疫兼痢，发热身痛，渴躁满吐，最为危急，宜槟芍顺气汤∶槟榔、白芍、枳实、
浓朴、大黄，生姜煎服。
疫兼水肿，宜小承气下之。
阳证似阴，外寒而内热，则小便必赤，最易辨也。
阴证似阳，此伤寒有之，瘟病无有也。
《内经》论疟，谓生于风。盖外感风寒，邪在太阳阳明属表，则发热。在少阳属
半表半里，则寒热往来。观《伤寒论》可见。疟疾往来寒热，邪在少阳也。故仲景
有疟脉自弦，弦数多热，弦迟多寒之说。喻嘉言亦谓∶邪在少阳或兼他经证则有之，
谓他经而全不涉少阳则不成其为疟。故不论兼有何脉，皆不离弦之一字，以弦乃少
阳脉也。然伤寒少阳证往来寒热无定期，而疟病往来寒热有定期者，以彼止受感无
形之邪风，风者善行数变故无定期。此虽亦感无形之邪风，然必郁成有形之痰涎留
滞一处，与日行之卫气相遇，邪正交争乃作，故有定期也。古谓无痰不成疟以此。
夫疟由于痰滞，而痰之滞也，岂独由于风寒，一切外感内伤皆能致之。故又谓无食
不成疟，以食滞成痰也。外感以风寒为举隅，内伤以食为举隅，所当推展以求之者
也。又推之外感内伤，既能郁热蓄痰，独不能停湿滞血而为是证乎？此杨仁斋所以
有黄水瘀血之论也。问曰∶痰血留滞之说深为有理，然尝见痰滞血凝结为疮肿，发
为寒热，亦无定期，且或有不发寒热者，何也？曰∶疮肿初起发寒热者，必其邪盛
势大者也。邪盛势大，连踞表里，无时不与卫气相遇，旋滞旋通，旋通旋滞，故无
定期。其后不复发寒热者，以日久正气另辟行径，不与之争也。（说见积聚。）若其初亦
不发寒热者，必其疮肿之小者乃然，小邪不足以滞大气也。《经》曰∶阳并于阴则寒，
（并，兼并为一之义。卫气与邪相争。正为邪滞，内郁不通，不达于表则表寒，不行于里则里寒，内外皆寒，似纯阴
无阳者然，故曰并也。河间谓并于阴乃阳气入于阴分，亦即内郁之说。）阴并于阳则热，（阳郁成
热，郁久则伸，内热外达，内外皆热，似纯阳无阴者然。）寒时毛发竖立，欠伸，遍体寒栗，鼓颔，
（阳并于阴则阳虚，阳明虚则鼓颔，以阳明脉循颊车也。高鼓峰谓∶热郁将发，火气冲突，元气走散，故寒凛。
与《经》少异，然亦通。）腰背头项俱痛，（太阳虚也。太阳脉抵腰夹背，上额交巅，下项。）中外皆寒，（此
非真寒，乃阳郁之寒耳。）汤火不能温也。（则此时不必用温药可知。）热时内外皆热，冰水不能寒也。
（此时不必用凉药可知。此段皆经文。）
有一日一作而或日早或日迟者，按《内经》谓风邪所客，视其虚而入之。如腰
脊虚则入腰脊，手足虚则入手足，风府虚则入风府，因举入风府者以例之。风府，
穴名，在项上陷中。邪客风府，有浅有深。浅者，卫气日行于表，与浅分之邪相遇，
夜行于里，则不与遇矣。深者反此，故每日一遇。如今日卯时与遇，明日卯时又与
遇也。卫气到则肉理开，邪气之在风府者，得以入之，正不客邪，相争而病作
矣。此邪气留滞其处，着而不行者，故每日如期而发。若邪气行而不着，每日循夹
脊之膂下行一节，自风府至尾 骨，共二十五节，则风府之邪，计二十五日下行至
骨，与卫气每日离一节，故其作日迟。如今日卯时卫气到风府，与适在风府之邪
遇而病者，明日卯时卫气又到风府，与已离风府而下行一节之邪不相遇，则必待卫
气追及邪气，相遇乃作，故日迟也。邪气二十六入于脊内，注于伏行夹脊膂间
之脉，其气上行，无关节之间隔，故九日而上出于缺盆之中。卫气从腹上行，从背
下行，伏膂之脉亦背也。下行之卫气迎上行之邪气，故其作日早也。此《内经》之
说如是。然有忽早忽晏，又忽复早者，则邪气忽上忽下，忽浅忽深，行无一定之故
也。岂必下尽二十五节乃始上行乎？发于昼者为阳，邪浅在阳分也；发于夜者为阴，
邪深在阴分也。日早者，邪由深出浅也；日晏者，邪由浅入深也。《经》言上下，不
言浅深者，以卫气昼行于表，夜行于里，即是言浅深耳。有间一日而作者，有间二
日而作者，有间数日而作者，皆邪气深入阴分，逼近脏腑，横连膜原。膜原者，膈
膜之处，空旷若平原，邪正可以并容，阻碍不甚，故久滞乃发也。《灵枢·岁露篇》
所谓蓄积乃作也。发于子、午、卯、酉日为少阴经疟；发于辰、戌、丑、未日为太
阴经疟；发于寅、申、巳、亥日为厥阴经疟。旧说如此，不必泥。
按卫气遇邪之说，《经》言不一而足。又一条云∶夏伤于暑，热气藏皮肤之内，
肠胃之外，此营气之所舍也。能令人汗孔疏，（热舍营分，蒸汗故也。）腠理开，（暑邪若可泄矣。）
