Chapter 36: Omphalia

Setting up a stall in town made Zuo Gui hesitate. His pride again. But yesterday’s rounds had given him practical experience of travelling medicine. It no longer seemed so shameful, and had earned more than waiting in the shop.

A stall might bring in holiday money.

“Very well. We’ll go to the market.”

Tang shops could stand along either side of a street. Traders without premises, however, had to gather in designated markets. In Chang’an these were called the East and West Markets; in local prefectures and counties, the wazi.

Hearing the plan, Madam Liang borrowed a handcart from the general shop opposite. She loaded a table and three chairs. Zuo Shaoyang added the chest and pushed the cart after his father through the streets.

The market was still quiet. They found a place, set out the furniture and tied the banner upright to a table leg. It fluttered in the wind as they sat to wait.

Gradually the market filled. Stalls opened; country people arrived to shop for New Year or simply look about.

Zuo Shaoyang had deliberately chosen somewhere near the firewood sellers, hoping to see the dark-skinned girl. Thinking of her, he took out the squirrel and offered it a pine kernel.

Most woodcutters walked in from the countryside and did not arrive until noon. Only a few early loads stood there, priced higher in hopes of a morning sale. Few buyers were interested.

She was not among them. Her home was probably far enough away to make the journey take time.

After a long wait without patients, he grew bored. Nearby stood wholesale medicine stalls.

“I’ll have a look at the medicines, Father. Call if you need me.”

“Mm.”

Hands in his sleeves, neck hunched, Zuo Gui looked discouraged and did not ask why.

Hezhou comprised six counties, with its seat at Shijing. The largest medicinal-ingredients market in the prefecture lay within this town’s wazi. Merchants, shops and clinics from all six counties bought there, as did many from neighbouring jurisdictions. Business was brisk.

The stalls were only part of it. Several large wholesalers occupied premises by the market entrance.

Zuo Shaoyang was not buying stock, so he ignored those and browsed the stalls. There were plenty, carrying a fairly complete range. He paid particular attention to things missing from Guizhi Hall. Most were expensive.

Yet some common ingredients were absent from every stall: red peony root, myrrh and green tangerine peel, among others.

Thinking back, he believed these had only come into medicinal use after the Song. That explained their absence.

He memorised the missing medicines. Many later formulas required them. He must find a way to obtain them, or lose the use of valuable prescriptions developed after the Tang.

When he returned, his father still had no customers.

Another hour or more passed. Near noon, the first finally arrived.

A vegetable seller’s child had accompanied his mother into town. He had been sitting quietly opposite until he began complaining of stomach pain. A trip to the privy did not help. Cold sweat broke out on his forehead.

Alarmed, his mother asked a neighbour to mind the stall and brought him over.

Zuo Gui sat the child down.

“Have you eaten anything bad?”

“Nothing,” his mother answered for him. “He hasn’t eaten since getting up. We meant to sell the vegetables, buy New Year things and go home for lunch.”

The boy was sallow and thin, with a swollen little belly. Probably roundworms.

“Has he taken medicine for worms?”

“Yes. The village physician saw him yesterday afternoon and said he had them. He gave pills. I fed him some last night.”

“What medicine?”

“I don’t know. Pills from our doctor. I have two left.”

She produced two little pellets, each about the size of a chopstick tip.

“These.”

Zuo Gui examined one, touched it with his tongue and spat.

“Omphalia—lei wan. A worm-killing medicine. How much did you give?”

“He said three times a day, three pills each time.”

“And how many did you give?”

“Five. His stomach kept hurting. The doctor said it was worms and we had to get them out. I worried three wouldn’t be enough, so I gave two extra.”

“Omphalia is poisonous. You mustn’t give a child too much!”

She started.

“Poisonous? He never told me that!”

“It is. *Shennong’s Classic of Materia Medica* says so plainly. It mustn’t be taken in excess.”

Omphalia was a broad-spectrum medicine for intestinal parasites, capable of killing roundworms, tapeworms and others. The ancient classic labelled it poisonous. Modern medicine, however, had found it non-toxic, or non-toxic within normal doses.

A normal single dose of raw omphalia powder reached sixty grams for an adult, thirty for a small child, taken three times daily for an anthelmintic effect. No poisoning had been reported at such doses. Ginseng in that quantity would have produced adverse effects long before; omphalia did not. Its safe range was broader than that of many Chinese medicines.

Yet the ancient text’s warning had made generations of physicians timid in using it.

Many traditional worm-expelling medicines did not kill intestinal parasites. They paralysed them, preventing them from holding onto the small intestine so bowel movement could carry them out. Omphalia was different: it killed worms and could even break them into fragments.

Like other anthelmintics, it required a sufficient dose. Too little left roundworms and tapeworms poisoned but alive, writhing inside the abdomen. Tangled worms could cause intestinal obstruction. Those entering the biliary tract could cause biliary ascariasis; some might even perforate the small intestine.

That was dangerous.

The boy’s dose had been insufficient. Irritated worms were moving violently and causing the pain. At such a time, trying to kill them could provoke a perilous struggle. First they had to be quietened, then expelled or killed.

Hearing only that the medicine was poisonous, the mother’s mouth twisted with anger.

“That damned quack! Poison for my son! The murderous—”

Zuo Gui disliked hearing another physician abused.

“You can’t say that. Every medicine has some harmful potential. Many are poisonous. Used correctly, even a poison becomes a good remedy. The important thing is not to overdose. Omphalia is a good medicine for worms. He chose correctly. Your child’s pain is probably because you gave too much. You can’t blame the doctor.”

She dared not continue her abuse. Instead, she begged him to save the boy.

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