妊娠患疟，无论胎息月数多少，总以安胎为主。而世之所谓安胎，无过黄芩、白术，不知黄芩乃治
热盛胎动不宁，白术乃治脾虚胎气不固。若气虚下陷误用黄芩，气滞壅逆误用白术，为害何可胜言。予
于前安胎方中，亦多有用芩、术，然亦有弃而不用者，总视其病之宜忌及人之气血，所谓可与意会，
难与言传。业医之活法，
在随机应变耳。要知胎息安与不安，全在母气之调与不调，故安胎先安母气，未有母气乖戾而胎独安
之理。亦有因胎气有故而致母病者，则先治胎而母病自愈，如子死腹中之类是也，又安有不去其胎而母
得无恙乎？故善治胎产证者，必审孕妇形体之肥瘦，气血之偏盛。若形盛色苍，肌肉 坚者，必多湿多
痰，无论何疾，必显湿热本病，脉多滑实有力，绝无虚寒脉弱之候，可峻用豁痰理气药治其本质，然后
兼客邪见证而为制剂，治宜二陈汤，随经加透表药，或合小柴胡用之。盖柴胡为疟证之向导，故多用之。
然有自汗过多，尺中微弱，或热盛手足清，始终不用柴胡而用建中、桂芍收功者。或见烦渴脉实，大便
六七日不通，阳明腑实，又宜凉膈去硝、黄，加鲜首乌调之。须知禀质坚固者，其气多滞，内外壅遏，
但有湿热，绝无虚寒之患。如元气本弱，或病后得之，必需理脾行气，惟六君子汤为合剂。有痰食结滞，
则加枳实、草果；内有寒，加炮姜；外受风，加桂枝；胎动上逆不安，加子芩；胎下坠，加柴胡，倍人
参，以参乃举胎圣药也，间有不应，又需补中益气汤升举之。若中有留滞，则枳实理中加桂枝、柴胡，
合表里而治之。大抵病邪初发，元气未耗，
疏风涤痰，消导饮食在所必需，然宜大剂白术培护中土，以脾胃为一身之津梁，土浓自能载物。其
最可虑在三四发至六七发，其势最剧。若过半月，虽淹缠不止，邪热渐衰，可无胎陨之虞矣。或有疟久，
气血虚败而小产者，此皆失于调治也。若六七发后不止，即当和营健脾。若禀质柔脆，虽有风邪不得纯
用表药，以风药性升，能使胎气上逆而为呕逆、喘胀、膈塞、痞满之患，虽有实滞不得过用降泄之味，能
引邪气下陷，致胎坠不安，而为泄利不食、小腹疼重之患矣。若疫疟毒盛势剧，急与凉膈、承气、黄连
解毒救之。瘟疟 不爽，烦热大渴，或壮热无寒，或先热后寒者，当与桂枝白虎、人参白虎，撤其在里
之热，不可与夏秋 疟比例而推也。盖有是证用是药，有故无陨，惟在速祛邪毒以救胎息之燔灼，若迟
疑未决，下手稍软，救无及矣。又有气血虚损，其疟由虚致，不因暑气而作，如经云∶阳微恶寒，
阴弱发热。或风寒因虚而乘之，若寒热不已，重蒸其胎，胎亦受伤而坠，宜轻解表邪，兼大补气血以
主之。更有患胎疟者，一遇有胎，疟病即发，此人素有肝火，遇
孕则水养胎元，肝虚血燥，寒热往来，似疟非疟也，以逍遥散清肝火，养肝血，兼六味丸以滋化源，寒
热自退。世医治妊娠疟初起，用散邪饮，不愈者，用截疟汤截之。又有初用柴胡知母汤，以平为期。
疟久不退，则用七圣散截之。然截疟内常山伤胎，万不得已，须用白术煎水煮透用之，然亦宜少用。即
寻常治疟，再以白术制之，方免呕泄。又夜明砂单方，亦治孕疟。予常用加减丹溪安胎饮治孕疟，甚觉稳
妥有效，从未用截药而孕疟未尝不愈也。
枳实理中汤（附理中汤，又附子理中汤。） 治胃虚挟食，及结胸本虚，不能受攻。
人参（一钱至三钱） 白术（一钱至二钱，土炒焦） 炮姜 炙草（各五分） 枳实（七八分，麸炒
）茯苓（一钱）
水煎服。此方参、术、姜、草四味，方名理中汤，治胸痹，心胸痞气，霍乱吐泻不渴，一切脾胃虚寒，
呕吐清水，饮食不入，完谷不化。理中汤内加熟附子，名附子理中汤，如方中人参用一钱，附子则宜用三分。
承气汤 治少阳、阳明腑证。
大黄（四钱，生） 浓朴（六钱，制） 枳实（三枚）
此二方胎产忌用，录之以备参考。
黄连解毒汤 治热邪内外俱盛。
黄连 黄芩 黄柏 山栀
等分煎服。
桂枝白虎汤（附白虎汤，人参白虎汤。） 治温病感冒客邪而渴，及温疟先热后寒。
石膏（四钱，生用，碎） 知母（一钱五分，生） 炙草（五分） 粳米（一撮） 桂枝（七分半）
水煎服。此方去桂枝，即白虎汤正方也。去桂枝，加人参一钱，名人参白虎汤，治热病大渴，发热背寒。
散邪饮 治疟初起。
羌活 柴胡 紫苏 陈皮（各六分） 苍术（米泔水制） 浓朴（姜汁制） 制半夏 青皮（各七分）
水煎服。不愈者，服后截疟汤截之。
截疟汤
白术（土炒） 山楂（并子） 槟榔 常山（白酒煮干，炒紫色，再用白术煎水煮透更妙。各八分） 草
果神曲（各四分）
水煎，遇发日五更服。
柴胡知母汤 治孕妇病疟，不可轻用截药，恐致损胎，此汤主之。
柴胡（一钱五分） 知母 人参 黄芩 白术（土炒） 归身（各一钱） 甘草（五分）
姜枣引，水煎多服，以平为期。
七圣截疟散 如疟久不退转甚者，宜用此散截之。
柴胡（一钱五分） 黄芩 知母（各一钱） 常山（八分，白酒煮干，炒紫色，再用白术煎水煮透更
妙） 草果仁（五分） 乌梅（二枚）
水酒各半煎，露一宿，临发日五更温服。忌生冷、鸡、鱼、面食。原方有炙草，予恐常山合之而
作吐，故去之。
明砂止疟丹
夜明砂（三钱）
为末，茶清调，空心服。予谓此药能行血，且下死胎甚速，非瘀血积聚成疟及久成疟母者，不可轻用也。
加减丹溪安胎饮 治孕妇疟疾。
白术（土炒） 当归 熟地（各二钱） 川芎 条芩（各八分） 制半夏（七分） 人参（一钱）
藿香（五分） 草果 青皮（各三分） 紫苏 广皮 炙草（各四分） 乌梅（二枚）
姜一片，煎服。
二陈汤（见本卷子烦门。） 小柴胡汤 建中汤 凉膈散 六君子汤 补中益气汤
（俱见本卷诸痛门。） 人参白虎汤（见本门，附桂枝白虎汤下。） 逍遥散（见本卷胎逆上逼
门。） 六味丸（见本卷诸痛门，附六味地黄汤下。）
Malaria during pregnancy, regardless of the number of months of gestation, should always prioritize stabilizing the fetus (An Tai). However, what the world calls "stabilizing the fetus" involves nothing more than Huang Qin (Scutellariae Radix) and Bai Zhu (Atractylodis Macrocephalae Rhizoma), without realizing that Huang Qin is used to treat restless fetal movement caused by excessive heat, while Bai Zhu is used to treat insecure fetal qi due to Spleen deficiency. If Qi deficiency with sinking is mistakenly treated with Huang Qin, or Qi stagnation with counterflow is mistakenly treated with Bai Zhu, the harm caused is incalculable. In my previous formulas for stabilizing the fetus, I have also often used Huang Qin and Bai Zhu, but there are cases where they are abandoned and not