黄帝问曰。夫 疟皆生于风。其蓄作有时者。何也。（ 音皆。吴 曰。 、亦疟也。夜病者谓之 。昼病者谓之疟。
方书言夜市谓之 市。盖本乎此也。蓄、病息邪伏也。卢子繇曰。疟者。惟火 金。酷虐殆甚也。）岐伯对曰。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。头痛如破。渴欲冷冻饮料。（伸欠、引伸而呵欠也。
卫气同邪气将入于阴。表气虚。故先起于毫毛。伸欠。）帝曰。何气使然。愿闻其道。岐伯曰。阴阳上下交争。虚实更作。
阴阳相移也。（邪正阴阳之气。上下出入。故交争于上下也。病并于阴。则阴实而阳虚。并于阳。则阳实而阴虚。是虚实
更作。阴阳寒热相移也。）阳并于阴。则阴实而阳虚。阳明虚。则寒栗鼓颔也。巨阳虚。则腰背头项痛。（邪与卫气内薄。
则三阳之气。同并于阴矣。并于阴。则阴实于内。而阳虚于外。阳明之气主肌肉。而经脉交于颔下。是以寒栗鼓颔。太
阳之气主表。而上升于头。其经脉上会于脑。出于项。下循背膂。故腰背头项俱痛。马莳曰。阳气陷则阴气胜。经云。
病痛者阴也。）三阳俱虚。则阴气胜。阴气胜。则骨寒而痛。寒生于内。故中外皆寒。阳盛则外热。阴虚则内热。外内皆
热。则喘而渴。故欲冷冻饮料也。（阳虚于外。则阴胜于里矣。经云。二阴主里。是以骨寒而痛。而寒生于内也。阴气逆极则
复出之阳。并于阳则阴虚而阳盛。阳盛则外热。阴虚则内热。外内皆热。是以喘渴而欲冷冻饮料也。卢子繇曰。不列少阳形
证者。以太阳为开。阳明为阖。少阳为枢。而开之能开。阖之能阖。枢转之也。设舍枢则无开阖矣。离开阖无从觅枢矣。
故开阖既陷。枢机岂能独留。倘中见枢象。即为开阖两持。所以持则俱持。陷则俱陷也。）此皆得之夏伤于暑。热气盛。
藏于皮肤之内。肠胃之外。此荣气之所舍也。（卢子繇曰。以夏气通于心。心主荣血之故也。经云。以奉生身者。莫贵于
经隧。故不注之经而溜之舍也。舍即经隧所历之界分。每有界分。必有其舍。如行人之有传舍也。倪冲之曰。天之暑热。
与君火之气相合。心主荣血。故邪藏于荣舍。卫气者。阳明之悍气也。风木寒水。乘侮土气。故风水之邪。与卫气并居。）
此令人汗空疏。腠理开。因得秋气。汗出遇风。及得之以浴。水气舍于皮肤之内。与卫气并居。卫气者。昼日行于阳。
夜行于阴。此气得阳而外出。得阴而内薄。内外相薄。是以日作。（卢子繇曰。暑令人汗出空疏。腠理开者。以暑性暄发。
致腠理但开。不能旋阖耳。不即病者。时值夏气之从内而外。卫气仗此。犹可捍御。因遇秋气。机衡已转。自外而内矣。
其留舍之暑。令汗出空疏。腠理开。风遂乘之以入。或得之以沐浴。水气舍于皮肤之内。与卫气并居。卫气者。昼日行
于阳。夜行于阴。风与水气。亦得阳随卫而外出。得阴随卫而内薄。内外相薄。是以日作也。莫子晋问曰。卫气日行于
阳。奚先入于阴而致寒栗伸欠也。曰。邪得阴而内入。得阳而外出。邪气与卫气并居。故同邪内陷。非卫气之行于阴也。
夫内为阴。外为阳。邪留于形身之外。与卫应乃作。卫气日行于阳。故发作于日也。）帝曰。其间日而作者何也。岐伯
曰。其气之舍深。内薄于阴。阳气独发。阴邪内着。阴与阳争不得出。是以间日而作也。（间去声言邪气舍深。内薄于里
阴之分。阳气独发于外。里阴之邪。留着于内。阴邪与阳气交争。而不得皆出于外。是以间日而作也。按此节经文。与
薄于五脏募原之因不同。）帝曰。善。其作日晏与其日早者。何气使然。岐伯曰。邪气客于风府。循膂而下。卫气一日
一夜。大会于风府。其明日日下一节。故其作也晏。此先客于脊背也。（此言邪从风府。而客于脊背之间者。发作有早晏
也。卫气一日一夜。行阴阳五十度。而大会于风府。其明日日下一节。故其作也晏。此邪先客于脊背而与卫气相遇故也。）
每至于风府则腠理开。腠理开则邪气入。邪气入则病作。以此日作稍益晏也。其出于风府。日下一节。二十一日下至
骨。（此申明卫气日下一节。则上会于风府也亦晏。故病作日晏也。盖卫气每至于风府则腠理开。开则客于脊背之邪。还
入风府。而与卫气相遇则病作。其卫气出于风府。日下一节。则上会与风府也稍晏。故病作稍晏。二十一日下至 骨。
则上会于风府也益晏。故病作益晏也。）二十二日入于脊内。注于伏膂之脉。其气上行。九日出于缺盆之中。其气日高。
故作日益早也。（伏膂、伏冲膂筋也。卫气外循督脉而下。内循冲脉而上。其气上行。九日出于缺盆。其气日高。则会于
风府也日早。故作日益早也。）其间日发者。由邪气内薄于五脏。横连募原也。其道远。其气深。其行迟。不能与卫气
俱行。不得皆出。故间日乃作也。（募原者。横连脏腑之膏膜。即金匮所谓皮肤脏腑之纹理。乃卫气游行之腠理也。不得
与卫气皆出。故间日也。）帝曰。夫子言卫气每至于风府。腠理乃发。发则邪气入。入则病作。今卫气日下一节。其气
之发也。不当风府。其日作者奈何。（帝问邪有不从风府而入。其病亦以日作者何也。）岐伯曰。此邪气客于头项。循膂
而下者也。故虚实不同。邪中异所。则不得当其风府也。故邪中于头项者。气至头项而病。中于背者。气至背而病。中
于腰脊者。气至腰脊而病。中于手足者。气至手足而病。（客于头项者。谓客于风府也。伯言邪入于风府。循膂而下。留
其处者。有虚实之不同。若邪中异所。则无有早晏矣。虚实者。早晏也。言卫气虚而日下。则其发日晏。卫气实而日上。
则其发日早。此邪从风府而留于脊膂之间者也。若邪中异所。则不得当其风府矣。如邪中于头项。卫气行至头项而病作。
中于腰背手足。邪即舍于腰背手足之间。卫气行至腰背。与腰背所舍之邪。相遇而病作。卫气行至于手足。与手足所舍
之邪。相遇而病作。此或发于早者。每日早发。或发于晏者。每日晏发。非若客于风府之邪。日晏而日早也。张兆璜曰。
风府循督脉而下。至脊内循冲脉而上。乃卫气之隧道。故邪留于此内者。遇卫气之日上日下。而病有早晏之分。）卫气
之所在。与邪气相合则病作。故风无常府。卫气之所发。必开其腠理。邪气之所合。则其府也。（卫气之所在者。谓卫气
行至邪气所在之处。与邪相合而病作。故风邪或中于头项。或中于腰背手足。无有常处。非定客于风府也。夫卫气之行。
至于所在之处而发。必开其腠理。腠理开。然后邪正相合。邪与卫合之处即其府也。）帝曰。善。夫风之与疟也。相似
同类。而风独常在。疟得有时而休者。何也。（夫 疟皆生于风。然病风者。常在其处。病疟者。休作有时。故帝有此问。）
岐伯曰。风气留其处。故常在。疟气随经络。沉以内薄。故卫气应乃作。（风邪则伤卫。故病风者。留于肌腠筋骨之间而
不移。疟气舍于荣。故随经络以内薄。与卫气相应乃作也。）帝曰。疟先寒而后热者何也。岐伯曰。夏伤于大暑。其汗
大出。腠理开发。因遇夏气凄沧之水寒。藏于腠理皮肤之中。秋伤于风。则病成矣。（风寒曰凄。水寒曰沧。盖夏时暑热
溽蒸。腠理开发。或汗湿从风。或得之于沐浴。水寒藏于腠理皮肤之中。至秋时复伤于风。风寒两感。是以寒热之病成
