魄汗未尽，形弱而气烁，穴俞已闭，发为风疟。（见生气通天论）秋善病风疟。（全文见五脏。）夏暑汗不
出者，秋成风疟。
〔《素》〕黄帝问曰∶夫 疟皆生于风，其蓄作有时者，何也？岐伯曰∶疟之始发也，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，渴欲饮冷。帝曰∶何气使然，愿闻其道？岐伯对曰∶
阴阳上下交争，虚实更作，阴阳相移也。阳并于阴，则阴实而阳虚。阳明虚，则寒栗鼓颔也。巨阳虚，则腰背
头项痛。三阳俱虚，则阴气胜，阴气胜，则骨寒而痛。寒生于内，故中外皆寒。阳盛则外热，阴虚则内热，内
外皆热，则喘而渴，故饮冷也。此皆得之夏伤于暑，热气盛，藏于皮肤之内，肠胃之外，此荣气之所舍也。此
令人汗空疏，腠理开，因得秋气，汗出遇风，及得之以浴，水气舍于皮肤之内，与卫气并居。卫气者，昼日行
于阳，夜行于阴，此气得阳而外出，得阴而内薄，内外相薄，是以日作。帝曰∶其间日而作者，何也？歧伯曰∶
其气之舍深，内薄于阴，阳气独发，阴邪内着，阴与阳争不得出，是以间日而作也。帝曰∶善。其作日晏与其
日早者，何气使然也？歧伯曰∶邪气客于风府，循膂而下，卫气一日一夜大会于风府，其明日日下一节，故其
作也晏，此先客于脊背也，每至于风府，则腠理开，腠理开则邪气入，邪气入则病作，以此作日稍益晏也。其
出于风府，日下一节，二十五日（“五”一作“一”。）下至 骨，二十六日（“六”一作“二”，）入于脊内，
注于伏膂（一作“伏中”。）之脉，其气上行，九日出于缺盆之中，其气日高，故作日益早也。其间日发者，
由邪气内薄于五脏，横连募原也，其道远，其气深，其行迟，不能与卫气俱行，不得皆出，故间日乃作也。
（《灵枢》经云∶疟者内簿于五脏，横连募原，其道远，其气深，其行迟，不能日作，故次日乃蓄积而作焉。
详“蓄积”二字，则作一日之义明矣。始明邪气未盛，未与卫气相当，故未作，必候蓄积与卫气相当，故作焉。）
帝曰∶夫子言卫气每至于风府，腠理乃发，发则邪气入，入则病作。今卫气日下一节，其气之始发也，不
当风汗，其日作者奈何？歧伯曰∶此邪气客于头项，循膂而下者也。故虚实不同，邪中异所，则不得当其风府
也。故邪中于头项者。气至头项而病。中于背者，气至背而病。中于腰脊者，气至腰脊而病。中于手足者，气
至手足而病。卫气之所在，与邪气相合，则病作。故风无常府，卫气之所发，必开其腠理，邪气之所舍，则其
府也。帝曰；疟先寒而后热者，何也？歧伯曰∶夏伤于大暑，其汗大出，腠理开发，因遇夏气凄沧之水寒，藏
于腠理皮肤之中，秋伤于风，则病成矣。夫寒者，阴气也。风者，阳气也。先伤于寒，而后伤于风，故先寒而
后热也，病以时作，名曰寒疟。帝曰∶先热而后寒者，何也？此先伤于风，而后伤于寒，故先热而后寒也，亦
以时作，名曰温疟。帝曰∶夫病温疟与寒疟，而皆安舍，舍于何藏？岐伯曰∶温疟得之冬中于风，寒气藏于骨
髓之中，至春则阳气大发，邪气不能自出，因遇大暑，脑髓烁，肌肉消，腠理发泄，或有所用力，邪气与汗皆
出，此病藏于肾，其气先从内出之于外者也。如是者，阴虚而阳盛，阳盛则热矣，衰则气复反入，入则阳虚，
阳虚则寒矣。故先热而后寒，名曰温疟。其但热不寒者，阴气先绝，阳气独发，则少气烦冤，手足热而欲呕，
名曰瘅疟。帝曰∶瘅疟何如？岐伯曰∶瘅疟者，肺素有热，气盛于身，厥逆上冲，中气实而不外泄，因有所用
力，腠理开，风寒舍于皮肤之内分肉之间而发，发则阳气盛，阳气盛而不衰则病矣。其气不及于阴，故但热而
不寒，气内藏于心，而外舍于分肉之间，令人消烁肌肉，故名曰瘅疟。帝曰∶疟未发，其应何如？歧伯曰∶
疟气者，必更盛更虚，当气之所在也，病在阳则热而脉躁，在阴则寒而脉静，极则阴阳俱衰。卫气相离，故病
得休，卫气集，则复病也。
卫与邪相并则病作，与邪相离则病休。其并于阴则寒，并于阳则热。离于阴则寒已，离于阳则热已。至
次日又集而并合，则复病也。
帝曰∶时有间二日，或至数日发，或渴或不渴，其故何也？岐伯曰∶其间日者，邪气与卫气客于六腑，而
有时相失，不能相得，故休数日乃作也。疟者，阴阳更胜也，或甚或不甚，故或渴或不渴。（以上俱疟论篇）
帝曰∶火热复，恶寒发热，有如疟状，或一日发，或间数日发，其故何也？岐伯曰∶胜复之气，会遇之时
有多少也。阴气多而阳气少，则其发日远。阳气多而阴气少，则其发日近。此胜复相薄，盛衰之节也。疟亦同
法。（至真要大论）
帝曰∶论言夏伤于暑，秋必病疟，今疟不必应者，何也？岐伯曰∶此应四时者也。其病异形者，反四时也。
其以秋病者寒甚，以冬病者寒不甚，以春病者恶风，以夏病者多汗。帝曰∶夫风之与疟，相似同类，而风独常
在，疟则有时而休者，何也？岐伯曰∶风气留其处，故常在。疟气随经络沉以内薄，故卫气应乃作。（疟论篇）
〔《保》〕夏伤于暑，秋必病疟。盖伤之浅也，近而暴。伤之重也，远而深。 疟者，久疟也。是知夏伤于
暑，湿热闭藏，而不能发泄于外，邪气内行，至秋而发为疟也。初不知何经受病，随其受而取之。有中三阳者，
有中三阴者。大抵经中邪气，其症各殊，同伤寒治之也。故《内经》曰∶五脏皆有疟，其治各别。在太阳经者，
谓之风疟，治多汗之。在阳明经者，谓之热疟，治多下之。在少阳经者，谓之风热疟，治多和之。此三阳受病，
皆谓暴疟也。发在夏至后处暑前者，此乃伤之浅者，近而暴也。在阴经者，则不分三经，皆谓之温疟，宜以太
阴经论之。其发处暑后冬至前者，此乃伤之重者，远而深也。 疟者，老疟也，故谓之久疟。
桂枝羌活汤 治疟病处暑前后，头痛项强，脉浮，恶风有汗。
桂枝 羌活 防风 甘草（炙。各半两）
