Another Formula for Diarrhoea and Dysentery

Two drugs and nothing else: gall-nut fried yellow and powdered, bound with water-steeped smoked plum flesh into pills the size of a bullet. Both are among the strongest astringents in the materia medica — gall-nut is largely gallotannin, and smoked plum is sour and tannic — so this is pure constipation by tannin. The one real piece of clinical thinking in the leaf is the vehicle: rice water for white dysentery, ginger decoction for red, cold water for watery diarrhoea, so that the same pill is directed three ways by what the stool looks like. That instinct is sound and the modern version of it is the division that matters now: **bloody stool against watery stool.** Watery diarrhoea is a fluid and electrolyte problem — the child is at risk from dehydration, and what saves such children is oral rehydration solution with zinc, the statement for which belongs on the 1.43 吐瀉 leaves of this chapter (it is written in full on the 玉露散 leaf at 037b) and is cross-referenced rather than repeated here. Bloody stool is a different matter: it means invasive infection — Shigella above all, and Campylobacter, Salmonella, amoebiasis — or, in a small child with colicky screaming and a mass, **intussusception**, where the redcurrant-jelly stool is a surgical emergency and not a dysentery at all. Shigella dysentery needs an antibiotic; so does enteric fever; amoebic dysentery needs a different one again. Against all of that, an astringent stops the stool without touching the cause, and in invasive bacillary dysentery slowing the bowel is actively harmful — antimotility agents are contraindicated in bloody diarrhoea for exactly that reason. **The patient is a child, the leaf gives no weight for either drug and no dose beyond one bullet-sized pill, and the chapter gives no dose by weight anywhere.** The section head above it is honest about where this ended: 小兒痢糓道不閉黃汁長流者不治 — when the child's bowel will not close and yellow fluid runs continuously, it cannot be treated. That is a description of a child dying of dehydration, and it is the one the rehydration statement answers. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.