矣。按此节所论先寒后热。与上节不同。上节以夏伤之暑。藏于荣之所舍。秋受之风寒。与卫气并居。盖荣为阴。卫为
阳。此气得阴而内薄。得阳而外出。是以荣舍之邪。先行于阴而为寒。复行于阳而为热。此乃吾身中之阴阳寒热也。此
节论夏受凄沧之水寒。秋伤于风之阳邪。此论天之阴阳寒热也。是以经旨少有不同。学人亦宜体析。）夫寒者阴气也。风
者阳气也。先伤于寒。而后伤于风。故先寒而后热也。病以时作。名曰寒疟。（天之阴邪。感吾身之阴寒。天之阳邪。感
吾身之阳热。是以先受之寒。先从阴而病寒。后受之风。复从阳而病热。病以时作者。应时而作。无早晏也。）帝曰。
先热而后寒者何也。岐伯曰。此先伤于风。而后伤于寒。故先热而后寒也。亦以时作。名曰温疟。（王冰曰。以其先热。
故谓之温。倪冲之曰。此天之阴阳。病患身之阴阳。阴阳两感。是以寒热交作。虽有先后之感。与故病新病不同。学
者亦宜体认。）其但热而不寒者。阴气先绝。阳气独发。则少气烦冤。手足热而欲呕。名曰瘅疟。（其者。承上文而言。
上文之所谓温疟者。邪气藏于骨髓之中。骨髓者。肾藏之精气所生。故久而不去。则与肾气相合。是以温疟之病气藏于
肾。其气先从内而出之外也。从内出之外。故阳病极而复反入之阴。其但热不寒者。邪气藏于骨髓之中。而肾阴之气。
先与骨气相绝。是外邪不及于里阴。而独发于阳也。热伤气。故少气。心恶热。故烦冤。手足为诸阳之本。故手足热。
经云。诸呕吐酸。皆属于热。此温疟之不复寒者。名曰瘅疟。瘅、单也。谓单发于阳而病热也。卢子繇曰。瘅疟有二因。
此其一也。）帝曰。夫经言有余者泻之。不足者补之。今热为有余。寒为不足。夫疟者之寒。汤火不能温也。及其热。
冰水不能寒也。此皆有余不足之类。当此之时。良工不能止。必须其自衰乃刺之。其故何也。愿闻其说。岐伯曰。经言
无刺 之热。无刺浑浑之脉。无刺漉漉之汗。故其为病逆。未可刺也。（ 音稿漉音鹿。阳热为有余。阴寒为不足。经
言。引灵枢顺逆篇而言。 、热甚貌。浑浑、邪盛而脉乱也。漉漉、汗大出也。言当此之时。邪病甚而正气逆。故未
可刺也。）夫疟之始发也。阳气并于阴。当是之时。阳虚而阴盛。外无气。故先寒栗也。阴气逆极。则复出之阳。阳与
阴复并于外。则阴虚而阳实。故先热而渴。（此言寒热始盛之时。乃阴阳之气交并。正气错乱未分。故未可刺。张兆璜
曰。此言热为阳实而有余。寒为无气而不足。所谓有余不足者。阳气邪气也。）夫疟气者。并于阳则阳胜。并于阴则阴胜。
阴胜则寒。阳胜则热。（上节论阳气虚实之寒热。此论阴阳胜并之寒热。皆属阴阳未和。而邪气方盛。俱未可刺。）疟者。
风寒之气不常也。病极则复至。（此复论在天阴阳之邪而为寒热也。风者阳邪也。寒者阴邪也。风寒之气。变幻不常。如
病风而为热。极则阴邪之寒气复至。病寒而为寒。极则风邪之阳热复至。当如寒热虚实之有三因也。）病之发也。如火之
热。如风雨不可当也。故经言曰。方其盛时必毁。因其衰也。事必大昌。此之谓也。（上节论阴阳交并。正气未分。故未
可刺。此承上文而言。邪气方盛。未可刺也。邪气之发。如火之烈。如风雨之不可当。故经言方其盛时而取之。必毁伤
其正气。因其衰也。事必大昌。此之谓也。兵法云。无迎逢逢之气。无击堂堂之阵。避其来锐。击其惰归。倪冲之曰。
如火之烈。阳热盛也。如风雨不可当。阴寒盛也。）夫疟之未发也。阴未并阳。阳未并阴。因而调之。真气得安。邪气乃
亡。故工不能治其已发。为其气逆也。（邪气未发。则正气未乱。因而调之。真气得安。邪气乃去。所谓治未病也。若待
其已发。虽良工弗能为。为其气逆故也。上节论治其已衰。此先治其未发。）帝曰。善。攻之奈何。早晏何如。（早者。
谓病之未发。晏者。谓病之已衰。）岐伯曰。疟之且发也。阴阳之且移也。必从四末始也。阳已伤。阴从之。故先其时。
坚束其处。令邪气不得入。阴气不得出。审候见之。在孙络盛坚而血者。皆取之。此真往而未得并者也。（此申明治未病
之法也。且者。未定之辞。言疟之将发。阴阳之将移。必从四末始。盖三阴三阳之气。从手足之井荥而更移也。如病在
阳而阳已伤。则阴经将从而受之。故当先其未发之时。坚束其四末。令邪在此经者。不得入于彼经。彼经之经气。不得
出而并于此经。审其证而候其脉。见其孙络盛坚而血者。皆取而去之。此阴阳真气。往来和平。而未得交并者也。倪
仲宣曰。疟气舍于皮肤肌腠之间。故病见于孙络。）帝曰。疟不发。其应何如。（言疟病未发之时。其脉候证候。何如
而应。）岐伯曰。疟气者。必更盛更虚。当气之所在也。病在阳则热而脉躁。在阴则寒而脉静。（言疟气者。有阴阳更并
之盛虚。皆当气之所在也。如病在阳则热而脉躁。在阴则寒而脉静。欲知脉与病之相应。但审证之寒热。脉之躁静。则
知病之在阴在阳矣。）极则阴阳俱衰。卫气相离。故病得休。卫气集则复病也。（言阴阳之所以更盛更虚者。卫气行之也。
卫气者。行阴而行阳者也。是以卫气相离。其病得休。卫气集则复病也。）帝曰。时有间二日。或至数日发。或渴或不
渴。其故何也。岐伯曰。其间日者。邪气与卫气客于六腑。而有时相失。不能相得。故休数日乃作也。（六腑者。谓六腑
Huangdi asked: Malaria is caused by wind pathogen. Why does it have a specific time for its accumulation and recurrence? (The character "dan" is pronounced 'jie'. Wu Kun said: "Dan" is also a type of malaria. Those that occur at night are called "dan", and those that occur during the day are called "malaria". Medical texts refer to the "night market" as "dan shi", which is likely derived from this. "Xu" refers to the latent disease and resting evil. Lu Ziyao said: Malaria, only fire conquers metal, its cruelty is extremely severe.)
