严 年届六旬，元气素弱，向有肝气，近患三疟。两月以
前，先受伏暑；小愈之后，三疟遂作。脉弦，肝胃尤甚。木胜胃
土，恶谷厌纳，痰多呕恶，心跳少寐，便闭溺赤。盖胃气一虚，
百病丛生矣。高年虽大便两旬不通，未可以通阳为务。培养中气，启胃化痰，是为扼要；调和营卫，退其寒热佐之。
党参 冬术 茯苓 半夏 陈皮 当归 桂枝 淡芩 枣仁 泽泻 谷芽 鹿角霜 生姜 红枣
上方以六君子汤坐镇中宫，补脾健胃，气运则痰湿自化，气
旺则津液自生。合入当归、桂枝，和营散邪。更复鹿角霜之通阳
者，以治背独恶寒。再加黄芩以泄热，监制桂、鹿之辛温，使无
偏畸，不失调和之义。枣仁安神，泽泻去湿，谷芽醒胃，姜、枣调和营卫，皆佐使之助耳。
某 大疟百日，营卫两虚。胃为卫之本，脾乃营之源。胃阳
虚则胸腹时痛而吞酸，脾阴虚则经事愆期而盗汗。补脾胃以化其疟痰，和营卫而退其寒热。营卫一和，盗汗自止。
党参（姜汁炒） 冬术（土炒） 半夏 茯苓 陈皮 川连（吴萸三分，煎汁
拌炒） 制首乌 白芍（桂枝三分，煎汁拌炒） 煨姜 红枣
吴 三疟一载有余，经停将及两载。腹中胀满，有块作痛。
是血先凝结于前，气复阻滞于后，加以寒痰积聚，中气失运。法当先运其中。
六君子去炙草，加木香、当归、川朴、生姜、茺蔚子、红枣。
石 三疟久而痰涎聚，肝胆逆而郁火盛，以致发狂。今狂已退，痰火犹未全除。拟化胃经之痰，平肝胆之火。
半夏 茯苓 橘红 牡蛎 淡芩 川贝 牛膝 鳖甲 白术（土炒） 竹茹 钩钩
徐 盗汗便溏，心脾之病也。脾气不运则便溏，心阴不守则
盗汗。大疟日久，寒热仍作，营卫不调。补心脾，和营卫，归脾
汤加减治之。
党参 黄 冬术 熟地 白芍 砂仁 六曲 枣仁 归身 茯神 木香 牡蛎 浮麦 红枣
渊按∶运脾气，补脾阴，和营卫，温督脉，前数方皆虚疟，久疟治法。
营 久患疮疥，湿热浸淫，复因外感暑湿为疟，缠绵不已，
变为三疟。诊脉濡小，其湿仍恋，而元气渐伤，虑加腹满，宜早图之。然须安逸忌口为要。
白术 半夏 赤苓 陈皮 大腹皮 川朴 神曲 藿梗 蔻仁 通草 鸡距子
此用正气散去甘、桔、苏、芷，加通草、蔻仁，疏通气分之湿，用鸡距子以解酒湿。
朱 厥阴过升，阳明失降，疟成烦闷、痞呕，当变柴胡制而为泻心法，和阳明即所以和少阳也。
川连（姜汁炒） 半夏 广皮 藿梗 白蔻仁 竹茹（姜汁炒）
此人舌苔半边白如水晶粉团，必有痰饮。后于此方中加生姜三片，其呕即止。
渊按∶本不当去生姜。若去之，便失南阳制方之义矣。
庄 但热不寒，此为牡疟，柴胡桂枝汤主之。
柴胡 桂枝 半夏 伏苓 陈皮 川朴 草果 炙甘草 生姜 红枣
又 疟发间日，但热不寒，口腻多涎，乃寒痰郁于心下，阳气不得宣越故也。
蜀漆 桂枝 半夏 陈皮 茯苓 羌活 菖蒲
另∶独头蒜六枚，黄丹六分，雄黄五分，共研末为丸。清晨朝向东分五服，开水送。
又 舌白胸闷，背寒独甚。拟宣通阳气，以化痰浊。
麻黄汤合二陈汤，加鹿角霜、石菖蒲。
又 疟止，当调胃气。
半夏 茯苓 炙甘草 陈皮 白蔻仁 生姜 红枣
孙 间疟变为大疟。其寒也，三日一作；其热也，日无间断。
此卫气不得疏通，邪痹不达，是属卫实而营虚，营虚故内热不止也。拟和营卫以祛邪。
桂枝 白芍 柴胡 半夏 赤苓 天花粉 淡芩 陈皮 生姜 红枣
徐 左脉细弦，肝肾亏也；右脉软弱，脾胃虚也。三疟之后，
气血两亏。补肝肾，调脾胃，养气血，必得安逸少劳而后可也。
党参 大熟地 杜仲 枸杞子 冬术 茯神 归身 陈皮 白芍 生姜 红枣
王 三疟止作，延及五年，营卫之不调，脾胃之不和，肝肾
之不足，不言可知矣。近今月经频至且多，而有血块，腹反胀满，
何也？夫血之与气，犹权衡也。和则平，偏则病，一胜必一负。
血去多则血虚，血虚则气旺，非真气之旺也。气无血以涵之，则
气肆横而有似于旺耳。盖疟久必伤脾，脾伤则肝亢。脾统血，肝
藏血，肝亢则血不藏，脾虚则血失统，故经事频来；而仍有血块
者，肝亢则火炽下焦，冲任之血受其迫燥，欲下而不尽下，故凝
而为瘀，瘀则结块也。图治之方，藏统肝脾之血，而固冲任之
经，一层。调其气之肆横而致和平，又一层。是治月事与腹满之
法。至于理脾胃，调营卫，又为三疟久缠之治。合而成剂，不出求本之图。
党参（元米炒） 冬术（川朴五分，拌炒） 香附（醋炒） 丹参 陈皮 茯苓
乌药 鳖甲 当归炭 白芍（桂枝三分，拌炒） 茜草炭 乌贼骨（漂淡）
鲜生地渣（姜汁炒焦） 姜渣（鲜生地汁炒焦）
鳖甲煎丸十五粒，药汁送下。
渊按∶因脾气伤而血失统，血去舍空，其气更失所根据，故腹
益胀满。调养脾气，治胀即所以摄血；润养肝阴，固血即所以涵
气。妙在交加散清血热而不寒滞，通营气而不辛散，其心思识
力，超越寻常。若辛香耗气以治胀，苦涩凉腻以治血，则失之远矣。
叶 疟为少阳病。少阳者，胆与三焦也。胆失清宁，则烦而
不寐；三焦失其输转，故胸闷而大便带溏，口腻味甜。热甚烦闷，热处湿中，故热愈甚也。拟温胆法。
半夏 茯苓 陈皮 枣仁 枳壳 天竺黄 川朴 青蒿 秫米 佩兰 竹茹
曾 浴出当风，腠理闭塞，水气舍于皮肤之内，与卫气恋
而不化，变为三疟。疟发不透，湿热内走经络，四肢无力，微微
内热，是半虚半实之症。和脾胃，化湿热，通经络，达肌表，标本兼治。
茅术 半夏 香薷 茯苓 秦艽 独活 泽泻 防风 川朴 陈皮 通草 姜皮 生苡仁
奚 三疟发于夜，而渐移至日中，原有自阴出阳之象。今届春深，阳气升发，当助其升举，参以化痰为法。
柴胡 防风 茯苓 丹皮 杜仲 冬术 制首乌 半夏 陈皮 牛膝
黄 大疟十番，寒热虽轻，而邪陷入于三阴。治必从中以达
外，体质虽虚，未可便投补药，仿王晋三加减达原饮。
