Formulas · Text · Donguibogam 東醫寶鑑

The Chest

Hyung

한글 흉 · Pinyin Xiong

The ominous place — why a heart pain is almost never the heart, nine kinds and six, the hand laid on the belly to tell vacuity from repletion, and the difference between a fullness and a bind

胸

The graph 胸 carries 凶, ominous, and the Immun says that is the point: breath and food both pass here, and when either goes wrong the evil qi gathers in the chest. The chapter's first real work is to take the heart out of heart pain. The true heart pain kills the same day and cannot be treated; everything else called heart pain is the stomach duct, which lies just behind the breastbone and which the classics themselves placed 當心, right at the heart. From there the chapter sorts: nine kinds by cause, six more by which viscus is behind them, and then the tests that actually decide treatment. Does heat ease it or make it worse. Does pressing lightly hurt and pressing hard relieve, or the reverse. Does it stop when the patient eats, or start. Danxi's warning runs under all of it — a cold pain that has lasted turns to depression, depression to steaming heat, and heat to fire, so that warming an old pain feeds it; and the chapter's own rule that in pain of any kind the qi is not to be supplemented, because a qi made stronger without being freed only hurts more. The second half separates two things that look alike: 痞, a fullness that does not hurt, and 結胸, a bind that hurts and cannot be touched. It ends with the plainest advice in the book — a man may go days without eating and come to no harm, but let him eat the moment the pain stops and it returns.

1.1 The Names Chest and Diaphragm Have Their Sense 胸膈之名有義

1.1.1

Source원문

夫人之胸者, 呼吸之所經, 飮食之所過. 一或失節, 則疾病邪氣交至於胸中, 乃有凶之兆, 故謂之胸也. 《入式》

Translation영역

A person's chest is where the breath passes and where food and drink go by. Let either once lose its measure and disease and evil qi come together into the chest — which is an ominous sign, and so it is called 胸.

Clinical note임상 주석

The graph 胸 is read as carrying 凶, ominous. It is a folk etymology, but it states the chapter's premise: this is the one place where the two indispensable traffics of the body cross.

Ipsik 入式

1.1.2

Source원문

膈膜在心肺之下, 與背脊胸腹周回相着, 如幕不漏. 盖膈者隔也, 遮隔濁氣, 不使上熏於心肺, 故謂之膈也. 《入門》

Translation영역

The diaphragm membrane lies below the heart and lung, attached all round to the spine, chest and abdomen like a curtain with no gap. 膈 means to partition: it screens off the turbid qi and does not let it steam up into the heart and lung, and so it is called 膈.

Immun 入門

1.2 The Measurements of the Chest 胸膈度數

1.2.1

Source원문

胸圍四尺五寸. 缺盆以下至𩩲骭長九寸. 《靈樞》咽以下膈以上通謂之胸. 《入門》

Translation영역

The chest is four cheok five chon round. From the supraclavicular fossa down to the xiphoid is nine chon. From below the gullet to above the diaphragm is called the chest.

Yeongchu 靈樞 · Immun 入門

1.3 The Parts of the Chest 胸膈部位

1.3.1

Source원문

膈者心肺之分野也. 《綱目》胸腹者藏府之郭也; 膻中者心主之宮城也. 《靈樞》

Translation영역

The diaphragm is the boundary of the heart and lung. The chest and abdomen are the outer wall of the viscera and bowels; Danjung is the palace city of the heart governor.

Gangmok 綱目 · Yeongchu 靈樞

1.3.2

Source원문

咽之下胃脘也, 貫膈與肺系相幷, 在肺系之後, 其上卽咽門也. 胃脘之下卽胃之上口也, 謂之賁門, 其膈膜相貼之間亦漫脂相包也. 《入門》

Translation영역

Below the gullet is the stomach duct, which threads the diaphragm and runs beside the lung's connection, lying behind it, with the gullet's gate above it. Below the stomach duct is the stomach's upper mouth, called the cardia; and where it lies against the diaphragm membrane it is wrapped about with spreading fat.

Clinical note임상 주석

賁門 — the cardia, which this passage places correctly: the oesophagus threading the diaphragm just behind the heart and opening into the stomach. It is the anatomical basis for 1.6's whole argument.

Immun 入門

1.3.3

Source원문

心包絡在心下橫膈膜之上, 竪斜膈膜之下, 與橫膜相粘. 黃脂漫包者心也; 漫脂之外細筋膜如絲, 與心肺相連, 此包絡也. 《入門》

Translation영역

The pericardiac network lies below the heart above the transverse diaphragm membrane and beneath the slanting membrane, sticking to the transverse one. What the yellow fat wraps about is the heart; outside that fat is a fine sinewy membrane like silk, joined to the heart and lung, and this is the pericardiac network.

Immun 入門

1.4 The Channels of the Viscera and Bowels All Thread the Diaphragm 藏府經脈皆貫膈

1.4.1

Source원문

手太陰之脈上膈屬肺. 手陽明之脈下膈屬大腸. 足陽明之脈下膈屬胃絡脾. 足太陰之脈上膈挾咽, 其支者別上膈注心中. 手少陰之脈下膈絡小腸. 手太陽之脈下膈屬小腸. 足少陰之脈上貫肝膈. 手厥陰之脈下膈歷絡三焦. 手少陽之脈下膈徧屬三焦. 足少陽之脈貫膈絡肝屬膽. 足厥陰之脈上貫膈布脇肋. 已上十一經皆貫膈, 惟足太陽循下于背, 故不貫膈. 《銅人》

Translation영역

The hand greater yin's channel rises through the diaphragm and belongs to the lung. The hand yang brightness's descends through it and belongs to the large intestine. The foot yang brightness's descends through it, belongs to the stomach and networks with the spleen. The foot greater yin's rises through it beside the gullet, and its branch separately rises through it and pours into the heart. The hand lesser yin's descends through it and networks with the small intestine. The hand greater yang's descends through it and belongs to the small intestine. The foot lesser yin's rises and threads the liver and diaphragm. The hand reverting yin's descends through it and networks all the three burners. The hand lesser yang's descends through it and belongs throughout to the three burners. The foot lesser yang's threads it, networks with the liver and belongs to the gallbladder. The foot reverting yin's rises and threads it, spreading in the flanks and ribs. These eleven channels all thread the diaphragm; only the foot greater yang runs down the back, and so does not.

Clinical note임상 주석

Eleven of the twelve channels pass through the diaphragm and only the bladder channel does not. It is the chapter's argument for why a disorder anywhere can present here.

Dongin 銅人

1.5 The Pulse 脉法

1.5.1

Source원문

脈陽微陰弦, 則胸痺而痛. 陽微故知在上焦, 陰弦故知胸痺心痛. 《仲景》胸痺痛, 寸口脈沈而遲, 關上小緊而數. 《仲景》

Translation영역

Where the yang pulse is faint and the yin stringlike, there is chest impediment with pain: the yang being faint one knows it is in the upper burner, and the yin being stringlike one knows it is chest impediment with heart pain. In chest impediment with pain the inch pulse is sunken and slow and the bar slightly tight and rapid.

Junggyeong 仲景

1.5.2

Source원문

心腹痛, 脈宜沈細, 忌浮大弦長. 《醫鑑》沈弦細動皆是痛證: 心痛在寸, 腹痛在關, 下部在尺, 脈象顯然. 《脈訣》

Translation영역

In pain of the heart and abdomen the pulse should be sunken and fine, and a floating, large, stringlike or long pulse is to be feared. Sunken, stringlike, fine and stirring are all pulses of pain: heart pain shows at the inch, abdominal pain at the bar, and the lower part at the cubit — the pulse image is plain.

Uigam 醫鑑 · Maekgyeol 脉訣

1.5.3

Source원문

心痛, 左手脈數熱多也, 脈澁有死血也; 右手脈緊實是痰積也, 脈大必是久病也. 兩手脈堅實不大便, 可下之. 痛甚者脈必伏. 《丹心》

Translation영역

In heart pain, a rapid pulse on the left hand means much heat and a rough one means dead blood; on the right, a tight replete pulse means accumulated phlegm and a large one a long illness. Where both pulses are firm and replete and the stool does not pass, it may be purged. Where the pain is severe the pulse will be hidden.

Clinical note임상 주석

痛甚者脈必伏 — where the pain is severe the pulse goes hidden. 1.30 turns this into a rule against supplementing: a pulse driven under by pain looks like a vacuity pulse and is not.

Dansim 丹心

1.6 Heart Pain and Stomach-Duct Pain Have Different Causes 心痛與胃脘痛病因不同

1.6.1

Source원문

眞心痛卽死不治. 其久心痛者, 是心之支別絡爲風邪冷熱所乘, 痛故成疹, 不死, 發作有時, 經久不得差也. 《得效》

Translation영역

True heart pain kills at once and is not treated. A long-standing heart pain is a branch network of the heart overcome by wind evil, cold or heat, and the pain makes a complaint of it; it does not kill, it breaks out at its own times, and it goes long without mending.

