反四时也 吴云。谓春时应暖。而反大凉。夏时应热。而反大寒。秋时应凉。而反大温。冬时应寒。
而反大热。疟病异形。职由此也。志云。非留蓄之邪。乃感四时之气。而为病也。
以秋病者寒甚 张云。秋以盛热之后。而新凉束之。阴阳相激。故病为寒甚。高云。秋伤于湿。人
气始收。故寒甚。
邪气不能自出 邪。甲乙。作寒。
气复反入 张云。阳极而衰。故复入于阴分。
故先热而后寒名曰温疟 张云。按此以冬中于寒。而发为温疟。即伤寒之属。故伤寒论。有温疟一
证。盖本诸张兆璜云。故先热而后寒者。名曰温疟。其但热而不寒者。名曰瘅疟矣。故字宜着眼。高云。上文
因寒疟。而及温疟。故寒疟详。而温疟略。此问温疟。而兼寒疟。故下文但论温疟。而不复言寒疟也。
不及于阴 高。据全本太素。及。作反。注云。上文温疟。气复反入。故先热后寒。瘅疟。其气不
反于阴。故但热而不寒。
命曰瘅疟 马云。此热气者。内藏于心肺。而外舍于分肉。令人消铄肌肉。病命曰瘅疟。由此观之。
则瘅疟之所舍者。肺与心耳。李云。肺素有热。气藏于心。即此二语。火来乘金。阴虚阳亢。明是不足之症。
挟外邪而然。故温疟瘅疟。皆非真疟也。
然 马云。张仲景以暑证为 。而此云 然者。其热似暑证之热也。
中 熊音。 。乞逆反。简按与隙同。
解 巢源。作解倦。高云。犹懈惰。枢转不力也。张云。解。懈也。 。迹也。身体解 。谓不耐
烦劳。形迹困倦也。王氏即以寒不甚热不甚为解。然细详之。若有不然。观其云身体解 。复云寒热。不甚分
明。各有所谓。意本不同。观刺要论曰。髓伤则销铄 酸。体解 然不去矣。是岂非举动解倦之谓乎。及考
字。不收于韵。若音为亦。殊无意味。当从迹韵。庶乎为妥。简按张辨驳王注。固是。然以亦为迹。则属臆解。
详义见于平人气象论。
寒不甚热不甚 张云。病在半表半里也。
刺足少阳 吴云。于少阳经穴刺之也。马高同。张志仍王注。
先寒洒淅 熊音。洒淅。上所丁反。下音析。寒惊貌。高云。经脉篇曰。足阳明是动。则病洒洒振
寒。故足阳明之疟。令人先寒洒淅。
喜见日月光 张云。经脉篇曰。阳明病至。则恶人与火。今反喜见之者。阳明受阴邪。胃之虚也。
足阳明跗上 甲乙。此下。有调冲阳三字。
令人不乐好太息 吴云。脾脉病则不运。不运则膻中之气不化。故不乐。气塞于膻中。必嘘出之而
后利。故好太息。
即取之 甲乙。此下有足太阴三字。根据上文例。当有此三字。
多寒热 多。巢源。作久。
欲闭户牖而处 张云。肾病则阴虚。阴虚故热多寒少。病在阴者喜静。故欲闭户牖而处。
其病难已 甲乙。此下。有取太溪三字。根据上文例。当有此三字。张云。肾为至阴之脏。而邪居之。
故病深难已。
数便 巢源。作数小便。
意恐惧 吴云。肝不足也。盖肝有余则怒。不足则恐。故承之曰气不足。
悒悒 说文。悒。不安也。○汪昂云。按伤寒言足经。而不及手经。本篇论疟。亦言足而不及手经。
本不传手乎。抑足经可以该手经也。篇后言腑疟。仅胃腑。而不及他腑。又岂以胃为六腑之长乎。（此事难知。
载李杲治足六经疟方。当并考。）
心寒 张云。肺者。心之盖也。以寒邪而乘所不胜。故肺疟者。令人心寒。高云。肺。天也。心。
日也。肺疟者。令人心寒。天日虚寒也。简按当从张注。
热间善惊 巢源。无热字。张云。心气受伤。故善惊如有所见。
欲得清水反寒多 马云。心热则烦且甚。故欲得水以救之。惟其热甚则反寒多。盖热极生寒也。吴
云。盖阳并于里而烦。心欲得清水。则阴出之表。无肌热而外寒。手少阴心之经也。简按据吴注。则不必从太
素而改字。
刺手少阴 千金翼。此下。有是谓神门四字。
苍苍然太息 甲乙。无太息二字。据下文如死者三字。必剩文。
鸣已汗出 志云。湿热下行则肠鸣。上蒸则汗出也。鸣已汗出者。下行极而上也。张云。寒已而热。
则脾气行。故肠中鸣。鸣已则阳气外达。汗出而解也。
洒洒然 甲乙。作凄凄然。
宛转大便难 吴云。宛。似也。转。传送也。言似乎传送。大便难出也。马云。宛转则难于转身也。
张云。腰脊之痛。苦于宛转。而大便难也。简按宛。屈也。转。运也。此状大便难也。马张并误。（庄子天下
