马云。疟。凌虐之义。故名篇。当与灵枢岁露篇七十九参看。简按刘熙释名云。疟。酷虐也。凡疾或寒
或热耳。而此疾先寒后热。两疾似酷虐也。
夫 疟 甲乙。千金。无 字。马云。 。音皆。后世从 。误也。 疟者。疟之总称也。王注以
为老疟。不必然。 疟皆生于风。则皆之一字。凡寒疟温疟瘅疟。不分每日间日三日。皆可称为 疟也。简按
广雅云。 。 疟也。说文云。 。二日一发疟也。盖疟多二日一发者。因为之总称耳。王以为老疟者。其说
盖出于张文仲。（外台。獭肝等八味方。传尸病。亦
名疟。遁注。骨蒸。伏连。 。 。是。）而其原因误读五十六难云。咳逆 疟。连岁不已尔。吴云。 。
亦疟也。夜病者谓之 。昼病者谓之疟。方言书。夜市谓之 市。本乎此也。（方言书。未知何等书。阅青箱
杂记。豫章漫录。五杂俎等。云。蜀有 市。而间日一集。如 疟之一发。则其俗又以冷热发歇。为市喻也。夜
市之说。无所考。）张云。 。皆也。疟。残虐之谓。疟证虽多。皆谓之虐。故曰 疟。李云。凡秋疟皆名 。
即其皆生于风。皆字。知诸疟之通称也。（医宗必读。不载秋疟之说。则云。凡疟皆名 。昔人之解非。）志
与吴同。而解生气通天论则云。阴疟也。高云。 。阴疟也。疟。阳疟也。以上数说。俱无稽之言。不可从。
孔颖达左传正义云。 是小疟。 是大疟。亦非本经之义。
畜作 赵府本。畜。作蓄。岁露篇。作 。马云。盖 。即积之义。故其旁皆从禾。不发之谓畜。发
时之谓作。
伸欠 张云。伸者。伸其四体。邪动于经也。欠。呵欠也。阴阳争引而然。简按曲礼。侍坐于君子。
君子欠伸。撰杖履。视日蚤莫。郑注。以君子有倦意也。前翼奉传。体病则欠伸动于貌。马云。伸。当作呻。
呻为肾之声。误也。此论疟之形状。专指寒疟。
寒栗鼓颔 汪云。愚谓此节。论疟之形状。张云。鼓者。振悚之谓。
愿闻其道 马云。道。犹路也。据下文有其道远。则此道当以路训之。
阴阳相移也 汪云。此节。论疟之所以发寒热也。又为一章之大旨。下发明此节也。
阳并于阴则阴实而阳虚 高云。相移者。相并之义。如阳气相移。而并于阴。则阴实而阳虚。须知
阴气相移。而并于阳。则阳实而阴虚。不言者省文也。
腰背头项痛 滑云。此下。当有少阳虚一节。卢氏 疟论疏云。不列少阳形证者。以太阳为开。阳
明为阖。少阳为枢。而开之能开。阖之能阖。枢转之也。
骨寒而痛 张云。阴胜则阳气不行。血脉凝滞。故骨寒而痛。终始篇曰。病痛者。阴也。
此营气之所舍也 张云。皮肤之内。肠胃之外。盖即经脉间耳。营行脉中。故曰。此营气之所舍也。
志云。舍。即经隧所历之界分。每有界分。必有其舍。如行人之有传舍也。
此令人汗空疏 吴云。此字。指暑气言。盖阳气主疏泄万物故也。卢氏云。暑令人汗空疏。腠理开
者。以暑性暄发。致腠理但开。不能旋阖耳。不即病者。时值夏出之。从内而外。卫气仗此。犹可捍御。高云。
暑热伤荣。则肌表不和。此令人汗孔疏。而腠理开也。空。孔同。
得之以浴水气舍于皮肤之内 诸注。浴下句。吴云。夏伤于暑。阳邪也。秋气。水气。阴邪也。阴
阳相薄。寒热相移。是以疟作。马云。夫暑热伏于营。而风寒居于卫。营专在内。无自而发。卫行于外。二邪
随之。以出入焉。志高。浴水气连读。非是。
与卫气并居 滑云。言卫气与营气相并合也。汪云。从夏伤于暑至此。原所以致疟之故也。张云。
新邪与卫气并居。则内合伏暑。故阴阳相薄。而疟作矣。高云。风水之气。舍于皮肤之内。则与卫气并居也。
简按滑注误。
此气得阳而外出得阴而内薄 滑云。此气指疟。马云。卫气者。昼行于足。手六阳经。二十五度。
此邪气者。得阳而外出。疟之所以发也。夜行于足。手六阴经。二十五度。此邪气者。得阴而内入。疟之所以
蓄也。内外相薄。随卫而行。是以一日一作也。病之始末。至是而备矣。高云。疟之
发也。必卫气应乃作。此卫气得日阳而外出。得夜阴而内薄。内外相薄。遇邪则发。是以日作。简按此气。滑
马为疟邪之气。高为卫气。未知孰是。得阳之阳。得阴之阴。马不解释。高则为日阳夜阴之义。果然则疟疾宜
无夜发者。此可疑焉。滑以得阳之阳。为荣中之阳。以得阴之阴为荣。其言糊涂。不可从。
循膂而下 张云。膂。吕同。脊骨曰吕。象形也。一曰。夹脊两旁之肉曰膂。下者。下行至尾 也。
简按说文。吕。脊骨也。广雅。膂肉也。前说本于说文。后说及王马注。原于广雅。据循膂而下语。其为脊骨
