Formulas · Text · Donguibogam 東醫寶鑑
Where 癰疽 上 set out the doctrine, this part goes site by site: the intestine, the arm, the buttock, the perineum, the groin, the scrotum, the bone, and then 疔, the clove sore. The modern readings are unusually firm here because the sites are named. 腸癰 is appendicitis and the abscess that follows it, and 1.1's description — 小腹腫而强, 按之則痛, 小便數似淋, 時時汗出, 發熱而復惡寒 — is a right-iliac-fossa mass with urinary frequency and a swinging fever. 附骨疽 is osteomyelitis, and its sign is the one that still defines it: 筋骨之內痛如錐刺, 外則全無赤腫, pain like an awl inside the bone with nothing at all to see outside. 流注骨疽 is the metastatic kind that appears far from its source, which the chapter correctly traces back to an earlier febrile illness — 流注者傷寒之餘毒, 骨疽者流注之敗證.
疔 is the chapter's most interesting entity and its most dangerous. It is a small hard sore with a black depressed centre that kills in a day or two — 初起僅一小瘡, 殺人於一二日之內 — and the Immun names three causes, the first of which is 食自死牛馬禽獸之肉, eating the flesh of cattle, horses and beasts that have died of themselves. There is a whole sub-section on it at 1.10.8, and that is the transmission route of cutaneous anthrax. 魚臍疔, a navel-shaped ulcer oozing yellow fluid, reads like an anthrax eschar; 紅絲疔, a red thread running up the limb toward the trunk, is ascending lymphangitis, and the instruction is to needle along the thread and let the blood out before it reaches the belly. None of these identifications is certain and the chapter is not making them, but the observations are sound enough that it is worth saying which modern disease each resembles.
Three sections are about instruments, and they are the most practical pages in the Bogam's surgery. 1.13 is the lance: 鈹鍼者, 末如劍鋒, 以取大膿 — a needle ending like a sword point, for taking large collections — with the rule that a boil's thin skin is opened with a needle and never cauterized, and that nothing is to be done blind near sinew, vessel or joint. 1.14 is the hot iron, argued for on the ground that thick skin over deep pus leaves no other opening, and with a reason for haste that is essentially correct: 若久留肉腠間, 則毒氣浸淫好肉亦化爲膿腐 — pus left among the tissues turns sound flesh to pus in its turn. 1.15 is moxa over garlic, with a dosing rule by tenderness (burn until it stops hurting, or until it starts) and a prognosis by day — ten of ten live if it is done on the first or second day, three or four of ten by the sixth. 1.13.1 is the leech, and the Dansim's verdict on it is the soundest sentence in the chapter: good for the small case, useless for the great one, 徒竭其血於外無益也.
1.16 is a list of what to avoid, and much of it is the ordinary good sense of convalescence — little sleep lying down, no anger, slow movement, few words, the sore washed often, the bowels regular. Then it says 防觸穢, guard against contact with filth, and 妄用惡草愈滋其毒, reckless use of bad herbs only feeds the poison. A chapter that has just finished prescribing arsenic sticks and toad venom ends by warning against careless drugs.
1.1 Welling Abscess of the Intestine and of the Belly 腸癰腹癰
譯 1.1.1 Source원문
關元穴名屬小腸, 天樞穴名屬大腸, 丹田穴名屬三焦. 其穴分隱痛者爲疽, 上肉微起者爲癰也. 《靈樞》
Translation영역
Gwanwon — the name of a point — belongs to the small intestine, Cheonchu — the name of a point — to the large intestine, and Danjeon — the name of a point — to the triple burner. A dull hidden pain at the division of those points is a flat-abscess; where the flesh above rises a little, it is a welling abscess.
譯 1.1.2 Source원문
腸癰爲病, 小腹腫而强, 按之則痛, 小便數似淋, 時時汗出, 發熱而復惡寒, 身皮甲錯, 腹皮急如腫狀. 甚者腹脹大, 轉側有水聲, 或遶臍生瘡, 膿從瘡出, 或有出臍中者. 惟大便下膿血者自愈. 《仲景》
Translation영역
In the disease of intestinal abscess the lower abdomen is swollen and firm and hurts when pressed; the urine is frequent as in dribbling, sweat breaks out from time to time, there is fever and then a loathing of cold again, the skin of the body is scaly and cracked like armour plates, and the skin of the belly is taut as though swollen. In the severe case the belly is greatly distended and water is heard on turning from side to side; or sores arise about the navel and pus comes out of them, or it comes out at the navel itself. Only he who passes pus and blood in the stool heals of himself.
Clinical note임상 주석
The best clinical description in either part of this chapter. 小腹腫而强, 按之則痛 with urinary frequency, a swinging fever and a taut belly is appendicitis with a peri-appendiceal mass; 轉側有水聲 is free fluid; 遶臍生瘡, 膿從瘡出 is an abscess discharging through the abdominal wall. 身皮甲錯 — skin like armour plates — is the classical sign of long-standing internal suppuration and the same phrase the 金匱 uses here. And 惟大便下膿血者自愈 is right: the collection that drains into the bowel resolves, and the one that does not had, in 1613, nowhere to go.
譯 1.1.3 Source원문
濕熱鬱積, 腸內成癰, 脉遲緊者, 宜大黃牡丹湯, 或五香連翹湯方見上下之. 脉芤濇者, 四物湯方見血門加桃仁ㆍ紅花ㆍ玄胡索ㆍ木香. 脉洪數者, 三仁湯. 小腹疼, 尿濇者, 膿滯也, 宜牡丹散. 《入門》
Translation영역
Where damp heat is depressed and accumulated and an abscess forms within the intestine: if the pulse is slow and tight, Daehwangmokdanpi-tang 大黃牡丹湯 is appropriate, or Ohyangyeongyo-tang 五香連翹湯 — the formula is given above — to precipitate it. If the pulse is hollow and rough, Samul-tang 四物湯 — the formula is given in the Blood chapter — with peach kernel, carthamus, corydalis and costus added. If the pulse is flooding and rapid, Samin-tang 三仁湯. Where the lower abdomen aches and the urine is rough, the pus is stagnant, and Mokdan-san 牡丹散 is appropriate.
譯 1.1.4 Source원문
腹皮急, 按之濡, 身無熱, 乃陰冷所成, 宜牡丹散, 或內托十宣散加茯苓, 甚者敗醬散. 小腹痞堅, 按之痛, 身有熱, 乃結熱所成, 宜大黃牡丹湯, 或桃仁承氣湯方見寒門ㆍ黃黑散. 《入門》
Translation영역
Where the skin of the belly is taut but soft under the finger and there is no heat in the body, it is made by yin cold, and Mokdan-san 牡丹散 is appropriate, or Naetaksipseon-san 內托十宣散 with poria added, and in the severe case Paejang-san 敗醬散. Where the lower abdomen is bound and hard and hurts when pressed and there is heat in the body, it is made by bound heat, and Daehwangmokdanpi-tang 大黃牡丹湯 is appropriate, or Doinseunggi-tang 桃仁承氣湯 — the formula is given in the Cold Damage chapter — or Hwangheuk-san 黃黑散.
Clinical note임상 주석
The decision turns on two things found at the bedside: whether the taut belly is soft or hard under the hand, and whether the patient is febrile. Soft and afebrile is supported; hard, tender and febrile is purged. That is a real triage of the same complaint into two courses of treatment, made on signs a clinician can get without instruments.
譯 1.1.5 Source원문
腸癰冷熱證, 雲母膏爲丸, 牛膝湯呑下, 利去瘀膿卽愈; 或蠟礬元亦佳方見上.
Translation영역
For intestinal abscess in either its cold or its hot pattern, Unmo-go 雲母膏 may be made into pills and swallowed down with an achyranthes decoction; once the stagnant pus is disinhibited and gone, it heals. Or Napban-won 蠟礬元 is good as well — the formulas are given above.
譯 1.1.6 Source원문
腹癰者, 生於肚腹皮裏膜外, 左關脉洪數而腹痛甚者是也. 治法同腸癰. 《入門》
Translation영역
Welling abscess of the belly arises inside the skin and outside the membrane of the abdomen; it is recognized where the left bar pulse is flooding and rapid and the abdominal pain is severe. The method of treatment is the same as for intestinal abscess.
Clinical note임상 주석
皮裏膜外 — inside the skin and outside the peritoneum — is the abdominal wall, and an abscess there is a different thing from one within the cavity: it can be reached. The Immun's distinction is anatomical and correct, even though it then treats the two alike.
1.2 The Pulse 脉法
譯 1.2.1 Source원문
腸癰難知, 脉滑可推. 數而下熱, 腸癰何疑. 遲緊未膿, 下以平之; 洪數膿成, 不下爲宜. 《脉訣》
Translation영역
Intestinal abscess is hard to know, but a slippery pulse lets it be inferred. Rapid, with heat below — what doubt is there of intestinal abscess? Slow and tight, the pus has not formed: precipitate to level it. Flooding and rapid, the pus has formed: better not to precipitate.
Clinical note임상 주석
The rule is the right way round and it is the one that matters: purge the inflamed mass that has not yet collected, and leave alone the one that has. Purging an abscess that has already formed does nothing for it and empties the patient.
譯 1.2.2 Source원문
趺陽脉滑而數, 知當屎膿也. 《仲景》
Translation영역
Where the Bugyang pulse is slippery and rapid, it is known that he will pass pus in the stool.
譯 1.2.3 Source원문
腸癰之脉, 滑而數. 滑則爲實, 數則爲熱. 滑則爲榮, 數則爲衛. 衛數下降, 榮滑上升, 榮衛相干, 血爲敗濁. 《脉經》
Translation영역
The pulse of intestinal abscess is slippery and rapid. Slippery means repletion and rapid means heat. Slippery governs the construction and rapid the defence. The rapid defence descends and the slippery construction ascends; construction and defence interfere with one another, and the blood is spoiled and made turbid.
1.2.1 A Case of Intestinal Abscess Treated 腸癰治驗
譯 1.2.1.1 Source원문
一婦腹痛, 百方不效. 孫兆診曰, 腹痛脉當沉細, 今反滑數, 此腸癰也. 雲母膏作丸, 溫酒呑下, 服一兩, 下膿血而安. 《綱目》
Translation영역
A woman had abdominal pain, and a hundred formulas had no effect. Sun Zhao examined her and said: in abdominal pain the pulse ought to be deep and fine; here it is slippery and rapid instead — this is an intestinal abscess. Unmo-go 雲母膏 was made into pills and swallowed down in warm wine; after a nyang had been taken, pus and blood came away below and she was well.
Clinical note임상 주석
A clean case record, and the diagnosis turns on a single discrepancy: the pain says one thing and the pulse says another, so the diagnosis is wrong. 腹痛脉當沉細, 今反滑數 is the whole of Sun Zhao's reasoning, and the tachycardia of an undrained collection is exactly what it rests on. The hundred formulas that failed were being given for the wrong disease.
譯 1.2.1.2 Source원문
灸腸癰法, 屈兩肘, 正肘頭銳骨端是穴, 灸百壯, 下膿血而安. 《千金》
Translation영역
The method of moxibustion for intestinal abscess: bend both elbows; the point is at the tip of the pointed bone right at the head of the elbow. Burn a hundred cones, and pus and blood come away below and he is well.
1.3 Welling Abscess of the Arm 臂癰
譯 1.3.1 Source원문
臂上手陽明經分生癰, 此得之八風之變者. 傷於風者上先受之, 宜服白芷升麻湯. 《入門》
Translation영역
An abscess arising on the arm in the division of the hand yang brightness channel is got from the mutations of the eight winds. Where a man is injured by wind, the upper part receives it first, and Baekjiseungma-tang 白芷升麻湯 should be given.
1.4 Welling Abscess of the Buttock 臀癰
譯 1.4.1 Source원문
臀居小腹之後, 又在於下, 此陰中之陰也. 其道遠, 其位僻, 雖曰多血, 氣運不到, 血亦罕來. 中年後不可生癰, 纔有腫痛, 參之脉證, 但見虛弱, 便與滋補氣血, 可保終吉. 若用尋常驅熱舒氣之藥, 虛虛之禍如指諸掌. 《丹心》
Translation영역
The buttock lies behind the lower abdomen and below it as well; this is yin within yin. Its road is long and its position out of the way, and though it is said to be rich in blood, the qi's movement does not reach it and the blood too comes there seldom. After middle age an abscess must not be allowed to arise there. As soon as there is swelling and pain, weigh the pulse and the signs, and if any vacuity and weakness is seen, enrich and supplement the qi and blood at once, and a good end may be assured. If the ordinary heat-expelling and qi-loosening drugs are used, the disaster of emptying the already empty is as plain as pointing at one's palm.
Clinical note임상 주석
氣運不到, 血亦罕來 — the qi's movement does not reach there and the blood comes seldom. A statement about regional perfusion, and the conclusion drawn from it is the right one: an abscess over the buttock in an older patient is not to be purged. Pressure sores and deep gluteal infections in the elderly and immobile are still among the worst-healing wounds there are, for the reason the Dansim gives.
譯 1.4.2 Translation영역
Where an abscess of the buttock is newly arisen and pus has not formed, use moxibustion over garlic, and then the scallion-fomentation method. Where pus is about to form, Naetakganghwal-tang 內托羌活湯; where the pain is severe, Seonbanghwalmyeong-eum 仙方活命飮 — both formulas are given above; where it is swollen and hard, Takrisodok-eum 托裏消毒飮 — the formula is given above; and after it has burst, Gamisipjeon-tang 加味十全湯 — the formula is given above — is appropriate. Where an abscess arises on the sacrum and buttock, hard and swollen and painful, Naetakganghwal-tang 內托羌活湯 — the formula is given above — is appropriate.
1.5 The Hanging Abscess 懸癰
譯 1.5.1 Source원문
穀道前後生癰, 謂之懸癰. 此病生穀道ㆍ外腎之間, 初發如松子大, 甚痒, 漸如蓮子, 數十日後始覺赤腫如桃子, 卽破. 若破而大小便皆從中出者, 爲難治. 宜服國老膏. 《精要》
Translation영역
An abscess arising before or behind the anus is called the hanging abscess. This illness arises between the anus and the external kidney; at its first appearance it is the size of a pine nut and itches greatly, then grows like a lotus seed, and after some tens of days it is at last felt to be red and swollen like a peach, and then it bursts. If after bursting both the stool and the urine come out through it, it is hard to treat. Gukro-go 國老膏 should be given.
Clinical note임상 주석
A perineal abscess that enlarges over weeks and then bursts, and the grave sign is that stool or urine comes out through the opening. That is a fistula — anorectal or rectourethral — and it is still what makes this disease difficult rather than simple. The account of the course, from an itching pine-nut to a bursting peach, is observation.
譯 1.5.2 Source원문
此疾首尾常服國老膏, 雖患亦輕, 雖潰亦淺. 誤用寒凉則不可救.
Translation영역
In this illness Gukro-go 國老膏 should be taken from beginning to end; then even if he suffers it, it is light, and even if it bursts, it is shallow. Where cold and cooling drugs are used by mistake, he cannot be saved.
譯 1.5.3 Source원문
初起作痛, 尿濇者, 仙方活命飮方見上去大黃服之. 膿已成者急鍼之. 久成漏者, 加味十全湯方見上ㆍ蠟礬元方見上.
Translation영역
Where at its first rising it gives pain and the urine is rough, Seonbanghwalmyeong-eum 仙方活命飮 — the formula is given above — is taken with the rhubarb left out. Where pus has already formed, needle it at once. Where it has long become a fistula, Gamisipjeon-tang 加味十全湯 and Napban-won 蠟礬元 — both formulas are given above.
Clinical note임상 주석
膿已成者急鍼之 — once pus has formed, needle it at once. The chapter says this plainly wherever the collection can be reached, and a perineal abscess can be. Incision and drainage is still the treatment, and the chronic case it names, 久成漏, is the fistula that follows one left too long.
譯 1.5.4 Source원문
穀道中生瘡, 取水中荇葉, 細糊, 綿裹納下部, 日三卽愈. 《入門》
Translation영역
For a sore arising inside the anus, take floating-heart leaves from the water, make them into a fine paste, wrap it in cotton wool and put it into the lower part; three times a day, and it heals.
