Yellow Scale Pill

瘧母, the malarial mother, is the chapter's name for the hard mass that settles in the side after a malaria has run for seasons. The section 瘧寒熱不歇有根 just above gives its roots as 飮, 水 and 敗血 — thin fluid, water and spoiled blood — and says that where a 癖 has bound at the rib-side the flank must hurt, and that the 癖 is itself what goes on making the cold and heat. This pill is the answer to that reading: asafoetida and pangolin scale to break the bound mass, areca seed to drive it downward, costus root to move the qi that holds it in place, and cinnabar with realgar for the possession the era heard in a fever that keeps its own calendar. The 黃甲 of the name is those last two things, the yellow mineral and the scale. What 瘧母 describes is a spleen enlarged by repeated infection — the splenomegaly of chronic malaria, palpable below the left ribs in someone with years of relapsing fever behind them. It is a real finding, and it recedes when the parasite is cleared, not when a mass-breaking powder is swallowed. **Contains cinnabar (mercury) and realgar (arsenic), both toxic, and pangolin scale, taken from a species protected under CITES. This must not be prepared.** — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.