柴胡 川朴 半夏 茯苓 当归 草果 川贝 花槟榔 陈皮 红花
童 大疟日久，小愈复作，寒热虽轻，其根不断。根者何？水饮痰涎是也。欲治其根，必温中土，用四兽饮加减。
六君子汤加乌梅、草果、蜀漆炭。
尤 久疟之后，脾虚木郁，痰阻气滞，胸闷恶心，头眩心嘈，经事不调。拟舒木郁，兼以化痰。
柴胡 石决明 半夏 陈皮 当归 炙甘草 茯苓 丹皮 砂仁 薄荷
又 投逍遥合二陈法，木郁稍舒，痰气稍化。今从前法加减。
柴胡 炙甘草 杏仁 冬术 陈皮 半夏 焦山栀 茯神 砂仁
吴 疟不离乎少阳，即兼阳明、太阳，亦必使其还返少阳而
后已。今预于疟发之前，先用柴胡引入少阳之界，则邪气从枢转出矣。
小柴胡汤去参、枣，加知母、草果、陈皮。
渊按∶仲景小柴胡治伤寒往来寒热，非治风疟往来寒热。风
疟与伤寒判若天渊，后人往往借用，积习深矣。风疟早用柴胡，必纠缠难愈，须中焦湿热半化，或秋深邪深乃合。
又 疟脉自弦，弦大者为阳，其邪易达。今疟来热势稍轻而短，邪有退机矣。仍从前法。
照前方加沙参、茯苓、通草。
又 疟势渐衰，当和中气，以化痰浊、养心阴，合病体标本而施治也。
沙参 陈皮 麦冬 炙甘草 冬术 半夏 扁豆 枣仁 茯苓 生姜
渊按∶疟病最忌扁豆，想未知之耳。
奚 三疟变为日作，延来两月有余。今则热发于夜，口干汗
少，邪恋营分，其阴已亏。而又胃弱纳少，怀孕半身，恐其正虚不克支持。姑拟和胃、扶正、达邪。
党参 制首乌 冬术 茯苓 川朴 天花粉 柴胡 防风 陈皮 淡芩
丁 三疟久延，营卫两伤，复因产后，下焦八脉空虚。今病
将九月，而疟仍未止，腹中结块偏左，此疟邪阻于血络，聚于肝
募，是属疟母。淹缠不已，虑成疟劳。夏至在迩，乃阴阳剥复之
际，瘦人久病，最怕阴伤。趁此图维，迎机导窍，和阳以生阴，从产后立法。稍佐搜络，以杜疟邪之根。
制首乌 冬术 白芍 杞子 当归 地骨皮 青皮 川芎 香附 乌梅 另鳖甲煎丸，每日服十粒
用四物去地，换首乌，从产后血分立脚。
渊按∶产后阴血固属虚耗，然久疟而至结块，必湿热痰涎，伏膜原未化，此方宜斟酌之。
又 三疟日久，腹中结癖。夏至前和阳生阴，通调营卫，参
入搜络方法。节后三疟仍来，但热势已减，癖块略小，然口干心
跳，营阴大亏，情怀郁勃，多令化火伤阴。木曰曲直，曲直作酸。
疟来多沃酸水，盖肝木郁热，挟胃中之宿饮上泛使然。夫养营阴
须求肝润，理肝郁必用苦辛。久疟堪截，癖块宜消。惟是体虚胃弱，诸宜加谨为上。
党参 冬术 鳖甲（醋炒） 当归 茯神 枣仁 香附 三棱（醋炒） 川连（吴萸炒） 牡蛎 陈皮
渊按∶膜原所伏之邪见矣。
又 丸方。
川贝 半夏 知母
共研细末，姜汁、醋各半泛丸。每朝三钱，开水送。
曹 劳疟，因劳碌而发。寒热似疟，淹缠不已，虑变疟劳。
舌苔白而干燥，胃燥气伤也。法当益气生津，用益气补中意。
党参 黄 冬术 炙甘草 麦冬 归身 陈皮 青蒿 五加皮 生熟谷芽
张 间疟，寒热，舌苔满白。用柴胡达原饮。
柴胡 黄芩 半夏 青皮 花槟榔 草果 川朴 茯苓 生姜
舌苔满白，邪伏膜原，必用槟榔、草果。若舌苔白而燥者忌用。
仁渊曰∶疟证甚多，所感不同，命名各异，《内经》言之详
矣。而诸疟中风疟最多，经谓夏暑汗不出者，秋成风疟。乃暑天
喜当风取凉，露卧湿地，受冷湿、热湿之邪，不使随汗泄出，秋
后凉风闭其汗孔，疟始发矣。前哲云“疟不离少阳”，其实不然。
夫伏暑与疟，同一邪耳，寒热间断者为疟，不断者为伏暑。但
伏暑虽重于疟，其伏较浅；疟虽轻于伏暑，其伏较深。伏暑邪在
太阴、阳明，不涉膜原者多，疟疾涉膜原者多。惟邪伏膜原，所
以纠缠不清。膜原二字，古人多未讲明。夫膜在脏腑之外，肌肉
之里，乃肌肉之里层皮也。俗名膜壑。原乃经穴，六腑皆有之。
经谓横连膜原，言不但邪在脏腑，并横及于肌肉之里，而伏于膜
壑之原，伏甚深矣。亦太阴、阳明所主。所谓少阳，亦犹伏暑之
寒热往来，脾胃升降失职，木郁不达耳。惟脾胃失化，湿浊阻
遏，所以疟必有痰，痰即湿饮。故疟发时能呕出黄涎苦水，其愈
较易。治能开其中焦，化其湿饮，最为先着。观古人清脾，休疟，
四兽等方，无不为开中化痰立法。即久而为疟母，为黄胆、中
满，皆湿热痰浊纠结不化，伤其脾胃所致。即各种疟疾，所因不
同，所治各异，要不离太阴、阳明--脾胃也。脾胃一病，痰湿自生。谚云“无痰不作疟”，其信然欤！
Yan, aged over sixty, has had constitutionally weak Yuan Qi (Original Qi) since youth and a history of Liver Qi stagnation. Recently, he contracted San Nue (a type of malaria with regular intervals). Two months prior, he was initially affected by Fu Shu (latent summerheat); after the symptoms subsided slightly, San Nue subsequently manifested. The pulse is wiry, with symptoms in the Liver and Stomach being particularly severe. Wood (Liver) overacting on Earth (Spleen/Stomach) leads to aversion to grains and poor appetite, excessive