Disperse the Lump Pill

The leaf is half case history. A year of malaria, every treatment tried, sweating and vomiting and purging all gone through, the nutritive and defensive qi spent, and what remains is a hard painful mass in the flank — and then the Bogam names it, 名曰瘧母. The closing line is the reasoning out loud: a lump is water held in place, so water-breaking drugs are what remove it. By that logic genkwa is the right answer, and genkwa is a harsh diuretic purgative that was used for pleural and peritoneal effusion. The cinnabar beside it is there for the spirit and adds nothing to the mass. A honey pill the size of a small bean, ten at a time with a jujube decoction, is the cautious end of genkwa dosing — but the patient being described has already been emptied out repeatedly, and there is a visible tension between the depletion in the indication and the force of the drug. **Contains genkwa, which is toxic and a drastic water-expelling purgative, and cinnabar, which is mercuric sulfide. This must not be prepared or taken; genkwa is also an abortifacient.** It is recorded as history. The hard flank mass being described is most often a malarial spleen, which needs imaging and a parasitological diagnosis rather than a purgative. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.