Formulas · External Application 外用 · Uihak Immun (醫學入門)

Croton Seed Paste

Padu-go

한글 파두고 · Pinyin Ba Dou Gao

巴豆膏

The leaf gives no weight for the single drug, only its preparation. 歛 is printed as 斂 and 癕 as 癰, following the corpus forms. 紙撚, the twisted paper taper used to carry the paste into a sinus, is apparatus rather than an ingredient and stays in the source text.

Composition 構成

Padu Ba Dou
巴豆 파두 · Croton Seed

—
Chief 君

去殼, 炒焦, 硏如膏 — husked, dry-fried to scorching, ground to a paste; croton seed, violently toxic

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

Smeared on dead flesh at the centre of an abscess so that it sloughs away
Carried into a long-open sore on a twisted paper taper to lift out the root of toxin
Spread in a band across the centre so that the dead area demarcates and separates

Indications 主治

Pattern-based

發背 with 中央肉死 — the flesh at the centre of the swelling dead
惡瘡ㆍ膁瘡 long failing to close, with a root of toxin in the flesh
毒氣散漫 with the original qi weak, the dead area not yet demarcated
Flesh that does not feel pain (肉不知痛) — read as a bad sign

Biomedical correlates

Necrotic tissue in an abscess or chronic ulcer — historical escharotic
Chronic shin ulceration with a sloughy base

Source text 原文

Donguibogam 東醫寶鑑

巴豆去殼, 炒焦, 硏如膏. 如發背中央肉死, 塗之卽腐, 未死塗之生肌. 惡瘡ㆍ膁瘡久不收斂, 肉有毒根, 以紙撚蘸藥納之, 根去卽斂. 如元氣虛弱, 毒氣散漫, 中央肉死, 急服大補之劑, 中塗三四寸許, 至五六日赤黯之界自裂紋如刀劃狀, 中央漸潰. 若脾胃大虛, 肉不知痛, 急補脾胃, 肉多復生. 《入門》

Translation

Croton seed, husked, dry-fried until scorched and ground to a paste. If in an abscess on the back the flesh at the centre is dead, smearing this on makes it slough at once; where the flesh is not yet dead, smearing it on grows new flesh. For malign sores and shin sores that have long failed to close, where the flesh holds a root of toxin, twist a paper taper, dip it in the medicine and insert it; once the root is gone the wound closes. If the original qi is weak and the toxic qi has spread diffusely with the flesh at the centre dead, have the patient urgently take a greatly supplementing agent, smear the medicine across some three or four inches of the centre, and by the fifth or sixth day the border between the red and the dusky will split of itself in lines as though drawn with a knife, and the centre will gradually break down. If the spleen and stomach are greatly depleted and the flesh does not feel pain, urgently supplement the spleen and stomach and much of the flesh will grow back. — Immun 入門 (Donguibogam · Ongjeo)

Clinical commentary 臨床

One drug prepared as a paste: croton seed husked, dry-fried to scorching and ground. It heads the 去惡肉 group — the applications meant to take dead flesh off a wound so that living flesh can close over it — and the leaf is unusually careful about its clinical reasoning. It distinguishes flesh already dead from flesh not yet dead, describes the demarcation line that appears at the red-and-dusky border by the fifth or sixth day, and twice breaks off to say that if the patient is depleted the first thing to do is supplement: 急服大補之劑, 急補脾胃. Insensate flesh is read as the worst sign, which it is. The split 如刀劃狀, in lines as though drawn with a knife, is a real observation. Necrotic tissue does demarcate from viable tissue along a visible border, and waiting for that border is still part of deciding when to debride. **Croton seed is a violent irritant and vesicant, and this must not be prepared or applied.** Croton oil raises phorbol-ester blisters on intact skin and destroys exposed tissue indiscriminately; it cannot distinguish dead flesh from living the way the leaf claims, and the 三四寸 band smeared across a back would burn whatever it covered. What the formula was for — removing necrotic tissue so that a wound can heal — is real and necessary, and it is done now by sharp or surgical debridement, with enzymatic and autolytic dressings as the gentler alternatives. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.