或问曰。发热头痛人俱称为伤寒。一以伤寒药治之可乎。予曰。当有所辨。诸般发热种种不一。
而最毒者在内伤有瘴疟。或曰。若内伤。果有东垣内外伤论。辨别详晰甚为有理。若医瘴疟则不能
无疑矣。将以予为妄。吾见子治斯病活人甚多。但未闻是书未聆是语。当明以告我。予曰。伤寒
内伤所病处广。况立法者。乃仲景东垣。二人圣医也。名重寰宇。而扩充是法者。陶节庵薛立斋二君。
故其书传之广。而心于活人者未有不读也。若夫瘴疟惟炎方有之
僻于一偶。况业医者鲜。惜李待制治瘴之圣。其书所传不广。宜乎吾子之未闻是书。未聆是语。
或曰。既有是书。其病形可得闻欤。予曰。其病有三。而形状不外于头痛。发热。腰重。脚软。
或冷或呕或泄。或大便秘。或小便赤。面赤。目红。口渴。心烦。胸中大热。舌或黑。狂言谵语。
欲饮水。欲坐水中。或吐血。或衄血。或腹痛。或有汗。或无汗。诸证。以有寒有热者为寒瘴。
或间日。或不间日。为易治。以单热不寒者。为热瘴。为难治。得间日犹可以不言语。惟噫噫作
声者。为 瘴为不治。瘴疟之形状大都如是矣。
天以一气覆于上。地以一气载于下。人居覆载中。若何能与覆我载我者。相肖也。上古圣
人等。天地人为三才。岂无灼见而妄立说耶。盖谓天以轻清之气。上浮而下转。地居其中。而干
健之运。无一毫少息。若一毫不续。则穹壤判。
一息不运。则机缄穷。人身肖之。其气亦无息。天以日月循环。人以荣卫循环。地有九州。人有
九窍。经曰。天气通于肺。地气通于嗌。风气通于肝。雷气通于心。谷气通于脾。风气通于肾。
六经为川。肠胃为海。九窍为水注之气。阳之汗以雨名。阳之气以风名。人之一身。身以上其气象天。
身以下其气象地。故天不足西北。而人之耳目。右不如左之聪明也。故西北之人头常冷。地不满东
南。而人之手足。左不如右之利便也。故东南之人。腰足常冷。天有阴阳。以生风暑湿燥寒。地有阴阳。
以生木火土金水。人有阴阳。以生肝心脾肺肾。天气以四时温热凉寒运于上。地气以生长收藏应
于下。而人之阳气以升浮降沉应之。为生生不息之妙何也。天令春其气温。惟其气温。故地中之阳气鼓
动而升于外。以生万物。人之阳气。亦应之以升。天令夏其气热。惟其气热。地中之阳气尽出于外。
以长万物。所以地之下极寒。人之阳气亦应之。尽出于
外。脾坤土也象地。斯时脾土亦寒。天令秋其气凉。惟其气凉。所以阳气能降于地。而行收成之令。
人之阳气。亦应之而降于内。天令冬其气寒。惟其气寒。阳气尽沉于地。而成闭藏之令。所以地
之下暖。人之阳气。亦应之沉藏于内。斯时脾土。亦暖。此天地得其常。而人之灾害亦不生。发
瘴之地则不然。春夏多寒。秋冬多热。盛夏久雨。则可挟纩。隆冬久晴。宁不摇扇。一日之间。
日未升则寒。日中则热。日入又寒。一日一夜。寒暑迭变。无论四时。久晴则热蒸。蒸极则雨。雨
下则湿。蒸雨久则凄凉。人生其间。饮食起居。安能一一谨慎。稍失调养。便感此乖戾之气。而
发寒热。即谓之瘴。然瘴之发。多在秋冬。以其天气热。地中之阳气不能收藏而外泄。故草木不
花而花。不叶而叶。人之阳气亦应之。不能收固。而恒泄之于外。惟其外泄。则脾土所以内虚寒。
身以上象天则极热。身以下象地则不热而寒。或热蒸极而汗。汗出则凄凉。其人身之寒热
湿蒸。一与天时相似。故曰。人身肖天地。瘴疟类天时。知斯道者。则治瘴之法过半矣。
有人问：“发热、头痛，人们都称之为伤寒。用治疗伤寒的药物来治疗可以吗？”我说：“应当加以辨别。各种发热症状各不相同，而其中最毒害的，在于内伤中的瘴疟。”有人说：“如果是内伤，果然有李东垣的《内外伤辨惑论》，辨别得非常详细且很有道理。但如果要治疗瘴疟，就不能不产生疑问了。您可能会被认为是在胡说八道。我见过您治疗这种病救活很多人，只是没听说过这本书，也没听过这番话。请您明确地告诉我。”我说：“伤寒和内伤所涉及的病症范围很广，况且制定这些法则的是张仲景和李东垣，这两位都是圣明的医生，名重天下。而扩充完善这些方法的是陶节庵和薛立斋两位先生，所以他们的书流传很广，凡是心里想着救人的人没有不读的。至于瘴疟，只有南方炎热地区才有，偏居一隅，况且从事医学的人很少，可惜李待制（李杲）治疗瘴疟的医术高超，但他的书流传并不广泛，难怪您没听说过这本书，没听过这番话。”
那人又说：“既然有这本书，它的病症形态可以讲给我听吗？”我说：“它的病症主要有三种，但症状表现不出头痛、发热、腰部沉重、脚部软弱、或发冷、或呕吐、或腹泻、或大便秘结、或小便赤红、面色发红、眼睛充血、口渴、心烦、胸中灼热、舌苔发黑、胡言乱语、想喝水、想坐在冷水里、或吐血、或鼻出血、或腹痛、或有汗、或无汗等这些证候。其中，伴有寒热交替症状的，称为寒瘴；或者隔日发作，或不隔日发作的，属于容易治疗的类型。如果只有发热而没有恶寒的，称为热瘴，属于难治的类型。如果是隔日发作，还可以言语交流；唯独发出‘噫噫’声音的，是瘴疟中的不治之症。瘴疟的症状大体上就是这样。”
