寶鑑Bogam

Formulas · Release the Exterior 解表 · Jeoneul 錢乙 · Gangmok 綱目

Four Sages Powder for the Pox That Will Not Come Out

Saseong-san

한글 사성산 (소아)  ·  Pinyin Si Sheng San

四聖散

A 四聖散 was already registered from the 得效 by way of the Sores chapter (saseong-san) and this leaf is a different prescription, so it takes the chapter tail. The registered one treats 瘰癧 and is four drugs at 一兩 each — 海藻, 石決明 calcined, 羌活, 瞿麥 — given as a powder in rice gruel after a purge. This leaf treats the pox and is 紫草茸, 木通, 枳殼 and 甘草 in equal parts, decocted. **Not one drug is shared between the two.** They have the name, the dosage form and the 二錢-or-一錢 powder dose in common and nothing else. The four drugs are 各等分 and the dose is 每一錢, so each is entered at a quarter of the 4 g dose, following the corpus's practice for an equal-parts powder with a stated dose. 麄 and 爲 are printed as the corpus prints them. 倒靨 is this corpus's first occurrence of 靨, which appears nowhere in the translated chapters in either of its two forms, so there is no majority to follow and the transcription's 靨 is printed — it is also the standard character for the crusting of the pox, which the smallpox sections use throughout in 收靨 and 倒靨. 木通 is Akebia quinata in this corpus; the Aristolochia manshuriensis sold under the same name is a different and dangerous plant.

Composition 構成

Total 4 g per packet (첩) · representative dosage — verify against source texts.

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

  • 痘瘡出不快 — the pox sores slow or incomplete
  • 倒靨 — the eruption failing to dry and crust

Biomedical correlates

  • Smallpox, eruptive stage
  • Smallpox in which the lesions do not progress to crusting

Source text 原文

Donguibogam 東醫寶鑑

治痘瘡出不快及倒靨. 紫草茸ㆍ木通ㆍ枳殼ㆍ甘草 各等分. 右爲麄末, 每一錢, 水煎服. 《錢乙》 ○疹痘最要大小分解, 錢氏四聖散用木通ㆍ枳殼極好. 《綱目》

Translation

Treats pox sores that will not come out freely, and the pox that turns back without crusting. The downy shoot of arnebia, akebia, bitter orange and licorice in equal parts. Make the above into a coarse powder; 1 don to a dose, decocted in water and taken. ○ In rash and pox the great thing is to separate and resolve the large and the small, and Qian's Four Sages Powder is excellent for using akebia and bitter orange. — Jeoneul 錢乙 · Gangmok 綱目 (Donguibogam · Soa)

Clinical commentary 臨床

Four drugs in equal parts, ground coarse, a don at a time in water: arnebia shoot to bring the eruption out, akebia and bitter orange to drain and move downward, licorice to moderate. The 綱目 clause explains why Qian Yi's version was admired — 大小分解, separating and resolving the large and the small — which in the chapter's reasoning means opening a second road for the poison, outward through the skin and downward through the urine and stool at the same time. **倒靨 is the sign that matters here, and it is real.** The lesions of smallpox dried and crusted from about day ten to fourteen, and crusting was the beginning of recovery; an eruption that did not crust, that stayed boggy and then sank, was the pattern the chapter calls 倒靨 and 陷伏, and it marked the flat and the haemorrhagic forms. Those killed very nearly everyone who had them, usually before the pustular stage was complete. So the chapter has named the failure of a specific stage of a specific disease and placed it correctly among the grave signs. It is the same observation that 1.85.18 gives a section of its own. On smallpox having no treatment at all, see sodok-eum-soa. **The patient is a child with smallpox, and the leaf gives a dose of 1 don but none scaled to the child's age or weight.** Akebia is a diuretic and the chapter is giving it to a febrile child who is losing fluid through a broken skin; of the four drugs it is the one that could do harm, by the same route that killed in confluent smallpox — dehydration. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.

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