五十五、湿温久羁，三焦弥漫，神昏窍阻，少腹硬满，大便不下，宣清导浊汤主之。
此湿久郁结于下焦气分，闭塞不通之象，故用能升、能降、苦泄滞、淡渗湿之猪苓，合甘少淡多之
茯苓，以渗湿利气；寒水石色白性寒，由肺直达肛门，宣湿清热，盖膀胱主气化，肺开气化之源，肺藏
魄，肛门曰魄门，肺与大肠相表里之义也；晚蚕砂化浊中清气，大凡肉体未有死而不腐者，蚕则僵
而不腐，得清气之纯粹者也，故其粪不臭不变色，得蚕之纯清，虽走浊道而清气独全，既能下走少腹
之浊部，又能化浊湿而使之归清，以己之正，正人之不正也，用晚者，本年再生之蚕，取其生化最速
也，皂荚辛咸性燥，入肺与大肠，金能退暑，燥能除湿，辛能通上下关窍，子更直达下焦，通大便之虚
闭，合之前药，俾郁结之湿邪，由大便而一齐解散矣。二苓、寒石，化无形之气；蚕砂、皂子，逐有形之湿也。
宣清导浊汤（苦辛淡法）
猪苓（五钱） 茯苓（六钱） 寒水石（六钱） 晚蚕砂（四钱） 皂荚子（去皮，三钱）
水五杯，煮成两杯，分二次服，以大便通快为度。
五十六、湿凝气阻，三焦俱闭，二便不通，半硫丸主之。
热伤气，湿亦伤气者何？热伤气者，肺主气而属金，火克金则肺所主之气伤矣。湿伤气者，肺主
天气，脾主地气，俱属太阴湿土，湿气太过，反伤本脏化气，湿久浊凝，至于下焦，气不惟伤而且阻矣。
气为湿阻，故二便不通，今人之通大便，悉用大黄，不知大黄性寒，主热结有形之燥粪；若湿阻无形之
气，气既伤而且阻，非温补真阳不可。硫黄热而不燥，能疏利大肠，半夏能入阴，燥胜湿，辛下气，温
开郁，三焦通而二便利矣。按上条之便闭，偏于湿重，故以行湿为主；此条之便闭，偏于气虚，故以补
气为主。盖肾司二便，肾中真阳为湿所困，久而弥虚，失其本然之职，故助之以硫黄，肝主疏泄，风湿
相为胜负，风胜则湿行，湿凝则风息，而失其疏泄之能，故通之以半夏。若湿尽热结，实有燥粪不
下，则又不能不用大黄矣。学人详审其证可也。
半硫丸（酸辛温法）
石硫黄（硫黄有三种∶土黄，水黄，石黄也。入药必须用产于石者。土黄土纹，水黄直丝，色皆滞
暗而臭；惟石硫黄方棱石纹而有宝光不臭，仙家谓之黄矾，其形大势如矾。按硫黄感日之精，聚土之
液，相结而成。生于艮土者佳，艮土者，少土也，其色晶莹，其气清而毒小。生于坤土者恶，坤土者，老
土也，秽浊之所归也，其色板滞，其气浊而毒重，不堪入药，只可作火药用。石黄产于外洋，来自舶
上，所谓倭黄是也。入莱菔内煮六时则毒去） 半夏（制）
上二味，各等分为细末，蒸饼为丸梧子大，每服一、二钱，白开水送下（按半硫丸通虚闭，若久久
便溏，服半硫丸亦能成条，皆其补肾燥湿之功也）。
五十七、浊湿久留，下注于肛，气闭肛门坠痛，胃不喜食，舌苔腐白，术附汤主之。
此浊湿久留肠胃，至肾阳亦困，而肛门坠痛也。肛门之脉曰尻，肾虚则痛，气结亦痛。但气结
之痛有二∶寒湿、热湿也。热湿气实之坠痛，如滞下门中用黄连、槟榔之证是也。此则气虚而为寒
湿所闭，故以参、附峻补肾中元阳之气，姜、术补脾中健运之气，朴、桔行浊湿之滞气，俾虚者充，闭者
通，浊者行，而坠痛自止，胃开进食矣。按肛痛有得之大恐或房劳者，治以参、鹿之属，证属虚劳，与此
对勘，故并及之。再此条应入寒湿门，以与上三条有互相发明之妙，故列于此，以便学人之触悟也。
术附汤方（苦辛温法）
生茅术（五钱） 人参（二钱） 浓朴（三钱） 生附子（三钱） 炮姜（三钱） 广皮（三钱）
水五杯，煮成两杯，先服一杯；约三时，再服一杯，以肛痛愈为度。
五十八、疟邪久羁，因疟成劳，谓之劳疟；络虚而痛，阳虚而胀，胁有疟母，邪留正伤，加味异功汤主之。
此证气血两伤，经云∶劳者温之。故以异功温补中焦之气，归、桂合异功温养下焦之血，以姜、枣
调和营卫，使气血相生而劳疟自愈。此方补气，人所易见，补血人所不知。经谓∶中焦受气，取汁变化
而赤，是谓血，凡阴阳两伤者，必于气中补血，定例也。
加味异功汤方（辛甘温阳法）
人参（三钱） 当归（一钱五分） 肉桂（一钱五分） 炙甘草（二钱） 茯苓（三钱） 于术（炒焦，三钱）
生姜（三钱） 大枣（去核，二枚） 广皮（二钱）
水五杯，煮成两杯，渣再煮一杯，分三次服。
五十九、疟久不解，胁下成块，谓之疟母，鳖甲煎丸主之。
疟邪久扰，正气必虚，清阳失转运之机，浊阴生窃踞之渐，气闭则痰凝血滞，而块势成矣。胁下
乃少阳厥阴所过之地，按少阳、厥阴为枢，疟不离乎肝胆，久扰则脏腑皆困，转枢失职，故结成积块，
居于所部之分。谓之疟母者，以其由疟而成，且无已时也。按《金匮》原文∶“病疟以一月一日发，当以
十五日愈；设不瘥，当月尽解；如其不瘥，当云何？此结为 瘕，名曰疟母，急治之，宜鳖甲煎丸。”盖
人身之气血与天地相应，故疟邪之着于人身也，其盈缩进退，亦必与天地相应。如月一日发者，发于
黑昼月廓空时，气之虚也，当俟十五日愈。五者，生数之终；十者，成数之极；生成之盈数相会，五日一
元，十五日三元一周；一气来复，白昼月廓满之时，天气实而人气复，邪气退而病当愈，设不瘥，必俟
天气再转，当于月尽解。如其不瘥，又当云何？然月自亏而满，阴已盈而阳已缩；自满而亏，阳已长
而阴已消；天地阴阳之盈缩消长已周，病尚不愈，是本身之气血，不能与天地之化机相为流转，日久
根深，牢不可破，故宜急治也。
鳖甲煎丸方
鳖甲（炙，十二分） 乌扇（烧，三分） 黄芩（三分）
柴胡（六分） 鼠妇（熬，三分） 干姜（三分） 大黄（三分） 芍药（五分） 桂枝（三分） 葶苈（熬
，一分） 石苇（去毛，三分） 浓朴（三分） 牡丹皮（五分） 瞿麦（二分） 紫葳（三分） 半夏（一
分） 人参（一分） 虫（熬，五分） 阿胶（炒，三分） 蜂窝（炙，四分） 赤硝（十二分） 蜣
螂（熬，六分） 桃仁（二分）
上二十三味，为细末。取 灶下灰一斗，清酒一斤五斗，浸灰，俟酒尽一半，煮鳖甲于中，煮令泛
烂如胶膝，绞取汁，纳诸药煎为丸，如梧子大。空心服七丸，日三服。
〔方论〕此辛苦通降，咸走络法。鳖甲煎丸者，君鳖甲而以煎成丸也，与他丸法迥异，故曰煎丸。
方以鳖甲为君者，以鳖甲守神入里，专入肝经血分，能消 瘕。领带四虫，深入脏络，飞者升，走者
降，飞者兼走络中气分，走者纯走络中血分。助以桃仁、丹皮、紫葳之破满行血，副以葶苈、石苇、瞿
麦之行气渗湿，臣以小柴胡、桂枝二汤，总去三阳经未结之邪；大承气急驱入腑已结之渣滓；佐以人
参、干姜、阿胶，护养鼓荡气血之正，俾邪无容留之地，而深入脏络之病根拔矣。按小柴胡汤中有甘