上为粗末，每服半两，水一盏半，煎至一盏，温服，迎发日服。吐者加半夏曲。
疟疾头痛项强，脉浮，恶风无汗者，宜麻黄羌活汤。
麻黄 羌活 防风 甘草（炙。各半两）
上同前服法。如吐，加半夏曲等分。
治疟病身热目痛，热多寒少，脉长，睡卧不安，先以大柴胡汤下之，微利为度。如下过外微邪未尽者，宜
白芷汤以尽其邪。
白芷汤
白芷 知母（各一两） 石膏（四两）
上为粗末，同前服法。
治疟无他症，隔日发，先寒后热，寒少热多，宜桂枝石膏汤。
桂枝（五钱） 石膏 知母（各一两半） 黄芩（一两）
上为粗末，分作三服，水半盏，同煎服。间日者，邪气所舍深也，如外邪已罢，内邪未已，再下之。从卯
至午发者，宜大柴胡汤下之。从午至酉者，知邪在内也，宜大承气汤下之。从酉至子发者，或至寅时发者，
知邪在血也，宜桃仁承气汤下之。前项下药，微利为度，以小柴胡汤彻其微邪之气。
治疟寒热大作，不论先后，此太阳阳明合病也，谓之交争，寒热作则必战动。经曰∶热胜则动也，发热则必
汗泄。经云∶汗出不愈，知为热也。阳盛阴虚之证，治当内实外虚，不治，恐久而传入阴经也，宜桂枝芍药汤
主之。
桂枝（二钱） 黄 知母 芍药 石膏（各半两）
上为粗末，五七钱，用水煎。
如前药服之，寒热转大者，知太阳阳明少阳三阳合病也，宜桂枝黄芩汤以和之。
甘草（四钱半） 石膏（五钱） 知母（五钱） 桂枝（二钱） 柴胡（一两二钱） 黄芩（四
钱半） 人参（四钱半） 半夏（四钱）
上为粗末，同煎服，服后如外邪已罢，内邪未已，用大柴胡、大承气等汤下之。
治处暑后冬至前后疟，其法并于久疟法求之。
〔《局方》〕双解饮子 治疟疾，辟瘴气，神效。
肉豆蔻 草豆蔻（各二个。一个用水和面裹煨，一个生用） 浓朴（二寸，一半用生姜汁浸炙，一半生用）
甘草（大者二两，一半炙，一半生用） 生姜（二块，如枣大一块，湿纸裹煨，一块生用）
上各 咀。每服分一半，用水一碗，煎至一大盏，去渣，空心温服。（东垣云∶秋暮暑气衰，病热疟，知其
寒也。局方用双解饮子是已，知此方治寒疟也。）
〔《保》〕治发疟如前症，是夜发者，麻黄黄芩汤主之。
麻黄（一两，去节） 甘草（炙，三钱） 桃仁（三十枚，去皮） 黄芩（五钱） 桂（二钱半）
上为细末，根据前服法。桃仁味苦甘辛，肝者血之海，血受邪则肝气燥，经所谓肝苦急，急食甘以缓之，故
桃仁散血缓肝，谓邪气深远而入血，故夜发，乃阴经有邪，此汤发散血中风寒之剂。
〔世〕桃仁承气汤 治夜疟有实热者。（方见伤寒。）
治先热后寒者，小柴胡汤。先寒后热者，小柴胡加桂枝汤。多热但热者，白虎加桂枝汤。多寒但寒者，柴
胡桂姜汤。（此以疟之寒热多少定治法也。若多寒而但有寒者，其脉或洪实或滑，当作实热治之。若便用桂
枝，误也。如或多热而但有热者，其脉或空虚或微弱，当作虚寒治之。若便用白虎汤，亦误也。所以欲学人必先问
其寒热，或热多热少，或寒多寒少，又诊脉以参之，百无一失矣。）小柴胡加桂汤，治疟先寒后
热。（方见伤寒。）小柴胡汤，治疟先热后寒。
〔仲〕温疟者，其脉如平，身无寒但热，骨节疼烦，时便难，白虎加桂枝汤主之。（《脉经》云∶朝发暮解，
暮发朝解。）
知母（六两） 甘草（二两，炙） 石膏（一斤） 粳米（二合） 桂（去皮，三两）
上锉每服五分，水一盏，煎八分，去渣温服，出汗愈。
柴胡桂姜汤 治疟寒多微有热，或寒不热。（方见伤寒。）
疟多寒者，名曰牡疟，蜀漆散主之。
蜀漆（烧去腥） 云母（烧三日夜） 龙骨（等分）
上三味，捣为散，未发前以浆水服半钱匕。如温疟，加蜀漆一钱，临发时服一钱匕。
牡蛎汤 治牡疟。
牡蛎（四两，炙） 麻黄（去节，三两） 甘草（二两） 蜀漆（三两）
上四味，以水八升，先煮蜀漆、麻黄，去上沫，得六升，内诸药，煮取二升，温服一升。若吐，则勿更服。
柴胡去半夏加栝蒌汤 治疟病后渴者，亦治劳疟。
柴胡（八两） 人参 黄芩（各三两） 栝蒌根（四两） 生姜（二两） 大枣（十二枚） 甘草（炙，三两）
上七味，以水一斗二升，煮取六升，去渣，再煎，取三升，温服一升，一日两三服。
〔丹〕疟有风，有暑，有食，有痰。
三日一发者，受病一年。间日一发者，受病半年。一日一发者，受病一月。二日连发住一日者，气血俱受病。
一日间日者，补药带表药，后用截疟丹截之。在阴分者，用药彻起阳分，方可用截方。
常山 草果 槟榔 知母 乌梅 穿山甲（炒） 甘草（炙）
用水酒各一大碗，煎至半碗，露一宿，临发前二时温服之。如吐则勿服之。
大法 暑风必当发汗。夏月多在风凉处歇，遂闭汗而不泄，因食者，必从饮食将息。疟而虚者，须先用参、
术一二帖，托住其气，不使下陷，后用他药治内伤，挟外邪者同法。内必生痰，必以汗解，二陈汤加柴胡、
常山、黄芩。疟而甚者，发寒热，头痛如破，渴而饮水，自汗，可与
人参 黄 白术 黄连 黄芩 栀子 川芎 苍术 半夏 天花粉 水煎服。
一丈夫疟，脉弦细，每日近午发，此风寒也。
白术 柴胡 青皮 半夏 苍术（二钱） 麻黄 木通（一钱半） 桂（一钱） 甘草
何氏子年二十岁，疟间日作，头痛恶寒为甚。
麻黄（一钱） 白术（五钱） 青皮（三钱） 木通（七钱） 苍术（二钱） 桂皮（一钱半） 半夏（
五钱） 炙甘草（三钱）
小娘患疟，汗，但未到下体。
白术（二钱） 麻黄 知母（一钱） 半夏（一钱半） 人参 桂枝（半钱）
分二帖，姜三片，水二盏半，煎至半盏，露星月下一夜，次日早空心热服。
陈一之子二岁，间日疟。
麻黄（五分） 白术（二钱） 苍术（一钱半） 陈皮（一钱） 半夏（一钱） 木通（一钱）
甘草（炙些）
何主首二十岁，疟间两日作，寒自足起，发时口渴，身痛头痛，服已有汗。
