证经七朝，两投温解，寒热退而复发，干呕不渴，舌腻头疼。病缘本质不足，因热贪凉
，感
受阴暑之邪，怯者着而为病。方订理阴煎，冀其云蒸雨化，邪从少阳转枢，归于疟途则吉。
寒热如期，呵欠，指甲变色，似走疟途，证因阴暑逗留，非开手正疟可比。仍宜壮中温托，
参以姜枣和解。现下寒来，且看晚间热势若何，明日再议。
寒热仍来，邪犯未解，口仍不渴，体犹怕风，时当盛夏，姜附服至四剂，并无火象，使
非阴
暑，安能胜任。不问是疟非疟，总属正虚邪留，辅正即所以祛邪，强主即所以逐寇。昨发热
至五更，汗出始退，今日午初又至，呕恶呵欠，前次尚有微寒，此番并无寒意，脉见弦急，
由阻转阳之机。大凡阴证得以转阳为顺，证既转阳，温药当退，中病则已，过恐伤阴。病经
多日，正气受亏，辅正驱邪为是。汗出热退，头痛稍减，脉仍弦急，舌苔转黄，疮刺俱见，
寒邪化热无疑。恐其热盛伤阴，酌以补阴益气煎出入。质亏感证经十二朝，单热无寒，午初
起势，黎明汗出退凉，确系伏暑为病，较之伤寒，其状稍缓，较之正疟，寒热又不分明。经
云∶少阳为枢，阴暑伏邪，得从枢转，尚属好机，不然则邪正溷淆，如白银中参入铅铜，不
成银色矣。夫伤寒一汗可解，温暑数汗不除。盖暑湿之邪，伏匿膜原，所以驱之不易。今寒
邪既化，似可清凉，惟嫌受病之原，终从阴分而来，甫经转阳，苦寒未便骤进。昨用养阴和
解，夜热稍轻，头痛稍减，脉急稍平，窥其大局，守过二候，当可获效。热来稍晏，势觉和
平，黎明退凉，渴饮较多。汗至午时，尚未收静。夫暑汗与虚汗不同，经言暑当与汗，皆出
勿止，脉急渐缓，头痛渐轻，小便渐淡，邪剩无多。今将二候，愈期不远，按纯热无寒，曰
瘅疟，瘅即阳亢之名，用药自应转手。昨热作止，势犹仿佛，脉急已平，神采稍好，惟舌根
尚有黄苔，口犹作渴，仍属伏暑余波，今明两日，热难骤止，好在发作有时，上瘅疟同例
。内经以为阴气孤绝，阳气独发，参加减一阴煎。昨热仍作，其势较轻，证属瘅疟，因系伏
暑，了无遗义。喻氏论瘅疟，会《内经》、《金匮》微旨，从饮食消息，调以甘药二语悟入
，主用甘寒保阴存液，《指南医案》治用梨蔗，亦此意也。推诸病状，似与秋时晚发之证相
类，气候稍有不符，情形不略则一。必须两三候外，日减一日，方得全解，届期可许霍然。
安波按∶秋时伏气之疾，考方书惟《己任编》另出心裁，论之甚晰。迄今以来，叶氏
独得其妙，此外无几人矣。
病程已持续七天，两次使用温散解表法后，寒热症状虽退但随即复发，出现干呕、口不渴、舌苔腻、头痛等症状。病因在于患者体质本虚，因贪凉受热，感染了阴暑之邪，正气虚弱者容易因此发病。处方拟定理阴煎，希望借助其作用使体内气机如云蒸雨化般运转，让病邪从少阳枢机转出，回归到疟疾的常规治疗路径上则预后良好。
寒热发作时间规律，伴有打哈欠、指甲颜色改变，似乎正走向疟疾的病理过程，但因阴暑之邪滞留体内，这与初起即患的正疟不可同日而语。仍宜采用壮中温托之法，配合姜枣以调和营卫。目前寒战尚存，暂且观察晚间发热情况如何，明日再行商议。
寒热症状依然反复，说明邪气未解，口仍不渴，身体仍然怕风，时值盛夏，服用姜、附子等温热药已达四剂，却无上火之象，若非阴暑之邪，怎能承受如此温补？不论是否为疟疾，总属正气虚弱、邪气留恋，扶助正气即是祛除邪气，强壮主体即是驱逐寇贼。昨日发热至五更天，汗出后方才退热，今日午初又再次发作，伴有呕吐恶心、打哈欠，前次尚有轻微恶寒，此次并无寒意，脉象呈现弦急，这是由阴证转为阳证的契机。大凡阴证能够转为阳证为顺，既然证候已转阳，温热药物应当停止，中病即止，过度担心可能会损伤阴液。病程多日，正气受损，扶助正气驱除邪气是正确的治法。
汗出热退，头痛稍减，脉象仍弦急，舌苔转为黄色，疮刺（皮肤粟粒样突起）全部显现，寒邪化为热邪无疑。恐其热盛伤阴，酌情选用补阴益气煎加减。体质亏虚感受外邪已十二天，现仅发热无寒，午初开始发作，黎明时分汗出退凉，确系伏暑致病，相较于伤寒，病情稍缓；相较于正疟，寒热又不分明。《内经》云：少阳为枢机，阴暑伏邪若能通过枢机转出，尚属好转之机，否则邪正混杂，如同白银中掺入铅铜，不成其为白银了。伤寒一汗可解，温暑需多次发汗才能去除。因为暑湿之邪伏匿于膜原，所以难以驱除。如今寒邪既已化热，看似可用清凉之法，只是嫌弃致病根源终归是从阴分而来，刚刚转为阳证，苦寒药物不便骤然进用。昨日使用养阴和解之法，夜间热势稍轻，头痛稍减，脉急稍平，纵观大局，坚守过两个疗程（约四天），应当可以见效。
