家人诊之。惊曰。脉绝矣。议作阴证。欲进附子汤未决。汪曰。阴证无头痛。今病如是。恐风暑
乘虚入于阴分。故脉伏耳。非绝也。若进附子汤。是以火济火。安能复生。姑待以观其变。次晚
果寒热头痛。躁渴痞闷。呕食自汗。脉皆濡小而数。脾部兼弦。遂用清暑益气汤减苍术、升麻。
二十余剂而愈。
李士材治陈眉公三日疟。浃岁未瘥。素畏药饵。尤不喜人参。其脉浮之则濡。沉之则弱。营
卫俱衰。故延不已。因固请曰。素不服参者。天畀之丰也。今不可缺者。病魔之久也。先服人参
钱许。口有津生。腹无烦满。遂以人参一两。何首乌一两煎成。入姜汁钟许。一剂势减七八。再
剂而疟遂截。
石顽治广文张安期夫人。先是其女及婿与婢。数日连毙三人。其仆尚传染垂危。安期夫人因
送女殓。归亦病疟。杂治罔效。遂成坏病。勉与生姜泻心汤救之。
故友李怀兹乃郎幼韩。触邓氏疫疟之气。染患月余不止。且左右乏人。失于调理。以致愈而
复发。加以五液注下。疟痢兼并。水谷不入者半月有余。当此虽有合剂。亦难克应。乃携归斋中。
日与补中益气。兼理中、六君、萸、桂之属。将养半月而康。
贰守金令友之室。春榜蒋旷生之妹也。旷生乔梓。见其亢热昏乱。意谓伤寒。同舟邀往。及
诊视之。是疟非寒。与柴胡桂枝汤四剂而安。
贰尹吴丹生。湿盛体肥。呕逆痞胀。寒热昏眩。与凉膈散加黄连下之。五日而止。越半月复
发。亦五日而止。
贰守汤子端。恶寒发热。面赤足冷。六脉弦细而数。自言不谨后受寒。以为伤寒阴证。余曰。
阴证无寒热例。与柴胡桂姜汤二服而痊。
文学顾若雨之女与甥女。先后并疟。皆先热后寒。并与桂枝白虎汤而瘥。
太学郑墨林夫人。怀孕七月。先疟后痢。而多鲜血。与补中益气加吴茱萸制川连而愈。每见
孕妇病疟。胎陨而致不救者多矣。
乡饮张怡泉。恒服参、附、鹿角胶等阳药而真阴向耗。年七十五。七月下浣病疟。时医误进
常山止截药一剂。遂致人事不省。六脉止歇。按之则二至一止。举指则三五至一止。惟在寒热之
际诊之则不止歇。热退则止歇如前。此真气衰微。不能贯通于脉。所以止歇不前。在寒热之时。
邪气冲激经脉。所以反得开通。此虚中伏邪之象。为制一方。用常山一钱酒拌。同人参五钱焙干。
去常山但用人参。以助胸中大气而祛逐之。当知因常山伤犯中气而变
剧。故仍用常山为向导耳。昼夜连进二服。遂得安寝。但寒热不止。脉止如前。乃令日进人参一
两。分二次进。并与稀糜助其胃气。数日寒热渐止。脉微续而安。
玉峰春榜顾玉书。疟发即昏热谵语。痞胀呕逆。切其气口。独见短滑。乃有宿滞之象。与凉
膈散易人中黄。加草果仁。一剂霍然。
督学汪缄庵之女。患前证。以桂枝白虎汤易人中黄。加葱、豉。四服而安。
中翰金淳还乃郎。八月间患疟。发于辰戌丑未。至春。子午卯酉每增小寒热。直至初夏。始
延治于石顽。诊其六脉如丝。面青唇白。乃与六君子加桂、附。四服不应。每服加用人参至一两。
桂、附各三钱。又四服。而辰戌丑未之寒热顿止。子午卯酉之寒热更甚。此中土有权而邪并至阴
也。仍与前药四服。而色荣食进。寒热悉除。后与独参汤送八味丸调理而安。
文学顾大来。年逾八旬。初秋患瘅疟。昏热谵语。喘乏遗尿。或者以为伤寒谵语。或者以为
中风遗尿。危疑莫定。予曰无虑。此三阳合病。谵语遗尿。口不仁而面垢。仲景暑证中原有是例。
遂以白虎加人参。三啜而安。同时文学愿次占夫人。朔客祁连山。皆患是证。一者兼风。用白虎
加桂枝。一者兼湿。用白虎加苍术。俱随手而痊。若以中风遗尿例治。则失之矣。是日坐间有同
道问及今岁疟脉不弦之故。予谓之曰。疟属少阳经证。其脉当弦。而反不弦如平人者。以邪气与
正气混合不分。故绝不显弦象。金匮有云。温疟者。其脉如平。身无寒但热。骨节烦疼。时呕。
白虎加桂枝汤主之。曷知脉即不弦。便非风木之邪。即不当用柴胡等少阳经药。岂可以常法施治乎。
飞畴治沈子嘉。平昔每至夏间。脐一着扇风则腹痛。且不时作泻。六脉但微数。无他异。此肾脏
本寒。闭藏不密。易于招风也。下寒则虚火上僭。故脉数耳。曾与六味去泽泻。加肉桂、肉果、
五味、白蒺作丸服。因是脐不畏风。脾胃亦实。明秋患疟。医用白虎、竹叶石膏等。疟寒甚而不
