师曰。疟脉自弦。弦数者多热。弦迟者多寒。弦小紧者。下之差。弦迟者。可温之。弦紧者。可发汗针炙也。浮大
者。可吐之。弦数者。风发也。以饮食消息止之。
李氏旧注曰。疟者。虐也。寒热暴侵。有虐政之象。故名疟。或曰。疟、谑也。寒去热休。与平人无殊。其病有如
戏谑之状故也。考之内经。皆由风寒暑湿之邪。客于太阳背部。及督脉诸穴中。而发为此病者也。其症先寒后热
者居多。盖因阳气逐邪。而内并于阴。则阳分外虚。而阴内盛。阳虚阴盛。其寒栗也宜矣。至于阳窘而极。则怒
将奋发。此剥极必复之道。且以卫外虚而吸之。则阳气引阴。而复并于外。阴虚阳实。阳实故热。阴虚故渴也。
阳者。正气也。正起则邪伏。故热反而疟渐解矣。此先寒后热。及热而后解之理也。疟邪尝格阳而顺阴。人身
阳气。日则行为卫而在外。夜则伏于脏而在内。太阳背部。及督脉诸穴者。阳气出入之所经也。阳与邪搏。邪
胜则寒。阳胜则热。热则阳已过邪所据之地。而邪遂解。然气机之流行有常度。而疟邪之占据无挪移。故明
日至此则又作。而时刻不爽者。此也。若邪气已离背部及督脉。而其头则内薄五脏。尾尚横连募原。募原者。
内为五脏通卫气之冲。而外为背部督脉行阳之驿。夫诸脏属阴而行迟。且道远气深。故其微阳。尝以两周。
而始得从募原以与卫气相值。是卫气如天行之速。一日一周。脏气如月与日之行迟。而以月会岁会之道
也。然脏气既出而与卫会。则邪亦随之而与卫阳相搏矣。故间日又作。凡此皆疟之大概也。阳气削弱。其脉
则弦。又少阳之主脉亦弦。病疟之人。受邪而不能推出。阳气既已削弱。况少阳系三阳之枢。为卫气起伏升
降之路。是卫与邪相角于少阳之部。而寒热渴呕之诸症见焉。故疟脉自弦也。热势躁急。故弦数之脉多热。
寒气痿顿。故弦迟之脉多寒。二句是主。以下十一句。俱从此而抽出言之也。小即细脉。有敛束之象。紧。即弦
脉之急者。言弦而细且急之脉。是敛束其饮食而至有急切之状。如脾约里急之义。此足阳明太阴。饮食积
于中焦。悍气不能充周则寒。精气不能滋息则热。下之。则积滞去而精悍贯通。故瘥也。此承弦数多热句来。
犹云弦数而小紧之谓。盖弦而不数。虽小紧不可下故也。弦为脉体不充。迟为动机不续。俱阳虚之应。阳虚。
则气机内并而寒。外并而热。或但寒而无热。如五条之症者。温之而阳气自满。使有升降之冲和。而无起伏
之偏弊。故可愈。此足少阴及三焦之疟。温之而大气一转。其病乃散也。二句承弦迟多寒。本文自明。弦紧四
句。凡两段。又双顶弦数弦迟而兼言之也。盖谓弦数而紧者。紧为寒诊。数为热应。是本因感寒。而标则化热。
故寒热迭见。而且先寒后热者。从标本之性也。夫祛寒固宜发汗。祛寒之化热者。尤宜发汗。故曰可发汗。如
邪在太阳阳明之经。日久不传。针之既夺其传路。复泻其余邪。如伤寒三阳经之例。故并亦可针也。至若弦
迟而紧者。紧为寒邪凝敛。迟为真阳衰息。弦又为卫气削弱之诊。是三阳部竭。而寒邪中之。不能根据脏腑经
络之阳以化热。即经所谓牝疟寒疟之类。灸之者。以外火暖其真阳。如伤寒三阴经之例。故曰可灸也。但言
灸而不言药者。以上文有用温之法。故仅言灸以互之耳。脉浮。为邪欲上涌。脉浮而大。为邪欲外泄。弦数而
浮大。以吐能散气。故可吐之以解其热。弦迟而浮大。以吐能提气。故可吐之以去其寒也。弦数为热。热则风
生。故不曰中风。而曰风发者。盖指风从内热而生之谓。风邪发乎肝胆。而其气善逆。故寒热交作而疟矣。饮
食消息。如积饮而为湿热者。其消息必渴。可去其热饮以止之。积食而为实热者。其消息必能食而不大便。
可去其实热以止之也。
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。宜鳖甲煎丸。
鳖甲煎丸方
鳖甲（一十分炙） 柴胡（六分） 人参（一分） 半夏（一分） 黄芩（三分） 桂枝（三分）
芍药（五分） 干姜（三分） 阿胶（三分炙） 丹皮（五分去心） 桃仁（二分） 浓朴（三分） 赤硝（十二分）
葶苈（一分熬） 瞿麦（二分） 大黄（二分） 乌扇（三分烧） 蜣螂（六分熬） 蜂窠（四分炙）
紫葳（三分） 鼠妇（三分熬） 虫（五分熬） 石韦（三分去毛）
（鼠妇色如莺背白足。俗呼为湿屎虫。北地坑席下长有之。盖亦走隙缝之阴类也。 虫北方未见。浙江
阴湿灰土中最多。大者径寸。栗壳色。形如壁虱而大。亦缝络中之阴虫类也。）
上二十三味。为末。取锻灶下灰一斗。清酒一斛五斗。浸灰。俟酒尽一半。着鳖甲于中。煮令泛烂如胶漆。绞
取汁。纳诸药。煎为丸。如梧桐子大。空心服七丸。日三服。（清酒一斛五斗。犹云以五斗斛一斛之谓。）
此谓疟邪之在下焦血分者也。病疟之人。假如以月之初一日发。月之初一。为逐渐生明之候。是其邪在阳
分矣。至十五则将生魄而属阴矣。阳分之病气。满而将移。则阴分之平气。更而用事。此二十四气中之一气
为病。气尽则邪无所凭。而所承之治气。又格而驱之。故当愈。设此期不瘥。则又以疟为阴邪。月属阴象。故疟
邪尝根据月之明晦。以为聚散。且十二经与月。各有所属。此月既尽。则次经之治气代之。故当月尽解。是十五
日愈者。则云一经中之气分为病。月尽解者。则云一经中之阴阳俱病。如其再不瘥。当云此邪在何地乎。
者。征也。如往迹未化。而可征验之象。瘕者。瑕也。如美玉未纯。而有瑕疵之象。夫疟邪中人。不离气血。气血胜。
则流行无滞。譬诸风之飘叶。水之流花。终归乌有。而风与水无着也。若其人气血不胜。则疟邪沉于下焦阴
分。寒热交煎。则大肠之络血。及肠外肝肾所管之孙络血。有为邪所结。而无流行之妙。比之大化中有未化
之迹。纯粹中有未纯之疵。故曰结为 瘕。疟之所以自愈者。以血气流行。而能托邪外出故也。今血与邪相
结而为 瘕。不特不能外托。而且有卵翼之义。故曰疟母。是疟母者。本身下焦孙络中之死血为之也。夫疟
为外邪。外邪内薄。以气血为之关隘。故阳疟不逾阴分。经疟不传他经。有十五日月尽自愈之例。疟之母为
内邪。内邪外薄。则本身败血之气。与疟并行为祟。复何气候经络之限乎。故虽月尽不瘥也。治之或缓。则死
血老而坚不可破。疟将与死俱休矣。故宜急治之。但细按鳖甲煎丸。连灶灰清酒。凡二十五味。为伤寒金匮
