师曰疟脉自弦。弦数者多热。弦迟者多寒。弦小紧者下之瘥。弦迟者可温之。弦紧者可发汗针灸也。浮
大者可吐之。弦数者风发也。以饮食消息止之。（弦紧下。脉经有数字。风发。外台作风疾。）
〔程〕内经曰。 疟皆生于风。其蓄作有时者何也。岐伯曰。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。渴欲饮水。方其寒。汤火不能温。及其热冰水不能寒。此阴阳交争。虚
实并作。邪舍于营卫之间。风寒之气不常。故休作有时。而作往来寒热也。木郁则发热。热则脉数。此邪气
微者。故以饮食消息止之。经曰。五脏病各有得者愈。五脏病各有所恶。各随其不喜者为病。
遂其喜恶。而消息之。则疟自止。上说如此。后并无汗吐下温针灸之法。去古既远。文多简略。不可考矣。
〔徐〕疟者。半表里病。而非骤发之外病也。故内经曰。夏伤于暑。秋必
疟。又曰。在皮肤之内。肠胃之外。唯其半表里。则脉必出于弦。弦者东方甲木之气。经属少阳。故曰疟脉
自弦。自者谓感有风寒。而脉唯自弦也。于是脉既有一定之象。而兼数为热。兼迟为寒。此其大纲也。
〔尤〕疟者。少阳之邪。弦者。少阳之脉。有是邪。则有是脉也。然疟之舍。固在半表半里之间。而疟之气。则有
偏多偏少之异。故其病有热多者。有寒多者。有里多而可下者。有表多而可汗可吐者。有风从热出。而不可以
药散者。当各随其脉而施治也。徐氏曰。脉大者为阳。小者为阴。紧虽寒脉。小紧则内入而为阴矣。阴
不可从表散。故曰下之愈。迟既为寒。温之无疑。弦紧不沉。为寒脉。而非阴脉。非阴故可发汗针灸也。疟
脉概弦。而忽浮大。知邪在高分。高者引而越之。故可吐。既云弦数者多热矣。而复申一义云。弦数者风发。
见多热不已。必至于极热。热极则生风。风生则肝木侮土。而传其热于胃。坐耗津液。此非徒求之药。须以饮
食消息。止其炽热。即梨汁蔗浆。生津止渴之属。正内经风淫于内。治以甘寒之旨也。
案风发以饮食消息止之。其义未清晰。姑举二氏之说。以备考。金鉴云。弦小紧者之小字。当是沉字。则
有可下之理。弦紧者。当是弦浮紧。则有可发汗之理。弦浮大者。当是弦滑大。则有可吐之理。且不遗本文疟
脉自弦之意。此说不必矣。徐尤之注。义自允当。
病疟。以月一日发。当以十五日愈。设不瘥。当月尽解。如其不瘥。当云何。师曰。此结为 瘕。名曰
疟母。急治之。宜鳖甲煎圆。（脉经。自病疟止师曰此三十字无。结上有疟疾二字。无急治之三字。
赵本圆作丸。下并同。）
〔程〕五日为一候。三候为一气。一气十五日也。夫人受
气于天。气节更移。营卫亦因之以易。故交一节气当愈。不
愈者。再易一气。故云月尽解也。
〔尤〕设更不愈。其邪必假血根据痰。结为 瘕。僻处胁下。将成负固不服
之势。故宜急治。鳖甲煎丸。行气逐血之药颇多。而不嫌其峻。一日三服。不嫌其急。所谓乘其未集而击之
也。
〔魏〕寒热杂合之邪。在少阳。而上下格阻之气结厥阴。聚肝下之血分。而实为疟病之母气。足于生疟而
不已。此所阴阳互盛。历月经年。而病不除也。盖有物以作患于里。如草树之有根 。必须急为拔去。不然旋
伐旋生。有母在焉。未有不滋蔓难图者矣。
案玉篇。HT 。莫浓切。病HT 癖也。乃疟母之母。从 者。
三因云。结为 癖。在腹胁。名曰老疟。亦名曰母疟。
鳖甲煎丸方（外台。作大鳖甲煎。引张仲景伤寒论。云出第十五卷中。）
鳖甲（十二分炙○千金作成死鳖注云要略作鳖甲三两） 乌扇（三分烧） 黄芩
（三分） 柴胡（六分） 鼠妇（三分熬） 干姜（三分） 大黄（三分） 芍药（五分） 桂
枝（三分） 葶苈（一分熬） 石韦（三分去毛） 浓朴（三分） 牡丹（五分去心） 瞿麦
（二分） 紫葳（三分） 半夏（一分） 人参（一分） 虫（五分熬） 阿胶（三分炙） 蜂
窠（四分炙） 赤硝（十二分） 蜣螂（六分熬） 桃仁（二分）
上二十三味。为末。取锻灶下灰一斗。清酒一斛。五斗浸灰。候酒尽一半。着鳖甲于中。煮令泛烂如
胶漆。绞取汁。纳诸药。煎为丸。如梧子大。空心服七丸。日三服。（〔原注〕千金方。用鳖甲十二片。又有海藻三分。
大戟一分。 虫五分。无鼠妇赤硝二味。以鳖甲煎
和诸药为丸。○案今考千金。无鼠妇紫葳赤硝。有虻虫紫菀海藻大戟。凡二十四味。分两
颇异。不繁引于此。浸灰候酒尽一半。作以酒浸灰去灰取酒。似是。）
〔程〕疟母者。邪气内搏于脏腑。血气羁留而不行息而成积。故内结 瘕。而外作往来寒热。内经曰。
坚者削之。结者行之。以鳖甲。主 瘕寒热。故以为君。邪结于血分者。用大黄芍药 虫桃仁赤硝牡丹鼠妇
