寶鑑Bogam

Formulas · Text · Donguibogam 東醫寶鑑

The Skin

Pi

한글 피부  ·  Pinyin Pi

The twelve channels have their territories in the skin — reading disease by colour, the macule and the papule, and why an itch is a mild heat and a pain a severe one

皮

The skin in this chapter is not a covering but a map. The twelve channels each have a territory in it, and the Suwen's instruction is to look at the floating network vessels in a territory and read the colour: mostly blue-green means pain, mostly black means impediment, yellow and red mean heat, mostly white means cold, and all five colours showing at once means alternating chills and fever. Beneath that the chapter is the lung's, since the lung pairs with the skin and its flourishing is in the body hair — and the interstices, the 腠理 where fluids seep out, are also called the dark palace, because a sweat pore is dark and sweat gathers inside before it comes out. On disease the organizing distinction is the plainest in the book: a coloured spot without a grain is a macule, a small raised spot with a grain is a papule. Then Hejian's remarkable argument about itch — that itch and pain are the same thing at different intensities, that a mild heat itches and a severe heat hurts, and that scratching relieves an itch because the friction is itself a small fire that disperses the greater one. The rest divides between rashes read as heat in the blood coming out (the macular eruptions, with the warning that a sparse faint yin-pattern eruption must never be given cooling medicines), rashes read as wind in the skin (hidden rash, prickly heat, cinnabar toxin), numbness read as yang qi failing to travel — with Dongwon's observation that numbness present only when the eyes are shut proves the point — and at the end the discolorations and moles, where the chapter's pharmacy turns to lye, lead and arsenic and stops being usable at all.

7.1 The Skin Has Its Territories 皮有部分

7.1.1
Source원문

凡十二經絡者, 皮之部也. 視其部中浮絡, 其色多靑則痛, 多黑則痺, 黃赤則爲熱, 多白則寒, 五色皆見則寒熱也. 絡盛則入客於經, 陽主外, 陰主內. 《內經》

Translation영역
The twelve channels and network vessels are the territories of the skin. Look at the floating network vessels within a territory: where the colour is mostly blue-green there is pain, mostly black there is impediment, yellow and red means heat, mostly white means cold, and when all five colours appear there are chills and fever. When the network vessels are full, the evil enters and lodges in the channel; the yang governs the outside and the yin the inside.

Naegyeong 內經

7.1.2
Source원문

皮者脈之部也. 十二經皆有部分, 不與而生大病也. 不與者, 不與他脈同色也. 《內經》

Translation영역
The skin is the territory of the vessels. All twelve channels have their divisions in it, and where one does not agree, a great disease arises. Not agreeing means not being the same colour as the other vessels.
Clinical note임상 주석
The chapter opens with a diagnostic method rather than an anatomy: the skin is divided into channel territories, and what is read in each is the colour of the superficial vessels. The second entry gives the rule that makes it workable — what matters is not a colour in itself but a territory whose colour disagrees with its neighbours.

Naegyeong 內經

7.2 The Skin and Body Hair Belong to the Lung 皮毛屬肺

7.2.1
Source원문

內經曰, 肺之合皮也, 其榮毛也. 又云, 肺主皮毛. 又云, 在藏爲肺, 在體爲皮毛. ○邪在肺, 則病皮膚痛. 《靈樞》

Translation영역
The Neijing says: what the lung pairs with is the skin, and its flourishing is in the body hair. It also says the lung governs the skin and body hair; and that in the viscera it is the lung, in the body the skin and hair. When evil is in the lung, the disease is pain of the skin.

Naegyeong 內經 · Yeongchu 靈樞

7.2.2
Source원문

皮膚亦曰腠理. 津液滲泄之所曰腠, 文理縫會之中曰理. 《內經》

Translation영역
The skin is also called the interstices. The place where the fluids seep out is the 腠; the seams and junctions of the grain of the flesh are the 理.

Naegyeong 內經

7.2.3
Source원문

腠理亦曰玄府. 玄府者, 汗孔也. 汗液色玄, 從空而出, 以汗聚於裏, 故謂之玄府. 府, 聚也. 《內經》

Translation영역
The interstices are also called the dark palace. The dark palace is the sweat pore. The sweat is dark in colour and comes out through an opening; and because the sweat gathers within, it is called the dark palace — 府 meaning a gathering place.
Clinical note임상 주석
Three names for one thing, each carrying a different claim. The skin belongs to the lung, which is why lung-visceral wind later in the chapter appears as an itch; the interstices are where fluid passes, which is why sweating is the chapter's commonest mechanism; and the dark palace is the pore considered as a reservoir, which is the reading behind treating a sweat rash by drying rather than by opening.

Naegyeong 內經

7.3 Wind and Cold Evils Enter the Skin and Hair First 風寒之邪先入皮毛

7.3.1
Source원문

百病之始生也, 必先於皮毛. 邪中之則腠理開, 開則入客於絡脈, 留而不去, 傳入於經, 留而不去, 傳入於府, 廩於腸胃. 邪之始入於皮也, 泝然起毫毛, 開腠理; 其入於絡也, 則絡脈盛色變; 其入客於經也, 則感虛乃陷下; 其留於筋骨之間, 寒多則筋攣骨痛, 熱多則筋弛骨消, 肉爍䐃破, 毛直而敗. 《內經》

Translation영역
The beginning of every disease is necessarily in the skin and body hair. When evil strikes it the interstices open, and once open the evil enters and lodges in the network vessels; lodging there and not leaving, it passes into the channel; lodging there and not leaving, it passes into the bowels and is stored up in the intestines and stomach. When the evil first enters the skin, the body hair rises with a shiver and the interstices open; when it enters the network vessels, those vessels fill and the colour changes; when it enters and lodges in the channel, it meets vacuity and sinks downward; and when it lodges between sinew and bone, much cold makes the sinews cramp and the bones ache, while much heat slackens the sinews, wastes the bone, melts the flesh, breaks the muscle bulk, and leaves the hair standing straight and spoiled.
Clinical note임상 주석
The classic statement of depth in this medicine, and the reason a skin chapter sits where it does: the skin is not a minor territory but the first one, and everything serious begins by passing through it. The sequence — hair, interstices, network vessels, channel, bowel — is also a prognosis, and the last clause describes cachexia.