1.6 The Groin Abscess 便癰
譯 1.6.1 Source원문
便癰, 俗名便毒, 實血疝也, 一名𩣔馬癰. 此奇經衝任爲病而癰見於厥陰經之分野, 其經多血, 故又名血疝. 或先有疳瘡而發, 或卒然起核疼痛而發, 皆熱鬱血聚而成. 初發宜疏利之卽散, 變膿後如常用托裏內補之藥. 《正傳》
Translation영역
The groin abscess, commonly called the groin toxin, is in truth a blood mounting, and is also named the straddling-horse abscess. Here the extraordinary thoroughfare and conception vessels are the disease, while the abscess appears in the territory of the reverting yin channel; that channel is rich in blood, and so it is also named blood mounting. Sometimes it breaks out where there has first been a chancre sore, sometimes a lump rises suddenly and painfully and it breaks out; in both, depressed heat and gathered blood make it. At its first appearance it should be thinned and disinhibited and it disperses; after it has turned to pus, the usual interior-thrusting and inward-supplementing drugs are used.
Clinical note임상 주석
或先有疳瘡而發 — sometimes it breaks out where there has first been a chancre sore. A swelling of the inguinal nodes following a genital ulcer is the bubo of syphilis or of chancroid, and the Jeongjeon has noticed the sequence without having a name for what connects the two. The rest of the section treats it as a local disease, which is as far as the period's understanding went.
譯 1.6.2 Source원문
便毒處所, 上不在腹, 下不在腿, 介乎兩者之中也. 《直指》
Translation영역
The place of the groin toxin is neither above in the belly nor below in the thigh, but lies between the two.
譯 1.6.3 Source원문
便癰生於腿胯ㆍ小腹之間, 或一邊腫痛, 或左右兩邊俱發. 先用五苓散方見寒門加大黃, 或雙解散ㆍ復元通氣散方見氣門. 痛甚者仙方活命飮方見上. 仍戒房室ㆍ行動. 《入門》
Translation영역
The groin abscess arises between the thigh and hip and the lower abdomen, swollen and painful on one side or breaking out on both left and right. First use Oryeong-san 五苓散 — the formula is given in the Cold Damage chapter — with rhubarb added, or Ssanghae-san 雙解散 or Bogwontonggi-san 復元通氣散 — the formula is given in the Qi chapter. Where the pain is severe, Seonbanghwalmyeong-eum 仙方活命飮 — the formula is given above. And he is to abstain from the bedchamber and from exertion.
譯 1.6.4 Translation영역
For the one-sided abscess, Sobang-san 蘇方散, Moryeodaehwang-tang 牡蠣大黃湯, Cheongeumnaeso-san 千金內消散, Hwangheuk-san 黃黑散 and Ohyangyeongyo-tang 五香連翹湯 — three of these formulas are given above — and Sodok-eum 消毒飮, Okchok-san 玉燭散 and Singi-san 神奇散 are appropriate.
譯 1.6.5 Source원문
便毒, 取大蜘蛛 一箇, 硏細, 熱酒調下. 《山居》
Translation영역
For the groin toxin, take one large spider, grind it fine and send it down stirred into hot wine.
譯 1.6.6 Source원문
便毒初起, 射干 三寸ㆍ生薑如指大, 搗細, 順流水煎服, 以瀉爲度. 因用阿膠醋煮, 塗患處. 《丹心》
Translation영역
At the first rising of the groin toxin, take three chun of belamcanda and fresh ginger the size of a finger, pound them fine, decoct in downstream water and take it, until there is purging. Then boil ass-hide glue in vinegar and spread it on the affected place.
譯 1.6.7 Source원문
生山藥ㆍ砂糖同搗, 塗上卽消. 又生薑 一塊, 蘸米醋磨取千步峯泥, 付腫處卽消. 千步峯, 卽人家行步地上高塊是也. 《得效》
Translation영역
Raw dioscorea and sugar pounded together and spread on it make it disperse. Or take a lump of fresh ginger, dip it in rice vinegar and grind it to get the mud of the thousand-step peak, and apply it to the swelling, and it disperses. The thousand-step peak is the raised lump on the ground where people walk about a house.
1.7 Welling Abscess of the Scrotum 囊癰
譯 1.7.1 Source원문
囊癰者, 濕熱下注也. 有作膿者, 此濁氣順下, 將流入滲道, 因陰道或虧, 水道不利而然. 膿盡自安, 勿藥可也. 或有因腹腫漸流入囊, 腫甚而囊自裂開, 睾丸懸掛, 水出, 以麩炭末付之, 外以紫蘇葉包裹, 仰臥養之.
Translation영역
Welling abscess of the scrotum is damp heat pouring downward. Where pus forms, this is turbid qi following its way down and about to flow into the seeping road; it comes of the yin road being somewhat deficient and the water road not free. When the pus is finished he is well of himself, and it is right to give no medicine. Sometimes, from swelling of the belly, it flows gradually into the scrotum; the swelling is severe and the scrotum splits open of itself, the testicles hang out and fluid runs. Apply bran-charcoal powder, wrap it outside in perilla leaf, and nurse him lying on his back.
譯 1.7.2 Source원문
癰疽入囊者, 曾治數人, 悉以濕熱入肝經處治, 而用補陰藥佐之. 雖膿潰皮脫, 睾丸懸掛者, 皆不死.
Translation영역
Of those in whom the abscess had entered the scrotum I have treated several, all of them on the reckoning of damp heat entering the liver channel, with yin-supplementing drugs as assistants. Even where the pus had burst and the skin come away and the testicles hung out, none of them died.
Clinical note임상 주석
A case series, and an honest one — 曾治數人, I have treated several, with the outcome given plainly. What is described is Fournier's gangrene or a comparable necrotizing infection of the scrotum, in which the skin is lost and the testicles are left exposed. That the testicles survive bare, because their blood supply comes from above and not from the scrotal skin, is the reason these patients can recover, and the next passage's treatment — keep them covered and moist, lie the man on his back, wait for skin to grow back — is sound nursing of exactly that injury.
譯 1.7.3 Source원문
取紫蘇葉焙乾爲末付之, 如燥, 香油間之. 皮脫者, 靑荷葉包之, 其皮自生. 《丹心》
Translation영역
Take perilla leaf, bake it dry, powder it and apply it; if it dries, sesame oil between times. Where the skin has come away, wrap it in a green lotus leaf, and the skin grows back of itself.
Clinical note임상 주석
A moist dressing changed for dryness, under a large smooth leaf, over a wound that has lost its skin. 其皮自生 is correct — scrotal skin re-epithelializes remarkably well — and a lotus leaf is about as good a non-adherent cover as the period could offer.
1.8 The Bone-Adhering Flat-Abscess 附骨疽
譯 1.8.1 Source원문
附骨疽與白虎ㆍ飛尸ㆍ歷節皆相類. 但歷節痛則走注不定; 白虎ㆍ飛尸痛淺, 按之則便止; 附骨疽痛深, 按之亦無益.
Translation영역
The bone-adhering flat-abscess resembles the white tiger, the flying corpse and the running joints. But in the running joints the pain travels and pours and does not stay put; in the white tiger and the flying corpse the pain is shallow and stops as soon as it is pressed; in the bone-adhering flat-abscess the pain is deep and pressing does no good at all.
Clinical note임상 주석
The differential is made on two questions: does the pain move, and does pressure relieve it? Pain that moves from joint to joint is arthritis; pain that pressure relieves is superficial; pain that is deep and that pressure does nothing for is in the bone. That last is osteomyelitis, and the three-way distinction is the right one to be drawing.
譯 1.8.2 Source원문
白虎ㆍ飛尸亦能作膿着骨而生, 及其腐潰, 碎骨出盡方愈. 然則同是一病, 但淺深不同耳. 《三因》
Translation영역
The white tiger and the flying corpse too can make pus and arise fastened to the bone, and when they rot and burst, it heals only when the crumbled bone has all come out. So they are one and the same illness, differing only in being shallow or deep.
Clinical note임상 주석
碎骨出盡方愈 — it heals only when the crumbled bone has all come out. That is sequestrum, and the observation that the disease does not resolve until the dead bone is discharged is the single most important fact about chronic osteomyelitis. Surgery now removes it; the Samin could only wait for it.
譯 1.8.3 Source원문
附骨疽, 筋骨之內痛如錐刺, 外則全無赤腫突起. 初因露臥風冷, 或乘凉浴水, 寒濕襲深. 初起痛不能轉, 寒熱無汗, 經久寒鬱爲熱, 變而爲膿. 膿成卽用火鍼, 使毒不得內潰. 《入門》
Translation영역
In the bone-adhering flat-abscess the pain within the sinew and bone is like the stabbing of an awl, while outside there is no redness, swelling or rising at all. It comes at first of lying out exposed to wind and cold, or of taking the cool and bathing in water, so that cold and damp strike deep. At its first rising the pain is such that he cannot turn, with chills and fever and no sweat; over time the pent cold becomes heat and changes into pus. Once the pus has formed, use the fire needle at once, so that the toxin cannot burst inward.
Clinical note임상 주석
筋骨之內痛如錐刺, 外則全無赤腫 — boring pain deep in the bone with nothing to see on the surface. This is the presentation of acute osteomyelitis, and it is the reason the disease is missed: there is no sign where the patient is looking. 膿成卽用火鍼, 使毒不得 內潰 is the right instinct too — subperiosteal pus must be let out or it spreads along the bone.
譯 1.8.4 Translation영역
At its first rising Nuro-eumja 漏蘆飮子 and Ohyangyeongyo-tang 五香連翹湯 — the formula is given above — should thin and precipitate it, and then Naesoseungma-tang 內消升麻湯 is used. On the sacrum and buttock, Naetakganghwal-tang 內托羌活湯 — the formula is given above; on the inner thigh, Ganghwalbanggi-tang 羌活防己湯; on the outer thigh, Takrihwanggi-tang 托裏黃芪湯 and Hwangryeonsodok-eum 黃連消毒飮 — the formula is given above. Where it has long failed to heal after bursting, Seomyeo-go 蟾蜍膏, Jeokchul-won 赤朮元 and Pyeonggi-san 平肌散 are appropriate.
譯 1.8.5 Source원문
初起大痛而肉色不變, 名附骨癰, 三生散最妙, 兼用靑皮ㆍ甘草節二味煎服. 《綱目》
Translation영역
Where at its first rising there is great pain and the colour of the flesh is unchanged, it is named the bone-adhering welling abscess; Samsaeng-san 三生散 is best, together with a decoction of the two drugs green tangerine peel and licorice knot.
譯 1.8.6 Source원문
附骨疽與緩疽ㆍ石疽ㆍ賊風相類, 宜辨而治之. 《入門》
Translation영역
The bone-adhering flat-abscess resembles the slow flat-abscess, the stone flat-abscess and the bandit wind, and they should be distinguished and treated accordingly.
1.8.1 Distinguishing the Slow Abscess, the Stone Abscess and the Bandit Wind 緩疽石疽賊風辨
譯 1.8.1.1 Source원문
緩疽ㆍ石疽皆寒氣伏於骨髓之間, 其熱緩慢, 積日不潰, 久乃紫黑, 皮肉俱爛, 故名曰緩疽.
Translation영역
The slow flat-abscess and the stone flat-abscess are both cold qi lying hidden between the bone and marrow; their heat is slow and slack, day piles on day without bursting, and in time they turn purple-black and skin and flesh rot together — and so it is named the slow flat-abscess.
譯 1.8.1.2 Source원문
腫與皮肉相似, 疼而堅硬如石, 故謂之石疽. 生商陸根擣爛, 和鹽少許, 塗付, 日一換卽軟.
Translation영역
The swelling is of a colour with the skin and flesh, and it aches and is hard as stone — and so it is called the stone flat-abscess. Pound raw phytolacca root to a pulp, mix in a little salt and apply it, changing it once a day, and it softens.
譯 1.8.1.3 Source원문
賊風由風邪搏於骨髓, 故其痛亦徹骨. 遇寒則甚, 外證惡寒有汗, 痛處常欲熱熨. 失治則變爲攣曲偏枯.
Translation영역
The bandit wind comes of wind evil striking at the bone and marrow, and so its pain too pierces to the bone. It worsens on meeting cold; its outward signs are a loathing of cold with sweating, and the painful place always wants hot fomentation. Treated wrongly, it changes into contracture, crookedness and withering of one side.
Clinical note임상 주석
Three deep painful swellings sorted by what they do over time: one that slowly rots, one that stays stony and does not suppurate, and one that is worse in cold, better with heat, and ends in contracture and wasting. The third is not an abscess at all — the course described is a chronic neuropathic or rheumatic condition — and the chapter is right to take it out of the suppurative group.
譯 1.8.1.4 Source원문
緩疽ㆍ石疽宜服補虛托裏溫熱之劑; 賊風宜服越婢湯疏通之劑. 《入門》
Translation영역
For the slow and the stone flat-abscess, vacuity-supplementing, interior-thrusting, warm and hot preparations should be given; for the bandit wind, Wolbi-tang 越婢湯 and preparations that thin and open should be given.
1.8.2 Guarding Against it at its First Outbreak 始發預防法
譯 1.8.2.1 Source원문
環跳穴痛不已, 防生附骨疽, 急用靑草蒼栢湯. 服此不愈, 加麻黃 一錢, 用二三貼. 又不效, 恐疽將成, 急掘地坑, 以火燒紅, 沃以小便, 令患人赤體坐其上, 以被圍抱下體, 使熱氣熏蒸, 氣血暢而愈. 《入門》
Translation영역
Where the pain at Hwando does not cease, guard against a bone-adhering flat-abscess arising, and use Cheongchochangbaek-tang 靑草蒼栢湯 at once. If taking it does not cure him, add 1 don of ephedra and use two or three doses. If that too has no effect, fear that the flat-abscess is forming: dig a pit in the ground at once, burn it red with fire, douse it with urine, and have the patient sit naked over it with a quilt wrapped round his lower body so that the hot vapour steams him; the qi and blood run free and he is cured.
Clinical note임상 주석
Persistent pain at Hwando — over the hip joint — read as the warning of a bone abscess to come. Septic arthritis of the hip and osteomyelitis of the proximal femur do begin as unexplained hip pain, and taking that seriously is right. The steam pit is not; and with urine poured on hot earth under a naked patient, the risk of scalding is real. **This must not be attempted.**
1.9 The Flowing-and-Pouring Bone Flat-Abscess 流注骨疽
譯 1.9.1 Source원문
流者行也, 注者住也. 或結塊, 或慢腫, 皆因素有痰火, 或感風寒邪氣, 流行至其痰注之處而發, 多生四肢, 或胸腹ㆍ腰臀ㆍ關節之處. 初起宜葱熨法方見下; 實者十六味流氣飮方見上, 兼服竹瀝達痰丸方見痰門; 通用榮衛返魂湯合二陳湯方見疾門, 令其自消自潰. 若潰後久不斂, 宜以托裏爲主, 更佐以豆豉餠ㆍ琥珀膏方見雜方. 膿成, 以火鍼破之. 《入門》
Translation영역
流is to travel and 注 is to lodge. Whether it binds into a lump or swells slowly, both come of phlegm fire already present, or of contracting wind-cold evil qi which travels until it reaches the place where the phlegm has lodged and there breaks out; it mostly arises on the limbs, or on the chest and belly, the loins and buttocks, and at the joints. At its first rising the scallion-fomentation method is appropriate — given below; for the replete, Sibyungmiyugi-eum 十六味流氣飮 — the formula is given above — together with Jukryeokdaltam-hwan 竹瀝達痰丸 — the formula is given in the Phlegm chapter; for general use Yeongwibanhon-tang 榮衛返魂湯 combined with Ijin-tang 二陳湯 — the formula is given in the Phlegm chapter — letting it disperse and burst of itself. If after bursting it long fails to close, interior-thrusting should be the chief thing, with fermented-bean cake and amber plaster as assistants — the formulas are given in the Miscellaneous chapter. Once the pus has formed, open it with the fire needle.
