鳖甲（炙）十二分 乌扇（烧）三分 黄芩三分 柴胡三分 鼠妇（熬）三分 干姜
三分大黄三分 芍药五分 桂枝三分 葶苈（熬）一分 石苇（去毛）三分 厚朴三
分牡丹（去心）五分 瞿麦二分 紫葳三分 半夏一分 人参一分 □虫（熬）五
分阿胶三分蜂巢（炙）四分 赤硝十二分 蜣螂（熬）六分 桃仁二分
右二十三味为末，取锻灶下灰一斗，清酒一斛五斗，浸灰，候酒尽一半，着□甲于中
，煮令泛烂如胶漆，绞取汁 ，内诸药，煎为丸，如梧子大，空心服七丸，日三服。
【集注】
徐彬曰：药用□甲煎者，□甲入肝，除邪养正，合煆灶灰所浸酒，去瘕，故以为君。
小柴胡汤、桂枝汤、大承气汤为三阳主药，故以为臣。但甘草嫌柔缓，而减药力，枳
实嫌破气而直下，故去之，外加干姜、阿胶、助人参、白术温养为佐。瘕必假血根据痰
，故以四虫、桃仁合半夏消血化痰；凡积必由气结，气利而积消，故以乌扇、葶苈、
利肺气，合石苇、瞿麦，清邪热而化气散结血。因邪聚则热，故以牡丹、紫葳去血中
伏火，膈中实热，为使。『千金方』去鼠妇、赤硝，而加海藻、大戟，以软坚化水更
妙。
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师曰：阴气孤绝，阳气独发，则热而少气、烦冤，手足热而欲呕，名曰瘅疟；若但热
不寒者，邪气内藏于心，外舍分肉之间，令人消铄肌肉。
【按】
此言瘅疟，其文脱简 ，『内经』已详，不复释。
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温疟者，其脉如平 ，身无寒，但热，骨节疼烦，时呕，白虎加桂枝汤主之。
【按】
此言温疟，其文脱简，『内经』已详，不复释。
鳖甲（经火炙）十二分，乌扇（烧制）三分，黄芩三分，柴胡三分，鼠妇（炒制）三分，干姜三分，大黄三分，芍药五分，桂枝三分，葶苈子（炒制）一分，石苇（去毛）三分，厚朴三分，牡丹皮（去心）五分，瞿麦二分，紫葳三分，半夏一分，人参一分，廑虫（熬制）五分，阿胶三分，蜂巢（炙）四分，赤硝十二分，蜣螂（熬制）六分，桃仁二分。
以上二十三味药研成细末，取锻铁灶下的灰一斗，清酒一斛五斗，浸泡灶灰，等到酒消耗掉一半时，将鳖甲放入其中，煮至烂熟如胶漆状，绞取汁液，加入各种药物，煎煮制成丸药，大小如梧桐子大，空腹服用七丸，每日三次。
【集注】
徐彬说：使用鳖甲作为煎剂的主药，是因为鳖甲入肝经，能祛除邪气、扶助正气，配合用煅灶灰浸泡的酒，可消除瘕积，所以将其作为君药。小柴胡汤、桂枝汤、大承气汤是治疗三阳病的主要方剂，所以作为臣药。但甘草性质柔缓，担心会减弱药效，枳实性质破气且作用直下，所以去掉它们，外加干姜、阿胶，辅助人参、白术进行温补滋养，作为佐药。瘕积必然假借血瘀和痰凝形成，所以用四种虫类药、桃仁配合半夏来消除血瘀、化解痰浊；凡是积聚必定由气机郁结引起，气机通畅则积聚消散，所以用乌扇、葶苈子利肺气，配合石苇、瞿麦，清除邪热并化气散结血。因为邪气聚集则生热，所以用牡丹皮、紫葳去除血中的伏火和膈中的实热，作为使药。《千金方》中去掉了鼠妇、赤硝，而加了海藻、大戟，以软化坚积、化解水饮更为巧妙。
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老师说：阴气孤立无援而绝灭，阳气独自发动，就会出现发热、气短、烦闷不适，手足发热且想呕吐的症状，这叫做瘅疟（一种但热不寒的疟疾）；如果只有发热而没有恶寒，说明邪气内藏于心，外留于肌肉之间，使人肌肉消瘦枯竭。
【按语】
这里讲的是瘅疟，原文有脱漏简缺，《内经》中已有详细说明，不再重复解释。
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温疟，其脉象如同正常平脉，身体没有恶寒，只有发热，骨节疼痛烦扰，时常呕吐，用白虎加桂枝汤主治。
【按语】
这里讲的是温疟，原文有脱漏简缺，《内经》中已有详细说明，不再重复解释。
Biejia (Zosterae Fructus, fire-roasted) 12 fen, Wushan (Iris Tectorii Rhizoma, burned) 3 fen, Huangqin (Scutellariae Radix) 3 fen, Chaihu (Bupleuri Radix) 3 fen, Shufu (Lithobii Faecus, stir-fried) 3 fen, Ganjiang (Zingiberis Rhizoma) 3 fen, Dahuang (Rhei Radix et Rhizoma) 3 fen, Shaoyao (Paeoniae Radix Alba) 5 fen, Guizhi (Cinnamomi Ramulus) 3 fen, Tingli (Semen Lepidii seu Descurainiae, stir-fried) 1 fen, Shiwei (Pyrrosiae Folium, hairs removed) 3 fen, Houpo (Magnoliae Officinalis Cortex) 3 fen, Mudanpi (Moutan Cortex, heart removed) 5 fen, Qumai (Dianthi Herba) 2 fen, Ziwei (Lagerstroemiae Indicae Flos) 3 fen, Banxia (Pinelliae Rhizoma Preparatum) 1 fen, Renshen (Ginseng Radix et Rhizoma) 1 fen, Jinchong (Eupolyphaga seu Steleophaga, roasted) 5 fen, Ejiao (Colla Corii Asini) 3 fen, Fengchao (Apis Nidi) 4 fen, Chixiao (Natrii Sulfas) 12 fen, Qianglang (Scarabaeus, roasted) 6 fen, Taoren (Persicae Semen) 2 fen.
