《孫真人備急千金要方》Vol. 35

“Warm Malaria,” Chapter Six (Discussion, Prescriptions, Moxibustion and Needling Methods, and Methods for Exorcising Malaria and Using Talismans)

The treatise says: Malaria is always caused by pathogenic wind. If a person is exposed to summer heat, the illness may develop into malaria in autumn.

Question: What causes malaria that begins with chills and is followed by fever?

Answer: Cold belongs to Yin Qi, while wind belongs to Yang Qi. The person is first exposed to pathogenic cold and later to pathogenic wind, so chills come first and fever follows. Because the illness occurs at regular intervals, it is called “cold malaria.”

Question: What causes malaria that begins with fever and is followed by chills?

Answer: The person is first exposed to pathogenic wind and later to pathogenic cold, so fever comes first and chills follow. This illness also occurs at regular intervals and is called “warm malaria.”

If there is fever without chills, it is because Yin Qi has first been depleted, leaving Yang Qi to flare up on its own. The patient may have shortness of breath, restlessness, heat in the hands and feet, and nausea. This is called “dan malaria,” or malaria with fever alone.

Question: Where do warm malaria and cold malaria lie hidden, and in which organ do they reside?

Answer: Warm malaria arises when a person is exposed to wind and cold in winter, and pathogenic cold lodges in the bone marrow. When Yang Qi becomes strong in spring, the pathogen cannot expel itself. Later, under the intense heat of midsummer, the brain marrow seems to melt, the muscles grow thin, and the interstices—the skin’s texture and sweat pores—open. Then, if the person exerts himself, the pathogen escapes along with the sweat. In this illness, the pathogen first lies hidden in the kidneys and later spreads from within to the exterior.

As a result, Yin Qi is insufficient and Yang Qi becomes excessive. The illness flares when Yang Qi is strong; when it weakens, the pathogen returns inside. As the pathogen moves inward, Yang Qi becomes weak, and weakness of Yang brings on chills. Thus the illness begins with fever and is followed by chills, and is called warm malaria.

Question: What kind of illness is dan malaria?

Answer: People with dan malaria ordinarily have heat in the lungs, abundant internal heat, and rebellious Qi surging upward. Qi in the middle burner—the region around the spleen and stomach—is obstructed and cannot disperse outward. If the person exerts himself at this point, the interstices open, allowing wind and cold to enter beneath the skin and between the muscles. When the illness flares, Yang Qi is strong; if it does not weaken, the disease breaks out. The pathogen has not reached the Yin aspect, so there is fever without chills. The pathogen lies hidden in the heart and remains externally among the muscles, causing emaciation and loss of muscle. For this reason, it is called dan malaria.

Malaria that breaks out in the early morning does so because Yin and Yang Qi change places at that time. This change must begin in the limbs. Yang Qi has already been damaged, and Yin Qi is damaged along with it. Thus, before the Qi has yet converged, the attack begins ahead of the time when they meet…

Whenever an attack occurs, tightly bind all ten fingers and toes with thin cords for about the time it takes to eat a meal. This is intended to keep pathogenic Qi from entering and Yin Qi from escaping. Untie the cords when the time is up.

The pulse of a person with malaria is usually wiry, tense like a string beneath the fingers. A wiry, rapid pulse generally indicates heat; a wiry, slow pulse indicates cold. If the wiry pulse is slightly tight, purgation may be used; if it is wiry and slow, warming treatment may be used. A tight, rapid pulse may be treated by inducing sweat or with acupuncture and moxibustion. If the pulse is floating and large—felt at the surface and forceful—the emetic method may be used, and the patient may recover after treatment. Malaria with a wiry, rapid pulse is brought on by Wind pathogen; adjusting the diet can ease and control the illness.

When malaria recurs year after year into the third year, or continues for several months without stopping, it is usually because there is a mass beneath the ribs. In treatment, this mass should not be attacked and expelled directly. Instead, its fluids should first be depleted. Before an attack, induce sweating in the patient. If the patient feels chilled after taking the medicine, cover them with clothing and blankets. Once they sweat and urinate freely, the illness will improve.

