升麻二两 当归一两 蜀椒（炒，去汗）一两 甘草二两 □甲（炙）手掌大一片
雄黄（研）半两
右六味，以水四升，煮取一升，顿服之；老小再服，取汗。
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师曰：疟脉自弦，弦数者多热，弦迟者多寒，弦小紧者下之差，弦迟者可温之，弦紧
者可发汗、针灸也，弦浮大者可吐之，弦数者风发也，以饮食消息止之。
【按】
弦小紧者之「小」字，当是「沉」字，则有有可下之理。弦紧者，当是「弦浮紧」，
则有可发汗之理。弦浮大者，当是「弦滑大」，则有可吐之理。且不遗本文疟脉自弦
之意。
【注】
疟之为病，寒热也，三阴三阳皆有之，因其邪伏藏于半表半里之间，故属少阳，脉自
弦也。弦数者多热，弦迟者多寒，谓发作之时，多热为阳盛，多寒为阴盛也。夫伤寒
少阳病，则有汗、吐、下三法之禁，而疟亦属少阳，何以有汗、吐、下三法之宜，是
盖疟属杂病，不可不知也。初发脉弦兼沉紧者，主乎里也，可下之；兼迟者，主乎寒
也，可温之；兼浮紧者，主乎表也，可汗之；兼滑大者，主乎饮也，可吐之；兼数者
，风发也，即风热之谓也，可清之。若久发不止，则不可以此法治之，当以饮食撙节
，调理消息止之，盖初病以治邪为急，久病以养正为主也。其他瘅疟，即『内经』所
谓但热不寒之瘅疟也；温疟，即『内经』所言先伤于风，后伤于寒，热多寒少之温疟
也；牝疟，即『内经』所言先伤于寒，后伤于风，寒多热少之寒疟也；惟疟母一证，
经所未载。然论诸疟，未有详于『内经』者也。其文虽略有不同，必是脱简，然所出
治法，亦未有过于仲景者也。
【集注】
徐彬曰：自者，谓感有风寒，而脉惟自弦也。于是脉既有一定之像，而兼数为热，兼
迟为寒，此其大纲也。
尤怡曰：疟之舍固在半表半里之间，而人之藏则有偏多偏少之异，故其病有热多者，
有寒多者，有里多而可下者，有表多而可汗、可吐者，当各随其脉而施治也。
周扬俊曰：人之疟证，由外邪之入，每伏于半表半里，入而与阴争则寒，出而与阳争
则热，故寒热往来，主少阳，谓兼他经证则有之，谓全不涉少阳，则无是理也。仲景
曰：疟脉自弦，正以脉之数、迟、小、紧、浮、大皆未可定，要必兼弦，弦为少阳脉
也。夫邪犯少阳与卫气并居，卫气昼行于阳，夜行于阴，故邪得阳而外出，得阴而内
薄，内外相薄，是以日作。若气之舍深，内薄于阴，阳气独发，阴气内着，阴与阳争
不得出，是以间日而作也。然则偏阴多寒，偏阳多热，其为瘅、为温、为牝，莫不自
少阳而造其极，补偏救弊，必从少阳之界，使邪去而阴阳适，归于和而后愈也。
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病疟以月一日发，当以十五日愈；设不差，当月尽解；如其不差，当云何？师曰：此
结为症瘕，名曰疟母，急治之，宜□甲煎圆。
【注】
病疟者，以月计之，如一日发者，当以十五日愈，以十五日更一气也。人受气于天，
天气更则人身之气亦更，更气旺，则不受疟邪，故愈也；设若不差，当月尽解，是又
更一旺气也。倘如更二气不差，此疟邪不衰，与病者气血痰饮，结为症瘕，名曰疟母
也，当急治之，宜用□甲煎丸攻之可也。
【集注】
程林曰：五日为一候，三候为一气，一气十五日也。夫人受气于天，气节更移，荣卫
亦因之以易也。
升麻二两，当归一两，蜀椒（炒制，去汗）一两，甘草二两，鳖甲（炙）手掌大一片，雄黄（研细）半两。
以上六味药，用水四升，煮取一升，一次性服用；老人和小孩可再服一次，以出汗为度。
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老师说：疟疾的脉象自然呈现弦脉，弦而数的脉象多表现为热证，弦而迟的脉象多表现为寒证，弦小紧的脉象用下法可以好转，弦迟的脉象可以用温法治疗，弦紧的脉象可以用发汗、针灸治疗，弦浮大的脉象可以用吐法治疗，弦数的脉象属于风热发作，可以通过饮食调理来止住。
【按语】
“弦小紧”中的“小”字，应当是“沉”字，这样就有可以使用下法的道理。“弦紧”者，应当是“弦浮紧”，这样就有可以使用发汗法的道理。“弦浮大”者，应当是“弦滑大”，这样就有可以使用吐法的道理。而且不违背原文中“疟脉自弦”的本意。
