虚寒之体忽患暑疟
建陵靳某之外家，于仲秋忽患暑疟，连日一作，寒洒热蒸，汗出如雨，口渴欲饮，脉来弦滑，舌苔微黄，
此暑疟也。靳问曰∶因何致病？丰曰∶良由暑月贪凉，过食生冷，其当时为患者，是为阴暑；伏匿日久，至
今而发者，即《内经》所谓夏伤于暑，秋为 疟是也。即用清营捍卫法，服下益热，急邀复诊。脉之转
为弦迟，询之口反不渴。丰曰∶此疟邪外达之征，请勿虑耳。观其形体肥白，知其本质虚寒，改用温补为主，
以理中汤加豆蔻、制夏、蜀漆、柴胡，姜枣为引，以河井水合煎，连尝三剂，疟邪遂遁矣。
暑疟热盛逼血上吐
城南叶某之子，偶染疟疾，邀丰诊之。脉象迢迢有力，寒热间日而来，口渴喜凉，热退多汗，此为
暑疟。遂用清营捍卫法去木贼，加藿香、草果、柴胡、甘草治之。服下疟势仍来，尤吐鲜红数口。复按其脉，
转为弦大而数，必因暑热内炎，逼伤血络所致。思古圣有“治病必求其本”之训，此证暑热是本，吐血是标，
可不必见病治病也。即用清凉涤暑法去扁豆，加黄芩、知母治之。连进两帖，疟发渐早，热势渐轻，
不知不觉而解，血恙亦未复萌。
截疟太早变成肿胀
西乡郑某，偶患疟疾，热重寒微，口渴便泻。先用符禁未
效，又服断截之药，疟与泻并止矣。数日后腹中忽胀，小便短少，来舍就诊，两手脉钝，沉取尚强。此乃暑疟
夹湿之证，其邪本欲向表分里而出，误用截法，阻其邪路，暑欲达表而不能，湿欲下行而不得，交阻于中，
气机不行而成肿胀，法当治标为先。即以木瓜、蒿、藿以解其暑，芩、苍、通草以行其湿，又以青皮、
浓朴、杏粒、槟榔，行其气而宽其膨。服下稍为中病，每得一矢气，腹内略松。更加菔子以破其气，鸡金以
消其水，服之矢气更多，溺亦通快，其腹逐渐消去。后用调脾化气，得全安耳。
江诚曰∶观以上三案，虽暑疟之轻证，但其夹证各有不同，设不细辨而妄治之，则轻证转重，重证转
危耳。如靳案本体虚寒，得温补而愈。叶案暑热劫络，得清剂而安。郑案夹湿变胀，得破削而宽。可见医
法有一定之理，无一定之方，倘胶于某证某药，则钝根莫化矣。
风疟时邪乘入血室
城南龚某之女，先微寒而后发热，口渴有汗，连日三发，脉弦而数，舌苔黄腻，此因夏伤于暑，加感
秋风，名风疟也。遂用辛散太阳法去羌活，加秦艽、藿梗治之。服二帖，疟势未衰，渐发渐晏，且夜来频欲
谵语。复诊其脉，与昨仿佛，但左部之形力，颇胜于右。思仲景有云∶昼则明了，夜则谵语，是为热入
血室。今脉左胜，疑其血室受邪，即询经转未曾。其母曰∶昨来甚寡，以后未行。此显然邪入血室之证也。
姑守前方去防风、淡豉，加当归、赤芍、川芎、柴胡，服之经水复来，点滴而少，谵语亦减，惟疟疾仍然。
再复其脉，左部转柔，余皆弦滑，已中病薮，可服原方。幸得疟势日衰一日，改用宣透膜原法加柴
胡、红枣治之，迭进三煎，疟邪遂解。
程曦曰∶时证易治，兼证难疗。若此案不细询其经事，则
医家病家，两相误也。倘见谵语之证，而为邪入心包，或为胃
家实热，清之攻之，变证必加。苟不熟仲景之书，而今日之证，
必成坏病矣。吾师尝谓不通仲景之书，不足以言医也。信夫！
寒疟之证温补治验
城东潘某，体素丰满，大便常溏，中土本属虚寒，固无论矣，忽于孟秋寒热交作，肌肤汗少，即延医诊，
遂作阴暑论治，辄投四味香薷饮加寒凉之剂，未获奏效，即来商治于丰。诊其脉弦而兼紧，舌苔白薄，寒先
热后，隔日而来，此寒疟也。良由体质本寒，加感秋凉致病，若果阴暑之证，在长夏而不在秋，况阴暑之寒
热，从未见隔日而发，当用附子理中汤加柴胡、草果、藿香、陈皮治之。服二剂，周身微汗，寒热略清。继服
二帖，疟邪遂未发矣。
湿疟之证辛散获效
新定王某之室，浣衣度活，平日难免无湿所受，患疟半月以来，前医之法无效，恳丰治之。切脉缓大
有力，遍身浮肿而疼，寒热汗无，连日一发，此明是湿邪为疟也。思先哲有风能胜湿之论，宜以辛温散邪，遂
以羌活渗湿汤加草果、浓朴为治，先服二剂小效，继服二剂全瘥。
温疟误为暑热
豫章张某，于仲夏中旬，发热连日，口渴喜饮，医者皆作暑热论治，所用不离藿、薷、滑、扁等药，未臻
效验。转商丰治，诊之脉濡且弱，舌苔微燥而黄，合其见证参之，似属暑热。但其未审既热之后，每有洒
淅恶寒之证，此即《内经》所谓“先热后寒，病以时作，名曰温疟”是也。温疟之证，最易伤阴，切忌温
散，治宜清凉透邪法。服之热势已挫，口渴依然，仍守原方，益以麦冬、鲜地，连服三剂，始得全愈。
产后瘅疟热补至变
四明沈某之室，诞后将匝月以来，忽然壮热汗多，口渴欲
饮。有谓产后阴虚，阳无所附；有谓气血大虚，虚热熏蒸，皆用温补之方，严禁寒凉之药。见病者忽尔 羸，
日晡发热，益信其为蓐痨，愈增热补，更加唇焦齿燥，舌绛无津。复请前二医合议，议用导龙入海，引火
归源之法，不但诸证未减，尤加气急神昏，始来商之于丰。丰即往诊，两手之脉，皆大无伦，推其致
病之因，阅其所服之药，实因误补益剧，非病至于此险也。沈曰∶此何证也？丰曰∶乃瘅疟也。此即古人
所谓阴气先伤，阳气独发，不寒瘅热，令人消烁肌肉，当用甘凉之剂治之。曰∶产后用凉，可无害乎？曰∶
有病则病当之，若再踌蹰，阴液立涸，必不可救矣。即用甘寒生津法，加两洋参、紫雪丹治之。头煎服下，
未见进退，次煎似有欲寐之形，大众见之，无不疑昏愦之变。复来请诊，脉象稍平，唇舌略润，诸恙如旧，
但增手战循衣。丰曰∶此阴阳似有相济之意，无何肝风又动之虞。仍守原章，佐以阿胶、龟版，及鸡子黄，
令其浓煎温服。是夜安神熟寐，热势大衰。次早诊之，诸逆证皆已屏去，继以清滋补养，调理两月方瘳。
阴邪入肾发为牝疟
江南陶某之室，寡居五载，腰如两截，带下淋漓，时值中秋，炎蒸如夏，或当风而纳凉，或因渴而饮冷，
其阴邪乘虚而陷少阴，发为牝疟。脉来沉小之象，畏寒而不甚热，肌肤浮肿，面色痿黄，饮食减少而乏味，小
水淡黄而欠舒，此阴虚邪陷之证，显而易见。丰用金匮肾气去萸肉、丹皮，加干姜、苍术，连服十
余剂，诸恙全安。
寒湿入脾证成牝疟
金陵张某，作客来衢，形素丰肥，向有卢同之癖，其体属寒湿者，先露一斑。忽患间日恶寒，按时而至，
胸前痞闷，口不作干，脉缓近迟，苔腻而白，此牝疟也。古人虽有邪气伏藏于心
于肾之论，但今之见证，皆属乎脾，宜用平胃合二陈，加干姜、草果、白蔻、砂仁治之。令尝五剂，三日
服尽，诸证咸瘥。
程曦曰∶凡学医者，必须天机活泼，毫无胶固之人而后可。如赵、喻注《金匮》，皆言邪舍于心，石
顽正其失，专言邪藏乎肾。吾师前以石顽之训为准绳，今观是案，又谓在脾，其实
非矛盾也，良由见证而断也。总因间日恶寒，按时而至，称为牝疟。可见医者，审证为第一耳。
疟发昏迷治痰得效
南乡酆某之母，年逾六旬，偶沾疟疾，淹缠数月，药石无功，乘舆来舍就诊。诊其脉，两手皆弦，其
