吴 二十五岁 癸亥七月十六日 但寒不热，似乎牝疟，然渴甚脉数，皮肤扪之亦热，
乃伏暑内发，新凉外加，热未透出之故。仍用苦辛寒法。加以升提。
杏仁泥（三钱） 天花粉（二钱） 蔻仁 滑石 浓朴（二钱） 青蒿（一钱） 苡仁 藿香
郁金（二钱） 黄芩（一钱） 知母
三杯，分三次服，三帖。
但寒不热之疟，昨用升提，已出阳分，渴甚，脉洪数甚，热反多。昨云热邪深伏，未曾
透出，不得作真牝疟者，非虚语也。用苦辛寒重剂。
杏仁粉（五钱） 滑石（三钱） 生石膏（八钱） 知母（一钱） 蔻仁（三钱） 藿梗（三钱）
浓朴（三钱） 黄芩（二钱） 郁金（三钱） 甘草（一钱）
伊芳氏 二十二岁 正月初七日 妊娠七月，每日午后，先寒后热，热至戌时，微汗而解
。已近十日，此上年伏暑成疟，由春初升发之气而发，病在少阳，与小柴胡法。
柴胡（五钱） 黄芩（三钱，炒） 炙甘草（二钱） 半夏（四钱） 人参（二钱） 生姜（三钱）
大枣（二枚）
一帖，寒热减。二帖，减大半。第三日用前方三分之一，全愈。
朱 三十三岁 八月二十五日 体浓本有小肠寒湿，粪后便血，舌苔灰白而浓，中黑，
呕恶不食，但寒不热，此脾湿疟也，与劫法。
生苍术（五钱） 生草果（三钱） 槟榔（三钱） 生苡仁（五钱） 杏仁（三钱） 茯苓（五钱）
熟附子（一钱） 黄芩炭（二钱）
二十八日 前方服三帖而病势渐减，舌苔化黄，减其制，又三帖而寒来甚微，一以理脾
为主。
于术（三钱，炒） 蔻仁（二钱） 益智仁（二钱） 广皮（三钱） 半夏（三钱） 黄芩炭（二
钱） 苡仁（五钱）
服七帖而胃开。
佟氏 四十岁 少阴三疟，二年不愈，寒多热少。脉弦细，阳微，损及八脉，通补奇经
丸四两，服完全愈。
萧 三十三岁 少阴三疟，久而不愈，六脉弦紧，形寒嗜卧，发时口不知味，不渴，肾
气上泛，面目黧黑，与扶阳汤法。
鹿茸（三钱） 桂枝（三钱） 人参（一钱） 熟附子（二钱） 蜀漆（二钱） 当归（三钱）
四帖愈，后调脾胃。
郑 五十五岁 四月十九日 脉双弦，伏暑成疟，间二日一至，舌苔白滑，热多寒少，
十月之久不止，邪入已深极，难速出，且与通宣三焦，使邪有出路，勿得骤补。
杏仁泥（四钱） 茯苓皮（五钱） 藿梗（三钱） 蔻仁（二钱） 知母（三钱，炒） 半夏（三
钱） 苡仁（五钱） 黄芩（二钱，炒） 青蒿（一钱）
服四帖。
二十六日 加青蒿（一钱）
服四帖。
初四日 脉紧汗多，加∶
桂枝（三钱）
服二帖。
初六日 脉已活动，色已毕，寒大减，热亦少减，共计已减其半。汗至足底，时已早至
八刻，议去青蒿，加黄芩一钱。舌苔虽减而仍白，余药如故，再服四帖。
十四日 三疟与宣三焦，右脉稍大，热多汗多，舌苔之白滑虽薄，而未尽化，湿中生热
，不能骤补，与两清湿热。
杏仁泥（三钱） 知母（二钱） 通草（钱半） 蔻仁（二钱） 黄芩（二钱） 苡仁（四钱） 黄
连（一钱） 茯苓皮（三钱） 半夏（三钱）
十九日 加广皮炭（三钱） 藿梗（三钱）
服四帖。
二十二日 病减者减其制，每日服前方半帖，六日服三帖。
二十九日 病又减，去黄连，加益智仁三钱，以其脉大而尚紧也，仍系六日服三帖。
六月初五日 余邪未尽，仍六日服三帖。
十二日 三疟与宣化三焦，十退其九，白苔尚未尽退。今日诊脉，弦中兼缓，气来至缓
，是阳气未充。议于前方退苦寒，进辛温。
杏仁（三钱） 益智仁（三钱） 桂枝（三钱） 蔻仁（三钱） 黄芩炭（三钱） 半夏（五钱）
茯苓（五钱） 藿梗（三钱）
四帖。
二十二日 左脉弦紧，右大而缓，舌白未化，疟虽止而余湿未消，此方仍服。去∶
蔻仁（一钱） 黄芩（一钱） 益智仁（一钱）
服八帖。
七月初二日 四疟已止，胃已开，脉已回阳，与平补中焦。
半夏（三钱） 蔻仁（钱半） 炙甘草（二钱） 广皮炭（三钱） 生苡仁（三钱） 茯苓（五钱）
