Malaria with High Fever, Delirium, and Sweating Like Rain? A Watermelon Saved His Life
What the patient was searching for: malaria / ague / high fever / talking nonsense / sweating like rain / red eyes / summer heatstroke Medical terms: malaria (plasmodium infection) · summer-heat accumulation · high fever with delirium
Opening: this famous doctor once said he had never met an incurable case
Today’s case comes from Doctor Wang Mengying (王孟英), one of the greatest physicians of the Qing dynasty. His medical skill was of the highest order, and he left behind an enormous number of case records — read them carefully, and you will see layer upon layer of clinical wisdom.
💬 Note from Doctor Luo: Wang Mengying, whose personal name was Shixiong, came from Haining, Zhejiang. He was the great synthesizer of the Warm Disease school and the author of Wen Re Jing Wei (《温热经纬》, The Classics and Their Extensions on Warm-Heat Diseases), Wang’s Case Records (《王氏医案》), and Sui Xi Ju Yin Shi Pu (《随息居饮食谱》, Food Regimens of Suixi Studio). He once made a famously proud remark: “In my whole life, I have never met a disease I could not treat.” Why could he say such a thing? Because his way of treating illness was different from everyone else’s — and this very case is the best example.
Who was the patient? A live-in tutor connected to the Jin family
The patient was a man named Zhuang Xiaochun (庄晓春), from the Jiangnan region. He was the house tutor (xi xi xian sheng) of the Jin family of Jinyuan Gushe — yes, the very family from the previous case, the one with the sick child. He lived in their home as a teacher and sometimes acted as a family aide. The record takes special care to mention that he was related to the Jins by marriage.
💬 Note from Doctor Luo: Why do the case records describe the relationships in such detail? Because all these people lived in the Jiangnan region and knew one another; many were people of standing. The more specific the record, the more trustworthy the case. For the ancient physicians, authenticity came first.
What was the illness? Malaria — a disease that still ravages the world today
Zhuang Xiaochun had malaria. As everyone knows, malaria is caused by plasmodium parasites. It still rages across the world today — especially in Africa, where it kills a huge number of people every year — and in the past it killed far more. In China, thanks to successful prevention and treatment programs, malaria has essentially been brought under control. In the old days, malaria was an everyday infectious disease, as common as a cold.
💬 Note from Doctor Luo: Traditional Chinese medicine has always had two strategies for attacking external pathogens. The first is to kill the pathogen outright: the Chinese Academy of Chinese Medical Sciences researcher Tu Youyou extracted artemisinin from qing hao (sweet wormwood, 青蒿), which kills the malaria parasite directly, and won a Nobel Prize for it — that idea actually exists in ancient formulas too. The second strategy is to adjust the body’s state: don’t attack the parasite at all; instead, look at which way the body has tipped — if you are hot, I clear the heat; if you are cold, I warm you up — set the state right, and the body clears the invader by itself. Doctor Wang Mengying’s specialty was precisely this second approach.
First visit: summer-heat is the extreme of heat — just clear it out
When Zhuang Xiaochun fell ill, the weather was extremely hot. Doctor Wang Mengying judged it to be summer-heat (shu re) — the summer-heat had been absorbed into the body, leaving it in a high-heat state. In Chinese medicine, summer-heat is “the extreme of heat” (shu wei re zhi jian): more intense than ordinary heat — when the temperature hits 40°C (104°F), that is definitely summer-heat. What to do? Clear and flush it out — that’s all that was needed. So Doctor Wang prescribed a light, clear formula to drain the heat. It was not a heavy prescription.
Setback: a few days later, the malaria turned fiercer
But a few days later, the malaria attacked more violently than ever: red eyes and raving (mu chi kuang yan) — his eyes were bloodshot and he started talking nonsense, becoming agitated; sweating like rain (han ru yu xia) — sweat poured off him as if it were raining. The whole family was terrified. The red eyes meant there was still heat; the raving meant the heart channel had been invaded; the torrential sweating meant the heat inside was boiling upward, forcing the body’s fluids out through the skin.
