疟疾不离少阳。少阳为半表半里，邪居表里之界。入与阴争则寒，出与阳争则热。争则
病作，息则痛止。止后其邪仍据于少阳之经。浅则一日一作，深则二日一作，更深则三日一
作。虽有别经，总以少阳为主。故仲景以弦字该本症之脉，盖于治法只一小柴胡汤。热多烦
渴，加知母、花粉；寒多身疼，加干姜、桂枝。治之得法。一二服可愈。
朱丹溪云∶无汗要有汗，散邪为主，带补正；有汗要无汗，补正为主，带散邪。大抵于
小柴胡汤中无汗，麻黄可加二钱，即三解汤意也。有汗，桂枝、酒芍可各加二钱，即柴胡桂
枝汤意也；如三五作不休，即于前方加常山三钱，一服即愈。俗谓常山截疟，用之太早，则
截住邪气而成他病。不知常山祛痰涌吐，从阴达阳之药，正所以鼓邪气外出，何截之有？
余每合穿山甲、金银花三味，取其通达经络，又以人参、当归、白术、何首乌之类，择
用一二两为君。于疟未出时，服之多愈。至于方书分定名色，多歧仅惑。而所应别者，如单
寒无热为牡疟，宜理中汤、理阴煎加柴胡主之；单热无寒为痹疟，或先热后寒为热疟，宜白
虎汤加桂枝主之；劳役饥饱过度为劳疟，宜补中益气汤加柴胡主之；受山岚瘴气为瘴疟，宜
藿香正气散、平胃散加柴胡主之；久疟心腹有块者，名疟母，以鳖甲饮主之。只此数症，略
宜分别，究亦不离少阳一经也。
若疟痢交作，只以小柴胡汤疏少阳之气，则陷者自举。加花粉三钱，滋阳明之液，则滞
者自通。或即以此汤送香连丸一钱五分，挟虚者，以补中益气汤倍柴胡煎，送香连丸二钱。
此薛立斋先生之心法也。
小柴胡汤（方见《伤寒》）
男元犀按∶凡服治疟药，宜疟未至前三时服，或煎两服。一服于疟期五鼓时服，留一服
于疟未至前二时服，最妙。凡治疟药，古法必露一宿，以疟为暑邪，暑气得露而消也。又近
医以初疟，忌用人参、白术、茯苓，此说本之嵩崖尊生。余虽不满，亦当从众。今即照嵩崖
，去人参加青皮一钱五分。寒多加干姜、桂枝各二钱；热多加知母、花粉各二钱，或加黄
连、石膏。本方去人参，加常山、草果、知母、槟榔、川贝母各二钱，名清中驱疟饮。大意
以无痰不成疟，此方为治症之总方也，然亦多效。
鳖甲饮
鳖甲（三钱，醋炙） 白术（炒） 黄 川芎 酒白芍 槟榔 草果（煨） 浓朴 陈皮 甘草（各一
钱） 生姜（三片） 枣肉（三枚） 乌梅（一枚）
水煎服。
又有久疟流连不愈，及三阴疟三日一作者，当分五脏之虚，而施温补。宜以景岳何人饮
、休疟饮常服。疟作之期，或加少阳药一二味，及常山、穿山甲、附子、金银花之类，以通
经络。或用人参一两、生姜一两，浓煎服之。此不截之截法也。家贫者，以冬白术一二两代
之；血虚者，以当归一两代之。
疟虽有五脏之分，而久疟证治法，只以补脾为主。盖以土为万物之母，五脏六腑皆受荫焉
。况疟为少阳之邪，戊己之土，久受甲木之克，扶弱抑强之法，权实操于医者，宜于六君子
汤、四君子汤、补中益气汤诸方，加之意焉。
何人饮
何首乌（一两，不见铁或生用） 人参（二三钱或一两） 陈皮（一二钱，虚者不用） 煨生姜（二三钱）
水煎服。
休疟饮
何首乌（四钱或一两） 人参（二三钱） 白术（三钱炒） 当归（三钱） 炙甘草（一钱）
阴阳水煎服。
又久疟不愈，必求之肾。如肾水不足，热多者以六味丸加味主之；肾火不足，寒多者以
八味丸加味主之。
《高鼓峰医案》云∶余治一人三阴疟不愈，令吞八味丸，服人参养荣汤，冬至日再加
附子一钱，至半夜汗出而愈。（汗出者阳回之兆，亦邪解之征也。愈于冬至日者以阳生而
阴退也。）
Malaria is inextricably linked to the Shaoyang (Lesser Yang) channel. The Shaoyang channel is located at the half-exterior and half-interior level, where pathogenic factors reside at the boundary between exterior and interior. When pathogens enter and contend with Yin, chills occur; when they emerge and contend with Yang, fever occurs. Disease manifests during contention and subsides when contention ceases. After symptoms subside, pathogens still occupy the Shaoyang channel. If the pathogen is shallow, attacks occur daily; if deeper, every two days; if even deeper, every three days. Although other channels may be involved, the Shaoyang channel remains primary. Therefore, Zhang Zhongjing used the term "wiry" (Xian Mai, Wiry Pulse) to characterize the typical pulse of this condition, and in treatment, primarily utilized Xiaochaihu Tang (Minor Bupleurum Decoction). If heat signs are prominent accompanied by irritability and thirst, add Zhi Mu (Anemarrhenae Rhizoma) and Hua Fen (Trichosanthis Radix); if cold signs are prominent accompanied by body pain, add Gan Jiang (Zingiberis Rhizoma) and Gui Zhi (Cinnamomi Ramulus). With appropriate treatment, recovery can be achieved after one or two doses.