者。于义为当。
大会于风府 大上。巢源有常字。简按王注热论云。风府。入发际同身寸之一寸。此云二寸。考甲
乙千金等。作二寸者误。
二十五日 灵枢。甲乙。太素。全元起。巢源。作二十一日。二十六日。作二十二日。马云。此曰
二十五日者。连风府之项骨三椎而言。彼曰二十一者。除项骨言。自大椎而始也。故二十六日。与二十二日亦
不同。吴同。张云。项骨三节。脊骨二十一节。共二十四节。邪气自风府。日下一节。故于二十五日。下至尾
。复自后而前。故于二十六日入脊内。简按志。高。二十五日。作二十一日。二十六日。作二十二日。据灵
枢等也。自风府始。则不除项骨者。似为有理。而考诸书。作二十五日。二十六日者。王所改正。（外台。亦
作五六。宋人所改。）今从志高。（徐廷璋活人针经云按甲乙经云。大椎至尾 。共二十一 。此中只长三尺。
以三尺内折量。取背上俞穴。一法用绳墨取穴。绳有舒缩不同。取穴无准。今以薄竹片。点量取穴。治病有准。
今精考二十一 骨。不至尾 尽。只至腰余穴尽已。腰余穴。第二十一 下。是腰余穴。穴旁分开一寸五分。
是自环余穴。穴下更有上 次 中 下 会阳五穴。皆在二十一 下。直至会阳穴。其穴交 。在尾 骨两旁。
则知二十
一骨。至腰余而尽。今经。二十一 骨。至尾 骨而尽。甚非也。言长三尺。此法亦不可准用。今详二十一
下。有四骨空。在下相连。直至尾 尽。以二十一 。又增四骨。骨空共二十五。据内经疟论篇云。疟邪初
出于风府。在椎骨上。其邪大椎为始。日下一节。二十五日。尾 尽处。二十六日。入于脊内。据此经云。即
是二十一日。下二十一节而尽。自二十二日。即下四骨空间。至二十五日。诸 及骨空传尽。即入脊中。以此
论之。其理甚明。则知甲乙经云。二十一 。至尾 骨。甚非也。○按此说太异。盖未考及灵枢。漫尔立论。
而杨继针灸大成背部图。亦载此论。不知其出于何人也。）
骨 岁露篇。作尾底。简按知是 即底。会意。
伏膂之脉 岁露篇。病源。作伏冲。甲乙。作太冲。简按天真论。太冲之脉盛。甲乙。太素。作伏
冲。知是太冲。伏冲。伏膂。皆一脉耳。膂。即吕。脊骨。王谓膂筋之间。恐非。上文日下一节。王云。节。
谓脊骨之节。若以膂为筋。则义相乖。
九日出于缺盆之中 吴云。气上行无关节之窒。故九日出于缺盆。简按缺盆。非阳明胃经之缺盆。
骨度篇云。结喉以下。至缺盆中。长四寸。缺盆以下。至 KT 。长九寸。骨空论云。治其喉中央。在缺盆中
者。本输篇云。缺盆之中任脉也。名曰天突。俱非胃经之缺盆。乃指任脉天突穴而言耳。
其间日发者云云 以下四十四字。高移前。为帝曰其间日而作者何也之答语。置其气之舍云云之上。
云。此段。旧本在故作日益早之下。今改正于此。简按此一节。乃前节答语。其为错简明矣。今从高注改定。
横连募原 简按举痛论。及全本。太素。巢源。作膜原。举痛论王注云。膜。谓膈间之膜。原。谓
膈肓之原。义未太明。此云膈募之原系。乃觉胜于彼注。盖膜本取义于帷幕之幕。膜间薄皮。遮隔浊气者。犹
幕之在上。故谓之幕。因从
肉作膜。其作募者。幕之讹尔。太阴阳明论。脾与胃以膜相连尔。太素。膜。作募。知此募幕互误。熊。张。
并音暮。张云。诸经募原之气。内连五脏。邪在阴分。故道远行迟。志云。募原者。横连脏腑之膏膜。即金匮
所谓皮肤脏腑之文理。乃卫气游行之腠理也。二家之说。并不允当。姑从王义。当与举痛论小肠膜原注参看。
不能与卫气俱行 甲乙。卫气。作营气。非也。
不得皆出 甲乙。皆。作偕。似是。
故间日乃作也 乃上。病源。外台。有蓄积二字。
此邪气客于头项云云 以下八十八字。外台有。此疑古注文。
卫气之所发 灵枢。病源。发。作应。简按下文云。卫气应乃作。发。当作应。
邪气之所合 吴本。及灵枢。病源。合。作舍。是。
风之与疟也 吴云。风。外受风邪也。受风病作。则无休时。志云。夫 疟皆生于风。然病风者。
常在其处。病疟者。休作有时。故帝有此问。马云。风。乃本经风论之风。简按马注恐非也。甲乙。无也字。
相似 灵枢。病源。似。作与。
凄沧之水寒 滑云。水。一作小。马云。当作小寒。吴本。作小寒。张云。凄沧之水寒。谓浴水乘
凉之类也。因暑受寒。则腠理闭。汗不出。寒邪先伏于皮肤之中。得清秋之气。而风袭于外。则病发矣。志云。
风寒曰凄。水寒曰沧。简按凄沧不必分风水。灵师传篇云。寒无凄沧。暑无出汗。
