经云。疟先寒而后热者。夏伤于大暑。其汗大出。腠理开发。因遇夏气凄沧之水寒。藏于腠
理皮肤之中。秋伤于风。则病成矣。夫寒者阴气也。风者阳气也。先伤于寒而后伤于风。故先寒
而后热也。病以时作。名曰寒疟。先热而后寒者。此先伤于风而后伤于寒。故先热而后寒也。亦
以时作。名曰温疟。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。温疟者。得之冬中于风。寒气藏于骨髓之中。至春则阳气大发。
邪气不能自出。因遇大暑。脑髓烁。肌肉消。腠理发泄。或有所用力。邪气与汗皆出。此病藏于
肾。其气先从内出之于外也。如是者。阴虚而阳盛。阳盛则热矣。衰则气复反入。入则阳虚。阳
虚则寒矣。故先热而后寒。名曰温疟。瘅疟者。肺素有热。气盛于身。厥逆上冲。中气实而不外
泄。因有所用力。腠理开。风寒舍于皮肤之内分肉之间而发。发则阳气盛。阳气盛而不衰。则病
矣。其气不及于阴。故但热而不寒。气内藏于心而外舍于分肉之间。令人消烁肌肉。故命曰瘅疟。
足太阳之疟。令人腰痛头重。寒从背起。先寒后热 然。热止汗出。足少阳之疟。令人身
体解 。寒不甚。热不甚。恶见人。见人心惕惕然。热多。汗出甚。足阳明之疟。令人先寒洒淅。
洒淅寒甚久乃热。热去汗出。喜见日月光火气。乃快然。足太阴之疟。令人不乐。好太息。不嗜
食。多寒热汗出。病至则善呕。呕已乃衰。足少阴之疟。令人呕吐甚。多寒热。热多寒少。欲闭
户牖而处。其病难已。足厥阴之疟。令人腰痛。少腹满。小便不利如癃状。非癃也。数便。意恐
惧。气不足。腹中悒悒。凡治疟先发时食顷。乃可以治。过之则失时也。
金匮云。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。令人消烁肌肉。
疟之寒热更作。因阴阳之气互为争并。若阴衰离绝其阳。而阳亦不并之阴。故阳独发。但热
而已。其少气烦冤者。肺主气。肺受火抑故也。手足热者。阳主四肢。阳盛则四肢热也。欲呕者。
火邪上冲。胃气逆也。内藏于心者。阳盛则火气内藏。而外舍分肉之间也。消烁肌肉者。火盛则
肌肉烁也。此条合后条温疟观之。亦可以白虎汤治瘅疟也。
白虎专于退热。其分肉四肢。内属脾胃。非切于所舍者乎。又泻肺火。非救其少气烦冤者乎。设
其别有兼证。岂不可推加桂之例而加别药乎。
温疟者。其脉如平。身无寒。但热。骨节烦疼。时呕。白虎加桂枝汤主之。
内经言温疟先热后寒。仲景言温疟则但热不寒。有似瘅疟而实不同也。瘅疟两阳合邪。上熏
心肺。所以少气烦冤。消烁肌肉。温疟脉如平人。则邪未合而津未伤。阳受病而阴不病。以其人
素有痹气。营卫不通。故疟发于阳不入于阴。所以骨节烦疼。时呕。邪气插格之状有如此者。惟
用白虎汤以治阳邪。而加桂枝以通营卫。斯阴阳和。血脉通。得汗而愈矣。至于伤寒前热未除而
复感风寒。脉阴阳俱盛之温疟。与其脉如平者。迥乎不同也。
疟多寒者。名曰牝疟。蜀漆散主之。
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。与素问少阴经证之多热少寒不
同。方用蜀漆和浆水吐之以发越阳气。龙骨以固敛阴津。云母从至下而举其阳。取山川云雾开霁
之意。盖云母即阳起石之根。性温而升。最能祛湿运痰。稍加蜀漆。则可以治太阴之湿疟。方后
有云。湿疟。加蜀漆半分。而坊本误作温疟。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。
疟病发渴者。柴胡去半夏加栝蒌汤。亦治劳疟。
渴者阳明津竭。而所以致阳明津竭者。本少阳木火之势。劫夺胃津而然。故疟邪进退于少阳。
则以小柴胡进退
而施治也。至于劳疟之由。亦木火盛而津衰致渴。故亦不外是方也。
疟寒多微有热。或但寒不热。柴胡桂姜汤。服一剂如神。
是证虽与牝疟相类。以方药论之则殊。牝疟邪伏少阴气分。而此邪伏少阳营血之分。夫邪气
入营。既无外出之势。而营中之邪。亦不出与阳争。所以多寒少热。或但寒无热也。小柴胡汤本
阴阳两停之方。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。
丹溪治六经疟。悉以二陈为主。各加引经药。可见无痰不成疟也。大法。先热后寒者。柴胡
