Source원문
榮氣不從, 逆於肉理, 乃生癰腫.
Translation영역
Where the construction qi does not follow its course and runs counter within the grain of the flesh, welling abscess and swelling arise.
Naegyeong 內經
Formulas · Text · Donguibogam 東醫寶鑑
Abscesses, Part 1
Ongjeo-sang
한글 옹저 상 · Pinyin Yong Ju Shang
The surgical chapter — swellings that suppurate, and what the Bogam did about pus
癰疽 上
This is the Bogam's surgery. 癰 and 疽 are both swellings that suppurate, and the chapter's first work is to tell them apart: 癰者壅也, 疽者沮也 — 癰 is a damming-up and 疽 an obstruction. The 癰 is shallow, hot, raised, shiny-skinned, painful and spreading; the 疽 is deep, hard, dull-coloured, often painless, and the chapter thinks it far worse. Translated through, the distinction is close to the one a surgeon still makes between a drainable superficial abscess and deep necrotizing infection, and 4.5 says the thing outright: 以有熱無熱爲死生妙訣 — whether there is heat or no heat is the secret of life and death. A swelling that is hot, raised and painful will declare itself and can be opened. A swelling that is cold, flat, sunken and painless has gone inward, and 蔵府已先潰爛, the organs have already rotted first.
Half of the chapter is procedure, not prescription. 4.11 is a page on how to tell whether there is pus and how deep it lies, all of it by palpation: heat under the palm means pus, no heat means none; pain on light pressure means shallow pus, pain only on deep pressure means deep pus; a swelling that springs back has pus and one that does not has none. 4.19 opens the abscess, 4.20 drains it and grows new flesh, 4.21 removes the dead tissue, 4.22 washes it and 4.23 dresses it. The order is stated once, in 4.15, and it is the right order: 初覺則散腫內消, 已潰則排膿歛毒, 膿盡則去腐內塞, 惡肉盡則生肌付痂 — disperse it while it is forming, drain it once it has burst, remove the rot once the pus is out, then grow flesh and let it scab. A modern wound service does these four things in that sequence.
The reasoning that holds it together is 托裏, thrusting from within. Twenty-odd formulas of the chapter are built on ginseng, astragalus and Korean angelica, and their purpose is not to attack the swelling but to give the body enough strength to push the pus out and close the hole: 腐肉不去由於 脾胃不壯, dead flesh does not come away because the spleen and stomach are not strong. Against them stands the smaller 疏/利 group — 內疏黃連湯, 五利大黃湯, 千金漏蘆湯 — which purges downward while the swelling is still hot and shut. Which of the two you reach for is decided by the pulse: 脉沉實, purge first; 脉浮大, support the interior first. The chapter is unembarrassed about saying that both are wrong at the wrong moment.
Two things here will not translate into anything usable. The 去惡肉 group of 4.21 dissolves dead tissue with arsenic sulfide, quicklime, croton and blister beetle — chemical debridement, and the reason surgeons stopped doing it is that the caustic does not know where the dead tissue ends. And 4.6 is a map of where a swelling kills you: the nape, the back over the organ points, the hollow behind the eye, the groin. It is not anatomy but a tally of where the mortality had been, kept over centuries by men who could not drain deep infection and therefore knew exactly where it was fatal. Read that way it is one of the more sober pages in the book.
4.1 The Origin of Abscess Disease 癰疽發病之原
Source원문
腎移寒於肝, 癰腫少氣. 脾移寒於肝, 癰腫筋攣.
Translation영역
When the kidney shifts cold into the liver, there is welling abscess and swelling with shortness of qi. When the spleen shifts cold into the liver, there is welling abscess and swelling with the sinews drawn up.
Naegyeong 內經
Source원문
諸癰腫ㆍ筋攣ㆍ骨痛, 此寒氣之腫, 八風之變也.
Translation영역
All welling abscess and swelling, drawing up of the sinews and pain in the bone — these are swellings of cold qi and the mutations of the eight winds.
Naegyeong 內經
Source원문
膏粱之變, 足生大丁, 受如持虛. 《內經》
Translation영역
The mutation of rich food and fine grain is enough to breed a great clove sore, and it is received as easily as holding out an empty vessel.
Clinical note임상 주석
膏粱 is the diet of the well-fed, and 受如持虛 — received as easily as holding an empty vessel — is as plain a statement of susceptibility as the vocabulary gets. The association of recurrent deep skin infection with a rich diet is not a bad one: the Bogam's own 俗方 clause at the foot of this section puts it together with 消渴, which is diabetes, and diabetic skin and soft-tissue infection is exactly this picture.
Naegyeong 內經
Source원문
帝曰, 癰疽何以別之? 岐伯曰, 榮衛稽留於經脉之中, 則血澁而不行, 不行則衛氣從之而不通, 壅遏而不得行, 故熱. 大熱不止, 熱勝則肉腐, 肉腐則爲膿. 然不能陷肌膚ㆍ骨髓, 不爲焦枯, 五藏不爲傷, 故命曰癰.
Translation영역
The Emperor said: how are welling abscess and flat-abscess to be told apart? Qi Bo said: when construction and defence are held up within the channel vessels, the blood turns sluggish and does not move; not moving, the defence qi follows it and does not pass through; dammed and unable to move, there is therefore heat. The great heat does not stop, and when heat prevails the flesh rots, and rotting, becomes pus. Yet it cannot sink into the skin and flesh or the bone marrow, nothing is scorched dry, and the five viscera take no injury — and so it is named 癰, the welling abscess.
Yeongchu 靈樞
Source원문
熱氣淳盛, 下陷肌膚, 筋髓枯, 內連五藏, 血氣竭, 筋骨良肉皆無餘, 故命曰疽. 《靈樞》
Translation영역
Where the heat qi is unmixed and abundant it sinks down into the skin and flesh, the sinews and marrow wither, it connects inward to the five viscera, the blood and qi are exhausted, and of sinew, bone and sound flesh nothing is left over — and so it is named 疽, the flat-abscess.
Clinical note임상 주석
The pair of definitions the whole chapter rests on. The 癰 stays above the fascia and the organs take no injury; the 疽 sinks below it, the tissue dies and the patient becomes systemically ill. That is a real and still-useful distinction — superficial abscess against deep, fascia-crossing necrotizing infection — arrived at by watching which swellings killed.
Yeongchu 靈樞
Source원문
六府不和則留結爲癰. 又云, 三陽發病, 下爲癰腫. 三陽, 乃足太陽膀胱經, 卽腦疽ㆍ背癰ㆍ臀癰之類是也. 《內經》
Translation영역
When the six bowels are out of harmony, what lodges and binds becomes a welling abscess. It is also said that when the three yang fall ill, below there is welling abscess and swelling. The three yang is the foot greater yang bladder channel — that is, such things as flat-abscess of the nape, welling abscess of the back and welling abscess of the buttock.
Naegyeong 內經
Source원문
癰疽因陰陽相滯而生. 蓋氣陽也, 血陰也. 血行脉內, 氣行脉外, 周流不息. 寒濕搏之, 則凝滯而行遲; 火熱搏之, 則沸騰而行速. 氣得邪而鬱, 津液稠粘, 爲痰爲飮, 積久滲入脉中, 血爲之濁, 此陰滯陽而爲癰. 血得邪而鬱, 隧道阻隔, 或溢或結, 積久溢出脉外, 氣爲之亂, 此陽滯於陰而爲疽. 《丹心》
Translation영역
Abscess disease arises because yin and yang obstruct one another. For qi is yang and blood is yin. The blood moves inside the vessels and the qi outside them, circulating without rest. When cold and damp strike at them, they congeal and move slowly; when fire and heat strike at them, they seethe and move fast. When the qi takes an evil and becomes depressed, the fluids thicken and grow sticky and turn to phlegm and to rheum; accumulating long, they seep into the vessels and the blood is made turbid by them — this is yin obstructing yang, and it makes a welling abscess. When the blood takes an evil and becomes depressed, the tunnels are blocked off and it either floods or binds; accumulating long, it floods out beyond the vessels and the qi is thrown into disorder by it — this is yang obstructed by yin, and it makes a flat-abscess.
Dansim 丹心
Source원문
癰者, 壅也; 疽者, 沮也. 血氣壅沮, 寒熱不散. 陰滯於陽則發癰, 陽滯於陰則發疽, 所發無定處也.
Translation영역
癰 is a damming-up; 疽 is an obstruction. Blood and qi are dammed and obstructed, and cold and heat do not disperse. Yin obstructed in yang breaks out as a welling abscess, yang obstructed in yin breaks out as a flat-abscess, and there is no fixed place in which they appear.
Jikji 直指
Source원문
六府蘊熱, 騰出於膚肉之間, 其發暴盛, 腫而光軟, 皮薄以澤, 侵展廣大者爲癰. 五藏蘊熱, 攻焮乎筋骨之內, 其發停蓄, 狀如㾦㿔, 皮厚以堅, 淡白焦枯者爲疽. 《直指》
Translation영역
Where heat is banked in the six bowels and rises out between the skin and the flesh, its outbreak is sudden and full, the swelling glossy and soft, the skin thin and shining, and it encroaches and spreads wide — that is the welling abscess. Where heat is banked in the five viscera and attacks and scorches within the sinews and bones, its outbreak is held back and stored up, shaped like a millet-rash, the skin thick and hard, pale white and withered — that is the flat-abscess.
Jikji 直指
Source원문
癰發於六府, 若燎原之火, 外潰肌肉; 疽發於五藏, 若陶室之隧, 內銷骨髓. 《入門》
Translation영역
The welling abscess breaks out from the six bowels like fire over open country, bursting the flesh outward; the flat-abscess breaks out from the five viscera like the flue of a kiln, melting the bone marrow within.
Immun 入門
Source원문
凡鬱抑傷心, 及久患消渴, 必發癰疽ㆍ丁瘡, 宜愼之. 《俗方》
Translation영역
Whoever is depressed and oppressed so that the heart is injured, and whoever has long suffered from dispersion-thirst, will certainly break out in abscesses and clove sores, and should be careful of it.
Clinical note임상 주석
久患消渴必發癰疽丁瘡 — long-standing dispersion-thirst will certainly bring out abscesses and boils. 消渴 is diabetes, and recurrent furunculosis, carbuncles and deep soft-tissue infection are among its most reliable complications. The Bogam's own 消渴 chapter has a section titled 消渴須預防癰疽, dispersion-thirst requires guarding against abscess in advance, so the observation is made from both ends of the book.
Sokbang 俗方
4.2 The Signs that an Abscess is About to Break Out 癰疽欲發之候
Source원문
凡發熱ㆍ憎寒ㆍ頭痛ㆍ惡心ㆍ筋脉拘牽ㆍ氣急煩悶, 或病渴多年, 是皆欲發癰疽之證也. 《直指》
Translation영역
Fever, a loathing of cold, headache, nausea, the sinews and vessels drawn and pulled, hurried breath with vexation and oppression, or thirst that has been the illness for many years — all of these are signs that an abscess is about to break out.
Jikji 直指
Source원문
諸脉浮數, 應當發熱而反洒淅惡寒, 若有痛處, 當發其癰.
Translation영역
Where the pulses are floating and rapid, there ought to be fever; if instead there is a shivering loathing of cold, and there is somewhere that hurts, a welling abscess is about to break out there.
Junggyeong 仲景
Source원문
脉微而遲, 反發熱; 弱而數, 反振寒, 當發癰腫.
Translation영역
A pulse faint and slow with fever instead, or weak and rapid with a shaking chill instead — a welling abscess and swelling is about to break out.
Junggyeong 仲景
Source원문
脉浮而數, 身體無熱, 形嘿嘿, 胸中微燥, 不知痛之所在, 此人當發癰. 《仲景》
Translation영역
A pulse floating and rapid, no heat in the body, the appearance mute and sunk in itself, a slight parching in the chest, and no knowing where the pain is — this person is about to break out in a welling abscess.
Clinical note임상 주석
Four pulse pictures that share one feature: the pulse and the surface do not agree. Fever with a slow pulse, chills with a floating rapid pulse, a sick-looking patient with no measurable heat. Taken as a group they describe the prodrome of a deep infection before there is anything to see — which is precisely the case in which a modern clinician is also working from the mismatch between how ill the patient looks and how little is findable.
Junggyeong 仲景
Source원문
癰疽皆因氣鬱而成. 經云, 氣宿于經絡, 與血俱澁而不行, 壅結爲癰疽. 此言七情而成. 《三因》
Translation영역
Abscesses are all made by depression of qi. The classic says that where qi lodges in the channels and network vessels it grows sluggish together with the blood and does not move, and dammed and bound makes an abscess. This speaks of their being made by the seven affects.
Samin 三因
Source원문
憤鬱不遂志欲之人, 多有此疾. 《精要》
Translation영역
People indignant and pent up, who have not got what they wished and willed, most often have this illness.
Jeongyo 精要
Source원문
久患口乾, 必生癰疽. 忍冬茶常服最佳. 《俗方》
Translation영역
Long-standing dryness of the mouth will certainly breed an abscess. Honeysuckle tea taken regularly is best.
Clinical note임상 주석
Dry mouth again, which is thirst again, which is diabetes again. Honeysuckle (忍冬, Lonicera japonica) is the single most used drug in the Korean and Chinese external-medicine tradition for suppurative disease, and it appears here as a tea to be drunk continually rather than as a treatment for an abscess already formed.
Sokbang 俗方
4.3 The Names and Shapes of Abscesses 癰疽名狀
Source원문
闊一寸至二寸爲癤, 二寸至五寸爲癰, 五寸至一尺爲疽, 一尺至二尺爲竟體疽.
Translation영역
One inch to two inches across is a boil; two to five inches is a welling abscess; five inches to a foot is a flat-abscess; a foot to two feet is a whole-body flat-abscess.
Immun 入門
Source원문
未潰色紫黑ㆍ堅硬, 已潰深陷如巖爲癌. 男則多發於腹, 女則多發於乳也. 四畔生如牛唇ㆍ黑硬爲瘭, 多見於手指之間, 或生於口齒ㆍ肚臍. 其無頭ㆍ面色淡紅爲痼. 大槩丁瘡惡類也. 《入門》
Translation영역
Where before it bursts the colour is purple-black and it is hard and stony, and after bursting it is deeply sunken like a crag, that is 癌. In men it mostly appears on the belly, in women mostly on the breast. Where the four margins rise like an ox's lip and are black and hard, that is 瘭, seen most often between the fingers, or arising on the mouth and teeth, or at the navel. Where it has no head and the colour of its surface is pale red, that is 痼. In the main these are the malignant kinds of the clove sore.
