大意
夏伤于暑。秋成 疟。（经文） 者。疟之总名也。因其有战寒壮热暴疟酷疟之义。故名。大抵无痰不成疟。外
感四气。内动七情。饮食饥饱。房室劳伤。皆能致之。其中气凝滞。鼓动痰涎。则一也。（汇补）
内因
夏时伏阴在内。阳浮于外。真气消烁。其汗大出。人多烦渴。或过食生冷瓜果。或坐卧阴地取凉。致肤腠闭
密。邪留于胃。聚而成痰。至秋阳气收肃。阴气下移。中州之痰气愈加壅滞。胃气行至其所。与之相遇。而寒
热作焉。阴阳之气。更相胜负。故卫气行过。与邪暂离。故有时汗解。及邪卫复集。病必再作。此阴阳之升降。
邪正之合离也。（汇补）
外候
其寒也。欠伸毛悚。鼓颔战栗。汤火不能温。其热也。头疼脊痛。烦躁饮冷。冰水不能寒。或先寒后热。或先热
后寒。或寒热多少。或单热单寒。（大全）
三阳经疟
太阳之疟。腰背头项俱疼。先寒后热。热止汗出。阳明之疟。目痛鼻干舌燥。寒甚乃热。热甚而汗出。喜见火
日光。少阳之疟。口苦胁痛而呕。寒热往来。身体解 。（入门）
三阴经疟
少阴之疟。寒少热多。呕吐独甚。舌干口燥。欲闭户牖而处。太阴之疟。惨然太息。腹满恶食。病至善呕。呕已
乃衰。厥阴之疟。腰痛小腹满。小便数而不利。恐惧不足。腹中悒悒。（指掌）
风疟
凡疟皆生于风。风疟者。因避暑乘凉。汗出当风。闭其毛孔。热不得泄越而作。所谓夏暑汗不出。秋成风疟。
其症烦燥头疼。恶寒自汗。先热后寒。治宜发汗。（汇补）
寒疟
纳凉之风寒。沐浴之水寒。先伏于腠中。因秋风凉肃而发。其症腰背头项疼痛。先寒后热。治当大汗。（汇补）
暑疟
暑疟者。其症大汗大烦大喘大渴。静则多言。体若燔炭。汗出而散。单热微寒。宜清暑解表。（汇补）
湿疟
外着雨露。内停水湿。发则一身尽痛。手足沉重。呕逆胀满。名曰湿疟。宜解表除湿。（汇补）
温疟
冬中风寒。藏于骨髓。及遇大暑。腠理发泄。邪气与汗皆出。故先热后寒。名曰温疟。宜和解。热多小柴胡。寒
多加桂枝。（汇补）
瘴疟
瘴疟者。山溪蒸毒。湿热蒸熏。邪郁中焦。发时迷闷。甚则狂妄。乍寒乍热。乍有乍无。一身沉重。不习水土者。
恒多患之。甚则血瘀于心。涎聚于脾。亦有口喑不能言者。宜先吐其痰。后利大肠。凉膈散。或小柴胡加大
黄、木香。轻者藿香正气散。（汇补）
疫疟
一方长幼。病皆相似。此因天时寒热不正。邪气乘虚袭入所致。宜随时令施治。此司天运气之所宜考也。（汇补）
鬼疟
鬼疟因卒感尸疰客忤。寒热日作。梦寐不详。多生恐怖。言动异常。俗云。夜发为鬼疟者非也。宜祛邪禁压
法。或平胃散。加桃仁、雄黄。（方考）
瘅疟
瘅疟者。肺素有热。腠理开发。风寒舍于皮肤之内。分肉之间。发则阳气盛。其气不及于阴。故但热而不寒。
（素问）今人素有火症。复挟饮食与痰。每多热而不寒。均宜消导清火。
痰疟
痰疟因夏月多食瓜果油面。郁结成痰。热多寒少。头疼肉跳。吐食呕沫。甚则昏迷卒倒。寸口脉浮大者。吐
之。关脉弦滑者。化之。若胸满热多。大便燥实。大柴胡汤下之。（汇补）
食疟
食疟一名胃疟。因饮食失节。饥饱不常。谷气乖乱。荣卫失所。寒已复热。热已复寒。寒热交并。噫气恶食。食
则吐逆。胸满腹胀。食在膈上。探吐之。食停未化。消克之。食已消。疏解之。（汇补）
虚疟
元气本虚。感邪患疟。饮食少进。四肢乏力。自汗不止。倦怠嗜卧。微有表症者。人参养胃汤为主。久而不已。
但宜养正。六君子加柴胡、干葛。不可用劫夺法。转成他症。又有入房感寒成疟者。昼则寒甚。夜则发热。服
药不得汗者。用苍、芎、桃、柳煎汤。浸足至膝。内服补剂。其汗必行。又有虚极之人。疟发之时。寒不成寒。热不
成热。气急神扬。精神恍惚。六脉豁大。此元气衰脱。将有大汗昏晕之虞。宜防之。（汇补）
劳疟
劳役过度。荣卫空虚。其症发热恶寒。寒中有热。热中有寒。或发于昼。或发于夜。遇小劳便发。必气虚多汗。
饮食少进。又血虚午后发热至晚微汗乃解。此似疟非疟也。若误投疟治。必危。久而成瘵。舍补奚为。（汇补）
疟母
凡疟经年不瘥。谓之老疟。或食积痰涎瘀血结成痞块。藏于腹胁。作胀且痛。令人多汗。乃疟母也。此荣卫
虚损。邪气留着。宜养正气。终当自化。设误为攻削。必至中满。慎之。（汇补）
为热为寒
人身之中。卫气居外。营血居内。阳邪与荣争。而邪火发于外。则为热。阴邪与卫争。而正气退于内。则为寒。
表邪多则寒多。里邪多则热多。表里相半。寒热相争。诸疟惟劳伤食积痰火。则寒已复热。热已复寒。谓之
寒热相并。（入门）外有瘅疟。但热不寒者。乃邪并于表。则阳盛阴虚。阴虚生内热。阳盛生外热。而中外皆热
也。牝疟。但寒不热者。乃邪并于里。则阴盛阳虚。肠虚生外寒。阴盛生内寒。而中外皆寒者。一定之则也。（汇补）
阳分阴分
大抵一日一发。及午后发者。邪在阳分。易已。间日发。及午后夜间发者。邪在阴分。难已。若间一日。连二日
发。或日夜各一发者。为阴阳俱病。（杂着）阴分多而阳分少。则其发日远。阳分多而阴分少。则其发日近。甚
则内外失守。真邪不分。休作无时也。（汇补）
连发间发
受病重者。邪气内薄于阴分。阴为脏。其邪深。横连募原。募原者五脏空穴之总名。在背为阳为募。在腹为
阴为原。其道远。其气深。邪内居之。不能与正气并行。故间日蓄积乃发。（入门）其有三日一发者。乃三阴经
疟。其病更深。发于子午卯酉者。少阴经也。辰戌丑未者。太阴经也。寅申巳亥者。厥阴经也。（丹溪）
日轻日重
时日支干之衰旺。每于人身有相关。盖甲丙戊庚壬。天时之阳也。乙丁己辛癸。天时之阴也。疟久食减。胃
中之正气已孤。而邪去未尽。是以值阳日助正。而邪不能胜正则轻。值阴日助邪。而正不能胜邪则重。（汇补）
日发夜发
受病轻者。邪气外舍于阳分。阳为腑。其邪浅。客于腠理。与卫气并行。故一日一发。发有昼夜之殊。因卫气
昼行于阳。夜行于阴。此气得阳而外出。故发于日间。荣卫昼行背与脊故也。得阴而内薄。故发于暮夜。荣
卫夜行胸与腹也。
移早移晏
邪气客于风府。循膂而下。卫气一日一夜。大会于风府。其明日下一节。故其作也晏。其出于风府。日下一
节。二十五日下至 骨。二十六日入于脊内。注于伏膂之内。其气上行。九日出于缺盆之中。其气日高。故
作日益早也。（内经）所以正气胜而外出。则移早。为轻。邪气胜而入内。则移晚。为重。（汇补）
脉法
疟脉自弦。弦数多热。弦迟多寒。弦虚宜补。弦紧宜汗。弦而浮大可吐。弦而实紧可下。微弱为虚。代散则死。
如六脉迟缓者。将自愈。
治法
无汗须发汗。散邪为主。有汗当敛汗。扶正为先。（心法）邪疟及新发者。可汗吐下。虚疟及久病者。宜补气血。
稍久而正虚邪滞者。宜一补一发。若深入于阴分者。宜先升后汗。至如邪乘虚入。则宜以发散祛其客邪。
然后扶培胃气。痰食气滞。则先以消导散其壅滞。然后渐补脾元。（汇补）
避其锐气
方其盛时。必毁。因其衰也。事必大昌。（内经）凡疟方发之时。不可服药。须于未发两时之先。否则药病交争。
转深为害。（汇补）
截宜权变
数发之后。曾经汗解。可商截法。久则中气愈虚。病邪愈深。设或脉尚紧盛。邪气方锐。未可轻截。恐补住邪
气。变生他患。（汇补）
截后宜补
截而不愈。不可再截。恐损其气。宜分昼发夜发。寒热多少。以和解之。久则脾气虚衰。须服养脾祛痰之药。
脾气一盛。自然平复。（大全）
疟病死症
凡疟至吐泻不食。肿胀归腹者。不治。亦有峻补参、 而获生者。亦仅百中之一二也。（汇补）
用药