草，大承气汤中有枳实，仲景之所以去甘草，畏其太缓，凡走络药不须守法；去枳实，畏其太急而直
走肠胃，亦非络药所宜也。
六十、太阴三疟，腹胀不渴，呕水，温脾汤主之。
三疟本系深入脏真之痼疾，往往经年不愈，现脾胃症，犹属稍轻。腹胀不渴，脾寒也，故以草果
温太阴独胜之寒，辅以浓朴消胀。呕水者，胃寒也。故以生姜降逆，辅以茯苓渗湿而养正。蜀漆
乃常山苗，其性急走疟邪，导以桂枝，外达太阳也。
温脾汤方（苦辛温里法）
草果（二钱） 桂枝（三钱） 生姜（五钱） 茯苓（五钱） 蜀漆（炒，三钱） 浓朴（三钱）
水五杯，煮取两杯，分二次温服。
六十一、少阴三疟，久而不愈，形寒嗜卧，舌淡脉微，发时不渴，气血两虚，扶阳汤主之。
《疟论》篇∶黄帝问曰∶时有间二日，或至数日发，或渴或不渴，其故何也？岐伯曰∶其间日者，邪
气客于六腑，而有时与卫气相失，不能相得，故休数日乃作也。疟者，阴阳更胜也。或甚或不甚，故
或渴或不渴。《刺疟篇》曰∶足少阴之疟，令人呕吐甚，多寒热，热多寒少，欲闭户牖而处，其病难
已。夫少阴疟，邪入至深，本难速已；三疟又系积重难反，与卫气相失之证，久不愈，其常也。既已久不
愈矣，气也血也，有不随时日耗散也哉！形寒嗜卧，
少阴本证，舌淡脉微不渴，阳微之象。故以鹿茸为君，峻补督脉，一者八脉丽于肝肾，少阴虚，则八脉
亦虚；一者督脉总督诸阳，为卫气之根本。人参、附子、桂枝，随鹿茸而峻补太阳，以实卫气；当归随鹿
茸以补血中之气，通阴中之阳；单以蜀漆一味，急提难出之疟邪，随诸阳药努力奋争，由卫而出。阴
脏阴证，故汤以扶阳为名。
扶阳汤（辛甘温阳法）
鹿茸（生锉末，先用黄酒煎得，五钱） 熟附子（三钱） 人参（二钱） 粗桂枝（三钱） 当归
（二钱） 蜀漆（炒黑，三钱）
水八杯，加入鹿茸酒，煎成三小杯，日三服。
六十二、厥阴三疟，日久不已，劳则发热，或有痞结，气逆欲呕，减味乌梅丸法主之。
凡厥阴病甚，未有不犯阳明者。邪不深不成三疟，三疟本有难已之势，既久不已，阴阳两伤。
劳则内发热者，阴气伤也；痞结者，阴邪也；气逆欲呕者，厥阴犯阳明，而阳明之阳将惫也。故以乌梅
丸法之刚柔并用，柔以救阴，而顺厥阴刚脏之体，刚以救阳，而充阳明阳腑之体也。
减味乌梅丸法（酸苦为阴，辛甘为阳复法）
（以下方中多无分量，以分量本难预定，用者临时斟酌可也）
半夏 黄连 干姜 吴萸 茯苓 桂枝 白芍 川椒（炒黑） 乌梅
按疟痢两门，日久不治，暑湿之邪，与下焦气血混处者∶或偏阴、偏阳、偏刚、偏柔；或宜补、宜
泻，宜通、宜涩；或从太阴、或从少阴、或从厥阴、或护阳明，其证至杂至多，不及备载。本论原为温暑
而设，附录数条于湿温门中者，以见疟痢之原起于暑湿，俾学人识得原头，使杂症有所统属，粗具规
模而已。欲求美备，勤绎各家。
六十三、酒客久痢，饮食不减，茵陈白芷汤主之。
久痢无他证，而且能饮食如故，知其病之未伤脏真胃土，而在肠中也；痢久不止者，酒客湿热下
注，故以风药之辛，佐以苦味入肠，芳香凉淡也。盖辛能胜湿而升脾阳，苦能渗湿清热，芳香悦脾而燥
湿，凉能清热，淡能渗湿也，俾湿热去而脾阳升，痢自止矣。
茵陈白芷汤方（苦辛淡法）
绵茵陈 白芷 北秦皮 茯苓皮 黄柏 藿香
六十四、老年久痢，脾阳受伤，食滑便溏，肾阳亦衰，双补汤主之。
老年下虚久痢，伤脾而及肾，食滑便溏，亦系脾肾两伤。无腹痛、肛坠、气胀等证，邪少虚多矣。
故以人参、山药、茯苓、莲子、芡实甘温而淡者补脾渗湿，再莲子、芡实水中之谷，补土而不克水者也；
以补骨、苁蓉、巴戟、菟丝、覆盆、萸肉、五味酸甘微辛者，升补肾脏阴中之阳，而兼能益精气安五脏者
也。此条与上条当对看。上条以酒客久痢，脏真未伤而湿热尚重，故虽日久仍以清热渗湿为主；此
条以老年久痢，湿热无多而脏真已歉，故虽滞下不净，一以补脏固正，立法于此，亦可以悟治病之必
先识证也。
双补汤方（复方也，法见注中）
人参 山药 茯苓 莲子 芡实 补骨脂 苁蓉 萸肉 五味子 巴戟天 菟丝子 覆盆子
六十五、久痢小便不通，厌食欲呕，加减理阴煎主之。
此由阳而伤及阴也。小便不通，阴液涸矣；厌
食欲呕，脾胃两阳败矣。故以熟地、白芍、五味收三阴之阴，附子通肾阳，炮姜理脾阳，茯苓理胃阳
也。按原方通守兼施，刚柔互用，而名理阴煎者，意在偏护阴也。熟地守下焦血分，甘草守中焦气
分，当归通下焦血分，炮姜通中焦气分，盖气能统血，由气分之通，及血分之守，此其所以为理也。
此方去甘草、当归，加白芍、五味、附子、茯苓者，为其厌食欲呕也。若久痢阳不见伤，无食少欲呕之
象，但阴伤甚者，又可以去刚增柔矣。用成方总以活泼流动，对症审药为要。
加减理阴煎方（辛淡为阳酸甘化阴复法。凡复法，皆久病未可以一法了事者）
熟地 白芍 附子 五味 炮姜 茯苓
六十六、久痢带瘀血，肛中气坠，腹中不痛，断下渗湿汤主之。
此涩血分之法也。腹不痛，无积滞可知，无积滞，故用涩也。然腹中虽无积滞，而肛门下坠，痢
带瘀血，是气分之湿热久而入于血分，故重用樗根皮之苦燥湿、寒胜热。涩以断下，专入血分而涩血
为君；地榆得先春之气，木火之精，去瘀生新；茅术、黄柏、赤苓、猪苓开膀胱，使气分之湿热，由前
阴而去，不致遗留于血分也，楂肉亦为化瘀而设，
银花为败毒而然。
断下渗湿汤方（苦辛淡法）
樗根皮（炒黑，一两） 生茅术（一钱） 生黄柏（一钱） 地榆（炒黑，一钱五分） 楂肉（炒黑
五十五、湿温病迁延日久，湿热弥漫三焦，蒙蔽心窍导致神志昏迷，阻滞气机，少腹部坚硬胀满，大便不通，用宣清导浊汤主治。
这是湿气久郁结在下焦气分，闭塞不通的表现，所以使用既能升提又能降泄、苦味能泻滞、淡味能渗湿的猪苓，配合甘味少而淡味多的茯苓，来渗利湿气、通调气机；寒水石色白性寒，从肺经直达肛门，宣散湿气、清除热邪，因为膀胱主管气化，肺是气化的源头，肺藏魄，肛门称为“魄门”，这体现了肺与大肠相表里的道理；晚蚕砂能在化浊的同时保留清气，大凡肉体没有死后不腐烂的，但蚕僵死后却不腐烂，是因为它得到了纯粹的清阳之气，所以它的粪便不臭且不变色，保留了蚕的纯清之性，虽然作用于浊道，但清气独存，既能下行至少腹的浊部，又能化解浊湿使其回归清纯，用自己的正气纠正人体的不正之气，选用晚蚕砂是因为它是当年第二次再生的蚕所产，取其生化速度最快的特性；皂荚辛咸性燥，入肺经和大肠经，金能退暑，燥能除湿，辛能通达上下关窍，种子更能直达下焦，通治大便虚闭，与前药合用，使郁结的湿邪通过大便一齐解散。茯苓和猪苓，化解无形的气滞；蚕砂和皂子，驱逐有形的湿邪。
