Calomel and Musk Powder

A tortoise shell basted with a bowl of vinegar and roasted until the vinegar is gone, then calcined, cooled and ground, with a don each of calomel and musk stirred in. The vinegar basting is a real processing technique — repeated quenching makes the shell friable and leaves acetate on it — and calcined shell is an absorbent calcium powder, so the bulk of this powder would take up exudate from a sloughing ulcer. The indication is the thing to notice: 臭爛, 數十年不愈 — stinking, sloughing, unhealed for several decades. A leg ulcer of that duration is a venous ulcer that has never been treated with elevation or compression, and at several decades it also raises the question of malignant change, which the chapter had no way to ask. The foul smell is anaerobic colonisation of slough, and the musk here is doing what musk usually does in this chapter, which is cover the smell. **Contains calomel, a mercury salt absorbed through an open ulcer, and musk from a CITES-protected species; the shell of a live tortoise is also protected-animal material, and taking it from a live animal is not acceptable. This must not be prepared.** An ulcer of decades' standing needs biopsy to exclude squamous carcinoma, arterial assessment, and then elevation and compression — which is what the chapter was reaching for at the head of the section when it wrote 須翹足端坐, 勿多行履. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.