Formulas · Transform Dampness 化濕 · Uihak Immun (醫學入門)

Old Malaria Pill

Nohak-hwan

한글 노학환 · Pinyin Lao Nue Wan

老瘧丸

The leaf gives the composition only by reference to the Sipjanggun-hwan (十將軍丸) printed immediately above it in the chapter: 與上十將軍丸同, 而常山ㆍ草果各二兩, 餘八味各一兩 — the same as that formula, but with dichroa and tsaoko at 2 nyang each and the remaining eight drugs at 1 nyang each. The eight are read off that leaf, which is registered here as sipjanggun-hwan, and the whole list is entered above; the preparation and the dosing are likewise 幷同上, the same as that formula's.

Composition 構成

Sangsan Chang Shan
常山 상산 · Dichroa Root (toxic)

80 g
Chief 君

steeped overnight in a bowl each of wine and vinegar, then simmered dry over charcoal; toxic
Chogwa Cao Guo
草果 초과 · Tsaoko Fruit

80 g
Deputy 臣

steeped and simmered with the dichroa
Sain Sha Ren
砂仁 사인 · Amomum

40 g
Assistant 佐
Billang Bing Lang
檳榔 빈랑 · Areca Seed

40 g
Assistant 佐
Samneung San Leng
三稜 삼릉 · Sparganium

40 g
Assistant 佐
Bongchul E Zhu
莪朮 봉출 · Zedoary

40 g
Assistant 佐
Cheongpi Qing Pi
靑皮 청피 · Green Tangerine Peel

40 g
Assistant 佐
Jinpi Chen Pi
陳皮 진피 · Aged Tangerine Peel

40 g
Assistant 佐
Omae Wu Mei
烏梅 오매 · Mume Plum

40 g
Assistant 佐
Banha Ban Xia
半夏 반하 · Pinellia

40 g
Assistant 佐

processed

Total 480 g per packet (첩) · representative dosage — verify against source texts.

Received this formula from your practitioner? Amounts shown here are classical reference values — granule and prepared products differ. Always follow your prescribed dosage and directions.

Actions 效能

Cuts short the paroxysm of a long-standing malaria
Breaks up the mass in the abdomen left behind by it

Indications 主治

Pattern-based

Intermittent malaria (痎瘧) long uncured
Abdominal pain with a malaria mother (瘧母) palpable in the abdomen
Old malaria (老瘧) with a hardened accumulation

Biomedical correlates

Malaria
Splenomegaly in chronic malaria
Relapsing febrile illness with periodic chills and fever

Source text 原文

Donguibogam 東醫寶鑑

治痎瘧久不差, 腹痛有母. 與上十將軍丸同, 而常山ㆍ草果各二兩, 餘八味各一兩. 劑法ㆍ服法幷同上. 《入門》

Translation

Treats intermittent malaria long uncured, with abdominal pain and a malaria mother present. The same as the Sipjanggun-hwan above, except that dichroa and tsaoko fruit are 2 nyang each and the remaining eight ingredients 1 nyang each. The method of compounding and the method of taking are both the same as above. — Immun 入門 (Donguibogam · Haehak)

Clinical commentary 臨床

Not a formula in its own right but a reweighting of the one above it. Sipjanggun-hwan — the Ten Generals Pill — puts ten drugs at equal weight; Nohak-hwan doubles dichroa and tsaoko fruit and leaves the other eight where they were, so the pill turns from a balanced paroxysm-cutter into one led from the front by its two most forceful ingredients. The indication explains the change. 腹痛有母 — abdominal pain with a mother present — is the chapter's phrase for the palpable mass that long malaria leaves in the left flank, which in modern terms is a malarial spleen. A formula aimed at that needs more weight behind it than one aimed at the fever alone, and doubling the two leading drugs is the simplest way the tradition has of saying so. **Contains dichroa at 2 nyang, which is emetic and hepatotoxic. This must not be prepared.** Only the two reweighted drugs are registered here; the other eight belong to the parent formula, which this leaf names but does not list. Splenomegaly in a patient with relapsing fever needs imaging and a parasitological diagnosis, and a malarial spleen carries a real risk of rupture. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.