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Chen Sansan treated a government official surnamed Wang, the Governor-General. He had contracted miasma (mountain miasma), presenting with alternating chills and fever (alternating chills and fever), headache, fullness and oppression in the chest and diaphragm, dizziness, and nausea. The pulse was rapid and surging. He prescribed Huoxiang Zhengqi San (Agastache Powder to Rectify the Qi) with added Houpo (Magnolia Bark), Binglang (Areca Seed), Qianghuo (Notopterygium Rhizome), Fangfeng (Saposhnikovia Root), and Zisuye (Perilla Leaf). After one dose, the alternating chills and fever subsided, and the headache ceased. Qianghuo, Zisu, and Fangfeng were removed, and Doukou (Grass Cardamom), Banxia (Pinellia Tuber), and Zhike (Aurantium Fruit) were added. The nausea and distension completely resolved.

He also treated a patient surnamed Fang from Wuzhou. Symptoms included headache, body pain, fever, nausea, and fullness/oppression. The pulse was wiry and rapid. He prescribed Qianghuo, Fangfeng, Xiong (Ligusticum Chuanxiong Rhizome), Zisu, Huoxiang, Banxia, Binglang, Cangzhu (Atractylodes Rhizome), Houpo, Chenpi (Tangerine Peel), and Gancao (Licorice Root). After two doses, symptoms decreased. Because the bloating had not fully resolved, Caoguo (Black Cardamom) and Doukou were added. Only then did the condition resolve. It must be understood that nausea and bloating are characteristics distinguishing miasma disease from common colds.

Li Biejia of Duanzhou, a member of the Plain Blue Banner, was over forty years old. He was skilled in horsemanship and archery. While serving as acting Prefect of Leizhou, he was adept at fighting tigers, braving wind, rain, cold, and heat, wading through streams, and climbing ridges. He had deeply contracted miasma. His exposure to wind, cold, summer-heat, and dampness was extensive. Additionally, due to visiting superiors, he became exhausted traveling to the provincial capital. The accumulated pathogenic factors suddenly manifested. Physicians initially provided mild dispersing treatments, followed immediately by tonifying agents, which caused the pathogenic factors to flare up severely. Symptoms included alternating chills and fever, coma, delirium, a hollow and rapid pulse without root, and scattered spirit. Physicians attempted both tonification and purgation simultaneously with no effect. Chen Sansan diagnosed the pulse as resembling soup floating on water, indicating imminent collapse. Alternating chills and fever occurred intermittently. Since the disease was deep-seated, both essence and qi were deficient, while pathogenic factors were vigorous, this case was deemed untreatable according to standard methods. Reluctantly, he formulated Wuji San (Five Accumulations Powder) with added Fuzi (Aconite Lateral Root) and Renshen (Ginseng Root), removing Mahuang (Ephedra Stem) and substituting it with Qianghuo. The family showed reluctance at the prescription and did not use it. Subsequent physicians identified it as Yin malaria with Yang deficiency and administered Jin Gui Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet) with Renshen. Others considered it a deficiency syndrome resembling malaria and used Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with doubled Renshen and Fuzi. After three doses, coma, asthma, profuse sweating like rain, and cold feet led to death. They failed to realize that the initial cause was real miasma infection, repeatedly contracting deeper pathogens, now manifesting upon deficiency. As the ancients said, "Shanghan (Cold Damage) tends to kill those with lower deficiency." How much more so for miasma involving wind, cold, summer-heat, and dampness?