桂枝汤。先寒后热者。小柴胡汤。多热但热者。白虎加桂枝汤。多寒但寒者。柴胡桂姜汤。虽多
寒但寒。脉洪实者。当作实治。不得便用桂、姜。虽多热但热。脉虚软者。当作虚治。不得便用
白虎。寒多热少。或少食易饥。恶心吐痰。人参养胃汤。热多寒少。口苦咽干。小便赤涩。或伤
食成疟。清脾饮。劳役所伤。饮食失节成疟。则虚弱自汗。补中益气加半夏。疟疾自汗日甚。不
能止。此表虚不能卫护也。人参实卫加桂枝。风疟。自感风而得。恶风自汗。烦躁头痛。风。阳
邪也。故先热后寒。宜半夏、柴胡、羌活、紫苏、细辛、生姜。寒疟。暑月乘凉沐浴。自感寒而
得。无汗恶寒。挛痛面惨。寒。阴邪也。故先寒后热。宜羌活、紫苏、桂枝、柴胡、草果、浓朴。
暑疟亦名瘅疟。但热不寒。里实不泄。烦渴而呕。肌肉消烁。小柴胡加香薷、黄连、竹叶。盛暑
发者。白虎汤。虚者。加人参。秋凉后发者。小柴胡汤。此肺素有热。阴气先绝。阳气独发。故
但热不寒也。温疟。由冬受非时之邪。伏藏骨髓之中。至春夏湿热气蒸而发。发则先热后寒。或
但热不寒。春用小柴胡。夏用白虎加桂枝。以邪热势盛。故不恶寒而便发热。热发于表之后。正
气内虚。反微似是寒之状。非恶寒也。牝疟。邪伏于肾。湿疟。则久受阴湿
而邪伏太阴。皆但寒不热。并宜蜀漆散。邪伏血分而多寒少热。惨惨振振。柴胡桂姜汤。劳疟大
渴。柴胡去半夏加栝蒌汤。汗出澡浴。身体重痛。肢节烦疼。寒热而呕逆者。亦属湿疟。胃苓汤
加羌活、紫苏。食疟。因饮食不节。中脘生痰。加以风气乘之。故善饥而不能食。食而支满。腹
大善呕。实者二陈加枳壳、草果。因饥饱劳役而发。日久不止。脉虚者理中汤加枳实、青皮。素
有阴虚劳嗽。或因疟成劳。但于调理本药中。稍加桂枝、姜、枣可也。不可纯用祛风豁痰药。若
表邪势盛。可用小建中、黄 建中为主。后与生料六味丸加桂枝、鳖甲。凡疟发于午前。是阳分
受病。易愈。发于午后。阴分受病。难愈。疟发日宴。为邪气下陷于阴分。必用升、柴升发其邪。
仍从阳分而发。补中益气加桂枝。疟发日早。为邪气上越于阳分。宜因势利导之。小柴胡加枳、桔。
夜疟俗名鬼疟。此邪入血分。宜升散血脉之邪。千金内补建中加升、柴、生首乌。脾胃素虚人。
补中益气加首乌、桂枝、芍药。瘴疟。山岚溪涧之毒。须用祛瘴涤痰之药为主。疫疟。夏秋之间。
沿门阖境皆是也。其证壮热多汗而渴。宜达原饮。烦热大渴。有表证。桂枝白虎汤。谵妄狂闷。
凉膈散加草果。寒热便秘。大柴胡汤。虚人发散后热不止。人参败毒散。有郁证似疟者。寒热与
疟无异。但口苦呕吐清水。或苦水。面青胁痛。耳鸣脉涩。逍遥散倍柴胡加吴茱萸、川连。痢后
发疟。邪从少阳循经外泄也。小柴胡去黄芩加桂枝。或补中益气倍升、柴。升散则愈。
大抵疟初起。宜散邪消导。日久宜养正调中。所谓气虚则恶寒。血虚则发热也。日数虽多。
饮食未节者。未可便断为虚。须禁食消导。凭脉下手可也。形盛气虚人多湿痰。发则多恶寒。日
久不已。脉软而沉带滑。用补中益气加苓、半。兼用熟附子二三分。疟后不喜食。四肢倦怠。面
色痿黄。六君子加山楂、黄连、枳实。久疟不止。元气虚盛者。用人参、常山
各五钱。锉碎。微火同炒。去常山。只以人参煎汤。未发前服。屡验。疟发四五遍后。曾经发散
者。何首乌散。壮实者。可用七宝饮。至夜热不止而脉实邪盛者。此邪干血分也。常山饮截之。
疟发已久。遍治无功。度无外邪。亦无内滞。惟人参一两。生姜一两。加桂枝少许。冬月无汗。
稍加麻黄。发前五更时服。温覆取微汗必止。甚者连进三日。无不愈者。愈后亦易康复。如在贫家。
人参减半。合白术五钱代之。此方不特虚人久疟。治三日疟更宜。夜发则加当归、首乌。无不应
手取效。然发于严冬之时。有屡用此方。及补中益气不效者。必待仲春。仍用前药加桂枝汗之即愈。
丹溪云。 疟者。三阴疟也。三日一发。发于子午卯酉日者。少阴疟也。发于寅申巳亥日者。
厥阴疟也。发于辰戌丑未日者。太阴疟也。更须以脉证参之。然后决其经而与法治。按内经云。
时有间二日或至数日而发者。邪气与卫气客于六腑。而有时相失。不能相得。故休数日乃作也。
李士材释云。客。犹会也。邪在六腑。则气远会稀。故间二日或休数日也。观此。则丹溪辰戌丑
未日为太阴疟。非矣。子午虽曰少阴。而卯酉则阳明矣。巳亥虽曰厥阴。而寅中则少阳矣。丑未
虽曰太阴。而辰戌则太阳矣。三日发者。犹可以此为言。数日发者。又将何以辨之。大抵三日疟。
