黄支冷阳虚者，茵陈四逆同服。若舌灰、脉迟、不食、寐者，椒附白通汤，皆所以治脾阳也。若
脾阴为湿伤者，舌先灰滑，后反苔燥、大便坚结，治以连、芩、白芍、枳实、半夏。以上皆所以
治中焦之湿也。若湿伤于下，邪水旺一分，正水亏一分。若跗踵者，治以鹿附汤升督脉之
阳，佐以兔丝。独一味草果，清太阴独胜之寒以醒脾阳。俾地气上蒸，白苔可除。若脾败而
及肾者安肾丸，以鹿茸补督脉，附韭补真阳，
苓术渗湿，所谓釜底增薪法也。又有痿弱不振、肢体麻痹、便血者，苓姜术附汤。及古方黄
土汤，夫肾之真水生于一阳，治少阴之湿，一以护肾阳，使火能生土以化湿；一以泄膀胱之
积水从下治，亦所以安肾中真阳也；一以升脾阳从上治，亦所以使水不没真阳也，此治少阴
之湿也。若湿太过，水能泛木，木无生气，自失其疏泄之任。治厥阴之湿，复其风木之本性，
便能疏泄，此治厥阴法也。皆下焦法也。
问∶《大易》“水流湿，火就燥”二句之义能畅言欤？《内经》“少秋伤于燥”一句，后人遂疑
燥不为病，得毋误欤？夫寒热燥湿皆有胜气、复气，燥病胜复二气能分别欤？喻西昌转补秋
伤干燥二句有所本欤自立清燥救肺法其用当在秋之何节欤以此治燥法果该备欤。燥症之
见于三焦者，何证分治者何方，能详言欤？燥病之变症能类举一二欤？《素问》有“燥极而
泽”能言其故欤？宋元明书罕言及燥，今人尤混，当细剖之。
圣人于干之九五示人以后天太极之象，此一节当连读、急读，言下俨然有一活太极在
目前。若分读则无意味，缓读则失神。理水、流湿二句有三义∶既是水则自然流湿，既是火
则自然就燥，一义也。水之流湿已有就燥之机，火之就燥已有流湿之机，又一义也。水不
能流湿，有火为之宰而湿乃流；火不能就燥，因水为之烁而燥乃就，又一义也。医家明乎此
二句急读之，故中藏三义之说。治湿当常目在燥，治燥当常目在湿。余曾于疮恙验之，东南
风起则滋水淋漓，顷之风转西北干枯燥痒，此其证也。《内经》少秋燥一句，后人疑燥不为
病，固属诞妄，而知论燥者如戴人云∶“休治风兮休治燥，治得火时风燥了。”亦仅知以润药
治燥，以清药治火，是治燥之复气而非燥之胜气也。复气云何？大抵五行之理“克之太过其
子必为母复仇”，知冬伤于寒，其胜气是寒胜热，用麻桂姜附治寒之胜气也。寒水剽火，克
之太过则火之子为母复仇，白虎承气治胃土，即寒之复气也。燥气亦然，燥属金，金属阴属
寒，金能克木，克之太过，木之子火，也为母复仇而化火，故治燥之胜气属寒，治燥之复气属
火。喻西昌“补秋伤干燥，冬生咳嗽”二句本生气，通天论曰∶“秋伤于燥，上逆而咳，发为痿
厥”数语，其自立清燥救肺汤甘寒润液治诸气， 郁诸痿喘呕之因于燥者，亦以治燥之复
气而非治燥之胜气也。大抵秋分以前属长夏伤湿之余气为病，秋分以后小雪以前属阳明
燥气为病。《内经》曰∶“阳明之胜清发于中，左 胁痛，溏泄，内为噎塞，外发 疝，大凉肃
杀，华英改容，毛虫乃殃，胸中不便，噎塞而咳。”据此经文，燥令必有凉气感人，肝木受邪
而为燥也。《性理大全》谓∶“燥属次寒。”知燥病属寒，与伤寒同类。经以寒淫所胜，治以甘
热。此则燥淫所胜，治以苦温，用苦温辛温解表，与冬令麻桂姜附虽不同，和中攻里则一，
故不立方。且如夏暑熏蒸肌肉潮润，冬寒肃杀干槁燥冽，深秋气凉，肺金应之肌肤亦燥，火
令无权。奈何诸贤皆谓属火，大相迳庭也。知此，则喻氏此法但可治复气之燥，而不可谓该
备也。欲求该备，先论上焦胜气为病。初感必在肺卫，清气分者桑杏汤，用桑、杏、象贝、香
豉以化其表，用沙参、梨皮、栀子以清其本，咳者桑菊饮。如燥伤肺卫阴分，北沙参麦冬汤，
用甘草、玉竹、桑叶、扁豆。清窍不利，用薄荷、桔梗、黑栀、绿豆衣、牛蒡，枯草。所谓火郁发
之，如初寒咳嗽、痰稀、鼻塞、无汗，此诚燥之正病也，用杏苏散治之，皆治上焦法也。中焦
之病，金能克木，木病与金病同见胸胁作痛，甚则疝瘕痛，以柴胡达少阳之气，即所以达肝
木之气，合桂枝而外，出太阳加吴萸、川楝、茴香，苦温通降。若病在阳明里实而坚者有二
法，脉仍短涩兼紧、面青，此未从热化也，用苦温下之，如《金匮》大黄附子细辛汤，及天台乌
药散加巴霜之类。如脉已数而坚、面赤、舌黄，参之他证皆见火象，此已从热化也，用苦寒下
之，如三承气之类，轻用硝黄亦可。病在下焦，燥气结于血分而成 者，无论男女皆当以化
回生丹主之，经又曰∶“燥淫所胜，男子
疝，女子少腹痛”，故燥症中下焦病 疝为多，所谓燥之变症也，亦自然之病也。然则变症其
尽于此乎？未也，中燥之极重者，如霍乱、寒疫。盖风火暑为阳邪，与秽浊相参则为瘟疫；
湿燥寒为阴邪，与秽浊相参则为寒疫。其证支麻、转筋、逆冷、吐泻，甚至反恶热、大渴、凉
饮。经谓∶“雾伤于上，湿伤于下。”此症乃燥金寒湿之气直犯筋络，由大络、别络内伤三阴藏
真，所以转筋入腹，即死；吐泻者，阴阳逆乱也；诸痛者，燥金湿土之气所抟也；渴思凉饮
者，仲景谓自利而渴者属少阴虚，故饮水自救也；阴邪上逼阳不能降，所谓戴阳也；喜凉恶
热者，饮邪内踞，阳气无附，欲外散也；阴病见阳症，水极似火也。辨此症者，以当脐痛甚拒
