick liquor, mix powdered alum into it, and smear it on.
Clinical note임상 주석
壁鏡, also written 壁錢, is the wall spider — the flat grey spider that lives behind beams and under eaves and fastens a round white egg sac to the plaster, which is what gives it its name, the coin or mirror on the wall. In Korea and Japan this is Uroctea compactilis. It is not a dangerous animal: it has no medically significant venom, it is reluctant to bite at all, and no death has ever been attributed to it. `人必死` is the section's own verdict and it is simply wrong. The spiders that do matter are elsewhere in the genus list — the widow spiders (Latrodectus), whose bite gives severe muscle cramping and autonomic upset and for which antivenom exists, and the recluse spiders (Loxosceles), whose bite can go on to a slow necrotic ulcer. Neither is a wall spider, and neither is treated by anything in this section. What a spider bite needs is washing, a cold pack, elevation, pain relief and tetanus cover, with assessment if systemic symptoms appear. Mulberry-ash lye with alum stirred into it is an astringent caustic wash laid on a puncture wound, and it will do more damage to the skin than the bite did.

Deukhyo 得效

1.15.11.2
Source원문

又醋磨雄黃塗之. 《得效》

Translation영역
Again, grind realgar in vinegar and smear it on.
Clinical note임상 주석
**Realgar 雄黃 is arsenic sulphide and is absorbed through broken skin. This must not be prepared.**

Deukhyo 得效

1.15.12 Keeping Flies and Maggots from Summer Wounds 夏月諸瘡傷辟蠅蛆法

1.15.12.1
Source원문

夏月諸般傷損潰爛, 蛆蟲極盛, 臭不可近. 蛇退(燒存性) 一兩, 蟬殼ㆍ靑黛 各五錢, 細辛 二錢半, 右爲末, 每三錢, 黃酒調下, 日二. 名曰蟬花散. 又寒水石治夏月諸瘡臭爛.

Translation영역
In summer, when injuries of every kind break down and rot, the maggots are at their thickest and the stench will not let anyone near. Snake slough (burnt with its nature kept) 1 nyang, cicada shell and natural indigo 5 don each, asarum 2 don 5 fun. Powder the above; for each dose 3 don, taken down in yellow wine, twice a day. It is called Seonhwa-san. Glauberite also treats the stinking rot of summer sores.
Clinical note임상 주석
What this section is about has a modern name: myiasis, the infestation of living tissue by fly larvae. A blowfly — Lucilia, Calliphora, Chrysomya, and in the worst case the obligate screwworms — lays on a wound's margin or on soiled dressings, the eggs hatch in a day, and the larvae feed in the slough. Before adhesive dressings and daily wound care this was not an exotic event but an ordinary summer complication of any open wound in a warm climate, and the chapter is right to give it a section of its own and to date it to 夏月. The strategy is also right in outline: cover the wound, clean away the dead tissue it is feeding on, and put something on and around it that flies will not settle on. A fly cannot lay where it cannot land. The specific materials are another matter — this is a powder taken by mouth, and no oral powder repels a blowfly from a wound on the leg. Modern management is mechanical: occlusive dressing, irrigation, removal of every larva, debride the necrotic tissue, and antibiotics for the secondary bacterial infection that is almost always present underneath. **Asarum 細辛 is given internally here at 3 don twice a day. The genus contains aristolochic acid, a nephrotoxin and carcinogen, together with safrole, and this must not be prepared.** The remaining ingredients — snake slough, cicada moult, indigo, and the glauberite of the closing line — are inert to the problem.

Hoechun 回春

1.15.12.2
Source원문

一人夏月收麥, 被騾跑倒, 又咬傷二三處, 至五七日膿潰臭惡, 蛆蠅極盛, 藥不能救. 一道人見之, 傳以此方, 修合服之, 蛆皆化水而出, 蠅亦不敢近, 旬日良愈. 《回春》

