脏，而胃者以容纳为用，暑邪吸入，必伏于此也。然气怯神昏，初病惊痫厥逆为多，在夏秋之时，断不可认为惊痫。大
方疟证，须分十二经，与咳证相等。若幼科，庸俗但以小柴胡去参，或香薷、葛根之属。
雄按∶举世无不尔，于幼科乎
何尤。不知柴胡劫肝阴，葛根竭胃汁，致变屡矣。
雄按∶柴葛之弊，二语见林北海重刊张司农《治暑全书》，叶氏引用，
原非杜撰，洄溪妄评，殊欠考也。幼稚纯阳，暑为热气。
雄按∶在天为暑，在地为热，故暑即热之气也。昔人谓有阴暑
者，已极可笑，其分中热、中暑为二病者，是析一气而两也。又谓暑合湿热而成者，是并二气而一也，奚可哉。证必热
多烦渴，邪自肺受者，桂枝白虎汤，二进必愈。其冷食不运，有足太阴脾病见证，初用正气，或用辛温，如草果、生姜、
半夏之属。
雄按∶切记，此是治暑月因寒湿而病之法。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。
雄按∶邪去而正衰，故可用此药。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下。
雄按∶叶氏《景岳发挥》内所论疟痢诸候，宜参。
初病暑风湿热疟药∶
脘痞闷∶枳壳 桔梗 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（淡渗清上）。重则用石膏，口渴用花粉，烦渴用竹叶
石膏汤。热甚则用黄芩、黄连、山栀。
夏季身痛属湿，羌、防辛温宜忌，宜用木防己、蚕砂。
雄按∶豆卷可用。
暑热邪伤，初在气分，日多不解，渐入血分，反渴不多饮，唇舌绛赤，芩、连、膏、知，不应。必用血药，量佐清
气热一味足矣。
轻则用青蒿、丹皮（汗多忌）、犀角、竹叶心、玄参、鲜生地、细生地、木通（亦能发汗）、淡竹叶。汪按∶此乃淡
竹叶草故与竹叶心别。若热久痞结，泻心汤选用。
夏月热久入血，最多蓄血一证。徐云∶历练之言。谵语昏狂，看法以小便清长，大便必黑为是，桃核承气汤为要药。
疟多用乌梅，以酸泄木安土之意。
雄按∶邪未衰者忌之。用常山、草果，乃劫其太阴之寒，以常山极走，使二邪不
相并之谓。徐云∶兼治痰。
雄按∶内无寒痰者不可浪用。用人参、生姜，曰∶露姜饮，一以固元，一以散邪，取通神明、
去秽恶之义。
雄按∶必邪衰而正气已虚者，可用此。总之，久疟气馁，凡壮胆气，皆可止疟，未必真有疟鬼。
雄按∶有
物凭之者，间或有之，不必凡患疟疾皆有祟也。又，疟疾既久，深入血分，或结疟母，鳖甲煎丸。设用煎方，活血通络
可矣。
徐忠可云∶幼儿未进谷食者，患疟久不止，用冰糖浓汤，余试果验。徐云∶亦一单方。汪按∶冰糖用秋露水煎尤良。
雄按∶食谷者，疟久不止，须究其所以不止而治之。
痢疾一证，古称滞下，盖里有滞浊而后下也。但滞在气、滞在血，冷伤、热伤而滞非一。今人以滞为食，但以消食，
并令禁忌饮食而已。
雄按∶更有拘泥“吃不死之痢疾”一言，不论痢属何邪，邪之轻重，强令纳食，以致剧者近尤多也。
盖所谓吃不死之痢疾者，言痢之能吃者，乃不死之证，非恶谷而强食也。
夫疟痢皆起夏秋，都因湿热郁蒸，以致脾胃水谷不运，湿热灼气，血为粘腻。先痛后痢，痢后不爽。若偶食瓜果水
寒即病，未必即变为热，先宜辛温疏利之剂。
雄按∶虽未必即化为热，然有暑湿内郁，本将作痢，偶食生冷，其病适发
者，仍须察脉证而施治法，未可遽以为寒证也，余见多矣，故谨赘之。若脓血几十行， 痛后重初用宣通驱热，如芩、
连、大黄，必加甘草以缓之。非如伤寒粪坚，须用芒硝咸以软坚，直走破泄至阴，此不过苦能胜湿，寒以逐热，足可却
病。古云∶行血则便脓愈，导气则后重除。行血凉血，如丹皮、桃仁、延胡、黑楂、归尾、红花之属。导气如木香、槟
榔、青皮、枳、朴、橘皮之属。世俗通套，不过如此。盖疟伤于经，犹可延挨。痢关乎脏，误治必危。诊之大法，先明
体质强弱，肌色苍嫩，更询起居致病因由。初病体坚质实，前法可遵。久病气馁神衰，虽有腹痛后重，亦宜详审，不可
概以攻积清夺施治。
噤口不纳水谷下痢，都因热升浊攻，必用大苦，如芩、连、石莲清热，人参辅胃益气，热气一开，即能进食，药宜
频频进二三日。徐云∶人参必同清热之药用，便为合度。
小儿热病最多者，以体属纯阳，六气着人，气血皆化为热也。
雄按∶大人虽非纯阳，而阴虚体多，客邪化热，亦甚
易也。饮食不化，蕴蒸于里，亦从热化矣。然有解表已，复热；攻里热己，复热；利小便愈后，复热。养阴滋清，热亦
不除者。张季明谓元气无所归着，阳浮则倏热矣。六神汤主之。
秋深初凉，稚年发热咳嗽。
雄按∶大人亦多病此。证似春月风温证。但温乃渐热之称，凉即渐冷之意。春月为病，
犹是冬令固密之余；秋令感伤，恰值夏月发泄之后。其体质之虚实不同。徐云∶通人之言也。但温自上受，燥自上伤，