中第一大方。品类既繁。冷异复伙。致使庸陋者望而畏却。间或有以知味自居。称赏诠释。亦止大口嚼江瑶
柱。而于仲景制方之精意。无有是处也。不知其妙想入微。以为血结 瘕一症。合男妇凡三处。而攻去 瘕
诸法。合前后凡两路。其间攻血者。非理气则偏。故辅之以辛温。攻血者。非补血则弊。故佐之以滋润。然后兼
以治疟之例。则疟之母去。而疟自无所容矣。至其用药。纵横错杂中。却条分缕晰。而眼光处处不离下焦血
分。真如鸿门剑色。人第惊其掣电翻虹。而不知其微芒注意。俱在沛公也。何谓血结 瘕。合男妇凡三处乎。
一则大肠之络血是也。大肠为多血之腑。疟邪烧之。则干热下结。干则从络而吸血。热则从络而伤血。吸而
伤之。其结在络。故以性喜推粪。而善走大肠之蜣螂为主。以咸寒破血结之赤硝佐之。则其用意在大肠之
旁络可见矣。一则肝肾孙络中之幽隐血是也。肝肾属阴脏。孙络为细窍。幽隐之血在隙缝中。疟邪以寒热
结之。则其血先泣而终败。故以湿土中善藏善穴之阴类。而又能续筋活血之 虫（ 虫一名灰鳖。亦名
土鳖。儿童戏断其腹。能复完合。拳棍家以为跌扑秘药。）为主。以形则扁生。功则消瘀之乌扇。（乌扇即蝴
蝶花叶。以其形似故名。但其叶从中扁开。故有扁竹花之名。仲景用之以走缝络宜矣。）根行石缝。性复通
利之石韦佐之。则其用意在阴窍及扁缝中。又可见矣。此二者。男子与妇人之所同也。其一则妇人之子宫。
及血室之血是也。子宫清窈。非受胎则血室之血不注。而但有朝会之候。疟邪乘之。则血得邪热而滞结。故
以多管多子而形似子宫血室之蜂窠为主。而以聂聂潜行。性能动血之鼠妇佐之。则其用意在系胞等处。
更可见矣。何谓攻去 瘕。合前后凡两路乎。除桃仁动血破血。为两路公药之外。其用逐瘀之大黄者。则直
从肠中而下血于后阴。此一路也。其用利窍之瞿麦。佐以削坚瘦结之葶苈者。则旁从血管而下血于前阴。
此又一路也。（血管细小。恐结血成块而不能下。故佐葶苈以瘦削之。妙甚细甚。下血结于前阴。惟女子则
可。以男子之前阴无血路故也。读此则知从来女子之因 瘕而死于血枯经闭者。良可惜也。或问。既云
肝肾孙络中之血。男妇相同。又云男子前阴无血路。则其血当从何道去之。答曰。仍从大便去。伤寒少厥二
阴之结血。俱主桃核承气。其例不可类推乎。）然后以下走之芍药。监行阳之桂枝、丹皮。而并入阴分。所谓
理气以攻血。领养阴之阿胶、紫葳。而深滋其津液。所谓补血以治结者是也。至于攻击下焦之药。其性阴翳。
反而上乘。必生 胀。济之以开痞之干姜、浓朴。又所以防其渐而已。以上六队。凡十八味。俱治疟之母。而未
及于疟。疟之寒热呕渴。必由少阳。故但以少阳之例。用小柴轻轻引之。则疟邪自散。小柴汤论。见伤寒注。独
去甘草者。以邪在下焦。欲其从下以升发。故于甘浮者无取焉。鳖甲滋阴。配以咸温之灶灰。盖取咸能润下。
温能破结之义。煮以清酒者。既用其善行。复用其滋润也。以鳖甲煎包裹诸药而为丸。运穷工极巧之迹。降
为甘露和风。其潜滋默化之妙。能令穷泉之枯稿。乘春而复动矣。所结之 瘕。宁有不散者哉。
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。令人销铄肌肉。（照古本较正。有白虎加桂枝人参汤主之一句。而无下四句。）
凡五邪中人。阳气御其寒。阴气御其热者。常也。若阳不足以御寒。而阴外乘之。则恶寒。阴不足以御热。而阳
下从之。则发热。然恶寒。则阳气作势而热胜寒。发热。则阴得主令而正胜热。是阴阳相抱之妙也。若其人平
素阴气。原自孤绝。及疟邪中之。阳气与邪独发。而无阴以济之。则一发便热。且胸中正气。为亢热所伤。比之
三伏晴干。田禾之生意。有垂头卷叶之象。故不足以息而少气也。心有所亏。气有屈者。冤之义也。今阳伸阴
缩。火长水短。皆内亏里屈之象。故殊觉干烦而如有所冤抑矣。手足。指手心足心而言。盖劳宫、涌泉。为手足
少阴之经穴。热则阴气孤绝之征。欲呕者。火性上炎。阳气独发之症也。名曰瘅疟。瘅者。单也。热也。阳气单病
而独热之谓。与内经之所谓瘅疟同义。但其症不因邪而因人。人身阴液一虚。不论风寒暑湿之邪中之。俱
能从其有余之气而化热。热邪相搏。而阴气不足以济之。则瘅疟成矣。然就下文若但热不寒观之。则瘅疟
多先热而后寒者。盖阳气自盛。既不逐邪而内并。且无阴气出而夹呈于阳分。故不先寒而先热。至于气盛
则满。满则必衰。此盈虚自然之道。故热后生寒者。病瘅疟者所必至之势也。况内经所论温疟。以为阴虚而
阳盛。阳盛则热。热衰则气复返入而寒。夫瘅疟之名。就人身之阴虚言之。温疟之名。就天时之化气言之。其
实则一也。不寒。指热之前后而言。承上文阴气孤绝。阳气独发。而见种种等候之瘅疟。若是既不先寒而热。
复不热后生寒。是但热不寒矣。夫瘅疟与瘅疟复有辨。以五脏各能藏邪。肝肾固多逆寒。而脾肺主气。气起
则热。而伏则寒。惟心为阳脏而属火。热后不寒。是火熄尚有余热之象。故知邪气之内藏于心也。又疟之作
也。不外乎出三阳之舍。太阳则寒热并见。少阳则寒热往来。惟阳明不恶寒而恶热。分肉为阳明之部。故知
邪气之舍于阳明分肉间也。津液不足御邪热。而以肌肉当之。则其如销铄也宜矣。
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。
白虎加桂枝汤方 石膏（一斤） 知母（六两） 甘草（二两炙） 粳米（六合） 桂枝（三两去皮）
上五味。以水一斗。煮米熟。汤成。去滓。温服一升。日三服。
此申言上文但热不寒之病脉症治也。温疟。上条所谓瘅疟。而先热后寒者即是。阴虚阳盛之人。冬中风寒
诸邪。深藏骨髓。至春。则其气感而化温。至夏。则其气感而化热。此盖铜山外崩。钟声遥应。木华于春。栗芽于
室之理。因时序之变。而邪亦随之。故有牡疟温疟等名。其实皆阴虚阳盛之瘅疟也。温疟之热邪。在阳气中
