俱痛。舌苔白薄而滑。因于暑湿者。体疼肢懈。热多烦渴。舌苔黄白相兼。挟痰食者。
咳嗽痰涎。嗳腐吞酸。舌苔白腻而浓。或黄浓而腻。若襁褓小孩。寒则战栗。热则气怯
神昏。状如惊痫。当因时辨证。不可误认为惊痫。妄用挑法。
【脉】弦紧弦迟者。风寒变疟也。弦洪弦滞者。暑湿化疟也。弦滑有力者。痰凝也
。弦实有力者。食积也。
【治】壮年初次病疟者。审其因而治之。方法已详前列。若小孩体更柔脆。易虚易
实。选药制方。尤宜灵活。先分寒热之多少。寒多热少者。先与葱豉荷米煎。加生姜（
一分）、细芽茶（二分）、微发其汗以和之。继与平
胃散。（制苍术二分、川朴三分、广皮四分、炙草二分、）加草果仁（二分）、炒常山
（二分）、以截之。终与冰糖乌梅汤。（冰糖一钱、乌梅肉一分、用水一茶钟、浓煎半
钟）。甘酸养胃以善其后。热多寒少者。先与白虎汤。（知母一钱、生石膏钱半、生甘
草三分、生粳米三十粒、荷叶包）。加草果仁（二分）、炒常山（三分）、辛凉消痰以
截之。继与五汁一枝煎。去紫苏旁枝、生姜汁二味。加冰糖（一钱）。重汤炖温服。轻
清甘润以补之。寒热平均者。则以半贝姜茶饮。（姜半夏、川贝、生姜、细芽茶各三
分、用阴阳水两茶钟、煎成一钟）。温清并用以和之。次分新久。新疟先截后补。久疟
先补后截。其大要也。然必要分阳分阴分。昼发而病在阳分气虚者。肢厥汗多。则以露
姜饮。（别直参三分、生姜二分、用阴阳水两钟、煎成一钟、露一宿服）。温补阳气以
截之。病在阴分血虚者。夜热神烦。则以首乌鳖甲汤（生首乌、炙鳖甲各一钱、乌梅
肉二分、冰糖八分、用雪水滚水两钟、煎成一钟、去渣温服）。清滋阴血以截之。
【荣斋按】胎疟之病，古无此名，其说始于万氏儿科。前明万密斋说∶“凡幼小及
壮年，初次患疟者，皆为胎疟，当审其因而治之。因于风寒者从风寒治，因于暑湿者从
暑湿治，因于痰食者从痰食治。大旨先分寒热之多少；寒多热少者，先与香苏葱豉汤发
其表，继与平胃散加草果、常山，除其疟。热多寒少者，先与柴胡白虎汤解其热，继与
白虎汤加常山、草果、平其疟。”此万氏治胎疟之方法，俞氏把它掌握起来，运用起来
，成为有力的一个武器。
九 疫疟
【因】大约有四。一由岚瘴蒸毒。二由阴水蕴毒。三由尸疰客忤。四由气候不正之
时毒。皆能变疟。
【证】瘴毒初起。即身重迷闷。口喑不语。继即谵语狂言。或寒微热甚。或寒
甚热微。胸痞腹满。舌苔灰腻满布。或白浓而腻。水毒初起。寒重热轻。胸膈满痛
。揉按则漉漉有声。干呕短气。或吐清水。甚则腹痛便泄。肢冷足肿。腰重溺少。舌苔
白润。或舌尖边俱黄。中夹一段白色。客忤初起。寒热日作。间有谵语。夜多恶梦
时或躁扰。心悸胆怯。多生恐怖。舌苔淡白。间挟淡灰。时毒初起。风毒则头痛怕
风。始虽寒热日作。继即热多寒少。咽痛喉肿。或发 腮。或发红痧。或发赤 。舌苔
白薄。边尖红燥。秽毒则头重腹痛。胸脘痞满。恶心欲呕。腹痛闷乱。寒热交作。不甚
分明。舌苔黄白相兼。或夹灰腻。
【脉】右寸伏。两关弦滑者。此由天气炎热。山气霉蒸。猝中岚瘴之毒也。双弦而
缓。甚则弦迟者。此由水气郁遏。阳气受困。内伤阴凝之毒也。乍大乍小。乍数乍疏者
。此由素性属阴。胆气不壮。猝被客忤。俗称夜发为鬼疟者是也。两手浮弦而数者。此
手太阴与足少阳经同受风毒也。两手弦细而缓者。此手太阴与足太阴经同受秽毒也。
【治】瘴毒先与《局方》妙香丸。宣窍导痰、以醒其神。继与藿香正气汤。调
冲紫金片。（文蛤四钱。毛茨菇二钱五分、辰砂、腰黄各二钱、红牙大戟、千金霜
各一钱八分、苏合香一钱、冰片五分、当门子三分各研细末、再同研极匀、米糊印成
小片、晒燥、瓷瓶密藏、每服三分至五分、极重一钱）。避瘴解毒。以除其疟。终用柴
平汤合除疟胜金丸。化湿泄热。以芟其根。水毒先与苓术二陈煎。化气利水。以解
阴毒。继与柴平汤加炒常山（二钱）、草果仁（八分）、温中涤涎。以截其疟。终与香
砂二陈汤。芳淡温化。以和胃气。客忤先与苏合香丸。（苏合香、安息香、广
木香各二两、犀角、麝香、梅冰、香附、乳香、沉香、丁香、冬术各一两、共研极
匀、蜜丸、作二百丸、以辰砂一两为衣、蜡匮、此从王晋三新定）辛香开发以除邪。继
与温胆汤加减。（淡竹茹三钱、姜半夏二钱、炒广皮钱半、辰茯神、青龙齿、左牡蛎、
各四钱川桂枝、清炙草各五分、紫金片三分、烊冲）辛通镇摄以壮胆、若时毒由
于厉风者。则以荆防败毒散加减。（荆芥、防风、薄荷、连翘、牛蒡各三钱、柴胡、前胡
各钱半、羌活、独活各一钱、橘红、枳壳、桔梗各二钱、紫金片、生甘草各一
钱、研粗末每服七钱、开水泡取清汤、随漱随咽、日二服、夜二服）、辛散风毒以解表
。痧尚未尽透者。急与透 解毒汤。（连翘、薄荷、炒牛蒡各二钱、蝉衣一钱、淡
豆豉二钱、鲜葱白二枚切、大青叶、鲜桑叶、脑头各四钱、先用野菰根二两、鲜西河柳
三钱、煎汤代水）。窜经透络以提 。 痧透净。津气受伤者。则以人参白虎汤。加鲜
生地（一两）、鲜石斛（四钱）、鲜茅根（八钱）、大生津液以善后。由于臭秽者。先
与藿香正气汤加紫金片。芳香避秽以解毒。毒解秽除。继与香砂二陈汤加炒谷麦芽。温
和胃气以善后。
【秀按】俞君审因辨证。对症施治。可谓知无不言。言无不尽。治疟一道。殆无遗
蕴。至若截疟以常山草果最效。半贝丸（生半夏、生川贝各三钱、研细、姜汁捣匀
为丸、每服三厘至五厘、生熟汤送下、）亦验。若三阴老疟。 疟除根丸如神。截止后
。仍须服药以调理之。庶免复发增重。
【荣斋按】关于疫疟，俞何原作，俱失重心；由于绍兴在那个年代里，不发生过疫
疟，两先生又不肯无中生有，捏造治验，所以说理比较零乱些。现下我把一九三四年江
苏省如皋县中医公会巡回诊疗队任务报告，摘录于下，以充实治例。因如皋县及其附近
地区，在这一年秋季，曾发生过大流行性的疫疟。根据报告上说∶“照保甲调查，各区
染疫者多至五、六万人，一甲内，最少有半数以上之住户，患此疫疟，每保中死亡者约
计三十
人，总共已达五千人以上。”报告者∶为实地参加巡回诊疗任务的黄星楼先生。他说∶
致疫原因 入夏气候太凉，大暑中霪雨不止，华氏寒暑表最高不出九十度以上，虽盛夏朝
暮犹着夹衣；迨立秋后，天气忽暖，寒暑表常达百度，夜静又恒降至八十度左右，寒暖
不时，病根因兹潜伏；加以近月余来，天干少雨，气候异常亢燥，伏邪乘机暴发，宜乎
斯症之猛且烈也。
