（论一首 法九条 律三条）
喻昌曰∶疟之一病，无如《内经》论之最详最彻，随其病之所形，按法刺之，莫不应手而愈。盖九针之用，通于神
明，不可有微芒之差忒，故《内经》论疟，不得不详也。后世恶于针石，不可与言至巧，乃以药剂攻邪存正，调荣卫之
偏，和阴阳之逆，于是种种圣法，不适于用矣。如张子和见羸人病疟二年，不敢辄投寒凉，取《刺疟论》详之，刺其十
指出血立愈。此正《内经》所谓疟之且发也，阴阳之且移也，必从四末始也。坚束其处，决去其血，则邪往而不得并，
故立愈也。以子和之久谙针法，且检《针经》致其详慎，针其可以渎用哉？舍针而求《内经》，用药之捷法，茫然无可下
手矣！予之所以心折仲景，称为百世之师者，每遇一证，必出一法，以纬《内经》之不逮，一言当千百言而居其要也。
夫人四体安然，外邪得以入而疟之，每伏藏于半表半里，入而与阴争则寒，出而与阳争则热。半表半里者，少阳也。所
以寒热往来，亦少阳所主，谓少阳而兼他经之证，则有之。谓他经而全不涉少阳，则不成其为疟矣。所以仲景曰∶疟脉
多弦，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，浮大者可吐之，弦数者风发
也，以饮食消息止之。只此七言，而少阳一经，汗、吐、下、和、温之法具备。其他瘅疟、温疟、牡疟、疟母四证，要
不外少阳求治耳。出《伤寒论》之绪余，以补《内经》下手之法，非圣人而能之乎？谨将《金匮》奥义，一一发明于左。
少阳乃东方甲木之象，故其脉主弦，此不但初病之脉乃尔，即久疟正虚，脉不鼓指，而弦象亦隐然在内。所以仲景
云∶疟脉自弦，由首及尾，脉之屡迁纵不同，而弦之一字，实贯彻之也。疟邪之舍于荣卫，正属少阳半表半里，始之
似疟非疟，与后之经年不解，总一少阳主之，盖疟发必有寒有热，其寒热之往来，适在少阳所主之界，偏阴则多寒，偏
阳则多热。即其纯热无寒，而为瘅疟、温疟。纯寒无热，而为牡疟。要皆自少阳而造其极偏，补偏救弊，亦必返还少
阳之界，阴阳两协于和，而后愈也。施汗、吐、下之法，以治实热。施和、温之法，以治虚寒，无非欲致其和平耳。疟
邪如傀儡，少阳则提傀儡之线索，操纵进退，一惟少阳主张，宁不恢恢乎游刃空虚也耶？
弦数者，风发也，以饮食消息止之。仲景既云，弦数者多热矣。而复申一义云∶弦数者风发，见多热不已，必至于
极热，热极则生风，风生则肝木侮土，而传其热于胃。坐耗津液，阳愈偏而不返，此未可徒求之于药也。须以饮食消息
而止其炽热，即梨汁、蔗浆，生津止渴之属。正《内经》“风淫于内，治以甘寒”之旨也。
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，
令人消烁肌肉。《内经》谓其但热而不寒者，阴气先绝，阳气独发，则少气烦冤，手足热而欲呕，名曰瘅疟。仲景之
重引其文，另有妙义。盖从上条弦数者风发也，以饮食消息止之，抽丝引絮，而出其证。谓弦数之脉，热盛生风，必侮
土而伤其津液，由少阳而入阳明。两经合邪，其热倍炽，倘不能以饮食消息，急止其热，则热之移于胃者，必上熏心
肺，少气烦冤而心肺病，手心热欲呕，而胃自病。所以继之曰∶邪气内藏于心，外舍分肉之间，令人消烁肌肉，盖伤寒
病三阳合邪，其来如风雨如霹雳，令人莫当。而疟之在少阳，苟不入于阴，而但出于阳，迨至两阳合邪，亦岂能堪之
耶？故知消息而止入胃之热邪，真圣法也。然仲景之法，亦从《内经》而得，《内经》谓疟脉缓大虚，便宜用药，不宜用
针。又谓虚者不宜用针，以甘药调之，昌知意中在用甘寒也。
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。《内经》言温疟有二，但先热后寒。仲景所名
温疟，则但热不寒，有似瘅疟，而实不同也。瘅疟两阳合邪，上熏心肺，肺主气者，少气烦冤，则心主脉者，阳盛脉
促，津亏脉代，从可推矣。温疟脉如平人，则邪未合，而津未伤，其所以但热而不寒者，则以其人素有痹气，荣卫不通、
故疟之发于阳，不入于阴，即入而阴亦不受。所以骨节烦疼，时呕，邪气 格之状，有如此者，惟用白虎汤以治阳邪，
而加桂枝以通荣卫，斯阴阳和，血脉通，得汗而愈矣。在伤寒病，卫强营弱，卫气不共营气和谐者，用桂枝汤复发其汗
立愈。此疟邪偏着于阳，桂枝阳药，即不可用。但用白虎汤大清气分之热，少加桂枝，合阴阳而两和之，乃知仲景之
法，丝丝入扣也。
其《内经》所称先热后寒之温疟，一者先伤于风，后伤于寒，风为阳邪，寒为阴邪，疟发时先阳后阴，故先热后寒
也。此以风寒两伤营卫之法治之，初无难也。其一为冬感风寒，深藏骨髓，内舍于肾，至春夏时令大热而始发。其发
也，疟邪从肾出之于外而大热，则其内先已如焚，水中火发，虽非真火，亦可畏也。俟其疟势外衰，复返于肾，而阴精
与之相持，乃始为寒，设不知壮水之主，以急救其阴，十数发而阴精尽矣。阴精尽，则真火自焚，洒洒时惊，目乱无
精，顷之死矣。所以伤寒偏死下虚之人，谓邪入少阴，无阴精以御之也。而温疟之惨，宁有异哉？此亦仲景意中之隐，
昌特比例陈情，以为来学之助。
疟多寒者，名曰牡疟，蜀漆散主之。
疟多寒者，寒多于热，如三七二八之分，非纯寒无热也。纯寒无热，则为阴证，而非疟证矣。此条又抽丝引絮，即
上条两阳合邪，上熏心肺证中，复指出多寒少热一证。盖邪之伏于心下，适在膻中心包之位，心为阳中之阳，阳邪从阳，
尤为易入。邪入则心虚。《经》曰∶心虚者，热收于内，内收其热，并其邪亦收之，不易外出，此寒多之一因也。邪入
心
胞，都城震动，周身精液，悉力内援，重重裹撷，胞内之邪，为外所拒，而不易出，又寒多之一因也。心者牡藏，故即
以寒多热少之疟，名曰牡疟。用蜀漆散和浆水，吐其心下结伏之邪，则内陷之邪，亦随之俱出，一举而荡逐无余矣。岂
不快哉！蜀漆，常山苗也。常山善吐，何以不用常山而用蜀漆？取苗性之轻扬者，入重阳之界，引拔其邪。合之龙骨镇
心宁神，蠲除伏气。云母安藏补虚，媚兹君主，仲景补天浴日之方，每多若此。至如温疟，亦用此方，更加蜀漆，以吐
