Formulas · Text · Donguibogam 東醫寶鑑

The Use of Medicines

Yongyak

한글 용약 · Pinyin Yong Yao

Root and branch, supplementing and draining, the four prohibitions and the eighteen preparations

用藥

The fifth and last of the introductory chapters of the Miscellaneous Disorders, and the one that sets out how a physician decides what to give. It has no formulas of its own — those come in the hundred chapters that follow — and what it offers instead is principle. Two schools are weighed at the start, Zhang Yuansu's that adjusts to the seasons and Liu Wansu's that clears the old to make way for the new, and the chapter asks for both. Then root and branch: which of two conditions to treat first, and the three exceptions where the branch takes precedence. Then the calendar — spring for ejecting, summer for sweating, autumn for purging, winter for warming — and the four prohibitions of season, channel, disease and medicine. The middle of the chapter turns on supplementing and draining, with the Nanjing's rule that a mother is supplemented and a child drained, and the warning that too much sweating destroys the yang and too much purging the yin. The second half is a set of maxims — a prescription is like a purse and should hold only what is needed; what is free of obstruction does not pain; the stomach qi must not be injured — and the Immun's eighteen preparations, which sort every formula by what it does. The chapter closes with the general rules for using medicines, from how a dose is measured to when a decoction is taken.

5.1 Recent Discussions of Medicine 近世論醫

5.1.1

Source원문

近世論醫, 有主河間劉氏者劉完素, 有主易州張氏者張元素. 張氏用藥, 依準四時陰陽升降而增損之, 正內經四氣調神之義. 醫而不知此, 是妄行也. 劉氏用藥, 務在推陳致新, 不使少有怫鬱, 正造化新新不停之義. 醫而不知此, 是無術也. 然主張氏者, 或未盡張氏之妙, 則瞑眩之藥終莫敢投, 至失期後時而不救者多矣. 主劉氏者, 或未極劉氏之妙, 則取效目前, 陰損正氣, 遺害於後日者多矣. 能用二子之長, 而無二子之弊, 則治病, 其庶幾乎. 《海藏》

Translation영역

In recent discussions of medicine, some take Master Liu of Hejian Liu Wansu as their authority and some Master Zhang of Yizhou Zhang Yuansu. Master Zhang's use of medicines follows the rising and falling of yin and yang through the four seasons and adds or subtracts accordingly — precisely the Neijing's meaning of regulating the spirit by the four qi. A physician who does not know this acts recklessly. Master Liu's use of medicines is bent on pushing out the old to bring in the new and letting nothing be pent up — precisely the meaning of creation renewing itself without cease. A physician who does not know this has no art. But those who follow Zhang, if they have not wholly grasped his subtlety, never dare give a medicine that makes the head swim, and so lose the moment and fail to save many. Those who follow Liu, if they have not reached the limit of his subtlety, take the effect that is before their eyes, secretly injure the right qi, and leave harm for later days in many. One who can use the strengths of both masters without the faults of either — that one is close to treating disease.

Clinical note임상 주석

The chapter opens by naming the two schools that shaped the tradition it belongs to — Zhang Yuansu, who taught Dongwon, and Liu Wansu, whose line ran to Danxi — and refusing to choose. Zhang's followers are too timid to give a strong medicine when one is needed; Liu's are too quick to clear and leave the patient weaker. 瞑眩之藥, a medicine that makes the head swim, is the phrase from the Book of Documents that the Vomiting chapter cites at To 6.7.1, and the Haejang's complaint is that Zhang's followers will not use one even when the case calls for it.

Haejang 海藏

5.2 Supplementing and Draining by Form and Qi 形氣用補瀉

5.2.1

Source원문

靈樞曰, 形氣不足, 病氣有餘, 是邪勝也. 急當瀉之. 形氣有餘, 病氣不足, 急當補之. 形氣不足, 病氣不足, 此陰陽俱不足也. 不可刺之. 刺之則重不足, 重不足則陰陽俱竭, 血氣皆盡, 五藏空虛, 筋骨髓枯, 老者絶滅, 壯者不復矣. 形氣有餘, 病氣有餘, 此謂陰陽俱有餘也. 急瀉其邪, 調其虛實.

Translation영역

The Lingshu says: where the form and qi are insufficient and the disease qi is in surplus, the evil prevails — it must urgently be drained. Where the form and qi are in surplus and the disease qi is insufficient, it must urgently be supplemented. Where the form and qi are insufficient and the disease qi is insufficient, this is yin and yang both insufficient, and it may not be needled; needling it doubles the insufficiency, and doubled insufficiency exhausts both yin and yang, the blood and qi are all spent, the five viscera are empty, sinew, bone and marrow wither — the old are extinguished and the strong do not recover. Where the form and qi are in surplus and the disease qi is in surplus, this is yin and yang both in surplus; urgently drain the evil and regulate the vacuity and repletion.

Clinical note임상 주석

Four cases from two variables — the body's strength and the disease's — and the third is the one the chapter cares about: a weak patient with a weak disease is not to be treated at all, because any treatment takes from a reserve that is already gone. The Pulse Diagnosis chapter's 4.2 says the same of the pulse without force, and both are warnings against doing something because something must be done.

Yeongchu 靈樞

5.2.2

Source원문

夫疾病之生也, 皆因外感內傷. 生火生濕, 濕而生熱, 火而生痰, 四者而已. 審其爲少壯新病, 是濕則燥之, 是火則瀉之. 是濕而生熱, 則燥濕而兼淸熱, 是火而生痰, 則瀉火而兼豁痰, 無餘蘊矣. 審其爲老衰久病, 又當半攻半補焉. 故曰, 少壯新病, 攻邪爲主. 老衰久疾, 補虛爲先. 《丹心》

Translation영역

Disease arises, in every case, from external contraction or internal damage; these engender fire or damp, damp engenders heat and fire engenders phlegm — four things and no more. Where it is judged a new disease in the young and strong, if damp, dry it; if fire, drain it; if damp engendering heat, dry the damp and clear the heat with it; if fire engendering phlegm, drain the fire and sweep the phlegm with it — and nothing remains. Where it is judged a long disease in the old and declining, half attack and half supplement. Hence it is said: in new disease in the young and strong, attacking the evil is the mainstay; in long illness in the old and declining, supplementing vacuity comes first.

Clinical note임상 주석

Danxi reduces all disease to four — fire, damp, and their two products — and then gives the rule that matters more than the four: young and new, attack; old and long, supplement. Two questions about the patient decide the direction of treatment before the disease is named.

Dansim 丹心

5.3 The General Outline of Using Medicines 用藥大體

5.3.1

Source원문

內經曰, 病之始起也, 可刺而已, 其盛可待衰而已. 故因其輕而揚之, 因其重而減之, 因其衰而彰之. 其高者, 因而越之, 其下者, 引而竭之. 中滿者, 瀉之於內. 其有邪者, 漬形以爲汗. 其在皮者, 汗而發之, 其慓悍者, 按而收之, 其實者, 散而瀉之.

Translation영역

The Neijing says: when a disease first arises it can be needled and no more; when it is exuberant one can wait for it to decline and no more. So what is light, lift it off; what is heavy, reduce it; what is declining, bring it out. What is high, thereby overflow it; what is below, draw it down and exhaust it. Where the centre is full, drain it within. Where there is an evil, soak the form to make a sweat. What is in the skin, sweat it out; what is fierce and violent, press and gather it; what is replete, scatter and drain it.

Clinical note임상 주석

The Suwen passage the three method chapters are built on. 其高者, 因而越之 is the Vomiting chapter's foundation at To 6.3; 其在皮者, 汗而發之 is the Sweating chapter's at Han 7.7.1; 其下者, 引而竭之 is the Purging chapter's. Here they are given together as the rule of direction: the evil leaves by the nearest exit.

Naegyeong 內經

5.3.2

Source원문

寒者熱之, 熱者寒之. 微者逆之, 甚者從之. 堅者削之, 客者除之. 勞者溫之, 結者散之. 留者攻之, 燥者濡之. 急者緩之, 散者收之. 損者益之, 逸者行之, 驚者平之. 上之下之, 摩之浴之, 薄之劫之, 開之發之, 適事爲故. 《內經》

Translation영역

What is cold, heat it; what is hot, cool it. What is slight, oppose it; what is severe, follow it. What is hard, pare it; what is a visitor, remove it. What is taxed, warm it; what is bound, scatter it. What lodges, attack it; what is dry, moisten it. What is tense, relax it; what is scattered, gather it. What is detrimented, boost it; what is idle, move it; what is frightened, calm it. Raise it or lower it, rub it or bathe it, press it or seize it, open it or effuse it — as suits the matter, that is the rule.

Clinical note임상 주석

Nineteen pairs and the whole method of the Neijing in them: every treatment is the reverse of its condition. The one exception is 甚者從之 — what is severe, follow it — and 5.14 will explain what following means. 適事爲故 — as suits the matter — is the closing clause and the one that governs the rest.

Naegyeong 內經

5.3.3

Source원문

衰者補之, 强者瀉之, 各安其氣, 必淸必靜, 則病氣衰去, 歸其所宗. 此治之大體也. 《內經》

Translation영역

What is declining, supplement it; what is strong, drain it; settle each in its own qi, keeping it clear and keeping it still, and the disease qi declines and departs and returns to its source. This is the general outline of treatment.

Naegyeong 內經

5.3.4

Source원문

上盛不已, 吐而脫之, 下盛不已, 下而奪之. 《王氷》

Translation영역

Where exuberance above does not cease, eject and strip it; where exuberance below does not cease, purge and seize it.

Wang Bing 王氷

5.4 The Song of Treating Water and Fire Separately 水火分治歌

5.4.1

Source원문

歌曰, 肝膽由來從火治, 三焦包絡都無異火. 脾胃相將濕處求, 肺與大腸同濕類水. 腎與膀胱心小腸, 寒熱臨時旋商議水火各半. 惡寒表熱小膀濕, 惡熱表寒心腎熾. 十二經最端的, 四經屬火四經濕肝膽三焦包絡屬火. 脾胃肺大腸屬濕, 四經有熱有寒時心小腸腎膀胱寒熱相半. 攻裏解表細消息, 裏熱裏寒宜越竭. 表熱表寒宜汗釋, 濕同寒. 火同熱, 寒熱到頭無兩說. 六分分來一分寒, 寒熱中停眞浪舌. 熱寒格拒病機深, 亢則害兮承乃制. 緊寒數熱脉正邪, 標本治之眞妙訣. 休治風休治燥, 治得火時風燥了. 當解表時莫攻裏, 當攻裏時莫解表. 表裏如或兩可攻, 後先內外分多少. 治濕無過似決川, 此箇筌蹄最分曉. 感謝軒岐萬世恩, 爭奈醯雞笑天小.

