Formulas · Purge Downward 瀉下 · Dansim (丹心)

Cattle Gallstone Snatch Back Life Powder

Uhwangtalmyeong-san

한글 우황탈명산  ·  Pinyin Niu Huang Duo Ming San

牛黃奪命散

This is not the 奪命散 of this chapter's own 1.31, registered as `talmyeong-san-soa`, which is two substances — 靑礞石 calcined with 焰硝 — and a phlegm-sinking powder with no purgative in it; the two leaves share the section head of 1.45 but nothing else. Nor is it any of the other four 奪命散 in the corpus: `talmyeong-san-buin` (myrrh and dragon's blood), `talmyeong-san-in` (calcined alum, silkworm, borax and gleditsia for throat closure), `talmyeong-san-pung` (arisaema, lepidium, angelica dahurica, pinellia and croton), `talmyeong-san-han` (ginseng alone), or `bibangtalmyeong-san` (the twelve-drug carbuncle powder). The leaf's 一名 一捻金 romanises onto `illyeomgeum`, which is already registered as the Immun's 一捻金 for 疔疽, 賽命丹 powdered — a different formula entirely; the name here is an alias only and the entry is registered under the head name. Note also that 牛黃, cattle gallstone, stands in the name but appears nowhere in the composition. 胷 is corrected to 胸; 麄 is printed as transcribed.

Composition 構成

Total 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

Indications 主治

Pattern-based

  • Lung distension in a child, chest full, panting coarse and the qi urgent (肺脹 胸滿喘麄 氣急)
  • Both flanks fanning, both nostrils flaring, phlegm welling up and blocking (兩脇扇動 兩鼻竅張 痰涎潮塞)
  • Smothering agitation and gasping, death by morning or evening (悶亂喘喝 死在朝夕)

Biomedical correlates

  • Severe respiratory distress in a child — recession, nasal flaring, grunting
  • Pneumonia with impending respiratory failure
  • Severe asthma or bronchiolitis

Source text 原文

Donguibogam 東醫寶鑑

治小兒肺脹, 胸滿喘麄, 氣急, 兩脇扇動, 兩鼻竅張, 痰涎潮塞, 悶亂喘喝, 死在朝夕. 白丑(半生半熟)ㆍ黑丑(半生半熟, 取頭末) 各五錢, 大黃 一兩, 檳榔 二錢半, 木香 一錢半. 右爲末, 入輕粉一字和勻, 每取一錢, 或二錢, 蜜水調下, 微利爲度. 《丹心》 ○一名一捻金. 《醫鑑》

Translation

Treats lung distension in children, the chest full and the panting coarse, the qi urgent, both flanks fanning in and out, both nostrils flaring, phlegm and drool welling up and blocking, smothering agitation and gasping, death by morning or evening. White morning-glory seed (half raw, half cooked) and black morning-glory seed (half raw, half cooked, the first-ground powder taken), 5 don each; rhubarb 1 nyang; areca seed 2.5 don; costus root 1.5 don. Powder the above, add 1 ja of calomel and mix evenly; take 1 don, or 2 don, each time, stirred into honey water, to the point of a mild loosening of the bowel. — Dansim 丹心 (Donguibogam · Soa) ○Also called One Pinch of Gold. — Uigam 醫鑑 (Donguibogam · Soa)

Clinical commentary 臨床

The indication is the most exact piece of paediatric observation in this part of the chapter. 兩脇扇動 — both flanks fanning in and out — is intercostal and subcostal recession. 兩鼻竅張 is nasal flaring. 胸滿喘麄 and 悶亂喘喝 are a full chest, coarse laboured breathing and agitated gasping. Those four signs together are exactly what a modern clinician looks for to say that a child's breathing is failing, and 死在朝夕, death by morning or evening, is the right prognosis for a child showing them untreated. The chapter saw this clearly. Its answer was to purge. Rhubarb at a nyang, white and black morning-glory seed at 5 don each with only the first-ground powder kept, areca seed and costus root, and calomel stirred in at the end — taken in honey water 微利爲度, to the point of a mild loosening of the bowel. The theory is that the lung is blocked and what blocks it must be brought down and out through the stool. **This must not be prepared or given.** Morning-glory seed is a drastic purgative and rhubarb an anthraquinone laxative on top of it; purging a child in respiratory failure takes fluid and potassium out of a patient who has none to spare, and in a child already losing fluid the purgative alone can kill by dehydration. Calomel is mercurous chloride — mercury, and the chapter's full statement on mercury is on 辰砂膏. Areca seed is a recognised human carcinogen. **The patient is a child and the text gives no dose by weight anywhere**: 1 or 2 don of powder, with the bowel's response as the only gauge. What a child with these signs needs is oxygen, an assessment of the cause, and treatment directed at it — antibiotics for pneumonia, bronchodilators and steroids for asthma, supported breathing where the work of breathing can no longer be sustained. **Honey must not be given to a child under twelve months**; the botulism hazard is set out on 香橘餠 in the preceding section. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.

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