陈三农治制府王姓，感冒瘴气，寒热，胸膈饱闷，头疼眩晕，恶心，脉数而洪。用藿香正气散加浓朴、槟
榔、羌活、防风、苏叶，一剂而寒热退，头不疼。减去羌、苏、防风，加草豆蔻、半夏、枳壳，恶心胀闷发热俱愈。
梧州方姓，脉弦而数，头疼身痛，恶心饱闷，发热。用羌、防、芎、苏、藿、朴、二陈、苍术、甘草、槟
榔，二服而愈。因饱胀未全退，加草豆蔻、草果方愈。（此头疼、恶心、饱服，所以异于感冒，乃瘴气也。）
端州李别驾，镶蓝旗人，年四十余，能骑射。署雷州府时，善搏虎，不避风雨寒暑，涉溪陟岭，染瘴已深。
其所感风寒暑热，不一而足，且久客半载，甫归本署，未暇休息，遂往省谢谒上台，可谓劳于公事，忘于己躬。
其如积邪所感，猝然皆发。医者纷沓，据云略为解散，已进补剂，而邪气大作，寒热，神昏谵语，脉空数无根，
神气散乱，补泻兼施，而议论纷然矣。招陈往视，脉已如水上萍，刻刻欲脱，寒热间作。盖受病既深，精气两
虚，邪气正炽，难以措手。拟用五积散加附子、人参，去麻黄而易羌活。已言明不治之症，不忍坐视，勉尽愚
诚，立方有难色，不欲下药之语，遂置不用。越一宿，复拉往视，脉症殆甚。因见案头昨药尚存，遂坚辞而出。
后闻以阴疟阳虚，而用《金匮》肾气汤加参者，有以为虚症似疟，当用补中汤而加参、附者，三剂而神昏气喘，
虚汗如雨，足冷而脱矣。不知此症，初实受瘴气，屡感深寒，今则乘虚而发，语云∶伤寒偏死下虚人，况瘴气
而风寒暑湿备感者乎。
正红旗孙兄，粤东转运高公令亲也。高扎云∶舍亲孙某，患不起之症，非某不治，亦作善之一端。时因余
创育婴局于广省，故云然也。往诊其脉，空豁恍恍不定，重按无根，神昏谵语，寒热大作，加之咳嗽痰喘，转
侧不能寐，昼夜惟伏几呻吟，且胸膈胀闷，足冷恶寒。询之，夏秋积劳，寒暑皆受。一月以前，初感头风身痛，
憎寒恶热，咳嗽。或用桔梗、杏仁、干葛、羌活，汗而不解。复用桑皮、前胡、苏子、半夏、贝母、知母、黄
芩，亦不应，寒热更甚。又用小柴胡加山栀、元参、薄荷，咳嗽更甚。不知此症，夏秋暑湿风寒，兼感而发，
尚未得汗，何能解散？遂用五积散二剂，汗出如淋，咳嗽亦减，可伏枕矣。惟寒热未退，病久元气已亏，气上
喘，小便如油短数，其火从下而上，上盛下虚，用《金匮》肾气丸二服，气平便顺。然潮热如故，时有呓语昏
冒，午后用参附六君子汤，朝与肾气丸，经月汗止神清。凡用参、附共斤许，又服还少丹加河车、桂、附、鹿胶，
及十全大补汤，五十余日，元气始复，饮食如常。此与李别驾同一病形，脉虽少异，一以信药而生，一以不信
药而殒。噫。
戊寅十一月，高鹾使公子，患似痢非痢，红多白少，恶寒微热，脉滑而数。询知自夏秋以来，由川北随任
之粤，久积暑湿，感冒而发。用平胃加羌、防、苏、藿，一剂而寒热退，再剂加槟榔、木香而瘳。或问∶痢忌
燥药，今用苍术而愈，何也？曰∶常人痢疾，因暑令火热之气而得，燥药乃天时之所忌，是以不可擅用。今以
积湿之病，发于隆冬外感，乃得力要药也。所谓治病而搜其源者，一七可瘳。故医无执方，病无执药云。
梁溪棋师周西侯之弟，开铜山于英德，其山下有水，人浣衣则垢腻皆去，相与为奇。以其近便，炊舋皆用
之，未几，人皆黄胖身软，腹胀而无力，饮食倍进，寒热间作，善啖鸡豕诸肉，则胃腹少安。在厂同事，毙者
不一，因来省求治。用平胃正气治其病，后以益气六君补其受毒水克削之愆而安。此即粤西、太平、柳州、南
宁毒水瘴之一斑也。
一时开山，同病还省数人，有似疟非疟。如驿官之仆陈某者，医以疟视，不及月余而疾笃，因势急，方求
诊。脉已弦紧而数，饮食不进。陈曰∶若欲治，何不在一月之前？病虽甚，而元气犹在。今精神殆尽，虽有婆