理亦相等，均是肺气受病，世人误认暴感风寒，混投三阳发散，津劫燥甚，喘急告危。若果暴凉外束，身热痰嗽，只宜
葱豉汤，或苏梗、前胡、杏仁、枳、桔之属，仅一二剂亦可。更有粗工亦知热病，与泻白散加芩、连之属，不知愈苦助
燥，必增他变，当以辛凉甘润之方，气燥自平而愈。慎勿用苦燥劫烁胃汁。
雄按∶夏令发泄，所以伏暑之证，多于伏寒
也。
秋燥一证，气分先受，治肺为急。若延绵数十日之久，病必入血分，又非轻浮肺药可治。须审体质证端，古谓治病
当活泼泼地，如盘走珠耳。
沈尧封曰∶在天为燥，在地为金，燥亦五气之一也。
雄按∶以五气而论，则燥为凉邪，阴凝则燥，乃其本气。但秋
燥二字，皆从火者，以秋承夏后，火之余焰未息也。若火既就之阴竭，则燥是其标气，治分温润、凉润二法。然金曰从
革，故本气病少，标气病多。此圣人制字之所以从火。而《内经》云∶燥者润之也。海峰云∶燥气胜复。片言而析，是
何等笔力。然燥万物者，莫 乎火。故火未有不燥，而燥未有不从火来。温热二证论火，即所以论燥也。若非论燥，仲
景条内，两“渴”字从何处得来？且热病条云∶“口燥渴”，明将燥字点出。喻氏云∶古人以燥热为暑，故用白虎汤主治。
此悟彻之言也。明乎此，则温热二证，火气兼燥，夫复何疑？
雄按∶今人以暑为阴邪，又谓暑中有湿，皆呓语也。
徐洄溪曰∶此卷议论，和平精切，字字金玉，可法可传。得古人之真诠而融化之，不仅名家，可称大家矣。敬服敬
服！
黄退 曰∶先生乃吴中之名医也，始习幼科，后学力日进，扩充其道，于内科一门，可称集大成焉。论温证虽宗河
间，而用方工细，可谓青出于蓝。但欲读其书者，须先将仲景以下诸家之说，用过工夫，然后探究叶氏方意所从来，庶
不为无根之萍也。
雄按∶叶氏医案，乃后人所辑。惟此卷《幼科要略》，为先生手定。华氏刻于医案后以传世，徐氏以为字字金玉。奈
大方家视为幼科治法，不过附庸于此集，皆不甚留意。而习幼科者，谓此书为大方之指南，更不过而问焉。即阐发叶氏，
如东扶鞠通、虚谷者，亦皆忽略而未之及也。余谓虽为小儿说法。大人岂有他殊，故于《温热论》后，附载春温、夏暑、
秋燥诸条，举一反三，不仅为活幼之慈航矣。
五脏之中，胃的功能在于容纳水谷，暑邪吸入后，必然潜伏于此。然而，若出现气虚怯弱、神志昏蒙的症状，初起时多表现为惊风、癫痫或厥逆，在夏秋季节，绝对不能将其误认为是惊痫病。
治疗疟疾证候，必须区分十二经络的病变，其复杂程度与咳嗽证相当。如果是儿科庸医，往往只是简单地用小柴胡汤去掉人参，或者使用香薷、葛根之类的药物。
王士雄按语：世人都这样做，对儿科医生又有什么可指责的呢？他们不知道柴胡会劫耗肝阴，葛根会竭尽胃中津液，导致病情变化的情况屡见不鲜。
王士雄按语：关于柴胡和葛根的弊端，这两句话出自林北海重刊张司农的《治暑全书》，叶天士引用此说，并非凭空捏造；徐洄溪（徐灵胎）妄加评论，确实缺乏考证。幼儿体质属于“纯阳”，暑邪即是热气。
王士雄按语：在天为暑，在地为热，所以暑就是热之气。古人说有“阴暑”的说法，已经非常可笑；将中暑和中热分为两种病的说法，是将一种气强行分割为二；又说暑邪结合湿热而成，这是将两种气合并为一，怎么可以这样呢？疟疾症状必定是热象多且烦渴，如果邪气从肺受入，使用桂枝白虎汤，服用两次必定痊愈。如果因冷食导致运化失常，出现足太阴脾病的见证，初期可用正气散，或使用辛温药物，如草果、生姜、半夏之类。
王士雄按语：切记，这是治疗暑月因寒湿致病的法则。方书中说草果治疗太阴经独盛的寒邪，知母治疗阳明经独盛的热邪。疟疾日久面色苍白无华，嘴唇发白、汗多、身体虚弱无力，必须使用四兽饮。
王士雄按语：因为邪气已去而正气衰败，所以可以使用此药。若是阴虚内热，必须使用鳖甲、何首乌、知母；若大便逐渐变溏者，忌用这些药物。久疟损伤营血，寒邪偏胜，加入桂枝、生姜，参考《国医》末篇疟门用药列于下方。
王士雄按语：叶天士《景岳发挥》中关于疟疾、痢疾各种证候的论述，值得参考。
初病暑风湿热疟的药物：
脘腹痞闷：枳壳、桔梗、杏仁、厚朴（这两味药对于气喘最适宜）、瓜蒌皮、山栀、香豉。
头痛宜用辛凉轻剂：连翘、薄荷、赤芍、羚羊角、蔓荆子、滑石（淡渗以清上焦）。重症则用石膏，口渴用天花粉，烦渴用竹叶石膏汤。热势甚则用黄芩、黄连、山栀。
夏季身痛属于湿邪，羌活、防风等辛温药物应当禁忌，宜用木防己、蚕砂。
暑热邪气伤人，起初在气分，日久不解，逐渐进入血分，反而口渴但饮水不多，嘴唇和舌头呈绛红色，此时用黄芩、黄连、石膏、知母无效。必须使用凉血药物，只需佐以一味清气热的药物即可。