去其心下结伏之邪、盖一吐则周身之痹者通，而营卫并可借以无忤，则又以吐法为和法者也。
其附《外台秘要》牡蛎汤一方，同治牡疟者，又初感病时，风寒未清，传变为疟，结伏心下，故方中用麻黄以散风
寒，并借之以通阳气耳。可见病之途原不一，学人于此一证二方，比而参之，以求生心之变化，则几矣。
论《金匮》柴胡去半夏加栝蒌汤方 治疟病发渴者，亦治劳疟。
此仲景治少阳病，全体大用之一方也。仲景谓疟邪盛衰出入，必在少阳表里之间，小柴胡汤乃伤寒少阳经天然不易
之法。渴者去半夏加栝蒌实，亦天然不易之法。而施之于少阳邪传阳明，伤耗津液之证，亦为天然不易之法。盖渴虽阳
明津竭，而所以致阳明津竭者，全本少阳之邪。观《内经》刺法，渴者取之少阳，非以其木火之势劫夺胃津而然耶。故
疟邪进退于少阳，即以此方进退而施其巧。柴胡、黄芩，对治木火。人参、甘草，扶助胃土。栝蒌生津润燥。姜枣发越
荣卫。若夫劳疟之病，其本火盛，营卫衰，津液竭，亦不待言，故并可施此方以治之也。
论柴胡桂姜汤 治疟寒多微有热，或但寒不热，服一剂如神。
此疟之寒多热少，或但寒不热，非不似于牡疟，而微甚则大不同。仲景不立论，止附一方，且云服一剂如神，其邪
之轻而且浅，从可识矣。盖以卫即表也，营即里也，胸中之阳气，散行于分肉之间。今以邪气痹之，则外卫之阳，反
郁伏于内守之阴。而血之痹者，愈瘀结而不散，遇卫气行阳二十五度而病发。其邪之入营者，既无外出之势，而营之素
痹者，亦不出而与阳争。所以多寒少热，或但有寒无热也。小柴胡汤，本阴阳两停之方，可随疟邪之进退以为进退
者，加桂枝、干姜，则进而从阳，痹着之邪，可以开矣。更加牡蛎以软其坚垒，则阴阳豁然贯通，而大汗解矣，所以服
一剂如神也。其加芩、连以退而从阴，即可类推。
病疟以月一日发，当十五日愈。设不瘥，当月尽解，如其不瘥，当云何？师曰∶此结为 瘕，名曰疟母。急治之，
宜鳖甲煎丸。
此见疟邪不能久据少阳，即或少阳经气衰弱，不能送邪外出，而天气半月一更，天气更，则人身之气亦更，疟邪自
无可容矣。不则天人之气再更，其疟邪纵盛，亦强弩之末，不能复振矣。设仍不解，以为元气未生耶，而月已生魄矣。
元气何以不生？以为邪气不尽耶，而月已由满而空矣。邪气何以不尽？此必少阳所主之胁肋，外邪盘踞其间，根据山傍险，
结为窠巢。州县当一指可扑之时，曾不加意，渐至滋蔓难图，兴言及此，不觉涕泗交流，乃知仲景急治之法，真经世宰
物之大法也。
再按∶谭医者当以《灵》、《素》为经，《金匮》为纬，读《灵》、《素》而不了了者，求之《金匮》，矩 森森，但旨
深
词约，味如嚼蜡，不若《内经》之刍豢悦口，所以古今注《内经》者，不下百家；而注《金匮》者卒罕其人。即间有之，
其胸中浑是疑团，择显明之句，发挥一二，随竟其说，观者曾何赖焉？历代名贤，屈指不过数人，咸以仲景之学为绝学，
存而不论，论而不议，其所以卓冠亿兆人千百年者，各从《内经》分头证入。如疟病一门，《巢氏病源》妄分五脏，后人
谓其发明《内经》，深信不疑。而不知疟邪不从藏发，《内经》所无之理，巢氏臆言之耳，陈无择三因之说韪矣。乃谓夏
伤于暑，秋为 疟者，不可专以此论，何其甘悖圣言耶？至论内因，剿袭巢氏心肝脾肺肾五疟立言，仍是巴人下里之音
矣！张子和治疟，喜用汗吐下三法，自夸本于长沙。讵知仲景所为汗下者，但从少阳之和法而进退其间，不从伤寒之汗
下起见也。其可吐者，或用瓜蒂，或用常山苗，各有深义，亦岂漫然而吐之耶。且子和谓治平之时，其民夷静，虽用砒
石、辰砂有毒之药，以热治热，亦能取效。是何言欤？至东垣、丹溪，确遵《内经》夏伤于暑，秋必 疟之论，多所发
明。而谓吴楚闽广之人，患疟至多。阳气素盛之处，其地卑湿，长夏之时，人多患 疟、霍乱、泻痢，伤湿热也，此语
诚为聪明绝世矣。然于《内经》之旨，尚隔一层。《内经》运气，暑与湿同推，不分彼此，曾何分南北乎？《内经》本谓
夏伤于暑，长夏伤于湿，秋必 疟，脱落五字，遂谓秋伤于湿，冬生咳嗽。而伤燥一气，古今绝无一人起而扬言，此等
大纲不正，亦何贵于识人之贤哉！且丹溪所论十二经皆能为病，固即刺疟篇之旨。曷不遵《金匮》推足少阳一经为主，
坐令多岐亡羊耶！方书俱以温疟为伤寒坏病，与风疟大同，此言出于何典？至于牡疟，总无其名，统括于寒疟之内，
误指寒疟为藏寒之极，故无热有寒，用姜、桂、附子温之。又有更其名为牡疟者云∶久受寒湿，阴盛阳虚，不能制阴。
所以寒多不热，凄怆振振，亦行温热之法，真是杀人不转睫矣。又谓暑疟即瘅疟，呕者用缩脾等药，从无有救少阳木
火之邪如救焚者，适燕而南其指，抑何生民之不幸耶！
【律三条】
凡治疟，不求邪之所在，辄行大汗大下，伤人正气者，医之罪也。疟邪在于半表半里，故有寒有热，若大汗以伤其
表，大下以伤其里，是药反增疟矣。倘疟邪伏而未尽，药过再发，更将何法以处之？
凡用吐法，妄施恶劣之药，并各种丸药，伤人脏腑者，医之罪也。吐法，止可用清芬之气，透入经络，引出疟邪。
如酒浸常山，不用火煎之类。其胆矾、信石等丸，吞入腹中，粘着不行，搅乱肠胃脏腑，究竟无益，戒之！戒之！
凡用截疟之法，不俟疟势稍衰，辄求速止者，医之罪也。截者，堵截也。兵精饷足，寇至方可堵截。若兵微城孤，
不可截也。在壮盛之体，三四发后，疟势少减，可以截之。其虚弱之人，始终不可截也。误截因致腹胀者，每多坏事。
即服药亦有避忌，疟将来可服药阻其来，将退可服药追其去。若疟势正盛，服药与之混战，徒自苦耳。但疟之来去既远，
药不相及，五不当一，故服药妙在将来将去之时。
（论一首 法九条 律三条）