Naegyeong 內經

7.4 The Pulse 脉法

7.4.1
Source원문

脈浮而大, 浮爲風虛, 大爲氣强, 風氣相搏, 以成癮疹, 身體爲痒. 痒者名泄風, 久久爲痂癩. 《仲景》

Translation영역
When the pulse is floating and large, the floating is wind vacuity and the large is strong qi; wind and qi beating against each other make a hidden rash, and the body itches. The itch is called draining wind, and in time it becomes a scabbed leprosy.

Junggyeong 仲景

7.4.2
Source원문

斑疹之脈, 陽浮而數, 陰實而大. 火盛而表, 故陽脈浮數; 下焦實熱, 故陰脈實大. 《正傳》

Translation영역
In the pulse of macules and papules the yang is floating and rapid and the yin replete and large. The fire is exuberant and at the exterior, so the yang pulse is floating and rapid; the lower burner is replete with heat, so the yin pulse is replete and large.

Jeongjeon 正傳

7.4.3
Source원문

脈多沈伏, 或細而散, 或絶無. 《正傳》 ○滑伯仁曰, 脈者血之波灡, 發癍者血散於皮膚, 故脈伏. 《正傳》

Translation영역
The pulse is mostly sunken and hidden, or fine and scattered, or altogether absent. Hwal Baekin said: the pulse is the wave of the blood, and in a macular eruption the blood has scattered into the skin, so the pulse hides.

Jeongjeon 正傳

7.4.4
Source원문

脈浮而濡屬氣虛, 關前得之麻在上體, 關後得之麻在下體. 《正傳》

Translation영역
A floating soggy pulse belongs to qi vacuity; found before the bar the numbness is in the upper body, found behind the bar it is in the lower.

Jeongjeon 正傳

7.4.5
Source원문

脈浮而緩屬濕, 爲麻痺; 脈緊而浮屬寒, 爲痛痺; 脈濇而芤屬死血, 爲木不知痛痒. 《正傳》

Translation영역
A floating moderate pulse belongs to damp and makes numb impediment; a tight floating pulse belongs to cold and makes painful impediment; a rough hollow pulse belongs to dead blood and makes a woodenness that feels neither pain nor itch.
Clinical note임상 주석
Two pulses worth holding. Hwal Baekin's explanation of why the pulse hides in a macular eruption — the blood has gone out of the vessel into the skin, so there is less wave to feel — is a mechanical argument, and it is the right one to make about a petechial rash. And the three-way split of impediment by pulse quality is the chapter's own way of deciding between damp, cold and static blood in a numb limb.

Jeongjeon 正傳

7.5 Itching and Pain 痒痛

7.5.1
Source원문

痒痛生於皮毛. ○內經曰, 諸痒爲虛. 血不榮肌腠, 所以痒也. 當以滋補藥以養陰血, 血和肌潤, 痒自不作. 《丹心》

Translation영역
Itching and pain arise in the skin and body hair. The Neijing says all itching is vacuity: the blood is not flourishing in the flesh and its interstices, and that is why it itches. One should use enriching and supplementing medicines to nourish the yin blood, and when the blood is harmonious and the flesh moist the itch stops of itself.

Dansim 丹心

7.5.2
Source원문

痒得爬而解者, 爬爲火化. 微則亦能痒, 甚則痒去者, 謂令皮膚辛辣而屬金化, 辛能散火, 故金化見則火化解矣. 《河間》

Translation영역
That an itch is relieved by scratching is because scratching is a transformation of fire. Mild, it can itself cause itching; severe, it takes the itch away — for it makes the skin acrid and smarting, which belongs to the transformation of metal, and the acrid can disperse fire; so when the metal transformation appears, the fire transformation is resolved.

Hagan 河間

7.5.3
Source원문

人近火氣者, 微熱則痒, 熱甚則痛, 附近則灼而爲瘡, 皆火之用也. 痒者美疾也, 故火旺於夏而萬物蕃美也. 或云痛爲實, 痒爲虛, 非謂虛爲寒也, 正謂熱之微甚也. 《河間》

Translation영역
When a person is near a fire, a mild heat itches, a severe heat hurts, and close up it scorches and makes a sore — all of these are the action of fire. Itching is a pleasant affliction, for fire flourishes in summer and all things grow lush and fine. Some say pain is repletion and itching vacuity; this does not mean that the vacuity is cold, but precisely that the heat is mild or severe.

Hagan 河間

7.5.4
Source원문

諸痛皆屬於火. 《內經》 ○皮膚痛屬心實. 內經曰, 夏脈者心也, 夏脈太過則病身熱膚痛, 爲浸淫. 《綱目》

Translation영역
All pains belong to fire. Pain of the skin belongs to repletion of the heart. The Neijing says: the summer pulse is the heart's, and when the summer pulse is excessive the disease is fever of the body with pain of the skin, becoming a spreading erosion.

Naegyeong 內經 · Gangmok 綱目

7.5.5
Source원문

身上虛痒, 四物湯加黃芩, 煎水調浮萍末服之. 《丹心》

Translation영역
For a vacuity itch over the body, Samul-tang with scutellaria added, decocted, and powdered duckweed stirred into the liquid and taken.

Dansim 丹心

7.5.6
Source원문

身痒如虫行, 此血虛也. 大料四物湯服之, 兼用澡洗藥. 《丹心》

Translation영역
Itching of the body as if insects were crawling is blood vacuity. Take Samul-tang in large doses, and use the Bathing and Washing Medicine along with it.