甚热。面青足冷。六脉弦细而数。用八味地黄三倍桂、附作汤。更以四君合保元早暮间进。二日
疟止。调理而愈。
家人诊察后，惊讶地说：“脉象已经断绝了。”大家商议将其作为阴证治疗，打算使用附子汤，但尚未决定。汪氏说：“阴证不会有头痛的症状。如今病人出现这种症状，恐怕是风暑之邪乘虚侵入阴分，导致脉象伏匿，并非真的断绝。如果服用附子汤，那就是以火救火，怎么能让人复活呢？暂且观察病情变化。”到了第二天晚上，果然出现了寒热往来、头痛、烦躁口渴、胸脘痞闷、呕吐食物、自汗等症状，脉象都表现为濡小而数，脾部兼见弦象。于是使用清暑益气汤，减去苍术和升麻，服用二十多剂后痊愈。
李士材治疗陈眉公的三日疟疾，经过一年仍未痊愈。陈眉公平时害怕服药，尤其不喜欢人参。他的脉象轻取则濡软，重按则虚弱，这是营卫两俱衰弱的表现，所以病情拖延不愈。李士材坚持请求说：“您平时不服用人参，是因为天赋体质丰盈；但现在不可缺少的，是因为病魔缠身日久。先服用人参一钱左右，如果口中生津，腹部没有烦闷胀满的感觉，就可以继续服用。”于是用人参一两、何首乌一两煎煮成汤，加入姜汁约一杯，服用一剂后病势减轻七八成，再服用一剂，疟疾便截断停止。
石顽治疗广文张安期夫人。此前，她的女儿、女婿和婢女在几天内接连去世三人，她的仆人还传染上疾病处于危急状态。张安期夫人因为送女儿入殓，回家后也患上疟疾，经过多种治疗无效，最终成了坏病。石勉且用生姜泻心汤来救治。
已故朋友李怀兹的儿子幼韩，感染了邓家流行的疫疟之气，患病一个多月不止。而且身边缺乏照料的人，失于调理，导致病愈后又复发。加上五脏津液下注腹泻，疟疾与痢疾并发，水谷不能入口已有半个多月。在这种情况下，即使有合适的方剂，也难以立刻见效。于是将他带回家中斋房调养，每日给予补中益气汤，兼用理中汤、六君子汤以及山茱萸、肉桂等药物进行调理，半个月后康复。
贰守金令友的妻子，是春榜蒋旷生的妹妹。蒋旷生父子见到她高热神志昏乱，以为是伤寒，便邀石顽同舟前往诊治。等到诊视后，发现是疟疾而非伤寒，给予柴胡桂枝汤四剂后安定。
贰尹吴丹生，湿气盛身体肥胖，呕吐逆气、胸脘痞闷胀满，寒热交替、头晕目眩。给予凉膈散加黄连攻下，五天后症状停止。过了半个月又复发，同样五天后停止。
贰守汤子端，恶寒发热，面红脚冷，六脉弦细而数。他自己说是因为房事不节制受寒，认为是伤寒阴证。我说：“阴证通常没有寒热往来的规律。”给予柴胡桂姜汤，服用两剂后痊愈。
文学顾若雨的女儿和外甥女，先后都患疟疾，都是先发热后发冷。给予桂枝白虎汤后痊愈。
太学郑墨林夫人，怀孕七个月，先患疟疾后患痢疾，且排出大量鲜血。给予补中益气汤加吴茱萸制过的川黄连后痊愈。我常看到孕妇患疟疾，因胎堕而导致不治的情况很多。
乡饮张怡泉，长期服用人参、附子、鹿角胶等温阳药物，导致真阴日渐消耗。他七十五岁时，七月下旬患疟疾。当时的医生误进常山止疟药一剂，导致人事不省，六脉出现间歇，轻按则每两次跳动停一次，重按则每三五次跳动停一次。只有在寒热发作之际诊脉，脉象才不间歇。热退后脉象又像之前一样间歇。这是真气衰微，不能贯通于脉道，所以出现间歇。在寒热发作时，邪气冲击经脉，所以反而得以通畅。这是虚证中潜伏邪气的征象。为此配制一方：用常山一钱拌酒，与人参五钱焙干，去掉常山只用人参，以助胸中大气从而驱除邪气。应当知道，因为常山损伤了中气导致病情加剧，所以仍然用常山作为向导。昼夜连续服用两剂，便能安睡。但寒热仍不止，脉象间歇如前。于是让他每日服用人参一两，分两次服用，并配合稀粥以扶助胃气。几天后寒热逐渐停止，脉象微弱续接而平安。
玉峰春榜顾玉书，疟疾发作即出现昏热谵语，胸脘痞闷胀满，呕吐逆气。切按其气口脉，独见短滑，这是有宿食停滞的迹象。给予凉膈散，将人中黄替换掉，加草果仁，一剂后霍然痊愈。
督学汪缄庵的女儿，患有上述症状，用桂枝白虎汤替换人中黄，加葱白、豆豉，服用四剂后安定。