【注解】
疟疾这种病，表现为寒热往来，三阴三阳各经都有发生，因为邪气潜伏藏匿在半表半里之间，所以归属于少阳经，脉象自然呈现弦脉。弦数脉多热，弦迟脉多寒，是指在发作的时候，多热是因为阳气盛，多寒是因为阴气盛。伤寒少阳病，有汗、吐、下三种治法的禁忌，而疟疾也归属于少阳，为什么却有汗、吐、下三种治法的适宜呢？这是因为疟疾属于杂病，不可不知道这一点。初发时脉象弦兼沉紧，主病在里，可以用下法；兼迟脉，主病在寒，可以用温法；兼浮紧脉，主病在表，可以用汗法；兼滑大脉，主病在有痰饮，可以用吐法；兼数脉，属于风热发作，即风热的意思，可以用清法。如果久发不止，就不能用这些方法治疗，应当节制饮食，通过调理身体来止住病情，大概初病以祛除邪气为急务，久病以养护正气为主。其他的瘅疟，就是《内经》所说的只有热没有寒的瘅疟；温疟，就是《内经》所说的先伤于风，后伤于寒，热多寒少的温疟；牝疟，就是《内经》所说的先伤于寒，后伤于风，寒多热少的寒疟；只有疟母这一证候，经典中没有记载。然而论述各种疟疾，没有比《内经》更详细的了。虽然文字略有不同，必定是竹简脱落所致，但所提出的治疗方法，也没有超过张仲景的了。
【集注】
徐彬说：“自”字，是说感受了风寒，而脉象唯独呈现弦脉。于是脉象既然有一定的形态，兼数脉为热，兼迟脉为寒，这是其大纲。
尤怡说：疟疾的病位固守在半表半里之间，而人的脏腑则有偏多偏少的差异，所以有的病热多，有的病寒多，有的病在里多而可以用下法，有的病在表多而可以用汗法、吐法，应当各自根据脉象来施治。
周扬俊说：人的疟疾病证，由外邪侵入，每伏藏在半表半里，进入体内与阴气相争则发冷，外出与阳气相争则发热，所以寒热往来，主要归属于少阳，如果说兼有其他经络的症状那是有的，如果说完全不涉及少阳，那是不可能的。张仲景说：疟脉自弦，正是因为在脉的数、迟、小、紧、浮、大中都不能确定，一定要兼见弦脉，弦脉是少阳经的脉象。邪气侵犯少阳与卫气并居，卫气白天行于阳分，夜晚行于阴分，所以邪气得阳气而外出，得阴气而内迫，内外相互搏击，所以每天发作。如果气机停留较深，内迫于阴分，阳气独发，阴气内着，阴与阳相争不得出，所以隔天发作。既然如此，偏阴分则多寒，偏阳分则多热，无论是瘅疟、温疟还是牝疟，无不从少阳发展至极点，纠正偏颇补救弊端，必须从少阳的界限入手，使邪气去除而阴阳调和，归于和谐而后痊愈。
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患疟疾的人，如果在农历初一发病，应当在十五天痊愈；假如不好转，应当在月底解除；如果还不好转，该怎么办？老师说：这结聚成为症瘕，名叫疟母，应当紧急治疗，适宜用鳖甲煎丸。
【注解】
患疟疾的人，按月计算，如初一发病，应当在十五天痊愈，因为十五天更换一个节气。人受气于天，天气变化则人身之气也随之变化，节气旺盛，则不受疟邪侵害，所以痊愈；假如不好转，应当在月底解除，这又是更换了一个旺盛的节气。倘若更换了两个节气仍不好转，这说明疟邪未衰，与病人的气血痰饮，结聚成症瘕，名叫疟母，应当紧急治疗，适宜用鳖甲煎丸攻伐它。
【集注】
程林说：五天为一候，三候为一气，一气是十五天。人受气于天，节气更替，营卫之气也因此发生变化。
Shengma (Rhizoma Cimicifugae) two liang, Danggui (Radix Angelicae Sinensis) one liang, Shujiao (Fructus Zanthoxyli) (stir-fried, remove sweat) one liang, Gancao (Radix Glycyrrhizae) two liang, Biejia (Carapax et Plastrum Testudinis) (roasted) the size of a palm, Xionghuang (Realgar) (ground) half a liang.