疟连日而发，每于薄暮时，先微寒而后微热，神识渐渐昏闷，约一时许始苏，日日如是。阅前医之方，皆
不出小柴胡汤清脾饮等法，思其发时昏闷，定属痰迷。即以二陈汤加老蔻、藿香、杏仁、草果、潞参、姜
汁治之。连进三剂，神识遂清。继服二剂，寒热亦却。
时行疫疟
己卯夏五，患寒热者甚众，医者皆以为疟。所用咸是小柴胡汤、清脾饮，及何人饮、休疟饮等方，未
有一方奏效。殊不思经谓“夏伤于暑，秋必 疟”，疟每发于秋令，今于芒种夏至而发者何也？考岁气阳明
加于少阳，天政布凉，民病寒热，斯时病疟者，尽是时行疫疟也。有建德钱某来舍就医，曰∶患疟
久矣，请先生截之。丰曰∶此乃时行疫疟。遂用宣透膜原法加豆卷、干姜治之，其效捷于影响。后来求
治者，皆与钱病无异，悉以此法治之，莫不中 。可见疫疟之病，不必拘疟门一定之方，又不必拘
一定之证，更又不必拘一定之时，但其见证相同，而用药亦相同者，断断然矣。
鬼疟□□□□□□□□□
东乡叶某，自初秋患疟，至孟冬未愈，每每发于午后，寒不
甚寒，热不甚热，言语错乱，如见鬼神，至后半夜，神识遂清，倦怠而寐，日日如是，曾延医治，尽属罔灵。
请丰诊之，两手之脉，不调之至。曰∶“此鬼疟也。”即用驱邪辟祟法去龙骨，加
草果、常山，服之神气稍清……。
久疟阴虚及阳
鉴湖黄某之内，患疟三年， 羸之至，无医不迓，靡药不尝。邀丰治之，脉象纤微无力，洒寒烘热，每
发于申酉之时，舌淡无荣，眠食俱废，大便溏薄，月水不行。丰曰∶此虚疟也。出方阅之，计有数百余纸，
聊审近日之方，非参、 、术、草，即地、芍、归、胶，未尝有一剂桴鼓。细思是证，乃疟邪深踞于阴，
阴虚及阳之候。即用制首乌五钱，补其阴也；淡附片三钱，补其阳也；鳖甲二钱，青蒿五分，搜其阴分久踞
之邪；鹿霜三钱，羌活五分，随即领邪而还于表；东洋参三钱，炙甘草八分，补其正而御其邪；生姜二片，
红枣五枚，安其内而攘其外。诸药虽经服过，然制方实属不同。古云用药如用兵，孰为主将，孰为
先锋，指挥得法，自可望其破垒耳。黄某深信，即使人拣来煎服，二剂寒热觉轻；又二剂，精神稍振；再
又二剂，诸 尽却。调补三月，月信始行，起居犹昔矣。
体虚劳疟
安徽汪某，体本虚怯，饮食并减，神气极疲，精遗于梦，汗漏于寐，闲居静养，诸恙如无，偶有烦劳，遂
作寒热等证。延丰诊之，脉来小涩，此属劳疟之证，分明若绘矣。拟用何人散加
鳖甲、牡蛎、茯神、龙骨，令服十余剂，调养数月而康。
疟母破剂无效温补碱软得安
南乡傅某，自同治纪元，患疟之后，左胁下结成一块，即疟母也，迄今十五载矣，身体安然，不知不觉，
每一违和，渐次居中，初服常山饮子，后用鳖甲煎丸，皆无效验，因停药勿治。迩
苦眩晕遗精，耳鸣盗汗，曾用六黄兼六味，服之虽妥，但其痞块渐大渐中，将有变蛊之势。脉形缓滞，两尺
皆弱，先天亏损，断断无疑，消破之剂，决难浪施。余用桂附八味加龙骨、牡蛎、龟
版、鳖甲，蜜丸。服一料诸恙少减，二料得全瘥矣。
疟母攻破致死
歙北一医，在吾衢名冠一时。时有里人范某，久患疟母，寝食若旧，动作如常，闻此医欲归梓里，恐郡
内诸医，不能杜其病根，即商其治。所用硝、黄、枳、朴、巴豆、蓬、棱，一派攻伐之剂，未数日腹如复釜，
神气顿疲，饮食减少，病势日加一日，至于危急，始来商治于丰。诊其脉沉小而涩，此因攻破太猛，正气受伤之
候，证弗易治，嘱商名手。其兄再四哀求，不得已，勉以香砂六君损益，服之未效，复请固辞，再商他医，
终不能起。
程曦曰∶古人谓不服药为中医，诚哉是言！历见因病致死者少，因药致死者多，若此病是药速其亡也。不
思李念莪云∶养正则邪自除，譬如满座皆君子，一、二小人，自无容身之地。曦之鄙见，当补
正为君，稍兼攻积，庶乎稳妥，偏于攻破，非法也。
三疟扰伤气血补益得效
南乡李某，患三日疟，缠绵两三载，方药靡效。近用多是甜茶，服之呕吐，吐伤胃气，谷食减少，神气
愈疲，而疟疾仍来，来舍求治于丰。诊其脉缓涩沉弦，形色清 之至，此气血阴阳受亏之象也，非补益不能望
痊。即用制首乌五钱，潞党四钱，鳖甲、鹿霜各二钱，干姜、附片各八分，嘱服十剂，临发之日勿服，至第八
剂，寒热遂未发矣。复来就诊曰∶先生之方效于拔刺，然诸药前医亦曾用，而未验者何也？丰曰∶一则药味杂
乱，二则服法未精，不知间二日之疟，其邪深，其正虚，所以用
补法于未发之先，助其气血阴阳，则邪不能胜正而自止矣。今脉转为缓小，沉分亦然，疟邪果远遁也，当
守旧法，加之熟地、归身，姜、枣为引，连服十剂而安。
产后三疟久缠
北乡杜某之内，自诞后气血未复，偶沾三疟，纠缠半载未瘳。发时背如负重，腰如两截，寒洒洒欲覆被，
热烘烘欲思饮。诊其脉，举之若浮绵，按之不满部，面色白而无荣，舌色淡而无苔，此属奇经本虚，疟邪窜
入于阴，阴虚及阳之证。斯宜未发之日，大补奇脉阴阳，俾正气复充，邪气自却，倘以常山、草果专治其疟，
便是舍本求末矣。丰用东参、熟地、鹿霜、狗脊、龟版、牡蛎、炙 、桂枝，姜、枣为引，约服二十余剂，
疟始脱体。
或问曰∶曾见景岳治疟，每迎其锐而击之，最捷最效。今先生治疟，用药于未发之先。究遵景岳耶？抑
虚寒体质的人突然患上暑疟
建陵靳某的外家（岳母），在仲秋时节突然患上暑疟，连续几天发作，恶寒战栗与高热蒸腾交替出现，出汗如雨，口渴想喝水，脉象弦滑，舌苔微黄。这是暑疟。靳某问道：“为什么会得这个病？”雷丰说：“大抵是因为在暑热月份贪凉，吃过多的生冷食物。当时就发病的，叫做阴暑；潜伏日久，到现在才发作的，就是《内经》所说的‘夏伤于暑，秋为痎疟’。”随即使用清营捍卫法，服药后反而觉得更热，急忙邀请复诊。切脉发现脉象转为弦迟，询问得知口反而不渴了。雷丰说：“这是疟邪向外透达的迹象，请不要担心。”观察他形体肥白，知道其本质是虚寒，改用温补为主的方法，用理中汤加豆蔻、制半夏、蜀漆、柴胡，以生姜、大枣为引子，用井水和河水混合煎煮，连服三剂，疟邪于是退去。
暑疟热盛逼迫血液上溢而吐血
城南叶某的儿子，偶然染上疟疾，请雷丰诊治。脉象长而有力，寒热症状隔日发作一次，口渴喜欢喝凉水，热退后大汗淋漓，这是暑疟。于是用清营捍卫法去掉木贼，加入藿香、草果、柴胡、甘草来治疗。服药后疟疾势头依然发作，而且吐出鲜红色的血几口。再次按脉，脉象转为弦大而数，一定是因为暑热在内炎灼，逼迫损伤血络所致。想到古圣有“治病必求其本”的教诲，此证暑热是本，吐血是标，可以不必见病治病（即不单纯止血）。立即用清凉涤暑法去掉扁豆，加入黄芩、知母来治疗。连续服用两帖，疟疾发作时间逐渐提前，热势逐渐减轻，不知不觉间痊愈，出血的症状也没有再复发。
截疟太早变成肿胀