Deukhyo 得效

1.6.2

Source원문

胃之上口名曰賁門. 賁門與心相連, 故經所謂胃脘當心而痛. 今俗呼爲心痛者誤也. 夫九種心痛, 詳其所由, 皆在胃脘而實不在於心也. 《正傳》

Translation영역

The stomach's upper mouth is named the cardia, and the cardia is joined to the heart; hence the classic's phrase, the stomach duct painful right at the heart. What people now call heart pain is a mistake: examine the cause of the nine kinds of heart pain and they are all in the stomach duct and truly not in the heart.

Clinical note임상 주석

今俗呼爲心痛者誤也 — what people call heart pain is a mistake. The chapter says so plainly, and the reasoning is anatomical: the cardia sits just behind the heart, so a pain there is felt where the heart is. Everything after this section is about the stomach.

Jeongjeon 正傳

1.6.3

Source원문

胃脘當心而痛, 脾藏連心而痛, 局方皆云心痛. 盖心痛少而脾胃痛居多. 心痛因傷思慮, 脾胃痛因傷飮食或痰飮故也. 《入門》

Translation영역

The stomach duct painful right at the heart, and the spleen viscus painful and drawing at the heart — the Gukbang calls both heart pain. But heart pain is rare and spleen and stomach pain common: heart pain comes of damage by brooding, and spleen and stomach pain of damage by food and drink, or of phlegm rheum.

Immun 入門

1.6.4

Source원문

諸經心痛引背, 多屬風冷; 諸府心痛難以俯仰, 嘔瀉, 多屬熱. 《入門》

Translation영역

Where a channel heart pain draws into the back it mostly belongs to wind cold; where a bowel heart pain makes it hard to bend forward or back, with vomiting and diarrhoea, it mostly belongs to heat.

Immun 入門

1.7 Heart Pain Has Nine Kinds 心痛有九種

1.7.1

Source원문

一曰蟲, 二曰疰, 三曰風, 四曰悸, 五曰食, 六曰飮, 七曰冷, 八曰熱, 九曰去來. 通用手拈散ㆍ九痛元ㆍ通靈散ㆍ拈痛元ㆍ神聖代鍼散方見前陰.

Translation영역

The first is worm, the second corpse infixation, the third wind, the fourth palpitation, the fifth food, the sixth drink, the seventh cold, the eighth heat, the ninth coming and going. For general use: Pinch of the Hand Powder, Nine Pains Pill, Penetrating Spirit Powder, Pinch the Pain Pill, and Divine Sage Needle-Substitute Powder formula in the Genitals chapter.

Donguibogam · Hyung

1.8 Worm Heart Pain 蟲心痛

1.8.1

Source원문

胃脘痛, 痛定便能食, 時作時止者, 是蟲痛也. 《丹心》心痛吐水者蟲痛, 不吐水冷心痛. 《綱目》

Translation영역

Where the stomach duct pains and, the pain once settled, one can eat at once, and it comes and goes by turns, it is worm pain. Where heart pain brings up water it is worm pain; where it does not, it is cold heart pain.

Clinical note임상 주석

痛定便能食 — once the pain settles the patient can eat straight away. The chapter uses appetite between attacks as a sign throughout; here it marks a pain that leaves nothing behind it.

Dansim 丹心 · Gangmok 綱目

1.8.2

Source원문

蟲痛之證, 心腹痛上下攻刺, 嘔噦涎沫, 或吐淸水, 面色靑黃, 宜化蟲丸ㆍ化蟲散ㆍ妙應丸三方幷見蟲門. 蟲痛小兒多有之, 當與蟲部參考治之.

Translation영역

In worm pain the heart and abdomen pain and stab upward and downward, with retching of frothy drool or vomiting of clear water and a green-yellow complexion: Transform Worms Pill, Transform Worms Powder and Wondrous Response Pill all three in the Worms chapter. Worm pain is commonest in children, and the Worms chapter should be consulted in treating it.

Donguibogam · Hyung

1.9 Corpse Infixation Heart Pain 疰心痛

1.9.1

Source원문

卒感惡氣, 尸疰, 神昏卒倒, 口噤不省, 宜蘇合香元方見氣門ㆍ備急丸方見救急. 與中惡同治. 《入門》

Translation영역

Where one is suddenly struck by a malign qi, with corpse infixation, the spirit clouded, a sudden fall, the jaw clenched and no awareness: Storax Pill formula in the Qi chapter and Prepare for Urgency Pill formula in the Emergencies chapter. It is treated the same as malignity strike.

Immun 入門

1.10 Wind Heart Pain 風心痛

1.10.1

Source원문

因傷風冷, 或肝邪乘心, 兩脇引痛, 宜麻黃桂枝湯或分心氣飮方見氣門. 《入門》

Translation영역

Where wind cold has done damage, or a liver evil overcomes the heart and the pain draws at both flanks: Ephedra and Cinnamon Twig Decoction, or Divide the Heart Qi Drink formula in the Qi chapter.

Immun 入門

1.11 Palpitation Heart Pain 悸心痛

1.11.1

Source원문

因七情煩惱驚悸, 以致心痛, 宜四七湯方見氣門ㆍ加味四七湯方見神門ㆍ七氣湯ㆍ正氣天香湯方幷見氣門. 《入門》

Translation영역

Where the seven affects bring vexation and fright palpitation and so cause heart pain: Four Sevens Decoction formula in the Qi chapter, Supplemented Four Sevens Decoction formula in the Spirit chapter, Seven Qi Decoction and Correct the Qi Heavenly Fragrance Decoction both in the Qi chapter.

Immun 入門

1.12 Food Heart Pain 食心痛

1.12.1

Source원문

因食生冷, 或食物過多, 以致心痛, 宜香蘇散方見寒門ㆍ平胃散方見五藏ㆍ香砂養胃湯方見內傷. 《入門》

Translation영역

Where raw and cold things have been eaten, or too much food taken, and so heart pain follows: Cyperus and Perilla Powder formula in the Cold Damage chapter, Calm the Stomach Powder formula in the Five Viscera chapter and Costus and Amomum Nourish the Stomach Decoction formula in the Internal Damage chapter.

Immun 入門

1.13 Rheum Heart Pain 飮心痛

1.13.1

Source원문

傷水飮, 聚痰涎, 心痛如刺, 宜芎夏湯方見痰飮ㆍ五苓散方見寒門. 水飮流注胸脇痛, 三花神祐丸方見下門. 《入門》

Translation영역

Where water drunk has done damage and phlegm drool gathers and the heart pain is like a stabbing: Chuanxiong and Pinellia Decoction formula in the Phlegm chapter and Five Ingredients Poria Powder formula in the Cold Damage chapter. Where water rheum pours into the chest and flank with pain, Three Flowers Divine Protection Pill formula in the Purgation chapter.

Immun 入門

1.14 Cold Heart Pain 冷心痛

1.14.1

Source원문

寒氣客於背兪之脈則血脈澁, 血脈澁則血虛, 血虛則痛. 其兪注於心, 故相引而痛. 《內經》

Translation영역

Where cold qi lodges in the vessels of the back transport points the blood vessels are rough; rough, the blood is vacuous; vacuous, there is pain. Those transport points pour into the heart, and so they draw on each other and there is pain.

Naegyeong 內經

1.14.2

Source원문

形寒飮冷, 當風取凉, 或腎邪乘心, 痛則心懸若飢, 泄利下重, 宜五積散. 《入門》寒冷心痛宜扶陽助胃湯ㆍ桂枝四七湯ㆍ鷄舌香散ㆍ神效散ㆍ半痛散ㆍ草豆蔲丸ㆍ溫胃湯ㆍ抽刀散ㆍ二薑丸.

Translation영역

Where the body is chilled and cold things drunk, or one takes the cool in a draught, or a kidney evil overcomes the heart, the pain makes the heart feel suspended as though with hunger, with diarrhoea and heaviness below: Five Accumulations Powder. For cold heart pain: Support the Yang and Aid the Stomach Decoction, Cinnamon Twig Four Sevens Decoction, Clove Powder, Divinely Effective Powder, Half Pain Powder, Tsaoko Pill, Warm the Stomach Decoction, Drawn Knife Powder and Two Gingers Pill.

Clinical note임상 주석

心懸若飢 — the heart feels suspended, as though with hunger. The sinking, hollow sensation of an empty stomach, which the chapter distinguishes from pain proper.

Immun 入門 · Donguibogam · Hyung

1.15 Heat Heart Pain 熱心痛

1.15.1

Source원문

積熱攻心, 暑毒入心, 面目赤黃, 身熱煩躁, 掌中熱, 大便堅, 宜連附六一湯ㆍ金鈴子散ㆍ莎芎散ㆍ梔薑飮. 甚者大承氣湯方見寒門下之. 《入門》

Translation영역

Where accumulated heat attacks the heart, or summerheat toxin enters it, with the face and eyes red-yellow, the body hot and vexed and restless, the palms hot and the stool hard: Coptis and Aconite Six to One Decoction, Toosendan Powder, Cyperus and Chuanxiong Powder and Gardenia and Ginger Drink. In a severe case, Major Order the Qi Decoction formula in the Cold Damage chapter to purge it.

