疟疾四时皆有，而多发于夏秋。以夏伤于暑，汗出腠开，当风浴水，受凄沧之水寒，及秋遇凉风束之，
裹邪不能外越，则随经络以内薄，舍于脏腑募原之间。居半表半里。与日行之卫气相值，而疟作焉，当其邪正
交争，并于阴，则中外皆寒。经所谓起于毫毛伸欠，寒栗鼓颔，腰脊俱痛也。并于阳，则外内皆热。经所谓
头痛如破，渴欲冷冻饮料也。极则阴阳俱衰，卫气相离，故病得休，卫气集，则复作。经云∶卫气日行于阳，
夜行于阴，疟邪得阳而外出，得阴而内搏，是以日作。邪气之舍深，内搏于阴，阳气独发，阴邪内着，阴与阳
争，不得出，故间日作。邪气内搏五脏，横连募原，其道远，其气深，其行迟，不能与卫气俱出，故间日乃作。
其间二日者，邪气与卫气客于六腑，有时相失，必休数日乃作也。浅者邪发三阳，随卫气以出，则日一作。
深者邪舍三阴，不能随卫气并出，或间日间二三日而作。病深者作愈迟。以疟邪有在经在腑在脏之别也。《己
任编》云∶脏腑相接处，有虚界之募原。而虚界中，复有刚柔筋脉。其为某脏腑之筋，即为某脏腑之病，究之
脏腑疟病，皆募原伏邪之气所迁移，间日间二三日，募原有远近耳。故邪传阳分，则作日早，邪陷阴分，
则作日晏。经曰∶邪客风府，循膂而下，与卫气一日夜会于风府，日下一节，故其作晏，其出风府，日下一节，二
十五日下至 骨。二十六日，入于脊内，注于伏膂，其气上行，九日出缺盆，其气日高，故作日乃益早。风
府在项后，入发际一寸，项骨三节，脊骨二十一节，其二十四节下为尾 骨。邪自风府日下一节故发晚，二十五日
至骨，二十六日邪复自后而前，入脊内注伏膂，循脊上行，无关节之阻，故九日出缺盆，其气日高，自阴就
阳，邪日退，故作渐早。治者须从阴分提出阳分，作日早则易瘳。无汗欲使有汗，散邪为主而兼补。汗多欲令
汗少，养正为主而兼散，尤必分经以论治。足太阳疟，腰痛头重，寒从背起，先寒后热，热止汗出，难已。
羌活黄芩汤加减。足少阳疟，身体解 ，见人心惕然，热
多，汗出甚，小柴胡汤加减。足阳明疟，头痛渴饮，洒淅寒甚，久乃热，热去汗出，竹叶石膏汤加减。足
太阴疟，不嗜食，寒多善呕，热甚则渴，桂枝汤加减，参入建中汤。足少阴疟，腰痛脊强，口渴呕吐，寒从
下起，热多寒少，病难已。桂枝人参白虎汤，后加鳖甲、牛膝。足厥阴疟，腰痛少腹满，小便不利，数便，先
用三黄石膏汤，后用鳖甲牛膝汤加减。此论六经疟也。若邪深伏，则为五脏疟。如肺疟令人心寒，寒甚热，
善惊。桂枝加芍药汤。心疟令人烦心。欲得清水，反寒多，不甚热。桂枝黄芩汤。肝疟令人色苍，面色青，太
息，状若死。四逆汤。脾疟令人寒，腹中痛，热则肠鸣，鸣已汗出。小建中汤，橘皮散。肾疟令人洒洒然，腰
脊痛，大便难、手足寒。归芍桂枝汤。其在腑则胃疟，令人善饥而不能食，食而支满腹大。二陈汤加枳壳、
草果。既辨六经脏腑，更审六淫所伤轻重。如风疟脉浮大，春夏为多。感风而得，恶风自汗头痛，风为阳邪，
故先热后寒。宜紫苏、川芎、白芷、姜皮等。寒疟脉紧盛，秋冬为多。乘凉浴水，感寒而成，恶寒无汗，
寒为阴邪，故先寒后热。宜桂枝、生姜、浓朴、草果等。暑疟脉虚受暑，热炽烦冤，邪伤上焦肺气，发必寒
轻热重，唇燥舌绛，渴喜冷冻饮料。盛暑发者，白虎汤，虚加人参、麦冬。秋凉伏暑发者，杏仁、贝母、花粉、黄
芩、半夏、知母、青蒿等。湿疟脉濡缓，面浮身痛，脘闷不饥，呕恶，邪阻中焦脾络，发必寒重肢冷，
舌白苔腻，喜热饮，大便不爽，忽秘忽溏，为湿结气痹。宜半夏、浓朴、白蔻、草果、薏苡、滑石、茯苓、
通草。或胃苓汤去桂、草。其湿热交蒸阻气，泄热渗湿，审其重轻，切忌柴葛劫津。宜杏、朴、芩、夏、橘红、
生姜、竹茹、麦冬、栝蒌、枳壳。瘅疟但热不寒，由阴气先伤，阳气独发，壮热少气烦冤，手足热，欲呕，
邪内藏于心，外舍肌肉，令人消烁肌肉。宜甘寒生津。生地、麦冬、知母、竹叶、丹皮、杏仁、贝母、花粉、
梨汁、蔗浆。盛暑发者，白虎汤。温疟脉如平人，但热不寒，骨节烦疼，时呕。《金匮》用桂枝白虎汤。
若温邪兼湿，宜半夏、杏仁、蔻仁、滑石，俱忌柴葛升举。牝疟多寒，《金匮》用蜀漆散。宜酌用二陈汤加姜、
桂枝。牝疟邪伏于肾经气分。寒疟邪伏于胆经营分。若但寒不热，柴胡姜桂汤。
痰疟素脾虚多痰，疟热又能蒸痰，胸闷欲呕。热痰君贝母，佐以竹茹、橘红、栝蒌霜、茯苓皮。寒痰君白术，
佐以半夏、陈皮、姜汁、苏子。食疟饮食生冷不节，致寒热较重，饥不思食，满闷腹疼。养胃汤减参术。瘴
疟岭南气炎，感受山岚涧溪之毒，乍寒乍热，迷闷发狂，须祛瘴涤痰。平胃散加减。疫疟因染时邪，寒热成疟，
其症沿门合境。达原饮、五瘟丹、不换金正气散。鬼疟夜发，为邪入血分，宜升散营中之邪。内补建中汤加升、
柴、生首乌。脾虚者，补中益气汤。劳疟病久延虚， 羸气怯，因劳辄发，寒热模糊，最难调治。补中益气
汤加牛膝、鳖甲、制首乌。疟母久病失调，邪入肝经，挟瘀血痰涎，胁下结块，宜疏通血络。用鳖甲、桃仁、
蓬术、牡蛎，加金铃子、归须、延胡、桂枝、甲片，或鳖甲煎丸。虚人疟母，宜补剂兼疏散药。疟疾变痢，
因暑湿迫注，失于解散，由经入腑，宜表里分消。用柴胡、半夏、黄芩、枳壳、陈皮、红曲、滑石、茯苓、
炙甘草。连进大剂，以痢愈为度，疟亦止，此治诸疟之大概也。此外又有似疟非疟，同一恶寒发热，或寒热
往来，最宜详辨脉症虚实，勿以阴阳内损之初症，误认疟邪，轻用表散。如小柴胡汤、祛疟饮之类。若脉症皆
虚，即宜黄 建中汤、补中益气汤，升、柴少用。血虚发热者，逍遥散。盖阳虚则恶寒，阴虚则发热。凡伤
寒后，及大病后、产后劳怯等症，俱有寒热往来，或一日一二发，俱宜作虚治。以疟之寒热有定时，杂症之寒
热无定时为辨。论中治法有未备者，参观后论。