生姜（三片） 于术（三钱，炒） 大枣（二个）
服七帖后，可加人参二钱，服至收功。
丸方 疟后六脉俱弦微数，与脾肾双补法。
何首乌（四两） 茯苓（六两） 枸杞子（四两） 五味子（二两） 沙苑子（三两） 山药（四
两） 于术（四两） 蔻仁（五钱） 莲实（六两，去心） 人参（四钱）
蜜丸如桐子大，每服三二钱，开水送下，逢节以人参五分，煎汤送。
高 十六岁 乙酉六月十六日 间三疟，脉弦，暑邪深入矣。
杏仁（三钱） 青蒿（三钱） 茯苓皮（三钱） 蔻仁（一钱） 半夏（三钱） 柴胡（一钱） 藿
香叶
（三钱） 黄芩（三钱） 知母（二钱） 苡仁（三钱） 炙甘草（一钱） 滑石（五钱） 生姜（三片）
大枣（二个）
十八日 诊脉数热，重加∶
知母（二钱）
二十八日 疟止热退，去知母、柴胡、青蒿、姜枣，改藿梗（二钱） 减∶
滑石（二钱）
初五日 余邪已轻，再服数帖。
朱 三十八岁 但寒不热，舌苔白滑而浓三四日，灰黑而滑五六日，黑滑可畏，脉沉弦
而紧
。太阴湿疟，与牝疟相参，但牝疟表寒重，此则偏于在里之寒湿重也。初起三日，用桂枝、
草果、苍术、黄芩、茯苓、苡仁、广皮、猪苓、泽泻。三四日加附子，五六日又加草果、苍
术分量。再加生姜，舌苔始微化黄，恶寒渐减。服至十二三日，舌苔恶寒始退。愈后峻补脾
肾两阳，然后收功。
姚 二十五岁 乙酉七月二十五日 久疟不愈，寒多，舌苔白滑，湿气重也，宜宣通三
焦，微偏于温。
杏仁（五钱） 青蒿（二钱） 广皮（二钱） 蔻仁（三钱） 半夏（五钱） 苡仁（五钱） 草果
（钱半） 黄芩（钱半炒） 茯苓皮（五钱） 生姜（二片）
八月初三日 前方服六帖，疟已止，照原方去∶草果 青蒿 加
滑石（六钱） 益智仁（三钱）
钱 二十岁 乙酉十一月初二日 三疟兼痹，舌苔白滑，终日一饮，热时不渴，胸痞，
此偏
于伏暑中之湿多者也。惟日已久，又加误补下行，邪已深入为难治。勉与宣通经络三焦，导
邪外出，毋使久羁。
桂枝（三钱） 防己（四钱） 杏仁（五钱） 青蒿（三钱） 半夏（三钱） 黄芩（三钱） 茯苓
（五钱） 蔻仁（二钱） 广皮（三钱） 煨草果（八分） 片姜黄（二钱）
十五日 阅来札知汗多而寒热减，舌白滑苔退，食后不饱闷，是伏邪已有活动之机。但
阴疟
发于戌亥时，不见日光，虽屡用升提，使邪外出法，毫不见早，大可虑也。勉与原方内加草
果分量，去茯苓、蔻仁，再加急走之蜀漆，活血络之当归。
桂枝（三钱） 柴胡（三钱） 半夏（三钱） 青蒿（一钱） 防己（三钱） 杏仁（四钱） 黄芩
炭（
三钱） 广皮炭（三钱） 草果（二钱） 姜黄（二钱） 蜀漆（三钱） 当归（三钱） 生苡仁（五钱
）
十二月 阅来札知寒热降序而未尽除，停饮痹痛太甚。议减治疟之品，加宣饮与痹之药
。然大有病退正衰之虑，饮与痹皆喜通不喜守，大忌呆补，奈何。
桂枝（五钱，三四帖后手背痛不减加至八钱或一两） 广皮（五钱） 防己（四钱） 青蒿（
二钱）
柴胡（三钱，寒热如再减二药亦须减） 山甲片（一钱，炒） 蜀漆（二钱，寒热微则去之）
生苡仁（五钱） 人参（一钱） 生姜（三钱） 半夏（六钱） 茯苓皮（五钱） 煨草果（二钱） 片
姜黄（三钱）
煎四大茶杯，分四次服，七日必须来信。
初十日 以后忽寒忽热，已非呆于寒热者可比。十五日寒大减，十八日寒热又减，二十
日申
酉时似发非发，俱属佳处。但手背之痛，左甚于右，伏邪甚深，腹左之块，即系疟母一类，
不过胁腹之别耳。合观寒多热少，当与补阳，议于原方内减柴胡、青蒿，加桂枝。其人参似
非高丽参可比，盖人生世上不可留后悔也。其疟母每日空心服化 回生丹一丸，开水送下。
盖化 丹中，原有鳖甲煎丸在内也，即久病在络，亦须用之。又天士先生云∶三时热病，病
久不解者，每借芳香以为搜逐之用。此证犹在畏途，不可随便饮啖也。
于前方内减∶青蒿（钱半） 柴胡（钱半） 加
