叶天士曰∶疟因暑发居多，方书虽有痰、食、寒、热、瘴疠之互异。幼稚之疟，都因脾胃受病，然气怯神
弱，初病惊痫厥逆为多，在夏秋之时，断不可认为惊痫。大凡疟症，须分十二经，与咳症相等。若幼科庸俗，
但以小柴胡去参，或香薷、葛根之属，不知柴胡动肝阴，葛根竭胃汁，致变屡矣。幼科纯阳，暑为热气，症必
热多烦渴。邪自肺受者，桂枝白虎汤，二进必愈。其有冷食不运，有足太阴脾病见症，初用正气，或用辛温，
如草果、生姜、半夏之属。方书谓草果治太阴独胜之寒，知母治阳明独胜之热。疟久色夺，唇白汗多馁弱，必
用四兽饮，即六君加草果、姜、枣、乌梅。阴虚内热，必用鳖甲、首乌、知母，便渐溏者忌用。久疟荣伤，寒
胜加桂、姜。拟初、中、末疟门用药于下∶
初病暑风湿热疟药∶胸膈痞闷，枳壳、桔梗、杏仁、浓朴、（四味最宜。）栝蒌皮、山栀子、香豆豉。头
痛，宜辛凉轻剂，连翘、薄荷、赤芍、羚羊角、蔓荆子、滑石，重则用石膏。口渴用花粉，烦渴用竹叶石膏汤。
热甚则用黄连、黄芩、山栀。
夏季牙痛属湿，羌、防辛温宜忌，宜用木防己、蚕砂。
暑热邪伤，初在气分，日多不解，渐入血分，反渴不多饮，唇舌绛赤，芩、连、膏、知不应，必用血药，
量佐清气热，一味足矣。轻则用青蒿、丹皮、（汗多忌。）犀角、竹叶心、元参、鲜生地、细生地、木通、淡竹叶。
若热久痞结，泻心汤选用。
又夏月热久伤血，最多蓄血一证，谵语昏狂，看法以小便清长者，大便必黑为是，桃仁承气汤为要药。
幼稚疟久，面肿腹膨，泄泻不欲食，或囊肿或跗肿，必用东垣益气以升阳。倘脾消败，前方不应，用理中
汤，或钱氏益黄散得效。二三日须投五苓散，一二日再与异功散，参苓白术之类必全好。徐忠可注《金匮》有
云∶幼儿未进谷食者，患疟久不止，用冰糖浓汤。余试果验。
疟多用乌梅，以酸泄木安土之意。用常山、草果，乃劫其太阴之寒，以常山极走，使二邪不相并之谓。用
人参、生姜，曰露姜饮，一以固元，一以散邪，取通神明去秽恶之意。总之，久疟气馁，凡壮胆气，皆可止疟，
未必真有疟鬼。又疟邪既久，深入血分，或结疟母，鳖甲煎丸设用煎方，活血通络可矣。
万密斋治一儿，岁半病疟，二日一发，久不愈，黄瘦，面浮肿，腹胀，用平疟养脾丸治之愈。人参、白术、
茯苓、甘草、当归、川芎、陈皮、半夏、苍术、浓朴、柴胡、黄芩、猪苓、泽泻、草果、常山、青皮、辣桂、
鳖甲各等分，于五日或三元八节、天月德日修合，酒煮，曲糊丸麻子大，陈皮汤下。
一儿病疟，医用截疟药，内有砒丹，三截之，遂成疳疟。其父懊恨前药之误。万用平疟养脾丸治疟，集圣
丸治疳，调理一月而愈。集圣丸∶芦荟、五灵脂、夜明砂、缩砂、橘皮、青皮、蓬术、木香、黄连、使君子、
虾蟆、猪胆。和药入膏为末。
一儿病疟，一日一发，万用家传斩鬼丹截之，止三日后一发。再截之，值三四日又发。其父怪而问之，时
六七月枣熟，疑其必啖生枣，故止而复发也。问之果然，乃禁之，先用胃苓丸，调理三日，（平胃苍、陈、朴、
草，合以五苓茯、猪、术、泽、桂，名胃苓丸。）更以斩鬼截之遂愈。五月五日午时，用黄丹研，独头大蒜，研
如泥同杵，众手为丸。随人大小，发日五更，取长流水面东下。
汪氏子七岁，病疟三年，诸医不效。万视其外候，面色白，山根带青，腹大而坚。此久疟成癖，癖为潮热，
当与补脾消癖，疟热自除。恨无九肋鳖甲耳，汪求得之，因立一方，用人参、白术、青皮、陈皮、三棱、莪术、
木香、砂仁、当归、川芎、黄连、柴胡、鳖甲为末，神曲糊丸。炒米煎水，日三服，调理五十余日而安。
李氏七岁女，先患外感，后变疟，因用截药，变作痢。至冬，痢虽止，疟益甚。万视其外候，大骨高起，
大肉陷下，发稀目陷，面黄鼻燥，不思饮食，唯啖莲肉，乃内伤脾虚疳劳症也。医皆谓不可治，万云∶可治也，
至春必愈。用集圣丸一料，次年二月果安。
王氏子病疟，三日一发，用胃苓丸合小柴胡汤方，作丸服之。初三日一发，又间日一发，后一日一发。初
发于午后，渐移于辰刻。问曰∶连日服药，疟发转频何也？曰∶此疟将退之渐也。盖疟三日一发者，邪气深，
难已；一日一发者，疟气浅，易愈。午后发者，邪在阴分，难已；午前发者，邪在阳分，易愈。今自三日移至
一日，自阴分移至阳分，故云将退之渐也。时有丁医闻其说，笑曰∶那得许多议论？吾有秘方，治疟如神。遂
求治之，不知其所用何物。自此仍三日一发，发以酉时，至次日巳后始退。万仍为调理一月而愈。
孙文垣治丁氏子，才二岁，患疟母，上壅咳嗽，每午后发热，至子丑时乃退，终日啼哭不止，鹅口白屑，
神气大弱。又痘后遍身疮疥未愈，诸医有灸之者，有刺之者，有以膏药贴之者，种种施之不应。孙曰∶乳下婴
孩，脏腑脆薄，不可乱攻乱补，参、 足以增其咳，灸刺适以惊其神，安能取效？教以白术、鳖甲各一钱五分，
