Formulas · Text · Donguibogam 東醫寶鑑

Stool

Daebyeon

한글 대변 · Pinyin Da Bian

The longest chapter in the book — the gate between the intestines, twenty kinds of diarrhoea and twenty of dysentery, why a dysentery must be purged rather than stopped, and the stool read by its colour

大便

Sixty-two sections and two hundred and fifty formulas, the largest chapter in the Donguibogam and the one that shows the tradition working hardest. It opens with an anatomy that is nearly right: the Nanjing's gate between the small and large intestines, where what comes down from the stomach is separated — the clear fluid to the bladder as urine, the dregs to the large intestine as stool. Then a long aetiology in which the chapter's two great families take shape. Diarrhoea is divided twenty ways, by cause (damp, wind, cold, summerheat, fire, vacuity, phlegm, food, wine) and by viscus (spleen, kidney, both), and the organizing idea throughout is that water which should have left by the bladder is leaving by the bowel instead, so the treatment redirects it. Dysentery is divided again twenty ways, by what is passed — red, white, both, pus and blood, water and grain, five colours — and here the chapter's one genuinely hard-won principle appears: a dysentery must be purged before it is bound, because matter lodged in the bowel is what causes the tenesmus, and stopping the stool early seals the heat in. Four sections are given to that argument alone. The stool is read by its colour with real care — a hot dysentery dark purple, a cold one white like duck slurry, a damp one like black-bean juice, a qi one like crab froth, an accumulation one like fish brain, a vacuity one white as mucus or frozen glue — and the prognostic sections are blunt about which signs mean death. The pharmacy is the chapter's weakness and its interest: poppy husk and opium appear by name in a dozen formulas and would have worked, dangerously; croton seed and kansui appear in as many and would have harmed; and against them stand the ginger-and-tea decoction, the honey-and-sesame-oil draught, the perilla gruel and the toasted dioscorea paste, which are food, which are safe, and which are close to what a pharmacy would dispense for the same complaints now. At the end the chapter turns to constipation, with the sharpest observation in it — the spleen-bound pattern, frequent urine with a hard stool, read as one disorder of where the body's water is going — and closes with the suppositories, the navel plasters and the bamboo tube, the things a physician reaches for when nothing can be given by mouth.

2.1 Where the Stool Comes From 大便原委

2.1.1

Source원문

難經曰, 大腸ㆍ小腸會爲闌門. 蓋胃中水糓腐熟, 自胃下口傳入於小腸上口; 自小腸下口泌別淸濁, 水液入膀胱爲溲尿, 滓穢入大腸爲大便. 由闌門而分別, 關闌分隔, 故名爲闌門也. 《綱目》

Translation영역

The Nanjing says that where the large and small intestines meet is the barrier gate. For the water and grain in the stomach, having been rotted and ripened, pass from the stomach's lower mouth into the small intestine's upper mouth; and from the small intestine's lower mouth the clear is strained apart from the turbid, the watery fluid entering the bladder to become urine and the dregs and foul matter entering the large intestine to become stool. It is at the barrier gate that they are divided, and because the barrier shuts and partitions them it is named the barrier gate.

Gangmok 綱目 · Nangyeong 難經

2.1.2

Source원문

內經曰, 大腸者, 傳導之官, 化物出焉. 註曰, 化物謂大便也.

Translation영역

The Neijing says: the large intestine is the office of conveyance, and from it the transformed matter comes out. The commentary says that the transformed matter means the stool.

Clinical note임상 주석

The chapter opens with an anatomy that is very nearly correct. There is a junction between the small and large intestines; what arrives there is separated, with water taken up and solid matter passed on. That the water is held to go directly to the bladder rather than through the blood is the error, and it is the one that shapes everything the chapter does next: if a watery stool is water that failed to turn aside at the gate, then the whole treatment of diarrhoea is to redirect it, which is why diuretics appear in almost every formula in the first third of this chapter.

Naegyeong 內經

2.2 The Causes of Disease of the Stool 大便病因

2.2.1

Source원문

犯賊風虛邪者, 陽受之; 食飮不節ㆍ起居不時者, 陰受之. 陽受之則入六府, 陰受之則入五藏. 入六府則身熱不時臥, 上爲喘呼; 入五藏則䐜滿閉塞, 下爲飱泄, 久爲腸澼. 《腸澼謂痢疾ㆍ內經》

Translation영역

One who meets with robber wind and vacuous evil — the yang receives it; one whose food and drink are without measure and whose rising and resting keep no time — the yin receives it. What the yang receives enters the six bowels, and what the yin receives enters the five viscera. Entering the six bowels, the body is hot and there is no lying down at the proper hours, and above there is panting; entering the five viscera, there is swollen fullness and blockage, and below there is undigested-food diarrhoea, which in time becomes intestinal flush.

Naegyeong 內經

2.2.2

Source원문

春傷於風, 夏必飱泄. ○春傷於風, 邪氣留連, 乃爲洞泄. ○久風入中則爲腸風飱泄. ○淸氣在下則生飱泄. ○濕勝則濡泄. 註曰, 濕勝則內攻於脾胃, 脾胃受濕則水糓不分, 故大腸傳導而注瀉也. 《內經》

Translation영역

Injured by wind in spring, there will certainly be undigested-food diarrhoea in summer. Injured by wind in spring, if the evil qi lingers on it becomes the cavernous diarrhoea. Enduring wind entering the centre becomes intestinal wind with undigested-food diarrhoea. When the clear qi is below, undigested-food diarrhoea arises. When damp prevails there is a seeping diarrhoea — the commentary: when damp prevails it attacks the spleen and stomach within, and when the spleen and stomach receive damp the water is not separated from the grain, so the large intestine conveys it and it pours out as diarrhoea.

Naegyeong 內經

2.2.3

Source원문

倉廪不藏者, 是門戶不要也. 註曰, 是大腸之門戶不得斂也. 《內經》

Translation영역

When the granary does not store, it is that the gateway does not hold. The commentary: this is the gateway of the large intestine failing to gather itself in.

Naegyeong 內經

2.2.4

Source원문

大腸有寒則多鶩溏, 有熱則便腸垢. 《仲景》 ○腸垢者, 腸間積汁垢膩也. 亦曰滯下, 言濕火滯於腸中, 故謂之滯下. 《入門》

Translation영역

Where the large intestine has cold there is much duck slurry; where it has heat the stool is intestinal grime. Intestinal grime is the accumulated juice and greasy filth between the folds of the bowel. It is also called the stagnant descent, meaning that damp and fire are stagnant within the intestine, and so it is called the stagnant descent.

Junggyeong 仲景 · Immun 入門

2.2.5

Source원문

痢因有二: 一者暑月煩渴, 恣食生冷; 二者夜臥失被, 風濕外侵. 二者皆令水糓不化, 鬱而生熱, 熱與濕合. 傷氣分則成白痢, 傷血分則成赤痢, 氣血俱傷則成赤白痢. 《丹心》

Translation영역

Dysentery has two causes: the first is vexing thirst in the summer months with unrestrained eating of raw and cold things; the second is losing the bedding at night, so that wind and damp invade from without. Both cause the water and grain not to be transformed, which becomes pent and breeds heat, and the heat joins with the damp. Where it injures the qi aspect there is a white dysentery; where it injures the blood aspect, a red dysentery; where both qi and blood are injured, a red and white dysentery.

Dansim 丹心

2.2.6

Source원문

古人云, 無積不成痢. 皆由暑月多食生冷, 不能剋化, 飮食積滯而成痢也. 《類聚》

Translation영역

The ancients said that without an accumulation no dysentery forms. It is in every case from eating much raw and cold food in the summer months, which cannot be conquered and transformed, so that food and drink accumulate and stagnate and become a dysentery.

Clinical note임상 주석

Two aetiologies set side by side, and both are substantially right about how the diseases were caught. The Dansim names the summer thirst that leads to drinking and eating whatever is cold and to hand, and the night chill of a man who has lost his bedding; between them those cover contaminated water and food in the hot months and the immune-lowering exposure that goes with poverty. The Yuchwi's maxim — no accumulation, no dysentery — is the sentence that governs the whole dysentery half of this chapter, and it is why the Bogam will insist on purging before binding. Intestinal grime, defined here as the greasy accumulated matter between the folds of the bowel, is as good a description of mucopurulent exudate as a pre-modern text produced.

Yuchwi 類聚

2.3 Distinguishing the Colour of the Stool 辨便色

2.3.1

Source원문

腸中寒則腸鳴飱泄, 腸中熱則出黃如糜. 《靈樞》

Translation영역

Where there is cold within the intestine there is rumbling and undigested-food diarrhoea; where there is heat within the intestine what comes out is yellow like gruel.

Yeongchu 靈樞

2.3.2

Source원문

瀉白爲寒, 靑ㆍ黃ㆍ紅ㆍ赤ㆍ黑皆爲熱也. 或以痢色靑爲寒者, 誤也. 傷寒少陰病下痢純靑水者, 熱在裏也; 小兒急驚, 利色多靑爲熱, 明矣. 痢色黃者, 脾熱也; 痢色紅者爲熱, 心火之色; 或赤者, 熱之甚也; 色黑者, 由火熱亢極則反兼水化, 故色黑也. 《原病》

Translation영역

A white diarrhoea is cold; blue-green, yellow, pink, red and black are all heat. Some take a blue-green dysentery for cold, and they are mistaken: in cold damage, in lesser yin disease, a dysentery of pure blue-green water means heat is in the interior; and in a child's acute fright the stool is mostly blue-green from heat — that much is plain. A yellow dysentery is spleen heat; a pink dysentery is heat, being the colour of the heart's fire; and a red one is heat at its height. A black one is because when fire heat is at its utmost it turns and takes on water's transformation, and so the colour is black.

Wonbyeongsik 原病

2.3.3

Source원문

血寒則凝, 痢色必紫黑成塊, 或雜膿血. 蓋膿爲陳積也, 血爲新積也. 《入門》

Translation영역

When the blood is cold it congeals, and the dysentery will be purple-black in clots, or mixed with pus and blood. For the pus is the stale accumulation and the blood the fresh.

Immun 入門

2.3.4

Source원문

濕多成五泄, 如水傾下. 《入門》

Translation영역

Where damp is abundant it makes the five diarrhoeas, pouring down like water.

Immun 入門

2.3.5

Source원문

熱痢紫黑色, 寒痢白如鴨溏, 濕痢下如黑豆汁, 風痢純下靑水, 氣痢狀如蟹渤, 積痢色黃或如魚腦, 虛痢色白如鼻涕ㆍ凍膠, 蠱疰痢黑如雞肝. 《入門》

Translation영역

A hot dysentery is purple-black; a cold dysentery white like duck slurry; a damp dysentery passes like black-bean juice; a wind dysentery passes pure blue-green water; a qi dysentery is shaped like crab froth; an accumulation dysentery is yellow, or like fish brain; a vacuity dysentery is white like nasal mucus or frozen glue; and a worm-curse dysentery is black like chicken liver.

Clinical note임상 주석

The eight-way colour table in the last entry is the chapter's single most useful page and the comparisons in it are exact enough to be recognized: duck slurry for a pale watery stool, black-bean juice for melaena, crab froth for a frothy mucous one, fish brain and frozen glue for mucus, chicken liver for the dark degraded blood of an amoebic dysentery. The Immun's distinction between pus as the stale accumulation and blood as the fresh is a real inference about chronology from appearance. Against that, the Wonbyeongsik's assignment of every colour but white to heat is doctrine, and it is argued for — the greater the heat the stranger the colour, until at its utmost it turns black — which is how this tradition rescues a scheme when the observations will not fit it.

Immun 入門

2.4 The Pulse 脉法

2.4.1

Source원문

泄瀉脉緩, 時小結者生; 浮大數者死. 《正傳》 ○病泄, 脉洪而大爲逆. 《靈樞》 ○泄而脫血, 脉實者難治. 《內經》

Translation영역

In diarrhoea, where the pulse is moderate and at times small and knotted, the patient lives; where it is floating, large and rapid, he dies. In the disease of diarrhoea, a surging and large pulse is contrary. Where there is diarrhoea with collapse of the blood, a replete pulse is hard to treat.

Jeongjeon 正傳 · Yeongchu 靈樞 · Naegyeong 內經

2.4.2

Source원문

泄瀉脉多沉. 傷風則浮, 傷寒則沉細, 傷暑則沉微, 傷濕則沉緩. 《醫鑑》 ○瀉脉自沉, 沉遲寒侵, 沉數火熱, 沉虛滑脫, 暑濕緩弱, 多在夏月. 《回春》

Translation영역

In diarrhoea the pulse is mostly sunken: injured by wind it floats, injured by cold it is sunken and fine, injured by summerheat sunken and faint, injured by damp sunken and moderate. The diarrhoea pulse is sunken of itself — sunken and slow for cold invading, sunken and rapid for fire heat, sunken and vacuous for a slippery escape, moderate and weak for summerheat damp, which is mostly in the summer months.

Uigam 醫鑑 · Hoechun 回春

2.4.3

Source원문

腸澼下膿血, 脉沉小留連者生; 數疾且大, 有熱者死. 《脉經》 ○下痢脉微弱數者, 爲欲自止, 雖發熱不死. 《仲景》 ○下痢脉大者, 爲未止. 《仲景》 ○下痢日十餘行, 脉反實者死. 《仲景》

Translation영역

In intestinal flush passing pus and blood, where the pulse is sunken, small and lingering the patient lives; where it is rapid, hurried and also large, with heat, he dies. In dysentery, a faint, weak and rapid pulse means it is about to stop of itself, and though there is fever the patient will not die. In dysentery a large pulse means it has not yet stopped. In dysentery with more than ten stools a day, if the pulse is on the contrary replete, the patient dies.

Maekgyeong 脉經 · Junggyeong 仲景

2.4.4

Source원문

下痢宜微小, 不宜洪大. 《得效》 ○下痢微小却爲生, 脉大浮洪無差日. 《脉訣》 ○無積不痢, 脉宜滑大; 浮弦急死, 沉細無害. 《脉訣》 ○凡痢身凉脉細者生, 身熱脉大者死. 《丹心》 ○下痢脉微小吉, 浮洪者難治. 《濟生》

Translation영역

In dysentery the pulse should be faint and small and not surging and large. In dysentery a faint small pulse is after all life, while a large, floating, surging pulse means no day of recovery. Without an accumulation there is no dysentery, so the pulse should be slippery and large; floating, wiry and urgent means death, while sunken and fine does no harm. In every dysentery, where the body is cool and the pulse fine the patient lives; where the body is hot and the pulse large he dies. In dysentery a faint small pulse is auspicious, and a floating surging one is hard to treat.

Deukhyo 得效 · Maekgyeol 脉訣 · Dansim 丹心 · Jesaeng 濟生

2.4.5

Source원문

大便閉結, 脾脉沉數下連於尺, 爲陽結; 二尺脉虛, 或沉細而遲, 爲陰結; 右尺脉浮, 爲風結. 《醫鑑》 ○燥結之脉, 沉伏勿疑. 熱結沉數, 虛結沉遲, 若是風燥, 右尺浮肥. 《回春》 ○老人虛人閉結, 脉雀啄者不治. 《醫鑑》

Translation영역

Where the stool is shut and bound: if the spleen pulse is sunken and rapid and runs down to the cubit position, it is a yang binding; if the two cubit pulses are vacuous, or sunken, fine and slow, it is a yin binding; if the right cubit pulse floats, it is a wind binding. The pulse of a dry binding is sunken and hidden — do not doubt it. A heat binding is sunken and rapid, a vacuity binding sunken and slow, and if it is a wind dryness the right cubit is floating and full. In the old and the depleted with a shut and bound stool, a pecking-sparrow pulse cannot be treated.

Clinical note임상 주석

The one rule running through all of this is worth extracting, because it is sound: in a patient losing fluid by the bowel, a large bounding pulse is bad and a small quiet one is good. That is the opposite of the usual reading of pulse strength, and it is correct — a wide pulse with high volume in a dehydrated patient means fever and a failing circulation, while a small pulse means the loss has stopped. Junggyeong's formulation is the sharpest: a faint weak rapid pulse means the dysentery is about to stop by itself, and the fever need not alarm you; ten stools a day with a replete pulse is death. The pecking-sparrow pulse at the end — irregular, interrupted, like a bird tapping — is an agonal rhythm, and the Uigam is right that it cannot be treated.

Uigam 醫鑑 · Hoechun 回春

2.5 The Diarrhoea Pattern Has Five Kinds 泄證有五

2.5.1

Source원문

有胃泄ㆍ脾泄ㆍ大腸泄ㆍ小腸泄ㆍ大瘕泄.

Translation영역

There are the stomach diarrhoea, the spleen diarrhoea, the large intestine diarrhoea, the small intestine diarrhoea and the great-lump diarrhoea.

Donguibogam · Daebyeon

2.5.2

Source원문

胃泄者, 飮食不化, 色黃, 宜胃風湯. ○脾泄者, 腹脹滿, 泄注, 食則吐逆, 宜胃苓湯. ○大腸泄者, 食已窘迫, 大便色白, 腸鳴切痛, 宜五苓散方見寒門. ○小腸泄者, 溲澁而便膿血, 小腹痛, 宜芍藥湯. ○大瘕泄者, 裏急後重, 數至圊而不能便, 莖中痛, 宜大黃湯. 《醫林》

Translation영역

In the stomach diarrhoea the food and drink are not transformed and the colour is yellow: Wipung-tang. In the spleen diarrhoea the belly is distended and full, the stool pours out, and eating brings retching: Wiryeong-tang. In the large intestine diarrhoea there is urgency as soon as one has eaten, the stool is white, and there is rumbling with cutting pain: Oryeong-san. In the small intestine diarrhoea the urine is inhibited, the stool is of pus and blood, and the lower belly aches: Jakyak-tang. In the great-lump diarrhoea there is inner urgency and dragging-down behind, with going repeatedly to the privy and being unable to pass, and pain in the urethra: Daehwang-tang.

Clinical note임상 주석

Five diarrhoeas named by organ, each with one formula, and the descriptions are precise enough to be sorted into modern categories. The stomach one is undigested food with a yellow stool, which is rapid transit; the large intestine one is post-prandial urgency with pain, which is the gastrocolic response of an irritable bowel; the small intestine and great-lump ones, with pus and blood, inner urgency and fruitless straining, are a proctitis — and the chapter's naming of tenesmus here, in its fifth section, is the first of some forty appearances. That the great-lump diarrhoea is treated with rhubarb alone, while the patient is already going repeatedly to the privy, is the chapter's purging principle stated before it has been argued for.

Uirim 醫林

2.6 The Several Patterns of Diarrhoea 泄瀉諸證

2.6.1

Source원문

有濕泄ㆍ濡泄ㆍ風泄ㆍ寒泄ㆍ暑泄ㆍ火泄ㆍ熱泄ㆍ虛泄ㆍ滑泄ㆍ飱泄ㆍ酒泄ㆍ痰泄ㆍ食積泄ㆍ脾泄ㆍ腎泄ㆍ脾腎泄ㆍ瀼泄ㆍ暴泄ㆍ洞泄ㆍ久泄.

Translation영역

There are the damp diarrhoea, the seeping diarrhoea, the wind diarrhoea, the cold diarrhoea, the summerheat diarrhoea, the fire diarrhoea, the heat diarrhoea, the vacuity diarrhoea, the slippery diarrhoea, the undigested-food diarrhoea, the wine diarrhoea, the phlegm diarrhoea, the food-accumulation diarrhoea, the spleen diarrhoea, the kidney diarrhoea, the spleen-and-kidney diarrhoea, the alternating diarrhoea, the violent diarrhoea, the cavernous diarrhoea and the enduring diarrhoea.

Donguibogam · Daebyeon

2.6.2

Source원문

凡泄皆兼濕. 初宜分利中焦ㆍ滲利下焦, 久則升舉; 必滑脫不禁, 然後用澁藥止之. 《入門》

Translation영역

Every diarrhoea has damp with it. At the beginning one should separate and free the middle burner and seep and free the lower burner; when it has gone on long, one lifts and raises. Only when it is slippery and escaping and cannot be held back should astringent medicines be used to stop it.

Immun 入門

2.6.3

Source원문

治泄補虛, 不可純用甘溫, 太甘, 甘則生濕; 淸熱亦不可太苦, 苦則傷脾. 惟淡劑利竅爲妙. 《入門》

Translation영역

In treating diarrhoea and supplementing vacuity one must not use the sweet and warm alone; too sweet, and the sweetness breeds damp. And in clearing heat one must not be too bitter, for bitterness injures the spleen. Only a bland prescription that frees the orifices is excellent.

Immun 入門

2.6.4

Source원문

治瀉之法: 先當分利水糓, 車前子煎湯調五苓散方見寒門; 次則理正中焦, 理中湯ㆍ治中湯方見寒門. 理中治不效, 然後方可斷下, 固腸丸是也. 《濟生》

Translation영역

The method of treating diarrhoea: first the water should be separated from the grain, with Oryeong-san stirred into a decoction of plantago seed; next the middle burner should be set right, with Ijung-tang or Chijung-tang. If setting the centre right has no effect, only then may the flow be cut off below — Gojang-hwan is the formula.

Jesaeng 濟生

2.6.5

Source원문

治瀉須先中焦, 理中湯ㆍ丸是也; 次分利水糓, 五苓散是也; 治中不效, 然後斷下, 赤石脂禹餘粮湯方見寒門.

Translation영역

In treating diarrhoea one must begin with the middle burner — Ijung-tang and the pill are the formulas; next separate the water from the grain — Oryeong-san; and if setting the centre right has no effect, only then cut off the flow below, with Jeokseokji-uyeoryang-tang.

Donguibogam · Daebyeon

2.6.6

Source원문

治泄瀉諸藥, 多作丸子服之. 《正傳》

Translation영역

The several medicines for treating diarrhoea are mostly made into pills to be taken.

Jeongjeon 正傳

2.6.7

Source원문

凡泄瀉, 小便淸白不澁爲寒, 赤澁爲熱. 《原病》 ○手足寒爲冷證, 手足溫爲熱證. 《直指》

Translation영역

In every diarrhoea, urine clear and white and not inhibited is cold, and red and inhibited is heat. Cold hands and feet are a cold pattern, warm hands and feet a heat pattern.

Wonbyeongsik 原病 · Jikji 直指

2.6.8

Source원문

大便完糓不化而色不變, 吐利腥穢, 小便淸白不澁, 身冷不渴, 脉微細而遲者, 皆寒證也. 凡糓肉消化, 無問色及他證, 便斷爲熱. 夫寒泄而糓消化者, 未之有也. 《原病》

Translation영역

Where the stool passes the grain whole and untransformed and the colour is unchanged, the vomit and stool smell rank and foul, the urine is clear and white and not inhibited, the body is cold and there is no thirst, and the pulse is faint, fine and slow — these are all cold patterns. Wherever the grain and meat are digested, then without asking about the colour or the other signs, judge at once that it is heat. For a cold diarrhoea in which the grain is digested has never been.

Wonbyeongsik 原病

2.6.9

Source원문

或火性急速, 傳化失常, 完糓不化而爲飱泄者亦有之. 仲景曰, 邪熱不殺糓, 然熱得濕則爲飱泄也. 《原病》

Translation영역

Yet where fire's nature is urgent and swift and conveyance and transformation lose their order, there are also cases of the grain passing whole as an undigested-food diarrhoea. Junggyeong says that evil heat does not kill the grain — and so heat, when it meets damp, makes an undigested-food diarrhoea.

Wonbyeongsik 原病

2.6.10

Source원문

暴瀉非陽, 久瀉非陰. 《機要》

Translation영역

A violent diarrhoea is not yang, and an enduring diarrhoea is not yin.

Giyo 機要

2.6.11

Source원문

通治用三白湯ㆍ燥濕湯ㆍ益元散方見暑門.

Translation영역

For general treatment use Sambaek-tang, Joseup-tang or Igwon-san.

Clinical note임상 주석

The chapter's method, and it is a staged one that deserves to be read as the argument it is. First separate the water from the grain, which is to say redirect the fluid to the bladder; then set the middle burner right, meaning restore digestion; and only if both fail, bind the bowel. Astringents last, and the Immun says only when it cannot be held back — which is the correct order, because arresting a stool before the cause is dealt with is the mistake the dysentery sections will later devote four sections to. The Wonbyeongsik's diagnostic rule in the seventh entry is the most quotable thing in the chapter: a cold diarrhoea in which the grain is digested has never been. So whole grain in the stool means cold, and digested food means heat, whatever else the patient shows — except, as the next entry immediately concedes, when fire moves things through so fast that the grain comes out whole anyway. The tradition states a rule and then states its exception, and prints both.

Donguibogam · Daebyeon

2.7 Damp Diarrhoea 濕泄

2.7.1

Source원문

卽濡泄也, 亦名洞泄. 其證如水傾下, 腸鳴身重, 腹不痛. 《入門》 ○左傳曰, 雨淫腹疾, 是也.

Translation영역

This is the seeping diarrhoea, also called the cavernous diarrhoea. Its sign is that it pours down like water, with rumbling of the bowel and heaviness of the body, and the belly does not hurt. The Zuozhuan says, excess of rain brings belly ailments — this is it.

Immun 入門

2.7.2

Source원문

寒濕傷於脾胃, 不能腐熟水糓, 故洞泄如水, 謂之濡泄. 胃苓湯加草豆蔲主之. 《綱目》

Translation영역

Cold damp injures the spleen and stomach so that they cannot rot and ripen the water and grain, and so there is a cavernous diarrhoea like water, which is called the seeping diarrhoea. Wiryeong-tang with cardamom added governs it.

Gangmok 綱目

2.7.3

Source원문

濕瀉身痛, 五苓散加羌活ㆍ蒼朮. 《得效》

Translation영역

For a damp diarrhoea with body pain, Oryeong-san with notopterygium and atractylodes added.

Deukhyo 得效

2.7.4

Source원문

水糓不化, 淸濁不分, 是濕泄也. 《回春》 ○凡瀉水腹不痛, 是濕泄, 宜麴芎丸. 《本事》

Translation영역

Where the water and grain are not transformed and the clear is not separated from the turbid, it is a damp diarrhoea. Whenever water is passed and the belly does not hurt, it is a damp diarrhoea: Gukgung-hwan.

Hoechun 回春 · Bonsa 本事

2.7.5

Source원문

大渴引飮, 因致水糓一時倂下, 宜五苓散. 《易老》

Translation영역

Where great thirst draws on drinking, so that water and grain come down together all at once, Oryeong-san.

Yeokro 易老

2.7.6

Source원문

洞泄宜瀉濕湯ㆍ衛生湯ㆍ萬病五苓散.

Translation영역

For the cavernous diarrhoea, Saseup-tang, Wisaeng-tang or Manbyeong-oryeong-san.

Clinical note임상 주석

The diagnostic sign is painlessness, and it is repeated three times in six entries: water pouring out, the bowel loud, the body heavy, the belly not hurting. That distinction does real work — a painless watery diarrhoea is secretory and a painful one inflammatory, and the chapter treats them by entirely different routes. The Zuozhuan quotation, that too much rain brings belly ailments, is the oldest observation in the chapter and may be the truest in it: the summer rains fouled the water.

Donguibogam · Daebyeon

2.8 Wind Diarrhoea 風泄

2.8.1

Source원문

惡風自汗, 或帶淸血. 由春傷風ㆍ夏感濕而發動, 故其瀉暴. 《入門》 ○風邪入於腸胃, 故大便不聚而瀉. 《直指》

Translation영역

There is aversion to wind and spontaneous sweating, or clear blood carried in the stool. It arises because wind injured the patient in spring and damp affected him in summer and so it breaks out, and therefore the diarrhoea is violent. Wind evil has entered the intestine and stomach, so the stool does not gather and there is diarrhoea.