因得秋气，（至秋而感冒寒气也。）汗出遇风，及遇水感寒，（些言或当时遇风、浴水，不必致秋乃感寒。）
气藏肤内，（暑邪不得泄矣。或谓暑邪已从汗泄，此言寒邪内藏耳。然《经》又谓∶夏暑汗不出，秋成风疟。当
从前说为是。）与卫气并居。（相遇即并居。）卫气日行阳，夜行阴，此气（暑气）得阳而外出，得阴
而内搏，（暑邪在阳分则外争，在阴分则内争也。）内外相搏，（或在外或在内，与卫气相迫搏。故曰作。是
亦以卫气为言也。）乃又出一条云∶夏伤于暑，汗出腠开，遇夏气凄清之水寒，（吴鹤皋
谓∶水当作小。）藏于皮肤，至秋复伤于风，先伤于寒为阴邪，后伤于风为阳邪，故先寒
后热，名寒疟。若先伤风后伤寒，则先热后寒，名温疟。详其意，是言阳风与阴寒
相争，而为寒热往来，全与卫气无涉。果尔则遇时可作，何必每日一作耶？且风寒
无大分别，无论冬月，即当暑令，得风则凉，是风亦即寒也。而谓风为热气可乎？
其说可疑，必后人之伪托也。又《经》论温疟先热后寒，谓得之冬中风寒，气藏骨
髓中，（此与《内经》所言，冬不藏精之人，外感风寒，深入骨髓，郁热于内，精不藏则肾水先虚，热伏则肾水益
涸，至春夏遇风寒，发为温暑病意同。）至春则气大发，（寒郁成热，因阳气而大发也。）邪不能自出，（邪深藏
也。）因遇暑气，脑髓烁，肌肉消，（言热至骨也。）腠理开发，或有所用力，邪气与汗
皆出，此病藏于肾，先从内出之于外也。如是者阴虚而阳盛，盛则热矣，衰（热衰
也。）则气复反入，入则阳虚，虚则寒矣。（阳气发泄太过，则表虚而怯寒。表怯寒则敛而内返，气内
返则表愈虚，故寒也。）此亦不言卫气与邪遇，且与上条所论温疟先伤风后伤寒，故先热后
寒不同。岂温疟固与他疟不同，特以其有寒热与疟相类，故亦以疟名之，其证自有
两种耶，安得起作《内经》者问之？
有经疟，《内经》曰∶足太阳（膀胱经）。之疟，腰痛头重，寒从背起，（太阳脉抵腰
上头夹背也。）先寒后热，刺 中。（ 中，即 中，太阳脉。易老用羌活加生地黄汤、小柴胡加桂枝
汤。）足少阳（胆经）。之疟，身体解亦，（身体解惰名解亦。）寒不甚，热不甚，（阳并于阴，自外之内，
则寒甚。阴并于阳，自内之外，则热甚。少阳在半表半里，往来不远，非若他经之大出大入，故其寒热不甚。想当
然耳。）恶见人，见人心惕惕然，（少阳以胆为腑，经虚则腑亦虚，故见人而恐也。）热多汗出甚，（少阳
木火升发使然。）刺本经。（易老用小柴胡汤。）足阳明（胃经）之疟，先洒淅寒甚，久乃热，热去汗
出，喜见天日火光，（阳明受阳邪，则恶日与火，若受阴邪，则反喜之，汗出热泄，阳气乍虚，虽原受阳邪，
亦喜之矣。）刺跗上。（本经冲阳穴。易老用桂枝二白虎一汤、黄芩芍药加桂汤。）足太阴（脾经）之疟，不乐，
好太息，（脾脉不运，则上焦气不行，故不乐，而太息以舒之。）不嗜食，（气不化故不饥。）多寒热汗出，
病至则呕，呕已乃衰，（脾脉络胃夹咽故善呕）。刺本经穴。（易老用小建中汤、异功散。）足少阴（肾经）
之疟，呕吐甚，（肾脉上贯肝膈，循喉咙故也。）多寒热，（邪入深故多。）热多寒少，（水虚也。）欲闭户牖
而处，（肾阴衰故恶躁喜静。）其病难已。（刺法失。易老用小柴胡加半夏汤。）足厥阴（肝经）之疟，腰痛少
腹痛，小便不利，（肝脉过阴器，抵小腹故也。）非癃也，（小便淋名疟。）数便，（言小便频数，涩短不利，
非淋也。）噫，（肝气郁，故噫以舒之。）恐惧，（肝有余则怒，不足则恐也。）气不足，腹中悒悒，（不快之意。
气不足则不得舒畅也。）刺本经。（易老用四物柴胡苦楝附子汤。）以上论别足六经证，不言手六经，
以足经长而远，可包手经。故此与伤寒并单举足经言，非病必不涉于手经也，可以
意推。按疟分六经，又分脏腑，正与卫气行阳行阴，或浅或深，与邪相遇说合，则
泥定少阳一经者非矣。然历 疟证，在少阳经者居多，此仲景、嘉言所以专主少阳
立说也。
有脏疟，《内经》曰∶肺疟心寒，（肺金本清肃，寒邪加之益寒，故心觉寒冷。）寒甚热，热间
善惊，如有所见者，（心近肺，心血为热耗，故神不安。）刺太阴肺经及手阳明大肠经。（两经相表
里，故分刺以杀其热。易老用桂枝加芍药汤。按五脏不受邪，而《经》列此五脏证者，盖有脏气素虚之人，为七情
所伤，脏气不行，因郁痰饮诸邪于内而成疟也。）心疟，令人烦心，欲得清水，反寒多，不甚热，
