Immediate Effect Powder (Children, Gum Canker)

**The patient is a child, the text gives no dose by weight anywhere, and this is a caustic powder going onto an open ulcer inside the mouth.** Calcined alum and gallnut are both strong astringents, and alum on raw ulcerated mucosa stings sharply and kills a further thin layer of tissue; indigo and phellodendron are bitter and comparatively harmless. Applied to the mouth of a dying child the powder is at best painful and at worst enlarges the slough it is meant to dry. This is the point to make once for the whole 疳瘡 section, and the other leaves here refer back to it rather than repeating it. **None of these formulas is food.** 疳 is childhood malnutrition — the protein-energy complex of marasmus and kwashiorkor with the infections and deficiency diseases that follow it — and what the child needs is calories, protein, micronutrients and fluid. What this section gives is bitters, astringents, minerals, dried animal parts and worm drugs. The one leaf in this batch that reaches in the right direction is 猪肚黃連丸, where the vehicle is a pig's stomach and the child actually eats something, and 布袋丸, where the pill is boiled with lean pork and the child is given the meat and the broth. Everything else treats the mouth or the belly and leaves the starvation untouched. 走馬牙疳 — "galloping tooth canker" — is noma, or cancrum oris: a gangrenous stomatitis that begins as a gum ulcer in a severely malnourished young child and in days destroys gum, cheek and jaw, leaving the teeth standing in a hole in the face. The Bogam's clinical description is exact, including how fast it moves and that the teeth fall and the lip is pierced (see 尿白散, the next leaf but one). It is almost entirely a disease of poverty and remains so; the WHO added it to its list of neglected tropical diseases in 2023. Untreated it kills the great majority of the children who get it. What changes that outcome is antibiotics for the anaerobic mouth flora, nutritional rehabilitation and basic oral hygiene, started early; survivors need reconstructive surgery for the defect. A dusting powder, however well chosen among astringents, cannot touch it. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.