虚人产妇。病后痨怯。俱有寒热似疟。必须辨明。方不误治。似疟脉来虚濡而数。不甚弦急。疟脉弦实。
自可辨也。戴氏曰。寒热发作。有期者疟也。无期者非也。此亦辨之甚明。最宜体认。盖少阳乃东
方甲木之象。故其脉主弦。不但初病如此。即久疟正虚。脉不鼓指。而弦象亦隐然在内。东垣云。夏伤
于暑。秋必 疟。夫暑为热邪。热则流通。何至伏藏于秋。必其人汗出遇风。或用冷水灌汗。暑邪藏于肌肉。半
在于表。半在于里。正当少阳部分。至秋金气下降。暑欲入而阴据之。则激而生寒。暑欲出而阳据之。则激而发热。
邪正相争。有残虐之意。故名曰疟。初起头疼身痛。寒多无汗者。宜用人参败毒散。加干葛半夏之类。热多汗出
者。宜用芎苏柴陈汤。发散之后。热多寒少。胸膈不宽。脉来弦滑者。痰与食积也。痰食在胃。荣卫从出之原闭塞
不舒。所以肌表之中。郁而生热。宜用柴陈化滞汤。若口中作渴者。由少阳而入膀胱之腑。热入膀胱。必伤津液。宜用
柴苓汤。导暑从小便而出。然柴苓汤一方。原为小便短少而设。如小便自利。渴欲饮水者。邪传阳明胃经。
宜用柴胡芍药汤。仲景云。脉弦数者风发也。以饮食消息止之。谓弦数之脉。热极生风。必侮土而伤其津液。
由少阳而入阳明。两经合邪。其热倍炽。当以食物速止其热。不可徒求之于药也。梨汁蔗浆。正食中之生津者。内
经所谓风淫于内。治以甘寒者是也。若不用此。则热之移于胃者。势必上传于肺。而为单热无寒之瘅疟。或
传心包。而为寒多热少之牡疟。可不慎乎。至于发利之后。脉细无力者。宜用二母补中汤。若有痰食未净。宜用六
君健脾汤。或资生丸之类。补而不愈。方可用截。所截之药。当分气血两途。热多脉数者。不受温补。宜用柴胡
四物汤。如乌梅何首乌极验。寒多脉缓者。宜用六君子汤。加人参五钱。此不截之截也。大抵截疟之法。无非收敛
气血。在壮盛之体。三五发后疟势少衰。犹可用截。若虚弱之人。气道错乱。虚不归元。截之涩于他歧。屡成腹胀。
不可不察也。虽然。疟疾属热者多。而属寒者亦有。不可泥定是热。凡当风露卧。冷水浴澡。阴邪客于荣卫。令人
寒多热少。脉来洪弦无力。（着眼在无力二字）仲景柴胡姜桂汤。真良方也。若胸中作冷畏寒减食。脉沉弦细者。
其病在里。宜用香砂理中汤。总而言之。一日一发者易治。间日三日者难痊。以其正气虚弱。涩而行迟。与邪会
之时缓也。其有住一日。连发二日。或一日数发者。正气大虚。散而错乱。多至不起。发于午后。移于午前者。
欲愈之兆。发于午前。移于午后者。羁迟难愈。服药宜在未发之前。发时诸经气乱。服之无效。至于饮食。俟其
热退身凉一两时许。方可量与。若带热饮食。多成疟母。肥甘浓味。尤宜禁之。（调摄要言）
又有疟母者。老痰食积留于胁下。按之有形。多成 疟。连岁不已。此症脉来弦细无力。甚难别其虚实。
大法积形坚大。外无怯弱诸症。脉虽沉细气滞。不能送之外出。宜用柴陈拈痛汤。若困倦喜卧。声音低小。
饮食减少者。宜用香砂六君子汤。大补元气。不可误用攻伐伤损胃气。极宜辨别。瘅疟者。热疟也。
单热而无寒也。脉滑有滞者。宜消食。小便短少者。宜分利。弦数口渴者。宜生津。不可概用大寒之剂。
（辨症确用药自验）惟大渴引饮。汗多脉来洪大者。不用竹叶石膏汤。断不愈也。此即少阳阳明两经合邪。上传于肺
者也。
牡疟者。寒疟也。寒多而热微也。如七分。寒三分热之类。诸书俱言纯寒无热。言之误矣。（发前人所未发）此即
少阳阳明两经合邪。上传于心者。邪入心包。都城震动。周身津液协力内援。重重裹撷胞内之邪。为外所拒。
故令寒多热少。表间虽有微冷。膻中全是邪热。内真热而外假寒也。宜用柴陈汤。加杏仁石菖蒲最妙。
加减败毒散
羌活 独活 柴胡 前胡 干葛 川芎 半夏 枳壳 桔梗 甘草
芎苏柴陈汤
川芎 紫苏 柴胡 黄芩 半夏 甘草 陈皮 白茯
汗出而热不解。邪未散也。故用此方从轻解之。若困倦无神。胸不宽畅。脉细无力。竟用六君健脾汤。
柴陈化滞汤
柴胡 黄芩 半夏 甘草 陈皮 白茯 枳壳 浓朴 山楂 赤芍
二母柴苓汤
知母 贝母 柴胡 黄芩 半夏 甘草 赤茯 泽泻 赤芍
柴胡芍药汤
柴胡 黄芩 花粉 甘草 白芍 麦冬 知母
二母补中汤
知母 贝母 人参 白术 黄 甘草 当归 陈皮 升麻 柴胡
资生丸 方见痢门。
加味柴物汤
柴胡 黄芩 半夏 甘草 当归 川芎 白芍 熟地 何首乌 知母 麦冬 乌梅（三阴 疟用此不截而截）
柴胡姜桂汤
柴胡 黄芩 半夏 甘草 干姜 桂枝 浓朴 山楂 陈皮
柴陈拈痛汤
柴胡 黄芩 半夏 甘草 陈皮 白茯 枳壳 浓朴 玄明粉 香附 鳖甲 归尾 赤芍
香砂六君子汤
人参 白术 白茯 甘草 半夏 陈皮 藿香 香附 砂仁
寒甚者。宜加姜桂。
竹叶石膏汤
麦冬 知母 石膏 人参 粳米 灯心 生姜 竹叶
合小柴胡汤。用之更妙。（按治瘅疟其效尤捷）
In individuals with deficiency constitutions, postpartum women, and those suffering from consumptive weakness after illness, chills and fever resembling malaria may occur. It is imperative to distinguish them clearly to avoid misdiagnosis and mistreatment. The pulse in such malaria-like conditions is deficient, soft, and rapid, lacking the wiry and forceful quality typical of true malaria, which allows for easy differentiation. Dai stated: Chills and fever occurring at fixed intervals indicate malaria; those without fixed intervals do not. This is a clear method of differentiation that requires deep understanding. The Shaoyang (Lesser Yang) channel corresponds to the image of Jia Wood in the East, hence its pulse is primarily wiry. This applies not only to initial stages but also to chronic malaria where righteous qi is deficient; even if the pulse fails to strike the fingers