得之于夏。邪气客于皮肤腠理之间矣。以瘅疟之气实而不泄，且不及于阴，则知牝疟
乃气虚而泄，且不及于阳矣。是皆不出于阴阳上下交争、虚实更作也。（《鸡峰》）
寒疟牡疟 寒疟临发时，先寒战动，相次发热，便头痛不可胜，忽热极，即汗出烦渴，相次便醒。
（《事证方后集》引杨子建）
《三因》云∶牡疟无热，则《内经》并无此证，惟《金匮要略》云∶疟多寒者，名日牡疟，蜀漆散主之。
亦非曰无热也。若果全无发热，而止见寒栗，此自真寒阳虚之证耳，又安得谓之疟耶。（《景岳》）
温疟瘅疟 夫病疟六七日，但见热者，温疟矣。（《病源论》）（按∶此仲景之温疟。）
温疟初发，浑身大发热，头痛不可胜忍，临醒时即寒栗战动，逡巡便醒。瘅疟发作有时，热多寒少，忽热
而不寒，头痛不安，身上肌肉忽然通身俱黑，大腑秘热，小便黄赤。（《事证方后集》引杨子建）
瘅疟一证，在《内经》则此以阳藏而病阳证也，自与诸疟不同，而治此之法有三。如热邪内蓄，而表邪未
未解者，则当散以苦凉，若热因邪致，表虽解而火独盛者，则当清以苦寒，此皆治其有余也。若邪火虽盛，
而气血已衰，真阴日耗者，急宜壮水固元。若但知泻火，则阴日以亡，必致不救。（《景岳》）
暑疟 暑疟，其人面垢口渴，虽热已退后，无事之时，亦常有汗，宜养胃汤一帖，香薷饮一帖，和匀
作二服。渴甚汗出多者，加味香薷饮，间进辰砂五苓散。不问已发未发，其人呕吐，痰食俱出，宜多进二陈汤
，每服加草果半钱。又恐伏暑蕴结为痰，宜消暑丸。（《要诀》）
本县二尹，北人形长魁伟，年逾四十，六月舟中受热，
病疟寒少热多，头疼躁渴汗多，医用七保饮治之不愈。予诊其脉，浮濡而快略弦，曰∶此暑疟也。以白虎汤加
人参三钱煎服，十余帖而疟止。（《石山》）
痰疟 痰实疟者，谓患人胸膈先有停痰结实，因成疟病，则令人心下胀满，气逆烦呕也。（《病源论》）
《卫州书》云∶疟，寒多热少者，痰疟。热少而脉浮，则痰无疑矣，可吐之也。若脉迟微者，恶寒疟耳，
宜柴胡桂姜汤。（《鸡峰》）（按∶《幼幼》同）
《全生指迷论》∶大人小儿疟疾，若寒从背起，冷大如手，不甚战栗，似欲发热而汗出，或即头痛，呕吐
时作，其脉迟小，此由脾胃素弱，因气寒而收聚，水谷不能克化，变而成痰，伏痰在内，阴上乘阳，阳为阴所
乘，所以作寒，逼而成汗。（《幼幼》）
痰疟，发作有时，热多寒少，头痛不可胜忍， 角并胸前肌肉跳起，食才入口，即便吐出，面色带赤。
（《事证方后集》引杨子建）
痰疟者，疟之兼证也，或先留饮感邪，或感邪而聚饮，气郁而津不行，则邪痰交结而不散，痰由邪甚，邪
为痰留，痰留不泄，则病亦屡发不已，故有用劫痰截法而愈者。（《医级》）
有人病疟月余日，又以药吐下之，气遂弱，疾来愈，观其病与脉，乃夏伤暑，秋又伤风，乃与柴胡汤一
剂安。后又饮食不节，寒热复作，此盖前以伤暑，今以饮食不谨，遂致吐逆不食，胁下牵急而痛，寒热无时，
病名痰疟，以十枣汤一服，下痰水数升，明日又与理中散二钱遂愈。（《本草衍义》）
食疟 《全生指迷论》∶若寒热如疟，不以时度，腹满
膨亨，起则头晕，大便不通，或时腹痛，胸膈痞闷，此由宿谷停留不化，结于肠间，气道不舒，阴阳交乱，宜
备急丸。（《幼幼》）
脾疟，寒热不定，非时发作，肌肉黄瘦，吃食减少，大腑不调，心中常如战栗，频频腹痛。（《事证方后
集》引杨子建）
食疟，乃是饮食伤脾得之，或疟已成而犹不忌口（按∶此本于《三因》），或寒热正作时吃食，其人噫气
吞酸，胸膈不利，宜生料平胃散，每服加草果半钱，砂仁半钱，仍佐以红丸子、七香丸。（《要诀》）
食疟者，疟之兼证也，由强食过饱，致经脉之气壅，不得畅达，故缠绵不已。（《医级》）
至若胃疟，既云饮食（按∶此《三因》之言），则明是内伤，且凡先因于疟而后滞于食者有之，未有不因
外邪而单有食疟者也。（《景岳》）
久疟 夫疟皆由伤暑及伤风所为，热盛之时，发汗吐下过度，腑脏空虚，荣卫伤损，邪气伏藏，所以
引日不瘥，仍故休作也。夫疟岁岁发，至三岁发，连月发不解，胁下有痞，治之不得攻其痞，但得虚其津液，
先其时发其汗，服汤已，先小寒者，引衣自温覆，汗出小便自引利，即愈也。（《病源论》）（按∶疟岁岁发
以下，《外台》引张仲景《伤寒论》）连月作连日，无“自引”二字，即愈下有“疟者病患形瘦皮上必粟起”
十一字。）
久疟不愈，必有留滞，须加鳖甲消之。如无留滞，只宜补益。（《医通》）
疟母 弥年阅岁，经吐汗下，荣卫亏损，邪气伏藏，胁间结为 癖，谓之疟母。此证未可直攻，急作
乌头七枣汤以
扶其里，俟其内气已充，继以经效疟丹或消癖丸下之取愈。（《直指》）（按∶拟方不确，姑存之。）疟母必
用毒药消之，行气消坚为主。（《丹溪新法》）
久疟经年累月，名曰疟母，又名劳疟，不宜十分攻之，所谓久疟不治者是也。进四兽饮，间山甲丸。
（《要诀》）（按∶《类方》山甲汤，用山甲、木鳖子，细末，酒服二钱。）凡疟经年不瘥，谓之老疟（按∶
此出《三因》）必有痰水瘀血，结成痞块，藏于腹胁，作胀且痛，乃疟母也。虽内虚者，非槟榔、常山，决不
能除，但须制熟，则不损胃，老疟丸是也。（方见托邪方中）血虚者，鳖甲丸（按∶系丹溪治疟母方）。体盛
有水癖者，暂用芫花丸，仍须以补脾化痰汤药辅之，老疟饮（按∶此方今不取），宜量气血虚实加减。（《入
门》）疟母，治之失宜，荣卫亏损，邪伏肝经，胁下有块，此证当以补虚为主，每见急于攻块者，多致不
救。（六君子汤加木香、肉桂、蓬术、鳖甲）（《必读》）
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。（《医通》）
劳疟 凡疟积久不瘥者，则表里俱虚，客邪未散，真气不复，故疾虽暂间，小劳便发。（《病源论》）
其寒热不止，食饮渐少，肌肤羸瘦，颜色萎黄，四肢无力，故名劳疟也。（《圣惠》）
劳疟法当调养气血，川芎、当归、官桂、芍药辈，所不可无。（《直指》）
若成劳疟者，宜以秦艽鳖甲散，只用姜钱、乌梅煎服效，亦可灸膏肓二穴，四花六穴尤佳。（《管见良
方》）
有劳疟者，经年不瘥，疟虽小愈，微劳不任，又复发作也。此脾虚证，宜用补中益气汤，合小建中汤，合
鳖甲治之。（《保命歌括》）
疟劳，或素有弱症而又患疟，以至旧病更深，或因疟煎熬，日久顿惫，精神衰耗，内热不清，肌肉消削，
渐至往来潮热，致成痨瘵，急宜察其何经受病，以补益调理之。（《尊生书》）
呕吐 胸满 其人素呕而发疟，慎勿用常山。万一呕不止而热不退，却用真料小柴胡汤，多加生姜主
治。其或呕吐大作而又发热，且先与治疟生熟饮，呕定以小柴胡汤继之。（《直指》）（按∶生熟饮用草果
、肉蔻、浓朴、姜、甘、枣、梅。）
