暑之阴阳，治各不同，其分别固为最要，复思长夏湿热交蒸，暑必夹湿，夏热人喜当风，易感暑风，更当分别，何者轻重余在羊城，诊琴友杨君星门暑邪变疟一症。初患暑时医谓外感重而暑湿轻，用柴葛羌防从风治(暑风作冬日风寒治谬甚)；更医谓湿重用苍术、茵陈；又更医谓热重用芩连知柏，终归罔效，以致暑热不解而成疟。邀余诊，以三说询余，余曰：是不难辨，即君亦能自辨之。古人谓伤风恶风，伤寒恶寒，伤食恶食推之，凡察其所恶，即知其所伤。今君喜披襟当风，是不恶风非伤于风可知。渴喜凉饮，饮多无痞满之患(湿病多饮必觉胸脘痞满)，且进西瓜梨汁，更觉胸脘畅适，是不恶湿，非伤于湿可知。疟宋身热炽，且心热而烦(暑先入心心烦是暑的症)，贪凉而恶热，是伤于暑热可断，况脉亦洪大耶2但暑热无质无形，本伏三焦气分，后医未读刘河间先生书，不知治暑法，程从用苦寒作六经实热主治，故仍不效耳。兹拟方，遵河间治暑，热当先清肃上焦气分，法选辛凉轻清之品，投剂谅无不效。果服二剂病减，四剂病痊。方用石膏、知母、麦冬、鲜嫩竹叶、滑石各三钱，莲子心、甘草各八分，香薷五分，同煎服。其出入加减，亦不过地骨、莲叶、洋参、粳米。
湿 症
湿有中湿、寒湿、风湿、酒湿、湿热、湿温、湿痹、湿痰之名，理宜分内因外因之治。兹订中和渗湿之剂，当察其所因而加减治之。凡湿症舌多白，脉濡缓，湿郁则脉象兼呆钝。仲景师云；湿家忌发汗，汗之变痉厥，患湿者不可不知。
茯苓皮四钱 绵茵陈一钱半 北杏仁一钱半 大腹皮二钱 白茯苓二钱 闽泽泻一钱半
加栀子一钱、淡豆豉二钱，引。或用通草五六钱，先煎汤去渣，将汤代水煎药。脾虚受湿加白术、苍术(去栀子杏)。舌白恶饮，或周身尽痛(此湿阻气机，以至气不能运行，故周身尽痛)宜加白蔻仁、马兜铃、或藿香梗、滑石。湿热加黄柏、黄芩。寒湿加附子、干姜(去栀子腹皮杏)。风湿加防风、藿香叶。湿痹加防风、狗脊。湿温重用鲜芦根、通草煎汤代水(去猪泽加滑石甘草)。酒湿加枳棋子、葛花。湿痰加制半夏、陈皮。
又湿在上宜防风，湿在中宜苍术，湿在下宜利小便(即本方或再加滑石车前便合)，湿在周身宜乌药、羌活、狗脊等，湿在两臂宜灵仙、桑枝、桑寄等，湿在两股宜牛膝、防己、萆薢等。审其患湿之处而方中加以主治之药为引道，则发药治病无不效矣。
泄 泻 症
书云：湿成五泻(飧溏鹜濡滑)。又云：气滞为胀，湿郁为泻，可知泻不外乎湿。然有腹痛，必兼食积；无腹痛，但湿郁阳明。
苍术一钱半 云苓三钱 陈皮一钱 木瓜一钱 防风一钱 猪苓二钱 腹皮一钱半 泽泻一钱半
方内苍术不觉燥加多，觉燥减少。至若腹痛则加木香、或湿槟榔、藿香梗。食积加厚朴、神曲或莱菔子、山查(或去腹皮木瓜)。酒积加干葛。热加芩连。寒加桂枝、吴萸、附子(去猪苓、腹皮、防风○凡大辛热大苦寒药，未涉医者，宜逐味渐加为稳。书首凡例已经列明)脾虚加人参、白术、附子(去腹皮、茯苓、泽泻)。若五更后泻且有定时者，为脾肾皆虚，宜四神丸加人参、茯苓、白术、附子、粟壳之类。又凡痛而泻，泻而痛减者，食积。若痛而泻，泻而痛不减者，乃土衰木乘(脾虚故泻，肝实故痛)宜用土炒白术三钱，炒白芍二钱，陈皮一钱，防风一钱(此名痛泻要方)或更加木瓜一钱，炒莲叶二钱，同煎，人参、茯苓、炙甘草、煨干葛皆可酌加。久泻者，须少佐升麻数分(二症上拟方皆不合用)。
痢 症
见症里急后重，腹痛欲便，不便湿热食积相并，则成此症。痢色有赤有白之不同，亦因其受病有热重湿重之各异。热胜于湿则伤胃之血分而为赤痢，湿胜于热则伤胃之气分而为白痢，若赤白各半，则气血两伤。治法当宗刘河间先生调气和血之旨(和血则脓血自愈，调气则后重自除)，兹因将赤痢、白痢、赤白痢，分症处方治之。
赤痢方
金银花三钱 建神曲一钱半 山查核二钱当归身一钱 红曲米一钱 生甘草八分 云黄连一钱
或加陈茶结糖各三钱同煎。
热甚黄连、银花各再加一二钱。湿加滑石、防风。食滞加莱菔子苗、厚朴。腹痛频加木香数分。便涩滞而大痛加酒炒大黄数分或钱零。若久痢微痛涩滞而燥渴者为下多伤阴加生地、阿胶、黑芝麻、白芍(去二曲、山查、连)，或独用六味地黄汤主治。凡痛缓积稀为热滞渐去，当和血，生熟地黄、生制首乌、当归、白芍、黑豆、黑芝麻为要药(去二曲连山查)。
白痢方
川滑石三钱 炒银花二钱 建神曲一钱半泡苍术一钱 绵茵陈二钱 生甘草五分 防风肉一钱
加炒香莲叶二钱为引(鲜干任用)。
湿微或渴减苍术，湿盛不渴加苍术，或再加白术、茯苓。另有见症当加药当看前赤痢症所列。
赤白痢方
银花三钱 建神曲一钱半 青皮五分 防风八分 滑石三分 黄连七分，土炒 陈皮五分甘草八分
如赤多于白当归倍苍术(或再加多些银花黄连)。白多于赤苍术倍当归(加多些防风)。服二三剂后若得痛缓积稀加白术、茯苓、当归、白芍以调和气血(去滑石、青皮，或再去黄连、苍术减少银花，或再加木瓜、甘草改用炙)。
另有见症当加药乃看前赤痢所列。
凡久痢仍脉数有热香连丸最佳。倘赤白将尽症，转脉虚自汗，真人养脏汤诃子散在所必用。
经验赤白痢方。银花、滑石、白糖各等分，多煎代茶漫饮。(又赤痢银花倍滑石，白痢滑石倍银花)痢已久便仍滞，加打破黑芝麻同煎，口干渴加生粉葛肉同煎。
附论时行传染二症
痢症惯有时行与传染二种，尤当分别治之。时行者，从皮毛而入，症必兼见微恶寒邪，风所过行于一家则一家病，行于一乡则一乡病，当宗喻嘉言初用辛凉解表，次用苦寒清里，法宜败毒散加减。传染者从口鼻入，症不见恶寒，秽气所触，染一人则一人病，染一方则一方病，当宗刘河间调气行血法，宜芍药汤或参入藿香正气散加减治之。
疟 症
疟一日一发者，其邪浅，两日一发者，其邪深；三日一发者，名三阴疟，流连难愈。其邪原伏少阳，入与阴争则寒，出与阳争则热，争则病作，息则病止。其邪仍伏，本经寒热之来，必应期而至。若寒热模糊，来势混而难分，此邪气重而正气怯。若寒热相等作，止有时斯，邪气轻而正气不甚，虚兹拟方先从正气未虚者商治。
