温疟一证，有指为春温者，有指为伤寒坏症者，议论纷纭，错出不一。考之《内经》，则冬中于风寒，气藏于骨髓，伏于肾脏，至春阳气大发，犹不能自出。复因大暑，灼肌消腠理发泄，然后有所用力，动其肾气，始得自内达外。发则先热后寒，求之《金匮》，则以为脉如平人，无寒但热，不过骨节烦疼，时时呕逆而已。《内经》言之甚重，《金匮》言之甚轻。夫《金匮》表章《内经》，何轻重相悬若此余深维其义而知。《金匮》一条正因《内经》言温疟之重，为之防微杜渐，而出一证，示人以未雨绸缪之意。盖冬日风寒深藏骨髓，至于三春阳气大发之时，一切昆虫草木莫不闻雷起蛰，疟邪何物而竟深藏不出耶纵寒为阴邪，内舍于肾，为阴寒固结而不能自出，而风为阳邪，自当随少阳木火之性发见于外，纵不能遽发于外，亦必显欲出不出之象而有骨节烦疼，时时呕逆，身热等证。于此际而商治法，惟即用白虎以解阳邪，加桂枝以通营卫，先使风性之善行数变者尽为驱除，而后阴寒之内伏者孤而无助，庶不至脑灼而肌消。且精积气充则命门之火升如旭日，即寒邪亦不治而自散。若其人真火衰微，不能解散，必因有所用力，动其肾气，而后与汗俱出。但阳邪即去，势必多寒，使此时而治，非其治则阴邪为害亦正非浅，故又后出多寒者名曰牡疟一条，补其未逮，而用龙骨之体阴而用阳者，合蜀漆轻扬上越之物，直入肾脏，俾所伏之寒一吐而出，此实仲景隐会《内经》温疟一条为极重之证而分作两层治法，以杀其势之意。然不仍其名曰温疟，而变其名曰牝疟者，盖以肾为牝脏，热少寒多，无温之可名也。设此种重证不得仲景，此种分治必待脑烁肌消，风寒俱发，而阴阳两虚，嗟何及已。
疟 母 论
疟母之说，《内经》独无。盖上古治疾多用针刺，不致疟气久留也。惟《金匮》有云：病疟以月一日发当十五日愈，设不瘥，当月尽解。如其不瘥，结为瘕瘕，名曰疟母，急治之，宜鳌甲煎。夫疟邪之初入也，必先伏于营舍，而发则由于卫气。人身之有营卫，犹天之有日月，日月之行于天也，至半月必一大交会，营卫之行于身也，至半月亦一大交会。夫此交会之际，正营卫两旺之时，疟邪何物，而犹得伏于营舍耶意必有渐入渐深，流经附骨，非随少阴而隐于腰脊，即随少阳而结于募原。募原者，少阳脉之尽处，章门之穴也。上有膈膜，下为软胁，疟邪据之，如依山傍水，稍有触动则随气上攻而作胀，略得安静则恃险内伏而不见。设不急用鳖甲煎破其坚垒，延之日久，必有滋蔓难图之势。今每见患疟经年，遂成疟母，正气日益消，邪气日益炽，不攻则据中，有耗精血，攻之则邪气散漫，往往变成膨胀等证，岂非不遵仲景急治之法，以至于此乎?
疟母问答
或曰：疟母之结于胸中，其义何居余曰：疟邪在外则藏于营舍，在内则藏于腰脊募原，此数处皆有空隙，邪得入而居之。若胸中至高之界，至阳之分，宗气之所发原，大气之所周流，所谓握寰中而运四方者也。即伤寒中风亦不能骤犯，而况疟邪乎？然其所以结于胸中者，非失于调养即失于药石。因其数发不止，日服悍勇之剂，俾脾阳困败，中气不支，疟邪因此而上逆作胀，乃更用宽中理气之剂，愈胀愈消，愈消愈胀，始而随气凝结，继而如铁石不动矣。则疟母之结于胸中，岂细故哉。余故曰：治疟之法，断无犯及胸中之阳为第一要义也。
痢疾大纲
痢疾一证，古今治法非不廷璧琳琅，棼然几案。然究之，皆各眩己长，自鸣一得，求其有精微之蕴、会归之旨，终难其人也。余尝考《内经》肠擗字义，谓游漂絮也，又谓肠中水也，以水而如絮漂泊肠中，非寒湿之凝结，即湿热之郁蒸。譬之污秽之水，得烈日曝晒，因如絮漂泊于上，得严寒冰冻亦如絮漂泊于上，而清水流泉则无也。可知痢疾之源莫不因于湿，而推其源则有二：一者湿兼于寒，一者湿兼于热。盖夏间阴气逼伏于内，阳气浮散于外，恣啖生冷则湿随寒入，暑热暴郁则湿随热入。至秋金司令，阳气将为内敛，而从前所积寒湿热湿之伏郁于内者，触动而痢作矣。总之，或寒或热，虽有不同，而湿之一因实为枢纽，此义如炉冶分金，最为捷要。再详《内经》之义，盖觉彰明较著矣。所云肠擗便血，身热则死，身凉则生，岂非因湿热扰乱，阴已消耗，而复见表热，则内外燔灼，营阴有立尽之势乎。又云肠擗下白沫，脉沉则生，脉浮则死，岂水因寒湿内著，脾阳已困，而反见浮脉，则内外相失，胃气有坐亡之机乎究《内经》之义，参诸《金匮》数条，若合荷节。夫痢疾不外乎寒热，寒热不外乎暑湿。盖当盛夏之时，阳气尽发于表，太阴湿土用事，兼之淫雨阴晦，湿气内侵，则太阴受之，受则必传少阴，所以久痢必关脾肾。脾虚则失其健运，不能为胃行其津液，上输于肺，而悉从下注；肾虚则失其闭藏，不能为小肠通其化物，下达膀胱，而直走大肠，此《内经》之奥而仲景之秘也。观仲景于《金匮》下痢一门，即将《伤寒沦》中少阴下利数条治法参入，其意可知矣。盖寒湿、湿热之邪，感即直入于内，虽与伤寒自表而入者悬绝，而于寒邪之直中少阴、热邪之传入少阴者初无少异，故于寒温、温热之极重者，概以少阴下利之方治也。此仲景一定之法，嘉言先生疑有缺文，谓后人借以补入，是亦智者之一失也。考痢疾一证，古谓之肠擗，又曰滞下。其致病之由无不以夏伤于暑一语为铁案。夫夏伤于暑，即仲景所谓中喝，随感随发，顷刻僵仆，其来暴，其中速，至痢则始于微，积于渐，发于秋。寒湿湿热不同，轻重缓急亦异。余推原其故，谓因于暑则可，谓伤于暑则不可也，盖时当六月，四阳浮于外，二阴伏于内，脏本寒也。其在富贵之子，高堂大厦，凉风自生，而又羽扇瓜梨恣啖，传为中寒而作痢矣。此因于暑之一验也。资贱之子作劳不息，挥汗如雨，张口抬肩，仅存喘息，由是生可啖也，冷可饮也，河水可浴也。夜则坐于风而卧于露也。剥肤之热即消而脏寒，寒之证旋见，此又因于暑之一验也。余究其受病之源，而知得之寒湿者六七，湿热者二三。如太阴阳明论曰：饮食不节，起居不时者，阴受之。阴受之则入五脏，入五脏则填满闭塞，下为飧泄，久为肠擗。细参经旨，未有一言及暑热者，奈因近代医流不知伤暑之因，胶执暑为热毒，概以芩连之属，佐以破坚消滞之品为治痢金丹。噫!未之思耳。虽然大行酷热，暑毒中人，酝酿而为痢，必须以苦寒之品解之，盖有之矣，而认为一定之常例则不可，是又在参证与脉而酌夺也。