紫葳。攻逐血结为臣。邪结于气分者。浓朴半夏石韦葶苈瞿麦乌羽蜂房蜣螂。下气利
小便。以为佐。调寒热和阴阳。则有黄芩干姜。通营卫。则有桂枝柴胡。和气血。则有阿胶人参。六味又
用之。以为使也。结得温即行。灶灰之温。清酒之热。所以制鳖甲。同诸
药而逐 瘕疟母。内经曰。治有缓急。方有大小。此急治之大方也。
案乌扇。即射干。见本经。千金作乌羽。赤硝。活人书云。硝石生于赤山。考本草。射干。散结气腹中
邪逆。鼠妇。治月闭血瘕寒热。石韦。治劳热邪气。利水道。紫葳。治 瘕血闭寒热。瞿麦。利小便。下
闭血。蜂窠。治寒热邪气。蜣螂。治腹胀寒热。利大小便。 虫。治血积 瘕破坚。
灶灰。即 铁灶中灰尔。亦主 瘕坚积。此方合小柴胡桂枝。大承气三汤。去甘草枳实。主以鳖甲。更用以
上数品。以攻半表之邪。半里之结。无所不至焉。然三因云。古方虽有鳖甲煎等。不特服不见效。抑亦药
料难备。此说殆有理焉。
师曰。阴气孤绝。阳气独发。则热而少气烦冤。手足热而欲呕。名曰瘅疟。若但热不寒者。邪气内
藏于心。外舍分肉之间。令人消铄肌肉。（肌。赵本作脱。案素问疟论曰。但热而不寒。气内
藏于心。而外舍于分肉之间。令人消铄脱肉。则赵本为是。）
〔程〕瘅。热也。内经曰。瘅疟者。肺素有热。气盛于身。厥逆上冲。中气实而不外泄。因有所用力。
腠理开。风寒客于皮肤之内。分肉之间而发。发则阳气盛。阳气盛而不衰。则病矣。其气不及于阴。故
但热而不寒。此肺素有热。而成瘅疟也。今所云阴气孤绝者。以热邪亢盛。热盛则气消。故
烦冤少气。表里俱病。今手足热而欲呕。心阳脏也。心恶热。邪气内藏于心。外舍于分肉之间。内外燔灼。
故令人消铄肌肉。此热藏于心。而为瘅疟也。然则瘅疟之所舍。属心肺两经者欤。
温疟者。其脉如平。身无寒但热。骨节疼烦。时呕。白虎加桂枝汤主之。（呕下。千金有朝发暮解。暮
发朝解名温疟十一字。）
〔程〕内经曰。温疟得之冬中于风寒。气藏于骨髓之中。至春则阳气大发。邪气不能自出。因遇大暑。
脑髓烁肌肉消。腠理发泄。或有所用力。邪气与汗皆出。此病藏之肾。其气先从内出之外也。如是者。阴虚
而阳盛。阳盛则热矣。衰则气复反入。入则阳虚。阳虚则寒矣。故先热而后寒。名曰温疟。今但热不寒。则
与瘅疟无异。意者内经。以先热后寒为温疟。仲景以但热不寒。为温疟也。脉如平。非平也。其气
不及于阴。故但热无寒。邪气内藏于心。故时呕。外舍于肌肉。故骨节疼烦。今阳邪偏胜。但热无寒。加桂
枝于白虎汤中。引白虎辛寒。而出入营卫。制其阳邪之亢害。
〔尤〕脉如平者。病非乍感。故脉如其平时也。
骨节烦疼时呕者。热从肾出。外舍于其合。而上并于阳明也。白虎甘寒除热。桂枝则因其势。而达之耳。
白虎加桂枝汤方
知母（六两） 甘草（二两炙） 石膏（一斤） 粳米（二合○案千金作六合据伤寒
论作六合为是） 桂（去皮三两○俞本作桂枝是）
上锉每五钱。水一盏半。煎至八分。去滓温服。汗出愈。（
俞本出下。有即字。案徐沈作上五味以水一斗。煮米熟汤成。去滓。温服一升。日三服。
一云。上锉每五钱。水盏半。煎至八分。去滓温取。汗出愈。尤本根据前法。此盖古之煎法
其云钱云盏。系于宋人改定。千金云。上四味 咀。以水一斗二升。煮米烂。去滓。加桂
枝三两。煎取三升。分三服。覆令汗。先寒发热者愈。外台。引千金。方后。伤寒论云。
用粳米。不熟稻米是也。）
案圣济总录。知母汤。治温疟骨节疼痛。时呕朝发暮解。暮发朝解。（即本方。）
活人白虎加苍术汤 治湿温多汗。于白虎汤中。加苍术三两。（此方出伤寒微旨。亦仿金匮白虎加桂汤。）
疟多寒者。名曰牡疟。蜀漆散主之。（程作牝疟。金鉴同。）
〔尤〕疟多寒者。非真寒也。阳气为痰饮所遏。不得外出肌表。而但内伏心间。心牡脏也。故名牡疟。
蜀漆吐疟痰。痰去则阳伸。而寒愈。取云母龙骨者。以蜀漆上越之猛。恐并动心中之神与气也。
案尤注详备。第牡疟之解。本于喻氏法律。此恐非也。外台引本条云。张仲景伤寒论。疟多寒者。名
牝疟。吴氏医方考云。牝阴也。无阳之名。故多寒名牝疟。此说得之金鉴云。此言牝疟。其文脱简。内经
已详。不复释。今考内经。无牝疟证。亦误。（兰台轨范云。似当作牝字。诸本皆作牡。存考。）
蜀漆散方
蜀漆（洗去腥○案赵本洗作烧非） 云母（烧二日夜） 龙骨（等分）
上三味。杵为散。未发前以浆水服半钱。○温疟。加蜀漆半分。临发时。服一钱匕。（〔原注〕一方云
母。作云实。○浆水。千金。作酢浆。外台。作清浆水。尤本删温疟以下十四字。千金注云。要略不用云母。
用云实。）
〔程〕蜀漆。常山苗也。得浆水。能吐疟之顽痰。三阴者。其道远。故于未发之先服。令药入阴分。以
