经云。疟先寒而后热者。夏伤于大暑。其汗大出。腠理开发。因遇夏气凄沧之水寒。藏于腠
理皮肤之中。秋伤于风。则病成矣。夫寒者阴气也。风者阳气也。先伤于寒而后伤于风。故先寒
而后热也。病以时作。名曰寒疟。先热而后寒者。此先伤于风而后伤于寒。故先热而后寒也。亦
以时作。名曰温疟。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。温疟者。得之冬中于风。寒气藏于骨髓之中。至春则阳气大发。
邪气不能自出。因遇大暑。脑髓烁。肌肉消。腠理发泄。或有所用力。邪气与汗皆出。此病藏于
肾。其气先从内出之于外也。如是者。阴虚而阳盛。阳盛则热矣。衰则气复反入。入则阳虚。阳
虚则寒矣。故先热而后寒。名曰温疟。瘅疟者。肺素有热。气盛于身。厥逆上冲。中气实而不外
泄。因有所用力。腠理开。风寒舍于皮肤之内分肉之间而发。发则阳气盛。阳气盛而不衰。则病
矣。其气不及于阴。故但热而不寒。气内藏于心而外舍于分肉之间。令人消烁肌肉。故命曰瘅疟。
足太阳之疟。令人腰痛头重。寒从背起。先寒后热 然。热止汗出。足少阳之疟。令人身
体解 。寒不甚。热不甚。恶见人。见人心惕惕然。热多。汗出甚。足阳明之疟。令人先寒洒淅。
洒淅寒甚久乃热。热去汗出。喜见日月光火气。乃快然。足太阴之疟。令人不乐。好太息。不嗜
食。多寒热汗出。病至则善呕。呕已乃衰。足少阴之疟。令人呕吐甚。多寒热。热多寒少。欲闭
户牖而处。其病难已。足厥阴之疟。令人腰痛。少腹满。小便不利如癃状。非癃也。数便。意恐
惧。气不足。腹中悒悒。凡治疟先发时食顷。乃可以治。过之则失时也。
金匮云。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。令人消烁肌肉。
疟之寒热更作。因阴阳之气互为争并。若阴衰离绝其阳。而阳亦不并之阴。故阳独发。但热
而已。其少气烦冤者。肺主气。肺受火抑故也。手足热者。阳主四肢。阳盛则四肢热也。欲呕者。
火邪上冲。胃气逆也。内藏于心者。阳盛则火气内藏。而外舍分肉之间也。消烁肌肉者。火盛则
肌肉烁也。此条合后条温疟观之。亦可以白虎汤治瘅疟也。
白虎专于退热。其分肉四肢。内属脾胃。非切于所舍者乎。又泻肺火。非救其少气烦冤者乎。设
其别有兼证。岂不可推加桂之例而加别药乎。
温疟者。其脉如平。身无寒。但热。骨节烦疼。时呕。白虎加桂枝汤主之。
内经言温疟先热后寒。仲景言温疟则但热不寒。有似瘅疟而实不同也。瘅疟两阳合邪。上熏
心肺。所以少气烦冤。消烁肌肉。温疟脉如平人。则邪未合而津未伤。阳受病而阴不病。以其人
素有痹气。营卫不通。故疟发于阳不入于阴。所以骨节烦疼。时呕。邪气插格之状有如此者。惟
用白虎汤以治阳邪。而加桂枝以通营卫。斯阴阳和。血脉通。得汗而愈矣。至于伤寒前热未除而
复感风寒。脉阴阳俱盛之温疟。与其脉如平者。迥乎不同也。
疟多寒者。名曰牝疟。蜀漆散主之。
邪气内藏于心。则但热而不寒。是为瘅疟。邪气伏藏于肾。故多寒而少热。则为牝疟。以邪
气伏结。则阳气不行于外。故外寒。积聚津液以成痰。是以多寒。与素问少阴经证之多热少寒不
同。方用蜀漆和浆水吐之以发越阳气。龙骨以固敛阴津。云母从至下而举其阳。取山川云雾开霁
之意。盖云母即阳起石之根。性温而升。最能祛湿运痰。稍加蜀漆。则可以治太阴之湿疟。方后
有云。湿疟。加蜀漆半分。而坊本误作温疟。大谬。此条本以邪伏髓海。谓之牝疟。赵以德不辨
亥豕。注为邪在心而为牡。喻嘉言亦仍其误而述之。非智者之一失欤。
疟病发渴者。柴胡去半夏加栝蒌汤。亦治劳疟。
渴者阳明津竭。而所以致阳明津竭者。本少阳木火之势。劫夺胃津而然。故疟邪进退于少阳。
则以小柴胡进退
而施治也。至于劳疟之由。亦木火盛而津衰致渴。故亦不外是方也。
疟寒多微有热。或但寒不热。柴胡桂姜汤。服一剂如神。
是证虽与牝疟相类。以方药论之则殊。牝疟邪伏少阴气分。而此邪伏少阳营血之分。夫邪气
入营。既无外出之势。而营中之邪。亦不出与阳争。所以多寒少热。或但寒无热也。小柴胡汤本
阴阳两停之方。可随疟之进退。加桂枝、干姜则进而从阳。若加栝蒌、石膏则退而从阴。可类推矣。
丹溪治六经疟。悉以二陈为主。各加引经药。可见无痰不成疟也。大法。先热后寒者。柴胡
桂枝汤。先寒后热者。小柴胡汤。多热但热者。白虎加桂枝汤。多寒但寒者。柴胡桂姜汤。虽多
寒但寒。脉洪实者。当作实治。不得便用桂、姜。虽多热但热。脉虚软者。当作虚治。不得便用
白虎。寒多热少。或少食易饥。恶心吐痰。人参养胃汤。热多寒少。口苦咽干。小便赤涩。或伤
食成疟。清脾饮。劳役所伤。饮食失节成疟。则虚弱自汗。补中益气加半夏。疟疾自汗日甚。不
能止。此表虚不能卫护也。人参实卫加桂枝。风疟。自感风而得。恶风自汗。烦躁头痛。风。阳
邪也。故先热后寒。宜半夏、柴胡、羌活、紫苏、细辛、生姜。寒疟。暑月乘凉沐浴。自感寒而
得。无汗恶寒。挛痛面惨。寒。阴邪也。故先寒后热。宜羌活、紫苏、桂枝、柴胡、草果、浓朴。
暑疟亦名瘅疟。但热不寒。里实不泄。烦渴而呕。肌肉消烁。小柴胡加香薷、黄连、竹叶。盛暑
发者。白虎汤。虚者。加人参。秋凉后发者。小柴胡汤。此肺素有热。阴气先绝。阳气独发。故
但热不寒也。温疟。由冬受非时之邪。伏藏骨髓之中。至春夏湿热气蒸而发。发则先热后寒。或
但热不寒。春用小柴胡。夏用白虎加桂枝。以邪热势盛。故不恶寒而便发热。热发于表之后。正
气内虚。反微似是寒之状。非恶寒也。牝疟。邪伏于肾。湿疟。则久受阴湿
而邪伏太阴。皆但寒不热。并宜蜀漆散。邪伏血分而多寒少热。惨惨振振。柴胡桂姜汤。劳疟大
渴。柴胡去半夏加栝蒌汤。汗出澡浴。身体重痛。肢节烦疼。寒热而呕逆者。亦属湿疟。胃苓汤
加羌活、紫苏。食疟。因饮食不节。中脘生痰。加以风气乘之。故善饥而不能食。食而支满。腹
