Harmonizing and Releasing Powder

Thirteen drugs in threes with a half-weight of ginseng, ginger and dates in the packet — the chapter's ordinary pox decoction, built on perilla leaf and pueraria to push an eruption outward, with the two tangerine peels, platycodon and bitter orange to move Qi, tangkuei and chuanxiong for the blood, purple gromwell shoot for the toxin and akebia to drain. There is nothing unusual in it; what is interesting is the condition it is aimed at. 倒靨 is the eruption failing to crust — the pocks going back instead of drying and scabbing at the end of the course — and it was a grave sign. 1.85.18 divides it by cause with real care: where the failure comes from inside, from exhausted Qi, the answer is to warm the centre and support from within, and the section sends the reader to 內托散 and 保元湯; where it comes from outside, from cold struck into a child with an open skin surface or from foul air breathed in, the answer is to warm and scatter, and that is this formula. The observation underneath it is good. A naked, febrile child with a confluent pox eruption loses heat very fast through a broken skin surface, and the description 爲風冷所折致氷硬 — struck by wind and cold until it goes hard as ice — is a recognizable account of a chilled, mottled, shut-down skin. A physician who noticed that chilling such a child made the eruption worse had noticed something true, and keeping the child warm was part of the nursing that did move outcomes in this disease. What the formula could not do is what the section hoped. Whether a pock crusted depended on whether it had ever filled, and a flat dusky eruption that would not raise or crust was most often the haemorrhagic form, which killed nearly everyone who had it; no decoction altered that. The section's alternative reading, that the cause is 觸穢, contact with foul air, is also worth a sentence: it is wrong as aetiology and it points in a useful direction anyway, since the thing in the room that mattered was the virus in the droplets. **The formula contains pinellia, which is toxic in the raw state and must be properly processed before use; the patient is a child, and the leaf gives no dose scaled to age or weight — 3 fun of each drug in one packet, whatever the child's size.** Raw pinellia is a mucous-membrane irritant that causes swelling of the mouth and throat, which in a child whose pharynx is already ulcerated by smallpox is a worse prospect than in an adult. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.