《后汉书·马援列传》曰：援在交趾，尝饵薏苡实，云能轻身资欲，以胜瘴气也。 《活人书·三昧论》曰：食饮有节，起居有常，则邪气不能为害。彼道路崎岖，人烟疏阔，水浆不洁，酒炙多腥，饮食起居，未免乖度。况复有阴阳相搏之气乎，故曰瘴气，惟染劳役伤饥之人者，此也。 《圣济总录》曰：岭南朴蛇瘴，亦名锁喉瘴，项大肿痛连喉。用赤足蜈蚣一二节，研细，水下即愈。 巢元方曰：夫岭南青草黄芒瘴，犹如岭北伤寒也。南地暖，故太阴之时，草木不黄落，伏蛰不闭藏，杂毒因暖而生。 又曰：瘴疟病生于岭南，带山瘴之气，其状发寒热，休作有时，皆由山溪原岭嶂湿毒气故也。其病重于伤暑之疟。 杨士瀛《直指方》曰：瘭疮，一名蛇瘴，蛮烟瘴雨之乡多毒，人有不伏水土风气而感触之者，数月以还，必发蛇瘴。惟赤足蜈蚣最能伏蛇为上药，白芷次之。 大梁李待诏《瘴疟论》曰：岭南既号炎方，而又濒海，地卑而土薄，炎方土薄，故阳懊之气常泄，濒海地卑，故阴湿之气常盛，二气相搏，此寒热所由作也。阳气泄，故冬无霜雪，四时放花，人居其地，气多上壅，肤多汗出，腠理不密，盖阳不反本而然。阴气盛，故晨夕雾昏，春夏淫雨，一岁之间，蒸湿过半，三伏之内，反不甚热，盛夏连雨，即复凄寒。饮食衣服药食之类，往往生醭，人居其间，类多中湿。肢体重倦，又多脚气之疾。盖阴常偏胜而然。阴阳之气既偏而相搏，故人亦因之而感受其寒热不齐之病也。又阳燠既泄，则使人本气不坚，阳不下降，常浮于上，故病者多上脘郁闷，胸中虚烦。阴湿既盛，则使人下体多寒，阴不上升，常沉而下。故病者腰膝重疼，腿足寒厥。余观岭南瘴疾，证候虽或不一，然大抵阴阳各不升降，上热下寒者十有八九。况人身上本属阳，下本属阴，兹又感此阳燠阴湿不和之气，自多上热下寒之证也。得病之因，正以阳气不固，每发寒热，身必大汗，又复投之以麻黄、金沸、青龙等汤，再发其表，则旋踵受毙。甚者又以胸中痞闷，用利药下之，病人下体既冷，下之则十无一生。若此者医害之也。其时余染瘴疾，全家特甚，余悉用温中固下，升降阴阳正气之药，十治十愈。二仆皆病胸中痞闷烦躁，昏不知人，一云愿凉药清膈，余审其证，上热下寒，皆以生姜附子汤冷温服之，即日皆醒。自言胸膈清凉，得凉药而然也。实不知附子也。翌日各与丹朱丸一粒，令空心服之，遂能食粥。然后用正气、平胃等药，自尔遂得平安。更治十数人皆安。盖附子用生姜煎，既能发散，以热攻热，又能导虚热向下焦，除宿冷，又能固接元气。若烦闷者，放冷服之。若病烦躁，不好饮水，反畏冷不能饮者，皆其虚热，非真热也。宜姜附汤。沈存中治瘴用七枣汤，正与此同，亦一服而愈，有用术附汤而病益甚，盖术附相济，能固热气，不能发散，惟附子一味为最妙。 又曰：或有脉证，实非上热下寒，而目黄赤者，不可用附子。脉若浮洪而数，寒热往来，无汗，乃小柴胡汤证。若证有可疑，寒热不辨，宜服嘉禾散。若热多者冷服之。嘉禾散能调中气，升降阴阳，治下虚中满，疗四时温疫伤寒，使无变动，虽伤暑及阳证伤寒服之亦愈。若或寒多，服之尤宜。服二三日，即寒热之证自判。然后随证调治，无不愈者。大抵岭南之地卑湿，又人食槟榔，多气疏而不实，四时汗出，不宜更用汗药，此理甚明。亦有当汗下者，然终不多也，明者察之。 新安王棐《指迷方·瘴疟论》曰：棐读书之余，留意医学，幸得其传，颇识方脉。就辟入南，研究此证，谓南人凡病皆谓之瘴，率不服药，惟事鬼神。夫瘴之为病，犹伤寒之病也。岂可坐视不药耶。每为中医荏苒而致不救者有之。人过桂林以南无医药，且居南之人，往往多汗，上盈下空，不可用汗吐下三法。其业医者既鲜且庸，或妄用汗吐下者，是谓虚虚。方书皆谓南方天气温暑，地气郁蒸，阴多闭固，阳多发泄，草木水泉皆禀恶气。人生其间，元气不固，感而为病，是谓之瘴。轻者寒热往来，正类痎疟，谓之冷瘴。重者蕴热沉沉，昼夜如卧灰火中，谓之热瘴。最重者一病便失音，莫知其所以然，谓之哑瘴。冷瘴必不死，热瘴久而死，哑瘴无不死。此方书之说也。