【脉】 疟脉自弦，弦数多热，弦迟多寒。弦小紧者，可下之；弦迟者，可温之
；弦数者，可汗，灸之；浮大者，可吐之；弦数者，风发也，以饮食消息止之。
【因】 夏暑舍于营卫之间，腠理不密，遇秋之风，玄府受之。惨怆之水，寒气
气闭而不出
，舍于肠胃之外，与营卫并行。昼行于阳，夜行于阴，并则病作，离则病止。并于阳则热，
并于阴则寒。浅则日作，深则间日。在气则早，在血则晏。因汗郁成痰，因虚弱阴阳相乘。
外因从六淫，有寒、湿、瘅、湿、牝。寒则先寒后热；温则先热后寒；瘅则但热不寒；
湿则
身骨节疼；牝则寒多不热。内因，有脏气不和，郁结痰饮所致。有肝、心、脾、肺、肾之说
。说见后。不内外因，疫疟，一岁之内，大小相似；鬼疟梦寐不详；瘅疟乍有乍已；食疟因
饮食得之；劳疟因劳得之；母疟有母传染者也。
李论 夏伤于暑，秋为 疟。暑者，季夏湿土。湿令不行则土亏矣，所胜妄行，
木气太
过，少阳主也。所生者受病，则肺金不足，不胜者侮之。水胜土之分，土者坤，坤在申，申
为相火。水入土，则水火相干，则阴阳交作，肺金不足，洒淅恶寒。土虚少阳乘之，则为寒
热。发于秋者，湿热则卯酉之分也。
【证治】 先寒而热，谓之寒疟；先热而寒，谓之温疟；治之宜乎中也。中者，
少阳也
。渴者，燥胜也。不渴者，湿胜也。又有得之于冬，而发于暑，邪舍于肾，足少阴也。有藏
之于心，内热蓄于肺，手太阴也。但热而不寒，谓之瘅疟，足阳明也。在太阳经谓之风疟，
宜汗之；在阳明经谓之热疟，宜下之；少阳经谓之风热，宜和之。此伤之浅也。在阴经则不
分三经，谓之温疟，宜从太阴经论之。此伤之重也。
太阳经，头痛腰痛，寒从背起，先寒后热，宜小柴胡、羌活地黄汤。
少阳经，心体解 ，寒热不甚，恶见人，多汗出甚，小柴胡汤。
阳明经，先寒久乃热，热大汗，喜见火乃快，宜桂枝二白虎一汤。
少阴经，呕吐烦闷，热多寒少，欲闭户而处，病难已，小柴胡加半夏汤。
太阴经，好太息，不嗜食，多寒热汗出，病至喜呕乃衰，理中汤。
厥阴经，小腹腰痛，小便不利，意恐惧，四物玄明苦楝附子汤。
心疟，烦心，甚欲得清水，反寒多不甚热，宜桂枝黄芩汤。
肺疟，心寒甚，热间善惊，如有见者，桂枝加芍药汤。
肝疟，色苍苍然太息，甚伏若死，通脉四逆汤。
脾疟，寒则腹痛，热则肠鸣，鸣已汗出，小建中汤、芍药甘草汤。
肾疟，腰脊痛宛转便难，目 然，手足寒，桂枝加当归芍药汤。
胃疟，将病也，善饥不能食，能食而支满腹胀，理中汤、丸主之。
劳疟，经年不瘥，后复发作，微劳力不任，名曰劳疟。
母疟，百药不瘥，结成 癖在腹胁，名疟母。
治虽不同，疟得于暑，当以汗解。或汗不彻，郁而成痰，宜以养胃化痰发汗，邪气得出
，自然和也。虚则补之，脉洪数无力者是也。
羌活汤 治邪气浅在表。
羌活 防风 甘草 恶寒有汗，加桂枝；恶风无汗，加麻黄；吐，加半夏。
麻黄桂枝汤 治夜疟。此散血中风寒。
麻黄（一两） 桂枝（二钱） 甘草（炙，三钱） 黄芩（五钱） 桃仁（三十粒，去皮尖） 邪
气深而入血，故夜。以桃仁缓肝，散血中邪。
桂枝石膏汤 治邪深间日。
桂枝 石膏 知母 黄芩 汗出不愈，为内实外虚，寒热大作，必传入阴。太阳阳明，
、芍；寒热传入，太阳阳明少阳合病，加柴胡、半夏、人参、甘草。
藜芦散 治久疟欲吐不能吐，宜吐之。
藜芦为末，温齑水调下半钱，以吐为度。
张法 白虎加参汤、小柴胡合五苓散、神祜丸治之。
服前三方未动，次与之承气汤治。甚者，甘露饮调之，人参柴胡饮子补之，常山饮吐之
。
老疟丹 治老疟，风暑入阴在脏，凝血气。
川芎 桃仁 红花 当归 苍术 白术 白芷 黄柏 甘草
上水煎，露一宿，次早服之。
疟母丸 治疟母、食疟。
鳖甲（醋炙，君） 三棱 莪术（醋炙） 香附子 阿魏（食积加醋化）
截疟丸 先补药、表药，彻起阳分，方可截。
川常山 草果 知母 槟榔 乌梅 穿山甲（炒） 甘草（炙）
用水一大碗，煎半碗，露一宿，临发时温服之，宜吐。
一补一发丹 治久疟内伤挟外邪。内发必主痰，外以汗解。
半夏 茯苓 陈皮 柴胡 黄芩 苍术
川常山 葛根 虚加参、术补气，甚加芩、连。有一人夏感，脉沉细，服之愈。
常山汤 治妇胎疟。
常山（二两） 黄芩（三两） 石膏（八钱，另研） 乌梅（十四个） 甘草（一两）
煎服之。
不二散 白面（二两） 砒（一钱）
和匀，以香油一斤煎之，色黄，用草纸压之，去油为末，入江茶三两，每服一字。
神妙绝疟 木通（川者） 秦艽（去芦） 穿山甲（炙） 常山（各等分） 辰砂（半钱
，另研） 乌梅（七个） 大枣（七个）
上以水三盏，煎至半，入酒一盏，再至半。先刮砂，枣服，次服药。