Translation영역

The song says: liver and gallbladder are treated from fire, and the three burners and pericardium are no different fire. Spleen and stomach together are sought at the damp, and lung with large intestine are the same, of the damp kind water. Kidney with bladder, heart with small intestine — cold and heat are settled as the moment demands half water, half fire. Aversion to cold with exterior heat is small intestine and bladder damp; aversion to heat with exterior cold is heart and kidney blazing. Of the twelve channels this is most exact: four channels belong to fire and four to damp liver, gallbladder, three burners and pericardium to fire; spleen, stomach, lung and large intestine to damp, and four have heat at times and cold at times heart, small intestine, kidney and bladder, cold and heat by halves. Attacking the interior and releasing the exterior are told apart by fine signs; interior heat and interior cold should be overflowed or exhausted; exterior heat and exterior cold should be released by sweat. Damp goes with cold, fire with heat — cold and heat in the end admit no second account. Of six parts, one part is cold; to call cold and heat evenly balanced is truly a wild tongue. Heat and cold repelling each other is the disease mechanism deep; where a thing is hyperactive it harms, and what succeeds it restrains. Tight is cold and rapid is heat — the pulse tells right from evil; treating root and branch is truly the subtle secret. Do not treat wind, do not treat dryness; treat the fire and wind and dryness are done. When the exterior should be released, do not attack the interior; when the interior should be attacked, do not release the exterior. Where exterior and interior may both be attacked, sort inner and outer by more and less, later and earlier. Treating damp is no more than opening a river's course — this fish-trap and hare-snare is most plain. Thanks to Xuanyuan and Qi Bo for ten thousand ages of grace; what can be done about the vinegar-fly that laughs at heaven as small?

Clinical note임상 주석

Zhang Congzheng's mnemonic, and its scheme sorts the twelve channels into three groups of four — fire, damp, and either. The point of the song is 休治風休治燥, 治得火時風燥了: do not treat wind or dryness as such, treat the fire and they go with it. That reduction to two agents is Liu Wansu's school, and 5.30 states it flat. 筌蹄, the fish-trap and hare-snare, is Zhuangzi's image for a device discarded once it has done its work. The vinegar-fly that laughs at heaven is the narrow physician who thinks the scheme is small because he is.

Jahwa 子和

5.5 The Song of Treating Branch and Root Separately 標本分治歌

5.5.1

Source원문

歌曰, 少陽從本爲相火, 太陰從中濕土坐. 厥陰從中火是家, 陽明從中濕是我. 太陽少陰標本從, 陰陽二氣相包裹. 風從火斷汗之宜, 燥與濕爭下之可. 萬病能將火濕分, 掣開軒岐無縫鎻. 《子和》

Translation영역

The song says: lesser yang follows its root and is ministerial fire; greater yin follows the centre and sits as damp earth. Reverting yin follows the centre and fire is its home; yang brightness follows the centre and damp is its self. Greater yang and lesser yin follow branch and root, the two qi of yin and yang wrapping each other. Wind decided by fire — sweating is fitting; dryness contending with damp — purging will do. Whoever can divide the ten thousand diseases into fire and damp has pulled open the seamless lock of Xuanyuan and Qi Bo.

Clinical note임상 주석

The six channels sorted by whether they are governed by their root (their climatic qi), their branch (their yin-yang name), or the channel paired with them in the middle. The scheme is Liu Wansu's from the Suwen's treatise on the six qi, and the song's last couplet says again that everything comes down to fire and damp.

Jahwa 子和

5.5.2

Source원문

標者, 梢末也. 本者, 根本也. 《入門》

Translation영역

The branch is the tip and end; the root is the base and origin.

Immun 入門

5.6 In Treating Disease One Must Seek the Root 治病必求於本

5.6.1

Source원문

夫治病者, 當知標本. 以身論之, 則外爲標, 內爲本, 陽爲標, 陰爲本. 故六府屬陽爲標, 五藏屬陰爲本. 各藏府之經絡, 在外爲標, 在內爲本. 更人身之氣爲標, 血爲本. 以病論之, 先受病爲本, 後流傳病爲標. 凡治病者, 必先治其本, 後治其標. 若先治其標, 後治其本, 則邪氣滋甚, 其病益蓄. 若先治其本, 後治其標, 則雖病有十數證皆去矣. 謂如先生輕病, 後滋生重病, 亦先治輕病, 後治重病. 如是則邪氣乃伏, 盖先治本故也. 若有中滿, 無問標本, 先治中滿, 謂其急也. 若中滿後有大小便不利, 亦無問標本, 先治大小便, 次治中滿, 謂尤急也. 除大小便不利, 及中滿三者之外, 其餘皆先治其本, 不可不愼也. 《入門》

Translation영역

One who treats disease must know branch and root. Speaking of the body, the outside is branch and the inside root; yang is branch and yin root. So the six bowels, belonging to yang, are branch, and the five viscera, belonging to yin, are root; the channels of each viscus and bowel are branch without and root within; and further, the body's qi is branch and its blood root. Speaking of disease, the disease first received is root and the disease passed on afterward is branch. Whoever treats disease must first treat the root and afterward the branch. If one treats the branch first and the root afterward, the evil qi grows worse and the disease stores up further. If one treats the root first and the branch afterward, then though the disease have ten or more patterns they all depart. That is, where a light disease arose first and a heavy one grew from it afterward, still treat the light disease first and the heavy one afterward; in this way the evil qi is subdued, because the root was treated first. But where there is fullness of the centre, without asking branch or root, treat the fullness first — because it is urgent. And where after fullness of the centre there is stool or urine not passing, again without asking branch or root, treat the stool and urine first and the fullness next — because that is more urgent still. Apart from these three — stool and urine not passing, and fullness of the centre — everything else has the root treated first, and this cannot be neglected.

Clinical note임상 주석

The rule and its three exceptions. Root first, always — even when the root is the lighter complaint — except for abdominal fullness, which is treated first, and blocked stool or urine, which is treated before that. The exceptions are the conditions that kill fastest if left, and the passage ranks them: obstruction of the bowel or bladder outranks distension, and both outrank whatever came first. That is a triage rule, and it is the chapter's most practical sentence.

Immun 入門

5.7 In Urgency Treat the Branch, in Leisure Treat the Root 急則治標緩則治本

5.7.1

Source원문

如先病發熱, 加之吐瀉, 粥藥難入, 則略緩治熱一節. 且以定嘔進食爲先, 方兼治瀉, 待元氣稍復, 乃攻熱耳. 此緩急之宜也. 《入門》

Translation영역

Where fever came first and vomiting and diarrhoea are added to it, so that neither congee nor medicine will go down, then set aside the treating of the fever a little. Take settling the vomiting and getting food in as the first thing, then treat the diarrhoea alongside, and wait for the origin qi to recover somewhat before attacking the heat. This is what suits urgency and leisure.

Clinical note임상 주석

The exception of 5.6 worked through a case. A feverish patient who cannot keep anything down is not treated for the fever until they can eat, because the medicine for the fever would come back up with everything else.

Immun 入門

5.8 The Order of Using Medicines for Branch and Root 標本用藥先後

5.8.1

Source원문

內經曰, 有其在標而求之於標, 有其在本而求之於本, 有其在本而求之於標, 有其在標而求之於本. 故治有取標而得者, 有取本而得者, 有逆取而得者, 有從取而得者. 故知逆與從, 正行無問, 知標本者, 萬擧萬當. 不知標本, 是謂妄行.

Translation영역

The Neijing says: there is what lies in the branch and is sought in the branch; what lies in the root and is sought in the root; what lies in the root and is sought in the branch; what lies in the branch and is sought in the root. Hence in treatment there are cases won by taking the branch, cases won by taking the root, cases won by taking the reverse, cases won by taking the compliant. So one who knows reverse and compliant proceeds rightly without question, and one who knows branch and root is right in ten thousand undertakings out of ten thousand. Not to know branch and root is called acting recklessly.

Naegyeong 內經

5.8.2

Source원문

先病而後逆者, 治其本, 先逆而後病者, 治其本. 先寒而後生病者, 治其本, 先病而後生寒者, 治其本. 先熱而後生病者, 治其本, 先熱而後生中滿者, 治其標. 先病而後泄者, 治其本, 先泄而後生他病者, 治其本, 必且調之, 乃治其他病. 先病而後生中滿者, 治其標, 先中滿而後煩心者, 治其本. 人有客氣有同氣. 小大不利, 治其標, 小大利, 治其本. 病發而有餘, 本而標之, 先治其本, 後治其標, 病發而不足, 標而本之, 先治其標, 後治其本. 謹察間甚, 以意調之, 間者幷行, 甚者獨行. 《內經》

Translation영역

Where disease came first and counterflow after, treat the root; where counterflow came first and disease after, treat the root. Where cold came first and disease arose after, treat the root; where disease came first and cold arose after, treat the root. Where heat came first and disease arose after, treat the root; where heat came first and fullness of the centre arose after, treat the branch. Where disease came first and diarrhoea after, treat the root; where diarrhoea came first and other disease arose after, treat the root — it must first be regulated, and then the other disease treated. Where disease came first and fullness of the centre arose after, treat the branch; where fullness of the centre came first and vexation of the heart after, treat the root. A person has visiting qi and same qi. Where stool and urine do not pass, treat the branch; where they pass, treat the root. Where the disease breaks out in surplus, it is root and then branch — treat the root first and the branch after; where it breaks out in insufficiency, it is branch and then root — treat the branch first and the root after. Carefully observe the mild and the severe and regulate by judgement: in the mild, proceed together; in the severe, proceed singly.

Clinical note임상 주석

The Suwen's full table of precedence, and every line but three says root. The three that say branch are 5.6's exceptions again — fullness of the centre, and stool or urine not passing. The last clause adds a fourth rule: mild cases can have root and branch treated together, severe ones only one at a time. Where the patient is strong enough, both; where not, choose.

Naegyeong 內經

5.9 Greater Yang and Lesser Yin Differ in Branch-and-Root Medicines 太陽少陰標本異藥

5.9.1

Source원문

太陽膀胱之經, 標熱本寒. 其脉緊而數, 按之不鼓而空虛, 是外見虛陽而內有眞寒. 故仲景以薑附湯熟煎而冷服之. 薑附熱藥, 治其本寒, 冷服者, 治其標陽也. 是熱因寒用也. 少陰心之經, 標寒本熱, 其脉沈細, 按之洪大, 是外見虛寒而內有實熱. 仲景以大承氣湯, 酒製大黃而熱服之. 酒製熱服以除標寒, 大黃芒硝以瀉本熱. 可以爲萬世法矣. 《綱目》

Translation영역

The greater yang bladder channel has a hot branch and a cold root. Its pulse is tight and rapid, but pressed it does not drum and is empty — this is vacuous yang seen without and true cold within. So Zhongjing decocts Ginger and Aconite Decoction through and gives it cold. Ginger and aconite, hot medicines, treat the cold root; giving it cold treats the yang branch. This is using heat by way of cold. The lesser yin heart channel has a cold branch and a hot root. Its pulse is sunken and fine, but pressed it is surging and large — this is vacuous cold seen without and replete heat within. Zhongjing uses Major Order the Qi Decoction with the rhubarb wine-prepared and gives it hot. Wine-preparing and giving hot remove the cold branch; rhubarb and mirabilite drain the hot root. This may stand as a rule for ten thousand ages.

Clinical note임상 주석

Two formulas given at the wrong temperature on purpose. A hot decoction served cold for a patient who is hot on the surface and cold inside, so the cold surface does not reject it; a purgative served hot for a patient cold on the surface and hot inside, for the same reason. The pulse under pressure is what reveals the root — the Pulse Diagnosis chapter's 4.17 is this same pair of cases from the pulse side.

