张戴人曰。尝观刺疟论。心欲试之。会陈下有病疟二年不愈者。屡服温热之剂。渐至衰
羸。命予治之。予见其羸。亦不敢便投寒凉药。乃取内经刺疟论详之。曰。诸疟不已。刺十
指间出血。正当发时。予刺其十指出血。血止而寒热立止。咸骇其神。又云。一书生病疟。
间日一作。将秋试。及试之日。乃疟之期。书生忧甚。误以葱蜜合食。大吐涎数升。瘀血宿
食皆尽。同室惊畏。至来日入院。疟亦不发。盖偶得吐法耳。
〔附〕资生经曰。有人患久疟。诸药不效。或教之以灸脾俞。即愈。更一人亦久疟。闻
之亦灸此穴而愈。盖疟多因饮食得之。故灸脾俞得效。
罗谦甫治书吏高士谦。年逾四十。至元戊寅七月间。因官事出外劳役。又因过饮。午后
大发热而渴。冰水不能解。早晨稍轻减。服药不效。罗诊其脉弦数。金匮要略云。疟脉自弦
弦数者多热。内经云。瘅疟者。肺素有热。气盛于身。厥逆上冲。中气实而不外泄。因有
所用力。腠理开。风寒舍于皮肤之内。分肉之间而发。发则阳气盛而不衰。则病矣。其气不
及于阴。故但热而不寒。气内藏于心。而外舍于分肉之间。令人消烁肌肉。故名曰瘅疟。士
谦远行劳役。又暑气有伤。酒热相搏。午后时助。故大热而渴。如在甑中。先以柴胡饮子下
之。后以白虎加栀子汤。数服而愈。
震按此系夏秋新得之疟。乃实证也。又系瘅疟。故用寒下之法。然其证易识易治。不比
丹溪诸案之难辨难治。
丹溪治一妇人久痢。因哭子变疟。医与四兽饮之类。一日五六作。汗如雨不止。凡两月
朱诊之。脉微数。食少疲甚。盖痢后无阴。悲哀伤气。又进湿热之药。助起旺火。正气愈
虚。今汗已大出。无邪可治。阴虚阳散。死在旦夕。岂小剂之所能补。遂用参、术各二两。
白芍一两。黄 五钱。炙甘草二钱。浓煎频服。两日。寒热即止而愈。
又治一少妇。身小味浓。 疟月余。间日发于申酉。头痛身热。寒多。口干。喜饮极热
辣汤。脉伏。面色惨晦。作实热痰治之。以十枣汤为末。粥丸如黍米大。津咽十粒。日三次
令淡饮食。半月后大汗而愈。
佥宪詹公年近六十。形状色苍味浓。春得 疟。丹溪视之。知其饫于 肥者。告之曰。
须却欲食淡。调理浃月。得大汗乃安。公不悦。一人许以易愈。与劫药三五帖。病退。旬日
后又大作。又与之。又退。绵延至冬。又求治于丹溪。知其久得药。痰亦少。惟胃气未完。
天寒欠汗。非补不可。以一味白术为末。粥丸。空腹热汤下二百丸。尽二斤。大汗而愈。如
此者多。但略有加减耳。
一富人年壮病疟。自卯时寒至酉时方热。至寅初方休。一日一夜。止苏一时。因思必为
入房感寒所致。及问之。九月暴寒。夜半有盗。急起。不着中衣。当时足即冷。十日后疟作
盖足阳明与冲脉合宗筋会于气街。入房太甚。则足阳明冲脉之气皆夺于所用。其寒乘虚入
中。舍于二经所过胫所会足 上。于是二经之阳气益衰。不能渗荣其经络。故病作卒不能休
乃用人参、白术大补。附子行经。加散寒之药以取汗。数日不得汗。病如前。因悟足 道
远。药力难及。用苍术、川芎、桃枝煎汤。以器盛之。浸足至膝。一食顷。以前所服药饮之
其汗通身大出。病即已。
一老人患疟嗽半载。脉之。两手尺数而有力。色稍枯。余料之。必服四兽饮等剂。中焦
湿热下流。伏结于肾。以致心火上连于肺。故疟嗽俱作。用参、术、升、柴、黄芩、黄连。
二三日与黄柏丸服之。两夜梦交通。来告急。余语之曰。此肾中热解。乃从前阴精窍而散走
故为是梦。勿忧。次日疟嗽顿止。
浦江洪宅一妇。病疟三日一发。食甚少。经不行已三月。丹溪诊之。两手脉俱无。时当
腊月。议作虚寒治。以四物加附子、吴茱、神曲为丸。心疑误。次早再诊。见其梳妆无异平
时。言语行步。并无怠倦。知果误矣。乃曰。经不行者。非无血也。为痰所碍而不行也。无
脉者。非气血衰而脉绝。乃积痰生热。结伏其脉而不见尔。以三花神佑丸与之。旬日后。食
稍进。脉渐出。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。经亦行。
震观丹溪诸案。思深而法备。真有周旋中规折旋中矩之妙。较之刘李。诚出其右。后人
犹欲诋毁之。何异蚍蜉撼树斥 笑 鹏哉。
虞天民治二男子。年皆逾四十五。各得 疟三年矣。俱发于寅申巳亥日。一人昼发于巳
而退于申。一人夜发于亥而退于寅。虞曰。昼发者。乃阴中之阳。宜补气解邪。与小柴胡汤
倍加柴胡、人参。加白术、川芎、葛根、陈皮、青皮、苍术。夜发者。为阴病。宜补血疏肝
用小柴胡汤合四物加青皮。各与十帖。俱加姜枣煎。于未发前二时服。每日一帖。服至八
帖。同日得大汗而愈。
震按二证为同中之异。花溪分别精细。用药熨贴。故八帖即愈。然亦缘疟已三年。发时
不爽。乃得间而入。如其不然。当另有说。但于未发前二时服。又云。每日一帖。则不发之
日。亦根据其时而服耶。
薛立斋治一产妇。患疟久不愈。百病蜂起。其脉或洪大。或微细。或弦紧。或沉伏。难
以名状。用六君子加炮姜。二十余剂。脉证稍得。又用参术煎膏。佐以归脾汤。百余剂而痊
又治一妇久疟。形体怯弱。内热晡热。自汗盗汗。饮食少思。月事不行。服通经丸。病
益甚。此因虚而致疟。因疟而致经闭。用补中益气汤及六味丸。各百余剂。疟愈而经行矣。
震按药已对病。尚百余剂始愈。设医者拿不定。则见异而迁病者。信不真则半途而废。
必至前功尽弃。因知虚证用补。慎毋欲速。
汪石山治一人。形瘦色脆。年三十余。八月因劳病疟。寒少热多。自汗体倦。头痛胸痞
略咳而渴。恶食。大便或秘或溏。发于寅申巳亥夜。医欲从丹溪用血药引出阳分治之。汪
诊其脉濡弱。近快稍弦。日观色察脉。乃属气血两虚。疟已深入厥阴矣。专用血药。不免损
胃又损肺。淹延岁月。恐久疟成劳也。盖嗽渴固宜养阴。自汗恶食胸痞。岂血药所能独理。
古人用药立例。指引迷途耳。因例达变。须后人推展之。遂以补中益气汤加川芎、黄柏、枳
实、神曲、麦冬。倍用参、 、术煎服。三十余帖。诸证稍除。疟犹未止。乃证之曰。今当
冬气沉潜。疟气亦因之以沉潜。难使浮达。况冬月汗孔宜乎闭固。而疟则必须汗解。当此蛰
藏之令。安得违天时以汗之乎。且以参、术、枳实、陈皮、归身、黄芩丸服。胃气既壮。来
年二月。疟当随春气而发泄矣。果如期而安。
震按冬藏难使浮达。亦备启悟之一端。其不用血药。诚为高见。然补中益气之升、柴。
已与嗽渴自汗不相宜。更加川芎何谓。
一人年三十。六月因劳取凉梦遗。遂觉恶寒。连日惨惨不爽。三日后。头痛躁闷。家人
诊之。惊曰。脉绝矣。议作阴证。欲进附子汤。未沃。请汪治。汪曰。阴证无头痛。今病如
是。恐风暑乘虚入于阴分。故脉犬耳。非绝也。若进附子汤。误则莫解。姑待以观其变。然
后议药。次日未末申初。果病寒少热多。头痛躁渴。痞闷呕食。自汗。大便或泻或结。脉皆
濡小而驶。脾部兼弦。此非寻常祛疟燥烈之剂所能治。遂用清暑益气汤去苍术、升麻。加柴
胡、知母、浓朴、川芎。以人参加作二钱。黄 钱半。白术、当归各一钱。煎服二十余帖而
震按脉证有可疑处。猛浪投以重药。脱有所误。噬脐何及。姑待以观其变。真老医之老
一人年二十余。八月。因劳病疟。汪诊之。脉数。皆六至而无力。曰。古人云。形瘦色
黑者。气实血虚也。间日发于午后。亦血分之病也。以色脉论之。当从血治。但今汗多。乃
