治久疟不愈，脉象弦而无力。
柴胡（三钱） 黄芩（二钱） 知母（三钱） 潞参（三钱） 鳖甲（三钱，醋炙） 清半夏（二钱）
常山（钱半，酒炒） 草果（一钱） 甘草（一钱） 酒曲（三钱） 生姜（三钱） 大枣（两枚，捭开）
疟初起者减潞参、鳖甲。热甚者，加生石膏五六钱或至一两。寒甚者，再加草果五分或至一钱。（神曲皆
发不好故方中用酒曲）
疟邪不专在少阳，而实以少阳为主，故其六脉恒露弦象。其先寒者，少阳之邪外与太阳并也，其后热者，
少阳之邪内与阳明并也。故方中用柴胡以升少阳之邪，草果、生姜以祛太阳之寒，黄芩、知母以清阳明之热。
又疟之成也，多挟痰挟食，故用半夏、常山以豁痰，酒曲以消食也。用人参，因其疟久气虚，扶其正即所以逐
邪外出。用鳖甲者，因疟久则胁下结有痞积（方书名疟母实由肝脾胀大），消其痞积，然后能断疟根株。用甘
草、大枣者，所以化常山之猛烈而服之不至瞑眩也。
或问∶叶天士医案，其治疟之方，多不用柴胡。其门人又有根传之说，谓不宜用柴胡治疟。若误用之，实
足偾事。其说果可
信乎？答曰∶叶氏当日声价甚高，疟原小疾，初起之时，鲜有延之延医者。迨至疟久，而虚证歧出，恒有疟邪
反轻，而他病转重，但将其病之重者治愈，而疟亦可随愈，此乃临证通变之法，非治疟之正法也。至于病在厥
阴，亦有先寒后热，出汗少愈，形状类疟之证。此系肝气虚极将脱，若误认为疟，用柴胡升之，凶危立见。此
当重用山萸肉，以敛而补之，是以《神农本草经》山茱萸，亦主寒热也。叶氏门人所谓，误用柴胡足偾事者，
大抵指此类耳。
或问∶叶氏治疟，遇其人阴虚燥热者，恒以青蒿代柴胡。后之论者，皆赞其用药，得化裁通变之妙。不知
青蒿果可以代柴胡乎？答曰∶疟邪伏于胁下两板油中，乃足少阳经之大都会。柴胡之力，能入其中，升提疟邪
透膈上出，而青蒿无斯力也。若遇阴虚者，或热入于血分者，不妨多用滋阴凉血之药佐之。若遇燥热者，或热
盛于气分者，不妨多用清燥散火之药佐之。曾治一人，疟间日一发，热时若燔，即不发疟之日，亦觉心中发热，
舌燥口干，脉象弦长（凡疟脉皆弦）重按甚实，知其阳明火盛也。投以大剂白虎汤，加柴胡三钱。服后顿觉心
中清爽，翌晨疟即未发。又煎前剂之半，加生姜三钱，服之而愈。
又尝治一人得温病，热入阳明之府，舌苔黄浓，脉象洪长，又间日一作寒热，此温而兼疟也。然其人素
有鸦片嗜好，病虽实，而身体素虚。投以拙拟白虎加人参以麦冬代知母、山药代粳米汤，亦少加柴胡，两剂而愈。
西人治疟，恒用金鸡纳霜，于未发疟之日，午间、晚间各服半瓦，白糖水送下。至翌晨又如此服一次，其疟即愈。
方书谓冬冷多温病，夏热多疟疾。此言冬日过冷，人身有伏寒，至春随春阳化热，即多成温病；夏日过
热，人身有伏暑，至秋为薄寒所激发，即多生疟疾也。丁卯季夏，暑热异常，京津一带因热而死者甚多，至秋
果多疟疾。服西药金鸡纳霜亦可愈，而
愈后恒屡次反复。姻家王姓少年，寄居津门，服金鸡纳霜愈疟三次后，又反复。连服前药数次，竟毫无效验。
诊其脉，左右皆弦长有力。夫弦为疟脉，其长而有力者，显系有伏暑之热也。为开白虎汤方，重用生石膏二两，
又加柴胡、何首乌各二钱，一剂而疟愈。恐未除根，即原方又服一剂，从此而病不反复矣。此方用白虎汤以解
伏暑，而又加柴胡、何首乌者，凡外感之证其脉有弦象者，必兼有少阳之病，宜用柴胡清之；而外邪久在少阳，
其经必虚，又宜用何首乌补之。二药并用，一扶正，一逐邪也。少阳与阳明并治，是以伏暑愈而疟亦随愈也。
治疗久疟不愈，脉象弦而无力。
柴胡（三钱） 黄芩（二钱） 知母（三钱） 潞参（三钱） 鳖甲（三钱，醋炙） 清半夏（二钱）
常山（钱半，酒炒） 草果（一钱） 甘草（一钱） 酒曲（三钱） 生姜（三钱） 大枣（两枚，掰开）
疟疾初起者减少潞参、鳖甲的用量。热势重者，加生石膏五六钱或至一两。寒势重者，再加草果五分或至一钱。（神曲容易发霉变质，所以方中使用酒曲）
