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。
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。喻氏曰。仲景既云
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。此非可徒求之药。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。
病疟以月一日发。当十五日愈。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。宜鳖甲煎丸。
天气十五日一更。人之气亦十五日一更。气更则邪当解也。否则三十日天人之气再更。而邪自不
能留矣。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。
鳖甲煎丸方
鳖甲（十二分炙） 乌扇（三分烧即射干） 黄芩（三分） 柴胡（六分） 鼠妇（三分熬）
干姜 大黄 桂枝 石韦（去毛） 浓朴 紫葳（即凌霄） 阿胶（各三分） 芍药 牡丹（去心）
虫（各五分） 半夏（一分） 葶苈 人参（各一分） 瞿麦（二分） 蜂窠（四分炙） 赤硝
（十二分） 蜣 （六分熬） 桃仁（二分去皮尖研）
上二十三味。为末。取 灶下灰一斗。清酒一斛五升。浸灰。俟酒尽一半。着鳖甲于中。煮令泛
烂加胶漆。绞取汁。内诸药。煎为丸。如梧子大。空心服七丸。日三服。千金方用鳖甲十二片。又有
海藻三分。大戟一分。无鼠妇、赤硝二味。
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。令人消烁肌肉。
此与内经论瘅疟文大同。夫阴气虚者。阳气必发。发则足以伤气而耗神。故少气烦冤也。四肢者。诸
阳之本。阳盛则手足热也。欲呕者。热干胃也。邪气内藏于心者。瘅为阳邪。心为阳脏。以阳从阳。故
邪外舍分肉。而其气则内通心脏也。消烁肌肉者。肌肉为阴。阳极则阴消也。
温疟者。其脉如平。身无寒但热。骨节烦疼。时呕。白虎加桂枝汤主之。
此与内经论温疟文不同。内经言其因。此详其脉与证也。瘅疟、温疟。俱无寒但热。俱呕。而其
因不同。瘅疟者。肺素有热。而加外感。为表寒里热之证。缘阴气内虚。不能与阳相争。故不作寒也。
温疟者。邪气内藏肾中。至春夏而始发。为伏气外出之证。寒蓄久而变热。故亦不作寒也。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） 石膏（一斤） 甘草（二两炙） 粳米（二合） 桂枝（三两）
上五味。以水一斗。煮米熟汤成。去滓。温服一升。日三。
疟多寒者。名曰牡疟。蜀漆散主之。
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、牡藏也。故名牡疟。
蜀漆能吐疟痰。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。
蜀漆散方
蜀漆（洗去腥） 云母（烧二日夜） 龙骨（等分）
上三味。杵为散。未发前。以浆水服半钱匕。
附外台秘要三方
牡蛎汤
牡蛎 麻黄（各四两） 甘草（二两） 蜀漆（三两）
上四味。以水八升。先煮蜀漆、麻黄。去上沫。得六升。内诸药。煮取二升。温服一升。若吐则
勿更服。
按、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。
柴胡去半夏加栝蒌根汤 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。
柴胡桂姜汤 治疟。寒多微有热。或但寒不热。服一剂如神。
柴胡（半斤） 桂枝（三两） 干姜（二两） 栝蒌根（四两） 黄芩（三两） 甘草（二两炙）
牡蛎（二两熬）
上七味。以水一斗。煮取六升。去滓。再煎。取三升。温服一升。日三。初服微烦。复服汗出便
愈。
赵氏曰。此与牡疟相类而实非。牡疟邪客心下。此风寒湿痹于肌表。肌表既痹。阳气不得通于外。
遂郁伏于营血之中。阳气化热。血滞成瘀。着于其处。遇卫气行阳二十五度及之。则病作。其邪之入
营者。既无外出之势。而营之素痹者。亦不出而与阳争。故少热或无热也。是用柴胡为君。发其郁伏
之阳。黄芩为佐。清其半里之热。桂枝、干姜。所以通肌表之痹。栝蒌根、牡蛎。除留热。消瘀血。
甘草和诸药。调阴阳也。得汗则痹邪散。血热行。而病愈矣。
The Master said: The pulse of malaria (Nüe Bing) is naturally wiry (Xian). A wiry and rapid (Shu) pulse indicates predominantly heat; a wiry and slow (Chi) pulse indicates predominantly cold. A wiry, small, and tight pulse may be treated with purgation to achieve recovery. A wiry and slow pulse may be treated with warming methods. A wiry and tight pulse may be treated with diaphoresis or acupuncture and moxibustion. A floating and large pulse may be treated with emesis. A wiry and rapid pulse indicates wind-heat onset; this can be controlled through dietary management.
