牡者阳物也，则牡疟者，亦阳胜阴亏之疾也。阳胜阴亏，何不治其阳，而以蜀漆散治其湿？则其人热甚
于内，而素有水饮，所谓夏伤于暑者，热也；长夏伤于湿者，湿也。湿为水邪，必犯心脏；心名牡脏，为诸阳
之主，水邪挟热干犯于心，故名牡疟。蜀漆，吐药也；和浆水以助其吐，非益其湿也；以云母、龙骨镇
其心，驱其邪，俱寓治水之义也。此仲景于牡疟之治，明湿邪之浸淫，将使热邪得留恋，去湿正所以去热也。（魏荔彤）
牡疟
瘅疟独热，温疟先热，牧疟无热，诸疟皆先寒后热。（《三因方》）
邪气内藏于心，则但热而不寒，是为瘅疟。邪气伏藏于肾，故多寒而少热，则为牝疟。以邪气伏结，则阳
气不行于外，故外寒积聚津液以成痰是以多寒。方用蜀漆和浆水吐之，以发越阳气；龙骨以固敛阴津；云母性
温而升，祛湿运痰。方后有云∶湿疟加蜀漆半分。坊本误作温疟，大谬。此条本以邪伏髓海，谓之牝疟，赵以
德不辨亥豕，注为邪在心而为牡；喻嘉言亦仍其误而述之，非智者之一失欤。（张路玉）
牝疟无热，《内经》并无此说。惟《金匮》云∶疟多寒者名曰牡疟，亦非全无热也。果全无热而止见寒栗，
此真寒阳虚证耳，安得谓之疟耶？（张景岳）
阴疟
疟邪入于阴分，宜用血药，引出阳分，如芎、归、红花、升麻之类。其不用别甲、首乌者，更恐引邪深陷
少厥之界耳。（方星岩）
疟发在酉时者，五发内俱当用香红饮。方用香附、益母草、红花、当归、人参、生姜。古人用升提法，转
出阳分，不过言其理当如是耳。时人执此法，愈提则阴愈虚，且凡属夜病，若俱要见阳而愈，则亦不胜其升提
矣。（《己任编》）
胎疟
疟疾一证，《内经》详言之，先贤备述之。至于人生初次发疟，名为胎疟，古人未有发明。患者延缠难愈，
或变虚咳，或变浮肿，体实之人亦成疟母。盖疟乃暑邪伏于膜原之间，呆在少阳
之界，不同伤寒、温疫转里之险。常发疟者，数发之后，邪无所容，即从毛窍熟径而出。若胎疟之作，隧道少
疏通之机，毛窍非熟由之路，缠绵不已，正气受亏，正愈虚邪愈陷。予悟此理，初发投小柴胡汤加减数剂，阴
虚者用救阴补元之法，阳虚者用温养元阳之法，俱重加人参，俾营卫气盛，则膜原留连之邪，急走隧道，肌腠
虽非熟径，自有不能不出之势矣。（汪蕴谷）
三日疟
疟者，老疟也。以其隔三日一发，缠绵不去也。（娄全善）
或问胎疟之故，既得闻命矣，乃三日疟尤难愈于胎疟，抑又何也？余曰∶膜原之界限，宜分阴阳浅深之不
同；营卫之气血，亦分阴阳盛衰之各异。在膜原之浅者，阳盛于阴，阳盛则正强而邪弱，随卫气出入而疟难久
留。在膜原之深者，阴盛于阳，阴盛则邪胜而正弱，居营气之间，而疟多伏藏。所以邪中浅者一日作，深者间
日作，极深者间二日作。汪机云∶三日一发者，非入脏也，由气血盛衰而然，气血强健，邪无容留矣。可见邪
伏膜原之深界，离肌腠之路远，宜阳分助气之药，加血药引入阴分，方可挈起。如是则气血日盛，邪不攻而自
走也。此证初发，用补中益气汤合桂枝汤，升其陷于阴经之邪。久发肾阴虚者，用六味汤合生脉散，补其真水；
肾阳虚者，用养营汤、八味汤，补其真火；脾胃虚者，用四君子汤，或六君子汤，补其脾土。总之，此证本于
根原内空，卫阳不密，邪有隙而可乘，惟重加参、术煎汤，吞八味丸，久服自有神功。血亏者加当归；气弱者
加黄 ；阴虚火盛者，二母汤吞六味丸，阴虚火盛而胃滞者，二母汤吞独何丸，治法不外乎是。（汪蕴谷）
三日疟，邪气入深，原非旦夕能愈，若在霜降后，更难获瘳。当久服扶正之药，待春分阳气发扬，方得全
愈。若服劫剂，不惟疟不能止，或劳或鼓，难免后忧。（《名医类案》）
三阴疟者，惟太阴疟当用理中汤，然必加肉桂。若在少阴、
厥阴，非八味地黄汤不效。（《赵氏医贯》）
久疟
久疟，乃属元气虚寒。盖气虚则寒，血虚则热，胃虚则恶寒，脾虚则发热，阴火下流则寒热交发，若误投
清脾、截疟二饮，多致不起。○久疟诸药不效，以补中益气汤加半夏，或用人参一两、煨姜五钱，此不截之截，
一服即愈。（薛立斋）
四明治久疟不愈，以养营汤送八味丸，仍于汤中加熟附子，谓十剂必除。又云∶久疟以补中益气汤不效者，
八味丸有神应。此益火之原以消阴翳也。（《己任编》）
三阳经疟
太阳之疟，腰背头项俱疼，先寒后热，热止汗出。阳明之疟，目痛鼻干舌燥，寒甚乃热，热甚汗出，畏见
火日光。少阳之疟。口苦胁痛而呕，寒热往来，身体解亦。（《医学入门》）
三阴经疟
少阴之疟，寒少热多，呕甚舌干口燥，欲闭户独处。太阴之疟，惨然太息，腹满恶食，病至善呕，呕已乃
衰。厥阴之疟，腰痛少腹满，小便数而不利，恐惧不定，心中悒悒。（《仁斋直指》）
风疟
凡疟皆生于风，风疟者，因避暑乘凉，汗出当风，邪闭毛孔，不得泄越而作。所谓夏暑汗不出者，秋成风
疟是也。其证烦躁头疼，恶寒自汗，先热后寒，治宜发汗。（《证治汇补》）
寒疟
柴胡桂姜汤，治疟寒多微有热，或但寒不热，服一剂如神。（《金匮》）
是证虽与牝疟相类，以方药论之则殊，牝疟邪伏少阴气分，此证邪伏少阳血分。夫邪入营血，既无外出之
势，而与阳争，所以多寒少热，或但寒无热也。小柴胡汤本阴阳两调之方，可随疟之进退，加桂枝，干姜，则
进而从阳，若加栝蒌、石膏，则退而
从阴，可类推矣。（张路玉）
纳凉之风寒，沐浴之水寒，伏于腠中，因触秋凉而发，其证腰背头项疼痛，先寒后热，治当温解。（《证治汇补》）
暑疟
暑疟者，其证汗烦喘喝，静则多言，体若燔炭，热多寒少，治宜清暑解表。（《证治汇补》）
湿疟
外着雨衣，内停水湿，发则一身尽痛，手足沉重，呕逆胀满，名曰湿疟。治宜解表除湿。（《证治汇补》）
瘴疟
瘴疟者，山溪瘴毒，湿热熏蒸，邪郁中焦，发时迷闷，甚则狂妄，乍寒乍热，一身沉重，不习水土者多
患之。治宜正气散。（《证治汇补》）
疫疟
一方老幼病皆相似，此因天时寒暄不正，邪气乘虚袭入所致，宜随时令施治，此司天运气之所宜考也。（《证治汇补》）
鬼疟
鬼疟者，因卒感尸疰客忤，寒热日作，言动异常，俗云夜发为鬼疟，非也。宜却邪禁厌法；或用平胃散
加桃仁、雄黄。（《医方考》）
鬼疟之说，此或以疟邪乱其神明，因致狂言似鬼者有之，岂真鬼祟能为疟乎？（《景岳全书》）
痰疟
问曰∶古云无痰不成疟，信乎？曰∶痰之所为，非热不生，其有先伤饮食，痰热内作，复挟暑邪。变而
为疟者有之。无痰不成疟，凡疟皆由脾虚，此二说乃透疟病之根。《己任编》痰疟者，因夏月多食瓜果油面，
郁结成痰。热多寒少，头疼呕吐，甚则昏迷卒倒，寸口脉滑大者吐之；关脉弦滑者化之。若胸满热多。大
便燥实者，大柴胡汤下之。（《证治汇补》）
食疟
食疟一名胃疟，因饮食失节，饥饱不常，谷气乖乱，营卫失和。其证寒热交并，恶食吐逆，胸满腹胀，食
在膈上者吐之；食停未化者消之；食已消者和之。（《证治汇补》）
胃疟既云饮食饥饱伤胃而成，明是内伤，然未有不因外邪而单有食疟者也。（张景岳）
劳疟
柴胡去半夏加栝蒌汤，治疟病发渴者，亦治劳疟。（《金匮》）
劳疟其本火甚，营卫衰，津液竭，故并可施此方以治之。（喻嘉言）
劳役过度，营卫空虚。其证发热恶寒，或发于昼，或发于夜，遇劳便发，气虚多汗，饮食少进，误作疟治，
久必成瘵。（《证治汇补》）
似疟
凡三春寒热如疟，非正疟也，其病在表，治宜疏解；不可作正疟用柴胡汤。（王协中）
秋时晚发，感证似疟，当以感证之法治之。（《己任编》）
似疟非疟一证，亦恶寒发热，或连日作，或间日作，而其与疟分别处，惟在乎脉之不弦耳。（方星岩）
似疟非疟之病，虽有寒热，而时作时止，本非疟类。凡病后，或产后，或虚损，俱有此证。《经》曰∶阳
虚则外寒，阴虚则内热。阴气上入阳中则恶寒，阳气下入阴中则发热。故凡无外邪而病为寒热者，必属虚证。
但虚有阴阳之异，阳虚者必多寒，阴虚者必多热。阳虚者宜补其阳，人所易知，惟阴虚之证，则不易辨。盖阴
中之水虚者，阴虚也；阴中之火虚者，亦阴虚也。（《景岳全书》）
有恶寒发热，与疟无异，面赤如脂，口渴不甚，吐痰如涌，
身以上热如烙，膝以下自觉冷，此真阳泛上，肾虚之极，急以八味汤冷冻饮料，继以人参建中汤调理。○又有一等郁
证伤疟者，其寒热亦与正疟无异，但其人口苦、呕吐、面青、胁痛、耳鸣、脉涩，先用逍遥散，加茱、连、贝
母，继以六味汤，加柴胡芍药调理。（《赵氏医贯》）
疟母
病疟以月一日发，当以十五日愈，设不瘥，当月尽解，如其不瘥，当何如？曰∶此结为 瘕，名曰疟母，
急治之，宜鳖甲煎丸。（《金匮》）
疟母者，痰挟血食而结为 瘕；鳖甲煎丸，此《金匮》法也。其有虚人久疟，结成痞积，宜芎归鳖甲饮。
不应，脾虚也，用补中益气汤加鳖甲。疟久必有留滞，须加鳖甲消之，如无留滞，只宜补益。盖疟母缘医治失
宜，邪伏肝经胁下致成痞块，不可作癖积治，每见急攻，多致不救。（《张氏医通》）
疟后变证
疟后变证，惟痢为急。求其所由，有因疟邪解散不早，或解散不畅，致陷于里，变而为痢者，法当表里
分治，痢愈疟亦止，即不止，其发亦轻。有因疟时误下，邪陷于内，变而为痢者，必兼腹满肿胀，呕恶不食等
证，法当逐邪培土，亦以痢止为度，二者俱宜补中益气汤加减。其次疟劳，或素有弱证，而又患疟，以至旧病
更深，煎熬日久，精神衰耗，肌肉消削，往来潮热，渐成劳瘵，察其何经受病，而补益之。其次疟厥，本由气