Clinical note임상 주석
This is the passage worth stopping at. 癌 is the character now used for cancer, and what the Immun describes under it is cancer: hard, stony, purple-black while closed, and after it ulcerates 深陷如巖 — sunken like a crag, which is what 癌 is built from (巖, a rocky cliff). 男則多發於腹, 女則多發於乳 — in men mostly the belly, in women mostly the breast — is a correct statement of where the common solid tumours of the age presented, and breast cancer is exactly the disease a physician of 1613 could see and feel from the outside. The Bogam files it here, among the swellings, because that is where it belonged in a surgery that worked by hand: a hard mass that does not suppurate and does not resolve.
瘭 (瘭疽) between the fingers is felon or whitlow — the pulp-space infection of a fingertip — and is still called that. 痼 with no head and pale red skin is the chronic indolent swelling that will not point.
瘭 (瘭疽) between the fingers is felon or whitlow — the pulp-space infection of a fingertip — and is still called that. 痼 with no head and pale red skin is the chronic indolent swelling that will not point.
Immun 入門
Source원문
徑一寸二寸爲癤, 三寸五寸腫圓赤爲癰, 八寸爲疽. 《得效》
Translation영역
One or two inches in diameter is a boil; a round red swelling of three to five inches is a welling abscess; eight inches is a flat-abscess.
Deukhyo 得效
Source원문
熱發於皮膚之間, 浮腫根小, 至大不過二三寸者, 癤也. 《東垣》
Translation영역
Heat breaking out between skin and flesh, with a superficial swelling on a small root, growing to no more than two or three inches, is a boil.
Dongwon 東垣
Source원문
瘍, 有頭小瘡也; 疹, 浮小癮疹也. 《河間》
Translation영역
瘍 is a small sore that has a head; 疹 is a superficial small weal.
Clinical note임상 주석
Four sources sorted by size, and they do not agree on the numbers — the Immun's welling abscess begins at two inches and the Deukhyo's at three, and the Deukhyo's flat-abscess is eight inches where the Immun's begins at five. The scheme matters more than the figures: a classification of suppurative disease by diameter, from the boil through the abscess to the carbuncle that takes a whole region of the body.
Hagan 河間
4.4 Why Abscesses Swell, Hurt and Itch 癰疽腫痛痒之因
Source원문
癰疽只是熱勝血. 《丹心》
Translation영역
Abscess disease is nothing but heat prevailing over blood.
Dansim 丹心
Source원문
熱勝則腫. 註云, 熱勝則陽氣內鬱, 故洪腫暴作, 甚則榮氣逆於肉理, 聚爲癰膿. 《內經》
Translation영역
When heat prevails there is swelling. The commentary says: when heat prevails the yang qi is depressed within, and so a flooding swelling arises suddenly; in the severe case the construction qi runs counter within the grain of the flesh and gathers into abscess and pus.
Naegyeong 內經
Source원문
癰疽之證, 皆能爲痛. 瘡先發爲腫, 氣血鬱積, 蒸肉爲膿, 故其痛多焉. 膿潰之後, 腫退皮寬, 痛必漸減; 而反痛者, 此爲虛也. 未潰而痛, 瀉之; 已潰而痛者, 補之. 其有穢氣所觸者, 宜和解; 風冷所逼者, 宜溫散. 《丹心》
Translation영역
The signs of abscess disease can all give pain. The sore first appears as a swelling; qi and blood are depressed and accumulate, and steaming the flesh make pus, and so there is much pain in it. After the pus has burst, the swelling goes down and the skin slackens, and the pain must gradually lessen; where instead it hurts, that is vacuity. Pain before it has burst — drain it. Pain after it has burst — supplement. Where filthy qi has touched it, harmonize and resolve; where wind and cold have pressed on it, warm and disperse.
Clinical note임상 주석
未潰而痛瀉之, 已潰而痛者補之 — drain pain before it bursts, supplement pain after. The rule turns on a real observation: pain in a closed abscess is pressure, and pain that persists after drainage means something else is wrong. 穢氣所觸 — filthy qi having touched it — is the chapter's name for a wound that has gone bad from outside, and the clause granting it a separate treatment is the nearest the section comes to naming contamination.
Dansim 丹心
Source원문
形傷則痛, 氣傷則腫. 腫痛並作, 氣血俱傷. 癰疽不可不痛, 亦不可大痛. 《入門》
Translation영역
When the form is injured there is pain; when the qi is injured there is swelling. Swelling and pain arising together means qi and blood are both injured. An abscess may not be without pain, and may not be in great pain either.
Immun 入門
Source원문
皮膚微高起而堅厚, 或痛或痒, 謂之腫. 有因風寒而得, 則腫硬色白; 有因熱毒而得, 則焮腫色赤. 《東垣》
Translation영역
Where the skin rises a little and is hard and thickened, and either hurts or itches, this is called a swelling. Where it is got from wind and cold, the swelling is hard and white in colour; where it is got from heat toxin, it is scorching and red.
Dongwon 東垣
Source원문
凡痛痒ㆍ瘡瘍ㆍ癰腫ㆍ疽疹ㆍ瘤氣ㆍ結核, 怫鬱甚者, 皆屬火熱. 蓋人近於火, 微熱則痒, 熱甚則痛, 附近則灼而爲瘡, 皆火之用也.
Translation영역
All pain and itching, sores and ulcers, welling abscess and swelling, flat-abscess and weal, tumour qi and bound lumps, where the pent-up depression is severe, belong to fire heat. For when a man goes near a fire, slight heat makes him itch, greater heat makes him hurt, and close up it burns him and makes a sore — all of it the working of fire.
Hagan 河間
Source원문
人之瘡腫, 皆由寒熱毒氣客於經絡, 使血澁而不通, 壅結成腫. 風邪內作, 卽無頭無根; 氣血相搏作者, 卽有頭有根. 壅結盛則爲膿矣. 瘡有痛痒, 痛則爲實, 痒則爲虛. 非謂虛爲寒也, 正謂熱之微甚也. 《河間》
Translation영역
Sores and swellings in a man all come of cold or hot toxic qi lodging as a guest in the channels and network vessels, making the blood sluggish so that it does not pass, and damming and binding to form a swelling. Where wind evil works within, it has no head and no root; where qi and blood strike at one another, it has a head and a root. When the damming and binding is full, it becomes pus. A sore either hurts or itches: hurting is repletion, itching is vacuity. This does not mean that vacuity is cold — it means precisely that the heat is slight or severe.
Clinical note임상 주석
無頭無根 against 有頭有根 is a useful pair of hands. A swelling with a head and a root is localizing and will point; one with neither is diffuse — cellulitis rather than abscess — and nothing can be drained from it. The chapter uses the distinction throughout to decide whether to open a swelling or wait.
Hagan 河間
Source원문
疽發深不痛者, 胃氣太虛, 必死. 蓋肉多而不知痛也. 《丹心》
Translation영역
A flat-abscess that breaks out deep and does not hurt means the stomach qi is greatly vacuous, and he will certainly die — for there is much flesh and yet no sense of pain.
Clinical note임상 주석
A painless deep swelling as a death sign. The reasoning offered is wrong and the sign is right: anaesthesia over a deep infection means the tissue and its nerves have died, which is the finding that distinguishes necrotizing fasciitis from cellulitis and still carries a grave prognosis.
Dansim 丹心
4.5 Telling Light from Grave and Shallow from Deep 癰疽輕重淺深之辨
Source원문
癰者, 其皮上薄以澤; 疽者, 上之皮夭以堅, 上如牛領之皮. 此其候也. 《靈樞》
Translation영역
In the welling abscess the skin above is thin and shining; in the flat-abscess the skin above is lifeless and hard, like the hide over an ox's neck. These are their signs.
Yeongchu 靈樞
Source원문
小按卽痛者, 病勢淺; 大按乃痛者, 病勢深. 此辨癰疽之法也. 《東垣》
Translation영역
Where light pressure brings pain at once, the disease lies shallow; where only heavy pressure brings pain, the disease lies deep. This is the method of distinguishing abscess disease.
Dongwon 東垣
Source원문
癰之邪淺, 其稽留壅遏獨在經脉之中, 而專攻乎外, 故初發時自表便發熱, 患處便如椀如盆, 高腫而痛甚, 縱欲下陷, 緣正氣內固, 不肯受, 故或便秘ㆍ或發渴ㆍ發逆以拒之. 是以骨髓終不焦枯, 五藏終不傷也.
Translation영역
The evil of the welling abscess is shallow; its holding-up and damming is only within the channel vessels and it attacks the outside alone. So at the first outbreak there is fever from the surface, and the affected place is at once like a bowl or a basin, high-swollen and very painful. Though it would sink downward, the upright qi is firm within and will not receive it, and so there is constipation, or thirst, or counterflow, by which it is refused. For this reason the bone marrow is in the end not scorched dry, and the five viscera are in the end not injured.
Gangmok 綱目
Source원문
疽之邪深, 其稽留壅遏內連五藏, 而不專攻于外, 故身體或無熱, 患處或不腫痛. 甚者聲嘶ㆍ氣脫ㆍ眼黑ㆍ眼小ㆍ十指腫黑如墨, 多死也. 《綱目》
Translation영역
The evil of the flat-abscess is deep; its holding-up and damming connects inward to the five viscera and does not attack the outside alone. So the body may have no heat and the affected place may not swell or hurt. In the severe case the voice is hoarse, the qi is lost, the eyes are dark and small, and the ten fingers are swollen and black as ink — and most die.
Clinical note임상 주석
十指腫黑如墨 with a lost voice and no fever is septic shock with peripheral gangrene, and the Gangmok puts it at the end of the deep abscess where it belongs. The pairing of the two passages — the loud shallow abscess that the body refuses, and the quiet deep one that it cannot — is the best piece of reasoning in this chapter.
Gangmok 綱目
Source원문
凡癰疽惡核, 男以左邊爲重, 女以右邊爲重. 《直指》
Translation영역
In abscess and malignant lump, in a man the left side is the graver and in a woman the right.
Jikji 直指
Source원문
癰疽之證, 以有熱無熱爲死生妙訣. 蓋陽證有熱則氣血行而生肌, 陰證無熱則氣血滯而不歛. 是以有實熱者易治, 虛寒者難治. 《入門》
Translation영역
In abscess disease, whether there is heat or no heat is the secret of life and death. For in a yang pattern there is heat, and so qi and blood move and new flesh grows; in a yin pattern there is no heat, and so qi and blood are stagnant and it does not close. Therefore he who has repletion heat is easily treated, and he who is vacuous and cold is treated with difficulty.
Immun 入門
Source원문
初發時身體便熱, 患處亦熱, 腫大而高, 多生疼痛, 破後肉色紅紫, 此爲外發, 雖大如盆椀必生. 初發時身體無熱, 患處亦不熱, 數日之間漸漸開大, 不腫不高不痛, 低陷而壞爛, 破後肉色紫黑, 此爲內發, 必死. 蓋未發之前, 藏府已先潰爛矣. 《得效》
Translation영역
If at the first outbreak the body is hot and the affected place is hot too, the swelling large and high, with much aching pain, and after it breaks the flesh is red-purple — this is an outward outbreak, and though it be as large as a basin or a bowl he will certainly live. If at the first outbreak there is no heat in the body and none in the affected place, and over some days it gradually opens wider without swelling, without rising and without pain, sunken low and rotting away, and after it breaks the flesh is purple-black — this is an inward outbreak, and he will certainly die. For before ever it broke out, the organs had already rotted first.
Clinical note임상 주석
雖大如盆椀必生 — though it be the size of a basin, he will live. The size of the swelling is explicitly ruled out as a prognostic sign, and heat, pain and the colour of the cut surface are put in its place. A large hot painful abscess drains and heals; a cold painless one that widens without rising is deep necrosis, and the Deukhyo's explanation for it (the organs rotted first) is wrong only in direction.
Deukhyo 得效
Source원문
癰疽腫高而軟者, 發於血脉; 腫下而堅者, 發於筋脉; 肉色不變者, 發於骨隨. 《東垣》
Translation영역
An abscess swollen high and soft breaks out from the blood vessels; swollen low and hard, from the sinew vessels; and where the colour of the flesh is unchanged, from the bone marrow.
Clinical note임상 주석
Depth read off the surface: soft and raised is superficial, hard and flat is in the fascial plane, and a swelling under skin of normal colour is in the bone. That last is osteomyelitis, and no colour change over it is the correct observation.
Dongwon 東垣
4.6 Fixing the Regions where an Abscess Kills 定癰疽死之部分
Source원문
身有五部, 伏兔一穴名, 腓二腓者, 腨也, 背三, 五藏之兪四, 項五. 此五部有癰疽者死. 《靈樞》
Translation영역
The body has five regions: Futu first — the name of a point —, the calf second — the 腓 is the belly of the calf —, the back third, the transport points of the five viscera fourth, and the nape fifth. Whoever has an abscess in these five regions dies.
Clinical note임상 주석
The five are Futu on the front of the thigh, the belly of the calf, the back, the line of the viscera's transport points beside the spine, and the nape — and apart from Futu they are the deep-fascia planes of the trunk, from which infection reaches the retroperitoneum, the paraspinal space and the neck. 伏兔 is the odd one, and a deep abscess of the anterior thigh compartment is in fact among the worse places to have one.
Yeongchu 靈樞
Source원문
腦ㆍ鬚ㆍ鬢ㆍ頤四處, 亦爲癰疽必死之地. 《海藏》
Translation영역
The nape, the beard, the temples and the jaw — these four places too are ground where an abscess is certain death.
Haejang 海藏
Source원문
不可患癰者七處. 眼後虛處. ○頤接骨處. ○陰根上毛間ㆍ胯與尻骨接處. ○耳門前後車骨接處. ○諸因小腹風水所成癰疽. ○頷骨下近耳後虛處. ○鼻骨中. 並能害人. 惟眼後虛處最險. 《涓子》
Translation영역
There are seven places in which a welling abscess must not be suffered. The hollow behind the eye. ○Where the jaw joins the bone. ○The hairy region above the root of the genitals, where the hip joins the sacrum. ○Before and behind the ear-gate, where the jawbone joins. ○Any abscess formed of wind-water in the lower abdomen. ○Below the jawbone, near the hollow behind the ear. ○Within the nose-bone. All of these can destroy a man, and of them the hollow behind the eye is the most dangerous.