phlegm, nausea, palpitations, and insomnia, along with constipation and dark urine. This is because once Stomach Qi becomes deficient, myriad diseases arise. Although the patient is elderly and has not had a bowel movement for twenty days, tonifying Yang and promoting unblocking should not be the primary task at this moment. The key lies in nourishing Middle Qi, awakening the Stomach, and resolving phlegm; simultaneously, harmonizing Ying and Wei (Defensive and Nutritive levels) serves to assist in reducing chills and fever.
Codonopsis Radix (Dangshen), Atractylodis Rhizoma (Dongzhu), Poria (Fuling), Pinelliae Rhizoma Preparatum (Banxia), Citri Reticulatae Pericarpium (Chenpi), Angelicae Sinensis Radix (Danggui), Cinnamomi Ramulus (Guizhi), Scutellariae Radix (Dan Qin), Ziziphi Jujubae Semen (Zaoren), Alismatis Rhizoma (Zexie), Oryzae Fructus Germinatus (Guye), Cornus Officinalis Cortex (Lujiaoshuang), Zingiberis Rhizoma Recens (Shengjiang), Ziziphi Jujubae Fructus (Hongzao).
The above formula uses Liu Junzi Tang (Six Gentlemen Decoction) to stabilize the Middle Jiao, tonifying Spleen Qi and strengthening the Stomach. When Qi moves, damp-phlegm transforms naturally; when Qi is robust, body fluids generate spontaneously. Adding Danggui and Guizhi harmonizes Ying and Wei and disperses pathogens. Furthermore, Lujiaoshuang’s yang-unblocking property treats the specific aversion to cold on the back. Huangqin is added to clear heat, restraining the acrid-warm nature of Guizhi and Lujiaoshuang, ensuring balance without bias. Zaoren calms the spirit, Zexie removes dampness, Guye awakens the Stomach, and Shengjiang with Hongzao harmonize Ying and Wei; these serve as adjuvant (assistant and guide) herbs.
Patient [Surname Unknown], suffering from Da Nue (severe malaria) for one hundred days, has deficiency in both Ying and Wei. The Stomach is the root of Wei Qi, and the Spleen is the source of Ying Blood. Deficiency of Stomach Yang causes intermittent chest and abdominal pain with acid regurgitation; deficiency of Spleen Yin leads to delayed menstruation and night sweats. Treatment should tonify the Spleen and Stomach to transform malaria-related phlegm, and harmonize Ying and Wei to reduce chills and fever. Once Ying and Wei are harmonized, night sweats will cease spontaneously.
