[Handongha's Boncho Yodam] Palmi-hwan Was a Famous Prescription That Strengthened Kidney Yang, Even for Physicians

[Financial News]Boncho Yodam (Miscellaneous Notes on Materia Medica) is a column by Korean medicine doctor Handongha that presents various case studies and other interesting and useful records found in classical Korean medical texts in an engaging story format.

Once there was a physician. He was constitutionally frail. Since his youth, he had suffered from kidney deficiency, with ringing in the ears, lower back pain, weak legs, and cold knees. He also had a burning sensation in his palms and soles, night sweats, phlegm, and a cough.
Every morning, while he was still at the table, he would collapse as if falling over and drift into a dazed sleep. He was also sluggish in movement. In addition, he suffered terribly from severe indigestion.
He thought to himself, "This must be due to weak qi and insufficient essence." So he took medicines such as Daebo-eum-hwan and Cheongsang-boha-hwan to nourish kidney essence, but they had no effect at all.
He then reasoned, "This is probably because both the spleen and the kidneys are deficient. The cold-natured medicines and phlegm-treating remedies only addressed the symptoms and did not treat the root cause. It would be better to take Yukmijihwang-hwan to nourish the damage to all five organs."
He was concerned that cooked rehmannia would weaken the stomach and cause indigestion, so he processed it with ginger before using it. After taking about half a dose, his symptoms were reduced by more than half, and the indigestion suddenly disappeared.
He found it remarkable that he could take cooked rehmannia without developing indigestion. After that, whenever he saw patients with kidney deficiency and food stagnation, he immediately recommended this prescription. Strangely enough, although people worried that it would worsen digestion, it actually helped bowel movements and did not interfere with digestion.
He recalled a line from Huang Shangu, who said that when he took dodder seed, its digestive effect was like pouring hot water over snow. Strengthening the kidneys also improved digestion.
In fact, this experience was possible because both he and his patients had symptoms caused by kidney deficiency and were constitutionally suited to cooked rehmannia. As he had originally feared, people with weak stomachs will inevitably develop indigestion and diarrhea if they take cooked rehmannia. Processing it with ginger reduces that risk, but in most cases the problem still occurs.
After that, he would sometimes take Yukmi-hwan, adding two pieces of placenta, along with medicines such as Ophiopogon root, Schisandra chinensis, anemarrhena rhizome, and phellodendron bark. He would take about four or five doses in all. Although he did not feel that it produced any especially remarkable effect, he generally ate well, stayed healthy, and had no other illnesses.
However, after stopping the medicine for several years, his symptoms seemed to worsen again. In particular, he suffered greatly from a feeling of fullness in the upper abdomen and indigestion. He could not eat rice cakes or sweets made with honey at all.
Normally, such symptoms would be treated with a prescription focused on the stomach and intestines. But when he again took the earlier prescription containing cooked rehmannia, the symptoms would soon stop. While taking it, the color of his urine also became clearer. His usual urine had been a deep red, and immediately after urination it would quickly turn cloudy, like yellow muddy water. But after taking the prescription for a while, the urine became clear and sediment settled at the bottom.
Time passed like this. Every year, toward the end of winter, he would inevitably develop dry, burning lips. And throughout the four seasons, his palms and soles were always warm.
One day, a physician friend asked him, "You suffer from similar symptoms every year. What do you think is the cause?" He replied, "Wouldn't my symptoms be caused by a deficiency of kidney water?"
The friend asked again, "But when you urinate, you have little force and no sound in the stream. Could the cause be not only kidney water deficiency but also kidney yang deficiency?" He then said, "Now that I think about it, I sometimes feel a faint numbness inside my lower abdomen and penis. That must be due to deficiency of the kidney's true yang. My vitality also seems to have weakened."
The friend said, "Then how about trying Palmi-hwan? You are already 60, so your kidney yang must have weakened. There is probably no better medicine than Palmi-hwan for this."
Following his friend's advice, the physician prepared pills according to the original Palmi-jihwang-hwan formula, adding large aconite processed by soaking in children's urine and one nyang each of hot cinnamon bark. After taking them, the color of his urine changed to a pale yellow, and a clear sound of forceful urination appeared. His other symptoms also seemed to lessen, and his kidney qi improved greatly, to the point that it was no worse than in his youth.
He told his friend, "Seeing how much Palmi-hwan helped me, it turns out my symptoms were caused by kidney yang deficiency all along. Thank you." His friend replied, "Your symptoms looked like heat on the surface, but because the kidney yang was deficient, taking warming herbs such as cinnamon bark and aconite actually made your urine clearer."