建神曲二三钱 黄芩一二钱 青皮八分法夏曲二三钱 青蒿二三钱 甘草八分
寒多加草果或桂枝。热多加知母或石膏(凡发热无汗最忌石膏，慎之。又有汗忌丹皮，无汗忌白芍，均不可不知)。渴加花粉、麦冬(去二曲)。痰多加瓜蒌、夏曲改用半夏。夜热加丹皮、地骨(去二曲)。夏日湿盛加滑石、茵陈。不渴寒多加苍术，兼暑热加滑石、黄连。秋燥(去二曲、青皮、芩)加桑白皮、地骨皮、麦冬、杷叶、或鲜芦根、冬瓜皮、梨皮。若正气虚者(拟方不合用)宜用补中益气汤加减治之。又单寒无热宜用附子理中汤加柴胡。单热无寒宜用白虎汤少加桂枝。
此症发于夏秋者，暑湿为患者居多，暑必夹湿，当分暑与湿何者为重暑热重者疟来者必热重而寒微，唇舌必绛赤烦渴而喜凉饮，饮多无痞满之患，当宗桂枝白虎汤法及六一散加入辛凉之品治之(凉如麦冬、竹叶、莲叶类，辛如青蒿、香薷类)。湿邪重者，疟来时虽则热势蒸燔，舌必有黏腻之苔，渴喜暖汤，胸脘觉痞胀呕恶，当宗藿香正气散及二陈汤去甘草加北杏仁、白蔻仁、生姜之类治之。
凡首列拟方原为轻症，投剂更有偏于寒者，主以大剂姜、桂、附。偏于热者主以大剂石膏、芩、连。王太仆云；热之不热是无火也，益火之源以消阴翳；寒之不寒是无水也，壮水之主以制阳光。赵养葵遵之，以八味丸益火之源，六味丸壮水之主，治久疟多以此法收功(六味是益阴和阳法，脉与症确阳胜于阴而后用此阴药，方无胎累，慎之)。
倘间日一发者，非疟期日，不宜用表药，祛邪亦不宜蔽固其邪。有湿者去湿，有热者清热，有滞者行滞，总以疏荡其邪为主。若气血虚者当佐以扶元。至期日然后用表药，以祛邪外出。服药宜早三个时许。三阴疟之治法亦然。期前后两日亦但当扶正，至期日然后少佐表药以祛邪，即春夏令主升泄柴胡亦当少佐。凡久病必入络须用当归、桃仁，少佐红花(上三味活络血下三味疏经气)草果、桂枝、柴胡，自能透邪外出。
兹拟因暑热成间日疟者立一法治(其余各因可推)。
间日疟期前一日后一日服方(剂宜轻小)。
建神曲一钱半 夏曲一钱半 陈皮三分甘草三分 生扁豆三钱，不打
加鲜莲叶三钱，切碎，同煎。
热加鲜竹茹。渴加麦冬、芦根。湿加茵陈。食滞加谷麦芽。虚加参术。寒加生姜、煨姜。有痰倍夏曲。
疟期日即用上初拟治疟六味原方，并参所列加减法治之。体虚者用补中益气汤加减。
三阴疟，余每用补中益气汤与何人饮法加减治之，疟期前后两日治法专主扶正。
三阴疟期前两日后两日服方(亦宜轻剂)。
三阴疟期日服方(早三个时服或五更服亦佳)。
人参随用 白术椙 桃仁八分 柴胡八分 黄耆二钱 首乌三钱 红花二分 黄芩八分 当归二钱 桂枝八分 草果八分 青皮五分
加生姜二片，大枣三枚煎(方中如用党参宜四五钱，丽参二三钱，人参，酌用之，)。
凡方中用人参，如野山土木、关东吉林、高丽、防党、潞党，须因人因症用之其分量轻重亦然。即凡方药中之轻重皆然。如原方服不知则分钱倍用（此三阴疟方宜于温补药中分钱倍用）。倘轻症与幼科其分钱或减半用之。
热多者加柴胡、黄芩(参、耆、术、归、桂、草果略减少)。寒多者加桂枝、草果。单寒无热者柴芩不用(少壮者此法多效，老弱者当遵下列高鼓峰法)。
高鼓峰先生云三阴大疟最难治，余于岁月未久者，用参汤下二妙丸(橘红、半夏二味，神曲和丸)，服至半月一月自愈。如年深月久虺羸不堪者大剂，养营汤吞八味丸，仍于汤中加附子一钱，十贴必除(久疟用补中益气不效，必须遵此法)。
附案(暑邪变疟)
黄君子飞余旧知也。余尝学琴于其尊，人太原广文于飞时少亦同学焉，今复同道而学医也。其尊堂夏日偶患暑疟症，适于飞外出延医，某治之误，用小柴胡再加苦寒升散药，服二剂病增剧，寒多呕恶不食，汗大泄，于飞旋里，频进温补，继复邀余同诊，六脉弱而无神，面唇舌俱白，且有一种寒冷象。阅近服方多用六君加归、耆、草果、姜枣等。余曰：药从温补病宜渐轻。于飞曰：仅得纳食，而疟至之苦依然也。疟将作必先频呕，疟止而呕仍不即止，家慈最苦者呕，君先除之。余曰：此呕原过服羌活、柴胡，升动肝风所致，肝风所欲动，更乘疟势，一作益挟之，以肆其升逆之威。夫木动必乘胃土，邪阻胃降，呕斯作矣。用术草枣而培胃虚以制肝，用黄耆而维阳气以固卫原，治久疟汗多善法，但现苦频呕，有升无降，此等究属升提守中，愚见姑拟暂停专取降逆理虚一法，方用生左牡蛎块一两，吉林参三钱，同煎，当归五钱，桂枝、陈皮、制半夏、生姜片各一钱，于飞见信，果一服疟即不复作。疟止后，乃用于飞参、耆、术、归、草、枣旧方法，加入附子温少火以生气，而调养复元。
又案(疟后辨寒热)
暑病的阴阳属性不同，治疗方法也各不相同，区分它们固然非常重要。我又想到长夏时节湿热交蒸，暑邪必定夹带湿邪；夏季炎热时人们喜欢迎风纳凉，容易感受暑风之邪，这些情况更应当加以分别。究竟哪一种是轻证、哪一种是重证呢？
我在羊城诊治琴友杨星门君患“暑邪变疟”这一病症。起初患病时，医生认为外感风寒较重而暑湿较轻，使用柴胡、葛根、羌活、防风等药物从风邪论治（将暑风当作冬季风寒来治疗是非常错误的）；换了一位医生认为湿邪重，使用苍术、茵陈；又换了一位医生认为热邪重，使用黄芩、黄连、知母、黄柏，最终都没有效果，导致暑热未解而演变成疟疾。邀请我诊治，他向我提出了这三种说法的疑问。我说：这并不难辨别，即使是你自己也能分辨出来。古人说伤风怕风，伤寒怕冷，伤食厌食，推而言之，凡是观察病人厌恶什么，就知道他受了什么邪气。现在你喜好敞开衣襟当风，说明你不恶风，可知不是伤于风邪。口渴喜欢喝冷饮，喝多了也没有胸脘痞满的困扰（湿病的人喝水多一定会觉得胸脘痞满），而且吃了西瓜、梨汁后，反而觉得胸脘舒畅舒适，说明你不恶湿，可知不是伤于湿邪。疟疾发作时身体高热，且心中烦热（暑邪先入心，心烦是暑邪的确切症状），贪凉而怕热，可以断定是伤于暑热，况且脉象也是洪大的吗？但是暑热是无质无形的，原本潜伏在三焦的气分中，后来的医生没有读过刘河间先生的书，不懂得治疗暑邪的方法，程从用却用苦寒药按照六经实热来主治，所以仍然无效。现在我拟定方剂，遵循河间先生治疗暑热的原则，热邪应当先清肃上焦气分，方法选用辛凉轻清的药材，投药下去想必没有不生效的。果然服用两剂后病情减轻，四剂后病愈。方子用石膏、知母、麦冬、鲜嫩竹叶、滑石各三钱，莲子心、甘草各八分，香薷五分，同煎服。其中的加减变化，也不过是用地骨皮、莲叶、西洋参、粳米而已。