主以二陈汤。合柴胡汤。因寒。加羌活、苏叶。因暑。加黄连、香薷。因湿。加苍术、浓朴。因瘴。加菖蒲、藿香。
因食。加山楂、麦芽。因痰。加枳实、胆星。头疼。加川芎。胸满。加枳壳。口渴。加知母。甚加石膏。去半夏。呕吐。
加藿香。大抵外感寒多。非草果、浓朴不能温散。热多。非柴胡、黄芩不能清解。阳疟无汗。须用苍术、葛根。阴疟无
汗。须用升麻、柴胡。阳疟多汗。敛以参、术、黄 。阴疟多汗。敛以归、芍、乌梅。阳疟三四发后不愈者。截以不二
饮。阴疟数十发不愈者。提以补中益气汤。加白蔻仁以分邪正而疟自止。脾虚多热者。清脾饮。胃虚多寒者。人参
养胃汤。其间日发。连两日发者。八珍汤大补气血。若微寒微热不能遽除。是正气已虚。邪气亦尽。加柴胡、
黄芩鳖甲。于补荣卫药中。寻当自愈。
疟疾选方
清脾饮（简易） 治疟疾热多寒少。口渴溺赤。脉弦数者。脉滑有力。用苍术。脉濡无力。用白术。
青皮 浓朴（姜炒） 草果 柴胡 黄芩 茯苓 半夏 甘草（炙各七分） 姜 枣
不二饮 治疟在阳分。三四发后。人壮可截者。
柴胡 黄芩 常山 知母 芍药 槟榔 青皮 甘草
水酒各一碗煎。露一宿。五更时服。忌热茶汤饭一日。
驱疟散（和剂） 治疟疾热少寒多。自汗肢冷。脉弦迟者。
前胡 柴胡（各八分） 桂心 桔梗 浓朴 半夏（各六分） 黄 干葛 甘草（各四分） 姜 枣
人参养胃汤 治虚疟食少诸症。
草果 人参 茯苓（各五分） 甘草 橘红（各八分） 浓朴 苍术 半夏（各一钱） 藿香（五分）
寒多。加干姜、桂枝。热多。加柴胡、黄芩、生姜、乌梅。水煎。
芎归鳖甲汤 治劳疟表虚里损。真元未复。疾虽暂可。少劳复作。
川芎 当归 鳖甲 茯苓 青皮 陈皮
半夏 芍药（等分）
生姜、乌梅煎。
四兽饮
即六君子汤加草果、乌梅、生姜、大枣。
黄 鳖甲汤
黄 （中） 鳖甲（下） 何首乌（上） 陈皮（下）
柴胡养阴汤
柴胡（上） 当归（中） 陈皮（中） 知母（下）
疟母丸
青皮 桃仁 红花 神曲（各五钱） 三棱 蓬术 海粉（各七钱） 鳖甲（醋制一两） 香附（醋炒八钱） 麦
芽（五钱）
神曲糊丸。以补药送下。
小柴胡汤（仲景） 治疟往来寒热。
柴胡 黄芩 半夏 人参（各一钱） 甘草（五分）
姜枣煎。加丹皮、山栀。名加味小柴胡汤。加石膏、知母。名柴胡白虎汤。
藿香正气散（方见似中风） 补中益气汤 八珍汤 六君子汤（三方俱见中风） 平胃散（方见暑症）
[General Principle]
Summer injury by summer-heat (Shu, 暑). Autumn formation of malaria (Nue, 疟). (From the Classic texts) "Malaria" is the general name for this disease. It is named so because it encompasses meanings of shivering chills, high fever, sudden onset, and severe intensity. Generally speaking, without phlegm turbidity (Tan, 痰), there is no malaria. External contraction of the four qi (Wind, Cold, Summer-heat, Dampness), internal movement of the seven emotions, dietary irregularities (hunger and fullness), and sexual exhaustion can all cause it. The mechanism is essentially the same: stagnation of qi in the middle jiao (Zhongjiao, 中焦) stirring up phlegm fluids. (From *Zhengzhi Huibu*)
[Internal Causes]
In summer, yin qi lies latent within, while yang qi floats on the exterior. True qi is consumed, leading to profuse sweating; people often feel irritable and thirsty. If one overconsumes raw or cold fruits and vegetables, or sits/lies in cool places to seek relief, the skin pores and interstices (Couli, 腠理) become closed and tight. Pathogenic factors remain in the stomach, gathering into phlegm. By autumn, yang qi retracts and肃descends, while yin qi moves downward. The phlegm qi in the spleen and stomach (Middle Earth, Zhongzhou, 中州) becomes even more congested. When stomach qi reaches this location and encounters the phlegm, chills and fever arise. Yin and yang qi compete for dominance. Thus, when Wei qi (Defensive Qi, 卫气) passes through and temporarily separates from the pathogen, sweating may occur, providing relief. However, when the pathogen and Wei qi gather again, the illness must recur. This is due to the ascending and descending of yin and yang, and the joining and separating of pathogen and righteous qi. (From *Zhengzhi Huibu*)
[External Manifestations]
During chills: yawning, stretching, gooseflesh, jaw quivering and trembling; hot water and fire cannot warm the body. During fever: headache, spine pain, irritability, desire for cold drinks; ice water cannot cool the body. Some present with chills first then fever, others with fever first then chills. The proportion of chills and fever may vary, or there may be only fever or only chills. (From *Yizong Bidu*)