初起发于夏秋者。宜用二陈去橘皮。加生术、槟榔、常山。逐去痰癖为先。稍加穿山甲以透经络。
至于暑结营分。又当以香薷、鳖甲、茯苓、半夏、甘草、当归、生姜、大枣祛暑为要。而前药为
无益也。若元气大虚。只用补正。宜六君加草果、乌梅。名四兽饮。兼本经引使药。若元气下陷。
日发渐晏者。补中益气汤大剂参、术、姜、枣为治。如常山、槟榔、山甲、草果。皆为戈戟矣。
疟母者。顽痰挟血食而结为 瘕。鳖甲煎丸。或小柴胡加鳖甲、蓬术、桃仁俱用醋制。其鳖
甲用栗灰汤煮糜烂入药。尤效。此金匮法也。病气俱实者。疟母丸。虚人久疟。时止时发。芎归
鳖甲饮。不应。脾虚也。急用补中益气加鳖甲。少食
痞闷。胃虚也。四兽饮加鳖甲、当归、蓬术、肉桂。虚人疟母。必用补益。盖缘治之失宜。邪伏
肝经。而胁下有块。仍寒热时作。不可以癖积治之。每见急于攻块者。多致不救。久疟不愈。必
有留滞。须加鳖甲消之。如无留滞。只宜补益。凡寒热有常期者。疟也。无常期者。杂证也。疟
证诸经有邪。总不离乎肝胆也。
石顽曰。经言夏暑汗不出者。秋成 疟。此论固是。然其轻重之殊。今昔迥异。良由天运使
然。以北方风气营运于南故也。夫疟疾一证。向来淮泗以北最剧。大江以南甚轻。康熙壬子。吾
吴患此者。比户皆然。自夏徂秋。日盛一日。其势不减淮北。证皆痞满呕逆。甚则昏热谵语。脉
多浑浑。不显弦象。亦有关尺微弦者。但其热至晨必减。不似热病之昼夜不分也。时医不察。混
以伤寒目之。因而误药致毙者。日以继踵。原其寒热之机。又与往岁不同。有一日连发二三次者。
有晨昏寒热再见者。有连发数日。中间二三日复发如前者。有先热后寒者。有独寒无热者。有独
热无寒者。有今日但寒明日但热者。证虽变易无常。总不越和营散邪等法。但须分虚实寒热轻重
治之。历观用劫剂及祝由之法者十无一验。间有寒热止而昏热不休者。又须随所禀形气之偏胜。
病气之盛衰而为调适。全在机用灵活。不可专守成则。而举世治疟。必先禁止饮食。概用疏风发
散。兼消克痰食宽膈破气之剂。消克不已。继进硝黄。胃气愈伤。浊邪愈逆。正气何由得行。而
振祛邪之力乎。余治久疟坏证。每令续进稠饮。继与稀糜。使胃气输运。可行药力。然后施治。
如此挽回者。未遑枚举。更有愈而复发。发而复愈。愈而又发者。又须推原所发之由而为清理。
若常山、草果、槟榔、浓朴、枳壳、青皮、石膏、知母等伤犯中州之药。咸非所宜。逮至仲秋以
后。不特白虎当禁。纵不犯石膏、知母。邪气 内陷而变肠 者甚多。有先疟后痢者。有疟痢
齐发者。尝遍考昔人治例。惟补中益气一方。虽未能尽合肯綮。然
一隅之举。余可类推。庸师不审。但守通因通用之法。致成夭扎者多矣。
〔诊〕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。
丹溪治一少年。冬月患疟。自卯足寒。至酉方热。寅初乃休。因思必为接内感寒所致。用人
参大补加附子行经散寒以取汗。数日不得汗。以足跗道远。药力难及。再以苍术、川芎、桃枝煎
汤。盛以高桶。扶坐浸足至膝。食顷。以前药服之。汗出通身而愈。
汪石山治一少年。六月因劳病疟。取凉梦遗。遂觉恶寒。连日惨惨不爽。三日后头痛躁闷。
The *Yellow Emperor's Inner Canon* states: In malaria where chills precede fever, it is due to summer-heat injury. During summer, excessive sweating causes the cou li (skin pores) to open. If one is then exposed to cold water or air, the cold qi hides within the cou li and skin. When wind injury occurs in autumn, the disease forms. Cold belongs to Yin Qi, while wind belongs to Yang Qi. Injury by cold first, followed by wind, results in chills preceding fever. This