疟脉自弦。弦数者热，弦迟者寒，代散者折。
《素问》疟论曰∶夫 疟皆生于风，盖风属木而应春。弦是其本脉，生于风则象
风，故脉自弦。又疟之作也，邪正交争，或寒而热，热而寒。寒热往来，正邪出入，
枢主于中。经云∶少阳为枢。少阳亦应乎春，故脉亦当弦。弦而兼数，数为热，是
知疟之多热也。（多热多汗，宜小柴胡汤，或加知母、石膏、黄连之类。甚则渴欲冷冻饮料，脉数大者，
宜白虎汤之类。）弦而兼迟，迟为寒，是知疟之多寒也。（热少寒多，甚则厥冷呕逆，宜二陈、姜、桂、
柴胡、白术、草果之类，虽附子亦不妨用，但宜细审其证，则百发百中矣。）若代止而又散，乃正气虚脱，
不续不敛之象。邪盛正衰，定主凶折。（此属危殆之证。若欲用药，非大补气血如参 炙甘术附姜桂之
类，不能挽回于万一者。）
仲景小柴胡汤 《伤寒论》云∶伤寒五六日，中风，往来寒热，胸胁苦满，默默不欲
饮食，心烦喜呕。或胸中烦而不呕，或渴，或腹中痛，或胁下痞硬，或心下悸，
小便不利，或不渴，身有微热，或咳者，小柴胡汤主之。此半表半里，寒热往来
之药也。今用治疟之寒热往来者皆效。
柴胡（半斤） 黄芩 人参 甘草（炙） 生姜（各三两） 半夏（半斤） 大枣（十二枚）
上七味，以水一斗二升，煮取六升。去滓，再煎取三升。温服一升，日三服。
若胸中烦而不呕者，去半夏、人参，加栝蒌实一枚。若渴者，去半夏加人参，合
前成四两半，加栝蒌根四两。若腹中痛者去黄芩，加芍药三两。若胁下痞硬，去
大枣，加牡蛎四两。若心下悸，小便不利者，去黄芩，加茯苓四两。若不渴，外有微热者，去人参，
加桂枝三两，温覆取微汗愈。若咳者，去人参、大枣、生姜，加五味子半升、干姜三两。
仲景白虎汤（加人参名人参白虎汤） 《伤寒论》云∶伤寒脉浮滑，此表有热，里有寒，白虎汤
主之。又云∶吐下后，七八日不解，热结在里，表里俱热，时时恶风，大渴，舌
上干燥而烦，欲饮水数升者，白虎加人参汤主之。大抵表里皆热，在表多汗，非
闭郁之热；在里渴烦，非入腑坚实之热，转夏为秋之剂也。
知母（六两） 石膏（一斤） 甘草（炙，二两） 粳米（六合）
上四味，以水一斗，煮米熟汤成。去滓，温服一升。日三。
疟疾的脉象自然呈现弦脉。脉象弦而数，表明有热；脉象弦而迟，表明有寒；脉象代且散，预示病情危重，可能导致死亡。
《素问·疟论》中说：所有的疟疾都源于风邪，因为风属木气，对应春季。弦脉是风的本脉，既然病由风邪引起，其脉象便像风一样，所以脉象自然呈弦状。另外，疟疾发作时，邪气与正气相互交争，时而发冷，时而发热，冷热交替。这种寒热往来的现象，反映了正气与邪气的出入进退，其枢纽作用在于少阳经。医经云：“少阳为枢。”少阳经也对应春季，因此脉象也应当呈现弦象。如果脉弦兼数，数为热象，由此可知疟疾多表现为热证。（若热多汗多，适宜使用小柴胡汤，或者加入知母、石膏、黄连等药物。如果严重到口渴想喝冰冻饮料，且脉象数大，适宜使用白虎汤之类的方剂。）如果脉弦兼迟，迟为寒象，由此可知疟疾多表现为寒证。（若热少寒多，严重时出现四肢厥冷、呕吐逆气，适宜使用二陈汤加上生姜、肉桂、柴胡、白术、草果等药物，即使使用附子也无妨，但必须仔细审察证候，这样才能百发百中。）如果出现代脉且止而又散，这是正气虚脱、不能接续收敛的征象。邪气盛而正气衰，必定主凶险之兆。（这属于危急的证候。如果想要用药救治，非用大补气血的药物如人参、炙甘草、白术、附子、生姜、肉桂等，无法挽回万一的希望。）
张仲景的小柴胡汤，《伤寒论》记载：患伤寒五六天，或中风，出现往来寒热，胸胁部苦闷胀满，神情沉默不想饮食，心烦喜呕。或者胸中烦闷但不呕吐，或者口渴，或者腹中疼痛，或者胁下痞塞硬满，或者心下悸动，小便不利，或者不渴，身体有轻微发热，或者咳嗽的，用小柴胡汤主治。这是治疗半表半里、寒热往来的药物。现在用它来治疗疟疾引起的寒热往来，都很有效。
药材组成：柴胡（半斤）、黄芩、人参、甘草（炙）、生姜（各三两）、半夏（半斤）、大枣（十二枚）。
以上七味药，用水一斗二升，煮取六升药液。滤去药渣，再煎取三升药液。每次温服一升，每日服用三次。
如果胸中烦闷但不呕吐的，去掉半夏、人参，加栝蒌实一枚。如果口渴的，去掉半夏，增加人参至四两半，再加栝蒌根四两。如果腹中疼痛的，去掉黄芩，加芍药三两。如果胁下痞塞硬满的，去掉大枣，加牡蛎四两。如果心下悸动、小便不利的，去掉黄芩，加茯苓四两。如果不渴、体表有轻微发热的，去掉人参，加桂枝三两，覆盖衣被使微微出汗即可痊愈。如果咳嗽的，去掉人参、大枣、生姜，加五味子半升、干姜三两。
张仲景的白虎汤（加入人参称为人参白虎汤），《伤寒论》记载：伤寒脉象浮滑，这是表有热、里有寒，用白虎汤主治。又说：吐下之后，七八天病仍未解，热结在体内，表里俱热，时时怕风，极度口渴，舌上干燥而烦躁，想要喝水几升的，用人参白虎汤主治。大体而言，表里皆热，在表的多汗，不是闭郁的热邪；在里的口渴烦躁，不是入腑成实的燥热，这是转夏为秋季节使用的方剂。
药材组成：知母（六两）、石膏（一斤）、甘草（炙，二两）、粳米（六合）。
以上四味药，用水一斗，煮至米熟汤成。滤去药渣，每次温服一升。每日服用三次。
The pulse of malaria naturally presents as a *Xian* (Wiry) pulse. A pulse that is Xian and Shu (Rapid) indicates heat; a pulse that is Xian and Chi (Slow) indicates cold; a pulse that is Dai (Intermittent) and San (Scattered) indicates a critical condition leading to death.
