经义
夏伤于暑，秋为 疟。○夏暑汗不出者，秋成风疟。（《素问》）
哲言
牡疟，但寒不热，无汗寒栗，头痛，病属太阳。瘅疟，但热不寒，烦热自汗，病属阳明。风疟，先热后
寒，恶风自汗，头痛，病属少阳。湿疟，先寒后热，身重呕逆，病属太阳。 疟，寒热间日一作，或三日一作，
缠绵不已，病属少阴、厥阴。（《医阶辨证》）
身后为太阳，太阳者，膀胱寒水也。身前为阳明，阳明者，大肠燥金也。少阳之邪在其中，近后膀胱寒
水则恶寒，近前阳明燥金则发热，故为寒热往来也。（李东垣）
疟病之寒战，乃内热将作，火冲其气，故凛凛而寒，非真冷也，不得以热药治之。（《己任编》）
疟发必有寒有热，有寒热之往来，适在少阳所主之界。偏阴则多寒，偏阳则多热，即其纯热无寒，而为
瘅疟、温疟；纯寒无热，而为牡疟。要皆自少阳而造其极偏，补偏救弊，亦必返还少阳之界，阴阳两协于和而
后愈也。疟邪如傀儡，少阳则提傀儡之线索，操纵进退，一惟少阳主张。（喻嘉言）
凡疟因于暑，人皆知之，不知夏令炎热，此自正气之宜，而人有畏热者，每多避暑贪凉，此因暑受寒，所
以致疟。《经》曰∶夏暑汗不出者，秋成风疟。义可知也。然又惟禀质薄弱，或劳倦过伤者，尤易感邪，此所
以受邪有浅深，而为病有轻重。第以病
因暑致，故曰受暑，而不知暑有阴阳，疟惟阴暑为病耳。至其病变，则有为寒证者，有为热证者，有宜散者，
有宜敛者，有宜温者，有宜清者，其要在标本虚实，因证制宜斯尽善矣。其有云伤暑，而认暑为火者；有云脾
寒，而执以为寒者，皆偏见也。○凡疟发在夏至后秋分前者，病在阳分，其病浅。发在秋分后冬至前者，病在阴
分，其病深。发在子后午前者，此阳分病也，易愈。发在午后子前者，此阴分病也，难愈。○凡疟自阴渐阳，自
迟渐早者，由重而轻也。自阳渐阴，自早渐迟者，由轻而重也。凡感邪深者，其发必迟，必使渐早渐近，方是
佳兆。故治此疾者，春夏为易，秋冬为难。（《景岳全书》）
疟有一日一发者，有间日一发者。昔人谓一日者轻，间日者重，以为卫气不胜邪，非积二日，不能逐出风
府也。然有间日一发而轻者，则邪微病微，必积二日，方能与卫气交争，迸出风府，不得以重论。○疟邪与瘟疫
相似，但疫重而疟轻耳。（《医参》）
谚云∶少不可弱，老不可疟。盖少年欲火正旺，阴水愈亏，老年气血衰微，不能任其寒热凌虐之状耳。（《见闻录》）
或问有疟发时而脉歇至，人事昏谵，疟退则神清而脉不歇至者，何也？答曰∶疟发之时，邪气阻滞，则正
气不能周流，故脉歇至。疟止邪散，正气复，则脉舒，故如常。疟发昏谵者，由热甚乱其神明故耳。（方星岩）
补编
疟疾有风、寒、暑、湿不同，治疗有汗、吐、下各异，方术百千，不能尽述。独无痰不成疟，无食不成疟，
深得致疟之因。无汗要有汗，散邪为主；有汗要无汗，扶正为主，深得治疟之法。（《赵氏医贯》）
疟病一门，《巢氏病原》妄分五脏。后人谓其发明《内经》，深信不疑，而不知疟邪不从脏发。《内经》
所无之理，巢氏臆言之耳。陈无择三因之说韪矣。乃谓夏伤于暑，秋为 疟者，不可
专以此论，何其甘悖圣言耶？至论内因，抄袭巢氏心、肝、脾、肺、肾五疟立言，仍是巴人下里之音矣。张子
和治疟，喜用汗、吐、下三法，自夸本于长沙。讵知仲景所谓汗下者，但从少阳之和法而进退其间，不从伤寒
之汗下起见也。其可吐者，或用瓜蒂，或用常山苗，各有深义，亦岂漫然而吐之耶？且子和谓治平之时，其民
夷静，虽用砒石毒药，以热治热，亦能取效，是何言欤？至东垣、丹溪，确遵《内经》夏伤于暑，秋必 疟之
论，多所发明。而谓吴楚闽广之人，患疟甚多，阳气素盛之处，其地卑湿，长夏之时，人多患 疟霍乱泻痢，
伤湿热也，此语诚为聪明绝世矣。然于《内经》之旨，尚隔一层。《内经》运气，暑与湿同推，不分彼此，曾
何分南北乎？且丹溪所论十二经，皆能为病，固即《刺疟篇》之旨，曷不遵《金匮》推足少阳一经为主，坐令
多歧亡羊耶。方书俱以温疟为伤寒坏病，与风疟大同，此言出于何典？至于牡疟，总无其名，统括于寒疟之内，
误指寒疟为脏寒之极，故无热有寒，用姜、桂、附子温之。又有更其名为牝疟者，云久受寒湿，阴盛阳虚，不
能制阴，所以寒多不热，凄怆振振，亦行温热之法，直是杀人不转睫矣。又谓暑疟即瘅疟，呕者用缩脾等药，
从无有救少阳木火之邪如救焚者，适燕而南其指，抑何生民之不幸耶？○弦数者风发也，以饮食消息止之。仲景
既云弦数者多热矣，复申一义云，弦数者风发，见多热不已，必至于极热，热极则生风，风生则肝木侮土，而
传其热于胃，坐耗津液，阳愈偏而不返。此未可徒求之于药也，须以饮食消息而止其炽热，即梨汁、蔗浆生津止
渴之属，正《内经》风淫于内，治以甘寒之旨也。（喻嘉言）
凡治疟当知标本，有标则治标，无标则治本，此最为治疟之肯綮。盖标以邪气言，本以正气言，夫邪正相
争，所以病疟。凡疟之初起，本由邪盛，此当治邪，固无疑也。若或表散已过，久而不愈，则于邪正之间，有
不可不辨矣。盖有邪者，证必猖炽，
脉必弦紧，或头痛未除，或汗出未透。凡属形证有余者，即其病虽已久，亦必有邪未清，但觉有邪，犹宜兼标
为治。若汗出已多，邪解已透，别无实证实脉可据，而犹不愈者，必由正气全虚，或以质弱，或以年衰，此当
专治其本，但使元气恢复，则无不愈。设或不明标本，无论有邪、无邪，而但知攻疟，则害多矣！○治疟之法，
若其久而汗多，腠理开泄，阳不能固者，必补敛之。无汗则腠理致密，邪不能解，必发散之。故曰∶有汗要无
汗，扶正为主。无汗要有汗，散邪为主，此大法也。盖疟本外邪，非汗不解，若不知善解其邪，而妄用劫剂，
多致胃气受伤，宜以补剂为主，加减取汗。若邪在阴分，则下体最难得汗，补药力到，自然汗出至足，方是佳
兆。○凡寒邪之自外入者，得汗即解，如伤寒之类是也。而惟瘟疟之候，则病有深浅不同，如病瘟者，虽有大
汗，而热仍不退。病疟者，屡发屡汗，而疟犹不止。此其所感者深，故不能以一、二汗而即愈，或通身如洗而
邪犹不能透。若此者，但当察其强弱，仍渐次再汗之，方得邪解。故不可谓汗后必无邪也，此但当以脉之紧与
不紧，头身之痛与不痛，寒热之甚与不甚为辨耳。○古称治疟，凡将发之时，与正发之际，慎勿施治，必待阴阳
并极，势平之后，然后治之；或于未发之先，迎而夺之。此说殊似不然，予近治疟，每迎其锐而击之，最捷最
效。是可见古法之有不必泥者。（《景岳全书》）
疟由伏邪而成，当辨其六气中所伤何气，六经中病涉何经，若小柴胡专主少阳，岂能兼括哉？此证春冬间
有，惟夏秋暑湿为患者居多。暑必挟湿，专伤气分，须分别其上焦中焦暑湿二气，何者为重？若暑热重者，专
究上焦肺脏清气，疟发必热重寒微，唇舌绛赤，烦渴喜饮，其脉色自有阳胜之候，当宗桂枝白虎，及天水散加
辛凉之品为治。若湿邪重者，当议中焦脾胃阳气，疟发虽热势蒸燔，然舌必有腻苔，渴喜暖汤，胸脘痞胀，呕
恶，其脉色自有阳气不舒之状，当宗正气散及二陈汤去甘草加杏、蔻、生
姜之类主之。必要阳盛于阴，而后配和阳之剂，方无贻累。倘证象两兼，则两法兼之可也。大凡是证，若邪轻
正不甚虚者，寒热相等，而作止有时。若邪重正怯者，寒热模糊，来势必混而不分。邪浅则一日一发，稍深则
