症，今当壮热之时，忽遇辛热之药，迫血妄行，溃涌数斗，昏晕不省，冷汗如珠，四肢皆冷，脉微欲绝。令以
独参两余，煎汁半钟灌之，始能吞咽。再煎再灌，次日稍苏。但呃逆不止，乃以温补之剂，重用人参冲服，诸
症渐平。但人参略少，呃逆便甚，八味、十全，早晚服，两月全愈。
韩老夫人患疟甚重，壮热无汗，六脉洪大而空。冯曰∶汗生于阴，肾主生液，今六脉有阳无阴，岂可更汗，
以促其孤阳亡越乎？（凡治伤寒感症，均宜达此，不惟疟疾为然。然必用于误表之后，斯为合法。）以八味加牛
膝、五味子，每剂纳熟地二两，煎碗余灌饮之。滋水即所以发汗也，果大汗而愈。
赵某形甚肥壮，而中气甚虚，下元不足。夏月患疟，医以发散和解不愈，复以补中益气调之，亦不应。发
时，寒热大作，喉如 鼾，脸红喘促，出多入少。脉之，寸关豁大，两尺甚微，势甚危困。谚云∶少不可弱，
老不可疟。老年气血衰微，大寒大热，非所堪也。故气多出少入，一时暴绝，理宜大补真阳，仍佐下焦敛纳封
藏之剂，如八味加五味、牛膝为稳。若补中益气，恐益令孤阳上浮，阳食于上，阴绝于下，便有不测之患。（观
此，则知补中益气不可漫用也。）况以阴亏阳损之躯，而犯阴竭阳浮之病，复当阳浮阳耗之时，升浮之药，断非所
宜。奈病家医者均以热天热病，畏投桂、附。补中益气，先哲良方，必欲进之，果喘促愈加，夜半而逝。（可以为
戒。雄按∶今秋，相简哉室患疟，初投消散，继以补中益气，延至匝月，骨瘦如柴，左乳震跃，气促心悸，眩晕
汗多，腹中如有聚气，时欲上冲，绵 已极。其师赵菊斋拉余诊之，脉来弦敝，而微细如丝，投以西洋参、龙齿、
牡蛎、龟板、鳖甲、冬虫夏草、甘草、小麦、熟地、归身、杞子、麦冬、红枣、莲子心等药，出入为方，浃旬而愈。）
徐氏妇七十余，患疟，上则咳嗽吐血，下则泄泻，粒米不进，人事不省，胸膈胀闷。脉则两寸细数，左关
弦大，右关甚微，两尺重按不起，势甚危笃。知为阴虚内热外寒，肝无血养而强，脾无气充而弱，血无所统而
吐，谷无所运而泻，气无所纳而胀，悉属本源为病。用重剂熟地、白术、麦冬、五味、牛膝、制附子，参汤冲
服，疟止神清。既而病患自谓胸膈有停滞，不肯用补，乃诡以八味丸为消食丸，参汤送下，遂诸症悉痊。
谢登之年七十余，偶途中遇雨，疾趋而归，继发疟疾，甚危，每发辄大便，便必昏晕欲绝。医以疏散，势
愈剧。冯曰∶冒雨受寒，疏散宜矣。独不思经曰惊而夺精，汗出于心，持重远行，汗出于肾，疾走恐惧，汗出
于肝，摇体劳苦，汗出于脾，皆伤脏也？凡入者为实，出者为虚，大便出而昏晕，元气欲脱矣，尚可以既散之
微寒为重，而垂绝之元气为轻耶？急以附子理中汤加五味，投之而愈。
按∶黄履素引立斋云∶凡久疟乃属元气虚寒。盖气虚则寒，血虚则热，胃虚则恶寒，脾虚则发热，阴火
下流则寒热交作。或吐涎不食，泄泻，手足厥冷，寒战加栗，若误投以清脾、截疟二饮，多致不起。又，
三疟久不止者，多成坏症，想不遵此治法，而医药乱投之故。予表兄沈鸿生孝廉，精神素旺，自闽游归，
患三疟，几一载，元气都耗，后疟虽止，而面黑眼黄，见者惊异。如是又二载，卒以鼓胀亡。先生指久疟
为元气虚寒，信为确论。余少时曾患此，虽不敢服清脾、截疟等药，而所进皆柴胡、黄芩之剂，十四五发
方得止，亦甚野狼狈矣。此病最忌生冷荤腥，使滋味淡泊，邪气自衰。予病守戒甚严，疟止后，茹素者半月，
才极乃荤，是以脾胃顿开，饮食较未病前倍增，精神始旺。
黄之侄倩孙培之，得吴与辰金铅丸。有一比邱患山疟，久不止，与一丸服之，减半。盖山疟属元气虚寒，
金铅丸能助阳气，故两丸竟愈。
张路玉治张怡泉，恒服参、附、鹿角胶等阳药，而真阴向耗，年七十五，七月病疟，误进常山截疟一剂，
遂人事不省。六脉止歇，按之则二至一止，举之则三五至一止。惟在寒热之际，诊之则不止，热退则如前。此
真气衰微，不能贯通于脉。及寒热时，邪气冲激，经脉反得开通，此虚中伏邪之象。为制方，常山一钱，酒拌，
同人参五钱焙干，去常山，但用人参，以助胸中大气而祛逐之。因常山伤犯中气而变剧，故仍用之为向导耳。
昼夜连进二服，遂得寝。但寒热不止，脉止如前，乃令日进人参一两，作二次服，并与稀粥助其胃气，数日寒
热止，脉微续而安。（雄按∶谈脉有理，用药可法。）
顾玉书疟发即昏睡呓语，痞胀呕逆。切其气口，独见短滑，乃有宿滞之象。与凉膈散，易人中黄，加草果
仁，一剂而霍然。
金氏子八月间患疟，发于辰戌丑未，至春，子午卯酉，每增小寒热，直至初夏。诊其脉如丝，面青唇白，
乃与六君子加桂、附。四服不应，每服加人参至一两，桂、附各三钱，辰戌丑未之寒热顿止，子午卯酉之寒热
更甚。此中气有权，而邪并至阴也。仍与前药四服，面色荣，食进，寒热悉除。后与独参汤送八味丸，调理而
安。