forcefully, the wiry character remains implicitly present. Dongyuan said, "Summer damage by heat pathogens leads to malaria in autumn." Heat is a pathogen of flow and diffusion; how can it remain hidden until autumn? It must be that sweating followed by exposure to wind, or washing sweat with cold water, causes the summer-heat pathogen to lodge in the muscles, half on the exterior and half on the interior, precisely within the Shaoyang region. When autumn's metal energy descends, the summer-heat pathogen attempts to enter but is blocked by yin, triggering chills; when it attempts to exit, it is blocked by yang, triggering fever. The struggle between pathogenic factors and righteous qi has a cruel nature, thus named "malaria" (nue). In the early stage, with headache, body ache, predominant chills, and absence of sweating, Renshen Baidu San (Ginseng Detoxification Powder) added with Ge Gen (Puerariae Radix) and Ban Xia (Pinelliae Rhizoma) is appropriate. With predominant fever and sweating, Xiong Su Chai Chen Tang (Ligusticum, Perilla, Bupleurum, and Tangerine Peel Decoction) is suitable. After dispersing the exterior, if fever predominates over chills, chest and diaphragm feel stuffy, and the pulse is wiry and slippery, this indicates phlegm and food stagnation. Phlegm and food retained in the Stomach block the origin of Ying and Wei (Nutritive and Defensive Qi), causing郁 heat in the muscle layer; Chai Chen Hua Zhi Tang (Bupleurum and Tangerine Peel Stagnation-Resolving Decoction) is indicated. If there is thirst in the mouth, it is because the pathogen has moved from Shaoyang to the Bladder organ; heat entering the Bladder damages fluids, so Chai Ling Tang (Bupleurum and Poria Decoction) should be used to guide summer-heat out via urination. However, Chai Ling Tang was originally designed for scanty urination. If urination is normal but thirst with desire to drink persists, the pathogen has transmitted to the Yangming Stomach channel; Chai Hu Shao Yao Tang (Bupleurum and Peony Decoction) is appropriate. Zhongjing stated, "A wiry and rapid pulse indicates 'wind generation'; stop it through dietary management." A wiry and rapid pulse signifies extreme heat generating wind, which attacks Earth (Spleen/Stomach) and damages fluids, transmitting from Shaoyang to Yangming. With both channels involved, heat intensifies. Food should be used to quickly curb the heat rather than relying solely on medicine. Pear juice and sugarcane syrup are foods that generate fluids. As the *Neijing* states, "For wind rampant internally, treat with sweet and cold substances." Without these, heat moving to the Stomach will likely transmit to the Lungs, resulting in Dan Nue (Feverish Malaria) characterized by fever without chills, or to the Pericardium, resulting in Mu Nue (Cold Malaria) with more chills than fever. One must be cautious.