Malaria occurs in all four seasons, but is more common in summer and autumn. This is because summer heat injury causes sweating and open pores (cou li). If one exposes oneself to wind or bathes in water while sweating, one contracts cold-dampness from the chilling water. In autumn, cool winds bind this pathogen, preventing it from dispersing outward. The pathogen then follows the meridians inward, lodging between the zang-fu organs and the mu-yuan (membranous origin). It resides in the half-exterior, half-interior region. When the malaria pathogen encounters the daily circulating Wei Qi (Defensive Qi), malaria attacks. During the struggle between pathogen and healthy qi, if the conflict shifts toward Yin, both interior and exterior become cold. As the classics state: "It begins with goosebumps and yawning, chills with teeth chattering, and pain in the waist and spine." If the conflict shifts toward Yang, both interior and exterior become hot. As the classics state: "Headache as if splitting, thirst for cold drinks." At the extreme, both Yin and Yang decline, and Wei Qi separates, so the disease rests. When Wei Qi gathers again, the disease recurs. The classics say: "Wei Qi travels through Yang during the day and Yin at night. The malaria pathogen moves outward when encountering Yang and inward when encountering Yin, hence daily attacks." If the pathogen lodges deeply, attacking Yin internally, only Yang Qi activates alone, while Yin pathogen adheres internally. The struggle between Yin and Yang prevents exit, resulting in every-other-day attacks. If the pathogen attacks the five Zang organs and spreads horizontally to the mu-yuan, the path is long, the qi is deep, and movement is slow; it cannot exit with Wei Qi, hence every-other-day attacks. If it skips two days, it is because the pathogen and Wei Qi reside in the six Fu organs, sometimes losing synchronization, requiring several days of rest before recurrence. Superficial pathogens attack the Three Yang meridians and follow Wei Qi outward, causing daily attacks. Deep pathogens lodge in the Three Yin meridians and cannot exit with Wei Qi, causing attacks every other day or every two to three days. Deeper illness results in longer intervals. This distinction exists because malaria pathogens vary by location: meridians, fu organs, or zang organs. *Ji Ren Bian* states: "At the junction of zang-fu organs lies the membranous origin (mu-yuan). Within this void boundary lie rigid and soft tendons and vessels. The tendon belonging to a specific zang-fu organ determines the specific zang-fu malaria. Ultimately, zang-fu malaria arises from the migration of latent pathogens in the mu-yuan. Variations in interval (every other day or two to three days) depend on the distance of the mu-yuan." Thus, pathogens transmitting to Yang result in earlier attacks; those sinking into Yin result in later attacks. The classics say: "Pathogens invading Fengfu (GV16) descend along the Du Meridian, meeting Wei Qi at Fengfu once per day-night cycle, descending one vertebral segment daily. Hence, attacks occur later. Upon exiting Fengfu, descending