宣清导浊汤（苦辛淡法）
猪苓（五钱） 茯苓（六钱） 寒水石（六钱） 晚蚕砂（四钱） 皂荚子（去皮，三钱）
用水五杯，煮取两杯，分两次服用，以大便通畅为度。
五十六、湿气凝滞导致气机受阻，三焦全部闭塞，大小便都不通，用半硫丸主治。
热邪伤气，湿气也伤气，为什么呢？热邪伤气，是因为肺主气属金，火克金则肺所主之气受伤。湿气伤气，是因为肺主天气，脾主地气，都属太阴湿土，湿气太过，反而损伤本脏的化气功能，湿气久留化为浊凝，至于下焦，气不仅受伤而且阻滞。气被湿邪阻滞，所以大小便不通。现在的人治疗便秘，都用大黄，不知道大黄性寒，主治热结形成的有形燥屎；如果是湿气阻滞无形之气，气既受伤又阻滞，非温补真阳不可。硫黄热而不燥，能疏利大肠；半夏能入阴分，燥胜湿，辛能下气，温能开郁，三焦通畅而二便利。按上一条的便秘，偏于湿重，所以以行湿为主；这一条的便秘，偏于气虚，所以以补气为主。肾主管二便，肾中的真阳被湿邪困阻，时间久了更加虚弱，失去了本来的职能，所以用硫黄来助阳；肝主疏泄，风湿相互胜负，风胜则湿行，湿凝则风息，从而失去疏泄的功能，所以用半夏来通利。如果湿气尽去而热结，确实有燥屎不下，那就又不能不用大黄了。学习者要详细审察证候。
半硫丸（酸辛温法）
石硫黄（硫黄有三种：土黄、水黄、石黄。入药必须用产于石头的。土黄土纹，水黄直丝，颜色都滞暗且有臭味；只有石硫黄呈方棱石纹且有宝光不臭，道家称之为黄矾，其形状大势像矾。按硫黄感应日之精华，聚集土之液汁，结合而成。生于艮土者佳，艮土即少土，其色晶莹，其气清而毒性小。生于坤土者恶，坤土即老土，是秽浊归聚之处，其色板滞，其气浊而毒重，不堪入药，只能作火药用。石黄产于外洋，来自船上，所谓倭黄就是。放入莱菔内煮六时辰则毒性去除） 半夏（制）
以上两味，各等分为细末，用蒸饼做成梧桐子大小的丸药，每次服一、二钱，白开水送下（按半硫丸通治虚闭，如果长期便溏，服用半硫丸也能成形，都是其补肾燥湿的功效）。
五十七、浊湿久留，向下注于肛门，气机闭塞导致肛门坠痛，胃不想进食，舌苔腐白，用术附汤主治。
这是浊湿久留肠胃，连肾阳也被困住，而出现肛门坠痛。肛门的经脉叫尻，肾虚则痛，气结也痛。但是气结引起的疼痛有两种：寒湿、热湿。热湿气实导致的坠痛，如痢疾门中用黄连、槟榔的证候就是。这里是气虚而被寒湿闭塞，所以用人参、附子峻补肾中元阳之气，干姜、白术补脾中健运之气，厚朴、桔梗行散浊湿的滞气，使虚者充实，闭者通利，浊者运行，而坠痛自然停止，胃口打开能进食了。按肛门疼痛有因大惊或房劳得病的，治疗用参、鹿茸之类，证属虚劳，与此对照参考，所以一并提及。另外这一条应归入寒湿门，因为与上三条有互相阐发的妙处，所以列在这里，以便学习者领悟。
术附汤方（苦辛温法）
生茅术（五钱） 人参（二钱） 浓朴（三钱） 生附子（三钱） 炮姜（三钱） 广皮（三钱）
用水五杯，煮取两杯，先服一杯；大约三个时辰后，再服一杯，以肛门疼痛痊愈为度。
五十八、疟邪久留，因患疟疾而成虚劳，称为劳疟；络脉空虚而痛，阳气虚而胀，胁下有疟母，邪气留恋正气受损，用加味异功汤主治。
此证气血两伤，《内经》说：“劳损要用温法。”所以用异功散温补中焦之气，当归、肉桂配合异功散温养下焦之血，用生姜、大枣调和营卫，使气血相生而劳疟自愈。这个方子补气，人们容易看见，补血人们却不知道。《内经》说：“中焦受纳水谷之气，提取汁液变化而赤，这就叫做血。”凡是阴阳两伤的，必须在补气中补血，这是定例。
加味异功汤方（辛甘温阳法）
人参（三钱） 当归（一钱五分） 肉桂（一钱五分） 炙甘草（二钱） 茯苓（三钱） 于术（炒焦，三钱）
生姜（三钱） 大枣（去核，二枚） 广皮（二钱）
用水五杯，煮取两杯，药渣再煮一杯，分三次服用。
五十九、疟疾久治不愈，胁下结成块状，称为疟母，用鳖甲煎丸主治。
疟邪长期扰乱，正气必然虚弱，清阳失去转运的机能，浊阴产生窃踞的开端，气机闭塞则痰凝血滞，肿块之势形成。胁下是少阳、厥阴经过的地方，按少阳、厥阴为枢机，疟疾不离肝胆，长期扰乱则脏腑皆困，转枢失职，所以结成积块，居于所属部位。称为疟母，是因为由疟疾而成，且无休止之时。按《金匮要略》原文：“患疟疾在初一发病，应当在十五日痊愈；假如不好，应当到月底解除；如果还不好，该怎么办？这是结为瘕积，名叫疟母，赶快治疗，宜用鳖甲煎丸。”大概人身的气血与天地相应，所以疟邪附着在人身，其盈缩进退，也必与天地相应。如初一发病，是在黑昼月廓空时，气虚的时候，应当等待十五日痊愈。五是生数的终结，十是成数的极致；生成之盈数相会，五日一元，十五日三元一周；一气来复，在白昼月廓满的时候，天气实而人气复，邪气退而病当愈，假如不好，必须等待天气再转，应当在月底解除。如果还不好，又该怎么办？然而月亮自亏而满，阴已盈而阳已缩；自满而亏，阳已长而阴已消；天地阴阳的盈缩消长已经周遍，病尚不愈，是本身的气血，不能与天地的化机相为流转，日久根深，牢不可破，所以宜赶快治疗。
鳖甲煎丸方
鳖甲（炙，十二分） 乌扇（烧，三分） 黄芩（三分）
柴胡（六分） 鼠妇（熬，三分） 干姜（三分） 大黄（三分） 芍药（五分） 桂枝（三分） 葶苈（熬，一分） 石苇（去毛，三分） 浓朴（三分） 牡丹皮（五分） 瞿麦（二分） 紫葳（三分） 半夏（一分） 人参（一分） 虫（熬，五分） 阿胶（炒，三分） 蜂窝（炙，四分） 赤硝（十二分） 蜣螂（熬，六分） 桃仁（二分）
以上二十三味，研为细末。取灶下灰一斗，清酒一斤五斗，浸泡灰，等到酒剩下一半，在其中煮鳖甲，煮到泛烂如胶膝，绞取汁液，纳入诸药煎制成丸，如梧桐子大。空腹服七丸，每日三次。
〔方论〕这是辛苦通降，咸走络脉的方法。鳖甲煎丸，以鳖甲为君药而以煎法成丸，与其他丸药方法迥然不同，所以叫煎丸。方中以鳖甲为君药，因为鳖甲守神入里，专入肝经血分，能消除瘕积。统领四种虫类药，深入脏络，飞行的升，行走的降，飞行的兼走络中气分，行走的纯走络中血分。辅助以桃仁、丹皮、紫葳的破满行血，副以葶苈、石苇、瞿麦的行气渗湿，臣以小柴胡汤、桂枝汤两方，总去三阳经未结之邪；大承气汤急驱入腑已结之渣滓；佐以人参、干姜、阿胶，护养鼓荡气血的正气，使邪气无容留之地，而深入脏络的病根拔除。按小柴胡汤中有甘草，大承气汤中有枳实，张仲景之所以去掉甘草，是怕它太缓，凡是走络的药不需要守法；去掉枳实，是怕它太急而直走肠胃，也不是走络药所适宜的。