譯 1.9.2 Source원문
流注起於傷寒. 傷寒表未盡, 遺毒於四肢經絡, 濇於所滯而後爲流注也. 蓋流注者傷寒之餘毒, 骨疽者流注之敗證也. 《回春》
Translation영역
The flowing-and-pouring begins from cold damage. Where the surface of a cold damage has not been wholly resolved, it leaves toxin behind in the channels and network vessels of the limbs, and growing rough where it is held up, it afterwards becomes the flowing-and-pouring. For the flowing-and-pouring is the remaining toxin of a cold damage, and the bone flat-abscess is the spoiled case of the flowing-and-pouring.
Clinical note임상 주석
流注者傷寒之餘毒 — the remaining toxin of a febrile illness. This is haematogenous spread: a deep abscess appearing at a distance, weeks after a fever, with nothing between the two but the blood. The Hoechun has the sequence and the causal direction right, and 骨疽者 流注之敗證 — bone abscess is the spoiled outcome of it — is what happens when the metastatic focus lands in bone.
譯 1.9.3 Source원문
痰飮流注於胸背ㆍ頭項ㆍ腋脇ㆍ腰腿ㆍ手足, 聚結腫硬, 或痛或不痛, 按之無血潮, 雖或有微紅亦淡薄不熱, 堅如石, 破之無膿, 或有薄血, 或出淸水, 或如紫汁. 又有壞肉如敗絮, 或又如瘰癧在皮肉之間, 如雞卵可移動, 軟活不硬, 破之亦無膿血, 鍼口努肉突出, 惟覺咽喉痰塞, 作寒作熱. 榮衛返魂湯主之. 《醫鑑》
Translation영역
Where phlegm rheum flows and pours into the chest and back, the head and nape, the armpit and flank, the loins and thighs, the hands and feet, it gathers and binds into a hard swelling, painful or not painful, with no tide of blood under the finger; though there may be a faint redness it is pale and thin and not hot, and it is hard as stone. Opened, it yields no pus, or thin blood, or clear water, or what is like purple juice. There is also spoiled flesh like rotten wadding; or again, like scrofulous lumps between skin and flesh, the size of a hen's egg and movable, soft and live and not hard, which opened likewise yield no pus or blood, and at the needle's mouth proud flesh pushes out, while the only thing felt is phlegm blocking the throat, with chills and fever.
Clinical note임상 주석
A cold abscess: hard or rubbery, not red, not hot, yielding thin fluid rather than pus when opened, with proud flesh at the opening and a sinus that will not close. That is tuberculosis of soft tissue or bone, and the Uigam's own comparison — 如瘰癧, like scrofulous lumps — points at the same disease by its neck presentation. The detail that matters clinically is 破之無膿: opening it gains nothing, which is why these sinuses persisted.
譯 1.9.4 Source원문
骨疽者, 由瘡潰後氣血不榮, 骨自脫出, 膿水腐潰, 碎骨出盡方愈. 蓋人身有正骨ㆍ附骨, 傅合成形. 附骨出則愈後如常, 正骨腐出則爲終身廢疾. 隨腫硬之處, 潰後久不愈, 則必出碎骨. 外用附子餠灸, 或葱熨法, 祛散寒邪, 補接榮氣, 則骨自脫, 瘡自斂矣. 《入門》
Translation영역
The bone flat-abscess comes of the qi and blood not flourishing after a sore has burst, so that bone comes away of itself; pus and water rot and burst, and it heals only when the crumbled bone has all come out. For the human body has the true bone and the adherent bone, laid together to make its form. When the adherent bone comes out, he is as before once healed; when the true bone rots and comes out, it is a lifelong crippling. Wherever the hard swelling was, if it long fails to heal after bursting, crumbled bone must come out. Outwardly use aconite-cake moxibustion, or the scallion-fomentation method, to drive off and disperse the cold evil and to supplement and join the construction qi; then the bone comes away of itself and the sore closes of itself.
Clinical note임상 주석
正骨 against 附骨 — the structural bone against the bone laid on it — is the chapter's attempt at what we would call cortex and periosteal new bone, and the prognosis drawn from the distinction is the real one: lose a sequestrum and the limb recovers, lose the shaft and it does not. 潰後久不愈則必出碎骨 is the rule that chronic osteomyelitis still follows, and it is the reason these wounds were followed for years.
1.10 The Clove Flat-Abscess 疔疽
譯 1.10.1 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.
譯 1.10.2 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; 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 it does not disperse but keeps gaining, it is not to be treated, and he dies in a hundred days.
譯 1.10.3 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. 《靈樞》
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, and 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.
譯 1.10.4 Source원문
膏粱之變, 足生大丁. 《內經》
Translation영역
The mutation of rich food and fine grain is enough to breed a great clove sore.
譯 1.10.5 Source원문
疔瘡初發, 突起如釘蓋, 故謂之疔. 近世多見因食自死牛馬禽獸之肉而發, 或感襲天地暴沴之氣而發, 或恣食辛辣厚味積毒而發. 其形有十三種, 治法皆同. 初起僅一小瘡, 殺人於一二日之內, 比之癰疽尤毒. 又有紅絲疔ㆍ魚臍疔, 其毒尤甚. 《入門》
Translation영역
The clove sore at its first appearance rises up like the head of a nail, and so it is called 疔, the clove. In recent times it is mostly seen to break out from eating the flesh of cattle, horses, fowl and beasts that have died of themselves; or from contracting the violently noxious qi of heaven and earth; or from indulging in pungent, acrid and rich flavours until the poison accumulates. It has thirteen forms, and the method of treatment is the same for all. At its rising it is only one small sore, and it kills a man within a day or two — more poisonous than the common abscess. There are also the red-thread clove and the fish-navel clove, whose poison is worse still.
Clinical note임상 주석
因食自死牛馬禽獸之肉而發 — breaking out from eating the flesh of cattle, horses and beasts dead of themselves. That is the transmission route of anthrax, and 1.10.8 is a whole sub-section on it. A small hard sore with a nail-head centre that kills in a day or two, arising in people who handled or ate animals dead of disease, is a recognizable description of the cutaneous and gastrointestinal forms. The chapter is not making the identification and neither is this note: 疔 is a wider category that also takes in ordinary furuncles and the fulminant streptococcal infections. But the first cause the Immun names is the right one for the worst cases.
譯 1.10.6 Source원문
疔瘡發無定處, 在手足ㆍ頭面ㆍ胸背ㆍ骨節間最急, 其餘處爲緩. 《正傳》
Translation영역
The clove sore breaks out in no fixed place; on the hands and feet, the head and face, the chest and back and between the joints it is most urgent, and elsewhere milder.
1.10.1 The Form and Signs of the Clove Abscess 疔疽形證
譯 1.10.1.1 Source원문
疔疽生黃疱中, 或紫黑色. 初發必先痒後痛, 先寒後熱, 四肢沉重, 頭痛心驚眼花. 若大重則嘔逆, 爲難治. 《三因》
Translation영역
The clove abscess arises in a yellow blister, or is purple-black in colour. At its first appearance there is always itching before pain and chill before fever, the four limbs are heavy as lead, and there is headache, fright at the heart and flowers before the eyes. If it is very grave there is retching counterflow, and it is hard to treat.
Clinical note임상 주석
生黃疱中 — it arises in a yellow blister. A vesicle that precedes the hard black centre is the sequence of an anthrax eschar, and 先痒後痛 — itching first, then pain — is how that lesion is described now.
譯 1.10.1.2 Source원문
瘡頭黑硬如釘, 四畔帶赤如火, 盤根突起, 隨變焦黑, 未幾腫大而光, 轉爲濕爛, 深孔透肌, 如大鍼穿之狀. 《入門》
Translation영역
The head of the sore is black and hard as a nail, its four margins carry a red as of fire, the base rises up in a disc, it soon turns scorched black, and before long swells large and shining, turns to a moist rotting, and a deep hole pierces the flesh as though a great needle had gone through it.
譯 1.10.1.3 Source원문
外證心驚ㆍ頭痛ㆍ拘急ㆍ惡寒ㆍ四肢痛强, 或寒熱交作, 頰舌間赤黑點點如珠. 《直指》
Translation영역
The outward signs are fright at the heart, headache, drawing tension, a loathing of cold and painful stiffness of the four limbs, or chills and fever by turns, with red-black specks like beads over the cheek and tongue.
譯 1.10.1.4 Source원문
或不痛痒, 只麻木ㆍ寒熱ㆍ眼中流火ㆍ牙關緊急ㆍ時時驚惕, 甚則嘔吐諸證中嘔吐最危. 以鍼刺瘡不痛無血, 是其候也. 又中陷如釘蓋, 撼之有根, 是疔也. 《精義》
Translation영역
Sometimes there is neither pain nor itching, only numbness, chills and fever, fire streaming in the eyes, the jaw clenched tight, and startling from time to time; in the severe case, vomiting — of all the signs, vomiting is the most dangerous. If the sore is pricked with a needle and does not hurt and no blood comes, that is its sign. And if the centre is depressed like a nail-head and it has a root when shaken, it is a clove.
Clinical note임상 주석
以鍼刺瘡不痛無血 — pricked with a needle it does not hurt and does not bleed. Anaesthesia and absence of bleeding over a lesion mean the tissue is dead, and that is the one bedside test in this chapter that is still diagnostic. The painless black eschar of cutaneous anthrax behaves exactly so. 牙關緊急 — the clenched jaw — is also worth noting: in a wound patient that is trismus, the first sign of tetanus.
1.10.2 The Method of Treating the Clove Abscess 疔疽治法
譯 1.10.2.1 Source원문
凡疔瘡毒氣攻心欲死, 以鍼刺瘡心, 若覺痛有血, 下錠子. 若累刺至心側皆不痛無血者, 急刺百會穴, 痛有血者下鋌子; 若無血, 以親人熱血代之, 猶活三四. 宜用廻瘡錠子ㆍ碧霞錠子ㆍ廻瘡蟾酥錠子. 《精義》
Translation영역
Wherever the toxic qi of a clove sore attacks the heart and he is at the point of death, prick the centre of the sore with a needle; if pain is felt and blood comes, put in a stick. If repeated pricking as far as the side of the heart gives no pain and no blood anywhere, prick Baekhoe at once; if there is pain and blood, put in a stick. If there is no blood, substitute the warm blood of a near relative, and three or four in ten still live. Hoechang-jeongja 廻瘡錠子, Byeokha-jeongja 碧霞錠子 and Hoechangseomsu-jeongja 廻瘡蟾酥錠子 should be used.
Clinical note임상 주석
The needle is being used as a prognostic instrument, not a treatment: pain and bleeding mean living tissue and a chance; silence and dryness over a widening area mean the patient is dying. That reading is correct. What follows it is not — the 錠子 are arsenical sticks pushed into the wound, and 以親人熱血代之, substituting a relative's warm blood, is desperation. **The sticks of this group are built on arsenic, toad venom and croton and must not be prepared; and no one's blood should be put into a wound.**
譯 1.10.2.2 Source원문
又法, 急以艾炷灸之, 鍼疔四邊皆令血出, 以廻瘡錠子絍之, 上用膏藥貼之, 因服五香連翹湯ㆍ千金漏蘆湯二方見上疏下之. 若鍼之不痛無血者, 以猛火燒鐵鍼通赤, 於瘡上烙之, 令如焦炭, 取痛爲效; 亦絍前錠子. 經一二日膿潰根出, 服托裏湯散以取平復. 《精義》
Translation영역
Another method: burn it at once with a moxa cone, needle all four sides of the clove so that blood comes out, pack it with Hoechang-jeongja 廻瘡錠子 on a wick and lay a plaster over it, and then give Ohyangyeongyo-tang 五香連翹湯 and Cheongeumnuro-tang 千金漏蘆湯 — both formulas are given above — to thin and precipitate it. If needling gives no pain and no blood, heat an iron needle red through in a fierce fire and cauterize the sore with it until it is like charred coal, taking pain as the sign of effect; and pack the stick as before. After a day or two the pus bursts and the root comes out, and interior-thrusting decoctions and powders are given to bring him back level.
Clinical note임상 주석
取痛爲效 — pain is taken as the sign that it has worked. The logic is consistent with the preceding passage: cauterize until the patient feels it, which is to say until living tissue is reached. Debriding a necrotic eschar back to bleeding tissue is still the principle. The red-hot needle is not how it is done. **Cauterizing a wound with a heated iron must not be attempted.**
譯 1.10.2.3 Translation영역
As to the method of treatment: use Biryongtalmyeong-dan 飛龍奪命丹 at once, or Unghwang-hwan 雄黃丸, to precipitate it and take away its toxic heat, and then give Hwadok-hwan 化毒丸 and Ihwal-san 二活散.
譯 1.10.2.4 Source원문
實者初服賽命丹方見上三丸, 以葱酒發表; 虛者服保生錠子以解毒. 《入門》
Translation영역
For the replete, give three pills of Saemyeong-dan 賽命丹 — the formula is given above — at the outset, with scallion wine to open the surface; for the vacuous, give Bosaeng-jeongja 保生錠子 to resolve the toxin.
譯 1.10.2.5 Translation영역
For general treatment, choose among Jageumjeong 紫金錠, Banhon-dan 返魂丹, Illyeomgeum 一捻金, Sinhyotalmyeong-dan 神效奪命丹, Seomsu-hwan 蟾酥丸, Dokseom-hwan 獨蟾丸, Oseong-tang 五聖湯, Hwanhon-san 還魂散 and Cheongeumsodok-san 千金消毒散.
1.10.3 The Red-Thread Clove 紅絲疔
譯 1.10.3.1 Source원문
疔瘡或有一條如紅線直上, 倉卒之際, 急用鍼於紅線所至處刺出毒血, 然後以蟾酥ㆍ乳香等膏於正瘡內塗之. 鍼時以病者知痛出血爲好, 否則紅線入腹, 必致危殆. 《綱目》
Translation영역
A clove sore sometimes has a single streak like a red thread running straight upward. In that sudden crisis, use a needle at once at the place the red thread has reached, to prick out the toxic blood, and then spread a paste of toad venom and frankincense within the sore itself. In needling, it is good that the patient feels pain and blood comes; otherwise the red thread enters the belly and danger must follow.
Clinical note임상 주석
A red streak running from a sore toward the trunk is ascending lymphangitis, and the urgency is justified: untreated, it ends in bacteraemia. The chapter's response — prick along the streak and let blood — does nothing for that, and 以病者知痛出血爲好 is the same test for living tissue used throughout this section. What the disease needs is the antibiotic the period did not have. **Toad venom is cardiotoxic and the paste must not be prepared.**
譯 1.10.3.2 Source원문
疔生兩足, 多有紅絲至臍; 疔生兩手, 多有紅絲至心; 疔生面部, 多有紅絲入喉者. 俱難治. 急鍼其絲出血, 以泄其毒, 方可保生. 《入門》
Translation영역
A clove on the feet often has a red thread reaching the navel; on the hands, often one reaching the heart; on the face, often one entering the throat. All are hard to treat. Needle the thread at once and let blood to drain the toxin, and then life may be preserved.
Clinical note임상 주석
The three routes given are the lymphatic drainage of the leg, the arm and the face, and the chapter has them right: a lesion on the foot tracks to the groin and abdomen, one on the hand to the axilla and chest, one on the face to the neck. The facial case is the worst, as 癰疽 上 4.6 also says of that region.
1.10.4 The Fish-Navel Clove 魚臍疔
譯 1.10.4.1 Source원문
又有一種, 瘡頭黑深, 形如魚臍, 破之滲出黃水, 四畔浮漿, 謂之魚臍疔, 其毒尤甚. 絲瓜葉ㆍ連鬚葱白ㆍ韭葉 各等分, 硏搗如泥, 取汁以酒和服, 其滓貼腋下. 如病在左手貼左腋下, 在右手貼右腋下; 在左脚貼左胯, 在右脚貼右胯; 在身中貼心臍. 幷以帛縛住, 候肉下紅絲皆白則安矣. 或蛇退燒灰, 雞子淸調付, 內服神仙解毒丸. 《丹心》
Translation영역
There is another kind in which the head of the sore is black and deep, shaped like a fish's navel; opened, it seeps yellow fluid, and its four margins are watery and raised. This is called the fish-navel clove, and its poison is worse still. Take loofah leaf, scallion white with its roots, and chive leaf in equal parts, grind and pound them to a pulp, take the juice and give it mixed with wine, and stick the dregs under the armpit — if the disease is in the left hand, under the left armpit; in the right hand, the right; in the left leg, the left groin; in the right leg, the right; in the trunk, at the heart or navel. Bind it on with cloth, and when the red threads under the flesh have all turned white, he is well. Or burn snake slough to ash, mix it with egg white and apply, giving Sinseonhaedok-hwan 神仙解毒丸 inwardly.