Translation영역
A man gathering wheat in summer was knocked down by a mule's kick and bitten besides in two or three places. By the fifth to seventh day the pus had broken through, the stench was foul, maggots and flies were at their thickest, and medicine could not save him. A wandering adept saw him, passed on this formula; it was made up and taken, and the maggots all turned to water and ran out, the flies dared not come near, and in ten days he was well healed.
Clinical note임상 주석
The case history is an unusually clean clinical picture. A mule kick and bite wounds in a harvest field, neglected; suppuration by the fifth to seventh day, which is the right interval for a contaminated animal bite to become frankly infected; then maggots. Horse and mule bites inoculate a mixed mouth flora and are among the dirtiest bite wounds there are, and the man would have needed debridement, drainage and tetanus cover. There is one accidental irony here. Blowfly larvae eat necrotic tissue preferentially, and sterile medical-grade Lucilia sericata larvae are a licensed debridement therapy today for sloughy chronic wounds. A wound that was going to granulate once the dead tissue was gone may genuinely have improved while the maggots were in it. That is not an argument for leaving a wild infestation alone — wild larvae are not sterile, the species cannot be chosen, and the screwworms invade living tissue — but it may be part of why the recovery was recorded as a cure.

Hoechun 回春

1.15.13 Bites from Miscellaneous Insects 雜色蟲傷

1.15.13.1
Source원문

夏月有雜色毛蟲極毒, 觸人生瘡, 痒痛, 骨肉皆爛. 豉 一椀, 淸油 半盞, 同擣, 厚付傷處, 經一宿, 取見豉中有蟲毛, 埋土中棄之. 白芷湯洗後, 烏賊魚骨末付之, 卽愈. 《綱目》

Translation영역
In summer there are mottled hairy caterpillars of the most virulent poison; where they touch a person a sore rises, with itching and pain, and bone and flesh alike rot away. Fermented soybeans 1 bowl and clear sesame oil half a jan, pounded together and laid thickly on the injured place. After a night, take it off and look, and the hairs of the creature will be in the soybeans; bury it in the ground and be rid of it. Wash with a decoction of dahurian angelica, then powder cuttlefish bone and apply it, and it heals at once.
Clinical note임상 주석
This is lepidopterism — caterpillar dermatitis — and the description is good. The hairy larvae of a number of moths, the tussock and processionary and flannel moths among them, carry setae that break off in the skin, work in mechanically and release an irritant protein, raising a burning papular eruption that can go on for weeks. The hairs are the whole mechanism, and they stay in the skin until they are taken out. The method follows from that correctly, and it is the one clause in this section with real merit. A thick adhesive paste laid over the area and lifted off the next day pulls the embedded setae out with it, and the text says so explicitly — you look in the soybeans and the hairs are there. That is the same principle as the modern first step, which is to lift the hairs off with adhesive tape or a facial-wax strip before anything else is done, since washing and rubbing only drive them deeper. Burying the poultice afterwards is sensible too, because the loose hairs remain irritant. `骨肉皆爛` overstates it; caterpillar hairs do not rot bone. After the hairs are out the treatment is a topical corticosteroid and an oral antihistamine. The wash and the cuttlefish-bone powder that close the clause are inert dressing.

Gangmok 綱目

1.15.13.2
Source원문

又伏龍肝醋和作團, 於傷處搓轉, 其毛皆出在土上, 痛立止, 神效. 《綱目》

Translation영역
Again, mix oven earth with vinegar and work it into a ball; roll and rub it over the injured place and the hairs all come out onto the earth. The pain stops on the spot, with marvellous effect.
Clinical note임상 주석
The same principle again, and the text states the mechanism outright: the hairs come out onto the clay. Rolling a tacky ball over the skin is a crude version of the adhesive lift, and it would work to a degree. The one objection is that oven earth is soil — on skin already excoriated by scratching, it brings a wound contamination and tetanus risk with it, which is why tape is used instead.

Gangmok 綱目

1.15.13.3
Source원문

又蒲公英根莖白汁付之. 《綱目》

Translation영역
Again, the white sap from the root and stem of dandelion, laid on.

