Formulas · Purge Downward 瀉下 · Gogeum Uigam (古今醫鑑)

Open and Guide Out Powder

Tongdo-san

한글 통도산 · Pinyin Tong Dao San

通導散

The alternate name 大成湯 carries its own source label 醫林 in the base text. 大成湯 is not separately registered on this site.

Composition 構成

Daehwang Da Huang
大黃 대황 · Rhubarb

8 g
Chief 君
Mangcho Mang Xiao
芒硝 망초 · Mirabilite

8 g
Chief 君
Danggwi Dang Gui
當歸 당귀 · Korean Angelica

4 g
Deputy 臣
Somok Su Mu
蘇木 소목 · Sappan Wood

4 g
Deputy 臣
Honghwa Hong Hua
紅花 홍화 · Safflower

4 g
Deputy 臣
Doin Tao Ren
桃仁 도인 · Peach Kernel

4 g
Deputy 臣
Hubak Hou Po
厚朴 후박 · Magnolia Bark

2 g
Assistant 佐
Jinpi Chen Pi
陳皮 진피 · Aged Tangerine Peel

2 g
Assistant 佐
Moktong Mu Tong
木通 목통 · Akebia

2 g
Assistant 佐
Jigak Zhi Qiao
枳殼 지각 · Bitter Orange

2 g
Assistant 佐
Gamcho Gan Cao
甘草 감초 · Licorice

2 g
Envoy 使

Total 42 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

Brings stagnant blood down where an injury is grave and neither stool nor urine will pass
Relieves distension and oppression of the heart region and abdomen

Indications 主治

Pattern-based

Injury of the gravest kind with neither stool nor urine passing
Distension and oppression of the heart region and abdomen

Biomedical correlates

Severe blunt trauma with ileus and urinary retention
Traumatic intra-abdominal haematoma

Source text 原文

Donguibogam 東醫寶鑑

治傷損極重, 大小便不通, 心腹脹悶, 宜用此下瘀血. 大黃ㆍ芒硝各二錢, 當歸ㆍ蘇木ㆍ紅花ㆍ桃仁各一錢, 厚朴ㆍ陳皮ㆍ木通ㆍ枳殼ㆍ甘草各五分. 右剉作一貼, 水煎, 空心服. 《醫鑑》 ○一名大成湯. 《醫林》

Translation

Treats injury of the gravest kind, with neither stool nor urine passing and distension and oppression of the heart region and abdomen; this should be used to bring the stagnant blood down. Rhubarb and mirabilite, 2 don each; angelica sinensis, sappanwood, safflower and peach kernel, 1 don each; magnolia bark, aged tangerine peel, akebia, bitter orange and licorice, 5 fun each. Cut as one packet, decoct in water, and take it on an empty stomach. ○ It is also called Daeseong-tang. — Uigam 醫鑑, Uirim 醫林 (Donguibogam · Jesang)

Clinical commentary 臨床

承氣湯 with blood-movers added. Rhubarb and mirabilite are the 大承氣湯 pair, and behind them stand angelica, sappanwood, safflower and peach kernel to break the stasis, with magnolia bark, tangerine peel, akebia and bitter orange to move Qi and free the water passage. The chapter names it for the gravest injury, where both passages have shut. This is the formula the chapter gives to the patient it can least afford to purge. 大小便不通 after 極重 trauma means a pelvic injury, a urethral tear, a retroperitoneal bleed or a paralytic ileus, and often more than one of those. The treatment for each is a catheter, imaging and an operating theatre. A combined rhubarb-and- mirabilite purge given on an empty stomach to a patient who is already losing circulating volume makes the hypovolaemia worse, and will not reach the obstruction if there is one. 下瘀血 was a coherent mechanism in its own system and it is the wrong thing to do. **Rhubarb with mirabilite is a strong purge and must not be given after severe trauma or where the abdomen may be obstructed.** — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.