治痢大法
湿乃痢疾之根源，少阳乃治痢之线索，何也湿邪夹寒热直入少阴太阴两脏，太阴为本，少阴为标，少阴生木者也，太阴畏木者也。少阴亏则木失其滋养而生气不伸，太阴亏则木乘所胜而生气下郁，故痢疾之见证虽非一端，而腹痛雷鸣始终兼有。《金匮》云：六腑气绝于外者，手足寒。上气脚缩，五脏气绝于内者，利不禁。下甚者，手足不仁。夫手足，脾所主也，而至不仁脚缩，则脾阳困疾，木邪结塞，为何如也施治者不可不早为培补脾阳，提出少阳生气，俾中州之土有主，输化有权哉。近代粗工，泥定后重为气滞而不敢用，不知少阳生气不升则肺气奔迫于大肠，未有不后重者也，泥定腹痛为食积而不敢用，不知少阳生气太升则木邪横克于太阴，未有不腹痛者。泥定赤色为暑热而不敢用，不知少阳之生气不升则木火剥削肠胃之膏脂，未有不赤色者，若必待不后重、不腹痛、不赤色而后用培补，势必至六腑气绝于外，五脏气绝于内而后已也。况余之所谓补土者，原非峻补之偏见也。审其为热也，则加以苦寒，审其为寒也，则加以辛温。始终总以土中提出少阳为洽痢一大关键。
世谓痢乃热邪内蕴，致膀胱气化不行，小便黄赤不利，当利其小便，分其热势，则下痢自止。此说遂牢不可破，岂知夏秋之交津液外泄，小便本少，再兼热邪内蕴，阴已消灼无几，更欲利之，是重竭其阴也。余因考之《金匮》，治法不下数十余条，未有言利小便者，但有一条曰：下利气者，当其小便利。后人遂以为证据，不知此泄泻非论痢疾也。盖气者，膀胱之气也。不曰下痢而曰下利，气是膀胱之气，并于大肠而下之，故当利其小便，使复还膀胱之气。若果是痢疾，何此独添一个气字哉粗工不察，专守其说，一见小便短少，即用木通、车前、猪苓、泽泻之类，愈服愈少，以至点滴皆无，反变出发热口渴，岂非阴竭之一验乎！余尝以补脾升清阳之法，正所以利小便也。使清气上升，津液下降，甚至兼以养阴，使肾水内充，虚阳有附。服之数日，短少者转长，黄赤者转清。治经千百，无不如鼓应桴也。
痢疾发汗之说，不知何人作俑。嘉言先生又从而知之，谓冬月伤寒，已称病热，至夏暑湿热三者交蒸，其热十倍，故下痢必先从汗解表。噫，以此引证，诚大谬矣。夫冬月阳在内而阴在外，夏月阴在内而阳在外，故伤寒应发热而不发热为重，以其寒外束而内无阳也。痢疾不应发热，发热则死，以其热外淫而内无阴也。此正当与伤寒对看，不得与伤寒同一例也。明乎此，则知伤寒宜发汗而痢疾不当发汗矣。又谓失于表者，外邪但从里出，不死不休，故虽百日之远，仍用逆挽之法引其邪而出之于外，此说尤为误人。夫久痢皮肤枯槁，津液已竭，汗从何来逆挽之法，阳气下陷者或偶中之，不可为例。至邪从外解，则断无之理。故仲景特申明下痢攻表之戒，谓汗出必胀满下痢，阴已内泄，发汗再使外泄可乎至《金匮》所云下痢腹胀满，身体疼痛者，必温其里，乃攻其表者，以外兼表证也。设无身体疼痛，其不可攻表明矣。业医者不于此等大关键处急为加之意哉《医源》终
温疟这一病证，有人将其指认为春温病，有人将其指认为是伤寒误治后的坏证，议论纷纷，说法不一。考证《内经》中的记载，则是冬季感受风寒，邪气藏匿于骨髓，潜伏在肾脏，到了春季阳气大发之时，邪气仍不能自行排出。又因盛夏酷暑，灼烧肌肉，消减腠理，使汗液发泄，此时邪气才有所凭借，触动肾气，才得以从体内达于体表。发作时先发热后恶寒。查阅《金匮要略》，则认为脉象如常人一样，没有恶寒只有发热，不过是骨节烦痛，时时呕吐逆气罢了。《内经》对此论述得很重要，《金匮要略》对此论述得很轻简。既然《金匮要略》是阐发《内经》宗旨的，为何轻重相差如此悬殊？我深入思考其义理才明白：《金匮要略》的这一条，正是因为《内经》说温疟病情严重，为了防微杜渐，所以提出一种证候，以此示人以未雨绸缪之意。大概冬日风寒深藏骨髓，到了三春阳气大发之时，一切昆虫草木无不闻雷而起蛰伏之虫，疟邪是什么东西竟然能深藏不出呢？纵然寒为阴邪，内舍于肾，因阴寒固结而不能自出；但风为阳邪，自然应当随着少阳木火之性发见于外，纵然不能立即发于外，也必然显现出欲出未出的征象，而有骨节烦痛、时时呕逆、身热等症状。在此时此刻商讨治疗方法，唯有直接用白虎汤以解除阳邪，加入桂枝以通达营卫，先使风性善行数变的邪气全部被驱除，然后阴寒之内伏者孤立无援，这样才不至于导致脑髓灼伤而肌肉消瘦。况且精气积聚充盛，则命门之火升起如同旭日东升，即使寒邪也不治而自散。如果其人真火衰微，不能解散，必定因为有所用力，动摇了肾气，而后与汗一起排出。但阳邪即去，势必出现多寒的情况，使此时进行治疗，如果不是正确的治法，阴邪为害也不浅，所以又有“后出多寒者名为牡疟”的一条，来补充前面的不足，使用龙骨这种体阴用阳的药物，配合蜀漆这种轻扬上越的药物，直入肾脏，使所伏藏的寒邪一吐而出。这实际上是张仲景隐晦地契合《内经》中温疟一条作为极重之证，而分为两层治法，以削弱其势气的用意。然而不仍然命名为温疟，而改变名称为牝疟（牡疟），大概是因为肾为牝脏，热少寒多，没有温热的名义可称。假如这种重证得不到张仲景的这种分治方法，必定等到脑髓销烁、肌肉消瘦，风寒俱发，而阴阳两虚，那时再叹息又怎么来得及呢？
疟母论
