虚寒之体忽患暑疟
建陵靳某之外家，于仲秋忽患暑疟，连日一作，寒洒热蒸，汗出如雨，口渴欲饮，脉来弦滑，舌苔微黄，
此暑疟也。靳问曰∶因何致病？丰曰∶良由暑月贪凉，过食生冷，其当时为患者，是为阴暑；伏匿日久，至
今而发者，即《内经》所谓夏伤于暑，秋为 疟是也。即用清营捍卫法，服下益热，急邀复诊。脉之转
为弦迟，询之口反不渴。丰曰∶此疟邪外达之征，请勿虑耳。观其形体肥白，知其本质虚寒，改用温补为主，
以理中汤加豆蔻、制夏、蜀漆、柴胡，姜枣为引，以河井水合煎，连尝三剂，疟邪遂遁矣。
暑疟热盛逼血上吐
城南叶某之子，偶染疟疾，邀丰诊之。脉象迢迢有力，寒热间日而来，口渴喜凉，热退多汗，此为
暑疟。遂用清营捍卫法去木贼，加藿香、草果、柴胡、甘草治之。服下疟势仍来，尤吐鲜红数口。复按其脉，
转为弦大而数，必因暑热内炎，逼伤血络所致。思古圣有“治病必求其本”之训，此证暑热是本，吐血是标，
可不必见病治病也。即用清凉涤暑法去扁豆，加黄芩、知母治之。连进两帖，疟发渐早，热势渐轻，
不知不觉而解，血恙亦未复萌。
截疟太早变成肿胀
西乡郑某，偶患疟疾，热重寒微，口渴便泻。先用符禁未
效，又服断截之药，疟与泻并止矣。数日后腹中忽胀，小便短少，来舍就诊，两手脉钝，沉取尚强。此乃暑疟
夹湿之证，其邪本欲向表分里而出，误用截法，阻其邪路，暑欲达表而不能，湿欲下行而不得，交阻于中，
气机不行而成肿胀，法当治标为先。即以木瓜、蒿、藿以解其暑，芩、苍、通草以行其湿，又以青皮、
浓朴、杏粒、槟榔，行其气而宽其膨。服下稍为中病，每得一矢气，腹内略松。更加菔子以破其气，鸡金以
消其水，服之矢气更多，溺亦通快，其腹逐渐消去。后用调脾化气，得全安耳。
江诚曰∶观以上三案，虽暑疟之轻证，但其夹证各有不同，设不细辨而妄治之，则轻证转重，重证转
危耳。如靳案本体虚寒，得温补而愈。叶案暑热劫络，得清剂而安。郑案夹湿变胀，得破削而宽。可见医
法有一定之理，无一定之方，倘胶于某证某药，则钝根莫化矣。
风疟时邪乘入血室
城南龚某之女，先微寒而后发热，口渴有汗，连日三发，脉弦而数，舌苔黄腻，此因夏伤于暑，加感
秋风，名风疟也。遂用辛散太阳法去羌活，加秦艽、藿梗治之。服二帖，疟势未衰，渐发渐晏，且夜来频欲
谵语。复诊其脉，与昨仿佛，但左部之形力，颇胜于右。思仲景有云∶昼则明了，夜则谵语，是为热入
血室。今脉左胜，疑其血室受邪，即询经转未曾。其母曰∶昨来甚寡，以后未行。此显然邪入血室之证也。
姑守前方去防风、淡豉，加当归、赤芍、川芎、柴胡，服之经水复来，点滴而少，谵语亦减，惟疟疾仍然。
再复其脉，左部转柔，余皆弦滑，已中病薮，可服原方。幸得疟势日衰一日，改用宣透膜原法加柴
胡、红枣治之，迭进三煎，疟邪遂解。
程曦曰∶时证易治，兼证难疗。若此案不细询其经事，则
医家病家，两相误也。倘见谵语之证，而为邪入心包，或为胃
家实热，清之攻之，变证必加。苟不熟仲景之书，而今日之证，
必成坏病矣。吾师尝谓不通仲景之书，不足以言医也。信夫！
寒疟之证温补治验
城东潘某，体素丰满，大便常溏，中土本属虚寒，固无论矣，忽于孟秋寒热交作，肌肤汗少，即延医诊，
遂作阴暑论治，辄投四味香薷饮加寒凉之剂，未获奏效，即来商治于丰。诊其脉弦而兼紧，舌苔白薄，寒先
热后，隔日而来，此寒疟也。良由体质本寒，加感秋凉致病，若果阴暑之证，在长夏而不在秋，况阴暑之寒
热，从未见隔日而发，当用附子理中汤加柴胡、草果、藿香、陈皮治之。服二剂，周身微汗，寒热略清。继服
二帖，疟邪遂未发矣。
湿疟之证辛散获效
新定王某之室，浣衣度活，平日难免无湿所受，患疟半月以来，前医之法无效，恳丰治之。切脉缓大
有力，遍身浮肿而疼，寒热汗无，连日一发，此明是湿邪为疟也。思先哲有风能胜湿之论，宜以辛温散邪，遂
以羌活渗湿汤加草果、浓朴为治，先服二剂小效，继服二剂全瘥。
温疟误为暑热
豫章张某，于仲夏中旬，发热连日，口渴喜饮，医者皆作暑热论治，所用不离藿、薷、滑、扁等药，未臻
效验。转商丰治，诊之脉濡且弱，舌苔微燥而黄，合其见证参之，似属暑热。但其未审既热之后，每有洒
淅恶寒之证，此即《内经》所谓“先热后寒，病以时作，名曰温疟”是也。温疟之证，最易伤阴，切忌温
散，治宜清凉透邪法。服之热势已挫，口渴依然，仍守原方，益以麦冬、鲜地，连服三剂，始得全愈。
产后瘅疟热补至变
四明沈某之室，诞后将匝月以来，忽然壮热汗多，口渴欲
饮。有谓产后阴虚，阳无所附；有谓气血大虚，虚热熏蒸，皆用温补之方，严禁寒凉之药。见病者忽尔 羸，
日晡发热，益信其为蓐痨，愈增热补，更加唇焦齿燥，舌绛无津。复请前二医合议，议用导龙入海，引火
归源之法，不但诸证未减，尤加气急神昏，始来商之于丰。丰即往诊，两手之脉，皆大无伦，推其致
病之因，阅其所服之药，实因误补益剧，非病至于此险也。沈曰∶此何证也？丰曰∶乃瘅疟也。此即古人
所谓阴气先伤，阳气独发，不寒瘅热，令人消烁肌肉，当用甘凉之剂治之。曰∶产后用凉，可无害乎？曰∶
有病则病当之，若再踌蹰，阴液立涸，必不可救矣。即用甘寒生津法，加两洋参、紫雪丹治之。头煎服下，
未见进退，次煎似有欲寐之形，大众见之，无不疑昏愦之变。复来请诊，脉象稍平，唇舌略润，诸恙如旧，
但增手战循衣。丰曰∶此阴阳似有相济之意，无何肝风又动之虞。仍守原章，佐以阿胶、龟版，及鸡子黄，
令其浓煎温服。是夜安神熟寐，热势大衰。次早诊之，诸逆证皆已屏去，继以清滋补养，调理两月方瘳。
阴邪入肾发为牝疟
江南陶某之室，寡居五载，腰如两截，带下淋漓，时值中秋，炎蒸如夏，或当风而纳凉，或因渴而饮冷，
其阴邪乘虚而陷少阴，发为牝疟。脉来沉小之象，畏寒而不甚热，肌肤浮肿，面色痿黄，饮食减少而乏味，小
水淡黄而欠舒，此阴虚邪陷之证，显而易见。丰用金匮肾气去萸肉、丹皮，加干姜、苍术，连服十
余剂，诸恙全安。
寒湿入脾证成牝疟
金陵张某，作客来衢，形素丰肥，向有卢同之癖，其体属寒湿者，先露一斑。忽患间日恶寒，按时而至，
胸前痞闷，口不作干，脉缓近迟，苔腻而白，此牝疟也。古人虽有邪气伏藏于心