Dansim 丹心

7.5.7
Source원문

飮酒後遍身痒如風瘡, 搔至血出, 宜服蟬蛻散. 《入門》

Translation영역
For itching all over the body after drinking wine, like a wind sore, scratched until the blood comes, Cicada Slough Powder should be taken.
Clinical note임상 주석
Hejian's argument is the most interesting thing in the chapter and is worth reading twice. Itch and pain are not different sensations but one sensation at two intensities, graded by how close the fire is: mild heat itches, severe heat hurts, closer still it burns. From which follows an explanation of scratching that is almost physiological — the friction is a small fire, acrid and metal-natured, and acrid disperses fire, so a small burn resolves a larger heat. Danggye's treatment runs the other way and is the practical one: an itch with no rash to show is blood too thin to moisten the skin, so give Samul-tang in large doses and bathe.

Immun 入門

7.6 Macules and Papules 癍疹

7.6.1
Source원문

有色點而無顆粒者曰癍, 浮小而有顆粒者曰疹. 隨出卽沒而又出. 《丹心》

Translation영역
A coloured spot without a grain is called a macule; one raised and small with a grain is called a papule. They come out, vanish at once, and come out again.

Dansim 丹心

7.6.2
Source원문

發癍者, 因胃熱助手少陰火, 入于手太陰肺也. 紅點如斑, 生於皮毛之間. 白虎湯ㆍ瀉心湯ㆍ調胃承氣湯(三方並見寒門)選用之. 《丹心》

Translation영역
A macular eruption comes of stomach heat aiding the hand lesser yin fire and entering the hand greater yin lung. Red spots like macules break out between the skin and the hair. Choose among Baekho-tang, Sasim-tang and Jowiseunggi-tang (all three formulas are in the Cold Damage chapter).

Dansim 丹心

7.6.3
Source원문

傷寒發癍謂之陽毒, 春溫發癍謂之溫毒, 夏熱發癍謂之熱毒, 時行發癍謂之時毒. 名雖不同, 同歸於熱, 皆心火入肺, 故紅點見於皮毛之間. 輕如疹子ㆍ蚊跡, 只在手足, 先紅後黃; 重如錦紋, 發在胸腹, 先紅後赤. 切忌發汗, 重令開泄, 甚則皮膚斑爛. 《入門》

Translation영역
A macular eruption in cold damage is called yang toxin; in spring warmth, warm toxin; in summer heat, heat toxin; in a seasonal epidemic, seasonal toxin. The names differ but all come back to heat, and all are the heart fire entering the lung, so that red spots appear between the skin and the hair. The mild kind is like papules or mosquito marks, only on the hands and feet, red first and then yellow; the severe kind is like brocade, breaking out on the chest and abdomen, red first and then crimson. Sweating is strictly forbidden, for it would open and drain the patient further, and at worst the skin breaks down and ulcerates.

Immun 入門

7.6.4
Source원문

陽毒發癍, 宜人參白虎湯ㆍ三黃石膏湯(並見寒門)ㆍ消癍靑黛飮. ○溫毒發癍, 宜黑膏ㆍ葛根橘皮湯ㆍ玄參升麻湯. ○熱毒發癍ㆍ時行發癍, 宜化癍湯ㆍ猪膽鷄子湯ㆍ犀角玄參湯. 癍盛破爛者, 用芒硝猪膽汁法. 《入門》

Translation영역
For a yang-toxin eruption, use Insam-baekho-tang, Samhwang-seokgo-tang (both in the Cold Damage chapter) or Soban-cheongdae-eum. For a warm-toxin eruption, Heuk-go, Galgeungyulpi-tang or Hyeonsamseungma-tang. For heat-toxin and seasonal eruptions, Hwaban-tang, Jeodamgyeja-tang or Seogakhyeonsam-tang; and where the macules are heavy and have broken down, the Mirabilite and Pig Bile Method.

Immun 入門

7.6.5
Source원문

冬月溫暖, 人受不正之氣, 至春冬溫始發, 肌中斑爛如錦紋, 而咳心悶, 但嘔淸水, 宜用黑膏. 《活人》

Translation영역
When the winter months are mild a person takes in an unseasonable qi, and come spring the winter warmth first breaks out: the flesh is mottled like brocade, with cough and oppression of the heart, and nothing vomited but clear water. Heuk-go should be used.

Hwarinseo 活人

7.6.6
Source원문

斑斑如錦紋, 色紅赤者胃熱也; 紫黑者胃爛也. 《海藏》

Translation영역
Macules patterned like brocade: red and crimson in colour, it is stomach heat; purple-black, the stomach is rotting.

Haejang 海藏

7.6.7
Source원문

孕婦傷寒發癍, 宜梔子大靑湯. 《入門》

Translation영역
For a pregnant woman's cold-damage macular eruption, Chijadaecheong-tang should be used.

Immun 入門

7.6.8
Source원문

癍色紫黑, 咽喉閉痛, 譫語煩躁, 宜用紫雪(方見火門). 《入門》

Translation영역
When the macules are purple-black with the throat closed and painful and there is delirious speech and agitation, Jaseol should be used (its formula is in the Fire chapter).
Clinical note임상 주석
The distinction the whole section rests on — a macule is flat, a papule is raised — is exactly the modern one, and the colour grading that follows it is sound observation: red is heat, purple-black is tissue dying. The prohibition is the clinically important part. A macular eruption must not be sweated, because the rash is already blood leaving the vessels and opening the surface further only drains the patient. That rule, and the reading of the colour, are what survive here; most of the pharmacy does not.