（热在里，故外不甚热而多寒。）刺本经。（易老用桂枝黄芩汤。）肝疟，色苍苍然，太息，（木气不畅，故太
息以达之。）其状若死者，（木为春生之气，不舒而闭也。）刺本经见血。（易老用四逆汤、通脉四逆汤。）脾
疟，寒，腹痛；热则肠鸣，鸣已汗出，刺本经。（易老用小建中汤、芍药甘草汤。）肾疟，洒洒
然，腰脊痛（腰脊属肾）宛转，大便难，（肾主二便故也。）目 然，（欲瞑也。《伤寒论》少阴病但欲寐，
即此意。按 、瞬同，目动也，无欲瞑意。此解恐非。）手足寒，刺本经及足太阳膀胱经。（表里并刺也。
易老用桂枝加当归芍药汤。）
有腑疟，《内经》曰∶胃疟，善饥而不能食，（胃热故饥，脾虚故不能食。）食而支满腹大，
（支，支撑之意。）刺本经及足太阴脾经横脉（二经络脉之横者。）出血。（此论胃腑疟证，不言诸腑，可以意
推。《伤寒论》亦止言胃腑，以诸经之邪，皆得入胃也。）大抵因风寒者，先必有怯寒、鼻塞等证，
宜发散。若春时感风寒成温疟者，必渴，必汗出不恶寒，热多寒少，多先热后
寒。（热多阳盛，阳性急，故先发热。衰而退，表气乍虚，故微觉寒。宜白虎汤。）因伤暑者，必多汗，
烦闷喘渴，体若燔炭，宜加暑门之药，煎成露一宿，乃热之而服。感燥气者，
必肤索唇揭，咽干鼻燥，宜滋润之剂。感湿气者，必身重而痛，小便不利，宜去湿。
因时气者，必一方长幼病皆相似，审系何气之邪治之。因饮食所伤者，证见痞闷，
恶食嗳腐，小柴胡汤（见寒热）。合平胃散。（见伤饮食。）便结者，大柴胡汤加芒硝、浓朴。
因气郁者，必面色青滞，脉涩，胁痛，呕吐清水或苦水，意不乐，逍遥散（见郁）加黄连、
（吴茱萸水浸炒。）贝母，倍柴胡。因劳倦者，必气虚喘乏，四肢困倦，遇劳即发，补中益
气汤。（见气。）经年不愈，邪结痞块，胀痛，曰疟母。以上均审所蓄之邪，是痰、是血、
是黄水，分别治之。又须看热多寒少、热少寒多，以分寒热。然热多寒少而脉空虚，
未可便用寒凉；热少寒多而脉洪数，未可概用温热，又当细察也。此外又有纯寒无
热者，曰牝疟，蜀漆散、牡蛎汤主之，或柴胡姜桂汤减黄芩加半夏。盖其人素寒，
所蓄之痰饮亦寒，与卫气相触，寒气发动，纯阴无阳，故但有寒无热也。又有纯热
无寒者，曰瘅疟，缘肺气素热，阳气盛，（所蓄之痰涎亦热，才遇卫气之触，热势即便激发也。）令
人消烁脱肉。《经》云∶阴气先绝，阳气独发，（言肺热偏于阳而无阴也。）则少气（壮火食气也）烦
冤，（烦热不安也。）手足热而欲呕。（小柴胡合白虎汤。）
又有感山岚瘴气，湿热熏蒸而为瘴疟者，王裴曰∶南方天气暑热，地气郁蒸，
草木水泉皆禀恶气，故病者往来寒热，名冷瘴。蕴热沉沉如卧炭火中者，名热瘴。
甚者病即失音，名哑瘴。热甚昼夜不止，稍迟二三日则血凝难救，南方谓之中箭，
又谓之中草子。有挑草子法，乃以针刺头额及上下唇，仍以楮叶擦舌，皆令血出，
徐以药解其内热，可愈。杨仁斋曰∶瘴疟，挟岚瘴溪毒之气致然，血乘上焦，令人
迷闷，甚则狂躁，哑不能言，皆由败血瘀心，毒涎聚脾。治须凉膈，疏通大肠，小
柴胡加大黄、观香丸、治瘴木香丸，皆为要药。僧继洪曰∶冷瘴宜用不换金正气散，
（见中寒。）热瘴宜用挑草子法。此病最难治，凉药多不可用，（句未妥，凉药虽恐冰血，独不可加
Epidemic diseases complicated with dysentery, presenting with fever, body pain, thirst, restlessness, abdominal fullness, and vomiting, are the most critical. The appropriate prescription is Bing Shao Shun Qi Tang (Betel Nut and White Peony Decoction to Regulate Qi): composed of Arecae Semen (Binglang), Paeoniae Radix Alba (Baishao), Aurantii Fructus Immaturus (Zhishi), Magnoliae Officinalis Cortex (Houpo), and Rhei Radix et Rhizoma (Dahuang), decocted with fresh ginger.