阳虚表失所卫。消谷善饥。乃胃虚火乘其土。俱为气虚之证。仲景法有证书不凭脉者。兹当
证书作气虚治。以参、 各三钱。白术、白芍、麦冬各一钱。归身、生地、甘草各七分。知
母、陈皮各五分。煎服二十余帖而安。
震阅石山治疟案二十二条。所载脉象。或曰浮濡无力。或曰浮而欲绝。或曰濡小而缓。
或曰浮大而濡。或曰濡弱近驶稍弦。或曰数而无力。是分明参 术草之病。无甚疑难。少分
寒热。自易取效。故仅登三条。余可类推。
王肯堂云。外祖母虞太孺人。年八十余。夏患疟。诸舅以年高不堪再发。议欲截之。予
曰。欲一剂而已。亦甚易。何必截乎。乃用柴胡、升麻、羌、防、葛根之甘辛气清以升阳气
使离于阴而寒自已。以知母、石膏、黄芩之苦甘寒。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。果一剂而止。
震读灵兰要览载此方治疟屡效。又附随证加减法。最为精当。是金坛得意之作也。李士
材治新安程武修蓝本于此。惟以白豆蔻换穿山甲。亦其善用药处。
李士材治相国沈铭缜。患疟。吐蛔。闷不思食。六脉沉细。李曰。疟伤太阴。中寒蛔动
也。用理中汤加乌梅三个。黄连五分。四剂后。胸中豁然。寒热亦减。蛔亦不吐。去黄连。
加黄 二钱。生姜五钱。五剂而疟止。
缪仲淳治梁溪王兴甫。偶食牛肉。觉不快。后遂发疟。饮食渐减。至食不下咽。已而水
饮亦不下。白汤过喉间。呕出作碧色。药不受。小便一滴如赤茶。大便闭。诸医束手。缪视
之。令仰卧。以指按至心口下偏右。大叫。因询得其由。即用矾红和平胃散作末。枣肉和丸
白汤下三钱。至喉辄不呕。水道渐通。次日下黑物数块如铁。其病若失。再以人参、麦冬
各五钱。橘红、白芍各三钱。煎服。四日起。
震按理中加梅、连以治吐蛔。矾红和平胃散以治停滞牛肉。原非奇方异法。然与诸案病
情稍别。故录之。
僧慎柔治淮安客。年三旬外。季夏患瘅疟。但热不寒。连日发于午后。热躁谵语。至次
日天明才退。数日后。忽腹痛。昼夜无间。勺水不进。呼号欲绝。遇疟发时即厥去。医治不
效。求慎柔诊之。脉弦细而濡。乃谓弦细为虚为暑。而濡为湿。盖暑邪成疟。湿热乘虚内陷
而腹痛。用酒炒白芍一两。炙甘草一钱五分。水煎。调下天水散五钱。服后腹痛如失。次日
疟亦不发。
震按此与缪仲淳用丹皮汁煮滑石法同。而此少逊之。且腹痛甚。遇疟发即厥。恐戊己天
高果哉治张习可。五月间。受微雨及风冷。逐患三疟。疟发于暮。热甚于夜。至九月中
诊得六脉虚数。此阴虚而暑入阴分。最难治。当先升举其阳。用生地、当归、川芎、白芍
炙草、知母、干姜、干葛、升麻、柴胡、姜、枣煎服。四剂后。加首乌、人参。又定丸方
首乌四两。生地三两。参、术、当归、龟版、猪苓、知母、黄芩、山楂各二两。柴胡一两
六钱。牛膝一两五钱。干姜、穿山甲各一两。甘草五钱。活鳖一个。入砂仁末二两。煮取鳖
肉。同药捣匀烘干。其骨亦炙为末。加入荷叶汤法丸。服完全愈。
又治高文甫三疟。有三月余。用首乌、生地、当归、白术、知母、青皮、枳壳、升、柴
制穿山甲、姜枣煎服。过疟期三转。第二次用生地一两。老姜一两。第三次用当归一两。
姜皮一两。第四次用白术一两。姜皮一两。每帖加桃叶七片。三转后。捡不破荷叶烘燥为末
三白酒调服五钱。又三转。疟渐止。但骨节腰膝疼酸。无力行走。腹上常热。乃用四物汤
加首乌、枸杞、萸肉、杜仲、牛膝、白术、甘草、虎骨、麦冬、五味、贝母、橘红为末。活
鳖一个。煮取肉。捣药烘干。鳖甲骨俱炙燥研末加入。以酒蒸常山四两煎浓汁煮枣为丸。姜
汤送下三四钱。
震按果哉先生乃王金坛之高弟。准绳序中所谓嘉善高生隐从余游。因采取古今方论。命
高生次第录之者是也。予童时习闻父老传诵。其治病如神。着有医林广见及杂证二书。未曾
刊印。世人得之者珍如拱璧。又有医案数卷。立方颇多奇巧。然险峻者亦难轻试。略选数条
以存吾邑之文献云耳。
喻嘉言治袁继明。素有房劳内伤。偶因小感。自煎姜葱汤表汗。因而发热三日。变成疟
疾。喻诊其脉。豁大空虚。且寒不成寒。热不成热。气急神扬。知为元阳衰脱之候。因谓其
父曰。令郎光景。窃虑来日疟至。大汗不止。难于救药。今晚宜用人参二两。煎浓汤。预服
防危。渠父不以为意。次日五鼓时。病者便觉精神恍惚。觉得参至。疟已先发矣。喻甚彷徨
恐以人参补住疟邪。虽救急。无益也。只得姑俟疟热稍退。方与服之。服时已汗出沾濡。
顷之。果然大汗不止。昏不知人。口流白沫。灌药难入。直至日暮。白沫转从大孔遗出。喻
喜曰。白沫下行。可无恐矣。但内虚肠滑。独参不能胜任。急以附子理中汤。连进四小剂。
人事方苏。能言。但对面谈事不清。门外有探病客至。渠忽先知。家人惊以为祟。喻曰。此
正神魂之离舍耳。吾以独参及附子理中驷马之力追之。尚在半返未返之界。以故能知宅外之
事。再与前药二剂而安。
张戴人说：我曾经阅读过《黄帝内经》中的《刺疟论》，心里想要尝试一下。恰逢陈地有个人患疟疾两年未愈，多次服用温热性质的药物，身体逐渐变得衰弱消瘦。他让我诊治。我看到他身体虚弱，也不敢立刻投用寒凉性质的药物，于是取出《黄帝内经·刺疟论》仔细研读，上面说：“各种疟疾久治不愈的，可以针刺十指间出血。应当在疟疾发作的时候进行。”我就针刺他的十个手指尖使其出血，血止住后，恶寒发热的症状立刻停止。大家都对这种神效感到惊骇。
又记载：有一个书生患疟疾，每隔一天发作一次。正值秋天参加科举考试，到了考试那天，正好是疟疾发作的时间。书生非常忧虑，误食了葱和蜜混合的食物，导致剧烈呕吐，吐出几升涎液，体内的瘀血和积滞的食物都排尽了。同屋的人惊恐害怕。到了第二天进入考场时，疟疾也没有再发作。这大概是偶然使用了吐法的效果罢了。
〔附〕《资生经》记载：有人患长期疟疾，各种药物都不见效。有人教他艾灸脾俞穴，病就好了。又有一个人也是长期患疟疾，听说了这个方法，也艾灸这个穴位而痊愈。大概是因为疟疾多因饮食不当引起，所以艾灸脾俞穴能取得疗效。
罗谦甫治疗书吏高士谦。年龄超过四十岁。在至元戊寅年七月间，因为公务外出劳累，又因为过量饮酒，午后出现大发热且口渴，喝冰水也不能缓解。早晨症状稍轻减，服药无效。罗谦甫诊察他的脉象弦数。《金匮要略》中说：“疟疾的脉象自然呈现弦象，弦而数的脉象多属热证。”《黄帝内经》中说：“瘅疟（一种但热不寒的疟疾），是因为肺中素有热邪，气盛于全身，厥逆之气上冲，中焦之气充实而不能向外宣泄，再加上用力劳作，腠理开泄，风寒之邪停留在皮肤之内、分肉之间而发病。发病时阳气亢盛而不衰退，这就形成了疾病。邪气不能到达阴分，所以只有发热而没有恶寒。邪气内藏于心，外舍于分肉之间，使人肌肉消烁，所以名叫瘅疟。”高士谦远行劳累，又受暑气伤害，酒热与暑热相互搏结，午后时辰阳气助长火势，所以大热而口渴，感觉像在蒸笼里一样。先用柴胡饮子攻下，后用白虎加栀子汤，服用几剂后痊愈。
俞震按语：这属于夏秋季节新得的疟疾，是实证。又是瘅疟，所以使用寒下之法。然而这种病症容易识别和治疗，不像朱丹溪那些医案那样难以辨别和治疗。