心，无药可施，奈之何哉。
阅一载，驿官复有甥陈姓，亦以开山病归，仍犯毒水，所得似痢非痢，寒热间作。医以香、连、朴、硝、
大黄行药消导，日益 羸。易医曰∶可以进补，用白术五分，陈皮二分，茯苓四分，病无退进。召陈诊，犹谓
饮食尚可，料不致大变。脉之，恍然不定，重按已绝，人将谢世，而饮食犹能。此所谓行尸之疾，邪火浮载，
真精告竭矣。辞之，阅二日而卒。
新安程圣林长子，年十六，精血充足，饮食倍进。丁丑春，从父到广，年余，患似痢非痢，足肿便赤。此
受暑湿瘴气之病。半年前，曾视其脉，数逾六至，每言于其父，此有积疾，非寿征也。即欲急治，已属难能，
人皆以为谬。未几而发此疾，医用寒如大黄、黄柏、黄芩、朴硝，消导如枳实、槟榔、浓朴、山楂、草蔻，补
如参、 、八珍，热如桂、附、姜、茱，兼投备进。时陈奉制府之招，留滞端州两月，归而往视，不可为矣。噫！
洞庭贺泽民，按察云南时，分巡腾冲等处讨贼，因染瘴疠，腰股发热，有监生杀犬煮馈之，令空心恣食，
饮酒数杯，即去溺溲，少顷清利，其胀渐退。盖犬肉能治瘴也。（《客坐新闻》。）
治瘴法，宜温中固下，升降阴阳，及灸中脘、气海、三里，或灸大指及第五指，皆能止热。若用大柴胡汤，
及麻黄金沸草散，青龙汤，胶柱鼓瑟，鲜不败矣。又中瘴失语，俗呼为中草子，移时血凝立死。法当用针刺头
额及上唇，仍以楮叶擦其舌令血出，徐以药解其内热立效。（《居易录》出《赤雅》。）
漳水界有一水，号乌脚溪，涉者足皆如墨，数十里间，水不可饮，饮则病瘴。梅龙图仪，尝沿履至漳州，
素多病，豫忧瘴疠为害，至乌脚溪，使数人肩荷之，以物蒙身，恐为毒水所沾，兢惕过甚，行至中流，忽堕水
中，至于没项乃出之，举体黑如昆仑奴，自此宿病尽除，顿觉康健。（《说颐》。）
江南溪有溪毒，病发时如重伤寒。识之者，取小笔管内鼻中，以指弹之三五下，即出黑血，良久即愈，不
然即不救。（《录异记》。）
行路时，但见前后山间，有气如虹或白，即是瘴气，急以身伏于地下，用口含土，候其气散乃起，则无伤。
盖其气浮空而过，不着于地也。若有槟榔及蒜，服之亦可。（《漱石闲谈》。）
瘴疾吐下，皆不可治。治之法，惟灸中脘、气海、三里三处，并灸大指，再用针多刺额及上唇，令多出血，
又以楮叶擦舌，令出血，然后用药解楮叶之毒，内热即除，瘴毒自消矣。（《粤拥》。）
友人言粤西某县瘴殊甚，县令赴任即死，无逾三月者。一丞至任，历十余年，家口染疾，死亡殆尽，此丞
久无恙，无他术，独嗜烧酒，终日沉醉而已。（《粤拥》。）
周公谨云∶香附四两，去黑皮微炒，片子姜黄，汤浸一宿，洗净二两，甘草四两，炒研细末，入盐点服，辟
岚瘴之气极妙。（《志雅堂杂录》。）
王珍、张衡、马均，冒重雾行，一人无恙，一人病，一人死。问其故，曰∶我饮酒，病者食，死者空腹。
（《博物志》。）
陈三农诊治制府一位姓王的官员，因感染瘴气而患病，表现为寒热往来、胸膈部饱胀闷塞、头痛眩晕、恶心，脉象数且洪大。使用藿香正气散（广藿香、紫苏、白芷等组成的解表化湿方剂）加入厚朴、槟榔、羌活、防风、紫苏叶，服用一剂后寒热退去，头痛消失。随后减去羌活、紫苏叶、防风，加入草豆蔻、半夏、枳壳，恶心、腹胀闷及发热症状全部痊愈。
梧州一位姓方的患者，脉象弦而数，头痛身痛，恶心饱闷，发热。使用羌活、防风、川芎、紫苏、藿香、厚朴、二陈汤（陈皮、半夏、茯苓、甘草）、苍术、甘草、槟榔，服用两剂后痊愈。因为饱胀感未完全消退，又加入草豆蔻、草果才彻底治愈。（这种头痛、恶心、饱闷的症状，之所以区别于普通感冒，是因为这是瘴气所致。）