然以愚意观之，所谓哑瘴者，非伤寒失音之证乎。又岂中风失语之证乎。治得其道，亦多可生，安得谓之无不死耶。若夫热瘴，乃是盛夏初秋，茅生狭道，人行其间，热气蒸郁，无林木以蔽日，无水泉以解渴，伏暑至重，因而感疾。或有饮酒而不节者，或食煎炙而积热者，偶成此证，其热昼夜不止，稍迟二三日，则血凝而不可救矣。南中谓之中箭，亦谓之中草子。然有挑草子法，乃以针刺头额及上下唇，仍以楮叶擦舌，皆令出血，徐以草药解其内热，应手而愈，安得谓之久而死耶。至于冷瘴，或寒多热少，或寒少热多，亦有叠日间日之作。及其愈也，疮发于唇，验其证即是外方之疟，本非重病，然每因误治而致祸，亦不可以必不死而忽之。但诊其脉息极微，见其元气果虚，即与附子汤而愈。若误投寒药，所谓承气入胃，阴盛乃亡。若脉洪盛，证候实热，宜服和解药而徐治之。若误投热药，所谓桂枝下咽，阳盛则毙。要在切脉审证，辨其寒热虚实，治之无不愈也。又人谓岭南水泉草木地气之毒，故凡往来岭南之人及宦而至者，无不病瘴而至危殆。又谓土人生长其间，与水土之气相习，外人入南必一病，但有轻重之异。若久而与之俱化则免矣。此说固若有理，但备之以将养之法，解之以平易之药，决保无病，纵病亦易愈。且瘴之为病，土人反重，外人反轻，盖土人淫而下元虚，又浴于溪而多感冒，恣食生冷酒馔，全不知节，所以重也。然则，病瘴者不可全咎风土之殊，皆人自失节养有以致之耳。君子之居是邦也，当慎起居，节饮食，适寒温，晨酒夜食，切忌太过。或有不快，即服正气散一二剂，则脾胃自壮，气血通畅，微邪速散，又何瘴之有。 吴兴章杰岭表十说：一曰岭表之俗，食槟榔，甚者日至十数枚。盖瘴疟之作，率由饮食过度，气滞痰结，而槟榔最能下气消食去痰，故人皆狃于近利，而暗于远患。此颇类北人之食酪酥，多致肤理致密。一旦病疫，当汗，则塞而不得出。峤南地热食槟榔，故藏气疏泄。若一旦病瘴，当攻发，则虚羸而不能堪。所以土人多瘠而色黄，岂全是气候所致，盖亦槟榔为患。殆勿思耳。 二曰《本草》载三人触雾晨行，饮酒者独不病。（吴又可《温疫论》引此文、谓饱食者不病，所记异也。）故北人度岭、率相勉饮酒，而迁客羁士，往往醺酣以自适。且岭外酒价尤廉，贩夫役卒，俱得肆饮，咸谓可以辟瘴，殊不知少则益，而多则滋瘴之源也。何以言之。盖南土暑湿，嗜酒则多中湿毒，兼以瘴疟之作，率因上膈痰饮，而酒则尤能聚痰。岭外谚云：莫饮卯时酒，莫食申时饭，诚摄生之要也。可见酒之为物，能辟瘴以生人，亦能滋瘴以害人。然则生也死也，非酒也，顾在人也。 三曰广南每以暑毒为患者。盖一岁之间，暑滋过半，使人难避而易犯。凡起居饮食少失节度，则为暑毒所中。道途之间，尤多冒暑，故土人于暑时相戒勿出。且遐荒之境，道路崎岖，而传舍饮食，皆不如欲，所以自北初至者，皆云不习水土而病，及既还则又谓之回头瘴。大率得之道路劳倦，冒犯暑气，与夫饮食居处失度也。 四曰岭南寒暑之候不常，尤难于调摄。故凡居人与在路者，冬夏之衣，皆不可缺，随其气候，速宜增减，缓则致病。又岭外海风异常，稍中人则为病，坐卧易衣时当慎也。 五曰岭外虽以多暑为病，而四时亦有伤寒温疫之疾，其类不一。土人不问何疾，悉谓之瘴，治疗多误。或有一岁盛寒，近类中州，而土俗素无蚕绩，冬不衣绵，居室疏漏，户扃不固，忽遭岁寒，则次年温疫必兴。医者之治温疫，亦当以本法治之，（此即伏邪，当详伏邪门治法治之。）而随风土气候，人之强弱，酌宜可也。 六曰瘴疟之作，多因伏暑伤冷所致。纵非饮食冷物，亦必寒邪感于外，饮食伤于内也。大抵伏暑浅而寒多者易治，伏暑深而热多者难治。近时北医至此，用大柴胡汤治热瘴，须是本气壮实者乃能堪之。如土人久服槟榔，脏气既虚，往往不能服寒药，又能当此峻剂乎。然土人才见发黄，便谓不治之疾，良可哀也。 七曰北人之来岭南，婢仆多病瘴气。盖劳役之人，饮食乖度，昼多冒暑，夜多卧地，又凡事不能避忌，故先受其毙。即与之同休戚，宜加意戒之。 八曰俚俗有病，必召巫觋而祭鬼神，士大夫咸笑其信巫不信医，愚谓此可悯恻而不可笑也。