disease occurs at fixed times and is called Cold Malaria (Han Nüe). Where fever precedes chills, it is due to wind injury first, followed by cold injury, resulting in fever preceding chills. It also occurs at fixed times and is called Warm Malaria (Wen Nüe). Where there is only fever without chills, it is because Yin Qi has exhausted first, allowing Yang Qi to flare alone. This presents with shortness of breath, vexation and oppression, heat in the hands and feet, and a desire to vomit; it is called Dan Nüe (Febrile Malaria).
Warm Malaria arises from wind injury in winter, where cold qi hides in the bone marrow. By spring, when Yang Qi expands vigorously, the pathogenic factor cannot exit on its own. If encountered with intense summer heat, the brain marrow is scorched, muscles waste, and the cou li opens. Or, due to physical exertion, the pathogen exits with sweat. This disease hides in the Kidney, and its qi moves from the interior to the exterior. In such cases, Yin is deficient and Yang is excess; excess Yang generates heat. When Yang declines, the qi returns inward; entering the interior leads to Yang deficiency, which generates cold. Thus, fever precedes chills, named Warm Malaria.
Dan Nüe arises from pre-existing heat in the Lungs, with Qi abundant throughout the body, counterflow rising upward, and fullness in the Middle Jiao that does not vent outward. Due to exertion, the cou li opens, and wind-cold lodges between the skin and muscle layers. Upon onset, Yang Qi becomes excessive. If Yang remains excessive without declining, disease ensues. The pathogen does not reach the Yin aspect, hence only fever without chills. The qi hides internally in the Heart and externally in the muscle layers, causing muscle wasting, thus named Dan Nüe.
