卫不循经行脉外，阳会昼发阴夜发，邪退自然归阳分，病进每必入阴家。
【注】营气循经而行脉中。卫气不循经而行脉外，惟日行于三阳，夜行于三阴。故邪
在三阳之浅者，则昼发。邪在三阴之深者，则夜发。病邪将退者，夜发退为昼发，此为去
阴就阳，则病欲已也，病邪渐进者，昼发进为夜发，此为去阳入阴，则病益甚也。
卫气平旦会风府，邪传日下一节间，从头循下故益晏，下极复上早之缘。
【注】卫气流行，每日平旦会于风府，而邪气中人，从头项历风府，下循背腰，日下
传脊之一节，邪与卫会日晚，故作日益晏也。邪传下极 冲，其气复上行，邪与卫会日早，
故作日益早也。
疟初气实汗吐下，表里俱清用解方，清解不愈方可截，久疟形虚补自当。
【注】疟初气实，均宜汗、吐、下。有表里证汗下之，胸满呕逆有饮者吐之。表里俱
清，宜用和解。清解不愈，表里无证，可用截药止之。久疟形羸气虚，宜用补剂，自当然也。
桂麻各半汤
疟初寒热两平者，桂麻各半汗方疗，汗
少寒多麻倍入，汗多倍桂热加膏。
【注】疟病初起，寒热不多不少两平者，宜桂麻各半汤汗之，汗少寒多热少者，倍麻
黄汤汗之。汗多寒少热平者，倍桂枝汤汗之，热多者，更加石膏。
麻黄羌活汤 桂枝羌活汤 麻黄羌活加半夏汤 白虎汤 白虎桂枝汤 柴胡白虎汤 柴胡桂枝汤
寒多寒疟而无汗，麻黄羌活草防寻。热多有汗为风疟，减麻添桂呕半均。先热后寒
名温疟，白虎汗多合桂君。瘅疟但热柴白虎，牝疟惟寒柴桂亲。
【注】此皆诸疟初起之汗法也，先伤于寒，后伤于风，先寒后热，寒多热少无汗，谓之
寒疟，宜用麻黄羌活汤，即麻黄、羌活、防风、甘草也。先伤于寒，后伤于风，先寒后
热，热多寒少有汗，谓之风疟，宜用桂枝羌活汤，即桂枝、羌活、防风、甘草也。二证
呕者，均加半夏。先伤于风，后伤于寒，先热后寒，谓之温疟，宜用白虎汤，汗多合桂
枝汤。阳气盛、阳独发，则但热而不寒，谓之瘅疟，宜用柴胡白虎汤，即小柴胡合白虎
汤也。阴气盛、阴独发，则但寒而不热，谓之牝疟，宜用柴胡桂枝汤，即小柴胡合桂枝
汤也。
草果柴平汤 大柴胡汤
食疟痞闷噫恶食，草果小柴平胃宜，疟里便硬大柴下，消槟果朴量加之。
【注】因食而病疟者，则痞闷、噫气、恶食，宜小柴胡合平胃散加草果清之。凡疟有
里不清、便硬者，宜大柴胡汤加芒硝、浓朴、草果、槟榔下之。
清脾饮
疟疾已经汗吐下，清解未尽寒热方，清脾白术青朴果，小柴参去入苓姜，气虚加参
痰橘半，饮多宜逐倍姜榔，渴热知膏天花粉，食滞麦曲湿泽苍。
【注】疟疾已经或汗或吐或下，表里无证，法当清解，宜用清脾饮和之。即白术。青皮、
浓朴、草果、柴胡、黄芩、半夏、甘草、茯苓、生姜也。气虚者加人参，痰多者加橘红
倍半夏，饮多者倍生姜加槟榔，渴热者加知母、石膏、天花粉，食滞者加麦芽、神曲，湿
盛者加泽泻、苍术。
Wei Qi (Defensive Qi) does not follow the regular meridians to circulate outside the vessels; when Yang Qi converges, symptoms manifest during the day, and when Yin Qi converges, they manifest at night. As pathogenic factors recede, they naturally return to the Yang aspect; as the disease progresses, it often enters the Yin aspect.
[Note] Ying Qi (Nutritive Qi) circulates within the vessels along the meridians. Wei Qi (Defensive Qi), not following the meridians, circulates outside the vessels, traveling through the Three Yang meridians during the day and the Three Yin meridians at night. Therefore, if pathogens are in the superficial layers of the Three Yang meridians, symptoms manifest during the day; if pathogens are deep within the Three Yin meridians, symptoms manifest at night. When pathogenic factors are about to recede, a shift from nighttime manifestation to daytime manifestation indicates moving from Yin to Yang, suggesting the disease is about to heal. When pathogenic factors gradually progress, a shift from daytime manifestation to nighttime manifestation indicates moving from Yang to Yin, suggesting the disease is worsening.