疫病症状 始则憎寒战栗，继则壮热无汗，或热后微汗，间日轻重，热
退不清，头痛脑胀，肢节酸麻，胸膈痞满，饮食减少，面色黄滞，舌苔白腻，间有吐泻
；久延失治，则发斑疹，出白 ，或昏热头汗，或谵语发狂，或舌黑便难，或下血吐蛔
，甚则面赤足冷，夜热神糊，气喘呃逆，烦躁螈 等现象。
病名考证 前贤论疫，以喻
嘉言、张石顽、吴又可、雷少逸诸家为最详，兹择要节录于后∶喻氏谓四时不正之气，
感之者因而致病，初不名疫也，因病致死，病气尸气，混和不正之气，斯为疫矣！又云
温暑热湿之气，交结互蒸，人在其中，无隙可避，焉能幸免？张氏谓疫邪皆由湿热郁蒸
而发，人触之者，皆从口鼻流入膜原，而至阳明之经，阳明居太阳之里，少阳之表，为
三阳之中道，邪犯膜原，当从和解，兼以逐秽。吴氏谓疟二三发，或七八发后，忽然昼
夜发热，烦渴不恶寒，舌苔生刺，心腹痞满，饮食不进，此疫疟也。雷氏谓疫疟之为病
，因天时寒热不正，邪气乘虚而袭膜原，欲出表而不能透达，欲陷里而未得空隙，故作
寒热往来，或一日二三次，或一次，无定期；寒轻热重，口渴有汗，右脉多胜于左，沿
门合境，长幼相似，此疫疟也。证诸各家论说，验之当前症状，斯名疫疟。
处方撮要
疫邪初发，宜藿香正气散；兼湿热者，宜甘露消毒丹；神昏闷乱者，宜清芬辟疫汤；湿
重郁闷者，宜开郁通络饮；兼湿温者，宜三仁汤；先寒后热者，宜小柴胡汤；寒热便秘
者，宜大柴胡汤；热多寒少者，宜白虎加桂枝汤；瘟疫瘴疟，宜解毒万病丹；夹痰者宜
常山饮，夹食者宜清脾饮。此数方，不过略举其例。他如
兼温热者，仍须以温热门中诸法治之。
【廉勘】前哲皆谓疟不离乎少阳。故治疟皆遵仲景法。多用小柴胡汤加减。执死法
以治活病。学识如张景岳徐灵台魏玉横诸公。尚犯此弊。何论其他。岂知叶天士先生早
经申明。谓疟之为病。因暑挟痰食而发者居多。初起必胸膈不宽。呕吐不食。岂非食物
停滞而为痰乎。即久疟不已而成疟母。亦多因顽痰与瘀血互结为患。大方疟证。须分十
二经。与咳证相等。幼稚患疟。多因脾胃受病。乃幼科多以小柴胡去参。或加香薷，葛
根之属。适犯张凤逵《治暑全书》曰。柴胡劫肝阴。葛根竭胃汁。致变屡矣。后贤学博
如张千里。亦谓江浙人病多挟湿。轻投柴葛提剂。瞑眩可必。获效犹赊。叶氏忌用。实
阅历之言。徐氏妄评。乃拘泥之说。刘河间所以有古法不可盲从之激论也。医学渊博如
王孟英。亦谓疟疾本是感证。不过轻于伤寒耳。近世南方正伤寒少。温热暑湿之病多。
疟亦正疟少。时疟多。温热暑湿。既不可以麻桂正伤寒法治之。时疟岂可以小柴胡正疟
法治之哉。必当辨其为风温。为湿温。为暑热。为伏邪。仍以时感法清其源耳。执是三
说以观之。柴胡治疟之流弊。信而有征。故予治疟。多遵叶法。凡夏秋之间。先辨暑与
湿。暑疟多燥。其治在肺。桂枝白虎汤为主。湿疟多寒。其治在脾。藿香正气散加减。
暑湿并重。治在脾胃。桂苓甘露饮加减。若兼痰多者。加半夏、川贝。食滞者。加枳实
、青皮。屡投辄验。间有不验者。则用除疟胜金丸以截之。或用金鸡纳霜丸以劫之。亦
多默收敏效。久疟则明辨气血阴阳。阳虚气馁者。四兽饮为主。阴虚血热者。青蒿鳖甲
汤加桑叶、首乌、乌梅。疟母则用活血通络汤送鳖甲煎丸。外贴鳖苋膏。信任持久者。
亦收成绩。其余诸疟。及伤寒转疟。悉遵氏成法。奏功亦速。
【荣斋按】关于疟疾用柴胡的标准，根据何廉臣先生看法，同意叶天士、张凤逵、张千
里、王孟英诸家，认为∶“正疟可用，暑湿疟不可用。”莫枚士在《研经言说》∶“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，往往有耳聋目赤，谵语
神昏，汗漏体枯，延成不治者。”他从实际问题里，肯定了柴胡的可用与不可用，是比
较有根据。然而日人汤本求真，却另有一说，他认为∶“仲景之书用柴胡皆有胸胁苦满
证，今乃施诸胸胁苦满而寒热往来者，其应如响；不仅疟疾如是，其他病亦然。无胸胁
苦满症者，用之则无效。”是则柴胡之能治疟疾，在胸胁苦满而不在寒热。陆渊雷先生
流行病须知里，更作了详细的分析。他说∶“用柴胡之证候，在古医书曰“胸胁苦满”
。此“满”字须读作“闷”，意即胸口自觉气闷也。然通常之胸闷，由于胃病，其闷之
重心在当心口，此非柴胡所主，宜黄连黄芩之类；胸胁苦满之闷，重心乃在两旁肋骨之
内，似胀似痛，又似窒塞，甚者，以指头沿肋骨圈下向上挖按，则坚硬而痛，若是者，
为柴胡之的证。”
又按∶廉臣先生此条勘语。系概括本节的九个疟型而言，不是单指疫疟。
都出现疼痛。舌苔白薄而滑。如果是因暑湿引起的，身体疼痛且四肢懈怠，发热多且心烦口渴，舌苔黄白相间。如果夹杂痰食，则咳嗽有痰涎，嗳气带有腐臭味，吞酸，舌苔白腻而厚，或者黄厚而腻。如果是襁褓中的婴儿，受寒则战栗，发热则气息虚弱、神志昏迷，症状像惊风癫痫一样。应当根据时令进行辨证，不可误认为是惊风癫痫，胡乱使用挑治法。
【脉象】脉弦紧或弦迟的，是风寒变化而成的疟疾。脉弦洪或弦滞的，是暑湿化生为疟疾。脉弦滑有力的，是痰凝所致。脉弦实有力的，是食积所致。
【治疗】壮年人初次患疟疾的，审查病因后进行治疗，方法已在前面详细列出。如果是小孩，体质更加柔弱脆弱，容易虚也容易实，选药制方尤其应该灵活。先分辨寒热多少：寒多热少的，先用葱豉荷米煎，加生姜（一分）、细芽茶（二分），微微发汗以调和它。接着用平胃散（制苍术二分、川朴三分、广皮四分、炙甘草二分），加草果仁（二分）、炒常山（二分），以截断疟疾。最后用冰糖乌梅汤（冰糖一钱、乌梅肉一分、用水一茶钟，浓煎至半钟），甘酸养胃以善后。热多寒少的，先用白虎汤（知母一钱、生石膏一钱半、生甘草三分、生粳米三十粒，荷叶包裹），加草果仁（二分）、炒常山（三分），辛凉消痰以截断疟疾。接着用五汁一枝煎，去掉紫苏旁枝、生姜汁两味，加冰糖（一钱），隔水炖温服，轻清甘润以补益它。寒热平均的，就用半贝姜茶饮（姜半夏、川贝、生姜、细芽茶各三分，用阴阳水两茶钟，煎成一钟），温清并用以调和它。其次分新久：新疟先截断后补益，久疟先补益后截断，这是大要。然而必须分清阳分和阴分：白天发作且病在阳分气虚的，四肢厥冷、出汗多，就用露姜饮（别直参三分、生姜二分，用阴阳水两钟，煎成一钟，露天放置一夜后服用），温补阳气以截断疟疾。病在阴分血虚的，夜间发热、神志烦乱，就用首乌鳖甲汤（生首乌、炙鳖甲各一钱、乌梅肉二分、冰糖八分，用雪水和滚水两钟，煎成一钟，去渣温服），清滋阴血以截断疟疾。
