证二条（按此上。当脱脉字。） 方六首
师曰。疟脉自弦。（外台。师曰上。有辨疟脉三字。可温之。作温药已。脉经。弦紧者。作若脉紧数者。宋本
外台。亦作数紧。巢源。作脉数而紧者。外台。可吐之。作吐之瘥。弦数上。有脉字。消息止之。作消息之。）
按此条。就脉候以示疟病证治之纲领。盖疟是半表半里之病。其有表里证。亦少阳病邪之所派及。不比伤寒太
阳阳明之情机。故其汗吐下。亦与伤寒之治例不同。所言弦数者多热。即白虎加桂枝汤。柴胡去半夏加栝蒌汤证也。
弦小紧者。下之瘥。鳖甲煎丸是也。弦迟者可温之。柴胡桂枝干姜汤是也。弦紧者可发汗。牡蛎汤是也。浮大者可
吐之。蜀漆散是也。疗疟之法。实不能出于此数件矣。程氏谓不可考者。恐不然也。又刺疟篇曰。疟脉小实急。灸
胫少阴。又按弦数者风发也。以饮食消息止之。外台无止字。似义稍长。巢源载本条。
无此二句。有凡疟先发如食顷。乃可以治之。过之则失时十七字。本是刺疟篇文。
又按外台引。此条后有一条。云。又辨疟岁岁发至三岁发。连日发不解者。以胁下有痞也。疗之不得攻其痞。
但虚其津液。先其时发汗。其服汤已。先小寒者。渐引衣自覆汗出。小便利则愈。疟者。病患形瘦。皮上必粟起。
（巢源。千金。亦有此条。千金。连日上。有或字。巢源文少异。末截。作夫疟其人形瘦皮必栗。）
病疟以月一日发。（外台。病上。有问字。其。作期。类聚。圆。作丸。下并同。）
鳖甲煎圆方（外台。乌扇下。无烧字。葶苈二分。石韦二分。无去毛字。浓朴三分下。有炙字。牡丹下。无去
心字。半夏一分下。有洗字。蜣螂。熬。作炙。桃仁。作三分去皮尖熬。灰字。并作土字。一斛五斗。作一斛五升。
按古方所言分者。系裁分之分。非六铢为分之分。此方鳖甲。千金注。作三两。而锻灶下灰。与清酒。俱有定量。
则他药以分称者。盖后人所妄改。其三分者。宜作十八铢。六分。宜作一两十二铢。五分。宜作一两六铢。一分。
宜作六铢。二分。宜作十二铢。四分。宜作一两。始合古义。又辑义。石韦。紫威。从草。是书误笔手。）
按弟子山内虑曰。此方逐血之品特多者。以疟至久则血道涩滞。与邪搏结。杨仁斋有疟有水有血。当以常山草
果槟榔青皮乌梅甘草作剂。加五灵脂桃仁为佐之说。其意可见矣。此说为是。此方。盖崔氏所谓羁縻攻之者。（见
外台 瘕中。）注家以为急治。恐误。又本草鼠妇条。图经云。张仲景主久疟大鳖甲丸中使之。以其主寒热也。又
芒硝条。陶隐居引皇甫士安解散硝石大凡说云。硝石。三月采于赤山。
圣济。鳖肉煎丸。（主证同）不用鳖甲。以生鳖肉半斤。治如食法。去紫威。蜂窠。赤硝。加海藻。紫菀。大
戟。各一分。（余药亦皆一分。）桑螵蛸一两。修制与本方同。
师曰。阴气孤绝。（外台引。师曰上。有辨疟病三字。则热而。作而脉微者其候必七字。肌。作脱。类聚。亦
作脱。）
温疟者。其脉如平（脉经。作疟但见热者。温疟也。其脉平。身无寒但热。骨节疼烦。时呕。朝发暮解。暮发
朝解。名曰温疟。白虎加桂枝汤主之。巢源曰。夫病疟六七日。但见热者。温疟矣。又千金。外台。文互有异。今
不繁载。）
按内经以先热后寒为温疟。仲景则以无寒但热为温疟。稍与上条瘅疟相近。盖是别发一义者。不宜援内经温疟
为说矣。内经称冬伤于寒。春必温病。而仲景则曰。太阳病。发热而渴。不恶寒者。为温病。知是温疟之温。与温
病之温。实同其义。（详论于伤寒论述义中。）疟邪本在少阳。故时呕。此证则热邪熏胃者为甚。故身无寒但热。更
就骨节疼烦视之。则犹有表邪在。故加桂枝于白虎汤中。以兼治表里。此证。白虎清凉。而少阳之邪亦解。犹三阳
合病用白虎之例。但其脉如平。诸注未莹。愚亦未曾遇此病。末由知其理。存而阙疑已。
疟多寒者。名曰牡疟。（宋本外台。作牡疟。下蜀漆散同。盖其作牝者。程衍道所意改。存考。）
蜀漆散方（外台引。作蜀漆。洗去腥。云母。龙骨。上三味等分。捣节为散。先未发前一炊。以清酢浆水和半
钱服。临发时。更服一钱。温疟者。加蜀漆半分。云母。炭火烧之三日三夜用。按外台。似是。千金。一炊下。有
顷字。）
按云母龙骨性用。注家所说。似未明晰。考之本草。亦未见有治疟之能。窃以为此二味及牡蛎。俱有解水结之功。
故与蜀漆相配。能豁疟痰也。肘后方曰。老疟久不断也。未龙骨方寸七。先发一时。以酒一升半煮三沸。