顾文学年逾八旬，初秋患瘅疟，昏热谵语，喘乏遗溺。或以为伤寒谵语，或以为中风遗溺，危疑莫定。张
曰∶无虑，此三阳合病，谵语遗溺，口不仁而面垢，仲景暑症，原有是例。遂以白虎加人参，三啜而安。同时
顾文学夫人，朔客祈连山，皆患是症，一者兼风，用白虎加桂枝，一者兼湿，用白虎加苍术，俱随手而瘥。或
问今岁疟脉不弦之故。曰∶疟属少阳经证，其脉当弦，而反不弦如平人者，以邪气与正气浑合不分故也。《金
匮》云∶温疟者，其脉如平，身无寒但热，骨节烦疼，时呕，白虎加桂枝汤主之。当知脉既不弦，便非风木之
邪，即不当用柴胡少阳经药，岂可以常法施治乎？
张飞畴治沈子嘉，平昔夏间，脐一着扇风则腹痛，且不时作泻，六脉俱微数。此肾脏本寒，闭藏不密，易
于招风也。下寒则虚火上 ，故脉数。与六味去泽泻，加肉桂、肉果、五味、白蒺藜，作丸服，由是脐不畏风，
脾胃亦实。明秋患疟，医用白虎、竹叶石膏等，疟寒甚而不甚热，面青足冷，六脉弦细而数。用八味丸，二倍
桂、附作汤，更以四君合保元，早暮间进，二日疟退，调理而愈。
高鼓峰治曹献 室人，十一月病疟，发则头重腰痛，寒从背起，顷之，壮热烙手，汗出不止。曰∶此太阳
经疟也，用大青龙汤。曹曰∶病来五六日，委顿甚矣。且病者禀素怯弱，又他医言有汗要无汗，带补为全。今
汗如此，而复用此药，恐不能当。高笑曰∶第服此，其病自除。当晚汗犹未止，进一大剂，即熟睡，次日不发。
逾日，以补中益气调理而痊。（全在认症明白，故能谈笑自若。）
徐方虎病三阴疟，已四年矣，幸所治皆武林名医，服药得法，不致溃败。（刻薄而善占地步。）用人参几十余斤，
然年久病深，至是遂不能支，形肉尽脱，饮食不进，每觉有气从左胁上冲，即烦乱欲脱，奄奄几殆。乃重用桂、
附、白芍、地黄，加以养荣逐积之药，冬至日正发期，是日遂不至。（予从侄藻明业医，患此治不效。偶端午大
啖黄鱼，竟愈。又数人患此，遇朔日亦痊。）附方∶用何首乌五钱，陈皮二钱，青皮三钱。酒一碗，河水一
碗，煎至一碗，温服。治疟不论久近即愈。
张三锡治翁氏妇，久疟，食少汗多，用六君子加黄连、枳实，月余不应。因悟连、枳之过，纯用补剂，又
令粥多于药而食进，再加附子三分半，一服而痊。
张三锡云∶《准绳》载一妇人，夏患疟，用柴胡、升麻、葛根、羌活、防风之甘辛气清，以升阳气，使离于
阴，而寒自已；以知母、石膏、黄芩之苦寒，引阴气下降，使离于阳，而热自已；以猪苓之淡渗，分利阴阳，
使不得交并；以穿山甲引之；以甘草和之。一剂而止。
有人患久疟，诸药不效，或教以灸脾 即愈。更一人亦久患疟，闻之亦灸此穴而愈。盖疟多因饮食得之，
故灸脾俞即效。
陆祖愚治朱襟湖，六旬外，肩上忽生疖毒，因褪衣敷药，致感冒成疟。（要知疖毒本由伏暑，又因遇寒，
遂发疟耳。）脉浮虚，乃于补气血药中，加疏表之味。数剂后，脓溃而精神愈惫，遂加参、 两许。六七日后，
疟虽轻而未止。有人谓斩鬼丹之妙，不可胜言，次早水吞一服。少顷，寒热愈炽，呕吐不止，昏晕异常，喘气
不定。乃用甘草为君，黄连为臣，佐以金银花、藿香，开胃解毒。晕吐止，乃用大剂人参、何首乌。数服疟止，
再用养血补托，收敛生肌，肿毒消而全愈。
陈雅仲四月初过仙霞岭，陡遇狂风骤两，雨具徒施，遍身俱湿，宿店又无火焙，兼长途劳顿，水土不服，
饮食失宜，遂患疟。闽医用药与浙迥殊，即柴胡一味，惟以前胡代之，名曰香柴胡。陈君之疗，发散为主，得
汗而病转甚。陆适在闽，诊之，面色槁而黑，自汗神昏，懒于言语，疲惫已甚，（此风去而湿存之候。）其脉左
手弦细而滑，气口缓弱。知其劳顿之后，重加发散，乃与养血健脾宽中和解之剂，去病犹反掌云。
严力庵着有《柳洲遗稿》，予之至友也。以在闽病疟数月，归及两旬而殁，因录是案，不觉惘然。天耶人耶。时己丑
长至后一曰。（雄按∶沈再平云∶今人治疟，必用柴胡，若非柴胡，即不足以为治者，故致展转淹滞，变生不测，竟能殒
命，则知疟本非死证，惟概以柴胡治疟者杀之也。夫柴胡为少阳表药，若其疟果发于少阳，而以柴胡治之，无不立愈。
若系他经，用之则必令他经之邪，展转而入少阳，迁延日久，正气已虚，邪气仍盛，而且弥漫诸经，以致毙命，所必然
矣。奈医家病家，彼此昏迷，率以柴胡为治疟要药，从无悔悟，良可浩叹。余谓不概以柴胡治疟，惟缪、叶丙家耳。）
薛立斋治大尹曹时用，患疟寒热，用止截之剂，反发热恶寒，饮食少思，神思甚倦，其脉或浮洪，或微细，
此阳气虚寒。用补中益气，内参、 、归、术各加三钱，甘草一钱五分，加炮姜、附子各一钱，一剂而寒热止，
数剂而元气复。又治东洞庭马志卿，与此同，但去附子加炮姜一钱。
一妇人劳役伤食患疟，或用消导止截，饮食少思，体瘦腹胀。以补中益气，倍参、 、归、术、草、当归，
加茯苓、半夏各一钱五分，炮姜五分，一剂顿安。前药炮姜用一钱，不数剂全愈。