血亏虚，调理失宜；或因寒而浓衣重被，过伤于暖；或因热而单衣露体，又感于寒，遂成湿厥，治当分别寒热，
不得混施汤剂。
疟脱
疟脱之证，魄汗淋漓，面色青黑，脉虚浮数，按之极虚，治非补中益气汤去升、柴，倍参、 ，加白芍、
五味、枣仁不可也。（吴天士）
厌疟
厌疟之法，俗多用之。有效、有不效，人每疑之，而其所以然者，自有的确之妙，人未知也。盖疟以邪
正相争，势犹楚汉相持，但得一助之者，为楚则楚胜，为汉则汉胜，故不论何物，皆可用以为厌。但使由之，
勿使知之，其人恃有所助，则胆壮而邪即败矣。然惟邪轻日作者可厌，而邪深间日者则不能厌。（张景岳）
截疟
疟用截药，不可太早，截早则邪气闭塞而成坏证。又不可太迟，截迟则元气衰惫而成怯证，当在三、四发
截之为好。（《万病回春》）
截疟之法，方固不少，若以愚见，并及治验，则未尝藉于截也。盖有邪者邪去则愈，若散邪既透，则但收
拾元气，气复即愈，能于邪正之间，得其攻补之宜，此截之最善者也。至于截疟诸方，虽不可执，亦不可无，
第有效于此，而不效于彼者，亦以人之气血阴阳，各有不同故耳。故凡截药，当察人之强弱，酌而用之，庶乎
得效。然亦惟轻者易截，而重者不易截也。（张景岳）
脉候
疟脉自弦，弦数者多热，弦迟者多寒。弦小紧者下之瘥，弦迟者可温之，弦紧者可发汗针灸也，浮大者
可吐之，弦数者风发也，以饮食消息止之。（《金匮》）
选案
熊丹孚病疟半年，诸药莫止，羸惫殊甚。诊曰∶正极虚矣，安可复投疟门药乎？命取人参二两，配合补
中益气汤，加熟地、五味子、山萸、山药浓煎服之，顿觉精神壮旺，疟鬼不知逃去无何有之乡矣。丹孚乃曰∶
昨日犹服常山截疟饮，寒热益甚，先生之术是何神也？予笑而不答。（程华仲）
一女年二十，初冬时，每日薄暮，发寒战一、二时，半夜后，寒战益甚，屡药不效。诊左关脉沉弦，余皆
平弱，此牝疟也。由
郁久兼受寒气客于肝脏，肝主筋与血，寒凝则血脉不和，故战栗而筋脉动摇。《经》云∶肝病者日晡甚，是以
薄暮而发也。药用芎、归、白芍、天麻、醋炒柴胡、香附、吴萸、肉桂、炮姜，一服即愈。（《医验录》）
程结先子病疟，每日辰时大寒，午后大热，热即厥，直视不能出声，颏脱，涎涌，日流数升，至丑时始汗
解，饮食不进，昏冒几绝。予往视之，皆诛伐太过所致也，值医者在，予谓此为何证？曰∶此肝疟也，肝疟令
人色苍苍然太息，其状若死。予笑曰∶据子述经言，当得通脉四逆矣，何用前药？予诚不识此为何病，但知其
虚甚耳，请先救人后治病。是夜用人参一两，黄 二两，炮姜三钱，比晓熟地、桂、附并进，次日辰时疟不复
Mu (Odd/Unpaired) refers to yang entities. Therefore, Mu Malaria (Malaria characterized by predominant heat), is also a disease of excessive yang and deficient yin. Since there is excessive yang and deficient yin, why not treat the yang, but instead use Shuqi San (Shuqi Powder) to treat the dampness? This is because the patient has intense heat within and chronic retention of fluid-drink. As stated, "Summer injury by summer-heat" refers to heat; "Late Summer injury by dampness" refers to dampness. Dampness belongs to water-pathogens and must invade the Heart; the Heart is named the "Mu Zang" (Yang Organ), the master of all yang channels. When water-dampness pathogens, carrying heat, invade the Heart, it is thus named Mu Malaria. Shuqi (Herba Descurainiae or similar emetic herb), is an emetic drug; combining it with Jiangshui (fermented grain liquid) aids vomiting, it does not increase dampness; using Yunmu (Microlite) and Longgu (Fossilized Bones) to calm the heart and expel pathogens, both embody the principle of treating water-dampness. This demonstrates how Zhang Zhongjing, in treating Mu Malaria, clearly indicated that the infiltration of dampness-pathogen would allow the heat-pathogen to linger; removing dampness is precisely the method to remove heat. (Wei Litong)
Mu Malaria
Dan Malaria (Heat Malaria) presents with heat only without chills; Wen Malaria (Warm Malaria) presents with heat preceding chills; Pin Malaria (Cold Malaria) presents with little to no heat; various malaria types present with chills preceding heat. (*San Yin Fang*)
When pathogenic factors hide internally in the Heart, there is heat only without chills, this is called Dan Malaria. When pathogenic factors hide in the Kidney, there is much chills and little heat, this is called Pin Malaria. Because pathogenic factors are stuck and hidden, Yang Qi cannot circulate externally, so external cold accumulates body fluids to form phlegm, hence presenting with much chills. The formula uses Shuqi combined with Jiangshui to induce vomiting, to vent Yang Qi; Longgu is used to consolidate and retain Yin fluids; Yunmu is warm and ascending, dispelling dampness and moving phlegm. The post-formula note says: For Shi Malaria (Damp Malaria), add half liang of Shuqi. Workshop editions mistakenly wrote "Wen Malaria", which is a major error. This clause originally referred to pathogenic factors hiding in the Sea of Marrow, called Pin Malaria. Zhao Yi-de failed to distinguish the characters and annotated it as pathogenic factors in the Heart becoming Mu Malaria; Yu Jiayan also followed this error and elaborated on it. Is this not a mistake by a wise man? (Zhang Luyu)
