经曰∶夏伤于暑，秋必 疟。其证先起于毫毛，伸欠乃作，寒栗鼓颔，腰脊俱痛，寒去则内
外皆热，头痛如破，渴欲冷冻饮料。盖邪气并于阳则阳胜，并于阴则阴胜，阴胜则寒，阳胜则热
，阴阳上下交争，虚实更作，故寒热间发也。有一日一发，二日一发，三日一发，有间一日
，连二日发，有日与夜各发，有上半日发，下半日发，及发于夜者；有有汗，有无汗，此其
略也。以详言之，当分六经、五脏，及痰、食、劳、暑、鬼、瘴之不同，邪中三阴之各异。
如足太阳之疟，令人腰痛头重，寒从背起，先寒内热， 然热止，汗出难已。足少阳
之疟，令人身体解 ，寒不甚，热不甚，恶见人，见人心惕惕然，热多汗出甚。足阳明之疟
，令人先寒，洒淅洒淅，寒甚久乃热，热去汗出，喜见日月光火，气乃快然。足太阴之疟，
令人不乐，好太息，不嗜食，多寒热，汗出病止则善呕，呕已乃衰。足少阴之疟，令人呕吐
，甚多寒热，热多寒少，欲开户而处，其病难已。足厥阴之疟，令人腰痛少腹满，小便不利
如癃状，非癃也，数便意，恐惧气不足，腹中悒悒，此六经疟也。肺疟者，令人心寒，寒甚
热，热间善惊，如有所见者。心疟者，令人烦心，甚欲得清水，反寒多不甚热。肝疟者，令
人色苍苍然太息，其状若死者。脾疟者，令人心腹中痛，热则肠中鸣，鸣已汗出。肾疟者，
令人洒淅然腰脊痛宛转，大便难，目 然手足寒。胃疟者，令人且病也，善饥而不能食，
食而支满腹大，此五脏疟也。痰疟者，胸膈先有停痰，因而成疟，令人心下胀满，气逆烦呕
是也。食疟者，是饮食伤脾，其人噫气吞酸，胸膈不和是也。劳疟者，久而不瘥，表里俱虚
，客邪未散，真气不复，故疾虽间遇劳即发是也。暑疟者，其人面垢口渴，虽热亦退，亦常
有汗是也。鬼疟者，进退无时是也。瘴疟者，感山岚瘴气，其状寒热，休作有时是也。作于
子午卯酉日为少阴疟，作于寅申巳亥日为厥阴疟，作于辰戌丑未日为太阴疟，此所谓三阴各
异也。久而不愈，名曰 疟。 疟，老疟也。老疟不愈，结癖于两胁之间，名曰疟母。此先
失于解散，或复外感风寒，内伤饮食，故缠绵不已也。治法∶风暑之邪，从外而入，宜解散
之，解表后，即宜扶持胃气。故丹溪曰∶无汗要有汗，散邪为主；有汗要无汗，固正气为主
。骤发之疟，宜解表。久发之疟，宜补脾。寒疟宜温，温疟宜和，瘅疟宜清，挟痰则行痰，
兼食则消食，劳疟宜安，暑疟宜解，鬼疟宜祛，瘴疟宜散，此亦其略也。更以详言之，则热
多寒少者，小柴胡汤。寒多热少者，清脾饮子。无汗者，桂枝麻黄各半汤。有汗者，柴胡桂
枝汤。渴而小便不利者，五苓散。热多汗出，腹满便秘者，大柴胡汤。痰疟者，二陈汤加柴
胡、黄芩，甚者加枳实。食疟者，先用大安丸，次用异功散。劳疟、 疟，并用补中益气汤
。暑疟者，十味香薷饮。鬼疟者，鬼哭散。瘴疟者，四兽饮。疟母者，鳖甲饮。凡脾胃虚而患疟者，不
拘有汗无汗，三阴六经，悉以六君子汤为主。热多加柴胡、山栀。寒多加干姜、肉桂。有汗
加黄 、浮麦。无汗加苍术、葛根。元气下陷，及肝木乘脾，并加升麻、柴胡为善。若用青
皮、草果、常山等药，以为攻截良法，正气益虚，邪气益深，是多延绵不止，而为劳热者有
矣。若乳母七情六欲，饮食不调，或寒热似疟，肝火炽盛，致儿为患者，又当治其乳母，斯
无误矣。
治验
一小儿先因停食腹痛，服峻厉之剂，后患疟，日晡而作，余以为元气下陷，欲治以补中益气
汤，不信，泛行清热消导，前症益甚，食少作泻，余朝用前汤，夕用异功散加当归，月余而愈。
一小儿每午前先寒后热，久不愈，用六君子加炮姜，丸芡实大，每服一丸，旬余而愈。
一小儿患疟兼便血、盗汗年余矣。审乳母素有郁怒，寒热便血，朝用加味归脾汤，夕用加味
逍遥散；儿以异功散加酒炒芍药为末，每服三四分，米饮下，月余母子并痊。
一小儿疟发热，服消导之剂，腹胀作呕，四肢浮肿，先用五味异功散加木香，诸症顿退，饮
食顿进。后因饮食过多，作泻，用补中益气汤加木香，又用五味异功散而痊。
一小儿疟后，腹胀咳嗽倦怠，属脾肺气虚，用补中益气汤、茯苓、半夏寻愈。后伤食发热如
疟，服寒凉之剂，更加便血，用四君、升麻、柴胡，便血顿止，又用补中益气汤而愈。
一小儿疟将愈，饮食过多，腹胀发热，大便不通，用消积丸、保和丸、异功散寻愈。后饮食
不节，寒热吐泻，用异功散、柴胡、升麻而愈。
一小儿疟后，少思饮食，便血，发热腹胀，属脾虚不能统血，先用异功散加升麻、柴胡而血
止；又补中益气汤，饮食顿进；仍用异功散而痊。
一小儿疟后腹胀，用五味异功散、四味肥儿丸而渐愈，用补中益气汤而愈。后伤食腹胀，大
便不实，小便不利，用五味异功散、金匮加减肾气丸而愈。
一小儿愈后便涩。用补中益气汤加山栀，而小便通，因劳发热不食，小便不利，用补中益气
、五味异功散加升麻、柴胡而痊。后每劳心，寒热如疟，用补中益气汤；饮食失节如疟，用五味异功
散随愈。
一小儿十四岁，疟后肚腹膨胀，小便不利，属脾肾虚寒，朝用补中益气汤，夕用金匮肾气丸
而痊。毕姻
气汤，夕用金匮加减肾气丸而愈。
一小儿疟疾将愈，饮食过多，腹胀发热，大便不通，用消积丸、保和丸、异功散，调理脾胃
而愈。后饮食不节，寒热吐泻，先用胃苓散，吐泻止；又用异功散、柴胡、升麻寒热愈。
一小儿十五岁，疟后发热吐痰。余谓脾气所变，不信，反服黄柏、知母之类，诸症悉具。谓