按者为真阴症，治之之法以附、桂、椒、姜、草果、吴萸、良姜驱其内走之寒，保住阳气，乌
木、降香、雄黄、薤白、丁、茴等芳香去秽，用细辛、石菖等以开其道，一面由真脏而别络大络
外出筋经以达皮毛，一面由脏络府络以通六腑外达九窍，俾秽浊阴邪一齐立解，所谓“离
照当空，群阴退避”，今人以谓痧症廖矣。若夫燥极而泽一语，以水为金子、土为金母故也，
其病多见于寒湿伏暑门中，如腹痛呕吐之类，均苦温治燥之正法也。学人宜知湿有兼热兼
寒、暑有兼风兼燥、燥有热化寒化，先将燥湿分开，再将寒热细细辨之，庶几胸有准的，而
手下丝丝入扣乎。
问∶疟疾之因何由，而发疟疾之理何书最详，能细述欤？历来论疟何家最精，何方最妙，
能缕述欤？温疟、瘅疟古方甚着，何以不验欤？ 疟、夜疟其说甚多，能辨其故欤？疟在少阳
一经，其轻重深浅亦分上中下三焦脏腑论治，能分剖而明辨欤？外感有风寒暑湿，内伤有痰
食瘀阻、有汗无汗、新久虚实，能条分缕晰欤？疟母、疟劳能详病因治法欤？其逐层条对毋
忽。
疟之因由于夏暑，疟之理详于《内经》。经曰∶“阴阳上下交争，虚实更作，阳并于阴，则
阴实而阳虚，阳明虚则寒 、鼓颔，巨阳虚则
腹背头项痛，三阳俱虚则阴虚骨寒而痛，寒生于内故中外皆寒，阴气逆极则复出之阳，阳与
阴复并于外则阴虚而阳实，阳盛则外热，阴虚则内热，故渴而欲饮水也，此皆得之夏、伤于
暑热。气藏于肌肤之内肠胃之外营气之所舍也，此令人汗孔疏，因得秋气汗出遇风，及得
之于浴水遂闭汗孔，暑毒无从发泄，故气舍于皮肤之内，与卫气并居。卫气者，盖日行于阳
夜行于阴，此气得阳而外出，得阴而内薄，内外相薄，是以日作。其间日作者，由气之舍深
内薄于阴，其道远，其气深，其行迟，不能与卫气俱行，不得皆出，故间日而作也。”读以上经
文，明朗朗如月，后人著作不昌斯言矣（以上疟因）。惜无治法，不得不求之后贤，而后贤亦
有精当之论，可与经文并行者朱丹溪曰∶“无痰不成疟。疟由暑邪舍于营卫，腠理不密，复
遇风寒，郁闭汗孔，郁汗成痰，寒热相搏，故为疟。其治法，无汗者要有汗，散邪为主，兼补正
气；有汗者要无汗，扶正为主，兼散邪气。”按丹溪补出痰字，所以易于缠绵。有汗无汗最当
明辨于后，秦元宫曰∶“少阳胆为震，为干之长子，诸阳所从，邪欲入阴而拒之，遂积于经，随
气行少阳而与邪争，二阳三阳并而入内为援。由是外无阳而战栗，顷之阳从外出则大热，胜
复之道也。间日一发者，战后两衰不能争，休息而更战也。”按∶此条可作经注。又曰∶“四序
五行皆顺生，惟夏交秋为火克金，虽有坤土间之，热极忽凉，火未退而金受制。庚日为伏，是
火未退而金潜伏也。立秋后金令当权，而木藉子之势不肯受制，于是金木相战。《易》曰∶“战
乎干是也。疟病者，金木相战也。脉弦，木强之征也。然必有外邪交构而祸作。暑邪甚者
党木，寒邪甚者党金。始则金先犯木，木火退而身寒；继则木出相争而大热，此其常也。木
火强者木先犯金，先热后寒，变也。但热不寒者瘅疟，木火太旺，肺金束手无权，不得不用
石膏、知母以泻其子，治法以助金为正理，以讲和为善术，柴胡疏肝，黄芩助肺金，甘草调
和，半夏驱邪，而阴用人参、生姜补肺金为左
袒，使相和而止，甚则膏知以助金，归桂以和肝。若虚人胃呕吐不堪，用人参姜皮专补肺
金，使木不敢交锋，大兵压胜法也。露一宿者，藉秋气之助金也。”按∶此条精当奇确，在诸家
之上，能清其界（以上语诸家）。薛一飘曰∶“疟邪皆得自夏秋浴水凄风，俞穴留邪与卫气相
遇乃作。”《内经》温疟论谓∶“冬寒藏于少阴，大暑用力而发，皆纸上空谈，仲景之白虎桂枝
用之不见其撤热之功，反见营热烦躁之害，石膏徒足郁邪，桂枝反热其营，故不中病情。余
制一方，治温疟、瘅疟颇效，名清疟饮，用青蒿、炒蜀漆、知母、花粉、淡芩、鳖甲、丹皮，取
蜀漆苦辛引达疟邪，知、芩、花粉、苦盐清肺胃之热，鳖甲、丹皮、辛盐、清盐以破肝血，其症
自愈，然不能速治，不可急，急则生变。”按∶此条知今日但热不寒之瘅疟，与古人方论不合，
当另出心裁（温疟瘅疟）。三日一发为 疟，以气虚不能抵受暑邪，邪气深陷故也。先哲皆以
大补元气为主，立斋用参术煨姜顿服即止，丹溪用大剂补中益气加煨姜亦妙。其有不效者
因暑邪未清，先宜清暑益气汤，驱散暑邪补养正气，再用温补。其病在脾肝肾，方详下焦疟
中（ 疟）。夜疟者，诸书皆作阴分受邪，惟汪石山谓阳虚陷入，当用助气药加血药引入阴
分，如四君加羌、防、柴、桂升接三阳，芎、归、桃仁引入阴分以出还阳分。按∶此条论夜疟，
宜与分晰。三四发后渐入阴分者，从阳虚陷入，宜上法；若初起即发于夜，是阴分受邪，宜
桂枝桃仁汤直散血中之邪。薛氏清疟饮、追疟饮亦治热入营中之疟，（夜疟）。上焦之疟，舌
白浊饮、咳嗽频仍，寒从背起，名曰肺疟，最忌小柴胡，以肺去半表半里甚远，不得引邪深
入，用杏、蔻、翘、桑、芩、滑轻宣肺气，无使邪聚则愈（肺疟）。昏狂谵语、烦渴者曰心疟，加
减银翘汤，甚则牛黄丸、紫雪丹（心疟）。中焦之疟变化最多，大约不外胃热脾湿两种。湿疟
见疮，苍术、白虎加草果，此胃热也。胸中痞结，邪渐入阴，草果、知母、半、朴、芩、粉、姜、