青蒿、麦芽、陈皮各八分，乌梅一个，贝母、知母各六分，甘草三分，八帖全愈。
水鉴仙人治百日儿疟歌云∶疟是邪风寒热攻，直须术治免成空，常山刻作形人状，钉在孩儿生气宫。如金
生人，金生在巳，即钉巳上，木生人，钉亥上，火生人，钉寅上，水生人，钉申上也。常山乃截疟之药。
万密斋外孙未周岁，因伤寒，发间日疟，在子丑时，发则搐搦，切牙呻吟，大便黄绿，努而出。以口吮母
口，得乳即止。疟后汗出，心下跳，腹中鸣，顶微热，未十日成疳矣。面色 白，囟陷发疏，儿渐羸瘦。此先
受暑湿，暑则为疟，湿则为痰。又伤饮食，脾土衰而肝木旺，疟曰食疟，疳曰食疳。用加减当归龙荟丸，
加味参苓白术散。其母用四物汤，加柴胡、升麻、麦冬、木通、酒芩、桔梗各五分，薄荷七分，灯草水煎服。
一儿病疟，医以柴胡汤投之不效，乃用平疟养脾丸而愈。
一女先惊后疟，疟久成疳，用集圣丸调理一月而安。
一儿先疟后惊，用调元汤、琥珀抱龙丸而痊。
一儿久疟成癖，因癖生热，或三五日内一发，发则余日不止。常在申酉时，但不寒颤，又微恶寒，即发
热，热亦不甚，发过不渴，不头痛。用消癖丸、平疟养脾丸间服，半年而愈。
马元仪治金氏子，寒热如疟，两脉弦虚无力。脉弦为风发，脉虚为气少。正虚则外风得以袭入，乃为寒热，
不当与气实有余者同治。乃用补正散邪一法，用人参、桂枝、干姜、肉桂、半夏、广皮、炙草等，调理数月而安。
Ye Tianshi said: Malaria is mostly caused by summerheat pathogen. Although medical texts record differences such as phlegm, food stagnation, cold, heat, and miasma, malaria in infants and children is primarily due to disease of the spleen and stomach. However, since their vital qi is deficient and spirit is weak, initial symptoms often manifest as fright convulsion (Jing Xian), epilepsy, or reversal syndrome (Jue Ni). During summer and autumn, these must not be mistaken for fright convulsion or epilepsy. Generally, malaria cases must be differentiated according to the twelve meridians, similar to the analysis of cough syndromes. If pediatric practitioners are mediocre, using Xiao Chai Hu Tang (Minor Bupleurum Decoction) with Ginseng removed, or herbs like Xiang Ru (Moslae Herba) and Ge Gen (Puerariae Radix), they fail to realize that Chai Hu (Bupleuri Radix) disturbs Liver Yin, and Ge Gen exhausts Stomach fluids, leading to frequent changes in the condition. Children possess a "pure yang" constitution; summerheat is a hot pathogen, so symptoms inevitably present with more heat than irritability and thirst. If the pathogen enters from the Lung, Gui Zhi Bai Hu Tang (Cinnamon Twig and White Tiger Decoction) will cure it after two doses. If there is stagnation of cold food with manifestations of Foot-Taiyin