（论一首 法九条 律三条）
喻昌曰∶疟之一病，无如《内经》论之最详最彻，随其病之所形，按法刺之，莫不应手而愈。盖九针之用，通于神
明，不可有微芒之差忒，故《内经》论疟，不得不详也。后世恶于针石，不可与言至巧，乃以药剂攻邪存正，调荣卫之
偏，和阴阳之逆，于是种种圣法，不适于用矣。如张子和见羸人病疟二年，不敢辄投寒凉，取《刺疟论》详之，刺其十
指出血立愈。此正《内经》所谓疟之且发也，阴阳之且移也，必从四末始也。坚束其处，决去其血，则邪往而不得并，
故立愈也。以子和之久谙针法，且检《针经》致其详慎，针其可以渎用哉？舍针而求《内经》，用药之捷法，茫然无可下
手矣！予之所以心折仲景，称为百世之师者，每遇一证，必出一法，以纬《内经》之不逮，一言当千百言而居其要也。
夫人四体安然，外邪得以入而疟之，每伏藏于半表半里，入而与阴争则寒，出而与阳争则热。半表半里者，少阳也。所
以寒热往来，亦少阳所主，谓少阳而兼他经之证，则有之。谓他经而全不涉少阳，则不成其为疟矣。所以仲景曰∶疟脉
多弦，弦数者多热，弦迟者多寒。弦小紧者下之差，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。只此七言，而少阳一经，汗、吐、下、和、温之法具备。其他瘅疟、温疟、牡疟、疟母四证，要
不外少阳求治耳。出《伤寒论》之绪余，以补《内经》下手之法，非圣人而能之乎？谨将《金匮》奥义，一一发明于左。
少阳乃东方甲木之象，故其脉主弦，此不但初病之脉乃尔，即久疟正虚，脉不鼓指，而弦象亦隐然在内。所以仲景
云∶疟脉自弦，由首及尾，脉之屡迁纵不同，而弦之一字，实贯彻之也。疟邪之舍于荣卫，正属少阳半表半里，始之
似疟非疟，与后之经年不解，总一少阳主之，盖疟发必有寒有热，其寒热之往来，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。施汗、吐、下之法，以治实热。施和、温之法，以治虚寒，无非欲致其和平耳。疟
邪如傀儡，少阳则提傀儡之线索，操纵进退，一惟少阳主张，宁不恢恢乎游刃空虚也耶？
弦数者，风发也，以饮食消息止之。仲景既云，弦数者多热矣。而复申一义云∶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。
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，
令人消烁肌肉。《内经》谓其但热而不寒者，阴气先绝，阳气独发，则少气烦冤，手足热而欲呕，名曰瘅疟。仲景之
重引其文，另有妙义。盖从上条弦数者风发也，以饮食消息止之，抽丝引絮，而出其证。谓弦数之脉，热盛生风，必侮
土而伤其津液，由少阳而入阳明。两经合邪，其热倍炽，倘不能以饮食消息，急止其热，则热之移于胃者，必上熏心
肺，少气烦冤而心肺病，手心热欲呕，而胃自病。所以继之曰∶邪气内藏于心，外舍分肉之间，令人消烁肌肉，盖伤寒
病三阳合邪，其来如风雨如霹雳，令人莫当。而疟之在少阳，苟不入于阴，而但出于阳，迨至两阳合邪，亦岂能堪之
耶？故知消息而止入胃之热邪，真圣法也。然仲景之法，亦从《内经》而得，《内经》谓疟脉缓大虚，便宜用药，不宜用
针。又谓虚者不宜用针，以甘药调之，昌知意中在用甘寒也。
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。《内经》言温疟有二，但先热后寒。仲景所名
温疟，则但热不寒，有似瘅疟，而实不同也。瘅疟两阳合邪，上熏心肺，肺主气者，少气烦冤，则心主脉者，阳盛脉
促，津亏脉代，从可推矣。温疟脉如平人，则邪未合，而津未伤，其所以但热而不寒者，则以其人素有痹气，荣卫不通、
故疟之发于阳，不入于阴，即入而阴亦不受。所以骨节烦疼，时呕，邪气 格之状，有如此者，惟用白虎汤以治阳邪，
而加桂枝以通荣卫，斯阴阳和，血脉通，得汗而愈矣。在伤寒病，卫强营弱，卫气不共营气和谐者，用桂枝汤复发其汗
立愈。此疟邪偏着于阳，桂枝阳药，即不可用。但用白虎汤大清气分之热，少加桂枝，合阴阳而两和之，乃知仲景之
法，丝丝入扣也。
其《内经》所称先热后寒之温疟，一者先伤于风，后伤于寒，风为阳邪，寒为阴邪，疟发时先阳后阴，故先热后寒
也。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，则其内先已如焚，水中火发，虽非真火，亦可畏也。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，以急救其阴，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。所以伤寒偏死下虚之人，谓邪入少阴，无阴精以御之也。而温疟之惨，宁有异哉？此亦仲景意中之隐，
昌特比例陈情，以为来学之助。
疟多寒者，名曰牡疟，蜀漆散主之。
疟多寒者，寒多于热，如三七二八之分，非纯寒无热也。纯寒无热，则为阴证，而非疟证矣。此条又抽丝引絮，即
上条两阳合邪，上熏心肺证中，复指出多寒少热一证。盖邪之伏于心下，适在膻中心包之位，心为阳中之阳，阳邪从阳，
尤为易入。邪入则心虚。《经》曰∶心虚者，热收于内，内收其热，并其邪亦收之，不易外出，此寒多之一因也。邪入
心
胞，都城震动，周身精液，悉力内援，重重裹撷，胞内之邪，为外所拒，而不易出，又寒多之一因也。心者牡藏，故即
以寒多热少之疟，名曰牡疟。用蜀漆散和浆水，吐其心下结伏之邪，则内陷之邪，亦随之俱出，一举而荡逐无余矣。岂
不快哉！蜀漆，常山苗也。常山善吐，何以不用常山而用蜀漆？取苗性之轻扬者，入重阳之界，引拔其邪。合之龙骨镇
心宁神，蠲除伏气。云母安藏补虚，媚兹君主，仲景补天浴日之方，每多若此。至如温疟，亦用此方，更加蜀漆，以吐
去其心下结伏之邪、盖一吐则周身之痹者通，而营卫并可借以无忤，则又以吐法为和法者也。
其附《外台秘要》牡蛎汤一方，同治牡疟者，又初感病时，风寒未清，传变为疟，结伏心下，故方中用麻黄以散风
寒，并借之以通阳气耳。可见病之途原不一，学人于此一证二方，比而参之，以求生心之变化，则几矣。
