Formulas · Clear Heat 淸熱 · Uihak Immun (醫學入門)

Rehmannia Powder for Pox Screens

Jihwang-san

한글 지황산 (소아)  ·  Pinyin Di Huang San

地黃散

Three formulas named 地黃散 now stand. jihwang-san-an, from the Seui Deukhyobang for the muddied eye, is four drugs — 生地黃 one nyang with 赤芍藥ㆍ當歸ㆍ甘草 five don each — and is unrelated to this leaf. jihwang-san-ye, from Haejang in the Screens and Membranes section of 眼門, is the close one and was compared drug by drug. Its drug list is this leaf's fourteen plus 黃連; its weights are a three-tier scheme of 五錢ㆍ三錢ㆍ二錢 against this leaf's flat 一錢 with 玄參 at 五分 and 木通ㆍ甘草 at 二分半; its dose is 二錢 against this leaf's 五分; it takes the liver as a decocted 羊肝湯 rather than as 羊肝煮汁; and it closes 《海藏》 where this closes 《入門》. The two are plainly the same prescription in two recensions, and the 眼門 entry even carries the child's indication in its own tail — 亦治小兒瘡疹餘毒入眼生瞖 — but they are not the same text, and the composition and every weight differ, so this leaf is registered separately with the chapter tail rather than folded into an entry whose source_hanja belongs to another chapter. The indication above the formulas at 1.87.1 is itself nearly the 眼門 entry's indication verbatim. The transcription writes 為, printed 爲; 糓精草 is kept with 糓, as the database prints it in all five places.

Composition 構成

Total 48 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

  • After the pox, the eye swollen and painful with red vessels or a white membrane veiling the pupil (痘後眼腫痛, 或生赤脉, 或白膜遮睛)
  • Scattered and diffuse at the four edges — easy to treat (四邊散漫者易治)
  • Suddenly veiling the black of the eye — mostly ends in loss of sight (暴遮黑睛, 多致失明)

Biomedical correlates

  • Keratitis with corneal vascularization after smallpox
  • Central corneal opacity with loss of vision

Source text 原文

Donguibogam 東醫寶鑑

生地黃ㆍ熟地黃ㆍ當歸ㆍ防風ㆍ羌活ㆍ蟬殼ㆍ犀角ㆍ木賊ㆍ糓精草ㆍ白蒺藜ㆍ大黃 各一錢, 玄參 五分, 木通ㆍ甘草 各二分半. 右爲末, 每取五分, 以羊肝煮汁調服. 《入門》

Translation

Raw rehmannia, prepared rehmannia, angelica sinensis, ledebouriella, notopterygium, cicada moulting, rhinoceros horn, horsetail, pipewort, tribulus and rhubarb 1 don each; scrophularia 5 fun; akebia and licorice 2 fun 5 ri each. Powder them; take 5 fun at a time, stirred into the liquor of boiled sheep liver. — Immun 入門 (Donguibogam · Soa)

Clinical commentary 臨床

The largest formula in the section and the only one with a shape to it: two rehmannias and angelica for the blood, the wind drugs ledebouriella and notopterygium, the eye set of cicada moulting, horsetail, pipewort and tribulus, rhinoceros horn and scrophularia for toxic heat, rhubarb to take the heat out through the stool, and akebia and licorice in small amounts to lead and to harmonise. It is the eye chapter's standard answer to a hot, red, screened eye, transmitted here in the Uihak Immun's recension, and the dose is tiny — 5 fun, two grams, in liver broth. What this section is treating, and what could and could not be done about it, is set out under Milmonghwa-san. The specific thing to grade here is the indication, because it is a good one. Red vessels rising into the cornea and a white membrane creeping over it, scattered and diffuse at the edges, easy; suddenly veiling the black of the eye, and it mostly ends in blindness. That is the distinction between peripheral vascularization with marginal infiltrates, which settles and leaves vision, and a central corneal ulcer or scar on the visual axis, which does not. A physician who sorted these children by where the opacity sat rather than by how much of it there was had found the thing that predicted the outcome, and nothing in this powder changed the outcome either way. **The patient is a child, and this leaf gives no dose scaled to age or weight — 5 fun, whatever the child's size. The rhinoceros horn is from a CITES Appendix I animal and is pharmacologically inert; the demand for it is why the rhinoceroses are nearly gone.** Rhubarb at a fourteenth of a 5-fun dose is not a purge, but it is a purgative given to a child who has just lost fluid through a confluent eruption, and fluid loss was among the things that actually killed these children. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.

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