Spleen disease, initially use Zheng Qi San (Regular Qi Powder) or acrid-warm herbs such as Cao Guo (Tsaoko Fructus), Sheng Jiang (Zingiberis Rhizoma Recens), and Ban Xia (Pinelliae Rhizoma). Medical texts state that Cao Guo treats exclusive cold of the Taiyin, and Zhi Mu (Anemarrhenae Rhizoma) treats exclusive heat of the Yangming. In chronic malaria with sallow complexion, white lips, profuse sweating, and weakness, Si Shou Yin (Four Beasts Infusion) must be used, which is Liu Jun Zi Tang (Six Gentlemen Decoction) plus Cao Guo, Sheng Jiang, Da Zao (Jujubae Fructus), and Wu Mei (Mume Fructus). For yin deficiency with internal heat, Bie Jia (Testudinis Carapax et Plastrum), Shou Wu Di (Polygoni Multiflori Preparata Radix), and Zhi Mu are required; however, they are contraindicated if stools become loose. In chronic malaria damaging Ying blood, if cold predominates, add Gui Zhi (Cinnamomi Ramulus) and Sheng Jiang. The following medications are proposed for the early, middle, and late stages of malaria:
For early-stage summerheat-dampness-wind-heat malaria: For chest and diaphragm fullness and oppression, use Zhi Ke (Aurantii Fructus), Jie Geng (Platycodonis Radix), Xing Ren (Armeniacae Semen Amarum), and Hou Po (Magnoliae Officinalis Cortex) (these four are most suitable), Gua Lou Pi (Trichosanthis Pericarpium), Shan Zhi Zi (Gardeniae Fructus), and Xiang Dou Chi (Sojae Semen Praeparatum). For headache, use light acrid-cool agents like Lian Qiao (Forsythiae Fructus), Bo He (Menthae Haplocalycis Herba), Chi Shao (Paeoniae Radix Rubra), Ling Yang Jiao (Capricornis Cornu), Man Jing Zi (Vittariae Spica), and Shi Gao (Gypsum Fibrosum) for severe cases. For thirst, use Hua Fen (Trichosanthis Radix); for irritability and thirst, use Zhu Ye Shi Gao Tang (Bamboo Leaf and White Tiger Decoction). For intense heat, use Huang Lian (Coptidis Rhizoma), Huang Qin (Scutellariae Radix), and Shan Zhi Zi.