秋伤于风则病成矣 生气通天论云。夏伤于暑。秋为 疟。金匮真言论云。秋善病风疟。阴阳应象
大论云。夏伤于暑。秋必 疟。（灵论疾诊尺篇同。）周礼疾医职。秋时有疟寒疾。左
传定四年。荀寅云。水潦方降。疾疟方起。
寒疟 张云。先受阴邪。后受阳邪。故先寒后热。人之患疟者。多属此证。简按上文云。疟之始发也。
先起于毫毛。伸欠乃作。寒栗鼓颔。腰脊俱痛。寒去则内外皆热。此乃疟之正证也。李云。温疟瘅疟。皆非真
疟也。知是寒疟。特真疟耳。
温疟 马云。据后第十三节。以冬中于风。而发于春者。为温疟。则温疟。非夏感于暑。而发于秋者
比也。故今秋时之疟。惟先寒而后热者最多。要知温疟原非秋时有也。
烦冤 千金。作烦闷。
瘅疟 志云。瘅。单也。谓单发于阳。而病热也。圣济总录云。单阳为瘅。万氏育婴家秘云。经中只
言瘅。俗称为疸。瘅者。单也。谓单阳而无阴也。简按瘅为单阳之义。在瘅疟则可。至脾瘅胆瘅消瘅。及瘅成
为消中等。则不通焉。王注为热。最为明确。盖瘅乃 之从 者。 说文。炊也。广韵。火起貌。国语周语。
火无炎 。瘅之为热。其在于此耶。（金匮。温疟。主白虎加桂枝汤。即本节瘅疟。当并考。）
经言 出灵逆顺第五十五篇。下同。
浑浑之脉 马云。脉以邪盛而乱也。张云。阴阳虚实未定也。简按浑浑。与脉要精微论浑浑同义。谓
脉盛也。七发注。浑浑。波相随貌。
先热而渴 吴。改先作后。简按今验先热而汗出。寻而发渴。乃作先者是。
病极则复至 王以至字连下句。吴张同。马志高并据甲乙全本太素。接上句。汪昂云。至字。有连上
句读者。言寒热复至。今从王氏。
必毁 简按灵逆顺篇云。方其盛也。勿敢毁伤。当从太
素文。
为其气逆也 马云。按后人用药。必当在疟气未发之前。方有为效。不但用针为然。若疟发而用药。
则寒药助寒。热药助热。反无益。而增其病势矣。此义当与灵枢逆顺篇参看。简按上文云病逆。此云气逆。其
义则一也。祝茹穹心医集云。疟疾每日如期而至。名曰疟信。此当原症发散。未可直攻。未可截也。或前或后。
此正气渐旺。邪将不容。名曰邪衰。方可截之。正本节之理也。
疟之且发也 志云。且者。未定之辞。言疟之将发。阴阳之将移。必从四末始。
坚束其处 吴云。谓 上也。取血之法。今北人行之。张云。其处。谓四关之上也。今北人多行此
法。砭出其血。谓之放寒。志云。坚束其四末。令邪在此经者。不得入于彼经。彼经之经气。不得出而并于此
经。简按志注为允当。千金。作故气未并。先其时一食顷。用细左索。坚束其手足十指。令邪气不得入。阴气
不得出。过时乃解。此亦一法。
真往 太素。作直往。似是。
其应如何 张云。欲察其应。
疟气者 甲乙。气字无。
邪气与卫气 吴。移与卫气三字于下句。作邪气客于六腑。而有时与卫气相失。文理始明。
客于六腑 张云。客。犹言会也。李云。客。犹会也。邪在六腑。则气远会希。故间二日。或休数
日也。志云。六腑者。谓六腑之膜原也。脏之膜原。而间日发者。乃胸中之膈膜。其道近。六腑之膜原。更下
而远。故有间二日。言至于数日也。简按考上文。并无客于六腑之说。疑是风府之讹。
此应四时者也 吴云。应。当也。张云。夏伤于暑。秋必病疟。此应四时者也。
Ma Yun: "Nue" (Malaria) means to torment or oppress, hence the name of this chapter. It should be read in conjunction with Chapter 79, "Sui Lu" (Annual Manifestations), in the *Ling Shu* (Spiritual Pivot). Jian An (commentator): Liu Xi, in his *Shi Ming* (Explaining Names), states: "Nue implies cruel oppression." Generally, diseases are either cold or heat. However, this disease presents with chills first and fever later, resembling a cruel oppression with two distinct phases.
