Sage-like Pill

Two bitter rhizomes and two worm drugs in equal nyang, carried in a paste made by steeping five dried toads in wine and simmering them down. The pattern it answers is the chapter's hedge: 冷熱疳, cold and hot interlocking, neither new nor old — which is to say a child who is both feverish and wasted, and the formula accordingly contains the cooling drugs of 熱疳 and the worm drugs together. For the elm fruit paste and the quisqualis, see the anthelmintic statement on 使君子丸 (`sagunja-hwan`); those two are the working part of this pill. For the picrorhiza, see 胡黃連丸 (`hohwangryeon-hwan`), where the point that none of this is food is also made in full. **Contains dried toad — 蝦蟆 — whose skin and parotid secretion carry bufadienolides, cardiac glycosides of the same class as digitalis. Toad-venom preparations have killed adults by arrhythmia; the dose in a dried animal cannot be measured, and the patient here is a small child. This must not be prepared.** Where the toad is calcined to ash (蝦蟆灰, 燒存性) the glycosides are largely destroyed and what is left is bone char; where it is only wine-steeped and simmered to a paste, as here, they are not. Here the toads are wine-steeped and simmered, not calcined, and five of them go into a single batch of pills given to a two-year-old. **The text gives no dose by weight anywhere.** **Contains musk — 麝香 — from a CITES Appendix I deer.** It cannot legally be traded, and the demand this tradition created is a direct cause of the musk deer's decline. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.