端州李别驾，镶蓝旗人，四十多岁，擅长骑马射箭。在代理雷州府职务时，善于搏虎，不避风雨寒暑，涉溪爬山，体内积累的瘴气已经很深。他所感受的风寒暑热，不止一种，而且长期客居他乡半年，刚回到本衙门，还没来得及休息，就去省城拜见上级长官，可以说是为公事劳累，忘记了自己身体。然而积存的邪气突然发作。医生们纷纷前来，声称稍微发散了一下邪气，已经进补药，结果邪气大作，出现寒热往来、神志昏迷胡言乱语，脉象空虚无根且数，神气散乱。此时补法泻法兼施，议论纷纷。邀请陈三农前往诊视，脉象已像水上的浮萍，时刻有脱失之象，寒热交替发作。这是因为受病既深，精气两虚，邪气正盛，难以着手治疗。拟定用五积散（苍术、厚朴、陈皮、甘草、当归、川芎、白芍、茯苓、桔梗、麻黄、干姜、肉桂、白芷组成）加入附子、人参，去掉麻黄改用羌活。此前已说明这是不治之症，不忍心坐视不管，勉强尽一点诚心，但对方对方剂面露难色，不想服药的话，于是将方子搁置不用。过了一夜，又拉他前去诊视，脉症更加严重。因为看到案头昨天开的药还在，于是坚决推辞离开。后来听说有人以阴疟阳虚为由，使用《金匮要略》中的肾气汤加人参；也有人认为是虚证似疟，应当用补中益气汤加人参、附子。结果服用三剂后，神志昏迷气喘，虚汗如雨，脚冷而亡。不知道这个病症，起初是实受瘴气，多次感受深寒，如今则是乘虚而发。俗话说：伤寒容易使下焦虚弱的人死亡，何况是同时感受风寒暑湿的瘴气呢？
正红旗孙兄，是广东转运高公的亲戚。高公写信说：我的亲戚孙某，患的是不治之症，只有我能治，这也是做善事的一个方面。当时因为我正在广州创办育婴局，所以这么说。我去诊脉，脉象空豁恍惚不定，重按无根，神志昏迷胡言乱语，寒热大作，加上咳嗽痰喘，翻身都不能入睡，昼夜只能趴在桌子上呻吟，而且胸膈胀闷，脚冷恶寒。询问得知，夏秋季节积累劳损，寒暑都受到了影响。一个月前，初次感到头风身痛，憎寒恶热，咳嗽。有人用桔梗、杏仁、干葛、羌活，发汗后病没好。又用桑白皮、前胡、苏子、半夏、贝母、知母、黄芩，也不见效，寒热更严重。又用小柴胡汤加山栀、元参、薄荷，咳嗽更严重。不知道这个病症，是夏秋暑湿风寒兼感而发，尚未得汗，怎么能解散？于是用五积散两剂，汗出如淋，咳嗽也减轻，可以伏枕睡觉了。只是寒热未退，病久元气已亏，气上逆作喘，小便如油短少频数，火气从下往上冲，上盛下虚，用《金匮要略》肾气丸两服，气平便顺。然而潮热依旧，时有梦话昏冒，午后用参附六君子汤，早晨与肾气丸同服，经过一个月汗止神清。总共用了约一斤人参、附子，又服用还少丹加紫河车、桂枝、附子、鹿角胶，以及十全大补汤，五十多天后，元气才恢复，饮食如常。这与李别驾是同一类病形，脉象虽然稍有不同，一个因为信药而生，一个因为不信药而死。唉。
戊寅年十一月，高盐运使公子，患似痢非痢，红多白少，恶寒微热，脉滑而数。询问得知自夏秋以来，由川北随任到广东，长期积聚暑湿，感冒而发。用平胃散（苍术、厚朴、陈皮、甘草）加羌活、防风、紫苏、藿香，一剂后寒热退去，再剂加入槟榔、木香而痊愈。有人问：痢疾忌用燥药，现在用苍术却好了，为什么呢？我说：常人得的痢疾，是因暑令火热之气而得，燥药是天时所忌，所以不可擅自使用。现在是积湿之病，发于隆冬外感，正是得力要药。所谓治病要探求根源，七天可愈。所以医生不要拘执成方，病人不要拘执药物。
梁溪棋手周西侯的弟弟，在英德开铜矿，山下有水，人们洗衣服则污垢腻物皆去，大家觉得很神奇。因为靠近方便，做饭舂米都用这水，没过多久，人都变得面色萎黄浮肿、身体软弱、腹胀无力，饮食加倍增加，寒热交替发作，喜欢吃鸡猪各种肉类，胃腹才能稍安。在矿厂共事的同事，死了好几个，因此来省城求治。用平胃正气散治疗其病，后用益气六君子汤补益其受毒水克削造成的亏损而安定。这就是粤西、太平、柳州、南宁毒水瘴气的情况之一斑。