轻症用青蒿、丹皮（汗多者忌用）、犀角、竹叶心、玄参、鲜生地、细生地、木通（也能发汗）、淡竹叶。汪氏按语：这是指淡竹叶草，所以与竹叶心不同。如果热久导致痞结，选用泻心汤。
夏季热邪日久入血分，最多见的是蓄血一证。徐忠可说：这是历练后的真知灼见。出现谵语、昏狂，诊断依据是小便清长，大便必黑，桃核承气汤是关键药物。
治疗疟疾多用乌梅，取其酸味以泄肝木、安脾土之意。
王士雄按语：邪气未衰者忌用。使用常山、草果，是为了劫除太阴之寒，常山药性极善走窜，使寒湿二邪不相搏结，这就是所谓的“兼治痰”。
王士雄按语：体内没有寒痰者不可滥用。用人参、生姜，称为“露姜饮”，一方面固护元气，一方面驱散邪气，取通达神明、去除秽恶之义。
王士雄按语：必须是邪气衰退而正气已虚者，才可使用此法。总之，久疟导致气馁，凡是能壮胆气的药物，都可以止疟，未必真有疟鬼作祟。
王士雄按语：有物凭附的情况，间或有之，不必凡患疟疾都有邪祟。另外，疟疾日久，深入血分，或结成疟母，使用鳖甲煎丸。如果采用煎剂，活血通络即可。
徐忠可说：幼儿尚未进食谷物者，患疟疾日久不止，用冰糖浓汤，我尝试果然有效。徐氏说：这也是一个单方。汪氏按语：用秋季露水煎煮冰糖效果更佳。
王士雄按语：进食谷物的人，疟疾日久不止，必须探究其之所以不止的原因而进行治疗。
痢疾一证，古称滞下，是因为肠道里有停滞的浊气而后下痢。但停滞在气分、停滞在血分，或因冷伤、热伤导致的停滞原因不一。现在的人认为滞下就是食积，只用消食药，并令患者禁忌饮食而已。
王士雄按语：更有拘泥于“吃不死之痢疾”这句话的人，不论痢疾属于何种邪气，邪气的轻重，强行让患者进食，导致病情加重甚至死亡的情况非常多。
所谓“吃不死之痢疾”，是说痢疾患者如果能吃东西，那是不会死的证候，并不是厌恶谷物而强行喂食。
疟疾和痢疾都起于夏秋，都是因为湿热郁蒸，导致脾胃运化水谷功能失常，湿热灼伤气分，血液变得粘腻。先腹痛后下痢，痢后仍有不爽快感。如果偶尔吃了瓜果凉水就发病，未必立即转化为热证，初期宜用辛温疏利的药剂。
王士雄按语：虽然未必立即化为热证，但是如果有暑湿内郁，本来就要发作痢疾，偶然吃了生冷食物，使得病情恰好发作的，仍然需要察脉辨证来施治，不能立刻认定为寒证，我见到的这种情况很多，所以谨慎地补充说明。如果脓血几十行，腹痛里急后重，初期用宣通驱热的方法，如黄芩、黄连、大黄，必须加甘草来缓和药性。不像伤寒粪便坚硬，需要用芒硝咸以软坚，直走破泄至阴，这里不过是苦能胜湿，寒以逐热，足以祛除疾病。古话说：行血则便脓自愈，导气则后重消除。行血凉血的药物，如丹皮、桃仁、延胡索、黑山楂、当归尾、红花之类。导气的药物如木香、槟榔、青皮、枳实、厚朴、橘皮之类。世俗通用的套路，不过如此。大概疟疾伤于经脉，还可以拖延；痢疾关乎脏腑，误治必然危险。诊察的大法，先要明确体质的强弱，观察肌肤颜色是苍老还是娇嫩，更要询问起居习惯及致病原因。初病体质坚实，前面的方法可以遵循。久病气馁神衰，虽然有腹痛后重，也应当详细审察，不可以一概用攻积清夺的方法治疗。
噤口痢（不能进食的水谷下痢），都是因为热升浊攻所致，必须用大苦寒的药物，如黄芩、黄连、石莲子清热，人参辅助胃气益气，热气一开，就能进食，药物宜频频服用两三天。徐氏说：人参必须同清热药一起使用，才算合乎法度。
王士雄按语：大人虽然不是纯阳，但阴虚体质居多，外感客邪化热，也非常容易。饮食不化，蕴蒸于体内，也会从热化。但是有解表后复热；攻里热后复热；利小便愈后复热。养阴滋清，热也不除的情况。张季明说元气无所归着，阳气浮越就会突然发热。用六神汤主治。
王士雄按语：大人也多患此病。证候类似春季的风温证。但“温”是逐渐变热的称呼，“凉”是逐渐变冷的意思。春季生病，还是冬季闭藏固密之后的余气；秋季感受外邪，恰逢夏季发泄之后。其体质的虚实不同。徐氏说：这是通达之人的言论。但温邪自上部受入，燥邪自上部损伤，道理也是相等的，都是肺气受病，世人误认为是暴感风寒，混投三阳发散药，导致津液被劫夺，燥邪更甚，喘急告危。如果确实是暴凉外束，身热痰嗽，只宜用葱豉汤，或苏梗、前胡、杏仁、枳实、桔梗之类，仅一二剂即可。更有粗劣的医生也知道是热病，用泻白散加黄芩、黄连之类，不知道愈苦助燥，必然增加其他变证，应当用辛凉甘润的方剂，气燥自然平复而痊愈。千万不要用苦燥药物劫烁胃汁。
秋燥一证，气分先受邪，治疗以肺为急。如果拖延数十日之久，病必入血分，又非轻浮的肺药可以治疗。必须审察体质和证候端绪，古人说治病应当活泼泼地，像盘中之珠滚动一样灵活。
沈尧封说：在天为燥，在地为金，燥也是五气之一。