关于疟母的说法，《内经》中唯独没有记载。大概上古时代治疗疾病多用针刺，不会导致疟气久留体内。只有《金匮要略》说：患疟疾的人在农历初一发病，应当在十五天痊愈，如果不好转，应当在当月月底解除。如果还是不好转，结聚成瘕瘕，名叫疟母，必须紧急治疗，适宜用鳖甲煎丸。夫疟邪初入人体时，必定先潜伏在营舍，发作则由于卫气。人身有营卫，就像天上有日月，日月在天运行，到半月必有一次大交会，营卫在人身运行，到半月也有一次大交会。在这交会之际，正是营卫两旺的时候，疟邪是什么东西，还能潜伏在营舍呢？我想必定是逐渐进入逐渐深入，流经附骨，不是随少阴经隐于腰脊，就是随少阳经结于募原。募原是少阳脉的尽头，即章门穴所在之处。上面有膈膜，下面是软胁，疟邪占据此地，如同依山傍水，稍有触动就随气上攻而作胀，稍微安静就依仗险要内伏而不显现。如果不紧急使用鳖甲煎丸攻破其坚固堡垒，拖延日久，必定有滋蔓难图之势。如今常见患疟疾经年，遂成为疟母，正气日益消耗，邪气日益炽盛，不攻伐则占据中焦，耗损精血；攻伐则邪气散漫，往往变成膨胀等证，这难道不是不遵循张仲景急治的方法，以至于此吗？
疟母问答
有人问：疟母结聚于胸中，其中的道理何在？我说：疟邪在外则藏于营舍，在内则藏于腰脊募原，这几个地方都有空隙，邪气得入而居之。若胸中是至高之界，至阳之分，是宗气所发源，大气所周流的地方，所谓掌握中枢而运转四方的地方。即使是伤寒中风也不能骤然侵犯，何况疟邪呢？然而它之所以结聚于胸中，不是失于调养就是失于药物治疗。因为多次发作不止，每日服用悍勇猛烈的药剂，使得脾阳困败，中气不支，疟邪因此上逆作胀，于是更用宽中理气的药物，结果愈胀愈消，愈消愈胀，开始随气凝结，继而像铁石一样不动了。那么疟母结聚于胸中，难道是小事吗？所以我常说，治疗疟疾的方法，绝不犯及胸中之阳是第一要义。
痢疾大纲
痢疾这一病证，古今治疗方法并非不多，琳琅满目，杂乱堆满几案。然而究其根本，都是各炫己长，自鸣得意，寻求其中有精微蕴涵、会归宗旨的，终究很难找到这样的人。我曾考证《内经》中“肠擗”的字义，说是游漂的絮状物，又说是指肠中的水，以水而像絮片漂泊于肠中，不是寒湿的凝结，就是湿热郁蒸所致。譬如污秽之水，得到烈日曝晒，便像絮片漂浮在上面；得到严寒冰冻，也像絮片漂浮在上面，而清水流泉则没有这种现象。可知痢疾的源头没有不是因为湿邪，推究其源则有二种：一种是湿兼寒，一种是湿兼热。大概夏季阴气逼迫伏藏于内，阳气浮散于外，恣意食用生冷则湿随寒入，暑热暴郁则湿随热入。到了秋季金气当令，阳气将要内敛，而从前所积存的寒湿、湿热之邪伏郁于内，被触动而痢疾发作了。总之，或寒或热，虽有不同，但湿这一因素实为枢纽，这个道理如同炉冶分金，最为简便扼要。再详细探究《内经》的意义，觉得更加彰明较著了。文中所说肠擗便血，身热则死，身凉则生，难道不是因为湿热扰乱，阴液已经消耗，而又见到表热，则内外燔灼，营阴有立刻耗尽的趋势吗？又说肠擗下白沫，脉沉则生，脉浮则死，难道不是水因寒湿内着，脾阳已困，反而见到浮脉，则内外相失，胃气有坐以待毙的危机吗？深入研究《内经》的意义，参考《金匮要略》的数条内容，如同符合符节一般吻合。夫痢疾不外乎寒热，寒热不外乎暑湿。大概在盛夏之时，阳气尽发于体表，太阴湿土主事，加之淫雨阴晦，湿气内侵，则太阴受邪，受邪则必传至少阴，所以久痢必定关乎脾肾。脾虚则失去健运功能，不能为胃行使其津液，上输于肺，而全部从下注泄；肾虚则失去闭藏功能，不能为小肠通调化物，下达膀胱，而直接走注大肠，这是《内经》的奥妙和张仲景的秘密所在。看张仲景在《金匮要略》下痢一门中，即将《伤寒论》中少阴下利的数条治法参入其中，其用意可知了。大概寒湿、湿热之邪，感邪即直入于内，虽然与伤寒自表而入者截然不同，但对于寒邪直中少阴、热邪传入少阴的情况起初并无多少差异，所以在寒温、温热病的极重阶段，一概以治疗少阴下利的方剂来治疗。这是张仲景一定之法，徐灵胎先生怀疑有缺文，谓是后人借以补入的，这也是智者的一失。考证痢疾这一病证，古时候称之为肠擗，又叫做滞下。其致病原因无不以“夏伤于暑”这句话为定论。夫夏伤于暑，即张仲景所说的中喝，随感随发，顷刻间僵仆倒地，其来势迅猛，其伤人迅速，至于痢疾则始于细微，积累于渐进，发作于秋季。寒湿湿热不同，轻重缓急也有差异。我推究其原因，说是“因于暑”可以，说是“伤于暑”则不可以，大概时令正值六月，四阳浮于外，二阴伏于内，脏腑本是寒凉的。那些富贵子弟，住在高堂大厦，凉风自生，而又摇着羽扇、吃着瓜梨恣意享用，传变为中寒而作痢疾了。这是因于暑的一个验证。贫贱之子劳作不息，挥汗如雨，张口抬肩，仅存喘息，由此产生想吃的欲望，想喝冷饮的欲望，想用河水洗澡的欲望。夜晚则坐在风中而卧于露地。剥肤之热即消而脏腑变寒，寒证随即出现，这又是因于暑的一个验证。我究查其受病的源头，而知得之寒湿者占六七成，湿热者占二三成。如《素问·太阴阳明论》说：饮食不节，起居不时者，阴受之。阴受之则入五脏，入五脏则填满闭塞，下为飧泄，久则为肠擗。仔细参悟经旨，没有一句话提及暑热的，无奈近代医流不知伤暑的原因，胶执地认为暑为热毒，一概以黄芩、黄连之类，佐以破坚消滞的药物作为治痢金丹。唉！未曾深思罢了。虽然大行酷热，暑毒中人，酝酿而成痢疾，必须以苦寒之品解之，这种情况确实存在，但如果认为这是一定的常例则不可以，这又在于参合证候与脉象而斟酌决定。
治痢大法