Whenever symptoms appeared, he took Palmi-hwan, and they would disappear again. For him, Palmi-hwan was no longer a prescription that saved patients, but one that saved his own life.
Palmi-hwan is also commonly called Shinki-hwan or Geumgwe Shinki-hwan. It is used when both yin and yang of the kidneys are deficient, causing coldness and weakness in the lower back and knees, cold hands and feet, low energy, or frequent and unsatisfying urination. In particular, it is a representative prescription for older men whose bodies are weak and cold and whose urinary function has declined, as it helps strengthen kidney yang and restore kidney qi.
I was born with a frail constitution. Since my youth, I had suffered from kidney deficiency, with ringing in the ears, lower back pain, weak legs, and cold knees. I had heat and discomfort in the five centers, night sweats, phlegm, and a cough. My yin was weak and my essence was insufficient. Every morning, while I was still at the table, I would collapse as if falling over and drift into a dazed sleep. I was also sluggish in movement, and severe indigestion caused me great distress. I took medicines such as Daebo-eum-hwan and Cheongsang-boha-hwan, but they had no effect at all. This was probably because both the spleen and kidneys were deficient. The cold-natured medicines and phlegm-treating remedies only addressed the symptoms and did not treat the root cause. I wanted to take Yukmijihwang-hwan to nourish the damage to all five organs, and to treat blood deficiency with fever and the transformation of water into phlegm. But I worried that the cooked rehmannia would be sticky and cause stagnation, so I processed it with ginger before using it. After taking about half a dose, my symptoms were reduced by more than half, and the indigestion suddenly disappeared. I found this very strange. After that, whenever I met someone with kidney deficiency and food stagnation, I immediately recommended this prescription. People suspected that it might worsen stagnation, but instead it helped bowel movements and digestion. Huang Shangu once said that when he took dodder seed, its digestive effect was like pouring hot water over snow. That was truly no exaggeration. Later, I would sometimes take Yukmi-hwan, adding two pieces of placenta and medicines such as Ophiopogon root, Schisandra chinensis, anemarrhena rhizome, and phellodendron bark, taking a total of four or five doses. Although I did not feel that it produced any especially remarkable effect, I generally ate well, stayed healthy, and had no other illnesses. However, after stopping the medicine for several years, my symptoms seemed to worsen again, and fullness and indigestion became especially painful. I could not eat rice cakes or sweets made with honey at all. When I took the earlier prescription again, the symptoms would soon stop. This is because kidney qi was weak and the original essence had declined, so food could not be digested. It is like rice in a cauldron that cannot cook without fire. My urine was usually deep red, and immediately after urination it would quickly turn cloudy, like yellow muddy water. After a while, the urine would clear and sediment would settle at the bottom. Also, every year toward the end of winter, I would inevitably develop dry, burning lips. Throughout the four seasons, my palms and soles were warm. This was because the kidneys belong to water and should be strong in winter, but they were too weak to flourish, so the spleen earth overpowered them and my fluids dried up, leaving my lips parched. The heat in my palms and soles came from deficiency heat caused by weakness of the kidney channel's true yin. When I urinated, I had little force and no sound in the stream, and sometimes I felt a faint numbness inside my lower abdomen and penis. This was numbness caused by deficiency of the kidney channel's true yang. Only when I was nearly 60 did I begin taking Palmi-hwan. Following the original formula, I used large aconite processed by soaking it in children's urine, scraped off the rough outer skin, and added one nyang each of hot cinnamon bark. After taking it, the color of my urine changed to a pale yellow, and a clear sound of forceful urination appeared. My other symptoms also seemed to lessen, and my kidney qi improved greatly, to the point that it was no worse than in my youth. This was because both yin and yang of the kidneys were deficient. Thus, although my symptoms outwardly seemed like heat, after taking warming herbs such as cinnamon bark and aconite, my urine actually became clearer. How could this be any different from a person suffering from deficiency malaria, who has such severe fever that he wants to sit in a well, or from someone whose urine is as red as blood and can only escape those symptoms after taking large doses of ginseng and astragalus? I took only one dose, and for the past three or four years I have not been able to take it again. As a result, the symptoms have gradually returned, which is truly regrettable.
/ Handongha, Director of Handongha Korean Medicine Clinic


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