寶鑑Bogam

Formulas · Text · Donguibogam 東醫寶鑑

The Purging Method

Ha

한글 하  ·  Pinyin Xia

Autumn is the season for purging — when to use the method, how far to take it, and what it costs

下

A short chapter and the third of the three great methods, after sweating and vomiting. It opens with Zhongjing's rule that autumn is the season for purging and then spends most of its length on restraint rather than technique. When to give it: only when the evil has reached the yang brightness, and the test offered is thirst — no thirst means nothing of form is there to be removed, and purging is wrong. When in the day: not early, and the chapter takes pains to gloss what late means, the hours after mid-morning when the yin division begins. How to hurry it or check it: a bowl of hot congee to make the medicine move, a bowl of cold to stop it. What it costs: heavy purging damages the blood, and purging after the evil is already gone destroys the yin the method was meant to preserve. The sixteen formulas at 8.8 are almost all built on the same medicinal, the fine first powder of the black morning glory seed, and the dose in every one of them is titrated to the bowel's answer rather than fixed. The chapter closes with fourteen simples and a cross-reference to the chapter on bound stool.

8.1 Autumn Is the Season for Purging 秋宜下

8.1.1
Source원문

仲景大法, 秋宜下.

Translation영역
Zhongjing's great rule: in autumn, purging is the method.
Clinical note임상 주석
Six graphs, and they place this chapter in a set. Spring is for vomiting, summer for sweating, autumn for purging — the three methods keyed to the direction the qi is already moving in the season. In autumn the qi descends, and a treatment that works downward goes with it rather than against it.

Junggyeong 仲景

8.2 In Purging There Is No Such Thing as Too Late 下無太晩

8.2.1
Source원문

非待久之晩, 乃當日巳後, 爲陰之分也. 下之謂當巳前, 爲陽之分也. 故曰, 下無太晩, 下不厭晩, 是謂善守. 《東垣》

Translation영역
Late does not mean waiting a long while; it means after the si hour of the same day, which is the yin division. Purging before the si hour falls in the yang division. Therefore it is said: in purging there is no such thing as too late, and purging is not troubled by lateness — this is what is called guarding well.
Clinical note임상 주석
A gloss written to prevent a misreading, and it is needed: 晩 here does not mean delaying the treatment by days but giving it later in the day. Before mid-morning is the yang division; after it the yin division begins, and a downward-moving treatment belongs there. 善守, guarding well, is the chapter's word for not rushing. The sweating chapter's rule at 7.2 runs the other way — 汗無太早, no such thing as too early — and the two together frame the whole approach: sweat early in the day, purge late.

Dongwon 東垣

8.2.2
Source원문

凡下積聚癲狂, 須五鼓或平朝, 空心服湯. 傷寒潮熱, 不納飮食者, 巳時以後尤好. 故曰, 下無太晩, 下不厭晩, 雜病皆同. 《入門》

Translation영역
In purging accumulations and gatherings, or mania and withdrawal, the decoction should be taken at the fifth watch or at daybreak, on an empty stomach. In cold damage with tidal fever where food is not taken in, after the si hour is better still. Therefore it is said: in purging there is no such thing as too late, and purging is not troubled by lateness — and in miscellaneous diseases it is all the same.
Clinical note임상 주석
The Immun qualifies the rule by condition rather than overturning it. Accumulations and mania are purged before dawn on an empty stomach; febrile cold damage after mid-morning. The distinction is practical: for a mass that must be shifted the bowel should be empty and the dose undiluted, while in fever the timing follows the tidal pattern of the heat.

