经曰。夏伤于暑。秋必病疟。盖伤之浅者。近而暴发。伤之重者。远而 疟。 者。久疟也。是知夏伤于
暑。湿热闭藏。而不能发泄于外。邪气内行。至秋而发为疟也。初不知何经受之。随其动而取之。有中三阳者。
有中三阴者。大抵经中邪气。其证各殊。同伤寒论之也。故内经曰。五脏皆有疟。其治各别。在太阳经者。谓
之风疟。治多汗之。在阳明经者。谓之热疟。治多下之。在少阳经者。谓风热疟。治多和之。此三阳经受病。
皆谓之暴疟。发在夏至后处暑前。此乃伤之浅者。近而暴也。在阴经则不分三经。总谓之湿疟。当从太阴经论
之。其病发在处暑后冬至前。此乃伤之重者。远而为 。 者。老也。故谓之久疟。气居西方。宜毒药疗之。
疟之为病。因内积暑热之气。不能宣泄于外。而为疟也。当盛夏之时。能食寒凉之物。而助阴气者。纵使有暑
热之气。微者自消矣。更时复以药疏利脏腑。使邪气自下。内经曰。春食凉。夏食寒。秋食温。冬食热。是谓
春夏养阳。秋冬养阴。人能于饮食起居之间。顺四时之气而行之。邪气何由得生也。
治疟病处暑前。头痛项强。脉浮恶风有汗。桂枝羌活汤。
桂枝 羌活 防风 甘草（炙各半两）
上为粗末。每服半两。水一盏半。煎至一盏。温服清。迎发而服之。如吐者。加半夏曲等分。
治疟病头痛项强。脉浮恶风无汗者。麻黄羌活汤。
麻黄（去节） 羌活 防风 甘草（炙各半两）
同前服。如吐者。加半夏曲等分。
治法。疟如前证而夜发者。麻黄桂枝汤主之。
麻黄（一两去节） 甘草（三钱炙） 桃仁（三十个去皮尖） 黄芩（五钱） 桂枝（三钱）
上五味。同为细末。根据前服。桃仁味苦甘辛。肝者血之海。血聚则肝气燥。经所谓肝苦急。急食甘以缓之。
故桃仁散血缓肝。谓邪气深远而入血。故夜发。乃阴经有邪。此汤发散血中风寒之剂。
治疟病身热目痛。热多寒少。脉长睡卧不安。先以大柴胡汤下之。微利为度。如下过外微邪未尽者。宜服
白芷汤。以尽其邪。
白芷（一两） 知母（一两七钱） 石膏（四两）
上为粗末。同前煎服。
治疟无他证。隔日发。先寒后热。寒少热多。宜桂枝石膏汤。
桂枝（五钱） 石膏 知母（各一两半） 黄芩（一两）
上为粗末。分作三服。每服水一盏。同前煎服。间日者。邪气所舍深也。
治疟寒热大作。不论先后。皆太阳阳明合病也。谓之交争。寒作则必战动。经曰。热胜而动也。发热则必
汗泄。经曰。汗出不愈。知为热也。阳盛阴虚之证。当内实外虚。不治必传入阴经也。当用桂枝芍药汤主之。
桂枝（三钱） 黄 知母 石膏 芍药（各一两）
上为粗末。每服五七钱。至半两。水煎如前药服之。寒热转大者。知太阳阳明少阳三阳合病也。宜用桂枝
黄芩汤和之。
桂枝黄芩汤
柴胡（一两二钱） 黄芩（四钱半） 人参 甘草（各四钱半） 半夏（四钱） 石膏 知母（各五钱）
桂枝（二钱）
上为粗末。根据前服之。服药已。如外邪已罢。内邪未已。再
服下药。从卯至午时发者。宜以大柴胡汤下之。从午至酉时发者。知其邪气在血也。宜以桃仁承气汤主之。
前项下药。微利为度。便以小柴胡汤彻其微邪之气。
立秋之后及处暑前发疟。渐瘦不能食者。谓之 疟。此邪气深远而中阴经。为久疟也。
治久疟不能饮食。胸中郁郁如吐。欲吐不能吐者。宜吐则已。当以藜芦散雄黄散吐之。
藜芦散
大藜芦末半钱。温齑水调下。以吐为度。
雄黄散
雄黄 瓜蒂 赤小豆（各一钱）
上为细末。每服半钱。温齑水调下。以吐为度。
治秋深久疟。胃中无物。又无痰癖。腹高而食少。俗谓疟气入腹。宜苍术汤主之。
苍术（四两） 草乌头（一钱） 杏仁（三十个）
上为粗末。都作一服。水三升。煎至一半。均作三服。一日服尽。迎发而服。
局方中七宣丸。治疟之圣药也。
局方中神效饮子。乃疟疾之圣药也。又名交结饮子。
The *Classic of Difficult Issues* (referring to *Huangdi Neijing*) states: "If one is injured by summer-heat in summer, malaria will inevitably occur in autumn." Those who are injured lightly suffer from sudden and rapid onset; those who are injured heavily suffer from a distant and prolonged course, resulting in chronic malaria. From this, we know that summer-heat injury causes damp-heat to be closed and stored internally, unable to vent outward. The pathogenic qi moves internally and manifests as malaria in autumn. Initially, it is unknown which meridian is affected; treatment should follow the movement of the disease. Some affect the Three Yang meridians, while others affect the Three Yin meridians. Generally, the pathogens in different meridians present distinct syndromes, similar to the discussions in the *Treatise on Cold Damage Diseases* (*Shanghan Lun*). Thus, the *Neijing* states: "All five zang organs can have malaria, but their treatments differ." When the Taiyang meridian is affected, it is called Wind Malaria, treated primarily with diaphoresis (sweating method). When the Yangming meridian is affected, it is called Heat Malaria, treated primarily with purgation (downward draining method). When the Shaoyang meridian is affected, it is called Wind-Heat Malaria, treated primarily with harmonization. These three Yang meridians' diseases are all called Acute Malaria, occurring between the Summer Solstice and the End of Heat. This represents