六十、太阴三疟，腹胀不渴，呕吐清水，用温脾汤主治。
三疟本是深入脏真的痼疾，往往经年不愈，现出脾胃症状，还算稍轻。腹胀不渴，是脾寒，所以用草果温太阴独胜之寒，辅以浓朴消胀。呕吐清水，是胃寒，所以用生姜降逆，辅以茯苓渗湿而养正。蜀漆乃常山的苗，其性急走疟邪，引导以桂枝，外达太阳经。
温脾汤方（苦辛温里法）
草果（二钱） 桂枝（三钱） 生姜（五钱） 茯苓（五钱） 蜀漆（炒，三钱） 浓朴（三钱）
用水五杯，煮取两杯，分二次温服。
六十一、少阴三疟，久而不愈，身体寒冷嗜睡，舌淡脉微，发作时不渴，气血两虚，用扶阳汤主治。
《疟论》篇：黄帝问：有时隔两天发作，或者到几天发作，有的口渴有的不口渴，这是什么原因？岐伯说：那隔日发作的，是因为邪气客居在六腑，有时与卫气相失，不能相得，所以休息几天才发作。疟疾，是阴阳更替胜负。有的严重有的不严重，所以有的口渴有的不口渴。《刺疟篇》说：足少阴之疟，使人呕吐严重，多寒热，热多寒少，想关着门窗居住，这种病难愈。夫少阴疟，邪气入至深处，本来难速愈；三疟又是积重难返，与卫气相失的证候，久不愈，是常态。既然已久不愈了，气和血，有不随着时日耗散的吗！身体寒冷嗜睡，是少阴本证，舌淡脉微不渴，是阳微之象。所以用鹿茸为君药，峻补督脉，一方面八脉隶属于肝肾，少阴虚，则八脉亦虚；一方面督脉总督诸阳，是卫气的根本。人参、附子、桂枝，跟随鹿茸而峻补太阳，以充实卫气；当归跟随鹿茸以补血中之气，通阴中之阳；单用蜀漆一味，急提难出的疟邪，跟随诸阳药努力奋争，由卫气而出。阴脏阴证，所以汤剂以扶阳为名。
扶阳汤（辛甘温阳法）
鹿茸（生锉末，先用黄酒煎得，五钱） 熟附子（三钱） 人参（二钱） 粗桂枝（三钱） 当归（二钱） 蜀漆（炒黑，三钱）
用水八杯，加入鹿茸酒，煎成三小杯，每日三次服。
六十二、厥阴三疟，日久不已，劳累则发热，或有痞结，气逆欲呕，用减味乌梅丸法主治。
凡是厥阴病重，没有不侵犯阳明的。邪气不深不成三疟，三疟本来有难愈的趋势，既久不已，阴阳两伤。劳累则内发热，是阴气伤；痞结，是阴邪；气逆欲呕，是厥阴犯阳明，而阳明之阳将惫乏。所以用乌梅丸法的刚柔并用，柔以救阴，而顺厥阴刚脏之体，刚以救阳，而充阳明阳腑之体。
减味乌梅丸法（酸苦为阴，辛甘为阳复法）
（以下方中多无分量，因为分量本难预定，使用者临时斟酌即可）
半夏 黄连 干姜 吴萸 茯苓 桂枝 白芍 川椒（炒黑） 乌梅
按疟疾、痢疾两门，日久不治，暑湿之邪，与下焦气血混处的：或偏阴、偏阳、偏刚、偏柔；或宜补、宜泻，宜通、宜涩；或从太阴、或从少阴、或从厥阴、或护阳明，其证至杂至多，不及备载。本论原为温暑而设，附录数条于湿温门中，是为了说明疟痢的原起于暑湿，使学习者识得源头，使杂症有所统属，粗具规模而已。欲求美备，勤读各家医书。
六十三、酒客久痢，饮食不减，用茵陈白芷汤主治。
久痢没有其他证候，而且能饮食如故，知道病未伤脏真胃土，而在肠中；痢久不止，是酒客湿热下注，所以用风药的辛，佐以苦味入肠，芳香凉淡。盖辛能胜湿而升脾阳，苦能渗湿清热，芳香悦脾而燥湿，凉能清热，淡能渗湿，使湿热去而脾阳升，痢自止。
茵陈白芷汤方（苦辛淡法）
绵茵陈 白芷 北秦皮 茯苓皮 黄柏 藿香
六十四、老年久痢，脾阳受伤，食滑便溏，肾阳亦衰，用双补汤主治。
老年下虚久痢，伤脾而及肾，食滑便溏，也是脾肾两伤。无腹痛、肛坠、气胀等证，邪少虚多了。所以用人参、山药、茯苓、莲子、芡实甘温而淡的补脾渗湿，再莲子、芡实是水中之谷，补土而不克水的；以补骨脂、苁蓉、巴戟天、菟丝子、覆盆子、萸肉、五味子酸甘微辛的，升补肾脏阴中之阳，而兼能益精气安五脏的。这一条与上一条当对照看。上一条以酒客久痢，脏真未伤而湿热尚重，所以虽日久仍以清热渗湿为主；这一条以老年久痢，湿热无多而脏真已歉，所以虽滞下不净，一以补脏固正，立法于此，也可以悟到治病必须先识证。
双补汤方（复方也，法见注中）
人参 山药 茯苓 莲子 芡实 补骨脂 苁蓉 萸肉 五味子 巴戟天 菟丝子 覆盆子
六十五、久痢小便不通，厌食欲呕，用加减理阴煎主治。
这是由阳伤及阴。小便不通，阴液枯竭；厌食欲呕，脾胃两阳败坏。所以用熟地、白芍、五味收三阴之阴，附子通肾阳，炮姜理脾阳，茯苓理胃阳。按原方通守兼施，刚柔互用，而名理阴煎，意在偏护阴。熟地守下焦血分，甘草守中焦气分，当归通下焦血分，炮姜通中焦气分，盖气能统血，由气分之通，及血分之守，这就是所谓的理。此方去掉甘草、当归，加白芍、五味、附子、茯苓，是因为厌食欲呕。如果久痢阳不见伤，无食少欲呕之象，但阴伤甚重的，又可以去掉刚药增加柔药。用成方总以活泼流动，对症审药为要。
加减理阴煎方（辛淡为阳酸甘化阴复法。凡复法，皆久病未可以一法了事者）
熟地 白芍 附子 五味 炮姜 茯苓
六十六、久痢带瘀血，肛中气坠，腹中不痛，用断下渗湿汤主治。
这是涩血分的方法。腹不痛，无积滞可知，无积滞，所以用涩。然腹中虽无积滞，而肛门下坠，痢带瘀血，是气分的湿热久而入于血分，所以重用樗根皮的苦燥湿、寒胜热。涩以断下，专入血分而涩血为君；地榆得先春之气，木火之精，去瘀生新；茅术、黄柏、赤苓、猪苓开膀胱，使气分的湿热，由前阴而去，不致遗留于血分，山楂肉也为化瘀而设，银花为败毒而然。
断下渗湿汤方（苦辛淡法）
樗根皮（炒黑，一两） 生茅术（一钱） 生黄柏（一钱） 地榆（炒黑，一钱五分） 楂肉（炒黑
55. When damp-warmth lingers for a long time, permeating the Triple Burner (San Jiao, a system of three cavities in the torso), clouding the orifices and causing coma, with hardness and fullness in the lower abdomen and constipation, Xuan Qing Dao Zhuo Tang (Disperse Clarity and Guide Out Turbidity Decoction) is the primary treatment.
