Formulas · Text · Donguibogam 東醫寶鑑

The Spirit

Sin

한글 신문 · Pinyin Shen

the Donguibogam chapter in translation

神

The Spirit chapter is where Korean medicine keeps its psychiatry. It opens by placing the spirit in the Heart and making it sovereign over the whole body, then works outward through the seven affects — joy, anger, worry, thought, sorrow, fright, fear — showing how each, carried past measure, damages a particular organ and becomes a physical illness. Fright palpitations, fearful throbbing, forgetfulness, mania and withdrawal all follow from that premise. It is the classical source for what Korean medicine later named hwa-byeong, and the chapter that most directly addresses what a modern clinic sees as anxiety, panic, and stress-driven illness.

5.1 The spirit is the master of the whole body 神爲一身之主

5.1.1

Source원문

內經曰, 心者君主之官, 神明出焉. ○無名子曰, 天一生水, 在人曰精; 地二生火, 在人曰神. ○回春曰, 心者一身之主, 淸淨之府, 外有包絡以羅之, 其中精華之聚萃者名之曰神, 通陰陽, 察纖毫, 無所紊亂. ○邵子曰, 神統於心, 氣統於腎, 形統於首. 形氣交而神主乎其中, 三才之道也.

Translation영역

The Inner Classic: the heart is the office of the sovereign, and the spirit brightness issues from it. Wumingzi: heaven's one engenders water, which in man is called essence; earth's two engenders fire, which in man is called spirit. The Hoechun: the heart is the master of the whole body and a clean and quiet palace, with the enclosing network spread about it on the outside; and what gathers as the flower of the essence within it is named the spirit, which communicates yin and yang, discerns the finest hair, and has nothing in it out of order. Shaozi: the spirit is gathered in the heart, the qi in the kidney, the bodily form in the head; form and qi meet and the spirit presides in the midst of them — this is the way of the three powers.

Clinical note임상 주석

通陰陽, 察纖毫, 無所紊亂 — passing between yin and yang, discerning the finest hair, with nothing out of order. The Hoechun's definition of 神 is functional: not a substance in the heart but the capacity for discrimination and order. Shaozi's three-powers scheme puts the spirit where form and qi meet, which is the premise the whole chapter rests on.

Naegyeong 內經 · Hoechun 回春 · Soja 邵子

5.1.2

Source원문

內經曰, 太上養神, 其次養形. 故養神者必知形之肥瘦, 榮衛血氣之盛衰. 血氣者, 人之神, 不可不謹養也. 註云, 神安則壽延, 神去則形弊, 故不可不謹養也.

Translation영역

The Inner Classic: highest is to nourish the spirit, next to nourish the form. Therefore one who nourishes the spirit must know whether the form is fat or thin and whether construction and defence, blood and qi, are exuberant or declining. Blood and qi are a man's spirit, and they must be carefully nourished. The commentary says: where the spirit is at peace the lifespan is extended; where the spirit departs the form decays — and so it must be carefully nourished.

Clinical note임상 주석

血氣者, 人之神 — blood and qi are the spirit. The passage puts the chapter's subject on a material footing before anything else is said about it: tending the spirit means knowing the patient's build and the state of their blood and qi, so nourishing the spirit and nourishing the form are not two tasks.

Naegyeong 內經

5.2 The five flavors engender the spirit 五味生神

5.2.1

Source원문

內經曰, 天食人以五氣, 地食人以五味. 五氣入鼻, 藏於心肺, 上使五色修明, 音聲能彰. 五味入口, 藏於腸胃, 味有所藏, 以養五氣, 氣和而生, 津液相成, 神乃自生.

Translation영역

The Inner Classic says: Heaven feeds a person with the five Qi, Earth feeds a person with the five flavors. The five Qi enter by the nose and are stored in Heart and Lung, making the five colors bright above and the voice able to sound. The five flavors enter by the mouth and are stored in intestines and stomach; the flavors being stored there nourish the five Qi, the Qi harmonizes and engenders, the fluids form together — and the spirit is engendered of itself.

Clinical note임상 주석

The passage that keeps this chapter from floating off into philosophy. The spirit is not installed in a person; it is produced — out of air and food, by way of the stomach and the fluids, and it arises 'of itself' when those are in order. Hence the instruction that anyone treating the spirit must first examine the body's substance: whether the patient is thin, what the blood and Qi are doing. Blood and Qi *are* the spirit, says the Classic, which is as materialist a sentence as the tradition produces.

Naegyeong 內經

5.3 The Heart stores the spirit 心藏神

5.3.1

Source원문

臞仙曰, 心者神明之舍, 中虛不過徑寸, 而神明居焉. 事物之滑, 如理亂棼, 如涉驚浸, 或怵惕, 或懲創, 或喜怒, 或思慮, 一日之間, 一時之頃, 徑寸之地, 炎如火矣. 若嗜慾一萌, 卽不善也, 歸而勿納, 是與良心競也. 凡七情六慾之生於心皆燃, 故曰心靜可以通乎神明, 事未至而先知. 是不出戶知天下, 不窺牖見天道也. 盖心如水之不撓, 久而澄淸, 洞見其底, 是謂靈明. 宜乎靜可以固元氣, 則萬病不生, 故能長久. 若一念旣萌, 神馳於外, 氣散於內, 血隨氣行, 榮衛昏亂, 百病相攻, 皆因心而生也. 大槩怡養天君, 疾病不作, 此治心之法也.

Translation영역

Quxian: the heart is the house of the spirit brightness; hollow within and no more than an inch across, and the spirit brightness dwells there. The slipperiness of affairs is like untangling a snarl of hemp, like wading into a startling flood — now apprehension, now chastening, now joy and anger, now thought and anxiety — and in the space of one day, in the space of one hour, that inch of ground blazes like fire. If appetite once sprouts, that instant is not good; send it back and do not take it in, for it is contending with the good heart. All the seven affects and six appetites that arise in the heart are like this. Therefore it is said: a still heart can reach through to the spirit brightness and knows a thing before it comes. This is to know the world without going out of doors and to see the way of heaven without peering through the window. For the heart is like water unstirred: in time it settles clear and one sees straight to the bottom, and this is called numinous brightness. Rightly, stillness can make the original qi firm, and then the ten thousand diseases do not arise, and so one can last long. But once a single thought sprouts, the spirit races outward and the qi scatters within, the blood follows the qi, construction and defence fall into disorder, and a hundred diseases attack together — all of them arising from the heart. In sum, keep the heavenly sovereign content and well, and illness does not occur: this is the method of treating the heart.

Clinical note임상 주석

心如水之不撓, 久而澄淸, 洞見其底 — the heart like water left unstirred, settling until one sees to the bottom. Quxian's essay is the chapter's one piece of sustained prose, and it argues a position: that disease begins in the heart's agitation, so that 治心, treating the heart, is prior to treating anything. 徑寸之地, 炎如火矣, an inch of ground blazing like fire in the space of an hour, is as good a description of an agitated mind as the literature has.

Guseon 臞仙

5.3.2

Source원문

內經曰, 心藏神. 神有餘則笑不休, 神不足則悲. 註云, 心藏脉, 脉舍神. 心氣虛則悲, 實則笑不休也. ○皇甫士安曰, 心虛則悲, 悲則憂; 心實則笑, 笑則喜.

Translation영역

The Inner Classic: the heart stores the spirit. Where the spirit is in surplus there is laughter without stopping; where the spirit is insufficient there is sorrow. The commentary says: the heart stores the vessels and the vessels house the spirit. Where the heart qi is vacuous there is sorrow; replete, laughter without stopping. Huangfu Shi'an: where the heart is vacuous there is sorrow, and sorrow becomes grief; where the heart is replete there is laughter, and laughter becomes joy.

Clinical note임상 주석

笑不休 and 悲 set as repletion and vacuity of one thing. The pairing is the chapter's simplest model of mood: elation and depression as too much and too little of the heart's spirit rather than as two diseases — which is also how 5.14 ends up treating withdrawal and mania as one combined illness.

Naegyeong 內經 · Hwangbo Sian 皇甫士安

5.4 The names of the spirits within the body 人身神名

5.4.1

Source원문

黃庭經曰, 肝神龍烟字含明, 形長七寸, 靑錦衣, 鳳玉鈴, 狀如懸瓠, 其色靑紫. 心神丹元字守靈, 形長九寸, 丹錦飛裳, 狀如未開垂蓮, 其色赤. 脾神常在字魂停, 形長七寸六分, 黃錦之衣, 狀如覆盆, 其色黃. 肺神皓華字虛成, 形長八寸, 素錦衣裳, 黃雲之帶, 狀如華盖覆磬, 其色紅白. 腎神玄冥字育嬰, 形長三寸六分, 蒼錦之衣, 狀如圓石, 其色黑. 膽神龍曜字威明, 形長三寸六分, 九色錦衣, 綠華裙, 狀如懸瓠, 其色靑.

Translation영역

The Yellow Court Classic: the liver's spirit is Yongyeon, styled Hammyeong, seven chon tall, in green brocade with a phoenix jade bell, shaped like a hanging gourd, and its colour is green-purple. The heart's spirit is Danwon, styled Suryeong, nine chon tall, in flying robes of red brocade, shaped like an unopened hanging lotus, and its colour is red. The spleen's spirit is Sangjae, styled Honjeong, seven chon six pun tall, in robes of yellow brocade, shaped like an upturned basin, and its colour is yellow. The lung's spirit is Hohwa, styled Heoseong, eight chon tall, in plain brocade robes with a belt of yellow cloud, shaped like a canopy over an inverted chime, and its colour is red-white. The kidney's spirit is Hyeonmyeong, styled Yugyeong, three chon six pun tall, in robes of dark brocade, shaped like a round stone, and its colour is black. The gallbladder's spirit is Yongyo, styled Wimyeong, three chon six pun tall, in brocade of nine colours with a green flowered skirt, shaped like a hanging gourd, and its colour is green.

Clinical note임상 주석

Each viscus given a name, a style, a height, a dress, a shape and a colour. The shapes and colours are the ones the Bogam uses for the organs themselves in 五臟六腑 — the hanging gourd for the liver, the unopened lotus for the heart, the upturned basin for the spleen — so the Daoist visualisation and the anatomical description share their images. Heights in 寸 and 分 are given for meditation, not measurement.

Hwangjeonggyeong 黃庭經

5.4.2

Source원문

正理曰, 黃庭經云, 至道不煩, 决存眞泥丸. 百節皆有神, 神名最多, 莫能枚擧. 身中有三部: 上部八景, 髮神ㆍ胷神ㆍ眼神ㆍ鼻神ㆍ耳神ㆍ口神ㆍ舌神ㆍ齒神; 中部八景, 肺神ㆍ心神ㆍ肝神ㆍ脾神ㆍ左腎神ㆍ右腎神ㆍ膽神ㆍ喉神; 下部八景, 腎神ㆍ大腸神ㆍ小腸神ㆍ胴神ㆍ胃神ㆍ膈神ㆍ兩脇神ㆍ左陽神ㆍ右陰神. 身中有九宮眞人心爲絳宮眞人, 腎爲丹元宮眞人, 肝爲蘭臺宮眞人, 肺爲尙書宮眞人, 脾爲黃庭宮眞人, 膽爲天靈宮眞人, 小腸爲玄靈宮眞人, 大腸爲末靈宮眞人, 膀胱爲玉房宮眞人. 又有元首九宮眞人腦有九瓣, 故頭有九宮: 一曰雙丹宮, 二曰明堂宮, 三曰泥丸宮, 四曰流珠宮, 五曰大帝宮, 六曰天庭宮, 七曰極眞宮, 八曰玄丹宮, 九曰大皇宮也. 又有金樓重門十二亭長. 身外有一萬八千陽神, 身內有一萬八千陰神. 所主者爲絳宮眞人, 卽心主也. 又有三身神ㆍ四智神ㆍ三魂神爽靈ㆍ胎光ㆍ幽精ㆍ七魄神尸狗ㆍ伏矢ㆍ雀滛ㆍ飛毒ㆍ天賊ㆍ除穢ㆍ臭師ㆍ七元八識神, 假名異字, 難可悉數.

Translation영역

The Jeongri: the Yellow Court Classic says, the highest way is not troublesome — it is settled by keeping the true one in the Mud Pellet. Every joint has its spirit, and the spirits' names are so many that they cannot be enumerated. The body has three divisions. The eight scenes of the upper division: the spirits of the hair, chest, eyes, nose, ears, mouth, tongue and teeth. The eight scenes of the middle division: the spirits of the lung, heart, liver, spleen, left kidney, right kidney, gallbladder and throat. The eight scenes of the lower division: the spirits of the kidney, large intestine, small intestine, trunk, stomach, diaphragm, both flanks, the left yang and the right yin. Within the body are the perfected of the nine palaces the heart is the perfected of the Crimson Palace; the kidney, of the Cinnabar Origin Palace; the liver, of the Orchid Terrace Palace; the lung, of the Secretariat Palace; the spleen, of the Yellow Court Palace; the gallbladder, of the Heavenly Numen Palace; the small intestine, of the Dark Numen Palace; the large intestine, of the Last Numen Palace; the bladder, of the Jade Chamber Palace. There are also the perfected of the nine palaces of the head the brain has nine lobes, and so the head has nine palaces: first the Twin Cinnabar Palace, second the Bright Hall Palace, third the Mud Pellet Palace, fourth the Flowing Pearl Palace, fifth the Great Emperor Palace, sixth the Heavenly Court Palace, seventh the Utmost Perfection Palace, eighth the Dark Cinnabar Palace, ninth the Great August Palace. There are also the twelve wardens of the golden tower's double gate. Outside the body are eighteen thousand yang spirits and within it eighteen thousand yin spirits, and the one that governs them is the perfected of the Crimson Palace, which is the heart master. There are also the three body spirits, the four wisdom spirits, the three ethereal-soul spirits Sangnyeong, Taegwang and Yujeong, the seven corporeal-soul spirits Corpse Dog, Hidden Arrow, Sparrow Lust, Flying Poison, Heaven's Thief, Filth Remover and Stench Master, the seven primes and the eight consciousnesses — borrowed names and variant characters, hard to count in full.

Clinical note임상 주석

泥丸, the Mud Pellet, is the Daoist name for the centre of the brain, and 决存眞泥丸 — settling by keeping the true one there — is the whole practice in six characters. The scheme is an inner topography for meditation rather than a physiology: three divisions of eight, nine palaces in the trunk, nine in the head, thirty-six thousand spirits in and out of the body. Two details are worth keeping. 腦有九瓣, the brain has nine lobes, is one of the few places in the Bogam that treats the brain as structured; and 假名異字, 難可悉數 — borrowed names and variant characters, hard to count — is the Jeongri's own acknowledgement that the lists do not agree with each other.

Jeongri 正理

5.4.3

Source원문

心主乃一身之君, 萬神爲之聽命焉, 故能虛靈知覺, 千變萬化.

Translation영역

The heart master is the sovereign of the whole body, and the ten thousand spirits take their orders from it; and so it can be empty and numinous, knowing and perceiving, through a thousand changes and ten thousand transformations.

Clinical note임상 주석

虛靈知覺 — empty, numinous, knowing and perceiving. The section's closing line brings the Daoist multitude of spirits back under the single heart of 5.1, which is why the Bogam prints it: the inner pantheon is subordinated to the one faculty the chapter is about.

Jeongri 正理

5.5 The five viscera store the seven spirits 五藏藏七神

5.5.1

Source원문

內經曰, 五藏所藏, 心藏神, 肺藏魄, 肝藏魂, 脾藏意, 腎藏志. 又曰, 脾藏意與智, 腎藏精與志, 是謂七神. 註云, 神者, 精氣之化成也. 魄者, 精氣之匡佐也. 魂者, 神氣之輔弼也. 意者, 記而不忘者也. 志者, 專意而不移者也. ○靈樞曰, 兩精相薄謂之神, 隨神往來謂之魂, 幷精出入謂之魄, 心有所憶謂之意, 意之所存謂之志, 因慮而處物謂之智也.

Translation영역

The Inner Classic says: as for what the five viscera store — the Heart stores the spirit, the Lung the corporeal soul, the Liver the ethereal soul, the Spleen the intent, the Kidney the will. And further: the Spleen stores intent together with wisdom, and the Kidney stores essence together with will — these are called the seven spirits. The commentary says: the spirit is what the essence-Qi has transformed into and completed; the corporeal soul is the essence-Qi's aide; the ethereal soul is the spirit-Qi's assistant; the intent is what remembers and does not forget; the will is what fixes on a purpose and does not shift. — The Numinous Pivot says: where two essences press upon one another, that is called the spirit; what comes and goes following the spirit is called the ethereal soul; what enters and exits along with the essence is called the corporeal soul; what the Heart holds in recollection is called the intent; what the intent preserves is called the will; and to deliberate and so dispose of matters is called wisdom.

Clinical note임상 주석

The clearest definitions in the chapter, and worth having because these terms recur everywhere. Intent is memory that holds; will is purpose that does not shift. The ethereal soul travels with the spirit — which is why it can fly up at night and fail to return, as the Dreams chapter describes. The corporeal soul travels with the essence, which is why it is the one that fails in bodily collapse. Once these are fixed, most of the chapter's stranger phrases become readable.

