德兄乃郎年十四岁，证患水肿，医投利水诸药无效，转致腹大如鼓，足冷如冰，头身俱
肿，
阴囊光亮欲裂，行动喘促，势甚危急，诊脉沉细无力。谓曰∶此脾肺肾三脏内亏之病也。肺
虚则气不化精而化水，脾虚则水无所制而反克，肾虚则水无所主而妄行，仲师金匮肾气丸，
如禹之治水，行所无事，实为至当不易之方。无如病久形羸，消耗药多，真元败坏，恐难挽
矣。德兄固请救治，仍用本方，旬日而验，不月而痊。
咏兄先天不足，形瘦质弱，夏夜贪凉，醉而使内，邪乘虚伏，交秋病发。初诊脉细肢冷
，舌
白面青，畏寒不热，腰痛无汗，方订附子理阴煎。服后夜发壮热，次日复视，谓其尊人曰∶
令郎病候，乃夹阴伤寒，势防内陷，药当温中托邪，冀其云蒸雨化。令守原方。服至六日，
病犹未减，举家忧甚。予曰∶正亏邪重，未易驱除，日来证未变幻，即为见效，须过二候，
方望转机。方内加入参 枸杞杜仲，一意照顾真元，毫不杂投标药。届期得汗热退，渠家以
为病愈，是晚复发寒热。诘朝往视，予曰∶疟作矣。咏兄曰∶疟疾吾生平未曾患过，恐其缠
绵，恳为截之。予曰∶子病乃极重伤寒，赖温补诸剂，守住三阴门户，不使内陷。经言少阳
为枢，今未净之邪，得从少阳转枢而出，乃佳兆也，乌可言截。于是早进八味丸，晚服补中
益气汤，十数发才止。予曰∶慎之防复。旬日后疟果复，更用养营汤，吞八味丸乃愈。按胎
疟一证，诸书鲜有言及，患者多至淹缠，轻则月余，重则数月，治不如法，或成虚劳，或变
肿胀，即质实之人，亦累成疟母，为终身之患。且常疟有不入阴，胎疟每多入阴，常疟愈后
少复，胎疟愈后多复。又究此病淹缠之故，想由经隧路径生疏，故邪不易出耳。续阅《会心
录》云∶常发疟者，邪从毛窍熟径而出，其愈易。若胎疟则隧道少疏通之机，毛窍非熟由之
路，其愈难，乃知昔贤之言，先得我心矣。再按其证，似与痘疹相类，人生皆不能免。夫人
禀父母之精血以成形，其所以必患痘疹者，盖因淫火种于有形之先，发于有生之后，不识胎
疟之因，果何所本耶，录中惜未详及。或谓此乃胎中感受风邪，故名胎疟，是说予未之信。
曹德兄的长子十四岁，患水肿病。医生使用利水药物无效，反而导致腹部胀大如鼓，双脚冰冷如冰，头部和全身都肿胀，阴囊光亮似要破裂，行动时气喘急促，病情非常危急。诊脉沉细无力。我对他说：这是脾、肺、肾三脏内部亏损的疾病。肺虚则气不能化生精微而化为水湿，脾虚则水湿失去制约而反克脾土，肾虚则水湿失去主宰而妄行泛滥。张仲景《金匮要略》中的肾气丸，就像大禹治水一样，顺应水性自然疏导，实在是恰当不可更改的良方。无奈病人病程长久，形体消瘦虚弱，消耗药物过多，真元败坏，恐怕难以挽救了。曹德兄坚决请求救治，我仍使用原方，十天见效，不到一个月痊愈。
咏兄先天不足，形体瘦弱体质差。夏夜贪凉，酒后行房，邪气乘虚潜伏，到了秋天发病。初诊时脉象细弱，四肢冰冷，舌苔白，面色青，怕冷而不发热，腰痛无汗，处方定为附子理阴煎。服药后夜间出现高热，第二天复诊，对他的父亲说：令郎的病候，是夹阴伤寒，担心病邪内陷，用药应当温中托毒外出，希望像云蒸雨化一样恢复生机。嘱咐他坚守原方。服药到第六天，病情仍未减轻，全家非常担忧。我说：正气亏虚而邪气重，不容易驱除，近日证候没有变化，就是见效的表现，必须度过两个候期（约六天），才有望转机。在方中加入人参、枸杞、杜仲，一心一意顾护真元，绝不掺杂解表药。到期后出汗热退，他家以为病愈，当晚又复发寒热。第二天早上去诊治，我说：疟疾发作了。咏兄说：我生平从未患过疟疾，担心病情缠绵，恳请医生截断疟疾。我说：您的病是极重的伤寒，依靠温补药物，守住三阴经门户，不让病邪内陷。经文说少阳为枢机，现在未净之邪，从少阳转枢而出，这是好兆头，怎么能说截断呢。于是早上服用八味丸，晚上服用补中益气汤，发作十几次后才停止。我说：谨慎以防复发。十天后疟疾果然复发，改用养营汤，吞服八味丸才痊愈。按语：胎疟这一证候，各书很少提及，患者多至缠绵难愈，轻则一个多月，重则几个月，治疗不合法度，或变成虚劳，或变为肿胀，即使是体质结实的人，也会累成疟母，成为终身隐患。而且常疟有不入阴经的，胎疟多入阴经；常疟痊愈后很少复发，胎疟痊愈后多会复发。又探究此病缠绵的原因，想是由于经络路径生疏，所以邪气不易排出罢了。后来阅读《会心录》说：常发疟疾者，邪气从毛窍熟悉的路径而出，容易痊愈。如果是胎疟，则隧道缺少疏通的机制，毛窍不是熟悉的出路，所以难愈，才知道先贤的话，正合我的心意。再分析其证候，似乎与痘疹相似，人生都不能避免。人禀受父母的精血形成身体，之所以必然患痘疹，大概是因为淫火种于有形之体之前，发于有生之后，不知道胎疟的成因，究竟本源是什么？书中可惜没有详细涉及。有人说这是因为胎中感受风邪，所以叫胎疟，这种说法我不相信。
Brother Cao De's eldest son, aged fourteen, suffered from edema. The physician administered diuretic herbs without effect, leading to a distended abdomen like a drum, feet cold as ice, swelling of the head and whole body, a shiny scrotum appearing ready to burst, panting upon movement, with the condition being critical. The pulse was deep, fine, and powerless. I said to him: This is a disease of internal deficiency in the Spleen, Lung, and Kidney organs. When the Lung is deficient, Qi fails to transform essence into fluids but instead transforms into water-dampness; when the Spleen is deficient, water-dampness lacks control and counter-attacks the Spleen; when the Kidney is deficient, water-dampness lacks mastery and runs wild. Shenqi Wan (Kidney Qi Pill) from Zhang Zhongjing's *Jin Gui Yao Lue* (*Essential Prescriptions from the Golden Cabinet*) acts like Yu the Great controlling the waters, guiding them naturally without force, which is indeed an appropriate and unchangeable prescription. However, given the prolonged illness, emaciated form, excessive consumption of medicines, and ruined true Yuan (Vital Energy), it may be difficult to rescue. Brother Cao De firmly requested treatment, so I used the original formula. It showed efficacy after ten days, and he recovered within a month.
