缪仲淳曰∶经云∶夏伤于暑，秋必 疟。疟论一篇，发明已详。盖其间中气不足，脾胃虚弱，暑邪乘
虚客之而作，虽随经随症投药解散，必先清暑益气，调理脾胃为主。有食者
兼消导夺食，有风兼散风，有老痰、伏饮者，兼豁痰逐饮，感瘴疠者兼消瘴疠，汗多者固表，无汗者解
表，泄利兼升发、利小便，便燥者兼益阴润燥。久而不解，必属于虚，气虚补气，血虚补血，两虚者气血兼
补，非大补真气，大健脾胃不得瘳也。
盖疟邪由于中气虚，破气则伤中气，邪不能解，甚则中满不思饮食，作泄，恶寒口干。惟伤食宜消，
不同此法。若误下则邪气陷于内，变为滞下，或腹痛、肿胀、呕恶、不思食。凡破气下泄药，切戒勿用。
宜清暑益气，健脾开胃，兼消痰。
宜分脏腑、手足六经所见症施治。先清暑热，宜服白虎汤加减，消息用之。其药俱宜黄昏煎以井水，
澄冷，露一宿，五更时温服。盖疟乃暑邪，得露则散也。
若足太阳见症，其人腰痛、头痛、头重、寒从背起，先寒后热， 然，热止汗出难已，或遍身骨
痛，小便赤，宜羌活、广皮、黄芩、前胡、甘草、猪苓、知母。若渴者，即兼阳明，宜加石膏，倍知母、
麦冬。渴而汗少，加葛根。若涉深秋，或入冬，宜多加姜皮。因虚加人参。虚汗多加黄 、桂枝，汗止即止，
桂枝不可多用。若病患素有热，去桂枝，以芍药、五味代之。若发于阴，并加当归。小便短涩，与六一散二三服
，下午服理脾健胃药橘红、豆蔻、茯苓、山楂、麦芽、藿香、人参、白术、白芍、扁豆。有肺火者，去参、
术，加麦冬，钗斛、乌梅肉。停食者必恶食，加消导药，食消即已，多服则损中气。胃家素有湿痰者，其症
不渴、寒多，方可用半夏、橘红、二术，大剂与之。呕甚者兼用姜皮。
若症见足阳明，其人发热头痛，鼻干，欲引饮，目 ， 不得眠，甚则烦躁，畏火光、人声、木声，
可加葛根。虚而
作劳者，加人参。汗多加白术，痰多加贝母、橘红。寒热俱盛，指爪见紫暗者，加桂枝。久而不解，用人参、
姜皮两许，下午服理脾健胃药如前。
若症见足少阳经，其人往来寒热，口苦耳聋，胸胁痛或呕，宜服小柴胡汤。渴者去半夏，加石膏、麦冬。
肺热去人参，加知母，倍加麦冬。有痰不渴，本方加贝母、白术、茯苓、姜皮。病患阴虚而有热者，虽呕恶
，忌用半夏、生姜，宜竹茹、橘红、
麦冬、茯苓、乌梅代之。以上三阳经疟。
邪在三阳，药宜辛寒，如石膏、知母、柴胡，甘寒如葛根、麦冬、竹叶、粳米，苦寒如黄芩之类为君，
乃可以散暑邪，除热渴，坠头痛。兼寒甚者，则间用辛温，如姜皮、桂枝以为向导，以伏其邪，则病易退。
凡寒甚者，病因于虚，或作劳者，亦因于虚，皆宜甘温，以人参、黄 ，术为君，佐以辛甘，如桂枝、姜皮之
属。脾胃虚弱，饮食不消者，则补之以参术，佐以消导，如白豆蔻、麦芽、砂仁、草豆寇、枳实、陈皮、山
楂之属。在阴分者，则以当归、牛膝为君，佐以姜、桂。如热甚而渴，去姜，桂，加知母，麦冬、竹叶，牛
膝、鳖甲。
若足厥阴经，其症先寒后热也，色苍苍然，善太息，甚者状如欲死，或头疼而渴，宜先服三黄石膏汤加
鳖甲、柴胡、陈皮，以祛暑邪，后用当归、鳖甲、牛膝、柴胡。如热甚而渴，加花粉、麦冬、知母。如脾胃
薄弱或溏泻，去当归，加人参。寒甚者，加桂枝，姜皮、人参。
足太阴见症，先寒后热或寒多。若脾疟，必寒从中起，善呕，呕已乃衰，然后发热，热过汗出乃已，
热甚者或渴，否则不渴，喜火，宜服桂枝汤、建中汤。虚者以人参、姜皮各两许。有痰加术、陈皮。
足少阴见症，寒热俱甚，腰痛脊强，口渴，寒从下起，小便短赤，宜先服人参白虎汤加桂枝，以祛
暑邪，后用鳖甲、牛膝。热甚者，加知母、麦冬。寒甚者，加桂枝。呕则兼加姜皮。如热甚而呕，去桂枝、
姜皮，加竹茹、人参、陈皮。肝肾同一治也。以上三阴经疟。
夫疟病多挟痰，以故热痰须用贝母为君，竹沥、竹茹、花粉、橘红、茯苓佐之。如寒痰发热不渴者，用
半夏、白术、陈皮为君，加生姜皮。
疟病多挟风，有风者必用何首乌为君，白术、陈皮为臣，葛根、姜皮、羌活佐之，不头痛除羌活。
劳疟病患阴不足，或作劳，或房劳，发于阴，或间日，或二日、三日一发，为病深，以鳖甲、牛膝、
何首乌为君，陈皮为佐。发于夜而便燥者，加当归，脾虚弱者勿加。
薛立斋曰∶疟因脾胃虚弱，饮食停滞，或外邪所感，或郁怒伤脾，或暑邪所伏。审系饮食停滞，用六君
子加桔梗、苍术、藿香。外邪多而饮食少，用藿香正气散。外邪少而饮食多，用人参养胃汤。劳伤元气，
用补中益气汤。若郁怒所伤，用小柴胡兼归脾汤，随证加减用之，病作时大热躁渴，以姜汤乘热饮之，此截疟