Gangmok 綱目

5.9.2

Source원문

手足少陰太陽四經, 標本寒熱不定. 標寒本熱者, 宜辛苦大寒入酒熱服, 以瀉其熱. 是寒因熱用也. 標熱本寒者, 宜辛熱大溫而冷飮, 以扶其眞陽, 是熱因寒用也. 陽明厥陰, 不從標本, 從乎中治. 是中者, 非中外中下之中, 乃隨時以取中也. 《入門》

Translation영역

The four channels of hand and foot lesser yin and greater yang have branch and root of no fixed cold or heat. Where the branch is cold and the root hot, acrid, bitter and greatly cold medicines should be put in wine and taken hot, to drain the heat — this is using cold by way of heat. Where the branch is hot and the root cold, acrid, hot and greatly warm medicines should be drunk cold, to support the true yang — this is using heat by way of cold. Yang brightness and reverting yin follow neither branch nor root but are treated from the centre; this centre is not the centre of inside-and-outside or middle-and-lower, but the centre taken according to the moment.

Immun 入門

5.10 Do Not Cut Down the Harmony of Heaven 毋伐天和

5.10.1

Source원문

內經曰, 必先歲氣, 毋伐天和. 又曰, 無失天信無逆氣宜. 又曰, 不知年之所加, 氣之盛衰虛實之所起, 不可以爲工矣.

Translation영역

The Neijing says: first know the qi of the year, and do not cut down the harmony of heaven. It also says: do not lose heaven's trust, do not go against what the qi finds fitting. And it says: one who does not know what the year adds, and where the exuberance and decline, vacuity and repletion of the qi arise, cannot be a craftsman.

Naegyeong 內經

5.10.2

Source원문

諸病四時用藥之法, 不問寒熱溫涼, 如春時則加淸涼風藥, 夏月加大寒之藥, 秋月加溫氣藥, 冬月加大熱藥, 是不絶生化之源也. 錢仲陽醫小兒, 深得此理. 內經曰, 必先歲氣, 毋伐天和, 是爲至治. 《東垣》

Translation영역

In the method of using medicines through the four seasons for all diseases, without regard to cold, hot, warm or cool: in spring add clearing, cooling wind medicines; in summer add greatly cold medicines; in autumn add warming qi medicines; in winter add greatly hot medicines — this is not cutting off the source of engendering and transformation. Qian Zhongyang in treating children grasped this principle deeply. The Neijing says: first know the qi of the year, and do not cut down the harmony of heaven — this is the utmost treatment.

Clinical note임상 주석

A seasonal supplement to every prescription, regardless of what the prescription is for. In summer something cold is added even to a warming formula, because the summer's own heat is part of what the patient is carrying. Dongwon names Qian Yi, the pediatrician, as the one who applied this best — and the Women chapter's Chukthae-hwan at 1.20.14, whose scutellaria dose changes with the season, is the rule in a single formula.

Dongwon 東垣

5.10.3

Source원문

淸平之世, 同水化也. 雖辛熱之藥, 不生他病. 擾攘之世, 同火化也. 若有辛熱之藥, 則發黃出斑, 變壞之病作矣. 盖人內火旣動, 外火又侵. 所以辛熱發汗, 不如辛溫, 辛溫又不如辛凉藥也. 《河間》

Translation영역

An age of peace and calm is like the transformation of water; even acrid and hot medicines engender no other disease. An age of turmoil is like the transformation of fire; if acrid and hot medicines are given, jaundice and macules break out and diseases of ruin and change arise. For the person's inner fire is already stirred and outer fire invades besides. That is why in effusing sweat, acrid-hot is not as good as acrid-warm, and acrid-warm not as good as acrid-cool.

Clinical note임상 주석

Liu Wansu's argument that the temper of the age is a climate too, and that a troubled time makes everyone hotter. Whatever is made of the premise, the conclusion is the whole of his school: cool medicines to release the exterior rather than hot ones.

Hagan 河間

5.11 The Great Rule for Using Medicines 用藥大法

5.11.1

Source원문

大法, 春宜吐, 夏宜汗, 秋宜下, 冬宜溫及灸. 《仲景》

Translation영역

The great rule: in spring, ejecting; in summer, sweating; in autumn, purging; in winter, warming and moxa.

Clinical note임상 주석

Four seasons and four methods, and the three method chapters each open on their own line of it — To 6.1, Han 7.1 and Ha 8.1. Here the rule is given whole, with winter's warming added to make four.

Junggyeong 仲景

5.12 In Using Any Medicine One Must Know the Four Prohibitions 凡用藥必知時禁經禁病禁藥禁

5.12.1

Source원문

凡用藥, 必知時禁ㆍ經禁ㆍ病禁ㆍ藥禁.

Translation영역

In using any medicine, one must know the prohibitions of season, of channel, of disease and of medicine.

Dongwon 東垣

5.12.1 The Prohibitions of Season 時禁

5.12.1.1

Source원문

時禁者, 必本四時升降之理, 汗下吐利之宜. 升降浮沈則順之, 寒熱溫涼則逆之. 謂春氣溫而宜涼藥, 夏氣熱而宜寒藥, 秋氣凉而宜溫藥, 冬氣寒而宜熱藥. 病在上而宜升, 病在下而宜降, 病在外而宜汗, 病在內而宜下. 《東垣》

Translation영역

The prohibitions of season rest on the principle of rising and falling through the four seasons, and on what suits sweating, purging, ejecting and disinhibiting. Rising and falling, floating and sinking, follow them; cold and heat, warmth and coolness, oppose them. That is, the qi of spring is warm and cooling medicines suit it; the qi of summer is hot and cold medicines suit it; the qi of autumn is cool and warming medicines suit it; the qi of winter is cold and hot medicines suit it. Disease above should be raised, disease below lowered, disease without sweated, disease within purged.

Clinical note임상 주석

Two rules that go opposite ways and are meant to. The direction of a medicine follows the season — rising in spring, sinking in autumn — while its temperature opposes it. Cool medicines in the warm season, hot in the cold.

Dongwon 東垣

5.12.1.2

Source원문

春宜吐, 象萬物之發生, 使陽氣之鬱者易達也. 夏宜汗, 象萬物之浮而有餘也. 秋宜下, 象萬物之收成, 推陳致新也. 冬宜周密, 象萬物之閉藏, 使陽氣不動也. 《東垣》

Translation영역

In spring, ejecting takes after the ten thousand things coming forth, so that pent yang qi may readily come through. In summer, sweating takes after the ten thousand things floating up in surplus. In autumn, purging takes after the ten thousand things being gathered in, pushing out the old to bring in the new. In winter, being closed and tight takes after the ten thousand things shut up and stored, so that the yang qi does not stir.

Dongwon 東垣

5.12.2 The Prohibitions of Channel 經禁

5.12.2.1

Source원문

經禁者, 足太陽膀胱經, 爲諸陽之首, 行身之後, 風寒所傷則宜汗, 傳入本則宜利小便. 若下之太早, 則變證百出, 此一禁也.

Translation영역

The prohibitions of channel: the foot greater yang bladder channel is the head of all the yang and runs the back of the body; damaged by wind and cold it should be sweated, and where the evil has passed into the root, the urine should be disinhibited. If it is purged too early, a hundred changed patterns break out — this is the first prohibition.

Dongwon 東垣

5.12.2.2

Source원문

足陽明胃經, 行身之前, 病主腹脹滿, 大便難, 宜下之. 若發汗利小便, 爲重損津液, 此二禁也.

Translation영역

The foot yang brightness stomach channel runs the front of the body; its disease is governed by abdominal distension and fullness and difficult stool, and it should be purged. If sweat is effused or the urine disinhibited, the fluids are doubly damaged — this is the second prohibition.

Dongwon 東垣

5.12.2.3

Source원문

足少陽膽經, 行身之側, 病往來寒熱, 口苦, 胸脇痛, 只宜和解. 且膽者, 無出入道, 下則犯太陽, 汗則犯陽明, 利小便則使生發之氣, 反陷入陰中, 此三禁也. 《東垣》

Translation영역

The foot lesser yang gallbladder channel runs the side of the body; its disease is cold and heat coming and going, bitter taste in the mouth and pain of chest and ribside, and it should only be harmonized and resolved. For the gallbladder has no road of entry or exit: purging offends the greater yang, sweating offends the yang brightness, and disinhibiting the urine makes the engendering and effusing qi sink instead into the yin — this is the third prohibition.

Clinical note임상 주석

Three channels and three forbidden methods. The back is sweated and not purged; the front is purged and not sweated; the side is neither, because the gallbladder has no exit and everything done to it drives the evil somewhere else. The third is the 三禁 the Women chapter invokes at 1.28.9.1 for cold damage in pregnancy, and Sosiho-tang is the formula that harmonizes without breaking any of them.

Dongwon 東垣

5.12.3 The Prohibitions of Disease 病禁

5.12.3.1

Source원문

病禁者, 如陽氣不足, 陰氣有餘之病, 則凡飮食及藥, 忌助陰瀉陽. 《東垣》

Translation영역

The prohibitions of disease: in a disease of yang qi insufficient and yin qi in surplus, all food and drink and all medicine that assist the yin and drain the yang are to be avoided.

Dongwon 東垣

5.12.4 The Prohibitions of Medicine 藥禁

5.12.4.1

Source원문

藥禁者, 如汗多禁利小便, 小便多禁發汗.

Translation영역

The prohibitions of medicine: where sweating is heavy, disinhibiting the urine is forbidden; where urine is copious, effusing sweat is forbidden.

Clinical note임상 주석

Sweat and urine draw on the same fluid, and a patient losing one cannot spare the other. The Sweating chapter's 7.8.2 makes the same argument for blood.

Dongwon 東垣

5.12.4.2

Source원문

咽痛, 禁發汗利小便. 《東垣》

Translation영역

In sore throat, effusing sweat and disinhibiting the urine are forbidden.

Dongwon 東垣

5.13 Treatment Methods for the Five Depressions 五鬱治法

5.13.1

Source원문

木鬱達之, 謂吐令條達也. 火鬱發之, 謂汗令疏散也. 土鬱奪之, 謂下無壅碍也. 金鬱泄之, 謂解表利小便也. 水鬱折之, 謂制其衝逆也. 《內經》

Translation영역

Wood depression, reach it — that is, eject so that it stretches out freely. Fire depression, effuse it — that is, sweat so that it is loosened and scattered. Earth depression, seize it — that is, purge so that there is no blockage. Metal depression, discharge it — that is, release the exterior and disinhibit the urine. Water depression, break it — that is, restrain its surging counterflow.

Clinical note임상 주석

The Suwen's five verbs — reach, effuse, seize, discharge, break — with a method under each. Three of them are the three method chapters: wood is ejected, fire is sweated, earth is purged. The Fire chapter's 5.12 applies 火鬱發之 to burning palms and soles, and the Internal Damage chapter's 1.37 applies 木鬱達之 to a pulse gone at the cubit.

Naegyeong 內經

5.14 Expedient Variation in Using Medicines 用藥權變

5.14.1

Source원문

內經曰, 寒者熱之, 熱者寒之, 微者逆之, 甚者從之. 逆者正治, 從者反治, 從少從多, 觀其事也. 帝曰, 何謂反治. 岐伯曰, 熱因寒用, 寒因熱用, 塞因塞用, 通因通用. 必伏其所主, 而先其所因. 其始則同, 其終則異, 可使破積, 可使潰堅, 可使氣和, 可使必已.

Translation영역

The Neijing says: what is cold, heat it; what is hot, cool it; what is slight, oppose it; what is severe, follow it. Opposing is straight treatment; following is reverse treatment. Whether to follow a little or much depends on the matter. The Emperor said: what is meant by reverse treatment? Qi Bo said: heat used by way of cold, cold used by way of heat, blocking used for blockage, freeing used for what is free. One must subdue what governs and go first to what caused it. The beginning is the same but the end is different — it can break accumulation, can burst what is hard, can make the qi harmonious, can bring it surely to an end.