夫民虽至愚，孰不思趋利避害，况性命所系，晓然易见。若医者能愈人疾，彼何不信。盖岭外良医甚鲜，药石艰难，且山谷海峡之民，何从而得医药，所以不免信巫也。岂得已哉。 九曰瘴病不一，而土人以哑瘴最为危急。其状初得之即失音，不过一二日即致不救。医家多言为极热所致，或云内蕴热而外为感寒所激。近见北医有用生附子一味愈此疾者，得非以热治热，或是发散寒气耶。（此即阴盛格阳之类。）予尝闻有饮溪涧水中毒，令人失音，则知凡失音者，未必皆瘴也。溪涧水毒，灼然有之。道路无井泉，而濒海之民与夫山行者，皆饮溪涧之水，岂无邂逅遇毒者。故途人所以多病，此得非是欤。（与即含沙射影之类，当以沙毒门诸法治之。） 十曰传云岭外多毒草，彘食之而人食其肉者亦毒人，所以北人度岭，多戒食彘。然岭南能致瘴毒者，非止一端，岂独彘哉。顺泉云：岭南之彘在市井者，食豆与酒糟，在乡村者，食糠与碎米芊苗，未有食草者。若以食草为戒，则马牛羊之肉，俱不可食耶。此其不足信也。 继洪曰：予寓岭南既久，愈知瘴疾不易用药。若身热而复寒，谓之冷瘴，不换金正气散主之。若身热胸痞，或呕或噎，大便不利者，嘉禾散。若病轻而有食积者，兼用感应丸。无食积不用。若病重者，不可妄用转利，惟当温中固下。若冬末春初因寒而作大热者，小柴胡汤。夏月因暑者，六和汤。若身极热而头极痛脉数者为热瘴，宜用南人挑草子法，亦不可不服药。第此证病深，最为难治。盖凉药多不可用，惟宜热药，须得法以用之。如附子汤冷服者是也。然此非工巧以处之则不可。如身热汗不多，头痛未解，或且与和解散。如腰以上极热，腰以下稍凉，胸膈烦渴，腰腿重疼，或大便溏滑，其脉数而按之不实，此阳浮阴闭也。惟李待诏生姜附子汤最妙。（此阴盛格阳之属。）凡初病者，以生姜、附子能发散耳。若病经去汗既多，虚烦潮上，则惟恐其不敛不降，宜用熟附、干姜、沉香冷服之。若便利则不用沉香，如烦甚则少加竹茹，渴甚多加人参、北五味，呃逆加丁香、淡竹茹。若烦躁而有异象眩惑，夜不安寝，可与温胆汤，惟大便利者不可服。若至四肢厥冷，两足冷甚，头额虚汗，时或呃逆，脉数而促，其证多危。惟以三建汤之属，能敛心液，能壮元阳，可以更生也。又有哑瘴，即热瘴之甚者。医书谓血得寒则凝泣，得热则淖溢，故热瘴面赤心热，舌破鼻衄，皆瘴热沸其血上涌所致，故宜用挑草子法。甚则血上塞其心窍，故昏不能言，或但噫噫作声，即哑瘴也。治此者当散其血，用局方黑神散，立见神效。其或涎迷心窍，而舌强者亦有之，却非真哑瘴也。及兼风痰之证者，俱当审察而后用药。 杨仁斋曰：瘴疟，挟岚瘴溪源蒸毒之气致然也。自岭以南，地毒苦炎，燥湿不常，人多瘴疟。其状血乘上焦，病欲来时，令人迷困，甚则发躁狂妄，亦有哑不能言者，皆由败血瘀于心，毒涎聚于脾。 戴复庵曰：近时因寒热发作，见其指甲青黑，遂名曰沙。或戛或挑，或灌以油茶，且禁其服药。此病即是南方瘴气，生料平胃散加草果、槟榔，正其所宜，岂有病而无药者哉。 蒋宝素曰：瘴气者，经旨所无，乃岭表方隅之疾。炎蒸湿郁，虫蛇毒气，上腾如雾，中人为患，类乎伏邪痎疟沙毒之证也。《后汉书》有薏苡解瘴之说，治其湿也。《圣济总录》、杨士瀛《直指》有瘴之名，用赤足蜈蚣、白芷治之，竟作蛇毒。《活人》三昧论，巢元方、杨仁斋有阴阳相搏之气，杂毒因暖而生岚瘴溪源蒸毒之语，亦以炎蒸气毒为主。王棐、继洪有寒瘴热瘴哑瘴之辨，及挑草子法，分其形证论治。沈存中、李待诏每用附子奏捷。盖岭南阳气外越，证多阴盛格阳，扶阳抑阴近理。然又云目黄赤者，不可用附子，亦有当汗下者，则此中表里寒热虚实无所不有，当以伏邪痎疟沙毒诸法参治。吴兴章杰岭表十说颇详，戴复庵言寒热作时，指甲青黑，是南方瘴气。诸家所论如是，余亦未历其境，难凭臆说。故故业师医案，家君医话，均未及此。谨录前哲精义于此，以俟国工君子。 略曰：砭曲池出血，北人谓之打寒，治伤寒温疫。刺头额上下唇出血，岭南谓之挑草子，治瘴气。挤眉心、承浆、胸前背后、出红斑，近代谓之挤沙，治感冒。（或用碗蘸香油刮诸处名刮沙，亦有用针挑者。）三者相似。然瘴与沙更近，则沙毒门射影丸、含沙散，治瘴可通用也。
