Raw Aconite Four Gentlemen Decoction

**Contains aconite, which is toxic. The patient is a child, the text gives no dose by weight anywhere, and this must not be prepared.** 生附子 is raw, unprocessed aconite — the form the materia medica itself treats as the most dangerous, since roasting (炮) is what drives off part of the aconitine. Aconite has almost no margin between an effect and a fatal ventricular arrhythmia, and in 1613 no way existed to measure what a given root contained: potency varied by species, by soil, by season and by how long the root had been stored. Here it is powdered raw and spooned into the mouth of an unrousable infant. The four Four Gentlemen drugs themselves — ginseng, atractylodes, poria, liquorice — are harmless at these amounts. The entire hazard of this prescription is the aconite. 慢脾風 is the decompensated end of the chronic convulsion picture, and it is worth saying once, plainly, what that child actually has. After a prolonged diarrhoea an infant arrives cold to the touch, sweating, limp, unrousable, with slow twitching. That is shock and metabolic collapse — hypovolaemia, electrolyte derangement, hypoglycaemia, sometimes hypothermia on top. It was almost always fatal, and the thing that changed it is fluid and electrolyte replacement, glucose and warming. Oral rehydration solution does most of that work for a few cents a sachet, and it did not exist until the twentieth century. Nothing in any 慢脾風 formula supplies water, salt or sugar. And the instinct behind this one is not wrong. The child is cold and sinking, so the text warms and raises, builds on the plainest Spleen-Qi formula in the book, and sets a real clinical endpoint — stop the moment the hands and feet turn warm. That is honest observation. The grim part is that the drug chosen to carry a sound instinct is one of the two or three most lethal substances in the pharmacopoeia. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.