喻昌说：疟疾这一疾病，没有哪部书像《黄帝内经》论述得那样详细透彻。根据病邪显现的部位，按照法则进行针刺，没有不立刻痊愈的。因为九针的运用，通达神明，不能有丝毫差错，所以《黄帝内经》论述疟疾不得不详尽。后世的人厌恶针石疗法，无法与他们谈论高深的医术，于是改用药物来攻逐邪气、扶助正气，调和营卫的偏颇，协调阴阳的逆乱，这样一来，各种圣人的治疗方法就不适用了。比如张子和见到一个消瘦的人患疟疾两年，不敢轻易投用寒凉药物，查阅《素问·刺疟篇》，针刺其十指指尖出血，立刻痊愈。这正是《黄帝内经》所说的“疟疾将要发作时，阴阳之气即将转移，必须从四肢末端开始”。紧紧束缚患处，刺破皮肤放血，那么邪气前往时就无法与正气相并合，所以立刻痊愈。凭借张子和对针法的长期熟悉，并且仔细检查《灵枢·针经》做到详尽谨慎，针刺难道可以轻率使用吗？舍弃针法而追求《黄帝内经》的精神，想用药物作为快捷的方法，就会茫然不知从何下手！我之所以心服口服地尊崇张仲景，称他为百世之师，是因为他每当遇到一种证候，必定提出一种治法，以弥补《黄帝内经》的不足，一句话抵得上千百句话的关键所在。
人四肢安和，外邪得以侵入而发为疟疾，每多伏藏于半表半里之间。邪气入内与阴气相争则恶寒，外出与阳气相争则发热。半表半里的部位，属于少阳经。所以寒热往来，也是少阳经所主，如果说少阳兼有其他经络的证候，那是有的；如果说其他经络完全不涉及少阳，那就不能称之为疟疾了。所以张仲景说：“疟疾的脉象多呈弦脉，弦数脉的多属热证，弦迟脉的多属寒证。弦小紧脉的用下法较好，弦迟脉的可温补，弦紧脉的可发汗或针灸，浮大脉的可催吐，弦数脉的是风热亢盛，通过饮食调理来制止。”仅仅这七句话，而少阳一经的汗、吐、下、和、温五种治法都具备了。其他的瘅疟、温疟、牡疟、疟母四种证候，关键都不外乎在少阳经寻求治疗。这是《伤寒论》的余绪，用来补充《黄帝内经》入手治疗的方法，如果不是圣人谁能做到呢？现将《金匮要略》的深奥义理，一一阐明如下。
少阳是东方甲木的象征，所以其脉象主弦，这不仅初病时脉象如此，即使是久疟导致正气虚弱，脉搏不鼓动手指，弦象也隐约存在于内部。所以张仲景说：“疟疾的脉象自始自终都是弦脉”，从头到尾，脉象虽然多次迁移变化不同，但“弦”这一个字，实际上贯穿始终。疟邪停留在营卫之间，正属于少阳半表半里的位置，起初似乎像疟非疟，后来经过多年不愈，总归由少阳主导。大概疟疾发作必然有寒有热，其寒热往来的特点，恰好处于少阳所主的界限，偏于阴则多寒，偏于阳则多热。即使是纯热无寒，成为瘅疟、温疟；纯寒无热，成为牡疟。总之都是从少阳走向极端偏颇，纠正偏颇补救弊端，也必须返还到少阳的界限，使阴阳两者协同和谐，然后才能痊愈。施用汗、吐、下法，是用来治疗实热证；施用和、温法，是用来治疗虚寒证，无非是想达到平和的状态罢了。疟邪如同傀儡，少阳则是提起傀儡的线索，操纵进退，完全由少阳主张，难道不是游刃有余吗？
弦数脉，是风热亢盛的表现，通过饮食调理来制止。张仲景既然说了弦数脉多热，又进一步阐述一个道理说：弦数脉是风热发作，见多热不止，必然发展到极热，热极则生风，风生则肝木克制脾土，并将热传给胃。这样坐耗津液，阳气更加偏亢而不能返回，这种情况不可以单纯依靠药物解决。必须通过饮食调理来制止炽热的火势，比如梨汁、甘蔗浆，属于生津止渴的药物。这正是《黄帝内经》“风邪淫盛于内，用甘寒之法治疗”的宗旨。
阴气孤绝，阳气独发，就会出现发热且气短烦闷，手足发热想呕吐的症状，名叫瘅疟。如果只有热没有寒，邪气内藏于心，外舍于分肉之间，使人肌肉消烁。《黄帝内经》说那些只有热没有寒的，是阴气先绝，阳气独发，就会气短烦闷，手足发热想呕吐，名叫瘅疟。张仲景再次引用这段经文，另有妙义。承接上一条“弦数者风发也，以饮食消息止之”，抽丝剥茧地引出这个证候。意思是说弦数脉，热盛生风，必然克伐脾土损伤津液，由少阳传入阳明。两经合邪，热势加倍炽盛，如果不能通过饮食调理急止其热，那么热邪移于胃的，必然上熏心肺，导致气短烦闷而心肺生病，手心热想呕吐，而胃自身也生病。所以接着说：“邪气内藏于心，外舍分肉之间，使人肌肉消烁。”大概伤寒病三阳合邪，其来势如风雨霹雳，令人抵挡不住。而疟邪在少阳，如果不入于阴，只出于阳，等到两阳合邪，又怎能承受得了呢？所以知道通过饮食调理来制止传入胃的热邪，真是圣明的方法。然而张仲景的方法，也是从《黄帝内经》得来的，《黄帝内经》说疟脉缓大虚，适宜用药，不宜用针。又说虚证不宜用针，用甘药调理，我知道其中的意思是用甘寒药。
温疟，其脉象像正常人，身体不恶寒只发热，骨节疼痛烦扰，时时呕吐，用白虎加桂枝汤主治。《黄帝内经》说的温疟有两种，一种是先热后寒。张仲景命名的温疟，则是只有热没有寒，看似瘅疟，实则不同。瘅疟是两阳合邪，上熏心肺，肺主气，气短烦闷；心主脉，阳盛则脉促，津亏则脉代，由此可以推断。温疟脉象像平人，说明邪气未合，津液未伤，之所以只有热而不寒，是因为病人素有痹气，营卫不通，所以疟疾发于阳，不入于阴，即使入于阴，阴也不受纳。所以骨节烦疼，时时呕吐，邪气格拒的状态，就像这样，只用白虎汤治疗阳邪，加上桂枝以通调营卫，这样阴阳调和，血脉通畅，出汗而痊愈。在伤寒病中，卫强营弱，卫气不与营气和谐，用桂枝汤再次发汗立刻痊愈。这里疟邪偏着于阳，桂枝是阳药，本来不可用。但只用白虎汤大清气分之热，少加桂枝，调和阴阳两者，才知道张仲景的方法，丝丝入扣。
至于《黄帝内经》所称的先热后寒的温疟，一种是先伤于风，后伤于寒，风为阳邪，寒为阴邪，疟疾发作时先阳后阴，所以先热后寒。对此用风寒两伤营卫的方法治疗，起初并不难。另一种是冬天感受风寒，深藏骨髓，内舍于肾，到了春夏时令大热时才发作。其发作时，疟邪从肾出于外而大热，那么体内先前已经如火焚，水中火发，虽然不是真火，也可畏惧。等到疟势向外衰退，又返回于肾，阴精与之相持，才开始发冷，假如不知道壮水之主，以急救其阴，发作十几次后阴精就耗尽了。阴精耗尽，则真火自焚，洒洒然时常惊恐，目光混乱无神，顷刻间就死了。所以伤寒病中偏死于下元虚弱之人，是说邪气入少阴，没有阴精来抵御它。而温疟的惨状，难道有区别吗？这也是张仲景意中的隐微之处，我特意举例陈述情理，作为后学者的帮助。
疟疾多寒的，名叫牡疟，用蜀漆散主治。