The "Book of Later Han: Biography of Ma Yuan" records: When Ma Yuan was in Jiaozhi, he once consumed Coicis Semen (Yiyiren, 薏苡仁), stating that it could lighten the body and boost vitality to resist Zang Qi (miasma).
The "San Mei Lun" chapter of the *Huoren Shu* states: If diet is regulated and daily life follows a routine, pathogenic factors cannot harm the body. In areas where roads are rugged, population is sparse, drinking water is unclean, and food and drink are often fishy or greasy, people's diet and lifestyle inevitably deviate from moderation. Moreover, there exists the qi of Yin-Yang struggling against each other; hence it is called Zang Qi. Only those whose healthy qi has been damaged by labor and hunger can contract it; this is the reason.
The *Shengji Zonglu* records: There is a type of Zang disease in Lingnan called Poshé Zang (Snake Miasma), also known as Suohou Zang (Throat-Locking Miasma), characterized by swelling and pain in the neck extending to the throat. Using one or two segments of Eupolyphaga seu Aspidosperma (Chi Zu Wu Gong, 赤足蜈蚣), ground into fine powder, taken with water, leads to immediate recovery.
Chao Yuanyuan stated: The Qingcao Huangmang Zang (Green Grass Yellow Spike Miasma) in Lingnan is similar to Shanghan (Cold Damage) in regions north of the mountains. The south is warm and low-lying; thus, during the period governed by Taiyin (Spleen/Stomach Earth), grass and trees do not wither and fall, and hibernating animals do not hide away. Various toxins arise due to the warmth.