篇。推拍 断。与物宛转。）
目 然 巢源。目下。有眩字。外台。作身掉不定。熊音。 。许县反。吴云。 。二音。县。
舜。目欲瞑也。仲景云。少阴之为病。但欲寐也。亦是目 然之意。张云。 。音眩。 然。眩动貌。目
视不明。水之亏也。简按当从张注。（详见于五脏生成篇。○此事难知。载李杲治五脏疟方。当并考。）
胃疟 张云。腑有六。而此独言胃者。以胃为六腑之长也。
横脉 张云。谓足内踝前斜过大脉。则太阴之经。盖即商丘也。吴云。谓二经孙络之横者。
疟发身方热 张云。此下言诸疟之刺法也。身方热者。谓于未发之前。热将作也。疟之先热者。温
疟也。高云。此复申明胃疟之义也。简按当从张注。
刺跗上动脉 马张俱云。当是足阳明冲阳之穴。
疟方欲寒 张云。寒之将发未发也。
满大急 张云。阳邪之实也。
背俞 吴云。背为诸阳之府。故刺背俞。高云。五脏之俞。皆在于背。故刺背俞。简按张为五 俞。似是。
中针 高云。不大不小之针也。
傍五 俞各一 马云。 。去中行开三寸。自附分魄户膏肓神堂。数至 。为第五。故曰五
俞。吴云。谓魄户神堂 膈关魂门也。张云。背为诸阳所出。故当刺之。即五 俞也。 者。胁也。（出于
广雅。）一曰。旁开也。（庄子 箧之 。）水热穴论曰。五脏俞傍五。以泻五脏之热。即此谓也。盖
此五者。乃五脏俞傍之穴。以其傍开近胁。故曰傍五 俞。即魄户神堂魂门意舍志室也。（简按每穴。在五脏
俞之旁。故以魄神魂意志命名焉。）志云。傍。倚也。高云。 。胁旁连背处也。五脏之俞。在背两行。两行
之外。复有两行。所谓 也。余并与张同。简按张注明确。殆胜于王。然 兼开义而释之。恐非。高注为是。
小实急 张云。阴邪胜也。阴盛者生内寒。故宜灸。
灸胫少阴刺指井 志云。艾。名冰台。能于水中取火。能启陷气之阳。故当灸少阴胫下之太溪。以
启经脉之生气。刺足小指之井穴。以泻经脉之实邪。高云。先灸后刺助正散邪之法也。简按志以少阴为太溪。
与王异。未知孰是。
疟脉满大急 简按志高以为申明前义。非也。今从新校正。删二十二字。
疟脉缓大虚 志云。血气两虚也。
用药 张云。针有泻而无补。故脉虚者。不宜用针。脉度篇曰。盛者泻之。虚者饮药以补之。即此之谓。
过之 高云。过其食顷之时。则为失时。失时而治。治无益也。简按志云。若太过之。则又失其时
矣。故高仍王注。暗斥其非。
诸疟而脉不见 甲乙。而。作如。吴张并云。邪盛气逆。而脉伏也。志云。此言邪在皮肤气分者。
宜刺十指之井穴也。疟在气分。故不见于脉。脉不见者谓不见满大急之脉也。高云。不见满大急小实急缓大虚
之脉也。简按吴张注为是。
赤如小豆 志云。邪在肤表。气分有伤。澹渗皮肤之血。故赤如小豆。高云。身之皮肤。赤点如小
豆者。尽取而刺之。夫所出为井。皮肤主表。病不在脉。故如是以刺之。
十二疟 张云。如前之六经六脏也。
其发各不同时 志云。言厥阴与肝疟。阳明与胃疟。太阴与脾疟。少阴与肾疟。各有脏腑经气之不同
也。简按千金翼。设黄岐问答。见十二疟鬼之说。固属荒诞焉。
二刺则知 张云。一刺之。病气虽衰。犹未觉也。故必再刺。始知其效。
侠脊者 志云。 俞。背俞也。吴云。谓背俞之挟脊者。马张仍王。
廉泉也 甲乙。泉下。有穴字。简按诸家为任脉之廉泉。非也。任脉廉泉只一穴。不宜言两脉。此
言足少阴廉泉也。气府论云。足少阴舌下各一。王注。足少阴舌下二穴。在人迎前陷中动脉前。是曰舌本左右
二也。根结篇云。少阴根于涌泉。结于廉泉。可以互证。
先必问 倪朱龙云。用三先字者。谓邪或舍于头项。而又兼中于腰背。或舍于腰背。而又兼中于手
足。卫气先至之处。其病先发。是一日之中。或又有两发之疟也。简按此说近凿。
先头背痛者 头。诸本作项。当改。
手少阴阳明十指间 张云。手少阴阳明。皆以井穴为言。又刺十指间者。各随其所病之经也。亦取
井穴。志云。谓十指间之少冲商阳也。高同。简按据新校正。作手阴阳。似是。然下文云足阳明十指间。则志
说为是。
足阳明十指间 志云。十指间之厉兑也。
风疟 志云。 疟皆生于风。故论刺风疟于后。
