Library

It was said in old texts that after returning from Lingnan, one might suffer from "returning miasma" (Huitou Zhang). This is generally no different from miasma contracted while in Guangxi or from acclimatization issues upon first entering Guangxi. In the south, Yang Qi tends to dissipate while Yin Qi is often abundant. The struggle between these two energies results in cold and heat fluctuations throughout all four seasons. When humans are affected by this, they develop diseases characterized by alternating chills and fever. Chills manifest as shivering, while fever presents as stifling oppression. Recovery usually occurs through sweating; this constitutes the chills and fever pattern of Guangxi miasma. The so-called "returning miasma" and illnesses arising from initial acclimatization difficulties in Guangxi are merely diseases caused by the struggle of Yin and Yang and climatic disharmony.

The climate in Lingnan features no frost or snow in winter, cold springs, and hot autumns, with inconsistent weather conditions that can change suddenly within a single day, differing greatly from climates elsewhere. "Returning miasma" typically arises when one has first been affected by the miasmic qi of Guangxi and subsequently exposed to external climatic factors. The conflict between cold and heat, and the imbalance of warmth and chill, lead to a disease of Yin-Yang struggle. Treatment must consider the seasonal temperature variations and assess the thickness and strength of the patient's Yuan Qi (Original Qi). For instance, those leaving Guangxi in the first month of winter find it still warm with little cold, though northerly winds may bring sudden chill. During travel, formulas such as Hejie San (Harmonizing Powder) or Shenzhu San (Divine Efficacy Powder) should be taken to harmonize the Spleen and Stomach and expel Wind pathogenic factors. Upon entering colder regions where the ground freezes, near the destination, Zhengqi San (Righteous Qi Powder) or Renshen Yangwei Tang (Ginseng Stomach-Nourishing Decoction) may be used to prevent old miasma and resist the current cold. However, these four types of medicines are merely means to an end (like a fish trap); the true key lies in self-care and regulation. One must carefully evaluate the situation and must not indulge desires upon leaving the miasma area, as this is the cause of such illnesses. Thus, the concept of "returning miasma" is not empty talk.

Ji Hong stated: Having resided in Lingnan for a long time, I have come to realize that treating miasma diseases requires careful selection of medications. If a patient exhibits fever accompanied by chills, it is called "Cold Miasma" (Leng Zhang), primarily treated with Buhuanjin Zhengqi San (Non-Exchanging Metal Righteous Qi Powder). If there is fever with chest fullness, vomiting, or dysphagia, along with constipation, Jiahe San (Abundant Grain Powder) is indicated. If the illness is mild and food stagnation is suspected, a small amount of Yinggan Wan (Responsive Pill) may be added; if there is no stagnation, it should not be used. In severe cases, do not use it recklessly. If diarrhea ensues, only warming the Middle and securing the Lower Jiao is appropriate. In late winter or early spring, if high fever is triggered by cold, Xiao Chaihu Tang (Minor Bupleurum Decoction) is used. In summer, if caused by summerheat, Liuhe Tang (Six Harmonies Decoction) is applied. If the body is extremely hot, the head suffers severe pain, and the pulse is rapid, it is termed "Hot Miasma" (Re Zhang). The southern method of "picking grass seeds" (Tiaocaozi Fa, likely a local therapeutic technique) is suitable, but medication cannot be omitted. This condition is deep-seated and difficult to treat. Cold-natured herbs are mostly contraindicated; only hot-natured herbs should be used, employing specific methods, such as taking Fuzi Tang (Aconite Decoction) when cooled. This requires skilled medical judgment. If fever persists with scant sweating and unresolved headache, Hejie San might be considered initially. If the upper body is extremely hot while the lower body is slightly cool, accompanied by chest/epigastric irritability and thirst, heavy/painful waist and legs, loose stools, and a rapid pulse that feels empty upon pressure, this indicates Floating Yang and Closed Yin. Li Daizhao’s Shengjiang Fuzi Tang (Fresh Ginger and Aconite Decoction) is most excellent. For initial onset, Fresh Ginger and Aconite help disperse pathogens. However, after excessive sweating leading to deficiency, vexation, and rising heat, one fears failure to consolidate and descend; thus, Prepared Aconite (Shu Fuzi), Dried Ginger (Gan Jiang), and Agarwood (Chen Xiang) should be taken cold. If bowel movements are free, Agarwood is unnecessary. For severe vexation, add Bamboo Shavings (Zhuru). For extreme thirst, increase Ginseng (Renshen) and Schisandra (Bei Wuwei Zi). For cough and rebellious Qi, add Clove (Dingxiang) and Light Bamboo Leaves (Dan Zhuye). If vexation is accompanied by abnormal signs, dizziness, confusion, and insomnia, Wendan Tang (Warm Gallbladder Decoction) may be given lightly, but it is contraindicated in cases of profuse diarrhea. For severe vexation and thirst, Duoming San (Life-Snatching Powder) or cold water with doubled Ginseng and Aconite is indicated. If there is vexatious heat, spontaneous diarrhea, or non-obstructed urination, red urine should not necessarily be interpreted as heat, especially if the knees and calves are slightly cool. This results from pathogenic stimulation causing Qi and Blood deficiency, where exterior heat fails to nourish the interior, leading to internal heat and deficiency. Immediately administer Jiangfu Tang (Ginger and Aconite Decoction) and moxa Qihai (CV6) and Zusanli (ST36). If progressing to cold limbs, extreme cold in both feet, deficient sweat on the forehead, occasional cough/rebellious Qi, and a rapid, intermittent pulse, the prognosis is critical. Only Sanjian Tang (Three Establishments Decoction) type formulas can consolidate Heart fluids and strengthen True Yang, potentially restoring life.

There is also "Mute Miasma" (Ya Zhang), which is a severe form of Hot Miasma. Medical texts state that blood coagulates in cold and flows freely in heat. Therefore, in Hot Miasma, facial redness, heart heat, tongue fissures, and epistaxis are caused by miasmic heat boiling blood upward. The "picking grass seeds" method is suitable. In severe cases, blood obstructs the Heart orifices, causing coma and inability to speak, or only producing groaning sounds; this is Mute Miasma. Treatment should resolve blood stasis using Heishen San (Black Divine Powder) from *Ju Fang*, which yields miraculous effects. Some cases involve phlegm misting the Heart orifices causing tongue stiffness, but this is not true Mute Miasma. Cases involving Wind-Phlegm must be carefully examined before treatment. (Unsubstantiated prescriptions in this treatise have been deleted.)