【湿症】
湿症有中湿、寒湿、风湿、酒湿、湿热、湿温、湿痹、湿痰的名称，按理应该区分内因和外因进行治疗。这里制定中和渗湿的药剂，应当根据致病原因进行加减治疗。凡是湿症，舌苔多为白色，脉象濡缓，湿邪郁结则脉象兼有呆钝之象。张仲景老师说：患有湿症的人忌用发汗法，发汗会导致痉厥，患湿症的人不可不知道这一点。
茯苓皮四钱，绵茵陈一钱半，北杏仁一钱半，大腹皮二钱，白茯苓二钱，闽泽泻一钱半。
如果加入栀子一钱、淡豆豉二钱作为引经药。或者用通草五六钱，先煎汤去渣，用汤代替水来煎药。脾虚受湿加白术、苍术（去掉栀子和杏仁）。舌苔白且不想喝水，或者周身疼痛（这是湿阻气机，导致气不能运行，所以周身疼痛），适宜加白蔻仁、马兜铃，或者藿香梗、滑石。湿热加黄柏、黄芩。寒湿加附子、干姜（去掉栀子、大腹皮、杏仁）。风湿加防风、藿香叶。湿痹加防风、狗脊。湿温重用鲜芦根、通草煎汤代水（去掉猪苓、泽泻，加滑石、甘草）。酒湿加枳棋子、葛花。湿痰加制半夏、陈皮。
另外，湿邪在上的宜用防风，湿邪在中的宜用苍术，湿邪在下的宜利小便（即本方或再加滑石、车前子合用），湿邪在周身宜用乌药、羌活、狗脊等，湿邪在两臂宜用威灵仙、桑枝、桑寄生等，湿邪在两腿宜用牛膝、防己、萆薢等。审察患湿的部位而在方中加入主治的药物作为引经药，那么发药治病就没有不生效的了。
【泄泻症】
书上说：湿气形成五种泄泻（飧泄、溏泄、鹜溏、濡泄、滑泄）。又说：气滞导致胀满，湿郁导致泄泻，可知泄泻不外乎湿邪所致。然而如果有腹痛，必定兼有食积；如果没有腹痛，只是湿郁阳明。
苍术一钱半，云茯苓三钱，陈皮一钱，木瓜一钱，防风一钱，猪苓二钱，大腹皮一钱半，泽泻一钱半。
方中苍术如果不觉得燥就多加，如果觉得燥就减少。至于腹痛则加木香，或者湿槟榔、藿香梗。食积加厚朴、神曲或莱菔子、山楂（或者去掉大腹皮、木瓜）。酒积加干葛。热证加黄芩、黄连。寒证加桂枝、吴茱萸、附子（去掉猪苓、大腹皮、防风○凡是大辛大热和大苦大寒的药，没有经验的医者，适宜逐味逐渐增加剂量以求稳妥。书首凡例已经列明）。脾虚加人参、白术、附子（去掉大腹皮、茯苓、泽泻）。如果是五更以后泄泻且有定时的，是脾肾皆虚，适宜用四神丸加人参、茯苓、白术、附子、罂粟壳之类。另外凡是痛而泄泻，泄泻后疼痛减轻的，是食积。如果痛而泄泻，泄泻后疼痛不减的，乃是土衰木乘（脾虚故泄泻，肝实故疼痛），适宜用土炒白术三钱，炒白芍二钱，陈皮一钱，防风一钱（此名痛泻要方），或者再加木瓜一钱，炒莲叶二钱，同煎，人参、茯苓、炙甘草、煨干葛都可以酌情加入。久泻者，须少佐升麻数分（以上两个拟定的方子都不适合这种情况）。
【痢症】
见症为里急后重，腹痛想大便，如果不便秘，则是湿热食积相并，才形成这个病症。痢疾的颜色有红色和白色的不同，也是因为它受病有热重和湿重的差异。热胜于湿则损伤胃的血分而成为赤痢，湿胜于热则损伤胃的气分而成为白痢，如果赤白各半，则气血两伤。治疗方法应当遵循刘河间先生调和气血的宗旨（和血则脓血自愈，调气则后重自除），现在因此将赤痢、白痢、赤白痢，分症处方治疗。
【赤痢方】
金银花三钱，建神曲一钱半，山楂核二钱，当归身一钱，红曲米一钱，生甘草八分，云黄连一钱。
或者加入陈茶结糖各三钱同煎。
热甚黄连、银花各再加一二钱。湿加滑石、防风。食滞加莱菔子苗、厚朴。腹痛频繁加木香数分。便涩滞且剧痛加酒炒大黄数分或一两零。如果久痢微痛涩滞且燥渴的是因为下利多伤阴，加生地、阿胶、黑芝麻、白芍（去掉二曲、山楂、黄连），或者独用六味地黄汤主治。凡是疼痛缓解、积滞稀少为热滞渐去，应当和血，生熟地黄、生制首乌、当归、白芍、黑豆、黑芝麻为要药（去掉二曲、黄连、山楂）。
【白痢方】
川滑石三钱，炒银花二钱，建神曲一钱半，泡苍术一钱，绵茵陈二钱，生甘草五分，防风肉一钱。
加炒香莲叶二钱作为引经药（鲜干任选）。
湿微或者口渴减苍术，湿盛不渴加苍术，或者再加白术、茯苓。另有见症当加药要看前面赤痢症所列。
【赤白痢方】
银花三钱，建神曲一钱半，青皮五分，防风八分，滑石三分，黄连七分（土炒），陈皮五分，甘草八分。
如果赤多于白，当归倍于苍术（或者再加多一些银花、黄连）。白多于赤，苍术倍于当归（加多一些防风）。服用二三剂后如果得到疼痛缓解、积滞稀少，加白术、茯苓、当归、白芍以调和气血（去掉滑石、青皮，或者再去掉黄连、苍术，减少银花，或者再加木瓜、甘草改用炙甘草）。
另有见症当加药乃看前面赤痢所列。
凡是久痢仍然脉数有热的，香连丸最佳。如果赤白将尽，症转脉虚自汗，真人养脏汤、诃子散在所必用。
经验赤白痢方：银花、滑石、白糖各等分，多煎代茶慢慢饮用。（另外赤痢银花倍滑石，白痢滑石倍银花）痢疾已久大便仍滞，加打破的黑芝麻同煎，口干渴加生粉葛肉同煎。
【附论时行传染二症】
痢症惯常有时行与传染两种，尤其应当分别治疗。时行的，从皮毛而入，症必兼见轻微恶寒邪气，风气所过行于一家则一家病，行于一乡则一乡病，应当遵循喻嘉言初用辛凉解表，次用苦寒清里的方法，适宜败毒散加减。传染的从口鼻入，症不见恶寒，秽气所触，染一人则一人病，染一方则一方病，应当遵循刘河间调气行血法，适宜芍药汤或参入藿香正气散加减治疗。
【疟症】
疟疾一日一发者，其邪浅，两日一发者，其邪深；三日一发者，名三阴疟，缠绵难愈。其邪原伏于少阳，入与阴争则寒，出与阳争则热，争则病作，息则病止。其邪仍伏，本经寒热之来，必应期而至。如果寒热模糊，来势混而难分，此邪气重而正气怯。如果寒热相等，发作停止有定时，斯邪气轻而正气不甚虚。这里拟定方剂先从正气未虚者商量治疗。