Malaria is an evil affecting the Shaoyang (Lesser Yang) channel, which governs the pivot and resides between the exterior and interior. The wiry pulse is the characteristic pulse of the Shaoyang channel. Where there is such an evil, there appears such a pulse. However, while the seat of malaria is indeed between the exterior and interior, the qi dynamics of malaria vary in their excess or deficiency. Thus, the disease manifests as having more heat, more cold, pathology primarily in the interior amenable to purgation, pathology primarily in the exterior amenable to diaphoresis or emesis, or wind emerging from heat which should not be dispersed by medication alone. Treatment must be administered according to the respective pulses.
Xu stated: A large pulse belongs to Yang; a small pulse belongs to Yin. Although a tight pulse is a cold pulse, a small and tight pulse indicates that the pathogen has entered inward and become Yin. Yin patterns cannot be dispersed from the exterior; therefore, it is said that purgation leads to healing. Since a slow pulse indicates cold, warming treatment is undoubtedly appropriate. A wiry and tight pulse that is not deep is a cold pulse but not a Yin pulse. Since it is not a Yin pattern, diaphoresis or acupuncture and moxibustion are permissible. Generally, the malaria pulse is wiry; if it suddenly becomes floating and large, it indicates the pathogen is in the high position (upper Jiao). For pathogens in high positions, guiding them upward and outward via emesis is indicated.
Yu stated: Zhang Zhongjing mentioned that a wiry and rapid pulse indicates much heat, and further elaborated: a wiry and rapid pulse signifies wind-heat onset. This implies that if heat persists, it will reach extreme heat. Extreme heat generates wind; wind generation causes Liver Wood to overact on Spleen Earth, transmitting heat to the Stomach, thereby consuming body fluids. This cannot be addressed solely by medication; one must use dietary management to curb the blazing heat. Substances like pear juice and sugarcane syrup, which generate fluids and quench thirst, align with the principle in the *Neijing* ("Wind rampant within, treat with sweet and cold").
If malaria begins on the first day of the lunar month, it should resolve after fifteen days. If it does not improve, it should resolve by the end of the month. If it does not resolve then, what should be done? The Master said: This occurs when the evil condenses into a mass (Jia), named Malaria Mother (Nu Mu - a spleenomegaly associated with chronic malaria). It requires urgent treatment, preferably using Biejia Jian Wan (Turtle Shell Decoction for Reducing Masses).
Heavenly Qi changes every fifteen days, and human Qi also changes every fifteen days. When Qi changes, the evil should resolve. Otherwise, at thirty days, the Qi of heaven and humanity changes again, and the evil cannot remain. If it still does not heal after this change, the evil must have attached itself to blood and relied on phlegm-fluids to form a mass, lodging in the hypochondrium. It will assume a posture of stubborn resistance. Therefore, urgent treatment is required. Biejia Jian Wan contains many herbs for moving Qi and driving out blood stasis, yet its harshness is not a concern. Taken three times a day, its urgency is not a concern. This is known as attacking the enemy before it has fully assembled.