髓病 张云。其邪深伏。故名曰 髓病。吴本。 。作附。高同。注云。按之不可。痛在骨也。
髓藏于骨。故名曰附髓病。志云。 。足面也。倪仲宣云。足 乃阳明之部分。此风木之邪。贼伤胃土。故名
曰髓病。简按训 为跗。
太误。痛在于 。安得谓之跗。
针 灵九针十二原篇云。 针。第一针。头大末锐。以泻阳气。
绝骨 简案王以为阳辅。张以为悬钟。考甲乙。阳辅。在足外踝上四寸。辅骨前。绝骨端。如前二
分。悬钟。在足踝上三寸。而按经中。无悬钟穴。如阳辅。则见本输篇。当从王注。（本输篇云。阳辅。外踝
之上。辅骨之前。及绝骨之端也。）又考四十五难。髓会绝骨。今邪伏而附于髓。故针髓会之绝骨。以祛其邪也。
身体小痛 志云。此言风疟之病。身体痛者。高云。不若 酸痛甚也。痛不在骨。在太阳之通体。
刺至阴 三字衍。当根据甲乙删之。
诸阴之井 志云。盖井穴乃经气之交。故邪在阳之气分者。宜泻出其血。病在阴之经。而宜取阴之
井者。可间日一刺。则邪气自泄。不必至于出血。以泄真阴之气。
疟不渴 张云。不渴者。内无邪。邪在表耳。故当刺足太阳。
渴而间日作 张云。渴则邪在表里之间。故当刺足少阳。杂病篇曰。疟不渴。间日而作。取足阳明。
渴而日作。取手阳明。与此不同。
Contradicts the laws of the four seasons. Wu Kun commented: This means that in spring, it should be warm, but instead it is very cold; in summer, it should be hot, but instead it is very cold; in autumn, it should be cool, but instead it is very warm; in winter, it should be cold, but instead it is very hot. The manifestations of malaria (Malaria) vary, and the cause lies in this. Zhang Jingyue commented: This is not a pathogenic factor that remains and accumulates, but rather a disease caused by contracting the qi of the four seasons.
In cases where the disease occurs in autumn, the coldness is severe. Zhang Jingyue commented: Autumn follows intense heat, and the new coolness binds it, causing yin and yang to clash, thus the disease manifests as severe coldness. Gao Shishi commented: In autumn, dampness injures the body, and the human qi begins to收 (gather/converge), hence the severe coldness.
The pathogenic factor cannot exit on its own. "Pathogenic factor" (Jia Yi Jing makes it "cold").
The qi returns and enters inward. Zhang Jingyue commented: When yang qi reaches its extreme, it declines, so it re-enters the yin aspect.