朱丹溪治疗一位妇人，长期痢疾，因为哭丧儿子变成疟疾。医生给予四兽饮之类的药物，一天发作五六次，汗如雨下不止。经过两个月，朱丹溪诊察她，脉象微数，食欲少，极度疲乏。这是因为痢疾之后阴液亏损，悲哀损伤了正气，又进服湿热性质的药物，助起了旺火，正气更加虚弱。现在汗已经大量流出，没有邪气可治了，这是阴虚阳散，死期就在旦夕之间，哪里是小剂量药物所能补益的呢？于是用人参、白术各二两，白芍一两，黄芩五钱，炙甘草二钱，浓煎后频频服用。两天后，寒热症状即停止而痊愈。
又治疗一位年轻妇女，身材瘦小，气味浓厚，患疟疾一个多月，每隔一天在申时、酉时发作，头痛身热，恶寒重，口干，喜欢喝极热的辣汤，脉象伏匿，面色惨暗晦涩。按照实热痰证来治疗，用十枣汤制成粉末，用米粥做成梧桐子大小的丸药，津液送服十粒，每天三次，嘱咐清淡饮食。半个月后大汗出而痊愈。
佥宪詹公年龄近六十岁，形体魁梧，面色青黑，口味浓厚。春天患疟疾。朱丹溪诊视后，知道他平时吃得太油腻肥甘，告诉他说：“必须戒除房事，饮食清淡，调理一个月，等到大汗出后才能安宁。”詹公不高兴。另一个人声称容易治愈，给他用了截疟药三五帖，病情退去。十天后又大发作，又给他用药，病情又退去。拖延到冬天，又向朱丹溪求治。朱丹溪知道他久服药物，痰湿已减少，只有胃气尚未恢复，天气寒冷缺乏汗出，非补不可。只用一味白术研成粉末，用米粥做成丸药，空腹用热汤送服二百丸，吃完两斤药，大汗出而痊愈。像这样的情况很多，只是略有加减罢了。
一个富人年轻时患疟疾，从卯时开始发冷直到酉时才发热，到寅初才停止。一天一夜之中，只有一小时清醒。因为他思考一定是因为入房后感寒所致。及至询问他，说是九月突然遇寒，半夜有盗贼，急忙起床，没有穿内衣，当时脚就变冷了。十天后疟疾发作。盖足阳明胃经与冲脉会合于宗筋，交会于气街部位。入房过度，则足阳明和冲脉的气血都被耗损。寒气乘虚侵入，停留在这两条经脉所经过的小腿和足部交会处，于是这两条经脉的阳气更加衰微，不能渗透濡养经络，所以病作且不能停止。于是用人参、白术大补气血，附子通行经络，加入散寒的药物以取汗。几天后不出汗，病情如前。于是领悟到足部道路遥远，药力难以到达，就用苍术、川芎、桃枝煎汤，用容器盛装，浸泡双脚至膝盖。一顿饭的功夫后，将之前服的药喝下去，全身大汗出，病即痊愈。
一个老人患疟疾咳嗽半年。诊察脉象，两手尺脉数而有力，面色稍枯。我推测他，一定服用了四兽饮等药剂，导致中焦湿热下流，伏结于肾，致使心火上连于肺，所以疟疾和咳嗽同时发作。用人参、白术、升麻、柴胡、黄芩、黄连，每两三天配合黄柏丸服用。两个晚上梦见性交，来告知紧急情况。我对他说：“这是肾中热邪解除，从前阴精窍散发出去，所以做这样的梦。不要担忧。”第二天疟疾和咳嗽顿时停止。
浦江洪家的一位妇人，患疟疾三天发作一次，吃得很少，月经三个月没来。朱丹溪诊察，两手脉象都摸不到。当时正是腊月，商议作为虚寒证治疗，用四物汤加附子、吴茱萸、神曲做成丸药。病人心里怀疑误诊。第二天早上再诊，见她梳妆打扮与平时无异，言语行走，并没有怠倦的样子，知道果然误诊了。于是说：“月经不来，不是没有血，是被痰阻碍而不行。无脉，不是气血衰败而脉绝，而是积痰生热，结伏在脉道中看不见罢了。”给她三花神佑丸。十天后，饮食稍进，脉象渐出，但带有微弦象，疟疾尚未痊愈。于是说胃气既然恢复，春深时节经血自然旺盛，病自然会好，不必服药。教导她用淡滋味、节制饮食的方法。半个月后疟疾痊愈，月经也来了。
俞震观察朱丹溪的各种医案，思虑深远而方法完备，真有周旋符合圆规、折旋符合矩尺的精妙之处。比起刘完素、李东垣等人，确实高出他们一筹。后人还要诋毁他，这与蚂蚁摇大树、斥责大鹏鸟有什么区别呢？
虞天民治疗两个男子，年龄都超过四十五岁，都患疟疾三年了。都在寅、申、巳、亥日发作。一个人在白天巳时发作而在申时退去，一个人在夜间亥时发作而在寅时退去。虞天民说：白天发作的，属于阴中之阳，宜补气解邪，用小柴胡汤加倍柴胡、人参，加白术、川芎、葛根、陈皮、青皮、苍术。夜间发作的，属于阴病，宜补血疏肝，用小柴胡汤合四物汤加青皮。各给十帖，都加生姜、大枣煎服。在未发作前两小时服用，每日一帖。服到第八帖，同日大汗出而痊愈。
俞震按语：这两个证候是同中之异。花溪（虞天民）分辨精细，用药熨贴，所以八帖即愈。然而也是因为疟疾已经三年，发作时间准确无误，才有间隙可以介入治疗。如果不是这样，应当另有说法。只是在未发作前两小时服用，又说每日一帖，那么不发之日，也是根据其时而服用吗？
薛立斋治疗一位产妇，患疟疾久治不愈，百病蜂起。她的脉象或洪大，或微细，或弦紧，或沉伏，难以形容。用六君子汤加炮姜，二十余剂后，脉证稍有好转。又用参、术煎膏，佐以归脾汤，一百余剂后痊愈。
又治疗一位妇人长期患疟疾，形体怯弱，内有热感，傍晚发热，自汗盗汗，饮食少想，月经不行。服用通经丸，病情更加严重。这是因为虚而导致疟疾，因疟疾而导致闭经。用补中益气汤及六味地黄丸，各一百余剂，疟疾痊愈而月经行了。
俞震按语：药已经对症，尚且需要一百余剂才痊愈。假如医者拿不定主意，就会见异思迁；病人如果不相信，就会半途而废。必定导致前功尽弃。因此知道虚证用补法，千万不要求快。
汪石山治疗一个人，形体瘦弱，肤色脆嫩，三十多岁。八月因为劳累患疟疾，寒少热多，自汗体倦，头痛胸痞，略微咳嗽且口渴，厌恶食物，大便有时便秘有时溏泄，在寅、申、巳、亥夜发作。医生想要依照朱丹溪的方法，用血药引出阳分来治疗。汪石山诊察他的脉象濡弱，近快稍弦。每日观察面色诊察脉象，认为是气血两虚，疟疾已经深入厥阴经了。专用血药，不免损伤胃又损伤肺，拖延岁月，恐怕久疟成劳损之症。咳嗽口渴固然适宜养阴，但自汗、厌恶食物、胸痞，难道单靠血药就能处理吗？古人用药立例，是指引迷途罢了。需要根据例子通达变化，须由后人推展。于是用补中益气汤加川芎、黄柏、枳实、神曲、麦冬，倍用人参、黄芪、白术煎服。三十余帖，诸证稍除，疟疾仍未停止。于是占测说：“现在正当冬季气机沉潜，疟气也随之沉潜，难以使之外浮发散。况且冬季毛孔应当闭合固守，而疟疾则需要通过汗解。在这蛰伏收藏的时令，怎么能违背天时强行发汗呢？”暂且用人参、白术、枳实、陈皮、当归身、黄芩做成丸药服用。胃气既壮，来年二月，疟疾应当随着春气而发泄出来。果然如期而安。
俞震按语：冬季收藏难使外浮发散，这也是启发感悟的一个方面。他不用血药，确实是高见。然而补中益气汤中的升麻、柴胡，已经与咳嗽、口渴、自汗不相适宜，再加川芎怎么说呢？
一个人三十岁，六月因为劳累受凉，梦中遗精，随即觉得恶寒，连续几天心情凄惨不爽。三天后，头痛躁闷。家人诊察，惊恐地说：“脉象没了。”商议作为阴证治疗，想要进服附子汤。还没煮好，请汪石山诊治。汪石山说：“阴证没有头痛。现在病情如此，恐怕是风暑乘虚侵入阴分，所以脉象细小而已。并不是绝脉。如果进服附子汤，误诊后果不堪设想。姑且等待观察其变化，然后再议用药。”次日未时末、申时初，果然病势变为寒少热多，头痛躁渴，痞闷呕食，自汗，大便或泻或结，脉象皆濡小而急。脾部兼见弦象。这不是寻常祛疟燥烈之剂所能治疗的。于是用清暑益气汤去掉苍术、升麻，加柴胡、知母、厚朴、川芎，以人参二钱，黄芪一钱半，白术、当归各一钱，煎服二十余帖而痊愈。
俞震按语：脉证有可疑之处，猛浪地投以重药，倘若有所误判，后悔莫及。姑且等待观察其变化，真是老练医生的老练之处。