西乡郑某，偶然患上疟疾，热重寒轻，口渴且腹泻。先用符咒禁术没有效果，又服用断截疟疾的药物，疟疾和腹泻同时停止了。几天后腹部突然胀满，小便短少，到雷丰住处就诊，两手脉象钝滞，沉取尚有力。这是暑疟夹湿的证候，邪气本来想要向表分和里分排出，误用截疟法，阻断了邪气的出路，暑邪想要达表而不能，湿邪想要下行而不得，交结阻滞在中焦，气机运行不畅而形成肿胀，治法应当先治标。即用木瓜、青蒿、藿香来解暑，黄芩、苍术、通草来行湿，又用青皮、厚朴、杏仁、槟榔来行气并消除胀满。服药后稍微见效，每放一个屁，腹内略微松快。再加莱菔子来破气，鸡内金来消水，服用后放屁更多，小便也通畅爽快，腹部逐渐消退。后来用调脾化气的方法，得以完全康复。
江诚说：看以上三个医案，虽然是暑疟的轻证，但其兼夹证候各不相同，如果不仔细辨别而胡乱治疗，那么轻证就会转重，重证就会转危。如靳某一案，本体虚寒，得到温补而痊愈。叶某一案，暑热劫伤血络，得到清热剂而安宁。郑某一案，夹湿导致肿胀，得到破气消积药而宽舒。可见医法有一定的道理，没有固定的方子，如果拘泥于某证用某药，那就僵化死板不能变通了。
风疟时邪乘入血室
城南龚某的女儿，先轻微恶寒而后发热，口渴有汗，连续几天发作三次，脉象弦而数，舌苔黄腻，这是因为夏天伤于暑气，加上感受秋风，名叫风疟。于是用辛散太阳法去掉羌活，加入秦艽、藿梗治疗。服用两帖，疟疾势头未减，发作时间逐渐推迟，并且夜里频繁出现胡言乱语。复诊其脉象，与昨天差不多，但左部的脉形力量，颇强于右部。想到张仲景说过：“白天神志清楚，晚上胡言乱语，这是热入血室。”现在脉象左部胜，怀疑是血室受邪，于是询问月经是否来过。其母亲说：“昨天量很少，以后就没有来了。”这显然是邪入血室的证候。暂且守住前方，去掉防风、淡豆豉，加入当归、赤芍、川芎、柴胡，服用后经血又来，点滴且量少，胡言乱语也减少，只有疟疾仍然发作。再次诊脉，左部脉转柔和，其余皆弦滑，已经击中病所，可以服用原方。幸好疟疾势头一天比一天衰弱，改用宣透膜原法加柴胡、红枣治疗，连续进服三剂，疟邪于是解除。
程曦说：时令病症容易治疗，兼夹病症难疗。如果此案不仔细询问月经情况，那么医生和病人都会误判。如果见到胡言乱语的证候，认为是邪入心包，或者是胃家实热，用清热或攻下的方法，变证一定会增加。如果不熟读张仲景的书，那么今天的证候，必然成为坏病。我的老师曾经说，不通晓张仲景的书，不足以谈论医学。确实如此！
寒疟之证温补治疗的验案
城东潘某，身体素来丰满，大便经常稀溏，中焦脾胃本属虚寒，这就不用说了，忽然在孟秋时节寒热交替发作，肌肤出汗少，就请医生诊治，于是当作阴暑论治，立刻投用四味香薷饮加寒凉药物，没有获得疗效，就来请教雷丰。诊其脉象弦而兼紧，舌苔白薄，先寒后热，隔日发作，这是寒疟。大抵是由于体质本寒，加上感受秋凉致病，如果是阴暑之证，应该在长夏而不是秋天，况且阴暑的寒热，从未见过隔日发作的，应当用附子理中汤加柴胡、草果、藿香、陈皮治疗。服用两剂，周身微微出汗，寒热略微清除。继服两帖，疟邪于是不再发作。
湿疟之证辛散获效
新定王某的妻子，靠洗衣服度日，平日难免不受湿气侵袭，患疟疾半个月以来，前医的方法无效，恳请雷丰治疗。切脉缓大有力，遍身浮肿且疼痛，无寒热也无汗，每天发作一次，这明明是湿邪导致的疟疾。想到先哲有风能胜湿的理论，宜用辛温散邪，于是用羌活渗湿汤加草果、厚朴来治疗，先服两剂小效，继服两剂全愈。
温疟误认为暑热
豫章张某，在仲夏中旬，发热连续几天，口渴喜欢喝水，医生都当作暑热论治，所用药物不离藿香、香薷、滑石、扁豆等，未达到疗效。转而请教雷丰治疗，诊之脉象濡且弱，舌苔微燥而黄，结合其见证参详，似乎属于暑热。但他没有考虑到既热之后，每每有洒淅恶寒的症状，这就是《内经》所说的“先热后寒，病以时作，名曰温疟”。温疟之证，最容易伤阴，切忌温散，治宜清凉透邪法。服用后热势已挫败，口渴依然，仍守原方，增加麦冬、鲜地黄，连服三剂，才得以全愈。
产后瘅疟因温热补益至变证
四明沈某的妻子，分娩后将近一个月，忽然壮热汗多，口渴想喝水。有人说产后阴虚，阳气无所依附；有人说气血大虚，虚热熏蒸，都用温补的方子，严禁寒凉药物。看见病人忽然消瘦，下午发热，更加相信她是蓐劳（产后虚损），越发增加热补，更加导致嘴唇焦裂牙齿干燥，舌质红绛无津液。再次请前两位医生合议，商议用导龙入海、引火归源的方法，不但各种症状没有减轻，反而加上气急神昏，才开始请教雷丰。雷丰就去诊治，两手脉象，都盛大无比，推究致病的原因，查阅他所服用的药物，实在是因为误补使病情加剧，并非病至于此险境。沈某问：“这是什么证？”雷丰说：“这是瘅疟。这就是古人所说的阴气先伤，阳气独发，不寒但热，使人肌肉消烁，应当用甘凉的药剂治疗。”沈某说：“产后用凉药，会有害处吗？”雷丰说：“有病则病当之（药力作用于病邪），如果再犹豫不决，阴液立刻枯竭，必不可救了。”立即用甘寒生津法，加西洋参、紫雪丹治疗。头煎服下，未见进退，二煎似有想睡觉的样子，大家看见，无不怀疑是昏愦的变证。再次请来诊脉，脉象稍平，嘴唇舌头略微滋润，各种症状依旧，只是增加了手抖循衣摸床的症状。雷丰说：“这是阴阳似乎有相济的意思，不久又有肝风又动的忧虑。”仍守原方，佐以阿胶、龟版，以及鸡蛋黄，令其浓煎温服。当晚安神熟睡，热势大衰。次日早晨诊脉，各种逆证都已屏除，继以清滋补养，调理两个月才好。
阴邪入肾发为牝疟
江南陶某的妻子，寡居五年，腰部感觉像断成两截，带下淋漓不断，正值中秋，炎热蒸腾如同夏天，或者当风纳凉，或者因渴而饮冷，其阴邪乘虚陷入少阴，发为牝疟。脉象沉小，畏寒而不甚热，肌肤浮肿，面色萎黄，饮食减少且无味，小便淡黄且不顺畅，这是阴虚邪陷的证候，显而易见。雷丰用金匮肾气丸去掉山茱萸、牡丹皮，加入干姜、苍术，连服十余剂，各种症状全安。
寒湿入脾证成牝疟
金陵张某，作客来到衢州，身体素来丰肥，向来有嗜酒的习惯，其体质属于寒湿，先显露一斑。忽然患隔日恶寒，按时而至，胸前痞闷，口不干，脉象缓近迟，苔腻而白，这是牝疟。古人虽有邪气伏藏于心、于肾的论述，但现在的见证，都属于脾，宜用平胃散合二陈汤，加干姜、草果、白蔻、砂仁治疗。令其尝服五剂，三日服完，各种症状全愈。
程曦说：凡是学医者，必须天机活泼，毫无胶固之人然后才可以。如赵献可、喻嘉言注解《金匮》，都说邪舍于心，石顽纠正他们的失误，专说邪藏乎肾。我的老师以前以石顽的训诫为准绳，现在看这个医案，又说在脾，其实并不矛盾，大抵是由见证来判断的。总因隔日恶寒，按时而至，称为牝疟。可见医者，审证是第一重要的。
疟发昏迷治痰得效
