Formulas · Text · Donguibogam 東醫寶鑑

Malaria

Haehak

한글 해학 · Pinyin Jie Nue

Fevers that come and go by the clock — the periodicity, the enlarged spleen, and the one drug in the chapter that worked

痎瘧

痎瘧 is the chapter on fevers that alternate with chills and return on a schedule. 痎 is the old fever that will not leave and 瘧 the fit itself; between them the chapter covers everything that shakes a patient with cold and then burns him, from a relapsing fever caught in late summer to the wasting illness of someone who has had it for years. The bulk of what it describes is malaria, and the chapter is at its most impressive where malaria is at its most regular.

What it got right is the timing. 1.6 sets out fevers that come daily, every other day, every third day and at longer intervals, and ties the interval to how deep the illness has gone; 1.7 watches the hour of onset creep later or earlier day by day and treats that drift as the thing to track. Quotidian, tertian and quartan periodicity is the single most useful clinical fact about malaria, and the chapter had it four centuries before anyone saw the parasite. 1.11 is equally good: the fever that will not stop has a 根, a root, and the root is a 癖 — a hard mass under the ribs that the chapter calls 瘧母, the mother of the fever. That is the enlarged spleen of chronic malaria, correctly identified as the reason the illness keeps coming back and correctly located.

The treatment is built around 常山, Dichroa febrifuga, which appears in formula after formula and which really is an antimalarial — its alkaloid febrifugine is active against the parasite, and the chapter's instinct to reach for it is sound. It is also a violent emetic and is hepatotoxic, which is why the chapter keeps saying it must be processed 製熟 so as not to injure the stomach, and why it is not a drug to prepare now. Alongside it sits 截瘧, cutting the fever short, a practice the chapter both recommends and distrusts: 1.16 warns in its first line that the arsenic preparations (砒丹) sold for the purpose are 大毒 and must not be used lightly, and tells the physician not to cut too early or too late. 1.17's 禳法 — amulet pills to ward the thing off — and the 鬼瘧 of 1.10.8, treated with earth from a cremation ground, mark where the chapter's understanding stopped.

A patient with malaria today needs parasite-specific treatment and needs it quickly; falciparum malaria kills. Nothing in this chapter is a substitute for that, and the sections on who cannot be cured (1.19) are a record of what untreated relapsing fever did to people.

1.1 The Origin of the Fever Illness 瘧病之源

1.1.1

Source원문

內經曰, 夏傷於暑, 秋爲痎瘧.

Translation영역

The Inner Classic says: injured by summerheat in summer, in autumn there is intermittent fever.

Clinical note임상 주석

The sentence governs the whole chapter. 夏傷於暑, 秋爲痎瘧 places the cause in one season and the illness in the next, and every explanation that follows is an attempt to say what was carried across the gap. The latency is real — Plasmodium vivax can relapse months after the mosquito bite from dormant liver forms — and the association with late summer is the mosquito season.

Naegyeong 內經

1.1.2

Source원문

夏暑汗不出者, 秋成風瘧. 《內經》

Translation영역

Where the summer's summerheat does not come out as sweat, in autumn it becomes wind fever.

Naegyeong 內經

1.1.3

Source원문

秋善病風瘧. 又曰, 魄汗未盡, 形弱而氣爍, 穴兪以閉, 發爲風瘧. 《內經》

Translation영역

Autumn is the season apt to fall ill of wind fever. It says again: where the bodily sweat has not been exhausted, the form is weak and the qi is scorched, and the points and hollows close up, it breaks out as wind fever.

Naegyeong 內經

1.1.4

Source원문

風成爲寒熱. 又曰, 因於露風, 乃生寒熱. 《內經》

Translation영역

Wind completed becomes cold and heat. It says again: from exposure to wind there arise cold and heat.

Naegyeong 內經

1.1.5

Source원문

風氣盛於皮膚之內, 內不得通, 外不得泄, 腠理開則洒然寒, 閉則熱而悶, 名曰寒熱. 《內經》

Translation영역

When wind qi is abundant within the skin, so that inwardly it cannot pass through and outwardly it cannot be discharged, then when the interstices open there is a shivering cold, and when they close there is heat and oppression: this is called cold and heat.

Clinical note임상 주석

The mechanism offered for the alternation is a valve: the pores open and the patient is cold, they close and he is hot. It is wrong about the cause and right about the sequence — the rigor comes first and the fever follows, and in malaria the two are a single paroxysm.

Naegyeong 內經

1.1.6

Source원문

夏傷於暑, 秋必病瘧. 盖傷之淺者, 近而暴; 傷之重者, 遠而深. 痎瘧者, 久瘧也. 是知夏傷於暑濕, 熱閉藏而不能發泄于外, 邪氣內行, 至秋而發爲瘧也. 《保命》

Translation영역

Injured by summerheat in summer, in autumn one is sure to fall ill of fever. For where the injury is shallow it is near at hand and violent; where the injury is severe it is distant and deep. 痎瘧 is the long-standing fever. From this we know that when the summer's injury is by summerheat and damp, and the heat is shut in and stored and cannot be discharged outward, the evil qi travels within, and when autumn comes it breaks out as fever.

Bomyeongjip 保命

1.1.7

Source원문

瘧之爲病, 以暑舍于榮衛之間, 得秋之風寒所傷而後發. 亦有非暑, 因風寒感冒而得之者. 在於陽則發熱, 在於陰則發寒. 幷則病作, 離則病止, 作止故有時. 在氣則發早, 在血則發晏. 淺則日作, 深則間日. 或在頭項, 或在背中, 或在腰脊, 雖上下遠近之不同, 在太陽則一也. 《東垣》

Translation영역

As an illness, fever comes of summerheat lodging between the construction and the defence, and only breaks out after the autumn's wind and cold have injured it. There are also cases not from summerheat but contracted from wind and cold. Where it is in the yang there is fever; where it is in the yin there is chill. When they join, the illness takes hold; when they part, it stops — and because it takes hold and stops, it has its hours. In the qi it breaks out early; in the blood it breaks out late. Shallow, it comes daily; deep, it comes on alternate days. It may be in the head and nape, or in the middle of the back, or in the lumbar spine — and though above and below, far and near, are not the same, in being of the greater yang they are one.

Dongwon 東垣

1.1.8

Source원문

大法, 風暑當發汗. 夏月多在風涼處歇, 遂閉其汗而不泄故也. 《丹心》

Translation영역

The general rule is that wind and summerheat should be made to sweat — because in the summer months people rest much in windy cool places, and so their sweat is shut in and not discharged.

Dansim 丹心

1.1.9

Source원문

病氣如凌虐人之狀. 又曰, 瘧有凌虐之狀. 在傷寒久則爲壞證, 在內傷久則爲勞瘵. 然則豈美疾哉. 《入門》

Translation영역

The illness qi is like the manner of a man tyrannising over another. It says again: the fever has the manner of a tyranny. Where it lies in cold damage, in time it becomes a ruined case; where it lies in internal damage, in time it becomes consumption. How then should it be a fine illness?

Clinical note임상 주석

凌虐 — to tyrannise, to bully — is the gloss on the graph 瘧 itself, which is written with the sickness radical over 虐, cruelty. The closing 豈美疾哉 is the chapter's answer to any suggestion that a fever which comes and goes politely by the clock is a mild thing.

Immun 入門

1.2 The Form and Signs of the Fever Illness 瘧疾形證

1.2.1

Source원문

瘧之始發也, 先起於毫毛伸欠, 乃作寒慄鼓頷, 腰脊俱痛. 寒去則內外皆熱, 頭痛如破, 渴欲飮冷. 《內經》

Translation영역

When the fever first breaks out, it begins with the fine hairs rising and with stretching and yawning; then come shivering and chattering of the jaw, and the lumbar spine aches throughout. When the cold has gone, inside and out are all hot, the head aches as though splitting, and there is thirst with a desire for cold drink.

Clinical note임상 주석

A description of a malarial paroxysm good enough to diagnose from: the prodrome of yawning and gooseflesh, the rigor with teeth chattering, then the hot stage with headache and thirst. The three stages — cold, hot, sweating — are the classical account of the fit.

Naegyeong 內經

1.2.2

Source원문

夫陰陽上下交爭, 虛實更作, 陰陽相移也. 陽幷於陰, 則陰實而陽虛. 陽明虛則寒慄鼓頷, 巨陽虛則腰背頭項痛, 三陽俱虛則陰氣勝. 陰氣勝則骨寒而痛, 寒生於內, 故中外皆寒. 陽盛則外熱, 陰虛則內熱, 內外皆熱則喘而渴, 故欲冷飮也. 《內經》

Translation영역

Now yin and yang contend above and below, vacuity and repletion take their turns, and yin and yang shift into one another. When yang joins with yin, then yin is replete and yang vacuous. When the yang brightness is vacuous there is shivering and chattering of the jaw; when the great yang is vacuous the lumbus, back, head and nape ache; when all three yang are vacuous the yin qi prevails. When the yin qi prevails the bones are cold and ache, and cold arises within, so that centre and exterior are both cold. When yang is exuberant there is heat without; when yin is vacuous there is heat within; and when inside and out are both hot there is panting and thirst, and hence the desire for cold drink.

Naegyeong 內經

1.2.3

Source원문

夫瘧之始發也, 陽氣幷於陰, 當是之時, 陽虛而陰盛, 外無氣, 故先寒慄也. 陰氣逆極則復出之陽, 陽與陰復幷於外, 則陰虛而陽實, 故先熱而渴. 夫瘧氣者, 幷於陽則陽勝, 幷於陰則陰勝. 陰勝則寒, 陽勝則熱. 《內經》

Translation영역

When the fever first breaks out, the yang qi joins with the yin; at that moment yang is vacuous and yin exuberant, and there is no qi without, and so the shivering comes first. When the yin qi has gone counter to the utmost, it comes out again into the yang; and when yang and yin join again at the exterior, then yin is vacuous and yang replete, and so heat and thirst come first. As for the fever qi: joined with the yang, yang prevails; joined with the yin, yin prevails. When yin prevails there is cold; when yang prevails there is heat.

Naegyeong 內經

1.2.4

Source원문

衛虛則先寒, 榮虛則先熱. 表邪多則寒多, 裏邪多則熱多, 表裏相半, 寒熱相等. 《入門》

Translation영역

When the defence is vacuous, cold comes first; when the construction is vacuous, heat comes first. Where the evil in the exterior is greater there is more cold; where the evil in the interior is greater there is more heat; and where exterior and interior are half and half, cold and heat are equal.