💬 Note from Doctor Luo: At this point people began to mutter: did Doctor Wang’s cooling medicine make things worse? When you catch an external pathogen, shouldn’t you disperse it? Have some ginger soup, take something that pushes the pathogen outward — that’s what most people assume. It is exactly what the family assumed here.
The detective moment: like Sherlock Holmes, Doctor Wang smelled the ginger and dates
When Doctor Wang Mengying came back, he took the pulse: it was hong da wu lun — bounding and forceful, but utterly without rhythm. He looked at the tongue: the coating was deep yellow, thick, and dry — there was heat, and no ordinary heat. Doctor Wang was puzzled: his cooling formula should have brought the heat down. Why was it burning hotter than ever? He asked: “Have you taken any other medicine?” “No,” they said, “only yours.”
But the moment he stepped through the door, Doctor Wang had caught a strong smell of ginger and dates (jiang zao qi) — a pot of ginger-date soup was simmering on the stove! He asked, and sure enough: the family believed an external pathogen must be dispersed, so they had been feeding him ginger-date soup for three days.
💬 Note from Doctor Luo: Doctor Wang said: “That was a mistake!” The patient already had heat inside. Drinking a warming ginger-date soup in that state was like pouring oil on a fire — that is why he became agitated, talked nonsense, and sweat poured out. Don’t misunderstand: ginger-date soup is not bad in itself. Xiao Chai Hu Tang (小柴胡汤, Minor Bupleurum Decoction) contains ginger and dates; they harmonize the stomach and spleen and help the medicine disperse, and ginger can induce sweating — but that is for people who need to disperse cold. When you have heat inside, drinking it turns everything upside down. I read this case when I was a child learning Chinese medicine, and it made a deep impression: the line between cold and heat is this fine. Use the wrong remedy and the consequences can be severe.
The turning point: bring a big watermelon — split it open and let him eat!
Doctor Wang Mengying said: “Here is the answer — bring a big watermelon, cut it open, and let the patient eat as much as he wants (ren huan zhe shi zhi).”
💬 Note from Doctor Luo: This is food therapy aimed exactly at the condition: the ginger-date soup had made the body even hotter, draining the fluids, while the summer-heat was not resolved one bit. Watermelon is sweet and cold (gan han) — it resolves summer-heat and restores body fluids. Doctor Wang called watermelon the “Heaven-Born White Tiger Decoction” (tian sheng bai hu tang): the White Tiger Decoction that heaven arranged for us! In summer, watermelons are sold on every street corner, and many people ask whether they should eat fruit or not — today’s case gives us the perfect chance to talk it through properly.
The science of watermelon: the Heaven-Born White Tiger Decoction — who should eat it, and who must not
Doctor Wang Mengying on watermelon: it is sweet and cold, and its actions are to clear the lungs and stomach, resolve summer-heat, stop vexation and thirst, and cool the ying (nutritive) level — clearing heat from the lung and stomach channels; once the fire is gone there is no vexation, once the fluids are restored there is no thirst; “cooling the ying” means cooling the blood. It also treats sore throat and mouth ulcers (throat and oral conditions born of heat) and fire-toxin dampness conditions (poison-fire diseases caught from abnormal weather). Even cholera, vomiting, and dysentery, as long as they come from summer-heat, can be treated with watermelon juice.
But there are people who absolutely must not eat it: those with yang deficiency (yang xu) — already deficient in yang, eating too much cold food only makes the dampness worse. Also people with loose stools, and people recovering from illness or after childbirth — anyone with yang deficiency should eat watermelon with great caution.
💬 Note from Doctor Luo: Doctor Wang also taught two more uses of watermelon. The white flesh — the pale layer just inside the rind — scraped off and dried, can be eaten as a pickle or side dish, and it helps with red eyes, heat flaring up, canker sores, and mouth ulcers. The green skin scraped off with a porcelain shard is xi gua cui yi (西瓜翠衣, watermelon rind), used in medicine to cool the fluids and ward off summer-heat — even better at dispelling summer heat. A watermelon is medicine from the outside in.
The result: White Tiger Decoction with raw gypsum, 1 liang 6 qian — the illness cleared at once
Doctor Wang then prescribed the White Tiger Decoction (Bai Hu Tang, 白虎汤), using raw gypsum (sheng shi gao), 1 liang 6 qian (about 48 grams). And the result? The illness resolved at once (bing ji huo ran). This Mr. Zhuang went on to live in good health and died sixteen years later of an unrelated illness — this case had nothing to do with it.
