全州桂林梧州平乐皆有之。八九月间。香气如桂。此瘴最急。触人口鼻即倒仆。此为中
瘴。必须同行之人。就其鼻旁。掘一穴。通地气。亦有得生。但腹痛饱胀。头晕恶心。重者
立危。轻者平胃正气散。下玉枢丹而活。有善避者。见有黑气如雾。其香必至。即刳一地穴
以身俯地上。口鼻向土潭穴中。勿使香气入穴。即解矣。其气不及一饷。即散。故此地人
枵腹行路。必用大蒜烧酒。亦避之之意。或先以行军散搐鼻亦妙。
又近云南交址地方。有糯米饭香。即病而绝。俗名江米瘴。亦可类治。
二三四月。泥水泛澜。人犯之。腹胀疼楚。如蚯蚓状者。青筋蟠现于肚腹。兴起痕高。
轻则以蒜捣汁。及土浆敷腹。亦用玉枢丹、紫金锭、姜汁灌入。次进苏合七香以通之。
三四五六七月。蚺蛇交媾。秽浊之气。顺水流下。人或犯之。胸腹胀痛异常。口鼻有腥
气。轻则紫金锭、玉枢丹、行军散、苏合丸。用之亦有得生。重者一二日即死。
大凡治病之道。寒证用热药。热证用寒剂。人所共晓。此如举业题之正面易做。而侧取
为难。更有外有余而内不足。有内真实而外假虚。阳证似阴。阴证似阳。其中精微深奥之处
差之毫厘。缪以千里。瘴疠虽从山川地气。随时令而得。亦必乘人本虚。方乃受病。其阳
虚火衰者。一时受瘴。因轻而不觉。瘴证变为本病。必虚寒而腹胀满。大便泄泻。恶寒手足
冷者是也。阴虚火旺者。
瘴轻而不觉。瘴后现为本病。必头晕口渴发热。腹胀恶心便赤者是也。再审五脏六腑。各有
素常偏患衰弱壮实之分。皆当以此类推。并须消息其夏秋劳逸行役。阴晴暑湿起居所履。庶
几有得。至如瘴脉。初感洪数。虚者大而芤。实者弦而滑。久则变迁。亦总以无力为虚。有
力为实也。
震按三农治瘴之方。与古方微有不同。将来刊于古今经验方按。此不及录。与治瘴相宜
若仍古方之旧者不录。
吾吴地有痧气。夏月更多。或腹痛。或胀闷昏仆。若不救之。亦立死。此与瘴气病情仿
佛。刮痧放痧。以行军散点眼。以痧药及紫金锭灌喉。皆可立愈。并非疑难证。不必更立一
门。而有侈张其说者。如王养吾着晰微补化全书。立六十四卦象方。至谓各种杂证。多由痧
气变迁。成案亦富。然不外散风清暑。豁痰消瘀。破气攻结诸法。而牵扯入痧。徒滋眩惑。
不足取也。较之吴又可温疫论。指诸杂证为疫。同一附会耳。
全州、桂林、梧州、平乐等地都有这种瘴气。在八九月间，香气像桂花一样浓郁。这种瘴气最为急骤，人一旦接触到它的气味，就会立即倒地仆倒。这属于中瘴。必须同行的同伴，在其鼻旁挖掘一个洞穴，以通达地下的空气，这样也有生存的希望。但患者会出现腹痛、饱胀、头晕、恶心的症状，病情严重的会立刻危及生命，病情较轻的，服用平胃正气散，并内服玉枢丹即可痊愈。有善于躲避的人，看到有黑气如雾般弥漫，知道香气必定会到来，就挖一个地穴，身体俯卧在地上，口鼻对着土潭般的穴口中，不让香气进入穴中，这样就能化解危险。那股气味不到一顿饭的工夫就会消散。所以当地人在空腹行走时，一定要吃大蒜、喝烧酒，这也是为了避瘴。或者先用行军散搐入鼻腔也很巧妙。
另外，靠近云南和交趾的地方，有一种糯米饭的香气，人闻到就会生病甚至昏迷，俗称江米瘴。也可以用类似的方法治疗。
在二、三、四月份，泥水泛滥，人如果沾染了它，会出现腹胀疼痛，腹部出现像蚯蚓一样的青筋盘绕显现，突起呈条索状高起。病情轻的，用蒜捣取汁液，以及泥土浆敷在腹部，也使用玉枢丹、紫金锭、姜汁灌入。随后进服苏合七香丸以疏通气机。
在三、四、五、六、七月，蚺蛇交配，产生秽浊之气，顺着水流向下扩散。人如果沾染了它，胸腹异常胀痛，口鼻有腥臭味。病情轻的，使用紫金锭、玉枢丹、行军散、苏合丸，用了也有能存活的。病情重的，一两天内就会死亡。
