叶案治疟，不用柴胡，徐评非之。解之者曰∶治伤寒少阳正疟用柴胡，治秋间寒热类疟
不用
柴胡。泉应之曰∶否，不然。《素·疟论》以夏伤于暑为端，而余疟附焉，是秋间寒热之为
正疟，经有明文。《病源》、《千金》皆本经说。《外台》既列《病源》之论，而所集方不
下千首，鲜用柴胡者。可见谓秋间之寒热，不用柴胡则是，而指为类疟则非。仲景于少阳篇
明言往来寒热，形如疟状。“如疟”二字，正类疟之谓。少阳症之为类疟，出于仲景亲口，
今反指为正疟何耶？但诸医犹止误于论症，徐氏则并论治亦误。何以言之？伤寒邪从表入，其
里无根，以柴胡提之则出；夏秋之病，新凉在外，而蕴暑在中，其里有根，若以柴胡提之，
则外邪虽解，而内热即升，横流冲决，不可复制，往往有耳聋、目赤、谵语神昏、汗漏体枯
，延成不治者，不得不以徐说为淫辞之助也。噫！亦究古训而已矣。
五尸、五疰、五疳、五蒸，杂病中之四大症也。仲景《伤寒》始言蒸蒸，《金匮》狐惑
实开
疳症，而走马汤治飞尸，獭肝散治冷疰，已略具大纲矣。至《巢源》、《肘后》、《千金》
、《外台》诸书，始畅厥论，以为内科专家最重之任也。近世书中鲜有之，非近世无此四症
也。医者遇尸疰，诡以肝气目之；遇疳蒸，诡以劳病目之。相沿既久，遂不措意，因不列名
耳！然“尸疰”二字，涉于不祥，“疳蒸”二字，仅见儿科。今若称此以告诸病家，及加诸
年壮，不几骇人听闻乎！古名诚难复也，但须于肝气一门，知有尸、疰二症混其中；于劳病
一门，知有疳、蒸二症混其中。隐其名而存其实，则临症了然矣。至古人治此四症之效方，
亦欲为大医者，所不可不备也。
叶天士治疗疟疾，不使用柴胡，徐灵胎对此进行了批评。为叶氏辩解的人说：“治疗伤寒少阳经的正疟使用柴胡，而治疗秋季寒热往来类似疟疾的病证则不使用柴胡。”我回应说：不对，并非如此。《素问·疟论》以夏季感受暑邪作为论述的开端，而其他类型的疟疾附属于此，因此秋季寒热往来属于正疟，经典中有明确的记载。《诸病源候论》和《千金方》都依据这一经典说法。《外台秘要》既然列出了《诸病源候论》的理论，所收集的方剂不下千首，却很少使用柴胡。由此可见，说秋季的寒热往来不使用柴胡是正确的，但将其指认为类疟则是错误的。张仲景在少阳病篇中明确提到“往来寒热，形如疟状”。“如疟”这两个字，正是类疟的意思。少阳病症表现为类疟，出自张仲景之口，现在反而将其指认为正疟，这是为什么呢？但是各位医生还只是误在辨证上，徐灵胎则在辨证和治疗上都错了。为什么这么说呢？伤寒邪气从体表侵入，其里无根基，用柴胡升提则邪气外出；夏秋季节的疾病，新凉之气在外，而暑热蕴结在内，其里有根基，如果用柴胡升提，那么体表的邪气虽然解除了，但体内的热邪就会上升，横冲直撞，无法控制，往往导致耳聋、目赤、谵语神昏、汗出淋漓身体枯槁，拖延成不治之症，所以不得不认为徐灵胎的说法是荒谬言论的佐证。唉！这不过是探究古代训诂罢了。
五尸、五疰、五疳、五蒸，是杂病中的四大重症。张仲景的《伤寒论》开始提到“蒸蒸”（形容发热如蒸），《金匮要略》中的狐惑病实际上开启了疳症的论述，而走马汤治疗飞尸，獭肝散治疗冷疰，已经大致具备了纲领。到了《诸病源候论》、《肘后备急方》、《千金方》、《外台秘要》等书籍，才充分阐述了这些理论，认为这是内科专家最重要的职责。近世的医书中很少见到这些内容，并不是近世没有这四种病症。医生遇到尸疰，诡称其为肝气病；遇到疳蒸，诡称其为劳病。这种错误沿袭已久，于是大家不再在意，因此不列出专门的名目了！然而，“尸疰”二字，涉及不吉利，“疳蒸”二字，仅见于儿科。现在如果这样称呼告诉病人家属，或者加在年壮之人身上，岂不是骇人听闻吗！古名确实难以恢复，但必须在肝气病的门类中，知道有尸、疰两种病症混杂其中；在劳病的门类中，知道有疳、蒸两种病症混杂其中。隐藏其名而保留其实质，那么在临证时就能了然于胸了。至于古人治疗这四种病症的有效方剂，也是大医者不可不准备的。
Ye Tianshi treated malaria without using Chaihu (Bupleuri Radix), and Xu Lingtai criticized this approach. Those who defended Ye explained: "Chaihu is used to treat Zheng Malaria (typical malaria) of the Shaoyang syndrome in Shanghan (Cold Damage), but it is not used for autumnal alternating chills and fever that resemble malaria." I responded: No, that is incorrect. The *Suwen: Malu Lun* (Treatise on Malaria in the Basic Questions) begins with summer injury by heat-pathogen, with other types of malaria attached thereto; thus, autumnal alternating chills and fever constitute Zheng Malaria, as explicitly stated in the classics. Both the *Zhubing Yuanhou Lun* (General Treatise on the Origins and Manifestations of All Diseases) and the *Qianjin Fang* (Essential Prescriptions Worth a Thousand Gold) base their theories on these classics. The *Waitai Miyao* (Secret Essentials of the Outer Cabinet), while listing the theories from the *Zhubing Yuanhou Lun*, collected no fewer than a thousand prescriptions, rarely using Chaihu. This shows that while it is correct to say that autumnal alternating chills and fever do not use Chaihu, it is incorrect to label them as Lei Malaria (malaria-like conditions). Zhang Zhongjing explicitly stated in the Shaoyang chapter: "alternating chills and fever, appearance resembling malaria." The phrase "resembling malaria" precisely refers to Lei Malaria. That Shaoyang syndromes manifest as Lei Malaria comes directly from Zhang Zhongjing himself; how can one now mistakenly identify them as Zheng Malaria? However, other physicians erred only in syndrome differentiation, whereas Xu Lingtai erred in both syndrome differentiation and treatment. Why is this so? In Shanghan, pathogens enter from the exterior, lacking a root in the interior; lifting with Chaihu allows the pathogen to exit. In diseases of summer and autumn, new coolness resides on the exterior while latent heat accumulates in the interior, possessing an internal root. If lifted with Chaihu, although the exterior pathogen may be resolved, the internal heat will rise, surging uncontrollably, often leading to deafness, red eyes, delirious speech, mental confusion, profuse sweating, and physical emaciation, eventually becoming incurable. Therefore, one must regard Xu's statements as supporting absurd arguments. Alas! This is merely an investigation into ancient teachings.
The Five Shi (Corpse-attacking), Five Zhu (Peripatetic), Five Gan (Emaciation), and Five Zheng (Steaming) are the four major severe conditions among miscellaneous diseases. Zhang Zhongjing’s *Shanghan Lun* first mentioned "Zheng Zheng" (steaming fever); the *Jingui Yaolue*’s discussion of Hu Huo (Fox Confusion) actually initiated the discourse on Gan syndromes; Zou Ma Tang (Running Horse Decoction) treats Fei Shi (Flying Corpse), and Ta Gan San (Badger Liver Powder) treats Leng Zhu (Cold Peripatetic), thereby roughly outlining the framework. It was not until the *Zhubing Yuanhou Lun*, *Zhouhou Beiji Fang* (Handbook of Prescriptions for Emergencies), *Qianjin Fang*, and *Waitai Miyao* that these theories were fully expounded, considered the most important responsibility of internal medicine specialists. Such content is rare in recent medical texts, not because these four conditions did not exist in recent times, but because physicians, upon encountering Shi Zhu, deceitfully labeled them as Liver Qi disorders; upon encountering Gan Zheng, deceitfully labeled them as Lao Bing (Consumption/Deficiency Fever). Having persisted for a long time, people ceased to pay attention, and thus they were not listed under specific names! Moreover, the terms "Shi Zhu" involve ominous connotations, and "Gan Zheng" appears only in pediatrics. To call these names to patients' families or apply them to robust adults would surely be shocking and terrifying! Ancient names are indeed difficult to restore, but one must know within the category of Liver Qi disorders that Shi and Zhu syndromes are mixed in; and within the category of Consumption, that Gan and Zheng syndromes are mixed in. By hiding the names but preserving the realities, clinical diagnosis becomes clear. As for the effective prescriptions of the ancients for treating these four conditions, they are indispensable preparations for great physicians.