used; this entirely depends on whether the condition is suitable or contraindicated, and on the patient's Qi and Blood status. This can be understood intuitively but is difficult to explain in words. The flexible method of practicing medicine lies in adapting to changing circumstances. It must be known that whether the fetus is stable or unstable depends entirely on whether the mother's Qi is harmonious or disharmonious. Therefore, to stabilize the fetus, one must first regulate the mother's Qi; there is no logic whereby the mother's Qi is chaotic yet the fetus remains alone stable. There are also cases where maternal illness is caused by fetal pathology; in such instances, treating the fetus first will cause the maternal illness to heal spontaneously, such as in the case of a dead fetus in the uterus. How could the mother remain unharmed without removing the dead fetus? Thus, those skilled in treating fetal and obstetric conditions must examine the fatness or thinness of the pregnant woman's physique, and the excess or deficiency of her Qi and Blood. If the physique is robust, complexion is dark/cyan, and muscles are firm, there is likely excessive dampness and phlegm. Regardless of the disease, it will manifest as the root pathology of Damp-Heat, with a pulse that is slippery, solid, and forceful, absolutely lacking signs of deficiency-cold and weak pulse. One may vigorously use herbs that resolve phlegm and regulate Qi to treat the root cause, and then formulate prescriptions based on concurrent exterior pathogen symptoms. The appropriate treatment is Er Chen Tang (Two-Cured Decoction), adding exterior-releasing herbs according to the affected meridian, or combining it with Xiao Chai Hu Tang (Minor Bupleurum Decoction). Since Chai Hu (Bupleuri Radix) acts as a guide for malaria treatments, it is used frequently. However, in cases of excessive spontaneous sweating and weak Chi pulse, or high fever with cold extremities, Chai Hu is never used; instead, Jian Zhong Tang (Establish the Middle Decoction) or Gui Zhi Shao Yao Tang (Cinnamon Twig and Peony Decoction) are used to conclude the treatment. Or, if irritability, thirst, solid pulse, and constipation for six to seven days indicate Yangming Fu organ excess, Liang Ge San (Cool the Diaphragm Powder) without Mang Xiao (Natrii Sulfas) and Da Huang (Rhei Radix et Rhizoma), plus fresh He Shou Wu (Polygoni Multiflori Preparata Radix), is suitable. It must be known that individuals with robust constitutions tend to have stagnant Qi, internal and external obstruction, suffering only from Damp-Heat, with absolutely no risk of deficiency-cold. If the Yuan Qi (Original Qi) is inherently weak, or if malaria occurs after an illness, regulating the Spleen and moving Qi is necessary; Liu Jun Zi Tang (Six Gentlemen Decoction) is the appropriate formula. If there is phlegm-food stagnation, add Zhi Shi (Aurantii Fructus Immaturus) and Cao Guo (Tsaoko Fructus); if there is internal cold, add Pao Jiang (Zingiberis Rhizoma Preparatum); if exposed to wind externally, add Gui Zhi (Cinnamomi Ramulus); if fetal movement