论《金匮》柴胡去半夏加栝蒌汤方 治疟病发渴者，亦治劳疟。
此仲景治少阳病，全体大用之一方也。仲景谓疟邪盛衰出入，必在少阳表里之间，小柴胡汤乃伤寒少阳经天然不易
之法。渴者去半夏加栝蒌实，亦天然不易之法。而施之于少阳邪传阳明，伤耗津液之证，亦为天然不易之法。盖渴虽阳
明津竭，而所以致阳明津竭者，全本少阳之邪。观《内经》刺法，渴者取之少阳，非以其木火之势劫夺胃津而然耶。故
疟邪进退于少阳，即以此方进退而施其巧。柴胡、黄芩，对治木火。人参、甘草，扶助胃土。栝蒌生津润燥。姜枣发越
荣卫。若夫劳疟之病，其本火盛，营卫衰，津液竭，亦不待言，故并可施此方以治之也。
论柴胡桂姜汤 治疟寒多微有热，或但寒不热，服一剂如神。
此疟之寒多热少，或但寒不热，非不似于牡疟，而微甚则大不同。仲景不立论，止附一方，且云服一剂如神，其邪
之轻而且浅，从可识矣。盖以卫即表也，营即里也，胸中之阳气，散行于分肉之间。今以邪气痹之，则外卫之阳，反
郁伏于内守之阴。而血之痹者，愈瘀结而不散，遇卫气行阳二十五度而病发。其邪之入营者，既无外出之势，而营之素
痹者，亦不出而与阳争。所以多寒少热，或但有寒无热也。小柴胡汤，本阴阳两停之方，可随疟邪之进退以为进退
者，加桂枝、干姜，则进而从阳，痹着之邪，可以开矣。更加牡蛎以软其坚垒，则阴阳豁然贯通，而大汗解矣，所以服
一剂如神也。其加芩、连以退而从阴，即可类推。
病疟以月一日发，当十五日愈。设不瘥，当月尽解，如其不瘥，当云何？师曰∶此结为 瘕，名曰疟母。急治之，
宜鳖甲煎丸。
此见疟邪不能久据少阳，即或少阳经气衰弱，不能送邪外出，而天气半月一更，天气更，则人身之气亦更，疟邪自
无可容矣。不则天人之气再更，其疟邪纵盛，亦强弩之末，不能复振矣。设仍不解，以为元气未生耶，而月已生魄矣。
元气何以不生？以为邪气不尽耶，而月已由满而空矣。邪气何以不尽？此必少阳所主之胁肋，外邪盘踞其间，根据山傍险，
结为窠巢。州县当一指可扑之时，曾不加意，渐至滋蔓难图，兴言及此，不觉涕泗交流，乃知仲景急治之法，真经世宰
物之大法也。
再按∶谭医者当以《灵》、《素》为经，《金匮》为纬，读《灵》、《素》而不了了者，求之《金匮》，矩 森森，但旨
深
词约，味如嚼蜡，不若《内经》之刍豢悦口，所以古今注《内经》者，不下百家；而注《金匮》者卒罕其人。即间有之，
其胸中浑是疑团，择显明之句，发挥一二，随竟其说，观者曾何赖焉？历代名贤，屈指不过数人，咸以仲景之学为绝学，
存而不论，论而不议，其所以卓冠亿兆人千百年者，各从《内经》分头证入。如疟病一门，《巢氏病源》妄分五脏，后人
谓其发明《内经》，深信不疑。而不知疟邪不从藏发，《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，剿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。讵知仲景所为汗下者，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、辰砂有毒之药，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，患疟至多。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？《内经》本谓
夏伤于暑，长夏伤于湿，秋必 疟，脱落五字，遂谓秋伤于湿，冬生咳嗽。而伤燥一气，古今绝无一人起而扬言，此等
大纲不正，亦何贵于识人之贤哉！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，
坐令多岐亡羊耶！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，
误指寒疟为藏寒之极，故无热有寒，用姜、桂、附子温之。又有更其名为牡疟者云∶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，真是杀人不转睫矣。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！
【律三条】
凡治疟，不求邪之所在，辄行大汗大下，伤人正气者，医之罪也。疟邪在于半表半里，故有寒有热，若大汗以伤其
表，大下以伤其里，是药反增疟矣。倘疟邪伏而未尽，药过再发，更将何法以处之？
凡用吐法，妄施恶劣之药，并各种丸药，伤人脏腑者，医之罪也。吐法，止可用清芬之气，透入经络，引出疟邪。
如酒浸常山，不用火煎之类。其胆矾、信石等丸，吞入腹中，粘着不行，搅乱肠胃脏腑，究竟无益，戒之！戒之！
凡用截疟之法，不俟疟势稍衰，辄求速止者，医之罪也。截者，堵截也。兵精饷足，寇至方可堵截。若兵微城孤，
不可截也。在壮盛之体，三四发后，疟势少减，可以截之。其虚弱之人，始终不可截也。误截因致腹胀者，每多坏事。
即服药亦有避忌，疟将来可服药阻其来，将退可服药追其去。若疟势正盛，服药与之混战，徒自苦耳。但疟之来去既远，
药不相及，五不当一，故服药妙在将来将去之时。
(One Treatise, Nine Methods, Three Laws)