Clinical note임상 주석

Reverse treatment defined: giving what seems to match the disease rather than oppose it. Four forms — hot medicine given cold, cold given hot, a supplement for what seems blocked, a purge for what is already running — and the reason is always that the appearance is false. 其始則同, 其終則異: it looks like the disease at first and turns out to be its cure.

Naegyeong 內經

5.14.2

Source원문

微者逆之, 甚者從之, 何謂也. 盖治寒以熱, 必凉而行之, 治熱以寒, 必溫而行之. 此亦欲其調和也. 盖病有微有甚, 微者逆治, 理之正也, 甚者從治, 理之權也. 《東垣》

Translation영역

What is slight, oppose it; what is severe, follow it — what does this mean? In treating cold with heat one must carry it in cool; in treating heat with cold one must carry it in warm. This too is so that they may be harmonized. Disease is slight or severe; opposing the slight is the straight principle, following the severe is the expedient principle.

Dongwon 東垣

5.14.3

Source원문

如硝黃ㆍ大寒之藥熱服, 是寒因熱用也. 如薑附ㆍ大熱之藥冷服, 是熱因寒用也. 《內經》

Translation영역

Mirabilite and rhubarb, greatly cold medicines, taken hot — this is cold used by way of heat. Ginger and aconite, greatly hot medicines, taken cold — this is heat used by way of cold.

Naegyeong 內經

5.14.4

Source원문

積熱, 用苦寒藥, 必以薑汁酒製. 沈寒, 用熱藥如附子, 必用童便蜜製. 亦寒因熱用, 熱因寒用也. 《入門》

Translation영역

For accumulated heat, bitter cold medicines are used, but must be prepared with ginger juice or wine. For deep cold, hot medicines such as aconite are used, but must be prepared with child's urine or honey. This too is cold used by way of heat and heat used by way of cold.

Clinical note임상 주석

The same principle applied in the processing rather than the serving. A cold medicine fried in ginger juice carries a little warmth into a body that would otherwise reject it, and aconite steeped in child's urine or honey has its heat tempered so the patient can take it. The Women chapter's Gyoga-san at 1.29.15.4, with ginger fried in rehmannia juice and rehmannia in ginger juice, is the most elegant instance in the book.

Immun 入門

5.14.5

Source원문

塞如腫脹補中, 通如痢疾宜下. 《入門》

Translation영역

Blocking for blockage — as in supplementing the centre for swelling and distension. Freeing for what is free — as in purging for dysentery.

Clinical note임상 주석

The two harder cases of 5.14.1 given examples. Distension looks like fullness and is treated by supplementing, because the fullness is the spleen too weak to move; dysentery looks like the bowel running and is treated by purging, because what is running is obstruction trying to clear. The Distension chapter's 6.6 and the Purging chapter's 8.3.1 are these two rules at length.

Immun 入門

5.15 The Warning on Sweating and Purging 汗下之戒

5.15.1

Source원문

汗多亡陽, 下多亡陰. 《仲景》

Translation영역

Sweating much destroys the yang; purging much destroys the yin.

Junggyeong 仲景

5.15.2

Source원문

不當汗而妄汗之, 奪其津液, 枯槁而死. 不當下而强下之, 令人開腸洞泄, 便尿不禁而死. 《仲景》

Translation영역

Where sweating is not called for and it is done rashly, the fluids are seized and the patient withers and dies. Where purging is not called for and it is forced, the bowel is thrown open and pours, stool and urine escape uncontrolled, and the patient dies.

Junggyeong 仲景

5.15.3

Source원문

大汗傷氣, 大下傷血. 《得效》

Translation영역

Heavy sweating damages the qi; heavy purging damages the blood.

Clinical note임상 주석

The chapter's warning against its own two commonest methods, in three sources and two lines each. The Sweating chapter carries the first at Han 7.9 and the Purging chapter at Ha 8.5, each in the position after its method — and here they stand together as one caution.

Deukhyo 得效

5.16 The Superior Craftsman Treats Disease Before It Arises 上工治未病

5.16.1

Source원문

上工治未病, 何也. 師曰, 見肝之病, 知肝傳脾, 當先實脾. 中工不曉相傳, 見肝之病, 不解實脾, 惟治肝也. 夫肝之病, 補用酸, 助用焦苦, 益用甘味之藥. 夫酸入肝, 焦苦入心, 甘入脾. 脾能傷腎之氣. 腎氣微弱則水不行. 水不行則心火盛. 心火盛則傷肺. 肺被傷則金氣不行, 金氣不行則肝木自愈. 此治肝補脾之要妙也. 餘藏倣此. 《仲景》

Translation영역

The superior craftsman treats disease before it arises — how? The master said: seeing a disease of the liver, he knows the liver will pass it to the spleen, and first makes the spleen replete. The middling craftsman does not understand transmission; seeing a disease of the liver, he does not grasp making the spleen replete and only treats the liver. In a disease of the liver, supplement with sour, assist with scorched bitter, and boost with sweet-flavoured medicines. Sour enters the liver, scorched bitter enters the heart, sweet enters the spleen. The spleen can damage the kidney's qi; where the kidney qi is faint and weak, water does not move; where water does not move, heart fire is exuberant; where heart fire is exuberant it damages the lung; where the lung is damaged the metal qi does not move; where the metal qi does not move, the liver wood recovers of itself. This is the essential subtlety of treating the liver by supplementing the spleen. The other viscera follow this.

Clinical note임상 주석

The opening of the Jingui, and the sentence the tradition quotes for what preventive medicine means: 見肝之病, 知肝傳脾, 當先實脾 — seeing liver disease, know it will go to the spleen, and strengthen the spleen first. The chain that follows runs the five phases round a full circle to explain why supplementing the spleen cures the liver. Whatever is made of the chain, the practice it produces — protect the organ that will be attacked next — is the same in any medicine.

Junggyeong 仲景

5.17 Supplementing and Draining in Vacuity and Repletion 虛實補瀉

5.17.1

Source원문

從前來者爲實邪, 從後來者爲虛邪. 此子能令母實, 母能令子虛, 是也. 治法曰, 虛則補其母, 實則瀉其子. 假令肝受心火之邪, 是從前來者爲實邪. 入肝經藥爲引, 用瀉心火藥爲君. 若肝受腎水之邪, 是從後來者爲虛邪. 以入腎經藥爲引, 用補肝經藥爲君, 是也. 《東垣》

Translation영역

What comes from in front is a repletion evil; what comes from behind is a vacuity evil. This is what is meant by the child being able to make the mother replete and the mother being able to make the child vacuous. The rule of treatment says: in vacuity supplement the mother, in repletion drain the child. Suppose the liver receives an evil from heart fire — that comes from in front and is a repletion evil; medicines entering the liver channel are the guide, and medicines draining heart fire are the chief. If the liver receives an evil from kidney water — that comes from behind and is a vacuity evil; medicines entering the kidney channel are the guide, and medicines supplementing the liver channel are the chief. That is it.

Clinical note임상 주석

Front and behind are the five-phase order: the organ ahead of the liver is its child, the heart; the one behind is its mother, the kidney. An evil from the child is treated by draining the child; one from the mother by supplementing the patient. The Nanjing's rule — 虛則補其母, 實則瀉其子 — is the tradition's standing formula for choosing a direction.

Dongwon 東垣

5.18 The Subtle Secret of Supplementing and Draining 補瀉妙訣

5.18.1

Source원문

難經曰, 東方實, 西方虛, 瀉南方, 補北方, 何謂也. 然金木水火土, 當更相平. 東方木也. 西方金也. 木欲實, 金當平之, 火欲實, 水當平之, 土欲實, 木當平之, 金欲實, 火當平之, 水欲實, 土當平之. 東方者肝也, 則知肝實, 西方者肺也, 則知肺虛. 瀉南方火, 補北方水. 南方火也. 火者木之子. 北方水也. 水者木之母. 水能勝火. 子能令母實, 母能令子虛. 故瀉火補水, 欲令金得平木也. 經曰, 不能治其虛, 何問其餘, 此之謂也. 夫水者木之母. 子能令母實一句, 言病因也. 母能令子虛一句, 言治法也. 其意盖曰, 火爲木之子, 子助其母, 使之過分而爲病. 今將何以處之. 惟有補水瀉火之治而已.

Translation영역

The Nanjing says: the east is replete and the west vacuous — drain the south and supplement the north. What does this mean? Well: metal, wood, water, fire and earth should keep each other level. The east is wood and the west is metal. Where wood would grow replete, metal should level it; where fire would, water should; where earth would, wood should; where metal would, fire should; where water would, earth should. The east is the liver, so the liver is known to be replete; the west is the lung, so the lung is known to be vacuous. Drain the fire of the south and supplement the water of the north. The south is fire, and fire is wood's child; the north is water, and water is wood's mother. Water can overcome fire. The child can make the mother replete, and the mother can make the child vacuous. So drain fire and supplement water, wishing metal to be able to level wood. The classic says: if you cannot treat its vacuity, what use asking about the rest — this means that. Water is wood's mother. The clause that the child can make the mother replete speaks of the cause of the disease; the clause that the mother can make the child vacuous speaks of the method of treatment. The sense is this: fire is wood's child, and the child assists its mother and makes her exceed her measure and become diseased. What is now to be done about it? There is only the treatment of supplementing water and draining fire.

Clinical note임상 주석

The seventy-fifth difficulty of the Nanjing, and the tradition's classic puzzle: the liver is replete and the lung vacuous, and the prescription is to treat the heart and the kidney. The answer takes the five phases round twice — drain the child that is feeding the liver, supplement the mother that will restrain it — and arrives at the pair the Fire chapter uses throughout for ministerial fire: enrich the water, and the fire goes down of itself.

Nangyeong 難經

5.18.2

Source원문

難經曰, 欲泄其邪, 先補其虛, 此之謂也. 《東垣》

Translation영역

The Nanjing says: wishing to discharge the evil, first supplement the vacuity — this means that.

Dongwon 東垣

5.19 Supplementing and Draining Combined 補瀉相兼

5.19.1

Source원문

程明祐曰, 人皆知補之爲補, 而不知瀉之爲補, 知瀉之爲瀉, 而不知補之爲瀉. 陰陽迭用, 剛柔互體, 故補血以益榮, 非順氣則血凝, 補氣以助衛, 非活血則氣滞. 盖脾爲中州, 水火交濟而後能生萬物也. 《入門》

Translation영역

Cheng Mingyou said: everyone knows that supplementing supplements, but not that draining supplements; knows that draining drains, but not that supplementing drains. Yin and yang are used by turns and hard and soft embody each other. So in supplementing blood to boost the construction, unless the qi is made to flow the blood congeals; in supplementing qi to assist the defence, unless the blood is quickened the qi stagnates. For the spleen is the central province, and only when water and fire aid each other across it can it engender the ten thousand things.

Clinical note임상 주석

Why a blood formula carries a qi-mover and a qi formula a blood-mover — Samul-tang has chuanxiong in it and Sagunja-tang has nothing to move the blood but is never given alone for long. A supplement that is not moved sits and becomes an obstruction, and that is the sense in which draining supplements.