一时开山，同病回省城的几个人，有的似疟非疟。如驿馆官员的仆人陈某，医生当作疟疾治疗，不到一个多月病情加重，因为形势紧急，才来求诊。脉象已弦紧而数，饮食不进。陈三农说：如果想治，为什么不在一个月之前？病虽然很重，但元气还在。现在精神几乎耗尽，虽然有慈悲心，也无药可施，怎么办呢。
过了一年，驿馆官员又有外甥姓陈的，也是因为开山病回省城，仍然接触毒水，所得也是似痢非痢，寒热交替发作。医生用香连丸、厚朴、芒硝、大黄行药消导，日益消瘦。换医生说要进补，用白术五分，陈皮二分，茯苓四分，病没有进退。召陈三农诊视，还说饮食尚可，料想不会有大变化。诊脉，恍惚不定，重按已绝，人将要谢世，而饮食还能吃。这就是所谓的“行尸”之疾，邪火浮载，真精告竭了。推辞不治，过了两天就死了。
新安程圣林长子，十六岁，精血充足，饮食加倍增加。丁丑年春天，跟随父亲到广州，一年多后，患似痢非痢，足肿便赤。这是受暑湿瘴气之病。半年前，曾诊视他的脉，数超过六至，每次都对他父亲说，这有积疾，不是长寿的征兆。即使想急治，也已经很难了，大家都认为荒谬。没过多久就发了此病，医生用寒凉药如大黄、黄柏、黄芩、朴硝，消导药如枳实、槟榔、厚朴、山楂、草蔻，补益药如人参、白术、八珍汤，温热药如桂枝、附子、干姜、茱萸，兼投备进。当时陈三农奉制府之招，滞留端州两个月，回来往视，已经不可救治了。唉！
洞庭贺泽民，在云南按察使任上，分巡腾冲等处讨伐贼寇，因感染瘴疠，腰股发热，有个监生杀狗煮肉给他吃，让他空腹恣意食用，饮酒几杯，随即排尿，一会儿清利，他的胀满逐渐消退。大概狗肉能治瘴气。（出自《客坐新闻》。）
治疗瘴气的方法，宜温中固下，升降阴阳，以及灸中脘、气海、足三里穴，或者灸大拇指及小拇指（第五指），都能止热。如果用大柴胡汤，以及麻黄金沸草散、青龙汤，拘泥固执，很少有不失败的。另外，中瘴失语，俗称中草子，片刻后血凝立死。方法应当用针刺头额及上唇，仍以楮树叶擦拭舌头令出血，慢慢用药解除内热立即见效。（出自《居易录》，引自《赤雅》。）
漳水边界有一条水，号称乌脚溪，涉水者双脚都像墨一样黑，几十里间的水不能喝，喝了就会病瘴。梅龙图仪，曾经徒步到漳州，平时多病，预先担心瘴疠危害，到了乌脚溪，让几个人抬着他，用东西蒙住身子，恐怕被毒水沾上，警惕过度，走到中流，忽然堕入水中，直到淹没脖子才被救出来，全身黑得像昆仑奴，从此宿病全除，顿觉康健。（出自《说颐》。）
江南某溪有溪毒，发病时像重伤寒。认识的人，取小笔管插入鼻中，用手指弹击三五下，即流出黑血，很久就好了，不然就无法救治。（出自《录异记》。）
走路时，只要看见前后山间，有气如虹或白色，就是瘴气，急忙趴在地上，用口含土，等气散后再起来，就不会受伤。因为那气浮空而过，不着于地。如果有槟榔及蒜，服用也可以。（出自《漱石闲谈》。）
瘴疾吐下，都不可治。治疗方法，只灸中脘、气海、三里三处，并灸大拇指，再用针多刺额头及上唇，令多出血，又以楮树叶擦舌，令出血，然后用药解除楮树叶的毒，内热即除，瘴毒自消矣。（出自《粤拥》。）
朋友说粤西某县瘴气特别厉害，县令赴任即死，没有超过三个月的。一个丞尉到任，历经十余年，家口染疾，死亡殆尽，这个丞尉长久无恙，没有其他法术，只是嗜好烧酒，终日沉醉而已。（出自《粤拥》。）
周公谨说：香附四两，去黑皮微炒，片子姜黄，汤浸一宿，洗净二两，甘草四两，炒研细末，入盐点服，辟岚瘴之气极妙。（出自《志雅堂杂录》。）
王珍、张衡、马均，冒着浓雾行走，一人无恙，一人病，一人死。问其原因，说：我喝酒，生病的人吃饭，死的人是空腹。（出自《博物志》。）
