（寒热往来附）
夏伤于暑。秋必 疟。又云疟病。必由风着。内经之言。宜为细度。夏月盛暑。腠理开发。汗出当风。浴后磅因礴。
卫气不守。邪气内薄。舍于膜原。应时而剧。暑日得风。根因是托。然而小儿。多由食抟。脾弱胃衰。乳食停积。诸邪
悉附。与正相角。壅遏阴阳。二气交错。阴盛阳虚。先寒而栗。阳胜阴虚。先热如烙。邪与卫并。故日挥霍。邪深入里。
故间日作。疟必有痰。停滞胸膈。疟必有湿。酸疼手脚。瘅牝温寒。鬼瘴名各。为症不同。而可约略。冷起毫毛。伸欠
萧索。战栗鼓颔。头痛如凿。及其热时。内外火铄。渴欲引饮。身疼筋缚。或先寒侵。或先热灼。阴阳偏胜。如酬如酢。
故以往来。寒热如约。丹溪有言。最为精确。无汗发汗。散邪为主。有汗止汗。固正宜速。务期邪尽。阴阳和协。无奈
世医。不知用药。小柴胡汤。以为定法。不知前贤。再四叮嘱。早服柴胡。淹缠难却。邪由外散。正无内削。用和阴阳。
才可下HT 。莫慢轻疏。切宜斟酌。久疟不愈。疟母内托。胸胁之间。可按可摸。治应消散。毋俾正弱。
曾氏曰。内经疟论云。夏伤于暑。秋必 疟。谓腠理开而汗出遇风。或得于澡浴。水气舍于皮肤间。因卫气不守。
邪气并居。其疾始作。伸欠寒栗。腰背俱痛。骨节烦疼。寒生则内外皆热。头疼而渴。乃阴阳二气交争。虚实更作而然。
阴气独盛。则阳虚。故先寒战栗。腰背头项骨节皆痛。阳气独胜。则阴虚。故先热。发时不嗜食。喜呕。头疼腰痛。小
便不利。阴盛阳虚。则内外皆寒。阴盛阴虚。则内外皆热。此外感六淫。或内伤七情。蕴积痰饮。病气与卫气并居。故
病日作。卫气昼行于阳。夜行于阴。得阳而外出。得阴而内薄。五脏病气深入。不能与卫气俱出。则间日而作。当卫气
所至。病气所在。则发。在阳则热。在阴则寒。俟阴阳各衰。卫气与病气相离。则病休。阴阳相搏。卫气与病气相集。
则复作。各随其卫气之所在。与所中邪气相合而然也。先寒后热者。先伤寒而后伤风。名寒疟。先热后寒者。先伤风而
后伤寒。名温疟。但热不寒者。名瘅疟。身重寒热。骨节痛。腹胀满。自汗善呕。名湿疟。但寒不热者。名牝疟。其病
不一。故治当随其阴阳虚实。汗吐下温。对症施治。以平为期。然必因正气虚。感受邪气。留而不去。其病为实。自表
传里。先汗后下。古今不易。故治疟必须先表。用百解散加姜、葱。次小柴胡加桂枝、姜、枣。以和解表里之邪。自然
作效。若表里实。用当归散、五和汤、乌犀丸下之。匀气散止补。后以藿香饮加草果、良姜、姜、枣。正胃气。去寒邪。
则自平复。如表解后。寒热往来。以二仙饮截之。寒热既除。用平胃散盐汤空心调服。温胃健脾。则外邪自清。此为明
论。有寒多热少。经久不愈。致脾胃弱。饮食少。神色变。二姜丸及清脾汤为治。
娄全善曰。治小儿疟疾。多与大人同法。以出汗为瘥。宜桂枝、柴胡、参、芩辈。其病食病痰。以意消息之。小儿
多由食积得之。必兼消药为先也。
叶桂曰。疟因暑发居多。方书虽有痰食寒热瘴疠之互异。幼稚之疟。都因脾胃受病。然气怯神弱。初病惊痫厥逆为
多。在夏秋之时。断不可认为惊痫。大方疟症。须分十二经。与咳症相等。若幼医庸俗。但以小柴胡去参。或香薷、葛
根之属。不知柴胡动肝阴。葛根竭胃汁。致变屡矣。幼科纯阳。暑为热气。症必热多烦渴。邪自肺受者。桂枝白虎汤。
二进必愈。其有冷食不运。有足太阴脾病见症。初用正气。或用辛温如草果、生姜、半夏之属。方书谓草果治太阴独胜
之寒。知母治阳明独胜之热。疟久色夺。唇白汗多。馁弱。必用四兽饮。阴虚内热。必用鳖甲、首乌、知母。便渐溏者。
忌用。久疟营伤寒胜。加桂、姜。拟国中末疟门用药于左。如初病暑风湿热疟药。兼脘痞闷。用桔梗、枳壳、杏仁、浓