This presents as dampness stagnating and knotting in the Qi aspect of the Lower Burner, causing blockage and obstruction. Therefore, we use Zhu Ling (Polyporus), which can ascend and descend, bitter to drain stagnation, and bland to leach out dampness, combined with Fu Ling (Poria), which is slightly sweet but predominantly bland, to leach dampness and promote Qi flow. Han Shui Shi (Alumen Rubrum), being white and cold in nature, travels from the Lung channel directly to the anus, dispersing dampness and clearing heat. This is because the Bladder governs Qi transformation; the Lung is the source of Qi transformation; the Lung stores the Po (Corporeal Soul); the anus is called the "Gate of Po"; this illustrates the exterior-interior relationship between the Lung and Large Intestine. Wan Can Sha (Bombyx Batryticatus, silkworm droppings) transforms turbidity while retaining clear Qi. Generally, flesh decays after death, but the silkworm stiffens without rotting because it possesses pure Clear Yang Qi. Thus, its feces do not smell nor change color, retaining the silkworm's pure clarity. Although it acts on turbid pathways, it preserves Clear Qi entirely. It can travel downward to the turbid region of the Lower Abdomen and transform turbid dampness back into clarity, using its own rectitude to correct the body's irregularity. We use late-season Bombyx Batryticatus because it comes from the second generation of silkworms that year, taking advantage of its rapid biological transformation. Zao Jia Zi (Gleditsiae Sinensis Seed), pungent, salty, and drying, enters the Lung and Large Intestine channels. Metal can dispel summer-heat; dryness can remove dampness; pungency can open upper and lower orifices; the seed reaches the Lower Burner directly, treating deficiency-type constipation. Combined with the previous herbs, the stagnant damp pathogen is dispersed through the stool. Er Ling (Zhu Ling and Fu Ling) transform formless Qi stagnation; Can Sha and Zao Jia Zi expel formless dampness.
Xuan Qing Dao Zhuo Tang (Bitter-Pungent-Bland Method)
Zhu Ling (Polyporus) [5 qian], Fu Ling (Poria) [6 qian], Han Shui Shi (Alumen Rubrum) [6 qian], Wan Can Sha (Bombyx Batryticatus) [4 qian], Zao Jia Zi (Gleditsiae Sinensis Seed, peeled) [3 qian].
Boil five cups of water until reduced to two cups; take in two doses. Stop when bowel movement becomes smooth.
56. When dampness coagulates and obstructs Qi, closing all three Burners, resulting in both urinary and fecal retention, Ban Liu Wan (Half-Sulfur Pill) is the primary treatment.
Why does heat injure Qi, and why does dampness also injure Qi? Heat injures Qi because the Lung governs Qi and belongs to Metal; Fire overcomes Metal, thus injuring the Qi governed by the Lung. Dampness injures Qi because the Lung governs Heavenly Qi and the Spleen governs Earthly Qi; both belong to Taiyin Damp-Soil. Excessive dampness damages the transforming Qi of the Zang organs themselves. Long-standing dampness turns into turbid coagulation, reaching the Lower Burner, where Qi is not only injured but also obstructed. Because Qi is obstructed by dampness, both urine and stool are blocked. Currently, people treat constipation using Da Huang (Rhei Radix et Rhizoma), unaware that Da Huang is cold in nature and treats heat-induced, formless dry feces. If dampness obstructs formless Qi, and Qi is both injured and obstructed, one must warm and tonify True Yang. Liu Huang (Sulfur) is hot but not drying, capable of unblocking and lubricating the Large Intestine; Ban Xia (Pinelliae Rhizoma) enters Yin aspects, dries dampness with dryness, descends Qi with pungency, and opens stagnation with warmth. The Triple Burner becomes unblocked, and urination and defecation become free. Regarding the previous case of constipation, it leaned towards heavy dampness, so the focus was on moving dampness. In this case, constipation leans towards Qi deficiency, so the focus is on tonifying Qi. The Kidneys govern urination and defecation; True Yang in the Kidneys is trapped by dampness, becoming increasingly deficient over time, losing its original function; thus, Liu Huang is used to assist Yang. The Liver governs dispersion and drainage; Wind and Dampness compete for dominance. When Wind dominates, Dampness moves; when Dampness coagulates, Wind ceases, and the function of dispersion and drainage is lost; thus, Ban Xia is used to unblock. If dampness is exhausted and heat knots, forming actual dry feces that cannot pass, then Da Huang must be used again. Students should examine the syndrome carefully.
Ban Liu Wan (Acrid-Sour-Warm Method)
Shi Liu Huang (Stony Sulfur). Note: There are three types of Sulfur: Earth Sulfur, Water Sulfur, and Stone Sulfur. For medicinal use, Stone Sulfur produced from rocks must be used. Earth Sulfur has earthy patterns; Water Sulfur has straight fibers; both are dull, dark, and foul-smelling. Only Stone Sulfur has square棱 (edges) and stone patterns, possessing a precious luster and no odor. Daoists call it Huang Fan (Yellow Alum). Its shape resembles alum. Sulfur forms from condensing the essence of the Sun and the fluids of the Earth. Sulfur produced in Gen Earth (Lesser Earth) is good; Gen Earth is young soil, crystal clear in color, pure in aroma, and low in toxicity. Sulfur produced in Kun Earth (Old Earth) is bad; Kun Earth is old soil, the gathering place of filth. It is dull in color, turbid in aroma, and highly toxic, unsuitable for medicine, usable only for firecrackers. Stone Sulfur comes from foreign lands via ships, known as Wo Huang (Japanese Sulfur). Boiling it in Radish (Lai Fu Zi) for six hours removes its toxicity. Ban Xia (Pinelliae Rhizoma, processed).
Grind the above two ingredients into fine powder equally. Make pills the size of mulberry seeds using steamed dough. Take 1-2 qian each time, washed down with plain boiled water. (Note: Ban Liu Wan treats deficiency-type constipation. Even if there is chronic loose stool, taking Ban Liu Wan can firm it up, due to its kidney-tonifying and damp-drying effects.)