Yu Chang said: Among all diseases, malaria is discussed most thoroughly and comprehensively in the *Huangdi Neijing* (Yellow Emperor's Inner Canon). According to the manifestation of the pathogenic factor, if one follows the principles for acupuncture, recovery is invariably immediate. The application of the Nine Needles penetrates divine wisdom; there can be no slightest deviation. Therefore, the *Neijing* must discuss malaria in detail. Later generations detested acupuncture and moxibustion, making it impossible to discuss profound techniques with them. Consequently, they relied on herbal medicines to attack pathogens and preserve healthy Qi, adjusting the imbalance of Ying and Wei (Nutritive and Defensive Qi), and harmonizing the reversal of Yin and Yang. Thus, various sage methods became inapplicable. For instance, Zhang Zihe encountered a emaciated patient suffering from malaria for two years. He dared not administer cold-natured herbs lightly but consulted the *Suwen: Cima Pian* (Treatise on Acupuncture for Malaria). He pricked the ten fingertips until bleeding occurred, resulting in immediate cure. This precisely aligns with what the *Neijing* states: "When malaria is about to manifest, Yin and Yang are shifting; treatment must begin at the four extremities." By tightly binding the affected area and puncturing to release blood, the pathogen cannot combine with healthy Qi upon its movement, hence the immediate recovery. Given Zhang Zihe's extensive familiarity with acupuncture and his meticulous reference to the *Lingshu: Zhenjing* (Spiritual Pivot: Classic of Acupuncture), how could acupuncture be used casually? Abandoning acupuncture to seek the spirit of the *Neijing*, and attempting to use herbs as a quick fix, leaves one bewildered and unsure where to start! My deep admiration for Zhang Zhongjing, whom I call the Teacher of a Hundred Generations, stems from his principle that for every syndrome, he proposes a specific method, compensating for the deficiencies of the *Neijing*. His concise words capture the essence better than thousands of verbose statements.
When the human limbs are peaceful, external pathogens invade and cause malaria, usually hiding in the Shaoyang (Half-Exterior/Half-Interior) region. When the pathogen enters and contends with Yin, chills occur; when it exits and contends with Yang, fever occurs. The Half-Exterior/Half-Interior region belongs to the Shaoyang channel. Therefore, alternating chills and fever are governed by Shaoyang. While Shaoyang may present with symptoms of other channels, if a channel is entirely unrelated to Shaoyang, it cannot be classified as malaria. Hence, Zhang Zhongjing stated: "The pulse in malaria is mostly wiry (Xian). A wiry and rapid pulse indicates heat; a wiry and slow pulse indicates cold. A wiry, small, and tight pulse suggests the use of purgation; a wiry and slow pulse suggests