In times when people know that biomedicine has no cure against Covid-19, Chinese medical practitioners are engaging with a rich archive of formulae and materia medica. They have learned how to engage with this historically grown archive with regional specificity, and renew it with imagination and inventiveness, playful tinkering and pragmatic adjustments. Our “praxeographic gaze” (cf. Mol 2002), which attends to the description of practice, allows us to marvel at the ingenuity of re-configuring Song, Ming, and Qing formulae for treating an unknown virus.

Of the approximately 350 formulae that have been found to record qinghao 青蒿 (Artemisia annua, A. apiacea) in formularies of Chinese dynastic history (221 BCE–1911 CE), three are presented here that treat wen yi 瘟疫 (warmth-factor epidemics). Translated with a view to the praxeography of their preparation techniques and dosage (Hsu et al., forthcoming), they are striking for their simplicity.

Artemisia annua is the plant from which the antimalarial chemical substance Artemisinin (or in Chinese, qinghaosu 青蒿素) can be extracted. While research on Artemisinin has led to its recognition as an essential drug by the WHO in 2005/2006, research on the plant-based Chinese materia medica called qinghao is minimal. Yet, some of the formula texts discussing qinghao recommend it for treating fevers of all sorts, ranging from extreme fever bouts to long-term low-grade temperatures, regardless of whether or not they would be classified as malarial today.

The Song dynasty formula of 1264 is interesting because it aims to dissipate acridity in the upper bodily regions; it clears away heat in the chest and dissolves poison. The ingredients chosen, such as mint, are uplifting. However, this formula does not reach an internally lingering heat in the diaphragm (which TCM considers a characteristic of Covid-19; see Sun and Hsu, this series). The Ming dynasty formula of 1406, by contrast, and thanks to the combination of qinghao and gypsum, is meant to treat internal heat. Finally, the formula of 1600 stands out because it attends to the seasonality of epidemic disorders in the body ecologic, an aspect that is also important to consider for Covid-19, as suggested by Tong Xiaoling 仝小林 (expert group leader of the State Administration of TCM Medical Treatment and academician of the Chinese Academy of Sciences; see Liu Chengwei 2020).

(1) The great green pellets (da qing wan) (extract from Renzhai’s Straightforward Guidance to the Discussion of Formulae [Renzhai zhi zhi fang lun 仁齋直指方論] of 1264):

treat seasonally occurring warmth-factor epidemics that give rise to fever episodes, as well as fatigue-induced epidemics that give rise to fever episodes, when, above the diaphragm, all is knotted and hot. Divinely effective. [大青丸 治時行瘟疫發熱 並勞役發熱 上膈一切結熱 神効]

[They contain:] Mint [bo he], licorice root [gan cao], gardenia fruit [zhi zi], scutellaria [huang qin], coptis rhizome [huang lian] three qian [3 × 4g in the Song dynasty] of each; rhubarb root [da huang] eight qian [8 × 4g]; sodium sulphate [xuan ming fen], forsythia fruit [lian qiao] six qian [6 × 4g] of each. [薄荷 甘草 梔子 黃芩 黃連 各三錢 大黃 八錢 玄明粉 連翹 各六錢]

Make the above into a fine powder. Use the natural juice of sweet wormwood [qing hao zi ran zhi] to make pellets the size of mung beans [lü dou]. Use realgar [xiong huang] as coating. . . . [右為細末 用青蒿自然汁為丸如菉豆大 用雄黃為衣]

(2) Sweet wormwood powder, comes from the Bao family’s formulary (extract from the Formulae of Universal Benefit [Pu ji fang 普劑方] of 1406):

[Contains:] Sweet wormwood [qing hao], gypsum [shi gao, CaSO₄·2H₂O] equal to amount of each. Make the above into powder. Administer before eating a meal. [青蒿散出鮑氏方 青蒿 石膏等分右為散 食前服]

(3) Sweet wormwood (extract from Simple Formulae Collected and Assembled by Shi Guzhai [lit. Master Ancient-House] [Shi Guzhai hui ju dan fang 師古齋彙聚單方] of 1600):

Another formula (一方)

At the beginning of the period of the dog days [hottest days of summer], pick sweet wormwood [huang hua hao] and dry it in the shade. At winter solstice grind [it] into a powder. At New Year's Day harmonize it with honey and administer to everyone. [初伏日 採黃花蒿 陰乾 冬至日研成細末 元旦蜜調各服之]

The formula of 1600 is remarkable because it foregrounds the importance of considering seasonality in combating epidemic disorders. Its ingredients are to be collected during the time of rising yang qi, at the beginning of the hottest period in the year. They are then ground to a powder and ingested during the time of the peaking yin and yang alternation at the winter solstice.

We are reminded here that Covid-19 first occurred in the depth of winter, the period when yin is predominant and yang at its lowest. According to Chinese medical rationale, Covid-19 classifies as a yin disorder that has caused damage to yang energies (yin bing shang yang 阴病伤阳). Its outbreak happened in Wuhan city during a period of incessant rain for twelve days. Hence it is closely associated with damp qi. Meanwhile, the rising yang of spring is well known to accelerate the spread of warmth-factor disorders. It is hence not advisable to travel in spring. In the course of developing its full potential, the yang qi will eliminate dampness, much like the sun dries out that which is moist.