吕沧洲治经历哈散侍人病喘不得卧，众作肺气受风邪治之。吕诊之气口盛于人迎一
倍，厥阴弦动而疾，两尺俱短而离经。因告之曰∶病盖得之毒药动血，以致胎死不下，奔
迫而上冲，非风寒作喘也。乃用催生汤加芎、归煮二三升服之，夜半果下一死胎，喘即止。
哈散密嘱曰∶病外家诚有怀，以室人见嫉，故药去之，众所不知也。众惭而去。
平安散 治妊娠上气喘急，大便不通，呕吐不食，腹胁胀痛。
川芎 木香（各一钱半） 陈皮 熟地黄（洗）
干姜（炮） 生姜 浓朴（去粗皮，制。炒） 甘草（各一钱）
上作一服，水二盅，入烧盐一捻，煎至一盅，不拘时服。
桔梗汤 马兜铃散（并见前咳嗽条。）
〔大〕妊娠病疟，乃夏伤于暑，客于皮肤，至秋而发，阳盛则热，阴盛则寒，阴阳
相离，寒热俱作。其发晏者，由风邪客于风府，循膂而下，卫气至一日一夜常大会于风
府，故发日晏与早者，卫气之行风府，日下一节，二十一日下至尾 ，二十二日入脊内，
上注于伏冲之脉，其行九日，出缺盆。其气既止，故发更早。其间日发者，风邪内搏五
脏，横连募原，其道远，其气深，其行迟，不能日作也。妊娠而发，多伤于胎。
〔薛〕前证因脾胃虚弱，饮食停滞，或外邪所感，或郁怒伤脾，或暑邪所伏。审系
饮食停滞，用六君子加桔梗、苍术、藿香。外邪多而饮食少，用藿香正气散。（杂病中风。）外
邪少而饮食多，用人参养胃汤。（杂疟。）劳伤元气，用补中益气汤。（杂劳倦。）若郁怒所伤，用
小柴胡汤（伤寒少阳病。）兼归脾汤。（健忘。）若木侮土，久而不愈，用六君子为主，佐以安胎药。
仍参三阴三阳经而治之。一妇人因怒患疟，举发无期，久而不已，胸腹不利，饮食少思，
吞酸吐痰。用六君子加柴胡、山栀，二十余剂，寻愈。但晡热少食，又用四君子加柴胡、
升麻为主，佐以逍遥散而痊。一妊妇疟久不已，嗳气下气，胸腹膨胀，食少欲呕，便
血少寐。此属肝脾郁怒，用归脾汤加柴胡、山栀渐愈；又用六君子汤加柴胡、山栀、升麻
而愈。一妊妇患疟已愈，但寒热少食，头痛晡热内热，此脾虚血弱也。用补中益气汤
加蔓荆子，头痛顿止；又用六君子汤加芎、归，饮食顿进；再用逍遥散加参、术而寒热愈。
驱邪散 治妊娠停食感冷，发为疟疾。
白术 草果仁 高良姜（炒） 缩砂仁 藿香叶 橘红 白茯苓（去皮，各一钱半）
甘草（炙，五分）
上作一服，水二盅，生姜五片，红枣一枚，煎一盅，不拘时服。
七宝散 治男妇一切疟疾，或先寒后热，或先热后寒，或寒多热少，或热多寒少，或
一日一发，或一日两三发，或连日发，或间日发，或三四日一发，不问鬼疟、食疟，不
伏水土，山岚瘴气似疟者，并皆治之。
常山 浓朴（姜制） 青皮 陈皮（并不去白） 甘草 槟榔 草果（去皮，各等分）
咀，每服半两，于未发隔夜，用水酒各一盏，煎至一大盏，去滓露一宿，再用酒
水煎滓次，去滓亦露一宿，来日当发之早，烫温面东先服头药，少顷再服药滓，大有神效。
予尝治一妊妇，六七个月患疟，先寒后热，六脉浮紧，医用柴胡、桂枝无效。予曰∶此
非常山不愈。众医难之，越数日疾甚，乃从予治，以七宝散一服瘥。黄帝问∶妇人重身，
毒之奈何？岐伯曰∶有故无殒。帝曰∶何谓也，岐伯曰∶大积大聚，其可犯也，衰其大
半而止。诚审药物之性，明治疗之方，何疑攻治哉。
柴胡散 治妊娠疟疾。
柴胡（二钱） 生大黄（二钱） 生黄芩（一钱半） 甘草（一钱）
上 咀作一服，水煎，临发日五更温服，必取利为愈。如胎上逼心，可服枳壳散。忌
油面辛热等物。
又方
用大黄（二两） 柴胡（一两半） 黄芩（一两） 芍药（一两）
为细末，清水糊为丸，如梧桐子大。每服百丸，临发日五更冷汤吞下，隔两时再服
五十丸，以利为度。
若妊娠疟疾，发热口干，渴饮无度者，亦用。
生地黄（一两半） 黄芩 麦门冬（去心） 人参 知母（各一两） 石膏（二两） 甘草（半两）
干葛
（一两）
上 咀，每服五钱，入乌梅（半个） 煎服。
又方
用常山（一两） 石膏（一两） 甘草（炙） 黄芩（各半两） 乌梅（七个）
细切，以水酒各一碗，浸一宿，平旦煎至一碗，去滓分二服，临发时服。
上方犯常山、大黄吐下之剂，若六脉浮紧有力，中有顽痰积热者用之，所谓有故无
殒也。其他疗治方法，已备杂证疟门，兹不赘。若热甚恐致动胎者，亦如伤寒热病治法，
以白药子、伏龙肝等，涂脐上下可也。
Lu Cangzhou treated a servant of Jingli Hasan who suffered from asthma (asthma/dyspnea) and could not lie flat. The physicians generally treated it as lung Qi affected by wind pathogen. Upon examination, Lu found that the Qi Kou pulse was one times larger than the Ying Ren pulse; the Jue Yin pulse was wiry, moving, and rapid; and both Chi pulses were short and deviated from the normal channel pattern (Li Jing Mai). He informed them: "This illness likely resulted from toxic drugs causing bleeding, leading to a dead fetus retained in the womb. The violent upward rush of Qi causes this, rather than asthma caused by