梅汤，此脾湿也。惟草果能治太阴独胜之寒，
能升邪使出；朴、半助之；知母能泻阳明独胜之热，花粉佐之；姜、半开痞，梅、芩清热和肝，
此从清脾达原两方化裁而出，实疟门之主方，用之善于剪裁可也。伤胃阴者味变酸浊，加减
泻心汤；不复者麦冬、麻仁、白芍、首乌、乌梅、知母（胃疟）。脾疟多呕，热聚心胸，芩、连、枳、
芍、姜、半；燥甚者，牛黄丸∶脉濡腹满肢冷，露姜饮；呕吐噫气，腹鸣溏泄，参、姜、草果、青
皮、陈、半；久不止者气虚，补中益气；偏热重者，青蒿鳖甲饮；少阳如伤寒者，小柴胡，热多
加花粉，寒多加干姜；舌白、脘闷、肢冷、渴喜热饮，湿蕴之故，浓朴草果汤（脾疟）。下焦之
疟皆三阴 疟。在太阴脾者腹胀、不渴、呕水，温脾汤，草果、桂、朴、苓、漆、生姜；在少阴肾
者形寒、嗜卧、舌淡、脉微，扶阳汤，鹿茸、参、附、归、桂、漆；在厥阴者痞结、气逆、欲呕，减
味乌梅丸，术、附、参、橘、归。此皆下焦法也（以上三焦）。风疟，恶风、自汗、脉浮，桂枝羌
活汤（羌桂防草）；无汗加麻黄，呕加陈半（风疟）。寒疟，恶寒、无汗、脉紧，麻黄羌活汤（即
前方加麻黄）。暑疟，面垢、口渴、热退亦常自汗，白虎汤（暑疟）。湿疟，小便不利、骨节重痛
而烦、胀满、自汗，渗湿汤加柴、芩，或胃芩汤加黄芩（湿疟）。痰疟，痰涎潮壅，二陈加常山、
枳实、柴芩（痰疟）。食疟，恶食、吞酸、嗳气、膈中不宽，平胃散加砂仁、草果、神曲、青皮（食
疟）。瘀阻，即阴分夜疟之一种，桂枝桃仁汤（瘀阻）。久疟无汗，属气虚，宜抚元气，不宜
散，虽属有汗、仍身疼怕风，此汗未彻，仍须汗之。初发多汗，当清暑疏风；无汗寒多，风寒未
For patients with spleen yang deficiency and cold, Yinchen Sini Decoction (茵陈四逆汤) is taken together with yang-warming herbs. If the tongue coating is grayish, the pulse is slow, there is an inability to eat, and drowsiness, Jiaofu Baitong Decoction (椒附白通汤) is used; all these methods aim to treat spleen yang deficiency. If spleen yin is injured by dampness, the tongue coating first appears gray and slippery, then becomes dry, accompanied by hard and constipated stool; treatment involves Coptis Rhizome (黄连), Scutellaria Root (黄芩), White Peony Root (白芍), Immature Bitter Orange (枳实), and Pinellia Tuber (半夏). All the above are methods for treating dampness in the middle jiao.
If dampness injures the lower jiao, one part of pathogenic water increases, while one part of genuine water decreases. If edema of the dorsum of the foot occurs, Lufu Decoction (鹿附汤) is used to raise the yang of the Du vessel, assisted by Dodder Seed (菟丝子). Using only Aromatic Tetterwort Rhizome (草果) alone clears the exclusive cold of the Taiyin spleen to awaken spleen yang, allowing earth qi to rise and evaporate, thereby eliminating white tongue coating. If spleen failure extends to the kidney, Anshen Pill (安肾丸) is used: Deer Antler (鹿茸) tonifies the Du vessel, Aconite Root (附子) and Chinese Chives (韭菜) tonify true yang, Poria (茯苓) and Atractylodes Macrocephala Rhizome (白术) leach out dampness; this