Codonopsis Radix (stir-fried with ginger juice), Atractylodis Rhizoma (earth-stir-fried), Pinelliae Rhizoma Preparatum (Banxia), Poria (Fuling), Citri Reticulatae Pericarpium (Chenpi), Coptidis Rhizoma (Chuanlian, stir-fried with juice of 0.3 fen of Evodiae Fructus), Polygoni Multiflori Preparata Radix (Zhi Shouwu), Paeoniae Radix Alba (Baishao, stir-fried with juice of 0.3 fen of Cinnamomi Ramulus), Zingiberis Rhizoma Preparatum (Weijiang), Ziziphi Jujubae Fructus (Hongzao).
Wu, suffering from San Nue for over a year, has had amenorrhea for nearly two years. Abdominal distension and painful masses are present. This indicates blood coagulation occurred first, followed by Qi obstruction. Additionally, accumulation of cold-phlegm has caused loss of Middle Qi transportation. The method should first focus on moving the Middle Jiao.
Liu Junzi Tang minus Zhi Gancao, plus Aucklandiae Radix (Muxiang), Angelicae Sinensis Radix (Danggui), Magnoliae Officinalis Cortex (Chuanpu), Zingiberis Rhizoma Recens (Shengjiang), Leonuri Fructus (Chongweizi), Ziziphi Jujubae Fructus (Hongzao).
Shi, suffering from prolonged San Nue, has accumulated phlegm-saliva, with rebellious Liver and Gallbladder Qi and flourishing constrained fire, leading to mania. Now that mania has subsided, phlegm-fire remains incompletely cleared. The prescription aims to resolve Stomach meridian phlegm and calm Liver-Gallbladder fire.
Pinelliae Rhizoma Preparatum (Banxia), Poria (Fuling), Citri Reticulatae Pericarpium (Juhong), Ostreae Concha (Muli), Scutellariae Radix (Dan Qin), Fritillariae Thunbergii Bulbus (Chuanbei), Achyranthis Bidentatae Radix (Niuxi), Testudinis et Chelydrae Carapax et Plastrum (Biejia), Atractylodis Macrocephalae Rhizoma (Baizhu, earth-stir-fried), Bambusae Folium (Zhuru), Uncariae Ramulus cum Uncis (Gougou).
Xu, presenting with night sweats and loose stools, suffers from Heart-Spleen pathology. Spleen Qi failing to transport results in loose stools; Heart Yin failing to secure results in night sweats. After prolonged Da Nue, chills and fever persist due to disharmony of Ying and Wei. Treatment involves tonifying Heart and Spleen and harmonizing Ying and Wei, using Gui Pi Tang modified.
Codonopsis Radix (Dangshen), Astragali Radix (Huangqi), Atractylodis Rhizoma (Dongzhu), Rehmanniae Radix Preparata (Shudi), Paeoniae Radix Alba (Baishao), Amomi Fructus Rotundus (Sharen), Saccharomyces Granulosus (Liuqu), Ziziphi Jujubae Semen (Zaoren), Angelicae Sinensis Radix (Guishen), Poria Cum Pino (Fushen), Aucklandiae Radix (Muxiang), Ostreae Concha (Muli), Tritici Levis Fructus (Fumai), Ziziphi Jujubae Fructus (Hongzao).
Yuanyuan notes: Moving Spleen Qi, tonifying Spleen Yin, harmonizing Ying and Wei, and warming the Du Mai are methods used in the previous formulas for treating deficiency-type and chronic malaria.
Ying, having suffered from sores and scabies for a long time, experienced damp-heat infiltration. Subsequently, external contraction of summer-dampness triggered malaria, which lingered and transformed into San Nue. The pulse is soggy and small, indicating lingering dampness, while Yuan Qi is gradually damaged. There is concern about developing abdominal fullness, requiring early intervention. However, rest and dietary restrictions are paramount.
Atractylodis Rhizoma (Baizhu), Pinelliae Rhizoma Preparatum (Banxia), Poria (Chiling), Citri Reticulatae Pericarpium (Chenpi), Arecae Pericarpium (Dafupi), Magnoliae Officinalis Cortex (Chuanpu), Saccharomyces Granulosus (Shenqu), Agastaches Herba (Huogeng), Amomi Fructus (Kouren), Tectona Grandis Stem (Tongcao), Berberidis Caulis (Jiju Zi).
This formula uses Zhengqi San, removing Gancao, Jiegeng, Zisu, and Baizhi, adding Tongcao and Kouren to circulate dampness in the Qi level, and Jiju Zi to resolve alcohol-induced dampness.
Zhu, with Jueyin Liver Qi ascending excessively and Yangming Stomach Qi failing to descend, presents with malaria complicated by irritability, epigastric fullness, and vomiting. The strategy should shift from Chaihu formulas to Xiexin (Drain the Epigastrium) methods; harmonizing Yangming thereby harmonizes Shaoyang.
Coptidis Rhizoma (stir-fried with ginger juice), Pinelliae Rhizoma Preparatum (Banxia), Citri Reticulatae Pericarpium (Guangpi), Agastaches Herba (Huogeng), Amomi Fructus (Baikouren), Bambusae Folium (stir-fried with ginger juice).
The patient has half of the tongue coated white like crystal powder clumps, indicating definite phlegm-fluid retention. Later, adding three slices of fresh ginger to this formula stopped the vomiting.
Yuanyuan notes: Ginger should not have been removed originally. Removing it loses the intent of Zhang Zhongjing’s formula construction.