余曰∶胃火盛而滋水，其症益甚，何也？余曰∶症在脾阴，土喜温和而恶寒湿，前所用药，
悉属沉阴，复伤其生气，故病愈甚也。先用六君、柴胡、升麻、木香四剂，诸症顿愈，乃佐
以异功散加柴胡、升麻，元气渐充，又朝用补中益气汤，夕用异功散而愈。毕姻后，发热如
疟。用补中益气汤，
已耗，而复伤耳，乃肾气虚寒之危症也。用大剂补中益气汤、八味地黄丸，喜其远帏幕而得生。
柴胡桂枝汤 治疟，身热多汗。
柴胡（八钱） 黄芩（三钱） 半夏（二钱半） 芍药 甘草 桂枝（各三钱）
上每服二三钱，姜枣水煎。
鬼哭散 治疟久不止。
常山 大腹皮 白茯苓 鳖甲（醋炙） 甘草（炙。各六钱）
上入桃柳枝各七寸，水煎服。
清脾饮子 治瘅疟脉弦数，但热不寒，或热多寒少，膈满不食，口苦舌干，烦渴，小便黄赤
，大肠不利。
青皮（炒） 浓朴（姜制） 白术 草果 柴胡 茯苓 半夏（泡七次） 黄芩 甘草（炙。各等分）
上每服二三钱，姜水煎服。
四兽饮 治阴阳相胜，结聚涎饮为疟，兼治瘴疟神效。
半夏 茯苓 人参 白术 草果 橘红（各等分） 甘草（减半）
上用乌梅、姜、枣，湿纸裹，煨香熟，焙干入药。每服二钱，水煎服。
鳖甲饮子 治疟久不愈，胁下痞满，形容羸瘦，腹中结块，时发寒热，名曰疟母。
鳖甲（醋炙） 白术 甘草 黄 白芍药 川芎
人参养胃汤 治外感风寒，内伤生冷，寒热如疟，或呕逆恶心。寒疟加桂枝。
人参 浓朴 苍术 半夏（泡） 藿香 草果仁 茯苓（各五钱） 甘草 橘红（二钱半）
上每服二三钱，姜七片，乌梅一个，水煎热服。
桂枝麻黄各半汤 治发热，自汗或无汗。
桂枝 白芍药 生姜 甘草（炙） 麻黄（各一钱） 杏仁（十粒，泡去皮尖）
上水一钟，大枣二枚，煎四分，食远服。
五苓散（方见五淋）
小柴胡汤
大柴胡汤（二方见痉症）
二陈汤（方见寒吐）
大安丸（即保和丸加白术）
补中益气汤（方见虚羸）
十味香薷饮（方见呕吐乳）
六君子汤
加味归脾丸
加味逍遥散
异功散（四方见内钓）
The *Yellow Emperor's Inner Canon* states: If one is injured by summer-heat in summer, malaria will inevitably occur in autumn. The symptoms initially manifest as goosebumps, followed by stretching and yawning, then aversion to cold with shivering and mandibular tremors, accompanied by pain in the waist and spine. When the cold subsides, both interior and exterior become hot, with severe headache as if splitting, and thirst for cold beverages. This is because when pathogenic factors merge with Yang, Yang becomes excessive; when they merge with Yin, Yin becomes excessive. Excess Yin leads to cold, excess Yang leads to heat. The continuous struggle between Yin and Yang above and below, alternating deficiency and excess, results in the intermittent occurrence of chills and fever. Cases may present with daily attacks, every two days, or every three days; some alternate days, some consecutive two days; some attack during day and night respectively, some in the first half of the day, some in the second half, and some at night; some have sweat, some do not. This is a brief overview. In detail, one must differentiate according to the Six Channels (Taiyang, Shaoyang, Yangming, Taiyin, Shaoyin, Jueyin), Five Zang organs, and differences due to Phlegm, Food Stagnation, Fatigue, Summer-heat, Ghostly influence, and Miasma, noting the variations when pathogens invade the Three Yin channels.