朴、（二味喘最宜）、栝蒌皮、山栀、香豉。头痛宜辛凉轻剂。连翘、薄荷、赤芍、羚羊角、蔓荆子、滑石。（此方淡渗
清上）重则用石膏。口渴用花粉。烦渴用竹叶石膏汤。热甚则用芩、连、山栀。夏季身痛属湿。羌、防辛温宜忌。宜用
木防己、蚕沙。暑热邪伤。初在气分。日久不解。渐入血分。反渴。不多饮。唇舌绛赤。芩连膏。如不应。必用血药。
凉佐清气热。一味足矣。轻则用丹皮、（汗多忌）青蒿、犀角、竹叶心、元参、鲜生地、细生地、木通、（亦能发汗）淡
竹叶。若热久痞结。泻心汤选用。又夏月热久入血。最多蓄血一症。谵语昏狂。看法以小便清长者。大便必黑为是。桃
仁承气汤为要药。幼稚疟久。面肿腹膨。泄泻不欲食。或囊肿。或跗肿。必用东垣益气以升阳。倘脾阳消惫。前方不应。
用理中汤或钱氏益黄散。得效二三日。须投五苓散。一二日。再与异功、参苓白术散之类。必全好。徐忠可注金匮。有
云。幼儿未进谷食者。患疟久不止。用冰糖浓汤。余试果验。疟多用乌梅。以酸泄木安土之意。用常山、草果。乃劫其
太阴之药。以常山极走。使二邪不相并之谓。用人参、生姜曰露姜饮。一以固元。一以散邪。取通神明去秽恶之气。总
之久疟气馁。凡壮胆气。皆可止疟。未必真有疟鬼。又疟邪既久。深入血分。或结疟母。鳖甲煎丸。设用煎方。活血通
络可矣。
（寒热往来附）
夏季感受暑邪，秋季必然发生疟疾。又说疟病，必定由风邪引起。《内经》中的言论，应当仔细审度。夏季盛暑之时，腠理（皮肤毛孔及肌肉间隙）开泄，汗出时当风，或洗澡后受风寒侵袭。
卫气不能固守，邪气内侵，停留于膜原（半表半里之隙），到相应时节病情加剧。暑日感受风邪，这是根本原因所在。然而小儿多因饮食积滞所致，脾弱胃衰，乳食停积，各种邪气都依附于此，与正气相争，壅遏阴阳，二气交错。阴盛阳虚，则先寒战栗；阳胜阴虚，则先热如烙。邪气与卫气相并，所以发作迅速（挥霍）。邪气深入体内，所以隔日发作。
疟疾必有痰，停滞在胸膈；疟疾必有湿，导致手脚酸痛。瘅疟、牝疟、温疟、寒疟、鬼疟、瘴疟名称各异，症状不同，但可以大致概括。冷起毫毛，伸欠萧索，战栗鼓颔（下巴打颤），头痛如凿。等到发热时，内外火热灼烧，口渴想喝水，身体疼痛筋脉拘急。或先寒侵，或先热灼，阴阳偏胜，如同酬酢（交互往复）。所以寒热往来，像约定好一样有规律。朱丹溪说过，最为精确。无汗者发汗，以散邪为主；有汗者止汗，以固护正气宜速。务必使邪气尽除，阴阳调和。无奈世俗医生，不知用药，将小柴胡汤作为定法。不知道前贤再三叮嘱，过早服用柴胡，会导致病程缠绵难愈。邪气应从外散去，正气才不会在内被削弱。只有调和阴阳，才可以考虑使用下法。不可轻率疏忽，切宜斟酌。
久疟不愈，形成疟母（脾脏肿大）内结，在胸胁之间，可以按摸到。治疗应消散它，不要让正气虚弱。
曾氏说：《内经·疟论》云：“夏伤于暑，秋必疟。”是指腠理开而汗出遇风，或得于澡浴，水气停留在皮肤间，因为卫气不守，邪气并居，疾病才开始发作。出现伸欠、寒栗、腰背俱痛、骨节烦疼。寒生则内外皆热，头疼而渴，这是阴阳二气交争，虚实更替造成的。阴气独盛，则阳虚，所以先寒战栗，腰背头项骨节都痛。阳气独胜，则阴虚，所以先热，发作时不想吃东西，喜欢呕吐，头疼腰痛，小便不利。阴盛阳虚，则内外皆寒；阴盛阴虚，则内外皆热。这是外感六淫，或内伤七情，蕴积痰饮，病气与卫气并居，所以病每日发作。卫气白天行于阳分，夜晚行于阴分，得阳而出外，得阴而内薄。五脏病气深入，不能与卫气一起外出，所以隔日发作。当卫气到达，病气所在的地方，就发病。在阳分则热，在阴分则寒。等到阴阳各自衰减，卫气与病气分离，疾病就休止。