[Malaria of the Three Yang Meridians]
Taiyang Malaria: Pain in the lower back, back, head, and neck; chills first, then fever; sweating occurs after fever subsides. Yangming Malaria: Eye pain, nasal dryness, dry tongue and mouth; intense chills precede fever; profuse sweating occurs when fever is intense; preference for firelight and sunlight. Shaoyang Malaria: Bitter taste in the mouth, hypochondriac pain, vomiting; alternating chills and fever; flaccidity and weakness of the body. (From *Yixue Rumen*)
[Malaria of the Three Yin Meridians]
Shaoyin Malaria: Few chills, many fevers; severe vomiting; dry tongue and mouth; desire to close doors and windows and stay alone. Taiyin Malaria: Sighing miserably; abdominal fullness, aversion to food; tendency to vomit upon onset; condition improves after vomiting. Jueyin Malaria: Lower back pain, lower abdominal fullness; frequent urination but difficult flow; fearfulness and inadequacy; inner depression in the abdomen. (From *Shanghan Zhizhang*)
[Wind Malaria]
All malaria originates from wind. Wind malaria arises from seeking coolness in summer; when sweating, exposure to wind closes the hair follicles, preventing heat from dissipating. As the saying goes, "Summer heat without sweat leads to wind malaria in autumn." Symptoms include irritability, headache, aversion to cold, spontaneous sweating, fever first then chills. Treatment should employ diaphoresis (sweating method). (From *Zhengzhi Huibu*)
[Cold Malaria]
Wind-cold from cooling off, and water-cold from bathing, lie latent in the interstices initially, manifesting due to the cool and austere autumn winds. Symptoms include pain in the lower back, back, head, and neck, with chills preceding fever. Treatment requires heavy sweating. (From *Zhengzhi Huibu*)
[Summer-heat Malaria]
Symptoms of summer-heat malaria include profuse sweating, severe irritability, severe panting, and extreme thirst. The patient talks excessively even when quiet. The body feels like burning charcoal; symptoms resolve with sweating. It presents as single fever with slight chills. Treatment should clear summer-heat and release the exterior. (From *Zhengzhi Huibu*)
[Damp Malaria]
External exposure to rain and dew, internal retention of water-dampness. Upon onset, the whole body aches, hands and feet feel heavy, with vomiting, regurgitation, and abdominal distension. This is called damp malaria. Treatment should release the exterior and eliminate dampness. (From *Zhengzhi Huibu*)
[Warm Malaria]
Wind-cold contracted in winter hides in the bone marrow. When great summer heat arrives, the interstices open and sweat outflows, carrying the pathogen out with the sweat. Hence, fever precedes chills. This is called warm malaria. Treatment should harmonize. For more heat, use Xiaochaihu Tang (Minor Bupleurum Decoction); for more chills, add Guizhi Tang (Cinnamon Twig Decoction). (From *Zhengzhi Huibu*)
