汗；上盛者一身尽热，下郁者小便为难；又有表虚里虚，热除作哕，火劫致黄。知病有不之因，故治
有不紊之法∶于是脉弦胁痛，少阳未罢，仍主以和；渴饮水浆，阳明化燥，急当泻热；湿在上，以辛散，
以风胜；湿在下，以苦泄，以淡渗；如狂蓄血，势以必攻；汗后溺白，自宜投补；酒客多蕴热，先用清
中，加之分利，后必顾其脾阳；女劳有秽浊，始以解毒，继以滑窍，终当峻补真阴；表虚者实卫，里虚者
建中；入水火劫，以及治逆变证，各立方论，以为后学津梁。至寒湿在里之治，阳明篇中，惟见一则，
不出方论，指人以寒湿中求之。盖脾本畏木而喜风燥，制水而恶寒湿。今阴黄一证，寒湿相抟，譬
如卑监之土，须暴风日之阳，纯阴之病，疗以辛热无疑，方虽不出，法已显然。奈丹溪云∶不必分五
疸，总是如 酱相似。以为得治黄之扼要，殊不知以之治阳黄，犹嫌其混，以之治阴黄，恶乎可哉！
喻嘉言于阴黄一证。竟谓仲景方论亡失，恍若无所循从。惟罗谦甫具有卓识，力辨阴阳，遵仲景寒
湿之旨，出茵陈四逆汤之治。塘于阴黄一证，究心有年，悉用罗氏法而化裁之，无不应手取效。间有
始即寒湿，从太阳寒水之化，继因其人阳气尚未十分衰败，得燥热药数帖，阳明转燥金之化而为阳证
者，即从阳黄例治之。
七十、夏秋疸病，湿热气蒸，外干时令，内蕴水谷，必以宣通气分为要。失治则为肿胀。由黄
疸而肿胀者，苦辛淡法，二金汤主之。
此揭疸病之由，与治疸之法，失治之变，又因变制方之法也。
二金汤方（苦辛淡法）
鸡内金（五钱） 海金沙（五钱） 浓朴（三钱） 大腹皮（三钱） 猪苓（三钱） 白通草（二钱）
水八杯，煮取三杯，分三次温服。
七一、诸黄胆小便短者，茵陈五苓散主之。
沈氏目南云∶此黄胆气分实证，通治之方也。胃为水谷之海，营卫之源，风入胃家气分，风湿
相蒸，是为阳黄；湿热流于膀胱，气郁不化，则小便不利，当用五苓散宣通表里之邪，茵陈开郁而
清湿热。
茵陈五苓散（五苓散方见前。五苓散系苦辛温法，今茵陈倍五苓，乃苦辛微寒法）
茵陈末（十分） 五苓散（五分）
共为细末，和匀，每服三钱，日三服。
《金匮》方不及备载，当于本书研究，独采此方者，以其为实证通治之方，备外风内湿一则也。
七二、黄胆脉沉，中痞恶心，便结溺赤，病属三焦里证，杏仁石膏汤主之。
前条两解表里，此条统治三焦，有一纵一横之义。杏仁、石膏开上焦，姜、半开中焦，枳实则由中
驱下矣，山栀通行三焦，黄柏直清下焦。凡通宣三焦之方，皆扼重上焦，以上焦为病之始入，且为气
化之先，虽统宣三焦之方，而汤则名杏仁石膏也。
杏仁石膏汤方（苦辛寒法）
杏仁（五钱） 石膏（八钱） 半夏（五钱） 山栀（三钱） 黄柏（三钱） 枳实汁（每次三茶匙，
冲） 姜汁（每次三茶匙，冲）
水八杯，煮取三杯，分三次服。
七三、素积劳倦，再感湿温，误用发表，身面俱黄，不饥溺赤，连翘赤豆饮煎送保和丸。
前第七十条，由黄而变他病，此则由他病而变黄，亦遥相对待。证系两感，故方用连翘赤豆饮以
解其外，保和丸以和其中，俾湿温、劳倦、治逆，一齐解散矣。保和丸苦温而运脾阳，行在里之湿；陈
皮、连翘由中达外，其行湿固然矣。兼治劳倦者何？经云∶劳者温之。盖人身之动作云为，皆赖阳
气为之主张，积劳伤阳。劳倦者，困劳而倦也，倦者，四肢倦怠也。脾主四肢，脾阳伤，则四肢倦而
无力也。再肺属金而主气，气者阳也；脾属土而生金，阳气虽分内外，其实特一气之转输耳。劳虽自
外而来，外阳既伤，则中阳不能独运，中阳不运，是人之赖食湿以生者，反为食湿所困，脾即困所食
湿，安能不失牝马之贞，而上承干健乎！古人善治劳者，前者有仲景，后则有东垣，均从此处得
手。奈之何后世医者，但云劳病，辄用补阴，非惑于丹溪一家之说哉！本论原为外感而设，并不及
内伤，兹特因两感而略言之。
连翘赤豆饮方（苦辛微寒法）
连翘（二钱） 山栀（一钱） 通草（一钱） 赤豆（二钱） 花粉（一钱） 香豆豉（一钱）
煎送保和丸三钱。
保和丸方（苦辛温平法）
山楂 神曲 茯苓 陈皮 匐子 连翘 半夏
七四、湿甚为热，疟邪痞结心下，舌白口渴。烦躁自利，初身痛，继则心下亦痛，泻心汤主之。
此疟邪结心下气分之方也。
泻心汤（方法见前）
七五、疮家湿疟，忌用发散，苍术白虎汤加草果主之。
《金匮》谓疮家忌汗，发汗则病痉。盖以疮者血脉间病，心主血脉，血脉必虚而热，然后成疮；既
成疮以后，疮脓又系血液所化，汗为心液，由血脉而达毛窍，再发汗以伤其心液，不痉何待！故以白
虎辛凉重剂，清阳明之热湿，由肺卫而出；加苍术、草果，温散脾中重滞之寒湿，亦由肺卫而出。阳明
阳土，清以石膏、知母之辛凉；太阴阴土，温以苍术、草果之苦温；适合其脏腑之宜，矫其一偏之性而已。
苍术白虎汤加草果方（辛凉复苦温法）
即前白虎汤内加苍术，草果。
七六、背寒，胸中痞结，疟来日晏，邪渐入阴，草果知母汤主之。
此素积烦劳，未病先虚，故伏邪不肯解散，正阳馁弱，邪热固结。是以草果温太阴独胜之寒，知
母泻阳明独胜之热，浓朴佐草果泻中焦之湿蕴，合姜、半而开痞结，花粉佐知母而生津退热；脾胃兼
病，最畏木克，乌梅、黄芩清热而和肝；疟来日晏，
邪欲入阴，其所以升之使出者，全赖草果（俗以乌梅、五味等酸敛，是知其一，莫知其他也。酸味秉
厥之气，居五味之首，与辛味合用，开发阳气最速，观小青龙汤自知）。
草果知母汤方（苦辛寒兼酸法）
草果（一钱五分） 知母（二钱） 半夏（三钱） 浓朴（二钱） 黄芩（一钱五分） 乌梅（一钱五分）
花粉（一钱五分） 姜汁（五匙，冲）
水五杯，煮取二杯，分二次温服。
按此方即吴又可之达原饮去槟榔，加半夏、乌梅、姜汁。治中焦热结阳陷之证，最为合拍；吴氏
乃以治不兼湿邪之温疫初起，其谬甚矣。
再按前贤制方，与集书者选方，不过示学人知法度，为学人立模范而已，未能预测后来之病证，
其变幻若何？其兼证若何？其年岁又若何？所谓大匠诲人，能与人规矩，不能使人巧；至于奇巧绝伦
之处，不能传，亦不可传，可遇而不可求，可暂而不可常者也。学人当心领神会，先务识其所以然之
故，而后增减古方之药品分量，宜重宜轻，宜多宜寡，自有准的，所谓神而明之，存乎其人！
七七、疟伤胃阳，气逆不降，热劫胃液，不饥不饱，不食不便，渴不欲饮，味变酸浊，加减人参泻心汤主之。
此虽阳气受伤，阴汁被劫，恰偏于阳伤为多。故救阳立胃基之药四，存阴泻邪热之药二，喻氏所
谓变胃而不受胃变之法也。
加减人参泻心汤（苦辛温复咸寒法）
人参（二钱） 黄连（一钱五分） 枳实（一钱） 干姜（一钱五分） 生姜（二钱） 牡蛎（二钱）
水五杯，煮取二杯，分二次温服。
按大辛大温，与大苦大寒合方，乃厥阴经之定例。盖别脏之与腑，皆分而为二，或上下，或左右，
不过经络贯通，臆膜相连耳，惟肝之与胆，合而为一，胆即居于肝之内，肝动则胆亦动，胆动而肝即
随。肝宜温，胆宜凉，仲景乌梅丸、泻心汤，立万世法程矣；于小柴胡，先露其端。此证疟邪扰胃，致
命胃气上逆，而亦用此辛温寒苦合法者何？盖胃之为腑，体阳而用阴，本系下降，无上升之理；其呕吐
哕痞，有时上逆，升者胃气，所以使胃气上升者，非胃气也，肝与胆也，故古人以呕为肝病，今人则以为胃病已耳。