大善呕。实者二陈加枳壳、草果。因饥饱劳役而发。日久不止。脉虚者理中汤加枳实、青皮。素
有阴虚劳嗽。或因疟成劳。但于调理本药中。稍加桂枝、姜、枣可也。不可纯用祛风豁痰药。若
表邪势盛。可用小建中、黄 建中为主。后与生料六味丸加桂枝、鳖甲。凡疟发于午前。是阳分
受病。易愈。发于午后。阴分受病。难愈。疟发日宴。为邪气下陷于阴分。必用升、柴升发其邪。
仍从阳分而发。补中益气加桂枝。疟发日早。为邪气上越于阳分。宜因势利导之。小柴胡加枳、桔。
夜疟俗名鬼疟。此邪入血分。宜升散血脉之邪。千金内补建中加升、柴、生首乌。脾胃素虚人。
补中益气加首乌、桂枝、芍药。瘴疟。山岚溪涧之毒。须用祛瘴涤痰之药为主。疫疟。夏秋之间。
沿门阖境皆是也。其证壮热多汗而渴。宜达原饮。烦热大渴。有表证。桂枝白虎汤。谵妄狂闷。
凉膈散加草果。寒热便秘。大柴胡汤。虚人发散后热不止。人参败毒散。有郁证似疟者。寒热与
疟无异。但口苦呕吐清水。或苦水。面青胁痛。耳鸣脉涩。逍遥散倍柴胡加吴茱萸、川连。痢后
发疟。邪从少阳循经外泄也。小柴胡去黄芩加桂枝。或补中益气倍升、柴。升散则愈。
大抵疟初起。宜散邪消导。日久宜养正调中。所谓气虚则恶寒。血虚则发热也。日数虽多。
饮食未节者。未可便断为虚。须禁食消导。凭脉下手可也。形盛气虚人多湿痰。发则多恶寒。日
久不已。脉软而沉带滑。用补中益气加苓、半。兼用熟附子二三分。疟后不喜食。四肢倦怠。面
色痿黄。六君子加山楂、黄连、枳实。久疟不止。元气虚盛者。用人参、常山
各五钱。锉碎。微火同炒。去常山。只以人参煎汤。未发前服。屡验。疟发四五遍后。曾经发散
者。何首乌散。壮实者。可用七宝饮。至夜热不止而脉实邪盛者。此邪干血分也。常山饮截之。
疟发已久。遍治无功。度无外邪。亦无内滞。惟人参一两。生姜一两。加桂枝少许。冬月无汗。
稍加麻黄。发前五更时服。温覆取微汗必止。甚者连进三日。无不愈者。愈后亦易康复。如在贫家。
人参减半。合白术五钱代之。此方不特虚人久疟。治三日疟更宜。夜发则加当归、首乌。无不应
手取效。然发于严冬之时。有屡用此方。及补中益气不效者。必待仲春。仍用前药加桂枝汗之即愈。
丹溪云。 疟者。三阴疟也。三日一发。发于子午卯酉日者。少阴疟也。发于寅申巳亥日者。
厥阴疟也。发于辰戌丑未日者。太阴疟也。更须以脉证参之。然后决其经而与法治。按内经云。
时有间二日或至数日而发者。邪气与卫气客于六腑。而有时相失。不能相得。故休数日乃作也。
李士材释云。客。犹会也。邪在六腑。则气远会稀。故间二日或休数日也。观此。则丹溪辰戌丑
未日为太阴疟。非矣。子午虽曰少阴。而卯酉则阳明矣。巳亥虽曰厥阴。而寅中则少阳矣。丑未
虽曰太阴。而辰戌则太阳矣。三日发者。犹可以此为言。数日发者。又将何以辨之。大抵三日疟。
初起发于夏秋者。宜用二陈去橘皮。加生术、槟榔、常山。逐去痰癖为先。稍加穿山甲以透经络。
至于暑结营分。又当以香薷、鳖甲、茯苓、半夏、甘草、当归、生姜、大枣祛暑为要。而前药为
无益也。若元气大虚。只用补正。宜六君加草果、乌梅。名四兽饮。兼本经引使药。若元气下陷。
日发渐晏者。补中益气汤大剂参、术、姜、枣为治。如常山、槟榔、山甲、草果。皆为戈戟矣。
疟母者。顽痰挟血食而结为 瘕。鳖甲煎丸。或小柴胡加鳖甲、蓬术、桃仁俱用醋制。其鳖
甲用栗灰汤煮糜烂入药。尤效。此金匮法也。病气俱实者。疟母丸。虚人久疟。时止时发。芎归
鳖甲饮。不应。脾虚也。急用补中益气加鳖甲。少食
痞闷。胃虚也。四兽饮加鳖甲、当归、蓬术、肉桂。虚人疟母。必用补益。盖缘治之失宜。邪伏
肝经。而胁下有块。仍寒热时作。不可以癖积治之。每见急于攻块者。多致不救。久疟不愈。必
有留滞。须加鳖甲消之。如无留滞。只宜补益。凡寒热有常期者。疟也。无常期者。杂证也。疟
证诸经有邪。总不离乎肝胆也。
石顽曰。经言夏暑汗不出者。秋成 疟。此论固是。然其轻重之殊。今昔迥异。良由天运使
然。以北方风气营运于南故也。夫疟疾一证。向来淮泗以北最剧。大江以南甚轻。康熙壬子。吾
吴患此者。比户皆然。自夏徂秋。日盛一日。其势不减淮北。证皆痞满呕逆。甚则昏热谵语。脉
多浑浑。不显弦象。亦有关尺微弦者。但其热至晨必减。不似热病之昼夜不分也。时医不察。混
以伤寒目之。因而误药致毙者。日以继踵。原其寒热之机。又与往岁不同。有一日连发二三次者。
有晨昏寒热再见者。有连发数日。中间二三日复发如前者。有先热后寒者。有独寒无热者。有独
热无寒者。有今日但寒明日但热者。证虽变易无常。总不越和营散邪等法。但须分虚实寒热轻重
治之。历观用劫剂及祝由之法者十无一验。间有寒热止而昏热不休者。又须随所禀形气之偏胜。
病气之盛衰而为调适。全在机用灵活。不可专守成则。而举世治疟。必先禁止饮食。概用疏风发
散。兼消克痰食宽膈破气之剂。消克不已。继进硝黄。胃气愈伤。浊邪愈逆。正气何由得行。而
振祛邪之力乎。余治久疟坏证。每令续进稠饮。继与稀糜。使胃气输运。可行药力。然后施治。
如此挽回者。未遑枚举。更有愈而复发。发而复愈。愈而又发者。又须推原所发之由而为清理。
若常山、草果、槟榔、浓朴、枳壳、青皮、石膏、知母等伤犯中州之药。咸非所宜。逮至仲秋以
后。不特白虎当禁。纵不犯石膏、知母。邪气 内陷而变肠 者甚多。有先疟后痢者。有疟痢
齐发者。尝遍考昔人治例。惟补中益气一方。虽未能尽合肯綮。然
一隅之举。余可类推。庸师不审。但守通因通用之法。致成夭扎者多矣。
〔诊〕疟脉自弦。弦数者多热。弦迟者多寒。弦小紧者下之瘥。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。
丹溪治一少年。冬月患疟。自卯足寒。至酉方热。寅初乃休。因思必为接内感寒所致。用人