[Zhang Malaria]
Zhang malaria results from toxic vapors steaming from mountain streams, where damp-heat steams and薰熏s. Pathogens stagnate in the middle jiao. Onset involves mental confusion and dizziness, progressing to madness. Chills and fever come and go intermittently; the body feels heavy. Those unaccustomed to the local environment are prone to this. Severe cases involve blood stasis in the heart and phlegm accumulation in the spleen; some lose their voice and cannot speak. Initially, induce vomiting to expel phlegm, then purge the large intestine. Use Liangge San (Cooling Chest Powder), or Xiaochaihu Tang plus Dahuang (Rhubarb Root) and Muxiang (Aucklandia Root). Mild cases use Huoxiang Zhengqi San (Agarwood and Magnolia Bark Powder). (From *Zhengzhi Huibu*)
[Epidemic Malaria]
In one area, young and old suffer similar illnesses. This is caused by abnormal seasonal cold and heat, allowing pathogens to invade due to deficiency. Treatment should follow the season. This relates to the study of Si Tian (Chief Physician of Heaven) and Yun Qi (Luck and Qi). (From *Zhengzhi Huibu*)
[Ghost Malaria]
Ghost malaria is caused by sudden infection with corpse transmission (Shizhu, 尸疰) or guest hostility (Kewu, 客忤). Chills and fever occur daily. Dreams are ominous; fear is prevalent; speech and movement are abnormal. The folk belief that "nighttime onset is ghost malaria" is incorrect. Treatment should dispel evil and suppress it using exorcism methods, or Pingwei San (Peaceful Stomach Powder) plus Taoren (Peach Kernel) and Xionghuang (Realgar). (From *Yifang Kao*)
[Dan Malaria]
Dan malaria occurs when the lungs have pre-existing heat, causing interstices to open. Wind-cold lodges between the skin and muscle layers. Onset features vigorous yang qi, which fails to reach yin, resulting in fever without chills. (From *Suwen*) Modern patients with pre-existing fire syndromes, complicated by diet and phlegm, often present with fever without chills. Treatment should use digestion-promoting and fire-clearing methods.
[Phlegm Malaria]
Phlegm malaria results from excessive consumption of fruits, melons, oil, and noodles in summer, leading to phlegm formation. There is more heat than chills, headache, muscle twitching, vomiting of food and foam, and sometimes coma or sudden collapse. If the Cun (Inch) pulse is floating and large, induce vomiting. If the Guan (Bar) pulse is wiry and slippery, transform phlegm. If there is chest fullness, much heat, and dry constipation, purge with Dachaihu Tang (Major Bupleurum Decoction). (From *Zhengzhi Huibu*)
[Food Malaria]
Also known as Stomach Malaria. Caused by dietary irregularity and inconsistent hunger/fullness, disrupting grain qi and disturbing Ying and Wei (Nutritive and Defensive) qi. Chills return after fever, fever returns after chills; chills and heat intertwine. Symptoms include belching, aversion to food, vomiting upon eating, chest fullness, and abdominal distension. Food lodged above the diaphragm should be expelled by inducing vomiting. Food stagnation not yet digested should be resolved. After food digestion, use dispersing and resolving methods. (From *Zhengzhi Huibu*)