Immun 入門

8.3 Patterns for Which Purging Is Indicated 宜下證

8.3.1
Source원문

凡轉下, 須體認明白在陽明胃經, 則不拘日數而下之. 過時失下, 則氣血不通, 四肢便厥. 不識者, 疑爲陰厥, 復進熱藥, 禍如反掌. 《得效》

Translation영역
Whenever the disease is to be turned downward, one must recognize clearly that it lies in the yang brightness stomach channel, and then purge without regard to the count of days. Where the time passes and the purging is missed, the qi and blood do not flow and the four limbs go reverse-cold. One who does not recognize this suspects a yin reversal and again gives hot medicines — and disaster follows as quickly as turning the hand.
Clinical note임상 주석
The chapter's sharpest warning. Cold limbs from heat bound in the interior look exactly like cold limbs from yang collapse, and the treatments are opposite. 禍如反掌 — disaster as quick as turning the hand — is not rhetorical. Giving aconite and dry ginger to a patient whose extremities are cold because heat is trapped inside will kill them. The discriminating finding is not in the limbs but in the channel: has the evil reached the yang brightness? 不拘日數, without regard to the count of days, means the six-channel timetable is set aside when the pattern is clear.

Deukhyo 得效

8.3.2
Source원문

凡用下藥, 若不渴者, 知不在有形也. 則不當下. 若渴者, 則知纏有形也. 纏有形是爲在裏, 在裏則當下, 三承氣湯擇用之. 《東垣》

Translation영역
Whenever purging medicines are to be used: if the patient is not thirsty, it is known that the disease does not lie in what has form, and purging is not called for. If the patient is thirsty, it is known that something of form is bound up in it. What is bound up in form lies in the interior, and what lies in the interior should be purged; the three Order the Qi Decoctions are chosen from.
Clinical note임상 주석
One question decides whether to purge: is the patient thirsty? Thirst means heat has bound something substantial, and only then is there anything for a purgative to remove. 有形 against 無形 — what has form and what has not — is the tradition's distinction between a disease with a physical accumulation and one without. The Internal Damage chapter argues the same point about alcohol at 1.10.6, where Danxi objects that a thing removed by sweat and urine must have form.

Dongwon 東垣

8.4 Methods for Hastening the Purge 促下法

8.4.1
Source원문

凡服利藥, 久不利, 則進熱粥一椀. 若利過不止, 進冷粥一椀. 盖藥熱則行, 冷則止故也. 《仲景》

Translation영역
Whenever a disinhibiting medicine has been taken and there is long no purging, give a bowl of hot congee. If the purging is excessive and does not stop, give a bowl of cold congee. For a medicine moves when hot and stops when cold.
Clinical note임상 주석
The most practical line in the chapter and the one worth carrying. Hot congee starts a purge that has not begun; cold congee stops one that has gone too far. 藥熱則行, 冷則止 — a medicine moves when hot and stops when cold — states the principle behind both, and it applies to the vehicle rather than to the drug. The same instruction appears in the Shanghanlun after Gyeji-tang, where hot gruel is given to help the sweat. Where a drastic purgative has been given and the dose cannot be recalled, having a means to check it matters.

Junggyeong 仲景

8.4.2
Source원문

如服藥不得通, 用蜜導法方見大便. 凡下藥, 用湯勝丸. 盖水能淨萬物故也. 《入門》

Translation영역
If the medicine has been taken and nothing passes, use the honey suppository method method in the Stool chapter. In purging medicines generally, a decoction is better than a pill, for water can cleanse the ten thousand things.
Clinical note임상 주석
用湯勝丸 — a decoction is better than a pill — runs against the whole of 8.8, where fifteen of the sixteen formulas are pills. The chapter records the principle and its own practice without reconciling them. The reason it gives is that water cleanses. A decoction carries the drug in volume and reaches the bowel diluted; a pill delivers it concentrated and slowly, which is why the drastic formulas are made that way.

Immun 入門

8.5 Purging Much Destroys the Yin 下多亡陰

8.5.1
Source원문

大下傷血. 《得效》

Translation영역
Heavy purging damages the blood.