湿是痢疾的根源，少阳是治疗痢疾的线索，为什么呢？湿邪夹带寒热直入少阴、太阴两脏，太阴为本，少阴为标，少阴生木，太阴畏木。少阴亏虚则木失其滋养而生气不伸，太阴亏虚则木乘其所胜而生气下郁，所以痢疾的见证虽非一端，但腹痛雷鸣始终兼有。《金匮要略》说：六腑气绝于外者，手足寒冷。上气脚缩，五脏气绝于内者，利不禁。下利严重者，手足麻木不仁。夫手足，由脾所主，而至麻木不仁、脚缩，则是脾阳困顿疾苦，木邪结塞，情况如何啊！施治者不可不早为培补脾阳，提出少阳生气，使得中州之土有主，输化有权。近代粗疏的工匠，拘泥于后重为气滞而不敢用（补土提阳之法），不知道少阳生气不升则肺气奔迫于大肠，没有不后重的；拘泥于腹痛为食积而不敢用，不知道少阳生气太升则木邪横克于太阴，没有不腹痛的；拘泥于赤色为暑热而不敢用，不知道少阳之生气不升则木火剥削肠胃之膏脂，没有不赤色的，如果必定等到不后重、不腹痛、不赤色而后用培补之法，势必至六腑气绝于外，五脏气绝于内才停止。况且我所说的补土，原本就不是峻补的偏见。审察其为热，则加以苦寒；审察其为寒，则加以辛温。始终总以土中提出少阳为治疗痢疾的一大关键。
世人认为痢疾乃热邪内蕴，导致膀胱气化不行，小便黄赤不利，应当利其小便，分其热势，则下痢自然停止。这种说法于是牢不可破，哪里知道夏秋之交津液外泄，小便本少，再加上热邪内蕴，阴液已经消灼无几，更要利之，这是再次竭尽其阴液啊。我因此考证《金匮要略》，治法不下数十余条，没有一条说利小便的，只有一条说：下利气者，当其小便利。后人遂以此为证据，不知道此泄泻并非论述痢疾。盖这里的“气”，是指膀胱之气。不说下痢而说下利，气是膀胱之气，并于大肠而下之，故应当利其小便，使复还膀胱之气。如果是痢疾，为何独独添一个“气”字呢？粗疏的工匠不加考察，专守其说，一见小便短少，即用木通、车前子、猪苓、泽泻之类，服得越多尿越少，以至点滴皆无，反而变出发热口渴，这难道不是阴竭的一个验证吗！我曾经用补脾升清阳的方法，这正是利小便的方法。使清气上升，津液下降，甚至兼以养阴，使肾水内充，虚阳有依附。服用数日，短少的转为长，黄赤的转为清。治疗千百例，没有不像敲鼓应槌那样灵验的。
痢疾发汗的说法，不知是谁始作俑者。徐灵胎先生又从而支持它，说冬月伤寒，已称为病热，到了夏月暑湿热三者交蒸，其热十倍，所以下痢必定先从汗解表。唉，以此引证，实在大谬矣。夫冬月阳气在内而阴气在外，夏月阴气在内而阳气在外，所以伤寒应发热而不发热为重，因为其寒邪外束而内无阳。痢疾不应发热，发热则死，因为其热邪外淫而内无阴。这正当与伤寒对照看待，不得与伤寒同一例。明了这一点，就知道伤寒宜发汗而痢疾不当发汗了。又说失于表者，外邪但从里出，不死不休，所以即使百日之久，仍用逆挽之法引其邪而出之于外，这种说法尤为误人。夫久痢皮肤枯槁，津液已竭，汗从何来？逆挽之法，对于阳气下陷者或许偶尔中肯，不可作为常规。至于邪从外解，则断无此理。所以张仲景特别申明下痢攻表的戒律，说汗出必胀满。下痢，阴已内泄，发汗再使外泄可以吗？至于《金匮要略》所说下痢腹胀满，身体疼痛者，必温其里，乃攻其表者，是因为外兼表证。假设没有身体疼痛，其不可攻表明显了。从事医疗行业的人，不在这些大关键处急切加意吗？《医源》终
Wen Nue (Warm Malaria) is a syndrome that some identify as Chun Wen (Spring Warmth), while others attribute it to the deteriorated condition following Shang Han (Cold Damage). Discussions are numerous and inconsistent. Examining the *Nei Jing* (Inner Canon), it states that one contracts wind-cold in winter, which hides in the bone marrow and lies dormant in the Kidney. When Yang Qi expands vigorously in spring, it still cannot exit on its own. Subsequently, due to intense summer heat scorching the muscles and dissipating through the pores and hair follicles, the pathogen finds leverage, stirs the Kidney Qi, and finally moves from the interior to the exterior. Upon onset, fever precedes chills. Consulting the *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet), it describes the pulse as normal, with no chills but only fever, accompanied merely by vexatious pain in the bone joints and occasional nausea/vomiting. The *Nei Jing* treats this seriously, whereas the *Jin Gui* treats it lightly. Since