one segment daily, after twenty-five days it reaches the sacrum. On the twenty-sixth day, it enters the spine, injecting into the Fulu (hidden Du) meridian, ascending upward. On the ninth day of ascent, it emerges at Quepen (LI12). As the qi rises higher, attacks occur progressively earlier." Fengfu is located one cun below the hairline at the nape, behind the third cervical vertebra. There are three cervical vertebrae, twenty-one thoracic/lumbar vertebrae, and the twenty-fourth segment down is the coccyx. Pathogens descending one segment daily from Fengfu cause late onset. After twenty-five days reaching the sacrum, on the twenty-sixth day, pathogens move posteriorly to anteriorly, entering the spine and Fulu meridian, ascending along the spine without joint obstruction. Emerging at Quepen on the ninth day, the qi rises daily, moving from Yin to Yang, retreating the pathogen, thus attacks become progressively earlier. Treatment must extract pathogens from Yin to Yang; earlier attacks heal easier. For no sweat, induce sweating, prioritizing pathogen dispersion with tonification. For excessive sweat, reduce sweating, prioritizing healthy qi support with mild dispersion. Crucially, treatment must differentiate by meridian. Taiyang Malaria: lower back pain, heavy head, cold starting from back, chills precede fever, sweating ends fever, difficult to cure. Modify Qianghuo Huangqin Tang. Shaoyang Malaria: body laxity, sudden fright, high fever, profuse sweating. Modify Xiaochaihu Tang. Yangming Malaria: headache, thirst, aversion to cold, delayed fever, sweating upon fever resolution. Modify Zhuye Shigao Tang. Taiyin Malaria: anorexia, frequent vomiting due to cold, thirst with high fever. Modify Guizhi Tang, combined with Jianzhong Tang. Shaoyin Malaria: lower back pain, stiff spine, thirst, vomiting, cold rising from below, more heat than cold, difficult to cure. Use Guizhi Renshen Baihu Tang, later adding Biejia (Turtle Shell) and Niuxi (Achyranthes). Jueyin Malaria: lower back pain, lower abdominal fullness, dysuria, frequent urination. Initially use Sanhuang Shigao Tang, later modify Biejia Niuxi Tang. This discusses Six Meridian Malaria. If pathogens lodge deeply, they form Five Zang Malaria. Lung Malaria: heart feels cold, severe chills followed by fever, prone to fright. Use Guizhi Jiabaishao Tang. Heart Malaria: mental restlessness, desire for cold water, more cold than heat. Use Guizhi Huangqin Tang. Liver Malaria: pale/greenish complexion, sighing, appearance of death. Use Sini Tang. Spleen Malaria: aversion to cold, abdominal pain, borborygmus with fever, sweating after borborygmus stops. Use Xiao Jianzhong Tang, Jupi San. Kidney Malaria: shivering, lower