（严用和） 治瘅疟，脉弦数，但热不寒。或热多寒少，膈满不食，口苦，舌干烦渴，
小便赤涩，大便不利。
青皮 浓朴（醋炒） 柴胡 黄芩（炒） 半夏（姜制） 茯苓 白术（土炒） 甘草
（炙） 草果
（二个，常山劫痰
疟为肝胆之邪，然多因脾胃受伤而起。脾属湿土，重感于暑湿，故见前证也。脾既受病，
木
茯苓用以渗湿，黄芩用以清热。草果辛热，能散太阴之积寒，除痰而截疟，（能清膏梁之痰
。）盖先去其害脾者。而以白术甘草，调而补之也。〔此即小柴胡汤加减，从温脾诸方而一
变也。张子和曰∶世医以疟为脾寒，甚者归之崇怪，良可笑也。刘宗浓曰∶盛暑阳极，伏阴
在内。人或纳凉澡浴，寒客肌肉之间，或饥饱劳役，内伤而病作。肌肉属脾，发则恶寒战栗
，乃谓之脾寒尔。实由风寒湿 ，邪郁腠理，夏时毛窍疏通而不为病。至秋收敛之际，表邪
不能发越，故进退不已，往来寒热，势如凌疟人之状，所以名疟。古方多兼理内伤取
脾胃和，精气通，阴阳和解，诸邪悉散，实非脾病也。世用发表解肌，温经散寒等法
尝执于燥脾劫剂也。吴鹤皋曰∶清脾非清凉之谓，乃攻去其邪，而脾部为之一清也。
因草果之辛热而讥焉。是未达严氏之精矣。高鼓峰曰∶治疟多方，俱不得要，唯此方为中正。
予每用此加减，无不愈者。盖疟发寒热，原属少阳半表半里，
脉之弦数，浓朴以宽胃中之积滞，草果以化痰消壅，苓术以实
疟固由外感，然必内伤而后外始感焉，此东垣之微旨也。严氏
起者，予每以苍术易白术，加陈皮以合平胃之意。热多寒少者
稍加前胡以发其郁热，无不应手而验。能审此而消息之，何
误服汤药病久者，不可执此为不易之法，是在学人神而明之
人参养胃汤养之。服热药多者，仍以小柴胡汤多加黄连丹皮
气以救之。发于夜者，益母草饮以济之。（益母草饮。一名
旨。不可脱也。〕
（严用和）治疗瘅疟，脉象弦数，只发热而不恶寒。或者热多寒少，胸膈胀满不想进食，口苦，舌干烦躁口渴，小便赤红涩痛，大便不通畅。
青皮、厚朴（醋炒）、柴胡、黄芩（炒）、半夏（姜制）、茯苓、白术（土炒）、甘草（炙）、草果。
（方解：）疟疾是肝胆之邪所致，然而大多因为脾胃受伤而引发。脾属湿土，再次感受暑湿之气，所以出现上述症状。脾既已受病，木气乘之（肝木克脾土），故用茯苓来渗利湿气，黄芩来清泄热邪。草果辛热，能驱散太阴脾经的积寒，祛除痰浊并截断疟疾。（它能清除因饮食肥甘厚味产生的痰浊。）这大概是先去除伤害脾脏的因素，然后用白术和甘草来调理并补益脾土。〔此方即小柴胡汤加减而来，是从温补脾阳诸方中一变而成。张子和说：世间的医生认为疟疾是脾寒，严重的甚至归结为鬼神作祟，实在可笑。刘宗浓说：盛夏阳极之时，伏阴在内。人们如果纳凉洗澡，寒气客居在肌肉之间，或者饥饱不匀、劳役过度，内伤而发病。肌肉属于脾，发作时恶寒战栗，所以才称之为脾寒。实际上是由风寒湿邪郁闭腠理，夏季毛窍疏通时未致病，到了秋季收敛之际，表邪不能发散，所以进退不已，往来寒热，态势如同凌虐病人一般，所以命名为疟。古方多兼理内伤，取脾胃调和，精气通畅，阴阳和解，各种邪气全部消散，其实并不是脾本身的病变。世人使用发表解肌、温经散寒等方法，常常拘执于燥脾劫痰的药剂。吴鹤皋说：清脾并非指清凉之意，而是攻去邪气，使脾部得以清净。他因为草果的辛热属性而讥讽此方。这是没有通达严氏用药的精妙之处。高鼓峰说：治疗疟疾的方法很多，都不得要领，只有这个方子最为中正平和。我每次使用此方加减，没有不痊愈的。大概疟疾发作的寒热，原本属于少阳半表半里证，脉象弦数，厚朴用来宽消胃中的积滞，草果用来化痰消除壅塞，茯苓和白术用来充实脾气。〕
疟疾固然由外感引起，但必须内伤之后外邪才能侵袭，这是李东垣的深意所在。严氏原方中，我每次用苍术代替白术，加入陈皮以符合平胃散的意旨。对于热多寒少的患者，稍加前胡以发散其郁热，没有不立即见效的。能够审察这些情况而斟酌运用，怎么会出错呢？误服汤药且病程长久的患者，不可固执地认为这是不变之法，这需要学习者神而明之地掌握。可用人参养胃汤来滋养。服用热药过多的患者，仍用小柴胡汤多加黄连、丹皮以救之。发于夜间的疟疾，用益母草饮来济助它。（益母草饮，又名……）[此处原文有缺漏或排版错误，依文意补全逻辑] 旨趣不可脱离。
(Yan Yonghe) Treats *Dan Nue* (Cachectic Malaria), characterized by a wiry and rapid pulse, fever without chills. Or, more heat than cold, chest fullness with anorexia, bitter taste in the mouth, dry tongue with restlessness and thirst, red and scanty urine, and difficult defecation.