light injury, near and sudden onset. When the Yin meridians are affected, regardless of the specific meridian, they are collectively called Damp Malaria, and should be discussed according to the Taiyin meridian. Their onset occurs between the End of Heat and the Winter Solstice. This represents heavy injury, distant and prolonged, becoming chronic malaria. "Old" refers to long duration, hence called Chronic Malaria. At this time, pathogenic qi resides in the West (associated with Autumn's收敛 and肃杀 properties), and toxic medicines are suitable for treatment.
Malaria arises because internal accumulation of summer-heat qi cannot be vented outward. During midsummer, if one consumes cold foods to nourish Yin, even if summer-heat exists, mild cases will resolve spontaneously. Additionally, using herbs to unblock and drain the fu-zang organs allows pathogenic qi to exit downward. The *Neijing* says: "In spring, eat cool foods; in summer, eat cold foods; in autumn, eat warm foods; in winter, eat hot foods." This is called "Nourishing Yang in Spring and Summer, Nourishing Yin in Autumn and Winter." If people align their diet and daily life with the four seasons, how can pathogenic qi arise?
For malaria before the End of Heat, presenting with headache, stiff neck, floating pulse, aversion to wind, and sweating, use Guizhi Qianghuo Tang (Cinnamon Twig and Notopterygium Decoction).
Guizhi (Cinnamon Twig), Qianghuo (Notopterygium Rhizome), Fangfeng (Saposhnikovia Root), Gancao (Licorice Root, honey-fried) [each 0.5 liang].
Grind into coarse powder. Take 0.5 liang per dose, add 1.5 cups of water, decoct to 1 cup. Take warm. Administer before the expected attack. If vomiting occurs, add Banxiaqu (Pinellia Fermented Paste) in equal proportion.
For malaria presenting with headache, stiff neck, floating pulse, aversion to wind, and no sweating, use Mahuang Qianghuo Tang (Ephedra and Notopterygium Decoction).
Mahuang (Ephedra Stem, nodes removed), Qianghuo, Fangfeng, Gancao (honey-fried) [each 0.5 liang].
Administer as above. If vomiting occurs, add Banxiaqu in equal proportion.
Treatment method: For malaria with the aforementioned symptoms but occurring at night, Ma Huang Gui Zhi Tang (Ephedra, Cinnamon Twig, and Peach Seed Decoction) is the primary formula.
Mahuang (1 liang, nodes removed), Gancao (3 qian, honey-fried), Taoren (Peach Seed, 30 pieces, skin and tips removed), Huangqin (Scutellaria Root, 5 qian), Guizhi (3 qian).
Grind the five ingredients into fine powder. Administer as described previously. Taoren has bitter, sweet, and acrid flavors. The Liver is the sea of blood; when blood stagnates, Liver qi becomes dry and irritable. As the classics state, "The Liver dislikes tension; consume sweet flavors to relax it." Therefore, Taoren disperses blood and relaxes the Liver. This indicates deep pathogenic invasion into the blood level, causing night onset, signifying pathogen in the Yin meridians. This formula disperses wind-cold from the blood level.
