冬官朱省庵，停食感寒而患疟，自用清脾、截疟二药，食后腹胀，时或作痛，服二陈、黄连、
枳实之类，小腹重坠，腿足浮肿，加白术、山楂，吐食未化。谓余曰∶何也?余曰∶食后胀痛
，乃脾虚不能克化也；小腹重坠，乃脾虚不能升举也；腿足浮肿，乃脾虚不能营运也；吐食
不消，乃脾胃虚寒无火也。治以补中益气加吴茱、炮姜、木香、肉桂，一剂诸症顿退，饮食
顿加，不数剂而痊。
大凡停食之症，宜用六君、枳实、浓朴，若食已消而不愈，用六君子汤
。若内伤外感，用藿香正气散。若内伤多而外感少，用人参养胃汤。若劳伤元气兼外感，用
补中益气加川芎。若劳伤元气兼停食，补中益气加神曲、陈皮。若气恼兼食，用六君加香附
、山栀。若咽酸或食后口酸，当节饮食，病作时，大热躁渴，以姜汤乘热饮之，此截疟之良
法也。每见发时，饮啖生冷物者，病或少愈，多致脾虚胃损，往往不治。大抵内伤饮食者，必恶
食，外感风寒者，不恶食，审系劳伤元气，虽有百症，但用补中益气汤，其病自愈。其属外感
者，主以补养，佐以解散，其邪自退。若外邪既退，即补中益气以实其表。若邪去而不实其
表，或过用发表，亏损脾胃，皆致绵延难治。凡此不问阴阳日夜所发，皆宜补中益气，此不
截之截也。
夫人以脾胃为主，未有脾胃实而患疟痢者，若专主发表攻里，降火导痰，是治其
末而忘其本。前所云乃疟之大略，如不应，当分六经表里而治之，说见各方。
大尹曹时用，患疟寒热，用止截之剂，反发热恶寒，饮食少思，神思甚倦，其脉或浮洪或微细
，此阳气虚寒，余用补中益气，内参、 、归、术各加三钱，甘草一钱五分，加炮姜、附子
各一钱，一剂而寒热止，数剂而元气复。
一儒者，秋患寒热，至春未愈，胸痞腹胀，余用人参二两，生姜二两煨熟，煎顿服，寒热即止。
更以调中益气加半夏、茯苓、炮姜，数剂，元气顿复。后任县尹，每饮食劳倦疾作，服前药即
愈。
大凡久疟乃属元气虚，盖气虚则寒，血虚则热，胃虚则恶寒，脾虚则发热，阴火下流
则寒热交作，或吐涎不食，泄泻腹痛，手足逆冷，寒战如栗，若误投以清脾、截疟二饮，多
致不起。
一上舍，每至夏秋，非停食作泻，必疟痢霍乱，遇劳吐痰，头眩体倦，发热恶寒，用四物、二
陈、芩、连、枳实、山栀之类，患疟服止截之药，前症益甚，时或遍身如芒刺然。余以补中
益气加茯苓、半夏，内参、 各用三钱，归、术各二钱，十余剂少愈，若间断其药，诸病仍
至，连服三十余剂全愈。又服还少丹半载，形体充实。
一妇人，疟久不愈，发后口干倦甚，用七味白术散加麦门、五味，作大剂，煎与恣饮，再发稍可
，乃用补中益气加茯苓、半夏，十余剂而愈。
凡截疟，余常以参、术各一两，生姜四两，煨熟
煎服即止，或以大剂补中益气加煨姜尤效，生姜一味亦效。
东洞庭马志卿，疟后，形体骨立，发热恶寒，食少体倦，用补中益气，内参、 、归、术各加
三钱，甘草一钱五分，炮姜二钱，一剂而寒热止，数剂而元气复。
一妇人，久患寒热，服清脾饮之类，胸膈饱胀，饮食减少，余用调中益气加茯苓、半夏、炮
姜各一钱，二剂而痊。
一妇人，劳役停食，患疟，或用消导止截，饮食少思，体瘦，腹胀，余以补中益气，倍用参、 、归
、术、甘草，加茯苓、半夏各一钱五分，炮姜五钱，一剂顿安。又以前药，炮姜用一钱，不数
剂，元气复而痊愈。
产后疟疾，见《女科撮要》。
冬官朱省庵，因饮食停滞又感受寒邪而患上疟疾，自行服用清脾饮和截疟药后，饭后出现腹部胀满，时而疼痛；接着服用二陈汤、黄连、枳实等药物，导致小腹沉重下坠感，腿脚浮肿；随后加入白术、山楂，结果呕吐出未消化的食物。他问我：“这是为什么呢？”我回答说：“饭后胀痛，是脾虚无法运化食物所致；小腹沉重下坠，是脾虚无法升提清气所致；腿脚浮肿，是脾虚无法运化水湿所致；呕吐不消化的食物，是脾胃虚寒、阳气不足（无火）所致。”治疗采用补中益气汤，加入吴茱萸、炮姜、木香、肉桂，服用一剂后所有症状迅速消退，饮食量立即增加，没过几剂药就痊愈了。