七八、疟伤胃阴，不饥不饱，不便，潮热，得食则烦热愈加，津液不复者，麦冬麻仁汤主之。
暑湿伤气，疟邪伤阴，故见证如是。此条与上条不饥不饱不便相同。上条以气逆味酸不食辨阳
伤，此条以潮热得食则烦热愈加定阴伤也。阴伤既定，复胃阴者莫若甘寒，复酸味者，酸甘化阴也。
两条胃病，皆有不便者何？九窍不和，皆属胃病也。
麦冬麻仁汤方（酸甘化阴法）
麦冬（连心，五钱） 火麻仁（四钱） 生白芍（四钱） 何首乌（三钱） 乌梅肉（二钱） 知母（二钱）
水八杯，煮取三杯，分三次温服。
七九、太阴脾疟，寒起四末，不渴多呕，热聚心胸，黄连白芍汤主之，烦躁甚者，可另服牛黄丸一丸。
脾主四肢，寒起四末而不渴，故知其为脾疟也。热聚心胸而多呕，中土病而肝木来乘，故方以
两和肝胃为主。此偏于热甚，故清热之品重，而以芍药收脾阴也。
黄连白芍汤方（苦辛寒法）
黄连（二钱） 黄芩（二钱） 半夏（三钱） 枳实（一钱五分） 白芍（三钱） 姜汁（五匙，冲）
水八杯，煮取三杯，分三次，温服。
八十、太阴脾疟，脉濡寒热，疟来日迟。腹微满，四肢不暖，露姜饮主之。
此偏于太阴虚寒，故以甘温补正。其退邪之妙，全在用露，清肃能清邪热，甘润不伤正阴，又得
气化之妙谛。
露姜饮方（甘温复甘凉法）
人参（一钱） 生姜（一钱）
水两杯半，煮成一杯，露一宿，重汤温服。
八一、太阴脾疟，脉弦而缓，寒战，甚则呕吐噫气，腹鸣溏泄，苦辛寒法，不中与也；苦辛温法，加味露姜饮主
之。
上条纯是太阴虚寒，此条邪气更甚，脉兼弦则土中有木矣，故加温燥泄木退邪。
加味露姜饮方（苦辛温法）
人参（一钱） 半夏（二钱） 草果（一钱） 生姜（二钱） 广皮（一钱） 青皮（醋炒，一钱）
水二杯半，煮成一杯，滴荷叶露三匙，温服，渣
再煮一杯服。
八二、中焦疟，寒热久不止，气虚留邪，补中益气汤主之。
留邪以气虚之故，自以升阳益气立法。
补中益气汤方
炙黄 （一钱五分） 人参（一钱） 炙甘草（一钱） 白术（炒，一钱） 广皮（五分） 当归（五
分） 升麻（炙，三分） 柴胡（炙，三分） 生姜（三片） 大枣（去核，二枚）
水五杯，煮取二杯，渣再煮一杯，分温三服。
八三、脉左弦，暮热早凉，汗解渴饮，少阳疟偏于热重者，青蒿鳖甲汤主之。
少阳切近三阴，立法以一面领邪外出，一面防邪内入为要领。小柴胡汤以柴胡领邪，以人参、大
枣、甘草护正；以柴胡清表热，以黄芩、甘草苦甘清里热∶半夏、生姜两和肝胃，蠲内饮，宣胃阳，降胃
阴，疏肝，用生姜大枣调和营卫。使表者不争，里者内安，清者清，补者补，升者升，降者降，平者平，
故曰和也。青蒿鳖甲汤，用小柴胡法而小变之，却不用小柴胡之药者，小柴胡原为伤寒立方，疟缘于
暑湿，其受邪之源，本自不同，故必变通其药味，以同在少阳一经，故不能离其法。青蒿鳖甲汤以青
蒿领邪，青蒿较柴胡力软，且芳香逐秽，开络之功，则较柴胡有独胜。寒邪伤阳，柴胡汤中之人参、甘
草、生姜，皆护阳者也；暑热伤阴，故改用鳖甲护阴，鳖甲乃蠕动之物，且能入阴络搜邪。柴胡汤以
胁痛、干呕为饮邪所致，故以姜、半通阳降阴而清饮邪；青蒿鳖甲汤以邪热伤阴，则用知母、花粉以
清热邪而止渴，丹皮清少阳血分，桑叶清少阳络中气分。宗古法而变古方者，以邪之偏寒偏热不同
也，此叶氏之读古书，善用古方，岂他人之死于句下者，所可同日语哉！
八四、少阳疟如伤寒证者，小柴胡汤主之。渴甚者去半夏，加栝蒌根；脉弦迟者，小柴胡加干姜
陈皮汤主之。
少阳疟如伤寒少阳证，乃偏于寒重而热轻，故仍从小柴胡法。若内躁渴甚，则去半夏之燥，加栝蒌
根生津止渴。脉弦迟则寒更重矣，金匮谓脉弦迟者，当温之，故于小柴胡汤内，加干姜、陈皮温
中，且能由中达外，使中阳得伸，逐邪外出也。
青蒿鳖甲汤方（苦辛咸寒法）
青蒿（三钱） 知母（二钱） 桑叶（二钱） 鳖甲（五钱） 丹皮（二钱） 花粉（二钱）
水五杯，煮取二杯。疟来前，分二次温服。
小柴胡汤方（苦辛甘温法）
柴胡（三钱） 黄芩（一钱五分） 半夏（二钱） 人参（一钱）
炙甘草（一钱五分） 生姜（三片） 大枣（去核，二枚）
水五杯，煮取二杯，分二次，温服。加减如伤寒论中法。渴甚者去半夏，加栝蒌根三钱。
小柴胡加干姜陈皮汤方（苦辛温法）
即于小柴胡汤内，加干姜（二钱），陈皮（二钱）。
水八杯，煮取三杯，分三次，温服。
八五、舌白脘闷，寒起四末，渴喜热饮，湿蕴之故，名曰湿疟，浓朴草果汤主之。
此热少湿多之证。舌白脘闷，皆温为之也；寒起四末，湿郁脾阳，脾主四肢，故寒起于此；渴，热
也，当喜凉饮，而反喜热饮者，湿为阴邪，弥漫于中，喜热以开之也。故方法以苦辛通降，纯用温
开，而不必苦寒也。
浓朴草果汤方（苦辛温法）
发汗后，若上部邪气盛则全身发热，下部湿邪郁滞则小便困难；又有表里俱虚者，热退后出现呃逆，或因火疗误治导致黄疸。认识到病因的复杂性，因此治疗有章法：脉弦且胁痛，说明少阳病未愈，仍用和解法；口渴饮水多，说明阳明化燥，急需泻热；湿邪在上部，用辛散法，以风药胜湿；湿邪在下部，用苦泄法，以淡渗利湿；出现如狂、蓄血症状，势必要攻下；发汗后小便清白，自然适宜投用补益剂；嗜酒之人多蕴藏内热，先用清中焦之法，加上分利湿热，之后必须顾护脾阳；女劳疸夹杂秽浊之气，开始用解毒法，接着用滑窍法，最终应当峻补真阴；表虚者实其卫气，里虚者建立中气；对于误用火疗及治疗逆变产生的变证，分别设立方论，作为后学的指引。至于寒湿在里的治疗，在《伤寒论》阳明篇中，仅见一条，没有列出方论，指示人们从寒湿角度求治。因为脾本畏木而喜风燥，制水而恶寒湿。如今阴黄一证，是寒湿相搏结，譬如卑监之土（比喻湿气过重的脾土），需要暴风烈日般的阳气来温煦，这是纯阴的病证，治疗用辛热药物无疑，虽然方子没列出来，但治法已经很明显了。无奈朱丹溪说：不必区分五种黄疸，总是像酱色一样。自以为掌握了治黄的要点，殊不知用这话治阳黄，尚且嫌其笼统，用来治阴黄，怎么可以呢！喻嘉言对于阴黄一证，竟说张仲景的方论亡失了，恍惚间无所遵循。只有罗谦甫具有卓识，极力辨析阴阳，遵从张仲景关于寒湿的宗旨，提出茵陈四逆汤的治疗。我在阴黄一证上，研究多年，完全采用罗氏的方法并加以化裁，没有不随手见效的。间或有开始时就是寒湿，从太阳寒水转化而来，后来因为病人阳气尚未十分衰败，服用几帖燥热药后，转化为阳明燥金之气而成为阳证的，就按照阳黄的例子治疗。
七十、夏秋季节发生的疸病，是湿热气蒸腾，外受时令邪气，内蕴水谷停滞，必须以宣通气分为关键。失治就会变成肿胀。由黄疸转为肿胀的，用苦辛淡法，主方二金汤。
这里揭示了疸病的成因，以及治疸的方法，失治后的变化，又因变化制定方剂的方法。
二金汤方（苦辛淡法）
鸡内金（五钱） 海金沙（五钱） 厚朴（三钱） 大腹皮（三钱） 猪苓（三钱） 白通草（二钱）
用水八杯，煮取三杯，分三次温服。
沈氏目南说：这是黄疸气分实证，通用的方剂。胃是水谷之海，营卫之源，风邪侵入胃家气分，风湿相互蒸腾，这就是阳黄；湿热流注于膀胱，气机郁滞不能化气，则小便不利，当用五苓散宣通表里之邪，茵陈开郁而清湿热。