Clinical note임상 주석
Every one of the seven is a place from which infection reaches somewhere that kills. The hollow behind the eye drains to the cavernous sinus; the nose-bone and the region before the ear do the same by the facial and ophthalmic veins; below the jawbone is the submandibular space, whose infection closes the airway; the sacro-iliac and perineal sites are deep spaces that cannot be drained from outside. Liu Yuanzi's list is not anatomy — it is a mortality register, and it is accurate.
Yeonja 涓子
Source원문
發腦ㆍ發鬢ㆍ發眉ㆍ發頤ㆍ發背, 謂之五發, 至險. 凡眼不見瘡, 皆惡. 《入門》
Translation영역
Outbreak of the nape, of the temple, of the brow, of the jaw and of the back are called the five outbreaks, and they are most dangerous. Any sore the eye cannot see is bad.
Immun 入門
Source원문
發於喉舌ㆍ頭面ㆍ腦項ㆍ肩背ㆍ胸腹ㆍ四肢大節ㆍ女子妬乳, 數者爲險; 他處爲緩. 《直指》
Translation영역
Breaking out in the throat and tongue, the head and face, the nape, the shoulder and back, the chest and belly, the great joints of the limbs, or a woman's caked breast — these several are dangerous; elsewhere is milder.
Jikji 直指
Source원문
俗以癌ㆍ痼ㆍ瘭付於癰疽之列, 豈知瘭與癌ㆍ痼不過癰疽之一物乎. 《直指》
Translation영역
The common usage sets 癌, 痼 and 瘭 in the list of abscesses — not knowing that 瘭, 癌 and 痼 are no more than one kind of thing with abscess disease.
Jikji 直指
Source원문
背雖膀胱督脉所主, 然五藏皆系於背. 或醇酒厚味, 或鬱怒ㆍ房勞, 以致水枯火炎ㆍ痰凝氣滯, 與毒相搏, 隨處發生. 《入門》
Translation영역
Though the back is governed by the bladder and the controlling vessel, yet all five viscera are tied to the back. Whether from strong drink and rich flavours, or from pent-up anger and bedroom exhaustion, the water withers and the fire flares, phlegm congeals and qi stagnates, and striking against the toxin it arises wherever it may.
Clinical note임상 주석
醇酒厚味 — strong drink and rich flavours — recurs through this chapter as the cause of abscess of the back, and 發背 is carbuncle: the confluent staphylococcal infection of the thick skin of the nape and upper back. Alcohol and diabetes are its two great predisposers, and the chapter has named both without connecting them.
Immun 入門
4.7 Abscesses Must be Divided into Inner and Outer 癰疽當分內外
Source원문
癰疽發於內者, 當審藏府. 如中府隱隱而痛者肺疽, 上肉微起者肺癰也. 巨闕屬心, 期門屬肝, 章門屬脾, 京門屬腎, 中脘屬胃, 天樞屬大腸, 關元屬小腸, 丹田屬三焦. 若有上證, 皆倣此辨之. 《靈樞》
Translation영역
Where an abscess breaks out within, the organs must be examined. Thus a dull hidden pain at Jungbu is flat-abscess of the lung, and where the flesh above it rises a little it is welling abscess of the lung. Geogwol belongs to the heart, Gimun to the liver, Jangmun to the spleen, Gyeongmun to the kidney, Jungwan to the stomach, Cheonchu to the large intestine, Gwanwon to the small intestine, and Danjeon to the triple burner. Wherever the signs above are found, all are distinguished on this model.
Clinical note임상 주석
A diagnostic grid built out of the alarm points: tenderness at a point localizes the abscess to that point's organ. The points are the correct 募 points for their organs and the method is palpation of the trunk for a deep tender spot, which is what one does; the assignment of a given spot to a given viscus is the part that does not hold. 上肉微起 — the flesh above it rising a little — is the chapter asking whether the tenderness has become a mass.
Yeongchu 靈樞
Source원문
發於腔子之內者, 曰內疽, 曰肺癰ㆍ心癰ㆍ肝癰ㆍ腎癰ㆍ胃脘癰ㆍ腸癰.
Translation영역
Those breaking out inside the cavity are called inner flat-abscess — welling abscess of the lung, of the heart, of the liver, of the kidney, of the stomach duct, and of the intestine.
Jeongjeon 正傳
Source원문
發於腔子之外者, 曰腦發ㆍ背發ㆍ鬢發ㆍ眉發ㆍ頤發ㆍ顋頷發ㆍ髭發ㆍ腋發ㆍ穿當發下部也ㆍ腿發ㆍ喉癰ㆍ臍癰ㆍ𩣔馬癰ㆍ囊癰ㆍ乳癰也. 《正傳》
Translation영역
Those breaking out outside the cavity are called outbreak of the nape, of the back, of the temple, of the brow, of the jaw, of the cheek and jawbone, of the moustache, of the armpit, the through-the-crotch outbreak — that is, the lower part, outbreak of the thigh, welling abscess of the throat, of the navel, of the groin, of the scrotum, and of the breast.
Clinical note임상 주석
The Jeongjeon's two lists are the chapter's working anatomy: six abscesses inside the body cavity, which cannot be seen or drained, and fifteen outside it, which can. 癰疽 下 takes the outer list section by section, and 4.24–4.29 here take the inner one. The line between them is the body wall, and it is the only line that mattered to a surgeon of the period: what is outside it you may open.
Jeongjeon 正傳
4.8 Abscesses Must be Divided by Channel 癰疽當分經絡
Source원문
肺癰, 手太陰經. 心癰, 手少陰經. 肝癰, 足厥陰經. 脾癰, 足太陰經. 腎癰, 足太陽經. 胃脘癰, 足陽明經. 腸癰, 手太陽經ㆍ足陽明經. 腦癰, 督脉與足太陽經. 背癰, 中屬督脉, 左右足太陽經. 鬢癰, 手足少陽經. 眉癰, 手足太陽經與手足少陽經. 頤癰, 手足陽明經. 顋頷癰, 手陽明經. 髭癰, 手足陽明經. 腋癰, 手太陽經. 穿當癰, 督ㆍ衝ㆍ任三脉. 腿癰, 表足三陽經, 裏足三陰經. 喉癰, 任脉與足陽明經. 臍癰, 任脉與足陽明經. 乳癰, 內足陽明經, 外足少陽經. 乳頭, 足厥陰經. 𩣔馬癰, 足厥陰經. 囊癰, 足厥陰經. 《正傳》
Translation영역
Welling abscess of the lung, the hand greater yin channel. Of the heart, the hand lesser yin. Of the liver, the foot reverting yin. Of the spleen, the foot greater yin. Of the kidney, the foot greater yang. Of the stomach duct, the foot yang brightness. Of the intestine, the hand greater yang and the foot yang brightness. Of the nape, the controlling vessel together with the foot greater yang. Of the back: at the midline it belongs to the controlling vessel, to left and right the foot greater yang. Of the temple, the hand and foot lesser yang. Of the brow, the hand and foot greater yang together with the hand and foot lesser yang. Of the jaw, the hand and foot yang brightness. Of the cheek and jawbone, the hand yang brightness. Of the moustache, the hand and foot yang brightness. Of the armpit, the hand greater yang. Of the crotch, the controlling, thoroughfare and conception vessels, all three. Of the thigh: on the outer aspect the three foot yang channels, on the inner the three foot yin. Of the throat, the conception vessel together with the foot yang brightness. Of the navel, the conception vessel together with the foot yang brightness. Of the breast: within, the foot yang brightness, without, the foot lesser yang; the nipple, the foot reverting yin. Of the groin, the foot reverting yin. Of the scrotum, the foot reverting yin.
Jeongjeon 正傳
Source원문
六陽經ㆍ六陰經分布周身, 有多氣少血者, 有多血少氣者, 有氣血俱多者, 不可一槩論也. 何則? 諸經惟少陽ㆍ厥陰經之生癰疽, 理宜預防, 以其多氣少血也. 其血本少, 肌肉難長, 瘡久未合, 必成危證. 苟不知此, 妄用驅毒利藥以伐其陰分之血, 禍不旋踵. 《丹心》
Translation영역
The six yang channels and the six yin channels are spread over the whole body; some have much qi and little blood, some much blood and little qi, and some have both in abundance, and they may not be spoken of all alike. Why? Of all the channels it is only abscess arising on the lesser yang and reverting yin that reason requires to be guarded against in advance, because they have much qi and little blood. Their blood being little from the first, flesh grows there with difficulty, the sore long fails to close, and it must become a grave case. If a man does not know this and recklessly uses toxin-expelling and disinhibiting drugs, cutting down the blood of the yin division, calamity will not take a step to arrive.
Clinical note임상 주석
其血本少, 肌肉難長 — the blood being little, flesh grows with difficulty — is a statement about regional blood supply and poor healing, and the channels it names are not arbitrary. The lesser yang runs over the temple and the lateral trunk and the reverting yin over the groin and genitals, and both are places where soft-tissue infection heals badly. The warning against purging such a patient is sound on its own terms and sound on ours: you do not dehydrate and weaken someone whose wound will not close.
Dansim 丹心
4.9 The Pulse in Abscess Disease 癰疽脉
Source원문
數脉不時則生惡瘡也. 《仲景》
Translation영역
Where the pulse is rapid out of season, a malignant sore arises.
Junggyeong 仲景
Source원문
癰疽浮數, 惡寒發熱, 若有痛處, 癰疽所發. 脉數發熱而疼者陽, 不數不熱不疼陰. 瘡發癰之脉, 弦洪相搏, 沉細而直, 肺肝俱數. 《脉訣》
Translation영역
In abscess the pulse is floating and rapid, with a loathing of cold and fever; and if there is somewhere that hurts, that is where the abscess is breaking out. Rapid pulse with fever and aching is yang; not rapid, not hot and not aching is yin. In the pulse of a sore breaking out into abscess, stringlike and flooding strike at one another, it is deep, fine and straight, and lung and liver are both rapid.
Maekgyeol 脉訣
Source원문
陰滯于陽則發癰, 陽滯于陰則發疽. 此二毒發無定處, 當以脉別之. 浮ㆍ洪ㆍ滑爲陽, 微ㆍ沉ㆍ緩ㆍ濇爲陰. 《精義》
Translation영역
Yin obstructed in yang breaks out as welling abscess, yang obstructed in yin as flat-abscess. These two toxins break out in no fixed place and must be distinguished by the pulse: floating, flooding and slippery are yang; faint, deep, moderate and rough are yin.
Jeongui 精義
Source원문
脉數身無熱, 內有膿一作癰也. 一云, 腹無積聚, 身無熱, 脉數, 此爲腸中有膿. 《脉經》
Translation영역
A rapid pulse with no heat in the body means there is pus within — one text has 癰, abscess. Another says: no accumulation or gathering in the belly, no heat in the body, and a rapid pulse — this means there is pus in the intestine.
Clinical note임상 주석
腹無積聚, 身無熱, 脉數 — nothing palpable in the belly, no fever, and a fast pulse — read as pus in the bowel. As a rule for finding an intra-abdominal abscess in a patient with an unremarkable abdomen, tachycardia without fever is the right thing to have noticed.
Maekgyeong 脉經
Source원문
脉滑而數, 數則爲熱, 滑則爲實. 滑則主榮, 數則主衛. 榮衛相干則結爲癰, 熱之所過則爲膿也. 《脉經》
Translation영역
A pulse slippery and rapid: rapid means heat and slippery means repletion. Slippery governs the construction and rapid the defence. When construction and defence interfere with one another they bind into a welling abscess, and where the heat has passed there is pus.
Maekgyeong 脉經
Source원문
瘡疽之人, 膿血大泄而脉滑大數者, 難治也. 凡瘻膿多, 或如淸泔, 脉滑大散而寒熱發渴者, 治之無功也. 《精義》
Translation영역
In a man with a suppurating flat-abscess, when pus and blood have poured out greatly and the pulse is slippery, large and rapid, he is treated with difficulty. Where a fistula discharges much pus, or pus like thin rice-water, and the pulse is slippery, large and dissipated with chills and fever and thirst, treatment is without effect.
Clinical note임상 주석
Heavy discharge with a large rapid pulse and thirst, after drainage has already happened, is sepsis — and the Jeongui says plainly that nothing it has will touch it. 如淸泔, like the water rice was rinsed in, is a good description of the thin seropurulent discharge of a chronic fistula.
Jeongui 精義
Source원문
患肺癰者, 咳唾膿血, 脉見洪滑, 治之難痊矣. 《精義》
Translation영역
In one who suffers welling abscess of the lung, coughing and spitting pus and blood, when the pulse shows flooding and slippery, it will hardly be cured.
Jeongui 精義
Source원문
癰疽已決去其膿, 而煩疼尙未全退, 其脉洪麄, 又難爲力. 《直指》
Translation영역
Where the abscess has been opened and its pus let out, and yet the vexing ache has not wholly gone, and the pulse is flooding and coarse — there again little can be done.
Jikji 直指
Source원문
癰疽脉來滯濇, 但得和緩爲平. 若洪麄則銳毒不收, 鮮有濟也. 《直指》
Translation영역
In abscess the pulse comes sluggish and rough; only when it becomes harmonious and moderate is it level. If it is flooding and coarse, the sharp toxin is not being gathered in, and there is rarely any saving him.
Clinical note임상 주석
Three passages in a row making the same point, which is the useful one in this section: persistent tachycardia after an abscess has been drained means the drainage was not enough. Any surgeon still works from that.
Jikji 直指
4.10 Signs Hard to Treat and Not to be Treated 癰疽難治不治證
Source원문
凡癰疽初發, 腫硬而高者, 毒氣却淺, 其證屬陽, 雖急而易治. 若初發如粟粒ㆍ如豆許, 與肉俱平, 或作赤色, 時覺痒痛, 愼勿爪破. 此乃爲疽, 其證屬陰, 毒氣內蓄, 勢雖緩而難治. 《仲景》
Translation영역
When an abscess first breaks out, if the swelling is hard and high the toxic qi lies rather shallow, its pattern belongs to yang, and though it is urgent it is easily treated. But if at the first outbreak it is like a millet grain or a bean, flush with the flesh, perhaps turning red, with itching and pain felt from time to time — take care not to scratch it open. This is a flat-abscess; its pattern belongs to yin, the toxic qi is banked up within, and though its course is slow it is treated with difficulty.
Clinical note임상 주석
愼勿爪破 — take care not to scratch it open. The small flush lesion that itches is the early carbuncle or the malignant pustule, and not breaking the skin over it is still the advice.