Zhuang, presenting with fever but no chills, suffers from Mu Nue (Yang Malaria). Chaihu Guizhi Tang is indicated.
Bupleuri Radix (Chaihu), Cinnamomi Ramulus (Guizhi), Pinelliae Rhizoma Preparatum (Banxia), Poria (Fuling), Citri Reticulatae Pericarpium (Chenpi), Magnoliae Officinalis Cortex (Chuanpu), Tsaoko Fructus (Caoguo), Glycyrrhizae Radix et Rhizoma Preparata (Zhi Gancao), Zingiberis Rhizoma Recens (Shengjiang), Ziziphi Jujubae Fructus (Hongzao).
Another case: Malaria occurs every other day, with fever but no chills, oral stickiness, and excess saliva. This is cold-phlegm constrained in the heart region, preventing the dissemination of Yang Qi.
Kaempferiae Galanga Rhizome (Shuqi), Cinnamomi Ramulus (Guizhi), Pinelliae Rhizoma Preparatum (Banxia), Citri Reticulatae Pericarpium (Chenpi), Poria (Fuling), Notopterygii Rhizoma et Radix (Qianghuo), Acori Tatarinowii Rhizoma (Changpu).
Separate prescription: Six bulbs of Allium fistulosum var. giganteum (single-head garlic), six fen of Minium (Huandan), five fen of Realgar (Xionghuang). Grind into fine powder and make pills. Take five doses in the morning facing east, washed down with boiled water.
Another case: White tongue coating, chest tightness, and severe cold sensation on the back. The plan is to disseminate and unblock Yang Qi to transform turbid phlegm.
Ephedrae Herba Decoction (Mahuang Tang) combined with Er Chen Tang, plus Cornus Officinalis Cortex (Lujiaoshuang) and Acori Tatarinowii Rhizoma (Shichangpu).
Another case: After malaria stops, regulate Stomach Qi.
Pinelliae Rhizoma Preparatum (Banxia), Poria (Fuling), Glycyrrhizae Radix et Rhizoma Preparata (Zhi Gancao), Citri Reticulatae Pericarpium (Chenpi), Amomi Fructus (Baikouren), Zingiberis Rhizoma Recens (Shengjiang), Ziziphi Jujubae Fructus (Hongzao).
Sun, whose intermittent malaria transformed into Da Nue. The chills occur every three days; the fever is continuous daily.
This indicates Wei Qi fails to circulate smoothly, pathogenic factors are obstructed and cannot reach the exterior, constituting Wei Excess and Ying Deficiency. Due to Ying deficiency, internal heat persists. The plan is to harmonize Ying and Wei to expel pathogens.
Cinnamomi Ramulus (Guizhi), Paeoniae Radix Alba (Baishao), Bupleuri Radix (Chaihu), Pinelliae Rhizoma Preparatum (Banxia), Poria (Chiling), Trichosanthis Radix (Tianhuafen), Scutellariae Radix (Dan Qin), Citri Reticulatae Pericarpium (Chenpi), Zingiberis Rhizoma Recens (Shengjiang), Ziziphi Jujubae Fructus (Hongzao).
Xu, left pulse fine and wiry indicates Liver-Kidney deficiency; right pulse soft and weak indicates Spleen-Stomach deficiency. Following San Nue, both Qi and Blood are depleted. Treatment must tonify Liver and Kidney, regulate Spleen and Stomach, and nourish Qi and Blood. Recovery requires rest and avoiding overwork.
Codonopsis Radix (Dangshen), Rehmanniae Radix Preparata (Da Shudi), Eucommiae Cortex (Duzhong), Lycii Fructus (Gouqizi), Atractylodis Rhizoma (Dongzhu), Poria Cum Pino (Fushen), Angelicae Sinensis Radix (Guishen), Citri Reticulatae Pericarpium (Chenpi), Paeoniae Radix Alba (Baishao), Zingiberis Rhizoma Recens (Shengjiang), Ziziphi Jujubae Fructus (Hongzao).
Wang, suffering from San Nue intermittently for five years, clearly exhibits disharmony of Ying and Wei, discordance of Spleen and Stomach, and insufficiency of Liver and Kidney. Recently, menstruation has become frequent and heavy with blood clots, yet the abdomen is distended. Why? Blood and Qi are like a balance scale. Harmony brings equilibrium; imbalance brings disease. If one prevails, the other suffers. Excessive blood loss leads to Blood deficiency; Blood deficiency makes Qi appear vigorous, but this is not true Qi. Without Blood to contain it, Qi becomes unruly and appears vigorous. Prolonged malaria injures the Spleen; Spleen injury causes Liver hyperactivity. The Spleen controls blood, the Liver stores blood. Liver hyperactivity prevents blood storage; Spleen deficiency causes loss of blood control, hence frequent menstruation. Blood clots remain because Liver hyperactivity generates intense fire in the Lower Jiao, forcing Chong and Ren vessels' blood to become dry and hot. It attempts to descend but does not fully exit, thus condensing into stasis and forming clots. Treatment involves two layers: first, storing and controlling Liver-Spleen blood and securing Chong-Ren channels; second, regulating unruly Qi to restore peace. These treat menstruation and abdominal fullness. Regulating Spleen-Stomach and harmonizing Ying-Wei addresses the chronic malaria. Combined, they adhere to treating the root.