南乡酆某的母亲，年过六十，偶然沾上疟疾，拖延数月，药石无功，乘坐轿子到雷丰住处就诊。诊其脉，两手皆弦，其疟疾连日发作，每当傍晚时分，先轻微恶寒而后轻微发热，神识渐渐昏闷，约一小时才苏醒，天天如此。翻阅前医的方子，都不出小柴胡汤、清脾饮等方法，想到其发作时昏闷，定属痰迷心窍。即用二陈汤加老蔻仁、藿香、杏仁、草果、党参、姜汁治疗。连续进服三剂，神识遂清。继服两剂，寒热也退去。
时行疫疟
己卯年五月，患寒热的人很多，医生都认为是疟疾。所用的都是小柴胡汤、清脾饮，及何人饮、休疟饮等方，没有一个方子奏效。殊不知经典说“夏伤于暑，秋必痎疟”，疟疾多在秋季发作，现在在芒种夏至时就发作为什么呢？考察岁气阳明加于少阳，天政布凉，民众病寒热，此时病疟的，尽是时行疫疟。有建德钱某到雷丰住处就医，说：“患疟疾很久了，请先生截断它。”雷丰说：“这是时行疫疟。”于是用宣透膜原法加豆卷、干姜治疗，其效快捷如影响。后来求治的人，都与钱某病情无异，全部用此法治之，没有不中的。可见疫疟之病，不必拘泥于疟门一定的方子，又不必拘泥于一定的证候，更又不必拘泥于一定的时间，但只要见证相同，而用药也相同的，这是确定的。
鬼疟
东乡叶某，从初秋患疟，到孟冬未愈，每每发于午后，寒不甚寒，热不甚热，言语错乱，如见鬼神，至后半夜，神识遂清，倦怠而睡，天天如此，曾请医生医治，全都无效。请雷丰诊脉，两手脉象不调至极。说：“这是鬼疟。”即用驱邪辟祟法去掉龙骨，加草果、常山，服用后神气稍清……。
久疟阴虚及阳
鉴湖黄某的儿媳，患疟疾三年，瘦弱至极，无医不迎，无药不尝。请雷丰治疗，脉象纤微无力，洒寒烘热，每每发于申酉之时，舌淡无光泽，眠食俱废，大便溏薄，月经不行。雷丰说：“这是虚疟。”拿出方子查阅，计有数百余纸，随便审视近日之方，不是人参、白术、甘草，就是地黄、芍药、当归、阿胶，未曾有一剂如鼓应响般有效。细思此证，乃疟邪深踞于阴，阴虚及阳的候象。即用制首乌五钱，补其阴；淡附片三钱，补其阳；鳖甲二钱，青蒿五分，搜其阴分久踞之邪；鹿霜三钱，羌活五分，随即领邪而还于表；东洋参三钱，炙甘草八分，补其正而御其邪；生姜二片，红枣五枚，安其内而攘其外。诸药虽经服过，然制方实属不同。古云用药如用兵，谁是主将，谁是先锋，指挥得法，自然可望其破垒耳。黄某深信，即使让人拣来煎服，两剂寒热觉轻；又两剂，精神稍振；再两剂，各种症状尽却。调补三月，月经始行，起居如昔矣。
体虚劳疟
安徽汪某，身体本虚怯，饮食并减，神气极疲，梦遗精液，睡中漏汗，闲居静养，各种症状如无，偶有烦劳，遂作寒热等证。请雷丰诊治，脉来小涩，这属于劳疟之证，分明如画。拟用何人散加鳖甲、牡蛎、茯神、龙骨，令服十余剂，调养数月而康。
疟母破剂无效温补碱软得安
南乡傅某，自同治纪元，患疟之后，左胁下结成一块，即疟母也，迄今十五年了，身体安然，不知不觉，每一违和，渐次居中，初服常山饮子，后用鳖甲煎丸，皆无效验，因停药勿治。近来苦眩晕遗精，耳鸣盗汗，曾用六黄汤兼六味地黄丸，服之虽妥，但其痞块渐大渐硬，将有变蛊之势。脉形缓滞，两尺皆弱，先天亏损，断断无疑，消破之剂，决难浪施。我用桂附八味丸加龙骨、牡蛎、龟版、鳖甲，蜜丸。服一料各种症状少减，二料得全愈矣。
疟母攻破致死
歙北一位医生，在衢州名冠一时。时有同乡范某，久患疟母，寝食若旧，动作如常，听说这位医生要回故乡，恐怕郡内其他医生，不能杜其病根，就商量他的治疗。所用硝石、大黄、枳实、厚朴、巴豆、蓬莪术、三棱，一派攻伐之剂，未数日腹如复釜，神气顿疲，饮食减少，病势日加一日，至于危急，才开始请教雷丰。诊其脉沉小而涩，这是因攻破太猛，正气受伤之候，证不易治，嘱咐商量名医。其兄再三哀求，不得已，勉以香砂六君子汤损益，服之未效，再次请求固辞，再商他医，终不能起。
程曦说：古人谓不服药为中医，诚哉是言！历见因病致死者少，因药致死者多，若此病是药速其亡也。不思李念莪云：养正则邪自除，譬如满座皆君子，一、二小人，自无容身之地。曦之鄙见，当补正为君，稍兼攻积，庶乎稳妥，偏于攻破，非法也。
三疟扰伤气血补益得效
南乡李某，患三日疟，缠绵两三载，方药靡效。近用多是甜茶，服之呕吐，吐伤胃气，谷食减少，神气愈疲，而疟疾仍来，到雷丰住处求治。诊其脉缓涩沉弦，形色清瘦至极，这是气血阴阳受亏之象也，非补益不能望痊。即用制首乌五钱，潞党参四钱，鳖甲、鹿霜各二钱，干姜、附片各八分，嘱服十剂，临发之日勿服，至第八剂，寒热遂未发矣。再次来就诊说：“先生的方子效如拔刺，然而诸药前医亦曾用，而未验者何也？”雷丰说：“一则药味杂乱，二则服法未精，不知间二日之疟，其邪深，其正虚，所以用补法于未发之先，助其气血阴阳，则邪不能胜正而自止矣。现在脉转为缓小，沉分亦然，疟邪果远遁也，当守旧法，加之熟地、归身，姜、枣为引，连服十剂而安。
产后三疟久缠
北乡杜某的儿媳，自分娩后气血未复，偶沾三疟，纠缠半载未愈。发作时背如负重，腰如两截，寒洒洒欲覆被，热烘烘欲思饮。诊其脉，举之若浮绵，按之不满部，面色白而无光泽，舌色淡而无苔，这属于奇经本虚，疟邪窜入于阴，阴虚及阳之证。斯宜未发之日，大补奇脉阴阳，俾正气复充，邪气自却，倘以常山、草果专治其疟，便是舍本求末矣。雷丰用东洋参、熟地、鹿霜、狗脊、龟版、牡蛎、炙黄芪、桂枝，姜、枣为引，约服二十余剂，疟始脱体。
有人问：曾见张景岳治疟，每迎其锐而击之，最捷最效。如今先生治疟，用药于未发之先。究竟遵景岳耶？抑……
Xu Han Ti Zhi Hu Huan Shu Nüe (Sudden Onset of Summerheat-Jaundice Malaria in a Deficient-Cold Constitution)