桂枝（一钱）
杨 二十四岁 丙戌二月十一日 伏暑自上年八月而来，邪已深入，三日一作，寒多热
少，亦宜通宣三焦为要法。
青蒿（三钱） 蔻仁（一钱） 蜀漆（一钱） 桂枝（三钱） 杏仁（二钱） 黄芩（钱半，炒）
苡仁（三钱） 柴胡（钱半）
服一帖而寒退，热反多，此阴邪已化热，去柴胡、桂枝，重用通宣三焦，加广皮、半夏
以和脾胃。
Wu, aged 25. On the 16th day of the 7th month in the Guihai year. Symptoms present as chills without fever, resembling Pin Malaria (malaria characterized by predominant chills); however, there is severe thirst, rapid pulse, and the skin feels hot to the touch. This is due to latent summerheat pathogen erupting from within, compounded by new external coolness, with the heat failing to vent out. Continue using the Bitter-Pungent-Cold method. Add lifting herbs.
Almond paste (3 qian) Tianshuafen (Trichosanthis Radix, 2 qian) Doukouren (Amomi Fructus Rotundus, unmeasured) Huashi (Talcum, unmeasured) Houpo (Magnoliae Officinalis Cortex, 2 qian) Qinghao (Artemisiae Annuae Herba, 1 qian) Yiren (Coicis Semen, unmeasured) Huoxiang (Pogostemonis Herba, unmeasured)
Yujin (Curcumae Longae Radix, 2 qian) Huangqin (Scutellariae Radix, 1 qian) Zhimu (Anemarrhenae Rhizoma, unmeasured)
Decoct in three cups, divide into three doses, total three prescriptions.
For malaria presenting with chills but no fever, yesterday the lifting method was used, and the pathogen has moved to the Yang aspect. Now there is severe thirst, a surging and rapid pulse, and the heat sensation has increased. Yesterday it was stated that the heat pathogen was deeply hidden and had not yet vented; thus, it cannot be diagnosed as true Pin Malaria, which was not an empty statement. Now use a heavy dose of Bitter-Pungent-Cold formula.
