似疟者，发作有时而准也。按似疟与潮热，皆不失时候。但热不寒者，名潮热；先寒后热
者，名似疟。故曰似疟，表症也。发于昼，邪在阳分气分者轻；发于夜，邪在阴分血分者
重。若发于寅卯二时，少阳症也，柴胡汤主之。寒多者，加羌活、防风；热多者，加黄芩、
山栀。若发于辰巳午三时，或一日一发者，太阳症也，加减羌活汤主之。寒多，倍加羌活、防
风；热多，加黄芩、山栀。发于未申二时，或间日一发者，阳明症也，干葛汤主之。若寅卯
先见烦躁烦热，至未申而热甚者，阳明而兼少阳也，重加柴胡黄芩。若发时寒多，加羌活、
防风；热多，加知母、石膏。此以时候分各经主治之法也。又有一日一发，恶寒头痛，脉浮
而数，为太阳经，即以前方羌活汤。若间日发作，热多寒少，脉长而大，烦渴消水者，为阳
明经，即以前方干葛汤加减主之。若寒热口苦，脉弦而数者，为少阳经，即以前方小柴胡汤
加减服之。此又据症据脉，分各经主治之法也。寒热发在午前者，表症也，宜发表。寒热发在
午后者，邪在半表半里，一半散表，一半清里。若但热不寒，发在午后者，瘅阳症，宜清里
为急。大凡似疟，发作不愆其期者，则非虚热，不论日数，悉作邪治。有表邪恶寒，失散表
邪，内伏变症。有里邪，失治，里邪病必不愈。若发时手足皆冷，甚至麻木，此积热从内发
外，风寒束其外，里热不得发越，是以手足反冷，宜先散表邪，后清积热。积热先感，伏于
内，未曾发病。风寒后感，束于外，其病乃发。后感之风，寒在外而近，故先寒。先感之积
热，在内而远，故后热。积热本病，表寒标病，近者先治，故凡病先散表，后清里也。若发
时胸前或满，或呕，或热，或嘈，或痛，或恶心，此痰饮内伏，故呕吐也，宜以二陈导痰
汤。热令有火，加山栀、川连、冲竹沥热服。若胸前饱闷，呕吐不食，此食滞胃家，宜以平
胃保和散、青皮槟榔散、草果饮，加白豆蔻、川连。若内有积热，忌辛燥者，冲萝卜汁。以
似疟症必夹痰食而起者，故曰疟家中脘，多蓄黄水，肠胃有痰饮积食，至其时则发作上潮，
宜先用吐法，随用导痰汤、草果饮、保和散消尽痰积，重加槟榔、楂肉，则无疟母癖块之患。
大凡痰饮食积似疟症，若在热令发作，虽忌辛温燥味，又忌生冷抑遏，以此症最易变重。夫
疟疾间日而发，发后清爽，仍能行走饮食。若一日一发，发后身虽凉，不能起身饮食，乃太
阳经先寒后热之寒热病，非真疟也。初起先寒后热，宛似疟症，失忌风寒饮食，一热不凉矣。
此症如发热汗多，表邪不解，久病不愈。直待汗少，方是热减可愈之机。若一起从来无汗，
或汗向少，尚有恶寒表症。直待汗多，方是表邪表散之征。故曰无汗恶寒，表症也，欲其有
汗，散表为先。有汗潮热，里症也，欲其无汗，清里为急。如初起胸前饱闷，恶寒发热，不
思饮食，此胃家有滞。直待胸前宽适，饮食能进，方有愈期。若胃强能食，发热不止，此阳
明有热，必减其饮食，则谷气不助热邪而热自减，故云日暮微烦，减谷即愈。
太阳病，得之八九日，如疟状，发热恶寒，热多寒少，其人不呕，清便欲自可。一日二三度
发，脉微缓者，为欲愈也。脉微而恶寒者，此阴阳俱虚，不可更发汗更下更吐也。面色反有
热色者，未解也，以其不得小汗出，身必痒，宜桂枝麻黄各半汤。
太阳病，得之八九日，一日一发，先寒后热，如疟状，若其人不呕，清便，则里无邪，当
自可。若一日二三度发，则是邪散，变轻而无准期，脉又见微缓，则为自愈。若仍见恶寒
表症而脉微，当知阴阳俱虚，不可更发汗更下更吐也。若见面热赤色，此其表邪未解，未
得小汗出，身必发痒，仍当发汗，冬月北方用麻桂各半汤。南方三时用羌活，防风汤。
服桂枝汤，大汗出，脉洪大者，与桂枝汤如前法。若形如疟，日再发，汗出必解，宜桂枝二
麻黄一汤。
服桂枝汤汗大出，病不解，脉反洪大，又与桂枝汤。又见形如疟，若一日两发，此是表邪
欲解之象。因桂枝止治风邪，寒邪终不得散，故加麻黄一半，以散寒邪，则汗出而必解。
可见太阳似疟，皆主散表，不比阳明似疟有汗下两条者。
病患烦热，汗出则解，又如疟状，日晡所发热者，属阳明也。脉实者宜下之，脉虚浮者，宜
发汗。下之，与大承气汤。发汗，宜桂枝汤。
太阳如疟，皆表邪。今日晡发热，此阳明似疟之症。故分脉沉而实，宜下之以大承气。脉