Clinical note임상 주석
瘡頭黑深, 形如魚臍, 破之滲出黃水, 四畔浮漿 — a deep black centre shaped like a navel, seeping yellow fluid, with a watery raised rim. That is a close description of the anthrax eschar with its surrounding ring of vesicles, and this is the lesion the chapter calls the most poisonous of the thirteen. The dressing is laid not on the sore but at the armpit or groin — over the draining nodes — and the endpoint is the red threads turning pale. Whatever one makes of the remedy, the clinician is watching the right thing.
1.10.5 The Sloughing Clove 脫疽疔
譯 1.10.5.1 Source원문
內經曰, 膏粱之變, 足生大疔. 蓋因膏粱酒色蘊積惡毒, 或久患消渴之餘, 多有此瘡. 靈樞經所謂發於足傍, 名曰厲疽; 發於足指, 名曰脫疽, 其狀赤黑者死不治, 治不衰, 急斬之, 否則死, 正謂此也. 謂之脫疽, 以其指節潰爛脫去也. 《入門》
Translation영역
The Inner Classic says: the mutation of rich food and fine grain is enough to breed a great clove. For it comes of rich food, wine and women banking up malign poison, or follows long suffering from dispersion-thirst, and this sore is often found then. What the Yeongchu calls breaking out at the side of the foot, named the pestilent flat-abscess, and breaking out on the toes, named the sloughing flat-abscess — red-black in appearance he dies and is not to be treated; if under treatment it does not abate, cut it off at once, otherwise he dies — this is precisely what is meant. It is called the sloughing flat-abscess because the joints of the toes rot and come away.
Clinical note임상 주석
久患消渴之餘, 多有此瘡 — this sore is often found after long-standing dispersion-thirst. Gangrene of the toes in a long-standing diabetic is the diabetic foot, and the Immun has put the two together explicitly. Taken with 癰疽 上 4.1's 久患消渴必發癰疽丁瘡 and 4.2's 久患口乾必生癰疽, this chapter states the association three separate times. It is the most securely correct piece of clinical observation in either part.
譯 1.10.5.2 Source원문
輕者色赤自潰, 先用隔蒜灸, 內服仙方活命飮方見上ㆍ還魂散. 重者色黯不痛, 先用隔蒜灸, 更服賽命丹方見上及補藥, 庶可保生.
Translation영역
In the light case the colour is red and it bursts of itself: first use moxibustion over garlic, and give Seonbanghwalmyeong-eum 仙方活命飮 — the formula is given above — and Hwanhon-san 還魂散 inwardly. In the grave case the colour is dull and it does not hurt: first use moxibustion over garlic, then give Saemyeong-dan 賽命丹 — the formula is given above — and supplementing drugs, and life may perhaps be preserved.
Clinical note임상 주석
色赤 against 色黯不痛 — red, or dull and painless. That is the distinction between a perfused foot with infection and an ischaemic one, and painlessness is the bad sign for the same reason it is throughout this chapter. The prognosis attached is the right way round; what it calls for now is restoring the blood supply, not moxa.
譯 1.10.5.3 Source원문
甚者赤變爲黑, 急須在指則斬, 在肉則割, 否則黑延上足必死. 外治用桐油及無名異, 煎一沸, 入川椒 一勺, 看瘡大小, 剪蓼葉在內同煎, 浸七日後, 單以此葉貼瘡上卽安. 《入門》
Translation영역
In the severest case the red turns black: it must at once be cut off if it is in a toe and cut away if it is in the flesh, for otherwise the black spreads up the foot and he must die. For outward treatment, take tung oil and pyrolusite, bring them to one boil, put in a spoonful of Sichuan pepper, and according to the size of the sore cut knotweed leaves in and boil them together; after steeping seven days, lay these leaves alone on the sore and he is well.
Clinical note임상 주석
黑延上足必死 — once the black spreads up the foot he must die, so amputate. This is the same decision as 癰疽 上 4.13's 急斬之, stated again with the level named: take the toe, or take the dead tissue, before the line moves proximally. Ascending gangrene in a diabetic or ischaemic foot still forces that decision, and the chapter is not wrong about the urgency — only about how much could be done beforehand to avoid it.
1.10.6 The Fatal Signs of the Clove Abscess 疔疽死證
譯 1.10.6.1 Source원문
疔瘡含蓄毒氣, 突出寸許, 痛痒異常, 一二日間害人甚速, 是尤在癰疽之上也. 《直指》
Translation영역
The clove sore holds its toxic qi stored up, protrudes an inch or so, and its pain and itching are out of the ordinary; within a day or two it destroys a man with great speed, standing in this above the common abscess.
譯 1.10.6.2 Source원문
疔毒入心, 則口乾ㆍ煩悶ㆍ恍惚似醉ㆍ嘔吐不定, 危證也. 萬病解毒丹卽紫金錠也以黃連ㆍ當歸煎湯化下, 或賽命丹ㆍ淵然眞人奪命丹皆可服. 《入門》
Translation영역
When the clove toxin enters the heart there is a dry mouth, vexed oppression, bewilderment as though drunk, and unceasing vomiting: a grave case. Manbyeonghaedok-dan 萬病解毒丹 — that is, Jageumjeong 紫金錠 — is dissolved and sent down in a decoction of coptis and Korean angelica, or Saemyeong-dan 賽命丹 and Yeonyeonjinintalmyeong-dan 淵然眞人奪命丹 may be given.
譯 1.10.6.3 Source원문
疔毒入心腹, 則煩悶ㆍ嘔逆ㆍ恍惚癡眠, 其斃可立待也. 《直指》
Translation영역
When the clove toxin enters the heart and belly there is vexed oppression, retching counterflow, and a bewildered stupid drowsiness, and his death may be awaited standing.
Clinical note임상 주석
Bewilderment, drowsiness and vomiting in a patient with a small skin lesion is sepsis with an altered mental state, and the chapter's name for it — the toxin entering the heart and belly — is a reasonable description of what is happening. 其斃可立待 is the Jikji saying plainly that nothing it has will change the outcome.
譯 1.10.6.4 Source원문
疔瘡走黃過心者難治. 若太重則嘔逆, 嘔逆者難治. 姑用乳粉托裏散方見下止之. 《三因》
Translation영역
A clove sore that runs yellow and passes the heart is hard to treat. If it is very grave there is retching counterflow, and he who has retching counterflow is hard to treat. Use Yubuntakri-san 乳粉托裏散 — the formula is given below — for the time being to stop it.
譯 1.10.6.5 Translation영역
He who sweats cold in the clove abscess dies.
譯 1.10.6.6 Source원문
人有暴死者, 多是疔毒. 急以燈照遍身, 若有小瘡, 急灸之, 幷服賽命丹, 亦有復甦者. 《入門》
Translation영역
Where a man dies suddenly, it is often the clove toxin. Hold a lamp over his whole body at once, and if there is any small sore, burn it at once and give Saemyeong-dan 賽命丹 with it; some such do revive.
Clinical note임상 주석
急以燈照遍身 — hold a lamp over the whole body at once. Searching a collapsed patient's skin by lamplight for the small lesion that explains it is sound practice, and the same search is made now for the petechiae of meningococcal disease or for an overlooked portal of entry. The reasoning behind it is better than the treatment that follows.
1.10.7 The Method of Drawing Out the Clove 拔疔法
譯 1.10.7.1 Source원문
疔瘡有毒根在內, 須拔去乃可救. 黑牯牛牽於石上必撤糞, 候糞上生菌, 取焙乾, 與𦻎薟草葉等分爲末. 用竹筒兩頭去節, 套在疔上陷入肉內, 以線緊縛, 取藥末一匙, 滴水和之, 放於筒內. 少時藥滾起則疔自拔起; 未效則漸加度數, 其疔必拔. 拔去後以金銀白芷散調之. 《正傳》
Translation영역
The clove sore has a toxic root within, and it must be drawn out before he can be saved. A black bullock led over a stone will surely drop dung; wait until a fungus grows on the dung, take it and bake it dry, and powder it in equal parts with siegesbeckia leaf. Take a bamboo tube with the nodes cut away at both ends, fit it over the clove so that it sinks into the flesh, bind it tight with thread, and put a spoonful of the powder, mixed with a drop of water, inside the tube. In a little while the medicine boils up and the clove draws itself out; if it has no effect, increase the number of times gradually and the clove must be drawn. After it is drawn out, Geumeunbaekji-san 金銀白芷散 is used to set it right.
Clinical note임상 주석
The tube bound tightly over the lesion is the same suction arrangement as 癰疽 上 4.23's 竹筒吸毒方, and what draws the core out is the negative pressure, not the powder. The principle survives in modern negative-pressure dressings. **Dung fungus packed against an open wound is a direct route to tetanus and deep infection, and this must not be done.**
譯 1.10.7.2 Translation영역
Hoechang-jeongja 廻瘡錠子, or Bosaeng-jeongja 保生錠子 and Saseongseonjeong-san 四聖旋疔散, should be used to draw out the clove's root and set it right.
譯 1.10.7.3 Source원문
蒼耳莖葉燒灰, 醋調塗疔上, 乾則易, 不過十度卽根出. 和雄黃尤妙. 《本草》
Translation영역
Burn cocklebur stem and leaf to ash, mix with vinegar and spread it on the clove, changing it when it dries; in not more than ten applications the root comes out. Mixed with realgar it is better still.
譯 1.10.7.4 Source원문
蟬蛻ㆍ白殭蠶爲末, 醋調, 留瘡口塗四圍, 竢疔根出拔去. 《綱目》
Translation영역
Powder cicada slough and silkworm, mix with vinegar, and spread it round the four sides leaving the mouth of the sore open; wait for the clove's root to come out and draw it away.
Clinical note임상 주석
留瘡口 — leaving the mouth of the sore open. Dressing the margins while keeping the centre free so that it can discharge is the right way round, and the same instruction appears in 癰疽 上 4.23.
譯 1.10.7.5 Source원문
蜣蜋安濃米泔小盞中, 以火逼之, 蟲熱喫泔及困死, 取腦中白肉, 新瓦上焙爲末, 熱酒調二錢服, 仍以少許塗疔上, 根自出. 《資生》
Translation영역
Put a dung beetle in a small cup of thick rice-rinse water and press it with fire; when the insect, heated, has drunk the water and died exhausted, take the white flesh from its head, bake it on a new tile and powder it, give 2 don stirred into hot wine, and spread a little on the clove, and the root comes out of itself.
譯 1.10.7.6 Source원문
一云, 蜣蜋於心腹下度取之, 其肉稍白, 貼疔上, 根出卽愈. 《本草》
Translation영역
Another account: measure and take it from beneath the beetle's heart and belly, where its flesh is somewhat white, and stick it on the clove; the root comes out and it heals.
譯 1.10.7.7 Source원문
斑猫 一枚, 捻破, 以鍼刺疔上封之, 根卽出.
Translation영역
Take one blister beetle, pinch it open, prick the clove with a needle and seal it on, and the root comes out.
譯 1.10.7.8 Source원문
取黑虱 十枚, 置疔上, 以荻箔繩作炷, 灸虱上, 卽根出.
Translation영역
Take ten black lice, set them on the clove, make a cone of reed-screen cord and burn it over the lice, and the root comes out.
譯 1.10.7.9 Source원문
白狗屎燒存性, 和酒服, 又塗疔上, 根自出.
Translation영역
Burn white dog dung with its nature kept, give it in wine, and also spread it on the clove, and the root comes out of itself.
譯 1.10.7.10 Translation영역
Take the white juice from the stem of wild lettuce and spread it on the clove, and the root comes out.
譯 1.10.7.11 Source원문
馬齒莧和梳垢, 爛搗封疔上, 根出. 《本草》
Translation영역
Pound purslane together with the dirt from a comb to a pulp and seal it on the clove, and the root comes out.
Clinical note임상 주석
Ten remedies in a row, all with the same endpoint — the root comes out — and most of them are things laid on a broken skin surface: beetle flesh, lice, dog dung, comb dirt, cantharides. **None of these may be applied to a wound.** What they share with the bamboo tube above is the belief that the dead core is a foreign body to be extracted, and in that they are not wrong: the eschar does have to come away. It comes away now by debridement, under antibiotic cover.
1.10.8 The Clove Arising from Eating the Flesh of Cattle, Horses, Fowl and Beasts Dead of Plague 食疫死牛馬禽獸肉生疔
譯 1.10.8.1 Source원문
近見患疔者, 皆是食自死牛馬禽獸之肉而生此疾, 十患十死. 宜急取紫金錠半錠, 淡酒化下; 重者服一錠, 外用凉水磨塗疔上, 日夜各數次, 或吐或利, 神效.
Translation영역
Of those lately seen to suffer the clove, all got this illness from eating the flesh of cattle, horses, fowl and beasts that had died of themselves, and of ten who suffer it ten die. Half a tablet of Jageumjeong 紫金錠 should be dissolved at once in weak wine and sent down; for the grave case a whole tablet, with more ground in cold water and spread on the clove, several times by day and by night, and whether he vomits or purges the effect is marvellous.
Clinical note임상 주석
A whole sub-section on a single route of transmission, with a case fatality stated as total: 十患十死. This is the Bogam coming as close as it ever does to naming a zoonosis. Eating or handling the carcass of an animal dead of disease, followed within days by a black necrotic sore and death, is anthrax, and the 1613 physicians had recognized the connection between the dead herd and the dead farmer without any notion of what passed between them. The treatment could not have worked. The observation is worth more than the treatment.
譯 1.10.8.2 Source원문
白頸蚯蚓 八九條, 擂爛和酒, 濾去滓飮之, 其滓塗疔四圍, 留頭出毒氣.
Translation영역
Grind eight or nine white-necked earthworms to a pulp, mix with wine, strain off the dregs and drink it, and spread the dregs round the four sides of the clove, leaving the head open for the toxic qi to come out.
譯 1.10.8.3 Source원문
大蜘蛛 一箇, 放疔上, 自咂其毒, 連易三五箇, 其毒自敗. 以蜘蛛入水, 不傷蛛命. 又兼用蜞鍼法方見下. 《種杏》
Translation영역
Set one large spider on the clove and it sucks out the poison of itself; change it three or five times in succession and the poison is broken. Put the spider into water, so that its life is not destroyed. The leech-needling method — given below — may be used with it.
Clinical note임상 주석
以蜘蛛入水, 不傷蛛命 — put the spider in water so its life is not destroyed. A small instruction about not killing the animal, in the middle of a page about a disease that kills ten out of ten. It is the only sentence of its kind in the chapter.
1.11 The Miscellaneous Signs of Abscess 癰疽雜證
譯 1.11.1 Source원문
癰疽雜證, 有癰疽煩渴, 有癰疽嘔逆, 有癰疽痰盛, 有癰疽寒熱, 有癰疽作痛, 有癰疽泄瀉.
Translation영역
Among the miscellaneous signs of abscess there is vexing thirst in abscess, retching counterflow in abscess, abounding phlegm in abscess, chills and fever in abscess, pain in abscess, and diarrhoea in abscess.
Clinical note임상 주석
Six headings, and they are the complications rather than the lesion: thirst, vomiting, sputum, fever, pain and diarrhoea. Read together they are a fair list of what goes wrong systemically in a patient with a deep suppuration — dehydration, ileus, aspiration, bacteraemia and the diarrhoea of sepsis. The chapter treats each as its own sign with its own remedy, where the modern reading is that they are one process.