Qibo replied: When malaria first begins to manifest, it starts with the erection of fine hairs, followed by stretching and yawning. Then chills and tremors occur, with the jaw quivering, and pain in the lower back and spine. After the cold subsides, both the interior and exterior become hot, causing a headache as if splitting, and thirst for cold drinks. ("Shen qian" refers to stretching the body and yawning. This occurs because the Wei Qi (Defensive Qi) and the pathogen are about to enter the Yin aspect, and the surface Qi is deficient, hence the initial erection of fine hairs and yawning.)
Huangdi asked: What qi causes this? I wish to hear the principle behind it.
Qibo said: This is due to the struggle between Yin and Yang above and below, the alternation of deficiency and excess, and the shifting of Yin and Yang. (Pathogenic and righteous Qi, i.e., Yin and Yang, move up and down, thus struggling in the upper and lower parts. If the pathogen merges into Yin, Yin becomes excess and Yang becomes deficient; if it merges into Yang, Yang becomes excess and Yin becomes deficient. This is the alternation of deficiency and excess, and the shifting of Yin-Yang cold and heat.) When Yang merges into Yin, Yin becomes excess and Yang becomes deficient. Deficiency of the Yangming channel leads to chills and jaw quivering. Deficiency of the Taiyang channel leads to pain in the waist, back, head, and neck. (The pathogen presses inward against the Wei Qi, causing the Qi of the Three Yang channels to merge into Yin. Merging into Yin means Yin is excess internally and Yang is deficient externally. The Qi of Yangming governs the muscles, and its meridians intersect below the jaw, hence the chills and jaw quivering. The Qi of Taiyang governs the exterior, rises to the head, its meridians converge at the brain, emerge from the neck, and descend along the back and spine, hence pain in the waist, back, head, and neck. Ma Shi said: When Yang Qi sinks, Yin Qi prevails. The classic states: Painful conditions belong to Yin.) If the Qi of the Three Yang channels is all deficient, then Yin Qi prevails. When Yin Qi prevails, the bones become cold and painful. Cold originates from within, so both the interior and exterior feel cold. If Yang is excess, there is external heat; if Yin is deficient, there is internal heat. With both internal and external heat, there is panting and thirst, hence the desire for cold drinks. (Yang is deficient externally, so Yin prevails internally. The classic states: Two Yin governs the interior, hence bone cold and pain, and cold originates from within. When Yin Qi reverses to its extreme, it re-emerges as Yang. Merging into Yang, Yin becomes deficient and Yang becomes excess. Yang excess leads to external heat; Yin deficiency leads to internal heat. With both internal and external heat, there is panting, thirst, and desire for cold drinks. Lu Ziyao said: The Shaoyang pattern is not listed here because Taiyang is the opening, Yangming is the closing, and Shaoyang is the pivot. The opening can open, and the