祛其邪。属心肺者。其道近。故于临发之时服。令药力入心肺。以祛其邪。
此方乃吐顽痰。和阴阳之剂。故牝疟温疟。俱可服。
医通云。方后有云。湿疟。加蜀漆半分。而坊本误作温疟。大谬。此条本以邪伏髓海。谓之牝疟。
赵以德不辨亥豕。注为邪在心而为牡。喻嘉言亦仍其误而述之。非智者之一失欤。案危氏得效方云。寒热
身重。烦疼胀满。名湿疟。丹溪纂要云。在三阴。总谓之湿疟。湿疟之称。古经方无所考。
仅见于此。则其言不可从。况邪伏髓海之说。未见所据。
仁斋直指云。凡疟方来与正发。不可服药。服药在于未
发两时之先。否则药病交争。转为深害。
案以未发前服之语观之。即是后世所谓截疟之药也。外台。载广济常山汤。常山三两。以浆水三升。浸
经一宿。煎取一升。欲发前顿服之。后微吐瘥止。与本方。其意殆同矣。
附外台秘要方（程本金鉴。并不载附方。以下各篇同。）
牡蛎汤 治牡疟。
牡蛎（四两熬） 麻黄（去节四两） 甘草（二两） 蜀漆（三两○外台云若无用常山代之）
上四味。以水八升。先煮蜀漆麻黄。去上沫。得六升。纳诸药。煮取二升。温服一升。若吐则勿更服。
〔尤〕案此系宋孙奇等所附。盖亦蜀漆散之意。而外攻之
力较猛矣。赵氏云。牡蛎。软坚消结。麻黄。非独散寒。且可发越阳气。使通于外。结散阳通。其病自愈。
外台云。仲景伤寒论。牝疟多寒者。名牝疟。牡蛎汤主之。根据此。则牡即牝之讹。
此方外台。列于蜀漆散前。云。并出第十五卷中。
柴胡去半夏加栝蒌汤 治疟病发渴者。亦治劳疟。
柴胡（八两） 人参 黄芩 甘草（各三两） 栝蒌根（四两） 生姜（二两） 大枣（十二枚）
上七味。以水一斗二升。煮取六升。去滓再煎。取三升。温服一升。日二服。
〔徐〕伤寒论。寒热往来。为少阳邪在半表里故也。疟邪亦在半表里。故入而与阴争则寒。出而与阳
争则热。此少阳之象也。是谓少阳而兼他经之证则有之。谓他经而全不涉少阳。则不成其为疟矣。所以
小柴胡。亦为治疟主方。渴易半夏加栝蒌根。亦治少阳成法也。攻补兼施。故亦主劳疟。
外台云。张仲景伤寒论。疟发渴者。与小柴胡去半夏加
栝蒌汤。经心录。疗劳疟。出第十五卷中。
案巢源劳疟候云。凡疟积久不瘥者。则表里俱虚。客邪未散。真气不复。故疾虽暂间。小劳便发。
柴胡桂姜汤 治疟寒多。微有热。或但寒不热。（〔原注〕服一剂如热○俞本姜作蒌非。）
柴胡（半斤） 桂枝（三两去皮） 干姜（二两） 栝蒌根（四两） 黄芩（三两） 牡蛎（二两熬）
甘草（二两炙）
上七味。以水一斗二升。煮取六升。去滓再煎。取三升。温服一升。日三服。初服微烦。复服汗出便愈。
〔徐〕胸中之阳气。散行于分肉之间。今以邪气痹之。则外卫之阳。郁伏于内守之阴。而血之痹者。既
The Master said: The pulse of malaria naturally presents as a string-like (Xian) pulse. A string-like and rapid pulse indicates mostly heat; a string-like and slow pulse indicates mostly cold. A string-like, small, and tight pulse can be treated with purgation to achieve recovery; a string-like and slow pulse can be treated with warming methods; a string-like and tight pulse can be treated with sweating methods and acupuncture; a floating and large pulse can be treated with emesis. A string-like and rapid pulse indicates wind-induced fever, which can be stopped by dietary regulation. (Note: In the phrase "string-like, tight, [purgation]", several characters are missing in *Mai Jing*. "Wind-induced" is written as "wind disease" in *Wai Tai Mi Yao*.)