**Biejia Jian Wan Formula:**
Bie Jia (Turtle Shell, 12 fen, processed with fire)
Wu Shan (Ophiopogon/Tuberous Ophiopogon Rhizome, 3 fen, roasted; i.e., She Gan/Iris Tectori Rhizoma)
Huang Qin (Scutellaria Root, 3 fen)
Chai Hu (Bupleurum Root, 6 fen)
Shu Fu (Male Fly, 3 fen, processed)
Gan Jiang (Dried Ginger)
Da Huang (Rhubarb Root)
Gui Zhi (Cinnamon Twig)
Shi Wei (Pyrrosia Leaf, de-haired)
Hou Po (Magnolia Bark)
Zi Wei (Lagerstroemia Flower, i.e., Ling Xiao Hua/Crape Myrtle Bark/Flower)
E Jiao (Donkey-hide Gelatin, 3 fen each with above)
Shao Yao (Peony Root)
Mu Dan Pi (Moutan Cortex, heart removed)
Jue Chong (Ground Beetle, 5 fen each with above)
Ban Xia (Pinellia Tuber, 1 fen)
Ting Li Zi (Descurainia Seed)
Ren Shen (Ginseng Root, 1 fen each with above)
Qu Mai (Polygonum Aviculare Herb, 2 fen)
Feng Ke (Honeycomb, 4 fen, processed)
Chi Xiao Dou (Red Adzuki Bean/Chixiaodou, 12 fen)
Qiang Lang (Dung Beetle, 6 fen, processed)
Tao Ren (Peach Kernel, 2 fen, skin and tip removed, crushed)
These twenty-three ingredients are powdered. Take one dou of ash from the kitchen stove and five sheng of clear wine. Soak the ash in the wine. When half the wine has been absorbed, place the Bie Jia in the mixture and boil until soft and rotten. Add gelatin and lacquer, strain to obtain the juice, add the other medicines, and decoct into pills the size of wutong seeds. Take seven pills on an empty stomach, three times daily. The *Qianjin Fang* uses twelve slices of Bie Jia, plus San Zao (Sargassum Thallus, 3 fen) and Da Ji (Euphorbia Root, 1 fen), omitting Shu Fu and Chi Xiao Dou.
The Master said: When Yin Qi is isolated and exhausted, and Yang Qi acts alone, fever, shortness of breath, and inner vexation occur. The hands and feet become hot, and there is a desire to vomit. This is called Dan Nüe (Febrile Malaria). If there is only heat without cold, the evil energy hides internally in the Heart and externally in the intermuscular spaces (Fen Rou), causing the muscles to waste away.
This text is largely consistent with the *Neijing*'s discussion on Dan Nüe. When Yin Qi is deficient, Yang Qi inevitably flares. Flaring damages Qi and consumes Spirit, resulting in shortness of breath and vexation. The four limbs are the root of all Yang channels; excessive Yang results in hot hands and feet. The desire to vomit is due to heat disturbing the Stomach. The evil hiding in the Heart: Dan is a Yang evil, and the Heart is a Yang organ. With Yang following Yang, the evil lodges externally in the Fen Rou, while its qi connects internally to the Heart. Muscle wasting occurs because muscles belong to Yin; extreme Yang leads to Yin consumption.
In Warm Malaria (Wen Nüe), the pulse resembles the normal state. There is no cold, only heat, severe joint pain, and occasional vomiting. Bai Hu Jia Gui Zhi Tang (White Tiger Plus Cinnamon Twig Decoction) is the primary treatment.
This differs from the *Neijing*'s description of Wen Nüe. The *Neijing* discusses etiology, whereas this text details the pulse and symptoms. Both Dan Nüe and Wen Nüe present with heat only (no cold) and vomiting, but their etiologies differ. Dan Nüe arises from pre-existing heat in the Lung combined with external contraction, resulting in an exterior-cold and interior-heat pattern. Because internal Yin Qi is deficient and cannot contend with Yang, chills do not occur. Wen Nüe involves an evil hidden in the Kidney, manifesting in spring and summer as latent Qi emerging outward. Cold accumulated over time transforms into heat, so chills also do not occur. The pulse resembling the normal state indicates the disease was not recently contracted, so the pulse reflects the patient's baseline. Severe joint pain and occasional vomiting occur because heat emerges from the Kidney, lodges externally in its paired area, and merges upward with the Yangming channel. Bai Hu Tang is sweet and cold to clear heat; Gui Zhi follows the pathological trend to vent the pathogen.
**Bai Hu Jia Gui Zhi Tang Formula:**
Zhi Mu (Anemarrhena Rhizome, 6 liang)
Shi Gao (Gypsum Fibrosum, 1 jin)
Gan Cao (Licorice Root, 2 liang, processed with fire)
Jing Mi (Glutinous Rice, 2 he)
Gui Zhi (Cinnamon Twig, 3 liang)
These five ingredients are boiled in ten dou of water until the rice is cooked and the decoction is ready. Strain. Take one sheng warm, three times daily.
When malaria presents with predominant chills, it is called Mu Nüe (Yang Malaria). Shu Qi San (Herba Patriniae Powder) is the primary treatment.