is the so-called "adding firewood to the bottom of the cauldron" method. For symptoms of flaccidity and weakness, limb numbness, and bloody stools, Lingjiang Zhufu Decoction (苓姜术附汤) is used. Also, the ancient formula Huangtu Tang (黄土汤) is employed. The true yin of the kidney is generated from the ministerial fire of Shaoyin; treating dampness of the Shaoyin channel involves protecting kidney yang so that fire can generate earth to transform dampness; draining accumulated water from the bladder to treat from below, which also stabilizes the true yang in the kidney; and raising spleen yang to treat from above, ensuring water does not submerge true yang. This is the method for treating dampness of the Shaoyin.
If dampness is excessive, water overacts on liver wood; lacking vital energy, wood loses its function of free flow and drainage. Treating dampness of the Jueyin channel involves restoring its wind-wood nature, enabling free flow and drainage; this is the method for Jueyin dampness. These are all methods for the lower jiao.
Question: Can you elaborate on the meaning of the two sentences from the *I Ching*: "Water flows to wetness, fire tends to dryness"? Regarding the sentence in the *Neijing* "Autumn injury by dryness," later scholars doubted that dryness causes disease; is this not a mistake? Cold, heat, dryness, and dampness all have dominant (sheng) and retaliatory (fu) qi. Can the dominant and retaliatory qi of dryness disease be distinguished? Does Yu Xi Chang's addition of "Autumn injury by dryness" have a basis? In which phase of autumn should his self-established Qingzao Jiufei method be applied? Is this method truly comprehensive for treating dryness? What are the syndromes and corresponding formulas for dryness appearing in the three jiao? Can you list a few variations of dryness disease? Regarding "Extreme dryness leads to moisture" in the *Suwen*, can you explain the reason? Medical books from Song, Yuan, and Ming dynasties rarely mention dryness, and modern people are particularly confused; this needs careful analysis.