疟邪并不专在少阳经，而是以少阳经为主，所以其六部脉象常常显露出弦象。先出现恶寒的，是少阳之邪外合太阳经所致；后出现发热的，是少阳之邪内合阳明经所致。所以方中用柴胡来升散少阳之邪，草果、生姜来祛除太阳之寒，黄芩、知母来清泄阳明之热。
另外，疟疾的形成，多夹杂痰湿和食积，所以用半夏、常山来豁痰，酒曲来消食。用人参，是因为疟疾日久导致气虚，扶助正气即是为了驱逐邪气外出。用鳖甲，是因为疟疾日久则胁下结有痞块积聚（方书称疟母，实由肝脾肿大引起），消除痞块积聚，然后才能断绝疟疾的病根。用甘草、大枣，是用来化解常山的猛烈药性，使服用后不至出现剧烈反应（瞑眩）。
有人问：叶天士的医案中，他治疗疟疾的方子，大多不用柴胡。他的门人又有“疟传”之说，认为不宜用柴胡治疗疟疾。如果误用，确实足以坏事。这种说法果真可信吗？回答说：叶氏当时声望很高，疟疾是小病，初起之时，很少有拖延到找医生治疗的。等到疟疾日久，虚证交错出现，常常是疟邪反而轻了，而其他疾病转重，只要将其重的疾病治愈，疟疾也可以随之痊愈，这是临证通变的方法，不是治疗疟疾的正法。至于病在厥阴经，也有先寒后热，出汗后稍好，症状类似疟疾的情况。这是肝气极度虚弱即将脱失，如果误认为是疟疾，用柴胡升提，凶险危急立刻显现。这应当重用山萸肉，来收敛并补益它，所以《神农本草经》记载山茱萸也能主治寒热。叶氏门人所讲，误用柴胡足以坏事的，大抵是指这类情况罢了。
有人问：叶氏治疗疟疾，遇到其人阴虚燥热的，常用青蒿代替柴胡。后来的评论者，都称赞他用药，得到了化裁通变的妙处。不知道青蒿果真可以代替柴胡吗？回答说：疟邪潜伏在胁下两板油中，那是足少阳经的大都会。柴胡的药力，能进入其中，升提疟邪透膈向上外出，而青蒿没有这种力量。如果遇到阴虚者，或者热入血分者，不妨多用滋阴凉血的药物辅助。如果遇到燥热者，或者热盛于气分者，不妨多用清燥散火的药物辅助。曾治疗一人，疟疾隔日发作一次，发热时如火烧，即使不发疟疾的日子，也感觉心中发热，舌燥口干，脉象弦长（凡是疟疾脉象皆弦），重按非常实，知道他是阳明火盛。投以大剂量的白虎汤，加柴胡三钱。服后顿觉心中清爽，第二天早晨疟疾就没有再发作。又煎前药的一半，加生姜三钱，服用后痊愈。
又曾治疗一人得温病，热入阳明之腑，舌苔黄厚，脉象洪大长，又隔日发作一次寒热，这是温病兼夹疟疾。然而那人素有鸦片嗜好，病虽属实证，但身体素来虚弱。投以我自己拟定的白虎加人参汤，用麦冬代替知母、山药代替粳米，也少量加入柴胡，两剂而痊愈。
西方人治疗疟疾，常用金鸡纳霜，在未发疟疾的日子，中午、晚上各服半瓦，白糖水送下。到了第二天早上又如此服一次，疟疾就痊愈了。
医书说冬天寒冷多温病，夏天炎热多疟疾。这话是说冬日过冷，人身有伏寒，到了春天随着春阳化为热，就多成为温病；夏日过热，人身有伏暑，到了秋天被薄寒所激发，就多生疟疾。丁卯年夏季末，暑热异常，京津一带因热而死的人很多，到了秋天果然多疟疾。服用西药金鸡纳霜也可以痊愈，但痊愈后常常屡次反复。姻亲王家少年，寄居天津，服用金鸡纳霜治愈疟疾三次后，又反复。连续服用前药数次，竟然毫无效验。诊察他的脉象，左右皆弦长有力。弦为疟脉，其长而有力的，明显是有伏暑之热。为他开具白虎汤方，重用生石膏二两，又加柴胡、何首乌各二钱，一剂而疟疾痊愈。恐怕未除根，就用原方又服一剂，从此病不再反复了。此方用白虎汤来解伏暑，而又加柴胡、何首乌的原因，凡是外感病症其脉有弦象的，必定兼有少阳的病，宜用柴胡清解；而外邪久留少阳，其经必虚，又宜用何首乌补益。两药并用，一扶正，一逐邪。少阳与阳明并治，所以伏暑愈而疟疾也随愈。
Treatment for chronic malaria that does not resolve, with a wiry and deficient pulse.