Naegyeong 內經 · Yeongchu 靈樞

5.6 When the viscus Qi is cut off, the spirit appears outside 藏氣絶則神見於外

5.6.1

Source원문

一士人喜觀書忘食. 一日, 有紫衣人立於前曰, 公不可苦思, 思則我死矣. 問其何人, 曰, 我穀神也. 於是絶思而食如故矣. 《延壽書》 ○無錫游氏子, 以酒色得疾, 常見兩女子, 衣服鮮麗, 冉冉至腰而沒. 醫曰, 此腎神也. 腎絶則神不守舍, 故見於外也. 《醫說》

Translation영역

A scholar loved reading so much that he forgot to eat. One day a figure in purple robes stood before him and said: you must not think so bitterly — think, and I shall die. He asked who it was. It answered: I am the spirit of grain. Thereupon he ceased his brooding and ate as before (Yeonsuseo 延壽書). — A son of the You family of Wuxi fell ill from wine and women. He constantly saw two women in bright fine clothes, drifting slowly up as far as the waist and then vanishing. The physician said: these are the Kidney spirits. When the Kidney is cut off, the spirit does not keep to its dwelling — and so it appears outside. (Uiseol 醫說)

Clinical note임상 주석

Two hallucinations read as organ failure rather than as visitation, which is the chapter's consistent move. The first is the better story: a man so absorbed in books that he stopped eating, visited by the spirit of grain itself, which tells him plainly that his brooding is killing it. The cure is that he starts eating again. The second is grimmer and closer to a clinical report — recurrent visual hallucinations in a man depleted by drink and sex, read as the Kidney spirit leaving its house. Note on modern practice: new visual hallucinations require prompt medical and psychiatric assessment; the causes range from delirium and withdrawal to neurological disease.

Yeonsuseo 延壽書 · Uiseol 醫說

5.7 Pulse signs 脉法

5.7.1

Source원문

七情傷脉: 喜則脉散, 怒則脉促一作激, 憂則脉澁, 思則脉沉一作結, 悲則脉結一作緊, 驚則脉顫一作動, 恐則脉沉. 《得效》

Translation영역

The pulses of damage by the seven affects: in joy the pulse is dissipated; in anger hurried one text has agitated; in grief rough; in thought sunken one text has bound; in sorrow bound one text has tight; in fright trembling one text has stirring; in fear sunken.

Clinical note임상 주석

Seven affects, seven pulses, with four variant readings carried in the Deukhyobang's own notes — which is a fair measure of how firm the correspondences were. Note that thought and fear share the sunken pulse, so the scheme does not separate all seven.

Deukhyo 得效

5.7.2

Source원문

喜傷心則脉虛, 思傷脾則脉結, 憂傷肺則脉澁, 怒傷肝則脉濡, 恐傷腎則脉沉, 驚傷膽則脉動, 悲傷心包則脉緊. 凡七情之脉惟氣口緊盛而已, 細分之則如此. 《入門》

Translation영역

Where joy damages the heart the pulse is vacuous; where thought damages the spleen, bound; where grief damages the lung, rough; where anger damages the liver, soggy; where fear damages the kidney, sunken; where fright damages the gallbladder, stirring; where sorrow damages the heart enclosure, tight. In the pulses of all seven affects there is only this — tight and exuberant at the qi opening; divided finely, it is as above.

Clinical note임상 주석

惟氣口緊盛而已 — the honest sentence in the section. The Immun gives the fine distinctions and then says what the pulse actually shows is one thing, tightness and fullness at the right wrist, with the rest a subdivision made after the fact.

Immun 入門

5.7.3

Source원문

癲疾脉搏大滑, 久自已; 脉小堅急, 死不治. 又曰, 癲疾脉虛則可治, 實則死. 《內經》

Translation영역

In withdrawal disease, where the pulse is pounding, large and slippery, in time it resolves of itself; where the pulse is small, hard and urgent, the patient dies and cannot be treated. It also says: in withdrawal disease a vacuous pulse can be treated, a replete one means death.

Clinical note임상 주석

The two Suwen passages contradict each other — a large pounding pulse is favourable in the first, a replete one fatal in the second — and the Bogam sets them side by side without comment, as it does throughout.

Naegyeong 內經

5.7.4

Source원문

癲癎之脉浮洪大長滑大堅實, 痰蓄心狂. 又曰, 大堅疾者癲狂. 《脉訣》

Translation영역

The pulse in withdrawal-epilepsy is floating, surging, large and long, slippery, large, hard and replete; phlegm amassed makes the heart mad. It also says: large, hard and fast is withdrawal-mania.

Maekgyeol 脉訣

5.7.5

Source원문

恍惚癲狂, 實大爲順, 沉細爲逆. 《得效》

Translation영역

In abstraction and withdrawal-mania, a replete large pulse goes with the disease and a sunken fine one against it.

Clinical note임상 주석

順 and 逆 here are prognostic, not pathological: the full pulse is what the condition ought to produce, and a thin sunken one in an agitated patient means the reserves are gone.

Deukhyo 得效

5.7.6

Source원문

靈樞曰, 凡脉急甚皆爲癲狂厥疾.

Translation영역

The Divine Pivot: wherever the pulse is severely urgent, it is withdrawal-mania or reversal disease.

Yeongchu 靈樞

5.7.7

Source원문

心中驚悸, 脉必結代; 飮食之悸, 沉伏動滑. 《脉訣》

Translation영역

In fright palpitations within the heart the pulse is certain to be bound and intermittent; in the palpitation that comes of food and drink it is sunken, hidden, stirring and slippery.

Clinical note임상 주석

結代 — bound and intermittent, which is to say an irregular pulse with dropped beats. Of all the correspondences in this section this is the one that holds: palpitation felt in the chest with a demonstrably irregular pulse is an arrhythmia and wants investigating.

Maekgyeol 脉訣

5.7.8

Source원문

寸口脉動而弱, 動爲驚, 弱爲悸. 又曰, 肝脉動曝, 有所驚駭. 《正傳》

Translation영역

Where the pulse at the inch opening is stirring and weak, the stirring is fright and the weakness palpitation. It also says: where the liver pulse stirs abruptly, there has been some fright.

Jeongjeon 正傳

5.7.9

Source원문

人恐怖, 其脉何狀? 師曰, 脉形如循絲纍纍然, 其面白脫色也. 又曰, 人愧者, 其脉何類? 師曰, 脉浮而面色乍白乍赤也. 《脉經》

Translation영역

When a man is afraid, what is his pulse like? The master said: the pulse's form is as though running along a thread, bead after bead, and his face is white and drained of colour. And: when a man is ashamed, what is his pulse like? The master said: the pulse is floating and the face goes now white, now red.

Clinical note임상 주석

如循絲纍纍然 — like running a finger along a thread strung with beads. The two answers are descriptions of autonomic arousal rather than of pulses: pallor with a thready pulse in fear, flushing and blanching with a bounding one in shame.

Maekgyeong 脉經

5.8 The spirit governs the seven affects — damaged, they become illness 神統七情傷則爲病

5.8.1

Source원문

心藏神, 爲一身君主, 統攝七情, 酬酢萬機. 七情者, 喜ㆍ怒ㆍ憂ㆍ思ㆍ悲ㆍ驚ㆍ恐也. 又魂ㆍ神ㆍ意ㆍ魄ㆍ志以爲神主, 故亦皆名神也. 《內經註》

Translation영역

The heart stores the spirit and is sovereign of the whole body; it gathers and governs the seven affects and answers the ten thousand turns of affairs. The seven affects are joy, anger, grief, thought, sorrow, fright and fear. And the ethereal soul, the spirit, the intent, the corporeal soul and the will have the spirit for their master, and so all of them too are named spirit.

Clinical note임상 주석

酬酢萬機 — answering the ten thousand turns of affairs, the phrase used of a sovereign's business. The section's premise: the seven affects are not disorders but the heart's ordinary work, and they become disease only in excess. The five spirits of 5.5 are folded in here as aspects of the one spirit.

Naegyeong 內經 (commentary)

5.8.2

Source원문

靈樞曰, 心怵惕思慮則傷神, 神傷則恐懼自失, 破䐃脫肉, 毛悴色夭, 死于冬. 脾憂愁而不解則傷意, 意傷則悗亂, 四肢不擧, 毛悴色夭, 死于春. 肝悲哀動中則傷魂, 魂傷則狂忘不精, 不精則不正當人, 陰縮而攣筋, 兩脇骨不擧, 毛悴色夭, 死于秋. 肺喜樂無極則傷魄, 魄傷則狂, 狂者意不存人, 皮革焦, 毛悴色夭, 死于夏. 腎盛怒而不止則傷志, 志傷則喜忘其前言, 腰脊不可以俛仰屈伸, 毛悴色夭, 死于季夏. 恐懼而不解則傷精, 精傷則骨痠痿厥, 精時自下. 是故五藏主藏精者也, 不可傷, 傷則失守而陰虛, 陰虛則無氣, 無氣則死矣.

Translation영역

The Divine Pivot: where the heart is apprehensive and anxious, the spirit is damaged; the spirit damaged, there is fear and a sense of being lost to oneself, the muscle bulk breaks down and the flesh falls away, the hair withers and the complexion is blighted, and death comes in winter. Where the spleen grieves and sorrows without release, the intent is damaged; the intent damaged, there is confusion and the four limbs will not lift, the hair withers and the complexion is blighted, and death comes in spring. Where the liver's sorrow stirs within, the ethereal soul is damaged; the ethereal soul damaged, there is madness and forgetting and no exactness, and without exactness a man does not deal rightly with people; the genitals retract and the sinews cramp, the ribs on both sides will not lift, the hair withers and the complexion is blighted, and death comes in autumn. Where the lung's joy and merriment are without limit, the corporeal soul is damaged; the corporeal soul damaged, there is madness, and the mad man does not hold others in mind; the skin is scorched, the hair withers and the complexion is blighted, and death comes in summer. Where the kidney's great anger does not stop, the will is damaged; the will damaged, one readily forgets what one has just said, the lumbus and spine cannot bend or stretch, the hair withers and the complexion is blighted, and death comes in late summer. Where fear is not released, the essence is damaged; the essence damaged, the bones ache and there is wilting and reversal, and the essence comes down of itself from time to time. Therefore the five viscera are what govern the storing of essence; they must not be damaged, for damaged they lose their guard and the yin becomes vacuous, and the yin vacuous there is no qi, and with no qi there is death.

Clinical note임상 주석

破䐃脫肉, 毛悴色夭 — the muscle bulk breaking down, the flesh falling away, the hair withering, the complexion blighted. The same four signs close each of the five, which is the Lingshu's way of saying that any affect sustained long enough ends in wasting. The seasonal deaths follow the phase of the damaged viscus and are schematic; the clinical content is in the specific damage — apathy and heaviness in the spleen's grief, retracted genitals and cramp in the liver's sorrow, loss of recent memory in the kidney's anger.

Yeongchu 靈樞

5.8.3

Source원문

又曰, 怵惕思慮者, 恐懼流滛而不止; 悲哀動中者, 竭絶而失生; 喜樂無極者, 神蕩散而不藏; 愁憂不解者, 氣閉塞而不行; 盛怒者, 迷惑而不治; 恐懼者, 神蕩散而不收.

Translation영역

It also says: in one who is apprehensive and anxious, fear overflows and does not stop; in one whose sorrow stirs within, the stores are exhausted and life is lost; in one whose joy is without limit, the spirit is washed loose and scattered and is not stored; in one whose grief is not released, the qi is blocked and does not move; in one of great anger, there is bewilderment and no governing; in one who is afraid, the spirit is washed loose and scattered and is not gathered in.

Yeongchu 靈樞

5.8.4

Source원문

內經曰, 五精所幷: 精氣幷於心則喜, 幷於肺則悲, 幷於肝則憂, 幷於脾則畏, 幷於腎則恐.註曰, 肺虛而心精幷之則爲喜; 肝虛而肺氣幷之則爲悲. 他藏倣此. 憂當作怒, 畏當作思.

Translation영역

The Inner Classic: what the five essences crowd into. Where the essence qi crowds into the heart there is joy; into the lung, sorrow; into the liver, grief; into the spleen, dread; into the kidney, fear. The commentary says: where the lung is vacuous and the heart's essence crowds into it there is joy; where the liver is vacuous and the lung's qi crowds into it there is sorrow. The other viscera follow this pattern. For 憂, grief, read 怒, anger; for 畏, dread, read 思, thought.

Clinical note임상 주석

憂當作怒, 畏當作思 — the commentator correcting the classic to make it agree with the standard five-mind assignments of 5.16. The Bogam prints both the text and the correction, which is how it treats every such disagreement.

Naegyeong 內經

5.8.5

Source원문

喜傷心者, 不可疾行, 不可久立. 怒傷肝者, 上氣不可忍, 熱氣盪胷, 短氣欲絶, 不得息. 憂傷肺者, 心系急, 上焦閉, 榮衛不通, 夜臥不安. 思傷脾者, 氣留不行, 積聚中脘, 不得飮食, 腹脹滿, 四肢怠惰. 悲傷心包者, 善忘不識人, 置物在處還取不得, 筋攣, 四肢浮腫. 恐傷腎者, 上焦氣閉不行, 下焦回還不散, 猶豫不决, 嘔逆惡心. 驚傷膽者, 神無所歸, 慮無所定, 說物不意而迫. 《得效》

Translation영역

Where joy has damaged the heart, one cannot walk fast and cannot stand long. Where anger has damaged the liver, the qi rising is past bearing, hot qi sloshes in the chest, the breath is short as if about to fail, and one cannot get a breath. Where grief has damaged the lung, the heart's connections are tense, the upper burner is blocked, construction and defence do not communicate, and one lies uneasily at night. Where thought has damaged the spleen, the qi stays and does not move, gathering and accumulating at the middle duct, and one cannot eat or drink, the belly is distended and full, and the four limbs are listless. Where sorrow has damaged the heart enclosure, one is forgetful and does not recognise people, puts a thing down in a place and cannot find it again, the sinews cramp and the four limbs are puffy. Where fear has damaged the kidney, the qi of the upper burner is blocked and does not move, the lower burner turns back and does not disperse, one hesitates and cannot decide, and there is retching and nausea. Where fright has damaged the gallbladder, the spirit has nowhere to return to and the thoughts nowhere to settle, and one speaks of things without meaning to, under pressure.

Clinical note임상 주석

The most clinically useful passage in the section, because it lists what a patient would actually report. 夜臥不安 for grief is insomnia; 置物在處還取不得 for sorrow is the misplacing of objects that the 健忘 section takes up; 猶豫不决 with nausea for fear is indecision with a churning stomach; and 說物不意而迫, speaking without meaning to and under pressure, is pressured speech. 不可疾行, 不可久立 under joy is the one that reads oddly until one takes 喜傷心 as the heart worn out rather than the mood.

Deukhyo 得效

5.8.6

Source원문

靈樞曰, 志意者, 所以御精神, 收魂魄, 適寒溫, 和喜怒者也. 志意和則精神專直, 魂魄不散, 悔怒不起, 五藏不受邪矣.

Translation영역

The Divine Pivot: the will and the intent are what drive the essence and spirit, gather in the two souls, suit oneself to cold and warmth, and harmonise joy and anger. Where will and intent are harmonised, the essence and spirit are concentrated and upright, the two souls do not scatter, regret and anger do not arise, and the five viscera do not receive evil.

Clinical note임상 주석

志意和則 … 五藏不受邪矣 — the section's conclusion, and it reverses the direction of everything before it. The affects damage the viscera, but the will and intent govern the affects, so the last word is not on pathology but on self-regulation. 適寒溫 sits in the same list as harmonising joy and anger: minding the weather and minding the temper are one discipline.

Yeongchu 靈樞

5.8.1 Joy 喜

5.8.1.1

Source원문

內經曰, 心在志爲喜. 又曰, 心實則笑, 笑則喜. 又曰, 暴喜傷陽. 又曰, 喜怒傷氣. 又曰, 喜怒不節, 寒暑過度, 生乃不固. 又曰, 喜則氣緩. 盖喜則氣和志達, 榮衛通利, 故氣緩矣.

Translation영역

The Inner Classic: the heart, in the minds, is joy. It also says: where the heart is replete there is laughter, and laughter is joy. And: sudden joy damages the yang. And: joy and anger damage the qi. And: where joy and anger are not moderated and cold and heat are taken to excess, life is not secure. And: in joy the qi slackens — for in joy the qi is harmonious and the will attains its object, construction and defence pass freely, and so the qi slackens.

Clinical note임상 주석

喜則氣緩 — the only one of the seven in which the qi's motion is benign. The Suwen gives the mechanism as free passage of construction and defence, so slackening here means ease rather than weakness; the harm comes only with 暴喜, joy that is sudden.

Naegyeong 內經

5.8.1.2

Source원문

皇甫謐曰, 喜發於心而成於肺, 故過節則二藏俱傷.

Translation영역

Huangfu Mi: joy arises in the heart and is completed in the lung, and so beyond moderation it damages both viscera.