warming; a wiry and tight pulse suggests diaphoresis or acupuncture; a floating and large pulse suggests emesis; a wiry and rapid pulse indicates wind-heat hyperactivity, which should be managed through dietary adjustments." In just these seven phrases, the five treatment methods for Shaoyang—diaphoresis, emesis, purgation, harmonization, and warming—are fully covered. The other four syndromes of malaria—Dan malaria (Cao Malaria), Wen malaria (Warm Malaria), Mu malaria (Male Malaria), and Nuoma (Malaria Mass)—essentially all require treatment focusing on the Shaoyang channel. This extends the legacy of the *Shanghan Lun* (Treatise on Cold Damage) to supplement the practical entry points of the *Neijing*. Who but a sage could achieve this? I will now elucidate the profound meanings of the *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) as follows.
Shaoyang corresponds to the image of Jia Wood in the East, so its pulse is predominantly wiry. This applies not only to initial illness but also to chronic malaria where healthy Qi is deficient; even if the pulse fails to beat forcefully under the fingers, the wiry quality remains subtly present. Thus, Zhang Zhongjing said: "The pulse in malaria is inherently wiry." From beginning to end, although the pulse may shift and vary, the character "wiry" permeates the entire condition. The malaria pathogen resides in the Ying and Wei, belonging to the Shaoyang Half-Exterior/Half-Interior. Initially, it may seem like malaria but isn't clearly so; later, it may persist for years without resolution, yet it is always dominated by Shaoyang. Generally, malaria manifests with both chills and fever. The alternation of chills and fever falls exactly within the domain of Shaoyang. Bias toward Yin results in more chills; bias toward Yang results in more fever. Even pure heat without chills constitutes Dan malaria or Wen malaria; pure cold without fever constitutes Mu malaria. All these originate from Shaoyang moving to an extreme deviation. To correct deviation and remedy defects, one must return to the boundary of Shaoyang, harmonizing Yin and Yang, before recovery can occur. Applying diaphoretic, emetic, or purgative methods treats excess heat; applying harmonizing or warming methods treats deficiency cold. The ultimate goal is always to restore peace and harmony. The malaria pathogen is like a puppet; Shaoyang holds the strings, controlling its advance and retreat. It relies entirely on Shaoyang's dominance, allowing for effortless maneuvering in empty spaces.
