鼻衄因受外感，内有伏火。为疟为单热，数日后忽鼻衄如注。此邪入血分，欲借血而泄
，名
为红汗。徒伤血分，不及正汗远甚，治须清疏中佐凉血之品。有少年磕伤成病，每逢烦劳即
发，宜当归补血汤，加生地炭、牛膝炭、荆芥炭，陈皮、归身，亦须炒黑，方能止血，免助
火也。有心肺火炎，犀角地黄汤亦可用。
宿有是病，屡屡发者，为劳损之苗。予每用黄连六味汤、补血汤，加旱莲草、生地、丹
皮，多效。亦有外感，内有伏火，出血吐地即凝者，此由郁火，药用柴胡、薄荷、黄连、
山栀、丹皮、赤芍之类，随其症而加减之。
疟成于夏秋为多，他时虽有，终不似夏秋之众也。盖夏月人食肥浓，并吸受暑邪，外感
凉风，
或冒露水，始则皮毛闭塞，暑邪欲泄不泄；内之肥浓，间化为痰。风露之感在表，暑食所
伤
在里，半表半里，足少阳胆经应之。卫气陷入营分，则为寒；营气不交于卫，则为热呕吐者
，胃有积痰也；心烦少寐者，胃不和也；口苦者，胆热也。此日疟、间疟之所由作也。治法
当疏邪清热，涤痰利气、消痰并施，柴胡、（日疟寒轻者用薄荷亦可。）青蒿、半夏、陈皮、
黄芩、神曲、甘草。无汗加苏叶；热甚加石膏、知母、竹叶；口渴加花粉；呕甚加炒竹茹，
小便短赤加滑石，胸满或闷，加枳实、栝
蒌皮；嗳腐加楂肉；舌黄或煤色，脉弦实，大便多日不解者，可加大黄下之；咳嗽加杏仁、
射
干、前胡。服药先一剂，系其惰，谓将解早一时服；第二帖迎而夺之，谓未发前早一时服。
近世富贵人，畏服柴胡。按∶此味惟
邪未入少阳服之，所谓开门揖盗，引邪入室，原所禁用。既往来寒热，脉弦口苦，心烦喜呕
，少阳症已见，柴胡升清肝胆之热，必用之品，何碍之有？凡疟之寒甚者，战栗气急，虽热
天绵被数重，不足蔽其辜，不知者当寒作时，恣饮姜汤火酒，寒不能祛，而其日热作必甚，
助其火也。《准绳》一说殊妙，谓疟之作寒，乃阳气陷入阴中，须升提之，予用之多效。一
医治一人寒重，用桂枝、当归，即变为壮热不休，几致丧命。嗟乎！治疟又当分初、中、后
，在气在血。以上之治，是在初在气之法也，中则气血之间，后则皆在血分矣。更宜疏中用
补，补中兼清，无一定之方，不移之法，如鸳鸯绣出，金针难度，在人聪明好学，神而明之
也。更有疟作，女人月事适行，为壮热谵语，甚有如狂者，此为热入血室，小柴胡去参，加
生地、归须、丹皮，一服可愈。其 疟，即三日疟，予医案中虽有数条，一时偶中，其大
段细节，未能深究，不敢妄言。《 疟论疏》一卷，明·卢之颐撰，至为详悉，可观也。
鼻衄（鼻出血）因感受外邪，体内有潜伏之火。表现为疟疾或单纯发热，数日后突然鼻出血如注。这是病邪进入血分，想要借由血液来宣泄，称为“红汗”。这比通过正常汗液泄邪对正气的损伤要严重得多，治疗需要在清热疏解中配合凉血的药物。
有一位少年因磕碰受伤而致病，每逢烦劳就会发作，适宜使用当归补血汤，加入生地炭、牛膝炭、荆芥炭，以及陈皮和归身（当归的根部），这些药材也需要炒黑，才能起到止血作用，避免助长火势。如果是心肺火炎上，犀角地黄汤也可以使用。
如果宿有此病，屡屡发作，这是劳损的先兆。我通常使用黄连六味汤、补血汤，加入旱莲草、生地、丹皮，大多有效。也有因外感、内有伏火，导致出血后吐出的血液立即凝固的情况，这是由于郁火所致，药用柴胡、薄荷、黄连、山栀、丹皮、赤芍之类，根据症状进行加减。
疟疾多在夏秋季节形成，其他季节虽有，但终究不如夏秋季节多。大概是因为夏季人们食用肥甘厚味，并吸受暑邪，又外感凉风，或者冒犯露水，起初皮毛闭塞，暑邪想排泄却排不出来；体内的肥甘厚味，有时转化为痰。风露之邪在体表，暑湿饮食所伤在体内，病位在半表半里，足少阳胆经对应此部位。卫气陷入营分，则表现为寒战；营气不与卫气相交，则表现为发热。呕吐的，是胃中有积痰；心烦睡眠少的，是胃气不和；口苦的，是胆热。这就是日疟、间疟产生的原因。治疗方法应当疏解邪气、清热、涤除痰浊、利气，消痰之法并用，常用柴胡、青蒿、半夏、陈皮、黄芩、神曲、甘草。（若是日疟且寒轻者，也可用薄荷代替柴胡。）无汗加苏叶；热甚加石膏、知母、竹叶；口渴加花粉；呕吐严重加炒竹茹；小便短赤加滑石；胸满或胸闷加枳实、栝楼皮；嗳腐吞酸加山楂肉；舌苔黄或黑，脉弦实，大便多日不解的，可以加大黄攻下；咳嗽加杏仁、射干、前胡。服药先服一剂，以抑制其惰性，即在预计发作前一小时服用；第二帖趁势夺其邪气，即在预计发作前一小时服用。
近代富贵之人，畏惧服用柴胡。按：此药只有当邪气尚未进入少阳经时才禁用，否则所谓“开门揖盗”，引邪入内，原属禁用。但如果已经出现往来寒热、脉弦、口苦、心烦喜呕等少阳证已见的情况，柴胡能升发清散肝胆之热，是必用之品，有什么妨碍呢？凡是疟疾寒战严重的，战栗气急，即使在夏天盖几层绵被，也不足以遮蔽其寒冷，不知病情的人往往在寒战时恣意饮用姜汤或烈酒，这样不仅不能祛除寒气，反而会使当天的热症更加严重，因为这是在助长火势。《准绳》中的一种说法非常精妙，认为疟疾发作时的寒战，是由于阳气陷入阴中，需要升提阳气，我使用这种方法大多有效。有一位医生治疗一位寒重患者，使用桂枝、当归，结果变成了壮热不退，几乎导致丧命。唉！治疗疟疾又应当分为初、中、后三个阶段，区分在气分还是在血分。以上所述的治疗方法，是在初期、在气分的治法；中期则是气血之间；后期则都在血分了。更应当在疏解中兼用补益，在补益中兼用清热，没有固定的方子，没有不变的方法，就像绣出的鸳鸯，金针难渡，全凭医生的聪明好学，神而明之。还有疟疾发作时，女子月经正好来潮，出现壮热谵语，甚至像发狂一样的，这是热入血室，用小柴胡汤去掉人参，加入生地、归须、丹皮，一服即可痊愈。至于三日疟，即三日内发作一次的疟疾，我的医案中虽有数条记录，但只是偶然中的，对其大体细节未能深入探究，不敢妄言。明代卢之颐撰写的《疟论疏》一卷，记载得非常详细，值得参考。