Hwangbo Mil 皇甫謐

5.8.1.3

Source원문

靈樞曰, 喜樂者神蕩散而不藏. 又曰, 喜樂無極則傷魄, 魄爲肺神也.

Translation영역

The Divine Pivot: in joy and merriment the spirit is washed loose and scattered and is not stored. It also says: joy and merriment without limit damage the corporeal soul — and the corporeal soul is the lung's spirit.

Yeongchu 靈樞

5.8.2 Anger 怒

5.8.2.1

Source원문

內經曰, 肝在志爲怒. 又曰, 暴怒傷陰. 又曰, 大怒則形氣絶而血菀於上, 使人薄厥.菀, 欝也. 薄厥, 謂氣絶也. 又曰, 血幷於上, 氣幷於下, 心煩惋善怒. 又曰, 怒則氣上. 又曰, 怒則氣逆, 甚則嘔血及飱泄矣. 註云, 怒則陽氣逆上而肝木乗脾, 故嘔血及飱泄也. 又曰, 膽爲怒.肝膽之病實則爲怒. 又曰, 陰出之陽則怒.

Translation영역

The Inner Classic: the liver, in the minds, is anger. It also says: sudden anger damages the yin. And: in great anger the bodily qi is cut off and the blood is dammed above, making a man collapse in reversal. 菀 means dammed up; 薄厥 means the qi cut off. And: where the blood crowds above and the qi crowds below, the heart is vexed and fretful and readily angry. And: in anger the qi goes up. And: in anger the qi counterflows, and severely there is vomiting of blood and food-remnant diarrhoea. The commentary says: in anger the yang qi counterflows upward and the liver wood mounts the spleen, and so there is vomiting of blood and food-remnant diarrhoea. And: the gallbladder makes anger. In disease of the liver and gallbladder, repletion makes anger. And: where the yin issues into the yang there is anger.

Clinical note임상 주석

大怒則形氣絶而血菀於上, 使人薄厥 — blood dammed above and the patient collapsing. This is the Suwen's account of what rage can precipitate, and read against modern practice it describes a hypertensive event in anger; 薄厥 is the classical name for the collapse. 嘔血 with the liver mounting the spleen is the other end of the same rise.

Naegyeong 內經

5.8.2.2

Source원문

綱目曰, 怒在陰陽爲陰, 閉遏而不得伸也. 東垣曰, 多怒者, 風熱陷下於地中是也.

Translation영역

The Gangmok: anger, among yin and yang, is yin — shut in and pressed down so that it cannot stretch out. Dongyuan: one given to much anger is wind heat fallen down into the midst of the earth.

Clinical note임상 주석

閉遏而不得伸 — shut in and unable to stretch out. Classing anger as yin runs against the Suwen's rising qi above, and the Gangmok means something different by it: not the outburst but the state that produces outbursts, pressure with no outlet. Dongyuan's image says the same thing in phase language.

Gangmok 綱目 · Dongwon 東垣

5.8.2.3

Source원문

先賢詩曰, 怒來劇炎火, 焚和徒自傷. 觸來勿與競, 事過心淸涼. 柳公度善養生, 年八十餘, 步履輕健. 或求其術, 答曰, 吾無術, 但平生未嘗以元氣佐喜怒, 使氣海常溫耳. 《延壽書》

Translation영역

A poem of the worthies of old: Anger comes like a blazing fire; it burns up harmony and injures only oneself. When it is provoked, do not contend with it; let the matter pass and the heart is cool and clear. Liu Gongdu was good at nourishing life: past eighty, his step was light and strong. Someone asked him his art, and he answered: I have no art. Only, all my life I have never spent my original qi in aid of joy or anger, and so I have kept the sea of qi always warm.

Clinical note임상 주석

未嘗以元氣佐喜怒 — never spending the original qi to fuel joy or anger. The Yanshoushu's answer to an old man's vigour is temperamental rather than medicinal, and it is the chapter's clearest statement that affect regulation is a practice rather than a treatment.

Yeonsuseo 延壽書

5.8.2.4

Source원문

七情傷人, 惟怒爲甚. 盖怒則肝木便克脾土, 脾傷則四藏俱傷矣. 《綱目》

Translation영역

Of the seven affects' damage to a man, anger is the worst. For in anger the liver wood at once restrains the spleen earth, and the spleen damaged, the other four viscera are all damaged.

Gangmok 綱目

5.8.2.5

Source원문

治怒方: 香附末ㆍ甘草末各一兩. 右和勻, 每三錢白湯調下. 《丹心》

Translation영역

A formula for treating anger: powdered cyperus and powdered licorice, 1 nyang each. Mix them evenly and take 3 don at a time, stirred into hot water.

Clinical note임상 주석

Two medicinals, one to move the liver qi and one to sweeten and relax, taken as a draught whenever needed. It is the only formula in the seven sub-sections, and the fact that anger alone gets one matches the passage before it.

Dansim 丹心

5.8.3 Grief 憂

5.8.3.1

Source원문

內經曰, 肺在志爲憂. 又曰, 憂則氣沉.

Translation영역

The Inner Classic: the lung, in the minds, is grief. It also says: in grief the qi sinks.

Naegyeong 內經

5.8.3.2

Source원문

靈樞曰, 愁憂不解則傷意, 意爲脾神也. 又曰, 愁憂者, 氣閉塞而不行. 盖憂則隔塞否閉, 氣脉斷絶而上下不通也. 氣固於內則大小便道偏不得通泄也.

Translation영역

The Divine Pivot: sorrow and grief not released damage the intent — and the intent is the spleen's spirit. It also says: in sorrow and grief the qi is blocked and does not move. For in grief there is partition and stoppage and blockage, the qi and vessels are cut off, and above and below do not communicate. And where the qi is bound within, the passages of stool and urine are kept from discharging freely.

Clinical note임상 주석

大小便道偏不得通泄 — the stool and urine not discharging freely. Grief is assigned to the lung but its damage is laid on the spleen's intent and on the bowels, which is the classical route to what would now be called the gut symptoms of a depressive state.

Yeongchu 靈樞

5.8.4 Thought 思

5.8.4.1

Source원문

內經曰, 脾在志爲思. 又曰, 思則氣結. 註云, 繫心不散, 故氣亦停留而結也.

Translation영역

The Inner Classic: the spleen, in the minds, is thought. It also says: in thought the qi binds. The commentary says: the heart is tied to something and does not let go, and so the qi too stays and binds.

Clinical note임상 주석

繫心不散 — the heart tied to a thing and not letting go, which is rumination rather than thinking. 氣結 is the mechanism the chapter uses for the girl in 5.16 who would not eat.

Naegyeong 內經

5.8.4.2

Source원문

皇甫謐曰, 思發於脾而成於心, 過節則二藏俱傷.

Translation영역

Huangfu Mi: thought arises in the spleen and is completed in the heart, and beyond moderation it damages both viscera.

Hwangbo Mil 皇甫謐

5.8.4.3

Source원문

靈樞曰, 因志而存變謂之思, 因思而遠慕謂之慮. 又曰, 怵惕思慮則傷神, 神傷則恐懼流滛而不止.

Translation영역

The Divine Pivot: to hold change in mind by means of the will is called thought; to long after what is far off by means of thought is called anxiety. It also says: apprehension and anxiety damage the spirit, and the spirit damaged, fear overflows and does not stop.

Clinical note임상 주석

The Lingshu's ladder of mental acts — 志, 思, 慮 — distinguishes holding a matter in mind from reaching after what is out of reach, and it is the second that becomes 怵惕思慮, the apprehensive anxiety that damages the spirit.

Yeongchu 靈樞

5.8.5 Sorrow 悲

5.8.5.1

Source원문

內經曰, 肺之志爲悲. 又曰, 心虛則悲, 悲則憂. 又曰, 精氣幷於肺則悲, 肝虛而肺氣幷之則爲悲. 又曰, 悲則氣消. 又曰, 肺主殺, 故其志爲悲.

Translation영역

The Inner Classic: the lung's mind is sorrow. It also says: where the heart is vacuous there is sorrow, and sorrow becomes grief. And: where the essence qi crowds into the lung there is sorrow — where the liver is vacuous and the lung qi crowds into it there is sorrow. And: in sorrow the qi is consumed. And: the lung governs killing, and so its mind is sorrow.

Clinical note임상 주석

肺主殺 — the lung governs killing, meaning autumn and the cutting down of what has grown. 悲則氣消, the qi consumed, is the one motion among the seven that is neither up, down nor bound but simply spent.

Naegyeong 內經

5.8.5.2

Source원문

靈樞曰, 悲哀動中則傷魂. 又曰, 悲哀動中者, 竭絶而失生.

Translation영역

The Divine Pivot: sorrow and grieving stirring within damage the ethereal soul. It also says: in one whose sorrow and grieving stir within, the stores are exhausted and life is lost.

Yeongchu 靈樞

5.8.6 Fright 驚

5.8.6.1

Source원문

詳見驚悸類.

Translation영역

See in full under Fright Palpitations.

Clinical note임상 주석

The one sub-section with no content of its own: fright is treated at 5.9, where the Bogam also gives its differential against fear and Zhang Zihe's case of treating it by exposure.

Donguibogam · Sin

5.8.7 Fear 恐

5.8.7.1

Source원문

內經曰, 腎在志爲恐. 又曰, 胃爲恐. 註曰, 胃熱則腎氣微弱, 故爲恐. 又曰, 精氣幷於腎則恐, 由心虛而腎氣並之, 故爲恐.

Translation영역

The Inner Classic: the kidney, in the minds, is fear. It also says: the stomach makes fear. The commentary says: where the stomach is hot the kidney qi is faint and weak, and so there is fear. And: where the essence qi crowds into the kidney there is fear — it is that the heart is vacuous and the kidney qi crowds into it, and so there is fear.

Naegyeong 內經

5.8.7.2

Source원문

靈樞曰, 足少陰之脉病善恐. 又曰, 恐懼而不解則傷精. 又曰, 恐懼者, 神蕩散而不收. 又曰, 恐則氣下. 註曰, 上焦固禁, 下焦氣還, 故氣不行矣.

Translation영역

The Divine Pivot: in disease of the foot lesser yin vessel one is readily afraid. It also says: fear not released damages the essence. And: in one who is afraid, the spirit is washed loose and scattered and is not gathered in. And: in fear the qi goes down. The commentary says: the upper burner is held shut and the lower burner's qi turns back, and so the qi does not move.

Yeongchu 靈樞

5.8.7.3

Source원문

子和曰, 肝藏血, 血不足則恐. 盖肝膽實則怒而勇敢, 虛則善恐而不敢也.

Translation영역

Zihe: the liver stores blood, and where the blood is insufficient there is fear. For where liver and gallbladder are replete one is angry and bold; vacuous, one is readily afraid and not bold.

Jahwa 子和

5.8.7.4

Source원문

綱目曰, 恐與驚相似, 然驚者爲自不知也, 恐者爲自知也. 盖驚者聞響乃驚, 恐者自知如人將捕之狀, 及不能獨自坐臥, 必須人爲伴侶方不恐懼, 或夜必用燈照, 無燈燭亦恐懼者是也.

Translation영역

The Gangmok: fear and fright resemble each other, but in fright one does not know it of oneself, while in fear one does. For in fright one hears a noise and is startled; in fear one knows the feeling oneself, as though someone were about to seize one, and cannot sit or lie alone but must have a companion before the dread will go, or must have a lamp burning at night and is afraid without candle or lamp.

Clinical note임상 주석

The best clinical paragraph in the seven sub-sections, and it separates the two states by exactly the right criterion: fright is a reflex the patient does not author, fear is a state the patient is aware of. 不能獨自坐臥, 必須人爲伴侶 and the lamp at night are the behaviours — not being able to be alone, and needing a light — that mark an anxiety disorder rather than a startle.

Gangmok 綱目

5.9 Fright palpitations 驚悸

5.9.1

Source원문

內經曰, 血幷於陰, 氣幷於陽, 故爲驚狂.

Translation영역

The Inner Classic: the blood crowds into the yin and the qi crowds into the yang, and so there is fright and mania.

Naegyeong 內經

5.9.2

Source원문

內經註曰, 悸者心跳動也.

Translation영역

The commentary on the Inner Classic: 悸 is the heart leaping and stirring.

Naegyeong 內經 (commentary)

5.9.3

Source원문

綱目曰, 驚者心卒動而不寧也; 悸者心跳動而怕驚也.

Translation영역

The Gangmok: 驚 is the heart stirring all at once and not settling; 悸 is the heart leaping and stirring with a dread of being startled.

Clinical note임상 주석

The distinction the whole section turns on. 驚 is the startle itself — sudden, outward in its cause; 悸 is the awareness of the heart beating, with an anticipatory dread attached. In modern terms, a startle response against a palpitation with anxiety about it.

Gangmok 綱目

5.9.4

Source원문

三因曰, 驚悸因事有所大驚而成者, 名曰心驚膽懾, 病在心膽經, 其脉大動, 宜朱砂安神丸ㆍ鎭心丹ㆍ加味溫膽湯.

Translation영역

The Samin: where fright palpitation is brought on by some matter in which the patient has had a great fright, it is named the heart frightened and the gall cowed; the disease is in the heart and gallbladder channels and the pulse is large and stirring. Cinnabar Quiet the Spirit Pill, Settle the Heart Elixir and Supplemented Warm the Gallbladder Decoction are appropriate.

Clinical note임상 주석

心驚膽懾 — the heart frightened and the gall cowed. The gallbladder's part in fright is a fixed idea in this chapter, and it is why 溫膽湯, a gallbladder formula, is the standing treatment for an anxiety state. **朱砂安神丸 and 鎭心丹 are built on cinnabar and are not to be prepared.**

Samin 三因

5.9.5

Source원문

仲景曰, 心悸者, 火懼水也, 惟腎欺心, 故爲悸. 傷寒飮水多, 必心下悸.

Translation영역

Zhang Zhongjing: in heart palpitation, fire fears water; it is only that the kidney bullies the heart, and so there is palpitation. In cold damage, where much water is drunk there is certain to be palpitation below the heart.

Clinical note임상 주석

惟腎欺心 — the kidney bullying the heart, water overwhelming fire. Set beside the second half of the passage, Zhongjing's mechanism is about fluid: palpitation after drinking freely in a febrile illness, which is the water-below-the-heart of the next two passages.

Junggyeong 仲景

5.9.6

Source원문

丹溪曰, 驚悸者有時而作, 血虛者宜朱砂安神丸, 有痰者宜加味定志丸. 大槩屬血虛與痰. 瘦人多是血虛, 肥人多是痰飮. 時覺心跳者亦是血虛.

Translation영역

Danxi: fright palpitation comes on at times. Where the blood is vacuous, Cinnabar Quiet the Spirit Pill; where there is phlegm, Supplemented Settle the Will Pill. Broadly it belongs to blood vacuity and to phlegm: a thin man is mostly blood vacuity, a fat man mostly phlegm-rheum. One who feels his heart leap from time to time is also blood vacuity.

Clinical note임상 주석

有時而作 — it comes on at times, which is the paroxysmal course. Danxi's split by body habitus is crude but it is the chapter's working rule, and 血虛 in a thin patient with intermittent palpitation covers what would now be looked at as anaemia or thyrotoxicosis.

Dansim 丹心

5.9.7

Source원문

仲景曰, 食少飮多, 水停心下, 甚者則悸, 微者短氣.

Translation영역

Zhang Zhongjing: where one eats little and drinks much, water stays below the heart; severely there is palpitation, slightly there is shortness of breath.

Junggyeong 仲景

5.9.8

Source원문

三因曰, 五飮停蓄, 閉於中脘, 最使人驚悸, 屬飮家.

Translation영역

The Samin: where the five rheums stay and gather and block at the middle duct, they most of all make a man have fright palpitation; it belongs to the rheum class.

Samin 三因

5.9.9

Source원문

入門曰, 驚悸因思慮過度及大驚恐而作, 甚則心跳欲厥, 宜淸心補血湯ㆍ辰砂妙香散. 氣血俱虛宜養心湯. 時作時止者, 痰因火動, 二陳湯加枳實ㆍ麥門冬ㆍ竹茹ㆍ黃連ㆍ梔子ㆍ人參ㆍ白朮ㆍ當歸ㆍ烏梅, 薑三片ㆍ棗一枚煎, 入竹瀝三匙ㆍ朱砂末三分調服.方見痰飮

Translation영역

The Immun: fright palpitation is brought on by excessive thought and anxiety or by a great fright or fear, and severely the heart leaps so that the patient is near to collapse. Clear the Heart and Supplement the Blood Decoction and Cinnabar Wondrous Fragrance Powder are appropriate. Where qi and blood are both vacuous, Nourish the Heart Decoction. Where it comes and goes, phlegm is stirring because of fire: Two Matured Ingredients Decoction formula in the Phlegm-Rheum chapter with immature bitter orange, ophiopogon, bamboo shavings, coptis, gardenia, ginseng, white atractylodes, angelica and smoked plum added, decocted with three slices of ginger and one jujube, and taken with three spoons of bamboo sap and 3 fun of powdered cinnabar stirred in.