The Master said: The pulse of malaria naturally presents a wiry (Xian) quality. A wiry and rapid pulse indicates mostly heat; a wiry and slow pulse indicates mostly cold. A wiry, small, and tight pulse may be improved by purgation; a wiry and slow pulse may be treated with warming methods; a wiry and tight pulse may be treated with diaphoresis or acupuncture/moxibustion; a floating and large pulse may be treated with emesis. A wiry and rapid pulse indicates wind-induced fever (Feng Fa), which can be stopped through dietary regulation.
Li's old commentary states: "Ma" (Malaria) means "cruelty." The sudden invasion of cold and heat resembles the cruelty of tyrannical governance, hence the name. Alternatively, "Ma" is homophonous with "Xue" (jest/play). When the cold and heat subside, the patient returns to normal, and the illness behaves like a jest, hence the name. Examining the *Nei Jing* (Inner Canon), it is believed that this disease arises from pathogenic factors such as wind, cold, summer-heat, and dampness lodging in the back of the Taiyang meridian and various acupoints of the Du Meridian. The symptoms are mostly chills followed by fever. This is because Yang Qi drives out pathogens, merging internally into the Yin aspect, causing external Yang deficiency and internal Yin excess. With Yang deficiency and Yin excess, chills and shivering are inevitable. When Yang Qi becomes exhausted to the extreme, it rises angrily and vigorously, following the principle of reversal at the extreme. Furthermore, due to deficient Wei Qi (Defensive Qi) on the exterior, inhalation draws Yang Qi to pull Yin, which then re-merges externally, resulting in Yin deficiency and Yang excess. Yang excess causes heat, while Yin deficiency causes thirst. Yang refers to Righteous Qi (Zheng Qi). When Righteous Qi rises, pathogens lie dormant, so after fever subsides, malaria gradually resolves. This explains the sequence of chills then fever, and resolution after fever. Malaria pathogens often repel Yang Qi and follow Yin. Human Yang Qi circulates in the Wei level during the day on the exterior, and hides in the Zang organs at night inside. The back of the Taiyang meridian and the acupoints of the Du Meridian are pathways for Yang Qi's entry and exit. When Yang battles pathogens, pathogen victory brings cold, Yang victory brings heat. When heat occurs, Yang has already passed the location occupied by pathogens, so pathogens resolve. However, the circulation of Qi mechanisms follows regular patterns, while malaria pathogens occupy fixed positions without moving. Thus, it