Immun 入門 · Jikji 直指

2.8.2

Source원문

瀉而便帶淸血, 宜胃風湯. 《回春》 ○風邪內縮, 宜桂枝麻黃湯汗之. 《方見寒門ㆍ綱目》

Translation영역

For a diarrhoea with clear blood carried in the stool, Wipung-tang. Where wind evil has drawn inward, sweat it out with Gyeji-mahwang-tang.

Clinical note임상 주석

A short section whose interest is the sign it names: aversion to wind and sweating with the diarrhoea, which makes it an illness of the exterior as well as the bowel, and clear blood in the stool. Bright unmixed blood with systemic symptoms is the presentation of an invasive enteric infection, and the tradition's instinct to treat it by sweating is the one place in the chapter where the treatment runs hardest against what the patient needs.

Hoechun 回春 · Gangmok 綱目

2.9 Cold Diarrhoea 寒泄

2.9.1

Source원문

惡寒身重, 腹脹切痛, 雷鳴鴨溏, 淸冷完糓不化, 宜理中湯加赤茯苓ㆍ厚朴, 或治中湯方見寒門加縮砂. 《入門》

Translation영역

There is aversion to cold and heaviness of the body, abdominal distension with cutting pain, thunderous rumbling and duck slurry, the stool clear and cold with the grain untransformed: Ijung-tang with red poria and magnolia bark added, or Chijung-tang with amomum added.

Immun 入門

2.9.2

Source원문

協寒自利不渴曰鴨溏, 亦曰鶩溏. 所下淸白如鴨屎狀也. 《入門》

Translation영역

A spontaneous diarrhoea with cold and no thirst is called duck slurry, also called wild-duck slurry; what is passed is clear and white in the shape of duck droppings.

Immun 入門

2.9.3

Source원문

寒泄一名鶩溏, 大便如水, 宜附子溫中湯, 或平胃散方見五藏合理中湯. 《入門》

Translation영역

The cold diarrhoea, also called wild-duck slurry, with a stool like water: Buja-onjung-tang, or Pyeongwi-san combined with Ijung-tang.

Immun 入門

2.9.4

Source원문

寒泄宜四柱散ㆍ六柱散.

Translation영역

For cold diarrhoea, Saju-san or Yukju-san.

Donguibogam · Daebyeon

2.9.5

Source원문

寒泄須早晩服藥. 蓋平朝服煖藥, 到夜藥力已盡, 無以敵一夜陰氣, 所以無效, 故臨臥再服可也. 《丹心》

Translation영역

In cold diarrhoea the medicine must be taken morning and evening. For if a warming medicine is taken at dawn, by night its force is already spent and there is nothing to withstand a whole night's yin qi, and so it has no effect; therefore it should be taken again on lying down.

Clinical note임상 주석

The last entry is the best piece of practical reasoning in this part of the chapter and the only explicit argument about dosing interval in it: a warming medicine given once at dawn is spent by nightfall, when the cold is greatest, so it must be given again at bedtime. That is pharmacokinetics by inference from the diurnal pattern of the symptoms, and the conclusion — twice daily, with the second dose timed to the worst hours — is the right one whatever the mechanism.

Dansim 丹心

2.10 Summerheat Diarrhoea 暑泄

2.10.1

Source원문

煩渴尿赤, 暴瀉如水, 宜薷苓湯加白芍藥ㆍ車前子, 或桂苓甘露飮. 《入門》

Translation영역

There is vexing thirst with red urine and a violent diarrhoea like water: Yuryeong-tang with white peony and plantago seed added, or Gyeryeong-gamro-eum.

Immun 入門

2.10.2

Source원문

夏月暴瀉如水, 面垢脉虛, 煩渴自汗, 香薷散方見暑門合異功散方見五藏加白芍藥ㆍ車前子, 入陳米(炒) 百粒ㆍ烏梅一箇ㆍ燈心一團, 同煎服. 《回春》

Translation영역

In the summer months, a violent diarrhoea like water with a grimy face and a vacuous pulse, vexing thirst and spontaneous sweating: Hyangyu-san combined with Igong-san, with white peony and plantago seed added, and a hundred grains of stir-fried aged rice, one mume plum and one bundle of rush pith put in and decocted together.

Hoechun 回春

2.10.3

Source원문

暑泄宜麴朮元ㆍ淸六丸ㆍ通苓散ㆍ益元散ㆍ六和湯ㆍ淸暑益氣湯三方幷見暑門.

Translation영역

For summerheat diarrhoea, Gukchul-won, Cheongryuk-hwan, Tongryeong-san, Igwon-san, Yukhwa-tang or Cheongseo-ikgi-tang.

Clinical note임상 주석

The signs in the second entry read like a clinical note: a grimy face, a vacuous pulse, thirst, sweating, water pouring out, in the summer months. That is heat exhaustion with an acute gastroenteritis, and the Hoechun's answer — a summerheat formula combined with a qi tonic, with a hundred grains of toasted rice and a plum added to the decoction — is a rehydration drink in all but name. The chapter reaches the same conclusion by three different routes in three different centuries and never quite says it outright.

Donguibogam · Daebyeon

2.11 Fire Diarrhoea 火泄

2.11.1

Source원문

卽熱泄也. 口乾喜冷, 痛一陣瀉一陣, 其來暴速, 稠粘, 宜黃連香薷散方見暑門合四苓散加白芍藥ㆍ梔子(炒). 《入門》

Translation영역

This is the heat diarrhoea. The mouth is dry and cold things are liked; a bout of pain, then a bout of diarrhoea; it comes violently and fast and is thick and sticky. Hwangryeon-hyangyu-san combined with Saryeong-san, with white peony and stir-fried gardenia added.

Immun 入門

2.11.2

Source원문

腹中痛, 痛一陣瀉一陣, 所下如湯, 後重如滯, 瀉下赤色, 小便赤澁, 煩渴脉數, 宜萬病四苓散. 《回春》

Translation영역

There is pain within the belly, a bout of pain and then a bout of diarrhoea, what is passed is like hot water, there is a dragging-down behind as of something stuck, the stool is red, the urine red and inhibited, with vexing thirst and a rapid pulse: Manbyeong-saryeong-san.

Hoechun 回春

2.11.3

Source원문

腹痛瀉水腸鳴, 痛一陣瀉一陣者, 是火. 四苓散加木通ㆍ滑石ㆍ黃芩ㆍ梔子. 《丹心》

Translation영역

Abdominal pain with watery diarrhoea and rumbling, a bout of pain and then a bout of diarrhoea — this is fire. Saryeong-san with akebia, talc, scutellaria and gardenia added.

Clinical note임상 주석

A bout of pain, then a bout of diarrhoea — the phrase is repeated in all three entries and it is the sign that defines the category. Cramp immediately relieved by passing stool is colic from an inflamed or hypermotile bowel, and it is the exact complement to the damp diarrhoea's painlessness two sections earlier. Between those two signs the chapter has drawn the line that matters most in practice, and every formula in both sections follows from which side of it the patient falls.

Dansim 丹心

2.12 Vacuity Diarrhoea 虛泄

2.12.1

Source원문

困倦無力, 遇飮食卽瀉, 或腹不痛. 四君子湯方見氣門加木香ㆍ縮砂ㆍ蓮肉ㆍ陳糯米爲末, 砂糖湯調下, 空心. 《入門》

Translation영역

There is lassitude and want of strength, and diarrhoea as soon as food is met with; or the belly does not hurt. Sagunja-tang with costus root, amomum, lotus seed and aged glutinous rice added, powdered and taken on an empty stomach stirred into sugar water.

Immun 入門

2.12.2

Source원문

飮食入胃卽下注, 或完糓不化者, 是虛泄, 宜升陽除濕湯. 《丹心》

Translation영역

Where food and drink enter the stomach and pour straight down, or the grain passes untransformed, it is a vacuity diarrhoea: Seungyang-jeseup-tang.

Dansim 丹心

2.12.3

Source원문

飮食入胃卽瀉, 水糓不化, 脉微弱, 宜參苓蓮朮散. 《回春》

Translation영역

Where food and drink enter the stomach and are at once passed, the water and grain untransformed, and the pulse is faint and weak: Samryeong-yeonchul-san.

Hoechun 回春

2.12.4

Source원문

氣虛泄瀉, 四君子湯倍白朮, 加黃芪ㆍ升麻ㆍ柴胡ㆍ防風以提之而愈. 《正傳》

Translation영역

For qi vacuity diarrhoea, Sagunja-tang with the white atractylodes doubled and astragalus, cimicifuga, bupleurum and saposhnikovia added to lift it, and it is healed.

Jeongjeon 正傳

2.12.5

Source원문

虛泄, 養元散ㆍ加味四君子湯皆佳. 《得效》

Translation영역

For vacuity diarrhoea, Yangwon-san and Gami-sagunja-tang are both good.

Clinical note임상 주석

The sign is specific and useful: diarrhoea the moment food is eaten, with lassitude and often no pain. That is the gastrocolic reflex in an overactive gut, and the chapter treats it as a weak spleen rather than an irritable one — which leads to the right prescription by the wrong reasoning, since what the patient needs is not to be purged or bound but fed and settled. The first entry adds sugar and glutinous rice to a tonic and gives it as a sweet powder, which is the chapter's recurring answer for a patient who has stopped eating.

Deukhyo 得效

2.13 Slippery Diarrhoea 滑泄

2.13.1

Source원문

滑泄不禁, 瀉久不止, 大孔如竹筒直出無禁, 氣陷下者, 補中益氣湯方見內傷加白芍藥ㆍ訶子ㆍ肉豆蔲. 《入門》

Translation영역

A slippery diarrhoea that cannot be held back, long continued and not stopping, the great orifice like a bamboo tube with the stool going straight out unchecked, the qi having fallen downward: Bojung-ikgi-tang with white peony, chebula and nutmeg added.

Immun 入門

2.13.2

Source원문

日夜無度, 腸胃虛滑不禁, 脉沉細, 宜八柱散. 《回春》

Translation영역

Without number day and night, the intestine and stomach vacuous and slippery and not to be held back, the pulse sunken and fine: Palju-san.

Hoechun 回春

2.13.3

Source원문

滑泄宜固腸丸方見下ㆍ禹餘粮丸ㆍ木香散ㆍ實腸散.

Translation영역

For slippery diarrhoea, Gojang-hwan, Uyeoryang-hwan, Mokhyang-san or Siljang-san.

Donguibogam · Daebyeon

2.13.4

Source원문

大腸滑泄, 小便精出者, 宜萬全丸. 《入門》

Translation영역

Where the large intestine is slippery and the essence comes out with the urine: Manjeon-hwan.

Clinical note임상 주석

The great orifice like a bamboo tube is the chapter's phrase for a patulous anus with the stool running straight through, which is faecal incontinence described anatomically. Where the earlier sections reserved astringents for last, here they come first and with the mineral binders behind them, because the thing to be treated is the loss itself. The Immun's addition of essence coming out with the urine makes the last entry's case a general failure of the lower closures rather than a bowel complaint alone.

Immun 入門

2.14 Undigested-Food Diarrhoea 飱泄

2.14.1

Source원문

飱泄者, 米糓不化而泄出也. 《綱目》 ○夕食謂之飱. 以食之難化者尤重於夕, 故食不化泄出者謂之飱泄. 《聖濟》

Translation영역

The undigested-food diarrhoea is one in which the grain is passed untransformed. The evening meal is called 'son'. Since food that is hard to transform is heaviest in the evening, a diarrhoea in which food passes untransformed is called the evening-meal diarrhoea.

Gangmok 綱目 · Seongje 聖濟

2.14.2

Source원문

內經曰, 淸氣在下則生飱泄. 註曰, 淸氣, 陽氣也; 陽爲熱, 熱氣在下則糓不化, 故爲飱泄也. ○又曰, 久風入中則爲腸風飱泄. 夫脾胃衝和之氣以化爲事, 今淸氣下降, 或風邪久而干胃, 是木賊土也, 故衝和之氣不能化而令物完出, 謂之飱泄. 或飮食太過, 腸胃受傷, 亦致米糓不化, 俗呼爲水糓痢也, 加減木香散主之. 《衛生》

Translation영역

The Neijing says: when the clear qi is below, an undigested-food diarrhoea arises. The commentary: the clear qi is the yang qi; yang is heat, and when hot qi is below the grain is not transformed, and so there is an undigested-food diarrhoea. It also says: enduring wind entering the centre becomes intestinal wind with undigested-food diarrhoea. Now the harmonious qi of the spleen and stomach has transformation for its business; when the clear qi descends, or wind evil has long offended against the stomach — which is wood plundering earth — the harmonious qi cannot transform and lets things come out whole, and this is called the undigested-food diarrhoea. Or where food and drink have been excessive and the intestine and stomach are injured, the grain likewise passes untransformed; this is commonly called the water-and-grain dysentery, and Gagam-mokhyang-san governs it.

Wisaeng 衛生 · Naegyeong 內經

2.14.3

Source원문

飱泄之證, 奪食則一日可止. 夫奪食之理, 爲胃弱不能剋化, 食則爲泄; 如食不下, 何以作泄? 更當以藥如養元散ㆍ八仙糕之類滋養元氣, 候泄漸止, 少與食, 胃勝則安矣. 《東垣》

Translation영역

In the undigested-food diarrhoea, withholding food can stop it within a day. The principle of withholding food is this: the stomach is weak and cannot conquer and transform, so eating makes diarrhoea; and if no food goes down, by what means should diarrhoea be made? Then medicines such as Yangwon-san or Palseon-go should be used to nourish the original qi; and when the diarrhoea has gradually stopped, give a little food, and once the stomach has the upper hand all is well.

Dongwon 東垣

2.14.4

Source원문

飱泄宜防風芍藥湯ㆍ蒼朮防風湯.

Translation영역

For undigested-food diarrhoea, Bangpung-jakyak-tang or Changchul-bangpung-tang.

Donguibogam · Daebyeon

2.14.5

Source원문

一人病飱泄, 腹中雷鳴, 泄注米糓不化, 小便澁滯. 以桂枝麻黃湯方見寒門加薑ㆍ棗, 煎大劑連進三服, 汗出終日而卽愈. 《子和》

Translation영역

A man had the undigested-food diarrhoea, with thunderous rumbling within the belly, the stool pouring out with the grain untransformed, and the urine inhibited and stagnant. Gyeji-mahwang-tang with ginger and jujube added was decocted in a large dose and given three times running; he sweated the whole day and was healed at once.

Clinical note임상 주석

Dongwon's argument in the third entry is the best clinical reasoning in this half of the chapter and it still holds: if eating produces the diarrhoea, stop the eating, and nothing will be produced. Withhold food, nourish with something light, and reintroduce food slowly once the stool settles — which is bowel rest, and is what would be advised now. The etymology in the first entry is a nice piece of philology (the evening meal is the one that sits undigested), and the Jahwa's case at the end, cured by sweating a patient already losing fluid, is the chapter at its most dangerous.

Jahwa 子和

2.15 Phlegm Diarrhoea 痰泄

2.15.1

Source원문

或瀉或不瀉, 或多或少. 二陳湯方見痰門加乾葛ㆍ白朮ㆍ神麴; 實者海靑丸, 虛者六君子湯方見痰飮. 《入門》

Translation영역

Sometimes there is diarrhoea and sometimes not, sometimes much and sometimes little. Ijin-tang with pueraria, white atractylodes and medicated leaven added; for the replete, Haecheong-hwan, and for the vacuous, Yukgunja-tang.

Immun 入門

2.15.2

Source원문

痰泄, 脉沉滑, 宜萬病二陳湯. 《回春》

Translation영역

For phlegm diarrhoea with a sunken slippery pulse: Manbyeong-ijin-tang.

Clinical note임상 주석

Two entries and one good observation: the stool comes and goes, sometimes loose and sometimes not, sometimes much and sometimes little. That inconstancy is the category's whole definition and it is the pattern of a functional bowel disorder rather than an infection. The treatment is the phlegm pharmacy, which does nothing for mucus secretion; the diagnosis, that an irregular stool is a different disease from a constant one, is sound.

Hoechun 回春

2.16 Food-Accumulation Diarrhoea 食積泄

2.16.1

Source원문

泄而腹痛甚, 瀉後痛減, 臭如抱壞雞子, 噫氣作酸. 平胃散方見五藏加香附ㆍ縮砂ㆍ草果ㆍ山査子ㆍ麥芽, 煎服. 《入門》

Translation영역

There is diarrhoea with severe abdominal pain, the pain lessening after the stool is passed, a smell like a rotten brooded egg, and belching that turns sour. Pyeongwi-san with cyperus, amomum, tsaoko, crataegus and barley sprout added, decocted and taken.

Immun 入門

2.16.2

Source원문

腹痛甚而瀉, 瀉後痛減, 脉弦而滑, 宜香砂平胃散方見內傷去枳實, 加白朮ㆍ白茯苓. 《回春》

Translation영역

Where the abdominal pain is severe and there is diarrhoea, the pain lessening after the stool, and the pulse is wiry and slippery: Hyangsa-pyeongwi-san with the bitter orange removed and white atractylodes and white poria added.

Hoechun 回春

2.16.3

Source원문

傷食積而泄, 糞白可驗. 《得效》

Translation영역

Where food has injured and accumulated and there is diarrhoea, a white stool proves it.

Deukhyo 得效

2.16.4

Source원문

凡積滯泄瀉, 腹必耕痛, 方泄者是也; 或肚腹滿, 按之堅者亦是也. 宜用神麴ㆍ麥芽ㆍ山査之類以消之. 《丹心》

Translation영역

In every accumulation-and-stagnation diarrhoea the belly must ache as if ploughed before the stool comes — that is it; or the belly is full and hard to the hand — that too is it. Medicated leaven, barley sprout, crataegus and the like should be used to disperse it.

Dansim 丹心

2.16.5

Source원문

有停飮食數日乃瀉, 名曰瀼泄, 宜枳朮丸方見內傷.

Translation영역

Where food and drink have stopped and only after some days there is diarrhoea, it is called the alternating diarrhoea: Jichul-hwan.

Clinical note임상 주석

Three signs here are worth keeping. Pain relieved by passing stool, which the chapter has already used to mark the fire diarrhoea and uses again; a smell like a rotten brooded egg, which is the sulphurous odour of bacterial fermentation and still a recognized sign of malabsorption; and a white stool, which the Deukhyo offers as proof of food accumulation and which in fact means fat not absorbed or bile not reaching the gut. The treatment is the digestive trio — leaven, barley sprout, hawthorn — and the Dansim's instruction to palpate for a full hard belly before using it is the kind of examination the chapter does not always trouble to mention.

Donguibogam · Daebyeon

2.17 Wine Diarrhoea 酒泄

2.17.1

Source원문

飮食過傷, 遂成酒泄, 骨立不能食, 但飮一二盃, 經年不愈, 宜香茸丸. 《得效》

Translation영역

Where eating and drinking have injured beyond measure and it has become a wine diarrhoea, the bones standing out and no food possible but one or two cups to drink, and years passing without recovery: Hyangyong-hwan.

Deukhyo 得效

2.17.2

Source원문

患酒泄, 飮酒後特甚. 平胃散加丁香ㆍ縮砂ㆍ乾葛ㆍ麥芽ㆍ神麴, 爲末, 空心, 米飮調下二錢, 立愈. 《得效》

Translation영역

One suffering from wine diarrhoea is particularly bad after drinking. Pyeongwi-san with clove, amomum, pueraria, barley sprout and medicated leaven added, powdered, and 2 don taken on an empty stomach stirred into rice water — healed at once.

Deukhyo 得效

2.17.3

Source원문

傷酒, 晨起必泄, 宜理中湯加生薑ㆍ乾葛, 煎水, 酒蒸黃連丸方見血門空心呑下二錢爲妙. 《丹心》

Translation영역

Where wine has done injury, there is certain to be diarrhoea on rising in the morning: Ijung-tang with fresh ginger and pueraria added, decocted, and 2 don of Jujeung-hwangryeon-hwan swallowed with it on an empty stomach — excellent.

Clinical note임상 주석

A whole section for the drinker's diarrhoea, and the portrait in the first entry is unsparing: the bones standing out, no food possible, a cup or two of wine the only intake, and years of it. That is alcoholic malnutrition with chronic diarrhoea, which follows from mucosal injury and pancreatic insufficiency, and the chapter has seen it clearly enough to give it its own category. Morning diarrhoea after drinking is noted twice as the characteristic timing, which is correct. What none of the three entries says is that the patient should stop drinking.

Dansim 丹心

2.18 Spleen Diarrhoea 脾泄

2.18.1

Source원문

脾泄者, 肢體重着, 中脘有妨, 面色萎黃, 腹肚微滿, 宜用蒼朮ㆍ白朮ㆍ厚朴ㆍ木香ㆍ乾薑ㆍ生肉豆蔲輩. 《直指》

Translation영역

In the spleen diarrhoea the limbs and body are heavy and encumbered, the middle stomach duct is obstructed, the complexion is sallow and withered, and the belly is slightly full: atractylodes, white atractylodes, magnolia bark, costus root, dried ginger, raw nutmeg and their like should be used.

Jikji 直指

2.18.2

Source원문

脾泄者, 食後倒飽, 瀉去卽寬, 脉細, 宜香砂六君子湯. 《回春》

Translation영역

In the spleen diarrhoea there is an overfull feeling after eating, relief as soon as the stool is passed, and a fine pulse: Hyangsa-yukgunja-tang.

Hoechun 回春

2.18.3

Source원문

脾泄多老人腎虛, 謂之水土同化, 宜吳茱萸湯. 《得效》

Translation영역

The spleen diarrhoea is often kidney vacuity in the old, which is called water and earth transforming together: Osuyu-tang.

Deukhyo 得效

2.18.4

Source원문

脾泄久傳腎爲腸澼, 經年不愈者, 宜調中健脾丸. 《入門》

Translation영역

Where the spleen diarrhoea has long since passed over to the kidney and become intestinal flush, with years passing and no recovery: Jojung-geonbi-hwan.

Immun 入門

2.18.5

Source원문

脾泄已久, 大腸不禁, 此脾氣已脫, 宜急澁之, 用赤石脂ㆍ肉豆蔲ㆍ乾薑之類. 《丹心》

Translation영역

Where the spleen diarrhoea has already run long and the large intestine cannot be held, the spleen qi has collapsed and it must be astringed at once, using halloysite, nutmeg, dried ginger and the like.

Dansim 丹心

2.18.6

Source원문

脾泄宜服固中丸. 《綱目》 ○老人奉養太過, 飮食傷脾, 常常泄瀉, 亦是脾泄, 宜用山査麴朮丸. 《入門》

Translation영역

For spleen diarrhoea, Gojung-hwan should be given. Where the old are too richly kept and food and drink injure the spleen so that they are constantly loose, this too is a spleen diarrhoea: Sanja-gukchul-hwan.

Clinical note임상 주석

The section reads as a progression rather than a list, and the progression is the point. It begins as fullness after eating with relief on passing stool and a sallow complexion; with years it passes to the kidney and becomes intestinal flush; and at the end the large intestine cannot be held and the Dansim says the spleen qi has collapsed and must be astringed at once. That is the natural history of a chronic inflammatory or malabsorptive bowel disease set out in five entries, and the escalation of treatment follows it exactly — digestives first, tonics next, binders only when the loss itself has become the danger.

Gangmok 綱目 · Immun 入門

2.19 Kidney Diarrhoea 腎泄

2.19.1

Source원문

一名晨泄, 一名瀼泄. 每五更溏泄一次, 此腎虛感陰氣而然, 宜五味子散. 《本事》

Translation영역

Also called the dawn diarrhoea, also called the alternating diarrhoea. Every fifth watch there is one loose stool; this is because the kidney is vacuous and is affected by the yin qi: Omija-san.

Bonsa 本事

2.19.2

Source원문

每日五更初洞泄, 服他藥無效, 此名脾腎泄, 宜二神丸ㆍ四神丸. 《入門》

Translation영역

Where every day at the beginning of the fifth watch there is a cavernous diarrhoea and other medicines have had no effect, this is called the spleen-and-kidney diarrhoea: Isin-hwan or Sasin-hwan.

Immun 入門

2.19.3

Source원문

老人脾腎虛泄, 宜猪藏丸. 《入門》

Translation영역

For spleen and kidney vacuity diarrhoea in the old: Jeojang-hwan.

Immun 入門

2.19.4

Source원문

腎虛色慾所傷, 多足冷, 久則肉削, 五鼓臍下絞痛, 或只微響溏泄一次, 宜二神丸ㆍ四神丸ㆍ五味子散. 《入門》

Translation영역

Where the kidney is vacuous and injured by sexual desire, the feet are often cold, and in time the flesh wastes; at the fifth drum there is griping pain below the navel, or only a faint rumble and one loose stool: Isin-hwan, Sasin-hwan or Omija-san.

Immun 入門

2.19.5

Source원문

腎泄者, 腹痛無定處, 似痢, 骨弱面黧, 脚下時冷, 尺脉虛弱者是也. 當以破故紙ㆍ生乾薑ㆍ肉桂ㆍ木香ㆍ當歸主之. 《直指》

Translation영역

In the kidney diarrhoea the abdominal pain has no fixed place and resembles a dysentery; the bones are weak and the face darkened, the soles are cold at times, and the cubit pulse is vacuous and weak — that is it. Psoralea, raw and dried ginger, cassia bark, costus root and tangkuei should govern it.

Jikji 直指

2.19.6

Source원문

脾腎虛晨泄, 宜三神丸ㆍ調中健脾丸ㆍ六神湯ㆍ香薑散ㆍ木香散.

Translation영역

For spleen and kidney vacuity dawn diarrhoea, Samsin-hwan, Jojung-geonbi-hwan, Yuksin-tang, Hyanggang-san or Mokhyang-san.

Clinical note임상 주석

The best-observed category in the chapter. One loose stool at the fifth watch, every day, and nothing wrong afterwards; the feet cold, the face darkened, the cubit pulse weak, and other medicines having had no effect. Early-morning diarrhoea as an isolated daily event is a real and still-recognized pattern — the urgency of an irritable bowel, and of bile-acid malabsorption — and the tradition's reading of it as the kidney's fire failing at the hour when yang should rise gave it the whole Two, Three, Four and Six Spirits family of formulas. The chapter's one dissenting voice, the Deukhyo's cold coptis powder two sections later, is for the same sign when warming has failed.

Donguibogam · Daebyeon

2.20 Violent Diarrhoea 暴泄

2.20.1

Source원문

太陽傳太陰, 下痢爲鶩溏, 大腸不能禁固, 卒然而下, 大便如水, 其中有小結糞硬物, 欲起而又下, 欲了而不了, 小便多淸, 此寒也, 宜溫之. 理中湯方見寒門ㆍ漿水散. 《易老》

Translation영역

Where the greater yang passes to the greater yin, the dysentery becomes wild-duck slurry: the large intestine cannot hold, and suddenly it comes down, the stool like water with small bound hard lumps in it; one would rise and it comes again, one would be finished and is not finished, and the urine is mostly clear. This is cold and should be warmed: Ijung-tang or Jangsu-san.

Yeokro 易老

2.20.2

Source원문

有暴下無聲, 身冷自汗, 小便淸利, 大便不禁, 氣難布息, 脉微嘔吐, 此爲寒泄, 急以重藥溫之, 宜漿水散. 《易老》

Translation영역

There is a sudden descent without sound, the body cold and sweating of itself, the urine clear and free, the stool not to be held, the breath hard to spread, the pulse faint, and vomiting. This is a cold diarrhoea and must be warmed urgently with a heavy medicine: Jangsu-san.

Yeokro 易老

2.20.3

Source원문

暴泄宜漿水散ㆍ朝眞丹.

Translation영역

For violent diarrhoea, Jangsu-san or Jojin-dan.