于肾之论，但今之见证，皆属乎脾，宜用平胃合二陈，加干姜、草果、白蔻、砂仁治之。令尝五剂，三日
服尽，诸证咸瘥。
程曦曰∶凡学医者，必须天机活泼，毫无胶固之人而后可。如赵、喻注《金匮》，皆言邪舍于心，石
顽正其失，专言邪藏乎肾。吾师前以石顽之训为准绳，今观是案，又谓在脾，其实
非矛盾也，良由见证而断也。总因间日恶寒，按时而至，称为牝疟。可见医者，审证为第一耳。
疟发昏迷治痰得效
南乡酆某之母，年逾六旬，偶沾疟疾，淹缠数月，药石无功，乘舆来舍就诊。诊其脉，两手皆弦，其
疟连日而发，每于薄暮时，先微寒而后微热，神识渐渐昏闷，约一时许始苏，日日如是。阅前医之方，皆
不出小柴胡汤清脾饮等法，思其发时昏闷，定属痰迷。即以二陈汤加老蔻、藿香、杏仁、草果、潞参、姜
汁治之。连进三剂，神识遂清。继服二剂，寒热亦却。
时行疫疟
己卯夏五，患寒热者甚众，医者皆以为疟。所用咸是小柴胡汤、清脾饮，及何人饮、休疟饮等方，未
有一方奏效。殊不思经谓“夏伤于暑，秋必 疟”，疟每发于秋令，今于芒种夏至而发者何也？考岁气阳明
加于少阳，天政布凉，民病寒热，斯时病疟者，尽是时行疫疟也。有建德钱某来舍就医，曰∶患疟
久矣，请先生截之。丰曰∶此乃时行疫疟。遂用宣透膜原法加豆卷、干姜治之，其效捷于影响。后来求
治者，皆与钱病无异，悉以此法治之，莫不中 。可见疫疟之病，不必拘疟门一定之方，又不必拘
一定之证，更又不必拘一定之时，但其见证相同，而用药亦相同者，断断然矣。
鬼疟□□□□□□□□□
东乡叶某，自初秋患疟，至孟冬未愈，每每发于午后，寒不
甚寒，热不甚热，言语错乱，如见鬼神，至后半夜，神识遂清，倦怠而寐，日日如是，曾延医治，尽属罔灵。
请丰诊之，两手之脉，不调之至。曰∶“此鬼疟也。”即用驱邪辟祟法去龙骨，加
草果、常山，服之神气稍清……。
久疟阴虚及阳
鉴湖黄某之内，患疟三年， 羸之至，无医不迓，靡药不尝。邀丰治之，脉象纤微无力，洒寒烘热，每
发于申酉之时，舌淡无荣，眠食俱废，大便溏薄，月水不行。丰曰∶此虚疟也。出方阅之，计有数百余纸，
聊审近日之方，非参、 、术、草，即地、芍、归、胶，未尝有一剂桴鼓。细思是证，乃疟邪深踞于阴，
阴虚及阳之候。即用制首乌五钱，补其阴也；淡附片三钱，补其阳也；鳖甲二钱，青蒿五分，搜其阴分久踞
之邪；鹿霜三钱，羌活五分，随即领邪而还于表；东洋参三钱，炙甘草八分，补其正而御其邪；生姜二片，
红枣五枚，安其内而攘其外。诸药虽经服过，然制方实属不同。古云用药如用兵，孰为主将，孰为
先锋，指挥得法，自可望其破垒耳。黄某深信，即使人拣来煎服，二剂寒热觉轻；又二剂，精神稍振；再
又二剂，诸 尽却。调补三月，月信始行，起居犹昔矣。
体虚劳疟
安徽汪某，体本虚怯，饮食并减，神气极疲，精遗于梦，汗漏于寐，闲居静养，诸恙如无，偶有烦劳，遂
作寒热等证。延丰诊之，脉来小涩，此属劳疟之证，分明若绘矣。拟用何人散加
鳖甲、牡蛎、茯神、龙骨，令服十余剂，调养数月而康。
疟母破剂无效温补碱软得安
南乡傅某，自同治纪元，患疟之后，左胁下结成一块，即疟母也，迄今十五载矣，身体安然，不知不觉，
每一违和，渐次居中，初服常山饮子，后用鳖甲煎丸，皆无效验，因停药勿治。迩
苦眩晕遗精，耳鸣盗汗，曾用六黄兼六味，服之虽妥，但其痞块渐大渐中，将有变蛊之势。脉形缓滞，两尺
皆弱，先天亏损，断断无疑，消破之剂，决难浪施。余用桂附八味加龙骨、牡蛎、龟
版、鳖甲，蜜丸。服一料诸恙少减，二料得全瘥矣。
疟母攻破致死
歙北一医，在吾衢名冠一时。时有里人范某，久患疟母，寝食若旧，动作如常，闻此医欲归梓里，恐郡
内诸医，不能杜其病根，即商其治。所用硝、黄、枳、朴、巴豆、蓬、棱，一派攻伐之剂，未数日腹如复釜，
神气顿疲，饮食减少，病势日加一日，至于危急，始来商治于丰。诊其脉沉小而涩，此因攻破太猛，正气受伤之
候，证弗易治，嘱商名手。其兄再四哀求，不得已，勉以香砂六君损益，服之未效，复请固辞，再商他医，
终不能起。
程曦曰∶古人谓不服药为中医，诚哉是言！历见因病致死者少，因药致死者多，若此病是药速其亡也。不
思李念莪云∶养正则邪自除，譬如满座皆君子，一、二小人，自无容身之地。曦之鄙见，当补
正为君，稍兼攻积，庶乎稳妥，偏于攻破，非法也。
三疟扰伤气血补益得效
南乡李某，患三日疟，缠绵两三载，方药靡效。近用多是甜茶，服之呕吐，吐伤胃气，谷食减少，神气
愈疲，而疟疾仍来，来舍求治于丰。诊其脉缓涩沉弦，形色清 之至，此气血阴阳受亏之象也，非补益不能望
痊。即用制首乌五钱，潞党四钱，鳖甲、鹿霜各二钱，干姜、附片各八分，嘱服十剂，临发之日勿服，至第八
剂，寒热遂未发矣。复来就诊曰∶先生之方效于拔刺，然诸药前医亦曾用，而未验者何也？丰曰∶一则药味杂
乱，二则服法未精，不知间二日之疟，其邪深，其正虚，所以用
补法于未发之先，助其气血阴阳，则邪不能胜正而自止矣。今脉转为缓小，沉分亦然，疟邪果远遁也，当
守旧法，加之熟地、归身，姜、枣为引，连服十剂而安。
产后三疟久缠
北乡杜某之内，自诞后气血未复，偶沾三疟，纠缠半载未瘳。发时背如负重，腰如两截，寒洒洒欲覆被，
热烘烘欲思饮。诊其脉，举之若浮绵，按之不满部，面色白而无荣，舌色淡而无苔，此属奇经本虚，疟邪窜
入于阴，阴虚及阳之证。斯宜未发之日，大补奇脉阴阳，俾正气复充，邪气自却，倘以常山、草果专治其疟，
便是舍本求末矣。丰用东参、熟地、鹿霜、狗脊、龟版、牡蛎、炙 、桂枝，姜、枣为引，约服二十余剂，
疟始脱体。
或问曰∶曾见景岳治疟，每迎其锐而击之，最捷最效。今先生治疟，用药于未发之先。究遵景岳耶？抑
Xu Han Ti Zhi Hu Huan Shu Nüe (Sudden Onset of Summerheat-Jaundice Malaria in a Deficient-Cold Constitution)