Immun 入門

5.20 The Method of Seeking the Category 求屬之法

5.20.1

Source원문

內經曰, 微者調之, 其次平之, 盛者奪之. 汗之下之, 寒熱溫涼, 衰之以屬, 隨其攸利. 註曰, 假如小寒之氣, 溫以和之, 大寒之氣, 熱以取之, 甚寒之氣, 則下奪之. 奪之不已, 則逆折之, 折之不盡, 則求其屬以衰之. 小熱之氣, 涼以和之, 大熱之氣, 寒以取之, 甚熱之氣, 則汗發之. 發之不已, 則逆制之, 制之不盡, 則求其屬以衰之. 《東垣》

Translation영역

The Neijing says: what is slight, regulate it; the next degree, level it; what is exuberant, seize it. Sweat it or purge it, cold or hot, warm or cool — weaken it by its category, following what benefits it. The commentary says: for a slight cold qi, warm to harmonize it; for a great cold qi, heat to take it; for an extreme cold qi, purge to seize it. Where seizing does not end it, oppose and break it; where breaking does not exhaust it, seek its category to weaken it. For a slight hot qi, cool to harmonize it; for a great hot qi, cold to take it; for an extreme hot qi, sweat to effuse it. Where effusing does not end it, oppose and restrain it; where restraining does not exhaust it, seek its category to weaken it.

Clinical note임상 주석

A ladder of escalation for cold and for heat, three rungs each, and then two more steps for when the ladder fails. 求其屬以衰之 — seek its category to weaken it — is the last resort, and the next passage says what the category is.

Dongwon 東垣

5.20.2

Source원문

求屬之法, 是同聲相應, 同氣相求. 經曰, 陷下者衰之. 夫衰熱之法, 同前所云, 火衰于戌, 金衰于辰之類, 是也. 《東垣》

Translation영역

The method of seeking the category is that like sounds answer each other and like qi seek each other. The classic says: what has sunk down, weaken it. The method of weakening heat is as said before — fire weakens at sul, metal weakens at jin, and the like.

Clinical note임상 주석

The category is the calendar. Fire is weakest at the hour and month of 戌, metal at 辰, and a heat that will not yield to medicine is attacked when its own season is against it. This is 5.10's harmony of heaven turned from a caution into a weapon, and it closes the chapter's first half.

Dongwon 東垣

5.21 The Three Methods of Treating Disease 治病三法

5.21.1

Source원문

治病之道有三焉, 初中末也. 初治之道, 法當猛峻者, 謂所用藥勢疾利猛峻也. 緣病得之新暴, 感之輕, 得之重, 皆當以疾利猛峻之藥, 急去之.

Translation영역

The way of treating disease has three parts: the beginning, the middle and the end. The way of treating at the beginning is by rule fierce and sharp — that is, the medicines used are swift, sharp, fierce and strong. Because the disease is newly and suddenly got, whether the contraction was light or heavy, in all cases it should be driven off at once with swift, sharp, fierce and strong medicines.

Dongwon 東垣

5.21.2

Source원문

中治之道, 法當寬猛相濟. 爲病得之非新非久, 當以緩疾得中, 養正去邪相兼濟而治之. 臨時消息, 更加鍼灸, 其效甚速.

Translation영역

The way of treating in the middle is by rule the lenient and the fierce aiding each other. Because the disease is neither new nor old, it should be treated with slow and swift finding the mean, nourishing the right and removing the evil aiding each other together. Adjust to the moment, and add needle and moxa, and the effect is very quick.

Dongwon 東垣

5.21.3

Source원문

末治之道, 法當寬緩. 寬者, 謂藥性平善, 廣服無毒. 惟能血氣安中, 使正氣多而邪氣自去. 更加鍼灸, 其效必速. 《東垣》

Translation영역

The way of treating at the end is by rule lenient and slow. Lenient means the medicines are level and kindly in nature, may be taken widely without toxicity, and only settle blood and qi in the centre, so that the right qi grows and the evil qi departs of itself. Add needle and moxa, and the effect is sure to be quick.

Clinical note임상 주석

Three stages of one illness, and the medicine softens as the illness ages. Fierce at the start, when the evil is fresh and the patient strong; balanced in the middle; gentle at the end, when only the reserve is left to work with. 5.2.2 gave the same rule across patients — young and new, attack; old and long, supplement — and here it is given across the course of a single case.

Dongwon 東垣

5.22 The Five Methods of Curing Disease 療病五法

5.22.1

Source원문

療病之道, 有五治法焉. 和ㆍ取ㆍ從ㆍ折ㆍ屬也.

Translation영역

The way of curing disease has five methods of treatment: harmonizing, taking, following, breaking and seeking the category.

Dongwon 東垣

5.22.2

Source원문

一治曰和. 假令小熱之病, 當以涼藥和之, 和之不已, 次用取.

Translation영역

The first treatment is called harmonizing. Suppose a disease of slight heat: it should be harmonized with cool medicines; where harmonizing does not end it, next use taking.

Dongwon 東垣

5.22.3

Source원문

二治曰取. 爲熱勢稍大, 當以寒藥取之, 取之不已, 次用從.

Translation영역

The second treatment is called taking. Because the force of the heat is somewhat greater, it should be taken with cold medicines; where taking does not end it, next use following.

Dongwon 東垣

5.22.4

Source원문

三治曰從. 爲勢旣甚, 當以溫藥從之, 爲藥氣溫也. 或以寒因熱用, 或寒以溫用, 或以汗發之. 不已次用折.

Translation영역

The third treatment is called following. Because the force is already severe, it should be followed with warm medicines — the medicine's qi being warm. Or cold is used by way of heat, or cold is carried in warm, or it is effused by sweat. Where this does not end it, next use breaking.

Dongwon 東垣

5.22.5

Source원문

四治曰折. 爲病勢極甚, 當以逆制之. 逆制之不已, 當以下奪之, 下奪之不已, 次用屬.

Translation영역

The fourth treatment is called breaking. Because the force of the disease is extreme, it should be opposed and restrained. Where opposing and restraining do not end it, it should be seized by purging; where purging does not end it, next use seeking the category.

Dongwon 東垣

5.22.6

Source원문

五治曰屬. 爲求其屬以衰之. 緣深陷在骨髓間, 無法可出, 鍼藥所不能及, 故求其屬以衰之. 《東垣》

Translation영역

The fifth treatment is called seeking the category — that is, seeking its category to weaken it. Because the evil has sunk deep between bone and marrow, there is no way to bring it out and neither needle nor medicine can reach it, and so its category is sought to weaken it.

Clinical note임상 주석

The escalation ladder of 5.20 given as five named rungs. What the sequence shows is the tradition's order of force: cool before cold, reverse before oppose, oppose before purge, and purge before the last resort of waiting for the calendar. The third rung is the surprising one — when cold medicine has failed against heat, the next step is warm medicine, on the reverse-treatment principle of 5.14. Only after that does the physician go back to opposing with full force.

Dongwon 東垣

5.23 Enriching the Source of Transformation 滋化源

5.23.1

Source원문

問寒病服熱藥而寒不退, 熱病服寒藥而熱不退, 其故何也. 啓玄子曰, 熱不得寒, 是無水也. 寒不得熱, 是無火也. 寒之不寒, 責其無水, 熱之不熱, 責其無火. 經云, 滋其化源, 源旣已絶, 藥之假, 不能滋其眞水火也. 《東垣》

Translation영역

Someone asked: where a cold disease is given hot medicine and the cold does not retreat, or a hot disease is given cold medicine and the heat does not retreat — why is this? Qixuanzi said: heat that does not yield to cold is the absence of water; cold that does not yield to heat is the absence of fire. Cooling that does not cool, fault the absence of water; heating that does not heat, fault the absence of fire. The classic says: enrich the source of transformation. Where the source is already cut off, borrowed medicine cannot enrich the true water and fire.

Clinical note임상 주석

The question every physician meets — the right medicine given and nothing happening — and Wang Bing's answer, which is that the medicine had nothing to work with. A cold medicine cools by strengthening the body's own water; where there is no water, it strengthens nothing. 藥之假 — borrowed medicine — is the phrase to keep. A medicine is a loan against the body's reserve, and where the reserve is gone the loan cannot be made.

Dongwon 東垣

5.23.2

Source원문

益火之源, 以消陰翳, 壯水之主, 以制陽光, 亦滋其化源也. 《內經》

Translation영역

Boost the source of fire to dispel the shadow of yin; strengthen the ruler of water to restrain the light of yang — this too is enriching the source of transformation.

Clinical note임상 주석

Wang Bing's two famous lines, and the Fire chapter's 5.26.10 quotes the second as the treatment for yin vacuity. They say that cold and heat are corrected not by their opposites but by strengthening what should have held them — the fire that dispels cold from within, the water that restrains heat from within.

Naegyeong 內經

5.23.3

Source원문

夫治寒以熱而寒彌甚, 治熱以寒而熱彌熾者, 何也. 盖不知五藏有陰陽之性, 可因其類而取之也. 假如心實生熱者, 當益其腎, 腎水滋則熱將自除矣. 腎虛生寒, 當補其心, 心火降則寒將自除矣. 此所謂寒之而熱者, 取之陰, 熱之而寒者, 取之陽也. 《東垣》

Translation영역

Where cold is treated with heat and the cold grows worse, or heat is treated with cold and the heat blazes higher — why is this? Because it is not known that the five viscera have natures of yin and yang and may be taken by their kind. Suppose the heart is replete and engenders heat: the kidney should be boosted, and when the kidney water is enriched the heat will be removed of itself. Where the kidney is vacuous and engenders cold, the heart should be supplemented, and when the heart fire descends the cold will be removed of itself. This is what is called: what grows hot on cooling, take it from the yin; what grows cold on heating, take it from the yang.

Clinical note임상 주석

The Suwen's 寒之而熱者, 取之陰 with its mechanism. Heat in the heart is not cooled at the heart but corrected at the kidney, because the kidney is what should have restrained it — and a patient who gets worse on the obvious treatment is the sign that the obvious treatment was aimed at the wrong organ.

Dongwon 東垣

5.24 Supplementing and Draining Child and Mother 子母補瀉

5.24.1

Source원문

難經曰, 虛則補母, 實則瀉子. 註云, 假如肺金之病而實, 當竭腎水, 使子來求食於母, 則肺之實可得而平矣. 肺之虛, 當補脾土, 則母來生子, 使肺之虛可得而平矣. 他藏倣此. 《錢乙》

Translation영역

The Nanjing says: in vacuity supplement the mother, in repletion drain the child. The commentary says: suppose a disease of the lung metal that is replete — the kidney water should be exhausted, so that the child comes to seek food from the mother, and the lung's repletion can be levelled. Where the lung is vacuous, the spleen earth should be supplemented, so that the mother comes to engender the child, and the lung's vacuity can be levelled. The other viscera follow this.

Clinical note임상 주석

The Nanjing's rule from 5.17 with Qian Yi's commentary, and the image makes the mechanism plain: drain the child and it draws on the mother to feed itself; feed the mother and she passes it to the child. Either way the patient organ is corrected from one step away.

Jeon Eul (錢乙)

5.25 In Medicines, Simplicity Is Prized 藥貴簡要

5.25.1

Source원문

上古用一藥治一病, 至漢張仲景, 用群藥治一病. 雖然亦不過三五味而已, 其間君臣佐使分兩不同, 主治引經, 秩然有序, 非若後世之效驗者, 一方用至二三十味尤未已也. 丹溪云, 予每效仲景立方, 效東垣用藥, 庶乎品味少而藥力專精也. 枳朮丸, 乃易老張先生之所製. 觀其用, 白朮二兩以補脾, 枳實一兩以消痞. 至東垣加陳皮一兩以和胃, 一補一消, 簡而又當, 眞得立方之指趣也. 《方廣》

Translation영역

In high antiquity one medicine treated one disease; by the Han, Zhang Zhongjing used a group of medicines for one disease. Even so, it was no more than three to five flavours, among which chief, minister, assistant and envoy differed in their weights, governing the treatment and guiding to the channel in orderly sequence — not like the proven prescriptions of later ages, which use twenty or thirty flavours in one formula and still do not stop. Danxi said: I always imitate Zhongjing in composing a formula and Dongwon in using medicines, so that the flavours are few and the medicine's force is concentrated. Bitter Orange and Atractylodes Pill was made by Master Zhang of Yizhou; look at its use — white atractylodes 2 nyang to supplement the spleen, bitter orange 1 nyang to disperse glomus. Dongwon added tangerine peel 1 nyang to harmonize the stomach — one supplement and one dispersal, simple and yet apt, truly grasping the intent of composing a formula.