一个人二十多岁，八月因为劳累患疟疾。汪石山诊察，脉数，都是六至而无力。说：“古人说，形体瘦弱面色黑的，是气实血虚。每隔一天在午后发作，也是血分的病。从色脉来看，应当从血分治疗。但现在汗多，是阳虚表失所卫护；消谷善饥，是胃虚火乘其土，都是气虚的证候。仲景的法度中有‘有是证不凭脉’的情况，这里应当根据证候作为气虚治疗。用人参、黄芪各三钱，白术、白芍、麦冬各一钱，当归身、生地、甘草各七分，知母、陈皮各五分，煎服二十余帖而安。”
俞震阅读汪石山治疗疟疾的医案二十二条，所载脉象，有的说浮濡无力，有的说浮而欲绝，有的说濡小而缓，有的说浮大而濡，有的说濡弱近急稍弦，有的说数而无力。这分明是参、术、草适用的病证，没有什么疑难，稍微分清寒热，自然容易取效。所以仅登载三条，其余的可以类推。
王肯堂说：我的外祖母虞太孺人，八十多岁。夏天患疟疾。各位舅舅认为年高不能再次发作，商议想要截断疟疾。我说：“想要一剂药就停止，也很简单，何必截断呢？”于是用柴胡、升麻、羌活、防风、葛根的甘辛清气以升举阳气，使阳气离开阴分而寒自止；用知母、石膏、黄芩的苦甘寒性，引导阴气下降，使阴气离开阳分而热自止；用猪苓的淡渗分利阴阳，使阴阳不得交并；用穿山甲引导药力；用甘草调和。果然一剂而止。
俞震读《灵兰要览》记载此方治疟屡效，又附有随证加减法，最为精当，这是金坛（王肯堂）得意的作品。李士材治疗新安程武修蓝本于此，只是用白豆蔻换掉穿山甲，也是他善于用药的地方。
李士材治疗相国沈铭缜，患疟疾，吐蛔虫，胸闷不想吃东西，六脉沉细。李士材说：“疟疾损伤太阴脾经，中焦寒盛蛔虫扰动。”用理中汤加乌梅三个，黄连五分。四剂后，胸中豁然开朗，寒热也减轻，也不吐蛔虫了。去掉黄连，加黄芪二钱，生姜五钱。五剂后疟疾停止。
缪仲淳治疗梁溪王兴甫，偶然吃了牛肉，觉得不舒服，后来就发了疟疾，饮食逐渐减少，直到吃不下咽。不久连水饮也下不去，白开水过喉间，呕出来呈碧绿色。药吃不进去，小便一滴如赤茶色，大便闭塞。众医束手无策。缪仲淳看他，让他仰卧，用手指按压到心口下偏右，病人大叫。于是询问得知病因，就用矾红和平胃散做成粉末，枣肉和丸，白汤送服三钱。到了喉咙就不呕吐了，水道渐渐通畅。第二天排出黑色块状物几块像铁一样，病好像消失了。再用人参、麦冬各五钱，橘红、白芍各三钱，煎服。第四天起床。
俞震按语：理中汤加乌梅、黄连来治疗吐蛔，矾红和平胃散来治疗停滞的牛肉，原本不是奇方异法。但是与各医案的病情稍有不同，所以记录下来。
僧慎柔治疗淮安的客人，三十多岁。季夏患瘅疟，但热不寒，连续几天在午后发作，热躁谵语，到第二天天明才退。数日后，忽然腹痛，昼夜无间，勺水不进，呼号欲绝，遇到疟疾发作时就昏厥过去。医生治疗无效，求慎柔诊治。脉象弦细而濡。就说弦细为虚为暑，而濡为湿。大概是暑邪形成疟疾，湿热乘虚内陷而腹痛。用酒炒白芍一两，炙甘草一钱五分，水煎，调下天水散五钱。服后腹痛如失。第二天疟疾也不发作了。
俞震按语：这与缪仲淳用丹皮汁煮滑石的方法相同，而这个稍逊一筹。而且腹痛严重，遇疟发即昏厥，恐怕是戊己天癸失调吧？
果哉治疗张习可。五月间，受微雨及风冷，逐渐患三疟（隔三日一发）。疟疾在暮时发作，夜间热甚。到九月中诊得六脉虚数。这是阴虚而暑入阴分，最难治。应当先升举其阳。用地黄、当归、川芎、白芍、炙甘草、知母、干姜、干葛、升麻、柴胡、姜、枣煎服。四剂后，加首乌、人参。又定丸方：首乌四两，地黄三两，参、术、当归、龟版、猪苓、知母、黄芩、山楂各二两，柴胡一两六钱，牛膝一两五钱，干姜、穿山甲各一两，甘草五钱，活鳖一个，入砂仁末二两，煮取鳖肉，同药捣匀烘干。其骨也炙为末，加入荷叶汤泛丸。服完全愈。
又治疗高文甫的三疟，有三月多。用首乌、地黄、当归、白术、知母、青皮、枳壳、升麻、柴胡、制穿山甲、姜枣煎服。过了疟期三轮。第二次用地黄一两，老姜一两。第三次用当归一两，姜皮一两。第四次用白术一两，姜皮一两。每帖加桃叶七片。三轮后，捡不破的荷叶烘燥为末，三白酒调服五钱。又三轮，疟疾渐止。但骨节腰膝疼酸，无力行走，腹上常热。于是用四物汤加首乌、枸杞、山茱萸、杜仲、牛膝、白术、甘草、虎骨、麦冬、五味子、贝母、橘红为末。活鳖一个，煮取肉，捣药烘干。鳖甲骨俱炙燥研末加入。以酒蒸常山四两煎浓汁煮枣为丸。姜汤送下三四钱。
俞震按语：果哉先生是王金坛的高徒，就是《准绳》序中所说的嘉善高生隐跟随我游学，于是采取古今方论，命高生依次记录下来的那个人。我小时候听父老传诵，他治病如神，著有《医林广见》及杂证二书，未曾刊印。世人得到它珍如拱璧。又有医案数卷，立方颇多奇巧，然而险峻者也不可轻易尝试。略选几条以保存我们县邑的文献罢了。
喻嘉言治疗袁继明，平素有房劳内伤，偶然因为轻微感受，自己煎姜葱汤发汗，因而发热三天，变成疟疾。喻嘉言诊察他的脉象，豁大空虚，而且寒不成寒，热不成热，气急神扬，知道是元阳衰脱的征候。于是对他的父亲说：“令郎的光景，我担心明天疟疾到来时，大汗不止，难于救药。今晚宜用人参二两，煎浓汤，预先服用以防危险。”他父亲不以为意。第二天五更时，病人便觉得精神恍惚，觉得人参送到时，疟疾已经先发作了。喻嘉言很彷徨，恐怕用人参补住了疟邪，虽然救急，也无益。只得姑且等疟热稍退，才给他服用。服用时已经汗出沾湿。一会儿，果然大汗不止，昏不知人，口流白沫，灌药难入。直至日暮，白沫转从肛门流出。喻嘉言高兴地说：“白沫下行，可以不用担心了。但内虚肠滑，独参不能胜任。急用附子理中汤，连进四小剂，人事才苏醒，能说话，但对面谈话不清楚。门外有探病的客人到，他突然先知。家人惊恐以为是鬼祟。喻嘉言说：“这正是神魂离舍的表现。我用独参及附子理中汤四马之力追摄神魂，还在半返未返的境界，所以能知道宅外的事。再与前药二剂而安。”
Zhang Dairen said: I once read the "Treatise on Acupuncture for Malaria" (Cinang Lun) in the *Huangdi Neijing* (Yellow Emperor's Inner Canon), and wished to try it. At that time, there was a person in Chen who had suffered from malaria for two years without cure. He had repeatedly taken warm-tonic medicines, gradually becoming emaciated and weak. He asked me to treat him. Seeing his debility, I dared not immediately administer cold-purging medicines. Instead, I consulted the "Treatise on Acupuncture for Malaria" in the *Neijing*, which states: "For various types of malaria that do not heal, prick the ten fingers to bleed. This should be done at the onset of the fever." I pricked his ten fingertips until they bled. Once the bleeding stopped, the chills and fever ceased immediately. Everyone was amazed by this miraculous effect.