间日一发，最深则三日一发，古称为三阴大疟，以肝脾肾三脏之见证为要领。其补泻寒温，亦不离仲景治三阴
之法为根蒂，可知阳经轻浅之方，治之无益也。所云移早则邪达于阳，移晏则邪陷于阴，阴阳胜复，于此可参。
若久而不已，必有他虞。太阴之虚浮胀满，有通补之理中汤，开腑之五苓散。少阴之痿弱成劳，有滋阴之复脉
汤，温养之升奇法。厥阴之厥逆吐蛔，及邪结为疟母，有乌梅丸与鳖甲煎法。又如心经疟久，必动其营，则为
烦渴见红，肺经疟久，必伤其津，则为胃秘肠痹，一则滋阴为主，一则清降为宜。或暑湿格拒三焦，而呕逆不
纳者，宗半夏泻心法。秽浊蒙蔽膻中，而清灵昧甚者，用牛黄清心丸。心阳暴脱，有龙、蛎之救逆。胃虚呕呃，
有旋复、代赭之成方。至于表散和解，通阳补气，滋阴化营，搜邪入络，动药劫截，辛酸两和，营卫并补，及
阳疟之后养胃阴，阴疟之后理脾阳等法，已全备矣。○治疟用乌梅，以酸泄木安土之意。用常山、草果，乃
劫其太阴之寒，使二邪不相并也。用人参、生姜曰露姜饮，一以固元，一以散邪，取通神明去秽恶之气。疟邪
既久，深入血分，或结疟母，宜鳖甲煎丸煎方活血通络。（《临证指南》）
少阳证知可解者，寒热日不移时而作，邪未退也。若用柴胡而移其时，早移于晏，晏移于早，气移于血，
血移于气，是邪无可容之地，知可解也。（王好古）
疟者，阴阳交争，寒热互作，用药须半生、半熟，半冷、半热，乃收十全之功。（《得效方》）
治疟药煎好，须露一宿服。盖疟者暑气为病，暑得露即解。（缪仲淳）
疟病须待热退身凉，方可饮食，切勿带热饮食，恐停积不消，
而成痞成鼓者有之。（《万病回春》）
凡治疟不求邪之所在，辄行大汗、大下，伤人正气者，医之罪也。○凡用截疟之法，不俟疟势稍衰，辄求
速止者，医之罪也。○凡用吐法，妄施恶劣之药，并各种丸药，伤人脏腑者，医之罪也。（《医门法律》）
瘅疟
师曰∶阴气孤绝，阳气独发，则热而少气烦冤，手足热而欲呕，名曰瘅疟。若但热不寒者，邪气内藏于心，
外舍分肉之间，令人销铄肌肉。（《金匮》）
瘅疟一证，在《内经》曰∶肺素有热，气盛于身，发则阳气盛，阳气盛而不衰，故致销铄肌肉者，命曰瘅
疟，自与诸疟不同。治法有三∶如热邪内蓄而表邪未解者，则当散以辛凉；如热因邪致，表虽解而火独盛者，
则当清以苦寒，此皆治其有余也。若邪火虽盛，而气血已衰，真阴自耗者，急宜壮水固元，若但知泻火，则阴
日亡，必致不救。（《景岳全书》）
温疟
温疟者，其脉如平，身无寒，但热，骨节疼烦，时呕，白虎加桂枝汤主之。（《金匮》）
《内经》所称先热后寒之温疟有二∶一者先伤于风，后伤于寒，风为阳邪，寒为阴邪，先阳后阴，故先热
后寒。此以风寒两伤营卫之法治之，初无难也。其一为冬感风寒，深藏骨髓，内舍于肾，至春夏时令大热而始
发。其发也，疟邪从肾出之于外而大热，俟其疟势外衰，复返于肾，而阴精与之相持，乃始为寒。设不知壮水
之主，急救其阴，十数发而阴精尽矣，阴精尽则真火自焚，洒洒时惊，目乱无精，顷之死矣。所以伤寒偏死下
虚人，谓邪入少阴，无阴精以御之也。而温疟之惨，岂有异哉！（喻嘉言）
温疟有三，总属阳盛，而浅深之邪不同。仲景所言于《金匮》者，温疟之一也。《素问》又有温疟二证，
证不同而因亦异。仲
景所言者二证，但热不寒之疟也，一曰瘅疟，一曰温疟。《内经》所言者二证，先热后寒之疟也，俱曰温疟，
此以寒热之有无、先后为分晰者也。仲景所名瘅疟，但热不寒之热，热根生于心，而热气舍于分肉；至于温疟
之但热不寒之热，则不渴，阳郁于表之热，故脉如平，此二证，其热大分浅深也。《内经》所言之第一种温疟，
其先热后寒之热，亦如仲景所言之温疟，不过阳郁于表之热，特寒热之次序，稍变于常疟耳，其发亦以时变，而
仍不失其常，亦热之浅者也。至《内经》所言第二种之温疟，则又似同于仲景所言之瘅疟矣。然先热后寒，与
瘅疟之但热不寒又不同。盖寒热之见于外不同，而积热生于里有同耳，何以谓之同于瘅疟？以仲景所言瘅疟有
夙热，而《内经》所言温疟，亦有夙热者也。仲景所言夙热藏于心脏，《内经》所言夙热藏于肾脏也。疟病原
非脏邪，以热在脏为疟之根，如疟母在肝脏，为疟之母，俱系于脏，而以脏言。而疟则究非脏病，故热藏于心，
即根于心；热藏于肾，即根于肾，此俱热之深者也。○《内经》言温疟有二，喻氏引以发明《金匮》之未备，但
未言方出治。予总以白虎汤主之，治心火于少阴，与治肾火于少阴，亦相去不远也。气虚加人参，津亡加生地，
血虚加归、芍，热甚在心加黄连，在肾加黄柏，俱不出阳盛救阴之法也。（魏荔彤）
牝疟
疟多寒者，名曰牝疟。蜀漆散主之。（《金匮》）
疟多寒者，寒多于热，如三七、二八之分，非纯寒无热也。若纯寒无热，则为阴证，而非疟证矣。（喻嘉言）
[Scriptural Interpretation]
Summer injury by summer-heat, autumn becomes malaria. ○ If sweat does not come out during the summer heat, wind-malaria will form in autumn. (From *Su Wen*)
[Philosophical Remarks]
Mu-malaria (Cold-predominant Malaria) presents with chills but no fever, anhidrosis, cold shivering, and headache; the disease location belongs to the Taiyang (Greater Yang) channel. Dan-malaria (Hot-predominant Malaria) presents with fever but no chills, mental restlessness, spontaneous heat, and sweating; the disease location belongs to the Yangming (Bright Yang) channel. Feng-malaria (Wind-malaria) presents with fever first followed by chills, aversion to wind, spontaneous sweating, and headache; the disease location belongs to the Shaoyang (Lesser Yang) channel. Shi-malaria (Dampness-malaria) presents with chills first followed by fever, heavy body, nausea, and vomiting; the disease location belongs to the Taiyang channel. Intermittent malaria (Sanri-nie) alternates between chills and fever, occurring every other day or every three days, lingering endlessly; the disease location belongs to the Shaoyin (Lesser Yin) and Jueyin (Terminal Yin) channels. (From *Yi Jie Bian Zheng*)
