Three Spirits Powder

**This section and 髮不生齒不生 describe one disease, and the book never joins them.** 解顱 — the sutures gaping, the fontanelle still open at two or three years, the skull soft under the fingers — together with delayed teeth and no hair (1.52), the beaded costochondral junction that keels the sternum forward and the humped back (1.53 龜背龜胷), bowed legs, soft bones and late walking (1.51 行遲) are the classical presentation of **rickets: vitamin D deficiency**. Every finding the chapter records across those four sections belongs to that single nutritional disease, and the text cannot assemble them because it has no concept of a nutrient. It reads them instead as 腎氣不成 — the Kidney Qi not completed — and in a sense the observation is not stupid, because the Kidney does govern bone in this system and bone is exactly what has failed. What it lacks is the cause. Vitamin D is made in the skin from sunlight and obtained from very few foods. Breast milk contains almost none. A baby kept indoors or kept covered, or exclusively breastfed without supplementation, becomes deficient; calcium cannot be absorbed, the growing bone is laid down unmineralised, and the skull, ribs, wrists and legs deform in the pattern the chapter describes section by section. It costs pennies to prevent — 400 IU a day for an infant — and it is wholly preventable and, caught early, wholly reversible. It is still common, and it is still being diagnosed in children in developed countries, because the two risk factors have not gone away. Nothing applied to the outside of the head can touch it. What the paste itself is: dried ginger, asarum and cinnamon heartwood, three of the hottest drugs in the pharmacopoeia, ground together and laid on the scalp in ginger juice. The endpoint given — 小兒面赤卽愈, apply until the child's face is red — is a rubefacient reaction, not a cure, and the text has mistaken the sign of irritation for the sign of healing. **It is being applied directly over an open fontanelle, where there is no bone between the paste and the dura, only skin and membrane; a strongly irritant preparation on broken or inflamed skin there is a route into an infant, and the text gives no dose by weight here.** Asarum in particular should not be put on a baby's head: the genus carries aristolochic acid and safrole, and 細辛 is one of the materials modern pharmacopoeias restrict for that reason. This must not be prepared. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.