Clinical note임상 주석

甚則心跳欲厥 — the heart leaping so that the patient is near collapse, which with 思慮過度 before it is a panic attack as plainly as the language allows. The decoction is 溫膽湯 in all but name, with 竹瀝 and cinnabar added. **The cinnabar must be left out.**

Immun 入門

5.9.10

Source원문

驚悸當補血安神, 宜靜神丹ㆍ寧志元ㆍ養血安神湯ㆍ朱砂膏. 若氣欝驚悸, 宜交感丹方見氣部ㆍ加味四七湯. 《諸方》

Translation영역

In fright palpitation the blood should be supplemented and the spirit quieted: Quiet the Spirit Elixir, Quiet the Will Pill, Nourish the Blood and Quiet the Spirit Decoction and Cinnabar Paste. Where qi depression causes the fright palpitation, Interact Elixir formula in the Qi chapter and Supplemented Four-Seven Decoction.

Clinical note임상 주석

補血安神 — the chapter's standing prescription for the condition, against which the phlegm-and-fire line of the passages above is the alternative. 加味四七湯 for 氣欝驚悸 is the one aimed at the globus-and-palpitation presentation. **朱砂膏 is a cinnabar preparation and is not to be prepared.**

Jebang 諸方

5.9.1 Treating fright by making it ordinary 常法治驚

5.9.1.1

Source원문

一婦人夜値盜劫, 大驚, 自後聞有響則驚倒不省. 醫作心病治, 不效. 戴人見之曰, 驚者爲陽, 從外入; 恐者爲陰, 從內出. 驚者爲自不知也, 恐者爲自知也. 膽者敢也, 驚怕則膽傷矣. 乃執兩手按於交椅上, 當前置一几, 謂之曰, 娘子當視此. 一木猛擊之, 其婦大驚. 竢少時又擊之, 驚少緩. 連擊四五次, 然後徐徐驚定而嘆曰, 是何治法? 戴人曰, 驚者平之, 平者常也, 平常見之, 必無驚矣. 是夜擊門窓, 自昏達曙, 熟臥不聞. 夫驚者神上越也, 從下擊几, 使之下視, 所以收神也. 《張子和》

Translation영역

A woman met with robbers in the night and had a great fright, and from then on, whenever she heard a noise, she fell in fright and knew nothing. The physicians treated it as a heart disease, without effect. Daeren saw her and said: fright is yang and comes in from outside; fear is yin and comes out from within. In fright one does not know it of oneself; in fear one does. 膽, the gall, means daring, and where there is fright and dread the gall is damaged. So he took both her hands and pressed them down on the arms of a folding chair, set a low table in front of her, and said to her: madam, look at this. He struck it hard with a piece of wood, and the woman was greatly frightened. He waited a little and struck it again, and the fright was somewhat less. He struck it four or five times running, and then little by little the fright settled, and she sighed and said: what manner of treatment is this? Daeren said: fright is treated by levelling it, and to level is to make ordinary; see a thing as ordinary and there will be no fright in it. That night they beat on the doors and windows from dusk until dawn, and she slept soundly and did not hear. Fright is the spirit leaping upward; striking the table low down, so that she had to look down, is the way to gather the spirit in.

Clinical note임상 주석

驚者平之, 平者常也 — treat fright by levelling it, and to level is to make ordinary. This is graded exposure, described in the twelfth century and carried out exactly as it would be now: a safe setting, a controlled stimulus, repetition until the response extinguishes, then a harder trial the same night. Zhang Zihe's own explanation is in the five-phase language of the spirit leaping up and being drawn down by the gaze, but the procedure is independent of it, and the outcome — sleeping through the noise that had been intolerable — is reported as the test. Set beside the formulas of 5.9, it is the one treatment in the chapter that needs no medicine at all.

Jang Jahwa 張子和

5.10 Fearful throbbing 怔忡

5.10.1

Source원문

戴氏曰, 怔忡者, 心中躁動不安, 惕惕然如人將捕者是也. 多因汲汲富貴, 戚戚貧賤, 不遂所願而成也.

Translation영역

Master Dai: fearful throbbing is the heart within stirring restlessly and not settling, apprehensive as though someone were about to seize one. It is brought on mostly by striving anxiously after wealth and rank, or grieving over poverty and low station, and not getting what one wished for.

Clinical note임상 주석

汲汲富貴, 戚戚貧賤, 不遂所願 — anxious striving after position, or grief at the lack of it, and the wish unfulfilled either way. The Bogam names a social cause for a cardiac symptom, and it names the same one twice: 5.14's withdrawal also comes of 求望高遠, 不得志.

Dai 戴氏

5.10.2

Source원문

綱目曰, 怔忡, 心動而不寧也.

Translation영역

The Gangmok: fearful throbbing is the heart stirring and not settling.

Gangmok 綱目

5.10.3

Source원문

心虛而痰欝則耳聞大聲, 目擊異物, 遇險臨危, 觸事喪志, 使人有惕惕之狀, 是爲驚悸. 心虛而停水則胷中滲漉, 虛氣流動, 水旣上升, 心火惡之, 心不自安, 使人有怏怏之狀, 是爲怔忡. 《直指》

Translation영역

Where the heart is vacuous and phlegm is depressed, then at hearing a loud sound, at the sight of something strange, at meeting a hazard or facing danger, at any matter that costs one one's resolve, the patient is left apprehensive — and this is fright palpitation. Where the heart is vacuous and water stays, then there is a trickling in the chest, the vacuous qi moves about, and once the water has risen the heart fire dislikes it and the heart is not at ease of itself, and the patient is left discontented — and this is fearful throbbing.

Clinical note임상 주석

The Jikji's differential between the chapter's two palpitations, and it is drawn on cause and on mood rather than on the sensation. 驚悸 is provoked from outside and leaves the patient apprehensive, 惕惕; 怔忡 arises from within and leaves him 怏怏, discontented and out of sorts. The water trickling in the chest, 胷中滲漉, is the one physical sign.

Jikji 直指

5.10.4

Source원문

怔忡者, 心中惕惕然動搖而不得安靜, 無時而作者是也. 《正傳》

Translation영역

Fearful throbbing is the heart within stirring apprehensively, unable to be still, and coming on at no set time.

Clinical note임상 주석

無時而作 — coming on at no set time, as against 驚悸's 有時而作 at 5.9. The contrast is the Jeongjeon's addition: fright palpitation has its occasions, fearful throbbing has none.

Jeongjeon 正傳

5.10.5

Source원문

怔忡因驚悸久而成也. 痰在下, 火在上, 參胡溫膽湯加黃連ㆍ梔子ㆍ當歸ㆍ貝母. 氣欝者, 加味四七湯加竹瀝ㆍ薑汁, 或金箔鎭心丸. 停飮者, 二陳湯方見痰飮加茯神ㆍ檳榔ㆍ麥門冬ㆍ沉香, 或朱雀丸. 《入門》

Translation영역

Fearful throbbing comes of fright palpitation having gone on long. Where the phlegm is below and the fire above, Ginseng and Bupleurum Warm the Gallbladder Decoction with coptis, gardenia, angelica and fritillary added. Where qi is depressed, Supplemented Four-Seven Decoction with bamboo sap and ginger juice added, or Gold Leaf Settle the Heart Pill. Where rheum has stayed, Two Matured Ingredients Decoction formula in the Phlegm-Rheum chapter with poria spirit, areca, ophiopogon and aquilaria added, or Vermilion Bird Pill.

Clinical note임상 주석

怔忡因驚悸久而成也 — the Immun makes the two one condition at different stages, which cuts against the Jikji's differential above; the Bogam prints both. Three sub-patterns, each with a base formula and its additions, and all three are modifications of 溫膽湯 or 二陳湯 — phlegm is taken as the common ground. **沉香, aquilaria, is a CITES-listed species and is not to be used.**

Immun 入門

5.10.6

Source원문

心下有水氣怔忪, 宜五苓散方見傷寒ㆍ芎夏湯方見痰飮. 水飮爲證, 頭眩心悸. 《直指》

Translation영역

Where there is water qi below the heart with fearful throbbing, Five Ingredients with Poria Powder formula in the Cold Damage chapter and Chuanxiong and Pinellia Decoction formula in the Phlegm-Rheum chapter are appropriate. Where water rheum makes the condition, there is dizziness of the head and palpitation of the heart.

Clinical note임상 주석

頭眩心悸 — dizziness with palpitation, treated with two diuretic formulas. Read with the Zhongjing passages at 5.9, this is the chapter's fluid-overload picture, and the treatment is to move the water rather than to quiet the heart.

Jikji 直指

5.10.7

Source원문

怔忡亦曰怔忪, 與驚悸同看. 宜益榮湯ㆍ茯苓飮子ㆍ安神補心湯ㆍ薑朮湯ㆍ朱雀丸ㆍ四物安神湯ㆍ辰砂寧志丸ㆍ加味寧神丸ㆍ天王補心丹三方見下.

Translation영역

Fearful throbbing is also called 怔忪, and it is to be viewed together with fright palpitation. Benefit the Construction Decoction, Poria Drink, Quiet the Spirit and Supplement the Heart Decoction, Ginger and Atractylodes Decoction, Vermilion Bird Pill, Four Substances Quiet the Spirit Decoction, Cinnabar Quiet the Will Pill, Supplemented Quiet the Spirit Pill and Heavenly Emperor Supplement the Heart Elixir the last three formulas below are appropriate.

Clinical note임상 주석

與驚悸同看 — to be looked at together with fright palpitation, which is the chapter's practical resolution of the dispute above. **辰砂寧志丸 is a cinnabar preparation and is not to be prepared.**

Jebang 諸方

5.11 Forgetfulness 健忘

5.11.1

Source원문

靈樞曰, 黃帝問, 人之善忘者何氣使然? 岐伯對曰, 上氣不足, 下氣有餘, 腸胃實而心肺虛, 虛則榮衛留於下, 久之不以時上, 故善忘也. 又曰, 腎盛怒而不止則傷志, 志傷則喜忘其前言.

Translation영역

The Divine Pivot: the Yellow Emperor asked, in one who is forgetful, what qi brings it about? Qibo answered: the qi above is insufficient and the qi below is in surplus; the intestines and stomach are replete and the heart and lung vacuous, and being vacuous, construction and defence stay below and in time do not rise when they should — and so he is forgetful. It also says: where the kidney's great anger does not stop, the will is damaged; the will damaged, one readily forgets what one has just said.

Clinical note임상 주석

上氣不足, 下氣有餘 — not enough qi above, too much below, so that construction and defence fail to rise in their time. The Lingshu locates forgetfulness in a failure of supply to the head, and the Bogam's treatment at the end of the section follows from it: build the blood and regulate the spleen rather than treat the memory.

Yeongchu 靈樞

5.11.2

Source원문

內經曰, 血幷於下, 氣幷於上, 亂而喜忘. ○丹溪曰, 健忘之證, 精神短少者多, 亦有痰者. ○戴氏曰, 健忘者, 爲事有始無終, 言談不知首尾. 此以爲病之名, 非生成之愚頑不知人事者.

Translation영역

The Inner Classic says: the Blood gathered below and the Qi gathered above, there is disorder and ready forgetting. — Danxi says: in the pattern of forgetfulness, most have essence and spirit run short; some also have phlegm. — Master Dai says: the forgetful person is one who begins affairs and does not finish them, and who in speaking does not know beginning from end. **This is the name of an illness — not a description of someone born dull and ignorant of human affairs.**

Clinical note임상 주석

Master Dai's closing sentence is the reason this section matters. Starting things and not finishing them, losing the thread mid-sentence — he insists these are the signs of a *condition*, explicitly not evidence that someone is stupid. Four hundred years on, that distinction is still the first thing many patients need to hear, and still one of the harder ones for them to believe about themselves.

Naegyeong 內經 · Dansim 丹心 · Dae-ssi 戴氏

5.11.3

Source원문

健忘者, 陟燃而忘其事, 盡心力思量不來也. 主心脾二經. 盖心之官則思, 脾之官亦主思. 此由思慮過多, 心傷則血耗散, 神不守舍, 脾傷則胃氣衰憊, 而慮愈深. 二者皆令人事卒然而忘也. ○治法, 必先養其心血, 理其脾土, 以凝神定智之劑調理之. 亦當以幽閑之處, 安樂之中, 使其絶於憂慮, 遠其六淫七情, 如此則日漸以安矣. 《醫鑑》

Translation영역

The forgetful person loses hold of a matter all at once, and though they spend the whole of their mind and strength on it, it will not come. It is governed by the two channels of Heart and Spleen — for the office of the Heart is thinking, and the office of the Spleen is likewise thought. It comes of brooding beyond measure: the Heart damaged, the Blood is worn and scattered and the spirit does not keep to its dwelling; the Spleen damaged, the stomach Qi wanes into exhaustion and the brooding grows only deeper. Either of these makes a person forget a matter suddenly. — The method of treatment: one must first nourish the Heart Blood and put the Spleen Earth in order, regulating with preparations that congeal the spirit and settle the wits. And one should also place them in a quiet, secluded spot, in the midst of ease and contentment, so that they are cut off from worry and kept far from the six excesses and seven affects — and so, day by day, they come to peace.

Clinical note임상 주석

Two things here are worth carrying. The first is the vicious circle, stated exactly: overthinking damages the Spleen, and the damaged Spleen makes the brooding deeper. Anyone who has watched their own rumination feed on exhaustion will recognize the loop. The second is that the treatment section names an environment before it names a formula — a quiet place, ease, distance from worry — and treats that as part of the prescription rather than as advice appended to it.

Donguibogam · Sin

5.11.4

Source원문

怔忡久則健忘, 由心脾血少神虧, 引神歸舍丹主之. 或所稟陰魄不足善忘者, 宜定志丸ㆍ開心散. 如年老善忘者, 宜加減固本丸. 《入門》 ○健忘, 宜服加味茯苓湯ㆍ聰明湯ㆍ歸脾湯ㆍ加減補心湯ㆍ天王補心丹ㆍ降心丹ㆍ壯元丸ㆍ加味壽星元ㆍ朱子讀書丸. 《諸方》

Translation영역

Fearful throbbing grown long-standing becomes forgetfulness, by reason of scant Blood and diminished spirit in Heart and Spleen: Insingwisa-dan governs it. Where the endowment of the corporeal soul's Yin is insufficient and one forgets readily: Jeongji-hwan 定志丸 and Gaesim-san 開心散. In the aged who forget readily: Gagamgobon-hwan (Immun 入門). — For forgetfulness one should take Gamibokryeong-tang, Chongmyeong-tang 聰明湯, Gwibi-tang 歸脾湯, Gagambosim-tang, Cheonwangbosim-dan 天王補心丹, Gangsim-dan, Jangwon-hwan, Gamisuseong-won, and Jujadokseo-hwan. — Gongjachimjung-bang 孔子大聖枕中方, taken, makes a person clear of hearing and bright of sight.

Clinical note임상 주석

The first line completes the chapter's arc: panic becomes chronic anxiety, and chronic anxiety long enough becomes forgetfulness. Three sections, one trajectory. The shelf that follows separates the causes rather than the symptoms — one set for the constitutionally timid, another for the aged, another for the depleted — and several of the names give away the world these were written in: the Top Graduate Pill, and Master Zhu's Study Pill.

Immun 入門 · Various formularies 諸方

5.12 The heart throbbing and stirring greatly 心澹澹大動

5.12.1

Source원문

綱目曰, 心澹澹動者, 因痰動也. 謂不怕驚而心自動也. 驚恐亦曰心中澹澹, 謂怕驚而心亦動也. ○靈樞曰, 手厥陰之脉, 是動則心中澹澹大動. 又曰, 膽病者, 心中澹澹, 恐如人將捕. ○內經曰, 太陽司天, 寒淫所勝, 則病心澹澹大動, 是寒傷心主也. ○釋曰, 澹澹, 水搖貌. 此屬飮病, 當用逐水消飮之劑, 二陳湯ㆍ芎夏湯, 皆是也.

Translation영역

The Gangmok says: a heart that throbs and stirs does so because phlegm is stirring — meaning the heart moves of itself, without any fear of being startled. In fright and fear one also speaks of a throbbing within the heart, but there it is fear of a start that makes the heart move. — The Numinous Pivot says: when the hand reverting-Yin vessel is stirred, there is a great throbbing stir within the heart. And: in gallbladder illness, the heart throbs, with fear as though someone were about to seize you. — The Inner Classic says: when greater-Yang governs the heavens and cold excess prevails, the illness is a great throbbing stir of the heart — this is cold damaging the Heart's ruler. — The gloss: *dam-dam* is the appearance of water shaking. This belongs to the rheum illnesses, and one should use preparations that expel water and disperse rheum: Ijin-tang 二陳湯 and Gunghha-tang are both such.

Clinical note임상 주석

A careful distinction inside a symptom that patients describe identically. Palpitations *with* fear belong to the previous sections and get spirit-settling, blood-building treatment. Palpitations *without* fear — the heart simply moving on its own — are read here as fluid, and the gloss makes the image literal: 澹澹 is the look of water sloshing. Its treatment is therefore the opposite of tonifying: drain the water and disperse the rheum. It's the chapter guarding against its own instinct, which by this point is to supplement everything.

