夫疟，犹酷疟之疟也。以夏伤酷暑而成 疟也，又有
气之积也。多在左胁之下，状如覆杯，是为 疟，犹
夏伤于暑而为疟，何后世之医者，皆以脾寒治之？世医既不知邪热蓄积之深为寒战，遂为寒
战所惑；又不悟邪热入而后出于表，发为燥渴，遂为交争所惑。相传以姜、附、硫黄、平胃、
异功散、交解饮子治之，百千之中，幸其一效。执以为是，至使父子兄弟相传。及其疟之甚
者，则归之祟怪，岂可不大笑耶？《内经》拘于鬼神者，不可与言至德。何世俗之愚而难化
也？又或因夏日饮冷过常，伤食生硬、瓜果、梨枣之属，指为食疟，此又非也。岂知《内经》之论则
不然。夏伤于暑，遇秋之风，因劳而汗，玄府受风，复遇凄怆之水，风闭而不出，舍于肠胃之外，与
荣卫并行，昼行于阳，夜行于阴。邪热浅，则连日而作；邪热深，则间日而作；并入于里则
热；并入于表则寒。若此而论，了不干于脾。
后世论药，如此之差误也。以时言之，治平之
时，常疟病少；扰攘之时，常疟病多。治平之时，虽用砒石、辰砂，有毒之药治之，亦能取
效。缘治平之时，其民夷静，故虽以热攻热，亦少后患。至于扰攘之时，其民劳苦，不可遽用
大毒、大热之药。若以热攻热，热甚则转为吐血、泄血、痈疽、疮疡、呕吐之疾。盖扰攘之
时，政令烦乱，徭役纷冗，朝戈暮戟，略无少暇，内火与外火俱动，在侯伯官吏尤甚，岂可与夷静之
人，同法而治哉？余亲见泰和六年丙寅，征南师旅大举，至明年军回。是岁瘴疠杀人，莫
知其数，昏瞀懊 ，十死八九，皆火之化也。次岁，疟
病大作，侯王官吏，上下皆病，轻者旬月，甚者弥年。夫富贵之人，劳心役智，不可骤用砒石
大毒之药，止宜先以白虎汤加人参小柴胡汤、五苓散之类，顿服立解。或不愈者，可服神佑
丸减用神芎等。甚者可大、小承气汤下之，五、七行，或十余行，峻泄夏月积热暑毒之气。此
药虽泄而无损于脏腑，乃所以安脏腑也。次以桂苓甘露散、石膏知母汤、大、小柴胡汤、人参柴
胡饮子，量虚实加减而用之。此药皆能治寒热往来，日晡发作，与治伤寒，其法颇同。更不愈者。以
常山散吐之，无不愈者。
余尝用张长沙汗、下、吐三法，愈疟极多。大忌错作脾寒，用暴热
之药治之。纵有愈者，后必发疮疽、下血之病，不死亦危。余自先世，授以医方，至于今日，五
十余年，苟不谙练，岂敢如是决也！又尝观刺疟论五十
九刺，一刺则衰，再刺则去，三刺则已。会陈下有病疟二年不愈者，止服温热之剂，渐至
衰羸，命予药之。余见其羸，亦不敢便投寒凉之剂，乃取《内经·刺疟论》详之曰∶诸疟不
已，刺十指间出血。正当发时，余刺其十指出血，血止而寒热立止。咸骇其神，余非炫术。窃
见晚学之人，不考诰典，谬说鬼疾，妄求符 ，祈祷辟匿，法外旁寻，以致病患迁延危殆。
疟病除
岚瘴一、二发必死，其余五脏六腑疟皆不死，如有死者，皆方士误杀之也。或曰∶汝言疟因于
暑者，春发之疟，亦伤暑乎？余曰∶此疟最深。何哉？暑伏于秋冬而不发，至春始发，
此疟之深者。《内经·气交变大论》∶岁火太过，炎暑流行，金肺受邪。启玄子云∶火不以
德，邪害于肺金也。故金肺先病，以金气不及，故为病。又《经》曰∶岁火太过，大热先发，故民病
疟。少气咳喘，血溢，血注下，嗌燥，耳聋中热，肩背热。上应荧惑星，见则山泽燔燎，雨乃不降，烁
石消金，涸泉焦草，火星大而明见。注曰∶火无德令，纵热害金，水复制心，故心火自病。
荧惑见则酷法大，故疟常与酷吏之政并行。或酷政行于先，而疟气应于后；或疟气行于先
，而酷政应于后。昔人有诗云∶大暑去酷吏。此言虽不为医设，亦于医巫之旨，有以暗相符
者也。以前人论疟者，未尝及于此，故予发之。及知圣人立疟之名，必有所谓云。
疟疾，就是酷烈之疟。它是由于夏季感受酷暑之气而形成的，体内又有邪气积聚。这种积聚多在左胁之下，形状像倒扣的杯子，这就是所谓的“疟”。既然是因为夏天被暑邪所伤而得疟疾，为什么后世的医生都用治疗脾寒的方法来治疗呢？世俗医生既然不知道邪热深重蓄积会导致寒战，于是被寒战的现象所迷惑；又不明白邪热深入体内后又出于体表，引发燥渴，于是被正邪交争的现象所迷惑。他们互相传习，用干姜、附子、硫黄、平胃散、异功散、交解饮子等药物治疗，千百人中侥幸有一例见效。便固执地认为这是正确的，以至于父子兄弟之间代代相传。等到疟疾发作严重的，就归结为鬼神作祟，这难道不让人大笑吗？《内经》说，拘泥于鬼神的人，不可以跟他谈论高深的医德道理。世俗人的愚昧怎么这么难以教化呢？又有人因为夏天过常饮用冷饮，损伤了生冷坚硬的食物如瓜果、梨枣之类，将其指称为“食疟”，这又是错误的。哪里知道《内经》的论述并不是这样的。夏季感受暑邪，遇到秋季的风邪，因为劳累而出汗，玄府（汗孔）受风邪侵袭，又遇到寒冷的水气，风邪闭塞而不能排出，停留在肠胃之外，与营卫之气并行，白天行于阳分，夜晚行于阴分。邪热浅，则每天发作；邪热深，则隔天发作；邪气并入里则发热；邪气并入表则发冷。像这样来论述，完全跟脾脏没有关联。