Immun 入門

7.7 The Yin-Pattern Macular Eruption 陰證發癍

7.7.1
Source원문

陰證發癍, 出胸背及手足, 亦稀少而微紅. 若作熱投之凉藥, 大誤矣. 此無根失守之火聚於胸中, 上獨熏肺, 傳於皮膚而爲斑點, 但如蚊蚋蚤虱咬形狀, 而非錦紋也. 宜用調中湯ㆍ升麻鱉甲湯之類, 其癍自退. 《活人》

Translation영역
The yin-pattern macular eruption comes out on the chest and back and on the hands and feet, and is sparse and faintly red. To take it for heat and give cooling medicines is a grave mistake. This is a rootless fire that has lost its station and gathered in the chest, fuming the lung alone above and passing to the skin as spots — like the marks of mosquitoes, gnats, fleas or lice, and not like brocade. Use Jojung-tang or Seungmabyeolgap-tang and their like, and the macules withdraw of themselves.
Clinical note임상 주석
The single most useful warning in the chapter, and it turns on three signs: sparse rather than confluent, faintly red rather than crimson, and shaped like insect bites rather than brocade. A rash of that description in a depleted patient is not heat to be cooled, and the Hwarinseo says plainly that cooling it is a grave mistake — the formulas it sends for are warming and aromatic, which is why they look so out of place among the rest.

Hwarinseo 活人

7.8 The Macular Eruption of Internal Damage 內傷發癍

7.8.1
Source원문

內傷發癍, 乃胃氣極虛, 一身之火遊行於外所致, 宜補以降之. 《丹心》

Translation영역
The macular eruption of internal damage comes of the stomach qi being utterly vacuous, so that the body's fire wanders to the outside; it should be supplemented in order to bring it down.

Dansim 丹心

7.8.2
Source원문

內傷發癍, 亦或痰熱所致. 火則補以降之, 痰熱則微汗以散之, 切不可下. 《丹心》

Translation영역
The macular eruption of internal damage may also come of phlegm heat. Where it is fire, supplement in order to bring it down; where it is phlegm heat, sweat lightly in order to disperse it; and on no account purge.

Dansim 丹心

7.8.3
Source원문

內傷發癍, 輕如蚊跡ㆍ疹子者, 多在手足, 初起無頭痛身熱, 宜調中益氣湯(方見內傷)ㆍ黃芪建中湯(方見虛勞). 《入門》

Translation영역
The macular eruption of internal damage, when mild and like mosquito marks or papules, is mostly on the hands and feet, and at its onset there is no headache or fever; Jojungikgi-tang (its formula is in the Internal Damage chapter) or Hwanggigeonjung-tang (its formula is in the Vacuity Taxation chapter) should be used.
Clinical note임상 주석
Danggye's paradox — supplement in order to bring the fire down — is the chapter's rule for a rash in a depleted patient: the fire is wandering outward because nothing holds it, so filling the centre is what brings it back. The differential sign is the absence of headache and fever at onset, which separates this from every eruption in 7.6.

Immun 入門

7.9 The Signs That an Eruption Is Coming 發癍候

7.9.1
Source원문

凡汗下不解, 足冷耳聾, 煩悶嘔咳, 便是發癍之候, 宜化癍ㆍ消癍之藥以防之. 《入門》

Translation영역
Whenever sweating and purging have not resolved the illness, and the feet are cold, the ears deaf, with agitation, oppression, vomiting and cough, these are the signs that an eruption is coming; medicines that transform and disperse the macules should be given to forestall it.

Immun 入門

7.9.2
Source원문

癍欲出未出之際, 且與升麻葛根湯(方見寒門), 先透其毒. 《回春》

Translation영역
At the point where the macules are about to come out but have not yet appeared, give Seungma-galgeun-tang (its formula is in the Cold Damage chapter) to let the toxin through first.
Clinical note임상 주석
A prodrome, and a good one: an illness that will not resolve to sweating or purging, cold feet, deafness, nausea and cough. The Hoechun's instruction is to vent the eruption out rather than hold it in, which is the opposite of the cooling approach and the same logic as cimicifuga heading so many of the formulas in 7.6.

Hoechun 回春

7.10 The Favourable and Unfavourable Signs in Macules and Papules 癍疹吉凶證

7.10.1
Source원문

赤癍出, 五死一生; 黑癍出, 十死一生. 皆用化癍湯, 兼與紫雪(方見火門). 《綱目》

Translation영역
When red macules come out, five die and one lives; when black macules come out, ten die and one lives. In both cases use Hwaban-tang, with Jaseol given alongside (its formula is in the Fire chapter).

Gangmok 綱目

7.10.2
Source원문

凡癍疹, 赤色身煖, 自胸腹散四肢者吉; 黑色身凉, 自四肢入胸腹者死. 《入門》

Translation영역
In macules and papules generally: red in colour with the body warm, spreading from chest and abdomen out to the limbs, is favourable; black in colour with the body cold, moving from the limbs inward to the chest and abdomen, is fatal.

Immun 入門

7.10.3
Source원문

陽毒發癍, 紅潤稀疎, 起發五六日自愈. 若陰脈見而黑癍稠密成片, 身凉, 六七日死. 《入門》

Translation영역
A yang-toxin eruption, red and moist and sparsely scattered, breaks out and heals of itself in five or six days. But if a yin pulse appears with black macules dense and run together in sheets and the body cold, death comes in six or seven days.

Immun 入門

7.10.4
Source원문

先紅後黯, 如果實者, 亦死. 《入門》

Translation영역
Red at first and then dull, like ripened fruit, is also fatal.

Immun 入門

7.10.5
Source원문

發癍大便自利者不治. 發癍先赤後黯, 面色黧晦者不治. 《得效》

Translation영역
An eruption with the stool running of itself cannot be treated. An eruption red at first and then dull, with the face dark and clouded, cannot be treated.

Deukhyo 得效

7.10.6
Source원문

發赤癍者半生半死, 發黑癍者九死一生. 《正傳》

Translation영역
With a red eruption, half live and half die; with a black eruption, nine die and one lives.

Jeongjeon 正傳

7.10.7
Source원문

發癍紅赤爲胃熱, 若紫不赤爲熱甚, 紫黑爲胃爛. 故赤癍爲輕, 黑癍爲重. 大抵鮮紅明朗者吉, 紫黑者難治, 雜黑斑爛者死. 《回春》

Translation영역
An eruption red and crimson is stomach heat; purple rather than crimson is severe heat; purple-black means the stomach is rotting. So a red eruption is mild and a black one grave. On the whole, bright clear red is favourable, purple-black is hard to treat, and mottled black breaking down is fatal.