The maternal grandmother of Jin from Jianling suddenly contracted summerheat-jia nüe (intermittent malaria caused by summerheat) in mid-autumn. It occurred daily for several days, with alternating chills and steaming fever, profuse sweating like rain, thirst with desire to drink, a wiry and slippery pulse, and a slightly yellow tongue coating. This is summerheat-jia nüe. Jin asked, "Why did I get this disease?" Lei Feng said, "It is largely due to seeking coolness during the summer months and overeating raw and cold foods. Those who manifest symptoms immediately are suffering from Yin Summerheat; those whose pathogenic factors lie dormant for a long time and only now manifest are experiencing what the *Neijing* calls 'Summer injury by summerheat, autumn becomes jia nüe'." He immediately employed the Method of Clearing the Ying Level and Guarding the Wei Level. After taking the medicine, the patient felt even hotter, so he was urgently invited for a follow-up consultation. The pulse had changed to wiry and slow, and upon inquiry, the mouth was no longer thirsty. Lei Feng said, "This is a sign that the malaria pathogen is reaching the exterior; do not worry." Observing his fat and white physique, he knew the underlying constitution was deficient and cold, so he switched to a primary method of warming and tonifying. He used Lizhong Tang (Cinnamon Twig and Ginger Decoction) added with Cardamomi Fructus (Doukou), processed Pinelliae Rhizoma (Zhi Banxia), Paecilomyces Militaris (Shuqi), and Bupleuri Radix (Chaihu), using fresh ginger and jujube as guides, decocted with well water and river water. After three doses, the malaria pathogen retreated.
Shu Nüe Re Sheng Bi Xue Shang Tu (Summerheat Jia Nüe with Excessive Heat Forcing Blood to Regurgitate)
The son of Ye from south of the city accidentally contracted malaria and invited Lei Feng to diagnose him. The pulse was long and forceful, with chills and fever occurring every other day, thirst preferring cold drinks, and profuse sweating after fever subsided. This was summerheat-jia nüe. He used the Method of Clearing the Ying Level and Guarding the Wei Level, removing Equiseti Herba (Mu Zei), and adding Agastachis Herba (Huoxiang), Tsaoko Fructus (Caoguo), Bupleuri Radix (Chaihu), and Glycyrrhizae Radix et Rhizoma (Gancao). After taking the medicine, the malaria势头 remained, and he vomited several mouthfuls of bright red blood. Palpating the pulse again, it had become wiry, large, and rapid. It must be due to summerheat blazing internally, forcing