寶鑑Bogam

Formulas · Clear Heat 淸熱 · Uigam (醫鑑)

Resolve Toxin Beverage for the Pox That Will Not Come Out

Sodok-eum

한글 소독음 (소아)  ·  Pinyin Xiao Du Yin

消毒飮

Two formulas named 消毒飮 were already registered and this leaf matches neither, so it takes the chapter tail. The 得效 formula of the Eye chapter (sodok-eum-an) is four drugs for 瞼生風粟 and is built on ash-roasted 大黃 with 荊芥穗 at 二錢 each and 惡實 and 甘草 at 一錢; it has no 防風 at all, and its rhubarb does not appear here. The 丹心 formula of the Abscess chapter (sodok-eum-ongjeo) is seven drugs at 一錢三分 each for 便毒 — 皂角刺, 金銀花, 防風, 當歸, 大黃, 瓜蔞仁, 甘草 — and shares only 防風 and 甘草 with this leaf. This leaf is four drugs at unequal weights for the pox, from the 醫鑑, with 鼠粘子 leading at 二錢. Three different prescriptions under one name. The transcription writes 胷前 and 山楂子; the corpus prints 胸 and 山査子 and those forms are given above. 䑕 is printed 鼠 as the variant-glyph table requires.

Composition 構成

Total 16 g per packet (첩) · representative dosage — verify against source texts. Excludes 4 ingredients 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

  • 痘不快出 — the eruption slow or incomplete at the eruptive stage
  • 胸前稠密 — the pox crowded together on the front of the chest

Biomedical correlates

  • Smallpox, eruptive stage, with a dense or confluent rash on the trunk

Source text 原文

Donguibogam 東醫寶鑑

治痘不快出及胸前稠密, 急用三四服, 快透解毒神效. 鼠粘子 二錢, 荊芥穗 一錢, 生甘草ㆍ防風 各五分. 右剉, 作一貼, 水煎服. 或加山査子ㆍ酒芩ㆍ紫草服, 或和犀角磨汁服尤佳. 《醫鑑》

Translation

Treats pox that will not come out freely, and pox dense on the front of the chest. Use it at once, three or four doses: it drives the eruption through and resolves the toxin, with divine effect. Burdock seed, 2 don; schizonepeta spikes, 1 don; raw licorice and siler, 5 pun each. Cut up the above, make one packet, decoct in water and take. Hawthorn, wine-fried scutellaria and arnebia may be added to the dose; or it may be taken with rhinoceros horn ground to a juice and stirred in, which is better still. — Uigam 醫鑑 (Donguibogam · Soa)

Clinical commentary 臨床

**This is the first of the fifteen formula leaves attached to 1.69.1, and the place to say plainly what none of them could do.** Smallpox had no treatment. No decoction, powder, pill or wash in this chapter or in any other text before the twentieth century altered the course of variola infection. What determined whether a child lived was the amount of virus and the form the disease took, and after that the quality of nursing: fluid by mouth in small repeated amounts, warmth without overheating, keeping the child from scratching, and keeping secondary bacterial infection off the broken skin. Those were the things that moved outcomes, and they are nursing rather than pharmacy. A 消毒 decoction, a 透肌 decoction or a 快癍 powder did not change whether the lesions came out, how many of them there were, or whether the child survived. The other fourteen leaves of this section are cross-referenced to this statement rather than repeating it. What the leaf does get right is what it looks at. 胸前稠密 — the pox crowded together on the front of the chest — is the single most useful observation anyone could make at this stage of the illness. **Density was the thing that actually predicted death.** A discrete eruption, lesions standing separately with normal skin between them, carried roughly ten per cent mortality; semi-confluent much more; a confluent eruption, where the lesions ran together into sheets, killed over sixty per cent. So a physician who looked at the chest and judged how crowded the pocks were was grading the patient by the right variable, two and a half centuries before anyone could say why. The error is in the direction of causation. The density was an index of how much virus the child was carrying; it was not a blockage that could be opened. 急用三四服 — use it at once, three or four doses — is a rational response to a sign correctly read as grave, and it had nothing to act on. The composition is a standard outthrusting and heat-clearing set: burdock seed at double the next weight, schizonepeta spikes, siler and raw licorice. Burdock seed and schizonepeta are the chapter's drugs for bringing an eruption to the surface, siler opens the exterior, licorice moderates. Hawthorn, wine-fried scutellaria and arnebia as optional additions push it further toward clearing heat. **The optional addition of 犀角 is rhinoceros horn. It is keratin, the same protein as hair and fingernail, and it has no pharmacological action whatever; all five rhinoceros species are listed on CITES Appendix I, and the demand this medical tradition created is the reason they are endangered. It must not be used.** The full statement is on seogaksodok-eum-soa, where the horn is a named constituent rather than an option. **The patient is a child with smallpox, and the leaf gives drug weights but no dose scaled to the child's age or weight — the same packet is prescribed for an infant as for an older child.** — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.

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