大凡饮食停滞的病症，适宜使用六君子汤、枳实、厚朴；如果食积已消但病未愈，则使用六君子汤。如果是内伤兼外感，使用藿香正气散。如果是内伤重而外感轻，使用人参养胃汤。如果是劳倦损伤元气兼有外感，使用补中益气汤加川芎。如果是劳倦损伤元气兼有食积，使用补中益气汤加神曲、陈皮。如果是气恼兼有食积，使用六君子汤加香附、山栀。如果出现咽酸或饭后口酸，应当节制饮食；发病时若出现大热、烦躁、口渴，用姜汤趁热饮用，这是治疗疟疾的良好方法。我常见到患者在发作时饮用生冷食物的人，病情或许暂时减轻，但大多导致脾虚胃损，往往难以治愈。大体上，内伤饮食的人，一定厌恶食物；外感风寒的人，不厌恶食物。仔细审察若是劳倦损伤元气，即使有一百种症状，只要使用补中益气汤，疾病自然痊愈。属于外感的，以补养为主，辅以解散表邪，邪气自然退去。如果外邪已经退去，就用补中益气汤来充实肌表。如果邪气去除而不充实肌表，或者过度使用发汗解表药，亏损脾胃，都会导致病情迁延难治。凡是这种情况，不论是在白天还是夜晚发作，也不论是阴证还是阳证，都适宜使用补中益气汤，这就是所谓的“不截之截”（即通过扶正来达到截断疟疾的目的）。
人是以脾胃为本的，没有脾胃实证而患疟疾或痢疾的。如果专门主张发表攻里、降火导痰，这是治疗其末节而忘记了根本。前面所说的是疟疾的大致原则，如果按照上述方法无效，应当分六经表里进行辨证治疗，具体说法见各相关方剂章节。
大尹曹时用，患有疟疾寒热交替的症状，使用止疟截疟的药物后，反而出现发热恶寒，饮食减少，精神极度疲倦，脉象有时浮洪有时微细，这是阳气虚寒的表现。我使用补中益气汤，其中人参、黄芪、当归、白术各加三钱，甘草一钱五分，加入炮姜、附子各一钱，服用一剂后寒热停止，数剂后元气恢复。
有一位儒生，秋天患寒热交替，到了春天仍未痊愈，伴有胸闷痞塞、腹胀。我用人参二两，生姜二两煨熟，煎汤一次服下，寒热随即停止。随后改用调中益气汤，加入半夏、茯苓、炮姜，服用数剂后元气迅速恢复。后来他担任县尹，每当饮食不当或劳累倦怠时疾病发作，服用之前的药物即可痊愈。
大凡久疟属于元气虚弱，大概气虚则生寒，血虚则生热，胃虚则恶寒，脾虚则发热，阴火下流则导致寒热交作，或者呕吐涎沫、不能进食、泄泻腹痛、手足逆冷、寒战如栗。如果误投清脾饮、截疟饮，大多会导致死亡。
一位上舍（国子监学生），每到夏秋季节，不是饮食停滞导致腹泻，就是疟疾、痢疾或霍乱；遇到劳累则呕吐痰涎，头晕体倦，发热恶寒。之前使用四物汤、二陈汤、黄芩、黄连、枳实、山栀等药物，患疟疾时服用止截药物，前面的症状更加严重，有时全身像有芒刺一样难受。我用补中益气汤，加入茯苓、半夏，其中人参、黄芪各用三钱，当归、白术各二钱，服用十余剂后稍有好转；如果间断服药，各种疾病仍会复发；连续服用三十多剂后完全痊愈。后来又服用还少丹半年，身体变得充实健壮。
一位妇人，疟疾长久不愈，发作后口干且极度疲倦。我用七味白术散，加入麦门冬、五味子，制成大剂量煎汤让她尽情饮用，再次发作时症状稍减，于是改用补中益气汤，加入茯苓、半夏，服用十余剂后痊愈。
关于截疟，我常用人参、白术各一两，生姜四两，煨熟后煎服，疟疾即可停止；或者用大剂量补中益气汤加入煨姜，效果尤为显著；单用生姜一味也有效。
东洞庭的马志卿，疟疾之后，形体消瘦如骨立，发热恶寒，饮食少，身体疲倦。我用补中益气汤，其中人参、黄芪、当归、白术各加三钱，甘草一钱五分，炮姜二钱，服用一剂后寒热停止，数剂后元气恢复。
一位妇人，长期患寒热交替，服用清脾饮之类的药物后，胸膈饱胀，饮食减少。我用调中益气汤，加入茯苓、半夏、炮姜各一钱，服用两剂后痊愈。