渴欲水浆，药入辄吐，人参煎汤效。（同上）
疟疾每发，呕吐不止，以盐汤探之，吐出积痰为佳。呕定，投清中导滞药。（《六要》）
大凡寒热乍已之时，胸中满闷不退，皆痰涎之故也。（《沙篆》）
疟疫兼证 疟疾二三发或七八发后，忽然昼夜发热，烦渴不恶寒，舌上胎刺，心腹痞满，饮食不进，
下证渐具，此温疫者，疟疾隐也，以疫法治之。温疫昼夜纯热，心腹痞满，饮食不进，下后脉静身凉，或间日
或每日，时恶寒而后发热如期者，此温疫解，疟邪未尽也，以疟法治之。（《温疫论》）
凡疟者寒热如期而发，余时脉静身凉，此常疟也，以疟法治之。设传胃者，必现里证，名为温疟（按∶此
温，温疫之温），以疫法治者生，以疟法治者死。里证者，下证也，下后里证除，寒热独存者，是温疫减，
疟证在也。疟邪来去者宜疏，邪去而疟势在者宜截，疟势在而挟虚者宜补。疏以清脾次，截以不二饮，补以四
君子。（同上）
疟痢兼证 疟后痢 （互见滞下门） 凡治疟疾、泻痢并作合潮者，非时邪疫之气，流运之所变致也。
《内经》云∶春伤于风，夏生飧泄；夏伤于暑，秋必病疟。须伤寒温疟流变法中加减四逆汤主之（按∶其方即
四逆散，每服五钱，水二盏，粟米一捻，同煎至一盏，去滓温服）。协热利不止，《活人》方中，葛根黄芩黄
连汤。若同杂病治痢之方，热药治之，反致夭殃，伤人甚众。（《端效方》）
疟痢者，疟久不瘥，寒热邪气内传肠胃也。其病寒热往来，痢下脓血，赤白相杂，肠中切痛，随其阴阳而
治之。（《圣济》）（按∶《外台》引《备急》论疟瘴后发痢，宜并参。）
疟后之痢从虚治，故用补脾胃为主，佐治痢药。（《统旨》）若其人不甚虚，痢重疟轻，还当以痢治。
（《大还》）
或疟后痢，痢后疟，或疟痢并作，俱以柴苓汤、六和汤、清脾饮加减分利。虚者补脾和血，三白汤加黄连
、木香、当归、砂仁，或四兽饮、补中益气汤。（《入门》）
若疟后变症，惟痢最为危急，而其变痢之由，有因暑邪太盛，解散不早，即或解散，不能通畅，以至陷入
于里，变而为痢者，急用表里分消之法以治之，连进大剂，以痢愈为度，痢愈疟亦止，即不止。其发亦轻，仍
随经随证施治。有因误下，邪气陷于内，变而为痢者，则必兼腹满肿胀、呕恶
不思食等证，法宜逐邪去滞以培土，亦以痢愈为度。此二因者，证之最急，治之之药，必宜大剂，若胆小，虽
用药不谬，终不去病，以至迁延不救。（《尊生书》）
变成诸证 （不治证） 若疟之变病，总由攻消太过，三焦内虚，或胀满，或浮肿，或泄泻，或咳嗽，
病虽有变，更当温其中土，助其三焦。若胀满者消之，浮肿者散之，泄泻者通之，咳嗽者清之，一时暂松，
不能全愈，耽延时日，断未有不毙者也。（《医学真传》）
凡疟后大汗出者，乃荣血不足之候，以人参养荣汤主之。（《医鉴》）误下则邪气陷于内，变为滞下，
或腹满肿胀，呕恶不思食。（《本草经疏》）
久疟不食，吐泻致肿胀者，不治。（《活人心统》）
疟愈之后，阴阳两虚，梦遗咳嗽，不善保养，遂成痨瘵。（《诸证辨疑》）
不治症 疟母日久成痨瘵。（《识病捷法》）
类证 外有伤寒往来寒热如疟，劳病往来寒热亦如疟，谓之如疟，非真疟也。然伤寒寒热如疟，初必
恶风寒发热，头痛体疼，自太阳经而来；劳病寒热如疟，初必五心发烦热，劳倦咳嗽，久乃成寒热，与正疟自
不同。诸病皆有寒热，如失血痰饮， 瘕积聚，小肠 气，风寒暑湿，食伤发劳，劳瘵香港脚疮毒，已各见本门
，其余不能尽举，应有不如发疟之传为寒热者，须问其元有何病而生寒热，则随病施治。寒热发作有期者，疟
也；无期者，诸病也。亦有非疟非劳等疾而自成寒热，乃是痰饮为之，不可不审，去痰行饮则愈。（《要诀》）
外有阴虚证，每日午后恶寒发热，至晚亦得微汗而解（《入门》曰∶宜加味逍遥散加地骨皮，若误用疟
药必死），
脉必虚濡而数，且疟脉弦而虚脉不大弦为辨耳。（《正传》）
治法总说 疟疾寒热相等，及先热后寒者，俱宜与小柴胡汤。先寒后热者，小柴胡加桂汤。有汗多烦
渴，小便赤涩，素有瘴气，及不伏水上，呕吐甚者，可服五苓散（《管见良方》辰砂五苓散）。脉小紧，寒热
呕吐，间日频日，发作无时，大便秘者，可服大柴胡汤下之。（《活人》）调胃气，和痰水，分阴阳，行三焦
，是又治法之纲领也。（《直指》）（宜参脉候）治疟之法，多用恒山，然本无定方。但欲收敛之，则佐以乌
梅；欲发散之，则助以桂枝。欲去积气，则兼用青皮、莪术；欲去痰饮，则或用半夏、槟榔。祛热，则更用秦
艽、甘草；去寒，则兼使草果、干姜。以热属心者，诱之以茯苓、茯神；以寒属脾者，引之以砂糖蜂糖云云。
又疟药多是一冷一热，半熟半生，分利阴阳之义也。（《澹寮》）
治疗之法，当先发散寒邪，不可骤用截补之药。若截早则补住邪气，其证变异，不能即愈，致成痨瘵者有
之。发散之药，热多宜小柴胡汤、参苏饮、清脾汤之类，寒多者宜养胃汤、四兽饮。发散不退，然后以常山饮
、胜金丸截之。截而不愈，久则脾气虚败，唯宜多进养脾驱痰之药，脾气一盛，自然平复。（《大成》）
Malaria is caused by summer pathogens. The pathogenic factors lodge between the skin and interstices. (Jifeng) Since Danmalaria (a type of malaria characterized by high fever without chills) involves excess Qi that fails to vent, and does not affect the Yin aspect, it can be known that Pinmalaria (a type of malaria characterized by chills without fever) involves deficient Qi with leakage, and does not affect the Yang aspect. All these situations do not exceed the scope of the struggle between upper and lower Yin and Yang, and the alternation of deficiency and excess.