建神曲二三钱，黄芩一二钱，青皮八分，法夏曲二三钱，青蒿二三钱，甘草八分。
寒多加草果或桂枝。热多加知母或石膏（凡发热无汗最忌石膏，慎之。又有汗忌丹皮，无汗忌白芍，均不可不知）。渴加花粉、麦冬（去掉二曲）。痰多加瓜蒌、夏曲改用半夏。夜热加丹皮、地骨（去掉二曲）。夏日湿盛加滑石、茵陈。不渴寒多加苍术，兼暑热加滑石、黄连。秋燥（去掉二曲、青皮、黄芩）加桑白皮、地骨皮、麦冬、枇杷叶，或者鲜芦根、冬瓜皮、梨皮。如果正气虚者（拟定的方子不适合用）适宜用补中益气汤加减治疗。另外单寒无热适宜用附子理中汤加柴胡。单热无寒适宜用白虎汤少加桂枝。
此症发于夏秋者，暑湿为患者居多，暑必夹湿，应当分暑与湿何者为重。暑热重者疟来者必热重而寒微，唇舌必绛赤烦渴而喜凉饮，饮多无痞满之患，应当遵循桂枝白虎汤法及六一散加入辛凉之品治疗（凉如麦冬、竹叶、莲叶类，辛如青蒿、香薷类）。湿邪重者，疟来时虽则热势蒸燔，舌必有黏腻之苔，渴喜暖汤，胸脘觉痞胀呕恶，应当遵循藿香正气散及二陈汤去甘草加北杏仁、白蔻仁、生姜之类治疗。
凡是首列拟定的方子原为轻症，投药更有偏于寒者，主以大剂姜、桂、附。偏于热者主以大剂石膏、芩、连。王太仆说：热之不热是无火也，益火之源以消阴翳；寒之不寒是无水也，壮水之主以制阳光。赵养葵遵循此法，以八味丸益火之源，六味丸壮水之主，治疗久疟多以此法收功（六味是益阴和阳法，脉与症确属阳胜于阴而后用此阴药，方才无牵累，慎之）。
如果间日一发者，非疟期日，不宜用表药，祛邪亦不宜闭塞固留其邪。有湿者去湿，有热者清热，有滞者行滞，总以疏荡其邪为主。如果气血虚者当佐以扶元。至期日然后用表药，以祛邪外出。服药宜早三个时许。三阴疟的治疗法亦然。期前后两日亦但当扶正，至期日然后少佐表药以祛邪，即春夏令主升泄的柴胡亦当少佐。凡是久病必入络须用当归、桃仁，少佐红花（上三味活络血，下三味疏经气），草果、桂枝、柴胡，自能透邪外出。
这里拟定因暑热成间日疟者立一法治（其余各因可推）。
间日疟期前一日后一日服方（剂宜轻小）。
建神曲一钱半，夏曲一钱半，陈皮三分，甘草三分，生扁豆三钱（不打碎）。
加鲜莲叶三钱，切碎，同煎。
热加鲜竹茹。渴加麦冬、芦根。湿加茵陈。食滞加谷麦芽。虚加参术。寒加生姜、煨姜。有痰倍夏曲。
疟期日即用上初拟治疟六味原方，并参所列加减法治之。体虚者用补中益气汤加减。
三阴疟，我每用补中益气汤与何人饮法加减治疗，疟期前后两日治法专主扶正。
三阴疟期前两日后两日服方（亦宜轻剂）。
党参三钱，首乌一钱（制），神曲七分（炒），陈皮四分，当归一钱。
三阴疟期日服方（早三个时服或五更服亦佳）。
人参随用，白术椙（注：原文此处可能有误，通常指白术用量），桃仁八分，柴胡八分，黄耆二钱，首乌三钱，红花二分，黄芩八分，当归二钱，桂枝八分，草果八分，青皮五分。
加生姜二片，大枣三枚煎（方中如用党参宜四五钱，丽参二三钱，人参，酌用之）。
凡是方中用人参，如野山土、木、关东吉林、高丽、防党、潞党，须因人因症用之，其分量轻重亦然。即凡方药中之轻重皆然。如原方服不知则分钱倍用（此三阴疟方宜于温补药中分钱倍用）。倘轻症与幼科其分钱或减半用之。
热多者加柴胡、黄芩（参、耆、术、归、桂、草果略减少）。寒多者加桂枝、草果。单寒无热者柴芩不用（少壮者此法多效，老弱者当遵下列高鼓峰法）。
高鼓峰先生说三阴大疟最难治，我于岁月未久者，用参汤下二妙丸（橘红、半夏二味，神曲和丸），服至半月一月自愈。如年深月久虺羸不堪者大剂，养营汤吞八味丸，仍于汤中加附子一钱，十贴必除（久疟用补中益气不效，必须遵此法）。
【附案（暑邪变疟）】
黄君子飞是我旧相识。我曾经向他父亲学琴，人太原广文于飞当时年少也同学焉，现在又同道而学医。他的母亲夏日偶患暑疟症，恰逢于飞外出延医，某医生治之误，用小柴胡再加苦寒升散药，服二剂病增剧，寒多呕恶不食，汗大泄，于飞旋里，频进温补，继复邀余同诊，六脉弱而无神，面唇舌俱白，且有一种寒冷象。阅近服方多用六君加归、耆、草果、姜枣等。我说：药从温补病宜渐轻。于飞说：仅得纳食，而疟至之苦依然也。疟将作必先频呕，疟止而呕仍不即止，家慈最苦者呕，君先除之。我说：此呕原过服羌活、柴胡，升动肝风所致，肝风所欲动，更乘疟势，一作益挟之，以肆其升逆之威。夫木动必乘胃土，邪阻胃降，呕斯作矣。用术草枣而培胃虚以制肝，用黄耆而维阳气以固卫原，治久疟汗多善法，但现苦频呕，有升无降，此等究属升提守中，愚见姑拟暂停专取降逆理虚一法，方用生左牡蛎块一两，吉林参三钱，同煎，当归五钱，桂枝、陈皮、制半夏、生姜片各一钱，于飞见信，果一服疟即不复作。疟止后，乃用于飞参、耆、术、归、草、枣旧方法，加入附子温少火以生气，而调养复元。
【又案（疟后辨寒热）】
The yin and yang aspects of summerheat differ, and their treatments vary accordingly; distinguishing them is indeed crucial. Furthermore, considering that in late summer dampness and heat steam together, summerheat must be accompanied by dampness; and since people often enjoy facing the wind when it is hot in summer, they are prone to contracting summerwind. These situations require further differentiation to determine which is mild and which is severe.
