蒋宝素曰：痎疟者，暑热内伏，风寒外乘，寒乱于卫，暑逆于营，邪正交争于少阳表里营卫之间，出表为热，入里为寒，先寒后热，作止有时，与伏邪相近之证也。伏邪乃伏寒化热，痎疟乃伏暑化虚。暑乃夏月之正邪，故可伏而后发，犹冬伤于寒，春必病温之义。《灵枢·经脉篇》曰：胆足少阳之脉，是主骨所生病者，振寒疟。又论疾诊尺篇曰：夏伤于暑，秋生痎疟。又岁露篇曰：夏日伤暑，秋病疟。又《素问·生气通天论》曰：夏伤于暑，秋为痎疟。又金匮真言论曰：夏暑汗不出者，秋成风疟。又阴阳应象大论曰：夏伤于暑，秋必痎疟。又疟论曰：夫痎疟皆生于风。又曰：此皆得之夏伤于暑。又刺疟论，少阳在太阳之后，阳明之前，以少阳为枢。又气交变大论曰：炎暑流行，民病疟。又五常政大论曰：赫曦之纪，病笑疟。又六元正纪大论曰：火郁之发，民病温疟。又至真要大论曰：少阳司天，火淫所胜，民病头痛，发热恶寒而疟。此《内经》诸篇，分明以暑热伏于前，风寒感于后，而会于少阳表里营卫之间，所受之气，本一寒一热，故病亦如是。少阳介乎表里，乃四战之地，营卫邪正之出入，必由乎此。卫为阳，营为阴，卫犹兵卫卫于外，营犹营垒营于中，营卫相维，不容邪扰。邪之所凑，其气必虚。邪正不两立，相遇必交争。暑热先伏营中，风寒后乘卫外，营阴不容暑热，逼之而外越。卫阳不容风寒，迫之而内侵。卫失外护，营失中守，邪正争，营卫乱，而寒热作。正气胜，营卫和，而寒热止。邪正复争，寒热更作。正气复胜，寒热更止。作者，邪争也。止者，正胜也。有热重于寒者，暑热多而风寒少也。有寒重于热者，风寒甚而暑热微也。有但热不寒者，暑热极甚，风寒极微，不觉其寒也。有但寒不热者，风寒极甚，暑热极微，不觉其热也。有日一作，夜一作，（俗名子母疟。）有一日一作，有间一日作，有间二日作，或间数日作，有连作二日，间一日，四日共三作，或间疟，当期日二作，（俗名间日子母。）或间日转为日作，或日作转为间日，或间疟转连日，正期止，间期作，仍为间疟，或潮热如瘅疟数次，时觉憎寒，转而为疟，或早或晏，或轻或重，或一日早，一日晏，一日轻，一日重，或依时不移，或寒热竟日，或今日之寒热未已，明日之寒热又至，或须臾即止，或数次即已，或延绵不断。盖由人之禀赋不同，受病有异，正气化邪有迟速，邪气化尽而已。如酒醉人，醉态不一，醒有迟速也。《内经》诸论，言其常也。余之所论，言其变也。若以浅深远近而分轻重迟速，则日作之寒热，常竟日不已。三疟之寒热，常须臾即止。此深者远者之寒热，何以反轻，浅者近者之寒热，何以反重，是未可以此分也。惟在正气化邪，邪尽而已。如受病应一日一作，一月解。若一日二次，则十五日尽。若二日一作，则六十日解。若三日一作，则至九十日矣。寒热轻而愈速者，邪本少也。而愈迟者，化之慢也。寒热重而愈迟者，邪本多也。而愈速者，化之快也。如寒热大作数次愈，此化之速也。以数日大作之寒热，分为数十次，则寒热轻而化之迟也。推此虽万变可知也。有热忽不退，而转为温热者，内与伏邪相遇也。有伏邪转为痎疟者，内有伏暑发动也。温疟者得之冬中于风，先热后寒，非正疟也。战汗者，正不容邪，大战于营卫之间，正胜而复，犹疟之意也。有疟邪尽而寒犹存，及产后与虚劳寒热往来如疟者，营卫乱而自相吞并也。一切内外证，发热恶寒，得汗而解者，无非邪正争而营卫乱也。但内无伏暑，不能作疟，故正伤寒无转疟之理，内无伏暑故也。《周礼》秋有疟寒疾，即风寒感于卫之意。《吕览》孟秋行夏令，民多疟疾，即暑热伏于营之意。《说文》曰痎，二日一发，疟也。即间二日一发，世俗所谓三疟也。《金匮要略》曰：病疟以月一日发，当以十五日愈。设不差，当以月尽解。如其不差，结为症瘕，名曰疟母，宜鳖甲煎丸。此言所伏之邪，正气化之，当一月解。如间日则六十日尽，间二日则九十日尽，正化邪尽而已。若化不尽，结为疟母，用鳖甲煎丸，以开治久疟之端。又曰：阴气孤绝，阳气独发，名曰瘅疟。若但热不寒者，邪气内藏于心，此言但热者，非无寒也。盖暑热极盛，风寒极微，不觉其寒也。又曰：疟多寒者，名曰牝疟。此言多寒者，非无热也。盖风寒极甚，暑热极微，不觉其热也。《伤寒论》曰：脉阴阳俱盛，重感于寒热，变为温疟。此先冬中于风，又复感寒，故先热后寒为温疟，非正疟也。又曰：邪正分争，往来寒热，小柴胡汤主之。此邪正战于少阳表里营卫之间，用和解之法，以开治疟之境。巢元方、孙思邈、刘完素、张子和俱宗经旨，以暑为主。李东垣曰：亦有非暑而感冒风寒得之者，谬矣。（怡斋曰：内无伏暑，不能作疟，正伤寒无转疟之证，内无伏暑故也。）丹溪始言痰疟，论治诸法皆佳。惟以日作与间日，乃受病一月与半年，乃三疟发于子午寅申辰戌之日分三阴，未免执泥。盖不知疟，犹酒徒之醉态不一，而醒有迟速也。王节斋始言日夜各一作之疟，薛立斋、张景岳证治俱得其中。吴又可所论，乃疟内与伏邪相遇。医案开旁通之路，医话制圆机之方。由是观之。治疟之法，亦云备矣。
略曰：天卫地外，地营天中，天地亦营卫也。暑蒸地气上为云，风搏天气下为雨，风云暑雨之合散，亦疟象也。人亦宜然。故疟之寒热，因暑而作，得汗而解，观乎天地，可以察人矣。
痎疟论列方
金匮鳖甲煎丸（四十五） 济生鳖甲饮（四十六） 小柴胡汤（三十三）
痢疾第十
《椿田医话》曰：痢疾多发于三秋，显系暑湿之毒，蕴结于肠胃之间，如暑疖湿痰流注脓窠疮之类，溃流脓血，即痢之赤白里急后重者，脓血淋漓涓滴而下也。与内痈同法。忌身热脉大，禁口不食，脓血色败如烂鱼肠屋漏水。初起宜攻，虚则宜补，久则宜涩。今约三方，以见其概。 攻发汤，主治痢疾初起壅实者。 生大黄（三钱） 川黄连（一钱） 黄芩（钱半） 金银花（三钱） 生木香（八分） 苦参（二钱） 飞滑石（三钱） 生甘草（五分） 赤芍（二钱） 夹表，先服败毒散一剂。 表微，加羌活（一钱），柴胡（一钱）。 夹虚，加大生地（八钱），人参（一钱）。 热甚，加白头翁（二钱），黑山栀（钱半）。 托补汤，主治痢疾无实证可据，及年迈体羸者。服攻发汤虽轻未已亦主之。 大熟地（八钱） 人参（一钱） 炙甘草（八分） 当归身（三钱） 生黄芪（三钱） 肉豆蔻（二钱） 冬白术（三钱） 椿根皮（三钱） 夹实，加生木香（一钱），槟榔（一钱）。 热重，加川黄连（八分）。 寒重，加制附子（五分）。 收涩丸，主治痢疾滑脱不止，连年不愈，诸药不应者。 赤石脂 禹余粮 罂粟壳 诃子肉 五倍子 人参 大熟地（砂仁水炒，以上各三两） 为末，椿根皮三两，煎水叠丸，早晚服三钱，开水下。 休息痢加明雄黄（猪胆汁拌，暴干） 牛角灰 羊角灰 鹿角灰 虎头骨灰（以上各一两） 为丸，服如前法，十年不愈者亦效。 《释名》曰：泄痢，言少漏泄而利也。 《北史》齐司马膺之好读《太玄经》，每云：我欲与杨子同游，患痢十七年不愈，齐亡岁，以痢终。 《唐太宗实录》曰：太宗苦于气痢，众医不效。即下诏问殿廷左右有能治此疾者，当重赏之。金吾卫士张宝藏，曾困其疾，即具疏乳煎荜茇方。上服之立瘥。宣下宰臣与五品官，魏征难之。逾月不进拟，上疾复发。问左右曰：吾前服乳煎荜茇有功，复命进一啜，又平。因思曰：尝令与进方人五品官，不见除授，何也？征惧曰：奉诏之后，未知文武二吏。上怒曰：治得宰相不妨，已授三品官，我天子也，岂不及汝耶？乃厉声曰：与三品文官，授鸿胪寺卿。其方每用牛乳半斤，荜茇三钱匕，同煎减半，空心顿服。 《赵溍养疴谩笔》曰：宋孝宗患痢，众医不效。高宗偶见一小药肆，召而问之。其人问得病之由，乃食湖蟹所致，遂诊脉曰：此冷痢也。乃用新采藕节捣烂，热酒调下，数服乃愈。（按：藕消瘀解热开胃，又解蟹毒，用酒调乃寒因热用也。若加苏梗解蟹毒更妙。）高宗大喜，即以捣药金杵臼赐之。 《夷坚甲志》曰：昔虞丞相自渠川被召，途中冒暑，得泄痢连月。萝壁间有韵语云：暑毒在脾，湿气连脚，不泄则痢，不痢则疟，独炼雄黄，蒸饼和药，甘草作汤，服之安乐，别作治疗，医家大错。如方制服，其疾随愈。 陆文量《菽园杂记》曰：痢疾最忌油腻生冷，惟白鲞鱼宜食。 《九峰医案》曰：肠澼赤白，气血俱伤，后重腹疼，溲赤脉数，暑滞俱重。河间云：溲而便脓血，气行而血止，行血则便自愈，调气则后重除，宜芍药汤。 赤芍药（二钱） 当归身（二钱） 川黄连（八分） 生木香（五分） 炙甘草（五分） 制大黄（三钱） 黄芩（钱半） 槟榔（一钱） 官桂（三分） 因热贪凉，人情之常，过食生冷，脾胃受伤，值大火流西，新凉得令，寒湿得以犯中，下传于肾，致成肠澼。溲色清澄，是其明验，脉来缓弱，温中为主。 藿香梗（二钱） 生木香（八分） 赤茯苓（二钱） 猪苓（钱半） 陈橘皮（一钱） 厚朴（一钱） 炙甘草（五分） 炮姜（八分） 冬白术（二钱） 经言：食饮有节，起居有常，饮食不节，起居不时，脾胃受伤，则上升精华之气，翻从下降而为飧泄，久则戊邪传癸，变生肠澼。