For epidemic diseases complicated with edema, Xiao Cheng Qi Tang (Minor Order the Yang Decoction) should be used to purge.
Yang syndromes resembling Yin syndromes present with cold extremities but internal heat; urination will necessarily be red, which is easiest to differentiate.
Yin syndromes resembling Yang syndromes occur in Cold Damage (Shanghan) but not in Epidemic Diseases (Wenbing).
The *Neijing* (Classic of Internal Medicine) discusses malaria, stating it arises from wind pathogenic factors. Generally, external contraction of wind-cold pathogens located in the Taiyang (Greater Yang) and Yangming (Bright Yang) meridians belong to the exterior level, manifesting as fever. When located in the Shaoyang (Lesser Yang) meridian, belonging to the half-exterior half-interior level, it manifests as alternating chills and fever. This can be observed in the *Shanghan Lun* (Treatise on Cold Damage). Malaria's alternating chills and fever indicate the pathogen is in the Shaoyang meridian. Therefore, Zhang Zhongjing stated: "Malaria pulse is naturally wiry; wiry and rapid indicates much heat; wiry and slow indicates much cold." Yu Jiayan also believed: Pathogens in the Shaoyang meridian or combined with other meridian symptoms do exist; however, if other meridians are involved without any connection to the Shaoyang meridian, it cannot be called malaria. Thus, regardless of what other pulses are combined, one cannot depart from the character "wiry," because the wiry pulse belongs to the Shaoyang meridian. However, the alternating chills and fever of the Shaoyang syndrome in Cold Damage have no fixed schedule, whereas the alternating chills and fever of malaria have a fixed schedule. This is because the former only contracts formless wind pathogens, and wind is agile and changeable, hence having no fixed schedule. The latter, although also contracting formless wind pathogens, must inevitably stagnate into tangible phlegm-fluids retained in one place. When these encounter the Wei-Qi (Defensive Qi) circulating daily, the struggle between pathogen and healthy qi causes the attack, thus having a fixed schedule. This is why ancients said "No phlegm, no malaria."
Malaria arises from phlegm stagnation. But does phlegm stagnation arise solely from wind-cold? All external contractions and internal injuries can cause it. Hence, it is also said "No food retention, no malaria," because food stagnation generates phlegm. External contraction takes wind-cold as an example; internal injury takes food retention as an example. One should deduce and seek the cause from these. Further deduction reveals that since external and internal injuries can stagnate heat and accumulate phlegm, can they not also retain dampness and stagnant blood to produce this condition? This is why Yang Renzhai proposed the theory of yellow water and stagnant blood. A question arises: The theory of phlegm and blood stagnation is very reasonable. Yet, I have seen phlegm stagnation and blood coagulation forming sores and swellings, triggering chills and fever, yet without a fixed schedule, and sometimes without chills and fever at all. Why? The answer is: When sores and swellings first appear with chills and fever, it must be due to strong pathogens and great momentum. Strong pathogens and great momentum occupy both interior and exterior, encountering Wei-Qi at all times. They stagnate and flow freely alternately, hence having no fixed schedule. Later, when chills and fever do not recur, it is because after a long time, healthy qi opens a new pathway and no longer struggles with the pathogen. (This explanation is found in the section on Accumulations.) If there were no chills and fever initially, it must be because the sore or swelling was small; minor pathogens are insufficient to obstruct major qi. The *Jing* (Scripture) says: When Yang merges into Yin, there is cold. (Merge means combining into one. Wei-Qi struggles with the pathogen. Healthy qi is obstructed by the pathogen, internally stagnated and blocked, unable to reach the exterior results in exterior cold; unable to circulate in the interior results in interior cold. Both interior and exterior are cold, resembling pure Yin without Yang, hence termed "merge." He Jian believed merging into Yin means Yang qi enters the Yin division, which is also the theory of internal stagnation.) When Yin merges into Yang, there is heat. (Yang stagnates into heat; after long stagnation, it extends. Internal heat reaches outward, both interior and exterior are hot, resembling pure Yang without Yin.) During chills, hair stands erect, yawning and stretching occur, whole-body tremors, and jaw clattering happen. (When Yang merges into Yin, Yang deficiency occurs. Yangming deficiency leads to jaw clattering, as the Yangming meridian passes through the Jiache point. Gao Gufeng stated: Heat stagnation about to erupt, fire qi conflicts, Yuan Qi scatters, hence feeling cold shivers. This differs slightly from the *Jing* but is also acceptable.) Pain occurs in the lower back, upper back, head, and neck. (Taiyang deficiency. The Taiyang meridian reaches the waist, flanks the back, goes up to the forehead, crosses the vertex, and descends the neck.) Both interior and exterior feel cold. (This is not true cold, but cold generated by Yang stagnation.) Drinking soup or using fire cannot warm them. (Thus, it is known that warming medicines are unnecessary at this time.) During fever, both interior and exterior feel hot; drinking ice water cannot cool them. (Thus, it is known that cooling medicines are unnecessary at this time. This paragraph consists of scriptural text.)