茵陈五苓散（五苓散方见前文。五苓散属于苦辛温法，现在茵陈加倍于五苓散，乃变为苦辛微寒法）
茵陈末（十分） 五苓散（五分）
共研为细末，混合均匀，每次服三钱，每日三次。
《金匮要略》中的方子来不及全部记载，应当在本书中研究，单独选取这个方子，是因为它是实证通用的方剂，以备外风内湿一例。
七十二、黄疸脉沉，胸脘痞闷恶心，大便干结小便赤，病属三焦里证，主方杏仁石膏汤。
前条两解表里，此条统治三焦，有一纵一横的含义。杏仁、石膏开通上焦，姜、半夏开通中焦，枳实则从中焦驱邪下行，山栀通行三焦，黄柏直清下焦。凡是通宣三焦的方剂，都重视上焦，因为上焦是病邪初入的地方，且是气化的先导，虽然是统宣三焦的方剂，但汤剂名叫杏仁石膏汤。
杏仁石膏汤方（苦辛寒法）
杏仁（五钱） 石膏（八钱） 半夏（五钱） 山栀（三钱） 黄柏（三钱） 枳实汁（每次三茶匙，冲服） 姜汁（每次三茶匙，冲服）
用水八杯，煮取三杯，分三次服。
七十三、平素积劳倦，再感湿温，误用发表药，身面俱黄，不想吃东西且小便赤，用连翘赤豆饮煎汤送服保和丸。
前第七十条，是由黄疸变为其他病，此条是由其他病变为黄疸，也是遥相对待。证候属于两感（内外同病），所以方用连翘赤豆饮以解其外，保和丸以调和其中，使湿温、劳倦、治逆等邪气一齐解散。保和丸苦温而运脾阳，运行在里的湿邪；陈皮、连翘由中达外，其行湿的作用固然如此。兼治劳倦的原因是什么？经云：劳者温之。大概人身动作行为，都赖阳气来主持，积劳损伤阳气。劳倦，是指困乏而疲倦；倦，是指四肢倦怠。脾主四肢，脾阳受伤，则四肢疲倦无力。另外肺属金而主气，气就是阳；脾属土而生金，阳气虽然分内外，其实只是一气之转输罢了。劳倦虽从外而来，外阳既伤，则中阳不能独自运转，中阳不运，那么人依赖饮食湿气生存的人，反而被食湿所困，脾即被所食的湿邪困住，怎么能不失牝马之贞（指顺承天道），而上承乾健（指天道的刚健）呢！古人善于治疗劳病，前有张仲景，后有李东垣，都是从这里入手。奈何后世医者，只要说是劳病，就用补阴药，不是惑于朱丹溪一家之说吗！本论原本是为外感而设，并不涉及内伤，这里特别因为两感而略微提及。
连翘赤豆饮方（苦辛微寒法）
连翘（二钱） 山栀（一钱） 通草（一钱） 赤豆（二钱） 花粉（一钱） 香豆豉（一钱）
煎汤送服保和丸三钱。
保和丸方（苦辛温平法）
山楂 神曲 茯苓 陈皮 莱菔子 连翘 半夏
七十四、湿甚化为热，疟邪痞结于心下，舌苔白口渴。烦躁自利，起初身痛，继则心下也痛，主方泻心汤。
泻心汤（方法见前文）
《金匮要略》说疮家忌汗，发汗则会导致痉病。大概因为疮是血脉间的病，心主血脉，血脉必虚而热，然后成疮；既已成疮以后，疮脓又是血液所化，汗为心液，由血脉通达毛窍，再发汗以损伤心液，不出现痉病还等什么！所以用白虎汤辛凉重剂，清阳明之热湿，由肺卫而出；加苍术、草果，温散脾中重滞之寒湿，也由肺卫而出。阳明是阳土，用石膏、知母之辛凉清之；太阴是阴土，用苍术、草果之苦温温之；适合其脏腑的宜性，纠正其一偏之性而已。
苍术白虎汤加草果方（辛凉复苦温法）
即前白虎汤内加苍术、草果。
七十六、背寒，胸中痞结，疟疾发作时间推迟，邪气渐入阴分，主方草果知母汤。
这是平素积烦劳，未病先虚，所以伏邪不肯解散，正气阳馁弱，邪热固结。因此草果温太阴独胜之寒，知母泻阳明独胜之热，厚朴佐草果泻中焦之湿蕴，合姜、半夏而开痞结，花粉佐知母而生津退热；脾胃兼病，最畏肝木克制，乌梅、黄芩清热而和肝；疟疾发作时间推迟，邪欲入阴，其所以升之使出的方法，全赖草果（世俗认为乌梅、五味子等酸敛药，是只知其一，不知其他。酸味秉受厥阴之气，居五味之首，与辛味合用，开发阳气最快，看小青龙汤就知道了）。
草果知母汤方（苦辛寒兼酸法）
草果（一钱五分） 知母（二钱） 半夏（三钱） 厚朴（二钱） 黄芩（一钱五分） 乌梅（一钱五分） 花粉（一钱五分） 姜汁（五匙，冲服）
用水五杯，煮取二杯，分二次温服。
按语：此方即吴又可的达原饮去掉槟榔，加半夏、乌梅、姜汁。治疗中焦热结阳陷之证，最为合拍；吴氏却用它来治不兼湿邪的温疫初起，这就错了。
再按：前贤制方，与集书者选方，不过是示学人知道法度，为学人树立模范而已，未能预测后来的病证，其变幻如何？其兼证如何？其年岁又如何？所谓大匠教人，能给人规矩，不能使人灵巧；至于奇巧绝伦之处，不能传，也不可传，可遇而不可求，可暂而不可常。学人应当心领神会，先务必认识其所以然的缘故，而后增减古方的药品分量，宜重宜轻，宜多宜寡，自有标准，所谓神而明之，存乎其人！
七十七、疟疾损伤胃阳，气逆不降，热劫胃液，不想吃不饱，不吃不便，渴但不想喝水，味道变酸浊，主方加减人参泻心汤。
这虽然是阳气受伤，阴汁被劫，恰好偏于阳伤较多。所以救阳立胃基的药有四味，存阴泻邪热的药有两味，这就是喻氏所说的“变胃而不受胃变”的方法。
加减人参泻心汤（苦辛温复咸寒法）
人参（二钱） 黄连（一钱五分） 枳实（一钱） 干姜（一钱五分） 生姜（二钱） 牡蛎（二钱）
用水五杯，煮取二杯，分二次温服。
按语：大辛大温，与大苦大寒合方，乃是厥阴经的定例。大概别的脏与腑，都是分而为二，或上下，或左右，不过经络贯通，膜原相连罢了，只有肝与胆，合而为一，胆居于肝之内，肝动则胆亦动，胆动而肝即随。肝宜温，胆宜凉，张仲景的乌梅丸、泻心汤，确立了万世法程；在小柴胡汤中，先露其端倪。此证疟邪扰胃，致使胃气上逆，也用此辛温寒苦合法的原因是什么？大概胃作为腑，体阳而用阴，本性是下降，没有上升的道理；其呕吐哕痞，有时上逆，使胃气上升的，不是胃气，而是肝与胆，所以古人认为呕是肝病，今人则认为是胃病罢了。
七十八、疟疾损伤胃阴，不想吃不饱，不便，潮热，进食则烦热更加厉害，津液不复的，主方麦冬麻仁汤。
暑湿伤气，疟邪伤阴，所以见证如此。此条与上一条的不饥不饱不便相同。上一条以气逆味酸不食辨别阳伤，此条以潮热得食则烦热更加厉害确定阴伤。阴伤既定，恢复胃阴莫过于甘寒，恢复酸味，是酸甘化阴。两条胃病，都有不便的情况，为什么？九窍不和，皆属胃病。
麦冬麻仁汤方（酸甘化阴法）
麦冬（连心，五钱） 火麻仁（四钱） 生白芍（四钱） 何首乌（三钱） 乌梅肉（二钱） 知母（二钱）
用水八杯，煮取三杯，分三次温服。
七十九、太阴脾疟，寒气起于四肢末端，不渴多呕，热聚心胸，主方黄连白芍汤，烦躁严重的，可另服牛黄丸一丸。
脾主四肢，寒气起于四肢末端而不渴，所以知道是脾疟。热聚心胸而多呕，中土病而肝木来乘，所以方剂以两和肝胃为主。此证偏于热甚，所以清热之品重用，而以芍药收敛脾阴。
黄连白芍汤方（苦辛寒法）
黄连（二钱） 黄芩（二钱） 半夏（三钱） 枳实（一钱五分） 白芍（三钱） 姜汁（五匙，冲服）
用水八杯，煮取三杯，分三次，温服。
八十、太阴脾疟，脉濡寒热，疟疾发作时间推迟。腹部微满，四肢不暖，主方露姜饮。
此证偏于太阴虚寒，所以用甘温补正。其退邪的妙处，全在用露，清肃能清邪热，甘润不伤正阴，又得气化的妙谛。
露姜饮方（甘温复甘凉法）
人参（一钱） 生姜（一钱）
用水两杯半，煮成一杯，露天放置一夜，隔水加热温服。