57. When turbid dampness lingers for a long time and flows downward to the anus, causing Qi blockage, anal prolapse pain, loss of appetite, and a rotten white tongue coating, Shu Fu Tang (Atractylodes and Aconite Decoction) is the primary treatment.
This indicates turbid dampness lingering in the intestines and stomach, trapping Kidney Yang, leading to anal heaviness and pain. The meridian of the anus is called Kao. Kidney deficiency causes pain; Qi stagnation also causes pain. However, there are two types of Qi stagnation pain: Cold-Damp and Hot-Damp. The heaviness and pain caused by excess Heat-Damp are seen in cases like those treated with Huang Lian (Coptidis Rhizoma) and Bing Lang (Arecae Semen) in the Dysentery chapter. Here, however, it is Qi deficiency closed by Cold-Damp. Therefore, Ren Shen (Ginseng Radix et Rhizoma) and Fu Zi (Aconiti Lateralis Radix Praeparata) are used to vigorously tonify the Primordial Yang of the Kidneys; Jiang (Zingiberis Rhizoma) and Zhu (Atractylodis Macrocephalae Rhizoma) tonify the transporting Qi of the Spleen; Hou Po (Magnoliae Officinalis Cortex) and Jie Geng (Platycodonis Radix) move the stagnant Qi of turbid dampness. This fills the deficient, opens the closed, moves the turbid, stops the heaviness and pain, and restores appetite. Note: Anal pain acquired from great fright or sexual exhaustion is treated with Ren Shen and Lu Rong (Cervi Cornu Pantotrichum), belonging to deficiency-wasting syndromes; compare this with the current case. This clause should belong to the Cold-Damp chapter, but is placed here to mutually illuminate the preceding three clauses, aiding student comprehension.
Shu Fu Tang Formula (Bitter-Pungent-Warm Method)
Sheng Mao Zhu (Raw Atractylodis Macrocephalae Rhizoma) [5 qian], Ren Shen (Ginseng Radix et Rhizoma) [2 qian], Nong Hou Po (Thick Magnoliae Officinalis Cortex) [3 qian], Sheng Fu Zi (Raw Aconiti Lateralis Radix Praeparata) [3 qian], Pao Jiang (Prepared Zingiberis Rhizoma) [3 qian], Guang Pi (Citri Reticulatae Pericarpium) [3 qian].
Boil five cups of water until reduced to two cups. Take one cup first; after about three shichen (hours), take the second cup. Stop when anal pain resolves.
58. When Malaria pathogen lingers for a long time, turning malaria into consumptive disease (Lao Nie), it is called Lao Nie (Consumptive Malaria). Deficient collaterals cause pain; Yang deficiency causes distension; Malaria Mother (Nue Mu) exists in the hypochondrium. Pathogen lingers, healthy Qi is injured; Jia Yi Gong Tang (Modified Yi Gong Decoction) is the primary treatment.
This syndrome involves injury to both Qi and Blood. The Classic states: "For consumption, use warmth." Therefore, Yi Gong San (Yi Gong Decoction) warms and tonifies Middle Burner Qi; Dang Gui (Angelicae Sinensis Radix) and Rou Gui (Cinnamomi Cortex) combined with Yi Gong Tang warm and nourish Lower Burner Blood; Sheng Jiang (Zingiberis Recens Rhizoma) and Da Zao (Jujubae Fructus) harmonize Ying and Wei, allowing Qi and Blood to generate each other, curing Lao Nie spontaneously. People easily see the Qi-tonifying aspect of this formula, but do not know the Blood-nourishing aspect. The Classic says: "The Middle Burner receives Qi, extracts juices, changes them to red, and this is called Blood." Whenever Yin and Yang are both injured, one must tonify Blood within Qi; this is a fixed rule.
Jia Yi Gong Tang Formula (Pungent-Sweet-Warm-Yang Method)
Ren Shen (Ginseng Radix et Rhizoma) [3 qian], Dang Gui (Angelicae Sinensis Radix) [1.5 qian], Rou Gui (Cinnamomi Cortex) [1.5 qian], Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma) [2 qian], Fu Ling (Poria) [3 qian], Yu Zhu (Atractylodis Macrocephalae Rhizoma, stir-fried scorched) [3 qian], Sheng Jiang (Zingiberis Recens Rhizoma) [3 qian], Da Zao (Jujubae Fructus, pitted) [2 pieces], Guang Pi (Citri Reticulatae Pericarpium) [2 qian].
Boil five cups of water until reduced to two cups. Boil the dregs again to get one cup. Take in three doses.
59. When Malaria persists for a long time and a mass forms under the hypochondrium, it is called Nue Mu (Malaria Mother); Bie Jia Jian Wan (Turtle Shell Decoction Pill) is the primary treatment.
Long-term disturbance by Malaria pathogen inevitably weakens Healthy Qi. The Clear Yang loses its mechanism of transport; the Turbid Yin begins to usurp position. Qi blockage leads to Phlegm stasis and Blood stagnation, forming the mass. The hypochondrium is the passage of Shaoyang and Jueyin. Shaoyang and Jueyin serve as the pivot. Malaria is inseparable from Liver and Gallbladder. Long-term disturbance exhausts the Zang-Fu organs, the pivot fails, and masses form in their respective regions. It is called Malaria Mother because it arises from Malaria and has no end. According to the original text of *Jin Gui Yao Lue*: "If Malaria starts on the first day of the month, it should heal in fifteen days; if not healed, it should resolve by the end of the month. If still not healed, what then? This forms a mass, named Malaria Mother. Treat it urgently with Bie Jia Jian Wan." Human Qi and Blood correspond to Heaven and Earth. Thus, the presence of Malaria pathogen in the body, its waxing and waning, advance and retreat, must also correspond to Heaven and Earth. If it starts on the first day, it occurs during the new moon (dark sky, empty moon outline), indicating Qi deficiency. One should wait for fifteen days for healing. Five is the end of the generating number; ten is the extreme of the completing number. When generating and completing numbers meet, every five days is one cycle; fifteen days is three cycles. When Qi returns, during the full moon (bright sky, full moon outline), Heavenly Qi is substantial and Human Qi recovers, Pathogenic Qi retreats, and the disease should heal. If not healed, one must wait for Heavenly Qi to turn again, resolving by month's end. If still not healed, what then? The moon waxes from waning; Yin is full and Yang is shrinking. From full to waning, Yang grows and Yin declines. The waxing and waning of Heaven and Earth Yin and Yang have completed a cycle. If the disease still does not heal, it means the body's Qi and Blood cannot circulate with Heaven and Earth's transformative mechanisms. The root is deep and established over time, unbreakable, so urgent treatment is required.
Bie Jia Jian Wan Formula
Bie Jia (Testudinis Carapax et Plastrum, roasted) [12 fen], Wu Shan (Iris Tectorii Rhizoma, burnt) [3 fen], Huang Qin (Scutellariae Radix) [3 fen], Chai Hu (Bupleuri Radix) [6 fen], Shu Fu (Phytolaccae Radix) [3 fen], Gan Jiang (Zingiberis Rhizoma) [3 fen], Da Huang (Rhei Radix et Rhizoma) [3 fen], Shao Yao (Paeoniae Radix Alba) [5 fen], Gui Zhi (Cinnamomi Ramulus) [3 fen], Ting Li (Lepidii Fructus, roasted) [1 fen], Shi Wei (Pyrrosiae Folium, de-haired) [3 fen], Nong Hou Po (Magnoliae Officinalis Cortex) [3 fen], Mu Dan Pi (Moutan Cortex) [5 fen], Qu Mai (Polygoni Avicularis Herba) [2 fen], Zi Wei (Campsis Radix) [3 fen], Ban Xia (Pinelliae Rhizoma) [1 fen], Ren Shen (Ginseng Radix et Rhizoma) [1 fen], Chong (Mylabris) [5 fen], E Jiao (Asini Corii Colla, fried) [3 fen], Feng Wo (Vespae Nidus, roasted) [4 fen], Chi Xiao Dou (not listed, likely Chi Xiao Dou or similar, text says Chi Xiao/Nitrum? Text says Chi Xiao (Sal Nitri)) [12 fen], Qiang Lang (Scarabaeus) [6 fen], Tao Ren (Persicae Semen) [2 fen].