[Deficiency Malaria]
Constitutional yuan qi is deficient, contracting pathogen-induced malaria. Reduced appetite, limb fatigue, continuous spontaneous sweating, lethargy, and desire to lie down. If mild exterior symptoms exist, Ren Shen Yang Wei Tang (Ginseng and Stomach-Nourishing Decoction) is primary. If chronic, only tonify righteousness using Liu Junzi Tang (Six Gentlemen Decoction) plus Chaihu (Bupleurum Root) and Gange (Kudzu Root). Do not use coercive interception methods, lest they transform into other syndromes. Another type arises from cold invasion after intercourse: severe chills by day, fever by night. If medication fails to induce sweat, soak feet to the knees in a decoction of Cangzhu (Atractylodes Rhizome), Xiong (Ligusticum Rhizome), Taoren (Peach Kernel), and Liu (Willow Branch), combined with internal tonics, and sweat will likely emerge. In extremely deficient patients during malaria attacks, chills do not feel like true chills, fever does not feel like true fever; rapid breathing, scattered spirit, and vague consciousness occur. The six pulses are wide and empty. This indicates yuan qi collapse, risking profuse sweating and fainting. Prevention is necessary. (From *Zhengzhi Huibu*)
[Labor Malaria]
Excessive labor depletes Ying and Wei. Symptoms include fever and aversion to cold, heat within chills, chills within heat. Onset may be day or night, triggered by minor exertion. Qi deficiency causes profuse sweating and reduced intake. Blood deficiency causes afternoon fever until evening, resolving with slight sweating. This resembles malaria but is not malaria. Misdiagnosis as malaria is dangerous and may lead to consumptive disease (Zhai, 瘵). Tonification is the only remedy. (From *Zhengzhi Huibu*)
[Malaria Mass]
Malaria persisting for years is called old malaria. Food stagnation, phlegm, and blood stasis may form a mass (Pi Kuai, 痞块) stored in the abdomen and hypochondrium, causing distension and pain, with profuse sweating. This is malaria mass. It results from Ying and Wei deficiency with lingering pathogens. Tonify righteous qi, and it will eventually resolve. Mistakenly using attacking/scraping methods will cause abdominal fullness. Be cautious. (From *Zhengzhi Huibu*)
[Heat and Chills Mechanism]
Within the body, Wei qi resides externally, Ying blood internally. Yang pathogens contest with Ying, causing fire to flare outward, resulting in heat. Yin pathogens contest with Wei, causing righteous qi to retreat inward, resulting in chills. More exterior pathogens mean more chills; more interior pathogens mean more heat. Exterior-interior balance leads to contesting chills and heat. Among malaria types, only those from labor injury, food stagnation, phlegm-fire