back/spine pain, difficult defecation, cold extremities. Use Guizhi Danggui Shaoyao Tang. Fu Organ Malaria involves Stomach Malaria: hunger without appetite, abdominal distension after eating. Erchen Tang plus Zhike (Aurantium) and Caoguo (Black Cardamom). Having differentiated Six Meridians and Zang-Fu, assess the severity of Six Excesses (Liu Yin). Wind Malaria: floating-large pulse, common in spring/summer. Caused by wind invasion, aversion to wind, spontaneous sweating, headache. Wind is Yang pathogen, so heat precedes cold. Use Zisu, Chuanxiong, Baizhi, Jiangpi. Cold Malaria: tight-full pulse, common in autumn/winter. Caused by cooling/bathing, aversion to cold, no sweat. Cold is Yin pathogen, so cold precedes heat. Use Guizhi, Shengjiang, Houpo, Caoguo. Summerheat Malaria: deficient pulse, intense heat, vexation, injuring Upper Jiao Lung Qi. Mild chills, severe heat, dry lips, crimson tongue, thirst for cold drinks. In peak summer, use Baihu Tang; add Renshen and Maidong for deficiency. In autumn with latent summerheat, use Xingren, Beimu, Huafen, Huangqin, Banxia, Zhimu, Qinghao. Dampness Malaria: soggy-slow pulse, facial edema, body pain, epigastric fullness, anorexia, nausea/vomiting. Pathogen obstructs Middle Jiao Spleen collaterals. Severe chills, cold limbs, white greasy coating, preference for hot drinks, irregular bowel movements (constipation/diarrhea alternation), indicating dampness binding and Qi stagnation. Use Banxia, Houpo, Baixiang, Caoguo, Yiyi, Huashi, Fuling, Tongcao. Or Weiling Tang removing Guizhi and Caoguo. For damp-heat steaming and Qi obstruction, clear heat and leach dampness, assessing severity. Avoid Chaihu and Gegen which consume fluids. Use Xingren, Houpo, Huangqin, Banxia, Juhong, Shengjiang, Zhuru, Maidong, Gualou, Zhike. Dan Malaria (Febrile Malaria): heat only, no chills. Due to prior Yin injury and solitary Yang activation. High fever, shortness of breath, vexation, hot extremities, nausea. Pathogen hides in Heart, affects muscles, causing emaciation. Use sweet-cold fluids to generate Jin Ye. Shengdi, Maidong, Zhimu, Zhuye, Danpi, Xingren, Beimu, Huafen, Lizhi, Zhejiazhi. In peak summer, use Baihu Tang. Wen Malaria (Warm Malaria): normal pulse, heat only, no chills, bone joint pain, occasional vomiting. *Jinkui Yaolue* uses Guizhi Baihu Tang. If warm pathogen combines with dampness, use Banxia, Xingren, Kourén, Huashi. Avoid Chaihu/Gegen lifting. Pin Malaria (Yin Malaria): predominance of cold. *Jinkui Yaolue* uses Shuqi San. Modify Erchen Tang with Jiang and Guizhi. Pin Malaria pathogens lodge in Kidney Jing Qi level. Cold Malaria pathogens lodge in Gallbladder Ying level. If only cold without heat, use Chaihu Jianggui Tang. Tan