之良法也。每见发时饮啖生冷，多致脾胃虚损。大抵属外感者主以补养，佐以解散，其邪自退。审系劳伤元气，
虽有百症，但用补中益气，其病自愈，若外邪既退，即补中益气，以实其表。若过用发表，亏损脾胃，
皆致绵延难治。凡此不问阴阳日夜所发，皆宜补中益气，此不截之截也。
夫人以脾胃为主，未有脾胃实而患疟痢者。若专主发表、攻里、降火、导痰，治其末而忘其本也。
然此乃疟之大略，如不应，当分六经表里而治之。
大凡久疟多属元气虚寒，盖气虚则寒，血虚则热，胃虚则恶寒，脾虚则发热，阴火下流则寒热交作，
或吐涎不食，战粟，泄泻，手足逆冷，皆脾胃虚弱，但补中益气，诸症悉愈。
喻嘉言曰∶夫人四体安然，外邪得入而疟之，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。寒热往来，一皆少阳所主。谓少阳而无他经之症则有之，谓他经而全不涉少阳，
则不成其为疟矣。
柴胡汤本阴阳两停之方，可随疟邪之进退以为进退∶如加桂枝、干姜，则进而从阳，痹着之邪可以开
矣；加黄芩，黄连，即退而从阴，暑留之邪，亦可以解矣。
Miao Zhongchun stated: The *Classic of Internal Medicine* records, "Summer injury by summerheat leads to malaria in autumn." The chapter on Malaria (*Suwen: Malü*) elaborates on this in detail. Generally, it arises because the middle qi is insufficient and the spleen and stomach are weak, allowing summerheat pathogenic factors to invade due to deficiency. Although treatment involves administering herbs to resolve the pathogen according to the affected meridian and symptoms, the primary approach must be clearing summerheat, benefiting qi, and regulating the spleen and stomach. If there is food stagnation, employ methods to digest food and guide stagnation out; if there is wind, employ methods to disperse wind; if there is old phlegm or retained fluid, employ methods to expel phlegm and drain fluid; if infected with miasma, employ methods to eliminate miasma; if sweating is excessive, secure the exterior; if there is no sweating, release the exterior; if there is diarrhea, raise yang and promote urination; if stool is dry, nourish yin and moisten dryness. If the condition persists for a long time, it must belong to deficiency. For qi deficiency, tonify qi; for blood deficiency, tonify blood; for both qi and blood deficiency, tonify both. Without vigorously tonifying true qi and strengthening the spleen and stomach, the disease cannot be cured.