People with malaria often become emaciated, and their skin may break out in gooseflesh. If malaria attacks once a day, it should, in theory, be cured within fifteen days; if it is not, it will usually ease by the end of the month. If it still does not resolve, what should be done? The Master replied: The pathogenic influence has gathered into an abdominal mass called a zhengjia, known as the “malaria mother.” It should be treated promptly.

Turtle-Shell Decoction Pills treat this condition. The formula contains a dead turtle (twelve jin, prepared in the usual way for cooking; the Jingui Yaolue records three liang of turtle shell), pinellia, ginseng, and kansui (six zhu each); dianthus, donkey-hide gelatin, crape myrtle (also called aster), moutan bark, pyrrosia leaf, dried ginger, rhubarb, magnolia bark, cassia bark, and seaweed (called red algae in the Jingui Yaolue), garden cress, and dung beetle (twelve zhu each); wasp nest, peach kernel, and peony (one liang each); bupleurum (one and a half liang); crow feathers, charred (also called iris), and baikal skullcap (eighteen zhu each); and ground beetle and gadfly (thirty zhu each; the Jingui Yaolue records woodlouse). There are twenty-four ingredients in all.

Grind the medicines into powder. Take one dou of ash from beneath the stove and soak it in one hu and five dou of clear wine, then strain off the wine. Use the wine to cook the turtle until it is completely soft and the liquid is thick like lacquer. Strain out the solids, add the remaining medicinal powders, and simmer the mixture into pills the size of parasol-tree seeds. Take seven pills on an empty stomach, three times a day. The formula recorded in the Treatise on Cold Damage does not include kansui or seaweed.

Bupleurum and Trichosanthes Root Decoction is used to treat thirst during a malaria attack. It contains bupleurum, astragalus, ginseng, licorice, and fresh ginger (three liang each), along with twenty jujubes.

Snakegourd root (four liang).

Coarsely cut the seven ingredients above. Boil them in one dou and two sheng of water until six sheng of liquid remain. Strain out the dregs, then continue boiling until three sheng remain. Take one sheng warm, three times a day.

Oyster Decoction

A formula for treating male-type malaria, in which chills predominate over fever during an attack. Some editions read “severe malaria” instead of “male-type malaria.”

Oyster shell and ephedra, four liang each; licorice, two liang; Shuqi, three liang. If Shuqi is unavailable, substitute Changshan.

First wash the four ingredients above three times to remove the fishy smell, then coarsely cut them. Boil the Shuqi and ephedra first in eight sheng of water until six sheng remain, skimming off the foam. Add the other ingredients and boil until two sheng remain. Take one sheng first. If you vomit it up, continue taking the medicine.

Sichuan Pepper Powder

A treatment for male-type malaria in which chills predominate.

Sichuan pepper, mica, and dragon bone, in equal amounts.

Grind the three ingredients above into a fine powder and sift it. About the time it takes to eat a meal before a malaria attack is expected, take half a qian with vinegar-fermented rice water. Take one qian when the attack is near. For warm malaria, add half a fen of Shuqi. The mica should be calcined over a fire for three days and nights. The edition of the Essentials from the Golden Cabinet omits mica and uses Yunshi instead.

Heat-Type Malaria and Warm Malaria

One form of heat-type malaria occurs when Yin Qi is depleted and Yang Qi is in excess, with a faint pulse. The patient has shortness of breath, tightness in the chest, heat in the hands and feet, and nausea. There is fever without chills. The pathogenic influence is lodged in the heart and remains externally between the muscles, gradually causing wasting and loss of muscle.

In warm malaria, the pulse is even and there are no episodes of chills. After six or seven days of illness, only fever remains. Symptoms include pain in the joints and bones, agitation, and sometimes vomiting. The fever may come in the morning and ease by evening, or come in the evening and ease the next morning. This is called warm malaria.

White Tiger Decoction with Cinnamon

Used to treat warm malaria.

Gypsum, one jin; Anemarrhena rhizome, six liang; licorice, two liang; polished rice, six ge.

Coarsely cut the four ingredients above. Boil them in one dou and two sheng of water. When the rice is cooked through, strain out the dregs, add three liang of cinnamon bark, and continue boiling until three sheng remain. Divide into three doses. After taking it, cover yourself well so that you sweat. If chills come first, followed by fever and sweating, this is a sign that the illness is improving.