1.11.1 Vexing Thirst in Abscess 癰疽煩渴
譯 1.11.1.1 Source원문
癰疽煩渴, 熱毒方盛, 或發大渴, 此乃毒氣攻心, 令舌乾煩渴. 但用補心氣藥內補卽止. 《涓子》
Translation영역
In vexing thirst in abscess, the toxic heat is at its height and a great thirst may arise; this is the toxic qi attacking the heart, making the tongue dry and the thirst vexing. Only use drugs that supplement the heart qi to supplement him within, and it stops.
Clinical note임상 주석
A patient with a large abscess, high fever and a great thirst is losing water faster than he is taking it, and the dry tongue is the sign of it. What he needs is fluid; the chapter gives heart-supplementing drugs. 1.17 and the 調理及禁忌法 section below both return to this thirst and both forbid cold water, which is the one instruction in the chapter that would do positive harm.
譯 1.11.1.2 Source원문
癰疽發渴, 乃氣血兩虛. 八物湯方見虛門加黃芪ㆍ麥門冬ㆍ山茱萸ㆍ五味子. 《回春》
Translation영역
Thirst arising in abscess is dual vacuity of qi and blood. Palmul-tang 八物湯 — the formula is given in the Vacuity chapter — with milkvetch, ophiopogon, cornus and schisandra added.
譯 1.11.1.3 Source원문
加減八味元方見虛門治癰疽渴疾, 首尾通用最佳, 老人尤宜. 《得效》
Translation영역
Gagampalmi-won 加減八味元 — the formula is given in the Vacuity chapter — treats the thirst disease of abscess; it is best used throughout from beginning to end, and suits the aged especially.
Clinical note임상 주석
加減八味元 is the kidney-supplementing pill given for 消渴, dispersion-thirst, and the Deukhyo is reaching for it here because the thirst of a suppurating patient looks like the thirst of a diabetic. The chapter has already said three times that the abscess often follows the dispersion-thirst; this passage is the same association read backwards, and in a diabetic with a deep infection the blood sugar does rise and the thirst with it.
譯 1.11.1.4 Translation영역
Cheongdanjukyeop-tang 淸膻竹葉湯, Jukyeophwanggi-tang 竹葉黃芪湯, Insamhwanggi-tang 人參黃芪湯, Hwanggiyugil-tang 黃芪六一湯, Geumeunhwa-san 金銀花散, Omija-tang 五味子湯, Indong-hwan 忍冬丸 and Indong-tang 忍冬湯 — the latter two formulas are given below — are chosen among.
1.11.2 Retching Counterflow in Abscess 癰疽嘔逆
譯 1.11.2.1 Source원문
癰疽嘔逆, 未潰時嘔者, 當作毒氣上攻治之; 潰後, 當作陰虛補之. 若年老人潰後嘔不能食, 宜參苓白朮膏方見內傷補之. 河間謂瘡瘍嘔者, 濕氣侵于胃也, 宜倍白朮. 《丹心》
Translation영역
As to retching counterflow in abscess: where he retches before it has burst, treat it as the toxic qi attacking upward; after it has burst, supplement it as yin vacuity. If an aged man retches after the bursting and cannot eat, Samryeongbaekchul-go 參苓白朮膏 — the formula is given in the Internal Damage chapter — should be given to supplement him. Hejian held that retching in a sore is damp qi encroaching on the stomach, and that atractylodes should be doubled.
譯 1.11.2.2 Source원문
癰疽及疔瘡ㆍ惡瘡毒氣攻心, 則多嘔逆. 宜乳粉托裏散ㆍ生薑甘䓀湯.
Translation영역
Where the toxic qi of an abscess, a clove sore or a malign sore attacks the heart, there is much retching counterflow. Yubuntakri-san 乳粉托裏散 and Saenggang-gamgil-tang 生薑甘䓀湯 should be given.
譯 1.11.2.3 Source원문
食不能下, 服藥而嘔, 六君子湯方見痰門加木香ㆍ縮砂. 《回春》
Translation영역
Where food will not go down and he retches on taking the drug, Yukgunja-tang 六君子湯 — the formula is given in the Phlegm chapter — with costus and cardamom added.
譯 1.11.2.4 Translation영역
Or use Doksam-tang 獨參湯 and it heals.
Clinical note임상 주석
Vomiting in a patient with a deep abscess, unable to keep food or medicine down, is the sign the chapter most consistently calls fatal — 1.10.6 says 嘔逆者難治 twice. It is the ileus and gastric stasis of sepsis, and the distinction the Dansim draws here between before and after the bursting is worth keeping: vomiting in an unopened abscess means the infection is still contained and spreading, while vomiting after drainage in an old man is the exhaustion of the illness itself.
1.11.3 Abounding Phlegm in Abscess 癰疽痰盛
譯 1.11.3.1 Source원문
癰疽生痰有二, 一者胃寒, 二者鬱熱. 俱宜二陳湯, 或榮衛返魂湯方見上加南星ㆍ半夏. 《入門》
Translation영역
Phlegm arising in abscess has two causes: the first is cold in the stomach, the second depressed heat. For both, Ijin-tang 二陳湯, or Yeongwibanhon-tang 榮衛返魂湯 — the formula is given above — with arisaema and pinellia added.
譯 1.11.3.2 Source원문
痰盛喘急, 六君子湯加薑ㆍ棗煎服, 或補中益氣湯方見內傷加麥門冬ㆍ五味子ㆍ桑白皮煎服. 《回春》
Translation영역
Where phlegm abounds and the breathing is hurried, Yukgunja-tang 六君子湯 with ginger and jujube added is boiled and given, or Bojungikgi-tang 補中益氣湯 — the formula is given in the Internal Damage chapter — with ophiopogon, schisandra and mulberry root bark added.
Clinical note임상 주석
痰盛喘急 — abounding phlegm and hurried breathing in a patient with an abscess. That is pneumonia, or septic pulmonary emboli from a deep suppuration, and in the bedridden it is aspiration. It is a late and bad development, and the chapter files it among the miscellaneous signs rather than among the fatal ones.
1.11.4 Chills and Fever in Abscess 癰疽寒熱
譯 1.11.4.1 Source원문
癰疽未愈之間, 先嘔痰而寒熱, 汗出而止, 或連日或間日, 宜服加味不換金正氣散. 《得效》
Translation영역
While the abscess is not yet healed, he first retches phlegm and then has chills and fever which stop when sweat comes, on consecutive days or on alternate days; Gamibulhwangeumjeonggi-san 加味不換金正氣散 should be given.
Clinical note임상 주석
寒熱 … 汗出而止, 或連日或間日 — chills and fever breaking with a sweat, daily or on alternate days. The Deukhyo is describing the rigors of intermittent bacteraemia from an undrained collection, and the alternate-day pattern is what made it look like malaria to the period. A spiking fever with rigors in a patient whose abscess has not been opened means the pus has somewhere to go and has not been let out.
譯 1.11.4.2 Source원문
癰疽虛證寒戰, 明乳香硏細半兩, 每一錢熱水調下. 戰發於肝, 乳香着肝而溫之, 寒戰隨止. 《直指》
Translation영역
For the shivering of the vacuity pattern in abscess, grind half a nyang of clear frankincense fine and send down 1 don each time stirred in hot water. Shivering arises from the liver, and frankincense settles on the liver and warms it, so the cold shivering stops with it.
1.11.5 Pain in Abscess 癰疽作痛
譯 1.11.5.1 Source원문
癰疽不可不痛, 亦不可大痛. 未潰前痛者爲熱毒, 便秘者內踈黃連湯方見上; 膿脹痛者鍼之. 已潰膿出而反痛者, 虛也. 《入門》
Translation영역
An abscess cannot but hurt, and yet it cannot hurt greatly either. Where it hurts before it has burst, that is toxic heat, and if the stool is bound, Naesohwangryeon-tang 內踈黃連湯 — the formula is given above; where it hurts from the pus distending it, needle it. Where it has already burst and the pus has come out and yet it hurts the more, that is vacuity.
Clinical note임상 주석
膿脹痛者鍼之 — where the pain is the pus distending it, open it. That is the one line in the section that is simply right, and it is still the rule: the pain of a collection under pressure is relieved by draining it and by nothing else. The sentence that follows is equally useful in the other direction — pain that increases after drainage means the drainage was inadequate or the wound is infected onward, not that the patient is depleted.
譯 1.11.5.2 Source원문
癰疽寒熱虛實皆能爲痛. 若熱毒之痛, 以寒凉之劑折其熱; 若寒邪之痛, 以溫熱之劑熨其寒; 虛而痛者補之, 實而痛者瀉之. 《精義》
Translation영역
Cold and heat, vacuity and repletion can all alike make pain in abscess. If it is the pain of toxic heat, break its heat with a cold and cool preparation; if the pain of a cold evil, iron out its cold with a warm and hot preparation; where it hurts from vacuity, supplement it, and where from repletion, drain it.
譯 1.11.5.3 Source원문
膿潰之後反痛者, 虛也, 宜補之; 穢氣所觸者, 宜和解之; 風冷所逼者, 宜溫散之. 補者當歸ㆍ黃芪之類, 和解者乳香ㆍ芍藥之類, 溫散者防風ㆍ桂枝之類. 《綱目》
Translation영역
Where it hurts the more after the pus has burst, that is vacuity and should be supplemented; where malign qi has touched it, it should be harmonized and resolved; where wind-cold presses it, it should be warmed and dispersed. For supplementing, such drugs as Korean angelica and milkvetch; for harmonizing and resolving, frankincense and peony; for warming and dispersing, saposhnikovia and cinnamon twig.
譯 1.11.5.4 Source원문
膿血旣泄, 腫痛尤甚, 人參黃芪湯, 或十全大補湯方見虛門加麥門冬ㆍ五味子. 《回春》
Translation영역
Where the pus and blood have already drained and yet the swelling and pain are worse still, Insamhwanggi-tang 人參黃芪湯, or Sipjeondaebo-tang 十全大補湯 — the formula is given in the Vacuity chapter — with ophiopogon and schisandra added.
Clinical note임상 주석
膿血旣泄, 腫痛尤甚 — drained, and worse. The chapter reads it as depletion and supplements. It is the presentation of an undrained loculus, a retained slough, or spreading cellulitis, and it is the single most useful sign in the section for recognizing that a wound needs looking at again rather than feeding.
譯 1.11.5.5 Translation영역
To stop the pain, Danggui-tang 當歸湯, Iseon-san 二仙散 and Hyangryeong-san 香靈散 are chosen among.
1.11.6 Diarrhoea in Abscess 癰疽泄瀉
譯 1.11.6.1 Translation영역
For diarrhoea in abscess, Yubuntakri-san 乳粉托裏散 should be given, stirred into a decoction of costus and poria; Gamibulhwangeumjeonggi-san 加味不換金正氣散 assists it.
譯 1.11.6.2 Source원문
腹痛泄瀉ㆍ咳逆昏憒, 急用托裏溫中湯, 或用六君子湯方見痰門加炮附子. 《回春》
Translation영역
For abdominal pain and diarrhoea with hiccough counterflow and clouded confusion, use Takrionjung-tang 托裏溫中湯 at once, or Yukgunja-tang 六君子湯 — the formula is given in the Phlegm chapter — with blast-fried aconite added.
Clinical note임상 주석
腹痛泄瀉ㆍ咳逆昏憒 — abdominal pain, diarrhoea, hiccough and a clouded mind, all at once in a patient with an abscess. That is septic shock, and the Hoechun's 急用 is the right instinct even though the aconite is not the answer. Diarrhoea appearing late in a deep suppuration is a bad sign for the same reason it is now.
1.12 Drugs of General Treatment for Abscess 癰疽通治藥
譯 1.12.1 Translation영역
For the general treatment of abscess, Cheongeumnuro-tang 千金漏蘆湯, Ohyangyeongyo-tang 五香連翹湯, Seonbanghwalmyeong-eum 仙方活命飮, Seungyangigwi-san 升陽益胃散, Cheongeumnaeso-san 千金內消散, Seonjeonhwadok-tang 仙傳化毒湯, Yeongwibanhon-tang 榮衛返魂湯, Jageumjeong 紫金錠, Saemyeong-dan 賽命丹, Yeonyeonjinintalmyeong-dan 淵然眞人奪命丹, Biryongtalmyeong-dan 飛龍奪命丹, Indong-hwan 忍冬丸, Indong-ju 忍冬酒 and Indong-tang 忍冬湯 may all be chosen among.
Clinical note임상 주석
Fourteen names, and the three 忍冬 preparations at the end are the ones worth marking: honeysuckle is the drug this chapter returns to for every stage of a suppuration, and it is the one ingredient in the list with demonstrable antibacterial activity in the laboratory. That is not the same as a treatment for an abscess, which needs drainage.
1.13 The Needling Method in Abscess 癰疽鍼法
譯 1.13.1 Source원문
鈹鍼者, 末如劎鋒, 以取大膿. 《靈樞》
Translation영역
The lance needle has a tip like a sword's edge, and takes away great pus.
Clinical note임상 주석
A sword-edged blade for letting out a large collection: the 鈹鍼 of the Yeongchu is a scalpel, not a needle, and this whole section is about incision and drainage rather than acupuncture. That is the plainest statement of the principle in either part of the chapter.
譯 1.13.2 Source원문
大癰氣之息者, 宜以鍼開除去之註云, 息與瘜同, 死肉也. 《內經》
Translation영역
Where a great welling abscess has qi that has bred flesh, it should be opened with the needle and removed — the commentary says that 息 is the same as 瘜, dead flesh.
譯 1.13.3 Source원문
癰疽成膿, 以馬𠾑鐵作鍼, 形如韭葉, 兩面皆利, 可以橫直開裂, 以取膿血. 《精要》
Translation영역
When the abscess has formed pus, make a needle of the iron of a horse's bit, shaped like a chive leaf and sharp on both faces, with which it may be opened crosswise or lengthwise to take away the pus and blood.
譯 1.13.4 Source원문
癰疽如椒眼數十粒, 或如蜂窠ㆍ蓮房而膿出痛不除, 宜以鈹鍼橫直裂之, 則毒血挾膿出而愈. 《綱目》
Translation영역
Where the abscess is like dozens of peppercorn eyes, or like a wasp's nest or a lotus pod, and pus comes out but the pain is not relieved, it should be cut crosswise and lengthwise with the lance needle, and then the toxic blood comes out together with the pus and it heals.
Clinical note임상 주석
如蜂窠ㆍ蓮房 — a honeycomb or a lotus pod, which is how the surface of a carbuncle looks when it is draining through many separate openings. 膿出痛不除, pus coming out and the pain not relieved, is the sign that the many small openings are not enough, and the Gangmok's answer — lay it open across — is what is still done. Deroofing a carbuncle into one cavity is the correct operation.
譯 1.13.5 Source원문
癰疽作膿, 若不鍼烙, 毒氣無從而解, 膿瘀無從而泄. 過時不鍼烙, 反攻其內, 欲望其生, 豈可得乎. 癤皮薄, 惟用鍼以決其膿血, 不可烙也. 《精義》
Translation영역
When the abscess has made pus, if it is not needled and cauterized the toxic qi has no way to be resolved and the stagnant pus no way to drain. Where the time has passed and it has not been needled and cauterized, it attacks inward instead, and to hope for his life then — how can it be had? The boil has thin skin, and only the needle is used to break open its pus and blood; it must not be cauterized.
Clinical note임상 주석
過時不鍼烙, 反攻其內 — let the moment pass without draining it, and it goes inward instead. This is the chapter stating the natural history of an undrained abscess, and it is correct: the collection does not stay where it is. The distinction drawn at the end is a surgical one — a superficial boil is incised, not burnt — and it shows the author grading the intervention to the depth of the lesion.
譯 1.13.6 Source원문
凡近筋脉骨節處, 不得亂行鍼烙.
Translation영역
Wherever it is near a sinew, a vessel or a joint, needling and cauterizing must not be done at random.
Clinical note임상 주석
The one cautionary line in the section, and it names exactly the structures that are still the reason to be careful where an incision goes: tendon, vessel, joint capsule. A blind cut over the flexor surface of a wrist or into a joint does harm that the abscess would not have done.