Chen Sansan treated a government official surnamed Wang, who suffered from miasma (Zhangqi, toxic mountain air/miasma) after catching a cold. His symptoms included alternating chills and fever, fullness and oppression in the chest and diaphragm, headache, dizziness, nausea, and a rapid, surging pulse. He was prescribed Huoxiang Zhengqi San (Agastache Powder to Rectify the Qi), with added Houpo (Magnolia Bark), Binglang (Areca Seed), Qianghuo (Notopterygium Rhizome), Fangfeng (Saposhnikovia Root), and Ziyeye (Perilla Leaf). After one dose, the alternating chills and fever subsided, and the headache ceased. Qianghuo, Ziyeye, and Fangfeng were then removed, and Caodoukou (Grass Cardamom), Banxia (Pinellia Tuber), and Zhike (Aurantium Fruit) were added. The nausea, abdominal distension, oppression, and fever all resolved.
A patient surnamed Fang in Wuzhou presented with a wiry and rapid pulse, headache, body pain, nausea, fullness, and fever. He was treated with Qianghuo, Fangfeng, Xiong (Ligusticum Chuanxiong), Su (Perilla Leaf), Huoxiang (Patchouli), Houpo, Erchen Tang (Two-Cured Decoction), Cangzhu (Atractylodes Rhizome), Gancao (Licorice Root), and Binglang. After two doses, he recovered. Because the feeling of fullness had not completely subsided, Caodoukou and Caoguo (Black Cardamom) were added until he was fully cured. (These symptoms of headache, nausea, and fullness distinguish this condition from an ordinary cold; it is caused by miasma.)