The son of the Governor-General of Liangguang was only ten years old. In June, he contracted wind and summer-heat, presenting with alternating chills and fever and headache. Ge Gen Jia Qianghuo Fangfeng Tang (Kudzu Decoction plus Notopterygium and Saposhnikovia) was used to release the exterior. Later, alternating chills and fever persisted, accompanied by asthma and abdominal distension. Xiao Chai Hu Tang (Minor Bupleurum Decoction) with digestive aids was ineffective. Coma, urgent breathing, intermittent alternating chills and fever, occasional dysentery-like diarrhea, and abdominal pain ensued. The nature of the disease was unknown. Chen Sansan visited after more than twenty days. The pulse was rapid and powerless; the spirit was confused. The whole family was panicked. Abdominal palpation revealed intermittent pain and distension. Observation of the spirit showed alternating calmness and agitation. Hands and feet were alternately cold and hot, with incessant spontaneous sweating. This indicated that while external pathogens were initially dispersed by medication, long-standing accumulated pathogens were not cleared, compounded by dietary irregularities leading to impending collapse of Yuan Qi (Original Qi). Thus, deficiency signs were prominent. Careful consideration of external pathogens sinking inward and transforming revealed depleted Yuan Qi. Saving the root was urgent. First, stabilize the Yuan Shen (Original Spirit), then plan treatment. Lizhong Tang (Regulate the Middle Decoction) with Guizhi (Cinnamon Twig) and Fuzi was used. Abdominal pain eased slightly, diarrhea decreased sharply, and hands and feet warmed. However, fever persisted, and urine was red, turbid, and difficult to pass. Jin Gui Shen Qi Wan was prepared as a decoction. After two doses, urination improved, but alternating chills and fever worsened. This indicated gradual recovery of Yuan Qi, causing latent pathogens to surface. Wind, cold, summer-heat, dampness, and food stagnation were all unclear. To restore the root, variations were necessary. Morning: Liujunzi Tang (Six Gentlemen Decoction) with Chaihu (Bupleurum Root), Gegen, Shenqu (Medicated Leaven), and Shengjiang (Fresh Ginger). Evening: Liuwei Dihuang Tang (Six-Ingredient Rehmannia Decoction) with Renshen and Guizhi. Ten days later, cold rigors, muscle spasms, eyes rolling back, teeth grinding, and groaning occurred. The family feared death. Chen Sansan stated: "This is called 'Han Zhan' (Cold Rigors). It indicates returning righteous Qi and expelling accumulated pathogens. A transformation occurs, offering a chance for recovery." From 9 AM to 5 PM, profuse sweating like rain occurred. Hands and feet became soft and limp; he fell into silent sleep. Although the family calmed somewhat, anxiety remained. Speech resumed at dawn. As deficiency symptoms changed daily, with tidal fever and profuse sweating, Buzhong Yiqi Tang combined with Jianzhong Tang (Establish the Middle Decoction) plus Fuzi was used. For insomnia, Guipi Tang (Restore the Spleen Decoction) was used. For weak Yuan Qi, Shiquan Dabu Tang (Ten Great Tonics Decoction) was used. For abdominal pain and slippery diarrhea, Lizhong Tang combined with Liujunzi Tang was used. After three months of such regulation, restoration was achieved.

Yu Zhen commented: Miasma is toxic air condensed from mountain mists. Why use warm tonification? Especially since the child was young and external pathogens were vigorous, yet Renshen, Shengjiang, Guizhi, and Fuzi were effective. This is remarkable. Only those familiar with local climate and pathology would dare try this. Chen Sansan also noted: This condition differs significantly from external invasions and internal injuries in Jiangsu, Zhejiang, Hubei, Henan, and northern provinces. Miasma is the root cause, leading to different transformations. Physicians must have unique insights, study carefully, and consult various treatises to gain understanding.

Official Sun of the Plain Red Banner had been ill for over a month. Chen Sansan found his pulse hollow, fluctuating, and rootless upon deep pressure. He presented with coma, delirium, severe alternating chills and fever, cough, phlegm, asthma, inability to turn, constant groaning while leaning on the desk, chest fullness, cold feet, and aversion to cold. History revealed accumulation of fatigue during summer and autumn, exposure to cold and heat. One month prior, initial symptoms were headache, body pain, aversion to cold, high fever, and cough. Physicians used Jiegeng (Platycodon Root), Xingren (Apricot Seed), Gegen, Qianghuo, and Zisu to induce sweat without relief. Then Sangbaipi (Mulberry Bark), Qianhu (Peucedanum Root), Suzi (Perilla Seed), Chenpi, Banxia, Zhimu (Anemarrhena Rhizome), Beimu (Fritillaria Bulb), and Huangqin (Scutellaria Root) were used without success. Due to worsening chills and fever, Xiao Chai Hu Tang with Zhizi (Gardenia Fruit), Xuanshen (Scrophularia Root), and Bohe (Mint Leaf) was used to clear phlegm and reduce fever, worsening the cough. The condition resulted from simultaneous contraction of summer-heat, dampness, wind, and cold in summer/autumn, without sweating, hence dispersal failed. Wuji San was prescribed. After two doses, profuse sweating occurred, cough decreased, and he could rest on a pillow. Alternating chills and fever persisted. Long-standing deep disease depleted Yuan Qi, causing upward rushing of Qi, oily short frequent urination. Fire rose from below, creating upper excess and lower deficiency, with exhausted Kidney Qi. Jin Gui Shen Qi Wan with Chenxiang (Aquilaria Wood) was used. After two doses, breathing normalized, and urination improved. However, tidal fever persisted, along with muttering and forgetfulness. Mental energy was scattered, requiring strong tonification. Afternoon: Shenfu Liujunzi Tang (Ginseng and Aconite Six Gentlemen Decoction); Morning: Shenqi Wan. Administered sequentially for a month. Appetite returned, muttering ceased, sweating stopped, spirit stabilized, and recognition of acquaintances resumed. Total usage of Renshen and Fuzi amounted to about one jin. Spirit partially recovered. Face was dark red, skin lacked luster. Huanshao Dan (Return to Youth Pill) with Guizhi, Fuzi, Heche (Placenta), and Lujiaojiao (Deer Antler Glue) was used. After a month, Shiquan Dabu Tang was given for over twenty doses. Yuan Qi grew daily, and diet normalized.