疟疾多寒，是指寒多于热，如三七二八的比例，并非纯寒无热。纯寒无热，就是阴证，而不是疟证了。这条又抽丝剥茧，即在上条两阳合邪，上熏心肺证候中，再次指出多寒少热一证。大概邪气伏在心下，恰好在膻中心包的位置，心为阳中之阳，阳邪从阳，尤为容易进入。邪气进入则心虚。《内经》说：心虚者，热收于内，内收其热，连同邪气也一起收住，不易外出，这是寒多的一个原因。邪气进入心胞，都城震动，周身精液，全力向内援助，重重包裹，胞内的邪气，被外部拒绝，而不易出来，又是寒多的一个原因。心是牡脏，所以就把寒多热少的疟疾，名叫牡疟。用蜀漆散配合浆水，吐出心下结伏的邪气，那么内陷的邪气，也随之全部排出，一举荡涤无余。难道不快活吗！蜀漆，是常山的嫩苗。常山善于催吐，为什么不用常山而用蜀漆？取嫩苗性质轻扬，进入重阳的界限，引拔邪气。配合龙骨镇心安神，清除伏气。云母安藏补虚，爱戴君主，张仲景补天浴日的方剂，大多像这样。至于温疟，也用此方，再加蜀漆，以吐出心下结伏的邪气。大概一吐则周身痹阻皆通，而营卫也可以借此不受干扰，这又把吐法当作和法了。
其中附在《外台秘要》中的牡蛎汤一方，同样治疗牡疟的，又是初感病时，风寒未清，传变为疟，结伏心下，所以方中使用麻黄以疏散风寒，并借之以通阳气罢了。可见病的途径原本不一，学者在这个证候两个方剂，比较参详，以求得心生的变化，就差不多了。
论《金匮要略》柴胡去半夏加栝蒌汤方，治疗疟病发渴的，也治疗劳疟。
这是张仲景治疗少阳病，全体大用的一个方剂。张仲景说疟邪盛衰出入，必在少阳表里之间，小柴胡汤乃是伤寒少阳经天然不易的方法。口渴的去半夏加栝楼实，也是天然不易的方法。而施用于少阳邪传阳明，伤耗津液的证候，也是天然不易的方法。大概口渴虽然是阳明津液枯竭，而导致阳明津液枯竭的原因，全在于少阳的邪气。看《黄帝内经》的刺法，口渴的取穴于少阳，不是因为它木火之势劫夺胃津才这样的吗？所以疟邪在少阳进退，就用此方进退而施展巧妙。柴胡、黄芩，对治木火。人参、甘草，扶助胃土。栝楼生津润燥。姜枣发越营卫。至于劳疟的病，其根本是火盛，营卫衰弱，津液枯竭，也不必多说，所以都可以施以此方来治疗。
论柴胡桂姜汤，治疗疟疾寒多微有热，或者但寒不热，服一剂如神效。
这是疟疾寒多热少，或者但寒不热，不像牡疟，但轻重则大不相同。张仲景不立论，只附一方，并且说服一剂如神，邪气的轻浅，由此可知。大概卫就是表，营就是里，胸中的阳气，散行于分肉之间。现在被邪气痹阻，那么外卫的阳，反而郁伏在内守的阴中。而血的痹阻者，更加瘀结不散，遇到卫气行阳二十五度时发病。邪气入营的，既没有外出的趋势，而营本身痹阻的，也不出来与阳争。所以多寒少热，或者只有寒没有热。小柴胡汤，本是阴阳两停的方剂，可随疟邪的进退而进退，加入桂枝、干姜，则进而从阳，痹着的邪气，可以开解。再加牡蛎以软化其坚垒，则阴阳豁然贯通，而出大汗而解，所以服一剂如神。其加入芩、连以退而从阴，就可以类推了。
病疟在初一发作，应当在十五天痊愈。假如不好，应当在月底解除，如果还不好，应当怎么办？老师说：这是结为癥块，名叫疟母。赶快治疗，宜用鳖甲煎丸。
这是看到疟邪不能长久占据少阳，就或少阳经气衰弱，不能送邪外出，而天气半月一更替，天气更替，则人身之气也更新，疟邪自然无处容身了。不然天人之气再更替，其疟邪纵然旺盛，也是强弩之末，不能再振作了。假如仍不解，认为是元气未生吗，而月亮已生魄了。元气为何不生？认为是邪气不尽吗，而月亮已由满而空了。邪气为何不尽？这一定是少阳所主的胁肋，外邪盘踞其间，依凭山险，结为巢穴。州县当一指可扑灭之时，曾不加意，渐渐至滋蔓难图，说起这些，不觉涕泗交流，才知道张仲景急治的方法，真是治理世间万物的伟大法则啊。
再按：谭医者应当以《灵枢》、《素问》为经，《金匮要略》为纬，读《灵》、《素》而不明白的，求之于《金匮》，规矩森严，但旨意深远言辞简约，味如嚼蜡，不如《内经》像美味佳肴悦口，所以古今注释《内经》的，不下百家；而注释《金匮》的终究很少有人。即使偶尔有，他们心中全是疑团，选择显明的句子，发挥一二，随即结束解说，读者有什么依赖呢？历代名贤，屈指不过几人，都以张仲景的学问为绝学，存而不论，论而不议，他们之所以卓绝冠于亿万人民千百年，各自从《内经》分头证候入手。比如疟病一门，《诸病源候论》妄分五脏，后人谓其发明《内经》，深信不疑。而不知道疟邪不从脏腑发出，《内经》所没有的道理，巢氏臆断之言罢了，陈无择三因之说是对的。却说夏天伤于暑，秋天为疟疾的，不可专以此论，何其甘愿违背圣言耶？至于论内因，剿袭巢氏心肝脾肺肾五疟立论，仍是粗俗之音啊！张子和治疟，喜欢用汗吐下三法，自夸本于长沙。岂知张仲景所说的汗下，只是从少阳的和法而进退其间，不从伤寒的汗下起见。其可吐的，或用瓜蒂，或用常山苗，各有深义，难道漫然而吐的吗。而且张子和说治平时，百姓夷静，即使使用砒石、辰砂有毒的药，以热治热，也能取效。这是什么话呢！至于东垣、丹溪，确实遵循《内经》夏伤于暑，秋必疟的论断，多有发明。而说吴楚闽广之人，患疟最多。阳气素盛之处，地势卑湿，长夏之时，人多患疟、霍乱、泻痢，伤湿热也，这话确实聪明绝世了。然而对于《内经》的宗旨，尚隔一层。《内经》运气，暑与湿同推，不分彼此，何曾分南北呢？《内经》本谓夏伤于暑，长夏伤于湿，秋必疟，脱落五字，遂谓秋伤于湿，冬生咳嗽。而伤燥一气，古今绝无一人起而扬言，这种大纲不正，又何贵于识人的贤能呢！而且丹溪所论十二经皆能为病，固然是刺疟篇的宗旨。何不遵《金匮》推足少阳一经为主，坐令多岐亡羊耶！方书俱以温疟为伤寒坏病，与风疟大同，此言出于何典？至于牡疟，总无其名，统括于寒疟之内，误指寒疟为藏寒之极，故无热有寒，用姜、桂、附子温之。又有更其名为牡疟者云：久受寒湿，阴盛阳虚，不能制阴。所以寒多不热，凄怆振振，亦行温热之法，真是杀人不眨眼啊。又谓暑疟即瘅疟，呕者用缩脾等药，从无有救少阳木火之邪如救焚者，适燕而南其指，抑何生民之不幸耶！
【律三条】
凡是治疗疟疾，不探求邪气所在的部位，就随意施行大汗大下，伤害人体正气的，是医生的罪过。疟邪位于半表半里，所以有寒有热，若大汗以伤害其表，大下以伤害其里，是药物反而增加疟疾了。倘若疟邪潜伏而未除尽，药力过后再次发作，又将用什么方法来处理呢？
