寶鑑Bogam

Formulas · Purge Downward 瀉下 · Haejang (海藏)

Tangkuei Pill

Danggwi-hwan

한글 당귀환  ·  Pinyin Dang Gui Wan

當歸丸

The transcription writes 為 twice — 右各為末 and 以利為度 — and 爲 is printed here, the corpus form in all 2,390 places where either appears. 菉豆 is kept as the transcription has it; the corpus prints 菉 by 136 places to 39. The source label 海藏 is not in the chapter brief's list of source romanisations; the corpus romanises it Haejang and carries it as a source in thirty-two other entries, and that reading is followed. The id is danggui-hwan. When this leaf was registered the corpus romanised 當歸 both ways in formula ids — twenty-seven on a danggui- stem against eleven on danggui- — while the herb id itself was danggui. The split has since been resolved in favour of danggui throughout, on the ground that the Korean Traditional Medicine Portal carries danggui as the official romanisation of 當歸; the revised romanisation of 귀 would give danggui, but a standard body's spelling governs over that derivation. Nothing else stood at danggui-hwan.

Composition 構成

Total 42 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

  • Bound and blocked stool in pox (痘瘡大便秘結)
  • An interior pattern with the stool bound, in which the chapter allows purging (有裏證及大便結者)
  • Stool bound so that the intestines and stomach are dammed and the toxic Qi has no way out (腸胃壅遏, 毒氣無從發泄)

Biomedical correlates

  • Constipation in a child with smallpox
  • In practice the reduced stool of a dehydrated, poorly fed child

Source text 原文

Donguibogam 東醫寶鑑

治痘瘡大便秘結. 當歸 五錢, 甘草 二錢半, 黃連ㆍ大黃 各一錢半. 右各爲末, 先將當歸熬膏子, 乃入三味末和勻, 作丸菉豆大, 米飮呑下五七丸, 漸加服, 以利爲度. 《海藏》

Translation

Treats a bound and blocked stool in smallpox. Tangkuei, 5 don; licorice, 2 don 5 fun; coptis and rhubarb, 1 don 5 fun each. Grind each of them to powder. First take the tangkuei and boil it down to a paste, then put in the powders of the three remaining drugs and mix them evenly, and make pills the size of mung beans. Swallow five to seven pills down with rice water, increasing the dose by degrees, and take the loosening of the stool as the measure. — Haejang 海藏 (Donguibogam · Soa)

Clinical commentary 臨床

Tangkuei carries the weight of the formula and gives it its name: five don of it, boiled down to a paste which then serves as the binder for powdered licorice, coptis and rhubarb. Rhubarb is the purgative, coptis the bitter cold drug the chapter pairs with it wherever heat is to be drawn downward, and licorice moderates. The instruction at the end is the important one — five to seven pills in rice water, increased by degrees, 以利爲度, until the stool loosens — which makes this a titrated purgative rather than a fixed dose. 1.85.17 便秘 is careful about this, and the care is worth noticing. The section quotes Qian Yi's rule that pox must not be purged from beginning to end, and then argues the exception: 若有裏證及大便結者安得不下, if there is an interior pattern and the stool is bound, how can one not bring it down. It also gives a reasoned threshold — a stool every other day is normal, one in three or four days is constipation, three or four in a day is diarrhoea — and a reason for caring, that a dammed bowel leaves the toxin no way out. That is a tradition arguing with itself about when to purge a sick child, and arriving at a position more cautious than its own enthusiasm. The modern reading is harder on it than the section is on itself. A child with a confluent smallpox eruption passes little stool mainly because he is taking little in and is losing fluid through broken skin; the constipation is a symptom of the dehydration, not a cause of anything. **Rhubarb is an anthraquinone stimulant laxative, the patient is a child, and the leaf gives no dose scaled to age or weight — only an instruction to increase until it works.** Purging to effect in a dehydrated infant deepens the fluid and potassium loss that was already the likeliest thing to kill him, and the titration makes it worse rather than better, because the endpoint is the purge itself. The section's own closing suggestion — fat tender pork boiled in plain water and given to the child to eat, which it calls the best method of all — would have done more good than the pills, and for the reason the section half sees: it is food and fluid. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.

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