The Sage, in the Nine-Five line of the Qian hexagram, shows people the image of the Post-Heaven Taiji. This section should be read continuously and quickly; spoken words seem to present a living Taiji before one's eyes. Reading separately lacks flavor, reading slowly loses spirit. There are three meanings in "Managing water, flowing to wetness": First, since it is water, it naturally flows to wet places; since it is fire, it naturally tends to dry places. Second, the flow of water to wetness already contains the mechanism of tending to dryness; the tendency of fire to dryness already contains the mechanism of flowing to wetness. Third, water cannot flow to wetness without fire as its master to move the dampness; fire cannot tend to dryness without water as its constraint to manifest dryness. Physicians who understand the quick reading of these two sentences grasp the three hidden meanings. When treating dampness, one must keep dryness in mind; when treating dryness, one must keep dampness in mind. I have verified this in skin diseases: when the southeast wind blows, moisture drips; suddenly the wind turns northwest, becoming dry and itchy. This is evidence. The *Neijing* says "Autumn injury by dryness"; later scholars doubting dryness causes disease is absurd. However, Dai Ren said, "Do not treat wind, do not treat dryness; when fire is treated, wind and dryness are resolved." He only knew to use moistening herbs for dryness and clearing herbs for fire, treating the retaliatory qi of dryness rather than the dominant qi. What is retaliatory qi? Generally, the principle of five elements is "if overacting, the child will avenge the mother." Knowing winter injury by cold, the dominant qi is cold overcoming heat, treated with Ephedra Herb (麻黄), Cinnamon Twig (桂枝), Ginger (干姜), and Aconite Root (附子) to treat the dominant cold. Cold water robs fire; if overacting, the child of fire (earth) avenges the mother, treated with Baihu Decoction and Chengqi Decoction for stomach earth, which is the retaliatory cold. Dryness is similar; dryness belongs to metal, metal is yin and cold, metal overacts on wood. If overacting, the child of wood (fire) avenges the mother and transforms into fire. Thus, treating the dominant qi of dryness belongs to cold, and treating the retaliatory qi of dryness belongs to fire. Yu Xi Chang's "Autumn injury by dryness, winter generates cough" is based on Sheng Qi. The Tongtian Lun says: "Autumn injury by dryness, rebellion upward causes cough, developing into flaccidity and cold limbs." His self-established Qingzao Jiufei Decoction uses sweet-cold moistening fluids to treat various qi stagnation, flaccidity, wheezing, and vomiting due to dryness; this treats the retaliatory qi of dryness, not the dominant qi. Generally, before Autumn Equinox, illness is due to residual dampness from summer dampness injury; after Autumn Equinox and before Minor Snow, illness is due to Yangming dryness qi. The *Neijing* says: "Yangming dominance, clear cold emerges internally, left hypochondriac pain, loose stool, internal obstruction, external hernia, severe cool desiccation, flowers lose color, hair-bearing insects suffer, chest discomfort, obstruction and cough." According to this scripture, dryness command must involve cool qi injuring people; liver wood is injured and transforms into dryness. *Xingli Daquan* states: "Dryness belongs to secondary cold." Thus, dryness disease belongs to cold, similar to cold damage. Classics state treating cold dominance with sweet-hot. Here, treating dryness dominance with bitter-warm, using bitter-warm and acrid-warm to release the exterior. Although different from winter Ephedra, Cinnamon, Ginger, and Aconite, the harmonizing middle and attacking interior are the same, so no specific formula is listed. Consider summer heat steaming muscles making them moist; winter cold desiccating making them dry and cold; late autumn air cools, lung metal responds, skin becomes dry, fire power is weak. Why do sages say it belongs to fire? This is vastly different. Understanding this, Yu's method only treats retaliatory dryness, not comprehensively. To be comprehensive, first discuss upper jiao dominant qi illness. Initial infection is in lung and defense; for clearing qi level, Sangxing Tang (桑杏汤) is used: Mulberry Leaf (桑叶), Apricot Kernel (杏仁), Fritillaria Bulb (象贝), Fermented Soybean (香豉) to resolve exterior; Glehnia Root (沙参), Pear Peel (梨皮), Gardenia Fruit (栀子) to clear root; for cough, Sangju Yin (桑菊饮). If dryness injures lung/defense yin, Beisha Shen Maidong Tang (北沙参麦冬汤) is used: Licorice Root (甘草), Polygonatum Odoratum Rhizome (玉竹), Mulberry Leaf (桑叶), Dolichos Bean (扁豆). For blocked orifices, Mint Herb (薄荷), Platycodon Root (桔梗), Black Gardenia (黑栀), Mung Bean Coat (绿豆衣), Arnebia Root (牛蒡), Prunella Spike (枯草) are used. This is "releasing fire depression." For initial cold cough, thin sputum, nasal congestion, no sweat, this is true dryness, treated with Xingsu San (杏苏散); these are upper jiao methods.