Almond powder (5 qian) Huashi (Talcum, 3 qian) Sheng Shigao (Gypsum Fibrosum, 8 qian) Zhimu (Anemarrhenae Rhizoma, 1 qian) Doukouren (Amomi Fructus Rotundus, 3 qian) Huogeng (Pogostemonis Rhizoma, 3 qian)
Houpo (Magnoliae Officinalis Cortex, 3 qian) Huangqin (Scutellariae Radix, 2 qian) Yujin (Curcumae Longae Radix, 3 qian) Gancao (Glycyrrhizae Radix et Rhizoma, 1 qian)
Ms. Yi, aged 22. On the 7th day of the 1st lunar month. Pregnant for seven months. Every afternoon, chills precede fever, which peaks at Xu hour (7-9 PM), resolving with slight sweating. This has persisted for nearly ten days. This is malaria formed by latent summerheat from last year, triggered by the ascending Qi of early spring. The disease is in the Shaoyang channel; prescribe Xiao Chai Hu Tang (Minor Bupleurum Decoction).
Chaihu (Bupleuri Radix, 5 qian) Huangqin (Scutellariae Radix, 3 qian, stir-fried) Zhi Gancao (Prepared Glycyrrhizae Radix et Rhizoma, 2 qian) Banxia (Pinelliae Rhizoma, 4 qian) Renshen (Ginseng Radix, 2 qian) Shengjiang (Zingiberis Rhizoma Recens, 3 qian)
Dazao (Jujubae Fructus, 2 pieces)
One prescription: chills and fever decrease. Two prescriptions: reduced by more than half. On the third day, use one-third of the previous formula; fully recovered.
Zhu, aged 33. On the 25th day of the 8th month. Constitutionally robust, originally suffering from cold-dampness in the small intestine, hematochezia after defecation. Tongue coating is grayish-white and thick, black in the center. Vomiting, nausea, inability to eat, chills without fever. This is Spleen-Damp Malaria. Prescribe Jie Fa (Malaria-intercepting method).
Sheng Cangzhu (Atractylodis Rhizoma, 5 qian) Sheng Caoguo (Tsao-ko Fruit, 3 qian) Binglang (Arecae Semen, 3 qian) Sheng Yiren (Coicis Semen, 5 qian) Xingren (Armeniacae Semen Amarum, 3 qian) Fuling (Poria, 5 qian)
Shu Fuzi (Aconiti Lateralis Radix Praeparata, 1 qian) Huangqin Tan (Scutellariae Radix Carbonized, 2 qian)
28th Day: After three prescriptions of the previous formula, the disease trend gradually decreases. Tongue coating turns yellow. Reduce the dosage. After another three prescriptions, chills are very mild. Focus primarily on regulating the Spleen.
Baizhu (Atractylodis Macrocephalae Rhizoma, 3 qian, stir-fried) Doukouren (Amomi Fructus Rotundus, 2 qian) Yizhiren (Alpiniae Oxyphyllae Fructus, 2 qian) Guangpi (Citri Reticulatae Pericarpium, 3 qian) Banxia (Pinelliae Rhizoma, 3 qian) Huangqin Tan (Scutellariae Radix Carbonized, 2 qian) Yiren (Coicis Semen, 5 qian)
After taking seven prescriptions, stomach Qi opens.
Ms. Tong, aged 40. Suffering from Shaoyin San Malaria (chronic malaria damaging Kidney Yang) for two years without cure. Chills predominate over fever. Pulse is wiry and thin, Yang Qi is weak, affecting the Eight Extraordinary Vessels. Prescribe Tongbu Qijing Wan (Pill for Unblocking and Tonifying the Extraordinary Vessels), four liang. Complete recovery after finishing the course.
Xiao, aged 33. Suffering from Shaoyin San Malaria, chronic and uncured. Six pulses are wiry and tight. Body feels cold, prefers lying down. During attacks, taste perception is lost, no thirst. Kidney Qi rebels upward, face and eyes are dark. Prescribe Fuyang Tang (Yang-Supporting Decoction).
Lurong (Cervi Cornu Degelatinatum, 3 qian) Guizhi (Cinnamomi Ramulus, 3 qian) Renshen (Ginseng Radix, 1 qian) Shu Fuzi (Aconiti Lateralis Radix Praeparata, 2 qian) Shuqi (Ephedrae Herba et Cistanches Scaposa, 2 qian) Danggui (Angelicae Sinensis Radix, 3 qian)
Four prescriptions lead to cure, followed by spleen and stomach regulation.