Codonopsis Radix (stir-fried with rice), Atractylodis Rhizoma (stir-fried with 5 fen Magnoliae Officinalis Cortex), Cyperi Rhizoma (vinegar-stir-fried), Salviae Miltiorrhizae Radix (Danshen), Citri Reticulatae Pericarpium (Chenpi), Poria (Fuling), Linderae Radix (Wuyao), Testudinis et Chelydrae Carapax et Plastrum (Biejia), Angelicae Sinensis Radix Carbonisata (Dangguitan), Paeoniae Radix Alba (stir-fried with 0.3 fen Cinnamomi Ramulus), Rubia Cordifolia Radix et Rhizoma Carbonisata (Qiancaotan), Sepiae Endoconcha (Uzeigu, leached), Fresh Rehmanniae Radix Residue (stir-fried scorched with ginger juice), Ginger Residue (stir-fried scorched with fresh Rehmanniae juice).
Biejia Jian Wan (Turtle Shell Pill) fifteen pills, taken with herbal decoction.
Yuanyuan notes: Because Spleen Qi is injured, blood loses control. Blood loss leaves emptiness, causing Qi to lose its foundation, thus increasing abdominal distension. Nourishing Spleen Qi treats distension, which in turn secures blood; moistening Liver Yin secures blood, which in turn contains Qi. The brilliance lies in Jiaojia San clearing blood heat without causing cold stagnation, and circulating Ying Qi without acrid dispersion. Its insight surpasses the ordinary. Using acrid-aromatics to deplete Qi for distension, or bitter-astringent-cool-greasy agents for blood disorders, would be far off the mark.
Ye, malaria belongs to Shaoyang disease. Shaoyang comprises the Gallbladder and Sanjiao. If the Gallbladder loses clarity and tranquility, irritability and insomnia result; if Sanjiao loses its transporting function, chest tightness, loose stools, and a sticky, sweet taste in the mouth occur. Severe heat causes irritability because heat resides within dampness, intensifying the heat. The plan employs Wen Dan Fa (Warm the Gallbladder Method).
Pinelliae Rhizoma Preparatum (Banxia), Poria (Fuling), Citri Reticulatae Pericarpium (Chenpi), Ziziphi Jujubae Semen (Zaoren), Aurantii Fructus (Zhike), Hyacinthtis Tuberosa Bulbus (Tianzhuhuang), Magnoliae Officinalis Cortex (Chuanpu), Artemisiae Annuae Herba (Qinghao), Setariae Milii Fructus (Sumi), Eupatorii Herba (Peilan), Bambusae Folium (Zhuru).
Zeng, after bathing exposed to wind, pores closed, water qi lodged in the skin, entangling with Wei Qi without transforming, resulting in San Nue. Malaria attacks are incomplete; damp-heat travels internally through meridians, causing limb weakness and slight internal heat. This is a semi-deficient, semi-excess condition. Treatment harmonizes Spleen and Stomach, resolves damp-heat, unblocks meridians, reaches the muscle layer, treating both root and branch.
Atractylodis Rhizoma (Maoyu), Pinelliae Rhizoma Preparatum (Banxia), Moslae Herba (Xiangru), Poria (Fuling), Gentianae Macrophyllae Radix (Qinjiao), Angelicae Dahuricae Radix (Duhuo), Alismatis Rhizoma (Zexie), Saposhnikoviae Radix (Fangfeng), Magnoliae Officinalis Cortex (Chuanpu), Citri Reticulatae Pericarpium (Chenpi), Tectona Grandis Stem (Tongcao), Zingiberis Pericarpium (Jiangpi), Coicis Semen (Sheng Yiren).
Xi, San Nue begins at night and gradually shifts to midday, showing signs of moving from Yin to Yang. Now in late spring, Yang Qi ascends; treatment should assist this ascent, incorporating phlegm resolution.
Bupleuri Radix (Chaihu), Saposhnikoviae Radix (Fangfeng), Poria (Fuling), Moutan Cortex (Danpi), Eucommiae Cortex (Duzhong), Atractylodis Rhizoma (Dongzhu), Polygoni Multiflori Preparata Radix (Zhi Shouwu), Pinelliae Rhizoma Preparatum (Banxia), Citri Reticulatae Pericarpium (Chenpi), Achyranthis Bidentatae Radix (Niuxi).
Huang, suffering from Da Nue ten times. Though chills and fever are mild, pathogens have sunk into the Three Yin. Treatment must reach the exterior from the Middle Jiao. Despite constitutional deficiency, tonics should not be given immediately. Follow Wang Jinshan’s Jiajian Dayuan Yin.
Bupleuri Radix (Chaihu), Magnoliae Officinalis Cortex (Chuanpu), Pinelliae Rhizoma Preparatum (Banxia), Poria (Fuling), Angelicae Sinensis Radix (Danggui), Tsaoko Fructus (Caoguo), Fritillariae Thunbergii Bulbus (Chuanbei), Arecae Semen (Huabinglang), Citri Reticulatae Pericarpium (Chenpi), Carthami Flos (Honghua).
Tong, suffering from prolonged Da Nue, relapses after slight improvement. Though chills and fever are mild, the root persists. What is the root? Water retention and phlegm-saliva. To treat the root, one must warm the Middle Earth. Use Si Shou Yin modified.
Liu Junzi Tang plus Terminalia Chebula Fructus (Wumei), Tsaoko Fructus (Caoguo), Kaempferiae Galanga Rhizome Carbonisata (Shuqi Tan).
You, following prolonged malaria, suffers from Spleen deficiency and Liver constraint, phlegm obstruction, Qi stagnation, chest tightness, nausea, dizziness, palpitations, and irregular menstruation. The plan soothes Liver constraint and resolves phlegm.