the *Jin Gui* elucidates the *Nei Jing*, why such a discrepancy in emphasis? After deep contemplation, I understand: The *Jin Gui* clause exists precisely because the *Nei Jing* emphasizes the severity of Wen Nue, aiming to prevent trouble before it happens, thus presenting a syndrome to illustrate the principle of preparing for rain before it falls. Generally, winter wind-cold hides deep in the bone marrow. By the time of the three spring months when Yang Qi expands, all insects and plants emerge from hibernation upon hearing thunder. What kind of malaria pathogen could remain deeply hidden? Although cold is a Yin pathogen lodging in the Kidney, forming Yin-cold stagnation that cannot exit easily, wind is a Yang pathogen and should naturally manifest externally following the nature of Shaoyang Wood-Fire. Even if it cannot immediately erupt, it must show signs of wanting to exit but failing, presenting symptoms like vexatious joint pain, frequent nausea, and body heat. At this juncture, discussing treatment, one should use Bai Hu Tang (White Tiger Decoction) to resolve Yang pathogens, add Gui Zhi (Cinnamon Twig) to unblock Ying and Wei, first driving out the wind's agile and changing nature, so that the internally latent Yin-cold becomes isolated and helpless, thereby avoiding brain scorching and muscle wasting. Moreover, if essence and Qi are accumulated and充盈 (full), the Fire of Ming Men (Gate of Life) rises like the morning sun, and even cold pathogens will disperse without specific treatment. If the person's True Fire is weak and unable to disperse, they must exert effort to stir Kidney Qi, after which the pathogen exits with sweat. However, once Yang pathogens leave, there will likely be excessive cold. Treating at this stage incorrectly causes significant harm from Yin pathogens. Hence, the clause "excessive cold appearing later named Mu Nue" supplements this, using Long Gu (Dragon Bone), which has a Yin substance but Yang function, combined with Shu Ji (Pteris Vittata), a light and ascending herb, entering directly into the Kidney to vomit out the latent cold. This is actually Zhang Zhongjing implicitly aligning with the *Nei Jing*'s view of Wen Nue as a critical syndrome, dividing treatment into two layers to curb its momentum. Yet, instead