Hoechun 回春

7.10.8
Source원문

凡丹毒, 先從四肢起而後入腹者死. 《正傳》 ○丹毒滿身遍黑, 入腹入陰, 難治. 《得效》

Translation영역
In cinnabar toxin generally, when it begins at the limbs and afterwards enters the abdomen, the patient dies. Cinnabar toxin filling the whole body and turning black throughout, entering the abdomen and the genitals, is hard to treat.
Clinical note임상 주석
Seven sources agreeing on one prognostic axis — colour and direction. Bright red spreading outward from the trunk is good; dark and moving inward from the limbs is not. Set beside what modern medicine reads in a rash that goes purpuric and confluent in a cold patient, the Bogam's figures of nine in ten and six or seven days are not far off, and the sign it adds — diarrhoea appearing with the eruption — is a real marker of severity.

Jeongjeon 正傳 · Deukhyo 得效

7.11 The Hidden Rash 癮疹

7.11.1
Source원문

癮疹多屬脾, 隱隱然在皮膚之間, 故言癮疹也. 發則多痒, 或不仁者是也. 兼風熱濕之殊, 色紅者兼火化也. 《丹心》

Translation영역
The hidden rash mostly belongs to the spleen; it lies faintly between skin and flesh, and so is called hidden. When it breaks out there is much itching, or sometimes numbness. It comes variously with wind, heat or damp, and where the colour is red it comes with a transformation of fire.

Dansim 丹心

7.11.2
Source원문

疹者, 紅靨隱隱皮膚表分, 但作瘙痒, 全無腫痛, 名曰癮疹. 當春而發最重, 卽溫毒也, 宜升麻葛根湯(方見寒門)加牛蒡子ㆍ荊芥ㆍ防風. 《入門》

Translation영역
A papule is a red blotch lying faintly at the surface of the skin, making only itching and no swelling or pain at all, and is called hidden rash. Breaking out in spring it is most severe, being warm toxin; Seungma-galgeun-tang (its formula is in the Cold Damage chapter) with burdock seed, schizonepeta and saposhnikovia added should be used.

Immun 入門

7.11.3
Source원문

疹有赤白. 赤疹屬陽, 遇淸凉而消; 白疹屬陰, 遇溫煖而滅. 《正傳》

Translation영역
Papules are of two kinds, red and white. The red belongs to yang and fades on meeting coolness; the white belongs to yin and fades on meeting warmth.

Jeongjeon 正傳

7.11.4
Source원문

赤疹宜胡麻散, 白疹宜消風散(方見頭部). 《入門》

Translation영역
For red papules Homa-san should be used, for white papules Sopung-san (its formula is in the Head chapter).

Immun 入門

7.11.5
Source원문

生癮疹或赤或白, 防風通聖散(方見風門)去芒硝, 加豆豉ㆍ葱白, 倍麻黃, 煎服出汗. 《臞仙》

Translation영역
For a hidden rash breaking out red or white, Bangpungtongseong-san (its formula is in the Wind chapter) with the mirabilite removed, fermented soybean and scallion added and the ephedra doubled, decocted and taken to bring out a sweat.

Guseon 臞仙

7.11.6
Source원문

遍身白疹瘙痒不止, 天陰日冷則重, 天淸日暖則輕, 此由寒邪伏於肌膚, 凝滯而成. 宜服枳實酒, 更用枳實煎水洗患處, 兼服烏藥順氣散(方見風門). 《得效》

Translation영역
White rash all over the body with ceaseless itching, worse when the sky is overcast and the day cold and lighter when the sky is clear and the day warm, comes of cold evil lying hidden in the skin and congealing there. Jisil-ju should be taken, with bitter orange decocted in water to wash the affected place as well, and Oyaksungi-san taken alongside (its formula is in the Wind chapter).

Deukhyo 得效

7.11.7
Source원문

癮疹若喫醋, 則風疹蝕人. 《直指》

Translation영역
If one eats vinegar with a hidden rash, the wind rash eats into the person.

Jikji 直指

7.11.8
Source원문

患風疹者必多眼暗, 但攻其風則暗自去. 《入門》

Translation영역
One who suffers from wind rash will often have dim eyes; attack the wind alone and the dimness goes of itself.

Immun 入門

7.11.9
Source원문

癮疹宜用樺皮散ㆍ淸肌散ㆍ加味羌活散ㆍ犀角消毒飮. 作瘡宜加味烏荊元.

Translation영역
For hidden rash use Hwapi-san, Cheonggi-san, Gamiganghwal-san or Seogaksodok-eum; where it has gone to sores, Gamiogyeong-won.
Clinical note임상 주석
Urticaria described accurately — faint, raised, intensely itchy, with no swelling or pain, coming and going — and then split by a rule a clinician can test: red weals that settle with cooling, white weals that settle with warmth, worse on cold dull days. That second picture is cold urticaria, and the Deukhyobang's treatment of it with warm wine extractions follows from the observation rather than from theory. The remark about dim eyes in a wind rash is the chapter noticing an association it cannot explain and recording it anyway.

Donguibogam · Pi

7.12 Pimples, Boils and Prickly Heat 㾴痤疿

7.12.1
Source원문

內經曰, 勞汗當風, 寒薄爲㾴, 鬱乃痤. 此勞汗出於玄府, 脂液所凝. 防風通聖散去芒硝, 倍加芍藥ㆍ當歸, 發散玄府之風, 調其榮衛. 俗云風刺. 《綱目》

Translation영역
The Neijing says: when a working sweat meets the wind and cold presses on it, a pimple forms, and when it is constrained a boil. This is the working sweat coming out of the dark palace with the oily fluid congealing. Bangpungtongseong-san with the mirabilite removed and the peony and Korean angelica doubled disperses the wind in the dark palace and regulates the construction and defence. It is commonly called wind-prick.

