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Luo Qianfu, in the Jihai year of the Zhiyuan era, treated Wang Qianhu from Liantai. The patient was forty-five years old and led troops to garrison Lianshui. This area was low-lying and damp. Due to excessive labor and irregular diet, by late autumn, malaria (Nüe Ji) and dysentery (Li Ji) occurred simultaneously and persisted for over a month without resolution. Appetite was completely lost, and the body became emaciated and weak. By mid-winter, he returned home while still ill. Dr. Luo’s pulse diagnosis revealed a string-taut (Xian) yet faint pulse, as thin as a spider’s thread. The body felt heavy, hands and feet were cold and reversed, numbness occurred intermittently, and the skin presented with crusts and scabies resembling leprosy. He lacked the strength to move. There was epigastric and abdominal fullness and distension, accompanied by incessant vomiting. These were all manifestations of Cold-Damp pathogenic factors. The disease had lingered for a long time, depleting True Qi (Zhen Qi), resulting in insufficiency of both form and Qi, as well as an insufficiency of pathogenic factors. The *Classic of Acupuncture* (*Zhen Jing*) states: "When both Yin and Yang are insufficient, acupuncture is not suitable; moxibustion is appropriate." The *Inner Canon* (*Nei Jing*) states: "For deficiency, apply tonification; for exhaustion, apply warming." The *Ten Categories of Medicinals* (*Shi Ji*) states: "Tonification can remove weakness." First, Li Zhong Tang (Regulate the Middle Decoction) with added Fuzi (Prepared Aconite Root) was used to warm and nourish the Spleen and Stomach, dispersing Cold-Damp. "Astringency can prevent collapse," so Yang Zang Tang (Nourish Viscera Decoction) with added Fuzi was used to consolidate the intestines and stop diarrhea and dysentery. Moxibustion was applied to various acupoints to eliminate the pathogens simultaneously. The Classics state: "The Hui-Point of the Fu organs is Tai Cang, which is Zhongwan (CV12)." Initially, five to seven moxa cones were burned to warm and nourish the Qi of the Spleen and Stomach, promoting appetite. Next, one hundred moxa cones were burned at Qihai (CV6) to generate Yuan Qi (Original Qi) to nourish all vessels and fill the muscles. Then, Zusanli (ST36), the He-Sea point of the Stomach meridian, was moxibusted with three times seven cones to guide Yang Qi downward into the Yin aspect, further assisting Stomach Qi. Subsequently, Yangfu (GB38) was moxibusted with fourteen cones to connect Yang Qi, warming the lower legs and dispersing Cold-Damp pathogens. After more than a month, the pathogenic factors were eliminated, and spirit and vitality returned to normal.

Yu Zhen commented: Treating deficiency-type malaria and dysentery with warming, tonifying, and astringent methods often yields slow results. When combined with various moxibustion techniques, the efficacy of Renshen (Ginseng Root) and Fuzi is doubled.

In cases of critical illness, one should emulate Hua Borén’s treatment of a woman in her fifties who suffered from malaria, alternating chills and fever, violent vomiting, central fullness and pain, diarrhea, inability to eat, and extreme debility. Medical treatments had failed. Hua Borén diagnosed her pulse as deep (Chen) and slow (Chi). He stated: "This is summer-heat and food retention, with phlegm-fluids stagnating in the middle. Purging is indicated." Someone asked: "The patient is this exhausted, and has diarrhea with anorexia; how can purging be used?" They originally planned to administer Renshen and Fuzi. Hua Borén said: "Although the pulse is deep and slow, it is forceful upon pressure. Although there is diarrhea, there is tenesmus. If not purged, the accumulation cannot be removed, and the disease will not resolve." He then administered Xiao Zhi Wan (Eliminate Stagnation Pills), which produced mild bowel movement, bringing slight relief. On the second day, another dose was given, expelling all accumulated fecal matter. By noon, she desired food. She was subsequently regulated with a mild, permeating, and harmonizing decoction containing Shengjiang (Fresh Ginger Rhizome), Juhua (Tangerine Peel), Renshen, and Fuling (Poria). She recovered within ten days.