After the malaria paroxysms cease, if the pulse is fine and weak, Er Mu Bu Zhong Tang (Anemarrhena and Belamcanda Tonifying Middle Decoction) is suitable. If phlegm and food stagnation remain, Liu Jun Zi Jian Pi Tang (Six Gentlemen Spleen-Strengthening Decoction) or Zisheng Wan (Nourishing Life Pill) may be used. If tonification fails, then antimalarial interception methods can be employed. Antimalarial herbs should be selected based on Qi and Blood aspects. For predominant heat and rapid pulse, warm tonification is contraindicated; Chai Hu Si Wu Tang (Bupleurum Four Substances Decoction) is suitable, with W Mei (Mume Fructus) and He Shou Wu (Polygoni Multiflori Radix Praeparata) being highly effective. For predominant chills and slow pulse, Liu Jun Zi Tang (Six Gentlemen Decoction) with five qian of Ren Shen (Ginseng Radix) is appropriate. This is an interception achieved without direct interception. Generally, antimalarial methods aim to consolidate Qi and Blood. In robust individuals, after three to five paroxysms when the malaria trend subsides, interception may still be used. In deficient individuals, however, Qi mechanisms are chaotic, and deficient Qi fails to return to its root; forced interception causes stagnation elsewhere, often leading to abdominal distension. This must be carefully observed.
Although most malaria cases are heat-type, some are cold-type; one must not rigidly assume all are heat. Cases involving sleeping exposed to wind and dew, or bathing in cold water, result in Yin pathogens lodging in Ying and Wei, causing predominant chills and mild fever with a surging, wiry, yet powerless pulse. (Focus on the word "powerless"). Zhongjing's Chai Hu Jiang Gui Tang (Bupleurum, Ginger, and Cinnamon Twig Decoction) is an excellent prescription. If there is coldness in the chest, aversion to cold, and reduced appetite with a deep, wiry, and fine pulse, the disease is internal; Xiang Sha Li Zhong Tang (Amomum and Aucklandia Regulating Middle Decoction) is indicated. In summary, daily paroxysms are easier to treat; every-other-day or every-three-day paroxysms are harder to cure due to deficient righteous qi, sluggish movement, and delayed confrontation with pathogens. Cases with a one-day pause followed by two consecutive days of paroxysms, or multiple paroxysms in one day, indicate severe righteous qi deficiency and chaotic dispersion, often fatal. Paroxysms occurring in the afternoon shifting to earlier times (before noon) signal impending recovery; those starting before noon and shifting later signal prolonged difficulty in cure. Medication should be taken before the onset of paroxysms, as administering during the attack when Qi mechanisms are chaotic is ineffective. Diet should be introduced only after the fever subsides and the body cools for one to two hours. Eating while still carrying heat often leads to "Malaria Mother" (splenic enlargement/mass). Rich, greasy, and strong-flavored foods must be strictly avoided. (These are essential words on regulation.)