【荣斋按】胎疟这个病名，古代没有这种说法，这种说法始于万氏儿科。前明万密斋说：“凡是幼小及壮年人，初次患疟疾的，都称为胎疟，应当审查病因后治疗。因风寒引起的从风寒治，因暑湿引起的从暑湿治，因痰食引起的从痰食治。大旨先分辨寒热多少；寒多热少的，先用香苏葱豉汤发散表邪，继用平胃散加草果、常山，祛除疟疾。热多寒少的，先用柴胡白虎汤解除热邪，继用白虎汤加常山、草果，平定疟疾。”这是万氏治疗胎疟的方法，俞氏将其掌握并运用起来，成为有力的一个武器。
九 疫疟
【病因】大约有四类。一是由岚瘴蒸腾之毒引起。二是由阴水蕴积之毒引起。三是由尸疰客忤引起。四是由气候不正之时毒引起。都能变成疟疾。
【证候】瘴毒初起，即身体沉重、迷闷，口哑不能说话，随后谵语狂言，或者寒微热甚，或者寒甚热微，胸痞腹满，舌苔灰腻满布，或者白厚而腻。水毒初起，寒重热轻，胸膈满痛，揉按时漉漉有声，干呕短气，或者吐清水，甚至腹痛便泄，肢冷足肿，腰重尿少，舌苔白润，或者舌尖边俱黄，中间夹一段白色。客忤初起，寒热每天发作，间或有谵语，夜里多恶梦，时而躁扰，心悸胆怯，多生恐怖，舌苔淡白，间挟淡灰。时毒初起，风毒则头痛怕风，开始虽然寒热每天发作，随后热多寒少，咽痛喉肿，或者发腮，或者发红痧，或者发赤疹。舌苔白薄，边尖红燥。秽毒则头重腹痛，胸脘痞满，恶心欲呕，腹痛闷乱，寒热交作，不甚分明，舌苔黄白相间，或者夹灰腻。
【脉象】右寸脉伏，两关脉弦滑的，这是由于天气炎热，山气霉蒸，猝然中受岚瘴之毒。双脉弦而缓，甚至弦迟的，这是由于水气郁遏，阳气受困，内伤阴凝之毒。脉乍大乍小，乍数乍疏的，这是由于素性属阴，胆气不壮，猝被客忤，俗称夜发为鬼疟的是这种情况。两手脉浮弦而数的，这是手太阴与足少阳经同受风毒。两手脉弦细而缓的，这是手太阴与足太阴经同受秽毒。
【治疗】瘴毒先用《局方》妙香丸，宣窍导痰，以醒其神。继用藿香正气汤，调冲紫金片（文蛤四钱，毛茨菇二钱五分、辰砂、腰黄各二钱、红牙大戟、千金霜各一钱八分、苏合香一钱、冰片五分、当门子三分各研细末，再同研极匀，米糊印成小片，晒燥，瓷瓶密藏，每服三分至五分，极重一钱），避瘴解毒，以除其疟。终用柴平汤合除疟胜金丸，化湿泄热，以芟除其根。水毒先用苓术二陈煎，化气利水，以解阴毒。继用柴平汤加炒常山（二钱）、草果仁（八分），温中涤涎，以截其疟。终用香砂二陈汤，芳淡温化，以和胃气。客忤先用苏合香丸（苏合香、安息香、广木香各二两、犀角、麝香、梅冰、香附、乳香、沉香、丁香、冬术各一两，共研极匀，蜜丸，作二百丸，以辰砂一两为衣，蜡匮，此从王晋三新定），辛香开发以除邪。继用温胆汤加减（淡竹茹三钱、姜半夏二钱、炒广皮一钱半、辰茯神、青龙齿、左牡蛎各四钱、川桂枝、清炙甘草各五分、紫金片三分，烊冲），辛通镇摄以壮胆。若时毒由于厉风的，就用荆防败毒散加减（荆芥、防风、薄荷、连翘、牛蒡各三钱、柴胡、前胡各一钱半、羌活、独活各一钱、橘红、枳壳、桔梗各二钱、紫金片、生甘草各一钱，研粗末每服七钱，开水泡取清汤，随漱随咽，日二服，夜二服），辛散风毒以解表。痧尚未尽透的，急用透痧解毒汤（连翘、薄荷、炒牛蒡各二钱、蝉衣一钱、淡豆豉二钱、鲜葱白二枚切、大青叶、鲜桑叶、脑头各四钱，先用野菰根二两、鲜西河柳三钱，煎汤代水），窜经透络以提痧。痧透净，津气受伤的，就用人参白虎汤，加鲜生地（一两）、鲜石斛（四钱）、鲜茅根（八钱），大生津液以善后。由于臭秽的，先用藿香正气汤加紫金片，芳香避秽以解毒。毒解秽除，继用香砂二陈汤加炒谷麦芽，温和胃气以善后。
【秀按】俞君审因辨证，对症施治，可谓知无不言，言无不尽。治疟一道，大概没有遗漏了。至于截疟以常山草果最效，半贝丸（生半夏、生川贝各三钱，研细，姜汁捣匀为丸，每服三厘至五厘，生熟汤送下）也有效验。如果是三阴老疟，疟除根丸如神。截止后，仍须服药以调理之，以免复发增重。
【荣斋按】关于疫疟，俞何原作，都失去了重心；由于绍兴在那个年代里，没有发生过疫疟，两位先生又不肯无中生有，捏造治验，所以说理比较零乱些。现在我把一九三四年江苏省如皋县中医公会巡回诊疗队任务报告，摘录于下，以充实治例。因为如皋县及其附近地区，在这一年秋季，曾发生过大流行性的疫疟。根据报告上说：“照保甲调查，各区染疫者多至五、六万人，一甲内，最少有半数以上之住户，患此疫疟，每保中死亡者约计三十人，总共已达五千人以上。”报告者是实地参加巡回诊疗任务的黄星楼先生。他说：致疫原因入夏气候太凉，大暑中霪雨不止，华氏寒暑表最高不出九十度以上，虽盛夏朝暮犹着夹衣；等到立秋后，天气忽暖，寒暑表常达百度，夜静又恒降至八十度左右，寒暖不时，病根因兹潜伏；加上近月余来，天干少雨，气候异常亢燥，伏邪乘机暴发，宜乎斯症之猛且烈也。疫病症状始则憎寒战栗，继则壮热无汗，或热后微汗，间日轻重，热退不清，头痛脑胀，肢节酸麻，胸膈痞满，饮食减少，面色黄滞，舌苔白腻，间有吐泻；久延失治，则发斑疹，出白痦，或昏热头汗，或谵语发狂，或舌黑便难，或下血吐蛔，甚则面赤足冷，夜热神糊，气喘呃逆，烦躁抽搐等现象。病名考证前贤论疫，以喻嘉言、张石顽、吴又可、雷少逸诸家为最详，兹择要节录于后：喻氏谓四时不正之气，感之者因而致病，初不名疫也，因病致死，病气尸气，混和不正之气，斯为疫矣！又云温暑热湿之气，交结互蒸，人在其中，无隙可避，焉能幸免？张氏谓疫邪皆由湿热郁蒸而发，人触之者，皆从口鼻流入膜原，而至阳明之经，阳明居太阳之里，少阳之表，为三阳之中道，邪犯膜原，当从和解，兼以逐秽。吴氏谓疟二三发，或七八发后，忽然昼夜发热，烦渴不恶寒，舌苔生刺，心腹痞满，饮食不进，此疫疟也。雷氏谓疫疟之为病，因天时寒热不正，邪气乘虚而袭膜原，欲出表而不能透达，欲陷里而未得空隙，故作寒热往来，或一日二三次，或一次，无定期；寒轻热重，口渴有汗，右脉多胜于左，沿门合境，长幼相似，此疫疟也。证诸各家论说，验之当前症状，斯名疫疟。处方撮要疫邪初发，宜藿香正气散；兼湿热者，宜甘露消毒丹；神昏闷乱者，宜清芬辟疫汤；湿重郁闷者，宜开郁通络饮；兼湿温者，宜三仁汤；先寒后热者，宜小柴胡汤；寒热便秘者，宜大柴胡汤；热多寒少者，宜白虎加桂枝汤；瘟疫瘴疟，宜解毒万病丹；夹痰者宜常山饮，夹食者宜清脾饮。此数方，不过略举其例。他如兼温热者，仍须以温热门中诸法治之。
