Library

Nutmeg (Myristicae Semen) warms the middle jiao and promotes digestion. It stops diarrhea and treats abdominal cold pain caused by food stagnation, as well as cholera-like vomiting, hangover discomfort, and rebellious qi. For dysentery with red and white discharge and deficiency-type dysentery, it is a key herb for warming the spleen and stomach and consolidating the large intestine. Generally, the spleen favors warmth and dislikes cold, favors fragrance and dislikes foul odors. Therefore, the warmth and fragrance of Nutmeg can treat all the aforementioned conditions. Kou Zongshi stated that it is good at descending qi, but excessive use depletes healthy qi. If taken in moderation, its nature is balanced. Zhu Danxi considered it to belong to Metal and Earth, capable of warming the middle and tonifying the spleen. Ri Hua Zi claimed it descends qi because, once the spleen is tonified and transportation/transformation functions improve, qi naturally descends. This differs from the rapid purgative effects of Chenpi (Citri Reticulatae Pericarpium) or Xiangfu (Cyperi Rhizoma). Kou's failure to investigate the reality led him to believe it should not be used in large quantities, which was an error.

Rhubarb (Rhei Radix et Rhizoma) has a bitter and cold nature and is non-toxic. Also known as "General" (Jiangjun) and "Fire Root" (Huoshen). Li Dongyuan said it eliminates the old and generates the new, akin to quelling chaos to bring about peace, hence the title "General." It primarily regulates stomach qi, directs rebellious qi downward, expels blood stasis, breaks up masses and accumulations, retains fluids, removes phlegm-dampness, purges various excess heat obstructions, clears damp-heat from the three jiao, treats epigastric fullness and stuffiness, dysentery with red and white discharge accompanied by tenesmus and abdominal pain, scanty and painful urination, delirium, jaundice, and fire-toxemias such as sores. This herb acts on the blood level of the Foot-Taiyin Spleen Meridian, Hand-Yangming Large Intestine Meridian, Foot-Yangming Stomach Meridian, Hand-Jueyin Pericardium Meridian, and Foot-Jueyin Liver Meridian. Using it when the pathology is in the qi level constitutes punishing the innocent (misdiagnosis/mistreatment). Su Song noted that ancients used toxic herbs to attack disease, always adjusting according to the patient's deficiency/excess and cold/heat patterns, never using them lightly. Emperor Wu of Liang, suffering from fever, wished to take Rhubarb. Yao Shengtan said, "Rhubarb is a drastic medicine; Your Majesty is advanced in age and must not use it lightly." The Emperor did not listen and nearly became prostrate. Emperor Yuan of Liang often suffered from heart and abdominal ailments. All physicians suggested using mild medicines to gradually promote circulation. Yao Shengtan said, "The pulse is surging and excess; this indicates retained food stagnation. Without Rhubarb, there is no hope of recovery." The Emperor agreed and recovered. From this, we see that modern physicians sometimes use one toxic herb to attack various diseases; if it occasionally works, they claim the prescription is miraculous, but if it fails, they do not admit the error in medication. Should one not be wary?

Xue Ji's medical records state: Pan Guan Wang Tianxi, over sixty years old, suffered from dysentery with abdominal pain and tenesmus, thirst with desire to drink, and inability to eat. He was prescribed Shaoyao Decoction (Peony Decoction) with one liang of Rhubarb. After four doses, there was slight improvement. The same prescription was continued with half the dose of Rhubarb, and after several doses, he recovered. Such patients have only one or two parts of their original vital energy remaining. Li Zhongzi, while advocating warm tonification in treating diseases, nevertheless applied drugs according to the condition and never abandoned purgative methods. Ge Kejiu possessed extraordinary martial prowess. Due to pulling a heavy bow, he suffered internal injury. The treatment involved eight liang of Rhubarb. His son, fearing the harshness, secretly halved the dose. The illness was not fully resolved. Ge questioned him carefully and discovered the reason, stating, "I will die next year." Indeed, he died at that time. This illustrates that one cannot generalize that toxic herbs need only be reduced by half, depending on the severity of the illness.

In the Wuyin year of the Chongzhen era, I was staying in Bianliang and treated a palace maid for postpartum hiccups. She mentioned her husband, in his prime, suffered from malaria, dysentery, and regurgitation. Despite extensive treatment, he did not recover and believed he would not survive. A herbalist skilled in pulse diagnosis administered five doses consecutively, using seven liang of Rhubarb, after which he could finally eat. Another ten-plus doses were given, totaling approximately one jin of Rhubarb, and the previous symptoms gradually resolved. Later, he took Gutan Wan (Phlegm-Purging Pills) daily and fully recovered within twenty days. Over the next year and a half, he fathered five sons and lived to ninety-three years before passing away. Such constitution is rare in the southeast.

In the summer of the Jiashen year, my cousin's nephew, Zhong Zhongzhang, asked me to treat his ancestor who had built a house during the hot season. The ancestor sweated heavily from labor and caught cold. A physician prescribed exterior-releasing herbs with one qian of Rhubarb. Before the decoction was finished, the patient became mentally exhausted and severely nauseous/vomiting. Another physician, Mao Fuyang, was consulted and prescribed appropriate herbs, which were not incorrect, but the stomach qi was already damaged, so recovery was slow. I used Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction) with modifications. After several doses, he gradually improved, but relapsed with slight exertion, taking three months to fully recover.

Observing Zhang Zhongjing's principles in Chengqi Decoctions (Gastrointestinal Purging Formulas) from Shanghan Lun, they should only be used when Taiyin, Shaoyin, or Jueyin interior syndromes present with dryness, fullness, excess, and hardness simultaneously. How can one rashly administer these for Yangming exterior syndromes? Does this not violate the warning: "In cases of yin excess and yang deficiency, sweating leads to cure, but purgation leads to death"? Especially in cases of fatigue-induced cold damage. Generally, herbs with extreme cold or hot natures, which are not of the harmonious superior grade, require careful consideration and should not be used recklessly.