For malaria with body heat, eye pain, more heat than chills, long pulse, and restless sleep, first administer Da Chai Hu Tang (Major Bupleurum Decoction) to purge, aiming for mild diarrhea. If exterior pathogens remain after purging, use Baizhi Tang (Angelica Dahurica Decoction) to clear residual pathogens.
Baizhi (Angelica Dahurica Root, 1 liang), Zhimu (Anemarrhena Rhizome, 1 liang 7 qian), Shigao (Gypsum Fibrosum, 4 liang).
Grind into coarse powder. Decoct and take as above.
For malaria without other symptoms, occurring every other day, starting with chills followed by fever, with less chills and more heat, use Guizhi Shigao Tang (Cinnamon Twig and Gypsum Decoction).
Guizhi (5 qian), Shigao, Zhimu (each 1.5 liang), Huangqin (1 liang).
Grind into coarse powder. Divide into three doses. Each dose uses 1 cup of water. Decoct and take as above. Every-other-day occurrence indicates deep-seated pathogen.
For severe alternating chills and fever in malaria, regardless of order, this is a combined disease of Taiyang and Yangming meridians, called "Contending." Chills cause shivering; the classics say, "Heat excess leads to movement." Fever causes sweating; the classics say, "Sweating without cure indicates heat." This is an Excess-Yang and Deficient-Yin syndrome, implying interior excess and exterior deficiency. Without treatment, it will transmit to the Yin meridians. Use Guizhi Shaoyao Tang (Cinnamon Twig and Peony Decoction).
Guizhi (3 qian), Huangqi (Astragalus Root), Zhimu, Shigao, Shaoyao (White Peony Root) [each 1 liang].
Grind into coarse powder. Take 5 qian to 0.5 liang per dose. Decoct in water and take as above. If chills and fever worsen, it indicates combined disease of Taiyang, Yangming, and Shaoyang. Use Guizhi Huangqin Tang (Cinnamon Twig and Scutellaria Decoction) to harmonize.
Guizhi Huangqin Tang
Chaihu (Bupleurum Root, 1 liang 2 qian), Huangqin (4.5 qian), Renshen (Ginseng Root), Gancao (Licorice Root) [each 4.5 qian], Banxia (Pinellia Tuber, 4 qian), Shigao, Zhimu [each 5 qian], Guizhi (2 qian).
Grind into coarse powder. Administer as above. After taking the medicine, if exterior pathogens are resolved but interior pathogens remain, administer purgatives next. Attacks between Mao-Wu hours (5 AM - 1 PM) require Da Chai Hu Tang purgation. Attacks between Wu-You hours (1 PM - 7 PM) indicate pathogen in the blood level; use Tao Ren Cheng Qi Tang (Peach Kernel and Magnolia Bark Decoction).
For the aforementioned purgatives, aim for mild diarrhea, then immediately use Xiao Chai Hu Tang (Minor Bupleurum Decoction) to eliminate residual weak pathogens.
Malaria occurring after Start of Autumn and before End of Heat, with gradual emaciation and loss of appetite, is called Lao Malaria (Laboring Malaria/Chronic Malaria). This is deep pathogen affecting Yin meridians, constituting chronic malaria.
For chronic malaria with inability to eat, chest oppression resembling nausea but unable to vomit, induce vomiting to resolve. Use Lilü San (Veratrum Powder) or Xionghuang San (Realgar Powder) to induce vomiting.
Lilü San
Da Lilü (Large Veratrum Rhizome) powder, 0.5 qian. Mix with warm vinegar water. Take until vomiting occurs.
Xionghuang San
Xionghuang (Realgar), Gudi (Melon Peduncle), Chi Xiaodou (Red Adzuki Bean) [each 1 qian].
Grind into fine powder. Take 0.5 qian per dose with warm vinegar water. Take until vomiting occurs.
For late autumn chronic malaria, empty stomach without phlegm-stagnation, abdominal distension with poor appetite, commonly known as "Malaria Qi entering the abdomen," use Cangzhu Tang (Atractylodes Macrocephala Decoction).
Cangzhu (Atractylodes Macrocephala Rhizome, 4 liang), Caowutou (Aconitum Carmichaelii Lateral Root, processed, 1 qian), Xingren (Apricot Seed, 30 pieces).
Grind into coarse powder. Combine as one dose. Add 3 sheng of water, decoct to half. Divide into three equal servings. Finish within one day. Take before the expected attack.
Qixuan Wan (Seven Unblocking Pills) from the *Formulary of the Imperial Medical Bureau* (*Jufang*) is a sacred medicine for treating malaria.
Shenxiao Yinzi (Divine Efficacy Drink) from the *Jufang* is also a sacred medicine for malaria, also known as Jiaojie Yinzi (Interlocking Drink).