Malaria of the Foot-Taiyang channel causes lower back pain and heaviness of the head, coldness arising from the back, initial chills followed by internal heat, and profuse sweating upon resolution that is difficult to stop. Malaria of the Foot-Shaoyang channel causes flaccidity of the body, mild chills and mild fever, aversion to seeing people, and palpitations/fear upon contact, with abundant fever and sweating. Malaria of the Foot-Yangming channel causes initial chills with shivering, prolonged coldness before fever arises, sweating upon resolution, and a preference for sunlight, moonlight, or fire to feel comfortable. Malaria of the Foot-Taiyin channel causes melancholy, frequent sighing, loss of appetite, alternating chills and fever, and vomiting after sweating resolves, with improvement following emesis. Malaria of the Foot-Shaoyin channel causes vomiting, severe alternating chills and fever (more heat than cold), desire to sit near open windows, and is difficult to cure. Malaria of the Foot-Jueyin channel causes lower back pain, abdominal fullness, difficulty urinating resembling strangury but not true strangury, frequent urge to urinate, fear of Qi deficiency, and inner depression. These are the six-channel malarias.
Lung malaria causes coldness in the heart/chest, extreme cold followed by heat, and fright/easily startled during heat intervals, with visual hallucinations. Heart malaria causes mental restlessness, strong desire for cold water, yet more chills than heat. Liver malaria causes a pale/greenish complexion, frequent sighing, and a demeanor resembling death. Spleen malaria causes pain in the heart and abdomen, intestinal borborygmus during fever, and sweating after borborygmus. Kidney malaria causes shivering, painful lower back and spine with rolling/restlessness, difficulty defecating, blurred vision, and cold hands and feet. Stomach malaria causes hunger at onset but inability to eat, abdominal distension and fullness after eating, and abdominal enlargement. These are the five-Zang malarias.
