Santau has been over-publicized and misunderstood over the years in Malaysia. It has became the collective noun for black magic and almost everything supernatural falls into this category; most of all a tool for some party to spread rumors and persecutions.
I believe the Malaysian Santau technique originates from India. As described in the book 'Malay Poisons and Charm Cures' by John D. Gimlette, Indian added poisons while making earth-wares to cause slow poisoning. While the old Malays smeared poisons on their keris so as to kill their enemies.
Many ingredients used in making santau are described in the above mentioned book. The technique of making santau is much more advance and lethal than the Indochinese Phi Phop (琵琶鬼) or the Chinese 'mountain-wind poison' (蛊毒).
As with all systems, a spirit is required as an agent for transmitting poisons although the actual one who drops poisons is still the sorcerer himself/herself.
As mentioned before, the purpose of administering santau or related techniques is for money mainly and revenge secondary.
Many stories told of travelers and especially merchants in isolated locations in Southern China and Indochina were being killed by unscrupulous rest house owners for their money. It is believed that the souls of those killed by santau type of poison are forced to serve the santau practitioner. Similar rumors were also went viral earlier in Malaysia that certain restaurant owners would drop santau in their dishes to poison their customers.
It is believed that a santau practitioner must 'sacrifice' one life in 3 years or his/her santau spirit will devour the master. But I think the main motivation is for money than for keeping ghosts to serve the sorcerer.
Since materials for santau making are irritants: glasses, bamboo hairs, caterpillars etc., once this mixtures are consumed; it directly attack the digestive and respiratory systems. Thus causing coughing, vomiting or difficulty to breathe. If lethal poisons are added, the victim may die in relatively short time.
So, logically speaking; the effects of santau are purely physical and nothing spiritual. Until today, I am not sure why spirits such as Hantu Raya or Phi Phops are employed in santau sort of systems.
I have major headache when people blamed a person of different characters a potential santau caster over some perhaps their own health problems, or even of jealousy in nature. Now you know what santau really is, stop persecuting others please.
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