Unfolding impossibly from beneath voluminous robes, this creature’s pockmarked, spindly arms end in clusters of narrow spikes. Its long, hollow, needle-like fingers and its many-jointed arms move with surprising speed and strength for such an emaciated creature.

Hunched and Robed. The cambium skulks through mortal society, hunched and contorted, concealing its nine-foot height and its supernumerary arms.

Devours Bodily Humors. The source of a cambium’s interest lies in every mortal body: the four humors, which it drains in precise amounts, sometimes to fix its own imbalances, sometimes to concoct serums meant for sale in hellish markets. Its victims are left in a desperate state, eager for a corrective fix and willing to obey the cambium’s every whim as servants and toadies.

Abandons Victims. After a sufficient crop has been harvested, the cambium abandons these addicts to die slowly from violent withdrawals, and allows the local population to lie fallow for a decade or so.

Cambium

Large fiend, neutral evil
Armor Class 19 (natural armor)
Hit Points 264 (23d10 + 138)
Speed 40 ft.

STR	DEX	CON	INT	WIS	CHA
21 (+5)	16 (+3)	23 (+6)	17 (+3)	16 (+3)	18 (+4)

Saving Throws Dex +8, Con +11, Int +8, Wis +8, Cha +9
Skills Arcana +8, Deception +9, Insight +8, Medicine +8, Perception +8, Stealth +8
Damage Immunities poison
Condition Immunities exhaustion, poisoned
Senses darkvision 60 ft., passive Perception 18
Languages Common, Draconic, Infernal
Challenge 14 (11,500 XP)

Innate Spellcasting. The cambium’s innate spellcasting ability is Charisma (spell save DC 17, +9 to hit with spell attacks). The cambium can innately cast the following spells, requiring no material components:
Constant: levitate
At will: alter self, detect thoughts, hold person, plane shift, spare the dying
3/day: cure wounds 21 (4d8 + 3), ray of sickness 18 (4d8), protection from poison, heal
1/day: finger of death

Actions

Multiattack. The cambium makes four needle fingers attacks.

Needle Fingers. Melee Weapon Attack: +10 to hit, reach 10 ft., one target. Hit: 21 (3d10 + 5) piercing damage. In addition, the target must make a DC 19 Constitution saving throw; if it fails, the cambium can either inflict Ability Damage or Imbalance Humors. A target makes this saving throw just once per turn, even if struck by more than one needle fingers attack.

Ability Damage (3/Day). When the target of the cambium’s needle fingers fails its Constitution saving throw, one of its ability scores (cambium’s choice) is reduced by 1d4 until it finishes a long rest. If this reduces a score to 0, the creature is unconscious until it regains at least one point.

Imbalance Humors (3/Day). When the target of the cambium’s needle fingers fails its Constitution saving throw, apply one of the following effects:

• Sanguine Flux: The target cannot be healed—naturally or magically—until after their next long rest.
• Choleric Flux: The target becomes confused (as the spell) for 3d6 rounds. The target can repeat the saving throw at the end of each of its turns to shrug off the flux before the duration ends.
• Melancholic Flux: The target is incapacitated for 1d4 rounds and slowed (as the spell) for 3d6 rounds. The target can repeat the saving throw at the end of each of its turns to shrug off the flux before the duration ends.
• Phlegmatic Flux: A successful DC 18 Constitution saving throw negates this effect. A failed saving throw means the target gains one level of exhaustion which lasts for 3d6 rounds.