Yu Zhen commented: Chen Sansan stated this case resembled that of Li Biejia. Li died due to distrust of the prescription. Had Li trusted it, large warm and tonifying methods would have been used. Such treatment for miasma is shocking. Perhaps in Liangguang, warm and humid climates promote dispersion without storage, causing Yang Qi to escape outward. Thus, severe cases are often treated as Yang collapse.

In November of the Wuyin year of Kangxi's reign, the son of Salt Commissioner Gao suffered from dysentery-like symptoms but not true dysentery: more red blood than white mucus, aversion to cold, and slight fever. History revealed travel from Northern Sichuan to Guangdong during summer/autumn, accumulating damp-heat, triggered by external contraction. Pingwei San (Peace the Stomach Powder) with Qianghuo, Fangfeng, Zisu, and Huoxiang was used. One dose resolved chills and fever. Adding Binglang and Muxiang cured the condition. Some asked: Dryness-inducing herbs are contraindicated in dysentery. Why did Cangzhu work? Answer: Common dysentery stems from summer heat/fire, making dryness contraindicated. Here, accumulated dampness manifested in winter with external contraction, making these herbs effective. Treating the root is essential.

The brother of Zhou Xihou, a chess master from Liangxi, managed a copper mine in Yingde. Water from the mountain base cleaned clothes effectively. Locals used it for cooking. Soon, people became yellow and puffy, weak, with abdominal distension, increased appetite, alternating chills and fever, and craving meat for stomach comfort. Colleagues died frequently. Seeking help from Chen Sansan in the provincial capital, Pingwei Zhengqi was used. Later, Yiqi Liujunzi was used to replenish deficits caused by toxic water. This exemplifies toxic water miasma in Taiping, Liuzhou, and Nanning, Western Guangdong.

Several miners returning to the province fell ill similarly. One, surnamed Chen, resembled malaria but was treated as malaria, worsening. Chen Sansan found a fine, tight, rapid pulse and anorexia. He remarked: "Why not treat a month ago when Yuan Qi was still present despite severe illness? Now the disease is deep, spirit exhausted. What medicine can be applied?" He soon died.

Another colleague had dysentery-like symptoms with alternating chills and fever. Physicians used Xianglian Wan (Coptis and Aucklandia Pill), Xiaoshi (Digestive clearing), and Xiaohuang (Purgation), worsening the condition. Another physician suggested tonification: Baizhu (Atractylodes Macrocephala Rhizome) 5 fen, Fuling (Poria), Chenpi 2 fen. Disease was mild, but fever persisted. Chen Sansan found a fluctuating pulse, absent upon deep pressure. Though eating was okay, he was a "walking corpse." Floating pathogenic fire, exhausted essence. Chen declined treatment. The patient died two days later.

Yu Zhen commented: Miasma presents variably; only those who have experienced it locally can understand. Thus, I dare not judge arbitrarily. Chen Sansan traveled extensively in Liangguang and described these cases in detail. Previously unrecorded, they are listed here.

"Zhang" (Miasma) means obstruction. Natural Qi of heaven and earth is obstructed by high mountains and steep ridges, failing to circulate freely. Combined with spring and early summer, when all things generate, chaotic and stagnant Qi leads to widespread infection. Travelers suffer more than those at home. In Xianxia (Fujian) and Yuling (Guangdong), Yang is closed by Yin, resulting mostly in Yang Miasma. In Western Guangdong near Gaoleilian, residual Qi from Eastern Guangdong causes similar syndromes. In Qingyuan, Liuzhou, and Taiping, near Annam, thousands of mountains block Southern Yang Qi. On the sunny side of mountains, Yin closes Yang, forming Yin Miasma. Yin-dampness condenses toxicity, making Yin Miasma particularly severe.