寶鑑Bogam

Formulas · Invigorate Blood 活血祛瘀 · Seui Deukhyobang (世醫得效方)

Wild Aconite Powder

Choo-san

한글 초오산  ·  Pinyin Cao Wu San

草烏散

The transcription writes 夾㝎 for 夾定 and the leaf carries the 初刊本 collation pair 㝎 : 定; the house correction 㝎→定 is applied and the normalized glyph printed. The leaf also carries the pair 邉 : 邊, but 邉 does not occur in this leaf — it belongs to the 骨折筋斷傷 section prose above it, which writes 夾㝎一邉一邉不用夾. 𥂁 is printed as 鹽. 木鼈 and 土鼈 are left in the transcription’s 鼈 form throughout, as the corpus does.

Composition 構成

Total 424 g per packet (첩) · representative dosage — verify against source texts.

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

  • Dislocation and fracture requiring reduction
  • Arrowhead lodged in bone

Biomedical correlates

  • Pre-reduction anaesthesia for dislocation and fracture
  • Retained foreign body in bone

Source text 原文

Donguibogam 東醫寶鑑

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

Translation

This is the numbing drug. Whenever a joint is out of its socket, use this to numb the patient, and only then set it by hand. Gleditsia pod, cochinchina momordica seed, zijinpi bark, angelica dahurica, pinellia, lindera root, Chinese angelica, chuanxiong and Sichuan aconite, 1 nyang 2 don 5 fun each; wild aconite, fennel and zuonacao, 2 don 5 fun each; costus root 1 don — none of it calcined or processed. Powder them. For any kind of joint out of its socket, 2 don a dose, stirred down in good red wine, until the patient falls numb and cannot tell where the pain is; then either open it with a knife, or shear off the bone spikes, set the joint back to its place with the hands, and splint it fast. Only then treat it. If an arrowhead has gone into the bone and will not come out, use this drug too, and after the numbing either draw it out with pincers or chisel it open and take it out; then give salt decoction or salt water and the patient wakes at once. — Seui Deukhyobang 得效 (Donguibogam · Jesang)

Clinical commentary 臨床

This is the chapter's anaesthetic and it says so in its first four characters: 卽麻藥也, this is the numbing drug. Eleven drugs, the two aconites among them, with 川烏 in the largest share of all at 1 nyang 2 don 5 fun; 2 don of the powder in good red wine, repeated until 麻倒不識痛處 — the patient goes down numb and can no longer tell where the pain is. Only then does the operator work: open the skin with a knife, shear off the bone spikes with shears, set the joint back into its socket by hand, splint it. The same powder is given before an arrowhead buried in bone is pulled with pincers or chiselled out, and salt water afterwards is the reversal agent, 立醒, waking the patient at once. As surgical thinking this is serious and in the right order — anaesthetise, reduce, immobilise, then treat. As pharmacology it is the most dangerous thing in the chapter. Aconitine and its relatives hold the cardiac and neuronal sodium channel open; the tingling mouth, the numb limbs and the loss of pain sense are the same action as the bradycardia, the ventricular tachycardia and the asystole that follow, and they are not separable. There is no window a practitioner can feel for. The endpoint the text asks for — insensible — is already past the dose at which arrhythmia begins in some patients, and the margin between a numb patient and a dead one is a matter of individual sensitivity and of how much alkaloid happened to be in that batch of root. 並無煆製 makes it worse: it states expressly that none of the drugs is processed, and the 炮 or soaking step omitted here is the one hydrolysis that converts the diester alkaloids to their far less toxic forms. 雙烏散, four pages earlier, roasts its 草烏 precisely because raw would be 太猛; this formula does not. **Contains aconite, in quantity and expressly unprocessed, which is toxic. This must not be prepared.** **It also contains raw pinellia and cochinchina momordica seed, both toxic unprocessed.** Reduction of a fracture or dislocation today is done under local block, regional block, procedural sedation or general anaesthesia, with the airway, the rhythm and the oxygen saturation monitored throughout and reversal agents to hand — which is what 立醒 was groping for, and could not provide. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.

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