发热时间稍晚，势头感觉平和，黎明退凉，口渴饮水较多。汗出至午时，尚未完全收敛平静。暑汗与虚汗不同，《内经》言暑邪当随汗出，汗出勿止，脉急渐缓，头痛渐轻，小便渐淡，邪气剩余不多。即将度过第二个疗程，痊愈期不远。按纯热无寒称为瘅疟，瘅即阳亢之名，用药自然应当转变思路。昨日热势起伏，势头仿佛，脉急已平，神采稍好，只是舌根仍有黄苔，口仍作渴，仍属伏暑余波，今明两日，热势难骤止，好在发作有定时，与瘅疟同例。《内经》认为这是阴气孤绝，阳气独发，加入减一阴煎。昨日热势仍作，但程度较轻，证属瘅疟，因系伏暑，毫无歧义。喻嘉言论瘅疟，领会《内经》、《金匮要略》的微旨，从“饮食消息，调以甘药”两句悟入，主张主用甘寒以保阴存液，《指南医案》治疗用梨汁蔗浆，也是此意。推究诸种病状，似乎与秋季晚发的证候相似，气候稍有不符合，情形大致相同。必须经过两三个疗程之外，每日减轻一日，方能全解，届时可许诺霍然痊愈。
安波按：秋季伏气温病，考证方书唯有《己任编》另出心裁，论述非常清晰。至今以来，叶天士独得其妙，此外没有几个人能做到。
The disease has persisted for seven days. After two administrations of warm resolving methods, the chills and fever subsided but recurred, accompanied by dry retching, absence of thirst, greasy tongue coating, and headache. The etiology lies in the patient's inherent deficiency; due to greed for coolness amidst heat, the pathogen of Yin-Shu (Yin Summerheat) was contracted, and those with weak constitution easily fell ill. The prescription Liyin Decoction (Nourishing Yin Decoction) was formulated, hoping that through its action, the internal qi mechanism would transform like clouds steaming and rain condensing, allowing the pathogen to pivot from Shaoyang (Lesser Yang) and return to the pathway of malaria, which would be auspicious.
The chills and fever occur at regular intervals, accompanied by yawning and discoloration of the fingernails, suggesting a progression toward malaria. However, since the Yin-Shu pathogen lingers, this condition is not comparable to typical malaria presenting at onset. It is still appropriate to employ methods to strengthen the middle jiao and warm/support the interior, combined with Ginger and Jujube to harmonize. Currently, chills are present; let us observe the severity of the fever tonight and discuss further tomorrow.