Clinical note임상 주석

The second entry is one of the most accurate descriptions of shock in the pre-modern literature: a sudden soundless flood, the body cold, sweating, the pulse faint, the breath hard to draw, vomiting. The Yeokro recognizes it as an emergency and says the medicine must be heavy and immediate. Hard lumps carried in watery stool, noted in the first entry, is also exact — it is overflow around an impaction — and that the chapter noticed it within a description of a violent diarrhoea says something about the quality of its observation, whatever one makes of the greater yang passing to the greater yin.

Donguibogam · Daebyeon

2.21 Enduring Diarrhoea 久泄

2.21.1

Source원문

厥陰經動, 下痢不止, 其脉沉遲, 手足厥逆, 涕唾膿血, 此證難治. 法曰, 風邪縮於內, 宜散之, 用桂枝麻黃湯方見寒門汗之. 《易老》

Translation영역

Where the reverting yin channel is stirred, the dysentery does not stop, the pulse is sunken and slow, the hands and feet are reverting and cold, and there is pus and blood in the spittle — this pattern is hard to treat. The rule says: wind evil has drawn in within and should be dispersed; sweat it out with Gyeji-mahwang-tang.

Yeokro 易老

2.21.2

Source원문

凡久瀉之由, 多因眞陰虛損ㆍ元氣下陷, 遂成久泄. 若非補中益氣湯方見內傷ㆍ四神丸滋其本源, 則後必胸痞腹脹ㆍ小便淋澁, 多致不起. 《回春》

Translation영역

The cause of an enduring diarrhoea is mostly vacuity damage of the true yin and the original qi fallen downward, which becomes an enduring diarrhoea. Unless Bojung-ikgi-tang and Sasin-hwan enrich its source, there will certainly follow glomus of the chest and distension of the belly, with the urine dribbling and inhibited, and many do not rise again.

Hoechun 回春

2.21.3

Source원문

久泄是風邪內縮, 宜發其汗. 此證係風邪縮於內, 宜麻黃升麻湯以發之, 散邪於四肢, 布於經絡, 外無其邪則藏氣安矣. 《丹溪》

Translation영역

An enduring diarrhoea is wind evil drawn in within, and the sweat should be raised. This pattern belongs to wind evil drawn in within: Mahwang-seungma-tang should raise it, scattering the evil to the four limbs and spreading it through the channels and network vessels; the evil once gone from the exterior, the visceral qi is at peace.

Danggye 丹溪

2.21.4

Source원문

虛滑久不愈, 多傳變爲痢, 宜厚朴枳實湯. 《保命》

Translation영역

A vacuity-slippery stool long unhealed often passes over and changes into dysentery: Hubak-jisil-tang.

Bomyeong 保命

2.21.5

Source원문

久泄不止, 用破故紙ㆍ肉豆蔲ㆍ山藥則止. 《丹心》

Translation영역

Where an enduring diarrhoea does not stop, psoralea, nutmeg and dioscorea will stop it.

Dansim 丹心

2.21.6

Source원문

久泄ㆍ洞泄屬於肝經, 木剋土而成, 亦是腸澼. 澼者, 腸中有積水也. 《子和》

Translation영역

The enduring diarrhoea and the cavernous diarrhoea belong to the liver channel, arising when wood plunders earth, and they too are intestinal flush. Flush means there is accumulated water within the bowel.

Jahwa 子和

2.21.7

Source원문

久泄宜參朮健脾丸ㆍ除濕健脾湯ㆍ溫脾散ㆍ訶子散.

Translation영역

For enduring diarrhoea, Samchul-geonbi-hwan, Jeseup-geonbi-tang, Onbi-san or Gaja-san.

Donguibogam · Daebyeon

2.21.8

Source원문

飮食不節ㆍ起居不時, 損其胃氣, 則上升精微之氣反下降. 泄久則太陰傳少陰而爲腸澼. 《東垣》

Translation영역

Where food and drink are without measure and rising and resting keep no time, the stomach qi is damaged and the fine essential qi that should rise descends instead. When the diarrhoea has gone on long, the greater yin passes to the lesser yin and becomes intestinal flush.

Clinical note임상 주석

Two incompatible readings of the same illness sit side by side here and the chapter prints both. The Yeokro and Danggye hold that an enduring diarrhoea is wind trapped inside and must be sweated out — which, in a patient with cold extremities, a slow pulse and blood in the sputum, would kill him. The Hoechun holds that it is the true yin damaged and the original qi sunk, and must be supplemented, with the warning that otherwise the patient will swell, stop passing water and not rise again — which is renal failure following prolonged fluid loss, correctly anticipated. The Bogam does not adjudicate, and a reader has to.

Dongwon 東垣

2.22 In Diarrhoea One Should Use Medicines That Raise the Yang 泄瀉宜用升陽之藥

2.22.1

Source원문

暑月霖雨時, 人多病泄瀉, 乃濕多成五泄故也. 內經曰, 在下者引而竭之; 又曰, 治濕不利小便, 非其治也. 法當以淡滲之劑利之. 然客邪寒濕之勝, 自外入裏而甚暴, 若用利小便之藥, 則是降之又降, 復益其陰而重竭其陽也, 玆以升陽之藥是爲宜耳. 羌活ㆍ獨活ㆍ升麻各一錢半, 防風ㆍ甘草(灸) 各一錢. 右剉, 水煎服, 卽愈. 大法曰, 寒濕之勝, 助風以平之; 又曰, 下者擧之. 正謂此也. 《東垣》

Translation영역

In the summer months at the time of the long rains many people fall ill of diarrhoea, which is because abundant damp makes the five diarrhoeas. The Neijing says: what is below, draw it out and exhaust it; and it says: to treat damp without freeing the urine is not to treat it. The rule would be to free it with a bland seeping prescription. But where visiting evil, cold and damp, prevails and comes from without into the interior and is very violent, then if medicines that free the urine are used, it is descending what is already descending, adding further to the yin and doubly exhausting the yang; and therefore medicines that raise the yang are what is fitting. Notopterygium, pubescent angelica and cimicifuga, 1.5 don each; saposhnikovia and roasted licorice, 1 don each. Cut up, decoct in water and take, and it is healed at once. The great rule says: where cold and damp prevail, assist the wind in order to level it; and it says: what is below, lift it. This is precisely what is meant.

Clinical note임상 주석

A whole section given to one argument, and it is the chapter arguing with itself. The standing rule — stated here from the Neijing and followed in every formula of the first eleven sections — is that a watery stool is water in the wrong channel and must be redirected to the bladder. Dongwon's objection is that in an acute severe diarrhoea this is exactly wrong: the patient is already losing downward, and a diuretic takes him further the same way. So he turns the treatment upside down, lifts instead of draining, and gives five wind drugs and nothing else. The physiology is not ours and the drugs do not raise anything; but the clinical judgement — do not give a diuretic to a patient who is pouring out fluid — is right, and it is the single most important correction anywhere in this chapter.

Dongwon 東垣

2.23 Diarrhoea and Dysentery Are Not the Same 瀉與痢不同

2.23.1

Source원문

泄瀉之證, 水糓或化或不化, 幷無努責, 惟覺困倦. 若滯下則不然: 或膿, 或血, 或膿血相雜, 或腸垢, 或無糟粕, 或糟粕相雜. 雖有痛不痛之異, 而皆裏急後重, 逼迫惱人, 赤白交下爲異. 《丹心》

Translation영역

In the pattern of diarrhoea the water and grain are sometimes transformed and sometimes not, and there is no straining at all, only a sense of lassitude. With the stagnant descent it is otherwise: there is pus, or blood, or pus and blood mixed, or intestinal grime, or no dregs at all, or dregs mixed in. And although they differ in being painful or painless, in every case there is inner urgency and dragging-down behind, pressing and distressing the patient, with red and white coming down alternately — and that is the difference.

Clinical note임상 주석

The chapter's hinge, and one of the clearest differential statements in the book. The distinction rests on two findings: straining, and what is in the stool. A diarrhoea has no straining and the stool is food and water; a dysentery has inner urgency and dragging-down, and the stool contains pus, blood or mucus with little or no faecal matter. That is precisely the modern division between a secretory or osmotic diarrhoea and an invasive colitis, and it is drawn here on exactly the right two signs. Everything in the chapter's second half follows from this page.

Dansim 丹心

2.24 An Enduring Diarrhoea Becomes a Dysentery 久泄成痢

2.24.1

Source원문

太陰經受濕而爲水泄, 虛滑身重, 微滿, 不知糓味, 久則傳變而爲膿血痢. 《機要》

Translation영역

The greater yin channel receives damp and there is a watery diarrhoea, vacuous and slippery, the body heavy and slightly full, and the taste of grain unknown; in time it passes over and changes into a dysentery of pus and blood.

Giyo 機要

2.24.2

Source원문

夫痢者, 皆由榮衛不和ㆍ腸胃虛弱, 冷熱之氣乘虛客於腸胃之間, 泄而爲痢也. 《類聚》

Translation영역

Dysentery arises in every case from the construction and defence being out of harmony and the intestine and stomach vacuous and weak, so that cold and hot qi take advantage of the vacuity and lodge between the intestine and stomach, and the diarrhoea becomes a dysentery.

Yuchwi 類聚

2.24.3

Source원문

飮食不節ㆍ起居不時, 損其胃氣, 則上乘精微之氣反下降, 是爲飱泄; 久則太陰傳少陰而爲腸澼. 《東垣》

Translation영역

Where food and drink are without measure and rising and resting keep no time, the stomach qi is damaged and the fine essential qi that should rise above descends instead, and this is the undigested-food diarrhoea; and in time the greater yin passes to the lesser yin and becomes intestinal flush.

Clinical note임상 주석

Three authorities on the same transition, and the clinical observation underneath it is correct even where the channel theory is not: a chronic diarrhoea can turn into a bloody one, and when it does the illness has changed in kind. The Giyo's description of the prodrome — watery, slippery, the body heavy, the taste of grain unknown — is the malabsorptive phase, and the dysentery of pus and blood that follows is what happens when an inflamed bowel ulcerates. The chapter has already given a formula aimed at preventing exactly this, Hubak-jisil-tang, which is why it bothers to make the point twice.

Dongwon 東垣

2.25 The Several Patterns of Dysentery 痢疾諸證

2.25.1

Source원문

滯下之證, 內經所載有血溢ㆍ血泄ㆍ血便ㆍ注下; 古方則有淸膿血及泄下. 近世幷呼爲痢疾, 其實一也. 《三因》

Translation영역

For the pattern of the stagnant descent, the Neijing records blood overflowing, blood diarrhoea, bloody stool and pouring down; the old formularies have the clearing of pus and blood, and the descent of diarrhoea. Recent ages call them all dysentery, and in truth they are one.

Samin 三因

2.25.2

Source원문

痢有赤痢ㆍ白痢ㆍ赤白痢ㆍ水糓痢ㆍ膿血痢ㆍ噤口痢ㆍ休息痢ㆍ風痢ㆍ寒痢ㆍ濕痢ㆍ熱痢ㆍ氣痢ㆍ虛痢ㆍ滑痢ㆍ積痢ㆍ久痢ㆍ疫痢ㆍ蠱疰痢ㆍ五色痢.

Translation영역

Dysentery has the red dysentery, the white, the red and white, the water-and-grain, the pus-and-blood, the clenched-mouth, the resting, the wind, the cold, the damp, the heat, the qi, the vacuity, the slippery, the accumulation, the enduring, the epidemic, the worm-curse and the five-colour dysenteries.

Clinical note임상 주석

Nineteen named dysenteries, and the Samin's note at the head is the sensible one: the older texts had several names and recent ages call them all dysentery, and in truth they are one. That is the right judgement — these are not nineteen diseases but one disease sorted by what is passed, how long it has lasted, and what the patient is like — and the chapter proceeds to give each its own section anyway, which is how a reference work of this kind is built.

Donguibogam · Daebyeon

2.26 Red Dysentery 赤痢

2.26.1

Source원문

赤痢自小腸來, 濕熱爲本. 《丹心》 ○赤痢卽血痢也.

Translation영역

The red dysentery comes from the small intestine, and damp heat is its root. The red dysentery is the blood dysentery.

Dansim 丹心

2.26.2

Source원문

下痢赤積ㆍ身熱, 益元散方見暑門加木通ㆍ芍藥(炒)ㆍ陳皮ㆍ白朮煎湯, 呑下保和丸方見積門.

Translation영역

For a dysentery with red accumulation and fever, decoct Igwon-san with akebia, stir-fried peony, tangerine peel and white atractylodes added, and swallow Bohwa-hwan with it.

Donguibogam · Daebyeon

2.26.3

Source원문

赤痢宜導赤地楡湯ㆍ加減平胃散ㆍ地楡散ㆍ固腸丸ㆍ淸六丸方見上.

Translation영역

For red dysentery, Dojeok-jiyu-tang, Gagam-pyeongwi-san, Jiyu-san, Gojang-hwan or Cheongryuk-hwan.

Clinical note임상 주석

Short, because the chapter has already said what matters: red means blood, blood means the small intestine, and the root is damp heat. The assignment to the small intestine is wrong — frank blood in the stool is colonic or rectal, and the small intestine would produce melaena — but the therapeutic conclusion drawn from it, that a red dysentery wants cooling and blood-stopping drugs rather than warming ones, is right.

Donguibogam · Daebyeon

2.27 White Dysentery 白痢

2.27.1

Source원문

白痢屬氣, 自大腸來, 濕熱爲本. 《丹心》

Translation영역

The white dysentery belongs to the qi and comes from the large intestine, and damp heat is its root.

Dansim 丹心

2.27.2

Source원문

痢爲濕熱甚於腸胃, 怫鬱而成, 其病皆熱證也. 俗以痢白爲寒, 誤也. 如熱生瘡癤而出白膿, 可以白爲寒乎? 若以白爲寒ㆍ赤爲熱, 則兼赤白者, 乃寒熱俱甚於腸胃之間而爲病乎? 況下迫窘痛ㆍ小便赤澁而痢白者亦多有之, 爲熱明矣. 《河間》

Translation영역

Dysentery is damp heat severe in the intestine and stomach, becoming pent and so forming it, and its disease is in every case a heat pattern. Common opinion takes a white dysentery for cold, and is mistaken. When heat breeds a boil and white pus comes out, can the white be called cold? And if white were cold and red were heat, then where both red and white are present, would cold and heat both be severe at once between the intestine and stomach and so make the disease? Besides, there are many cases of a white dysentery with downward pressing and cramping pain and the urine red and inhibited — plainly heat.

Hagan 河間

2.27.3

Source원문

凡泄痢無已, 變作白膿點滴而下, 爲之溫脾不愈, 法當溫腎. 蓋腎主骨髓, 白膿者骨髓之異名也. 其證面色微黑ㆍ骨力羸弱, 的見腎虛, 當用破故紙ㆍ當歸ㆍ木香ㆍ乾薑ㆍ肉桂之屬. 《直指》

Translation영역

Wherever a diarrhoea or dysentery does not end but changes into white pus coming down drop by drop, and warming the spleen does not heal it, the rule is to warm the kidney. For the kidney governs the bone marrow, and white pus is another name for bone marrow. Its signs are a slightly blackened complexion and weakness of the bones' strength — clearly kidney vacuity — and psoralea, tangkuei, costus root, dried ginger, cassia bark and their kind should be used.

Jikji 直指

2.27.4

Source원문

白痢宜益元散方見暑門ㆍ溫六丸ㆍ水煮木香元ㆍ瀉白安胃飮.

Translation영역

For white dysentery, Igwon-san, Onryuk-hwan, Suja-mokhyang-won or Sabaek-anwi-eum.

Clinical note임상 주석

Hejian's argument in the second entry is the most forceful piece of polemic in the chapter and it is conducted properly, by analogy and by reductio. If white meant cold, then a boil — which is plainly hot — could not discharge white pus; and a stool that is both red and white would have to mean cold and heat at their height together, which is absurd; and anyway a white dysentery often comes with cramping and scalding urine, which are heat signs. He is right: the colour of an exudate reflects its cell content, not its temperature. The Jikji's rejoinder in the third entry is the counter-case — a chronic white discharge in a wasted patient with a dark complexion, which warming the spleen has failed to help — and the chapter prints both without choosing.

Donguibogam · Daebyeon

2.28 Red and White Dysentery 赤白痢

2.28.1

Source원문

冷熱不調, 赤白各半, 宜薑墨丸. 乍溏乍澁, 似痢非痢, 宜茱連丸. 《入門》

Translation영역

Where cold and heat are out of order and red and white are half and half: Gangmeok-hwan. Where it is now loose and now inhibited, like a dysentery and not a dysentery: Suryeon-hwan.

Immun 入門

2.28.2

Source원문

或赤或白, 冷熱不調, 宜小駐車元. 《入門》

Translation영역

Where it is now red and now white and cold and heat are out of order: Sojuja-won.

Immun 入門

2.28.3

Source원문

赤白痢宜黃連阿膠元ㆍ固腸湯ㆍ眞人養藏湯ㆍ茱連丸.

Translation영역

For red and white dysentery, Hwangryeon-agyo-won, Gojang-tang, Jinin-yangjang-tang or Suryeon-hwan.

Clinical note임상 주석

Now loose and now inhibited, like a dysentery and not a dysentery — the phrase in the first entry names the hardest case in the chapter, and the formula given for it is the ingenious Evodia and Coptis Pill, where two drugs are steeped together and then separated so that a cold pill and a warm one can be dispensed from one preparation. Where the pattern will not declare itself, the tradition's answer is to hold both readings simultaneously, and it builds the pharmacy to allow it.

Donguibogam · Daebyeon

2.29 Water-and-Grain Dysentery 水糓痢

2.29.1

Source원문

脾胃氣虛則不能消化水糓, 糟粕不聚, 變而爲水糓痢. 《神巧》 ○飱泄亦曰水糓痢, 宜參看.

Translation영역

When the spleen and stomach qi are vacuous they cannot digest the water and grain, the dregs do not gather, and it changes into the water-and-grain dysentery. The undigested-food diarrhoea is also called the water-and-grain dysentery, and the two should be read together.

Clinical note임상 주석

Two lines, and the second is an editorial cross-reference rather than a clinical one: this and the undigested-food diarrhoea are the same thing under two names, and the Bogam says so and sends the reader back. That it keeps the section at all, rather than merging them, is because the name appears in the formularies and a reader meeting it needs somewhere to look.

Singyo 神巧

2.30 Pus and Blood Dysentery 膿血痢

2.30.1

Source원문

如煩燥, 或先便膿後見血, 非黃連不止, 此上部血也. ○如惡寒脉沉, 或腰痛臍下痛, 非黃芩不除, 此中部血也. ○如惡寒脉沉, 先見血後便膿, 非地楡不除, 此下部血也. 《易老》

Translation영역

Where there is vexation and agitation, or pus comes first in the stool and blood appears after, nothing but coptis will stop it — this is blood of the upper part. Where there is aversion to cold with a sunken pulse, or pain in the lumbus and below the navel, nothing but scutellaria will remove it — this is blood of the middle part. Where there is aversion to cold with a sunken pulse and blood appears first with pus after, nothing but sanguisorba will remove it — this is blood of the lower part.

Yeokro 易老

2.30.2

Source원문

膿血稠粘ㆍ裏急後重, 皆屬於火. 內經曰, 溲澁而便膿血, 知氣行而血止也. 蓋溲澁而便膿血者, 言病因也; 氣行而血止者, 言治法也. 故曰, 行血則便膿自愈, 調氣則後重自除. 芍藥湯主之. 《易老》

Translation영역

Pus and blood thick and sticky with inner urgency and dragging-down behind all belong to fire. The Neijing says: the urine inhibited and the stool of pus and blood — know that when the qi moves the blood stops. For the urine inhibited and the stool of pus and blood states the cause of the disease, and the qi moving and the blood stopping states the method of treatment. Hence: make the blood move and the pus in the stool heals of itself; regulate the qi and the dragging-down behind is removed of itself. Jakyak-tang governs it.

Yeokro 易老

2.30.3

Source원문

溲澁而便膿血, 宜大黃湯下之, 是謂重劑; 黃芩芍藥湯和之, 是謂輕劑. 《易老》

Translation영역

Where the urine is inhibited and the stool is of pus and blood, purge it with Daehwang-tang — that is called the heavy prescription; harmonize it with Hwanggeum-jakyak-tang — that is called the light one.

Yeokro 易老

2.30.4

Source원문

膿血稠粘皆屬於火. 夫太陰濕主瀉, 少陰主痢. 是先泄亡津液而火就燥, 腎惡燥, 居下焦血分, 其受邪者故便膿血. 所謂瀉屬脾而痢屬腎也. 《綱目》

Translation영역

Pus and blood thick and sticky all belong to fire. Now the damp of the greater yin governs diarrhoea and the lesser yin governs dysentery. Thus the diarrhoea comes first and the fluids are lost, and fire turns to dryness; the kidney hates dryness, and dwelling in the lower burner and the blood aspect it is what receives the evil, and therefore the stool is of pus and blood. This is what is meant by saying that diarrhoea belongs to the spleen and dysentery to the kidney.

Gangmok 綱目

2.30.5

Source원문

熱積紫黑色者, 瘀血也. 腹痛後重異常, 桃仁承氣湯方見寒門下之. 要知諸痢皆血瘀, 惟黑爲瘀甚耳. 《入門》

Translation영역

Where heat has accumulated and the colour is purple-black, it is stagnant blood. The abdominal pain and dragging-down are beyond the ordinary: purge it with Doin-seunggi-tang. Know that in all dysenteries the blood is stagnant, and black only means the stagnation is severe.

Immun 入門

2.30.6

Source원문

膿血痢宜桃花湯方見寒門ㆍ導氣湯ㆍ黃連阿膠湯ㆍ導滯湯ㆍ地楡散ㆍ解毒金花散ㆍ芍藥栢皮丸ㆍ赤石脂丸ㆍ人參散.

Translation영역

For pus and blood dysentery, Dohwa-tang, Dogi-tang, Hwangryeon-agyo-tang, Doche-tang, Jiyu-san, Haedok-geumhwa-san, Jakyak-baekpi-hwan, Jeokseokji-hwan or Insam-san.

Clinical note임상 주석

Two things in this section are worth more than the rest of the dysentery sections put together. The first is the Yeokro's three-level localization: pus before blood means the upper part and wants coptis; lumbar and suprapubic pain mean the middle and want scutellaria; blood before pus means the lower part and wants sanguisorba. Reading the order in which pus and blood appear as a guide to where the lesion sits is a real inference, and sigmoid disease does bleed earlier in the stool than proximal disease. The second is the Neijing couplet the whole section turns on — make the blood move and the pus heals of itself, regulate the qi and the tenesmus goes of itself — which the Yeokro correctly separates into a statement of cause and a statement of method, and which licenses the chapter's refusal to bind a dysentery. Daehwang-tang heavy, Hwanggeum- jakyak-tang light: two prescriptions and a choice, which is how the section ends.

Donguibogam · Daebyeon

2.31 Clenched-Mouth Dysentery 噤口痢

2.31.1

Source원문

痢疾不納飮食者, 俗謂之噤口痢. 如頭疼ㆍ心煩ㆍ手足溫熱, 此乃毒氣上衝心肺. 敗毒散方見寒門五錢加蓮肉一錢ㆍ陳米百粒ㆍ薑三ㆍ棗二, 煎服. 如過飮苦澁凉藥, 以致聞食先嘔, 山藥剉如小豆, 銀石器一半炒一半生, 用爲末, 米飮調下卽效. 《綱目》

Translation영역

A dysentery in which no food or drink is taken in is commonly called the clenched-mouth dysentery. Where there is headache, vexation of the heart and warmth and heat of the hands and feet, this is toxic qi surging upward against the heart and lung: Paedok-san, 5 don, with lotus seed 1 don, a hundred grains of aged rice, three of ginger and two jujubes added, decocted and taken. Where bitter, astringent and cooling medicines have been drunk to excess so that the patient retches at the smell of food, cut dioscorea to the size of small beans, stir-fry half of it in a silver or earthen vessel and leave half raw, powder it and take it stirred into rice water — immediate effect.

Gangmok 綱目

2.31.2

Source원문

噤口痢, 胃口熱甚故也, 宜參連湯ㆍ罨臍法. 人不知此, 多用溫熱藥及甘味, 此以火濟火ㆍ以滯益滯也. 《丹心》

Translation영역

The clenched-mouth dysentery is because heat is severe at the mouth of the stomach: Samryeon-tang and the navel-poultice method. People do not know this and mostly use warm and hot medicines and sweet flavours — which is to aid fire with fire and to add stagnation to stagnation.

Dansim 丹心

2.31.3

Source원문

下痢噤口不食, 亦由脾虛, 宜以參苓白朮散方見內傷去山藥, 加石菖蒲爲末, 粳米飮調下二錢; 或人參ㆍ赤茯苓ㆍ石蓮子入些菖蒲煎服, 胸次一開, 自然思食. 《直指》

Translation영역

A dysentery with the mouth clenched and no eating also comes of spleen vacuity: Samryeong-baekchul-san with the dioscorea removed and acorus added, powdered, and 2 don taken stirred into rice water; or ginseng, red poria and stone lotus seed with a little acorus decocted and taken — once the chest is opened, the appetite comes of itself.

Jikji 直指

2.31.4

Source원문

凡治痢早用鸎粟殼, 則令毒氣閉塞心絡, 令噤口不食, 宜以御米煮稀粥溫啜解之. 《類聚》

Translation영역

Whenever poppy husk is used early in treating a dysentery, it makes the toxic qi block the heart's network vessels and brings on the clenched mouth with no eating; a thin gruel boiled from poppy seed, sipped warm, should resolve it.

Yuchwi 類聚

2.31.5

Source원문

噤口痢宜倉廪湯ㆍ開噤湯ㆍ石蓮散ㆍ解噤丸ㆍ納臍膏.

Translation영역

For clenched-mouth dysentery, Changnim-tang, Gaegeum-tang, Seokryeon-san, Haegeum-hwan or Napje-go.

Clinical note임상 주석

The fourth entry is the most valuable sentence in the chapter's second half, and it is a warning against the chapter's own favourite drug: give poppy husk early in a dysentery and you produce the clenched mouth. That is correct in substance — opiates given in an invasive colitis slow the gut, cause nausea and vomiting, and can precipitate ileus and toxic dilatation — and the Yuchwi has traced the complication to its cause by observation alone. The Dansim's complaint in the second entry is the matching one: people meet a patient who cannot eat and reach for warm sweet medicines, which is to aid fire with fire. Between them the two entries are the chapter criticizing its own practice, and both criticisms are right.

Donguibogam · Daebyeon

2.32 Resting Dysentery 休息痢

2.32.1

Source원문

凡痢乍發乍止者, 名休息痢. 《類聚》

Translation영역

Any dysentery that breaks out and stops again by turns is called the resting dysentery.

Yuchwi 類聚

2.32.2

Source원문

休息痢經年不差, 以致氣血虛而不斂, 八物湯方見虛勞加陳皮ㆍ阿膠珠ㆍ黃連ㆍ黃芩各少許; 脾胃虛者, 補中益氣湯ㆍ參苓白朮散幷見內傷. 《入門》

Translation영역

Where the resting dysentery goes years without recovery, so that the qi and blood become vacuous and do not gather: Palmul-tang with a little each of tangerine peel, beaded ass-hide glue, coptis and scutellaria added; where the spleen and stomach are vacuous, Bojung-ikgi-tang or Samryeong-baekchul-san.

Immun 入門

2.32.3

Source원문

休息痢宜加味養藏湯ㆍ三根飮ㆍ訶黎勒丸ㆍ神效丸.

Translation영역

For resting dysentery, Gami-yangjang-tang, Samgeun-eum, Garyeoreuk-hwan or Sinhyo-hwan.