八十一、太阴脾疟，脉弦而缓，寒战，甚至呕吐噫气，腹鸣溏泄，苦辛寒法，不适用；苦辛温法，主方加味露姜饮。
上一条纯是太阴虚寒，此条邪气更甚，脉兼弦则土中有木（肝木克脾土）了，所以加温燥泄木退邪。
加味露姜饮方（苦辛温法）
人参（一钱） 半夏（二钱） 草果（一钱） 生姜（二钱） 广皮（一钱） 青皮（醋炒，一钱）
用水二杯半，煮成一杯，滴荷叶露三匙，温服，药渣再煮一杯服。
留邪是因为气虚的缘故，自然以升阳益气立法。
补中益气汤方
炙黄芪（一钱五分） 人参（一钱） 炙甘草（一钱） 白术（炒，一钱） 广皮（五分） 当归（五分） 升麻（炙，三分） 柴胡（炙，三分） 生姜（三片） 大枣（去核，二枚）
用水五杯，煮取二杯，药渣再煮一杯，分温三服。
八十三、脉左弦，暮热早凉，汗出缓解且口渴饮水，少阳疟偏于热重的，主方青蒿鳖甲汤。
少阳切近三阴，立法以一面领邪外出，一面防邪内入为要领。小柴胡汤以柴胡领邪，以人参、大枣、甘草护正；以柴胡清表热，以黄芩、甘草苦甘清里热；半夏、生姜两和肝胃，蠲除内饮，宣通胃阳，降胃阴，疏肝，用生姜大枣调和营卫。使表者不争，里者内安，清者清，补者补，升者升，降者降，平者平，所以叫“和”。青蒿鳖甲汤，用小柴胡法而稍作变化，却不用小柴胡的药物，因为小柴胡原为伤寒立方，疟疾缘于暑湿，其受邪之源，本自不同，所以必须变通其药味，以同在少阳一经，故不能离其法。青蒿鳖甲汤以青蒿领邪，青蒿较柴胡力软，且芳香逐秽，开络之功，则较柴胡有独胜。寒邪伤阳，柴胡汤中的人参、甘草、生姜，都是护阳的；暑热伤阴，故改用鳖甲护阴，鳖甲乃蠕动之物，且能入阴络搜邪。柴胡汤以胁痛、干呕为饮邪所致，故以姜、半夏通阳降阴而清饮邪；青蒿鳖甲汤以邪热伤阴，则用知母、花粉以清热邪而止渴，丹皮清少阳血分，桑叶清少阳络中气分。宗古法而变古方者，是因为邪气的偏寒偏热不同，这是叶天士读古书，善用古方，岂他人之死于句下者，所可同日而语哉！
八十四、少阳疟如同伤寒证的，主方小柴胡汤。渴甚者去半夏，加栝蒌根；脉弦迟者，主方小柴胡加干姜陈皮汤。
少阳疟如同伤寒少阳证，乃偏于寒重而热轻，所以仍从小柴胡法。若内躁渴甚，则去半夏之燥，加栝蒌根生津止渴。脉弦迟则寒更重了，《金匮要略》说脉弦迟者，当温之，所以在小柴胡汤内，加干姜、陈皮温中，且能由中达外，使中阳得伸，逐邪外出也。
青蒿鳖甲汤方（苦辛咸寒法）
青蒿（三钱） 知母（二钱） 桑叶（二钱） 鳖甲（五钱） 丹皮（二钱） 花粉（二钱）
用水五杯，煮取二杯。疟疾发作前，分二次温服。
小柴胡汤方（苦辛甘温法）
柴胡（三钱） 黄芩（一钱五分） 半夏（二钱） 人参（一钱） 炙甘草（一钱五分） 生姜（三片） 大枣（去核，二枚）
用水五杯，煮取二杯，分二次，温服。加减如《伤寒论》中法。渴甚者去半夏，加栝蒌根三钱。
小柴胡加干姜陈皮汤方（苦辛温法）
即于小柴胡汤内，加干姜（二钱），陈皮（二钱）。
用水八杯，煮取三杯，分三次，温服。
八十五、舌苔白脘闷，寒气起于四肢末端，渴喜热饮，是湿蕴的缘故，名叫湿疟，主方厚朴草果汤。
这是热少湿多的证候。舌白脘闷，都是湿为之也；寒气起于四肢末端，湿郁脾阳，脾主四肢，所以寒起于此；渴，是热象，应当喜凉饮，而反喜热饮者，湿为阴邪，弥漫于中，喜热以开之也。所以方法以苦辛通降，纯用温开，而不必苦寒也。
Sweating; if pathogenic factors are excessive in the upper part, the whole body will be hot; if dampness is stagnant in the lower part, urination will be difficult. There are also cases of deficiency in both exterior and interior, where after the fever subsides, hiccups occur, or jaundice results from erroneous fire therapy. Knowing that diseases have diverse causes, treatments follow orderly methods: thus, when the pulse is wiry and there is hypochondriac pain, indicating Shaoyang disease has not resolved, harmonization remains the primary approach; when there is thirst and excessive drinking, indicating Yangming transformation into dryness, clearing heat urgently is required; for dampness in the upper part, acrid dispersal is used, employing wind-dispelling herbs to overcome dampness; for dampness in the lower part, bitter purgation is used, along with bland diuresis; if mania-like symptoms and blood stasis occur, aggressive attack (purging) is necessary; if urine becomes clear white after sweating, tonification is appropriate; patients habitually consuming alcohol often harbor internal heat, so clearing the middle initially, combined with separating and draining damp-heat, followed by protecting Spleen Yang is essential; for female labor jaundice complicated by turbid pathogens, detoxification is started, followed by unblocking orifices, and finally vigorous tonification of True Yin is required; for exterior deficiency, strengthening Wei Qi is indicated; for interior deficiency, establishing the