寶鑑Bogam

Formulas · Release the Exterior 解表 · Junggyeong (仲景)

Soul-Restoring Decoction

Hwanhon-tang

한글 환혼탕  ·  Pinyin Huan Hun Tang

還魂湯

The leaf gives 追魂湯 as an alternate name. The composition printed here is four drugs — 麻黃ㆍ杏仁ㆍ桂心ㆍ甘草 — which is 麻黃湯 (registered as mahwang-tang, with 桂枝 where this has 桂心), not the three-drug 還魂湯 of the 金匱 tradition, which is 麻黃ㆍ杏仁ㆍ甘草 alone. The corpus has no other entry for this formula: 還魂散 (hwanhon-san) is an unrelated 醫鑑 formula for the clove sore and the abscess, and the name 還魂湯 appears elsewhere only in a passing mention in the note to yunhoe-ju. A collation note 泡 : 炮(First Edition) sits among the lines of this leaf at the 031a page break, but the word it annotates is 附子泡 in the 尸厥 prose above the leaf, not anything in the leaf itself, and it has not been acted on here. The transcription writes 黄 for 黃, 欝 for 鬱, 凣 for 凡 and 撃 for 擊; the standard forms are printed, 撃 following the corpus, which writes 擊 throughout and has no instance of 撃.

Composition 構成

Total 20 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

  • 尸厥 — the corpse-like faint, the pulse beating but the breath shut off
  • 中惡ㆍ客忤ㆍ鬼擊ㆍ飛尸 — malign stroke, offence by a visiting influence, the ghost-strike, the flying corpse
  • 暴死 — sudden death, with the jaw locked and the breath cut off
  • 鬱冒ㆍ卒中 — the muffled collapse and sudden stroke, which the chapter also treats by releasing the exterior

Biomedical correlates

  • Sudden collapse with apparent apnoea — cardiac arrest, respiratory arrest, deep syncope
  • Status epilepticus or post-ictal unresponsiveness

Source text 原文

Donguibogam 東醫寶鑑

一名追魂湯. 主中惡ㆍ尸厥ㆍ暴死ㆍ客忤ㆍ鬼擊ㆍ飛尸, 奄忽口噤氣絶. 麻黃 三錢, 杏仁 二十五粒, 桂心ㆍ甘草 各一錢. 右剉, 作一貼, 水煎灌服. 口噤者, 斡開口灌之, 藥下立甦. 《仲景》 ○凡尸厥ㆍ鬱冒ㆍ卒死ㆍ卒中之類, 皆當發表. 仲景云, 鬱冒欲解, 必大汗出, 是也. 《綱目》

Translation

Another name for it is Chuhon-tang, the Soul-Summoning Decoction. It governs malign stroke, the corpse-like faint, sudden death, offence by a visiting influence, the ghost-strike and the flying corpse, where the patient suddenly has the jaw locked and the breath cut off. Ephedra 3 don, twenty-five apricot kernels, cinnamon heartwood and licorice 1 don each. Cut them up, make one packet, boil in water and pour it in. If the jaw is locked, lever the mouth open and pour it in; as the medicine goes down the patient revives at once. — Junggyeong 仲景 ○ In all cases of the corpse-like faint, the muffled collapse, sudden death and sudden stroke and the like, the exterior should be released. Junggyeong says that when the muffled collapse is about to resolve there must be a great sweat — this is what he means. — Gangmok 綱目 (Donguibogam · Gugeup)

Clinical commentary 臨床

This is 麻黃湯 under an emergency name. The reasoning is in the 綱目 clause the leaf prints after the formula: 皆當發表 — in the corpse-like faint and the muffled collapse the exterior should be released, and the sign that the thing is resolving is a great sweat. So the book gives a sweating decoction to a patient who has stopped breathing, on the theory that the breath is shut in rather than gone, and that opening the exterior will let it out. The clinical picture the chapter describes for 尸厥 is specific and worth reading as written: 脉動而無氣, 氣閉不通, 故靜如死也 — the pulse beats but there is no breath. That is respiratory arrest with a pulse still present, and it is a real and recoverable state. What such a patient needs is ventilation, immediately; within a few minutes the pulse is lost too. Ephedra is a sympathomimetic and would raise heart rate and blood pressure in someone with a circulation, but it does nothing for an airway and nothing for apnoea. The instruction 口噤者斡開口灌之 — if the jaw is locked, lever the mouth open and pour it in — is the most dangerous sentence in the leaf. An unresponsive patient has no gag reflex, and fluid forced past a clenched jaw goes into the lungs. The airway comes first: open the airway, check for breathing, give rescue breaths and start chest compressions if there is no pulse, and put nothing in the mouth of a patient who cannot swallow. **Contains ephedra, which raises blood pressure and heart rate and is restricted or prohibited in many jurisdictions. Not suitable for self-administration, and contraindicated in hypertension and cardiac disease.** — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.

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