内经曰夏伤于暑秋必 疟盖伤之浅者近而暴伤之重者远而为 者久疟也是知夏伤暑气
闭而
不能发泄于外邪气内行至秋而为疟也良由乳母抱持解脱不避风寒又因触冒暑湿致令邪气客于
皮肤痰饮积于脏腑阴阳偏胜邪正相攻而作往来寒热也若阳盛则热阴盛则寒先寒而后热者阳不
足也先热而后寒者阴不足也寒多而热少者阴胜阳也热多而寒少者阳胜阴也寒热相半阴阳交攻
也寒热相间阴阳乍离也大抵小儿皆自饮食上得之者为多须用先与消导然后随其得病所由而调
理之斯为良法
明医杂着云疟是风暑之邪有一日一发有二日一发有三日一发有间一日连二日发有日与夜
各发有汗有无汗有上半日发或下半日发有发于夜者治法邪从外入宜散发之然以扶胃气为本
又须分别阳分阴分而用药邪疟及暂发者可散可截虚疟及久者宜补气血若过服截药致伤脾胃则
必延绵不休凡热多寒少无汗者桂枝麻黄各半汤有汗多者柴胡桂枝汤汗多而渴者白虎加桂汤小
便赤热多寒少者小柴胡汤寒多热少者清脾汤养胃汤久未止者鬼哭散止之热多汗出为泻腹痛者
大柴胡下之久疟不愈肠下结块者木香丸鳖甲饮子调之甚则以神 丸消之烦渴者五苓散有小儿
疟疾用药退热太早变作浮肿外肾肿大或食伤于脾胃浮者脾之外应也宜大腹皮汤草果饮之类
治之
《黄帝内经》说:夏季感受暑邪,到了秋天必定发生疟疾。这是因为感受邪气较浅的,发病较快;感受邪气较重的,发病较晚;发作时间长的,称为久疟。由此可知,夏季被暑气所伤,若不能向外发泄,邪气内行,到了秋天就会发为疟疾。这大多是因为乳母怀抱婴儿时,未能避开风寒,又因触犯冒受暑湿之气,致使邪气客居在皮肤之间,痰饮积聚于脏腑之中,阴阳偏盛,邪正相互交攻,从而产生忽冷忽热的症状。如果阳气偏盛则发热,阴气偏盛则发冷。先感到寒冷而后发热的,是阳气不足;先感到发热而后发冷的,是阴气不足。寒冷多而发热少的,是阴胜阳衰;发热多而寒冷少的,是阳胜阴衰。寒热程度相当的,是阴阳相互交攻;寒热交替出现的,是阴阳暂时分离。大抵小儿患疟疾,大多是从饮食方面得来的,应当先用消食导滞的方法,然后根据致病的原因进行调理,这才是良法。
明代医家李梴在《医学入门》(注:原文“明医杂着”通常指李梴《医学入门》或相关医案汇编,此处依文意直译)中说:疟疾是风邪和暑邪所致,有一日发作一次的,有两日发作一次的,有三日发作一次的,有隔一天连两天发作的,有白天和夜晚各发作一次的,有出汗的和无汗的,有上午发作或下午发作的,也有夜间发作的。治疗方法上,邪气从外侵入的,宜用发散的方法治疗,但以扶持胃气为根本。又必须区分阳分和阴分来用药。邪气盛的疟疾以及刚发作不久的,可以用发散或截断的方法;虚证疟疾以及病程久的,宜补益气血。如果过服截疟药物导致损伤脾胃,病情必然会迁延不愈。凡是发热多、发冷少且无汗的,用桂枝麻黄各半汤;有汗多的,用柴胡桂枝汤;汗多且口渴的,用白虎加桂枝汤;小便赤涩、发热多发冷少的,用小柴胡汤;发冷多发热少的,用清脾汤或养胃汤;久治不止的,用鬼哭散止疟。发热多且出汗后出现腹泻腹痛的,用大柴胡汤下之;久疟不愈,肠道内有结块的,用木香丸或鳖甲煎丸调治;病情严重的,用神功丸消除积块。烦躁口渴的,用五苓散。小儿疟疾用药退热太早,变成浮肿,外肾肿大,或者是饮食损伤脾胃导致的浮肿,这是脾的外在表现,宜用大腹皮汤、草果饮之类治疗。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "If one is injured by summer heat in summer, malaria will inevitably occur in autumn." This is because those who are lightly injured manifest symptoms quickly; those heavily injured manifest symptoms later; and those with prolonged episodes are termed chronic malaria (Jiu Nüe). Thus, it is understood that if summer heat qi is trapped and cannot be vented outward, the pathogenic qi moves inward, leading to malaria in autumn. This often arises because nursing mothers hold infants without avoiding wind and cold, or due to exposure to summer dampness, causing pathogenic qi to lodge in the skin and phlegm-fluids (Tan Yin) to accumulate in the zang-fu organs. When yin and yang become unbalanced and pathogenic factors attack healthy qi, alternating chills and fever ensue. If yang is excessive, there is fever; if yin is excessive, there is chills. Chills preceding fever indicates insufficient yang; fever preceding chills indicates insufficient yin. More chills than fever indicates yin prevailing over yang; more fever than chills indicates yang prevailing over yin. Equal amounts of chills and fever indicate an attack between yin and yang; alternating chills and fever indicate a temporary separation of yin and yang. Generally, children contract malaria mostly from dietary issues. One should first use methods to promote digestion and guide out stagnation, then regulate according to the cause of the disease. This is the excellent method.
Li Chan, in his medical writings, states: Malaria is caused by wind and summer heat pathogens. It may occur once daily, once every two days, once every three days, or on alternate days for two consecutive days. It may occur both day and night, with or without sweating, in the morning or afternoon, or at night. The treatment principle for pathogens entering from the exterior is to disperse them, but supporting stomach qi (Wei Qi) is fundamental. Medication must be differentiated based on whether the condition involves the yang aspect or yin aspect. For excess malaria or recent onset, dispersing or intercepting methods can be used. For deficiency malaria or chronic cases, tonifying qi and blood is appropriate. Overuse of antimalarial drugs damages the spleen and stomach, causing the condition to linger indefinitely. For cases with more heat than cold and no sweat, Guizhi Mahuang Ban Tang (Cinnamon Twig and Ephedra Half-Decoction) is indicated. For cases with profuse sweating, Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) is used. For profuse sweating with thirst, Baihu Jia Guizhi Tang (White Tiger Plus Cinnamon Twig Decoction) is prescribed. For dark, hot urine with more heat than cold, Xiaochaihu Tang (Minor Bupleurum Decoction) is used. For more cold than heat, Qingpi Tang (Clear the Spleen Decoction) or Yangwei Tang (Nourish the Stomach Decoction) is used. For persistent cases not stopping, Gui Ku San (Ghost Cry Powder) stops the malaria. For heat predominance with sweating followed by diarrhea and abdominal pain, Daxiehu Tang (Major Bupleurum Decoction) is used to purge. For chronic malaria with masses in the intestines, Muxiang Wan (Aucklandia Pill) or Biejia Yinzi (Turtle Shell Infusion) regulates the condition. For severe cases, Shengong Wan (Divine Merit Pill) eliminates the masses. For irritability and thirst, Wuling San (Five-Ingredient Powder with Poria) is used. If antimalarial cooling medications are used too early in children, edema may result, including swelling of the external genitalia. Alternatively, food injury to the spleen and stomach causes edema, which is an external manifestation of the spleen. Such cases should be treated with Dafupi Tang (Areca Peel Decoction), Caoguo Yin (Tsaoko Infusion), and similar formulas.