麻黄（半分） 黄 白术（炒） 青皮（二钱） 芍药 苍术（二钱） 木通（一钱） 炙甘草（三钱）
柴胡（一钱）
王舅疟，左弦甚，右略涩，将退时有汗。
人参（一两） 半夏（一两） 白术 柴胡（各六钱） 苍术 青皮（各五钱） 木通（一两） 甘草（些）
分五帖，煎服三之一，去渣，入姜汁半杯，露一夜，次早温服之。
王孺人旧患疟疾，因劳心力又发，今骨节疼痛，恶心食少，与此方。
人参（五钱） 白术（一两半） 苍术（一两） 陈皮（一两） 川芎 当归 木通（各七钱） 甘草
（一钱）
分六帖，姜三片。
冯官人发疟，脉弦有汗。
[Background Information]
Book: *Medical Outline* (Yixue Gangmu)
Author: Lou Ying
Dynasty: Ming
Chapter: Malaria Chills and Fever (Part 1/2)
Category: Medical Theory
[English Translation]
If the body's sweat is not fully discharged, the form becomes weak and the vital energy is scorched, the acupoints and pores are already closed, wind malaria will develop. (See *Suwen: Treatise on Shengqi Tongtian*). In autumn, one is prone to wind malaria. (The full text is in *Wuzang*). If summer heat causes sweating but no sweat is released, wind malaria will form in autumn.
*[Suwen: Treatise on Malaria]* The Yellow Emperor asked: "Malaria is all caused by wind pathogen, yet its accumulation and发作 (onset) occur at specific times. Why is this?" Qibo replied: "When malaria first begins, it starts with the standing of fine hairs, followed by stretching and yawning. Then chills and trembling occur, with the jaw quivering, and pain in the waist and spine. When the cold subsides, both interior and exterior become hot, causing headache as if splitting, thirst, and a desire to drink cold water." The Emperor said: "What qi causes this? I wish to hear the principle." Qibo answered: "It is the contention between Yin and Yang above and below, the alternation of deficiency and excess, and the shifting of Yin and Yang. When Yang merges into Yin, Yin becomes excess and Yang becomes deficient. Deficiency of Yangming leads to chills and jaw quivering. Deficiency of Juyang (Taiyang) leads to pain in the lower back, back, head, and neck. When all three Yang meridians are deficient, Yin qi prevails; when Yin qi prevails, the bones become cold and painful. Cold originates from within, hence both interior and exterior feel cold. Excess Yang leads to external heat, while deficiency Yin leads to internal heat. When both interior and exterior are hot, panting and thirst occur, hence the desire to drink cold water. All these result from summer injury by summer heat. The heat qi is abundant, hiding inside the skin and outside the stomach/intestines, where Ying Qi