参大补加附子行经散寒以取汗。数日不得汗。以足跗道远。药力难及。再以苍术、川芎、桃枝煎
汤。盛以高桶。扶坐浸足至膝。食顷。以前药服之。汗出通身而愈。
汪石山治一少年。六月因劳病疟。取凉梦遗。遂觉恶寒。连日惨惨不爽。三日后头痛躁闷。
《黄帝内经》说：疟疾先出现寒战，随后发热的，是因为夏季遭受大暑之邪。当时汗出过多，腠理（皮肤毛孔）开泄，又因遭遇夏日清凉的水寒之气，寒气潜伏在腠理和皮肤之中。到了秋季再感受风邪，疾病就形成了。寒属于阴气，风属于阳气。先受寒邪后受风邪，所以先寒战后发热。这种病定时发作，称为寒疟。先发热后出现寒战的，这是先受风邪后受寒邪，所以先热后寒。也是定时发作，称为温疟。只有发热而没有寒战的，是阴气先竭，阳气独盛外发，就会出现气短、心中烦闷郁结、手足发热且想呕吐的症状，称为瘅疟（dàn nüè，一种但热不寒的疟疾）。
温疟的成因，是冬季感受了风邪，寒气潜伏在骨髓之中。到了春季，阳气大发，邪气不能自行排出。如果遇到大暑天气，脑髓被灼烧，肌肉消瘦，腠理开泄，或者因为用力劳作，邪气随着汗水一起排出。这种病潜伏在肾，其气先从体内发出到体表。像这样的情况，阴虚而阳盛，阳盛就会发热；当阳气衰退时，气又会重新返回体内，入内则导致阳虚，阳虚就会发冷。所以先热后寒，称为温疟。
瘅疟的成因，是肺中素有积热，气机壅盛于全身，气逆上冲，中焦气实而不能向外宣泄。如果因为用力劳作，腠理开张，风寒之邪停留在皮肤之内、分肉之间而发病。发病时阳气亢盛，如果阳气亢盛而不衰减，就会致病。邪气不及于阴分，所以只发热而不恶寒。邪气内藏于心，外留于分肉之间，使人肌肉消烁，所以命名为瘅疟。
足太阳经发生的疟疾，使人腰痛、头重，寒气从背部开始，先寒战后发热，热退后出汗。足少阳经发生的疟疾，使人身体懈怠无力，寒热都不严重，厌恶见人，见到人心里就惊恐不安，发热较多，出汗很多。足阳明经发生的疟疾，使人先感到寒冷战栗，寒冷持续很久才发热，热退后出汗，喜欢见到日光、月光或火光，感到舒适。足太阴经发生的疟疾，使人心情不愉快，喜欢叹气，不想吃东西，寒热交替且多汗，病发时容易呕吐，吐完后病情减轻。足少阴经发生的疟疾，使人呕吐严重，寒热交替，热多寒少，想要关上门窗独自居住，这种病难以治愈。足厥阴经发生的疟疾，使人腰痛，小腹胀满，小便不利像癃闭（排尿困难）的样子，其实并非癃闭，而是尿频，心中恐惧，气不足，腹部郁闷不舒。
凡是治疗疟疾，要在发作前大约一顿饭的时间进行治疗，过了这个时间就失去了最佳时机。
《金匮要略》说：老师说，阴气孤绝，阳气独发，就会发热、气短、心中烦闷郁结、手足发热且想呕吐，称为瘅疟。如果只有发热没有恶寒，邪气内藏于心，外留于分肉之间，使人肌肉消烁。
疟疾的寒热交替发作，是因为阴阳之气互相争胜。如果阴气衰败离绝，阳气不与阴气相并，所以阳气独发，只是发热而已。所谓气短烦闷，是因为肺主气，肺受到火邪抑制的缘故。手足发热，是因为阳主四肢，阳盛则四肢发热。想呕吐，是因为火邪上冲，胃气上逆。邪气内藏于心，是因为阳盛则火气内藏，而外留于分肉之间。肌肉消烁，是因为火盛则肌肉被灼烧。这一条结合后面的温疟来看，也可以用白虎汤来治疗瘅疟。
白虎汤专门用于退热，其作用部位在分肉和四肢，内部归属于脾胃，这不正是切中邪气所停留的部位吗？又能清泻肺火，这不正是救治气短烦闷的方法吗？假使另有兼证，难道不可以参考加桂枝的例子而加入其他药物吗？
温疟的症状，脉象像正常人一样，身体没有寒战，只有发热，骨节烦痛，时常呕吐，用白虎加桂枝汤主治。
《内经》说温疟是先热后寒，张仲景说温疟是只有发热没有恶寒，看起来像瘅疟但实际上不同。瘅疟是两阳合邪，上熏心肺，所以气短烦闷，肌肉消烁。温疟脉象如平人，说明邪气未合而津液未伤，阳受病而阴不受病。因为患者素来有痹症，营卫不通，所以疟疾发于阳分而不入阴分，因此骨节烦痛，时常呕吐。邪气格拒的状态就是这样。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，出汗后就能痊愈。至于伤寒前期热势未除又感受风寒，脉象寸关尺都盛的温疟，与脉象如平人的温疟，截然不同。
疟疾寒多热少的，称为牝疟（pìn nüè，一种寒多热少的疟疾），用蜀漆散主治。
邪气内藏于心，就是只有发热没有恶寒，这是瘅疟。邪气潜伏在肾，所以寒多热少，这就是牝疟。因为邪气伏结，阳气不能行于体表，所以体表发冷。积聚津液形成痰饮，所以寒多。这与《素问·少阴经》证候中多热少寒的情况不同。方剂用蜀漆配合浆水催吐，以发散阳气；龙骨用来固敛阴津；云母性沉降而能升举阳气，取山川云雾消散之意。大概云母就是阳起石的根部，性质温和而上升，最能祛湿运痰。稍微加入蜀漆，就可以治疗太阴经的湿疟。方后注说：“湿疟，加蜀漆半分”，而坊间刻本误作“温疟”，这是极大的错误。这一条本来是因为邪气潜伏在髓海，称为牝疟。赵以德没有分辨文字错误，注释为邪在心而为牡疟；喻嘉言也沿袭了这个错误并加以阐述，这难道是智者的失误吗？
疟病发作时口渴的，用柴胡去半夏加栝蒌汤。也能治疗劳疟（久疟致虚）。
口渴是因为阳明津液枯竭，而导致阳明津液枯竭的原因，是本源于少阳木火之势，劫夺胃津所致。所以疟邪在少阳经进退，就用小柴胡汤加减施治。至于劳疟的成因，也是木火旺盛而津液衰败导致口渴，所以也不超出这个方子的范围。
疟疾寒多微有热，或者只有寒没有热的，用柴胡桂姜汤。服一剂效果神奇。
这个证候虽然与牝疟相似，但从方药来看则不同。牝疟是邪气潜伏在少阴气分，而这个证候是邪气潜伏在少阳营血之分。邪气进入营分，既没有外出的趋势，而营中的邪气也不出来与阳气争胜，所以寒多热少，或者只有寒没有热。小柴胡汤本来是阴阳平衡的方子，可以根据疟疾的进退进行加减。加入桂枝、干姜则是进而从阳；如果加入栝蒚、石膏则是退而从阴，可以类推。