Pin Malaria with no heat is not mentioned in *Nei Jing* (The Inner Canon). Only *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet) states: Malaria with much chills is named Mu Malaria (Note: Text likely contains textual variant confusion here, traditionally Pin Malaria is much chills), but it is not completely without heat. If there is truly no heat and only chills are seen, this is a true Cold syndrome and Yang Deficiency, how can it be called Malaria? (Zhang Jingyue)
Yin Malaria
When Malaria pathogens enter the Yin aspect, blood-invigorating drugs should be used to draw them out to the Yang aspect, such as Xiong (Szechwan Lovage Rhizome), Gui (Chinese Angelica Root), Honghua (Carthamus Flower), Shengma (Cimicifuga Rhizome), etc. The reason for not using Biejia (Tartaric Turtle Shell) or Shouwu (Polygonum Multiflorum Root) is to avoid drawing the pathogen deeper into the Shaoyin and Jueyin realms. (Fang Xingyan)
For malaria occurring at You hour (5-7 PM), during the first five attacks, Xianghong Yin (Xianghong Decoction) should be used. The formula consists of Xiangfu (Cyperus Rhizome), Yimucao (Leonurus Herb), Honghua (Carthamus Flower), Danggui (Chinese Angelica Root), Renshen (Ginseng Root), and Shengjiang (Fresh Ginger Rhizome). The ancients used lifting methods to turn the pathogen out to the Yang aspect; this merely explains that the principle should be so. Modern people rigidly apply this method; the more they lift, the more Yin becomes deficient. Moreover, for any night illness, if one insists on resolving it by bringing it to the Yang aspect, then lifting methods would be insufficient. (*Jiren Bian*)
Tai Malaria (Primary Malaria)
The syndrome of Malaria is detailed in *Nei Jing* and fully described by former sages. However, regarding the first occurrence of malaria in a person's life, named Tai Malaria, the ancients had not elucidated it. Patients suffer from lingering and difficult-to-cure conditions, which may transform into deficiency cough or edema; even those with strong constitutions may develop Nuomother (Malaria Mass). Generally, malaria is summer-heat pathogen hiding between the Membrane Source (Mo Yuan), staying in the Shaoyang boundary, different from the danger of Shanghan (Cold Damage) or Warm Epidemics turning inward. For frequently recurring malaria, after several attacks, the pathogen has nowhere to stay and exits through the hair pores via familiar pathways. If Tai Malaria occurs, the meridians lack the opportunity for unblocking, and hair pores are not familiar routes; it lingers endlessly, damaging Zheng Qi (Upright Qi); the more deficient the Zheng Qi, the deeper the pathogen sinks. I realized this principle: upon initial attack, administer Xiaochaihu Tang (Minor Bupleurum Decoction) with modifications for a few doses. For Yin deficiency, use methods to save Yin and tonify Yuan; for Yang deficiency, use methods to warm and nourish Yuan Yang. In all cases, heavily add Renshen (Ginseng) to make Ying and Wei Qi abundant, so that pathogens lingering in the Membrane Source will urgently move through the meridians. Although muscle-couplings are not familiar routes, there is naturally a tendency for the pathogen to exit. (Wang Yungu)
Sanri Malaria (Every-Three-Day Malaria)
Malaria is old malaria. Because it occurs every three days and lingers without going away. (Lou Quanshan)