延绵不已，变态多歧。见在下血或少或多，鲜瘀不一，此血不归经，气失统摄，下时里急后重，脾阳肾水俱伤，下后魄门瘙痒，中虚逼阳于下，脐旁动气有形，或左右上下，殆越人所谓动气之状，腹胁胀坠，不为便减，土困于中，魄门锁束，小溲不利，水亏于下，均非热象，矢气欲解不解，则肛门胀坠，时或燥热直逼前阴，肾囊收缩，气随上逆，皆水亏土弱之征，小腹坠，大腹膨，矢气解则舒，不解则胀连胁肋，右胜于左，以脾用在右，脾病故得后与气，则快然如衰，常觉中下二焦否塞，大便有时畅下，则诸证较减，以肾居于下，为胃之关，开窍于二阴，大便既畅，土郁暂宣，水源暂畅，故减至于或为之，犹浮云之过太虚耳。治病必求其本，法当脾肾双培，偏寒偏热，恐致偏害。 人参（一两） 炙黄芪（三两） 冬白术（三两，土炒） 炙甘草（八钱） 煨木香（五钱） 酸枣仁（三两） 远志肉（两半） 炙升麻（三钱） 煨肉果（二两） 云茯苓（三两） 当归身（三两，土炒） 川芎䓖（一两） 为末，以大生地十二两，大白芍六两，罂粟壳六两，石榴皮六两，乌梅肉四两，熬膏，再入龟板胶三两，鹿角胶三两，熔化和丸，每早晚服三钱，开水下。 二气素虚，七情不节，致伤脾胃，传化失常，清不能升，浊无由降，清气在下，则生飧泄，戊邪传癸，转为肠澼。色白如脓，日十余次，下时里急后重，脾阳肾水潜伤，舌苔色常黧黑，中寒格阳于上，腹中隐痛，澼久剥及肠胃脂膏，食减神疲，夜多妄梦，肾不交心，而中虚气馁，因循怠治，希冀自瘥，反覆相仍，病情转剧，将近一载。前进补中益气、归脾、六君等汤，以行升降之令，继服胃关煎、四神丸、五味子散，温固三阴，病势退而复进，脉体和而又否，病势苦深，殊难奏捷。勉拟温固命门，引火归窟，冀其丹田暖，则火就燥，下元固，则气归精，然否质诸明哲。 怀山药（三两） 补骨脂（二两，盐水炒） 煨木香（八钱） 炙甘草（八钱） 冬白术（三两，土炒） 诃子肉（三两） 罂粟壳（三两） 干姜（八钱） 白芍药（二两） 石榴皮（二两） 缩砂仁（两半） 荜茇（二两） 赤石脂（三两） 煅龙骨（三两） 淡吴萸（八钱） 煨肉果（二两） 煨草果（一两） 五味子（二两） 为末，用大熟地十六两，大洋参十二两，嫩黄芪十二两，龙眼肉八两，熬膏和丸，每早晚服三钱，开水下。 痢成休息，本是缠绵，气伤则白，血伤则赤，痢下纯血，血分受伤，起自客冬，暮春未已，大和中土，培补胃关，共服十有六剂，痢势十减六七，第尊年胃气易伤，饮食颇减，宜停煎剂，以丸缓图。 大熟地（八两） 怀山药（四两） 人参（一两） 陈橘皮（两半） 炙升麻（五钱） 炙甘草（八钱） 五味子（二两） 赤石脂（三两） 煨木香（五钱） 为末，地榆六两，煎水叠丸，早晚服三钱，开水下。
蒋宝素曰：痢疾者注下赤白，里急后重，腹痛，昼夜无度数，至圊而不能便，乃暑湿食毒，郁蒸酝酿于藏府肠胃膜原连络之间，津液脂膏化为脓血，渗入肠中而下。盖痈疖流注疮疡之类，即《内经》肠澼之证也。
Jiang Baosu said: Jiemie (a general term for various types of malaria) is caused by summer-heat pathogenic factors latent within the interior and wind-cold pathogenic factors attacking the exterior. Cold disrupts the Wei (Defensive Qi), while summer-heat rebels in the Ying (Nutritive Qi). The pathogen and righteous Qi contend between the exterior-interior and Ying-Wei levels of the Shaoyang (Lesser Yang) channel. When the pathogen moves outward to the exterior, it manifests as fever; when it enters the interior, it manifests as aversion to cold. It presents with initial aversion to cold followed by fever, with regular intervals of onset and cessation, resembling syndromes of latent pathogens (Fu Xie, pathogens that lie dormant before manifesting). Fu Xie refers to latent cold transforming into heat, whereas Jiemie refers to latent summer-heat transforming into deficiency. Summer-heat is the proper pathogen of summer, so it can lie dormant and later manifest, similar to the principle that injury to cold in winter leads to warm diseases in spring. *Lingshu · Jingmai Pian* states: "The Gallbladder Foot-Shaoyang channel is responsible for bone-related diseases, including chills and malaria." Additionally, *Lun Ji Zhen Chi Pian* states: "Injury to summer-heat in summer leads to Jiemie in autumn." *Suilü Pian* states: "Summer-heat injury in summer results in malaria in autumn." *Suwen · Shengqi Tongtian Lun* states: "Injury to summer-heat in summer becomes Jiemie in autumn." *Jingui Zhenyan Lun* states: "Those who do not sweat during summer heat will develop Fengmie (wind-malaria) in autumn." *Yinyang Yingxiang Dalun* states: "Injury to summer-heat in summer inevitably leads to Jiemie in autumn." *Malun* states: "All Jiemie arises from wind pathogens." It further states: "These are all due to summer-heat injury in summer." *Cimalun* states that the Shaoyang channel is located after the Taiyang and before the Yangming, acting as the pivot. *Qijiaobian Dalun* states: "When hot summer heat prevails, the people suffer from malaria." *Wuchangzheng Dalun* states: "In the era of Hexi (excessive Fire transport), people suffer from Xiao Mie (laughing malaria)." *Liuyuan Zhengji Dalun* states: "When Fire depression erupts, the people suffer from Wenmie (warm malaria)." *Zhiyao Dalun* states: "When Shaoyang governs the heaven and Fire excess prevails, the people suffer from headache, fever, aversion to cold, and malaria." These chapters in *Neijing* clearly indicate that summer-heat lies latent first, wind-cold is contracted later, and they converge at the exterior-interior and Ying-Wei levels of the Shaoyang channel. The Qi received is fundamentally one cold and one heat, so the disease manifests accordingly. Shaoyang is situated between the exterior and interior, a battleground where the entry and exit of Ying-Wei, pathogens, and righteous Qi must pass through. Wei Qi belongs to Yang, Ying Qi belongs to Yin. Wei is like guards protecting the outside, while Ying is like a camp defending the inside. Ying and Wei support each other and do not allow pathogenic interference. Where pathogens gather, Qi must be deficient. Pathogens and righteous Qi cannot coexist; upon meeting, they contend. Summer-heat first lies latent in the Ying, and wind-cold later attacks the exterior Wei. Ying-Yin cannot accommodate summer-heat, forcing it to move outward. Wei-Yang cannot accommodate wind-cold, forcing it to invade inward. Wei loses its external protection, Ying loses its internal defense. Pathogen and righteous Qi contend, Ying and Wei become disordered, and chills and fever arise. When righteous Qi wins, Ying and Wei harmonize, and chills and fever cease. When pathogen and righteous Qi contend again, chills and fever recur. When righteous Qi wins again, chills and fever cease again. Onset represents pathogen contention; cessation represents righteous Qi victory. In cases where heat outweighs cold, there is more summer-heat and less wind-cold. In cases where cold outweighs heat, there is severe wind-cold and mild summer-heat. In cases of only heat without cold, summer-heat is extremely severe and wind-cold is extremely slight, so cold is not felt. In cases of only cold without heat, wind-cold is extremely severe and summer-heat is extremely slight, so heat is not felt. Some occur once daily, some at night (commonly called Zimu Malaria). Some occur once every day, some every two days, some every three days, or after several days. Some occur consecutively for two days, then pause for one day, totaling three episodes in four days. Some are intermittent, occurring twice on scheduled days (commonly called Jianri Zimu), or intermittent malaria converts to daily occurrence, or daily occurrence converts to intermittent. Or intermittent malaria converts to consecutive days. Scheduled periods stop, intermittent periods occur, remaining as intermittent malaria. Or tidal fever resembles Danmie (fever-malaria) several times, often feeling aversion to cold, transforming into malaria. Onset may be early or late, mild or severe. One day early, one day late; one day mild, one day severe. Or fixed to time without change, or chills and fever last all day. Or today's chills and fever have not ended, tomorrow's chills and fever arrive again. Or stopping after a moment, or ending after several episodes, or lingering continuously. This is because people's constitutions differ, illnesses vary, and the speed at which righteous Qi resolves pathogens differs; the disease ends only when the pathogen is exhausted. Like drunk people, their drunken states vary, and waking up has varying speeds. The discussions in *Neijing* describe the normal patterns; my discussion describes the variable patterns. If one were to distinguish severity and speed based