久疟者， 疟也，以其隔二三日一发，缠绵不去。
〔丹〕老疟系风暑之邪入在阴分，在脏，宜用血药，引出阳分而散，川芎、抚芎、红花、当归、苍白术、
白芷、黄柏、甘草，露一宿，早服。古方多用峻剂，恐非禀受怯弱与居养所移者所宜。始悟常山、砒丹、乌梅
劫剂，或误投之，轻病变重，重必危矣。三日一作者，邪入于三阴经也。作于子午卯酉日者，少阴经疟也。作
于寅申巳亥日者，厥阴经疟也。作于辰戌丑未日者，太阴经疟也。疟得于暑，当以汗解。或因取凉太过，汗郁
成痰，其初感也，弱者即病，胃气强者，伏而未发，至于再感，复因内伤，其病乃作，宜其难瘥。夫感暑与风，
皆外邪也，故非汗多不解。今之遘此疾者，已经再三劫试，胃气重伤，何由得愈。欲治此症，必先与参、术等
补剂为君，加柴、葛等发散药，渐而收汗，得汗而虚，又行补养，下体属阴，最难得汗，补药力到，汗出至足，
方是佳兆。
〔丹〕治一妇病疟，三日一发，食少，经不行已三月，脉无，时冬寒，议作虚寒治，疑误。再诊见其梳洗
言动如常，知果误也。经不行，非无血，为痰所碍。脉无，非血气虚，及积痰生热，结伏其脉而不见耳。当作
实热治，与三花丸，旬日后食进脉出，带微弦，谓胃气既全，虽不药，疟当自愈而经行也，令淡滋味，果
应。（三花神佑丸，方见水胀。）
一妇身材小，味浓， 疟月余，间日发于申酉，头与身痛，寒多喜极热辣汤，脉伏面惨晦，作实热治之，
以十枣汤为末，粥丸，黍米大，服十粒，津咽，日三次，令淡饭，半月大汗愈。
久疟欲吐不吐，宜吐之，用藜芦散，或雄黄散。
疟病能食而痰伏者，小胃丹。（方见内伤饮食。）
一人性急，好酒色，味浓。适多忧怒，患久疟，忽大热，下臭积，大孔痛陷下，此大虚。脉弦大而浮。以
瓦磨如钱圆，烧红，童便 ，急取以纸裹于痛处，恐外寒乘虚而入也。以参、归、陈皮煎服，淡味半月而安。
一妇人久痢，因哭子变疟，一日五六作，汗如雨不止，脉微数，疲甚，无邪可治，阴虚阳散，死在旦夕，
且服四兽等热剂。遂用参、术各二两，白芍药一两，黄 半两，炙甘草二钱，作大剂，四五服而愈。
一人因劳役发嗽，得 疟，又服发散药，变为发热，舌短，语言不正，痰吼有声，脉洪实似滑。先用独参
汤，加竹沥二蛤壳，一服后吐胶痰，舌本正，后用黄 人参汤，服半月而愈。
藜芦散
大藜芦末（五分） 温齑水调下，以吐为度。
雄黄散
雄黄 瓜蒂 赤小豆（各一钱）
上为细末，每服半钱，温水调下，以吐为度。
鳖甲煎丸 治疟母。
鳖甲（十二分，炙） 乌扇（三分，烧） 黄芩 鼠妇（熬） 大黄 桂枝 石韦（去毛） 浓朴 紫葳
阿胶（各三分） 干姜 人参 桃
仁（各二分） 柴胡 蜣螂（熬。各六分） 芍药 牡丹皮 虫（炒。各五分） 蜂窠（炙，四分）
瞿麦（二分） 葶苈（炒） 半夏（各一分） 赤硝（十二分）
上二十三味为末，取锻灶下灰一斗，清酒一斛五斗，浸灰，候酒尽一半，着鳖甲于中，煮令泛烂如胶漆，
绞取汁，内诸药煎为丸，如桐子大。空心服七丸，日三服。
疟母丸
青皮 桃仁 红花 神曲 麦芽 鳖甲（醋煮，为君） 三棱 蓬术 海粉 香附（俱用醋煮）
上为末，神曲糊为丸，如桐子大。每服五七十丸，白汤下。
小儿疟疾痞块，用生地、芍药各一钱半，陈皮、川芎、黄芩、半夏各一钱，甘草二分，姜水煎调鳖甲末服。
十枣汤
芫花（醋浸煮） 大戟 甘遂（制。各等分）
上为末，每服半钱，水一盏，枣十枚，同煎半盏服。