Therefore, fever followed by chills is named Warm Malaria (Wen Nüe). Zhang Jingyue commented: According to this passage, contracting cold in winter leads to Warm Malaria, which belongs to the category of Cold Damage (Shang Han). Thus, *Treatise on Cold Damage* includes Warm Malaria as a syndrome. This originates from the view of Zhang Zhaohuang: Therefore, fever preceding chills is named Warm Malaria; fever without chills is named Dan Malaria (Dan Nüe). Hence, the character "gu" (therefore/originally) deserves attention. Gao Shishi commented: The previous text mentioned Warm Malaria due to Cold Malaria, so Cold Malaria was detailed while Warm Malaria was brief. Here, asking about Warm Malaria also involves Cold Malaria, so the following text only discusses Warm Malaria and does not repeat Cold Malaria.
Does not enter the yin aspect. Gao Shishi, based on the complete version of *Tai Su*, changed "ji" (and) to "fan" (reverse/opposite). The annotation states: In the previous text regarding Warm Malaria, the qi reverses and enters the yin aspect, resulting in fever preceding chills. In Dan Malaria, the qi does not reverse into the yin aspect, resulting in fever without chills.
Named Dan Malaria. Ma Shi commented: This heat qi resides internally in the Heart and Lungs, and externally lodges in the fenrou (muscle intervals), causing muscle emaciation. The disease is named Dan Malaria. From this, we see that the location of Dan Malaria is the Lung and Heart. Li Zhongzi commented: The Lung has inherent heat, and the qi resides in the Heart. These two phrases indicate Fire overacting on Metal (Huo Lai Cheng Jin), Yin deficiency with Yang hyperactivity, clearly indicating a deficiency syndrome complicated by external pathogens. Therefore, both Warm Malaria and Dan Malaria are not true malaria.
Ran (然): Ma Shi commented: Zhang Zhongjing referred to Summerheat syndromes as He (暍). Here it says "Ran," implying the heat resembles that of Summerheat syndromes.
Chen (䐜) Zhong: Xiong Zongli phonetically annotated: "Chen," pronounced as Qi Ni fanqie. Jian An: Identical to Xi (隙).
Xie Jue (解㑊): Chao Yuanfang wrote "Xie Juan." Gao Shishi commented: Similar to lassitude and lethargy, with weak pivot movement. Zhang Jingyue commented: Xie is synonymous with Xie (dissipated/sluggish). Jue is synonymous with Ji (trace/mark). Body Xie Jue refers to intolerance to labor and physical fatigue. Wang Bing interpreted "not too cold, not too hot" as Xie Jue, but upon careful examination, this seems incorrect. The text says "body Xie Jue" and then "chills and fever are not distinct, each having its meaning," implying different intents. Referring to *Ci Yao Lun*: If the marrow is injured, it dissolves and becomes sour, and the body feels Xie Jue and does not depart. Does this not refer to sluggishness and fatigue during movement? Furthermore, the character "Jue" is not recorded in rhyme books. If pronounced as "Yi," it lacks meaning. It should follow the rhyme of "Ji," which is more appropriate. Jian An: Zhang Jingyue's refutation of Wang Bing's annotation is correct, but interpreting "Yi" as "Ji" is speculative. Detailed meanings can be found in *Ping Ren Qi Xiang Lun*.
Chills not severe, fever not severe: Zhang Jingyue commented: The disease is at the half-exterior half-interior level.
Puncture the Foot Shaoyang Meridian: Wu Kun commented: Puncture the acupoints on the Shaoyang meridian. Ma Shi and Gao Shishi agree. Zhang Zhicong follows Wang Bing's annotation.
First experiencing chills and shivering (Sa Xi): Xiong Zongli phonetically annotated: "Sa," pronounced as Shang Suo Ding fanqie; "Xi," pronounced as Xia Yin Xi. Describes a state of cold fear. Gao Shishi commented: *Jing Mai Pian* states: When the Foot Yangming Meridian moves, it causes Sa Sa Zhen Han (shivering chills). Therefore, Foot Yangming Malaria causes people to first experience chills and shivering.
Prefers sunlight and moonlight: Zhang Jingyue commented: *Jing Mai Pian* states: When Yangming disease arrives, one fears people and fire. Now preferring them indicates Yangming meridian affected by yin pathogen and stomach deficiency.
Foot Yangming Dorsum Artery: Jia Yi Jing has three characters "Tiao Chong Yang" below this.