若不实而浮，尚是太阳似疟，而以桂枝发汗也。
少阳篇曰∶妇人中风，七八日续得寒热，发作有时，经水适断者，此为热入血室，其血必结，
故使如疟状，发作有时，小柴胡汤主之。
此条专言女科热入血室似疟症。小柴胡汤兼治少阳、厥阴，再加引入血分之味。
小柴胡汤 见寒热头眩二门。
按似疟症，若发寅卯二时，又见弦数之脉，以此方主治。若恶寒身痛，加羌活；无汗，加
防风；胸前饱闷，加枳壳、浓朴、草果、白豆蔻；口渴，加知母、石膏、干葛；呕恶，加竹
茹，倍半夏。
加减羌活汤 见恶寒。
似疟发于午前，见恶寒身痛，伸欠拘禁，为太阳症，故以此方发表。
升麻干葛汤
升麻 干葛 白芍药 甘草
此治阳明经有汗恶寒之疟。若无汗，去白芍药，加防风，恶寒身痛，加羌活；呕恶，加半
夏、浓朴；口渴消水，加干葛、石膏；胸前饱闷，加草果、白豆蔻。
白虎加桂枝汤
似疟症，表有寒邪，忌白虎，里有积热，忌桂枝。今以石膏之清凉同桂枝，亦能散表。桂
枝辛热同石膏，亦化清凉。桂枝治先恶寒；石膏治后发热。
二陈导痰汤
半夏 南星 枳实 赤茯苓 橘红 甘草 石菖蒲
胸前饱闷，又见寒热似疟，此因痰成疟，故立此方。外感表邪，加羌活、柴胡、干葛。里
有积热，加山栀、黄连、白豆蔻、浓朴。
平胃散 见谵语。
肠胃湿热，恒发似疟。若发时胸前饱闷，悉以食积主治。兼冒寒邪，加羌活、柴胡、葛根、
防风；内兼积热，加山栀、黄连、枳壳，食积重者，加楂肉一两，青皮三钱，呕吐，加竹
茹、半夏、白豆蔻。
草果饮
草果仁 青皮 白芷 甘草 紫苏 白豆蔻 山楂 莱菔子
人冒外邪，但发寒热，不成疟症。若肠胃先有食积痰涎，后又外感风寒，则发似疟，故家
秘以此消痰积。若发时恶寒身痛，此后感之表邪急也，加羌活、柴胡、升麻；口渴唇焦，
先感之积热重也，加栀、连。
不思饮食，似疟不愈，消其饮食，不助热邪，而热自除。能食而似疟不愈，禁其饮食，不
助邪热，而热自减。以似疟之症，皆因内有痰饮积热故耳。
家秘截疟饮
羌活 柴胡 升麻 半夏 浓朴 槟榔 青皮 枳壳 木通 楂肉
所谓“似疟”，是指寒热发作的时间规律且准确。大抵“似疟”与“潮热”，都不违背其发作的时辰规律。但只有发热而没有恶寒的，称为“潮热”；先出现恶寒随后发热的，称为“似疟”。因此称之为“似疟”，属于表证。如果在白天（寅卯时）发作，说明邪气在阳分、气分，病情较轻；如果在夜间（未申时等）发作，说明邪气在阴分、血分，病情较重。
如果病发于寅时、卯时这两个时辰，属于少阳病，主治方剂为小柴胡汤（Chaihu Tang）。若恶寒症状明显，加入羌活、防风；若发热症状明显，加入黄芩、山栀。如果病发于辰时、巳时、午时这三个时辰，或者是一天发作一次，属于太阳病，主治方剂为加减羌活汤。若恶寒重，加倍使用羌活、防风；若发热重，加入黄芩、山栀。如果病发于未时、申时这两个时辰，或者是隔天发作一次，属于阳明病，主治方剂为升麻干葛汤（Shengma Gange Tang）。如果在寅卯时先出现烦躁烦热，到了未申时发热加重，这是阳明病兼有少阳病，应加重柴胡、黄芩的用量。如果发作时恶寒多，加入羌活、防风；发热多，加入知母、石膏。这是根据发病时辰来区分各经主治的方法。
另外，如果一天发作一次，伴有恶寒头痛，脉象浮而数，这是太阳经病，就用前面的羌活汤。如果是隔天发作，发热多而恶寒少，脉象长而大，心烦口渴想喝水，这是阳明经病，就用前面的干葛汤加减主治。如果寒热往来、口苦，脉象弦而数，这是少阳经病，就用前面的小柴胡汤加减服用。这是又根据症状和脉象，来区分各经主治的方法。
寒热发作在中午之前的，属于表证，适宜用解表法。寒热发作在中午之后的，邪气在半表半里，一半散在表，一半清在里。如果只有发热没有恶寒，且在中午之后发作，这是瘅阳症（Dan Yang Syndrome），急需清里热。大凡“似疟”症，发作不违背其周期的，就不是虚热，不论天数多少，都当作邪气实证来治疗。如果有表邪导致恶寒，误失了发散表邪的机会，邪气内伏就会变生他症。如果有里邪，误治则里邪病必不愈。如果发作时手脚都冷，甚至麻木，这是因为积热从内发向外部，风寒束缚在体表，导致里热不能发散透达，所以手脚反而发冷，适宜先散表邪，后清积热。积热先感受，潜伏在体内，尚未发病；风寒后感受，束缚在体表，疾病这才发作。后感的风寒在体表且较近，所以先感到恶寒；先感的积热在体内且较远，所以后感到发热。积热是本病，表寒是标病，近的（标）先治，所以凡是这类病都是先散表邪，后清里热。