For summer toothache due to dampness, acrid-warm herbs like Qiang Huo (Notopterygii Rhizoma et Radix) and Fang Feng (Saposhnikoviae Radix) should be avoided; instead, use Mu Fang Ji (Stephaniae Tetrandrae Radix) and Can Sha (Bombyx Batryticatus).
When summerheat-pathogen injures the body, initially affecting the Qi level, if unresolved over days, it gradually enters the Blood level. This presents as thirst but little desire to drink, crimson lips and tongue. When Huang Qin, Huang Lian, Shi Gao, and Zhi Mu are ineffective, blood-invigorating herbs must be used, slightly assisted by one herb clearing Qi-level heat. For mild cases, use Qing Hao (Artemisiae Annuae Herba), Dan Pi (Moutan Cortex), Xi Jiao (Rhinocerotis Cornu - *note: substitute with water buffalo horn in modern practice*), Zhu Ye Xin (Phyllostachys Viridis Folium), Xuan Shen (Scrophulariae Radix), Xian Sheng Di (Rehmanniae Radix Recens), Xi Sheng Di (Rehmanniae Radix Preparata), Mu Tong (Akebiae Caulis), and Dan Zhu Ye (Lophatheri Herba). If heat persists causing stagnation, select Xie Xin Tang (Drain the Epigastrium Decoction).
Furthermore, prolonged summerheat injuring blood often results in Blood Stasis syndrome, presenting with delirium, coma, and mania. Diagnosis involves observing clear and copious urine, indicating black stools; Tao Ren Cheng Qi Tang (Peach Kernel and Major Order the Qi Decoction) is the essential medicine.
In chronic childhood malaria with facial edema, abdominal distension, diarrhea, anorexia, testicular swelling, or dorsal foot edema, Li Dongyuan’s method of tonifying Qi and raising Yang must be used. If Spleen Qi fails and previous formulas are ineffective, use Li Zhong Tang (Regulate the Middle Decoction) or Qian Yi’s Yi Huang San (Benefit the Spleen Powder) for efficacy. After two to three days, administer Wu Ling San (Five-Ingredient Powder with Poria); after one to two days, give Yi Gong San (Extraordinary Efficacy Powder) or Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) to ensure complete recovery. Xu Zhongke, annotating the *Jin Gui Yao Lue*, stated: For infants who have not yet consumed grain and suffer from persistent chronic malaria, use strong sugar water decoction. My trials confirmed its efficacy.
Malaria treatment often uses Wu Mei (Mume Fructus) to employ sour flavor to drain Liver Wood and calm Spleen Earth. Using Chang Shan (Dichroae Radix) and Cao Guo is to劫 (rob/seize) Taiyin cold; Chang Shan moves rapidly, preventing the two pathogens from combining. Using Ren Shen (Ginseng Radix) and Sheng Jiang constitutes Lu Jiang Yin (Dew Ginger Drink), one to secure Yuan Qi and one to disperse pathogen, aiming to unblock the Spirit and remove filth. In summary, chronic malaria depletes Qi; any herb that strengthens Gallbladder Qi can stop malaria; it is not necessarily due to a "malaria ghost." Furthermore, if malaria pathogen lingers long and enters the Blood level, forming a Malaria Mass (Nu Mu), Bie Jia Jian Wan (Turtle Shell Decoction Pill) can be used as a decoction to invigorate blood and unblock collaterals.