closing can close, due to the pivot turning. If the pivot is abandoned, there is no opening or closing. Without opening and closing, one cannot seek the pivot. Thus, if opening and closing fall into depression, how can the pivot remain alone? If the pivot image appears in the middle, it means holding both opening and closing. Therefore, holding implies holding together, and depression implies depression together.) These conditions arise from summer injury by summer-heat. The heat qi was abundant, hiding inside the skin and outside the stomach and intestines, which is where Ying Qi (Nutritive Qi) resides. (Lu Ziyao said: Because summer qi connects with the Heart, and the Heart governs Ying Blood. The classic states: Nothing is more precious for nourishing the body than the meridians. Thus, it does not flow into the meridians but rests in the 'she' (residence). 'She' refers to the boundaries traversed by the meridians. Wherever there is a boundary, there is a residence, like travelers having relay stations. Ni Chongzhi said: The heavenly summer-heat combines with the Qi of Ministerial Fire. Since the Heart governs Ying Blood, the pathogen hides in the Ying residence. Wei Qi is the fierce Qi of Yangming. Wind-Wood and Cold-Water attack and insult Earth-Qi. Thus, Wind-Water pathogens reside together with Wei Qi.) This causes sweat pores to be loose and interstices (Couli) to open. Consequently, autumn Qi invades. Sweat exposure to wind, or bathing, allows water Qi to settle inside the skin, residing together with Wei Qi. Wei Qi travels in Yang during the day and in Yin at night. This pathogen moves outward when encountering Yang and presses inward when encountering Yin. Internal and external interaction causes daily attacks. (Lu Ziyao said: Summer-heat causes sweating, loose pores, and open interstices because summer nature is warm and dispersing, causing interstices to open but not close immediately. Not falling ill immediately is because summer Qi moves from inside to outside, and Wei Qi relies on this to defend. Upon encountering autumn Qi, the mechanism turns from outside to inside. The retained summer-heat causes sweating and open interstices, allowing Wind to enter. Or, bathing allows Water Qi to settle inside the skin, residing with Wei Qi. Wei Qi travels in Yang during the day and in Yin at night. Wind and Water pathogens follow Wei Qi outward in Yang and inward in Yin. Internal and external interaction causes daily attacks. Mo Zijin asked: Wei Qi travels in Yang during the day, why does it enter Yin first causing chills and yawning? Answer: Pathogen enters Yin when encountering Yin and exits Yang when encountering Yang. Pathogen and Wei Qi reside together, so they sink inward together. It is not Wei Qi traveling in Yin. Inside is Yin, outside is Yang. Pathogen stays outside the body and acts when corresponding with Wei Qi. Wei Qi travels in Yang during the day, so attacks occur during the day.)