Yu Zhen commented: This case of malaria and dysentery complicated by vomiting was cured using digestive-promoting herbs, contrasting with cases cured solely by diaphoretic herbs, representing two major approaches. However, one must focus on "central fullness and pain" and "deep, forceful pulse" to understand that the pathology is interior rather than exterior.

Dong Zongbo of Nanxun had a servant named Ma Chu who fell ill in early July. After twenty-plus days, the condition worsened. Symptoms included severe alternating chills and fever; feeling so cold he did not fear entering the stove, and so hot he did not fear jumping into the well. Dysentery with red and white discharge occurred eighty to ninety times daily. Abdominal pain, nausea, and extreme mental fatigue were present. At that time, Sun Dongsu was staying at Dong Zongbo’s residence. Asking about previous physicians' pulse diagnoses, a guest remarked: "The pulse is inauspicious. In dysentery, a洪大 (Huge and Large) pulse indicates death, while a细微 (Fine and Minute) pulse indicates survival. The current huge pulse is a counter-indication." Sun Dongsu replied: "While a huge pulse is indeed contraindicated in dysentery, alternating chills and fever are also not typical for a fine/minute pulse. There must be a cause. Let us examine him." The patient’s face was slightly red, and sweat poured down. Upon investigating the etiology, he explained that due to many visitors, the kitchen was dry and hot, and he had consumed excessive melons, water chestnuts, and lotus roots. That night, he drank excessively and engaged in sexual activity, sleeping under the eaves. The next day, chills, fever, abdominal pain, and dysentery began. Although the history was clear, the treatment strategy was difficult to harmonize. After deep contemplation, Sun told Dong Zongbo: "I have a sudden insight; this is a 'back-to-the-river battle' strategy." The prescription consisted of Renshen, Baizhu (Atractylodes Macrocephala Rhizome), Shigao (Gypsum Fibrosum), Huashi (Talcum), each 5 qian; Zhimu (Anemarrhena Rhizome), Paojiang (Processed Ginger Rhizome), each 3 qian; Dafuzi (Large Prepared Aconite Root), Zhi Gancao (Honey-fried Licorice Root), each 2 qian. This large dose was decocted and taken. If sleep followed, Yin and Yang would begin to harmonize. Harmonization would allow sweat to收敛 (consolidate), stopping chills, fever, vomiting, and nausea. By night, dysentery reduced by half, sweating and vomiting ceased entirely, and the pulse consolidated. A second formula used Renshen, Baizhu, Baishao (White Peony Root), Shigao, and Huashi, each 3 qian; Paojiang, Rougui (Cinnamon Bark), and Zhimu, each 2 qian; Zhi Gancao and Fuzi, each 1 qian. After ingestion, malaria stopped, dysentery halved again, diet improved, and spirit revived. The formula was modified to use Jiuchaobaishao (Wine-fried White Peony Root) 5 qian, removing Shigao and Fuzi, reducing other herbs by 1 qian each. Three doses resulted in complete recovery. The guest asked: "You used both cold and hot herbs. What syndrome is this? What is the name of the formula?" Sun Dongsu replied: "This is what Hua Gong called Hundun Tang (Chaos Decoction). The Classic states: 'Summer injury by summer-heat leads to malaria and dysentery in autumn.' Baihu Tang (White Tiger Decoction) and Yiyuan San (Benefit Origin Powder) are all summer-heat resolving agents. Cold melons and fruits injured the Middle Qi; alcohol and sexual excess damaged the Lower Yuan. Thus, Fuzi Lizhong Tang was combined to warm the middle and tonify the lower. If you doubt the simultaneous use of cold and hot herbs, consider Zhang Zhongjing’s Fuzi Xie Xin Tang, where Dahuang (Rhubarb Root), Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), and Fuzi are used together. How do you explain that? It is essentially false addressing false, and true addressing true."