〔朱丹溪〕老疟是由于风暑之邪侵入阴分、脏腑所致，应当使用养血药物，将邪气引出阳分从而发散出去。方用川芎、抚芎、红花、当归、苍术、白术、白芷、黄柏、甘草，放置露天一夜，清晨服用。古方多使用峻猛的药物，恐怕不适合体质虚弱或因居住调养不当而致病的人。这才明白常山、砒丹、乌梅等劫截疟疾的猛烈药剂，如果误用，轻病会转为重病，重病则必然危及生命。每隔三日发作一次的，是邪气侵入三阴经。在子、午、卯、酉日发作的，是少阴经疟疾。在寅、申、巳、亥日发作的，是厥阴经疟疾。在辰、戌、丑、未日发作的，是太阴经疟疾。疟疾由暑邪引起，应当通过发汗来解除。或者因为贪凉过度，汗液郁结变成痰饮，初次感受时，体质弱者立即发病，胃气强盛者，邪气潜伏而未发作，等到再次感受外邪，又因内伤诱发，疾病才发作，所以难以痊愈。感受暑邪和风邪，都属于外邪，所以不是大汗淋漓就不能解除。如今患此病的人，已经经过多次劫截治疗的尝试，胃气受到严重损伤，怎么能痊愈呢？想要治疗这个病症，必须先用人参、白术等补益剂作为主药，加入柴胡、葛根等发散药物，逐渐促使出汗；如果出汗后出现虚象，再进行补养。下半身属阴，最难得汗，当补药之力到达，汗出至足部，这才是佳兆。
〔朱丹溪〕治疗一位妇女患疟疾，每隔三日发作一次，食欲减退，月经停止三个月，脉象摸不到，当时正值冬季寒冷，议论按虚寒证治疗，怀疑有误。再次诊察，见她梳洗言语行动如常人，知道果然误诊了。月经不行，并非无血，而是被痰所阻碍。脉象摸不到，并非气血虚弱，而是积痰生热，结伏于脉道之中而不显现罢了。应当当作实热证治疗，给予三花神佑丸，十天后饮食增加，脉象出现，略带弦象，说胃气既然恢复完整，即使不服药，疟疾也会自愈且月经来潮，嘱咐吃清淡食物，果然应验。（三花神佑丸，方剂见“水胀”条下。）
一位身材矮小的妇女，口味浓厚，患疟疾一个多月，隔天在申时、酉时发作，头部和身体疼痛，怕冷喜欢喝极热的汤，脉象沉伏面色惨暗晦涩，当作实热证治疗，用十枣汤研成末，米粥为丸，大小如黍米，每次服用十粒，温水送服，每日三次，嘱咐吃淡饭，半个月后大汗出而痊愈。
疟疾病人能吃但体内有伏痰的，用小胃丹。（方剂见“内伤饮食”条下。）
一位性格急躁，好酒色，口味浓重的男子。恰逢多忧怒，患久疟，忽然高热，大便排出恶臭积滞，肛门疼痛下陷，这是大虚之证。脉象弦大而浮。用瓦片磨得像铜钱一样圆，烧红，蘸童便，急忙取来用纸包裹敷在疼痛处，恐怕外寒乘虚而入。用人参、当归、陈皮煎服，吃清淡食物半个月而安定。
一位妇人长期痢疾，因哭丧儿子变为疟疾，一天发作五六次，汗如雨下不止，脉象微数，极度疲乏，没有邪气可治，阴虚阳散，死在旦夕之间，暂且服用四兽饮等温热药剂。随即用人参、白术各二两，白芍药一两，黄芩半两，炙甘草二钱，组成大剂量药剂，服用四五副而痊愈。
一人因劳累引发咳嗽，得了疟疾，又服用发散药物，变为发热，舌体短缩，语言不正，喉间痰鸣有声，脉象洪实似滑。先用独参汤，加竹沥、蛤壳，一服药后吐出胶状痰液，舌体恢复正常，后用黄芩人参汤，服用半个月而痊愈。
雄黄散
雄黄 瓜蒂 赤小豆（各一钱）
以上研成细末，每次服用半钱，温水调服，以吐出为度。
鳖甲煎丸 治疗疟母。
鳖甲（十二分，炙烤） 乌扇（三分，烧制） 黄芩 鼠妇（熬制） 大黄 桂枝 石韦（去毛） 厚朴 紫葳 阿胶（各三分） 干姜 人参 桃仁（各二分） 柴胡 蜣螂（熬制，各六分） 芍药 牡丹皮 䗪虫（炒制，各五分） 蜂窠（炙烤，四分） 瞿麦（二分） 葶苈（炒制） 半夏（各一分） 赤硝（十二分）
以上二十三味药研成末，取锻铁炉下的灰一斗，清酒一斛五斗，浸泡药灰，等候酒消耗掉一半，放入鳖甲在其中，煮至烂熟如胶漆状，绞取汁液，加入诸药煎煮制成丸药，大小如梧桐子。空腹服用七丸，每日三次。
疟母丸
青皮 桃仁 红花 神曲 麦芽 鳖甲（醋煮，作为君药） 三棱 蓬术 海粉 香附（均用醋煮）
以上研成末，用神曲糊制作成丸药，大小如梧桐子。每次服用五七十丸，白开水送下。
Chronic malaria refers to malaria where the attacks occur at intervals of two or three days, lingering and difficult to resolve.