A wiry and rapid pulse indicates wind-heat hyperactivity, which should be controlled through dietary management. Although Zhang Zhongjing noted that wiry and rapid pulses indicate heat, he further elaborated: "Wiry and rapid pulses signify wind-heat onset." Persistent excessive heat inevitably leads to extreme heat. Extreme heat generates wind; wind generation causes Liver Wood to overact on Spleen Earth, transmitting heat to the Stomach. This consumes body fluids, causing Yang to become increasingly biased and unable to return. Such cases cannot be treated solely with herbs. One must use dietary management to curb the blazing heat, such as using pear juice or sugarcane syrup, which generate fluids and quench thirst. This aligns with the *Neijing* principle: "For wind rampant internally, treat with sweet-cold substances."
When Yin Qi is isolated and extinct, and Yang Qi acts alone, fever occurs accompanied by shortness of breath, vexation, hot hands and feet, and nausea. This is named Dan Malaria. If there is only heat without chills, the pathogen hides internally in the Heart and externally in the interstices of muscles and flesh, causing muscle wasting. The *Neijing* states that those with only heat and no chills have Yin Qi extinguished first, with Yang Qi acting alone, leading to shortness of breath, vexation, hot extremities, and nausea, named Dan Malaria. Zhang Zhongjing's re-quotation of this text carries profound implications. Following the previous point about "wiry and rapid pulses indicating wind-heat managed by diet," he draws out this syndrome logically. He implies that a wiry and rapid pulse signifies heat generating wind, which attacks Earth and damages fluids, moving from Shaoyang to Yangming. With pathogens combining in both channels, heat intensifies doubly. If dietary management does not urgently stop the heat, the heat transferring to the Stomach will scorch upward to the Heart and Lungs, causing shortness of breath, vexation, heart-lung pathology, hot palms, nausea, and stomach pathology. Thus, he continues: "The pathogen hides internally in the Heart and externally in the muscles/flesh, causing muscle wasting." In cold damage, when three Yang channels combine, the onset is violent like wind, rain, or thunder, overwhelming the patient. However, if malaria in Shaoyang does not enter Yin but stays in Yang, until two Yangs combine, who could endure it? Therefore, knowing how to manage and stop the heat entering the Stomach via diet is truly a sage method. Zhang Zhongjing's methods derive from the *Neijing*, which states: "If the malaria pulse is slow, large, and deficient, medication is suitable, but acupuncture is not." It also says: "Deficiency patterns should not be treated with acupuncture; use sweet medicine to regulate." I understand this implies the use of sweet-cold herbs.
In Wen Malaria, the pulse resembles that of a healthy person. The body has no chills, only fever, with painful and烦 (vexatious) joints, and occasional vomiting. Bai Hu Jia Gui Zhi Tang (White Tiger plus Cinnamon Twig Decoction) is the primary formula. The *Neijing* mentions two types of Wen Malaria, one presenting with fever followed by chills. Zhang Zhongjing's definition of Wen Malaria presents with only heat and no chills, resembling Dan Malaria but fundamentally different. Dan Malaria involves two Yangs combining, scorching the Heart and Lungs; Lung governs Qi (leading to shortness of breath/vexation), and Heart governs vessels (Yang excess leads to hurried pulse, fluid deficiency leads to intermittent pulse). In contrast, Wen Malaria has a normal-like pulse, indicating combined pathogens and damaged fluids are absent. The reason for heat without chills is that the patient has pre-existing Bi (obstruction) qi, blocking Ying and Wei. Thus, when malaria arises in Yang, it does not enter Yin; even if it tries, Yin rejects it. Hence, joint pain and vomiting occur due to pathogenic rejection. Using Bai Hu Tang (White Tiger Decoction) clears Yang pathogenic heat, while adding Gui Zhi (Cinnamon Twig) unblocks Ying and Wei. This harmonizes Yin and Yang, unblocks blood vessels, and induces sweating for recovery. In cold damage, when Wei is strong and Ying is weak, and Wei Qi does not harmonize with Ying Qi, Gui Zhi Tang (Cinnamon Twig Decoction) induces sweating for immediate cure. Here, however, the malaria pathogen adheres to Yang, and since Gui Zhi is a Yang herb, it is generally contraindicated. But using Bai Hu Tang to clear Qi-level heat heavily, with a small amount of Gui Zhi to harmonize Yin and Yang, demonstrates Zhang Zhongjing's precise methodology.