exhibit "chills returning to heat, heat returning to chills," termed intertwining chills and heat. (From *Yixue Rumen*) Externally, Dan Malaria presents with heat only, no chills; this is pathogen merging with the exterior, leading to excess yang and deficiency yin. Deficiency yin generates internal heat; excess yang generates external heat, causing heat throughout. Pin Malaria presents with chills only, no heat; this is pathogen merging with the interior, leading to excess yin and deficiency yang. Intestinal emptiness generates external cold; excess yin generates internal cold, causing cold throughout. This is a fixed rule. (From *Zhengzhi Huibu*)
[Yang and Yin Divisions]
Generally, daily onset and afternoon onset indicate pathogen in the Yang division; easy to cure. Every-other-day onset and afternoon/night onset indicate pathogen in the Yin division; hard to cure. If skipping one day then two days consecutively, or occurring once day and once night, both Yin and Yang are diseased. (From *Zazhe*) More Yin than Yang means longer intervals between attacks; more Yang than Yin means shorter intervals. Severe cases involve loss of interior-exterior control and indistinction between true and false, with irregular onset. (From *Zhengzhi Huibu*)
[Continuous and Interval Onset]
Severe infection pushes pathogens deep into the Yin division. Yin represents Zang organs, so the pathogen is deep, spreading horizontally to the Mu Yuan (Sea of Origin). Mu Yuan is the general name for the empty cavities of the five zang organs. Back is Yang/Mu; abdomen is Yin/Yuan. The path is long, the qi is deep; pathogens reside inside, unable to move with righteous qi, hence accumulating to erupt every other day. (From *Yixue Rumen*) Three-day intervals indicate Three Yin Malaria, deeper still. Onset at Zi, Wu, Mao, You hours belongs to Shaoyin Meridian; Chen, Xu, Chou, Wei hours to Taiyin Meridian; Yin, Shen, Si, Hai hours to Jueyin Meridian. (From Zhu Danxi)
[Daily Lightness and Heaviness]
The waxing and waning of Heavenly Stems relate to the human body. Jia, Bing, Wu, Geng, Ren are Yang stems; Yi, Ding, Ji, Xin, Gui are Yin stems. Chronic malaria with poor appetite leaves stomach righteous qi isolated, while pathogens remain. On Yang days, yang assists righteous qi, so pathogens cannot overcome it, making the condition light. On Yin days, yin assists pathogens, so righteous qi cannot overcome them, making the condition heavy. (From *Zhengzhi Huibu*)
[Day vs. Night Onset]
Light infection keeps pathogens in the Yang division. Yang represents Fu organs; the pathogen is shallow, lodging in interstices, moving with Wei qi, hence daily onset. Variations in day/night onset depend on Wei qi: daytime movement in Yang, nighttime in Yin. Receiving yang qi allows outward movement, causing daytime onset (Wei/Nutritive qi travel the back and spine by day). Receiving yin qi causes inward pressure, causing nighttime onset (Wei/Nutritive qi travel the chest and abdomen by night).