朱丹溪治浦江洪宅一妇人病疟，间两日而发，饮食绝少，经脉不行，已三月矣。诊其脉，两手并无。时正
腊月，极寒，议作虚寒治之，遂以四物汤加吴茱萸、附子、神曲为丸与之。朱自以处方未当，次早，再求诊之，
见其梳妆无异平时，言语行步并无倦怠。朱惊曰∶前药误矣。经不行者，非无血也，为痰所碍而不行也。无脉
者，非血衰少而脉绝，实乃积痰生热，结伏而脉不见尔。当作实热治之，遂以三花神 丸与之。旬日后，食稍
进，脉亦稍出。一月后，六脉俱出，但带微弦，疟尚未愈。因谓胃气既全，春深经血自旺，便自可愈，不必服
药。教以淡滋味，节饮食之法，半月而疟愈，经自行矣。（以丹溪之才，而如此虚心，如此细心，真可为后世法。）
一男子患疟，久而腹胀，脉不数而微弦，重取则来不滑利，轻又皆无力。遂与三和汤，令于方中倍加白术，
入姜汁服之，数服而小便利一二行，腹稍减。随又小便短少，作血气两虚，于前药中入人参、牛膝、归身，作
大剂服，四十余帖而愈。
一人久疟，先间日，后一日一来，早晚不定，皆肾不纳气故也。用人参、茯苓、半夏各一钱，丁香、五味
子各五分，益智、甘草各三分，姜水煎服。
王宇泰治蒋先生牝疟。众医因身疼寒甚，欲用桂、附。曰∶溽暑未衰，明系邪热，安可温也？经曰，阳并
于阴，则阴实而阳虚，阳明虚则寒栗鼓颔，巨阳虚则腰背头项疼，三阳俱虚则阴气胜，斯骨寒而痛。寒生于内，
则中外皆寒。此寒乃阴阳交争，非真寒也。遂以柴胡、羌活、防风、升麻、葛根以升接三阳，以桃仁、红花引
入阴分而取邪气出还于阳分，以猪苓分隔之，使邪不复下，一服而愈。
又治刘令君患疟，而洞泄不止，以交加饮子，一剂而愈。
一人患三日疟，久而不愈，饮食不思，口不知味，热多寒少，用人参、黄 、柴胡、半夏、茯苓、当归各
一钱，黄芩七分，甘草、青皮各五分，姜、枣煎服。
又治一老妪患疟，因年高惧其再发，欲截。曰∶一剂而已，亦甚易，焉用截为？遂以羌、防、柴、葛、升
麻，升阳气使离于阴；知母、石膏、黄芩，引阴气下降，使离于阳；以猪苓之淡渗，分利阴阳，勿使交并；
以山甲引之，甘草和之。一剂而愈。（此与李士材治杨太史一案合辙，其方大同小异。）
治一老妇夜疟，疟作时，大小便俱下血，饮食不进，危甚。此邪热在于血分，故夜作发。血得热而妄行，
故便血。以桂枝桃仁汤，去血中之邪，一剂而愈。
Symptoms manifested as: during a period of high fever, sudden misuse of acrid-hot herbs caused blood to flow recklessly, resulting in profuse bleeding of several dou, unconsciousness, cold sweat like pearls, cold limbs, and a faint pulse nearly imperceptible. Ordered to administer more than one liang of Ginseng Radix et Rhizoma (Renshen), decocted to half a zhong, and灌ed into the patient, allowing swallowing. After repeated decoction and administration, the patient slightly regained consciousness the next day. However, hiccups persisted, so a warming and tonifying formula was used with a heavy dose of Ginseng Radix et Rhizoma (Renshen) taken in suspension; various symptoms gradually subsided. Yet, when the dose of Ginseng Radix et Rhizoma (Renshen) was slightly reduced, hiccups worsened. Taking Bawei Wan (Eight-Ingredient Pill with Rehmannia Root) and Shiquan Dabu Tang (Complete Great Tonifying Decoction) morning and evening led to full recovery after two months.