Regarding the *Neijing*'s description of Wen Malaria with fever preceding chills: First, injury by Wind (Yang pathogen) followed by Cold (Yin pathogen) causes Yang to precede Yin during onset, resulting in fever then chills. This is treated by methods for Wind-Cold affecting Ying and Wei, which is straightforward. Second, Winter exposure to Wind-Cold hides deeply in the Marrow and Kidney, emerging only in Spring/Summer heat. The pathogen emerges from the Kidney outward, causing high fever, implying internal burning ("Fire arising from Water"). Although not true Fire, it is fearsome. Waiting for the malaria trend to weaken and return to the Kidney, Yin Essence contends with it, causing chills. If one does not strengthen the Master of Water to urgently save Yin, after several episodes, Yin Essence is exhausted. Exhausted Yin leads to self-burning of True Fire, shivering,惊 (fright), blurred vision, and death shortly. Thus, in cold damage, death often occurs in those with lower deficiency because the pathogen enters Shaoyin without Yin Essence to resist. Is the tragedy of Wen Malaria any different? This is the hidden meaning in Zhang Zhongjing's intent. I illustrate this to assist future learners.
Malaria with predominant chills is named Mu Malaria, treated with Shu Qi San (Chinese Perilla Leaf Powder).
Predominant chills mean chills exceed fever (e.g., 70% chills, 30% fever), not pure cold without heat. Pure cold without heat is a Yin syndrome, not malaria. This section logically follows the previous discussion on two Yangs combining and scorching the Heart/Lungs, pointing out the syndrome of more chills than heat. The pathogen hides in the Epigastrium, specifically at the Tanzhong (Conception Vessel 17) and Pericardium location. The Heart is Yang within Yang; Yang pathogens easily enter Yang. Entry causes Heart deficiency. The *Classic* states: "Heart deficiency retains heat internally." Internal retention of heat also traps the pathogen, making it difficult to exit, contributing to more chills. Pathogens entering the Pericardium shake the capital; body fluids rally inward, wrapping the pathogen tightly. The pathogen inside is rejected by the exterior, making exit difficult, another cause of chills. Since the Heart is a "Mu" (Male/Yang) organ, malaria with more chills than heat is named Mu Malaria. Shu Qi San mixed with fermented grain water induces vomiting to expel the knotted pathogen in the epigastrium. The internalized pathogen exits along with it, clearing everything in one stroke. How delightful! Shu Qi is the tender shoot of Chang Shan (Dichroa Root). Chang Shan is known for inducing vomiting; why use the shoot instead? The shoot's light and ascending nature enters the realm of extreme Yang, drawing out the pathogen. Combined with Long Gu (Dragon Bone) to calm the Heart and Spirit, and remove latent Qi, and Yun Mu (Mica) to settle and tonify deficiency, honoring the Monarch (Heart). Zhang Zhongjing's restorative formulas often employ such strategies. For Wen Malaria, this formula is also used, with added Shu Qi to vomit out knotted pathogens. Vomiting unblocks general obstruction, allowing Ying and Wei to function without conflict, thus treating vomiting as a harmonizing method.
The Muli Tang (Oyster Shell Decoction) attached to the *Waitai Miyao* (Secret Essentials of the Outer Cabinet) also treats Mu Malaria. This applies when initial Wind-Cold is unresolved, transforming into malaria, knotting in the epigastrium. Ma Huang (Ephedra) disperses Wind-Cold and aids Yang Qi circulation. This shows disease pathways vary. Scholars should compare these two formulas for this syndrome to grasp clinical flexibility.
