陈三农治制府王姓。感冒瘴气。寒热头疼。胸膈饱闷。眩晕恶心。脉数而洪。用藿香正
气散。加浓朴、槟榔、羌、防、苏叶。一剂而寒热退。头不疼。减去羌、苏、防风。加草豆
蔻、半夏、枳壳。恶心胀闷皆愈。
又治梧州方姓。头疼身痛发热。恶心饱闷。脉弦而数。用羌、防、芎、苏、藿、半、槟
榔、苍、朴、橘、草。二服而减。因饱胀未全退。加草果、草豆蔻。方愈。要知恶心饱胀。
乃瘴气之异于感冒也。
端州李别驾。镶蓝旗人。年四十余。能骑射。署雷州府时。善搏虎。不避风雨寒暑。涉
溪陟岭。染瘴已深。其所感风寒暑湿。不一而足矣。又以谢谒上台。到省过劳。积邪所感。
猝然皆发。医者略为解散。即用补剂。而邪气大作。寒热神昏谵语。脉空数无根。神气散乱
补泻兼施。毫无一效。三农诊之。脉如水上羹。刻刻欲脱。寒热间作。盖受病既深。精气
两虚。邪气正炽。法在不治。勉拟五积散加附子、人参。去麻黄而易羌活。其家见立方有难
色。置不用。后医有认阴疟阳虚。而进金匮肾气加参者。有谓虚证似疟。而以补中倍加参附
者。三剂而神昏气喘。虚汗如雨。足冷而脱矣。不知此证初实受瘴气。屡感屡深。今则乘虚
而发。古云。伤寒偏死下虚人。况瘴气而风寒暑湿备感者乎。
两广总制石公子。年甫十龄。六月。感冒风暑。寒热头疼。已用葛根加羌、防解表矣。
后复寒热不减。气喘腹胀。再用小柴胡汤加消导。不应。神昏喘急。寒热间作。时或泄泻似
痢。腹痛。不知名为何病也。陈往视。已二十余日矣。脉数无力。神气昏乱。举家惊惶。按
其腹。时痛时胀。观其神。时静时躁。手足或冷或热。虚汗不已。此外邪初感者。为药而解
久积者。未曾清理。加之以饮食失调。元气欲脱。故虚象显露。细思外邪内陷变病之证。
元气已亏。救本为急。且扶住元神。再筹治病之策。因用理中汤加桂、附。腹痛稍缓。泄泻
顿减。手足亦暖。然发热不退。小便赤浊不利。因用金匮肾气丸作汤。二服小便方利。寒热
愈加。此元气渐回。病证乍现。风寒暑湿食积。种种不清。若欲返本还元。正尔变端不一。
仍朝用六君子汤加柴胡、干葛、神曲、干姜。夜用六味汤加参、桂。旬日后。寒冷拘挛。
眼目翻白。切牙呻吟。举家惊恐恸哭。以为无救矣。陈曰。此名寒战。正气将回。积邪欲出
从
此一变。反有复生之机。自未至酉。始得大汗如雨。手足软怠。不语熟睡。人情虽少定。而
错愕未安也。天明方能言语。然虚证日变。潮热汗多。则用补中合建中加附子。不能安寝则
用归脾汤。元气弱则用十全大补汤。腹痛滑泻则用理中六君汤。如是调摄三阅月。方得返本
还元而奏功也。
震按瘴气者。山岚郁毒之气也。何以可用温补。况系髫年外邪正炽。而参、姜、桂、附
靡不应手。奇矣。自非熟悉其风土病情者。岂敢轻试乎。陈三农亦曰。此证与江浙楚豫北
方各省所患外感内伤迥异。总之瘴气为得病之根。变证便尔不同。医家治之当别具手眼。静
心揣摩。参以各论。庶几有得。
正红旗孙公。病已月余。陈诊其脉空豁。恍惚不定。重按无根。神昏谵语。寒热大作。
加之咳嗽痰喘。转侧不能。昼夜伏几。呻吟而已。且胸膈饱闷。足冷恶寒。询知夏秋积劳。
寒暑皆受。一月以前。初感头疼身痛。憎寒壮热咳嗽。医者用桔梗、杏仁、干葛、羌、苏。
汗而不解。复用桑皮、前胡、苏子、橘、半、知、贝、黄芩。亦不应。因寒热更甚。有用小
柴胡加栀子、元参、薄荷。清痰退热。而咳嗽更甚。不知此证。夏秋暑湿风寒兼感而发。尚