Zheng, aged 55. On the 19th day of the 4th month. Pulses are double-wiry. Malaria caused by latent summerheat, occurring every other day. Tongue coating is white and slippery. Heat predominates over chills. The condition has persisted for ten months; the pathogen has penetrated extremely deep and is difficult to expel quickly. Temporarily use Tongxuan Sanjiao (Unblocking and Ventilating the Triple Burner) to provide an exit for the pathogen; do not rush to tonify.
Almond paste (4 qian) Fulingpi (Poria Peel, 5 qian) Huogeng (Pogostemonis Rhizoma, 3 qian) Doukouren (Amomi Fructus Rotundus, 2 qian) Zhimu (Anemarrhenae Rhizoma, 3 qian, stir-fried) Banxia (Pinelliae Rhizoma, 3 qian) Yiren (Coicis Semen, 5 qian) Huangqin (Scutellariae Radix, 2 qian, stir-fried) Qinghao (Artemisiae Annuae Herba, 1 qian)
Take four prescriptions.
26th Day: Add Qinghao (Artemisiae Annuae Herba, 1 qian).
Take four prescriptions.
4th Day (of next month): Pulse is tight with profuse sweating. Add:
Guizhi (Cinnamomi Ramulus, 3 qian)
Take two prescriptions.
6th Day: Pulse has become active, complexion has improved, chills greatly reduced, heat also decreased, totaling about half reduction. Sweating reaches the soles of the feet. Time is already eight ke past dawn. Suggest removing Qinghao, adding Huangqin (Scutellariae Radix, 1 qian). Tongue coating has decreased but remains white. Other herbs remain the same. Take four more prescriptions.
14th Day: For San Malaria treated with Sanjiao ventilation, right pulse is slightly larger, heat and sweating are abundant. Tongue coating of white slipperiness is thin but not fully resolved. Dampness generating heat inside prevents sudden tonification. Prescribe Liangqing Shire (Clearing Both Heat and Dampness).
Almond paste (3 qian) Zhimu (Anemarrhenae Rhizoma, 2 qian) Tongcao (Tetrapanacis Medulla, 1.5 qian) Doukouren (Amomi Fructus Rotundus, 2 qian) Huangqin (Scutellariae Radix, 2 qian) Yiren (Coicis Semen, 4 qian) Huanglian (Coptidis Rhizoma, 1 qian) Fulingpi (Poria Peel, 3 qian) Banxia (Pinelliae Rhizoma, 3 qian)
19th Day: Add Guangpi Tan (Citri Reticulatae Pericarpium Carbonized, 3 qian) Huogeng (Pogostemonis Rhizoma, 3 qian).
Take four prescriptions.
22nd Day: Disease reduced, so reduce dosage. Take half a prescription daily, three prescriptions over six days.
29th Day: Disease further reduced. Remove Huanglian, add Yizhiren (Alpiniae Oxyphyllae Fructus, 3 qian) because the pulse is large and still tight. Maintain three prescriptions over six days.
5th Day of 6th Month: Residual pathogen not fully cleared. Still three prescriptions over six days.
12th Day: San Malaria treated with Sanjiao transformation. Ninety percent resolved, white coating not fully gone. Today’s pulse diagnosis shows wiry with moderate slowness, Qi arrival is slow, indicating insufficient Yang Qi. Suggest reducing bitter-cold herbs and introducing pungent-warm herbs in the previous formula.
Xingren (Armeniacae Semen Amarum, 3 qian) Yizhiren (Alpiniae Oxyphyllae Fructus, 3 qian) Guizhi (Cinnamomi Ramulus, 3 qian) Doukouren (Amomi Fructus Rotundus, 3 qian) Huangqin Tan (Scutellariae Radix Carbonized, 3 qian) Banxia (Pinelliae Rhizoma, 5 qian)
Fuling (Poria, 5 qian) Huogeng (Pogostemonis Rhizoma, 3 qian)
Four prescriptions.