of naming it Wen Nue, he changed the name to Pin Nue (Female Malaria/Mu Nue), likely because the Kidney is a Yin organ, characterized by less heat and more cold, lacking the name of warmth. If such a severe case does not receive Zhang Zhongjing's differentiated treatment, one must wait until brain scorching, muscle wasting, simultaneous attack of wind and cold, and deficiency of both Yin and Yang, then sighing would be too late.
On Nu Mu (Malaria Mass)
The concept of Nu Mu is absent in the *Nei Jing*. Probably in ancient times, diseases were treated mostly with acupuncture, preventing malaria qi from lingering. Only the *Jin Gui* states: If malaria starts on the first day of the lunar month, it should heal by the 15th; if not, it should resolve by the end of the month. If it persists, it forms a mass called Nu Mu, requiring urgent treatment with Bie Jia Jian Wan (Turtle Shell Decoction). Initially, the malaria pathogen lodges in the Ying (Nutritive) level, and attacks occur due to Wei (Defensive) Qi. The body's Ying and Wei are like the Sun and Moon in the sky; just as celestial bodies meet every half-month, Ying and Wei also converge significantly every half-month. During this convergence, Ying and Wei are abundant. How can the malaria pathogen remain hidden in the Ying level? It must gradually penetrate deeper, traveling along the bones, either hiding in the lumbar spine via the Shaoyin channel or knotting at the Mu Yuan (Master Origin) via the Shaoyang channel. The Mu Yuan is the end of the Shaoyang meridian, located at the Zhangmen acupoint. Above is the diaphragm, below is the soft hypochondrium. The pathogen occupies this place like relying on mountains and water; slight agitation causes it to rise with Qi and cause distension, while quietness allows it to hide within the terrain. If Bie Jia Jian Wan is not used urgently to break its fortress, prolonged delay leads to uncontrollable spread. Today, we often see malaria lasting years becoming Nu Mu, where healthy Qi declines daily and pathogenic Qi intensifies. Without attacking, it occupies the center, consuming essence and blood; attacking causes pathogenic Qi to scatter, often transforming into distension syndromes. Is this not due to ignoring Zhang Zhongjing's urgent treatment method?