Brother Yong had congenital insufficiency, with a thin physique and weak constitution. In summer nights, he indulged in cold exposure and engaged in sexual intercourse while intoxicated. Pathogenic factors took advantage of the deficiency to lie dormant, manifesting in autumn. At the first consultation, the pulse was fine, limbs were cold, tongue coating was white, complexion was bluish-green, there was aversion to cold without fever, lower back pain, and no sweating. The prescribed formula was Fuzi Liyin Decoction (Aconite Decoction for Nourishing Yin). After taking it, high fever occurred at night. On the second day, during follow-up, I told his father: Your son's condition is Cold Damage with Yin involvement (Jia Yin Shang Han). There is a risk of pathogenic factors sinking inward. Medication should warm the Middle Jiao and expel pathogens outward, hoping for recovery like cloud evaporation and rain transformation. He was instructed to stick to the original formula. By the sixth day, the illness had not subsided, causing great anxiety for the family. I said: With deficient righteous Qi and heavy pathogenic factors, elimination is not easy. The fact that the symptoms have not changed recently indicates efficacy. We must wait through two five-day periods (Hou) before expecting a turning point. Ginseng, Goji Berry, and Eucommia Bark were added to the formula to focus entirely on protecting the True Yuan, without mixing any exterior-releasing drugs. Upon the due date, sweating occurred, and fever subsided. His family thought he was cured, but chills and fever recurred that night. The next morning, upon examination, I said: Malaria has developed. Brother Yong said: I have never suffered from malaria in my life. I fear it will become lingering. Please cure it by cutting off the attacks. I said: Your illness is severe Cold Damage. Relying on warming and tonifying agents, we guarded the gates of the Three Yin channels, preventing the pathogens from sinking inward. The classics state that Shaoyang serves as the pivot. Now, the unresolved pathogens are exiting via the Shaoyang pivot, which is a favorable sign. How can we speak of cutting it off? Thus, Bawei Wan (Eight-Ingredient Pill) was administered in the morning, and Buzhong Yiqi Tang (Decoction for Supplementing the Middle and Augmenting the Qi) in the evening. After more than ten episodes, it stopped. I advised caution to prevent recurrence. Ten days later, malaria indeed relapsed. Yangying Tang (Nourishing Blood Decoction) was used, combined with swallowing Bawei Wan, until he recovered. Note: The syndrome of Tai Malaria (Fetal Malaria) is rarely mentioned in books. Patients often suffer from lingering illness, lasting over a month in mild cases or several months in severe cases. If treated improperly, it may develop into Consumption (Xu Lao) or distension/swelling. Even those with solid constitutions may accumulate Malaria Mass (Nuomu), becoming a lifelong affliction. Moreover, while Chang Malaria (Common Malaria) may not enter the Yin channels, Tai Malaria often does. Chang Malaria rarely recurs after cure, whereas Tai Malaria frequently recurs. Investigating the reason for its lingering nature, it seems due to unfamiliarity with the meridian pathways, making it difficult for pathogens to exit. Later, reading *Huixin Lu* (*Records of Heart-to-Heart Understanding*), it states: For commonly recurring malaria, pathogens exit through familiar pores, making recovery easier. For Tai Malaria, however, the meridians lack ventilation mechanisms, and pores are not familiar routes, making recovery difficult. This confirms that the words of past sages align with my thoughts. Analyzing the syndrome further, it resembles smallpox/variolae, which everyone cannot avoid. Humans take shape from parents' essence and blood. The reason one inevitably suffers from variolae is likely because "libidinous fire" is planted before physical form exists and manifests after life begins. It is unknown what the root cause of Tai Malaria is. The book unfortunately does not detail this. Some say it is named Tai Malaria because wind-pathogens were contracted in the womb. I do not believe this theory.