未得汗。何能解散。遂用五积散。二剂而得汗如淋。咳嗽亦减。可以伏枕。惟寒热未退。积
久病深。元气已亏。气上喘。小便如油短数。其火从下而上。上盛下虚。肾气虚惫。因用金
匮肾气加沉香。二服而气平便顺。然潮热如故。时有呓语。人亦忘识。乃知精神耗散。极宜
大补。午后用参附六君汤。朝用肾气丸。次序并进。经月。方思饮食。呓语亦退。虚汗亦止
神气始安。方识平日交往之人。凡用人参、附子。共斤许。精神稍复。然面目黎赤。肌血
不华。再用还少丹加桂、附、河车、鹿角胶。月余。又用十全大补汤二十余剂。元气日长而
饮食如常矣。
震按三农云。此与李别驾等一病形。彼以不信予药而殒。然则李若信之。亦必用大温大
补也。瘴气有此种治法。殊属可骇。或者两粤地方。天暖湿蒸。有发泄而无收藏。人之阳气
外越。故病重者。多以亡阳为治乎。
康熙戊寅十一月。高鹾使公子。患似痢非痢。红多白少。身恶寒微热。询知自夏秋以来
由川北随任之粤。久积暑湿。感冒而发。用平胃加羌、防、紫苏、藿香。一剂而寒热退。
再加槟榔、木香而瘳。或曰。痢疾所忌燥药。今用苍术而愈。何也。曰。常人痢疾。因暑令
火热之气。燥药乃天时之忌。故不可用。今以积湿之气。发于隆冬外感。乃得力之药也。所
谓治病必搜其原耳。梁溪棋师周西候之弟。开铜山于英德。其山下有水。人浣其衣。则腻垢
皆去。咸以为奇物也。以其近便。炊爨亦用之。未几人皆黄胖。身软腹胀而无力。饮食倍进
寒热间作。善啖鸡豕诸肉。则胃腹稍安。在厂同事。毙者不一。因至省会。求救于陈。用
平胃正气治其病。后以益气六君。补其受毒水克削之愆。而安。此即粤西太平柳州南宁毒水
瘴之一班也。
一时开山同病而返省者数人。有陈某似疟非疟。以疟治。势渐笃。三农诊之。脉已细紧
而数。饮食不进。乃曰。若欲治之。何不于一月以前。虽病笃而元气尚在。今病已深。精神
殆尽矣。何药可施乎。旋毙。
又同事一人。似痢非痢。寒热间作。医以香、连、硝、黄。消攻清理。日剧。 羸。因
易一医。曰。可以进补。用白术五分。茯苓四分。陈皮二分。病虽不甚。热亦不减。三农诊
其脉。恍然不定。重按已绝。虽饮食尚可。所谓行尸耳。邪火浮载。真精告竭矣。辞之。阅
二日而死。
震按瘴气为病。情形不一。非亲历其地者。莫能知也。故所叙诸案。不敢妄断。三农久
游两粤。言之甚详。向来诸书未载。今录于后。
瘴者。障也。天地自然之气。为崇山峻岭。障蔽不舒而然也。再加之以春夏之交。万物
发生之际。乖戾郁遏。人多染患。是以道路行役者恒多。而安闲居室者恒少也。闽之仙霞。
粤之庾岭。阳闭于阴。阳瘴为多。粤西近高雷廉者。粤东之余气。证亦相似。其庆远柳州太
平。近于交址诸郡。千山万壑。屏障于南。反阻塞其阳威之气。为山之阳。阴闭于阳。每成
阴瘴。阴湿蕴毒。故阴瘴尤重也。
陈三农诊治制府王姓官员。因感染瘴气，出现寒热往来、头痛、胸膈部胀满憋闷、眩晕恶心等症状，脉象数而洪大。使用藿香正气散（化湿和中、解表散寒的方剂），加入浓朴、槟榔、羌活、防风、紫苏叶。服用一剂后，寒热退去，头痛停止。减去羌活、紫苏、防风，加入草豆蔻、半夏、枳壳。恶心和胀闷症状全部痊愈。
又诊治梧州方姓患者。出现头痛、身痛、发热、恶心、胀满憋闷，脉象弦而数。使用羌活、防风、川芎、紫苏、藿香、半夏、槟榔、苍术、厚朴、陈皮、甘草。服用两剂后症状减轻。因饱胀感未完全消退，加入草果、草豆蔻。病情才痊愈。要知道，恶心和饱胀，是瘴气病区别于普通感冒的特征。
