Purple Gromwell and Akebia Decoction

The same complication as the leaf before it, treated with four of the same drugs in smaller weights, with glutinous rice in place of white peony and cicada shell. Glutinous rice is the chapter's habitual addition wherever a pox formula is given to a child who is not eating; it is a demulcent and a little food, and in a block where the children who died of fluid loss outnumbered the children who died of anything a formula could touch, the rice is the most defensible thing in the cup. Purple gromwell shoot heads the formula and gives it its name. The whole smallpox block uses it on one doctrine — that the pox is a toxin which must be brought out through the blood — and it is the drug most consistently reached for across the sixty-two sections. It has no antiviral action; smallpox ran its course regardless. Akebia and red poria are the pair meant to open the urine, and the scanty urine they were aimed at was in fact a sign of dehydration, so the direction of effort was wrong even where the observation was right. **The patient is a child and this leaf gives no dose scaled to age or weight — 4 fun of each drug in one decoction, whatever the child's size.** None of the six drugs is a poison. The one modern caution attaches to the drug in the formula's name: material sold as 木通 has repeatedly proved to be Aristolochia manshuriensis rather than Akebia, and aristolochic acid causes irreversible kidney failure and urothelial cancer. That is a problem of the modern supply chain, not of the 1613 text, but it means a 木通 formula cannot be prepared today without botanical identification of the material. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.