【廉勘】前哲皆谓疟不离乎少阳。故治疟皆遵仲景法。多用小柴胡汤加减。执死法以治活病。学识如张景岳徐灵台魏玉横诸公。尚犯此弊。何论其他。岂知叶天士先生早经申明。谓疟之为病。因暑挟痰食而发者居多。初起必胸膈不宽。呕吐不食。岂非食物停滞而为痰乎。即久疟不已而成疟母。亦多因顽痰与瘀血互结为患。大方疟证。须分十二经。与咳证相等。幼稚患疟。多因脾胃受病。乃幼科多以小柴胡去参。或加香薷，葛根之属。适犯张凤逵《治暑全书》曰。柴胡劫肝阴。葛根竭胃汁。致变屡矣。后贤学博如张千里。亦谓江浙人病多挟湿。轻投柴葛提剂。瞑眩可必。获效犹赊。叶氏忌用。实阅历之言。徐氏妄评。乃拘泥之说。刘河间所以有古法不可盲从之激论也。医学渊博如王孟英。亦谓疟疾本是感证。不过轻于伤寒耳。近世南方正伤寒少。温热暑湿之病多。疟亦正疟少。时疟多。温热暑湿。既不可以麻桂正伤寒法治之。时疟岂可以小柴胡正疟法治之哉。必当辨其为风温。为湿温。为暑热。为伏邪。仍以时感法清其源耳。执是三说以观之。柴胡治疟之流弊。信而有征。故予治疟。多遵叶法。凡夏秋之间。先辨暑与湿。暑疟多燥。其治在肺。桂枝白虎汤为主。湿疟多寒。其治在脾。藿香正气散加减。暑湿并重。治在脾胃。桂苓甘露饮加减。若兼痰多者。加半夏、川贝。食滞者。加枳实、青皮。屡投辄验。间有不验者。则用除疟胜金丸以截之。或用金鸡纳霜丸以劫之。亦多默收敏效。久疟则明辨气血阴阳。阳虚气馁者。四兽饮为主。阴虚血热者。青蒿鳖甲汤加桑叶、首乌、乌梅。疟母则用活血通络汤送鳖甲煎丸。外贴鳖苋膏。信任持久者。亦收成绩。其余诸疟。及伤寒转疟。悉遵氏成法。奏功亦速。
【荣斋按】关于疟疾用柴胡的标准，根据何廉臣先生看法，同意叶天士、张凤逵、张千里、王孟英诸家，认为：“正疟可用，暑湿疟不可用。”莫枚士在《研经言说》：“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，往往有耳聋目赤，谵语神昏，汗漏体枯，延成不治者。”他从实际问题里，肯定了柴胡的可用与不可用，是比较有根据。然而日人汤本求真，却另有一说，他认为：“仲景之书用柴胡皆有胸胁苦满证，今乃施诸胸胁苦满而寒热往来者，其应如响；不仅疟疾如是，其他病亦然。无胸胁苦满症者，用之则无效。”是则柴胡之能治疟疾，在胸胁苦满而不在寒热。陆渊雷先生流行病须知里，更作了详细的分析。他说：“用柴胡之证候，在古医书曰‘胸胁苦满’。此‘满’字须读作‘闷’，意即胸口自觉气闷也。然通常之胸闷，由于胃病，其闷之重心在当心口，此非柴胡所主，宜黄连黄芩之类；胸胁苦满之闷，重心乃在两旁肋骨之内，似胀似痛，又似窒塞，甚者，以指头沿肋骨圈下向上挖按，则坚硬而痛，若是者，为柴胡之的证。”
又按：廉臣先生此条勘语，系概括本节的九个疟型而言，不是单指疫疟。
All present pain. The tongue coating is white, thin, and slippery. If caused by summerheat-dampness, the body aches and limbs are flaccid, with more heat, vexation, and thirst; the tongue coating is intermixed yellow and white. If complicated by phlegm and food retention, there is coughing with sputum, belching with a putrid odor, acid regurgitation, and the tongue coating is white, greasy, and thick, or yellow, thick, and greasy. For infants in swaddling clothes, cold causes shivering, while heat causes weak breathing and coma, resembling convulsions and epilepsy. One must differentiate syndromes according to the season, and must not mistakenly diagnose it as convulsions or epilepsy, nor recklessly apply the picking method (a folk therapy).
[Pulse] A wiry-tight or wiry-slow pulse indicates malaria transformed from wind-cold. A wiry-hong (surging) or wiry-stagnant pulse indicates malaria transformed from summerheat-dampness. A wiry-slippery and forceful pulse indicates phlegm coagulation. A wiry-solid and forceful pulse indicates food accumulation.