Someone asked about the cause of Tai Malaria, which I have heard. But why is Sanri Malaria even harder to cure than Tai Malaria? I said: The boundaries of the Membrane Source should be distinguished by the differences in depth and Yin-Yang; the Qi and Blood of Ying and Wei also differ in Yin-Yang prosperity and decline. In the shallow part of the Membrane Source, Yang is prosperous over Yin; Yang prosperity means Zheng Qi is strong and Pathogen is weak, so following the出入 (entry and exit) of Wei Qi, malaria is hard to linger. In the deep part of the Membrane Source, Yin is prosperous over Yang; Yin prosperity means Pathogen wins and Zheng Qi is weak, residing between Ying Qi, so malaria hides often. Thus, pathogens attacking shallow layers manifest daily; deep layers manifest every other day; extremely deep layers manifest every two days. Wang Ji said: Occurring every three days does not mean entering the Zang organs, but results from the rise and fall of Qi and Blood. If Qi and Blood are strong, the pathogen has no place to stay. It is visible that when pathogens hide deeply in the Membrane Source, far from the muscle-couplings, it is appropriate to use drugs that assist Qi in the Yang aspect, adding blood drugs to guide them into the Yin aspect, so they can be lifted up. In this way, Qi and Blood grow daily, and the pathogen leaves without being attacked. For the initial onset of this condition, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) combined with Guizhi Tang (Cinnamon Twig Decoction) to raise pathogens trapped in the Yin meridians. For long-term onset causing Kidney Yin deficiency, use Liuwei Wan (Six-Ingredient Rehmannia Pill) combined with Shengmai San (Generate the Pulse Powder) to tonify True Water; for Kidney Yang deficiency, use Yangying Tang (Nourish the Nutritive Decoction) and Bawei Wan (Eight-Ingredient Pill) to tonify True Fire; for Spleen-Stomach deficiency, use Sijunzi Tang (Four Gentlemen Decoction) or Liujunzi Tang (Six Gentlemen Decoction) to tonify Spleen Earth. In short, this condition originates from internal emptiness of the root, with insecure Wei Yang, allowing pathogens to take advantage of gaps. Only by heavily decocting Renshen and Baizhu, and swallowing Bawei Wan for a long time, will miraculous effects appear. For blood deficiency, add Danggui; for Qi weakness, add Huangqi; for Yin deficiency with hyperactive fire, swallow Liuwei Wan with Ermu Tang (Two Mothers Decoction); for Yin deficiency with hyperactive fire and Stomach stagnation, swallow Duhe Wan with Ermu Tang. Treatment methods do not go beyond these. (Wang Yungu)
Sanri Malaria involves pathogens entering deeply; it is not something that can be cured in a day or two. If it occurs after Frost's Descent, it is even harder to recover. One should take anti-deficiency medicines for a long time, waiting until Spring Equinox when Yang Qi flourishes, to achieve full recovery. If one takes drastic purgative/cutting drugs, not only will the malaria not stop, but one may suffer from consumptive diseases or drum-distension, inevitably facing future worries. (*Mingyi Leian*)
For San Yin (Three Yin) Meridian Malaria, only Taim Malaria should use Lizhong Tang (Regulate the Middle Decoction), but it must be added with Rougui (Cinnamon Bark). If it is Shaoyin or Jueyin, only Badihuang Wan (Rehmannia Pill with Eight Ingredients) is effective. (*Zhao Shi Yi Guan*)
Jiu Malaria (Chronic Malaria)
Chronic Malaria belongs to Yuan Qi (Original Qi) deficiency and cold. Generally, Qi deficiency leads to cold, Blood deficiency leads to heat, Stomach deficiency leads to aversion to cold, Spleen deficiency leads to fever. If Yin Fire flows downward, cold and heat alternate. If mistakenly administered Qingpi Yin (Clear the Spleen Drink) or Jiemie Yin (Intercept Malaria Drink), it often leads to death. ○ For chronic malaria where various drugs fail, use Buzhong Yiqi Tang with Banxia (Pinellia Tuber), or use one liang of Renshen and five qian of Wei Jiang (Baked Ginger). This is "intercepting without intercepting"; one dose brings cure. (Xue Lizhai)