Clinical note임상 주석

The argument for small formulas, made against the twenty- and thirty-ingredient prescriptions the chapter has itself recorded — the Women chapter's Boan-hwan at 1.34 has twenty-three. Zhongjing's formulas have three to five, and Jichul-hwan has two, or three with Dongwon's addition. 藥力專精 — the medicine's force concentrated — is the reason given. Every added ingredient dilutes the ones already there.

Banggwang 方廣

5.25.2

Source원문

許學士釋微論曰, 予讀仲景書, 用仲景之法. 然未嘗守仲景之方, 乃爲得仲景之心也. 《東垣》

Translation영역

Scholar Xu's Explaining the Subtle says: I read Zhongjing's book and use Zhongjing's method, yet have never held to Zhongjing's formulas — that is to have grasped Zhongjing's mind.

Clinical note임상 주석

Xu Shuwei on what it means to follow a master: take the method and not the recipe. The Wasting Thirst chapter's 4.6 is Xu at work, reasoning from Zhongjing's principle to a conclusion Zhongjing never drew.

Dongwon 東垣

5.25.3

Source원문

丹溪, 何以不法東垣而效仲景耶. 曰明察藥性, 莫如東垣. 盖所謂聖於醫者也. 故在東垣則可多, 他人而效其多, 斯亂雜矣. 或曰, 東垣如韓信將兵多多益善, 盖諱之也. 《節齋》

Translation영역

Why did Danxi not take Dongwon as his model but imitate Zhongjing? The answer: in clear discernment of the natures of medicines none equals Dongwon — he is what is called a sage of medicine. So in Dongwon's hands many may be used, but when others imitate his many, it is confusion and clutter. Some say Dongwon was like Han Xin commanding troops, the more the better — which is to gloss over it.

Clinical note임상 주석

Dongwon's formulas are large — Bojungikgi-tang has eight ingredients, and his others run to fifteen — and the Jeoljae defends them by saying only Dongwon knew enough to use so many. In anyone else's hands the same size is a fault. Han Xin, the Han general who said he could command any number of troops, is the comparison, and 蓋諱之 — to gloss over it — is the Jeoljae's judgement on those who use it.

Jeoljae 節齋

5.26 Binding a Formula Is Like Binding a Purse 約方猶約囊

5.26.1

Source원문

靈樞曰, 約方, 猶約囊也. 囊滿不約則輸泄. 方成不約, 則神與氣不俱. 故仲景以桂枝湯, 治外感風邪, 則曰若一服汗出, 病瘥停後服, 不必盡劑. 大承氣湯下大實大滿, 則曰得更衣, 止後服, 不必盡劑, 其愼之如此. 此爲大戒, 盖得聖人約囊之旨也. 《寶鑑》

Translation영역

The Lingshu says: binding a formula is like binding a purse. A full purse not bound spills and leaks; a formula composed and not bound, the spirit and the qi do not go together. So Zhongjing, treating external wind evil with Cinnamon Twig Decoction, says: if after one dose the sweat comes out and the disease is cured, stop the later doses — it is not necessary to finish the preparation. For Major Order the Qi Decoction purging great repletion and great fullness, he says: on getting to the privy, stop the later doses — it is not necessary to finish the preparation. Such was his care. This is the great caution, and it grasps the sage's meaning of binding the purse.

Clinical note임상 주석

不必盡劑 — it is not necessary to finish the preparation. The phrase every one of the three method chapters uses, given here with its origin in Zhongjing and its principle: a dose is stopped when it has worked, not when it is used up. The purse image is exact. A formula holds what is needed for the case and nothing more, and is closed once the case is met.

Bogam 寶鑑

5.26.2

Source원문

用藥無據, 反爲氣賊. 《靈樞》

Translation영역

Using medicine without grounds is on the contrary a thief of the qi.

Yeongchu 靈樞

5.26.3

Source원문

班固曰, 有病不治, 得中醫. 倘一藥之誤, 悔將噬臍. 古人云, 拙醫療病, 不如不療, 與此意同. 《入門》

Translation영역

Ban Gu said: to have a disease and not treat it is to get a middling physician. Should one medicine be mistaken, the regret will be like biting one's own navel. The ancients said: a clumsy physician's treating a disease is not as good as not treating it — the sense is the same.

Clinical note임상 주석

有病不治, 得中醫 — a disease untreated gets the result of an average doctor. Ban Gu's line from the Han history, and the chapter's second statement of the principle that doing nothing has a value. 5.2.1 gave the case where it is required.

Immun 入門

5.27 A Physician Who Would Not Write a Book 醫不著書

5.27.1

Source원문

唐許胤宗不著書, 或勸之著書貽後世. 答曰, 醫者, 意也, 思慮精則得之. 脉之候, 幽而難明, 吾意所解, 口莫能宣也. 古之上醫, 要在視脉, 病乃可識. 病與藥値, 惟用一物攻之, 氣純而愈速. 今人不善爲脉, 以情度病, 多其物以幸有功. 譬如獵不知兎, 廣絡原野, 冀一人獲之, 術亦疏矣. 一藥偶得, 他藥相制, 不能專力, 此難愈之驗也. 脉之妙處, 不可言傳, 虛著方論, 終無人能悟, 此吾所以不著書也. 《入門》

Translation영역

Xu Yinzong of the Tang would not write a book. Someone urged him to write one to leave to later ages. He answered: medicine is intention, and it is got where thought is refined. The signs of the pulse are obscure and hard to make plain; what my intention grasps, my mouth cannot set forth. The superior physicians of old made everything of reading the pulse, and then the disease could be known. Where the disease and the medicine meet, one thing alone is used to attack it, and the qi being pure the cure is quick. People today are not skilled at the pulse; they guess at the disease by its look and multiply their ingredients in the hope that some will work — like a hunter who does not know where the hare is and casts his net over the whole plain, hoping one man will catch it; the art is slack indeed. One medicine happens to hit and the others check it, so that none can act with full force — this is the proof of why they are hard to cure. The subtlety of the pulse cannot be passed on in words; to write a treatise of formulas in vain, that no one will ever understand — this is why I do not write a book.

Clinical note임상 주석

Xu Yinzong's refusal, from the Tang history, and the reason is the chapter's whole argument against large formulas in one image: the hunter who does not know where the hare is and nets the whole field. A physician who cannot read the pulse does not know what to give, so he gives everything. 醫者, 意也 — medicine is intention — is the sentence quoted from it. The judgement that matters cannot be written down, and a book of formulas without it is a net without a hare.

Immun 入門

5.27.2

Source원문

孫眞人曰, 醫者, 意也. 隨時增損, 物無定方, 眞知言哉. 《千金》

Translation영역

The True Man Sun said: medicine is intention. Adding and subtracting according to the moment, with no fixed formula for anything — truly one who knew what he was saying.

Cheongeum 千金

5.28 Where There Is Free Passage There Is No Pain 通則不痛

5.28.1

Source원문

痛則不通, 不通則痛. 又云, 諸痛爲實, 痛隨利減, 世多以下之爲利. 假令痛在表者實也. 痛在裏者實也. 痛在血氣者亦實也. 故在表者, 汗之則愈, 在裏者, 下之則愈, 在血氣者, 散之行之則愈. 豈可以利爲下乎. 作通字訓則可矣. 《東垣》

Translation영역

Where there is pain there is no free passage; where there is no free passage there is pain. It is also said: all pain is repletion, and pain diminishes as it is disinhibited — and the world mostly takes disinhibiting to mean purging. Suppose the pain is in the exterior: that is repletion. In the interior: repletion. In the blood and qi: also repletion. So what is in the exterior is cured by sweating, what is in the interior by purging, what is in the blood and qi by scattering and moving. How can disinhibiting be taken to mean purging? Read it as the word for free passage, and it will do.

Clinical note임상 주석

痛則不通, 不通則痛 — the tradition's first principle of pain, and a correction of a misreading in the same breath. 利 in the old rule means to free, not to purge, and Dongwon's point is that a physician who purges every pain is treating one of three locations as though it were all of them.

Dongwon 東垣

5.28.2

Source원문

諸痛皆屬火, 寒涼藥不可峻用. 必用溫散之藥. 《丹心》

Translation영역

All pain belongs to fire, but cold and cooling medicines may not be used forcefully; warm scattering medicines must be used.

Clinical note임상 주석

Pain is fire and is nonetheless not treated with cold, because cold contracts and pain is obstruction. Warm medicines open, and the Fire chapter's 5.26.5 makes the same point about fire in general.

Dansim 丹心

5.28.3

Source원문

諸痛不可補氣, 不可用人參. 盖補氣, 氣旺則不通而痛愈甚矣. 《丹心》

Translation영역

In any pain the qi may not be supplemented and ginseng may not be used, for on supplementing the qi it grows effulgent and does not pass, and the pain grows worse.

Clinical note임상 주석

Danxi's rule against ginseng in pain, and the reason follows from 5.28.1: pain is blockage, and adding to the qi behind a blockage increases the pressure on it. The Accumulations chapter's 1.8 and the Distension chapter's 6.6 work through the exceptions.

Dansim 丹心

5.29 Warm It with Qi 溫之以氣

5.29.1

Source원문

內經曰, 形不足者, 溫之以氣. 溫者, 養也. 溫之者, 所以調其飮食, 適其起居, 澄心息慮, 從容以待其眞氣之復常也. 禮記所謂, 柔色以溫之. 此溫字, 正與彼同. 或以藥扶助之, 亦溫養也. 東垣, 乃以溫爲溫涼之溫, 謂宜溫藥以補元氣而瀉火邪, 亦賢者之一失也. 《丹心》

Translation영역

The Neijing says: where the form is insufficient, warm it with qi. Warm means nourish. To warm it is to regulate the food and drink, suit the rising and resting, clear the heart and still the thoughts, and wait at leisure for the true qi to return to its norm. What the Book of Rites calls softening one's countenance to warm them — that warm is exactly the same as this. Or supporting it with medicine is also warm nourishing. Dongwon took warm as the warm of warm-and-cool, saying warm medicines should be used to supplement the origin qi and drain the fire evil — that too is one lapse of a worthy man.

Clinical note임상 주석

A dispute over one graph. Dongwon read 溫 as a temperature and built his method on warm medicines for the depleted; Danxi reads it as 養, to nurture, and finds the instruction in diet, rest and calm rather than in any drug. 賢者之一失 — one lapse of a worthy man — is as far as Danxi goes in disagreeing with the teacher he otherwise follows, and the Internal Damage chapter is where the disagreement plays out.