端州李别驾，镶蓝旗人，四十多岁。擅长骑马射箭，在代理雷州府知府期间，善于搏虎，不避风雨寒暑，涉溪爬山，感染瘴气已深。其所感受的风寒暑湿，不一而足。又因拜见上级官员，到省城途中过度劳累，积存的邪气突然发作。医生稍微给予发散治疗，随即使用补益药剂，导致邪气大作，出现寒热交替、神志昏迷、胡言乱语，脉象空虚无根且数，神气散乱。医生补泻兼施，毫无效果。陈三农诊察，脉象如水上浮羹，时刻有脱绝之象，寒热间歇发作。这是因为受病既深，精气两虚，而邪气正盛，按法属于不治之症。勉强拟定五积散（散寒祛湿、理气活血的方剂）加入附子、人参，去掉麻黄而改用羌活。家属看到处方面露难色，放置不用。后来医生有的认为是阴疟阳虚，进服金匮肾气丸（温补肾阳的方剂）加人参；有的认为是虚证似疟，用补中益气汤（补中益气、升阳举陷的方剂）倍加人参、附子。服用三剂后，神志昏迷、气喘、虚汗如雨，脚冷而亡。不知道此证起初实为感染瘴气，屡次感受，邪气愈深，如今乘虚而发。古云：“伤寒偏死下虚之人”，何况是风寒暑湿皆感的瘴气呢？
两广总制石公子，年仅十岁。六月时，感染风暑，出现寒热、头痛。已经使用葛根汤（解肌发表的方剂）加羌活、防风解表。后来寒热仍不减，出现气喘、腹胀，再用小柴胡汤（和解少阳的方剂）加消导药，无效。出现神志昏迷、喘急，寒热间作，时而泄泻似痢疾，腹痛。不知这是什么病。陈三农前往诊治，病程已二十余日。脉象数而无力，神气昏乱，全家惊慌。按压其腹部，时而痛时而胀；观察其神态，时而静时而躁；手足或冷或热，虚汗不止。这是外邪初感时，被药物解散，但久积之邪未曾清理，加之饮食失调，元气欲脱，所以虚象显露。仔细思考外邪内陷变生之证，元气已亏，救本为急务。先扶住元神，再筹划治病之策。于是使用理中汤（温中祛寒、补气健脾的方剂）加桂枝、附子。腹痛稍缓，泄泻顿减，手足亦暖。然而发热不退，小便赤浊不利。于是使用金匮肾气丸改为汤剂。服用两剂后小便方利，寒热更加剧烈。这是元气渐回，病证乍现。风寒暑湿食积，种种不清。若想返本还元，正变化端不一。仍早晨服用六君子汤（健脾化痰的方剂）加柴胡、干葛、神曲、干姜；晚上服用六味地黄汤（滋阴补肾的方剂）加人参、桂枝。旬日后，出现寒冷拘挛，眼目翻白，切牙呻吟，全家惊恐痛哭，以为无救了。陈三农说：这叫“寒战”，是正气将回，积邪欲出，从此一变，反而有复生的机会。从上午九点到下午五点，始得大汗如雨，手足软怠，不语熟睡。人情虽稍定，但仍错愕不安。天明方能言语。然而虚证日日变化，潮热汗多，则用补中益气汤合建中汤加附子；不能安寝则用归脾汤（益气补血、健脾养心的方剂）；元气弱则用十全大补汤（气血双补的方剂）；腹痛滑泻则用理中汤合六君子汤。如此调摄三个月，方才返本还元而奏效。
俞震按：瘴气，是山岚郁结毒浊之气。为何可用温补？况且患儿年幼，外邪正炽，而人参、干姜、桂枝、附子无不应手取效，真是奇妙啊。若非熟悉当地风土病情者，岂敢轻易尝试？陈三农也说：此证与江浙楚豫北方各省所患之外感内伤截然不同。总之，瘴气是致病之根，变证便尔不同。医家治疗当别具手眼，静心揣摩，参以各论，庶几有所心得。