He further said: Zhang Nue (Miasma Malaria) originates in Lingnan, carrying the qi of mountain miasma. Its symptoms include alternating chills and fever occurring at regular intervals. This is caused by the damp-toxic qi of mountain streams, plains, and ridges. This illness is more severe than malaria caused by heatstroke.
Yang Shiyin in the *Zhizhi Fang* stated: Biaochuang (Bubonic Plague/Snake Zang), also named Shezhang (Snake Miasma), occurs frequently in regions of misty smoke and miasma rain where toxins abound. People who fail to adapt to the local climate and wind may contract these pathogens. After several months, Shezhang will manifest. Only Chi Zu Wu Gong (Eupolyphaga seu Aspidosperma) is most effective in subduing snake venom and is considered the superior herb; Bai Zhi (Angelicae Dahuricae Radix) is secondary.
Li Daizhao of Daliang in his *Zhang Nue Lun* stated: Lingnan is not only known as a hot region but also borders the sea. The land is low and the soil thin. In such hot regions with thin soil, Yang heat qi often escapes outward; in low-lying coastal areas, Yin damp qi often prevails. These two types of qi struggle against each other, giving rise to alternating chills and fever. Because Yang qi escapes, there is no frost or snow in winter, and flowers bloom in all four seasons. People living there experience qi stagnation rising upward, excessive sweating, and loose interstices (Couli), because Yang qi fails to return to its root. Because Yin damp qi prevails, mornings and evenings are foggy, spring and summer bring excessive rain, and steaming humidity accounts for over half the year. Even during the Sanfu days, it is not particularly hot; continuous rain in midsummer brings chilliness. Food, clothing, and medicines often mold. People living here mostly contract dampness. They suffer from heavy limbs and fatigue, and frequently develop Jiaoqi (Beriberi/Lower Limb Weakness). This is because Yin qi often predominates. Since Yin and Yang qi are biased and struggle, humans consequently contract diseases of uneven chills and fever. Furthermore, when Yang warmth escapes, it weakens the person's fundamental qi. Yang qi does not descend but floats upward, causing patients to feel oppression in the upper epigastrium and empty irritability in the chest. When Yin dampness prevails, the lower body becomes cold. Yin qi does not ascend but sinks downward, causing patients to have heavy, painful loins and knees, and cold,厥逆 (cold reversal) legs and feet. Observing Lingnan Zang diseases, although symptoms vary, the vast majority present with impaired ascending and descending of Yin and Yang, featuring upper heat and lower cold. Since the human body is naturally Yang above and Yin below, contracting this discordant qi of Yang warmth and Yin dampness naturally leads to upper heat and lower cold syndromes. The cause of illness lies in insecure Yang qi. Each episode of chills and fever causes profuse sweating. If one then administers diaphoretic formulas like Mahuang Tang (Ephedra Decoction), Jinfei San (Boiling Herb Powder), or Qinglong Tang (Azure Dragon Decoction) to disperse the exterior again, death ensues quickly. In severe cases, if chest fullness is treated with purgatives, given the patient's already cold lower body, death is inevitable. Such outcomes are iatrogenic harms. At that time, I contracted Zang disease, and my whole family suffered severely. I treated them all with herbs that warm the middle and secure the lower, regulating the upright qi of Yin and Yang. All ten recovered. Two servants suffered from chest fullness, irritability, and coma. One requested cooling herbs for the diaphragm. Upon examining the syndrome, I identified it as upper heat and lower cold, and prescribed Shengjiang Fuzi Tang (Ginger and Aconite Decoction) to be taken cool. Both woke up that day. They claimed their diaphragm felt cool due to cooling herbs, unaware it was actually the effect of Fuzi (Aconiti Lateralis Radix Praeparata). The next day, I gave each a pill of Danzhu Wan (Cinnabar Pill) on an empty stomach, after which they could eat congee. Then, using Zhengqi San (Righteous Qi Powder) and Pingwei San (Stomach-Pacifying Powder), they recovered completely. I treated over ten others similarly. Generally, when Fuzi is decocted with Shengjiang (Fresh Ginger), it can disperse pathogens, attack heat with heat, guide deficient heat to the lower jiao, eliminate old cold, and consolidate primordial qi. For those with oppressiveness, take it cool. For those with irritability, no desire to drink, and aversion to cold fluids, this indicates deficient heat, not true heat. Jiang Fu Tang (Ginger and Aconite Decoction) is appropriate. Shen Cunzhong used Qizao Tang (Seven Date Decoction) for Zang disease, achieving similar results with one dose. However, Shufu Tang (Atractylodes and Aconite Decoction) sometimes worsened the condition because the combination consolidates heat rather than dispersing it; using Fuzi alone is best.