“天以一气覆盖在上，地以一气承载在下。人生活在天地之间，怎么能与覆盖我、承载我的天地相类似呢？上古圣人将天、地、人并列为三才，难道是没有深刻的见解而随意立说吗？大概是因为天以轻清之气上浮而下转，地居于其中，运行着刚健不息的力量，没有丝毫停歇。如果有一毫不停续，那么天地就会分离；如果有一息不运转，那么生机就会穷尽。人身与之相似，人体的气也是没有停息的。天以日月循环，人以营气和卫气循环；地有九州，人有九窍。经书说：天气通于肺，地气通于咽喉，风气通于肝，雷气通于心，谷气通于脾，湿气通于肾。六经如同河流，肠胃如同大海，九窍是水气灌注的地方。阳气的汗液被称为雨，阳气的气机被称为风。人的全身，上半身象天，下半身象地。所以天在西北方不足，人的耳目右边不如左边灵敏；所以西北方的人头部常觉寒冷。地在东南方不满，人的手足左边不如右边便利；所以东南方的人腰脚常觉寒冷。天有阴阳，从而生出风、暑、湿、燥、寒；地有阴阳，从而生出木、火、土、金、水；人有阴阳，从而生出肝、心、脾、肺、肾。天气以春、夏、秋、冬四时的温、热、凉、寒在上方运行，地气以生、长、收、藏在下方响应，而人的阳气以升、浮、降、沉与之相应。这是生生不息的奥妙所在。为什么呢？天的时令在春季，气温温和，正因为气温温和，所以地中的阳气鼓动而升发于外，以生长万物。人的阳气也顺应它而升发。天的时令在夏季，气候炎热，正因为气候炎热，地中的阳气完全出于外部，以长养万物。所以地下的极寒之处，人的阳气也顺应它，完全出于外部。脾属坤土，象征大地，此时脾土也寒。天的时令在秋季，气候凉爽，正因为气候凉爽，所以阳气能沉降于地，执行收敛收藏的命令。人的阳气也顺应它而降入内部。天的时令在冬季，气候寒冷，正因为气候寒冷，阳气完全沉伏于地，执行闭藏的命令。所以地下温暖，人的阳气也顺应它沉藏于内部。此时脾土也温暖。这是天地得其常态，而人的灾害也不发生。
但是，发生瘴气的地方则不然。春夏多寒，秋冬多热。盛夏久雨，甚至可以穿棉衣；隆冬久晴，岂能不摇扇子。一天之中，太阳未出时寒冷，中午时炎热，日落后又寒冷。一日一夜，寒暑交替变化。不论四季，久晴则热气蒸腾，蒸腾到极点就下雨，下雨后则潮湿，蒸雨久了则凄凉。人生存其间，饮食起居，怎能一一谨慎？稍加失调养护，就会感受这种乖戾之气，从而引发寒热，这就叫做瘴。然而瘴气的发作，多在秋冬季节，因为天气热，地中的阳气不能收藏而向外泄露，所以草木不开花却开花，不长叶却长叶。人的阳气也顺应它，不能固守而常常泄露于外。正因为向外泄露，所以脾土因此在内虚寒。上半身象天，所以极热；下半身象地，所以不热而寒。或者热蒸到极致而出汗，出汗后则感到凄凉。他身体的寒热湿蒸，与天时非常相似，所以说：人身肖似天地，瘴疟类比天时。懂得这个道理，那么治疗瘴疟的方法就掌握了一半了。”
A question was asked: "Fever and headache are commonly referred to as *Shanghan* (Cold Damage). Can they be treated with medicines for *Shanghan*?" I replied, "One must distinguish between them. Various types of fever are diverse, but the most toxic among internal injuries is *Zhangmiao* (Miasma Malaria). Some say, 'If it is an internal injury, there is indeed Li Dongyuan's *Treatise on Differentiating Internal and External Injuries*, which distinguishes them in detail and is very reasonable. But if one treats *Zhangmiao*, doubts inevitably arise. You might be considered to be speaking nonsense. I have seen you save many lives treating this disease, yet