Cold Malaria and Mu Malaria: When Cold Malaria is about to attack, there are initially chills and tremors, followed by fever, then severe headache that is unbearable. Suddenly, when the heat reaches its peak, sweating occurs accompanied by irritability and thirst, after which the patient awakens. (Shizheng Fanghou Ji, citing Yang Zijian)
The San Yin Fang states: Mu Malaria has no fever, but this syndrome is not recorded in the Nei Jing. Only the Jin Gui Yao Lue says: "Malaria manifesting mostly with chills is named Mu Malaria," treated with Shuqi San. This does not mean there is absolutely no fever. If there is truly no fever at all, and only chills and trembling are seen, this is naturally a syndrome of true cold and Yang deficiency; how can it be called malaria? (Jingyue Quanshu)
Warm Malaria and Dan Malaria: If malaria persists for six or seven days and only fever is observed, it is Warm Malaria. (Bingyuan Lun) [Note: This refers to Zhang Zhongjing's definition of Warm Malaria.]
When Warm Malaria first attacks, the whole body becomes very hot, the headache is unbearable. Upon waking, there are chills and tremors, and one awakens shortly after. Dan Malaria attacks at fixed times, with more heat than cold, sudden heat without cold, headache and restlessness, sudden blackening of the muscles throughout the body, constipation with internal heat, and yellow-red urine. (Shizheng Fanghou Ji, citing Yang Zijian)
Regarding the syndrome of Dan Malaria, in the Nei Jing, it is considered a Yang organ suffering from a Yang syndrome, thus different from other malarias. There are three methods to treat it. If heat pathogens are accumulated internally while exterior pathogens remain unresolved, bitter-cool herbs should be used to disperse them. If the heat arises from pathogens, the exterior is resolved but fire burns alone, bitter-cold herbs should be used to clear it. Both methods treat excess conditions. If the pathogenic fire is strong but Qi and Blood are already depleted, and True Yin is daily consumed, urgent measures to nourish Water and secure the Origin are required. If one only knows how to purge fire, Yin will perish daily, leading to untreatable conditions. (Jingyue Quanshu)
Summerheat Malaria: Patients with Summerheat Malaria have a greasy complexion and thirst. Even after the fever subsides, they often sweat when idle. One dose of Yangwei Tang and one dose of Xiangru Yin should be taken, mixed and divided into two doses. For severe thirst and profuse sweating, Jia Wei Xiangru Yin should be used, alternating with Chensha Wuling San. Regardless of whether an attack has occurred, if the patient vomits and expels phlegm and food residue, Erchen Tang should be administered frequently, adding Ban Qian (half a qian) of Caoguo per dose. To prevent latent summerheat from condensing into phlegm, Xiaoshu Wan is suitable. (Yijue)