Gangmok 綱目

1.15.13.4
Source원문

毒蛇尿草木, 着人似刺箚, 便腫痛肉爛. 若着手足, 指節墮落. 硏砒礵, 和膠淸塗之. 《本草》

Translation영역
Grass and trees that a venomous snake has urinated on: where they touch a person it is as though he had been pricked with a thorn, and at once there is swelling, pain and rotting of the flesh. If it touches the hands or feet the finger and toe joints drop off. Grind arsenic trioxide, mix it with clear glue and smear it on.
Clinical note임상 주석
The aetiology is imaginary — snakes do not pass venom in urine, and vegetation does not carry it — but the clinical picture of a pricking contact followed by swelling, pain and flesh that rots, with digits lost in severe cases, describes something that does happen. Phytophotodermatitis and the blistering sap of the Euphorbia and Anacardiaceae families produce exactly that sequence after brushing through undergrowth, and a thorn prick that seeds Clostridium or a necrotising soft-tissue infection genuinely does take fingers and toes. The text has observed the syndrome and misassigned the cause to the most alarming animal in the vicinity. **Arsenic trioxide is a lethal poison, and it is being ground up and smeared into open, rotting tissue, from which it is absorbed. This must not be prepared.** A limb infection that is destroying tissue is a surgical emergency: it needs debridement in theatre and intravenous antibiotics, and hours matter.

Boncho 本草

1.15.13.5
Source원문

蛇骨刺人, 毒腫痛, 燒死鼠爲末付之. 《本草》

Translation영역
When a snake's bone pricks a person, with poisonous swelling and pain, burn a dead rat, powder it and apply.
Clinical note임상 주석
A puncture from the bone of a dead snake is a dirty penetrating wound, and swelling and pain two days later are an infection, not a residual poison. There is no venom in a bone. **Powder made from a burnt dead rat and laid on a puncture wound is a raw animal material on broken skin and must not be used.** Rats carry Leptospira, Streptobacillus moniliformis and Seoul hantavirus, and incineration done over a fire is not sterilisation. The wound needs irrigation, exploration if anything may be retained, tetanus cover, and antibiotics if it is already inflamed.

Boncho 本草

1.15.13.6
Source원문

諸蟲毒傷, 靑黛ㆍ雄黃等分爲末, 新汲水調下二錢, 又外塗之. 《本草》

Translation영역
For poisonous injury by any insect, natural indigo and realgar in equal parts, powdered; 2 don taken down in newly drawn water, and also smeared on outwardly.
Clinical note임상 주석
**This is 1 don of realgar swallowed twice over — arsenic sulphide taken internally in quantity, and also laid on the skin. Realgar is converted in the body to inorganic arsenic; a dose on this scale, repeated, causes vomiting, diarrhoea, liver and kidney injury and peripheral neuropathy, and is capable of killing. This must not be prepared.** It is the most dangerous prescription in this group of sections, and it is offered as a general remedy for any insect bite whatever.

Boncho 本草

1.15.13.7
Source원문

人被天蛇毒, 似癩而非癩. 天蛇卽草間黃花蜘蛛也. 人被其螫, 因爲露水所濡, 乃成此疾. 遂煮秦皮汁一斗飮之差. 《本草》

Translation영역
When a person is poisoned by the heaven-snake it resembles leprosy but is not leprosy. The heaven-snake is the yellow-flower spider that lives among the grass. A person is stung by it, and then soaked by dew-water, and so this disease comes about. Boil ash bark and drink 1 mal of the liquor, and he is cured.
Clinical note임상 주석
The gloss is the interesting part: the compiler stops to say what 天蛇 actually is, a yellow-flowered garden spider in the grass, and to insist that the resulting disease is not leprosy even though it looks like one. That is a careful differential, and the thing being differentiated is a skin eruption with thickened, insensate-looking patches. A lingering necrotic or granulomatous lesion after a spider bite can be mistaken for the leprosy of a pre-bacteriological nosology, and so can a fungal infection or discoid eczema. The requirement that dew-water be involved as a second cause is a humoral addition, not an observation. A mal of ash-bark decoction drunk at one go is a large volume of a bitter, mildly astringent liquor; it is not dangerous and it is not a treatment. Anything resembling leprosy today is diagnosed by skin smear and biopsy and treated with multidrug therapy.

Boncho 本草

1.15.13.8
Source원문

諸毒蟲傷, 大紙撚蘸香油, 燒火吹滅, 以烟熏之, 卽愈. 《綱目》

Translation영역
For injury by any poisonous insect, dip a large paper taper in sesame oil, set it alight, blow it out, and fumigate the place with the smoke; it heals at once.