The *Su Wen* (Basic Questions), chapter "Malaria Theory," states: All malaria arises from wind pathogen, because wind belongs to Wood and corresponds to Spring. The Wiry pulse is the intrinsic pulse of wind; since the disease originates from wind, its pulse resembles wind, thus naturally presenting as Wiry. Furthermore, during the onset of malaria, pathogenic factors and healthy Qi contend with each other, alternating between chills and fever. This alternation of chills and heat reflects the entry and exit of healthy Qi and pathogens, with the pivot mechanism governed by the Shaoyang channel. The classics state: "Shaoyang serves as the pivot." Shaoyang also corresponds to Spring, therefore the pulse should also be Wiry. If the pulse is Wiry and accompanied by Rapidness, Rapidness indicates heat, from which it can be known that malaria often manifests as heat syndromes. (If there is excessive heat and sweating, *Xiao Chai Hu Tang* (Minor Bupleurum Decoction) is suitable, or one may add herbs such as *Zhi Mu* (Anemarrhenae Rhizoma), *Shi Gao* (Gypsum Fibrosum), and *Huang Lian* (Coptidis Rhizoma). In severe cases where the patient craves frozen drinks and the pulse is Rapid and Large, *Bai Hu Tang* (White Tiger Decoction) or similar formulas are suitable.) If the pulse is Wiry and accompanied by Slowness, Slowness indicates cold, from which it can be known that malaria often manifests as cold syndromes. (If there is little heat and much cold, progressing to cold extremities and vomiting/regurgitation, *Er Chen Tang* (Two-Cured Decoction) added with *Sheng Jiang* (Zingiberis Rhizoma Recens), *Rou Gui* (Cinnamomi Cortex), *Chai Hu* (Bupleuri Radix), *Bai Zhu* (Atractylodis Macrocephalae Rhizoma), and *Cao Guo* (Tsao-ko Fruit) is suitable. Even the use of *Fu Zi* (Aconiti Lateralis Radix Praeparata) is permissible, provided the syndrome is carefully examined, ensuring efficacy in every instance.) If the pulse is Intermittent, stopping and then Scattered, this is a sign of healthy Qi deficiency and collapse, unable to continue or gather. Pathogenic factors are abundant while healthy Qi is depleted, definitely indicating a fatal outcome. (This belongs to critical conditions. If medication is desired for rescue, only major tonification of Qi and Blood using herbs such as *Ren Shen* (Ginseng Radix et Rhizoma), Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma), *Bai Zhu*, *Fu Zi*, *Sheng Jiang*, and *Rou Gui* can salvage even a fraction of hope.)