damage to the blood collaterals. Recalling the ancient sage's instruction that "treating disease must seek its root," in this case, summerheat is the root, and hematemesis is the branch; one need not treat the symptom directly without addressing the cause. He immediately used the Method of Cooling and Washing Away Summerheat, removing Dolichos Lablab Seed (Bian Dou), and adding Scutellariae Radix (Huangqin) and Anemarrhenae Rhizoma (Zhimu). After two doses, the malaria attacks came earlier, the heat intensity lessened, and it resolved unknowingly, with the bleeding not recurring.
Jie Nüe Tai Zao Bian Cheng Zhong Zhang (Malaria Interrupted Too Early Leads to Distension and Swelling)
Zheng from Xixiang accidentally contracted malaria, with heavy heat and slight chills, thirst, and diarrhea. He first tried talismanic spells without effect, then took drugs to interrupt the malaria, causing both malaria and diarrhea to stop simultaneously. A few days later, his abdomen suddenly distended, and urination became scanty. He came to Lei Feng's residence for treatment. Both hands' pulses were dull and sluggish, but strong on deep pressure. This was a syndrome of summerheat-jia nüe complicated with dampness. The pathogen originally wanted to exit via the exterior and interior branches. Mistakenly using interruption methods blocked the path of the pathogen; summerheat wanted to reach the exterior but could not, dampness wanted to descend but could not. They obstructed each other in the middle, causing qi mechanism stagnation and resulting in distension and swelling. The treatment method should prioritize treating the branch. He used Chaenomeli Fructus (Mugua), Artemisiae Annuae Herba (Qinghao), and Agastachis Herba (Huoxiang) to resolve summerheat; Scutellariae Radix (Huangqin), Atractylodis Rhizoma (Cangzhu), and Tectona Grandis Stem (Tongcao) to move dampness; Citri Reticulatae Pericarpium (Qingpi), Magnoliae Officinalis Cortex (Houpo), Armeniacae Semen (Xingren), and Arecae Seed (Binglang) to move qi and relieve fullness. After taking the medicine, there was slight relief, with flatulence providing some abdominal loosening. He added Raphani Fructus (Fuzi) to break qi stagnation and Cruris Galliformatis Endothelium Corneum (Jijin) to eliminate fluid retention. After taking it, there was more flatulence, urination became smooth, and the abdomen gradually subsided. Later, using methods to regulate spleen and transform qi, he made a complete recovery.