on depth and distance, daily chills and fever usually last all day. Sanmiao (three-day) malaria chills and fever usually stop after a moment. Why are the chills and fever of the deep and distant milder? Why are the chills and fever of the shallow and closer more severe? This distinction is invalid. It depends solely on righteous Qi resolving the pathogen until it is exhausted. If illness requires daily onset, resolution takes one month. If twice daily, resolution takes fifteen days. If every two days, resolution takes sixty days. If every three days, it reaches ninety days. Mild chills and fever resolve quickly because the pathogen is originally scant. Slow resolution indicates slow transformation. Severe chills and fever resolve slowly because the pathogen is originally abundant. Fast resolution indicates rapid transformation. For example, severe chills and fever resolving after several episodes indicates rapid transformation. Dividing several days of severe chills and fever into dozens of episodes means mild chills and fever with slow transformation. Inferring from this, even ten thousand changes can be understood. If heat suddenly does not recede and transforms into Warmth Disease, it is because the interior encounters latent pathogens. If latent pathogens transform into Jiemie, it is because latent summer-heat activates internally. Wenmie (Warm Malaria) results from wind injury in winter, presenting with initial heat followed by cold, and is not standard malaria. Zhanhan (Shivering Sweat) occurs when righteous Qi cannot tolerate pathogens, fighting fiercely between Ying and Wei; after righteous Qi wins and recovers, it retains the nature of malaria. Cases where malaria pathogens are exhausted but cold remains, as well as postpartum and consumptive disorders with alternating chills and fever resembling malaria, result from Ying-Wei disorder and mutual consumption. All internal and external conditions featuring fever and aversion to cold that resolve with sweating are essentially due to pathogen-righteous Qi contention and Ying-Wei disorder. However, without latent summer-heat internally, malaria cannot form; thus, Zheng Shanghan (Standard Cold Damage) does not transform into malaria because there is no latent summer-heat. *Zhouli* mentions malaria chills in autumn, meaning wind-cold affecting Wei Qi. *Lüshi Chunqiu* states that practicing summer commands in early autumn causes many people to suffer malaria, meaning summer-heat lies latent in Ying Qi. *Shuowen* defines Jie as occurring every two days, referring to malaria. This is intermittent every two days, commonly known as Sanmiao (Three-Day Malaria). *Jingui Yaolue* states: "For malaria starting on the first day of the month, healing should occur within fifteen days. If not healed, it should resolve by the end of the month. If still not healed, it forms a mass called Nuomu (Malaria Mother), treated with Biejia Jian Wan." This indicates that latent pathogens resolved by righteous Qi should heal in one month. If intermittent, sixty days; if every two days, ninety days; this is simply the exhaustion of transformed pathogens. If transformation is incomplete, forming Nuomu, Biejia Jian Wan is used to initiate treatment for chronic malaria. It also states: "When Yin Qi is isolated and Yang Qi alone erupts, it is called Danmie (Fever Malaria). If there is only heat without cold, the pathogen hides in the Heart." Here, 'only heat' does not mean absence of cold; rather, summer-heat is extremely severe and wind-cold