I have never heard of this book or these words. Please tell me clearly.' I said, 'The scope of diseases covered by *Shanghan* and internal injuries is broad. Moreover, the law-makers were Zhang Zhongjing and Li Dongyuan, two sage physicians whose fame spread across the world. Those who expanded upon their methods were Tao Jie'an and Xue Lizhai. Therefore, their books were widely transmitted, and anyone who sincerely wished to save lives would not fail to read them. As for *Zhangmiao*, it exists only in the hot southern regions, confined to a remote corner. Furthermore, few practitioners deal with it. It is a pity that Li Daizhi (Li Gao), a sage in treating *Zhangmiao*, did not have his works widely circulated. Hence, it is no wonder you have not heard of this book or these words.'"
The other person said, "Since such a book exists, can you describe its clinical manifestations?" I said, "There are three main types of this disease, but the symptoms generally include headache, fever, heaviness in the waist, weakness in the legs, chills, vomiting, diarrhea, constipation, red urine, flushed face, red eyes, thirst, mental restlessness, burning sensation in the chest, black tongue coating, delirious speech, desire to drink water, desire to sit in cold water, hematemesis (vomiting blood), epistaxis (nosebleed), abdominal pain, presence or absence of sweating, etc. Among these syndromes, those accompanied by alternating chills and fever are called *Han Zhang* (Cold Miasma); whether occurring every other day or not, they are relatively easy to treat. Those with fever alone without chills are called *Re Zhang* (Heat Miasma) and are difficult to treat. If the condition occurs every other day, the patient can still speak; however, if the patient makes 'yi yi' sounds, it indicates a terminal stage of *Zhangmiao* that is incurable. The clinical picture of *Zhangmiao* is largely as described above."