阴阳相搏，卫气与病气相聚，就再次发作。各随其卫气所在，与所中邪气相合而如此。先寒后热的，先伤伤寒后伤风，名叫寒疟。先热后寒的，先伤风而后伤寒，名叫温疟。但热不寒的，名叫瘅疟。身重寒热，骨节痛，腹胀满，自汗善呕，名叫湿疟。但寒不热的，名叫牝疟。病症不一，所以治疗应当根据阴阳虚实，采用汗、吐、下、温等方法，对症施治，以平衡为准则。然而必定是因为正气虚，感受邪气，留而不去，其病表现为实。从表传里，先汗后下，古今不变。所以治疟必须先解表，用百解散加姜、葱，其次用小柴胡加桂枝、姜、枣，来和解表里之邪，自然见效。如果表里实证，用当归散、五和汤、乌犀丸攻下。匀气散止补。后用藿香饮加草果、良姜、姜、枣，调理胃气，去除寒邪，则自然平复。如果表证解除后，寒热往来，用二仙饮截断。寒热既除，用平胃散盐汤空心调服，温胃健脾，则外邪自清。这是明论。有寒多热少，经久不愈，导致脾胃弱，饮食少，神色变，用二姜丸及清脾汤治疗。
娄全善说：治疗小儿疟疾，大多与大人同法，以出汗为痊愈。适宜用桂枝、柴胡、人参、黄芩等药。如果是食病、痰病，凭意消息之。小儿多由食积得之，必须兼用消食药为先。
叶桂说：疟疾因暑引发的居多。方书虽有痰、食、寒、热、瘴、疠的互异，但幼稚之疟，都因脾胃受病。然而小儿气怯神弱，初病惊痫厥逆为多。在夏秋之时，断不可认为是惊痫。成人疟症，须分十二经，与咳症相等。如果幼医庸俗，只以小柴胡去参，或香薷、葛根之类，不知道柴胡动肝阴，葛根竭胃汁，导致变证屡出。幼儿纯阳，暑为热气，症状必定热多烦渴。邪自肺受的，用桂枝白虎汤，两次服用必愈。如果有冷食不运，有足太阴脾病见症，初用正气，或用辛温如草果、生姜、半夏之类。方书谓草果治太阴独胜之寒，知母治阳明独胜之热。疟久色夺，唇白汗多，馁弱，必须用四兽饮。阴虚内热，必须用鳖甲、首乌、知母。便渐溏者，忌用。久疟营伤寒胜，加桂、姜。拟国中末疟门用药于左。如初病暑风湿热疟药，兼脘痞闷，用桔梗、枳壳、杏仁、浓朴（二味喘最宜）、栝蒌皮、山栀、香豉。头痛宜辛凉轻剂，连翘、薄荷、赤芍、羚羊角、蔓荆子、滑石（此方淡渗清上）。重则用石膏。口渴用花粉。烦渴用竹叶石膏汤。热甚则用芩、连、山栀。夏季身痛属湿，羌活、防风辛温宜忌。宜用木防己、蚕沙。暑热邪伤，初在气分，日久不解，渐入血分，反渴，不多饮，唇舌绛赤，用芩连膏。如不应，必须用血药，凉佐清气热，一味足矣。轻则用丹皮（汗多忌）、青蒿、犀角、竹叶心、元参、鲜生地、细生地、木通（亦能发汗）、淡竹叶。若热久痞结，选用泻心汤。又夏月热久入血，最多蓄血一症，谵语昏狂，看法以小便清长者，大便必黑为是。桃仁承气汤为要药。幼稚疟久，面肿腹膨，泄泻不欲食，或囊肿，或跗肿，必须用东垣益气以升阳。倘脾阳消惫，前方不应，用理中汤或钱氏益黄散。得效二三日，须投五苓散。一二日，再与异功、参苓白术散之类，必全好。徐忠可注金匮，有云：幼儿未进谷食者，患疟久不止，用冰糖浓汤，余试果验。疟多用乌梅，以酸泄木安土之意。用常山、草果，乃劫其太阴之药，以常山极走，使二邪不相并之谓。用人参、生姜曰露姜饮，一以固元，一以散邪，取通神明去秽恶之气。总之久疟气馁，凡壮胆气，皆可止疟，未必真有疟鬼。又疟邪既久，深入血分，或结疟母，鳖甲煎丸。设用煎方，活血通络可矣。
(Attached to Alternating Chills and Fever)