The above six herbs, with four sheng of water, boil to obtain one sheng, take in one dose; for the elderly and children, take another dose, aiming for sweating.
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The Master said: The pulse of malaria naturally presents as a Xian (Wiry) pulse. A Xian-Shu (Wiry-Rapid) pulse indicates mostly heat; a Xian-Chi (Wiry-Slow) pulse indicates mostly cold. A Xian-Xiao-Jin (Wiry-Small-Tight) pulse can be improved by purgation; a Xian-Chi (Wiry-Slow) pulse can be treated with warming methods; a Xian-Jin (Wiry-Tight) pulse can be treated with diaphoresis or acupuncture; a Xian-Fu-Da (Wiry-Float-Large) pulse can be treated with emesis. A Xian-Shu (Wiry-Rapid) pulse indicates Wind-Heat attack, which can be stopped by dietary regulation.
[Commentary]
The character "Xiao" (Small) in "Xian-Xiao-Jin" should be "Chen" (Deep), which provides the rationale for using purgation. "Xian-Jin" should be "Xian-Fu-Jin" (Wiry-Float-Tight), providing the rationale for using diaphoresis. "Xian-Fu-Da" should be "Xian-Hua-Da" (Wiry-Slippery-Large), providing the rationale for using emesis. This does not contradict the original meaning that "the pulse of malaria is naturally Xian."
[Annotation]
Malaria is a disease characterized by alternating chills and fever, occurring in all three Yin and three Yang meridians. Because the pathogen lies hidden between the exterior and interior, it belongs to Shaoyang (Lesser Yang), and the pulse is naturally Xian (Wiry). Xian-Shu (Wiry-Rapid) pulses indicate mostly heat, and Xian-Chi (Wiry-Slow) pulses indicate mostly cold, referring to the fact that during attacks, excessive heat signifies Yang excess, and excessive cold signifies Yin excess. In Taiyang-Shaoyang disease (Shaoyang syndrome in Cold Damage), there are prohibitions against diaphoresis, emesis, and purgation. However, since malaria also belongs to Shaoyang, why are diaphoresis, emesis, and purgation appropriate? This is because malaria is considered a miscellaneous disease, a point that must be understood. When first attacking, if the pulse is Xian combined with Chen-Jin (Deep-Tight), it indicates pathology in the interior, and purgation can be used; if combined with Chi (Slow), it indicates cold, and warming can be used; if combined with Fu-Jin (Float-Tight), it indicates pathology in the exterior, and diaphoresis can be used; if combined with Hua-Da (Slippery-Large), it indicates phlegm-fluid retention, and emesis can be used; if combined with Shu (Rapid), it indicates Wind-Heat attack, i.e., wind-heat, and clearing methods can be used. If the disease persists for a long time without stopping, these methods cannot be used; instead, dietary restraint and regulatory measures should be employed to stop the condition. Generally, acute illness prioritizes eliminating pathogens, while chronic illness prioritizes nourishing Zheng Qi (Upright Qi). Other types include Dan-Nue (Grave Malaria), which is the "only heat without chills" described in Neijing; Wen-Nue (Warm Malaria), which is "wind injury followed by cold injury, more heat than cold" described in Neijing; Pin-Nue (Female Malaria), which is "cold injury followed by wind injury, more cold than heat" described in Neijing. Only Nuomu (Malarial Mass) is not recorded in the classics. However, no text discusses various malarias more comprehensively than Neijing. Although the wording differs slightly, it is likely due to lost bamboo slips. Nevertheless, the therapeutic methods proposed do not exceed those of Zhang Zhongjing.
