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In the spring and autumn seasons, people are affected by the miasma and fog of the mountains, developing alternating chills and fever (Han Re), chest and diaphragm fullness and oppression, and loss of appetite. This is because toxic vapors enter the body through the nose and mouth. Treatment should focus on clearing the Upper Jiao (Upper Burner), resolving internal toxins, moving Qi, and descending phlegm; sweating methods should not be used.

Main Formula:
Huanglian (Stir-fried with ginger juice), Huangqin, Muxiang, Nongpuo (Processed with ginger juice), Zhishi (Stir-fried with bran), Banxia (Washed after decoction), Jiegeng, Chaihu, Chuanxiong, Mutong (each 1 qian), Sheng Gancao (0.7 qian), Shengma, Cangzhu (Soaked in rice water, stir-fried with salt water, each 1.5 qian).
Decoct the above herbs with ginger and water, and take hot before meals.

My Commentary: Lingnan is a hot region bordering the sea, with low terrain and thin soil. Therefore, Yang Qi often leaks outward, while Yin Qi is often abundant. Flowers bloom in all four seasons, there is no frost or snow in winter, and heat accounts for more than half the year. In late December, prolonged sunshine may even cause people to fan themselves. People living here often have Qi stagnating upward, excessive sweating, and loose Cou Li (skin pores and interstices). This occurs because Yang Qi fails to return to its root. Once Yang Qi has leaked, the person's fundamental Qi becomes insecure. Yang Qi does not descend but floats upward. When Qi floats and lacks stability, the Xuan Fu (pores) open, making sweat easily lost. Thus, symptoms of internal cold and external heat, or upper heat and lower cold, arise. Treatment should primarily consolidate Yang Qi and strengthen the Cou Li. If dispersing and releasing exterior drugs are overused, Yang Qi will become more deficient, and Wind pathogen will flourish; few cases will avoid mismanagement. If the disease is caused by external pathogens, they should be dispersed. If the external pathogens are resolved but the illness persists, it indicates Lung Qi injury; use Buzhong Yiqi Tang (Spleen-Raising Qi-Supplementing Decoction). If the head and eyes feel unclear, it is due to Stomach Qi failing to ascend; add Manjingzi. If appetite is poor, it is Stomach Qi deficiency; use Sijunzi Tang (Four Gentlemen Decoction). If food is difficult to digest, it is Spleen Qi deficiency; use Liujunzi Tang (Six Gentlemen Decoction) plus Shaoyao and Danggui. If one fears cold, avoids cold drinks/food, or experiences acid regurgitation, it is Spleen Qi deficiency and cold; add Paogjiang (Pregnant Ginger) to the previous formula. If ineffective, add Wuzhuyu (0.4 qian) and Huanglian (0.2 qian). Other conditions should be treated based on deduction. Various symptoms of Lingnan miasma are detailed in the "Hygiene Chapter". Those traveling to this area should keep this book for frequent reference.

If temperature regulation is improper, such as removing clothes during sweating and catching Wind-Cold, leading to Qi blockage, fever, and headache, this belongs to the category of Shanghan (Cold Damage). However, Lingnan's warm climate causes easy sweating, so symptoms often resemble Nué (Malaria). Severe cases involve persistent chills and fever; mild cases are Nué. Southern Qi tends to rise, so Lingnan patients suffering from this condition suddenly present with chest fullness, phlegm-saliva obstruction, and inability to eat. This differs from Northern Shanghan, which only affects the exterior while the interior remains harmonious. Treatment should release the exterior, clear heat, descend Qi, and move phlegm. This formula is suitable for cold months, or warm months where Wind-Cold was contracted.

Qianghuo, Cangzhu (Soaked in rice water), Chaihu, Huangqin, Juhong, Banxia (Washed after decoction), Zhishi, Zhi Gancao (Honey-fried), Chuanxiong (each 1 qian).
Decoct with ginger and water, take before meals, including the dregs. Stop taking when sweat appears.