[Zhu Danxi] Chronic malaria is caused by wind-heat and summer-heat pathogens invading the Yin aspect and the Zang organs. It is appropriate to use blood-nourishing herbs to draw the pathogen out to the Yang aspect for dispersion. The prescription consists of Chuanxiong Rhizoma (Chuanxiong), Fuxiong Rhizoma (Fuxiong), Safflower (Honghua), Angelicae Sinensis Radix (Danggui), Atractylodis Rhizoma Alba (Baizhu), Atractylodis Rhizoma (Cangzhu), Angelicae Dahuricae Radix (Baizhi), Phellodendri Cortex (Huangbai), and Glycyrrhizae Radix et Rhizoma (Gancao). Leave exposed overnight and take in the early morning. Ancient prescriptions often used harsh agents, which are likely unsuitable for those with weak constitutions or whose conditions were altered by improper living and care. Only then did I realize that drastic astringent or expelling agents such as Dichroa Radix (Changshan), Arsenic Trioxide (Pidan), and Mume Fructus (Wumei), if misused, can turn mild illness into severe, and severe illness into critical. Attacks occurring every third day indicate the pathogen has entered the Three Yin meridians. Attacks on Zi, Wu, Mao, and You days indicate Shaoyin meridian malaria. Attacks on Yin, Shen, Si, and Hai days indicate Jueyin meridian malaria. Attacks on Chen, Xu, Chou, and Wei days indicate Taiyin meridian malaria. Malaria acquired from summer-heat should be resolved through sweating. However, excessive cooling may cause sweat to stagnate and transform into phlegm. Upon initial infection, those with weak constitutions fall ill immediately, while those with strong Stomach Qi harbor the pathogen without symptoms until a subsequent infection combined with internal injury triggers the disease, making it difficult to cure. Both summer-heat and wind are external pathogens; thus, they cannot be resolved without profuse sweating. Patients suffering from this condition have already undergone multiple drastic treatments, severely damaging their Stomach Qi, so how can they recover? To treat this syndrome, one must first use tonifying agents like Ginseng Radix et Rhizoma (Renshen) and Atractylodis Macrocephalae Rhizoma (Baizhu) as the sovereign drugs, adding dispersing herbs like Bupleuri Radix (Chaihu) and Puerariae Radix (Gegen) to gradually induce sweating. If deficiency appears after sweating, tonification and nourishment should follow. The lower body belongs to Yin and is hardest to sweat; when the power of the tonifying herbs reaches the extremities and sweat emerges down to the feet, this is a favorable sign.
[Zhu Danxi] Treated a woman with malaria attacking every three days, poor appetite, and amenorrhea for three months. Her pulse was imperceptible. It was winter and cold, so there was discussion to treat it as deficiency-cold, but I suspected an error. On re-examination, seeing her grooming, speaking, and moving normally, I knew the diagnosis was indeed wrong. Amenorrhea does not mean lack of blood, but obstruction by phlegm. An imperceptible pulse does not mean Qi and Blood deficiency, but rather accumulated phlegm generating heat, knotting and hiding within the vessels, rendering the pulse invisible. It should be treated as excess-heat. Prescribed Sanhua Shenyao Wan. Ten days later, her appetite improved and her pulse emerged, slightly wiry. I stated that since Stomach Qi had recovered, even without medication, the malaria would self-resolve and menstruation would return. Advised a bland diet, which proved correct. (Sanhua Shenyao Wan, see "Water Swelling" section.)
