Formulas · External Application 外用 · Uihak Gangmok (醫學綱目)

Frankincense Pill

Yuhyang-hwan

한글 유향환 · Pinyin Ru Xiang Wan

乳香丸

The transcription writes 𥂁 for 鹽 and 為-family forms as elsewhere; 𥂁 is normalized to 鹽. 卧 is kept as written rather than normalized to 臥, following the corpus. The thin paper is apparatus and partly ingredient — a little of it is rolled into the pills — and is left in the method rather than carried as a drug. The corpus holds eleven other 乳香 formulas, all with a second element in the name; `yuhyang-hwan` was free. Section 1.38.16 疳瘡's two following leaves, 立效散 and 銅靑散, treat the same 走馬牙疳 and are registered by a sibling batch.

Composition 構成

Yuhyang Ru Xiang
乳香 유향 · Frankincense

2 g
Chief 君

5 fun
Gyeongbun Qing Fen
輕粉 경분 · Calomel (toxic)

2 g
Deputy 臣

輕粉, 5 fun · calomel, mercurous chloride, toxic
Bisang Pi Shuang
砒礵 비상 · Arsenic Trioxide

2 g
Deputy 臣

砒礵, 5 fun · arsenic trioxide, a lethal poison
Sahyang She Xiang
麝香 사향 · Musk (prohibited)

—
Envoy 使

a little (少許) · musk, CITES Appendix I

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

Treats galloping-horse tooth gan — the rapidly spreading gangrene of the mouth — and is said to work like a god
Four drugs ground fine, pressed through thin paper and rolled with a little of the paper into millet-sized pills
Packed into the sore at bedtime; soy sauce, salt and vinegar are to be avoided

Indications 主治

Pattern-based

走馬牙疳 — galloping-horse tooth gan: the gums and cheek rotting away at speed in a child with gan

Biomedical correlates

Noma (cancrum oris) — necrotising gangrenous stomatitis of childhood malnutrition

Source text 原文

Donguibogam 東醫寶鑑

治走馬牙疳如神. 乳香ㆍ輕粉ㆍ砒礵各五分, 麝香少許. 右硏細, 以薄紙一韭葉許按過, 揉紙少許和丸如黃米大. 臨卧將藥塡患處, 至明卽愈. 忌食醬ㆍ鹽ㆍ醋. 《綱目》

Translation

Treats galloping-horse tooth gan like a god. Frankincense, calomel and arsenic trioxide, 5 fun each; musk, a little. Grind the above fine, press it through a piece of thin paper about the width of a chive leaf, and roll it with a little of the paper into pills the size of yellow millet. At bedtime pack the medicine into the affected place; by daybreak it is healed. Soy sauce, salt and vinegar are to be avoided. — Gangmok 綱目 (Donguibogam · Soa)

Clinical commentary 臨床

Frankincense with calomel, arsenic and musk, ground fine, pressed through a chive-leaf of thin paper and rolled into millet-sized pellets to be packed into the rotting gum overnight. 走馬牙疳 — gan that gallops like a horse — is noma, cancrum oris: a necrotising gangrenous stomatitis that starts as a gingival ulcer in a severely malnourished child and destroys the cheek, lip and jaw within days. The name is an exact description of how fast it moves, and 如神, like a god, is the claim the leaf makes for this pill. Noma is a disease of malnutrition, poor oral hygiene and measles or another intercurrent infection in a child whose immunity has collapsed. It is treated now with antibiotics, wound debridement, oral hygiene and above all nutritional rehabilitation, and reconstructive surgery afterwards for the survivors; mortality untreated is reported at around four in five. The point made in full on 胡黃連丸 (`hohwangryeon-hwan`) is the whole of the matter here — **this child is starving**, and the chapter is packing a caustic into the hole instead of feeding him. **Contains arsenic trioxide — 砒礵 — and calomel, mercurous chloride, packed overnight into an open gangrenous wound in the mouth of a starving child, and the text gives no dose by weight anywhere beyond 5 fun of each in the batch. This must not be prepared.** Arsenic trioxide is lethal to an adult at a few hundred milligrams; absorption across a raw, necrotic mucosal surface is rapid and the dose is whatever sticks. It will kill tissue, which is why it looked as though it worked — an eschar over a slough can be mistaken for healing. For the calomel, see the full mercury statement on 下蟲丸 (`hachung-hwan`), and for mercury in general 辰砂膏 (`jinsa-go-soa`); 雜方門 5.3.33 is where 輕粉 was manufactured and 諸瘡門 records the poisoning in four sections. **Contains musk — 麝香 — from a CITES Appendix I deer.** It cannot legally be traded, and the demand this tradition created is a direct cause of the musk deer's decline. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.