Zǒumǎ jígān zhēnfāng 走馬急疳真方
True Prescriptions for Galloping Acute Childhood Cancrum Oris attributed to 滕伯祥 Téng Bóxiáng of Nányáng 南陽.
About the work
A short single-juǎn formulary devoted to the treatment of paediatric zǒumǎ gān 走馬疳 (“galloping infantile cancrum oris” — the rapidly-spreading necrotising stomatitis of malnourished children, classically termed noma in Western nosology) and its associated kǒugān 口疳 (mouth-cancrum), ěrgān 耳疳 (ear-cancrum, suppurative otitis externa), bígān 鼻疳 (nasal-cancrum), tāidú tóugān 胎毒頭疳 (foetal-toxin head-cancrum, i.e. infantile tinea capitis-like dermatosis), xiàgān 下疳 (lower-cancrum = genital chancre / chancroid), and yángméichuāng 楊梅瘡 (pox = syphilis). The text consists of (i) a fanciful preface by Téng Bóxiáng 滕伯祥 dated Déyòu yuán nián 德祐元年 (1275, the penultimate year of the Southern Sòng), (ii) a brief zhìfǎ 治法 (treatment-method) section, and (iii) the formulary proper, comprising the principal prescriptions Zǐjīn sǎn 紫金散, Lǜpáo sǎn 綠袍散, Èrshèng sǎn 二聖散, Lìxiào sǎn 立效散, Lùér gāo 鹿兒膏, Máojūn sǎn 茅君散, Shíxiān dān 十仙丹, Èrmiào dān 二妙丹, Èrhuáng sǎn 二黃散, Bīnghuáng sǎn 冰黃散, Xiāodú sǎn 消毒散, Gānlù yǐn 甘露飲, Xiāogān wán 消疳丸, Bǎotóng wán 保童丸, Féiér wán 肥兒丸, Shèngbǐngzǐ 聖餅子, and Lánxiāng sǎn 蘭香散. The work closes with a Yàopǐn yìmíng kuò 藥品異名括 — a versified pharmacological-cryptonym key, since most of the formulas in the body of the work are written using biémíng 別名 (Daoist / cryptonymic synonyms) of the constituent herbs rather than their ordinary names.
Prefaces
The single preface, dated Déyòu yuán nián suì cì yǐhài mèngxià jírì 德祐元年歲次乙亥孟夏吉日 (early summer 1275), is signed Lèshàn lǎorén Nányáng Téng Bóxiáng 樂善老人南陽滕伯祥 (“the good-pleased old man Téng Bóxiáng of Nányáng”). It is a religious-anecdotal frame-narrative: the author, of an old jīnshì family stretching back six hundred years, had at age twenty-eight in Bǎoqìng yuán nián (1225) gone to visit his ancestral graves and met an unearthly old man (lǎosǒu 老叟) on the road who, on being asked for the gift of progeny rather than the gift of wealth, presented him with a manuscript on the condition that it be widely shared. The author opened the manuscript and found it to be the Zǒumǎ jígān zhēnfāng; he subsequently fathered a son named Guī 珪 who became a zhōu sīxùn 州司訓 (prefectural educational officer) at Wújiāng 吳江 and grandfather of Qīng 清, and lived past eighty. The preface is therefore signed in 1275, fifty years after the alleged encounter, which the preface places in 1225.
Abstract
The frame-narrative attribution to Téng Bóxiáng 滕伯祥 of Nányáng (born ca. 1197 on the preface’s own chronology) cannot be controlled against any independent biographical source. CBDB records one Téng Bóxiáng 滕伯祥 (CBDB id 21566, c_index_year 1214) but with no further detail and no medical-authorship attestation. The preface’s pseudepigraphic features — the encounter with the immortal lǎosǒu, the family-genealogy interpolation, the precise dating of both the encounter (1225) and the preface (1275) — are characteristic of the late-Sòng / Yuán xiānfāng 仙方 (immortal-prescription) frame-narrative genre, and the preface should not be taken as straightforward biography.
Dating: the preface is dated 1275; the terminus ante quem of the received recension is best fixed by external diffusion, which is hard to pin down for this small manuscript-tradition text. The yángméichuāng 楊梅瘡 (syphilis) sub-section is internally important for dating, since yángméichuāng in the Chinese-medical sense entered the textual tradition only in the early sixteenth century after the late-fifteenth-century introduction of the disease into south China. The presence of yángméichuāng in the text indicates that the received recension cannot be older than ca. 1500, even if the preface is genuinely dated to 1275 (which is doubtful). The Lèshàn lǎorén Téng Bóxiáng attribution is therefore very probably a sixteenth-century pseudepigraphic frame for a longer-circulating paediatric-formulary tradition, with the layer containing the yángméichuāng material reflecting the early-Míng updating. The conservative composition window adopted here is 1275 (the preface’s claimed date) to ca. 1600 (the late-Míng outer-bound).
The text is of interest in three ways. First, the zǒumǎ gān / cancrum oris discussion is unusually clinically explicit, with detailed instructions for tongue-depression, throat-examination, the surgical excision (with a dāo 刀, knife) of necrotic tissue from the palate, and the differential prognostic significance of pain-sensation in the excised tissue. Second, the work’s pharmacology employs an extensive biémíng (cryptonym) system — e.g. yǔzé 羽澤 for alum (míngfán 明礬), míngyǔzé 明羽澤; yùxūfàn 玉虛飰 for bīngpiàn 冰片 (camphor / borneol); shuǐyínlà 水銀臘 for qīngfěn 輕粉 (calomel); bǎichóng cāng 百蟲倉 for wǔbèizǐ 五倍子 (Rhus chinensis galls); chìqiān huá 赤鉛華 for dōngdān 東丹 (red lead); tàiqīng zūnzhě 太清尊者 for pòxiāo 朴硝 (mirabilite); etc. The Yàopǐn yìmíng kuò (versified cryptonym key) at the end of the work provides the decoding. This cryptonym system is reminiscent of Daoist wàidān 外丹 / fúshí 服食 literature and points to a milieu in which oral-dental-cancrum medicine was transmitted under religious-secret protections. Third, the work’s stratigraphy — the late-Sòng pseudepigraphic frame, the early-Míng yángméichuāng layer, the consistent Daoist biémíng system — makes it a useful witness for the layered transmission of practical-formulary medicine through the late-imperial period.
Translations and research
No substantial Western-language secondary literature located.
For the zǒumǎ gān / zǒumǎ yágān 走馬牙疳 tradition in Chinese paediatrics see standard modern accounts of érkē 兒科 history; for the noma / cancrum oris disease itself in global medical history see the modern epidemiological literature (the disease remains endemic in malnourished populations).
Other points of interest
The biémíng cryptonym system of the work is its most distinctive textual feature and is worth study in its own right as a witness to the transmission of practical pharmacological knowledge under a Daoist-style protective vocabulary. Each principal prescription is presented in cryptonym-form as a shījué 詩訣 (verse-formula) and then followed by the decoded ingredient-list with weights; the closing Yàopǐn yìmíng kuò serves as the master key.