[Treatment] For young adults suffering from malaria for the first time, treat based on the etiology; methods have been detailed above. For children, whose constitutions are more fragile and prone to both deficiency and excess, herb selection and formula preparation require particular flexibility. First, distinguish the degree of cold and heat: In cases where cold predominates over heat, first administer Congchi Hemijian (Scallion and Fermented Soybean Decoction with Lotus Leaf and Rice), adding Shengjiang (Zingiberis Rhizoma Recens, 1 fen) and Xi Yacha (Fine Bud Tea, 2 fen), to induce slight sweating and harmonize the condition. Subsequently, use Pingwei San (Calm the Stomach Powder: Zhi Cangzhu 2 fen, Chuan Pu 3 fen, Guang Pi 4 fen, Zhi Gancao 2 fen), added with Caoguo Ren (Tsaoko Fructus, 2 fen) and Chao Changshan (Processed Radix Dichroae, 2 fen), to arrest the malaria. Finally, use Bingtang Wumei Tang (Rock Sugar and Dark Plum Decoction: Bingtang 1 qian, Wumei Rou 1 fen, water one tea cup, decocted strongly to half a cup); the sweet and sour nature nourishes the stomach to conclude treatment. In cases where heat predominates over cold, first use Baihu Tang (White Tiger Decoction: Zhimu 1 qian, Sheng Shigao 1.5 qian, Sheng Gancao 3 fen, Sheng Jingmi 30 grains, wrapped in He Ye), added with Caoguo Ren (2 fen) and Chao Changshan (3 fen), using acrid-cool properties to resolve phlegm and arrest the malaria. Subsequently, use Wuzhi Yizhi Jian (Five Juices and One Branch Decoction), removing Zisu Pangzhi (Perilla Stem) and Shengjiang Zhi (Ginger Juice), adding Bingtang (1 qian), and serving warm after double-boiling; the light, clear, sweet, and moistening nature tonifies the condition. When cold and heat are balanced, use Banbei Jiangcha Yin (Pinellia and Fritillaria Ginger Tea Drink: Jiang Banxia, Chuan Bei, Shengjiang, Xi Yacha each 3 fen, two tea cups of Yin-Yang Water, decocted to one cup); warming and clearing are used together to harmonize. Next, distinguish between new and chronic: For new malaria, arrest first then tonify; for chronic malaria, tonify first then arrest; this is the general principle. However, one must distinguish between Yang and Yin aspects: For daytime onset with Qi deficiency in the Yang aspect, presenting with cold extremities and profuse sweating, use Lujian Yin (Dew-Exposed Ginger Drink: Biezhi Renshen 3 fen, Shengjiang 2 fen, two tea cups of Yin-Yang Water, decocted to one cup, exposed overnight before taking); warming and tonifying Yang Qi to arrest the malaria. For pathology in the Yin aspect with Blood deficiency, presenting with night fever and mental restlessness, use Shouwu Biejia Tang (Polygoni Multiflori and Turtle Shell Decoction: Sheng Shouwu, Zhi Biejia each 1 qian, Wumei Rou 2 fen, Bingtang 8 fen, snow water and boiling water two cups, decocted to one cup, strain and take warm); clearing and nourishing Yin Blood to arrest the malaria.