Grind the above 23 ingredients into fine powder. Take one dou (unit of volume) of ash from the stove bottom, and one jin five dou of clear wine. Soak the ash in the wine. When half the wine is absorbed, boil Bie Jia in it until it dissolves like gelatin. Strain the juice, add all other medicines, and decoct into pills the size of mulberry seeds. Take seven pills on an empty stomach, three times a day.
[Formula Commentary] This uses Bitter-Pungent descending and Salty entering collaterals methods. Bie Jia Jian Wan uses Bie Jia as the Sovereign herb and is made by decoction into pills, distinct from other pill methods, hence "Decoction Pill." Bie Jia is Sovereign because it guards the Spirit, enters deeply, specifically targets Liver Blood aspect, and eliminates masses. It leads four insect drugs deep into organ collaterals. Flying insects ascend; walking insects descend. Flying ones affect Qi aspect in collaterals; walking ones affect Blood aspect in collaterals. Assisted by Tao Ren, Mu Dan Pi, Zi Wei to break fullness and move Blood. Supported by Ting Li, Shi Wei, Qu Mai to move Qi and leach dampness. Ministers are Xiao Chai Hu Tang and Gui Zhi Tang, removing pathogens in the Three Yang meridians not yet knotted. Da Cheng Qi Tang urgently drives out waste knotted in the Fu organs. Assistants are Ren Shen, Gan Jiang, E Jiao, protecting and stirring Healthy Qi, leaving no room for pathogens, extracting the root of disease deep in organ collaterals. Note: Xiao Chai Hu Tang contains Gan Cao; Da Cheng Qi Tang contains Zhi Shi. Zhang Zhongjing removed Gan Cao fearing it too slow (collateral drugs need not follow standard rules); removed Zhi Shi fearing it too fast/direct to intestines/stomach (unsuitable for collateral drugs).
60. Taiyin Triadic Malaria, abdominal distension, no thirst, vomiting water, Wen Pi Tang (Warm Spleen Decoction) is the primary treatment.
Triadic Malaria is a stubborn disease penetrating deep into the Zhen (True) Qi of the organs, often lasting years. Presenting with Spleen-Stomach symptoms is relatively mild. Abdominal distension and no thirst indicate Spleen Cold. Cao Gu (Tsao-ko Fruit) warms the unique cold of Taiyin; Nong Hou Po reduces distension. Vomiting water indicates Stomach Cold. Sheng Jiang descends rebellious Qi; Fu Ling leaches dampness and supports Healthy Qi. Shu Qi (Changshan bud/Metapolygias Myriantha) has a rapid action against Malaria pathogen; Gui Zhi guides it outward to the Taiyang channel.
Wen Pi Tang Formula (Bitter-Pungent-Warm Interior Method)
Cao Gu (Tsao-ko Fruit) [2 qian], Gui Zhi (Cinnamomi Ramulus) [3 qian], Sheng Jiang (Zingiberis Recens Rhizoma) [5 qian], Fu Ling (Poria) [5 qian], Shu Qi (Metapolygias Myriantha, fried) [3 qian], Nong Hou Po (Magnoliae Officinalis Cortex) [3 qian].
Boil five cups of water until reduced to two cups. Take in two warm doses.
61. Shaoyin Triadic Malaria, persisting for a long time without cure, aversion to cold, desire to lie down, pale tongue, faint pulse, no thirst during attacks, Qi and Blood both deficient, Fu Yang Tang (Support Yang Decoction) is the primary treatment.
In the *Malaria Theory* chapter: Yellow Emperor asked: Sometimes attacks occur every two days, or several days later; sometimes thirsty, sometimes not. Why? Qibo replied: The intermittent ones occur because the pathogen resides in the Six Fu organs, occasionally losing sync with Wei Qi, unable to interact, hence resting for days before attacking. Malaria is alternating victory/defeat of Yin and Yang. Severity varies, hence thirst varies. *Needling Malaria* chapter says: Shaoyin Malaria causes severe vomiting, many chills and fever, more heat than cold, desire to close doors/windows. Shaoyin Malaria, pathogen enters deeply, inherently hard to cure quickly; Triadic Malaria is accumulated heaviness hard to reverse, losing sync with Wei Qi. Long persistence is normal. Since it persists long, Qi and Blood must dissipate over time. Aversion to cold and desire to lie down are Shaoyin proper symptoms. Pale tongue, faint pulse, no thirst indicate Yang deficiency. Therefore, Lu Rong (Cervi Cornu Pantotrichum) is Sovereign, vigorously tonifying the Du Mai (Governing Vessel). First, Eight Extraordinary Vessels attach to Liver and Kidney; Shaoyin deficiency implies Eight Vessels deficiency. Second, Du Mai commands all Yang, the root of Wei Qi. Ren Shen, Fu Zi, Gui Zhi follow Lu Rong to vigorously tonify Taiyang, solidifying Wei Qi. Dang Gui follows Lu Rong to tonify Qi in Blood, unblocking Yang in Yin. Only Shu Qi is used alone to urgently lift the entrenched Malaria pathogen, striving with the Yang drugs to exit via Wei Qi. Yin Zang, Yin Syndrome, hence named Fu Yang (Support Yang) Tang.
Fu Yang Tang (Pungent-Sweet-Warm-Yang Method)
Lu Rong (Cervi Cornu Pantotrichum, fresh ground powder, pre-decocted in yellow wine) [5 qian], Shu Fu Zi (Prepared Aconiti Lateralis Radix) [3 qian], Ren Shen (Ginseng Radix et Rhizoma) [2 qian], Cu Gui Zhi (Coarse Cinnamomi Ramulus) [3 qian], Dang Gui (Angelicae Sinensis Radix) [2 qian], Shu Qi (Metapolygias Myriantha, fried black) [3 qian].
Boil eight cups of water, add Lu Rong wine, decoct to three small cups. Take three times a day.
62. Jueyin Triadic Malaria, persisting for a long time, fever upon exertion, possible epigastric fullness/mass, rebellious Qi with urge to vomit, Jian Wei Wu Mei Wan Fa (Reduced Wu Mei Pill Method) is the primary treatment.
Severe Jueyin diseases invariably involve Yangming. Pathogen not deep does not cause Triadic Malaria. Triadic Malaria has inherent difficulty in cure. Long persistence injures both Yin and Yang. Fever upon exertion indicates Yin injury. Fullness/mass indicates Yin pathogen. Rebellious Qi and urge to vomit indicate Jueyin invading Yangming, with Yangming Yang nearing exhaustion. Therefore, the Wu Mei Wan method uses both rigid (Yang) and soft (Yin) approaches. Soft saves Yin, accommodating Jueyin's rigid Zang nature. Rigid saves Yang, filling Yangming's Yang Fu nature.
Jian Wei Wu Mei Wan Method (Sour-Bitter for Yin, Pungent-Sweet for Yang Recovery)
(Note: Dosages omitted below as they are difficult to preset; adjust according to circumstances.)
Ban Xia (Pinelliae Rhizoma), Huang Lian (Coptidis Rhizoma), Gan Jiang (Zingiberis Rhizoma), Wu Zhu Yu (Evodiae Fructus), Fu Ling (Poria), Gui Zhi (Cinnamomi Ramulus), Bai Shao (Paeoniae Radix Alba), Chuan Jiao (Zanthoxyli Pericarpium, fried black), Wu Mei (Mume Fructus).
