治证同前。呕吐不止者。用此藿香叶（晒干） 陈皮（去白） 半夏（汤泡姜汁浸炒） 甘草
浓朴（去皮姜汁炒）
上各等分。姜枣水煎。此即前方去苍术草果。治瘴之呕甚者。闻药气则呕。
苍术草果其气太辛窜。故去之。
治证同前。若兼耳闭心痛者。用此苍术。浓朴。陈皮。藿香。甘草。石菖蒲。姜水煎服。
此方即不换金去半夏。加石蒲。此太无治瘴之方。若瘴初起兼耳闭心气痛者。
可择用之。以菖蒲味辛能散邪开窍。治冷气也。
治瘴病术术欲吐不吐。及呕而膨胀。又治证候未分。用此服之待其明白见证。
方用对证药。
陈皮（五两） 半夏（五两汤泡七次） 茯苓（一两去皮） 甘草（一两）
上 散。每服五钱。姜七片。乌梅一个。水煎温服。不拘时候。
谚云无痰不成疟。故瘴病当以治痰为主。痰生于湿。由脾土不能制湿而成。是方用半夏辛
温能燥湿。茯苓甘淡能渗湿。湿去则痰不生。陈皮辛温能和气。甘草甘平能益脾。则土足以制湿。
和气则痰不能留滞。名曰二陈者。以半夏陈皮二药宜陈用之为君。故名之。此方治瘴。首尾俱可
用温中固下之药。恐其太峻。加入此方。含用则少缓。
治外感风寒。内伤生冷。增寒壮热。头目昏痛。肢体拘急。乃辟山岚瘴气。脾寒痰疟。四时疫病。
治冷瘴及寒痰。加附子。人参。伏苓。甘草。半夏。苍术。浓朴。藿香。草果。陈皮。上各等分。
每服三钱。乌梅一个。姜七片煎。热服不拘时。是方乃不换金。合二陈加人参乌梅。瘴初起于湿痰
之内积。邪气之外感而成。故平胃以除湿。二陈以去痰。正气以正不正之气。人参之甘温补脾。
益元气而利痰。乌梅之酸以止渴。收肺气。可为治瘴良方。予每用温中固下之药。参合此方。甚
获奇效。
The symptoms are the same as described above. For those with incessant vomiting, use this formula: *Huoxiang Ye* (Dried Patchouli Leaf), *Chenpi* (Aged Tangerine Peel [removed albedo]), *Banxia* (Pinellia Rhizome [soaked in boiling water and stir-fried with ginger juice]), *Gancao* (Licorice Root), and *Houpo* (Magnolia Bark [removed periderm and stir-fried with ginger juice]. All ingredients are taken in equal proportions. Decoct with ginger and jujube in water. This formula is the previous one minus *Cangzhu* (Atractylodis Rhizoma) and *Caoguo* (Tsaoko Fructus). It treats severe vomiting caused by miasma, where the patient vomits upon smelling the medicine. *Cangzhu* and *Caoguo* have overly pungent and dispersing aromas, hence they are removed.
The symptoms are the same as described above. If accompanied by ear blockage and heart pain, use this formula: *Cangzhu*, *Houpo*, *Chenpi*, *Huoxiang*, *Gancao*, and *Shichangpu* (Rhizoma Acori Tatarinowii). Decoct with water and ginger. This formula is *Buhuanjin Zhengqi San* (Golden Changeless Qi-Regulating Powder) minus *Banxia*, plus *Shichangpu*. This is a formula for treating miasma by Sun Simiao. If miasma has just begun and is accompanied by ear blockage and qi pain in the heart, this formula may be selected. This is because *Shichangpu* is pungent in flavor and can disperse pathogenic factors and open orifices to treat cold qi.
To treat miasma disease presenting with retching without actual vomiting, or vomiting accompanied by abdominal distension; or when the syndrome pattern has not yet been clearly distinguished, administer this formula first. Wait until the specific manifestations become clear, then use medication targeted at the syndrome. *Chenpi* (five liang), *Banxia* (five liang, soaked seven times in boiling water), *Fuling* (Poria [removed skin], one liang), *Gancao* (one liang). Process the above into a powder. Take five qian per dose, with seven slices of ginger and one smoked plum (*Wumei*). Decoct in water and take warm. No restriction on timing. The proverb says, "No phlegm, no malaria"; therefore, treating phlegm is primary in managing miasma. Phlegm arises from dampness, resulting from the Spleen Earth's inability to control dampness. In this formula, *Banxia* is pungent and warm, capable of drying dampness; *Fuling* is sweet and bland, capable of leaching out dampness. When dampness is removed, phlegm cannot form. *Chenpi* is pungent and warm, capable of harmonizing qi; *Gancao* is sweet and neutral, capable of benefiting Spleen qi. Thus, the Earth element is sufficient to control dampness, and harmonized qi prevents phlegm stagnation. It is named "Erchen" (Two Aged Ingredients) because *Banxia* and *Chenpi* are best used when aged, serving as the sovereign herbs. Hence the name. This formula can be used throughout the course of treating miasma, combined with warming-middle and securing-lower medicines. However, fearing the potency might be too harsh, this formula is added; taking it slowly moderates the effect.
It treats external contraction of wind-cold and internal injury from raw/cold food, leading to increased chills and high fever, dizziness and headache, and stiffness/tightness of limbs. It wards off mountainous miasma, treats spleen-cold phlegmatic malaria, seasonal epidemics, cold miasma, and cold-phlegm. Add *Fuzi* (Prepared Aconite Lateralis Radix), *Renshen* (Ginseng Radix et Rhizoma), *Fuling*, *Gancao*, *Banxia*, *Cangzhu*, *Houpo*, *Huoxiang*, *Caoguo*, and *Chenpi*. All in equal proportions. Take three qian per dose, with one *Wumei* and seven slices of ginger. Decoct and take hot, no restriction on timing. This formula combines *Buhuanjin Zhengqi San* and *Erchen Tang*, adding *Renshen* and *Wumei*. Miasma initially arises from the accumulation of damp-phlegm internally and the contraction of pathogenic factors externally. Therefore, *Pingwei San* (Regularize the Stomach Powder) is used to remove dampness, *Erchen Tang* (Two-Aged Decoction) to eliminate phlegm, and *Zhengqi San* to correct abnormal qi. *Renshen*, being sweet and warm, tonifies the Spleen, benefits Yuan qi, and facilitates phlegm resolution. *Wumei*, being sour, stops thirst and astringes Lung qi. This can be considered an excellent formula for treating miasma. I often combine this formula with warming-middle and securing-lower medicines, achieving remarkable efficacy.