extremely slight, so cold is not perceived. It also states: "Malaria with predominant cold is called Pinmie (Yin Malaria)." Here, 'predominant cold' does not mean absence of heat; rather, wind-cold is extremely severe and summer-heat extremely slight, so heat is not perceived. *Shanghan Lun* states: "When pulse Yin and Yang are both full, and re-injured by cold and heat, it transforms into Wenmie." This results from wind injury in winter followed by cold contraction, causing initial heat then cold, classified as Wenmie, not standard malaria. It also states: "When pathogen and righteous Qi contend, with alternating chills and fever, Xiaochaihu Tang is indicated." This describes pathogen-righteous Qi contention at the exterior-interior and Ying-Wei levels of Shaoyang, treated with Harmonizing methods to open the approach to treating malaria. Chao Yuanfang, Sun Simiao, Liu Wansu, and Zhang Zihe all followed the classic principles, emphasizing summer-heat. Li Dongyuan stated: "There are also cases not caused by summer-heat but by wind-cold contraction," which is erroneous. (Yizhai stated: Without latent summer-heat internally, malaria cannot form; Zheng Shanghan does not transform into malaria because there is no latent summer-heat.) Danxi first discussed Tanmie (Phlegm Malaria); his therapeutic theories were excellent. However, asserting that daily and intermittent occurrences correspond to one-month and half-year durations, and that Sanmiao occurs on specific days corresponding to the Three Yin, was somewhat rigid. He failed to realize that malaria, like the varied drunken states of wine drinkers, has varying speeds of recovery. Wang Jiezhai first discussed malaria occurring once day and once night. Xue Lizhai and Zhang Jingyue's syndrome differentiation and treatment were appropriate. Wu Keyou's discussion addressed malaria encountering latent pathogens internally. Medical records opened paths for lateral thinking, and medical conversations provided flexible strategies. From this, we see that methods for treating malaria are indeed comprehensive.
Briefly: Heaven protects, Earth is external; Earth nurtures, Heaven is central. Heaven and Earth also represent Ying and Wei. Summer-heat steams Earth Qi upward into clouds; wind strikes Heaven Qi downward into rain. The combination and dispersion of wind, clouds, summer-heat, and rain mirror the phenomenon of malaria. Humans are similarly constituted. Thus, malaria's chills and fever arise from summer-heat and resolve with sweating. Observing Heaven and Earth allows us to understand the human body.
Formulas Listed in the Discussion of Jiemie
Jingui Biejia Jian Wan (45) Jisheng Biejia Yin (46) Xiaochaihu Tang (33)
Dysentery Chapter 10
*Chuntian Yihua* states: Dysentery mostly occurs in the three autumns, clearly indicating toxicity of summer-dampness accumulating between the intestines and stomach, similar to summer boils, damp-phlegm flowing abscesses, and pustular sores. Ulceration and discharge of pus and blood correspond to the red and white dysentery with tenesmus and heaviness in the rectum, where pus and blood drip down continuously. It is treated similarly to internal abscesses. Contraindications include fever with large pulse, inability to eat due to nausea, and pus/blood appearing败坏 (rotten) like rotten fish intestines or leaking roof water. Initial stage requires purging; deficiency requires tonification; chronic stage requires astringency. Here are three formulas to illustrate the general principles.