Madam Han suffered from severe malaria, presenting with high fever, absence of sweating, and six pulses that were surging yet empty upon pressure. Physician Feng stated: Sweat is generated from Yin fluids, and the Kidney governs fluid production. Now, the six pulses show Yang without Yin; how can we induce sweating again, thereby hastening the collapse and escape of solitary Yang? (In treating all cases of Cold Damage or pathogenic infections, this principle must be understood, not only for malaria. However, it is appropriate specifically after erroneous use of diaphoretic methods.) Using Bawei Wan (Eight-Ingredient Pill with Rehmannia Root) added with Achyranthes Bidentatae Radix (Niuxi) and Schisandrae Fructus (Wuweizi), each dose included two liang of prepared Rehmanniae Radix (Shudi), decocted to over one bowl for drinking. Nourishing Kidney Water serves as a method to induce sweating; indeed, profuse sweating occurred, leading to recovery.
Mr. Zhao had a very robust physique but deficient Middle Qi and insufficient Lower Yuan. In summer, he contracted malaria. Physicians first attempted dispersing and harmonizing methods without success, then tried Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), which also failed. During attacks, chills and high fever erupted violently, phlegm rattled in the throat like snoring, face was red, breathing was rapid and shallow with exhalation exceeding inhalation. Pulse diagnosis revealed large and hollow pulses at Cun and Guan positions, while Chi positions were extremely faint; the condition was critical. As the proverb says: Youth should not be weak, nor elders suffer from malaria. Elderly individuals have declining Qi and Blood, unable to withstand extreme cold and heat. Thus, excessive exhalation and insufficient inhalation lead to sudden collapse; it is proper to greatly tonify True Yang, assisted by formulas that astringe and store in the Lower Jiao, such as Bawei Wan (Eight-Ingredient Pill with Rehmannia Root) added with Schisandrae Fructus (Wuweizi) and Achyranthes Bidentatae Radix (Niuxi). Using Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) might cause solitary Yang to float upward, depleting Yang above and cutting off Yin below, leading to unpredictable disaster. (From this, we know Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) should not be used indiscriminately.) Moreover, in a body with Yin deficiency and Yang damage, suffering from exhaustion of Yin and floating of Yang, especially during times of Yang floating and consumption, ascending and dispersing herbs are absolutely unsuitable. Unfortunately, patients and physicians feared using Cinnamomi Ramulus (Guizhi) and Aconiti Lateralis Radix Praeparata (Fuzi) due to the hot weather and disease. Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) is an excellent prescription from ancient sages; they insisted on using it, resulting in worsened dyspnea, and death at midnight. (This serves as a warning. Note: This autumn, someone in Xiang Jianzai's household contracted malaria. Initially treated with dispersing agents, then with Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), lasting a month, becoming emaciated. Symptoms included pulsation in the left breast, shortness of breath, palpitations, dizziness, profuse sweating, abdominal sensation of gathering Qi rushing upward, and extreme weakness. His teacher Zhao Juzhai invited me to diagnose. The pulse was wiry and loose, fine as silk. I prescribed Panax Quinquefolii Radix (Xiyangshen), Long Gu (Dragon Bone), Mu Li (Oyster Shell), Guiban (Tortoise Carapace), Biejia (Softshell Turtle Carapace), Cordyceps Sinensis (Dongchongxiacao), Glycyrrhizae Radix et Rhizoma (Gancao), Triticum Semen (Xiaomai), prepared Rehmanniae Radix (Shudi), Angelicae Sinensis Radix (Guishen), Lycii Fructus (Gouqi), Ophiopogonis Radix (Maidong), Ziziphus Jujubae Fructus (Hongzao), and Nelumbinis Plumula (Lianzixin), adjusting the formula as needed. Recovery occurred within ten days.)
Mrs. Xu, over seventy years old, suffered from malaria, presenting with coughing and hemoptysis above, diarrhea below, inability to eat, unconsciousness, and chest/epigastric distension. Pulses were fine and rapid at both Cun, wiry and large at the left Guan, extremely faint at the right Guan, and unresponsive to deep pressure at both Chi positions; the condition was critical. This was identified as Yin deficiency with internal heat and external cold, Liver lacking Blood nourishment becoming hyperactive, Spleen lacking Qi support becoming weak, Blood lacking control causing vomiting, food lacking transportation causing diarrhea, and Qi lacking reception causing distension—all originating from the root. Heavy doses of prepared Rehmanniae Radix (Shudi), Atractylodis Macrocephalae Rhizoma (Baizhu), Ophiopogonis Radix (Maidong), Schisandrae Fructus (Wuweizi), Achyranthes Bidentatae Radix (Niuxi), and processed Aconiti Lateralis Radix (Fuzi), suspended in Ginseng Radix et Rhizoma (Renshen) decoction, stopped the malaria and cleared the mind. Later, the patient felt stagnation in the chest and refused tonics, so Bawei Wan (Eight-Ingredient Pill with Rehmannia Root) was disguised as a digestive pill and taken with Ginseng Radix et Rhizoma (Renshen) decoction, leading to complete recovery.
Xie Dengnian, over seventy, caught rain on the road, hurried home, and subsequently developed severe malaria. Each attack was accompanied by defecation followed by near-syncope. Dispersing treatments worsened the condition. Physician Feng said: Exposure to rain and cold justifies dispersing. But did you not consider the Classic stating: Fright steals Essence, sweat comes from Heart; carrying heavy loads and traveling far, sweat comes from Kidney; running fast and fearing, sweat comes from Liver; bodily labor and hardship, sweat comes from Spleen—all damaging the Zang organs? What enters is Excess, what exits is Deficiency. Defecation with syncope indicates impending collapse of Yuan Qi. How can one weigh the residual mild cold against the dying Yuan Qi? Urgently administered Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction) added with Schisandrae Fructus (Wuweizi), resulting in recovery.