A short-statured woman with a preference for rich flavors suffered from malaria for over a month, alternating-day attacks during Shen and You hours, headache and body pain, aversion to cold preferring extremely hot soups, sunken pulse, and sallow, dull complexion. Treated as excess-heat using Shizao Tang powdered, formed into pills with congee, size of broomcorn millet seeds. Administered ten pills per dose, taken with warm water, three times daily. Advised a bland diet. She recovered with profuse sweating after half a month.
For chronic malaria with urge to vomit but inability to do so, emesis is indicated. Use Liliu San or Xionghuang San.
For malaria patients who can eat but have latent phlegm, use Xiaowei Dan. (See "Internal Injury due to Diet" section.)
A man with an impatient temperament, fond of alcohol and sex, and rich dietary habits, suffered from chronic malaria after excessive worry and anger. He suddenly developed high fever, passed foul fecal accumulation, and experienced painful sinking of the anus. This indicates severe deficiency. His pulse was wiry, large, and floating. I ground a tile into a coin shape, heated it red-hot, dipped it in child's urine, and quickly wrapped it in paper to apply to the painful area, fearing external cold might invade the deficiency. Prescribed a decoction of Renshen, Danggui, and Chenpi. He stabilized after half a month of a bland diet.
A woman with chronic dysentery transformed into malaria due to weeping for her deceased son. She had five to six attacks per day, sweating profusely like rain, with a faint and rapid pulse, extreme fatigue, no pathogenic factor to treat, Yin deficiency with Yang scattering, facing imminent death. Temporarily administered Si Shou Yin and other warming agents. Then prescribed a large dose containing Renshen and Baizhu (2 liang each), Bai Shaoyao (1 liang), Huangqin (0.5 liang), and Zhi Gancao (2 qian). She recovered after four to five doses.
A man developed cough due to overwork, contracted malaria, and took dispersing herbs, which transformed into fever, shortened tongue, slurred speech, and loud phlegm rales. His pulse was surging, solid, and seemingly slippery. First used Dushen Tang added with Zhuli and Geke. After one dose, he expectorated gelatinous phlegm, and his tongue returned to normal. Subsequently used Huangqin Renshen Tang, recovering after half a month.
Liliu San
Da Liliu powder (5 fen). Mix with warm vinegar water and administer. Stop when vomiting occurs.
Xionghuang San
Xionghuang, Gouti, Chi Xiaodou (each 1 qian).
Grind into fine powder. Take 0.5 qian per dose with warm water. Stop when vomiting occurs.
Biejia Jian Wan Treats Mamo (Malaria Mass).
Biejia (12 parts, roasted), Wushan (3 parts, burned), Huangqin, Shufu (stir-fried), Dahuang, Guizhi, Shiwei (de-haired), Houpo, Ziwei, Ejiao (each 3 parts), Ganjiang, Renshen, Taoren (each 2 parts), Chaihu, Qianglang (stir-fried, each 6 parts), Shaoyao, Mudanpi, Chan (fried, each 5 parts), Fengke (roasted, 4 parts), Qumai (2 parts), Tingli (fried), Banxia (each 1 part), Chixiao (12 parts).
Grind the above twenty-three ingredients into powder. Take one dou of ash from a forge furnace and one hu five dou of clear wine. Soak the ash in the wine. When half the wine has evaporated, add Biejia and boil until it dissolves into a glue-like consistency. Strain the juice, add the herbal powders, and decoct into pills the size of tung tree seeds. Take seven pills on an empty stomach, three times daily.
Maomu Wan
Qingpi, Taoren, Honghua, Shenqu, Maiya, Biejia (boiled in vinegar, as sovereign), Sanleng, Pengze, Haifen, Xiangfu (all boiled in vinegar).
Grind into powder, bind with Shenqu paste into pills the size of tung tree seeds. Take 50-70 pills per dose with plain warm water.
For pediatric malaria with masses, use Dihuang and Shaoyao (1.5 qian each), Chenpi, Chuanxiong, Huangqin, Banxia (1 qian each), Gancao (2 fen). Decoct with ginger water and mix with Biejia powder for administration.
Shizao Tang
Yuanhua (soaked in vinegar and boiled), Daji, Gansui (processed, equal parts).
Grind into powder. Take 0.5 qian per dose with one cup of water and ten dates. Decoct together to half a cup and administer.