I treated a case of "summerheat transforming into malaria" for my friend Yang Xingmen in Guangzhou. Initially, physicians believed the external contraction was heavy while summerdampness was light, using Chaihu (Bupleuri Radix), Gegen (Puerariae Lobatae Radix), Qianghuo (Notopterygii Rhizoma et Radix), and Fangfeng (Saposhnikoviae Radix) to treat it as a wind disorder (treating summerwind as winter cold wind is a serious error). Another physician considered dampness heavy and used Cangzhu (Atractylodis Rhizoma) and Yinchen (Artemisiae Scopariae Herba); yet another considered heat heavy and used Huangqin (Scutellariae Radix), Lianhua (Coptidis Rhizoma), Zhimu (Anemarrhenae Rhizoma), and Huangbai (Phellodendri Cortex), but all were ineffective, leading to unresolved summerheat transforming into malaria. Upon invitation, he presented these three theories to me. I said: This is not difficult to distinguish; even you can discern it yourself. The ancients stated that wind injury causes aversion to wind, cold injury causes aversion to cold, and food stagnation causes aversion to food. By observing what the patient dislikes, one knows the pathogen. Now, you like to open your robe and face the wind, indicating no aversion to wind, thus proving it is not wind injury. You are thirsty and prefer cold drinks, drinking much without chest or epigastric fullness (patients with dampness who drink much will feel chest/epigastric fullness), and eating watermelon or pear juice brings comfort to the chest and epigastrium, indicating no aversion to dampness, thus proving it is not dampness injury. During malaria attacks, your body temperature is high, and you feel heart heat and vexation (summerheat enters the heart first; vexation is a definitive symptom of summerheat). You seek coolness and fear heat, confirming summerheat injury. Moreover, your pulse is surging and large. However, summerheat is formless and substance-less, originally latent in the Sanjiao Qi level. Subsequent doctors had not read Liu Hejian's works and did not know how to treat summerheat. Cheng Congyong mistakenly treated it as Six Channels excess heat with bitter-cold herbs, hence the failure. I now prescribe according to Hejian's principles: heat should first clear the Upper Jiao Qi level. Using acrid-cool and light-clearing herbs, efficacy is assured. Indeed, after two doses, symptoms reduced; after four doses, the disease was cured. The formula uses Shigao (Gypsum Fibrosum), Zhimu (Anemarrhenae Rhizoma), Maidong (Ophiopogonis Tuber), fresh Zhuyeqing (Lophatheri Herba), Huashi (Talcum), each 3 qian; Lianzixin (Nelumbinis Plumula), Gancao (Glycyrrhizae Radix et Rhizoma), each 8 fen; Xiangru (Moslae Herba), 5 fen. Decoct together. Modifications include Digupi (Daturae Radix), Lianye (Nelumbinis Folium), Yangshen (Panacis Quinquefolii Radix), Jingmi (Oryzae Semen).
[Regarding Dampness Disorders]
Dampness disorders include Zhongshi (Central Dampness), Han Shi (Cold Dampness), Feng Shi (Wind-Dampness), Jiu Shi (Alcohol Dampness), Shi Re (Damp-Heat), Shi Wen (Damp-Warmth), Shi Bi (Damp Bi), and Shi Tan (Damp Phlegm). Treatment should distinguish between internal and external causes. Here, a harmonizing and draining dampness formula is prescribed, modified according to the cause. In dampness disorders, the tongue coating is usually white, and the pulse is soggy and slow; if dampness is stagnant, the pulse may appear dull. Zhang Zhongjing stated: Patients with dampness should avoid sweating; inducing sweat may lead to spasms and convulsions. This must be known.
Formula: Fulingpi (Poria Cum Cortice), 4 qian; Mian Yinchen (Artemisiae Scopariae Herba), 1.5 qian; Bei Xingren (Armeniaca Semen Amarum), 1.5 qian; Dafupi (Arecae Pericarpium), 2 qian; Bai Fuling (Poria), 2 qian; Min Zexie (Alismatis Rhizoma), 1.5 qian.
Add Zhizi (Gardeniae Fructus), 1 qian, and Danshi (Fermented Sojae Semen Preparatum), 2 qian, as guides. Or use Tongcao (Tetrapanacis Medulla), 5-6 qian, decoct first, remove dregs, and use the liquid to decoct other herbs. For Spleen deficiency with dampness, add Baizhu (Atractylodis Macrocephalae Rhizoma) and Cangzhu (Atractylodis Rhizoma) [remove Zhizi and Xingren]. If the tongue is white, there is no thirst, or the whole body aches (due to damp obstructing Qi mechanism), add Baokouren (Amomi Fructus Rotundus), Madouling (Aristolochiae Radix), or Huoxiang Geng (Agastaches Caulis), Huashi (Talcum). For damp-heat, add Huangbai (Phellodendri Cortex) and Huangqin (Scutellariae Radix). For cold-damp, add Fuzi (Aconiti Lateralis Radix Praeparata) and Ganjiang (Zingiberis Rhizoma) [remove Zhizi, Dafupi, Xingren]. For wind-damp, add Fangfeng (Saposhnikoviae Radix) and Huoxiang Ye (Agastaches Folium). For damp-bi, add Fangfeng (Saposhnikoviae Radix) and Gouji (Cibotii Rhizoma). For damp-warmth, heavily use Xian Luhgen (Phragmitis Rhizoma) and Tongcao (Tetrapanacis Medulla) decocted as water substitute [remove Zhuling, Zexie, add Huashi, Gancao]. For alcohol-damp, add Zhizi Zi (Schisandrae Chinensis Fructus) and Gehua (Puerariae Flos). For damp-phlegm, add Banxia (Pinelliae Rhizoma) and Chenpi (Citri Reticulatae Pericarpium).