中翰金淳还的儿子，八月间患疟疾，发作时间在辰、戌、丑、未时。到了春季，在子、午、卯、酉时每次增加轻微寒热。直到初夏，才开始找石顽治疗。诊其六脉如丝线般细微，面色青唇色白，于是给予六君子汤加肉桂、附子，服用四剂未见效果。每剂药中加入人参至一两，肉桂、附子各三钱，又服用四剂，辰戌丑未时的寒热顿时停止，但子午卯酉时的寒热更加严重。这是中土有权（脾胃功能恢复）而邪气并入阴分所致。仍然给予前面的药物四剂，面色红润，食欲增进，寒热全部消除。后来给予独参汤送服八味丸进行调理而平安。
文学顾大来，年过八十，初秋患瘅疟，出现昏热谵语，气喘乏力，遗尿。有人认为是伤寒谵语，有人认为是中风遗尿，危险疑虑无法确定。我说：“不用担心，这是三阳合病。谵语、遗尿、口舌不灵而面部污垢，张仲景的暑证原文中就有这样的例子。”于是使用白虎加人参汤，服用三次后安定。同时，文学愿次占的夫人，朔客祁连山，都患了同样的病症。其中一人兼夹风邪，用白虎加桂枝汤；另一人兼夹湿邪，用白虎加苍术汤，都随手治愈。如果用中风遗尿的例子来治疗，那就错了。当天坐席中有同道问我今年疟疾脉象不弦的原因，我对他说：“疟疾属于少阳经证，脉象应当弦，但反而像常人一样不弦，是因为邪气与正气混合不分，所以完全不显现弦象。《金匮要略》中说：‘温疟者，其脉如平，身无寒但热，骨节烦疼，时呕。’用白虎加桂枝汤主治。怎么知道脉象不弦，就不是风木之邪，就不当使用柴胡等少阳经药物呢？岂可以用常规方法施治呢？”
飞畴治疗沈子嘉。平时每到夏天，脐部一接触扇风就会腹痛，并且不时腹泻。六脉只是微数，没有其他异常。这是肾脏本寒，闭藏不严密，容易招致风邪。下焦寒则虚火上僭，所以脉数。曾给予六味地黄丸去掉泽泻，加肉桂、肉豆蔻、五味子、白蒺藜制成丸药服用。因此脐部不怕风，脾胃也充实。第二年秋天患疟疾，医生使用白虎汤、竹叶石膏汤等，疟疾寒甚而不甚热，面青脚冷，六脉弦细而数。使用八味地黄丸三倍肉桂、附子煎汤，早晚间配合四君子汤合保元汤进服，两天后疟疾停止，调理后痊愈。
The family physician examined the pulse and exclaimed in surprise, "The pulse has ceased." They discussed treating it as a Yin syndrome (Yin Zheng) and intended to administer Fuzi Tang (Aconite Decoction), but had not yet decided. Wang said, "Yin syndromes do not present with headache. Since the patient currently exhibits such symptoms, it is likely that wind-heat (Feng-Shu) has invaded the Yin level due to deficiency, causing the pulse to be deep-hidden (Fu), rather than truly ceased. If Fuzi Tang were administered, it would be using fire to assist fire; how could life be restored? Let us wait and observe any changes." On the following evening, indeed, alternating chills and fever, headache, restlessness, thirst, epigastric fullness and oppression, vomiting of food, and spontaneous sweating occurred. The pulse was all soft (Ru), small, and rapid, with the Spleen area additionally showing a wiry (Xian) quality. Thus, Qingshu Yiqi Tang (Clear Summerheat and Boost Qi Decoction) was used, with Cangzhu (Atractylodis Rhizoma) and Shengma (Cimicifugae Rhizoma) omitted. After more than twenty doses, the patient recovered.
