Finger-Rolled Powder for Pain at the Crusting Stage

Six drugs in one packet, and the shape of it is plain enough: rhubarb, peach kernel and safflower together are the blood-moving and purging core, white peony softens the cramp, cinnamon twig at 2 pun 5 ri is a trace, and burdock seed is there because this is a pox formula. The indication is narrow and precise — pain at the crusting stage, the pox not crusting, the pain sitting at the 中脘 — and the reading given is 熱毒凝滯, 瘀血作痛, heat-toxin congealed and static blood making the pain. **The section it belongs to is describing something real.** Severe lumbar and back pain was a classic feature of the smallpox prodrome: two to four days of high fever, headache and a crushing backache before any rash appeared at all. 腰如被杖 — the loins as though beaten with a stick — is as good a description of it as has ever been written, and 凡發熱欲出痘腰痛, backache with the fever before the pox comes out, is simply what the illness did. The section also records that backache at the very beginning with dark purple spots appearing means the child mostly dies. That is the haemorrhagic form being recognised at onset, and it is correct. This particular leaf, though, is for abdominal pain late in the illness, and the reading behind it is wrong in a way that matters. Abdominal pain in a child ten days into a confluent eruption is not congealed blood. It is more likely ileus, the enteritis that often came with the disease, or the beginning of a secondary bacterial infection. **Rhubarb is a stimulant laxative, and it is being given to a child who is already losing fluid — through fever, through hundreds of broken lesions, and often through the stool.** Purging that child adds loss to a reserve that is already small, and the loss is the thing that killed. This is the wrong direction, and it is the formula's heaviest ingredient class. Peach kernel and safflower do not move static blood in any sense a modern reader can use. **Contains rhubarb, a stimulant laxative, given to a child with smallpox who is already dehydrated. The patient is a child and the leaf gives no dose scaled to age or weight.** The statement on fluid replacement for this chapter is written on the 玉露散 leaf of 1.43 吐瀉 at 037b. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.