Immun 入門

1.15.2

Source원문

實熱心痛, 小柴胡湯方見寒門去人參ㆍ甘草, 加枳殼ㆍ梔子仁ㆍ赤芍藥各一錢, 水煎服. 《醫鑑》

Translation영역

For repletion heat heart pain, Minor Bupleurum Decoction formula in the Cold Damage chapter with the ginseng and licorice removed and bitter orange, gardenia kernel and red peony 1 don each added, decocted in water and taken.

Uigam 醫鑑

1.16 Coming and Going Pain 去來痛

1.16.1

Source원문

心痛或作或止, 久而不愈也. 心包絡爲風邪冷熱所乘, 痛故成疹不死, 發作有時, 經久不得差. 神仙九氣湯方見氣門呑下九痛元方見上, 一服卽止. 《得效》

Translation영역

A heart pain that breaks out and stops by turns and goes long without healing. The pericardiac network is overcome by wind evil, cold or heat, and the pain makes a complaint of it but does not kill; it breaks out at its own times and goes long without mending. Divine Immortal Nine Qi Decoction formula in the Qi chapter used to swallow Nine Pains Pill formula above, and one dose stops it.

Deukhyo 得效

1.17 Heart Pain Also Has Six 心痛亦有六

1.17.1

Source원문

有脾心痛ㆍ胃心痛ㆍ腎心痛ㆍ積心痛ㆍ厥心痛ㆍ眞心痛.

Translation영역

There are spleen heart pain, stomach heart pain, kidney heart pain, accumulation heart pain, reversal heart pain and true heart pain.

Donguibogam · Hyung

1.18 Spleen Heart Pain 脾心痛

1.18.1

Source원문

脾心痛者, 心下急痛也. 心痛甚而至於脇下如刀刺之痛者, 已連及於脾藏矣, 古方名爲脾痛者是也. 《正傳》如以錐鍼刺其心, 心痛甚者, 脾心痛也. 《靈樞》

Translation영역

Spleen heart pain is an urgent pain below the heart. Where the heart pain is severe and reaches below the flank with a pain like a knife stabbing, it has already drawn in the spleen viscus, and this is what the old formularies named spleen pain. Where it is as though an awl or a needle were piercing the heart and the heart pain is severe, it is spleen heart pain.

Jeongjeon 正傳 · Yeongchu 靈樞

1.18.2

Source원문

宜用訶子散ㆍ手拈散方見上ㆍ復元通氣散方見氣門.

Translation영역

Chebula Powder, Pinch of the Hand Powder formula above and Restore the Origin and Free the Qi Powder formula in the Qi chapter are appropriate.

Donguibogam · Hyung

1.19 Stomach Heart Pain 胃心痛

1.19.1

Source원문

胃心痛者, 腹脹而心痛, 胃脘當心而痛. 內經曰, 木鬱之發, 民病胃脘當心而痛, 上支兩脇, 咽膈不通. 又厥陰之勝, 胃脘當心而痛. 《綱目》

Translation영역

Stomach heart pain is the abdomen distended with heart pain, the stomach duct painful right at the heart. The Neijing says: when the wood's depression breaks out, the people suffer the stomach duct painful right at the heart, propping up both flanks, with the gullet and diaphragm not passing. It also says: where the reverting yin prevails, the stomach duct pains right at the heart.

Gangmok 綱目

1.19.2

Source원문

盖木氣被鬱, 發則太過, 故民病有土敗木賊之候也. 夫胃爲脾之府, 陽先於陰, 故藏未病而府先病也. 《正傳》

Translation영역

The wood qi having been depressed, when it breaks out it is excessive, and so the people's disease shows the sign of the earth defeated and the wood plundering. The stomach is the spleen's bowel, and yang comes before yin, so the viscus is not yet diseased while the bowel falls ill first.

Clinical note임상 주석

土敗木賊 — the earth defeated and the wood plundering it. The five-phase name for what the chapter elsewhere calls anger lodging in the stomach, and 1.24's case is the same mechanism in a single patient.

Jeongjeon 正傳

1.19.3

Source원문

宜用草豆蔲丸方見上ㆍ加味枳朮丸ㆍ淸熱解鬱湯ㆍ淸鬱散.

Translation영역

Tsaoko Pill formula above, Supplemented Bitter Orange and Atractylodes Pill, Clear Heat and Resolve Depression Decoction and Clear Depression Powder are appropriate.

Donguibogam · Hyung

1.20 Kidney Heart Pain 腎心痛

1.20.1

Source원문

心痛與背相控, 善瘈, 如從後觸其心, 傴僂者, 腎心痛也. 《靈樞》下重而苦泄寒中, 名腎心痛. 《類聚》

Translation영역

Where the heart pain and the back draw on each other, with ready spasm, as though something touched the heart from behind, and the patient is bent over, it is kidney heart pain. Where there is heaviness below with distressing diarrhoea and cold in the centre, it is named kidney heart pain.

Clinical note임상 주석

如從後觸其心, 傴僂 — as though touched from behind, and the patient doubled over. A pain felt to come from the back that forces the patient to bend forward, which is how posterior abdominal pain actually presents.

Yeongchu 靈樞 · Yuchwi 類聚

1.20.2

Source원문

腎傳之心, 病筋脈相引而急, 病名曰瘈. 《內經》腎之積名曰奔豚, 自臍下上衝心痛最甚, 五苓散方見寒門去白朮倍肉桂服之. 《入門》

Translation영역

Where the kidney passes it on to the heart, the sinews and vessels draw on each other and tighten, and the disease is named spasm. The kidney's accumulation is named running piglet: it surges up from below the navel and the heart pain is at its worst — Five Ingredients Poria Powder formula in the Cold Damage chapter with the white atractylodes removed and the cinnamon doubled.

Naegyeong 內經 · Immun 入門

1.20.3

Source원문

宜用神保元ㆍ烏沈湯方幷見氣門ㆍ蟠葱散方見前陰ㆍ神聖復氣湯.

Translation영역

Divine Protection Pill and Lindera and Aloeswood Decoction both in the Qi chapter, Coiled Scallion Powder formula in the Genitals chapter and Divine Sage Restore the Qi Decoction are appropriate.

Donguibogam · Hyung

1.21 Accumulation Heart Pain 積心痛

1.21.1

Source원문

飮食積聚, 遇食還發, 名曰積心痛. 《類聚》

Translation영역

Where food and drink accumulate and gather, and it breaks out again whenever one eats, it is named accumulation heart pain.

Yuchwi 類聚

1.21.2

Source원문

凡人飮食後忽然暈倒, 口噤不言, 目不識人, 四肢不擧, 多因飮食過度, 氣道窒塞, 或着氣惱而然. 急用薑鹽湯多灌探吐之, 後服平胃散方見內傷ㆍ六君子湯方見痰飮.

Translation영역

Where a person after eating suddenly falls in a faint, the jaw clenched and speechless, the eyes not knowing anyone and the four limbs not lifting, it is mostly from eating and drinking beyond measure so that the qi passages are stopped and blocked, or from vexation of the qi besides. Quickly pour in plenty of ginger and salt water and probe to make them vomit; afterwards give Calm the Stomach Powder formula in the Internal Damage chapter and Six Gentlemen Decoction formula in the Phlegm chapter.

Clinical note임상 주석

A collapse immediately after a heavy meal with the jaw clenched and no response. Whatever lies behind it, emptying the stomach before anything else is the chapter's instinct, and 1.32 gives the same measure.

Donguibogam · Hyung

1.21.3

Source원문

食積心痛宜用行氣香蘇散ㆍ煮黃丸ㆍ草豆蔲丸ㆍ加味枳朮丸.

Translation영역

For food accumulation heart pain: Move the Qi Cyperus and Perilla Powder, Boiled Yellow Pill, Tsaoko Pill and Supplemented Bitter Orange and Atractylodes Pill.

Donguibogam · Hyung

1.22 Reversal Heart Pain 厥心痛

1.22.1

Source원문

厥心痛者, 因內外邪犯心之包絡, 或他藏之邪犯心之支脈. 謂之厥者, 諸痛皆少陰厥陰氣逆上衝, 又痛極則發厥也. 《入門》厥心痛者, 他藏病干之而痛也; 邪在心則亦心痛. 《綱目》

Translation영역

Reversal heart pain is where an evil from within or without offends the pericardiac network, or an evil of another viscus offends a branch channel of the heart. It is called reversal because in all these pains the lesser yin and reverting yin qi counterflow and surge upward, and because at the height of the pain reversal breaks out. Reversal heart pain is another viscus's disease intruding on it and making pain; and where the evil is in the heart itself there is heart pain too.

Immun 入門 · Gangmok 綱目

1.22.2

Source원문

寒厥心痛者, 手足厥逆而通身冷汗出, 尿淸不渴, 氣微力弱, 急以朮附湯方見寒門溫之. 熱厥心痛者, 身熱足冷, 痛甚煩躁, 其脈洪大, 可與金鈴子散方見上. 《保命》

Translation영역

In cold reversal heart pain the hands and feet are cold in reversal, cold sweat comes out over the whole body, the urine is clear and there is no thirst, the qi is faint and the strength weak: quickly warm it with Atractylodes and Aconite Decoction formula in the Cold Damage chapter. In heat reversal heart pain the body is hot and the feet cold, the pain severe with vexed restlessness and the pulse surging and large: Toosendan Powder formula above may be given.

