Turtle Carapace Pill

The clearest statement in the chapter of what a 瘧母 is taken to be: a hard mass left in the flank by malaria that has gone on too long, and treatable as a mass rather than as a fever. Nothing in this pill is aimed at the paroxysm at all. Turtle carapace leads at a full nyang, boiled in vinegar to soften it, and the vinegar paste that binds the pills does the same work again — vinegar being the tradition's solvent for hardness. Behind it sit two pairs. Sparganium and zedoary break accumulation; peach kernel and safflower move blood. Cyperus and green tangerine peel free the qi of the flank, and medicated leaven, barley sprout and sea hare egg mass reduce the food stagnation that goes with a spleen too big to leave room for a meal. The night-attack variant adds cnidium, Korean angelica and red peony and is given its own name, Eumhak-hwan, which is the chapter reading a nocturnal rhythm as a blood-level disease. A palpable left-flank mass in a patient with years of relapsing fever is most often a malarial spleen, and the formula's instinct — that the mass is now the problem — is sound. The treatment is not: splenomegaly of this kind needs imaging, a parasitological diagnosis and antimalarial therapy, and the spleen in that state is at real risk of rupture. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.