后世对药物的论述，出现如此大的差错。从时间上来说，太平盛世时，普通疟疾病人较少；动乱时期，普通疟疾病人较多。在太平盛世，即使使用砒石、辰砂这些有毒的药物来治疗，也能取得疗效。因为太平盛世时，百姓安宁平静，所以虽然是用热药攻治热病，也很少留下后患。到了动乱时期，百姓劳苦，不能立刻使用大毒、大热的药物。如果用热药攻治热病，热势加剧就会转变为吐血、便血、痈疽、疮疡、呕吐等疾病。大概是因为动乱时期，政令烦乱，徭役繁多，早晚都在征战，几乎没有片刻闲暇，体内的火邪与外界的火热之气同时发动，对于侯伯官吏来说尤其严重，怎么能和安宁平静的百姓用同样的方法治疗呢？我亲眼见到泰和六年丙寅年，征讨南方的军队大规模出动，到第二年军队撤回。这一年瘟疫杀人，不知其数，患者昏闷懊恼，十有八九死亡，这都是火邪化生的结果。次年，疟疾大规模爆发，侯王官吏上下都患病，轻者十天一个月，重的长达一年。富贵之人，用心劳神，不能骤然使用砒石等大毒药物，只适宜先用白虎汤加人参、小柴胡汤、五苓散之类的药物，顿服即可立即缓解。如果不见效，可以服用神佑丸减量或神芎丸等。病情严重的可以用大承气汤或小承气汤泻下，排便五到七次，或者十几次，峻猛地排泄夏季积聚的热暑毒气。这些药物虽然泻下但不会损伤脏腑，这正是为了安养脏腑。接着再用桂苓甘露散、石膏知母汤、大柴胡汤、小柴胡汤、人参柴胡饮子，根据虚实情况加减使用。这些药物都能治疗寒热往来、日晡时分发作的症状，与治疗伤寒的方法颇为相同。如果仍然不见效，用常山散催吐，没有不好的。
我曾经运用张仲景的汗、下、吐三法，治愈了很多疟疾病人。最忌讳错误地将其当作脾寒，用暴热的药物治疗。纵然有治愈的，后来必定会发作疮疽、便血的疾病，不死也会危险。我从先祖那里传授医方，直到今天，五十多年，如果不熟悉精通，怎么敢如此决断呢！我又曾观察《刺疟论》中的五十九刺法，刺一次则病势衰退，刺两次则病邪去除，刺三次则病愈。恰逢陈下有个人患疟疾两年不好，只服用温热的药剂，逐渐导致身体衰弱消瘦，请我用药治疗。我看到他身体虚弱，也不敢立刻投用寒凉的药物，于是取《内经·刺疟论》仔细研究说：各种疟疾不止，针刺十个手指间出血。正当疟疾发作的时候，我针刺他的十个手指使其出血，血止住后寒热症状立刻停止。大家都惊叹其神奇，我并非炫耀医术。私下看到晚学之人，不考察经典，荒谬地说鬼怪致病，胡乱求符咒，祈祷躲避，在常规疗法之外旁门左道地寻找方法，致使病患拖延陷入危殆。疟疾除了岚瘴一两种发作一两次必死外，其余五脏六腑的疟疾都不会致死，如果有死亡的，都是庸医误杀的。有人说：你说疟疾是因为暑邪引起的，春天发作的疟疾，也是伤于暑邪吗？我说：这种疟疾最深重。为什么呢？暑邪潜伏在秋冬季节而不发作，到春天才发作，这是疟疾中深重的类型。《内经·气交变大论》说：岁运火气太过，炎暑流行，肺金受邪。启玄子说：火气不以德行事，邪气伤害肺金。所以肺金先发病，因为金气不及，所以生病。又说：岁运火气太过，大热先发，所以民众患疟疾。少气咳喘，血溢，下部出血，咽喉干燥，耳聋内热，肩背发热。上应荧惑星，荧惑星出现则山泽燃烧，雨水不降，熔化石头销融金属，枯竭泉水烧焦草木，火星大而明亮可见。注解说：火气没有德行号令，放纵热邪伤害金气，水气反过来克制心火，所以心火自病。荧惑星出现则严刑酷法盛行，所以疟疾常常与酷吏的政治并行。或者是酷政施行在前，而疟气感应在后；或者是疟气流行在前，而酷政感应在后。古人有诗说：大暑去酷吏。这话虽然不是为了医学设立的，但在医巫的宗旨上，也有暗中相符的地方。以前论述疟疾的人，未曾涉及这一点，所以我把它阐发出来。等到知道圣人确立疟疾的名称，必定有所依据。
Malaria (Nue, 疟) is akin to the severe form of malaria. It arises from summer-heat injury during the summer season, accompanied by the accumulation of pathogenic factors. This accumulation typically occurs below the left hypochondrium, resembling an inverted cup, which constitutes "malaria." Since