Clinical note임상 주석

身熱足冷 — the body hot and the feet cold, against cold limbs with cold sweat in the other kind. Two states that both end in cold extremities, told apart by whether the trunk is hot and whether the patient is thirsty.

Bomyeongjip 保命

1.23 True Heart Pain 眞心痛

1.23.1

Source원문

眞心痛, 手足靑至節, 心痛甚, 旦發夕死, 夕發旦死. 《靈樞》

Translation영역

In true heart pain the hands and feet are green to the joints and the heart pain is severe: breaking out in the morning, death by evening; breaking out in the evening, death by morning.

Clinical note임상 주석

手足靑至節, 旦發夕死 — the limbs blue to the joints, and death within the day. Cyanosis to elbows and knees with crushing central pain: cardiogenic shock. The Lingshu names it, puts it apart from everything else in the chapter, and offers nothing.

Yeongchu 靈樞

1.24 Heart and Abdomen Painful Together 心腹幷痛

1.24.1

Source원문

心腹幷痛宜二炒香良散ㆍ二胡散ㆍ厚朴湯ㆍ桂靈散ㆍ鷄舌香散方見上ㆍ蟠葱散方見前陰ㆍ五積散方見寒門ㆍ備急丸方見救急ㆍ蘇合香元方見氣門.

Translation영역

Where the heart and abdomen are painful together: Twice-Fried Cyperus and Galangal Powder, Two Hu Powder, Magnolia Bark Decoction, Cinnamon and Flying-Squirrel Powder, Clove Powder formula above, Coiled Scallion Powder formula in the Genitals chapter, Five Accumulations Powder formula in the Cold Damage chapter, Prepare for Urgency Pill formula in the Emergencies chapter and Storax Pill formula in the Qi chapter.

Donguibogam · Hyung

1.25 The Seven Affects Make Heart Pain 七情作心痛

1.25.1

Source원문

七情者, 喜怒憂思悲驚恐. 盖喜則氣散, 怒則氣上, 憂則氣沈, 思則氣結, 悲則氣消, 驚則氣亂, 恐則氣下. 六情皆令心氣鬱結, 所以作痛; 惟喜則氣散, 所以散六情之鬱, 能止痛也.

Translation영역

The seven affects are joy, anger, anxiety, thought, grief, fright and fear. Joy scatters the qi, anger raises it, anxiety sinks it, thought binds it, grief consumes it, fright throws it into confusion, fear sends it down. Six of them make the heart qi depressed and bound, and so make pain; only joy scatters the qi, and so it can scatter the depression of the other six and stop the pain.

Donguibogam · Hyung

1.25.2

Source원문

息城司侯聞父死于賊, 乃大悲哭, 哭罷便覺心痛, 日增不已, 月餘成塊狀如覆盃, 大痛不堪, 百藥無效. 戴人至, 學巫者雜以狂言以謔病者, 至是大笑不忍, 回面向壁, 數日心中結硬皆散. 戴人曰, 憂則氣結, 喜則氣散, 又云喜勝悲, 內經自有此法. 《入門》

Translation영역

The magistrate of Xicheng heard that his father had been killed by bandits and wept in great grief; when the weeping was done he felt a pain in the heart, which grew daily without stopping, and in a month more had become a lump like an upturned cup, with pain past bearing, and a hundred medicines had no effect. Zhang Zihe came, took up the manner of a shaman and mixed in wild talk to make sport with the patient, until he laughed so that he could not stop himself and turned his face to the wall; in a few days the hard knot in his heart had all dispersed. Zhang Zihe said: anxiety binds the qi and joy scatters it, and it is also said that joy overcomes grief — the Neijing has this method of its own.

Clinical note임상 주석

A physician playing the fool deliberately until the patient laughs. The reasoning is the five-phase overcoming sequence applied to the emotions, and it is the Bogam's clearest case of a treatment that is entirely psychological.

Immun 入門

1.26 Stomach-Duct Pain from Food Accumulation 食積胃脘痛

1.26.1

Source원문

飮食過多, 以致積滯成胃脘痛, 先用吐法, 次用香蘇散方見寒門入生薑ㆍ葱白ㆍ烏梅煎服. 《得效》或平胃散方見內傷加神麴ㆍ麥芽ㆍ山査肉. 《入門》宜用加味二陳湯ㆍ加味枳朮丸.

Translation영역

Where too much has been eaten and drunk so that it lodges and makes stomach-duct pain, first use the ejection method, then Cyperus and Perilla Powder formula in the Cold Damage chapter with fresh ginger, scallion white and mume added and decocted; or Calm the Stomach Powder formula in the Internal Damage chapter with medicated leaven, barley sprout and hawthorn fruit. Supplemented Two Matured Ingredients Decoction and Supplemented Bitter Orange and Atractylodes Pill are appropriate.

Deukhyo 得效 · Immun 入門 · Donguibogam · Hyung

1.27 Stomach-Duct Pain from Phlegm Rheum 痰飮胃脘痛

1.27.1

Source원문

胃中若有流飮淸痰作痛, 腹中漉漉有聲, 及手足寒痛, 或腰膝背脇抽引作痛, 宜用小胃丹ㆍ控涎丹方幷見痰飮ㆍ三花神祐丸ㆍ芎夏湯ㆍ加味二陳湯ㆍ加味枳朮丸.

Translation영역

Where there is flowing rheum and clear phlegm in the stomach making pain, with a gurgling sound in the belly, and the hands and feet cold and painful, or a drawing pain in the waist, knees, back and flanks: Minor Stomach Pill and Control Drool Elixir both in the Phlegm chapter, Three Flowers Divine Protection Pill, Chuanxiong and Pinellia Decoction, Supplemented Two Matured Ingredients Decoction and Supplemented Bitter Orange and Atractylodes Pill.

Donguibogam · Hyung

1.27.2

Source원문

一方治痰飮胃脘痛. 白螺螄殼(火煆)ㆍ南星(炮)ㆍ滑石ㆍ梔子(炒)ㆍ便香附子ㆍ蒼朮各一兩, 枳殼ㆍ靑皮ㆍ木香ㆍ半夏ㆍ縮砂各五錢. 右爲末, 薑汁浸蒸餠和丸菉豆大, 每五七十丸, 薑湯下. 春加川芎, 夏黃連, 冬吳茱萸. 一名白螺殼丸. 《丹心》

Translation영역

Another formula treats stomach-duct pain from phlegm rheum. White river-snail shell (calcined), arisaema (blast-fried), talc, gardenia (stir-fried), urine-processed cyperus and atractylodes lancea 1 nyang each; bitter orange, green tangerine peel, costus, pinellia and amomum 5 don each. Powder them, bind with steamed bread soaked in ginger juice into pills the size of a mung bean, and take fifty to seventy with ginger decoction. In spring add chuanxiong, in summer coptis, in winter evodia. It is named White Snail Shell Pill.

Clinical note임상 주석

A medicinal added by season — chuanxiong in spring, coptis in summer, evodia in winter. The calcined snail shell is calcium carbonate and the formula is an antacid with additions, which is why it answers an acid pain.

Dansim 丹心

1.28 Stomach-Duct Pain from Static Blood 瘀血胃脘痛

1.28.1

Source원문

心痛脈澁者有死血也. 又云, 作時飮湯水下作呃者, 有死血. 桃仁承氣湯方見寒門下之. 《丹心》

Translation영역

Where in heart pain the pulse is rough there is dead blood. It is also said: where at the time of the attack drinking hot water makes it hiccup as it goes down, there is dead blood. Peach Kernel Order the Qi Decoction formula in the Cold Damage chapter purges it.

Dansim 丹心

1.28.2

Source원문

如平日喜食熱物, 以致死血留於胃口作痛者, 桃仁承氣湯下之; 輕者韭汁ㆍ桔梗開之. 《丹心》

Translation영역

Where one has habitually liked hot foods so that dead blood stays at the stomach's mouth and makes pain, Peach Kernel Order the Qi Decoction purges it; in a lighter case, leek juice and platycodon open it.

Clinical note임상 주석

喜食熱物 — a habit of eating things hot. Danxi names it as the cause of a fixed, stabbing pain at the cardia, and habitually very hot food is a recognized risk for oesophageal injury.

Dansim 丹心

1.28.3

Source원문

婦人瘀血入心, 脾痛甚者, 五積散方見寒門加三稜ㆍ蓬朮ㆍ桃仁ㆍ紅花. 《入門》宜用失笑散方見婦人ㆍ神仙沈麝元方見氣門ㆍ玄胡索丸ㆍ勝金散.

Translation영역

Where in a woman static blood enters the heart and the spleen pain is severe, Five Accumulations Powder formula in the Cold Damage chapter with sparganium, zedoary, peach kernel and safflower added. Sudden Smile Powder formula in the Women chapter, Divine Immortal Aloeswood and Musk Pill formula in the Qi chapter, Corydalis Pill and Victorious Gold Powder are appropriate.