"Malaria Mother" refers to old phlegm and food stagnation lodged under the hypochondrium, palpable as a mass, persisting for years. The pulse is wiry, fine, and weak, making differentiation of deficiency and excess difficult. The general rule is: if the mass is hard and large, with no external signs of deficiency, but the pulse is deep and fine indicating Qi stagnation preventing expulsion, Chai Chen Nian Tong Tang (Bupleurum and Tangerine Peel Pain-Relieving Decoction) is suitable. If there is fatigue, preference for lying down, low voice, and reduced diet, Xiang Sha Liu Jun Zi Tang (Amomum and Aucklandia Six Gentlemen Decoction) is used to greatly tonify Yuan Qi. Do not mistakenly use attacking methods that damage Stomach Qi. This distinction is crucial.
Dan Nue (Feverish Malaria) is heat-malaria, featuring fever without chills. If the pulse is slippery with stagnation, resolve food; if urination is scanty, promote diuresis; if wiry, rapid, and thirsty, generate fluids. Do not indiscriminately use major cold agents. (Accurate syndrome differentiation ensures effective medication.) Only in cases of extreme thirst with copious drinking, profuse sweating, and a surging, large pulse, is Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) indispensable for recovery. This represents combined Shaoyang-Yangming pathology transmitting to the Lungs.
Mu Nue (Cold Malaria) is cold-malaria, with predominant chills and slight fever (e.g., seven parts cold, three parts heat). Many texts claim pure cold without heat, which is erroneous. This is combined Shaoyang-Yangming pathology transmitting to the Heart. Pathogens enter the Pericardium, shaking the capital; whole-body fluids rally inward to support, wrapping the pathogens within the Pericardium, rejected by the exterior, causing more chills than fever. Although the surface feels slightly cold, the Danzhong (Chest Center) is full of pathogenic heat; internally true heat, externally false cold. Chai Chen Tang (Bupleurum and Tangerine Peel Decoction) added with Xing Ren (Armeniacae Semen) and Shi Chang Pu (Acori Tatarinowii Rhizoma) is best.
Jiajian Baidu San (Modified Detoxification Powder)
Qiang Huo (Notopterygii Rhizoma et Radix), Du Huo (Angelicae Pubescentis Radix), Chai Hu (Bupleuri Radix), Qian Hu (Peucedani Radix), Gan Ge (Puerariae Radix), Chuan Xiong (Chuanxiong Rhizoma), Ban Xia (Pinelliae Rhizoma), Zhi Ke (Aurantii Fructus Immaturus), Jie Geng (Platycodonis Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma).
Xiong Su Chai Chen Tang (Ligusticum, Perilla, Bupleurum, and Tangerine Peel Decoction)
Chuan Xiong (Chuanxiong Rhizoma), Zi Su (Perillae Folium), Chai Hu (Bupleuri Radix), Huang Qin (Scutellariae Radix), Ban Xia (Pinelliae Rhizoma), Gan Cao (Glycyrrhizae Radix et Rhizoma), Chen Pi (Citri Reticulatae Pericarpium), Bai Fu (Poria).
If sweating occurs but fever does not resolve, the pathogen has not dispersed; thus, this formula is used for mild resolution. If fatigued and listless, with chest stuffiness and a fine, weak pulse, directly use Liu Jun Zi Jian Pi Tang (Six Gentlemen Spleen-Strengthening Decoction).
Chai Chen Hua Zhi Tang (Bupleurum and Tangerine Peel Stagnation-Resolving Decoction)
Chai Hu (Bupleuri Radix), Huang Qin (Scutellariae Radix), Ban Xia (Pinelliae Rhizoma), Gan Cao (Glycyrrhizae Radix et Rhizoma), Chen Pi (Citri Reticulatae Pericarpium), Bai Fu (Poria), Zhi Ke (Aurantii Fructus Immaturus), Hou Po (Magnoliae Officinalis Cortex), Shan Zha (Crataegi Fructus), Chi Shao (Paeoniae Radix Rubra).
Er Mu Chai Ling Tang (Anemarrhena, Belamcanda, Bupleurum, and Poria Decoction)
Zhi Mu (Anemarrhenae Rhizoma), Bei Mu (Fritillariae Thunbergii Bulbus), Chai Hu (Bupleuri Radix), Huang Qin (Scutellariae Radix), Ban Xia (Pinelliae Rhizoma), Gan Cao (Glycyrrhizae Radix et Rhizoma), Chi Fu (Poria), Ze Xie (Alismatis Rhizoma), Chi Shao (Paeoniae Radix Rubra).