[Cheng Lin] *Nei Jing* states that malaria arises from wind pathogens. Why do its paroxysms have a specific timing? Qibo said: When malaria first begins, it starts with goosebumps, followed by yawning, then chills with jaw quivering, and pain in the waist and spine. After the cold subsides, both interior and exterior become hot, accompanied by thirst and desire to drink water. During the chills, neither hot soup nor fire can warm the body; during the fever, neither ice nor cold water can cool it. This is due to the conflict between Yin and Yang, with deficiency and excess pathogens occurring simultaneously. The pathogen lodges between Ying (Nutritive) and Wei (Defensive) levels. Because the wind-cold qi fluctuates irregularly, the paroxysms and remissions occur at regular intervals, manifesting as alternating chills and fever. Liver Qi stagnation generates heat, and heat causes a rapid pulse. This represents a mild pathogenic factor, so dietary regulation is used to stop it. The classic says: Each of the five Zang organs has foods that aid recovery and substances they dislike. By following their dislikes to avoid aggravating the disease and accommodating their preferences through dietary adjustment, malaria will naturally cease. The above methods are described thus, but subsequent texts lack detailed explanations of sweating, emesis, purgation, warming, and acupuncture. Due to the great distance from antiquity, the text is often abbreviated and cannot be verified.
[Xu Dacun] Malaria is a disease of the half-exterior and half-interior, not an acute external contraction. Thus, *Nei Jing* states: Summerheat injured in summer leads to malaria in autumn. It also states: The location is inside the skin but outside the stomach and intestines. Precisely because it is in the half-exterior and half-interior, the pulse must be string-like. The string-like pulse corresponds to the Wood Qi of East Jia, belonging to the Shaoyang channel. Hence, it is said that the malaria pulse is naturally string-like. "Naturally" means that although wind-cold is contracted, the pulse specifically appears string-like. Since the pulse has a definite form, combined with rapidness indicates heat, and combined with slowness indicates cold; this is the general principle.
[You Zaijing] Malaria is Shaoyang pathogen; the string-like pulse is the Shaoyang pulse. With this pathogen comes this pulse. However, while the seat of malaria is indeed between half-exterior and half-interior, the Qi of malaria varies in degree. Thus, some cases have more heat, some more cold, some predominantly interior allowing purgation, some predominantly exterior allowing sweating or emesis, and some where wind emerges from heat, which cannot be dispersed by medicine alone. Treatment should follow the pulse. Xu stated: Large pulse is Yang, small pulse is Yin. Tight is a cold pulse, but small-tight enters inward becoming Yin. Yin cannot be dispersed from the exterior, hence purgation heals. Slow indicates cold, so warming is unquestionable. String-like and tight without sinking is a cold pulse, not a Yin pulse. Not being Yin allows for sweating and acupuncture. Generally, malaria pulses are string-like; if suddenly floating and large, the pathogen is high. High pathogens are guided upward and outward via emesis. Having stated that string-like and rapid indicates much heat, another point is added: string-like and rapid indicates wind-induced fever, meaning excessive heat reaches extreme heat. Extreme heat generates wind; wind generation causes Liver Wood to overact on Spleen Earth, transmitting heat to the Stomach, consuming fluids. This requires not just medicine but dietary regulation to curb the blazing heat. Items like pear juice and sugarcane syrup, which generate fluids and quench thirst, align with the principle of *Nei Jing*: "Wind rampant within, treat with sweet-cold."
Commentary: The meaning of "stopping wind-induced fever by dietary regulation" is unclear. I cite these two scholars' views for reference. *Yi Zong Jin Jian* states that the "small" in "string-like, small, tight" should be "deep," providing rationale for purgation. "String-like, tight" should be "string-like, floating, tight," providing rationale for sweating. "String-like, floating, large" should be "string-like, slippery, large," providing rationale for emesis. This preserves the original meaning of "malaria pulse is naturally string-like." Such interpretations are unnecessary. The annotations by Xu and You are reasonable.