Immun 入門 · Donguibogam · Hyung

1.29 Heart and Stomach Pain Should Be Divided into Vacuity and Repletion 心胃痛當分虛實

1.29.1

Source원문

按之痛止者爲虛, 二陳湯方見痰飮加炒乾薑和之. 《丹心》虛痛宜歸脾湯方見神門ㆍ加味小建中湯ㆍ參朮散.

Translation영역

Where pressing stops the pain it is vacuity: Two Matured Ingredients Decoction formula in the Phlegm chapter with fried dried ginger added to harmonize it. For vacuity pain: Restore the Spleen Decoction formula in the Spirit chapter, Supplemented Minor Construct the Middle Decoction and Ginseng and Atractylodes Powder.

Dansim 丹心 · Donguibogam · Hyung

1.29.2

Source원문

按之痛反甚者爲實, 宜大柴胡湯方見寒門下之. 《仲景》實痛宜梔萸丸ㆍ煮黃丸.

Translation영역

Where pressing makes the pain worse it is repletion: Major Bupleurum Decoction formula in the Cold Damage chapter to purge it. For repletion pain: Gardenia and Evodia Pill and Boiled Yellow Pill.

Clinical note임상 주석

按之痛止者爲虛, 按之痛反甚者爲實 — pressure relieving means vacuity, pressure worsening means repletion. The chapter's single most useful rule, and it needs nothing but a hand. Pain relieved by pressure and worsened by it do still separate different causes.

Junggyeong 仲景 · Donguibogam · Hyung

1.30 The Method of Treating Heart and Stomach Pain 心胃痛治法

1.30.1

Source원문

凡心胃痛須分新久. 若明知身受寒氣, 口喫寒物而得者, 於初得之時當與溫散, 或溫利之. 溫散謂麻黃桂枝湯ㆍ桂枝四七湯, 溫利謂九痛元ㆍ煮黃丸. 得之稍久則成鬱, 鬱久則蒸熱, 熱久必生火. 若行溫散溫利, 寧不助火添病耶. 由是方中多以山梔爲熱藥之向導, 則邪易伏, 病易退, 正氣復而病安矣. 《丹心》

Translation영역

In any heart or stomach pain the new must be told from the old. Where one plainly knows the body took in cold qi or the mouth ate cold things, at the first getting of it warm dispersing or warm freeing should be given — warm dispersing means Ephedra and Cinnamon Twig Decoction and Cinnamon Twig Four Sevens Decoction, warm freeing means Nine Pains Pill and Boiled Yellow Pill. But once it has lasted a while it becomes depression; depression lasting steams into heat; and heat lasting must engender fire. If one then warms and disperses or warms and frees, how should it not help the fire and add to the disease? For this reason most formulas use gardenia as the guide for the hot medicines, so that the evil is easily subdued, the disease easily retreats, the upright qi recovers and the patient is well.

Clinical note임상 주석

The chapter's central warning, and it undercuts half of its own formulas: a cold pain that has lasted is no longer cold, and warming it feeds what it has become. Gardenia is Danxi's answer — a cold medicinal carried in among hot ones.

Dansim 丹心

1.30.2

Source원문

寒冷自外而入, 初則是寒, 鬱久則變熱, 始終俱是熱也. 宜分寒ㆍ熱ㆍ血ㆍ蟲四條: 寒則溫之, 熱則淸之, 血則散之, 蟲則殺之, 庶乎不惑也. 《丹心》

Translation영역

Cold comes in from without: at first it is cold, but depressed and lasting it turns to heat, and from first to last it is all heat. It should be divided under four heads — cold, heat, blood and worm: cold is warmed, heat is cleared, blood is dispersed, worm is killed — and then one may not be confused.

Dansim 丹心

1.31 In Pain of Any Kind, Qi-Supplementing Medicines Must Not Be Used 諸痛不可用補氣藥

1.31.1

Source원문

痛甚則脈必伏, 多用溫藥附子之類, 不可用參朮. 盖諸痛不可補氣故也. 《丹心》諸痛不可用補氣藥, 氣旺不通而痛愈甚矣. 《醫鑑》

Translation영역

Where the pain is severe the pulse will be hidden; warm medicines of the aconite kind are much used, and ginseng and atractylodes must not be. For in pain of any kind the qi is not to be supplemented. Qi-supplementing medicines must not be used in any pain: the qi made exuberant without being freed, the pain is worse than before.

Clinical note임상 주석

氣旺不通而痛愈甚 — the qi made strong while still blocked, and the pain grows worse. A short section with a plain mechanical reason behind it, and it explains why so many formulas here are made of movers rather than tonics.

Dansim 丹心 · Uigam 醫鑑

1.32 Overpowering Medicines for Heart and Stomach Pain 心胃痛劫藥

1.32.1

Source원문

止痛劫藥, 用倉卒散ㆍ連附六一湯ㆍ抽刀散ㆍ愈痛散ㆍ梔薑飮ㆍ神靈丹ㆍ治心頭疼方.

Translation영역

For overpowering medicines that stop pain: Sudden Emergency Powder, Coptis and Aconite Six to One Decoction, Drawn Knife Powder, Heal the Pain Powder, Gardenia and Ginger Drink, Divine Spirit Elixir and the Formula for Pain at the Heart.

Donguibogam · Hyung

1.32.2

Source원문

心痛用山梔幷劫藥止之, 又復發, 前藥必不效, 可加玄明粉一錢卽止. 《丹心》

Translation영역

Where heart pain has been stopped with gardenia and an overpowering medicine and breaks out again, the former medicine will surely not answer; adding 1 don of mirabilite powder stops it.

Dansim 丹心

1.32.3

Source원문

歌曰, 三箇烏梅三箇棗, 七箇杏仁一處搗, 麝香一粒用酒煎, 永不心疼直到老. 《必用》

Translation영역

The verse says: three mume and three jujubes, seven apricot kernels pounded together, one grain of musk decocted in wine — and never a heart pain again, right into old age. — Piryongbang 必用 (Donguibogam · Hyung)

Piryongbang 必用

1.33 Heart and Stomach Pain Should Be Ejected 心胃痛宜吐

1.33.1

Source원문

凡心痛皆痰粘, 通用二陳湯方見痰飮隨證加減. 《入門》凡痛攻走腰背, 發厥嘔吐, 諸藥不效, 二陳湯加蒼朮ㆍ川芎ㆍ梔子煎服, 探吐積痰椀許乃愈. 《入門》

Translation영역

In any heart pain there is sticky phlegm, and Two Matured Ingredients Decoction formula in the Phlegm chapter is used generally with additions and subtractions to suit the pattern. Where the pain attacks and runs into waist and back with reversal and vomiting and no medicine answers, Two Matured Ingredients Decoction with atractylodes lancea, chuanxiong and gardenia added, decocted and taken, and a bowlful of accumulated phlegm brought up by probing, and it heals.

Immun 入門

1.33.2

Source원문

多飮鹽湯, 以鵝翎探吐痰積, 痛卽止. 《醫鑑》飮食過傷, 心胸痛甚不省人事, 多飮薑鹽湯探吐之, 卽止痛. 《雜著》

Translation영역

Drink plenty of salt water and probe with a goose quill to bring up the accumulated phlegm, and the pain stops at once. Where food and drink have done great damage and the pain of the chest is so severe that the patient knows no one, let them drink plenty of ginger and salt water and probe to make them vomit, and the pain stops.

Clinical note임상 주석

Salt water and a feather at the back of the throat, for a patient overcome by what they have eaten. Emptying the stomach is not unreasonable in acute gastric distension, and it is the chapter's first measure where nothing can be swallowed.

Uigam 醫鑑 · Japjeo 雜著

1.34 Heart and Stomach Pain Should Be Purged 心胃痛宜下

1.34.1

Source원문

心脾痛大小便不通者, 此是痰隔中焦, 氣聚下焦也. 《丹心》心痛脈堅實不大便者下之, 宜大柴胡湯方見寒門. 胃脘有濕而痛, 小胃丹方見痰飮下之. 《丹心》

Translation영역

Where in heart and spleen pain neither stool nor urine passes, phlegm is partitioning the middle burner and the qi is gathered in the lower. Where in heart pain the pulse is firm and replete and the stool does not pass, purge it with Major Bupleurum Decoction formula in the Cold Damage chapter. Where there is damp in the stomach duct with pain, Minor Stomach Pill formula in the Phlegm chapter purges it.

Dansim 丹心

1.34.2

Source원문

通則不痛, 不通則痛. 又云諸實爲痛, 痛隨利減. 凡心胃痛甚, 須用下藥利之, 是爲捷法. 《東垣》

Translation영역

Where it passes there is no pain; where it does not pass there is pain. It is also said that all repletion makes pain, and the pain lessens as the bowel is freed. In any severe heart or stomach pain a purging medicine should be used to free it, and this is the quick method.

Clinical note임상 주석

通則不痛, 不通則痛 — what passes does not hurt, what does not pass hurts. Six graphs that the tradition built most of its thinking about pain on, and the Abdomen chapter's 3.20 quotes the same couplet.