Malaria of the Foot-Taiyang channel causes lower back pain and heavy head, with cold starting from the back, chills preceding fever, and sweating upon cessation of fever. Malaria of the Foot-Shaoyang channel causes bodily flaccidity, mild chills and fever, aversion to people, and palpitations upon seeing others, with profuse sweating. Malaria of the Foot-Yangming channel causes initial shivering chills, lasting long before fever, followed by sweating; patients prefer sunlight or firelight for comfort. Malaria of the Foot-Taiyin channel causes dissatisfaction, frequent sighing, anorexia, alternating chills and fever with sweating, vomiting upon onset, with improvement after vomiting. Malaria of the Foot-Shaoyin channel causes severe vomiting, alternating chills and fever (more fever than chills), a desire to stay behind closed doors, and is difficult to cure. Malaria of the Foot-Jueyin channel causes lower back pain, abdominal fullness, difficulty urinating resembling strangury but actually frequent urination, fearfulness, Qi deficiency, and abdominal depression.
Generally, treat malaria approximately one meal's time before onset; treating later misses the optimal timing.
The *Jin Gui Yao Lue* states: "When Yin Qi is isolated and exhausted, and Yang Qi flares alone, there is fever, shortness of breath, vexation, heat in the hands and feet, and desire to vomit; this is Dan Nüe. If there is only fever without chills, the pathogen hides internally in the Heart and externally in the muscle layers, causing muscle wasting."
The alternating chills and fever in malaria result from the struggle between Yin and Yang Qi. If Yin declines and separates, and Yang does not merge with Yin, Yang flares alone, causing only fever. Shortness of breath and vexation occur because the Lung governs Qi and is suppressed by Fire. Heat in the hands and feet occurs because Yang governs the four limbs; excess Yang causes limb heat. Desire to vomit occurs because Fire pathogen rushes upward, reversing Stomach Qi. Internal hiding in the Heart is due to excess Yang storing Fire internally and lodging externally in muscle layers. Muscle wasting is due to Fire scorching muscles. Viewing this alongside Warm Malaria, Bai Hu Tang (White Tiger Decoction) can be used for Dan Nüe.
Bai Hu Tang specializes in reducing fever; its action on muscle layers and limbs corresponds internally to the Spleen and Stomach, hitting the site of the pathogen. It also clears Lung Fire, addressing shortness of breath and vexation. If other concurrent symptoms exist, one might add herbs like Guizhi (Cinnamon Twig) as a precedent.
For Warm Malaria, the pulse resembles a normal person's, the body has no chills, only fever, joint soreness, and occasional vomiting; treat with Bai Hu Jia Guizhi Tang (White Tiger plus Cinnamon Twig Decoction).
The *Inner Canon* states Warm Malaria has fever preceding chills, while Zhang Zhongjing states it has only fever without chills, resembling Dan Nüe but distinct. Dan Nüe involves combined Yang pathogens steaming the Heart and Lungs, causing shortness of breath and muscle wasting. Warm Malaria has a normal pulse, indicating uncombined pathogen and undamaged fluids; Yang is diseased but Yin is not. Due to pre-existing Bi syndrome (obstruction) and blocked Ying and Wei circulation, malaria originates in Yang and does not enter Yin, causing joint soreness and vomiting. Use Bai Hu Tang to clear Yang pathogen and Guizhi to unblock Ying and Wei, harmonizing Yin and Yang, unblocking blood vessels, and curing through sweating. This differs significantly from Warm Malaria with surging pulses following unresolved Shanghan (Cold Damage) fever.
Malaria with predominant chills is called Pin Nüe (Yin Malaria); treat with Shuqi San (Shuqi Powder).
Pathogen hiding in the Heart causes only fever without chills (Dan Nüe). Pathogen hiding in the Kidney causes more chills than fever (Pin Nüe). Because the pathogen is knotted, Yang Qi cannot move outward, causing external cold. Accumulated fluids form phlegm, leading to more chills. This differs from the Shaoyin pattern in *Su Wen* which features more heat than chills. Use Shuqi with Jiangshui (fermented grain liquid) to induce vomiting and disperse Yang Qi; Longgu (Dragon Bone) consolidates Yin fluids; Yunmu (Mica) sinks yet lifts Yang, symbolizing clearing clouds. Yunmu is the root of Qiyanshi (Yang Rising Stone), warm and ascending, best for resolving dampness and moving phlegm. Adding Shuqi treats Taiyin Damp Malaria. The formula note says "Damp Malaria, add half fen of Shuqi," but editions mistakenly say "Warm Malaria," a major error. This refers to pathogen hiding in the marrow sea, named Pin Nüe. Zhao Yi-de misread the text, calling it Mu Nüe (Yang Malaria) due to heart involvement; Yu Jiayan repeated this error.
