Formulas · Warm the Interior 溫裏 · Junggyeong (仲景)

Free the Pulse Counterflow Cold Decoction

Tongmaek-sayeok-tang

한글 통맥사역탕 · Pinyin Tong Mai Si Ni Tang

通脉四逆湯

A strengthening of 四逆湯 with the aconite raised; the two conditional additions, pig bile for an absent pulse and scallion white for a red face, are given in the source as separate lines.

Composition 構成

Buja Fu Zi
附子 부자 · Prepared Aconite

10 g
Chief 君

blast-fried · toxic
Geongang Gan Jiang
乾薑 건강 · Dried Ginger

6 g
Chief 君

blast-fried
Gamcho Gan Cao
甘草 감초 · Licorice

4 g
Envoy 使
Jeodamjeup Zhu Dan Zhi
猪膽汁 저담즙 · Pig Bile

—
Envoy 使

half a gallbladder's worth, stirred in where the pulse is cut off
Chongbaek Cong Bai
蔥白 총백 · Scallion White

—
Envoy 使

three stalks, decocted in where the face is red

Total 20 g per packet (첩) · representative dosage — verify against source texts. Excludes 2 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

Treats shaoyin disease with diarrhoea and the four limbs reversed and cold and the pulse faint and about to be cut off or absent
Recovers the yang and frees the pulse

Indications 主治

Pattern-based

Yang collapse with the pulse cut off
Shaoyin cold with diarrhoea and cold limbs

Biomedical correlates

Circulatory collapse
Shock with hypothermia

Source text 原文

Donguibogam 東醫寶鑑

治少陰病下利ㆍ四肢厥冷ㆍ脉微欲絶, 或無脉. 附子二錢半, 乾薑一錢半, 甘草一錢. 右剉, 作一貼, 水煎服. 《仲景》 ○脉絶者, 通脉四逆湯煎水和猪膽汁半枚, 溫服. 《仲景》 ○面赤色者, 通脉四逆湯入葱白三莖, 同煎服. 《入門》

Translation

Treats shaoyin disease with diarrhoea, the four limbs reversed and cold and the pulse faint and about to be cut off, or no pulse at all. Aconite, 2 don 5 fun; dried ginger, 1 don 5 fun; licorice, 1 don. Cut up, make one packet and decoct in water. Where the pulse is cut off, decoct Tongmaek-sayeok-tang and stir in half a pig's gallbladder of bile, taken warm. Where the face is red, add three stalks of scallion white and decoct together. — Junggyeong 仲景 · Uihak Immun 入門 (Donguibogam · Han)

Clinical commentary 臨床

Sayeok-tang with the aconite raised, for the case where the pulse has gone. The two conditional additions are what make the entry instructive. Pig bile is bitter and cold and is added to a formula of two hot drugs when the pulse is wholly absent — the tradition's reasoning being that the yang has risen and scattered and must be led back down, which in a patient with no palpable pulse is at least an attempt at something other than more heat. Scallion white for a red face answers the same problem from the other side. A patient with cold limbs, diarrhoea and no pulse is in shock, and this formula is the chapter's final intervention for it. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.