正红旗孙公，患病已月余。陈三农诊其脉象空豁，恍惚不定，重按无根，神志昏迷、胡言乱语，寒热大作。加之咳嗽痰喘，转侧不能，昼夜伏案，只是呻吟。且胸膈胀满憋闷，足冷恶寒。询问得知夏秋季节积劳，寒暑皆受。一个月以前，初感头痛身痛，憎寒壮热咳嗽。医生用桔梗、杏仁、干葛、羌活、紫苏，发汗而不解。复用桑白皮、前胡、苏子、陈皮、半夏、知母、贝母、黄芩，亦无效。因寒热更甚，有用小柴胡汤加栀子、玄参、薄荷，清痰退热，而咳嗽更甚。不知此证，是夏秋暑湿风寒兼感而发，尚未得汗，何能解散？遂用五积散。二剂后得汗如淋，咳嗽亦减，可以伏枕。惟寒热未退。积久病深，元气已亏，气上喘，小便如油短数。其火从下而上，上盛下虚，肾气虚惫。于是用金匮肾气丸加沉香。二剂后气平便顺。然而潮热如故，时有呓语，人也忘识。乃知精神耗散，极宜大补。午后用参附六君子汤，早晨用肾气丸，次序并进。经一月，方思饮食，呓语亦退，虚汗亦止，神气始安，方识平日交往之人。凡用人参、附子，共一斤许，精神稍复。然面目黎赤，肌血不华。再用还少丹（温肾健脾的方剂）加桂枝、附子、紫河车、鹿角胶。月余，又用十全大补汤二十余剂。元气日长而饮食如常矣。
俞震按：陈三农说，此与李别驾等病情相似。彼因不信予药而殒命。然则李若信之，也必用大温大补之法。瘴气有此种治法，殊属可骇。或许两粤地方，天暖湿蒸，有发泄而无收藏。人之阳气外越，故病重者，多以亡阳为治乎？
康熙戊寅年十一月，高盐运使公子，患似痢非痢，红多白少，身体恶寒微热。询问得知自夏秋以来由川北随任至粤，久积暑湿，感冒而发。用平胃散（燥湿运脾的方剂）加羌活、防风、紫苏、藿香。一剂后寒热退。再加槟榔、木香而痊愈。有人说：痢疾所忌燥药，今用苍术而愈，为何？答曰：常人痢疾，因暑令火热之气，燥药乃天时之忌，故不可用。今以积湿之气，发于隆冬外感，乃得力之药也。所谓治病必搜其原耳。梁溪棋师周西候之弟，在英德开铜山。其山下有水，人浣其衣，则腻垢皆去，咸以为奇物也。以其近便，炊爨亦用之。未几人皆黄胖，身软腹胀而无力，饮食倍进，寒热间作，善啖鸡豕诸肉，则胃腹稍安。在厂同事，毙者不一。因至省会，求救于陈三农。用平胃正气治其病。后以益气六君，补其受毒水克削之愆，而安。此即粤西太平柳州南宁毒水瘴之一班也。
一时开山同病而返省者数人，有陈某似疟非疟，以疟治，势渐笃。陈三农诊之，脉已细紧而数，饮食不进。乃曰：若欲治之，何不于一月以前？虽病笃而元气尚在。今病已深，精神殆尽矣，何药可施乎？旋毙。
又同事一人，似痢非痢，寒热间作。医以香连丸、硝黄，消攻清理，日剧。羸。因易一医，曰：可以进补。用白术五分，茯苓四分，陈皮二分。病虽不甚，热亦不减。陈三农诊其脉，恍然不定，重按已绝。虽饮食尚可，所谓行尸耳。邪火浮载，真精告竭矣。辞之。阅二日而死。
俞震按：瘴气为病，情形不一，非亲历其地者，莫能知也。故所叙诸案，不敢妄断。陈三农久游两粤，言之甚详。向来诸书未载，今录于后。
瘴者，障也。天地自然之气，为崇山峻岭，障蔽不舒而然也。再加之以春夏之交，万物发生之际，乖戾郁遏，人多染患。是以道路行役者恒多，而安闲居室者恒少也。闽之仙霞，粤之庾岭，阳闭于阴，阳瘴为多。粤西近高雷廉者，粤东之余气，证亦相似。其庆远柳州太平，近于交址诸郡，千山万壑，屏障于南，反阻塞其阳威之气，为山之阳，阴闭于阳，每成阴瘴。阴湿蕴毒，故阴瘴尤重也。