Ephedra Decoction

Used to treat malaria by inducing sweating.

Ephedra, snakegourd root, and rhubarb, four liang each; licorice, one liang.

Coarsely cut the four ingredients above. Boil them in seven sheng of water until two and a half sheng remain, then divide into three doses. Take one dose about the time it takes to eat a meal before the attack, and another when the attack is near. After each dose, cover yourself well to promote sweating.

A prescription for treating malaria, whether the attacks occur every other day or at night:

Three liang each of Changshan and bamboo leaves, one hundred grains of glutinous millet, and eight liang of gypsum.

Chop the four ingredients and soak them in eight sheng of water in a copper vessel. Place it somewhere high and clean, and leave it exposed to the night air beneath the stars and moon overnight, with a knife laid across the medicine. The next day, take it into the patient’s room and simmer it over low heat until three sheng of liquid remain. Divide the dose into three portions: take one at daybreak, one about as long as a meal before the expected attack, and the last just as the attack is about to begin. After taking all three portions, the patient should lie alone in a quiet room and speak to no one. That day, do not wash the hands or face, rinse the mouth, or eat. After the expected time of the attack has passed and it is clear that no attack has occurred, wash and eat. At the same time, rub the liquid onto the palms, soles, chest, head, and face, and place the residue beside the pillow. This method has been remarkably effective. The Jiujifang (“Prescriptions for Emergencies”) uses twenty dark plums instead.

Another prescription: First cook mutton into a soup, then prepare flatbread. Have the patient eat until full and drink a little wine, according to their tolerance, enough to feel slightly tipsy. Then have them enter a closed room, light charcoal, and cover them with a thick quilt until they sweat profusely; the illness will then be cured.

Another prescription: Burn the hair from the tip of a black ox’s tail to ash. Take one square-inch spoonful with wine three times a day.

Changshan Pills, for treating malaria; the specific condition is not recorded.

Eighteen zhu each of Changshan, Anemarrhena, licorice, and rhubarb, and one liang of ephedra.

Grind the five ingredients into a fine powder and mix with honey to make pills the size of Chinese parasol tree seeds. Take five pills twice daily before meals. If there is no response, gradually increase the dose until the illness is cured. The Zhouhoufang (“Handbook of Prescriptions for Emergencies”) omits the rhubarb.

Another prescription: For malaria that has persisted for years without being cured. Two doses should cure it; if the illness has lasted less than a month, one dose should suffice.

Grind three liang of Changshan into powder, mix with egg white, and roll into pills the size of Chinese parasol tree seeds. Place them in a copper bowl and steam them over water until the raw smell disappears. Take twenty pills with a decoction of bamboo leaves. If vomiting is desired, the patient may vomit until the attack begins; arrange three doses around the time of the attack, before and after it. The patient may skip breakfast, but should not go without food in the evening. A thin porridge cooked with bamboo-leaf juice may be eaten in small amounts.

Gardenia Decoction, for treating the same kind of malaria described above.

Fourteen gardenia fruits, fourteen grains of glutinous millet, three liang of Changshan, and twenty-six plantain leaves, roasted dry.

Chop the four ingredients and boil them in nine sheng of water until three sheng of liquid remain. Divide into three doses.

Take one dose before the attack, another during it, and a third after it. If vomiting or diarrhea occurs after taking it, the illness should improve after four or five episodes. If it still does not stop, eating cold rice may bring it to an end.

A formula for chronic malaria in the elderly that has resisted treatment

Take three liang of Hengshan, and one liang each of zei gu, shengma, biejia, and fuzi. Chop the five ingredients, place them in a silk bag, and soak the bag in six sheng of wine. Warm it gently near a fire, turning the bag repeatedly, and leave it to soak overnight. Take one he each time; several doses may be taken shortly before an attack. Vomiting or diarrhea may follow.

A formula for recent or long-standing malaria

Take one and a half sheng of urine and seven-tenths of a fen of honey. Boil the two ingredients together until they have boiled three times, then drink the whole amount at once. On each day an attack is expected, take the medicine at dawn. Do not eat between taking it and the expected attack. In severe cases, the illness will gradually ease; no more than three doses should be needed for a cure.