Middle jiao disease: Metal overacts on wood; wood disease and metal disease appear together with chest/hypochondriac pain, even hernia masses. Use Bupleurum Root (柴胡) to reach Shaoyang qi, thus reaching liver wood qi. Combined with Cinnamon Twig (桂枝), exiting Taiyang, add Evodia Fruit (吴萸), Sichuan Chinaberry (川楝), Fennel (茴香), bitter-warm and descending. If disease is Yangming interior excess and hard, two methods: if pulse is short, choppy, tight, face green, not transformed to heat, use bitter-warm purgatives like Dahuang Fuzi Xixin Decoction (大黄附子细辛汤) from *Jinkui Yaolue*, or Tiantai Wuyao Powder plus Croton Seed (巴霜). If pulse is rapid and hard, face red, tongue yellow, other signs show fire, transformed to heat, use bitter-cold purgatives like the three Chengqi formulas, lightly using Mirabilite (硝) and Rhubarb (黄). Disease in lower jiao: dryness qi knots in blood level forming masses; regardless of gender, Huahuisheng Dan (化回生丹) is main treatment. Scripture says: "Dryness dominance, men hernia, women lower abdominal pain." Thus, lower jiao dryness often presents as hernia, a variation of dryness, a natural disease. Are variations limited here? No. Extreme middle dryness includes cholera and cold plague. Wind, fire, summerheat are yang pathogens; mixed with turbid qi, they become epidemics. Dampness, dryness, cold are yin pathogens; mixed with turbid qi, they become cold plague. Symptoms: limb numbness, tendon twitching, cold extremities, vomiting/diarrhea, even aversion to heat, extreme thirst, desire for cold drinks. Scripture: "Mist injures upper, dampness injures lower." This syndrome is dryness-metal cold-damp qi directly invading sinews/collaterals, damaging Three Yin organs via large/distal collaterals. Tendon twitching entering abdomen means death; vomiting/diarrhea is yin-yang reversal; pains are dryness-metal/damp-earth knotting; thirst for cold drinks: Zhang Zhongjing says diarrhea with thirst belongs to Shaoyin deficiency, drinking water to save itself; yin evil forces up, yang cannot descend, called Dai Yang (floating yang); liking cold/aversion to heat: fluid retention occupies inside, yang has no attachment, wants to scatter outward; yin disease showing yang signs, water extreme resembles fire. Differentiate by severe pain at umbilicus refusing pressure: true yin syndrome. Treatment: Aconite (附), Cinnamon (桂), Pepper (椒), Ginger (姜), Aromatic Tetterwort (草果), Evodia (吴萸), Galangal (良姜) drive inward cold, protect yang; Ebony Wood (乌木), Agarwood (降香), Realgar (雄黄), Shallot (薤白), Clove (丁), Fennel (茴香) aromatic remove turbidity; Asarum (细辛), Acorus (石菖蒲) open pathways. One way exits from Zang via collaterals to sinews/skin; another way connects Zang/Fu collaterals to Six Fu and nine orifices, resolving turbid yin evil immediately. "Sun shines high, yin evils retreat." Modern people call this Sha syndrome. "Extreme dryness leads to moisture" is because water is metal's child, earth is metal's mother. Disease often appears in cold-damp latent summerheat category, such as abdominal pain/vomiting; all are bitter-warm correct methods for dryness. Students should know dampness combines with heat/cold, summerheat combines with wind/dryness, dryness has heat/cold transformation. Separate dryness/dampness first, then carefully distinguish cold/heat, so the mind has accuracy and hands act precisely.
Question: What is the cause of malaria? Which book details the principle of malaria best? Who discussed malaria most accurately? Which formula is best? Explain Wenmalaria and Danmalaria ancient formulas why ineffective? Many theories on Malaria and Ye Malaria, can you distinguish? Malaria is in Shaoyang channel, severity/depth divided by upper/middle/lower jiao/zang-fu, can you analyze? External invasion: wind/cold/summerheat/dampness; internal injury: phlegm/food/stasis, sweating/no sweating, new/old, deficiency/excess, can you clarify? Mamo and Malao etiology/treatment? Answer layer by layer.
