Formulas · Text · Donguibogam 東醫寶鑑

Accumulations and Gatherings

Jeokchwi

한글 적취 · Pinyin Ji Ju

Masses in the abdomen, sorted by whether they move — and the long argument over how hard to attack them

積聚

The chapter on lumps. It opens with the Lingshu's account of how one forms — the viscera damaged by unregulated joy and anger, cold entering from below, congealed blood and frothy fluid pressed together outside the intestine until they will not disperse — and then sets out the categories: five accumulations belonging to the viscera, which do not move; six gatherings belonging to the bowels, which shift and can be cured; and the concretions, aggregations, string-like masses and glomus lumps that fill the space between. What follows is a long and unresolved argument about force. Dongwon's rule at 1.8 is to grind, disperse, push and wear away but never to purge down; the Neijing's is to stop when a little more than half is gone, because medicine past its measure kills; and the Yiaeo passage at 1.10 puts it most plainly — the strong have no accumulations, only the depleted do, so supplement first and the mass disperses of itself. Against that stand the formulas the chapter nonetheless records, some of the most violent in the book. Heo Jun sets both down and leaves the practitioner to judge.

1.1 The Causes of Accumulation and Gathering 積聚之因

1.1.1

Source원문

靈樞曰, 喜怒不節則傷藏, 藏傷則虛. 風雨襲虛, 則病起於上. 留着於脉, 稽留不去, 息而成積.

Translation영역

The Lingshu says: when joy and anger are not regulated the viscera are damaged, and when the viscera are damaged there is vacuity. Wind and rain then strike at the vacuity, and disease arises above. It lodges and settles in the vessels, and remaining there without going, it rests and forms an accumulation.

Clinical note임상 주석

The sequence is the chapter's foundation: emotion damages the viscera, damage leaves a vacancy, and only then does an external cause find purchase. An accumulation is not something that arrives from outside but something that settles where the body has already given way — which is why the treatment section at 1.10 argues that supplementing must come first.

Yeongchu 靈樞

1.1.2

Source원문

着於陽明之經, 則挾臍而居, 飽食則益大, 飢則益小.

Translation영역

Settling in the yang brightness channel, it takes up its place flanking the navel; when the person eats to fullness it grows larger, and when hungry it grows smaller.

Yeongchu 靈樞

1.1.3

Source원문

着於緩筋也, 似陽明之積, 飽食則痛, 飢則安.

Translation영역

Settling in the slack sinews, it resembles a yang brightness accumulation, but eating to fullness brings pain and hunger brings ease.

Yeongchu 靈樞

1.1.4

Source원문

着於腸胃之膜原, 痛而外連於緩筋, 飽食則安, 飢則痛.

Translation영역

Settling in the membrane source of the intestines and stomach, it is painful and connects outward to the slack sinews; eating to fullness brings ease and hunger brings pain.

Yeongchu 靈樞

1.1.5

Source원문

着於膂筋在腸後者, 飢則積見, 飽則積不見, 按之不得.

Translation영역

Settling in the spinal sinews behind the intestines, the accumulation appears when the person is hungry and disappears when full, and it cannot be found by pressing.

Clinical note임상 주석

Four passages that locate a mass by how it answers to eating, which is a genuinely useful bedside distinction and has no equivalent elsewhere in the chapter. A mass that grows with food is in the channel; one that hurts with food is in the sinews; one that eases with food is in the membrane source; one that vanishes with food is behind the intestines. The examination is done twice, fed and fasting, and the difference between the two readings gives the depth.

Yeongchu 靈樞

1.1.6

Source원문

淸濕襲虛, 則病起於下. 積之始生, 得寒乃生, 厥乃成積. 厥氣生足悗, 足悗生脛寒, 脛寒則血脉凝澁, 血脉凝澁則寒氣上入於腸胃, 入於腸胃則䐜脹, 䐜脹則腸外之汁沫迫聚不得散, 日以成積.

Translation영역

When cold damp strikes at the vacuity, disease arises below. In the first arising of an accumulation, it comes into being on contracting cold, and reversal then completes it. Reversal qi produces vexation in the foot; vexation in the foot produces cold in the shin; cold in the shin congeals and roughens the blood vessels; the blood vessels congealed and rough, the cold qi ascends and enters the intestines and stomach; entering there it produces distension; and with distension the frothy fluid outside the intestines is pressed together and cannot disperse, so that day by day an accumulation forms.

Clinical note임상 주석

A causal chain traced from the foot upward in seven linked steps, each stated as producing the next. The mechanism it arrives at is precise: 汁沫, the frothy fluid outside the intestine, pressed together until it will not disperse. That is a description of what would now be called an inflammatory exudate becoming loculated, and it is the closest thing in the chapter to a physical account of how a mass forms.

Yeongchu 靈樞

1.1.7

Source원문

卒然多飮食則脹滿, 起居不節, 用力過度, 則陽絡脉傷. 陽絡傷則血外溢, 陰絡傷則血內溢, 血內溢則後血. 腸胃之絡傷, 則血溢於腸外, 腸外有寒, 汁沫與血相搏, 則幷合凝聚不得散而積成矣.

Translation영역

Sudden excess of food and drink brings distension and fullness; unregulated activity and rest, and excessive use of strength, damage the yang network vessels. When the yang network vessels are damaged blood spills outward; when the yin network vessels are damaged blood spills inward; and blood spilling inward means blood passed behind. When the network vessels of the intestines and stomach are damaged, blood spills outside the intestines; there being cold outside the intestines, the frothy fluid and the blood contend with one another, and joining they congeal and gather so that they cannot disperse, and the accumulation is formed.

Clinical note임상 주석

The second mechanism, and the one the chapter relies on when it treats masses with blood-movers. Blood escapes the network vessels, meets the frothy fluid outside the intestine, and the two congeal together. This is the passage that licenses the peach kernel and safflower in the lump formulas at 1.7, and it is echoed in the Danxi line at 1.7.2 that a lump is phlegm, food accumulation and dead blood.

Yeongchu 靈樞

1.1.8

Source원문

帝曰, 人之善病腸中積聚者, 何以候之. 少兪答曰, 皮膚薄而不澤, 肉不堅而淖澤. 如此則腸胃惡, 惡則邪氣留止, 積聚乃成. 腸胃之間, 寒溫不次, 邪氣稍至, 蓄積留止, 大聚乃起.

Translation영역

The Yellow Emperor said: in a person prone to accumulation and gathering within the intestines, by what signs is it foretold? Shaoyu answered: the skin is thin and without lustre, and the flesh is not firm but soft and moist. When it is so, the intestines and stomach are poor; being poor, evil qi lodges and stays, and accumulation and gathering are formed. Between the intestines and stomach, cold and warmth out of their proper order, evil qi arrives little by little, builds up and lodges, and a great gathering then arises.

Clinical note임상 주석

A constitutional reading: thin lustreless skin and soft flesh mark the person who will form accumulations. The examination is of the surface and the inference is about the gut, on the reasoning that the outside reflects the state of the inside — the same logic the Phlegm-Rheum chapter uses at 6.7 when it reads phlegm from the skin of the forearm and the colour beneath the eyes.

Yeongchu 靈樞

1.1.9

Source원문

內經曰, 寒氣客於小腸膜原之間, 絡血之中, 血澁不得注於大經, 血氣稽留不得行, 故宿昔而成積矣.

Translation영역

The Neijing says: cold qi lodges as a guest between the membrane source of the small intestine, within the network blood; the blood is rough and cannot pour into the great channels, and blood and qi remain and cannot move — and so overnight an accumulation is formed.

Naegyeong 內經

1.2 On the Five Accumulations and Six Gatherings 論五積六聚

1.2.1

Source원문

病有積有聚, 何以別之. 然積者, 陰氣也. 聚者, 陽氣也. 故陰沈而伏, 陽浮而動. 氣之所積, 名曰積, 氣之所聚, 名曰聚. 積者, 五藏所生, 聚者, 六府所成. 積者, 陰氣也. 其始發有常處, 其痛不離其部, 上下有所終始, 左右有所窮處. 聚者, 陽氣也. 其始發無根本, 上下無所留止, 其痛無常處. 故以是別知積聚也. 《難經》

Translation영역

Disease may be accumulation or gathering — how are they distinguished? Accumulation is yin qi; gathering is yang qi. Yin therefore sinks and lies hidden, yang floats and moves. Where qi accumulates is called accumulation; where qi gathers is called gathering. Accumulation is engendered by the five viscera, gathering is formed by the six bowels. Accumulation, being yin qi, arises in a constant place, its pain does not leave its region, it has a beginning and an end above and below, and a limit to left and right. Gathering, being yang qi, arises without root, has no fixed place above or below, and its pain has no constant seat. By this the two are told apart.

Clinical note임상 주석

The chapter's founding distinction, and the whole of its therapeutics follows from it. Accumulation is fixed and belongs to the viscera; gathering shifts and belongs to the bowels. The one is ground down over months with pills, the other is scattered with a decoction — which is why Sanchwi-tang at 1.8.10 contains nothing that breaks a mass, and why the five viscus pills at 1.8.3 to 1.8.7 all contain croton frost.

Nangyeong 難經

1.2.2

Source원문

病有積有聚有㯏氣, 何謂也. 師曰, 積者, 藏病也, 終不移. 聚者, 府病也, 發作有時, 展轉痛移, 爲可治. 㯏氣者, 脇下痛, 按之則愈, 復發爲㯏氣. 《仲景》

Translation영역

Disease may be accumulation, gathering, or gu qi — what is meant by this? The master said: accumulation is a disease of the viscera and in the end does not move. Gathering is a disease of the bowels; it breaks out at intervals, and the pain turns and shifts about, and it can be cured. Gu qi is pain below the ribside which is relieved by pressure and then breaks out again.

Clinical note임상 주석

Zhongjing adds a third and mildest category to the Nanjing's two, and the criterion for it is that pressure relieves the pain. In the accumulations, pressure finds a fixed hard mass; in gu qi there is nothing to find, and the pain answers to the hand. 爲可治 — it can be cured — is said of gathering and not of accumulation, which is the chapter's first statement of prognosis.

Junggyeong 仲景

1.2.3

Source원문

肝之積, 名曰肥氣, 在左脇下, 如覆盃, 有頭足, 久不愈, 令人發咳逆, 痎瘧連歲不已.

Translation영역

The accumulation of the liver is called fat qi. It lies below the left ribside like an upturned cup, having a head and feet; if it does not resolve for long it causes cough with counterflow, and recurrent malaria continuing from year to year.

Nangyeong 難經

1.2.4

Source원문

心之積, 名曰伏梁, 起臍上大如臂, 上至心下, 久不愈, 令人煩心.

Translation영역

The accumulation of the heart is called hidden beam. It rises above the navel, thick as an arm, reaching up to below the heart; if it does not resolve for long it causes vexation of the heart.

Nangyeong 難經

1.2.5

Source원문

脾之積, 名曰痞氣, 在胃脘, 覆大如盤, 久不愈, 令人四肢不收, 發黃疸, 飮食不爲肌膚.

Translation영역

The accumulation of the spleen is called glomus qi. It lies in the stomach duct, covering an area as large as a platter; if it does not resolve for long it causes the four limbs to be unable to be drawn in, jaundice arises, and food and drink do not become flesh.

Clinical note임상 주석

飮食不爲肌膚 — food and drink not becoming flesh — is the phrase worth carrying. Eating without gaining is a sign the Phlegm-Rheum chapter also uses at 6.7, and paired here with jaundice and a mass in the epigastrium it makes a picture that would today prompt investigation of the liver and pancreas.

Nangyeong 難經

1.2.6

Source원문

肺之積, 名曰息賁, 在右脇下, 覆大如盃, 久不已, 令人洒淅寒熱, 喘咳, 發肺癰.

Translation영역

The accumulation of the lung is called panting rush. It lies below the right ribside, covering an area as large as a cup; if it does not resolve for long it causes shivering cold and heat, panting and cough, and lung abscess arises.

Nangyeong 難經

1.2.7

Source원문

腎之積, 名曰奔豚, 發於小腹上至心下, 若豚狀, 或下或上無時, 久不已, 令人喘逆, 骨痿, 少氣. 《難經》

Translation영역

The accumulation of the kidney is called running piglet. It breaks out in the lower abdomen and rises to below the heart, in the manner of a piglet, now down and now up without fixed time; if it does not resolve for long it causes panting counterflow, wilting of the bones, and scant qi.

Clinical note임상 주석

The five accumulations are given as one block, each with a viscus, a name, a site, a size measured against a household object, and a consequence of neglect. Running piglet is the odd one out: alone among the five it moves, which sits awkwardly with the Nanjing's own rule that accumulation does not move. The section at 1.18 singles it out as the hardest of the five to treat.

Nangyeong 難經

1.2.8

Source원문

肝積面靑, 脉弦而長, 定在左脇下.

Translation영역

In liver accumulation the complexion is green, the pulse wiry and long, and it is fixed below the left ribside.

Gangmok 綱目

1.2.9

Source원문

心積面赤, 脉數而實, 定在心下.

Translation영역

In heart accumulation the complexion is red, the pulse rapid and replete, and it is fixed below the heart.

Gangmok 綱目

1.2.10

Source원문

脾積面黃, 脉大而虛, 定在中脘.

Translation영역

In spleen accumulation the complexion is yellow, the pulse large and vacuous, and it is fixed in the middle duct.

Gangmok 綱目

1.2.11

Source원문

肺積面白, 脉數而浮, 定在右脇下.

Translation영역

In lung accumulation the complexion is white, the pulse rapid and floating, and it is fixed below the right ribside.