Commentary: Huang Lusù cited Lizhai saying: Chronic malaria belongs to Yuan Qi deficiency and cold. Generally, Qi deficiency causes cold, Blood deficiency causes heat, Stomach deficiency causes aversion to cold, Spleen deficiency causes fever, and sinking of Yin fire causes alternating chills and fever. Symptoms may include spitting saliva, anorexia, diarrhea, cold extremities, and severe shivering. Misusing Qingpi Yin (Clear Spleen Drink) or Jienue Yin (Stop Malaria Drink) often leads to death. Furthermore, San Nue (Three-Day Malaria) persisting long-term often becomes a complicated syndrome, likely due to ignoring this treatment method and indiscriminate medication. My cousin Shen Hongsheng, originally vigorous, returned from Fujian with San Nue lasting nearly a year, exhausting his Yuan Qi. Although the malaria ceased, his face turned black and eyes yellow, alarming observers. Two years later, he died of abdominal distension (Guzhang). Mr. Lizhai’s assertion that chronic malaria is Yuan Qi deficiency and cold is undoubtedly correct. In my youth, I suffered from this. Though I dared not take Qingpi Yin or Jienue Yin, I took Chaihu (Bupleuri Radix) and Huangqin (Scutellariae Radix) formulas, enduring fourteen or fifteen attacks before cessation, quite wretched. This disease strictly forbids raw/cold and greasy foods; maintaining a bland diet naturally weakens pathogenic factors. I adhered strictly to these restrictions, eating vegetarian for half a month after malaria cessation, then introducing meat sparingly. Consequently, Spleen and Stomach function improved, appetite doubled, and vitality recovered.
Huang’s nephew Sun Peizhi obtained Jin Qian Wan (Gold-Lead Pill) from Wu Yuichen. A nun suffering from mountain malaria (Shan Nue) for a long time took one pill, reducing severity by half. Since Shan Nue belongs to Yuan Qi deficiency and cold, and Jin Qian Wan assists Yang Qi, two pills resulted in cure.
Zhang Luyu treated Zhang Yiquan, who chronically consumed Yang-tonifying herbs like Ginseng Radix et Rhizoma (Renshen), Aconiti Lateralis Radix Praeparata (Fuzi), and Cervi Cornu Colla (Lujiaojiao), while True Yin was depleted. At age 75, in July, he contracted malaria and mistakenly took one dose of Changshan (Dichroae Radix) to stop malaria, leading to unconsciousness. The six pulses showed intermissions: pressing revealed one stop per two beats, lifting revealed one stop per three to five beats. Only during chills and fever were pulses regular; after fever subsided, intermissions returned. This indicated衰微 (decline) of True Qi failing to penetrate the vessels. During chills/fever, pathogenic agitation temporarily opened the meridians, revealing latent pathogens in deficiency. The prescription used one qian of Dichroae Radix (Changshan) soaked in wine, combined with five qian of roasted Ginseng Radix et Rhizoma (Renshen); the Dichroae Radix (Changshan) was removed, retaining only Ginseng Radix et Rhizoma (Renshen) to boost Upper Jiao Qi and expel pathogens. Because Dichroae Radix (Changshan) damages Middle Qi and worsens conditions, it was used merely as a guide. Two doses given day and night allowed sleep. However, chills/fever and pulse intermissions persisted. He was instructed to take one liang of Ginseng Radix et Rhizoma (Renshen) daily in two doses, accompanied by thin rice gruel to support Stomach Qi. Within days, chills/fever ceased, pulses became continuous, and stability returned. (Note: Pulse analysis is sound; medication strategy is exemplary.)
Gu Yushu presented with malaria-induced somnolence, muttering, epigastric fullness, and vomiting/regurgitation. Palpation of the Qi Kou pulse revealed only short and slippery qualities, indicating retained stagnation. Given Liangge San (Cool the Epigastrium Powder) modified with Renzhonghuang (Human Excrement Charcoal) and Caoguoren (Black Cardamom Seed), resulting in immediate recovery after one dose.
The son of the Jin family contracted malaria in August, occurring at Chen/Xu/Chou/Wei hours. By spring, it shifted to Zi/Wu/Mao/You hours, increasing minor chills and fevers until early summer. Pulses were thread-like; complexion was green, lips white. Prescribed Liu Junzi Tang (Six-Gentlemen Decoction) added with Cinnamomi Ramulus (Guizhi) and Aconiti Lateralis Radix Praeparata (Fuzi). Four doses yielded no response. Each dose was increased with Ginseng Radix et Rhizoma (Renshen) to one liang, and Cinnamomi Ramulus (Guizhi)/Aconiti Lateralis Radix Praeparata (Fuzi) to three qian. Chills/fever at Chen/Xu/Chou/Wei ceased, but those at Zi/Wu/Mao/You intensified. This indicated sufficient Middle Qi but pathogenic invasion of Yin. Continuing the previous four doses improved complexion and appetite, eliminating chills/fever. Subsequently, Dushen Tang (Single Ginseng Decoction) delivered Bawei Wan (Eight-Ingredient Pill with Rehmannia Root) for convalescence, leading to stability.