Clinical note임상 주석

Breaks out and stops again by turns, going on for years. That is the definition of a relapsing illness, and naming it as a category of its own — rather than as a failure to cure one of the others — is good clinical taxonomy. The treatment is an aftercare prescription: the Eight Treasures with a little coptis and glue, or a qi tonic, because what wears the patient out across years of remission and relapse is the depletion rather than the attack.

Donguibogam · Daebyeon

2.33 Wind Dysentery 風痢

2.33.1

Source원문

風痢惡風鼻塞ㆍ身重色靑, 或純下淸水, 宜蒼朮防風湯. 《方見上ㆍ入門》

Translation영역

In the wind dysentery there is aversion to wind, a blocked nose, heaviness of the body and a blue-green colour, or pure clear water passed: Changchul-bangpung-tang.

Immun 入門

2.33.2

Source원문

風痢所下似痢非痢, 似血非血, 宜倉廪湯. 《方見上ㆍ得效》

Translation영역

In the wind dysentery what is passed is like a dysentery and not a dysentery, like blood and not blood: Changnim-tang.

Deukhyo 得效

2.33.3

Source원문

風痢宜胃風湯方見上ㆍ露宿湯.

Translation영역

For wind dysentery, Wipung-tang or Nosuk-tang.

Clinical note임상 주석

A blocked nose and aversion to wind alongside the stool, which is the chapter's way of marking a bowel illness with systemic and upper-respiratory symptoms — a viral gastroenteritis, in all likelihood, where the two do travel together. Like a dysentery and not a dysentery, like blood and not blood, is an honest description of a thin blood-tinged stool that will not fit either category.

Donguibogam · Daebyeon

2.34 Cold Dysentery 寒痢

2.34.1

Source원문

寒痢白如鴨溏, 腸鳴, 痛墜不甚, 宜理中湯方見寒門加訶子ㆍ肉豆蔲; 日久者, 黃連補腸湯. 《入門》

Translation영역

The cold dysentery is white like duck slurry, with rumbling of the bowel and no great pain or bearing down: Ijung-tang with chebula and nutmeg added; where the days have run long, Hwangryeon-bojang-tang.

Immun 入門

2.34.2

Source원문

寒痢宜赤石脂散.

Translation영역

For cold dysentery, Jeokseokji-san.

Clinical note임상 주석

The sign that places it is the absence of pain and tenesmus: a white mucous stool with rumbling but no bearing down. Against Hejian's argument two sections earlier — that white is not cold — the Immun keeps the category but defines it by the painlessness rather than by the colour, which is the better criterion and may be the chapter's quiet concession to the objection.

Donguibogam · Daebyeon

2.35 Damp Dysentery 濕痢

2.35.1

Source원문

濕痢腹脹身重, 下如黑豆汁, 或赤黑渾濁, 此危證也, 宜當歸和血散方見後陰ㆍ加味除濕湯ㆍ戊己丸. 《入門》

Translation영역

In the damp dysentery the belly is distended and the body heavy, and what is passed is like black-bean juice, or red-black and turbid — this is a dangerous pattern: Danggwi-hwahyeol-san, Gami-jeseup-tang or Mugi-hwan.

Immun 入門

2.35.2

Source원문

下痢如豆汁者, 濕也. 蓋脾胃爲水糓之海, 常兼四藏, 故有五色之相雜, 當先通利, 此迎而奪之之義也. 《丹心》

Translation영역

A dysentery passing what is like bean juice is damp. For the spleen and stomach are the sea of water and grain and always take in the other four viscera, and so there is a mixture of the five colours; one should first free and drain, and this is the sense of going out to meet it and seizing it.

Clinical note임상 주석

This is a dangerous pattern, says the Immun, of a stool like black-bean juice or red-black and turbid — and it is right to. That is melaena or degraded blood, and it means bleeding higher in the gut than a dysentery usually reaches. The Dansim's instruction to free and drain first rather than bind is the chapter's standing rule, and the phrase for it — go out to meet it and seize it — is the most vivid statement of that rule anywhere in the chapter.

Dansim 丹心

2.36 Heat Dysentery 熱痢

2.36.1

Source원문

熱痢與暑痢同. ○大凡痢疾多因伏暑而得. 但背寒ㆍ面垢, 或面如塗油, 齒乾ㆍ煩寃ㆍ燥渴引飮, 皆暑證也, 不宜輕用附子等熱藥, 宜酒蒸黃連丸. 《方見血門ㆍ得效》

Translation영역

The heat dysentery is the same as the summerheat dysentery. In general dysentery is mostly got from latent summerheat. A cold back and a grimy face, or a face as if smeared with oil, dry teeth, vexation and distress, parching thirst drawing on drinking — these are all summerheat signs, and warm medicines such as aconite must not be used lightly: Jujeung-hwangryeon-hwan.

Deukhyo 得效

2.36.2

Source원문

其冷熱蘊積腸胃間ㆍ滑泄垢膩者, 名腸垢, 卽熱痢也. 《類聚》

Translation영역

Where cold and heat are stored up and accumulated between the intestine and stomach and there is a slippery diarrhoea of grimy greasy matter, it is called intestinal grime, which is the heat dysentery.

Yuchwi 類聚

2.36.3

Source원문

偏熱純赤, 見暑證, 輕者黃芩芍藥湯, 重者導滯湯, 日久者黃連阿膠湯. 《入門》

Translation영역

Where it is one-sidedly hot and purely red and summerheat signs appear: for the light case Hwanggeum-jakyak-tang, for the severe Doche-tang, and where the days have run long Hwangryeon-agyo-tang.

Immun 入門

2.36.4

Source원문

挾熱下痢者, 身熱ㆍ口渴ㆍ小便澁少ㆍ大便急痛, 所下黃赤色. 《入門》 ○熱痢黃芩芍藥湯最妙. 《入門》

Translation영역

In a dysentery with heat there is fever, thirst, urine inhibited and scant, urgent painful stool, and what is passed is yellow-red. For a heat dysentery Hwanggeum-jakyak-tang is best of all.

Immun 入門

2.36.5

Source원문

下痢壯熱, 須用倉廪湯. 《直指》 ○下痢欲飮水, 有熱故, 宜白頭翁湯. 《方見寒門ㆍ仲景》

Translation영역

For a dysentery with high fever, Changnim-tang must be used. Where in dysentery the patient wants water, it is because there is heat: Baekduong-tang.

Jikji 直指 · Junggyeong 仲景

2.36.6

Source원문

熱痢宜烏梅丸ㆍ寧胃散加當歸方見下.

Translation영역

For heat dysentery, Omae-hwan, or Yeongwi-san with tangkuei added.

Clinical note임상 주석

The signs in the first entry are an observed syndrome and a good one: a cold back with a grimy or oily face, dry teeth, distress, and thirst driving the patient to drink. Dry teeth and a greasy face in a feverish patient with diarrhoea are dehydration, and the Deukhyo's conclusion — do not reach lightly for aconite — is the right one, because the warming formulas that serve a cold diarrhoea will harm this patient. The scant inhibited urine named in the fourth entry is the sign that would now be read as the measure of how much fluid has been lost.

Donguibogam · Daebyeon

2.37 Qi Dysentery 氣痢

2.37.1

Source원문

氣痢狀如蟹渤, 拘急獨甚, 宜茱連丸方見上ㆍ氣痢丸ㆍ牛乳湯.

Translation영역

The qi dysentery is shaped like crab froth, and the tightness and urgency alone are severe: Suryeon-hwan, Giri-hwan or Uyu-tang.

Clinical note임상 주석

One line, and two precise observations in it. Crab froth describes a stool worked through with gas into bubbles; and the tightness and urgency alone are severe says that the cramping is out of proportion to anything else — no fever, no blood, no wasting. A painful, urgent, frothy stool without systemic illness is a functional bowel disorder, and the chapter gives it a category, three formulas and no alarm.

Donguibogam · Daebyeon

2.38 Vacuity Dysentery 虛痢

2.38.1

Source원문

氣弱困倦, 糓食難化, 腹微痛, 或大痛, 幷無努責. 《入門》

Translation영역

The qi is weak and there is lassitude, the grain is hard to transform, the belly aches slightly or aches greatly, and there is no straining at all.

Immun 入門

2.38.2

Source원문

滑痢與虛痢同. 虛滑不禁, 甚則氣血俱脫. 血虛, 四物湯加人參ㆍ白朮ㆍ地楡ㆍ樗白皮; 氣虛, 眞人養藏湯. 《入門》

Translation영역

The slippery dysentery is the same as the vacuity dysentery. It is vacuous and slippery and cannot be held back, and when severe the qi and blood both collapse. For blood vacuity, Samul-tang with ginseng, white atractylodes, sanguisorba and ailanthus bark added; for qi vacuity, Jinin-yangjang-tang.

Immun 入門

2.38.3

Source원문

氣虛色白如鼻涕ㆍ凍膠, 理中湯加木香ㆍ肉桂ㆍ厚朴ㆍ赤茯苓. 《入門》

Translation영역

Where the qi is vacuous and the colour is white like nasal mucus or frozen glue: Ijung-tang with costus root, cassia bark, magnolia bark and red poria added.

Immun 入門

2.38.4

Source원문

如力倦ㆍ自覺氣少ㆍ惡食, 此爲挾虛證, 宜用補氣血之藥, 虛廻而痢自止. 《丹心》

Translation영역

Where there is weariness of strength, a sense of scant breath, and aversion to food, this is a pattern with vacuity in it: medicines that supplement the qi and blood should be used, and when the vacuity turns back the dysentery stops of itself.

Dansim 丹心

2.38.5

Source원문

痢疾日久, 氣血虛弱, 宜用八物湯方見虛勞ㆍ補中益氣湯方見內傷. 《回春》 ○痢稍久者不可下, 胃虛故也. 調中理氣湯ㆍ加味香連丸擇用之. 《醫鑑》

Translation영역

Where a dysentery has run long days and the qi and blood are vacuous and weak, Palmul-tang or Bojung-ikgi-tang should be used. A dysentery of some duration must not be purged, because the stomach is vacuous: choose between Jojung-igi-tang and Gami-hyangryeon-hwan.

Hoechun 回春 · Uigam 醫鑑

2.38.6

Source원문

久痢五虛證危困者, 宜大斷下丸. 五虛者, 脉細ㆍ皮寒ㆍ氣少ㆍ泄利前後ㆍ飮食不入是也. 如漿粥入胃, 泄注止, 則虛者活矣. 《得效》

Translation영역

Where an enduring dysentery has the five vacuities and the case is critical: Daedanha-hwan. The five vacuities are a fine pulse, cold skin, scant breath, leakage before and behind, and no food or drink taken in. If gruel goes into the stomach and the pouring stool stops, then the vacuous patient lives.

Deukhyo 得效

2.38.7

Source원문

虛寒痢脫肛, 宜訶子皮散. 《東垣》

Translation영역

For a vacuity cold dysentery with prolapse of the rectum: Gajapi-san.

Clinical note임상 주석

The five vacuities in the sixth entry are a prognostic score, and they are the right five: a thready pulse, cold skin, shallow breathing, incontinence of stool and urine, and inability to take food. That is shock with multi-organ failure, assembled from the Neijing and applied at the bedside — and the Deukhyo's endpoint is as practical as the criteria: if gruel will stay down and the stool stops, the patient lives. The Uigam's rule in the fifth entry is the chapter's one explicit limit on its own purging principle: a dysentery of some duration must not be purged, because the stomach is vacuous.

Dongwon 東垣

2.39 Accumulation Dysentery 積痢

2.39.1

Source원문

積痢色黃, 或如魚腦漿, 腹脹痛, 惡食. 《入門》 ○無積不成痢. 《直指》

Translation영역

The accumulation dysentery is yellow, or like fish-brain paste, with distension and pain of the belly and aversion to food. Without an accumulation no dysentery forms.

Immun 入門 · Jikji 直指

2.39.2

Source원문

痢出於積滯. 積, 物積也; 滯, 氣滯也. 物積欲出, 氣滯而不與之出, 所以下墜ㆍ裏急, 乍起乍止, 日夜凡百餘度. 人有此證, 不論色之赤白ㆍ脉之大小, 一皆以通利行之. 《直指》

Translation영역

Dysentery comes out of accumulation and stagnation. Accumulation is matter accumulated; stagnation is qi stagnant. The accumulated matter would come out, and the stagnant qi will not let it come out — and this is why there is bearing down and inner urgency, now starting and now stopping, more than a hundred times in a day and night. Where a person has this pattern, then without regard to whether the colour is red or white or the pulse large or small, in every case treat it by freeing and draining.

Jikji 直指

2.39.3

Source원문

飮食傷飽者, 注下酸臭. 諸有積者, 以肚熱纏痛推之. 《直指》 ○傷積滯則糞白有效. 《得效》

Translation영역

Where eating and drinking have injured by surfeit, what pours down is sour and foul-smelling. In all cases of accumulation, infer it from heat in the belly and binding pain. Where injury has accumulated and stagnated, a white stool proves it.

Jikji 直指 · Deukhyo 得效

2.39.4

Source원문

食積痢宜保和丸方見積門ㆍ感應元ㆍ蘇感元ㆍ生熟飮子.

Translation영역

For food-accumulation dysentery, Bohwa-hwan, Gameung-won, Sogam-won or Saengsuk-eumja.

Clinical note임상 주석

The second entry is the theoretical core of the chapter's whole dysentery practice, and it deserves to be read as the mechanical account it is. There is matter in the bowel that wants to come out; the qi is stuck and will not let it; the result is bearing down, inner urgency, and a hundred fruitless attempts a day. Therefore — and the Jikji is emphatic — whatever the colour and whatever the pulse, treat by freeing and draining. That is the argument that licenses rhubarb in a patient already passing a hundred stools, and it is the reason the chapter's dysentery sections look so unlike its diarrhoea sections. Fish- brain paste is a good description of mucoid exudate, and the instruction to palpate for a hot, bound belly before purging is the safeguard that makes the practice defensible.

Donguibogam · Daebyeon

2.40 Enduring Dysentery 久痢

2.40.1

Source원문

痢已減十之七八, 穢積已盡, 糟粕未實, 當以炒芍藥ㆍ炒白朮ㆍ灸甘草ㆍ陳皮ㆍ茯苓煎湯, 下固腸丸三十粒. 然此丸性燥, 若滯氣未盡, 不可遽用. 《丹心》

Translation영역

Where the dysentery is already reduced by seven or eight tenths, the foul accumulation already exhausted and the dregs not yet solid, a decoction of stir-fried peony, stir-fried white atractylodes, roasted licorice, tangerine peel and poria should be made, and thirty Gojang-hwan taken with it. But this pill is drying in nature, and if the stagnant qi is not yet exhausted it must not be used in haste.

Dansim 丹心

2.40.2

Source원문

久痢體虛氣弱, 滑泄不止, 當以訶子ㆍ肉豆蔲ㆍ白礬ㆍ半夏等藥澁之; 甚者添牡礪, 須以陳皮爲佐, 恐太澁亦能作疼也. 《丹心》

Translation영역

Where in an enduring dysentery the body is vacuous and the qi weak and the slippery stool does not stop, it should be astringed with chebula, nutmeg, alum, pinellia and such medicines; in a severe case add oyster shell, and tangerine peel must be the assistant, for fear that too much astringing can itself cause pain.

Dansim 丹心

2.40.3

Source원문

久痢不止, 服理中湯益甚, 此痢在下焦, 赤石脂禹餘粮湯主之方見寒門. 理中者, 理中焦, 用此以固其下焦故也. 《仲景》

Translation영역

Where an enduring dysentery does not stop and taking Ijung-tang makes it worse, this dysentery is in the lower burner, and Jeokseokji-uyeoryang-tang governs it. For to set the centre right is to set the middle burner right, and this formula is used because it secures the lower burner.

Junggyeong 仲景

2.40.4

Source원문

久痢宜大斷下元ㆍ萬全丸二方見上ㆍ眞人養藏湯ㆍ木香散ㆍ實腸散ㆍ加減益氣湯ㆍ樗白皮散.

Translation영역

For enduring dysentery, Daedanha-won, Manjeon-hwan, Jinin-yangjang-tang, Mokhyang-san, Siljang-san, Gagam-ikgi-tang or Jeobaekpi-san.

Clinical note임상 주석

Two warnings and a differential, and all three are good. The first: do not bind until the foul accumulation is gone — and the test offered is quantitative, seven or eight tenths reduced. The second: too much astringing causes pain in itself, so put tangerine peel in with the binders. The third is Junggyeong's and it is a piece of real diagnostic reasoning — if the formula for the middle burner makes the dysentery worse, the lesion is lower down, so use the formula that secures the lower burner. Inferring the site of disease from a failed treatment is as sophisticated as this tradition gets.

Donguibogam · Daebyeon

2.41 Epidemic Dysentery 疫痢

2.41.1

Source원문

一方一家之內, 上下傳染, 長幼相似, 是疫毒痢也. 當察運氣之相勝以治之. 《良方》

Translation영역

Where within one district or one household it is passed from high to low and old and young are alike affected, this is the epidemic toxin dysentery. One should examine which of the circuit qi is prevailing and treat accordingly.

Yangbang 良方

2.41.2

Source원문

一方長幼相似, 名曰疫痢, 人參敗毒散方見寒門加陳皮ㆍ白芍藥煎服, 或薑茶湯以防之. 《入門》

Translation영역

Where in one district old and young are alike affected it is called the epidemic dysentery: Insam-paedok-san with tangerine peel and white peony added, decocted and taken; or Gangcha-tang to guard against it.

Clinical note임상 주석

A household or a district, young and old alike, passed from one to another — and the tradition names it epidemic toxin and treats it as a single entity. That is the correct observation about communicability and it is made without any notion of an organism; the only mechanism available is the circuit qi, the year's prevailing climatic phase, which is why the Yangbang tells the physician to work out which one is in the ascendant. The Immun's second clause is the more useful: ginger-and-tea decoction to guard against it, which is prophylaxis offered to the household rather than treatment offered to the sick.

Immun 入門

2.42 Worm-Curse Dysentery 蠱疰痢

2.42.1

Source원문

久痢不已, 毒氣蝕於藏府, 下血如雞肝, 雜膿瘀者, 名曰蠱疰痢. 《類聚》

Translation영역

Where an enduring dysentery does not end and the toxic qi gnaws at the viscera and bowels, and blood is passed like chicken liver, mixed with pus and stasis, it is called the worm-curse dysentery.

Yuchwi 類聚

2.42.2

Source원문

蠱疰痢下黑血如雞肝, 發渴, 五內切痛, 此因服五石湯丸所致. 其血自百脉經絡而來, 以茜根丸救之. 《入門》

Translation영역

The worm-curse dysentery passes black blood like chicken liver, with thirst and cutting pain in the five inward parts; this is brought on by taking the five-mineral decoctions and pills. Its blood comes from the hundred vessels and the channels and network vessels: rescue it with Cheongeun-hwan.

Immun 入門

2.42.3

Source원문

蠱疰痢宜羚羊角元ㆍ薑墨丸方見上.

Translation영역

For worm-curse dysentery, Yeongyanggak-won or Gangmeok-hwan.

Clinical note임상 주석

Blood like chicken liver — dark, clotted, mixed with pus — and the toxic qi gnawing at the viscera. That is as good a description of amoebic colitis as the literature contains, and the name worm-curse suggests the tradition suspected something alive was doing it. The Immun's aetiology in the second entry is the interesting one, and it is iatrogenic: the five-mineral elixirs, taken for longevity, produce exactly this. Mineral-elixir poisoning with gastrointestinal haemorrhage was a real and much-noted hazard of the period, and the chapter names it as a cause of a bloody dysentery without comment.

Donguibogam · Daebyeon

2.43 Five-Colour Dysentery 五色痢

2.43.1

Source원문

痢疾五色俱下, 乃脾胃食積及四氣相倂, 以茱連丸救之. 《入門》

Translation영역

Where a dysentery passes all five colours together, it is food accumulated in the spleen and stomach with the four qi joining in: rescue it with Suryeon-hwan.

Immun 入門

2.43.2

Source원문

脾胃爲水糓之海, 無物不受, 常兼四藏, 故痢有五色之相雜, 當先通利. 《丹心》

Translation영역

The spleen and stomach are the sea of water and grain and receive everything, and they always take in the other four viscera, and so a dysentery has a mixture of the five colours; one should first free and drain.

Dansim 丹心

2.43.3

Source원문

濕毒甚盛, 下痢腹痛, 大便如膿血, 或如爛肉汁, 宜地楡散ㆍ黃連阿膠湯二方見上ㆍ活人.

Translation영역

Where damp toxin is very exuberant, with dysentery and abdominal pain and the stool like pus and blood or like the juice of rotted flesh: Jiyu-san or Hwangryeon-agyo-tang.

Hwarin 活人

2.43.4

Source원문

五色痢宜服秘方養藏湯ㆍ絲瓜散ㆍ神效參香散.

Translation영역

For five-colour dysentery, Bibang-yangjang-tang, Sagwa-san or Sinhyo-samhyang-san.

Clinical note임상 주석

The gravest of the chapter's dysentery categories and the one whose formulas are all opiates. A stool carrying blood, pus, bile, mucus and sloughed tissue together is a severe ulcerating colitis, and the five colours mapped onto the five viscera is the tradition's way of saying that the whole depth of the bowel is involved. The juice of rotted flesh, repeated here from the pus-and-blood section, is the phrase to keep.

Donguibogam · Daebyeon

2.44 The Eight Dysenteries and Their Dangerous Signs 八痢危證

2.44.1

Source원문

一曰熱赤, 二曰冷白, 三曰冷熱相加赤白, 四曰食積酸臭, 五曰驚靑, 六曰脾虛不化, 七曰時行有血, 八曰疳, 卽瀼瀉. 《類聚》

Translation영역

The first is hot and red; the second cold and white; the third cold and heat together, red and white; the fourth food accumulation, sour and foul; the fifth fright, blue-green; the sixth spleen vacuity without transformation; the seventh the seasonal kind, with blood; and the eighth gan-wasting, which is the alternating diarrhoea.

Yuchwi 類聚

2.44.2

Source원문

一曰冷痢白積, 二曰熱痢赤積, 三曰冷熱不調積下赤白, 四曰疳痢黃白積或見五色, 五曰驚痢靑積不臭, 六曰休息痢糞黑如魚腸, 七曰醲痢腹脹便臭肛痛, 八曰蠱疰痢下紫黑血如猪肝. 《入門》

Translation영역

The first is the cold dysentery with white accumulation; the second the heat dysentery with red accumulation; the third cold and heat out of order with red and white accumulation passed; the fourth the gan-wasting dysentery with yellow-white accumulation, or the five colours appearing; the fifth the fright dysentery with blue-green accumulation and no smell; the sixth the resting dysentery with the stool black like fish gut; the seventh the thick dysentery with the belly distended, the stool stinking and the anus painful; and the eighth the worm-curse dysentery passing purple-black blood like pig's liver.

Immun 入門

2.44.3

Source원문

通用小駐車丸ㆍ眞人養藏湯二方見上ㆍ入門.

Translation영역

For general use, Sojuja-hwan or Jinin-yangjang-tang.

Clinical note임상 주석

Two eight-fold lists set side by side, and they do not agree — which is why the Bogam prints both. The interest is in the signs that only appear here: the fright dysentery with a blue-green stool and no smell, which is a child's illness; the gan-wasting dysentery, which is paediatric malnutrition; the thick dysentery with a distended belly, a stinking stool and a painful anus; and the resting dysentery with a stool black like fish gut. The last is melaena in a relapsing illness, and of the sixteen entries it is the one that would most alarm a modern reader. That both lists are headed dangerous signs tells you the Bogam regarded this section as prognostic rather than therapeutic, and the two formulas at the end are given without distinction, for all eight.

Immun 入門

2.45 Abdominal Pain in Dysentery 痢疾腹痛

2.45.1

Source원문

下痢腹痛者, 肺經之氣鬱在大腸之間. 實者下之, 虛者以苦梗發之. 《丹心》 ○下痢腹痛, 不可用參ㆍ芪. 《丹心》

Translation영역

In a dysentery with abdominal pain, the qi of the lung channel is pent between the folds of the large intestine. For the replete, purge it; for the vacuous, raise it with bitter platycodon. In a dysentery with abdominal pain, ginseng and astragalus must not be used.

Dansim 丹心

2.45.2

Source원문

凡痢腹痛, 以白芍藥ㆍ甘草爲君, 當歸ㆍ白朮爲佐. 惡寒者加桂, 惡熱者加黃栢. 《丹心》

Translation영역

In every dysentery with abdominal pain, white peony and licorice are the sovereign and tangkuei and white atractylodes the assistants. For aversion to cold add cassia; for aversion to heat add phellodendron.

Dansim 丹心

2.45.3

Source원문

或食粥及肉稍多作痛, 宜以白朮ㆍ陳皮煎湯服之, 且宜奪食. 奪食者, 減其粥食ㆍ絶其肉味也. 《丹心》

Translation영역

Where eating a little too much gruel or meat brings on the pain, a decoction of white atractylodes and tangerine peel should be taken, and food should also be withheld. Withholding food means reducing the gruel and cutting off meat altogether.

Dansim 丹心

2.45.4

Source원문

下痢膿血腹痛不止, 調胃承氣湯加薑ㆍ棗煎服方見寒門; 瀉訖, 以五苓散煎水, 益元散調下.

Translation영역

Where a dysentery of pus and blood with abdominal pain does not stop, Jowi-seunggi-tang with ginger and jujube added, decocted and taken; and when the purge is finished, decoct Oryeong-san in water and stir Igwon-san into it.

Donguibogam · Daebyeon

2.45.5

Source원문

痢疾腹痛宜香連丸ㆍ薑茶湯方見上ㆍ神效越桃散.

Translation영역

For abdominal pain in dysentery, Hyangryeon-hwan, Gangcha-tang or Sinhyo-woldo-san.

Clinical note임상 주석

The prohibition in the first entry is worth noting for what it reveals about how carefully this was thought through: ginseng and astragalus must not be used in a dysentery with abdominal pain. They are the tradition's two great qi tonics, and the objection is that supplementing qi in a bowel already distended with pent qi makes the pain worse. The second entry gives the standing pair for the pain — peony and licorice, which is Jakyak-gamcho-tang, a real antispasmodic combination still used — and the third says to cut out meat and reduce the gruel, which is dietary management of a flare.

Donguibogam · Daebyeon

2.46 Inner Urgency and Dragging-Down Behind in Dysentery 痢疾裏急後重

2.46.1

Source원문

裏急, 窘迫急痛是也; 後重者, 大腸墜重而下也. 其證不一: 有因火熱者, 謂火性急速而能燥物是也; 有因氣滯者, 此大腸之氣壅而不宣通也; 有因積滯壅盛者, 是有物結墜也; 有氣虛者, 此大腸氣降而不能升也; 有血虛者, 所謂虛坐努責是也. 治法: 火熱者淸之, 氣滯者調之, 積滯者去之, 氣虛者升之, 血虛者補之. 《玉機》

Translation영역

Inner urgency is the cramping, urgent pain; dragging-down behind is the large intestine bearing heavily downward. Its patterns are not one. Some are from fire heat — fire's nature being urgent and swift and able to dry things. Some are from qi stagnation — the qi of the large intestine congested and not freely diffused. Some are from accumulation and stagnation in abundance — there is matter bound and bearing down. Some are from qi vacuity — the large intestine's qi descending and unable to rise. Some are from blood vacuity — what is called sitting to no purpose and straining. The method: for fire heat, clear it; for qi stagnation, regulate it; for accumulation and stagnation, remove it; for qi vacuity, raise it; for blood vacuity, supplement it.