Chen Sansan treated a government official surnamed Wang, the Governor-General. He had contracted miasma (mountain miasma), presenting with alternating chills and fever (alternating chills and fever), headache, fullness and oppression in the chest and diaphragm, dizziness, and nausea. The pulse was rapid and surging. He prescribed Huoxiang Zhengqi San (Agastache Powder to Rectify the Qi) with added Houpo (Magnolia Bark), Binglang (Areca Seed), Qianghuo (Notopterygium Rhizome), Fangfeng (Saposhnikovia Root), and Zisuye (Perilla Leaf). After one dose, the alternating chills and fever subsided, and the headache ceased. Qianghuo, Zisu, and Fangfeng were removed, and Doukou (Grass Cardamom), Banxia (Pinellia Tuber), and Zhike (Aurantium Fruit) were added. The nausea and distension completely resolved.
He also treated a patient surnamed Fang from Wuzhou. Symptoms included headache, body pain, fever, nausea, and fullness/oppression. The pulse was wiry and rapid. He prescribed Qianghuo, Fangfeng, Xiong (Ligusticum Chuanxiong Rhizome), Zisu, Huoxiang, Banxia, Binglang, Cangzhu (Atractylodes Rhizome), Houpo, Chenpi (Tangerine Peel), and Gancao (Licorice Root). After two doses, symptoms decreased. Because the bloating had not fully resolved, Caoguo (Black Cardamom) and Doukou were added. Only then did the condition resolve. It must be understood that nausea and bloating are characteristics distinguishing miasma disease from common colds.