Li Shicai treated Chen Meigong for tertian malaria (Sanri Nue) which had persisted for a year without remission. Chen was generally averse to medication, especially ginseng. His pulse was soft (Ru) upon light palpation and weak (Ruo) upon heavy pressure, indicating depletion of both Ying (Nutritive) and Wei (Defensive) qi, hence the prolonged course. Li insisted, saying, "You usually avoid ginseng because your constitution is naturally robust. However, what is indispensable now is ginseng due to the long-standing nature of the pathogen. First, take about one qian of ginseng. If saliva is produced in the mouth and there is no abdominal distension or discomfort, then proceed." Consequently, one liang of Ginseng Radix et Rhizoma Rubra (Renshen) and one liang of Polygoni Multiflori Caulis (Heshouwu) were decocted together, with approximately one cup of fresh ginger juice added. After one dose, the condition improved by seven or eight tenths; after another dose, the malaria was arrested.
Shiwan treated the wife of Zhang Anqi, a Guangwen official. Previously, her daughter, son-in-law, and a maid had died within a few days, and her servant was critically ill from contagion. After attending her daughter's funeral, Mrs. Zhang returned home and contracted malaria. Various treatments failed, resulting in a complicated disease (Huai Bing). Shiwan reluctantly prescribed Shengjiang Xiexin Tang (Ginger Heart-Draining Decoction) to rescue her.