Gangmok 綱目 · Yeongchu 靈樞 · Naegyeong 內經

5.12.2

Source원문

心忪, 非心忪也. 內經曰, 胃之大絡, 名曰虛里, 貫膈絡肺, 出於左乳下, 其動應衣, 脉宗氣也. 虛而有痰則動, 更須臾發一陣熱者, 是也. 《資生》

Translation영역

What seems a throbbing heart is sometimes not the heart at all. The Inner Classic says: the great network vessel of the stomach is named the Empty Hamlet; it threads the diaphragm, nets the lung, and issues below the left breast, where its stirring answers against the clothing — this is the pulse of the ancestral Qi. Where there is vacuity with phlegm, it stirs; and there is a brief wave of heat that follows — this is the case.

Clinical note임상 주석

The 'Empty Hamlet' below the left breast, whose beating is strong enough to move a person's clothing, is the apex beat — the visible impulse of the heart against the chest wall — described accurately and given its own name. The clinical point is subtle and modern: a patient reporting palpitations may be feeling a normal, forceful apex beat rather than an arrhythmia, particularly when depleted. Naming that possibility is good practice in any century, though today the way to settle the question is an ECG.

Jasaeng 資生

5.13 Epilepsy and withdrawal 癲癎

5.13.1

Source원문

黃帝問曰, 人生而有病巓疾者, 病名曰何? 安所得之? 歧伯對曰, 病名爲胎病. 此得之在母腹中時, 其母有所大驚, 氣上而不下, 精氣幷居, 故令子發爲巓疾也. 《內經》又曰, 厥成爲癲疾. 又曰, 邪搏陽則爲癲疾.

Translation영역

The Yellow Emperor asked: where a man is born with the falling disease, what is the disease called, and where does he get it? Qibo answered: the disease is called a womb disease. He gets it while he is in his mother's belly: the mother has some great fright, the qi goes up and does not come down, and essence and qi dwell together, and so the child is made to break out in the falling disease. It also says: reversal, completed, becomes withdrawal disease. And: where evil strikes the yang it becomes withdrawal disease.

Clinical note임상 주석

氣上而不下, 精氣幷居 — a fright in pregnancy that drives the qi up and leaves it there. The Suwen's account of congenital epilepsy is the oldest in the literature to place the cause before birth rather than in the child, and the mechanism it gives, qi carried up and not returning, is the same one the chapter uses later for the adult form.

Naegyeong 內經

5.13.2

Source원문

風眩之病, 起於心氣不足, 胷上蓄熱, 實痰熱相感而動風, 風心相亂則悶瞀, 故謂之風眩. 《資生》

Translation영역

Wind dizziness arises from insufficiency of the heart qi with heat amassed above the chest; phlegm repletion and heat answer each other and stir wind, and when wind and heart throw each other into disorder there is oppression and dimming — and so it is called wind dizziness.

Clinical note임상 주석

悶瞀 — oppression in the chest with the sight going dim, which is the aura rather than the fit. 風眩 is the name the Jasaenggyeong gives to what the next passage calls 癲癎 when the phlegm stays below the diaphragm and the patient does not fall.

Jasaeng 資生

5.13.3

Source원문

痰在膈間則眩微不仆, 痰溢膈上則眩甚仆倒於地而不知人, 名之曰癲癎. 大人曰癲, 小兒曰癎, 其實一也. 又曰, 仆倒不省, 皆由邪氣逆上陽分而亂於頭中也. 癲癎者, 痰邪逆上也; 痰邪逆上則頭中氣亂, 頭中氣亂則脉道閉塞, 孔竅不通, 故耳不聞聲, 目不識人, 而昏眩倒仆也. 以其病在頭巓, 故曰癲疾. 《綱目》

Translation영역

Where the phlegm is between the diaphragm and the chest the dizziness is slight and there is no falling; where the phlegm floods above the diaphragm the dizziness is severe and the patient falls to the ground and does not know anyone — and this is named withdrawal-epilepsy. In an adult it is called 癲, in a child 癎, but in fact they are one. It also says: falling and not knowing anything comes always of evil qi counterflowing up into the yang division and throwing the inside of the head into disorder. Withdrawal-epilepsy is phlegm evil counterflowing up; when phlegm evil counterflows up the qi within the head is disordered, and when the qi within the head is disordered the vessel ways are blocked and the orifices do not open — and so the ear does not hear sound, the eye does not know people, and there is dizziness and falling. Because the disease is at the crown of the head, it is called the crown disease.

Clinical note임상 주석

以其病在頭巓, 故曰癲疾 — the Gangmok's etymology: 癲 is read as 巓, the crown, so the disease is named for where it happens rather than for what it looks like. The graded account — phlegm below the diaphragm giving dizziness without a fall, phlegm above it giving the fall — is the Bogam's way of putting the aura and the generalised seizure on one continuum.

Gangmok 綱目

5.13.4

Source원문

癎有五: 肝曰雞癎, 心曰馬癎, 脾曰牛癎, 肺曰羊癎, 腎曰猪癎. 以病狀偶類, 故爲名, 其實痰ㆍ火與驚三者而已. 《入門》

Translation영역

There are five epilepsies: of the liver the fowl epilepsy, of the heart the horse epilepsy, of the spleen the ox epilepsy, of the lung the sheep epilepsy, of the kidney the pig epilepsy. They are named because the look of the illness happens to resemble those creatures; in fact they are no more than three things — phlegm, fire and fright.

Clinical note임상 주석

以病狀偶類, 故爲名 — named by chance resemblance, and the Immun says so in the act of listing them. The five animal cries were taken from the sound the patient makes at the onset; the sentence that follows is the Bogam's own correction, reducing the five to three mechanisms and so to three lines of treatment.

Immun 入門

5.13.5

Source원문

大率多因痰結於心胷間, 宜開痰鎭心神. 若神不守舍, 狂言妄作, 經年不愈, 如心經蓄熱, 當淸心除熱; 如痰迷心竅, 當去痰寧心, 宜大吐大下而愈. 《正傳》

Translation영역

As a rule it comes mostly of phlegm bound between the heart and the chest, and phlegm should be opened and the heart spirit settled. Where the spirit does not keep to its house, the speech is mad and the acts are wild, and years pass without healing: if there is heat amassed in the heart channel, the heart should be cleared and the heat removed; if phlegm confuses the heart's orifice, the phlegm should be driven out and the heart quieted — and it heals by great ejection and great precipitation.

Clinical note임상 주석

宜大吐大下而愈 — ejection above and precipitation below, both at full strength. This is the chapter's most aggressive line, and 5.18 repeats it as the standing rule for chronic cases. The reasoning holds only while the fit is read as phlegm to be removed.

Jeongjeon 正傳

5.13.6

Source원문

凡癲癎仆時口中作聲, 將省時吐涎沫, 省後又復發, 時作時止而不休息. 中風ㆍ中寒ㆍ中暑ㆍ尸厥之類則仆時無聲, 省時無涎, 後不再發. 《綱目》

Translation영역

In withdrawal-epilepsy, at the moment of falling a sound is made in the mouth; as the patient comes round he spits foam; and after he has come round it breaks out again — now happening, now stopping, and never at rest. In wind stroke, cold stroke, summerheat stroke, corpse reversal and their like, there is no sound at the moment of falling, no foam when the patient comes round, and no recurrence afterwards.

Clinical note임상 주석

The differential, and it is a good one. The ictal cry, the frothing at the mouth and above all the recurrence are exactly the three features that still separate a seizure from a faint, a stroke or heat collapse at the bedside. 時作時止而不休息 — the paroxysmal course is the diagnosis.

Gangmok 綱目

5.13.7

Source원문

癲者, 異常也. 平日能言, 癎則沉黙; 平日不言, 癲則呻吟. 甚則僵仆直視, 心常不樂, 言語無倫, 如醉如痴. 癎者, 卒然暈倒, 咬牙作聲, 吐涎沫, 不省人事, 隨後醒醒.

Translation영역

癲 means out of the ordinary. One who could speak every other day falls silent in the fit; one who did not speak groans in it. In severe cases he lies stiff and prostrate staring straight ahead, his heart is never glad, his speech has no order, and he is as if drunk, as if witless. 癎 is to faint and fall all at once, to grind the teeth so that they sound, to spit foam, to know nothing — and then presently to come round.

Clinical note임상 주석

The Bogam's own summary, and the one place it separates the two words it has just called one. 癎 here is the discrete fit with a clear ending; 癲 is the lasting change in speech and mood between fits. 隨後醒醒, coming round presently, is what makes the first a seizure and the second a psychosis.

Donguibogam · Sin

5.13.8

Source원문

胎癎宜燒丹丸. 又身熱脉浮爲陽癎, 宜妙香丸方見火門; 身凉脉沉爲陰癎, 宜五生丸. 肥人多痰, 宜追風祛痰丸ㆍ加味壽星元ㆍ引神歸舍丹; 瘦人火盛, 宜淸心滾痰丸ㆍ龍腦安神丸. 痰迷心竅, 宜金箔鎭心丸ㆍ控涎丸. 痰火俱盛者, 宜甘遂散吐下之. 因驚者宜驚氣元ㆍ抱膽丸; 因怒者宜寧神導痰湯方見風門ㆍ當歸龍薈丸方見五藏. 心藏虛損, 氣血不足, 宜滋陰寧神湯ㆍ淸心溫膽湯ㆍ歸神丹. 婦人宜加味逍遙散方見婦人ㆍ朱砂膏見上. 五癎通治宜龍腦安神丸ㆍ五癎丸ㆍ六珎丹ㆍ錢氏五色丸ㆍ育魂丹ㆍ丑寶丸ㆍ鴟頭丸ㆍ活虎丹ㆍ蝙蝠散ㆍ礬丹丸. 癎愈復發宜斷癎丹. 《諸方》

Translation영역

For womb epilepsy, Burnt Cinnabar Pill. Where the body is hot and the pulse floating it is yang epilepsy, and Wondrous Fragrance Pill formula in the Fire chapter is appropriate; where the body is cool and the pulse sunken it is yin epilepsy, and Five Raw Ingredients Pill is appropriate. A fat man has much phlegm: Chase the Wind and Dispel Phlegm Pill, Supplemented Longevity Star Pill and Lead the Spirit Home Elixir. A thin man has exuberant fire: Clear the Heart and Roll the Phlegm Pill and Borneol Quiet the Spirit Pill. Where phlegm confuses the heart's orifice, Gold Leaf Settle the Heart Pill and Control the Drool Pill. Where phlegm and fire are both exuberant, Kansui Powder to eject and precipitate. Where it comes of fright, Fright Qi Pill and Embrace the Gall Pill; where of anger, Quiet the Spirit and Abduct Phlegm Decoction formula in the Wind chapter and Angelica, Gentian and Aloe Pill formula in the Five Viscera chapter. Where the heart viscus is vacuous and damaged and qi and blood insufficient, Enrich Yin and Quiet the Spirit Decoction, Clear the Heart and Warm the Gallbladder Decoction and Return the Spirit Elixir. For a woman, Supplemented Free and Easy Wanderer Powder formula in the Women chapter and Cinnabar Paste formula above. For the five epilepsies in general, Borneol Quiet the Spirit Pill, Five Epilepsies Pill, Six Treasures Elixir, Qian's Five Colours Pill, Nourish the Soul Elixir, Ox Treasure Pill, Kite's Head Pill, Live Tiger Elixir, Bat Powder and Alum and Cinnabar Pill. Where the epilepsy heals and then breaks out again, Cut Off Epilepsy Elixir.

Clinical note임상 주석

Thirty-one formulas, sorted not by the five epilepsies but by body habitus, by trigger and by what is left after the fit — fat or thin, fright or anger, and the heart viscus worn down by years of fits. That is the chapter's real taxonomy, and it is more useful than the animal names. **Several of these are not to be prepared.** 朱砂膏 and 錢氏五色丸 are built on cinnabar, 礬丹丸 on alum with cinnabar, 葉氏雄朱丸 on realgar with cinnabar; 控涎丸 and 甘遂散 are kansui, a drastic purgative; 鴟頭丸, 活虎丹 and 蝙蝠散 are made from protected animals.

Jebang 諸方

5.14 Mania and withdrawal 癲狂

5.14.1

Source원문

內經曰, 黃帝問曰, 有病怒狂者, 此病安生? 歧伯對曰, 生於陽也. 帝曰, 陽何以使人狂? 歧伯曰, 陽氣者, 因暴折而難决, 故善怒也, 病名曰陽厥. 帝曰, 治之柰何? 歧伯曰, 奪其食卽已. 夫食入於陰, 長氣於陽, 故奪其食卽已, 使之服以生鐵洛爲飮. 夫生鐵洛者, 下氣疾也.

Translation영역

The Inner Classic: the Yellow Emperor asked, where there is the disease of angry mania, how does this disease arise? Qibo answered, it arises from the yang. The Emperor said, how does the yang make a man mad? Qibo said, the yang qi, being abruptly broken off and unable to resolve itself, grows easily angry, and the disease is named yang reversal. The Emperor said, how is it treated? Qibo said, take his food away and it stops. Food enters at the yin and grows qi at the yang, and so taking his food away stops it; and have him drink a draught made with iron filings. Iron filings bring the qi down fast.

Clinical note임상 주석

奪其食卽已 — starve him and it stops. The reasoning is that food entering at the yin feeds the yang that is already in excess, and it is the oldest treatment for mania on record. 生鐵洛, iron filings quenched in water, remained in use for agitated states into the twentieth century; 下氣疾也, it brings the qi down fast, is as plain a statement of a sedative effect as the classical language allows. Neither measure is one to repeat — withholding food from an agitated patient is dangerous, and iron is not a sedative.

Naegyeong 內經

5.14.2

Source원문

又曰, 多喜曰癲, 多怒曰狂. 又曰, 陰不勝其陽則脉流薄疾, 幷乃狂. 又曰, 衣被不歛, 言語善惡不避親疎, 此神明之亂也.

Translation영역

It also says: much joy is called withdrawal, much anger is called mania. And: where the yin cannot overcome the yang, the vessels run thin and fast, and when they crowd together there is mania. And: the clothes and bedding are not kept in order, and the speech, good or bad, spares neither kin nor stranger — this is the disorder of the spirit brightness.

Clinical note임상 주석

衣被不歛, 言語善惡不避親疎 — not keeping one's clothes in order and speaking without regard to who is present. Two signs, both behavioural, and both still part of how a manic episode is recognised. The Suwen's 神明之亂 is the nearest thing in the classical literature to a diagnosis of psychosis as such.

Naegyeong 內經

5.14.3

Source원문

又帝曰, 陽明病甚則棄衣而走, 登高而歌, 或至不食數日, 踰垣上屋, 所上之處皆非其素所能也, 病反能者何也? 歧伯曰, 四肢者諸陽之本也, 陽盛則四肢實, 實則能登高也. 帝曰, 其棄衣而走者何也? 歧伯曰, 熱甚於身, 故棄衣欲走也. 帝曰, 其妄言罵詈不避親疎而歌者何也? 歧伯曰, 陽盛則使人妄言罵詈不避親疎而不欲食, 不欲食故妄走也. 又曰, 邪入於陽則狂.

Translation영역

The Emperor said again: when yang brightness disease is severe the patient throws off his clothes and runs, climbs high and sings, sometimes goes some days without eating, leaps walls and climbs onto roofs — and the places he climbs are none of them places he could manage ordinarily. Why is it that, ill, he can do more? Qibo said: the four limbs are the root of all the yang; when the yang is exuberant the four limbs are replete, and being replete he can climb high. The Emperor said: and his throwing off his clothes and running? Qibo said: the heat is severe in his body, and so he throws off his clothes and wants to run. The Emperor said: and his wild talk and cursing, sparing neither kin nor stranger, and his singing? Qibo said: when the yang is exuberant it makes a man talk wildly and curse without regard to kin or stranger and not want to eat, and not wanting to eat he runs wild. It also says: where evil enters the yang there is mania.

Clinical note임상 주석

所上之處皆非其素所能也 — he climbs where ordinarily he could not. The Emperor asks the right question, and the answer, that the yang filling the limbs lends strength, is the classical account of the raised energy and lost fatigue of mania. The clinical picture here — undressing, singing, climbing, not sleeping, not eating, pressured abusive speech — is a recognisable manic episode, described two millennia before it had a name.

Naegyeong 內經

5.14.4

Source원문

難經曰, 重陽者狂, 重陰者癲. 又曰, 狂之始發, 少臥而多起, 自高賢也, 自辨智也, 自貴倨也, 妄笑好歌樂, 妄行不休是也. 癲疾始發, 意不樂, 直視僵仆, 其脉三部陰陽俱盛者是也.

Translation영역

The Classic of Difficult Issues: doubled yang is mania, doubled yin is withdrawal. And: when mania first breaks out, the patient lies down little and gets up often, holds himself lofty and worthy, holds himself quick and wise, holds himself noble and haughty, laughs wildly and is fond of singing and merriment, and goes about wildly without rest. When withdrawal disease first breaks out, the mind is not glad, the gaze is fixed and the body falls stiff, and the pulse at all three bars is exuberant in both yin and yang.