There are cases occurring once a day, either earlier or later each day. According to the *Neijing*, where wind pathogens lodge depends on where deficiency exists. If the waist and spine are deficient, the pathogen enters there; if hands and feet are deficient, it enters there; if the Fengfu acupoint is deficient, it enters there. Taking entry into Fengfu as an example: Fengfu is an acupoint name, located in the depression above the nape. Pathogens lodging in Fengfu vary in depth. For shallow locations, Wei-Qi travels on the exterior during the day and encounters the shallow pathogen; at night, it travels inside and does not encounter it. For deep locations, it is the opposite, hence meeting once daily. For instance, meeting at Mao hour today, meeting again at Mao hour tomorrow. When Wei-Qi arrives, muscle texture opens, allowing pathogens in Fengfu to enter deeper. Healthy qi rejects the pathogen, they struggle, and the disease manifests. Because this pathogen remains stagnant in that spot, adhering and not moving, it attacks regularly every day. If the pathogen moves and does not adhere, descending one segment daily along the Du Meridian between the vertebrae from Fengfu to the coccyx, totaling twenty-five segments, then the pathogen in Fengfu calculates to descend to the bone over twenty-five days. Since Wei-Qi leaves one segment daily, the onset is delayed. For example, today at Mao hour Wei-Qi arrives at Fengfu and meets the pathogen exactly there, causing illness. Tomorrow at Mao hour Wei-Qi arrives at Fengfu again, but the pathogen has already left Fengfu and descended one segment, so they do not meet. It must wait until Wei-Qi catches up to the pathogen for them to meet and cause illness, hence the delay. On the twenty-sixth entry, the pathogen enters the spine interior, pouring into the vessels running between the vertebrae. Its qi ascends without joint barriers, hence emerging from the Clavicular Fossa (Quepen) center after nine days. Wei-Qi ascends from the abdomen and descends from the back; the Fu-Lü vessels are also on the back. Descending Wei-Qi meets ascending pathogen qi, hence the onset is early. This is how the *Neijing* states. However, if onset is suddenly early, suddenly late, then suddenly early again, it is because the pathogen moves up and down, shallow and deep, without a fixed route. Must it necessarily descend all twenty-five segments before ascending? Attacks occurring during the day are Yang, meaning the pathogen is shallow in the Yang division; attacks occurring at night are Yin, meaning the pathogen is deep in the Yin division. Early onset means the pathogen moves from deep to shallow; late onset means the pathogen moves from shallow to deep. The *Jing* speaks of up and down, not shallow and deep, because Wei-Qi travels on the exterior by day and interior by night, which implies shallow and deep. There are cases occurring every other day, every two days, or every few days. These all indicate the pathogen has deeply entered the Yin division, approaching the Zang-Fu organs, and horizontally connecting to the Mo-Yuan (Membrane Source). The Mo-Yuan is the area of the diaphragm, vast like a plain, where pathogen and healthy qi can coexist, with little obstruction, hence long stagnation before eruption. This corresponds to the *Ling Shu · Sui Lu Pian* saying "accumulates power before acting." Attacks on Zi, Wu, Mao, You days are Shaoyin Meridian Malaria; attacks on Chen, Xu, Chou, Wei days are Taiyin Meridian Malaria; attacks on Yin, Shen, Si, Hai days are Jueyin Meridian Malaria. Old theories state this, but one need not be rigid.