Another record states: A scholar contracted malaria, occurring every other day. It coincided with the autumn imperial examinations. On the day of the exam, the malaria attack occurred. The scholar was extremely anxious and accidentally consumed a mixture of green onions and honey, inducing severe vomiting. Several shengs (a unit of volume) of saliva were vomited out, along with stagnant blood and undigested food. His roommates were terrified. However, when he entered the examination hall the next day, the malaria did not recur. This was likely an accidental result of using the vomiting method (Shu Fa).
[Appendix] *Zisheng Jing* (Classic of Nourishing Life) records: A person suffered from chronic malaria, unresponsive to all medicines. Someone advised him to moxa the Pishu (BL20) acupoint, and he recovered. Another person with chronic malaria heard of this and also moxa this point, recovering as well. This is likely because malaria often arises from dietary issues, so moxaing Pishu (Spleen Shu) yields efficacy.
Luo Qianfu treated Gao Shiqian, a scribe, who was over forty years old. In July of the Wuyin year of the Zhiyuan era, due to official duties requiring outdoor labor and excessive drinking, he developed high fever and thirst in the afternoon, which ice water could not relieve. Symptoms were slightly lighter in the morning, but medications failed. Luo diagnosed his pulse as wiry and rapid (Xian Shu). The *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) states: "The pulse of malaria is naturally wiry; a wiry and rapid pulse indicates heat." The *Neijing* states: "Dan Malaria (Malaria with only heat and no chills) occurs because the lungs harbor latent heat, causing qi to flourish throughout the body. Rebellious qi rushes upward, the middle jiao is full and cannot vent outward. Combined with physical exertion, the couli (pores) open, allowing wind-cold pathogens to lodge between the skin and muscle layers. Upon onset, yang qi becomes excessive and does not decline, resulting in disease. The pathogen fails to reach the yin level, hence only heat without chills. The qi hides internally in the heart and externally in the muscle layers, causing muscle wasting, thus named Dan Malaria." Gao Shiqian’s long journey caused fatigue, compounded by summer-heat injury and the interaction of alcohol heat. The afternoon hours amplified the fire, leading to intense heat and thirst, feeling like being in a steamer. First, Chaihu Yinzi (Bupleurum Drink) was used to purge downward, followed by Baihu Jia Zhizi Tang (White Tiger plus Gardenia Decoction). After several doses, he recovered.