My Commentary: For the aforementioned symptoms, if there is internal food retention and external Wind-Cold contraction, use Huoxiang Zhengqi San (Patchouli Powder to Rectify the Qi). If Spleen Qi is weak with chills, fever, and vomiting, use Jinbuhuan San. Generally, in Lingnan, damp-heat steams, Cou Li do not close, fluids leak excessively, and internal Yang Qi is deficient. The method should prioritize regulating and tonifying Lung Qi. The Lung governs Qi and controls Cou Li; Lung Qi deficiency leads to loose Cou Li and fluid leakage, causing these symptoms. Once external pathogens are gone, tonify Spleen Earth to generate Lung Metal.

Zhang Nué (Miasma Malaria) and Shi Nué (Seasonal Malaria) with alternating chills and fever.
Chaihu, Zhimu (each 1.5 qian, stir-fried), Cangzhu (Soaked in rice water), Huangqin (Wine-fried), Gange, Chenpi, Banxia (Washed after decoction), Chuanxiong (each 1 qian), Zhi Gancao (0.7 qian, honey-fried).
Decoct with three slices of ginger and two dark plums (Wumei) in water. Take in the early morning and before noon.

My Commentary: For the aforementioned symptoms, if alternating chills and fever are due to unresolved external pathogens, use the original formula to disperse them. If due to inherent weak Spleen Qi, or if chills and fever persist after external pathogens are cleared by previous medicines, accompanied by nausea and poor appetite, this is Spleen Qi damage; use Buzhong Yiqi Tang plus Banxia, Gange, and Fuling for regulation. If chills and fever occur before noon, it belongs to Qi deficiency; use Sijunzi Tang plus Danggui and Shengma. If chills and fever occur after noon, it belongs to Blood deficiency; use Bazhen Tang plus Chaihu and Shengma. Generally, long-term illness causing Qi deficiency and weak Blood inevitably leads to fever; Tonify the Spleen and Stomach with formulas like Sijunzi Tang. Once the Spleen and Stomach are strong, Qi and Blood generate naturally. If mistakenly treated as Blood deficiency using heavy, yin-nourishing agents like Siwu Tang to directly generate Blood, the Spleen Earth will be further injured, affecting all organs, causing numerous deficiency syndromes, making treatment difficult, potentially fatal.

For chronic Nué, add Renshen (1.5 qian) and Danggui (1 qian). For excessive sweating, remove Cangzhu, replace with Baizhu, and add Shaoyao (wine-fried, 1.5 qian).

My Commentary: Chronic Nué that does not heal belongs to Middle Qi deficiency failing to nourish the organs; regulating and tonifying the Spleen and Stomach will resolve other diseases. Spontaneous sweating indicates Yang Qi deficiency failing to secure the Cou Li; use Sijunzi Tang plus Danggui, [missing character, likely Huangqi], and Chenpi. If ineffective, add Jiang and Rougui. Cold extremities require immediate addition of Fuzi. Night sweats indicate Yin deficiency and loose Cou Li; use Bazhen Tang plus Rougui and Wuweizi. Restlessness, heat, and thirst temporarily require Danggui Liu Huang Tang, where the three Huang herbs are charred, and double the amount of Renshen and [missing character]. Once sweating stops, resume Bazhen San. If Kidney Qi is inherently weak with fever and thirst, use Liuwei Wan. Cold extremities or Phlegm-Qi attacking upward require Bawei Wan. If pathogens are scattered but chills and fever persist, this is True Qi deficiency; use Buzhong Yiqi Tang. If Qi and Blood deficiency cause chills and fever, use Bazhen Tang. Improper treatment damages Yuan Qi, causing myriad changes, not just chronic Nué.