Phlegm malaria arises from retained phlegm-fluids in the chest and diaphragm, causing epigastric fullness, rebellious Qi, irritability, and vomiting. Food stagnation malaria results from dietary injury to the Spleen, characterized by belching, acid regurgitation, and chest/diaphragmal discomfort. Labor fatigue malaria occurs when the disease lingers without recovery, leading to exterior-interior deficiency, lingering pathogen, and unrecovered True Qi; thus, though remitting, it recurs upon exertion. Summer-heat malaria presents with a greasy face, thirst, easy resolution of fever, and frequent sweating. Ghost malaria has irregular onset and progression. Miasma malaria results from inhaling mountain miasma, presenting with alternating chills and fever at regular intervals.
Attacks on Zi, Wu, Mao, You days correspond to Shaoyin malaria; on Yin, Shen, Si, Hai days to Jueyin malaria; on Chen, Xu, Chou, Wei days to Taiyin malaria. This explains the differences among Three Yin malarias. If chronic and unhealed, it is called "Old Malaria" (La Nüe). If Old Malaria persists, a mass forms between the hypochondrium, termed "Malaria Mother" (Nüe Mu). This results from failure to resolve the pathogen early, or subsequent external wind-cold invasion and internal dietary injury, leading to chronicity.
Treatment principles: For wind-summer-heat entering from outside, use resolving methods. After releasing the exterior, immediately support Stomach Qi. As Zhu Danxi stated: For anhidrotic malaria, induce sweating to scatter pathogens; for hyperhidrotic malaria, stop sweating to consolidate Zheng Qi. Acute malaria requires exterior release; chronic malaria requires Spleen tonification. Cold malaria requires warming; Warm malaria requires harmonizing; Dan malaria (pure heat) requires clearing; Phlegm-malaria requires resolving phlegm; Food-stagnation malaria requires digesting food; Labor malaria requires calming/nourishing; Summer-heat malaria requires resolving summer-heat; Ghost malaria requires expelling ghosts; Miasma malaria requires dispersing miasma.
Specific prescriptions: Heat > Cold: Xiao Chai Hu Tang (Minor Bupleurum Decoction). Cold > Heat: Qing Pi Yin Zi (Clear Spleen Drink). Anhidrosis: Gui Zhi Ma Huang Ge Ban Tang (Cinnamon Twig and Ephedra Half-Dose Decoction). Hyperhidrosis: Chai Hu Gui Zhi Tang (Bupleurum and Cinnamon Twig Decoction). Thirst + oliguria: Wu Ling San (Five-Ingredient Powder with Poria). Heat + sweating + abdominal fullness + constipation: Da Chai Hu Tang (Major Bupleurum Decoction). Phlegm malaria: Er Chen Tang (Two-Aged Decoction) plus Chai Hu, Huang Qin; severe cases add Zhi Shi. Food malaria: First Da An Wan, then Yi Gong San. Labor/Old malaria: Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). Summer-heat malaria: Shi Wei Xiang Ru Yin (Ten-Ingredient Elsholtzia Decoction). Ghost malaria: Gui Ku San (Ghost Cry Powder). Miasma malaria: Si Shou Yin (Four Beasts Drink). Malaria Mother: Bie Jia Yin Zi (Turtle Shell Decoction).
For malaria due to Spleen-Stomach deficiency, regardless of sweating status or channel involvement, Liu Jun Zi Tang (Six-Gentleman Decoction) is primary. Add Chai Hu, Shan Zhi for heat; Gan Jiang, Rou Gui for cold; Huang Qi, Fu Xiao Mai for sweating; Cang Zhu, Ge Gen for no sweat. For sinking Yuan Qi or Liver Wood overacting on Spleen, add Sheng Ma, Chai Hu. Avoid aggressive drugs like Qing Pi, Cao Guo, Chang Shan, as they deplete Zheng Qi and deepen pathogens, potentially transforming into labor-fever. If a nursing mother has emotional/dietary issues causing malaria-like symptoms and liver fire affecting the infant, treat the mother.