Yu Zhen commented: Ancient formulas frequently combine cold and hot herbs, such as Zhang Zhongjing’s Five Xie Xin Tangs, Huanglian Tang, Wumei Wan, and Mahuang Shengma Tang, which are ancestors to later formulas like Lianli Tang and Zuojin Wan. Examining their principles: Xie Xin Tang uses the bitterness of Huangqin and Huanglian to drain Pi-re (epigastric heat) and the pungency of Jiang and Banxia to disperse knot-Qi; this is "treating cold with heat." Huanglian Tang replaces Chaihu with Guizhi, Huangqin with Huanglian, and Shengjiang with Ganjiang, analogous to Yu Jiyang’s description of modifying Xiao Chaihu Tang to harmonize exterior and interior, serving as a method to unblock upper and lower. Wumei Wan addresses the Jueyin channel, which is Yin in substance but Heat in manifestation, thus using the pungent-hot of Jiang and Fuzi assisted by the bitter-cold of Lian and Bo. Ke Yunbo cites the Classic: "Subdue the dominant factor and address the primary cause first." Mahuang Shengma Tang combines Zhimu and Shigao with Mahuang, Guizhi, and Ganjiang, following the pattern of Yebipao Tang. The addition of Danggui, Baishao, Fuling, Baizhu, Tiandong, and Yuzhu addresses pathogen sinking into Jueyin, Cold stagnation with Heat entrapment, and fluid depletion caused by harsh purgatives; thus, pungent-warm ascending-dispersing herbs are used to expel pathogens, necessitating cool-moistening herbs to counteract dryness. Zhang Zhongjing’s formulas possess profound spiritual essence; they are far superior to Hundun Tang’s indiscriminate clearing of summer-heat and restoration of Yang. Citing Fuzi Xie Xin Tang as evidence ignores that Dahuang, Huangqin, and Huanglian are steeped in boiling water, while Fuzi is separately boiled for juice; this prioritizes strong Yang consolidation as the sovereign herb, with heat-draining as the assistant. The methodology is rigorous. Jie’an inherited this idea, creating Huiyang Fanben Tang, using Laicha (Aged Tea), Huanglian, and Dizhang (Earth Slurry) as guides for Renshen Sini Tang, which is appropriate. How can one杂乱 (clumsily) combine Renshen, Baizhu, Guizhi, Fuzi, Paojiang with Zhimu, Shigao, and Huashi? This is like merging three theater troupes into one, performing Pipa Ji, Qianjin Ji, and Shagou Ji simultaneously on stage—is this logical? Re-examining Zhang Zhongjing’s Yangdan presentation: cold extremities, dry throat, calf cramping, and delirium represent mixed cold and heat. Yet, Guizhi Jia Fuzi Tang was given first, increasing Guizhi to induce sweating. Although Yangming interior binding caused delirium and agitation, Ganjiang Gancao Tang was drunk next to restore Yang and warm the feet. Only then was Shaoyao Gancao Tang given to extend the legs, followed by Chengqi Tang to stop delirium. Between sequence and urgency, not confused by the disease, and adhering to rhythm, one earns the title of "Immortal Hand." If Mr. Sun faced this, he would likely mix four formulas into one decoction, mocking Zhang Zhongjing’s arduous step-by-step approach. However, I record this because the book claims miraculous efficacy, so I preserve his theory tentatively.

Mr. Sun’s original case note adds: "Excess refers to pathogenic excess, addressed by Baihu Tang and Yiyuan San. Deficiency refers to Zheng Qi (Upright Qi) deficiency, addressed by Lizhong Tang." Now examining this formula’s dosage, it strictly follows the Shaoyin channel method for Yin Excess repelling Yang. If summer-heat truly existed, could 5 qian of Shigao and Huashi achieve efficacy alongside large doses of Renshen, Baizhu, Jiang, and Fuzi? The case records a huge pulse but omits whether it is forceful or not, nor does it mention thirst, tongue coating, or urination. Why boldly use warming and tonifying? If dysentery with red/white discharge, abdominal pain, nausea, red face, profuse sweating, and severe chills/fever confirm summer-heat pathology, warming and tonifying is fundamentally contrary. If efficacy is achieved, it confirms deficiency-cold. The minute amounts of Zhimu and Shigao act like Baitong Tang plus human urine and pig bile. One must not invoke "summer-heat" to confuse the issue. Moreover, after twenty days, deficiency-cold would have already depleted Yang. Can one wait for Mr. Sun’s medication...