[Rongzhai's Note] The disease name "Tai Malaria" (Fetal Malaria) did not exist in ancient texts; this concept originated from Wan's Pediatrics. Wan Mizhai of the Ming Dynasty stated: "For young children and adults suffering from malaria for the first time, all are termed Tai Malaria and should be treated based on etiology. Those caused by wind-cold are treated as wind-cold; those by summerheat-dampness as summerheat-dampness; those by phlegm-food as phlegm-food. The main idea is to first distinguish the degree of cold and heat; for cold > heat, first use Xiangsu Congchi Tang to release the exterior, then Pingwei San with Caoguo and Changshan to remove the malaria. For heat > cold, first use Chaihu Baihu Tang to resolve heat, then Baihu Tang with Changshan and Caoguo to calm the malaria." This is Wan's method for treating Tai Malaria. Yu Ge applied and mastered this, making it a powerful weapon.
9. Epidemic Malaria
[Etiology] There are approximately four types. One is caused by the toxic vapor of mountain miasma (Lanzhang). Two is caused by toxin accumulated in Yin waters. Three is caused by corpse transmission and sudden fright (Shizhu and Kewu). Four is caused by pathogenic factors due to abnormal climate. All can transform into malaria.
[Symptoms] At the onset of miasma toxin, the body feels heavy and confused, the mouth is mute, and speech is impaired, followed by delirious speech and狂言 (mad talk), or mild cold with severe heat, or severe cold with mild heat, chest oppression and abdominal fullness, with the tongue coating gray and greasy covering the whole surface, or white, thick, and greasy. At the onset of water toxin, cold is heavy and heat is light, with fullness and pain in the chest and diaphragm, producing gurgling sounds upon palpation, dry retching, shortness of breath, or vomiting clear fluid; severely, abdominal pain and diarrhea, cold extremities and swollen feet, heavy waist and scanty urination occur, with a white, moist tongue coating, or yellow at the tip and edges with a white segment in the middle. At the onset of sudden fright, chills and fever occur daily, occasionally with delirium, frequent nightmares at night, occasional restlessness, palpitations, timidity, and excessive fear; the tongue coating is pale white, occasionally mixed with pale gray. At the onset of seasonal toxins, wind-toxin presents with headache and aversion to wind; initially chills and fever occur daily, later heat predominates over cold, with sore throat and swollen throat, or swollen cheeks, or red rashes, or red macules. The tongue coating is white and thin, with red and dry edges and tip. Filth-toxin presents with heavy head and abdominal pain, chest and epigastric oppression, nausea and desire to vomit, abdominal pain and confusion, alternating chills and heat indistinctly; the tongue coating is intermixed yellow and white, or mixed with gray and greasy.
[Pulse] A hidden pulse at Right Cun and wiry-slipper pulses at both Guan indicate sudden contraction of Lanzhang toxin due to hot weather and moldy mountain air. Bilateral wiry and slow, or even wiry-slow pulses indicate internal injury from Yin-coagulating toxin due to water qi stagnation trapping Yang qi. Pulses that fluctuate between large and small, rapid and sparse indicate inherent Yin constitution and unsteady Gallbladder qi, suddenly struck by Kewu, commonly known as Ghost Malaria occurring at night. Floating-wiry-rapid pulses in both hands indicate simultaneous contraction of Wind-Toxin by Hand-Taiyin and Foot-Shaoyang meridians. Wiry-thin-slow pulses in both hands indicate simultaneous contraction of Filth-Toxin by Hand-Taiyin and Foot-Taiyin meridians.