He further stated: If pulse and symptoms indicate it is truly not upper heat and lower cold, but the eyes are yellow and red, Fuzi should not be used. If the pulse is floating, surging, and rapid, with alternating chills and fever and no sweat, this is a Xiaochaihu Tang (Minor Bupleurum Decoction) syndrome. If the syndrome is doubtful and chills/fever are indistinguishable, Jiahe San (Harvesting Grain Powder) is suitable. Take it cool if heat predominates. Jiahe San regulates middle qi, ascends and descends Yin and Yang, treats deficiency below and fullness in the middle, and manages seasonal epidemic cold damage, preventing progression. It even cures heatstroke and Yang-pattern cold damage. It is especially suitable if cold predominates. After two to three doses, the nature of chills and fever becomes clear. Subsequent treatment based on the syndrome ensures recovery. Generally, Lingnan is low and damp. People consume Binglang (Arecae Semen), which promotes qi movement but makes the constitution loose. With sweating throughout the year, diaphoretics are contraindicated. This logic is clear. Although some cases require diaphoresis or purgation, they are rare. Wise practitioners observe this.
Wang Fei of Xin'an in the *Zhimi Fang · Zhang Nue Lun* stated: Besides reading, I paid attention to medicine and inherited knowledge, becoming familiar with formulas and pulses. Sent to the South, I studied this condition. Southerners call all illnesses "Zang" and usually refuse medication, relying on spirits. However, Zang disease is like Shanghan. How can one ignore it? Many die due to delayed TCM treatment. South of Guilin, medical care is scarce. Southerners sweat excessively, leading to excess above and deficiency below; thus, diaphoresis, emesis, and purgation are contraindicated. Local doctors are few and incompetent. Misusing these three methods constitutes "making the deficient deficient." Medical texts state that southern weather is warm and humid, earth qi is stagnant, Yin is closed, and Yang is released. Plants and water absorb evil qi. Humans living there have insecure fundamental qi and contract illness, called Zang. Mild cases involve alternating chills and fever, resembling Jie Nue (Intermittent Malaria), called Lengzhang (Cold Zang). Severe cases involve deep heat, feeling like lying in ashes day and night, called Rezhang (Hot Zang). Most severe is Yazhang (Mute Zang), where loss of voice occurs immediately upon onset. Medical texts claim Cold Zang is never fatal, Hot Zang dies after a long time, and Mute Zang is always fatal. However, I believe Mute Zang resembles loss of voice in Shanghan or stroke. With proper treatment, survival is possible. Hot Zang occurs in mid-summer to early autumn in dense vegetation paths without shade or water, causing severe latent heatstroke. Alcohol abuse or eating fried foods can trigger it. Heat persists day and night; if delayed 2-3 days, blood coagulates and becomes incurable. Locals call this "Arrow Strike" or "Grass Seed Strike." Treatment involves pricking the forehead, upper/lower lips, and rubbing the tongue with Broussonetia papyrifera leaves to bleed, followed by herbal cooling. Recovery is swift. Regarding Cold Zang, whether cold-dominant or heat-dominant, or intermittent, it often heals with lip sores. It is essentially external malaria, not severe, but misdiagnosis causes disaster. Do not ignore it just because it's rarely fatal. If pulse is extremely faint and fundamental qi is deficient, Fuzi Tang restores health. Misusing cold herbs ("Chengqi entering the stomach, Yin excess leads to death") is dangerous. If pulse is surging and syndrome is excess heat, use harmonizing herbs slowly. Misusing hot herbs ("Guizhi swallowing, Yang excess leads to death") is fatal. Accurate pulse diagnosis and differentiation of cold/heat/deficiency/excess ensure cure. Some say Lingnan's environmental toxins cause illness in visitors. Locals adapt, but outsiders get sick. Adaptation prevents illness. However, with proper care and mild herbs, prevention is assured. Interestingly, locals suffer more than visitors due to licentiousness, cold baths, and dietary indiscretion. Illness stems from lack of self-discipline, not just environment. Gentlemen should regulate lifestyle, diet, and temperature. Taking Zhengqi San strengthens spleen/stomach, moves qi/blood, and dispels minor pathogens.