Yu Zhen’s commentary: This is a newly acquired malaria in summer/autumn, representing an excess syndrome. As it is Dan Malaria, cold-purging methods are appropriate. However, this case is easy to identify and treat, unlike Zhu Danxi’s cases which are difficult to distinguish and manage.
Zhu Danxi treated a woman with chronic dysentery who developed malaria after weeping for her deceased son. Physicians prescribed formulas like Sishou Yin (Four Beasts Drink). She experienced attacks 5-6 times a day with profuse sweating like rain. After two months, Zhu diagnosed her pulse as faint and rapid. She had poor appetite and extreme fatigue. This was due to yin deficiency following dysentery, qi damage from grief, and the aggravation of vigorous fire by damp-heat medicines, further depleting righteous qi. With massive sweating, there was no pathogen left to treat; this was yin deficiency with yang dispersion, indicating imminent death. Small doses could not tonify. Zhu prescribed Ren Shen (Ginseng Root) and Bai Zhu (Atractylodes Rhizome) each 2 liang, Bai Shao (White Peony Root) 1 liang, Huang Qin (Scutellaria Root) 5 qian, and Zhi Gan Cao (Honey-fried Licorice Root) 2 qian. Decocted strongly and taken frequently. Within two days, chills and fever ceased, and she recovered.
He also treated a young woman, small in stature with strong bodily odor, suffering from malaria for over a month. Attacks occurred every other day at Shen and You hours (3-7 PM), with headache, fever, severe chills, dry mouth, craving for very hot spicy soup, hidden pulse, and dull complexion. Treated as excess heat-phlegm, Shi Zao Tang (Ten Date Decoction) powder was made into millet-sized pills with congee. Ten pills swallowed with saliva, three times daily, with light diet instructions. After half a month, profuse sweating led to recovery.
Censor Zhan, nearly sixty, robust with dark complexion and rich taste, contracted malaria in spring. Zhu Danxi observed he was accustomed to rich, fatty foods and advised abstinence from sexual activity and bland diet for a month, expecting heavy sweating for relief. The Censor was displeased. Another practitioner promised quick cure with antimalarial drugs (Jie Yao). Symptoms subsided after 3-5 doses but relapsed severely after ten days. Treatment repeated, symptoms recurred again. By winter, he sought Zhu again. Zhu noted phlegm had reduced due to prolonged medication, but stomach qi remained incomplete, lacking sweat due to cold. Tonification was necessary. Only Bai Zhu (Atractylodes Rhizome) powder, pillized with congee, was prescribed. Taken on an empty stomach with hot water, 200 pills per dose. After consuming 2 jin (approx. 1kg), heavy sweating occurred, and he recovered. Similar cases were common, with minor modifications.
A wealthy young man suffered from malaria. Chills began at Mao hour (5-7 AM) and ended at You hour (5-7 PM) with fever, stopping only at Yin-Chu hour (1-2 AM). He was awake for only one hour in a 24-hour cycle. He suspected cold invasion after intercourse. Inquiry revealed he woke abruptly in late September during a cold night to chase thieves, without wearing inner garments, causing his feet to go cold immediately. Malaria started ten days later. The Foot-Yangming Stomach Meridian and Chong Mai (Penetrating Vessel) converge at the Zongjin (Master Tendon) and Qi Street (Qichong ST12). Excessive intercourse depleted qi in these meridians. Cold invaded the deficiency, lodging where the meridians pass through the lower legs and feet. Yang qi in these meridians declined, failing to nourish the channels, causing persistent illness. Ren Shen (Ginseng) and Bai Zhu (Atractylodes) were used to greatly tonify, Fuzi (Aconite Lateral Root) to circulate meridians, and cold-dispelling herbs to induce sweating. No sweat occurred after several days, and symptoms persisted. Realizing foot pathways are distant and drug potency hard to reach, Cang Zhu (Black Atractylodes Rhizome), Chuan Xiong (Szechwan Lovage Rhizome), and Tao Zhi (Peach Twig) were decocted for foot bathing up to the knees. After one meal’s time, the previous oral medicine was drunk. Profuse whole-body sweating ensued, and the disease resolved.
An elderly man suffered from malaria and cough for half a year. Pulse at both Chi positions (Kidney) was rapid and forceful; complexion was slightly withered. I deduced he had taken Sishou Yin (Four Beasts Drink) and similar agents, causing damp-heat in the middle jiao to flow downward and knot in the Kidneys, connecting Heart fire to the Lungs, triggering both malaria and cough. Ren Shen (Ginseng), Bai Zhu (Atractylodes), Sheng Ma (Cimicifuga Rhizome), Chai Hu (Bupleurum Root), Huang Qin (Scutellaria Root), and Huang Lian (Coptis Rhizome) were given. Every two to three days, Huang Bo Phellodendri Cortex) pills were added. He dreamed of sexual intercourse for two nights and reported it urgently. I told him: "This indicates kidney heat resolving, dispersing through the anterior yin orifice. Do not worry." The next day, malaria and cough stopped suddenly.
A woman in the Hong family of Pujiang had malaria every three days, ate little, and had amenorrhea for three months. Zhu Danxi found no pulse in both hands. It was the twelfth lunar month; treatment was planned for deficiency-cold using Si Wu Tang (Four Substances Decoction) plus Fu Zi (Aconite), Wu Zhu Yu (Evodia Fruit), and Shen Qu (Medicated Leaven). The patient doubted the diagnosis. The next morning, upon re-examination, she was dressing normally, speaking and walking without fatigue. Zhu realized the error: "Amenorrhea is not due to lack of blood, but obstruction by phlegm. Absent pulse is not qi-blood exhaustion, but accumulated phlegm generating heat, blocking the pulse vessels." San Hua Shen You Wan (Three Flowers Shenyou Pill) was administered. After ten days, appetite improved, pulse emerged slightly wiry, but malaria persisted. Zhu stated that since stomach qi recovered, spring warmth would restore menstruation and cure malaria without medicine. Advised bland diet. Half a month later, malaria healed, and menstruation resumed.
Yu Zhen observes that Zhu Danxi’s cases show profound thought and comprehensive methods, possessing the subtlety of moving within compasses and squares. Compared to Liu Wansu and Li Dongyuan, he is superior. Later critics disparage him, akin to ants shaking trees or mocking Peng (the mythical giant bird).
Yu Tianmin treated two men, both over forty-five, suffering from malaria for three years. Both attacked on Yin, Shen, Si, Hai days. One attacked during the day at Si hour (9-11 AM) and subsided at Shen hour (3-5 PM); the other at night at Hai hour (9-11 PM) and subsided at Yin hour (3-5 AM). Yu said: Daytime attacks belong to yang within yin; suitable for tonifying qi and resolving pathogens. Xiao Chai Hu Tang (Minor Bupleurum Decoction) with doubled Chai Hu (Bupleurum) and Ren Shen (Ginseng), plus Bai Zhu (Atractylodes), Chuan Xiong (Szechwan Lovage), Ge Gen (Kudzu Root), Chen Pi (Citrus Peel), Qing Pi (Green Citrus Peel), and Cang Zhu (Black Atractylodes). Nighttime attacks are yin diseases; suitable for nourishing blood and soothing liver. Xiao Chai Hu Tang combined with Si Wu Tang (Four Substances Decoction) plus Qing Pi (Green Citrus Peel). Ten doses each, decocted with Ginger and Jujube. Taken two hours before onset, one dose daily. After eight doses, both sweated heavily on the same day and recovered.