Jiang Cheng said: Looking at these three cases above, although they are mild forms of summerheat-jia nüe, their complicating syndromes are different. If not carefully differentiated and treated recklessly, mild conditions will worsen, and severe conditions will become critical. In Jin's case, the constitution was deficient and cold, cured by warming and tonifying. In Ye's case, summerheat damaged the collaterals, calmed by cooling agents. In Zheng's case, dampness complication led to swelling, relieved by breaking and reducing agents. Thus, medical methods have certain principles but no fixed formulas. If one sticks rigidly to specific drugs for specific syndromes, one becomes inflexible and ineffective.
Feng Nüe Shi Xie Cheng Ru Xue Shi (Wind Malaria with Pathogenic Factors Entering the Blood Chamber)
The daughter of Gong from south of the city first had slight chills then fever, with thirst and sweating, occurring three times daily for several days. The pulse was wiry and rapid, and the tongue coating was yellow and greasy. This was due to summerheat injury in summer plus wind sensation in autumn, named Wind Malaria. He used the Method of Acrid Dispersal of the Taiyang Channel, removing Notopterygii Rhizoma (Qianghuo), and adding Gentianae Macrophyllae Radix (Qinjiao) and Agastachis Herba (Huoxiang). After two doses, the malaria势头 did not decrease, attacks became delayed, and at night he frequently spoke deliriously. Follow-up pulse was similar to yesterday, but the left side was stronger than the right. Recalling Zhang Zhongjing's saying: "Clear during the day, delirious at night, this is heat entering the blood chamber." With the left pulse prevailing, suspecting blood chamber involvement, he asked if menstruation had occurred. The mother said, "It was very light yesterday, and has not continued since." This is clearly a syndrome of pathogen entering the blood chamber. Temporarily sticking to the previous formula, removing Saposhnikoviae Radix (Fangfeng) and Sojae Preparata (Danchi), adding Angelicae Sinensis Radix (Danggui), Paeoniae Radix Rubra (Chishao), Chuanxiong Rhizome (Chuanxiong), and Bupleuri Radix (Chaihu). After taking it, menstruation returned, scanty and drop-like, delirium decreased, but malaria persisted. Re-palpating the pulse, the left side turned soft, others wiry and slippery, indicating hitting the disease source, so the original formula could be taken. Fortunately, the malaria势头 declined daily. He switched to the Method of Venting and Penetrating the Membrane Source, adding Bupleuri Radix (Chaihu) and Red Jujube (Hongzao). After three doses, the malaria pathogen was resolved.
Cheng Xi said: Seasonal diseases are easy to treat, complicating diseases are difficult. If this case did not carefully inquire about menstruation, both doctor and patient would be mistaken. If seeing delirium and attributing it to pathogen entering the pericardium or stomach heat, using clearing or purging methods would add complications. Without familiarity with Zhang Zhongjing's books, today's syndrome would surely become a ruined disease. My teacher once said, without mastering Zhang Zhongjing's works, one cannot speak of medicine. Truly so!
Han Nüe Zhi Zheng Wen Bu Zhi Yan (Verified Case of Warming and Tonifying for Cold Malaria Syndrome)
Pan from east of the city had a plump constitution, frequent loose stools, indicating middle jiao deficiency and cold, which goes without saying. Suddenly in early autumn, he had alternating chills and fever, little sweat on skin. A doctor diagnosed it as Yin Summerheat and prescribed Siwei Xiangru Yin (Four-Ingredient Schizonepeta and Elsholtzia Decoction) with cold-natured herbs, without effect. He came to consult Lei Feng. The pulse was wiry and tight, tongue coating white and thin, chills before fever, occurring every other day. This was Cold Malaria. Largely due to cold constitution plus autumn coolness. If it were Yin Summerheat, it would occur in late summer, not autumn, and Yin Summerheat chills/fever never occur every other day. He should use Fuzi Lizhong Tang (Aconite and Cinnamon Twig Decoction) added with Bupleuri Radix (Chaihu), Tsaoko Fructus (Caoguo), Agastachis Herba (Huoxiang), and Citri Reticulatae Pericarpium (Chenpi). After two doses, slight whole-body sweat, chills and fever slightly cleared. After two more doses, malaria pathogen did not recur.