Malaria with thirst uses Chaihu Qu Banxia Gua Lou Tang (Bupleurum Decoction removing Banxia adding Trichosanthes Root). It also treats Lao Nüe (Consumptive Malaria). Thirst indicates exhaustion of Yangming fluids, caused by Shaoyang Wood-Fire robbing Stomach fluids. Since malaria pathogens fluctuate in Shaoyang, modify Xiao Chaihu Tang accordingly. Consumptive malaria also stems from Wood-Fire excess depleting fluids, so this formula applies.
Malaria with many chills and slight fever, or only chills, uses Chaihu Guijiang Tang (Bupleurum, Cinnamon Twig, and Ginger Decoction). One dose works miraculously. Though similar to Pin Nüe, the pathology differs: Pin Nüe hides in Shaoyin Qi level, whereas this hides in Shaoyang Ying-Blood level. Pathogen in Ying lacks outward momentum and does not contest Yang, causing chills predominance. Xiao Chaihu Tang balances Yin and Yang; adding Guizhi and Ganjiang moves toward Yang; adding Gualou and Shigypsum moves toward Yin.
Zhu Danxi treated Six Channels Malaria primarily with Er Chen Tang, adding channel-guiding herbs, proving "no phlegm, no malaria." General rules: Fever-chills use Chaihu Guizhi Tang; Chills-fever use Xiao Chaihu Tang; Much-fever/Only-fever use Bai Hu Jia Guizhi Tang; Much-chills/Only-chills use Chaihu Guijiang Tang. If much-chills but pulse is surging-full, treat as excess, do not use Guizhi/Ganjiang immediately. If much-fever but pulse is empty-soft, treat as deficiency, do not use Bai Hu Tang immediately. Chills > fever, anorexia, nausea/phlegm: Renshen Yangwei Tang. Fever > chills, bitter taste, dry throat, dark urine, or food-stagnation malaria: Qingpi Yin. Labor/diet-induced malaria with weakness/sweating: Buzhong Yiqi Tang + Banxia. Persistent sweating post-malaria (Wei deficiency): Renshen Shiwei Tang + Guizhi. Feng Nüe (Wind Malaria), aversion to wind, sweating, irritability, headache (Yang pathogen, fever-chills): Banxia, Chaihu, Qianghuo, Zisuye, Xixin, Shengjiang. Han Nüe (Cold Malaria), cooling/bathing in summer, no sweat, aversion to cold, cramps/pallor (Yin pathogen, chills-fever): Qianghuo, Zisuye, Guizhi, Chaihu, Caoguo, Houpo.
Shu Nüe (Summerheat Malaria), also called Dan Nüe, only fever, internal excess, vexation/thirst/vomiting, wasting: Xiao Chaihu Tang + Xiangru, Huanglian, Zhuye. Summer onset: Bai Hu Tang; Deficient: + Renshen. Autumn onset: Xiao Chaihu Tang. This is Lung heat, exhausted Yin, flaring Yang.
Wen Nüe comes from winter non-seasonal pathogens hiding in marrow, erupting in spring/summer heat-damp. Fever-chills or only fever. Spring: Xiao Chaihu Tang; Summer: Bai Hu Jia Guizhi Tang. High heat causes immediate fever without chills. Post-fever, internal deficiency mimics mild chills (not true aversion).
Pin Nüe hides in Kidney; Shī Nüe (Damp Malaria) hides in Taiyin from chronic dampness; both only chills, no fever. Treat with Shuqi San. Pathogen in Blood level, chills > fever, trembling: Chaihu Guijiang Tang. Lao Nüe with great thirst: Chaihu Qu Banxia Gua Lou Tang. Sweating/bathing, heaviness/pain, chills-fever/vomiting: Damp Malaria, Weiling Tang + Qianghuo, Zisuye. Shi Nüe (Food Malaria), irregular diet, phlegm in Middle Jiao + Wind: hunger but inability to eat, fullness after eating, distension, vomiting. Excess: Er Chen Tang + Zhike, Caoguo. Irregular diet/labor, prolonged, weak pulse: Lizhong Tang + Zhishi, Qingpi. Pre-existing Yin deficiency/cough or malaria-induced consumption: Modify tonic base with Guizhi, Shengjiang, Dazao. Do not use purely wind-resolving/phlegm-expelling drugs. If exterior pathogen is strong: Xiaojianzhong Tang or Huangqi Jianzhong Tang, followed by Liusheng Liuwei Wan + Guizhi, Biejia.