凡是使用吐法，妄施恶劣的药物，以及各种丸药，伤害人脏腑的，是医生的罪过。吐法，只可用清芬之气，透入经络，引出疟邪。如酒浸常山，不用火煎之类。其胆矾、信石等丸，吞入腹中，粘着不行，搅乱肠胃脏腑，究竟无益，戒之！戒之！
凡是使用截疟的方法，不等待疟势稍衰，就追求速止的，是医生的罪过。截，是堵截的意思。兵精粮足，寇至方可堵截。若兵力微弱城池孤立，不可截也。在体质壮盛的人，三四次发作后，疟势稍减，可以截之。其虚弱的人，始终不可截也。误截因而导致腹胀的，每多坏事。即使服药也有避忌，疟疾将来时可服药阻止其来，将退时可服药追击其去。若疟势正盛，服药与之混战，徒自苦耳。但疟疾的来去既然遥远，药力不相及，五不当一，所以服药妙在将来将去之时。
(One Treatise, Nine Methods, Three Laws)
Yu Chang said: Among all diseases, malaria is discussed most thoroughly and comprehensively in the *Huangdi Neijing* (Yellow Emperor's Inner Canon). According to the manifestation of the pathogenic factor, if one follows the principles for acupuncture, recovery is invariably immediate. The application of the Nine Needles penetrates divine wisdom; there can be no slightest deviation. Therefore, the *Neijing* must discuss malaria in detail. Later generations detested acupuncture and moxibustion, making it impossible to discuss profound techniques with them. Consequently, they relied on herbal medicines to attack pathogens and preserve healthy Qi, adjusting the imbalance of Ying and Wei (Nutritive and Defensive Qi), and harmonizing the reversal of Yin and Yang. Thus, various sage methods became inapplicable. For instance, Zhang Zihe encountered a emaciated patient suffering from malaria for two years. He dared not administer cold-natured herbs lightly but consulted the *Suwen: Cima Pian* (Treatise on Acupuncture for Malaria). He pricked the ten fingertips until bleeding occurred, resulting in immediate cure. This precisely aligns with what the *Neijing* states: "When malaria is about to manifest, Yin and Yang are shifting; treatment must begin at the four extremities." By tightly binding the affected area and puncturing to release blood, the pathogen cannot combine with healthy Qi upon its movement, hence the immediate recovery. Given Zhang Zihe's extensive familiarity with acupuncture and his meticulous reference to the *Lingshu: Zhenjing* (Spiritual Pivot: Classic of Acupuncture), how could acupuncture be used casually? Abandoning acupuncture to seek the spirit of the *Neijing*, and attempting to use herbs as a quick fix, leaves one bewildered and unsure where to start! My deep admiration for Zhang Zhongjing, whom I call the Teacher of a Hundred Generations, stems from his principle that for every syndrome, he proposes a specific method, compensating for the deficiencies of the *Neijing*. His concise words capture the essence better than thousands of verbose statements.