Epistaxis (nosebleed) caused by external pathogenic invasion and latent fire within. It manifests as malaria or simple fever, followed days later by sudden profuse epistaxis. This indicates the pathogen has entered the blood level, seeking to vent through blood, termed "red sweat" (Hong Han). This injures the blood level far more severely than venting through normal sweat; treatment requires clearing and dispersing with the addition of blood-cooling agents.
A young man fell ill due to a contusion, recurring whenever he exerted himself. He should be treated with Danggui Buxue Tang (Angelica Sinensis Decoction for Replenishing Blood), added with Tan Shengdi (Charred Rehmanniae Radix), Tan Niuxi (Charred Achyranthis Bidentatae Radix), Tan Jingjie (Charred Schizonepetae Spica), Chenpi (Citri Reticulatae Pericarpium), and Dangguishen (the root part of Angelicae Sinensis Radix). These herbs must also be charred black to achieve hemostasis and avoid aggravating fire. If there is flaming fire of the Heart and Lungs, Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) may also be used.
If this condition is chronic and recurs frequently, it is a precursor to consumptive disease. I often use Huanglian Liuwang Tang (Coptis Hexagenus Decoction) and Buxue Tang (Replenishing Blood Decoction), added with Hanliancao (Ecliptae Herba), Shengdi (Rehmanniae Radix), and Danpi (Moutan Cortex), which are mostly effective. There are also cases of external invasion with latent fire, where bleeding stops immediately after spitting out congealed blood; this is due to constrained fire. Medications such as Chaihu (Bupleuri Radix), Bohe (Menthae Haplocalycis Herba), Huanglian (Coptidis Rhizoma), Shanzhi (Gardeniae Fructus), Danpi (Moutan Cortex), and Chishao (Paeoniae Radix Rubra) are used, modified according to symptoms.