朱丹溪治疗六经疟疾，都以二陈汤为主，各加引经药。可见无痰不成疟。一般法则：先热后寒的，用柴胡桂枝汤；先寒后热的，用小柴胡汤；多热但热的，用白虎加桂枝汤；多寒但寒的，用柴胡桂姜汤。虽然多寒但寒，如果脉象洪实，应当作为实证治疗，不能直接用桂枝、干姜。虽然多热但热，如果脉象虚软，应当作为虚证治疗，不能直接用白虎汤。寒多热少，或少食易饥，恶心吐痰的，用人参养胃汤。热多寒少，口苦咽干，小便赤涩的，或者是因饮食停滞成疟的，用清脾饮。因劳累损伤，饮食失节成疟的，则虚弱自汗，用补中益气汤加半夏。疟疾自汗日益加重，不能停止的，这是表虚不能卫护，用人参实卫汤加桂枝。风疟，因感受风邪而得，恶风自汗，烦躁头痛。风是阳邪，所以先热后寒，宜用半夏、柴胡、羌活、紫苏、细辛、生姜。寒疟，在暑月乘凉沐浴，自感寒邪而得，无汗恶寒，肢体挛痛面色惨白。寒是阴邪，所以先寒后热，宜用羌活、紫苏、桂枝、柴胡、草果、厚朴。
暑疟也称为瘅疟，只有发热没有恶寒，里实不泄，烦渴而呕，肌肉消烁。用小柴胡汤加香薷、黄连、竹叶。在盛暑时节发作的，用白虎汤；体虚的，加人参。在秋凉后发作的，用小柴胡汤。这是因为肺中素有热，阴气先绝，阳气独发，所以只有发热没有恶寒。
温疟，由冬季感受非时之邪，潜伏在骨髓之中，到春夏季湿热蒸腾而发作，发作时先热后寒，或者只有发热没有恶寒。春季用小柴胡汤，夏季用白虎加桂枝汤。因为邪热势盛，所以不恶寒而直接发热。热发于体表之后，正气内虚，反而出现轻微的类似恶寒的现象，并不是真正的恶寒。
牝疟，邪气潜伏在肾；湿疟，则是长期感受阴湿之邪，邪气潜伏在太阴经，都是只有寒没有热，都适宜用蜀漆散。邪气潜伏在血分而寒多热少，神情凄惨，身体颤抖，用柴胡桂姜汤。劳疟大渴，用柴胡去半夏加栝蒌汤。因出汗洗澡，身体沉重疼痛，肢节烦痛，寒热且呕吐逆气的，也属于湿疟，用胃苓汤加羌活、紫苏。食疟，因饮食不节制，中脘生痰，再加上风气侵袭，所以容易饥饿但不能进食，进食后胸胁胀满，腹部膨隆，经常呕吐。实证用二陈汤加枳壳、草果；因饥饱劳役而发作，日久不止，脉虚的，用理中汤加枳实、青皮。素来有阴虚劳嗽，或者因疟疾变成劳损的，只在调理本病的药物中，稍微加入桂枝、生姜、大枣即可。不可单纯使用祛风豁痰的药物。如果表邪势盛，可用小建中汤、黄芪建中汤为主，随后用生料六味丸加桂枝、鳖甲。凡是疟疾在午前发作的，是阳分受病，容易治愈；在午后发作的，是阴分受病，难治愈。疟疾发作时间越来越晚，是邪气下陷于阴分，必须用升麻、柴胡升发邪气，仍然从阳分而发，用补中益气汤加桂枝。疟疾发作时间提前，是邪气上越于阳分，适宜顺势利导，用小柴胡汤加枳壳、桔梗。
夜疟俗称鬼疟，这是邪气进入血分，适宜升散血脉中的邪气，用千金内补建中汤加升麻、柴胡、制何首乌。脾胃素虚的人，用补中益气汤加何首乌、桂枝、芍药。瘴疟，是山岚溪涧的毒气，必须用祛瘴涤痰的药物为主。疫疟，在夏秋之间，沿门阖境皆是，症状壮热多汗而口渴，宜用达原饮。烦热大渴，有表证的，用桂枝白虎汤。谵妄狂闷的，用凉膈散加草果。寒热便秘的，用大柴胡汤。体虚之人发散后热势不止的，用人参败毒散。有郁证类似疟疾的，寒热与疟疾无异，但口苦呕吐清水或苦水，面青胁痛，耳鸣脉涩，用逍遥散倍加柴胡，加吴茱萸、黄连。痢疾后发作疟疾，是邪气从少阳经循经外泄，用小柴胡汤去黄芩加桂枝，或者补中益气汤倍加升麻、柴胡，升散后即可痊愈。
大抵疟疾初起，宜疏散邪气、消导积滞；日久则宜扶正调中。所谓气虚则恶寒，血虚则发热。虽然病程天数多，但如果饮食未加节制，还不能立即断定为虚证，必须禁止食用难消化食物并进行消导，凭脉象下药即可。形体丰盛但气虚的人多湿痰，发作时多恶寒，日久不愈，脉象软而沉带滑的，用补中益气汤加茯苓、半夏，兼用熟附子二三分。疟疾后不喜欢吃东西，四肢倦怠，面色萎黄，用六君子汤加山楂、黄连、枳实。久疟不止，元气不虚的，用人参、常山各五钱，切碎，用微火同炒，去掉常山，只用煎煮人参的汤，在疟疾发作前服用，屡试有效。疟疾发作四五次后，曾经用过发散法的，用何首乌散。体质壮实的，可以用七宝饮。到了夜间热势不止且脉实邪盛的，这是邪气侵犯血分，用常山饮截疟。
疟疾发作已久，遍治无效，判断没有外邪，也没有内滞，只用人参一两，生姜一两，加少许桂枝，冬季无汗的，稍加麻黄。在发作前五更时分服用，盖被保暖取微汗，必定停止。严重的连续进服三日，无不痊愈的。痊愈后也容易康复。如果在贫寒人家，人参减半，用白术五钱代替。此方不仅适用于虚人久疟，治疗三日疟更适宜。夜间发作的加当归、何首乌，没有不随手见效的。然而如果在严冬时节发作，有屡用此方及补中益气汤无效的，必须等到仲春时节，仍用前药加桂枝发汗即愈。
朱丹溪说：疟疾是三阴疟。三日一发，在子、午、卯、酉日发作的，是少阴疟；在寅、申、巳、亥日发作的，是厥阴疟；在辰、戌、丑、未日发作的，是太阴疟。还必须结合脉证来判断，然后决定所属经络并施治。按《内经》说：有时隔两天或至数日才发作的，是因为邪气与卫气客居在六腑，有时错过，不能相遇，所以要休息数日才发作。李士材解释说：客，就是会合的意思。邪在六腑，则气远会稀，所以隔两天或休息数日。看这个解释，那么朱丹溪说的辰戌丑未日为太阴疟，就不对了。子午虽说是少阴，但卯酉则是阳明；巳亥虽说是厥阴，但寅中则是少阳；丑未虽说是太阴，但辰戌则是太阳。三日发作的，还可以这样说；如果是数日发作的，又将如何辨别呢？大抵三日疟，初起在夏秋季节发作的，宜用二陈汤去橘皮，加生白术、槟榔、常山，以逐去痰癖为先，稍加穿山甲以透经络。至于暑邪结在营分，又当以香薷、鳖甲、茯苓、半夏、甘草、当归、生姜、大枣祛暑为要，前面的药就没有益处了。如果元气大虚，只用补正，宜用六君子汤加草果、乌梅，名为四兽饮，兼用本经引经药。如果元气下陷，每日发作时间逐渐推迟的，用补中益气汤大剂量人参、白术、生姜、大枣治疗。像常山、槟榔、山甲、草果，都成了戈戟（阻碍治疗的药物）了。