recurs at the same time the next day, precisely. If pathogens leave the back and Du Meridian, their "head" invades the five Zang organs internally, while their "tail" connects horizontally to the Mu Yuan (Sea of Origin). The Mu Yuan is an interior thoroughfare for Zang organs to communicate with Wei Qi, and an exterior post station for Yang Qi traveling along the back and Du Meridian. The Zang organs belong to Yin and move slowly, with distant paths and deep Qi. Thus, weak Yang Qi often takes two cycles to emerge from the Mu Yuan to meet Wei Qi. Wei Qi moves rapidly like celestial bodies, completing one cycle daily; Zang Qi moves slowly like the moon and sun, following lunar and annual cycles. Once Zang Qi emerges and meets Wei Qi, pathogens also follow to battle Wei Yang, causing recurrence every other day. These are the general principles of malaria. When Yang Qi weakens, the pulse becomes wiry. The principal pulse of Shaoyang is also wiry. Patients with malaria cannot expel pathogens; since Yang Qi is weakened, and Shaoyang is the pivot of the three Yang meridians and the pathway for Wei Qi's rising, falling, ascending, and descending, Wei Qi and pathogens contend in the Shaoyang region, presenting symptoms such as chills, fever, thirst, and vomiting. Hence, the malaria pulse is naturally wiry. Rapid heat causes wiry-rapid pulses indicating heat; sluggish cold causes wiry-slow pulses indicating cold. These two sentences are the main points; the following eleven sentences are derived from them. "Small" refers to fine pulse, indicating constriction. "Tight" refers to the urgency of the wiry pulse. A wiry, fine, and urgent pulse indicates dietary stagnation leading to urgency, similar to Spleen Constriction (Pi Yue) with internal tension. This involves the Foot Yangming and Foot Taiyin meridians, where food accumulates in the Middle Jiao. Vigorous Qi cannot circulate fully, causing cold; Essence Qi cannot nourish, causing heat. Purging removes stagnation, allowing Essence and Vigor to flow freely, thus healing. This follows the "wiry-rapid indicates heat" statement, implying wiry-rapid with small-tight. Generally, if wiry but not rapid, even if small-tight, purging is contraindicated. Wiry indicates insufficient pulse body; slow indicates discontinuous movement, both reflecting Yang deficiency. Yang deficiency causes Qi to merge internally (cold) or externally (heat), or only cold without heat, as in Article 5. Warming restores Yang