Great Yang-Securing Decoction

Aconite with dried ginger and white atractylodes is the tradition's core yang-rescuing combination, close to 四逆湯 with 白朮 and 木香 added, and here it is given at the largest practical dose — a whole large tuber to a single packet, with a second packet to follow at once. The one odd instruction is 放冷灌服, let it go cold before pouring it in, which is the usual precaution when a hot drug is given to a patient whose qi is rising: the cold vehicle is meant to keep it down. The condition is described precisely enough to read: after great vomiting and purging, the limbs cold to the trunk, the face dark, gasping breath, a cold sweat, the scrotum drawn up, and no awareness. That is hypovolaemic shock from fluid loss, and in the Bogam's time the commonest cause of exactly this picture was cholera — which the chapter puts first in its list of ten critical conditions. The physiology the book offers, yang escaping and not connecting, is wrong, but the observation is sound and the urgency is correct: this patient dies within hours untreated. What such a patient needs is volume, fast — intravenous or intraosseous fluid, or oral rehydration solution if they are awake enough to drink — and treatment of the cause. A decoction cannot do it, and aconite makes it worse: aconitine is a cardiotoxin that causes ventricular arrhythmia, and a shocked, acidotic, potassium-depleted heart is the one most likely to arrest from it. The instruction to pour the decoction into an unresponsive patient carries the same aspiration risk as the rest of the chapter — no gag reflex means fluid in the lungs, and the airway comes first. **Contains aconite, at a full tuber to the dose. Aconitine is a cardiotoxin and this is a lethal amount. This must not be prepared or taken.** — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.