In malaria, if onset occurs on the first day of the lunar month, it should heal in fifteen days. If not healed, it should resolve by the end of the month. If still not healed, what should be done? The Master said: This condenses into a mass called "Malaria Mother" (Nuomu). It must be treated urgently. Use Biejia Jian Wan (Turtle Shell Decoction Pill). (*Mai Jing* omits thirty characters from "Bing Nue" to "Shi Yue Ci". Two characters "Nue Ji" appear before "Jie". Three characters "Ji Zhi Zhi" are absent. Zhao edition writes "Yuan" as "Wan", same below.)
[Cheng Lin] Five days constitute one Hou (decad); three Hous make one Qi (term/season), which is fifteen days. Humans receive Qi from Heaven; as solar terms shift, Ying and Wei Qi change accordingly. Thus, after one solar term, it should heal. If not, after changing another term, it resolves. Hence, "resolve by month's end."
[You Zaijing] If it still does not heal, the pathogen likely borrows blood and phlegm to form a mass, lodging eccentrically in the hypochondrium, threatening stubborn resistance. Therefore, urgent treatment is needed. Biejia Jian Wan contains many Qi-moving and blood-draining herbs, yet their harshness is acceptable. Taken three times daily, the urgency is acceptable. This is attacking while the pathogen has not fully gathered.
[Wei Litong] Cold-heat mixed pathogens reside in Shaoyang, while obstructed Qi knots in Jueyin, gathering blood in the liver area, truly forming the mother Qi of malaria, causing continuous attacks. This involves Yin-Yang mutual excess, lasting months or years without resolution. Essentially, a physical entity acts as a nuisance internally, like roots of grass and trees, requiring urgent removal. Otherwise, cutting leads to regrowth because the "mother" remains, leading to uncontrollable spread.
Commentary: *Yu Pian* defines "HT" (Pi) with pronunciation Mo Nong Qie. Disease "HT Pi" refers to the "Mother" of Malaria Mother. From the disease radical. *San Yin Fang* states: Knotting forms "HT Pi" in abdomen/hypochondrium, named Old Malaria or Mother Malaria.
Biejia Jian Wan Formula (*Wai Tai Mi Yao* calls it Da Biejia Jian, citing Zhang Zhongjing's *Shang Han Lun*, Vol 15):
Biejia (Turtle Shell) (12 fen, roasted. *Qian Jin* makes dead turtle, note says *Yao Lue* uses 3 liang Biejia), Wushan (Black Cuscuta Seed/Shexiang) (3 fen, burned), Huangqin (Scutellaria Root) (3 fen), Chaihu (Bupleurum Root) (6 fen), Shufu (Jersey Devil Crab) (3 fen, roasted), Ganjiang (Dried Ginger) (3 fen), Dahuang (Rhubarb Rhizome) (3 fen), Shaoyao (Peony Root) (5 fen), Guizhi (Cinnamon Twig) (3 fen), Tingli (Perilla Seed) (1 fen, roasted), Shiwei (Pyrrosia Leaf) (3 fen, de-haired), Houpo (Magnolia Bark) (3 fen), Mudan (Moutan Cortex) (5 fen, heart removed), Qumai (Dianthus Herb) (2 fen), Ziwei (Cornus Flower) (3 fen), Banxia (Pinellia Tuber) (1 fen), Renshen (Ginseng Root) (1 fen), Mengchong (Blister Beetle) (5 fen, roasted), Ejiao (Donkey-hide Gelatin) (3 fen, roasted), Fengke (Honeycomb) (4 fen, roasted), Chixiao (Red Niter) (12 fen), Qianglang (Dung Beetle) (6 fen, roasted), Taoren (Peach Kernel) (2 fen).
These twenty-three ingredients are powdered. Take one dou of ash from a forged iron stove, one hu of clear wine, soak the ash in five dou of wine. Wait until half the wine is absorbed. Add Biejia, boil until soft like glue. Strain the juice, add all medicines, decoct into pills the size of wutong seeds. Take seven pills on an empty stomach, three times daily. ([Original Note] *Qian Jin Fang* uses 12 pieces of Biejia, plus Haizao 3 fen, Daji 1 fen, Mengchong 5 fen, lacking Shufu and Chixiao. Uses Biejia decoction to bind other herbs. ○ Commentary: Current *Qian Jin* lacks Shufu, Ziwei, Chixiao, but has Mengchong, Ziwan, Haizao, Daji, totaling 24 ingredients. Dosages differ significantly; not cited here. Soaking ash waiting for half wine absorption implies soaking ash in wine, removing ash to get wine, which seems plausible.)