When the human limbs are peaceful, external pathogens invade and cause malaria, usually hiding in the Shaoyang (Half-Exterior/Half-Interior) region. When the pathogen enters and contends with Yin, chills occur; when it exits and contends with Yang, fever occurs. The Half-Exterior/Half-Interior region belongs to the Shaoyang channel. Therefore, alternating chills and fever are governed by Shaoyang. While Shaoyang may present with symptoms of other channels, if a channel is entirely unrelated to Shaoyang, it cannot be classified as malaria. Hence, Zhang Zhongjing stated: "The pulse in malaria is mostly wiry (Xian). A wiry and rapid pulse indicates heat; a wiry and slow pulse indicates cold. A wiry, small, and tight pulse suggests the use of purgation; a wiry and slow pulse suggests warming; a wiry and tight pulse suggests diaphoresis or acupuncture; a floating and large pulse suggests emesis; a wiry and rapid pulse indicates wind-heat hyperactivity, which should be managed through dietary adjustments." In just these seven phrases, the five treatment methods for Shaoyang—diaphoresis, emesis, purgation, harmonization, and warming—are fully covered. The other four syndromes of malaria—Dan malaria (Cao Malaria), Wen malaria (Warm Malaria), Mu malaria (Male Malaria), and Nuoma (Malaria Mass)—essentially all require treatment focusing on the Shaoyang channel. This extends the legacy of the *Shanghan Lun* (Treatise on Cold Damage) to supplement the practical entry points of the *Neijing*. Who but a sage could achieve this? I will now elucidate the profound meanings of the *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) as follows.
Shaoyang corresponds to the image of Jia Wood in the East, so its pulse is predominantly wiry. This applies not only to initial illness but also to chronic malaria where healthy Qi is deficient; even if the pulse fails to beat forcefully under the fingers, the wiry quality remains subtly present. Thus, Zhang Zhongjing said: "The pulse in malaria is inherently wiry." From beginning to end, although the pulse may shift and vary, the character "wiry" permeates the entire condition. The malaria pathogen resides in the Ying and Wei, belonging to the Shaoyang Half-Exterior/Half-Interior. Initially, it may seem like malaria but isn't clearly so; later, it may persist for years without resolution, yet it is always dominated by Shaoyang. Generally, malaria manifests with both chills and fever. The alternation of chills and fever falls exactly within the domain of Shaoyang. Bias toward Yin results in more chills; bias toward Yang results in more fever. Even pure heat without chills constitutes Dan malaria or Wen malaria; pure cold without fever constitutes Mu malaria. All these originate from Shaoyang moving to an extreme deviation. To correct deviation and remedy defects, one must return to the boundary of Shaoyang, harmonizing Yin and Yang, before recovery can occur. Applying diaphoretic, emetic, or purgative methods treats excess heat; applying harmonizing or warming methods treats deficiency cold. The ultimate goal is always to restore peace and harmony. The malaria pathogen is like a puppet; Shaoyang holds the strings, controlling its advance and retreat. It relies entirely on Shaoyang's dominance, allowing for effortless maneuvering in empty spaces.
A wiry and rapid pulse indicates wind-heat hyperactivity, which should be controlled through dietary management. Although Zhang Zhongjing noted that wiry and rapid pulses indicate heat, he further elaborated: "Wiry and rapid pulses signify wind-heat onset." Persistent excessive heat inevitably leads to extreme heat. Extreme heat generates wind; wind generation causes Liver Wood to overact on Spleen Earth, transmitting heat to the Stomach. This consumes body fluids, causing Yang to become increasingly biased and unable to return. Such cases cannot be treated solely with herbs. One must use dietary management to curb the blazing heat, such as using pear juice or sugarcane syrup, which generate fluids and quench thirst. This aligns with the *Neijing* principle: "For wind rampant internally, treat with sweet-cold substances."
When Yin Qi is isolated and extinct, and Yang Qi acts alone, fever occurs accompanied by shortness of breath, vexation, hot hands and feet, and nausea. This is named Dan Malaria. If there is only heat without chills, the pathogen hides internally in the Heart and externally in the interstices of muscles and flesh, causing muscle wasting. The *Neijing* states that those with only heat and no chills have Yin Qi extinguished first, with Yang Qi acting alone, leading to shortness of breath, vexation, hot extremities, and nausea, named Dan Malaria. Zhang Zhongjing's re-quotation of this text carries profound implications. Following the previous point about "wiry and rapid pulses indicating wind-heat managed by diet," he draws out this syndrome logically. He implies that a wiry and rapid pulse signifies heat generating wind, which attacks Earth and damages fluids, moving from Shaoyang to Yangming. With pathogens combining in both channels, heat intensifies doubly. If dietary management does not urgently stop the heat, the heat transferring to the Stomach will scorch upward to the Heart and Lungs, causing shortness of breath, vexation, heart-lung pathology, hot palms, nausea, and stomach pathology. Thus, he continues: "The pathogen hides internally in the Heart and externally in the muscles/flesh, causing muscle wasting." In cold damage, when three Yang channels combine, the onset is violent like wind, rain, or thunder, overwhelming the patient. However, if malaria in Shaoyang does not enter Yin but stays in Yang, until two Yangs combine, who could endure it? Therefore, knowing how to manage and stop the heat entering the Stomach via diet is truly a sage method. Zhang Zhongjing's methods derive from the *Neijing*, which states: "If the malaria pulse is slow, large, and deficient, medication is suitable, but acupuncture is not." It also says: "Deficiency patterns should not be treated with acupuncture; use sweet medicine to regulate." I understand this implies the use of sweet-cold herbs.
