Horse-Spleen Wind Powder

**馬脾風 is an emergency and this leaf is one of the few places in the book that says so in its own words**: 若不速治, 立見危亡 — if it is not treated quickly, death is seen at once. The presentation the name carries is a child who chokes suddenly, breathes with a hard rattling noise, sits up and will not lie down, and may be drooling because swallowing has become impossible. That reads as acute upper airway obstruction: croup at its severe end, epiglottitis, bacterial tracheitis, a swallowed foreign body, or severe bronchiolitis in the youngest infants. It is minutes-to-hours urgent and it is treatable. **Nebulised adrenaline with systemic corticosteroid is what reverses severe croup; oxygen supports any of them; and epiglottitis needs an airway secured by someone able to secure it, in an operating theatre where possible.** Two things must not be done. **The child must not be laid flat, and the mouth must not be forced open or examined** — either can convert a narrowed airway into a closed one, and children have died on the examination couch for exactly that reason. A child in this state is carried upright, kept calm, and taken straight to hospital. What this powder does instead is pour three poisons into that child. **This must not be prepared or given.** Cinnabar is mercuric sulfide, and the full account of mercury in this chapter is on 辰砂膏. Calomel is mercurous chloride, so the formula carries mercury twice over by two different routes; 5 fun of it was a measured dose of a drug whose chronic poisoning (acrodynia, with the pink, peeling, agonised hands and feet) was a recognised disease of children until calomel teething powders were withdrawn in the twentieth century. Kansui is a violent purgative of the Euphorbia group and belongs with 大戟 and 芫花; in a child who is already in respiratory distress, the fluid loss it causes is simply more harm. **The patient is a child and the text gives no dose by weight anywhere** — 一字, one ja, is a scoop of powder. And the final step is the worst of it: 灌之, poured down the throat of a choking child who cannot protect the airway, which is how aspiration happens. The oil-float step is the same trick as 朱沉煎 in the vomiting section, and it has the same consequence here — what sinks through the film first is the heaviest mineral, so the dose that is actually given is enriched in the cinnabar. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.