[Cheng Lin] Malaria Mother is pathogen internal binding to Zang-Fu, Qi and Blood stagnating to form accumulation. Internally knots as mass, externally causes alternating chills/fever. *Nei Jing* says: Hardness requires削 (scraping/reducing), knotting requires moving. Biejia treats masses and chills/fever, serving as Sovereign herb. Pathogens knotting in Blood level use Dahuang, Shaoyao, Mengchong, Taoren, Chixiao, Mudan, Shufu, Ziwei to attack blood stasis, serving as Minister. Pathogens knotting in Qi level use Houpo, Banxia, Shiwei, Tingli, Qumai, Wushan, Fengke, Qianglang to descend Qi and promote urination, serving as Assistant. To harmonize cold/heat and Yin/Yang, use Huangqin, Ganjiang; to unblock Ying/Wei, use Guizhi, Chaihu; to harmonize Qi/Blood, use Ejiao, Renshen. These six serve as Envoy. Knots move when warmed; stove ash warmth and clear wine heat constrain Biejia, working with other herbs to drive out mass and Malaria Mother. *Nei Jing* says: Treatment has urgency, formulas have sizes. This is a large formula for urgent treatment.
Commentary: Wushan is Shegan (Belamcanda Rhizome), seen in *Ben Jing*. *Qian Jin* writes Wu Yu. Chixiao: *Huoren Shu* says Niter grows in Red Mountain. *Ben Cao* notes: Shegan disperses knotting Qi and abdominal rebellion; Shufu treats amenorrhea, blood masses, chills/fever; Shiwei treats labor fever, pathogenic Qi, promotes waterways; Ziwei treats masses, blood closure, chills/fever; Qumai promotes urination, passes closed blood; Fengke treats chills/fever, pathogenic Qi; Qianglang treats abdominal distension, chills/fever, promotes bowel/bladder movement; Mengchong treats blood accumulation, breaks masses. Stove ash is ash from iron forging, also treating hard masses. This formula combines Xiao Chai Hu Tang, Gui Zhi Tang, and Da Cheng Qi Tang, removing Gancao and Zhishi, prioritizing Biejia, adding aforementioned items to attack half-exterior pathogens and half-interior knots, reaching everywhere. However, *San Yin Fang* states ancient formulas like Biejia Jian are ineffective and hard to prepare. This view has merit.
The Master said: When Yin Qi is isolated and extinct, and Yang Qi fires alone, there is fever, shortness of breath, oppression, hot hands/feet, and desire to vomit. This is named Dan Nue (Cancer Malaria/Hot Malaria). If only heat without cold, the pathogen hides internally in the Heart, externally in the flesh spaces, causing muscle wasting. ("Muscle" in Zhao edition is "Tuò" (wasting). Commentary: *Su Wen · Nue Lun* says: Only heat no cold, Qi hides in Heart, externally in flesh spaces, causing muscle wasting. Thus Zhao edition is correct.)
[Cheng Lin] Dan means heat. *Nei Jing* says: Dan Nue arises because Lung has prior heat, Qi is abundant in body, rebellious rising upward, Middle Qi full but not escaping externally. Due to exertion, pores open, wind-cold enters skin/flesh spaces. Onset makes Yang Qi abundant. Abundant Yang without decline causes disease. Its Qi does not reach Yin, so only heat, no cold. This is Lung prior heat forming Dan Nue. What is now called "Yin Qi isolated/extinct" is because Heat pathogen is hyperactive. Heat excess consumes Qi, causing oppression and shortness of breath. Exterior/Interior diseased. Now hot hands/feet and vomiting indicate Heart (Yang organ). Heart dislikes heat. Pathogen hides in Heart, externally in flesh spaces, burning inside/outside, causing muscle wasting. This is Heat hiding in Heart, forming Dan Nue. Thus, Dan Nue resides in Lung and Heart meridians?
Wen Nue (Warm Malaria) has a pulse like normal. Body has no cold, only heat, joint pain/distress, occasional vomiting. Treat with Baihu Jia Guizhi Tang (White Tiger Plus Cinnamon Twig Decoction). (Below "Vomit", *Qian Jin* adds "Morning onset evening resolve, evening onset morning resolve named Wen Nue" - 11 chars.)
[Cheng Lin] *Nei Jing* says: Wen Nue results from wind-cold in winter, Qi hidden in bone marrow. Spring Yang expands, pathogen cannot exit. Encountering intense summer heat, brain marrow melts, muscles waste, pores open. Exertion causes pathogen and sweat to exit. Disease hides in Kidney, Qi moves from interior to exterior. Thus, Yin deficiency and Yang excess. Yang excess brings heat. Decline allows Qi to re-enter. Re-entry causes Yang deficiency, bringing cold. Hence, heat first, then cold, named Wen Nue. Now only heat no cold is similar to Dan Nue. Hypothesis: *Nei Jing* defines Wen Nue as heat-then-cold; Zhongjing defines it as heat-only-no-cold. Pulse like normal is not truly normal; Qi fails to reach Yin, so only heat no cold. Pathogen hides in Heart, causing vomiting. Externally in muscles, causing joint pain. Yang pathogen dominates, only heat no cold. Adding Guizhi to Baihu Tang guides Baihu's acrid-cold nature into Ying/Wei, restraining Yang pathogen's hyperactivity.
[You Zaijing] Pulse like normal means disease is not sudden, so pulse resembles normal state.