如果发作时胸前或胀满，或呕吐，或发热，或嘈杂感，或疼痛，或恶心，这是痰饮潜伏在内，导致呕吐，适宜用二陈导痰汤（Erchen Daotan Tang）。如果在热令（夏季）发作且有火象，加入山栀、川连，冲服竹沥热服。如果胸前饱闷，呕吐不能进食，这是食滞停留在胃家，适宜用平胃保和散（Pingwei Baohe San）、青皮槟榔散、草果饮，加入白豆蔻、川连。如果内有积热，忌用辛燥药，可冲服萝卜汁。因为“似疟”症必定夹杂痰食而起，所以说患疟疾的人中脘穴部位，多蓄积黄水，肠胃中有痰饮积食，到了发作时间就向上涌起发作，适宜先用吐法，随后用导痰汤、草果饮、保和散消除尽痰积，重用槟榔、山楂肉，就不会有疟母癖块（脾脏肿大）的祸患。
大凡因痰饮食积导致的“似疟”症，如果在热令发作，虽然忌讳辛温燥味，也忌讳生冷抑制，因为这个病症最容易变得严重。疟疾是隔天发作，发作后神志清爽，仍能行走饮食。如果是一天发作一次，发作后身体虽凉，但不能起身饮食，这是太阳经先寒后热的寒热病，不是真正的疟疾。初起先寒后热，宛然像疟症，如果失于禁忌风寒饮食，一旦发热就不再退凉。这个病症如果发热汗多，表邪不解，久病不愈。必须等到汗少，才是热减可愈的时机。如果从一开始就没有汗，或者汗很少，还有恶寒的表证。必须等到汗多，才是表邪随汗解散的迹象。所以说无汗恶寒，是表证，想要它有汗，以发散表邪为先。有汗潮热，是里证，想要它无汗，以清里热为急。如果初起胸前饱闷，恶寒发热，不想饮食，这是胃家有停滞。必须等到胸前宽适，能进食，才有痊愈的日期。如果胃强能食，发热不止，这是阳明有热，必须减少饮食，那么谷气就不助长热邪而热自然减退，所以说日暮微烦，减少饮食即愈。
太阳病，得病八九日，像疟疾的样子，发热恶寒，热多寒少，病人不呕吐，大小便尚正常。一天发作两三次，脉象微缓的，是快要痊愈了。脉象微而恶寒的，这是阴阳俱虚，不可再用发汗、攻下、催吐的方法。面色反现红赤色的，病邪未解，因为他不能出小汗，身体必然发痒，适宜用桂枝麻黄各半汤（Guizhi Mahuang Ge Ban Tang）。
太阳病，得病八九日，一天发作一次，先寒后热，像疟疾的样子，如果病人不呕吐，大小便正常，则里没有邪气，应当自愈。如果一天发作两三次，则是邪气已散，病情减轻且发作不准时，脉象又见微缓，则为自愈。如果仍然见到恶寒的表证而脉微，应当知道阴阳俱虚，不可再用发汗、攻下、催吐的方法。如果见面部发热呈红色，这是表邪未解，未能出小汗，身体必然发痒，仍当发汗，冬季北方用麻桂各半汤。南方三伏天用羌活、防风汤。
服用桂枝汤后，大汗出，脉象洪大的，仍按前法给予桂枝汤。如果身形像疟疾一样，一天发作两次，汗出必解，适宜用桂枝二麻黄一汤（Guizhi Er Mahuang Yi Tang）。
服用桂枝汤汗大出，病不解，脉反洪大，又给予桂枝汤。又见身形像疟疾，如果一天两发，这是表邪欲解之象。因为桂枝只治风邪，寒邪终究不得散，所以加一半麻黄，以散寒邪，则汗出而必解。可见太阳病的“似疟”，都以发散表邪为主，不像阳明病的“似疟”有攻下和解表两条途径。
病患烦热，汗出则解，又像疟疾的样子，傍晚时分发热的，属于阳明病。脉实者适宜攻下，脉虚浮者适宜发汗。攻下，用大承气汤（Da Chengqi Tang）。发汗，宜用桂枝汤。
太阳病如疟，都是表邪。今日晡（傍晚）发热，这是阳明病似疟的症状。所以分脉沉而实，适宜用大承气汤攻下。脉若不实而浮，尚是太阳病似疟，用桂枝汤发汗。
少阳篇说：妇人中风，七八天后持续出现寒热，发作有时，月经恰好中断，这是热入血室（Re Ru Xue Shi），血必凝结，所以使症状像疟疾一样，发作有时，用小柴胡汤主治。