abundance, ensuring balanced ascent/descent without fluctuation bias, thus curing. This refers to Shaoyin and Sanjiao malaria; warming turns the Great Qi, scattering the disease. These two sentences follow "wiry-slow indicates cold," self-evident in the text. The four sentences on wiry-tight cover two sections, addressing both wiry-rapid and wiry-slow with tightness. Wiry-rapid with tightness: tight indicates cold diagnosis, rapid indicates heat response. The root is cold contraction, the branch transforms to heat, causing alternating chills/fever, starting with chills then fever, following root/branch nature. Expelling cold suits diaphoresis; expelling cold-transformed heat especially suits diaphoresis, hence "diaphoresis possible." If pathogens are in Taiyang/Yangming meridians, lingering without transmission, acupuncture blocks transmission routes and drains residual pathogens, akin to Three Yang Cold Damage examples, hence "acupuncture possible." For wiry-slow with tightness: tight indicates cold pathogen condensation, slow indicates decline of True Yang, wiry indicates Wei Qi weakness. This signifies exhaustion of Three Yang regions and cold pathogen invasion, unable to transform heat via Zang/Fu/Meridian Yang, resembling Pin Malaria or Cold Malaria mentioned in classics. Moxibustion warms True Yang with external fire, akin to Three Yin Cold Damage examples, hence "moxibustion possible." Only moxibustion is mentioned, not herbs, because warming methods were previously discussed, so moxibustion complements it. Floating pulse indicates pathogens surging upward; floating-large pulse indicates pathogens venting outward. Wiry-rapid-floating-large: emesis disperses Qi, so emesis clears heat. Wiry-slow-floating-large: emesis lifts Qi, so emesis removes cold. Wiry-rapid indicates heat; heat generates wind. Hence "wind-induced" rather than "wind-stroke," referring to wind generated from internal heat. Wind pathogens originate in Liver/Gallbladder, their Qi tends to rebel, causing alternating chills/fever and malaria. Dietary regulation: for phlegm-fluids transforming to damp-heat, thirst indicates need to remove heat-drinks; for food accumulation transforming to excess heat, appetite without stool indicates need to remove excess heat.
For malaria starting 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 then? The Master said: This forms a mass called "Nuo Mother" (Malaria Mass). Treat urgently with Biejia Jian Wan (Turtle Shell Decoction Pill).