Okgi 玉機

2.46.2

Source원문

後重者, 本因邪壓大腸而墜下, 故大腸不能升上, 而重用大黃ㆍ檳榔輩瀉其所壓之邪. 今邪旣瀉而其重因在者, 知大腸虛滑不能自收, 而重用御米殼等澁劑固其滑ㆍ收其氣, 亦愈也. 《丹心》

Translation영역

Dragging-down behind is originally because the evil presses on the large intestine and bears it down, so that the large intestine cannot rise up; and so rhubarb, areca and their like are used in quantity to drain the evil that presses on it. If now the evil has been drained and yet the heaviness remains, know that the large intestine is vacuous and slippery and cannot gather itself, and poppy husk and such astringent prescriptions are used in quantity to secure its slipperiness and gather its qi — and that heals it too.

Dansim 丹心

2.46.3

Source원문

下墜異常, 積中有紫黑血而又痛甚, 此爲死血, 用桃仁泥ㆍ滑石行之. 《丹心》

Translation영역

Where the bearing down is beyond the ordinary, there is purple-black blood within the accumulation and the pain too is severe, this is dead blood: use peach kernel ground to a paste and talc to move it.

Dansim 丹心

2.46.4

Source원문

後重窘迫, 當和氣, 宜木香ㆍ檳榔. 《易老》 ○自古治裏急後重, 但用木香ㆍ檳榔調氣及大黃下積; 至丹溪始用桃仁ㆍ滑石活死血, 其效如鼓應桴. 《綱目》

Translation영역

For dragging-down behind with cramping urgency the qi should be harmonized: costus root and areca. From of old, inner urgency and dragging-down behind were treated only with costus root and areca to regulate the qi and rhubarb to bring down the accumulation; it was Danggye who first used peach kernel and talc to quicken the dead blood, and the effect was like a drum answering the stick.

Yeokro 易老 · Gangmok 綱目

2.46.5

Source원문

氣行血和ㆍ積少, 但虛坐努責, 此爲亡血證, 倍用當歸身ㆍ尾, 却以生地黃ㆍ生芍藥ㆍ生桃仁佐之, 陳皮和之. 血生自安. 血虛則裏急, 故用當歸身. 《丹心》

Translation영역

Where the qi moves, the blood is harmonized and the accumulation is slight, and there is only sitting to no purpose and straining, this is a blood-loss pattern: double the body and tail of tangkuei, assist it with raw rehmannia, raw peony and raw peach kernel, and harmonize with tangerine peel. When the blood is generated it settles of itself. Blood vacuity makes the inner urgency, and so the body of tangkuei is used.

Dansim 丹心

2.46.6

Source원문

裏急者, 腹中不寬快也; 虛坐而大便不行者, 血虛也; 後重者, 虛氣墜下也. 《回春》

Translation영역

Inner urgency is the belly not being easy and free within; sitting to no purpose with no stool passing is blood vacuity; dragging-down behind is vacuous qi bearing downward.

Clinical note임상 주석

The chapter's best single section. Tenesmus is taken apart into five mechanisms — heat, qi stagnation, retained matter, qi vacuity and blood vacuity — each with its own treatment, and the five are genuinely distinguishable at the bedside. The Dansim's sequential rule in the second entry is better still: purge the pressing evil first with rhubarb and areca, and if the heaviness persists after the purge, then the bowel has become slack and should be astringed. That is a two-stage protocol with a defined decision point, which is rare in this literature. Sitting to no purpose and straining — virtual tenesmus with nothing passed — is read as blood loss, and the phrase is as exact a description of the symptom as exists. The Gangmok's historical note, that Danggye was the first to treat it as stagnant blood with peach kernel and talc, shows the tradition aware of its own innovations.

Hoechun 回春

2.47 Pain of the Great Orifice in Dysentery 痢疾大孔痛

2.47.1

Source원문

下痢大孔痛, 因熱流于下, 用木香ㆍ檳榔ㆍ芩ㆍ連加炒乾薑煎服. 《綱目》 ○下痢大孔痛, 宜溫煖之. 《仲景》

Translation영역

In a dysentery with pain of the great orifice, it is because heat has flowed downward: use costus root, areca, scutellaria and coptis with stir-fried dried ginger added, decocted and taken. In a dysentery with pain of the great orifice, it should be warmed.

Gangmok 綱目 · Junggyeong 仲景

2.47.2

Source원문

下痢大孔痛, 一曰溫之, 一曰淸之. 如久病身冷脉沉小, 宜溫之; 如暴病身熱脉浮洪, 宜淸之. 《丹心》 ○作痛, 熱流於下也. 《醫鑑》

Translation영역

For a dysentery with pain of the great orifice, one authority says warm it and another says clear it. Where the illness is of long standing with a cold body and a sunken small pulse, warm it; where it is sudden with a hot body and a floating surging pulse, clear it. That it causes pain is heat flowing downward.

Dansim 丹心 · Uigam 醫鑑

2.47.3

Source원문

下痢大便不禁, 大孔開如空洞, 用葱ㆍ椒ㆍ木爛擣, 塞糓道中, 倂服酸澁固腸之劑, 如御米殼ㆍ訶子皮之類收之. 《綱目》

Translation영역

In a dysentery with the stool not to be held and the great orifice open like an empty cavern: pound scallion, zanthoxylum and wood to a pulp and plug the grain passage with it, and at the same time give sour astringent prescriptions that secure the intestine, such as poppy husk and chebula rind, to gather it.

Gangmok 綱目

2.47.4

Source원문

下痢大孔痛, 此大虛也. 瓦片圓如銅錢大, 燒紅投童尿中, 急取令乾, 紙裹安痛處; 以人參ㆍ當歸ㆍ陳皮濃煎飮之. 《綱目》

Translation영역

A dysentery with pain of the great orifice is a great vacuity. Take a potsherd round and the size of a copper coin, heat it red, throw it into a boy's urine, take it out at once and let it dry, wrap it in paper and set it on the painful place; and give a thick decoction of ginseng, tangkuei and tangerine peel to drink.

Gangmok 綱目

2.47.5

Source원문

又灸枳實熨之, 炒鹽熨之; 又熟艾ㆍ黃蠟ㆍ訶子燒烟熏之, 妙. 《綱目》

Translation영역

Also roast bitter orange and iron it on, or iron it with stir-fried salt; and fume it with the smoke of mugwort floss, beeswax and chebula burnt together — excellent.

Clinical note임상 주석

Anal pain in dysentery, treated locally and ingeniously: a hot potsherd quenched in urine, dried and laid on in paper as a warm compress; roasted bitter orange or toasted salt used the same way; a plug of pounded scallion and zanthoxylum for a patulous anus; and a fume of mugwort, wax and chebula. All of it is warmth and local counter-irritation, and for proctalgia and the perianal excoriation of a severe dysentery it is both plausible and humane. The disagreement in the second entry is resolved properly, by duration and pulse rather than by authority: chronic, cold and sunken means warm it, acute, hot and surging means cool it.

Gangmok 綱目

2.48 A Dysentery Should Be Purged 痢疾宜下

2.48.1

Source원문

痢初得一二日間, 元氣未虛, 必推蕩之, 此通因通用之法, 用大承氣湯或調胃承氣湯. 下後看氣血調理, 五日後不可下, 脾胃虛故也. 《丹心》

Translation영역

In the first day or two of a dysentery, while the original qi is not yet vacuous, it must be pushed and swept out — this is the method of using freeing for what is already free: Daeseunggi-tang or Jowi-seunggi-tang. After the purge, look to the qi and blood and regulate them; after five days it must not be purged, because the spleen and stomach are vacuous.

Dansim 丹心

2.48.2

Source원문

此亦大槩言之. 氣血弱者, 雖一二日不可下; 實者, 十餘日後亦可下之. 《正傳》

Translation영역

This too is spoken of only in general. Where the qi and blood are weak, it must not be purged even in the first day or two; where the patient is replete, it may still be purged after ten days and more.

Jeongjeon 正傳

2.48.3

Source원문

下痢腹滿爲實, 當下之. 《脉經》 ○下痢脉反滑者, 當有所去, 下之乃愈. 《仲景》

Translation영역

In a dysentery, fullness of the belly means repletion and it should be purged. In a dysentery, if the pulse is on the contrary slippery, there is something to be removed, and purging it heals.

Maekgyeong 脉經 · Junggyeong 仲景

2.48.4

Source원문

下痢已差, 至其年月日時復發者, 以病不盡故也, 當下之, 宜大承氣湯. 《仲景》

Translation영역

Where a dysentery has already recovered and breaks out again at the same year, month, day and hour, it is because the disease was not exhausted: it should be purged, with Daeseunggi-tang.

Junggyeong 仲景

2.48.5

Source원문

仲景治痢可下者, 悉用承氣等湯加減下之. 大黃之寒, 其性善走; 佐以厚朴之溫, 善行滯氣; 緩以甘草之甘, 飮以湯液, 灌滌腸胃, 滋潤輕快, 積行卽止. 局方例以熱藥爲主ㆍ澁藥爲佐, 用之於下痢淸白者猶可; 其裏急後重, 經所謂下迫者, 皆屬火熱所爲, 加以澁熱, 非殺之而何? 《丹溪》

Translation영역

Where Junggyeong judged a dysentery purgeable, he used the Order the Qi decoctions and their modifications in every case to purge it. Rhubarb's coldness is swift-moving by nature; assisted by magnolia bark's warmth it moves stagnant qi well; moderated by licorice's sweetness and drunk as a liquid, it flushes and washes the intestine and stomach, enriching and moistening and lightening, and when the accumulation has moved it stops at once. The Gukbang's practice makes hot medicines the sovereign and astringent medicines the assistants; used in a dysentery that is clear and white it may still do, but inner urgency and dragging-down behind — what the classic calls the downward pressing — belong in every case to fire heat, and to add astringing and heat to that is nothing but to kill the patient.

Clinical note임상 주석

The chapter's central argument, and Danggye's last paragraph is the most forceful writing in it. Using freeing for what is already free — purging a patient who is already passing stool — sounds like a contradiction and is the chapter's considered position: the tenesmus comes from matter lodged in the bowel, so clearing it is the cure. The timing rule is explicit and sensible: purge in the first day or two while the patient has reserves, regulate afterwards, and do not purge after five days — with the Jeongjeon's immediate correction that the five days is a generalization and the patient's strength is what decides. And then the accusation: the Gukbang's practice of hot and astringent drugs may pass in a white dysentery, but applied to a patient with tenesmus it is nothing but to kill him. He is right. Arresting an invasive colitis with opiates and astringents is how it perforates, and the chapter's own opiate formulas stand a few pages away.

Danggye 丹溪

2.49 The Essentials of Treating Dysentery 治痢要訣

2.49.1

Source원문

行血則便膿自愈, 調氣則後重自除. 《河間》

Translation영역

Make the blood move and the pus in the stool heals of itself; regulate the qi and the dragging-down behind is removed of itself.

Hagan 河間

2.49.2

Source원문

下痢治法曰: 後重者宜下, 木香ㆍ檳榔, 又木香檳榔丸方見氣門. ○腹痛者宜和, 芍藥ㆍ陳皮, 又芍藥甘草湯方見腹門. ○身重者除濕, 茯苓ㆍ澤瀉, 又五苓散方見寒門. ○脉弦者去風, 秦芃ㆍ防風, 又敗毒散方見寒門. ○膿血稠粘者以重藥竭之, 大黃ㆍ芒硝, 又大黃湯. ○身冷自汗者以熱藥溫之, 附子ㆍ乾薑, 又漿水散. ○風邪內縮者宜汗之, 麻黃ㆍ白芷ㆍ乾葛, 又麻黃升麻湯方見血門. ○鶩溏爲痢者宜溫之, 肉桂ㆍ木香, 又水煮木香丸. 《已上易老》

Translation영역

The method of treating dysentery says: for dragging-down behind, purge — costus root and areca, or Mokhyang-binrang-hwan. For abdominal pain, harmonize — peony and tangerine peel, or Jakyak-gamcho-tang. For heaviness of the body, eliminate damp — poria and alisma, or Oryeong-san. For a wiry pulse, remove wind — large-leaf gentian and saposhnikovia, or Paedok-san. For pus and blood thick and sticky, exhaust it with heavy medicines — rhubarb and mirabilite, or Daehwang-tang. For a cold body with spontaneous sweating, warm it with hot medicines — aconite and dried ginger, or Jangsu-san. For wind evil drawn in within, sweat it — ephedra, angelica dahurica and pueraria, or Mahwang-seungma-tang. For wild-duck slurry become a dysentery, warm it — cassia bark and costus root, or Suja-mokhyang-hwan.

Yeokro 易老

2.49.3

Source원문

又曰, 在表者發之, 在裏者下之, 在上者涌之, 在下者竭之, 身表熱者內踈之, 小便澁者分利之. 《易老》 ○又曰, 盛者和之, 去者送之, 過者止之. 《易老》

Translation영역

It also says: what is in the exterior, raise it out; what is in the interior, purge it; what is above, make it well up; what is below, exhaust it; where the body's surface is hot, loosen it from within; where the urine is inhibited, separate and free it. And it says: where it is exuberant, harmonize it; where it is going, send it on; where it has gone too far, stop it.

Yeokro 易老

2.49.4

Source원문

治痢藥法: 色黑大黃, 色紫地楡, 色紅黃芩, 色淡生薑, 色白肉桂, 色黃山査, 水泄粟殼, 痛甚木香ㆍ梔子. 《入門》

Translation영역

The drug method for treating dysentery: for a black colour, rhubarb; purple, sanguisorba; pink, scutellaria; pale, fresh ginger; white, cassia bark; yellow, crataegus; a watery stool, poppy husk; severe pain, costus root and gardenia.

Immun 入門

2.49.5

Source원문

凡痢之初, 宜立效散一服卽愈, 或木香導氣湯以撤其毒, 皆良法也. 《醫鑑》

Translation영역

At the beginning of any dysentery, one dose of Iphyo-san heals it at once, or Mokhyang-dogi-tang to strip away its toxin — both are good methods.

Uigam 醫鑑

2.49.6

Source원문

治痢者, 必用寒以勝熱ㆍ苦以燥濕, 微加辛熱佐之, 以爲發散開通之用, 固無不效矣. 《河間》

Translation영역

One who treats dysentery must use the cold to overcome the heat and the bitter to dry the damp, with a little acrid and hot added as assistant to serve for dispersing and opening through — and then there is assuredly no case in which it fails.

Hagan 河間

2.49.7

Source원문

痢疾宜以阿膠珠ㆍ當歸ㆍ靑皮ㆍ赤茯苓ㆍ黃連作劑, 入烏梅ㆍ濃蜜同煎, 最能蕩滌惡穢. 積滯旣去, 則遍數自踈矣. 《直指》

Translation영역

In dysentery, beaded ass-hide glue, tangkuei, unripe tangerine peel, red poria and coptis should be made into a prescription with mume plum and thick honey put in and decocted together; it is best able to flush away the malign filth. The accumulation and stagnation once gone, the number of stools thins of itself.

Jikji 直指

2.49.8

Source원문

大要以散風邪ㆍ行滯氣ㆍ開胃脘爲先. 不可遽用豆蔲ㆍ訶子ㆍ白朮輩以補住邪氣, 及粟殼ㆍ龍骨ㆍ牡礪輩以閉澁腸胃, 必爲日久淹延之疾. 待其腹痛ㆍ後重皆除, 然後乃用斷下之藥.

Translation영역

The main thing is to put first the dispersing of wind evil, the moving of stagnant qi and the opening of the stomach duct. Nutmeg, chebula, white atractylodes and their like must not be used in haste, lest they supplement and lodge the evil qi; nor poppy husk, dragon bone, oyster shell and their like, lest they shut and astringe the intestine and stomach — for it will certainly become a protracted illness dragging on for days. Wait until the abdominal pain and the dragging-down behind are both removed, and only then use the medicines that cut off the flow below.

Clinical note임상 주석

The chapter's summary section, and the last entry is the Bogam's own voice rather than a citation — the compilers stating the rule in their own words, and stating it as a prohibition. Do not reach for nutmeg and chebula, which lodge the evil; do not reach for poppy husk, dragon bone and oyster shell, which shut the bowel; wait until the pain and the tenesmus are gone, and only then bind. Set against the dozen opiate formulas this chapter also prints, that is a clear and correct clinical instruction, and it is the one a reader should take away. The Immun's colour-to-drug table in the fourth entry is the chapter's practice reduced to eight lines, and the Yeokro's eight-way method in the second is the same thing arranged by sign rather than by colour.

Donguibogam · Daebyeon

2.50 Medicines Treating Dysentery Generally 痢疾通治藥

2.50.1

Source원문

痢疾諸證, 臍腹㽲痛, 或下鮮血, 或下瘀血, 或下紫黑血, 或下白膿, 或赤白相雜, 或如黑豆汁, 或如煎腦, 或如茅屋漏水, 皆裏急後重, 頻欲登厠, 日夜無度, 通用水煮木香膏ㆍ六神丸ㆍ香連丸方見上ㆍ加味香連丸ㆍ白朮安胃散ㆍ百中散ㆍ和中飮ㆍ易簡斷下湯ㆍ寧胃散方見上ㆍ救命延年丸.

Translation영역

For the several patterns of dysentery — griping pain about the navel and belly; or fresh blood passed, or stagnant blood, or purple-black blood, or white pus, or red and white mixed; or a stool like black-bean juice, or like boiled brains, or like water leaking through a thatched roof; with inner urgency and dragging-down behind in every case, and frequent wanting of the privy without number day and night — for general use: Suja-mokhyang-go, Yuksin-hwan, Hyangryeon-hwan, Gami-hyangryeon-hwan, Baekchul-anwi-san, Baekjung-san, Hwajung-eum, Igan-danha-tang, Yeongwi-san or Gumyeong-yeonnyeon-hwan.

Donguibogam · Daebyeon

2.50.2

Source원문

瘧後痢, 黃連木香湯.

Translation영역

For a dysentery following malaria, Hwangryeon-mokhyang-tang.

Clinical note임상 주석

Three new similes appear in the list of stools and all three are good: like boiled brains, like water leaking through a thatched roof, and the earlier black-bean juice. Thatch-leak water — thin, brownish, dripping — describes the serous stool of a severe secretory diarrhoea, and it recurs in the prognostic section as a fatal sign. That ten formulas are offered for all of these indifferently is the honest admission of a general section: where the pattern cannot be determined, these are the things that have helped.

Donguibogam · Daebyeon

2.51 Distinguishing Diarrhoea and Dysentery Easy to Treat from Hard 泄痢易治難治辨

2.51.1

Source원문

太陰脾經受濕而爲水泄, 久則傳變而爲膿血痢, 是脾傳腎, 謂之賊邪, 故難愈. 若先痢而後瀉, 是腎傳脾, 謂之微邪, 故易愈. 《易老》

Translation영역

The greater yin spleen channel receives damp and there is a watery diarrhoea, and in time it passes over and changes into a dysentery of pus and blood — this is the spleen passing to the kidney, which is called the robber evil, and so it is hard to heal. But where the dysentery comes first and the diarrhoea after, this is the kidney passing to the spleen, which is called the slight evil, and so it is easy to heal.

Yeokro 易老

2.51.2

Source원문

飱泄脉大ㆍ手足寒, 難已; 脉小ㆍ手足溫, 易已. 《脉經》

Translation영역

In undigested-food diarrhoea, a large pulse with cold hands and feet is hard to end; a small pulse with warm hands and feet is easy to end.

Maekgyeong 脉經

2.51.3

Source원문

下痢有微熱而渴, 脉弱者, 自愈. ○下痢脉數, 有微熱汗出, 今自愈. 《脉經》 ○下痢脉大者, 爲未止. 《脉經》

Translation영역

In dysentery, slight fever with thirst and a weak pulse heals of itself. In dysentery, a rapid pulse with slight fever and sweating heals of itself. In dysentery a large pulse means it has not yet stopped.

Maekgyeong 脉經

2.51.4

Source원문

下痢手足溫, 易治; 手足寒, 難治. 《直指》 ○下痢嘔噦ㆍ發呃ㆍ煩躁ㆍ身熱者, 難治. 《醫鑑》

Translation영역

In dysentery, warm hands and feet are easy to treat and cold hands and feet hard. In dysentery, retching, hiccup, vexed agitation and a hot body are hard to treat.

Clinical note임상 주석

The sign the whole section turns on is the temperature of the hands and feet, and it is the right one: warm extremities mean the circulation is holding, cold ones mean it is not. Combined with the pulse rule from the earlier section — small is good, large is bad — the tradition has arrived at a two-variable assessment of peripheral perfusion that would not be out of place at a modern bedside. The channel-transmission argument in the first entry adds nothing clinically, but the observation behind it does: a diarrhoea that becomes bloody is worse than a bloody stool that settles into a diarrhoea.

Jikji 直指 · Uigam 醫鑑

2.52 Auspicious and Fatal Signs in Diarrhoea and Dysentery 泄痢吉凶證

2.52.1

Source원문

下痢如魚腦髓者, 半生半死. ○身熱脉大者, 半生半死. ○下痢如塵腐色者死. ○下純血者死. ○下如茅屋漏水者死. ○大孔開如竹筒者死. ○脣如朱紅者死. 《已上丹溪》

Translation영역

A dysentery passing what is like fish brain and marrow — half live and half die. A hot body with a large pulse — half live and half die. Passing the colour of dust and rot — death. Passing pure blood — death. Passing what is like water leaking through a thatched roof — death. The great orifice open like a bamboo tube — death. Lips like vermilion — death.

Danggye 丹溪

2.52.2

Source원문

內經曰, 腸澼便血, 身熱則死, 身寒則生. ○內經云身熱則死ㆍ寒則生, 此是大槩言之, 必兼證詳之方可. 豈無熱生而寒死者乎? 《丹心》

Translation영역

The Neijing says: in intestinal flush with bloody stool, if the body is hot the patient dies and if the body is cold he lives. The Neijing's saying that a hot body means death and a cold one life is spoken of only in general, and must be examined together with the other signs before it can be used. For are there none who are hot and live and cold and die?

Naegyeong 內經 · Dansim 丹心

2.52.3

Source원문

下痢手足厥冷無脉者, 灸之. 灸之不溫, 若脉不還ㆍ反微喘者死. 《仲景》 ○下痢脉絶ㆍ手足厥冷, 晬時脉還ㆍ手足溫者生; 脉不還者死. 《仲景》

Translation영역

In a dysentery with reverting cold of the hands and feet and no pulse, moxa it. If moxa does not warm it, and the pulse does not return and there is on the contrary faint panting, the patient dies. In a dysentery with the pulse cut off and the hands and feet reverting cold, if within a full day the pulse returns and the hands and feet grow warm he lives; if the pulse does not return he dies.

Junggyeong 仲景

2.52.4

Source원문

腹鳴而滿, 四肢淸而泄, 其脉大, 是逆也, 不過十五日死. 《靈樞》 ○腹大而脹, 四末淸, 脫形, 泄甚, 是逆也, 不及一時死. 《靈樞》

Translation영역

The belly rumbling and full, the four limbs cold and diarrhoea, with a large pulse — this is contrary, and death comes within fifteen days. The belly large and distended, the four extremities cold, the form wasted away and the diarrhoea severe — this is contrary, and death comes in less than an hour.

Yeongchu 靈樞

2.52.5

Source원문

下痢之證, 身凉能食ㆍ小便通, 易安; 若體熱多汗ㆍ渴甚ㆍ小便不利, 或手足厥冷ㆍ灸之不溫, 兼微喘不食者死. 《得效》

Translation영역

In the pattern of dysentery, a cool body with the ability to eat and the urine passing is easily settled; but a hot body with much sweating, severe thirst and urine not free, or reverting cold of the hands and feet that moxa does not warm, with faint panting and no eating besides — death.

Deukhyo 得效

2.52.6

Source원문

凡下痢譫語ㆍ直視, 及厥躁不得眠, 汗不止, 無脉, 及自利不禁, 身熱脉實者, 皆死. 《入門》 ○泄瀉久不止, 手足寒, 脉虛脫, 煩躁, 發呃, 氣短, 目直視, 昏冒不識人, 皆死證也. 《回春》

Translation영역

In any dysentery with raving speech and a fixed stare, or reversal and agitation with no sleep, sweating that does not stop, no pulse, or spontaneous diarrhoea not to be held with a hot body and a replete pulse — all these die. Where a diarrhoea has long not stopped, with cold hands and feet, a vacuous and collapsed pulse, vexed agitation, hiccup, shortness of breath, a fixed stare and clouded stupor not knowing people — all are fatal signs.

Immun 入門 · Hoechun 回春

2.52.7

Source원문

痢不治證: ○脉大 ○身熱 ○鴨屎 ○發渴 ○咳逆 ○五色 ○噤口 ○紅水 ○脣紅 ○手足冷 ○氣喘 ○痢後煩渴欲飮爲心絶 ○小便絶不通爲胃絶 ○下痢小便不通或絶無者, 此毒氣倂歸一藏, 胃乾者死. 《類聚》

Translation영역

Untreatable signs in dysentery: a large pulse; a hot body; duck droppings; thirst; hiccough and counterflow; five colours; a clenched mouth; red water; red lips; cold hands and feet; panting. Vexing thirst with a wish to drink after a dysentery is the heart cut off. Urine entirely stopped is the stomach cut off. In a dysentery with the urine not passing or wholly absent, the toxic qi has gathered into one viscus, and where the stomach is dry the patient dies.

Yuchwi 類聚

2.52.8

Source원문

小兒之痢重傷胃氣, 全不飮食, 名曰噤口. 肛門寬大深黑可畏, 腹肚疼痛, 裏急後重, 鮮血點滴, 名曰刮腸. 日夜頻倂, 飮食直過, 名曰滑腸. 皆爲惡候. 《省翁》 ○小兒痢糓道不閉ㆍ黃汁長流者, 不治. 《得效》 ○病人臥遺屎不覺者死. 《扁鵲》

Translation영역

A child's dysentery that badly injures the stomach qi so that nothing at all is eaten or drunk is called the clenched mouth. Where the anus is wide and deep black and fearful to see, with pain of the belly, inner urgency and dragging-down behind and fresh blood dripping, it is called the scraped intestine. Where day and night it comes repeatedly and food and drink pass straight through, it is called the slippery intestine. All are evil signs. In a child's dysentery, where the grain passage does not close and yellow fluid runs continually, it cannot be treated. A sick person who passes stool lying down without being aware of it dies.

Clinical note임상 주석

The longest prognostic section in the Bogam and one of the most accurate. Reduce it to its findings and they are the findings of circulatory collapse and renal failure: no pulse, cold extremities that moxa will not warm, panting, sweating that will not stop, raving and a fixed stare, and — twice named, and named as the stomach cut off — urine entirely absent. Anuria in a patient with profuse diarrhoea is the sign that matters most, and the Yuchwi has it. The Dansim's objection in the second entry is the chapter at its most scrupulous: the Neijing's rule that heat means death and cold means life is a generalization, and are there none who are hot and live and cold and die? The paediatric entries at the end name three stages of a child's dysentery, and the scraped intestine — a black gaping anus with blood dripping and tenesmus — is as grim and as recognizable as anything in the book.

Seongong 省翁 · Deukhyo 得效 · Pyeonjak 扁鵲

2.53 Passing Stool Immediately After Eating 飯後隨卽大便

2.53.1

Source원문

飯後隨卽大便者, 蓋脾腎交濟, 所以有水糓之分. 脾氣雖强而腎氣不足, 故飮食下咽而大府爲之飱泄也. 治法取二神丸空心鹽湯送下, 使脾腎之氣交通, 則水糓自然剋化. 此所謂妙合而凝者也. 《直指》

Translation영역

One who passes stool immediately after eating — now the spleen and kidney aid one another, and that is why water and grain are separated. Though the spleen qi be strong, the kidney qi is insufficient, and so food and drink go down the throat and the great bowel makes an undigested-food diarrhoea of it. The method: take Isin-hwan on an empty stomach, sent down with salt water, so that the qi of the spleen and kidney communicate; then the water and grain are conquered and transformed of themselves. This is what is meant by the marvellous joining and congealing.