这一条专门论述女科热入血室导致的似疟症。小柴胡汤兼治少阳、厥阴，再加引入血分的药物。
小柴胡汤 见寒热头眩二门。
按：似疟症，如果发于寅卯二时，又见弦数之脉，以此方主治。若恶寒身痛，加羌活；无汗，加防风；胸前饱闷，加枳壳、浓朴、草果、白豆蔻；口渴，加知母、石膏、干葛；呕恶，加竹茹，倍用半夏。
似疟发于午前，见恶寒身痛，伸欠拘禁，为太阳症，故以此方发表。
升麻干葛汤
升麻、干葛、白芍药、甘草。
此治阳明经有汗恶寒之疟。若无汗，去白芍药，加防风，恶寒身痛，加羌活；呕恶，加半夏、浓朴；口渴消水，加干葛、石膏；胸前饱闷，加草果、白豆蔻。
白虎加桂枝汤
似疟症，表有寒邪，忌用白虎汤；里有积热，忌用桂枝。今以石膏之清凉同桂枝，亦能散表。桂枝辛热同石膏，亦化清凉。桂枝治先恶寒；石膏治后发热。
二陈导痰汤
半夏、南星、枳实、赤茯苓、橘红、甘草、石菖蒲。
胸前饱闷，又见寒热似疟，此因痰成疟，故立此方。外感表邪，加羌活、柴胡、干葛。里有积热，加山栀、黄连、白豆蔻、浓朴。
平胃散 见谵语。
肠胃湿热，恒发似疟。若发时胸前饱闷，悉以食积主治。兼冒寒邪，加羌活、柴胡、葛根、防风；内兼积热，加山栀、黄连、枳壳，食积重者，加楂肉一两，青皮三钱，呕吐，加竹茹、半夏、白豆蔻。
草果饮
草果仁、青皮、白芷、甘草、紫苏、白豆蔻、山楂、莱菔子。
人冒外邪，但发寒热，不成疟症。若肠胃先有食积痰涎，后又外感风寒，则发似疟，故家秘以此消痰积。若发时恶寒身痛，此后感之表邪急也，加羌活、柴胡、升麻；口渴唇焦，先感之积热重也，加栀、连。
不思饮食，似疟不愈，消其饮食，不助热邪，而热自除。能食而似疟不愈，禁其饮食，不助邪热，而热自减。以似疟之症，皆因内有痰饮积热故耳。
"Si Nuè" (Malaria-like syndrome) refers to the regular and accurate timing of chills and fever. Generally, both "Si Nuè" and "Chao Re" (Tidal Fever) adhere to their respective timing patterns. However, only fever without chills is termed "Chao Re"; chills followed by fever is termed "Si Nuè". Therefore, it is called "Si Nuè" and belongs to Exterior Syndromes (Biao Zheng). If it occurs during the day (Yin-Mao hours), the pathogen is in the Yang aspect and Qi level, indicating a lighter condition; if it occurs at night (Wei-Shen hours, etc.), the pathogen is in the Yin aspect and Blood level, indicating a heavier condition.
If the onset occurs during the Yin and Mao hours, it is a Shaoyang Disease (Shaoyang Bing), primarily treated with Chaihu Tang (Bupleurum Decoction). If chills are predominant, add Qiang Huo (Notopterygii Rhizoma et Radix) and Fang Feng (Saposhnikoviae Radix); if fever is predominant, add Huang Qin (Scutellariae Radix) and Shan Zhi (Gardeniae Fructus). If the