Huangdi asked: What causes attacks every other day?
Qibo said: The pathogen resides deeply, pressing inward on Yin. Yang Qi alone activates, while Yin pathogen lingers inside. Yin and Yang struggle but cannot exit together, hence every-other-day attacks. (Pronunciation of "jian" is departing tone. It means the pathogen resides deeply, pressing inward on the Yin portion of the interior. Yang Qi alone activates externally, while interior Yin pathogen lingers inside. Yin pathogen and Yang Qi struggle but cannot all exit externally, hence every-other-day attacks. Note: This verse differs from the condition of pathogen pressing on the Five Zang organs and Mu Yuan.)
Huangdi said: Good. What causes attacks to be delayed or advanced in time?
Qibo said: The pathogen lodges in the Fengfu point and descends along the Du Mai (Governor Vessel). Wei Qi gathers at Fengfu once a day and night. The next day, it descends one vertebral segment, hence the delay in onset. This is because the pathogen first lodged in the back. (This discusses pathogen entering from Fengfu and lodging in the spine, resulting in variable onset times. Wei Qi circulates 50 cycles through Yin and Yang in a day and night, gathering at Fengfu. The next day, it descends one segment, hence the delay. This is because the pathogen first lodged in the spine and met Wei Qi.) Each time Wei Qi reaches Fengfu, the interstices open. When interstices open, pathogen enters. When pathogen enters, the disease manifests. Thus, daily attacks gradually become later. Wei Qi emerges from Fengfu, descending one segment daily. After twenty-one days, it reaches the coccyx. (This clarifies that as Wei Qi descends one segment daily, its convergence at Fengfu is also delayed, hence later attacks. Generally, when Wei Qi reaches Fengfu, interstices open. Once open, the pathogen lodged in the spine returns to Fengfu and meets Wei Qi, causing the disease. As Wei Qi emerges from Fengfu and descends one segment daily, its upward convergence at Fengfu is increasingly delayed, hence increasingly later attacks. After twenty-one days reaching the coccyx, the upward convergence at Fengfu is even more delayed, hence even later attacks.) On the twenty-second day, it enters the spine interior and pours into the Fulu Mai (Hidden Du Mai). The Qi ascends. After nine days, it emerges from the Quepen area. The Qi rises daily, hence attacks become increasingly earlier. (Fulu refers to the hidden Chong and Du tendons. Wei Qi circulates externally along the Du Mai downward and internally along the Chong Mai upward. The Qi ascends, emerging from Quepen after nine days. As the Qi rises daily, its convergence at Fengfu becomes earlier, hence attacks become earlier.)