王士雄按语：从五气而论，燥为凉邪，阴凝则燥，这是它的本气。但“秋燥”二字，都带有火的意思，因为秋天承接夏天之后，火的余焰未息。如果火既退而阴液枯竭，那么燥就是它的标气，治疗分为温润、凉润二法。然而金曰从革，所以本气病少，标气病多。这就是圣人制字之所以从火的原因。而《内经》说：燥者润之。海峰说：燥气胜复。片言而析，是何等笔力。然而使万物干燥的，没有比火更厉害的了。所以火没有不燥的，而燥没有不从火来的。温热二证论火，即所以论燥。如果不是论燥，仲景条文内的两个“渴”字从何而来？且在热病条中说：“口燥渴”，明确将燥字点出。喻嘉言说：古人以燥热为暑，所以用白虎汤主治。这是悟彻之言。明白这一点，那么温热二证，火气兼燥，还有什么可疑疑的呢？
王士雄按语：现在的人认为暑为阴邪，又说暑中有湿，都是胡言乱语。
徐洄溪说：这一卷的议论，和平精切，字字金玉，可法可传。得到古人的真诠而融化它，不仅是名家，可称大家了。敬服敬服！
黄退说：先生是吴中的名医，开始学习儿科，后来学力日益进步，扩充其道，在内科一门，可称集大成。论述温证虽然宗法河间，但用方工细，可谓青出于蓝。但是想要读他书的人，须先将仲景以下诸家的学说，下过功夫，然后探究叶氏方意的来源，才不会成为无根之萍。
王士雄按语：叶天士的医案，是后人辑录的。只有这一卷《幼科要略》，是先生亲手订定。华氏刻印在医案后面以传世，徐氏认为字字金玉。无奈大方家视为儿科治法，不过是附庸于此集，都不甚留意。而学习儿科的人，谓此书是大方的指南，也不过是不问而知。即使阐发叶氏学说的人，如东扶、鞠通、虚谷等人，也都忽略而未提及。我认为虽然是给小儿说法，大人难道有其他不同吗？所以在《温热论》后，附录春温、夏暑、秋燥诸条，举一反三，不仅是活幼的慈航了。
Among the five zang organs, the stomach's function lies in receiving and containing. When summerheat pathogen is inhaled, it must lodge here. However, when there is qi deficiency with mental confusion, the initial presentation often involves fright, convulsions, or jue-ni (reversal cold). During summer and autumn, one must absolutely not mistake this for fright-epilepsy.
Treating malaria syndromes requires distinguishing the involvement of the twelve meridians; its complexity is comparable to that of cough syndromes. If treated by mediocre pediatric practitioners, they merely use Xiao Chai Hu Tang (Minor Bupleurum Decoction) without Ren Shen (Ginseng), or employ herbs such as Xiang Ru (Moslae Herba) and Ge Gen (Puerariae Radix).
Wang Shihiong's Note: The world universally acts this way, so what blame can be placed on pediatric doctors? They do not know that Chai Hu (Bupleuri Radix) depletes Liver Yin, and Ge Gen exhausts Stomach fluids, leading to frequent changes in the condition.
Wang Shihiong's Note: Regarding the drawbacks of Chai Hu and Ge Gen, these two sentences appear in Lin Beihai's reprinted edition of Zhang Sinong's "Quan Shu Zhi Shu" (Complete Book on Treating Summerheat). Ye Tianshi cited this; it was not fabricated. Xu Huixi's (Xu Lingtai's) reckless commentary lacks proper textual research. Young children possess a "pure yang" constitution, and summerheat is heat energy.
