【纲】仲景曰。太阳病。得之八九日。如疟状。发热恶寒。热多寒少。其人不呕。圊便欲自可。
一日二三度发。脉微缓者。为欲愈也。桂枝麻黄合半汤。
【目】杨士瀛曰。疟状作止有时。非若寒热往来或疏或数。而作止无定时也。凡感冒之人。忽
觉毛寒股栗。筋节拘挛。百骸鼓撼。呕不欲食。其寒不可御。未几即转而发热者。此即温疟。不必
谓如疟。脉自弦。或洪数。或紧实。或虚缓。或刮涩。皆为疟状。但以外症别之。用药固有本条小
柴胡汤。如加减法。亦是活法。然血虚能生寒热。败血亦作寒热。阴阳相胜。一症虽各有一方。皆
当以川芎为佐。
柯琴曰。寒热如疟。是虚实互有之症。太阳以阳为主。热多寒少。是主胜客负。有将解之兆
矣。不呕。胃无邪。圊便。胃不实。脉微缓。有胃气。应不转属阳明。一日二三度发。是邪无可容
之地。正胜邪却。可勿药也。
【纲】仲景曰。服桂枝汤。大汗出。脉洪大者。与桂枝汤如前法。若形如疟。日再发者。汗出
必解。宜桂枝二麻黄一汤。
【目】魏荔彤曰。与桂枝汤如前法者。仍是太阳风伤卫所用之桂枝汤。如前法者。仍是服桂枝
汤。啜热粥。勿令大汗出如水流漓之法。何必另求深文耶。盖初为风多寒少之症。而脉见微弱。故
用桂枝二越婢一汤。今寒去风留。而脉见洪大。类于浮缓之象。故独用桂枝汤。桂枝升阳固卫而解
肌。既无碍于脉之浮大。且能护救阳之虚浮。岂非恰合之剂。仍自始终不悖哉。然病机不一。或者
其人服桂枝二越婢一汤。而大汗不出。但形如疟。日再发者。此即上条如疟状之谓也。方喻俱言少
有之寒邪。持多有之风邪。欲出不能出者是也。又变一法。用桂枝二麻黄一汤。倍桂枝以治风多。
少麻黄以治寒少。又一方两治。而不失轻重之分者也。
陶华曰。妇人热入血室。其血必结。亦如疟状。小柴胡汤。
【纲】仲景曰。病患烦热。汗出则解。又如疟状。日晡所发热者。属阳明也。脉实者。宜下之。
脉虚浮者。宜发汗。下之宜大承气汤。发汗宜桂枝汤。
【目】王肯堂曰。虽得阳明症。未可便为里实。审看脉候。以别内外。其脉实者。热已入腑。
故可下。其脉浮虚者。是热未入腑。犹在于表也。可发汗。
柯琴曰。烦热自汗。似桂枝症。寒热如疟。似柴胡症。然日晡潮热。则属阳明。而脉已沉实。
确为可下。是承气主症主脉也。
【纲】仲景曰。妇人中风。七八日。续得寒热。发作有时。经水适断者。此为热入血室。其血
必结。故使如疟状。发作有时。小柴胡汤主之。
【目】庞安常曰。经水适断于寒热时。是不当止而止也。必其月事下而血室虚。热邪乘虚而入。
其余血之未下者。干结于内。故适断耳。用小柴胡和之。使结血散。则其寒热自除而愈矣。
鳌按。上条。本阳明症。此条。又少阳症。下条。又厥阴症。以其如疟。故类书于此。若少阳
乘阴。热多寒少而尺脉迟者。亦往往作如疟状。先以黄 建中汤养其营卫。待脉不迟。却以小柴胡
和之。凡少阳症中。往来寒热。休作有时者。多半是如疟之状。仲景虽未言。学人以意会之可耳。
【纲】仲景曰。厥阴病。脉浮缓。囊不缩。必发热恶寒。似疟。为欲愈。桂枝麻黄合半汤。
【目】楼全善曰。病虽厥阴。而脉见浮缓。则邪有欲出之势。故寒热交作如疟而愈也。
[General Principle] Zhang Zhongjing said: In Taiyang disease, after eight or nine days of onset, the symptoms resemble malaria, with fever and aversion to cold, where heat predominates over cold. The patient does not vomit, and defecation/urination is relatively normal. If the condition occurs two or three times a day and the pulse is slightly slow (Wei Huan), it indicates impending recovery. Use Guizhi Mahuang Gehan Tang (Half-Dose Combination of Cinnamon Twig and Ephedra Decoction).
[Commentary] Yang Shiyin said: Malaria symptoms have fixed times for onset and cessation, unlike alternating chills and fever which may occur irregularly without fixed timing. For those suffering from common cold, suddenly feeling cold hair and trembling thighs, stiffness in joints, whole-body shaking, nausea without appetite, unbearable coldness, followed shortly by fever, this is Warm Malaria (Wen Nue). It need not be strictly defined as resembling malaria. The pulse may naturally be wiry (Xian), or surging-rapid (Hong Shu), tight-solid (Jin Shi), deficient-slow (Xu Huan), or scraping-rough (Gua Se); all are considered malaria-like symptoms. Differentiate them by external signs. The treatment originally involves Xiaochaihu Tang (Minor Bupleurum Decoction) according to specific guidelines; modifications also represent flexible methods. However, blood deficiency can generate chills and fever, and stagnant blood can also cause chills and fever. When Yin and Yang contend, although each symptom has its specific formula, Chuanxiong Rhizoma (Chuanxiong) should always be used as an assistant herb.