wind-cold." Therefore, he used Cui Sheng Tang (Delivery Decoction) with added Xiong (Ligusticum Chuanxiong Rhizome) and Gui (Angelica Sinensis Radix), boiled to obtain two or three sheng, which the patient took. At midnight, a dead fetus was indeed expelled, and the asthma ceased immediately. Hasan secretly instructed: "The patient's mother-in-law was indeed pregnant. Because the principal wife was jealous, she used medicine to terminate the pregnancy. This is unknown to the public." The other physicians left in shame.
Ping An San (Peaceful Safety Powder) treats asthma and urgent breathing during pregnancy, accompanied by constipation, vomiting, inability to eat, and abdominal and hypochondriac distension and pain.
Xiong (Ligusticum Chuanxiong Rhizome), Mu Xiang (Aucklandiae Radix) (each 1.5 qian); Chen Pi (Citri Reticulatae Pericarpium); Shu Di Huang (Rehmanniae Radix Praeparata); Gan Jiang (Zingiberis Rhizoma Praeparatum); Sheng Jiang (Zingiberis Rhizoma Recens); Nong Po (Magnoliae Officinalis Cortex); Gan Cao (Glycyrrhizae Radix et Rhizoma) (each 1 qian).
Take as one dose, add two zhong of water, a pinch of burnt salt, decoct to one zhong, take at any time.
Jie Geng Tang (Platycodon Decoction) and Ma Dou Ling San (Aristolochiae Fructus Powder) (see previous section on cough.)
[Da] Malaria during pregnancy results from summer-heat injury in summer, where the pathogen lodges in the skin and manifests in autumn. When Yang is excess, there is heat; when Yin is excess, there is cold. When Yin and Yang separate, both cold and heat occur simultaneously. If the onset is late, it is because wind pathogen has lodged in Feng Fu (DU16), traveling down along the spine. Wei Qi (Defensive Qi) gathers at Feng Fu once a day and night. Thus, the variation in early or late onset is due to Wei Qi moving down one vertebral level daily at Feng Fu. After twenty-one days, it reaches the coccyx; on the twenty-second day, it enters the spine, ascends into the Fu Chong vessel, travels for nine days, and emerges at Que Pen (LI18). Once this Qi stops descending, the onset becomes earlier. For every-other-day attacks, the wind pathogen internally combats the five Zang organs and horizontally connects to the Mu Yuan (Sea of Origin). The path is long, the Qi is deep, and its movement is slow, preventing daily attacks. Malaria occurring during pregnancy often damages the fetus.
