Food-Advancing Pill

Five drugs at 3 don apiece around 1 don of croton frost and 5 fun of musk: costus and bitter orange peel to move qi downward, angelica for the blood, haematite as a heavy settling mineral, cinnabar, and the croton to empty the bowel. The whole design is to drive the mass out through the stool. **This is the clinical statement for the 1.42 積癖 leaves of this batch, and the other ten cross-reference it.** 積癖 is a palpable abdominal mass in a child, and the text treats it as stagnant milk and food to be broken up and purged. The modern differential is short, specific, and almost entirely outside the reach of anything in this section: faecal loading; splenomegaly, with malaria first and the chronic haemolytic anaemias next; hepatomegaly; **intussusception**, which is a surgical emergency and presents as a child screaming in colicky bouts with a sausage-shaped mass and redcurrant-jelly stool; abdominal tuberculosis; and the two solid tumours of childhood that are now largely curable, **Wilms tumour** of the kidney and **neuroblastoma**. That last pair is the reason a persistent abdominal mass in a child is an imaging question today and cannot wait: cure rates for both depend heavily on stage at diagnosis. None of the formulas in this section treats any of these conditions, and several would make an obstruction worse — a violent purgative given into an intussusception or any other mechanical obstruction is directly dangerous. **Contains croton frost (巴豆霜), a violent purgative and vesicant, and cinnabar (朱砂), mercuric sulfide. The patient is a child — a one-year-old is named in the text — the chapter gives no dose by weight anywhere, and this must not be prepared.** Croton blisters skin on contact and empties the bowel violently; a small child already losing fluid can be killed by the dehydration alone, which is the mechanism and not a theoretical risk. For the full mercury statement see 辰砂膏 (jinsa-go-soa), written out in that entry and not repeated here. **Every leaf in this batch that carries 巴豆 or 朱砂 refers back to these two sentences.** The musk is from a CITES Appendix I deer. The haematite is the one quiet irony of the section: it is iron oxide, and iron is what the earth-eating child two leaves on (治喫泥方) actually needs — but it is here as a settling mineral for a mass, not as a haematinic, and mineral haematite is poorly absorbed. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.