及热尽服。温覆取汗。便即效。千金翼曰。疗痰饮头痛。往来寒热方。常山一两。云母粉二两。上二味为散。
熟汤服方寸匕。吐之止。若吐不尽更服。并与此方。其意相似。又刺疟篇次注曰。先其发时。真邪异居。波陇不起。
故可治。过时则真邪相合。攻之则反伤真气。故曰失时。盖得此说。而此方服法。义益明矣。（辑义所引。得效方文。
本出三因方。丹溪纂要文。本出保命集。）
附外台秘要方
牡蛎汤（外台。甘草炙。上四味切。以水先洗蜀漆三遍。去腥。以水八升。煮蜀漆及麻黄。去沫。取六升。内
二物。更煎取二升。去滓。温服一升。即吐勿更服则愈。）
按此方。吐而兼汗者。张戴人法。间有此类。然愚尝用治疟夜间发。及热甚无汗者。服后不吐而汗。稍稍邪解
就愈。尤氏以谓外攻之力较猛者。信矣。
柴胡去半夏加栝蒌汤（外台。甘草下。有炙字。生姜三两。大枣下。有擘字。七味下。有切字。再。作更。日
二服。作日三。千金。名柴胡栝蒌汤。用柴胡三两。大枣二十枚。讹。）
柴胡桂枝干姜汤（原注。如热。是如神讹。）
按此方。宋人取而附此。盖有所据也。今根据治疟。如神之言。殆不虚诬。太阳下编所用。系于太少并病。而兼
饮结者。如此条。徐注为核。（本于赵氏。）然疟有痰 积聚。许仁则既有其说。则此所用。亦为兼治饮结者。盖其
趣似异而实同者也。
Two Symptom Patterns (Note: The character "pulse" [Mai] is likely missing here.) Six Formulas
The Master said, "The pulse of malaria naturally presents as wiry [Xian]." (*Wai Tai Mi Yao* adds the phrase "Differentiating Malaria Pulses" before "The Master said." It suggests warm treatment. After administering warm medicines, *Mai Jing* records it as "If the pulse is tight and rapid." Song edition of *Wai Tai Mi Yao* also reads "rapid and tight." Chao Yuan-fang's *Zhu Bing Yuan Hou Lun* reads "the pulse is rapid and tight." *Wai Tai Mi Yao* also mentions "can induce vomiting," reading "vomiting leads to recovery." Before "wiry and rapid," the character "pulse" is present. "Adjust and stop" reads "adjust it." Note that in *Wai Tai Mi Yao*, there is no character for "stop," which seems to extend the meaning slightly. *Zhu Bing Yuan Hou Lun* includes this passage but omits these two sentences; instead, it contains seventeen characters stating: "For all malaria, treatment can be administered approximately one meal's time before onset; if missed, the opportunity is lost." These seventeen characters originally belong to the "Acupuncture for Malaria" chapter.)