大凡治病的原则，寒证用热药，热证用寒凉药剂，这是大家都知道的道理。这就像科举考试题目中的正面容易作答，而侧面取材则较难。更有外表现象有余而内部正气不足的情况，有内部真实邪盛而外部表现为假虚的情况，阳证似阴，阴证似阳。其中精微深奥之处，稍微差一点，结果就会谬以千里。瘴疠之气虽然来源于山川地气，随季节时令而产生，但也必须乘人体本虚之时，才会使人受病。那些阳气虚弱、火衰的人，一时受到瘴气侵袭，因为症状轻微而不觉得难受，瘴气转化为内在的本病，必然表现为虚寒导致的腹胀满、大便泄泻、怕冷、手脚冰凉。阴虚火旺的人，瘴气轻微而不觉得难受，瘴气过后显现为本病，必然表现为头晕、口渴、发热、腹胀、恶心、小便短赤。再审视五脏六腑，各自有素常偏患、衰弱或壮实的不同情况，都应当以此类推。并且必须斟酌考虑其在夏秋季节的劳逸、行役（长途跋涉），以及阴晴暑湿等起居生活情况，这样才能有所收获。至于瘴气的脉象，初感时脉象洪数，虚证者脉大而芤，实证者脉弦而滑。时间久了脉象会有变化，但总体以无力为虚，有力为实。
俞震按语：三农治疗瘴气的方子，与古方略有不同。将来刊印在《古今经验方按》中，此处不及收录。与治瘴相适宜的，如果是沿用古方旧制的，就不收录了。
我们吴地有痧气，夏季更多见。有的腹痛，有的胀闷昏倒，如果不救治，也会立即死亡。这与瘴气的病情非常相似。刮痧、放痧，用行军散点眼，用痧药及紫金锭灌喉，都可以立即痊愈。这并不是疑难病症，不必单独设立一门。但有夸大其说的人，比如王养吾著《晰微补化全书》，设立了六十四卦象方，甚至说各种杂证多由痧气变迁而成，医案也很多，然而不外乎散风、清暑、豁痰、消瘀、破气攻结等方法，却牵扯到痧气上，徒然增加迷惑性，不值得采纳。这与吴又可《温疫论》将各种杂证指认为疫病，是同一种附会之谈罢了。
There are such miasmas in Quanzhou, Guilin, Wuzhou, and Pingle. Between the eighth and ninth lunar months, the aroma is like that of osmanthus flowers. This type of miasma is the most acute; upon contact with its odor, one may immediately collapse. This is classified as intermediate miasma (Zhong Zhang). Companions must dig a hole near the victim's nose to allow ventilation from the earth, which offers a chance of survival. However, symptoms include abdominal pain, fullness, dizziness, and nausea. Severe cases face immediate danger, while mild cases can be saved by administering Pingwei Zhengqi San and Yu Shu Dan. Those skilled at avoidance, seeing black mist-like clouds indicating the approaching odor, will dig a ground pit, lie prone with their mouth and nose directed into the soil cavity, preventing the odor from entering, thus resolving the danger. The odor dissipates within a short time. Therefore, locals traveling on an empty stomach consume garlic and strong liquor to ward off the miasma. Alternatively, inserting Xingjun San into the nasal cavity is also effective.