Regarding the theory of Wei-Qi encountering pathogens, the *Jing* mentions it repeatedly. Another passage states: Summer injury by summer-heat, hot qi hides within the skin, outside the intestines and stomach; this is where Ying-Qi (Nutritive Qi) resides. It causes sweat pores to loosen, (Heat lodges in the Ying division, steaming sweat.) and muscle texture to open, (Summer-heat seems able to be vented.) Then autumn air arrives, (Contracting cold qi in autumn.) sweating while encountering wind, or encountering water and cold, (These words refer to encountering wind or bathing at that time, not necessarily contracting cold only in autumn.) qi hides within the skin, (Summer-heat cannot be vented. Some say summer-heat has been vented via sweat; here it refers to cold qi hiding internally. However, the *Jing* also says: If summer heat does not cause sweating, autumn becomes wind-malaria. The former interpretation is correct.) residing together with Wei-Qi. (Meeting is residing together.) Wei-Qi travels in Yang by day and Yin by night. This qi (summer-heat) goes out when obtaining Yang, and fights internally when obtaining Yin, (Summer-heat contends externally in the Yang division, internally in the Yin division.) and when interior and exterior contend, (Either outside or inside, pressing against Wei-Qi. Hence it acts. This also speaks of Wei-Qi.) another passage states: Summer injury by summer-heat, sweating and opening of muscle texture, encountering cold water of the crisp summer air, (Wu Hegao believed: 'Water' should be read as 'Small'.) hiding in the skin, and in autumn injuring by wind again. First injured by cold is Yin pathogen, later injured by wind is Yang pathogen, hence first cold then heat, named Cold Malaria. If first injured by wind then cold, then first heat then cold, named Warm Malaria. Examining the intent, it speaks of Yang wind contending with Yin cold, causing alternating chills and heat, completely unrelated to Wei-Qi. If so, attacks would occur whenever encountered, why must they occur daily? Moreover, wind and cold have little difference; whether in winter or even in summer, encountering wind brings coolness, so wind is also cold. How can wind be considered hot qi? This theory is suspicious and likely a later forgery. Furthermore, the *Jing* discusses Warm Malaria starting with heat then cold, stating it comes from winter wind-cold, qi hiding in bone marrow, (This is similar to the *Neijing*'s concept that people who do not store essence in winter contract wind-cold externally, penetrating deep into bone marrow, stagnating heat internally. Not storing essence makes Kidney Water deficient first; heat伏 makes Kidney Water drier. Encountering wind-cold in spring/summer triggers Warm-Heat disease.) In spring, the qi erupts greatly, (Cold stagnates into heat, erupting greatly due to Yang qi.) the pathogen cannot exit itself, (Pathogen is deeply hidden.) then encountering summer-heat, brain marrow is scorched, muscles waste, (Saying heat reaches bone.) muscle texture opens, or exertion occurs, pathogen and sweat both exit. This disease hides in the Kidney, first exiting from interior to exterior. In such cases, Yin deficiency and Yang excess occur; excess means heat. When heat declines, qi returns inward; entering means Yang deficiency, deficiency means cold. (Yang qi excretion is excessive, leading to exterior deficiency and aversion to cold. Exterior aversion to cold leads to contraction and return inward; qi returning inward makes exterior more deficient, hence cold.) This also does not mention Wei-Qi encountering the pathogen, and differs from the previous paragraph discussing Warm Malaria caused by first wind then cold, hence first heat then cold. Is it that Warm Malaria is inherently different from other malarias, specifically because it has chills and heat similar to malaria, hence named malaria, but its symptoms naturally have two types? How can one revive the author of the *Neijing* to ask?
There is Meridian Malaria. The *Neijing* says: Malaria of the Foot-Taiyang (Bladder Meridian) involves lower back pain, heavy head, cold starting from the back, (Taiyang meridian reaches waist, goes up head, flanks back.) first cold then heat, puncture Xi-Zhong. (Xi-Zhong is Weizhong, Taiyang meridian. Yi Lao used Qiang Huo plus Sheng Di Huang Tang, Xiao Chai Hu Tang plus Gui Zhi Tang.) Malaria of the Foot-Shaoyang (Gallbladder Meridian) involves body laxity, (Body laxity is named Xie Yi.) cold not severe, heat not severe, (Yang merging into Yin from exterior to interior makes cold severe. Yin merging into Yang from interior to exterior makes heat severe. Shaoyang is half-exterior half-interior,往来 not far, unlike other meridians' large exits and entries, hence cold/heat not severe. Presumably.) aversion to seeing people, seeing people causes heart palpitations, (Shaoyang has Gallbladder as the Fu organ; meridian deficiency leads to Fu deficiency, hence fear