Shi Nüe Zhi Zheng Xin San Huo Xiao (Efficacy of Acrid Dispersal for Damp Malaria Syndrome)
Wang's wife from Xinding earned a living by washing clothes, inevitably exposed to dampness. Suffering from malaria for half a month, previous doctors' methods failed. She begged Lei Feng to treat her. Pulse was slow, large, and forceful. Whole body edema and pain, no chills/fever/sweat, occurring daily. Clearly dampness-induced malaria. Recalling the ancients' theory that wind can overcome dampness, suitable for acrid-warm dispersal of pathogens. He used Qianghuo Shenshi Tang (Notopterygium Dampness-Permeating Decoction) added with Tsaoko Fructus (Caoguo) and Magnoliae Officinalis Cortex (Houpo). Two doses showed slight effect, two more doses resulted in full recovery.
Wen Nüe Wu Wei Shu Re (Warm Malaria Misdiagnosed as Summerheat)
Zhang from Yuzhang, in mid-summer, had continuous fever for days, thirst preferring drinks. Doctors treated as summerheat, using herbs like Agastachis Herba (Huoxiang), Schizonepetae Herba (Xiangru), Polyporus (Hua Zhu), and Dolichos Lablab Seed (Bian Dou), without effect. He consulted Lei Feng. Pulse was soggy and weak, tongue coating slightly dry and yellow. Combined with symptoms, it seemed like summerheat. However, after fever, there were always aversion to cold with shivering. This is what the *Neijing* calls "Heat first, then cold, occurring at times, named Warm Malaria." Warm malaria easily damages yin fluids; warm dispersal is strictly contraindicated. Treatment should use the Method of Cooling and Clearing to vent pathogens. After taking, heat intensity was suppressed, thirst remained. Sticking to the original formula, adding Ophiopogonis Radix (Maidong) and Rehmanniae Radix Recens (Xian Di). Three doses led to full recovery.
Chan Nüe Chan Hou Re Bu Zhi Bian (Postpartum Chan Malaria Complicated by Heat Tonification)
Shen's wife from Siming, nearly a month postpartum, suddenly had high fever, profuse sweat, thirst. Some said postpartum yin deficiency with unattached yang; others said severe qi/blood deficiency with steaming deficiency heat. All used heat-tonifying formulas, forbidding cold herbs. Seeing the patient emaciate, afternoon fever, they believed it was postpartum consumption (Rulao), increasing heat tonification. Lips cracked, teeth dry, tongue crimson without fluids. Previous two doctors discussed using "Guiding Dragon to Sea" and "Leading Fire Back to Source" methods. Symptoms did not decrease; instead, shortness of breath and confusion appeared. They consulted Lei Feng. Both hands' pulses were extremely large. Investigating the cause and reviewing past meds, it was indeed worsened by mistaken tonification. Shen asked, "What syndrome is this?" Lei Feng said, "This is Chan Malaria. As ancients said: Yin qi injured first, yang qi alone flares, no chills but heat, causing muscle wasting. Use sweet-cool agents." Shen asked, "Is it safe to use cool herbs postpartum?" Lei Feng said, "When there is disease, the disease bears the drug's action. Hesitation leads to immediate yin fluid exhaustion, incurable." Immediately used Sweet-Cold Generating Fluids Method, adding American Ginseng (Yangshen) and Zi Xue Dan (Purple Snow Pill). First decoction showed no change; second decoction showed drowsiness. Everyone feared confusion/death. Re-pulse was calmer, lips/tongue moist, symptoms same, but hand tremors and grasping at bedclothes appeared. Lei Feng said, "Yin and yang seem to harmonize, but fear liver wind stirring." Stuck to original formula, added Donkey-Hide Gelatin (Ejiao), Tortoise Plastron (Guiban), and Egg Yolk (Jizi Huang), decocted thick and taken warm. That night, sound sleep, heat greatly reduced. Next morning, adverse symptoms gone. Continued with clearing, tonifying, and nourishing for two months until recovered.
Yin Xie Ru Shen Fa Wei Pin Nüe (Yin Pathogen Entering Kidney Manifests as Pin Malaria)
Tao's wife from Jiangnan, widowed for five years, waist felt severed, leukorrhea dripping. Mid-autumn, hot and muggy like summer. Exposure to wind/coolness or drinking cold when thirsty allowed yin pathogen to sink into Shaoyin, manifesting as Pin Malaria. Pulse was deep and small, aversion to cold without much heat, edema, sallow complexion, poor appetite, pale yellow uncomfortable urination. Clearly yin deficiency with pathogen sinking. Lei Feng used Jinkui Shenqi Wan (Golden Cabinet Kidney Qi Pill) removing Corni Fructus (Yurou) and Moutan Cortex (Danpi), adding dried ginger (Ganjiang) and Atractylodis Rhizoma (Cangzhu). Over ten doses, all symptoms resolved.