疟母，是顽痰挟带瘀血和食物结成的痞块，用鳖甲煎丸，或者小柴胡汤加鳖甲、莪术、桃仁，都用醋制。其中鳖甲要用栗灰汤煮烂入药，尤其有效。这是《金匮要略》的法度。病气都实的，用疟母丸。虚人久疟，时止时发的，用芎归鳖甲饮。如果不效，是脾虚，急用补中益气汤加鳖甲。少食痞闷，是胃虚，用四兽饮加鳖甲、当归、莪术、肉桂。虚人疟母，必须用补益法。大概是因为治疗不当，邪气潜伏在肝经，而胁下有肿块，仍然寒热时作，不可以当作癖积来治疗。每见急于攻伐痞块的，多导致不治。久疟不愈，必有留滞，须加鳖甲消除它。如果没有留滞，只宜补益。凡是寒热有固定周期的，是疟疾；没有固定周期的，是杂证。疟证诸经有邪，总离不开肝胆。
石顽说：经文说夏季中暑汗不出者，秋天成为疟疾。这个论述固然正确，但是轻重的区别，古今迥然不同。这大概是由天运使然，因为北方的风气营运到了南方。疟疾这一证候，向来淮河泗水以北最严重，大江以南很轻微。康熙壬子年，我们吴地患此病的人，家家户户都是如此。从夏天到秋天，一天比一天严重，其势头不亚于淮北。症状都是痞满呕逆，严重的甚至昏热谵语，脉象大多浑浑噩噩，不显弦象，也有关尺部微弦的。但其热势到早晨必然减轻，不像热病那样昼夜不分。当时的医生不加考察，混同于伤寒看待，因而误药致死的，每天接踵而至。推究其寒热的机理，又与往年不同。有一日内连发二三次的，有晨昏寒热再次出现的，有连发数日，中间两三天复发像以前的，有先热后寒的，有独寒无热的，有独热无寒的，有今日但寒明日但热的。证候虽然变幻无常，总不离和营散邪等法。但必须分虚实寒热轻重来治疗。纵观使用劫剂及祝由法术的，十无一验。间或有寒热停止但昏热不休的，又必须根据禀赋形气的偏胜，病气的盛衰来进行调适。全在于机用灵活，不可专守成法。而举世治疗疟疾，必先禁止饮食，一概使用疏风发散，兼消克痰食宽膈破气的药剂。消克不已，继进硝石、大黄，胃气更加受伤，浊邪更加上逆，正气如何能够运行，从而振奋祛除邪气的力量呢？我治疗久疟坏证，每每令病人继续进食稠粥，继与稀糜，使胃气输运，可行药力，然后施治。如此挽回的，不胜枚举。更有痊愈后又复发，复发后又痊愈，痊愈而又复发的，又须推究发作的原因而进行清理。像常山、草果、槟榔、厚朴、枳壳、青皮、石膏、知母等损伤中州脾胃的药，都不适宜。等到仲秋以后，不仅白虎汤应当禁用，即使不犯石膏、知母，邪气内陷变为肠澼（痢疾）的也很多。有先疟后痢的，有疟痢齐发的。曾遍考昔人治例，只有补中益气一方，虽然未能完全切合肯綮（关键），但也算是一隅之举，其余可类推。庸医不审察，只守通因通用的方法，导致夭折的很多。
〔诊法〕疟疾的脉象自然呈弦脉。弦数的多热，弦迟的多寒。弦小紧的可以下法治愈，弦迟的可以温法治疗，弦紧的可以发汗或针灸。浮大的可以吐法治疗。弦数的，是风邪发热，用饮食调养来制止它。
朱丹溪治疗一个少年，冬天患疟疾，从卯时足部寒冷，直到酉时才发热，寅初才停止。心想一定是因为房事后感寒所致。用人参大补汤加附子行经散寒以取汗，数日不得汗，因为足跗距离心脏远，药力难及。再用苍术、川芎、桃枝煎汤，盛在高桶里，扶着坐浸足至膝，约一顿饭功夫，以前药服用，汗出通身而愈。
汪石山治疗一个少年，六月因劳累患疟疾，取凉后梦遗，于是觉得恶寒，连日凄惨不爽。三日后头痛躁闷。
The *Yellow Emperor's Inner Canon* states: In malaria where chills precede fever, it is due to summer-heat injury. During summer, excessive sweating causes the cou li (skin pores) to open. If one is then exposed to cold water or air, the cold qi hides within the cou li and skin. When wind injury occurs in autumn, the disease forms. Cold belongs to Yin Qi, while wind belongs to Yang Qi. Injury by cold first, followed by wind, results in chills preceding fever. This disease occurs at fixed times and is called Cold Malaria (Han Nüe). Where fever precedes chills, it is due to wind injury first, followed by cold injury, resulting in fever preceding chills. It also occurs at fixed times and is called Warm Malaria (Wen Nüe). Where there is only fever without chills, it is because Yin Qi has exhausted first, allowing Yang Qi to flare alone. This presents with shortness of breath, vexation and oppression, heat in the hands and feet, and a desire to vomit; it is called Dan Nüe (Febrile Malaria).