Clinical note임상 주석

少臥而多起 … 自高賢也, 自辨智也, 自貴倨也 — sleeping little, and the three self-regarding postures: lofty, clever, grand. The Nanjing's list reads almost as a modern criterion set for a manic episode: reduced need for sleep, inflated self-esteem, increased activity, and pressured elevated mood.

Nangyeong 難經

5.14.5

Source원문

癲者, 異常也, 精神痴呆, 言語失倫. 狂者, 凶狂也, 輕則自高自是, 好歌好舞; 甚則棄衣走而踰垣上屋; 又甚則披頭大呌, 不避水火, 且欲殺人. 此痰火壅盛而然. 《入門》

Translation영역

癲 means out of the ordinary: the spirit is dull and witless and the speech has lost its order. 狂 means fierce and wild: lightly, the patient holds himself lofty and right and is fond of singing and dancing; severely, he throws off his clothes and runs, leaping walls and climbing roofs; more severely still, he goes with his hair loose, shouting, heedless of water or fire, and means to kill. This comes of phlegm and fire congested and exuberant.

Clinical note임상 주석

不避水火, 且欲殺人 — heedless of water or fire and meaning to kill. The Immun grades mania by severity and puts the danger to others at the top of the scale, which is the one judgement in this chapter that still has to be made the same way at the bedside.

Immun 入門

5.14.6

Source원문

陽虛陰實則癲, 陰虛陽實則狂. 又曰, 陽盛則狂, 狂者欲奔走呌呼; 陰盛則癲, 癲者眩倒不省. 《百要》

Translation영역

Where the yang is vacuous and the yin replete there is withdrawal; where the yin is vacuous and the yang replete there is mania. It also says: when the yang is exuberant there is mania, and the manic patient wants to run about and shout; when the yin is exuberant there is withdrawal, and the withdrawn patient falls dizzy and knows nothing.

Clinical note임상 주석

The same yin-yang opposition as the Nanjing, read as vacuity and repletion rather than doubling. Note that 癲 here has slid back to the falling fit of 5.13 rather than the dullness of the passage before — the chapter never settles the word, and the next passage says as much.

Baekyo 百要

5.14.7

Source원문

狂謂妄言妄走也, 癲謂僵仆不省也. 經有言狂癲疾者, 又言癲疾爲狂者, 是癲狂爲兼病也. 《綱目》

Translation영역

狂 means wild speech and wild running; 癲 means falling stiff and knowing nothing. The classics speak in one place of mania-withdrawal disease and in another of withdrawal disease turning into mania — and so withdrawal and mania are a combined disease.

Clinical note임상 주석

是癲狂爲兼病也 — the Gangmok's resolution, and it is an honest one: the classics use the two words inconsistently because the two states occur in the same patients. The chapter's closing line repeats it.

Gangmok 綱目

5.14.8

Source원문

火盛癲狂宜當歸承氣湯ㆍ三黃瀉心湯方見寒門ㆍ黃連瀉心湯ㆍ牛黃瀉心湯. 痰火欝塞癲狂宜牛黃淸心元方見風門ㆍ淸心滾痰丸方見上. 風痰迷心癲狂宜鐵粉散ㆍ欝金丸ㆍ通泄散. 因驚喪心亡魂失魄爲癲狂宜鎭心丹ㆍ抱膽丸ㆍ葉氏雄朱丸ㆍ一醉膏. 勞神過度甚至癲狂宜辰砂寧志丸ㆍ寧志化痰湯ㆍ養血淸心湯ㆍ牛車肉. 癲狂不得睡臥宜寧志膏方見夢部ㆍ辰砂散. 《諸方》

Translation영역

For withdrawal-mania with exuberant fire, Angelica Order the Qi Decoction, Three Yellows Drain the Heart Decoction formula in the Cold Damage chapter, Coptis Drain the Heart Decoction and Bezoar Drain the Heart Decoction. For withdrawal-mania with phlegm and fire congested and blocking, Bezoar Clear the Heart Pill formula in the Wind chapter and Clear the Heart and Roll the Phlegm Pill formula above. For withdrawal-mania with wind phlegm confusing the heart, Iron Powder Powder, Curcuma Pill and Free the Flow Powder. Where fright has cost the patient his mind and his soul is lost, Settle the Heart Elixir, Embrace the Gall Pill, Ye's Realgar and Cinnabar Pill and Single Drunkenness Paste. Where overtaxing the spirit has gone as far as withdrawal-mania, Cinnabar Quiet the Will Pill, Quiet the Will and Transform Phlegm Decoction, Nourish the Blood and Clear the Heart Decoction and Ox Tripe and Placenta. Where in withdrawal-mania the patient cannot sleep, Quiet the Will Paste formula in the Dreams chapter and Cinnabar Powder.

Clinical note임상 주석

Sorted by cause rather than by severity — fire, phlegm-fire, wind-phlegm, fright, and overwork — with sleeplessness treated separately at the end. 牛車肉, ox tripe and placenta boiled and eaten, is the chapter's one formula that is a food rather than a medicine. **Several of these are not to be prepared.** 鎭心丹, 辰砂寧志丸, 辰砂散 and 朱砂膏 are built on cinnabar, 葉氏雄朱丸 on realgar with cinnabar, 鐵粉散 on iron and 一醉膏 on spirits taken to insensibility.

Jebang 諸方

5.14.9

Source원문

癲者, 顚倒錯亂, 於癎於狂皆兼病也.

Translation영역

癲 is to be overturned and thrown into confusion, and with epilepsy and with mania alike it is a combined disease.

Clinical note임상 주석

The chapter's last word on the three names, and it declines to separate them: 癲 overlaps the fit on one side and the mania on the other. Read against 5.13, the Bogam is describing what modern practice splits into epilepsy, the post-ictal and interictal psychoses, and bipolar mania — and it is candid that its own sources cannot tell them apart.

Donguibogam · Sin

5.14.1 Mania healed by great precipitation 大下愈狂

5.14.1.1

Source원문

一人病陽厥狂怒, 罵詈, 或歌或哭, 六脉無力, 身表如氷石, 發則呌呼高聲. 易老曰, 奪食則已. 因不與食, 又以大承氣湯方見寒門下之五七行, 瀉渣穢數斗, 身溫脉生而愈. 《綱目》

Translation영역

A man was ill with yang reversal: mania and anger, cursing, now singing and now weeping; the pulse at all six positions was without strength and the surface of his body was like ice and stone, and when it came on he shouted in a loud voice. Yeongno said: take his food away and it will stop. So food was withheld, and Great Order the Qi Decoction formula in the Cold Damage chapter was also given to precipitate him five to seven times; he passed several mal of foul dregs, his body grew warm, the pulse came up, and he recovered.

Clinical note임상 주석

六脉無力, 身表如氷石 — no strength in the pulse and a surface cold as ice, in a man shouting with mania. The cold surface with heat bound within is the 陽厥 of 5.14's first passage, and it is the reason the case is printed: the presentation argues for warming and the treatment given is a drastic purge. 奪食則已 is the Suwen's own measure, applied here as it was written.

Gangmok 綱目

5.14.1.2

Source원문

一叟値徭役煩擾而暴發狂, 口鼻覺如蟲行, 兩手爬搔, 數年不已, 脉皆洪大如絙. 戴人斷之曰, 肝主謀, 膽主决. 徭役迫遽, 財不能支, 則肝屢謀而膽屢不能决, 屈無所伸, 怒無所泄, 心火盤礡, 乗陽明金. 然胃本屬土而肝屬木, 膽屬相火, 火隨木氣而入胃, 故暴發狂. 乃置燠室中, 涌而汗出三次, 又以調胃承氣湯方見寒門大下二十餘行, 血水與瘀血相雜而下數升, 來日乃康. 後以通聖散調其後. 《儒門事親》

Translation영역

An old man, harassed by corvée duty, broke out suddenly in mania: he felt as though worms were crawling in his mouth and nose and clawed at himself with both hands, and it did not leave off for some years, and his pulses were all surging and large as a rope. Daeren judged it thus: the liver governs planning and the gallbladder governs deciding. With the corvée pressing hard and his means unable to meet it, the liver planned again and again while the gallbladder could not decide; bent, he had no way to straighten, and angry, no way to vent it, so the heart fire spread wide and mounted the yang brightness metal. But the stomach belongs to earth while the liver belongs to wood and the gallbladder to the ministerial fire, and the fire followed the wood qi into the stomach — and so the mania broke out suddenly. So he put him in a heated room, made him vomit and sweat three times, and also gave Regulate the Stomach and Order the Qi Decoction formula in the Cold Damage chapter to precipitate him more than twenty times; several seung came down of bloody water mixed with static blood, and the next day he was well. Afterwards Sage-Unblocking Powder was used to settle him.

Clinical note임상 주석

肝屢謀而膽屢不能决, 屈無所伸, 怒無所泄 — planning over and over with no power to decide, bent with no way to straighten, angry with no way to vent. Zhang Zihe's formulation of the cause is a psychological one, and it is specific: a tax demand the man could not meet. The sensation of insects in the mouth and nose with constant clawing is a tactile hallucination, and the years of it mark a chronic psychosis rather than an episode. The treatment — heat, induced vomiting and sweating, then purging twenty times over — is violent enough to be dangerous in itself, and the account offers no follow-up beyond the next day.

Yumun Sachin 儒門事親

5.15 Wasted construction and lost essence 脫營失精證

5.15.1

Source원문

內經曰, 嘗貴後賤, 名曰脫營. 嘗富後貧, 名曰失精. 雖不中邪, 病從內生, 身體日減, 氣虛無精, 病深無氣, 洒洒然時驚. 病深者, 以其外耗於衛, 內奪於榮. 註云, 血爲憂煎, 氣隨悲減, 故外耗於衛, 內奪於榮. ○是證令人飮食無味, 神倦肌瘦. 內服交感丹方見氣門, 外用香鹽散方見牙齒擦牙. 《入門》 ○宜嘗服天王補心丹方見下ㆍ加減鎭心丹ㆍ升陽順氣湯ㆍ淸心補血湯方見上.

Translation영역

The Inner Classic says: once honored and afterward humbled — this is called wasted construction. Once wealthy and afterward poor — this is called lost essence. Though no evil has struck them, the illness arises from within: the body diminishes by the day, the Qi is vacuous and the essence gone, and when the illness has gone deep there is no Qi at all, with a chill shuddering and starting from time to time. That the illness goes deep is because the defense is worn away without and the construction is plundered within. The commentary says: the Blood is simmered away by worry, and the Qi diminishes along with grief — hence worn without and plundered within. — In this pattern food and drink have no taste, the spirit is weary and the flesh thin. Internally take Gyogam-dan — formula in the Qi chapter —; externally use Hyangyeom-san — formula in the Teeth chapter — to rub the teeth (Immun 入門). — One should take Cheonwangbosim-dan 天王補心丹 — formula below —, Gagamjinsim-dan 加減鎭心丹, Seungyangsungi-tang 升陽順氣湯, and Cheongsimbohyeol-tang 淸心補血湯 — formula above —.

Clinical note임상 주석

Two illnesses named for a change in circumstance and nothing else — **once honored and afterward humbled; once wealthy and afterward poor.** No pathogen, no exposure: the illness arises from within, and the body visibly diminishes. The commentary supplies the mechanism in one line that is hard to improve on: *the Blood is simmered away by worry, and the Qi diminishes along with grief.* Food loses its taste, the flesh thins, and the person startles at nothing. This is the same territory the Womb chapter enters when it names a reversal of fortune among the causes of abnormal bleeding, and it is the classical ground from which hwa-byeong 火病 later grew — illness from a life that changed and a heart that could not.

Naegyeong 內經 · Immun 入門

5.16 Using the five minds against one another as treatment 五志相勝爲治

5.16.1

Source원문

內經曰, 肝在志爲怒, 怒傷肝, 悲勝怒; 心在志爲喜, 喜傷心, 恐勝喜; 脾在志爲思, 思傷脾, 怒勝思; 肺在志爲憂, 憂傷肺, 喜勝憂; 腎在志爲恐, 恐傷腎, 思勝恐.

Translation영역

The Inner Classic: the liver, in the minds, is anger; anger damages the liver, and sorrow overcomes anger. The heart, in the minds, is joy; joy damages the heart, and fear overcomes joy. The spleen, in the minds, is thought; thought damages the spleen, and anger overcomes thought. The lung, in the minds, is grief; grief damages the lung, and joy overcomes grief. The kidney, in the minds, is fear; fear damages the kidney, and thought overcomes fear.

Clinical note임상 주석

The five minds set in the overcoming cycle, so that each is checked by the one its phase is checked by. The therapeutic claim is in the second clause of each pair: an affect can be treated with another affect, and the next passage turns that into a method.

Naegyeong 內經

5.16.2

Source원문

丹溪曰, 五志之火欝而成痰爲癲狂, 宜以人事制之. 如怒傷肝者, 以憂一作悲勝之, 以恐解之; 喜傷心者, 以恐勝之, 以怒解之; 思傷脾者, 以怒勝之, 以喜解之; 憂傷肺者, 以喜勝之, 以思解之; 恐傷腎者, 以思勝之, 以憂解之; 驚傷膽者, 以憂勝之, 以恐解之; 悲傷心包者, 以恐勝之, 以怒解之. 此法惟賢者能之.

Translation영역

Danxi: where the fire of the five minds is depressed and becomes phlegm, making withdrawal-mania, it should be controlled by human means. Thus where anger has damaged the liver, overcome it with grief one text has sorrow and resolve it with fear; where joy has damaged the heart, overcome it with fear and resolve it with anger; where thought has damaged the spleen, overcome it with anger and resolve it with joy; where grief has damaged the lung, overcome it with joy and resolve it with thought; where fear has damaged the kidney, overcome it with thought and resolve it with grief; where fright has damaged the gallbladder, overcome it with grief and resolve it with fear; where sorrow has damaged the heart enclosure, overcome it with fear and resolve it with anger. Only a man of parts can do this.

Clinical note임상 주석

宜以人事制之 — to be controlled by human means rather than by medicine, which is the whole claim of this section. Danxi extends the Suwen's five pairs to seven by adding the gallbladder and the heart enclosure, and he distinguishes two moves: 勝, overcoming, the affect that counters, and 解, resolving, the one that releases it afterwards. 此法惟賢者能之 is the warning that goes with it — the method depends entirely on the practitioner's judgement, and the two cases that follow show what it looks like done well.

Dansim 丹心

5.16.3

Source원문

一婦人飢不欲食, 常好怒罵, 欲殺左右, 惡言不輟, 衆醫不效. 戴人視之曰, 此難以藥治. 乃使二娼各塗丹粉作伶人狀, 其婦大笑. 次日又作角觝, 又大笑. 其傍常以兩箇能食之婦誇其食美, 病婦亦索食而爲一甞之. 不數日怒減食增, 不藥而差, 後生一子. 夫醫貴有才, 無才則何以應變無窮. 《子和》

Translation영역

A woman was hungry but would not eat; she was always given to angry abuse and meant to kill those about her, and would not leave off foul language, and many physicians had no effect. Daeren saw her and said: this is hard to treat with medicine. So he had two singing girls paint themselves with rouge and powder and play the clown, and the woman laughed aloud. The next day they wrestled, and again she laughed aloud. All the while two women with good appetites were kept beside her praising how good the food was, and the sick woman too asked for food and took a taste of it. Within a few days her anger was less and she ate more; she recovered without medicine, and afterwards bore a son. In a physician what is prized is resourcefulness; without it, how is he to answer the endless turns of a case?

Clinical note임상 주석

A refusal to eat with irritable aggression, treated by making the patient laugh and by having others eat appetisingly beside her. Both halves are recognisable: humour to break a fixed affect, and modelling to restart eating. 夫醫貴有才 — Zhang Zihe's own moral, and the reason the Bogam prints the case rather than a formula.

Jahwa 子和

5.16.4

Source원문

一女許婚後, 夫經商二年不歸. 其女因不食困臥如痴, 無他病, 多向裏床坐. 此思想氣結也. 藥獨難治, 得喜可解; 不然, 令其怒. 予自徃激之, 大怒而哭, 至三時許, 令父母解之, 與藥一貼, 卽求食矣. 予曰, 病雖愈, 必得喜方已. 乃紿以夫回, 旣而果然, 病不擧矣. 盖脾主思, 過思則脾氣結而不食; 怒屬肝木, 怒則木氣升發而衝開脾氣矣. 《丹溪》

Translation영역

A girl was betrothed, and after the betrothal her husband went away trading and did not come back for two years. She would not eat and lay listless as if witless, with no other illness, and mostly sat facing the inside of the bed. This was qi bound by longing. Medicine alone was hard to treat it with: joy could release it, and failing that, she must be made angry. I went myself and provoked her; she grew greatly angry and wept, and after some six hours I had her parents calm her and gave her one packet of medicine, and at once she asked for food. I said: the illness is relieved, but she must have joy before it is done. So they deceived her with word that her husband was returning, and presently he did return, and the illness did not rise again. The spleen governs thought, and excessive thought binds the spleen qi so that one does not eat; anger belongs to liver wood, and anger makes the wood qi rise up and break the spleen qi open.