of seeing people.) much heat and profuse sweating, (Shaoyang Wood-Fire rising and emitting causes this.) puncture the meridian itself. (Yi Lao used Xiao Chai Hu Tang.) Malaria of the Foot-Yangming (Stomach Meridian) involves initial chilliness and severe cold, later heat, heat leaving with sweating, liking sunlight and firelight, (Yangming receiving Yang pathogen dislikes sun and fire; receiving Yin pathogen likes it. Sweating vents heat, Yang qi temporarily deficient; though originally Yang pathogen, it likes it now.) puncture the dorsum of the foot. (Chongyang acupoint of this meridian. Yi Lao used Gui Zhi Er Bai Hu Yi Tang, Huang Qin Shao Yao plus Gui Tang.) Malaria of the Foot-Taiyin (Spleen Meridian) involves unhappiness, frequent sighing, (Spleen meridian dysfunction prevents Upper Jiao qi movement, hence unhappiness, sighing to relieve it.) lack of appetite, (Qi transformation fails, hence no hunger.) much cold/heat and sweating, vomiting upon onset, declining after vomiting, (Spleen meridian connects Stomach and flanks throat, hence prone to vomiting.) puncture meridian points. (Yi Lao used Xiao Jian Zhong Tang, Yi Gong San.) Malaria of the Foot-Shaoyin (Kidney Meridian) involves severe vomiting, (Kidney meridian pierces Liver/Diaphragm, follows throat.) much cold/heat, (Pathogen enters deep, hence much.) heat more than cold, (Water deficiency.) wanting to close doors/windows and stay alone, (Kidney Yin decline, hence aversion to noise, preference for quiet.) this disease is difficult to cure. (Puncture method failed. Yi Lao used Xiao Chai Hu Tang plus Ban Xia.) Malaria of the Foot-Jueyin (Liver Meridian) involves lower back pain, lower abdominal pain, difficulty urinating, (Liver meridian passes through genitalia, reaches lower abdomen.) not strangury, (Strangury is named Nüe here.) frequent urination, (Meaning frequent urination, scanty and difficult, not strangury.) belching, (Liver qi stagnation, belching to relieve it.) fear, (Liver excess leads to anger, deficiency leads to fear.) qi deficiency, abdominal oppression, (Unhappiness. Qi deficiency prevents smooth flow.) puncture the meridian itself. (Yi Lao used Si Wu Chai Hu Ku Lian Fu Zi Tang.) Above discusses distinguishing Foot Six Meridians symptoms, not mentioning Hand Six Meridians, because Foot meridians are long and distant, encompassing Hand meridians. Thus, here alongside Cold Damage, only Foot meridians are mentioned, not implying the disease definitely doesn't involve Hand meridians; this can be inferred. Regarding malaria divided by Six Meridians and Zang-Fu, it aligns with the theory of Wei-Qi traveling in Yang/Yin, shallow/deep, encountering pathogens. Thus, those rigidly sticking to the Shaoyang meridian alone are wrong. However, historically, most malaria cases involve the Shaoyang meridian; this is why Zhang Zhongjing and Yu Jiayan focused their theories on Shaoyang.
There is Zang Malaria. The *Neijing* says: Lung Malaria causes heart cold, (Lung Metal is naturally clear and肃; adding cold pathogen increases cold, hence heart feels cold.) severe cold, then heat; during heat intervals, prone to fright, seeing things, (Heart is near Lung, Heart Blood consumed by heat, hence Spirit unsettled.) puncture Taiyin Lung Meridian and Hand-Yangming Large Intestine Meridian. (Two meridians are exterior-interior, hence punctured separately to reduce heat. Yi Lao used Gui Zhi plus Shao Yao Tang. Note: The Five Zang do not receive pathogens; the *Jing* lists these five Zang symptoms probably because people with inherent Zang Qi deficiency, injured by Seven Emotions, have stagnant Zang Qi, leading to internal stagnation of Phlegm-Fluids and other pathogens causing malaria.) Heart Malaria causes mental vexation, desire for cold water,反而 cold more, heat not severe, (Heat is in interior, hence exterior not very hot and much cold.) puncture the meridian itself. (Yi Lao used Gui Zhi Huang Qin Tang.) Liver Malaria presents with pale/greenish complexion, frequent sighing, (Wood qi unsmooth, sighing to release it.) appearance like a dead person, (Wood is Spring generating qi; unsmooth and closed.) puncture the meridian until bleeding occurs. (Yi Lao used Si Ni Tang, Tong Mai Si Ni Tang.) Spleen Malaria involves cold, abdominal pain; heat causes bowel sounds, sweating after sounds cease, puncture the meridian itself. (Yi Lao used Xiao Jian Zhong Tang, Shao Yao Gan Cao Tang.) Kidney Malaria involves shivering, lower back/spine pain (Waist/spine belongs to Kidney), turning around, difficulty defecating, (Kidney governs two passages.) blurry vision, (Desire to close eyes. *Shanghan Lun* Shaoyin disease 'only desires sleep' shares this meaning. Note: 、 Shun are same, eye movement, no desire to close eyes. This explanation may be incorrect.) cold hands and feet, puncture the meridian itself and Foot-Taiyang Bladder Meridian. (Exterior-Interior simultaneous puncture. Yi Lao used Gui Zhi plus Dang Gui Shao Yao Tang.)