Junggyeong 仲景
Source원문
始發便熱腫大作痛, 此爲外發, 雖大如盆, 百治百活. 自始發不熱不痛, 低陷而壞爛, 此爲內發, 難治必死. 《精要》
Translation영역
Hot from the outset, with a large swelling and much pain — this is an outward outbreak, and though it be the size of a basin, a hundred so treated are a hundred alive. From the outset without heat and without pain, sunken low and rotting away — this is an inward outbreak, hard to treat, and he will certainly die.
Jeongyo 精要
Source원문
癰者, 壅也, 爲陽, 屬六府, 易治; 疽者, 沮也, 爲陰, 屬五藏, 難治. 《入門》
Translation영역
癰 is a damming-up; it is yang, belongs to the six bowels, and is easily treated. 疽 is an obstruction; it is yin, belongs to the five viscera, and is treated with difficulty.
Immun 入門
Source원문
難治有六證. 兩臉紅似胚染, 心病深. ○得之久, 全不腫痛, 乃藏府受病深. ○病處硬如牛領皮, 又如石榴狀, 用藥不軟者, 病深. ○病人無時喜笑, 乃神氣奪, 病深. ○瘡口小, 內闊, 常出靑白膿汁不痛者, 內壞, 病深. ○貼膏藥後, 出鮮血ㆍ黑血間雜血, 病深. 《得效》
Translation영역
There are six signs of the hard to treat. Both cheeks red as though stained with dye — the heart's illness is deep. ○Where it has been long had and there is no swelling or pain at all — the organs have taken the illness deep. ○Where the diseased place is hard as the hide over an ox's neck, or shaped like a pomegranate, and does not soften under medicine — the illness is deep. ○Where the sick man laughs and smiles at no occasion — the spirit qi has been seized, and the illness is deep. ○Where the mouth of the sore is small and it is wide within, constantly discharging a blue-white pus without pain — it is rotting within, and the illness is deep. ○Where after a plaster has been applied fresh blood and black blood come out mixed together — the illness is deep.
Clinical note임상 주석
瘡口小, 內闊 — a small opening over a wide cavity — is the undrained abscess, and the Deukhyo puts it among the fatal signs because an opening too small to drain through is worse than none: it keeps the cavity closed while letting the clinician believe it has been dealt with. The cure is to lay the cavity open, which is what a modern incision does and what 4.19 is reaching for with its caustics.
Deukhyo 得效
Source원문
癰疽有實熱者易治, 虛寒有邪熱者難治. 《醫鑑》
Translation영역
He who has repletion heat in abscess disease is easily treated; he who is vacuous and cold and has an evil heat is treated with difficulty.
Uigam 醫鑑
4.11 Telling Whether There is Pus, and How Deep 癰疽辨膿有無及淺深
Source원문
諸癰疽欲知有膿無膿, 以手掩腫上, 熱者爲有膿, 不熱者爲無膿. 《仲景》
Translation영역
To know whether there is pus or no pus in any abscess, lay the hand over the swelling: hot means there is pus, not hot means there is none.
Junggyeong 仲景
Source원문
按而後痛者, 其膿深; 小按卽痛者, 其膿淺. 按之軟而卽復者, 有膿; 按之强而不復者, 無膿. 《得效》
Translation영역
Where pain comes only after pressing, the pus is deep; where light pressure brings pain at once, the pus is shallow. Where it is soft under the finger and springs straight back, there is pus; where it is firm and does not spring back, there is none.
Deukhyo 得效
Source원문
按之堅硬, 未有膿也; 按之半軟半硬, 已有膿也, 宜急破之. 半軟, 謂中央膿處; 半硬, 謂四方腫肉. 《精要》
Translation영역
Firm and hard under the finger — there is not yet pus. Half soft and half hard under the finger — there is pus already, and it should be opened at once. The half that is soft is the pus in the centre; the half that is hard is the swollen flesh on all four sides.
Clinical note임상 주석
Half soft, half hard — a soft centre inside an indurated rim — is fluctuance, and the Jeongyo reads it exactly as it is read now: pus has collected, and the thing to do is open it without waiting. 宜急破之, open it at once, is the correct instruction.
Jeongyo 精要
Source원문
用手按之, 熱則有膿, 不熱則無膿. 重按乃痛, 膿之深也; 輕按卽痛, 膿之淺也. 按之不甚痛者, 未成膿也. 按之卽復者, 有膿也; 按之不復者, 無膿也, 非也, 必是水也. 《入門》
Translation영역
Press with the hand: hot means pus, not hot means no pus. Pain only on heavy pressure means the pus is deep; pain on light pressure means it is shallow. Where pressing gives no great pain, pus has not yet formed. Where it springs back under the finger there is pus; where it does not spring back there is no pus — or rather, it is not pus at all, but certainly water.
Clinical note임상 주석
必是水也 — it must be water. The Immun has separated a fluctuant collection that refills from one that does not, and called the second something other than pus. That is the distinction between an abscess and an oedematous or cystic swelling, and it is the distinction that decides whether opening it will help.
Immun 入門
Source원문
以手掩上, 大熱者, 膿成自軟也. 若其上薄皮剝起者, 膿淺也. 其腫不甚熱者, 膿未成也. 若患瘰癧結核, 寒熱發渴, 經久不消者, 其人面色萎黃, 被熱上蒸, 已成膿也. 《入門》
Translation영역
Lay the hand over it: where it is very hot, the pus has formed and will soften of itself. If the thin skin above it peels up, the pus is shallow. Where the swelling is not very hot, the pus has not yet formed. And where a man suffers scrofulous lumps with chills and fever and thirst that do not disperse over a long time, and his face is sallow and withered from being steamed by the heat from below, the pus has formed already.
Immun 入門
Source원문
血熱肉敗, 榮衛不行, 必將爲膿. 《內經》
Translation영역
When the blood is hot and the flesh spoiled and construction and defence do not move, it will certainly become pus.
Naegyeong 內經
Source원문
瘡瘍皆爲火熱, 而反腐出膿水者, 猶穀肉果菜熱極腐爛而潰爲汚水也. 潰而腐爛, 水之化也; 熱勝血則爲膿也. 《河間》
Translation영역
Sores and ulcers are all fire heat, and that they rot instead and put out pus and water is as grain, meat, fruit and vegetables rot when the heat is extreme and break down into foul water. That it breaks down and rots away is the transformation of water; that heat prevails over blood is what makes pus.
Clinical note임상 주석
Liu Wansu reaches for putrefaction to explain suppuration, which is as close as the period's chemistry gets, and the analogy is not a bad one: he has noticed that heat and time turn living tissue into something like what they turn food into.
Hagan 河間
Source원문
腫硬膿稠者爲實, 腫軟膿稀者爲虛. 敗膿不去, 加白芷, 不可用白朮, 蓋白朮能生膿故也. 《醫鑑》
Translation영역
A hard swelling with thick pus is repletion; a soft swelling with thin pus is vacuity. Where spoiled pus will not come away, add angelica dahurica, and do not use white atractylodes — for white atractylodes can breed pus.
Uigam 醫鑑
4.12 The Haloes of an Abscess 癰疽發暈
Source원문
俗以腫㾗所至爲暈, 非眞暈也. 暈生於瘡口之傍, 狀如紅暈. 二暈三暈尙可, 四暈五暈者死. 《入門》
Translation영역
The common usage takes the reach of the swelling's mark for a halo, but that is not a true halo. The halo arises beside the mouth of the sore, shaped like a ring of red. Two haloes or three may still do; four or five, and he dies.
Immun 入門
Source원문
眞暈生於瘡口之傍, 如紅筋之狀. 纔見暈則非美證矣. 一暈二暈以至三暈, 尙可措手; 若四暈五暈, 是藏府蘊受銳毒, 斷斷難醫. 《直指》
Translation영역
The true halo arises beside the mouth of the sore, in the shape of a red cord. The moment a halo is seen it is not a good sign. One halo, two, up to three, and the hand may still be set to it; but four or five means the organs have taken in and banked up the sharp toxin, and he is quite certainly beyond medicine.
Clinical note임상 주석
如紅筋之狀 — in the shape of a red cord — is the detail that identifies this. These are not concentric rings but red streaks running away from the wound, which is lymphangitis, and counting them is a crude measure of how far the infection has travelled up the limb. The prognosis attached is the right way round.
Jikji 直指
4.13 The Fatal Signs of Abscess 癰疽死證
Source원문
癰發於嗌中, 名曰猛疽. 不治, 化爲膿; 膿不瀉, 塞咽半日死.
Translation영역
A welling abscess breaking out in the gullet is called the fierce flat-abscess. Untreated it turns to pus; if the pus is not drained it blocks the throat, and in half a day he dies.
Clinical note임상 주석
Half a day from blocked throat to death, and the whole of the treatment is 瀉 — drain it. This is retropharyngeal or peritonsillar abscess closing the airway, and the Yeongchu's account of both the timescale and the remedy is correct.
Yeongchu 靈樞
Source원문
發於頸, 名夭疽. 其癰大而赤黑, 不急治則熱氣下入淵腋, 前傷任脉, 內熏肝肺, 十餘日而死.
Translation영역
Breaking out on the neck, it is called the untimely flat-abscess. The abscess is large and red-black, and if not treated at once the heat qi passes down into Yeonaek, injures the conception vessel in front and smokes the liver and lung within, and in a little over ten days he dies.
Clinical note임상 주석
A black abscess of the neck that travels downward and kills in ten days is descending necrotizing mediastinitis. The route the Yeongchu gives it — down past the axilla and inward to the lung — is the route it takes, along the deep cervical fascia into the chest.
Yeongchu 靈樞
Source원문
陽氣大發, 消腦溜項, 名曰腦爍. 痛如鍼刺, 煩心者死不可治.
Translation영역
Where the yang qi breaks out greatly, melting the brain and lodging in the nape, it is called brain-melting. The pain is like the stabbing of a needle, and he who is vexed at heart dies and cannot be treated.
Yeongchu 靈樞
Source원문
發於胸, 名曰井疽. 狀如大豆, 三四日起; 不早治, 下入腹, 不治, 七日死.
Translation영역
Breaking out on the chest, it is called the well flat-abscess. It is shaped like a large bean and rises in three or four days; if not treated early it passes down into the belly, and untreated, in seven days he dies.
Yeongchu 靈樞
Source원문
發於膺, 名曰甘疽. 色靑, 狀如穀實ㆍ瓜蔞, 常苦寒熱. 不急治, 十歲死, 死後出膿.
Translation영역
Breaking out on the breast, it is called the sweet flat-abscess. Its colour is blue-green, it is shaped like a grain of corn or a trichosanthes fruit, and he is always troubled with chills and fever. If not treated at once he dies in ten years, and after death pus comes out.
Yeongchu 靈樞
Source원문
發於尻, 名曰銳疽. 其狀赤ㆍ堅ㆍ大, 急治之; 不治, 三十日死.
Translation영역
Breaking out on the buttock, it is called the sharp flat-abscess. Its appearance is red, firm and large; treat it at once, for untreated he dies in thirty days.
Yeongchu 靈樞
Source원문
發於足上下, 名曰四淫. 其狀大癰, 不急治之, 百日死.
Translation영역
Breaking out above and below the foot, it is called the four-fold soaking. It appears as a great welling abscess, and if it is not treated at once he dies in a hundred days.
Yeongchu 靈樞
Source원문
發於足傍, 名曰厲疽. 其狀不大, 初從小指發, 急治之, 去其黑者; 黑不消輒益, 不治, 百日死.
Translation영역
Breaking out at the side of the foot, it is called the pestilent flat-abscess. It is not large in appearance and begins from the little toe. Treat it at once and take away what is black; if the black does not disperse but keeps gaining, it is not to be treated, and he dies in a hundred days.
Yeongchu 靈樞
Source원문
發於足指, 名曰脫疽. 其狀赤黑者死不治; 不赤黑者不死. 治之不衰, 急斬之; 否則死.
Translation영역
Breaking out on the toes, it is called the sloughing flat-abscess. Where its appearance is red-black he dies and is not to be treated; where it is not red-black he does not die. If under treatment it does not abate, cut it off at once; otherwise he dies.
Clinical note임상 주석
脫疽 — the flat-abscess that sloughs — is gangrene of the toes, and this is the oldest clear instruction to amputate in the East Asian literature: 治之不衰, 急斬之, 否則死. If it does not abate under treatment, cut it off at once, otherwise he dies. The two preceding sections describe the same disease spreading up the foot, and 去其黑者 — take away what is black — is debridement. The condition is diabetic or atherosclerotic gangrene, and the decision the Yeongchu is making, that the limb must go to save the man, is still the decision. Which toes are 赤黑 and therefore hopeless is where the ancient and the modern judgment part company: that colour now calls for revascularization, not for abandonment.
Yeongchu 靈樞
Source원문
諸癰疽之發於節而相應者, 不可治也. 發於陽者百日死, 發於陰者三十日死. 陽謂諸節之背, 陰謂諸節之膕郄間. 應者, 內發透外也. 《靈樞》
Translation영역
Any abscess breaking out at a joint and answering through to the other side is not to be treated. Breaking out on the yang aspect he dies in a hundred days; on the yin aspect, in thirty. Yang means the dorsal aspect of the joints, yin the hollow of the knee and the crease. Answering means that what broke out within has pierced through to the outside.
Clinical note임상 주석
內發透外 — what broke out within has come through to the outside — is a joint infection that has tracked out through the skin, which is to say a septic joint with a sinus. That it was untreatable is right; that the flexor aspect killed three times faster is the kind of observation that comes from watching, since the popliteal and antecubital spaces drain toward the great vessels.
Yeongchu 靈樞
4.14 The Good and Bad Signs of Abscess 癰疽善惡證
Source원문
癰疽破潰後, 善證有五, 惡證有九.
Translation영역
After an abscess has burst open there are five good signs and nine bad.
Jeongyo 精要
Source원문
動息自寧, 飮食知味, 一善也. ○便尿調勻, 二善也. ○神彩精明, 語聲淸朗, 三善也. ○膿淸腫消, 色鮮不臭, 四善也. ○體氣和平, 五善也.
Translation영역
Movement and breathing settled of themselves and food tasted for its flavour — the first good sign. ○Stool and urine regular and even — the second. ○The look of the spirit clear and bright and the voice clear and ringing — the third. ○The pus clean, the swelling gone down, the colour fresh and no stench — the fourth. ○The body's qi at peace — the fifth.