22nd Day: Left pulse wiry and tight, right pulse large and slow. Tongue white not transformed. Malaria stopped but residual dampness remains. Continue this formula. Remove:
Doukouren (Amomi Fructus Rotundus, 1 qian) Huangqin (Scutellariae Radix, 1 qian) Yizhiren (Alpiniae Oxyphyllae Fructus, 1 qian)
Take eight prescriptions.
2nd Day of 7th Month: Malaria stopped, stomach opened, pulse returned to Yang. Prescribe Pingbu Zhongjiao (Level Tonification of the Middle Jiao).
Banxia (Pinelliae Rhizoma, 3 qian) Doukouren (Amomi Fructus Rotundus, 1.5 qian) Zhi Gancao (Prepared Glycyrrhizae Radix et Rhizoma, 2 qian) Guangpi Tan (Citri Reticulatae Pericarpium Carbonized, 3 qian) Sheng Yiren (Coicis Semen, 3 qian) Fuling (Poria, 5 qian)
Shengjiang (Zingiberis Rhizoma Recens, 3 slices) Baizhu (Atractylodis Macrocephalae Rhizoma, 3 qian, stir-fried) Dazao (Jujubae Fructus, 2 pieces)
After seven prescriptions, add Renshen (Ginseng Radix, 2 qian), continue until completion.
Pill Formula: After malaria, all six pulses are wiry and slightly rapid. Prescribe Shipen Shuangbu (Dual Tonification of Spleen and Kidney).
Heshouwu (Polygoni Multiflori Radix, 4 liang) Fuling (Poria, 6 liang) Gouqizi (Lycii Fructus, 4 liang) Wuweizi (Schisandrae Fructus, 2 liang) Shayuanzi (Astragali Complanati Semen, 3 liang) Shanyao (Dioscoreae Rhizoma, 4 liang) Baizhu (Atractylodis Macrocephalae Rhizoma, 4 liang) Doukouren (Amomi Fructus Rotundus, 5 qian) Lianshi (Nelumbinis Semen, 6 liang, heart removed) Renshen (Ginseng Radix, 4 qian)
Honey pills sized like tung seeds. Take 2-3 qian each time with warm water. On festivals, take 0.5 qian of Ginseng decocted in water to wash down.
Gao, aged 16. On the 16th day of the 6th month in the Yiyu year. Suffering from Jian Ri Malaria (every-other-day malaria), pulse wiry. Summerheat pathogen has penetrated deeply.
Xingren (Armeniacae Semen Amarum, 3 qian) Qinghao (Artemisiae Annuae Herba, 3 qian) Fulingpi (Poria Peel, 3 qian) Doukouren (Amomi Fructus Rotundus, 1 qian) Banxia (Pinelliae Rhizoma, 3 qian) Chaihu (Bupleuri Radix, 1 qian) Huoxiangye (Pogostemonis Folium, 3 qian)
Huangqin (Scutellariae Radix, 3 qian) Zhimu (Anemarrhenae Rhizoma, 2 qian) Yiren (Coicis Semen, 3 qian) Zhi Gancao (Prepared Glycyrrhizae Radix et Rhizoma, 1 qian) Huashi (Talcum, 5 qian) Shengjiang (Zingiberis Rhizoma Recens, 3 slices)
Dazao (Jujubae Fructus, 2 pieces)
18th Day: Pulse rapid with heat. Heavily add:
Zhimu (Anemarrhenae Rhizoma, 2 qian)
28th Day: Malaria stopped, heat retreated. Remove Zhimu, Chaihu, Qinghao, Jiang, Zao. Change to Huogeng (Pogostemonis Rhizoma, 2 qian). Reduce:
Huashi (Talcum, 2 qian)
5th Day: Residual pathogen is light. Take several more prescriptions.
Zhu, aged 38. Chills without fever. Tongue coating white, slippery, and thick for 3-4 days; gray-black and slippery for 5-6 days; black and slippery is frightening. Pulse deep, wiry, and tight.