譯 1.13.7 Source원문
癰疽皮厚口小, 膿水出不快者, 宜大用鍼烙. 《精義》
Translation영역
Where the abscess has thick skin and a small mouth and the pus and fluid do not come away freely, needling and cauterizing should be used freely.
譯 1.13.8 Source원문
大抵用鍼, 只欲引膿出. 如鍼刺無膿, 是氣伏也, 不可用鍼烙. 《涓子》
Translation영역
In general the needle is used only to draw the pus out. If needling finds no pus, that is qi lying hidden, and needling and cauterizing must not be used.
Clinical note임상 주석
如鍼刺無膿 … 不可用鍼烙 — if there is no pus, do not cut. A negative aspiration means the swelling is not yet a collection, and cutting into a cellulitis makes it worse rather than better. Diagnostic aspiration before incision is the same step, and this is the Yeonja arriving at it.
1.13.1 The Leech-Needling Method 蜞鍼法
譯 1.13.1.1 Source원문
癰癤初發漸大, 以濕紙一片搭瘡上, 其一點先乾處卽是正頂. 先以水洗去人皮醎, 取大筆管一箇, 安於正頂上, 却用大水蛭一條安其中, 頻以冷水灌之, 蛭當吮其正穴, 膿血皮皺肉白, 是毒散, 無不差. 如毒大蛭小, 須用三四條方見效. 若吮着正穴, 蛭必死, 用水救活, 累試奇效. 如血不止, 以藕節上泥塗之. 《得效》
Translation영역
When a welling abscess or boil has just broken out and is growing, lay a piece of wet paper on the sore, and the one spot that dries first is the true crown. First wash away the salt of the skin with water, take one large brush-barrel and set it over the true crown, then put one large leech inside it and pour cold water in frequently; the leech will suck at the true point, and when the pus and blood are gone, the skin wrinkled and the flesh pale, the toxin is dispersed and he always recovers. If the toxin is great and the leech small, three or four must be used before any effect is seen. If it has sucked at the true point the leech will surely die; revive it with water, and in repeated trials the effect is marvellous. If the bleeding will not stop, smear it with the mud from a lotus-root node.
Clinical note임상 주석
以濕紙一片搭瘡上, 其一點先乾處卽是正頂 — the spot where wet paper dries first is the centre. The paper dries fastest over the hottest and most inflamed point, which is where the pus is nearest the surface, and the same test appears in 1.15 for siting the moxa. As a way of finding where to drain it is sound. The leech is not drainage, and medicinal leeching is used now for quite another purpose — relieving venous congestion in a replanted flap — not for infection. **Applying a leech to an infected wound would seed it, and this should not be done.** Note also the instruction to revive the leech in water, as at 1.10.8.
譯 1.13.1.2 Source원문
蜞鍼一法, 可施於輕小證候. 若癰疽大毒積在藏府, 徒竭其血於外, 無益也. 《丹心》
Translation영역
The one method of leech-needling may be applied in light and small cases. If the great toxin of an abscess is banked up in the viscera, merely exhausting his blood on the outside is of no benefit.
Clinical note임상 주석
The Dansim putting the limit on it: a small superficial lesion may be treated this way, and a deep or systemic infection is not touched by anything done at the surface. That is the right criticism, and it is the same objection a modern reader would make.
1.14 The Cauterizing Method in Abscess 癰疽烙法
譯 1.14.1 Source원문
或問, 烙法何如. 曰, 膿或汪洋欲出, 奈何皮厚肉深難穴者, 不用烙以開竅脉, 膿何由出.
Translation영역
One asks: what of the cauterizing method? The answer: where the pus is brimming and about to come out, but the skin is thick and the flesh deep so that it cannot be pierced — if cautery is not used to open a passage, by what way is the pus to come out?
譯 1.14.2 Source원문
膿本肉腐所成, 皆挾毒熱之氣. 若久留肉腠間, 則毒氣浸淫好肉, 亦化爲膿腐. 此所以烙法有功乎潰瘍也. 《涓子》
Translation영역
Pus is formed in the first place by the rotting of flesh, and all of it carries toxic and hot qi. If it stays long between the flesh and its interstices, the toxic qi soaks into the good flesh and that too turns to pus and rot. This is why the cauterizing method does its work on the burst sore.
Clinical note임상 주석
若久留肉腠間, 則毒氣浸淫好肉, 亦化爲膿腐 — pus left in the tissues eats into the sound flesh and that rots in its turn. This is as close as the tradition comes to stating why an abscess must be evacuated, and the observation is exactly right: retained pus enlarges its own cavity. The conclusion drawn — that the way to let it out is a hot iron — is where it parts from modern practice, which reaches the same cavity with a blade and keeps it open with a drain.
譯 1.14.3 Source원문
癰疽成膿宜烙. 可用銀篦, 大二分, 長六寸, 火上燒令赤, 急手熨烙毒上, 得膿爲效. 《精要》
Translation영역
When the abscess has formed pus, cautery is appropriate. A silver bodkin may be used, two fun broad and six chi long, heated red in the fire and pressed with a quick hand on the toxin; getting pus is the sign of effect.
Clinical note임상 주석
得膿爲效 — pus coming is the sign it worked, which is to say the endpoint of the procedure is drainage and the iron is only the instrument. **A red-hot bodkin must not be used on a patient.**
譯 1.14.4 Source원문
近代良醫只以金銀鐵鋌, 其㨾如鍼者, 以木炭熟火猛燒通赤, 蘸油烙之尤妙. 隨鍼烙出膿者, 順也. 如膿不出, 實者撚髮爲絍, 虛者以紙爲絍, 於絍上蘸藥, 絍入鍼孔, 引出膿毒. 如腫不退疼不除, 急服排膿托裏湯藥以助其勢.
Translation영역
Good physicians of recent times use only a bar of gold, silver or iron shaped like a needle, burnt red through in a fierce charcoal fire and dipped in oil before cauterizing, which is better still. Where the pus comes out as the needle cauterizes, that is the favourable course. If the pus does not come, for the replete twist hair into a wick and for the vacuous make the wick of paper, dip the wick in the drug and pack it into the needle hole to draw the pus and toxin out. If the swelling does not go down and the pain is not relieved, give pus-expelling and interior-thrusting decoctions at once to help it along.
Clinical note임상 주석
絍入鍼孔, 引出膿毒 — a wick packed into the opening to draw the pus out. That is a wick drain, and keeping a track open with a wick so that it drains rather than sealing over is still how a small abscess cavity is managed. The hair and the paper are the wrong materials; the principle is the right one.
譯 1.14.5 Source원문
膿色黃白卽好. 若赤黑色, 防後有鮮血出. 《精要》
Translation영역
Pus yellow-white in colour is good. If it is red-black, guard against fresh blood coming afterwards.
Clinical note임상 주석
Grading the discharge by colour, with red-black read as a warning of haemorrhage to come. The inference is reasonable — blood in the pus means a vessel is in the cavity wall — and secondary haemorrhage from an eroded vessel in an abscess is a real event. The chapter is telling the operator to expect it.
1.15 The Moxibustion Method in Abscess 癰疽灸法
譯 1.15.1 Source원문
凡癰疽之發, 或因內有積熱, 或因外寒鬰內熱. 若於生發之處艾灸以散其毒, 治之于早, 可以移深爲淺, 改重爲輕. 諸項灸法皆好, 惟騎竹馬灸法方見鍼灸尤爲切要, 此消患於未形之策. 《丹心》
Translation영역
Wherever an abscess breaks out, it is either because heat has accumulated within, or because cold without has depressed the heat within. If moxa is burnt at the place where it is arising so as to disperse its toxin, and it is treated early, the deep may be shifted to the shallow and the grave altered to the light. All the several moxibustion methods are good, but the riding-the-bamboo-horse method — given in the Acupuncture chapter — is the most essential of all, this being the way to dissolve the trouble before it has taken form.
Clinical note임상 주석
消患於未形 — dissolving it before it has taken form, which is the whole claim of this section: that burning the skin over a lesion at its outset prevents it becoming an abscess. A boil at the stage of 1.15's 初發小點 may well resolve on its own, and that is the honest account of the successes recorded here.
譯 1.15.2 Source원문
癰疽已覺微漫腫硬ㆍ皮不變色ㆍ脉沉不痛者, 當外灸之, 引邪氣出而方止. 經曰, 陷下者灸之. 如外微覺木硬而不痛者, 當急灸之, 是邪氣深陷也. 淺者不可灸. 如有膿水, 亦不可灸, 當鍼之. 《保命》
Translation영역
Where the abscess is already felt faintly spread, swollen and hard, the skin unchanged in colour, the pulse deep and it does not hurt, it should be burnt from without, and only when the evil qi has been drawn out does one stop. The classic says: what has sunken down, burn it. Where from without it is faintly felt woody and hard and does not hurt, it should be burnt at once, for the evil qi has sunk deep. What is shallow must not be burnt. If there is pus and fluid, that too must not be burnt, but needled.
Clinical note임상 주석
如有膿水, 亦不可灸, 當鍼之 — once there is pus, do not burn it but open it. The line divides the two previous sections from this one, and it divides them correctly: before a collection has formed there is nothing to drain, and once it has formed nothing but drainage will do. 木硬而不痛, woody-hard and painless, is the deep induration of a spreading infection, and the painlessness is the same bad sign as throughout.
譯 1.15.3 Source원문
癰疽初覺腫痛, 先以濕紙覆其上, 視之先乾處是頭也. 大蒜切片安頭上, 以大艾炷灸之, 三壯卽換一蒜. 痛者灸至不痛, 不痛者灸至痛乃止. 大槩以百壯爲准. 最要早覺早灸爲上. 如有頭則不必紙覆也. 《三因》
Translation영역
When swelling and pain are first felt in an abscess, cover it first with wet paper and look: the place that dries first is the head. Set a slice of garlic on the head and burn a large moxa cone over it, changing the garlic every three cones. Where it hurts, burn until it does not hurt; where it does not hurt, burn until it does, and then stop. A hundred cones is the general measure. The chief thing is that noticing it early and burning it early is best. If it already has a head, the paper covering is not needed.
Clinical note임상 주석
痛者灸至不痛, 不痛者灸至痛 — burn the painful until it stops hurting and the painless until it starts. It is the same use of sensation as the needle test in 1.10, and the second half is the meaningful one: restoring feeling over an insensate area means living tissue has been reached. The garlic slice is there to keep the cone off the skin. A hundred cones over a boil is a burn, and the burn is itself a wound.
譯 1.15.4 Source원문
若十數頭作一處生者, 卽用大蒜硏成膏, 作薄餠鋪頭上, 聚艾于餠上灸之. 《三因》
Translation영역
If ten or more heads arise in one place, grind garlic to a paste, make a thin cake of it and spread it over the heads, gather moxa on the cake and burn it.
譯 1.15.5 Source원문
初發小點一二日, 急以蒜片貼其中心, 以小艾炷灸五壯而止. 《直指》
Translation영역
Where it has just broken out as a small point of a day or two, stick a garlic slice at once on its centre and burn five small moxa cones, then stop.
譯 1.15.6 Source원문
始發一二日, 十灸十活; 三四日, 六七活; 五六日, 三四活. 《綱目》
Translation영역
Burnt on the first or second day of its breaking out, ten in ten live; on the third or fourth day, six or seven; by the fifth or sixth day, only three or four.
Clinical note임상 주석
A survival figure by the day of treatment, falling from ten in ten to three or four in ten over five days. The numbers are not data in any sense a modern reader would accept, but the shape of the curve is the correct one for an untreated deep infection, and the Gangmok is using it to argue for early intervention. That argument is still the right one, with drainage and antibiotics in place of the moxa.
譯 1.15.7 Source원문
灸法所以暢達拔引鬱毒, 此從治之意也. 譬如盜入人家, 必開門逐之使出; 萬一門不開, 無從而出, 必傷主乃已. 《綱目》
Translation영역
The moxibustion method is a way of opening a path and drawing out the depressed toxin, and this is the sense of treating with the current. It is as when a thief has entered a house: the door must be opened and he driven out through it; and if by any chance the door is not opened, he has no way out and will surely injure the master before he is done.
Clinical note임상 주석
The thief and the open door is the best image in the chapter for why a closed suppuration has to be given an exit, and it is the same reasoning as 1.13's 過時不鍼烙, 反攻其內. The door is opened with a knife, not a moxa cone.
譯 1.15.8 Source원문
頭爲諸陽之會, 若有發, 宜灸艾炷宜小, 壯數宜少, 三五壯而已. 腹背則多灸爲妙. 《精要》
Translation영역
The head is the meeting of all the yang, and if an eruption is there the moxa cone used should be small and the number of cones few — three or five and no more. On the abdomen and back, burning many is better.
譯 1.15.9 Source원문
多灸則內服乳粉托裏散, 防火氣入心. 《丹心》
Translation영역
Where many cones are burnt, Yubuntakri-san 乳粉托裏散 is given inwardly to guard against the fire qi entering the heart.
譯 1.15.10 Source원문
有善治癰疽者, 皆於瘡上灸至二三百壯, 無有不愈. 但艾炷小作之, 小則人不畏灸, 灸多則作效必矣. 《資生》
Translation영역
Those who treat abscess well all burn two or three hundred cones on the sore, and none fails to heal. Only let the moxa cones be made small, for if they are small a man does not dread the burning, and if the burning is much the effect is certain.
Clinical note임상 주석
小則人不畏灸 — make the cones small and the patient will not dread it. The Jasaeng is being candid about compliance rather than about mechanism, and two or three hundred cones over an abscess is a full-thickness burn whatever their size. **This should not be attempted.**
譯 1.15.11 Source원문
隔蒜灸法ㆍ豆豉餠灸法ㆍ桑枝灸法ㆍ附子灸法ㆍ硫黃灸法ㆍ土餠灸法, 並治癰疽ㆍ惡瘡ㆍ腫毒詳見鍼灸.
Translation영역
The garlic-interposed, fermented-bean-cake, mulberry-twig, aconite, sulphur and earth-cake moxibustion methods all treat abscess, malign sores and swelling toxin — described in detail in the Acupuncture chapter.
1.15.1 A Case Proved by Moxibustion 艾灸治驗
譯 1.15.1.1 Source원문
一人發背, 醫療逾月, 勢益甚. 有張生者, 敎以艾火灸其上, 至一百五十壯, 知痛乃止. 明日鑷去黑痂, 膿盡潰, 肉理皆紅, 不復痛. 乃以膏藥貼之, 日一易, 易時剪去黑爛, 月餘乃平復. 《本事》
Translation영역
A man had an eruption on the back. The physicians treated it for more than a month and it grew worse. A certain Zhang taught him to burn moxa fire upon it, and at a hundred and fifty cones he felt the pain and they stopped. The next day the black crust was taken off with tweezers, the pus burst out entirely, the grain of the flesh was all red and it hurt no more. A plaster was then laid on and changed once a day, and at each change the black and rotten part was cut away; in rather more than a month he was restored.
Clinical note임상 주석
The one full case history in the chapter, and the sequence is worth reading closely: burning until sensation returns, the eschar lifted off the next day, the pus evacuated, red granulation underneath, then a dressing changed daily with the dead tissue trimmed at each change until it closed in a month. Strip out the moxa and that is debridement followed by serial dressing changes with sharp excision of slough — which is how a carbuncle on the back is still managed. 知痛乃止, stopping when he felt the pain, and 剪去黑爛, cutting away the black and rotten, are the two steps that did the work. It took a month, as it still does.
1.15.2 Burning the Stone Abscess 灸石癰法
譯 1.15.2.1 Source원문
堅硬不潰, 名曰石癰, 當上灸百壯, 石子當碎出. 《資生》
Translation영역
What is hard and will not burst is called the stone welling abscess; a hundred cones should be burnt over it, and the little stone will break up and come away.
Clinical note임상 주석
石癰 was described at 1.8.1 as hard, unchanged in colour and slow — the cold abscess of tuberculosis, or a chronic fibrous mass. A hundred cones will not break up anything in it.