onset occurs during the Chen, Si, and Wu hours, or once daily, it is a Taiyang Disease (Taiyang Bing), primarily treated with Jiajian Qiang Huo Tang (Modified Notopterygium Decoction). If chills are severe, double the dosage of Qiang Huo and Fang Feng; if fever is severe, add Huang Qin and Shan Zhi. If the onset occurs during the Wei and Shen hours, or every other day, it is a Yangming Disease (Yangming Bing), primarily treated with Shengma Gange Tang (Cimicifugae and Puerariae Decoction). If irritability and heat appear first during the Yin-Mao hours, and fever intensifies during the Wei-Shen hours, this is Yangming disease combined with Shaoyang disease; increase the dosage of Chai Hu (Bupleuri Radix) and Huang Qin. If chills are predominant during onset, add Qiang Huo and Fang Feng; if fever is predominant, add Zhi Mu (Anemarrhenae Rhizoma) and Shi Gao (Gypsum Fibrosum). This method distinguishes the primary treatment for each meridian based on the time of onset.
Furthermore, if it occurs once daily with chills, headache, and a floating and rapid pulse, it is a Taiyang Meridian disease; use the aforementioned Qiang Huo Tang. If it occurs every other day with more fever than chills, a long and large pulse, irritability, and thirst with water drinking, it is a Yangming Meridian disease; use the aforementioned Gange Tang with modifications. If there are alternating chills and fever, bitter taste in the mouth, and a string-tight and rapid pulse, it is a Shaoyang Meridian disease; use the aforementioned Xiao Chai Hu Tang (Minor Bupleurum Decoction) with modifications. This is another method of distinguishing primary treatments for each meridian based on symptoms and pulses.