Onset timing: Before noon = Yang channel, easy to cure. After noon = Yin channel, hard to cure. Delayed onset = pathogen sinking to Yin; use Shengma, Chaihu to lift, Buzhong Yiqi Tang + Guizhi. Early onset = pathogen rising to Yang; guide via Xiao Chaihu Tang + Zhike, Jiegeng. Ye Nüe (Night Malaria), ghost malaria, pathogen in Blood; use Qianjin Neibu Jianzhong Tang + Shengma, Chaihu, Heshouwu. Spleen/Stomach deficiency: Buzhong Yiqi Tang + Heshouwu, Guizhi, Shaoyao. Zhang Nüe (Miasma Malaria), mountain/stream toxins; use anti-miasma/phlegm-resolving drugs. Yi Nüe (Epidemic Malaria), summer/autumn widespread, high fever, sweating, thirst: Dayuan Yin. Vexation/thirst/exterior signs: Guizhi Baihu Tang. Delirium/restlessness: Liangge San + Caoguo. Chills/fever/constipation: Da Chaihu Tang. Weak patient, post-dispersal persistent fever: Renshen Baidu San. Yu Zheng resembling malaria, bitter taste, vomiting clear fluid, blue face, hypochondriac pain, tinnitus, choppy pulse: Xiaoyao San double Chaihu + Wuzhuyu, Huanglian. Post-dysentery malaria, pathogen exiting Shaoyang: Xiao Chaihu Tang remove Huanglian + Guizhi, or Buzhong Yiqi Tang double Shengma, Chaihu.
Generally, early malaria: disperse pathogen, guide out. Prolonged: nourish Zheng, regulate Middle. Qi deficiency = chills; Blood deficiency = fever. Even if prolonged, if diet is unregulated, do not assume deficiency; restrict diet and guide out based on pulse. Robust appearance but Qi deficiency often has damp-phlegm, chills predominance. Prolonged, soft/deep/slipping pulse: Buzhong Yiqi Tang + Fuling, Banxia, + Shufuzi 2-3 fen. Post-malaria anorexia, fatigue, sallow complexion: Liujunzi Tang + Shanzha, Huanglian, Zhishi. Prolonged malaria, robust Yuan Qi: Renshen, Changshan 5 qian each, stir-fry lightly, remove Changshan, decoct Renshen, take before onset. Proven effective. After 4-5 attacks, previously dispersed: Heshouwu San. Robust: Qibao Yin. Night fever, excess pulse/pathogen (Blood level): Changshan Yin to intercept.
Prolonged malaria, failed treatments, no exterior/internal stagnation: Renshen 1 liang, Shengjiang 1 liang, slight Guizhi. Winter/no sweat: + Mahuang. Take at 5 AM before onset, cover for slight sweat. Severe cases: 3 days consecutively. All recover. Easy recovery post-cure. Poor families: halve Renshen, replace with Baizhu 5 qian. Suitable for deficiency/prolonged malaria, especially Three-Day Malaria. Night onset: + Danggui, Heshouwu. Effective. However, severe winter onset may fail with this or Buzhong Yiqi Tang; wait until mid-spring, use previous formula + Guizhi to sweat.
Zhu Danxi: Malaria is Three Yin Malaria. Every three days: Zi/Wu/Mao/You days = Shaoyin Malaria; Yin/Shen/Si/Hai days = Jueyin Malaria; Chen/Xu/Chou/Wei days = Taiyin Malaria. Correlate with pulse/symptoms to determine channel and treatment. *Inner Canon*: Intervals of 2+ days occur because pathogen and Wei Qi lodge in Six Fu organs, missing each other. Li Shicai: "Lodge" means meet. Pathogen in Fu organs means distant/rare meetings, hence intervals. Thus, Zhu Danxi's classification of Chen/Xu/Chou/Wei as Taiyin is incorrect. Zi/Wu are Shaoyin, but Mao/You are Yangming; Si/Hai are Jueyin, but Yin contains Shaoyang; Chou/Wei are Taiyin, but Chen/Xu are Taiyang. This logic holds for every three days, but fails for multi-day intervals.