Gangmok 綱目

1.2.12

Source원문

腎積面黑, 脉寸口大實, 定在小腹. 《綱目》

Translation영역

In kidney accumulation the complexion is black, the pulse at the inch opening large and replete, and it is fixed in the lower abdomen.

Clinical note임상 주석

The Gangmok reduces the Nanjing's five to a three-part formula — colour, pulse, site — with the five phase colours running green, red, yellow, white, black in the standard order. It is a mnemonic rather than an observation, and the variants recorded alongside three of the five suggest the pulses were less settled than the scheme implies.

Gangmok 綱目

1.3 Hidden Beam Has Two Patterns 伏梁有二證

1.3.1

Source원문

帝曰, 病有小腹盛, 上下左右皆有根, 此爲何病可治否. 岐伯曰, 病名曰伏梁, 裹大膿血, 居腸胃之外, 不可治, 治之, 每切按之致死.

Translation영역

The Yellow Emperor said: there is a disease in which the lower abdomen is full and there is a root above, below, to left and right — what disease is this, and can it be treated? Qi Bo said: the disease is called hidden beam. It wraps a great quantity of pus and blood and lies outside the intestines and stomach. It cannot be treated; in treating it, pressing firmly upon it each time brings death.

Clinical note임상 주석

A named contraindication, stated without qualification. A mass rooted in all four directions and containing pus and blood outside the gut is what would now be recognized as a walled-off abscess or a phlegmon, and the warning that firm palpation kills is a warning about rupture and peritonitis. It is among the most clinically sound statements in the chapter. **A tender abdominal mass with fever must not be palpated forcefully and requires urgent surgical assessment.**

Naegyeong 內經

1.3.2

Source원문

帝曰, 人有身體髀股胻皆腫, 環臍而痛, 是爲何病. 岐伯曰, 病名伏梁, 此風根也. 其氣溢於大腸而着於肓, 肓之原在臍下, 故環臍而痛, 不可動之, 動之爲水尿澁之病. 此二病, 同名而實異也. 《內經》

Translation영역

The Yellow Emperor said: a person has swelling of the body, the thigh, the hip and the shin, with pain encircling the navel — what disease is this? Qi Bo said: the disease is called hidden beam; this is a root of wind. Its qi spills into the large intestine and settles in the huang membrane, whose source lies below the navel, and so there is pain encircling the navel. It must not be stirred; stirring it produces a disease of water with rough urination. These two diseases share a name but differ in substance.

Clinical note임상 주석

Two conditions, one name, and the chapter gives the section over to separating them. The closing sentence is Heo Jun's editorial point and it is the reason the section exists: 伏梁 appears in the five accumulations as the heart accumulation at 1.2, and neither of these two is that. Three quite different things carry the name. The second here — generalized oedema with periumbilical pain and, if disturbed, retention of urine — reads as an obstructive process. Both passages end in the same instruction: do not press, do not stir.

Naegyeong 內經

1.4 Pulse Method 脉法

1.4.1

Source원문

鬱脉多沈伏, 或結, 或促, 或代. 《正傳》

Translation영역

The depression pulse is mostly sunken and hidden, or bound, or skipping, or intermittent.

Jeongjeon 正傳

1.4.2

Source원문

鬱脉沈濇, 積脉弦堅. 《丹心》

Translation영역

The depression pulse is sunken and rough; the accumulation pulse is wiry and firm.

Dansim 丹心

1.4.3

Source원문

病在右脇有積氣, 得肺脉結, 結甚則積甚, 結微則積微. 肺脉雖不見, 右手脉當沈伏. 《難經》

Translation영역

When the disease lies in the right ribside with accumulated qi, the lung pulse is found to be bound; the more bound, the more severe the accumulation, and the fainter the binding, the slighter the accumulation. Even where the lung pulse is not evident, the pulse of the right hand should be sunken and hidden.

Nangyeong 難經

1.4.4

Source원문

心肺有積, 其脉皆喘數, 肝有積, 其脉弦長, 脾腎有積, 其脉皆大. 《綱目》

Translation영역

Where heart or lung has an accumulation, the pulse in both cases is panting and rapid; where the liver has one, the pulse is wiry and long; where spleen or kidney has one, the pulse in both cases is large.

Gangmok 綱目

1.4.5

Source원문

脉弦緊爲積, 脉弦緊而微細者, 癥也. 夫癥瘕積聚之脉皆弦緊, 在心下卽寸弦緊, 在胃脘卽關弦緊, 在臍下卽尺弦緊.

Translation영역

A wiry tight pulse indicates accumulation; wiry and tight with a faint fine quality indicates concretion. The pulses of concretion, aggregation, accumulation and gathering are all wiry and tight: for a mass below the heart it is the inch that is wiry and tight, for one in the stomach duct the bar, and for one below the navel the cubit.

Clinical note임상 주석

The one passage in the section that maps position to position: the three pulse stations correspond to the three levels of the abdomen, so where the wiry tightness is felt tells where the mass lies. Simple, and consistent with the fixed-site definition of accumulation at 1.2.

Maekgyeong 脉經

1.4.6

Source원문

內有積不見脉難治, 見一脉相應爲易治.

Translation영역

Where there is an accumulation within and no pulse is evident, it is hard to treat; where a pulse is seen that corresponds to it, treatment is easy.

Maekgyeong 脉經

1.4.7

Source원문

診積聚, 其脉堅强急者生, 虛弱者死.

Translation영역

In examining accumulation and gathering, a pulse firm, strong and tense means life; vacuous and weak means death.

Maekgyeong 脉經

1.4.8

Source원문

脉弦而伏者, 腹中有癥, 不可轉也. 必死不治. 《脉經》

Translation영역

A pulse wiry and hidden means there is a concretion within the abdomen which cannot be turned. Such a case will certainly die and cannot be treated.

Clinical note임상 주석

The rule the section returns to twice more, at 1.18 and in the general prognosis: a mass that will not move is fatal, and a weak pulse in a patient who has one is fatal. Both statements amount to the same judgement, that what matters is not the mass but whether the patient still has the strength to be treated.

Maekgyeong 脉經

1.4.9

Source원문

五藏爲積, 六府爲聚. 積在本位, 聚無定處. 駃緊浮牢, 小而沈實, 或結或伏, 爲聚爲積. 實强者生, 沈小者死. 《脉訣》

Translation영역

The five viscera make accumulations, the six bowels make gatherings. Accumulation stays in its own position, gathering has no fixed place. Swift, tight, floating and firm; small yet sunken and replete; or bound, or hidden — these make gathering and accumulation. Replete and strong means life, sunken and small means death.

Maekgyeol 脉訣

1.4.10

Source원문

五積屬陰, 沈伏附骨. 肝弦心芤, 腎沈急滑, 脾實且長, 肺浮喘卒.

Translation영역

The five accumulations belong to yin, sunken and hidden, cleaving to the bone. In the liver the pulse is wiry, in the heart scallion-stalk; in the kidney sunken, tense and slippery; in the spleen replete and long; in the lung floating, panting and abrupt.

Hoechun 回春

1.4.11

Source원문

六聚結沈, 痼則浮結.

Translation영역

The six gatherings are bound and sunken; when they have become inveterate the pulse is floating and bound.

Hoechun 回春

1.4.12

Source원문

又有癥瘕, 其脉多弦, 弦急瘕疾, 弦細癥堅.

Translation영역

There are also concretion and aggregation, whose pulse is mostly wiry: wiry and tense indicates aggregation disease, wiry and fine indicates a firm concretion.

Hoechun 回春

1.4.13

Source원문

沈重中散, 食成癖痃, 左轉沈重, 氣癥胸前, 若是肉癥, 右轉橫旋.

Translation영역

Sunken and heavy, scattering in the middle, indicates food that has become an aggregation or a string-like mass; turning to the left, sunken and heavy, a qi concretion before the chest; and if it is a flesh concretion, it turns to the right and revolves crosswise.

Hoechun 回春

1.4.14

Source원문

積聚癥瘕, 緊則痛纏, 虛弱者死, 實强可痊. 《回春》

Translation영역

In accumulation, gathering, concretion and aggregation, a tight pulse means pain that binds; vacuous and weak means death, replete and strong means recovery is possible.

Hoechun 回春

1.4.15

Source원문

腹中有積, 脉忌虛弱. 《醫鑑》

Translation영역

Where there is an accumulation within the abdomen, a vacuous weak pulse is to be shunned.

Uigam 醫鑑

1.4.16

Source원문

診婦人疝瘕積聚之脉, 弦急者生, 虛弱小者死. 《脉經》

Translation영역

In examining the pulse of mounting, aggregation, accumulation and gathering in women, wiry and tense means life; vacuous, weak and small means death.

Clinical note임상 주석

Five separate authorities in this section arrive at the same prognostic rule, stated five times in slightly different words: a strong pulse in a patient with a mass is survivable, a weak one is not. The repetition is itself the argument — what the section is really about is not identifying the mass but judging whether the patient can withstand what would be done about it.

Maekgyeong 脉經

1.5 The Six Depressions Are the Root of Accumulation, Concretion and Aggregation 六鬱爲積聚癥瘕痃癖之本

1.5.1

Source원문

氣血冲和, 百病不生, 一有怫鬱, 諸病生焉. 鬱者, 病結不散也. 《丹心》

Translation영역

When qi and blood are in harmony, the hundred diseases do not arise; let there be one thwarting or depression and all diseases come into being. Depression means that the disease is bound and does not disperse.

Clinical note임상 주석

The premise of the section and of much of Danxi's medicine. Depression is not itself a disease but the condition in which diseases become possible, and the definition given — bound and not dispersing — is the same one the chapter applies to an accumulation. What separates them is only time.

Dansim 丹心

1.5.2

Source원문

熱鬱而成痰, 痰鬱而成癖, 血鬱而成癥, 食鬱而成痞滿, 此必然之理也.

Translation영역

Heat depressed becomes phlegm; phlegm depressed becomes an aggregation; blood depressed becomes a concretion; food depressed becomes glomus and fullness. This is a principle that holds of necessity.

Jeongjeon 正傳

1.5.3

Source원문

又氣鬱而濕滯, 濕滯而成熱, 熱鬱而成痰, 痰滯而血不行, 血滯而食不消化, 而遂成痞塊. 此六者, 相因而爲病也. 《正傳》

Translation영역

Again: qi depressed brings damp stagnation; damp stagnating becomes heat; heat depressed becomes phlegm; phlegm stagnating stops the blood moving; blood stagnating stops food being digested — and so a glomus lump is formed. These six follow one from another in making disease.

Clinical note임상 주석

The chain that gives the section its title. Six depressions arise in sequence, each producing the next, and a glomus lump is what stands at the end of the series. That is the argument for why a chapter on abdominal masses opens with a section on depression: the mass is the last term, and the treatment has to reach back along the chain.

Jeongjeon 正傳

1.5.4

Source원문

鬱者, 結聚而不得發越也. 當升者不得升, 當降者不得降, 當變化者不得變化也. 此爲傳化失常, 六鬱之病見矣. 《丹心》

Translation영역

Depression is being bound and gathered so that it cannot break out and rise. What ought to ascend cannot ascend; what ought to descend cannot descend; what ought to transform cannot transform. This is conveyance and transformation losing their normal course, and the disease of the six depressions appears.

Clinical note임상 주석

Three failures, one for each direction of movement, and this is the definition the section works from. It also explains a formula that would otherwise look odd: Seungbalijin-tang at 1.5.15 treats depressed phlegm with bupleurum, saposhnikovia and cimicifuga, none of which touches phlegm — because what ought to ascend has not ascended.

Dansim 丹心

1.5.5

Source원문

一曰氣鬱, 二曰濕鬱, 三曰熱鬱, 四曰痰鬱, 五曰血鬱, 六曰食鬱, 此六鬱也. 六鬱不言風寒者, 風寒鬱則爲熱故也. 《丹心》

Translation영역

The first is qi depression, the second damp, the third heat, the fourth phlegm, the fifth blood, the sixth food — these are the six depressions. Wind and cold are not named among the six because wind and cold, once depressed, become heat.

Clinical note임상 주석

The closing clause is the interesting one. Wind and cold are omitted not by oversight but because they convert: anything depressed long enough turns to heat, so they enter the list under the third heading. The Phlegm-Rheum chapter makes the same move at 6.5, where the ten phlegms are sorted by what set them moving rather than by what they are.

Dansim 丹心

1.5.6

Source원문

治鬱之法, 順氣爲先, 降火, 化痰, 消積, 分多少而治. 蒼朮ㆍ蕪芎, 總解諸鬱. 《丹心》

Translation영역

In the method of treating depression, normalizing the qi comes first; then downbearing fire, transforming phlegm and dispersing accumulation, treating each according to how much of it there is. Atractylodes lancea and chuanxiong resolve all the depressions generally.

Clinical note임상 주석

Normalizing the qi first is the same sequencing rule the Phlegm-Rheum chapter gives at 6.19, and the two chapters agree on it. The naming of atractylodes lancea and chuanxiong as the general solvent explains why those two, with cyperus, form the core of Wolguk-hwan and appear in nearly every formula in this section.

Dansim 丹心

1.5.7

Source원문

內經曰, 木鬱達之, 火鬱發之, 土鬱奪之, 金鬱泄之, 水鬱折之. 張子和曰, 木鬱達之, 謂吐之, 令其條達也. 火鬱發之, 謂汗之, 令其疏散也. 土鬱奪之, 謂下之, 令無壅碍也. 金鬱泄之, 謂滲泄解表利小便也. 水鬱折之, 謂抑之, 制其衝逆也. 此治五鬱之大要耳. 《正傳》

Translation영역

The Neijing says: wood depressed, free it through; fire depressed, effuse it; earth depressed, seize it away; metal depressed, drain it off; water depressed, break it down. Zhang Zihe said: to free wood through means to induce vomiting, so that it may extend and reach; to effuse fire means to induce sweating, so that it may be dispersed; to seize earth away means to purge, so that there is no blockage; to drain metal off means to percolate and drain, to resolve the exterior and disinhibit urine; to break water down means to suppress it, checking its surging counterflow. These are the essentials of treating the five depressions.