Literati Gu, over eighty, contracted Dan Nue (Blazing Malaria) in early autumn, presenting with delirium, heat, dyspnea, and urinary incontinence. Some attributed delirium to Cold Damage, others incontinence to Wind Stroke, creating diagnostic uncertainty. Physician Zhang said: Do not worry. This is a combination of the Three Yang channels. Delirium, incontinence, oral dysfunction, and facial dirtiness are examples found in Zhang Zhongjing’s Summerheat disorders. Prescribed Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction); three doses brought peace. Simultaneously, Mrs. Gu and guest Shi Ke Qilianshan suffered similar symptoms. One had wind complication, treated with Baihu Jia Guizhi Tang (White Tiger Plus Cinnamon Twig Decoction); the other had damp complication, treated with Baihu Jia Cangzhu Tang (White Tiger Plus Atractylodis Lanceae Rhizoma Decoction). Both recovered promptly. Asked why malaria pulses were not wiry this year, Zhang replied: Malaria belongs to Shaoyang channel patterns, where pulses should be wiry. If not wiry like normal people, it is because pathogen and healthy Qi are indistinguishable. The *Jingui Yaolue* states: Wen Nue (Warm Malaria) presents with normal-like pulses, no chills but heat, bone/joint pain, occasional vomiting, treated with Baihu Jia Guizhi Tang (White Tiger Plus Cinnamon Twig Decoction). Knowing the pulse is not wiry means it is not Wind-Wood pathogen, so Chaihu (Bupleuri Radix) Shaoyang herbs are inappropriate. How can standard methods apply?
Zhang Feichou treated Shen Zijia, who typically experienced abdominal pain and diarrhea upon fan exposure to the umbilicus in summer, with faint-rapid six pulses. This indicated Kidney origin cold, insecure closure, prone to wind invasion. Lower cold causes deficient fire to flare, hence rapid pulse. Prescribed Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) minus Alisma Rhizoma (Zexie), added with Cinnamomi Cortex (Rougui), Myristicae Semen (Roukou), Schisandrae Fructus (Wuweizi), and Tribuli Fructus (Bajili), made into pills. Thereafter, the umbilicus tolerated wind, and Spleen/Stomach strengthened. Next autumn, malaria occurred. Physicians used Baihu Tang (White Tiger Decoction) or Zhuyebashao Tang (Bamboo Leaf and Gypsum Decoction). Chills were severe, heat mild, face blue, feet cold, pulses wiry-fine-rapid. Used Bawei Wan (Eight-Ingredient Pill with Rehmannia Root), doubling Cinnamomi Ramulus (Guizhi) and Aconiti Lateralis Radix Praeparata (Fuzi) as decoction, combined with Sijunzi Tang (Four-Gentlemen Decoction) and Baoyuan Tang (Preserve Origin Decoction) morning and evening. Malaria receded in two days; convalescence ensued.
Gao Gufeng treated Cao Xian’s wife, who contracted malaria in November, presenting with heavy head, low back pain, cold starting from the back, quickly progressing to burning fever, profuse sweating. Diagnosed as Taiyang Channel Malaria, prescribed Da Qinglong Tang (Major Green Dragon Decoction). Cao objected: Ill for 5-6 days, severely prostrate. Patient constitution is weak; another doctor advised inducing sweating requires tonification. Current sweating is profuse; using this strong formula seems risky. Gao laughed: Just take it, the illness will resolve. That night, sweating continued. One large dose induced deep sleep; no recurrence the next day. Convalesced with Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). (Success relied on accurate diagnosis, allowing calm confidence.)
Xu Fanghu suffered from Sanyin Malaria (Three-Yin Malaria) for four years. Fortunately treated by renowned Hangzhou physicians with appropriate medication, preventing collapse. Consumed dozens of jin of Ginseng Radix et Rhizoma (Renshen). However, chronic deep disease eventually overwhelmed him: emaciation, anorexia, sensation of Qi rushing up from left hypochondrium causing agitation/near-collapse, critical state. Heavy doses of Cinnamomi Ramulus (Guizhi), Aconiti Lateralis Radix Praeparata (Fuzi), Paeoniae Radix Alba (Baishao), and Rehmanniae Radix Preparata (Shudi) were used, plus herbs to nourish Ying and expel accumulation. On Winter Solstice, the expected attack date, the episode did not occur. (My nephew Zao Ming, a physician, suffered this unsuccessfully. Accidentally ate large yellow croaker on Dragon Boat Festival and cured. Several others cured on New Moon days.) Supplementary Formula: Polygoni Multiflori Preparata Radix (Heshouwu) 5 qian, Citri Reticulatae Pericarpium (Chenpi) 2 qian, Citri Reticulatae Viride Pericarpium (Qingpi) 3 qian. Decocted in one bowl wine and one bowl river water to one bowl. Warmly taken. Cures malaria regardless of duration.
Zhang Sanxi treated Mrs. Weng, chronic malaria, poor appetite, profuse sweating. Prescribed Liu Junzi Tang (Six-Gentlemen Decoction) added with Coptidis Rhizoma (Huanglian) and Aurantii Fructus Immaturus (Zhishi). No improvement after a month. Realizing the error of Huanglian and Zhishi, switched to pure tonics. Advised consuming more congee than medicine to improve intake. Added 0.35 qian of Aconiti Lateralis Radix Praeparata (Fuzi). Cure after one dose.
Zhang Sanxi noted: *Zhunsheng* records a woman with summer malaria treated with Chaihu (Bupleuri Radix), Shengma (Cimicifugae Rhizoma), Gegen (Puerariae Lobatae Radix), Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix)—acrid-sweet clear aromatics to ascend Yang, separating it from Yin, resolving cold; Zhimu (Anemarrhenae Rhizoma), Shigao (Gypsum Fibrosum), Huangqin (Scutellariae Radix)—bitter-cold to descend Yin, separating it from Yang, resolving heat; Zhu Ling (Polyporus) light-pungent to differentiate Yin/Yang preventing interaction; Chanshanjia (Manis Squama) to guide; Gancao (Glycyrrhizae Radix et Rhizoma) to harmonize. Cure in one dose.