Middle Jiao is indicated; for errors involving fire therapy and treatment-induced complications, separate formulas are provided as guides for future students. Regarding the treatment of cold-dampness in the interior, only one case appears in the Yangming chapter of the *Shanghan Lun*, without a specific formula, instructing practitioners to seek treatment based on cold-dampness principles. The Spleen naturally fears Wood and prefers wind-dryness, controls Water but detests cold-dampness. In the current syndrome of Yin Jaundice, cold and dampness bind together, resembling earth under a low supervisory influence (metaphor for spleen overwhelmed by dampness), requiring the yang of fierce winds and bright sun to warm it. This is a pure yin pathology, undoubtedly treated with acrid-hot herbs; although no formula is listed, the method is clear. Regrettably, Zhu Danxi stated: "There is no need to distinguish among the five types of jaundice; they all resemble sauce." Believing this grasps the essence of treating jaundice, he failed to realize that applying this to Yang Jaundice is still too vague, and applying it to Yin Jaundice is absolutely unacceptable. Yu Jiayan claimed that Zhang Zhongjing's formulas for Yin Jaundice were lost, leaving no reference. Only Luo Qianfu demonstrated profound insight, vigorously distinguishing yin and yang, following Zhang Zhongjing’s principles regarding cold-dampness, and proposing Yinchen Sini Tang. I have studied Yin Jaundice for years, completely adopting Luo’s methods with modifications, achieving immediate efficacy in every case. Occasionally, cases starting as cold-dampness transforming from Taiyang Cold-Water may, if the patient's Yang Qi is not severely depleted, transform upon taking several doses of drying-hot herbs into Yangming Dry-Metal transformation, becoming a Yang syndrome; these should be treated according to Yang Jaundice examples.
Seventy: Jaundice occurring in summer and autumn is caused by steaming damp-heat, externally affected by seasonal factors, and internally accumulated food-grain stagnation. It is essential to ventilate and circulate the Qi aspect. Failure to treat properly leads to swelling. Jaundice progressing to swelling is treated with the Bitter-Acid-Bland method, primarily using Erjin Tang.
This section reveals the origin of jaundice, its treatment methods, changes due to improper treatment, and the formulation of new methods based on these changes.
Erjin Tang Formula (Bitter-Acid-Bland Method)
Jineijin (Chicken Gizzard Lining, 5 qian) Haijinssha (Lygodium Spores, 5 qian) Houpo (Magnolia Bark, 3 qian) Dafupi (Areca Peel, 3 qian) Zhuling (Polyporus, 3 qian) Baotongcao (Tetrapanax Pith, 2 qian)
Boil in eight cups of water until three cups remain. Divide into three doses, taken warm.
Seventy-One: For various types of jaundice accompanied by short urine, Yinchin Wuling San is the primary formula.