[Pulse] The pulse of malaria naturally presents as a *Xian* (Wiry) pulse. A wiry and rapid (*Shu*) pulse indicates excess heat, while a wiry and slow (*Chi*) pulse indicates excess cold. If the pulse is wiry, small, and tight, purgation may be used; if wiry and slow, warming methods may be applied; if wiry and rapid, diaphoresis or moxibustion may be used; if floating and large, emesis may be induced; if wiry and rapid, it is termed "Wind-Fire" (*Feng Fa*, fever caused by wind pathogen), which can be resolved through dietary regulation.
[Etiology] Summer-heat lingers between the Ying (Nutritive) and Wei (Defensive) levels. If the Cou Li (skin pores and interstices) are not dense, autumn wind pathogens invade the Xuan Fu (sweat pores). The biting cold closes off and cannot exit, lodging outside the intestines and stomach, running parallel with Ying and Wei. During the day, it travels in Yang; at night, in Yin. When they merge, disease manifests; when they separate, disease ceases. Merging in Yang causes heat; merging in Yin causes cold. Shallow involvement leads to daily attacks; deep involvement leads to every-other-day attacks. Involvement in Qi results in earlier onset; involvement in Blood results in later onset. Pathogenesis arises from sweat retention transforming into phlegm, or from deficiency causing Yin and Yang to attack each other. External causes include the Six Excesses (Wind, Cold, Summer-Heat, Dampness, Dryness, Fire), manifesting as Cold Malaria (chills precede fever), Warm Malaria (fever precedes chills), Dan Malaria (fever without chills), Damp Malaria (body and joint pain), and Pin Malaria (more chills than fever). Internal causes involve disharmony of Zang organs, stagnation, and fluid retention, involving the Liver, Heart, Spleen, Lung, and Kidney (see below). Non-internal/external causes include Epidemic Malaria (similar symptoms among all patients in a year), Ghost Malaria (disturbing dreams), Dan Malaria (intermittent onset), Food Malaria (caused by diet), Labor Malaria (caused by overexertion), and Mother Malaria (transmitted from mother).
