Costus Pill (Children, 疳 Dysentery)

**Contains bat guano, an animal excretion given by mouth to a child, and the text gives no dose by weight anywhere.** 夜明砂 is bat droppings, dry-fried; frying does not sterilise it, and bat guano carries fungal spores as well as enteric organisms. The full statement on the faecal materials in this section is on 十全丹. The other five drugs are ordinary and comparatively harmless at these amounts. 疳痢 is dysentery in a child who is already malnourished, and that pairing is one of the deadliest in paediatrics: the dysentery accelerates the wasting, and the wasting makes the dysentery invasive. The organism is usually Shigella, sometimes invasive E. coli or amoeba, and the child arrives with frequent small bloody stools, fever, cramping and progressive dehydration. What saves such a child now is specific and cheap: **oral rehydration solution**, continued feeding, zinc for ten to fourteen days, and an antibiotic to which the local Shigella is still sensitive when the stool is bloody. ORS is a sachet of glucose and salts costing a few cents, and it is the single intervention that has saved the most children's lives in the last fifty years. Against that, this formula is not the worst in the section. It does not purge — 訶子肉 binds, and that is the right direction for a child losing stool — and 黃連 at 3 don is the largest drug, contributing berberine, which has demonstrable antibacterial and antisecretory activity and has been trialled in the secretory diarrhoeas. But fifteen small pills supply no water, no salt, no sugar and no potassium, and dehydration is what kills in dysentery. On the larger point that none of these formulas is food, see 立效散 in this same section. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.