Bupleuri Radix (Chaihu), Praeparated Ostreae Concha (Shijueming), Pinelliae Rhizoma Preparatum (Banxia), Citri Reticulatae Pericarpium (Chenpi), Angelicae Sinensis Radix (Danggui), Glycyrrhizae Radix et Rhizoma Preparata (Zhi Gancao), Poria (Fuling), Moutan Cortex (Danpi), Amomi Fructus Rotundus (Sharen), Menthae Haplocalycis Herba (Bohe).
Another case: After using Xiaoyao San combined with Er Chen Tang, Liver constraint slightly relieved, phlegm-Qi slightly transformed. Modify the previous method.
Bupleuri Radix (Chaihu), Glycyrrhizae Radix et Rhizoma Preparata (Zhi Gancao), Armeniacae Semen Amarum (Xingren), Atractylodis Rhizoma (Dongzhu), Citri Reticulatae Pericarpium (Chenpi), Pinelliae Rhizoma Preparatum (Banxia), Gardeniae Fructus Carbonisatus (Jiao Shanzhi), Poria Cum Pino (Fushen), Amomi Fructus Rotundus (Sharen).
Wu, malaria is inherently linked to Shaoyang. Even if involving Yangming or Taiyang, it must return to Shaoyang before resolving. Preemptively, before malaria onset, use Chaihu to guide pathogens into the Shaoyang boundary, allowing them to exit via the pivot.
Xiao Chaihu Tang minus Codonopsis Radix (Renshen) and Ziziphi Jujubae Fructus (Hongzao), plus Anemarrhenae Rhizoma (Zhimu), Tsaoko Fructus (Caoguo), Citri Reticulatae Pericarpium (Chenpi).
Yuanyuan notes: Zhang Zhongjing used Xiao Chaihu Tang for alternating chills and fever in Shanghan (Cold Damage), not for Feng Nue (Wind Malaria). Feng Nue and Shanghan are worlds apart. Later physicians often borrowed it, creating deep habits. Early use of Chaihu for Feng Nue leads to lingering difficulty; it is suitable only when Middle Jiao damp-heat is partially resolved or in late autumn when pathogens are deep.
Another case: Malaria pulse is naturally wiry. Wiry and large indicates Yang, meaning pathogens are easily reachable. Now, malaria intensity is lighter and shorter, suggesting pathogens are retreating. Continue the previous method.
Add Glehniae Radix (Shashen), Poria (Fuling), Tectona Grandis Stem (Tongcao) to the previous formula.
Another case: Malaria trend is declining. Harmonize Middle Qi to resolve turbid phlegm and nourish Heart Yin, treating according to the patient's root and branch.
Glehniae Radix (Shashen), Citri Reticulatae Pericarpium (Chenpi), Ophiopogonis Radix (Maidong), Glycyrrhizae Radix et Rhizoma Preparata (Zhi Gancao), Atractylodis Rhizoma (Dongzhu), Pinelliae Rhizoma Preparatum (Banxia), Dolichoris Semen (Biandou), Ziziphi Jujubae Semen (Zaoren), Poria (Fuling), Zingiberis Rhizoma Recens (Shengjiang).
Yuanyuan notes: Malaria strictly contraindicates Biandou (Dolichoris Semen); perhaps this was unknown.
Xi, San Nue changed to daily occurrence, lasting over two months. Now fever occurs at night, with dry mouth and little sweat. Pathogens linger in the Ying level, damaging Yin. With weak Stomach and poor intake, and being halfway pregnant, there is fear that deficiency cannot sustain. Temporarily prescribe harmonizing Stomach, supporting Righteousness, and expelling pathogens.
Codonopsis Radix (Dangshen), Polygoni Multiflori Preparata Radix (Zhi Shouwu), Atractylodis Rhizoma (Dongzhu), Poria (Fuling), Magnoliae Officinalis Cortex (Chuanpu), Trichosanthis Radix (Tianhuafen), Bupleuri Radix (Chaihu), Saposhnikoviae Radix (Fangfeng), Citri Reticulatae Pericarpium (Chenpi), Scutellariae Radix (Dan Qin).
Ding, prolonged San Nue damages both Ying and Wei. Postpartum, the Eight Extraordinary Vessels in the Lower Jiao are empty. Nine months into illness, malaria persists. A mass forms on the left abdomen; this is malaria pathogens blocking blood collaterals and gathering at the Liver Shu point, known as Nuomu (Malaria Mother). Lingering indefinitely, it risks becoming Malao (Malaria Consumption). Approaching Summer Solstice, a time of Yin-Yang transformation, thin chronically ill patients fear Yin damage most. Seize this opportunity to support vitality, guide orifices, harmonize Yang to generate Yin, prescribing based on postpartum principles. Slightly add collaterals-searching herbs to eradicate malaria roots.
Polygoni Multiflori Preparata Radix (Zhi Shouwu), Atractylodis Rhizoma (Dongzhu), Paeoniae Radix Alba (Baishao), Lycii Fructus (Qizi), Angelicae Sinensis Radix (Danggui), Lycii Cortex (Digupi), Qingpi (Green Tangerine Peel), Ligusticum Chuanxiong Rhizoma (Chuanxiong), Cyperi Rhizoma (Xiangfu), Terminalia Chebula Fructus (Wumei). Also take Biejia Jian Wan, ten pills daily.
Use Siwu Tang minus Rehmanniae Radix, replacing it with Polygoni Multiflori Preparata Radix, establishing the prescription on postpartum blood deficiency.
Yuanyuan notes: Postpartum Yin-Blood is indeed depleted, but persistent malaria leading to masses implies damp-heat and phlegm-saliva lurking in Moyuan (Diaphragmatic Origin) unresolved. This formula requires careful consideration.