resides. This causes sweat pores to be loose and interstices open. Consequently, autumn qi enters; upon sweating and encountering wind, or bathing, water qi settles inside the skin, residing together with Wei Qi. Wei Qi travels through Yang during the day and Yin at night. This pathogen goes out with Yang and presses inward with Yin. The mutual pressing of interior and exterior causes daily onset." The Emperor said: "Why do some cases occur every other day?" Qibo said: "Because the pathogen resides deeply, pressing inward toward Yin. Yang qi alone issues forth, while Yin pathogen adheres internally. Yin and Yang contend but cannot exit, hence the every-other-day onset." The Emperor said: "Excellent. Why do some cases start later each day, and others earlier? What qi causes this?" Qibo said: "The pathogen lodges in Fengfu, descending along the Du meridian. Wei Qi gathers at Fengfu once a day and night. The next day, it descends one vertebral segment, so the onset is delayed. This is because the pathogen first lodged in the back. Whenever it reaches Fengfu, the interstices open; when they open, the pathogen enters; when it enters, the disease acts. Thus, the onset time gradually delays. From Fengfu, it descends one segment daily. After twenty-five days ('five' is read as 'one' in some versions), it reaches the bone. On the twenty-sixth day ('six' is read as 'two'), it enters the spine, pouring into the Fulu (or Fuzhong) vessels. The qi ascends and emerges from Quepen after nine days. As the qi rises higher, the onset becomes progressively earlier. Cases occurring every other day occur because the pathogen presses inward to the five Zang organs and horizontally connects to the Mu Yuan (Diaphragm). The path is long, the qi is deep, and its movement is slow. It cannot travel with Wei Qi and cannot fully exit, hence it occurs every other day. (*Lingshu* states: 'Malaria pathogen presses inward to the five Zang and horizontally connects to Mu Yuan. The path is long, the qi is deep, and movement is slow, so it cannot occur daily. It accumulates and acts the next day.' Examining the term 'accumulate' clarifies that it acts after one day. Initially, the pathogen is not strong enough to match Wei Qi, so it does not act. It must wait until it accumulates to match Wei Qi before acting.")