[Advancing and Delaying Onset]
Pathogens lodge at Fengfu (GV16), descending along the Du vessel. Wei qi gathers at Fengfu daily. The next day it descends one segment, so onset delays (Yan). Emerging from Fengfu, it descends one segment daily. After 25 days, it reaches the sacrum. On the 26th day, it enters the spine, injecting into the Fulu vessels. Ascending qi emerges from Quepen (ST12) after nine days. As qi rises, onset advances (Zao). (From *Neijing*) Righteous qi victory and outward movement advance onset (lighter); pathogen victory and inward movement delay onset (heavier). (From *Zhengzhi Huibu*)
[Pulse Diagnosis]
Malaria pulses are naturally Wiry (Xian, 弦). Wiry-rapid indicates much heat; Wiry-slow indicates much chills. Wiry-deficient requires tonification; Wiry-tight requires sweating. Wiry-floating-large allows vomiting; Wiry-solid-tight allows purging. Weak-thin indicates deficiency; Intermitting-scattered indicates death. If all six pulses are slow-slow, self-healing is expected.
[Treatment Principles]
No sweat requires diaphoresis, focusing on dispersing pathogens. Sweating requires astringing sweat, focusing on supporting righteous qi. (From *Jingyue Quanshu*) Pathogenic malaria and new onset allow sweating, vomiting, purging. Deficiency malaria and chronic illness require tonifying qi and blood. Slightly chronic with deficiency and stagnation requires one tonification followed by one release. Deep penetration into Yin requires lifting first, then sweating. Invasion via deficiency requires dispersing external pathogens first, then supporting stomach qi. Phlegm-food stagnation requires resolving obstruction first, then gradually tonifying spleen source. (From *Zhengzhi Huibu*)
[Avoiding Sharp Qi]
When peak, it breaks; when declining, success is assured. (From *Neijing*) Medication should not be given when malaria is just starting. It must be taken two hours before onset; otherwise, medicine and disease contend, worsening the condition. (From *Zhengzhi Huibu*)
[Interception Requires Flexibility]
After several attacks and previous sweating resolution, interception methods may be considered. Long duration increases middle qi deficiency and deepens pathogens. If pulses remain tight-full and pathogens are sharp, do not lightly intercept, lest you trap pathogens and cause complications. (From *Zhengzhi Huibu*)
[Tonification After Interception]
If interception fails, do not repeat it, fearing qi damage. Differentiate day/night onset and heat/chill ratio, treating with harmonization. Chronic cases involve spleen qi deficiency; use spleen-nourishing and phlegm-resolving herbs. Once spleen qi thrives, recovery follows naturally. (From *Yizong Bidu*)
[Fatal Malaria Syndromes]
Malaria progressing to vomiting, diarrhea, anorexia, and abdominal swelling is incurable. Rarely, aggressive tonification with Ginseng and Aconite saves one or two in a hundred. (From *Zhengzhi Huibu*)
[Medication Usage]
Base formula: Erchen Tang (Two-Aged Decoction) combined with Xiaochaihu Tang. Due to cold, add Qianghuo (Notopterygium Rhizome) and Ziye (Perilla Leaf). Due to summer-heat, add Huanglian (Coptis Rhizome) and Xiangru (Elsholtzia Herb). Due to dampness, add Cangzhu (Atractylodes Rhizome) and Houpo (Magnolia Bark). Due to Zhang toxin, add Shichangpu (Acorus Rhizome) and Huoxiang (Patchouli Herb). Due to food, add Shanzha (Hawthorn Fruit) and Maiya (Germinated Hordeum). Due to phlegm, add Zhishi (Immature Bitter Orange) and Dansheng (Fried Arisaema with Bile). Headache: add Chuanxiong (Szechwan Lovage Rhizome). Chest fullness: add Zhike (Bitter Orange). Thirst: add Zhimu (Anemarrhena Rhizome); severe: add Shigao (Gypsum), remove Banxia (Pinellia Tuber). Vomiting: add Huoxiang. Generally, exterior cold requires CaoGuo (Tsaoko Cardamom) and Houpo for warming dispersion; heat requires Chaihu and Huangqin (Scutellaria Root) for clearing resolution. Yang malaria without sweat requires Cangzhu and Gegen (Kudzu Root); Yin malaria without sweat requires Shengma (Cimicifuga Rhizome) and Chaihu. Yang malaria with profuse sweat uses Renshen (Ginseng Root), Baizhu (Atractylodes Macrocephala Rhizome), Huangqi (Astragalus Root) to astringe; Yin malaria with profuse sweat uses Danggui (Angelica Sinensis Root), Shaoyao (Peony Root), Wumei (Mume Fruit) to astringe. Yang malaria unrelieved after 3-4 attacks: intercept with Bu'er Yin (Two-Unmatched Decoction). Yin malaria unrelieved after dozens of attacks: lift with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Baixiaren (White Cardamom Seed) to separate pathogen and righteous qi, stopping malaria. Spleen deficiency with much heat: Qingpi Yin (Clear Gallbladder Decoction). Stomach deficiency with much cold: Renshen Yangwei Tang. Every-other-day or consecutive two-day onset: Bazhen Tang (Eight-Treasure Decoction) to greatly tonify qi and blood. If mild chills/fever persist, indicating exhausted righteous qi and pathogens, add Chaihu, Huangqin, Biejia (Turtle Shell) to nutritive-defensive tonics; self-healing will follow.