Warm Malaria arises from wind injury in winter, where cold qi hides in the bone marrow. By spring, when Yang Qi expands vigorously, the pathogenic factor cannot exit on its own. If encountered with intense summer heat, the brain marrow is scorched, muscles waste, and the cou li opens. Or, due to physical exertion, the pathogen exits with sweat. This disease hides in the Kidney, and its qi moves from the interior to the exterior. In such cases, Yin is deficient and Yang is excess; excess Yang generates heat. When Yang declines, the qi returns inward; entering the interior leads to Yang deficiency, which generates cold. Thus, fever precedes chills, named Warm Malaria.
Dan Nüe arises from pre-existing heat in the Lungs, with Qi abundant throughout the body, counterflow rising upward, and fullness in the Middle Jiao that does not vent outward. Due to exertion, the cou li opens, and wind-cold lodges between the skin and muscle layers. Upon onset, Yang Qi becomes excessive. If Yang remains excessive without declining, disease ensues. The pathogen does not reach the Yin aspect, hence only fever without chills. The qi hides internally in the Heart and externally in the muscle layers, causing muscle wasting, thus named Dan Nüe.
Malaria of the Foot-Taiyang channel causes lower back pain and heavy head, with cold starting from the back, chills preceding fever, and sweating upon cessation of fever. Malaria of the Foot-Shaoyang channel causes bodily flaccidity, mild chills and fever, aversion to people, and palpitations upon seeing others, with profuse sweating. Malaria of the Foot-Yangming channel causes initial shivering chills, lasting long before fever, followed by sweating; patients prefer sunlight or firelight for comfort. Malaria of the Foot-Taiyin channel causes dissatisfaction, frequent sighing, anorexia, alternating chills and fever with sweating, vomiting upon onset, with improvement after vomiting. Malaria of the Foot-Shaoyin channel causes severe vomiting, alternating chills and fever (more fever than chills), a desire to stay behind closed doors, and is difficult to cure. Malaria of the Foot-Jueyin channel causes lower back pain, abdominal fullness, difficulty urinating resembling strangury but actually frequent urination, fearfulness, Qi deficiency, and abdominal depression.
Generally, treat malaria approximately one meal's time before onset; treating later misses the optimal timing.
The *Jin Gui Yao Lue* states: "When Yin Qi is isolated and exhausted, and Yang Qi flares alone, there is fever, shortness of breath, vexation, heat in the hands and feet, and desire to vomit; this is Dan Nüe. If there is only fever without chills, the pathogen hides internally in the Heart and externally in the muscle layers, causing muscle wasting."
The alternating chills and fever in malaria result from the struggle between Yin and Yang Qi. If Yin declines and separates, and Yang does not merge with Yin, Yang flares alone, causing only fever. Shortness of breath and vexation occur because the Lung governs Qi and is suppressed by Fire. Heat in the hands and feet occurs because Yang governs the four limbs; excess Yang causes limb heat. Desire to vomit occurs because Fire pathogen rushes upward, reversing Stomach Qi. Internal hiding in the Heart is due to excess Yang storing Fire internally and lodging externally in muscle layers. Muscle wasting is due to Fire scorching muscles. Viewing this alongside Warm Malaria, Bai Hu Tang (White Tiger Decoction) can be used for Dan Nüe.
Bai Hu Tang specializes in reducing fever; its action on muscle layers and limbs corresponds internally to the Spleen and Stomach, hitting the site of the pathogen. It also clears Lung Fire, addressing shortness of breath and vexation. If other concurrent symptoms exist, one might add herbs like Guizhi (Cinnamon Twig) as a precedent.
For Warm Malaria, the pulse resembles a normal person's, the body has no chills, only fever, joint soreness, and occasional vomiting; treat with Bai Hu Jia Guizhi Tang (White Tiger plus Cinnamon Twig Decoction).
The *Inner Canon* states Warm Malaria has fever preceding chills, while Zhang Zhongjing states it has only fever without chills, resembling Dan Nüe but distinct. Dan Nüe involves combined Yang pathogens steaming the Heart and Lungs, causing shortness of breath and muscle wasting. Warm Malaria has a normal pulse, indicating uncombined pathogen and undamaged fluids; Yang is diseased but Yin is not. Due to pre-existing Bi syndrome (obstruction) and blocked Ying and Wei circulation, malaria originates in Yang and does not enter Yin, causing joint soreness and vomiting. Use Bai Hu Tang to clear Yang pathogen and Guizhi to unblock Ying and Wei, harmonizing Yin and Yang, unblocking blood vessels, and curing through sweating. This differs significantly from Warm Malaria with surging pulses following unresolved Shanghan (Cold Damage) fever.
Malaria with predominant chills is called Pin Nüe (Yin Malaria); treat with Shuqi San (Shuqi Powder).