Additionally, for dampness in the upper part, use Fangfeng; in the middle, Cangzhu; in the lower, promote urination (add Shigao, Cheqianzi to this formula). For dampness in the whole body, use Wuyao (Linderae Radix), Qianghuo (Notopterygii Rhizoma et Radix), Gouji (Cibotii Rhizoma). For dampness in the arms, use Lingxian (Syneilesis Rhizoma), Sangzhi (Mori Ramulus), Sangjisheng (Taxilli Caulis et Folium). For dampness in the thighs, use Niuxi (Achyranthis Bidentatae Radix), Fangji (Stephaniae Tetrandrae Radix), Bibi (Dioscoreae Hypoglaucae Rhizoma). Identify the location of dampness and add guiding herbs to the formula for effective treatment.
[Regarding Diarrhea]
Books state: Dampness forms five types of diarrhea (Sun Tang, Tang Tang, Wu Ru, Ru Xi, Hua Xi). Also: Qi stagnation causes distension; dampness stagnation causes diarrhea. Thus, diarrhea is essentially due to dampness. Abdominal pain implies food stagnation; absence of pain suggests dampness stagnating in the Yangming channel.
Formula: Cangzhu (Atractylodis Rhizoma), 1.5 qian; Yun Ling (Poria), 3 qian; Chenpi (Citri Reticulatae Pericarpium), 1 qian; Mugua (Chaenomelis Fructus), 1 qian; Fangfeng (Saposhnikoviae Radix), 1 qian; Zhuling (Polyporus), 2 qian; Fupi (Arecae Pericarpium), 1.5 qian; Zexie (Alismatis Rhizoma), 1.5 qian.
Adjust Cangzhu dosage based on dryness sensation. For abdominal pain, add Muxiang (Aucklandiae Radix), or Binlang (Arecae Semen), Huoxiang Geng (Agastaches Caulis). For food stagnation, add Houpo (Magnoliae Officinalis Cortex), Shenqu (Mashii Fermentatio), Laifuzi (Raphani Semen), Shanzha (Crataegi Fructus) [remove Fupi, Mugua]. For alcohol accumulation, add Ge Gen (Puerariae Lobatae Radix). For heat, add Huangqin (Scutellariae Radix), Lianhua (Coptidis Rhizoma). For cold, add Guizhi (Cinnamomi Ramulus), Wuyu (Evodiae Fructus), Fuzi (Aconiti Lateralis Radix Praeparata) [remove Zhuling, Fupi, Fangfeng]. For Spleen deficiency, add Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Fuzi (Aconiti Lateralis Radix Praeparata) [remove Fupi, Fuling, Zexie]. If diarrhea occurs at dawn with regularity, it indicates Spleen-Kidney deficiency; use Sishen Wan (Four Spirits Pill) plus Renshen (Ginseng Radix), Fuling (Poria), Baizhu (Atractylodis Macrocephalae Rhizoma), Fuzi (Aconiti Lateralis Radix Praeparata), Yuke (Papaveris Pericarpium). Pain relieved by defecation indicates food stagnation; pain persisting after defecation indicates Spleen deficiency with Liver overacting (Wood insulting Earth); use Tuxiao Baizhu (Earth-fried Atractylodis Macrocephalae Rhizoma), 3 qian; Chao Baishao (Fried Paeoniae Radix Alba), 2 qian; Chenpi (Citri Reticulatae Pericarpium), 1 qian; Fangfeng (Saposhnikoviae Radix), 1 qian (this is Tongxie Yaofang). Add Mugua (Chaenomelis Fructus), 1 qian; Chao Lianye (Fried Nelumbinis Folium), 2 qian. Renshen (Ginseng Radix), Fuling (Poria), Zhigancao (Honey-fried Glycyrrhizae Radix et Rhizoma), Wei Ge Gen (Baked Puerariae Lobatae Radix) can be added as needed. For chronic diarrhea, add Shengma (Cimicifugae Rhizoma), a few fen.
[Regarding Dysentery]
Symptoms include tenesmus, abdominal pain, and urge to defecate. If not constipated, it is due to combined damp-heat and food stagnation. Dysentery color varies red or white depending on whether heat or dampness predominates. Heat exceeding dampness damages Stomach blood, causing red dysentery; dampness exceeding heat damages Stomach Qi, causing white dysentery; equal amounts damage both Qi and Blood. Treatment follows Liu Hejian's principle of harmonizing Qi and Blood.
[Red Dysentery Formula]
Jinyinhua (Lonicerae Japonicae Flos), 3 qian; Jian Shenqu (Mashii Fermentatio), 1.5 qian; Shanzha He (Crataegi Fructus Core), 2 qian; Danggui Shen (Angelicae Sinensis Radix Cor), 1 qian; Hongqu Mi (Red Yeast Rice), 1 qian; Sheng Gancao (Raw Glycyrrhizae Radix et Rhizoma), 8 fen; Yun Huanglian (Coptidis Rhizoma), 1 qian.
Add Chen Cha Jie Tang (Old Tea Knot Sugar), 3 qian each, decoct together.
If redness is severe, add Honghua (Carthami Flos), 6-7 fen; Diyü (Sanguisorbae Radix), 7-8 fen, as guides.
For severe heat, add more Huanglian (Coptidis Rhizoma) and Jinyinhua (Lonicerae Japonicae Flos). For dampness, add Huashi (Talcum), Fangfeng (Saposhnikoviae Radix). For food stagnation, add Laifuzi Miao (Raphani Semen Plume), Houpo (Magnoliae Officinalis Cortex). For frequent abdominal pain, add Muxiang (Aucklandiae Radix), a few fen. For painful, difficult defecation, add Jiuhuang Da Huang (Wine-fried Rheii Radix et Rhizoma), a few fen or slightly more. For chronic dysentery with slight pain, difficulty, and dry mouth/thirst due to excessive purging damaging Yin, add Shengdi (Rehmanniae Radix), Ejiao (Asini Corii Colla), Heihema (Sesami Fructus Nigrum), Baishao (Paeoniae Radix Alba) [remove Shenqu, Shanzha, Huanglian], or use Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia). When pain eases and discharge decreases, heat stagnation is resolving; harmonize blood using Sheng/Shu Dihuang (Raw/Cooked Rehmanniae Radix), Sheng/Zhi Shouwu (Raw/Prepared Polygoni Multiflori Radix), Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba), Heidou (Sojae Semen Nigrum), Heihema (Sesami Fructus Nigrum) [remove Shenqu, Huanglian, Shanzha].
[White Dysentery Formula]
Chuan Huashi (Talcum), 3 qian; Chao Yinhua (Fried Lonicerae Japonicae Flos), 2 qian; Jian Shenqu (Mashii Fermentatio), 1.5 qian; Pao Cangzhu (Steamed Atractylodis Rhizoma), 1 qian; Mian Yinchen (Artemisiae Scopariae Herba), 2 qian; Sheng Gancao (Raw Glycyrrhizae Radix et Rhizoma), 5 fen; Fangfeng Rou (Saposhnikoviae Radix Flesh), 1 qian.
Add Chao Xiang Lianye (Fried Fragrant Nelumbinis Folium), 2 qian, as guide.
For slight dampness or thirst, reduce Cangzhu; for heavy dampness without thirst, add Cangzhu (Atractylodis Rhizoma) or add Baizhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria). Refer to Red Dysentery section for other modifications.