According to this passage, pulse diagnosis serves as the guiding principle for treating malaria symptoms. Generally, malaria is a disease located at the half-exterior and half-interior level. Although it may present with exterior or interior signs, these are also extensions of Shaoyang pathogenic factors, differing significantly from the mechanisms of Taiyang and Yangming diseases in Cold Damage syndrome. Therefore, its methods of sweating, vomiting, and purging differ from those used in Cold Damage treatments. A wiry and rapid pulse indicates excessive heat, corresponding to the patterns treated by Baihu Jia Guizhi Tang (White Tiger plus Cinnamon Twig Decoction) and Chaihu Qu Banxia Gua Lou Tang (Bupleurum Decoction without Pinellia, plus Trichosanthes Root). A wiry, small, and tight pulse indicates that purgation will lead to recovery, corresponding to Biejia Jian Wan (Clam Shell Building-Dispersing Pill). A wiry and slow pulse indicates that warming therapy is appropriate, corresponding to Chaihu Guizhi Ganjiang Tang (Bupleurum, Cinnamon Twig, and Dried Ginger Decoction). A wiry and tight pulse indicates that diaphoresis (sweating) is indicated, corresponding to Musi Tang (Oyster Shell Decoction). A floating and large pulse indicates that emesis is indicated, corresponding to Shuqi San (Freesia Powder). The methods for treating malaria essentially cannot exceed these categories. Mr. Cheng claimed these were untraceable, which is likely incorrect. Furthermore, the "Acupuncture for Malaria" chapter states: "When the malaria pulse is small, solid, and urgent, moxa should be applied to the Shaoyin points on the lower legs." Additionally, a wiry and rapid pulse signifies wind-heat onset; it can be managed through dietary adjustments. *Wai Tai Mi Yao* lacks the character for "stop" in this context, suggesting a slightly different interpretation. *Zhu Bing Yuan Hou Lun* records this section without these two sentences but includes seventeen characters from the "Acupuncture for Malaria" chapter regarding timing.
Furthermore, following the citation in *Wai Tai Mi Yao*, there is another passage: "Regarding malaria that recurs annually up to every three years, or continuous daily attacks that do not resolve, this is due to a mass under the hypochondrium. Treatment should not attack the mass directly, as this only depletes body fluids. Instead, induce sweating prior to the onset. After taking the decoction, if the patient feels slight chills, gradually cover with clothing to induce sweating; when urination becomes smooth, the patient recovers. Patients with malaria appear emaciated, and their skin must exhibit gooseflesh." (*Zhu Bing Yuan Hou Lun* and *Qianjin Fang* contain this passage. In *Qianjin Fang*, the character "or" appears before "continuous days." *Zhu Bing Yuan Hou Lun* has slight textual variations, ending with "As for malaria, the person is emaciated and the skin must shiver.")
Malaria occurring on the first day of the lunar month. (*Wai Tai Mi Yao* adds the character "ask" before "disease." The character "qi" [his/her/its] is read as "qi" [period]. In *Yi Xin Fang / Lei Ju Yi Shu*, "yuan" [round] is read as "wan" [pill], consistent throughout the text below.*)
**Biejia Jian Wan Formula** (*Wai Tai Mi Yao*: No character for "burn" after "Wushan." Tingli [Descurainia Seed] 2 fen, Shiwei [Pyrosia Leaf] 2 fen, omitting "remove hairs." Houpo [Magnolia Bark] 3 fen, adding "roasted" after. Mudan [Moutan Cortex], omitting "remove heart." Banxia [Pinellia Tuber] 1 fen, adding "wash." Qianglang [Dung Beetle], "stir-fry" instead of "bake." Taoren [Peach Kernel], specified as "3 fen, remove skin and tip, stir-fry." The character "hui" [ash] is written as "tu" [soil] throughout. "One hu five dou" is recorded as "one hu five sheng." Note: In ancient prescriptions, "fen" refers to proportional division, not the weight unit where six zhu equals one fen. In this formula, Biejia [Trionyx Carapace] is noted in *Qianjin Fang* as 3 liang. Since the ash from the forge and Qingjiu [clear wine] have fixed quantities, the other herbs measured in "fen" were likely altered by later editors. Thus, 3 fen should be 18 zhu; 6 fen should be 1 liang 2 zhu; 5 fen should be 1 liang 6 zhu; 1 fen should be 6 zhu; 2 fen should be 12 zhu; 4 fen should be 1 liang. This aligns with ancient principles. Also, editorial notes indicate Shiwei was mistakenly written with a hand radical instead of grass radical.)