Li Huaici, a deceased friend, had a son named Youhan who contracted epidemic malaria qi from the Deng family. The illness persisted for over a month. With no one around to care for him and lacking proper nursing, he recovered only to relapse. This was compounded by the downward flow of fluids (diarrhea), concurrent malaria and dysentery, and inability to ingest food or water for over half a month. Even with an appropriate formula, immediate results were difficult to expect. He was brought to my study for recuperation. Daily, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was given, combined with Lizhong Tang (Regulate the Middle Decoction), Liu Junzi Tang (Six Gentlemen Decoction), and herbs such as Cornus Fructus (Yuzhu) and Cinnamomi Cortex (Guizhi). After half a month of nursing, he recovered.
The wife of Jin Lingyou, a Fushou official, was the sister of Jiang Kuangsheng, a successful candidate in the spring examination. Jiang and his father saw her suffering from high fever and confusion, assuming it was Cold Damage (Shanghan). They invited me aboard their boat. Upon examination, I determined it was malaria, not cold damage. Four doses of Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) resolved the condition.
Wu Dansheng, a Wuyin official, had excessive dampness and a corpulent body. He suffered from vomiting, reflux, epigastric fullness and distension, alternating chills and fever, and dizziness. Liangge San (Cooling the Chest Powder) with added Coptidis Rhizoma (Huanglian) was administered to purge. Symptoms ceased after five days. Half a month later, they recurred and ceased again after five days.
Tang Ziduan, a Fushou official, experienced aversion to cold and fever, red face, and cold feet. His six pulses were wiry, thin, and rapid. He claimed the cause was cold invasion due to immoderate sexual activity, suspecting a Cold Damage Yin syndrome. I stated, "Yin syndromes typically do not present with alternating chills and fever." Two doses of Chaihu Guijiang Tang (Bupleurum, Cinnamon Twig, and Gypsum Decoction) cured him.
The daughter and niece of Gu Ruoyu, a Wenxue official, contracted malaria successively. Both presented with fever preceding chills. Guizhi Baihu Tang (Cinnamon Twig and White Tiger Decoction) cured them.
Mrs. Zheng Molin, a Tai Xue official's wife, was seven months pregnant when she first developed malaria followed by dysentery with significant bright red blood. Buzhong Yiqi Tang with Evodiae Fructus (Wuzhuyu) processed Coptidis Rhizoma (Chuanlianjun) cured her. I often see cases where pregnant women with malaria suffer fetal loss leading to death.
Zhang Yiquan, a Xiangyin official, had long consumed Yang-tonifying drugs like Renshen, Fuzi, and Cervi Cornu Colla (Lujiaojiao), depleting his True Yin. At age 75, in late July, he contracted malaria. A contemporary doctor mistakenly administered one dose of Changshan (Dichroa Root) to arrest malaria, leading to unconsciousness. The six pulses showed intermissions: two beats followed by a pause on light pressure, or three to five beats followed by a pause on heavy pressure. Only during the chills and fever phase did the pulse not intermit; after the fever subsided, intermissions resumed. This indicated severe depletion of True Qi unable to flow through the vessels. During chills and fever, pathogenic qi agitates the meridians, allowing temporary patency. This is a sign of latent pathogen within deficiency. I formulated a prescription: Dichroa Radix (Changshan) one qian soaked in wine, dried with five qian of Renshen, then discarded the Changshan, using only Renshen to boost the Great Qi in the chest to expel the pathogen. Note that Changshan damaged the Middle Qi, exacerbating the condition; thus, Changshan was retained as a guide. Administered day and night, two doses allowed sleep. However, chills and fever persisted, and pulse intermissions remained. He was instructed to take one liang of Renshen daily, divided into two doses, accompanied by thin gruel to support Stomach Qi. After several days, chills and fever gradually stopped, the pulse became faintly continuous, and he stabilized.