Deukhyo 得效

8.5.2
Source원문

下者, 本所以助陰也. 若陰受陽邪, 熱結有形, 須當除去已敗壞者, 以致新陰. 若陽邪旣去, 而復下之, 反亡陰也. 經曰, 重陰必陽. 故陰氣自亡, 下多亡陰, 此之謂也. 《東垣》

Translation영역
Purging is fundamentally the means of assisting the yin. Where the yin has received a yang evil and heat has bound something of form, what is already spoiled must be removed so that new yin may come. But where the yang evil has already gone and purging is done again, on the contrary the yin is destroyed. The classic says: doubled yin must become yang. Hence the yin qi is destroyed of itself, and purging much destroying the yin means this.
Clinical note임상 주석
The argument that makes the chapter's caution coherent. Purging is not an attack on the yin but a way of protecting it: heat bound in the interior consumes the yin, and removing the heat lets new yin form. The harm comes from continuing after the evil is gone, when there is nothing left to remove and the purge takes the yin itself. That is why every formula in 8.8 says 以利爲度 — take purging as the measure — and stop. **Severe or prolonged diarrhoea causes dehydration and electrolyte loss, and is dangerous in the elderly and the frail.**

Dongwon 東垣

8.6 The Purging Method Calls for Caution 下法宜愼

8.6.1
Source원문

大凡攻擊之藥, 有病則病受之, 病邪輕而藥力重, 則胃氣受傷. 夫胃氣者, 淸純冲和之氣也. 惟與穀肉菜果相宜, 藥石皆是偏勝之氣, 雖參ㆍ芪性亦偏, 況攻擊之藥乎. 《東垣》

Translation영역
In general, with medicines that attack, where there is disease the disease receives them; but where the disease evil is light and the medicine's force heavy, the stomach qi is damaged. The stomach qi is a qi clear, pure and harmonious. It agrees only with grain, meat, vegetables and fruit; medicines and minerals are all qi of one-sided prevalence — even ginseng and astragalus are partial in nature, how much more the medicines that attack.
Clinical note임상 주석
有病則病受之 — where there is disease, the disease receives the medicine — is the principle the whole chapter rests on. A drastic medicine given to a body that needs it is absorbed by the illness; given where the illness is slight, it falls on the stomach instead. 雖參ㆍ芪性亦偏 appears word for word in the Internal Damage chapter at 1.2.1, where Danxi uses it to argue that grain can be eaten daily and medicine cannot. Here Dongwon uses the same sentence to argue for restraint in purging. The two chapters make different points from one observation.

Dongwon 東垣

8.7 After Heavy Purging It Is Hard to Check 大下後難禁

8.7.1
Source원문

凡誤用大黃ㆍ芒硝, 令人下利不禁, 理中湯方見傷寒, 加(炒)糯米ㆍ烏梅ㆍ東壁土救之. 《入門》

Translation영역
Wherever rhubarb and mirabilite have been used in error so that the patient purges without check, rescue them with Rectify the Centre Decoction formula in the Cold Damage chapter with stir-fried glutinous rice, mume and earth from an east-facing wall added.
Clinical note임상 주석
A whole section given to the antidote, which tells how often the accident happened. Ijung-tang warms the centre that the purgative has chilled; glutinous rice and mume bind; earth from an east-facing wall is the tradition's standing remedy for diarrhoea that will not stop. 東壁土, earth from an east-facing wall, is taken from the side warmed by the morning sun, and the Bogam uses it elsewhere for the same purpose. Like the stove earth of the Uterus chapter at 13.23, it is clay that has been dried by years of heat. **Uncontrolled diarrhoea after a purgative requires fluid replacement. This is a medical matter rather than one for household remedies.**

Immun 入門

8.8 Purging Medicines 下藥

8.8.1
Source원문

宜用全眞丸ㆍ神芎導水丸ㆍ導水丸ㆍ舟車丸ㆍ舟車神祐丸ㆍ三花神祐丸ㆍ大聖濬川散ㆍ搜風丸ㆍ四生丸ㆍ解毒丸ㆍ木香順氣丸ㆍ三黃解毒丸ㆍ開結枳實丸ㆍ通膈丸ㆍ宣毒丸ㆍ禹功散ㆍ靈寶丹方見大便ㆍ大承氣湯ㆍ小承氣湯ㆍ調胃承氣湯ㆍ三一順氣湯ㆍ六一順氣湯五方幷見寒門.