Another case of chronic malaria unresponsive to drugs was cured by moxibustion on Pishu (BL20). Another chronic malaria case also cured by moxibustion on this point. Since malaria often arises from dietary issues, moxibustion on Pishu (BL20) is effective.
Lu Zuyu treated Zhu Jinhu, over sixty, who suddenly developed a boil on the shoulder. Removing clothes to apply medicine led to cold contraction and malaria. (Note: Boils originate from latent summerheat; encountering cold triggers malaria.) Floating-empty pulse. Added exterior-dispersing herbs to Qi/Blood tonics. After several doses, pus drained, spirit weakened further. Added 1-2 liang of Ginseng Radix et Rhizoma (Renshen) and Astragali Membranacei Radix (Huangqi). Six-seven days later, malaria lightened but persisted. Someone praised Zhangui Dan (Ghost-Slaying Pill). Taken next morning with water. Shortly after, chills/fever intensified, persistent vomiting, abnormal syncope, irregular breathing. Used Gancao (Glycyrrhizae Radix et Rhizoma) as Sovereign, Huanglian (Coptidis Rhizoma) as Minister, assisted by Jinyinhua (Lonicerae Japonicae Flos) and Huoxiang (Agastaches Herba) to open stomach and detoxify. Syncope/vomiting stopped. Then large doses of Ginseng Radix et Rhizoma (Renshen) and Polygoni Multiflori Preparata Radix (Heshouwu). Several doses stopped malaria. Followed by blood-nourishing, tonifying, astringing, and flesh-regenerating herbs. Swelling/toxin resolved, full recovery.
Chen Yazhong crossed Xianxia Ridge in early April, encountered fierce wind and sudden rain. Rain gear ineffective, body wet, inn lacked fire to dry, plus travel fatigue,水土不服 (acclimatization issues), improper diet, leading to malaria. Fujian doctors’ medications differed significantly from Zhejiang’s; even Chaihu (Bupleuri Radix) was replaced by Qianhu (Peucedani Radix), called Xiang Chaihu (Fragrant Bupleuri). Chen’s treatment focused on dispersing; sweating worsened the condition. Lu, present in Fujian, diagnosed: sallow-black complexion, spontaneous sweating, confusion, reluctance to speak, extreme fatigue (sign of wind gone, damp remaining). Left hand pulse wiry-fine-slippery; Qi Kou pulse slow-weak. Recognizing post-fatigue excessive dispersing, prescribed blood-nourishing, Spleen-strengthening, middle-widening, harmonizing formula. Disease resolved easily.
Yan Li’an authored *Liuzhou Yigao*, my close friend. Died twenty days after returning from months of malaria in Fujian. Recorded this case, feeling desolate. Heaven or Man? Date: Day after Winter Solstice, Ji Chou Year. (Note: Shen Zaiping says: Modern physicians insist on Chaihu (Bupleuri Radix) for malaria; if not Chaihu (Bupleuri Radix), treatment is deemed insufficient. This leads to lingering illness, unpredictable changes, even death. Thus, malaria is not inherently fatal; indiscriminate use of Chaihu (Bupleuri Radix) kills. Chaihu (Bupleuri Radix) is a Shaoyang exterior herb. If malaria truly originates in Shaoyang, Chaihu (Bupleuri Radix) cures instantly. If from other channels, using Chaihu (Bupleuri Radix) draws pathogen into Shaoyang, prolonging illness, depleting healthy Qi, strengthening pathogen, spreading through channels, inevitably causing death. Physicians and patients remain confused, habitually using Chaihu (Bupleuri Radix) without remorse, lamentable. I believe avoiding indiscriminate Chaihu (Bupleuri Radix) use is characteristic of Miao and Ye schools.)
Xue Lizhai treated Da Yin Cao Shiyong, suffering malaria chills/fever. Used antimalarial/stopping agents, resulting in worsening fever/aversion to cold, poor appetite, mental fatigue. Pulses fluctuated between floating-surging and faint-fine. Diagnosed as Yang Qi deficiency/cold. Prescribed Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with Ginseng Radix et Rhizoma (Renshen), Astragali Membranacei Radix (Huangqi), Angelicae Sinensis Radix (Danggui), Atractylodis Macrocephalae Rhizoma (Baizhu) each increased by three qian, Glycyrrhizae Radix et Rhizoma (Gancao) 1.5 qian, plus fried Ginger (Paojiang) and Aconiti Lateralis Radix Praeparata (Fuzi) each one qian. Chills/fever stopped after one dose; Yuan Qi restored after several doses. Also treated Ma Zhiqing from Dong Dongting with same formula, but omitted Fuzi, added one qian fried Ginger.
A woman suffering malaria from labor and food stagnation used digestion-promoting/stopping agents, leading to poor appetite, emaciation, abdominal distension. Treated with Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), doubling Ginseng Radix et Rhizoma (Renshen), Astragali Membranacei Radix (Huangqi), Angelicae Sinensis Radix (Danggui), Atractylodis Macrocephalae Rhizoma (Baizhu), Glycyrrhizae Radix et Rhizoma (Gancao), plus Poria (Fuling) and Pinelliae Rhizoma (Banxia) each 1.5 qian, fried Ginger (Paojiang) 0.5 qian. Immediate relief after one dose. Previous dose used one qian fried Ginger; cured in few doses.