Discussion on the *Jingui* Chai Hu Qu Ban Xia Gua Lou Tang (Bupleurum Decoction with Banxia Removed and Trichosanthes Fruit Added) treats malaria with thirst, and also Labor Malaria (Lao Malaria).
This is a primary formula for Zhang Zhongjing's treatment of Shaoyang disease. He stated that malaria pathogens fluctuate between the interior and exterior of Shaoyang. Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the natural, unchangeable method for Shaoyang cold damage. Removing Ban Xia (Pinellia Tuber) and adding Gua Lou Shi (Trichosanthes Fruit) for thirst is also a natural, unchangeable method. Applied to Shaoyang pathogens transmitting to Yangming, damaging fluids, it remains appropriate. Thirst indicates Yangming fluid exhaustion, caused by Shaoyang pathogens. The *Neijing* acupuncture methods for thirst select Shaoyang points, recognizing that Wood-Fire momentum robs Stomach fluids. Thus, as malaria pathogens advance/retreat in Shaoyang, this formula adjusts accordingly. Chai Hu (Bupleurum Root) and Huang Qin (Scutellaria Root) counteract Wood-Fire. Ren Shen (Ginseng Radix) and Gan Cao (Licorice Root) support Stomach Earth. Gua Lou generates fluids and moistens dryness. Jiang (Ginger Rhizome) and Zao (Jujube Fruit) stimulate Ying and Wei. Labor Malaria fundamentally involves Fire excess, Ying/Wei decline, and fluid exhaustion, warranting this formula.
Discussion on Chai Hu Gui Jiang Tang (Bupleurum, Cinnamon Twig, and Ginger Decoction) treats malaria with predominant chills and slight fever, or only chills without fever. One dose yields miraculous results.
This syndrome of predominant chills/slight fever or only chills differs significantly from Mu Malaria in severity. Zhang Zhongjing provided no commentary, only the formula and the note "miraculous effect after one dose," indicating the pathogen is mild and superficial. Wei is Exterior; Ying is Interior. Chest Yang Qi circulates in muscle interstices. Pathogenic Bi blocks this, causing Exterior Yang to stagnate within Interior Yin. Blood stasis worsens. When Wei Qi circulates Yang twenty-five times, the disease manifests. Pathogens in Ying lack outward momentum; Ying itself is blocked, failing to contend with Yang. Hence, predominant chills/slight fever or only chills. Xiao Chai Hu Tang balances Yin and Yang. Adding Gui Zhi (Cinnamon Twig) and Gan Jiang (Dried Ginger) advances toward Yang, opening Bi-obstructed pathogens. Adding Mu Li (Oyster Shell) softens hardness, allowing Yin and Yang to connect, inducing heavy sweating for resolution. Hence the miraculous effect. Adding Huang Qin and Huang Lian to retreat toward Yin can be inferred similarly.
Malaria starting on the first day of the lunar month should heal by the fifteenth. If not, it should resolve by month-end. If still unresolved, what then? The Master said: This forms a mass named Nuoma (Malaria Mother). Treat urgently with Bie Jia Jian Wan (Softshell Turtle Pill).
This illustrates that malaria pathogens cannot occupy Shaoyang indefinitely. If Shaoyang Qi is weak and cannot expel pathogens, and celestial cycles change every half-month, human Qi also updates, leaving no room for pathogens. Otherwise, after two cycles, even strong pathogens are spent arrows. If unresolved, is it lack of Yuan Qi? No, the moon waxes. Is it lingering pathogens? No, the moon wanes. Why do pathogens persist? They likely lodge in the hypochondrium (Shaoyang domain), fortifying themselves like a nest. Ignoring them when they are small allows them to spread. This reveals Zhang Zhongjing's urgent treatment method as a great strategy for governing life.