一位妇人，因劳役和饮食停滞患疟疾，有人使用消导和止截药物，导致她饮食减少，身体消瘦，腹胀。我用补中益气汤，加倍使用人参、黄芪、当归、白术、甘草，加入茯苓、半夏各一钱五分，炮姜五钱，服用一剂后顿时安宁。然后又用前面的药方，将炮姜用量减为一钱，没过几剂，元气恢复而痊愈。
产后疟疾，详见《女科撮要》。
Zhu Shengan, an official of the Ministry of Works (Dongguan), contracted malaria due to food stagnation and cold invasion. He self-medicated with Qingpi Yin (Clear the Spleen Decoction) and Jiemai drugs (antimalarial agents). Subsequently, he experienced abdominal distension after meals and intermittent pain. He then took Erchen Tang (Two-Cured Decoction), Huanglian (Coptidis Rhizoma), and Zhishi (Immature Bitter Orange), which led to a heavy bearing sensation in the lower abdomen and edema of the legs and feet. Adding Baizhu (Atractylodis Macrocephalae Rhizoma) and Shanzha (Crataegi Fructus) resulted in vomiting undigested food. He asked me, "Why is this?" I replied, "Abdominal distension and pain after eating indicate Spleen deficiency failing to transform and transport; the heavy bearing sensation in the lower abdomen indicates Spleen deficiency failing to raise the clear Yang; edema of the legs and feet indicates Spleen deficiency failing to circulate and transport fluids; vomiting undigested food indicates deficiency-cold of the Spleen and Stomach with insufficient Fire (Yang)." The treatment was Buyi Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Wuzhuyu (Evodiae Fructus), Paojiang (Prepared Ginger), Muxiang (Aucklandiae Radix), and Rougui (Cinnamon Bark). After one dose, all symptoms receded abruptly, dietary intake increased immediately, and recovery occurred within a few doses.