Chai Hu Shao Yao Tang (Bupleurum and Peony Decoction)
Chai Hu (Bupleuri Radix), Huang Qin (Scutellariae Radix), Hua Fen (Trichosanthis Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma), Bai Shao (Paeoniae Radix Alba), Mai Dong (Ophiopogonis Radix), Zhi Mu (Anemarrhenae Rhizoma).
Er Mu Bu Zhong Tang (Anemarrhena and Belamcanda Tonifying Middle Decoction)
Zhi Mu (Anemarrhenae Rhizoma), Bei Mu (Fritillariae Thunbergii Bulbus), Ren Shen (Ginseng Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Huang Qi (Astragali Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma), Dang Gui (Angelicae Sinensis Radix), Chen Pi (Citri Reticulatae Pericarpium), Sheng Ma (Cimicifugae Rhizoma), Chai Hu (Bupleuri Radix).
Zisheng Wan (Nourishing Life Pill) - See Dysentery section.
Jiawei Chai Wu Tang (Modified Bupleurum and Four Substances Decoction)
Chai Hu (Bupleuri Radix), Huang Qin (Scutellariae Radix), Ban Xia (Pinelliae Rhizoma), Gan Cao (Glycyrrhizae Radix et Rhizoma), Dang Gui (Angelicae Sinensis Radix), Chuan Xiong (Chuanxiong Rhizoma), Bai Shao (Paeoniae Radix Alba), Shu Di (Rehmanniae Radix Praeparata), He Shou Wu (Polygoni Multiflori Radix Praeparata), Zhi Mu (Anemarrhenae Rhizoma), Mai Dong (Ophiopogonis Radix), Wu Mei (Mume Fructus). (For San Yin Malaria, this achieves interception without direct interception).
Chai Hu Jiang Gui Tang (Bupleurum, Ginger, and Cinnamon Twig Decoction)
Chai Hu (Bupleuri Radix), Huang Qin (Scutellariae Radix), Ban Xia (Pinelliae Rhizoma), Gan Cao (Glycyrrhizae Radix et Rhizoma), Gan Jiang (Zingiberis Rhizoma), Gui Zhi (Cinnamomi Ramulus), Hou Po (Magnoliae Officinalis Cortex), Shan Zha (Crataegi Fructus), Chen Pi (Citri Reticulatae Pericarpium).
Chai Chen Nian Tong Tang (Bupleurum and Tangerine Peel Pain-Relieving Decoction)
Chai Hu (Bupleuri Radix), Huang Qin (Scutellariae Radix), Ban Xia (Pinelliae Rhizoma), Gan Cao (Glycyrrhizae Radix et Rhizoma), Chen Pi (Citri Reticulatae Pericarpium), Bai Fu (Poria), Zhi Ke (Aurantii Fructus Immaturus), Hou Po (Magnoliae Officinalis Cortex), Xuan Ming Fen (Mirabilite), Xiang Fu (Cyperi Rhizoma), Bie Jia (Testudinis Carapax et Plastrum), Gui Wei (Angelicae Sinensis Radix), Chi Shao (Paeoniae Radix Rubra).
Xiang Sha Liu Jun Zi Tang (Amomum and Aucklandia Six Gentlemen Decoction)
Ren Shen (Ginseng Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Bai Fu (Poria), Gan Cao (Glycyrrhizae Radix et Rhizoma), Ban Xia (Pinelliae Rhizoma), Chen Pi (Citri Reticulatae Pericarpium), Huo Xiang (Agastaches Herba), Xiang Fu (Cyperi Rhizoma), Sha Ren (Amomi Fructus).
For severe chills, add Jiang (Ginger) and Gui (Cinnamon Twig).
Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction)
Mai Dong (Ophiopogonis Radix), Zhi Mu (Anemarrhenae Rhizoma), Shi Gao (Gypsi Fibrosus), Ren Shen (Ginseng Radix), Jing Mi (Oryza Sativa), Deng Xin Cao (Junci Medulla), Sheng Jiang (Zingiberis Rhizoma Recens), Zhu Ye (Bambusae Folium).
Combine with Xiao Chai Hu Tang (Minor Bupleurum Decoction) for better effect. (Note: Particularly effective for treating Dan Nue).