Library

(Appendix: Wang Zisheng's Da Gui Shao Tang, Zhang Jiegu's Shaoyao Tang; with a discussion on Jin Kou Li [Dysentery with inability to swallow food])

Mr. Ni Hanchu's three prescriptions for treating malaria and dysentery truly reflect his extensive clinical experience and painstaking effort. They are sufficient to save lives and benefit the world, a stark contrast to Wu Keyi's hasty compilation of his book.

In diseases caused by seasonal pathogens (Shi Qi), malaria and dysentery are the most common, especially among patients in summer and autumn. Between these two diseases, malaria is milder; however, it must be treated correctly. If the treatment method is inappropriate, it can still cause significant harm. The *Neijing* [Classic of Internal Medicine] provides the most detailed discussion on malaria, yet at that time, only acupuncture was used, without herbal medicines or prescriptions. Later medical prescriptions are numerous, none more so than those for malaria. For instance, *Waitai Miyao* [Essential Prescriptions Worth a Thousand Gold] collected prescriptions from the Wei and Jin dynasties onwards, numbering over a hundred. It cites *Qianjin Fang* [Prescriptions Worth a Thousand Gold] and *Zhouhou Fang* [Handbook of Prescriptions for Emergencies], seemingly selecting the finest, almost as if passed down by immortals. Other famous prescriptions by Cui Shi and Shen Shi are too numerous to enumerate. Most claim miraculous efficacy. However, these prescriptions mostly use Chanshan [Dichroa Root] as the chief ingredient, rarely omitting it. Can modern constitutions withstand the severe vomiting induced by Chanshan? Thus, although there are many prescriptions, they are not applicable. In contrast, *Jingyue Quanshu* [Complete Works of Jingyue] focuses primarily on tonification, aiming to strengthen healthy qi and expel pathogenic factors. Unfortunately, tonification often aids the pathogen, making it harder to eliminate. A doctor in my hometown rigidly adhered to this book; upon seeing patients with malaria, he even stated he would not treat them unless they took tonifying medicine. Consequently, many died under his care. This doctor later contracted malaria himself, took tonifying medicine, and died because the pathogen could not be expelled. Although Zhang Jingyue leaned towards tonification, his prescriptions were not exclusively tonic. It was those who failed to read carefully who harmed others and themselves, which is indeed unjust! Furthermore, Ye Tianshi's *Linzheng Zhinan* [Guide to Clinical Practice] contains hundreds of prescriptions for malaria, yet uses not a single grain of Chaihu [Bupleurum Root]. Chaihu is a dispersing herb for the Shaoyang channel. Without it, there is no second choice. When malaria affects the Shaoyang, how can Chaihu be omitted? Indeed, for malaria with predominant heat, Ye's Qinghao [Artemisia Annua Herb], Biejia [Tartar Testudinis Carapax], Sangye [Morus Folium], Danpi [Moutan Cortex], Zhimu [Anemarrhenae Rhizoma], and Huafen [Puerariae Radix] can be used with modifications; but for cases with predominant cold, Chaihu is indispensable. However, because Ye Tianshi refuted Xue's statement that "malaria should not be treated with Chaihu," he subsequently never used Chaihu for malaria. To this day, people in Wu do not use Chaihu for malaria, leading to lingering, difficult-to-cure cases lasting months. Then, how can the prescriptions in *Zhinan* be relied upon!

