疟之为言虐也。有如凌虐者然。故云疟也。当其寒。则战栗鼓颔。汤火不能
温。及其热。则烦冤少气。冰水不能寒。此无他。阴阳相并。邪正交争也。并之
阴则寒。并之阳则热。正虚则怯。邪盛则肆。一身之内。有不听令而任其摧
残者乎。然则何经主之。何药制之。曰仲景伤寒少阳一经。寒热往来。用小
柴胡汤。可假之治也。方中柴芩除表里之热。姜半除表里之寒。参甘大枣
和阴阳而扶正气。非疟之的方乎。余扩而充之。寒多热少。则入藿香。寒少
热多。则入知母。独寒不热。则去黄芩。独热不寒。则去半夏。气虚则加苓术。
血虚则加归芍。即此方而出入之。鲜不应手取效。以是知疟之主少阳也
明矣。其作有早晏。何也。经曰。卫气一日夜。大会于风府。明日日下一节。故
其作也晏。此客于脊膂。凡二十五日。下至 骨。二十六日。其气上行。九日
出于缺盆之中。故作日益早。邪在阳分轻。阴分重。引出于阳分则散。其有
日作间日作何也。经曰。邪入之浅则日作。入之深则间作。有三日作者。邪
愈甚而正益衰也。有一日三四作。十数作。又何也。此不可作疟论。而亦未
始不可以疟推之也。阳虚则寒。阴虚则热。阴阳虚则寒热交作。非大补气
血。则寒热不止也。然经又言太阳之疟。腰痛头重。寒从背起。少阳之疟。寒
不甚。热不甚。心惕惕然。汗出。阳明之疟。先寒洒淅。久乃热。热去汗出。喜见
日火光。太阴之疟。好太息。不嗜食。多寒热。汗出。善呕。少阴之疟。呕吐。热多。
欲闭牖而处。其病难已。厥阴之疟。少腹满。如癃。数便。意恐惧。则是六经又
各有治法也。虽然。疟之发也。如火之热。如风雨不可当。此时而欲止之。良
工不能。必从未发时。阴未并阳。阳未并阴。因而调之。真气乃安。邪气乃出。
此露姜饮所由设。可推而通之也。至于邪未尽。早截之。变必作。岂若调其
阴阳之为愈乎。立斋治疟发不止。用人参一两。生姜五钱。未发前服之。疟
可立止则养正除邪胜着也。岂能为疟困哉。
按疟有云是脾疾。长夏暑热所伤。至秋新凉束之。疟乃作。故其发也有
候。而一以理脾为主。平胃散六君子补中益气。审虚实而施之可也。不
知脾畏木者也。柴胡非疏肝乎。脾喜甘者也。人参甘草非补中州乎。脾
恶湿者也。半夏非燥湿乎。脾畏热者也。黄芩非清热乎。使果因风与食。
则疏之消之。寒与热。则温之清之。虚则补之。下陷则提之。学人神而明
焉。又安得胶柱鼓瑟为也。
治验
一儒者季秋发疟。凡解表疏利之药。遍尝勿效。至四旬后。肢体俱冷。其汗
如雨。犹是覆密不敢见风。此余诊之。六脉皆弱。连进归脾汤。大倍参 。
加熟附子五分。数剂而痊。继以六君调理月余。
一女子疟疾。烦热呕吐。口干饮水。独热不寒。有与和解不效。余诊之。脉数
且疾。此瘅疟也。得之肺素有热。用门冬知母黄芩山栀花粉浓朴陈皮
甘草。一剂而减。二剂而愈。
一人年五旬余。患痢半月。痢止疟作。发则昏愦不支。余诊之。脉空大无力。
以补中益气汤。倍人参加半夏。二剂而愈。
小柴胡汤
柴胡（二钱） 黄芩 人参 半夏（各一钱） 甘草（五分）
姜枣水煎。如口渴。加葛粉一钱。如右关有力。胸膈不宽。加浓朴莱菔子
各一钱。烦渴。去半夏。脉不数。去黄芩。如气虚。同四君子或补中益气用。
如阴虚。则以六味汤继之。
疟疾的名称来源于“虐”，就像遭受凌辱虐待一样，所以称为疟疾。当寒邪发作时，患者战栗、下巴打颤，即使使用汤水或火烤也无法温暖身体；等到热邪发作时，患者感到烦闷郁结、气短乏力，即使饮用冰水也无法降温。这没有别的原因，是阴阳之气相互搏结、正气与邪气交争的结果。阴气偏盛则表现为寒，阳气偏盛则表现为热。正气虚弱则显得怯弱，邪气强盛则肆意妄为。全身上下，难道有不听指挥而任由邪气摧残的吗？那么，究竟哪条经脉主管此病？用什么药物来制约它呢？回答说：张仲景在《伤寒论》少阳经篇中提到，对于寒热往来的症状，可以使用小柴胡汤来治疗。方中的柴胡和黄芩可以清除表里之热，生姜和半夏可以消除表里之寒，人参、甘草和大枣调和阴阳并扶助正气，这难道不是治疗疟疾的对症良方吗？我在此基础上加以扩充和完善：如果寒多热少，就加入藿香；如果寒少热多，就加入知母；如果只有寒而没有热，就去掉黄芩；如果只有热而没有寒，就去掉半夏。气虚则加入茯苓和白术，血虚则加入当归和白芍。仅仅在这个方剂的基础上进行加减变化，很少有不立即见效的。由此可知，疟疾主要归属于少阳经，这是很明确的。