[Red and White Dysentery Formula]
Yinhua (Lonicerae Japonicae Flos), 3 qian; Jian Shenqu (Mashii Fermentatio), 1.5 qian; Qingpi (Citri Reticulatae Pericarpium Viride), 5 fen; Fangfeng (Saposhnikoviae Radix), 8 fen; Huashi (Talcum), 3 fen; Huanglian (Coptidis Rhizoma), 7 fen (earth-fried); Chenpi (Citri Reticulatae Pericarpium), 5 fen; Gancao (Glycyrrhizae Radix et Rhizoma), 8 fen.
Add Danggui (Angelicae Sinensis Radix), 5 fen; Cangzhu (Atractylodis Rhizoma), 5 fen, as guides.
If red exceeds white, double Danggui relative to Cangzhu (add more Yinhua, Huanglian). If white exceeds red, double Cangzhu relative to Danggui (add more Fangfeng). After 2-3 doses, if pain eases and discharge decreases, add Baizhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria), Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba) to harmonize Qi and Blood [remove Huashi, Qingpi, or also Huanglian, Cangzhu, reduce Yinhua, or add Mugua, Gancao honey-fried]. Refer to Red Dysentery for other modifications.
For chronic dysentery with rapid pulse and heat, Xianglian Wan (Fragrant Coptis Pill) is best. If red/white discharge is nearly gone, pulse becomes deficient, and spontaneous sweating occurs, Zhenren Yangzang Tang (True Man's Nourishing Viscera Decoction) and Hezi San (Persimmon Seed Powder) are essential.
Empirical Red/White Dysentery Formula: Equal parts Jinyinhua (Lonicerae Japonicae Flos), Huashi (Talcum), Baixtang (Sucrose). Decoct heavily and drink slowly as tea. (For red dysentery, double Jinyinhua; for white, double Huashi). If stool remains stuck after long duration, add broken Heihema (Sesami Fructus Nigrum). If dry mouth/thirst, add Sheng Fen Ge Rou (Raw Puerariae Lobatae Radix Flesh).
[Appendix: Epidemic and Contagious Dysentery]
Dysentery has epidemic and contagious types, requiring distinct treatments. Epidemic cases enter via skin/hair, presenting with mild aversion to cold/wind; spreading through families/villages. Follow Yu Jiayan's method: initial acrid-cool exterior release, then bitter-cold interior clearing; use Baidu San (Resist Toxin Powder) modified. Contagious cases enter via mouth/nose, no aversion to cold, spread by foul air; infect individuals/areas. Follow Liu Hejian's Qi-harmonizing and Blood-moving method; use Shaoyao Tang (Peony Decoction) or Huoxiang Zhengqi San (Agastache Powder for Regulating the Middle) modified.
[Malaria]
Daily malaria indicates shallow pathogen; every second day indicates deep pathogen; every third day is "Three-Yin Malaria," lingering and hard to cure. Pathogen lies in Shaoyang; entering Yin causes chills, exiting Yang causes fever. Conflict causes attack; rest stops it. Pathogen remains latent, returning periodically. Blurred chills/fever indicates heavy pathogen and weak righteous Qi. Equal chills/fever with regular timing indicates light pathogen and moderate righteous Qi. Prescribe for those with un-depleted righteous Qi first.
Formula: Jian Shenqu (Mashii Fermentatio), 2-3 qian; Huangqin (Scutellariae Radix), 1-2 qian; Qingpi (Citri Reticulatae Pericarpium Viride), 8 fen; Fa Xiaqu (Processed Pinellia Ferment), 2-3 qian; Qinghao (Artemisiae Annuae Herba), 2-3 qian; Gancao (Glycyrrhizae Radix et Rhizoma), 8 fen.
Spring/Winter: add Jiang (Zingiberis Rhizoma), Zao (Jujubae Fructus). Summer/Autumn: add Lianye (Nelumbinis Folium). Chronic malaria/Winter: remove Qinghao, add Chaihu (Bupleuri Radix).
For severe chills, add Caoguo (Tsaoko Fructus) or Guizhi (Cinnamomi Ramulus). For severe heat, add Zhimu (Anemarrhenae Rhizoma) or Shigao (Gypsum Fibrosum) [Caution: Shigao contraindicated if fever with no sweat; Danpi contraindicated with sweat; Baishao contraindicated without sweat]. For thirst, add Huafen (Trichosanthis Radix), Maidong (Ophiopogonis Tuber) [remove Shenqu]. For phlegm, add Gualou (Trichosanthis Fructus), replace Xiaqu with Banxia (Pinelliae Rhizoma). For night fever, add Danpi (Moutan Cortex), Digupi (Daturae Radix) [remove Shenqu]. Summer heavy dampness: add Huashi (Talcum), Yinchen (Artemisiae Scopariae Herba). No thirst/severe chills: add Cangzhu (Atractylodis Rhizoma); combined summerheat-heat: add Huashi (Talcum), Huanglian (Coptidis Rhizoma). Autumn dryness [remove Shenqu, Qingpi, Huangqin]: add Sangbaipi (Mori Cortex), Digupi (Daturae Radix), Maidong (Ophiopogonis Tuber), Paye (Eriobotryae Folium), or Xian Luhgen (Phragmitis Rhizoma), Dongguapi (Benincasae Exocarpium), Lipi (Piri Pericarpium). For righteous Qi deficiency, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) modified. For single chills/no fever, use Fuzi Lizhong Tang (Aconite Decoction to Warm the Middle) plus Chaihu (Bupleuri Radix). For single fever/no chills, use Baihu Tang (White Tiger Decoction) with slight Guizhi (Cinnamomi Ramulus).
Summer/Autumn malaria is mostly summerdampness. Differentiate summerheat vs. dampness dominance. Summerheat dominant: high fever, slight chills, crimson lips/tongue, vexation/thirst for cold drinks, no chest fullness. Follow Guizhi Baihu Tang (Cinnamon Twig and White Tiger Decoction) and Liuyi San (Six-to-One Powder) with acrid-cool herbs (cool: Maidong, Zhuyeqing, Lianye; acrid: Qinghao, Xiangru). Dampness dominant: steaming fever, sticky tongue coating, preference for warm drinks, chest/epigastric fullness, nausea. Follow Huoxiang Zhengqi San (Agastache Powder for Regulating the Middle) and Erchen Tang (Two-Aged Decoction) minus Gancao, plus Bei Xingren (Armeniaca Semen Amarum), Baokouren (Amomi Fructus Rotundus), Shengjiang (Zingiberis Rhizoma Recens).
Initial formulas are for mild cases. For cold-predominant cases, use heavy Jiang/Gui/Fu. For heat-predominant, use heavy Shigao/Qin/Lian. Wang Taipu said: "If heat therapy fails to produce warmth, there is no Fire; augment the source of Fire to dissipate Yin shadows." Zhao Yangkui followed this: Bayi Wan (Eight-Ingredient Pill) augments Fire source; Liuwei Wan (Six-Ingredient Pill) strengthens Water source. Effective for chronic malaria [Liuwei Wan nourishes Yin and harmonizes Yang; use only when pulse/symptoms show Yang exceeding Yin, otherwise caution].