Translation영역
Complete Truth Pill, Spirit Ligusticum Conduct Water Pill, Conduct Water Pill, Boat and Cart Pill, Boat and Cart Spirit Protection Pill, Three Flowers Spirit Protection Pill, Great Sage Dredge the River Powder, Search Out Wind Pill, Four Engenderings Pill, Resolve Toxin Pill, Costus Normalize the Qi Pill, Three Yellows Resolve Toxin Pill, Open the Bind Bitter Orange Fruit Pill, Free the Diaphragm Pill, Diffuse Toxin Pill, Yu's Achievement Powder, Numinous Treasure Elixir formula in the Stool chapter, Major Order the Qi Decoction, Minor Order the Qi Decoction, Regulate the Stomach and Order the Qi Decoction, Three-to-One Normalize the Qi Decoction and Six-to-One Normalize the Qi Decoction the last five formulas in the Cold Damage chapter are used.
Clinical note임상 주석
Sixteen formulas set down here in full and six more sent to other chapters. Three Flowers Spirit Protection Pill is the one the Phlegm-Rheum, Accumulations and Dampness chapters cite as 方見下門, and that the Oedema chapter cites in error as 方見濕門 — its place is here. Fourteen of the sixteen are built on the same medicinal, the fine first powder of the black morning glory seed. The chapter's method is essentially one drug, varied by what is set beside it: euphorbias for standing water, the three yellows for heat, gleditsia for phlegm, fennel for cold. **Almost every formula in this section is a drastic purgative, and two contain calomel. Contraindicated in pregnancy. Not suitable for self-administration.**

Donguibogam · Ha

8.9 Simple Medicinals 單方

8.9.1
Source원문

大麻仁 治腸胃結熱, 通利大小便. 擣取汁, 煮作粥服之. 《本草》

Translation영역
Hemp seed (大麻仁): Treats heat bound in the intestines and stomach, and frees and disinhibits both stool and urine. Pound out the juice, boil it into congee and take.
Clinical note임상 주석
The section opens with its gentlest medicinal. Hemp seed is oily and moistens rather than purges, and taken as congee it is food. That the chapter puts it first, ahead of the euphorbias and croton, reflects the order of preference its own sections argue for.

Boncho 本草

8.9.2
Source원문

脂麻油 潤腸胃, 通利大小腸, 下熱結. 空心, 飮一二合, 大府卽通. 《本草》

Translation영역
Sesame oil (脂麻油): Moistens the intestines and stomach, frees and disinhibits both large and small intestine, and brings down bound heat. Drink 1 or 2 hop on an empty stomach and the large bowel passes at once.

Boncho 本草

8.9.3
Source원문

桃花萼 破積聚, 利大小便. 花落時, 取萼, 和麪, 作燒餠食之. 《本草》

Translation영역
Peach blossom calyx (桃花萼): Breaks accumulations and gatherings and disinhibits both stool and urine. When the blossom falls, take the calyx, mix it with flour, make a baked cake and eat it.

Boncho 本草

8.9.4
Source원문

千金子 一名續隨子. 利大小腸. 爲末, 飮調一二錢, 或作丸服. 《本草》

Translation영역
Caper spurge seed (千金子): Also called soksuja. Disinhibits both large and small intestine. Powder it and take 1 or 2 don stirred into a drink, or make pills and take.

Boncho 本草

8.9.5
Source원문

大黃 通利水穀, 蕩滌腸胃. 剉取五錢, 水煎服, 或作丸服之亦可. 《本草》

Translation영역
Rhubarb (大黃): Frees and disinhibits water and grain, and washes out the intestines and stomach. Cut up and take 5 don, decoct in water and take; or make pills and take, which will also serve.

Boncho 本草

8.9.6
Source원문

黑牽牛子 黑者主水, 白者主氣. 取頭末, 二錢卽下利, 作丸服亦良. 《本草》

Translation영역
Black morning glory seed (黑牽牛子): The black governs water, the white governs qi. Take the first powder, and 2 don purges at once; made into pills and taken it is also good.
Clinical note임상 주석
黑者主水, 白者主氣 — the black governs water and the white governs qi. The two colours of the seed are treated as different drugs, and the chapter's formulary uses the black throughout because its subject is standing water. 二錢卽下利 — 2 don purges at once — gives the effective dose, and every formula in 8.8 is built around it.