causes upward counterflow and unrest, add Zi Qin (Huang Qin prepared for calming the fetus); if the fetus feels heavy/descending, add Chai Hu and double the dose of Ren Shen (Ginseng Radix et Rhizoma), as Ren Shen is the supreme herb for lifting the fetus. Occasionally, if ineffective, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) is needed to lift the fetus. If there is retention/stagnation internally, use Zhi Shi Li Zhong Tang (Immature Bitter Orange and Middle-Regulating Decoction) combined with Gui Zhi and Chai Hu to treat both interior and exterior simultaneously. Generally, when pathogens first appear and Yuan Qi is not yet depleted, dispersing wind, resolving phlegm, and promoting digestion are necessary, but large doses of Bai Zhu should be used to nourish the Middle Jiao (Middle Burner), because the Spleen and Stomach are the hub of fluids for the body; thick Earth naturally supports things. The most concerning stage is between three to four attacks up to six to seven attacks, where the pathogenic intensity is most severe. If it lasts over half a month, although lingering, the pathogenic heat gradually declines, and there is no fear of fetal miscarriage. However, some women miscarry due to prolonged malaria causing exhaustion of Qi and Blood; this is all due to improper regulation and treatment. If attacks continue after six or seven occurrences, Ying (Nutritive) level harmonization and Spleen strengthening are required. If the constitution is delicate, even with wind pathogens, purely exterior-releasing herbs should not be used, because wind herbs have ascending properties that can cause fetal Qi to counterflow upwards, leading to vomiting, wheezing, chest oppression, and fullness. Even with excess stagnation, descending/purgative herbs should not be overused, as they can draw pathogens downward, causing fetal instability, diarrhea, loss of appetite, and heavy lower abdominal pain. If epidemic malaria toxins are abundant and severe, urgently use Liang Ge San, Cheng Qi Tang (Drain the Ganglion Decoction), or Huang Lian Jie Du Tang (Coptis Decoction to Resolve Toxicity) for rescue. For Wen Malaria (Warm Malaria) presenting with discomfort, irritability, heat, and extreme thirst, or high fever without chills, or fever preceding chills, Gui Zhi Bai Hu Tang (Cinnamon Twig and White Tiger Decoction) or Ren Shen Bai Hu Tang (Ginseng and White Tiger Decoction) should be used to clear internal heat; these cannot be compared or extrapolated from summer-autumn malaria. Because specific symptoms require specific medicines; if there is a pathogen, there is no danger to the fetus, provided the pathogenic toxin is quickly expelled to save the fetus from burning consumption. Hesitation or mild intervention will result in untreatable situations. Furthermore, in cases of Qi and Blood deficiency, malaria arises from deficiency, not summer heat, as stated in the classics: "Yang deficiency leads to aversion to cold, Yin weakness leads to fever." If wind-cold takes advantage of deficiency, and chills and fever persist, the fetus is steamed and