Dongwon 東垣

1.35 What Is Forbidden in Eating and Drinking 飮食禁忌

1.35.1

Source원문

心痛雖日數多不喫飯不死; 若痛止便喫物, 卽還痛. 必須三五服藥方可喫物. 《丹心》凡心痛數日不食無妨; 痛止恣食卽復發. 《入門》

Translation영역

In heart pain, though many days go by without eating, one does not die; but let the pain stop and food be eaten at once, and the pain returns. Three or five doses of the medicine must be taken before anything is eaten. In any heart pain, going some days without food does no harm; but eating freely as soon as the pain stops brings it straight back.

Clinical note임상 주석

數日不食無妨 — some days without food do no harm. The plainest piece of advice in the chapter, and still correct: resting an inflamed stomach is most of the treatment, and eating at the first relief is what brings the pain back.

Dansim 丹心 · Immun 入門

1.35.2

Source원문

病安之後, 若縱恣口味, 病必復作, 勿歸咎於醫也. 《丹心》

Translation영역

After the illness has settled, if one indulges the appetite the disease will surely break out again — and let no blame be laid on the physician.

Dansim 丹心

1.36 Pigeon Chest 龜胸

1.36.1

Source원문

詳見小兒門.

Translation영역

Treated in detail in the Children chapter.

Donguibogam · Hyung

1.37 Glomus of the Chest 胸痞

1.37.1

Source원문

胸滿而不痛者爲痞, 滿而痛者爲結胸. 痞悶比之結胸爲輕, 始末用藥俱同, 但有輕重之殊耳. 《入門》

Translation영역

Where the chest is full and does not pain it is glomus; full and painful, it is chest bind. The oppression of glomus is lighter than chest bind, and the medicines used from first to last are the same, only differing in weight.

Immun 入門

1.37.2

Source원문

痞者, 心下滿而不痛是也. 太陰濕土主壅塞, 乃土來心下而爲痞也. 傷寒下之早亦爲痞, 乃寒傷榮血, 心主血, 邪入於本, 故爲心下痞. 仲景瀉心湯數方皆用黃連瀉心下之土邪, 其效如響應桴. 《東垣》

Translation영역

Glomus is fullness below the heart without pain. The greater yin's damp earth governs congestion and blockage, and it is the earth coming below the heart and making glomus. Purging too early in cold damage also makes glomus: the cold damages the construction blood, and the heart governs blood, so the evil enters its root and makes glomus below the heart. Zhongjing's several Drain the Heart Decoctions all use coptis to drain the earth evil below the heart, and their effect is as a drum answers the stick.

Dongwon 東垣

1.37.3

Source원문

痞滿與脹滿不同. 脹滿內脹而外亦形; 痞則內覺痞悶而外無脹急之形也. 盖由陰伏陽蓄, 氣血不運而成, 位于心下之中, 塡滿痞塞, 皆土邪之所爲耳. 《丹心》

Translation영역

Glomus fullness is not the same as distension fullness: in distension there is swelling within and a shape to be seen without; in glomus one feels the oppression within and there is no shape of urgent distension without. It comes of yin lying hidden and yang stored up with the qi and blood not moving, and settles in the middle below the heart, filling and blocking — all of it the work of the earth evil.

Clinical note임상 주석

內覺痞悶而外無脹急之形 — oppression felt within with nothing to be seen without. The distinction between a subjective fullness and a visibly distended abdomen, and it is a real one at the bedside.

Dansim 丹心

1.37.4

Source원문

痞者否也, 如易所謂天地不交之否, 內柔外剛, 萬物不通之義也. 物不可以終否, 故痞久則成脹滿而莫能療焉. 《正傳》

Translation영역

痞 is the hexagram Pi: as the Book of Changes says, the standstill where heaven and earth do not intercourse, soft within and hard without, the sense that the ten thousand things do not pass. Nothing can stand still for ever, and so glomus long continued becomes distension fullness, which cannot be cured.

Jeongjeon 正傳

1.37.5

Source원문

寒痞枳實理中元, 熱痞加減陷胸湯, 痰痞柴梗半夏湯, 痞痛瓜蔞實丸, 久痞黃連消痞丸, 食已心下痞平補枳朮丸, 虛痞枳實消痞丸, 飮食不消痞橘皮枳朮丸方見內傷, 陰伏陽蓄爲痞香砂養胃湯ㆍ加味枳朮丸. 通用桔梗枳殼湯ㆍ解鬱和中湯.

Translation영역

For cold glomus, Bitter Orange Regulate the Centre Pill; heat glomus, Modified Sink into the Chest Decoction; phlegm glomus, Bupleurum, Platycodon and Pinellia Decoction; glomus with pain, Trichosanthes Fruit Pill; long-standing glomus, Coptis Disperse Glomus Pill; glomus below the heart after eating, Even Supplementation Bitter Orange and Atractylodes Pill; vacuity glomus, Bitter Orange Disperse Glomus Pill; glomus from food undigested, Tangerine Peel, Bitter Orange and Atractylodes Pill formula in the Internal Damage chapter; glomus from yin hidden and yang stored, Costus and Amomum Nourish the Stomach Decoction and Supplemented Bitter Orange and Atractylodes Pill. For general use, Platycodon and Bitter Orange Decoction and Resolve Depression and Harmonize the Centre Decoction.

Donguibogam · Hyung

1.38 Glomus Has Cold and Heat 痞有寒熱

1.38.1

Source원문

寒痞不渴, 脈遲, 宜辛甘散之, 枳實理中丸之類方見上. 熱痞煩渴, 脈數, 宜苦寒泄之, 黃連消痞丸ㆍ加味陷胸湯之類方幷見上. 《綱目》

Translation영역

Cold glomus is without thirst and the pulse slow: it should be dispersed with the acrid and sweet, as with Bitter Orange Regulate the Centre Pill and its kind formula above. Heat glomus has vexing thirst and a rapid pulse: it should be drained with the bitter and cold, as with Coptis Disperse Glomus Pill and Supplemented Sink into the Chest Decoction both above.

Gangmok 綱目

1.39 Glomus Has Vacuity and Repletion 痞有虛實

1.39.1

Source원문

痞有虛實之殊. 實痞大便閉, 厚朴枳實湯方見大便主之; 虛痞大便利, 芍藥陳皮湯主之. 《東垣》痞有虛有實: 大便易而利者爲虛, 大便難而閉者爲實. 《入門》

Translation영역

Glomus differs as vacuity and repletion. In repletion glomus the stool is blocked, and Magnolia Bark and Bitter Orange Decoction formula in the Stool chapter governs it; in vacuity glomus the stool passes freely, and Peony and Tangerine Peel Decoction governs it. Glomus has its vacuity and its repletion: where the stool passes easily and freely it is vacuity, where it is difficult and blocked it is repletion.

Clinical note임상 주석

The stool decides it. Where 1.28 used the hand on the abdomen to sort pain, this sorts fullness by what passes below — and the two tests are the chapter's whole practical apparatus.

Dongwon 東垣 · Immun 入門

1.40 Glomus Should Be Ejected or Purged 痞宜吐下

1.40.1

Source원문

飮食過傷, 心胸痞悶, 兀兀欲吐者, 宜吐之. 《東垣》

Translation영역

Where food and drink have done too much damage and the chest is oppressed with glomus and there is a dull wish to vomit, it should be ejected.

Dongwon 東垣

1.40.2

Source원문

飮食傷脾痞滿, 輕者黃連消痞丸方見上ㆍ橘皮枳朮丸方見內傷; 甚者微下之, 吐之. 下者枳實導滯丸加檳榔ㆍ木香方見內傷ㆍ煮黃丸方見上; 吐者二陳湯方見痰飮ㆍ瓜蔕散方見吐門. 《丹心》

Translation영역

Where food and drink have damaged the spleen with glomus fullness, in a light case Coptis Disperse Glomus Pill formula above and Tangerine Peel, Bitter Orange and Atractylodes Pill formula in the Internal Damage chapter; in a severe case purge it a little, or eject it. For purging, Bitter Orange Abduct Stagnation Pill with areca and costus added formula in the Internal Damage chapter and Boiled Yellow Pill formula above; for ejecting, Two Matured Ingredients Decoction formula in the Phlegm chapter and Melon Pedicel Powder formula in the Ejection chapter.

Dansim 丹心

1.41 The Method of Treating Glomus Patterns 痞證治法

1.41.1

Source원문

心下痞須用枳實ㆍ炒黃連. 如稟實氣實而痞, 宜枳實ㆍ黃連ㆍ靑皮ㆍ陳皮ㆍ枳殼. 如稟弱氣弱飮食不化而痞, 宜白朮ㆍ山査ㆍ神麴ㆍ麥芽ㆍ陳皮. 《丹心》

Translation영역

For glomus below the heart, bitter orange and fried coptis must be used. Where the constitution is solid and the qi replete and there is glomus: bitter orange, coptis, green tangerine peel, tangerine peel and bitter orange peel. Where the constitution is weak and the qi weak and food does not transform and there is glomus: white atractylodes, hawthorn fruit, medicated leaven, barley sprout and tangerine peel.