Malaria cause is summerheat; principle detailed in *Neijing*. Scripture: "Yin-Yang struggle up/down, deficiency/excess alternate, yang merges into yin, yin excess/yang deficiency. Yangming deficiency causes chills/jaw trembling; Juyang deficiency causes back/head/neck pain; Three Yang deficiency causes yin deficiency bone cold/pain; cold generated internally causes whole body cold. Yin qi reverses extremely then returns to yang; yang and yin merge externally causing yin deficiency/yang excess. Yang excess causes external heat, yin deficiency causes internal heat, hence thirst/water craving. All from summer heat injury." Qi hides in skin/muscle inside/gastro-intestinal outside, where Ying qi resides, causing open pores. Meeting autumn air, sweating meets wind, or bathwater closes pores, summer toxin cannot vent. Qi stays in skin with Wei qi. Wei qi moves Yang by day, Yin by night. This qi moves out with Yang, enters with Yin. Internal/external interaction causes daily发作. Intermittent发作: qi hides deep, interacts with Yin, path is long, qi is deep, movement slow, cannot move with Wei qi, cannot all exit, hence every other day. Reading this scripture is clear as the moon; later works are not as brilliant (Above: Malaria Cause). Sadly, no treatment method, so we seek later experts. Zhu Danxi said: "No phlegm, no malaria. Malaria from summerheat staying in Ying/Wei, pores not tight, meeting wind/cold, closing pores, condensing sweat into phlegm, cold/heat fighting. Treatment: no sweat needs sweat, disperse evil mainly, supplement right qi; has sweat needs no sweat, support right mainly, disperse evil." Danxi added phlegm, explaining lingering nature. Sweating/no sweating must be distinguished. Qin Yuangong said: "Shaoyang Gallbladder is Zhen, eldest son of Qian, source of all Yang. Evil wants to enter Yin but is rejected, accumulates in channel, follows Qi in Shaoyang fighting evil, Two/Yang Three Yang join inside. Externally no Yang causes shivering, soon Yang exits causing high heat, win/lose principle. Every other day发作: after battle both decline, cannot fight, rest then fight again." This serves as Neijing commentary. Also: "Four seasons/five elements follow generation, only Summer-Autumn is Fire overacting Metal. Though Kun Earth intervenes, extreme heat suddenly cools, fire not gone, metal controlled. Geng day is Fu (hidden), fire not gone, metal hidden. After Start of Autumn, Metal command rules, Wood relies on Child power refuses control, Metal/Wood fight. Yi Jing: 'Fight in Qian.' Malaria is Metal/Wood fight. Stringy pulse, Wood strong sign. Must have external evil conflict. Summerheat evil sides with Wood, Cold evil sides with Metal. Initially Metal attacks Wood, Wood/Fire retreat, body cold; then Wood fights, high heat, normal. Wood/Fire strong, Wood attacks Metal, heat then cold, variation. Only heat no cold is Danmalaria, Wood/Fire too旺, Lung Metal helpless, must use Gypsum (石膏), Anemarrhena (知母) to drain child. Treatment helps Metal as principle, harmony as skill. Chaihu soothes Liver, Huangqin assists Lung Metal, Licorice harmonizes, Banxia drives evil, Yin uses Ginseng/Ginger to tonify Lung Metal as support, making harmony stop. Severe cases Gypsum/Anemarrhena help Metal, Guizhi/Gui Pian harmonize Liver. If deficient person vomits, Ginseng/Ginger peel tonifies Lung Metal, Wood dares not fight, army suppression method. Dew overnight borrows Autumn air to help Metal." This is precise and superior, clarifying boundaries (Above: Various Experts). Xue Yipiao said: "Malaria evil comes from Summer/Autumn bathwater/cold wind, evil stays in Shu points meeting Wei qi to发作." *Neijing* Wenmalaria theory says "Winter cold hides in Shaoyin, great heat exertion causes发作," all empty talk. Zhang Zhongjing's Baihu Guizhi shows no heat-clearing effect, causes Ying heat/restlessness; Gypsum traps evil, Guizhi heats Ying, not suitable. I made Qingmie Yin: Artemisia Annua (青蒿), Fried Kudzu Root (炒蜀漆), Anemarrhena (知母), Trichosanthes Root (花粉), Light Scutellaria (淡芩), Turtle Shell (鳖甲), Moutan Bark (丹皮). Kudzu acrid-bitter guides to malaria evil; Anemarrhena/Scutellaria/Trichosanthes/bitter salt clear Lung/Stomach