The Vice Magistrate of our county, a northerner with a tall and sturdy build, over forty years old, suffered heat exposure on a boat in June. He contracted malaria with less chills and more heat, headache, irritability, thirst, and profuse sweating. The physician treated him with Qibao Yin without success. I palpated his pulse: floating, soft, rapid, and slightly wiry. I said, "This is Summerheat Malaria." I prescribed Baihu Tang with three qian of Renshen decocted and administered. After more than ten doses, the malaria ceased. (Shishan)
Phlegm Malaria: Phlegm-excess malaria refers to patients who have stagnant phlegm and solid accumulation in the chest and diaphragm prior to onset, leading to malaria, causing fullness below the heart, rebellious Qi, irritability, and vomiting. (Bingyuan Lun)
The Weizhou Shu states: In malaria, if chills are predominant and heat is minor, it is Phlegm Malaria. If heat is minor and the pulse is floating, it is undoubtedly phlegm, and emesis therapy can be used. If the pulse is slow and faint, it is merely a chills-predominant malaria, treated with Chaihu Guijiang Tang. (Jifeng) [Note: Same view in Youyou Xinshu]
Quansheng Zhimi Lun: In adults and children with malaria, if cold sensation rises from the back, feeling as large as a hand, with little trembling, seeming to want to generate heat and sweat, or suddenly experiencing headache and intermittent vomiting, with a slow and small pulse, this is due to inherent weakness of the Spleen and Stomach. Cold Qi causes contraction, water and grain fail to digest, transforming into phlegm. Latent phlegm resides inside, Yin overcomes Yang, and Yang is oppressed by Yin, causing cold sensations, forcing sweat. (Youyou Xinshu)
Phlegm Malaria attacks at fixed times, with more heat than cold, unbearable headache, twitching of the temples and chest muscles, immediate vomiting upon eating, and a reddish complexion. (Shizheng Fanghou Ji, citing Yang Zijian)
Phlegm Malaria is a concurrent syndrome of malaria. It may arise from retained fluids contracting pathogens, or pathogens gathering fluids. Qi stagnation prevents fluid circulation, causing pathogen and phlegm to knot together and not disperse. Phlegm intensifies the pathogen, and the pathogen retains the phlegm. With phlegm retention failing to drain, the disease recurs repeatedly. Thus, some cases are cured by phlegm-expelling and malaria-intercepting methods. (Yiji)
