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(Venomous Herb) Induces Vomiting to Expel Malaria Phlegm and Fluid Retention in the Epigastrium

Changshan (Dichroa Radix, 常山) (Specifically enters the epigastric region.) Bitter and acrid in flavor, cold in nature. Toxic. Its function is specifically to induce vomiting and promote water metabolism. It is a crucial herb for eliminating stubborn phlegm and fluid retention associated with malaria. Generally, malaria invariably involves phlegm, which forms accompanied by heat. However, there are distinctions among wind-phlegm, cold-phlegm, food-stagnation phlegm, and qi-phlegm. (Wind-phlegm is suitable for processing with Acori Tatarinowii Rhizoma, Tian Nan Xing, and Aconiti Lateralis Radix Praeparata, Zhi Wu Tou; cold-phlegm is suitable for Ginger, Gan Jiang, and Aconiti Radix Praeparata, Zhi Fu Zi; heat-phlegm is suitable for Fritillariae Cirrhosae Bulbus, Bei Mu; food-stagnation phlegm is suitable for Crataegi Fructus, Shan Zha and Malt, Shen Qu; qi-phlegm is suitable for Linderae Radix, Wu Yao. If phlegm is located above the diaphragm and in the meridians, it cannot be resolved without inducing vomiting; if phlegm is located in the skin and between the muscles of the four limbs, it cannot reach these areas without Ginger Juice, Jiang Zhi and Asparagi Rhizoma, Zhu Li; if phlegum is located in the hypochondrium, it cannot be eliminated without Brassicae Semen Album, Bai Jie Zi; if phlegm is in the joint spaces causing difficulty in walking, it cannot be dispelled without Dioscoreae Hypoglaucae Rhizome, Bi Xie and Sophorae Flavescentis Radix, Ku Shen; if phlegm causes soreness and pain in the arms, shoulders, and back, it cannot be harmonized without Dao Tan Tang plus Curcumae Longae Rhizoma, Jiang Huang, Aucklandiae Radix, Mu Xiang, and Cinnamomi Ramulus, Gui Zhi; if phlegm-solidification exists in the intestines and stomach, it cannot be cured without using purgatives.) Treatment must determine the method based on differentiation of yin and yang, deficiency and excess, exterior and interior. For instance, if malaria results from Cold Damage (Shang Han) with alternating chills and fever, or due to seasonal warm pathogens and epidemics, leading to yellow saliva accumulating in the chest and firmly resisting resolution in the epigastrium, then this herb should be used to induce vomiting. However, it must only be employed after releasing the pathogenic factors from the exterior and drawing the pathogen out from the Yang level. The administration should also consider the specific site of the lesion and the coordinating and guiding properties of accompanying herbs. For example, when Changshan is combined with Glycyrrhizae Radix et Rhizoma, Gan Cao, it induces vomiting, making it suitable for fluid retention in the Upper Jiao. When combined with Mume Fructus, Wu Mei and Pangolin Scales, Chuan Shan Jia, it enters the Liver channel, suitable for fluid retention in the hypochondrium. When combined with Rheismi Radix et Rhizoma, Da Huang, it promotes urination/drainage of water, suitable for internal excess formed by the intermingling of evil heat. When combined with Tritici Semen, Xiao Mai and Bambusae Folium, Zhu Ye, it enters the Heart. When combined with Milii Glutinis Semen, Shu Mi and Ephedrae Herba, Ma Huang, it enters the Lung. When combined with Draconis Os, Long Gu and Aconiti Radix Praeparata, Zhi Fu Zi, it enters the Kidney. When combined with Amomi Fructus Rotundus, Cao Guo and Arecae Semen, Bing Lang, it enters the Spleen. However, this is a venomous herb of Yin nature, with a fierce and violent character. Although it has the ability to break through miasma and drive out fluid retention, it ultimately damages the True Qi. Therefore, Zhang Zhongjing never included this herb in his formulas for treating malaria. (The Classic says: When Taiyin governs the lower heaven, dampness prevails as the excessive influence, and the people suffer from fluid accumulation diseases. It also says: In years where Earth energy is excessive, rain and dampness circulate widely, and severe cases result in the onset of fluid diseases. Generally, there are five types of fluid retention: those flowing into the Lung are called Branch Fluid (Zhi Yin); those remaining in the Liver are called Suspended Fluid (Xuan Yin); those hidden in the Heart are called Hidden Fluid (Fu Yin); those overflowing into the meridians are called Overflowing Fluid (Yi Yin); and those staying in the intestines and stomach are called Phlegm-Fluid (Tan Yin).) Furthermore, summer injury by heat leads to severe malaria in autumn. For malaria affecting the Three Yin channels, or in individuals with deficient and cold Yuan Qi, herbs like Changshan become harmful like halberds. One might ask: There are many emetic herbs, why must Changshan and Shuqi be used for malaria? This is because Changshan possesses the property of expelling epidemic pathogens, and since malaria originates from damp-epidemic pathogens, Changshan and Shuqi are appropriate. Just as Genggenis Rhizoma, Gua Di, Aconiti Lateralis Radix, Wujian, Aconiti Radix, Fuzi Jian, Raphani Semen, Laifuzi, and Veratrum Viride, Lilü, are all emetics, yet Gua Di is only suitable for heat-phlegm, Wujian and Fuzi Jian are only suitable for damp-phlegm, Laifuzi is only suitable for qi-phlegm, and Lilü is only suitable for wind-phlegm. Use after soaking in wine and stir-frying. The root is Shuqi, with similar functions. However, the leaves have a light and ascending nature, making them more suitable for treating pathological accumulations in the Upper Jiao.