寶鑑Bogam

Formulas · Clear Heat 淸熱 · Hwaje Gukbang (和劑局方)

Child-Protecting Pill for the Five Gan

Ogambodong-won

한글 오감보동원  ·  Pinyin Wu Gan Bao Tong Yuan

五疳保童元

The transcription writes 䧺黃, normalized to 雄黃; the First Edition reads 雄, and the collation note recording that stands three lines below, inside the 消疳丸 leaf, on the page boundary rather than beside the word it annotates. 蟾頭 is registered against 乾蟾, following the alias the corpus already carries for 乾蟾頭 in 風疳丸. 白鱔頭 has no herb entry and is left out of the ingredient list; the substitution gloss 無則蕪荑代之 is printed in parentheses as a substance gloss, as the corpus does for 無則狗頭骨代之 at saenggi-san-ongjeo. The leaf writes 灸黃色 where 炙 would be expected; 灸/炙 is not normalized in this corpus and the transcription's glyph stands.

Composition 構成

Total 140 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

  • 五藏疳 — gan of the five viscera, divided by which organ the wasting is referred to
  • 肝疳 with 白膜遮睛 and 雀目, 心疳 with mouth sores and bloody stool, 脾疳 with a swollen belly and earth-eating, 肺疳 with cough and sores at mouth and nose, 腎疳 with gum ulceration

Biomedical correlates

  • Protein-energy malnutrition in a young child (marasmus, kwashiorkor)
  • Intestinal helminthiasis, chiefly ascariasis
  • Vitamin A deficiency with corneal involvement
  • Oral and gingival ulceration in a malnourished child

Source text 原文

Donguibogam 東醫寶鑑

治五藏疳. 黃連ㆍ白鱔頭(無則蕪荑代之)ㆍ草龍膽ㆍ五倍子ㆍ靑皮ㆍ夜明砂(炒)ㆍ苦練根ㆍ雄黃ㆍ麝香ㆍ靑黛ㆍ天漿子ㆍ熊膽ㆍ蘆薈ㆍ胡黃連 各二錢半, 蟾頭 一枚(灸黃色). 右爲末, 飯丸麻子大, 一歲兒米飮下一二丸. 《局方》

Translation

Treats gan of the five viscera. Coptis, white eel head (substitute elm-fruit paste where it is not to be had), gentian root, gallnut, green tangerine peel, bat droppings (stir-fried), chinaberry root bark, realgar, musk, indigo, slug-moth cocoon, bear bile, aloe and picrorhiza, 2 don 5 fun each; one toad head, roasted to a yellow colour. Powder the above and make pills with cooked rice the size of a hemp seed; a one-year-old child takes one or two in rice decoction. — Gukbang 局方 (Donguibogam · Soa)

Clinical commentary 臨床

Fourteen drugs at an identical 2 don 5 fun with one roasted toad head, bound with cooked rice into hemp-seed pills. Three bitters carry it — coptis, picrorhiza and gentian root — with gallnut and green tangerine peel for the loose stool and the distended belly, and then the whole 疳 pharmacopoeia of its day laid on top: realgar, musk, bear bile, indigo, bat droppings, a slug-moth cocoon, aloe, a chinaberry root bark and a toad's head. **None of this is food, and that is the whole of the matter.** 疳 is childhood malnutrition — the protein-energy malnutrition complex of a young child, with the deficiency diseases and the infections that ride on it. The chapter's own aetiology says as much in passing (疳病因多食肥甘所致 — gan comes of eating too much rich and sweet food) and gets it exactly backwards; what the children in these sections have is too little of everything. A wasted one-year-old needs energy and protein, delivered by mouth, in quantity, with micronutrients and with the infections treated; today that is ready-to-use therapeutic food, and it works. This formula gives bitters, two arsenic- and mercury-free minerals, animal bile and a bat's droppings. It cannot put weight on a child, and the chapter's own 諸疳不治證 section — the list of signs after which the case is given up — is the record of how that ended. **The anthelmintics in it are the real drugs.** Chinaberry root bark (苦練根, Melia) is a genuine anthelmintic, and the elm-fruit paste (蕪荑) that stands in for the eel head is another; 使君子 in the companion formulas of this group is still in use. What they treat is real too: ascariasis, which is why 蛔疳 gets a section of its own, and a heavy worm burden in an underfed child both steals calories and causes obstruction. A single dose of albendazole or mebendazole now does the same job, cheaply and measurably. That is also the hazard. An effective drug with no stated dose is still a hazard: chinaberry root bark is neurotoxic and hepatotoxic in overdose, 使君子 in quantity causes hiccup, vomiting and diarrhoea, and this leaf's only quantity is one or two pills for a child of one year. **Contains realgar — 雄黃, arsenic sulfide — in a pill for a one-year-old. This must not be prepared.** The chapter gives no dose by weight anywhere, and a pill counted out to an infant is not a dose. Arsenic is cumulative, and the kidneys of a wasted baby clear it poorly. **It also contains aloe, a stimulant laxative, given to a child who is very likely already losing fluid to 疳瀉** — the section's own picture is 下痢頻多 and 瀉痢頻作. And two of its drugs are from protected animals: the musk is from a CITES Appendix I deer, the bile from a bear. The bat droppings and the roasted toad head are what they sound like — raw animal faeces and a dried toad, and the toad's skin and parotoid glands carry bufadienolides, cardiac glycosides that have killed adults by arrhythmia. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.

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