This is Taiyin Damp Malaria, comparable to Pin Malaria, but Pin Malaria has heavy exterior cold, whereas this case has heavy interior cold-dampness. In the first three days, use Guizhi (Cinnamomi Ramulus), Caoguo (Tsao-ko Fruit), Cangzhu (Atractylodis Rhizoma), Huangqin (Scutellariae Radix), Fuling (Poria), Yiren (Coicis Semen), Guangpi (Citri Reticulatae Pericarpium), Zhuling (Polyporus), Zexie (Alismatis Rhizoma). Add Fuzi (Aconiti Lateralis Radix Praeparata) on days 3-4. Increase amounts of Caoguo and Cangzhu on days 5-6. Add Shengjiang (Zingiberis Rhizoma Recens). Tongue coating begins to turn slightly yellow, chills gradually decrease. By days 12-13, tongue coating and chills recede. After cure, vigorously tonify Spleen and Kidney Yang to conclude treatment.
Yao, aged 25. On the 25th day of the 7th month in the Yiyu year. Chronic malaria uncured, chills predominate. Tongue coating white and slippery, indicating heavy dampness. Should ventilate and unblock the Triple Burner, slightly leaning towards warmth.
Xingren (Armeniacae Semen Amarum, 5 qian) Qinghao (Artemisiae Annuae Herba, 2 qian) Guangpi (Citri Reticulatae Pericarpium, 2 qian) Doukouren (Amomi Fructus Rotundus, 3 qian) Banxia (Pinelliae Rhizoma, 5 qian) Yiren (Coicis Semen, 5 qian) Caoguo (Tsao-ko Fruit, 1.5 qian) Huangqin (Scutellariae Radix, 1.5 qian, stir-fried) Fulingpi (Poria Peel, 5 qian) Shengjiang (Zingiberis Rhizoma Recens, 2 slices)
3rd Day of 8th Month: Previous formula taken for six prescriptions, malaria stopped. Follow original formula, remove: Caoguo, Qinghao. Add:
Huashi (Talcum, 6 qian) Yizhiren (Alpiniae Oxyphyllae Fructus, 3 qian)
Qian, aged 20. On the 2nd day of the 11th month in the Yiyu year. San Malaria combined with Bi syndrome (obstruction). Tongue coating white and slippery. Drinks all day, no thirst during fever, chest fullness. This leans towards excess dampness within latent summerheat. Duration is long, plus mistaken downward tonification, pathogen has penetrated deeply, making it difficult to treat. Tentatively use Xuantong Jingluo Sanjiao (Ventilate and Unblock Meridians and Triple Burner) to guide pathogen out, preventing lingering.
Guizhi (Cinnamomi Ramulus, 3 qian) Fangji (Stephaniae Tetrandrae Radix, 4 qian) Xingren (Armeniacae Semen Amarum, 5 qian) Qinghao (Artemisiae Annuae Herba, 3 qian) Banxia (Pinelliae Rhizoma, 3 qian) Huangqin (Scutellariae Radix, 3 qian) Fuling (Poria, 5 qian)
Doukouren (Amomi Fructus Rotundus, 2 qian) Guangpi (Citri Reticulatae Pericarpium, 3 qian) Wei Caoguo (Tsao-ko Fruit Roasted, 0.8 fen) Pian Jianghuang (Curcumae Longae Rhizoma, 2 qian)
15th Day: Letter received indicates profuse sweating with reduced chills/fever, white slippery tongue coating receded, no fullness after eating. Pathogen has signs of movement. However, Yin Malaria occurs at Xu-Hai hours (7 PM-11 AM), unseen by sunlight. Although lifting methods were repeatedly used to expel pathogen, no early resolution seen, highly concerning. Tentatively add Caoguo amount to original formula, remove Fuling, Doukouren. Add Shuqi (Ephedrae Herba et Cistanches Scaposa) for rapid action, Danggui (Angelicae Sinensis Radix) for activating blood collaterals.