Attacks every other day occur because the pathogen presses inward on the Five Zang organs and horizontally connects to the Mu Yuan (Omental Field). The path is long, the pathogen is deep, and its movement is slow. It cannot travel with Wei Qi nor exit completely, hence occurring every other day. (Mu Yuan refers to the fatty membranes connecting the Zang and Fu organs, i.e., the textures between skin and organs mentioned in the Jin Gui, which are the interstices where Wei Qi travels. Unable to exit with Wei Qi, it occurs every other day.)
Huangdi said: You stated that when Wei Qi reaches Fengfu, interstices open, pathogen enters, and disease manifests. Now Wei Qi descends one segment daily, and its manifestation is not at Fengfu. How do daily attacks occur? (Huangdi asks: What is the cause when pathogen does not enter via Fengfu but still results in daily attacks?)
Qibo said: This is because the pathogen lodges in the head and neck and descends along the Du Mai. Thus, deficiency and excess differ, and since pathogen strikes different locations, it does not align exactly with Fengfu. Therefore, if pathogen strikes the head and neck, disease manifests when Qi reaches the head and neck; if it strikes the back, disease manifests when Qi reaches the back; if it strikes the waist and spine, disease manifests when Qi reaches the waist and spine; if it strikes the hands and feet, disease manifests when Qi reaches the hands and feet. (Lodging in head and neck refers to lodging in Fengfu. Qibo says pathogen enters Fengfu and descends along Du Mai, staying in places with varying deficiency/excess. If pathogen strikes different locations, there is no early/late distinction. Deficiency/excess refers to early/late. When Wei Qi is deficient, it descends daily, causing delayed onset; when Wei Qi is excess, it ascends daily, causing early onset. This describes pathogen lingering in the spine between Fengfu. If pathogen strikes elsewhere, it does not align with Fengfu. For example, if pathogen strikes head and neck, disease manifests when Wei Qi reaches head and neck; if it strikes waist/back/hands/feet, pathogen stays there, and disease manifests when Wei Qi meets it. Some attack early, some late, unlike pathogen at Fengfu which gets progressively later or earlier. Zhang Zhaohuang said: Fengfu follows Du Mai downward to the spine interior and Chong Mai upward. This is the tunnel of Wei Qi. Thus, pathogen lingering inside encounters Wei Qi's daily ascent/descent, causing early/late variations.) Disease manifests when Wei Qi location coincides with pathogen. Hence, Wind has no fixed Fengfu. Wherever Wei Qi activates, it opens interstices; wherever pathogen coincides, that is its "Fu" (seat). (Wei Qi location means Wei Qi travels to where pathogen is, coinciding to cause disease. Thus, Wind pathogen may strike head/neck or waist/back/hands/feet, without fixed location, not necessarily Fengfu. Wei Qi movement activates where it arrives, opening interstices. Only when interstices open do pathogen and righteousness coincide. The place where pathogen and Wei Qi coincide is its "Fu".)
Huangdi said: Good. Wind and Malaria are similar and of the same category, yet Wind persists constantly, while Malaria has periods of rest. Why? (Malaria arises from Wind. However, Wind disease remains in its location, while Malaria has periodic rest and activity, hence Huangdi's question.)
Qibo said: Wind pathogen stays in its location, hence constant. Malaria Qi follows the meridians, sinking and pressing inward, hence acting when Wei Qi responds. (Wind pathogen injures Wei Qi, so Wind disease stays in muscle, interstices, sinews, and bones without moving. Malaria Qi lodges in Ying Qi, following meridians to press inward, acting when responding to Wei Qi.)
Huangdi asked: What causes Malaria to start with cold followed by heat?