Immun 入門

1.2.5

Source원문

人之榮衛, 晝行於陽陽則表也, 夜行於陰陰則裏也. 榮衛行到病所不通, 乃作寒戰鼓振, 頭頷中外皆寒, 腰脊俱痛, 此邪氣入於內也. 寒戰俱已, 內外皆熱, 頭痛如破, 渴欲飮冷, 煩滿欲吐自汗, 此邪氣發於外也. 《丹心》

Translation영역

A person's construction and defence travel by day in the yang — the yang being the exterior — and by night in the yin — the yin being the interior. When the construction and defence reach the seat of the illness and cannot pass, then come shivering and shaking, the head and jaw and centre and exterior all cold, and the lumbar spine aching throughout: this is the evil qi entering within. When the shivering has all finished and inside and out are hot, the head aching as though splitting, thirst with a desire for cold drink, vexation and fullness with retching and spontaneous sweating: this is the evil qi breaking out at the exterior.

Clinical note임상 주석

The interlinear gloss makes yang the exterior and yin the interior, and the passage then uses the day-and-night circuit of the construction and defence to explain why the fit arrives at an hour. It is the chapter's own attempt at a clock, and 1.7 develops it.

Dansim 丹心

1.2.6

Source원문

暑瘧單熱, 濕瘧多寒, 寒瘧先寒後熱, 風瘧先熱後寒, 餘皆先寒後熱. 《入門》

Translation영역

Summerheat fever is heat alone; damp fever is mostly cold; cold fever is cold first and heat after; wind fever is heat first and cold after; and all the rest are cold first and heat after.

Immun 入門

1.3 The Pulse 脉法

1.3.1

Source원문

瘧脉自弦. 弦數多熱, 弦遲多寒. 弦小緊者宜下之, 弦遲者可溫之, 弦緊者可發汗, 浮大者可吐之, 弦數者風發也, 以飮食消息止之. 《要略》

Translation영역

The pulse in fever is of itself stringlike. Stringlike and rapid, there is much heat; stringlike and slow, much cold. Stringlike, small and tight: precipitate. Stringlike and slow: it may be warmed. Stringlike and tight: sweating may be induced. Floating and large: vomiting may be induced. Stringlike and rapid is wind breaking out, and it is to be stopped by regulating food and drink.

Yoryak 要略

1.3.2

Source원문

瘧脉自弦, 微則爲虛, 代散則死. 《脉經》

Translation영역

The pulse in fever is of itself stringlike; faint, it signifies vacuity; intermittent or dissipated, the patient dies.

Maekgyeong 脉經

1.3.3

Source원문

瘧脉自弦, 弦遲多寒, 弦數多熱, 隨時變遷. 《脉訣》

Translation영역

The pulse in fever is of itself stringlike; stringlike and slow, much cold; stringlike and rapid, much heat; and it shifts with the hour.

Maekgyeol 脉訣

1.3.4

Source원문

瘧脉多弦. 但熱則弦而帶數, 寒則弦而帶遲. 亦有病久而脉極虛微而無力, 似乎不弦, 然而必於虛數之中見弦, 但不搏手耳, 細察可也. 《丹心》

Translation영역

The pulse in fever is mostly stringlike. Where there is heat alone it is stringlike with rapidity; where cold, stringlike with slowness. There are also cases where the illness is long-standing and the pulse utterly vacuous, faint and without strength, so that it seems not to be stringlike — yet the stringlike quality will certainly be found within that vacuous rapidity; it merely does not strike the finger. Examine closely and it can be done.

Dansim 丹心

1.3.5

Source원문

弦短者傷食, 弦滑者多痰, 虛微無力爲久瘧. 《醫鑑》

Translation영역

Stringlike and short: food damage. Stringlike and slippery: much phlegm. Vacuous, faint and without strength: long-standing fever.

Uigam 醫鑑

1.3.6

Source원문

瘧脉遲緩者, 病自愈. 《回春》

Translation영역

Where the pulse in fever is slow and moderate, the illness resolves of itself.

Hoechun 回春

1.4 Which Comes First, Cold or Heat 寒熱先後

1.4.1

Source원문

瘧先寒而後熱者, 由夏傷於大暑, 其汗大出, 腠理開發, 因遇夏氣凄滄之水寒, 藏於腠理皮膚之中, 秋傷於風, 則病成矣. 夫寒者陰氣也, 風者陽氣也. 先傷於寒而後傷於風, 故先寒而後熱也. 病以時作, 名曰寒瘧. 《內經》

Translation영역

That the fever is cold first and heat after comes of being injured in summer by the great summerheat, so that the sweat pours out and the interstices open; then, meeting with the chill water-cold of the summer air, it is stored within the interstices and the skin, and when autumn injures with wind the illness is complete. Now cold is a yin qi and wind a yang qi; injured first by cold and after by wind, therefore cold comes first and heat after. The illness takes hold at its hour, and is called cold fever.

Naegyeong 內經

1.4.2

Source원문

先熱而後寒者, 由先傷於風而後傷於寒, 故先熱而後寒. 亦以時作, 名曰溫瘧. 《內經》

Translation영역

That it is heat first and cold after comes of being injured first by wind and after by cold, and therefore heat comes first and cold after. This too takes hold at its hour, and is called warm fever.

Naegyeong 內經

1.4.3

Source원문

其但熱而不寒者, 陰氣先絶, 陽氣獨發, 則少氣煩寃, 手足熱而欲嘔, 名曰癉瘧. 癉謂熱也. 《內經》

Translation영역

Where there is heat alone and no cold, the yin qi is cut off first and the yang qi breaks out by itself, so that there is shortness of qi and vexed distress, the hands and feet are hot and there is a desire to retch: this is called scorching fever. 癉 means heat.

Naegyeong 內經

1.5 The Coming and Going of Cold and Heat 寒熱往來

1.5.1

Source원문

病有洒淅惡寒而復發熱者, 何也. 曰, 陰脉不足, 陽往從之; 陽脉不足, 陰往乘之. 何謂陽不足. 假令寸脉微, 名曰陽不足, 陰氣上入陽中, 則洒淅惡寒. 何謂陰不足. 假令尺脉弱, 名曰陰不足, 陽氣下陷入陰中, 則發熱也. 《仲景》

Translation영역

There are illnesses with a shivering aversion to cold and then fever again — why? The answer: when the yin pulse is insufficient, the yang goes and follows it; when the yang pulse is insufficient, the yin goes and overrides it. What is meant by yang insufficiency? Suppose the inch pulse is faint: that is called yang insufficiency, and the yin qi enters upward into the yang, and so there is a shivering aversion to cold. What is meant by yin insufficiency? Suppose the cubit pulse is weak: that is called yin insufficiency, and the yang qi falls downward into the yin, and so there is fever.

Junggyeong 仲景

1.5.2

Source원문

陽微則惡寒, 陰微則發熱. 大抵陰不足, 陽往從之, 故內陷而發熱; 陽不足, 陰往乘之, 故陰氣上入陽中則惡寒. 《仲景》

Translation영역

Where yang is faint there is aversion to cold; where yin is faint there is fever. In general, when yin is insufficient the yang goes and follows it, and so falls inward and produces fever; when yang is insufficient the yin goes and overrides it, and so the yin qi enters upward into the yang and there is aversion to cold.

Junggyeong 仲景

1.5.3

Source원문

陽不足則陰邪出表而與陽爭, 乃陰勝而爲寒也; 陰不足則陽邪入裏而與陰爭, 乃陽勝而爲熱也. 若邪入而正氣不與之爭, 則但熱而無寒矣. 陽不足則先寒, 陰不足則先熱. 表邪多則寒多, 裏邪多則熱多, 半表半裏則寒熱相等, 乍往乍來而間作也. 《入門》

Translation영역

When yang is insufficient the yin evil comes out to the exterior and contends with the yang, and so yin prevails and there is cold; when yin is insufficient the yang evil enters the interior and contends with the yin, and so yang prevails and there is heat. If the evil enters and the upright qi does not contend with it, then there is heat alone and no cold. Yang insufficient, cold comes first; yin insufficient, heat comes first. Much evil in the exterior, much cold; much in the interior, much heat; half exterior and half interior, cold and heat equal, now going and now coming, and taking hold at intervals.

Immun 入門

1.5.4

Source원문

瘧者少陽也. 少陽者, 東方之氣也. 逆行則發寒, 順行則發熱, 故分之氣異, 往來之不定也. 《東垣》

Translation영역

Fever belongs to the lesser yang, and the lesser yang is the qi of the east. Travelling counter it breaks out as cold; travelling with the flow it breaks out as heat — and so the qi of its division differs, and its coming and going is not fixed.

Dongwon 東垣

1.5.5

Source원문

身後爲太陽, 太陽者膀胱水寒也; 身前爲陽明, 陽明者大腸金燥也. 少陽之邪在其中, 近後膀胱水則惡寒, 近前陽明燥則發熱, 故爲往來寒熱也. 《東垣》

Translation영역

The back of the body is the greater yang, and the greater yang is the bladder's water cold; the front of the body is the yang brightness, and the yang brightness is the large intestine's metal dryness. The lesser yang's evil lies between them: near the back, to the bladder's water, there is aversion to cold; near the front, to the yang brightness's dryness, there is fever — and so there is cold and heat coming and going.

Dongwon 東垣

1.5.6

Source원문

甚者, 內外失守, 眞邪不分, 陰陽迭勝, 寒熱互起, 則休作無定時矣. 《直指》

Translation영역

In severe cases inside and out lose their guard, the true and the evil are not distinguished, yin and yang prevail by turns and cold and heat rise against each other — and then the stopping and taking hold have no fixed hour.

Clinical note임상 주석

休作無定時 — no fixed hour — is the chapter's own marker of a bad case, and it is a sound one. Regular periodicity belongs to an established vivax or malariae infection; falciparum malaria is characteristically irregular, and it is falciparum that kills.