Li Biejia of Duanzhou, a member of the Blue Banner with White Border, was over forty years old and skilled in horsemanship and archery. While acting as the prefect of Leizhou, he was adept at fighting tigers, disregarding wind, rain, cold, and heat, wading through streams, and climbing ridges, thereby accumulating deep-seated miasma. He had been exposed to various pathogenic factors including wind, cold, summer-heat, and heat. Having been away for half a year, he returned to his office without resting and immediately went to the provincial capital to pay respects to superiors. This can be described as exhausting oneself for public duties while neglecting one's own body. However, the accumulated pathogens suddenly manifested. Physicians came in droves, claiming they had slightly dispersed the pathogens and had already administered tonics, but the pathogenic qi intensified, causing alternating chills and fever, coma with delirious speech, a vacant and rapid pulse without root, and scattered spirit and qi. Both tonifying and purging methods were applied, leading to conflicting opinions. Chen was invited to examine the patient. The pulse was like duckweed on water, constantly threatening to escape. Alternating chills and fever occurred. Since the disease was deep-rooted, both essence and qi were deficient, while pathogenic qi was vigorous, making treatment difficult. A prescription of Wuji San (Five Accumulations Powder) with Fuzi (Aconite Lateral Root) and Renshen (Ginseng Root) was proposed, removing Mahuang (Ephedra) and substituting Qianghuo. It had been clearly stated that this was an incurable case. Unwilling to stand by idly, Chen tried his best sincerity, but the patient showed reluctance towards the prescription and expressed unwillingness to take medicine, so it was set aside. Overnight, he was pulled back for examination; the pulse and symptoms had worsened significantly. Seeing the previous day's prescription still on the desk, Chen firmly declined and left. Later, it was heard that someone used Shengdi Huang Qin Tang (Rehmannia and Scutellaria Decoction? Note: Text says Jin Gui Shen Qi Tang - Kidney Qi Decoction from the Golden Cabinet) with Ginseng for yin malaria and yang deficiency. Others thought it was a deficiency syndrome resembling malaria and should be treated with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Ginseng and Aconite. After three doses, the patient fell into coma with panting, profuse sweating like rain, cold feet, and death. They did not realize that initially, the patient had truly contracted miasma and repeatedly suffered from deep cold. Now, the pathogens took advantage of the deficiency. As the saying goes: "Shanghan (Cold Damage) tends to kill those with lower jiao deficiency." How much more so for miasma involving wind, cold, summer-heat, and dampness?
Sun Xiong of the Plain Red Banner was a relative of Gao Gong, the Transport Commissioner of Guangdong. Gao wrote: "My relative Sun suffers from an incurable illness; only I can cure him. This is also a way to do good." At that time, because I was establishing an Infant Orphanage in Guangzhou, he said this. Upon examining his pulse, it was empty, vague, and unstable, with no root upon deep pressure. He had coma with delirious speech, severe alternating chills and fever, cough with phlegm and wheezing, inability to turn over or sleep, groaning day and night while leaning on the table, chest and diaphragm oppression, cold feet, and aversion to cold. Inquiry revealed accumulation of fatigue during summer and autumn, exposure to both cold and heat. One month prior, he first felt head wind and body pain, aversion to cold and hatred of heat, and cough. Someone used Jiegeng (Platycodon Root), Xingren (Apricot Seed), Ge Gen (Kudzu Root), and Qianghuo, inducing sweat without resolution. Then Sangpi (Mulberry Bark), Qianhu (Peucedanum Root), Suzi (Perilla Seed), Banxia, Beimu (Fritillaria Bulb), Zhimu (Anemarrhena Rhizome), and Huangqin (Scutellaria Root) were used, also ineffective, with worsening chills and fever. Then Xiao Chaihu Tang (Minor Bupleurum Decoction) with Zhizi (Gardenia Fruit), Yuanshen (Scrophularia Root), and Bohe (Mint) was used, worsening the cough. They did not realize that this illness was triggered by simultaneous contraction of summer-heat, dampness, wind, and cold during summer and autumn. Without inducing sweat, how could it be dispersed? Thus, Wuji San was prescribed for two doses. Sweat poured like rain, cough decreased, and he could lie on a pillow. Only the alternating chills remained. Due to long-standing illness, yuan qi (original qi) was depleted. Qi rushed upward causing panting, urine was oily, short, and frequent. Fire rose from below, resulting in excess above and deficiency below. Two doses of Shenqi Wan (Kidney Qi Pill) from Jin Gui Yao Lue (Essential Prescriptions from the Golden Cabinet) smoothed the qi and regulated urination. However, tidal fever persisted, with occasional mumbling and confusion. In the afternoon, Shenfu Liujunzi Tang (Ginseng and Aconite Six-Gentlemen Decoction) was given, along with Shenqi Wan in the morning. After a month, sweating stopped, and clarity returned. Approximately one jin (500g) of Ginseng and Aconite were used in total. Additionally, Hushao Dan (Young Preservation Pill) with Heche (Placenta), Guizhi (Cinnamon Twig), Fuzi, and Lu Jiao Jiao (Deer Antler Glue), as well as Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction), were taken. After fifty-plus days, yuan qi recovered, and diet normalized. This case shared the same pathology as Li Biejia. Although the pulses differed slightly, one lived due to faith in medicine, and the other died due to lack thereof. Alas.