The back of the body belongs to Taiyang, which corresponds to the Bladder and its Qi is Cold Water. The front of the body belongs to Yangming, which corresponds to the Large Intestine and its Qi is Dry Metal. The pathogen of Shaoyang resides within; when it approaches the posterior Bladder Cold Water, there is aversion to cold; when it approaches the anterior Yangming Dry Metal, there is fever. Hence, it manifests as alternating chills and fever. (Li Dongyuan)
The chills in malaria are caused by internal heat about to arise; Fire rushes its Qi, causing a chilling sensation, which is not true cold. Therefore, hot medicines should not be used for treatment. (From *Ji Ren Bian*)
Malaria attacks must involve both chills and fever, with alternating chills and heat, fitting precisely within the domain governed by Shaoyang. Bias towards Yin results in more chills; bias towards Yang results in more heat. Even pure heat without chills (Dan-malaria, Wen-malaria) or pure chills without heat (Mu-malaria) are all extremes deviating from Shaoyang. To correct this deviation and remedy the flaw, one must return to the boundary of Shaoyang; only when Yin and Yang coordinate harmoniously can recovery occur. The malaria pathogen is like a puppet; Shaoyang holds the strings, controlling advance and retreat, entirely subject to Shaoyang's dominance. (Yu Jiayan)
Everyone knows that malaria is caused by summer-heat, but few realize that while summer heat is naturally suitable for righteous Qi, those who fear heat often seek coolness and avoid heat. This leads to contracting cold due to summer-heat, resulting in malaria. The Classics state: "If sweat does not come out during summer heat, wind-malaria forms in autumn." The meaning is clear here. However, only those with weak constitutions or excessive fatigue and injury are prone to pathogenic invasion. This explains why pathogenic invasion varies in depth, leading to varying severity of illness. Although the cause is summer-heat, termed "contracting summer-heat," one must understand that summer-heat has Yin and Yang aspects; malaria is specifically caused by Yin summer-heat. Regarding pathological changes, some present as cold syndromes, some as heat syndromes; some require dispersing methods, some requiring astringent methods, some warming methods, and some clearing methods. The key lies in distinguishing root and branch, excess and deficiency, and adapting treatment to the syndrome. Those who mistake summer-heat injury for Fire, or stubbornly treat Spleen-cold as mere cold, hold biased views. ○ Malaria occurring after Summer Solstice and before Autumn Equinox is in the Yang aspect, indicating shallow disease. Malaria occurring after Autumn Equinox and