Clinical note임상 주석

怒則木氣升發而衝開脾氣 — anger makes the wood qi rise and break open the bound spleen qi. The case is an account of what would now be called a depressive withdrawal with refusal of food in a young woman, treated by provoking an affect strong enough to break the fixed state, then held with hope. The deception at the end is the part that does not transfer: it worked here only because the husband did come back.

Dansim 丹心

5.17 Signs in spirit illness that cannot be treated 神病不治證

5.17.1

Source원문

內經曰, 得神者昌, 失神者亡. 失神者, 謂失精神而昏亂者也. ○靈樞曰, 癲疾, 嘔多沃沫, 氣下泄, 不治. ○癲癎之病, 乍作乍醒者甦, 不食迷痴者死. 《得效》 ○凡癲狂癎之病, 若神脫而目瞪如愚痴者, 不可治. 《正傳》 ○靈樞曰, 癲疾者疾發如狂, 死不治.

Translation영역

The Inner Classic: he who keeps the spirit flourishes, he who loses the spirit dies. To lose the spirit is to lose the essence-spirit and be clouded and disordered. The Divine Pivot: in withdrawal disease, where there is much retching of foam and the qi discharges downward, it cannot be treated. Of withdrawal-epilepsy: where it comes and goes with waking between, the patient recovers; where he will not eat and is confused and witless, he dies. In any disease of withdrawal, mania or epilepsy, where the spirit has gone out of him and he stares blankly as though witless, it cannot be treated. The Divine Pivot: where withdrawal disease breaks out suddenly as mania, the patient dies and cannot be treated.

Clinical note임상 주석

乍作乍醒者甦, 不食迷痴者死 — the one prognostic distinction in the section, and it is the right one: recovery between episodes is the favourable sign, while a state that does not lift, with refusal of food and a vacant stare, is not. 氣下泄 with persistent vomiting of froth describes the exhausted, incontinent patient after prolonged seizures — status epilepticus, and still the dangerous presentation.

Naegyeong 內經 · Yeongchu 靈樞 · Deukhyo 得效 · Jeongjeon 正傳

5.18 The rule for using medicines in spirit illness 神病用藥訣

5.18.1

Source원문

人之所主者心, 心之所養者血. 心血一虛, 神氣不守, 此驚悸之所肇端也. 驚者, 恐怖之謂; 悸者, 怔忪之謂. 驚者與之豁痰定驚之劑, 悸者與之逐水消飮之劑. 怔忪卽怔忡也. 《直指》

Translation영역

What presides in a man is the heart, and what nourishes the heart is the blood. Once the heart blood is vacuous the spirit qi does not keep its guard, and this is where fright palpitation begins. 驚 means dread and fear; 悸 means fearful throbbing. To the one give a medicine that opens phlegm and settles fright; to the other, a medicine that expels water and disperses rheum. 怔忪 is the same as 怔忡.

Clinical note임상 주석

The chapter's two palpitations and their two prescriptions, set out as a rule: phlegm for fright, water for throbbing. It reads as a summary of 5.9 and 5.10 written for the bedside.

Jikji 直指

5.18.2

Source원문

健忘者, 心脾二藏血少神虧故也, 宜養血安神以調之. 《醫鑑》

Translation영역

Forgetfulness is because the blood of the two viscera, heart and spleen, is scant and the spirit depleted; it should be regulated by nourishing the blood and quieting the spirit.

Uigam 醫鑑

5.18.3

Source원문

狂爲痰火實盛, 癲爲心血不足, 多爲求望高遠不得志者有之. 癎病獨主乎痰, 因火動之所作也. 治法, 癎宜乎吐, 狂宜乎下, 癲則宜乎安神養血, 兼降痰火. 《正傳》

Translation영역

Mania is phlegm and fire replete and exuberant; withdrawal is the heart blood insufficient, and it is found mostly in those who have reached high and far and not got what they wished. Epilepsy is governed by phlegm alone, and is brought about by fire stirring it. As to treatment: epilepsy calls for ejection, mania for precipitation, and withdrawal for quieting the spirit and nourishing the blood, with the phlegm and fire brought down as well.

Clinical note임상 주석

癎宜乎吐, 狂宜乎下, 癲則宜乎安神養血 — one line each for the three, and it is the most useful sentence in the chapter: eject for epilepsy, purge for mania, build for withdrawal. Note that withdrawal alone is treated by supplementing, which follows from its cause — 求望高遠不得志, having reached high and failed — being read as depletion rather than excess.

Jeongjeon 正傳

5.18.4

Source원문

癲狂久不愈, 三聖散吐之方見吐門, 後用三承氣湯方見寒門大下之. 《保命》

Translation영역

Where withdrawal-mania has gone long without healing, eject with Three Sages Powder formula in the Ejection chapter and afterwards use the three Order the Qi Decoctions to precipitate greatly.

Clinical note임상 주석

吐 then 下, in that order, which is the sequence the two cases of 5.14.1 follow. **三聖散 contains 藜蘆, veratrum, a cardiotoxic emetic, and is not to be prepared.**

Bomyeong 保命

5.18.5

Source원문

河間曰, 五志過極皆爲火也. 盖氣爲陽而主輕微, 諸所動亂勞傷, 皆爲陽化之火, 神狂氣亂而爲病熱者多矣. 子和曰, 河間治五志, 獨得言外之意. 凡見喜怒悲思恐之證, 皆以平心火爲主. 至於勞者傷於動, 動便屬陽; 驚者駭於心, 心便屬火. 二者亦皆以平心火爲主也. 《丹心》

Translation영역

Hejian: the five minds carried to excess all become fire. For qi is yang and governs what is light and slight, and everything that stirs disorder or wearies and damages becomes the fire of yang transformed; and so the spirit runs mad and the qi is disordered, and the disease is most often a heat. Zihe: in treating the five minds, Hejian alone caught the meaning beyond the words. In any case showing joy, anger, sorrow, thought or fear, the governing aim is to level the heart fire. As for overwork, it damages through motion, and motion belongs to yang; and fright startles the heart, and the heart belongs to fire. In both of these too the governing aim is to level the heart fire.

Clinical note임상 주석

五志過極皆爲火也 — the five minds in excess all become fire, which is Liu Hejian's reduction of the whole of 5.8 to one mechanism and one aim, 平心火. The chapter ends on it, and it is the theoretical ground for why cooling and phlegm-clearing formulas dominate the treatment lists even where the cause given is grief or thwarted ambition.

Dansim 丹心

5.19 Medicines that treat spirit illness across the board 神病通治藥餌

5.19.1

Source원문

牛黃淸心元ㆍ八物定志元ㆍ十四友元ㆍ朱砂安神丸ㆍ平補鎭心丹ㆍ育魂丹ㆍ丑寶丸ㆍ安神丸ㆍ琥珀定智丸ㆍ天王補心丹ㆍ金箔鎭心丸ㆍ辰砂寧志丸ㆍ加味寧神丸ㆍ辰砂妙香散ㆍ加减溫膽湯ㆍ補心丸, 皆通治心神之病. 《諸方》

Translation영역

Uhwangcheongsim-won 牛黃淸心元, Palmuljeongji-won 八物定志元, Sipsau-won 十四友元, Jusaansin-hwan 朱砂安神丸, Pyeongbojinsim-dan 平補鎭心丹, Yukhon-dan 育魂丹, Chubo-hwan 丑寶丸, Ansin-hwan 安神丸, Hobakjeongji-hwan 琥珀定智丸, Cheonwangbosim-dan 天王補心丹, Geumbakjinsim-hwan 金箔鎭心丸, Jinsayeongji-hwan 辰砂寧志丸, Gamiyeongsin-hwan 加味寧神丸, Jinsamyohyang-san 辰砂妙香散, Gagamondam-tang 加减溫膽湯 and Bosim-hwan 補心丸 all treat diseases of the heart spirit across the board.

Clinical note임상 주석

The chapter's general shelf, and its composition is worth reading as a whole. A striking number of these are built on minerals — cinnabar, gold leaf, amber, ox bezoar — the tradition's answer to a spirit that will not stay put being, quite literally, weight. Several of those are not used today for good reasons, and the formulas that survive into contemporary practice are the ones that work by supplementing and coursing rather than by anchoring: the warm-the-gallbladder family for the easily startled, and the heart-supplementing pills for the depleted. Six of the sixteen are given their own entries elsewhere in this chapter rather than here, and the heading 藥餌, medicinal fare, is the Bogam's word for a standing shelf of ready-made preparations rather than a prescription written for one patient.

Various formularies 諸方

5.20 Simple medicinals 單方

5.20.1

Source원문

凡二十三種.

Translation영역

Twenty-three kinds in all.

Donguibogam · Sin

5.20.2

Source원문

朱砂養精神, 安魂魄. 久服通神明. 又云, 心熱心虛, 非此不除. 細末水飛, 取一錢, 蜜水調下. 《本草》

Translation영역

Cinnabar (朱砂): Nourishes the essence-spirit and quiets the ethereal and corporeal souls. Taken over a long time it opens through to the spirit light. It is also said: where the heart is hot and the heart is vacuous, nothing but this will remove it. Powder it fine, levigate it in water, and take 1 don stirred down in honey water.

Clinical note임상 주석

**This is not to be used.** Cinnabar is mercuric sulphide, and the five entries that open this section — cinnabar, fluorite, quicksilver with its sublimate, iron water and red lead — are all mineral weights. That is the section's governing idea, and it is worth seeing stated plainly: a spirit that will not stay in its place was thought to need something heavy to hold it down, and the heaviest and most lustrous substances to hand were recruited for it. Three of the five are poisons.

Boncho 本草

5.20.3

Source원문

紫石英 定驚悸, 安魂魄. 取碎如米豆大, 水一斗煮取二升, 澄淸細細飮之. 卽今之紫水晶也. 《本草》

Translation영역

Fluorite (紫石英): Settles fright palpitations and quiets the souls. Break it to the size of rice grains or beans, boil it in 1 mal of water down to 2 seung, let it settle clear, and sip it little by little. This is what is now called purple crystal.

Clinical note임상 주석

卽今之紫水晶也 — the Bogam glosses the drug as purple crystal, that is, amethyst, but 紫石英 in the materia medica is the violet variety of fluorite, calcium fluoride, and amethyst is quartz. The gloss is a mineralogical mistake of a kind that recurs wherever a drug was identified by colour, and it matters: fluorite is a source of absorbable fluoride, so water boiled on it is not inert.

Boncho 本草

5.20.4

Source원문

水銀安神. 又云, 定心藏之怔忡驚悸. 《入門》 ○靈砂, 久服連神, 安魂魄, 令人心靈. 楊子度云, 靈砂飼猢猻, 輒會人語, 可見通心神. 水銀四兩ㆍ硫黃一兩, 同入鐵銚內, 炒成砂子. 有烟焰起, 以醋灑之. 硏細, 入水火鼎, 赤石脂封口, 鹽泥固濟, 炭二十斤煅, 經宿取出, 細硏, 糯米糊和丸麻子大. 每五丸ㆍ七丸至十五丸, 空心以人參大棗湯呑下. 《局方》

Translation영역

Quicksilver (水銀): Quiets the spirit. It is also said: it settles fearful throbbing and fright palpitations of the heart viscus (Immun 入門). ○ Numinous cinnabar 靈砂, taken over a long time, opens through to the spirit, quiets the souls, and makes a person's heart numinous. Yang Zidu said: numinous cinnabar was fed to a monkey and it came at once to understand human speech — from which one may see that it opens through to the heart spirit. Quicksilver 4 nyang and sulphur 1 nyang, put together into an iron pan and roasted until they form into grains; when smoke and flame rise, sprinkle them with vinegar. Grind fine, place in a water-and-fire crucible, seal the mouth with kaolin, lute it tight with salt clay, calcine over 20 geun of charcoal, leave it overnight, take it out, grind it fine, and make pills the size of hemp seeds with glutinous rice paste. Take 5 pills, 7 pills, up to 15, swallowed down on an empty stomach with a decoction of ginseng and jujube. (Gukbang 局方)

Clinical note임상 주석

**This must not be prepared.** The procedure is a genuine synthesis — quicksilver and sulphur roasted together, then calcined in a sealed crucible — and what comes out is mercuric sulphide, which is to say cinnabar made by hand. Mercury is a cumulative neurotoxin with no safe dose, and the full method is translated here only because the entry is a real piece of chemistry, correct down to the vinegar quench when the mixture flames. The monkey anecdote shows how far the reasoning could travel: a substance that makes an animal speak must open the heart's orifices, therefore give it to a person whose speech and mind are disordered. The formula appears in full under 靈砂.

Immun 入門 · Gukbang 局方

5.20.5

Source원문

鐵漿治癲癎發熱狂走. 又治心氣狂甚走呼. 取生鐵置器中, 以水浸之, 經久取飮. 《本草》

Translation영역

Iron water (鐵漿): Treats withdrawal and epilepsy with heat effusion and running about in mania. It also treats the heart qi in extreme derangement, running and shouting. Take raw iron, set it in a vessel, steep it in water, and after a long while take the water and drink it.

Clinical note임상 주석

The cheapest version of the section's idea: steep iron, drink the water, let the metal's weight settle a mind that is running. What the patient actually drank was dilute iron salts, and in an iron-deficient population that is not nothing, though it is not what the entry claims. 狂甚走呼, extreme derangement with running and shouting, is acute psychotic agitation, and it is a psychiatric emergency rather than a thing to steep overnight.

Boncho 本草

5.20.6

Source원문

黃丹治驚癎ㆍ癲疾ㆍ狂走. 鎭心安神, 收歛神氣, 以鎭驚. 作丸單服, 或入丸散用. 《本草》

Translation영역

Red lead (黃丹): Treats fright epilepsy, the withdrawal disease and running about in mania. It settles the heart and quiets the spirit, gathers in the spirit qi and thereby settles fright. Make pills and take it alone, or put it into pills and powders.

Clinical note임상 주석

**This is not to be used.** Red lead is lead tetroxide. Lead is a neurotoxin that produces precisely the picture this entry is given for — irritability, confusion, convulsions — so a long course would deepen the complaint it was prescribed against. There is no safe dose and no threshold below which children are unaffected.

Boncho 本草

5.20.7

Source원문

人參安精神, 定魂魄, 止驚悸, 開心益智, 令人不忘. 人參末一兩ㆍ猪肪十分, 酒拌和服百日, 則日誦千言, 肌膚悅澤. 《本草》

Translation영역

Ginseng (人參): Quiets the essence-spirit, settles the souls, stops fright palpitations, opens the heart and boosts the wits, and keeps a person from forgetting. Powdered ginseng 1 nyang and pork fat 10 pun, stirred together in wine and taken for a hundred days: then one recites a thousand words in a day and the skin becomes glossy and fair.

Clinical note임상 주석

The section's second half begins here, and the four herbs that carry it — ginseng, acorus, polygala and hostwood poria — are the same four that make up nearly every formula in the chapter. Seeing them listed alone is clarifying: the elaborate pills are these four with weights adjusted and a phlegm-mover or a cooler added for the particular case. 日誦千言, reciting a thousand words in a day, is the claim a student would have cared about, and it is why this group of drugs is still reached for in East Asian practice for memory and concentration.

Boncho 本草

5.20.8

Source원문

天門冬 安魂定魄, 治驚悸ㆍ健忘ㆍ癲狂. 取去心爲末, 每二錢, 酒飮任下, 久服佳. 《本草》

Translation영역

Asparagus root (天門冬): Quiets the ethereal soul and settles the corporeal soul; treats fright palpitations, forgetfulness, and mania and withdrawal. Take it, remove the core, powder it, and take 2 don each time down with wine or any liquid; taken over a long time it is good.

Boncho 本草

5.20.9

Source원문

石菖蒲 開心孔, 治多忘長智. 取菖蒲ㆍ遠志爲細末, 每服一錢, 酒飮任下, 日三, 令人耳目聰明, 從外見裏, 及千里外事. 《千金》 ○治癲癎, 取石菖蒲末二錢, 猪心煎湯調服, 空心. 《正傳》

Translation영역

Acorus (石菖蒲): Opens the orifices of the heart, treats much forgetting and lengthens the wits. Take acorus and polygala, powder them fine, and take 1 don each time down with wine or any liquid, three times a day; it makes the ears and eyes clear and bright, so that one sees the inside from without, and affairs a thousand li away (Cheongeum 千金). ○ For withdrawal and epilepsy: take 2 don of powdered acorus and take it stirred into a decoction of pig's heart, on an empty stomach. (Jeongjeon 正傳)

Clinical note임상 주석

The acorus-and-polygala pair is the chapter's signature combination and is still the reference pairing for memory and mental clarity in Korean and Chinese practice. The Thousand Gold Formulas' claim for it is the most extravagant in the section — eyes clear enough to see a thousand li — but the pairing outlasted the promise. The second method, powdered acorus carried in pig's heart broth, is the chapter's organ-for-organ logic: send the drug to the heart by giving it a heart to travel in.