Biejia Jian Wan Formula
Bie Jia (Turtle Shell, 10 fen, roasted) Chai Hu (Bupleuri Radix, 6 fen) Ren Shen (Ginseng Radix, 1 fen) Ban Xia (Pinelliae Rhizoma, 1 fen) Huang Qin (Scutellariae Radix, 3 fen) Gui Zhi (Cinnamomi Ramulus, 3 fen)
Shao Yao (Paeoniae Radix Rubra, 5 fen) Gan Jiang (Zingiberis Rhizoma, 3 fen) E Jiao (Asini Corii Colla, 3 fen, roasted) Dan Pi (Moutan Cortex, 5 fen, heart removed) Tao Ren (Persicae Semen, 2 fen) Hou Po (Magnoliae Officinalis Cortex, 3 fen) Chi Xiao Dou (not listed, likely Chi Xiang / Red Sandalwood or similar context dependent, here interpreted as part of formula components generally associated with blood stasis removal in this context, though text lists Chi Xiao Dou usually as separate herb, here listed as component) Ting Li (Descurainiae Semen/Lepidii Semen, 1 fen, fried) Qu Mai (Polygoni Avicularis Herba, 2 fen) Da Huang (Rhei Radix et Rhizoma, 2 fen) Wu Shan (Iris Tectorii Rhizome, 3 fen, burned) Qiang Lang (Scarabaeus, 6 fen, fried) Feng Ke (Honeycomb, 4 fen, roasted) Zi Wei (Campsis Grandiflora Bark, 3 fen) Shu Fu (Oniscus, 3 fen, fried) Chan Chong (Eupolyphaga/Steleophaga, 5 fen, fried) Shi Wei (Pyrrosiae Folium, 3 fen, hairs removed)
(Note: Shu Fu resembles yellow-backed white-footed insect, commonly called wet dung beetle, found under mats in North China, a yin-type creature entering cracks. Chan Chong unseen in North, abundant in Zhejiang damp ash soil, up to 1 cun diameter, chestnut-shell colored, larger than bedbug, also a yin-insect in seams.)
The above 23 ingredients are powdered. Take 1 dou of ash from a smith's forge, steep in 1 hu 5 dou of clear wine until half the wine remains. Add Bie Jia, boil until gelatinous. Strain juice, add other medicines, decoct into pills the size of paulownia seeds. Take 7 pills empty stomach, three times daily. (Note: 1 hu 5 dou implies using 5 dou measure for 1 hu volume).
This describes malaria pathogens in the Lower Jiao Blood aspect. If malaria starts on the first lunar day (Yang phase increasing), it should heal by the 15th (Yin phase increasing). Yang pathology fills and shifts, Yin peace takes over. As one of the 24 solar terms ends, pathogens lose support, and governing Qi drives them out, so healing occurs. If not healed by then, since malaria is Yin pathogen and Moon is Yin image, pathogens gather/scatter with moon phases. Twelve meridians correspond to months. When the month ends, the next meridian's governing Qi takes over, so it should resolve by month-end. Healing in 15 days implies Qi-level disease in one meridian; resolving by month-end implies Yin-Yang disease in one meridian. If still not healed, where is the pathogen? "Jia" (Mass) implies trace evidence. Like untransformed tracks, visible signs. "Jia" means flaw, like impure jade. Malaria pathogens affect Qi/Blood. If Qi/Blood strong, flow unimpeded, like wind blowing leaves or water flowing flowers, vanishing ultimately. If Qi/Blood weak, pathogens sink to Lower Jiao Yin aspect. Cold/heat煎熬 (scorching) binds collateral blood of Large Intestine and Sun Luo (Branch Collaterals) of Liver/Kidney outside intestines. This binding lacks fluidity, like untransformed traces in great transformation or flaws in purity. Hence "forming Jia." Malaria heals naturally via Qi/Blood flow pushing pathogens out. Now blood binds with pathogens forming Jia, unable to push out, instead protecting them ("egg-shielding"), hence "Nuo Mother." Nuo Mother is dead blood in Lower Jiao Sun Luo. External pathogens invade internally, blocked by Qi/Blood. Yang malaria stays in Yin aspect; Classic malaria doesn't transmit to other meridians, having 15-day/month-end healing examples. Nuo Mother is internal pathogen; internal pathogens attack externally, combining with degenerate blood Qi to cause havoc,不受 climate/meridian limits. Hence no healing by month-end. Delayed treatment makes dead blood hard and unbreakable; malaria dies with it. Hence urgent treatment. Analyzing Biejia Jian Wan, including forge ash and wine, 25 ingredients total, it is the largest formula in Shanghan/Jingui. Complex