Gu Yushu, a successful candidate from Yufeng, experienced confusion, fever, and delirium upon malaria onset, along with epigastric fullness, distension, vomiting, and reflux. Palpation of the Qi Kou (Radial Artery at the wrist) revealed a short and slippery pulse alone, indicating old stagnation. Liangge San with Renzhonghuang (Human Excrement Cake) replaced by Caoguo Ren (Tsao-ko Fruit) cured him in one dose.
The daughter of Wang Jian'an, a Duxue official, suffered the same condition. Guizhi Baihu Tang with Renzhonghuang replaced by Congbai (Scallion Stem) and Douchi (Fermented Soybean) cured her in four doses.
Jin Chunhuan, a Zhonghan official, had his son contract malaria in August, occurring at Chen, Xu, Chou, and Wei hours. By spring, minor chills and fever increased at Zi, Wu, Mao, and You hours. Treatment began in early summer. Pulses were thread-like and fine; complexion was green, lips white. Liujunzi Tang with Guizhi and Fuzi was given for four doses without effect. Each dose was increased to include one liang of Renshen, and three qian each of Guizhi and Fuzi. After four more doses, chills and fever at Chen/Xu/Chou/Wei ceased, but those at Zi/Wu/Mao/You worsened. This indicated the Middle Earth regained authority while pathogens merged into Yin. The previous prescription continued for four doses. Complexion brightened, appetite improved, and chills/fever disappeared. Later, Dushen Tang (Single Ginseng Decoction) with Bawei Wan (Eight-Ingredient Pill) was used for convalescence.
Gu Dalai, a Wenxue official, over eighty years old, contracted Dan Nue (Hot Malaria) in early autumn, presenting with confusion, fever, delirium, asthma, fatigue, and enuresis. Some attributed delirium to Cold Damage, others enuresis to Wind Stroke. Uncertainty prevailed. I said, "Do not worry. This is a combination of the Three Yang channels. Delirium, enuresis, oral dysfunction, and facial dirtiness are examples found in Zhang Zhongjing's treatise on Summerheat." Baibu Jia Renshen Tang (White Tiger plus Ginseng Decoction) cured him after three doses. Simultaneously, Mrs. Yuan Cizhan (wife of Wenxue Yuan Cizhan) and Qi Lianshan (guest from Shuoke) suffered similar conditions. One had concurrent wind, treated with Baibu Jia Guizhi Tang; the other had concurrent dampness, treated with Baibu Jia Cangzhu Tang. Both recovered promptly. Treating them as Wind Stroke would have been erroneous.
During this gathering, a colleague asked why malaria pulses were not wiry this year. I replied, "Malaria belongs to the Shaoyang channel; the pulse should be wiry. If it resembles a normal person's pulse, it is because pathogenic qi and healthy qi are mixed indistinguishably, hiding the wiry image. The Jingui Yaolue states: 'In Warm Malaria, the pulse is like normal; there is no chills, only fever, bone joint pain, and occasional vomiting.' It is treated with Baibu Jia Guizhi Tang. How can one assume that a non-wiry pulse excludes wind-wood pathogens or precludes the use of Shaoyang herbs like Chaihu? Can routine methods apply?"
Feichou treated Shen Zijia. Every summer, exposure of the navel to fan wind caused abdominal pain and frequent diarrhea. Pulses were slightly rapid without other abnormalities. This indicated Kidney origin cold and insecure closure, easily attracting wind. Lower cold causes deficient fire to flare upward, hence the rapid pulse. Previously, Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) minus Ze Xie, plus Rougui (Cinnamon Bark), Rouguo (Nutmeg), Wuweizi (Schisandra), and Baijili (Tribulus), made into pills, cured the navel sensitivity and strengthened the Spleen/Stomach. The following autumn, he contracted malaria. Doctors used Baibu Tang and Zhuye Shigao Tang. Chills were severe, fever mild; face was green, feet cold; pulses wiry, thin, and rapid. Babai Dihuang Wan with tripled Guizhi and Fuzi decocted, combined with Sijunzi Tang and Baoyuan Tang morning and evening, stopped malaria in two days. Convalescence led to recovery.