Yu Zhen’s commentary: These cases represent differences within similarities. Huaxi (Yu Tianmin) distinguished them finely and prescribed aptly, hence recovery in eight doses. However, this was possible because the malaria had been stable for three years, allowing intervention. Otherwise, different strategies would apply. Regarding taking medicine two hours before onset and daily dosing, does this imply dosing on non-attack days according to timing?
Xue Lizhai treated a postpartum woman with chronic malaria and multiple complications. Pulses varied: surging-large, faint-thin, wiry-tight, or deep-hidden. Liu Jun Zi Tang (Six Gentlemen Decoction) plus Pao Jiang (Fried Ginger) for over twenty doses improved pulses and symptoms. Then, a paste of Ren Shen (Ginseng) and Bai Zhu (Atractylodes) supplemented with Gui Pi Tang (Restore the Spleen Decoction) for over a hundred doses cured her.
He also treated a woman with chronic malaria, frail constitution, internal heat, evening fever, spontaneous and nocturnal sweating, poor appetite, and amenorrhea. Tong Jing Wan (Menstruation-Promoting Pills) worsened her condition. This was malaria caused by deficiency, leading to amenorrhea. Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) and Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) were used, each for over a hundred doses. Malaria healed, and menstruation resumed.
Yu Zhen’s commentary: The prescription matched the disease, yet required over a hundred doses. If the physician lacked resolve, changing treatments upon seeing variations, or if the patient lacked faith, abandoning halfway, all prior efforts would be wasted. Thus, for deficiency syndromes using tonification, one must not seek speed.
Wang Shishan treated a man, thirty-something, thin and delicate. In August, labor-induced malaria presented with less chills, more heat, spontaneous sweating, fatigue, headache, chest oppression, slight cough, thirst, aversion to food, alternating constipation/diarrhea, attacking at night on Yin, Shen, Si, Hai days. The doctor intended to follow Zhu Danxi’s method of using blood-nourishing herbs to draw yang out. Wang diagnosed the pulse as soggy-weak, slightly rapid and wiry. Daily observation of color and pulse indicated qi-blood deficiency, with malaria penetrating the Jueyin Liver channel. Using only blood herbs would damage stomach and lungs, prolonging the illness into consumption. While cough/thirst suit yin-nourishment, sweating, anorexia, and chest oppression cannot be managed by blood herbs alone. Ancient prescriptions provide guidelines, but flexibility is needed. Wang used Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Chuan Xiong (Szechwan Lovage), Huang Bo (Phellodendron Bark), Zhi Shi (Immature Bitter Orange), Shen Qu (Medicated Leaven), Mai Dong (Ophiopogon Tuber), doubling Ren Shen (Ginseng), Huang Qi (Astragalus Root), and Bai Zhu (Atractylodes). Thirty-plus doses alleviated symptoms, but malaria persisted. He reasoned: Winter energy sinks; malaria follows suit, making it hard to surface. Winter pores should close, but malaria requires sweating. Against seasonal storage, forcing sweat is inappropriate. He switched to pills of Ren Shen (Ginseng), Bai Zhu (Atractylodes), Zhi Shi (Immature Bitter Orange), Chen Pi (Citrus Peel), Dang Gui (Angelica Sinensis), Huang Qin (Scutellaria). Strengthening stomach qi, he predicted malaria would erupt with spring qi in February. It happened as predicted.
Yu Zhen’s commentary: Winter storage makes surfacing difficult; this is a valid insight. Avoiding blood herbs was wise. However, Sheng Ma (Cimicifuga) and Chai Hu (Bupleurum) in Bu Zhong Yi Qi Tang are unsuitable for cough/thirst/sweating; adding Chuan Xiong (Szechwan Lovage) is questionable.
A thirty-year-old man, in June, suffered labor, cooling, and seminal emission, followed by aversion to cold and misery for days. Three days later, headache and agitation. Family doctors feared absent pulse, diagnosing yin syndrome and preparing Fu Zi Tang (Aconite Decoction). Before brewing, Wang Shishan was consulted. Wang said: "Yin syndrome lacks headache. Wind-summerheat invading yin levels causes fine pulses, not absence. Fu Zi Tang would be disastrous." He advised waiting. Next day, symptoms shifted to less chills, more heat, headache, thirst, chest stuffiness, vomiting, sweating, diarrhea/constipation. Pulse was soggy-small-rapid, spleen area wiry. Ordinary drying/hot malaria herbs were unsuitable. Qing Shu Yi Qi Tang (Clear Summerheat and Augment Qi Decoction) minus Cang Zhu (Black Atractylodes) and Sheng Ma (Cimicifuga), plus Chai Hu (Bupleurum), Zhi Mu (Anemarrhena Rhizome), Hou Po (Magnolia Bark), Chuan Xiong (Szechwan Lovage), with Ren Shen (Ginseng) 2 qian, Huang Qi (Astragalus) 1.5 qian, Bai Zhu (Atractylodes) and Dang Gui (Angelica) 1 qian each. Twenty-plus doses cured him.
Yu Zhen’s commentary: With doubtful pulse/symptoms, rash heavy medication risks disaster. Waiting to observe changes is truly the mark of an experienced physician.
A man in his twenties, in August, contracted malaria from labor. Wang diagnosed rapid, six-beats-per-breath, powerless pulse. He cited: "Thin body, dark complexion indicates excess qi, deficient blood. Bi-daily afternoon attacks indicate blood-level pathology." Color/pulse suggested blood treatment. However, profuse sweating indicated yang deficiency failing to protect the exterior; hunger with rapid digestion indicated stomach deficiency-fire. Both are qi-deficiency signs. Following Zhang Zhongjing’s principle of prioritizing symptoms over pulse, Wang treated as qi deficiency: Ren Shen (Ginseng) and Huang Qi (Astragalus) 3 qian each, Bai Zhu (Atractylodes), Bai Shao (White Peony), Mai Dong (Ophiopogon) 1 qian each, Dang Gui (Angelica), Sheng Di (Rehmannia), Gan Cao (Licorice) 0.7 qian each, Zhi Mu (Anemarrhena), Chen Pi (Citrus Peel) 0.5 qian each. Twenty-plus doses brought peace.
Yu Zhen reviewed Wang Shishan’s 22 malaria cases. Pulses described included floating-soggy-powerless, floating-almost-absent, soggy-small-slow, floating-large-soggy, soggy-weak-rapid-wiry, and rapid-powerless. These clearly indicated indications for Ren Shen (Ginseng), Bai Zhu (Atractylodes), and Gan Cao (Licorice). With minimal differentiation of cold/heat, efficacy was expected. Only three cases are recorded here; others can be inferred.
Wang Kentang stated: My maternal grandmother, Lady Yu, over eighty, contracted summer malaria. Uncles argued against recurrence due to age, suggesting suppression. I said: "One dose can stop it easily; why suppress?" Prescription: Chai Hu (Bupleurum), Sheng Ma (Cimicifuga), Qiang Huo (Notopterygium Rhizome), Fang Feng (Saposhnikovia Root), Ge Gen (Kudzu Root) – sweet-acrid clear herbs to raise yang, separating it from yin to stop chills. Zhi Mu (Anemarrhena), Shi Gao (Gypsum), Huang Qin (Scutellaria) – bitter-sweet-cold herbs to guide yin down, separating it from yang to stop heat. Zhu Ling (Polyporus) – bland-draining to separate yin/yang preventing interaction. Shan Zha Jia (Pangolin Scales) to guide. Gan Cao (Licorice) to harmonize. One dose stopped the malaria.