Wan Mizhai treated a child of eighteen months with malaria occurring every two days, persisting despite treatment, presenting with yellow emaciation, facial edema, and abdominal distension. He cured it with Ping Mie Yang Pi Wan (Level Malaria and Nourish Spleen Pill). Ingredients: Ren Shen, Bai Zhu (Atractodis Macrocephalae Rhizoma), Fu Ling (Poria), Gan Cao (Glycyrrhizae Radix et Rhizoma), Dang Gui (Angelicae Sinensis Radix), Chuan Xiong (Chuanxiong Rhizoma), Chen Pi (Citri Reticulatae Pericarpium), Ban Xia (Pinelliae Rhizoma), Cang Zhu (Atractodis Rhizoma), Hou Po, Chai Hu (Bupleuri Radix), Huang Qin, Zhu Ling (Poria), Ze Xie (Alismatis Rhizoma), Cao Guo, Chang Shan, Qing Pi (Citri Reticulatae Pericarpium Viride), La Gui (Cinnamomi Cortex), and Bie Jia in equal parts. Prepared on the 5th day of the 5th lunar month or during specific auspicious days, boiled in wine, formed into pills the size of hemp seeds with Qu paste, taken with Chen Pi decoction.
Another child developed malaria; the physician used antimalarial drugs containing Arsenic (Pi Dan). After three courses, it transformed into Gan Malaria (Childhood Malnutrition Syndrome associated with Malaria). The father regretted the error. Wan Mizhai treated the malaria with Ping Mie Yang Pi Wan and the Gan syndrome with Ji Sheng Wan (Accumulation-Sage Pill), resulting in recovery after one month of regulation. Ji Sheng Wan ingredients: Lu Hui (Aloe), Wu Ling Zhi (Trogopterori Faeces), Ye Ming Sha (Typhlopidae Oculus), Suo Sha (Amomi Fructus Rotundus), Ju Pi (Citri Reticulatae Pericarpium), Qing Pi, Peng Zhu (Curcumae Rhizoma), Mu Xiang (Aucklandiae Radix), Huang Lian, Shi Jun Zi (Quisqualis Fructus), Ha Ma (Bufo Skin), and Zhu Dan (Porcine Bile). Mixed into paste and powdered.
Another child had malaria once daily. Wan used his family's Zhán Guǐ Dan (Ghost-Slaying Pill) to intercept it, stopping for three days before recurrence. Intercepting again, it recurred after three to four days. The father asked why. At that time, dates were ripe in July; he suspected the child ate raw dates, causing recurrence upon stopping medication. Inquiry confirmed this. They banned date consumption, first regulating with Wei Ling Wan (Stomach-Ling Pill) for three days (Ping Wei San combined with Wu Ling San), then using Zhán Guǐ Dan to intercept, resulting in cure. On the 5th day of the 5th lunar month at noon, use Huang Dan (Lead Monoxide) ground with single-clove garlic into a paste, rolled into pills by many hands. Size appropriate to the child; take at dawn on the day of fever with flowing water facing east.
Wang’s son, seven years old, suffered malaria for three years with no effect from other physicians. Wan observed pale complexion, bluish root of the nose, and firm abdominal distension. This was chronic malaria forming a mass (Pi), causing tidal fever. Treatment should tonify Spleen and dissipate masses; malaria heat would naturally resolve. Lacking nine-ribbed Bie Jia, Wang obtained some. Formula: Ren Shen, Bai Zhu, Qing Pi, Chen Pi, San Leng (Sparganii Rhizoma), E Zhu (Curcumae Rhizoma), Mu Xiang, Sha Ren (Amomi Fructus), Dang Gui, Chuan Xiong, Huang Lian, Chai Hu, Bie Jia powdered, pillified with Shen Qu paste. Taken with fried rice decoction, three times daily. Regulated for over fifty days until stable.
Li’s seven-year-old daughter initially had external contraction, transforming into malaria. Due to antimalarial interception, it transformed into dysentery. By winter, dysentery stopped, but malaria worsened. Wan observed prominent bones, sunken muscles, sparse hair, sunken eyes, sallow face, dry nose, anorexia, and preference for lotus seeds. This was internal injury Spleen deficiency Gan Lao (Consumption Syndrome). Physicians deemed it incurable, but Wan predicted recovery by spring. One course of Ji Sheng Wan resulted in health by February of the next year.
