Formulas · External Application 外用 · Uigam (醫鑑)

Powder to Rub on the Teeth

Chaa-san

한글 차아산 · Pinyin Cha Ya San

搽牙散

The transcription writes 醫鍳 and the corpus prints 醫鑑; 鑑 is printed, following the project variant-glyph list. 煆 is left as both the transcription and the corpus print it, and 爲 is printed for 為. The preparation words 燒存性, 枯 and 煆 stand bare in the transcription without ≪≫ and are therefore printed in parentheses, unlike the 卽鉛粉 of myeolban-san, which the transcriber did bracket. 老茶, the old tea of the pre-application wash, has no entry in this corpus: the alias table carries a bare 茶 under sechacha, but sechacha is 細芽茶, the fine young bud, which is the opposite of 老茶, so no substitution was made and the drug is recorded as missing. 韭菜根 resolves to gu through the alias table and is entered with its role as the wash noted, since it is a drug rather than apparatus; the chicken feather and the bamboo tube are apparatus and stay in the source text. hanrom.py reads 搽牙散 correctly as chaa-san and the id is free.

Composition 構成

Injungbaek Ren Zhong Bai
人中白 인중백 · Urinary Sediment

20 g
Chief 君

煆, calcined; 5 don · human urine sediment
Baengmae Bai Mei
白梅 백매 · Salted Mume Plum

10 g
Chief 君

白梅肉, the flesh, burnt with its nature preserved (燒存性); 2 don 5 fun
Baekban Bai Fan
白礬 백반 · Alum

10 g
Deputy 臣

枯, dried; 2 don 5 fun
Gu Jiu
韭 구 · Chinese Chive

—
Assistant 佐

韭菜根, the root, decocted strong with old tea as the wash used before the powder

Total 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

Applied to gums rotted by 走馬疳 after the pox, three times a day, after the slough has been washed away until fresh blood shows
Blown into the throat through a small bamboo tube where the rot has reached that far
Claimed to heal even where the teeth have fallen out and the lips are pierced through

Indications 主治

Pattern-based

痘愈後餘毒成走馬疳, 牙齦腐爛 — after the pox has healed, the residual toxin becoming galloping gum rot, the gums putrid and sloughing
牙齒爛落, 口唇穿破 — teeth rotted and fallen, the lips pierced through
鼻梁發紅點 — red spots coming out on the bridge of the nose, which the leaf calls incurable

Biomedical correlates

Cancrum oris (noma) following smallpox in a malnourished child
Acute necrotising gingivitis and orofacial gangrene

Source text 原文

Donguibogam 東醫寶鑑

白梅肉(燒存性)ㆍ白礬(枯) 各二錢半, 人中白(煆) 五錢. 右爲細末. 先以韭菜根ㆍ老茶濃煎水, 雞羽蘸洗去腐爛惡肉, 至見鮮血, 乃付藥, 日三次. 爛至喉中者, 用小竹筒吹藥入. 雖牙齒爛落, 口唇穿破, 付藥皆愈. 但鼻梁發紅點, 則不可治. 《醫鑑》

Translation

White plum flesh, burnt with its nature preserved, and alum, dried, 2 don 5 fun of each; human urine sediment, calcined, 5 don. Make the above into a fine powder. First decoct Chinese chive root and old tea strong in water; dip a chicken feather in it and wash away the putrid and rotten flesh until fresh blood shows, and then apply the drug, three times a day. Where the rot has reached into the throat, use a small bamboo tube to blow the drug in. Even where the teeth have rotted and fallen out and the lips are pierced through, applying the drug heals it all. But if red spots come out on the bridge of the nose, then it cannot be cured. — Uigam 醫鑑 (Donguibogam · Soa)

Clinical commentary 臨床

The worst thing in this section, and the leaf that watched it most carefully. 走馬疳, galloping gum rot, is cancrum oris — noma: a rapidly spreading gangrene that starts in the gum and eats outward through the cheek and lip and into the bone of the face. It followed measles, smallpox and other debilitating infections in severely malnourished children, it is polymicrobial, and untreated it killed most of the children who developed it; those who lived were left with the face destroyed. It has not gone the way smallpox went — it still occurs, and the World Health Organization now classifies it as a neglected tropical disease. Three of the leaf's observations are worth grading separately. First, 至見鮮血 — wash away the dead tissue until fresh blood shows. That is debridement to viable margins, and it is still the principle; the instrument is a chicken feather and the antiseptic is chive root and strong tea, but the aim is correct and the endpoint is the right endpoint. Second, 牙齒爛落, 口唇穿破 — teeth falling out, the lip pierced through — is the course of the disease set down in two phrases, and the leaf is describing it rather than guessing at it. Third, and this is the best of them: 但鼻梁發紅點, 則不可治. A red spot appearing on the bridge of the nose means it cannot be cured. That is the gangrene crossing into the midface, and it did mark the point past which these children were not saved. A physician without any notion of bacteria had found an external sign that told him when to stop, and had found the right one. What the leaf gets wrong is the claim in between: 付藥皆愈, applying the drug heals it all. It did not. Noma needs antibiotics, aggressive wound care, and above all the nutritional rehabilitation of a starved child, and then reconstructive surgery for what is left; it is a disease of poverty and malnutrition, and that is why it is still here. **Contains human urine sediment, calcined, 5 don of it — the largest part of the powder — packed into an open gangrenous wound in a child's mouth. Human material laid on an open wound is a route of infection, and tetanus is the specific danger in a wound of this kind. The alum is a caustic astringent being applied to raw, bleeding tissue three times a day. And the method carries its own hazard: powder blown through a bamboo tube into the throat of a sick child can be aspirated. The patient is a child who has just survived smallpox and is now severely ill again. This must not be prepared.** — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.