There is Fu Malaria. The *Neijing* says: Stomach Malaria involves easy hunger but inability to eat, (Stomach heat causes hunger, Spleen deficiency causes inability to eat.) eating leads to distension and large abdomen, (Zhi means supporting sensation.) puncture the meridian itself and Foot-Taiyin Spleen Meridian horizontal vessels (Horizontal Luo vessels of the two meridians.) and bleed. (This discusses Stomach Fu Malaria symptoms, not other Fus, can be inferred. *Shanghan Lun* also only mentions Stomach Fu, as pathogens of all meridians can enter the Stomach.) Generally, those caused by wind-cold must initially have aversion to cold, nasal congestion, etc., suitable for dispersing. If wind-cold contracted in spring becomes Warm Malaria, there must be thirst, sweating without aversion to cold, heat more than cold, mostly heat preceding cold. (Heat more indicates Yang excess; Yang nature is urgent, hence heat first. Decline and retreat, exterior qi temporarily deficient, hence slight cold. Use Bai Hu Tang.) Those caused by summer-heat must have much sweating, vexation, stifling, panting, thirst, body like burning charcoal; suitable for adding drugs from the Summer-Heat category, decocted, exposed overnight, then warmed and taken. Those affected by dryness must have dry skin, peeling lips, dry throat, dry nose; suitable for moistening agents. Those affected by dampness must have heavy body and pain, difficulty urinating; suitable for removing dampness. Those affected by seasonal qi must have similar illnesses among all ages in one region; examine what pathogen of qi it is and treat accordingly. Those injured by diet present with stuffiness, aversion to food, belching of rotten smell; Xiao Chai Hu Tang (see Chills/Fever) combined with Ping Wei San (see Food Injury). Constipation: Da Chai Hu Tang plus Mang Xiao, Hou Po. Those due to Qi stagnation present with bluish/dull complexion, choppy pulse, hypochondriac pain, vomiting clear or bitter water, unhappiness; Xiao Yao San (see Stagnation) plus Huang Lian, (Soaked in Evodia water and stir-fried.) Bei Mu, double Chai Hu. Those due to fatigue present with Qi deficiency, panting, exhaustion, limbs weary, onset upon exertion; Bu Zhong Yi Qi Tang (see Qi). Unhealed for years, pathogen knots into masses, distension/pain, called Malaria Mother (Nuomu). Above all examine the accumulated pathogen: is it phlegm, blood, or yellow water; treat separately. Also observe heat more/cold less, heat less/cold more to distinguish cold/heat. However, heat more/cold less with empty pulse: do not hastily use cold/cooling; heat less/cold more with surging/rapid pulse: do not generally use warm/hot; careful observation is needed. Additionally, there is pure cold without heat, called Pin Malaria, treated with Shu Qi San, Mu Li Tang, or Chai Hu Jiang Gui Tang reducing Huang Qin and adding Ban Xia. Basically, the person is constitutionally cold, accumulated phlegm-fluids are also cold; touching Wei-Qi, cold qi activates, pure Yin without Yang, hence only cold without heat. There is also pure heat without cold, called Dan Malaria, due to Lung Qi constitutionally hot, Yang qi abundant, (Accumulated phlegm-fluids are also hot; upon touching Wei-Qi, heat potential immediately ignites.) causing emaciation. The *Jing* says: Yin qi exhausted first, Yang qi alone erupts, (Saying Lung heat leans toward Yang without Yin.) then shortness of breath (Strong fire consumes Qi), vexation/oppression, (Vexatious heat and unrest,) hot hands/feet and desire to vomit. (Xiao Chai Hu combined with Bai Hu Tang.)
There are also cases contracting mountain miasma qi, steamed by damp-heat into Miasma Malaria. Wang Pei said: Southern weather is hot, earth qi stagnates and steams, grass/trees/water springs all inherit evil qi, hence patients have alternating chills/heat, named Cold Miasma. Deeply蕴 heat like lying in charcoal fire, named Hot Miasma. Severe cases lose voice, named Dumb Miasma. Heat severe day and night uninterrupted; delaying two-three days leads to blood coagulation and untreatability. South calls this "Arrow Stroke" or "Grass Seed Strike." There is a Grass Seed Pricking Method: prick forehead and upper/lower lips with needles, rub tongue with Broussonetia papyrifera leaves until bleeding, then slowly use medicine to resolve internal heat, can cure. Yang Renzhai said: Miasma Malaria, carrying miasma/stream poison qi causes this. Blood rushes to Upper Jiao, causing confusion, severe mania, dumb speechlessness, all due to敗血 stasis in Heart, toxic phlegm gathering in Spleen. Treatment requires cooling the Chest, unblocking Large Intestine. Xiao Chai Hu plus Da Huang, Guan Xiang Wan, Zhi Zhang Mu Xiang Wan are key medicines. Monk Ji Hong said: Cold Miasma suitable for Bu Huan Jin Zheng Qi San (see Cold Damage); Hot Miasma suitable for Grass Seed Pricking Method. This disease is hardest to treat; cooling medicines mostly unusable, (Sentence incomplete, cooling medicines although feared to freeze blood, can they not be added...