Clinical note임상 주석

Five phases, five verbs, and Zhang Zihe converting each into a concrete method. His reading is characteristically forceful — three of the five come out as sweating, vomiting and purging, his standard triad. The chapter records it here and then declines to be bound by it at 1.8, in the same way the Phlegm-Rheum chapter records and then qualifies him at 6.19.

Jeongjeon 正傳

1.5.8

Source원문

諸鬱, 通用六鬱湯ㆍ䴰麴丸ㆍ䴰麴保和丸ㆍ加味䴰麴丸. 《諸方》

Translation영역

For all depressions, Six Depressions Decoction, the Leaven Pill, the Leaven Preserve Harmony Pill and the Augmented Leaven Pill are used generally.

Jebang 諸方

1.5.1 Qi Depression 氣鬱

1.5.1.1

Source원문

胸滿脇痛, 脉沈澁, 宜用香附ㆍ蕪芎ㆍ蒼朮. 《入門》

Translation영역

Chest fullness with ribside pain and a sunken rough pulse; cyperus, chuanxiong and atractylodes lancea should be used.

Immun 入門

1.5.1.2

Source원문

宜服木香調氣散ㆍ解鬱調胃湯ㆍ䴰麴丸.

Translation영역

Costus Regulate the Qi Powder, Resolve Depression and Regulate the Stomach Decoction and the Leaven Pill should be taken.

Donguibogam · Jeokchwi

1.5.1.3

Source원문

二陳湯煎水, 呑下交感丹方見神門. 《入門》

Translation영역

Decoct Two Matured Ingredients Decoction in water and take Communicating Elixir formula in the Spirit chapter down with it.

Clinical note임상 주석

The six subsections that follow share one shape: a line of signs with a pulse, then a short list of medicinals, then the formulas. The medicinals named here are the three the section has just called the general solvent, which makes qi depression the base case against which the other five are variations.

Immun 入門

1.5.2 Damp Depression 濕鬱

1.5.2.1

Source원문

周身關節走痛, 首如物蒙, 足重, 遇陰寒便發, 脉沈濡, 宜用蒼朮ㆍ川芎ㆍ白芷ㆍ赤茯苓. 《入門》

Translation영역

Roving pain through the joints of the whole body, the head as though something were draped over it, heaviness of the feet, breaking out whenever the weather turns overcast and cold, and a sunken soggy pulse; atractylodes lancea, chuanxiong, angelica dahurica and red poria should be used.

Clinical note임상 주석

首如物蒙 — the head as though something were draped over it — is the classical description of damp clouding the clear yang, and the detail that it breaks out with overcast cold weather is the differentiating sign. Pain that roves would otherwise suggest wind.

Immun 入門

1.5.2.2

Source원문

宜服滲濕湯方見濕門ㆍ平胃散方見內傷.

Translation영역

Percolate Damp Decoction formula in the Dampness chapter and Calm the Stomach Powder formula in the Internal Damage chapter should be taken.

Donguibogam · Jeokchwi

1.5.3 Heat Depression 熱鬱

1.5.3.1

Source원문

目蒙口乾舌燥, 小便赤濁, 脉沈數, 宜用靑黛ㆍ香附ㆍ蒼朮ㆍ川芎ㆍ梔子. 《入門》

Translation영역

Clouded vision, dry mouth and parched tongue, red turbid urine, and a sunken rapid pulse; indigo, cyperus, atractylodes lancea, chuanxiong and gardenia should be used.

Immun 入門

1.5.3.2

Source원문

宜服升陽散火湯ㆍ火鬱湯二方幷見火門.

Translation영역

Upraise Yang and Scatter Fire Decoction and Fire Depression Decoction both formulas in the Fire chapter should be taken.

Clinical note임상 주석

Both formulas named come from the Fire chapter and both work by raising and effusing rather than by draining downward — which follows the Neijing rule quoted at 1.5.7, that fire depressed is to be effused. Depressed heat is treated by opening a way out for it, not by cooling it in place.

Donguibogam · Jeokchwi

1.5.4 Phlegm Depression 痰鬱

1.5.4.1

Source원문

胸滿, 動則喘急, 起臥怠惰, 寸脉沈滑, 宜用海石ㆍ香附子ㆍ瓜蔞仁ㆍ南星. 《入門》

Translation영역

Chest fullness with hasty panting on movement, lassitude in rising and lying down, and a sunken slippery pulse at the inch; pumice, cyperus, trichosanthes seed and arisaema should be used.

Immun 入門

1.5.4.2

Source원문

宜服瓜蔞枳殼湯ㆍ升發二陳湯.

Translation영역

Trichosanthes and Bitter Orange Decoction and Upraising Two Matured Ingredients Decoction should be taken.

Clinical note임상 주석

The two formulas take opposite routes to the same phlegm — the first courses and downbears, the second raises and effuses — and the section offers both without ranking them. Compare the Phlegm-Rheum chapter at 6.5.5, where depressed phlegm is identified with old and dry phlegm and treated by softening instead.

Donguibogam · Jeokchwi

1.5.5 Blood Depression 血鬱

1.5.5.1

Source원문

四肢無力, 能食, 小便淋, 大便紅, 脉沈芤澁, 宜用桃仁ㆍ紅花ㆍ靑黛ㆍ川芎ㆍ香附子. 《入門》

Translation영역

No strength in the four limbs though the appetite is good, dribbling urination, red stool, and a pulse sunken, scallion-stalk and rough; peach kernel, safflower, indigo, chuanxiong and cyperus should be used.

Clinical note임상 주석

能食 — the appetite is good — is the discriminating sign, and it is placed against weakness of the limbs. Where food is taken and strength does not follow, the fault is read as lying in the blood rather than in the spleen. The scallion-stalk pulse, hollow in the middle, is the classical marker of blood that has left the vessels.

Immun 入門

1.5.5.2

Source원문

宜服生韭飮ㆍ順氣丸ㆍ當歸活血湯.

Translation영역

Fresh Chive Drink, Normalize the Qi Pill and Angelica Quicken the Blood Decoction should be taken.

Donguibogam · Jeokchwi

1.5.6 Food Depression 食鬱

1.5.6.1

Source원문

噫酸惡食, 黃疸, 鼔脹, 痞塊, 脉氣口緊盛, 宜用蒼朮ㆍ香附ㆍ山査子ㆍ神麴ㆍ鍼砂(醋炒). 《入門》

Translation영역

Belching of acid with aversion to food, jaundice, drum distension, glomus lumps, and a tight exuberant pulse at the qi opening; atractylodes lancea, cyperus, hawthorn, medicated leaven and needle filings (vinegar-fried) should be used.

Clinical note임상 주석

The only one of the six whose sign list includes a mass, which is where the section joins the rest of the chapter. Needle filings are iron, vinegar-fried to make them workable, and they appear here for jaundice and drum distension rather than for the food itself.

Immun 入門

1.5.6.2

Source원문

宜服香砂平胃散ㆍ散鬱湯.

Translation영역

Cyperus and Amomum Calm the Stomach Powder and Scatter Depression Decoction should be taken.

Donguibogam · Jeokchwi

1.6 The Regions to Which Glomus Lumps and Accumulations Belong 痞塊積聚所屬部分

1.6.1

Source원문

凡痞塊積聚在中, 爲痰飮.

Translation영역

A glomus lump or accumulation lying in the middle is phlegm-rheum.

Dansim 丹心

1.6.2

Source원문

在右爲食積.

Translation영역

Lying on the right, it is food accumulation.

Dansim 丹心

1.6.3

Source원문

在左爲血積. 《丹心》

Translation영역

Lying on the left, it is blood accumulation.

Dansim 丹心

1.6.4

Source원문

夫左爲血塊, 右爲食積, 中爲痰飮, 此言誠然. 夫左關肝膽之位, 主藏血液. 右關脾胃之位, 主藏飮食. 中間則爲水穀出入之道路. 所以左爲血塊, 右爲食積, 中爲痰飮, 其理昭然. 《丹心》

Translation영역

That the left is a blood lump, the right a food accumulation, and the middle phlegm-rheum — this saying is true indeed. The left bar is the position of the liver and gallbladder, which govern the storing of blood and humour. The right bar is the position of the spleen and stomach, which govern the storing of food and drink. The space between is the road by which water and grain enter and leave. Hence the left is a blood lump, the right a food accumulation, and the middle phlegm-rheum, and the principle of it is plain.

Clinical note임상 주석

A three-part rule with its reasoning attached, and the reasoning is the pulse rather than the abdomen: left bar for liver and gallbladder, right bar for spleen and stomach, the middle for the passage of food. The scheme is transposed from the wrist to the belly and applied there. It is the most compact diagnostic statement in the chapter and it recurs throughout — in Yeonna-hwan at 1.7.2, which treats a lump caused by all three at once, and in the food accumulation section at 1.13, which notes that food accumulation may carry static blood with it.

Dansim 丹心

1.7 The Signs and Treatment of Glomus Lumps 痞塊證治

1.7.1

Source원문

塊是有形之物, 氣不能成塊, 乃痰與食積死血也. 宜用化塊丸. 《丹心》

Translation영역

A lump is a thing having form; qi cannot make a lump. It is phlegm, food accumulation and dead blood. Transform the Lump Pill should be used.

Clinical note임상 주석

氣不能成塊 — qi cannot make a lump — is the section's governing sentence and it draws a firm line. Whatever the qi may do, a palpable mass is made of substance, and the substances are three. This is why the chapter's lump formulas all contain phlegm medicinals, food medicinals and blood medicinals together, and why the qi-movers in them are supporting players.

Dansim 丹心

1.7.2

Source원문

凡痞塊在皮裏膜外, 俱宜二陳湯, 加補氣行氣藥, 先須斷厚味. 《丹心》

Translation영역

Glomus lumps lying inside the skin and outside the membrane all call for Two Matured Ingredients Decoction with qi-supplementing and qi-moving medicinals added; and first of all rich flavours must be cut off.

Clinical note임상 주석

皮裏膜外 is the same anatomical space the Phlegm-Rheum chapter uses at 6.13 for phlegm nodules, and both chapters treat what lies there with Ijin-tang modified. The dietary instruction placed first — cut off rich flavours before anything else — recurs at 1.10, where it heads a list of four things the patient must do.

Dansim 丹心

1.7.3

Source원문

治塊, 當降火, 消食積卽痰也, 行死血, 塊去後, 須大補之. 《丹心》

Translation영역

In treating a lump one should downbear fire, disperse the food accumulation — which is to say the phlegm — and move the dead blood; and after the lump has gone, one must greatly supplement.

Clinical note임상 주석

The four-step sequence the section's formulas are built on, and the last step is the one most easily lost. Sojeokbojung-hwan at 1.7.5 and Bohwa-hwan at 1.7.8 both put three or five nyang of white atractylodes at the head so that the supplementing runs alongside the attacking rather than waiting for it to finish.

Dansim 丹心

1.7.4

Source원문

凡婦人有塊, 多屬死血. 《丹心》

Translation영역

Lumps in women mostly belong to dead blood.

Dansim 丹心

1.7.5

Source원문

痞塊, 一名癥瘕. 其不能移動者, 是癥塊也. 或有或無, 或上或下, 或左或右者, 是瘕塊也. 俱用潰堅湯丸爲主. 《丹心》

Translation영역

A glomus lump is also called concretion and aggregation. What cannot be moved is a concretion lump. What is now present and now absent, now above and now below, now left and now right, is an aggregation lump. For both, Break Down Hardness Decoction and Pill are the principal medicines.

Clinical note임상 주석

The same fixed-and-shifting distinction the Nanjing applies to accumulation and gathering at 1.2, applied here to concretion and aggregation. The chapter keeps two vocabularies for one contrast, and 1.9 will note that in practice accumulation, gathering, concretion, aggregation, string-like mass and glomus lump are all one thing.

Dansim 丹心

1.7.6

Source원문

脇下有塊, 宜當歸龍薈丸方見五藏, 加桃仁ㆍ薑黃各一兩, 蜜丸服之. 《入門》

Translation영역

For a lump below the ribside, Angelica, Gentian and Aloe Pill formula in the Five Viscera chapter with peach kernel and turmeric 1 nyang each added, made into honey pills and taken.

Immun 入門

1.7.7

Source원문

驚氣成塊者, 妙應丹方見痰飮, 加穿山甲(炒)ㆍ鱉甲(燒) 各三錢, 玄胡索ㆍ蓬朮各四錢, 每服五七十丸, 以利爲度. 《綱目》

Translation영역

Where fright qi has formed a lump, Wondrous Response Elixir formula in the Phlegm-Rheum chapter with pangolin scale (stir-fried) and turtle carapace (calcined) 3 don each and corydalis and curcuma 4 don each added; take fifty to seventy at a dose, taking free passage as the measure.