Gangmok 綱目

1.15.13.9
Source원문

五毒蟲毛螫, 赤痛不止, 馬齒莧挼付之. 《本草》

Translation영역
When the hairs of the five poisonous insects sting and the redness and pain will not stop, rub purslane between the hands and lay it on.
Clinical note임상 주석
Purslane is a succulent, so this amounts to a cool wet compress of plant mucilage, and for the burning of caterpillar dermatitis it will give some relief. It does not remove the hairs, which is what the first two clauses of this section correctly set out to do.

Boncho 本草

1.15.13.10
Source원문

蛇蝎蜘蛛咬, 生雞卵輕敲一小孔, 合咬處, 立差. 《本草》

Translation영역
For the bite of a snake, scorpion or spider, tap a small hole lightly in a raw hen's egg and fit it over the bitten place; cured on the spot.
Clinical note임상 주석
This is a suction method — the opened shell is set over the puncture in the expectation that the poison will be drawn into the egg. Suction does not remove venom. It has been tested with mechanical extractors and recovers a negligible fraction while delaying transport, and it is now advised against for snakebite everywhere. Raw egg held against a puncture wound also brings Salmonella to it. For a snakebite the measures that matter are to immobilise the limb at heart level or below, keep the patient still, remove rings and watches before the swelling, and get to a hospital for assessment and antivenom where it is indicated. Scorpion and spider bites in this region are painful rather than dangerous and need a cold pack and analgesia.

Boncho 本草

1.15.13.11
Source원문

諸蟲咬, 麝香塗之. 又小薊或藍葉擣汁飮, 又付之. 《本草》

Translation영역
For the bite of any insect, smear musk on it. Again, pound field thistle or indigo-plant leaves for the juice and drink it, and also lay it on.
Clinical note임상 주석
**Musk is from the musk deer, a CITES Appendix I species, and cannot lawfully be traded.** The thistle and indigo juice are harmless. This closing clause is the section's catch-all for a bite nobody could identify, and it is a fair summary of what the whole section is — a list of things to do when the animal is unknown and the complaint is an itching, inflamed puncture. For that, the modern answer is equally simple and rather more effective: wash it, cool it, leave it alone, and watch for spreading redness, fever or systemic symptoms, which mean it needs to be seen.

Boncho 本草

1.16 Wounds from Splinters and Thorns 簽刺傷

1.16.1
Source원문

竹木刺入肉不出, 瞿麥濃煎取汁, 飮日三. 《本草》

Translation영역
When a splinter of bamboo or wood has entered the flesh and will not come out, decoct dianthus thick, take the liquor and drink it three times a day.
Clinical note임상 주석
The section is about a retained foreign body — a bamboo or wood splinter, a thorn, a fish bone, an iron spike — and about getting it out without cutting. That is a real and respectable aim, and for a superficial splinter the drawing poultices that follow are plausible: a warm, wet, occlusive dressing left on overnight softens and macerates the keratin around a shallow fragment and can let it work its own way to the surface, and a small superficial splinter does often extrude by itself. This clause, though, is a decoction taken by mouth three times a day, and nothing swallowed draws a splinter out of a finger. The distinction that governs the whole section is depth. A superficial splinter can be grasped with fine forceps after the skin is cleaned, or left to extrude. A deep or obliquely retained fragment, one under a nail, one near a joint or tendon sheath, or any organic material that has gone in with force needs to be removed properly — explored under local anaesthetic, with imaging where the fragment is radiolucent, since wood and thorn do not show on plain films and ultrasound is the usual study. Organic foreign bodies left in tissue reliably go on to abscess and granuloma. Every puncture of this kind also raises tetanus. A thorn or splinter driven into the flesh is the classic tetanus-prone wound, and the chapter itself knows 破傷風 as the disease that follows a wound. Immunisation status must be checked and a booster, with immunoglobulin for a dirty wound in an unimmunised patient, given at the time — not after the jaw stiffens.