Yu Zhen reads *Linglan Yaolan* recording this formula’s frequent success in malaria, with modification methods, considered Wang Kentang’s masterpiece. Li Shicai adapted it for Cheng Wuxiu, replacing Pangolin Scales with Bai Dou Kou (Cardamom Seed), showing skillful herb substitution.
Li Shicai treated Chancellor Shen Mingzhen, who had malaria, vomiting roundworms, chest fullness, anorexia, and deep-thin-six pulses. Li said: "Malaria damaged Taiyin Spleen; middle-jiao cold agitated worms." Li Zhong Tang (Regulate the Middle Decoction) plus three W Mei (Myrobalan) and 5 fen Huang Lian (Coptis). After four doses, chest cleared, chills/heat reduced, worm vomiting stopped. Remove Huang Lian, add Huang Qi (Astragalus) 2 qian, Sheng Jiang (Fresh Ginger) 5 qian. Five doses stopped malaria.
Miu Zhongchun treated Wang Xingfu from Liangxi. After eating beef, he felt uncomfortable, then developed malaria. Appetite decreased until swallowing food was impossible. Even water failed; white water turned green bile upon vomiting. Medications rejected. Urine scanty red-brown; stool blocked. Physicians helpless. Miu examined him supine, pressing right below the heart, causing pain. Inquiry confirmed cause. Fan Hong (Alum and Cinnabar) mixed with Ping Wei San (Peaceful Stomach Powder) as powder, pillized with date flesh, taken with white water 3 qian. Vomiting stopped at throat, water passage opened. Next day, black iron-like stools passed; disease vanished. Follow-up: Ren Shen (Ginseng), Mai Dong (Ophiopogon) 5 qian each, Ju Hong (Tangerine Red), Bai Shao (White Peony) 3 qian each. Decocted. Recovery on fourth day.
Yu Zhen’s commentary: Li Zhong Tang with Plum/Coptis treats worm vomiting; Alum-Cinnabar with Ping Wei San treats beef stagnation. Not miraculous methods, but distinct from other cases, hence recorded.
Monk Shen Rou treated a guest from Huai’an, thirties. Late summer Dan Malaria (heat-only), bi-daily afternoon attacks, restlessness, delirium, resolving at dawn. Days later, sudden abdominal pain, day/night continuous, unable to drink, screaming, fainting with attacks. Doctors failed. Shen Rou diagnosed wiry-thin-soggy pulse: wiry-thin indicates deficiency-summerheat; soggy indicates dampness. Summerheat formed malaria; damp-heat sank inward causing pain. Jiu Chao Bai Shao (Wine-fried White Peony) 1 liang, Zhi Gan Cao (Honey-fried Licorice) 1.5 qian, decocted, mixed with Tian Shui San (Sky Water Powder) 5 qian. Abdominal pain vanished. Next day, malaria ceased.
Yu Zhen’s commentary: Similar to Miu Zhongchun’s use of Moutan juice boiled with Shi Gao (Gypsum), but slightly inferior. Severe pain and fainting suggest complex patterns.
Guozai treated Zhang Xike. May exposure to rain/cold led to tri-malaria (every third day). Evening attacks, severe night heat. Mid-autumn, six pulses were deficiency-rapid. Yin deficiency with summerheat in yin level, hardest to treat. First raise yang: Sheng Di (Rehmannia), Dang Gui (Angelica), Chuan Xiong (Szechwan Lovage), Bai Shao (White Peony), Zhi Gan Cao (Licorice), Zhi Mu (Anemarrhena), Gan Jiang (Dried Ginger), Gan Ge (Dried Kudzu), Sheng Ma (Cimicifuga), Chai Hu (Bupleurum), Ginger, Jujube. Four doses, then add Shou Wu (Polygonum) and Ren Shen (Ginseng). Pill formula: Shou Wu 4 liang, Sheng Di 3 liang, Shen, Zhu, Dang Gui, Gui Ban (Tortoise Shell), Zhu Ling (Polyporus), Zhi Mu, Huang Qin, Shan Zha each 2 liang, Chai Hu 1.6 liang, Niu Xi (Achyranthes) 1.5 liang, Gan Jiang, Shan Zha Jia (Pangolin) each 1 liang, Gan Cao 5 qian, live soft-shelled turtle. Cook turtle meat with Sha Ren (Amomum) powder, mix with herbs, dry. Bones powdered, added. Pillized with Lotus Leaf decoction. Full course cured.
Also treated Gao Wenfu’s tri-malaria (>3 months). Shou Wu, Sheng Di, Dang Gui, Bai Zhu, Zhi Mu, Qing Pi, Zhi Ke, Sheng Ma, Chai Hu, processed Pangolin, Ginger/Jujube. Passed malaria cycles three times. Second cycle: Sheng Di 1 liang, Old Ginger 1 liang. Third: Dang Gui 1 liang, Ginger Skin 1 liang. Fourth: Bai Zhu 1 liang, Ginger Skin 1 liang. Add seven Peach Leaves per dose. After three cycles, dried lotus leaf powder taken with San Bai Jiu (Three Whites Wine) 5 qian. Three more cycles, malaria subsided. Joint/lower back soreness, weakness, abdominal heat remained. Si Wu Tang (Four Substances) plus Shou Wu, Gou Qi (Goji), Yu Rou (Cornus), Du Zhong (Eucommia), Niu Xi, Bai Zhu, Gan Cao, Hu Gu (Tiger Bone - note: protected species, historically used), Mai Dong, Wu Wei Zi (Schisandra), Bei Mu (Fritillaria), Ju Hong. Live turtle meat mixed, dried. Turtle shell/bone powdered, added. Chang Shan (Dichroa) steamed in wine, decocted thick, cooked with dates for pills. Taken with Ginger tea 3-4 qian.
Yu Zhen’s commentary: Guozai was Wang Jintan’s senior disciple, mentioned in *Zhunsheng* preface. Heard in childhood as miraculous healer. Authored *Yilin Guangjian* and miscellaneous disease books, unpublished, highly valued. Case volumes show clever but risky prescriptions. Selected few to preserve local medical literature.
Yu Jiayan treated Yuan Jiming, who had chronic sexual depletion. Minor external contraction led to self-administered Ginger-Scallion sweat-inducing decoction, causing three days fever, transforming into malaria. Yu diagnosed hollow-large-empty pulse, indistinct chills/heat, shortness of breath, scattered spirit, indicating yuan-yang collapse. Warned father: "Tomorrow’s malaria may cause uncontrollable sweating, untreatable. Tonight, take 2 liang Ren Shen (Ginseng) in strong decoction as precaution." Father ignored. Next day, pre-dawn, patient confused. Ginseng arrived as malaria started. Yu hesitated, fearing ginseng trapping pathogen. Waited for fever to subside before administration. Patient was already drenched in sweat. Soon, massive sweating, coma, foaming mouth, inability to swallow. By dusk, foam exited anus. Yu rejoiced: "Foam descending is safe. But internal deficiency and loose bowels require more than single herb. Urgently administer Fu Zi Li Zhong Tang (Aconite Regulate Middle Decoction), four small doses." Consciousness returned, speech resumed but unclear. Visitor arrival anticipated by patient. Family feared spirits. Yu explained: "Soul has departed. Single Ginseng and Fu Zi Li Zhong Tang pursued soul, still in transition, hence knowing outside events. Two more doses restored stability."