Leftover Grain Decoction to Disperse Swelling

This is 仙遺粮丸 made into a decoction. The drug list is the same to within one substitution — red poria for white, which shifts the emphasis from quieting to draining — and the weights are the same five don across the middle of the list. What changes is the form: twenty packets, one morning and one evening, so the course runs ten days at a time and the dose arrives hot rather than as a honey pill. Fifteen nyang of smilax spread over twenty packets comes to about three quarters of a nyang in a dose, which is a modest amount for the drug the formula is named after; the pill version concentrated it far more. Either way the target is the gummatous lump of late syphilis, and neither form could affect it. **防己 is sourced as Sinomenium acutum (청풍등) in Korea and as Stephania tetrandra (분방기) in China; neither contains aristolochic acid. The danger is substitution: 광방기 (Aristolochia fangchi) and 한중방기 (A. heterophylla) are Aristolochiaceae, they do contain aristolochic acid, and they have caused end-stage renal failure and urothelial carcinoma — the Belgian cases arose precisely because A. fangchi was supplied in place of Stephania. Their use is prohibited in Korea. So the drug must be sourced as Sinomenium with the species verified; it is the adulterant, not the medicinal, that destroys kidneys.** — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.