Clinical note임상 주석

One passage, one sign, one formula. Passing stool the moment a meal is eaten is the gastrocolic reflex at its most exaggerated, and giving it a section of its own — rather than folding it into the vacuity diarrhoea where it also appears — is the Bogam recognizing that patients present with this complaint and nothing else. The Jikji's reading, a strong spleen with a weak kidney, is why the formula is the dawn-diarrhoea pill rather than a digestive.

Jikji 直指

2.54 Constipation of the Stool 大便秘結

2.54.1

Source원문

腎主五液, 津液潤則大便如常. 若飢飽勞役, 或食辛熱, 火邪伏於血中, 耗散眞陰, 津液虧少, 故大便結燥. 又有年老氣虛ㆍ津液不足而結者. 經曰, 腎惡燥, 急食辛以潤之者是也. 《東垣》

Translation영역

The kidney governs the five fluids, and when the fluids are moist the stool is as usual. But where there is hunger and surfeit and hard labour, or acrid and hot food is eaten, fire evil lies hidden within the blood, wastes and scatters the true yin, and the fluids are diminished, and so the stool is bound and dry. There are also those in whom it binds from age, with qi vacuous and fluids insufficient. The classic says: the kidney hates dryness, so eat the acrid urgently to moisten it — this is that.

Dongwon 東垣

2.54.2

Source원문

脉有陽結ㆍ陰結者, 何以別之? 曰, 脉浮而數, 能食, 不大便, 此爲實, 名曰陽結也, 期十七日當劇. 脉沉而遲, 不能食, 身體重, 大便反硬, 名曰陰結, 期十四日當劇. 《仲景》

Translation영역

There are a yang binding and a yin binding of the pulse; how are they distinguished? It is said: where the pulse is floating and rapid, the patient can eat and does not pass stool, this is repletion and is called the yang binding, and on the seventeenth day it should be at its worst. Where the pulse is sunken and slow, the patient cannot eat, the body is heavy and the stool is on the contrary hard, it is called the yin binding, and on the fourteenth day it should be at its worst.

Junggyeong 仲景

2.54.3

Source원문

有熱燥ㆍ風燥ㆍ陽結ㆍ陰結. 經曰, 結者散之. 治法: 陽結者散之, 陰結者溫之. 陽結宜大黃牽牛散, 陰結宜半硫丸. 《東垣》

Translation영역

There are heat dryness, wind dryness, the yang binding and the yin binding. The classic says: what is bound, disperse it. The method: a yang binding is dispersed and a yin binding is warmed. For a yang binding, Daehwang-gyeonu-san; for a yin binding, Banryu-hwan.

Dongwon 東垣

2.54.4

Source원문

燥結者, 大便秘澁不通也. 燥屬少陰, 津液不足, 以辛潤之; 結屬太陰, 有燥糞, 以苦泄之. 《入門》

Translation영역

A dry binding is the stool bound, inhibited and not passing. Dryness belongs to the lesser yin, the fluids being insufficient, and is moistened with the acrid; binding belongs to the greater yin, there being dry faeces, and is drained with the bitter.

Immun 入門

2.54.5

Source원문

藏府之秘, 不可一槩論. 有實秘, 有虛秘. 實秘者, 物也; 虛秘者, 氣也. 胃實而秘者, 能飮食, 小便赤, 脾約丸方見下ㆍ七宣丸主之. 胃虛而秘者, 不能飮食, 小便淸利, 厚朴湯主之. 《易老》

Translation영역

The binding of the viscera and bowels must not be spoken of all as one. There is a repletion binding and a vacuity binding. The repletion binding is matter; the vacuity binding is qi. Where the stomach is replete and bound, the patient can eat and drink and the urine is red: Biyak-hwan or Chilseon-hwan governs it. Where the stomach is vacuous and bound, the patient cannot eat and drink and the urine is clear and free: Hubak-tang governs it.

Yeokro 易老

2.54.6

Source원문

秘結之證, 有虛有實. 實則宜蕩滌腸胃ㆍ開結軟堅, 如大黃ㆍ芒硝ㆍ枳實ㆍ厚朴ㆍ承氣湯之類是也方見寒門. 虛則宜滋養陰血ㆍ潤燥散結, 如當歸ㆍ地黃ㆍ桃仁ㆍ麻仁ㆍ條芩ㆍ潤燥湯之類是也. 《丹心》

Translation영역

The pattern of a bound stool has its vacuity and its repletion. For repletion, the intestine and stomach should be flushed and washed and the binding opened and the hardness softened, as with rhubarb, mirabilite, bitter orange, magnolia bark and the Order the Qi decoctions. For vacuity, the yin blood should be enriched and nourished and the dryness moistened and the binding dispersed, as with tangkuei, rehmannia, peach kernel, hemp seed, scutellaria and Yunjo-tang.

Dansim 丹心

2.54.7

Source원문

桃ㆍ杏仁俱治大便秘, 當以氣血分之. 晝則便難, 行陽氣也, 宜用杏仁; 夜則便難, 行陰血也, 當用桃仁. 老虛人大便燥秘, 脉浮在氣, 杏仁ㆍ陳皮; 脉沉在血, 桃仁ㆍ陳皮. 所以俱用陳皮者, 以手陽明與手太陰俱爲表裏也. 《海藏》

Translation영역

Peach kernel and apricot kernel both treat a bound stool, and they should be divided by qi and blood. Where the difficulty is by day, it is the yang qi moving, and apricot kernel should be used; where by night, it is the yin blood moving, and peach kernel should be used. In an old or depleted person with a dry bound stool, a floating pulse means it is in the qi — apricot kernel and tangerine peel; a sunken pulse means it is in the blood — peach kernel and tangerine peel. The reason tangerine peel is used in both is that the hand yang brightness and the hand greater yin are exterior and interior to one another.

Haejang 海藏

2.54.8

Source원문

血燥以桃仁ㆍ酒大黃通之; 氣燥以杏仁ㆍ枳實通之; 風燥以麻子仁加大黃利之; 氣澁而不通者, 以郁李仁ㆍ皂角仁潤之. 《東垣》

Translation영역

A blood dryness is freed with peach kernel and wine-treated rhubarb; a qi dryness with apricot kernel and bitter orange; a wind dryness is freed with hemp seed and rhubarb added; and where the qi is inhibited and does not pass, it is moistened with bush-cherry kernel and soap-pod kernel.

Dongwon 東垣

2.54.9

Source원문

風燥宜踈風潤腸丸ㆍ皂角元ㆍ活血潤燥丸. ○血燥宜潤腸丸ㆍ潤麻丸ㆍ蓯沉丸ㆍ五仁丸ㆍ小麻仁丸ㆍ通幽湯ㆍ和血潤腸湯ㆍ當歸潤燥湯. ○氣滯參仁丸ㆍ搜風潤腸丸ㆍ三和湯ㆍ四磨湯ㆍ六磨湯. ○婦人秘結宜通神散ㆍ大麻仁丸.

Translation영역

For wind dryness, Sopung-yunjang-hwan, Jogak-won or Hwalhyeol-yunjo-hwan. For blood dryness, Yunjang-hwan, Yunma-hwan, Jongchim-hwan, Oin-hwan, Somain-hwan, Tongyu-tang, Hwahyeol-yunjang-tang or Danggui-yunjo-tang. For qi stagnation, Samin-hwan, Supung-yunjang-hwan, Samhwa-tang, Sama-tang or Yungma-tang. For a woman's bound stool, Tongsin-san or Daemain-hwan.

Clinical note임상 주석

The constipation sections are the best-organized part of the chapter, and the organizing distinction is the Yeokro's: a repletion binding is matter and a vacuity binding is qi, and the way to tell them apart is whether the patient can eat and whether the urine is dark. Appetite preserved with dark urine means there is something to be purged; no appetite with clear urine means there is not, and purging will harm. From that follows everything else — four kinds of dryness, each with its own moistening drug, and the Haejang's refinement in the seventh entry, which divides apricot kernel from peach kernel by whether the difficulty comes by day or by night. Two notes on that. The day-and-night rule is doctrine, not observation. But the pulse rule given alongside it — floating means qi and apricot kernel, sunken means blood and peach kernel — is a genuine attempt to make the choice on a finding rather than a report, and the explanation for why tangerine peel goes in both (the large intestine and the lung are paired) is the chapter reasoning from its own anatomy rather than from habit.

Donguibogam · Daebyeon

2.55 Constipation in the Old 老人秘結

2.55.1

Source원문

老人藏府秘澁, 不可用大黃. 緣老人津液少, 所以秘澁; 若服大黃以瀉之, 津液皆去, 定須再秘, 甚於前. 只可服滋潤大腸之藥, 更用槐花煎湯淋洗肛門, 亦效. 《得效》

Translation영역

Where the viscera and bowels of an old person are bound and inhibited, rhubarb must not be used. The reason an old person is bound and inhibited is that the fluids are scant; and if rhubarb is taken to purge, the fluids all go and he will certainly be bound again, worse than before. Only medicines that enrich and moisten the large intestine may be given; and a decoction of sophora flower used to bathe the anus is also effective.

Deukhyo 得效

2.55.2

Source원문

老人秘結宜踈風順氣元ㆍ小皂角元ㆍ二仁元ㆍ橘杏丸ㆍ黃芪湯ㆍ膠蜜湯ㆍ蘇麻粥ㆍ三仁粥. ○常食乳酪ㆍ血䐈ㆍ脂麻汁爲妙.

Translation영역

For constipation in the old, Sopung-sungi-won, Sojogak-won, Iin-won, Gyulhaeng-hwan, Hwanggi-tang, Gyomil-tang, Soma-juk or Samin-juk. It is excellent to eat milk curds, fatty broth and sesame juice regularly.

Clinical note임상 주석

The first entry is the chapter's clearest therapeutic prohibition and it is correct: do not purge an old person's constipation, because the fluid loss leaves him worse bound than before. Stimulant laxatives in the elderly do produce exactly that rebound, and the alternative offered — moisten only — is what is advised now. The closing dietary line is the most sensible sentence in the section: milk curds, fatty broth and sesame juice, taken regularly. Fat and fluid in the diet, every day, rather than a drug when the bowel stops.

Donguibogam · Daebyeon

2.56 The Spleen-Bound Pattern 脾約證

2.56.1

Source원문

傷寒陽明病, 自汗出, 小便數, 則津液內竭, 大便必難, 其脾爲約, 脾約丸主之. 《方見下ㆍ仲景》

Translation영역

In cold damage, in yang brightness disease, where there is spontaneous sweating and frequent urination, the fluids are exhausted within and the stool will certainly be difficult: the spleen is bound, and Biyak-hwan governs it.

Junggyeong 仲景

2.56.2

Source원문

成無己曰, 胃强脾弱, 約束津液, 不得四布, 但輸膀胱, 故小便數而大便難. 制脾約丸以下脾之結燥. 丹溪曰, 旣云脾弱, 脾弱則土虧, 肺金受火之剋; 肺耗則津竭, 脾失轉輸之令, 肺失傳送之職, 宜大便秘而難ㆍ小便數而無藏蓄也. 理宜滋養陰血, 使陽火不熾, 則肺金行淸化, 脾土淸健而運行津液, 則腸潤而自通矣. 今此丸用之於熱甚而氣實, 與西北人壯實者, 無有不安; 若用於東南人, 與熱雖盛而氣血不實者, 將見脾愈弱而腸愈燥矣. 須知在西北以開結爲主, 在東南以潤燥爲功. 《丹溪》

Translation영역

Cheng Wuji said: the stomach is strong and the spleen weak, so that the fluids are bound and restrained and cannot spread in the four directions but are sent only to the bladder, and therefore the urine is frequent and the stool difficult. Biyak-hwan was devised to bring down the spleen's bound dryness. Danggye said: if it is called spleen weakness, then weak spleen means earth is depleted, and lung metal receives the plundering of fire; the lung being wasted, the fluids are exhausted, the spleen loses its command of conveyance and the lung its office of transmission, and the stool must be bound and difficult and the urine frequent with nothing stored up. The principle calls for enriching and nourishing the yin blood, so that the yang fire does not blaze; then lung metal carries out its clear transformation, the spleen's earth is clear and robust and moves the fluids, and the bowel is moistened and passes of itself. Now this pill, used where heat is severe and the qi replete, and in people of the north-west who are robust, there is no case in which it does not settle them; but used in people of the south-east, or where heat is exuberant but the qi and blood are not replete, one will see the spleen grow weaker and the bowel drier. One must know that in the north-west opening the binding is the main thing, and in the south-east moistening the dryness is what answers.

Clinical note임상 주석

The sharpest observation in the chapter and the best argument in it. The observation is Cheng Wuji's: frequent urination with a hard stool is one disorder, because the fluid that should have moistened the bowel is going out by the bladder instead. That association is real — it is how diabetes, diuretic use and simple dehydration present — and reading the two symptoms as a single mechanism rather than two complaints is a genuine insight. The argument is Danggye's, and it is a criticism of the formula the section is named for: if the spleen is weak, as the name says, then purging it with rhubarb must weaken it further, so the pill belongs to robust patients and to the dry north-west and will harm a depleted patient in the humid south-east. Whatever one makes of the regional constitutionalism, the clinical point stands: the same prescription is right or wrong according to the patient's reserves, and the formula's own name tells against its own method.

Danggye 丹溪

2.57 The Stool Not Passing 大便不通

2.57.1

Source원문

大便秘結者, 常常乾燥而艱難放下也; 不通者, 累日不得通, 閉塞脹滿也.

Translation영역

A bound stool is one constantly dry and hard, let down with difficulty; a stool not passing is one that for days together cannot be got through, with blockage, distension and fullness.

Donguibogam · Daebyeon

2.57.2

Source원문

熱邪入裏則胃有燥糞, 三焦伏熱則津液中乾, 此大腸之挾熱然也. 虛人藏冷而血脉枯, 老人腸寒而氣道澁, 此大腸之挾冷然也. 腹脹痛悶ㆍ胸痞欲嘔, 此宿食留滯也. 腸胃受風ㆍ涸燥秘澁, 此風氣燔灼也. 若氣不下降而糓道難, 噫逆泛滿, 必有其證矣. 熱者三黃湯方見火門, 冷者半硫丸, 宿食宜脾積元, 風秘宜麻仁丸卽脾約丸, 氣不下降則䓀莄枳殼湯方見胸門. 大腸與肺爲表裏, 大腸者諸氣之道路關焉, 孰知流行肺氣爲治法之樞紐乎? 《直指》

Translation영역

Where heat evil enters the interior there are dry faeces in the stomach, and where heat lies hidden in the three burners the fluids are dry within — this is the large intestine with heat in it. In a depleted person the viscera are cold and the blood vessels withered; in an old person the bowel is cold and the qi passages inhibited — this is the large intestine with cold in it. Distension, pain and oppression of the belly with glomus of the chest and a wish to retch — this is old food lodged and stagnant. The intestine and stomach receiving wind, parched and dry and bound and inhibited — this is wind qi scorching and burning. And where the qi does not descend and the grain passage is difficult, there will certainly be belching, counterflow and overflowing fullness as its signs. For heat, Samhwang-tang; for cold, Banryu-hwan; for old food, Bijeok-won; for wind constipation, Main-hwan, which is Biyak-hwan; for qi not descending, Gilgyeong-jigak-tang. The large intestine and the lung are exterior and interior to one another, and the large intestine is the gateway of the road of all the qi — who knows that making the lung qi flow is the pivot of the method of treatment?

Jikji 直指

2.57.3

Source원문

久病腹中有實熱, 大便不通, 潤腸丸微利之, 不可用峻利之藥. 《正傳》

Translation영역

Where in a long illness there is repletion heat within the belly and the stool does not pass, free it slightly with Yunjang-hwan; drastic freeing medicines must not be used.

Jeongjeon 正傳

2.57.4

Source원문

大便閉, 服承氣湯之類不通者, 四物湯方見血門加檳榔ㆍ枳殼ㆍ桃仁ㆍ紅花. 《醫鑑》

Translation영역

Where the stool is shut and taking the Order the Qi decoctions and their like does not open it: Samul-tang with areca, bitter orange, peach kernel and safflower added.

Uigam 醫鑑

2.57.5

Source원문

古方通大便皆用降氣之劑. 蓋肺氣不降則大便難於傳送, 用杏仁ㆍ枳殼ㆍ沉香ㆍ訶子等是也. 老人ㆍ虛人ㆍ風人津液少而秘者, 宜以藥滑之, 用麻仁ㆍ脂麻ㆍ阿膠等是也. 若妄以峻劑逐之, 則津液走ㆍ氣血耗, 雖暫通而卽復秘, 或更生他病矣. 《丹心》

Translation영역

The old formularies all used qi-descending prescriptions to free the stool. For if the lung qi does not descend, the stool is hard to convey onward, and apricot kernel, bitter orange, aquilaria and chebula are used. For the old, the depleted and those subject to wind, in whom the fluids are scant and there is binding, medicines should be used to make it slip — hemp seed, sesame and ass-hide glue. But if one recklessly drives it out with drastic prescriptions, the fluids run off and the qi and blood are wasted, and though it passes for a moment it is bound again at once, or some other disease arises besides.

Dansim 丹心

2.57.6

Source원문

大便不通宜靈寶丹ㆍ蘇感元方見上ㆍ潤腸湯ㆍ大黃飮子; 老人ㆍ虛人宜潤腸丸ㆍ潤腸湯; 婦人宜通神散方見上ㆍ調導飮. ○外治宜宣積丸ㆍ提盆散.

Translation영역

For a stool not passing, Yeongbo-dan, Sogam-won, Yunjang-tang or Daehwang-eumja; for the old and the depleted, Yunjang-hwan or Yunjang-tang; for women, Tongsin-san or Jodo-eum. For external treatment, Seonjeok-hwan or Jebun-san.

Clinical note임상 주석

The section opens with a definition worth having — a bound stool is chronically dry and hard to pass, a stool not passing is days of complete blockage with distension — and the second is obstruction rather than constipation. The Jikji then sorts the causes five ways and ends with the question the whole section turns on: the large intestine and the lung are paired, so who knows that making the lung qi descend is the pivot of treatment? That is why apricot kernel, bitter orange and aquilaria appear in formula after formula here. The Dansim's warning in the fifth entry is the chapter's position in one sentence: drive it out with a drastic purgative and it passes once, binds again immediately, and leaves another illness behind.

Donguibogam · Daebyeon

2.58 Neither Stool Nor Urine Passing 大小便不通

2.58.1

Source원문

凡大小便不通, 內經謂之三焦約. 約者, 不行也. 又曰, 大小便不通者, 陰陽關格, 乃三焦約之病也. 《病源》

Translation영역

Wherever neither stool nor urine passes, the Neijing calls it the binding of the three burners. Binding means not moving. It also says that where neither stool nor urine passes, yin and yang are barred and blocked, and this is the disease of the binding of the three burners.

Byeongwon 病源

2.58.2

Source원문

三焦約大小便不通, 宜枳殼丸方見五藏ㆍ推氣丸.

Translation영역

For the binding of the three burners with neither stool nor urine passing, Jigak-hwan or Chugi-hwan.

Donguibogam · Daebyeon

2.58.3

Source원문

大小便不通宜三一承氣湯ㆍ車狗散ㆍ鐵脚丸ㆍ顚倒散ㆍ倒換散ㆍ蜣蜋散ㆍ甘遂散ㆍ貼臍膏. ○外治宜廻生神膏ㆍ丁香散ㆍ掩臍法ㆍ導便法.

Translation영역

For neither stool nor urine passing, Samil-seunggi-tang, Chagu-san, Cheolgak-hwan, Jeondo-san, Dohwan-san, Ganglang-san, Gamsu-san or Cheopje-go. For external treatment, Hoesaengsin-go, Jeonghyang-san, the navel-poultice method or the stool-guiding method.

Clinical note임상 주석

Yin and yang barred and blocked is the Neijing's name for it, and the condition it names is an emergency: nothing passing either way, with distension. Obstruction with urinary retention, or obstruction severe enough to have shut the kidneys down. Eight internal formulas and four external methods are offered, and the proportion tells you the Bogam's estimate of the situation — half of what it has to suggest is applied to the skin or introduced below, because a patient in this state cannot swallow much and has little time.

Donguibogam · Daebyeon

2.59 The Navel-Poultice Method 罨臍法

2.59.1

Source원문

治大小便不通: 以白礬末一匙安臍中, 冷水滴之, 令冷透腹內, 卽通. 《丹心》

Translation영역

For neither stool nor urine passing: set a spoonful of powdered alum in the navel and drip cold water on it, so that the cold penetrates within the belly, and it passes at once.

Dansim 丹心

2.59.2

Source원문

治大小便不通: 連根葱一二莖, 帶土生薑一塊, 淡豆豉二十一粒, 鹽一匙, 同硏作餠, 烘熱, 掩臍中, 以帛繫定. 良久, 氣透自通; 不通, 再換一餠. 《丹溪》

Translation영역

For neither stool nor urine passing: one or two scallions with their roots on, a lump of fresh ginger with the earth still on it, twenty-one fermented soybeans and a spoonful of salt, ground together and made into a cake; warm it over the fire, lay it on the navel and bind it in place with a cloth. After a good while the qi penetrates and it passes of itself; if it does not, change it for another cake.

Danggye 丹溪

2.59.3

Source원문

治大便閉結至極ㆍ昏不省人: 生大田螺一二枚, 鹽一匙, 和殼生擣, 置病人臍下一寸三分, 用帛包繫, 卽大通. 《得效》

Translation영역

For a bound stool at its extremity with the patient clouded and senseless: one or two large live rice-field snails and a spoonful of salt, pounded raw with the shells, set at one cun three fun below the navel and bound with a cloth, and it passes freely at once.

Deukhyo 得效

2.59.4

Source원문

又方: 田螺連殼擣爛, 入麝少許, 貼臍中, 以手揉按, 立通. 《入門》

Translation영역

Another: rice-field snail pounded to a pulp with the shell, with a little musk put in, applied to the navel and rubbed and pressed with the hand — it passes at once.

Immun 入門

2.59.5

Source원문

治大小便不通: 巴豆肉ㆍ杏仁ㆍ皂角, 右爲末作餠, 掩臍上, 火灸, 自通. 《綱目》

Translation영역

For neither stool nor urine passing: croton flesh, apricot kernel and soap-pod, powdered and made into a cake, laid over the navel and warmed with moxa, and it passes of itself.

Gangmok 綱目

2.59.6

Source원문

蝸牛膏治大小便不通: 蝸牛三枚, 連殼擣爲泥, 加麝香少許, 貼臍中, 以手揉按之, 立通. 無蝸牛則用田螺, 歷試殊效. 《回春》

Translation영역

Snail Paste treats neither stool nor urine passing: three snails pounded to a paste with their shells, with a little musk added, applied to the navel and rubbed and pressed with the hand — it passes at once. If there are no snails, use rice-field snails; it has been tried repeatedly with remarkable effect.

Clinical note임상 주석

Six poultices, and what they have in common is cold and moisture applied over the umbilicus with pressure — snail flesh, alum with cold water dripped on it, a warm cake of scallion and ginger. Rubbing and pressing the hand over the navel is specified twice, and that is abdominal massage over the sigmoid and the bladder; in retention and in simple constipation it can work. The rest is the logic of the navel as a gate into the abdomen, which it is not. The third entry's patient — clouded and senseless from a bound stool at its extremity — is faecal impaction with delirium in the old, and that it is real is why the section exists.

Hoechun 回春

2.60 The Stool-Guiding Method 導便法

2.60.1

Source원문

諸大便不通, 老人ㆍ虛人不可用藥者: 用蜜熬, 入皂角末少許, 捻作錠子, 納肛門, 卽通. 《丹心》

Translation영역

For all cases of the stool not passing, in the old and the depleted to whom medicines cannot be given: boil honey down, put in a little powdered soap-pod, roll it into a cone and introduce it into the anus, and it passes at once.

Dansim 丹心

2.60.2

Source원문

蜜煎導法: 取蜜七合, 微火煎如飴, 捻作錠如棗核㨾, 納糓道中, 用手按住, 欲大便時去之. 《仲景》

Translation영역

The honey-decoction guiding method: take seven hop of honey, decoct it over a low fire to the consistency of malt syrup, roll it into a cone shaped like a jujube stone, introduce it into the grain passage and hold it in place with the hand, removing it when the wish to pass stool comes.

Junggyeong 仲景

2.60.3

Source원문

治大便不通: 取大猪膽一箇, 瀉汁和醋少許, 灌入糓道中, 須臾大便自通. 《仲景》

Translation영역

For the stool not passing: take one large pig's gallbladder, pour out the bile, mix a little vinegar with it, and instil it into the grain passage; in a short while the stool passes of itself.

Junggyeong 仲景

2.60.4

Source원문

蜜兊法治大便不通: 蜜三合, 入猪膽汁兩枚, 煎如飴, 候凝, 捻作小指頭大, 沉冷水中, 取納肛門, 立通. 一方入皂角末和勻作錠尤好, 入薄荷末亦佳. 《得效》

Translation영역

The honey-plug method treats the stool not passing: three hop of honey with the bile of two pig gallbladders put in, decocted to the consistency of malt syrup; when it has set, roll it to the size of a little finger's end, sink it in cold water, and take it and introduce it into the anus — it passes at once. One version adds powdered soap-pod mixed in to make the cone, which is better still, and powdered mint added is also good.

Deukhyo 得效

2.60.5

Source원문

熏方治大便不通: 皂角用椀燒, 置桶內, 熏下部, 自通. 《得效》

Translation영역

The fumigation method treats the stool not passing: burn soap-pod in a bowl, set it inside a tub, and fume the lower part, and it passes of itself.

Deukhyo 得效

2.60.6

Source원문

蜜導法: 火煉蜜稠厚黃色, 傾入冷水中, 急捻如指大, 隨用皂角末ㆍ麝香共爲衣, 將油塗抹大腸內, 納入糓道, 大便卽通. 《回春》

Translation영역

The honey-guiding method: boil honey over the fire until it is thick and yellow, pour it into cold water, roll it quickly to the size of a finger, then coat it with powdered soap-pod and musk together, smear oil within the large intestine, introduce it into the grain passage, and the stool passes at once.

Hoechun 回春

2.60.7

Source원문

猪膽汁導法: 猪膽一箇, 傾去汁少許, 入醋在內, 用竹管相接, 套入糓道中, 以手指撚之, 令膽汁直射入內, 少時卽通. 《回春》

Translation영역

The pig-bile guiding method: take one pig's gallbladder, pour off a little of the bile, put vinegar in, join a bamboo tube to it, fit it into the grain passage, and squeeze it with the fingers so that the bile shoots straight in; in a little while it passes.

Hoechun 回春

2.60.8

Source원문

香油導法: 用竹管蘸葱汁, 深入大腸內, 以香油一半ㆍ溫水一半同入猪尿脬內, 撚入竹管, 將病人倒放, 脚向上, 半時立通. 《回春》

Translation영역

The sesame-oil guiding method: dip a bamboo tube in scallion juice and pass it deep within the large intestine; put half sesame oil and half warm water together into a pig's bladder, squeeze it into the bamboo tube, lay the patient upside down with the legs upward, and in half an hour it passes at once.

Hoechun 回春

2.60.9

Source원문

大便不通多日, 百方不效: 令人口含香油, 以小竹筒一箇套入肛門, 吹油入肛內, 病者自覺其油如蚯蚓漸漸上行, 片時下黑糞而安. 《正傳》

Translation영역

Where the stool has not passed for many days and a hundred prescriptions have failed: have someone hold sesame oil in the mouth, fit a small bamboo tube into the anus, and blow the oil in; the patient feels the oil creeping gradually upward like an earthworm, and in a little while black stool comes down and he is at ease.