Gongfa Tang (Attacking and Ejecting Decoction) treats early-stage dysentery with excess and accumulation. Raw Dahuang (Rhubarb Root and Rhizome) 3 qian, Chuan Huanglian (Coptis Rhizome) 1 qian, Huangqin (Scutellaria Root) 1.5 qian, Jinyinhua (Honeysuckle Flower) 3 qian, Sheng Muxiang (Vladimiria Root) 0.8 fen, Kushen (Sophora Root) 2 qian, Fei Huashi (Prepared Talcum) 3 qian, Sheng Gancao (Licorice Root) 0.5 fen, Chishao (Red Peony Root) 2 qian. If accompanied by exterior syndrome, first administer Baidu San (Decoction for Overcoming Toxins) for one dose. If exterior is slight, add Qianghuo (Notopterygium Rhizome) 1 qian, Chaihu (Bupleurum Root) 1 qian. If accompanied by deficiency, add Da Shengdi (Rehmannia Root) 8 qian, Renshen (Ginseng Root) 1 qian. If heat is severe, add Baitouweng (Pulsatilla Root) 2 qian, Hei Shanzhi (Gardenia Fruit) 1.5 qian.
Tuobu Tang (Supporting and Tonifying Decoction) treats dysentery without clear excess signs, and in elderly or frail patients. It is also indicated if Gongfa Tang alleviates symptoms but does not cure. Da Shudi (Prepared Rehmannia Root) 8 qian, Renshen (Ginseng Root) 1 qian, Zhi Gancao (Honey-fried Licorice Root) 0.8 fen, Dangguishen (Codonopsis Root or Angelica Sinensis Root Center) 3 qian, Sheng Huangqi (Astragalus Root) 3 qian, Roudoukou (Nutmeg) 2 qian, Dong Baizhu (Atractylodes Macrocephala Rhizome) 3 qian, Chun Genpi (Toona Bark) 3 qian. If accompanied by excess, add Sheng Muxiang (Vladimiria Root) 1 qian, Binglang (Areca Seed) 1 qian. If heat is heavy, add Chuan Huanglian (Coptis Rhizome) 0.8 fen. If cold is heavy, add Zhi Fuzi (Prepared Aconite Lateral Root) 0.5 fen.
Shouse Wan (Astringent Pill) treats dysentery with sliding incontinence, persisting for years unresponsive to other medicines. Chishizhi (Halloysitum Rubrum) Yuyuliang (Magnetitum) Yingsuqiao (Poppy Shell) Hezirou (Chebula Fruit Flesh) Wubeizi (Galla Chinensis) Renshen (Ginseng Root) Da Shudi (Prepared Rehmannia Root) stir-fried with Amomum water, each above 3 liang. Grind into powder. Use Chun Genpi (Toona Bark) 3 liang, decoct in water, and make pills. Take 3 qian morning and evening with boiled water. For Xixi Li (Resting Dysentery), add Ming Xionghuang (Realgar) mixed with pig bile and dried, Niujiaohui (Buffalo Horn Ash), Yangjiaohui (Sheep Horn Ash), Lu Jiaohui (Deer Horn Ash), Huitou Guhui (Tiger Skull Bone Ash), each 1 liang. Make pills and take as before; effective even for ten-year cases.
*Shiming* states: Xi Li implies leakage and diarrhea. *Beishi* records that Sima Yingzhi of Qi loved reading *Taixuan Jing*, often saying: "I wish to travel with Yangzi, but I suffered from dysentery for seventeen years without cure. I died of dysentery in the year Qi fell." *Shilu of Emperor Taizong of Tang* states: Emperor Taizong suffered from Qi Li (Gas Dysentery); physicians were ineffective. He issued an edict promising heavy rewards to anyone in the palace who could cure this disease. Jinwu Guard Zhang Baozang, who had previously suffered from this disease, submitted a prescription of milk-decocted Biba (Long Pepper). The Emperor took it and recovered immediately. He ordered the Chancellor and fifth-rank officials to confer a rank on him, but Wei Zheng hesitated. After a month, he did not submit the proposal, and the Emperor's illness recurred. Asking attendants: "My previous use of milk-decocted Biba was effective; order another cup to be taken," and it subsided again. Thinking: "I once ordered a fifth-rank official for the person submitting the formula, but no appointment was made. Why?" Wei Zheng feared and said: "After receiving the edict, I did not know whether to appoint civil or military officials." The Emperor angrily said: "If you can cure a Prime Minister, it doesn't matter; I have already granted a third-rank official. I am the Son of Heaven, how could I be inferior to you?" Then loudly declared: "Grant a third-rank Civil Official title, appoint as Minister of the Court of State Ceremonial." The formula uses half a jin of cow milk and three qian-bi of Biba, decocted together until reduced by half, taken on an empty stomach in one dose. *Zhao Min Yangke Manbi* states: Emperor Xiaozong of Song suffered from dysentery; physicians were ineffective. Emperor Gaozong偶然 saw a small pharmacy and summoned the owner. Upon asking the cause of illness, it was revealed to be eating lake crabs. The physician diagnosed the pulse and said: "This is Cold Li." He used freshly collected lotus node stems, mashed and mixed with hot wine. After several doses, it cured. (Note: Lotus nodes remove stasis, clear heat, benefit the stomach, and detoxify crab poison. Using wine aligns with 'treating cold with heat.' Adding Suzhu (Perilla Stem) to detoxify crab poison would be better.) Emperor Gaozong was greatly pleased and gifted him a gold mortar and pestle. *Yijian Jiazhi* states: Formerly, Chancellor Yu was summoned from Quchuan. On the way, exposed to summer heat, he suffered from diarrhea and dysentery for months. A rhyme on the wall read: "Summer toxin in Spleen, dampness connects to feet. No diarrhea means dysentery, no dysentery means malaria. Only refine Realgar, mix with steamed dough pill, decoct Licorice soup, take it for peace. Other treatments are major errors by physicians." Following the formula, the disease healed immediately. Lu Wenliang's *Shuyuan Zaji* states: Dysentery strictly forbids greasy and raw/cold foods; only Bai Xiangyu (White Salted Fish) is suitable. *Jiufeng Yi'an* states: Changpi with red and white discharge injures both Qi and Blood; tenesmus and abdominal pain, dark urine and rapid pulse indicate severe summer-stagnation. Hejian stated: "Urine with pus and blood, moving Qi stops Blood; moving Blood heals stool, regulating Qi removes tenesmus." Suitable for Shaoyao Tang. Chishao Yao (Red Peony Root) 2 qian, Dangguishen (Angelica Sinensis Root Center) 2 qian, Chuan Huanglian (Coptis Rhizome) 0.8 fen, Sheng Muxiang (Vladimiria Root) 0.5 fen, Zhi Gancao (Honey-fried Licorice Root) 0.5 fen, Zhi Dahuang (Prepared Rhubarb Root and Rhizome) 3 qian, Huangqin (Scutellaria Root) 1.5 qian, Binglang (Areca Seed) 1 qian, Guanzi (Cinnamon Bark) 0.3 fen. Due to heat seeking coolness, a common human tendency, overeating raw/cold foods injures Spleen and Stomach. When the Great Fire flows west and new coolness takes command, cold-dampness invades the center and transmits downward to the Kidney, resulting in Changpi. Clear urine color is clear evidence; slow and weak pulse indicates warming the center as primary. Huoxiang Geng (Patchouli Stem) 2 qian, Sheng Muxiang (Vladimiria Root) 0.8 fen, Chifuling (Poria with Red Sandalwood) 2 qian, Zhuling (Polyporus) 1.5 qian, Chen Ju Pi (Aged Tangerine Peel) 1 qian, Houpo (Magnolia Bark) 1 qian, Zhi Gancao (Honey-fried Licorice Root) 0.5 fen, Pao Jiang (Roasted Ginger) 0.8 fen, Dong Baizhu (Atractylodes Macrocephala Rhizome) 2 qian. Classics state: Food and drink have moderation, daily life has routine. Irregular diet and lifestyle injure Spleen and Stomach. The ascending essence Qi turns downward into Sundxie (undigested food diarrhea). Long-term, Wu Evil transmits to Gui, transforming into Changpi. Lingering endlessly, variations are diverse. Lower bleeding varies in amount and freshness/stasis. This is Blood not returning to vessels, Qi losing control. During defecation, tenesmus and heaviness occur; Spleen Yang and Kidney Water are both injured. After defecation, the anus itches; middle deficiency forces Yang downward. Pulsatile Qi near the navel is palpable, left/right/up/down, resembling Yue Ren's description of pulsatile Qi. Abdominal and hypochondriac distension/heaviness does not decrease with defecation. Earth is trapped in the center, the Anus locks, urination is difficult. Water is deficient below; none are heat signs. Flatulence desires release but fails, causing anal distension/heaviness. Sometimes dry heat directly presses the anterior yin, scrotum contracts, Qi reverses upward. All are signs of Water deficiency and Earth weakness. Lower abdomen droops, great abdomen distends. Flatulence releases brings comfort; failure brings distension connecting to hypochondrium. Right exceeds left because Spleen functions on the right; Spleen disease thus, after passing stool and gas, feels relieved like decline. Often feel blockage in Middle and Lower Jiao. Sometimes stool passes smoothly, reducing various symptoms. Kidney resides below, gate of Stomach, opens to two yins. Once stool is smooth, Earth stagnation temporarily vents, Water source temporarily flows, hence reduction. Even if done occasionally, it is like floating clouds passing through the great void. Treating disease must seek the root; method should tonify Spleen and Kidney simultaneously. Bias toward cold or heat may cause partial harm. Renshen (Ginseng Root) 1 liang, Zhi Huangqi (Honey-fried Astragalus Root) 3 liang, Dong Baizhu (Atractylodes Macrocephala Rhizome) 3 liang, earth-fried, Zhi Gancao (Honey-fried Licorice Root) 8 qian, Wei Muxiang (Roasted Vladimiria Root) 5 qian, Suanzaoren (Ziziphus Seed) 3 liang, Yuanzhi Rou (Polygala