寶鑑Bogam

Formulas · Tonify Qi 補氣 · Gogeum Uigam (古今醫鑑)

Preserve the Origin Decoction

Bowon-tang

한글 보원탕  ·  Pinyin Bao Yuan Tang

保元湯

The leaf writes 白伏苓 for 白茯苓; the transcription's reading is printed here under this project's base-text rule, and it is noted that the corpus writes 白茯苓 in three hundred and eighty-nine other places and 白伏苓 nowhere else. 䑕粘子 is printed 鼠粘子, 𠔥 is printed 兼, and 為 is printed 爲, following the corpus. The day series runs 1–2, 2–3, 4–5, 5–6, 6–7, 7–8, 8–9, 11–12, 13–15, with no clause for days 3–4 or days 9–10; the ninth and tenth days are treated in the body of 1.71 貫膿三朝 instead. The ingredient list gives the base decoction only; the drugs of the nine dated clauses are additions and are named in the translation.

Composition 構成

Total 16 g per packet (첩) · representative dosage — verify against source texts. Excludes 1 ingredient measured by count or used as a vehicle, shown as —.

Received this formula from your practitioner? Amounts shown here are classical reference values — granule and prepared products differ. Always follow your prescribed dosage and directions.

Actions 效能

Indications 主治

Pattern-based

  • 痘瘡首尾 — the pox from beginning to end, as the main treatment throughout
  • 根窠雖圓而頂陷 — the base round but the crown sunken, read as qi vacuity
  • 色淡 — a pale colour in the suppurating pock, read as vacuity
  • 漿不冲滿氣弱而險 — the pus not filling out, the qi weak, the case dangerous

Biomedical correlates

  • Supportive feeding and fluid in a child with a febrile exanthem — historical
  • No antiviral or disease-modifying action

Source text 原文

Donguibogam 東醫寶鑑

人參 二錢, 嫩黃芪ㆍ甘草 各一錢. 右剉作一貼, 入薑一片, 水煎服. 《醫鑑》 ○一二日初出乾紅少潤, 此毒尙淺, 宜用活血勻氣兼解毒之藥, 加白芍藥 一錢ㆍ當歸 五分以活血, 加陳皮 五分以勻氣, 加玄參ㆍ鼠粘子 各七分以解毒. ○二三日根窠雖圓而頂陷者, 爲氣虛弱血亦難聚, 宜加川芎ㆍ官桂. ○四五日根窠雖起色不光澤, 爲氣弱血盛, 宜加白芍藥ㆍ官桂ㆍ糯米. ○五六日氣盈血弱色昏紅紫, 宜加木香ㆍ當歸ㆍ川芎. ○六七日不能成漿, 爲氣血少寒不能制, 宜加官桂ㆍ糯米. ○七八日毒雖化漿而不滿, 宜加官桂ㆍ糯米發陽助漿. ○八九日漿不冲滿氣弱而險, 宜加糯米以成漿. ○十一日十二日血盡漿足濕潤不斂者內虛也, 加白朮ㆍ白伏苓助其收斂. ○十三十四十五日毒雖盡解, 或有雜證相仍, 只以此藥隨證加減, 不可用大寒大熱之劑, 恐致內損之患. 《醫鑑》

Translation

Ginseng, 2 don; young astragalus and liquorice, 1 don of each. Cut the above and make one packet, add one slice of ginger, decoct in water and give. — Uigam 醫鑑 ○On the first and second days, when the eruption first comes out dry and red with little moisture, the toxin is still shallow, and drugs that quicken the blood and even out the qi together with resolving the toxin should be used: add 1 don of white peony and 5 fun of tangkuei to quicken the blood, add 5 fun of tangerine peel to even out the qi, and add 7 fun each of scrophularia and burdock seed to resolve the toxin. ○On the second and third days, where the base of the pock is round but the crown is sunken, this is the qi being vacuous and weak so that the blood too gathers with difficulty: add cnidium and official cinnamon. ○On the fourth and fifth days, where the base has risen but the colour is not bright and glossy, this is the qi weak and the blood replete: add white peony, official cinnamon and glutinous rice. ○On the fifth and sixth days, where the qi is full and the blood weak and the colour is a dull red-purple: add costus, tangkuei and cnidium. ○On the sixth and seventh days, where the pus will not form, this is the qi and blood scant and the cold not being held in check: add official cinnamon and glutinous rice. ○On the seventh and eighth days, where the toxin has turned to pus but the pock is not full: add official cinnamon and glutinous rice to raise the yang and help the pus. ○On the eighth and ninth days, where the pus does not well up and fill, the qi weak and the case dangerous: add glutinous rice to bring the pus on. ○On the eleventh and twelfth days, where the blood is spent and the pus is full but the pock stays damp and will not draw in, this is interior vacuity: add white atractylodes and white poria to help it draw in. ○On the thirteenth, fourteenth and fifteenth days, even where the toxin is wholly resolved there may be miscellaneous signs following one on another; use only this formula, adding and subtracting according to the signs. Do not use a greatly cold or greatly hot preparation, for fear of bringing on injury within. — Uigam 醫鑑 (Donguibogam · Soa)

Clinical commentary 臨床

Three drugs and a slice of ginger, and the chapter puts it at the centre of everything: 痘瘡首尾宜保元湯爲主治 — from the first day of the pox to the last, this is the main treatment. Ginseng two don, young astragalus and liquorice one don each. It is a plain qi-supplementing decoction, Wei Zhi's formula by way of the Gogeum Uigam, and what follows the base recipe is more interesting than the recipe: a schedule running the length of the fifteen-day course, with a different pair or trio of drugs added for each stage, keyed to what the pocks look like on that day. Blood-quickeners early while the eruption is dry and red, cinnamon and glutinous rice through the days when the pus should be forming, atractylodes and poria at the end when the crusting is slow. It is worth being exact about what such a decoction would and would not have done. It would have supplied warm, slightly sweet fluid to a child who was febrile and had stopped eating, and a child who will drink it is a child getting water and some calories; ginseng and astragalus decoctions are palatable and were taken. That is not nothing in an illness whose main killer was fluid loss. What it would not have done is anything to the disease. There is no antiviral action in any of these drugs, and nothing in the fifteen-day schedule could change whether the lesions rose, filled with pus, crusted and separated on the days the chapter expected, or whether the child survived. The staging itself is sound observation — the five triads really are the stages of smallpox in the real order — but the inference that a formula tracked to the staging was steering it is not. The nursing measures set out at jacho-go-soa are what moved outcomes, and the chapter's own 保護, 飮食 and 浴法 sections, a few pages on, are where its useful advice actually lies. **Liquorice at 1 don a day, continued across a fifteen-day course as this leaf directs, is the hazard here and not an obvious one. Glycyrrhizin has mineralocorticoid activity: sustained dosing causes potassium loss, sodium and water retention and hypertension, and the resulting hypokalaemia is dangerous in a small child who is already losing fluid and potassium through fever, vomiting and diarrhoea. Ginseng in an infant can cause agitation and sleeplessness. The patient is a child and the leaf gives one packet with no dose scaled to age or weight.** — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.

Related formulas 關聯

Look up another