寶鑑Bogam

Formulas · Warm the Interior 溫裏 · Seui Deukhyobang (世醫得效方)

Black Aconite Decoction

Heukbu-tang

한글 흑부탕  ·  Pinyin Hei Fu Tang

黑附湯

The transcription reads 入薑 五 with no counting word; every parallel leaf in the chapter writes 入薑 五片, five slices, and the 片 is almost certainly dropped. The transcription's reading is printed and the omission noted here. 灸 is left as written rather than normalised to 炙, following the corpus. 白附子 is Typhonii Rhizoma, a different drug from the 附子 beside it, despite the shared character. The two further 慢脾風 formulas the section names, 生附四君子湯 and 蝎附散, are leaves of this same section registered elsewhere in this round and are not linked here; 補脾益眞湯 and 全蝎觀音散, named in the prose above, are cross-references out of the section.

Composition 構成

Total 24 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

  • 慢脾風 — chronic spleen wind, the decompensated end of the chronic picture
  • 面靑額汗, 眼合不開 — the face blue, the forehead sweating, the eyes closed and not opening
  • 手足微搐而不收, 身冷 — feeble twitching that does not resolve, the body cold
  • 脈沈微 — the pulse deep and faint

Biomedical correlates

  • Hypovolaemic and septic shock in a child after prolonged diarrhoea
  • Hypoglycaemia and hypothermia with depressed consciousness
  • Severe electrolyte derangement — hyponatraemia, hypokalaemia, hypocalcaemia
  • Metabolic acidosis of dehydration

Source text 原文

Donguibogam 東醫寶鑑

治慢脾風危急者. 附子(炮) 三錢, 木香 一錢半, 白附子 一錢, 甘草(灸) 半錢. 右剉, 分二貼, 入薑 五, 水煎, 以匙灌下. 若手足煖而甦省, 卽止. 《得效》

Translation

Treats chronic spleen wind in a child in extremity. Aconite, blast-fried, 3 don; costus root, 1 don 5 fun; typhonium, 1 don; licorice, mix-fried, half a don. Cut the above, divide it into two packets, put in five of ginger, decoct in water and spoon it in. If the hands and feet grow warm and the child comes round, stop at once. — Deukhyo 得效 (Donguibogam · Soa)

Clinical commentary 臨床

Four drugs, of which the first is aconite at three don, the largest weight in the formula, with a second root in the name that only looks like it — 白附子 is typhonium, not aconite. The reasoning behind it is explicit in the section above: the child is cold, the yang has gone, so warm and raise it, and stop the moment the hands and feet are warm again. That stopping rule is the most careful instruction in the whole chapter and it was written by someone watching closely. 慢脾風 is the decompensated end of the chronic picture, and it should be described plainly. A child who has had diarrhoea for days or weeks: cold to the touch, sweating on the forehead, the face dusky, the eyes closed and not opening, the tongue short, the jaw clenched, the limbs twitching feebly without ever quite stopping, the pulse deep and faint. The text's own figure is one or two saved in ten, and that is honest. This is hypovolaemic and septic shock with hypoglycaemia, hypothermia and a wrecked electrolyte balance. It really was almost always fatal. What changed it is not a formula: it is fluid and electrolyte replacement — oral rehydration solution where the child can still drink and intravenous fluid where it cannot — glucose, warming, and antibiotics for the sepsis underneath. Those are cheap and they are decisive, and none of them existed. The grim logic here deserves to be stated rather than mocked. The instinct is not wrong. A child in shock is cold and needs warming, and the circulation does need support; the chapter identified the right problem from the outside. The drug reached for was one of the most dangerous in the entire pharmacopoeia, and it was reached for because it is the one that unmistakably does something. **This formula is built on 附子, aconite, blast-fried, at three don — the largest weight in it. Aconitine has almost no margin between an effect and a fatal ventricular arrhythmia, the margin narrows further in a dehydrated child with deranged potassium, and no way existed to measure either the alkaloid content of a given root or the dose reaching the child. The patient is a child and the text gives no dose by weight anywhere. This must not be prepared.** — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.

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