Gangmok 綱目

7.12.2
Source원문

內經曰, 汗出見濕, 乃生痤疿. 痤者, 小癤也, 大如酸棗, 或如豆, 色赤而內有膿血也. 《綱目》

Translation영역
The Neijing says: when sweat comes out and meets damp, boils and prickly heat arise. A boil is a small furuncle, the size of a sour jujube or a bean, red in colour with pus and blood inside.

Gangmok 綱目

7.12.3
Source원문

暑月汗漬肌, 生紅粟, 謂之疿子; 爛破成瘡, 謂之疿瘡. 宜用玉女英. 《奇效》

Translation영역
In the hot months, when sweat soaks the flesh and red millet-like grains come up, these are called prickly-heat grains; and when they break down into sores, prickly-heat sores. Ongnyeo-yeong should be used.

Gihyobang 奇效

7.12.4
Source원문

痤疿瘡, 靑蒿煎湯洗之. 《入門》 ○疿子痒痛, 井水挼靑蒿汁, 調蛤粉付之. 《得效》

Translation영역
For boils and prickly-heat sores, wash them with a decoction of sweet wormwood. For prickly-heat grains with itching and pain, rub sweet wormwood in well water for its juice, mix clamshell powder into it and apply.

Immun 入門 · Deukhyo 得效

7.12.5
Source원문

臘雪水洗疿瘡妙, 和蚌粉付之尤妙. 《入門》 ○棗葉擣汁, 揩熱疿瘡良. 《本草》

Translation영역
Washing prickly-heat sores with water from the last snow of the year works well, and mixing mussel-shell powder into it is better still. Jujube leaf pounded for its juice is good rubbed on hot prickly-heat sores.

Immun 入門 · Bonchogang 本草

7.12.6
Source원문

粟米浸累日令敗, 硏澄取之, 去疿瘡甚佳, 名曰英粉. 《本草》 ○疿瘡宜用玉粉散.

Translation영역
Millet steeped for days until it spoils, then ground and allowed to settle and the sediment taken, is excellent for clearing prickly-heat sores, and is called 英粉, fine powder. For prickly-heat sores Okbun-san should be used.
Clinical note임상 주석
The Neijing's mechanism for acne is remarkably close: a sweat raised by work, the pore blocked by cold, the oily fluid congealing. 風刺, wind-prick, was the common name for it. Everything after that is for miliaria, and every remedy is a drying powder or a cool wash — wormwood, clamshell, snow water, millet starch. None of it is doubtful and most of it is still sensible; only Okbun-san, with white lead in it, is not.

Bonchogang 本草 · Donguibogam · Pi

7.13 Cinnabar Toxin 丹毒

7.13.1
Source원문

丹毒者, 人身忽然變赤, 如塗丹之狀, 俗云赤瘤. 或有因瘡而誤觸, 四畔焮赤, 謂之瘡瘤, 皆遊走不定, 狀如雲氣者是也. 小兒得之最忌, 百日之內謂之胎瘤, 最爲難治. 《東垣》

Translation영역
In cinnabar toxin the body suddenly turns red as if painted with cinnabar, commonly called a red tumour. Sometimes a sore is accidentally knocked and the margin all round flushes red, which is called a sore tumour; both wander without fixed place and look like drifting cloud. In a child it is most to be feared, and within the first hundred days it is called a foetal tumour and is hardest of all to treat.

Dongwon 東垣

7.13.2
Source원문

丹疹皆是惡毒熱血, 蘊蓄於命門, 遇君相二火合起則發也. 如遇熱時, 以通聖辛凉之劑解之; 寒時, 以葛根ㆍ升麻辛溫之劑解之. 凡丹從四肢起入腹者死. 《丹心》

Translation영역
Cinnabar rashes are all malign toxic hot blood stored up at the life gate, breaking out when the sovereign and ministerial fires rise together. In hot weather resolve it with the acrid cool medicines of the Tongseong type; in cold weather with the acrid warm medicines of the pueraria and cimicifuga type. Whenever a cinnabar toxin begins at the limbs and enters the abdomen, the patient dies.

Dansim 丹心

7.13.3
Source원문

小兒丹毒及胎丹, 並詳見小兒門. ○丹毒宜藍葉散ㆍ拔毒散ㆍ犀角消毒飮.

Translation영역
For a child's cinnabar toxin and foetal cinnabar, see the Children chapter in detail. For cinnabar toxin use Namyeop-san, Baldok-san or Seogaksodok-eum.
Clinical note임상 주석
Erysipelas, described by its two defining features: a sheet of skin suddenly scarlet with an advancing margin, and the margin wandering like cloud. The Bogam's fear of it in the newborn is well placed, and so is its prognostic rule — spreading from the limbs inward to the trunk is the bad direction. The treatment divides by season rather than by patient, which is Danggye reading the same disorder as needing cool resolution in summer and warm resolution in winter.

Donguibogam · Pi

7.14 Numbness and Woodenness 麻木

7.14.1
Source원문

靈樞曰, 衛氣不行則爲麻木.

Translation영역
The Lingshu says: when the defence qi does not travel, there is numbness and woodenness.

Yeongchu 靈樞

7.14.2
Source원문

靈樞曰, 開目則陽道行, 陽氣遍布周身; 閉目則陽道閉而不行, 如晝夜之分. 知其陽衰而陰旺也. 久坐而起亦有麻木, 知其氣不行也. 當補其肺中之氣, 則麻木自去矣. 《東垣》

Translation영역
The Lingshu says: when the eyes open the yang pathway travels and the yang qi spreads throughout the body; when they close the yang pathway shuts and does not travel, as day is divided from night. By this one knows that the yang is declining and the yin flourishing. Sitting long and then rising also brings numbness, by which one knows the qi is not travelling. One should supplement the qi within the lung, and the numbness goes of itself.

Dongwon 東垣

7.14.3
Source원문

如肌肉麻, 必待瀉榮氣而愈. 《綱目》 ○諸痺之中, 着痺卽麻木不仁也. 《綱目》

Translation영역
Where the flesh itself is numb, it waits upon draining the construction qi to be cured. Among the impediments, fixed impediment is numbness, woodenness and insensibility.