Chills and fever occurring before noon belong to Exterior Syndromes and are suitable for exterior-releasing methods. Chills and fever occurring after noon indicate the pathogen is in the Half-Exterior Half-Interior stage; half is dispersed from the exterior, and half is cleared from the interior. If there is only fever without chills, occurring after noon, this is Dan Yang Syndrome (Heat Exhaustion Syndrome), requiring urgent clearing of interior heat. Generally, for "Si Nuè" syndromes where the发作 (onset) does not deviate from its cycle, it is not deficiency-heat; regardless of the number of days, it should be treated as an excess pathogenic factor. If there is exterior pathogen causing chills, failing to release the exterior pathogen allows it to lodge internally and transform into other syndromes. If there is interior pathogen, mistreatment ensures the interior pathogen will not resolve. If hands and feet are cold during onset, even to the point of numbness, this is because accumulated heat arises from within but is constrained externally by wind-cold, preventing the interior heat from venting; thus, hands and feet become cold. It is appropriate to first release the exterior pathogen and then clear the accumulated heat. The accumulated heat was contracted first and lay dormant internally before manifesting; the wind-cold was contracted later and constrained the exterior, causing the disease to manifest. The subsequently contracted wind-cold is external and proximate, hence chills occur first; the previously contracted accumulated heat is internal and distant, hence fever occurs later. Accumulated heat is the root disease, while exterior cold is the branch manifestation; treating the proximate (branch) first means that for such diseases, one must first release the exterior and then clear the interior.
If upon onset there is chest fullness, vomiting, fever, epigastric discomfort, pain, or nausea, this indicates phlegm-fluid retention lodged internally causing vomiting; Erchen Daotan Tang (Two-Aged Phlegm-Resolving Decoction) is appropriate. If occurring in the hot season with fire signs, add Shan Zhi and Chuan Lian (Coptidis Rhizoma), mixed with Zhu Li (Bamboo Sap) and taken warm. If there is chest fullness, vomiting, and inability to eat, this is food stagnation in the Stomach; Pingwei Baohe San (Peaceful Stomach and Harmony Powder), Qingpi Binglang San (Green Peel and Areca Seed Powder), or Caoguo Yin (Tsaoko Decoction) with Bai Doukou (Amomi Fructus Rotundus) and Chuan Lian are appropriate. If there is interior accumulated heat, avoid acrid-drying herbs; Luobo Zhi (Radish Juice) can be mixed in. Since "Si Nuè" syndromes invariably involve phlegm and food, it is said that patients with malaria often have yellow fluid accumulation in the Zhongwan area, with phlegm-fluid and food stagnation in the intestines and stomach. At the time of onset, these rise upward; it is appropriate to first induce vomiting, then use Daotan Tang, Caoguo Yin, and Baohe San to eliminate phlegm and stagnation, heavily using Bing Lang (Arecae Semen) and Zha Rou (Crataegi Fructus) to prevent complications like Mamo (splenomegaly).
Generally, for "Si Nuè" caused by phlegm, food, and stagnation, if occurring in the hot season, although acrid-warm-drying flavors are contraindicated, cold and raw foods that suppress yang are also contraindicated, as this syndrome easily becomes severe. Malaria typically occurs every other day; after onset, the patient feels refreshed and can walk and eat. If it occurs once daily, and although the body cools after onset, the patient cannot rise or eat, this is the chills-and-fever disease of the Taiyang Meridian (chills first, then fever), not true malaria. Initially presenting with chills then fever, resembling malaria, if wind-cold and diet are not avoided, once fever starts, it does not subside. In this syndrome, if fever is accompanied by profuse sweating and the exterior pathogen is not resolved, the chronic illness will not heal. One must wait until sweating decreases to see the sign of heat reduction and recovery. If there has been no sweat from the beginning, or very little, and exterior signs like chills persist, one must wait until profuse sweating occurs, which is the sign of the exterior pathogen dispersing. Thus, it is said: no sweat and chills indicate an Exterior Syndrome; to induce sweat, releasing the exterior is paramount. Sweat and tidal fever indicate an Interior Syndrome; to stop sweat, clearing the interior is urgent. If initially there is chest fullness, chills, fever, and loss of appetite, this indicates stagnation in the Stomach. One must wait until the chest feels comfortable and eating resumes to anticipate recovery. If the Stomach is strong and the patient eats well but fever persists, this indicates Heat in the Yangming; reducing food intake prevents grain qi from assisting the pathogenic heat, so the heat naturally subsides. Hence it is said: slight irritability at dusk resolves with reduced food intake.