Dansim 丹心

1.41.2

Source원문

如肥人心下痞, 乃濕痰, 宜蒼朮ㆍ半夏ㆍ縮砂ㆍ茯苓ㆍ滑石. 如瘦人心下痞, 乃鬱熱, 宜枳實ㆍ黃連ㆍ葛根ㆍ升麻. 如感寒食不化心下痞, 宜藿香ㆍ草豆蔲ㆍ縮砂ㆍ吳茱萸. 痞挾血成窠囊, 宜桃仁ㆍ紅花ㆍ香附ㆍ大黃. 《丹心》

Translation영역

Where a stout person has glomus below the heart it is damp phlegm: atractylodes lancea, pinellia, amomum, poria and talc. Where a thin person has it, it is depressed heat: bitter orange, coptis, pueraria and cimicifuga. Where cold has been contracted and food does not transform and there is glomus: agastache, tsaoko, amomum and evodia. Where glomus carries blood with it and makes a nest-sac: peach kernel, safflower, cyperus and rhubarb.

Clinical note임상 주석

Six versions of one complaint, sorted by build and by history rather than by pulse. 窠囊, a nest-sac — Danxi's name for an old pocket of phlegm and blood walled off where it sits, and the one that needs blood medicinals rather than qi ones.

Dansim 丹心

1.41.3

Source원문

王道消補, 不輕吐下. 故古人治痞, 用黃連ㆍ黃芩ㆍ枳實之苦以泄之, 厚朴ㆍ生薑ㆍ半夏之辛以散之, 人參ㆍ白朮之甘溫以補之, 猪苓ㆍ茯苓ㆍ澤瀉之淡以滲之. 大槪與濕同治, 使上下分消其濕可也. 《正傳》

Translation영역

The kingly way disperses and supplements and is not quick to eject or purge. So the ancients in treating glomus used the bitterness of coptis, scutellaria and bitter orange to drain it, the acridity of magnolia bark, fresh ginger and pinellia to disperse it, the sweet warmth of ginseng and white atractylodes to supplement it, and the blandness of polyporus, poria and alisma to percolate it. In the main it is treated as damp is treated, letting the damp be dispersed above and below.

Clinical note임상 주석

王道 — the kingly way, against the forceful methods of ejecting and purging. The Jeongjeon is arguing against the section just before it, and the Bogam prints both without choosing.

Jeongjeon 正傳

1.41.4

Source원문

傷寒本無痞, 應發汗, 醫反下之, 遂成痞. 枳實理中丸方見上最良. 審知是痞, 先用桔梗枳殼湯尤妙, 枳桔能行氣故也. 《活人》盖痞自血中來, 治痞獨益脾土, 以血藥治之, 其法無以加矣. 《海藏》

Translation영역

In cold damage there is properly no glomus; sweating should have been promoted, and the physician purged instead, and so glomus was made. Bitter Orange Regulate the Centre Pill formula above is best. Once one knows surely that it is glomus, using Platycodon and Bitter Orange Decoction first is better still, for bitter orange and platycodon can move the qi. Glomus comes from the blood, and in treating it, to boost the spleen earth alone and to treat it with blood medicines — to that method nothing can be added.

Hwarin 活人 · Haejang 海藏

1.42 The Method of Warm Plastering for Glomus Qi 熁痞氣法

1.42.1

Source원문

蘿葍子三合, 生薑二兩, 葱白七莖, 橘葉一握, 白麪半合, 共搗勻炒令溫, 熁痞滿之處, 外用絹帛縛之. 候半日許, 胸中煩熱卽解去, 復以熱手摩之. 不拘寒熱虛實幷用之. 無橘葉代椒葉. 《入門》

Translation영역

Radish seed three hop, fresh ginger 2 nyang, seven stalks of scallion white, a handful of tangerine leaves and half a hop of white flour, pounded together evenly and fried warm; plaster it on the place of glomus fullness and bind it over with silk. After about half a day, when the chest feels vexed and hot, take it off and rub the place with a warm hand. It is used alike whether the case is cold or hot, vacuous or replete. If there are no tangerine leaves, use pepper leaves.

Clinical note임상 주석

A warm poultice bound on for half a day, with the endpoint being heat felt inside rather than a set time. The Navel chapter's moxa rule works the same way.

Immun 入門

1.43 The Method of Ironing for Glomus Qi 熨痞氣法

1.43.1

Source원문

治心胸痞, 及一切胸膈寒結ㆍ熱結ㆍ水結ㆍ食結ㆍ痰結ㆍ痞結皆治之. 生薑一斤, 搗取汁, 以貯, 只取渣炒熱, 帛包熨心胸脇下, 其痛豁然而愈. 若薑冷, 再拌汁炒再熨之. 若熱結不用炒. 《入門》

Translation영역

Treats glomus of the heart and chest, and all binds of the chest and diaphragm — cold bind, heat bind, water bind, food bind, phlegm bind and glomus bind. Take a geun of fresh ginger, pound it for the juice and keep the juice by; take only the dregs, fry them hot, wrap them in cloth and iron the chest and below the flanks with it, and the pain opens out and heals. If the ginger grows cold, mix it again with the juice, fry it and iron again. Where the bind is a heat one, do not fry it.

Clinical note임상 주석

若熱結不用炒 — where the bind is from heat, do not fry it. The same ginger dregs used cold instead of hot, which is a sensible adjustment and rarely made this explicitly.

Immun 入門

1.44 Chest Bind 結胸

1.44.1

Source원문

傷寒病發於陽而反下之, 熱入, 因作結胸; 病發於陰而反下之, 因作痞. 所以成結胸者, 以下之太早故也. 《仲景》

Translation영역

In cold damage, where the disease breaks out in the yang and one purges instead, the heat enters and makes chest bind; where it breaks out in the yin and one purges instead, it makes glomus. What makes a chest bind is purging too early.

Junggyeong 仲景

1.44.2

Source원문

結胸之證, 當心緊痛而煩, 水漿不入, 但能仰而不能俯, 項强如柔痓狀. 《入門》心下滿而硬痛爲結胸, 滿而不痛爲痞, 半夏瀉心湯方見寒門主之. 《仲景》

Translation영역

In the pattern of chest bind there is a tight pain right at the heart with vexation, neither water nor gruel going in, the patient able to lean back but not forward, and the nape stiff as in soft tetany. Below the heart full and hard and painful is chest bind; full and not painful is glomus, and Pinellia Drain the Heart Decoction formula in the Cold Damage chapter governs it.

Clinical note임상 주석

但能仰而不能俯 — able to lean back but not to bend forward. A posture forced on the patient by the pain, and one of the chapter's few purely observational signs.

Immun 入門 · Junggyeong 仲景

1.44.3

Source원문

有大結胸ㆍ小結胸ㆍ寒實結胸ㆍ熱實結胸ㆍ水結胸ㆍ血結胸ㆍ陰陽毒結胸, 又有支結證. 桔梗枳殼湯治結胸痞氣通用. 《入門》

Translation영역

There are great chest bind, minor chest bind, cold repletion chest bind, heat repletion chest bind, water chest bind, blood chest bind and yin-yang toxin chest bind, and besides these the branch bind pattern. Platycodon and Bitter Orange Decoction is used generally for chest bind and glomus qi alike.

Immun 入門

1.45 Great Chest Bind 大結胸

1.45.1

Source원문

大結胸者, 不按而痛, 胸連臍腹痛硬, 手不可近, 不大便, 日晡潮熱, 宜大陷胸湯ㆍ大陷胸丸方幷見寒門ㆍ穿結散. 大結胸者, 心下滿而硬痛, 手不可按. 《仲景》

Translation영역

In great chest bind it pains without being pressed, the chest and navel and abdomen are painful and hard together, the hand cannot be brought near, the stool does not pass and there is tidal fever in the late afternoon: Major Sink into the Chest Decoction and Pill both in the Cold Damage chapter and Pierce the Bind Powder. In great chest bind it is full below the heart, hard and painful, and the hand cannot press it.

Junggyeong 仲景

1.46 Minor Chest Bind 小結胸

1.46.1

Source원문

小結胸者, 按之方痛, 只心下硬, 宜小陷胸湯方見寒門. 小結胸者正在心下, 按之則痛. 《仲景》

Translation영역

In minor chest bind it pains only when pressed, and only below the heart is hard: Minor Sink into the Chest Decoction formula in the Cold Damage chapter. Minor chest bind is right below the heart and pains on pressure.

Junggyeong 仲景

1.47 Cold Repletion Chest Bind 寒實結胸

1.47.1

Source원문

寒實結胸者, 身不熱, 口不渴, 只心中脹硬而痛, 無熱證, 宜枳實理中丸方見上, 甚者三物白散方見寒門. 《入門》

Translation영역

In cold repletion chest bind the body is not hot and the mouth not thirsty, and only within the chest is distended, hard and painful, with no heat signs: Bitter Orange Regulate the Centre Pill formula above, and in a severe case Three Ingredients White Powder formula in the Cold Damage chapter.

Immun 入門

1.48 Heat Repletion Chest Bind 熱實結胸

1.48.1

Source원문

熱實結胸者, 心下滿硬, 懊憹煩躁而渴, 宜加味陷胸湯方見上ㆍ柴陷湯. 《入門》

Translation영역

In heat repletion chest bind it is full and hard below the heart, with anguish, vexed restlessness and thirst: Supplemented Sink into the Chest Decoction formula above and Bupleurum Sink into the Chest Decoction.