1.15.3 Burning the Eruption at the Jaw 灸發頤法
譯 1.15.3.1 Source원문
此瘡最險, 頭面腫大, 牙齒亦脫. 解開頭髮, 尋頂螺中灸二十一壯; 如不達, 灸至四十九壯而止. 《直指》
Translation영역
This sore is the most perilous: the head and face swell large and the teeth even fall out. Undo the hair, find the whorl at the crown and burn twenty-one cones there; if it does not reach, burn up to forty-nine and stop.
Clinical note임상 주석
發頤, the eruption at the jaw, is 癰疽 上 4.11's section: a suppuration below the ear and along the jaw, which the chapter there connects to the aftermath of a febrile illness. Swelling of the whole head and face with teeth loosening is a deep facial and submandibular infection — Ludwig's angina spreading to the parapharyngeal space, or suppurative parotitis eroding the alveolus — and 最險 is the correct estimate: that infection obstructs the airway. The cones at the crown of the head are a treatment at the far end of the body from the disease. **Swelling of the jaw and floor of the mouth with difficulty swallowing is an airway emergency and needs surgical care at once.**
1.15.4 Burning the Clove Abscess 灸疔疽法
譯 1.15.4.1 Source원문
大蒜爛搗成膏, 塗瘡四圍, 留瘡頂, 以艾炷灸之, 以爆爲度, 不爆難愈. 灸百壯無不愈. 《正傳》
Translation영역
Pound garlic to a pulp and a paste, spread it round the four sides of the sore leaving the crown of the sore clear, and burn moxa cones over it, taking a popping sound as the measure; where there is no popping it is hard to heal. Burn a hundred cones and none fails to heal.
1.15.5 Burning the Groin Toxin 灸便毒法
譯 1.15.5.1 Source원문
用細草, 隨患人左右手, 量中指自手掌盡處橫紋量起, 通三節至指盡則住, 不量爪甲, 切斷. 却將此草於手腕橫紋量起, 引草向臂當中, 草盡處卽是穴. 艾炷如麥大, 灸二三壯, 腫散痛止卽安. 《得效》
Translation영역
Take a fine stalk and, following the patient's left or right hand, measure the middle finger from the transverse crease where the palm ends, through all three joints to the end of the finger, not measuring the nail, and cut it off there. Then lay this stalk from the transverse crease of the wrist and draw it up the middle of the forearm; where the stalk ends is the point. With a moxa cone the size of a barley grain, burn two or three cones, and when the swelling disperses and the pain stops he is well.
Clinical note임상 주석
A proportional measurement taken from the patient's own middle finger — the 同身寸 of the acupuncture tradition — used to site a point on the forearm for a lesion in the groin. 便毒 is 1.6's section: the inguinal bubo. Two cones on the forearm will not drain one.
1.16 Regulation and the Prohibitions 調理及禁忌法
譯 1.16.1 Source원문
癰疽患時將理法, 避風邪ㆍ少睡臥ㆍ勿驚憂ㆍ勿嗔怒ㆍ徐行動ㆍ省言語ㆍ戒閨房ㆍ絶思慮ㆍ防觸穢ㆍ聽好事ㆍ瘡頻洗ㆍ藥常助ㆍ盥漱聞香ㆍ二便順序ㆍ擇飮食內充無飢飽失度ㆍ付藥運掉屈伸瘡口常加愛護ㆍ妄用惡草愈滋其毒ㆍ不忌飮食反害其瘡. 《直指》
Translation영역
The method of management while suffering an abscess: avoid wind evil; sleep and lie little; do not be frightened or anxious; do not rage; move about slowly; be sparing of speech; abstain from the bedchamber; break off brooding; guard against contact with filth; listen to good things; wash the sore often; keep the drugs always at hand; wash and rinse the mouth and smell what is fragrant; keep the two excretions in order; choose the food and be filled within without losing the measure of hunger and fullness; in applying the drugs, in moving and in bending and stretching, always take care of the mouth of the sore; using bad herbs at random only feeds the toxin the more; and not abstaining in food and drink harms the sore instead.
Clinical note임상 주석
Eighteen rules, and three of them are the ones a modern reader would keep: 瘡頻洗, wash the sore often; 防觸穢, keep filth away from it; and 瘡口常加愛護, protect the mouth of the wound in moving and dressing it. Wound hygiene and avoiding contamination are the whole of what the period could offer against infection, and the Jikji has put them on the list without knowing why they work. 妄用惡草愈滋其毒 — bad herbs applied at random only feed the toxin — is also worth noting, given what the rest of this chapter proposes to apply.
譯 1.16.2 Source원문
惡肉去盡, 瘡口收歛, 欲平之際, 尙忌起立行步ㆍ揖待賓客ㆍ酒肉宴會ㆍ嗔怒沐浴ㆍ勞動等事. 直待瘡痂平復, 精神如故, 氣力完全, 方無所忌. 百日內愼勿觸犯. 《精義》
Translation영역
When the malign flesh is all gone, the mouth of the sore is drawing together and it is about to be level, there are still to be avoided standing and walking, bowing to guests, feasting with wine and meat, raging, bathing and hard work. Only when the scab of the sore is fully restored, the spirit as before and the strength complete, is there nothing to avoid. Within a hundred days take care not to transgress.
譯 1.16.3 Source원문
癰疽最宜節愼飮食. 其熱毒方盛, 或發大渴, 多飮冷水及水漿之類, 此乃毒氣攻心, 令口乾煩溫. 但以心氣藥內補藏府卽止矣. 《丹心》
Translation영역
In abscess, moderation and care in food and drink are most needed. Where the toxic heat is at its height and a great thirst may arise, so that he drinks much cold water and thin gruels and the like — this is the toxic qi attacking the heart, making the mouth dry and vexedly warm. Only supplement the viscera within with heart-qi drugs and it stops.
Clinical note임상 주석
The one instruction in the chapter that would do positive harm. A febrile patient with a large suppuration who is drinking cold water in quantity is replacing what the fever is taking out of him, and the thirst is the body asking correctly. Restricting his fluid would make him worse. 1.11.1 states the same doctrine; both are wrong in the same place.
譯 1.16.4 Source원문
凡癰疽勿食羊ㆍ雞ㆍ牛ㆍ鵝ㆍ魚ㆍ麵ㆍ煎煿ㆍ灸炒ㆍ法酒等味, 犯之必發熱. 盖厚味能引起宿火之熱. 此誠富貴豢養口腹者所宜謹守. 若冬寒與虛老人, 寧無權法乎. 略加滋味以補胃氣, 庶易收歛. 《丹心》
Translation영역
In abscess generally, do not eat mutton, chicken, beef, goose, fish, wheat-flour food, what is fried or seared, what is roasted or parched, or brewed wine and such flavours; transgressing in them will surely bring fever. For rich flavours can draw up the heat of an old fire. This indeed is what the rich, who have fed their mouths and bellies, ought carefully to keep. But for the cold of winter, and for the vacuous and the aged, is there to be no latitude? Add a little savour to supplement the stomach qi, and the drawing-together will come the more easily.
Clinical note임상 주석
A long prohibition on animal protein, and then the Dansim taking it back for the old and the depleted in the same breath. The exception is the better medicine: a patient healing a large wound needs protein, and withholding meat from an elderly man with a draining abscess delays the closure the chapter is trying to hasten. The author's instinct that the frail need 滋味 is right even though his reasoning runs through the stomach qi.
譯 1.16.5 Source원문
膿潰之後, 氣血虛弱, 則可食羊肉ㆍ鵪鶉ㆍ蔓菁ㆍ蘿葍ㆍ薑醬ㆍ苽薺ㆍ稀粥ㆍ軟飯. 若肌肉漸生, 思想滋味, 則宜食白熟酥餠ㆍ虀粥ㆍ羹湯, 熟軟溫和, 勿令大飽. 《精義》
Translation영역
After the pus has burst, where the qi and blood are vacuous and weak, he may eat mutton, quail, turnip, radish, ginger and fermented paste, melon and shepherd's purse, thin gruel and soft rice. If the flesh is gradually growing and he has a mind for savour, he should eat plain-boiled butter cakes, pickle gruel and broths — cooked soft, warm and mild — and should not be let eat to full satiety.
Clinical note임상 주석
The constructive counterpart to the prohibition: after drainage, feed him, softly and often and not to repletion. Mutton and quail are protein, the root vegetables and gruels are what a weak patient can keep down, and 肌肉漸生 — the flesh growing again — is the endpoint. This is nutritional support of a healing wound, and the Jeongui has it right.
譯 1.16.6 Source원문
諸痛痒瘡瘍皆屬於心, 如茯苓ㆍ茯神ㆍ遠志ㆍ益智ㆍ石菖蒲等輩須當佐助於其間. 抑使病人不得憂恐ㆍ嗔怒ㆍ勞精疲神, 有觸於心, 尤關利害. 《直指》
Translation영역
All pains, itchings and sores belong to the heart, and such drugs as poria, poria-with-wood, polygala, bitter cardamom and acorus should be used as assistants among them. And keeping the patient from anxiety and fear, from rage, from wearing out his essence and tiring his spirit, from anything that strikes at the heart, bears still more on whether he does well or ill.
譯 1.16.7 Source원문
背疽之人難於隱. 凡用菉豆十餘斗作一大袋, 隱伏則自然心凉身安. 《精要》
Translation영역
A man with an abscess on the back has difficulty lying against anything. Take ten and more mal of mung beans and make one large sack of them, and lying back on it the heart is naturally cooled and the body at ease.
Clinical note임상 주석
A bean-bag mattress for a patient who cannot lie on his back. That is pressure relief, and it is the same reasoning behind every modern support surface: a man immobilized with a carbuncle on his back will ulcerate where he rests unless the load is spread. The mung beans conform to the body and the chapter credits the coolness; the mechanism is the conforming.
譯 1.16.8 Source원문
瘡瘍面赤, 雖伏火熱, 禁不得攻裏, 宜發表以去之.
Translation영역
Where the face is red in a sore, though fire-heat lie hidden, attacking the interior is forbidden; the surface should be opened to take it away.
譯 1.16.9 Source원문
瘡瘍鬰冒, 俗呼昏迷, 愼不可下, 汗之則愈. 《東垣》
Translation영역
The depressed covering-over of a sore, commonly called clouded confusion, must on no account be precipitated; sweating it heals it.
Clinical note임상 주석
昏迷 in a patient with a suppurating sore is the altered consciousness of sepsis, which 1.11.6 and 1.10.6 both record as grave. Dongwon forbids purging it, which is at least a restraint; sweating it is not a treatment. Confusion appearing in a patient with an infected wound is the sign to escalate care, and it is the sign the chapter names most often without being able to act on it.
1.17 Simple Medicinals 單方
譯 1.17.1 Translation영역
Thirty-seven kinds in all. There is Dojam-go 陶潛膏, Tao Qian's Paste.
Clinical note임상 주석
The count settles the misbinding recorded in this chapter's base_note. As the leaves are bound, only twenty items stand between the heading and the opening of 諸瘡; the other seventeen are on 020a and 020b, which the binder placed after the 諸瘡 heading. Read in the order the transcriber reconstructs — 018b, then 020a and 020b, then 019a and 019b — the items come to exactly thirty-seven, and the list ends with the two human substances, as the materia medica ordering requires. The 諸瘡 text broken off at the foot of 019b is also what 021a resumes. They are printed here in that reconstructed order.
譯 1.17.2 Source원문
朱砂雄黃 古之瘍醫以五毒攻瘍中物也. 凡解瘡毒, 不可無雄黃ㆍ朱砂. 《本草》
Translation영역
Cinnabar and realgar (朱砂雄黃): The sore-physicians of old used the five poisons to attack what was in the sore. In resolving the toxin of a sore generally, realgar and cinnabar cannot be dispensed with.
譯 1.17.3 Source원문
朱砂ㆍ雄黃ㆍ膽礬ㆍ白礬ㆍ磁石置瓦盒中, 火煆三日夜, 其烟上着盖中, 以雞羽掃取之, 以注惡瘡, 則惡肉附骨膿血卽潰出而愈. 此五毒也. 《入門》
Translation영역
Put cinnabar, realgar, blue vitriol, alum and magnetite in an earthenware box and calcine them in fire for three days and nights; the fume settles above inside the lid, and it is swept up with a fowl's feather and poured into the malign sore, whereupon the malign flesh, the bone-adhering pus and the blood burst out and it heals. These are the five poisons.
Clinical note임상 주석
**This preparation must not be made or used.** Calcining cinnabar and realgar together drives off mercury and arsenic, and the sublimate swept from the lid is a concentrate of both, with copper from the vitriol. Poured into an open wound over a bone it is absorbed directly. The 五毒 of the old sore-physicians is named honestly — these are poisons, and the escharotic effect the Immun describes is the chemical destruction of living tissue along with the dead. The thing it was reaching for, removing necrotic tissue and bone-adherent pus, is now done with a blade.
譯 1.17.4 Source원문
伏龍肝 諸癰疽發背ㆍ一切腫毒, 以雞子黃和塗之, 或醋調, 或大蒜同硏貼之, 並佳. 《本草》
Translation영역
Furnace earth (伏龍肝): For abscesses of every kind, the eruption on the back and all swelling toxins, mix it with egg yolk and spread it on, or stir it with vinegar, or grind it with garlic and stick it on — all are good.
譯 1.17.5 Source원문
煉石 諸惡腫及發背, 取石子火燒赤, 醋淬十餘度, 取屑爲末, 醋調塗之卽愈. 此造磨磑尋常石也. 《本草》
Translation영역
Calcined stone (煉石): For malign swellings of every kind and the eruption on the back, take a small stone, burn it red in the fire and quench it in vinegar ten times and more, take the flakes and powder them, stir with vinegar and spread it on, and it heals. This is the ordinary stone of which millstones are made.
譯 1.17.6 Source원문
甘菊 治癰毒及疔腫垂死. 菊葉搗取汁, 飮一升, 神驗. ○又取莖葉塗付疔上亦效, 名曰陶潛膏. 《醫鑑》
Translation영역
Chrysanthemum (甘菊): Treats abscess toxin and the clove swelling when he is at the point of death. Pound chrysanthemum leaf, take the juice and drink one seung; the effect is marvellous. ○ Taking the stem and leaf and spreading them on the clove is also effective, and this is named Tao Qian's Paste.
譯 1.17.7 Source원문
野菊花 治疔瘡. 野菊花ㆍ菉豆爲末, 酒調飮, 醉睡覺, 痛定熱除. 《入門》
Translation영역
Wild chrysanthemum flower (野菊花): Treats the clove sore. Powder wild chrysanthemum flower and mung bean, stir it in wine and drink; he sleeps drunk, and on waking the pain is settled and the heat gone.
譯 1.17.8 Source원문
生地黃 治一切癰腫. 地黃搗爲泥, 攤布上, 糝木香末於中, 再攤地黃泥, 貼腫上, 三度差. 《本草》
Translation영역
Fresh rehmannia (生地黃): Treats all abscess swellings. Pound rehmannia to a pulp, spread it on cloth, sprinkle powdered costus in the middle, spread rehmannia pulp over it again and stick it on the swelling; in three applications it is cured.
譯 1.17.9 Source원문
茺蔚莖葉 療疔瘡ㆍ乳癰及諸毒腫. 搗取汁飮之, 滓外付. 《本草》
Translation영역
Leonurus stem and leaf (茺蔚莖葉): Cures the clove sore, the breast abscess and all toxic swellings. Pound it, take the juice and drink it, and apply the dregs outwardly.
譯 1.17.10 Source원문
白鳳仙花 治癰疽發背. 取花連根葉搗爛, 先以米醋洗患處, 後付藥, 一日一換, 如神. 《回春》
Translation영역
White garden balsam (白鳳仙花): Treats abscess and the eruption on the back. Take the flower with its root and leaf and pound it to a pulp; first wash the affected place with rice vinegar, then apply the drug, changing it once a day, with marvellous effect.
Clinical note임상 주석
先以米醋洗患處 — wash the place first, then dress it. Cleansing a wound before applying anything, and renewing the dressing daily, is the part of this recipe that does work, and it is the same sequence as the case at 1.15.1.