Wang Shihiong's Note: In heaven it is called summerheat, on earth it is called heat; thus, summerheat is simply the qi of heat. The ancient assertion of "yin summerheat" is extremely ridiculous. Dividing zhong shu (heatstroke) and zhong re (summerheat illness) into two diseases splits one qi into two. Claiming that summerheat combines with dampness to form disease merges two qis into one; how can this be acceptable? Malaria symptoms must present with abundant heat, vexation, and thirst. If the pathogen enters from the Lung, Gui Zhi Bai Hu Tang (Cinnamon Twig and White Tiger Decoction) should be used; two doses will surely cure it. If cold food causes stagnation and presents with signs of Taiyin Spleen disease, initially use Zheng Qi San (Regular Qi Powder) or acrid-warm herbs such as Cao Guo (Tsaoko Fructus), Sheng Jiang (Zingiberis Rhizoma Recens), and Ban Xia (Pinelliae Rhizoma).
Wang Shihiong's Note: Remember firmly, this is the method for treating illnesses caused by cold-dampness during the summer month. Formulary texts state that Cao Guo treats excessive cold in the Taiyin, and Zhi Mu (Anemarrhenae Rhizoma) treats excessive heat in the Yangming. For chronic malaria with sallow complexion, white lips, profuse sweating, and weakness, Si Shou Yin (Four Beasts Decoction) must be used.
Wang Shihiong's Note: Since the pathogen has departed and the healthy qi is depleted, this medicine can be used. For yin deficiency with internal heat, Bie Jia (Testudinis Carapax et Plastrum), Shou Wu (Polygoni Multiflori Radix), and Zhi Mu are required. If stools become loose, these are contraindicated. For chronic malaria damaging Ying blood with excess cold, add Gui Zhi (Cinnamomi Ramulus) and Sheng Jiang. Refer to the medication listed at the end of the Malaria section in "Guo Yi".