The maternal grandmother of Jin from Jianling suddenly contracted summerheat-jia nüe (intermittent malaria caused by summerheat) in mid-autumn. It occurred daily for several days, with alternating chills and steaming fever, profuse sweating like rain, thirst with desire to drink, a wiry and slippery pulse, and a slightly yellow tongue coating. This is summerheat-jia nüe. Jin asked, "Why did I get this disease?" Lei Feng said, "It is largely due to seeking coolness during the summer months and overeating raw and cold foods. Those who manifest symptoms immediately are suffering from Yin Summerheat; those whose pathogenic factors lie dormant for a long time and only now manifest are experiencing what the *Neijing* calls 'Summer injury by summerheat, autumn becomes jia nüe'." He immediately employed the Method of Clearing the Ying Level and Guarding the Wei Level. After taking the medicine, the patient felt even hotter, so he was urgently invited for a follow-up consultation. The pulse had changed to wiry and slow, and upon inquiry, the mouth was no longer thirsty. Lei Feng said, "This is a sign that the malaria pathogen is reaching the exterior; do not worry." Observing his fat and white physique, he knew the underlying constitution was deficient and cold, so he switched to a primary method of warming and tonifying. He used Lizhong Tang (Cinnamon Twig and Ginger Decoction) added with Cardamomi Fructus (Doukou), processed Pinelliae Rhizoma (Zhi Banxia), Paecilomyces Militaris (Shuqi), and Bupleuri Radix (Chaihu), using fresh ginger and jujube as guides, decocted with well water and river water. After three doses, the malaria pathogen retreated.
Shu Nüe Re Sheng Bi Xue Shang Tu (Summerheat Jia Nüe with Excessive Heat Forcing Blood to Regurgitate)
The son of Ye from south of the city accidentally contracted malaria and invited Lei Feng to diagnose him. The pulse was long and forceful, with chills and fever occurring every other day, thirst preferring cold drinks, and profuse sweating after fever subsided. This was summerheat-jia nüe. He used the Method of Clearing the Ying Level and Guarding the Wei Level, removing Equiseti Herba (Mu Zei), and adding Agastachis Herba (Huoxiang), Tsaoko Fructus (Caoguo), Bupleuri Radix (Chaihu), and Glycyrrhizae Radix et Rhizoma (Gancao). After taking the medicine, the malaria势头 remained, and he vomited several mouthfuls of bright red blood. Palpating the pulse again, it had become wiry, large, and rapid. It must be due to summerheat blazing internally, forcing damage to the blood collaterals. Recalling the ancient sage's instruction that "treating disease must seek its root," in this case, summerheat is the root, and hematemesis is the branch; one need not treat the symptom directly without addressing the cause. He immediately used the Method of Cooling and Washing Away Summerheat, removing Dolichos Lablab Seed (Bian Dou), and adding Scutellariae Radix (Huangqin) and Anemarrhenae Rhizoma (Zhimu). After two doses, the malaria attacks came earlier, the heat intensity lessened, and it resolved unknowingly, with the bleeding not recurring.