The above twenty-three ingredients are ground into fine powder. Take one dou of ash from a forged stove, and one hu five dou of clear wine. Soak the ash in the wine. When half of the wine has been consumed, place Biejia into the mixture and boil until it becomes soft and glutinous like glue or lacquer. Strain to obtain the juice, add all other medicines, and decoct to form pills the size of wu-tzu (smartweed seeds). Take seven pills on an empty stomach, three times a day.
[Collected Annotations]
Xu Bin stated: The use of Biejia as the principal ingredient in this decoction is because Biejia enters the Liver channel, dispels pathogenic factors, and nourishes healthy qi. Combined with wine soaked in stove ash, it eliminates mass accumulations (Jia), thus serving as the Sovereign drug. Xiao Chai Hu Tang (Minor Jueyang Decoction), Gui Zhi Tang (Cinnamon Twig Decoction), and Da Cheng Qi Tang (Major Order the Qi Decoction) are the primary formulas for treating the Three Yang stages, so they serve as the Minister drugs. However, Gancao (Licorice Root) is considered too soft and slow-acting, potentially reducing efficacy; Zhishi (Immature Bitter Orange) is considered too disruptive to qi and acting too directly downward, so they are omitted. Instead, Ganjiang (Dried Ginger) and Ejiao (Donkey-Hide Gelatin) are added to assist Renshen (Ginseng) and Baizhu (Atractylodis Macrocephalae Rhizoma) in warming and nourishing, serving as Assistant drugs. Mass accumulations (Jia) necessarily rely on blood stasis and phlegm accumulation; therefore, four types of insect drugs, Taoren (Peach Seed), and Banxia (Pinellia Tuber) are used to resolve blood stasis and transform phlegm. Since all accumulations arise from qi stagnation, and when qi flows smoothly, accumulations dissipate, Wushan (Iris Tectorii Rhizoma) and Tingli (Semen Lepidii seu Descurainiae) are used to benefit Lung qi. Combined with Shiwei (Pyrrosia Leaf) and Qumai (Dianthus Herb), they clear pathogenic heat, move qi, and dissipate blood nodules. Because pathogen aggregation generates heat, Mudanpi (Tree Peony Bark) and Ziwei (Crape Myrtle Flower) are used to remove latent fire in the blood and excess heat in the diaphragm, serving as Guide drugs. In the *Qianjin Fang* (Essential Prescriptions Worth a Thousand Gold), Shufu (Lithobii Faecus) and Chixiao (Natrii Sulfas) were removed, while Haizao (Sargassum Thallus) and Daji (Euphorbiae Pekinensis Radix) were added to soften hardness and resolve water retention, which is even more ingenious.
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The Master said: When Yin qi is isolated and exhausted, and Yang qi acts alone, fever, shortness of breath, and vexatious discomfort occur, accompanied by hot hands and feet and a desire to vomit. This is called Dan Nu (Febrile Malaria); if there is only fever without chills, it indicates that the pathogenic factor is stored internally in the Heart and resides externally between the muscles, causing emaciation and wasting of the flesh.
[Commentary]
This passage discusses Dan Nu (Febrile Malaria). The original text has missing sections. The *Neijing* (Inner Canon) has already detailed this condition thoroughly, so no further explanation is provided here.
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Wen Nu (Warm Malaria) presents with a pulse similar to a normal pulse, absence of chills, presence of only fever, pain and irritability in the bone joints, and occasional vomiting. Bai Hu Jia Gui Zhi Tang (White Tiger Plus Cinnamon Twig Decoction) is the principal treatment.
[Commentary]
This passage discusses Wen Nu (Warm Malaria). The original text has missing sections. The *Neijing* (Inner Canon) has already detailed this condition thoroughly, so no further explanation is provided here.