Malaria occurs most frequently in summer and autumn; although it appears at other times, it is never as prevalent as in these seasons. Generally, in summer, people consume rich and fatty foods and inhale summer-heat pathogens. External cold wind or exposure to dew causes initial closure of the skin pores, preventing the release of summer-heat. Internally, rich food transforms into phlegm. The pathogenic factors of wind and dew are on the exterior, while those of summer-heat and diet are in the interior. The location is half-exterior and half-interior, corresponding to the Foot-Shaoyang Gallbladder Meridian. When Wei Qi (Defensive Qi) sinks into Ying level (Nutritive level), chills occur; when Ying Qi does not interact with Wei Qi, fever occurs. Vomiting indicates accumulated phlegm in the Stomach; irritability and insomnia indicate disharmony of the Stomach; bitter taste in the mouth indicates Gallbladder heat. These are the origins of daily malaria and intermittent malaria. The treatment method should involve dispersing pathogens, clearing heat, purging phlegm, promoting Qi movement, and eliminating phlegm simultaneously. Common herbs include Chaihu (Bupleuri Radix), Qinghao (Artemisiae Annuae Herba), Banxia (Pinelliae Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Huangqin (Scutellariae Radix), Shenqu (Massae Fermentatae Medicae), and Gancao (Glycyrrhizae Radix et Rhizoma). (For daily malaria with mild chills, Bohe may be used instead of Chaihu.) Add Ziyeh (Perillae Folium) if there is no sweat; add Shigao (Gypsum Fibrosum), Zhimu (Anemarrhenae Rhizoma), and Zhuyeh (Phyllostachys Folium) if heat is severe; add Huafen (Trichosanthis Radix) if thirsty; add Chao Zhuru (Processed Bambusae Caulis in Taeniam) if vomiting is severe; add Huashi (Talcum) if urine is short and red; add Zhishi (Aurantii Fructus Immaturus) and Gualoupi (Benincasae Exocarpium) if chest fullness or oppression exists; add Zharon (Crataegi Fructus) if belching with sour regurgitation occurs; if the tongue coating is yellow or black, the pulse is wiry and excess, and bowel movements have been absent for several days, Dahuang (Rhei Radix et Rhizoma) can be added to purge. Add Xingren (Armeniacae Semen Amarum), Shegan (Belamcandae Rhizoma), and Qianhu (Peucedani Radix) if coughing occurs. Take the first dose one hour before the expected onset to suppress its inertia; take the second dose one hour before the expected onset to intercept and seize the pathogen.
In modern times, wealthy people fear taking Chaihu. Note: This herb is contraindicated only when the pathogen has not yet entered the Shaoyang stage; otherwise, it would be like "opening the door to invite thieves," drawing the pathogen inside. However, if symptoms such as alternating chills and fever, wiry pulse, bitter taste, irritability, and frequent vomiting—indicative of established Shaoyang syndrome—are present, Chaihu is essential to ascend and clear heat from the Liver and Gallbladder. What harm could it do? In cases of severe malaria chills, where shivering and rapid breathing occur, even multiple layers of cotton quilts in summer are insufficient to cover the patient. Unknowingly, patients often drink copious amounts of ginger soup or strong liquor during the chills. This fails to dispel the cold but exacerbates the subsequent fever, as it aids the fire. A theory in *Zhunsheng* is particularly brilliant: the chills in malaria are due to Yang Qi sinking into Yin, requiring lifting and raising. I have used this method with much success. One physician treated a patient with severe chills using Guizhi (Cinnamomi Ramulus) and Danggui (Angelicae Sinensis Radix), resulting in persistent high fever that nearly caused death. Alas! Treating malaria requires distinguishing between early, middle, and late stages, and whether the pathology is in Qi or Blood. The above treatments apply to the early stage and Qi level; the middle stage involves both Qi and Blood; the late stage involves the Blood level. One should combine dispersing with tonifying, and tonifying with clearing. There are no fixed formulas or unchanging methods; it is like embroidery, where the golden needle is hard to guide, depending entirely on the physician's intelligence and diligent study to understand profoundly. Furthermore, if malaria occurs while a woman's menstruation is just beginning, accompanied by high fever, delirium, and manic behavior resembling madness, this is heat entering the Blood Chamber. Use Xiaochaihu Tang (Minor Bupleurum Decoction) removing Renshen (Ginseng Radix), adding Shengdi (Rehmanniae Radix), Guixu (Angelicae Sinensis Radix filamentous root), and Danpi (Moutan Cortex); one dose can cure it. Regarding Sanri Nüe (tertian malaria), although my medical records contain a few cases, they were accidental successes, and I have not deeply investigated the major details, so I dare not speak rashly. The volume *Nüelun Shu* (Commentary on Malaria Theory) written by Lu Zhiyi of the Ming Dynasty is very detailed and worth reading.