Wei Qi (Defensive Qi) converges at Fengfu (GV16) at dawn. Pathogens transmit downward by one spinal segment daily. Because the transmission follows a downward course from the head, the onset time becomes progressively later; reaching the lowest point and then reversing upward causes the onset time to become progressively earlier.
[Note] Wei Qi (Defensive Qi) circulates and converges at Fengfu (GV16) every morning. Pathogenic factors invading the human body travel from the head and neck through Fengfu (GV16), descending along the back and waist, transmitting downward to one segment of the spine each day. The interaction between pathogens and Wei Qi (Defensive Qi) occurs in the evening, causing the onset time to delay day by day. When pathogens reach the extreme lower limit and their Qi reverses upward, the interaction with Wei Qi (Defensive Qi) occurs earlier, causing the onset time to advance day by day.
In the early stage of malaria, if Zheng Qi (Upright Qi) is substantial, sweating, vomiting, or purging methods may be used. If exterior and interior patterns are cleared, harmonizing formulas should be employed. If clearing heat and harmonizing fail, antimalarial drugs may be used. For chronic malaria resulting in physical weakness, tonification is appropriate.
[Note] In the early stage of malaria with substantial Zheng Qi (Upright Qi), sweating, vomiting, and purging are all suitable. For exterior and interior patterns, sweating and purging are used; for chest fullness, vomiting, and retching accompanied by fluid retention, vomiting is used. Once exterior and interior patterns are cleared, harmonizing is appropriate. If clearing heat and harmonizing do not resolve the condition and no exterior/interior patterns remain, antimalarial drugs can be used to stop attacks. For chronic malaria leading to emaciation and Qi deficiency, tonifying agents are naturally indicated.
Guizhi Mahuang Ge Ban Tang (Cinnamon Twig and Ephedra Half-Dose Decoction)
For early-stage malaria where chills and fever are balanced, Guizhi Mahuang Ge Ban Tang (Cinnamon Twig and Ephedra Half-Dose Decoction) is used as a diaphoretic formula. If there is little sweat and more chills, double the dose of Mahuang (Ephedra); if there is much sweat, double the dose of Guizhi (Cinnamon Twig); if heat is prominent, add Shigao (Gypsum).
[Note] At the onset of malaria, when chills and fever are neither excessive nor deficient but balanced, Guizhi Mahuang Ge Ban Tang (Cinnamon Twig and Ephedra Half-Dose Decoction) should be used to induce sweating. If there is little sweat, more chills, and less heat, double the dose of Mahuang Huang Tang (Ephedra Decoction) to induce sweating. If there is much sweat, less chills, and balanced heat, double the dose of Guizhi Tang (Cinnamon Twig Decoction); if heat is prominent, add Gypsum.
Mahuang Qianghuo Tang (Ephedra and Notopterygium Decoction), Guizhi Qianghuo Tang (Cinnamon Twig and Notopterygium Decoction), Mahuang Qianghuo Jia Banxia Tang (Ephedra, Notopterygium, and Pinellia Decoction), Baitu Tang (White Tiger Decoction), Baitu Guizhi Tang (White Tiger and Cinnamon Twig Decoction), Chaihu Baitu Tang (Bupleurum and White Tiger Decoction), Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction)
For cold-predominant malaria without sweat, seek Mahuang (Ephedra), Qianghuo (Notopterygium Root), Gancao (Licorice Root), and Fangfeng (Saposhnikovia Root). For heat-predominant malaria with sweat, reduce Mahuang (Ephedra) and add Guizhi (Cinnamon Twig); for vomiting, add Banxia (Pinellia Tuber) to harmonize. Malaria starting with heat followed by cold is called Wenre (Warm Malaria); use Baitu Tang (White Tiger Decoction), combining with Guizhi Tang (Cinnamon Twig Decoction) if sweat is excessive. Danre (Feverish Malaria) presents only with heat; use Chaihu Baitu Tang (Bupleurum and White Tiger Decoction). Pinre (Yin Malaria) presents only with cold; use Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction).