In Taiyang Disease, after eight or nine days, presenting like malaria with fever and chills, more heat than cold, no vomiting, and normal bowel/bladder function, if it occurs two or three times a day and the pulse is slightly slow and moderate, it indicates impending recovery. If the pulse is slightly weak with chills, this indicates deficiency of both Yin and Yang; do not use diaphoresis, purgation, or emesis. If the face appears flushed with heat color, the pathogen has not resolved; due to the inability to produce slight sweating, the body will likely itch; Guizhi Mahuang Ge Ban Tang (Half-Dose Combination of Cinnamon Twig and Ephedra Decoction) is appropriate.
In Taiyang Disease, after eight or nine days, occurring once daily with chills first then fever, resembling malaria, if the patient does not vomit and bowel/bladder functions are normal, there is no interior pathogen, and it should resolve spontaneously. If it occurs two or three times a day, the pathogen is dispersing, becoming lighter and irregular; if the pulse is slightly slow and moderate, it indicates spontaneous recovery. If chills and exterior signs persist with a weak pulse, know that Yin and Yang are deficient; do not use diaphoresis, purgation, or emesis. If facial heat and redness appear, the exterior pathogen has not resolved, slight sweating has not occurred, and the body will itch; diaphoresis is still required. In winter in the North, use Mahuang Ge Ban Tang; in summer in the South, use Qiang Huo and Fang Feng Tang.
After taking Guizhi Tang (Cinnamon Twig Decoction), if profuse sweating occurs and the pulse becomes flooding and large, continue giving Guizhi Tang as previously directed. If the condition resembles malaria, occurring twice a day, resolution will follow sweating; Guizhi Er Mahuang Yi Tang (Two Parts Cinnamon Twig, One Part Ephedra Decoction) is appropriate.
After taking Guizhi Tang, if profuse sweating occurs but the disease does not resolve, and the pulse reverses to flooding and large, give Guizhi Tang again. If the condition resembles malaria, occurring twice a day, this is a sign that the exterior pathogen is resolving. Because Guizhi Tang treats wind pathogen but cannot disperse cold pathogen, adding half the dose of Mahuang (Ephedrae Herba) disperses the cold pathogen, ensuring resolution through sweating. Thus, it is evident that Taiyang "Si Nuè" is primarily treated by releasing the exterior, unlike Yangming "Si Nuè" which has both purgative and diaphoretic approaches.
If the patient experiences irritability and heat, resolving with sweat, yet resembles malaria with fever in the late afternoon (Wu hour), it belongs to Yangming. If the pulse is solid, purgation is appropriate; if the pulse is deficient and floating, diaphoresis is appropriate. For purgation, use Da Chengqi Tang (Major Order the Qi Decoction). For diaphoresis, use Guizhi Tang.
Taiyang malaria-like syndromes are all exterior pathogens. Late afternoon fever indicates a Yangming malaria-like syndrome. Thus, if the pulse is deep and solid, use Da Chengqi Tang for purgation. If the pulse is not solid but floating, it remains a Taiyang malaria-like syndrome, treated with Guizhi Tang for diaphoresis.
The Shaoyang Chapter states: In women with Wind-Stroke, after seven or eight days, continuous chills and fever occurring at specific times, coinciding with the abrupt cessation of menstruation, this is Heat Entering the Blood Chamber (Re Ru Xue Shi). The blood must be congealed, causing symptoms resembling malaria with regular onset; Xiao Chai Hu Tang is the primary treatment.
This section specifically discusses the "Si Nuè" syndrome of Heat Entering the Blood Chamber in gynecology. Xiao Chai Hu Tang treats both Shaoyang and Jueyin; add herbs that enter the Blood level.
Xiao Chai Hu Tang - See sections on Chills/Fever and Dizziness.
Note: For "Si Nuè" occurring during Yin-Mao hours with a string-tight and rapid pulse, this formula is primary. If chills and body ache exist, add Qiang Huo; if no sweat, add Fang Feng; if chest fullness, add Zhi Ke (Aurantii Fructus), Hou Po (Magnoliae Officinalis Cortex), Cao Guo (Tsaoko Fructus), and Bai Doukou; if thirsty, add Zhi Mu, Shi Gao, and Gan Ge (Puerariae Radix); if vomiting/nausea, add Zhu Ru (Bambusae Caulis in Taenia) and double Ban Xia (Pinelliae Rhizoma).
