Bring Down the Worms Pill

The most purposeful formula in the section. Six of its ten drugs are anthelmintics — melia root bark, dryopteris, elm fruit paste, areca, carpesium and the flesh of fifty quisqualis fruits — and the name says what it is for: bring the worms down. The section head it answers is equally clear-eyed about cause, blaming early weaning onto gruel and meat, and describing the child who cries, vomits froth, has belly pain and purple lips. The worm drugs in this section are the part of it that works. 使君子 (Quisqualis indica fruit), 苦練根 (Melia root bark) and 蕪荑 (elm fruit paste) are genuine anthelmintics, and 使君子 is still in use: its active quisqualic acid paralyses Ascaris, which is exactly the 蛔虫 the chapter names. 蛔疳 is ascariasis, and 下蟲丸 — bring-down-the-worms pill — says so in its name. A child with a heavy Ascaris burden really is malnourished by it, and clearing the worms really does help. The modern version is one 400 mg dose of albendazole, or 500 mg of mebendazole, given once; it costs a few cents, works better, and is measured. **An effective drug with no stated dose is still a hazard, and the text gives no dose by weight anywhere: enough 使君子 causes hiccup, vomiting and diarrhoea, which is the last thing a child already losing fluid to 疳瀉 can afford.** What this leaf shows is a tradition that had the diagnosis, the cause and a working drug class, and still had no way to measure a dose. The point made in full on 胡黃連丸 (`hohwangryeon-hwan`) stands beside it: worms were part of this child's malnutrition, not the whole of it. **Contains calomel — 輕粉, mercurous chloride — in a pill for a malnourished child, and the text gives no dose by weight anywhere. This must not be prepared.** 輕粉 is mercury. The Donguibogam itself shows what that meant: 雜方門 5.3.33 is the recipe for manufacturing it out of quicksilver, alum and salt, and 諸瘡門 records the poisoning it caused in four separate sections. Mercury is absorbed from the gut and from a raw mucosal surface, it is excreted slowly by immature kidneys, and the developing nervous system is the organ at risk; the injury does not reverse. A child of this weight has no margin at all. **Melia root bark — 苦練根皮 — is itself toxic as well as effective: its triterpenoid toosendanin is hepatotoxic and neurotoxic, and poisoning from root-bark decoctions is documented. This must not be prepared.** For the toad, see 如聖丸 (`yeoseong-hwan`); here it is calcined, which destroys most of the glycoside. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.