Predominant chills in malaria are not true cold; rather, Yang Qi is obstructed by phlegm-fluids and cannot reach the muscle surface, remaining latent in the Heart. The Heart is a Yang (Mu) organ, hence the name Mu Nüe. Shu Qi induces vomiting to expel malaria phlegm; once phlegm is gone, Yang Qi extends, and chills cease. Yun Mu (Cloud Mother/Mica) and Long Gu (Dragon Bone/Fossilized Bones) are used because Shu Qi's ascending action is fierce, and we fear it might disturb the Spirit and Qi of the Heart.
**Shu Qi San Formula:**
Shu Qi (Herba Patriniae, washed to remove fishy odor)
Yun Mu (Lepidolite/Mica, roasted for two days and nights)
Long Gu (Fossilized Bones, equal parts)
These three ingredients are pounded into a powder. Before the onset of the attack, take half a qian bi (measure) with Jiang Shui (fermented grain water).
**Appendix: Three Formulas from *Waitai Miyao***
**Muli Tang (Oyster Shell Decoction)**
Muli (Oyster Shell)
Ma Huang (Ephedra Stem, 4 liang each)
Gan Cao (Licorice Root, 2 liang)
Shu Qi (Herba Patriniae, 3 liang)
These four ingredients are boiled in eight sheng of water. First decoct Shu Qi and Ma Huang, removing the foam. Obtain six sheng of liquid. Add the remaining medicines and decoct to obtain two sheng. Take one sheng warm. If vomiting occurs, do not continue administration.
Note: This was appended by Sun Qi et al. in the Song Dynasty. It shares the intent of Shu Qi San but has stronger exterior-dispersing power. Zhao stated: Muli softens hardness and dissipates nodules; Ma Huang not only disperses cold but also vents Yang Qi, allowing it to circulate outward. When nodules dissipate and Yang Qi flows freely, the disease heals spontaneously.
**Chai Hu Qu Ban Xia Gua Lou Gen Tang (Bupleurum Decoction with Ban Xia Removed and Trichosanthes Root Added)**
Indicated for malaria with thirst, and also for Lao Nüe (Chronic/Wasting Malaria).
Chai Hu (Bupleurum Root, 8 liang)
Ren Shen (Ginseng Root)
Huang Qin (Scutellaria Root)
Gan Cao (Licorice Root, 3 liang each)
Gua Lou Gen (Trichosanthes Root, 4 liang)
Sheng Jiang (Fresh Ginger, 2 liang)
Da Zao (Jujube Fruit, 12 pieces)
These seven ingredients are boiled in twelve dou of water to obtain six sheng. Strain, then decoct again to obtain three sheng. Take one sheng warm, twice daily.
**Chai Hu Gui Jiang Tang (Bupleurum and Dried Ginger Decoction)**
Indicated for malaria with predominant chills and slight fever, or only chills without fever. One dose yields miraculous results.
Chai Hu (Bupleurum Root, 0.5 jin)
Gui Zhi (Cinnamon Twig, 3 liang)
Gan Jiang (Dried Ginger, 2 liang)
Gua Lou Gen (Trichosanthes Root, 4 liang)
Huang Qin (Scutellaria Root, 3 liang)
Gan Cao (Licorice Root, 2 liang, processed with fire)
Muli (Oyster Shell, 2 liang, processed)
These seven ingredients are boiled in ten dou of water to obtain six sheng. Strain, then decoct again to obtain three sheng. Take one sheng warm, three times daily. Mild irritability upon the first dose is expected; sweating upon subsequent doses indicates cure.
Zhao stated: This formula is similar to Mu Nüe but fundamentally different. In Mu Nüe, the evil lodges below the heart; here, Wind-Cold-Dampness Bi syndrome obstructs the muscle surface. Once the surface is Bi-obstructed, Yang Qi cannot circulate outward and becomes depressed within the Ying-Blood level. Yang Qi transforms into heat, and blood stasis forms, adhering to the site. When the Wei Qi circulates through the Yang levels twenty-five times and reaches this site, the disease manifests. The evil in the Ying level lacks the momentum to exit, and the Bi-obstructed Ying level does not emerge to contend with Yang, resulting in little or no fever. Therefore, Chai Hu is used as the Sovereign herb to vent the depressed Yang; Huang Qin as the Minister herb to clear semi-interior heat; Gui Zhi and Gan Jiang to unblock surface Bi; Gua Lou Gen and Muli to eliminate residual heat and resolve blood stasis; Gan Cao to harmonize the herbs and regulate Yin and Yang. Sweating disperses the Bi evil and moves blood heat, leading to recovery.