Tiger Bone Pill

**The chief drug is tiger bone, and two things have to be said about it together. Tiger bone is pharmacologically inert — it is calcium phosphate and collagen, the same material as any other mammal bone, and there is nothing in it that acts on sinew, joint or marrow. And the demand recorded by prescriptions like this one is part of why the tiger is endangered: the trade it feeds has helped reduce a species that ranged across most of Asia to a few thousand animals. Tiger is CITES Appendix I, all international commercial trade in it is prohibited, and domestic trade is banned in the countries that still have wild tigers. It must not be prepared, and it must not be sourced.** That combination is the worst case the pharmacopoeia offers: a substance that does nothing, obtained by killing an animal there are almost none of. Where this formula is of any interest it is historical. The rest of it — rehmannia, angelica, cnidium, astragalus, achyranthes, poria, cinnamon, saposhnikovia, sour jujube seed — is a conventional Qi-and-Blood tonic with a sinew-and-bone emphasis, and would be unremarkable without the bone. **The patient is a small child and the text gives no dose by weight here**, only five or ten pills. A child not walking is what the section is actually looking at, and the chapter's own reading — 氣血不充, 骨髓不滿, the marrow unfilled and the bone soft — is a description of **rickets**, which is vitamin D deficiency and which does cause late walking along with bowed legs and the soft skull of 解顱. The full statement is at 三神散. The other thing a child not walking by 18 months needs is a developmental assessment: cerebral palsy, a myopathy or spinal muscular atrophy, developmental hip dysplasia, and global delay all present this way, and all of them do better identified early. Any loss of walking a child had already achieved is a different and more urgent matter entirely. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.