A person suffered from malaria for over a month and was treated with emetics and purgatives, weakening their Qi and worsening the disease. Observing the symptoms and pulse, it was determined that summerheat was injured in summer and wind in autumn. One dose of Chaihu Tang brought relief. Later, irregular diet caused a recurrence of chills and heat. This was likely due to previous summerheat injury, now exacerbated by dietary indiscretion, leading to vomiting, refusal to eat, pulling pain in the hypochondrium, and irregular chills and heat. The diagnosis was Phlegm Malaria. One dose of Shizao Tang expelled several sheng of phlegm-water. The next day, Lizhong San (two qian) cured him. (Bencao Yan Yi)
Food Malaria: Quansheng Zhimi Lun: If chills and heat resemble malaria but occur irregularly, with abdominal distension and bloating, dizziness upon standing, constipation, occasional abdominal pain, and chest/diaphragm stuffiness, this is due to undigested food remaining in the intestines, obstructing Qi flow, disturbing Yin and Yang. Beiji Wan is indicated. (Youyou Xinshu)
Spleen Malaria: Irregular chills and heat, unpredictable attacks, sallow and emaciated muscles, reduced appetite, bowel irregularity, constant feeling of trembling in the heart, and frequent abdominal pain. (Shizheng Fanghou Ji, citing Yang Zijian)
Food Malaria results from dietary injury to the Spleen. It may occur if one does not observe dietary restrictions after malaria onset (based on San Yin), or if eating during chills and heat episodes, causing belching, acid regurgitation, and chest discomfort. Shengliao Pingwei San is indicated, adding Ban Qian of Caoguo and Ban Qian of Sharen per dose, assisted by Hong Wanzi and Qixiang Wan. (Yijue)
Food Malaria is a concurrent syndrome of malaria, caused by overeating, leading to congestion of meridian Qi and inability to flow freely, resulting in lingering illness. (Yiji)
As for Stomach Malaria, since it mentions diet (from San Yin), it is clearly an internal injury. While there are cases where malaria precedes food stagnation, there are no cases of Food Malaria occurring solely from internal factors without external pathogens. (Jingyue Quanshu)
Chronic Malaria: Malaria is caused by summerheat and wind injuries. During intense heat, excessive sweating, vomiting, or purging empties the viscera, damaging Ying and Wei, allowing pathogens to lie dormant. Thus, the illness drags on without recovery, recurring periodically. If malaria recurs yearly, or in the third year, or continuously for months with subcostal masses, treatment must not directly attack the mass, as this depletes fluids. Instead, induce sweating before the attack. After taking the decoction, if slight chills occur, cover oneself warmly. When sweating occurs and urination becomes free, the patient recovers. (Bingyuan Lun) [Note: From "recurs yearly" onwards, Waitai cites Zhang Zhongjing's Shanghan Lun. The text varies slightly.]