疟疾发作时间有早有晚，为什么呢？医经说：卫气在一昼夜中，大会合于风府穴。第二天向下移动一节脊椎，所以发作时间推迟（晏）。这是因为邪气客居于脊膂部位，经过二十五天，下行至骶骨；第二十六天，邪气向上行，九天之后出于缺盆穴，所以发作时间一天比一天早。邪气在阳分则病情轻，在阴分则病情重，引导邪气从阳分出散即可。至于为什么有的每天发作，有的隔天发作呢？医经说：邪气侵入浅则每天发作，侵入深则隔天发作。还有三天发作一次的，是因为邪气更盛而正气更加衰败。有一天发作三四次，甚至十几次，又是怎么回事呢？这种情况不能单纯按疟疾来论述，但也可以依据疟疾的原理来推演。阳气虚则生寒，阴气虚则生热，阴阳俱虚则寒热交替发作，如果不大补气血，寒热就不会停止。然而医经又提到：太阳经疟疾，腰痛头重，寒气从背部升起；少阳经疟疾，寒不太重，热也不太重，心中惊恐不安，出汗；阳明经疟疾，先寒冷战栗，很久才发热，热退后出汗，喜欢见到日光火光；太阴经疟疾，喜欢叹气，不想吃东西，多有寒热，出汗，容易呕吐；少阴经疟疾，呕吐，热多，想关闭门窗居住，这种病难以治愈；厥阴经疟疾，小腹胀满，像小便不通的样子，频繁排尿，内心恐惧。这样看来，六经各有不同的治疗方法。虽然如此，疟疾发作时，就像火热炽盛，像风雨一样不可抵挡，此时想要强行止住它，即使是高明的医生也做不到。必须从未发作之前，趁阴气未合并阳气、阳气未合并阴气之时，顺势调理，真气才能安宁，邪气才能排出。这就是设立露姜饮的道理，可以由此推演贯通。如果邪气未尽就过早截断疟疾，必然会产生变证，哪里比得上调理阴阳更好呢？薛立斋治疗疟疾发作不止，用人参一两、生姜五钱，在未发作前服用，疟疾可以立即停止，这是扶正以祛邪的高明手段，怎么会被疟疾所困呢？
按语：有人说疟疾是脾脏的疾病，因长夏暑热受伤，到了秋天新凉束表，疟疾于是发作。所以它的发作有固定的时辰，治疗应以调理脾胃为主，如平胃散、六君子汤、补中益气汤等，审察虚实后施用即可。却不知道脾脏畏惧肝木克制。柴胡不是疏肝药吗？脾脏喜好甘味，人参、甘草不是补益中焦吗？脾脏厌恶湿气，半夏不是燥湿药吗？脾脏畏惧热邪，黄芩不是清热药吗？如果确实是因为风邪和食积引起的，就疏散它、消导它；如果是寒热所致，就温散它、清解它；虚证就补益它，下陷的就提升它。学习者若能神妙地领悟这些道理，又怎能拘泥固执不知变通呢？
治验案例：
一位读书人在深秋时节患疟疾，凡是解表、疏通利下的药物都尝试过，但无效。四十天后，四肢冰冷，汗如雨下，仍然盖得严严实实不敢见风。我诊察他的脉象，六脉皆弱，连续服用归脾汤，将人参用量加倍，加入熟附子五分，几剂药后痊愈。随后用六君子汤调理一个多月。
一位女子患疟疾，烦热呕吐，口干想喝水，只有热而没有寒。有人给予和解法治疗无效。我诊察她的脉象，数且快，这是瘅疟（热疟）。因为肺素来有热，使用麦冬、知母、黄芩、山栀、花粉、厚朴、陈皮、甘草，一剂后症状减轻，两剂后痊愈。
一位五十多岁的男子，患痢疾半个月，痢疾停止后疟疾发作，发作时昏沉迷糊支撑不住。我诊察他的脉象，空大无力，使用补中益气汤，将人参用量加倍，加入半夏，两剂后痊愈。
小柴胡汤
柴胡（二钱） 黄芩 人参 半夏（各一钱） 甘草（五分）
加生姜、大枣用水煎煮。如果口渴，加葛粉一钱。如果右关脉有力，胸膈不宽畅，加厚朴、莱菔子各一钱。烦渴，去掉半夏。脉不数，去掉黄芩。如果气虚，配合四君子汤或补中益气汤使用。如果阴虚，则以六味地黄丸继服。
Malaria (Nue) derives its name from "cruelty" or "tyranny," resembling the suffering of being oppressed and abused; hence it is called Malaria. When the cold phase occurs, patients experience shivering and chattering teeth; even hot water or fire cannot warm them. When the heat phase follows, they feel vexation, oppression, and shortness of breath; even ice