In Siming region, for chronic malaria not healing, use Yangying Tang to swallow Bawei Wan, still adding Shufu Zi (Prepared Aconite) to the decoction, claiming ten doses will eliminate it. Also said: For chronic malaria where Buzhong Yiqi Tang fails, Bawei Wan has divine efficacy. This is benefiting the source of Fire to eliminate Yin shadows. (*Jiren Bian*)
San Yang (Three Yang) Meridian Malaria
Taiyang Malaria: Pain in lower back, upper back, head, and neck; chills precede heat; sweating follows cessation of heat. Yangming Malaria: Eye pain, nasal dryness, dry tongue and mouth; severe chills then heat; heavy sweating with heat; aversion to fire and sunlight. Shaoyang Malaria: Bitter taste, hypochondriac pain, vomiting; alternating chills and heat; body feels loose and weak. (*Yixue Rumen*)
San Yin (Three Yin) Meridian Malaria
Shaoyin Malaria: Few chills, much heat; severe vomiting, dry tongue and mouth; desire to close doors and stay alone. Taim Malaria: Depressed sighing, abdominal fullness, aversion to food; prone to vomiting at onset; symptoms subside after vomiting. Jueyin Malaria: Lower back pain, lower abdominal fullness, frequent urination but difficult flow; fearfulness and instability; inner depression. (*Ren Zhi Zhishi*)
Feng Malaria (Wind Malaria)
All malaria arises from Wind. Feng Malaria is caused by seeking coolness in summer, sweating and exposing to wind; pathogens close the hair pores, unable to vent, leading to onset. It is said: "Those who suffer summer heat but do not sweat, will become Wind Malaria in autumn." Symptoms include irritability, headache, aversion to cold, spontaneous sweating, heat preceding chills. Treatment should induce sweating. (*Zhengzhi Huibu*)
Han Malaria (Cold Malaria)
Chaihu Guijiang Tang (Bupleurum, Cinnamon Twig, and Ginger Decoction) treats malaria with much chills and slight heat, or only chills without heat; one dose works like magic. (*Jin Gui Yao Lue*)
Although this condition resembles Pin Malaria, pharmacologically they differ: Pin Malaria pathogens hide in the Qi aspect of Shaoyin, while this condition's pathogens hide in the Blood aspect of Shaoyang. When pathogens enter Ying and Blood, there is no trend for external exit, and they contend with Yang, hence much chills and little heat, or only chills without heat. Xiaochaihu Tang is originally a formula harmonizing Yin and Yang; depending on the progression of malaria, adding Guizhi and Ganjiang moves it towards Yang; adding Gualou and Shigao moves it towards Yin. This can be extrapolated. (Zhang Luyu)
Wind and cold from cooling off, and water cold from bathing, hide in the couli (pores/skin interstices), triggered by autumn chill. Symptoms include pain in lower back, upper back, head, and neck; chills precede heat. Treatment should warm and resolve. (*Zhengzhi Huibu*)
Shu Malaria (Summer-heat Malaria)
Shu Malaria symptoms: Sweating, irritability, panting, loud shouting; quiet yet talkative; body hot as burning charcoal; much heat, little chills. Treatment should clear summer-heat and resolve the exterior. (*Zhengzhi Huibu*)
Shi Malaria (Damp Malaria)
External exposure to raincoats, internal retention of water-dampness. Upon onset, whole-body pain, heavy hands and feet, vomiting, abdominal distension and fullness. Named Shi Malaria. Treatment should resolve exterior and dispel dampness. (*Zhengzhi Huibu*)
Zhang Malaria (Miasma Malaria)
Zhang Malaria is caused by mountain stream miasma toxins, steaming and steaming with damp-heat, pathogens郁 (depressing/stagnating) in the Middle Jiao. Onset involves confusion and dizziness, even madness; alternating chills and heat; whole-body heaviness. Those unaccustomed to local waters and soils often suffer from it. Treatment should use Zhengqi San (Righteous Qi Powder). (*Zhengzhi Huibu*)