The Emperor said: "You stated that whenever Wei Qi reaches Fengfu, the interstices open, allowing the pathogen to enter and cause disease. Now, since Wei Qi descends one segment daily, and the initial onset may not be at Fengfu, why do some cases occur daily?" Qibo said: "This is because the pathogen lodges in the head and neck, descending along the Du meridian. Therefore, depending on deficiency/excess and the site of invasion, it does not necessarily manifest at Fengfu. If the pathogen invades the head/neck, disease occurs when Wei Qi reaches there. If it invades the back, disease occurs when Wei Qi reaches the back. If it invades the waist/spine, disease occurs when Wei Qi reaches there. If it invades the limbs, disease occurs when Wei Qi reaches there. Wherever Wei Qi is, and where it combines with the pathogen, the disease acts. Thus, Wind has no fixed 'Fengfu' (gate/site); wherever Wei Qi issues and opens the interstices, and where the pathogen resides, that is its gate." The Emperor said: "Why does malaria sometimes present with chills first and then fever?" Qibo said: "Summer injury by severe heat causes profuse sweating and open interstices. If one encounters cold water/qi in summer, the cold hides in the interstices and skin. Autumn injury by wind completes the disease. Cold is Yin qi; Wind is Yang qi. Injury by cold first, then wind, results in chills first, then fever. Occurring at set times, it is named Cold Malaria." The Emperor said: "Why fever first and then chills?" Qibo said: "Injury by wind first, then cold, results in fever first, then chills. Occurring at set times, it is named Warm Malaria." The Emperor said: "Where do Warm Malaria and Cold Malaria lodge, and in which Zang organ?" Qibo said: "Warm Malaria results from winter wind injury. Cold qi hides in the marrow. In spring, Yang qi expands greatly, but the pathogen cannot exit. Encountering great summer heat, the brain marrow is scorched, muscles waste, and interstices open. With exertion, the pathogen exits with sweat. This disease lodges in the Kidney, with qi issuing from interior to exterior. In such cases, Yin is deficient and Yang is excessive. Excess Yang causes heat. When it declines, qi returns inward, causing Yang deficiency and cold. Hence, chills follow fever, named Warm Malaria. Cases with only heat and no chills occur when Yin qi is exhausted and Yang qi issues alone. This causes shortness of breath, vexation, heat in hands/feet, and nausea, named Dan Malaria (Cao Malaria)." The Emperor said: "Describe Dan Malaria." Qibo said: "Dan Malaria patients have latent lung heat, with abundant qi in the body. Rebellious qi rushes upward, middle jiao is full but cannot vent. With exertion, interstices open, and wind-cold lodges between skin and muscle layers. Upon onset, Yang qi becomes excessive. If Yang remains excessive without decline, disease persists. The qi does not reach Yin, hence only heat, no chills. The qi stores in the Heart and lodges externally in the muscle layers, wasting muscles, hence named Dan Malaria." The Emperor said: "What is the response when malaria has not yet started?" Qibo said: "Malaria qi alternates between excess and deficiency. Wherever the qi is located: if in Yang, there is heat and rapid pulse; if in Yin, there is chills and quiet pulse. At the extreme, both Yin and Yang decline. Wei Qi separates from the pathogen, so the disease rests. When Wei Qi gathers, the disease recurs."
When Wei Qi combines with the pathogen, disease acts; when it separates, disease rests. Combining with Yin causes chills; combining with Yang causes heat. Separating from Yin stops chills; separating from Yang stops heat. On the next day, they gather and combine again, causing recurrence.