[Collected Annotations]
Xu Bin said: The word "Zi" (naturally) means that after contracting wind-cold, the pulse is exclusively Xian (Wiry). Since the pulse has a definite form, combined Shu (Rapid) indicates heat, and combined Chi (Slow) indicates cold; this is the general principle.
You Yi said: The seat of malaria is firmly located between the exterior and interior, but people's zang-fu organs have differences in excess or deficiency. Thus, some cases have more heat, some have more cold, some have more interior pathology treatable by purgation, and some have more exterior pathology treatable by diaphoresis or emesis. Treatment should be administered according to each pulse pattern.
Zhou Yangjun said: Human malaria cases, caused by external pathogens entering, often lie dormant between the exterior and interior. Entering and fighting with Yin causes chills; exiting and fighting with Yang causes fever. Hence, alternating chills and fever primarily belong to Shaoyang. While other meridian symptoms may coexist, it is impossible for malaria to completely exclude Shaoyang. Zhang Zhongjing said: "The pulse of malaria is naturally Xian," precisely because among Shu, Chi, Xiao, Jin, Fu, and Da, nothing is fixed; one must always see the Xian pulse, which is the pulse of Shaoyang. When pathogens invade Shaoyang and reside with Wei Qi (Defensive Qi), Wei Qi travels through Yang during the day and Yin at night. Thus, pathogens exit with Yang and penetrate inward with Yin. The internal and external struggle results in daily attacks. If the qi stays deep, penetrating Yin, Yang Qi alone erupts while Yin Qi adheres internally. The struggle between Yin and Yang prevents exit, resulting in every-other-day attacks. Therefore,偏向 Yin leads to more cold, and偏向 Yang leads to more heat. Whether Dan-Nue, Wen-Nue, or Pin-Nue, all originate from Shaoyang and reach their extreme. To correct imbalance and remedy deficiency, one must act from the boundary of Shaoyang, allowing pathogens to leave so Yin and Yang harmonize, returning to balance before recovery.
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Patients with malaria who develop on the first day of the lunar month should recover within fifteen days; if they do not improve, they should resolve by the end of the month. If they still do not improve, what should be done? The Master said: This condenses into a mass called Nuomu (Malarial Mass); it must be treated urgently, preferably with Biejia Jian Wan (Turtle Shell Decoction Pills).
[Annotation]
For patients with malaria, calculated by months: if onset is on the first day, recovery should occur by the fifteenth day, as fifteen days mark the change of a Jieqi (Solar Term). Humans receive Qi from Heaven; when Heavenly Qi changes, human Qi also changes. When the new Qi is prosperous, the body is not affected by Malaria pathogens, hence recovery. If improvement does not occur, resolution should happen by the end of the month, marking another cycle of prosperous Qi. If two cycles pass without improvement, the Malaria pathogen remains strong, combining with the patient's Blood, Qi, Phlegm, and Fluids to form a mass called Nuomu (Malarial Mass). It must be treated urgently, preferably with Biejia Jian Wan (Turtle Shell Decoction Pills) to attack it.
[Collected Annotations]
Cheng Lin said: Five days constitute one Hou (Decad), three Hous make one Jieqi (Solar Term), totaling fifteen days. Humans receive Qi from Heaven; as solar terms shift, Ying-Qi (Nutritive Qi) and Wei-Qi (Defensive Qi) also change accordingly.