Regarding Malaria and Dysentery chapters: Long-term untreated, Summer-Heat-Damp pathogens mix with Lower Burner Qi and Blood. They may lean Yin, Yang, Rigid, or Soft; require Tonification, Purging, Unblocking, or Astringing; may originate from Taiyin, Shaoyin, Jueyin, or protect Yangming. Syndromes are extremely complex and numerous, not fully recorded here. This treatise was originally set for Warm-Heat and Summer-Heat. Appending these clauses to the Damp-Warmth chapter shows that Malaria and Dysentery originate from Summer-Heat-Damp, helping students identify origins and categorize miscellaneous diseases, providing a rough framework. For completeness, study various schools diligently.
63. Wine-drinker's chronic dysentery, food intake unchanged, Yin Chen Bai Zhi Tang (Artemisiae Scopariae and Angelicae Dahuricae Decoction) is the primary treatment.
Chronic dysentery without other symptoms, and normal appetite, indicates the disease has not injured the Zhen Qi or Stomach Earth, but remains in the intestines. Persistent dysentery in wine drinkers is due to Damp-Heat flowing downward. Therefore, use acrid wind herbs to raise Spleen Yang, assisted by bitter herbs entering intestines, aromatic, cool, and bland. Acrid overcomes dampness and raises Spleen Yang; bitter leaches dampness and clears heat; aromatic pleases Spleen and dries dampness; cool clears heat; bland leaches dampness. This removes Damp-Heat, raises Spleen Yang, and stops dysentery.
Yin Chen Bai Zhi Tang Formula (Bitter-Pungent-Bland Method)
Mian Yin Chen (Artemisiae Scopariae Herba), Bai Zhi (Angelicae Dahuricae Radix), Bei Qin Pi (Fraxini Cortex), Fu Ling Pi (Poria Peel), Huang Bo (Phellodendri Cortex), Huo Xiang (Agastaches Herba).
64. Elderly person's chronic dysentery, Spleen Yang injured, slippery food passage and loose stools, Kidney Yang also declining, Shuang Bu Tang (Double Tonification Decoction) is the primary treatment.
Elderly lower deficiency chronic dysentery injures Spleen and affects Kidney. Slippery food passage and loose stools indicate dual Spleen-Kidney injury. Absence of abdominal pain, anal prolapse, or Qi distension indicates less pathogen and more deficiency. Therefore, Ren Shen, Shan Yao (Dioscoreae Rhizoma), Fu Ling, Lian Zi (Nelumbinis Semen), Qian Shi (Euryales Semen), sweet-warm and bland, tonify Spleen and leach dampness. Lian Zi and Qian Shi are grains from water, tonifying Earth without overcoming Water. Bu Gu Zhi (Psoraleae Fructus), Cong Rong (Cynomorii Herba), Ba Ji Tian (Morindae Officinalis Radix), Tu Si Zi (Cuscutae Semen), Fu Pen Zi (Rubi Fructus), Yu Rou (Corni Fructus), Wu Wei Zi (Schisandrae Fructus), sour-sweet-mildly pungent, ascend and tonify Yang within Yin of Kidneys, benefiting Essence/Qi and calming Five Zang. Compare this with the previous clause. Previous: Wine drinker, Zhen Qi intact, Damp-Heat heavy, focus on clearing heat/leaching dampness despite duration. This: Elderly, little Damp-Heat, Zhen Qi depleted, focus on tonifying Zang and securing Healthy Qi despite incomplete evacuation. This teaches that treating disease requires identifying the syndrome first.
Shuang Bu Tang Formula (Compound Formula, method in notes)
Ren Shen (Ginseng Radix et Rhizoma), Shan Yao (Dioscoreae Rhizoma), Fu Ling (Poria), Lian Zi (Nelumbinis Semen), Qian Shi (Euryales Semen), Bu Gu Zhi (Psoraleae Fructus), Cong Rong (Cynomorii Herba), Yu Rou (Corni Fructus), Wu Wei Zi (Schisandrae Fructus), Ba Ji Tian (Morindae Officinalis Radix), Tu Si Zi (Cuscutae Semen), Fu Pen Zi (Rubi Fructus).
65. Chronic dysentery with no urination, aversion to eating with urge to vomit, Jia Jian Li Yin Jian (Modified Li Yin Decoction) is the primary treatment.
This is injury extending from Yang to Yin. No urination indicates Yin fluid exhaustion. Aversion to eating and urge to vomit indicate failure of Spleen and Stomach Yang. Therefore, Shu Di Huang (Rehmanniae Radix Preparata), Bai Shao (Paeoniae Radix Alba), Wu Wei Zi (Schisandrae Fructus) gather Yin of Three Yin channels. Fu Zi (Aconiti Lateralis Radix Praeparata) unblocks Kidney Yang. Pao Jiang (Prepared Zingiberis Rhizoma) regulates Spleen Yang. Fu Ling (Poria) regulates Stomach Yang. Original formula combines unblocking and guarding, rigid and soft, named Li Yin (Regulating Yin) Decoction, intending to protect Yin. Shu Di guards Lower Burner Blood aspect; Gan Cao guards Middle Burner Qi aspect; Dang Gui unblocks Lower Burner Blood aspect; Pao Jiang unblocks Middle Burner Qi aspect. Qi controls Blood; unblocking Qi leads to guarding Blood; this is "Li" (Regulation). This formula removes Gan Cao and Dang Gui, adding Bai Shao, Wu Wei Zi, Fu Zi, Fu Ling, due to aversion to eating and urge to vomit. If chronic dysentery does not injure Yang, no signs of poor appetite/vomiting, but severe Yin injury, one can remove rigid herbs and increase soft ones. Using prepared formulas requires flexibility and matching herbs to syndrome.
Jia Jian Li Yin Jian Formula (Pungent-Bland for Yang, Sour-Sweet generating Yin recovery method. Recovery methods imply long diseases cannot be cured by one method alone.)
Shu Di Huang (Rehmanniae Radix Preparata), Bai Shao (Paeoniae Radix Alba), Fu Zi (Aconiti Lateralis Radix Praeparata), Wu Wei Zi (Schisandrae Fructus), Pao Jiang (Prepared Zingiberis Rhizoma), Fu Ling (Poria).
66. Chronic dysentery with blood stasis, anal heaviness/prolapse, no abdominal pain, Duan Xia Shen Shi Tang (Stop Dysentery and Leach Dampness Decoction) is the primary treatment.
This is a method of astringing Blood aspect. No abdominal pain indicates no accumulation; no accumulation allows astringing. Although no accumulation, anal heaviness and bloody dysentery indicate Damp-Heat in Qi aspect entering Blood aspect over time. Therefore, heavily use Chu Gen Pi (Celastrae Cortex) bitter-drying dampness and cold-clearing heat. Astringing stops dysentery, specifically entering Blood aspect to astringe Blood as Sovereign. Di Yu (Sanguisorbae Radix) obtains early spring Qi, essence of Wood/Fire, removing stasis generating new. Mao Zhu (Atractylodis Rhizoma), Huang Bo (Phellodendri Cortex), Chi Ling (Red Poria), Zhu Ling (Polyporus) open Bladder, letting Damp-Heat in Qi aspect exit via anterior yin, preventing residue in Blood aspect. Zha Rou ( Hawthorn flesh) is for resolving stasis; Yin Hua (Lonicerae Japonicae Flos) is for detoxifying.
Duan Xia Shen Shi Tang Formula (Bitter-Pungent-Bland Method)
Chu Gen Pi (Celastrae Cortex, fried black) [1 liang], Sheng Mao Zhu (Raw Atractylodis Rhizoma) [1 qian], Sheng Huang Bo (Raw Phellodendri Cortex) [1 qian], Di Yu (Sanguisorbae Radix, fried black) [1.5 qian], Zha Rou (Hawthorn Flesh, fried black)