before Winter Solstice is in the Yin aspect, indicating deep disease. Malaria occurring after Zi hour (11 PM–1 AM) and before Wu hour (11 AM–1 PM) is a Yang aspect disease, easy to cure. Malaria occurring after Wu hour and before Zi hour is a Yin aspect disease, difficult to cure. ○ Malaria shifting from Yin to Yang, and from long intervals to short intervals (earlier onset), indicates progression from severe to mild. Shifting from Yang to Yin, and from earlier to later onset, indicates progression from mild to severe. Deep pathogenic invasion causes late onset; if the onset gradually becomes earlier and closer to normal, it is a good sign. Thus, treating this disease is easier in Spring and Summer, and harder in Autumn and Winter. (From *Jing Yue Quan Shu*)
Malaria may occur daily or every other day. Ancients believed daily occurrence is mild, while every-other-day occurrence is severe, attributing this to Wei Qi (Defensive Qi) failing to overcome the pathogen, requiring two days' accumulation to expel the pathogen from Fengfu. However, some every-other-day cases are mild because the pathogen and disease are slight, requiring two days to accumulate before Wei Qi can contend and expel the pathogen from Fengfu; thus, they cannot be deemed severe. ○ Malaria pathogens resemble epidemic toxins, but epidemics are severe while malaria is mild. (From *Yi Can*)
The proverb says: "Youth should not be weak, elders should not have malaria." This is because youth have vigorous desire-fire and declining Yin-water; elders have declining Qi and Blood, unable to endure the torment of alternating chills and fever. (From *Jian Wen Lu*)
Question: Why does the pulse skip beats and consciousness become confused/delirious during malaria attacks, but clarity and normal pulse return after the attack? Answer: During the attack, pathogenic obstruction prevents righteous Qi from circulating freely, causing skipped pulses. After the attack, the pathogen dissipates, righteous Qi recovers, and the pulse relaxes, returning to normal. Delirium during attacks is due to extreme heat disturbing the Spirit. (Fang Xingyan)
[Supplement]
Malaria differs by Wind, Cold, Summer-heat, and Dampness; treatments vary by Sweating, Vomiting, and Purging methods. Thousands of formulas exist, impossible to list fully. Only "No phlegm, no malaria; no food stagnation, no malaria" captures the etiology well. For anhidrotic malaria, induce sweating to disperse pathogens; for diaphoretic malaria, stop sweating to support righteousness. This captures the essence of malaria treatment. (From *Zhao Shi Yi Guan*)