water cannot cool them. This is due to no other reason than the intermingling of Yin and Yang, and the struggle between healthy Qi (Zheng Qi) and pathogenic factors (Xie Qi). When Yin predominates, cold manifests; when Yang predominates, heat manifests. When healthy Qi is deficient, there is timidity; when pathogenic factors are excessive, they run rampant. Is there any part of the body that does not obey commands but instead allows itself to be devastated? So, which meridian governs this disease? What medicine controls it? It is said: Zhang Zhongjing, in the Shaoyang chapter of *Shanghan Lun* (Treatise on Cold Damage), mentions that for alternating chills and fever, Xiaochaihu Tang (Minor Bupleurum Decoction) can be used. In this formula, Chaihu (Bupleuri Radix) and Huangqin (Scutellariae Radix) clear heat from the exterior and interior; Shengjiang (Zingiberis Rhizoma Recens) and Banxia (Pinelliae Rhizoma) eliminate cold from the exterior and interior; Renshen (Ginseng Radix), Gancao (Glycyrrhizae Radix et Rhizoma), and Dazao (Jujubae Fructus) harmonize Yin and Yang and support healthy Qi. Is this not an appropriate formula for treating malaria? I have expanded upon it: If chills are more frequent than fever, add Huoxiang (Agastaches Herba); if fever is more frequent than chills, add Zhimu (Anemarrhenae Rhizoma); if there is only cold without fever, remove Huangqin; if there is only heat without cold, remove Banxia. If Qi is deficient, add Fuling (Poria) and Baizhu (Atractylodis Macrocephalae Rhizoma); if Blood is deficient, add Danggui (Angelicae Sinensis Radix) and Shaoyao (Paeoniae Radix Alba). Merely by modifying this base formula, few cases fail to respond promptly. From this, it is clear that malaria primarily belongs to the Shaoyang meridian.