Zhu Danxi stated: In cases without sweating, induce sweating as the primary method to disperse pathogens, while simultaneously tonifying healthy Qi; in cases with sweating, stop sweating as the primary method to tonify healthy Qi, while simultaneously dispersing pathogens. Generally, based on Xiaochaihu Tang, if there is no sweating, add Ma Huang (Ephedrae Herba) two qian, which aligns with the principle of Sanjie Tang (Three-Resolving Decoction); if there is sweating, add Gui Zhi (Cinnamomi Ramulus) and Jiu Bai Shao (Paeoniae Radix Alba processed with wine) each two qian, which aligns with the principle of Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction); if attacks occur irregularly every three to five days without cessation, add Chang Shan (Dichroae Radix) three qian to the previous formula, and recovery follows one dose. It is commonly believed that Chang Shan (Dichroae Radix) can arrest malaria; using it too early traps pathogens and causes other diseases. They fail to realize that Chang Shan (Dichroae Radix) is a herb that expels phlegm, induces vomiting, and guides energy from Yin to Yang, precisely to urge pathogens outward, so how could it trap them? I often combine Chang Shan (Dichroae Radix), Chuan Shan Jia (Manis Squama), and Jin Yin Hua (Lonicerae Japonicae Flos), utilizing their ability to unblock collaterals, and select Ren Shen (Ginseng Radix et Rhizoma), Dang Gui (Angelicae Sinensis Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma), and He Shou Wu (Polygoni Multiflori Radix), choosing one or two liang as the sovereign drug. Administered before the onset of malaria, it cures most cases. As for the classifications and names defined in medical texts, there are many divergences causing confusion. However, distinct types should be differentiated: Mulinie (Male Malaria), characterized by chills only without fever, is treated with Lizhong Tang (Regulate the Middle Decoction) or Liyin Jian (Yin-Nourishing Decoction) plus Chai Hu (Bupleuri Radix); Bi Lanie (Bi Malaria), characterized by fever only without chills, or Re Lanie (Heat Malaria), characterized by fever preceding chills, is treated with Baihu Tang (White Tiger Decoction) plus Gui Zhi (Cinnamomi Ramulus); Laolie (Labor Malaria), caused by overexertion or irregular diet, is treated with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Chai Hu (Bupleuri Radix); Zhanlie (Miasma Malaria), contracted from mountain miasma, is treated with Huoxiang Zhengqi San (Agarwood Powder for Regulating Qi) or Pingwei San (Calm the Stomach Powder) plus Chai Hu (Bupleuri Radix); Jiulie (Chronic Malaria) resulting in masses in the heart and abdomen is called Mumai (Malaria Mother), treated with Biejia Yin (Softshell Turtle Decoction). These few categories require slight differentiation, yet fundamentally remain within the Shaoyang channel.
If malaria and dysentery occur simultaneously, use Xiaochaihu Tang (Minor Bupleurum Decoction) to soothe the Qi of the Shaoyang channel, thereby lifting sunken Qi. Add Hua Fen (Trichosanthis Radix) three qian to nourish the fluids of the Yangming channel, thereby unblocking stagnation. Alternatively, administer Xianglian Wan (Fringeflower and Coptis Pill) one qian five fen with this decoction; for cases with deficiency, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with doubled Chai Hu (Bupleuri Radix) decocted, administering Xianglian Wan (Fringeflower and Coptis Pill) two qian. This is the core method of Mr. Xue Lizhai.
Xiaochaihu Tang (Formula see *Shanghan Lun*)
Disciple Yuan Xi notes: Medications for treating malaria should ideally be taken three hours before the onset of the attack, or decocted into two doses. Take one dose at wugeng (5-7 AM) on the day of the attack, and reserve the second dose for two hours before the anticipated onset, which is optimal. Ancient methods required exposing malaria medications overnight because malaria is attributed to summerheat pathogens, and exposure to dew dissipates summerheat energy. Furthermore, contemporary physicians prohibit the use of Ren Shen (Ginseng Radix et Rhizoma), Bai Zhu (Atractylodis Macrocephalae Rhizoma), and Fu Ling (Poria) for initial malaria, a view originating from Songya Zunsheng. Although I do not fully agree, I shall follow the majority. Thus, following Songya, remove Ren Shen (Ginseng Radix et Rhizoma) and add Qing Pi (Citri Reticulatae Pericarpium Viride) one qian five fen. Increase Gan Jiang (Zingiberis Rhizoma) and Gui Zhi (Cinnamomi Ramulus) by two qian each for excess cold; increase Zhi Mu (Anemarrhenae Rhizoma) and Hua Fen (Trichosanthis Radix) by two qian each for excess heat, or add Huang Lian (Coptidis Rhizoma) and Shi Gao (Gypsum Fibrosum). Removing Ren Shen (Ginseng Radix et Rhizoma) from this base formula and adding Chang Shan (Dichroae Radix), Cao Guo (Tsaoko Fructus), Zhi Mu (Anemarrhenae Rhizoma), Bing Lang (Arecae Semen), and Chuan Bei Mu (Fritillariae Cirrhosae Bulbus) each two qian creates Qingzhong Qumai Yin (Clear the Middle and Drive Out Malaria Decoction). The general idea is that "no phlegm, no malaria," making this the master formula for treating the condition, and it is indeed effective.