it results from summer-heat injury leading to malaria, why do later physicians treat it as spleen-cold? Ignorant physicians fail to recognize that deep accumulation of pathogenic heat causes chills (Han Zhan, 寒战), thus being confused by this symptom; they also fail to comprehend that after pathogenic heat enters deeply and then emerges to the exterior, causing dryness and thirst (Zao Ke, 燥渴), they are misled by the struggle between righteous qi and pathogens. They pass down treatments using dried ginger (Ganjiang, 干姜), prepared aconite (Fuzi, 附子), sulfur (Liuhuang, 硫黄), Pingwei San (Stomach Harmonizing Powder), Yigong San (Extraordinary Efficacy Powder), and Jiaoxie Yinzi (Interacting Decoction). Among thousands of cases, one might occasionally succeed. Clinging to this as correct, fathers and sons, brothers, pass it down through generations. When malaria becomes severe, they attribute it to malevolent spirits, which is truly laughable. The *Neijing* states: "One who is bound by ghosts and spirits cannot be spoken to regarding the highest virtues." How foolish and unteachable the common people are! Some attribute it to excessive consumption of cold drinks in summer or damage from raw, hard foods like melons, pears, and dates, calling it "food malaria," which is also incorrect. Does one not know that the *Neijing* does not argue this way? Summer-heat injury, combined with autumn wind, sweating due to exertion, wind entering the xuankou (sweat pores, Xuanfu, 玄府), and subsequent exposure to chilling water, causes wind closure preventing expulsion. The pathogen resides outside the intestines and stomach, moving alongside Ying and Wei qi, traveling through Yang during the day and Yin at night. If pathogenic heat is shallow, it manifests daily; if deep, every other day. If it merges inward, there is fever; if outward, chills. Thus discussed, it has nothing to do with the spleen.