In the eleventh month of the Wuyin year, the son of Gao Cuoshi (Salt Commissioner) suffered from a condition resembling dysentery but not quite dysentery, with more red blood than white mucus, aversion to cold, slight fever, and a slippery, rapid pulse. Inquiry revealed that since summer and autumn, he had traveled from Northern Sichuan to Guangdong with his post, accumulating summer-heat and dampness, which was triggered by a cold. Pingwei San (Stomach-Ping Powder) with Qianghuo, Fangfeng, Su (Perilla), and Huoxiang was prescribed. After one dose, chills and fever subsided. After two doses, Binglang and Muxiang (Costus Root) were added, leading to recovery. Someone asked: "Dysentery contraindicates drying herbs. Why did Cangzhu work here?" I replied: "Ordinary dysentery arises from the fiery qi of the summer season; drying herbs are taboo in such weather, hence they should not be used arbitrarily. Here, however, it is a disease of accumulated dampness manifesting in winter with external contraction; thus, it is a key effective herb. Treating the disease by searching for its source can lead to recovery in seven days. Therefore, physicians should not stick rigidly to formulas, and patients should not cling to specific drugs."
The younger brother of Zhou Xihou, a chess master from Liangxi, opened a copper mine in Yingde. There was water at the foot of the mountain; when people washed clothes in it, dirt and grease disappeared, which everyone found miraculous. Due to its convenience, cooking and milling used this water. Soon, everyone became yellow, puffy, weak, with abdominal distension and weakness, yet appetite doubled. They craved chicken and pork meat to soothe their stomachs. Colleagues in the factory died one after another, prompting them to seek treatment in the provincial capital. Pingwei Zhengqi San was used to treat the illness, followed by Yiqi Liujunzi Tang (Qi-Nourishing Six-Gentlemen Decoction) to replenish the damage caused by the toxic water. This illustrates one aspect of the toxic water miasma in Western Guangdong, Taiping, Liuzhou, and Nanning.
Several people who worked on opening the mountain returned to the province with similar illnesses, some resembling malaria but not quite. For example, Chen, a servant of a postal official, was treated as having malaria by a physician. Within less than a month, the disease worsened. Due to the urgency, he sought my consultation. The pulse was wiry, tight, and rapid, with no intake of food or drink. I said, "If you wanted treatment, why not a month ago? Although the disease is severe, yuan qi remains. Now spirit and energy are nearly exhausted. Despite my compassionate heart, there is no medicine to apply. What can be done?"
One year later, the nephew of the postal official, also surnamed Chen, returned sick from mining, having again been exposed to toxic water. He suffered from a condition resembling dysentery but not quite, with alternating chills and fever. Physicians used Xianglian Wan (Coptis and Aucklandia Pill), Houpo, Mangxiao (Mirabilite), and Dahuang (Rhubarb) for digestion and purging, leading to emaciation. Another physician suggested tonification, using Baizhu (Atractylodes Macrocephala Rhizome) 5 fen, Chenpi (Tangerine Peel) 2 fen, and Fuling (Poria) 4 fen. The disease neither improved nor worsened. I was summoned to diagnose. The patient claimed diet was acceptable, predicting no major change. Upon palpation, the pulse was vague and unstable, disappearing upon deep pressure. The patient was near death, yet still able to eat. This is what is called the disease of a "walking corpse," where evil fire floats, and true essence is exhausted. I declined treatment. Two days later, he died.
The eldest son of Cheng Shenglin from Xin'an was sixteen, with abundant essence and blood, and a voracious appetite. In the spring of Dingchou, he accompanied his father to Guangzhou. After more than a year, he developed a condition resembling dysentery but not quite, with swollen legs and red urine. This was a disease contracted from summer-heat, dampness, and miasma. Half a year prior, I examined his pulse, which was rapid exceeding six beats per breath. I told his father repeatedly that this indicated an underlying chronic condition and was not a sign of longevity. Even if urgent treatment were attempted, it would have been difficult. Everyone considered this absurd. Shortly thereafter, this illness erupted. Physicians used cold herbs like Dahuang, Huangbai (Phellodendron Bark), Huangqin, and Mangxiao; digestive herbs like Zhishi (Immature Bitter Orange), Binglang, Houpo, Shanzha (Hawthorn Fruit), and Cao Kou; tonics like Renshen, Baizhu, and Bazhen Tang (Eight-Treasure Decoction); and hot herbs like Guizhi, Fuzi, Jiang (Ginger), and Zhuyu (Cornus Fruit). All were administered simultaneously. At that time, I was summoned by the Governor-General and stayed in Duanzhou for two months. Upon returning, I examined him, but it was too late. Alas!