Jikji 直指

1.6 How Many Days Between the Fits 瘧發日數多少

1.6.1

Source원문

夏傷於暑, 熱氣盛, 藏於皮膚之內ㆍ腸胃之外, 因秋遇風, 及得之以浴, 水氣舍於皮膚之內, 與衛氣幷居. 衛氣者, 晝日行於陽, 夜行於陰. 此氣得陽而外出, 得陰而內薄, 內外相薄, 是以日作. 《內經》

Translation영역

Injured in summer by summerheat, the heat qi is exuberant and is stored within the skin and outside the stomach and intestines; then in autumn it meets with wind, or is got by bathing, and the water qi lodges within the skin and dwells together with the defence qi. The defence qi travels by day in the yang and by night in the yin. This qi, finding the yang, comes out; finding the yin, it presses inward; and with the pressing inside and out, the fit comes daily.

Naegyeong 內經

1.6.2

Source원문

衛氣與邪相幷則病作, 與邪相離則病休. 其幷於陰則寒, 幷於陽則熱, 離於陰則寒已, 離於陽則熱已. 至次日又集而幷合, 則復病也. 《綱目》

Translation영역

When the defence qi joins with the evil the illness takes hold; when it parts from the evil the illness rests. Joined with the yin there is cold; joined with the yang, heat; parted from the yin the cold is over; parted from the yang the heat is over. When the next day comes they gather and join again, and the illness returns.

Gangmok 綱目

1.6.3

Source원문

其間日發者, 由邪氣內薄於五藏, 橫連募原也. 其道遠, 其行遲, 不能與衛氣俱行, 不得皆出, 故間日乃作也. 《內經》

Translation영역

That it breaks out on alternate days comes of the evil qi pressing inward on the five viscera and running crosswise into the membrane source. Its road is far and its travel slow; it cannot travel together with the defence qi and cannot all come out, and so it takes hold on alternate days.

Naegyeong 內經

1.6.4

Source원문

時有間二日, 或至數日發, 或渴或不渴, 其故何也. 曰, 其間日者, 邪氣與衛氣客於六府, 而有時相失, 不能相得, 故休數日乃作也. 瘧者, 陰陽更勝也, 或甚或不甚, 故或渴或不渴. 《內經》

Translation영역

Sometimes there are two days between, or it breaks out only after several days; sometimes there is thirst and sometimes not — why is this? The answer: where days intervene, the evil qi and the defence qi are lodged as guests in the six bowels and at times miss each other and cannot meet, and so it rests several days and then takes hold. Fever is yin and yang prevailing by turns, now severely and now not, and therefore there is sometimes thirst and sometimes not.

Naegyeong 內經

1.6.5

Source원문

三日一發者, 受病一年; 間日一發者, 受病半年; 連日發者, 受病一月; 二日連發住一日者, 氣血俱受病也. 又曰, 三日一發, 陰經受病也, 最重. 《丹心》

Translation영역

Breaking out once in three days, the illness has been held a year; once on alternate days, half a year; daily, a month; two days together and then one day's rest, both qi and blood have taken the illness. It says again: once in three days is the yin channels having taken the illness, and it is the gravest.

Clinical note임상 주석

The equation of a longer interval with a longer illness is the chapter reading chronicity off the clock. The grouping itself is sound observation: quartan fever — once in three days by the inclusive count — is Plasmodium malariae, which is indeed the most persistent of the species, capable of relapsing for decades.

Dansim 丹心

1.6.6

Source원문

陽爲府邪淺, 與榮衛並行, 一日一發.

Translation영역

Yang is a bowel, the evil shallow, travelling together with the construction and defence: it breaks out once a day.

Immun 入門

1.6.7

Source원문

陰爲藏邪深, 橫連募原, 不能與正氣並行, 故間日蓄積乃發, 或三四日一發, 久則必爲瘧母. 《入門》

Translation영역

Yin is a viscus, the evil deep, running crosswise into the membrane source and unable to travel together with the upright qi; so it accumulates on the intervening day and then breaks out, or once in three or four days — and in time it will certainly become a mother of fever.

Clinical note임상 주석

瘧母, the mother of the fever, is the hard mass under the ribs that 1.11 and 1.10.11 treat as the reason a fever will not leave. It is splenomegaly, the enlarged spleen of chronic malaria, and the chapter's judgment that the long-interval fevers are the ones that produce it is correct.

Immun 入門

1.7 That the Fits Differ by Day and Night, Early and Late 瘧發有晝夜早晏之異

1.7.1

Source원문

帝曰, 其作日晏與日早者, 何氣使然. 歧伯曰, 邪氣客於風府, 循膂而下, 衛氣一日一夜大會於風府, 其明日日下一節, 故其作也晏. 此先客於脊背也. 每至於風府則腠理開, 腠理開則邪氣入, 邪氣入則病作, 以此作日稍益晏也. 其出於風府, 日下一節, 二十五日下至骶骨, 二十六日入於脊內, 注於伏膂之脉, 其氣上行, 九日出於缺盆之中. 其氣日高, 故作日益早也. 《內經》

Translation영역

The Emperor said: that the fit comes later or earlier by the day — what qi brings this about? Qibo said: the evil qi lodges as a guest at the wind mansion and descends along the spine. The defence qi in one day and night holds its great meeting at the wind mansion, and on the following day descends one joint, and so the fit comes later. This is because it first lodged in the spine and back. Each time it reaches the wind mansion the interstices open; the interstices open and the evil qi enters; the evil qi enters and the illness takes hold — and by this the fit grows a little later each day. Coming out from the wind mansion it descends one joint a day, and in twenty-five days descends to the sacrum, and on the twenty-sixth day enters within the spine and pours into the vessel hidden along the spine; its qi travels upward, and in nine days comes out in the midst of the empty basin. As its qi rises higher by the day, so the fit comes earlier by the day.

Clinical note임상 주석

The thirty-five-day cycle down the spine and back up is invented anatomy serving a real observation: the hour of the paroxysm drifts. In vivax malaria the fit does shift by an hour or two from cycle to cycle, and a drift in one direction or the other is what the chapter is tracking. 1.15 turns the same drift into a sign of recovery.

Naegyeong 內經

1.7.2

Source원문

陽爲晝發, 邪淺, 榮衛晝行背與脊故也.

Translation영역

Yang breaks out by day: the evil is shallow, because the construction and defence travel by day in the back and spine.

Immun 入門

1.7.3

Source원문

陰爲夜發, 邪深, 榮衛夜行胷與腹故也.

Translation영역

Yin breaks out by night: the evil is deep, because the construction and defence travel by night in the chest and abdomen.

Immun 入門

1.7.4

Source원문

陽爲子時至巳, 陰爲午時至亥. 如發寅卯而退於未申, 或發未申而退於子丑, 皆謂之陰陽不分, 須用藥趲早, 或移時分定陰陽, 然後陽瘧截住, 陰瘧升散. 《入門》

Translation영역

Yang runs from the hour of the rat to the hour of the serpent, yin from the hour of the horse to the hour of the pig. Where it breaks out at the hours of the tiger or hare and retires at the hours of the goat or monkey, or breaks out at the goat or monkey and retires at the rat or ox, this is in every case called yin and yang undivided; medicine must be used to hurry it earlier, or to shift the hour and settle the division of yin and yang — and only then is yang fever cut short and yin fever raised and dispersed.

Immun 入門

1.7.5

Source원문

從卯至午發者, 邪在外也; 從午至酉發者, 邪在內也; 從酉至子發, 或至寅發者, 知邪在血分也. 《保命》

Translation영역

Breaking out between the hare and the horse, the evil is at the exterior; between the horse and the cock, the evil is within; breaking out between the cock and the rat, or on to the tiger, one knows the evil is in the blood division.

Bomyeongjip 保命

1.8 Fever in the Six Channels 六經瘧

1.8.1

Source원문

夏傷於暑, 秋必病瘧. 初不知何經受病, 隨其受而取之. 有中三陽者, 有中三陰者. 大抵經中邪氣, 其證各殊. 在太陽經者謂之寒瘧, 治多汗之; 在陽明經者謂之熱瘧, 治多下之; 在少陽經者謂之風瘧, 治多和之. 此三陽受病, 皆謂暴瘧, 發在夏至後ㆍ處暑前, 此乃傷之淺者, 近而暴也.

Translation영역

Injured in summer by summerheat, in autumn one falls ill of fever. At first it is not known which channel has taken the illness; one follows what it has taken and treats accordingly. Some are struck in the three yang, some in the three yin. In general, where the evil qi is in the channel the signs differ in each. In the greater yang channel it is called cold fever, and the treatment is mostly to make it sweat; in the yang brightness channel it is called heat fever, and the treatment is mostly to precipitate; in the lesser yang channel it is called wind fever, and the treatment is mostly to harmonise. These three yang taking the illness are all called sudden fever, breaking out after the summer solstice and before the end of heat — this being the shallow injury, near at hand and violent.

Bomyeongjip 保命

1.8.2

Source원문

在陰經者, 則不分三陰, 皆謂之溫瘧. 其發在處暑後ㆍ冬至前, 此乃傷之重者, 遠而深也. 痎瘧者, 老瘧也, 故謂之久瘧. 《保命》

Translation영역

Where it is in the yin channels, the three yin are not distinguished but all are called warm fever. These break out after the end of heat and before the winter solstice — this being the severe injury, distant and deep. 痎瘧 is the old fever, and so is called the long-standing fever.

Bomyeongjip 保命

1.8.3

Source원문

傷寒餘熱未淨, 重感於寒而變瘧, 名曰溫瘧, 亦曰風瘧. 此爲傷寒壞病, 其證先熱後寒. 《入門》

Translation영역

Where the residual heat of cold damage is not yet cleared and cold is contracted again so that it turns into fever, it is called warm fever, and also wind fever. This is a ruined case of cold damage, and its signs are heat first and cold after.

Immun 入門

1.8.4

Source원문

瘧屬三陽, 宜汗宜吐; 瘧屬三陰, 宜下宜和宜溫. 《正傳》

Translation영역

Fever belonging to the three yang: sweat it, or make it vomit. Fever belonging to the three yin: precipitate it, harmonise it, or warm it.

Jeongjeon 正傳

1.8.5

Source원문

太陽瘧, 宜桂枝羌活湯ㆍ麻黃羌活湯.

Translation영역

For greater yang fever, Cinnamon Twig and Notopterygium Decoction or Ephedra and Notopterygium Decoction is appropriate.

Bomyeongjip 保命

1.8.6

Source원문

陽明瘧, 宜人參白虎湯ㆍ柴苓湯二方並見寒門.

