Library

The family physician examined the pulse and exclaimed in surprise, "The pulse has ceased." They discussed treating it as a Yin syndrome (Yin Zheng) and intended to administer Fuzi Tang (Aconite Decoction), but had not yet decided. Wang said, "Yin syndromes do not present with headache. Since the patient currently exhibits such symptoms, it is likely that wind-heat (Feng-Shu) has invaded the Yin level due to deficiency, causing the pulse to be deep-hidden (Fu), rather than truly ceased. If Fuzi Tang were administered, it would be using fire to assist fire; how could life be restored? Let us wait and observe any changes." On the following evening, indeed, alternating chills and fever, headache, restlessness, thirst, epigastric fullness and oppression, vomiting of food, and spontaneous sweating occurred. The pulse was all soft (Ru), small, and rapid, with the Spleen area additionally showing a wiry (Xian) quality. Thus, Qingshu Yiqi Tang (Clear Summerheat and Boost Qi Decoction) was used, with Cangzhu (Atractylodis Rhizoma) and Shengma (Cimicifugae Rhizoma) omitted. After more than twenty doses, the patient recovered.

Li Shicai treated Chen Meigong for tertian malaria (Sanri Nue) which had persisted for a year without remission. Chen was generally averse to medication, especially ginseng. His pulse was soft (Ru) upon light palpation and weak (Ruo) upon heavy pressure, indicating depletion of both Ying (Nutritive) and Wei (Defensive) qi, hence the prolonged course. Li insisted, saying, "You usually avoid ginseng because your constitution is naturally robust. However, what is indispensable now is ginseng due to the long-standing nature of the pathogen. First, take about one qian of ginseng. If saliva is produced in the mouth and there is no abdominal distension or discomfort, then proceed." Consequently, one liang of Ginseng Radix et Rhizoma Rubra (Renshen) and one liang of Polygoni Multiflori Caulis (Heshouwu) were decocted together, with approximately one cup of fresh ginger juice added. After one dose, the condition improved by seven or eight tenths; after another dose, the malaria was arrested.

Shiwan treated the wife of Zhang Anqi, a Guangwen official. Previously, her daughter, son-in-law, and a maid had died within a few days, and her servant was critically ill from contagion. After attending her daughter's funeral, Mrs. Zhang returned home and contracted malaria. Various treatments failed, resulting in a complicated disease (Huai Bing). Shiwan reluctantly prescribed Shengjiang Xiexin Tang (Ginger Heart-Draining Decoction) to rescue her.

Li Huaici, a deceased friend, had a son named Youhan who contracted epidemic malaria qi from the Deng family. The illness persisted for over a month. With no one around to care for him and lacking proper nursing, he recovered only to relapse. This was compounded by the downward flow of fluids (diarrhea), concurrent malaria and dysentery, and inability to ingest food or water for over half a month. Even with an appropriate formula, immediate results were difficult to expect. He was brought to my study for recuperation. Daily, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was given, combined with Lizhong Tang (Regulate the Middle Decoction), Liu Junzi Tang (Six Gentlemen Decoction), and herbs such as Cornus Fructus (Yuzhu) and Cinnamomi Cortex (Guizhi). After half a month of nursing, he recovered.

The wife of Jin Lingyou, a Fushou official, was the sister of Jiang Kuangsheng, a successful candidate in the spring examination. Jiang and his father saw her suffering from high fever and confusion, assuming it was Cold Damage (Shanghan). They invited me aboard their boat. Upon examination, I determined it was malaria, not cold damage. Four doses of Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) resolved the condition.

Wu Dansheng, a Wuyin official, had excessive dampness and a corpulent body. He suffered from vomiting, reflux, epigastric fullness and distension, alternating chills and fever, and dizziness. Liangge San (Cooling the Chest Powder) with added Coptidis Rhizoma (Huanglian) was administered to purge. Symptoms ceased after five days. Half a month later, they recurred and ceased again after five days.

Tang Ziduan, a Fushou official, experienced aversion to cold and fever, red face, and cold feet. His six pulses were wiry, thin, and rapid. He claimed the cause was cold invasion due to immoderate sexual activity, suspecting a Cold Damage Yin syndrome. I stated, "Yin syndromes typically do not present with alternating chills and fever." Two doses of Chaihu Guijiang Tang (Bupleurum, Cinnamon Twig, and Gypsum Decoction) cured him.

The daughter and niece of Gu Ruoyu, a Wenxue official, contracted malaria successively. Both presented with fever preceding chills. Guizhi Baihu Tang (Cinnamon Twig and White Tiger Decoction) cured them.

Mrs. Zheng Molin, a Tai Xue official's wife, was seven months pregnant when she first developed malaria followed by dysentery with significant bright red blood. Buzhong Yiqi Tang with Evodiae Fructus (Wuzhuyu) processed Coptidis Rhizoma (Chuanlianjun) cured her. I often see cases where pregnant women with malaria suffer fetal loss leading to death.

