Inner Expression Powder

One drug added, and the leaf does not bother to write the rest out: Sipseon-san with white peony. The addition answers the indication. Sipseon-san is for the sore itself and is read as a general expressing powder; this is for the patient left hollow after the sore has opened, or the weak patient in whom a sore has arisen in the first place, and white peony is what the tradition adds to hold the blood when a body is being pushed outward by warming and moving drugs. The method leaf calls for this formula twice, and both passages are worth reading together. The first is the Yu Yuanzi's: where a sore that rose high in the first five or seven days suddenly flattens and sinks, that is the sign of inward attack, so urgently use Naetak-san and the inward-supplementing decoctions to fill the bowels and viscera and make them solid — what is most to be feared is that the membrane is pierced, and of ten whose membrane is pierced not one lives. The second pairs it with Takri-san for a sore in its first days where the pulse is already sunken and fine, with vexation and oppression, the evil toxin fierce and sudden, and the outward signs deep-lying. In both the reasoning is the same: a swelling that collapses inward instead of coming to a head is the dangerous one, and the answer is to build the patient up so it is driven out. That is the exact inverse of the 疏 and 利 arm — Naesohwangryeon-tang, Oridaehwang-tang, Cheongeumnuro-tang — which assumes a repleted patient and carries the toxin down and out. A sunken fine pulse, vexation, a collapsing swelling and fear of the toxin reaching the viscera describe sepsis, which is what the chapter is actually looking at here and is right to fear. The honest modern reading is that the observation is good and the remedy is not. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.