Biejia Yin (Softshell Turtle Decoction)
Biejia (Softshell Turtle Carapace, three qian, vinegar-fried) Bai Zhu (Atractylodis Macrocephalae Rhizoma, stir-fried) Huang Qi (Astragali Radix) Chuan Xiong (Ligustici Chuanxiong Rhizoma) Jiu Bai Shao (Paeoniae Radix Alba, wine-processed) Bing Lang (Arecae Semen) Cao Guo (Tsaoko Fructus, baked) Hou Po (Magnoliae Officinalis Cortex) Chen Pi (Citri Reticulatae Pericarpium) Gan Cao (Glycyrrhizae Radix et Rhizoma) (each one qian) Sheng Jiang (Zingiberis Recens Rhizoma, three slices) Zao Rou (Jujubae Fructus pulp, three pieces) Wumei (Mume Fructus, one piece)
Decoct in water and take orally.
For chronic malaria lingering without resolution, or San Yin Malaria (Three-Yin Malaria) attacking every three days, differentiate the deficiency of the Five Zang organs and apply warming tonification. Regularly consume Jingyue's Heren Yin (Hereu Decoction) or Xiumai Yin (Rest Malaria Decoction). During the period of malaria attack, add one or two Shaoyang herbs, such as Chang Shan (Dichroae Radix), Chuan Shan Jia (Manis Squama), Fu Zi (Aconiti Lateralis Radix Preparata), or Jin Yin Hua (Lonicerae Japonicae Flos), to unblock collaterals. Alternatively, use Ren Shen (Ginseng Radix et Rhizoma) one liang and Sheng Jiang (Zingiberis Recens Rhizoma) one liang, decoct strongly and take orally. This is the method of arresting malaria without forcibly stopping it. For those with poor financial means, replace Ren Shen (Ginseng Radix et Rhizoma) with Dong Bai Zhu (Winter Atractylodis Macrocephalae Rhizoma) one to two liang; for blood deficiency, replace it with Dang Gui (Angelicae Sinensis Radix) one liang.
Although malaria is divided among the Five Zang organs, the treatment principle for chronic malaria focuses primarily on tonifying the Spleen. Earth (Spleen/Stomach) is the mother of all things, shading the Five Zang and Six Fu organs. Moreover, malaria is a Shaoyang pathogen; the Earth of Wu and Ji (Spleen/Stomach) suffers long-term overcoming by the Wood of Jia and Yi (Liver/Gallbladder). The method of supporting weakness and suppressing strength lies in the hands of the physician, who should carefully consider formulas such as Liu Junzi Tang (Six Gentlemen Decoction), Si Junzi Tang (Four Gentlemen Decoction), and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction).
Heren Yin (Hereu Decoction)
He Shou Wu (Polygoni Multiflori Radix, one liang, avoid iron or use raw) Ren Shen (Ginseng Radix et Rhizoma, two to three qian or one liang) Chen Pi (Citri Reticulatae Pericarpium, one to two qian, omit in deficiency) Wei Sheng Jiang (Zingiberis Recens Rhizoma, baked, two to three qian)
Decoct in water and take orally.
Xiumai Yin (Rest Malaria Decoction)
He Shou Wu (Polygoni Multiflori Radix, four qian or one liang) Ren Shen (Ginseng Radix et Rhizoma, two to three qian) Bai Zhu (Atractylodis Macrocephalae Rhizoma, three qian, stir-fried) Dang Gui (Angelicae Sinensis Radix, three qian) Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried, one qian)
Decoct in Yin-Yang Water and take orally.
Furthermore, for chronic malaria that does not resolve, seek the cause in the Kidney. If Kidney Water is insufficient with prominent heat, treat with Liuwei Wan (Six-Ingredient Pill with Rehmannia) modified; if Kidney Fire is insufficient with prominent cold, treat with Bawei Wan (Eight-Ingredient Pill with Rehmannia) modified.
*Gao Gufeng Medical Cases* records: I treated a patient with persistent San Yin Malaria, instructing him to swallow Bawei Wan (Eight-Ingredient Pill with Rehmannia) and take Ren Shen Yangrong Tang (Ginseng Nourishing Courage Decoction). On the Winter Solstice day, add Fu Zi (Aconiti Lateralis Radix Preparata) one qian. By midnight, he sweated and recovered. (Sweating is a sign of Yang returning and pathogens resolving. Recovery on the Winter Solstice occurs because Yang grows and Yin recedes.)