Causes unhappiness and frequent sighing: Wu Kun commented: Spleen meridian pathology leads to poor transportation; poor transportation leads to stagnation of Qi in the Danzhong, causing unhappiness. Qi blocked in Danzhong must be exhaled to flow smoothly, hence frequent sighing.
Immediately take the point: Jia Yi Jing has three characters "Foot Taiyin" below this. Based on the context above, these three characters should be present.
Frequent chills and fever: Chao Yuanfang writes "Jiu" (long-lasting) for "Duo" (many/frequent).
Desires to close doors and windows to reside: Zhang Jingyue commented: Kidney disease leads to Yin deficiency; Yin deficiency results in more heat and less cold. Diseases in the Yin aspect prefer quietness, hence desiring to close doors and windows.
This disease is difficult to cure: Jia Yi Jing has three characters "Qu Tai Xi" below this. Based on the context above, these three characters should be present. Zhang Jingyue commented: The Kidney is the organ of Supreme Yin, and pathogenic factors occupy it, so the disease is deep and difficult to cure.
Frequent urination: Chao Yuanfang writes "Shu Xiao Bian" (frequent small urination).
Feeling of fear: Wu Kun commented: Liver Qi deficiency. Generally, Liver excess leads to anger, deficiency leads to fear. Hence it follows saying "Qi deficiency."
Yi Yi (悒悒): *Shuo Wen Jie Zi*: Yi means unrest. ○ Wang Ang commented: Regarding *Shang Han Lun*, it discusses Foot meridians but not Hand meridians. This chapter on Malaria also discusses Foot meridians but not Hand meridians. Is it that Hand meridians are not transmitted? Or do Foot meridians encompass Hand meridians? Later in the chapter, regarding Fu Malaria, only the Stomach Fu is mentioned, not other Fus. Is it because the Stomach is the chief of the Six Fus? (This matter is difficult to know; Li Gao's formulas for treating Six Foot Meridian Malaria are recorded and should be cross-referenced.)
Heart Cold: Zhang Jingyue commented: The Lung is the canopy of the Heart. With cold pathogen invading what it cannot overcome (Note: Lung is Metal, Heart is Fire; Fire controls Metal. Here it implies cold injuring Lung, affecting Heart, or cold directly attacking Pericardium/etc., original text logic is complex, usually understood as Lung pathology affecting Heart Fire, or cold pathogen overcoming the heart's inability to resist), thus Lung Malaria causes Heart Cold. Gao Shishi commented: Lung is Heaven, Heart is Sun. Lung Malaria causes Heart Cold, representing the hollowness and coldness of Heaven and Sun. Jian An: Should follow Zhang Jingyue's annotation.
Easily startled during fever intervals: Chao Yuanfang omits the character "Re" (fever). Zhang Jingyue commented: Heart Qi is injured, leading to easy startle, as if seeing something.
Desires cold water but has excessive cold: Ma Shi commented: Heart heat causes vexation and severity, so one desires water to relieve it. Precisely because the heat is extreme, cold appears excessively. This is likely "extreme heat generates cold." Wu Kun commented: Likely Yang Qi merges into the interior causing vexation; Heart desires cold water, then Yin Qi emerges to the exterior, lacking muscle heat and presenting external cold. This is the pathology of the Hand Shaoyin Heart Meridian. Jian An: Based on Wu Kun's annotation, there is no need to follow *Tai Su* to change the character.
Puncture the Hand Shaoyin Meridian: *Qianjin Yi Fang* has four characters "Shi Wei Shen Men" below this.
Cyan complexion and sighing: Jia Yi Jing lacks the two characters "Tai Xi". Based on the later text "like a dead person," these are likely redundant.
Intestinal borborygmus followed by sweating: Zhang Jingyue commented: Damp-heat descending causes intestinal borborygmus; ascending steaming causes sweating. Borborygmus followed by sweating means descending to the extreme then ascending. Zhang Jingyue commented: After cold recedes and heat arises, Spleen Qi moves, causing intestinal rumbling. After rumbling, Yang Qi reaches the exterior, sweating occurs, and the disease resolves.
Sa Sa Ran (Qi Qi Ran): Jia Yi Jing writes "Qi Qi Ran."