Translation영역

For yang brightness fever, Ginseng White Tiger Decoction or Bupleurum and Poria Decoction is appropriate — both formulas are given in the Cold Damage chapter.

Bomyeongjip 保命

1.8.7

Source원문

少陽瘧, 宜柴胡桂枝湯ㆍ柴胡加桂湯.

Translation영역

For lesser yang fever, Bupleurum and Cinnamon Twig Decoction or Bupleurum with Added Cinnamon Decoction is appropriate.

Bomyeongjip 保命

1.8.8

Source원문

三陰溫瘧, 宜白虎桂枝湯ㆍ麻黃白朮湯, 或小柴胡合四物湯, 名曰柴胡四物湯.

Translation영역

For warm fever of the three yin, White Tiger and Cinnamon Twig Decoction or Ephedra and White Atractylodes Decoction is appropriate, or Minor Bupleurum combined with Four Substances Decoction, which is called Bupleurum Four Substances Decoction.

Bomyeongjip 保命

1.8.9

Source원문

太陽陽明合病, 桂枝芍藥湯ㆍ桂枝石膏湯. 三陽合病, 宜桂枝黃芩湯以和之. 《保命》

Translation영역

For a combined illness of greater yang and yang brightness, Cinnamon Twig and Peony Decoction or Cinnamon Twig and Gypsum Decoction. For a combined illness of the three yang, Cinnamon Twig and Scutellaria Decoction is appropriate, to harmonise it.

Clinical note임상 주석

The six-channel scheme is borrowed wholesale from cold damage doctrine, and so are the formulas: every one named here is a cinnamon-twig, ephedra, bupleurum or white-tiger variant. 1.13 says the same thing outright — 桂枝湯治太陽, 白虎湯治陽明, 小柴胡湯治少陽.

Bomyeongjip 保命

1.9 Fevers Breaking Out by Day and by Night Should Be Treated Separately 瘧晝發夜發宜分治

1.9.1

Source원문

氣虛晝發, 宜六君子湯方見痰門ㆍ補中益氣湯方見內傷加半夏ㆍ黃芩.

Translation영역

For qi vacuity breaking out by day, Six Gentlemen Decoction — the formula is given in the Phlegm chapter — or Centre-Supplementing Qi-Boosting Decoction — the formula is given in the Internal Damage chapter — with pinellia and scutellaria added is appropriate.

Jebang 諸方

1.9.2

Source원문

血虛夜發, 宜柴胡四物湯方見上ㆍ桃仁承氣湯方見寒門ㆍ麻黃黃芩湯ㆍ柴胡芎歸湯. 《諸方》

Translation영역

For blood vacuity breaking out by night, Bupleurum Four Substances Decoction — the formula is given above — Peach Kernel Qi-Coordinating Decoction — the formula is given in the Cold Damage chapter — Ephedra and Scutellaria Decoction, or Bupleurum, Chuanxiong and Tangkuei Decoction is appropriate.

Clinical note임상 주석

Day and night are read as qi and blood, and the division decides the prescription: a spleen-supplementing formula for the daytime fever, a blood-moving one for the night. The chapter is consistent about this — 1.7's hours, 1.9's formulas and 1.13's 夜發加桃仁赤芍藥 are the same rule applied three times.

Jebang 諸方

1.10 The Signs and Treatment of the Several Fevers 諸瘧證治

1.10.1

Source원문

瘧有風瘧ㆍ寒瘧ㆍ熱瘧ㆍ濕瘧ㆍ痰瘧ㆍ食瘧ㆍ勞瘧ㆍ鬼瘧ㆍ疫瘧ㆍ瘴瘧ㆍ痎瘧ㆍ老瘧. 《諸方》

Translation영역

Fevers include wind fever, cold fever, heat fever, damp fever, phlegm fever, food fever, taxation fever, demon fever, epidemic fever, miasma fever, intermittent fever and old fever.

Clinical note임상 주석

Twelve names for one chapter's worth of illness, and the last two are the same thing — 1.10.11 glosses 痎瘧 as 老瘧 in its first line. The list is a differential by cause and season rather than by organism, and it is worth reading as such: the same paroxysm is being sorted by what the physician thought brought it on.

Jebang 諸方

1.10.1 Wind Fever 風瘧

1.10.1.1

Source원문

風瘧, 自感風而得, 先熱後寒. 宜麻黃白朮湯. 無汗則宜散邪湯, 有汗則宜正氣湯. 《入門》

Translation영역

Wind fever is got from contracting wind, and is heat first and cold after. Ephedra and White Atractylodes Decoction is appropriate. Where there is no sweat, Evil-Dispersing Decoction; where there is sweat, Upright Qi Decoction.

Immun 入門

1.10.2 Cold Fever 寒瘧

1.10.2.1

Source원문

寒瘧, 自感寒而得, 寒多熱少. 宜人參養胃湯方見寒門ㆍ交解飮ㆍ果附湯ㆍ草果飮ㆍ柴胡桂薑湯. ○一名牝瘧. 《入門》

Translation영역

Cold fever is got from contracting cold, and has much cold and little heat. Ginseng Stomach-Nourishing Decoction — the formula is given in the Cold Damage chapter — Interchange-Resolving Beverage, Tsaoko and Aconite Decoction, Tsaoko Beverage, or Bupleurum with Cinnamon Twig and Ginger Decoction is appropriate. ○ Another name is female fever.

Immun 入門

1.10.3 Heat Fever 熱瘧

1.10.3.1

Source원문

熱瘧, 因暑勝熱多得之. 一名癉瘧, 亦曰暑瘧. 宜人參白虎湯ㆍ柴苓湯二方見寒門ㆍ柴胡知母湯ㆍ爭功散ㆍ龍虎湯. 《入門》

Translation영역

Heat fever is got where summerheat prevails and heat is abundant. Another name is scorching fever, and it is also called summerheat fever. Ginseng White Tiger Decoction or Bupleurum and Poria Decoction — both formulas are given in the Cold Damage chapter — Bupleurum and Anemarrhena Decoction, Merit-Contending Powder, or Dragon and Tiger Decoction is appropriate.

Immun 入門

1.10.4 Damp Fever 濕瘧

1.10.4.1

Source원문

濕瘧, 因冒襲雨濕ㆍ汗出澡浴得之. 寒熱相半, 小便不利. 宜五苓散方見寒門加蒼朮ㆍ川芎ㆍ羌活. 《入門》

Translation영역

Damp fever is got from braving rain and damp, or from bathing while sweating. Cold and heat are half and half, and urination is inhibited. Five Ingredient Powder with Poria — the formula is given in the Cold Damage chapter — with atractylodes, chuanxiong and notopterygium added is appropriate.

Immun 入門

1.10.5 Phlegm Fever 痰瘧

1.10.5.1

Source원문

痰瘧, 因外感內傷鬱聚成痰. 頭痛肉跳, 吐食嘔沫, 甚則昏迷卒倒. 宜柴陳湯加草果, 或四獸飮ㆍ冷附湯. 久不止, 以露薑飮截之. 《入門》

Translation영역

Phlegm fever comes of external contraction or internal damage gathering in depression and forming phlegm. There is headache and twitching of the flesh, vomiting of food and retching of froth, and in severe cases clouding and sudden collapse. Bupleurum and Pinellia Decoction with tsaoko added is appropriate, or Four Beasts Beverage or Cold Aconite Decoction. Where it will not stop for a long time, cut it short with Dew-Exposed Ginger Beverage.

Immun 入門

1.10.5.2

Source원문

有人忽得瘧疾, 嘔吐異常. 以二陳湯方見痰門加人參ㆍ縮砂, 倍用白豆蔲, 進一二貼, 自然寒熱不作. 盖白豆蔲能消能磨, 流行三焦, 榮衛一轉, 寒熱自平也. 《直指》

Translation영역

There was a man who suddenly took the fever illness with retching and vomiting beyond the ordinary. Two Matured Ingredients Decoction — the formula is given in the Phlegm chapter — with ginseng and amomum added and round cardamom doubled was given, one or two packets, and the cold and heat of themselves ceased to take hold. For round cardamom can disperse and can grind; it flows through the three burners, and once the construction and defence have turned, the cold and heat level of themselves.

Jikji 直指

1.10.6 Food Fever 食瘧

1.10.6.1

Source원문

食瘧, 一名胃瘧. 因飮食失節, 飢飽有傷所致. 寒已復熱, 熱已復寒, 寒熱交倂, 苦飢而不能食, 食則吐痰. 經曰, 寒熱善飢而不能食, 食已支滿腹脹, 病以日作, 名曰胃瘧, 是也. 宜平陳湯加枳實ㆍ白朮ㆍ山楂子ㆍ神麴ㆍ靑皮, 或淸脾飮ㆍ小淸脾湯. 又二陳湯加靑皮ㆍ檳榔ㆍ縮砂ㆍ白豆蔲亦佳. 《諸方》

Translation영역

Food fever is also called stomach fever. It is brought on by failing to moderate food and drink, so that hunger and surfeit do injury. The cold over, heat returns; the heat over, cold returns; cold and heat press together; the patient suffers hunger yet cannot eat, and if he eats he vomits phlegm. The Classic says: cold and heat, with a ready hunger yet an inability to eat, and once food is taken propping fullness and abdominal distension, the illness taking hold daily — this is called stomach fever; and so it is. Level Pinellia Decoction with unripe bitter orange, white atractylodes, hawthorn, medicated leaven and green tangerine peel added is appropriate, or Spleen-Clearing Beverage or Minor Spleen-Clearing Decoction. Two Matured Ingredients Decoction with green tangerine peel, areca, amomum and round cardamom added is also good.

Jebang 諸方

1.10.7 Taxation Fever 勞瘧

1.10.7.1

Source원문

勞瘧, 卽久瘧也. 寒熱微微, 寒中有熱, 熱中有寒, 最難調治. 由表裏俱虛, 眞元未復, 疾雖暫止, 小勞復來, 經年不差. 宜芎歸鼈甲散ㆍ常山飮ㆍ五勞元ㆍ六和湯ㆍ烏頭七棗湯ㆍ露薑養胃湯ㆍ十將軍丸ㆍ一補一發丹ㆍ辰砂元ㆍ養胃丹. 《諸方》

Translation영역

Taxation fever is the long-standing fever. The cold and heat are slight; there is heat within the cold and cold within the heat, and it is the hardest of all to regulate. It comes of exterior and interior both being vacuous and the true origin not yet restored, so that although the illness stops for a time, a little exertion brings it back, and it does not mend for years. Chuanxiong, Tangkuei and Turtle Shell Powder, Dichroa Beverage, Five Taxations Elixir, Six Harmonies Decoction, Aconite Main Tuber and Seven Jujubes Decoction, Dew-Exposed Ginger Stomach-Nourishing Decoction, Ten Generals Pill, One-Supplementing One-Dispersing Elixir, Cinnabar Elixir, or Stomach-Nourishing Elixir is appropriate.