Disciple Shannai Lu stated: "This formula contains many blood-dispelling herbs because prolonged malaria causes blood stasis and binding with pathogens. Yang Renzhai proposed that since malaria involves water and blood, one should use Changshan [Radix Dichroae], Caoguo [Tsaoko Fructus], Binglang [Areca Seed], Qingpi [Aurantii Fructus Pericarpium], Wumei [Mume Fructus], and Gancao [Licorice Root] as the base, supplemented by Wulingzhi [Trogopterus Dung] and Taoren [Peach Kernel]. This insight is valid. This formula represents what Cui Shi described as 'indirect attacking' (see *Wai Tai Mi Yao*, Zhong Man Section). Commentators consider it an urgent treatment, which is likely mistaken. Additionally, regarding Shufu [Isotoma Fruit] in Ben Cao, Tu Jing states: Zhang Zhongjing used it in the Large Biejia Wan for chronic malaria because it treats chills and fever. Regarding Mangxiao [Natrii Sulfas], Tao Hongjing quotes Huangfu Mi'an saying: Natrii Sulfas is harvested in March from Red Mountain."
**Shengji Zonglu Bie Rou Jian Wan** (Indications same). Does not use Biejia; uses 0.5 jin of raw Bie Rou [Trionyx Flesh], prepared for consumption. Removes Ziwei [Stemona Radix], Fengke [Honeycomb], Chixiao [Red Natrii Sulfas]; adds Haizao [Sargassum Thallus], Ziwan [Asteris Radix], Daji [Euphorbiae Pekinensis Radix], each 1 fen. (Other herbs are also 1 fen each.) Sangpiaoxiao [Mantis Egg Case] 1 liang. Preparation is the same as the main formula.
The Master said: "Yin qi is isolated and exhausted." (*Wai Tai Mi Yao* adds "Differentiating Malaria Disease" before "The Master said." "Ze re er" is read as "Er mai wei zhe qi hou bi" [If the pulse is faint, the prognosis is certain]. "Ji" [muscle] is read as "tuo" [exhausted]. *Lei Ju Yi Shu* also reads "tuo".)*
**Wen Re** (Warm Malaria): Its pulse resembles that of a healthy person. (*Mai Jing* reads: "When malaria presents only with heat, it is Warm Malaria. The pulse is normal. The body has no chills, only heat; joints are painful and vexed; occasional vomiting. Onset in morning resolves evening; onset in evening resolves morning. Named Warm Malaria. Treated with Baihu Jia Guizhi Tang. *Zhu Bing Yuan Hou Lun* says: If malaria persists for six or seven days and presents only with heat, it is Warm Malaria." *Qianjin Fang* and *Wai Tai Mi Yao* have variant texts, not listed here for brevity.*)
According to *Nei Jing*, malaria starting with heat followed by cold is called Wen Re. Zhang Zhongjing defines it as having no chills, only heat, which is slightly similar to the previous pattern of Dan Re (Cachectic Malaria). It seems to introduce a separate conceptual meaning, so one should not cite *Nei Jing*'s definition of Wen Re here. *Nei Jing* states that winter injury by cold leads to warm diseases in spring, whereas Zhang Zhongjing states: "Taiyang disease with fever, thirst, and aversion to cold absent is termed Warm Disease." Thus, the "warmth" in Wen Re and Warm Disease shares the same underlying meaning (detailed in *Shanghan Lun Shuyi*). The malaria pathogen resides in Shaoyang, causing occasional vomiting. In this condition, heat pathogen steaming the stomach is severe, hence no chills, only heat. Considering joint pain and vexation, there remains an exterior pathogen. Therefore, Guizhi [Cinnamomi Ramulus] is added to Baihu Tang (White Tiger Decoction) to treat both exterior and interior. Here, Baihu Tang clears heat, resolving Shaoyang pathogen, similar to using Baihu Tang for combined Three-Yang disease. However, the pulse being "like normal" is not clearly explained by commentators. Having never encountered this specific presentation, I leave it as a doubt.