heat; Turtle/Moutan acrid-salt clear salt to break Liver blood, symptoms heal. But cannot cure fast, do not rush, rushing causes changes. (Wenmalaria/Danmalaria). Every three days发作 is Sanrimie, Qi deficiency cannot resist summerheat, evil sinks deep. Ancients focused on tonifying Yuan Qi. Lizhai used Ginseng/Atractylodes/Roasted Ginger bolus stops it; Danxi used large dose Buzhong Yiqi + Roasted Ginger is good. Ineffective cases: summerheat not cleared, first use Qingshu Yiqi Tang to disperse summerheat/tonify right qi, then warm tonification. Disease in Spleen/Liver/Kidney, see Lower Jiao Malaria (Sanrimie). Ye Malaria: books say Yin level evil, Wang Shishan said Yang deficiency sinking, use Qi-tonifying + Blood herbs to enter Yin, e.g., Sijunzi + Qianghuo/Fangfeng/Chaihu/Guizhi lift Three Yang, Chuanxiong/Danggui/Taoren enter Yin to return to Yang. Analyze Ye Malaria: 3-4发作 gradually entering Yin from Yang sinking, use above method; if starts at night initially, Yin level evil, use Guizhi Taoren Tang to scatter blood evil. Xue's Qingmie Yin/Zhuimie Yin treat heat entering Ying malaria (Ye Malaria). Upper Jiao Malaria: white greasy tongue/phlegm, frequent cough, cold from back, named Fei Malaria, strictly avoid Xiaochaihu Tang as Lung is far from Half-Exterior/Half-Interior, do not lead evil deep. Use Apricot Kernel (杏), Cardamom (蔻), Forsythia (翘), Mulberry Leaf (桑), Scutellaria (芩), Polyporus (滑) to lightly diffuse Lung Qi, prevent evil aggregation heals (Fei Malaria). Confusion/delirium/thirst is Xin Malaria, Modified Yinqiao Tang, severe Niuhuang Wan/Zixue Dan (Xin Malaria). Middle Jiao Malaria varies most, mostly Stomach Heat/Spleen Damp. Damp Malaria with sores, Cangzhu/Baihu + Caoguo, Stomach Heat. Chest fullness, evil entering Yin, Caoguo/Anemarrhena/Banxia/Pohuang/Qin/Fen/Jiang/Meitang, Spleen Damp. Only Caoguo treats Taiyin exclusive cold, lifts evil out; Pohuang/Banxia assist; Anemarrhena drains Yangming exclusive heat, Fen assists; Jiang/Banxia opens fullness, Mei/Qin clears heat/harmonizes Liver. Derived from Qingshi/Daoyuan, main Malaria formula, use well. Injuring Stomach Yin tastes sour/turbid, Modified Xiexin Tang; non-recovering Maidong/Huomaren/Baishou/Shouwu/Wumei/Anemarrhena (Wei Malaria). Pi Malaria often vomits, heat gathers chest/heart, Qin/Lian/Zhi/Shao/Jiang/Ban; extreme dryness Niuhuang Wan; soggy pulse/full abdomen/cold limbs, Lujiang Yin; vomiting/belching/bowel sounds/loose stool, Renshen/Jiang/Caoguo/Qingpi/Chenpi/Banxia; long-term Qi deficiency, Buzhong Yiqi; heat-heavy Qinghao Biejia Yin; Shaoyang like Cold Damage, Xiaochaihu, heat+Fen, cold+Ganjiang; white tongue/chest stuffiness/cold limbs/thirst for hot drink, damp accumulation, Houpo Caoguo Tang (Pi Malaria). Lower Jiao Malaria are Three Yin Malaria. Taiyin Spleen: abdominal distension/no thirst/vomit water, Wenyi Tang, Caoguo/Guizhi/Houpo/Fuling/Shuku/Shengjiang; Shaoyin Kidney: cold form/lethargy/pale tongue/faint pulse, Fuyang Tang, Lurong/Renshen/Fuzi/Danggui/Guizhi/Shuku; Jueyin: fullness/reverse Qi/vomit, Modified Wumei Wan, Baizhu/Fuzi/Renshen/Jupi/Danggui. These are Lower Jiao methods (Above: Three Jiao). Feng Malaria: aversion to wind/sweat/floating pulse, Guizhi Qianghuo Tang (Qianghuo/Guizhi/Fangfeng/Gancao); no sweat add Mahuang, vomit add Chenpi/Banxia (Feng Malaria). Han Malaria: aversion to cold/no sweat/tight pulse, Mahuang Qianghuo Tang (above + Mahuang). Shu Malaria: dirty face/thirst/sweat after heat subsides, Baihu Tang (Shu Malaria). Shi Malaria: difficult urination/heavy joint pain/irritability/distension/sweat, Shenshi Tang + Chaihu/Huangqin, or Weiqin Tang + Huangqin (Shi Malaria). Tan Malaria: profuse phlegm, Erchen Tang + Changshan/Zhishi/Chaihu/Huangqin (Tan Malaria). Shi Malaria: aversion to food/acid regurgitation/belching/chest tightness, Pingwei San + Sharen/Caoguo/Shenqu/Qingpi (Shi Malaria). Yu Zu: a type of Yin level Ye Malaria, Guizhi Taoren Tang (Yu Zu). Long-term Malaria no sweat: Qi deficiency, soothe Yuan Qi, do not disperse. Even with sweat/body ache/aversion to wind, sweat incomplete, still need sweating. Initial发作 much sweat: clear summerheat/disperse wind; no sweat much cold: wind-cold un...