Jeongyo 精要
Source원문
眼白睛黑而目緊小, 一惡也. ○不能飮食, 納藥而嘔, 食不知味, 二惡也. ○腹痛渴甚, 三惡也. ○肩背不便, 四肢沉重, 四惡也. ○聲嘶色脫, 唇鼻靑黑, 面目四肢浮腫, 五惡也. ○煩躁時嗽, 泄利無度, 小便如淋, 六惡也. ○膿血大泄, 焮痛尤甚, 膿色敗臭, 氣不可近, 七惡也. ○喘麄短氣, 恍惚嗜卧, 八惡也. ○未潰先黑陷下, 面靑唇黑, 便汚者, 九惡也. 五善見三則吉, 九逆見六則危. 《精要》
Translation영역
The white of the eye dark and the eye drawn tight and small — the first bad sign. ○Unable to eat or drink, vomiting the medicine up, and food not tasted for its flavour — the second. ○Abdominal pain with severe thirst — the third. ○Shoulder and back unmanageable and the four limbs heavy as lead — the fourth. ○The voice hoarse and the colour fled, lips and nose blue-black, face, eyes and limbs puffy — the fifth. ○Vexed restlessness with coughing from time to time, diarrhoea without measure, and urine passing in drips — the sixth. ○Pus and blood pouring out, the scorching pain worse than ever, the pus spoiled and stinking so that one cannot come near — the seventh. ○Coarse panting and short breath, bewilderment and a craving to lie down — the eighth. ○Turning black and sinking before it has even burst, the face blue and the lips black, and fouling himself — the ninth. If three of the five good signs are seen it is auspicious; if six of the nine contrary signs are seen, he is in danger.
Clinical note임상 주석
Read straight through, the nine are a sepsis score. Altered mental state (恍惚), tachypnoea (喘麄短氣), oliguria (小便如淋), hypotension with peripheral cyanosis (色脫, 唇鼻靑黑), failure to take food, diarrhoea, and incontinence — these are the items a modern bedside score counts, and the Jeongyo is counting them for the same purpose, to say how near death the patient is. 九逆見六則危, six of the nine means danger, is a threshold.
Jeongyo 精要
Source원문
眼白睛黑ㆍ眼小, 是一逆也; 納藥而嘔, 是二逆也; 腹痛渴甚, 是三逆也; 肩項中不便, 是四逆也; 聲嘶色脫, 是五逆也. 無此五者爲順. 《靈樞》
Translation영역
The white of the eye dark and the eye small is the first contrary sign; vomiting up the medicine the second; abdominal pain with severe thirst the third; the shoulder and nape unmanageable the fourth; the voice hoarse and the colour fled the fifth. He who has none of these five is going with the current.
Yeongchu 靈樞
Source원문
更有氣噫痞塞ㆍ咳嗽ㆍ身冷自汗無時ㆍ目瞪ㆍ耳聾ㆍ恍惚驚悸ㆍ言語顚倒, 皆是惡證. 《精要》
Translation영역
Further, belching with blockage and stuffiness, coughing, a cold body sweating of itself at no set time, a fixed stare, deafness, bewilderment with fright palpitation, and speech turned upside down — all these are bad signs.
Jeongyo 精要
4.15 The Great Method of Treating Abscesses 治癰疽大法
Source원문
初覺則散腫內消, 已潰則排膿歛毒, 膿盡則去腐內塞, 惡肉盡則生肌付痂. 此定則也. 《直指》
Translation영역
At the first sign, disperse the swelling and make it melt away within. Once it has burst, drain the pus and gather in the toxin. Once the pus is finished, remove the rot and pack within. Once the dead flesh is finished, grow new flesh and let it scab. This is the settled rule.
Clinical note임상 주석
The four stages of this chapter, and of a modern wound service: resolve what has not yet collected, drain what has, debride, then let it granulate and close. The Jikji calls it 定則, the settled rule, and the rest of the chapter is arranged in that order — 4.19 opens, 4.20 drains, 4.21 debrides, 4.22 washes, 4.23 dresses.
Jikji 直指
Source원문
癰之初發, 當以潔古法爲主. 表者散之, 裏者下之, 火以灸之, 藥以敷之. 膿未成者必消, 膿已成者速潰也.
Translation영역
At the first outbreak of a welling abscess, Jiegu's method should be the chief one. What is in the exterior, disperse; what is in the interior, precipitate; use fire to cauterize it and medicine to spread on it. Where pus has not formed it must disperse, and where pus has formed it will burst the sooner.
Gangmok 綱目
Source원문
疽之初發, 當以涓子法爲主. 補塡藏府令實, 勿令下陷之邪蔓延. 外以火灸引邪透出, 使有穴歸着而不亂, 則可轉死回生, 變凶爲吉矣. 《綱目》
Translation영역
At the first outbreak of a flat-abscess, Liu Yuanzi's method should be the chief one. Supplement and fill the organs to make them replete, and do not let the downward-sinking evil creep onward. Outside, draw the evil through with moxa, so that it has an opening to go to and settle at and is not thrown into disorder — and then death may be turned to life, and the inauspicious changed to the auspicious.
Clinical note임상 주석
Two schools set side by side and assigned to the two diseases: Zhang Yuansu's for the superficial abscess, which is to be dispersed or purged and opened, and Liu Yuanzi's for the deep one, which is to be supported from within while a path is made for the pus to come out. 使有穴歸着而不亂 — so that it has an opening to go to and does not run wild — is the governing idea of the whole treatment: give the infection somewhere to drain, or it will find its own way.
Gangmok 綱目
Translation영역
Naesohwangryeon-tang 內疏黃連湯 and Cheongeumnuro-tang 千金漏蘆湯 govern the yang welling abscess, scorching and swollen and facing outward; Naetakbokjeon-san 內托復煎散 and Yeonyeonjinintalmyeong-dan 淵然奪命丹 treat the yin flat-abscess with its toxin banked up within.
Dansim 丹心
Source원문
瘡瘍者, 火之屬, 須分內外. 若脉沉實, 當先疏其內以絶其源; 若脉浮大, 當先托裏, 恐邪氣入內. 有內外之中者, 邪氣至甚, 遏絶經絡, 故發癰腫. 治法大要, 須明托裏ㆍ疏通ㆍ行榮衛三法. 《易老》
Translation영역
Sores and ulcers belong to fire, and inner and outer must be divided. If the pulse is deep and replete, first thin out the interior so as to cut off the source; if the pulse is floating and large, first thrust from within, for fear the evil qi enters inward. Where it stands between inner and outer, the evil qi has reached its height and has choked off the channels, and so a welling abscess and swelling breaks out. The great essential of the method of treatment is to understand the three methods: thrusting from within, thinning and opening, and moving construction and defence. 《易老》
Clinical note임상 주석
The pulse decides which way to go, and the rule is the right way round. A deep replete pulse in a patient who is systemically well means purge and open; a floating large pulse in a patient who is already failing means support, because purging him would let the infection in. 托裏ㆍ疏通ㆍ行榮衛 are the three method-names the whole formula apparatus of this chapter hangs on.
Yi Lao 易老
Translation영역
Where at the first outbreak of an abscess the qi is replete, give Ohyangyeongyo-tang 五香連翹湯 or Cheongeumnuro-tang 千金漏蘆湯 at once. For the young and robust, Oridaehwang-tang 五利大黃湯 or Hwadok-dan 化毒丹 may be given, taking one or two free movements of the bowel. If the pus has formed and it has burst and spoiled, Ohyang-tang 五香湯 and Takri-san 托裏散 are appropriate.
Jeongui 精義
Translation영역
For an outer pattern the surface should be dispersed, and Hwangryeonsodok-san 黃連消毒散 and Naetakganghwal-tang 內托羌活湯 are appropriate. For an inner pattern it should be thinned and led out, and Naesohwangryeon-tang 內疏黃連湯 and Seonbanghwalmyeong-eum 仙方活命飮 are appropriate, or for the lighter case Cheongyeolsodok-eum 淸熱消毒飮. If the surface is to be opened and the interior attacked together, Bangpungtongseong-san 防風通聖散 — the formula is given in the Wind chapter — and Ohyangyeongyo-tang 五香連翹湯 are appropriate.
Immun 入門
Source원문
血得溫則流行, 氣得溫則和暢. 服餌貼付藥, 用和平. 《直指》
Translation영역
Blood warmed will flow and move; qi warmed will be harmonious and free. In the drugs taken by mouth and those laid on, use what is harmonious and even.
Jikji 直指
Source원문
大凡癰疽, 惟藉有熱. 則發熱則氣血行, 冷則氣血滯. 遇有熱者, 切不可退熱, 但用溫藥, 以微凉少濟之. 《直指》
Translation영역
In abscess disease generally, one relies on there being heat. For when there is heat, qi and blood move; when it is cold, qi and blood stagnate. Where you meet with heat, on no account bring the heat down; use warm drugs only, and help them a little with something slightly cool.
Clinical note임상 주석
切不可退熱 — on no account bring the heat down. Read as the Jikji means it, this is a warning against cooling a patient whose body is mounting the response that will localize and expel the pus; the companion passages at 4.5 and 4.10 say the same thing from the prognostic side. Read as a modern instruction it would be wrong, and the chapter's own 疏/利 group contradicts it for the hot shut abscess. What the two together amount to is that febrile response is not itself the disease.
Jikji 直指
4.16 The Method of Thrusting an Abscess from Within 癰疽內托法
Source원문
癰疽因積毒在藏府, 當先助胃壯氣, 使根本堅固, 而以行經活血藥爲佐, 參以經絡時令, 使毒氣外發. 施治之早, 可以內消, 此內托之意也. 《正傳》
Translation영역
Since abscess disease comes of toxin accumulated in the organs, one should first aid the stomach and strengthen the qi so that the root and foundation are firm, with channel-moving and blood-quickening drugs as assistants, taking the channels and the season into account, so that the toxic qi breaks out outward. Where treatment is applied early it may melt away within. This is what thrusting from within means.
Jeongjeon 正傳
Source원문
一切瘡腫, 始覺患起高腫, 五七日忽平陷者, 是內攻之候. 急以內托散及內補湯藥, 補塡藏府令實. 最怕透膜, 膜穿十無一生矣. 《劉涓子》
Translation영역
In any sore or swelling, where it is first felt to rise up high and swollen and then after five or seven days suddenly flattens and sinks, that is the sign of its attacking inward. Use Naetak-san 內托散 at once, and inward-supplementing decoctions, to supplement and fill the organs and make them replete. What is most to be feared is its piercing the membrane; where the membrane is pierced, not one in ten lives.
Clinical note임상 주석
最怕透膜 — what is most feared is its piercing the membrane. A swelling that was rising and then collapses has not resolved; it has decompressed inward, and the membrane is the peritoneum or the pleura. 膜穿十無一生 is not an exaggeration for the period: an abscess rupturing into a body cavity without surgery was lethal.
Yu Yeonja 劉涓子
Translation영역
Where in the first day or two of an abscess the pulse is felt to be deep and fine with vexation and oppression, the evil toxin fierce and sudden, the patient bewildered and unsettled, and the outward signs deep and sunken, Takri-san 托裏散 — the formula is given above — and Naetak-san 內托散 should be used.
Jeongui 精義
Source원문
癰疽焮于外, 根盤不深, 形證在表, 其脉多浮, 非氣盛則必侵于內, 急須內托, 宜復煎散方見上, 除濕散鬱, 使胃氣和平, 榮衛俱行, 則邪氣不能內侵也. 《河間》
Translation영역
Where the abscess scorches on the outside, its root-plate not deep, its form and signs in the exterior, and the pulse mostly floating — if the qi is not strong it will certainly encroach inward, and it must be thrust from within at once. Bokjeon-san 復煎散 — the formula is given above — is appropriate, to eliminate damp and disperse depression, so that the stomach qi is at peace and construction and defence both move, and then the evil qi cannot encroach inward.
Hagan 河間
Translation영역
For thrusting from within, use Sipseon-san 十宣散, Gamisipgi-san 加味十奇散, Cheongeumnaeso-san 千金內消散, Takrisodok-san 托裏消毒散, Cheongeumtakri-san 千金托裏散, Gunggwitakri-san 芎歸托裏散, Naetakcheongeum-san 內托千金散, Seonjeonhwadok-tang 仙傳化毒湯, Takrihwanggi-tang 托裏黃芪湯, Takribokryeong-tang 托裏茯苓湯, Cheonsangap-san 穿山甲散 or Bibangtalmyeong-san 秘方奪命散.
Jeongui 精義
Source원문
癰疽經久不差, 氣血漸衰, 膿汁淸稀, 瘡口不合, 外證不明, 並宜托裏. 膿未成者使膿速成, 膿已潰者使新肉早生. 血氣虛者補之, 陰陽不和者調之. 大抵托裏之法, 使瘡無變壞之證矣. 《精義》
Translation영역
Where an abscess has gone long without healing, the qi and blood gradually failing, the pus thin and watery, the mouth of the sore not closing and the outward signs unclear, in all these it should be thrust from within. Where pus has not formed, make the pus form quickly; where pus has burst, make new flesh grow early. Supplement him whose blood and qi are vacuous, and regulate him in whom yin and yang are out of harmony. In the main, the method of thrusting from within is to keep the sore from turning to a spoiled case.
Clinical note임상 주석
膿未成者使膿速成 — where pus has not formed, make it form quickly. The aim is not to prevent suppuration but to hurry it, because a collection that has formed can be drained and one that has not cannot. The whole 托裏 group is built on ginseng, astragalus and Korean angelica, and what it is actually treating is the malnourished, anaemic, chronically infected patient whose wound will not close — a real clinical type, and the nutritional part of the answer is the right part.
Jeongui 精義
4.17 The Method of Raising a Yin Flat-Abscess 陰疽起發法
Source원문
凡背發大瘡, 惟發熱則謂之背; 若不發熱, 皆癤也. 其有陰證於五藏內發者, 却又沉晦無熱. 《直指》
Translation영역
Of the great sores that break out on the back, only one that brings fever is called an outbreak of the back; if there is no fever they are all boils. And where there is a yin pattern breaking out from within the five viscera, that again is sunken and obscure and without heat.
Jikji 直指
Source원문
疽者, 上之皮夭以堅, 如牛領之皮. 《靈樞》
Translation영역
In the flat-abscess the skin above is lifeless and hard, like the hide over an ox's neck.