Summer injury by Shu (Summer Heat) [Shu, 暑: Summer-Heat pathogen] leads to Nuojue (Malaria) [Nuojue, 疟: Malaria] in autumn. It is also said that Nuojue disease must originate from Feng (Wind) [Feng, 风: Wind pathogen]. The statements in Nei Jing (Inner Canon of the Yellow Emperor) [Nei Jing, 内经: Inner Canon of the Yellow Emperor] should be carefully considered. During the peak of summer heat, the Couli (pores and interstitial spaces) [Couli, 腠理: Pores and interstitial spaces] are open, sweat is produced, and exposure to wind occurs, or after bathing, one is exposed to cold and dampness.
Wei Qi (Defensive Qi) [Wei Qi, 卫气: Defensive Qi] fails to guard, and Xie Qi (Evil Qi/Pathogenic factors) [Xie Qi, 邪气: Pathogenic factors] invades internally, lodging in Moyuan (Membrane Source) [Moyuan, 膜原: Membrane Source], manifesting severely at the corresponding time. Contracting Wind on a hot day provides the root cause. However, children often suffer from food retention (Shi Tuan) [Shi Tuan, 食抟: Food retention/stagnation]; with weak Spleen and declining Stomach function, milk and food stagnate, allowing various pathogens to attach. These conflict with Zheng Qi (Upright Qi) [Zheng Qi, 正气: Upright/Healthy Qi], obstructing Yin and Yang, causing the two energies to intertwine. When Yin is excessive and Yang deficient, chills and trembling occur first; when Yang is excessive and Yin deficient, intense heat occurs first. When Xie Qi combines with Wei Qi, attacks are sudden ("huo huo"). When Xie Qi penetrates deeply into the interior, the disease manifests every other day.