Jebang 諸方

1.10.7.2

Source원문

久瘧屬元氣虛寒. 盖氣虛則寒, 血虛則熱, 胃虛則惡寒, 脾虛則發熱. 陰火下流則寒熱交作, 或吐涎不食, 或泄瀉腹痛, 手足逆冷, 寒戰如慄, 皆脾胃虛弱也. 但服補中益氣湯方見內傷, 諸證悉愈. 若投淸脾截瘧, 多致不起. 《醫鑑》

Translation영역

Long-standing fever belongs to vacuity cold of the original qi. For where qi is vacuous there is cold, where blood is vacuous there is heat, where the stomach is vacuous there is aversion to cold, and where the spleen is vacuous there is fever. When yin fire flows downward, cold and heat take hold by turns; there may be vomiting of drool and no eating, or diarrhoea with abdominal pain, counterflow cold of the hands and feet, and shivering as with a rigor — and all of this is vacuity and weakness of the spleen and stomach. Simply give Centre-Supplementing Qi-Boosting Decoction — the formula is given in the Internal Damage chapter — and all the signs are cured. If spleen-clearing and fever-cutting are administered, in most cases the patient does not get up again.

Clinical note임상 주석

The warning is the most useful clinical sentence in the chapter: in a patient already wasted by months of relapsing fever, the violent emetic and purgative 截瘧 preparations finish him. 多致不起 — most do not get up again — is the Uigam setting itself against the chapter's own main line of treatment, and the Bogam prints both.

Uigam 醫鑑

1.10.8 Demon Fever 鬼瘧

1.10.8.1

Source원문

鬼瘧, 因感尸疰客忤. 寒熱日作, 夢寐不祥, 多生恐怖. 宜辟邪丹ㆍ雄朱丹, 或燒人場土作丸, 塞男左女右鼻中. 《入門》

Translation영역

Demon fever comes of contracting corpse infixation or a guest offence. Cold and heat take hold daily, sleep is full of ill omens, and much fright arises. Evil-Averting Elixir or Realgar and Cinnabar Elixir is appropriate; or earth from a cremation ground is made into pills and stopped into the left nostril in a man, the right in a woman.

Clinical note임상 주석

**The pills of cremation-ground earth are not to be prepared, and neither of the two elixirs named here is: one is built on realgar, which is arsenic, and cinnabar, which is mercury.** The section is the chapter at its furthest from observation. What it is describing is probably the delirium and nightmares of a high malarial fever, read back as its cause.

Immun 入門

1.10.9 Epidemic Fever 疫瘧

1.10.9.1

Source원문

疫瘧, 一方長幼相似, 或染時行, 變成寒熱. 須參運氣用藥. 宜不換金正氣散方見寒門ㆍ如意丹ㆍ五瘟丹ㆍ瘴疸丸三方見瘟疫. 《入門》

Translation영역

In epidemic fever a whole district, old and young alike, is the same; or a seasonal contagion is caught and turns into cold and heat. The circuit qi must be consulted in using medicine. Gold-Unexchangeable Upright Qi Powder — the formula is given in the Cold Damage chapter — As-You-Wish Elixir, Five Pestilences Elixir, or Miasma Jaundice Pill — all three formulas are given in the Epidemic Pestilence chapter — is appropriate.

Clinical note임상 주석

一方長幼相似 — a whole district, old and young alike — is the chapter noticing that this one spreads. Malaria does arrive in epidemics where the mosquito does, and a district falling ill together is the pattern of a transmission season rather than of a contagion passed person to person; the chapter has the observation without the vector.

Immun 入門

1.10.10 Miasma Fever 瘴瘧

1.10.10.1

Source원문

瘴瘧, 挾山溪嵐瘴蒸毒之氣, 令人迷困發狂, 或啞, 乍寒乍熱, 乍有乍無. 南方多病此. 宜雙解飮子ㆍ地龍飮ㆍ羌活蒼朮湯ㆍ瘴疸丸方見疸門ㆍ觀音元. 《諸方》

Translation영역

Miasma fever carries the qi of the mountain-stream vapours and the steaming poison of the miasma; it makes the patient dazed and heavy and sends him mad, or mute, now cold and now hot, now present and now gone. In the south this illness is common. Double-Resolving Beverage, Earthworm Beverage, Notopterygium and Atractylodes Decoction, Miasma Jaundice Pill — the formula is given in the Jaundice chapter — or Avalokitesvara Elixir is appropriate.

Clinical note임상 주석

瘴 is the bad air of hot wet country, and 南方多病此 — in the south this illness is common — is correct for the reason the chapter could not know: the south is where the anopheline mosquito breeds. The cerebral signs it lists here, madness and muteness with an irregular fever, are the ones that mark falciparum malaria, which is the species of the hot south and the one that kills.

Jebang 諸方

1.10.11 Intermittent Fever 痎瘧

1.10.11.1

Source원문

痎瘧者, 老瘧也, 以其隔三日一發, 纏綿不去也. 《綱目》

Translation영역

痎瘧 is the old fever, so called because it breaks out once every third day and drags on without leaving.

Gangmok 綱目

1.10.11.2

Source원문

三日一作者, 邪入於三陰經也. 作於子午卯酉日者, 少陰經瘧也; 作於寅申巳亥日者, 厥陰經瘧也; 作於辰戌丑未日者, 太陰經瘧也. 瘧得於暑, 當以汗解. 夫感冒與風皆外邪也, 故非汗多不解. 必先與參朮等補劑爲君, 加柴葛等發散藥, 漸而收汗. 得汗而虛, 又行補養. 下體屬陰, 最難得汗; 補藥力到, 汗出至足, 方是佳兆. 《丹心》

Translation영역

That it takes hold once in three days is the evil having entered the three yin channels. Taking hold on the days of the rat, horse, hare and cock, it is a lesser yin channel fever; on the days of the tiger, monkey, serpent and pig, a reverting yin channel fever; on the days of the dragon, dog, ox and goat, a greater yin channel fever. Fever is got from summerheat and should be resolved by sweating. Now contraction and wind are both external evils, and so without much sweat there is no resolving them. One must first give supplementing agents such as ginseng and atractylodes as sovereign, add dispersing medicinals such as bupleurum and pueraria, and gradually gather the sweat. Having got the sweat, the patient is vacuous, and nourishment is given again. The lower body belongs to yin and is the hardest to bring to sweat; when the strength of the supplementing medicine has arrived and the sweat comes out as far as the feet, that is the good omen.

Dansim 丹心

1.10.11.3

Source원문

老瘧係風暑之邪入在陰分, 宜用血藥引出陽分而散. 古方多用峻劑, 恐非所宜. 《丹心》

Translation영역

Old fever is a case of the wind and summerheat evil having entered the yin division; blood medicinals should be used to draw it out into the yang division and disperse it. The old formulas mostly use drastic agents, which is to be feared as not appropriate.

Dansim 丹心

1.10.11.4

Source원문

若感病極深, 雖得大汗, 所感之邪必自藏傳出至府, 其發無時, 必亂而失期. 若發於午之後ㆍ寅之前者, 血受病也, 爲難愈, 須漸趲早亦是佳兆. 故治此病, 春夏爲易, 秋冬爲難, 非有他也, 以汗之難易爲優劣也. 《丹心》

Translation영역

If the contracted illness is very deep, then although a great sweat is obtained, the evil contracted must pass out from the viscus to the bowel, and its breaking out has no hour but is certain to be disordered and to miss its term. If it breaks out after the hour of the horse and before the hour of the tiger, the blood has taken the illness and it is hard to cure; it must be hurried gradually earlier, and that too is a good omen. So in treating this illness spring and summer are easy and autumn and winter hard — for no other reason than that the ease or difficulty of sweating makes it better or worse.

Dansim 丹心

1.10.11.5

Source원문

凡瘧經年不差, 謂之老瘧. 必有痰水瘀血結成痞塊, 藏於腹脇, 作脹且痛, 乃瘧母也. 雖內虛, 非常山ㆍ檳榔决不能除, 但須製熟則不損胃, 老瘧丸是也. 血虛者宜鼈甲丸, 有水癖者暫用消癖元, 以補脾化痰湯藥輔之, 且量虛實用老瘧飮. 《入門》

Translation영역

Any fever that does not mend for years is called old fever. There is certain to be phlegm water and static blood bound into a lump, lodged in the abdomen and flanks, making distension and pain: this is the mother of the fever. Although the patient is vacuous within, without dichroa and areca it cannot be removed at all; only they must be processed until matured, and then they do not injure the stomach — Old Fever Pill is the formula. For blood vacuity, Turtle Shell Pill is appropriate; where there is a water aggregation, use Aggregation-Dispersing Elixir for a time, supported by spleen-supplementing and phlegm-transforming decoctions; and gauging vacuity and repletion, use Old Fever Beverage.

Clinical note임상 주석

**Dichroa is a violent emetic and is hepatotoxic; the formulas built on it are not to be prepared.** This is the passage that names the enlarged spleen — a lump in the flank, distended and painful, in a patient who has had fever for years — and ties it to the relapses. 製熟, processing until matured, is the chapter's attempt to keep the dichroa from emptying the patient's stomach, and the repeated insistence on it is a measure of how roughly the drug was acting.

Immun 入門

1.10.11.6

Source원문

老瘧, 宜七棗湯ㆍ鼈甲飮子ㆍ參歸鼈甲散ㆍ秘方淸脾丸ㆍ經效瘧丹ㆍ黃甲丸.

Translation영역

For old fever, Seven Jujubes Decoction, Turtle Shell Beverage, Ginseng, Tangkuei and Turtle Shell Powder, Secret Formula Spleen-Clearing Pill, Proven Fever Elixir, or Yellow Carapace Pill is appropriate.