In chronic malaria that does not resolve, there must be residual stagnation requiring Biejia to dissipate it. If no stagnation exists, tonification is appropriate. (Yitong)
Malaria Mass: After a year or more, following emetic, sweating, and purging therapies, Ying and Wei are depleted, and pathogens lie dormant. A mass forms in the hypochondrium, called Malaria Mass. Direct attack is contraindicated. Urgently use Wutou Qizao Tang to support the interior. Once internal Qi is sufficient, follow with Jingxiao Nuedan or Xiao Pi Wan to purge and cure. (Zhizhi) [Note: Formula formulation is questionable, preserved for reference.] Malaria Mass requires toxic drugs to dissipate, focusing on moving Qi and dissolving hardness. (Danxi Xinfa)
Chronic malaria lasting years is called Malaria Mass, also Labor Malaria. It should not be aggressively attacked. Admin Sizhu Yin, alternating with Shan Jia Wan. (Yijue) [Note: Leifang's Shan Jia Tang uses Shan Jia and Mugua Zi, powdered, taken with wine.] Any malaria persisting for years is called Old Malaria (from San Yin). It must involve phlegm-water and blood stasis forming masses in the abdomen and hypochondrium, causing distension and pain. Even with internal deficiency, only Binglang and Changshan can remove it, provided they are processed熟 (cooked/prepared) to protect the stomach, as in Laonue Wan. For blood deficiency, Biejia Wan (Danxi's formula) is used. For those with phlegm-fluid retention, Yuanhua Wan is temporarily used, supported by Pipi Huatan decoctions. Laonue Yin (not currently adopted) should be adjusted based on Qi/Blood deficiency/excess. (Rumen) For Malaria Mass, improper treatment depletes Ying/Wei, trapping pathogens in the Liver Meridian, forming hypochondriac masses. Tonification is primary. Those eager to attack masses often fail. (Liujunzi Tang + Muxiang, Rougui, E Zhu, Biejia) (Bidu)
Malaria Mass is stubborn phlegm binding with blood and food into masses. Biejia Jian Wan, or Xiao Chaihu Tang plus Biejia, E Zhu, Tao Ren (all vinegar-processed), with Biejia boiled in chestnut ash soup until soft, is effective, following Jin Gui principles. For excess conditions, Nuomu Wan. For deficient patients with chronic, intermittent malaria, Xionggui Biejia Yin. If ineffective, it is Spleen deficiency; urgently use Buzhong Yiqi Tang plus Biejia. For poor appetite and stuffiness, it is Stomach deficiency; Sizhu Yin plus Biejia, Danggui, E Zhu, Rougui. Deficient patients with Malaria Mass require tonification, as improper treatment traps pathogens in the Liver Meridian, causing hypochondriac masses and intermittent chills/heat. Do not treat as simple accumulations; aggressive mass-busting often leads to failure. (Rumen citing Yitong)
Labor Malaria: When malaria lingers without resolution, both exterior and interior become deficient, pathogenic factors remain, and True Qi fails to recover. Although symptoms may temporarily cease, slight exertion triggers recurrence. (Bingyuan Lun)
With persistent chills and heat, reduced intake, emaciation, sallow complexion, and limb weakness, it is named Labor Malaria. (Shenghui)
Treatment for Labor Malaria should nourish Qi and Blood. Chuanxiong, Danggui, Guirou, Shaoyao, etc., are indispensable. (Zhizhi)
For established Labor Malaria, Qinjiao Biejia San is suitable, decocted with ginger slices and wumei. Acupoints Gaohuang and Sihua Liuxue can be moxa-ed. (Guanjian Liangfang)
For Labor Malaria persisting for years, with minor improvement but intolerance to slight labor and subsequent recurrence, this is a Spleen deficiency syndrome. Use Buzhong Yiqi Tang combined with Xiaojianzhong Tang and Biejia. (Baoming Ge Kuo)
Malaria Consumption: If one has pre-existing weakness and contracts malaria, deepening the old disease, or if prolonged malaria consumption exhausts spirit and reduces muscle, leading to tidal fever and finally Tuberculosis (Lao Zhai), urgently determine the affected meridian and apply tonification and regulation. (Zunsheng Shu)
Vomiting: If a patient prone to vomiting develops malaria, avoid Changshan. If vomiting persists and fever remains, use authentic Xiao Chaihu Tang with increased Shengjiang. If vomiting is severe with fever, first administer Zhimie Shengshu Yin; once vomiting stops, follow with Xiao Chaihu Tang. (Zhizhi) [Note: Shengshu Yin contains Caoguo, Roukou, Houpo, Jiang, Gancao, Dazao, Wumei.]