Nuojue always involves Tan (Phlegm) [Tan, 痰: Phlegm] stagnating in the chest and diaphragm; it always involves Shi (Dampness) [Shi, 湿: Dampness], causing soreness and pain in the hands and feet. Dan Nuo (Hot Malaria), Pin Nuo (Cold Malaria), Wen Nuo (Warm Malaria), Han Nuo (Chill Malaria), Gui Nuo (Ghost Malaria), and Zhang Nuo (Miasma Malaria) have different names and symptoms but can be roughly summarized. Cold rises in the fine hairs, yawning and listlessness occur, trembling and jaw-chattering happen, and headache feels like drilling. When fever sets in, internal and external heat scorches, thirst arises with desire to drink, body ache and tendon binding occur. Whether starting with cold invasion or heat scorching, Yin and Yang become unbalanced, alternating like social exchanges. Thus, alternating chills and fever occur rhythmically. Zhu Danxi stated this most accurately. For no sweat, induce sweating to disperse Xie Qi as the primary goal; for existing sweat, stop sweating to secure Zheng Qi quickly. The aim is to eliminate all Xie Qi and harmonize Yin and Yang. Regrettably, worldly physicians do not know how to prescribe, treating Xiao Chai Hu Tang (Minor Bupleurum Decoction) [Xiao Chai Hu Tang, 小柴胡汤: Minor Bupleurum Decoction] as a fixed method. They ignore the repeated warnings of former sages: taking Chai Hu (Bupleuri Radix) [Chai Hu, 柴胡: Bupleuri Radix] too early leads to lingering and difficult-to-resolve disease. Xie Qi should be dispersed from the exterior so Zheng Qi is not depleted internally. Only by harmonizing Yin and Yang can purgative methods be considered. One must not be negligent or superficial; careful deliberation is essential.
For chronic Nuojue that does not heal, Nuomu (Malaria Mother/Splenomegaly) [Nuomu, 疟母: Splenomegaly/Mass due to malaria] forms internally, palpable between the chest and hypochondrium. Treatment should focus on dissipation to prevent weakening of Zheng Qi.
Zeng said: Nei Jing's "Treatise on Malaria" states: "Summer injury by Shu leads to Nuojue in autumn." This refers to open Couli and sweat upon encountering wind, or water qi lodging in the skin after bathing, because Wei Qi fails to guard and Xie Qi resides together, initiating the disease. Symptoms include yawning, chills, pain in the waist and back, and severe joint pain. When cold generates, both interior and exterior become hot, accompanied by headache and thirst. This results from the struggle between Yin and Yang energies and the alternation of deficiency and excess. If Yin alone is excessive, Yang becomes deficient, causing initial chills and trembling, with pain in the waist, back, head, neck, and joints. If Yang alone is excessive, Yin becomes deficient, causing initial heat, anorexia during attacks, preference for vomiting, headache, lower back pain, and difficulty urinating. Yin excess and Yang deficiency lead to internal and external cold; Yin excess and Yin deficiency (likely meant Yang deficiency relative to Yin excess or vice versa in context of heat/cold patterns) lead to internal and external heat. This is caused by external contraction of the Six Excesses (Liu Yin) [Liu Yin, 六淫: Six Exogenous Pathogens] or internal injury from the Seven Emotions (Qi Qing) [Qi Qing, 七情: Seven Emotions], accumulating Tan and Yin (Fluids) [Yin, 饮: Fluid retention], where Bing Qi (Disease Qi) and Wei Qi reside together, causing daily attacks. Wei Qi travels through Yang during the day and Yin at night; it moves outward when meeting Yang and inward when meeting Yin. When Zang-Fu disease Qi penetrates deeply and cannot exit with Wei Qi, the disease manifests every other day. When Wei Qi arrives at the location of the disease Qi, the attack begins. In Yang, there is heat; in Yin, there is cold. When Yin and Yang decline separately, Wei Qi separates from Disease Qi, and the disease rests. When Yin and Yang contend, and Wei Qi gathers with Disease Qi, the disease recurs. This depends on the location of Wei Qi and its combination with the contracted Xie Qi.