injured, leading to miscarriage. Lightly release exterior pathogens and simultaneously tonify Qi and Blood. Additionally, some suffer from "Fetal Malaria," where malaria attacks immediately upon conception. These individuals typically have Liver Fire; upon pregnancy, Water nourishes the Fetal Origin, causing Liver Blood deficiency and dryness, resulting in alternating chills and fever resembling malaria but not being true malaria. Use Xiao Yao San (Free and Easy Wanderer Powder) to clear Liver Fire and nourish Liver Blood, combined with Liu Wei Wan (Six-Ingredient Pill) to nourish the source of transformation, so chills and fever subside spontaneously. Physicians of the world treat early-stage pregnancy malaria with San Xie Yin (Disperse Pathogens Drink); if ineffective, they use Jie Nue Tang (Stop Malaria Decoction) to arrest it. Others initially use Chai Hu Zhi Mu Tang (Bupleurum and Anemarrhena Decoction), aiming for equilibrium. If malaria persists long-term, Qi Sheng San (Seven-Saints Powder) is used to arrest it. However, Chang Shan (Dichroae Radix) in malaria-arresting formulas damages the fetus. Only when absolutely necessary should it be used after boiling thoroughly in Bai Zhu decoction, and even then, in small doses. Even for ordinary malaria treatment, using Bai Zhu to moderate it prevents vomiting and diarrhea. Also, Ye Ming Sha (Crepidotus/Feces Vespertilionis) single-herb remedy treats pregnancy malaria. I commonly use Jia Jian Dan Xi An Tai Yin (Modified Danxi Fetus-Stabilizing Decoction) to treat pregnancy malaria, finding it very safe and effective; I have never used malaria-arresting drugs, yet pregnancy malaria has invariably healed.
Zhi Shi Li Zhong Tang (Immature Bitter Orange and Middle-Regulating Decoction) [Attached: Li Zhong Tang, Fu Zi Li Zhong Tang]. Treats Stomach deficiency with food retention, and Jie Xiong (Chest Binding) due to root deficiency, where aggressive treatment cannot be tolerated.
Ren Shen (1-3 qian) Bai Zhu (1-2 qian, stir-fried with earth until scorched) Pao Jiang Zhi Gan Cao (each 5 fen) Zhi Shi (7-8 fen, bran-fried) Fu Ling (1 qian)
Decoct in water and take orally. This formula consists of Ren Shen, Bai Zhu, Gan Jiang, and Gan Cao, named Li Zhong Tang. It treats Xiong Bi (Chest Bi), chest/epigastric fullness/oppression, Huoluan (Cholera-like syndrome) with vomiting/diarrhea and no thirst, all types of Spleen-Stomach deficiency-cold, vomiting clear fluid, inability to eat, and undigested food in stool. Adding Shu Fu Zi (Prepared Aconite Lateral Root) to Li Zhong Tang creates Fu Zi Li Zhong Tang. If Ren Shen is used at 1 qian, Fu Zi should be used at 3 fen.
Cheng Qi Tang (Drain the Ganglion Decoction) Treats Shao Yang and Yangming Fu organ syndromes.
Da Huang (4 qian, raw) Hou Po (6 qian, processed) Zhi Shi (3 pieces)
These two formulas are contraindicated in fetal and obstetric conditions; recorded here for reference.
Huang Lian Jie Du Tang (Coptis Decoction to Resolve Toxicity) Treats Excess Heat in both interior and exterior.
Huang Lian Huang Qin Huang Bo Zhi Zi
Equal parts, decoct and take orally.