Immun 入門

1.49 Water Chest Bind 水結胸

1.49.1

Source원문

傷寒結胸無大熱者, 此爲水結在胸脇, 但頭微汗出. 《仲景》凡水結胸脇間, 頭必有汗. 《綱目》

Translation영역

Where in cold damage chest bind there is no great heat, it is water bound in the chest and flank, and only the head sweats a little. Wherever water is bound between chest and flank the head will have sweat on it.

Junggyeong 仲景 · Gangmok 綱目

1.49.2

Source원문

一人忽患微熱, 心下滿, 頭有汗, 衆醫以爲濕病, 或以爲食積. 孫兆曰, 水結胸也. 用半夏茯苓湯遂差. 衆問其故, 答曰, 頭有汗心下滿, 非濕病, 乃水結胸脇也. 水旣去其病當愈. 若濕氣心下滿, 自當遍身汗; 若食積, 頭豈有汗乎. 故知之. 《綱目》

Translation영역

A man suddenly fell ill with slight heat, fullness below the heart and sweat on the head; the physicians took it for a damp disease or for food accumulation. Sun Zhao said: it is water chest bind. He used Pinellia and Poria Decoction and the man mended. Asked the reason, he answered: sweat on the head with fullness below the heart is not a damp disease but water bound in the chest and flank; the water once gone, the disease must heal. In damp qi with fullness below the heart the whole body would sweat; and in food accumulation, how should the head sweat at all? That is how I knew it.

Clinical note임상 주석

Sweat on the head and nowhere else is the whole of Sun Zhao's reasoning, and he states what would have been true for each alternative. It is the most carefully argued differential in the chapter.

Gangmok 綱目

1.49.3

Source원문

水結宜枳朮湯.

Translation영역

For water bind, Bitter Orange and Atractylodes Decoction is appropriate.

Donguibogam · Hyung

1.50 Blood Chest Bind 血結胸

1.50.1

Source원문

婦人傷寒血結胸, 痛不可忍, 宜服海蛤散ㆍ玄胡索散. 《入門》

Translation영역

Where in a woman's cold damage there is blood chest bind with pain past bearing: Clam Shell Powder and Corydalis Powder should be taken.

Immun 入門

1.51 Yin and Yang Toxin Chest Bind 陰陽毒結胸

1.51.1

Source원문

傷寒陰陽二毒伏逆變爲結胸, 有自利者, 有不得利者, 依結胸灸臍法以利之. 陽毒內服活龍散, 陰毒內服破結丹. 得泄則陰陽升降, 榮衛流行, 自然大汗而解矣. 若心下已結, 延至五日間斷不可治. 《入門》

Translation영역

Where in cold damage the two toxins, yin and yang, lie and counterflow and turn into chest bind, some have spontaneous diarrhoea and some do not, and the moxa-at-the-navel method for chest bind is used to free it. For yang toxin, Live Dragon Powder is taken inwardly; for yin toxin, Break the Bind Elixir. Once it drains, yin and yang rise and fall, construction and defence flow, and a great sweat comes of itself and resolves it. But where it has already bound below the heart and has dragged on to the fifth day, it is decidedly not to be treated.

Immun 入門

1.51.2

Source원문

治陽證結胸, 死無可藥者, 活蚯蚓十二條搗爛, 蜜半盞, 水半椀, 和灌之. 《得效》服後穩睡一場, 卽摩心下片時, 再令睡. 有汗卽愈. 《醫鑑》

Translation영역

To treat a yang pattern chest bind where the patient is dying and no medicine serves: twelve live earthworms pounded soft with half a jan of honey and half a bowl of water, poured in. After taking it let them sleep quietly a while, then rub below the heart a short time and let them sleep again; when sweat comes it heals.

Deukhyo 得效 · Uigam 醫鑑

1.52 Branch Bind 支結

1.52.1

Source원문

傷寒心下妨悶, 不滿不硬者, 謂之支結, 宜桂枝人參湯. 傷寒未經下而胸膈氣塞滿悶者, 非痞亦非結胸也. 柴梗湯ㆍ柴陳湯; 胃虛者半夏瀉心湯方見寒門. 《入門》

Translation영역

Where in cold damage there is obstruction and oppression below the heart but it is neither full nor hard, it is called branch bind: Cinnamon Twig and Ginseng Decoction. Where in cold damage no purge has yet been given and the qi of the chest and diaphragm is stopped, full and oppressed, it is neither glomus nor chest bind: Bupleurum and Platycodon Decoction and Bupleurum and Tangerine Peel Decoction; where the stomach is vacuous, Pinellia Drain the Heart Decoction formula in the Cold Damage chapter.

Clinical note임상 주석

非痞亦非結胸 — neither glomus nor chest bind. A third category for what fits neither, which is an unusually honest piece of classification.

Immun 入門

1.53 The Method of Warm Plastering for Chest Bind 熁結胸法

1.53.1

Source원문

用初出殼黃毛鷄子一隻, 生薑四兩, 共搗爛炒微溫, 罨在胸前結實之處, 外以絹帛縛之. 候半日許, 覺腹中熱躁, 解去, 更以熱手摩之. 《入門》

Translation영역

Take one newly hatched yellow-downed chick and 4 nyang of fresh ginger, pound them together soft and fry slightly warm; lay it over the hard bound place at the front of the chest and bind it over with silk. After about half a day, when heat and restlessness are felt in the belly, take it off and rub the place with a warm hand.

Immun 入門

1.54 The Method of Ironing for Chest Bind 熨結胸法

1.54.1

Source원문

治陰證結胸手足厥逆. 大葱白十莖, 生薑一兩, 搗爛作餠, 灸熱貼臍中, 以熨斗火熨餠上. 待熱氣入內, 覺響卽住, 復用枳實理中丸之類方見上. 《入門》

Translation영역

Treats a yin pattern chest bind with the hands and feet cold in reversal. Ten stalks of large scallion white and 1 nyang of fresh ginger, pounded soft and made into a cake, roasted hot and stuck on the navel, with a charcoal iron held over the cake. Wait until the hot qi enters within, and when a rumbling is felt stop; then use Bitter Orange Regulate the Centre Pill and its kind formula above.

Clinical note임상 주석

覺響卽住 — stop when a rumbling is heard. Bowel sounds returning as the endpoint of an external treatment, which is a sound thing to listen for and a rare one to find written down.

Immun 入門

1.55 Untreatable Signs in Chest Bind 結胸不治證

1.55.1

Source원문

結胸脈浮大者, 不可下, 下之卽死. 《仲景》結胸證悉具, 煩躁者死. 《仲景》結胸見陰脈陰證, 及喘急呃逆者, 亦死. 《入門》

Translation영역

Where in chest bind the pulse is floating and large it must not be purged, and purging kills. Where all the signs of chest bind are present and there is vexed restlessness, death. Where chest bind shows a yin pulse and yin signs, and there is panting and hiccup, likewise death.

Clinical note임상 주석

A floating large pulse in a patient who looks as though they need purging is the trap, and Zhongjing states the consequence plainly. The sign is that the strength is at the surface and there is nothing left to purge.

Junggyeong 仲景 · Immun 入門

1.56 Simple Medicinals 單方

1.56.1

Source원문

凡三十八種.

Translation영역

Thirty-eight kinds in all.

Clinical note임상 주석

Thirty-eight simples. Three groups stand out. For glomus below the heart, coptis — which the chapter calls the medicinal that must be used, since all five of Zhongjing's Drain the Heart Decoctions have it. For chest impediment with pain through to the back and a patient who cannot lie down, trichosanthes with chive bulb and pinellia boiled in white wine, which is Zhongjing's formula and is still the base prescription for that complaint. And for sudden stomach pain with no medicine at hand, salt heated red on a knife blade and quenched in water, drunk hot to bring up phlegm. The rest divide between warming things — galangal, costus, tsaoko, pepper — and the two that kill worms, pomegranate root and mugwort.

Donguibogam · Hyung

1.57 Acupuncture and Moxibustion 鍼灸法

1.57.1

Source원문

卒心痛不可忍, 取然谷ㆍ上脘ㆍ氣海ㆍ湧泉ㆍ間使ㆍ支溝ㆍ公孫ㆍ太衝ㆍ陰陵泉ㆍ太谿. 《綱目》

Translation영역

For sudden heart pain past bearing, take Yeongok (然谷, KI2), Sangwan (上脘, CV13), Gihae (氣海, CV6), Yongcheon (湧泉, KI1), Gansa (間使, PC5), Jigu (支溝, TE6), Gongson (公孫, SP4), Taechung (太衝, LR3), Eumneungcheon (陰陵泉, SP9) and Taegye (太谿, KI3).

Clinical note임상 주석

Gongson paired with Naegwan is the classical couple for anything in the epigastrium, and Gongson heads the list here for that reason. The Abdomen chapter's needling section overlaps closely.

Gangmok 綱目

About this translation 凡例

Base text: Donguibogam (東醫寶鑑, 1613 first edition), Outer Form, Volume 3, Chest 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.