Malaria with predominant chills is named Mu Re (Male Malaria). (Song edition and *Wai Tai Mi Yao* read "Mu Re"; the subsequent Shuqi San is identical. The variant "Pin Re" [Female Malaria] was likely a subjective alteration by Cheng Yandao; kept for reference.)
**Shuqi San Formula** (*Wai Tai Mi Yao* citation: "Shuqi, wash to remove fishy odor. Yunmu [Muscovite], Longgu [Fossilized Bones]. These three ingredients in equal parts, grind into powder. Take half a qian mixed with clear vinegar juice one meal's time before onset. At onset, take another qian. For Warm Malaria, add half a qian of Shuqi. Yunmu, fired in charcoal fire for three days and nights." *Wai Tai Mi Yao* seems correct. *Qianjin Fang* adds "moment" after "one meal's time".)
Commentary: The properties of Yunmu and Longgu are unclear in commentaries. Examination of Ben Cao reveals no specific efficacy for malaria. I suspect these two herbs, along with Musi [Oyster Shell], possess the ability to resolve fluid accumulations. Combined with Shuqi, they can expel malaria phlegm. *Zhouhou Beiji Fang* states: "For chronic, persistent malaria. One cun square of Longgu, one hour before onset, boil in 1.5 sheng of wine for three boils. Drink hot while covered to induce sweat; effective immediately. *Qianjin Yi Fang* states: For phlegm-fluid headache with alternating chills and fever. Changshan [Radix Dichroae] 1 liang, Yunmu Fen [Powder] 2 liang. Grind into powder, take with cooked water using a fang cun spoon. Induce vomiting to stop symptoms. If vomiting is incomplete, administer again. This intent is similar to the current formula. Furthermore, the commentary on the 'Acupuncture for Malaria' chapter states: Treat before onset when true qi and pathogen are separated and waves have not risen. If delayed, true qi and pathogen merge, and attacking harms true qi, hence 'missing the time.' Understanding this clarifies the administration method of this formula." (Editorial notes cite *De Xiao Fang* from *San Yin Fang*; Danxi Cuanya from *Bao Ming Ji*.)
**Appendix: *Wai Tai Mi Yao* Formula**
**Musi Tang** (*Wai Tai Mi Yao*: Gancao [Licorice Root] roasted. Cut the four ingredients. Wash Shuqi three times with water to remove fishy odor. Add 8 sheng of water, boil Shuqi and Mahuang [Ephedrae Herba], skim foam, reduce to 6 sheng. Add remaining two herbs, boil down to 2 sheng. Strain, warm, drink 1 sheng. If vomiting occurs, do not take more; recovery follows.)
Commentary: This formula induces both vomiting and sweating, a method attributed to Zhang Dairen. I have used it for nocturnal malaria and cases with high fever and no sweat. Post-administration, patients sweated rather than vomited, leading to gradual resolution. You Shi correctly noted its strong exterior-attacking power.
**Chaihu Qu Banxia Gua Lou Tang** (*Wai Tai Mi Yao*: Gancao [Licorice Root] roasted. Shengjiang [Fresh Ginger] 3 liang. Dazao [Jujubae Fructus] cracked. Seven ingredients cut. "Re-" read as "Geng" [more]. Twice daily read as "Three times daily." *Qianjin Fang* names it Chaihu Gua Lou Tang, using Chaihu [Bupleuri Radix] 3 liang, Dazao 20 pieces; considered erroneous.)
**Chaihu Guizhi Ganjiang Tang** (Original note: "Ru Re" [Like Heat] is a typo for "Ru Shen" [Like God/Miraculous].)
Commentary: Song dynasty editors attached this formula here, likely based on evidence. Current application for malaria aligns with the "miraculous" description. In the Taiyang section of *Shanghan Lun*, it is used for concurrent Taiyang-Shaoyang disease with fluid retention. As per this passage, Xu's annotation is accurate (based on Zhao's work). However, since malaria involves phlegm accumulation, as noted by Xu Renze, this formula also addresses fluid retention. Though the applications seem different, the essence is the same.