Donguibogam · Haehak

1.11 That a Fever Whose Cold and Heat Will Not Cease Has a Root 瘧寒熱不歇有根

1.11.1

Source원문

瘧之寒熱不歇者, 有根在也. 根者何. 曰飮, 曰水, 曰敗血, 是爾. 惟癖爲瘧之母, 惟敗血爲暑熱之毒, 惟飮與水皆生寒熱. 故治法, 挾水飮者爲之逐水消飮, 結癖者脇必痛, 爲之攻癖, 敗血暑毒隨證而疏利之, 則寒熱自除矣.

Translation영역

Where the cold and heat of a fever will not cease, there is a root present. What is the root? Rheum, water, and decayed blood — these. The aggregation alone is the mother of the fever; decayed blood alone is the poison of summerheat; and rheum and water both of them generate cold and heat. So in the method of treatment: where water and rheum are carried, drive out the water and disperse the rheum; where an aggregation is bound, the flank will certainly ache, and the aggregation is to be attacked; and decayed blood and summerheat poison are to be freed and drained according to the signs — and then the cold and heat are removed of themselves.

Jikji 直指

1.11.2

Source원문

凡瘧皆因停蓄黃水, 或於脇間結癖. 惟癖爲能生寒熱, 若取下毒水, 去其病根, 則寒熱自解. 所以瘧劑多用常山, 盖水在上則吐之, 水在中下則亦能破其癖而下其水故也. 《直指》

Translation영역

Every fever is caused by yellow water standing and gathering, or by an aggregation bound in the flank. The aggregation alone is able to generate cold and heat; if the poisoned water is taken downward and the root of the illness removed, the cold and heat resolve of themselves. This is why the fever agents mostly use dichroa — for when the water is above it makes it vomited up, and when the water is in the middle or below it is likewise able to break the aggregation and bring the water down.

Clinical note임상 주석

**Dichroa is a violent emetic and is hepatotoxic and must not be prepared.** The reasoning here is the clearest statement of why the chapter uses the drug it does: the fever has a root, the root is the lump in the flank, and dichroa is credited with breaking the lump. What dichroa actually does is kill the parasite; the relapses stop and the spleen in time comes down, which from the outside looks exactly like the lump being broken.

Jikji 直指

1.12 Cold and Heat Resembling Fever 寒熱似瘧

1.12.1

Source원문

帝曰, 火熱復惡寒發熱, 有如瘧狀, 或一日發, 或間日發, 其故何也. 歧伯曰, 勝復之氣, 會遇之時有多少也. 陰氣多而陽氣少, 則其發日遠; 陽氣多而陰氣少, 則其發日近. 此勝復相薄, 盛衰之節, 瘧亦同法. 《內經》

Translation영역

The Emperor said: in fire heat there is again aversion to cold and then fever, having the manner of a fever illness, breaking out either daily or on alternate days — what is the reason? Qibo said: in the qi of prevailing and retribution, the times of meeting are more or fewer. Where the yin qi is abundant and the yang qi scant, the days between its breaking out are far; where the yang qi is abundant and the yin scant, they are near. This is prevailing and retribution pressing on each other, the measure of waxing and waning — and fever follows the same law.

Naegyeong 內經

1.12.2

Source원문

感冒之人, 忽覺毛寒股慄, 百骸鼓撼, 嘔不能食, 未幾轉而發熱, 皆似瘧證. 不必脉弦, 但隨證施治. 熱多, 小柴胡湯; 寒多, 人參養胃湯和解之. 內傷虛者, 補中益氣湯方見內傷加山楂ㆍ麥芽ㆍ白豆蔲, 扶脾自止矣. 《入門》

Translation영역

In a person who has caught a contraction, there is a sudden sense of cold in the hairs and trembling in the thighs, every bone shaking, retching with an inability to eat, and before long it turns to fever: all of this resembles the signs of the fever illness. The pulse need not be stringlike; one simply treats according to the signs. Where heat is greater, Minor Bupleurum Decoction; where cold is greater, Ginseng Stomach-Nourishing Decoction, to harmonise and resolve it. Where internal damage has left the patient vacuous, Centre-Supplementing Qi-Boosting Decoction — the formula is given in the Internal Damage chapter — with hawthorn, malt and round cardamom added will support the spleen and it will stop of itself.

Clinical note임상 주석

A section on what is not malaria, and the distinction it draws is the right one: a rigor with fever following, in a patient who has simply caught something, without the stringlike pulse and without the schedule. 不必脉弦 — the pulse need not be stringlike — is the chapter declining to make the pulse decide.

Immun 入門

1.13 The Method of Treating the Fever Illness 瘧疾治法

1.13.1

Source원문

內經主於暑風, 局方主於傷食, 丹溪主於痰. 雖三因雜至, 錯亂氣血, 然捷徑以袪暑消痰爲要. 通用二陳湯方見痰門, 無汗加葛根ㆍ柴胡, 氣虛加參朮, 熱甚加芩連, 寒多加草果, 口渴加烏梅. 《入門》

Translation영역

The Inner Classic makes summerheat and wind the master of it, the Gukbang makes food damage the master, and Danxi makes phlegm the master. Though the three causes arrive mixed together and throw the qi and blood into disorder, the short road is to make dispelling summerheat and dispersing phlegm the essential. Two Matured Ingredients Decoction is used in general — the formula is given in the Phlegm chapter — with pueraria and bupleurum added where there is no sweat, ginseng and atractylodes where qi is vacuous, scutellaria and coptis where heat is severe, tsaoko where cold is abundant, and mume where there is thirst.

Immun 入門

1.13.2

Source원문

無汗者要有汗, 散邪爲主, 帶補; 有汗者要無汗, 扶正氣爲主, 帶散邪. 宜散邪湯ㆍ正氣湯. 《丹心》

Translation영역

Where there is no sweat, sweat is wanted: dispersing the evil is the master, with supplementation carried alongside. Where there is sweat, no sweat is wanted: supporting the upright qi is the master, with dispersing the evil carried alongside. Evil-Dispersing Decoction or Upright Qi Decoction is appropriate.

Dansim 丹心

1.13.3

Source원문

寒瘧非草果ㆍ厚朴不能溫散, 熱瘧非柴胡ㆍ黃芩不能淸解. 陽瘧無汗, 須用柴胡ㆍ蒼朮ㆍ乾葛; 陰瘧無汗, 須用柴胡ㆍ升麻ㆍ川芎; 汗多, 須用白朮ㆍ烏梅以歛之. 《入門》

Translation영역

Cold fever cannot be warmed and dispersed without tsaoko and magnolia bark; heat fever cannot be cleared and resolved without bupleurum and scutellaria. For yang fever without sweat, bupleurum, atractylodes and dried pueraria must be used; for yin fever without sweat, bupleurum, cimicifuga and chuanxiong; and where sweat is excessive, white atractylodes and mume must be used to astringe it.

Immun 入門

1.13.4

Source원문

先熱後寒, 宜小柴胡湯; 先寒後熱, 宜柴胡加桂湯; 多熱但熱, 宜白虎桂枝湯; 多寒但寒, 宜柴胡桂薑湯. 《綱目》

Translation영역

Heat first and cold after: Minor Bupleurum Decoction. Cold first and heat after: Bupleurum with Added Cinnamon Decoction. Much heat, or heat alone: White Tiger and Cinnamon Twig Decoction. Much cold, or cold alone: Bupleurum with Cinnamon Twig and Ginger Decoction.

Gangmok 綱目

1.13.5

Source원문

痎瘧熱多者, 投以半冷半熱解散分陰陽減寒熱之劑, 度其所作之日, 先一時進以抵截之藥, 去其痰水, 則收效矣. 寒多者, 投以半生半熟壯脾進食之劑, 次以抵截之藥, 則痰癖去而疾愈矣. 須令愼飮食ㆍ謹起居, 則無復攻之患矣. 《得效》

Translation영역

Where intermittent fever has much heat, administer an agent half cold and half hot, resolving and dispersing, dividing yin from yang and reducing the cold and heat; reckon the day on which it will take hold and, one double-hour beforehand, give the fever-blocking medicine to remove the phlegm water — and the effect will be gathered. Where there is much cold, administer an agent half raw and half cooked, to strengthen the spleen and bring on appetite, and then the fever-blocking medicine — and the phlegm aggregation goes and the illness is cured. The patient must be made careful of food and drink and circumspect in rising and resting, and then there is no trouble of its attacking again.

Clinical note임상 주석

先一時進 — give it one double-hour before the fit is due — is timed dosing, and the timing comes straight from the periodicity of 1.6. Giving an antimalarial ahead of the expected paroxysm is sound practice; what the chapter lacked was a drug that could be given safely enough to repeat.

Deukhyo 得效

1.13.6

Source원문

桂枝湯治太陽, 白虎湯治陽明, 小柴胡湯治少陽, 意甚明顯. 挾痰合二陳湯, 食積合平胃散, 尿澁合五苓散, 便閉合大柴胡湯. 無汗加乾葛ㆍ蒼朮, 有汗加黃芪ㆍ白朮, 夜發加桃仁ㆍ赤芍藥, 日久加常山ㆍ檳榔吐之. 治瘧之法盡矣. 《入門》

Translation영역

Cinnamon Twig Decoction treats the greater yang, White Tiger Decoction the yang brightness, Minor Bupleurum Decoction the lesser yang — the intention is perfectly plain. Where phlegm is carried, combine with Two Matured Ingredients Decoction; for food accumulation, with Stomach-Levelling Powder; for rough urination, with Five Ingredient Powder with Poria; for stopped stool, with Major Bupleurum Decoction. Where there is no sweat add dried pueraria and atractylodes; where there is sweat, astragalus and white atractylodes; for breaking out at night, peach kernel and red peony; and where it is long-standing, add dichroa and areca and make him vomit. The method of treating fever is complete in this.

Clinical note임상 주석

治瘧之法盡矣 — the method is complete in this — closes the section, and the recipe it closes with is the six-channel scheme of 1.8 plus a list of additions. **The last instruction, dichroa and areca to induce vomiting, is not to be followed.**

Immun 入門

1.14 That Treating Fever Requires Medicines Which Divide Yin from Yang 治瘧須用分陰陽之藥

1.14.1

Source원문

瘧疾者, 陰陽交爭, 寒熱互作. 用藥須半生半熟ㆍ半冷半熱, 乃收十全之功.