[Treatment] For Miasma Toxin, first use Miaoxiang Wan from Ju Fang (Regulated Formulas) to open orifices and guide out phlegm to awaken the spirit. Subsequently use Huoxiang Zhengqi Tang (Agastache Decoction to Rectify the Qi) adjusted with Zhongchun Zijian (Purple Gold Tablets: Wen Ge 4 qian, Mao Cigu 2.5 qian, Chen Sha and Yao Huang each 2 qian, Hongya Daji and Qianjin Shuang each 1.8 qian, Suhexiang 1 qian, Bingpian 5 fen, Dangmenzi 3 fen, all ground fine, mixed evenly, formed into small tablets with rice paste, dried, stored in porcelain bottles; dose 3-5 fen, up to 1 qian for severe cases) to avoid miasma and resolve toxin to eliminate malaria. Finally use Chaiping Tang combined with Chumie Shengjin Wan to transform dampness and drain heat to eradicate the root. For Water Toxin, first use Lingzhu Erchen Jian to transform qi and promote urination to resolve Yin toxin. Subsequently use Chaiping Tang with Chao Changshan (2 qian) and Caoguo Ren (8 fen) to warm the middle and wash away saliva to arrest malaria. Finally use Xiangsha Erchen Tang to use aromatic and bland warmth to harmonize Stomach qi. For Sudden Fright, first use Suhexiang Wan (Suhexiang, Anshixiang, Guang Muxiang each 2 liang, Xijiao, Shexiang, Meibing, Xiangfu, Ruxiang, Chenxiang, Dingxiang, Dongzhu each 1 liang, ground fine, honey pills, 200 pills total, coated with 1 liang Chen Sha, sealed with wax, revised by Wang Jin-san) to use acrid-aromatic properties to develop and expel evil. Subsequently use Wendan Tang modified (Dan Zhuru 3 qian, Jiang Banxia 2 qian, Chao Guangpi 1.5 qian, Chen Fushen, Qinglongchi, Zuomuli each 4 qian, Chuan Guizhi, Qingzhigancao each 5 fen, Zijian 3 fen, melted and poured in) to use acrid-unblocking and calming-affecting properties to strengthen the Gallbladder. If seasonal toxin is due to fierce wind, use Jingfang Baidu San modified (Jingjie, Fangfeng, Bohe, Lianqiao, Niubang each 3 qian, Chaihu, Qianhu each 1.5 qian, Qianghuo, Duhuo each 1 qian, Juhong, Zhike, Jiegeng each 2 qian, Zijian, Sheng Gancao each 1 qian, ground coarse, dose 7 qian, steep in boiling water for clear soup, gargle and swallow, twice day, twice night) to disperse wind-toxin and release the exterior. If rash has not fully emerged, urgently use Tousha Jiedu Tang (Lianqiao, Bohe, Chao Niubang each 2 qian, Chan Yi 1 qian, Danshichu 2 qian, Xian Congbai 2 pieces cut, Daqingye, Xian Sangye, Naotou each 4 qian, first decoct Yegugen 2 liang and Xian Xi Heliu 3 qian in water as substitute) to penetrate channels and collaterals to lift the rash. Once rash is fully emerged and fluids/Qi are injured, use Renshen Baihu Tang with Xian Shengdi (1 liang), Xian Shihu (4 qian), Xian Maogen (8 qian) to greatly generate fluids and conclude treatment. Due to foul odors, first use Huoxiang Zhengqi Tang plus Zijian to use aromatic properties to avoid filth and resolve toxin. After toxin resolves and filth is removed, use Xiangsha Erchen Tang with Chao Guma Ya to mildly warm and harmonize Stomach qi.
[Xiu's Note] Master Yu differentiates etiology and syndrome, treats symptoms accordingly; he speaks without reservation. His approach to treating malaria seems comprehensive. Regarding arresting malaria, Caoguo and Changshan are most effective; Banbei Wan (Sheng Banxia, Sheng Chuanbei each 3 qian, ground fine, mixed with Ginger Juice into pills, dose 3-5 li, taken with raw/cooked water soup) is also verified. For old malaria of the Three Yin, Chumie Gen Wan is miraculous. After arresting, medication must still be taken for regulation to prevent recurrence and worsening.
[Rongzhai's Note] Regarding epidemic malaria, the original works by Yu and He lost focus; since no epidemic malaria occurred in Shaoxing during that era, and the two masters would not fabricate clinical cases, their theoretical discussion is somewhat fragmented. I now excerpt the Task Report of the Traditional Chinese Medicine Association Touring Diagnosis Team in Rugao County, Jiangsu Province, 1934, to enrich the treatment examples. Because a pandemic epidemic malaria occurred in Rugao County and its vicinity in the autumn of that year. According to the report: "According to Baojia investigation, infected people in various districts reached 50,000-60,000; in one Jia (neighborhood unit), at least half of households suffered from this epidemic malaria; about 30 deaths per Bao, totaling over 5,000." The reporter was Mr. Huang Xinglou, who participated in the touring diagnosis. He stated: Cause of Epidemic: Summer climate was too cool, continuous rain during Major Heat, Fahrenheit thermometer never exceeded 90 degrees; even in midsummer, layers were worn morning and evening; after Start of Autumn, weather suddenly warmed, thermometer often reached 100 degrees, dropping to around 80 degrees at night; irregular cold and warmth allowed pathogenic roots to lie latent; coupled with recent month-long drought and abnormally dry/arid climate, latent pathogens erupted opportunistically, hence the severity of this syndrome. Symptoms of Epidemic Disease: Initially aversion to cold and shivering, then high fever without sweat, or slight sweat after fever, alternating severity every other day, unclear resolution of heat, headache and brain distension, soreness and numbness of limbs and joints, chest/diaphragm oppression, reduced appetite, sallow and dull complexion, white greasy tongue coating, occasional vomiting/diarrhea; if prolonged and untreated, macules/rashes appear, white papules erupt, or coma/fever/head sweat, or delirium/madness, or black tongue/hard stool, or bloody stool/vomiting roundworms, severely red face/cold feet, night fever/confusion, asthma/belching, irritability, and convulsions. Verification of Disease Name: Ancient experts discussing epidemics, such as Yu Jiayan, Zhang Shiwang, Wu Youke, and Lei Shaoyi, are most detailed. Selected excerpts follow: Yu stated that abnormal Qi of four seasons causes disease, initially not called epidemic; only when death occurs does disease Qi and corpse Qi mix with abnormal Qi, becoming epidemic! Also, Warm/Summer/Heat/Damp Qi intertwine and steam; humans within cannot avoid it. Zhang stated epidemic pathogens arise from Damp-Heat stagnation, entering via mouth/nose to Membrane Source, reaching Yangming Meridian; Yangming is interior to Taiyang, exterior to Shaoyang, the middle path of Three Yang; pathogen attacking Membrane Source requires harmonizing and purging filth. Wu stated after 2-3 or 7-8 attacks of malaria, sudden day/night fever, vexation/thirst without aversion to cold, prickly tongue coating, heart/abdominal oppression, inability to eat, is Epidemic Malaria. Lei stated Epidemic Malaria arises from abnormal seasonal cold/heat, pathogen invading Membrane Source via deficiency, wanting to exit exterior but unable to penetrate, wanting to sink interior but lacking space, causing alternating chills/heat, 2-3 times daily or once, irregular; mild cold/heavy heat, thirst with sweat, Right pulse stronger than Left, affecting entire neighborhood, young and old similar, is Epidemic Malaria. Verifying these theories against current symptoms confirms the name Epidemic Malaria. Prescription Summary: Early stage epidemic pathogen, use Huoxiang Zhengqi San; with Damp-Heat, use Ganlu Xiaodu Dan; with coma/confusion, use Qingfen Biyi Tang; with heavy damp/depression, use Kaiyu Tongluo Yin; with Damp-Warmth, use Sanren Tang; initial cold then heat, use Xiao Chaihu Tang; cold/heat with constipation, use Da Chaihu Tang; heat > cold, use Baihu Jia Guizhi Tang; plague/miasma malaria, use Jiedu Wanbing Dan; with phlegm, use Changshan Yin; with food, use Qingpi Yin. These formulas are merely examples. Others with Warm-Thermal elements still require Warm-Thermal category treatments.