Additionally, in areas near Yunnan and Cochinchina, there is an odor resembling glutinous rice; exposure causes illness or coma, commonly known as Jiangmi Zhang (Glutinous Rice Miasma). It can be treated similarly.
In the second, third, and fourth lunar months, when muddy waters flood, exposure leads to abdominal distension and pain, with green veins appearing coiled on the abdomen like earthworms, forming raised ridges. For mild cases, crushed garlic juice and mud slurry are applied to the abdomen, along with Yu Shu Dan, Zijin Ding, and ginger juice administered orally. Subsequently, Suhhe Qixiang Wan is given to unblock the qi mechanism.
From the third to the seventh lunar months, during the mating season of Boas, foul odors flow downstream with water. Exposure causes severe chest and abdominal pain and a fishy smell from the mouth and nose. Mild cases treated with Zijin Ding, Yu Shu Dan, Xingjun San, and Suhhe Wan may survive. Severe cases result in death within one or two days.
Generally, the principle of treatment dictates using hot herbs for cold syndromes and cold herbs for heat syndromes, a fact well known to all. This is akin to the easier task of answering the direct question in an examination versus the harder side approach. There are cases where exterior signs suggest excess but interior deficiency exists, or where interior reality is excess but exterior signs mimic deficiency; Yang syndromes may resemble Yin, and Yin syndromes may resemble Yang. The subtle and profound nuances mean that a slight deviation leads to great error. Although miasmas arise from mountain and earth qi according to seasonal changes, disease occurs only when it exploits underlying human deficiency. In individuals with Yang deficiency and fire decline, initial miasma exposure may go unnoticed due to mild symptoms, eventually transforming into internal disease characterized by deficiency-cold abdominal fullness, diarrhea, aversion to cold, and cold extremities. In those with Yin deficiency and fire hyperactivity, mild miasma exposure goes unnoticed, later manifesting as dizziness, thirst, fever, abdominal distension, nausea, and dark urine. One must also consider the inherent strength or weakness of the five zang and six fu organs, applying this logic analogously. Careful consideration of summer-autumn labor, travel, and living conditions regarding weather and dampness is essential for success. Regarding miasma pulse: initially, it is surging and rapid; in deficiency, it is large and hollow (Kou); in excess, it is wiry and slippery. Over time, it changes, but generally, forceless indicates deficiency, and forceful indicates excess.
Yu Zhen notes: The formulas used by San Nong to treat miasma differ slightly from ancient prescriptions. They will be published in "Ancient and Modern Experienced Formulas Annotated," so they are not recorded here. Compatible treatments that merely follow ancient formulas are not recorded.
Our Wu region suffers from Sha Qi (Sha Qi), more common in summer. Symptoms include abdominal pain, distension, fainting, and if untreated, immediate death. This condition closely resembles miasma. Scraping, bloodletting, applying Xingjun San to the eyes, and administering Sha medicine or Zijin Ding into the throat can lead to immediate recovery. This is not a difficult syndrome, nor does it require a separate category. However, some exaggerate its nature. For instance, Wang Yangwu's "Xi Wei Bu Hua Quan Shu" proposes sixty-four hexagram-based formulas, claiming various miscellaneous diseases stem from Sha Qi transformations. While rich in case records, the methods essentially involve dispersing wind, clearing summerheat, resolving phlegm, eliminating stasis, and breaking qi stagnation, merely attributing them to Sha Qi, causing confusion. This is no different from Wu Youke's "Wen Yi Lun," which attributes miscellaneous diseases to epidemic febrile diseases; both are forced associations.