Shen Munan stated: This is a universal formula for excess syndromes of the Qi aspect in jaundice. The Stomach is the sea of water and grain, the source of Ying and Wei. When Wind enters the Qi aspect of the Stomach, Wind-Damp steams together, resulting in Yang Jaundice; when Damp-Heat flows into the Bladder, Qi stagnates and fails to transform, causing difficult urination. One should use Wuling San to vent pathogenic factors from the exterior and interior, while Yinchin opens stagnation and clears Damp-Heat.
Yinchin Wuling San (Wuling San formula seen previously. Wuling San belongs to the Bitter-Acid-Warm method; here, doubling Yinchin relative to Wuling San makes it a Bitter-Acid-Slightly-Cold method)
Yinchin powder (10 fen) Wuling San (5 fen)
Grind into fine powder, mix evenly. Take 3 qian per dose, three times daily.
The formulas in the *Jingui Yaolue* are not fully recorded here; they should be studied within this book. This formula was selected specifically because it is a universal formula for excess syndromes, serving as an example for external Wind and internal Dampness.
Seventy-Two: For jaundice with a deep pulse, epigastric fullness and nausea, constipation, and red urine, the pathology belongs to the Interior of the Three Jiao. Xingren Shigao Tang is the primary formula.
The previous clause addressed both Exterior and Interior; this clause governs the entire Three Jiao, implying a vertical and horizontal strategy. Xingren and Shigao open the Upper Jiao; Jiang (Ginger) and Banxia open the Middle Jiao; Zhishi drives pathogens downward from the Middle. Shanzhi circulates through the Three Jiao; Huangbai directly clears the Lower Jiao. In any formula that unblocks and circulates the Three Jiao, emphasis is placed on the Upper Jiao because it is the initial entry point for pathogens and the precursor of Qi transformation. Although it governs the Three Jiao, the decoction is named Xingren Shigao Tang.
Xingren Shigao Tang Formula (Bitter-Acid-Cold Method)
Xingren (Apricot Seed, 5 qian) Shigao (Gypsum, 8 qian) Banxia (Pinellia, 5 qian) Shanzhi (Gardenia, 3 qian) Huangbai (Phellodendron, 3 qian) Zhishi juice (3 tea spoons each time, mixed in) Jiangzhi (Ginger juice, 3 tea spoons each time, mixed in)
Boil in eight cups of water until three cups remain. Divide into three doses.
Seventy-Three: For those with chronic fatigue who contract Damp-Warmth and are erroneously treated with diaphoretics, resulting in yellowing of the body and face, lack of appetite, and red urine, Lianqiao Chidou Yin decocted to swallow Baohe Wan is used.
Clause Seventy described jaundice transforming into other diseases; this clause describes other diseases transforming into jaundice, forming a parallel contrast. The syndrome involves simultaneous contraction (Exterior and Interior). Thus, Lianqiao Chidou Yin is used to resolve the Exterior, and Baohe Wan is used to harmonize the Interior, allowing Damp-Warmth, fatigue, and treatment-induced complications to dissipate simultaneously. Baohe Wan is Bitter-Warm and moves Spleen Yang, circulating internal dampness; Chenpi and Lianqiao move from the center to the exterior, effectively resolving dampness. Why does it also treat fatigue? The Classics state: "For exhaustion, use Warmth." Human movement and activity rely on Yang Qi. Chronic fatigue injures Yang Qi. Fatigue refers to being trapped and weary; weariness refers to limp limbs. The Spleen governs the limbs; when Spleen Yang is injured, limbs become weary and weak. Furthermore, Lung belongs to Metal and governs Qi (Yang); Spleen belongs to Earth and generates Metal. Although Yang Qi is divided into interior and exterior, it is essentially a single Qi circulation. Although fatigue originates externally, once External Yang is injured, Middle Yang cannot function independently. If Middle Yang fails to circulate, humans relying on food and dampness for life become trapped by dietary dampness. If the Spleen is trapped by ingested dampness, how can it maintain its submissive nature and support the creative Heaven? Ancient masters skilled in treating fatigue include Zhang Zhongjing and Li Dongyuan, who both approached it from this perspective. Alas, why do later physicians, whenever mentioning fatigue disease, immediately use Yin-tonifying herbs, falling prey to Zhu Danxi’s school of thought? This treatise was originally designed for external contractions, not internal injuries; it is mentioned here briefly due to the simultaneous contraction.
Lianqiao Chidou Yin Formula (Bitter-Acid-Slightly-Cold Method)
Lianqiao (Forsythia, 2 qian) Shanzhi (Gardenia, 1 qian) Tongcao (Tetrapanax Pith, 1 qian) Chidou (Red Bean, 2 qian) Huafen (Trichosanthes Root, 1 qian) Xiangdouchi (Fermented Soybean, 1 qian)
Decoct and use to swallow 3 qian of Baohe Wan.
Baohe Wan Formula (Bitter-Acid-Warm-Neutral Method)
Shanzha (Hawthorn) Shenqu (Medicated Leaven) Fuling (Poria) Chenpi (Citrus Peel) Fuzi (Note: Text says 'Fuzi' but context implies Laofanzi/Radish seed usually in Baohe Wan, sticking to text 'Fuzi' or likely typo for Laofanzi/Lai Fuzi - Ra Dispersing Seed. Text says 'Fuzi', I will translate as written but note standard is Lai Fu Zi. Actually text says 'Fuzi' which is Aconite, highly unlikely for Baohe Wan. Standard Baohe Wan contains Shan Zha, Shen Qu, Ban Xia, Chen Pi, Fu Ling, Lian Qiao, Lai Fu Zi. The text provided says 'Fuzi'. I will translate literally as 'Fuzi' but it is likely a typo for Lai Fuzi in the source text provided by user. I will stick to the text provided: Fuzi.) Lianqiao (Forsythia) Banxia (Pinellia)
Seventy-Four: When severe dampness transforms into heat, Malaria pathogens cause epigastric fullness and binding, with a white tongue coating and thirst. Restlessness with spontaneous diarrhea, initial body pain followed by epigastric pain, is treated with Xiexin Tang.
This is a formula for Malaria pathogens binding in the Qi aspect of the epigastrium.
Xiexin Tang (Method seen previously)
Seventy-Five: For patients with skin sores suffering from Damp Malaria, diaphoretics are contraindicated. Cangzhu Baizhu Tang plus Caoguo is the primary formula.
The *Jingui Yaolue* states that patients with sores should avoid sweating; inducing sweat leads to spasms. Sores are diseases within the blood vessels; the Heart governs blood vessels. Blood vessels must be deficient and hot before sores form. After sores form, pus is derived from blood. Sweat is the fluid of the Heart, reaching hair follicles from blood vessels. Inducing sweat again damages Heart fluids; spasms are inevitable. Therefore, Baizhu Tang, a heavy Bitter-Acid-Cold agent, clears Heat-Dampness of the Yangming, releasing it via the Lung and Wei. Cangzhu and Caoguo are added to warmly disperse heavy, stagnant Cold-Dampness in the Spleen, also releasing via the Lung and Wei. Yangming is Yang Earth, cleared with the Bitter-Acid-Cold of Shigao and Zhimu; Taiyin is Yin Earth, warmed with the Bitter-Warm of Cangzhu and Caoguo. This suits the organs’ preferences and corrects their extreme natures.
Cangzhu Baizhu Tang plus Caoguo Formula (Bitter-Acid-Cold combined with Bitter-Warm Method)
Add Cangzhu and Caoguo to the previous Baizhu Tang.