[Liankan's Commentary] Ancients stated malaria is inseparable from Shaoyang. Thus, treating malaria follows Zhongjing's methods, mostly modifying Xiao Chaihu Tang. Adhering to rigid methods for dynamic diseases is a flaw even learned scholars like Zhang Jingyue, Xu Lingtai, and Wei Yuheng committed. Did they not know Master Ye Tianshi clarified early on? He stated malaria is mostly caused by Summerheat complicated by Phlegm-Food. Initial stage must have chest/diaphragm tightness, vomiting, anorexia; is this not food stagnation transforming into phlegm? Even chronic malaria forming Malaria Mother is mostly due to stubborn phlegm and blood stasis interacting. Large-scale malaria syndromes must be differentiated by Twelve Meridians, equal to cough syndromes. Children suffering from malaria mostly have Spleen/Stomach pathology. Pediatricians often use Xiao Chaihu Tang removing Renshen, or adding Xiangru, Gegen. This violates Zhang Fengkui's *Zhi Shu Quan Shu*: "Chaihu depletes Liver Yin; Gegen exhausts Stomach fluids," leading to frequent complications. Later learned scholars like Zhang Qianli also stated Jiang-Zhe people's diseases often carry Dampness; lightly using Chai/Gegen lifting agents guarantees adverse reactions (Mingxuan), yet efficacy remains distant. Ye's prohibition on use is truly experiential advice; Xu's criticism is rigid dogma. This explains Liu Hejian's passionate argument that ancient methods cannot be blindly followed. Medical scholars as profound as Wang Mengying also stated malaria is essentially a contracted syndrome, merely lighter than Shanghan. In recent times, Southern regions have few true Shanghan, mostly Warm-Thermal/Summerheat-Dampness diseases. True malaria is rare; seasonal malaria is common. Since Warm-Thermal/Summerheat-Dampness cannot be treated with Mahuang/Guizhi Shanghan methods, how can seasonal malaria be treated with Xiao Chaihu True Malaria methods? One must differentiate whether it is Wind-Warmth, Damp-Warmth, Summerheat-Heat, or Latent Pathogen, and still use Seasonal Contraction methods to clear the source. Based on these three views, the弊端 (drawbacks) of using Chaihu for malaria are indeed evidenced. Therefore, my treatment of malaria mostly follows Ye's methods. Between Summer and Autumn, first distinguish Summerheat and Dampness. Summerheat malaria is mostly dry; treatment focuses on Lung, using Guizhi Baihu Tang as main formula. Damp malaria is mostly cold; treatment focuses on Spleen, using Huoxiang Zhengqi San modified. Equal Summerheat and Dampness; treatment focuses on Spleen/Stomach, using Guiling Ganlu Yin modified. If accompanied by much phlegm, add Banxia, Chuanbei. If food stagnation, add Zhishi, Qingpi. Repeated administration yields verification. Occasionally ineffective cases use Chumie Shengjin Wan to arrest, or Cinchona Bark Pills to forcefully stop; often achieving sensitive effects. For chronic malaria, clearly differentiate Qi/Blood/Yin/Yang. For Yang deficiency/Qi collapse, Si Shou Yin is main. For Yin deficiency/Blood heat, Qinghao Biejia Tang plus Sangye, Shouwu, Wumei. For Malaria Mother, use Huoxue Tongluo Tang delivering Biejia Jian Wan, externally applying Bixian Gao. Trusting persistence yields results. Other malaria types and Shanghan transforming into malaria all follow Chengfa, achieving rapid success.
[Rongzhai's Note] Regarding the standard for using Chaihu in malaria, based on Mr. He Lianchen's view, agreeing with Ye Tianshi, Zhang Fengkui, Zhang Qianli, Wang Mengying, etc., believing: "True Malaria can use it, Summerheat-Dampness Malaria cannot use it." Mo Meishi in *Yanjing Yan Shuo* stated: "Shanghan pathogen enters from exterior, interior has no root; lifting with Chaihu brings it out. Summer/Autumn diseases have new cool outside and accumulated summerheat inside, interior has root; if lifted with Chaihu, although exterior pathogen resolves, interior heat rises, often resulting in deafness/red eyes, delirium/coma, leaking sweat/emaciation, progressing to untreatable conditions." He affirmed the usability and non-usability of Chaihu from practical issues, which is relatively well-founded. However, Japanese physician Katsusuke Yimoto offered another view: "Zhongjing's books use Chaihu only for Chest/Hypochondriac Fullness syndrome. Now applying it to those with Chest/Hypochondriac Fullness and alternating chills/heat, the response is immediate; not just malaria, other diseases too. Without Chest/Hypochondriac Fullness syndrome, using it is ineffective." Thus, Chaihu's ability to treat malaria lies in Chest/Hypochondriac Fullness, not alternating chills/heat. Mr. Yuanlei Lu provided detailed analysis in *Epidemic Disease Essentials*: "The syndrome for using Chaihu in ancient medical books is 'Chest/Hypochondriac Ku Man' (Bitter Fullness). This 'Man' character must be read as 'Men' (Oppression/Stuffiness), meaning subjective chest stuffiness. However, typical chest stuffiness due to Stomach disease centers at the epigastrium; this is not Chaihu's domain, suitable for Huanglian/Huangqin etc.; the 'Ku Man' oppression of Chest/Hypochondriac centers inside the lateral ribs, feeling like bloating/pain, or blockage; severely, pressing along the rib circle upward with fingertips reveals hardness and pain; such cases are the specific indication for Chaihu."
Note: Mr. Lianchen's commentary here summarizes the nine malaria types in this section, not solely referring to Epidemic Malaria.