Jie Nüe Tai Zao Bian Cheng Zhong Zhang (Malaria Interrupted Too Early Leads to Distension and Swelling)
Zheng from Xixiang accidentally contracted malaria, with heavy heat and slight chills, thirst, and diarrhea. He first tried talismanic spells without effect, then took drugs to interrupt the malaria, causing both malaria and diarrhea to stop simultaneously. A few days later, his abdomen suddenly distended, and urination became scanty. He came to Lei Feng's residence for treatment. Both hands' pulses were dull and sluggish, but strong on deep pressure. This was a syndrome of summerheat-jia nüe complicated with dampness. The pathogen originally wanted to exit via the exterior and interior branches. Mistakenly using interruption methods blocked the path of the pathogen; summerheat wanted to reach the exterior but could not, dampness wanted to descend but could not. They obstructed each other in the middle, causing qi mechanism stagnation and resulting in distension and swelling. The treatment method should prioritize treating the branch. He used Chaenomeli Fructus (Mugua), Artemisiae Annuae Herba (Qinghao), and Agastachis Herba (Huoxiang) to resolve summerheat; Scutellariae Radix (Huangqin), Atractylodis Rhizoma (Cangzhu), and Tectona Grandis Stem (Tongcao) to move dampness; Citri Reticulatae Pericarpium (Qingpi), Magnoliae Officinalis Cortex (Houpo), Armeniacae Semen (Xingren), and Arecae Seed (Binglang) to move qi and relieve fullness. After taking the medicine, there was slight relief, with flatulence providing some abdominal loosening. He added Raphani Fructus (Fuzi) to break qi stagnation and Cruris Galliformatis Endothelium Corneum (Jijin) to eliminate fluid retention. After taking it, there was more flatulence, urination became smooth, and the abdomen gradually subsided. Later, using methods to regulate spleen and transform qi, he made a complete recovery.
Jiang Cheng said: Looking at these three cases above, although they are mild forms of summerheat-jia nüe, their complicating syndromes are different. If not carefully differentiated and treated recklessly, mild conditions will worsen, and severe conditions will become critical. In Jin's case, the constitution was deficient and cold, cured by warming and tonifying. In Ye's case, summerheat damaged the collaterals, calmed by cooling agents. In Zheng's case, dampness complication led to swelling, relieved by breaking and reducing agents. Thus, medical methods have certain principles but no fixed formulas. If one sticks rigidly to specific drugs for specific syndromes, one becomes inflexible and ineffective.
Feng Nüe Shi Xie Cheng Ru Xue Shi (Wind Malaria with Pathogenic Factors Entering the Blood Chamber)
The daughter of Gong from south of the city first had slight chills then fever, with thirst and sweating, occurring three times daily for several days. The pulse was wiry and rapid, and the tongue coating was yellow and greasy. This was due to summerheat injury in summer plus wind sensation in autumn, named Wind Malaria. He used the Method of Acrid Dispersal of the Taiyang Channel, removing Notopterygii Rhizoma (Qianghuo), and adding Gentianae Macrophyllae Radix (Qinjiao) and Agastachis Herba (Huoxiang). After two doses, the malaria势头 did not decrease, attacks became delayed, and at night he frequently spoke deliriously. Follow-up pulse was similar to yesterday, but the left side was stronger than the right. Recalling Zhang Zhongjing's saying: "Clear during the day, delirious at night, this is heat entering the blood chamber." With the left pulse prevailing, suspecting blood chamber involvement, he asked if menstruation had occurred. The mother said, "It was very light yesterday, and has not continued since." This is clearly a syndrome of pathogen entering the blood chamber. Temporarily sticking to the previous formula, removing Saposhnikoviae Radix (Fangfeng) and Sojae Preparata (Danchi), adding Angelicae Sinensis Radix (Danggui), Paeoniae Radix Rubra (Chishao), Chuanxiong Rhizome (Chuanxiong), and Bupleuri Radix (Chaihu). After taking it, menstruation returned, scanty and drop-like, delirium decreased, but malaria persisted. Re-palpating the pulse, the left side turned soft, others wiry and slippery, indicating hitting the disease source, so the original formula could be taken. Fortunately, the malaria势头 declined daily. He switched to the Method of Venting and Penetrating the Membrane Source, adding Bupleuri Radix (Chaihu) and Red Jujube (Hongzao). After three doses, the malaria pathogen was resolved.
Cheng Xi said: Seasonal diseases are easy to treat, complicating diseases are difficult. If this case did not carefully inquire about menstruation, both doctor and patient would be mistaken. If seeing delirium and attributing it to pathogen entering the pericardium or stomach heat, using clearing or purging methods would add complications. Without familiarity with Zhang Zhongjing's books, today's syndrome would surely become a ruined disease. My teacher once said, without mastering Zhang Zhongjing's works, one cannot speak of medicine. Truly so!
Han Nüe Zhi Zheng Wen Bu Zhi Yan (Verified Case of Warming and Tonifying for Cold Malaria Syndrome)
Pan from east of the city had a plump constitution, frequent loose stools, indicating middle jiao deficiency and cold, which goes without saying. Suddenly in early autumn, he had alternating chills and fever, little sweat on skin. A doctor diagnosed it as Yin Summerheat and prescribed Siwei Xiangru Yin (Four-Ingredient Schizonepeta and Elsholtzia Decoction) with cold-natured herbs, without effect. He came to consult Lei Feng. The pulse was wiry and tight, tongue coating white and thin, chills before fever, occurring every other day. This was Cold Malaria. Largely due to cold constitution plus autumn coolness. If it were Yin Summerheat, it would occur in late summer, not autumn, and Yin Summerheat chills/fever never occur every other day. He should use Fuzi Lizhong Tang (Aconite and Cinnamon Twig Decoction) added with Bupleuri Radix (Chaihu), Tsaoko Fructus (Caoguo), Agastachis Herba (Huoxiang), and Citri Reticulatae Pericarpium (Chenpi). After two doses, slight whole-body sweat, chills and fever slightly cleared. After two more doses, malaria pathogen did not recur.
Shi Nüe Zhi Zheng Xin San Huo Xiao (Efficacy of Acrid Dispersal for Damp Malaria Syndrome)
Wang's wife from Xinding earned a living by washing clothes, inevitably exposed to dampness. Suffering from malaria for half a month, previous doctors' methods failed. She begged Lei Feng to treat her. Pulse was slow, large, and forceful. Whole body edema and pain, no chills/fever/sweat, occurring daily. Clearly dampness-induced malaria. Recalling the ancients' theory that wind can overcome dampness, suitable for acrid-warm dispersal of pathogens. He used Qianghuo Shenshi Tang (Notopterygium Dampness-Permeating Decoction) added with Tsaoko Fructus (Caoguo) and Magnoliae Officinalis Cortex (Houpo). Two doses showed slight effect, two more doses resulted in full recovery.
