Formulas · External Application 外用 · Uihak Immun (醫學入門)

Dead-Flesh Removing Powder

Geoak-san

한글 거악산 · Pinyin Qu E San

去惡散

The single croton seed is a count item and the 少許 of frankincense and myrrh a quantity at discretion, so neither carries a gram figure. The collation line printed within this leaf's lines, giving 丁 as the first edition's reading for 丹, sits at the 051a–051b page boundary and annotates 白丹香 in the Chudok-dan leaf earlier on the same page; it is recorded there and is not part of this text. The 白丁香 of the appended Dongwon note is an alternative laid on afterwards rather than part of the powder, so it is kept out of the ingredient list.

Composition 構成

Unghwang Xiong Huang
雄黃 웅황 · Realgar

4 g
Chief 君

一錢; realgar, an arsenic sulphide
Padu Ba Dou
巴豆 파두 · Croton Seed

—
Chief 君

一箇 — one seed; croton seed, violently toxic
Yuhyang Ru Xiang
乳香 유향 · Frankincense

—
Assistant 佐

末各少許, a little of the powder
Moryak Mo Yao
沒藥 몰약 · Myrrh

—
Assistant 佐

末各少許, a little of the powder

Total 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 paste dabbed onto dead flesh, not swallowed
Takes away dead flesh that cannot otherwise be removed
Added in small amount to a plaster for the same purpose

Indications 主治

Pattern-based

癰疽 and all sores with 惡肉 that cannot be removed
死血不去 — dead blood that will not clear from a sore

Biomedical correlates

Necrotic tissue and slough in an abscess or chronic ulcer — historical escharotic

Source text 原文

Donguibogam 東醫寶鑑

治癰疽及諸瘡有惡肉不能去者. 雄黃一錢, 巴豆一箇. 右同硏如泥, 入乳香ㆍ沒藥末各少許, 又再硏勻, 每取少許點上惡肉卽去. 《入門》 ○諸瘡有惡肉者, 膏藥內入巴豆ㆍ雄黃, 不傷良肉, 只去惡肉. 有死血不去, 白丁香上之. 《東垣》

Translation

Treats abscesses and all sores with dead flesh that cannot be removed. Realgar 1 don, croton seed 1 piece. Grind the two together to a mud, add a little powdered frankincense and myrrh each, grind again until even, and each time take a little and dab it onto the dead flesh, which then comes away. — Immun 入門 ○ For any sore with dead flesh, put croton seed and realgar into a plaster; it does not injure the good flesh and takes away only the dead. Where there is dead blood that will not go, apply sparrow droppings on top. — Dongwon 東垣 (Donguibogam · Ongjeo)

Clinical commentary 臨床

The shortest of the dead-flesh applications: realgar and a single croton seed ground together to a mud, with a little frankincense and myrrh worked in, dabbed on the dead flesh a little at a time. The note appended from 東垣 carries the group's central claim and the reason it was used at all — 不傷良肉, 只去惡肉, it does not injure the good flesh and takes away only the dead. That claim is false, and it is worth saying so plainly because it is the premise the whole 去惡肉 group rests on. Neither realgar nor croton oil can tell necrotic tissue from viable tissue; both destroy whatever they touch. The apparent selectivity was the ordinary observation that already-dead tissue separates painlessly while living tissue hurts and so is treated more gingerly. **Contains realgar, an arsenic sulphide, and croton seed, a violent vesicant. This must not be prepared.** Arsenic applied to an open wound is absorbed systemically, and arsenical escharotic pastes have caused deaths, amputations and disfigurement every time they have been revived as black-salve remedies. Removing dead flesh from a wound is a real and necessary job; surgical debridement is how it is done. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.