Yi Malaria (Epidemic Malaria)
In one area, old and young suffer similarly. This is due to abnormal seasonal cold and warmth, pathogens taking advantage of deficiency to invade. Treatment should follow the seasons. This is what Si Tian Yun Qi (Heavenly Governance and Luck Movement) theory should examine. (*Zhengzhi Huibu*)
Gui Malaria (Ghost Malaria)
Gui Malaria is caused by sudden infection with corpse-transmission or guest-hostility. Daily alternating chills and heat, abnormal speech and movement. Folklore says night-onset is Ghost Malaria, which is incorrect. Appropriate methods include exorcising pathogens and taboos; or use Pingwei San (Peace the Stomach Powder) plus Taoren (Peach Kernel) and Xionghuang (Realgar). (*Yifang Kao*)
Regarding the saying of Ghost Malaria, perhaps malaria pathogens disturb the Spirit-Mind, leading to mad speech resembling ghosts. Could it really be ghosts causing malaria? (*Jingquan Quanshu*)
Tan Malaria (Phlegm Malaria)
Question: Ancient texts say "No Phlegm, No Malaria," is this true? Answer: Phlegm formation requires Heat. Some first injure diet, generating internal Phlegm-Heat, then combine with summer-heat to transform into malaria. "No Phlegm, No Malaria" implies all malaria stems from Spleen deficiency. These two sayings penetrate the root of malaria pathology. *Jiren Bian* records Tan Malaria: Caused by eating too many melons, fruits, oils, and noodles in summer, condensing into Phlegm. Much heat, little chills; headache, vomiting; even coma and sudden collapse. If Cun (Inch) pulse is slippery and large, use emesis; if Guan (Bar) pulse is string-like and slippery, use transformation/dissolution. If chest fullness and much heat, with dry and solid stool, use Dachaihu Tang to purge. (*Zhengzhi Huibu*)
Shi Malaria (Food Malaria)
Shi Malaria is also called Wei Malaria (Stomach Malaria). Caused by irregular diet, inconsistent hunger and fullness, chaotic Grain Qi, disharmony of Ying and Wei. Symptoms: Alternating chills and heat, aversion to food, vomiting, chest fullness, abdominal distension. Food in the diaphragm: use emesis; Food stagnant and undigested: use digestion/promotion; Food already digested: use harmonization. (*Zhengzhi Huibu*)
Since Wei Malaria is said to be caused by dietary irregularity injuring the Stomach, it is clearly an internal injury. However, there is no case of isolated Food Malaria without external pathogens. (Zhang Jingyue)
Lao Malaria (Consumptive Malaria)
Chaihu Qu Banxia Jia Gualou Tang (Bupleurum Decoction minus Pinellia plus Trichosanthes Fruit) treats malaria with thirst upon onset, and also treats Lao Malaria. (*Jin Gui Yao Lue*)
The root of Lao Malaria is excessive Fire, with decline of Ying and Wei, and exhaustion of Jin Ye (Body Fluids). Thus, this formula can be applied. (Yu Jiayan)
Overwork leads to emptiness of Ying and Wei. Symptoms: Fever and aversion to cold, occurring by day or night, triggered by exertion, Qi deficiency with profuse sweating, poor appetite. Mistakenly treated as malaria, it eventually becomes consumption. (*Zhengzhi Huibu*)
Si Malaria (Resembling Malaria)
Any chills and fever resembling malaria in spring are not true malaria; the disease is in the exterior, treatment should disperse and resolve; do not use Chaihu Tang for true malaria. (Wang Xiezong)
Late autumn onset, pathogenic signs resembling malaria, should be treated according to pathogenic sign protocols. (*Jiren Bian*)
This condition of resembling malaria but not being malaria also presents with chills and fever, either consecutive days or every other day. The distinction lies solely in the pulse not being string-like. (Fang Xingyan)