Turning over with difficulty and hard stool: Wu Kun commented: Wan means similar/apparently. Zhuan means transport/transmit. It seems like transmission, but stool is difficult to pass. Ma Shi commented: Turning over makes turning the body difficult. Zhang Jingyue commented: Waist and spine pain suffers from turning over, accompanied by hard stool. Jian An: Wan means bent/crooked. Zhuan means move/transport. This describes the difficulty of defecation. Ma Shi and Zhang Jingyue are mistaken. (*Zhuangzi · Tianxia Pian*: Push and beat, breaking off, turning with things.)
Mu Xuan Ran (目䀮然): Chao Yuanfang adds the character "Xuan" (dizzy) after "Mu". *Waitai Miyao* writes "Shen Diao Bu Ding" (body trembling/unstable). Xiong Zongli phonetically annotated: "Nian", pronounced Xu Xian fanqie. Wu Kun phonetically annotated: Two pronunciations, Xian, Shun. Eyes want to close. Zhang Zhongjing said: The manifestation of Shaoyin disease is merely wanting to sleep. This is also the meaning of Mu Xuan Ran. Zhang Jingyue commented: Nian, pronounced Xuan. Xuan Ran, means dizzy/moving appearance. Vision is unclear, indicating Water deficiency. Jian An: Should follow Zhang Jingyue's annotation. (See *Wu Zang Sheng Cheng Pian* for details. ○ This matter is difficult to know; Li Gao's formulas for treating Five Zang Malaria are recorded and should be cross-referenced.)
Stomach Malaria: Zhang Jingyue commented: There are six Fus, yet only the Stomach is mentioned here, because the Stomach is the chief of the Six Fus.
Transverse Vessel: Zhang Jingyue commented: Refers to the large vessel slanting across the front of the medial malleolus of the Foot, which is the Taiyin Meridian. Probably the Shangqiu point. Wu Kun commented: Refers to the transverse collateral vessels of the two meridians.
Malaria onset with body just heating up: Zhang Jingyue commented: The following text discusses acupuncture methods for various Malarias. "Body just heating up" means before onset, when heat is about to arise. Malaria with preceding fever is Warm Malaria. Gao Shishi commented: This reiterates the meaning of Stomach Malaria. Jian An: Should follow Zhang Jingyue's annotation.
Puncture the dorsum artery: Both Ma Shi and Zhang Jingyue believe it should be the Chongyang point of the Foot Yangming Meridian.
Malaria about to feel cold: Zhang Jingyue commented: Cold is about to manifest but has not yet.
Full, Large, and Urgent Pulse: Zhang Jingyue commented: This is an Excess syndrome of Yang pathogen.
Back Shu Points: Wu Kun commented: The back is the mansion of all Yang meridians, so puncture the Back Shu points. Gao Shishi commented: The Shu points of the Five Zang organs are all on the back, so puncture the Back Shu points. Jian An: Zhang Jingyue considers them the Five Shu points, which seems plausible.
Zhong Zhen (中针 - Middle Needle): Gao Shishi commented: A needle of medium size.
Bang Wu Shu Ge Yi (傍五俞各一 - One point beside each of the Five Adjacent Shu points): Ma Shi commented: Three cun away from the midline, starting from Fufen, Pohu, Gaohuang, Shentang, counting to the fifth, hence called Five Shu points. Wu Kun commented: Refers to Pohu, Shentang, Gegan, Hunmen. Zhang Jingyue commented: The back is where all Yang emerges, so it should be punctured. These are the Five Shu points. Xie (胁) means flank. (From *Guang Ya*). Another interpretation: Side-opening. (*Zhuangzi · Qu Qie*). *Shui Re Xue Lun* states: Five points beside the Five Zang Shu points to drain heat from the Five Zang organs. This refers to that. Essentially, these five points are beside the Five Zang Shu points. Because they open sideways near the flank, they are called Bang Wu Shu points. Namely Pohu, Shentang, Hunmen, Yishe, Zhishi. (Jian An: Each point is beside the Five Zang Shu points, hence named with Po, Hun, Shen, Yi, Zhi.) Zhang Jingyue commented: Bang means lean/support. Gao Shishi commented: The area connecting the flank and back. The Shu points of the Five Zang organs are in two rows on the back. Outside these two rows, there are another two rows, called Xie. The rest aligns with Zhang Jingyue. Jian An: Zhang Jingyue's annotation is clear, likely superior to Wang Bing. However, interpreting "Xie" to include the meaning of "opening" may be incorrect. Gao Shishi's annotation is correct.