Yeongchu 靈樞
Source원문
癰疽陰證, 頭平向內, 沉黯不痛, 渾身及患處不熱, 宜服當歸酒, 以排膿內補散卽十宣散ㆍ加味不換金正氣散方見下爲佐; 兼以米餔ㆍ猪蹄ㆍ膂肉爲養. 蕎麥麫能發起, 可煮食之. 如更不起發, 可用穿山甲(頭切片, 蘸醋焦炒)ㆍ生人牙(煆) 各二錢半, 右爲末, 分兩貼, 用辣桂ㆍ當歸ㆍ麻黃煎酒調服, 外取薑汁和麫厚塗患處. 《直指》
Translation영역
In the yin pattern of abscess the head is flat and faces inward, sunken and dull and painless, with no heat in the whole body or in the affected place. Danggui-ju 當歸酒 should be given, with Baenongnaebo-san 排膿內補散 — that is, Sipseon-san 十宣散 — and Gamibulhwangeumjeonggi-san 加味不換金正氣散 — the formula is given below — as assistants, together with rice gruel, pig's trotter and loin meat for nourishment. Buckwheat flour can raise it up, and may be boiled and eaten. If even then it does not rise up, take pangolin scale (the head ones, sliced, dipped in vinegar and fried till scorched) and a living man's tooth (calcined), 2 don 5 fun of each; powder them and divide into two doses, and give stirred into a wine decoction of cassia bark, Korean angelica and ephedra, applying ginger juice mixed with flour thickly over the affected place on the outside.
Clinical note임상 주석
The nutritional half of this is the sound half: rice gruel, trotter and loin meat for a patient whose wound will not rise, which is feeding protein to someone who cannot heal without it. The 穿山甲 and 生人牙 half is not. Pangolin is a critically endangered species traded almost to extinction for exactly this use, and a human tooth has no business in a prescription. **Pangolin scale is from a protected species and must not be obtained or used, and human material taken from a living person must not be used. This preparation must not be made.**
Jikji 直指
Translation영역
For a yin flat-abscess, Seonbanghwalmyeong-eum 仙方活命飮, Bibangtalmyeong-san 秘方奪命散, Seonjeonhwadok-tang 仙傳化毒湯 — these three formulas are given above, Gyehyeol-san 雞血散, Gubo-hwan 狗寶丸 and Saemyeong-dan 賽命丹 should be given, and Saho-san 四虎散 applied outside.
Donguibogam · Ongjeo
4.18 The Five Outbreaks of Abscess 癰疽五發證
Translation영역
Outbreak of the nape, of the temple, of the brow, of the jaw and of the back — these are the five outbreaks, and they are most dangerous. Their signs all give a man headache, nausea, chills and fever, hurried breath and drawing cramps. Ohyang-san 五香散 and Ohyang-tang 五香湯 are appropriate.
Jikji 直指
Source원문
正腦上一處起爲腦癰及腦疽. 腦鑠並在大顀骨上入髮際生.
Translation영역
Rising at the one place right on top of the nape, it is welling abscess of the nape, or flat-abscess of the nape. Brain-melting likewise arises above the great vertebra, within the hairline.
Yeonja 涓子
Source원문
腦癰皮起, 易得破穴, 急破出膿不害.
Translation영역
In welling abscess of the nape the skin lifts and an opening is easily got; open it at once and let the pus out and it does no harm.
Yeonja 涓子
Source원문
腦疽皮厚, 難得破穴, 須急發內毒, 使破穴方可.
Translation영역
In flat-abscess of the nape the skin is thick and an opening is hard to get; the toxin within must be brought out at once, and only when an opening is made will it do.
Yeonja 涓子
Source원문
腦鑠初起如橫木, 色靑黑如靴皮, 大硬不見膿, 難愈.
Translation영역
Brain-melting at first rises like a bar laid crosswise, blue-black in colour like boot leather, large and hard with no pus to be seen, and it is hard to heal.
Clinical note임상 주석
Three lesions of the nape distinguished by the skin over them, and the distinction governs what is done. Thin skin that lifts can be opened and the patient is safe. Thick skin that will not open must be made to open. Skin like boot leather, blue-black, hard and with no pus is the third thing, and it cannot be healed — which is carbuncle progressing to necrosis of the thick nuchal skin, in the era before it could be excised.
Yeonja 涓子
Source원문
左右鬢生癰疽, 是爲鬢發, 亦危篤. 左右額角及太陽穴生, 皆同.
Translation영역
Where an abscess arises on either temple, that is outbreak of the temple, and it too is grave. Arising at either corner of the forehead or at the Taeyang point, it is all the same.
Yeonja 涓子
Source원문
左右眉稜發爲發眉, 亦重.
Translation영역
Breaking out on either brow ridge is outbreak of the brow, and it too is serious.
Yeonja 涓子
Source원문
鼻下人中及下頤發爲發頤, 亦曰發髭, 亦害人.
Translation영역
Breaking out below the nose at Injung and on the lower jaw is outbreak of the jaw, also called outbreak of the moustache, and it too destroys a man.
Yeonja 涓子
Source원문
背後五藏兪分生癰疽, 是爲發背, 最重. 《涓子》
Translation영역
Where an abscess arises on the back at the divisions of the transport points of the five viscera, that is outbreak of the back, and it is the most serious of all.
Clinical note임상 주석
The five outbreaks are the nape, temple, brow, jaw and back, and four of the five are on the head. They are the sites from which infection reaches the cranial venous sinuses, and the chapter's insistence that they are the dangerous ones is the same observation as 4.6's seven forbidden places, made from the other direction.
Yeonja 涓子
Source원문
究其病源, 有風ㆍ有氣ㆍ有食ㆍ有藥毒ㆍ有勞損卽房勞. 風則多痒, 氣則多痛, 食則發寒熱, 藥毒則堅硬, 勞損則瘦弱. 風ㆍ氣ㆍ食三種易療, 宜二香散; 藥毒ㆍ勞損二者難醫. 《直指》
Translation영역
Tracing the source of the disease, there is wind, there is qi, there is food, there is drug toxin, and there is taxation damage — that is, bedroom exhaustion. Wind gives much itching, qi much pain, food brings chills and fever, drug toxin makes it hard and stony, and taxation damage makes him thin and weak. The three kinds — wind, qi and food — are easily cured, and Ihyang-san 二香散 is appropriate; the two, drug toxin and taxation damage, are hard to doctor.
Jikji 直指
Translation영역
For the outer cause, the four qi, Hwanggam-san 黃甘散, Yeongyopaedok-san 連翹敗毒散 and Changchulbokjeon-san 蒼朮復煎散 — the formula is given in the Wind chapter — should be given.
Jikji 直指
Translation영역
For the inner cause, the seven affects, Wonji-ju 遠志酒 and Dokseung-san 獨勝散 are appropriate.
Jikji 直指
Translation영역
For the cause that is neither inner nor outer — drug toxin and bedroom exhaustion — Gukro-go 國老膏 and Goehwa-ju 槐花酒 are appropriate.
Jikji 直指
Translation영역
An outbreak from the toxin of metal and mineral drugs is hard and stony as a rock and painless, and Gamdu-tang 甘豆湯 — the formula is given in the Resolving Toxins chapter — and Napban-won 蠟礬元 are appropriate.
Clinical note임상 주석
金石藥毒 — the toxin of metal and mineral drugs — as a cause of abscess, with its own treatment. The physicians of the period were treating the consequences of the mineral pharmacy they themselves prescribed, and a hard painless stony swelling in a patient who had been taking arsenic, mercury or lead preparations is a recognizable thing. 甘豆湯 is licorice and black soybean, the standard antidote decoction.
Jikji 直指
Source원문
虛勞瘦弱, 榮衛否濇, 患處重着如負石, 不可用香燥疏泄之藥, 宜腎氣丸方見虛勞ㆍ托裏散方見上. 《丹心》
Translation영역
Where there is vacuity taxation with thinness and weakness, construction and defence blocked and rough, and the affected place heavy and weighed down as though carrying a stone, aromatic, drying, thinning and draining drugs may not be used, and Singi-hwan 腎氣丸 — the formula is given in the Vacuity Taxation chapter — and Takri-san 托裏散 — the formula is given above — are appropriate.
Dansim 丹心
Translation영역
Where in the five outbreaks there is scorching swelling with pain, and vexing thirst that draws him to cold drink, Hwangryeonsodok-san 黃連消毒散 — the formula is given above, Dangguiganghwal-tang 當歸羌活湯 and Cheongyeolsodok-eum 淸熱消毒飮 — the formula is given above — are appropriate.
Immun 入門
Translation영역
If there is swelling and pain with a thirsty mouth and he likes to drink hot liquid, this is kidney vacuity with the yang fire blazing, and Takrisodok-san 托裏消毒散 — the formula is given above, Takriikgi-tang 托裏益氣湯 and Singi-hwan 腎氣丸 are appropriate.
Clinical note임상 주석
The pair of passages turns on one question asked at the bedside: does the thirsty patient want his drink cold or hot? Cold means the heat is real and is to be cooled; hot means it is not, and the patient is to be supported. It is a cheap and genuinely discriminating question, and a version of it is still asked.
Immun 入門
Source원문
若色黯不潰不歛, 爲陰精消涸, 名腦爍, 不治.
Translation영역
If the colour is dull and it neither bursts nor closes, the yin essence is consumed and dried up; this is called brain-melting, and it is not to be treated.
Immun 入門
Translation영역
Outbreak of the temple comes of the fire of anger, and Sihocheonggan-tang 柴胡淸肝湯 is appropriate; for pent-up anger, Sibyungmiyugi-eum 十六味流氣飮 — the interlinear reference is damaged here; and in the severe case Seonbanghwalmyeong-eum 仙方活命飮 — the formula is given above.
Immun 入門
Translation영역
Outbreak of the jaw is the most dangerous: the toxic qi pours into the head and face, the swelling is great and fearful to see, and the teeth fall out too. Naesohwangryeon-tang 內疏黃連湯 and Cheongeumnuro-tang 千金漏蘆湯 — both formulas are given above — are appropriate.
Clinical note임상 주석
毒氣灌注頭面, 腫大可畏, 牙齒亦脫 — the toxin pours into the head and face, the swelling fearful, and the teeth come out as well. This is Ludwig's angina or a spreading odontogenic infection of the submandibular space, which swells the floor of the mouth and the neck and kills by closing the airway. The chapter is right that it is the most dangerous of the five, and 4.6 has already named the region below the jawbone as one of the seven places an abscess must not be suffered.
Immun 入門
Source원문
通用玄靈散. 《活心》
Translation영역
For general use, Hyeonryeong-san 玄靈散.
Hwalsim 活心
4.19 The Method of Making an Opening and Letting the Pus Out 癰疽作穴出膿法
Translation영역
Where an abscess has already made pus and the head will not break so that the pus cannot get out, Chechim-hwan 替鍼丸, Tunong-san 透膿散, Sahyang-san 麝香散, Yongcheon-go 涌泉膏, Sanong-hwan 射膿丸, Tanong-san 打膿散 and Gyeokpichwinong-beop 隔皮取膿法 should be used.
Donguibogam · Ongjeo
Source원문
鍼後閉合脹痛, 宜追毒餠.
Translation영역
Where after needling it closes over again with distension and pain, Chudok-byeong 追毒餠 is appropriate.
Donguibogam · Ongjeo
Source원문
破穴入毒水作痛, 宜去水膏.
Translation영역
Where the opening has been made and toxic water gets in and gives pain, Geosu-go 去水膏 is appropriate.
Donguibogam · Ongjeo
Source원문
凡癰疽膿成未破, 於上薄皮剝起者, 卽當用破頭代鍼之劑, 安其上, 膿出之後, 乃用搜膿化毒之藥, 取效如神矣. 《精義》
Translation영역
Whenever an abscess has formed pus and not yet broken, and the thin skin above it peels up, a head-breaking needle-substitute preparation should at once be used, set upon it; and after the pus has come out, drugs that search out the pus and transform the toxin are then used, and the effect is got as though by a spirit.
Clinical note임상 주석
代鍼 — needle-substitute — is the chapter's name for a caustic paste laid on the pointing head of an abscess to eat through the skin, used in place of a blade. 替鍼丸 and 麝香散 are both of this kind, and 替鍼丸's name says the same thing. The sequence is correct — decompress the collection, then clean the cavity — and it is what is done now with a scalpel and irrigation. The caustic is the part that failed: it cannot be aimed, it burns living skin as readily as dead, and the opening it makes is the small hole over a wide cavity that 4.10 counts among the fatal signs. **These preparations are built on blister beetle, arsenic sulfide and quicklime and must not be made or applied.**
Jeongui 精義
4.20 The Method of Draining the Pus and Growing New Flesh 癰疽排膿生肌法
Source원문
癰疽潰後氣血大虛, 惟恐毒陷, 托裏之法不可一日缺也. 宜用十宣散ㆍ托裏散二方見上ㆍ托裏和中湯ㆍ芎歸托裏散ㆍ托裏消毒飮ㆍ加味十全湯ㆍ神效托裏散ㆍ聖愈湯. 蓋托裏則氣血壯而脾胃盛, 膿穢自排, 毒氣自解, 死肉自去, 新肉自生, 瘡口自歛矣. 《入門》
Translation영역
After an abscess has burst, the qi and blood are greatly vacuous and the one fear is that the toxin will sink inward, so the method of thrusting from within may not be left off for a single day. Sipseon-san 十宣散, Takri-san 托裏散 — both formulas are given above, Takrihwajung-tang 托裏和中湯, Gunggwitakri-san 芎歸托裏散, Takrisodok-eum 托裏消毒飮, Gamisipjeon-tang 加味十全湯, Sinhyotakri-san 神效托裏散 and Seongyu-tang 聖愈湯 should be used. For when it is thrust from within, the qi and blood are strong and the spleen and stomach are full; the foul pus drains of itself, the toxic qi resolves of itself, the dead flesh comes away of itself, new flesh grows of itself, and the mouth of the sore closes of itself.
Immun 入門
Source원문
瘡肉不歛, 由於肌肉不生; 肌肉不生, 由於腐肉不去; 腐肉不去, 由於脾胃不壯, 氣血不旺. 必以補托爲主, 而佐以行經活血之藥, 則新肉自生, 死肉自潰, 又何待於點割耶. 《入門》
Translation영역
The flesh of the sore does not close because new flesh does not grow; new flesh does not grow because the rotten flesh does not come away; the rotten flesh does not come away because the spleen and stomach are not strong and the qi and blood are not vigorous. Supplementing and thrusting must be the chief thing, with channel-moving and blood-quickening drugs as assistants, and then new flesh will grow of itself and dead flesh will slough of itself — and what need then to wait upon cautery and the knife?