He Ze-min from Dongting, while serving as Surveillance Commissioner in Yunnan, patrolled Tengchong and other areas to suppress rebels. He contracted miasma, experiencing heat in the waist and thighs. A licentiate killed a dog, boiled the meat, and offered it to him. He ate it greedily on an empty stomach and drank several cups of wine. He then urinated, and soon felt clear and comfortable, with the distension gradually receding. It seems dog meat can treat miasma. (From *Kezuo Xinwen*.)
The method for treating miasma involves warming the middle and securing the lower jiao, regulating the ascending and descending of yin and yang, and moxa application at Zhongwan (CV12), Qihai (CV6), and Zusanli (ST36). Alternatively, moxa can be applied to the thumb and the fifth finger (little finger), which can stop heat. Using Da Chaihu Tang (Major Bupleurum Decoction), Majin Feicui San (Ephedra, Goldthread, and Fern Powder), or Qinglong Tang (Azure Dragon Decoction) would be rigid and unlikely to succeed. Furthermore, for loss of speech due to miasma, commonly called "Zhong Caozi," blood coagulation leads to immediate death within moments. The method is to prick the forehead and upper lip with needles, and rub the tongue with Cye leaves (Paper Mulberry leaves) to induce bleeding, then slowly administer medicine to resolve internal heat for immediate effect. (From *Juyi Lu*, citing *Chiya*.)
At the border of Zhangshui, there is a stream called Wuji Xi (Black Foot Creek). Those who wade through it have feet turning black as ink. Water within tens of miles cannot be drunk; drinking it causes miasma disease. Mei Longtu Yi once walked to Zhangzhou. Prone to illness, he feared miasma. At Wuji Xi, he had several people carry him, covering his body with cloth to avoid contact with toxic water, being overly cautious. Mid-stream, he suddenly fell into the water and was pulled out up to his neck. His whole body turned black like a Kunlun slave. From then on, his chronic illnesses vanished, and he felt healthy. (From *Shuo Yi*.)
There is stream poison in a creek in Jiangnan. Onset resembles severe cold damage. Those who recognize it insert a small pen tube into the nose and tap it three to five times with a finger, causing black blood to flow out. Recovery occurs after a while; otherwise, it is fatal. (From *Lu Yi Ji*.)
When traveling, if one sees vapor like a rainbow or white mist between mountains ahead and behind, it is miasma. Immediately lie flat on the ground, hold soil in the mouth, and wait for the vapor to dissipate before rising. This prevents injury. The vapor floats in the air and does not touch the ground. If Areca nut and garlic are available, consuming them is also helpful. (From *Shoushi Xiantan*.)
For miasma with vomiting and diarrhea, treatment is generally ineffective. The method is to moxa Zhongwan, Qihai, and Zusanli, and the thumb. Then, prick the forehead and upper lip frequently with needles to induce bleeding. Rub the tongue with Cye leaves to cause bleeding. Finally, use medicine to detoxify the Cye leaf poison. Internal heat will be cleared, and miasma toxin will dissipate. (From *Yue Yong*.)
A friend said that in a certain county in Western Guangdong, miasma is extremely severe. County magistrates die upon taking office, none surviving beyond three months. One assistant magistrate served for over ten years. His family members contracted the disease and almost all died. This assistant magistrate remained unharmed for a long time. He had no other skill; he simply loved strong liquor and was intoxicated all day. (From *Yue Yong*.)
Zhou Jingjin said: Take 4 liang of Xiangfu (Cyperi Rhizoma), remove black skin and stir-fry lightly. Take 2 liang of Pianzi Jianghuang (Curcuma Longa), soak in soup overnight, wash clean. Take 4 liang of Gancao, stir-fry and grind into fine powder. Mix with salt and take with water. This is excellent for repelling mountain miasma. (From *Zhoya Tang Zalu*.)
Wang Zhen, Zhang Heng, and Ma Jun walked through heavy fog. One was unharmed, one fell ill, and one died. When asked why, they replied: "I drank alcohol; the sick person ate food; the dead person fasted." (From *Bowu Zhi*.)