庆侄 暑风化疟，寒热交作，头胀脘闷，气络不舒，脉弦滑数，治宜疏解。
连翘 川郁金 建神曲 益元散 广藿香 青蒿子 新会皮 青荷梗 白杏仁 地骨皮 半贝丸 鲜佛手
吾师云∶寒湿疟，日日作，藿香正气散为主。
无汗加苏梗，豆豉，杏仁；
寒多加草蔻，生姜；
热多加青蒿，地骨皮；
腹胀加枳实，大腹绒。
又云∶不可用扁豆，用之必复发也。
愚见如正疟者宜当详考《金匮》论诸条，
柴胡汤等法，又不可废也，亦不可拘处暑之前柴胡不可用。
阮左（九月八日） 夏秋暑湿留伏阳明，近加新凉扰动，邪自肺胃干及少阳，寒热间日
而作，咳嗽痰稠，四肢酸倦，便闭溺赤，口苦脘闷，皆由此致，脉弦滑数，舌苔黄腻，阴虚体质，治宜清解。
鳖血炒柴 胡 知母 金斛 炒竹茹 淡鳖甲（防柴胡无鳖血拌故用此） 地骨皮 杏
仁路路通 青蒿子 淡条芩 半贝丸 车前草。
又潮有余波，胃纳欠醒，眩晕肢倦，口苦溺赤，此阴虚留湿未清，脉小弦数，治宜清理。
元参 新会皮 鲜佛手 车前草 佩兰叶 宋半夏 地骨皮 生谷芽 金斛 青蒿子 泽泻 鲜糯稻苗叶
沈太太（五十九岁，六月二十九日） 肝升太过，胃降不及，平素操劳，肝胃两虚，肝胆
气火偏旺，气滞不和，又加感受暑风，自肺胃扰动肝阳，肝胃气失通调，脘痛胁胀，身热烦
渴，口干呕吐，骨络烦疼，眠食欠安，《内经》谓∶阴气先伤，阳气独发，疟自阴来者，谓之瘅
疟。又云∶厥阴之为病苦寒热是也。脉弦滑数兼见尺部濡数，舌苔黄糙少润，脉证互参切忌
怒，怒则气逆阳升，防有肝厥之虞，治宜清解暑热，两和肝胃法，冀其退机。另纸录方请正。
连翘 青蒿 东白芍 川郁金 车前草 银花露 地骨皮 朱茯神 玫瑰花 鲜金
斛淡鳖甲 纯嫩钩 薄橘红
陈少云（五十二岁，南浔，三月二日） 肝阴素本不足，肝胆气火偏旺，操劳动肝，肝木
与心火相为煽动，肝与胃脏腑相对，一胜一
负，肝善升而胃少降，激动肝中湿浊，痰饮加以食滞壅遏，府气始起，寒热脘闷，继则左胁
引痛，咳嗽身热，骨络烦疼，大便秘结，此病本在肝胃，而标在肺经，所谓厥阴之为病苦寒热是也。脉气六
阳，按左弦数而濡，右寸关弦滑数，兼见舌苔黄腻尖边红。治宜清热豁痰平肝降气。附方请高明政之。
西秦艽 青蒿子 赤苓 玫瑰花（二分挫末再研极细分冲） 淡鳖甲 地骨皮 方
通草 东白芍 半贝丸 银胡 金扁斛 丝瓜络 枷楠香
庆侄：暑风之邪转化为疟疾，寒热交替发作，头部胀痛、胃脘部闷塞，气机经络不畅，脉象弦滑数，治疗应当疏风解表。
连翘、川郁金、建神曲、益元散、广藿香、青蒿子、新会皮（陈皮）、青荷梗、白杏仁、地骨皮、半贝丸、鲜佛手。
我的老师曾说：寒湿疟，每日发作，以藿香正气散为主方。
无汗者加紫苏梗、豆豉、杏仁；
寒重者加草蔻、生姜；
热重者加青蒿、地骨皮；
腹胀者加枳实、大腹绒。
又说：不可用扁豆，用了必定复发。
我个人的见解认为，如果是正疟，应当详细考证《金匮要略》中的相关论述，柴胡汤等治法也不可废弃，也不应拘泥于“处暑之前不可用柴胡”的说法。
阮左（九月八日）：夏秋季节的暑湿邪气留伏于阳明经，近日又受新凉扰动，邪气从肺胃波及少阳经，寒热隔日发作，咳嗽痰稠，四肢酸软疲倦，大便闭结，小便赤黄，口苦胃闷，皆由此引起，脉象弦滑数，舌苔黄腻，患者为阴虚体质，治疗应当清热解表。
鳖血炒柴胡、知母、金斛、炒竹茹、淡鳖甲（因为防柴胡若无鳖血拌制，故用此药替代或辅助）、地骨皮、杏仁、路路通、青蒿子、淡条芩、半贝丸、车前草。
又说：潮热仍有残余波动，胃纳不佳，眩晕四肢疲倦，口苦小便赤黄，这是阴虚留湿未清，脉象小弦数，治疗应当清理余热湿邪。
玄参、新会皮、鲜佛手、车前草、佩兰叶、宋半夏、地骨皮、生谷芽、金斛、青蒿子、泽泻、鲜糯稻苗叶。
沈太太（五十九岁，六月二十九日）：肝气升发太过，胃气下降不及，平素操劳过度，导致肝胃两虚，肝胆气火偏旺，气机滞涩不和，又加上感受暑风，邪气自肺胃扰动肝阳，致使肝胃气机失于通调，出现胃脘痛、胁肋胀满，身体发热烦渴，口干呕吐，骨骼经络烦疼，睡眠饮食不安。《内经》说：“阴气先伤，阳气独发，疟疾从阴分而来者，称为瘅疟。”又说：“厥阴经的病证，表现为苦于寒热往来。”脉象弦滑数，尺部兼见濡数，舌苔黄糙少润，脉证互参，切忌发怒，怒则气逆阳升，防止发生肝厥的危险，治疗应当清解暑热，调和肝胃，希望病情缓解。另纸记录处方请指正。
连翘、青蒿、东白芍、川郁金、车前草、银花露、地骨皮、朱茯神、玫瑰花、鲜金斛、淡鳖甲、纯嫩钩藤、薄橘红。
陈少云（五十二岁，南浔，三月二日）：肝阴素来不足，肝胆气火偏旺，操劳触动肝气，肝木与心火相互煽动。肝与胃脏腑位置相对，一胜一负，肝性善升而胃性少降，激动了肝中的湿浊，加之痰饮和食滞壅遏，腑气始动，出现寒热、胃脘闷塞，继而左胁牵引疼痛，咳嗽身热，骨骼经络烦疼，大便秘结。此病本在肝胃，而标在肺经，所谓“厥阴之为病苦寒热”是也。脉象六阳，按之左脉弦数而濡，右寸关脉弦滑数，兼见舌苔黄腻，舌尖边红。治疗应当清热豁痰、平肝降气。附上方请高明之士指正。
西秦艽、青蒿子、赤茯苓、玫瑰花（二分捣碎研极细粉冲服）、淡鳖甲、地骨皮、方通草、东白芍、半贝丸、银胡、金扁斛、丝瓜络、枷楠香。
Qing's nephew: Summer-wind pathogen transforming into malaria, alternating chills and fever, head distension and pain, epigastric stuffiness, qi collaterals not smooth, pulse wiry-slippery-rapid. Treatment should be to disperse and resolve.