Seventy-Six: Back chills, epigastric fullness and binding, delayed onset of malaria attacks, indicating pathogens gradually entering Yin. Caoguo Zhimu Tang is the primary formula.
This occurs in those with chronic mental exertion, leading to pre-existing deficiency. Thus, latent pathogens refuse to dissipate, Zheng Yang is weak, and Pathogenic Heat binds firmly. Caoguo warms the exclusive Cold of Taiyin; Zhimu drains the exclusive Heat of Yangming. Houpo assists Caoguo to drain Middle Jiao dampness accumulation. Combined with Jiang and Banxia, it opens binding. Huafen assists Zhimu to generate fluids and reduce fever. Since Spleen and Stomach are jointly diseased, they fear Wood overacting; Wumei and Huangqin clear heat and harmonize Liver. The delay in malaria attacks suggests pathogens entering Yin. The method to lift and expel them relies entirely on Caoguo (Common belief holds that sour-astringent herbs like Wumei and Wuweizi are key; this knows only half the truth. Sour flavor inherits Jueyin Qi, ranks first among flavors, and when combined with Acrid flavor, rapidly develops Yang Qi, as seen in Xiao Qinglong Tang).
Caoguo Zhimu Tang Formula (Bitter-Acid-Cold combined with Sour Method)
Caoguo (Black Cardamom, 1.5 qian) Zhimu (Anemarrhena, 2 qian) Banxia (Pinellia, 3 qian) Houpo (Magnolia Bark, 2 qian) Huangqin (Scutellaria, 1.5 qian) Wumei (Mume Fruit, 1.5 qian) Huafen (Trichosanthes Root, 1.5 qian) Jiangzhi (Ginger juice, 5 spoons, mixed in)
Boil in five cups of water until two cups remain. Divide into two warm doses.
Commentary: This formula is Wu Youke’s Da Yuan Yin minus Binglang, plus Banxia, Wumei, and Jiangzhi. It fits the syndrome of Middle Jiao heat binding with Yang sinking perfectly; Wu Youke mistakenly used it for early-stage Warm Epidemics without dampness, which is erroneous.
Further Commentary: Ancient masters formulating prescriptions and compilers selecting formulas merely demonstrate rules and set models for students; they could not predict future disease variations, accompanying syndromes, or patient ages. As the saying goes, a master craftsman teaches standards but cannot make someone clever. Extraordinary skill cannot be transmitted nor sought; it is encountered, not demanded. Students must understand the rationale, then adjust ancient formula dosages appropriately. Divine understanding depends on the individual!
Seventy-Seven: Malaria injuring Stomach Yang causes rebellious Qi failing to descend; Heat depletes Stomach fluids, resulting in neither hunger nor satiety, inability to eat or defecate, thirst without desire to drink, and sour-turbid taste. Jiaren Renshen Xiexin Tang is the primary formula.
Although both Yang Qi is injured and Yin fluids are depleted, this case leans more towards Yang injury. Thus, four herbs save Yang and establish the Stomach foundation, while two herbs preserve Yin and drain pathogenic heat. This is what Yu Jia Yan called "transforming the Stomach without being transformed by the Stomach."
Jiaren Renshen Xiexin Tang Formula (Bitter-Acid-Warm combined with Salty-Cold Method)
Renshen (Ginseng, 2 qian) Huanglian (Coptis, 1.5 qian) Zhishi (Immature Bitter Orange, 1 qian) Ganjiang (Dried Ginger, 1.5 qian) Shengjiang (Fresh Ginger, 2 qian) Muli (Oyster Shell, 2 qian)
Boil in five cups of water until two cups remain. Divide into two warm doses.
Commentary: Combining Great Acrid-Great Warm with Great Bitter-Great Cold is the fixed rule for the Jueyin Meridian. Other Zang-Fu pairs are separated, connected only by meridians and membranes. However, Liver and Gallbladder are united; Gallbladder resides within the Liver. Liver movement triggers Gallbladder movement, and vice versa. Liver prefers Warmth; Gallbladder prefers Coolness. Zhang Zhongjing’s Wumei Wan and Xiexin Tang established eternal precedents, hinted at in Xiao Chaihu Tang. In this case, Malaria pathogens disturb the Stomach, causing Qi rebellion. Why use Acrid-Warm and Bitter-Cold combination? The Stomach, as a Fu organ, has a Yang substance but Yin function, naturally descending. Vomiting and fullness involve upward rebellion driven not by Stomach Qi itself, but by Liver and Gallbladder. Hence ancients viewed vomiting as a Liver issue, while moderns view it as Stomach disease.
Seventy-Eight: Malaria injuring Stomach Yin causes neither hunger nor satiety, constipation, tidal fever, and increased irritability/heat after eating, with failure to restore fluids. Maidong Mahuang Tang is the primary formula.
Summer-Dampness injures Qi; Malaria pathogens injure Yin, resulting in these manifestations. This clause shares "neither hunger nor satiety, constipation" with the previous one. The previous clause distinguished Yang injury by rebellious Qi, sour taste, and anorexia; this clause determines Yin injury by tidal fever worsening after eating. Once Yin injury is confirmed, Sweet-Cold herbs best restore Stomach Yin; Sour herbs aid this via Sour-Sweet transforming into Yin. Both Stomach disease clauses mention constipation because dysfunction of the nine orifices belongs to the Stomach.
Maidong Mahuang Tang Formula (Sour-Sweet Transforming into Yin Method)
Maidong (Ophiopogon, heart included, 5 qian) Huomaren (Hemp Seed, 4 qian) Sheng Baishao (Raw White Peony, 4 qian) Heshouwu (Polygonum Multiflorum, 3 qian) Wumei Rou (Mume Flesh, 2 qian) Zhimu (Anemarrhena, 2 qian)
Boil in eight cups of water until three cups remain. Divide into three warm doses.
Seventy-Nine: Taiyin Spleen Malaria presents with cold starting in the extremities, no thirst, frequent vomiting, and heat gathering in the chest and heart. Huanglian Baishao Tang is the primary formula; for severe restlessness, separately take one pill of Niuhuang Wan.
The Spleen governs the limbs. Cold starting in extremities without thirst indicates Spleen Malaria. Heat gathering in the chest with frequent vomiting indicates Middle Earth disease with Liver Wood overacting. The formula primarily harmonizes Liver and Stomach. Since this case leans towards severe heat, cooling agents are heavy, and Baishao is used to collect Spleen Yin.
Huanglian Baishao Tang Formula (Bitter-Acid-Cold Method)
Huanglian (Coptis, 2 qian) Huangqin (Scutellaria, 2 qian) Banxia (Pinellia, 3 qian) Zhishi (Immature Bitter Orange, 1.5 qian) Baishao (White Peony, 3 qian) Jiangzhi (Ginger juice, 5 spoons, mixed in)
Boil in eight cups of water until three cups remain. Divide into three warm doses.
Eighty: Taiyin Spleen Malaria presents with soggy pulse, alternating chills and fever, delayed malaria onset, slight abdominal fullness, and cold limbs. Lujiang Yin is the primary formula.
This case leans towards Taiyin Deficiency-Cold, so Sweet-Warm herbs tonify Zheng Qi. The subtlety of expelling pathogens lies in the "Dew" preparation method. Clearing肃 (Qing Su) clears pathogenic heat; Sweet-Moist (Gan Run) does not injure Zheng Yin, achieving the essence of Qi transformation.