Later discussions on medicine contain such significant errors. Temporally, in times of peace, ordinary malaria cases are few; in turbulent times, they are many. In peaceful eras, even toxic drugs like realgar (Pishi, 砒石) and cinnabar (Chensha, 辰砂) can be effective because the populace is tranquil, so treating heat with heat rarely causes aftermath issues. In turbulent times, when people suffer labor and hardship, one must not abruptly use highly toxic or hot drugs. Using heat to treat heat may exacerbate heat, leading to hematemesis, hematochezia, carbuncles, sores, vomiting, etc. Turbulent times feature chaotic governance, heavy corvée, constant warfare, leaving no rest. Internal fire and external fire activate simultaneously, especially among nobles and officials. How can they be treated the same as tranquil people? I witnessed in the Bingyin year of Taihe 6th year, when southern campaigns were launched, returning the next year. That year, pestilence killed countless people, many dying of dizziness and oppression, nine out of ten deaths caused by fire transformation. The following year, malaria erupted widely among nobles and officials, lasting weeks for mild cases, over a year for severe ones. Wealthy individuals, straining their minds, should not suddenly use highly toxic drugs like realgar. Instead, start with Baihu Tang plus Ginseng, Xiaochaihu Tang, or Wuling San, taken in one dose for immediate relief. If ineffective, try Shenyu Wan reduced dosage or Shenxiong Wan. For severe cases, use Dachengqi Tang or Xiaochengqi Tang to purge, resulting in five to seven or more bowel movements, vigorously draining summer accumulated heat and toxicity. These purgatives drain without damaging zang-fu organs, thereby stabilizing them. Subsequently, use Guiling Ganlu San, Shigao Zhimu Tang, Da Chaihu Tang, Xiao Chaihu Tang, or Renshen Chaihu Yinzi, adjusted for deficiency or excess. These treat alternating chills and fever, afternoon exacerbations, similar to shaoyang syndrome treatment in Cold Damage. If still ineffective, induce vomiting with Changshan San, which invariably succeeds.
I have used Zhang Zhongjing’s methods of sweating, purging, and vomiting to cure many malaria cases. One must strictly avoid misdiagnosing it as spleen-cold and using violent hot drugs. Even if cured, carbuncles or bleeding disorders will likely follow, endangering life. My family has transmitted medical prescriptions for over fifty years. Without thorough mastery, how dare I make such definitive judgments? I also studied the Fifty-Nine Acupoints for Malaria from the *Needling Malaria* chapter: one needling reduces severity, two removes the pathogen, three cures it. A patient in Chenxia suffered from malaria for two years, taking only warm herbs until emaciated. Seeing his weakness, I hesitated to use cold/cool herbs immediately. Consulting the *Neijing*, I noted: "For persistent malaria, prick the ten fingers to bleed." At the onset of attack, I pricked his ten fingers. Bleeding stopped, and chills/fever ceased instantly. People marveled at the efficacy, but I merely applied technique. I see young scholars ignoring classics, blaming ghosts, seeking talismans, praying, and using unorthodox methods, prolonging patients' suffering. Except for specific miasma types where death is inevitable after one or two attacks, most organ-related malaria is curable; deaths are usually due to physician error. Someone asked: "If malaria stems from summer-heat, what about spring-onset malaria?" I replied: "This is the deepest type. Summer-heat lies dormant in autumn/winter, manifesting in spring." The *Neijing·Qi Jiao Bian Da Lun* states: "Excessive fire leads to widespread heat, injuring lung metal." Qixuanzi commented: "Fire lacking virtue harms lung metal." Thus lung disease precedes due to metal deficiency. Also: "Excessive fire causes early great heat, leading to malaria, shortness of breath, cough, asthma, bleeding, throat dryness, deafness, internal heat, shoulder/back heat." This corresponds to the Mars star (Yinghuo, 荧惑); its appearance brings drought and fire. Annotations explain: Fire harming metal triggers water counteracting heart fire, causing heart pathology. Mars appearing signifies harsh laws; thus malaria parallels cruel governance. Either cruel policy precedes malaria, or vice versa. Ancient poetry says: "Great heat drives away cruel officials." Though not medical, it aligns with medical principles. Previous authors omitted this, so I elucidate it. The sage's naming of malaria implies profound meaning.