Forsythiae Fructus (Lianqiao), Curcumae Aromatae Rhizoma (Chuan Yujin), Jianshenqu, Yi Yuan San, Pogostemonis Herba (Guang Huoxiang), Artemisiae Annuae Herba (Qinghaozi), Xinhui Chenpi, Nelumbinis Petiolus (Qing Hegeng), Prunus Armeniaca Semen Album (Bai Xingren), Lycii Cortex (Digupi), Banbei Wan, Fresh Bergamot Fruit (Xian Foshou).
My master said: For cold-damp malaria, occurring daily, Huoxiang Zhengqi San is the main formula.
If no sweating, add Perillae Caulis (Sugeng), Fermented Soybean (Douchi), Apricot Seed (Xingren);
If cold predominates, add Cardamomum Rotundum (Caokou), Zingiberis Rhizoma Recens (Shengjiang);
If heat predominates, add Artemisiae Annuae Herba (Qinghao), Lycii Cortex (Digupi);
If abdominal distension, add Immature Bitter Orange (Zhishi), Arecae Pericarpium (Dafurong).
He also said: Do not use Dolichoris Semen (Biandou), as its use will surely cause recurrence.
My humble opinion is that for typical malaria, one should carefully examine the relevant discussions in *Jinkui Yaolue*. Methods such as Chaihu Tang should not be discarded, nor should one rigidly adhere to the notion that Chaihu cannot be used before the Beginning of Autumn (Chushu).
Ruan Zuo (September 8): Summer-autumn summer-heat dampness has remained latent in the Yangming channel, recently disturbed by new coolness. The pathogen moves from Lung and Stomach to involve the Shaoyang channel, causing alternating chills and fever every other day, cough with thick phlegm, soreness and fatigue in the four limbs, constipation, and dark urine. Bitter taste in mouth and epigastric stuffiness are all caused by this. Pulse is wiry-slippery-rapid, tongue coating is yellow and greasy. The patient has a Yin-deficient constitution; treatment should be to clear and resolve.
Bupleuri Radix stir-fried with turtle blood (Xie Xue Chai Hu), Anemarrhenae Rhizoma (Zhimu), Dendrobii Nodulum (Jin Hu), Bamboo Shavings (Chao Zhuru), Turtle Carapax et Plastrum (Dan Biejia) [Note: Used because Bupleuri Radix without turtle blood mixing is feared, so this is used instead/with], Lycii Cortex (Digupi), Apricot Seed (Xingren), Liquidambar Fructus (Lulutong), Artemisiae Annuae Herba (Qinghaozi), Scutellariae Radix (Dan Tiao Qin), Banbei Wan, Plantaginis Herba (Cheqiancao).
