Formulas · Release the Exterior 解表 · Seui Deukhyobang (世醫得效方)

Cicada Slough Decoction for the Pox That Will Not Come Through

Seontoe-tang

한글 선퇴탕 · Pinyin Chan Tui Tang

蟬退湯

蟬殼 is a recorded variant of 蟬退 and is entered under that headword in the herb dictionary; the formula name uses the headword and the leaf body the variant. 二十一箇 is a count, three sevens, and carries no weight. The transcription writes 為, printed 爲 as the corpus prints it. The Anterior Yin chapter's 蟬退散 (seontoe-san) and the Skin chapter's 蟬蛻散 (seontoe-san-pi) are separate formulas and neither is this one.

Composition 構成

Seontoe Chan Tui
蟬退 선퇴 · Cicada Moulting

—
Chief 君

蟬殼二十一箇, twenty-one cicada sloughs, a count with no weight given
Gamcho Gan Cao
甘草 감초 · Licorice

6 g
Deputy 臣

1 don 5 fun

Total 6 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

Given where the pox and rash do not come through, with severe abdominal pain, or where the pox has gone to black sinking
Decocted, or powdered and taken 1 don at a time in plain hot water
Claimed to stop the abdominal pain at once and bring the eruption through

Indications 主治

Pattern-based

痘疹出不透 — the pox and rash not coming through
腹痛甚 — severe abdominal pain
黑陷 — the pox black and sunken

Biomedical correlates

Smallpox with a flat or failing eruption

Source text 原文

Donguibogam 東醫寶鑑

蟬殼二十一箇, 甘草一錢半. 右剉, 水煎服. 或爲末, 每一錢, 白湯調下. 腹痛立止, 而出透神效. 《得效》

Translation

Cicada slough, twenty-one pieces; licorice, 1 don 5 fun. Cut up the above and decoct in water and take; or powder it and take 1 don at a time stirred down in plain hot water. The abdominal pain stops at once, and it brings the eruption through with divine effect. — Deukhyo 得效 (Donguibogam · Soa)

Clinical commentary 臨床

Twenty-one cicada sloughs and a don and a half of licorice — decocted, or ground and taken a don at a time in plain hot water. The claim made for it is the largest in the section: 腹痛立止, 而出透神效, the abdominal pain stops at once and the eruption comes through, with divine effect. Cicada slough is the moulted exoskeleton of the insect: chitin with some protein and mineral residue. The tradition reaches for it to release what is held at the surface, on the reasoning that the creature sheds it, and it is the standard drug wherever a rash is held to be stuck under the skin. There is nothing in it that acts on a viral exanthem. Licorice is sweet and moderating, and in a decoction it is mostly what makes the drink palatable. **The indication is the grave sign, and the chapter is right that it is grave and wrong about what it is.** 出不透 — the eruption failing to come through — and 黑陷, black sinking, describe the same appearance: pocks that stay flat, dusky and level with the skin instead of raising into vesicles. That is haemorrhagic smallpox, bleeding into the lesions and into the skin, and it killed very nearly everyone who had it, usually before the pustular stage. It is not a blockage that can be opened from outside, and no drug opens it. The chapter's full treatment of 黑陷 is at 1.85.19, where it is given more room than anything else in the chapter, and that statement is not repeated here. The abdominal-pain claim should be read for what it is. 立止 — stopping at once — from two bland materials is not a result that can be taken at face value; what a warm, sweet drink does for a child in pain is settle him briefly, which is worth something and is not what is being claimed. Licorice in repeated doses is worth one caution of its own: glycyrrhizin causes sodium retention and potassium loss, and a child with smallpox who is vomiting or purging is already short of potassium. **The patient is a child, the leaf gives no weight at all for the cicada sloughs, and it gives no dose scaled to the child's age or weight.** — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.