Chai Hu (Bupleuri Radix) (3 qian), Huang Qin (Scutellariae Radix) (2 qian), Zhi Mu (Anemarrhenae Rhizoma) (3 qian), Lu Shen (Codonopsis Radix) (3 qian), Bie Jia (Testudinis Carapax et Plastrum) (3 qian, vinegar-fried), Qing Ban Xia (Pinelliae Rhizoma Praeparatum cum Alumine et Zingibere) (2 qian), Chang Shan (Dichroae Radix) (1.5 qian, wine-fried), Cao Guo (Tsaoko Fructus) (1 qian), Gan Cao (Glycyrrhizae Radix et Rhizoma) (1 qian), Jiu Qu (Zea Mays Fermentata) (3 qian), Sheng Jiang (Zingiberis Rhizoma Recens) (3 qian), Da Zao (Jujubae Fructus) (2 pieces, split open).
For early-stage malaria, reduce the dosage of Lu Shen and Bie Jia. For severe heat, add Sheng Shi Gao (Gypsum Fibrosum) 5-6 qian or up to 1 liang. For severe cold, add an additional 5 fen to 1 qian of Cao Guo. (Shen Qu is prone to mold, hence Jiu Qu is used in this formula.)
The pathogen of malaria is not exclusively located in the Shaoyang channel, but primarily resides there; thus, the six pulses often manifest a wiry quality. The initial chills result from the Shaoyang pathogen combining externally with the Taiyang channel; the subsequent fever results from the Shaoyang pathogen combining internally with the Yangming channel. Therefore, Chai Hu is used in the formula to ascend and disperse the Shaoyang pathogen; Cao Guo and Sheng Jiang are used to dispel the Taiyang cold; Huang Qin and Zhi Mu are used to clear the Yangming heat.
Furthermore, the formation of malaria often involves phlegm and food retention; thus, Ban Xia and Chang Shan are used to resolve phlegm, and Jiu Qu is used to digest food. Ren Shen (Ginseng Radix) is employed because prolonged malaria leads to Qi deficiency; supporting the righteous Qi serves to expel the pathogenic factor. Bie Jia is used because prolonged malaria leads to the formation of masses and accumulations under the hypochondrium (formulas refer to these as "Malaria Mother," actually caused by hepatosplenomegaly); resolving these masses allows for the eradication of the root cause of malaria. Gan Cao and Da Zao are used to mitigate the harsh nature of Chang Shan, preventing severe adverse reactions (mingxuan) upon ingestion.
A question was raised: In Ye Tianshi's medical cases, his formulas for treating malaria rarely use Chai Hu. His disciples also proposed the theory of "malaria transmission," stating that Chai Hu should not be used to treat malaria. Misusing it could indeed ruin the treatment. Is this claim credible? The answer is: Ye Tianshi had high prestige at the time. Malaria is a minor ailment, and in its early stages, few patients delay seeking medical attention. However, when malaria becomes chronic, various deficiency syndromes emerge. Often, the malaria pathogen becomes milder while other diseases worsen. If the more serious disease is cured, the malaria may also resolve spontaneously. This is a method of clinical flexibility, not the standard treatment for malaria. Regarding conditions in the Jueyin channel, there are cases presenting with initial chills followed by fever, slight improvement after sweating, and symptoms resembling malaria. This indicates extreme deficiency of Liver Qi nearing collapse. If misdiagnosed as malaria and treated with Chai Hu to ascend, danger will appear immediately. In such cases, Shan Yu Rou (Corni Fructus) should be heavily used to astringe and tonify. Thus, the *Shennong Bencao Jing* states that Shan Zhu Yu (Corni Fructus) also treats chills and fever. When Ye's disciples said that misusing Chai Hu ruins the case, they were likely referring to such scenarios.