The chapter on malaria in *Chao Shi Bing Yuan* arbitrarily divides it into Five Zang organs. Later scholars believed it elucidated *Nei Jing*, trusting it implicitly, unaware that malaria pathogens do not originate from the Zang organs. This concept absent in *Nei Jing* is merely Chao's speculation. Chen Wuyue's Three Causes theory is correct. However, claiming "Summer injury by summer-heat, autumn becomes malaria" cannot be solely relied upon is contrary to sage words. Regarding internal causes, copying Chao's Five Zang malaria theories remains vulgar. Zhang Hezi treated malaria favoring Sweating, Vomiting, and Purging, boasting of following Zhang Zhongjing. Unaware that Zhongjing's sweating/purging referred to adjusting the Harmonizing method of Shaoyang, not Taoyang sweating/purging. Those suitable for vomiting used Geng Ti or Chang Shan, each with deep meaning, not arbitrary. Zhang claimed that in peaceful times, even using arsenic poison to treat heat with heat could work—what nonsense! Li Dongyuan and Zhu Danxi strictly followed *Nei Jing*'s "Summer injury by summer-heat, autumn must have malaria," making many discoveries. They noted people in Wu, Chu, Min, Guang suffer much malaria due to abundant Yang, low damp terrain, and long summer damp-heat causing malaria, cholera, and dysentery—a wise observation. Yet regarding *Nei Jing*'s intent, it falls short. *Nei Jing* treats Summer-heat and Dampness together,不分南北 (distinguishing North/South). Danxi discussed twelve channels causing disease, aligning with *Ci Nie Pian*, yet why not follow *Jin Gui* focusing on Foot Shaoyang, leading to confusion? Formulas classify Wen-malaria as a complication of Cold Damage, similar to Wind-malaria; source unknown. Mu-malaria lacks a specific name, grouped under Cold-malaria, mistakenly identified as extreme organ cold, hence no heat, treated with Ginger, Cinnamon, Aconite. Some renamed it Pin-malaria, citing chronic cold-damp, Yin excess/Yang deficiency, treating with warming methods, effectively killing patients instantly. Others equated Summer-malaria with Dan-malaria, using She Pi for vomiting, never saving Shaoyang Wood-Fire like saving a fire—truly misguided and unfortunate for the people. ○ String-numerous pulse indicates Wind-Heat; stop it with dietary adjustments. Zhongjing stated string-numerous implies heat, adding that string-numerous indicates Wind-Heat progressing to extreme heat, generating Wind, where Liver Wood insults Spleen Earth, transmitting heat to Stomach, consuming fluids, causing Yang excess. This requires dietary management (Pear juice, Sugarcane syrup) per *Nei Jing*'s "Wind rampant inside, treat with Sweet-Cold." (Yu Jiayan)
Treating malaria requires knowing Root and Branch. Treat Branch if present, Root if not; this is crucial. Branch refers to Pathogen, Root to Righteous Qi. Pathogen-Righteous contention causes malaria. Initial malaria involves strong Pathogen, so treat Pathogen. If dispersing has been done and it persists, distinguish Pathogen vs. Righteous Qi. Pathogenic presence shows fierce symptoms, string-tight pulse, unrelieved headache, or incomplete sweating. If signs indicate excess, even if chronic, pathogen remains; treat both. If sweating is profuse, pathogen