Only Mr. Ni Hanchu's three prescriptions for malaria avoid both tonification and harsh purging/cutting. The herbs are ordinary, yet they yield miraculous effects, truly serving as the master approach for treating malaria. Among his three prescriptions, two are particularly excellent. Although the third is also good, malaria symptoms vary between cold and heat. The cold aspect may originate from the Taiyang or Yangming channels. Pathogens resolved through sweating must exit via the Yangming and Taiyang channels. Taiyang is the "head gate," Yangming is the "second gate," and Shaoyang is the "third gate." Chaihu opens the Shaoyang gate, but if the Taiyang and Yangming gates remain closed, sweat will not easily penetrate, and pathogens will not resolve. I often use his first prescription but add Qianghuo [Notopterygii Rhizoma et Radix], Fangfeng [Saposhnikoviae Radix], Gegen [Puerariae Lobatae Radix], and Baizhi [Angelicae Dahuricae Radix] to first open the Taiyang and Yangming gates. After one or two doses, I then use Chaihu, removing Qianghuo, Fangfeng, Gegen, and Baizhi. If thirst persists, Gegen is retained. Sweat penetrates thoroughly, and pathogens gradually lighten. Weilingxian [Clematidis Radix] is initially avoided; although its antimalarial effect is potent, repeated use often proves ineffective. It is reserved for the second prescription, where it often stops the attack after a single dose. I also do not use the second prescription abruptly; I wait until the malaria trend has subsided. I prepare the medicine exactly according to the formula, without any modification. After decoction, it is exposed overnight. Taken on an empty stomach early on the day of the malaria paroxysm, the malaria rarely fails to stop. These are my personal insights gained from admiring Mr. Ni's prescriptions. My descendants should remember this firmly; even beginners can then treat malaria.

Regarding the three prescriptions for dysentery, the first is the best, and its dosages should not be altered. Its subtle principles and profound discussions emphasize four taboos: avoiding warm tonification, avoiding drastic purgation, avoiding diaphoresis (sweating), and avoiding diuresis (separating turbid fluids). These are precise and undeniable, with the taboo against warm tonification being particularly crucial. Recently, I have observed fewer deaths from treating malaria but significantly more from treating dysentery. Inquiring into the causes of death, they largely stem from warm tonification. A wealthy family member in my hometown suffered from bloody dysentery, undoubtedly a heat syndrome suitable for Sanhuang Tang [Three Yellows Decoction] or adding Sheng Dihuang Tang [Raw Rehmannia Decoction]. However, the physician stuck to Zhang Jingyue's emphasis on warm tonification. The family had abundant Ginseng, so Renshen [Ginseng Radix] and Fuzi [Aconiti Lateralis Radix Praeparata] were administered repeatedly without cessation. Within nine days, the intestines and stomach rotted, and the patient died passing material resembling rotten fish intestines. How harmful is warm tonification? It must be considered a major taboo! Had they followed Mr. Ni's teachings, such recklessness would not have occurred. For over forty years, I have treated many cases of dysentery without any deaths, largely due to the influence of Mr. Ni's theories. Mr. Ni's prescriptions and discussions are few but exquisitely refined. Students of medicine should study them diligently, not failing the hidden golden needle passed down by former sages!

Ni Hanchu's First Prescription for Malaria:
Chenpi [Citri Reticulatae Pericarpium] (1 qian) Banxia [Pinelliae Rhizoma] (1 qian) Baifuling [Poria] (1 qian) Weilingxian [Clematidis Radix] (1 qian) Chaihu [Bupleuri Radix] (8 fen) Cangzhu [Atractylodis Rhizoma] (8 fen) Huangqin [Scutellariae Radix] (8 fen) Houpo [Magnoliae Officinalis Cortex] (8 fen) Qingpi [Citri Reticulatae Pericarpium Viride] (6 fen) Binglang [Arecae Semen] (6 fen) Gancao [Glycyrrhizae Radix et Rhizoma] (3 fen)

Second Prescription:
Sheng Shouwu [Polygoni Multiflori Radix] (3 qian) Chenpi [Citri Reticulatae Pericarpium] (8 fen) Chaihu [Bupleuri Radix] (8 fen) Baifuling [Poria] (8 fen) Chao Baizhu [Atractylodis Macrocephalae Rhizoma] (2 qian) Huangqin [Scutellariae Radix] (8 fen) Guishen [Angelicae Sinensis Radix] (1 qian) Weilingxian [Clematidis Radix] (1 qian) Biejia [Testudinis et Trionycis Carapax et Plastrum] (2 qian, vinegar-fried) Zhimu [Anemarrhenae Rhizoma] (2 qian) Gancao [Glycyrrhizae Radix et Rhizoma] (3 fen)
Add 3 slices of Shengjiang [Zingiberis Rhizoma Recens], one bowl of river water and one bowl of well water. Decoct to 0.8 parts. Add 0.5 parts of wine free of ash impurities. Boil a few more times. Expose overnight. Take on an empty stomach early on the day of the malaria paroxysm.