Another formula

Take a handful each of mouse-tail herb seeds and plantain seeds. Chop them, add five sheng of water, and boil until reduced to two sheng. Drink the whole amount at once before an attack.

Another formula

Take five he of vervain juice and three he of wine. Divide into three doses.

Another formula

Pound the root of henbane, burn it to ash, and mix it with water. Take one he. Adjust the amount to the person’s age, build, and constitution.

Another formula

Take fourteen melon stalks, pound them, and soak them in water overnight. Drink the mixture.

Another formula

Gather hemp flowers on the day of the Tiger in the seventh month and grind them into powder. Take one square-inch spoonful with wine.

Another formula

Cut off both ends of an old shoe sole, burn it to ash, and take it with well water.

Another formula

Take the juice of qiaoyao.

Another formula

Grind peach blossoms into powder and take one square-inch spoonful with water.

A formula for treating malaria

Take one square-inch measure of roasted biejia, two of wuzei gu, one liang each of processed fuzi and licorice, and two liang of Hengshan. Chop the five ingredients and soak them overnight in two and a half sheng of wine. The next day, apply the liquid to the body’s five centers: the palms of both hands, the soles of both feet, and the center of the chest. If applied before the time of an attack, it should stop the malaria from recurring. If it does not stop, drink about one he of the liquid, and the illness should be cured.

Shuqi Pill: for taxation malaria, and also for periodic bouts of chills and fever resembling malaria that arise after prolonged physical strain

Take thirty zhu each of shuqi, maidong, zhimu, baiwei, digupi, and shengma; one liang each of licorice, biejia, black plum flesh, and yu zhu; one and a half liang of Hengshan; two liang of gypsum; and one he of fermented soybean.

The liang, he, sheng, zhu, and square-inch spoonful mentioned here are ancient units of measurement. “The five centers” refers to the palms of both hands, the soles of both feet, and the center of the chest. This is a plain-language rendering of the original text. Some ingredients in these traditional formulas are toxic and should not be taken on the basis of this account.

Grind the thirteen ingredients listed above into a fine powder. Mix with honey and form pills about the size of parasol tree seeds. Take ten pills at a time with a beverage, twice daily, then gradually increase to twenty or thirty pills. The book says this prescription has a marked effect and that everyone who takes it recovers. One liang of Guangming Sand—that is, cinnabar—may also be added.

Mume Pill: For malaria with alternating chills and fever, brought on by exertion, when the illness has lasted a long time without recovery and is accompanied by weight loss, phlegm collecting in the chest, and reduced appetite. It is also suitable for people who fall ill after a long journey or prolonged labor and remain unwell for years. The book says this prescription has a marked effect.

Mume pulp and fermented soybeans (one ge each); cimicifuga, lycium root bark, bupleurum, turtle shell, Changshan, and hogfennel root (one liang each); cistanche, scrophularia, lily bulb, Shu lacquer, cassia bark, ginseng, and anemarrhena (half a liang each); eighty-one peach kernels.

Grind the sixteen ingredients above into a fine powder and form pills with honey. Take thirty pills on an empty stomach with finely brewed tea, twice daily. Older adults and children may take an amount suited to their condition; the book says there are no restrictions.

Prescription for persistent malaria caused by overwork, when all other treatments have failed

Take a handful of fresh, thick-growing achyranthes root and chop it. Add six sheng of water and boil until two sheng of liquid remain. Divide into two doses. Take the first about one mealtime before the malaria attack, and the second just before the attack is due to begin.

Great Five Tonics Decoction: For miasmatic malaria that develops after an epidemic illness.

Cassia bark, thirty zhu; polygala, platycodon, and Sichuan lovage (two liang each); poria, dried rehmannia, peony, ginseng, atractylodes, angelica, astragalus, and licorice (three liang each); bamboo leaves, five liang; twenty jujubes; fresh lycium root and fresh ginger (one jin each); pinellia and ophiopogon (one sheng each).

Chop the eighteen ingredients above. First boil the bamboo leaves and lycium root in three dou of water until two dou of liquid remain. Add the other ingredients and continue boiling until six sheng remain. Divide into six doses and take them all within one day and night.

