White Atractylodes Powder (Master Qian's seven-ingredient)

This is 四君子湯 — ginseng, atractylodes, poria and licorice — with agastache, costus root and a double dose of pueraria added, which is to say it is Qian Yi's seven-ingredient 白朮散, the formula the Wasting-Thirst chapter sends the reader here to find. Pueraria leads it, at twice the weight of anything else, and the instruction attached to it is the most striking line in the section: 多煎滿意, 取足飮之, 彌多彌好 — decoct plenty, let the child take his fill, and the more the better. That instruction is the reason this leaf matters. The child described has been vomiting and passing stool for days, is pale and thirsty and on the edge of the limp twitching the chapter calls 慢驚風, and what Qian Yi tells the practitioner to do is to get as much warm, slightly sweet fluid into him as he will swallow, repeatedly, without worrying about the pattern. **The intervention that would have saved most of these children is fluid and electrolyte replacement** — oral rehydration solution, which is sugar and salt in clean water, costs a few cents a sachet, and did not exist until the second half of the twentieth century, when the discovery of sodium–glucose co-transport in the gut made it possible. It is credited with saving tens of millions of children's lives since. A child seizing after a long diarrhoea is seizing because of what the diarrhoea has done to him: dehydration, sodium and potassium derangement, hypoglycaemia, sometimes hypocalcaemia, or the encephalopathy of severe malnutrition. The prognosis really was bad, and it was bad for a reason that was fixable with water. So the form of this prescription is closer to right than almost anything else in the chapter. What it lacks is the salt. A decoction of these seven drugs supplies water and a little starch and sugar from the pueraria and dioscorea, and essentially no sodium; it cannot replace what is being lost in the stool, and in a child losing large volumes, water without electrolyte can worsen hyponatraemia. The drugs themselves do nothing for the convulsion. But the clinical instinct — give fluid, give a lot of it, give it by mouth, do not stop to classify — is the right instinct, and it is worth saying so plainly in a section where most of the answers are mercury and scorpion. The optional additions move the other way. 天麻ㆍ細辛ㆍ全蝎ㆍ白附子 for a child in whom the chronic fright has already declared itself bring in the wind drugs, and **scorpion is a neurotoxic animal venom and typhonium (白附子) a toxic tuber, given to a child with no dose by weight stated anywhere; neither should be prepared.** The base seven are benign. The other 慢驚風 leaves in this section carry the same clinical reading; see this note rather than repeating it. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.