寶鑑Bogam

Formulas · Dispel Wind 祛風 · Dansim (丹心)

Bitter Orange Pill for the Tortoise Back

Jigak-hwan

한글 지각환  ·  Pinyin Zhi Qiao Wan

枳殼丸

A 枳殼丸 was already registered from the Triple Burner chapter and this leaf is not that formula, so it takes the chapter tail. The registered `jigak-hwan` is Liu Wansu's pill from the 河間 for the adult whose three burners have shut both outlets — 治三焦約, 大小便不通 — and it is built of bitter orange 2 nyang, tangerine peel 1 nyang, areca 5 don, costus 2 don 5 pun and black morning-glory seed 4 nyang taken down to its first sifting, honey-bound into firmiana-seed pills, thirty to fifty at a dose in ginger decoction. This leaf is from the 丹心, treats the tortoise back of a small child, and is built of seven drugs at a flat 3 don each — siler, pubescent angelica, rhubarb, hogfennel, Korean angelica and ephedra beside the bitter orange — bound with flour paste into millet-sized pills, ten to twenty in rice decoction. Only 枳殼 is common to the two, and even its weight and standing differ. They are homonyms. The leaf's 一名龜背丸 romanises to `gwibae-hwan`, which is unoccupied, so the alias raises no further clash.

Composition 構成

Total 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

  • Tortoise back in a child (龜背)
  • Wind lodged in the spinal bone (風入於脊骨)

Biomedical correlates

  • Rickets — nutritional vitamin D deficiency with kyphosis
  • Thoracic kyphosis in infancy
  • Spinal tuberculosis (Pott's disease) where the hump is sharp and angular

Source text 原文

Donguibogam 東醫寶鑑

治同上. 枳殼ㆍ防風ㆍ獨活ㆍ大黃ㆍ前胡ㆍ當歸ㆍ麻黃 各三錢. 右爲末, 麪糊和丸黍米大, 米飮呑下一二十丸. 《丹心》 ○一名龜背丸. 《回春》

Translation

Treats the same as above. Bitter orange, siler, pubescent angelica, rhubarb, hogfennel root, Korean angelica and ephedra, 3 don each. Powder the above, bind with wheat-flour paste into pills the size of a millet grain, and give ten to twenty swallowed down in rice decoction. ○One name for it is Gwibae-hwan 龜背丸. — Dansim 丹心 (Donguibogam · Soa)

Clinical commentary 臨床

The second of the two tortoise-back pills and the plainer one: the same wind-opening set as 松蘂丹 with the pine pollen and the cinnamon heart dropped, Korean angelica added, every drug at a flat 3 don, and flour paste in place of honey. The 回春 calls it simply the tortoise-back pill. Set beside 松蘂丹 it shows what the section thought it was treating: a surface opened with siler, pubescent angelica and ephedra, and a bowel moved with bitter orange and rhubarb. The disease is rickets, and the full statement belongs with the 解顱 leaves of 1.49, where the chapter's three separate records of vitamin D deficiency — the open skull, the missing hair and teeth, the humped back and keeled chest — are read as one. For the shape of the hump see 松蘂丹: a smooth kyphosis that softens when the child is lifted is rachitic, while a sharp angular gibbus over one or two vertebrae is spinal tuberculosis, which destroys vertebral bodies and can compress the cord. **Contains ephedra and rhubarb in a pill for a small child, and the text gives no dose by weight here — ten to twenty pills the size of a millet grain. This must not be prepared.** Ephedrine is a cardiac and central stimulant; rhubarb is a stimulant laxative and a purging infant dehydrates quickly. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.

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