The origin of malaria pathogens lies in the deficiency of middle qi. Qi-dispersing drugs damage middle qi, preventing the pathogen from resolving, and may lead to severe abdominal fullness, loss of appetite, diarrhea, aversion to cold, and dry mouth. Only cases caused by food stagnation are suitable for digestion methods, which differ from the above approaches. If purgatives are mistakenly used, the pathogen sinks inward, transforming into dysentery (stagnant downflow), or causing abdominal pain, swelling, nausea/vomiting, and anorexia. All qi-dispersing and purgative drugs must be strictly prohibited. It is appropriate to use methods that clear summerheat, benefit qi, strengthen the spleen, open the appetite, and resolve phlegm.
Treatment should be administered based on the symptoms manifested in the zang-fu organs and the six meridians of hand and foot. First, clear summerheat; it is suitable to take *Baihu Tang* (White Tiger Decoction) with modifications, adjusting usage as needed. These herbs should be decocted at dusk well water, clarified, cooled, exposed to dew overnight, and taken warm during the first watch of the night (wugeng). This is because malaria is caused by summerheat pathogen, which disperses upon exposure to dew.
If symptoms appear in the Foot-Taiyang Bladder Meridian, the patient experiences lower back pain, headache, heavy head, cold sensation rising from the back, initial chills followed by fever, stiffness, profuse sweating after fever subsides, generalized bone pain, and dark urine. It is suitable to use *Qianghuo* (Notopterygii Rhizoma et Radix), *Guangpi* (Exocarpium Citri Reticulatae), *Huangqin* (Scutellariae Radix), *Qianhu* (Peucedani Radix), *Gancao* (Glycyrrhizae Radix et Rhizoma), *Zhuling* (Polyporus), and *Zhimu* (Anemarrhenae Rhizoma). If thirsty, indicating involvement of the Yangming meridian, add *Shigao* (Gypsum Fibrosum), and double the dosage of *Zhimu* and *Maidong* (Ophiopogonis Radix). If thirsty with little sweat, add *Gegen* (Puerariae Lobatae Radix). If late autumn or winter, increase the amount of *Jiangpi* (Zingiberis Pericarpium). Add *Renshen* (Ginseng Radix et Rhizoma) for deficiency. For deficient sweating, add *Huangqi* (Astragali Radix) and *Guizhi* (Cinnamomi Ramulus); stop when sweating ceases, and do not use *Guizhi* excessively. If the patient has inherent heat, remove *Guizhi* and replace with *Shaoyao* (Paeoniae Radix Alba) and *Wuweizi* (Schisandrae Fructus). If the disease manifests in the yin aspect, add *Danggui* (Angelicae Sinensis Radix). For scanty and difficult urination, administer *Liuyi San* (Six-to-One Powder) two or three doses, and in the afternoon, administer spleen-regulating and stomach-strengthening herbs such as *Juhong* (Tangerine Peel), *Doukou* (Cardamomi Fructus Rotundus), *Fuling* (Poria), *Shanzha* (Crataegi Fructus), *Maiya* (Hordei Fructus Germinatus), *Huoxiang* (Agastaches Herba), *Renshen*, *Baizhu* (Atractylodis Macrocephalae Rhizoma), *Baishao* (Paeoniae Radix Alba), and *Bidou* (Dolichoris Semen). If there is lung fire, remove *Renshen* and *Baizhu*, and add *Maidong*, *Chihuhu* (Dendrobii Caulis), and *Wumei Rou* (Mume Fructus). Food stagnation causes aversion to food; add digestive herbs. Stop when food is digested; excessive use damages middle qi. If the stomach has inherent damp-phlegm, characterized by non-thirst and predominant chills, *Banxia* (Pinelliae Rhizoma), *Juhong*, *Baizhu*, and *Cangzhu* (Atractylodis Rhizoma) can be used in large doses. For severe vomiting, add *Jiangpi*.
If symptoms appear in the Foot-Yangming Stomach Meridian, the patient has fever, headache, dry nose, desire to drink, blurred vision, insomnia, irritability, and fear of light, sound, and noise. *Gegen* can be added. For deficiency with fatigue, add *Renshen*. For excessive sweating, add *Baizhu*. For excessive phlegm, add *Beimu* (Fritillariae Bulbus) and *Juhong*. For simultaneous severe chills and fever with purple-dark fingernails, add *Guizhi*. For chronic unresolved cases, use *Renshen* and *Jiangpi* each in amounts of one liang, and in the afternoon, administer spleen-regulating and stomach-strengthening herbs as previously described.