Han Shi Ru Pi Zheng Cheng Pin Nüe (Cold-Damp Entering Spleen Forms Pin Malaria)
Zhang from Jinling, staying in Quzhou, plump constitution, habitual drinker, constitution cold-damp. Suddenly had alternating chills every other day, on time, chest oppression, no dry mouth, slow/near-slow pulse, greasy white coating. This was Pin Malaria. Ancients spoke of pathogen hiding in heart/kidney, but current symptoms belong to spleen. Used Pingwei San combined with Erchen Tang, adding dried ginger (Ganjiang), Tsaoko Fructus (Caoguo), White Cardamom (Baiko), and Amomum Fruit (Sharen). Five doses taken over three days, all symptoms healed.
Cheng Xi said: Medical students must be flexible, not rigid. Zhao and Yu annotated *Jinkui* saying pathogen stays in heart; Shiwang corrected them, saying it stays in kidney. My teacher followed Shiwang. Now seeing this case says spleen. Not contradictory, but based on symptoms. Total alternating chills every other day on time is called Pin Malaria. Thus, syndrome differentiation is paramount for physicians.
Ma Fa Hunzhi Zhi Tan De Xiao (Malaria with Coma Cured by Treating Phlegm)
Feng's mother from Nanxiang, over sixty, contracted malaria, lingering months, medicines useless. Came by sedan chair. Pulse wiry in both hands. Malaria daily, dusk slight chills then slight heat, consciousness gradually confused, recovering after an hour, daily. Past prescriptions were Xiaochaihu Tang or Qingpi Yin. Thinking confusion at onset indicates phlegm confusing the mind. Used Erchen Tang added with Old Cardamom (Laoke), Agastachis Herba (Huoxiang), Apricot Kernel (Xingren), Tsaoko Fructus (Caoguo), Codonopsis Radix (Lushen), and Ginger Juice (Jiangzhi). Three doses cleared consciousness. Two more doses stopped chills/fever.
Shi Xing Yi Nüe (Seasonal Epidemic Malaria)
In the fifth month of Ji Mao year, many had chills/fever, doctors thought malaria. Used Xiaochaihu Tang, Qingpi Yin, Heren Yin, Xiumai Yin, none effective. Didn't consider classics: "Summer injury by summerheat, autumn becomes jia nüe." Malaria usually in autumn, why here at Mangzhong/Xiazhi? Examining annual qi: Yangming adds to Shaoyang, heaven governs coolness, people suffer chills/fever. Malaria here is seasonal epidemic malaria. Qian from Jiande came, said malaria long-standing, asked to interrupt. Lei Feng said, "Seasonal epidemic malaria." Used Xuanti Moyuan Fa (Venting/Penetrating Membrane Source Method) added with Soybean (Doujuan) and dried ginger (Ganjiang). Effect swift. Others treated similarly, all successful. Thus, epidemic malaria need not stick to fixed malaria formulas, syndromes, or times. If symptoms match, drugs match.
Gui Nüe (Ghost Malaria)
Ye from Dongxiang, malaria from early autumn to early winter, unhealed. Occurred afternoons, slight chills/heat, confused speech, seeing ghosts, clear by late night, tired sleep, daily. Doctors ineffective. Lei Feng palpated irregular pulses. Said, "Ghost Malaria." Used Quxie Bisui Fa (Expel Evil/Avert Curse Method) removing Longgu (Long Gu), added Tsaoko Fructus (Caoguo) and Clitoria Ternatea Root (Changshan). Spirit slightly cleared...
Jiu Nüe Yin Xu Ji Yang (Long-term Malaria Yin Deficiency Affecting Yang)
Huang's daughter-in-law from Jianhu, malaria three years, extremely emaciated, sought all doctors, tried all drugs. Lei Feng palpated fine, weak pulse, chills/fever, occurring at Shen/You hours (3-7 PM), pale tongue, no sleep/eat, loose stool, amenorrhea. Lei Feng said, "Deficiency Malaria." Reviewed hundreds of past prescriptions: mostly Ginseng, Atractylodes, Licorice, Rehmannia, Peony, Angelica, Gelatin. None worked. Thought: Pathogen deeply rooted in yin, yin deficiency affecting yang. Used Prepared Polygonum Multiflorum (Zhi Shouwu) 5 qian to tonify yin; Processed Aconite (Dan Fupian) 3 qian to tonify yang; Turtle Plastron (Biejia) 2 qian, Artemisiae Annuae Herba (Qinghao) 0.5 fen to search out pathogen in yin level; Deer Antler Glue (Lushuang) 3 qian, Notopterygii Rhizoma (Qianghuo) 0.5 fen to lead pathogen back to exterior; Japanese Ginseng (Dongyangshen) 3 qian, Roasted Licorice (Zhi Gancao) 0.8 fen to tonify upright qi and resist pathogen; Ginger 2 slices, Jujube 5 pieces to calm interior and repel exterior. Although similar herbs used before, formulation differed. Medicine like war: commander vs vanguard. Huang trusted, took two doses, chills/fever lighter; two more, spirit revived; two more, symptoms gone. Tonified three months, menstruation returned, normal life.