Qibo said: Summer injury by intense heat causes profuse sweating and open interstices. Encountering cold water Qi in summer, it hides in the interstices and skin. Autumn injury by Wind completes the disease. (Cold-Wind is "Qi", Cold-Water is "Cang". In summer, heat and humidity evaporate, interstices open. Sweat may follow wind, or bathing may cause cold water to hide in interstices/skin. In autumn, Wind injury occurs. Cold and Wind dual infection forms cold-heat disease. Note: This discussion on cold-then-heat differs from the previous section. Previous section: Summer heat hides in Ying residence; Autumn Wind-Cold resides with Wei Qi. Ying is Yin, Wei is Yang. This pathogen presses inward in Yin and exits outward in Yang. Thus, Ying-resident pathogen first goes to Yin (cold), then to Yang (heat). This is internal Yin-Yang cold-heat. This section: Summer cold-water and Autumn Wind-Yang pathogen discuss heavenly Yin-Yang cold-heat. Thus, the classic's intent differs slightly, and students should analyze carefully.) Cold is Yin Qi; Wind is Yang Qi. Injury by Cold first, then Wind, hence cold first, then heat. Disease acts at set times, named Han Malaria (Cold Malaria). (Heavenly Yin pathogen induces human Yin cold; Heavenly Yang pathogen induces human Yang heat. Thus, first Cold induces Yin cold; later Wind induces Yang heat. Acting at set times means timely action without early/late variation.)
Huangdi asked: What causes heat first, then cold?
Qibo said: This is injury by Wind first, then Cold, hence heat first, then cold. Also acts at set times, named Wen Malaria (Warm Malaria). (Wang Bing said: Called Warm because it starts with heat. Ni Chongzhi said: This is heavenly Yin-Yang and patient's Yin-Yang. Dual Yin-Yang infection causes alternating cold-heat. Although there is sequence of infection, it differs from old/new disease. Scholars should recognize this.)
Those with heat only and no cold: Yin Qi is exhausted first, Yang Qi alone activates. There is shortness of breath, vexation, heat in hands and feet, and desire to vomit. Named Dan Malaria (Intense Heat Malaria). ("Qi" continues from above. Wen Malaria mentioned above: Pathogen hides in marrow. Marrow is generated by Kidney essence. Long-standing, it combines with Kidney Qi. Thus, Wen Malaria pathogen hides in Kidney, Qi first exits from inside to outside. Exiting inside to outside, Yang disease extremes return to Yin. Those with heat only: Pathogen hides in marrow, but Kidney Yin Qi first separates from Bone Qi. External pathogen does not reach interior Yin, but activates alone in Yang. Heat injures Qi, hence shortness of breath. Heart dislikes heat, hence vexation. Hands and feet are root of all Yang, hence heat in hands and feet. Classic states: All vomiting and acid regurgitation belong to Heat. This Wen Malaria without returning to cold is named Dan Malaria. Dan means single, referring to single activation in Yang causing heat. Lu Ziyao said: Dan Malaria has two causes, this is one.)
Huangdi asked: The classic says excess should be drained, deficiency should be tonified. Heat is excess, Cold is deficiency. In Malaria, cold cannot be warmed by soup or fire; heat cannot be cooled by ice or water. These belong to excess/deficiency categories. At this time, even skilled doctors cannot stop it; must wait for natural decline before needling. Why? I wish to hear the explanation.
Qibo said: The classic says: Do not needle Malaria with high fever (He), do not needle with chaotic pulse (Hunhun), do not needle with dripping sweat (Lulu). Thus, these are adverse conditions, not suitable for needling. ("He" pronounced 'gao', "Lulu" pronounced 'lu'. Yang heat is excess, Yin cold is deficiency. Citing Ling Shu Shun Ni Pian: "He" means intense heat. "Hunhun" means pathogen excess and chaotic pulse. "Lulu" means heavy sweating. At this time, pathogen is severe and righteous Qi is reversed, hence not suitable for needling.)
When Malaria first starts, Yang merges into Yin. At this time, Yang is deficient and Yin is excess, with no Qi on the exterior, hence chills first. When Yin Qi reverses to extreme, it re-emerges as Yang. Yang and Yin merge again externally, Yin becomes deficient and Yang becomes excess, hence heat and thirst first. (This describes the initial盛 (excess) of cold and heat, where Yin-Yang Qi interact and righteous Qi is confused and undivided, hence not suitable for needling. Zhang Zhaohuang said: Here, heat is Yang excess and有余 (redundant), cold is no Qi and deficiency. The so-called excess/deficiency refers to Yang pathogenic Qi.)