Jeongjeon 正傳

2.60.10

Source원문

俗方: 以淸醬ㆍ香油相和, 灌肛內卽通; 或以生䓀莄浸油醬, 挿入肛內亦通. ○蜜導非皂角則不通. 《入門》

Translation영역

A vernacular formula: clear soy sauce and sesame oil mixed together and instilled into the anus — it passes at once; or raw platycodon root steeped in oil and soy and inserted into the anus also makes it pass. A honey plug will not work without soap-pod.

Clinical note임상 주석

The most purely practical section in the chapter and the one that has aged best. These are suppositories and enemas, described with enough precision to be reproduced: honey boiled to a hard syrup, dropped into cold water, rolled to the size of a finger and coated with soap-pod — which is a glycerine suppository with a surfactant on it, and glycerine suppositories remain standard treatment. The pig's bladder squeezed through a bamboo tube with oil and warm water in it is an enema, delivered with a bag and a catheter; laying the patient head-down to help it travel is good technique. Pig bile with vinegar is a hypertonic and irritant instillation, and it comes from the Shanghanlun. The vernacular formula at the end is Korean, and the Immun's closing remark is the kind of detail only use teaches: a honey plug will not work without soap-pod, because honey alone dissolves without irritating. Every method here is given for the old and the depleted to whom medicines cannot be given, which is the right indication for all of them.

Sokbang 俗方 · Immun 入門

2.61 Simple Medicinals 單方

2.61.1

Source원문

硫黃治冷瀉ㆍ暴瀉, 所下如水. 硫黃ㆍ滑石等分爲末, 溫水調下三錢, 立止. 《得效》

Translation영역

Sulphur (硫黃): Treats cold diarrhoea and sudden diarrhoea where what descends is like water. Sulphur and talc in equal parts, powdered; 3 don stirred into warm water stops it at once.

Clinical note임상 주석

The section opens with the chapter's most violent pair. Sulphur is hot and acrid and sulphur with talc is a strange combination — one of the hottest drugs with one of the coldest — but the pairing is deliberate: the sulphur warms the cold that is driving the diarrhoea while the talc carries the water out through the urine, which is the standing strategy of 利小便以實大便, freeing the urine to firm the stool. The indication is precise and worth keeping: a cold, sudden, purely watery stool, not a hot or bloody one.

Deukhyo 得效

2.61.2

Source원문

焰硝治關格, 大小便不通. 蜜一鍾, 硝二錢, 白湯一鍾, 空心調服, 卽通. 《回春》

Translation영역

Saltpetre (焰硝): Treats barrier and obstruction with stool and urine both blocked. Honey 1 jong, saltpetre 2 don, plain hot water 1 jong; stir together and take on an empty stomach, and it passes at once.

Hoechun 回春

2.61.3

Source원문

好黃土 治泄痢赤白, 腹痛下血. 好黃土, 水煮三五沸, 去滓, 煖服一二升. 《本草》

Translation영역

Good yellow earth (好黃土): Treats red and white diarrhoea and dysentery with abdominal pain and blood descending. Boil good yellow earth in water to three or five bubblings, strain off the dregs, and take 1 to 2 seung warm.

Clinical note임상 주석

Clay taken internally for diarrhoea is not as odd as it looks. Kaolin preparations were standard antidiarrhoeal medicine into the late twentieth century, and the adsorptive action is real. The dose here is large — a seung or two of the decanted water, not of the earth — and the specification 好, good earth, means clean subsoil rather than surface dirt.

Boncho 本草

2.61.4

Source원문

百草霜 治暴瀉痢. 取細末二錢, 米飮調下. 《本草》 ○久瀉不止, 百草霜末, 粥丸, 白湯呑下. 《綱目》

Translation영역

Stove soot (百草霜): Treats sudden diarrhoea and dysentery. Take 2 don of the fine powder stirred into rice water. ○ For a long diarrhoea that will not stop: powdered stove soot made into pills with gruel and swallowed down with plain hot water.

Boncho 本草 · Gangmok 綱目

2.61.5

Source원문

蒼朮治傷濕泄瀉. 或白茯苓, 或合芍藥, 每五錢水煎服之. 若傷風泄瀉, 合防風水煎服之. 《湯液》

Translation영역

Black atractylodes (蒼朮): Treats diarrhoea from damage by damp. Either with poria or combined with peony, 5 don each time decocted in water and taken. If the diarrhoea is from damage by wind, combine it with saposhnikovia, decoct in water and take.

Clinical note임상 주석

Two drugs for two aetiologies, and the distinction is the chapter's working one: damp damage gets atractylodes paired with a drug that drains water, wind damage gets it paired with a drug that releases the exterior. The same herb, a different partner, and the partner carries the diagnosis.

Tangaek 湯液

2.61.6

Source원문

白朮治一切泄瀉. 煎服ㆍ末服ㆍ丸服幷佳. 或合白芍藥ㆍ白茯苓同煎服, 止泄尤佳. 《湯液》

Translation영역

White atractylodes (白朮): Treats every kind of diarrhoea. Decocted, powdered or pilled, all are good. Or combine it with white peony and white poria and decoct together; for stopping diarrhoea this is better still.

Tangaek 湯液

2.61.7

Source원문

車前草 治熱泄. 取莖葉擣取汁一盞, 入蜜一合, 溫分二服. 《本草》

Translation영역

Plantain herb (車前草): Treats hot diarrhoea. Take the stems and leaves, pound them and take 1 jan of the juice, add 1 hop of honey, warm it and take in two doses.

Boncho 本草

2.61.8

Source원문

車前子 治一切泄瀉. 炒爲末, 空心取二錢, 米飮調下, 最妙. 或水煎服亦良. 《得效》

Translation영역

Plantago seed (車前子): Treats every kind of diarrhoea. Stir-fry and powder it; take 2 don on an empty stomach stirred into rice water — this is most excellent. Decocted in water and taken it is also good.

Clinical note임상 주석

Plantago seed is a urinary drug, and that is exactly why it is here. It works on diarrhoea by the same 利小便以實大便 route as the talc above: it does not astringe the bowel, it moves the water out by the other road. This makes it useful where astringents are contraindicated — in a damp-heat diarrhoea that should not be bound up.

Deukhyo 得效

2.61.9

Source원문

木香治諸泄瀉ㆍ痢疾皆佳. 煎服ㆍ末服幷良. 或合黃連爲丸, 治赤白諸痢甚佳. 《本草》

Translation영역

Costus root (木香): Good for all diarrhoeas and dysenteries alike. Decocted or powdered, both are fine. Or combine it with coptis and make pills; for treating the red and white dysenteries it is very good.

Clinical note임상 주석

Costus root with coptis is 香連丸, named in the chapter above and still the most-used two-drug pair in dysentery: the coptis for the heat and the costus for the tenesmus. That the Bogam lists the pair under a single-drug heading shows how thoroughly the two had fused into one medicine.

Boncho 本草

2.61.10

Source원문

白芍藥 治泄瀉ㆍ痢疾, 煎服ㆍ末服ㆍ丸服皆佳. 酸收甘緩, 下痢必思之藥也. 《湯液》

Translation영역

White peony (白芍藥): Treats diarrhoea and dysentery; decocted, powdered or pilled, all are good. Sour, it gathers in; sweet, it relaxes — in dysentery it is the medicine one is bound to think of.

Clinical note임상 주석

酸收甘緩 is the whole of peony's pharmacology in four characters, and in dysentery both halves are wanted at once: the sourness gathers in a bowel that is pouring out, the sweetness relaxes a gut in spasm. The second is the part that matters clinically — tenesmus is cramp, and peony with licorice is still the pair given for it.

Tangaek 湯液

2.61.11

Source원문

黃連治赤白痢腹痛, 或下膿血. 黃連三錢, 酒煮服. 或爲末, 雞子白和丸服, 幷佳. 黃連治痢, 蓋以苦燥之義. 若熱痢ㆍ血痢則佳, 冷痢則不可用. 《本草》

Translation영역

Coptis (黃連): Treats red and white dysentery with abdominal pain, or pus and blood descending. Coptis 3 don boiled in wine and taken; or powdered, made into pills with egg white and taken — both are good. That coptis treats dysentery is on the principle of bitterness drying. For a hot dysentery or a bloody dysentery it is good; for a cold dysentery it must not be used.

Clinical note임상 주석

The caution at the end is the single most important line in this section. Coptis is the reflex drug for dysentery and the entry says plainly that in a cold dysentery it must not be used — the same warning the chapter gives at length above and the one most often ignored, because a bloody stool looks hot whatever is driving it. The distinguishing signs are the ones the chapter sets out: thirst and a scanty dark urine with heat, a pale tongue and a craving for warmth with cold.

Boncho 本草

2.61.12

Source원문

乾薑主冷泄ㆍ冷痢, 煎服ㆍ末服幷佳. 若血痢則燒存性爲末, 每一錢米飮調下. 《本草》

Translation영역

Dried ginger (乾薑): Governs cold diarrhoea and cold dysentery; decocted or powdered, both are good. If it is a bloody dysentery, burn it with its nature retained, powder it, and take 1 don each time stirred into rice water.

Clinical note임상 주석

Dried ginger is the counterpart to the coptis above, and the pair of entries read as one instruction: coptis for the hot dysentery, ginger for the cold one. The charring in the second method is the standard manoeuvre for turning a warming drug into a haemostatic; burning 存性, with the nature retained, means charred through but not reduced to ash.

Boncho 本草

2.61.13

Source원문

土瓜根 治大便不通. 擣取汁, 以竹管吹入肛內, 卽通. 《綱目》

Translation영역

Snake gourd root (土瓜根): Treats stool that will not pass. Pound it and take the juice; blow it into the anus through a bamboo tube, and it passes at once.

Clinical note임상 주석

One of the chapter's several enemas, and the simplest — an irritant juice instilled per rectum through a tube. The method is the same as the pig's-bladder enema of the Guide-the-Stool Method above, with a reed for apparatus.

Gangmok 綱目

2.61.14

Source원문

馬藺子 治水痢. 熬黃爲末, 同白麵等分, 米飮下二錢. 《本草》

Translation영역

Iris seed (馬藺子): Treats watery dysentery. Parch it yellow and powder it with an equal part of white wheat flour; take 2 don down with rice water.

Boncho 本草

2.61.15

Source원문

萱草根 治大便不通. 取一握, 同生薑擣取汁服之, 立通. 《綱目》

Translation영역

Daylily root (萱草根): Treats stool that will not pass. Take a handful, pound it together with fresh ginger, and drink the juice; it passes at once.

Gangmok 綱目

2.61.16

Source원문

黃芩主腸澼ㆍ赤白痢, 腹痛身熱. 與芍藥同用, 煎服ㆍ丸服ㆍ末服幷佳. 《湯液》

Translation영역

Scutellaria (黃芩): Governs intestinal flux and red and white dysentery with abdominal pain and generalized heat. Used together with peony; decocted, pilled or powdered, all are good.

Clinical note임상 주석

Scutellaria with peony is 黃芩芍藥湯 in everything but name, and the indication given — dysentery with abdominal pain and fever — is that formula's indication exactly. The Bogam gives the pair here as a single-drug entry because the combination was too familiar to need a formula heading.

Tangaek 湯液

2.61.17

Source원문

艾葉主赤白痢及膿血痢. 醋煎, 空心服之. 《本草》

Translation영역

Mugwort leaf (艾葉): Governs red and white dysentery and pus-and-blood dysentery. Decoct in vinegar and take on an empty stomach.

Boncho 本草

2.61.18

Source원문

地楡治痢. 性沉寒, 入下焦. 赤白痢及膿血痢, 水煎空心服三合. 如水瀉及白痢, 不可用. 《本草》

Translation영역

Burnet root (地楡): Treats dysentery. Its nature is sinking and cold and it enters the lower burner. For red and white dysentery and pus-and-blood dysentery, decoct in water and take 3 hop on an empty stomach. In a watery diarrhoea, or a white dysentery, it must not be used.

Clinical note임상 주석

Sanguisorba is the chapter's drug for a bloody stool from the lower burner, and like the coptis above it comes with its contraindication attached. The exclusion is narrower and more useful than coptis's: not a watery diarrhoea, and not a white dysentery — that is, not where there is no blood to cool.

Boncho 本草

2.61.19

Source원문

肉豆蔲 主泄瀉. 如暴水泄不止, 取二箇, 麵裹煨, 爲末, 作一服, 米飮調下, 神效. 若冷痢腹痛不能食, 取末一錢, 米飮下. 《綱目》

Translation영역

Nutmeg (肉豆蔲): Governs diarrhoea. Where a sudden watery diarrhoea will not stop: take two nuts, wrap them in wheat-flour dough and roast them in the embers, powder them, make up one dose and take it stirred into rice water — miraculously effective. If it is a cold dysentery with abdominal pain and an inability to eat: take 1 don of the powder down with rice water.

Clinical note임상 주석

麵裹煨, wrapped in dough and roasted in the embers, is nutmeg's standard preparation and it has a purpose: the volatile oil is what irritates the stomach, and roasting inside a flour case drives off the lighter fraction without scorching the nut. Nutmeg is the section's warming astringent, and both indications here are cold ones.

Gangmok 綱目

2.61.20

Source원문

縮砂治冷泄及休息痢. 取末一錢, 空心米飮調下. 《丹心》

Translation영역

Amomum (縮砂): Treats cold diarrhoea and intermittent dysentery. Take 1 don of the powder on an empty stomach stirred into rice water.

Dansim 丹心

2.61.21

Source원문

大黃通利大小便, 又治熱痢下膿血. 欲通大便, 水煎服. 熱痢, 酒煎服之. 《綱目》

Translation영역

Rhubarb (大黃): Frees the stool and the urine, and also treats a hot dysentery with pus and blood descending. To free the stool, decoct in water and take. For a hot dysentery, decoct in wine and take.

Clinical note임상 주석

The two vehicles are not interchangeable. Decocted in water, rhubarb purges downward; decocted in wine, it is carried outward and upward to the blood, which is why the hot dysentery with pus and blood gets the wine. The same principle runs through the whole corpus — 酒製升提, wine preparation raises and lifts — and rhubarb is where it is most often applied.

Gangmok 綱目

2.61.22

Source원문

黑牽牛子 通利大小便. 如大便不通, 半生半炒爲末, 每二錢薑湯調下. 如未通, 再以熱茶淸調下. ○風秘結澁, 微炒爲末一兩, 麩炒桃仁末五錢, 蜜丸梧子大, 溫水下三十丸. 《本草》

Translation영역

Black morning glory seed (黑牽牛子): Frees the stool and the urine. Where the stool will not pass: half raw and half stir-fried, powdered, 2 don each time stirred into ginger decoction. If it still does not pass, take it again stirred into hot clear tea. ○ For a wind constipation, bound and rough: lightly stir-fried and powdered, 1 nyang, with bran-fried peach kernel powder 5 don, made into honey pills the size of a paulownia seed; 30 pills down with warm water.

Clinical note임상 주석

半生半炒, half raw and half stir-fried, is the standard dodge for a drug whose raw form purges too hard and whose roasted form purges too little: the mixture gives a usable middle. The second method, with peach kernel in honey pills, is the gentler one and is aimed at the 風秘 of the chapter above — a dry, bound stool in an old or depleted patient where a single hard purge would do harm.

Boncho 本草

2.61.23

Source원문

萹蓄主大小便不通. 開紫花ㆍ水邊生者爲佳. 採根擣取汁一盞服之, 得通卽止. 《綱目》

Translation영역

Knotweed (萹蓄): Governs stool and urine that will not pass. The kind that opens purple flowers and grows at the water's edge is the good one. Gather the root, pound it, take 1 jan of the juice and drink it; once it passes, stop.

Clinical note임상 주석

得通卽止 — once it passes, stop — is the instruction that turns a purgative into a safe one, and it is given here rather than with the rhubarb because knotweed is mild enough that a prescriber might keep going. The note on which plant to gather is the kind of detail that only field use produces.

Gangmok 綱目

2.61.24

Source원문

楡白皮 主大小便不通. 水煎空心服. 《本草》

Translation영역

Elm bark (楡白皮): Governs stool and urine that will not pass. Decoct in water and take on an empty stomach.

Clinical note임상 주석

Slippery elm is pure mucilage, and it acts as a lubricant rather than a purgative — the bulk-and-slip laxative of the section, alongside the hemp seed and sesame oil further down. It is the safest thing in the list for the old and the dry.

Boncho 本草

2.61.25

Source원문

檳榔通利大小便, 又治大便不通. 取細末二錢, 空心蜜水下. 《綱目》

Translation영역

Areca seed (檳榔): Frees the stool and the urine, and also treats a stool that will not pass. Take 2 don of the fine powder on an empty stomach, down with honey water.

Gangmok 綱目

2.61.26

Source원문

五倍子 治腸虛泄瀉. 取爲末, 以白湯調二錢服, 立止. 《本草》

Translation영역

Chinese gall (五倍子): Treats a diarrhoea from an empty intestine. Take it powdered, 2 don stirred into plain hot water, and it stops at once.

Clinical note임상 주석

Gallnut is about half tannic acid by weight, the most astringent thing in the Korean materia medica, and 立止, it stops at once, is not an exaggeration. The indication is strictly 腸虛 — an empty, slack bowel. Given in a dysentery with heat and pus still to come out, an astringent this strong shuts the problem in.

Boncho 本草

2.61.27

Source원문

訶子皮 主泄瀉及赤白諸痢. 訶子三箇, 兩枚炮ㆍ一枚生用, 同爲末, 溫水和服. ○氣痢ㆍ久痢, 煨取皮爲末二錢, 和米飮頓服. 《本草》

Translation영역

Chebula rind (訶子皮): Governs diarrhoea and the red and white dysenteries. Chebula, three fruits — two of them blast-roasted and one used raw — powdered together and taken mixed with warm water. ○ For a qi dysentery or a long-standing dysentery: roast it in the embers, take the rind, powder it, and take 2 don mixed with rice water at one draught.

Clinical note임상 주석

Two roasted and one raw, in one powder, and the proportion carries the whole therapeutic idea: roasting makes chebula astringent, raw it still moves, so the mixture holds the bowel without closing it. This is the same solution as the half-raw-half-fried morning glory seed above, reached from the opposite direction.

Boncho 本草

2.61.28

Source원문

樗根白皮 主赤白痢及久痢腸滑不禁. 取皮一握ㆍ陳米一合ㆍ葱白三莖ㆍ甘草三寸ㆍ豉二合, 水煎空心頓服. 血痢尤神效. 爲末作丸, 名固腸丸. 《本草》

Translation영역

Ailanthus root bark (樗根白皮): Governs red and white dysentery, and a long dysentery with the intestine slippery and no holding. Take the bark, a handful; aged rice, 1 hop; scallion white, three stalks; licorice, three chon; fermented soybean, 2 hop; decoct in water and take at one draught on an empty stomach. For a bloody dysentery it is especially miraculous. Powdered and made into pills it is called Gojang-hwan 固腸丸, Firm the Intestine Pill.

Clinical note임상 주석

Not really a simple at all — five ingredients, and three of them food. Ailanthus bark is the active drug, strongly astringent and bitter, and it survives in modern Korean practice for chronic diarrhoea and for discharge. The rice, scallion and fermented soybean are there to make a bitter bark tolerable to a patient who has been losing stool for weeks.

Boncho 本草

2.61.29

Source원문

橡實澁腸止泄瀉. 作細末, 和米飮常服. 《本草》

Translation영역

Acorn (橡實): Astringes the intestine and stops diarrhoea. Make a fine powder and take it regularly mixed with rice water.

Clinical note임상 주석

常服, taken regularly, marks this out from the rest of the section: acorn flour is a famine food as much as a medicine, and in Korea it still is. For a long slack diarrhoea it was something a household could eat every day. Korean cooking still makes acorn jelly, dotorimuk, from the same flour.

Boncho 本草

2.61.30

Source원문

槿花主赤白痢. 作末和米飮服, 或和麵作煎餠食之. 《本草》

Translation영역

Rose of Sharon flower (槿花): Governs red and white dysentery. Powder it and take with rice water, or mix it with wheat flour, make pancakes and eat them.

Boncho 本草

2.61.31

Source원문

蜜治痢爲最. 蜜與薑汁各一合, 溫水和頓服. 《本草》

Translation영역

Honey (蜜): For treating dysentery it is the best. Honey and ginger juice, 1 hop each, mixed with warm water and taken at one draught.

Clinical note임상 주석

治痢爲最, the best thing for dysentery, is a strong claim for honey and it belongs to a particular case: honey is a demulcent and a mild laxative, so it suits the dysentery that is tenesmus and straining without much to pass. Honey with ginger juice is also a household remedy that survives in Korea unchanged.

Boncho 本草

2.61.32

Source원문

蠟主下痢膿血. 黃蠟不拘多少, 用銀篦挑於香油燈上燒, 熏落下水椀內, 如此七次, 爲丸蘿葍子大. 每三十丸, 白痢甘草湯下, 赤痢烏梅湯下. 《綱目》

Translation영역

Beeswax (蠟): Governs a dysentery descending with pus and blood. Yellow beeswax, any amount; lift it on a silver spatula and burn it over a sesame-oil lamp, letting the drippings fall into a bowl of water, and do this seven times; make pills the size of a radish seed. Thirty pills each time — for a white dysentery down with licorice decoction, for a red dysentery with mume plum decoction.

Clinical note임상 주석

A laborious preparation with an obvious physical purpose: seven passes through flame and water leave a hard, water-quenched wax that will not melt or dissolve in the stomach, so the pills reach the intestine intact. Wax coats and protects an ulcerated bowel, and the two vehicles carry the diagnosis — licorice for the white, mume plum for the red.

Gangmok 綱目

2.61.33

Source원문

牡蠣粉 止大小便, 治遺尿不覺. 牡蠣粉ㆍ白礬枯, 等分爲末, 酒服二錢, 日三. 亦治遺尿. 《綱目》

Translation영역

Oyster shell powder (牡蠣粉): Checks the stool and the urine, and treats incontinence of urine that goes unnoticed. Oyster shell powder and alum, calcined, in equal parts, powdered; 2 don taken in wine, three times a day. It also treats dribbling urine.

Gangmok 綱目

2.61.34

Source원문

鱉治痢後脫肛. ○一人患痢月餘, 糟粕不實, 晝夜五六次, 又脫肛. 取鱉一箇, 治如食法, 用生薑ㆍ米糒作羹, 入砂糖一小塊, 不用鹽醬, 熟煮喫一二椀, 三日而愈. 蓋鱉乃介虫, 屬金而補肺與大腸, 故有效焉. 《正傳》

Translation영역

Soft-shelled turtle (鱉): Treats prolapse of the rectum after dysentery. ○ A man had suffered from dysentery for more than a month, the dregs unformed, five or six times by day and night, and the rectum had prolapsed as well. A soft-shelled turtle was taken and dressed as for food, made into a soup with fresh ginger and parched rice, a small lump of sugar added and no salt or soy used; he ate one or two bowls of it well boiled, and in three days he was well. For the turtle is a shelled creature, belonging to metal, and so it supplements the lung and the large intestine — hence its effect.

Clinical note임상 주석

One of the few case histories in any 單方 section, and worth reading closely. The patient has a month of unformed stool five or six times a night with a prolapsed rectum, which is a picture of exhaustion rather than of anything to be driven out, and the treatment is food: a rich soup, sweetened, deliberately unsalted. The reasoning offered — shell, metal, lung and large intestine — is five-phase bookkeeping applied after the fact, and the fact it is applied to is that a severely depleted patient recovered on three days of protein.

Jeongjeon 正傳

2.61.35

Source원문

鮒魚膾 主久赤白痢ㆍ腸澼. 和醋醬蒜虀食之. 《本草》 ○血痢及噤口痢, 魚肚釀白礬, 燒灰爲末, 米飮調下. 或入白礬蒸熟, 和鹽醋喫, 卽效. 《得效》

Translation영역

Raw crucian carp (鮒魚膾): Governs a long red or white dysentery and intestinal flux. Dress it with vinegar, soy, garlic and pickle, and eat it. ○ For a bloody dysentery or a dysentery with the mouth clenched: stuff the fish's belly with alum, burn it to ash, powder it, and take stirred into rice water. Or put alum in it, steam it through, and eat it dressed with salt and vinegar — it takes effect at once.

Clinical note임상 주석

Raw fish for a month-old dysentery would now be the last thing prescribed, and the entry is a reminder that the tradition's reasoning about 久痢 was nutritional before it was anything else. The second method is on firmer ground: alum is a strong astringent, and charring the stuffed fish leaves an astringent ash with the protein burned off.

Boncho 本草 · Deukhyo 得效

2.61.36

Source원문

露蜂房 療赤白痢, 亦治大小便不通. 取房蔕爲末, 溫酒調一錢服之, 卽效. 一名紫金砂. 《類聚》

Translation영역

Hornet's nest (露蜂房): Cures red and white dysentery, and also treats stool and urine that will not pass. Take the stalk of the nest, powder it, and take 1 don stirred into warm wine — it takes effect at once. It is also called Jageum-sa 紫金砂, purple gold sand.

Yuchwi 類聚

2.61.37

Source원문

糞蛆治噤口痢甚效. 取蛆焙爲末, 淸米飮調下一錢. 《正傳》

Translation영역

Dung maggot (糞蛆): Treats a dysentery with the mouth clenched, and is very effective. Take maggots, dry them over a fire, powder them, and take 1 don stirred into clear rice water.

Clinical note임상 주석

噤口痢, the clenched-mouth dysentery — a patient who can no longer take anything by mouth — is the condition in this chapter with the worst prognosis, and it draws the section's strangest remedies: maggots here, lotus seed and black-boned fowl below. The common thread is that all of them are given in the smallest possible bulk, in clear rice water, to someone who will not swallow.

Jeongjeon 正傳

2.61.38

Source원문

蓮子肉 止痢, 又治噤口痢. 去皮留心爲末, 米飮下二錢. 《百一方》

Translation영역

Lotus seed (蓮子肉): Checks dysentery, and also treats a dysentery with the mouth clenched. Remove the skin, keep the heart, powder it, and take 2 don down with rice water.

Clinical note임상 주석

去皮留心 — skin off, heart kept — reverses the usual instruction, since the bitter green plumule is normally discarded as too cold. It is kept here on purpose: the clenched-mouth dysentery is read as heat blocking the stomach above while the bowel pours out below, and the heart of the lotus seed is the part that clears the heart and opens the stomach.

Baegilbang 百一方

2.61.39

Source원문

烏梅澁腸止痢. ○血痢, 白梅肉一箇, 合臘茶加醋湯沃服之, 一啜而差. ○赤痢及久痢, 烏梅水煎和蜜服. ○休息痢, 合建茶ㆍ乾薑爲丸服之, 大驗. 《本草》

Translation영역

Mume plum (烏梅): Astringes the intestine and checks dysentery. ○ For a bloody dysentery: white plum flesh, one piece, with winter tea, vinegar added and hot water poured over it, and taken — a single sip and it is cured. ○ For a red dysentery or a long dysentery: decoct mume plum in water and take it mixed with honey. ○ For an intermittent dysentery: with Jian tea 建茶 and dried ginger, made into pills and taken — greatly proven.

Clinical note임상 주석

Four methods under one heading, and each is a different combination rather than a different dose: plum with tea and vinegar for blood, plum with honey for a long red dysentery, plum with tea and ginger for the dysentery that comes and goes. The sourness is constant; what changes is whether the pairing is cooling, moistening or warming. Mume plum is the one astringent in this section the tradition never warns against, because its sourness gathers in without the binding coldness of gallnut or the heaviness of acorn.