For thirst wanting fluids but immediate vomiting upon ingestion, Renshen decoction is effective. (Same source)
If malaria attacks cause persistent vomiting, probe with salt water to induce vomiting of accumulated phlegm. Once stopped, administer Qingzhong Daozhi herbs. (Liuyao)
Generally, when chills and heat subside but chest fullness persists, it is due to phlegm-fluids. (Shazhuan)
Malaria-Epidemic Concurrent Syndromes: After 2-3 or 7-8 attacks of malaria, if sudden day-and-night fever, irritability, thirst without chills, prickly tongue coating, chest/abdominal fullness, anorexia, and downward syndromes appear, this is Warm Epidemic, hidden within malaria. Treat as epidemic. If Warm Epidemic presents with pure day-and-night heat, chest/abdominal fullness, anorexia, and after purging, pulse calms and body cools, but later periodic chills and heat recur, the epidemic has resolved but malaria pathogens remain. Treat as malaria. (Wenyi Lun)
Typical malaria features periodic chills and heat, with normal pulse and temperature otherwise. Treat as malaria. If it transmits to the Stomach, interior syndromes appear, named Warm Malaria (here "Warm" refers to Warm Epidemic). Treating as epidemic saves; treating as malaria kills. Interior syndromes are downward syndromes. After purging, if interior signs clear but chills/heat remain, the epidemic has lessened but malaria persists. For wandering malaria pathogens, use dispersing methods; for residual malaria momentum after pathogen removal, use intercepting methods; for malaria momentum with deficiency, use tonifying methods. Disperse with Qingpi Yin; intercept with Bu'er Yin; tonify with Sijunzi Tang. (Same source)
Malaria-Dysentery Concurrent Syndromes: Post-malaria Dysentery (See under Dysentery section): When treating simultaneous malaria and diarrhea/dysentery, consider non-seasonal epidemic qi transformations. Nei Jing states: Wind injury in spring leads to undigested diarrhea in summer; Summerheat injury in summer leads to malaria in autumn. Modify Sini Tang within the context of Cold Damage/Warm Malaria variations (Formula is Sini San: 5 qian per dose, 2 cups water, pinch of millet, decoct to 1 cup, warm). For協熱利 (Heat-collateral diarrhea) persisting, use Gegen Huangqin Huanglian Tang from Huren Shu. Using hot herbs for dysentery like miscellaneous diseases causes disaster. (Duanyou Fang)
Malaria-Dysentery: Chronic malaria fails to resolve, chills/heat pathogens transmit internally to intestines/stomach. Symptoms include alternating chills/heat, dysenteric stool with pus/blood, red/white mixture, severe intestinal pain. Treat according to Yin/Yang differentiation. (Shengji Zonglu) [Note: Waitai cites Beiji regarding post-malarial dysentery.]