resolved, no excess signs, yet persistent, it is Righteous Qi deficiency (weak constitution or old age); treat Root exclusively. Restoring Yuan Qi ensures cure. Ignoring Root/Branch and attacking malaria blindly causes harm. ○ Treatment: Chronic malaria with profuse sweating and open pores (Yang insecurity) requires tonifying and astringing. Anhidrosis with closed pores (pathogen unresolved) requires dispersing. Thus: Diaphoresis needs astringency/supporting Righteous Qi; Anhidrosis needs sweating/dispatching Pathogens. Malaria is external pathogen, resolved by sweating. Without proper dispersal, using coercive agents damages Stomach Qi; use tonics with modifications to induce sweating. If pathogen is in Yin aspect, lower body resists sweating; tonic efficacy reaching feet induces sweating to toes, a good sign. ○ External Cold resolves with sweating (e.g., Cold Damage). Plague-malaria varies in depth; plague persists despite sweating. Malaria recurs despite sweating. Deep invasion requires gradual sweating based on strength. Do not assume pathogen absence post-sweat; judge by pulse tightness, pain, and heat intensity. Ancients advised against treating during impending or active attacks, waiting for peak Yin/Yang balance or striking before onset. I find striking at peak effectiveness fastest. Ancient methods need not be rigid. (From *Jing Yue Quan Shu*)
Malaria arises from latent pathogens; distinguish which of Six Qi injured which channel. Xiao Chai Hu Tang targets Shaoyang only. Occurs in Spring/Winter, mostly Summer/Autumn Summer-heat/Dampness. Summer-heat carries Dampness, injuring Qi aspect. Differentiate Upper/Middle Jiao burden. Heavy Summer-heat: Focus on Lung Qi; fever > chills, red lips/tongue, thirst/desire for drinks, Yang-excess pulse/color. Use Gui Zhi Bai Hu Tang or Tian Shui San plus Acrid-Cool herbs. Heavy Dampness: Focus on Spleen/Stomach Yang; steaming fever, greasy tongue coating, desire for warm drinks, chest/epigastric fullness, nausea. Use Zheng Qi San or Er Chen Tang minus Gan Cao plus Xing Ren, Dou Kou, Sheng Jiang. Balance Yang over Yin before harmonizing. Combined syndromes use combined methods. Mild pathogen/moderate Righteous Qi: Equal chills/fever, regular timing. Severe pathogen/weak Righteous Qi: Blurred chills/fever, chaotic onset. Shallow pathogen: Daily. Deeper: Every other day. Deepest: Every three days (Three Yin Great Malaria), involving Liver/Spleen/Kidney signs. Tonify/Clear/Warm/Cool follow Zhongjing's Three Yin methods; Yang channel formulas ineffective. "Earlier onset reaches Yang, later onset sinks to Yin"; Yin/Yang fluctuation observable. Chronic cases risk complications. Taiyin deficiency/bloating: Li Zhong Tang (Tonify/Pass), Wu Ling San (Open Fu). Shaoyin emaciation/labor: Fu Mai Tang (Nourish Yin), Sheng Qi Fa (Warm/Nourish). Jueyin reversal/vomiting roundworms/malaria mass: Wu Mei Wan, Bie Jia Jian Wan. Heart channel chronic: Disturbs Ying, causes thirst/redness; nourish Yin. Lung channel chronic: Damages Jin Ye, causes constipation/obstruction; clear/descend. Summer-heat/Dampness blocking San Jiao, vomiting/refusal: Ban Xia Xie Xin Tang. Turbid misting Dan Zhong, dull spirit: Niu Huang Qing Xin Wan. Heart Yang sudden collapse: Long Gu, Mu Li rescue. Stomach deficiency retching: Xuan Fu Dai Zhe Tang. Methods include dispersing/harmonizing, unblocking Yang/tonifying Qi, nourishing Yin/resolving Ying, searching pathogen into collaterals, coercive interception, Sour/Pungent harmony, Ying/Wei tonification, Stomach Yin nourishment post-Yang malaria, Spleen Yang regulation post-Yin malaria—all complete. ○ Wu Mei uses sourness to drain Wood/peace Earth. Chang Shan, Cao Guo coerce Taiyin Cold, preventing pathogen merger. Ren Shen, Sheng Jiang (Lu Jiang Yin) secure Origin/scatter pathogen, clearing turbidity. Chronic pathogen entering Blood/mass: Bie Jia Jian Wan activates blood/unblocks collaterals. (From *Lin Zheng Zhi Nan*)
Shaoyang syndrome resolution indicated by consistent timing; unchanged timing means pathogen remains. Using Chai Hu to shift timing (early to late, late to early) moves Qi to Blood, Blood to Qi, leaving no room for pathogen, indicating resolution. (Wang Haogu)
Malaria involves Yin/Yang contention, alternating chills/fever; medicine should be half raw/half cooked, half cold/half hot for perfect results. (From *De Xiao Fang*)
Malaria decoctions should be exposed overnight before taking. Malaria is caused by Summer-heat; Summer-heat dissolves with dew. (Miu Zhongchun)
Malaria patients must wait for fever to subside and body to cool before eating. Avoid hot food/drink to prevent stagnation forming masses or drum-like distension. (From *Wan Bing Hui Chun*)
Doctors sin by treating malaria without locating the pathogen, using excessive sweating/purging, damaging Righteous Qi. Doctors sin by using intercepting methods before malaria wanes, seeking quick cessation. Doctors sin by using vomiting methods with harsh drugs/pills, damaging Zang/Fu organs. (From *Yi Men Fa Lv*)
[Dan Malaria]
Master said: Yin Qi isolated/extinct, Yang Qi alone erupts, causing fever, shortness of breath, mental oppression, hot hands/feet, nausea; named Dan Malaria. If only fever without chills, pathogen hides in Heart, resides in Fen Rou (muscle interspaces), causing muscle wasting. (From *Jin Gui Yao Lue*)
Dan Malaria in *Nei Jing*: Lung previously hot, Qi abundant in body; eruption causes Yang abundance, unceasing, leading to muscle wasting. Named Dan Malaria, distinct from others. Three treatments: 1. Heat internal/stagnant, exterior unresolved: Disperse with Acrid-Cool. 2. Heat caused by pathogen, exterior resolved, Fire alone strong: Clear with Bitter-Cold. These treat excess. 3. Fire strong but Qi/Blood depleted, True Yin consumed: Urgently strengthen Water/secure Origin. Knowing only to purge Fire leads to Yin loss and death. (From *Jing Yue Quan Shu*)