Boncho 本草

8.9.7
Source원문

檳榔 宣利藏府壅滯氣. 細硏爲末, 每二錢, 蜜水調下. 《本草》

Translation영역
Areca (檳榔): Diffuses and disinhibits qi congested and stagnant in the viscera and bowels. Grind fine to a powder and take 2 don at a dose, stirred into honey water.

Boncho 本草

8.9.8
Source원문

甘遂 破積聚, 利水穀道. 爲末, 調飮服. 或作丸服. 《本草》

Translation영역
Kansui (甘遂): Breaks accumulations and gatherings and disinhibits the water and grain passages. Powder it and take stirred into a drink, or make pills and take.
Clinical note임상 주석
**Kansui is toxic and can cause severe dehydration and cardiac disturbance. It is a prescription-only medicinal where it is legal at all.**

Boncho 本草

8.9.9
Source원문

大戟 破癥結, 利大小腸. 或剉三錢, 水煎服. 或作丸, 作散服. 《本草》

Translation영역
Euphorbia root (大戟): Breaks concretions and binds and disinhibits both large and small intestine. Cut up and take 3 don decocted in water, or make pills or a powder and take.

Boncho 本草

8.9.10
Source원문

芫花 利五藏, 通水道. 水煎服. 或末服丸服幷佳. 《本草》

Translation영역
Genkwa flower (芫花): Disinhibits the five viscera and frees the waterways. Decoct in water and take, or take as a powder or as pills — both are good.

Boncho 本草

8.9.11
Source원문

郁李仁 通泄五藏, 治關格不通. 爲末, 飮調二錢服. 或丸服亦佳. 《本草》

Translation영역
Bush cherry kernel (郁李仁): Frees and drains the five viscera and treats block and repulsion that will not pass. Powder it and take 2 don stirred into a drink, or as pills, which is also good.

Boncho 本草

8.9.12
Source원문

芒硝 破積聚, 利大小便. 溫湯和服一二錢. 或入丸散服. 《本草》

Translation영역
Mirabilite (芒硝): Breaks accumulations and gatherings and disinhibits both stool and urine. Take 1 or 2 don mixed into warm water, or put into pills or powders and take.

Boncho 本草

8.9.13
Source원문

巴豆 去胃中寒積, 利水穀道. 去皮油爲末, 入丸散用之. 《本草》

Translation영역
Croton seed (巴豆): Removes cold accumulation in the stomach and disinhibits the water and grain passages. Remove the skin and the oil, powder it, and use it in pills or powders.
Clinical note임상 주석
去皮油 — removing the skin and the oil — is the essential processing, and the oil is where the irritant sits. Croton is the one warm purgative in the section and is used where the accumulation is cold, which is why it has its own line rather than being grouped with the euphorbias. **Croton is violently purgative and severely irritant. Contact with the skin or eyes causes blistering. It must not be prepared or taken.**

Boncho 本草

8.9.14
Source원문

商陸 通利大小腸, 瀉十水腫. 取白色者, 末服或丸服良. 《本草》

Translation영역
Phytolacca (商陸): Frees and disinhibits both large and small intestine and drains the ten kinds of water swelling. Take the white-coloured kind; taken as a powder or as pills it is good.
Clinical note임상 주석
取白色者 — take the white-coloured kind — is a safety instruction rather than a preference. The red-rooted phytolacca is more toxic, and the Oedema chapter gives the same warning. 十水腫, the ten kinds of water swelling, is the Oedema chapter's classification at 2.4. **Phytolacca is toxic; the root causes vomiting, severe diarrhoea and convulsions. Contraindicated in pregnancy.**

Boncho 本草

8.9.15
Source원문

當與大便不通門參看.

Translation영역
This should be read together with the chapter on stool that will not pass.
Clinical note임상 주석
The chapter ends by pointing elsewhere. Purging as a method and constipation as a complaint are treated separately in the Bogam — this chapter is about when and how to use the method, the Stool chapter about the condition it most often answers.

Donguibogam · Ha

About this translation 凡例

Base text: Donguibogam (東醫寶鑑, 1613 first edition), Miscellaneous Disorders, Volume 1, The Purging Method chapter. The Chinese text is collated against the public-domain Wikisource transcription and a printed edition; 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.