Zhang Yiquan, a Xiangyin official, had long consumed Yang-tonifying drugs like Renshen, Fuzi, and Cervi Cornu Colla (Lujiaojiao), depleting his True Yin. At age 75, in late July, he contracted malaria. A contemporary doctor mistakenly administered one dose of Changshan (Dichroa Root) to arrest malaria, leading to unconsciousness. The six pulses showed intermissions: two beats followed by a pause on light pressure, or three to five beats followed by a pause on heavy pressure. Only during the chills and fever phase did the pulse not intermit; after the fever subsided, intermissions resumed. This indicated severe depletion of True Qi unable to flow through the vessels. During chills and fever, pathogenic qi agitates the meridians, allowing temporary patency. This is a sign of latent pathogen within deficiency. I formulated a prescription: Dichroa Radix (Changshan) one qian soaked in wine, dried with five qian of Renshen, then discarded the Changshan, using only Renshen to boost the Great Qi in the chest to expel the pathogen. Note that Changshan damaged the Middle Qi, exacerbating the condition; thus, Changshan was retained as a guide. Administered day and night, two doses allowed sleep. However, chills and fever persisted, and pulse intermissions remained. He was instructed to take one liang of Renshen daily, divided into two doses, accompanied by thin gruel to support Stomach Qi. After several days, chills and fever gradually stopped, the pulse became faintly continuous, and he stabilized.

Gu Yushu, a successful candidate from Yufeng, experienced confusion, fever, and delirium upon malaria onset, along with epigastric fullness, distension, vomiting, and reflux. Palpation of the Qi Kou (Radial Artery at the wrist) revealed a short and slippery pulse alone, indicating old stagnation. Liangge San with Renzhonghuang (Human Excrement Cake) replaced by Caoguo Ren (Tsao-ko Fruit) cured him in one dose.

The daughter of Wang Jian'an, a Duxue official, suffered the same condition. Guizhi Baihu Tang with Renzhonghuang replaced by Congbai (Scallion Stem) and Douchi (Fermented Soybean) cured her in four doses.

Jin Chunhuan, a Zhonghan official, had his son contract malaria in August, occurring at Chen, Xu, Chou, and Wei hours. By spring, minor chills and fever increased at Zi, Wu, Mao, and You hours. Treatment began in early summer. Pulses were thread-like and fine; complexion was green, lips white. Liujunzi Tang with Guizhi and Fuzi was given for four doses without effect. Each dose was increased to include one liang of Renshen, and three qian each of Guizhi and Fuzi. After four more doses, chills and fever at Chen/Xu/Chou/Wei ceased, but those at Zi/Wu/Mao/You worsened. This indicated the Middle Earth regained authority while pathogens merged into Yin. The previous prescription continued for four doses. Complexion brightened, appetite improved, and chills/fever disappeared. Later, Dushen Tang (Single Ginseng Decoction) with Bawei Wan (Eight-Ingredient Pill) was used for convalescence.

Gu Dalai, a Wenxue official, over eighty years old, contracted Dan Nue (Hot Malaria) in early autumn, presenting with confusion, fever, delirium, asthma, fatigue, and enuresis. Some attributed delirium to Cold Damage, others enuresis to Wind Stroke. Uncertainty prevailed. I said, "Do not worry. This is a combination of the Three Yang channels. Delirium, enuresis, oral dysfunction, and facial dirtiness are examples found in Zhang Zhongjing's treatise on Summerheat." Baibu Jia Renshen Tang (White Tiger plus Ginseng Decoction) cured him after three doses. Simultaneously, Mrs. Yuan Cizhan (wife of Wenxue Yuan Cizhan) and Qi Lianshan (guest from Shuoke) suffered similar conditions. One had concurrent wind, treated with Baibu Jia Guizhi Tang; the other had concurrent dampness, treated with Baibu Jia Cangzhu Tang. Both recovered promptly. Treating them as Wind Stroke would have been erroneous.

During this gathering, a colleague asked why malaria pulses were not wiry this year. I replied, "Malaria belongs to the Shaoyang channel; the pulse should be wiry. If it resembles a normal person's pulse, it is because pathogenic qi and healthy qi are mixed indistinguishably, hiding the wiry image. The Jingui Yaolue states: 'In Warm Malaria, the pulse is like normal; there is no chills, only fever, bone joint pain, and occasional vomiting.' It is treated with Baibu Jia Guizhi Tang. How can one assume that a non-wiry pulse excludes wind-wood pathogens or precludes the use of Shaoyang herbs like Chaihu? Can routine methods apply?"

Feichou treated Shen Zijia. Every summer, exposure of the navel to fan wind caused abdominal pain and frequent diarrhea. Pulses were slightly rapid without other abnormalities. This indicated Kidney origin cold and insecure closure, easily attracting wind. Lower cold causes deficient fire to flare upward, hence the rapid pulse. Previously, Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) minus Ze Xie, plus Rougui (Cinnamon Bark), Rouguo (Nutmeg), Wuweizi (Schisandra), and Baijili (Tribulus), made into pills, cured the navel sensitivity and strengthened the Spleen/Stomach. The following autumn, he contracted malaria. Doctors used Baibu Tang and Zhuye Shigao Tang. Chills were severe, fever mild; face was green, feet cold; pulses wiry, thin, and rapid. Babai Dihuang Wan with tripled Guizhi and Fuzi decocted, combined with Sijunzi Tang and Baoyuan Tang morning and evening, stopped malaria in two days. Convalescence led to recovery.