The Emperor said: "Sometimes it occurs every two days, or several days. Some are thirsty, some are not. Why?" Qibo said: "In every-other-day cases, the pathogen and Wei Qi reside in the Six Fu organs but sometimes miss each other, failing to interact, hence resting for several days before acting. Malaria is the alternating victory of Yin and Yang. Sometimes severe, sometimes mild, hence sometimes thirsty, sometimes not. (From *Treatise on Malaria*)"
The Emperor said: "Fire and heat repeat, with aversion to cold and fever, resembling malaria. Sometimes daily, sometimes every few days. Why?" Qibo said: "The meeting of Victory and Repayment Qi varies in quantity. More Yin and less Yang means distant onset intervals. More Yang and less Yin means close onset intervals. This is the thin interaction of Victory and Repayment, the rhythm of abundance and decline. Malaria follows the same law. (From *Zhizhen Yao Da Lun*)"
The Emperor said: "Texts say summer heat injury leads to autumn malaria. Now, malaria does not always correspond. Why?" Qibo said: "This corresponds to the Four Seasons. Diseases with different forms violate the seasons. Autumn onset indicates severe cold. Winter onset indicates mild cold. Spring onset indicates wind aversion. Summer onset indicates profuse sweating." The Emperor said: "Wind and Malaria are similar and of the same category. Why is Wind constant, while Malaria has intervals?" Qibo said: "Wind pathogen stays in its location, hence constant. Malaria qi sinks along meridians and presses inward, hence it acts only when Wei Qi responds. (From *Treatise on Malaria*)"
*[Baoming Ji]* Summer heat injury leads to autumn malaria. Light injury is near and sudden. Heavy injury is distant and deep. Malaria refers to chronic malaria. Thus, summer heat injury causes damp-heat to hide and fail to vent outward. Pathogen moves inward and manifests in autumn. Initially, one does not know which meridian is affected; treat according to the affected meridian. Some affect the Three Yang meridians; some affect the Three Yin meridians. Generally, pathogens in the meridians present with distinct symptoms, treated similarly to Cold Damage. Thus, *Neijing* states: "All five Zang organs have malaria, with distinct treatments." In Taiyang, it is called Wind Malaria, treated mostly with sweating. In Yangming, it is called Heat Malaria, treated mostly with purging. In Shaoyang, it is called Wind-Heat Malaria, treated mostly with harmonizing. These Three Yang diseases are called Acute Malaria. Onset after Summer Solstice and before End of Heat indicates light injury, near and sudden. In Yin meridians, regardless of the specific meridian, it is called Warm Malaria, discussed under Taiyin. Onset after End of Heat and before Winter Solstice indicates heavy injury, distant and deep. Malaria here refers to old/chronic malaria, hence called Long-term Malaria.
**Guizhi Qianghuo Tang**: Treats malaria around End of Heat, with headache, stiff neck, floating pulse, wind aversion, and sweating.
Ingredients: Guizhi (Cinnamon Twig), Qianghuo (Notopterygii Rhizoma), Fangfeng (Saposhnikoviae Radix), Gancao (Licorice Root, honey-fried). Each half liang.
Preparation: Coarse powder. Take half liang per dose, add 1.5 cups water, boil to 1 cup. Take warm. Administer before expected onset. Add Banxia Qu (Pinellia Fermented Powder) if vomiting.
For malaria with headache, stiff neck, floating pulse, wind aversion, and NO sweating, use **Mahuang Qianghuo Tang**.
Ingredients: Mahuang (Ephedrae Herba), Qianghuo, Fangfeng, Gancao (honey-fried). Each half liang.
Preparation: Same as above. Add equal parts Banxia Qu if vomiting.
For malaria with body heat, eye pain, more heat than chills, long pulse, and restlessness, first purge with **Dachaihu Tang**, aiming for mild diarrhea. If exterior pathogen remains after purging, use **Baizhi Tang** to clear remaining pathogen.
**Baizhi Tang**
Ingredients: Baizhi (Angelicae Dahuricae Radix), Zhimu (Anemarrhenae Rhizoma). Each 1 liang. Shigao (Gypsum Fibrosum). 4 liang.
Preparation: Coarse powder. Same method as above.
For malaria with no other symptoms, every-other-day onset, chills first then heat, less chills more heat, use **Guizhi Shigao Tang**.
Ingredients: Guizhi (5 qian). Shigao, Zhimu (each 1.5 liang). Huangqin (Scutellariae Radix) (1 liang).
Preparation: Coarse powder. Divide into three doses. Add 0.5 cup water, decoct together. For every-other-day cases, pathogen resides deeply. If exterior pathogen is resolved but interior remains, purge again. Onset from Mao to Wu hours: Purge with Dachaihu Tang. Onset from Wu to You hours: Pathogen is interior, purge with Dachengqi Tang. Onset from You to Zi hours, or Yin hours: Pathogen is in Blood, purge with Tao Ren Chengqi Tang. For the above purgatives, aim for mild diarrhea, then use Xiaochaihu Tang to clear residual pathogen.
For severe malaria chills and fever, regardless of order, this is Taiyang-Yangming Combined Disease, called "Contention." Chills and fever cause trembling. Text says: "Heat excess causes movement." Fever causes sweating. Text says: "Sweating without cure indicates Heat." This is Yang Excess and Yin Deficiency. Treatment should address interior excess and exterior deficiency. Without treatment, it may transmit to Yin meridians over time. Use **Guizhi Shaoyao Tang**.
Ingredients: Guizhi (2 qian). Huangqi (Astragali Radix), Zhimu, Shaoyao (Paeoniae Radix Alba), Shigao. Each half liang.
Preparation: Coarse powder. 5-7 qian per dose, decoct in water.
If chills/fever worsen after taking previous medicine, it is Taiyang-Yangming-Shaoyang Three Yang Combined Disease. Use **Guizhi Huangqin Tang** to harmonize.