Clinical note임상 주석

The chapter reaches into Phlegm-Rheum for its fright-lump formula, which is consistent: the Damum chapter's own fright phlegm section at 6.5.9 describes phlegm bound into a lump in the chest and abdomen that leaps when it breaks out, and prescribes the same elixir. **Control Drool Elixir contains kansui and euphorbia, both toxic drastic purgatives, and the addition named here includes pangolin scale, a CITES Appendix I product prohibited in trade. Not suitable for self-administration and contraindicated in pregnancy.**

Gangmok 綱目

1.7.8

Source원문

痞塊, 宜用連蘿丸ㆍ消塊丸ㆍ加味柴平湯ㆍ消積保中丸ㆍ開懷散ㆍ柴香散ㆍ保和丸ㆍ化痞丹, 兼用膏藥外貼之. 《諸方》

Translation영역

For glomus lumps, Coptis and Radish Seed Pill, Disperse the Lump Pill, Augmented Bupleurum and Calm the Stomach Decoction, Disperse Accumulation and Preserve the Centre Pill, Open the Heart Powder, Bupleurum and Elsholtzia Powder, Preserve Harmony Pill and Transform Glomus Elixir should be used, together with a plaster applied externally.

Jebang 諸方

1.7.9

Source원문

凡腹中有塊, 不問積聚癥瘕, 俱爲惡候, 切勿視爲尋常. 若脹滿已成, 胸腹鼔急, 雖倉扁復生, 亦莫能救其萬一也. 《正傳》

Translation영역

Whenever there is a lump within the abdomen, whether accumulation, gathering, concretion or aggregation, it is in every case an ill sign, and it must never be regarded as ordinary. Should distension and fullness already have formed, with chest and abdomen taut as a drum, then though Cang and Bian were to live again they could not save one case in ten thousand.

Clinical note임상 주석

The most serious sentence in the chapter and it closes the section. Never regard an abdominal mass as ordinary; and once tense distension has set in, no physician can help — Cang Gong and Bian Que being the two the tradition names when it means the best there ever was. The picture described, an abdominal mass followed by tense distension, is ascites supervening on an intra-abdominal malignancy or on cirrhosis, and the prognosis given matches what those carried before modern care. **Any new or growing abdominal mass requires prompt medical evaluation, and abdominal distension developing on top of one makes it urgent.**

Jeongjeon 正傳

1.8 The Treatment Method for Accumulation and Gathering 積聚治法

1.8.1

Source원문

治積, 當察其所痛, 以知其病有餘不足, 可補可瀉, 無逆天時. 詳藏府之高下, 如高者越之, 結者散之, 客者除之, 留者行之, 堅者削之, 强者奪之, 醎以耎之, 苦以瀉之. 全眞氣藥補之. 隨所利而行之, 節飮食愼起居, 和其中外, 可使必已. 《東垣》

Translation영역

In treating accumulation one should examine where the pain lies, so as to know whether the disease is in surplus or insufficiency, and whether to supplement or to drain, without going against the season. Consider carefully the high and low of the viscera and bowels: what is high, send it over; what is bound, scatter it; what lodges as a guest, remove it; what stays, move it on; what is hard, pare it away; what is strong, seize it; use salt flavour to soften and bitter flavour to drain. Supplement with medicines that preserve the true qi. Act according to what benefits; regulate food and drink and be careful of activity and rest; harmonize the inner and the outer, and the disease can certainly be brought to an end.

Clinical note임상 주석

Eight verbs for eight conditions, and the list is the chapter's therapeutic vocabulary in one place. Note what closes it: supplement with medicines that preserve the true qi, and regulate the diet and the daily round. The attacking methods are framed at both ends by things that are not attacks.

Dongwon 東垣

1.8.2

Source원문

凡積病, 不可用下藥, 徒損眞氣, 病亦不退. 當用消積藥, 使之融化, 則自消除根矣. 《丹心》

Translation영역

In accumulation disease generally, purging medicines must not be used; they merely damage the true qi and the disease does not retreat either. Medicines that disperse accumulation should be used, so that it melts away, and then it disperses of itself and the root is removed.

Dansim 丹心

1.8.3

Source원문

經曰, 治積聚, 有化積, 消積, 挨積, 磨積, 而無下積之說. 盖不可直便取下, 以傷胃氣也. 《永類》

Translation영역

The classic says: in treating accumulation and gathering there is transforming accumulation, dispersing accumulation, pushing accumulation and grinding accumulation, but there is no talk of purging accumulation down. For it must not be taken straight downward, since that damages the stomach qi.

Clinical note임상 주석

Four verbs admitted and one refused, and the distinction is the chapter's most quoted rule. 化·消·挨·磨 all describe working a mass away over time; 下 describes driving it out at once. The reason given is not that purging fails but that it damages the stomach qi, which is the same argument the section makes about vacuity throughout. Whether the chapter keeps to its own rule is another matter. Manbyeong-won at 1.14.2 is dosed to the endpoint of vomiting and purging.

Yeongnyu 永類

1.8.4

Source원문

諸積, 勿輕吐下. 徒損眞氣, 積亦不去. 奔豚尤不可吐. 五積古有五方, 今增損五積丸更妙. 《入門》

Translation영역

For accumulations of every kind, do not lightly induce vomiting or purging; they merely damage the true qi and the accumulation does not go either. Running piglet especially must not be treated by vomiting. For the five accumulations the ancients had five formulas; now the Augmented and Reduced Five Accumulations Pill is better still.

Immun 入門

1.8.5

Source원문

內經曰, 破積用毒藥, 衰其太半而止藥. 凡大積大聚, 消其太半乃止. 藥過劑則死. 《東垣》

Translation영역

The Neijing says: in breaking accumulation, toxic medicines are used, and the medicine is stopped when a little more than half has been reduced. In any great accumulation or great gathering, disperse a little more than half and then stop. Medicine beyond its measure kills.

Clinical note임상 주석

The single most important sentence in the chapter for anyone reading its formulas. Stopping at somewhat past half is not caution but rule, and it is what the dosing schedules attached to the five viscus pills at 1.8.3 to 1.8.7 are implementing — increase until the stool loosens, then taper, and stop when the mass is halved.

Dongwon 東垣

1.8.6

Source원문

肝積, 用肥氣丸.

Translation영역

For liver accumulation, use the Fat Qi Pill.

Immun 入門

1.8.7

Source원문

心積, 用伏梁丸.

Translation영역

For heart accumulation, use the Hidden Beam Pill.

Immun 入門

1.8.8

Source원문

脾積, 用痞氣丸.

Translation영역

For spleen accumulation, use the Glomus Qi Pill.

Immun 入門

1.8.9

Source원문

肺積, 用息賁丸.

Translation영역

For lung accumulation, use the Panting Rush Pill.

Immun 入門

1.8.10

Source원문

腎積, 用奔豚丸.

Translation영역

For kidney accumulation, use the Running Piglet Pill.

Clinical note임상 주석

Five lines, one per viscus, and the five pills they name share a seven-medicinal core whose proportions shift by viscus — coptis rising as the accumulation sits higher, dry ginger rising as it sits lower. They are the five columns of the matrix set out at 1.8.1.

Immun 入門

1.8.11

Source원문

六聚, 宜用散聚湯ㆍ香稜丸ㆍ大七氣湯ㆍ大阿魏丸ㆍ大安丸. 《入門》

Translation영역

For the six gatherings, Scatter Gatherings Decoction, Cyperus and Sparganium Pill, Major Seven Qi Decoction, Major Asafoetida Pill and Great Peace Pill should be used.

Immun 入門

1.8.12

Source원문

積初爲寒, 宜辛溫消導, 大七氣湯ㆍ烏白丸ㆍ阿魏丸.

Translation영역

An accumulation at its beginning is cold, and acrid warm dispersing and conducting is appropriate: Major Seven Qi Decoction, Mume and Alum Pill and Asafoetida Pill.

Immun 入門

1.8.13

Source원문

久則爲熱, 宜辛寒推蕩, 木香檳榔丸方見氣門ㆍ通玄二八丹ㆍ消塊丸. 《入門》

Translation영역

Long-standing, it becomes hot, and acrid cold pushing and washing away is appropriate: Costus and Areca Pill formula in the Qi chapter, Penetrating Mystery Two-Eight Elixir and Disperse the Lump Pill.

Clinical note임상 주석

A staging by time rather than by category: cold at the start, hot when long-standing, with the treatment reversing accordingly. The same progression appears in the Phlegm-Rheum chapter at 6.7, where new phlegm is thin and clear and old phlegm thick and yellow.

Immun 入門

1.8.14

Source원문

治積要法, 大抵以所惡者攻之, 所喜者誘之, 則易愈.

Translation영역

The essential method in treating accumulation is broadly this: attack it with what it hates, and entice it with what it likes, and then it is easily cured.

Clinical note임상 주석

The principle behind the eight pairs that follow. An accumulation is treated as something with appetites, to be baited as well as struck — which is the reasoning behind Aui-won at 1.13.18, where the vehicle is chosen to match the offending food.

Bonsa 本事

1.8.15

Source원문

如䃃砂ㆍ水銀, 治肉積.

Translation영역

Thus sal ammoniac and quicksilver treat meat accumulation.

Bonsa 本事

1.8.16

Source원문

神麴ㆍ麥芽, 治酒積.

Translation영역

Medicated leaven and barley sprout treat alcohol accumulation.

Bonsa 本事

1.8.17

Source원문

水蛭ㆍ䖟蟲, 治血積.

Translation영역

Leech and tabanus treat blood accumulation.

Bonsa 本事

1.8.18

Source원문

木香ㆍ檳榔, 治氣積.

Translation영역

Costus and areca treat qi accumulation.

Bonsa 本事

1.8.19

Source원문

牽牛ㆍ甘遂, 治水積, 雄黃ㆍ膩粉, 治痰積.

Translation영역

Morning glory seed and kansui treat water accumulation; realgar and calomel treat phlegm accumulation.

Bonsa 本事

1.8.20

Source원문

礞石ㆍ巴豆, 治食積, 各從其類也. 《本事》

Translation영역

Chlorite schist and croton treat food accumulation — each following its own kind.

Clinical note임상 주석

Seven pairs, one for each kind of accumulation, and the closing phrase 各從其類 states the logic: like answers to like. **Several of these pairs are lethal. Quicksilver and calomel are mercury compounds, realgar is arsenic sulfide, and kansui and croton are toxic drastic purgatives. The list is recorded as the historical scheme it is, not as a guide to practice.**

Bonsa 本事

1.8.21

Source원문

又云三稜ㆍ蓬朮, 治血積. 香附ㆍ枳實, 治食積. 山査ㆍ阿魏, 治肉積. 海粉ㆍ礞石, 治痰積. 雄黃ㆍ白礬, 治蟲積. 乾薑ㆍ巴豆, 治寒積. 黃連ㆍ大黃, 治熱積. 《丹心》

Translation영역

It is also said: sparganium and curcuma treat blood accumulation; cyperus and bitter orange fruit treat food accumulation; hawthorn and asafoetida treat meat accumulation; sea hare egg mass and chlorite schist treat phlegm accumulation; realgar and alum treat worm accumulation; dry ginger and croton treat cold accumulation; coptis and rhubarb treat heat accumulation.

Clinical note임상 주석

The Dansim's revision of the list above, and the changes are all in the direction of safety. Quicksilver and leech and tabanus are gone; hawthorn and asafoetida replace them for meat, sparganium and curcuma for blood. Two lists, a few centuries apart, and the drift is visible.

Dansim 丹心

1.8.22

Source원문

五積六聚, 通用增損五積丸ㆍ消積正元散ㆍ肥氣丸ㆍ伏梁丸ㆍ痞氣丸ㆍ息賁丸ㆍ奔豚丸. 又有奔豚湯ㆍ散聚湯ㆍ香稜丸ㆍ大七氣湯ㆍ潰堅湯ㆍ潰堅丸ㆍ眞人化鐵湯. 《諸方》

Translation영역

For the five accumulations and six gatherings in general: the Augmented and Reduced Five Accumulations Pill, Disperse Accumulation and Right the Origin Powder, Fat Qi Pill, Hidden Beam Pill, Glomus Qi Pill, Panting Rush Pill and Running Piglet Pill. There are also Running Piglet Decoction, Scatter Gatherings Decoction, Cyperus and Sparganium Pill, Major Seven Qi Decoction, Break Down Hardness Decoction and Pill, and the True Man's Iron-Dissolving Decoction.

Jebang 諸方

1.8.23

Source원문

宿血滯氣, 凝結爲癥瘕, 腹中痞塊, 堅硬作楚. 當以破氣藥伐之, 或以類相從. 如敗梳治虱瘕, 銅屑治龍瘕, 麴糵治米瘕, 石灰治髮瘕. 《得效》

Translation영역

Old blood and stagnant qi congeal and bind into concretion and aggregation, a glomus lump within the abdomen, hard and causing distress. It should be cut down with qi-breaking medicines, or else treated by like following like — thus a broken comb treats louse aggregation, copper filings treat dragon aggregation, leaven and malt treat rice aggregation, and lime treats hair aggregation.

Clinical note임상 주석

The like-treats-like principle carried to its limit, and the four examples show what it looks like when the reasoning runs on the name of the mass rather than on anything observable. A comb for lice, lime for hair. The one that is not absurd is leaven and malt for rice aggregation, which works by digestion and appears throughout the chapter for that reason. Hair aggregation is worth noting as the one entry here with a modern counterpart: trichobezoar, a mass of swallowed hair in the stomach, is a real condition and does present as a hard abdominal mass.

Deukhyo 得效

1.9 The Signs and Treatment of Concretion, Aggregation and String-Like Masses 癥瘕痃癖證治

1.9.1

Source원문

癥者, 堅而不移, 瘕者, 堅而能移. 皆因痰飮, 食積, 死血而成塊, 積聚, 癥瘕, 痃癖, 其實一也. 《入門》

Translation영역

A concretion is firm and does not move; an aggregation is firm and can move. Both are formed into a lump by phlegm-rheum, food accumulation and dead blood. Accumulation and gathering, concretion and aggregation, string-like mass and aggregation — in truth they are one.