Ti Xu Lao Nüe (Body Deficiency Labor Malaria)
Wang from Anhui, constitution deficient/cowardly, poor appetite, extreme fatigue, nocturnal emission, night sweats. Resting, symptoms absent; exertion caused chills/fever. Lei Feng palpated small, choppy pulse. Clearly Labor Malaria. Prescribed Heren San added with Turtle Plastron (Biejia), Oyster Shell (Muli), Poria (Fushen), and Dragon Bone (Longgu). Ten doses, months of recuperation, recovered.
Nu Mu Po Ji Wu Xiao Wen Bu Jian Ruan De An (Malaria Mass: Breaking Agents Ineffective, Warming/Tonifying Softening Effective)
Fu from Nanxiang, after malaria in Tongzhi era, mass formed under left hypochondrium (Nu Mu/Mass), fifteen years. Body fine, unaware. When unwell, mass moved center. Tried Changshan Yinzi, Biejia Jian Wan, ineffective, stopped treatment. Recently dizzy, seminal emission, tinnitus, night sweats. Used Liu Huang Tang + Liuwei Dihuang Wan, okay, but mass grew hard/large, risk of Gu disease. Pulse slow/stagnant, both Chi weak, congenital deficiency undeniable. Breaking agents risky. Used Gui Fu Ba Wei Wan added with Longgu, Muli, Guiban, Biejia, honey pills. One dose symptoms reduced; two doses fully healed.
Nu Mu Gong Po Zhi Si (Malaria Mass Killed by Aggressive Purging)
A famous doctor in Quzhou treated Fan, long-term Nu Mu, normal life. Doctor leaving hometown, Fan sought him to remove root. Used Nitre, Rhubarb, Immature Bitter Orange, Magnolia Bark, Croton Seed, Curcuma, Burreed Tuber. Pure attacking agents. Days later, abdomen like inverted cauldron, spirit exhausted, poor appetite, worsening. Came to Lei Feng. Pulse deep/small/choppy, due to excessive purging damaging upright qi. Hard to treat, referred to expert. Brother begged, Lei Feng reluctantly used Xiangsha Liujun Zi Tang modified. Ineffective. Refused further, sought other doctors, died.
Cheng Xi said: Ancients say "not taking medicine is intermediate medicine." True! Few die of disease, many of medicine. This case killed by medicine. Li Nian'e said: Nourish upright, evil removes naturally. Like a room of gentlemen, villains have no place. Opinion: Tonify upright as main, slightly attack accumulation. Safe. Pure attacking is illegal/unorthodox.
San Nüe Rao Shang Qi Xue Bu Yi De Xiao (Three-Day Malaria Damaging Qi/Blood: Tonification Effective)
Li from Nanxiang, three-day malaria, two-three years, medicines failed. Recently drank sweet tea, vomited, damaged stomach qi, poor intake, fatigue, malaria persisted. Lei Feng palpated slow/choppy/deep/wiry pulse, emaciated appearance. Qi/blood/yin/yang deficiency. Must tonify. Used Prepared Polygonum Multiflorum (Zhi Shouwu) 5 qian, Codonopsis (Ludang) 4 qian, Turtle Plastron (Biejia), Deer Antler Glue (Lushuang) 2 qian each, Dried Ginger (Ganjiang), Aconite (Fupian) 0.8 fen each. Ten doses, skip on attack day. By eighth dose, chills/fever stopped. Patient asked why previous herbs failed. Lei Feng said: 1. Messy herbs; 2. Poor administration. Three-day malaria: deep pathogen, deficient upright. Tonify before attack to boost qi/blood/yin/yang, so pathogen cannot defeat upright. Pulse now slow/small, deep same. Pathogen fled. Stick to old method, add Rehmannia (Shudi), Angelica (Guishen), Ginger/Jujube. Ten doses, stable.
Chan Hou San Nüe Jiu Chan (Postpartum Three-Day Malaria Lingering)
Du's daughter-in-law from Beixiang, postpartum qi/blood not restored, caught three-day malaria, half-year unhealed. Attack: back heavy, waist severed, shaking chills wanting covers, steaming heat wanting drink. Pulse floating/spongy superficially, empty deeply. Pale face, pale tongue no coating. Odd vessels deficient, pathogen entered yin, yin deficiency affecting yang. Should tonify odd vessels yin/yang before attack, restore upright, expel pathogen. Using Changshan/Caoguo specifically for malaria is neglecting root for branch. Lei Feng used Japanese Ginseng (Dongyangshen), Rehmannia (Shudi), Deer Antler Glue (Lushuang), Dogwood Spine (Gouji), Turtle Plastron (Guiban), Oyster Shell (Muli), Roasted Astragalus (Zhi Huangqi), Cinnamon Twig (Guizhi), Ginger/Jujube guide. Twenty doses, malaria detached.
Question: Zhang Jingyue treated malaria by attacking its vigor, most swift/efficacious. You treat before attack. Do you follow Jingyue or...