Clinical Cases:
1. A child had post-prandial abdominal pain treated with harsh purgatives, then developed evening-onset malaria. Diagnosed as sinking Yuan Qi, prescribed Bu Zhong Yi Qi Tang. Parents refused, using cooling/digestive herbs instead, worsening symptoms (anorexia, diarrhea). I prescribed Bu Zhong Yi Qi Tang morning, Yi Gong San + Dang Gui evening. Recovered in one month.
2. A child had pre-noon chills then fever, chronic. Prescribed Liu Jun Zi Tang + Pao Jiang, made into pills size of Euryale Seed. One pill per dose. Recovered in ten days.
3. A child had malaria with hematochezia and night sweats for a year. Mother had history of anger/stress with similar symptoms. Mother took Jia Wei Gui Pi Tang (morning) and Jia Wei Xiao Yao San (evening). Child took Yi Gong San + Jiu Chao Shao Yao powder, 3-4 fen with rice water. Both recovered in one month.
4. A child had malaria fever, took digestive herbs, developed abdominal distension, vomiting, limb edema. Treated with Wu Wei Yi Gong San + Mu Xiang, symptoms resolved, appetite returned. Later, overeating caused diarrhea; treated with Bu Zhong Yi Qi Tang + Mu Xiang, then Yi Gong San. Recovered.
5. Post-malaria child had distension, cough, fatigue (Spleen-Lung Qi deficiency). Treated with Bu Zhong Yi Qi Tang, Fu Ling, Ban Xia. Recovered. Later, food stagnation fever mimicking malaria, took cold herbs, worsened with hematochezia. Treated with Si Jun Zi Tang, Sheng Ma, Chai Hu; bleeding stopped. Then Bu Zhong Yi Qi Tang. Recovered.
6. Child nearing malaria recovery ate too much, developed distension, fever, constipation. Treated with Xiao Ji Wan, Bao He Wan, Yi Gong San. Recovered. Later, irregular diet caused chills, fever, vomiting, diarrhea. Treated with Yi Gong San, Chai Hu, Sheng Ma. Recovered.
7. Post-malaria child had poor appetite, hematochezia, fever, distension (Spleen failing to control blood). Treated with Yi Gong San + Sheng Ma, Chai Hu; bleeding stopped. Then Bu Zhong Yi Qi Tang; appetite improved. Continued Yi Gong San. Recovered.
8. Post-malaria child had distension. Treated with Wu Wei Yi Gong San, Si Wei Fei Er Wan; gradually improved, then Bu Zhong Yi Qi Tang. Later, food stagnation distension, loose stools, oliguria. Treated with Wu Wei Yi Gong San, Jin Gui Jia Jian Shen Qi Wan. Recovered.
9. Post-recovery child had dysuria. Treated with Bu Zhong Yi Qi Tang + Shan Zhi; urination cleared. Later, labor-induced fever/anorexia, oliguria. Treated with Bu Zhong Yi Qi Tang, Wu Wei Yi Gong San + Sheng Ma, Chai Hu. Recovered. Later, mental labor caused malaria-like chills/fever; treated with Bu Zhong Yi Qi Tang. Dietary irregularities caused similar symptoms; treated with Yi Gong San. Recovered.
10. Fourteen-year-old child, post-malaria abdominal distension, oliguria (Spleen-Kidney Yang deficiency). Morning: Bu Zhong Yi Qi Tang; Evening: Jin Gui Shen Qi Wan. Recovered. Post-marriage, used Bu Zhong Yi Qi Tang, evening Jin Gui Jia Jian Shen Qi Wan. Recovered.
11. Child nearing malaria recovery ate too much, distension, fever, constipation. Treated with Xiao Ji Wan, Bao He Wan, Yi Gong San, regulating Spleen/Stomach. Recovered. Later, irregular diet caused chills, fever, vomiting, diarrhea. First Wei Ling San stopped vomiting/diarrhea. Then Yi Gong San, Chai Hu, Sheng Ma cured chills/fever.