Clinical note임상 주석

The chapter's own admission that its categories collapse. Having spent 1.2 distinguishing accumulation from gathering and 1.7 distinguishing concretion from aggregation, the Immun says the six terms describe one thing. What remains constant across all of them is the three substances — phlegm, food, dead blood — which is the operative fact for treatment.

Immun 入門

1.9.2

Source원문

癥名有七, 蛟龍魚鱉獺狐蛇, 是也. 亦曰, 蛇蛟鱉肉髮虱米也. 瘕名有八, 靑黃燥血脂狐蛇鱉, 是也. 此等病, 偶因食物相感而然, 瘕比癥稍輕. 又有腸覃, 石瘕, 血蠱, 皆女子之疾, 種種不同, 乃痞塊之異名也. 《千金》

Translation영역

The concretions have seven names: flood dragon, dragon, fish, turtle, otter, fox and snake. It is also said: snake, flood dragon, turtle, flesh, hair, louse and rice. The aggregations have eight names: green, yellow, dry, blood, fat, fox, snake and turtle. Such diseases come about by chance through some sympathy with a food eaten, and aggregation is somewhat lighter than concretion. There are also intestinal mushroom, stone concretion and blood gu, all diseases of women, differing in kind — these being other names for the glomus lump.

Clinical note임상 주석

Fifteen names drawn from animals, colours and foods, and the classification rests on what the mass was thought to have been formed from — a creature or substance eaten that took hold within. The closing sentence is the useful one: these are all other names for a glomus lump. Heo Jun records the nomenclature and then says it names one thing.

Cheongeum 千金

1.9.3

Source원문

癥者, 徵也. 腹中堅硬, 按之應手曰癥. 瘕者, 假也. 腹中雖硬, 而忽聚忽散, 無有常處曰瘕. 癥因傷食, 瘕是血生. 痞原傷氣, 癖則傷精. 《入門》

Translation영역

A concretion is an evidence: what is firm and hard within the abdomen and answers to the hand on pressure is called a concretion. An aggregation is a borrowing: what is hard within the abdomen yet now gathers and now scatters, having no constant place, is called an aggregation. Concretion arises from damage by food, aggregation is engendered from blood; glomus originates in damage to the qi, and aggregation of the ribside in damage to essence.

Clinical note임상 주석

Four terms glossed by the words they pun on: 癥 as 徵 evidence, 瘕 as 假 borrowing. The etymologies are doing diagnostic work — what leaves evidence is fixed and findable, what is borrowed is neither.

Immun 入門

1.9.4

Source원문

癥瘕入於婦人子藏則絶産, 入於胞絡則經閉, 治法詳見婦人門. 《入門》

Translation영역

When concretion and aggregation enter a woman's womb, childbearing is cut off; entering the uterine network vessels, the menses close. For the treatment method see the Women's chapter.

Immun 入門

1.9.5

Source원문

痃者, 在腹內近臍, 左右各有一條, 筋脉急痛, 如臂如指, 如弦之狀, 名曰痃.

Translation영역

A string-like mass lies within the abdomen near the navel, one on the left and one on the right, with the sinews and vessels tense and painful, thick as an arm or as a finger, in the shape of a bowstring — this is called a string-like mass.

Immun 入門

1.9.6

Source원문

癖者, 偏僻在兩脇之間, 有時而痛名曰癖. 凡癥瘕痃癖, 得冷則痛. 《入門》

Translation영역

An aggregation of the ribside lies off to one side between the two ribsides and is painful at times — this is called a ribside aggregation. In concretion, aggregation, string-like mass and ribside aggregation alike, cold brings on the pain.

Clinical note임상 주석

得冷則痛 — cold brings on the pain — is the one sign the four share, and it is why the formulas for them are warm almost without exception. Gwanjung-hwan at 1.14.7 contains no cooling medicinal at all.

Immun 入門

1.9.7

Source원문

積者, 跡也. 挾痰血以成形跡, 亦鬱積至久之謂也. 聚者, 緖也. 依元氣以爲端緖, 亦聚散不常之意也.

Translation영역

An accumulation is a trace: it carries phlegm and blood with it to form a visible trace, and it also means what has been depressed and accumulated for a long time. A gathering is a thread-end: it depends on the original qi to make its beginning, and it also carries the sense of gathering and scattering without constancy.

Jeongjeon 正傳

1.9.8

Source원문

癥者, 徵也, 又精也. 以其有所徵驗, 及久而成精萃也. 瘕者, 假也, 又遐也. 以其假借氣血成形, 及歷年遐遠之謂也.

Translation영역

A concretion is an evidence, and also an essence: because there is something to be verified in it, and because in time it becomes a concentrated essence. An aggregation is a borrowing, and also a distance: because it borrows qi and blood to take form, and because it runs on through distant years.

Jeongjeon 正傳

1.9.9

Source원문

痃癖者, 懸絶隱僻, 又玄妙莫測之名也.

Translation영역

String-like and ribside aggregations are named for hanging apart and lying hidden away, and also for being mysterious and beyond fathoming.

Jeongjeon 正傳

1.9.10

Source원문

大抵痞與痃癖, 乃胸膈間之病, 積與聚, 爲肚腹內之疾. 其爲上中二焦之病, 多見于男子. 其癥與瘕, 獨見于臍下, 是爲下焦之疾, 故常得于婦人也. 《正傳》

Translation영역

Broadly, glomus and the string-like and ribside aggregations are diseases of the chest and diaphragm, while accumulation and gathering are diseases within the belly and abdomen. Being diseases of the upper and middle burners, they are seen mostly in men. Concretion and aggregation are seen only below the navel, being diseases of the lower burner, and so they are commonly found in women.

Clinical note임상 주석

A distribution by sex derived from anatomy: masses above the navel are read as men's, masses below as women's. The observation behind it is real — pelvic masses are more common in women — but the inference is stated far more broadly than the observation supports, and it should be read as a statement about the categories of the text rather than an epidemiological one.

Jeongjeon 正傳

1.9.11

Source원문

治法, 同積聚.

Translation영역

The method of treatment is the same as for accumulation and gathering.

Jeongjeon 正傳

1.9.12

Source원문

腸覃, 石瘕, 血蠱見下, 腸覃生於腸外, 月事時下. 石瘕生於胞中, 月事不下. 《千金》

Translation영역

Intestinal mushroom, stone concretion and blood gu appear below. Intestinal mushroom arises outside the intestine and the menses still come in their season; stone concretion arises within the womb and the menses do not come down.

Clinical note임상 주석

The differential the next section is built on, stated here in two lines. Both masses grow to the size of a pregnancy; whether the menses continue tells them apart, and that single sign decides whether the treatment is qi-breaking or blood-moving.

Cheongeum 千金

1.10 Nourish the Upright and the Accumulation Disperses of Itself 養正積自除

1.10.1

Source원문

易老云, 養正積自除. 譬如滿座皆君子, 縱有一小人, 自無容地而出. 令人眞氣實, 胃氣强, 則積自消矣. 更能斷厚味, 節色慾, 戒暴怒, 正思慮, 庶乎萬全而無害. 《綱目》

Translation영역

Yiaeo said: nourish the upright and the accumulation disperses of itself. It is as when a hall is filled with gentlemen — though there be one small man among them, he finds no place to stay and goes out of himself. Make a person's true qi substantial and their stomach qi strong, and the accumulation disperses of itself. If further they can cut off rich flavours, moderate desire, guard against violent anger and set their thoughts right, then all may be made whole and without harm.

Clinical note임상 주석

The section title and the chapter's counter-argument to its own formulary, put as an image rather than a mechanism. The four things asked of the patient at the end are not incidental — rich food, sexual excess, anger, disordered thinking — and they answer directly to the causes given at 1.1, where unregulated joy and anger damage the viscera first and the disease settles afterwards.

Gangmok 綱目

1.10.2

Source원문

壯人無積, 虛人則有之. 皆由脾胃怯弱, 氣血兩衰, 四時有感, 皆能成積. 若遽以磨積破結之藥治之, 疾似去, 而人已衰矣. 治法當先補虛, 使氣血壯則積自消. 宜用木香枳殼丸. 《入門》

Translation영역

The strong have no accumulations; it is the depleted who have them. In every case it comes from a timid and weak spleen and stomach, with qi and blood both in decline, so that a contraction in any of the four seasons is able to form an accumulation. If one treats it at once with medicines that grind accumulation and break binding, the disease seems to go, but the person is already ruined. The method should be to supplement the vacuity first; make the qi and blood strong and the accumulation disperses of itself. The Costus and Bitter Orange Pill should be used.

Clinical note임상 주석

疾似去, 而人已衰矣 — the disease seems to go, but the person is already ruined — is the sentence to hold when reading the rest of this chapter. Set beside Manbyeong-won at 1.14.2, which is taken until vomiting and purging, it shows how far apart the chapter's argument and its formulary stand.

Immun 入門

1.10.3

Source원문

又治五積六聚, 癥瘕積塊, 元氣虛弱, 瘦怯, 飮食不進, 四肢沈困, 宜補中益氣湯方見內傷, 加三稜ㆍ蓬朮ㆍ靑皮ㆍ香附ㆍ桔梗ㆍ藿香ㆍ益智ㆍ肉桂. 《回春》

Translation영역

It also treats the five accumulations and six gatherings, concretion, aggregation and accumulation lumps, where the original qi is vacuous and weak, the patient thin and timid, food and drink not taken, and the four limbs heavy and exhausted: Supplement the Centre and Boost the Qi Decoction formula in the Internal Damage chapter with sparganium, curcuma, green tangerine peel, cyperus, platycodon, agastache, alpinia and cinnamon bark added.

Clinical note임상 주석

The principle applied without compromise: Dongwon's great qi-supplementing formula with eight mass-moving medicinals grafted on. Where the section's other prescription puts attacking and supplementing side by side, this one starts from the supplement.

Hoechun 回春

1.10.4

Source원문

凡攻擊之藥, 有病則病受之, 無病則胃氣受傷. 胃氣者, 淸純冲和之氣也. 惟與穀肉菜果相宜. 盖藥石皆偏勝之氣, 雖參芪性亦偏, 況攻擊者乎. 《丹心》

Translation영역

As for attacking medicines: where there is disease, the disease receives them; where there is none, the stomach qi is damaged. The stomach qi is a clear, pure, harmonious qi, and it agrees only with grain, meat, vegetables and fruit. For medicines and minerals are all qi of one-sided predominance — even ginseng and astragalus are one-sided in nature, how much more so those that attack.

Clinical note임상 주석

The closing passage of the section and the widest claim in it: every medicinal is one-sided, and even the supplementing ones are. What agrees with the stomach qi is food. That places the whole pharmacopoeia, attacking and supplementing alike, in the position of an intervention to be justified rather than a good in itself.

Dansim 丹心

1.11 The Signs and Treatment of Intestinal Mushroom, Stone Concretion and Blood Gu 腸覃石瘕血蠱證治

1.11.1

Source원문

腸覃, 乃寒氣客於大腸與胃相搏結而爲瘕. 覃延日久, 瘜肉乃生, 始如雞卵, 久如懷胎, 按之堅, 推之移, 月事時下, 或多或少, 此氣病而血未病也. 宜二陳湯, 加香附ㆍ三稜ㆍ蓬朮ㆍ鱉甲, 幷醋炒.

Translation영역

Intestinal mushroom is cold qi lodging as a guest in the large intestine, contending with the stomach and binding to form an aggregation. Spreading over many days, polypous flesh is engendered; at first like a hen's egg, in time like a pregnancy. Pressed, it is firm; pushed, it moves; the menses still come in their season, whether much or little. This is a disease of the qi in which the blood is not yet diseased. Two Matured Ingredients Decoction with cyperus, sparganium, curcuma and turtle carapace added, all vinegar-fried, is appropriate.

Clinical note임상 주석

The clinical description is exact and worth reading closely: firm to pressure but movable to the push, growing from egg-sized to the size of a pregnancy, and the menses unaffected. A large mobile pelvic or abdominal mass that does not disturb the cycle is most often an ovarian cyst or a pedunculated fibroid. **Any abdominal mass reaching this size requires imaging and specialist assessment.**

Cheongeum 千金

1.11.2

Source원문

石瘕者, 胞中傷損, 瘀血結成. 久則堅硬如石, 塞於子門, 大如懷孕, 月事不下. 乃先感寒氣而後血壅所致. 宜用晞露丸ㆍ石英散ㆍ通經丸方見婦人ㆍ桃仁煎.

Translation영역

Stone concretion arises from damage within the womb, static blood binding and forming. In time it becomes hard as stone, blocking the mouth of the uterus, as large as a pregnancy, and the menses do not come down. It comes about from contracting cold qi first and blood being dammed afterwards. Dawn Dew Pill, Fluorite Powder, Free the Menses Pill formula in the Women's chapter and Peach Kernel Decoct should be used.

Clinical note임상 주석

Stone concretion is intramural where intestinal mushroom is external, and the closed menses are the sign of it. Hard as stone, blocking the mouth of the uterus, as large as a pregnancy — that is a large fibroid, and the aetiology given, cold contracted and blood dammed behind it, is a reasonable account within the framework. **All four formulas named contain drastic or toxic medicinals. A pelvic mass with amenorrhoea requires specialist assessment.**

Cheongeum 千金

1.11.3

Source원문

血蠱, 卽癥瘕之甚者, 腹肚堅硬如石. 宜用醋煮三稜丸ㆍ三稜煎元ㆍ萬病丸ㆍ桃奴散ㆍ抱甕丸ㆍ斑玄丸. 《諸方》

Translation영역

Blood gu is the severest form of concretion and aggregation, the belly hard as stone. Vinegar-Boiled Sparganium Pill, Sparganium Decoct Pill, Myriad Diseases Pill, Withered Peach Powder, Embracing a Jar Pill and Mylabris and Corydalis Pill should be used.