The timing of malaria attacks varies (early or late). Why? The classics state: Wei Qi (Defensive Qi) gathers at Fengfu (GV16) once every twenty-four hours. The next day, it descends one vertebral segment; thus, the attack is delayed (Yan). This is because the pathogen resides in the spine and back muscles. After twenty-five days, it descends to the sacrum; on the twenty-sixth day, it ascends. Nine days later, it emerges from the Jianjing area (Qiepen), so the attacks occur progressively earlier. Pathogens in the Yang aspect indicate mild disease; those in the Yin aspect indicate severe disease. Guiding pathogens out through the Yang aspect disperses them. As for why some attacks occur daily while others occur every other day: The classics say, shallow invasion leads to daily attacks; deep invasion leads to intermittent attacks. Some occur every three days because the pathogen is stronger and healthy Qi is weaker. What about attacks occurring three or four times a day, or even ten times? This cannot be discussed solely as malaria but can be deduced from the principles of malaria. Yang deficiency generates cold; Yin deficiency generates heat; deficiency of both Yin and Yang leads to alternating cold and heat. Without significantly tonifying Qi and Blood, the cold and heat will not cease. However, the classics also mention: Taiyang malaria presents with lower back pain, heavy head, and cold starting from the back; Shaoyang malaria presents with mild chills and mild fever, palpitations, and sweating; Yangming malaria presents with initial aversion to cold and shivering, followed by heat after a long time, sweating after heat subsides, and a preference for sunlight or firelight; Taiyin malaria presents with frequent sighing, loss of appetite, alternating chills and fever, sweating, and vomiting; Shaoyin malaria presents with vomiting, predominant heat, a desire to stay in closed rooms, and difficulty in cure; Jueyin malaria presents with fullness in the lower abdomen, sensation of urinary difficulty, frequent urination, and fear. Thus, each of the Six Meridians has its own treatment methods. Nevertheless, when malaria erupts, it is like intense heat or violent wind and rain; stopping it at this stage is impossible, even for skilled physicians. One must regulate the body before the onset, when Yin has not yet merged with Yang and Yang has not yet merged with Yin. By doing so, True Qi becomes peaceful, and pathogenic factors are expelled. This is the rationale behind the formulation of Lujiang Yin (Dew and Ginger Drink), which can be understood through deduction. If one attempts to arrest malaria prematurely before pathogens are fully resolved, complications will arise. Is this not inferior to regulating Yin and Yang? Xue Lizhai treated persistent malaria by administering one liang of Renshen and five qian of Shengjiang before onset, stopping the malaria immediately. This demonstrates the superiority of supporting healthy Qi to overcome pathogens. How could one be trapped by malaria then?
Note: Some claim malaria is a Spleen disease, caused by summer-heat injury in late summer, constrained by early autumn coolness, leading to malaria. Thus, attacks have specific timings, and treatment should focus on regulating the Spleen, using formulas such as Pingwei San (Calm the Stomach Powder), Liujunzi Tang (Six Gentlemen Decoction), or Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), depending on excess or deficiency. However, one must know that the Spleen fears Liver Wood. Is Chaihu not a Liver-soothing herb? The Spleen favors sweet flavors; are Renshen and Gancao not tonifying the Middle Jiao? The Spleen dislikes dampness; is Banxia not a damp-drying herb? The Spleen fears heat; is Huangqin not a heat-clearing herb? If the cause is wind or food stagnation, disperse and digest it. If caused by cold or heat, warm or clear it. For deficiency, tonify it; for sinking, lift it. If practitioners can master these principles flexibly, how could they remain rigid and inflexible?
Case Records:
A scholar developed malaria in late autumn. He had tried various exterior-releasing and purgative herbs without effect. After forty days, his limbs were cold, he sweated profusely like rain, and he covered himself tightly, fearing wind. Upon diagnosis, all six pulses were weak. I administered Guipi Tang (Restore the Spleen Decoction) with doubled Renshen and added Wuzhuyu (Evodiae Fructus) or here specified as Shufuzi (Prepared Aconite Lateralis Radix Preparata) 5 fen. After several doses, he recovered. Subsequently, he was regulated with Liujunzi Tang for over a month.
A young woman suffered from malaria with vexatious heat, vomiting, dry mouth, and thirst, presenting with heat but no chills. Previous harmonizing treatments failed. Her pulse was rapid and hurried. This was Dan Nue (Febrile Malaria), caused by pre-existing lung heat. I used Maidong (Ophiopogonis Radix), Zhimu, Huangqin, Zhizi (Gardeniae Fructus), Huafen (Trichosanthis Radix), Houpo (Magnoliae Officinalis Cortex), Chenpi (Citri Reticulatae Pericarpium), and Gancao. Symptoms reduced after one dose and resolved after two.
A man over fifty years old suffered from dysentery for half a month. After dysentery ceased, malaria began. During attacks, he became confused and unable to support himself. His pulse was empty, large, and forceless. I used Buzhong Yiqi Tang with doubled Renshen and added Banxia. He recovered after two doses.
Xiaochaihu Tang (Minor Bupleurum Decoction)
Chaihu (2 qian), Huangqin, Renshen, Banxia (each 1 qian), Gancao (0.5 qian).
Decoct with Shengjiang and Dazao. If thirsty, add Gegen (Puerariae Lobatae Radix) 1 qian. If the right Guan pulse is forceful and chest/epigastrium feels tight, add Houpo and Laifuzi (Raphani Semen) each 1 qian. If vexed and thirsty, remove Banxia. If pulse is not rapid, remove Huangqin. If Qi deficient, combine with Sijunzi Tang (Four Gentlemen Decoction) or Buzhong Yiqi Tang. If Yin deficient, follow with Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia).