Formulas · External Application 外用 · Jeongyo (精要)

Needle Substitute Pill

Chechim-hwan

한글 체침환 · Pinyin Ti Zhen Wan

替鍼丸

The chapter prints two formulas under this name, one after the other. This is the first, the Jeongyo leaf; the second, the Samin leaf headed 治同上, is registered as chechim-hwan-2. 爐灰, the hearth or furnace ash, is registered for this leaf as nohoe-stove, under a disambiguating id because 蘆薈, aloe, already holds the plain romanisation; the leaf gives it at 3 seung, leached together with the lime into one lye. 熬至三五升 reads oddly — 5 seung of water reduced to three or five — and is printed as transcribed. 䃃砂 is the form this corpus prints for the sal ammoniac. The transcription prints 癕 and 面 here as 癕 and 面; 癰 is printed above.

Composition 構成

Seokhoe Shi Hui
石灰 석회 · Lime (caustic)

—
Chief 君

石灰五升 — 5 seung of lime, leached with the hearth ash in 5 seung of water and the liquor boiled down, kept in an earthenware jar; the lye is the active base · caustic
Nohoe (Cinis) Lu Hui
爐灰 노회 · Hearth Ash (caustic)

—
Deputy 臣

爐灰三升 — 3 seung of hearth ash, leached with the lime into one lye · caustic
Baekjeonghyang Bai Ding Xiang
白丁香 백정향 · Sparrow Droppings

1 g
Assistant 佐

one ja
Nosa Nao Sha
硇砂 노사 · Sal Ammoniac (toxic)

1 g
Assistant 佐

䃃砂, one ja · caustic
Moryak Mo Yao
沒藥 몰약 · Myrrh

1 g
Assistant 佐

one ja
Yuhyang Ru Xiang
乳香 유향 · Frankincense

1 g
Assistant 佐

one ja
Nami Nuo Mi
糯米 나미 · Glutinous Rice

—
Assistant 佐

14 grains of glutinous rice, left overnight on oiled paper laid over half a cup of the strong lye, then ground into the powder

Total 4 g per packet (첩) · representative dosage — verify against source texts. Excludes 3 ingredients 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

A caustic grain stuck with saliva on the head of an unbroken swelling, so that it opens without a blade
A single grain put into the mouth of a sore whose pus is not running freely
Said to keep the pus from stagnating so that sound flesh grows back easily

Indications 主治

Pattern-based

癰疽膿成未破 — pus formed and the swelling not yet broken
膿出不快 — pus not running freely
瘡頭 — the head of the sore
膿滯 — pus stagnating in the opening

Biomedical correlates

Pointing abscess requiring drainage
Abscess with inadequate drainage
Wound requiring debridement

Source text 原文

Donguibogam 東醫寶鑑

治癰疽膿成未破, 或膿出不快. 先以石灰五升ㆍ爐灰三升ㆍ水五升, 淋取汁, 入鍋內熬至三五升, 瓦器盛貯. 臨用時, 以小盞盛取半盞濃汁, 却用皮紙貼盞中濃汁面上安定, 然後取糯米十四粒放在紙上, 經一宿取用. 白丁香ㆍ䃃砂ㆍ沒藥ㆍ乳香各一字. 右細末, 入糯米硏勻, 丸如麥粒大. 每用一粒, 用津貼瘡頭, 卽破膿出. 若膿滯不快, 則取一粒納瘡口, 使膿不滯, 好肉易生. 《精要》

Translation

Treats an abscess in which pus has formed and which has not broken, or one whose pus does not run freely. First take 5 seung of lime, 3 seung of hearth ash and 5 seung of water, leach the liquor off, boil it down in a pan to three or five seung, and store it in an earthenware vessel. When it is to be used, pour half a cup of the strong liquor into a small cup, lay a sheet of oiled paper flat on the surface of the liquor in the cup, and set fourteen grains of glutinous rice on the paper; leave them a night and then take them up. Sparrow droppings, sal ammoniac, myrrh and frankincense, one ja each. Grind the above fine, work the glutinous rice in evenly, and make pills the size of a barley grain. Use one grain at a time, stuck with saliva on the head of the sore, and it breaks at once and the pus comes out. If the pus is stagnating and not running freely, take one grain and put it into the mouth of the sore; the pus will not stagnate and sound flesh grows back easily. — Jeongyo 精要 (Donguibogam · Ongjeo)

Clinical commentary 臨床

The name is the method: 替鍼, standing in for the needle. A grain the size of a barley seed is stuck with spit on the head of a ripe abscess and the abscess opens — which it does, because the grain is soaked in lye. The long first half of the leaf is lye-making, the same procedure as the Skin chapter's Nohoe-go: lime and hearth ash leached with water, the run-off boiled down to a caustic concentrate, and glutinous rice left overnight on paper floating on it so that each grain takes up as much as it will hold. Sal ammoniac is a second caustic; frankincense and myrrh are there for the pain. The reasoning behind it is sound and is still the reasoning today: a collection of pus has to be let out, and until it is out nothing else helps. The second use in the leaf is the better one — a grain placed in the mouth of a sore to keep it from sealing over — which is a wick, and packing a cavity so it drains from the bottom up is ordinary wound care. What has changed is everything about how it is done. **This is a caustic: quicklime lye and sal ammoniac, applied to skin in order to burn through it. It must not be prepared or used.** Chemical cautery destroys tissue it cannot be aimed at, and the job this formula is doing — opening and draining an abscess, and debriding what is dead — is done now under sterile conditions with anaesthesia and a blade. Lancing a swelling at home, with any instrument, risks seeding the infection deeper. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.