Illnesses resembling malaria but not malaria have chills and fever, but come and go, fundamentally not belonging to malaria class. Post-illness, post-partum, or deficiency syndromes all have this presentation. *Jing* says: Yang deficiency leads to external cold, Yin deficiency leads to internal heat. Yin Qi entering Yang causes chills; Yang Qi entering Yin causes fever. Thus, any chills and fever without external pathogens belong to deficiency syndromes. Deficiency differs in Yin and Yang: Yang deficiency has much cold, Yin deficiency has much heat. Yang deficiency should be tonified with Yang, which is easy to know. Yin deficiency is hard to differentiate. Water deficiency within Yin is Yin deficiency; Fire deficiency within Yin is also Yin deficiency. (*Jingquan Quanshu*)
There are cases of chills and fever identical to malaria, red face like grease, mild thirst, profuse phlegm, heat above body like branding iron, cold below knees. This is True Yang floating upward, extreme Kidney deficiency. Urgently use Bawei Wan (Eight-Ingredient Pill) served cold, followed by Renshen Jianzhong Tang (Ginseng and Middle-Building Decoction) for regulation. ○ Another type is Depression Syndrome injuring Malaria; chills and fever identical to true malaria, but with bitter taste, vomiting, green face, hypochondriac pain, tinnitus, choppy pulse. First use Xiaoyao San (Free and Easy Wanderer Powder) plus Zhuyu (Evodia), Lian (Coptis), Beimu (Fritillaria), followed by Liuwei Tang plus Chaihu and Shaoyao for regulation. (*Zhao Shi Yi Guan*)
Nuomother (Malaria Mass)
If malaria starts on the 1st of the lunar month, it should heal by the 15th. If not, it should resolve by month-end. If not, what then? Answer: This knots into a mass, named Nuomother. Treat urgently with Biejia Jian Wan (Softening Turtle Shell Decoction Pill). (*Jin Gui Yao Lue*)
Nuomother is Phlegm binding with Blood and Food to form a mass; Biejia Jian Wan is the method from *Jin Gui*. For deficient patients with chronic malaria forming痞积 (痞 accumulation), use Xionggui Biejia Yin (Liquorice, Angelica, and Turtle Shell Decoction). If ineffective, it is Spleen deficiency; use Buzhong Yiqi Tang plus Biejia. Chronic malaria必有 (must have) stagnation, must add Biejia to dissipate it; if no stagnation, only tonification is suitable. Nuomother arises from improper treatment, pathogens hiding in Liver meridian under hypochondrium forming masses. Do not treat as simple accumulation. Often seeing aggressive attack leads to untreatable cases. (*Zhangshi Yitong*)
Post-Malaria Complications
Among post-malaria complications, Dysentery is most urgent. Investigating the cause: Either malaria pathogens were not resolved early enough, or resolution was incomplete, causing them to sink inward and transform into dysentery. Method: Treat exterior and interior separately. Once dysentery heals, malaria stops; if not, attacks become lighter. Or, mistaken purging during malaria caused pathogens to sink inward, transforming into dysentery. Must accompany abdominal fullness, swelling, vomiting, anorexia. Method: Expel pathogens and fortify Earth (Spleen). Stop when dysentery stops. Both cases suit Buzhong Yiqi Tang with modifications. Secondly, Malaria Consumption: If one had weak constitution before contracting malaria, old illness deepens. Long煎熬 (simmering/burning) depletes spirit and consumes flesh, with tidal fever, gradually becoming consumption. Observe which meridian is diseased and tonify. Thirdly, Malaria Jue (Syncope/Cold Extremities): Originally due to Qi and Blood deficiency and improper regulation; or due to cold wearing thick clothes/quilts, overheating; or due to heat wearing thin clothes/exposing body, catching cold again, leading to Damp Jue. Method: Differentiate cold and heat, do not mix decoctions.
