Ginseng and Cicada Shell Powder

Seven drugs in equal fives — ginseng, cicada shell, akebia, white peony, red poria, the downy shoot of purple gromwell and licorice — for a child with smallpox who is passing little or no urine, restless, and grinding his teeth. Akebia and red poria are the chapter's standing pair for driving water downward; purple gromwell is the one drug used throughout this block on the reasoning that the pox toxin has to be moved out through the blood; cicada shell is there because a cast skin was taken to help a skin eruption come out. What the physician was looking at is worth stating plainly, because the chapter gets the sign right and the cause wrong. A child with a confluent pox eruption loses a great deal of fluid through a broken skin surface, drinks badly because the mouth and throat are ulcerated, and vomits; the urine goes down because the circulating volume has gone down. 1.85.16 reads the scanty urine as toxin pent up inside and tries to open a channel for it. The scanty urine was real and it was a danger sign, and the correct answer to it — then as now — is fluid, which is the one intervention that would have changed outcomes in this block and which this formula is not. A diuretic action, had akebia and poria possessed one worth the name, would have made a dehydrated child worse rather than better. **The patient is a child and this leaf gives no dose scaled to age or weight — 5 fun of each of the seven drugs, one packet, whatever the child's size.** None of the seven is a poison, so the risk here is the risk of the thing not done rather than of the thing given. One caution belongs to akebia and not to the formula: the drug name 木通 has covered more than one plant, and material sold under it has repeatedly turned out to be Aristolochia manshuriensis, which contains aristolochic acid and is nephrotoxic and carcinogenic. True Akebia is not that plant, but the substitution is common enough that no modern preparation of a 木通 formula is safe without botanical identification. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.