The character "Nue" is absent in the *Jia Yi Jing* (Classical Text of Acupuncture and Moxibustion) and *Qian Jin Fang* (Thousand Gold Formulas). Ma Yun states that "Yue" (an older variant) sounds like "Jie" (all/both). Later generations used "Yue," which is an error. "Nue" is the general term for all malaria types. Wang Bing's commentary identifies it specifically as chronic malaria, which is not necessarily correct. Since all malaria originates from wind, the character "Jie" (all) indicates that whether it is Cold Malaria, Warm Malaria, or Hot Malaria, and regardless of whether it occurs daily, every other day, or every third day, it can all be termed "Nue." Jian An notes: The *Guang Ya* states, "Yue is Nue." The *Shuo Wen Jie Zi* states, "Yue is malaria occurring every two days." This suggests that because malaria often occurs every other day, it became the general term. Wang Bing's view of it being chronic malaria likely stems from Zhang Wenzhong (as cited in *Wai Tai Mi Yao*, where transmission diseases like liver abscess formulas mention 'transmission corpse' also named Nue, and Dun's commentary mentions bone-steaming, fu-lian, etc.). The cause of this error may be a misreading of *Nan Jing* (Classic of Difficult Issues) Chapter 56: "Cough and counterflow qi with Nue, persisting year after year." Wu Kun states: "Yue is also a type of Nue. Those occurring at night are called Yue, those during the day are called Nue." In dialectal texts, night markets are called "Yue Shi" (Night Market), originating from this usage. (The specific dialect text is unknown; checking *Qing Xiang Za Ji*, *Yu Zhang Man Lu*, *Wu Za Zu*, etc., it is said that in Shu, there is a "Yue Shi" gathering every other day, likened to the发作 of malaria, using the alternation of cold and heat as a metaphor for the market. The theory regarding night markets is unverified.) Zhang Jingyue says: "Jie means all. Nue means cruel oppression. Although there are many types of malaria manifestations, they are all called 'Nue', hence 'Nue'." Li Zhongzi says: "All autumn malaria is named Nue." This aligns with the idea that all originate from wind, confirming "Nue" as the general term for various malaria types. (*Yi Zong Bi Du* does not record the autumn malaria theory but states: "All malaria is named Nue." Previous interpretations are incorrect.) Gao Shixi agrees with Wu Kun but in annotating *Sheng Qi Tong Tian Lun* says: "Yin Nue." Gao Shixi further clarifies: "Yue is Yin Nue; Nue is Yang Nue." All the above explanations are baseless and should not be followed. Kong Yingda, in his *Zuo Zhuan Zheng Yi*, states: "Yue is minor malaria, Nue is major malaria." This is also not the original meaning of the *Nei Jing*.
In the Zhao Fu edition, "Chu" (accumulate) is written as "Xu" (store). In *Sui Lu*, it is written as "Yue". Ma Yun says: "Chu" essentially means accumulation, hence the radical relates to grain. When not erupting, it is called Chu; when erupting, it is called Zuo (act/start).
Regarding "Shen Qian" (stretching and yawning), Zhang Jingyue says: "Shen refers to stretching the limbs, caused by pathogenic factors disturbing the meridians. Qian refers to yawning, resulting from the contention and pulling of Yin and Yang." Jian An notes: *Qu Li* states: "When attending a gentleman, if the gentleman yawns and stretches, adjusts his cane and shoes, and checks the time..." Zheng Xuan's commentary explains this indicates the gentleman is tired. *Han Shu: Biography of Yi Feng* states: "When the body is ill, yawning and stretching appear on the face." Ma Yun suggests "Shen" should be read as "Shen" (groan), claiming groaning is the sound of the Kidney. This is incorrect. This section describes the physical manifestation of malaria, specifically referring to Cold Malaria.
"Chills and trembling of the jaw" (Han Li Gu Han): Wang Ang states: "I believe this section discusses the physical shape of malaria." Zhang Jingyue adds: "Gu (drum/tremble) refers to shivering and trembling."
"Wish to hear the Dao (path/mechanism)": Ma Yun says: "Dao here means path/way. Based on the later text mentioning 'the path is long,' this 'Dao' should be interpreted as path."