Malaria Qi: Merging into Yang makes Yang prevail; merging into Yin makes Yin prevail. Yin prevailing causes cold; Yang prevailing causes heat. (Previous section discussed cold-heat of Yang Qi deficiency/excess; this section discusses cold-heat of Yin-Yang prevalence/merging. Both belong to Yin-Yang disharmony and pathogen excess, unsuitable for needling.)
Malaria is due to Wind-Cold Qi, which is not constant. Disease extremity leads to recurrence. (Re-discussing heavenly Yin-Yang pathogens causing cold-heat. Wind is Yang pathogen, Cold is Yin pathogen. Wind-Cold Qi changes unpredictably. If Wind disease becomes heat, extreme leads to Yin Cold pathogen returning; if Cold disease becomes cold, extreme leads to Wind Yang heat returning. Should be viewed like the three causes of cold-heat deficiency/excess.)
Disease manifestation is like fire heat or wind-rain, unstoppable. Hence the classic says: Strike when盛 (excess) leads to destruction; treat when衰 (decline) leads to great prosperity. This is what is meant. (Previous section: Yin-Yang interaction, righteous Qi undivided, not suitable for needling. Here continuing: Pathogen just excess, not suitable for needling. Pathogen manifestation is fierce like fire, unstoppable like wind-rain. Hence classic says striking when excess destroys righteous Qi. Treating when decline ensures prosperity. This is the meaning. Military strategy says: Do not meet vigorous Qi, do not attack solid formations. Avoid their sharpness, strike their fatigue. Ni Chongzhi said: Like fire fierce is Yang heat excess; like wind-rain unstoppable is Yin cold excess.)
Before Malaria manifests, Yin has not merged into Yang, Yang has not merged into Yin. Regulate it then, True Qi settles, pathogen perishes. Hence doctors cannot treat already manifested Malaria, because Qi is reversed. (Pathogen not manifested, righteous Qi not disturbed. Regulate then, True Qi settles, pathogen perishes. This is treating before disease. If waiting for manifestation, even skilled doctors cannot help, because Qi is reversed. Previous section treated decline; this treats before manifestation.)
Huangdi said: Good. How to attack it? What about timing (early/late)? (Early means before disease; Late means after disease decline.)
Qibo said: When Malaria is about to manifest, Yin-Yang is about to shift. It must start from the four extremities. Yang is already injured, Yin follows. Hence, before the time, firmly bind the area, preventing pathogen entry and Yin Qi exit. Examine carefully; if Sun Luo (branch vessels) are full, hard, and bloody, needle them all. This is True Qi going forth without merging. (Clarifying treating-before-disease method. "Qie" means uncertain/future tense. Malaria about to manifest, Yin-Yang about to shift, starting from four extremities. Three Yin and Three Yang Qi shift from Jing-River points of hands and feet. If disease in Yang and Yang injured, Yin channels will follow and suffer. Hence, before manifestation, firmly bind four extremities, preventing pathogen in this channel from entering that channel, and Qi in that channel from exiting and merging into this channel. Examine signs and pulse; if branch vessels are full, hard, and bloody, needle them. This is Yin-Yang True Qi coming and going peacefully, without merging. Ni Zhongxuan said: Malaria Qi lodges in skin and muscle interstices, hence disease appears in branch vessels.)
Huangdi asked: What are the responses when Malaria is not manifesting? (Asking what pulse and sign responses occur when Malaria is not manifesting.)
Qibo said: Malaria Qi must alternate between excess and deficiency, depending on where the Qi is located. Disease in Yang presents with heat and restless pulse; disease in Yin presents with cold and quiet pulse. (Malaria Qi has alternating Yin-Yang prevalence/deficiency, all depending on Qi location. Disease in Yang means heat and restless pulse; disease in Yin means cold and quiet pulse. To know pulse-disease correspondence, examine cold-heat signs and pulse restlessness/quietness to know if disease is in Yin or Yang.)
At extremity, Yin and Yang both decline, Wei Qi separates, hence disease rests. When Wei Qi gathers, disease recurs. (Explaining why Yin-Yang alternates excess/deficiency is due to Wei Qi movement. Wei Qi travels Yin and Yang. Hence Wei Qi separation allows disease rest; Wei Qi gathering causes disease recurrence.)
Huangdi asked: Sometimes intervals are two days or several days; sometimes thirsty, sometimes not. Why?
Qibo said: Every-other-day attacks occur because pathogen and Wei Qi lodge in the Six Fu organs, sometimes missing each other, unable to interact, hence resting for several days before manifesting. (Six Fu refers to Six Fu...