Another question: When treating malaria in patients with Yin deficiency and dry heat, Ye Tianshi often substituted Qing Hao (Artemisiae Annuae Herba) for Chai Hu. Later commentators praised this medication choice as demonstrating skillful adaptation. Is it true that Qing Hao can truly replace Chai Hu? The answer is: The malaria pathogen lies dormant in the fatty tissue under the hypochondrium, which is the major hub of the Foot-Shaoyang channel. The power of Chai Hu can enter this area, ascending and lifting the malaria pathogen through the diaphragm to exit outward, whereas Qing Hao lacks this capability. For patients with Yin deficiency or heat entering the Blood level, one may appropriately add more herbs that nourish Yin and cool the blood. For those with dry heat or excess heat in the Qi level, one may appropriately add more herbs that clear dryness and dissipate fire. I once treated a patient with intermittent malaria occurring every other day. During febrile episodes, the heat felt like burning; even on days without malaria, he felt internal heat, dry tongue and mouth, and a wiry and long pulse (all malaria pulses are wiry), which was very solid upon heavy pressure. This indicated excessive Fire in the Yangming. I prescribed a large dose of Bai Hu Tang (White Tiger Decoction) with 3 qian of Chai Hu. After ingestion, he immediately felt refreshed in the heart region, and the next morning the malaria did not recur. He then took half the previous dose with an added 3 qian of Sheng Jiang, and was cured.
I also treated a patient suffering from warm disease, where heat entered the Fu organs of the Yangming, presenting with a thick yellow tongue coating and a surging, long pulse, along with alternating chills and fever every other day. This was warm disease complicated by malaria. However, the patient had a history of opium addiction; although the illness was excess in nature, his constitution was inherently deficient. I prescribed my own modified Bai Hu Jia Ren Shen Tang (White Tiger plus Ginseng Decoction), using Mai Dong (Ophiopogonis Radix) instead of Zhi Mu, and Shan Yao (Dioscoreae Rhizoma) instead of Jing Mi (Rice), with a small amount of Chai Hu added. He recovered after two doses.
Western medicine often uses Cinchona Bark Alkaloids (Jin Ji Na Shuang) to treat malaria. On days without fever, half a grain is taken at noon and evening with sugar water. Another dose is taken the following morning, after which the malaria resolves.
Medical texts state that cold winters lead to many warm diseases, and hot summers lead to many malaria cases. This means that if winter is excessively cold, latent cold remains in the body; in spring, following the warming of Spring Yang, it transforms into heat, resulting in warm diseases. If summer is excessively hot, latent summer-heat remains in the body; in autumn, triggered by mild cold, malaria arises. In the late summer of the Dingmao year, the heat was abnormal, causing many deaths in the Beijing-Tianjin area due to heat. Consequently, autumn saw many malaria cases. Taking Western medicine Cinchona Bark Alkaloids could cure the malaria, but relapses were common after recovery. A young man from my wife's family Wang, residing in Tianjin, suffered relapses after being cured three times by Cinchona Bark Alkaloids. Repeated doses proved ineffective. His pulse was wiry, long, and forceful on both sides. Wiry indicates malaria; long and forceful indicates latent summer-heat. I prescribed Bai Hu Tang (White Tiger Decoction), heavily using 2 liang of Sheng Shi Gao (Gypsum Fibrosum), plus 2 qian each of Chai Hu and He Shou Wu (Polygoni Multiflori Radix). The malaria resolved after one dose. Fearing incomplete eradication, he took another dose of the same formula, and the disease never relapsed again. This formula uses Bai Hu Tang to resolve latent summer-heat, and adds Chai Hu and He Shou Wu because any external contraction presenting with a wiry pulse must involve Shaoyang pathology, requiring Chai Hu to clear it; furthermore, since the exterior pathogen has lingered in the Shaoyang, the channel must be deficient, requiring He Shou Wu to tonify. The two herbs work together: one supports the righteous Qi, the other expels the pathogen. By treating both Shaoyang and Yangming, the latent summer-heat resolves, and the malaria follows suit.