Another case: Prolonged San Nue with abdominal masses. Before Summer Solstice, harmonize Yang to generate Yin, regulate Ying-Wei, incorporate collaterals-searching methods. After the solstice, San Nue returns, but heat is reduced and masses smaller. However, dry mouth and palpitations indicate severe Ying-Yin deficiency. Emotional depression often transforms into fire damaging Yin. Wood is described as "curved and straight," producing sourness. Frequent sour fluid during malaria arises from Liver Wood constrained heat carrying old fluids from the Stomach upward. Nourishing Ying Yin requires moistening the Liver; resolving Liver constraint requires bitter and acrid agents. Chronic malaria can be intercepted; masses should be消散 (dissipated). Given constitutional weakness and weak Stomach, caution is paramount.
Codonopsis Radix (Dangshen), Atractylodis Rhizoma (Dongzhu), Testudinis et Chelydrae Carapax et Plastrum (vinegar-stir-fried, Biejia), Angelicae Sinensis Radix (Danggui), Poria Cum Pino (Fushen), Ziziphi Jujubae Semen (Zaoren), Cyperi Rhizoma (Xiangfu), Sparganii Rhizoma (Sanleng, vinegar-stir-fried), Coptidis Rhizoma (stir-fried with Evodiae Fructus, Chuanlian), Ostreae Concha (Muli), Citri Reticulatae Pericarpium (Chenpi).
Yuanyuan notes: Pathogens lurking in Moyuan have appeared.
Another case: Pill formula.
Fritillariae Thunbergii Bulbus (Chuanbei), Pinelliae Rhizoma Preparatum (Banxia).
Grind into fine powder, pill with equal parts ginger juice and vinegar. Take three qian every morning, washed down with boiled water.
Cao, Laonue (Labor Malaria), triggered by exertion. Chills and fever resemble malaria, lingering indefinitely, risking transformation into Malao. Tongue coating is white and dry, indicating Stomach dryness and Qi injury. Method: Tonify Qi and generate fluids, using Yi Qi Bu Zhong principles.
Codonopsis Radix (Dangshen), Astragali Radix (Huangqi), Atractylodis Rhizoma (Dongzhu), Glycyrrhizae Radix et Rhizoma Preparata (Zhi Gancao), Ophiopogonis Radix (Maidong), Angelicae Sinensis Radix (Guishen), Citri Reticulatae Pericarpium (Chenpi), Artemisiae Annuae Herba (Qinghao), Acanthopanacis Senticosi Cortex (Wujapi), Germinated Oryzae Fructus (Sheng Shu Guye).
Zhang, intermittent malaria with chills and fever, tongue coated entirely white. Use Chaihu Dayuan Yin.
Bupleuri Radix (Chaihu), Scutellariae Radix (Huangqin), Pinelliae Rhizoma Preparatum (Banxia), Citri Reticulatae Pericarpium (Qingpi), Arecae Semen (Huabinglang), Tsaoko Fructus (Caoguo), Magnoliae Officinalis Cortex (Chuanpu), Poria (Fuling), Zingiberis Rhizoma Recens (Shengjiang).
Entirely white tongue coating indicates pathogens lurking in Moyuan; Binglang and Caoguo are essential. Avoid if tongue coating is white and dry.
Ren Yuan states: Malaria syndromes are numerous, differing by pathogen and naming conventions, detailed in Neijing. Among them, Feng Nue (Wind Malaria) is most common. The classics state: those who do not sweat during summer heat develop Wind Malaria in autumn. This occurs when people seek coolness in drafts or sleep on damp ground during summer, contracting cold-damp or heat-damp pathogens. If these do not exit via sweat, autumn cool winds close the pores, triggering malaria. Ancients said "Malaria never leaves Shaoyang," but this is inaccurate. Fu Shu and Malaria share the same pathogen nature; intermittent chills/fever is Malaria, continuous is Fu Shu. Although Fu Shu is heavier, its depth is shallower; Malaria is lighter but deeper. Fu Shu pathogens reside in Taiyin and Yangming, rarely involving Moyuan; Malaria frequently involves Moyuan. Only pathogens lurking in Moyuan cause persistent confusion. The term Moyuan was poorly explained by ancients. "Mo" refers to the membrane between organs and muscles, the inner layer of muscle skin, colloquially "Mohe." "Yuan" refers to acupoints, present in all six Fu organs. Classics say "horizontally connecting Moyuan," meaning pathogens not only affect organs but extend horizontally into the muscle interior, lurking deeply in Mohe/Yuan. This also relates to Taiyin and Yangming. The so-called Shaoyang involvement resembles Fu Shu's alternating chills/fever, where Spleen-Stomach ascending-descending functions fail, and Wood constraint prevents smooth flow. Since Spleen-Stomach fails to transform, damp-turbidity obstructs, Malaria always involves phlegm (which is damp-fluid). Thus, vomiting yellow-bitter fluid during attacks aids recovery. Treating by opening the Middle Jiao and resolving damp-fluid is the primary step. Observing ancient formulas like Qingpi, Xiumie, and Si Shou, all aim to open the middle and resolve phlegm. Even progression to Nuomu, Jaundice, or Fullness results from unresolved damp-heat-phlegm injuring Spleen-Stomach. Various malaria types differ in cause and treatment, but fundamentally relate to Taiyin-Yangming (Spleen-Stomach). Once Spleen-Stomach is diseased, damp-phlegm generates spontaneously. As the proverb says, "No phlegm, no malaria," is this not true?