Jiajian Qiang Huo Tang - See Chills.
"Si Nuè" occurring before noon with chills, body ache, yawning, and stiffness indicates a Taiyang syndrome; thus, this formula is used to release the exterior.
Shengma Gange Tang
Sheng Ma (Cimicifugae Rhizoma), Gan Ge (Puerariae Radix), Bai Shao Yao (Paeoniae Radix Alba), Gan Cao (Glycyrrhizae Radix et Rhizoma).
This treats Yangming Meridian malaria with sweat and chills. If no sweat, remove Bai Shao Yao, add Fang Feng; for chills/body ache, add Qiang Huo; for vomiting/nausea, add Ban Xia and Hou Po; for thirst/water drinking, add Gan Ge and Shi Gao; for chest fullness, add Cao Guo and Bai Doukou.
Bai Hu Jia Guizhi Tang (White Tiger Plus Cinnamon Twig Decoction)
For "Si Nuè", if there is exterior cold pathogen, Bai Hu Tang is contraindicated; if there is interior accumulated heat, Guizhi is contraindicated. Here, the cooling nature of Shi Gao combined with Guizhi can still release the exterior. The acrid-warm nature of Guizhi combined with Shi Gao transforms into cooling. Guizhi treats the initial chills; Shi Gao treats the subsequent fever.
Erchen Daotan Tang
Ban Xia, Nan Xing (Arisaematis Cum Bile), Zhi Shi (Aurantii Fructus Immaturus), Chi Fu Ling (Poria cum Risu Rubrum), Ju Hong (Citri Reticulatae Pericarpium), Gan Cao, Shi Chang Pu (Acori Tatarinowii Rhizoma).
Chest fullness with chills and fever resembling malaria is caused by phlegm inducing malaria; thus, this formula is established. For exterior wind-cold, add Qiang Huo, Chai Hu, Gan Ge. For interior accumulated heat, add Shan Zhi, Huang Lian (Coptidis Rhizoma), Bai Doukou, and Hou Po.
Pingwei San - See Delirium.
Damp-heat in the intestines and stomach frequently causes "Si Nuè". If chest fullness occurs at onset, treat as food stagnation. If complicated by cold pathogen, add Qiang Huo, Chai Hu, Ge Gen (Puerariae Radix), Fang Feng; if complicated by interior accumulated heat, add Shan Zhi, Huang Lian, Zhi Ke. For severe food stagnation, add 1 liang of Zha Rou (Crataegi Fructus) and 3 qian of Qing Pi (Aurantii Fructus Viridis); for vomiting, add Zhu Ru, Ban Xia, Bai Doukou.
Caoguo Yin
Cao Guo Ren (Tsaoko Fructus), Qing Pi, Bai Zhi (Angelicae Dahuricae Radix), Gan Cao, Zi Su (Perillae Folium), Bai Doukou, Shan Zha (Crataegi Fructus), Lai Fu Zi (Radish Seed).
When contracting external pathogens, only chills and fever occur, not forming malaria. If there is pre-existing food stagnation and phlegm-fluid in the intestines/stomach, followed by external wind-cold, "Si Nuè" develops; thus, this family secret formula eliminates phlegm-stagnation. If chills and body ache occur at onset, the recently contracted exterior pathogen is urgent; add Qiang Huo, Chai Hu, Sheng Ma. If thirst and dry lips occur, the previously contracted accumulated heat is heavy; add Zhi and Lian (Shan Zhi and Huang Lian).
Loss of appetite with unresolved "Si Nuè": eliminating food prevents heat pathogen assistance, and heat removes itself. Ability to eat with unresolved "Si Nuè": restricting food prevents evil heat assistance, and heat reduces itself. "Si Nuè" syndromes are all due to internal phlegm-fluid and accumulated heat.
Family Secret Jié Nuè Yin (Malaria-Cutting Decoction)
Qiang Huo, Chai Hu, Sheng Ma, Ban Xia, Hou Po, Bing Lang, Qing Pi, Zhi Ke, Mu Tong (Akebiae Caulis), Zha Rou.