Clinical note임상 주석
腐肉不去由於脾胃不壯 — the rotten flesh does not come away because the spleen and stomach are not strong. The chain of reasoning runs backward from the non-healing wound to nutrition, and it arrives somewhere true: a wound will not granulate in a patient who is not being fed. The conclusion drawn from it is the wrong one. 又何待於點割耶 — what need then of cautery and the knife — argues that feeding the patient makes debridement unnecessary, and it does not; dead tissue has to be removed. The chapter contradicts itself here, since 4.21 is a whole section on removing it.
Immun 入門
Source원문
凡膿血出多, 陰陽兩虛, 十全大補湯方見虛勞補氣血ㆍ進飮食, 有回生起死之功. 但不分經絡, 不載時令, 醫者觸類而長之可也. 或見腫平痛寬, 遂以爲安, 慢不知省, 無補養調攝之功, 愈後虛證復見, 因而轉成他病者多矣. 《丹溪》
Translation영역
Wherever much pus and blood has come out and yin and yang are both vacuous, Sipjeondaebo-tang 十全大補湯 — the formula is given in the Vacuity Taxation chapter — supplements qi and blood and improves the appetite, and has the power of bringing back life and raising the dead. But it does not divide the channels and does not take the season into account, and the physician should extend it by analogy as the case requires. Some, seeing the swelling flatten and the pain slacken, take it for safety, and being idle and careless do not reflect; and having done nothing to supplement, nourish and regulate him, after the healing the vacuity signs appear again, and by this many turn into some other illness.
Clinical note임상 주석
The last sentence is the one worth keeping: the patient whose swelling has gone down and whose pain has eased is not well, and if nothing is done for him he becomes ill in some other way. Convalescence from a major suppurative illness is a real and long thing, and the Dansim is noticing that the treatment usually stopped at the point where the wound looked better.
Dangye 丹溪
4.21 Formulas for Removing Dead Flesh from an Abscess 癰疽去惡肉方
Translation영역
Where there is dead flesh within an abscess or malignant sore, if it is not removed then sound flesh will not grow and the mouth of the sore will not close, and drugs should be used to melt and eat it away. Chwiha-san 翠霞散 — the formula is given in the Sores chapter, Padu-go 巴豆膏, Chudok-dan 追毒丹, Geoak-san 去惡散, Sosik-san 消蝕散, Nokgak-san 鹿角散 and Unghwang-san 雄黃散 will all do.
Clinical note임상 주석
若不去則好肉不生 — if it is not removed, sound flesh will not grow. The principle is exactly right and is the reason debridement exists: granulation tissue will not form over necrotic slough. What the chapter has instead of an instrument is 消蝕, melting and eating away, and the six preparations named here work by chemical destruction — croton oil, arsenic sulfide, quicklime, blister beetle, mercury salts. **Every one of these is a caustic poison and none of them may be prepared or applied.** The objection is not only toxicity: a caustic cannot distinguish dead tissue from living, so it enlarges the wound it is meant to clean. Sharp debridement replaced it for that reason.
Donguibogam · Ongjeo
Source원문
癰疽惡瘡有死肉不去者, 白丁香ㆍ霜梅爲末, 深則絍之, 淺則乾糝, 甚妙. 《精要》
Translation영역
Where in an abscess or malignant sore there is dead flesh that will not come away, powder sparrow droppings and frosted plum; where it is deep, pack it in on a wick, and where it is shallow, dust it on dry. It is most effective.
Clinical note임상 주석
深則絍之 — where it is deep, pack it on a wick. 絍 is to thread or pack, and packing a deep cavity with a medicated wick so that it drains and does not close over at the mouth is exactly what is still done with a gauze wick. The medicament is the part to leave behind: **bird droppings packed into an open wound is a direct route to tetanus and deep infection and must not be done.**
Jeongyo 精要
4.22 The Method of Washing an Abscess with Decoctions 癰疽湯洗法
Source원문
瘡家藏府生熱, 熱蒸其血, 血敗則肉腐, 肉腐則成膿. 當膿血焮聚之時, 所賴朝夕洗瘡, 以外舒其毒氣. 纔覺有膿, 卽煖醋蘸熨而破之; 纔見破肉, 卽煮藥盪射而去之. 稍或稽延, 不返掌而侵蝕筋骨矣. 《直指》
Translation영역
In one who has sores, heat arises in the organs; the heat steams his blood, the blood is spoiled and the flesh rots, and the flesh rotting becomes pus. At the time when pus and blood are scorching and gathering, what one depends on is washing the sore morning and evening, to let its toxic qi out at the surface. The moment pus is felt, dip a cloth in warm vinegar and press it on to break it; the moment broken flesh is seen, boil the drugs and flush it out with the stream to carry it away. Delay a little, and in less time than turning the hand it has eaten into sinew and bone.
Clinical note임상 주석
朝夕洗瘡 — washing the sore morning and evening — as the thing one depends on, and 煮藥盪射 for flushing it out with a stream of the decoction. Irrigation twice a day with a boiled and therefore sterile fluid is good wound care by any standard, and the Jikji is right about the consequence of delay: untreated, these infections do reach bone.
Jikji 直指
Source원문
夫湯洗之法, 宣通肌表, 發散邪氣, 使瘡內消也. 蓋湯水有盪滌之功. 凡瘡腫初生一二日, 須用藥湯淋射之; 在四肢者溻漬之, 在腰腹背者淋射之, 在下部委曲者浴漬之. 如藥二兩, 用水二升, 煎取一升半, 以凈布或新綿蘸藥水, 稍熱溻漬患處, 稍涼則急令再溫, 勿用冷者. 日用五七次, 以腫消痛止爲驗. 《精義》
Translation영역
Now the method of washing with decoctions diffuses and opens the flesh and surface, disperses the evil qi, and makes the sore melt away within — for hot water has the power of rinsing and scouring. In the first day or two of any sore or swelling, a medicinal decoction should be used to pour and play upon it: on the limbs, soak it; on the loins, belly and back, pour it on; in the lower parts and the folds, bathe and steep it. For two nyang of the drugs, use 2 seung of water and boil it down to 1 seung 5 hop; dip clean cloth or fresh cotton wool in the medicated water and soak the affected place with it moderately hot, and as soon as it cools a little have it warmed again at once — never use it cold. Use it five or seven times a day, and take the swelling going down and the pain stopping as the proof.
Clinical note임상 주석
A wound-care protocol, and a good one. Clean cloth, a boiled solution, warm not cold, renewed as it cools, five to seven times a day, with resolution of swelling and pain as the endpoint. 在下部委曲者浴漬之 — bathe and steep what is in the lower parts and the folds — is a sitz bath for perineal and intertriginous disease. The one thing missing is any notion of why boiling the water matters.
Jeongui 精義
Source원문
初作宜宣熱拔毒, 外以洗滌ㆍ角付, 以歛其暈. 已潰則排膿止痛, 朝夕洗滌以舒毒氣. 膿盡則生肌付痂, 次第施治. 《得效》
Translation영역
At the outset, the heat should be diffused and the toxin drawn out, and outwardly it should be washed and dressed to draw in the halo. Once it has burst, drain the pus and stop the pain, washing morning and evening to let the toxic qi out. Once the pus is finished, grow new flesh and let it scab — treating in order, stage by stage.
Deukhyo 得效
Translation영역
Jeoje-tang 猪蹄湯, Haedok-tang 解毒湯, Sedok-tang 洗毒湯 and Geonae-tang 乾艾湯 — choose among them for use.
Clinical note임상 주석
All four are washes, not drinks. The point is worth making because three of the four names are indistinguishable in form from formulas taken by mouth, and 解毒湯 in particular is also the name of a decoction drunk for a quite different complaint in the Haemorrhoid chapter.
Immun 入門
4.23 The Method of Dusting and Plastering an Abscess 癰疽糝貼法
Source원문
凡瘡腫初生似有頭者, 卽貼溫熱藥, 引出熱毒, 火就燥之義也. 於四畔赤焮處, 貼生寒藥, 折伏熱勢, 驅逐邪惡, 乃撲火之義也. 腫皮厚者, 以故軟帛或紙花子塗藥貼之; 腫皮薄者, 用疏紗或薄紙塗藥貼之, 乾則換易新者. 宜用乳香膏ㆍ圍藥ㆍ鐵井欄ㆍ水澄膏ㆍ沈水膏ㆍ三神膏ㆍ洪寶膏ㆍ妙勝散. 《精要》
Translation영역
Wherever a sore or swelling newly arisen seems to have a head, lay on a warm hot medicine at once to draw the heat toxin out — the sense of fire going to what is dry. On the red scorching ground at its four margins, lay on a raw cold medicine to break and subdue the force of the heat and drive off the evil — the sense of beating out a fire. Where the skin over the swelling is thick, spread the medicine on worn soft silk or on patterned paper and lay it on; where the skin over the swelling is thin, use loose gauze or thin paper, spread the medicine and lay it on, changing it for a fresh one when it dries. Yuhyang-go 乳香膏, Wi-yak 圍藥, Cheoljeong-ran 鐵井欄, Sujing-go 水澄膏, Chimsu-go 沈水膏, Samsin-go 三神膏, Hongbo-go 洪寶膏 and Myoseung-san 妙勝散 should be used.
Clinical note임상 주석
Two dressings on one lesion, and they do opposite things on purpose: something warm on the head of the swelling to bring it to a point, something cold on the inflamed skin around it to stop the spread. The 圍藥 and 鐵井欄 are of the second kind, spread in a ring and not on the lesion at all. Whether the heat does anything is doubtful; the cool ring is at worst harmless, and the dressing choice by skin thickness — soft cloth over thick skin, loose gauze or thin paper over thin — is practical sense about not macerating what is already fragile.
Jeongyo 精要
Source원문
貼膏藥之法, 瘡口有膿血不凈, 痂瘢閉礙, 須用藥水洗凈拭乾, 候水氣乾, 却用膏貼. 貼後有黃水膿血出流, 用紙揩從側畔出. 一日一換; 黃水膿血止, 二三日一換, 貼至愈. 宜用神異膏ㆍ萬應膏ㆍ靈應膏ㆍ太乙膏ㆍ雲母膏ㆍ善應膏ㆍ糯米膏ㆍ斂瘡散ㆍ桃花散ㆍ紅玉散ㆍ生肌散ㆍ木香檳榔散ㆍ竹筒吸毒方. 《得效》
Translation영역
The method of laying on a plaster: where the mouth of the sore has pus and blood that is not clean and scab and crust block it up, it must be washed clean with medicated water and wiped dry, and when the moisture has dried the plaster is then laid on. After it is laid on, yellow water, pus and blood will run out, and paper is used to wipe it away from the side. Change it once a day; when the yellow water, pus and blood have stopped, change it once in two or three days, and keep it on until it is healed. Sini-go 神異膏, Maneung-go 萬應膏, Yeongeung-go 靈應膏, Taeeul-go 太乙膏, Unmo-go 雲母膏, Seoneung-go 善應膏, Nami-go 糯米膏, Yeomchang-san 斂瘡散, Dohwa-san 桃花散, Hongok-san 紅玉散, Saenggi-san 生肌散, Mokhyangbinrang-san 木香檳榔散 and Juktonghupdok-bang 竹筒吸毒方 should be used.
Clinical note임상 주석
Debride the crust, clean, dry, dress; change daily while it is discharging and every two or three days once it is not; keep it dressed until healed. That is a dressing regimen, and it is the right one. 用紙揩從側畔出 — wipe the discharge away from the side — even keeps the clinician from pushing it back into the cavity.
Deukhyo 得效
Source원문
凡付貼之藥, 須是細末則不痛. 《直指》
Translation영역
Any medicine to be laid on must be a fine powder, and then it does not hurt.
Jikji 直指
4.24 Dividing Abscesses into Inner and Outer 內外分癰疽
Source원문
內疽者, 皆因飮食之火挾七情之火相鬱而發. 飮食者陰受之, 七情者藏府受之, 宜其發在腔子而向裏, 非干腸胃肓膜也. 謂之內疽者, 以其視之不見, 故名焉. 《綱目》
Translation영역
The inner flat-abscess always breaks out from the fire of food and drink joining with the fire of the seven affects, each depressing the other. Food and drink are received by the yin, the seven affects by the organs, and so it is fitting that it breaks out within the cavity and faces inward, having nothing to do with the intestines, the stomach or the membranes. It is called an inner flat-abscess because looking at it one sees nothing, and so it is named.
Clinical note임상 주석
以其視之不見, 故名焉 — it is named for not being visible. That is the whole content of the category: these are the abscesses the physician could not see, and the chapter's inability to do anything about them follows from that and not from the doctrine offered here.
Gangmok 綱目
Source원문
發於內者, 曰肺癰ㆍ心癰ㆍ肝癰ㆍ腎癰ㆍ胃脘癰ㆍ腸癰ㆍ腹癰.
Translation영역
Those breaking out within are called welling abscess of the lung, of the heart, of the liver, of the kidney, of the stomach duct, of the intestine, and of the belly.
Gangmok 綱目
Source원문
發於外者, 曰臂癰ㆍ乳癰ㆍ臀癰ㆍ懸癰ㆍ便癰ㆍ囊癰ㆍ附骨疽ㆍ流注骨疽ㆍ疔疽.
Translation영역
Those breaking out without are called welling abscess of the arm, of the breast, of the buttock, the hanging abscess, the groin abscess, abscess of the scrotum, the bone-adhering flat-abscess, the flowing-and-pouring bone flat-abscess, and the clove flat-abscess.
Clinical note임상 주석
附骨疽 is osteomyelitis and 流注骨疽 the metastatic kind that appears at a distance from its source — the Gangmok has separated the bone infection that spreads from an adjacent focus from the one that arrives by the blood, which is a real distinction and the one still made. 癰疽 下 takes these outer sites one by one.
Gangmok 綱目
Translation영역
For an inner flat-abscess, apply Jeomeumgyo-beop 點陰膠法, and then give Seonbanghwalmyeong-eum 仙方活命飮 — the formula is given above — and Naesookseol-tang 內消沃雪湯.
Gangmok 綱目
Translation영역
For an inner flat-abscess use the drugs that thrust from within, and outside open it with a needle, and it heals. First give Samul-tang 四物湯 — the formula is given in the Blood chapter — with platycodon, cyperus and fresh ginger added, decocted and taken; after it has burst, use Samul-tang again to set him in order; and Unmo-go 雲母膏 or Taeeul-go 太乙膏 may be made into pills and taken alongside.
Clinical note임상 주석
外以鍼開之而愈 — open it with a needle from outside, and it heals. Set against the Gangmok passage just above, which sends the physician to a divinatory test and two decoctions, the Dansim's line is the one that would actually have saved anyone. Drainage is the treatment, and the chapter knows it whenever the collection can be reached.