Wen Nüe Wu Wei Shu Re (Warm Malaria Misdiagnosed as Summerheat)
Zhang from Yuzhang, in mid-summer, had continuous fever for days, thirst preferring drinks. Doctors treated as summerheat, using herbs like Agastachis Herba (Huoxiang), Schizonepetae Herba (Xiangru), Polyporus (Hua Zhu), and Dolichos Lablab Seed (Bian Dou), without effect. He consulted Lei Feng. Pulse was soggy and weak, tongue coating slightly dry and yellow. Combined with symptoms, it seemed like summerheat. However, after fever, there were always aversion to cold with shivering. This is what the *Neijing* calls "Heat first, then cold, occurring at times, named Warm Malaria." Warm malaria easily damages yin fluids; warm dispersal is strictly contraindicated. Treatment should use the Method of Cooling and Clearing to vent pathogens. After taking, heat intensity was suppressed, thirst remained. Sticking to the original formula, adding Ophiopogonis Radix (Maidong) and Rehmanniae Radix Recens (Xian Di). Three doses led to full recovery.
Chan Nüe Chan Hou Re Bu Zhi Bian (Postpartum Chan Malaria Complicated by Heat Tonification)
Shen's wife from Siming, nearly a month postpartum, suddenly had high fever, profuse sweat, thirst. Some said postpartum yin deficiency with unattached yang; others said severe qi/blood deficiency with steaming deficiency heat. All used heat-tonifying formulas, forbidding cold herbs. Seeing the patient emaciate, afternoon fever, they believed it was postpartum consumption (Rulao), increasing heat tonification. Lips cracked, teeth dry, tongue crimson without fluids. Previous two doctors discussed using "Guiding Dragon to Sea" and "Leading Fire Back to Source" methods. Symptoms did not decrease; instead, shortness of breath and confusion appeared. They consulted Lei Feng. Both hands' pulses were extremely large. Investigating the cause and reviewing past meds, it was indeed worsened by mistaken tonification. Shen asked, "What syndrome is this?" Lei Feng said, "This is Chan Malaria. As ancients said: Yin qi injured first, yang qi alone flares, no chills but heat, causing muscle wasting. Use sweet-cool agents." Shen asked, "Is it safe to use cool herbs postpartum?" Lei Feng said, "When there is disease, the disease bears the drug's action. Hesitation leads to immediate yin fluid exhaustion, incurable." Immediately used Sweet-Cold Generating Fluids Method, adding American Ginseng (Yangshen) and Zi Xue Dan (Purple Snow Pill). First decoction showed no change; second decoction showed drowsiness. Everyone feared confusion/death. Re-pulse was calmer, lips/tongue moist, symptoms same, but hand tremors and grasping at bedclothes appeared. Lei Feng said, "Yin and yang seem to harmonize, but fear liver wind stirring." Stuck to original formula, added Donkey-Hide Gelatin (Ejiao), Tortoise Plastron (Guiban), and Egg Yolk (Jizi Huang), decocted thick and taken warm. That night, sound sleep, heat greatly reduced. Next morning, adverse symptoms gone. Continued with clearing, tonifying, and nourishing for two months until recovered.
Yin Xie Ru Shen Fa Wei Pin Nüe (Yin Pathogen Entering Kidney Manifests as Pin Malaria)
Tao's wife from Jiangnan, widowed for five years, waist felt severed, leukorrhea dripping. Mid-autumn, hot and muggy like summer. Exposure to wind/coolness or drinking cold when thirsty allowed yin pathogen to sink into Shaoyin, manifesting as Pin Malaria. Pulse was deep and small, aversion to cold without much heat, edema, sallow complexion, poor appetite, pale yellow uncomfortable urination. Clearly yin deficiency with pathogen sinking. Lei Feng used Jinkui Shenqi Wan (Golden Cabinet Kidney Qi Pill) removing Corni Fructus (Yurou) and Moutan Cortex (Danpi), adding dried ginger (Ganjiang) and Atractylodis Rhizoma (Cangzhu). Over ten doses, all symptoms resolved.
Han Shi Ru Pi Zheng Cheng Pin Nüe (Cold-Damp Entering Spleen Forms Pin Malaria)
Zhang from Jinling, staying in Quzhou, plump constitution, habitual drinker, constitution cold-damp. Suddenly had alternating chills every other day, on time, chest oppression, no dry mouth, slow/near-slow pulse, greasy white coating. This was Pin Malaria. Ancients spoke of pathogen hiding in heart/kidney, but current symptoms belong to spleen. Used Pingwei San combined with Erchen Tang, adding dried ginger (Ganjiang), Tsaoko Fructus (Caoguo), White Cardamom (Baiko), and Amomum Fruit (Sharen). Five doses taken over three days, all symptoms healed.
Cheng Xi said: Medical students must be flexible, not rigid. Zhao and Yu annotated *Jinkui* saying pathogen stays in heart; Shiwang corrected them, saying it stays in kidney. My teacher followed Shiwang. Now seeing this case says spleen. Not contradictory, but based on symptoms. Total alternating chills every other day on time is called Pin Malaria. Thus, syndrome differentiation is paramount for physicians.
Ma Fa Hunzhi Zhi Tan De Xiao (Malaria with Coma Cured by Treating Phlegm)
Feng's mother from Nanxiang, over sixty, contracted malaria, lingering months, medicines useless. Came by sedan chair. Pulse wiry in both hands. Malaria daily, dusk slight chills then slight heat, consciousness gradually confused, recovering after an hour, daily. Past prescriptions were Xiaochaihu Tang or Qingpi Yin. Thinking confusion at onset indicates phlegm confusing the mind. Used Erchen Tang added with Old Cardamom (Laoke), Agastachis Herba (Huoxiang), Apricot Kernel (Xingren), Tsaoko Fructus (Caoguo), Codonopsis Radix (Lushen), and Ginger Juice (Jiangzhi). Three doses cleared consciousness. Two more doses stopped chills/fever.
Shi Xing Yi Nüe (Seasonal Epidemic Malaria)
In the fifth month of Ji Mao year, many had chills/fever, doctors thought malaria. Used Xiaochaihu Tang, Qingpi Yin, Heren Yin, Xiumai Yin, none effective. Didn't consider classics: "Summer injury by summerheat, autumn becomes jia nüe." Malaria usually in autumn, why here at Mangzhong/Xiazhi? Examining annual qi: Yangming adds to Shaoyang, heaven governs coolness, people suffer chills/fever. Malaria here is seasonal epidemic malaria. Qian from Jiande came, said malaria long-standing, asked to interrupt. Lei Feng said, "Seasonal epidemic malaria." Used Xuanti Moyuan Fa (Venting/Penetrating Membrane Source Method) added with Soybean (Doujuan) and dried ginger (Ganjiang). Effect swift. Others treated similarly, all successful. Thus, epidemic malaria need not stick to fixed malaria formulas, syndromes, or times. If symptoms match, drugs match.