Chills followed by heat indicates initial injury by Cold then Wind, named Han Nuo (Chill Malaria). Heat followed by chills indicates initial injury by Wind then Cold, named Wen Nuo (Warm Malaria). Heat without chills is named Dan Nuo (Hot Malaria). Heavy body, alternating chills and fever, joint pain, abdominal fullness, spontaneous sweating, and frequent vomiting is named Shi Nuo (Damp Malaria). Chills without heat is named Pin Nuo (Cold Malaria). Since diseases vary, treatment must follow Yin/Yang and Deficiency/Excess, using Sweating, Vomiting, Purging, and Warming methods, targeting symptoms to achieve balance. However, it is always due to Zheng Qi deficiency contracting Xie Qi, which remains and causes Excess conditions. Transmission from Exterior to Interior requires Sweating first, then Purging, unchanged since ancient times. Therefore, treating Nuojue must start with releasing the Exterior, using Bai Jie San (Hundred Dissolution Powder) [Bai Jie San, 百解散: Hundred Dissolution Powder] plus Ginger and Scallion, followed by Xiao Chai Hu Tang plus Guizhi (Cinnamon Twig) [Guizhi, 桂枝: Cinnamon Twig], Ginger, and Jujube to harmonize and release Exterior-Interior Xie Qi, naturally yielding results. If Exterior and Interior are Excess, use Dang Gui San (Angelica Powder) [Dang Gui San, 当归散: Angelica Powder], Wu He Tang (Five Harmonies Decoction) [Wu He Tang, 五和汤: Five Harmonies Decoction], or Wu Xi Wan (Black Rhinoceros Pill) [Wu Xi Wan, 乌犀丸: Black Rhinoceros Pill] to purge. Yun Qi San (Harmonizing Qi Powder) [Yun Qi San, 匀气散: Harmonizing Qi Powder] stops tonification. Later, use Huo Xiang Yin (Agastache Drink) [Huo Xiang Yin, 藿香饮: Agastache Drink] plus Cao Guo (Tsaoko Cardamom Fruit) [Cao Guo, 草果: Tsaoko Cardamom Fruit], Liang Jiang (Galangal) [Liang Jiang, 良姜: Galangal], Ginger, and Jujube to regulate Stomach Qi and remove Cold Xie Qi, leading to natural recovery. If Exterior is resolved but alternating chills and fever persist, use Er Xian Yin (Two Immortals Drink) [Er Xian Yin, 二仙饮: Two Immortals Drink] to intercept. Once chills and fever cease, use Ping Wei San (Peaceful Stomach Powder) [Ping Wei San, 平胃散: Peaceful Stomach Powder] mixed with salt water on an empty stomach to warm the Stomach and strengthen the Spleen, clearing external Xie Qi naturally. This is a clear theory. For cases with more chills than heat, lingering long-term, causing weak Spleen/Stomach, poor appetite, and altered complexion, treat with Er Jiang Wan (Two Gingers Pill) [Er Jiang Wan, 二姜丸: Two Gingers Pill] and Qing Pi Tang (Clear Spleen Decoction) [Qing Pi Tang, 清脾汤: Clear Spleen Decoction].
Lou Quanshan said: Treating pediatric Nuojue is mostly similar to adults, aiming for sweating as recovery. Suitable herbs include Guizhi, Chai Hu, Ren Shen (Ginseng Root) [Ren Shen, 人参: Ginseng Root], and Huang Qin (Scutellaria Root) [Huang Qin, 黄芩: Scutellaria Root]. For food or phlegm diseases, adjust according to circumstances. Children often get it from food accumulation, requiring digestive herbs first.