The chills and fever persist, indicating the pathogen remains unresolved. The mouth is still not thirsty, and the body still fears wind. Although it is midsummer, four doses of Ginger and Aconite have been administered without signs of fire/heat excess. If this were not Yin-Shu, how could such warming medicines be tolerated? Regardless of whether it is malaria or not, it fundamentally belongs to deficiency of righteous qi and lingering pathogen. Assisting righteous qi is tantamount to dispelling the pathogen; strengthening the host is tantamount to driving out the bandit. Yesterday, fever lasted until the fifth watch (5-7 AM), subsiding only after sweating. Today, it resumed at noon (11 AM-1 PM), accompanied by vomiting, nausea, and yawning. Previously, there was slight aversion to cold; this time, there was no sense of cold. The pulse is wiry and rapid, indicating a shift from Yin to Yang. Generally, when a Yin syndrome transforms into a Yang syndrome, it is favorable. Since the syndrome has transformed to Yang, warm medicines should be withdrawn. One should stop upon hitting the target; excessive caution may damage Yin. The disease has lasted many days, depleting righteous qi; assisting righteous qi to drive out the pathogen is correct.
After sweating and fever reduction, the headache decreased slightly, but the pulse remains wiry and rapid. The tongue coating has turned yellow, and pruritic papules (skin eruptions) are fully visible; it is undeniable that the Cold pathogen has transformed into Heat. Fearing that excessive Heat will damage Yin, Bu Yin Yi Qi Decoction (Supplementing Yin and Boosting Qi Decoction) is selected for modification. With constitutional deficiency and external contraction lasting twelve days, now there is only fever without chills. Onset occurs at noon, and cooling follows dawn sweating. This is indeed caused by latent Summerheat. Compared to Shanghan (Cold Damage), the presentation is slightly milder; compared to typical malaria, the chills and fever are indistinct. The Classic states: "Shaoyang serves as the pivot." If the latent Yin-Shu pathogen can pivot through Shaoyang, it is a good sign; otherwise, pathogen and righteous qi will mix chaotically, like lead and copper mixed into silver, losing its true nature. Shanghan can be resolved with one sweat; Warm-Shu requires multiple sweats to eliminate. This is because Damp-Heat pathogens hide in the Membrane Source (Moyuan), making them difficult to expel. Now that the Cold pathogen has transformed into Heat, it seems clear heat-clearing methods could be used. However, the origin of the illness ultimately stems from the Yin aspect. Having just transformed to Yang, bitter-cold medicines should not be introduced abruptly. Yesterday, using nourishing Yin and harmonizing methods, night fever lightened slightly, headache decreased slightly, and rapid pulse flattened slightly. Viewing the overall situation, maintaining this approach for two periods (approx. 4 days) should yield results.
Fever onset is slightly later, and the momentum feels peaceful. Cooling occurs at dawn, but thirst and fluid intake are increased. Sweating continues until noon without stabilizing. Summerheat sweat differs from deficiency sweat. The Classic says: "Summerheat should be released with sweat; do not stop it prematurely." The rapid pulse gradually slows, headache lightens, urine becomes lighter, and little pathogen remains. Approaching the end of the second period, recovery is near. Pure fever without chills is termed Dan Malaria (Crimson Fever Malaria); "Dan" refers to hyperactive Yang, so medication strategy must change. Yesterday, fever fluctuated, pulse rapidness normalized, and spirit improved slightly. However, yellow coating remains at the tongue root, and thirst persists, indicating residual latent Summerheat. For the next two days, fever will not cease abruptly, but since attacks are timed, it aligns with Dan Malaria. The Inner Canon attributes this to isolation of Yin qi and solitary emission of Yang qi. Add Jianyi Yiyin Decoction (Modified One-Yin Decoction). Yesterday's fever occurred again but with lesser intensity. The syndrome is Dan Malaria due to latent Summerheat, leaving no ambiguity. Yu Jiayan discussed Dan Malaria, grasping the subtle principles of the *Inner Canon* and *Jin Gui Yao Lue*, inspired by "adjust diet and regulate with sweet medicines," advocating sweet-cold herbs to preserve Yin and fluids. *Zhinan Yi An* treats this with pear and sugarcane juice, sharing this intent. Analyzing the symptoms, they resemble late-onset autumn conditions, differing only slightly in climate context but largely similar in presentation. Only after two or three periods, with daily reduction, can full resolution be achieved, promising a complete cure at that time.
An Bo notes: Regarding autumn latent qi diseases, only *Jiren Bian* offers unique insights with clear discussions. To date, Ye Tianshi alone has mastered these subtleties; few others have achieved this.