[Xue] The aforementioned symptoms are due to Spleen and Stomach deficiency, food stagnation, external pathogen invasion, anger injuring the Spleen, or latent summer-heat. If due to food stagnation, use Liu Jun Zi Tang (Six Gentlemen Decoction) with added Jie Geng (Platycodonis Radix), Cang Zhu (Atractylodis Rhizoma), and Huo Xiang (Pogostemonis Herba). If external pathogens are heavy and food stagnation is light, use Huo Xiang Zheng Qi San (Patchouli Regulating Qi Powder). If external pathogens are light and food stagnation is heavy, use Ren Shen Yang Wei Tang (Ginseng Nourishing Stomach Decoction). If labor and fatigue damage Yuan Qi (Primal Qi), use Bu Zhong Yi Qi Tang (Supplement the Middle and Augment the Qi Decoction). If injured by anger, use Xiao Chai Hu Tang (Minor Bupleurum Decoction), combined with Gui Pi Tang (Restore the Spleen Decoction). If Liver Wood insults Spleen Earth and remains uncured for a long time, use Liu Jun Zi Tang as the main formula, assisted by fetal-calming herbs. Treatment should still refer to the Three Yin and Three Yang channels. A woman suffered from malaria due to anger, with irregular onset, persisting for a long time, causing chest and abdominal discomfort, reduced appetite, acid regurgitation, and phlegm expectoration. She used Liu Jun Zi Tang with added Chai Hu (Bupleuri Radix) and Shan Zhi (Gardeniae Fructus) for over twenty doses, then recovered. However, with afternoon fever and poor appetite, she used Si Jun Zi Tang (Four Gentlemen Decoction) with added Chai Hu and Sheng Ma (Cimicifugae Rhizoma) as the main formula, assisted by Xiao Yao San (Free and Easy Wanderer Powder), and recovered. A pregnant woman suffered from persistent malaria, with belching, flatus, abdominal distension, poor appetite, nausea, hematochezia, and insomnia. This belonged to Liver and Spleen depression and anger. She used Gui Pi Tang with added Chai Hu and Shan Zhi, gradually improving; then used Liu Jun Zi Tang with added Chai Hu, Shan Zhi, and Sheng Ma, and recovered. Another pregnant woman had recovered from malaria but still had chills and fever, poor appetite, headache, afternoon fever, and internal heat. This was Spleen deficiency and Blood weakness. She used Bu Zhong Yi Tang with added Man Jing Zi (Vernoniae Capitulum), and the headache stopped instantly; then used Liu Jun Zi Tang with added Xiong and Gui, and appetite improved instantly; finally used Xiao Yao San with added Ren Shen (Ginseng Radix) and Bai Zhu (Atractylodis Macrocephalae Rhizoma), and chills and fever resolved.
Qu Xie San (Expel Evil Powder) treats pregnancy complicated by food retention and cold invasion, manifesting as malaria.
Bai Zhu (Atractylodis Macrocephalae Rhizoma), Cao Guo Ren (Tsaoko Fructus Seed), Gao Liang Jiang (Alpiniae Officinarum Rhizoma) (stir-fried), Suo Sha Ren (Amomi Fructus Rotundus), Huo Xiang Ye (Pogostemonis Folium), Ju Hong (Citri Reticulatae Pericarpium Rubrum), Bai Fu Ling (Poria) (peeled, each 1.5 qian); Gan Cao (Glycyrrhizae Radix et Rhizoma) (honey-fried, 0.5 qian).
Take as one dose, add two zhong of water, five slices of Sheng Jiang, one red date, decoct to one zhong, take at any time.
Qi Bao San (Seven Treasures Powder) treats all types of malaria in men and women, whether presenting with chills first then fever, fever first then chills, more chills than fever, more fever than chills, daily attacks, multiple attacks per day, consecutive days, every other day, or every three to four days. It treats ghost malaria, food malaria, maladaptation to local climate, and mountain miasma resembling malaria.