Wang Shihiong's Note: Ye Tianshi's discussion on various manifestations of malaria and dysentery in "Jing Yue Fa Hui" is worth consulting.
Medicines for initial summerheat, wind-dampness, and heat malaria:
For epigastric fullness and oppression: Zhi Ke (Aurantii Fructus), Jie Geng (Platycodonis Radix), Xing Ren (Armeniacae Semen Amarum), Hou Po (Magnoliae Officinalis Cortex) [these two are best for asthma], Gua Lou Pi (Trichosanthis Pericarpium), Shan Zhi (Gardeniae Fructus), Xiang Chi (Fermented Soybean).
For headache, use light acrid-cool agents: Lian Qiao (Forsythiae Fructus), Bo He (Menthae Haplocalycis Herba), Chi Shao (Paeoniae Radix Rubra), Ling Yang Jiao (Capricornus Saigae), Man Jing Zi (Vittariae Fructus), Hua Shi (Talcum) [light and penetrating to clear the upper jiao]. For severe cases, use Shi Gao (Gypsum Fibrosum); for thirst, use Hua Fen (Trichosanthis Radix); for vexation and thirst, use Zhu Ye Shi Gao Tang (Bamboo Leaf and White Tiger Decoction). For intense heat, use Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), and Shan Zhi.
Summer body pain belongs to dampness; Qiang Huo (Notopterygii Rhizoma et Radix) and Fang Feng (Saposhnikoviae Radix), being acrid-warm, should be avoided. Use Mu Fang Ji (Stephaniae Tetrandrae Radix) and Can Sha (Bombyx Batryticatus).
Wang Shihiong's Note: Dou Juan (Sojae Preparata) can also be used.
When summerheat-pathogen injures the body, initially affecting the Qi level, if unresolved after many days, it gradually enters the Blood level. This presents as thirst but little desire to drink, crimson lips and tongue. Huang Qin, Huang Lian, Shi Gao, and Zhi Mu will be ineffective. One must use blood-invigorating/clearing herbs, aided by only one herb that clears Qi-level heat.
For mild cases, use Qing Hao (Artemisiae Annuae Herba), Dan Pi (Moutan Cortex), Xi Jiao (Rhinocerotis Cornu - *Note: substitute with Buffalo Horn in modern practice*), Zhu Ye Xin (Bambusae Folium), Xuan Shen (Scrophulariae Radix), Xian Sheng Di (Rehmanniae Radix Recens), Xi Sheng Di (Rehmanniae Radix Praeparata), Mu Tong (Akebiae Caulis) [also induces sweating], and Dan Zhu Ye (Lophatheri Herba). Wang's Note: This refers to the herb Lophatherum, distinct from Bamboo Leaf Heart. If heat persists causing stagnation, select from Xie Xin Tang (Drain the Epigastrium Decoctions).
In summer, prolonged heat entering the blood level most frequently results in Blood Stasis. Xu Zhongke states: These are words born of experience. With delirium, coma, and mania, the diagnostic sign is clear, long urination accompanied by black stool; Tao He Cheng Qi Tang (Peach Kernel and Mirabilite Decoction) is the essential medicine.
Malaria treatment often uses Mei Guo (Mume Fructus), employing the principle of sourness to drain Wood and calm Earth.
Wang Shihiong's Note: Contraindicated when the pathogen has not yet declined. Using Chang Shan (Daphnes Genkwa Bark) and Cao Guo is to劫 (rob/seize) Taiyin cold. Chang Shan moves rapidly, preventing the two pathogens from combining; this is referred to as "simultaneously treating phlegm."
Wang Shihiong's Note: Do not use recklessly if there is no cold-phlegm internally. Using Ren Shen and Sheng Jiang constitutes Lu Jiang Yin (Dew Ginger Drink): one aspect consolidates Yuan Qi, the other disperses pathogenic factors, taking the meaning of unblocking spirit and removing filth.
Wang Shiong's Note: Only usable when the pathogen has declined and healthy qi is already deficient. In summary, chronic malaria leads to qi depletion; any herb that strengthens Gallbladder Qi can stop malaria; it is not necessarily due to a "malaria ghost."
Wang Shihiong's Note: Cases of possession by entities occur occasionally; not every malaria case involves evil spirits. Furthermore, chronic malaria entering the blood level may form a "malaria mother" (splenomegaly); use Bie Jia Jian Wan (Turtle Shell Pill). If using decoctions, blood-invigorating and collateral-unblocking methods suffice.