[Wen Malaria]
Wen Malaria: Pulse like normal, no chills, only fever, bone/joint pain/annoyance, occasional vomiting; treated with Bai Hu Jia Gui Zhi Tang. (From *Jin Gui Yao Lue*)
*Nei Jing* describes two types of Wen Malaria (fever then chills): 1. Wind injury first, Cold second. Wind is Yang, Cold is Yin; Yang then Yin causes fever then chills. Treat with methods for Wind-Cold injuring Ying/Wei; simple. 2. Winter Wind-Cold hides deep in Marrow/Kidney; erupts in Spring/Summer heat. Pathogen exits Kidney externally causing high fever; as momentum fades, returns to Kidney, Yin essence contends, causing chills. If not strengthening Water/Emergency Yin, dozens of attacks exhaust Yin essence; Essence exhausted leads to True Fire self-immolation, trembling/fright, blurred vision, death quickly. Cold damage kills deficient persons because pathogen enters Shaoyin without Yin defense. Wen malaria is equally cruel! (Yu Jiayan)
Three types of Wen Malaria, all Yang excess, differing depth. Zhongjing's *Jin Gui* type is one. *Su Wen* has two Wen Malaria types, different symptoms/causes. Zhongjing's two types (Dan, Wen) are fever-only. *Nei Jing*'s two types are fever-then-chills, both called Wen Malaria, distinguished by presence/order of chills/fever. Zhongjing's Dan Malaria: Fever-only, root in Heart, heat in Fen Rou. Zhongjing's Wen Malaria: Fever-only, no thirst, Yang trapped in exterior, pulse normal. These differ in heat depth. *Nei Jing* Type 1 Wen Malaria: Fever-then-chills, like Zhongjing's Wen Malaria (Yang trapped in exterior), just order differs slightly from common malaria, timing variable but constant, shallow heat. *Nei Jing* Type 2 Wen Malaria: Similar to Zhongjing's Dan Malaria. But fever-then-chills differs from Dan's fever-only. External chills/fever differ, internal accumulated heat same. Why similar to Dan? Both have "Suo Re" (Pre-existing Heat). Zhongjing: Suo Re in Heart. *Nei Jing*: Suo Re in Kidney. Malaria not originally Zang pathogen; heat in Zang is root. Malaria mass in Liver is mother of malaria, associated with Zang. Malaria is not Zang disease. Heat in Heart = root in Heart; Heat in Kidney = root in Kidney. These are deep heat. ○ *Nei Jing* mentions two Wen Malarias; Yu cites them to supplement *Jin Gui*, but omits formulas. I generally use Bai Hu Tang. Treating Heart Fire in Shaoyin vs. Kidney Fire in Shaoyin is similar. Qi deficiency add Ren Shen; Fluid loss add Sheng Di; Blood deficiency add Dang Gui, Bai Shao; Heat in Heart add Huang Lian; Heat in Kidney add Huang Bo. All fall under Yang Excess Saving Yin method. (Wei Litong)
[Pin Malaria]
Malaria with more chills is named Pin Malaria. Treated with Shu Qi San. (From *Jin Gui Yao Lue*)
Malaria with more chills means chills exceed heat (e.g., 30% heat, 70% chills), not pure chills without heat. Pure chills without heat is Yin syndrome, not malaria. (Yu Jiayan)