Gui Nüe (Ghost Malaria)
Ye from Dongxiang, malaria from early autumn to early winter, unhealed. Occurred afternoons, slight chills/heat, confused speech, seeing ghosts, clear by late night, tired sleep, daily. Doctors ineffective. Lei Feng palpated irregular pulses. Said, "Ghost Malaria." Used Quxie Bisui Fa (Expel Evil/Avert Curse Method) removing Longgu (Long Gu), added Tsaoko Fructus (Caoguo) and Clitoria Ternatea Root (Changshan). Spirit slightly cleared...
Jiu Nüe Yin Xu Ji Yang (Long-term Malaria Yin Deficiency Affecting Yang)
Huang's daughter-in-law from Jianhu, malaria three years, extremely emaciated, sought all doctors, tried all drugs. Lei Feng palpated fine, weak pulse, chills/fever, occurring at Shen/You hours (3-7 PM), pale tongue, no sleep/eat, loose stool, amenorrhea. Lei Feng said, "Deficiency Malaria." Reviewed hundreds of past prescriptions: mostly Ginseng, Atractylodes, Licorice, Rehmannia, Peony, Angelica, Gelatin. None worked. Thought: Pathogen deeply rooted in yin, yin deficiency affecting yang. Used Prepared Polygonum Multiflorum (Zhi Shouwu) 5 qian to tonify yin; Processed Aconite (Dan Fupian) 3 qian to tonify yang; Turtle Plastron (Biejia) 2 qian, Artemisiae Annuae Herba (Qinghao) 0.5 fen to search out pathogen in yin level; Deer Antler Glue (Lushuang) 3 qian, Notopterygii Rhizoma (Qianghuo) 0.5 fen to lead pathogen back to exterior; Japanese Ginseng (Dongyangshen) 3 qian, Roasted Licorice (Zhi Gancao) 0.8 fen to tonify upright qi and resist pathogen; Ginger 2 slices, Jujube 5 pieces to calm interior and repel exterior. Although similar herbs used before, formulation differed. Medicine like war: commander vs vanguard. Huang trusted, took two doses, chills/fever lighter; two more, spirit revived; two more, symptoms gone. Tonified three months, menstruation returned, normal life.
Ti Xu Lao Nüe (Body Deficiency Labor Malaria)
Wang from Anhui, constitution deficient/cowardly, poor appetite, extreme fatigue, nocturnal emission, night sweats. Resting, symptoms absent; exertion caused chills/fever. Lei Feng palpated small, choppy pulse. Clearly Labor Malaria. Prescribed Heren San added with Turtle Plastron (Biejia), Oyster Shell (Muli), Poria (Fushen), and Dragon Bone (Longgu). Ten doses, months of recuperation, recovered.
Nu Mu Po Ji Wu Xiao Wen Bu Jian Ruan De An (Malaria Mass: Breaking Agents Ineffective, Warming/Tonifying Softening Effective)
Fu from Nanxiang, after malaria in Tongzhi era, mass formed under left hypochondrium (Nu Mu/Mass), fifteen years. Body fine, unaware. When unwell, mass moved center. Tried Changshan Yinzi, Biejia Jian Wan, ineffective, stopped treatment. Recently dizzy, seminal emission, tinnitus, night sweats. Used Liu Huang Tang + Liuwei Dihuang Wan, okay, but mass grew hard/large, risk of Gu disease. Pulse slow/stagnant, both Chi weak, congenital deficiency undeniable. Breaking agents risky. Used Gui Fu Ba Wei Wan added with Longgu, Muli, Guiban, Biejia, honey pills. One dose symptoms reduced; two doses fully healed.
Nu Mu Gong Po Zhi Si (Malaria Mass Killed by Aggressive Purging)
A famous doctor in Quzhou treated Fan, long-term Nu Mu, normal life. Doctor leaving hometown, Fan sought him to remove root. Used Nitre, Rhubarb, Immature Bitter Orange, Magnolia Bark, Croton Seed, Curcuma, Burreed Tuber. Pure attacking agents. Days later, abdomen like inverted cauldron, spirit exhausted, poor appetite, worsening. Came to Lei Feng. Pulse deep/small/choppy, due to excessive purging damaging upright qi. Hard to treat, referred to expert. Brother begged, Lei Feng reluctantly used Xiangsha Liujun Zi Tang modified. Ineffective. Refused further, sought other doctors, died.
Cheng Xi said: Ancients say "not taking medicine is intermediate medicine." True! Few die of disease, many of medicine. This case killed by medicine. Li Nian'e said: Nourish upright, evil removes naturally. Like a room of gentlemen, villains have no place. Opinion: Tonify upright as main, slightly attack accumulation. Safe. Pure attacking is illegal/unorthodox.
San Nüe Rao Shang Qi Xue Bu Yi De Xiao (Three-Day Malaria Damaging Qi/Blood: Tonification Effective)
Li from Nanxiang, three-day malaria, two-three years, medicines failed. Recently drank sweet tea, vomited, damaged stomach qi, poor intake, fatigue, malaria persisted. Lei Feng palpated slow/choppy/deep/wiry pulse, emaciated appearance. Qi/blood/yin/yang deficiency. Must tonify. Used Prepared Polygonum Multiflorum (Zhi Shouwu) 5 qian, Codonopsis (Ludang) 4 qian, Turtle Plastron (Biejia), Deer Antler Glue (Lushuang) 2 qian each, Dried Ginger (Ganjiang), Aconite (Fupian) 0.8 fen each. Ten doses, skip on attack day. By eighth dose, chills/fever stopped. Patient asked why previous herbs failed. Lei Feng said: 1. Messy herbs; 2. Poor administration. Three-day malaria: deep pathogen, deficient upright. Tonify before attack to boost qi/blood/yin/yang, so pathogen cannot defeat upright. Pulse now slow/small, deep same. Pathogen fled. Stick to old method, add Rehmannia (Shudi), Angelica (Guishen), Ginger/Jujube. Ten doses, stable.
Chan Hou San Nüe Jiu Chan (Postpartum Three-Day Malaria Lingering)
Du's daughter-in-law from Beixiang, postpartum qi/blood not restored, caught three-day malaria, half-year unhealed. Attack: back heavy, waist severed, shaking chills wanting covers, steaming heat wanting drink. Pulse floating/spongy superficially, empty deeply. Pale face, pale tongue no coating. Odd vessels deficient, pathogen entered yin, yin deficiency affecting yang. Should tonify odd vessels yin/yang before attack, restore upright, expel pathogen. Using Changshan/Caoguo specifically for malaria is neglecting root for branch. Lei Feng used Japanese Ginseng (Dongyangshen), Rehmannia (Shudi), Deer Antler Glue (Lushuang), Dogwood Spine (Gouji), Turtle Plastron (Guiban), Oyster Shell (Muli), Roasted Astragalus (Zhi Huangqi), Cinnamon Twig (Guizhi), Ginger/Jujube guide. Twenty doses, malaria detached.
Question: Zhang Jingyue treated malaria by attacking its vigor, most swift/efficacious. You treat before attack. Do you follow Jingyue or...