Generally, for conditions of food stagnation, Liu Jun Zi Tang (Six-Gentlemen Decoction), Zhishi (Immature Bitter Orange), and Houpo (Magnoliae Officinalis Cortex) are appropriate. If the food stagnation has resolved but the illness persists, use Liu Jun Zi Tang (Six-Gentlemen Decoction). For internal injury combined with external contraction, use Huoxiang Zhengqi San (Agaricus Powder for Rectifying the Qi). For internal injury predominant with slight external contraction, use Renshen Yangwei Tang (Ginseng Decoction for Nourishing the Stomach). For exhaustion damaging Yuan Qi (Primal Qi) with external contraction, use Buyi Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Chuanxiong (Ligustici Chuanxiong Rhizoma). For exhaustion damaging Yuan Qi (Primal Qi) with food stagnation, use Buyi Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Shenqu (Massa Medicata Fermentata) and Chenpi (Citri Reticulatae Pericarpium). For anger combined with food stagnation, use Liu Jun Zi Tang (Six-Gentlemen Decoction) added with Xiangfu (Cyperi Rhizoma) and Shanzhi (Gardeniae Fructus). If there is acid regurgitation or sour taste in the mouth after eating, diet should be regulated. During an attack, if there is intense heat, restlessness, and thirst, drink hot ginger soup while it is still hot; this is an excellent method for arresting malaria. I often see patients who consume raw and cold substances during attacks; although their condition may temporarily improve, it frequently leads to Spleen deficiency and Stomach damage, often resulting in untreatable cases. Generally, those with internal injury from diet will dislike food, whereas those with external contraction from wind-cold will not dislike food. Carefully ascertain if it is exhaustion damaging Yuan Qi (Primal Qi); even with a hundred symptoms, simply using Buyi Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) will lead to spontaneous recovery. For cases belonging to external contraction, prioritize nourishment and support with dispersing methods, so that the pathogenic factor naturally retreats. Once the external pathogen has retreated, use Buyi Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to solidify the exterior. If the pathogen is removed without consolidating the exterior, or if excessive diaphoretic methods are used, damaging the Spleen and Stomach, the disease will become chronic and difficult to treat. In all these cases, regardless of whether the malaria occurs day or night, or involves Yin or Yang patterns, Buyi Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) is suitable. This is what is called "arresting without arresting" (achieving arrest through tonification).
The human body relies on the Spleen and Stomach as the foundation. There are no cases of malaria or dysentery arising from excess patterns of the Spleen and Stomach. To focus solely on releasing the exterior, purging the interior, clearing fire, or guiding out phlegm is to treat the branch while forgetting the root. The above describes the general principles of malaria. If these do not apply, treatment should be differentiated according to the Six Channels (Taiyang, Yangming, Shaoyang, Taiyin, Shaoyin, Jueyin) and interior-exterior relationships, as detailed in the respective formula sections.
Cao Shiyong, a Dayin (Magistrate), suffered from alternating chills and fever of malaria. Using antimalarial arresters caused him to develop fever and aversion to cold, reduced appetite, and extreme mental fatigue. His pulse was sometimes floating and surging, sometimes faint and fine, indicating deficiency-cold of Yang Qi. I used Buyi Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), adding three qian each of Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix), Danggui (Angelicae Sinensis Radix), and Baizhu (Atractylodis Macrocephalae Rhizoma), one qian five fen of Gancao (Licorice Root), and one qian each of Paojiang (Prepared Ginger) and Fuzi (Aconiti Lateralis Radix Praeparata). After one dose, the chills and fever ceased; after several doses, Yuan Qi (Primal Qi) recovered.
A scholar suffered from alternating chills and fever in autumn, which persisted into spring, accompanied by chest stuffiness and abdominal distension. I prescribed two liang of Renshen (Ginseng Radix et Rhizoma) and two liang of Shengjiang (Zingiberis Rhizoma Recens), baked until ripe, decocted and taken in one dose. The chills and fever stopped immediately. Then, using Tiaozhong Yiqi Tang (Regulate the Middle and Augment the Qi Decoction) added with Banxia (Pinelliae Rhizoma), Fuling (Poria), and Paojiang (Prepared Ginger), his Yuan Qi (Primal Qi) recovered rapidly after several doses. Later, when serving as a County Magistrate, whenever his illness was triggered by improper diet or labor fatigue, taking the previous medicine cured him.