Dansim 丹心
4.25 Welling Abscess of the Lung 肺癰
Source원문
中府穴名隱隱而痛者肺疽, 上肉微起者肺癰也. 《靈樞》
Translation영역
A dull hidden pain at Jungbu — the name of a point — is flat-abscess of the lung; where the flesh above it rises a little, it is welling abscess of the lung.
Yeongchu 靈樞
Source원문
肺之癰, 喘而兩胠滿. 肺癰吐膿如糯米粥, 咽燥振寒. 《內經》
Translation영역
In welling abscess of the lung there is panting and both flanks are full. Welling abscess of the lung brings up pus like glutinous rice gruel, with a parched throat and a shaking chill.
Naegyeong 內經
Source원문
振寒發熱, 寸脉滑數, 咳唾膿血, 其人飮食起居如故, 此爲癰腫, 膿在胸中, 爲肺癰. 其脉緊數爲膿未成, 緊去但數爲膿已成. 《仲景》
Translation영역
A shaking chill with fever, the inch pulse slippery and rapid, coughing and spitting pus and blood, while the man eats and drinks and goes about as before — this is welling abscess and swelling, with the pus in the chest, and it is welling abscess of the lung. A pulse tight and rapid means the pus has not yet formed; when the tightness goes and it is only rapid, the pus has formed already.
Clinical note임상 주석
飮食起居如故 — he eats and goes about as before — in a patient coughing up pus and blood. The observation that a lung abscess can coexist with a preserved general state is a good one, and it is what distinguishes this from the chapter's fatal septic pictures. The pulse rule, tightness going as the pus matures, tracks the point at which a consolidated area has cavitated.
Junggyeong 仲景
Source원문
肺癰吐膿後, 其脉短而濇者自痊, 浮大者難治. 其面色白而反赤者, 此火之克金, 不可治. 《丹心》
Translation영역
After welling abscess of the lung has brought up pus, a pulse short and rough will heal of itself; floating and large is hard to treat. Where the colour of his face was white and turns red instead, this is fire overcoming metal, and it cannot be treated.
Dansim 丹心
Source원문
大凡肺癰, 當咳喘短氣, 胸滿時唾膿血. 久久如糯米粥者難治; 其嘔膿而自止者自愈. 《精義》
Translation영역
In welling abscess of the lung generally there must be cough and panting with short breath, a full chest, and pus and blood spat up from time to time. Where it goes on long and is like glutinous rice gruel, it is hard to treat; where he vomits pus and it stops of itself, he heals of himself.
Jeongui 精義
Source원문
始萌可救, 膿成多死. 《仲景》
Translation영역
At the first budding he may be saved; once the pus has formed, most die.
Junggyeong 仲景
Source원문
肺癰乃風寒之氣內舍於肺而作, 先須發表, 宜參蘇飮方見寒門.
Translation영역
Welling abscess of the lung is made by wind and cold qi lodging inward in the lung, and the surface must first be opened; Samso-eum 參蘇飮 — the formula is given in the Cold Damage chapter — is appropriate.
Deukhyo 得效
Translation영역
In welling abscess of the lung there is cough with a dull hidden pain in the chest and diaphragm, and from time to time turbid sputum of a rank stench is brought up. For the replete, give four doses of Samso-eum 參蘇飮 first; for the vacuous, four doses of Socheongryong-tang 小靑龍湯 first — the formula is given in the Cold Damage chapter.
Clinical note임상 주석
濁唾腥臭 — turbid sputum of a rank stench. Foul-smelling purulent sputum is the single most characteristic finding of lung abscess and of anaerobic pulmonary infection, and it is what makes this section's identification secure where the chapter's other organ abscesses are guesswork. The modern readings are lung abscess, bronchiectasis with infected secretions, and empyema draining through a bronchus.
Deukhyo 得效
Translation영역
In welling abscess of the lung the mouth is parched and the throat dry, there is a dull hidden pain in the chest, both excretions are red and rough, and he coughs and spits pus and blood of a rank stench which, dropped into water, sinks. Gilgyeong-tang 桔梗湯, Sonong-eum 消膿飮, Wiyeop-tang 葦葉湯, Hwanghon-tang 黃昏湯, Ohyangbaekchul-san 五香白朮散, Mokdanpi-tang 牡丹皮湯, Samgibopye-tang 參芪補肺湯 and Samchulbobi-tang 參朮補脾湯 should be used.
Clinical note임상 주석
置之水中則沉 — dropped into water it sinks. A bedside test: purulent sputum is denser than water and sinks, ordinary phlegm floats. The distinction is crude but it is a real physical difference, and this is a physician trying to make a laboratory out of a bowl of water.
Immun 入門
Source원문
肺癰之證, 男子以氣爲主, 得之十救二三; 婦人以血爲主, 得之十全七八. 歷試屢驗. 《得效》
Translation영역
In the pattern of welling abscess of the lung, a man is governed by qi, and of those who get it two or three in ten are saved; a woman is governed by blood, and of those who get it seven or eight in ten come through whole. Tried repeatedly and proved again and again.
Clinical note임상 주석
歷試屢驗 — tried repeatedly and proved. A claimed survival of two or three in ten for men against seven or eight for women is the kind of figure that invites checking, and the explanation offered (qi against blood) explains nothing. If there was a real difference it would more likely lie in who drank, since alcohol and aspiration are the great causes of lung abscess and the drinking was not evenly distributed.
Deukhyo 得效
Translation영역
Unmo-go 雲母膏 may be made into pills and taken, and Taeeul-go 太乙膏 will do as well.
Immun 入門
4.26 Welling Abscess of the Heart 心癰
Source원문
巨闕穴名隱隱而痛者心疽, 上肉微起者心癰也. 《靈樞》
Translation영역
A dull hidden pain at Geogwol — the name of a point — is flat-abscess of the heart; where the flesh above it rises a little, it is welling abscess of the heart.
Yeongchu 靈樞
Translation영역
Welling abscess of the heart arises where there is heat in the heart channel, or he is given to drink, or fond of hot things, so that it accumulates and gathers into heat and congeals and stagnates. Give Yanghyeol-eum 凉血飮 first, and then Gamisipgi-san 加味十奇散 — the formula is given above.
Deukhyo 得效
Translation영역
In welling abscess of the heart a honeycomb abscess arises between the chest and the breast. Its outbreak is what the Yeongchu calls by the one name the well flat-abscess, shaped like a bean in size, rising in three or four days; if not treated early it enters the belly, and in seven days he dies. Drugs that thin and lead out the heart fire must be used at once: Cheongsim-hwan 淸心丸, Cheongsim-san 淸心散, Naegocheongsim-san 內固淸心散 and Sasim-tang 瀉心湯 are appropriate.
Clinical note임상 주석
蜂窠癰 — honeycomb abscess — is the useful word in this section: a swelling of the chest wall riddled with multiple communicating cavities, which is what a carbuncle of thick skin looks like when it is laid open. The Immun has identified it with the Yeongchu's 井疽 of 4.13, the same bean-sized lesion that travels inward in days. What is under discussion is therefore a chest-wall infection, not anything to do with the heart; the organ name comes from the alarm point it sits over.
Immun 入門
4.27 Welling Abscess of the Liver 肝癰
Source원문
期門▣▣隱隱而痛者肝疽, 上肉微起者肝癰也. 《靈樞》
Translation영역
A dull hidden pain at Gimun — the gloss is lost here — is flat-abscess of the liver; where the flesh above it rises a little, it is welling abscess of the liver.
Yeongchu 靈樞
Source원문
發於腋下赤堅者, 名曰米疽, 治之以砭石. 其堅而不潰者爲馬刀挾癭, 急治之. 《靈樞》
Translation영역
Breaking out below the armpit, red and firm, it is called the grain flat-abscess, and it is treated with the lancing stone. Where it is firm and does not burst, it is the horse-knife lodged goitre, and must be treated at once.
Clinical note임상 주석
治之以砭石 — treat it with the lancing stone. The 砭石 is the sharpened stone of the pre-metal instrument set, and this is a direct instruction to incise an axillary abscess. 馬刀挾癭, the horse-knife lodged goitre, is the hard chain of nodes that does not suppurate, which is tuberculous lymphadenitis — the 瘰癧 of the Bogam's own chapter — and distinguishing it from the drainable abscess beside it is the right call to be making.
Yeongchu 靈樞
Source원문
脇癰由肝心火盛, 宜柴胡淸肝湯方見上. 潰後方可淸熱托裏, 忌熱藥. 《入門》
Translation영역
Welling abscess of the flank comes of liver and heart fire in excess, and Sihocheonggan-tang 柴胡淸肝湯 — the formula is given above — is appropriate. Only after it has burst may heat be cleared and the interior thrust, and hot drugs are to be avoided.
Immun 入門
Source원문
肝癰兩胠滿, 卧則驚, 不得小便. 《內經》
Translation영역
In welling abscess of the liver both flanks are full, he startles when he lies down, and he cannot pass urine.
Naegyeong 內經
Source원문
小柴胡湯隨證加減用. 方見寒門
Translation영역
Sosiho-tang 小柴胡湯 is used with additions and subtractions according to the pattern. — the formula is given in the Cold Damage chapter
Immun 入門
4.28 Welling Abscess of the Kidney 腎癰
Source원문
京門穴名隱隱而痛者腎疽, 上肉微起者腎癰也. 《靈樞》
Translation영역
A dull hidden pain at Gyeongmun — the name of a point — is flat-abscess of the kidney; where the flesh above it rises a little, it is welling abscess of the kidney.
Yeongchu 靈樞
Source원문
腎癰胠下至小腹滿. 《內經》
Translation영역
In welling abscess of the kidney there is fullness from below the flank down to the lower abdomen.
Naegyeong 內經
Translation영역
Welling abscess of the kidney stands opposite the kidney within, and all of it is made by the kidney qi failing and spoiling. Where it stands out raised with red skin he is easily settled; where it sinks in with black skin he is cured with difficulty. Gagampalmi-won 加減八味元 — the formula is given in the Vacuity chapter — and Gamisipgi-san 加味十奇散 — the formula is given above — are appropriate.
Clinical note임상 주석
A deep swelling of the loin, opposite the kidney, in a patient the chapter reads as constitutionally failing. The modern readings are perinephric abscess and psoas abscess, both of which present exactly here and both of which were beyond reach. The prognostic rule — raised and red does well, sunken and black does badly — is the chapter's rule for every site, and holds here too.
Deukhyo 得效
Translation영역
For abscess of any of the five viscera, Sibyungmiyugi-eum 十六味流氣飮 is appropriate, or Takri-san 托裏散 — the formula is given above — with gardenia kernel, scutellaria, apricot kernel and forsythia added; and it is to be used alongside the general method of treating abscesses.
Immun 入門
4.29 Welling Abscess of the Stomach Duct 胃脘癰
Source원문
帝曰, 人病胃脘癰者, 診當何如? 岐伯曰, 診此者當候胃脉, 其脉當沉細. 沉細者, 氣逆也; 逆者, 人迎甚盛, 甚盛則熱. 人迎者, 胃脉也. 逆而盛則熱聚於胃口而不行, 故胃脘爲癰也. 《內經》
Translation영역
The Emperor said: when a man is ill of welling abscess of the stomach duct, how should it be examined? Qi Bo said: in examining this one should watch the stomach pulse, and that pulse will be deep and fine. Deep and fine means the qi is counterflowing; counterflowing, the Inying is very full, and very full means heat. The Inying is the stomach pulse. Counterflowing and full, the heat gathers at the mouth of the stomach and does not move, and so the stomach duct becomes a welling abscess.
Naegyeong 內經
Source원문
中脘穴名屬胃, 隱隱痛者胃脘癰也. 《靈樞》
Translation영역
Jungwan — the name of a point — belongs to the stomach, and a dull hidden pain there is welling abscess of the stomach duct.
Yeongchu 靈樞
Source원문
脉洪數者膿已成也. 設脉遲緊, 雖膿未就, 已有瘀血也, 宜急治之. 《精義》
Translation영역
A pulse flooding and rapid means the pus has formed already. Should the pulse be slow and tight, then though pus has not yet come to be there is static blood already, and it should be treated at once.
Jeongui 精義
Source원문
多因飮食及七情火鬱, 復感風寒, 使熱濁之氣塡塞胃脘, 胃中淸氣下陷, 故胃脉沉細; 惟寒氣所隔, 故人迎緊盛. 有此二脉, 眞胃脘癰也. 《入門》
Translation영역
It mostly comes of food and drink and the depressed fire of the seven affects, with wind and cold contracted again on top, so that hot turbid qi stops up the stomach duct and the clear qi in the stomach sinks downward — and hence the stomach pulse is deep and fine; and only because the cold qi stands between is the Inying tight and full. Where these two pulses are present, it is a true welling abscess of the stomach duct.
Immun 入門
Source원문
外證寒熱如瘧. 胃濁則肺金失養, 故身皮甲錯, 或咳ㆍ或嘔ㆍ或唾膿血. 射干湯主之. 千金內消散方見上ㆍ內消沃雪湯ㆍ東垣托裏散皆可服. 又雲母膏作丸, 以桔梗甘草湯呑下; 太乙膏亦佳. 《入門》
Translation영역
The outward signs are chills and fever like malaria. When the stomach is turbid the lung metal loses its nourishment, and so the skin of the body is scaly and cracked, and he either coughs, or retches, or spits pus and blood. Sagan-tang 射干湯 governs it. Cheongeumnaeso-san 千金內消散 — the formula is given above, Naesookseol-tang 內消沃雪湯 and Dongwontakri-san 東垣托裏散 may all be taken. And Unmo-go 雲母膏 may be made into pills and swallowed down with Gilgyeonggamcho-tang 桔梗甘草湯; Taeeul-go 太乙膏 is good as well.
Clinical note임상 주석
身皮甲錯 — skin scaly and cracked like armour plates — is the classical sign of long-standing internal suppuration, and it is the same phrase the 金匱 uses of intestinal abscess. What the section describes, a deep epigastric collection with swinging fever and wasting, fits subphrenic or lesser-sac abscess; the two-pulse rule (deep and fine at the wrist, tight and full at the carotid) is as near to an objective sign as the method could get, and it is offered as the thing that makes the diagnosis 眞, true.
Immun 入門
About this translation 凡例
Base text: Donguibogam (東醫寶鑑, 1613 first edition), Miscellaneous Disorders, Volume 7, Abscesses chapter, first part. The Chinese text is collated against the Kyujanggak transcription of the 1613 edition; collation notes are given on the passages they concern. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.