Q&A on Nu Mu
Question: What is the rationale for Nu Mu knotting in the chest? Answer: Malaria pathogen hides in the Ying level externally and in the lumbar spine/Mu Yuan internally. These areas have gaps allowing the pathogen to reside. The chest is the highest realm, the most Yang division, the source of Zong Qi (Gathering Qi) and the circulation of Da Qi (Great Qi), governing the center and directing the four directions. Even Shang Han (Cold Damage) or Feng Han (Wind-Cold) cannot suddenly invade, let alone malaria pathogen. However, its knotting in the chest results from poor nursing care or improper medication. Due to repeated attacks, daily use of harsh medicines damages Pi Yang (Spleen Yang) and exhausts Middle Qi. The malaria pathogen rebels upward causing distension. Using Qi-regulating medicines worsens the cycle: more distension leads to more reduction, more reduction leads to more distension. Initially condensing with Qi, it eventually becomes hard as iron/stone. Thus, Nu Mu in the chest is no trivial matter. Therefore, I say the primary principle of treating malaria is absolutely avoiding injury to the Yang of the chest.
General Outline of Li Ji (Dysentery)
Treatments for Li Ji throughout history are numerous and varied. However, each claims superiority, seeking profound wisdom is rare. I examined the term "Chang Pi" (Intestinal Splitting) in the *Nei Jing*, meaning floating debris like cotton wool, or water in the intestines. Water carrying debris floats in the intestines, caused either by Cold-Damp coagulation or Damp-Heat stagnation. Like dirty water exposed to scorching sun or freezing cold, debris floats, but clear flowing water does not. Thus, the root of dysentery is always Dampness, derived from two sources: Damp-Cold and Damp-Heat. In summer, Yin Qi is forced inward, Yang Qi floats outward. Indulging in raw/cold foods brings Damp with Cold; sudden Summer-Heat oppression brings Damp with Heat. In autumn, Metal Qi commands, Yang Qi turns inward, stirring previously accumulated Cold/Damp and Heat/Damp, triggering dysentery. Regardless of Cold or Heat, Dampness is the pivot, a crucial insight. Further analyzing the *Nei Jing*: "Chang Pi with bloody stool, fever indicates death, coolness indicates survival." This implies Damp-Heat disturbance depletes Yin; appearance of exterior heat means internal/external burning, leading to rapid exhaustion of Ying Yin. "Chang Pi with white mucus, deep pulse indicates survival, floating pulse indicates death." This implies Cold-Damp lingers internally, Spleen Yang is trapped; floating pulse means internal/external disconnect, signaling stomach Qi collapse. Comparing *Nei Jing* with *Jin Gui*, they align perfectly. Dysentery involves Cold/Heat, which involves Summer-Heat/Dampness. In midsummer, Yang emits outward, Taiyin Damp Earth dominates. With rainy gloom, Damp invades Taiyin, transmitting to Shaoyin. Thus, chronic dysentery involves Spleen and Kidney. Spleen deficiency fails to transport fluids to Lung, causing downward flow; Kidney deficiency fails to store, allowing small intestine waste to go directly to Large Intestine. This is the secret of *Nei Jing* and Zhang Zhongjing. Zhang Zhongjing incorporated Shaoyin diarrhea treatments from *Shang Lun* into *Jin Gui*'s dysentery section, showing his intent. Cold-Damp/Heat-Damp pathogens enter directly inward, differing from Shang Han's exterior entry, yet similar to Cold invading Shaoyin directly or Heat transmitting to Shaoyin. Thus, severe Cold/Warm diseases are treated with Shaoyin diarrhea formulas. This is Zhang's fixed method. Xu Lingtai suspected missing text, suggesting later interpolation, which is a mistake. Anciently called Chang Pi or Zhi Xia, the cause is invariably "Summer Injury from Heat". Summer Heat injury is "Zhong Re" (Heat Stroke), sudden and fast. Dysentery starts subtly, accumulates slowly, manifests in autumn. Causes differ in Cold/Heat and severity. I argue it is "due to Summer Heat" rather than "injured by Summer Heat". In June, Yang floats outward, Yin hides inward, organs are cold. Wealthy people in cool houses eating melons develop Cold Dysentery. Poor laborers sweating heavily drinking cold water bathing in rivers sleeping in wind/dew develop Cold Dysentery. Analyzing sources, 60-70% is Cold-Damp, 20-30% is Damp-Heat. *Taiyin Yangming Treatise* says: Irregular diet/lifestyle harms Yin, entering Five Zang, blocking lower passages, causing loose stools, eventually Chang Pi. No mention of Summer-Heat. Modern doctors mistakenly believe Summer-Heat is Toxic Heat, using Huang Qin (Scutellaria) and Huang Lian (Phellodendron) with breaking/stagnation-resolving drugs as panaceas. Alas! Though extreme heat causing dysentery requires bitter-cold resolution, it is not a constant rule; one must judge based on signs and pulses.