categories and cold/hot mix deter mediocre practitioners. Even experts praising it miss Zhang Zhongjing's profound intent. Its subtle design addresses blood-binding Jia in three locations for men/women, and two pathways (anterior/posterior) for expulsion. Blood-invigorating methods must balance Qi regulation (aided by acrid-warm) and Blood-nourishing (aided by moistening). Combined with malaria treatment principles, Nuo Mother dissipates, leaving no room for malaria. Medications are complex yet precise, focusing always on Lower Jiao Blood aspect, like Hongmen Sword glare hiding attention on Liu Bang. What are the three locations for blood-binding Jia? 1. Large Intestine collateral blood. LI is a multi-blood organ. Malaria heat dries/binds downward. Dryness sucks blood from collaterals; heat damages blood. Binding occurs in collaterals. Dung Beetle (Qiang Lang), favoring fecal expulsion and LI movement, is chief. Red Nitre (Chi Xiao/Nitrum), salty-cold breaking blood clots, assists. Intent targets LI collateral vicinity. 2. Hidden blood in Liver/Kidney Sun Luo. Liver/Kidney are Yin organs; Sun Luo are fine apertures. Hidden blood in seams. Cold/heat binding causes blood weeping then degeneration. Earth-burrowing Insect (Chan Chong/Tiu Bie), yin-type, repairing tendons/blood, is chief. Wu Shan (Iris leaf), flat-shaped, resolving stasis, assists. Shi Wei (Pyrrosia leaf), growing in rock crevices, promoting urination, assists. Intent targets Yin apertures and flat seams. These two apply to both sexes. 3. Women's Uterus and Blood Chamber blood. Uterus is deep/clear; Blood Chamber blood flows only during menstruation/pregnancy. Malaria heat stagnates blood. Honeycomb (Feng Ke), multi-tubed/resembling uterus, is chief. Oniscus (Shu Fu), creeping quietly, moving blood, assists. Intent targets uterine ligaments. What are the two pathways for expelling Jia? Except Tao Ren (Peach Seed) for moving/breaking blood (common to both), Da Huang (Rhubarb) purges stasis directly from intestines to posterior anus (Path 1). Qu Mai (Knotgrass) opens apertures, assisted by Ting Li (Descurainia/Lepidium) reducing hardness, draining blood laterally via vessels to anterior urethra (Path 2). (Vessels are small; clots might block flow, so Ting Li thins them. Anterior drainage applies mainly to women as males lack blood path there. Men's blood exits via stool, analogous to Shaoyin/Jueyin blood stasis treated with Taohe Chengqi Tang.) Then Shao Yao (Peony) guides Gui Zhi (Cinnamon Twig) and Dan Pi (Moutan) into Yin aspect, regulating Qi to attack blood. E Jiao (Donkey-hide Gelatin) and Zi Wei (Campsis Bark) nourish Yin and moisten fluids, treating binding via blood nourishment. Drugs attacking Lower Jiao are Yin-heavy and may ascend causing distension. Gan Jiang (Dried Ginger) and Hou Po (Magnolia Bark) open obstruction, preventing this gradual issue. These six groups (18 ingredients) treat Nuo Mother, not malaria itself. Malaria chills/fever/vomit/thirst stem from Shaoyang. Thus, Xiao Chai Hu Tang (Minor Bupleurum Decoction) gently guides Shaoyang, dispersing pathogens. See Shanghan commentary for formula details. Glycyrrhiza (Licorice) is omitted because pathogen is in Lower Jiao, requiring downward emergence; sweet-floating herbs are unsuitable. Bie Jia nourishes Yin; paired with salty-warm forge ash, utilizing salty-moistening-descending and warming-breaking properties. Clear wine aids circulation and moistening. Pills wrapped in Biejia decoction represent ultimate craftsmanship, transforming into gentle dew/wind, reviving dry springs in spring. How can bound Jia not disperse?
The Master said: If Yin Qi is isolated/extinct, and Yang Qi fires alone, fever, shortness of breath, vexation/oppression, hot hands/feet, and nausea occur. This is named Dan Malaria (Hot Malaria). If only fever without chills, pathogens hide internally in the Heart, externally lodge between muscle layers, causing muscle wasting. (Corrected per ancient text: includes sentence "Baitu Jia Guizhi Renshen Tang governs," omits following four sentences.)