Translation영역

In the fever illness yin and yang contend together and cold and heat take hold by turns. In using medicine it must be half raw and half cooked, half cold and half hot, and only so is the full effect gathered.

Deukhyo 得效

1.14.2

Source원문

諺云, 無痰不成瘧. 盖半生半熟, 所以分陰陽解寒熱也. 《得效》

Translation영역

The saying goes: without phlegm no fever is made. For half raw and half cooked is the means of dividing yin from yang and resolving cold and heat.

Clinical note임상 주석

半生半熟 is literal: part of the drug raw and part of it cooked in the same packet, on the reasoning that an illness made of two opposed halves needs a medicine made the same way. It is symmetry doing the work of pharmacology, and it is the chapter's own explanation for a practice that the 截瘧 formulas follow throughout.

Deukhyo 得效

1.15 Knowing That the Fever Is About to Mend 知瘧將差

1.15.1

Source원문

少陽證知可解者, 寒熱日不移時而作, 邪未退也. 若用柴胡而移其時, 早移之于晏, 晏移之于早, 氣移之于血, 血移之于氣, 是邪無可容之地, 知可解也. 《海藏》

Translation영역

As to knowing that a lesser yang case can be resolved: while the cold and heat take hold day after day without shifting their hour, the evil has not yet retreated. If bupleurum is used and the hour shifts — early shifting to late, late to early, qi shifting to blood, blood to qi — then the evil has no ground it can occupy, and one knows it can be resolved.

Clinical note임상 주석

The sign of recovery is the schedule breaking down. Clinically this is backwards and forwards at once: a fever losing its periodicity under treatment is indeed often a fever being cleared, but loss of periodicity without treatment is the mark of the dangerous species — which is what 1.5's 休作無定時 says.

Haejang 海藏

1.15.2

Source원문

若移時或早或晩, 是邪無容地, 瘧將差也. 《醫鑑》

Translation영역

If the hour shifts, whether earlier or later, the evil has no ground to occupy and the fever is about to mend.

Uigam 醫鑑

1.16 The Method of Cutting the Fever Short 截瘧法

1.16.1

Source원문

凡瘧數發之後, 便宜截而除之. 久則中氣虛弱, 病邪已深而難治. 世有砒丹等截藥, 大毒, 不可輕用. 《正傳》

Translation영역

After a fever has broken out several times, it is proper at once to cut it short and remove it; for if it is long-standing the centre qi is vacuous and weak, the illness evil already deep, and it is hard to treat. There are in the world arsenic elixirs and the like as fever-cutting medicines; they are greatly toxic and must not be used lightly.

Clinical note임상 주석

**砒丹 is arsenic trioxide. These preparations are lethal and must never be prepared.** The Jeongjeon's warning is the chapter opening its most aggressive section with a caution against the drugs that section's name was associated with, and the caution is correct: arsenic was used against malaria into the nineteenth century and killed people doing it.

Jeongjeon 正傳

1.16.2

Source원문

若用截藥吐出黃膠水者, 瘧自愈也. 不可一二日早截, 早則邪氣閉塞而成壞證; 又不可遲截, 遲則元氣衰憊而成虛怯. 當在三四日就截爲好. 須待熱退身凉, 方可飮食也. 切不可帶熱飮食, 恐不消而成痞, 痞散成鼓者有之矣. 《回春》

Translation영역

If on using a fever-cutting medicine a yellow glutinous water is vomited up, the fever is cured of itself. It must not be cut early, on the first or second day: cut early, the evil qi is blocked and shut in and a ruined case is made. Nor must it be cut late: cut late, the original qi is worn down and a vacuous timidity is made. It is best to cut it on the third or fourth day. One must wait until the heat has retreated and the body is cool before there can be food or drink. On no account may food or drink be taken while the heat is still carried, for fear that it will not be digested and will make a glomus — and there are cases where the glomus has spread and become drum distension.

Hoechun 回春

1.16.3

Source원문

凡瘧須分利陰陽, 柴苓湯方見寒門最效. 甚者截而除之, 不二飮ㆍ勝金丸之類截之. 不愈, 乃氣大虛, 要扶胃氣爲本, 露薑養胃湯ㆍ養胃丹之類方見上. 又有經歲久瘧, 汗吐下不愈, 榮衛虧損, 邪氣伏藏脇間, 結爲癥痞, 謂之瘧母, 痎瘧飮ㆍ黃甲丸之類方見上○醫鑑.

Translation영역

In every fever yin and yang must be divided and drained, and Bupleurum and Poria Decoction — the formula is given in the Cold Damage chapter — is the most effective. In severe cases cut it short and remove it, cutting it with such as Second-to-None Beverage or Gold-Surpassing Pill. If it is not cured, then the qi is greatly vacuous and supporting the stomach qi must be made the root, with such as Dew-Exposed Ginger Stomach-Nourishing Decoction or Stomach-Nourishing Elixir — the formulas are given above. There are also fevers of years' standing which sweating, vomiting and precipitation have not cured, where the construction and defence are depleted and the evil qi lies hidden in the flank, bound into a concretion and glomus, which is called the mother of the fever: such as Intermittent Fever Beverage or Yellow Carapace Pill — the formulas are given above.

Clinical note임상 주석

痎瘧飮 is named here with 方見上, the formula being given above, but no leaf of that name stands in this chapter. The formula above that it points to is 老瘧飮 — 1.10.11 glosses 痎瘧 as 老瘧 in its first line, and the two names are the same formula.

Uigam 醫鑑

1.16.4

Source원문

在陰分者, 用藥徹起陽分, 方可用截方. 《丹心》

Translation영역

Where it is in the yin division, medicine is used to draw it right up into the yang division, and only then may a cutting formula be used.

Dansim 丹心

1.16.5

Source원문

截瘧, 宜截瘧常山飮ㆍ截瘧七寶飮ㆍ截瘧飮子ㆍ人參截瘧飮ㆍ鬼哭丹ㆍ勝金丹ㆍ參歸養榮湯. 《諸方》

Translation영역

For cutting a fever short, Fever-Cutting Dichroa Beverage, Fever-Cutting Seven Treasures Beverage, Fever-Cutting Beverage, Ginseng Fever-Cutting Beverage, Demon-Wailing Elixir, Gold-Surpassing Elixir, or Ginseng and Tangkuei Construction-Nourishing Decoction is appropriate.

Jebang 諸方

1.17 The Method of Warding It Off 禳法

1.17.1

Source원문

宜用神仙碧霞丹ㆍ斷瘧如聖丸, 治一切瘧. 《諸方》

Translation영역

Divine Immortal Azure Cloud Elixir or Fever-Severing Sagelike Pill is to be used; they treat every kind of fever.

Clinical note임상 주석

禳 is to avert by rite, and the section is one line long — the shortest in the chapter. The Bogam gives it a heading of its own and then puts nothing in it but two formula names, which is as close as the compilers come to declining a topic.

Jebang 諸方

1.18 Things Forbidden 禁忌法

1.18.1

Source원문

凡瘧大忌飽食. 遇發日食飽, 病愈加重. 《正傳》

Translation영역

In every fever a full meal is greatly to be avoided. Eat to fullness on a day when the fit comes, and the illness grows heavier still.

Jeongjeon 正傳

1.18.2

Source원문

凡瘧發時, 切不可帶熱飮食, 恐不消而成痞塊也. 《回春》

Translation영역

Whenever a fever is breaking out, on no account may food or drink be taken while the heat is still carried, for fear that it will not be digested and will make a lump.

Hoechun 回春

1.18.3

Source원문

凡瘧方來與正發, 不可服藥. 服藥在於未發兩時之先, 否則藥病交爭, 轉爲深害.

Translation영역

When a fever is just coming on, and while it is actually breaking out, medicine must not be taken. Medicine is to be taken two double-hours before it breaks out; otherwise the medicine and the illness contend together and it turns to deep harm.

Jikji 直指

1.18.4

Source원문

服藥當於未發以前兩時之先, 或遇發日凌晨空心與服. 《直指》

Translation영역

Medicine should be given two double-hours before it breaks out, or on the day of the fit at first light on an empty stomach.

Clinical note임상 주석

Four hours before the expected paroxysm, or at dawn on an empty stomach — the chapter is consistent about timing from 1.13 onward, and the rule is the practical core of its treatment: dose ahead of the fit, never into it.

Jikji 直指

1.18.5

Source원문

仍節飮食ㆍ避風寒ㆍ遠酒色ㆍ愼起居, 無不愈. 《丹心》

Translation영역

Moderate food and drink besides, avoid wind and cold, keep far from wine and sexual activity, and be circumspect in rising and resting, and there is none that is not cured.

Dansim 丹心

1.18.6

Source원문

患瘧人, 切忌食猪肉ㆍ牛肉, 必再發. 《本草》

Translation영역

A person suffering from fever must strictly avoid eating pork and beef; it will certainly break out again.

Boncho 本草

1.19 Signs Hard to Treat and Not to Be Treated 難治不治證

1.19.1

Source원문

大凡陽瘧易治, 陰瘧難治. 《入門》

Translation영역

In general yang fever is easy to treat and yin fever hard.

Immun 入門

1.19.2

Source원문

久瘧而復作, 虛浮不食者, 未之有瘳. 《得效》

Translation영역

Where a long-standing fever breaks out again, and the patient is vacuously puffy and does not eat, there has never been a recovery.

Clinical note임상 주석

虛浮不食 — puffy and off his food — in a patient with months of relapsing fever is the oedema of severe anaemia and hypoproteinaemia, which is what chronic malaria does. The chapter's judgment that these patients did not recover was accurate for the medicine it had.

Deukhyo 得效

1.19.3

Source원문

瘧病久, 腰脊強急瘈瘲者, 不可治. 《醫鑑》

Translation영역

Where the fever illness is long-standing and the lumbar spine is stiff and tense with tugging and slackening, it cannot be treated.

Uigam 醫鑑

1.19.4

Source원문

寒熱脫形而脉堅搏, 是爲逆, 死不治. 《靈樞》

Translation영역

Where in cold and heat the form is stripped away and yet the pulse is hard and pounding, this is counterflow: the patient dies and is not to be treated.

Yeongchu 靈樞

1.20 Single Remedies 單方

1.20.1

Source원문

凡十九種, 有脾寒丹.

Translation영역

Nineteen kinds in all, including Spleen Cold Elixir.