Chang Shan (Dichroae Radix), Nong Po (Magnoliae Officinalis Cortex) (ginger-processed), Qing Pi (Citri Reticulatae Pericarpium Viride), Chen Pi (Citri Reticulatae Pericarpium) (do not remove albedo), Gan Cao (Glycyrrhizae Radix et Rhizoma), Bing Lang (Arecae Semen), Cao Guo (Tsaoko Fructus) (peeled, equal parts).
Coarsely crush. Take half liang per dose. On the eve before onset, decoct with one zhong of water and one zhong of wine to one large zhong. Remove dregs and expose overnight. Decoct the dregs again with water and wine, remove dregs, and expose overnight. On the morning of onset, face east and drink the first decoction warm. Shortly after, take the second decoction (dregs). This has miraculous effects.
I once treated a pregnant woman of six or seven months suffering from malaria, with chills first then fever. All six pulses were floating and tight. Physicians used Chai Hu and Gui Zhi (Cinnamomi Ramulus) without effect. I said: "Only Chang Shan can cure this." The physicians hesitated. After several days, the disease worsened, so they followed my treatment. One dose of Qi Bao San cured her. The Yellow Emperor asked: How should toxic substances be used for pregnant women? Qibo replied: "If there is an existing pathology, there will be no harm to the fetus." The Emperor asked: What does this mean? Qibo replied: "For large accumulations and masses, attack may be undertaken, but stop when the pathology has diminished by more than half." As long as the nature of the drugs is carefully examined and the treatment method is clear, what doubt is there in using attacking therapies?
Chai Hu San (Bupleurum Decoction) treats malaria during pregnancy.
Chai Hu (Bupleuri Radix) (2 qian), Sheng Da Huang (Rhei Radix et Rhizoma Raw) (2 qian), Sheng Huang Qin (Scutellariae Radix Raw) (1.5 qian), Gan Cao (Glycyrrhizae Radix et Rhizoma) (1 qian).
Coarsely crush for one dose. Decoct in water. Take warm at Wu Geng (3-5 AM) on the day of onset. Recovery requires purgation. If the fetus presses against the heart, Zhi Ke San (Aurantii Fructus Immaturus Powder) can be taken. Avoid oily noodles, spicy, and hot foods.
Another Prescription
Use Da Huang (Rhei Radix et Rhizoma) (2 liang), Chai Hu (Bupleuri Radix) (1.5 liang), Huang Qin (Scutellariae Radix) (1 liang), Shao Yao (Paeoniae Radix Alba) (1 liang).
Grind into fine powder, make pills with clear water paste, size of Sophora japonica seeds. Take 100 pills per dose. On the day of onset, swallow with cold water at Wu Geng. Take another 50 pills two hours later. Stop when purged.
This prescription is also used if pregnancy malaria presents with fever, dry mouth, and excessive thirst.
Sheng Di Huang (Rehmanniae Radix Raw) (1.5 liang), Huang Qin (Scutellariae Radix), Mai Men Dong (Ophiopogonis Radix) (core removed), Ren Shen (Ginseng Radix), Zhi Mu (Anemarrhenae Rhizoma) (each 1 liang), Shi Gao (Gypsum Fibrosum) (2 liang), Gan Cao (Glycyrrhizae Radix et Rhizoma) (0.5 liang), Gan Ge (Puerariae Lobatae Radix) (1 liang).
Coarsely crush. Take 5 qian per dose. Add half a Mei (Prunus mume) and decoct.
Another Prescription
Use Chang Shan (Dichroae Radix) (1 liang), Shi Gao (Gypsum Fibrosum) (1 liang), Gan Cao (Glycyrrhizae Radix et Rhizoma) (honey-fried), Huang Qin (Scutellariae Radix) (each 0.5 liang), Wu Mei (Pruni Mume Fructus) (7 pieces).
Finely cut. Soak overnight in one bowl of water and one bowl of wine. Decoct at dawn to one bowl. Remove dregs and divide into two doses. Take at the time of onset.
The above prescriptions contain Chang Shan and Da Huang, which induce vomiting and purgation. They are used if the six pulses are floating, tight, and forceful, indicating stubborn phlegm and accumulated heat. This is the principle of "having pathology means no harm." Other treatment methods are detailed in the Miscellaneous Diseases Malaria section and are not repeated here. If the heat is severe and risks disturbing the fetus, treat it like cold-heat diseases in Shang Han Lun, applying Bai Yao Zi (Radix Dichroae) and Fu Long Gan (Furnace Soil) around the navel.