"The shifting of Yin and Yang": Wang Ang states: "This section discusses why malaria causes chills and fever. It is the main theme of the chapter, elaborated upon below."
"When Yang merges into Yin, Yin becomes excess and Yang becomes deficient": Gao Shixi explains: "Xiang Yi (mutual shift) means merging. If Yang shifts and merges into Yin, Yin becomes excess and Yang deficient. One must understand that if Yin shifts and merges into Yang, Yang becomes excess and Yin deficient. The text omits this for brevity."
"Pain in the waist, back, head, and neck": Hua Shou comments: "Below, there should be a section on Shaoyang deficiency." Lu's *Mao Lun Shu* explains: "It does not list Shaoyang symptoms because Taiyang acts as the opening, Yangming as the closing, and Shaoyang as the pivot. The opening and closing functions depend on the pivot's rotation."
"Cold bones and pain": Zhang Jingyue says: "When Yin prevails, Yang qi cannot circulate, causing blood vessels to stagnate, leading to cold and painful bones." The *Zhong Shi* chapter states: "Painful conditions belong to Yin."
"This is where Ying Qi resides": Zhang Jingyue says: "Inside the skin, outside the stomach and intestines—this is essentially between the meridians. Ying Qi flows within the vessels, hence it is said: 'This is where Ying Qi resides.'" Gao Shixi adds: "She (residence) refers to the boundaries traversed by the meridians. Wherever there is a boundary, there is a residence, just as travelers have relay stations."
"This causes sweat pores to be loose": Wu Kun says: "This 'Shu' (heat/stuffiness) refers to summer heat. Yang qi governs the dispersal and excretion of all things." Lu氏 says: "Summer heat causes sweating and open pores because its nature is warm and dispersing, causing pores to open but not close immediately. If illness does not occur immediately, during the transition from summer to autumn, the pathogen moves from inside out. Wei Qi can still defend against it based on this." Gao Shixi says: "Summer heat injures Ying, causing disharmony in the muscle surface, making sweat pores loose and interstices open." "Kong" is identical to "Kong" (pore).
"Acquired from bathing, water qi settles inside the skin": Various commentators place "Yu" (bathe) at the start of the next sentence. Wu Kun says: "Summer injury by summer heat is Yang pathogen. Autumn air and water qi are Yin pathogens. Yin and Yang contend, cold and heat shift, thus malaria arises." Ma Yun says: "Summer heat hides in Ying, while wind-cold resides in Wei. Ying stays inside and cannot emerge; Wei moves outside, and the two pathogens follow it in and out." Gao Shixi reads "Yu Shui Qi" together, which is incorrect.
"Dwelling together with Wei Qi": Hua Shou says: "This means Wei Qi and Ying Qi merge." Wang Ang says: "From 'Summer injury by summer heat' to here, it explains the cause of malaria." Zhang Jingyue says: "New pathogens dwelling with Wei Qi merge internally with latent summer heat, causing Yin-Yang contention and malaria onset." Gao Shixi says: "Wind-water qi settling inside the skin dwells together with Wei Qi." Jian An notes: Hua Shou's annotation is erroneous.
"This qi exits outward when encountering Yang and invades inward when encountering Yin": Hua Shou says: "This qi refers to malaria pathogen." Ma Yun says: "Wei Qi travels through the foot and hand Six Yang meridians during the day, twenty-five cycles. This pathogenic qi, encountering Yang, exits outward, causing malaria eruption. At night, it travels through the foot and hand Six Yin meridians, twenty-five cycles. This pathogenic qi, encountering Yin, enters inward, causing malaria accumulation. Internal and external contention, following Wei Qi, results in daily attacks. The beginning and end of the disease are complete here." Gao Shixi says: "Malaria eruption requires Wei Qi to respond before occurring. This Wei Qi, encountering day-Yang, exits outward; encountering night-Yin, invades inward. Internal-external contention, meeting pathogen, causes eruption, hence daily attacks." Jian An notes: Regarding "this qi," Hua and Ma consider it malaria pathogen qi, while Gao considers it Wei Qi; it is unclear who is correct. Ma did not explain "Yang of Yang" and "Yin of Yin." Gao interprets them as Day-Yang and Night-Yin. If true, malaria should never occur at night, which is doubtful. Hua interprets "Yang of Yang" as Yang within Ying and "Yin of Yin" as Ying itself; his explanation is confused and unacceptable.
"Following Lv downward": Zhang Jingyue says: "Lv is same as 'Lu'. Spine bone is called Lu, pictographic. Another view: flesh beside the spine is called Lv. Downward means descending to the coccyx." Jian An notes: *Shuo Wen*: "Lu is spine bone." *Guang Ya*: "Lv is flesh." The former view derives from *Shuo Wen*; the latter and Wang/Ma annotations derive from *Guang Ya*. Based on "following Lv downward," interpreting it as spine bone is more appropriate.