Small, Solid, and Urgent: Zhang Jingyue commented: Yin pathogen prevails. Yin excess generates internal cold, so moxibustion is suitable.
Moxa the lower leg Shaoyin, puncture the finger Jing Well: Zhang Jingyue commented: Mugwort, named Bing Tai, can extract fire from water and stimulate the Yang of sunken Qi. Therefore, moxa Tai Xi on the lower leg of Shaoyin to stimulate the vital Qi of the meridian. Puncture the Jing Well point of the little toe to drain the excess pathogen of the meridian. Gao Shishi commented: Moxa first, then puncture, is a method to support healthy Qi and scatter pathogenic factors. Jian An: Zhang Jingyue identifies Shaoyin as Tai Xi, differing from Wang Bing. It is unknown who is correct.
Malaria pulse Full, Large, and Urgent: Jian An: Zhang Jingyue and Gao Shishi consider this a restatement of previous meaning, which is incorrect. Following the New Correction, delete twenty-two characters.
Malaria pulse Slow, Large, and Deficient: Zhang Jingyue commented: Blood and Qi are both deficient.
Use Medication: Zhang Jingyue commented: Acupuncture has draining effects but no tonifying effects. Therefore, those with deficient pulses should not use acupuncture. *Mai Du Pian* states: Excess is drained, deficiency is tonified with herbal medicine. This is what it means.
Exceeding [the time]: Gao Shishi commented: Exceeding the time of a meal is losing the proper timing. Treating out of timing yields no benefit. Jian An: Zhang Jingyue said: If too much [time passes], one loses the timing again. Thus Gao Shishi retains Wang Bing's annotation, implicitly criticizing it.
Various Malarias where the pulse is not visible: Jia Yi Jing, "Er" (and) is written as "Ru" (like). Wu Kun and Zhang Jingyue both say: Pathogen excess and Qi reversal cause the pulse to sink. Zhang Jingyue commented: This refers to pathogen in the skin and Qi level, suitable for puncturing the Jing Well points of the ten fingers. Malaria in the Qi level is not visible in the pulse. "Pulse not visible" means the Full, Large, and Urgent pulse is not seen. Gao Shishi commented: The Full, Large, Urgent, Small, Solid, Urgent, Slow, Large, Deficient pulses are not seen. Jian An: Wu Kun and Zhang Jingyue's annotations are correct.
Red like small beans: Zhang Jingyue commented: Pathogen in the skin surface, injury to the Qi level, seeping blood into the skin, hence red like small beans. Gao Shishi commented: Red spots on the body's skin like small beans should all be taken and punctured. The Jing points are where Qi exits; skin governs the exterior; the disease is not in the pulse, hence puncture in this manner.
Twelve Malarias: Zhang Jingyue commented: Like the previous Six Meridians and Six Zang organs.
Their onset times differ: Zhang Jingyue commented: Refers to Jueyin and Liver Malaria, Yangming and Stomach Malaria, Taiyin and Spleen Malaria, Shaoyin and Kidney Malaria, each having different Zang-Fu and Meridian Qi characteristics. Jian An: *Qianjin Yi Fang* sets up a dialogue between Huangdi and Qibo, revealing the theory of Twelve Malaria Ghosts, which is indeed absurd.
Two punctures to know [the effect]: Zhang Jingyue commented: After one puncture, although pathogenic Qi declines, one does not yet feel it. Therefore, one must puncture twice to know the effect.
Those flanking the spine: Zhang Jingyue commented: Xie Shu refers to Back Shu points. Wu Kun commented: Refers to the Back Shu points flanking the spine. Ma Shi and Zhang Jingyue follow Wang Bing.
Lianquan Point: Jia Yi Jing has the character "Xue" (point) after "Quan". Jian An: Various schools consider it the Lianquan point of the Ren Mai, which is incorrect. The Ren Mai Lianquan has only one point and should not speak of two pulses. This refers to the Foot Shaoyin Lianquan. *Qi Fu Lun* states: Foot Shaoyin, one on each side under the tongue. Wang Bing's annotation: Foot Shaoyin, two points under the tongue, located anterior to the pulsating depression in front of Yingchang, known as the left and right roots of the tongue. *Gen Jie Pian* states: Shaoyin roots at Yongquan and knots at Lianquan, which corroborates each other.