Boncho 本草

1.16.2
Source원문

又鹿角燒爲末, 水和塗, 立出. 《本草》

Translation영역
Again, burn deer antler, powder it, mix with water and smear it on; it comes out on the spot.

Boncho 本草

1.16.3
Source원문

又乾羊屎燒灰, 和猪脂塗之, 不覺自出. 《本草》

Translation영역
Again, burn dried sheep dung to ash, mix it with lard and smear it on; without his noticing, it comes out of itself.
Clinical note임상 주석
**Sheep dung, even burnt, laid in lard over a puncture wound is a faecal material on broken skin and must not be used.** Animal faeces is the principal environmental reservoir of Clostridium tetani, and a puncture wound is the entry it needs; this is the combination that causes tetanus. The lard base is at least occlusive, which is the part of the idea that has any merit, and plain petrolatum under a dressing does the same thing safely.

Boncho 本草

1.16.4
Source원문

又人頭垢塗之卽出. 又烏雄雞生擣罨之亦出. 《本草》

Translation영역
Again, smear the scurf of a person's head on and it comes out. Again, pound a black cock raw and poultice with it, and that too brings it out.
Clinical note임상 주석
**Scurf from a person's head is a human material, and raw pounded fowl laid on an open puncture is a raw animal material; neither must be used.** Raw poultry is the commonest source of Campylobacter and Salmonella, and this is a poultice of it over a wound.

Boncho 本草

1.16.5
Source원문

又白梅肉嚼封之, 刺卽出. 又栗楔生嚼罨之亦出. 又螻蛄硏付之妙. 又蠮螉生硏罨之亦妙. 又蠐螬▼(石+辛)付之, 刺卽出. 又牛膝根擣爛塗之亦出. 又魚鰾取付瘡上, 四邊肉爛, 刺卽出. 《本草》

Translation영역
Again, chew the flesh of salted mume plum and seal the place with it, and the splinter comes out. Again, chew a raw chestnut wedge-kernel and poultice with it, and that too brings it out. Again, mole cricket ground and applied is excellent. Again, a potter wasp ground raw and poulticed on is excellent too. Again, crush a beetle grub and lay it on, and the splinter comes out. Again, pound achyranthes root to a mash and smear it on, and that too brings it out. Again, take isinglass and lay it on the sore, and when the flesh all round has rotted the splinter comes out.
Clinical note임상 주석
Seven drawing poultices in a row, and the last one tells on the method: lay isinglass on and wait until the flesh round about has rotted, and then the splinter comes out. That is an accurate account of what happens when a splinter is left in and occluded — the tissue around it suppurates, and the fragment is discharged with the pus. It works, in the sense that the splinter eventually leaves, at the cost of a local abscess. Chewing a plum stone's flesh or a chestnut kernel and sealing the site with it is the same tactic by a safer route. **Chewed material and raw ground insects — mole cricket, potter wasp, beetle grub — laid into an open puncture introduce oral and environmental flora into a tetanus-prone wound and must not be used.** Human saliva carries a dense anaerobic flora and is why human bites become infected so readily. None of this is needed for a splinter that can be reached. Clean the skin, grip the fragment with fine forceps along its line of entry, and bring it straight out; if it cannot be seen or gripped, or it is deep, under a nail, in a joint or made of plant material driven in hard, it should be removed under local anaesthetic with imaging rather than waited out.

Boncho 本草

1.16.6
Source원문

魚骨在肉中不出, 嚼吳茱萸封之, 骨當爛出. 又取海獺皮煮汁服. 又魚狗鳥燒爲末, 和飮頓服. 又象牙末厚塗自軟出. 《本草》

Translation영역
When a fish bone is in the flesh and will not come out, chew evodia and seal the place with it, and the bone will rot and come out. Again, take sea otter skin, boil it and take the liquor. Again, burn a kingfisher, powder it, mix it in drink and swallow it at one draught. Again, lay ivory powder on thickly and it softens and comes out of itself.
Clinical note임상 주석
The fish-bone remedies are chosen by association rather than by action: the sea otter and the kingfisher both live on fish, so both are given against a fish bone. Nothing drunk dissolves a bone embedded in tissue. **Sea otter and elephant are CITES-listed and ivory and otter pelt cannot lawfully be traded; kingfishers are protected wild birds. None of these may be used.** A fish bone in the hand is dealt with as any other retained foreign body, and fish-spine punctures carry their own problem — marine and freshwater organisms, Vibrio and Mycobacterium marinum and Aeromonas among them, which the usual oral antibiotic for a skin infection does not cover. A hand puncture from a fish that becomes inflamed should be seen.