Pangolin Decoction: For mountain miasma malaria with alternating chills and fever that comes and goes.

Pangolin scales, fourteen pieces; turtle shell and cuttlefish bone (one liang each); Changshan, three liang; one aconite tuber.

Chop the five ingredients above and soak them overnight in three sheng of wine. Before the attack, sip the liquid gradually, taking care not to let the doses lapse. If vomiting occurs after taking it, apply the liquid to the body as well. Wait some time before eating or drinking.

Black Plum Pill (Wumei Yuan): Treats malaria caused by pathogenic heat affecting the Liver. Symptoms include a bluish, pale complexion, rapid breathing and tightness in the chest, and shivering and shaking. In severe cases, the person may seem dead. Some people have a fever for a long time and develop malaria-like attacks after even slight exertion. The illness may persist for years without healing. Use one liang each of black plum flesh, Shuqi (a Chinese medicinal herb), soft-shelled turtle shell, Yuwei (a Chinese medicinal herb), Anemarrhena, and Sophora root; one and a half liang of Changshan (a Chinese medicinal herb); two liang of gypsum; eighteen zhu each of licorice root and Asarum; and one ge of fermented soybeans. Grind the eleven ingredients into powder and mix with honey to make pills the size of Chinese parasol tree seeds. Take ten pills with wine twice daily; they may also be taken with another drink.

Formula for Malaria Caused by Heat Affecting the Heart: Treats malaria attacks that do not stop, or a fever that continues after the attacks cease. The fever comes and goes, causing restlessness and a strong desire for cold water. Sometimes, however, chills predominate and the fever is slight. Use one liang of licorice root, three liang of Shuqi, four liang each of Changshan and soft-shelled turtle shell, five liang of gypsum, one ge of fermented soybeans, thirty each of gardenia fruits and black plums, and two sheng of chopped light bamboo leaves. Chop the nine ingredients, decoct them in nine sheng of water, and reduce the liquid to three sheng. Divide it into three doses.

Changshan Pill (Changshan Yuan): Treats malaria caused by heat affecting the Spleen. Symptoms may include thirst or no thirst; heat becomes trapped inside and cannot disperse, causing chills, abdominal pain, rumbling intestines, and sweating during an attack. Use three liang of Changshan, half a liang of licorice root, and one liang each of Anemarrhena and soft-shelled turtle shell. Grind the four ingredients into powder and mix with honey to make pills the size of Chinese parasol tree seeds. Before a malaria attack, take ten pills with wine: once shortly before the attack and again while it is underway.

Changshan Decoction (Changshan Tang): Treats heat affecting the Lungs, with phlegm gathering in the chest. The illness comes and goes, then develops into malaria. Symptoms include a cold feeling within the chest, followed by fever as the chills intensify. When the fever subsides, the person is easily startled, as if seeing something. Use three liang of Changshan, half a liang of licorice root, and 320 grains of glutinous millet. Chop the three ingredients, decoct them in seven sheng of water, and reduce the liquid to three sheng. Divide it into three doses, and finish all three before the malaria attack begins.

Another Formula: Treats malaria caused by heat affecting the Kidneys. Symptoms include chills throughout the body, pain in the lower back and along the spine, tossing about restlessly, constipation, dizziness, unsteady movements, and cold hands and feet. The original text gives no formula here.

Take three liang of Hengshan, thirty-seven dark plums, one sheng of chopped bamboo leaves, eight ge of fermented soybeans, and a handful of scallion whites. Chop all five ingredients. Boil them in nine sheng of water until three sheng of medicinal liquid remain. Divide it into three doses and take them, finishing the medicine by the time the malarial attack begins.

Veratrum Pills: Malarial symptoms may occur in all five viscera, but generally not in the six bowels. The only exception is the stomach, which may also be affected. Stomach malaria causes attacks in the morning. The person easily feels hungry but cannot eat; after eating, they feel full and bloated, with a distended abdomen. The treatment is as follows:

Take one liang each of veratrum, Hengshan, Chinese honey locust, and Achyranthes, along with thirty croton seeds. First, stir-fry the veratrum and Chinese honey locust until yellow. Then pound them together with the other ingredients into a powder and use honey to form pills the size of small beans. Take one pill in the morning and another when the attack begins. Do not eat too much during the day. (The Zhouhou Fang does not include Hengshan or Achyranthes.)