💬 Note from Doctor Luo: Later, a certain Mr. Chen Yangshan (陈养山) caught malaria, and Doctor Wang treated him with the same method — but the illness did not ease. Doctor Wang suspected: “Has he also been drinking ginger-date soup?” He asked, and sure enough — he had! It was the local custom: whenever anyone caught an external pathogen, they drank ginger-date soup, just as people today brew ginger or scallion-ginger soup for a cold. Doctor Wang said: “Stop it at once.” Once the ginger-date soup was stopped and the same treatment continued, the illness cleared. Several more patients were cured this way afterwards — all with variations of the White Tiger Decoction. There were too many cases to write up one by one, and Doctor Wang hoped the reader would draw inferences from this one example.
Extended topic: so can you eat fruit, or not? Chinese medicine “takes the middle”
After the case, Doctor Luo Dalun turns to the question everyone loves to ask: can you eat fruit? Does Chinese medicine allow fruit and milk?
💬 Note from Doctor Luo: My answer is: it depends on your constitution. Strictly speaking, every food has a one-sided nature (pian xing) — most foods lean in some direction. When the body leans too far, you can use food to correct the lean; that is exactly how Chinese herbs work. Ask “Is the White Tiger Decoction good or bad?” — there is no answer. Used when there is heat, paired with some raw gypsum, it is a treasure; used when there is cold, it is poison. Watermelon is the same: a yang-deficient person who starts the morning with a whole watermelon is asking for trouble. But for someone overcome by summer heat, restless and on the verge of collapse, watermelon is a life-saver.
Why is Chinese medicine called zhong yi — the “middle” medicine? Because it balances yin and yang, balances cold and heat, and brings people to the middle — back to the calm, centered state of the ping ren, the balanced person. All foods and medicines are one-sided; they exist to help us adjust.
For a healthy, balanced person (ping ren), there is no need to agonize: you eat all kinds of things day in and day out, and across a broad spectrum, the balance happens naturally — eat watermelon today, hotpot tomorrow, and looking at the week as a whole, your diet is level. Humans are omnivores; we don’t tip into illness that easily. Unless you eat only one thing every day — if you just love watermelon and eat it morning and night, that is a different story.
💬 Note from Doctor Luo: But people whose bodies lean to one side really need to understand this principle. If you are usually yang deficient — afraid of cold, cold hands and feet, diarrhea the moment a cold wind blows — then choose warming foods; stop eating indiscriminately, because one watermelon might send you straight to the bathroom. If you are yin deficient with fire — hot and dry, flaming up every day, a dry throat — then choose cooling foods. Take the classic yin-deficient person: red tongue with no coating, thin build, sallow complexion, poor sleep at night, hot palms and soles, restless. Do not feed that person beef or mutton, which are warming. What about milk? It depends on the person: for someone with dried-up fluids (jin ku ye fa), throat so dry they can hardly swallow, milk is actually life-saving nectar — a little milk, sugarcane juice, or pear juice to moisten and bring the empty fire down is a good thing. Cold conditions are warmed, hot conditions are cooled (han zhe wen zhi, re zhe liang zhi): people with heat should eat duck, pork (without heavy seasoning), tremella, Chinese yam, and other cooling foods — not beef or mutton.
Then why are some Chinese medicine doctors so strict that they forbid everything? It may come down to the patients they see. Right now yang deficiency has become the dominant constitution; a doctor who treats yang-deficient people all day naturally stresses warming foods, and that majority benefits. But there genuinely remains a group of yin-deficient-with-fire people for whom eating cooling, refreshing foods is no problem at all. As in Doctor Wang’s case: match the food therapy to the condition, and the problem is solved. Can you eat fruit? Yes — with targeting. When the body leans too far, choose your food deliberately. That is the logic of Chinese medicine.
Compiled from Doctor Luo Dalun’s explanation of Doctor Wang Mengying’s case records; the original case is from Wang’s Case Records (《王氏医案》).