Joint distress and vomiting occur because heat exits Kidney, lodges in its opening, and merges with Yangming. Baihu's sweet-cold removes heat; Guizhi follows the trend to guide it out.
Baihu Jia Guizhi Tang Formula
Zhimu (Anemarrhena Rhizome) (6 liang), Gancao (Licorice Root) (2 liang, roasted), Shigao (Gypsum Fibrosum) (1 jin), Jingmi (Rice Grain) (2 he. Commentary: *Qian Jin* says 6 he, consistent with *Shang Han Lun*). Gui (Cinnamon) (3 liang, bark removed. Yu edition says Guizhi is correct).
Five ingredients. Coarsely crush. Every 5 qian, add 1.5 cups water, decoct to 0.8 cup, strain, take warm. Sweating indicates cure. (Yu edition adds "Ji" after "Chu". Commentary: Xu/Shen version: 5 ingredients, 1 dou water, boil rice until cooked, strain, take 1 sheng warm, 3x daily. Another version: Crush 5 qian, 1.5 cup water, decoct to 0.8 cup, strain, take warm, sweat cures. You edition follows previous method. Ancient decoction methods using "qian" and "cup" were Song dynasty modifications. *Qian Jin*: 4 ingredients coarse crush, 1.2 dou water, boil rice soft, strain, add Guizhi 3 liang, decoct to 3 sheng, divide 3 doses, cover to sweat. Chills-then-fever cures. *Wai Tai* cites *Qian Jin*. *Shang Han Lun*: Uses Jingmi, unripe rice.)
Commentary: *Sheng Ji Zong Lu* Zhimu Tang treats Wen Nue joint pain, vomiting, morning/evening onset-resolve. (Same formula.)
*Huoren Shu* Baihu Jia Cangzhu Tang treats damp-warmth with profuse sweating, adding Cangzhu 3 liang to Baihu Tang. (From *Shang Han Wei Zhi*, imitating *Jin Gui* Baihu Jia Guizhi Tang.)
Malaria with much cold is named Mu Nue (Male Malaria/Yang Malaria). Treat with Shuqi San (Patrinia Powder). (Cheng Lin writes Pin Nue, same as *Jin Jian*.)
[You Zaijing] Much cold in malaria is not true cold. Yang Qi is suppressed by Phlegm-Fluid, unable to exit to muscle surface, hiding internally in Heart. Heart is Yang (Mu) organ, hence named Mu Nue. Shuqi induces vomiting of malaria phlegm. Phlegm gone, Yang extends, cold heals. Yunmu and Longgu are used because Shuqi's ascending force is fierce, fearing it disturbs Heart Spirit and Qi.
Commentary: You's annotation is detailed. However, the explanation of Mu Nue originates from Yu Jia Yan's *Fa Lü*, which is likely incorrect. *Wai Tai Mi Yao* cites this clause: Zhang Zhongjing *Shang Han Lun*, Malaria much cold named Pin Nue. Wu Shi *Yi Fang Kao* says: Pin is Yin, no Yang name, hence much cold named Pin Nue. This view is correct. *Yi Zong Jin Jian* says: Text regarding Pin Nue has missing slips; *Nei Jing* details it, no need to explain. Examining *Nei Jing*, there is no Pin Nue syndrome, also an error. (*Lan Tai Gui Fan* says: Should probably be Pin character. All editions write Mu, preserve for study.)
Shuqi San Formula
Shuqi (Patrinia Herba) (wash to remove fishy smell. Commentary: Zhao edition washes as burns, incorrect), Yunmu (Cloud Mother/Mica) (burn for two nights), Longgu (Fossilized Bone) (equal parts).
Three ingredients, pound into powder. Take half a qian with Jiangshui (fermented grain water) before onset. ○ For Wen Nue, add Shuqi half a qian, take one qian-bi at onset. ([Original Note] One formula uses Yunshi instead of Yunmu. ○ Jiangshui: *Qian Jin* writes Cujiang, *Wai Tai* writes Qingjiangshui. You edition deletes 14 characters below Wen Nue. *Qian Jin* note: *Yao Lue* does not use Yunmu, uses Yunshi.)
[Cheng Lin] Shuqi is the sprout of Changshan (Dichroa Root). With Jiangshui, it can vomit stubborn malaria phlegm. Diseases of the Three Yin channels are distant, so taken before onset to enter Yin level and dispel pathogen. Diseases of Lung/Heart are close, so taken at onset to enter Lung/Heart and dispel pathogen.
This formula vomits stubborn phlegm and harmonizes Yin/Yang, suitable for both Pin Nue and Wen Nue.
*Yi Tong* states: Formula postscript mentions Wet Malaria, add Shuqi half qian, but market editions mistakenly write Warm Malaria, a major error. This clause originally refers to pathogen hiding in Marrow Sea, called Pin Nue. Zhao Yi De failed to distinguish characters, annotating as pathogen in Heart as Mu. Yu Jiayan repeated this error. Is this not a slip of the wise? Commentary: Wei Shi *De Xiao Fang* says: Chills/fever, heavy body, painful distension named Wet Malaria. Danxi *Zuan Yao* says: In Three Yin, collectively Wet Malaria. Wet Malaria term found nowhere in ancient classics/formulas, only here, so its words cannot be followed. Moreover, pathogen hiding in Marrow Sea lacks basis.