Clinical note임상 주석

**Two of the six formulas named are abortifacients and one contains mylabris, whose active principle cantharidin is lethal at small doses. None of them is suitable for self-administration.**

Jebang 諸方

1.12 Lodged Accumulation Disease 息積病

1.12.1

Source원문

帝曰, 人有病脇下滿, 氣逆, 二三歲不已, 是爲何病. 岐伯曰, 病名曰息積, 此不妨於食, 不可灸刺, 積爲導引服藥, 藥不能獨治也. 《內經》

Translation영역

The Yellow Emperor said: a person has fullness below the ribside with qi counterflow, and it does not resolve for two or three years — what disease is this? Qi Bo said: the disease is called lodged accumulation. It does not interfere with eating. It must not be moxaed or needled. For the accumulation, guiding and pulling exercises are used along with taking medicine, for medicine alone cannot cure it.

Clinical note임상 주석

Three things are stated about this condition and each is unusual. It does not interfere with eating, which separates it from every other accumulation in the chapter. Moxa and needling are forbidden. And medicine alone will not cure it — exercise must accompany it, which is why a guiding and pulling method is given as one of the three treatments at 1.12.3. A condition of two or three years' standing with ribside fullness and breathlessness that leaves the appetite intact reads as a chronic pleural or subphrenic process.

Naegyeong 內經

1.12.2

Source원문

宜服磨積元ㆍ化氣湯, 兼行導引法. 《得效》

Translation영역

Grind Accumulation Pill and Transform the Qi Decoction should be taken, together with performing the guiding and pulling method.

Deukhyo 得效

1.13 Accumulations Formed by Damage from Various Substances 諸物傷成積

1.13.1

Source원문

凡人脾胃虛弱, 或飮食過常, 或生冷過度, 不能剋化, 致成積聚結塊, 心腹脹滿, 噫氣呑酸, 面靑肌瘦. 一曰食積, 二曰酒積, 三曰麪積, 四曰肉積, 五曰魚蟹積, 六曰果菜積, 七曰茶積, 八曰水積, 九曰血積, 十曰蟲積. 《得效》

Translation영역

When a person's spleen and stomach are vacuous and weak, and food and drink are taken beyond the usual measure, or raw and cold things beyond what is proper, so that they cannot be subdued and transformed, then accumulation, gathering and a bound lump are formed, with distension and fullness of the heart and abdomen, belching and swallowing of acid, a green complexion and wasted flesh. The first is food accumulation, the second alcohol, the third flour, the fourth meat, the fifth fish and crab, the sixth fruit and vegetable, the seventh tea, the eighth water, the ninth blood, the tenth worm.

Clinical note임상 주석

Ten accumulations sorted by what was eaten, which is a different axis from the five viscera of 1.2 or the six depressions of 1.5. This is the chapter's most practical section: the practitioner asks what the patient habitually consumes, and the answer selects the formula. The instruction at 1.7.1 to ask what foods they favour belongs here.

Deukhyo 得效

1.13.1 Food Accumulation 食積

1.13.1.1

Source원문

食不消化成積, 痞悶, 宜用平胃散方見內傷, 加縮砂ㆍ香附子ㆍ神麴ㆍ麥芽, 入生薑ㆍ紫蘇葉煎服. 《得效》

Translation영역

Where food is not digested and becomes an accumulation, with glomus and oppression, Calm the Stomach Powder formula in the Internal Damage chapter with amomum, cyperus, medicated leaven and barley sprout added, and fresh ginger and perilla leaf put in, decocted and taken.

Deukhyo 得效

1.13.1.2

Source원문

食積, 宜用保和丸ㆍ大安丸ㆍ連蘿丸方見上ㆍ紅元子ㆍ佐脾丸. 《諸方》

Translation영역

For food accumulation, Preserve Harmony Pill, Great Peace Pill, Coptis and Radish Seed Pill formula above, Red Pill and Assist the Spleen Pill should be used.

Jebang 諸方

1.13.2 Alcohol Accumulation 酒積

1.13.2.1

Source원문

酒傷成積者, 面黃黑, 腹脹, 時嘔痰水. 宜用對金飮子方見內傷, 加葛根ㆍ赤茯苓ㆍ縮砂ㆍ神麴煎服. 《局方》

Translation영역

Where damage from wine has formed an accumulation, the complexion is yellow-black, the abdomen distended, and phlegm-water is vomited from time to time. Worth Its Weight in Gold Drink formula in the Internal Damage chapter with pueraria, red poria, amomum and medicated leaven added, decocted and taken.

Clinical note임상 주석

面黃黑 — a yellow-black complexion — with abdominal distension in a heavy drinker is a picture that would now prompt assessment of the liver. The chapter records it as the presenting sign of alcohol accumulation without further comment.

Gukbang 局方

1.13.2.2

Source원문

酒積, 宜用麴糵元ㆍ酒積丸.

Translation영역

For alcohol accumulation, Leaven and Malt Pill and Alcohol Accumulation Pill should be used.

Donguibogam · Jeokchwi

1.13.2.3

Source원문

治酒積方, 甘遂一錢爲末, 以猪槽頭肉一兩, 細切搗爛, 和藥末作一丸, 濕紙裹, 火煨令香熟, 取出. 臨臥, 細嚼, 以酒送下. 《丹心》

Translation영역

A formula treating alcohol accumulation: kansui 1 don, powdered; take 1 nyang of pork from the trough end, cut fine and pound to a pulp, mix with the powder and form a single pill, wrap in damp paper and roast in the fire until fragrant and done, then take it out. At bedtime chew it thoroughly and send it down with wine.

Clinical note임상 주석

The same containment technique the chapter uses at 1.8.8 and 1.13.21 — a toxic medicinal cooked inside animal tissue before it is taken. Here a single don of kansui is buried in an ounce of pork. **Kansui is a toxic drastic purgative. This preparation must not be attempted.**

Dansim 丹心

1.13.2.4

Source원문

又方, 黃連酒浸一宿, 焙爲末, 以橘紅ㆍ葛根湯調下一錢. 《壽域》

Translation영역

Another formula: coptis steeped in wine overnight, dry-roasted and powdered; take 1 don stirred into a decoction of red tangerine peel and pueraria.

Suyeok 壽域

1.13.2.5

Source원문

葛花解酲湯, 常服亦佳. 《東垣》

Translation영역

Pueraria Flower Resolve Drunkenness Decoction, taken regularly, is also good.

Dongwon 東垣

1.13.2.6

Source원문

遇仙丹方見蟲門ㆍ保和丸ㆍ烏白丸, 幷治酒積. 《入門》

Translation영역

Meeting the Immortal Elixir formula in the Worms chapter, Preserve Harmony Pill and Mume and Alum Pill all treat alcohol accumulation.

Clinical note임상 주석

Six passages for alcohol accumulation, more than any of the other nine, and pueraria appears in three of them. It is the classical medicinal for resolving alcohol and the section returns to it whether the formula is mild or drastic.

Immun 入門

1.13.3 Flour Accumulation 麪積

1.13.3.1

Source원문

食麪過多成積, 取阿魏元, 以濃煎蘿葍子湯呑下.

Translation영역

Where too much flour food has been eaten and become an accumulation, take the Asafoetida Pill down with a strong decoction of radish seed.

Deukhyo 得效

1.13.3.2

Source원문

糍糕傷成積, 噫酸心腹作痛, 百藥不效, 取靑木香元方見前陰三百粒, 白丁香十粒, 神麴二錢, 同爲末, 入巴豆肉三粒, 更硏和勻, 蒸餠爲丸菉豆大. 以生薑橘皮湯下二三十丸, 滯去自安.

Translation영역

Where damage from glutinous rice cake has formed an accumulation, with swallowing of acid and pain in the heart and abdomen that a hundred medicines have not helped: take 300 pellets of Green Costus Pill formula in the Anterior Yin chapter, 10 pellets of sparrow droppings and 2 don of medicated leaven, powder them together, add 3 croton kernels, grind again until evenly mixed, and make pills with steamed cake the size of a mung bean. Take twenty or thirty down with a decoction of fresh ginger and tangerine peel; the stagnation goes and ease follows of itself.

Clinical note임상 주석

**Contains croton, which is toxic. Not suitable for self-administration.**

Deukhyo 得效

1.13.3.3

Source원문

素粉積, 以紫蘇濃煎湯, 加杏仁泥服卽散. 《得效》

Translation영역

For an accumulation of plain flour food, a strong decoction of perilla with apricot kernel ground to a paste added, taken, and it disperses at once.

Deukhyo 得效

1.13.4 Meat Accumulation 肉積

1.13.4.1

Source원문

食肉過多成積, 宜用阿魏元ㆍ小阿魏丸ㆍ三稜煎元. 《入門》

Translation영역

Where too much meat has been eaten and become an accumulation, the Asafoetida Pill, the Small Asafoetida Pill and the Sparganium Decoct Pill should be used.

Clinical note임상 주석

Asafoetida in all three, which is the section's specific for meat. Its resinous and intensely fetid character is what the tradition reads as able to break down flesh, and it appears nowhere else in the chapter except in these formulas and in Maneung-hwan.

Immun 入門

1.13.5 Fish and Crab Accumulation 魚蟹積

1.13.5.1

Source원문

食魚蟹過傷成積, 香蘇散方見瘟疫, 多加生薑ㆍ木香煎服.

Translation영역

Where damage from eating too much fish and crab has formed an accumulation, Cyperus and Perilla Powder formula in the Epidemic chapter with a generous addition of fresh ginger and costus, decocted and taken.

Clinical note임상 주석

Fresh ginger and perilla are the classical antidotes to fish and crab poisoning, and both are in this prescription — perilla in the base formula, ginger added generously. The reasoning is the like-treats-like principle of 1.8, applied to what was eaten.

Deukhyo 得效

1.13.5.2

Source원문

妙應丹, 遇仙丹方見蟲門幷佳. 《得效》

Translation영역

Wondrous Response Elixir and Meeting the Immortal Elixir formula in the Worms chapter are both good.

Deukhyo 得效

1.13.6 Fruit and Vegetable Accumulation 果菜積

1.13.6.1

Source원문

多食果菜成積, 用平胃散, 加丁香ㆍ麝香爲末, 熱鹽湯調服, 日三.

Translation영역

Where much fruit and vegetable has been eaten and become an accumulation, use Calm the Stomach Powder with clove and musk added, powdered and taken stirred into hot salt decoction, three times a day.

Clinical note임상 주석

**Musk is CITES Appendix I and prohibited in international trade; contemporary practice substitutes with medicinals such as 蘇合香.**

Deukhyo 得效

1.13.6.2

Source원문

果菜積, 宜用桂香丸ㆍ妙應丹. 《得效》

Translation영역

For fruit and vegetable accumulation, Cinnamon and Musk Pill and Wondrous Response Elixir should be used.

Clinical note임상 주석

Raw fruit and vegetables are cold, and what they leave in the belly is treated with warmth rather than with anything that disperses food — cinnamon heart in the pill, clove in the powder above. That is why this category and food accumulation, which look alike, get quite different prescriptions.

Deukhyo 得效

1.13.7 Tea Accumulation 茶積

1.13.7.1

Source원문

喜吃茶成積成癖, 及吃乾茶者, 石膏ㆍ黃芩ㆍ升麻, 爲末, 砂糖水調下. 《綱目》

Translation영역

Where a liking for drinking tea has formed an accumulation or an aggregation, and for those who chew dry tea: gypsum, scutellaria and cimicifuga, powdered and taken stirred into sugar water.

Clinical note임상 주석

吃乾茶 — chewing dry tea leaves — is the detail that marks this out. Together with the pica described at 1.8.12, where the craving is for raw rice, wall earth and charcoal, it belongs to a small set of observations in the Bogam about compulsive eating of non-nutritive substances. Both are associated with iron deficiency in current understanding.

Gangmok 綱目

1.13.7.2

Source원문

茶積, 取川椒爲末, 麪糊和丸梧子大. 茶淸下十丸. 《丹心》

Translation영역

For tea accumulation, take zanthoxylum, powder it, make pills with wheat paste the size of a firmiana seed, and take ten down with clear tea.

Clinical note임상 주석

Taking the remedy for tea accumulation down with tea is the like-treats-like principle at its most literal — attack it with what it hates, entice it with what it likes, as 1.8.14 puts it.

Dansim 丹心

1.13.7.3

Source원문

茶癖茶積, 宜用星朮丸方見內傷ㆍ磨積元. 《得效》

Translation영역

For tea aggregation and tea accumulation, Arisaema and Atractylodes Pill formula in the Internal Damage chapter and Grind Accumulation Pill should be used.

Deukhyo 得效

1.13.8 Water Accumulation 水積

1.13.8.1

Source원문

多飮水漿成積, 胸脇引痛, 瀝洛有聲, 宜十棗湯方見寒門ㆍ三花神佑丸方見下門.

Translation영역

Where much water and thin gruel has been drunk and become an accumulation, with pain drawing through the chest and ribside and a trickling sound, Ten Jujube Decoction formula in the Cold Damage chapter and Three Flowers Spirit-Aid Pill formula in the Purging chapter are appropriate.

Clinical note임상 주석

瀝洛有聲 is the same audible fluid the Phlegm-Rheum chapter describes at 6.4.3 with the graphs 瀝瀝有聲, and the two chapters treat it with overlapping formulas. Water accumulation here is effectively phlegm-rheum seen from the accumulation side.