Xu Zhongke says: For infants who have not yet eaten grain, suffering from persistent malaria, use strong sugar water decoction; I have tested this and it is effective. Xu notes: This is also a folk remedy. Wang's Note: Using autumn dew water to decoct rock sugar is even better.
Wang Shihiong's Note: For those who eat grain, if malaria persists chronically, one must investigate the cause of persistence and treat accordingly.
Dysentery, anciently called "Zhi Xia" (stagnant downflow), occurs because turbid stagnation exists in the interior before downward discharge. However, stagnation may be in the Qi level or Blood level, caused by cold injury or heat injury, with various reasons. Modern people equate stagnation solely with food retention, using only digestive aids and imposing dietary taboos.
Wang Shihiong's Note: Moreover, some rigidly adhere to the saying "dysentery patients who can eat will not die," regardless of the pathogen type or severity, forcing food intake, leading to severe deterioration and death in many cases.
The phrase "dysentery patients who can eat will not die" means that if a dysentery patient can eat, it indicates a non-fatal prognosis; it does not mean forcing food upon those who hate grains.
Both malaria and dysentery arise in summer and autumn, caused by damp-heat郁蒸 (stifling steaming), leading to spleen-stomach failure in transporting water and grain. Damp-heat scorches the Qi, making blood viscous. Abdominal pain precedes dysentery, followed by incomplete relief after defecation. If illness occurs after eating melons or cold water, it may not immediately transform into heat; initially, use acrid-warm dispersing and draining agents.
Wang Shihiong's Note: Although it may not immediately transform into heat, if there is internal summerheat-dampness stagnation, intending to develop into dysentery, and eating raw/cold food triggers the onset, one must still examine pulse and symptoms to determine treatment. Do not hastily diagnose it as a cold syndrome; I have seen this often, hence the caution. If there are dozens of passages of pus and blood, with abdominal pain and tenesmus, initially use宣通 (disperse and unblock) to drive out heat, such as Huang Qin, Huang Lian, and Da Huang (Rhei Radix et Rhizoma), adding Gan Cao (Glycyrrhizae Radix) to moderate. Unlike Taiyang disease with hard feces requiring Mang Xiao (Mirabilite) to soften hardness and purge the lower jiao, here bitter herbs overcome dampness and cold herbs expel heat, which is sufficient to cure the disease. Ancient wisdom states: Invigorating blood heals pus and blood in stool; directing qi eliminates tenesmus. Blood-invigorating and cooling herbs include Dan Pi, Tao Ren (Persicae Semen), Yan Hu Suo (Corydalis Rhizoma), Hei Zha (Crataegi Fructus Carbonized), Gui Wei (Angelicae Sinensis Radix), and Hong Hua (Carthami Flos). Qi-directing herbs include Mu Xiang (Aucklandiae Radix), Bing Lang (Arecae Semen), Qing Pi (Citri Reticulatae Pericarpium Viride), Zhi Shi (Aurantii Fructus Immaturus), Hou Po, and Ju Pi (Citri Reticulatae Pericarpium). Secular standard practices are limited to this. Generally, malaria injuring meridians can be delayed; dysentery affecting zang organs, if mis-treated, becomes critical. The major principle of diagnosis is first determining constitutional strength, observing whether skin is rough or tender, and inquiring about lifestyle and etiology. In acute stages with solid constitution, the aforementioned methods apply. In chronic stages with depleted qi and spirit, even with abdominal pain and tenesmus, careful examination is needed; do not indiscriminately use purging and clearing-depletion methods.
Jin Kou Li (Dysentery with inability to swallow food/water) is caused by heat rising and turbidity attacking. Strong bitter-cold herbs like Huang Qin, Huang Lian, and Shi Lian Zi (Nelumbinis Nucillus) are used to clear heat, while Ren Shen assists Stomach Qi. Once heat opens, appetite returns; medicines should be taken frequently over two to three days. Xu notes: Ren Shen must be used with heat-clearing herbs to be appropriate.
Children suffer most from heat diseases because their constitution is pure yang; when the six climatic factors invade, qi and blood all transform into heat.
Wang Shihiong's Note: Adults, though not purely yang, often have yin deficiency; external pathogens transforming into heat is also very easy. Undigested food fermenting internally also transforms into heat. However, there are cases of recurrent fever after releasing the exterior, after purging interior heat, or after promoting urination. Nourishing yin and clearing heat fails to remove the fever. Zhang Jiming states that when Yuan Qi has no anchor, floating yang causes sudden heat. Liu Shen Tang (Six Spirits Decoction) is the primary formula.
In late autumn when coolness begins, young children suffer fever and cough.