Zhang Zhongjing's *Xiao Chai Hu Tang* (Minor Bupleurum Decoction): The *Shang Han Lun* (Treatise on Cold Damage) states: After five or six days of cold damage, or wind strike, presenting with alternating chills and heat, fullness and distress in the chest and hypochondrium, silence with lack of desire for food, irritability, and frequent vomiting. Or if there is irritability in the chest without vomiting, thirst, abdominal pain, hardness and fullness under the ribs, palpitations in the epigastrium, difficult urination, absence of thirst, slight fever on the body, or cough, *Xiao Chai Hu Tang* is the primary treatment. This is a formula for treating half-exterior half-interior conditions with alternating chills and heat. Currently, it is effective in treating the alternating chills and heat caused by malaria.
Ingredients: *Chai Hu* (Bupleuri Radix) (half jin), *Huang Qin* (Scutellariae Radix), *Ren Shen* (Ginseng Radix et Rhizoma), Gan Cao (Licorice Radix et Rhizoma) (prepared), *Sheng Jiang* (Zingiberis Rhizoma Recens) (each three liang), *Ban Xia* (Pinelliae Tuber), Da Zao (Jujubae Fructus) (twelve pieces).
Take these seven ingredients, boil in ten dou two sheng of water, reduce to six sheng. Remove the dregs, decoct again to obtain three sheng. Take one sheng warm, three times daily.
If there is irritability in the chest without vomiting, remove Ban Xia and Ren Shen, add one Gua Lou Shi (Trichosanthis Fructus). If there is thirst, remove Ban Xia, increase Ren Shen to four liang and half, add four liang of Gua Lou Gen (Trichosanthis Radix). If there is abdominal pain, remove Huang Qin, add three liang of Shao Yao (Paeoniae Radix Alba). If there is hardness and fullness under the ribs, remove Da Zao, add four liang of Mu Li (Ostreae Concha). If there are palpitations in the epigastrium and difficult urination, remove Huang Qin, add four liang of Fu Ling (Poria). If there is no thirst and slight external fever, remove Ren Shen, add three liang of Gui Zhi (Cinnamomi Ramulus), cover with blankets to induce slight sweating for cure. If there is cough, remove Ren Shen, Da Zao, and Sheng Jiang, add half sheng of Wu Wei Zi (Schisandrae Chinensis Fructus) and three liang of Gan Jiang (Zingiberis Rhizoma).
Zhang Zhongjing's *Bai Hu Tang* (White Tiger Decoction) (adding Ren Shen makes it *Ren Shen Bai Hu Tang*): The *Shang Han Lun* states: Cold damage with a floating and slippery pulse, indicating exterior heat and interior cold, is treated with *Bai Hu Tang*. It also states: After emesis and purgation, if the disease persists for seven or eight days, heat is bound internally, with heat in both exterior and interior, occasional aversion to wind, extreme thirst, dryness and irritation on the tongue, desiring to drink several sheng of water, *Ren Shen Bai Hu Tang* (White Tiger Decoction with Ginseng) is the primary treatment. Generally speaking, when both exterior and interior are hot, the exterior presents with much sweat, not heat due to closure and stagnation; the interior presents with thirst and irritation, not heat due to solid accumulation in the fu organs. This is a formula for the transition from summer to autumn.
Ingredients: *Zhi Mu* (Anemarrhenae Rhizoma) (six liang), *Shi Gao* (Gypsum Fibrosum) (one jin), Gan Cao (Licorice Radix et Rhizoma) (prepared, two liang), Jing Mi (Oryza Sativa var. glutinosa).
Take these four ingredients, boil in ten dou of water until the rice is cooked and the decoction is ready. Remove the dregs, take one sheng warm. Three times daily.