Note: Physicians should take *Lingshu* and *Suwen* as the warp and *Jingui Yaolue* as the weft. Those unclear on *Lingshu/Suwen* should consult *Jingui*. Its rules are strict, but its meaning is deep and language concise, tasting like wax, unlike the *Neijing* which is palatable. Hence, hundreds comment on the *Neijing*, but few on *Jingui*. Commentators often harbor doubts, selecting obvious sentences to elaborate briefly, offering little value to readers. Few sages throughout history mastered Zhang Zhongjing's learning, often preserving it without discussion. Their superiority lies in entering each syndrome from the *Neijing*. For example, *Zhubing Yuanhou* (Source Book of Diseases and Syndromes) erroneously divided malaria into Five Zang organs. Later scholars believed this invented upon the *Neijing*, unaware that malaria pathogens do not originate from Zang organs—a concept absent in the *Neijing*, merely Chuishi's speculation. Chen Wuyi's Three Causes theory was correct. Yet, claiming "Summer heat injury leads to Autumn malaria" cannot be the sole rule is a betrayal of sage words. Regarding internal causes, copying Chuishi's Five Zang malaria theories is crude. Zhang Zihe favored sweating, vomiting, and purging for malaria, claiming lineage from Changsha (Zhongjing). Did he know Zhongjing's sweating/purging derived from Shaoyang harmonization, not cold damage protocols? His emetics (Gua Di, Chang Shan shoots) had deep meanings. Zhang Zihe claimed that in peaceful times, toxic drugs like Arsenic or Cinnabar could treat heat with heat effectively. What nonsense! Dongyuan and Danxi followed the *Neijing* regarding summer heat/autumn malaria, innovating much. They noted malaria prevalence in Wu/Chu/Fujian/Guangdong due to low-lying dampness and long summers causing damp-heat. This insight was brilliant but missed the *Neijing* nuance: *Neijing* treats Summer Heat and Dampness together,不分南北 (without distinguishing North/South). The *Neijing* states: "Summer injury by Summer Heat, Long Summer injury by Dampness, Autumn malaria." Omitting "Long Summer injury by Dampness" led to the error "Autumn injury by Dampness causes Winter cough." No one defended the Dryness pathogen. Such fundamental errors undermine scholarly reputation. Danxi's view that all twelve channels can cause disease aligns with the *Cima Pian*. Why not follow *Jingui* prioritizing Foot Shaoyang, leading to confusion? Formulary books classify Wen Malaria as a complication of cold damage, similar to Wind Malaria—what source is this? As for Mu Malaria, it lacks a distinct name, subsumed under Cold Malaria. Misidentifying Cold Malaria as extreme internal cold (no heat, only chills) leads to using Ginger, Cinnamon, and Aconite for warming. Others rename it Mu Malaria, attributing it to chronic cold-damp, Yin excess/Yang deficiency, causing chills without heat, trembling, and using warming methods. This is indeed lethal. Claiming Summer Malaria equals Dan Malaria, using She Pi (Areca Seed) etc. for vomiting, never saving Shaoyang Wood-Fire pathogens as if putting out a fire, is like pointing South while intending to go North. How unfortunate for the people!
[Three Laws]
Any physician who treats malaria without locating the pathogen, resorting to drastic sweating or purging, thereby damaging healthy Qi, bears medical guilt. Malaria pathogens reside in the Half-Exterior/Half-Interior, causing alternating chills and fever. Drastic sweating harms the Exterior; drastic purging harms the Interior. Medication thus exacerbates malaria. If pathogens remain latent after treatment, recurrence leaves no effective method.
Any physician who uses emesis with harsh drugs or various pills, damaging viscera, bears medical guilt. Emesis should only use aromatic, penetrating agents to draw pathogens out via meridians, e.g., Chang Shan soaked in wine, not boiled. Pills like Dan Fan (Chalcanthite) or Xin Shi (Arsenic) stick in the abdomen, disturbing intestines and viscera with no benefit. Beware! Beware!
Any physician using malaria-intercepting methods without waiting for the malaria trend to subside, seeking rapid cessation, bears medical guilt. "Intercept" means blockading. Only with sufficient troops and supplies can one blockade invaders. With weak forces and isolated cities, interception is impossible. In robust patients, interception is possible after 3-4 episodes when the trend subsides. In weak patients, interception is never appropriate. Mistaken interception causing abdominal distension often leads to disaster. Even medication requires caution. Medication can block incoming malaria or chase departing malaria. If administered during peak intensity, it fights the pathogen directly, causing futile suffering. Since malaria comes and goes far apart, medication misses the target (one part effort for five parts result). Thus, the art of medication lies in timing administration just before onset or departure.