Zhu Danxi treated a woman in Hong residence, Pujiang, with malaria every two days, minimal food intake, amenorrhea for three months. Pulses absent in both hands. It was mid-winter, extremely cold. Discussed treating as deficiency-cold. Prescribed Siwu Tang (Four-Substance Decoction) added with Evodiae Fructus (Wuzhuyu), Aconiti Lateralis Radix Praeparata (Fuzi), and Shenqu (Medicated Leaven) as pills. Zhu felt the prescription was incorrect. Next morning, re-diagnosed. Found her dressing normally, speaking/walking without fatigue. Zhu exclaimed: Previous medicine was wrong. Amenorrhea is not lack of Blood, but obstruction by Phlegm. Absent pulses are not Blood deficiency/collapse, but accumulated Phlegm generating heat, knotting and hiding the pulse. Should treat as Excess-Heat. Prescribed Sanhua Shenyou Wan (Three-Flower Divine Preservation Pill). Ten days later, appetite improved, pulses emerged slightly. One month later, all six pulses appeared, slightly wiry. Malaria not yet cured. Zhu reasoned: With restored Stomach Qi, deep Spring will see abundant menstruation; self-recovery expected, no need for medicine. Advised bland diet and moderation. Malaria cured in half a month, menstruation resumed. (With Danxi’s talent, such humility and meticulousness serve as a model for posterity.)
A man suffered chronic malaria with abdominal distension. Pulse not rapid but slightly wiry; deep pressure not smooth, light pressure powerless. Prescribed Sanhe Tang (Harmonizing Decoction), instructing to double Baizhu (Atractylodis Macrocephalae Rhizoma) in the formula, taken with ginger juice. Few doses improved urination, reduced abdomen. Subsequently, urine volume decreased. Diagnosed as dual Qi/Blood deficiency. Added Ginseng Radix et Rhizoma (Renshen), Achyranthes Bidentatae Radix (Niuxi), Angelicae Sinensis Radix (Guishen) to previous formula, taken in large doses. Cured after forty-plus prescriptions.
One person with chronic malaria, initially every two days, then daily, irregular timing, attributed to Kidney failing to receive Qi. Prescribed Ginseng Radix et Rhizoma (Renshen), Poria (Fuling), Pinelliae Rhizoma (Banxia) each one qian, Symplocos Fructus (Dingxiang - *Correction: Dingxiang is Clove, Symplocos is different. Text says Dingxiang*), Schisandrae Fructus (Wuweizi) each 0.5 qian, Alpiniae Oxyphyllae Fructus (Yizhi), Glycyrrhizae Radix et Rhizoma (Gancao) each 0.3 qian, decocted in ginger water.
Wang Yutai treated Mr. Jiang’s Pin Nue (Female Malaria). Physicians, seeing body pain and severe chills, wanted to use Cinnamomi Ramulus (Guizhi) and Aconiti Lateralis Radix Praeparata (Fuzi). Wang said: Humid heat has not faded; clearly pathogenic heat. How can warmth be applied? The Classic states: Yang merging into Yin makes Yin excess and Yang deficient. Yangming deficiency causes chills/chattering jaws; Juyang (Taiyang) deficiency causes low back/back/head pain; all Three Yang deficient allows Yin dominance, causing bone cold/pain. Cold generated internally causes external/internal cold. This cold is Yin-Yang conflict, not true cold. Prescribed Chaihu (Bupleuri Radix), Notopterygii Rhizoma et Radix (Qianghuo), Saposhnikoviae Radix (Fangfeng), Cimicifugae Rhizoma (Shengma), Puerariae Lobatae Radix (Gegen) to ascend/connect Three Yang; Persicae Semen (Taoren), Carthami Flos (Honghua) to guide into Yin branch to extract pathogen back to Yang; Polyporus (Zhu Ling) to separate, preventing pathogen descent. Cure in one dose.
Also treated Magistrate Liu with malaria and persistent diarrhea. Prescribed Jiaojia Yinzi (Interacting Decoction). Cure in one dose.
One person with three-day malaria, chronic, anorexia, loss of taste, more heat than chills. Prescribed Ginseng Radix et Rhizoma (Renshen), Astragali Membranacei Radix (Huangqi), Chaihu (Bupleuri Radix), Pinelliae Rhizoma (Banxia), Poria (Fuling), Angelicae Sinensis Radix (Danggui) each one qian, Scutellariae Radix (Huangqin) 0.7 qian, Glycyrrhizae Radix et Rhizoma (Gancao), Citri Reticulatae Viride Pericarpium (Qingpi) each 0.5 qian, decocted with ginger/date.
Also treated an elderly woman with malaria. Fearful of recurrence due to age, desired suppression. Wang said: One dose suffices, very easy, why suppress? Prescribed Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), Chaihu (Bupleuri Radix), Gegen (Puerariae Lobatae Radix), Shengma (Cimicifugae Rhizoma) to ascend Yang away from Yin; Zhimu (Anemarrhenae Rhizoma), Shigao (Gypsum Fibrosum), Huangqin (Scutellariae Radix) to descend Yin away from Yang; Polyporus (Zhu Ling) to differentiate Yin/Yang preventing interaction; Manis Squama (Chanshanjia) to guide; Glycyrrhizae Radix et Rhizoma (Gancao) to harmonize. Cure in one dose. (Consistent with Li Shicai’s case of Grand Secretary Yang; formula largely same, slightly varied.)
Treated an elderly woman with nocturnal malaria. During attacks, hematochezia and hematuria, anorexia, critical condition. Pathogenic heat in Blood branch causes nocturnal onset. Heat agitates Blood causing bleeding. Prescribed Guizhi TaoRen Tang (Cinnamon Twig and Peach Kernel Decoction) to remove pathogen from Blood. Cure in one dose.