Donguibogam · Haehak

1.20.2

Source원문

牛膝治老瘧久不愈. 取肥大牛膝一握, 剉, 酒水相半煎服, 三劑差. 《本草》

Translation영역

Achyranthes treats old fever that has long gone uncured. Take a handful of large fat achyranthes, cut it up, and decoct it in half wine and half water; three doses and it mends.

Boncho 本草

1.20.3

Source원문

茵蔯治瘴瘧. 煎湯服之. 又煮羹作虀, 幷可食之. 《本草》

Translation영역

Capillaris treats miasma fever. Decoct it and drink. It may also be boiled as a broth or made into a pickle, and either may be eaten.

Clinical note임상 주석

茵蔯 is Artemisia capillaris, and it is worth being exact about what that does and does not mean. The artemisia that yields artemisinin, the most important antimalarial of the modern era, is Artemisia annua — 靑蒿 or 黃花蒿, a different species; this entry is not that drug. What it is is the one place in the chapter where an artemisia is given for fever, and in a tradition that used 靑蒿 for 瘧 elsewhere the near miss is striking.

Boncho 本草

1.20.4

Source원문

葛根療瘧. 取一兩, 煎湯服之. 《本草》

Translation영역

Pueraria cures fever. Take 1 nyang, decoct it and drink.

Boncho 本草

1.20.5

Source원문

麻黃治溫瘧無汗. 煎湯服, 發汗差. 《本草》

Translation영역

Ephedra treats warm fever without sweat. Decoct it and drink; sweating is induced and it mends.

Boncho 本草

1.20.6

Source원문

知母主熱瘧. 煎湯服之良. 《本草》

Translation영역

Anemarrhena governs heat fever. Decocting it and drinking is good.

Boncho 本草

1.20.7

Source원문

半夏治痰瘧. 取一兩, 煎湯, 和薑汁服之. 《本草》

Translation영역

Pinellia treats phlegm fever. Take 1 nyang, decoct it, and drink it mixed with ginger juice.

Clinical note임상 주석

**Raw pinellia is toxic and must be properly processed; the ginger juice here is part of that processing rather than a flavouring.**

Boncho 本草

1.20.8

Source원문

松蘿療溫瘧. 煎湯服, 可爲吐痰. 《本草》

Translation영역

Usnea cures warm fever. Decoct it and drink; it can serve to make phlegm vomited up.

Boncho 本草

1.20.9

Source원문

蛇蛻主瘧. 當發日取皮塞兩耳, 又手持少許良. 《本草》

Translation영역

Snake slough governs fever. On the day the fit is due take the skin and stop it into both ears; holding a little in the hand is also good.

Boncho 本草

1.20.10

Source원문

鼈甲主溫瘧ㆍ老瘧. 取甲灸爲末, 每二錢, 溫酒調下, 連三服, 無不斷. 《本草》

Translation영역

Turtle shell governs warm fever and old fever. Take the carapace, roast it and powder it, and take 2 don at a time stirred into warm wine, three doses running; there is none it does not sever.

Clinical note임상 주석

Turtle shell is the drug the chapter reaches for against 瘧母, the mass in the flank, and it appears in four of the old-fever formulas. **Most freshwater turtles whose shell was used are now protected species.**

Boncho 本草

1.20.11

Source원문

蜈蚣主溫瘧ㆍ瘴瘧. 灸爲末, 調溫酒服半錢. 《本草》

Translation영역

Centipede governs warm fever and miasma fever. Roast it, powder it, and take half a don stirred into warm wine.

Clinical note임상 주석

**Centipede is toxic and is not to be prepared.**

Boncho 本草

1.20.12

Source원문

䑕婦主寒熱瘧. 取三枚, 硏, 和溫酒服. 小兒尤良. 《本草》

Translation영역

Woodlouse governs fever with cold and heat. Take three of them, grind them, and drink mixed with warm wine. For small children it is especially good.

Clinical note임상 주석

**Raw invertebrates carry parasites and are not to be prepared, least of all for a child.**

Boncho 本草

1.20.13

Source원문

白葵花 主痎瘧. 取花陰乾, 搗爲末, 酒調服一錢. 《本草》

Translation영역

White hollyhock flower governs intermittent fever. Take the flowers, dry them in the shade, pound them to a powder, and take 1 don stirred into wine.

Boncho 本草

1.20.14

Source원문

烏梅主熱瘧煩渴. 煮湯飮. 《本草》

Translation영역

Mume governs heat fever with vexation and thirst. Boil it and drink the liquor.

Clinical note임상 주석

Mume is the drug 1.13 adds for thirst and again for an excess of sweating, and here it stands alone for the same thing. A sour drink for a patient in the hot stage of a paroxysm is the most defensible single remedy in the section.

Boncho 本草

1.20.15

Source원문

虎頭骨 治溫瘧. 酥灸黃, 爲末, 溫酒下二錢. 又取肉煮食之. 又取皮覆身上. 《本草》

Translation영역

Tiger skull bone treats warm fever. Roast it with butter until yellow, powder it, and take 2 don down with warm wine. The flesh may also be boiled and eaten, and the skin laid over the body.

Clinical note임상 주석

**The tiger is critically endangered and trade in its parts is prohibited everywhere. This entry is printed as history and nothing in it is to be prepared.**

Boncho 本草

1.20.16

Source원문

狸糞主鬼瘧. 燒灰和酒服. 又煮肉食之. 又頭骨亦主瘧, 用如虎骨法. 《本草》

Translation영역

Leopard cat dung governs demon fever. Burn it to ash and drink it mixed with wine. The flesh may also be boiled and eaten. The skull bone likewise governs fever, used by the method given for tiger bone.

Clinical note임상 주석

**Animal faeces carry bacteria and parasites; nothing in this entry is to be prepared.**

Boncho 本草

1.20.17

Source원문

狐肉主寒熱瘧. 取五藏及腸, 治如食法, 和五味煮食之良. 《本草》

Translation영역

Fox flesh governs fever with cold and heat. Take the five viscera and the intestines, dress them as for food, and boil them with the five flavours and eat: this is good.

Boncho 本草

1.20.18

Source원문

燕屎治瘧疾. 取屎二錢, 和酒一升, 盛椀中, 令病人於發日朝兩手捧椀, 當鼻下熏氣, 妙. 《本草》

Translation영역

Swallow droppings treat the fever illness. Take 2 don of the droppings, mix with 1 seung of wine, put it in a bowl, and on the morning of the day the fit is due have the patient hold the bowl in both hands and let the vapour fume beneath his nose: excellent.

Clinical note임상 주석

**Bird droppings are a source of fungal and bacterial infection and this is not to be prepared.** The entry is one of several in the section that work by fumigation or contact rather than ingestion, and its place on the morning of the expected fit is the timing rule of 1.18 applied to a charm.

Boncho 本草

1.20.19

Source원문

夜明砂 蝙蝠屎也. 治五瘧. 搗爲末, 每取一錢, 冷茶調下, 立效. 《本草》

Translation영역

Bat droppings — this is the dung of the bat. It treats the five fevers. Pound it to a powder and take 1 don at a time stirred into cold tea: the effect is immediate.

Clinical note임상 주석

**Bat guano carries histoplasma and bat-borne viruses and is not to be handled or prepared.**

Boncho 本草

1.20.20

Source원문

小蒜治瘧. 取蒜硏極爛, 和黃丹作丸梧子大, 每七丸, 桃柳枝煎湯呑下, 名脾寒丹. 《類聚》

Translation영역

Small garlic treats fever. Take garlic, grind it until it is quite pulpy, mix it with minium and make pills the size of a paulownia seed, and swallow seven at a time down with a decoction of peach and willow twigs. It is called Spleen Cold Elixir.

Clinical note임상 주석

**黃丹 is red lead, and this must not be prepared.** The 脾寒丹 named in the section's own opening line is this one, and that it is the only one of the nineteen to be given a name suggests it was the one in actual use.

Yuchwi 類聚

1.21 Needling and Moxibustion 鍼灸法

1.21.1

Source원문

瘧之且發也, 陰陽之且移也, 必從四末始也. 陽已傷, 陰從之, 故先其時堅束其處, 審候見之, 在孫絡盛堅而血者, 皆取之. 《內經》

Translation영역

When a fever is about to break out, and yin and yang are about to shift, it certainly begins from the four extremities. The yang having already been injured, the yin follows it; and so before the hour one binds the place tightly, examines and watches for it, and wherever in the grandchild network vessels they are full and hard and holding blood, one takes them all.

Naegyeong 內經

1.21.2

Source원문

謂用三稜鍼視孫絡出血也. 《正傳》

Translation영역

This means using a three-edged needle and letting blood from the grandchild network vessels under observation.

Jeongjeon 正傳

1.21.3

Source원문

凡瘧必先問其病之所先發者, 先刺之.

Translation영역

In every fever one must first ask where the illness first breaks out, and needle that place first.

Gangmok 綱目

1.21.4

Source원문

久瘧不愈, 大顀先鍼後灸三七壯. 或云第三骨節.

Translation영역

For a long-standing fever that is not cured, at the great vertebra needle first and then moxa twenty-one cones. Some say the third bone joint.

Gangmok 綱目

1.21.5

Source원문

諸瘧而脉不見, 刺十指間出血, 血去必已. 先視身之赤如小豆者, 盡取之.

Translation영역

In any fever where the pulse cannot be found, needle between the ten fingers and let blood; once the blood has gone it will certainly stop. First look for the places on the body red like small beans, and take them all.

Gangmok 綱目

1.21.6

Source원문

凡瘧取間使爲妙.

Translation영역

In every fever, taking the intermediary messenger point is excellent.

Gangmok 綱目

1.21.7

Source원문

瘧脉緩大虛, 便宜用藥, 不宜用鍼. 《綱目》

Translation영역

Where the pulse in fever is moderate, large and vacuous, it is proper to use medicine and not proper to use the needle.

Clinical note임상 주석

The section ends by setting a limit on itself: a patient whose pulse has gone slack and empty is not to be bled. Given that the preceding lines prescribe bloodletting from the fingers and from any distended surface vessel, in patients who were often severely anaemic, the last line is the one that matters.

Gangmok 綱目

About this translation 凡例

Base text: Donguibogam (東醫寶鑑, 1613 first edition), Miscellaneous Disorders, Volume 7, Malaria chapter. The Chinese text is collated against the Kyujanggak transcription of the 1613 edition; collation notes are given on the passages they concern. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.