Modified Red Cotton Powder for Convulsion in the Pox

Seven drugs at 5 pun each with a stalk of scallion white in the pot. **It is the 加減 of the chapter's own 紅綿散 and of nothing else:** take the fever-stage decoction of 1.68 發熱三朝 — whole scorpion, ephedra, schizonepeta spikes, gastrodia and licorice, with mint, arnebia and cicada slough added at the end — drop the licorice, take the arnebia as its downy shoot, put all seven on one line and add a scallion, and this is what comes out. The Ear chapter's 紅綿散 is an astringent powder blown into a suppurating ear and has nothing to do with it. **What 驚搐 was.** A child with smallpox convulsing has one of three things: a simple febrile seizure brought on by the prodromal fever, a seizure from the metabolic wreckage of dehydration — sodium and glucose both deranged — or encephalitis. Postinfectious encephalomyelitis followed smallpox in something of the order of one case in several hundred to a thousand, came in the second week, and was often fatal or left permanent damage. The chapter's clinical frame for a convulsing child is set out on the 1.29 急驚風 and 1.30 慢驚風 leaves of this chapter — the acute febrile seizure on 靈神膏, the chronic depleted picture on 神效散 — and is cross-referenced here rather than rewritten. What is particular to this section is that it reads the convulsion as a sign of where the pox is, and then grades the prognosis by it. 發熱時發驚者, 痘在心經而出也, 乃爲吉兆 — a convulsion during the fever stage means the pox is coming out through the Heart channel, and is a good omen; 先驚後痘者輕, 先痘後驚者逆 — fright first and pox after is mild, pox first and fright after goes against the grain. The channel reading is a correspondence and stays one. The direction of the grading, though, happens to hold: a convulsion at the onset of a febrile illness in a small child is usually a simple febrile seizure and usually benign, while a child who convulses late in a dense eruption is convulsing because something systemic has gone wrong, and that child really did do worse. The chapter's own 非驚風 — this is not fright wind — is the same observation from the other side. **Contains whole scorpion, a neurotoxic animal venom, and ephedra, and the patient is a child. The leaf gives no dose scaled to the child's age or weight.** Dried scorpion is the standard material and the amount of toxin in a given animal is unmeasurable; the venom acts on sodium channels, and it is being given to a child who is already convulsing. Ephedra is ephedrine and pseudoephedrine, a sympathomimetic that raises the heart rate and the blood pressure and lowers the seizure threshold, given to a child who is febrile, dehydrated and convulsing. Both drugs point the wrong way for this indication. What such a child needs is the airway protected, the blood sugar and the electrolytes measured, the fever brought down, and a benzodiazepine if the seizure has not stopped in five minutes. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.