Furthermore: tidal fever has residual waves, stomach appetite is poor, dizziness and limb fatigue, bitter taste in mouth and dark urine. This indicates Yin deficiency with lingering dampness not yet cleared. Pulse is small-wiry-rapid. Treatment should be to clear and purify.
Scrophulariae Radix (Yuanshen), Xinhui Chenpi, Fresh Bergamot Fruit (Xian Foshou), Plantaginis Herba (Cheqiancao), Eupatorii Herba (Peilan Ye), Pinelliae Rhizoma Processatum (Song Banxia), Lycii Cortex (Digupi), Hordeum Vulgare Germinatum (Sheng Guya), Dendrobii Nodulum (Jin Hu), Artemisiae Annuae Herba (Qinghaozi), Alismatis Rhizoma (Zexie), Fresh Oryza Sativa Seedling Leaves (Xian Nuodaomiaye).
Mrs. Shen (59 years old, June 29): Liver Qi ascends excessively, Stomach Qi descends insufficiently. Due to chronic overwork, both Liver and Stomach are deficient. Liver-Gallbladder Qi and Fire are hyperactive, Qi stagnation and disharmony exist. Additionally, affected by summer-wind, the pathogen disturbs Liver Yang from Lung and Stomach. Liver-Stomach Qi fails to circulate smoothly, resulting in epigastric pain, hypochondriac distension, body heat with irritability and thirst, dry mouth, vomiting, bone-collateral irritability and pain, and poor sleep and appetite. *Neijing* states: "When Yin Qi is injured first and Yang Qi alone flares up, malaria originating from the Yin aspect is called Dan Malaria." It also says: "The disease of Jueyin manifests as suffering from alternating chills and fever." Pulse is wiry-slippery-rapid, with Chi position showing slippery-rapid. Tongue coating is yellow, rough, and lacking moisture. Correlating pulse and symptoms, anger must be avoided; anger causes Qi reversal and Yang rising, risking Liver Jue. Treatment should clear summer-heat and resolve it, harmonizing Liver and Stomach, hoping for symptom relief. Prescription recorded on separate paper for correction.
Forsythiae Fructus (Lianqiao), Artemisiae Annuae Herba (Qinghao), Paeoniae Radix Alba (Dong Baishao), Curcumae Aromatae Rhizoma (Chuan Yujin), Plantaginis Herba (Cheqiancao), Lonicerae Japonicae Flos Dew (Yinhua Lu), Lycii Cortex (Digupi), Poria Cocos with Polyporus (Zhu Fushen), Rosae Rugosae Flos (Meiguihua), Fresh Dendrobii Nodulum (Xian Jinhu), Turtle Carapax et Plastrum (Dan Biejia), Uncariae Ramulus cum Uncis (Chun Nen Gou), Citri Reticulatae Pericarpium (Bo Juhong).
Chen Shaoyun (52 years old, Nanxun, March 2): Liver Yin has been inherently insufficient, Liver-Gallbladder Qi and Fire are hyperactive. Overwork agitates Liver Qi. Liver Wood and Heart Fire fan each other. Liver and Stomach are anatomically opposite; when one wins, the other loses. Liver tends to ascend, while Stomach tends less to descend. This agitates damp-turbidity within the Liver. Combined with Phlegm-fluids and food retention obstructing, Fu Qi begins to move. Symptoms include alternating chills, epigastric stuffiness, followed by left hypochondriac pulling pain, cough, body heat, bone-collateral irritability and pain, and constipation. The root of this disease lies in Liver and Stomach, while the branch lies in the Lung Meridian. This is what is meant by "The disease of Jueyin manifests as suffering from alternating chills and fever." Pulse is Six Yang positions full; palpating, Left pulse is wiry-rapid and slippery, Right Cun and Guan pulses are wiry-slippery-rapid. Tongue coating is yellow and greasy, tip and edges red. Treatment should clear heat, resolve phlegm, calm Liver, and direct Qi downward. Attached prescription for correction by experts.
Gentianae Macrophyllae Radix (Xi Qinjiao), Artemisiae Annuae Herba (Qinghaozi), Poria Cocos with Red Coir (Chi Ling), Rosae Rugosae Flos [2 fen, crushed, ground extremely fine, taken with decoction] (Meiguihua), Turtle Carapax et Plastrum (Dan Biejia), Lycii Cortex (Digupi), Tectonae Cordis Medulla (Fang Tongcao), Paeoniae Radix Alba (Dong Baishao), Banbei Wan, Bupleuri Radix (Yin Hu), Dendrobii Officinalis Caulis (Jin Bianhu), Luffae Fructus Retinervus (Sigualuo), Aquilariae Lignum Resinatum (Jianan Xiang).