If symptoms appear in the Foot-Shaoyang Gallbladder Meridian, the patient experiences alternating chills and fever, bitter taste, deafness, chest/hypochondriac pain, or vomiting. It is suitable to take *Xiaochaihu Tang* (Minor Bupleurum Decoction). If thirsty, remove *Banxia*, add *Shigao* and *Maidong*. If there is lung heat, remove *Renshen*, add *Zhimu*, and double *Maidong*. For phlegm without thirst, add *Beimu*, *Baizhu*, *Fuling*, and *Jiangpi* to the base formula. For patients with yin deficiency and heat, even if vomiting/nausea occurs, avoid *Banxia* and *Shengjiang* (Zingiberis Rhizoma Recens); instead, use *Zhuru* (Bambusae Caulis in Taenia), *Juhong*, *Maidong*, *Fuling*, and *Wumei*. These are the malaria types involving the three yang meridians.
When pathogens are in the three yang meridians, herbs should be pungent-cold, such as *Shigao*, *Zhimu*, *Chaihu* (Bupleuri Radix); sweet-cold, such as *Gegen*, *Maidong*, *Zhuye* (Phyllostachidis Folium), *Jingsmi* (Oryzae Semen); and bitter-cold, such as *Huangqin*, serving as sovereign drugs. This can dissipate summerheat pathogens, relieve heat and thirst, and alleviate headache. If accompanied by severe cold, occasionally use pungent-warm herbs like *Jiangpi* and *Guizhi* as guides to subdue the pathogen, facilitating recovery.
For severe chills caused by deficiency or fatigue, sweet-warm herbs are suitable, using *Renshen*, *Huangqi*, and *Baizhu* as sovereign drugs, assisted by pungent-sweet herbs like *Guizhi* and *Jiangpi*. For spleen/stomach weakness and indigestion, tonify with *Renshen* and *Baizhu*, assisted by digestive herbs like *Baidoukou* (Amomi Fructus Rotundus), *Maiya*, *Sharen* (Amomi Fructus), *Caodoukou* (Myristicae Semen), *Zhishi* (Aurantii Fructus Immaturus), *Chenpi* (Citri Reticulatae Pericarpium), and *Shanzha*. For conditions in the yin aspect, use *Danggui* and *Niuxi* (Achyranthis Bidentatae Radix) as sovereign drugs, assisted by ginger and cinnamon. If heat is severe with thirst, remove ginger and cinnamon, adding *Zhimu*, *Maidong*, *Zhuye*, *Niuxi*, and *Biejia* (Trionycis Carapax et Plastrum).
If symptoms appear in the Foot-Jueyin Liver Meridian, the pattern is initial chills followed by fever, sallow/greenish complexion, frequent sighing, severe cases resembling impending death, headache with thirst. Initially take *Sanhuang Shigao Tang* (Three-Yellow White Tiger Decoction) with *Biejia*, *Chaihu*, and *Chenpi* to dispel summerheat, followed by *Danggui*, *Biejia*, *Niuxi*, and *Chaihu*. If heat is severe with thirst, add *Huafen* (Trichosanthis Radix), *Maidong*, and *Zhimu*. If spleen/stomach is weak or loose stools occur, remove *Danggui* and add *Renshen*. For severe chills, add *Guizhi*, *Jiangpi*, and *Renshen*.
If symptoms appear in the Foot-Taiyin Spleen Meridian, there is initial chills followed by fever, or predominant chills. In Spleen Malaria, cold originates internally, with frequent vomiting; symptoms subside after vomiting, then fever occurs, ending with sweating. Severe heat may cause thirst, otherwise no thirst; preference for warmth. Take *Guizhi Tang* (Cinnamon Twig Decoction) or *Jianzhong Tang* (Establish the Middle Decoction). For deficiency, use *Renshen* and *Jiangpi* each in amounts of one liang. Add *Baizhu* and *Chenpi* for phlegm.
If symptoms appear in the Foot-Shaoyin Kidney Meridian, severe chills and fever, lower back pain, stiff spine, thirst, cold rising from lower limbs, scanty dark urine. Initially take *Renshen Baihu Tang* (Ginseng White Tiger Decoction) with *Guizhi* to dispel summerheat, followed by *Biejia* and *Niuxi*. For severe heat, add *Zhimu* and *Maidong*. For severe cold, add *Guizhi*. For vomiting, add *Jiangpi*. If severe heat with vomiting, remove *Guizhi* and *Jiangpi*, add *Zhuru*, *Renshen*, and *Chenpi*. Liver and Kidney are treated similarly. These are the malaria types involving the three yin meridians.