Lujiang Yin Formula (Sweet-Warm combined with Sweet-Cool Method)
Renshen (Ginseng, 1 qian) Shengjiang (Fresh Ginger, 1 qian)
Boil in two and a half cups of water until one cup remains. Leave exposed overnight (to absorb dew). Reheat gently and take warm.
Eighty-One: Taiyin Spleen Malaria presents with wiry yet slow pulse, chills, severe vomiting and belching, borborygmus, and loose stools. The Bitter-Acid-Cold method is unsuitable; the Bitter-Acid-Warm method, Jiawei Lujiang Yin, is primary.
The previous clause was purely Taiyin Deficiency-Cold; this clause has stronger pathogens. The wiry pulse indicates Wood within Earth (Liver overacting on Spleen), so warming-drying herbs to drain Wood and expel pathogens are added.
Jiawei Lujiang Yin Formula (Bitter-Acid-Warm Method)
Renshen (Ginseng, 1 qian) Banxia (Pinellia, 2 qian) Caoguo (Black Cardamom, 1 qian) Shengjiang (Fresh Ginger, 2 qian) Guangpi (Tangerine Peel, 1 qian) Qingpi (Green Tangerine Peel, vinegar-fried, 1 qian)
Boil in two and a half cups of water until one cup remains. Add three spoons of Lotus Leaf Dew. Take warm. Decoct residue again for one cup.
Eighty-Two: Middle Jiao Malaria with persistent chills and fever due to Qi deficiency retaining pathogens. Buzhong Yiqi Tang is the primary formula.
Pathogen retention due to Qi deficiency requires raising Yang and benefiting Qi.
Buzhong Yiqi Tang Formula
Zhi Huangqi (Astragalus, 1.5 qian) Renshen (Ginseng, 1 qian) Zhi Gancao (Licorice, 1 qian) Baizhu (Atractylodes, fried, 1 qian) Guangpi (Tangerine Peel, 0.5 qian) Danggui (Angelica Sinensis, 0.5 qian) Shengma (Cimicifuga, roasted, 0.3 qian) Chaihu (Bupleurum, roasted, 0.3 qian) Shengjiang (Fresh Ginger, 3 slices) Dazao (Jujube, pitted, 2 pieces)
Boil in five cups of water until two cups remain. Decoct residue for one cup. Divide into three warm doses.
Eighty-Three: Left-side wiry pulse, evening fever and morning coolness, relief with sweating and thirst requiring drinking. For Shaoyang Malaria leaning towards severe heat, Qinghao Biejia Tang is the primary formula.
Shaoyang is close to the Three Yin. The principle is to lead pathogens out from one side while preventing inward entry from the other. Xiao Chaihu Tang uses Chaihu to lead pathogens out, and Renshen, Dazao, Gancao to protect Zheng. Chaihu clears exterior heat; Huangqin and Gancao clear interior heat with Bitter-Sweet. Banxia and Shengjiang harmonize Liver and Stomach, remove internal fluid retention, promote Stomach Yang, descend Stomach Yin, and soothe Liver. Shengjiang and Dazao harmonize Ying and Wei. This ensures exterior stability, interior peace, proper clearing, tonifying, ascending, descending, and balancing—hence "Harmonizing." Qinghao Biejia Tang adopts Xiao Chaihu Tang’s method with slight modification, omitting its herbs because Xiao Chaihu Tang was formulated for Cold Damage, whereas Malaria arises from Summer-Dampness, having different etiologies. Thus, herb substitution is necessary, though the Shaoyang method remains. Qinghao leads pathogens out; it is milder than Chaihu but excels in aromatic purification and opening collaterals. Cold Damage injures Yang, so Renshen, Gancao, and Shengjiang in Chaihu Tang protect Yang; Summer-Heat injures Yin, so Biejia is used to protect Yin. Biejia is a crawling creature capable of entering Yin collaterals to search for pathogens. Chaihu Tang treats hypochondriac pain and dry retching caused by fluid retention using Jiang and Banxia to promote Yang and descend Yin; Qinghao Biejia Tang treats Yin injury by Heat using Zhimu and Huafen to clear heat and stop thirst, Danpi to clear Shaoyang Blood level, and Sangye to clear Shaoyang Collateral Qi level. Adapting ancient methods and formulas based on pathogenic bias (Cold vs. Heat) demonstrates Ye Tianshi’s mastery of classics, unlike rigid scholars.
Eighty-Four: For Shaoyang Malaria resembling Cold Damage syndromes, Xiao Chaihu Tang is primary. For severe thirst, remove Banxia and add Gualou Gen. For wiry-slow pulse, Xiao Chaihu Tang plus Ganjiang and Chenpi is primary.
Shaoyang Malaria resembling Cold Damage indicates Cold predominance over Heat, so Xiao Chaihu method is retained. Severe internal irritability and thirst require removing drying Banxia and adding Gualou Gen to generate fluids. A wiry-slow pulse indicates heavier Cold; *Jingui* states such pulses require warming. Thus, Ganjiang and Chenpi are added to Xiao Chaihu Tang to warm the Middle and reach the Exterior, extending Middle Yang to expel pathogens.
Qinghao Biejia Tang Formula (Bitter-Acid-Salty-Cold Method)
Qinghao (Artemisia Annua, 3 qian) Zhimu (Anemarrhena, 2 qian) Sangye (Mulberry Leaf, 2 qian) Biejia (Turtle Shell, 5 qian) Danpi (Moutan Bark, 2 qian) Huafen (Trichosanthes Root, 2 qian)
Boil in five cups of water until two cups remain. Take two warm doses before malaria onset.
Xiao Chaihu Tang Formula (Bitter-Acid-Sweet-Warm Method)
Chaihu (Bupleurum, 3 qian) Huangqin (Scutellaria, 1.5 qian) Banxia (Pinellia, 2 qian) Renshen (Ginseng, 1 qian) Zhi Gancao (Licorice, 1.5 qian) Shengjiang (Fresh Ginger, 3 slices) Dazao (Jujube, pitted, 2 pieces)
Boil in five cups of water until two cups remain. Divide into two warm doses. Modifications follow *Shanghan Lun*. For severe thirst, remove Banxia and add 3 qian Gualou Gen.
Xiao Chaihu Tang plus Ganjiang Chenpi Formula (Bitter-Acid-Warm Method)
Add Ganjiang (2 qian) and Chenpi (2 qian) to Xiao Chaihu Tang.
Boil in eight cups of water until three cups remain. Divide into three warm doses.
Eighty-Five: White tongue coating, epigastric stuffiness, cold starting in extremities, thirst preferring hot drinks indicates Dampness accumulation. Named Wet Malaria. Houpo Caoguo Tang is the primary formula.
This is a syndrome with less Heat and more Dampness. White tongue and epigastric stuffiness are caused by Dampness; cold in extremities results from Dampness obstructing Spleen Yang (which governs limbs). Thirst indicates Heat, usually preferring cold drinks; preferring hot drinks indicates Yin-pathogenic Dampness filling the Middle, requiring Heat to open it. The method uses Bitter-Acid to promote descending, purely using Warm-Opening, avoiding Bitter-Cold.
Houpo Caoguo Tang Formula (Bitter-Acid-Warm Method)