Acupuncture and Moxibustion Methods

For liver malaria, needle the Foot Jueyin channel and let it bleed. For heart malaria, needle the Hand Shaoyin channel; for spleen malaria, the Foot Taiyin channel; for lung malaria, the Hand Taiyin and Hand Yangming channels; and for kidney malaria, the Foot Shaoyin and Foot Taiyang channels.

For stomach malaria, needle the Foot Taiyin and Foot Yangming channels, and prick the transverse vessels to let them bleed.

When treating malaria with moxibustion, first ask where the attack begins, then apply moxibustion at the corresponding location. If it begins in the head and neck, apply moxibustion to Dazhui, an acupoint at the back of the neck, before the attack. Apply it gradually until the time of the attack has passed. If it begins in the lower back, apply one hundred cones of moxa to Shenshu. If it begins in the arm, apply moxibustion to Sanjian.

Before an attack, moxibustion may be applied to Shangxing and Dazhui. By the time the attack begins, apply a total of one hundred cones. Each moxa cone should be about the size of a millet grain. People who do not know how to locate the points often make the cones too large. If the condition changes slightly, apply seven cones to Baihui. If another attack occurs later, apply seven more. For cases that are difficult to cure, apply moxibustion no more than three times. Wrap a cord once around the foot, then fold it in half. Use it to measure from Dazhui to Baihui, and apply twenty-one cones at one end of the folded cord, each the size of a small bean. Also apply three cones to each Fengchi point.

For any kind of malaria, regardless of how long it has lasted, have the patient lie on their back. Measure the distance between the nipples with a cord, fold the cord in half, then measure that same length downward from a nipple. Apply moxibustion at the point reached, using a number of cones determined by the patient’s age. For men, use the left side; for women, the right.

For all kinds of malaria associated with the five viscera, seven cones of moxa may be applied to Chize. Chize is above the elbow crease, where the pulse can be felt.

For any kind of malaria, if no blood vessels are visible, prick between the ten fingers to let blood. The text states that the illness will stop once the blood has been released.

The medicines mentioned here, including veratrum and croton, as well as the acupuncture and moxibustion procedures, are presented only as a plain-language interpretation of a classical text.

First check whether there are any small red spots on the body, like beans. If there are, remove them all.

To treat malaria, needle the Foot Shaoyin channel (the Kidney channel) until it bleeds; the illness will then be cured.

For intermittent malaria, select Shangxing. This point lies in the hollow at the center of the bridge of the nose, one cun above the hairline, and is bean-shaped. Apply seven cones of moxa. First select Yixi, then Tianyou and Fengchi.

If malaria attacks at sunset, select Linqi. This point lies in the hollow above the outer corner of the eye, five fen into the hairline. Apply seven cones of moxa.

During a malaria attack, if the condition is excess and the lower back and spine hurt, or if it is deficiency, with nasal congestion and nosebleeds, select Feiyang. This point lies seven cun above the outer ankle. Apply seven cones of moxa.

During a malaria attack, if there is heavy sweating and lower back pain, and the person cannot bend forward or lean back, while the eyes seem about to pop out and the neck seems to be pulled upward, select Kunlun. This point lies in the hollow behind the outer ankle, above the heel bone. Apply three cones of moxa.

Method for dispelling malaria: Before an attack begins, hold a large rooster in your arms and startle it from time to time so that it crows loudly. The illness will then be cured at once.

Malaria talisman (two talismans are used together):

The boy who causes malaria is named Shi Ba, and his mother is named Shi Chui. So-and-so (fill in the name of the person who is ill) has malaria. The sick person should quietly recite: “Heaven and Earth, mountains and waters, the City God, the sun and moon, and the Five Stars all honor the Kitchen Lord. Now a little malaria demon dares to call the Kitchen Lord a black-faced servant. If it does not believe this, let it come and see the document. Quickly, quickly, in accordance with the statutes and decrees.”