In Wen Malaria, the pulse resembles that of a healthy person. The body has no chills, only fever, with painful and烦 (vexatious) joints, and occasional vomiting. Bai Hu Jia Gui Zhi Tang (White Tiger plus Cinnamon Twig Decoction) is the primary formula. The *Neijing* mentions two types of Wen Malaria, one presenting with fever followed by chills. Zhang Zhongjing's definition of Wen Malaria presents with only heat and no chills, resembling Dan Malaria but fundamentally different. Dan Malaria involves two Yangs combining, scorching the Heart and Lungs; Lung governs Qi (leading to shortness of breath/vexation), and Heart governs vessels (Yang excess leads to hurried pulse, fluid deficiency leads to intermittent pulse). In contrast, Wen Malaria has a normal-like pulse, indicating combined pathogens and damaged fluids are absent. The reason for heat without chills is that the patient has pre-existing Bi (obstruction) qi, blocking Ying and Wei. Thus, when malaria arises in Yang, it does not enter Yin; even if it tries, Yin rejects it. Hence, joint pain and vomiting occur due to pathogenic rejection. Using Bai Hu Tang (White Tiger Decoction) clears Yang pathogenic heat, while adding Gui Zhi (Cinnamon Twig) unblocks Ying and Wei. This harmonizes Yin and Yang, unblocks blood vessels, and induces sweating for recovery. In cold damage, when Wei is strong and Ying is weak, and Wei Qi does not harmonize with Ying Qi, Gui Zhi Tang (Cinnamon Twig Decoction) induces sweating for immediate cure. Here, however, the malaria pathogen adheres to Yang, and since Gui Zhi is a Yang herb, it is generally contraindicated. But using Bai Hu Tang to clear Qi-level heat heavily, with a small amount of Gui Zhi to harmonize Yin and Yang, demonstrates Zhang Zhongjing's precise methodology.
Regarding the *Neijing*'s description of Wen Malaria with fever preceding chills: First, injury by Wind (Yang pathogen) followed by Cold (Yin pathogen) causes Yang to precede Yin during onset, resulting in fever then chills. This is treated by methods for Wind-Cold affecting Ying and Wei, which is straightforward. Second, Winter exposure to Wind-Cold hides deeply in the Marrow and Kidney, emerging only in Spring/Summer heat. The pathogen emerges from the Kidney outward, causing high fever, implying internal burning ("Fire arising from Water"). Although not true Fire, it is fearsome. Waiting for the malaria trend to weaken and return to the Kidney, Yin Essence contends with it, causing chills. If one does not strengthen the Master of Water to urgently save Yin, after several episodes, Yin Essence is exhausted. Exhausted Yin leads to self-burning of True Fire, shivering,惊 (fright), blurred vision, and death shortly. Thus, in cold damage, death often occurs in those with lower deficiency because the pathogen enters Shaoyin without Yin Essence to resist. Is the tragedy of Wen Malaria any different? This is the hidden meaning in Zhang Zhongjing's intent. I illustrate this to assist future learners.
Malaria with predominant chills is named Mu Malaria, treated with Shu Qi San (Chinese Perilla Leaf Powder).
Predominant chills mean chills exceed fever (e.g., 70% chills, 30% fever), not pure cold without heat. Pure cold without heat is a Yin syndrome, not malaria. This section logically follows the previous discussion on two Yangs combining and scorching the Heart/Lungs, pointing out the syndrome of more chills than heat. The pathogen hides in the Epigastrium, specifically at the Tanzhong (Conception Vessel 17) and Pericardium location. The Heart is Yang within Yang; Yang pathogens easily enter Yang. Entry causes Heart deficiency. The *Classic* states: "Heart deficiency retains heat internally." Internal retention of heat also traps the pathogen, making it difficult to exit, contributing to more chills. Pathogens entering the Pericardium shake the capital; body fluids rally inward, wrapping the pathogen tightly. The pathogen inside is rejected by the exterior, making exit difficult, another cause of chills. Since the Heart is a "Mu" (Male/Yang) organ, malaria with more chills than heat is named Mu Malaria. Shu Qi San mixed with fermented grain water induces vomiting to expel the knotted pathogen in the epigastrium. The internalized pathogen exits along with it, clearing everything in one stroke. How delightful! Shu Qi is the tender shoot of Chang Shan (Dichroa Root). Chang Shan is known for inducing vomiting; why use the shoot instead? The shoot's light and ascending nature enters the realm of extreme Yang, drawing out the pathogen. Combined with Long Gu (Dragon Bone) to calm the Heart and Spirit, and remove latent Qi, and Yun Mu (Mica) to settle and tonify deficiency, honoring the Monarch (Heart). Zhang Zhongjing's restorative formulas often employ such strategies. For Wen Malaria, this formula is also used, with added Shu Qi to vomit out knotted pathogens. Vomiting unblocks general obstruction, allowing Ying and Wei to function without conflict, thus treating vomiting as a harmonizing method.
The Muli Tang (Oyster Shell Decoction) attached to the *Waitai Miyao* (Secret Essentials of the Outer Cabinet) also treats Mu Malaria. This applies when initial Wind-Cold is unresolved, transforming into malaria, knotting in the epigastrium. Ma Huang (Ephedra) disperses Wind-Cold and aids Yang Qi circulation. This shows disease pathways vary. Scholars should compare these two formulas for this syndrome to grasp clinical flexibility.
Discussion on the *Jingui* Chai Hu Qu Ban Xia Gua Lou Tang (Bupleurum Decoction with Banxia Removed and Trichosanthes Fruit Added) treats malaria with thirst, and also Labor Malaria (Lao Malaria).
This is a primary formula for Zhang Zhongjing's treatment of Shaoyang disease. He stated that malaria pathogens fluctuate between the interior and exterior of Shaoyang. Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the natural, unchangeable method for Shaoyang cold damage. Removing Ban Xia (Pinellia Tuber) and adding Gua Lou Shi (Trichosanthes Fruit) for thirst is also a natural, unchangeable method. Applied to Shaoyang pathogens transmitting to Yangming, damaging fluids, it remains appropriate. Thirst indicates Yangming fluid exhaustion, caused by Shaoyang pathogens. The *Neijing* acupuncture methods for thirst select Shaoyang points, recognizing that Wood-Fire momentum robs Stomach fluids. Thus, as malaria pathogens advance/retreat in Shaoyang, this formula adjusts accordingly. Chai Hu (Bupleurum Root) and Huang Qin (Scutellaria Root) counteract Wood-Fire. Ren Shen (Ginseng Radix) and Gan Cao (Licorice Root) support Stomach Earth. Gua Lou generates fluids and moistens dryness. Jiang (Ginger Rhizome) and Zao (Jujube Fruit) stimulate Ying and Wei. Labor Malaria fundamentally involves Fire excess, Ying/Wei decline, and fluid exhaustion, warranting this formula.
Discussion on Chai Hu Gui Jiang Tang (Bupleurum, Cinnamon Twig, and Ginger Decoction) treats malaria with predominant chills and slight fever, or only chills without fever. One dose yields miraculous results.