Ren Zhai *Zhi Zhi Fang* states: When malaria is coming or fully erupting, do not administer medicine. Medication must be given before the pre-onset period. Otherwise, medicine and disease contend, causing deeper harm.
Commentary: Taking medicine before onset implies later "intercepting malaria" drugs. *Wai Tai* records Guangji Changshan Tang: Changshan 3 liang, soaked in 3 sheng Jiangshui overnight, decoct to 1 sheng, take all before onset, slight vomiting stops disease. Similar intent to this formula.
Append *Wai Tai Mi Yao* Formulas (Cheng Lin and *Jin Jian* do not record appendices, same for following chapters.)
Muli Tang (Oyster Shell Decoction) treats Mu Nue.
Muli (Oyster Shell) (4 liang, roasted), Mahuang (Ephedra Stem) (4 liang, nodes removed), Gancao (Licorice Root) (2 liang), Shuqi (Patrinia Herba) (3 liang. ○ *Wai Tai* says if unavailable, replace with Changshan).
Four ingredients. 8 sheng water. First decoct Shuqi and Mahuang, remove foam, obtain 6 sheng. Add remaining herbs, decoct to 2 sheng. Take 1 sheng warm. If vomiting occurs, do not take further.
[You Zaijing] Commentary: This was appended by Song dynasty Sun Qi et al., sharing the intent of Shuqi San but with stronger exterior-attacking power. Zhao Shi says: Muli softens hardness and dissipates knots; Mahuang not only disperses cold but also vents Yang Qi outward. Knots scatter, Yang connects, disease heals. *Wai Tai* says: Zhongjing *Shang Han Lun*, Pin Nue much cold, named Pin Nue, Muli Tang treats it. Based on this, Mu is a corruption of Pin.
*Wai Tai* lists this before Shuqi San, stating both come from Vol 15.
Chaihu Qu Banxia Jia Gualou Tang (Bupleurum Decoction minus Pinellia plus Trichosanthes Root) treats Malaria with thirst, also treats Lao Nue (Consumptive Malaria).
Chaihu (Bupleurum Root) (8 liang), Renshen (Ginseng Root), Huangqin (Scutellaria Root), Gancao (Licorice Root) (3 liang each), Gualougen (Trichosanthes Root) (4 liang), Shengjiang (Fresh Ginger) (2 liang), Dazao (Jujube) (12 pieces).
Seven ingredients. 1.2 dou water, decoct to 6 sheng, strain, decoct again to 3 sheng. Take 1 sheng warm, twice daily.
[Xu Dacun] *Shang Han Lun* states: Alternating chills/fever indicates Shaoyang pathogen in half-exterior/half-interior. Malaria pathogen is also in half-exterior/half-interior. Entering contests with Yin causing cold; exiting contests with Yang causing heat. This is Shaoyang image. Shaoyang combining other meridians exists; other meridals entirely unrelated to Shaoyang do not constitute malaria. Thus Xiao Chai Hu Tang is a main formula for malaria. Thirst replaces Banxia with Gualougen, a standard Shaoyang method. Attacking and tonifying combined, thus treats Lao Nue.
*Wai Tai* says: Zhang Zhongjing *Shang Han Lun*, Malaria with thirst, give Chaihu Qu Banxia Jia Gualou Tang. *Jing Xin Lu* treats Lao Nue, from Vol 15.
Commentary: Chao Yuanfang *Zhu Bing Yuan Hou Lun* Lao Nue section states: Malaria lingering long causes exterior/interior deficiency, guest pathogen not scattered, true Qi not restored. Disease temporarily pauses, minor exertion triggers recurrence.
Chaihu Guijiang Tang (Bupleurum, Cinnamon, and Dried Ginger Decoction) treats Malaria with much cold, slight heat, or only cold no heat. ([Original Note] After one dose feels like heat. ○ Yu edition writes Jiang as Lou, incorrect.)
Chaihu (Bupleurum Root) (0.5 jin), Guizhi (Cinnamon Twig) (3 liang, bark removed), Ganjiang (Dried Ginger) (2 liang), Gualougen (Trichosanthes Root) (4 liang), Huangqin (Scutellaria Root) (3 liang), Muli (Oyster Shell) (2 liang, roasted), Gancao (Licorice Root) (2 liang, roasted).
Seven ingredients. 1.2 dou water, decoct to 6 sheng, strain, decoct again to 3 sheng. Take 1 sheng warm, three times daily. Initial dose causes slight irritability; subsequent doses cause sweating and cure.
[Xu Dacun] Yang Qi in chest scatters between flesh spaces. Now blocked by pathogen, exterior defensive Yang is depressed within interior-storing Yin, and blood stasis...