"Gathering at Fengfu": The characters "Da Shang" appear in *Chao Yuan*. Jian An notes: Wang Bing's annotation on *Re Lun* states: "Fengfu is one cun below the hairline." Here it says two cun. Checking *Jia Yi Jing*, *Qian Jin Fang*, etc., the two cun reading is erroneous.
"Twenty-five days": *Ling Shu*, *Jia Yi Jing*, *Tai Su*, Quan Yuanqi, and *Chao Yuan* state twenty-one days, twenty-six days, and twenty-two days respectively. Ma Yun says: "Here it says twenty-five days, including the three vertebrae of the neck at Fengfu. There it says twenty-one, excluding the neck vertebrae, starting from Dazhui. Thus twenty-six and twenty-two differ." Wu Kun agrees. Zhang Jingyue says: "Three neck vertebrae plus twenty-one spine vertebrae equal twenty-four segments. Pathogen descends one segment daily from Fengfu, reaching the coccyx on the twenty-fifth day, then moving forward from behind, entering the spine interior on the twenty-sixth day." Jian An notes: Gao Shixi changes twenty-five to twenty-one and twenty-six to twenty-two, citing *Ling Shu*. Starting from Fengfu, excluding neck vertebrae seems reasonable. However, books stating twenty-five and twenty-six were corrected by Wang Bing (*Wai Tai Mi Yao* also has five/six, altered by Song scholars). I now follow Gao Shixi. (Xu Tingzhang's *Huo Ren Zhen Jing* cites *Jia Yi Jing*: Dazhui to coccyx has twenty-one segments, length three chi. Measuring back acupoints by folding three chi is inaccurate due to rope elasticity. Using thin bamboo strips is more precise. Careful examination shows twenty-one segments do not reach the coccyx but end at the lumbar remaining points. The second point below the twenty-first segment is the lumbar remaining point, one-and-a-half cun lateral. Below this are Huan Yu points, and further down are Shangliao, Ciliao, Zhongliao, Xialiao, and Huiyang, all below the twenty-first segment, extending to Huiyang, crossing the sacrum, on both sides of the coccyx. Thus, twenty-one segments end at the lumbar region. The current text saying twenty-one segments reach the coccyx is very incorrect. The claim of three chi length is also unreliable. Detailed study shows four bone spaces below the twenty-first segment connect to the coccyx. Adding these four to twenty-one makes twenty-five bone spaces. According to *Nei Jing: Mao Lun Pian*: Malaria pathogen starts at Fengfu, above the vertebral bone, starting at Dazhui, descending one segment daily. Twenty-five days to coccyx end, twenty-sixth day entering spine interior. Based on this text, it is actually twenty-one segments ending descent, then four bone spaces from twenty-second to twenty-fifth day, then entering spine. This logic is clear. Thus *Jia Yi Jing* claiming twenty-one segments reach coccyx is incorrect. ○ This view is too divergent, likely failing to check *Ling Shu* and arguing rashly. Yang Jizhou's *Zhen Jiu Da Cheng* back diagram also carries this theory, source unknown.)
"Sacrum": *Sui Lu* writes "Wei Di" (tail bottom). Jian An notes: "Di" means bottom, ideographic.
"Fu Lv Mai (Hidden Lv Meridian)": *Sui Lu* and *Bing Yuan* write "Fu Chong"; *Jia Yi Jing* writes "Tai Chong". Jian An notes: *Tian Zhen Lun* "Tai Chong Mai Sheng" in *Jia Yi Jing* and *Tai Su* is written as "Fu Chong". Knowing Tai Chong, Fu Chong, and Fu Lv are all one meridian. "Lv" is "Lu", spine bone. Wang Bing interprets it as between Lv tendons, which is likely wrong. The earlier text "descending one segment daily," Wang Bing says "segment refers to spine bone joints." If Lv were tendons, the meaning would conflict.
"Ninth day emerging from Quepen": Wu Kun says: "Qi ascends without joint obstruction, thus emerging from Quepen on the ninth day." Jian An notes: Quepen here is not the Stomach Meridian's Quepen. *Gu Du* states: "From laryngeal prominence to middle of Quepen is four cun. From middle of Quepen to transverse bone of chest is nine cun." *Gu Kong Lun* states: "Treat center of throat, in middle of Quepen." *Ben Shu* states: "Middle of Quepen is Ren Mai, named Tiantu." None refer to Stomach Meridian's Quepen, but rather Ren Mai's Tiantu point.
"Regarding every-other-day发作..." The following forty-four characters were moved by Gao Shixi to answer Emperor's question "Why does it occur every other day?" placed above "Where its qi resides...". He states: "This paragraph was originally below 'thus becoming earlier each day,' now corrected here." Jian An notes: This paragraph is the answer to the previous section, clearly a misplaced slip. Now corrected according to Gao's note.