[Note] These are diaphoretic treatments for various types of malaria at onset. Contracting cold first, then wind, presenting with initial chills followed by heat, where chills predominate over heat and there is no sweat, is called Hanre (Cold Malaria). It is suitable for Mahuang Qianghuo Tang (Ephedra and Notopterygium Decoction), composed of Mahuang (Ephedra Herba), Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), and Gancao (Glycyrrhizae Radix et Rhizoma). Contracting cold first, then wind, presenting with initial chills followed by heat, where heat predominates over chills and there is sweat, is called Fengre (Wind Malaria). It is suitable for Guizhi Qianghuo Tang (Cinnamon Twig and Notopterygium Decoction), composed of Guizhi (Cinnamomi Ramulus), Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), and Gancao (Glycyrrhizae Radix et Rhizoma). If either condition involves vomiting, add Banxia (Pinelliae Rhizoma). Contracting wind first, then cold, presenting with initial heat followed by cold, is called Wenre (Warm Malaria). It is suitable for Baitu Tang (White Tiger Decoction); if sweat is excessive, combine with Guizhi Tang (Cinnamon Twig Decoction). When Yang Qi is abundant and Yang acts alone, presenting with heat only and no cold, it is called Danre (Feverish Malaria). It is suitable for Chaihu Baitu Tang (Bupleurum and White Tiger Decoction), which is Xiao Chaihu Tang (Minor Bupleurum Decoction) combined with Baitu Tang (White Tiger Decoction). When Yin Qi is abundant and Yin acts alone, presenting with cold only and no heat, it is called Pinre (Yin Malaria). It is suitable for Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction), which is Xiao Chaihu Tang (Minor Bupleurum Decoction) combined with Guizhi Tang (Cinnamon Twig Decoction).
Caoguo Chaiping Tang (Tsaoko and Bupleurum-Piwei Decoction), Daxiehu Tang (Major Bupleurum Decoction)
For malaria caused by food stagnation, presenting with epigastric fullness, belching, and aversion to food, use Xiaochaihu Tang (Minor Bupleurum Decoction) combined with Pingwei San (Level the Stomach Powder) plus Caoguo (Tsaoko Fructus) to clear. For malaria with interior excess and hard stools, use Daxiehu Tang (Major Bupleurum Decoction) plus Mangxiao (Mirabilite), Houpo (Magnolia Bark), Caoguo (Tsaoko Fructus), and Binglang (Areca Seed) to purge.
[Note] For malaria caused by dietary indiscretion, presenting with epigastric fullness, belching, and aversion to food, use Xiaochaihu Tang (Minor Bupleurum Decoction) combined with Pingwei San (Level the Stomach Powder) plus Caoguo (Tsaoko Fructus) for clearance. For any malaria with unresolved interior conditions and hard stools, use Daxiehu Tang (Major Bupleurum Decoction) plus Mangxiao (Mirabilite), Houpo (Magnoliae Officinalis Cortex), Caoguo (Tsaoko Fructus), and Binglang (Arecae Semen) for purgation.
Qingpi Yin (Clear the Spleen Drink)
For malaria that has already undergone sweating, vomiting, or purging, where clearing heat and harmonizing have not fully resolved chills and fever. Qingpi Yin consists of Baizhu (Atractylodis Macrocephalae Rhizoma), Qingpi (Citri Reticulatae Pericarpium Viride), Houpo (Magnoliae Officinalis Cortex), Caoguo (Tsaoko Fructus), Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), Banxia (Pinelliae Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), Fuling (Poria), and Shengjiang (Zingiberis Rhizoma Recens). Add Renshen (Ginseng Radix) for Qi deficiency; add Juhong (Citri Reticulatae Pericarpium Rubrum) and double Banxia (Pinelliae Rhizoma) for excessive phlegm; double Shengjiang (Zingiberis Rhizoma Recens) and add Binglang (Arecae Semen) for excessive fluid retention; add Zhimu (Anemarrhenae Rhizoma), Shigao (Gypsum Fibrosum), and Tianhuafen (Trichosanthis Radix) for thirst and heat; add Maiya (Hordei Fructus Germinatus) and Shenqu (Massa Medicata Fermentata) for food stagnation; add Zexie (Alismatis Rhizoma) and Cangzhu (Atractylodis Rhizoma) for dampness abundance.
[Note] For malaria that has already been treated with sweating, vomiting, or purging, where no exterior or interior excess patterns remain, the treatment method should focus on clearing heat and harmonizing. Use Qingpi Yin (Clear the Spleen Drink) to harmonize. This formula consists of Baizhu (Atractylodis Macrocephalae Rhizoma), Qingpi (Citri Reticulatae Pericarpium Viride), Houpo (Magnoliae Officinalis Cortex), Caoguo (Tsaoko Fructus), Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), Banxia (Pinelliae Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), Fuling (Poria), and Shengjiang (Zingiberis Rhizoma Recens). Add Renshen (Panax Ginseng Radix et Rhizoma) for Qi deficiency; add Juhong (Citri Reticulatae Pericarpium Rubrum) and double Banxia (Pinelliae Rhizoma) for excessive phlegm; double Shengjiang (Zingiberis Rhizoma Recens) and add Binglang (Arecae Semen) for excessive fluid retention; add Zhimu (Anemarrhenae Rhizoma), Shigao (Gypsum Fibrosum), and Tianhuafen (Trichosanthis Radix) for thirst and heat; add Maiya (Hordei Fructus Germinatus) and Shenqu (Massa Medicata Fermentata) for food stagnation; add Zexie (Alismatis Rhizoma) and Cangzhu (Atractylodis Rhizoma) for dampness abundance.