Wang’s son had malaria every three days. He took Wei Ling Wan combined with Xiao Chai Hu Tang pills. Initially every three days, then every other day, then daily. Initial onset shifted from afternoon to Chen hour (7-9 AM). Asked why frequency increased despite medication, Wan replied: This indicates the malaria is retreating. Three-day intervals indicate deep pathogen, hard to cure; daily intervals indicate shallow pathogen, easy to cure. Afternoon onset indicates pathogen in Yin level, hard to cure; morning onset indicates pathogen in Yang level, easy to cure. Shift from three days to one day, and from Yin to Yang, indicates retreat. Physician Ding laughed, claiming secret remedies. He sought treatment, unknown ingredients. Recurrence remained every three days at You hour (5-7 PM), resolving after Si hour (9-11 AM). Wan regulated him for a month until cured.
Sun Wen Yuan treated Ding’s son, two years old, with Malaria Mass (Nu Mu), upper congestion cough, afternoon fever resolving at Zi-Chou hours (11 PM-3 AM), constant crying, thrush, and weak spirit. Post-smallpox skin sores persisted. Other treatments (moxibustion, acupuncture, plasters) failed. Sun stated: Infants have fragile organs; do not attack or tonify blindly. Ren Shen and Mai Dong increase cough; moxa/acupuncture startles the spirit. Prescription: Bai Zhu, Bie Jia 1.5 qian each; Qing Hao, Mai Ya, Chen Pi 0.8 qian each; Wu Mei 1 piece; Bei Mu, Zhi Mu 0.6 qian each; Gan Cao 0.3 qian. Eight doses resulted in full recovery.
Water-Jade Immortal’s song for treating malaria in hundred-day infants states: Malaria is wind-cold-heat attacking; treat directly to avoid emptiness. Shape Chang Shan as a human figure and nail it into the child’s Life Palace. For Metal births, nail at Si position; Wood at Hai; Fire at Yin; Water at Shen. Chang Shan is an antimalarial drug.
Wan Mizhai’s grandson, under one year, contracted malaria after cold damage, occurring every other day at Zi-Chou hours, with convulsions, grinding teeth, groaning, and yellow-green stool passed with effort. Sucking mother’s breast stopped symptoms. Post-malaria sweating, palpitations, borborygmus, slight vertex heat led to Gan syndrome within ten days. Pale complexion, depressed fontanelle, sparse hair, emaciation. Caused by prior summerheat-dampness: summerheat became malaria, dampness became phlegm. Food injury weakened Spleen Earth and strengthened Liver Wood. Called Food Malaria and Food Gan. Treated with Modified Dang Gui Long Hui Wan and Modified Shen Ling Bai Zhu San. Mother took Si Wu Tang modified with Chai Hu, Sheng Ma, Mai Dong, Mu Tong, Jiu Qin, Jie Geng 0.5 qian each, Bo He 0.7 qian, cooked with Deng Cao water.
One child’s malaria did not respond to Chai Hu Tang; Ping Mie Yang Pi Wan cured it.
One girl had fright followed by malaria, becoming Gan syndrome after duration; Ji Sheng Wan regulated her for a month to safety.
One child had malaria followed by fright; Diao Yuan Tang and Hu Po Bao Long Wan cured him.
One child’s chronic malaria formed a mass, generating heat, recurring every 3-5 days, with residual heat between attacks. Occurring at Shen-You hours (3-7 PM), without chills but slight aversion to cold, followed by mild fever, no thirst or headache after onset. Xiao Pi Wan and Ping Mie Yang Pi Wan alternated for half a year until cured.
Ma Yuan Yi treated Jin’s son with chills and heat resembling malaria, wiry and deficient pulse. Wiry indicates wind; deficient indicates Qi shortage. Deficient Zheng allows external wind invasion, causing chills/heat. Do not treat like excess cases. Used Tonify Zheng Disperse Pathogen method: Ren Shen, Gui Zhi, Gan Jiang, Rou Gui, Ban Xia, Guang Pi, Zhi Gan Cao, etc. Regulated for months until stable.