This syndrome of predominant chills/slight fever or only chills differs significantly from Mu Malaria in severity. Zhang Zhongjing provided no commentary, only the formula and the note "miraculous effect after one dose," indicating the pathogen is mild and superficial. Wei is Exterior; Ying is Interior. Chest Yang Qi circulates in muscle interstices. Pathogenic Bi blocks this, causing Exterior Yang to stagnate within Interior Yin. Blood stasis worsens. When Wei Qi circulates Yang twenty-five times, the disease manifests. Pathogens in Ying lack outward momentum; Ying itself is blocked, failing to contend with Yang. Hence, predominant chills/slight fever or only chills. Xiao Chai Hu Tang balances Yin and Yang. Adding Gui Zhi (Cinnamon Twig) and Gan Jiang (Dried Ginger) advances toward Yang, opening Bi-obstructed pathogens. Adding Mu Li (Oyster Shell) softens hardness, allowing Yin and Yang to connect, inducing heavy sweating for resolution. Hence the miraculous effect. Adding Huang Qin and Huang Lian to retreat toward Yin can be inferred similarly.
Malaria starting on the first day of the lunar month should heal by the fifteenth. If not, it should resolve by month-end. If still unresolved, what then? The Master said: This forms a mass named Nuoma (Malaria Mother). Treat urgently with Bie Jia Jian Wan (Softshell Turtle Pill).
This illustrates that malaria pathogens cannot occupy Shaoyang indefinitely. If Shaoyang Qi is weak and cannot expel pathogens, and celestial cycles change every half-month, human Qi also updates, leaving no room for pathogens. Otherwise, after two cycles, even strong pathogens are spent arrows. If unresolved, is it lack of Yuan Qi? No, the moon waxes. Is it lingering pathogens? No, the moon wanes. Why do pathogens persist? They likely lodge in the hypochondrium (Shaoyang domain), fortifying themselves like a nest. Ignoring them when they are small allows them to spread. This reveals Zhang Zhongjing's urgent treatment method as a great strategy for governing life.
Note: Physicians should take *Lingshu* and *Suwen* as the warp and *Jingui Yaolue* as the weft. Those unclear on *Lingshu/Suwen* should consult *Jingui*. Its rules are strict, but its meaning is deep and language concise, tasting like wax, unlike the *Neijing* which is palatable. Hence, hundreds comment on the *Neijing*, but few on *Jingui*. Commentators often harbor doubts, selecting obvious sentences to elaborate briefly, offering little value to readers. Few sages throughout history mastered Zhang Zhongjing's learning, often preserving it without discussion. Their superiority lies in entering each syndrome from the *Neijing*. For example, *Zhubing Yuanhou* (Source Book of Diseases and Syndromes) erroneously divided malaria into Five Zang organs. Later scholars believed this invented upon the *Neijing*, unaware that malaria pathogens do not originate from Zang organs—a concept absent in the *Neijing*, merely Chuishi's speculation. Chen Wuyi's Three Causes theory was correct. Yet, claiming "Summer heat injury leads to Autumn malaria" cannot be the sole rule is a betrayal of sage words. Regarding internal causes, copying Chuishi's Five Zang malaria theories is crude. Zhang Zihe favored sweating, vomiting, and purging for malaria, claiming lineage from Changsha (Zhongjing). Did he know Zhongjing's sweating/purging derived from Shaoyang harmonization, not cold damage protocols? His emetics (Gua Di, Chang Shan shoots) had deep meanings. Zhang Zihe claimed that in peaceful times, toxic drugs like Arsenic or Cinnabar could treat heat with heat effectively. What nonsense! Dongyuan and Danxi followed the *Neijing* regarding summer heat/autumn malaria, innovating much. They noted malaria prevalence in Wu/Chu/Fujian/Guangdong due to low-lying dampness and long summers causing damp-heat. This insight was brilliant but missed the *Neijing* nuance: *Neijing* treats Summer Heat and Dampness together,不分南北 (without distinguishing North/South). The *Neijing* states: "Summer injury by Summer Heat, Long Summer injury by Dampness, Autumn malaria." Omitting "Long Summer injury by Dampness" led to the error "Autumn injury by Dampness causes Winter cough." No one defended the Dryness pathogen. Such fundamental errors undermine scholarly reputation. Danxi's view that all twelve channels can cause disease aligns with the *Cima Pian*. Why not follow *Jingui* prioritizing Foot Shaoyang, leading to confusion? Formulary books classify Wen Malaria as a complication of cold damage, similar to Wind Malaria—what source is this? As for Mu Malaria, it lacks a distinct name, subsumed under Cold Malaria. Misidentifying Cold Malaria as extreme internal cold (no heat, only chills) leads to using Ginger, Cinnamon, and Aconite for warming. Others rename it Mu Malaria, attributing it to chronic cold-damp, Yin excess/Yang deficiency, causing chills without heat, trembling, and using warming methods. This is indeed lethal. Claiming Summer Malaria equals Dan Malaria, using She Pi (Areca Seed) etc. for vomiting, never saving Shaoyang Wood-Fire pathogens as if putting out a fire, is like pointing South while intending to go North. How unfortunate for the people!
[Three Laws]
Any physician who treats malaria without locating the pathogen, resorting to drastic sweating or purging, thereby damaging healthy Qi, bears medical guilt. Malaria pathogens reside in the Half-Exterior/Half-Interior, causing alternating chills and fever. Drastic sweating harms the Exterior; drastic purging harms the Interior. Medication thus exacerbates malaria. If pathogens remain latent after treatment, recurrence leaves no effective method.
Any physician who uses emesis with harsh drugs or various pills, damaging viscera, bears medical guilt. Emesis should only use aromatic, penetrating agents to draw pathogens out via meridians, e.g., Chang Shan soaked in wine, not boiled. Pills like Dan Fan (Chalcanthite) or Xin Shi (Arsenic) stick in the abdomen, disturbing intestines and viscera with no benefit. Beware! Beware!
Any physician using malaria-intercepting methods without waiting for the malaria trend to subside, seeking rapid cessation, bears medical guilt. "Intercept" means blockading. Only with sufficient troops and supplies can one blockade invaders. With weak forces and isolated cities, interception is impossible. In robust patients, interception is possible after 3-4 episodes when the trend subsides. In weak patients, interception is never appropriate. Mistaken interception causing abdominal distension often leads to disaster. Even medication requires caution. Medication can block incoming malaria or chase departing malaria. If administered during peak intensity, it fights the pathogen directly, causing futile suffering. Since malaria comes and goes far apart, medication misses the target (one part effort for five parts result). Thus, the art of medication lies in timing administration just before onset or departure.