Guizhi (Cinnamomi Ramulus, 3 qian) Chaihu (Bupleuri Radix, 3 qian) Banxia (Pinelliae Rhizoma, 3 qian) Qinghao (Artemisiae Annuae Herba, 1 qian) Fangji (Stephaniae Tetrandrae Radix, 3 qian) Xingren (Armeniacae Semen Amarum, 4 qian) Huangqin Tan (Scutellariae Radix Carbonized, 3 qian) Guangpi Tan (Citri Reticulatae Pericarpium Carbonized, 3 qian) Caoguo (Tsao-ko Fruit, 2 qian) Jianghuang (Curcumae Longae Rhizoma, 2 qian) Shuqi (Ephedrae Herba et Cistanches Scaposa, 3 qian) Danggui (Angelicae Sinensis Radix, 3 qian) Sheng Yiren (Coicis Semen, 5 qian)
December: Letter received indicates chills/fever decreasing but not fully eliminated, fluid retention and Bi pain are severe. Suggest reducing anti-malarial herbs, adding herbs for fluid retention and Bi. However, concern for deficiency following disease retreat. Fluid and Bi syndromes prefer unblocking over retaining; rigid tonification is strictly contraindicated.
Guizhi (Cinnamomi Ramulus, 5 qian, increase to 8 qian or 1 liang if hand/back pain persists after 3-4 prescriptions) Guangpi (Citri Reticulatae Pericarpium, 5 qian) Fangji (Stephaniae Tetrandrae Radix, 4 qian) Qinghao (Artemisiae Annuae Herba, 2 qian)
Chaihu (Bupleuri Radix, 3 qian, reduce these two if chills/fever decrease again) Shanjiapian (Manis Squama, 1 qian, stir-fried) Shuqi (Ephedrae Herba et Cistanches Scaposa, 2 qian, remove if chills/fever subside)
Sheng Yiren (Coicis Semen, 5 qian) Renshen (Ginseng Radix, 1 qian) Shengjiang (Zingiberis Rhizoma Recens, 3 qian) Banxia (Pinelliae Rhizoma, 6 qian) Fulingpi (Poria Peel, 5 qian) Wei Caoguo (Tsao-ko Fruit Roasted, 2 qian) Pian Jianghuang (Curcumae Longae Rhizoma, 3 qian)
Decoct in four large teacups, divide into four doses. Must reply in seven days.
10th Day: Subsequent alternating chills/fever differ from static patterns. 15th Day: Chills greatly reduced. 18th Day: Chills/fever further reduced. 20th Day: Shen-You hours (3-7 PM) show quasi-symptoms, all favorable signs. However, hand back pain, left worse than right, indicates deep-seated pathogen. Lump on left abdomen is similar to Nuomu (Malaria Mass), merely differing in location (hypochondrium vs abdomen). Considering chills > heat, should tonify Yang. Suggest reducing Chaihu, Qinghao in original formula, adding Guizhi. The Renshen used is not comparable to Korean Ginseng, as one must avoid regret in life. For Nuomu, take one pill of Huasheng Dan (Life-Generating Pill) on an empty stomach daily with warm water. Huasheng Dan contains Biejia Jian Wan (Turtle Shell Decoction), necessary even for chronic diseases in collaterals. Mr. Tianshi said: For heat diseases in three seasons lasting long, aromatic herbs are often borrowed for searching and purging. This case is still in dangerous territory; diet must not be casual.
In previous formula, remove: Qinghao (1.5 qian) Chaihu (1.5 qian). Add:
Guizhi (Cinnamomi Ramulus, 1 qian)
Yang, aged 24. On the 11th day of the 2nd month in the Bingxu year. Latent summerheat started last August, pathogen deeply penetrated. Occurs every three days, chills > heat. Also requires Tongxuan Sanjiao (Unblocking and Ventilating Triple Burner) as key method.
Qinghao (Artemisiae Annuae Herba, 3 qian) Doukouren (Amomi Fructus Rotundus, 1 qian) Shuqi (Ephedrae Herba et Cistanches Scaposa, 1 qian) Guizhi (Cinnamomi Ramulus, 3 qian) Xingren (Armeniacae Semen Amarum, 2 qian) Huangqin (Scutellariae Radix, 1.5 qian, stir-fried)
Yiren (Coicis Semen, 3 qian) Chaihu (Bupleuri Radix, 1.5 qian)
After one prescription, chills retreat, heat increases. This indicates Yin pathogen transforming into heat. Remove Chaihu, Guizhi. Heavily use Tongxuan Sanjiao, add Guangpi (Citri Reticulatae Pericarpium) and Banxia (Pinelliae Rhizoma) to harmonize Spleen and Stomach.