Must first ask: Ni Zhulong commented: Using three "Xian" (first) words means that the pathogen might lodge in the head and neck and simultaneously affect the waist and back, or lodge in the waist and back and simultaneously affect the hands and feet. Where the Wei Qi arrives first, the disease starts first. Within a day, there might even be two episodes of malaria. Jian An: This explanation is somewhat far-fetched.
First headache and back pain: "Head", in all editions originally written as "Neck" (Xiang), should be corrected.
Hand Shaoyin and Yangming between the ten fingers: Zhang Jingyue commented: Hand Shaoyin and Yangming both refer to Jing Well points. Also, puncturing between the ten fingers follows the diseased meridian, taking Jing Well points. Zhang Jingyue commented: Refers to Shaochong and Shangyang between the ten fingers. Gao Shishi agrees. Jian An: According to the New Correction, writing "Hand Yin-Yang" seems plausible. But since the next sentence says "Foot Yangming between the ten fingers," Zhang Jingyue's interpretation is correct.
Foot Yangming between the ten fingers: Zhang Jingyue commented: Lidui point between the ten fingers.
Wind Malaria: Zhang Jingyue commented: Wind Malaria all arises from wind, hence discussing the puncture of Wind Malaria later.
Fu Sui Bing (附髓病 - Attaching Marrow Disease): Zhang Jingyue commented: The pathogen is deeply lodged, hence named Attaching Marrow Disease. Wu Ben, "Fu" is written as "Fu". Gao Shishi agrees. Annotation: Pressing reveals nothing, pain is in the bone. Marrow resides in the bone, hence named Attaching Marrow Disease. Zhang Jingyue commented: Fu means the dorsum of the foot. Ni Zhongxuan commented: The dorsum of the foot is the domain of the Yangming Meridian. This Wood-Wind pathogen attacks and damages Stomach Earth, hence named Attaching Marrow Disease. Jian An: Interpreting "Fu" as "Fu" (dorsum of foot) is a great error. If the pain is in the dorsum of the foot, how can it be called dorsum of the foot?
Chan Zhen (镵针 - Needling Needle): *Ling Shu · Jiu Zhen Er Shi Yi Yuan Pian* states: Chan Zhen, the first needle, has a large head and sharp tip, used to drain Yang Qi.
Jue Gu (绝骨 - Absent Bone): Jian An: Wang Bing considered it Yangfu, Zhang Jingyue considered it Xuanzhong. Examining *Jia Yi Jing*, Yangfu is 4 cun above the lateral malleolus, anterior to the fibula, at the end of Juegu, 2 cun forward. Xuanzhong is 3 cun above the ankle joint. However, in standard meridian texts, there is no Xuanzhong point. As for Yangfu, it appears in *Ben Shu Pian*, so one should follow Wang Bing's annotation. (*Ben Shu Pian* states: Yangfu is above the lateral malleolus, anterior to the fibula, and at the end of Juegu.) Also examining *Nan Jing · Chapter 45*, Marrow meets at Juegu. Now the pathogen is lodged and attaches to the marrow, so puncturing Juegu, the meeting point of Marrow, dispels the pathogen.
Slight body pain: Zhang Jingyue commented: This refers to the pathology of Wind Malaria, where the body hurts. Gao Shishi commented: Not as severe as soreness and pain. The pain is not in the bone, but throughout the Taiyang body.
Puncture Zhiyin: These three characters are redundant and should be deleted according to Jia Yi Jing.
Jing Wells of all Yin meridians: Zhang Jingyue commented: Jing Well points are intersections of meridian Qi. Therefore, for pathogen in the Qi level of Yang, draining blood is suitable. For disease in the Yin meridian, taking the Jing Well points of Yin allows puncturing every other day, allowing pathogenic Qi to leak out naturally, without necessarily bleeding to avoid draining True Yin Qi.
Malaria without thirst: Zhang Jingyue commented: No thirst indicates no internal pathogen; the pathogen is in the exterior. Therefore, puncture the Foot Taiyang.
Thirst and occurring every other day: Zhang Jingyue commented: Thirst indicates the pathogen is between exterior and interior, so puncture the Foot Shaoyang. *Za Bing Pian* states: Malaria without thirst, occurring every other day, take Foot Yangming. Thirst and occurring daily, take Hand Yangming. This differs from the current text.