Gui Zhi Bai Hu Tang (Cinnamon Twig and White Tiger Decoction) [Attached: Bai Hu Tang, Ren Shen Bai Hu Tang]. Treats Warm Disease with exogenous pathogen causing thirst, and Wen Nue (Warm Malaria) with fever preceding chills.
Shi Gao (4 qian, raw, crushed) Zhi Mu (1.5 qian, raw) Zhi Gan Cao (5 fen) Jing Mi (a pinch) Gui Zhi (0.75 qian)
Decoct in water and take orally. Removing Gui Zhi from this formula yields the standard Bai Hu Tang (White Tiger Decoction). Removing Gui Zhi and adding 1 qian of Ren Shen creates Ren Shen Bai Hu Tang (Ginseng and White Tiger Decoction), which treats extreme thirst and fever with chills in the back due to heat diseases.
San Xie Yin (Disperse Pathogens Drink) Treats early-stage malaria.
Qiang Huo Chai Hu Zi Su Chen Pi (each 6 fen) Cang Zhu (processed with rice wash water) Hou Po (processed with ginger juice) Zhi Ban Xia Qing Pi (each 7 fen)
Decoct in water and take orally. If ineffective, follow with Jie Nue Tang to arrest the malaria.
Jie Nue Tang (Stop Malaria Decoction)
Bai Zhu (earth-fried) Shan Zha (with seeds) Bing Lang Chang Shan (boiled in white wine until dry, stir-fried until purple, then boiled thoroughly in Bai Zhu decoction for best effect. Each 8 fen) Cao Guo Shen Qu (each 4 fen)
Decoct in water. Take at dawn (Wu Geng) on days of attack.
Chai Hu Zhi Mu Tang (Bupleurum and Anemarrhena Decoction) Treats malaria in pregnant women. Do not lightly use malaria-arresting drugs for fear of damaging the fetus; this decoction is indicated.
Chai Hu (1.5 qian) Zhi Mu Ren Shen Huang Qin Bai Zhu (earth-fried) Dang Gui Shen (each 1 qian) Gan Cao (5 fen)
Use Ginger and Jujube as guides, decoct in water, take generously, aiming for equilibrium.
Qi Sheng Jie Nue San (Seven-Saints Malaria-Arresting Powder) If malaria persists long-term and worsens, use this powder to arrest it.
Chai Hu (1.5 qian) Huang Qin Zhi Mu (each 1 qian) Chang Shan (8 fen, boiled in white wine until dry, stir-fried until purple, then boiled thoroughly in Bai Zhu decoction for best effect) Cao Guo Ren (5 fen) Wu Mei (2 pieces)
Decoct in half water and half wine. Leave exposed overnight. Take warm at dawn on the day of attack. Avoid cold/raw foods, chicken, fish, and wheat/noodle products. The original formula contains Zhi Gan Cao, but I fear Chang Shan combined with it may induce vomiting, so I removed it.
Ming Sha Zhi Nue Dan (Bright Sand Malaria-Arresting Elixir)
Ye Ming Sha (3 qian)
Grind into powder. Mix with clear tea water. Take on an empty stomach. I believe this herb moves Blood and expels dead fetuses rapidly; it should not be used lightly unless the malaria is caused by Blood stasis accumulation or has become a Nue Mu (Malaria Mass) after long duration.
Jia Jian Dan Xi An Tai Yin (Modified Danxi Fetus-Stabilizing Decoction) Treats malaria in pregnant women.
Bai Zhu (earth-fried) Dang Gui Shu Di (each 2 qian) Chuan Xiong Tiao Qin (each 8 fen) Zhi Ban Xia (7 fen) Ren Shen (1 qian)
Huo Xiang (5 fen) Cao Guo Qing Pi (each 3 fen) Zi Su Guang Pi Zhi Gan Cao (each 4 fen) Wu Mei (2 pieces)
Add one slice of Ginger. Decoct and take orally.
Er Chen Tang (See Fan Men in this volume.) Xiao Chai Hu Tang Jian Zhong Tang Liang Ge San Liu Jun Zi Tang Bu Zhong Yi Qi Tang
(All see Zhu Tong Men in this volume.) Ren Shen Bai Hu Tang (See this section, attached under Gui Zhi Bai Hu Tang.) Xiao Yao San (See Tai Ni Shang Bi Men in this volume.) Liu Wei Wan (See Zhu Tong Men in this volume, attached under Liu Wei Di Huang Tang.)