Ingredients: Gancao (4.5 qian). Shigao (5 qian). Zhimu (5 qian). Guizhi (2 qian). Chaihu (Bupleuri Radix) (1.2 liang). Huangqin (4.5 qian). Renshen (Ginseng Radix) (4.5 qian). Banxia (Pinelliae Rhizoma) (4 qian).
Preparation: Coarse powder. Decoct together. If exterior resolves but interior remains, use Dachaihu Tang or Dachengqi Tang to purge.
For malaria around End of Heat to Winter Solstice, refer to Chronic Malaria methods.
*[Jufang]* **Shuangjie Yinzi**: Treats malaria, dispels miasma, miraculous effect.
Ingredients: Roudoukou (Myristicae Semen), Caodoukou (Cardamomi Fructus). Each 2 pods. One wrapped in dough and baked; one raw. Houpo (Magnoliae Officinalis Cortex) (2 cun). Half soaked in ginger juice and fried; half raw. Gancao (large root, 2 liang). Half fried; half raw. Shengjiang (Zingiberis Rhizoma Recens) (2 pieces, date-sized). One wrapped in wet paper and baked; one raw.
Preparation: Chew/break each ingredient. Take half per dose. Add 1 bowl water, boil to 1 large cup. Strain. Take warm on empty stomach. (Li Dongyuan notes: Late autumn, summer heat fades, treating Heat Malaria implies underlying cold. Jufang's Shuangjie Yinzi is appropriate, indicating this formula treats Cold Malaria.)
*[Baoming Ji]* For malaria with preceding symptoms, if nocturnal onset, use **Mahuang Huangqin Tang**.
Ingredients: Mahuang (1 liang, remove nodes). Gancao (fried, 3 qian). Tao Ren (Peach Kernel) (30 kernels, peel). Huangqin (5 qian). Gui (Cinnamomi Ramulus) (2.5 qian).
Preparation: Fine powder. Follow previous administration. Tao Ren is bitter, sweet, pungent. Liver is the sea of blood. Blood pathogen dries Liver Qi. Text: "Liver dislikes constraint; eat sweet to relax." Thus Tao Ren disperses blood and relaxes Liver. Because pathogen is deep in Blood, onset is nocturnal (Yin meridian pathogen). This formula disperses wind-cold from blood.
*[Shiyi]* **Tao Ren Chengqi Tang**: Treats nocturnal malaria with excess heat. (Formula in *Shanghan Lun*.)
For fever first, chills second: **Xiaochaihu Tang**.
For chills first, fever second: **Xiaochaihu Tang plus Guizhi**.
For much heat, only heat: **Baihu Jia Guizhi Tang**.
For much chills, only chills: **Chaihu Guijin Tang**.
(Note: Treatment depends on the ratio of chills/heat. If much chills but only chills, pulse may be surging/slippery; treat as excess heat. Using Guizhi would be an error. If much heat but only heat, pulse may be empty/weak; treat as deficiency cold. Using Baihu Tang would be an error. Students must ask about chills/heat ratios and check pulses to ensure accuracy.)
**Xiaochaihu Jia Guizhi Tang**: Treats malaria with chills first, fever second. (Formula in *Shanghan Lun*.)
**Xiaochaihu Tang**: Treats malaria with fever first, chills second.
*[Zhang Zhongjing]* **Warm Malaria**: Pulse like normal, body no chills only heat, joint pain/vexation, occasional constipation. Use **Baihu Jia Guizhi Tang**. (*Maibian* says: Morning onset resolves evening; evening onset resolves morning.)
Ingredients: Zhimu (6 liang). Gancao (fried, 2 liang). Shigao (1 jin). Jingmi (Rice) (2 he). Gui (peeled, 3 liang).
Preparation: Cut. Take 5 fen per dose. Add 1 cup water, boil to 8 fen. Strain. Take warm. Sweating indicates cure.
**Chaihu Guijin Tang**: Treats malaria with much chills, slight heat, or chills without heat. (Formula in *Shanghan Lun*.)
Malaria with much chills is named **Mu Malaria**. Use **Shuqi San**.
Ingredients: Shuqi (Burned to remove fishy smell), Yunmu (Cloud Mother Stone, burned for 3 days/nights), Longgu (Fossilized Bones). Equal parts.
Preparation: Powder. Take half a coin-bite with Jiangshui (fermented rice water) before onset. For Warm Malaria, add 1 qian Shuqi. Take 1 coin-bite at onset.
**Muli Tang**: Treats Mu Malaria.
Ingredients: Muli (Oyster Shell, fried, 4 liang). Mahuang (remove nodes, 3 liang). Gancao (2 liang). Shuqi (3 liang).
