论寒热瘴疟证 凡瘴疟病，虽是时行之疾，然老少虚实，受病有浅深，大率不同。有发
热不寒，浑身似火，头痛烦渴谵语者；有发寒不热，嘿嘿昏倦，四肢厥冷，脐腹疼痛；有外
寒内热；有外热内寒；有寒热相半；有哑不能言者；有吐、有泻、有吐泻俱作，当随证用药
。若只言瘴病，一概治之，万一不能取效也。若发时热多寒少，或内热外寒，但热不寒，浑
身如火，头痛烦渴，心胸躁闷，谵语乱言，大小便秘涩，发作无时者，可与小柴胡汤、败毒
散、升麻葛根汤、来苏散、葱白散、神术散。烦渴者，与五苓散、竹叶汤。谵语心闷者，与
五苓散，入辰砂细研和匀，冷热水调服，兼与大至宝丹，及小儿金箔丸两、三丸作一服。头
痛者，与太阳丹、白龙丸、茶调散之类。或热少寒多，或内寒外热，或寒热相半，或骨节酸
痛，脐腹作痛者，可与不换金正气散、人参轻骨散、正气散、圣散子、五积散、香苏散、建
中散、草果饮、嘉禾散或来苏散之类。或不热，只是寒，或吐、或泻、或吐泻俱作，四肢厥
冷，汗出如雨，嘿嘿昏倦者，可与术附汤、四柱散、嘉禾散或鹿茸丸、二姜丸、十华散。若
服前药吐泻不止，四肢厥冷，自汗如雨，小便频数者，与参苓白术散吞来复丹三十丸至五十
丸，甚者姜附汤合和五苓散同煎服。渴者，与参苓白术散。此一证，二广及漳州界上多有之
，余处无。此证发药，须用仔细询问的实，不可轻用，误人性命。切记不可轻发热药。若发
作有时，或连日，或隔日，或三、五日一发，发则热多寒少，或但热不寒者，于未发前，先
与小柴胡汤、败毒散之类。至发日，却服露天饮或圣饮子、胜金丸。呕逆有痰涎者，常山饮
、消暑丸之类，有效如神。若热少寒多，或只寒不热，或寒热相半者，于未发前，可多与不
换金正气散、建中汤、正气散、平胃散、和脾散、嘉禾散之类。至发日五更初，却服常山饮
、草果饮。发久者，克效饼、灵疟丹。老者及怯弱者，不可服，自宜斟酌。孕妇患疟疾，难
为用药，但只可与草果饮，兼用平胃散，入盐少许，用温酒调服。瘴疟瘥后，吃粥或烂饮。
更常调和脾胃，可与黄 建中汤、四君子汤、嘉禾散、参苓白术散、曹脾散、挝脾散、健
脾汤、平胃散、和气散、思食丸、大、小养脾丸。切忌生冷、酒、果、房色，洗浴半月。
论寒热瘴疟证候：凡是瘴疟病，虽然属于时行疫病，但老少体质的虚实不同，受病的深浅也有差异，大体上各不相同。有的发热而不恶寒，全身如火烧，头痛、心烦口渴、胡言乱语；有的发冷而不发热，神情沉默、昏沉疲倦，四肢厥冷，肚脐及腹部疼痛；有的外有寒象内有热象；有的外有热象内有寒象；有的寒热各半；有的失音不能说话；有的呕吐，有的腹泻，有的吐泻同时发作，应当根据具体证候用药。如果只说瘴病，一概而论进行治疗，万一不能取效。若发作时热多寒少，或内热外寒，但热不寒，全身如火烧，头痛心烦口渴，心胸烦躁闷乱，胡言乱语，大小便干结涩滞，发作没有固定时间者，可以给予小柴胡汤、败毒散、升麻葛根汤、来苏散、葱白散、神术散。心烦口渴者，给予五苓散、竹叶汤。胡言乱语且心胸烦闷者，给予五苓散，加入辰砂细研均匀，用冷热水调服，兼服大至宝丹，以及小儿金箔丸两三丸作为一服。头痛者，给予太阳丹、白龙丸、茶调散之类。或者热少寒多，或内寒外热，或寒热相半，或骨节酸痛，肚脐腹部作痛者，可以给予不换金正气散、人参轻骨散、正气散、圣散子、五积散、香苏散、建中散、草果饮、嘉禾散或来苏散之类。或者不发热，只是发冷，或呕吐，或腹泻，或吐泻同时发作，四肢厥冷，汗出如雨，神情沉默、昏沉疲倦者，可以给予术附汤、四柱散、嘉禾散或鹿茸丸、二姜丸、十华散。如果服用前面的药物后吐泻不止，四肢厥冷，自汗如雨，小便频数者，给予参苓白术散吞服来复丹三十丸至五十丸，严重的用姜附汤合和五苓散同煎服。口渴者，给予参苓白术散。这一种证候，两广及漳州边界地区多有发生，其他地方没有。此证发病用药，必须仔细询问核实病情，不可轻易使用，以免误人性命。切记不可轻易使用温热发散的药物。若发作有定时，或连日发作，或隔日发作，或三、五日发作一次，发作时热多寒少，或但热不寒者，在发作前，先给予小柴胡汤、败毒散之类。到了发作之日，却服用露天饮或圣饮子、胜金丸。呕吐逆气且有痰涎者，常山饮、消暑丸之类，有效如神。若热少寒多，或只寒不热，或寒热相半者，在发作前，可多给予不换金正气散、建中汤、正气散、平胃散、和脾散、嘉禾散之类。到了发作之日五更初，却服用常山饮、草果饮。病程长久者，克效饼、灵疟丹。年老及体弱胆怯者，不可服用，应自行斟酌。孕妇患疟疾，难以用药，只能给予草果饮，兼用平胃散，加入少许盐，用温酒调服。瘴疟痊愈后，吃粥或稀烂的饮食。更要经常调和脾胃，可以给予黄耆建中汤、四君子汤、嘉禾散、参苓白术散、曹脾散、挝脾散、健脾汤、平胃散、和气散、思食丸、大、小养脾丸。切忌生冷、酒、水果、房事，洗浴半个月。
Discussion on the Manifestations of Cold and Heat Malaria (Zhang Nue): All cases of Zhang malaria, although they are seasonal epidemics, vary in deficiency and excess among the young and old, and differ in the depth of pathogenic invasion. Generally, they are not uniform. Some present with fever without chills, a body feeling like fire, headache, restlessness, thirst, and delirious speech; some present with chills without fever, taciturnity, drowsiness and fatigue, coldness of the four limbs, and pain in the umbilical and abdominal regions; some have exterior cold and interior heat; some have exterior heat and interior cold; some have equal amounts of cold and heat; some are aphonic and unable to speak; some vomit, some have diarrhea, and some experience both vomiting