Nué transforming into Li Ji (Dysentery) should be treated as deficiency; thus, Spleen and Stomach tonics are used.
Huanglian (Stir-fried), Muxiang, Suosha, Huangqin (Stir-fried), Juapi, Baizhu, Danggui (Wine-washed, each 1 qian), Shaoyao (Stir-fried, 2 qian), Zhi Gancao (0.5 qian).
Decoct with ginger and water, take before meals.

My Commentary: The aforementioned symptoms result from excess Pathogenic Qi and insufficient Form Qi. Use the original formula to clear and resolve Stomach and Spleen pathogenic heat. If both Pathogenic Qi and Form Qi are insufficient and healing fails, use Buzhong Yiqi Tang to nourish the organs for self-healing.

In warm and summer months, if people suffer from epidemic febrile diseases, treatment should use heat-clearing and detoxifying agents, addressing both interior and exterior. After recovery, regulate the Spleen and Stomach to strengthen Yuan Qi.
Kuang Huangqin, Shengma, Gange, Zhimu (wine-fried, each 1 qian), Renshen, Shigao, Shaoyao (each 1.5 qian), Huanglian (wine-fried, 0.4 qian), Gancao (0.7 qian), Qianghuo (2 qian), Sheng Dihuang (wine-washed, 0.5 qian).
Decoct with ginger and water, take hot before meals, continue with dregs.

My Commentary: If the pathogen is in the Foot Yangming channel with unresolved exterior and interior, use this formula to harmonize. If excessive purging damages Stomach Qi, causing fever and thirst, use Zhuye Shigao Tang to generate fluids. If mistaken sweating causes Yang collapse with fever and thirst, use Shengyang Yiguo Tang. If mistaken purging causes Yin collapse with fever and irritability, use Lizhong Tang.

For chest/diaphragm oppression and phlegm-saliva obstruction, add Zhishi and Banxia (each 1 qian) and 4-5 spoons of fresh ginger juice. For unstable Spleen/Stomach, add Baizhu (1.5 qian).

My Commentary: If form and disease are both excess with phlegm-caused oppression, use this formula. If Spleen/Lung Qi is weak with untransformed phlegm causing oppression, use Liujunzi Tang with small amounts of Jiegeng and Zhike. If Spleen/Stomach weakness fails to control phlegm origin causing oppression, use Liujunzi Tang with Paogjiang.

If seasonal Qi fever transforms into Huang Bing (Jaundice), known as Wen Huang (Epidemic Jaundice), treatment should internally drain damp-heat.
Yinchen, Huanglian (fried with ginger water), Shanzhiren, Bai Fuling, Nongpuo (fried with ginger water), Mutong, Baizhu, Renshen (each 1 qian), Muxiang (0.7 qian), Shaoyao (wine-fried), Gange (each 1.5 qian).
Decoct with ginger and water, take before meals, continue with dregs.

My Commentary: If caused by damp-heat stagnation, use this formula. If due to long-term illness worsening Yuan Qi deficiency, with Spleen's true color appearing externally, use Buzhong Yiqi Tang plus Yinchen and Fuling. If Middle Qi deficiency-cold with cold extremities, edema, or black-yellow jaundice, use Renshen Lizhong Tang plus Fuling and Yinchen. Su Dongpo used Shengsanzi in Huangzhou, reflecting this intent. Locals did not understand, instead using Binglang to guide and damage True Qi, opening Cou Li, inviting external pathogens, and causing illness. If diet is regulated,起居 (daily routine) is cautious, cold/heat is adapted, and Yuan Qi is solidified to repel external pathogens, even if afflicted, the condition is mild. In the spring of Jiashen (Jiajing Year 3), a major epidemic occurred in Nanjing. Shengsanzi was decocted and distributed to old and young. Patients crowded in, and corpses blocked roads, which is truly pitiable! It is unknown that this formula was created for Lingnan's climate. Zhejiang and Guangdong are ten thousand li apart, different regions with distinct climates and human circumstances. How can uniform treatment without error be expected?