Malaria Collapse
Malaria Collapse syndrome: Profuse sweating (Po Han), blue-black complexion, pulse empty, floating, rapid, extremely empty upon pressure. Treatment requires Buzhong Yiqi Tang minus Shengma and Chaihu, doubling Renshen and Huangqi, adding Baishao (White Peony Root), Wuweizi (Schisandra Berry), Zaoren (Ziziphus Seed). (Wu Tianshi)
Suppressing Malaria
The method of suppressing malaria is commonly used by folk. Effective in some cases, ineffective in others. People doubt it, but its mechanism has definite subtleties unknown to people. Malaria is struggle between Pathogen and Zheng Qi, like Chu and Han contending. Whoever gets help wins. Thus, anything can be used for suppression. Let the patient follow it without knowing why. Relying on help, courage strengthens and pathogen defeats. However, only light pathogens with daily onset can be suppressed; deep pathogens with every-other-day onset cannot. (Zhang Jingyue)
Intercepting Malaria
Using intercepting drugs for malaria should not be too early; early interception closes pathogens leading to bad syndromes. Nor too late; late interception exhausts Yuan Qi leading to timidity syndrome. Best to intercept at the 3rd or 4th attack. (*Wanbing Hui Chun*)
Methods for intercepting malaria are numerous. In my view and experience, one never relies on interception. If there is a pathogen, removing it cures. If dispersing pathogens is thorough, just restore Yuan Qi; once Qi recovers, cure is achieved. Finding the balance between attacking and tonifying between Pathogen and Zheng Qi is the best interception. Intercepting formulas are not to be rigidly held, nor discarded. Some work for some, fail for others, because people's Qi, Blood, Yin, and Yang differ. Thus, observe strength/weakness of person, use discretion. Light cases are easy to intercept; heavy cases are not. (Zhang Jingyue)
Pulse Signs
Malaria pulses are naturally Xian (String-like). Xian-Shu (String-Rapid) indicates much heat; Xian-Chi (String-Slow) indicates much cold. Xian-Xiao-Jin (String-Small-Tight) can be treated with purgation; Xian-Chi can be warmed; Xian-Jin (String-Tight) can be treated with sweating or acupuncture/moxibustion; Fu-Da (Floating-Large) can be treated with emesis; Xian-Shu indicates Wind-Fire onset, managed by dietary adjustments. (*Jin Gui Yao Lue*)
Selected Cases
Xiong Danfu suffered malaria for half a year, drugs failed, extremely emaciated and exhausted. Diagnosis: Extreme Zheng Qi deficiency. How can malaria drugs be given? Ordered two liang of Renshen, combined with Buzhong Yiqi Tang, plus Shudi (Rehmannia), Wuweizi, Shanzhuyu (Cornus), Shanyao (Dioscorea), decocted thick. Suddenly felt spirit strengthen, malaria ghost fled to non-existence. Danfu said: Yesterday I took Changshan (Periwinkle) intercepting drink, chills and heat worsened. Why is your art so divine? I smiled and did not answer. (Cheng Huazhong)
A twenty-year-old girl. Early winter. Every dusk, chills and tremors for 1-2 hours. After midnight, chills worsen. Drugs failed. Left Guan pulse Chen-Xian (Deep-String-like), others flat/weak. This is Pin Malaria. Due to long-standing depression combined with cold invading Liver. Liver governs sinews and Blood. Cold coagulation leads to disharmony of blood vessels, hence trembling and sinew movement. *Jing* says: Liver disease worsens at dusk. Hence onset at dusk. Medicine: Xiong, Gui, Baishao, Tianma (Gastrodia), Vine-processed Chaihu, Xiangfu, Wuyu (Evodia), Rougui, Paojiang (Baked Ginger). One dose cured. (*Yi Yan Lu*)
Father of Cheng Jiexian suffered malaria. Every Chen hour (7-9 AM) severe chills; Wu hour (1-3 PM) severe heat. Heat led to Jue (collapse), staring straight, inability to speak, chin dropped, saliva surging, liters flowing daily. Until Chou hour (1-3 AM) sweat released, symptoms eased. No food intake, nearly unconscious coma. I visited, saw this was caused by excessive attacking drugs. Doctor was present. I asked: What syndrome is this? Doctor said: This is Liver Malaria. Liver Malaria makes person look pale/grey, sigh, appearance like death. I laughed: Based on your description of classics, should use Tongmai Sini Tang (Pulse-Unifying Counterflow Cold Decoction). Why previous drugs? I don't know this disease, only know deficiency is extreme. Save life first, treat disease later. That night: Renshen one liang, Huangqi two liang, Paojiang three qian. By dawn: Shudi, Rougui, Fuzi (Aconite) given together. Next day Chen hour, malaria did not recur...