Gangmok 綱目

7.14.4
Source원문

河間曰, 着痺者, 留着不去, 四肢麻木拘攣也. 內經曰, 病久入深, 榮衛之行澁, 經絡時疎, 故不痛, 皮膚不榮, 故爲不仁. 夫所謂不仁者, 或周身, 或四肢, 喞喞然麻木不知痛痒, 如繩札縳初解之狀, 古方名爲麻痺者是也. 《正傳》

Translation영역
Hejian says: in fixed impediment the evil lodges and does not leave, and the four limbs are numb, wooden and cramped. The Neijing says: when a disease is long-standing and has entered deep, the travel of construction and defence is rough and the channels at times sparse, so there is no pain; and the skin is not flourishing, so there is insensibility. What is called insensibility is a buzzing numbness, over the whole body or in the four limbs, that feels neither pain nor itch, like the state just after a cord that has bound one is untied — this is what the old formularies called numb impediment.

Jeongjeon 正傳

7.14.5
Source원문

麻是氣虛, 木是濕痰死血. 然則曰麻曰木, 以不仁中而分爲二也. 《丹心》

Translation영역
Numbness is qi vacuity; woodenness is damp phlegm and dead blood. So numbness and woodenness are a division of insensibility into two.

Dansim 丹心

7.14.6
Source원문

手十指麻, 是胃中有濕痰死血. 痰用二陳湯(方見痰飮)加蒼白朮ㆍ桃仁ㆍ紅花, 少加附子行經; 血用四物湯(方見血門)加蒼白朮ㆍ陳皮ㆍ茯苓ㆍ羌活ㆍ蘇木ㆍ紅花. 《醫鑑》

Translation영역
Numbness of the ten fingers is damp phlegm and dead blood in the stomach. For the phlegm use Ijin-tang (its formula is in the Phlegm-Rheum chapter) with atractylodes lancea and white atractylodes, peach kernel and carthamus added, and a little aconite to move the channels; for the blood, Samul-tang (its formula is in the Blood chapter) with atractylodes lancea and white atractylodes, tangerine peel, poria, notopterygium, sappanwood and carthamus added.

Uigam 醫鑑

7.14.7
Source원문

手足麻因濕者, 香蘇散(方見寒門)加蒼朮ㆍ麻黃ㆍ桂枝ㆍ羌活ㆍ白芷ㆍ木瓜. 《醫鑑》

Translation영역
For numbness of the hands and feet from damp, Hyangso-san (its formula is in the Cold Damage chapter) with atractylodes lancea, ephedra, cinnamon twig, notopterygium, angelica dahurica and chaenomeles added.

Uigam 醫鑑

7.14.8
Source원문

手足麻木, 四物湯合二陳湯加桃仁ㆍ紅花ㆍ白芥子ㆍ竹瀝ㆍ薑汁, 以行經. 《醫鑑》

Translation영역
For numbness and woodenness of the hands and feet, Samul-tang combined with Ijin-tang, with peach kernel, carthamus, white mustard seed, bamboo sap and ginger juice added, to move the channels.

Uigam 醫鑑

7.14.9
Source원문

渾身麻, 是氣虛也. 補中益氣湯(方見內傷)加木香ㆍ烏藥ㆍ香附ㆍ靑皮ㆍ防風ㆍ川芎, 少加桂枝行經. 《醫鑑》

Translation영역
Numbness of the whole body is qi vacuity. Bojungikgi-tang (its formula is in the Internal Damage chapter) with saussurea, lindera, cyperus, green tangerine peel, saposhnikovia and chuanxiong added, and a little cinnamon twig to move the channels.

Uigam 醫鑑

7.14.10
Source원문

麻木宜人參益氣湯ㆍ神效黃芪湯ㆍ冲和補氣湯ㆍ雙合湯ㆍ開結舒經湯ㆍ麻骨方.

Translation영역
For numbness and woodenness use Insam-ikgi-tang, Sinhyohwanggi-tang, Chunghwabogi-tang, Ssanghap-tang, Gaegyeolseogyeong-tang or Magol-bang.
Clinical note임상 주석
The section's best thinking is Dongwon's. Numbness that comes when the eyes are closed and goes when they open, and numbness after sitting still too long, are both offered as proof that the complaint is yang qi failing to circulate rather than anything in the limb — and that is a sound inference from a real observation. Danggye's split follows: 麻, numbness, is qi vacuity, and 木, woodenness, is damp phlegm with dead blood, which decides between Bojungikgi-tang and Ssanghap-tang. The description of insensibility as the feeling just after an untied cord is released is as good a sentence on paraesthesia as the book has.

Donguibogam · Pi

7.15 The Exhausted Lustre 索澤證

7.15.1
Source원문

內經曰, 三陽爲病, 發寒熱, 其傳爲索澤. 王註云, 索, 盡也, 精血枯涸, 故皮膚潤澤之氣皆盡也. ○足少陽之脈病, 體無膏澤. 《靈樞》

Translation영역
The Neijing says: when the three yang are diseased there are chills and fever, and what it passes into is exhausted lustre. Wang's commentary says 索 means exhausted — the essence and blood have dried up, so the qi that keeps the skin moist and lustrous is all spent. When the foot lesser yang vessel is diseased, the body has no oily lustre.

Naegyeong 內經 · Yeongchu 靈樞

7.15.2
Source원문

虛損之疾, 一損損於肺, 皮聚而毛落, 宜四君子湯(方見氣門); 心肺俱虛, 則宜八物湯(方見虛勞). 《綱目》

Translation영역
In the diseases of vacuity detriment, the first detriment is to the lung, the skin gathers and the hair falls; Sagunja-tang should be used (its formula is in the Qi chapter). Where heart and lung are both vacuous, Palmul-tang should be used (its formula is in the Vacuity Taxation chapter).