Furthermore, Yu Tianmin treated a woman with epidemic disease by combining three formulas into one, called Sanhe Tang, merely adding cold-purgative herbs to blood-invigorating herbs—a different approach altogether, unrelated to Hundun Tang. The name Hundun Tang originates from *Baiyun Ji*, where Hua Borén treated Chen Boying for lung Qi scorching and fullness. He explained: "Illness stems from excessive worry and drinking, exhausting Ying and causing mental strain, accumulating phlegm-fluids internally, and contracting Wind externally. Attacks manifest as wheezing, coughing with phlegm, and unrest." He prescribed a bitter-pungent formula to clear Lung, drain fullness, descend Fire, and moisten dryness. After taking it, the patient recovered. When asked for the source and name, Hua replied: "It is Hundun Tang." However, observing its formulation principle, it is truly not chaotic, unlike Mr. Sun’s actual chaos.

He also treated Jin Daquan’s malaria complicated by dysentery, occurring forty times daily. Severe lower abdominal pain, profuse sweating during defecation, tenesmus, painful/difficult urination, headache, thirst, afternoon fever subsiding at dawn. Left pulse: floating, string-taut, rapid. Right pulse: weak. Middle: slightly slippery. This resulted from internal dietary injury and external Wind contraction. First, Chai Ling Tang was given for one dose; urination cleared, pain ceased. During malaria attacks, chills predominated over fever. At night, Renshen Baidu San (Ginseng Detoxication Powder) was given, removing Qianghuo and Duhuo, adding Gegen (Kudzu Root), Fangfeng (Saposhnikovia Root), Guizhi, and Baishao. The next day, headache and dysentery decreased; nocturnal visits dropped to three. Modified to Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with wine-fried Huangqin, Guizhi, and Baishao. That night, malaria stopped, leaving only slight fever. Changed to Weifeng Tang (Stomach Wind Decoction): Renshen, Baizhu, Guipi (Cinnamon Bark), each 2 qian; Baishao 4 qian; wine-fried Huangqin and Huanglian, each 1 qian; Danggui, Fuling, Chuanxiong as assistants; Paojiang and Diyu (Sanguisorba Root) as guides. After ingestion, chills and fever vanished; nocturnal visits reduced to once. Guizhi was removed from the previous formula. After several doses, he recovered and left bed.

Yu Zhen commented: This case’s prescription is appropriate and excellent, worthy of emulation. Consider Wang Jin Tan treating Prefect Liu Rongchuan, who suffered from malaria and profuse diarrhea in late autumn. Wanting to eliminate one ailment quickly, he used Ju Fang Shuangjie Yinzi (Official Formulation Double-Resolution Decoction), curing both diseases with one dose, appearing even more miraculous. This derives from Danliao’s principle of using one cold and one hot herb, half-cooked and half-raw, to separate and benefit Yin and Yang. However, I privately reflect that for concurrent malaria and dysentery at onset, exclusively using diaphoretics like Qianghuo, Fangfeng, Chaihu, and Gegen, assisted by Chifuling and Shenqu, adding Dangguishen and Chuanxiong for bloody dysentery, and adding Houpo if the right Guan pulse is large, to lift Fu-pathogens to the channels for exterior resolution, is the most rapid method. If ineffective, assess Cold or Heat involvement and use exterior-interior dispersion. For Heat, remove Qianghuo/Fangfeng, add Huangqin, Huanglian, Xiangru, and Huashi. For Cold, remove Chaihu/Gegen, add Guizhi and Ganjiang. Severe Heat usually indicates Excess; wind herbs are unsuitable. Use Daxiehu Tang with Huanglian and Huashi. Severe Cold usually indicates Deficiency; wind herbs should be avoided. Use Zhenwu Tang with Guizhi and Renshen. This remains an exterior-interior dual resolution method. Regarding Renshen Baidu San and Buzhong Yiqi Tang, these are exterior herbs for deficiency. Lizhong Tang and Bawei Wan are interior herbs for deficiency. Exterior deficiency with Heat: Xiao Chaihu Tang. Interior deficiency with Heat: Lianli Tang. Exterior deficiency with Cold: Mahuang Fuzi Xixin Tang. Interior excess with Cold: Wenpi Tang. By matching pulse and symptoms to these methods, success is assured. In this case, the weak right pulse indicates deficiency; chills exceeding fever in malaria also indicate deficiency. Hence, Renshen was used in the second dose. Given profuse sweating, removing Qianghuo and Duhuo from Baidu San and adding Guizhi and Baishao was correct. Adding Gegen and Fangfeng, however, seems excessive.