Cheongeum 千金 · Jeongjeon 正傳

5.20.10

Source원문

遠志安魂魄, 益智慧, 治健忘, 令人不迷. 以甘草水浸煮, 去骨取肉爲末, 每二錢, 酒飮任下. 《本草》

Translation영역

Polygala (遠志): Quiets the souls, boosts the wisdom, treats forgetfulness, and keeps a person from losing their way. Soak and boil it in licorice water, discard the woody core and take the flesh, powder it, and take 2 don each time down with wine or any liquid.

Clinical note임상 주석

去骨取肉, discard the bone and take the flesh — the woody central strand of the root is pulled out and thrown away, and the licorice soak is what makes it come free. Both steps are still standard processing for polygala, and the licorice is held to blunt the root's throat-irritating harshness as well.

Boncho 本草

5.20.11

Source원문

茯神安魂魄, 養精神, 主驚悸, 療善忘. 取爲末, 酒飮任下二錢, 或丸服亦佳. 與遠志同用尤佳. 《本草》

Translation영역

Poria with hostwood (茯神): Quiets the souls, nourishes the essence-spirit, governs fright palpitations and heals ready forgetting. Take it, powder it, and take 2 don down with wine or any liquid, or take it as pills, which is also good. Used together with polygala it is better still.

Clinical note임상 주석

茯神 is the part of the poria fungus that has grown around the pine root, the root left in the middle of the slice, and it is distinguished from plain 茯苓 precisely for this chapter's purpose: the wood at the centre is held to carry the drug to the spirit rather than to the water pathways.

Boncho 本草

5.20.12

Source원문

黃連主驚悸煩躁, 淸心熱. 爲末, 蜜水點服一錢, 或作丸服之亦佳. 《本草》

Translation영역

Coptis (黃連): Governs fright palpitations with vexation and agitation, and clears heat of the heart. Powder it and take 1 don infused in honey water, or make pills of it and take them, which is also good.

Clinical note임상 주석

The one cooling drug among the herbs here, and the only answer the section offers for the hot and agitated presentation rather than the depleted one. Coptis is intensely bitter and the honey water is there to get it down.

Boncho 本草

5.20.13

Source원문

商陸花 主多忘喜誤. 取花陰乾爲末, 臨臥水服一錢, 思念所欲事, 卽於眼中自覺, 神效. 《本草》

Translation영역

Pokeweed flower (商陸花): Governs much forgetting and a liking for mistakes. Take the flowers, dry them in the shade, powder them, and take 1 don in water on going to bed; think on the matter one wishes to know, and it will come to one's own awareness before the eyes — a marvellous effect.

Clinical note임상 주석

**This is not to be used.** Pokeweed root and flower contain phytolaccatoxin and the related saponins and are a recognized poison, producing violent vomiting, diarrhoea and, in quantity, cardiac and respiratory depression. Taken at bedtime for a vision, it is among the most dangerous prescriptions in the chapter. 卽於眼中自覺 — it comes to awareness before the eyes — is the entry promising a hypnagogic vision on command, and a plant with that effect is acting on the central nervous system, not on the memory.

Boncho 本草

5.20.14

Source원문

萱草利心志, 令人好歡樂無憂. 種於庭中常玩之佳. 《本草》

Translation영역

Daylily (萱草): Benefits the heart and the will and makes a person fond of joy and free of care. Plant it in the courtyard and look on it often — good.

Clinical note임상 주석

Not a drug at all: plant it where you will see it. This entry and the mimosa that follows are the two places in the whole chapter where the prescription is to arrange one's surroundings rather than to swallow something, and they sit here among the mercury and the lead without any sense of incongruity. The Chinese name for the daylily is 忘憂草, the grass that forgets sorrow, which is the reasoning in a word.

Boncho 本草

5.20.15

Source원문

合歡蠲忿, 令人歡樂無憂. 樹之庭除, 使人不忿. 《本草》

Translation영역

Mimosa tree (合歡): Dispels resentment and makes a person joyful and free of care. Plant it about the courtyard steps and it keeps a person from resentment.

Clinical note임상 주석

合歡 is the tree of joined joy, named for the leaflets that fold together at nightfall, and that name is the whole indication. Its bark and flower are still standard materials for irritability, resentment and poor sleep in Korean and Chinese practice, which makes this one of the few entries in the section whose drug survived alongside its idea — though here the instruction is only to plant it.

Boncho 本草

5.20.16

Source원문

蜘蛛絲 療喜忘. 七月七日取着衣領中, 巧去健忘. 《本草》

Translation영역

Spider silk (蜘蛛絲): Heals a tendency to forget. On the seventh day of the seventh month, gather it and place it in the collar of the robe, and it cleverly removes forgetfulness.

Clinical note임상 주석

七月七日, the seventh day of the seventh month, is Chilseok, and the date is not incidental: it is the festival of the Weaver Maid, and silk gathered on it is thread with the day's meaning in it. The entry is a charm rather than a drug — nothing is swallowed and nothing is applied — and the Bogam records it in the same list and the same voice as the mercury.

Boncho 本草

5.20.17

Source원문

蓮實養神, 多食止怒, 令人喜. 久服歡心, 作粥常餌之佳. ○石蓮子, 去黑皮取肉, 砂盆中乾擦去浮上赤皮, 留靑心爲末, 入龍腦少許, 湯點服, 寧志淸神. 《本草》

Translation영역

Lotus seed (蓮實): Nourishes the spirit; eaten in quantity it stops anger and makes a person glad. Taken over a long time it gladdens the heart. Made into a gruel and eaten regularly it is good. ○ Aged lotus seed: remove the black husk and take the flesh, rub it dry in an earthenware basin to take off the red skin that lifts, keep the green germ, powder it, add a little borneol, and take it infused — it calms the will and clears the spirit.

Clinical note임상 주석

留靑心, keep the green germ — the bitter embryo at the centre of the seed, which is ordinarily picked out before eating and which the materia medica treats as a drug of its own, 蓮子心, for heat in the heart. The processing instruction is therefore the reverse of the kitchen's: remove the husk and the red skin, keep the bitter part. Lotus seed gruel is the most ordinary thing prescribed anywhere in the chapter and the one a reader could make tonight.

Boncho 本草

5.20.18

Source원문

鴟頭主癲癎. 取肉灸食之. 又鴟頭二枚ㆍ燒黃丹一兩, 爲末作丸服之. 《本草》

Translation영역

Kite's head (鴟頭): Governs withdrawal and epilepsy. Take the flesh, roast it and eat it. Or kite's head, 2 of them, with calcined red lead 1 nyang, powdered and made into pills and taken.

Clinical note임상 주석

**This is not to be used.** Birds of prey are protected in Korea and throughout the region, and the second formula adds red lead. The reasoning behind the first is the bird's steady, unwavering gaze, set against the rolled eyes and loss of awareness of a seizure — a correspondence of appearances, which is how most of the animal materia medica was assembled.

Boncho 本草

5.20.19

Source원문

伏翼卽蝙蝠也. 久服令人喜樂媚好無憂. 久服解愁去憂. 燒煮食之, 入蟄者佳. 《本草》

Translation영역

Bat (伏翼): That is, the bat. Taken over a long time it makes a person glad, winning and free of care. Taken over a long time it dissolves sorrow and drives off care. Roast or boil it and eat it; one taken in hibernation is best.

Clinical note임상 주석

**This is not to be used.** Bats are a reservoir for rabies, coronaviruses and other zoonoses, and handling or eating one is a real and present hazard rather than a theoretical one. The same drug appears in the Dreams chapter, where its blood is dropped into the eye to keep a person awake; here the indication is cheerfulness, and 入蟄者佳 — the hibernating one is best — is the sort of collecting instruction that shows a drug was in genuine use.

Boncho 本草

5.20.20

Source원문

麝香主癎痓, 安神, 除驚怪恍惚. 取眞香爲末, 湯點一字服. 《本草》

Translation영역

Musk (麝香): Governs epilepsy with rigidity, quiets the spirit, and removes fright, strangeness and abstraction. Take the true musk, powder it, and take 1 ja infused.

Clinical note임상 주석

**This is not to be used.** The musk deer is listed on CITES Appendix I and the trade is prohibited; synthetic substitutes are what appear in licensed preparations. 取眞香, take the true musk, is the entry's own acknowledgement that the article was adulterated even in the seventeenth century, when it was among the most valuable substances in the pharmacy. The dose, 1 ja, is a quarter of a don — the smallest unit the book uses.

Boncho 本草

5.20.21

Source원문

牛黃安魂定魄, 療驚悸ㆍ癲狂, 主健忘. 末服丸服幷佳. 《本草》

Translation영역

Cattle gallstone (牛黃): Quiets the ethereal soul and settles the corporeal soul, heals fright palpitations and mania and withdrawal, and governs forgetfulness. Powdered or pilled, both are good.

Clinical note임상 주석

Ox bezoar is a gallstone recovered at slaughter, rare enough that it was weighed against its price, and it is the chief drug of the chapter's most famous formula, 牛黃淸心元. It remains in use, with cultivated and synthetic bezoar substituted for the natural article in licensed products.

Boncho 本草

5.20.22

Source원문

猪心補心血不足, 主驚悸ㆍ健忘ㆍ癲癎ㆍ驚邪ㆍ憂恚. 取血入藥用, 或蒸煮食之. 《本草》

Translation영역

Pig's heart (猪心): Supplements insufficiency of the heart blood, and governs fright palpitations, forgetfulness, withdrawal and epilepsy, fright evil, and grief and rancour. Take the blood and put it into medicines, or steam or boil the heart and eat it.

Clinical note임상 주석

Organ for organ, and the most literal statement of it in the chapter: for a heart short of blood, give a heart and its blood. The pig's heart also serves as the vehicle for the acorus powder above. Eaten cooked it is an ordinary and nourishing food; the blood taken raw into medicines is not, and should not be.

Boncho 本草

5.20.23

Source원문

震肉主因驚失心. 作脯食之. 此六畜爲天雷所震死肉也. 《本草》

Translation영역

Thunder-struck flesh (震肉): Governs loss of mind from fright. Make it into dried meat and eat it. This is the flesh of one of the six domestic animals struck dead by heaven's thunder.

Clinical note임상 주석

The purest case of sympathetic reasoning in the chapter: a mind undone by a shock is treated with the flesh of an animal killed by the greatest shock there is. It is also the one entry whose supply could not be arranged — you waited for lightning — which tells you the list was assembled by compilation rather than by practice. Meat from an animal found dead is not safe to eat, whatever killed it.

Boncho 本草

5.20.24

Source원문

紫河車 卽人胎衣也. 主癲狂ㆍ健忘ㆍ怔忡ㆍ失志, 及恍惚ㆍ驚怖ㆍ心神不守ㆍ多言不定. 大能安心養血定神. 蒸熟入藥丸服, 或蒸熟單服之亦佳. 《本草》

Translation영역

Placenta (紫河車): That is, the human afterbirth. It governs mania and withdrawal, forgetfulness, fearful throbbing and loss of purpose, together with abstraction, fright and terror, a heart spirit that will not keep to its place, and much talking without settling. It is greatly able to quiet the heart, nourish the blood and settle the spirit. Steam it through, put it into medicines and take them as pills, or steam it through and take it alone, which is also good.

Clinical note임상 주석

**This is not to be used.** Human placenta is not a tissue that can be dispensed or eaten: its use is prohibited in Korea outside licensed pharmaceutical preparation, and raw or home-prepared placenta carries a real risk of transmitting bloodborne infection. The indication list is the whole chapter compressed into one line, from mania to abstraction to talking without settling, and the drug closes the section as its most comprehensive remedy — the placenta standing for the origin of a person's own spirit. It appears again in the Flesh chapter under the name 人胞.

Boncho 本草

5.21 Acupuncture and moxibustion 鍼灸法

5.21.1

Source원문

癲癎晝發治陽蹻申脉, 夜發治陰蹻照海, 各灸二七壯. 《易老》

Translation영역

Where withdrawal-epilepsy breaks out by day, treat the yang springing vessel Sinmaek (申脉, BL62); where it breaks out by night, treat the yin springing vessel Johae (照海, KI6), moxaing fourteen cones at each.

Clinical note임상 주석

Daytime and night-time seizures sent to the two springing vessels, which is as near as the classical literature comes to distinguishing seizures by the sleep-wake cycle — a distinction modern epileptology makes too.

Yeongno 易老

5.21.2

Source원문

又灸百會ㆍ風池. 《資生》

Translation영역

Also moxa Baekhoe (百會, GV20) and Pungji (風池, GB20).

Jasaeng 資生

5.21.3

Source원문

癎病, 取鳩尾ㆍ後谿ㆍ湧泉ㆍ心兪ㆍ陽交ㆍ三里ㆍ大衝ㆍ間使ㆍ上脘. 凡癎病, 必先下之乃可灸, 不然則氣不通, 能殺人. 針不拘此. 《綱目》

Translation영역

For epilepsy, take Gumi (鳩尾, CV15), Husi (後谿, SI3), Yongcheon (湧泉, KI1), Simyu (心兪, BL15), Yanggyo (陽交, GB35), Samni (三里, ST36), Daechung (大衝, LR3), Gansa (間使, PC5) and Sangwan (上脘, CV13). In any epilepsy the patient must first be precipitated before moxa may be used; otherwise the qi does not pass, and it can kill. Needling is not bound by this.

Clinical note임상 주석

必先下之乃可灸 … 能殺人 — purge before moxaing or it can kill. The warning is unusually blunt, and the exemption for needling at the end shows it was a rule about heat rather than about the points. Whatever its reasoning, it is a caution against moxa in an unprepared patient.

Gangmok 綱目

5.21.4

Source원문

癲狂, 取豊隆ㆍ期門ㆍ溫留ㆍ通谷ㆍ築賓ㆍ陽谷ㆍ後谿ㆍ陰谷. 《甲乙》

Translation영역

For withdrawal-mania, take Pungnyung (豊隆, ST40), Gimun (期門, LR14), Ollyu (溫留, LI7), Tonggok (通谷, BL66), Chukpin (築賓, KI9), Yanggok (陽谷, SI5), Husi (後谿, SI3) and Eumgok (陰谷, KI10).

Clinical note임상 주석

豊隆 heads the list, which is consistent: it is the phlegm point, and 5.14 reads mania as phlegm and fire.

Gabeul 甲乙

5.21.5

Source원문

又灸間使三十壯. 《得效》

Translation영역

Also moxa Gansa (間使, PC5) thirty cones.

Deukhyo 得效

5.21.6

Source원문

又灸天樞百壯. 《得效》

Translation영역

Also moxa Cheonchu (天樞, ST25) a hundred cones.

Deukhyo 得效

5.21.7

Source원문

健忘, 取列缺ㆍ心兪ㆍ神門ㆍ中脘ㆍ三里ㆍ少海, 又灸百會. 《綱目》

Translation영역

For forgetfulness, take Yeolgyeol (列缺, LU7), Simyu (心兪, BL15), Sinmun (神門, HT7), Jungwan (中脘, CV12), Samni (三里, ST36) and Sohae (少海, HT3), and also moxa Baekhoe (百會, GV20).

Clinical note임상 주석

中脘 and 三里 among the points for forgetfulness follow 5.11's reasoning that the condition sits in the heart and the spleen together, so the stomach points belong in the prescription.

Gangmok 綱目

5.21.8

Source원문

失志痴騃, 取神門ㆍ中衝ㆍ鬼眼ㆍ鳩尾ㆍ百會ㆍ後谿ㆍ大鍾. 《綱目》

Translation영역

For loss of the will with dullness and witlessness, take Sinmun (神門, HT7), Jungchung (中衝, PC9), Gwian (鬼眼), Gumi (鳩尾, CV15), Baekhoe (百會, GV20), Husi (後谿, SI3) and Daejong (大鍾, KI4).

Clinical note임상 주석

鬼眼, the ghost eyes, is one of the 鬼穴 taken for spirit disorders; the Bogam's own 鍼灸篇 places it at the inner corners of the thumbnails and the great toenails.

Gangmok 綱目

5.21.9

Source원문

善恐心惕惕, 取然谷ㆍ內關ㆍ陰陵泉ㆍ俠谿ㆍ行間. 《綱目》

Translation영역

For being readily afraid with the heart apprehensive, take Yeongok (然谷, KI2), Naegwan (內關, PC6), Eumneungcheon (陰陵泉, SP9), Hyeopgye (俠谿, GB43) and Haenggan (行間, LR2).

Gangmok 綱目

5.21.10

Source원문

心澹澹大動, 取大陵ㆍ三里. 《綱目》

Translation영역

For the heart throbbing and stirring greatly, take Daeneung (大陵, PC7) and Samni (三里, ST36).

Gangmok 綱目

About this translation 凡例

Base text: Donguibogam (東醫寶鑑, 1613 first edition), Internal Bodily Elements, Volume 1, The Spirit chapter. The Chinese text is collated against the public-domain Wikisource transcription and a printed edition; original character forms (脉, 人參) are retained. Terminology follows Wiseman & Feng, A Practical Dictionary of Chinese Medicine. Translation and clinical notes are original to this site. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.