Zhang Jie of Wuxing in *Lingbiao Shi Shuo*: First, locals chew Binglang (Arecae Semen), up to ten times daily. Miasma arises from dietary excess, qi stagnation, and phlegm. Binglang resolves this. Locals rely on this short-term benefit, ignoring long-term harm. Like Northerners eating dairy, it thickens skin. Once epidemics strike, sweating is blocked. Southern heat plus Binglang makes internal organs loose. If attacked by miasma requiring dispersion, the weakened body cannot withstand it. Hence locals are thin and sallow, partly due to Binglang.
Second, Materia Medica records that three men walking in morning mist did not get sick if one drank wine. Northerners crossing the ridge encourage drinking. Exiles drink to comfort themselves. Wine is cheap in Lingnan; laborers drink freely believing it wards off miasma. However, small amounts help; large amounts generate miasma. Southern damp-heat combined with alcohol creates damp-toxin. Miasma often involves upper diaphragm phlegm-fluids, which alcohol gathers. Proverb: "Do not drink at Mao hour (5-7 AM), do not eat at Shen hour (3-5 PM)." Wine can save or kill depending on usage.
Third, Guangnan suffers from Summer-Toxin. Heat dominates half the year. Improper lifestyle invites toxin. Travelers expose themselves to heat. Locals avoid going out in summer. Remote areas have poor roads and food. Newcomers complain of maladaptation ("Huitou Zhang" - Return Miasma). Causes include travel fatigue, heat exposure, and improper diet/living.
Fourth, Lingnan's climate is unpredictable. Winter and summer clothes are essential. Adjust quickly to weather changes. Sea winds are abnormal; changing clothes while sitting/lying requires caution.
Fifth, besides heat, Lingnan has seasonal cold and epidemic diseases. Locals label everything "Zang," leading to misdiagnosis. Cold winters resemble Central Plains. Lack of winter clothing and poor housing lead to next-year epidemics. Treat epidemics according to standard methods (latent pathogens), adjusting for local climate and individual strength.
Sixth, Zang Nue often results from latent heatstroke and cold injury. Even without cold food, external cold and internal dietary injury occur. Latent heat with more cold is easy to treat; deep latent heat with more fire is hard. Northern doctors using Dachaihu Tang (Major Bupleurum Decoction) for Hot Zang must ensure strong constitution. Locals taking Binglang long-term have weak organs and cannot tolerate cold/herbs or harsh formulas. Locals seeing jaundice despair, which is pitiable.
Seventh, Northern visitors' servants often contract Zang. Laborers with poor diet, daytime heat exposure, and sleeping on the ground are vulnerable. Share their fate and warn them.
Eighth, commoners summon shamans instead of doctors. Scholars mock this, but it is pitiable. People seek to avoid harm. If doctors worked, they would trust them. Few good doctors exist in Lingnan; medicine is scarce. Mountain/coastal people lack access. Shamanism is a last resort.
Ninth, Yazhang (Mute Zang) is critical. Immediate voice loss leads to death in 1-2 days. Doctors attribute it to extreme heat or internal heat triggered by external cold. Recently, Northern doctors cured it with raw Fuzi (Aconiti Radix), possibly using heat to treat heat or dispersing cold (Yin excess repelling Yang). I heard of stream water poisoning causing voice loss. Not all voice loss is Zang. Stream water toxicity is real. Coastal/mountain people drink stream water. Poisoning explains many illnesses. Similar to "Shadow Shooting" toxin; treat with Sand Toxin methods.
Tenth, legends say Lingnan has toxic plants eaten by pigs, making pork toxic. Northerners avoid pork. But Zang toxins come from many sources, not just pigs. Shunquan noted market pigs eat beans/dregs, rural pigs eat bran/rice/grass shoots, not grass. Avoiding pork based on grass-eating is illogical.