Malaria often involves phlegm. For hot phlegm, use *Beimu* as sovereign drug, assisted by *Zhuli* (Bambusae Caulis in Taenia), *Zhuru*, *Huafen*, *Juhong*, and *Fuling*. For cold phlegm with fever but no thirst, use *Banxia*, *Baizhu*, and *Chenpi* as sovereign drugs, adding *Shengjiangpi* (Zingiberis Pericarpium).
Malaria often involves wind. For wind patterns, use *Heshouwu* (Polygoni Multiflori Radix) as sovereign drug, *Baizhu* and *Chenpi* as minister drugs, *Gegen*, *Jiangpi*, and *Qianghuo* as assistant drugs. Remove *Qianghuo* if there is no headache.
In Labor Malaria, patients have yin deficiency, or suffer from fatigue or sexual exhaustion. Manifesting in yin, occurring every other day, or every two/three days, indicates deep disease. Use *Biejia*, *Niuxi*, and *Heshouwu* as sovereign drugs, *Chenpi* as assistant. If occurring at night with dry stool, add *Danggui*; do not add if spleen is weak.
Xue Lizhai stated: Malaria results from spleen/stomach weakness, food stagnation, external pathogens, anger injuring the spleen, or latent summerheat. If confirmed as food stagnation, use *Liujunzi Tang* (Six-Gentleman Decoction) with *Jiegeng* (Platycodonis Radix), *Cangzhu*, and *Huoxiang*. If external pathogens are dominant and food intake is low, use *Huoxiang Zhengqi San* (Agastache Powder to Rectify the Qi). If external pathogens are minor and food intake is high, use *Renshen Yangwei Tang* (Ginseng Decoction to Nourish the Stomach). For qi depletion due to labor, use *Buzhong Yiqi Tang* (Decoction to Supplement the Middle and Benefit Qi). If injured by anger, use *Xiaochaihu Tang* combined with *Guipi Tang* (Restore the Spleen Decoction), modifying according to symptoms. When the disease flares with high fever and thirst, drink ginger soup while hot; this is an excellent method to arrest malaria. Often, consuming cold/raw foods during attacks damages the spleen and stomach. Generally, for exogenous patterns, prioritize tonification with assistance from dispersion, and the pathogen will retreat. For qi depletion due to labor, even with various symptoms, using *Buzhong Yiqi Tang* alone cures the disease. After external pathogens recede, use *Buzhong Yiqi Tang* to solidify the exterior. Overuse of diaphoretics damages spleen/stomach, leading to chronic difficult-to-treat conditions. Regardless of yin/yang or day/night onset, *Buzhong Yiqi Tang* is suitable; this is arresting malaria without direct intervention.
Humans rely on the spleen and stomach as the foundation; none with solid spleen/stomach contract malaria or dysentery. Focusing solely on releasing the exterior, purging the interior, descending fire, or guiding out phlegm treats the branch while forgetting the root.
However, this is only a general overview of malaria treatment. If ineffective, treat according to the six meridians' exterior-interior relationships.
Generally, chronic malaria belongs to primordial qi deficiency and cold. Qi deficiency causes cold; blood deficiency causes heat. Stomach deficiency causes aversion to cold; spleen deficiency causes fever. Yin fire flowing downward causes alternating chills and fever. Symptoms include spitting saliva, anorexia, tremors, diarrhea, and cold extremities. All indicate spleen/stomach weakness; simply tonifying the middle and benefiting qi resolves all symptoms.
Yu Jiayan stated: When the body is healthy, external pathogens enter and cause malaria, usually hiding in the half-exterior half-interior region. Entering and fighting with yin causes chills; exiting and fighting with yang causes fever. The half-exterior half-interior refers to the Shaoyang meridian. Alternating chills and fever are entirely governed by Shaoyang. It is possible for Shaoyang to present without other meridian symptoms, but if other meridans are completely uninvolved with Shaoyang, it does not constitute malaria.
*Chaihu Tang* (Bupleurum Decoction) is a formula balancing yin and yang, adjustable according to the progression/regression of malaria pathogens: Adding *Guizhi* and *Ganjiang* (Zingiberis Rhizoma) advances towards yang, opening obstructions; adding *Huangqin* and *Huanglian* (Coptidis Rhizoma) retreats towards yin, resolving lingering summerheat.