譯 1.17.11 Source원문
薜荔 治背癰. 取葉爛硏取汁, 和蜜飮數升, 以滓付瘡上. 一方, 細硏和酒, 絞取汁, 煎數沸服之. 《本草》
Translation영역
Climbing fig (薜荔): Treats the abscess on the back. Take the leaf, grind it to a pulp and take the juice, give several seung of it mixed with honey, and apply the dregs to the sore. In another method, grind it fine with wine, wring out the juice, bring it to a boil several times and take it.
譯 1.17.12 Source원문
黃芪 治癰疽久敗瘡, 排膿止痛, 濃煎服之. 內托陰證瘡瘍必用之藥也. 《東垣》
Translation영역
Milkvetch (黃芪): Treats abscess and the long-spoiled sore, expels pus and stops pain; boil it thick and take it. It is the drug that must be used to thrust outward from within in the yin-pattern sore.
Clinical note임상 주석
久敗瘡 — the long-spoiled sore, which is the chronic non-healing ulcer, and 內托陰證 is the cold, flat, undemarcated lesion of 癰疽 上 4.17. Milkvetch is the chapter's drug for both, and it is the one internal medicine in this list that the tradition used with real consistency rather than as one option among twenty.
譯 1.17.13 Source원문
忍冬藤 治一切癰疽腫毒. 花莖與葉生搗, 煖酒調服. 《直指》
Translation영역
Honeysuckle vine (忍冬藤): Treats all abscess and swelling toxins. Pound the flower, stem and leaf fresh and take them stirred into warm wine.
Clinical note임상 주석
Honeysuckle is the thread running through both parts of this chapter — 癰疽 上 4.2's 忍冬茶常服最佳, the three 忍冬 preparations of 1.12, and this. It has demonstrable antibacterial activity in the laboratory, which is more than can be said for most of the list, and is still not a treatment for a collection of pus.
譯 1.17.14 Source원문
蒼耳 主疔瘡. 取莖葉燒存性, 醋調塗疔上, 當出根, 加雄黃尤妙. ○又方, 蒼耳 一握, 生薑 四兩, 搗取汁, 入酒和服, 治疔毒入心嘔逆者效. 《入門》
Translation영역
Cocklebur (蒼耳): Governs the clove sore. Take the stem and leaf, burn them with their nature kept, stir with vinegar and spread on the clove, and the root should come out; adding realgar is better still. ○ Another method: a handful of cocklebur and 4 nyang of fresh ginger, pounded for their juice and taken mixed in wine, is effective where the clove toxin has entered the heart and there is retching counterflow.
譯 1.17.15 Source원문
白芷 治發背ㆍ乳癰, 能止痛生肌蝕膿. ○敗膿不去, 加白芷卽去. 《丹心》
Translation영역
Angelica dahurica (白芷): Treats the eruption on the back and the breast abscess; it can stop pain, breed flesh and eat away pus. ○ Where spoiled pus will not clear, add angelica and it clears.
譯 1.17.16 Source원문
茅鍼 癰毒惡瘡不作頭, 酒煎茅鍼取汁服, 一鍼一孔, 二鍼二孔, 必穿穴. 《本草》
Translation영역
Reed spear (茅鍼): Where an abscess toxin or malign sore makes no head, boil reed spears in wine, take the liquid and drink it: one spear one hole, two spears two holes — it will surely pierce an opening.
Clinical note임상 주석
一鍼一孔, 二鍼二孔 — one spear one hole, two spears two. The arithmetic is sympathetic magic built on the name of the drug, the reed's pointed shoot being called a 鍼, a needle. It is the clearest case in the chapter of a remedy chosen for what it is called rather than for anything it does.
譯 1.17.17 Source원문
大黃 治癰疽熱毒. 大黃酒洗剉 二錢, 甘草 一錢, 煎服. 脉實膏粱之人宜服. 《綱目》
Translation영역
Rhubarb (大黃): Treats the toxic heat of abscess. Rhubarb, washed in wine and chopped, 2 don, and licorice 1 don, boiled and taken. It suits those of replete pulse who live on rich food and fine grain.
譯 1.17.18 Source원문
茨菰 取根莖搗付腫毒癰上卽消, 水煎服亦效. 《俗方》
Translation영역
Arrowhead (茨菰): Take the root and stem, pound them and apply them on the swelling toxin or abscess and it disperses; boiled in water and taken it is also effective.
譯 1.17.19 Source원문
槐花 治百種瘡毒. 槐花 四兩炒香, 入酒二椀, 煎二三沸, 去滓盡服卽消. 《入門》
Translation영역
Pagoda tree flower (槐花): Treats a hundred kinds of sore toxin. Pagoda tree flower 4 nyang, parched fragrant, put into two bowls of wine, boiled two or three times; strain off the dregs and drink it all, and it disperses.
譯 1.17.20 Source원문
黃桑葉 癰疽瘡口成大窟不歛, 經霜黃桑葉爲末, 頻糝瘡中, 或煎湯洗之. 《本草》
Translation영역
Yellow mulberry leaf (黃桑葉): Where the mouth of an abscess sore has become a great cavern and will not draw together, powder frost-touched yellow mulberry leaf and sprinkle it often into the sore, or boil it and wash with the decoction.
Clinical note임상 주석
成大窟不歛 — a cavity that will not close. That is the chronic abscess cavity or sinus of 1.8's 附骨疽 and 1.8.1's 石癰, and nothing sprinkled into it closes it: a cavity persists while it has dead bone or a foreign body at the bottom, or an epithelialized track. The washing is of some use in keeping it clean.
譯 1.17.21 Source원문
乳香 止痛長肉, 令諸瘡內消. ○凡血滯則氣壅, 經絡滿急而作痛腫. 乳香能破宿血ㆍ消腫止痛, 爲瘡家奇藥也. 《入門》
Translation영역
Frankincense (乳香): Stops pain and grows flesh, and makes sores of every kind disperse from within. ○ Wherever blood stagnates the qi is dammed, and the channels and network vessels, full and tense, make pain and swelling. Frankincense can break up old blood, disperse swelling and stop pain, and is the marvellous drug of the sore-doctors.
譯 1.17.22 Source원문
皂角刺 治癰疽, 能鑽引至痛處, 亦能宣毒. 燒存性爲末, 薄酒調下一錢. 《綱目》
Translation영역
Gleditsia thorn (皂角刺): Treats abscess; it can bore its way to the painful place and can also diffuse the toxin. Burn it with its nature kept, powder it, and send down 1 don stirred in thin wine.
譯 1.17.23 Source원문
槲木皮 煎湯洗諸敗爛瘡及乳癰諸瘡最佳. 《本草》
Translation영역
Oak bark (槲木皮): Boiled and used as a wash for all spoiled and rotting sores and for the breast abscess and every sore, it is the best.
Clinical note임상 주석
Oak bark is tannin, and a tannin wash does astringe a weeping surface. Of the washes in this list it is the one with a plausible effect on a discharging ulcer, though it treats the surface and not the cause.
譯 1.17.24 Source원문
生龜 刺取血, 塗癰疽腫毒卽消, 神驗. 《俗方》
Translation영역
Live tortoise (生龜): Pierce it, take the blood and spread it on the abscess or swelling toxin, and it disperses; the effect is marvellous.
Clinical note임상 주석
**Blood must not be put on an open sore.** The same objection applies as to 1.10.2's substituted relative's blood: it is a culture medium laid on an infected surface. The label 《俗方》 marks this as a domestic recipe rather than a cited authority.
譯 1.17.25 Source원문
蜘蛛 治懸癰. 取大者一箇, 硏爛調服, 隨病左右側臥良. 《醫林》
Translation영역
Spider (蜘蛛): Treats the hanging abscess. Take one large one, grind it to a pulp and take it stirred up, lying on the side according to which side the disease is on.
Clinical note임상 주석
懸癰 is 1.5's section — the perineal abscess between the anus and the genitals. The spider appears there too, at 1.10.8, as a thing to be set on the sore; here it is swallowed.
譯 1.17.26 Source원문
脂麻油 治癰疽發背毒瘡. 初作便服, 使毒氣不內攻. 麻油煎十餘沸, 候冷一斤, 好酒二椀, 和勻, 分五次溫服, 一日夜服盡, 此神仙截法. ○亦解陰證沉毒. 《直指》
Translation영역
Sesame oil (脂麻油): Treats abscess, the eruption on the back and the toxic sore. Take it as soon as it begins, so that the toxic qi does not attack inward. Boil sesame oil ten times and more and let it cool — one geun of it with two bowls of good wine, mixed even, divided into five portions and taken warm, drinking it all within a day and a night: this is the immortals' method of cutting it off. ○ It also resolves the sunken toxin of the yin pattern.
譯 1.17.27 Source원문
雄雀屎 一名白丁香. 治癰腫已有膿未潰出, 以醋調雀屎如小豆大付之, 卽穿出膿. 《本草》
Translation영역
Cock sparrow droppings (雄雀屎): Also named white clove-spice. Treats the abscess swelling that already has pus but has not burst; stir sparrow droppings with vinegar to the size of a small bean and apply it, and the pus is pierced out at once.
Clinical note임상 주석
**Bird droppings must not be applied to a sore.** What the recipe is for is real — a collection with pus in it that has not opened — and the answer to that is the knife of 1.13, not a caustic that happens to be filth. 白丁香 as the drug-name for this is worth recording: the transcription of 諸瘡 uses the same name.
譯 1.17.28 Source원문
甛瓜子 主腹內結聚, 破潰膿血, 最爲腸胃腹內癰要藥. 爲末, 酒下二三錢. 《本草》
Translation영역
Melon seed (甛瓜子): Governs binding and gathering within the abdomen and breaks and bursts pus and blood; it is the chief drug for the abscess within the stomach, intestines and abdomen. Powder it and send down 2 or 3 don in wine.
Clinical note임상 주석
腸胃腹內癰 is this chapter's opening section, 1.1 腸癰腹癰 — the intra-abdominal abscess, and appendicitis among it. The melon seed is the 本草's nomination for it, and this is the single named simple for the one lesion in the chapter that the period could do least about.
譯 1.17.29 Source원문
蜀葵花 諸癰瘡腫痛不可忍, 葵花根爛搗貼之, 立效. 黃蜀葵花葉入鹽硏爛付之亦效. 《綱目》
Translation영역
Hollyhock flower (蜀葵花): Where the swelling and pain of an abscess or sore of any kind cannot be borne, pound hollyhock root to a pulp and stick it on, with immediate effect. Grinding yellow hollyhock flower and leaf to a pulp with salt added and applying it is also effective.
譯 1.17.30 Source원문
葫 小蒜也. 治癰毒瘡腫叫呼不得臥. 取獨頭蒜紀搗, 麻油調和, 厚付瘡上, 乾則易, 神效. 《本草》
Translation영역
Garlic (葫): This is the small garlic. Treats the abscess toxin and sore swelling in which he cries out and cannot lie down. Take single-headed garlic, pound it, mix it with sesame oil, apply it thickly on the sore and change it when it dries, with marvellous effect.
譯 1.17.31 Source원문
人口中唾 凡癰癤微有紅頭隱疼者, 急用不語津唾頻頻塗之自消. 飮酒了不可用. 《綱目》
Translation영역
Human spittle (人口中唾): Wherever an abscess or boil has a faint red head and an obscure pain, use at once the spittle gathered without speaking, spreading it on often, and it disperses of itself. It must not be used after drinking wine.
Clinical note임상 주석
**Saliva must not be put on a sore.** The human mouth carries the organisms that cause the worst of the hand and face infections this chapter describes, and a bite or a saliva-contaminated wound is treated as infected from the start. 飮酒了不可用 shows the author thinking about what was in the spittle; he was looking at the wrong variable.
譯 1.17.32 Source원문
猪懸蹄 治癰疽潰爛. 取猪蹄濃煎取淸, 浸洗妙. 《直指》
Translation영역
Pig's dew-claw (猪懸蹄): Treats the burst and rotting abscess. Take pig's trotter, boil it thick, take the clear part and soak and wash with it; this is excellent.
Clinical note임상 주석
A boiled trotter decoction used as a wound soak. Boiling makes it clean, which is more than can be said for most of what this section applies, and soaking a sloughing wound in warm fluid does loosen slough. It is a dressing technique dressed as a drug.
譯 1.17.33 Source원문
商陸 熨除癰腫, 付惡瘡. ○一切熱毒腫, 商陸根和少鹽搗付, 日一易, 效. 《本草》
Translation영역
Phytolacca (商陸): Ironed on, it removes the abscess swelling, and it is applied to malign sores. ○ For all heat-toxin swellings, pound phytolacca root with a little salt and apply it, changing it once a day, with effect.
譯 1.17.34 Source원문
苧根 癰疽發背未成膿者, 苧根葉熟搗付上, 日數易, 腫消卽差. 《本草》
Translation영역
Ramie root (苧根): Where an abscess or eruption on the back has not yet formed pus, pound ramie root and leaf well and apply them, changing them several times a day; the swelling disperses and he is cured.
譯 1.17.35 Source원문
醋 消癰腫. 歌曰, 發背疔瘡識者稀, 醋磨京墨遶四圍, 生薑猪膽同塗上, 天明恰似鬼神移. 《種杏》
Translation영역
Vinegar (醋): Disperses the abscess swelling. The verse says: Of the back-eruption and the clove sore, few are they that know; / Grind capital ink in vinegar and ring it round about; / Ginger and pig's gall spread together over it, / And by daybreak it is as though spirits had moved it away.
Clinical note임상 주석
醋磨京墨遶四圍 — ring the lesion round with ink. Drawing a line at the edge of a spreading redness and seeing in the morning whether it has crossed the mark is still done, and it is the only way to tell by looking whether a cellulitis is advancing. The verse means it as a treatment and credits the spirits with the result; as a way of watching the margin it is sound practice.
譯 1.17.36 Source원문
赤小豆 消熱毒癰腫. 作末, 雞子淸調塗之卽差. 亦治一切腫毒作痛. 《本草》
Translation영역
Adzuki bean (赤小豆): Disperses the heat-toxin abscess swelling. Make it into powder, stir it with egg white, spread it on and he is cured. It also treats all swelling toxins that give pain.
譯 1.17.37 Source원문
芙蓉 治發背ㆍ瘡癤ㆍ諸般腫毒及杖瘡. 芙蓉花及葉並晒乾爲末, 醋調付; 杖瘡, 雞白淸調. 白蓮尤佳. 《丹心》
Translation영역
Cotton rose (芙蓉): Treats the eruption on the back, sores and boils, swelling toxins of every kind, and the cudgel wound. Sun-dry cotton rose flower and leaf together, powder them and apply them stirred with vinegar; for the cudgel wound, stir them with egg white. The white lotus is better still.
譯 1.17.38 Source원문
荊芥 搗爛和醋付疔腫甚效. 又水煎取濃汁服之亦可. 《本草》
Translation영역
Schizonepeta (荊芥): Pounded to a pulp and mixed with vinegar and applied to the clove swelling, it is very effective. Boiled in water and the thick liquid taken, it will also serve.
譯 1.17.39 Source원문
人屎 癰疽發背欲死, 取野人乾屎燒存性, 醋和如泥付腫上, 乾則易, 甚良. 又治疔腫, 封其上一日根爛. 《本草》
Translation영역
Human faeces (人屎): Where in abscess or the eruption on the back he is at the point of death, take dried faeces found in the open, burn them with their nature kept, mix them with vinegar to a pulp and apply them on the swelling, changing it when it dries; it is very good. It also treats the clove swelling: seal it over and in a day the root rots away.
Clinical note임상 주석
**This must not be done.** Faeces applied to an open wound is the classical route to tetanus, and the chapter has already described trismus at 1.10.1 without connecting it to the dressings it recommends. The list closes with the two human substances, as the materia medica ordering requires, and they are the two most dangerous things in it.
About this translation 凡例
Base text: Donguibogam (東醫寶鑑, 1613 first edition), Miscellaneous Disorders, Volume 8, Abscesses chapter, second part. The Chinese text is collated against the Kyujanggak transcription of the 1613 edition; collation notes are given on the passages they concern. The transcriber records that leaves 019a and 019b of this volume are bound out of order and belong after 20b; the text is read in its intended order and the note is given at the Single Remedies section. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.