Generally, prolonged malaria belongs to deficiency of Yuan Qi (Primal Qi). Qi deficiency generates cold, blood deficiency generates heat, Stomach deficiency causes aversion to cold, and Spleen deficiency causes fever. Downward flow of deficient fire leads to alternating chills and fever, or vomiting saliva, inability to eat, diarrhea, abdominal pain, cold extremities, and severe shivering like trembling millet. Misusing Qingpi Yin (Clear the Spleen Decoction) or Jiemai Yin (Antimalarial Decoction) often leads to death.
A Shangshe (Student at the Imperial Academy), every summer and autumn, would suffer either from diarrhea due to food stagnation or from malaria, dysentery, or cholera. Upon exertion, he vomited phlegm, felt dizzy and fatigued, with fever and aversion to cold. He had previously used Siwu Tang (Four-Substance Decoction), Erchen Tang (Two-Cured Decoction), Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Zhishi (Immature Bitter Orange), and Shanzhi (Gardeniae Fructus). When contracting malaria, he took antimalarial arresters, causing his previous symptoms to worsen, with occasional sensations of prickling all over his body like thorns. I used Buyi Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Fuling (Poria) and Banxia (Pinelliae Rhizoma), using three qian each of Renshen (Ginseng Radix et Rhizoma) and Huangqi (Astragali Radix), and two qian each of Danggui (Angelicae Sinensis Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma). After more than ten doses, he improved slightly. If the medication was interrupted, the illnesses returned. After continuous administration for over thirty doses, he fully recovered. He then took Hushao Dan (Preserve Youth Pill) for half a year, becoming physically robust.
A woman suffered from prolonged malaria that did not resolve. After attacks, she experienced dry mouth and extreme fatigue. I used Qiwu Baizhu San (Seven-Ingredient Atractylodes Powder) added with Maidong (Ophiopogonis Radix) and Wuweizi (Schisandrae Fructus), prepared in a large dosage for her to drink freely. Her subsequent attacks were milder. Then, using Buyi Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Fuling (Poria) and Banxia (Pinelliae Rhizoma), she recovered after more than ten doses.
Regarding arresting malaria, I often use one liang each of Renshen (Ginseng Radix et Rhizoma) and Baizhu (Atractylodis Macrocephalae Rhizoma), and four liang of Shengjiang (Zingiberis Rhizoma Recens), baked and decocted, which stops the malaria. Alternatively, using a large dose of Buyi Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with baked ginger is particularly effective; using only Shengjiang (Zingiberis Rhizoma Recens) alone is also effective.
Ma Zhiqing from Dongting East suffered from emaciation (body resembling bones), fever, aversion to cold, reduced appetite, and fatigue after malaria. I used Buyi Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), adding three qian each of Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix), Danggui (Angelicae Sinensis Radix), and Baizhu (Atractylodis Macrocephalae Rhizoma), one qian five fen of Gancao (Licorice Root), and two qian of Paojiang (Prepared Ginger). After one dose, the chills and fever ceased; after several doses, Yuan Qi (Primal Qi) recovered.
A woman suffered from prolonged alternating chills and fever. After taking Qingpi Yin (Clear the Spleen Decoction) and similar formulas, she experienced fullness and distension in the chest and diaphragm, and reduced appetite. I used Tiaozhong Yiqi Tang (Regulate the Middle and Augment the Qi Decoction) added with one qian each of Fuling (Poria), Banxia (Pinelliae Rhizoma), and Paojiang (Prepared Ginger). She recovered after two doses.
A woman contracted malaria due to labor and food stagnation. Others used digestive and antimalarial arresters, leading to reduced appetite, emaciation, and abdominal distension. I used Buyi Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), doubling the dosage of Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix), Danggui (Angelicae Sinensis Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), and Gancao (Licorice Root), adding one qian five fen each of Fuling (Poria) and Banxia (Pinelliae Rhizoma), and five qian of Paojiang (Prepared Ginger). After one dose, she was instantly relieved. Then, using the same prescription but reducing Paojiang (Prepared Ginger) to one qian, she recovered her Yuan Qi (Primal Qi) and healed after a few doses.
Postpartum malaria is discussed in *Nuke Cuoyao* (Essentials of Gynecology).