Jikji 直指

1.13.8.2

Source원문

芎夏湯方見痰門ㆍ破積導飮丸服之, 幷佳. 《直指》

Translation영역

Chuanxiong and Pinellia Decoction formula in the Phlegm-Rheum chapter and Break Accumulation and Conduct Rheum Pill, taken, are both good.

Jikji 直指

1.13.9 Blood Accumulation 血積

1.13.9.1

Source원문

瘀血成積, 或因打撲, 或因墮落, 以致蓄于胸腹, 面黃糞黑, 宜用抵當湯方見寒門ㆍ桃仁承氣湯方見寒門ㆍ勝紅元ㆍ增味四物湯ㆍ三稜煎ㆍ三稜煎丸方見上.

Translation영역

Where static blood has become an accumulation, whether from a blow or from a fall, so that it has gathered in the chest and abdomen, with a yellow complexion and black stool: Resistance Decoction formula in the Cold Damage chapter, Peach Kernel Order the Qi Decoction formula in the Cold Damage chapter, Prevailing Red Pill, Augmented Four Substances Decoction, Sparganium Decoct and Sparganium Decoct Pill formula above should be used.

Clinical note임상 주석

The one accumulation with a stated external cause — a blow or a fall — and the signs given are precise: a yellow complexion and black stool. Melaena after abdominal trauma is upper gastrointestinal bleeding, and the classical reading of it as static blood gathered in the abdomen is a reasonable inference from what could be observed. **Black stool following injury is a medical emergency requiring immediate assessment.**

Donguibogam · Jeokchwi

1.13.10 Worm Accumulation 蟲積

1.13.10.1

Source원문

飮食積聚, 變化成蟲, 宜用妙應丸方見蟲門ㆍ溫白元ㆍ萬病元ㆍ紫金錠方見解毒.

Translation영역

Where food and drink have accumulated and gathered and transformed into worms, Wondrous Response Pill formula in the Worms chapter, Warm White Pill, Myriad Diseases Pill and Purple Gold Lozenge formula in the Antidotes chapter should be used.

Clinical note임상 주석

The belief that retained food transforms into worms is stated plainly. Behind it is a real association — intestinal parasitosis with abdominal masses and wasting — arrived at by inference from what emerged in the stool. **Warm White Pill and Myriad Diseases Pill both contain multiple toxic medicinals and are not suitable for use. Suspected parasitic infection requires laboratory diagnosis.**

Donguibogam · Jeokchwi

1.14 Medicines for Accumulation, Concretion and Glomus Lumps in General Use 積聚癥瘕痃癖痞塊通治藥

1.14.1

Source원문

宜用溫白元ㆍ萬病元ㆍ金露元ㆍ荊蓬煎元ㆍ秘方化滯丸ㆍ三稜消積丸ㆍ寬中丸ㆍ萬應丸ㆍ延年護命丹ㆍ桃溪氣寶丸.

Translation영역

Warm White Pill, Myriad Diseases Pill, Golden Dew Pill, Sparganium and Curcuma Decoct Pill, Secret Formula Transform Stagnation Pill, Sparganium Disperse Accumulation Pill, Loosen the Centre Pill, Myriad Responses Pill, Prolong Years and Guard Life Elixir and Peach Stream Qi Treasure Pill should be used.

Clinical note임상 주석

Ten formulas as a single index, and they are not interchangeable. Loosen the Centre Pill contains nothing toxic and is for a sallow, wasted patient; Myriad Diseases Pill contains four drastic purgatives, arsenic, mercury and cantharidin and is dosed to vomiting and purging. The list gives no guidance on choosing between them, which is why the treatment section at 1.8 and the section on nourishing the upright at 1.10 have to be read alongside it.

Donguibogam · Jeokchwi

1.15 The Method of External Application 外貼法

1.15.1

Source원문

凡積聚痞塊, 用藥外貼令消散, 可用三聖膏ㆍ琥珀膏ㆍ五仙膏ㆍ貼痞膏. 《諸方》

Translation영역

For accumulation, gathering and glomus lumps, medicine may be applied externally to make them disperse: Three Sages Plaster, Amber Plaster, Five Immortals Plaster and Glomus Plaster may be used.

Clinical note임상 주석

**All four plasters are caustic. Three of the four contain lime, garlic or gleditsia pod applied under occlusion, and the Glomus Plaster names blackened skin as its sign of success — a description of a full-thickness chemical burn. None of them should be prepared or applied.**

Jebang 諸方

1.16 The Method of Fomenting a Concretion 熨癥法

1.16.1

Source원문

吳茱萸三升碎之, 酒和煮熱, 布裹熨癥上, 冷更炒熨, 移走則逐而熨之. 《外臺》

Translation영역

Evodia 3 seung, broken up, mixed with wine and boiled hot; wrap in cloth and foment over the concretion. When it cools, fry it again and foment; and if the mass shifts, follow it and foment there.

Clinical note임상 주석

A hot compress rather than a plaster, and the only external method in the chapter that is not caustic. The instruction to follow the mass if it shifts is a nice detail: it treats the thing as mobile, which is the definition of an aggregation rather than an accumulation. Evodia is acrid and hot and is used here for its warmth rather than taken.

Oedae 外臺

1.17 Holding Medicine in the Hand to Disperse Accumulation 握藥宣積

1.17.1

Source원문

巴豆ㆍ乾薑ㆍ芥子ㆍ良薑ㆍ硫黃ㆍ甘遂ㆍ檳榔各等分. 右爲末, 飯丸如中指頭大. 早朝, 先以川椒湯洗手了, 麻油塗手掌中, 握藥一圓, 移時便瀉. 欲止瀉, 卽以冷水洗手. 《得效》

Translation영역

Croton, dry ginger, mustard seed, lesser galangal, sulphur, kansui and areca in equal parts. Powder them and make rice pills the size of the tip of the middle finger. Early in the morning first wash the hands in a decoction of zanthoxylum, smear sesame oil in the palm, and hold one pill; after a while purging follows. To stop the purging, wash the hands at once in cold water.

Clinical note임상 주석

A purgative administered through the palm. Sesame oil is smeared first, which would in fact assist absorption through the skin, and washing the hands in cold water is given as the means of stopping it — so the method is understood to work by contact and to be reversible by removing the contact. Whether it worked as described is doubtful; that the reasoning is internally consistent is not. **Croton, kansui and sulphur are toxic, and croton oil is a severe skin irritant that causes blistering on contact. This method must not be attempted.**

Deukhyo 得效

1.18 Patterns That Are Hard to Treat 難治證

1.18.1

Source원문

積聚癥瘕, 不轉動者, 難治必死.

Translation영역

In accumulation, gathering, concretion and aggregation, what does not turn or move is hard to treat and will certainly die.

Donguibogam · Jeokchwi

1.18.2

Source원문

五積中, 奔豚證最爲難治. 奔豚, 從小腹起上衝咽喉, 發作欲死, 復還止, 皆從驚恐得之. 越人曰, 驚者, 神上越也. 盖奔豚病, 上衝咽喉者, 隨神上越故也. 《仲景》

Translation영역

Among the five accumulations, the running piglet pattern is the hardest to treat. Running piglet rises from the lower abdomen and surges up to the throat; when it breaks out the patient feels they will die, and then it returns and stops. In every case it is contracted from fright and terror. Yueren said: fright is the spirit going up and away. So in running piglet disease, what surges to the throat does so because it follows the spirit going up and away.

Clinical note임상 주석

The explanation offered is that the surging follows the spirit rather than the qi — fright sends the spirit upward and the sensation goes with it. That is a psychosomatic account stated in the period's own terms, and it is consistent with the two formulas the chapter gives: one attacks with croton and aconite, the other settles with plum root bark and contains no purgative at all. The description — a rising sensation from the lower abdomen to the throat, a conviction of imminent death, then resolution — is a panic attack.

Junggyeong 仲景

1.18.3

Source원문

抑嘗論之, 醫爲病所困首, 惟陰虛之難補, 久積之難除. 玉山自倒, 陰虛之謂也. 養虎遺患, 久積之謂也. 人之罹此二患者, 可不懼哉. 《丹心》

Translation영역

Reflecting on it: the only diseases that defeat a physician are yin vacuity, which is hard to supplement, and long-standing accumulation, which is hard to remove. That the jade mountain falls of itself speaks of yin vacuity; that rearing a tiger leaves calamity behind speaks of long accumulation. When a person is stricken with these two afflictions, how should they not be afraid?

Clinical note임상 주석

Two allusions, precisely matched. The jade mountain falling of itself comes from the Shishuo xinyu, where Ji Kang's bearing is likened to a jade mountain about to collapse — something that gives way under its own weight, not from any push, which is yin vacuity. Rearing a tiger and leaving calamity behind comes from the Shiji's account of Xiang Yu: the thing could have been killed when it was small and was not, and the fault lies in the delay. One is a collapse nothing could have prevented; the other a harm that could have been prevented and was not. As the closing passage of the section, it is exact.

Dansim 丹心

1.19 Simple Medicinals 單方

1.19.1

Source원문

凡二十四種.

Translation영역

Twenty-four kinds in all.

Donguibogam · Jeokchwi

1.19.2

Source원문

牛膝破癥結, 及卒暴〔瘕〕, 腹中有如石刺. 取一兩, 細剉, 酒煎溫服, 空心. 《本草》

Translation영역

Achyranthes (牛膝): Breaks concretion and binding, and sudden violent aggregation with something in the abdomen like a stone piercing. Take 1 nyang, cut fine, decoct in wine and take warm on an empty stomach.

Boncho 本草

1.19.3

Source원문

三稜主老癖, 癥瘕, 結塊. 取三稜, 濃煎成膏, 每朝, 取一匕, 酒服, 日二. 《本草》

Translation영역

Sparganium (三稜): Governs old aggregation, concretion and aggregation, and bound lumps. Take sparganium, decoct strongly to a paste, and each morning take a spoonful in wine, twice a day.

Boncho 本草

1.19.4

Source원문

玄胡索 破癥癖. 與三稜ㆍ鱉甲ㆍ大黃等分爲末, 酒服二錢效. 《本草》

Translation영역

Corydalis (玄胡索): Breaks concretion and aggregation. With sparganium, turtle carapace and rhubarb in equal parts, powdered, take 2 don in wine, with effect.

Boncho 本草

1.19.5

Source원문

大黃破癥瘕, 積聚, 推陳致新最效. 大黃爲末, 醋煮成膏, 入蜜更煎, 丸如梧子. 薑湯下三十丸.

Translation영역

Rhubarb (大黃): Breaks concretion, aggregation, accumulation and gathering, and is most effective at pushing out the old and bringing in the new. Powder rhubarb, boil in vinegar to a paste, add honey and reduce again, and form pills the size of a firmiana seed. Take thirty down with ginger decoction.

Clinical note임상 주석

推陳致新 — pushing out the old and bringing in the new — is rhubarb's standing epithet in the materia medica, and it explains why a purgative sits at the centre of so many formulas in a chapter that says at 1.8.3 that accumulation must not be purged down. What rhubarb is credited with is renewal, not merely evacuation.

Boncho 本草

1.19.6

Source원문

大黃疏風熱, 去積滯. 大黃ㆍ黑丑(頭末半生半炒) 等分, 蜜丸梧子大. 茶淸下十五丸, 空心. 《本草》

Translation영역

Rhubarb (大黃), second method: Courses wind heat and removes accumulation and stagnation. Rhubarb and black morning glory seed (first milling, half raw and half stir-fried) in equal parts, made into honey pills the size of a firmiana seed. Take fifteen down with clear tea on an empty stomach.

Boncho 本草

1.19.7

Source원문

商陸主暴癥, 腹中有物如石痛刺, 若不治百日死. 多取商陸根, 搗爛蒸之, 以布藉腹上, 安藥熨之, 冷復易自消. 《本草》

Translation영역

Pokeweed root (商陸): Governs sudden concretion, with something in the abdomen like a stone, painful and piercing; if untreated, death within a hundred days. Take a good quantity of pokeweed root, pound to a pulp and steam it, lay cloth over the abdomen, set the medicine on it and foment; when it cools, change it, and the mass disperses of itself.

Clinical note임상 주석

**Pokeweed root is toxic and irritant. This is an external fomentation, not to be taken, and it should not be attempted.**

Boncho 本草

1.19.8

Source원문

牽牛子 治五般積聚, 痃癖氣塊. 黑丑, 取頭末, 半生半炒, 蜜丸梧子大. 臨臥時, 以薑湯呑下, 甚妙. 《本草》

Translation영역

Morning glory seed (牽牛子): Treats the five kinds of accumulation and gathering, and string-like aggregations and qi lumps. Black morning glory seed, first milling only, half raw and half stir-fried, made into honey pills the size of a firmiana seed. Take at bedtime down with ginger decoction, with marked effect.

Boncho 本草

1.19.9

Source원문

蒴藋主暴癥, 腹中堅如石痛欲死. 蒴藋根一小束細切, 酒一甁浸三宿, 溫服五合, 日三, 神效. 《本草》

Translation영역

Chinese elder root (蒴藋): Governs sudden concretion, the abdomen hard as stone with pain so that one feels like dying. One small bundle of Chinese elder root cut fine, steeped in a bottle of wine three nights; take 5 hop warm, three times a day, with marked effect.

Boncho 本草

1.19.10

Source원문

續隨子 宣一切積滯. 日服十粒, 若瀉多, 取薄酸冷粥喫之卽止. 《本草》

Translation영역

Caper spurge seed (續隨子): Disperses all accumulation and stagnation. Take ten seeds a day; if purging is excessive, eat a little sour cold congee and it stops at once.