Pathogen hiding in the Heart causes only fever without chills (Dan Nüe). Pathogen hiding in the Kidney causes more chills than fever (Pin Nüe). Because the pathogen is knotted, Yang Qi cannot move outward, causing external cold. Accumulated fluids form phlegm, leading to more chills. This differs from the Shaoyin pattern in *Su Wen* which features more heat than chills. Use Shuqi with Jiangshui (fermented grain liquid) to induce vomiting and disperse Yang Qi; Longgu (Dragon Bone) consolidates Yin fluids; Yunmu (Mica) sinks yet lifts Yang, symbolizing clearing clouds. Yunmu is the root of Qiyanshi (Yang Rising Stone), warm and ascending, best for resolving dampness and moving phlegm. Adding Shuqi treats Taiyin Damp Malaria. The formula note says "Damp Malaria, add half fen of Shuqi," but editions mistakenly say "Warm Malaria," a major error. This refers to pathogen hiding in the marrow sea, named Pin Nüe. Zhao Yi-de misread the text, calling it Mu Nüe (Yang Malaria) due to heart involvement; Yu Jiayan repeated this error.
Malaria with thirst uses Chaihu Qu Banxia Gua Lou Tang (Bupleurum Decoction removing Banxia adding Trichosanthes Root). It also treats Lao Nüe (Consumptive Malaria). Thirst indicates exhaustion of Yangming fluids, caused by Shaoyang Wood-Fire robbing Stomach fluids. Since malaria pathogens fluctuate in Shaoyang, modify Xiao Chaihu Tang accordingly. Consumptive malaria also stems from Wood-Fire excess depleting fluids, so this formula applies.
Malaria with many chills and slight fever, or only chills, uses Chaihu Guijiang Tang (Bupleurum, Cinnamon Twig, and Ginger Decoction). One dose works miraculously. Though similar to Pin Nüe, the pathology differs: Pin Nüe hides in Shaoyin Qi level, whereas this hides in Shaoyang Ying-Blood level. Pathogen in Ying lacks outward momentum and does not contest Yang, causing chills predominance. Xiao Chaihu Tang balances Yin and Yang; adding Guizhi and Ganjiang moves toward Yang; adding Gualou and Shigypsum moves toward Yin.
Zhu Danxi treated Six Channels Malaria primarily with Er Chen Tang, adding channel-guiding herbs, proving "no phlegm, no malaria." General rules: Fever-chills use Chaihu Guizhi Tang; Chills-fever use Xiao Chaihu Tang; Much-fever/Only-fever use Bai Hu Jia Guizhi Tang; Much-chills/Only-chills use Chaihu Guijiang Tang. If much-chills but pulse is surging-full, treat as excess, do not use Guizhi/Ganjiang immediately. If much-fever but pulse is empty-soft, treat as deficiency, do not use Bai Hu Tang immediately. Chills > fever, anorexia, nausea/phlegm: Renshen Yangwei Tang. Fever > chills, bitter taste, dry throat, dark urine, or food-stagnation malaria: Qingpi Yin. Labor/diet-induced malaria with weakness/sweating: Buzhong Yiqi Tang + Banxia. Persistent sweating post-malaria (Wei deficiency): Renshen Shiwei Tang + Guizhi. Feng Nüe (Wind Malaria), aversion to wind, sweating, irritability, headache (Yang pathogen, fever-chills): Banxia, Chaihu, Qianghuo, Zisuye, Xixin, Shengjiang. Han Nüe (Cold Malaria), cooling/bathing in summer, no sweat, aversion to cold, cramps/pallor (Yin pathogen, chills-fever): Qianghuo, Zisuye, Guizhi, Chaihu, Caoguo, Houpo.
Shu Nüe (Summerheat Malaria), also called Dan Nüe, only fever, internal excess, vexation/thirst/vomiting, wasting: Xiao Chaihu Tang + Xiangru, Huanglian, Zhuye. Summer onset: Bai Hu Tang; Deficient: + Renshen. Autumn onset: Xiao Chaihu Tang. This is Lung heat, exhausted Yin, flaring Yang.
Wen Nüe comes from winter non-seasonal pathogens hiding in marrow, erupting in spring/summer heat-damp. Fever-chills or only fever. Spring: Xiao Chaihu Tang; Summer: Bai Hu Jia Guizhi Tang. High heat causes immediate fever without chills. Post-fever, internal deficiency mimics mild chills (not true aversion).
Pin Nüe hides in Kidney; Shī Nüe (Damp Malaria) hides in Taiyin from chronic dampness; both only chills, no fever. Treat with Shuqi San. Pathogen in Blood level, chills > fever, trembling: Chaihu Guijiang Tang. Lao Nüe with great thirst: Chaihu Qu Banxia Gua Lou Tang. Sweating/bathing, heaviness/pain, chills-fever/vomiting: Damp Malaria, Weiling Tang + Qianghuo, Zisuye. Shi Nüe (Food Malaria), irregular diet, phlegm in Middle Jiao + Wind: hunger but inability to eat, fullness after eating, distension, vomiting. Excess: Er Chen Tang + Zhike, Caoguo. Irregular diet/labor, prolonged, weak pulse: Lizhong Tang + Zhishi, Qingpi. Pre-existing Yin deficiency/cough or malaria-induced consumption: Modify tonic base with Guizhi, Shengjiang, Dazao. Do not use purely wind-resolving/phlegm-expelling drugs. If exterior pathogen is strong: Xiaojianzhong Tang or Huangqi Jianzhong Tang, followed by Liusheng Liuwei Wan + Guizhi, Biejia.
Onset timing: Before noon = Yang channel, easy to cure. After noon = Yin channel, hard to cure. Delayed onset = pathogen sinking to Yin; use Shengma, Chaihu to lift, Buzhong Yiqi Tang + Guizhi. Early onset = pathogen rising to Yang; guide via Xiao Chaihu Tang + Zhike, Jiegeng. Ye Nüe (Night Malaria), ghost malaria, pathogen in Blood; use Qianjin Neibu Jianzhong Tang + Shengma, Chaihu, Heshouwu. Spleen/Stomach deficiency: Buzhong Yiqi Tang + Heshouwu, Guizhi, Shaoyao. Zhang Nüe (Miasma Malaria), mountain/stream toxins; use anti-miasma/phlegm-resolving drugs. Yi Nüe (Epidemic Malaria), summer/autumn widespread, high fever, sweating, thirst: Dayuan Yin. Vexation/thirst/exterior signs: Guizhi Baihu Tang. Delirium/restlessness: Liangge San + Caoguo. Chills/fever/constipation: Da Chaihu Tang. Weak patient, post-dispersal persistent fever: Renshen Baidu San. Yu Zheng resembling malaria, bitter taste, vomiting clear fluid, blue face, hypochondriac pain, tinnitus, choppy pulse: Xiaoyao San double Chaihu + Wuzhuyu, Huanglian. Post-dysentery malaria, pathogen exiting Shaoyang: Xiao Chaihu Tang remove Huanglian + Guizhi, or Buzhong Yiqi Tang double Shengma, Chaihu.