Post-malaria dysentery is treated from a deficiency perspective, primarily tonifying Spleen/Stomach, assisting with dysentery herbs. (Tongzhi) If the patient is not severely deficient and dysentery is heavy/malaria light, treat the dysentery primarily. (Dahuan)
Whether post-malaria dysentery, post-dysentery malaria, or simultaneous occurrence, modify Chai Ling Tang, Liuhe Tang, or Qingpi Yin to separate and drain. For deficiency, tonify Spleen and harmonize Blood: Sanbai Tang + Huanglian, Muxiang, Danggui, Sharen; or Sizhu Yin, Buzhong Yiqi Tang. (Rumen)
If malaria transforms into complications, dysentery is most critical. Causes include excessive summerheat not dispersed early, or dispersion failing to unblock, allowing pathogens to sink inward. Urgently use exterior-interior resolving methods with large doses until dysentery resolves; malaria will also stop or lessen. Treat according to meridians/syndromes. If mistaken purging sinks pathogens, causing dysentery with abdominal fullness/bloating, nausea, and anorexia, eliminate pathogens and stagnation to fortify Earth, aiming for dysentery resolution. These two causes are most urgent; large doses are essential. Timidity in dosing, even if correct, fails to cure, leading to delay and death. (Zunsheng Shu)
Transformed Syndromes (Incurable): Malaria complications generally result from excessive attacking/clearing, causing Three Burner internal deficiency. Symptoms include distension, edema, diarrhea, cough. Although symptoms change, warm the Middle Earth and assist the Three Burners. Resolve distension, scatter edema, unblock diarrhea, clear cough. Temporary relief without full cure leads to delay and certain death. (Yixue Zhenchuan)
Profuse sweating after malaria indicates Ying-Blood deficiency. Ren Shen Yang Rong Tang is indicated. (Yijian) Mistaken purging sinks pathogens, causing dysentery, abdominal fullness/bloating, nausea, anorexia. (Bencao Jing Shu)
Chronic malaria with anorexia, vomiting/diarrhea leading to swelling is incurable. (Huoxin Tongstong)
After malaria recovery, dual Yin/Yang deficiency, nocturnal emissions, cough, and poor self-care lead to Tuberculosis. (Zhuzheng Biyi)
Incurable Syndrome: Long-standing Malaria Mass transforms into Tuberculosis. ( Shibian Jiefang)
Similar Syndromes: Exterior Cold Damage presents with alternating chills/heat resembling malaria; Labor disease also presents similarly, called "resembling malaria," not true malaria. Cold Damage resembling malaria begins with aversion to wind/cold, fever, headache, body ache, originating from Taiyang Meridian. Labor disease resembling malaria begins with five-center heat, fatigue, cough, evolving into chills/heat, distinct from true malaria. Many diseases feature chills/heat: blood loss, phlegm-fluids, masses, hernias, wind/cold/summerheat/dampness, food injury, labor consumption, tuberculosis, beriberi, sores. Refer to respective sections. For others not listed, ask what underlying disease causes the chills/heat and treat accordingly. Periodic chills/heat indicate malaria; non-periodic indicate other diseases. Some non-malaria/non-labor diseases develop chills/heat due to phlegm-fluids; examine carefully, dispel phlegm/fluids to cure. (Yijue)
Exterior Yin Deficiency Syndrome: Daily afternoon chills/heat, resolving with slight sweat at night. (Rumen suggests Jia Wei Xiaoyao San + Digupi; mistaken malaria drugs cause death.) Pulse is deficient, soft, and rapid. Differentiate from malaria pulse (wiry vs. not strongly wiry). (Zhengchuan)
General Treatment Principles: For malaria with equal chills/heat, or heat preceding chills, Xiao Chaihu Tang is indicated. For chills preceding heat, Xiao Chaihu Tang plus Guizhi. For profuse sweating, irritability/thirst, red/scanty urine, historical miasma, water intolerance, or severe vomiting, Wuling San is suitable (Chensha Wuling San in Guan Jian Liang Fang). For small-tight pulse, chills/heat/vomiting, every-other-day or frequent irregular attacks, constipation, Da Chaihu Tang to purge. (Huren Shu) Regulating Stomach Qi, harmonizing phlegm/water, separating Yin/Yang, and circulating the Three Burners are the general guidelines. (Zhizhi) [Refer to Pulse Diagnosis] Malaria treatment often uses Changshan, but there is no fixed formula. To astringe, add Wumei; to disperse, assist with Guizhi. To remove stagnant Qi, add Qingpi, Ezhu; to remove phlegm-fluids, use Banxia, Binglang. To clear heat, use Qinjiao, Gancao; to dispel cold, use Caoguo, Ganjiang. For heat associated with Heart, guide with Fuling, Fushen; for cold associated with Spleen, guide with brown sugar/honey. Malaria medicines often combine cold/hot, raw/cooked, reflecting the principle of separating/benefiting Yin/Yang. (Danliao Fang)
Treatment should first disperse cold pathogens; do not abruptly use intercepting/tonifying drugs. Early interception traps pathogens, altering syndromes and preventing cure, potentially leading to Tuberculosis. For dispersing herbs: Heat-predominant cases use Xiao Chaihu Tang, Rensu Yin, Qingpi Tang; Cold-predominant cases use Yangwei Tang, Sizhu Yin. If dispersing fails, then intercept with Changshan Yin or Shengjin Wan. If interception fails and Spleen Qi becomes deficient over time, administer Spleen-nourishing/phlegm-dispelling herbs. Once Spleen Qi recovers, natural recovery occurs. (Yixue Dacheng)