Li Zhongzi's Discussion: Summer injury by summer-heat leads to autumn malaria. Summer-heat belongs to the damp earth of late summer. If dampness fails to circulate, Earth Qi is deficient, allowing Wood Qi to overact, governed by Shaoyang. The generated element suffers, leading to insufficient Lung Metal, which allows Water to insult. Water overcoming Earth corresponds to Kun trigram, located at Shen, associated with Ministerial Fire. Water entering Earth causes water-fire conflict, leading to alternating Yin-Yang fluctuations. Insufficient Lung Metal causes shivering chills. Deficient Earth allows Shaoyang to invade, causing alternating chills and fever. Autumn onset relates to damp-heat at Mao-You positions.
[Syndrome Differentiation and Treatment] Chills preceding fever is Cold Malaria; fever preceding chills is Warm Malaria; treatment should be moderate, targeting Shaoyang. Thirst indicates dryness predominance; no thirst indicates dampness predominance. Some contract pathogens in winter but manifest in summer, with pathogens lodging in the Kidney (Foot Shaoyin). Some lodge in the Heart, with internal heat accumulating in the Lung (Hand Taiyin). Fever without chills is Dan Malaria, related to Foot Yangming. Involvement of Taiyang channel is Wind Malaria, treated by diaphoresis; Yangming channel is Heat Malaria, treated by purgation; Shaoyang channel is Wind-Heat, treated by harmonization. This represents shallow invasion. Involvement of Yin channels is called Warm Malaria, treated via Taiyin channel theory, representing severe invasion.
Taiyang Channel: Headache, lower back pain, cold starting from the back, chills then fever. Use Xiao Chai Hu Tang (Minor Bupleurum Decoction) or Qiang Huo Di Huang Tang.
Shaoyang Channel: Body lethargy, mild chills and fever, aversion to people, profuse sweating. Use Xiao Chai Hu Tang.
Yangming Channel: Prolonged chills followed by fever, profuse sweating during fever, preference for warmth/fire. Use Gui Zhi Er Bai Hu Yi Tang (Cinnamon Twig Twice, Gypsum Decoction One Part).
Shaoyin Channel: Vomiting, oppression, more heat than chills, desire to stay behind closed doors, difficult to cure. Use Xiao Chai Hu Tang plus Ban Xia (Pinellia).
Taiyin Channel: Frequent sighing, poor appetite, alternating chills/fever with sweating, vomiting marks decline. Use Li Zhong Tang (Regulate the Middle Decoction).
Jueyin Channel: Lower abdominal and lower back pain, dysuria, fearfulness. Use Si Wu Xuan Ming Ku Lian Fu Zi Tang.
Heart Malaria: Mental restlessness, intense desire for cold water, more chills than mild fever. Use Gui Zhi Huang Qin Tang.
Lung Malaria: Severe mental coldness, palpitations during fever intervals, hallucinations. Use Gui Zhi Jia Shao Yao Tang.
Liver Malaria: Pale/greenish complexion, frequent sighing, severe cases curled up like death. Use Tong Mai Si Ni Tang.
Spleen Malaria: Abdominal pain during chills, borborygmus during fever, sweating after borborygmus. Use Xiao Jian Zhong Tang or Shao Yao Gan Cao Tang.
Kidney Malaria: Lower back/spine pain, difficulty turning, difficult defecation, blurred vision, cold extremities. Use Gui Zhi Jia Dang Gui Shao Yao Tang.
Stomach Malaria: Hunger before onset but inability to eat; if eating, chest/flank fullness and abdominal distension. Use Li Zhong Tang or Wan.
Labor Malaria: Persisting for a year, recurring, intolerance to slight exertion.
Mother Malaria: Refractory to medicines, forming masses in abdomen/flanks, termed Nu Malaria Mass.
Although treatments vary, malaria originates from summer-heat and should primarily be resolved by diaphoresis. If sweating is incomplete, phlegm forms from retention; treat by nourishing stomach, resolving phlegm, and inducing sweating to expel pathogens. For deficiency (pulse large, rapid, forceless), tonify.