Gangmok 綱目

7.15.3
Source원문

皮膚索澤, 卽仲景所謂皮膚甲錯. 盖皮膚澁而不滑澤者是也. 《綱目》

Translation영역
Exhausted lustre of the skin is what Zhongjing called the skin scaled like armour — that is, a skin rough and not smooth or lustrous.

Gangmok 綱目

7.15.4
Source원문

肺者行氣溫於皮毛者也. 氣不營則皮毛焦, 皮毛焦則津液去, 津液去則皮節傷; 津液旣去, 則爪枯毛折而死. 《綱目》

Translation영역
The lung is what moves the qi to warm the skin and hair. When the qi does not flourish, the skin and hair are scorched; scorched, the fluids are lost; the fluids lost, the skin and the joints are damaged; and once the fluids are gone, the nails wither and the hair breaks and the patient dies.

Gangmok 綱目

7.15.5
Source원문

五勞虛極羸瘦, 內有乾血, 則皮膚甲錯. 《仲景》

Translation영역
In the five taxations, at the extreme of vacuity and emaciation, with dry blood within, the skin is scaled like armour.
Clinical note임상 주석
A short section on one sign and it reads as a modern one: skin that has lost its lustre and gone rough and scaled, in a wasted patient, taken as evidence of exhausted essence and dry blood within. Zhongjing's 皮膚甲錯 is the same observation under another name and he attached it to internal dry blood, which is why Daehwang-jechung-hwan exists. Here the Bogam treats it as a vacuity and gives Sagunja-tang and Palmul-tang.

Junggyeong 仲景

7.16 Lichen Wind, Wandering Lichen Wind and White Patches 癜風癧瘍風白䮕

7.16.1
Source원문

凡人身體皮肉變色, 赤者謂之紫癜, 白者謂之白癜, 或謂之癧瘍風. 白䮕者, 浸淫漸長, 色白似癬, 但無瘡也. 皆因風博皮膚, 血氣不和所生. 宜胡麻散(方見上)ㆍ蒼耳散ㆍ追風丸ㆍ三黃散ㆍ加減何首烏散ㆍ如聖膏.

Translation영역
Whenever the skin and flesh of the body change colour, the red kind is called purple lichen and the white kind white lichen, or else wandering lichen wind. White patches spread and gradually enlarge, white in colour and like a lichen, only without sores. All of these arise from wind contending with the skin so that the blood and qi are not harmonized. Use Homa-san (its formula is above), Changi-san, Chupung-hwan, Samhwang-san, Gagamhasuo-san or Yeoseong-go.
Clinical note임상 주석
Three names for two things, and the chapter separates them on the one sign that matters: white patches that spread and enlarge but never ulcerate. That is vitiligo and pityriasis versicolor between them, read as wind contending with the skin so that blood and qi do not meet. The internal treatments are the fleeceflower-and-sophora group and are harmless; the external ones below are lead and arsenic, and they are not.

Donguibogam · Pi

7.17 Black Moles and Dark Blemishes 黑痣靨子

7.17.1
Source원문

黑痣者, 黑子也. 是風邪變生也. 《類聚》 ○色黑而大曰靨. ○宜用爐灰膏ㆍ取痣餠ㆍ去黑靨方.

Translation영역
A black mole is a black spot, and it arises from a change wrought by wind evil. One that is black in colour and large is called a blemish. Nohoe-go, Chuji-byeong or the Method for Removing a Dark Blemish should be used.
Clinical note임상 주석
Four lines for a cosmetic complaint, and all three treatments are caustics — lye from lime and furnace ash, with croton and toad venom worked in, applied to skin deliberately opened with a needle. They worked, in the sense that they destroyed the tissue they were put on. None of them can be prepared, and a pigmented lesion that changes is a reason to see a clinician rather than to burn it off.

Yuchwi 類聚

7.18 Simple Medicinals 單方

7.18.1
Source원문

凡三十二種.

Translation영역
Thirty-two kinds in all.
Clinical note임상 주석
Thirty-two simples, and they sort by how they are used. Bathed in or washed with, for itching and rash: salt — the chapter says nothing beats a strong salt decoction, and sea bathing better still — lime water, sophora root, mugwort, peach leaf, elm, and burdock with duckweed. Taken inwardly: sophora root boiled to a paste with gleditsia and made into pills, burdock seed with duckweed in mint decoction, and dandelion-type juices pressed and drunk. Applied: sulphur boiled in vinegar with cuttlebone for lichen wind, rhubarb-root ground on iron with good vinegar for wandering lichen wind, and the milky sap of a stem rubbed into a white patch until it breaks. And a long animal tail — hornet's nest with cicada slough, grub juice, eel, snake flesh and blood, dung beetle, cheese with salt — most of it for the stubborn discolorations, which is where a chapter runs out of answers and starts recording whatever was tried. Two entries carry a warning rather than a recommendation: the last of them puts arsenic and mung bean flour in vinegared egg and rubs it into skin scraped raw, which must not be prepared.

Donguibogam · Pi

7.19 Moxibustion 灸法

7.19.1
Source원문

瘕風及癧瘍風, 灸左右手中指節宛宛中, 灸三五壯. 凡贅疣ㆍ諸痣皆效. 《入門》

Translation영역
For conglomeration wind and wandering lichen wind, moxa the hollow at the joint of the middle finger of each hand, three to five cones. It answers for warts and all moles as well.
Clinical note임상 주석
One point and one method for the whole chapter — the hollow at the middle finger's joint, three to five cones, for the discolorations and for warts and moles. Set beside the caustics of 7.17 it is the gentler of the two things the Bogam offers for a mole, and the only one that can still be done.

Immun 入門

About this translation 凡例

Base text: Donguibogam (東醫寶鑑, 1613 first edition), Outer Form, Volume 3, Skin chapter. The Chinese text is collated against the public-domain Wikisource transcription and a printed edition; original character forms (脉, 人參) are retained. Terminology follows Wiseman & Feng, A Practical Dictionary of Chinese Medicine. Translation and clinical notes are original to this site. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.