Ji Hong stated: Living in Lingnan long taught me that treating Zang is difficult. Chills after fever is Lengzhang (Cold Zang); treat with Buhuanjin Zhengqi San. Fever with chest fullness, vomiting, or constipation is treated with Jiahe San. Mild cases with food stagnation add Yinggan Wan. No food stagnation, do not use. Severe cases: do not use purgatives; warm the middle and secure the lower. Late winter/early spring fever from cold: Xiaochaihu Tang. Summer heat: Liuhe Tang. Extreme fever, headache, rapid pulse is Rezhang (Hot Zang); use local "Prick Grass Seed" method and medication. Deep illness, hard to treat. Cooling herbs are generally contraindicated; use hot herbs correctly, e.g., Fuzi Tang taken cool. Requires skill. If fever, little sweat, unresolved headache, try Hejie San. Upper body hot, lower body cool, chest thirst, heavy legs, loose stool, rapid/empty pulse indicates floating Yang and closed Yin. Li Daizhao's Shengjiang Fuzi Tang is best (Yin excess repelling Yang). Early stage: Ginger/Aconite disperses. Post-sweat deficiency with floating irritability: use prepared Fuzi, dried Ginger, Chenxiang taken cool. If normal bowel movement, omit Chenxiang. Add Zhuru (Bambusae Caulis in Recens) for severe irritability, Renshen (Ginseng Radix et Rhizoma) and Wuweizi (Schisandrae Fructus) for thirst, Dingxiang (Caryophylli Flos) and Zhuru for hiccups. Restlessness with dizziness/poor sleep: Wendan Tang (unless diarrhea). Cold limbs, cold feet, forehead sweat, hiccups, rapid/faltering pulse: critical. Use Sanjian Tang (Three Jian Decoction) to consolidate heart fluid and strengthen primordial qi. Yazhang is severe Rezhang. Blood coagulates with cold, flows with heat. Hot Zang causes red face, heart heat, tongue ulcers, nosebleeds from boiling blood. Use Prick Grass Seed method. If blood blocks heart orifices, coma/silence occurs. Disperse blood with Heishen San (Black Divine Powder). Phlegm confusing heart/orifice stiffness is not true Yazhang. Differentiate wind-phlegm before treating.
Yang Renzhai stated: Zhang Nue is caused by mountain mist and stream vapor toxins. South of the ridge, land is toxic and hot, dry/wet irregular. Blood rises to upper jiao. Before onset, confusion occurs; severe cases involve mania or muteness. Caused by failed blood stasis in heart and toxic phlegm in spleen.
Dai Fu'an stated: Recent cases of chills/fever with blue-black nails were called "Sha." Treated by scraping/pricking or tea oil, forbidding meds. This is Southern Zang Qi. Shengliao Pingwei San (Raw Stomach-Pacifying Powder) plus Cao Guo (Tsaoko Fructus) and Binglang is appropriate. Why deny medicine?
Jiang Baosu stated: Zang Qi is not in classics but is a regional Lingnan disease. Heat/humidity stagnation and insect/snake toxins rise like fog, harming humans. Resembles latent pathogen, Jie Nue, or Sha Toxin. *Later Han* mentions Coix seed for dampness. *Shengji Zonglu* and Yang Shiyin use centipede/Bai Zhi for snake venom. *Huoren Shu*, Chao Yuanyuan, and Yang Renzhai discuss Yin-Yang struggle and warm-generated toxins. Wang Fei and Ji Hong differentiate Cold/Hot/Mute Zang and use Prick Grass Seed method. Shen Cunzhong and Li Daizhao succeed with Fuzi. Lingnan Yang qi escapes, causing Yin excess repelling Yang; supporting Yang is logical. However, yellow/red eyes contraindicate Fuzi. Diaphoresis/purgation may be needed. Table/interior/cold/heat/deficiency/excess are all present. Treat with latent pathogen/Jie Nue/Sha Toxin methods. Zhang Jie's *Ten Sayings* are detailed. Dai Fu'an links blue-black nails to Zang Qi. I haven't visited Lingnan, so I record past masters' wisdom for experts.
Briefly: Pricking Quchi (Quchi, LI11) to bleed is called "Da Han" (Beating Cold) in the North for Shanghan/Epidemics. Pricking forehead/lips to bleed is "Tiao Caozi" (Pricking Grass Seeds) in Lingnan for Zang Qi. Squeezing eyebrows, Chengjiang (Chengjiang, CV24), chest/back for red spots is "Ji Sha" (Squeezing Sand) for colds (or Gua Sha scraping). These are similar. Zang and Sha are close; Sha Toxin formulas (Sheying Wan, Hansha San) can treat Zang.