For early Three-Day Malaria (summer/autumn): Er Chen Tang remove Juapi, + Baizhu, Binglang, Changshan to resolve phlegm-pi, + Chanshunjia to penetrate channels. Summerheat in Ying level: Xiangru, Biejia, Fuling, Banxia, Gancao, Danggui, Shengjiang, Dazao to resolve summerheat; previous herbs are useless. Great Qi deficiency: Tonify only, Liujunzi Tang + Caoguo, Wumei (Sishou Yin). Qi sinking, delayed onset: Buzhong Yiqi Tang large dose Renshen, Baizhu, Shengjiang, Dazao. Changshan, Binglang, etc., become obstacles.
Nü Mu (Malaria Mass), stubborn phlegm/blood/food knot forming mass: Biejia Jian Wan, or Xiao Chaihu Tang + Biejia, Ezhu, Taoren (vinegar processed). Biejia boiled in chestnut ash soup until soft. For excess pathogen/Qi: Nümu Wan. Deficiency/prolonged malaria, intermittent: Xionggui Biejia Yin. If ineffective, Spleen deficiency: Buzhong Yiqi Tang + Biejia. Anorexia/fullness, Stomach deficiency: Sishou Yin + Biejia, Danggui, Ezhu, Rougui. Deficiency Nü Mu requires tonification. Improper treatment leaves pathogen in Liver channel, hypochondriac mass, alternating chills/fever. Do not treat as accumulation; aggressive attack often fails. Prolonged malaria implies stagnation; add Biejia. No stagnation: tonify only. Fixed cycle = Malaria; irregular = Miscellaneous disease. Malaria always involves Liver/Gallbladder.
Shiwan: Text says summer heat without sweat leads to autumn malaria. True, but severity varies by era/climate due to northern winds moving south. Historically, north of Huai-Si was severe; south of Yangtze mild. Kangxi Renzi year, Wu region suffered heavily, daily worsening, comparable to north. Symptoms: fullness, vomiting, delirium, chaotic pulse (not necessarily wiry), heat subsiding by morning (unlike general fevers). Doctors mistook it for Shanghan, causing deaths. Mechanisms varied: multiple daily attacks, morning/evening cycles, relapses, various chills/fever patterns. Treatment must differentiate deficiency/excess/cold/heat.劫剂 (intercepting agents) and magical methods failed. If chills stop but fever/delirium persist, adjust based on constitution/pathogen strength. Flexibility is key. Global practice forbids diet, uses wind-dispersing/phlegm-resolving/breaking-agents, leading to further damage from Xiaoshi/Niaohuang, harming Stomach Qi and trapping turbid pathogens. I treat complicated prolonged malaria by maintaining congee/gruel to support Stomach Qi and transport medicine, then treating. Many recovered. Recurrent cases require investigating cause. Avoid damaging Middle Jiao herbs like Changshan, Caoguo, etc. After mid-autumn, avoid Baihu Tang even without Shigypsum/Zhimu, as pathogen may sink into intestines causing dysentery. Reviewing past cases, Buzhong Yiqi Tang is useful, though not perfect. Ignoring this leads to death.
[Diagnosis] Malaria pulse is naturally Wirly (Xian). Wirly-Rapid = more heat; Wirly-Chronous = more cold. Wirly-Small-Tight = purge; Wirly-Chronous = warm; Wirly-Tight = sweat/acupuncture. Floating-Big = vomit. Wirly-Rapid = Wind-Heat, manage with diet.
Zhu Danxi treated a youth with winter malaria: cold feet from Mao to You, fever until Yin. Suspected intercourse-induced cold. Used Renshen Dadu Tang + Fuzi to sweat, failed due to distance. Soaked feet in Cangzhu, Chuanxiong, Taozhi decoction, then administered medicine; whole-body sweat cured him.
Wang Shishan treated a youth with labor-induced June malaria, cooling after emission, chills, misery. Three days later: headache, restlessness.