Li Biejia of Duanzhou, a member of the Plain Blue Banner, was over forty years old. He was skilled in horsemanship and archery. While serving as acting Prefect of Leizhou, he was adept at fighting tigers, braving wind, rain, cold, and heat, wading through streams, and climbing ridges. He had deeply contracted miasma. His exposure to wind, cold, summer-heat, and dampness was extensive. Additionally, due to visiting superiors, he became exhausted traveling to the provincial capital. The accumulated pathogenic factors suddenly manifested. Physicians initially provided mild dispersing treatments, followed immediately by tonifying agents, which caused the pathogenic factors to flare up severely. Symptoms included alternating chills and fever, coma, delirium, a hollow and rapid pulse without root, and scattered spirit. Physicians attempted both tonification and purgation simultaneously with no effect. Chen Sansan diagnosed the pulse as resembling soup floating on water, indicating imminent collapse. Alternating chills and fever occurred intermittently. Since the disease was deep-seated, both essence and qi were deficient, while pathogenic factors were vigorous, this case was deemed untreatable according to standard methods. Reluctantly, he formulated Wuji San (Five Accumulations Powder) with added Fuzi (Aconite Lateral Root) and Renshen (Ginseng Root), removing Mahuang (Ephedra Stem) and substituting it with Qianghuo. The family showed reluctance at the prescription and did not use it. Subsequent physicians identified it as Yin malaria with Yang deficiency and administered Jin Gui Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet) with Renshen. Others considered it a deficiency syndrome resembling malaria and used Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with doubled Renshen and Fuzi. After three doses, coma, asthma, profuse sweating like rain, and cold feet led to death. They failed to realize that the initial cause was real miasma infection, repeatedly contracting deeper pathogens, now manifesting upon deficiency. As the ancients said, "Shanghan (Cold Damage) tends to kill those with lower deficiency." How much more so for miasma involving wind, cold, summer-heat, and dampness?
The son of the Governor-General of Liangguang was only ten years old. In June, he contracted wind and summer-heat, presenting with alternating chills and fever and headache. Ge Gen Jia Qianghuo Fangfeng Tang (Kudzu Decoction plus Notopterygium and Saposhnikovia) was used to release the exterior. Later, alternating chills and fever persisted, accompanied by asthma and abdominal distension. Xiao Chai Hu Tang (Minor Bupleurum Decoction) with digestive aids was ineffective. Coma, urgent breathing, intermittent alternating chills and fever, occasional dysentery-like diarrhea, and abdominal pain ensued. The nature of the disease was unknown. Chen Sansan visited after more than twenty days. The pulse was rapid and powerless; the spirit was confused. The whole family was panicked. Abdominal palpation revealed intermittent pain and distension. Observation of the spirit showed alternating calmness and agitation. Hands and feet were alternately cold and hot, with incessant spontaneous sweating. This indicated that while external pathogens were initially dispersed by medication, long-standing accumulated pathogens were not cleared, compounded by dietary irregularities leading to impending collapse of Yuan Qi (Original Qi). Thus, deficiency signs were prominent. Careful consideration of external pathogens sinking inward and transforming revealed depleted Yuan Qi. Saving the root was urgent. First, stabilize the Yuan Shen (Original Spirit), then plan treatment. Lizhong Tang (Regulate the Middle Decoction) with Guizhi (Cinnamon Twig) and Fuzi was used. Abdominal pain eased slightly, diarrhea decreased sharply, and hands and feet warmed. However, fever persisted, and urine was red, turbid, and difficult to pass. Jin Gui Shen Qi Wan was prepared as a decoction. After two doses, urination improved, but alternating chills and fever worsened. This indicated gradual recovery of Yuan Qi, causing latent pathogens to surface. Wind, cold, summer-heat, dampness, and food stagnation were all unclear. To restore the root, variations were necessary. Morning: Liujunzi Tang (Six Gentlemen Decoction) with Chaihu (Bupleurum Root), Gegen, Shenqu (Medicated Leaven), and Shengjiang (Fresh Ginger). Evening: Liuwei Dihuang Tang (Six-Ingredient Rehmannia Decoction) with Renshen and Guizhi. Ten days later, cold rigors, muscle spasms, eyes rolling back, teeth grinding, and groaning occurred. The family feared death. Chen Sansan stated: "This is called 'Han Zhan' (Cold Rigors). It indicates returning righteous Qi and expelling accumulated pathogens. A transformation occurs, offering a chance for recovery." From 9 AM to 5 PM, profuse sweating like rain occurred. Hands and feet became soft and limp; he fell into silent sleep. Although the family calmed somewhat, anxiety remained. Speech resumed at dawn. As deficiency symptoms changed daily, with tidal fever and profuse sweating, Buzhong Yiqi Tang combined with Jianzhong Tang (Establish the Middle Decoction) plus Fuzi was used. For insomnia, Guipi Tang (Restore the Spleen Decoction) was used. For weak Yuan Qi, Shiquan Dabu Tang (Ten Great Tonics Decoction) was used. For abdominal pain and slippery diarrhea, Lizhong Tang combined with Liujunzi Tang was used. After three months of such regulation, restoration was achieved.