Ke Qin said: Chills and fever resembling malaria indicate a condition involving both deficiency and excess. Taiyang disease is dominated by Yang; when heat exceeds cold, it means the host Qi prevails while pathogenic factors recede, signaling impending resolution. No vomiting indicates no pathogen in the Stomach; normal bowel movements indicate no dryness-excess in the Stomach; a slightly slow pulse indicates the presence of Stomach Qi. It should not transform into Yangming disease. Occurring two or three times a day implies there is no place for the pathogen to reside; righteous Qi defeats the pathogen, so medication may be withheld.
[General Principle] Zhang Zhongjing said: After taking Guizhi Tang, if profuse sweating occurs and the pulse becomes surging (Hong Da), administer Guizhi Tang again using the previous method. If the body resembles malaria, occurring twice a day, relief will come through sweating; Guizhi Er Mahuang Yi Tang (Cinnamon Twig Twice, Ephedra Once Decoction) is appropriate.
[Commentary] Wei Litong said: "Administer Guizhi Tang using the previous method" refers to continuing the use of Guizhi Tang for Taiyang wind-striking the Defensive layer. "Using the previous method" means drinking hot porridge after taking Guizhi Tang, avoiding profuse sweating like flowing water. Why seek overly profound interpretations? Initially, it was a condition with more wind than cold and a weak pulse, so Guizhi Er Yubi Yi Tang (Cinnamon Twig Twice, Ma Xing Shi Gan Tang Variant Once) was used. Now that cold has gone and wind remains, with a surging pulse resembling floating-slow, only Guizhi Tang is used alone. Cinnamon Twig ascends Yang, secures the Defensive layer, and releases the muscle layer. It does not hinder the floating-large pulse and protects against the floating deficiency of Yang. Is this not precisely suitable? It remains consistent throughout. However, pathological mechanisms vary. Perhaps the patient took Guizhi Er Yubi Yi Tang but did not sweat profusely, merely presenting with malaria-like symptoms occurring twice a day; this corresponds to the "resembling malaria" mentioned in the previous clause. Fang and Yu both state this is due to slight cold pathogens holding back abundant wind pathogens, wanting to exit but unable to do so. Another method varies: using Guizhi Er Mahuang Yi Tang, doubling Cinnamon Twig to treat abundant wind, reducing Ephedra to treat slight cold. This is another dual-treatment approach that maintains proper balance.
Tao Hua said: In women, when Heat enters the Blood Chamber (Xue Shi), the blood must coagulate, also resembling malaria. Use Xiaochaihu Tang.
[General Principle] Zhang Zhongjing said: Patients with vexatious heat who find relief after sweating, yet present with malaria-like symptoms and tidal fever at Dibu (late afternoon, 3-5 PM), belong to Yangming disease. If the pulse is solid (Shi), purgation is indicated. If the pulse is deficient-floating (Xu Fu), diaphoresis is indicated. For purgation, Dachengqi Tang (Major Order the Qi Decoction) is suitable; for diaphoresis, Guizhi Tang is suitable.
[Commentary] Wang Kentang said: Although Yangming symptoms are present, one cannot immediately assume interior excess. Carefully examine the pulse to distinguish interior from exterior. A solid pulse indicates heat has entered the Fu organs, so purgation is applicable. A floating-deficient pulse indicates heat has not entered the Fu organs but remains in the Exterior, so diaphoresis is applicable.
Ke Qin said: Vexatious heat with spontaneous sweating resembles Guizhi syndrome; chills and fever resembling malaria resembles Chaihu syndrome. However, tidal fever at Dibu belongs to Yangming, and with a deep-solid pulse, it is indeed suitable for purgation. These are the main symptoms and pulses for Chengqi formulas.
[General Principle] Zhang Zhongjing said: In women with Wind-stroke, after seven or eight days, continuous chills and fever occurring at fixed times, coinciding with the sudden cessation of menstruation, is Heat entering the Blood Chamber. The blood must coagulate, causing malaria-like symptoms with fixed timing. Xiaochaihu Tang is the primary treatment.
[Commentary] Pang Anchang said: Menstruation ceasing suddenly during chills and fever is abnormal cessation. Likely, menstrual flow caused emptiness in the Blood Chamber, allowing Heat pathogens to enter vacuously. Residual un-discharged blood dries and knots internally, causing the sudden stop. Use Xiaochaihu Tang to harmonize, dispersing the knotted blood, thereby eliminating chills and fever and achieving cure.
Shen Jin'ao notes: The previous clause originated from Yangming disease; this clause involves Shaoyang disease; the next clause involves Jueyin disease. They are classified here because they all resemble malaria. If Shaoyang invades Yin, with more heat than cold and a slow Chi pulse, it often presents as resembling malaria. First use Huangqi Jianzhong Tang (Astragalus Decoction to Establish the Middle) to nourish Ying and Wei. Wait until the pulse is no longer slow, then harmonize with Xiaochaihu Tang. In all Shaoyang diseases, alternating chills and fever with fixed intervals mostly present as malaria-like states. Although Zhang Zhongjing did not explicitly state this, students should comprehend it through reasoning.
[General Principle] Zhang Zhongjing said: In Jueyin disease, if the pulse is floating-slow, the scrotum is not retracted, and there is definitely fever and aversion to cold resembling malaria, it indicates impending recovery. Use Guizhi Mahuang Gehan Tang.
[Commentary] Lou Quanshan said: Although the disease is in Jueyin, the floating-slow pulse indicates the pathogen has a tendency to exit. Thus, alternating chills and fever resembling malaria leads to recovery.