Ye Gui said: Nuojue is mostly triggered by Shu. Although formularies distinguish between Phlegm, Food, Cold, Heat, Miasma, and Pestilence, pediatric Nuojue always stems from Spleen/Stomach pathology. However, children have weak Qi and Spirit, often presenting initially with Jing Xian (Startle Epilepsy) [Jing Xian, 惊痫: Startle Epilepsy] or Jue Ni (Reversal Collapse) [Jue Ni, 厥逆: Reversal Collapse]. In summer and autumn, never mistake it for Jing Xian. Adult Nuojue must be differentiated by the Twelve Meridians, similar to cough syndromes. Vulgar pediatricians only use Xiao Chai Hu Tang minus Ren Shen, or herbs like Xiang Ru (Patrinia Herb) [Xiang Ru, 香薷: Patrinia Herb] and Ge Gen (Kudzu Root) [Ge Gen, 葛根: Kudzu Root], unaware that Chai Hu damages Liver Yin and Ge Gen depletes Stomach fluids, causing frequent complications. Children are purely Yang; Shu is Hot Qi, so symptoms are predominantly heat with irritability and thirst. If Xie enters via the Lung, Gui Zhi Bai Hu Tang (Cinnamon Twig and White Tiger Decoction) [Gui Zhi Bai Hu Tang, 桂枝白虎汤: Cinnamon Twig and White Tiger Decoction] cures it in two doses. If cold food fails to transform, showing Taiyin Spleen symptoms, initially support Zheng Qi or use acrid-warm herbs like Cao Guo, Sheng Jiang (Fresh Ginger) [Sheng Jiang, 生姜: Fresh Ginger], and Ban Xia (Pinellia Tuber) [Ban Xia, 半夏: Pinellia Tuber]. Formularies state Cao Guo treats Taiyin-exclusive Cold, and Zhi Mu (Anemarrhena Rhizome) [Zhi Mu, 知母: Anemarrhena Rhizome] treats Yangming-exclusive Heat. For chronic Nuojue with pallor, white lips, profuse sweating, and weakness, Si Shou Yin (Four Beasts Drink) [Si Shou Yin, 四兽饮: Four Beasts Drink] is necessary. For Yin deficiency with internal heat, use Bie Jia (Tartar Turtle Shell) [Bie Jia, 鳖甲: Tartar Turtle Shell], Shou Wu (Polygonum Multiflorum Root) [Shou Wu, 首乌: Polygonum Multiflorum Root], and Zhi Mu. Avoid if stool becomes loose. For chronic Nuojue with Ying/Blood Cold and Xie Heat, add Guizhi and Jiang. Refer to the left for Nuojue medications. For initial summer-damp-wind-heat Nuojue with epigastric stuffiness, use Jie Geng (Platycodon Root) [Jie Geng, 桔梗: Platycodon Root], Zhi Ke (Aurantii Fructus) [Zhi Ke, 枳壳: Aurantii Fructus], Xing Ren (Apricot Seed) [Xing Ren, 杏仁: Apricot Seed], Hou Po (Magnolia Bark) [Hou Po, 厚朴: Magnolia Bark] (best for wheezing), Gua Lou Pi (Trichosanthes Peel) [Gua Lou Pi, 栝蒌皮: Trichosanthes Peel], Shan Zhi (Gardenia Fruit) [Shan Zhi, 山栀: Gardenia Fruit], and Chi Dou (Fermented Soybean) [Chi Dou, 香豉: Fermented Soybean]. For headache, use acrid-cool light agents: Lian Qiao (Forsythia Fruit) [Lian Qiao, 连翘: Forsythia Fruit], Bo He (Mint) [Bo He, 薄荷: Mint], Chi Shao (Red Peony Root) [Chi Shao, 赤芍: Red Peony Root], Ling Yang Jiao (Antelope Horn) [Ling Yang Jiao, 羚羊角: Antelope Horn], Man Jing Zi (Vibrant Seed) [Man Jing Zi, 蔓荆子: Vibrant Seed], and Hua Shi (Talcum) [Hua Shi, 滑石: Talcum] (this formula clears upper jiao with bland leaching). For severe cases, use Shi Gao (Gypsum Fibrosum) [Shi Gao, 石膏: Gypsum Fibrosum]. For thirst, use Hua Fen (Trichosanthes Root) [Hua Fen, 花粉: Trichosanthes Root]. For vexatious thirst, use Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) [Zhu Ye Shi Gao Tang, 竹叶石膏汤: Bamboo Leaf and Gypsum Decoction]. For extreme heat, use Huang Qin, Huang Lian (Coptis Rhizome) [Huang Lian, 黄连: Coptis Rhizome], and Shan Zhi. Summer body pain due to dampness: avoid acrid-warm Qiang Huo (Notopterygium Root) [Qiang Huo, 羌活: Notopterygium Root] and Fang Feng (Saposhnikovia Root) [Fang Feng, 防风: Saposhnikovia Root]. Use Mu Fang Ji (Stephania Root) [Mu Fang Ji, 木防己: Stephania Root] and Can Sha (Silkworm Frass) [Can Sha, 蚕沙: Silkworm Frass]. Shu-Heat Xie injury starts in Qi level; if unresolved long-term, it enters Blood level, causing paradoxical thirst with little drinking, crimson lips/tongue. Use Qin Lian Gao (Honeysuckle and Coptis Paste) [Qin Lian Gao, 芩连膏: Honeysuckle and Coptis Paste]. If ineffective, use Blood-invigorating herbs, cooling while clearing Qi-level heat; one herb suffices. Mildly use Dan Pi (Moutan Cortex) [Dan Pi, 丹皮: Moutan Cortex] (avoid if sweating profusely), Qing Hao (Artemisia Annua Herba) [Qing Hao, 青蒿: Artemisiae Annuae Herba], Xi Jiao (Rhinoceros Horn) [Xi Jiao, 犀角: Rhinoceros Horn], Zhu Ye Xin (Bamboo Leaf Heart) [Zhu Ye Xin, 竹叶心: Bamboo Leaf Heart], Yuan Shen (Scrophularia Root) [Yuan Shen, 元参: Scrophularia Root], Xian Sheng Di (Fresh Rehmannia Root) [Xian Sheng Di, 鲜生地: Fresh Rehmannia Root], Xi Sheng Di (Fine Rehmannia Root) [Xi Sheng Di, 细生地: Fine Rehmannia Root], Mu Tong (Akebia Stem) [Mu Tong, 木通: Akebia Stem] (can also induce sweating), and Dan Zhu Ye (Lophatherum Herb) [Dan Zhu Ye, 淡竹叶: Lophatherum Herb]. If heat persists with stagnation, select Xie Xin Tang (Drain the Epigastrium Decoction) [Xie Xin Tang, 泻心汤: Drain the Epigastrium Decoction]. In summer, prolonged heat entering Blood often causes Blood Stasis: delirium, coma, madness. If urine is clear and abundant, stool will likely be black. Tao Ren Cheng Qi Tang (Peach Kernel and Cathartic Decoction) [Tao Ren Cheng Qi Tang, 桃仁承气汤: Peach Kernel and Cathartic Decoction] is essential. For chronic pediatric Nuojue with facial swelling, abdominal distension, diarrhea, anorexia, scrotal edema, or foot swelling, use Dongyuan's method to tonify Qi and raise Yang. If Spleen Yang is exhausted and previous formulas fail, use Li Zhong Tang (Regulate the Middle Decoction) [Li Zhong Tang, 理中汤: Regulate the Middle Decoction] or Qian's Yi Huang San (Strengthen Earth Powder) [Yi Huang San, 益黄散: Strengthen Earth Powder]. After 2-3 days of efficacy, administer Wu Ling San (Five Ingredient Powder with Poria) [Wu Ling San, 五苓散: Five Ingredient Powder with Poria]. After 1-2 days, use Yi Gong San (Single Skill Powder) [Yi Gong San, 异功散: Single Skill Powder] or Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) [Shen Ling Bai Zhu San, 参苓白术散: Ginseng, Poria, and Atractylodes Macrocephala Powder] until fully recovered. Xu Zhongke annotated Jin Gui, stating: For infants not yet eating grain, chronic Nuojue unrelenting, use strong rock sugar soup; I tested this and it works. Nuojue often uses Wu Mei (Mume Fruit) [Wu Mei, 乌梅: Mume Fruit] to sour-drain Wood and calm Earth. Using Chang Shan (Polygala Root) [Chang Shan, 常山: Polygala Root] and Cao Guo are drugs to rob Taiyin; Chang Shan is extremely mobile, preventing the two evils from combining. Using Ren Shen and Sheng Jiang is called Lu Jiang Yin (Dew Ginger Drink) [Lu Jiang Yin, 露姜饮: Dew Ginger Drink], one to secure Yuan Qi, one to disperse Xie Qi, aiming to clarify spirit and remove foul qi. Ultimately, chronic Nuojue depletes Qi; strengthening Gallbladder Qi can stop Nuojue; there may not truly be a Nuojue ghost. Furthermore, long-standing Nuojue Xie penetrates deep into Blood level or forms Nuomu; Bie Jia Jian Wan (Turtle Shell Decoction Pill) [Bie Jia Jian Wan, 鳖甲煎丸: Turtle Shell Decoction Pill] is used. If decoctions are set, blood-invigorating and collateral-unblocking methods suffice.