Root Flesh) 1.5 liang, Zhi Shengma (Honey-fried Cimicifuga Rhizome) 3 qian, Wei Rouguo (Roasted Nutmeg) 2 liang, Yun Fuling (Cloud Poria) 3 liang, Dangguishen (Angelica Sinensis Root Center) 3 liang, earth-fried, Chuanxiong (Szechwan Lovage Rhizome) 1 liang. Grind into powder. Use Da Shengdi (Raw Rehmannia Root) 12 liang, Da Baishao (Large White Peony Root) 6 liang, Yingsuqiao (Poppy Shell) 6 liang, Shiliupi (Pomegranate Peel) 6 liang, Wumei Rou (Smoked Plum Flesh) 4 liang, boil into paste. Add Guiban Jiao (Tortoise Shell Glue) 3 liang, Lu Jiao Jiao (Deer Antler Glue) 3 liang, melt and make pills. Take 3 qian morning and evening with boiled water. Two Qi are inherently deficient, Seven Emotions unregulated, injuring Spleen and Stomach. Transportation and transformation fail; Clear cannot ascend, Turbid has no way to descend. Clear Qi sinks, generating Sundxie. Wu Evil transmits to Gui, transforming into Changpi. Color white like pus, ten times daily, tenesmus and heaviness during defecation. Spleen Yang and Kidney Water secretly injured. Tongue coating often dark/black. Middle cold repels Yang upward, dull abdominal pain. Long-term Changpi strips intestinal and stomach fat. Reduced appetite, mental fatigue, many false dreams at night. Kidney does not communicate with Heart; middle deficiency and Qi exhaustion. Procrastinating treatment, hoping for self-healing, recurring repeatedly, condition worsens, nearing one year. Previously administered Buzhong Yiqi Tang, Guipi Tang, Liu Jun Tang to regulate ascending-descending commands. Subsequently took Weiguan Jian, Sishen Wan, Wuweizi San to warm and secure Three Yin. Condition retreated then advanced; pulse and body harmonious yet blocked. Condition deeply bitter, hard to achieve quick success. Reluctantly proposed warming and securing Mingmen, guiding Fire back to the cave. Hope that if Dantian warms, Fire seeks dryness; if Lower Origin secures, Qi returns to Essence. Whether correct or not, submitted to wise men. Huaishanyao (Chinese Yam) 3 liang, Buguzhi (Psoralea Fruit) 2 liang, salt-water fried, Wei Muxiang (Roasted Vladimiria Root) 8 qian, Zhi Gancao (Honey-fried Licorice Root) 8 qian, Dong Baizhu (Atractylodes Macrocephala Rhizome) 3 liang, earth-fried, Hezirou (Chebula Fruit Flesh) 3 liang, Yingsuqiao (Poppy Shell) 3 liang, Ganjiang (Dried Ginger) 8 qian, Baishao Yao (White Peony Root) 2 liang, Shiliupi (Pomegranate Peel) 2 liang, Suosharen (Cardamom) 1.5 liang, Biba (Long Pepper) 2 liang, Chishizhi (Halloysitum Rubrum) 3 liang, Duanculonggu (Calcined Dragon Bone) 3 liang, Dan Wuyu (Light Evodia Fruit) 8 qian, Wei Rouguo (Roasted Nutmeg) 2 liang, Wei Caoguo (Roasted Tsaoko Fruit) 1 liang, Wuweizi (Schisandra Berry) 2 liang. Grind into powder. Use Da Shudi (Prepared Rehmannia Root) 16 liang, Dayangshen (Large Codonopsis Root) 12 liang, Nen Huangqi (Young Astragalus Root) 12 liang, Longyanrou (Longan Flesh) 8 liang, boil into paste and make pills. Take 3 qian morning and evening with boiled water. Dysentery becoming Resting Dysentery is inherently lingering. Qi injury yields white; Blood injury yields red. Pure blood in stool indicates Blood aspect injury. Starting from last winter, continuing until late spring. Greatly harmonize Central Earth, nourish Stomach Gate. Total sixteen doses taken, dysentery reduced by six or seven tenths. However, elderly Stomach Qi is easily injured, appetite significantly decreased. Should stop decoctions, use pills for slow planning. Da Shudi (Prepared Rehmannia Root) 8 liang, Huaishanyao (Chinese Yam) 4 liang, Renshen (Ginseng Root) 1 liang, Chen Ju Pi (Aged Tangerine Peel) 1.5 liang, Zhi Shengma (Honey-fried Cimicifuga Rhizome) 5 qian, Zhi Gancao (Honey-fried Licorice Root) 8 qian, Wuweizi (Schisandra Berry) 2 liang, Chishizhi (Halloysitum Rubrum) 3 liang, Wei Muxiang (Roasted Vladimiria Root) 5 qian. Grind into powder. Diyu (Sanguisorba Root) 6 liang, decoct in water, make pills. Take 3 qian morning and evening with boiled water.
Jiang Baosu said: Dysentery involves passing red and white discharge, tenesmus and heaviness in the rectum, abdominal pain, without limit day or night, going to the toilet but unable to defecate. It is summer-dampness and food toxicity, stagnating and fermenting between the Zang-Fu organs, intestines, stomach, membrane origins, and connections. Body fluids and fats transform into pus and blood, seeping into the intestines and passing down. Essentially, it is similar to carbuncles, boils, flowing abscesses, and sores, which corresponds to the Changpi syndrome in *Neijing*.