Boncho 本草

2.61.40

Source원문

桃花利大小便. 花落時拾取陰乾爲末, 水調服, 或作煎餠喫. 治大小便不通, 卽效. 《子和方》

Translation영역

Peach blossom (桃花): Frees the stool and the urine. When the flowers fall, gather them, dry them in the shade and powder them; take stirred into water, or make pancakes and eat them. It treats stool and urine that will not pass, and takes effect at once.

Jahwabang 子和方

2.61.41

Source원문

桃葉主大小便不通. 擣取汁服半升, 卽通. 《本草》

Translation영역

Peach leaf (桃葉): Governs stool and urine that will not pass. Pound it, drink half a seung of the juice, and it passes at once.

Boncho 本草

2.61.42

Source원문

桃仁治大便血結ㆍ血秘ㆍ血燥秘澁不通. 硏取汁作粥服之. 《湯液》

Translation영역

Peach kernel (桃仁): Treats a stool bound by blood, a blood constipation, and a dry-blood constipation, bound and rough and not passing. Grind it, take the juice, make a gruel and take it.

Clinical note임상 주석

Peach flower, leaf and kernel appear in three consecutive entries and they are not interchangeable. The flower and leaf are given as straightforward purgatives; the kernel is given specifically for the blood constipation — a dry, bound stool where the problem is read as blood no longer moistening rather than as heat or wind. That distinction is carried over into the formulas: peach kernel is in 當歸潤燥湯 and in the honey-pill method under black morning glory seed above, and in both it is doing the same work.

Tangaek 湯液

2.61.43

Source원문

酸石榴殼 止赤白痢. 燒赤爲末, 米飮下二錢. 亦治暴瀉不止. ○冷熱不調, 或下赤白靑黃者, 石榴五枚, 合殼杵絞取汁, 每取一合數服, 卽斷. 或取殼爲末, 飯丸服亦得. 《本草》

Translation영역

Sour pomegranate rind (酸石榴殼): Checks red and white dysentery. Burn it red, powder it, and take 2 don down with rice water. It also treats a sudden diarrhoea that will not stop. ○ Where cold and heat are out of order, or where what descends is red, white, blue-green or yellow: pomegranate, five fruits, pounded rind and all and the juice pressed out; take 1 hop at a time for several doses and it is cut off at once. Or take the rind, powder it, and make pills with cooked rice — this also serves.

Clinical note임상 주석

赤白靑黃, a stool of four colours, is the chapter's shorthand for a dysentery no single pattern accounts for, and the answer offered is an astringent given regardless of pattern. Pomegranate rind is heavily tannic and the indication 冷熱不調 — cold and heat out of order — is as close as the tradition comes to saying that the diagnosis cannot be made and the bleeding must simply be stopped.

Boncho 本草

2.61.44

Source원문

大麻仁 治大小便不通及風秘ㆍ熱秘ㆍ血秘. 硏取汁作粥食之. 或與蘇子取汁作粥, 名蘇麻粥. 《本草》

Translation영역

Hemp seed (大麻仁): Treats stool and urine that will not pass, and wind constipation, heat constipation and blood constipation. Grind it, take the juice, make a gruel and eat it. Or take the juice together with perilla seed and make a gruel — this is called Soma-juk 蘇麻粥, Perilla and Hemp Gruel.

Clinical note임상 주석

The gentlest of the chapter's answers to constipation and the one still most used. Hemp seed is oily and bulky and works mechanically, so it covers all three of the named constipations without having to distinguish them. 蘇麻粥 is food, not medicine — a gruel of two oily seeds — and that is exactly why the Bogam gives it for the old, the pregnant and the postpartum, where a purgative is not safe.

Boncho 本草

2.61.45

Source원문

生脂麻油 治熱秘大便不通. 每服一合, 取利爲度. 《本草》

Translation영역

Raw sesame oil (生脂麻油): Treats a heat constipation with the stool not passing. Take 1 hop each dose, taking the passing of stool as the measure.

Clinical note임상 주석

取利爲度, take the passing as the measure, means to go on dosing until the bowel moves and then stop — the same self-limiting instruction as 得通卽止 under knotweed. A hop of raw oil is a large dose and it works as a lubricant, which is why it can be titrated this way without the risk a purgative would carry.

Boncho 本草

2.61.46

Source원문

赤小豆 止泄痢. 作粥食之. ○赤白痢, 作粥和蠟一兩頓服差. 《本草》

Translation영역

Adzuki bean (赤小豆): Checks diarrhoea and dysentery. Make a gruel and eat it. ○ For red and white dysentery: make the gruel, mix in 1 nyang of beeswax and take at one draught — it cures.

Boncho 本草

2.61.47

Source원문

糯米止泄瀉. 半生半炒, 煮粥食甚效. 《醫鑑》

Translation영역

Glutinous rice (糯米): Checks diarrhoea. Half raw and half stir-fried, boiled into a gruel and eaten, it is very effective.

Uigam 醫鑑

2.61.48

Source원문

神麴止泄痢. 熬爲末, 粟米飮調下二錢, 日三. 《本草》 ○暑時暴泄, 神麴炒ㆍ蒼朮製等分爲末, 麵糊和丸梧子大, 米飮下三十丸, 名麴朮丸. 《綱目》

Translation영역

Medicated leaven (神麴): Checks diarrhoea and dysentery. Parch it, powder it, and take 2 don stirred into millet water, three times a day. ○ For a sudden diarrhoea in the hot season: medicated leaven, stir-fried, and black atractylodes, processed, in equal parts, powdered and made into pills the size of a paulownia seed with wheat-flour paste; 30 pills down with rice water. This is called Gukchul-hwan 麴朮丸, Leaven and Atractylodes Pill.

Clinical note임상 주석

暑時暴泄 — the sudden summer diarrhoea — is the one indication in this section that names a season, and the two-drug answer to it is sound: leaven for the food that will not move, atractylodes for the damp. This is the simples section's version of the 平胃散 strategy, and 麴朮丸 is small enough to keep made up through the hot months.

Boncho 本草 · Gangmok 綱目

2.61.49

Source원문

鸎粟殼 主一切痢. 若日久腹中無痛, 當澁腸, 則去瓤蔕, 醋炒爲末, 米飮調一錢服. 《直指》 ○此物治痢如神, 但用早則性緊澁, 多令人嘔逆, 或成噤口痢. 《綱目》 ○久痢虛滑, 一日百行, 取殼薑汁浸一宿, 炒乾爲末, 每二錢米飮調下, 卽效, 名百中散. 《入門》

Translation영역

Opium poppy capsule (鸎粟殼): Governs every kind of dysentery. If it has gone on for days with no pain in the abdomen, then the intestine ought to be astringed: remove the pith and the stalk, stir-fry in vinegar, powder, and take 1 don stirred into rice water. ○ This substance treats dysentery as if by a spirit; but used early, its nature is binding and rough, and it often makes the patient retch, or brings on the clenched-mouth dysentery. ○ For a long dysentery, empty and slippery, a hundred movements in a day: take the capsules, steep them in ginger juice for a night, stir-fry them dry, powder them, and take 2 don each time stirred into rice water — it takes effect at once. This is called Baekjung-san 百中散, Hundred Hits Powder.

Clinical note임상 주석

Poppy capsule is the most effective thing in this section and the entry says so twice over, 治痢如神, while spending most of its length on when not to give it. The two conditions are explicit: the pain must be gone, and the illness must be old. Given early, while there is still pain and still something to come out, it binds the bowel shut and produces exactly the clenched-mouth dysentery that the section's worst remedies are for. This is opium — the alkaloids are in the capsule wall — and the clinical picture of nausea, vomiting and ileus from an opiate given into an acute infective colitis is recognisable in the warning. The drug is a controlled narcotic and is not prescribed from this text; the entry is translated here as a record of what the Bogam taught.

Jikji 直指 · Gangmok 綱目 · Immun 入門

2.61.50

Source원문

冬葵子 治大小便不通, 腹滿欲死. 取二升, 水四升, 煮取一升, 入猪脂一合調服, 卽通. 《本草》

Translation영역

Mallow seed (冬葵子): Treats stool and urine that will not pass, with the abdomen full and the patient at the point of death. Take 2 seung, boil in 4 seung of water down to 1 seung, stir in 1 hop of lard, and take; it passes at once.

Clinical note임상 주석

腹滿欲死 is an obstructed bowel, and the dose matches the emergency — 2 seung of seed reduced to a seung of mucilaginous liquid, with a hop of lard stirred in. Mallow seed and pig fat together are a bulk lubricant given in quantity, which is the only kind of purgative that is safe in an abdomen already distended.

Boncho 本草

2.61.51

Source원문

雞腸草 主小兒赤白痢. 取汁一合, 和蜜服之良. 《本草》

Translation영역

Chickweed (雞腸草): Governs red and white dysentery in children. Take 1 hop of the juice mixed with honey — it is good.

Boncho 本草

2.61.52

Source원문

薺菜主赤白痢. 取根葉燒灰爲末, 和米飮服, 極效. 《本草》

Translation영역

Shepherd's purse (薺菜): Governs red and white dysentery. Take the root and leaves, burn them to ash, powder them and take mixed with rice water — extremely effective.

Boncho 本草

2.61.53

Source원문

葱白治大小腸不通. 取白擣爛, 和醋封小腹上, 卽效. ○赤白痢, 葱白一握, 細切和米煮粥食之. 《本草》

Translation영역

Scallion white (葱白): Treats the large and small intestine not passing. Take the white, pound it to a mash, mix it with vinegar and seal it over the lower abdomen; it takes effect at once. ○ For red and white dysentery: scallion white, a handful, finely cut, boiled with rice into a gruel and eaten.

Clinical note임상 주석

The first method is external — a pounded scallion and vinegar poultice over the lower abdomen — and it belongs with the 葱熨法 of the Cold Damage chapter rather than with anything swallowed. Warmth and a counter-irritant over the belly for an obstructed bowel is a measure with a long life in domestic practice; what it chiefly does is relieve cramping pain.

Boncho 本草

2.61.54

Source원문

韭菜治諸痢. 如赤痢, 韭汁和酒溫服一盞. 如水糓痢, 作羹粥或煠炒任食之. 白痢則煮食之. 《本草》

Translation영역

Chinese chive (韭菜): Treats all the dysenteries. For a red dysentery, chive juice mixed with wine, 1 jan taken warm. For a water-and-grain dysentery, make a soup or a gruel of it, or scald and fry it, and eat it as you please. For a white dysentery, boil it and eat it.

Boncho 本草

2.61.55

Source원문

薤白止久痢ㆍ冷瀉, 常煮食之. ○赤白痢, 取白和米作粥食之. 《本草》

Translation영역

Chinese chive bulb (薤白): Checks a long dysentery and a cold diarrhoea; boil it and eat it regularly. ○ For red and white dysentery: take the white, make a gruel of it with rice, and eat it.

Boncho 本草

2.61.56

Source원문

獨頭蒜 治大便不通. 取一枚煨熟去皮, 綿裹納下部, 冷則易, 卽通. 《本草》

Translation영역

Single-clove garlic (獨頭蒜): Treats stool that will not pass. Take one clove, roast it in the embers till done and peel it, wrap it in cotton wool and put it into the lower part; when it goes cold, change it, and the stool passes.

Clinical note임상 주석

A garlic suppository, and a sound one. Roasting softens the clove and takes the edge off the allicin; what is left is a warm irritant held against the rectal mucosa, which provokes the reflex the chapter's whole Guide-the-Stool section is aiming at. The cotton wrapping and the instruction to replace it when cold are the kind of practical detail that marks a method actually used.

Boncho 本草

2.61.57

Source원문

馬齒莧 利大小便. 和米糝五味作羹食之. ○赤白痢, 擣取汁三合, 和雞子白一枚, 和勻溫服, 再服卽愈. 或取莧煮熟, 入鹽醬薑醋拌勻食之. ○小兒血痢, 取汁一合, 和蜜一匙服. 《本草》

Translation영역

Purslane (馬齒莧): Frees the stool and the urine. Make a soup of it with rice meal and the five flavours, and eat it. ○ For red and white dysentery: pound it, take 3 hop of the juice, mix it evenly with one egg white and take warm; a second dose and it is cured. Or boil the purslane through and eat it dressed with salt, soy, ginger and vinegar, well mixed. ○ For a bloody dysentery in a child: take 1 hop of the juice mixed with a spoonful of honey.

Clinical note임상 주석

Purslane is one of the few plants in this section that is squarely a vegetable, and the entry treats it as both food and medicine without marking any line between them. Its standing use in East Asian practice is for a damp-heat dysentery, which fits the red-and- white indication here, and the paediatric dose at the end — a hop of juice with honey — is the sort of thing a mother could give without a prescriber.

Boncho 本草

2.61.58

Source원문

白蘿蔔 治久痢. 取汁一鍾, 蜜一鍾, 煎勻溫服, 立止. 《回春》

Translation영역

White radish (白蘿蔔): Treats a long dysentery. Take 1 jong of the juice and 1 jong of honey, boil them together evenly and take warm; it stops at once.

Hoechun 回春

2.61.59

Source원문

亂髮主大小便不通. 燒爲灰, 取一錢, 調溫水, 一日三服. ○赤白痢, 服如上法, 或作丸服. 《本草》

Translation영역

Tangled hair (亂髮): Governs stool and urine that will not pass. Burn it to ash, take 1 don stirred into warm water, three doses a day. ○ For red and white dysentery, take it by the method above, or make pills of it and take them.

Boncho 本草

2.61.60

Source원문

黃雌雞 治赤白久痢. 取一隻, 治如食法, 作羹常食之. ○腸滑下痢, 取一隻, 治如食法, 火灸鹽醋刷之, 又灸令燥, 空腹食之, 名灸雞散. 《本草》

Translation영역

Yellow hen (黃雌雞): Treats a long red or white dysentery. Take one bird, dress it as for food, make a soup of it and eat it regularly. ○ For a slippery intestine with dysentery descending: take one bird, dress it as for food, roast it over the fire brushing it with salt and vinegar, roast it again until dry, and eat it on an empty stomach. This is called Gugye-san 灸雞散, Roast Fowl Powder.

Clinical note임상 주석

The animal entries that close the section are all for the same case — a dysentery that has gone on long enough to waste the patient — and they are all, plainly, feeding. 治如食法, dressed as for food, is repeated in six consecutive entries, and the instruction 常食之, eat it regularly, settles the matter: this is a prescription for nourishment given a formula name.

Boncho 本草

2.61.61

Source원문

雞子治久赤白痢. 醋煮熟, 空心食之. 或取一箇打破, 用蠟一錢熔化拌勻炒食之. 又取黃和胡粉, 燒成末, 酒服一錢. 《本草》

Translation영역

Hen's egg (雞子): Treats a long red or white dysentery. Boil it through in vinegar and eat it on an empty stomach. Or take one, break it, melt 1 don of beeswax into it, mix evenly, fry and eat. Or take the yolk mixed with white lead, burn it to a powder, and take 1 don in wine.

Clinical note임상 주석

**The third method must not be prepared.** 胡粉 is white lead — basic lead carbonate — and a don of it taken in wine is a toxic dose of a cumulative poison with no safe threshold. It appears in the old materia medica as an astringent for a bleeding bowel and the astringency is real, but so is the lead. The first two methods are harmless and are the ones the entry is useful for.

Boncho 本草

2.61.62

Source원문

烏骨雞 治小兒噤口痢. 取一隻, 治如食法, 煮取淸汁, 頻與服之, 痢止胃開. 《省翁》

Translation영역

Black-boned fowl (烏骨雞): Treats the clenched-mouth dysentery in children. Take one bird, dress it as for food, boil it and take the clear broth, giving it frequently; the dysentery stops and the stomach opens.

Clinical note임상 주석

The best entry in the section, and the one that needs least explaining. A child who will not eat and is losing stool is dying of dehydration and starvation, and clear chicken broth given frequently in small amounts is what will save it. 痢止胃開 — the dysentery stops and the stomach opens — names the two things in the right order, and the sequence is correct: feeding restores the appetite, not the other way round.

Seongong 省翁

2.61.63

Source원문

家鴨止痢. 治如食法, 煮爛飮汁食肉, 或作羹食之. 《本草》

Translation영역

Domestic duck (家鴨): Checks dysentery. Dress it as for food, boil it soft, drink the broth and eat the flesh, or make a soup of it and eat.

Boncho 本草

2.61.64

Source원문

雉主久痢腸滑不下食. 治如食法, 着橘椒葱鹽醬調和, 作餛飩食之. 《本草》

Translation영역

Pheasant (雉): Governs a long dysentery with a slippery intestine and no food going down. Dress it as for food, season it with tangerine peel, pepper, scallion, salt and soy, make dumplings of it and eat them.

Clinical note임상 주석

餛飩, wontons — the pheasant is minced, seasoned and wrapped, which is how you get meat into someone who 不下食, in whom food will not go down. The seasonings are not decorative either: tangerine peel and pepper are the two drugs the chapter uses to rouse a stomach that has stopped.

Boncho 本草

2.61.65

Source원문

牛肝治痢. 醋煮食之. 《本草》

Translation영역

Ox liver (牛肝): Treats dysentery. Boil it in vinegar and eat it.

Boncho 本草

2.61.66

Source원문

牛角䚡 主赤白痢及冷痢瀉血. 燒存性爲末, 溫酒或米飮調下二錢. 或蜜和作丸服之. 《本草》

Translation영역

Ox horn core (牛角䚡): Governs red and white dysentery, and a cold dysentery pouring blood. Burn it with its nature retained, powder it, and take 2 don stirred into warm wine or rice water. Or mix it with honey, make pills of it and take them.

Boncho 本草

2.61.67

Source원문

黃雄狗頭骨 主久痢ㆍ勞痢ㆍ休息痢. 取腦骨灸黃爲末, 米飮調二錢服. 或蜜和作丸服之. 《本草》

Translation영역

Yellow male dog's skull (黃雄狗頭骨): Governs a long dysentery, a taxation dysentery and an intermittent dysentery. Take the cranium, roast it yellow, powder it, and take 2 don stirred into rice water. Or mix it with honey, make pills of it and take them.

Boncho 本草

2.61.68

Source원문

狗肝治下痢臍腹痛. 狗肝一具, 細切, 米一升和煮粥, 着葱椒鹽醬喫之. 《本草》

Translation영역

Dog liver (狗肝): Treats dysentery descending with pain around the navel and in the abdomen. One dog's liver, finely cut, boiled with 1 seung of rice into a gruel, seasoned with scallion, pepper, salt and soy, and eaten.

Boncho 本草

2.61.69

Source원문

猪肝主冷泄ㆍ濕泄ㆍ滑泄. 取肝薄切, 溫塗煨訶子皮末, 微火灸, 盡末五錢, 空心細嚼, 米飮送下. 《本草》 ○暴泄ㆍ濕泄, 猪肝漿水煮熟食之. 《得效》 ○氣虛下痢瘦乏, 猪肝一具, 切片, 入醋一升煮乾, 空心食甚妙. 《入門》

Translation영역

Pig liver (猪肝): Governs cold diarrhoea, damp diarrhoea and slippery diarrhoea. Take the liver, slice it thin, spread it while warm with powdered ember-roasted chebula rind and roast it over a low fire, until all of 5 don of the powder is used up; then chew it fine on an empty stomach and send it down with rice water. ○ For a sudden diarrhoea or a damp diarrhoea: boil pig's liver through in fermented rice water and eat it. ○ For a qi vacuity with dysentery descending, emaciation and exhaustion: one pig's liver, sliced, put into 1 seung of vinegar and boiled dry, eaten on an empty stomach — very fine.

Clinical note임상 주석

The first method is the interesting one: liver used as a vehicle for the astringent rather than as the drug, five don of chebula powder worked into the slices a layer at a time as they roast. The third is the chapter's closing statement on the whole subject — 氣虛下痢瘦乏, a qi vacuity with dysentery, wasting and exhaustion — and the treatment is liver. Liver is the richest available source of iron, B₁₂ and folate, and a patient wasted by weeks of bloody stool is anaemic before anything else. This is the best piece of nutritional reasoning in the section.

Boncho 本草 · Deukhyo 得效 · Immun 入門

2.61.70

Source원문

猪膽治大便不通. 詳見導便法

Translation영역

Pig bile (猪膽): Treats a stool that will not pass. described in detail under the Guide-the-Stool Method

Donguibogam · Daebyeon

2.62 Needling and Moxibustion 鍼灸法

2.62.1

Source원문

大渴飮水多爲滑泄, 水入卽泄, 泄而復飮, 此無藥, 當灸大顀三五壯. 《易老》

Translation영역

Where great thirst and much drinking make a slippery diarrhoea, so that water goes in and is at once passed, and having passed it the patient drinks again — for this there is no medicine, and Daechu GV-14 should be moxaed three to five cones.

Yeokro 易老

2.62.2

Source원문

泄瀉三五年不愈, 灸百會五七壯卽愈. 《醫鑑》 ○久泄痢, 灸天樞ㆍ氣海, 大能止泄. 《丹溪》

Translation영역

Where a diarrhoea of three or five years has not healed, moxa Baekhoe GV-20 five to seven cones and it heals. For an enduring diarrhoea or dysentery, moxa Cheonchu ST-25 and Gihae CV-6 — greatly able to stop the diarrhoea.

Uigam 醫鑑 · Danggye 丹溪

2.62.3

Source원문

泄痢不止, 灸神闕七壯一云三七壯ㆍ關元三十壯. 《得效》 ○溏泄, 灸臍中爲第一, 三陰交次之. 《資生》

Translation영역

Where a diarrhoea or dysentery does not stop, moxa Sinkwol CV-8 seven cones — one text says twenty-one — and Gwanwon CV-4 thirty cones. For a loose stool, moxa at the navel is first and Sameumgyo SP-6 next.

Deukhyo 得效 · Jasaeng 資生

2.62.4

Source원문

泄痢, 灸脾兪隨年壯ㆍ臍中二十壯ㆍ關元百壯三報ㆍ二七壯. 《得效》

Translation영역

For diarrhoea and dysentery, moxa Biyu BL-20 with as many cones as the patient's years, the navel twenty cones, and Gwanwon CV-4 a hundred cones in three courses, or twenty-one cones.

Deukhyo 得效

2.62.5

Source원문

飱泄, 取陰陵泉ㆍ然谷ㆍ巨虛上廉ㆍ大衝. 《綱目》

Translation영역

For undigested-food diarrhoea, take Eumreungcheon SP-9, Yeongok KI-2, Geoheo-sangryeom ST-37 and Taechung LR-3.

Gangmok 綱目

2.62.6

Source원문

泄瀉如水, 手足冷, 脉欲絶, 臍腹痛, 漸漸短氣, 灸氣海百壯. 《得效》

Translation영역

Where the diarrhoea is like water, the hands and feet cold, the pulse on the point of being cut off, the navel and belly painful and the breath growing shorter and shorter, moxa Gihae CV-6 a hundred cones.

Deukhyo 得效

2.62.7

Source원문

下痢腹痛便膿血, 取丹田ㆍ復溜ㆍ小腸兪ㆍ天樞ㆍ腹哀. 《東垣》 ○冷痢, 關元ㆍ窮谷各灸五十壯. 《東垣》 ○裏急後重, 取合谷ㆍ外關. 《東垣》

Translation영역

For a dysentery with abdominal pain and pus and blood in the stool, take Danjeon, Bongnyu KI-7, Sojangyu BL-27, Cheonchu ST-25 and Bogae SP-16. For a cold dysentery, moxa Gwanwon CV-4 and Gunggok fifty cones each. For inner urgency and dragging-down behind, take Hapgok LI-4 and Oegwan TE-5.

Dongwon 東垣

2.62.8

Source원문

痢不止, 取合谷ㆍ三里ㆍ陰陵泉ㆍ中脘ㆍ關元ㆍ天樞ㆍ神闕ㆍ中極. 《綱目》 ○諸下痢皆可灸大都五壯ㆍ商丘ㆍ陰陵泉各三壯. 《綱目》

Translation영역

Where a dysentery does not stop, take Hapgok LI-4, Samri ST-36, Eumreungcheon SP-9, Jungwan CV-12, Gwanwon CV-4, Cheonchu ST-25, Sinkwol CV-8 and Junggeuk CV-3. For all dysenteries one may moxa Daedo SP-2 five cones, and Sanggu SP-5 and Eumreungcheon SP-9 three cones each.

Gangmok 綱目

2.62.9

Source원문

大便秘澁, 取照海鍼入五分, 補三呼, 瀉六吸, 立通ㆍ支溝鍼半寸, 瀉三吸ㆍ太白瀉之. 《綱目》

Translation영역

For a bound and inhibited stool, take Johae KI-6 — needle in 5 fun, supplement for three breaths out and drain for six breaths in, and it passes at once; Jigu TE-6 — needle half a chi, draining for three breaths in; and Taebaek SP-3, draining.

Gangmok 綱目

2.62.10

Source원문

大便不通, 取三間ㆍ承山ㆍ太白ㆍ太鍾ㆍ三里ㆍ涌泉ㆍ崑崙ㆍ照海ㆍ章門ㆍ氣海. 《綱目》 ○大小便不通, 取大都ㆍ環崗ㆍ水道. 《綱目》

Translation영역

For the stool not passing, take Samgan LI-3, Seungsan BL-57, Taebaek SP-3, Taejong KI-4, Samri ST-36, Yongcheon KI-1, Gollyun BL-60, Johae KI-6, Jangmun LR-13 and Gihae CV-6. For neither stool nor urine passing, take Daedo SP-2, Hwangang and Sudo ST-28.

Gangmok 綱目

2.62.11

Source원문

關格吐逆而小便不通, 先灸氣海ㆍ天樞各三七壯, 吐止然後用益元散以利小便. 《正傳》

Translation영역

In the barred and blocked state, with retching counterflow and the urine not passing, first moxa Gihae CV-6 and Cheonchu ST-25 twenty-one cones each; once the vomiting has stopped, then use Igwon-san to free the urine.

Jeongjeon 正傳

2.62.12

Source원문

婦人産後腹脹ㆍ大小便不通, 取氣海ㆍ足三里ㆍ關元ㆍ三陰交ㆍ陰谷. 《綱目》

Translation영역

For a woman after childbirth with abdominal distension and neither stool nor urine passing, take Gihae CV-6, Jok-samri ST-36, Gwanwon CV-4, Sameumgyo SP-6 and Eumgok KI-10.

Clinical note임상 주석

The needling section is almost entirely moxa, and the point selection is consistent and sensible: the navel and Gwanwon below it, Cheonchu beside it, Gihae between them, with Samri and the spleen-channel points distally. Those are the points over and around the large intestine and the ones a modern acupuncturist would choose for the same complaints. Two entries stand out. The first — where water goes in and is at once passed and the patient drinks again — ends with the admission that for this there is no medicine, and offers moxa at the base of the neck instead; that is the honest response to a secretory diarrhoea the pharmacy could not touch. And the sixth, with the stool like water, the limbs cold, the pulse failing and the breath shortening, prescribes a hundred cones at Gihae, which is what a physician does when he has nothing else. The needling instructions for constipation in the ninth entry are the most technically precise in the chapter — depth, supplementation and drainage counted in breaths — and the dose of moxa elsewhere, as many cones as the patient's years, is the chapter's way of scaling a treatment to the person rather than the disease.

Gangmok 綱目

About this translation 凡例

Base text: Donguibogam (東醫寶鑑, 1613 first edition), Inner Landscape, Volume 4, Stool chapter. The Chinese text is collated against a transcription carrying the printed edition's leaf numbers and first-edition collation notes; original character forms (脉, 人參) are retained. Terminology follows Wiseman & Feng, A Practical Dictionary of Chinese Medicine. Translation and clinical notes are original to this site. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.