Boncho 本草

1.16.7
Source원문

鐵棘竹木刺入肉不出, 鼠腦厚塗之, 卽出. 《本草》

Translation영역
When an iron spike or a splinter of bamboo or wood has entered the flesh and will not come out, lay rat's brain on thickly and it comes out.
Clinical note임상 주석
**Rat brain laid on an open puncture wound is raw animal tissue from a rodent and must not be used.** Rats carry Leptospira, Streptobacillus moniliformis, Seoul hantavirus and the enteric organisms, and this puts all of them into the wound. An iron spike is the one foreign body in this section that will show on a radiograph, and a metal fragment driven deep into the flesh is also the one most likely to have taken soil in with it. That makes it both the easiest to localise and the most tetanus-prone.

Boncho 本草

1.17 The Moxibustion Method 灸法

1.17.1
Source원문

凡蛇虺蜈蚣毒蟲咬傷, 於傷處灸五壯或七壯, 卽愈. 《丹心》

Translation영역
For all bites and wounds from snakes, vipers, centipedes and poisonous insects, burn five cones, or seven, on the wounded place, and it heals.
Clinical note임상 주석
The chapter closes on moxibustion, and on a single idea: burn the bite. The reasoning is that heat drives the poison back out by the way it came, and the same thought runs through the snakebite and rabid-dog sections earlier in the chapter, where the wound is to be cauterised or pressed out. It does not work, and it is now specifically contraindicated. Heat does not denature venom already in the tissue or in the lymphatics, because by the time cones are being lit the venom has moved; what it does is add a full-thickness burn to a contaminated puncture wound, which means more dead tissue, more pain, a worse scar and a higher chance of infection — and, on a limb already swelling from envenomation, a burn that is difficult to assess and slow to heal. Cautery, incision, suction and tourniquets have all been dropped from snakebite first aid for the same reason. What to do instead is unglamorous: keep the patient still, immobilise the bitten limb, take off rings and anything constricting, mark the edge of the swelling and the time, and get to a hospital where the species can be considered and antivenom given if it is indicated. Centipede and insect stings need a cold pack and analgesia, not a flame. Every bite also needs tetanus cover.

Dansim 丹心

1.17.2
Source원문

被惡蛇螫, 卽貼蛇皮於螫處, 艾火灸其上, 引出毒氣, 卽止. 《本草》

Translation영역
When bitten by a malignant snake, stick a snake's skin on the bitten place at once and burn mugwort fire on top of it to draw the poisonous qi out; it stops at once.
Clinical note임상 주석
The snake's own skin interposed between the moxa and the wound is the sympathetic logic of this chapter at its plainest — like draws out like, the animal's covering fetches back the animal's poison. In practice the skin is a layer of dried hide that slows the burn a little, so this clause does marginally less damage than the one before it, for the same absence of effect. It is also the last thing the chapter says. The Injuries chapter has run from sutured bowel and reduced fractures — careful, observant, genuinely surgical work — to this, and the contrast is worth noticing. Where the problem was mechanical and visible, the book is impressive. Where the problem was a toxin it had no means of seeing, it fell back on correspondence, and the result is a measure that harms the patient.

Boncho 本草

About this translation 凡例

Base text: Donguibogam (東醫寶鑑, 1613 first edition), Miscellaneous Disorders, Volume 9, Injuries chapter, leaves 001a to 019a. The Chinese text is collated against the Kyujanggak transcription of the 1613 edition; collation notes are given on the passages they concern. The leaves run in order with no misbinding. The table of contents lists seventeen sections; the text itself stands up fifty, so thirty-three are given here as numbered sub-sections in source order, leaving the table of contents' numbering untouched. Each of the five Single Remedies sections declares its own count — twenty-four, seventeen, fourteen, five and six — and all five agree with the items actually present, sixty-six in all. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.