and diarrhea simultaneously. Medication should be administered according to the specific syndrome. If one merely refers to "Zhang disease" and treats it uniformly, efficacy may not be achieved. If, upon onset, there is more heat than cold, or interior heat with exterior cold, or only heat without cold, with a body feeling like fire, headache, restlessness, thirst, chest and heart irritability and oppression, delirious speech, and constipation or difficult urination and defecation, occurring at irregular intervals, Xiao Chai Hu Tang (Minor Bupleurum Decoction), Bai Du San (Decoction for Overcoming Toxicity), Sheng Ma Ge Gen Tang (Cimicifugae and Puerariae Root Decoction), Lai Su San, Cong Bai San (Scallion White Powder), or Shen Shu San (Divine Efficacy Powder) may be given. For those with restlessness and thirst, Wu Ling San (Five-Ingredient Powder with Poria) and Zhu Ye Tang (Bamboo Leaf Decoction) may be given. For those with delirium and chest oppression, Wu Ling San (Five-Ingredient Powder with Poria) mixed with finely ground Chen Sha (Cinnabar) and taken with cold or warm water, along with Da Zhi Bao Dan (Great Treasure Pill) and two or three pills of Xiao Er Jin Bo Wan (Child's Gold Foil Pill) per dose, may be given. For headache, Tai Yang Dan, Bai Long Wan (White Dragon Pill), or Cha Tiao San (Tea Mixing Powder) may be given. If there is less heat and more cold, or interior cold with exterior heat, or equal amounts of cold and heat, or soreness and pain in the bone joints, and pain in the umbilical and abdominal regions, Bu Huan Jin Zheng Qi San (Unchanging Golden Upright Qi Powder), Ren Shen Qing Gu San (Ginseng Light Bone Powder), Zheng Qi San (Upright Qi Powder), Sheng San Zi, Wu Ji San (Accumulated Cold Powder), Xiang Su San (Tso-Sao Powder), Jian Zhong San (Establish the Middle Powder), Cao Guo Yin (Arenga Seed Drink), Jia He San (Harmonious Grain Powder), or Lai Su San may be given. If there is no fever, only chills, or vomiting, or diarrhea, or both vomiting and diarrhea, with coldness of the four limbs, sweating profusely like rain, taciturnity, drowsiness, and fatigue, Shu Fu Tang (Atractylodes and Aconite Decoction), Si Zhu San (Four Pillar Powder), Jia He San (Harmonious Grain Powder), Lu Rong Wan (Deer Antler Pill), Er Jiang Wan (Two Gingers Pill), or Shi Hua San may be given. If vomiting and diarrhea persist after taking the aforementioned medicines, accompanied by coldness of the four limbs, spontaneous sweating profusely like rain, and frequent urination, Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) taken with 30 to 50 Lai Fu Dan (Restoring Vitality Pills) may be given; for severe cases, Jiang Fu Tang (Ginger and Aconite Decoction) combined with Wu Ling San (Five-Ingredient Powder with Poria) decocted together may be given. For thirst, Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) may be given. This syndrome occurs frequently in Liangguang and the border areas of Zhangzhou, but rarely elsewhere. When prescribing for this condition, careful inquiry and verification are essential; do not use lightly, lest it endanger lives. Remember strictly not to use warming and dispersing herbs lightly. If the attacks occur at regular intervals, or consecutively for days, or every other day, or every three to five days, and during attacks there is more heat than cold, or only heat without cold, Xiao Chai Hu Tang (Minor Bupleurum Decoction) or Bai Du San (Decoction for Overcoming Toxicity) may be given before the onset. On the day of the attack, Tian Lu Yin (Open Sky Drink), Sheng Yin Zi, or Sheng Jin Wan (Winning Metal Pill) may be taken. For retching with phlegm-fluids, Chang Shan Yin (Dichroa Root Drink) or Xiao Shu Wan (Summer-Heat Resolving Pill) may be used, with effects as if divine. If there is less heat and more cold, or only cold without heat, or equal amounts of cold and heat, Bu Huan Jin Zheng Qi San (Unchanging Golden Upright Qi Powder), Jian Zhong Tang (Establish the Middle Decoction), Zheng Qi San (Upright Qi Powder), Ping Wei San (Peaceful Stomach Powder), He Pi San (Harmonize Spleen Powder), or Jia He San (Harmonious Grain Powder) may be given in larger amounts before the onset. At dawn on the day of the attack, Chang Shan Yin (Dichroa Root Drink) or Cao Guo Yin (Arenga Seed Drink) may be taken. For chronic cases, Ke Xiao Bing (Efficacy Achieved Cake) or Ling Nue Dan (Spiritual Malaria Pill) may be used. These are contraindicated for the elderly and the timid/weak; dosage should be adjusted accordingly. Pregnant women suffering from malaria are difficult to treat with medication; only Cao Guo Yin (Arenga Seed Drink) may be given, combined with Ping Wei San (Peaceful Stomach Powder) and a small amount of salt, taken with warm wine. After recovery from Zhang malaria, congee or soft food should be consumed. The spleen and stomach should be regularly harmonized; Huang Qi Jian Zhong Tang (Astragalus Establish the Middle Decoction), Si Jun Zi Tang (Four Gentlemen Decoction), Jia He San (Harmonious Grain Powder), Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder), Cao Pi San, Zhua Pi San, Jian Pi Tang (Strengthen Spleen Decoction), Ping Wei San (Peaceful Stomach Powder), He Qi San (Harmonize Qi Powder), Si Shi Wan (Desire Food Pill), Da Yang Pi Wan (Large Nourish Spleen Pill), or Xiao Yang Pi Wan (Small Nourish Spleen Pill) may be given. Strictly avoid raw/cold foods, alcohol, fruits, sexual intercourse, and bathing for half a month.