Malaria (Phlegm Malaria): inherent Spleen deficiency with phlegm; malaria heat steams phlegm, causing chest fullness and nausea. For Heat Phlegm, principal Beimu, adjunct Zhuru, Juhong, Gualou Shuang, Fuling Pi. For Cold Phlegm, principal Baizhu, adjunct Banxia, Chenpi, Jiangzhi, Suzi. Shi Malaria (Food Malaria): irregular intake of raw/cold food causing severe chills/fever, hunger without appetite, abdominal distension/pain. Yangwei Tang reducing Renshen/Baizhu. Zhang Malaria (Miasma Malaria): Southern Lingnan climate, mountain mist toxins, alternating chills/fever, confusion/manic behavior. Must dispel miasma and resolve phlegm. Pingwei San modified. Yi Malaria (Epidemic Malaria): seasonal epidemic pathogens, household contagion. Dayuan Yin, Wuwen Dan, Buhuanjin Zhengqi San. Gui Malaria (Ghost Malaria): nocturnal onset, pathogen in Blood level. Disperse Ying pathogen. Neibu Jianzhong Tang plus Shengma, Chaihu, Sheng Shouwu. For Spleen deficiency, use Buzhong Yiqi Tang. Lao Malaria (Exhaustion Malaria): chronic illness leading to deficiency, emaciation, fatigue-induced attacks, vague chills/fever, difficult to treat. Buzhong Yiqi Tang plus Niuxi, Biejia, Zhi Shouwu. Nuomu (Malaria Mass): chronic imbalance, pathogen in Liver channel, mixed with blood stasis/phlegm, subcostal mass. Unblock blood collaterals. Biejia, Taoren, Pengzhu, Muli, plus Jinlingzi, Guixu, Yanhu, Guizhi, Jiapian, or Biejia Jian Wan. For deficient patients with Nuomu, use tonics with dispersing herbs. Malaria transforming into Dysentery: summer-dampness forcing downward, failure to release exterior, pathogen moves from meridian to fu. Resolve exterior and interior simultaneously. Chaihu, Banxia, Huangqin, Zhike, Chenpi, Hongqu, Huashi, Fuling, Zhi Gancao. Administer large doses until dysentery resolves, malaria also stops. This summarizes general malaria treatment. Additionally, there are malaria-like conditions sharing chills/fever or alternating chills/fever. Carefully differentiate pulse/symptoms for deficiency/excess. Do not mistake early Yin/Yang internal damage symptoms for malaria pathogen and lightly use exterior-releasing methods like Xiaochaihu Tang or Qunie Yin. If pulse/symptoms indicate deficiency, use Huangqi Jianzhong Tang or Buzhong Yiqi Tang, using minimal Shengma/Chaihu. For Blood Deficiency Fever, use Xiaoyao San. Yang deficiency causes aversion to cold; Yin deficiency causes fever. Post-typhoid, post-major illness, postpartum exhaustion often present with alternating chills/fever or 1-2 episodes daily; treat as deficiency. Differentiate by fixed timing in malaria vs. non-fixed timing in miscellaneous diseases. For incomplete treatments in this chapter, refer to subsequent discussions.