Dansim 丹心

5.30 Human Disease Is Nothing More Than Cold, Damp, Heat and Dryness 人病不過寒濕熱燥

5.30.1

Source원문

夫寒濕屬陰, 燥熱屬陽, 人之爲病, 不過二者而已. 善用藥者, 以苦寒而泄其陽, 以辛溫而散其陰, 病之不愈者, 未之有也. 余嘗以防風通聖散治熱燥, 生料五積散治寒濕, 各得其效也. 《醫鑑》

Translation영역

Cold and damp belong to yin, dryness and heat to yang, and human disease is nothing more than these two. One skilled in using medicines discharges the yang with the bitter and cold and scatters the yin with the acrid and warm, and there has never been a disease that did not recover. I have used Saposhnikovia Sage-Inspired Powder for heat and dryness and Five Accumulations Powder with raw ingredients for cold and damp, and each has had its effect.

Clinical note임상 주석

Liu Wansu's reduction of 5.4 taken to its end — two classes and two formulas. The Uigam claims never to have met a case they did not cover, which is the kind of claim the chapter has been warning against since 5.1.

Uigam 醫鑑

5.31 The Utmost Yang Assisted by the Utmost Yin 至陽佐以至陰

5.31.1

Source원문

太白丹佐以硝石, 來復丹用硝石之類, 至陽佐以至陰. 與仲景白通湯, 佐以人尿猪膽汁, 大意相同. 所以去格拒之寒, 兼有伏陽, 不得不爾. 如無伏陽, 不必以陰藥佐之也. 《湯液》

Translation영역

Great White Elixir assisted by nitre, Return and Restore Elixir using nitre and its kind — the utmost yang assisted by the utmost yin. This is of one intent with Zhongjing's White Free Decoction assisted by human urine and pig's bile. It is because in removing the cold that repels there is also hidden yang, and it cannot be otherwise. Where there is no hidden yang, there is no need to assist with yin medicines.

Clinical note임상 주석

A pinch of the coldest substance in a formula of the hottest, and the reason is 5.9's: a body so cold that it rejects heat must be tricked into taking it. Nitre or bile in an aconite formula is the trick. 如無伏陽, 不必 — where there is no hidden yang, no need. The addition is for one case only, and the Tangaek says so.

Tangaek 湯液

5.32 Do Not Injure the Stomach Qi 勿傷胃氣

5.32.1

Source원문

凡治雜病, 先調其氣, 次療諸疾, 無損胃氣, 是其要也. 若血受病, 亦先調氣, 謂氣不調則血不行. 又氣爲之綱, 卽夫也. 夫不唱, 婦不隨也. 《東垣》

Translation영역

In treating any miscellaneous disease, first regulate the qi and next cure the various ills, without harming the stomach qi — that is the essential. If the blood has taken the disease, still regulate the qi first, because where the qi is not regulated the blood does not move. Qi is the guiding cord, that is, the husband; where the husband does not lead, the wife does not follow.

Dongwon 東垣

5.32.2

Source원문

凡攻擊之藥, 有病則病受之. 病邪輕, 藥力重, 則胃氣受傷. 夫胃氣者, 淸純冲和之氣, 惟與穀肉菜果相宜. 藥石皆偏勝之氣, 雖參ㆍ芪性亦偏, 況攻擊之藥乎. 《東垣》

Translation영역

Any attacking medicine, where there is disease, the disease receives it. Where the disease evil is light and the medicine's force heavy, the stomach qi takes the injury. The stomach qi is a clear, pure and harmonious qi, suited only to grain, meat, vegetable and fruit. Medicines and minerals are all qi of one-sided predominance — even ginseng and astragalus are one-sided in nature, let alone attacking medicines.

Clinical note임상 주석

Dongwon's clearest statement of what a medicine is: a one-sided force, and the body's own harmony is the only thing without a side. Food suits the stomach because it has no bias; every drug has one, and the drug's bias lands on the stomach whenever the disease is too small to absorb it. 雖參ㆍ芪性亦偏 — even ginseng and astragalus are one-sided — is the sentence to keep. The supplements are not exempt.

Dongwon 東垣

5.32.3

Source원문

凡疾病, 量人素氣弱者, 當去苦寒之藥, 多加人參ㆍ黃芪ㆍ甘草之類, 瀉火而先補元氣. 《東垣》

Translation영역

In any illness, judging that the person's qi has always been weak, bitter cold medicines should be removed and ginseng, astragalus, licorice and their kind added in quantity, so that fire is drained by first supplementing the origin qi.

Dongwon 東垣

5.33 Using Medicines for the Fat and the Thin 肥瘦用藥

5.33.1

Source원문

肥人, 氣虛多痰, 宜豁痰補氣, 瘦人, 血虛有火, 宜瀉火滋陰. 《入門》

Translation영역

The fat have vacuous qi and much phlegm, and should have phlegm swept and qi supplemented; the thin have vacuous blood and fire, and should have fire drained and yin enriched.

Clinical note임상 주석

The rule the Women chapter applies to infertility at 1.1.9 and the Internal Damage chapter to constitution at 1.19.3. Build tells the physician which of the two directions to lean.

Immun 入門

5.33.2

Source원문

肥人補氣, 面白補氣. 《丹心》

Translation영역

For the fat, supplement qi; for the pale-faced, supplement qi.

Dansim 丹心

5.33.3

Source원문

面白人, 不可多服發散藥. 以其氣虛而又虧之也. 面黑人, 不可多服黃芪, 以其氣實而又補之也. 氣實人, 因服黃芪過多而喘者, 三拗湯方見咳嗽以瀉之. 《丹心》

Translation영역

The pale-faced may not take much effusing and scattering medicine, because the qi is vacuous and would be depleted further. The dark-faced may not take much astragalus, because the qi is replete and would be supplemented further. Where a person of replete qi pants from taking too much astragalus, Three Unrefined Ingredients Decoction formula in the Cough chapter drains it.

Clinical note임상 주석

Complexion as a guide to constitution, and a specific harm named: too much astragalus in a full-blooded patient brings on wheezing. The remedy is the plainest ephedra formula in the book. Danxi's habit of recording the mistake alongside the rule is what makes his passages useful.

Dansim 丹心

5.34 Treating Disease by Diet 食療治病

5.34.1

Source원문

孫眞人曰, 醫者先曉病源, 知其所犯, 以食治之. 食療不愈, 然後命藥. 不特老人小兒相宜. 凡驕養及久病厭藥, 窮乏無財者, 俱宜以飮食調治之也. 《入門》

Translation영역

The True Man Sun said: the physician first understands the source of the disease and knows what has been offended against, and treats it with food. Where diet does not cure it, only then does he order medicine. This is not only suited to the old and to children; the pampered, the long ill who are weary of medicine, and the poor who have no money — all should be treated by regulating food and drink.

Clinical note임상 주석

Sun Simiao's order of treatment — food first, medicine only when food fails — and the list of who it is for closes on 窮乏無財者, the poor who have no money. The Bogam's own preface says the book was compiled so that the common people could treat themselves, and this passage is the principle behind the simples that end every chapter.

Immun 入門

5.35 The Eight Essentials of Treating Disease 治病八要

5.35.1

Source원문

經曰, 病有八要, 不知其要, 病將安去. 乃表裏, 寒熱, 虛實, 邪正而已. 《入門》

Translation영역

The classic says: disease has eight essentials, and not knowing the essentials, where is the disease to go? They are no more than exterior and interior, cold and heat, vacuity and repletion, evil and right.

Clinical note임상 주석

Four pairs, eight terms, and the tradition's diagnostic frame in one line. Three of the pairs are the eight principles as later formalized; the fourth, evil and right, is the question of whether the disease or the patient is winning, which 5.2 opened the chapter with.

Immun 入門

5.36 Four Diseases That May Not Be Supplemented 病有不可補者四

5.36.1

Source원문

乃瘧疾, 狂疾, 水氣, 脚氣也. 《醫說》

Translation영역

They are malaria, mania, water qi and leg qi.

Clinical note임상 주석

Four conditions in which the reflex to strengthen the patient is wrong. Malaria and mania are evils that supplementing feeds; water qi and leg qi are accumulations that supplementing holds in. The Oedema chapter's 3.11 and the Women chapter's 1.29.22.3 both forbid drastic supplementing in swelling for this reason.

Uiseol 醫說

5.37 Medicines for Exterior and Interior, Vacuity and Repletion 表裏虛實藥

5.37.1

Source원문

麻黃瀉表之實, 桂枝補表之虛, 硝ㆍ黃瀉裏之實, 薑ㆍ附補裏之虛. 《雲岐》

Translation영역

Ephedra drains repletion of the exterior; cinnamon twig supplements vacuity of the exterior; mirabilite and rhubarb drain repletion of the interior; ginger and aconite supplement vacuity of the interior.

Ungi 雲岐

5.37.2

Source원문

表虛宜桂枝湯方見寒門, 表實宜麻黃湯方見寒門, 裏虛宜小建中湯方見虛勞, 裏實宜調胃承氣湯方見寒門. 《東垣》

Translation영역

For exterior vacuity, Cinnamon Twig Decoction formula in the Cold Damage chapter; for exterior repletion, Ephedra Decoction formula in the Cold Damage chapter; for interior vacuity, Minor Fortify the Centre Decoction formula in the Vacuity Taxation chapter; for interior repletion, Regulate the Stomach and Order the Qi Decoction formula in the Cold Damage chapter.

Clinical note임상 주석

Four medicinals and four formulas for the four cells of the exterior-interior, vacuity-repletion grid. 5.35's first two pairs made into a table with one entry each — the chapter's plainest piece of reference.

Dongwon 東垣

5.38 Treatment Methods for Wind, Heat, Dryness, Damp and Cold 風熱燥濕寒治法

5.38.1

Source원문

風屬陽, 善行數變, 自外而入, 以鬱正氣. 故治風, 多行氣開表藥. 又風入久變熱, 熱能生痰, 宜用祛風化痰藥. 又熱極生風, 風能燥液, 宜用淸熱潤燥藥.

Translation영역

Wind belongs to yang, travels readily and changes often, enters from without and depresses the right qi. So in treating wind, medicines that move the qi and open the exterior are mostly used. Also, wind entered long turns to heat, and heat can engender phlegm; medicines that dispel wind and transform phlegm should be used. Also, heat at its extreme engenders wind, and wind can dry the fluids; medicines that clear heat and moisten dryness should be used.

Goam 古庵

5.38.2

Source원문

治熱以寒. 寒藥屬陰, 故治熱多陰藥. 又鬱火, 宜發散, 宜用風門藥. 火鬱則發之, 宜升陽散火.

Translation영역

Treat heat with cold. Cold medicines belong to yin, so in treating heat yin medicines are mostly used. Also, depressed fire should be effused and scattered, and the medicines of the Wind chapter used; where fire is depressed, effuse it — raise the yang and scatter the fire.

Goam 古庵

5.38.3

Source원문

濕因氣虛, 不能運化水穀而生, 宜用補氣除濕藥. 又宜溫中消導藥, 行濕利大小便藥.

Translation영역

Damp arises from qi vacuity unable to move and transform water and grain; medicines that supplement qi and eliminate damp should be used. Also medicines that warm the centre and disperse and conduct, and medicines that move damp and disinhibit stool and urine.

Goam 古庵

5.38.4

Source원문

燥因血虛而然. 盖血虛生熱, 熱生燥, 是也. 宜解熱生津藥, 及滋血潤燥藥.

Translation영역

Dryness comes of blood vacuity — blood vacuity engenders heat, and heat engenders dryness. Medicines that resolve heat and engender fluids should be used, and medicines that enrich blood and moisten dryness.