Qingpi (Green Tangerine Peel), Houpo (Magnolia Bark, vinegar-fried), Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix, stir-fried), Banxia (Pinelliae Rhizoma, ginger-processed), Fuling (Poria), Baizhu (Atractylodis Macrocephalae Rhizoma, soil-stir-fried), Gancao (Licorice Root, honey-roasted), Caoguo (Tsaoko Fructus).
(Commentary:) *Nue* (Malaria) is caused by pathogenic factors of the Liver and Gallbladder, yet it often arises due to injury to the Spleen and Stomach. The Spleen belongs to Wet Earth; when heavily affected by Summerheat-Dampness, the aforementioned symptoms appear. Once the Spleen is diseased, Wood overacts on Earth (Liver Qi invades Spleen); therefore, Fuling (Poria) is used to leach out Dampness, and Huangqin (Scutellariae Radix) to clear Heat. Caoguo (Tsaoko Fructus) is pungent and hot; it can disperse accumulated Cold in the Taiyin (Spleen) channel, eliminate Phlegm, and arrest malaria. (It can clear Phlegm generated from rich dietary intake.) This implies first removing the factor harming the Spleen, and then using Baizhu (Atractylodis Macrocephalae Rhizoma) and Gancao (Licorice Root) to regulate and tonify it. [This formula is a modification of Xiao Chai Hu Tang (Minor Bupleurum Decoction), representing a shift from formulas that warm the Spleen. Zhang Zihe said: "Physicians of the world consider malaria as Spleen Cold; severe cases are attributed to demonic influence, which is truly laughable." Liu Zongnong said: "In the height of summer when Yang is at its peak, Yin lies hidden within. If people seek coolness or bathe, Cold pathogens lodge between the muscles; or if there is irregular eating or overexertion, internal injury occurs and disease manifests. Muscles belong to the Spleen; upon onset, there is aversion to cold and shivering, hence it is called 'Spleen Cold.' In reality, it is due to Wind-Cold-Damp pathogens stagnating in the cou-li (interstices). In summer, when pores are open, no disease occurs. But in autumn, when Qi converges, exterior pathogens cannot be vented, leading to alternating progression and regression, with alternating chills and fever, resembling the torment of malaria patients, thus named 'Malaria.' Ancient formulas often address internal injury simultaneously, aiming for harmony of the Spleen and Stomach, unobstructed Jing-Qi, reconciliation of Yin and Yang, and dispersion of all pathogens; this is actually not a disease of the Spleen itself. People use methods such as releasing the exterior and resolving the muscle layer, warming meridians and dispersing Cold, often sticking rigidly to drying-Spleen and expelling-Phlegm agents. Wu Hegao said: 'Qing Pi' does not mean cooling; rather, it means attacking and removing pathogens so that the Spleen region becomes clear. He ridiculed this formula because of the pungent-hot nature of Caoguo. This shows he did not grasp the subtlety of Yan's prescription. Gao Gugeng said: 'There are many methods for treating malaria, none hitting the mark, except this formula, which is perfectly balanced. I use this formula with modifications every time, and there is never a failure. Generally, the chills and fever of malaria originate in Shaoyang (Lesser Yang), half-exterior and half-interior. A wiry and rapid pulse indicates... Houpo (Magnolia Bark) widens and eliminates stagnation in the Stomach; Caoguo (Tsaoko Fructus) transforms Phlegm and removes obstruction; Fuling (Poria) and Baizhu (Atractylodis Macrocephalae Rhizoma) strengthen the Spleen Qi.']
Although malaria is indeed caused by external contraction, it must involve internal injury before the external pathogen can invade; this is the profound insight of Li Dongyuan. In Yan's original formula, I often substitute Cangzhu (Atractylodis Rhizoma) for Baizhu (Atractylodis Macrocephalae Rhizoma) and add Chenpi (Citri Reticulatae Pericarpium) to align with the intent of Pingwei San (Regularize the Stomach Powder). For cases with more heat than cold, adding slightly Qianhu (Peucedani Radix) to vent latent Heat yields immediate results. By examining these details and adjusting accordingly, how could one err? For those who have taken decoctions incorrectly and suffered long-term illness, one should not rigidly adhere to this as an immutable method; this requires practitioners to understand it spiritually and clearly. Use Renshen Yangwei Tang (Ginseng Decoction to Nourish the Stomach) to nourish them. For those who have taken too many hot medicines, still use Xiao Chai Hu Tang (Minor Bupleurum Decoction) with added Huanglian (Coptidis Rhizoma) and Danpi (Moutan Cortex) to rescue them. For malaria manifesting at night, use Yimucao Yin (Motherwort Decoction) to assist it. (Yimucao Yin, also known as...) [The text contains gaps/typos here, logical completion based on context]. The purport must not be detached.]