Acanthopanax Bark Powder for Late Walking

Two prescriptions in this book carry the name 五加皮散, both labelled 得效, and they are not the same formula. The other one stands in 莖項門 1.6 項軟, immediately after 天柱元, and its whole text is 治同上. 取皮爲末, 酒調傅項骨上 — take the bark, powder it, mix with wine and apply it over the nape bone, renewing it when it dries. That is a single drug, used externally, for the soft neck that cannot hold the head up. This one has three drugs, is swallowed in rice water at 1 don a dose, and is for a three-year-old who is not walking. One ingredient against three, outside against inside, neck against legs: they share nothing but a name and a source label, so this leaf is a homonym and takes the chapter tail. The 莖項 passage that cites 五加皮散 for a child's soft neck is pointing at the formula that is written out two leaves below it in its own chapter, which is the right one. What the three drugs are doing is coherent on its own terms. Acanthopanax bark is the tradition's standing agent for strengthening sinew and bone, achyranthes is the drug that is said to lead action down to the knees and lower back, and quince relaxes the sinew — a wind-damp formula aimed at the legs, at a quarter the weight of the chief for each of the two deputies. There is nothing toxic in it and nothing that would hurt a child, which is more than can be said for 虎骨丸 standing three leaves above it in the same section. It will not make a three-year-old walk. A child who is not walking at three is well past the point where that needed explaining — the threshold for assessment is 18 months — and what the delay represents is a question with real answers: **rickets** (vitamin D deficiency, the disease behind this section's soft bones and the open skull of 解顱 — the full statement is at 三神散), cerebral palsy, a muscular dystrophy or spinal muscular atrophy, developmental hip dysplasia, or global developmental delay. Several of those are treatable and all of them do better the earlier they are found. **The text gives no dose by weight here, only 1 don of powder for a patient described solely by age.** — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.