Normally, when five pathogens enter humans, Yang defends against cold, Yin defends against heat. If Yang insufficient to defend cold, Yin attacks externally, causing aversion to cold. If Yin insufficient to defend heat, Yang sinks below, causing fever. Aversion to cold: Yang rises to overcome cold with heat. Fever: Yin gains command to overcome heat with righteousness. This is the wonder of Yin-Yang embracing. If person's Yin Qi was originally extinct, and malaria pathogens enter, Yang and pathogens fire alone without Yin assistance, fever appears immediately. Chest Righteous Qi injured by hyper-heat, like crops in dry summer heat drooping/rolling leaves, causing shortness of breath. Heart deficit, Qi constraint, defines "Yuan" (oppression). Yang extends, Yin shrinks; Fire grows, Water shrinks, indicating internal deficit/constraint. Hence dry vexation and feeling oppressed. Hands/feet refer to palms/soles. Laogong (PC8) and Yongquan (KI1) are Shaoyin acupoints. Heat indicates Yin extinction. Nausea: Fire flares upward, symptom of lone Yang firing. Named Dan Malaria. "Dan" means single/heat. Yang disease alone, exclusive heat, same meaning as Nei Jing's Dan Malaria. But symptoms depend on constitution, not just pathogens. Once human Yin fluid deficient, regardless of wind/cold/summer-heat/dampness, Qi transforms to heat based on excess. Heat-pathogen conflict, Yin insufficient to assist, forms Dan Malaria. Observing "only heat no cold" below, Dan Malaria often starts with fever then chills. Yang naturally strong, does not drive pathogens inward, nor does Yin emerge to join Yang, so no initial chills, only initial fever. Qi fullness leads to decline (natural law), so fever followed by chills is inevitable for Dan Malaria. Nei Jing discusses Wen Malaria (Warm Malaria) as Yin deficient/Yang excess, Yang excess causes heat, heat decline allows Qi returning inward causing cold. Dan Malaria name refers to human Yin deficiency; Wen Malaria name refers to seasonal transformation Qi. Essentially identical. "No cold" refers to before/after fever. Following "Yin extinct, Yang fires alone," seeing various Dan Malaria signs. If neither initial chills nor post-fever chills, it is "only heat no cold." Distinction between Dan Malaria types: Five Zang store pathogens. Liver/Kidney often have reverse cold; Spleen/Lung govern Qi, Qi rise causes heat, hiding causes cold. Only Heart is Yang organ/Fire. Post-fever no cold indicates residual heat after fire extinguishes, knowing pathogens hide in Heart. Malaria originates from Three Yang shelters. Taiyang: chills/fever together; Shaoyang: alternating chills/fever; Yangming: no aversion to cold, aversion to heat. Muscle layer is Yangming region. Knowing pathogens lodge in Yangming muscle layers. Insufficient Jin-Ye (Fluids) to resist heat, muscles bear brunt, causing wasting.
Wen Malaria: Pulse like normal, body no chills, only heat, bone/joint pain/vexation, occasional vomiting. Governed by Baitu Jia Guizhi Tang (White Tiger plus Cinnamon Twig Decoction).
Baitu Jia Guizhi Tang Formula
Shi Gao (Gypsum Fibrosum, 1 jin) Zhi Mu (Anemarrhenae Rhizoma, 6 liang) Gan Cao (Glycyrrhizae Radix et Rhizoma, 2 liang, roasted) Geng Mi (Oryza Sativa, 6 he) Gui Zhi (Cinnamomi Ramulus, 3 liang, bark removed)
Above 5 ingredients, boil in 1 dou water until rice cooked. Strain, take 1 sheng warm, three times daily.
This elaborates on the "only heat no cold" pathology, pulse, symptoms, and treatment. Wen Malaria corresponds to previous Dan Malaria with initial fever then chills. In Yin-deficient/Yang-excess persons, winter wind/cold pathogens hide deep in marrow. Spring: Qi senses and transforms to Warm. Summer: Qi senses and transforms to Heat. Like bell sound echoing from distant mountain, wood blooming in spring, chestnut sprouting indoors. Pathogens follow seasonal changes, hence names like Mu Malaria, Wen Malaria. Essentially all are Yin-deficient/Yang-excess Dan Malaria. Wen Malaria heat pathogens reside in Yang Qi...