Nine Dragons Check the Drool Powder

**Contains realgar and centipede, both toxic. The patient is a child, the text gives no dose by weight anywhere, and this must not be prepared.** 雄黃 is arsenic sulphide at 2 don, the joint-largest quantity in the formula; arsenic is a cumulative poison with no safe intake, and an infant's kidneys clear it poorly. 蜈蚣 is one whole centipede, a venomous animal drug whose active content cannot be standardised. The rest of the shelf here is genuinely innocuous — tea, liquorice, mung bean, bamboo sugar, frankincense, schizonepeta tops — and calcined alum, while astringent and unpleasant, is not in the same class as the arsenic. 天吊 is described exactly in the section text: 頭目仰視, the head drawn back and the eyes rolled up so far that the pupils hide, with the limbs jerking 如魚之上釣, like a fish on a hook — which is where the name comes from. That is opisthotonos with upward gaze deviation, and in an infant it should raise two things at once: meningitis and raised intracranial pressure. Both are emergencies. A baby with a rigid arched neck, a bulging fontanelle, fixed upward gaze and seizures needs assessment now — lumbar puncture, imaging, intravenous antibiotics started before the result comes back — because untreated bacterial meningitis in infancy kills within days and leaves survivors deaf or brain-injured. The leaf's own aetiology is worth noticing: the section blames the wet nurse's rich and heated diet, and 錢仲陽 adds that one should not come near an infant after walking through filth. The second half of that is accidentally right for the wrong reason — hand hygiene around newborns prevents exactly the infections that present this way — but nothing in this powder treats one. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.