Wang Shihiong's Note: Adults also commonly suffer this. The syndrome resembles spring Wind-Warmth. But "Warmth" implies gradual heating, while "Coolness" implies gradual cooling. Illnesses in spring stem from the residual closure of winter; injuries in autumn occur after the venting of summer. Their constitutions differ in deficiency and excess. Xu notes: Words of a wise person. Warmth enters from above, Dryness injures from above; the logic is equal, both affecting Lung Qi. People mistakenly recognize sudden exposure to wind-cold and indiscriminately administer Taiyang/Solitary-Yang dispersants,劫 (depriving) fluids, worsening dryness, leading to dangerous wheezing. If indeed bound by sudden coolness externally, with fever, phlegm, and cough, only Cong Chi Tang (Scallion and Fermented Soybean Decoction) or Su Geng (Perillae Caulis), Qian Hu (Peucedani Radix), Xing Ren, Zhi Shi, and Jie Geng should be used, for just one or two doses. More often, incompetent doctors know it is a heat disease and use Bai Du San modified with Huang Qin and Huang Lian, not knowing that increasing bitterness aids dryness, inevitably causing other complications. One should use acrid-cool and sweet-moist formulas; atmospheric dryness will naturally flatten and heal. Beware of using bitter-dry herbs that劫 (rob) Stomach fluids.
Wang Shihiong's Note: Summer venting is why latent summerheat syndromes are more common than latent cold.
Autumn Dryness syndrome affects the Qi level first; treating the Lung is urgent. If lingering for dozens of days, the disease enters the Blood level, and light-floating Lung herbs cannot treat it. One must assess constitution and symptom details. As ancients said, treating disease should be lively and flexible, like a pearl rolling on a plate.
Shen Yaofeng says: In heaven it is Dryness, on earth it is Metal; Dryness is one of the five qi.
Wang Shihiong's Note: From the perspective of the five qi, Dryness is a Cool pathogen; yin condensation causes dryness, which is its fundamental nature. However, the characters "Autumn Dryness" both contain fire components because autumn follows summer, and the residual flames of fire have not ceased. If fire subsides and yin is exhausted, dryness becomes its secondary manifestation. Treatment divides into warm-moist and cool-moist methods. Since Metal is described as "following change," fundamental nature diseases are rare, while secondary manifestation diseases are common. This explains why the character contains fire. The "Nei Jing" states: "For dryness, moisten it." Haifeng says: Dryness qi victory and restitution. Such concise analysis demonstrates great literary power. Yet, nothing dries things more than fire. Thus, fire is never without dryness, and dryness always comes from fire. Discussing Heat-Warmth via fire is discussing dryness. Without discussing dryness, where do the two "thirst" characters in Zhang Zhongjing's clauses come from? Furthermore, the heat disease clause states: "Oral dryness and thirst," explicitly pointing out the character "dryness." Yu Jiayan says: Ancients considered dryness-heat as summerheat, hence using Bai Hu Tang as the main treatment. This is a profound insight. Understanding this, there is no doubt that Heat-Warmth syndromes involve Fire Qi combined with Dryness.
Wang Shihiong's Note: Modern people consider summerheat a yin pathogen and claim summerheat contains dampness; these are nonsense.
Xu Huixi says: The discussions in this volume are peaceful, precise, every word like gold and jade, worthy of emulation and transmission. Having assimilated the true essence of the ancients, he is not just a famous doctor, but a master. I admire him deeply!
Huang Tui says: The Master is a renowned doctor in Wu region. Starting with pediatrics, his scholarship advanced daily, expanding his scope to Internal Medicine, achieving a grand synthesis. While his theory on Warm diseases follows He Jian, his prescriptions are meticulous, truly surpassing his teacher. However, readers must first study the theories of Zhang Zhongjing and subsequent masters before exploring Ye Tianshi's prescription logic, lest they become rootless duckweed.
Wang Shihiong's Note: Ye Tianshi's medical cases were compiled by later generations. Only this volume, "You Ke Yao Lue" (Essentials of Pediatrics), was personally finalized by the Master. Hua Shi printed it after the cases to pass down. Xu considered it "words of gold and jade." Regrettably, grand masters viewed it merely as pediatric treatment, an appendage to the collection, paying little attention. Pediatric students regarded it as a guide for grand medicine, ignoring it further. Even those expounding Ye's teachings, such as Dong Fu, Ju Tong, and Xu Gu, overlooked it. I argue that although stated for children, adults are no different. Therefore, after "Wen Re Lun" (Treatise on Warm-Heat), I appended sections on Spring Warmth, Summer Summerheat, and Autumn Dryness, drawing inferences to extend beyond mere pediatric care.