Goam 古庵

5.38.5

Source원문

治寒以熱. 熱藥屬陽, 故治寒多陽藥. 外寒宜汗散, 宜用風門藥, 寒從汗解也. 《古庵》

Translation영역

Treat cold with heat. Hot medicines belong to yang, so in treating cold yang medicines are mostly used. Outer cold should be sweated and scattered, and the medicines of the Wind chapter used — cold is resolved through sweat.

Clinical note임상 주석

Five agents and a method for each, from Wang Lun. The two interesting ones are the derivations — dryness from blood vacuity through heat, damp from qi vacuity through failed transformation — which make both a consequence of depletion rather than an invasion. That is the position 5.2.2 took: fire and damp are what the body produces when it is damaged, and the treatment goes to the damage.

Goam 古庵

5.39 In Treating Disease, First Remove the Root 治病先去根

5.39.1

Source원문

治病之法, 先去病根, 然後可用收澁. 若澣衣然, 先去垢膩然後, 可加粉飾也. 《丹心》

Translation영역

In the method of treating disease, first remove the root of the disease, and only then may astringing be used. It is like washing clothes — first remove the grime, and only then may the finish be applied.

Clinical note임상 주석

Astringents come last. A cough, a discharge, a flux — each is stopped only after what caused it has been cleared, because stopping it first seals the cause in. The laundry image is Danxi's, and the Purging chapter's 8.3.1 is the case it guards against.

Dansim 丹心

5.39.2

Source원문

張戴人曰, 養生與攻痾, 本自不同, 今人以補劑療病, 宜乎不效也. 《綱目》

Translation영역

Zhang Dairen said: nourishing life and attacking sickness are of themselves different things; that people today treat disease with supplementing preparations — no wonder it does not work.

Clinical note임상 주석

Zhang Congzheng, who taught the three methods and distrusted supplementing, gets the last word before the formulary. What keeps a healthy person well is not what cures a sick one, and 5.36 named four diseases where the confusion is fatal.

Gangmok 綱目

5.40 The Eighteen Preparations 十八劑

5.40.1

Source원문

輕劑ㆍ淸劑ㆍ解劑ㆍ緩劑ㆍ寒劑ㆍ調劑ㆍ甘劑ㆍ火劑ㆍ暑劑ㆍ淡劑ㆍ濕劑ㆍ奪劑ㆍ補劑ㆍ平劑ㆍ榮劑ㆍ澁劑ㆍ溫劑ㆍ和劑, 是爲十八也. 《紺珠》

Translation영역

The light preparation, the clearing, the resolving, the relaxing, the cold, the regulating, the sweet, the fire, the summerheat, the bland, the damp, the seizing, the supplementing, the level, the construction, the astringent, the warm and the harmonizing — these make the eighteen.

Clinical note임상 주석

Eighteen classes and one representative formula for each, and the scheme is the tradition's answer to the question of what a formula is for. Every prescription in the hundred chapters that follow can be placed in one of these.

Gamju 紺珠

5.40.2

Source원문

輕劑, 防風通聖散. 發表. 方見風門

Translation영역

The light preparation: Saposhnikovia Sage-Inspired Powder. Effuses the exterior. formula in the Wind chapter

Gamju 紺珠

5.40.3

Source원문

淸劑, 涼膈散. 積熱. 方見火門

Translation영역

The clearing preparation: Cool the Diaphragm Powder. Accumulated heat. formula in the Fire chapter

Gamju 紺珠

5.40.4

Source원문

解劑, 小柴胡湯. 和解. 方見寒門

Translation영역

The resolving preparation: Minor Bupleurum Decoction. Harmonizes and resolves. formula in the Cold Damage chapter

Gamju 紺珠

5.40.5

Source원문

緩劑, 大柴胡湯. 裏熱. 方見寒門

Translation영역

The relaxing preparation: Major Bupleurum Decoction. Interior heat. formula in the Cold Damage chapter

Gamju 紺珠

5.40.6

Source원문

寒劑, 大承氣湯. 痞實滿. 方見寒門

Translation영역

The cold preparation: Major Order the Qi Decoction. Glomus, repletion and fullness. formula in the Cold Damage chapter

Gamju 紺珠

5.40.7

Source원문

調劑, 調胃承氣湯. 胃熱. 方見寒門

Translation영역

The regulating preparation: Regulate the Stomach and Order the Qi Decoction. Stomach heat. formula in the Cold Damage chapter

Gamju 紺珠

5.40.8

Source원문

甘劑, 天水散. 虛熱. 方見暑門

Translation영역

The sweet preparation: Heaven and Water Powder. Vacuity heat. formula in the Summerheat chapter

Gamju 紺珠

5.40.9

Source원문

火劑, 黃連解毒湯. 瀉火. 方見寒門

Translation영역

The fire preparation: Coptis Resolve Toxin Decoction. Drains fire. formula in the Cold Damage chapter

Gamju 紺珠

5.40.10

Source원문

暑劑, 白虎湯. 中暑. 方見寒門

Translation영역

The summerheat preparation: White Tiger Decoction. Summerheat stroke. formula in the Cold Damage chapter

Gamju 紺珠

5.40.11

Source원문

淡劑, 五苓散. 利水. 方見寒門

Translation영역

The bland preparation: Five Ingredients Powder with Poria. Disinhibits water. formula in the Cold Damage chapter

Gamju 紺珠

5.40.12

Source원문

濕劑, 三花神祐丸. 泄水. 方見下門

Translation영역

The damp preparation: Three Flowers Spirit Blessing Pill. Discharges water. formula in the Purging chapter

Gamju 紺珠

5.40.13

Source원문

奪劑, 三黃丸. 瀉熱. 方見火門

Translation영역

The seizing preparation: Three Yellows Pill. Drains heat. formula in the Fire chapter

Gamju 紺珠

5.40.14

Source원문

補劑, 防風當歸飮子. 補虛. 方見火門

Translation영역

The supplementing preparation: Saposhnikovia and Angelica Drink. Supplements vacuity. formula in the Fire chapter

Gamju 紺珠

5.40.15

Source원문

平劑, 四君子湯. 氣虛. 方見氣門

Translation영역

The level preparation: Four Gentlemen Decoction. Qi vacuity. formula in the Qi chapter

Gamju 紺珠

5.40.16

Source원문

榮劑, 四物湯. 血虛. 方見血門

Translation영역

The construction preparation: Four Substances Decoction. Blood vacuity. formula in the Blood chapter

Gamju 紺珠

5.40.17

Source원문

澁劑, 胃風湯. 血痢. 方見大便

Translation영역

The astringent preparation: Stomach Wind Decoction. Bloody dysentery. formula in the Stool chapter

Gamju 紺珠

5.40.18

Source원문

溫劑, 理中湯. 中寒. 方見寒門

Translation영역

The warm preparation: Regulate the Centre Decoction. Cold stroke. formula in the Cold Damage chapter

Gamju 紺珠

5.40.19

Source원문

和劑, 平胃散. 和胃. 方見五藏

Translation영역

The harmonizing preparation: Calm the Stomach Powder. Harmonizes the stomach. formula in the Five Viscera chapter

Clinical note임상 주석

Eighteen formulas, and the striking thing is where they come from: seven from the Cold Damage chapter, three from the Fire chapter, and the rest scattered. The scheme is Liu Wansu's school's — 防風通聖散 leads it, and 三花神祐丸 and 三黃丸 are Zhang Congzheng's — and the supplementing preparation is a formula from the Fire chapter rather than any of the Vacuity Taxation chapter's. What the list gives a physician is a reference: one formula per action, to modify from. The Purging chapter registered 三花神祐丸 at Ha 8.7 and the Fire chapter 涼膈散 at 5.9.1.

Gamju 紺珠

5.41 General Rules for Using Medicines 用藥凡例

5.41.1

Source원문

凡諸風以防風爲君. 解利傷風, 以防風爲君. 白朮ㆍ甘草爲佐, 是風宜辛散也.

Translation영역

In all wind, saposhnikovia is chief. In resolving wind damage, saposhnikovia is chief and white atractylodes and licorice assist — wind should be acrid-scattered.

Dongwon 東垣

5.41.2

Source원문

凡解利傷寒, 以甘草爲君, 防風ㆍ白朮爲佐, 是寒宜甘發也.

Translation영역

In resolving cold damage, licorice is chief and saposhnikovia and white atractylodes assist — cold should be sweet-effused.

Dongwon 東垣

5.41.3

Source원문

凡眼暴發赤腫, 以防風ㆍ黃芩爲君以瀉火, 黃連ㆍ當歸爲佐以和血. 眼久病昏暗, 以熟地黃ㆍ當歸爲君, 羌活ㆍ防風爲臣, 甘菊ㆍ甘草爲佐.

Translation영역

In eyes suddenly red and swollen, saposhnikovia and scutellaria are chief to drain fire, and coptis and angelica assist to harmonize blood. In eyes long ill and dim, cooked rehmannia and angelica are chief, notopterygium and saposhnikovia ministers, and chrysanthemum and licorice assistants.

Dongwon 東垣

5.41.4

Source원문

凡痢疾腹痛, 以白芍藥ㆍ甘草爲君, 當歸ㆍ白朮爲佐. 水瀉, 茯苓ㆍ白朮爲君, 芍藥ㆍ甘草爲佐.

Translation영역

In dysentery with abdominal pain, white peony and licorice are chief, angelica and white atractylodes assist. In watery diarrhoea, poria and white atractylodes are chief, peony and licorice assist.

Dongwon 東垣

5.41.5

Source원문

凡嗽, 以五味子爲君, 痰以半夏, 喘以阿膠爲佐, 熱以黃芩爲佐.

Translation영역

In cough, schisandra is chief; for phlegm, pinellia; for panting, ass-hide glue assists; for heat, scutellaria assists.

Dongwon 東垣

5.41.6

Source원문

凡瘧, 以柴胡爲君.

Translation영역

In malaria, bupleurum is chief.

Dongwon 東垣

5.41.7

Source원문

凡小便不利, 以黃柏ㆍ知母爲君, 茯苓ㆍ澤瀉爲佐.

Translation영역

In urine not passing freely, phellodendron and anemarrhena are chief, poria and alisma assist.

Dongwon 東垣

5.41.8

Source원문

凡下焦有濕, 以草龍膽ㆍ防己爲君, 甘草梢ㆍ黃柏爲佐.

Translation영역

In damp of the lower burner, gentian and stephania are chief, licorice tip and phellodendron assist.

Dongwon 東垣

5.41.9

Source원문

凡痔漏, 以蒼朮ㆍ防風爲君, 甘草ㆍ芍藥爲佐.

Translation영역

In haemorrhoids and fistula, atractylodes lancea and saposhnikovia are chief, licorice and peony assist.

Dongwon 東垣

5.41.10

Source원문

凡諸瘡, 以黃連ㆍ當歸爲君, 甘草ㆍ黃芩爲佐. 《東垣》

Translation영역

In all sores, coptis and angelica are chief, licorice and scutellaria assist.

Clinical note임상 주석

Ten conditions, and for each the chief medicinal and its assistants — the skeleton a formula is built on before anything is added for the particular case. This is Dongwon's answer to 5.27's hunter with his net: know where the hare is, and the net can be small. The chapter ends on the practical rather than the principle, and it is the right ending. Everything from 5.1 to 5.39 was about how to think; this is what to reach for.

Dongwon 東垣

About this translation 凡例

Base text: Donguibogam (東醫寶鑑, 1613 first edition), Miscellaneous Disorders, Volume 1, The Use of Medicines 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.