12. Fifteen-year-old child, post-malaria fever, expectoration. Attributed to Spleen transformation. Parents disagreed, used Huang Bo, Zhi Mu, worsening symptoms. Parent asked why "Stomach fire nourishing Water" worsened it. I explained pathology lies in Spleen Yin; Earth likes warmth, dislikes cold-damp. Previous heavy-yin herbs damaged Sheng Qi. Treated with Liu Jun Zi Tang, Chai Hu, Sheng Ma, Mu Xiang (4 doses); symptoms resolved. Then Yi Gong San + Chai Hu, Sheng Ma to replenish Qi. Morning Bu Zhong Yi Qi Tang, evening Yi Gong San. Recovered. Post-marriage, malaria-like fever. Used Bu Zhong Yi Qi Tang... [Text fragment] ...Qi exhausted, further injured, indicating critical Kidney Qi deficiency-cold. Used large dose Bu Zhong Yi Qi Tang, Ba Wei Di Huang Wan. Survived due to abstinence.
Formulas:
Chai Hu Gui Zhi Tang: Treats malaria with fever and profuse sweating.
Chai Hu (8 qian), Huang Qin (3 qian), Ban Xia (2.5 qian), Shao Yao, Gan Cao, Gui Zhi (3 qian each).
Take 2-3 qian, decoct with Ginger and Jujube.
Gui Ku San: Treats chronic persistent malaria.
Chang Shan, Da Fu Pi, Bai Fu Ling, Bie Jia (vinegar-fried), Gan Cao (roasted, 6 qian each).
Decoct with Peach and Willow branches (7 cun each) in water.
Qing Pi Yin Zi: Treats Dan malaria with wiry-rapid pulse, heat only or heat > cold, chest fullness, anorexia, bitter taste, dry tongue, irritability/thirst, yellow-red urine, bowel obstruction.
Qing Pi (stir-fried), Hou Po (ginger-processed), Bai Zhu, Cao Guo, Chai Hu, Fu Ling, Ban Xia (soaked 7 times), Huang Qin, Gan Cao (roasted, equal parts).
Take 2-3 qian, decoct with Ginger water.
Si Shou Yin: Treats malaria due to Yin-Yang conflict and phlegm-fluid accumulation; also effective for miasma malaria.
Ban Xia, Fu Ling, Ren Shen, Bai Zhu, Cao Guo, Ju Hong (equal parts), Gan Cao (half amount).
Roast Wumei, Ginger, Jujube wrapped in wet paper until fragrant and cooked, dry and add to medicine. Take 2 qian, decoct in water.
Bie Jia Yin Zi: Treats chronic malaria, hypochondriac fullness, emaciation, abdominal masses, intermittent chills/fever, named Malaria Mother.
Bie Jia (vinegar-fried), Bai Zhu, Gan Cao, Huang Qi, Bai Shao Yao, Chuan Xiong, Ren Shen.
Ren Shen Yang Wei Tang: Treats external wind-cold, internal cold/raw food injury, malaria-like chills/fever, or vomiting/nausea. Add Gui Zhi for cold malaria.
Ren Shen, Hou Po, Cang Zhu, Ban Xia (soaked), Huo Xiang, Cao Guo Ren, Fu Ling (5 qian each), Gan Cao, Ju Hong (2.5 qian).
Take 2-3 qian, decoct with 7 slices of Ginger and 1 Wumei, serve hot.
Gui Zhi Ma Huang Ge Ban Tang: Treats fever with spontaneous sweating or anhidrosis.
Gui Zhi, Bai Shao Yao, Sheng Jiang, Gan Cao (roasted), Ma Huang (1 qian each), Xing Ren (10 seeds, soaked, peeled, core removed).
Decoct 1 zhong water with 2 Jujubes to 40% volume, take far from meals.
Wu Ling San (See Wu Lin)
Xiao Chai Hu Tang
Da Chai Hu Tang (See Jing Zheng)
Er Chen Tang (See Han Tu)
Da An Wan (Bao He Wan + Bai Zhu)
Bu Zhong Yi Qi Tang (See Xu Lei)
Shi Wei Xiang Ru Yin (See Ou Tu Ru)
Liu Jun Zi Tang
Jia Wei Gui Pi Wan
Jia Wei Xiao Yao San
Yi Gong San (See Nei Diao)