Strengthen the Bone Powder

One drug. Dry-fried silkworm, powdered, 5 fun or 1 don three times a day, stirred into mint-steeped wine. The reasoning is that a head that will not stay up is wind in the neck, and 白殭蠶 is the tradition's wind drug; 天柱骨倒, the Celestial Pillar fallen, is a good name for head lag. **The vehicle is wine, given to an infant three times a day. This must not be prepared.** Ethanol in a baby causes hypoglycaemia and depression of the nervous system at quantities that would do nothing to an adult, and a hypoglycaemic infant can be left with permanent injury or die. The powder dose is written out — 5 fun or 1 don — but **the text gives no dose by weight here**: nothing in the leaf is scaled to the child's size, and the amount of wine is not stated at all. What the formula is named for is the right question to ask of it. **A child whose bones and head are soft, who is late to sit and walk, is a child to be assessed for rickets — vitamin D deficiency — which is the reading the 解顱 leaves of 1.49 set out in full, and the same deficiency stands behind 1.52 髮不生齒不生 and 1.53 龜背龜胷.** Vitamin D costs pennies and rickets is wholly preventable. But head and neck softness by itself is first of all a question of tone, and that is the distinction a paediatric neurologist still makes before anything else: **the floppy infant against the stiff one**, hypotonia against spasticity, which is precisely the 五軟/五硬 division this section draws. Behind the floppy child are cerebral palsy, **congenital hypothyroidism**, spinal muscular atrophy and rickets. Congenital hypothyroidism is the one that must not be missed: the newborn blood-spot screen finds it, thyroxine makes the child entirely normal, and untreated it does not reverse. The text's own verdict — 若不治必成篤疾, if it is not treated it becomes a grave disease — is accurate, and it is accurate for a reason the text could not reach. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.