Yu Zhen commented: Miasma is toxic air condensed from mountain mists. Why use warm tonification? Especially since the child was young and external pathogens were vigorous, yet Renshen, Shengjiang, Guizhi, and Fuzi were effective. This is remarkable. Only those familiar with local climate and pathology would dare try this. Chen Sansan also noted: This condition differs significantly from external invasions and internal injuries in Jiangsu, Zhejiang, Hubei, Henan, and northern provinces. Miasma is the root cause, leading to different transformations. Physicians must have unique insights, study carefully, and consult various treatises to gain understanding.
Official Sun of the Plain Red Banner had been ill for over a month. Chen Sansan found his pulse hollow, fluctuating, and rootless upon deep pressure. He presented with coma, delirium, severe alternating chills and fever, cough, phlegm, asthma, inability to turn, constant groaning while leaning on the desk, chest fullness, cold feet, and aversion to cold. History revealed accumulation of fatigue during summer and autumn, exposure to cold and heat. One month prior, initial symptoms were headache, body pain, aversion to cold, high fever, and cough. Physicians used Jiegeng (Platycodon Root), Xingren (Apricot Seed), Gegen, Qianghuo, and Zisu to induce sweat without relief. Then Sangbaipi (Mulberry Bark), Qianhu (Peucedanum Root), Suzi (Perilla Seed), Chenpi, Banxia, Zhimu (Anemarrhena Rhizome), Beimu (Fritillaria Bulb), and Huangqin (Scutellaria Root) were used without success. Due to worsening chills and fever, Xiao Chai Hu Tang with Zhizi (Gardenia Fruit), Xuanshen (Scrophularia Root), and Bohe (Mint Leaf) was used to clear phlegm and reduce fever, worsening the cough. The condition resulted from simultaneous contraction of summer-heat, dampness, wind, and cold in summer/autumn, without sweating, hence dispersal failed. Wuji San was prescribed. After two doses, profuse sweating occurred, cough decreased, and he could rest on a pillow. Alternating chills and fever persisted. Long-standing deep disease depleted Yuan Qi, causing upward rushing of Qi, oily short frequent urination. Fire rose from below, creating upper excess and lower deficiency, with exhausted Kidney Qi. Jin Gui Shen Qi Wan with Chenxiang (Aquilaria Wood) was used. After two doses, breathing normalized, and urination improved. However, tidal fever persisted, along with muttering and forgetfulness. Mental energy was scattered, requiring strong tonification. Afternoon: Shenfu Liujunzi Tang (Ginseng and Aconite Six Gentlemen Decoction); Morning: Shenqi Wan. Administered sequentially for a month. Appetite returned, muttering ceased, sweating stopped, spirit stabilized, and recognition of acquaintances resumed. Total usage of Renshen and Fuzi amounted to about one jin. Spirit partially recovered. Face was dark red, skin lacked luster. Huanshao Dan (Return to Youth Pill) with Guizhi, Fuzi, Heche (Placenta), and Lujiaojiao (Deer Antler Glue) was used. After a month, Shiquan Dabu Tang was given for over twenty doses. Yuan Qi grew daily, and diet normalized.
