Prepare for Urgency Pill

Three drugs in equal weight: rhubarb, dried ginger, and croton seed with the oil pressed out. Two of the three are purgatives and the third is there to warm the stomach while they work. It is the 金匱's 三物備急丸, and in its original use it is a formula for a cold accumulation blocking the bowel — a blockage broken by force from above. Given that, the later Chinese and Japanese use of it for acute intestinal obstruction is at least coherent, and the chapter's own 丹心 clause calls it what it is: 急劑, an urgent agent. What it is doing in an emergency chapter is a different matter. The indication printed here is 諸卒死ㆍ暴疾ㆍ 百病 — every sudden death, every violent illness, the hundred diseases — given to a patient whose face is blue and whose breath has stopped. A blue face and absent breathing is hypoxia, and the patient is in arrest or close to it. A violent purge does nothing for that and takes away what little circulating volume is left; in a collapsed, shocked patient, purging is actively harmful. The administration is the same hazard as elsewhere in the chapter: 口噤則以酒化灌之 — if the jaw is locked, dissolve the pills in wine and pour it in. A patient with a locked jaw and no breath has no gag reflex, and what is poured into the mouth enters the lungs. The airway comes first. For a collapsed patient the modern sequence is to check response and breathing, call emergency services, start chest compressions and use a defibrillator if one is to hand, and give nothing by mouth. **Contains croton seed (巴豆霜), one of the most violent purgatives in the materia medica and a severe irritant poison — the fresh seed is lethal in small amounts and the pressed powder is still drastic — and it is given here to a collapsed patient. This must not be prepared or taken.** — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.