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In the month of May in the Dingwei year, Xing Yuanhui, a fellow townsman, contracted Shanghan (Cold Damage). He presented with alternating chills and fever (Wanglai Hanre), oppression in the epigastrium, and a white, slippery coating on the tongue. I said: A slippery coating on the tongue can indicate several patterns. There are cases where both Yin and Yang pulses are tight, accompanied by nasal discharge; there are Zang-Jie (Organ Binding) patterns that are incurable; there are Wen-Nue (Warm Malaria) with heat in the Dantian; and there are Yangming patterns with hardness under the hypochondrium. This case belongs to Yangming disease. It is appropriate to first induce vomiting with Zhizi Tang (Gardenia Decoction), followed by Xiaochaihu Tang (Minor Bupleurum Decoction). After a few days, he recovered through sweating.

Zhang Shimei from Suiyang contracted Shanghan for seven or eight days. His mouth was dry, and he desired water but could not swallow it. Soon after, he suffered an epistaxis (nosebleed). His pulse was floating and tight, and his body was hot. The physician stated this was Shanghan; according to the principle that "if one should sweat but does not, leading to epistaxis," it belongs to Mahuang Tang (Ephedra Decoction). I said: No. Although ancients stated that when sweating is indicated but not performed, heat transforms into blood, there are cases where sweating is contraindicated. Zhang Zhongjing stated: In Yangming disease, if the mouth is dry and the patient desires water but cannot swallow, epistaxis will inevitably occur. One who frequently suffers from epistaxis must not be induced to sweat. If sweating is forced, it leads to sunken forehead, insomnia, and inability to see clearly. This case should only be treated with Xijiao Tang (Rhinoceros Horn Decoction) and Dihuang Tang (Rehmannia Decoction). Had Mahuang been used at that time, it would certainly have resulted in sunken forehead, fixed gaze, and insomnia.

Dong Qixian contracted Shanghan for several days. Pain between the two hypochondria and around the umbilicus was unbearable. Someone attempted to treat it as Ben-Tun (Running Piglet). Upon examination, I said: Incorrect. The Shaoyang Gallbladder Meridian circulates along the hypochondrium and enters the ear. Pathogenic factors in this meridian cause mental irritability, frequent vomiting, thirst, alternating chills and fever, silence with loss of appetite, and fullness and oppression in the chest and hypochondrium. These are Shaoyang syndrome characteristics. Initially, the Taiyang pattern transmitted to this meridian, hence these symptoms. Zhang Zhongjing stated: If Taiyang disease is unresolved and transmits to Shaoyang, presenting with hypochondriac fullness and dry retching, Xiaochaihu Tang (Minor Bupleurum Decoction) is the primary formula. After three doses, the pain ceased, and subsequent sweating led to resolution.

My friend Kong Yanfu contracted Shanghan. He had high fever, headache, spontaneous sweating, and aversion to heat. This is a Yangming syndrome. This gentleman neglected proper care; while the illness remained, he exposed himself to wind to cool off for comfort. Half a month later, chills and fever occurred violently and alternately. Upon re-examination, it had transformed into a Huai-Bing (Damaged Disease) known as Wen-Nue (Warm Malaria). Zhang Zhongjing stated: If more than thirteen days pass and one contracts different pathogenic factors, transforming into another disease, it should be treated according to the damaged disease patterns. If the pulse is vigorous in all positions (Yin and Yang), and one contracts cold again, transforming into Warm Malaria, the treatment follows standard methods, such as Xiaochaihu Tang (Minor Bupleurum Decoction) modified with Guizhi (Cinnamon Twig). He recovered.

Commentary: I once saw a scholar posting malaria prescriptions in shops in Suiyang market, mostly involving Chaihu (Bupleurum) and Baihu Tang (White Tiger Decoction). Laypeople, without distinguishing the type of malaria, routinely used these formulas, often worsening the condition into severe illness. Alas! Intending to save people, yet harming them—is this reasonable? I have often said that malaria encompasses many types: Summerheat Malaria, Food Stagnation Malaria, Spleen-Cold Malaria, etc. Malaria can affect the Three Yin and Three Yang meridians of the hands and feet, and also the Spleen, Lung, Kidney, Liver, Heart, and Stomach. They differ significantly; how can one uniformly apply Chaihu Tang and Baihu Tang? Misdiagnosis allows for discussion, but Spleen-Cold and Summerheat syndromes are particularly critical, akin to fire and water clashing. The Suwen states: "Summer injury by summerheat leads to malaria in autumn." It also says: "If summer heat causes no sweating, Wind-Malaria forms in autumn." Initially, due to latent summerheat, it manifests upon receiving autumn Qi. Thus, it presents with heat preceding chills, or more heat than chills, dizziness, head pain, and trembling when deficient, stopping after a bout of sweating. The Heart dislikes summerheat. As the Sovereign Organ, the Heart does not directly accept pathogens; rather, phlegm-fluids accumulate in the Pericardium. Summerheat lies hidden within these fluids. How can this be dispelled by the acrid-warm herbs like Houpo (Magnolia Bark) and Caoguo (Tsaoko Fruit) used for Spleen-Cold, or stopped by Chaihu (Bupleurum) and Huangqin (Scutellaria Root) for Warm Malaria? Such cases require substances like Pishuang (Arsenic Trioxide), Bingpian (Borneol), and Shexiang (Musk) to penetrate. Therefore, patients with Summerheat Malaria and Spleen-Cold are common, yet physicians fail to recognize them, recklessly administering cold medicines. The True Qi is injured first, causing the illness to linger. I have meticulously studied malaria; one must examine carefully before prescribing. My success rate has been ten out of ten. While others find malaria difficult to treat, I find it easy, provided one distinguishes the syndrome categories and understands their sequence. I mention this in the context of Warm Malaria to warn patients against reckless medication. The Suwen's chapter on Malaria is detailed; it should be studied diligently.