"Horizontally connecting Mu Yuan": Jian An notes: *Ju Tong Lun*, full text, *Tai Su*, and *Chao Yuan* write "Mo Yuan". Wang Bing's note on *Ju Tong Lun* says: "Mo refers to membrane between diaphragm; Yuan refers to origin of diaphragm fat." Meaning unclear. Here "Diaphragm Mu Yuan system" seems superior. "Mo" originally derived from "Mu" (curtain). Thin skin between membranes blocks turbid qi, like a curtain above, hence called Mu, later written with meat radical as Mo. Writing it as "Mu" is a corruption of "Mu". *Tai Yin Yang Ming Lun* says: "Spleen and stomach connected by Mo." *Tai Su* writes "Mo" as "Mu". Knowing Mu and Mu are interchangeable errors. Xiong and Zhang pronounce it "Mu". Zhang Jingyue says: "Qi of various meridians' Mu Yuan connects internally to Five Zang. Pathogen in Yin division, thus path is long and movement slow." Gao Shixi says: "Mu Yuan is fatty membrane horizontally connecting Zang and Fu, i.e., texture of skin and organs mentioned in *Jin Gui*, where Wei Qi circulates." Both explanations are inadequate. Tentatively follow Wang's meaning; compare with Small Intestine Mo Yuan note in *Ju Tong Lun*.
"Cannot travel together with Wei Qi": *Jia Yi Jing* changes "Wei Qi" to "Ying Qi", which is incorrect.
"Not all can exit": *Jia Yi Jing* changes "Jie" (all) to "Xie" (together), which seems plausible.
"Therefore it occurs every other day": Above "Nai" (then), *Bing Yuan* and *Wai Tai* have "Xu Ji" (accumulation).
"This pathogen guest at head and neck..." The following eighty-eight characters appear in *Wai Tai*. Suspected ancient commentary.
"Where Wei Qi originates": *Ling Shu* and *Bing Yuan* change "Fa" (originate) to "Ying" (respond). Jian An notes: Later text says "Wei Qi Ying Nai Zuo" (Wei Qi responds then erupts). "Fa" should be "Ying".
"Where pathogen combines": Wu version, *Ling Shu*, and *Bing Yuan* change "He" (combine) to "She" (reside), which is correct.
"Wind compared to Nue": Wu Kun says: "Wind refers to externally contracted wind pathogen. Contracting wind disease has no rest." Gao Shixi says: "All Nue originates from wind, yet wind disease usually stays in place. Nue disease has periods of rest and activity. Hence the Emperor's question." Ma Yun says: "Wind refers to Wind in this chapter's *Feng Lun*." Jian An notes: Ma's note is likely incorrect. *Jia Yi Jing* lacks the particle "Ye".
"Similar": *Ling Shu* and *Bing Yuan* change "Si" (similar) to "Yu" (and/with).
"Cold water chill": Hua Shou says: "Shui (water), alternatively Xiao (small)." Ma Yun says: "Should be Xiao Han (minor cold)." Wu version writes "Xiao Han". Zhang Jingyue says: "Qi Cang Zhi Shui Han refers to bathing in cool water. Due to summer heat contracting cold, pores close, no sweat. Cold pathogen hides in skin, receiving clear autumn air and external wind attack, causing disease." Gao Shixi says: "Wind-cold is Qi, Water-cold is Cang." Jian An notes: Qi Cang need not distinguish wind/water. *Ling Shu: Bian Ke Zhuan* states: "Do not fear cold Qi Cang, do not sweat in summer heat."
"Injury by wind in autumn leads to disease completion": *Sheng Qi Tong Tian Lun* states: "Summer injury by summer heat, autumn becomes Nue." *Jin Gui Zhen Yan Lun* states: "Autumn prone to wind-Nue." *Yin Yang Ying Xiang Da Lun* states: "Summer injury by summer heat, autumn must get Nue." (*Ling Shu: Lun Ji Zhen Chi Pian* same.) *Zhou Li: Ji Yi Zhi* states: "Autumn has Nue cold disease." *Zuo Zhuan: Ding Year 4* Xun Yin says: "Water floods just descended, disease Nue just rising."
"Cold Malaria": Zhang Jingyue says: "First contracting Yin pathogen, then Yang pathogen, hence chills first, fever later. Most people suffering from malaria belong to this syndrome." Jian An notes: Earlier text says: "Beginning of malaria starts at fine hairs, stretching/yawning erupts, chills/jaw tremble, waist/spine all pain. After cold passes, internal/external both hot." This is the standard malaria syndrome. Li says: "Warm Malaria and Dan Malaria are not true malaria." Knowing Cold Malaria is the true malaria.
"Warm Malaria": Ma Yun says: "According to Section 13 below, contracting wind in winter and erupting in spring is Warm Malaria. Thus Warm Malaria is not comparable to summer heat contraction erupting in autumn. Therefore, autumn malaria is mostly chills first, fever later. Know that Warm Malaria originally does not exist in autumn."