"Heaven covers from above with one Qi, and Earth supports from below with one Qi. Humans live within this covering and supporting environment. How can humans resemble Heaven and Earth that cover and support us? The sages of antiquity established Heaven, Earth, and Man as the Three Powers (San Cai). Did they do so without profound insight or arbitrarily? It is because Heaven moves upward with light and clear Qi and downward with heavy Qi, while Earth resides in the middle, undergoing constant vigorous movement without the slightest pause. If this movement ceases even slightly, Heaven and Earth would separate; if it stops for even a breath, vitality would cease. The human body resembles this, with Qi flowing continuously without pause. Just as Heaven cycles through sun and moon, the human body cycles through Ying (Nutritive) Qi and Wei (Defensive) Qi; just as Earth has Nine Provinces, the human body has Nine Orifices. The Classics state: Heavenly Qi connects with the Lung; Earthly Qi connects with the throat; Wind Qi connects with the Liver; Thunder Qi connects with the Heart; Grain Qi connects with the Spleen; Dampness Qi connects with the Kidney. The Six Channels (Liu Jing) are like rivers, the stomach and intestines are like seas, and the Nine Orifices are where Water Qi flows. Sweat from Yang Qi is named Rain, and the movement of Yang Qi is named Wind. The upper part of the human body resembles Heaven, and the lower part resembles Earth. Thus, since Heaven is deficient in the northwest, the right side of a person's ears and eyes is less acute than the left; consequently, people in the northwest often feel cold in the head. Since Earth is incomplete in the southeast, the left side of a person's hands and feet is less agile than the right; consequently, people in the southeast often feel cold in the waist and feet. Heaven possesses Yin and Yang, generating Wind, Summer Heat, Dampness, Dryness, and Cold. Earth possesses Yin and Yang, generating Wood, Fire, Earth, Metal, and Water. Man possesses Yin and Yang, generating the Liver, Heart, Spleen, Lungs, and Kidneys. Heavenly Qi circulates warmth, heat, coolness, and cold through the four seasons above, while Earthly Qi responds with growth, flourishing, harvesting, and storing below. Human Yang Qi responds accordingly with ascending, floating, descending, and sinking. This is the mystery of endless generation. Why? In spring, Heavenly Qi is warm; due to this warmth, Earthly Yang Qi stirs and rises outward to generate all things. Human Yang Qi also responds by rising. In summer, Heavenly Qi is hot; due to this heat, Earthly Yang Qi fully emerges outward to nourish all things. Thus, even in the coldest depths of the earth, human Yang Qi responds by fully emerging outward. The Spleen belongs to Kun Earth and symbolizes the Earth; at this time, Spleen Earth is also cold. In autumn, Heavenly Qi is cool; due to this coolness, Yang Qi descends into the Earth to execute the command of harvesting and storing. Human Yang Qi also responds by descending inward. In winter, Heavenly Qi is cold; due to this cold, Yang Qi sinks completely into the Earth to execute the command of closure and storage. Thus, the interior of the Earth remains warm, and human Yang Qi responds by sinking and storing inward. At this time, Spleen Earth is also warm. When Heaven and Earth maintain their normal order, disasters do not befall humans.
However, places prone to Miasma are different. Spring and Summer are often cold, while Autumn and Winter are often hot. During prolonged rains in midsummer, one may need to wear cotton; during prolonged sunshine in deep winter, one might wish to wave a fan. Within a single day, it is cold before sunrise, hot at noon, and cold again after sunset. Day and night alternate between cold and heat. Regardless of the season, prolonged sunshine causes heat to steam; when steaming reaches its peak, rain falls, bringing dampness. Prolonged steaming and rain lead to chilliness. Living amidst such conditions, how can one be cautious enough in diet and daily life? A slight imbalance in care leads to contracting this aberrant Qi, resulting in chills and fever, which is termed *Zhang*. However, *Zhang* typically manifests in Autumn and Winter. Because the weather is hot, Earthly Yang Qi cannot store itself and leaks outward. Consequently, plants bloom without flowering and leaf out without growing leaves. Human Yang Qi also responds by failing to consolidate and constantly leaking outward. Due to this outward leakage, Spleen Earth becomes internally deficient and cold. The upper body, resembling Heaven, becomes extremely hot; the lower body, resembling Earth, becomes cold rather than hot. Or, extreme steaming leads to sweating, and post-sweat brings chilliness. The body's cold, heat, dampness, and steaming closely mirror the heavenly timing. Thus it is said: The human body resembles Heaven and Earth, and *Zhangmiao* parallels heavenly timing. Those who understand this principle have mastered half of the methods for treating *Zhangmiao*."