Qiang Huo Tang: Treats superficial pathogen.
Ingredients: Qiang Huo, Fang Feng, Gan Cao. Add Gui Zhi for chills with sweating; add Ma Huang for aversion to wind without sweating; add Ban Xia for vomiting.
Ma Huang Gui Zhi Tang: Treats nocturnal malaria. Disperses wind-cold in blood.
Ingredients: Ma Huang (1 liang), Gui Zhi (2 qian), Zhi Gan Cao (3 qian), Huang Qin (5 qian), Tao Ren (30 pits, peeled). Pathogen deep in blood causes nocturnal onset. Tao Ren soothes Liver and disperses blood pathogens.
Gui Zhi Shi Gao Tang: Treats deep pathogen with every-other-day attacks.
Ingredients: Gui Zhi, Shi Gao, Zhi Mu, Huang Qin. If sweating fails, indicating interior excess/exterior deficiency with severe chills/fever transitioning to Yin, add Shao Yao for Taiyang-Yangming combination. For Taiyang-Yangming-Shaoyang combined disease, add Chai Hu, Ban Xia, Ren Shen, Gan Cao.
Li Lu San: Treats chronic malaria with urge to vomit but inability. Induce emesis.
Preparation: Li Lu powder mixed with warm vinegar water, half qian dose, until vomited.
Zhang's Method: Use Bai Hu Jia Shen Tang, Xiao Chai Hu Tang combined with Wu Ling San, Shen You Wan.
If ineffective, use Cheng Qi Tang. Severe cases: Gan Lu Yin for regulation, Ren Shen Chai Hu Yin Zi for tonification, Chang Shan Yin for emesis.
Lao Nue Dan: Treats chronic malaria where wind-heat enters Yin/Zang, coagulating Qi/Blood.
Ingredients: Chuan Xiong, Tao Ren, Hong Hua, Dang Gui, Cang Zhu, Bai Zhu, Bai Zhi, Huang Bo, Gan Cao.
Decoct in water, expose overnight, take next morning.
Nu Malaria Pill: Treats Nu Malaria Mass, Food Malaria.
Ingredients: Bie Jia (vinegar-fried, Sovereign), San Leng, E Zhu (vinegar-fried), Xiang Fu Zi, A Wei (add vinegar for food stagnation).
Jie Nue Wan: First use tonics and exterior-releasing agents to raise Yang Qi to Yang level, then intercept malaria.
Ingredients: Chuan Chang Shan, Cao Guo, Zhi Mu, Bing Lang, Wu Mei, Chuan Shan Jia (fried), Zhi Gan Cao.
Decoct in one bowl water to half bowl, expose overnight, take warm before onset, induce vomiting.
Yi Bu Yi Fa Dan: Treats chronic malaria with internal injury and external pathogens. Internal phlegm must be addressed; external pathogens resolved by sweating.
Ingredients: Ban Xia, Fu Ling, Chen Pi, Chai Hu, Huang Qin, Cang Zhu, Chuan Chang Shan, Ge Gen. Add Ren Shen, Bai Zhu for deficiency; add Huang Qin, Huang Lian for severity. Case: Summer pathogen, deep/thin pulse, cured.
Chang Shan Tang: Treats pregnancy malaria.
Ingredients: Chang Shan (2 liang), Huang Qin (3 liang), Shi Gao (8 qian, separately ground), Wu Mei (14), Gan Cao (1 liang).
Decoct and take.
Bu Er San: Bai Mian (2 liang), Pi (1 qian).
Mix, fry in sesame oil (1 jin) until yellow, press with grass paper to remove oil, grind to powder, mix with Jiang Cha (3 liang). Dosage: one character measure.
Shen Miao Jue Nue: Mu Tong (Sichuan), Qin Jiao (de-rhizome), Chuan Shan Jia (fried), Chang Shan (equal parts), Chen Sha (half qian, separately ground), Wu Mei (7), Da Zao (7).
Decoct in three cups water to half cup, add one cup wine, reduce to half cup. Scrape Chen Sha and Da Zao first, then take medicine.