Yu Zhen commented: Chen Sansan stated this case resembled that of Li Biejia. Li died due to distrust of the prescription. Had Li trusted it, large warm and tonifying methods would have been used. Such treatment for miasma is shocking. Perhaps in Liangguang, warm and humid climates promote dispersion without storage, causing Yang Qi to escape outward. Thus, severe cases are often treated as Yang collapse.
In November of the Wuyin year of Kangxi's reign, the son of Salt Commissioner Gao suffered from dysentery-like symptoms but not true dysentery: more red blood than white mucus, aversion to cold, and slight fever. History revealed travel from Northern Sichuan to Guangdong during summer/autumn, accumulating damp-heat, triggered by external contraction. Pingwei San (Peace the Stomach Powder) with Qianghuo, Fangfeng, Zisu, and Huoxiang was used. One dose resolved chills and fever. Adding Binglang and Muxiang cured the condition. Some asked: Dryness-inducing herbs are contraindicated in dysentery. Why did Cangzhu work? Answer: Common dysentery stems from summer heat/fire, making dryness contraindicated. Here, accumulated dampness manifested in winter with external contraction, making these herbs effective. Treating the root is essential.
The brother of Zhou Xihou, a chess master from Liangxi, managed a copper mine in Yingde. Water from the mountain base cleaned clothes effectively. Locals used it for cooking. Soon, people became yellow and puffy, weak, with abdominal distension, increased appetite, alternating chills and fever, and craving meat for stomach comfort. Colleagues died frequently. Seeking help from Chen Sansan in the provincial capital, Pingwei Zhengqi was used. Later, Yiqi Liujunzi was used to replenish deficits caused by toxic water. This exemplifies toxic water miasma in Taiping, Liuzhou, and Nanning, Western Guangdong.
Several miners returning to the province fell ill similarly. One, surnamed Chen, resembled malaria but was treated as malaria, worsening. Chen Sansan found a fine, tight, rapid pulse and anorexia. He remarked: "Why not treat a month ago when Yuan Qi was still present despite severe illness? Now the disease is deep, spirit exhausted. What medicine can be applied?" He soon died.
Another colleague had dysentery-like symptoms with alternating chills and fever. Physicians used Xianglian Wan (Coptis and Aucklandia Pill), Xiaoshi (Digestive clearing), and Xiaohuang (Purgation), worsening the condition. Another physician suggested tonification: Baizhu (Atractylodes Macrocephala Rhizome) 5 fen, Fuling (Poria), Chenpi 2 fen. Disease was mild, but fever persisted. Chen Sansan found a fluctuating pulse, absent upon deep pressure. Though eating was okay, he was a "walking corpse." Floating pathogenic fire, exhausted essence. Chen declined treatment. The patient died two days later.
Yu Zhen commented: Miasma presents variably; only those who have experienced it locally can understand. Thus, I dare not judge arbitrarily. Chen Sansan traveled extensively in Liangguang and described these cases in detail. Previously unrecorded, they are listed here.
"Zhang" (Miasma) means obstruction. Natural Qi of heaven and earth is obstructed by high mountains and steep ridges, failing to circulate freely. Combined with spring and early summer, when all things generate, chaotic and stagnant Qi leads to widespread infection. Travelers suffer more than those at home. In Xianxia (Fujian) and Yuling (Guangdong), Yang is closed by Yin, resulting mostly in Yang Miasma. In Western Guangdong near Gaoleilian, residual Qi from Eastern Guangdong causes similar syndromes. In Qingyuan, Liuzhou, and Taiping, near Annam, thousands of mountains block Southern Yang Qi. On the sunny side of mountains, Yin closes Yang, forming Yin Miasma. Yin-dampness condenses toxicity, making Yin Miasma particularly severe.