Nutmeg Pill (Pox Diarrhoea)

Seven drugs, about 130 g of powder, rolled with flour paste into millet-sized pills. Five of the seven do one thing: red halloysite and white dragon bone are adsorbent mineral earths, calcined alum is an astringent salt, and nutmeg and chebula flesh are the two standard astringent antidiarrhoeals of the tradition. Costus root and cardamom are there to keep that mass from blocking the stomach. It is one of only three leaves in this chapter that scale a dose to the patient — the others are 煮肝丸 at 1.39 and 加味六一散 at 1.68.1 — and the scaling is worth reading closely. Thirty pills at one year, a hundred at three: a bit over threefold in two years, while a child's weight roughly doubles over the same span. The pill is a fixed size and the children are not, so this is a dose by age rather than by body size, and the step is steeper than growth. **Every drug here but the costus root and the cardamom is an astringent or an adsorbent, and that is the objection to the whole pill. Antidiarrhoeal and antimotility drugs are contraindicated in young children: they slow or bind the stool without slowing the loss, so fluid collects in the gut instead of leaving it and the child goes on dehydrating while appearing to improve, and where the cause is an invasive infection, slowing the bowel makes it worse. Calcined alum is aluminium sulfate, corrosive to mucosa and a route of aluminium absorption through an inflamed infant gut. Nutmeg in quantity contains myristicin and is a deliriant and a hepatotoxin. The patient is an infant, and the dose this leaf gives is set by age, not by weight. This must not be prepared.** What the child needed was the fluid, not the binding; the statement is on the 異功散 leaf of this section and in full on the 玉露散 leaf of 1.43 吐瀉. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.