Preparation: 8 sheng water. Boil Shuqi and Mahuang first, remove foam, get 6 sheng. Add other herbs, boil to 2 sheng. Take 1 sheng warm. If vomiting, stop administration.
**Chaihu Qu Banxia Gua Lou Gen Tang**: Treats thirst after malaria, also Labor Malaria.
Ingredients: Chaihu (8 liang). Renshen, Huangqin (each 3 liang). Gua Lou Gen (Trichosanthis Radix) (4 liang). Shengjiang (2 liang). Dazao (Jujubae Fructus) (12 pieces). Gancao (fried, 3 liang).
Preparation: 12 dou water. Boil to 6 sheng. Strain. Re-boil to 3 sheng. Take 1 sheng warm. 2-3 doses per day.
*[Zhu Danxi]* Malaria can be due to Wind, Summer Heat, Food Stagnation, or Phlegm.
Every 3 days: Ill for 1 year. Every other day: Ill for 6 months. Daily: Ill for 1 month. Two days continuous, one day pause: Qi and Blood both diseased. Daily or every other day: Use tonics with releasing agents, then **Jiemie Dan** to cut the malaria. If in Yin division, lift pathogen to Yang division before using cutting formulas.
Ingredients: Changshan (Dichroae Radix), Caoguo (Tsaoko Fructus), Binglang (Arecae Semen), Zhimu, Wumei (Mume Fructus), Chuanshanjia (Pangolin Scales, fried), Gancao (fried).
Preparation: Water and wine, 1 large bowl each. Boil to half bowl. Leave overnight. Take warm 2 hours before onset. If vomiting, do not take.
General Principles: Summer-Wind requires sweating. Resting in cool breezes in summer closes sweat and prevents release. Diet-related cases require dietary regulation. Deficient malaria requires Renshen and Baizhu for 1-2 doses to support Qi and prevent sinking, then treat internal injury. External pathogen combined uses same method. Internal phlegm must be resolved via sweating: Erchen Tang plus Chaihu, Changshan, Huangqin. Severe malaria with chills/fever, splitting headache, thirst, spontaneous sweating: Use Renshen, Huangqi, Baizhu, Huanglian, Huangqin, Zhizi, Chuanxiong, Cangzhu, Banxia, Tianhuafen. Decoct in water.
Case 1: Husband, string-thin fine pulse, onset near noon. Wind-Cold.
Prescription: Baizhu, Chaihu, Qingpi, Banxia, Cangzhu (2 qian). Mahuang, Mutong (1.5 qian). Gui (1 qian). Gancao.
Case 2: He's son, age 20, every-other-day malaria, severe headache/cold aversion.
Prescription: Mahuang (1 qian). Baizhu (5 qian). Qingpi (3 qian). Mutong (7 qian). Cangzhu (2 qian). Guipi (1.5 qian). Banxia (5 qian). Zhi Gancao (3 qian).
Case 3: Xiao Niang, malaria with sweating, but not reaching lower body.
Prescription: Baizhu (2 qian). Mahuang, Zhimu (1 qian). Banxia (1.5 qian). Renshen, Guizhi (0.5 qian).
Preparation: 2 doses. 3 slices ginger, 2.5 cups water. Boil to 0.5 cup. Leave under stars/moon overnight. Take warm on empty stomach next morning.
Case 4: Chen Yi's son, age 2, every-other-day malaria.
Prescription: Mahuang (0.5 fen). Baizhu (2 qian). Cangzhu (1.5 qian). Chenpi (1 qian). Banxia (1 qian). Mutong (1 qian). Gancao (lightly fried).
Case 5: He Zhushou, age 20, malaria every 2 days, chills starting from feet, thirst/pain/headache at onset, sweating after medication.
Prescription: Mahuang (0.5 fen). Huangqi, Baizhu (stir-fried), Qingpi (2 qian), Shaoyao, Cangzhu (2 qian), Mutong (1 qian), Zhi Gancao (3 qian). Chaihu (1 qian).
Case 6: Wang's Uncle, left pulse very string-like, right slightly choppy, sweating during resolution phase.
Prescription: Renshen (1 liang). Banxia (1 liang). Baizhu, Chaihu (each 6 qian). Cangzhu, Qingpi (each 5 qian). Mutong (1 liang). Gancao (some).
Preparation: 5 doses. Decoct 1/3. Strain. Add 0.5 cup ginger juice. Leave overnight. Take warm next morning.
Case 7: Wang Runren, old malaria relapsed due to mental labor. Joint pain, nausea, poor appetite.
Prescription: Renshen (5 qian). Baizhu (1.5 liang). Cangzhu (1 liang). Chenpi (1 liang). Chuanxiong, Danggui, Mutong (each 7 qian). Gancao (1 qian).
Preparation: 6 doses. 3 slices ginger.
Case 8: Feng Guanren, malaria onset, string-like pulse with sweating.