Clinical note임상 주석

**Caper spurge seed is a drastic purgative and toxic. Not suitable for use.**

Boncho 本草

1.19.11

Source원문

桑耳主血病, 癥瘕, 積聚. 取燒爲末, 酒調服之. 《本草》

Translation영역

Mulberry fungus (桑耳): Governs blood disease, concretion, aggregation, accumulation and gathering. Burn it to a powder and take stirred into wine.

Boncho 本草

1.19.12

Source원문

虎杖根 主癥結, 暴瘕, 痛欲死. 取根爲麄末, 酒漬飮, 日三. 《本草》

Translation영역

Knotweed root (虎杖根): Governs concretion and binding, and sudden aggregation with pain so that one feels like dying. Take the root coarsely powdered, steep in wine and drink, three times a day.

Boncho 本草

1.19.13

Source원문

郁李仁 療癖. 取仁湯浸, 去皮爲細末, 每二錢, 白麪搜和作燒餠, 空心食之. 當快利, 若不止, 飮冷醋湯. 《本草》

Translation영역

Bush cherry kernel (郁李仁): Cures aggregation. Take the kernels, steep in hot water, remove the skins and grind to a fine powder; work 2 don into white flour, make a griddle cake, and eat it on an empty stomach. Free passage should follow; if it does not stop, drink cold vinegar broth.

Boncho 本草

1.19.14

Source원문

白楊木 療癥癖, 堅如石, 積年不差. 取東南枝細剉, 五升熬令黃, 以酒五升漬之, 封口經二宿, 每服一合, 日三. 《本草》

Translation영역

White poplar (白楊木): Cures concretion and aggregation hard as stone, of years' standing and not healing. Take branches from the southeast side, cut fine, reduce 5 seung until yellow, steep in 5 seung of wine, seal the mouth and leave two nights; take 1 hop at a dose, three times a day.

Boncho 本草

1.19.15

Source원문

魚膾主腹內伏梁, 痃癖, 氣塊. 以蒜虀ㆍ薑ㆍ醋食之. 鯉魚膾尤佳. 《本草》

Translation영역

Sliced raw fish (魚膾): Governs hidden beam within the abdomen, string-like aggregation and qi lumps. Eat it with garlic pickle, ginger and vinegar; carp is best of all.

Clinical note임상 주석

A food rather than a medicine, and the accompaniments are the point: garlic, ginger and vinegar are the standard trio against the harms of raw fish, and the fish and crab accumulation section at 1.13.5 prescribes ginger and perilla for exactly that. **Raw freshwater fish is a route of transmission for liver flukes and other parasites and should not be eaten raw.**

Boncho 本草

1.19.16

Source원문

鱉甲主癥瘕, 痃癖. 燒黃爲末, 酒服二錢, 日二次. 《本草》

Translation영역

Turtle carapace (鱉甲): Governs concretion, aggregation and string-like aggregation. Calcine until yellow, powder, and take 2 don in wine twice a day.

Boncho 本草

1.19.17

Source원문

蚶殼治冷氣癥癖, 能消血塊, 又能消痰. 一名瓦壟子. 火煆醋淬三次爲末, 醋糊和丸, 薑湯呑下. 《入門》

Translation영역

Ark shell (蚶殼): Treats cold qi concretion and aggregation, can disperse blood lumps, and can also disperse phlegm. Also called warongja. Calcine in fire and quench in vinegar three times, powder, make pills with vinegar paste, and take down with ginger decoction.

Immun 入門

1.19.18

Source원문

黍米泔 患鱉瘕者, 以新熟赤黍米, 淘取泔汁生服一升. 不過三兩度愈. 《入門》

Translation영역

Millet washing water (黍米泔): For one suffering turtle aggregation, wash newly ripened red millet and take 1 seung of the washing water raw. No more than two or three doses and it is cured.

Immun 入門

1.19.19

Source원문

白頸蚯蚓 主蛇瘕. 取汁服之. 《入門》

Translation영역

White-necked earthworm (白頸蚯蚓): Governs snake aggregation. Take the juice and drink it.

Clinical note임상 주석

Snake aggregation and turtle aggregation above belong to the seven concretions and eight aggregations listed at 1.9.2, where masses are named after the creature they were thought to have been formed from. The medicinal is chosen to match the name — an earthworm for a snake, millet for rice — which is the like-treats-like reasoning of 1.8.23 carried to its limit.

Immun 入門

1.19.20

Source원문

桃花萼 破積聚. 花落時取萼, 和麪作燒餠食之. 《子和》

Translation영역

Peach flower calyx (桃花萼): Breaks accumulation and gathering. When the blossom falls, take the calyces, work them into flour, make a griddle cake and eat it.

Jahwa 子和

1.19.21

Source원문

桃奴治伏梁, 氣在心下, 結聚不散. 桃奴三兩爲末, 空心, 酒調二錢服之. 《本草》

Translation영역

Withered peach (桃奴): Treats hidden beam, with qi below the heart bound and gathered and not dispersing. Withered peach 3 nyang, powdered; take 2 don stirred into wine on an empty stomach.

Boncho 本草

1.19.22

Source원문

蓼主痃癖, 積氣. 每日取一握, 水煮, 空心服. 《本草》

Translation영역

Water pepper (蓼): Governs string-like aggregation and accumulated qi. Each day take a handful, boil in water, and take on an empty stomach.

Boncho 本草

1.19.23

Source원문

大蒜爛痃癖. 可常食之. 《本草》

Translation영역

Garlic (大蒜): Rots away string-like aggregation. It may be eaten regularly.

Boncho 本草

1.19.24

Source원문

白馬尿 治鱉瘕. 取飮之卽消. 《本草》

Translation영역

White horse urine (白馬尿): Treats turtle aggregation. Drink it and the mass disperses.

Boncho 本草

1.19.25

Source원문

白馬尿 癥積滿腹, 諸藥不差, 白馬尿服之愈. 《綱目》

Translation영역

White horse urine (白馬尿), second method: Where concretion and accumulation fill the abdomen and no medicine has helped, taking white horse urine cures it.

Gangmok 綱目

1.19.26

Source원문

雄雀屎 主癥瘕, 痃癖, 伏梁, 諸塊. 爲末, 蜜丸, 空心, 以米飮呑下. 《本草》

Translation영역

Cock sparrow droppings (雄雀屎): Governs concretion, aggregation, string-like aggregation, hidden beam and lumps of every kind. Powder and make honey pills, and take on an empty stomach down with rice broth.

Boncho 本草

1.19.27

Source원문

人尿主癥積滿腹, 諸藥不差. 人尿溫服一升, 空心. 童子尿尤佳. 《本草》

Translation영역

Human urine (人尿): Governs concretion and accumulation filling the abdomen where no medicine has helped. Take 1 seung of human urine warm on an empty stomach; a boy's urine is best of all.

Clinical note임상 주석

The section closes with three urine entries, all for the case where nothing else has worked. Child's urine appears throughout the chapter as a processing agent — cyperus is steeped in it in half a dozen formulas — but here it is the medicine itself. **Ingesting urine carries a risk of infection and offers no established benefit.**

Boncho 本草

1.20 Acupuncture and Moxibustion Methods 鍼灸法

1.20.1

Source원문

奔豚上氣, 心痛欲絶, 急以溫湯浸手足, 數數易之, 仍灸氣海ㆍ關元ㆍ期門ㆍ章門, 各百壯, 中極, 五十壯. 《得效》

Translation영역

In running piglet with qi rising and heart pain so that the patient feels they will expire, urgently steep the hands and feet in warm water, changing it repeatedly; then moxa Gihae (氣海, CV6), Gwanwon (關元, CV4), Gimun (期門, LR14) and Jangmun (章門, LR13), a hundred cones each, and Junggeuk (中極, CV3), fifty cones.

Clinical note임상 주석

Warm water for the hands and feet first, before any moxa — an immediate measure for the reversal-cold of the extremities that accompanies a running piglet attack. The points that follow are all on the front midline and the liver channel, tracking the route the sensation is said to take. **Severe chest pain with a sense of impending death requires emergency assessment; cardiac causes must be excluded before any traditional category is applied.**

Deukhyo 得效

1.20.2

Source원문

癥瘕, 灸足踝後宛宛中, 灸隨年壯. 又灸氣海百壯, 中脘二百壯. 《得效》

Translation영역

For concretion and aggregation, moxa the hollow behind the ankle, cones to the number of the patient's years. Also moxa Gihae (氣海, CV6) a hundred cones and Jungwan (中脘, CV12) two hundred.

Deukhyo 得效

1.20.3

Source원문

癥瘕積塊, 先於塊上鍼之, 甚者又於塊首一鍼, 塊尾一鍼, 立應鍼, 訖灸之. 又灸三里. 《綱目》

Translation영역

For concretion, aggregation and accumulation lumps, first needle upon the lump itself; in severe cases add one needle at the head of the lump and one at its tail, with immediate response. When the needling is finished, moxa there. Also moxa Samni (三里, ST36).

Clinical note임상 주석

Needling directly into an abdominal mass, with two further needles at its upper and lower poles. Set against the Neijing warning at 1.3 that a hidden beam wrapping pus and blood must not be pressed firmly, this is a direct contradiction within the chapter. **Needling into an undiagnosed abdominal mass carries serious risk of haemorrhage, perforation and seeding, and must not be done.**

Gangmok 綱目

1.20.4

Source원문

積聚取中脘ㆍ懸樞ㆍ脾兪ㆍ商曲, 補尺澤ㆍ〔陷〕谿. 《綱目》

Translation영역

For accumulation and gathering take Jungwan (中脘, CV12), Hyeonchu (懸樞, GV5), Bisu (脾兪, BL20) and Sanggok (商曲, KI17), and supplement Cheoktaek (尺澤, LU5) and Hamgok (陷谷, ST43).

Gangmok 綱目

1.20.5

Source원문

伏梁, 取上脘ㆍ三里.

Translation영역

For hidden beam, take Sangwan (上脘, CV13) and Samni (三里, ST36).

Gabeul 甲乙

1.20.6

Source원문

息賁, 取巨闕ㆍ期門.

Translation영역

For panting rush, take Geogwol (巨闕, CV14) and Gimun (期門, LR14).

Gabeul 甲乙

1.20.7

Source원문

奔豚, 取玉泉ㆍ章門. 《甲乙》

Translation영역

For running piglet, take Okcheon (玉泉 — that is, the point Junggeuk 中極, CV3) and Jangmun (章門, LR13).

Clinical note임상 주석

Three of the five accumulations get their own point pair, chosen by site: upper duct for the hidden beam below the heart, Geogwol and Gimun for the panting rush below the right ribside, and the two lowest points for running piglet. The correspondence between the pattern descriptions at 1.2 and these prescriptions is exact.

Gabeul 甲乙

1.20.8

Source원문

積塊, 取章門ㆍ中脘ㆍ氣海ㆍ天樞ㆍ上脘ㆍ通谷. 《綱目》

Translation영역

For accumulation lumps take Jangmun (章門, LR13), Jungwan (中脘, CV12), Gihae (氣海, CV6), Cheonchu (天樞, ST25), Sangwan (上脘, CV13) and Tonggok (通谷, KI20).

Gangmok 綱目

1.20.9

Source원문

專治痞塊, 取痞根穴. 穴在十三顀下, 各開三寸半, 多灸左邊, 如左右俱有, 左右俱灸.

Translation영역

Specifically for glomus lumps, take the Bigeun (痞根) point. The point lies below the thirteenth vertebra, three and a half chon to either side. Moxa the left side more; if lumps are present on both sides, moxa both.

Clinical note임상 주석

痞根, the glomus root point, is an extra point named for this condition alone. The instruction to favour the left follows from 1.6, where a lump on the left is blood accumulation — the harder of the three to move.

Immun 入門

1.20.10

Source원문

又法, 用稈心, 量患人足大指齊, 量至足後跟中住, 將此稈, 從尾骨尖, 量至稈盡處, 兩傍各開一韭葉許, 在左灸右, 在右灸左, 鍼三分, 灸七壯, 神效.

Translation영역

Another method: take a straw, measure from the level of the patient's big toe to the middle of the heel, and stop there. Lay this straw from the tip of the coccyx and measure to where it ends; a chive-leaf's breadth to either side is the point. For a lump on the left, moxa the right; for one on the right, moxa the left. Needle 3 pun and moxa seven cones, with marked effect.

Clinical note임상 주석

A proportional measurement taken from the patient's own foot and transferred to the back — the length of the foot laid up from the coccyx. Measuring the body against itself rather than against a fixed rule is the standard method for locating points, and this is a clear worked example of it.

Immun 入門

1.20.11

Source원문

又法, 於足第二指岐叉處, 灸五七壯, 左患灸右, 右患灸左. 灸後一晚夕, 覺腹中響動, 是驗也. 《入門》

Translation영역

Another method: at the fork of the second toe, moxa five or seven cones; for trouble on the left moxa the right, for trouble on the right moxa the left. One evening after the moxa, a rumbling stirring is felt in the abdomen — this is the sign of its effect.

Clinical note임상 주석

The chapter closes on a sign rather than a treatment: a rumbling in the belly the evening after. Like the trickling descent that closes the Phlegm-Rheum chapter at 6.22, it gives the practitioner something observable to wait for — which, after twenty sections of masses that resist every method, is a modest note to end on.

Immun 入門

About this translation 凡例

Base text: Donguibogam (東醫寶鑑, 1613 first edition), Miscellaneous Disorders, Volume 6, Accumulations and Gatherings 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.