Major Principles of Treating Dysentery
Dampness is the root of dysentery; Shaoyang is the clue for treatment. Why? Dampness with Cold/Heat enters Shaoyin and Taiyin. Taiyin is Root, Shaoyin is Branch. Shaoyin generates Wood; Taiyin fears Wood. Shaoyin deficiency starves Wood, stifling Sheng Qi (Generating Qi); Taiyin deficiency allows Wood to overact, depressing Sheng Qi downward. Thus, dysentery presents with abdominal pain and borborygmus. *Jin Gui* states: Six Fu organs Qi failure externally causes cold limbs, upper Qi, curled legs; Five Zang Qi failure internally causes uncontrollable diarrhea, severe cases cause numbness. Limbs are governed by Spleen; numbness/curled legs indicate Spleen Yang distress and Wood pathogen blockage. Treatment must nourish Spleen Yang and raise Shaoyang Sheng Qi, giving the Central Earth a master and regulatory power. Modern crude practitioners fear using this due to tenesmus (Qi stagnation), not knowing Shaoyang Sheng Qi failure causes Lung Qi rushing to Large Intestine, causing tenesmus. They fear using it due to abdominal pain (Food Stagnation), not knowing Shaoyang Sheng Qi rising excessively causes Wood attacking Taiyin, causing pain. They fear using it due to red color (Summer-Heat), not knowing Shaoyang Sheng Qi failure causes Wood-Fire stripping intestinal lining, causing redness. Waiting for absence of these symptoms before tonifying leads to total Qi failure. My "Tonifying Earth" is not峻补 (violent tonification). If Heat, add bitter-cold; if Cold, add pungent-warm. Always extracting Shaoyang from Earth is key.
Refutation of Diuresis for Dysentery
Worldly belief: Dysentery is internal Heat obstructing Bladder Qi transformation, causing yellow/scanty urine. One should promote urination to drain Heat, stopping diarrhea. This is entrenched. But in Summer/Autumn, fluids leak outward, urine is naturally scant. With internal Heat depleting Yin, promoting urition further exhausts Yin. Examining *Jin Gui*, dozens of clauses mention no diuresis. One says: "Diarrhea with Qi sensation, ensure urine flows." Later interpreted as evidence, but this refers to Xie Xie (Loose Stools), not Li Ji (Dysentery). "Qi" here refers to Bladder Qi accompanying stool. If it were dysentery, why add "Qi"? Crude doctors seeing scant urine use Mu Tong (Akebia), Che Qian Zi (Plantago Seed), Zhu Ling (Polyporus), Ze Xie (Alisma), reducing urine to zero, causing fever/thirst—signs of Yin exhaustion. I use Spleen-tonifying and Clear-Yang-raising methods to promote urination. Raising Clear Qi descends fluids; adding Yin-nourishing fills Kidney Water, anchoring Floating Yang. Days of服用 result in increased volume and cleared color. Hundreds of cases succeed instantly.
Refutation of Sweating for Dysentery
Who started sweating for dysentery? Xu Lingtai supported it, claiming Winter Cold Damage is hot; Summer Heat/Damp/Cold mix is ten times hotter, so dysentery must release via sweat. This is absurd. Winter: Yang inside, Yin outside. Lack of fever in Cold Damage is serious (Cold binding exterior, no interior Yang). Dysentery: Should not have fever; fever means death (Heat invading exterior, no interior Yin). Compare them; do not equate them. Thus, Shang Han needs sweating; Dysentery does not. Claiming external pathogens exit from interior even after 100 days using reverse-pull methods is misleading. Chronic dysentery has dry skin and exhausted fluids; where does sweat come from? Reverse-pull works for sinking Yang occasionally, not as rule. Pathogens exiting externally is impossible. Zhang Zhongjing warned against attacking exterior in dysentery: Sweating causes fullness. Dysentery leaks Yin internally; sweating leaks it externally again? *Jin Gui* says: Dysentery with abdominal fullness and body pain requires warming interior then attacking exterior, because of concurrent exterior syndrome. Without body pain, attacking exterior is forbidden. Physicians must heed these critical points. End of *Yi Yuan*.