For intermittent malaria on non-attack days, avoid exterior-releasing herbs to prevent trapping pathogens. Remove dampness, clear heat, move stagnation, primarily dispersing pathogens. If Qi/Blood deficient, support Yuan Qi. On attack days, use exterior herbs to expel pathogens. Take medicine early (3 hours prior). Same for Three-Yin Malaria. Days before/after attack: support righteousness; on attack day, slight exterior herbs. Even Chaihu (ascending/dispersing) should be slight. Chronic illness enters collaterals: use Danggui (Angelicae Sinensis Radix), Taoren (Persicae Semen), slight Honghua (Carthami Flos) [upper three activate blood; lower three move meridian Qi]; Caoguo (Tsaoko Fructus), Guizhi (Cinnamomi Ramulus), Chaihu (Bupleuri Radix) naturally expel pathogens.
Prescription for Intermittent Malaria due to Summerheat:
Day before/after attack (light dose):
Jian Shenqu (Mashii Fermentatio), 1.5 qian; Xiaqu (Pinellia Ferment), 1.5 qian; Chenpi (Citri Reticulatae Pericarpium), 3 fen; Gancao (Glycyrrhizae Radix et Rhizoma), 3 fen; Sheng Bian Dou (Raw Dolichos Lablab Semen), 3 qian (not crushed).
Add Xian Lianye (Fresh Nelumbinis Folium), 3 qian, chopped, decoct together.
Heat: add Xian Zhuru (Fresh Bambusae Medulla). Thirst: add Maidong (Ophiopogonis Tuber), Lugen (Phragmitis Rhizoma). Dampness: add Yinchen (Artemisiae Scopariae Herba). Food stagnation: add Guya/Maya (Hordei Fructus Germinatus/Zea Mays Granen Germinatum). Deficiency: add Renshen/Baizhu. Cold: add Shengjiang (Zingiberis Rhizoma Recens), Wei Jiang (Zingiberis Rhizoma). Phlegm: double Xiaqu.
On attack day: use original six-herb malaria formula + modifications. For deficiency: Buzhong Yiqi Tang modified.
For Three-Yin Malaria, I use Buzhong Yiqi Tang and Heren Yin modified. Days before/after attack focus on supporting righteousness.
Days before/after Three-Yin Malaria attack (light dose):
Dangshen (Codonopsis Radix), 3 qian; Shouwu (Polygoni Multiflori Radix), 1 qian (prepared); Shenqu (Mashii Fermentatio), 7 fen (fried); Chenpi (Citri Reticulatae Pericarpium), 4 fen; Danggui (Angelicae Sinensis Radix), 1 qian.
Add Shengjiang (Zingiberis Rhizoma Recens), 1-2 slices (add Banxia for phlegm; Baizhu/Dazao/Renshen for Spleen deficiency).
On Three-Yin Malaria attack day (take 3 hours early or at wu geng):
Renshen (Ginseng Radix) as needed; Baizhu (Atractylodis Macrocephalae Rhizoma); Taoren (Persicae Semen), 8 fen; Chaihu (Bupleuri Radix), 8 fen; Huangqi (Astragali Radix), 2 qian; Shouwu (Polygoni Multiflori Radix), 3 qian; Honghua (Carthami Flos), 2 fen; Huangqin (Scutellariae Radix), 8 fen; Danggui (Angelicae Sinensis Radix), 2 qian; Guizhi (Cinnamomi Ramulus), 8 fen; Caoguo (Tsaoko Fructus), 8 fen; Qingpi (Citri Reticulatae Pericarpium Viride), 5 fen.
Add Shengjiang (Zingiberis Rhizoma Recens), 2 slices; Dazao (Jujubae Fructus), 3 pieces. Decoct. [If using Dangshen, 4-5 qian; Lishen, 2-3 qian; choose Renshen appropriately.]
Choose Ginseng type (Wild, Changbai, Korean, Fangdang, Ludang) based on patient/condition. Dosage varies similarly. For mild cases/pediatrics, halve dosage.
More heat: add Chaihu, Huangqin [reduce Renshen, Huangqi, Baizhu, Danggui, Guizhi, Caoguo]. More cold: add Guizhi, Caoguo. Single cold/no heat: omit Chaihu/Huangqin [effective for young/strong; elderly/weak follow Gao Gufeng's method below].
Gao Gufeng stated Three-Yin Great Malaria is hardest to treat. For recent onset, use Renshen Tang with Ermiao Wan (Juhong, Banxia, Shenqu pills) for half a month to a month for self-healing. For chronic emaciation, use Yangying Tang swallowing Bayi Wan, plus Fuzi (Aconiti Lateralis Radix Praeparata), 1 qian in decoction; 10 doses likely cure [if Buzhong Yiqi Tang fails for chronic malaria, follow this method].
[Attached Case: Summerheat Transforming into Malaria]
Mr. Huang Ziyufei is an old acquaintance. I learned zither from his father; Ziyufei studied with me in Taiyuan. Now we study medicine together. His mother contracted summermalaria in summer. Ziyufei was away seeking medical help. A doctor erred, using Xiao Chaihu Tang plus bitter-cold ascending herbs. After two doses, condition worsened: severe chills, vomiting, anorexia, profuse sweating. Ziyufei returned, administered warming tonics repeatedly, then invited me. Pulse: weak and spiritless. Face/lips/tongue: pale/cold appearance. Recent prescriptions used Liujun Zi Tang plus Danggui, Huangqi, Caoguo, Jiang/Zao. I said: Warming tonics should gradually improve the disease. Ziyufei said: Appetite returned, but malaria suffering persists. Before malaria starts, frequent vomiting occurs; vomiting continues after malaria stops. My mother suffers most from vomiting; please eliminate it first. I said: This vomiting resulted from excessive Qianghuo/Chaihu, stirring Liver Wind. Liver Wind, aided by malaria momentum, exacerbates rebellious Qi. Wood moving insults Earth Stomach; pathogen blocks Stomach descending, causing vomiting. Use Baizhu/Gancao/Dazao to strengthen Spleen/Stomach to control Liver; use Huangqi to sustain Yang Qi and secure Wei Defense. Good for chronic malaria with sweating. But currently, frequent vomiting with ascending but no descending Qi belongs to ascending/middle-stabilizing methods. I propose pausing this, focusing on descending/rebellious Qi regulation. Formula: Sheng Zuomuli (Ostreae Concha), 1 liang; Jilin Renshen (Jilin Ginseng Radix), 3 qian, decoct together; Danggui (Angelicae Sinensis Radix), 5 qian; Guizhi (Cinnamomi Ramulus), Chenpi (Citri Reticulatae Pericarpium), Zhi Banxia (Pinelliae Rhizoma Preparata), Shengjiang Pian (Zingiberis Rhizoma Recens Slice), each 1 qian. Ziyufei trusted this; after one dose, malaria ceased. After cessation, resumed his previous method (Renshen, Huangqi, Baizhu, Danggui, Gancao, Dazao) adding Fuzi (Aconiti Lateralis Radix Praeparata) to warm minor fire and generate Qi, restoring health.
[Another Case: Differentiating Cold/Heat after Malaria]