This talisman must be carefully written in cinnabar or ink, leaving a blank line of paper at both its beginning and end. It is to be placed on the Kitchen Lord’s forehead and weighed down with a tile or stone. Do not place the weight over the writing, and do not let anyone approach the talisman. Ideally, assign someone specifically to guard it. Do not let ash fall onto it either, lest the writing become blurred.

Place the talisman as follows: If the malaria is expected to strike after sunrise the next day, sweep the dust from before the Kitchen Lord and from his forehead the previous night. On the morning of the attack, the sick person should be properly dressed and stand before the stove to recite the talisman. The reciter must pronounce every character clearly and make no mistakes. Each time it is recited, if someone else recites it on the sick person’s behalf, the sick person should kneel and bow once; someone should also tug the sick person once. If the sick person recites it alone, they should tug at their own clothing once and say, “So-and-so of the So-and-so family.” Recite it three times and bow three times in all. Then use clean tiles or stones to weigh down the two corners of the talisman, placing it writing-side up on the Kitchen Lord’s forehead without covering the characters.

If the malaria strikes at sunset, follow the same procedure: recite the talisman three times, until noon…

Following the method above, read the text three times at intervals. If the illness comes on at night, read it three times again at dusk. You may continue to use the stove fire as usual when cooking, but do not move the talisman.

If there are two stoves in the home, affix the talisman to the larger one. If the stove is outdoors, affix it to the outdoor stove; if it is indoors, affix it to the indoor stove. If there is only an outdoor stove, affix the talisman in the same way. Hold the talisman in your hand as you affix it. The talisman is drawn as follows.

If the patient is staying here as a visitor and will remain for some time after an attack, affix the talisman as described above during each attack, taking care to do so each time. The talisman should also bear the patient’s name and the words: “Suffering from malaria; I beg you to seize and register the malaria demon.” The talisman for a child is as follows.

For patients whose illness has lasted a long time, affixing the talisman once will gradually improve their condition. Alternatively, affix it five times, as at the beginning, until they recover completely. Hold the talisman below in your hand as well.

The Wang Liang talisman, written by Zhang Jibo, should end with the words “Urgently, urgently, in accordance with the statutes and commands” (a phrase in Daoist talismanic incantations urging swift execution).

Roll up the Wang Liang talisman lengthwise according to the prescribed method, hold it in both hands, recite it, and then sit upright. When you need to move, check that it is properly prepared, then place the talisman inside your robe at the chest, with its head pointing upward.

Both of the talismans above must be used together as prescribed; neither may be omitted. If the patient does not recover, even a single further attack will be milder. At the next attack, read the talisman again and the patient will recover. Follow each instruction carefully. If any character on the talisman is written incorrectly, it will have no effect.

Diagnosing and Treating Stream Poison, Part Seven

Near the headwaters of streams in the Jiangdong and Jiangnan regions lives an insect called the “short fox.” The poison it causes is known as “stream poison,” also called “shooting worker.” The insect has no eyes but keen hearing, and lives in mountain streams. When it hears a person, it shoots venom from its mouth and injures them; hence the name “shooting worker.”

This insect’s poison is relatively mild. If it merely pursues someone or strikes their shadow, it will not immediately cause sores to appear. At first, the patient alternates between chills and fever, feels cold, and has tense sinews, headaches, eye pain, yawning with the mouth open, coughing, difficulty breathing, and a troubled mind. In the morning, the patient may feel somewhat clearer and better, but by evening the chills and fever often return. At times, the illness appears like an attack of Cold Damage or a reaction to taking mineral powder. It may also resemble corpse poison, leaving the patient unable to speak.

Someone who is not from the area and does not often walk mountain paths or wade through streams may not recognize these as symptoms of stream poison. They may mistake it for Cold Damage or a reaction to mineral powder and apply the wrong treatment. When the poison is severe, sores may appear, and the illness may be mistaken for “biaoju” (a severe toxic sore). The patient may even vomit, have diarrhea, and pass blood in the stool, leading others to suspect Gu poison and ultimately causing harm. These similar symptoms are described here so that people can distinguish stream poison from Cold Damage. The specific prescriptions are given in another volume.