Third Prescription:
Renshen [Ginseng Radix] (1 qian) Huangqi [Astragali Radix] (1.2 qian, honey-fried)
Guishen [Angelicae Sinensis Radix] (1.2 qian) Baizhu [Atractylodis Macrocephalae Rhizoma] (1 qian) Chenpi [Citri Reticulatae Pericarpium] (8 fen) Chaihu [Bupleuri Radix] (8 fen) Shengma [Cimicifugae Rhizoma] (4 fen) Gancao [Glycyrrhizae Radix et Rhizoma] (3 fen)
Optional additions: Heshouwu [Polygoni Multiflori Radix] (2 qian) Chao Zhimu [Anemarrhenae Rhizoma] (1 qian)
Further additions: Qinghaozi [Artemisiae Annuae Fructus] (8 fen) Maiya [Hordei Fructus Germinatus] (1 qian)

Ni Hanchu's First Prescription for Dysentery: (Second and Third prescriptions not recorded)
Sheng Huanglian [Coptidis Rhizoma] (1.2 qian) Sheng Huangqin [Scutellariae Radix] (1.2 qian) Baishao [Paeoniae Radix Alba] (1.2 qian) Shanzha Rou [Crataegi Fructus] (1.2 qian) Zhiqiao [Aurantii Fructus Immaturus] (8 fen) Chunpu [Magnoliae Officinalis Cortex] (8 fen) Binglang [Arecae Semen] (8 fen) Qingpi [Citri Reticulatae Pericarpium Viride] (8 fen) Guishen [Angelicae Sinensis Radix] (5 fen) Gancao [Glycyrrhizae Radix et Rhizoma] (5 fen) Diyu [Sanguisorbae Radix] (5 fen) Honghua [Carthami Flos] (3 fen) Taoren [Persicae Semen] (1 qian) Muxiang [Aucklandiae Radix] (2 fen)
If stagnation and downward flow are severe, add Dahuang [Rhei Radix et Rhizoma] 2-3 qian.

Although Mr. Ni Hanchu's prescriptions for dysentery are exquisite, there are cases of weak constitutions suffering from dysentery with abdominal pain, tenesmus, and heaviness in the rectum. In such situations, one must employ "tong yin tong yong" [treating obstruction with unblocking methods] and cannot help but use Dahuang [Rhei Radix et Rhizoma], yet one fears the patient may not tolerate it. What then? I heard of the senior practitioner Wang Zisheng, who was quite famous for treating dysentery with great efficacy regardless of deficiency or excess. He published a book on malaria and dysentery, though it was not widely circulated. I found it in the book box of a friend named Jin. Upon reviewing it, I found his approach to malaria, based on Si Tian Sui Hui [Heavenly Stems and Earthly Branches theory applied to epidemiology], was somewhat rigid, resulting in mediocre efficacy. However, his Da Gui Shao Tang [Large Tonify Blood and Peony Decoction] for dysentery was effective. Even for patients with deficiency-type dysentery, it promoted bowel movement after one dose and cured within two to three doses. I know this prescription is derived from Zhang Jiegu's Shaoyao Tang [Peony Decoction], deeply aligning with the *Neijing*'s principle: "Moving blood allows pus and stool to heal naturally; regulating qi eliminates tenesmus." Not only can deficient patients rely on it fearlessly, but those not severely deficient also find it suitable. Therefore, when treating dysentery, I sometimes use Mr. Ni's prescriptions and sometimes Da Gui Shao Tang, achieving good results. I record them here now for future generations to select from!