"Fanyuan (Vexation/Depression)": *Qian Jin Fang* writes "Fan Men" (Vexation/Stuffy).
"Dan Malaria": Gao Shixi says: "Dan means single. Refers to single eruption in Yang, causing heat disease." *Sheng Ji Zong Lu* states: "Single Yang is Dan." Wan's *Yu Ying Jia Mi* states: "Text only mentions Dan, commonly called Jaundice. Dan means single, referring to single Yang without Yin." Jian An notes: Dan as single Yang applies to Dan Malaria. But for Pi Dan, Dan Dan, Xiao Dan, and Dan becoming Xiao, it doesn't fit. Wang Bing's annotation as Heat is most clear. Dan is derived from Yan (smoke/fire). *Shuo Wen*: "Cooking." *Guang Yun*: "Fire rising appearance." *Guo Yu: Zhou Yu*: "Fire has no flame Dan." Dan as heat lies here. (*Jin Gui* Warm Malaria uses Bai Hu Jia Gui Zhi Tang, which is this section's Dan Malaria, should be cross-referenced.)
"Scripture says": From *Ling Shu: Ni Shun* Chapter 55, same below.
"Hun Hun Pulse": Ma Yun says: "Pulse is chaotic due to excess pathogen." Zhang Jingyue says: "Yin/Yang, Deficiency/Excess undetermined." Jian An notes: "Hun Hun" has same meaning as in *Mai Yao Jing Wei Lun*, indicating strong pulse. *Qi Fa* note: "Hun Hun, waves following each other."
"Fever first then thirst": Wu Kun changes "Xian" (first) to "Hou" (later). Jian An notes: Clinical observation shows fever first, then sweating, then thirst follows, so "first" is correct.
"Disease extreme then returns": Wang Bing connects "Zhi" (arrive) to next sentence, Wu/Zhang agree. Ma/Gao cite *Jia Yi Jing*, full text, *Tai Su*, connecting to previous sentence. Wang Ang says: "Readers connect 'Zhi' to previous sentence: meaning cold/heat return." Now follow Wang Shi.
"Must destroy": Jian An notes: *Ling Shu: Ni Shun* states: "While盛 (excess), do not harm." Should follow *Tai Su* text.
"Because its qi is reversed": Ma Yun says: "Later medication must be taken before malaria qi erupts to be effective. Not just acupuncture. If medicated during eruption, cold drugs aid cold, heat drugs aid heat, increasing disease severity. This principle should be cross-referenced with *Ling Shu: Ni Shun*." Jian An notes: Earlier text says "Disease Reversed," here "Qi Reversed," meaning is same. Zhu Ruqiong *Xin Yi Ji* states: "Malaria arriving daily on schedule is called 'Mao Xin'. Must treat original syndrome to disperse, cannot directly attack or intercept. If early or late, this is righteous qi growing, pathogen intolerant, called 'Pathogen Declining', then can intercept." This rectifies the principle of this section.
"Malaria about to erupt": Gao Shixi says: "Qie means uncertain/future. Means malaria about to erupt, Yin/Yang about to shift, must start from four extremities."
"Tightly bind the area": Wu Kun says: "Refers to above. Method to draw blood, practiced by Northerners today." Zhang Jingyue says: "Area refers to above Four Gates. Northerners practice this, pricking to bleed, called releasing cold." Gao Shixi says: "Tightly bind four extremities, preventing pathogen in this meridian from entering another, and qi from another meridian merging into this one." Jian An notes: Zhi's annotation is appropriate. *Qian Jin Fang* says: "Before Qi merges, one meal time prior, use thin left cord, tightly bind ten fingers of hands and feet, preventing pathogen entry, Yin qi exit. Release when time passes." This is another method.
"Zhen Wang": *Tai Su* writes "Zhi Wang", seems plausible.
"How should it respond?": Zhang Jingyue says: "To observe its response."
"Malaria Qi": *Jia Yi Jing* lacks "Qi".
"Pathogen and Wei Qi": Wu Kun moves "Yu Wei Qi" to next sentence: "Pathogen guests in Six Fu, sometimes losing sync with Wei Qi," making text coherent.
"Guesting in Six Fu": Zhang Jingyue says: "Ke (guest) means meet/gather." Li says: "Ke means meet. Pathogen in Six Fu, qi is distant, meetings rare, hence every other day or resting several days." Gao Shixi says: "Six Fu refers to Six Fu's Mu Yuan. Zang's Mu Yuan, erupting every other day, is diaphragm in chest, path is near. Six Fu's Mu Yuan is lower and far, hence every other day or several days." Jian An notes: Examining above text, no mention of "Guesting in Six Fu," suspect corruption of "Fengfu."
"This corresponds to the Four Seasons": Wu Kun says: "Ying means correspond/match." Zhang Jingyue says: "Summer injury by summer heat, autumn must get malaria, this corresponds to Four Seasons."