寶鑑Bogam

Formulas · Reduce Food Stagnation 消食 · Gogeum Uigam (古今醫鑑)

Gan-Accumulation Biscuit

Gamjeok-byeong

한글 감적병  ·  Pinyin Gan Ji Bing

疳積餠

The transcription writes 山楂肉 here and in 消疳丸 and 肥兒丸 but 山査肉 in 五疳消食元; the corpus elsewhere prints 山査肉, and the transcription's glyph is kept on each leaf as the 底本 rule requires. 醫鍳 is normalized to 醫鑑. 嚼吃 and 蔲 are kept as written.

Composition 構成

Total 2322 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

  • 五疳諸積 — the five gan with food accumulation, the belly distended and the stool foul
  • 食疳 — the earth-eating, sour-smelling stool and swollen belly of the spleen pattern

Biomedical correlates

  • Protein-energy malnutrition in a young child
  • Ascariasis and other intestinal helminthiasis
  • Chronic diarrhoea with abdominal distension

Source text 原文

Donguibogam 東醫寶鑑

治五疳諸積. 使君子肉 一兩, 白朮ㆍ黃連 各三錢, 靑皮ㆍ陳皮ㆍ山楂肉ㆍ神麴(炒)ㆍ麥芽(炒)ㆍ三稜(煨)ㆍ蓬朮(煨)ㆍ木香 各二錢半, 縮砂ㆍ檳榔ㆍ肉豆蔲ㆍ訶子肉ㆍ甘草(灸) 各二錢, 茴香(炒)ㆍ川練肉ㆍ夜明砂(炒) 各一錢半, 乾蟾 一箇. 右爲末, 白麪 三斤炒黃, 以砂糖 五兩水煮化, 和勻得所, 印作餠子, 每重一錢. 每服二三餠, 任意嚼吃, 米飮送下. 《醫鑑》

Translation

Treats the five gan with all their accumulations. Shelled Quisqualis kernel, 1 nyang; white atractylodes and coptis, 3 don each; green tangerine peel, tangerine peel, hawthorn flesh, medicated leaven (stir-fried), malt (stir-fried), sparganium (roasted in the ashes), zedoary (roasted in the ashes) and costus root, 2 don 5 fun each; cardamom, areca nut, nutmeg, stoned chebula and roasted licorice, 2 don each; fennel (stir-fried), toosendan flesh and bat droppings (stir-fried), 1 don 5 fun each; one dried toad. Powder the above; stir-fry 3 geun of white wheat flour yellow, dissolve 5 nyang of sugar in boiling water, mix it all evenly to the right consistency, and press it out into biscuits weighing 1 don each. Two or three biscuits a dose, chewed at will and washed down with rice decoction. — Uigam 醫鑑 (Donguibogam · Soa)

Clinical commentary 臨床

This is the one formula in the group that is also food. Twenty drugs powdered into 3 geun of stir-fried wheat flour and 5 nyang of dissolved sugar, pressed into 1 don biscuits that a child chews two or three of at a time — and the flour and the sugar outweigh the medicine by better than twenty to one. The chapter pairs it with 肥兒丸 as the two mainstays of 疳 (凡疳病以肥兒丸疳積餠爲主), and of the two it is this one that puts calories into the patient. That deserves saying, because it is reaching in the right direction: wheat flour and sugar are energy, and a wasted child needs energy before anything else. It is not therapeutic feeding — there is no protein to speak of in it, no fat, and no micronutrients — but it is not nothing either. The medicine inside the biscuit is a digestive formula built on 使君子 with hawthorn, malt and medicated leaven for the food accumulation, sparganium and zedoary for the mass, and coptis for the heat. On the honest reading of 疳 as malnutrition, and on why bitters and worm drugs are not a treatment for it, see 五疳保童元. **The Quisqualis is a real anthelmintic and the 1 nyang of it is the largest dose of a real drug in this group.** Ascariasis is what it treats, a heavy worm burden steals calories from a child who has none to spare, and a single dose of albendazole or mebendazole now does the same work for a few cents. The toosendan flesh is a second worm drug and is mildly toxic in its own right. **That is also the hazard: an effective drug with no stated dose is still a hazard.** Enough 使君子 causes hiccup, vomiting and diarrhoea, and there is no dose by weight for the child anywhere here — only "two or three biscuits, chewed at will", which for a toddler left with the tin is no limit at all. **The dried toad and the bat droppings are what they sound like**: a whole dried toad, whose skin and parotoid glands carry bufadienolides — cardiac glycosides that have killed adults by arrhythmia — and raw bat faeces, baked into a sweet biscuit for a small child. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.

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