[Malaria Selected Formulas]
Qingpi Yin (From *Jianyi Fanglun*): Treats malaria with more heat than chills, thirst, red urine, wiry-rapid pulse. Use Cangzhu if pulse is slippery-forceful; use Baizhu if pulse is soggy-weak.
Qingpi (Green Tangerina Peel), Houpo (Magnolia Bark, stir-fried with ginger), Caoguo (Tsaoko Cardamom), Chaihu (Bupleurum Root), Huangqin (Scutellaria Root), Fuling (Poria), Banxia (Pinellia Tuber), Gancao (Licorice Root, honey-fried, each 0.7 fen), Ginger, Jujube.
Bu'er Yin: Treats Yang-malaria, interceptable after 3-4 attacks in robust patients.
Chaihu, Huangqin, Changshan (Dichroa Root), Zhimu, Shaoyao, Binglang (Areca Seed), Qingpi, Gancao.
Decoct in water and wine (one bowl each), expose overnight, take at dawn. Avoid hot tea/soup/meals for one day.
Quemie San (From *Heji Ju Fang*): Treats malaria with less heat than chills, spontaneous sweating, cold limbs, wiry-slow pulse.
Qianhu (Peucedanum Root), Chaihu (each 0.8 fen), Guixin (Cinnamon Heart), Jiegeng (Platycodon Root), Houpo, Banxia (each 0.6 fen), Huangqi, Gange (Kudzu Root), Gancao (each 0.4 fen), Ginger, Jujube.
Renshen Yangwei Tang: Treats deficiency malaria with poor appetite.
Caoguo, Renshen, Fuling (each 0.5 qian), Gancao, Juhong (Aged Tangerina Peel, each 0.8 fen), Houpo, Cangzhu, Banxia (each 1 qian), Huoxiang (0.5 qian).
More cold: add Ganjiang (Dried Ginger), Guizhi (Cinnamon Twig). More heat: add Chaihu, Huangqin, Shengjiang (Fresh Ginger), Wumei. Decoct in water.
Xionggui Biejia Tang: Treats labor malaria with exterior deficiency and interior damage, incomplete recovery of true yuan, recurrence with minor exertion.
Chuanxiong, Danggui, Biejia (Vinegar-processed), Fuling, Qingpi, Chenpi (Citrus Peel), Banxia, Shaoyao (equal parts).
Decoct with Ginger and Wumei.
Sishou Yin: Six Gentlemen Decoction plus Caoguo, Wumei, Ginger, Jujube.
Huangqi Biejia Tang: Huangqi (Medium amount), Biejia (Low amount), Heshouwu (Polygonum Multiflorum Root, High amount), Chenpi (Low amount).
Chaihu Yangyin Tang: Chaihu (High amount), Danggui (Medium amount), Chenpi (Medium amount), Zhimu (Low amount).
Nuomu Wan: Qingpi, Taoren, Honghua (Safflower), Shenqu (Medicated Leaven, each 5 qian), Sanleng (Sparganium Rhizome), Pengzhu (Curcuma Zedoaria Rhizome), Haifen (Calcium Carbonate/Sponge Ash, each 7 qian), Biejia (Vinegar-processed, 1 liang), Xiangfu (Cyperus Rhizome, vinegar-fried, 8 qian), Maiya (Germinated Hordeum, 5 qian).
Form pills with Shenqu paste. Take with tonifying medicine.
Xiaochaihu Tang (Zhang Zhongjing): Treats alternating chills and fever in malaria.
Chaihu, Huangqin, Banxia, Renshen (each 1 qian), Gancao (0.5 fen).
Decoct with Ginger and Jujube. Add Mudanpi (Tree Peony Root Bark), Shanzhi (Gardenia Fruit) -> Named Modified Xiaochaihu Tang. Add Shigao, Zhimu -> Named Chaihu Baihu Tang.
Huoxiang Zhengqi San (See "Resembling Wind-Stroke"), Buzhong Yiqi Tang, Bazhen Tang, Liu Junzi Tang (See "Resembling Wind-Stroke"), Pingwei San (See "Summer Syndrome").