Generally, early malaria: disperse pathogen, guide out. Prolonged: nourish Zheng, regulate Middle. Qi deficiency = chills; Blood deficiency = fever. Even if prolonged, if diet is unregulated, do not assume deficiency; restrict diet and guide out based on pulse. Robust appearance but Qi deficiency often has damp-phlegm, chills predominance. Prolonged, soft/deep/slipping pulse: Buzhong Yiqi Tang + Fuling, Banxia, + Shufuzi 2-3 fen. Post-malaria anorexia, fatigue, sallow complexion: Liujunzi Tang + Shanzha, Huanglian, Zhishi. Prolonged malaria, robust Yuan Qi: Renshen, Changshan 5 qian each, stir-fry lightly, remove Changshan, decoct Renshen, take before onset. Proven effective. After 4-5 attacks, previously dispersed: Heshouwu San. Robust: Qibao Yin. Night fever, excess pulse/pathogen (Blood level): Changshan Yin to intercept.
Prolonged malaria, failed treatments, no exterior/internal stagnation: Renshen 1 liang, Shengjiang 1 liang, slight Guizhi. Winter/no sweat: + Mahuang. Take at 5 AM before onset, cover for slight sweat. Severe cases: 3 days consecutively. All recover. Easy recovery post-cure. Poor families: halve Renshen, replace with Baizhu 5 qian. Suitable for deficiency/prolonged malaria, especially Three-Day Malaria. Night onset: + Danggui, Heshouwu. Effective. However, severe winter onset may fail with this or Buzhong Yiqi Tang; wait until mid-spring, use previous formula + Guizhi to sweat.
Zhu Danxi: Malaria is Three Yin Malaria. Every three days: Zi/Wu/Mao/You days = Shaoyin Malaria; Yin/Shen/Si/Hai days = Jueyin Malaria; Chen/Xu/Chou/Wei days = Taiyin Malaria. Correlate with pulse/symptoms to determine channel and treatment. *Inner Canon*: Intervals of 2+ days occur because pathogen and Wei Qi lodge in Six Fu organs, missing each other. Li Shicai: "Lodge" means meet. Pathogen in Fu organs means distant/rare meetings, hence intervals. Thus, Zhu Danxi's classification of Chen/Xu/Chou/Wei as Taiyin is incorrect. Zi/Wu are Shaoyin, but Mao/You are Yangming; Si/Hai are Jueyin, but Yin contains Shaoyang; Chou/Wei are Taiyin, but Chen/Xu are Taiyang. This logic holds for every three days, but fails for multi-day intervals.
For early Three-Day Malaria (summer/autumn): Er Chen Tang remove Juapi, + Baizhu, Binglang, Changshan to resolve phlegm-pi, + Chanshunjia to penetrate channels. Summerheat in Ying level: Xiangru, Biejia, Fuling, Banxia, Gancao, Danggui, Shengjiang, Dazao to resolve summerheat; previous herbs are useless. Great Qi deficiency: Tonify only, Liujunzi Tang + Caoguo, Wumei (Sishou Yin). Qi sinking, delayed onset: Buzhong Yiqi Tang large dose Renshen, Baizhu, Shengjiang, Dazao. Changshan, Binglang, etc., become obstacles.
Nü Mu (Malaria Mass), stubborn phlegm/blood/food knot forming mass: Biejia Jian Wan, or Xiao Chaihu Tang + Biejia, Ezhu, Taoren (vinegar processed). Biejia boiled in chestnut ash soup until soft. For excess pathogen/Qi: Nümu Wan. Deficiency/prolonged malaria, intermittent: Xionggui Biejia Yin. If ineffective, Spleen deficiency: Buzhong Yiqi Tang + Biejia. Anorexia/fullness, Stomach deficiency: Sishou Yin + Biejia, Danggui, Ezhu, Rougui. Deficiency Nü Mu requires tonification. Improper treatment leaves pathogen in Liver channel, hypochondriac mass, alternating chills/fever. Do not treat as accumulation; aggressive attack often fails. Prolonged malaria implies stagnation; add Biejia. No stagnation: tonify only. Fixed cycle = Malaria; irregular = Miscellaneous disease. Malaria always involves Liver/Gallbladder.
Shiwan: Text says summer heat without sweat leads to autumn malaria. True, but severity varies by era/climate due to northern winds moving south. Historically, north of Huai-Si was severe; south of Yangtze mild. Kangxi Renzi year, Wu region suffered heavily, daily worsening, comparable to north. Symptoms: fullness, vomiting, delirium, chaotic pulse (not necessarily wiry), heat subsiding by morning (unlike general fevers). Doctors mistook it for Shanghan, causing deaths. Mechanisms varied: multiple daily attacks, morning/evening cycles, relapses, various chills/fever patterns. Treatment must differentiate deficiency/excess/cold/heat.劫剂 (intercepting agents) and magical methods failed. If chills stop but fever/delirium persist, adjust based on constitution/pathogen strength. Flexibility is key. Global practice forbids diet, uses wind-dispersing/phlegm-resolving/breaking-agents, leading to further damage from Xiaoshi/Niaohuang, harming Stomach Qi and trapping turbid pathogens. I treat complicated prolonged malaria by maintaining congee/gruel to support Stomach Qi and transport medicine, then treating. Many recovered. Recurrent cases require investigating cause. Avoid damaging Middle Jiao herbs like Changshan, Caoguo, etc. After mid-autumn, avoid Baihu Tang even without Shigypsum/Zhimu, as pathogen may sink into intestines causing dysentery. Reviewing past cases, Buzhong Yiqi Tang is useful, though not perfect. Ignoring this leads to death.
[Diagnosis] Malaria pulse is naturally Wirly (Xian). Wirly-Rapid = more heat; Wirly-Chronous = more cold. Wirly-Small-Tight = purge; Wirly-Chronous = warm; Wirly-Tight = sweat/acupuncture. Floating-Big = vomit. Wirly-Rapid = Wind-Heat, manage with diet.
Zhu Danxi treated a youth with winter malaria: cold feet from Mao to You, fever until Yin. Suspected intercourse-induced cold. Used Renshen Dadu Tang + Fuzi to sweat, failed due to distance. Soaked feet in Cangzhu, Chuanxiong, Taozhi decoction, then administered medicine; whole-body sweat cured him.
Wang Shishan treated a youth with labor-induced June malaria, cooling after emission, chills, misery. Three days later: headache, restlessness.