本草于知母、草果、乌梅、穿山甲皆言治疟。然知母性寒，入治足阳明独盛之火，使其退就太阳也；
草果性温燥，治足太阳独盛之寒，使其退就阳明也。二味合和，则无阴阳交作之变，故为君药。常山
主寒热疟，吐胸中痰结，故用为臣。甘草和诸药，乌梅去痰，槟榔除痰癖、破滞气，故用为佐。穿山甲以
其穴山而居，遇水而入，则是出阴入阳，穿其经络于荣分，以破暑结之邪，故用为使。若脾胃郁伏痰涎，用
之必效，苟或无痰，止是暑结荣分，独应足太阴血分热者，当发唇疮，此方无效。
《内经》诸病，惟疟最详。语邪则风、寒、暑、湿四气，皆得留着而病疟；语邪入客处所，则有肠胃
之
别，荣卫之舍，脊骨之间，五脏膜原与入客于脏者，浅深不一；语其病状，则分寒热先后；语
寒热多寡，则因反时而病，以应令气生长收藏之。此皆外邪所致也。湿在脏者，止以风寒中于肾。瘅疟
者，止以肺素有热。然冬令之寒得中于肾，其四脏令气之邪又宁无入客于所属脏乎？既肺本气之
热为疟，则四脏之气郁而为热者，又宁不似肺之为疟耶？举例可知余也。陈无择谓内伤七情、饥饱、
房劳，皆得郁而蕴积痰涎，其病气与卫气并则病疟。盖内外所伤之邪，皆因客在荣气之舍，故疟有止
发之定期。荣气有舍，犹行人之有传舍也。荣卫之气日行一周，历五脏六腑十二经络，界分必有其舍，舍
与邪合，合则阴盛，阴盛则阳虚，于是阴阳相并而病作。其作也，不惟脉外之卫虚并入于阴，《灵枢》所
谓足阳明与卫俱行者亦虚，阳明之气虚，则天真因水谷而充大者亦暂衰，所以疟作之际禁勿治刺，恐伤
胃气与其真也。必待阴阳并极而退，荣卫天真胃气继而复集，邪留所客之地，然后治之；或当其
病未作之先，迎而夺之。先生谓∶疟邪得于四气之初，胃气弱者即病，胃气强者伏而不动。至于再感，胃
气重伤，其病乃作。此为外邪，必用汗解。虚者先以参、术实胃，加药取汗。惟足属阴，最难得汗，汗
出至足
乃佳。取汗非特麻黄，但开郁通经，其邪热则散为汗矣。又云∶疟发于子后午前者，阳分受病，
易愈；午后亥前者，阴分，难愈。必分阴阳气血药以佐之，观形察色以别之，尝从是法以治。形壮色
泽者，病在气分，则通经开郁以取汗；色稍夭者，则补虚取汗。挟痰者，先实其胃一二日，方服劫
药。形弱色枯则不取汗，亦不可劫，补养，以通经调之。形壮而色紫黑，病在血分，则开其涩滞。色枯
者，补血调气。此其常也。至若取汗而不得汗，理血而血不开，非更求药，切中病情，直造邪所着处，
安能愈乎？
一老人疟、嗽半载，两尺脉数有力，色稍枯，盖服四兽饮等剂，中焦湿热下流，伏结于肾，以致肾
水上连于肺，故疟、嗽俱作。参、术、芩、连、升麻、柴胡调中一二日，与黄柏丸两日，夜梦交通。此肾热
欲解，故从前阴精窍而走散。无忧也，次日疟、嗽顿止。
一富家子，年壮病疟，自卯足寒，至酉分方热，至寅初乃休，一日一夜止苏一时。因思必为入房感寒所
致，问云∶九月暴寒夜半，有盗急起，不着中衣，当时足即冷，十日后疟作。盖足阳明与冲脉合宗筋会于
气街，入房太甚则足阳明与冲脉之气皆夺于所用，其
寒乘虚而入，舍于二经；二经过胫，会足跗上，于是二经之阳气益损，不能渗荣其经络，故病作，卒
不得休。因用参、术大补，附子行经，加散寒以取汗。数日不得汗，病如前。因思足跗道远，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，以前所服药饮之，汗出通身病愈。先
生遇奇症，则设规矩，旁求曲会，施行以权。
本草书中对于知母、草果、乌梅、穿山甲都记载有治疗疟疾的功效。然而，知母性寒，用于治疗足阳明经独盛的火热之邪，使其退却并归于太阳经；草果性温燥，用于治疗足太阳经独盛的寒邪，使其退却并归于阳明经。这两味药配合使用，就能避免阴阳交替发作的变化，因此作为君药（主药）。常山主治寒热往来的疟疾，能吐出胸中的痰结，所以用作臣药（辅药）。甘草调和诸药，乌梅去除痰湿，槟榔消除痰癖、破滞气，所以用作佐药（协助药）。穿山甲因为它的习性是居山穴处，遇水则入，这象征着从阴出阳，穿透经络进入营分（运行于脉中的气血），以破除暑邪结聚的病邪，所以用作使药（引经药或引导药）。如果是因为脾胃郁伏的痰涎导致的疟疾，用此方必然有效；但如果体内没有痰，仅仅是暑邪结聚在荣分，且仅对应足太阴脾经血分的热证，表现为嘴唇生疮，那么此方就无效了。
《黄帝内经》中关于各种疾病的论述，唯独对疟疾最为详尽。论及致病邪气，风、寒、暑、湿四气，都能留滞体内而引发疟疾；论及邪气入侵的部位，则有肠胃之别、营卫之所、脊骨之间、五脏膜原以及侵入脏腑等不同层次，深浅不一；论及其病症表现，则分为寒与热的先后顺序；论及寒热症状的多寡，则因反季节发病，以应合时令之气生长收藏的规律。这些都是由外邪引起的。湿气在脏，仅是风寒侵袭肾脏所致。瘅疟（一种但热不寒的疟疾），仅是因为肺素来有热。然而，冬季的寒邪中伤肾脏，其他四脏时令之气的邪气难道不会侵入所属的脏腑吗？既然肺本气之热可以导致疟疾，那么其他四脏之气郁结化为热，难道不会像肺一样导致疟疾吗？以此为例可以推知其余情况。陈无择认为内伤七情、饥饱失调、房劳过度，都会导致郁结蕴积痰涎，其病气与卫气（行于脉外，具有防御作用的气）相搏结就会患疟疾。大概内外所伤的邪气，都是因为客居于营气之所，所以疟疾有固定的发作时间。营气有所居之处，就像行人有驿站一样。营卫之气每天循环一周，经过五脏六腑和十二经络，界限分明必有其所居之处，居所与邪气结合，结合后阴气盛，阴气盛则阳气虚，于是阴阳相搏结而疾病发作。发作时，不仅脉外的卫气虚弱并入于阴，《灵枢》所说的足阳明经与卫气共同运行的部分也虚弱，阳明之气虚弱，那么依靠水谷精微充养的天真元气也会暂时衰退，所以在疟疾发作之际禁止针刺治疗，恐怕会损伤胃气与真气。必须等到阴阳极盛之后消退，营卫天真胃气随后重新聚集，邪气留在其所客居的地方，然后再进行治疗；或者在疾病未发作之前，迎头痛击以祛除邪气。先生曾说：疟邪在感受四气之初，胃气弱的人立即发病，胃气强的人邪气潜伏而不发作。直到再次感邪，胃气严重受损，疾病才发作。这是外邪所致，必须用发汗法解表。体虚者先用人参、白术充实胃气，加药取汗。只有足部属阴，最难出汗，汗出至足部为佳。取汗不仅仅依靠麻黄，只要开通郁结、疏通经络，邪热就会随汗消散。又说：疟疾在子时后午时前发作的，属于阳分受病，容易治愈；午后亥时前的，属于阴分，难治愈。必须分辨阴阳气血用药来辅助，观察形体面色来辨别，我曾遵循这种方法治疗。形体壮实、色泽好的，病在气分，则疏通经络、开郁结以取汗；色泽稍显枯槁的，则补虚以取汗。挟带痰湿的，先充实胃气一两天，再服用截疟药。形体虚弱、面色枯槁的则不取汗，也不可强行截疟，应补养身体，通过疏通经络来调理。形体壮实而面色紫黑，病在血分，则开通涩滞。面色枯槁的，补血调气。这是一般规律。至于取汗而不得汗，理血而血不开通，如果不另求药物，切中病情，直达邪气所在之处，怎么能痊愈呢？
一位老人患疟疾、咳嗽半年，两尺脉数而有力，面色稍枯，大概是服用了四兽饮等药剂，导致中焦湿热下流，伏结于肾，致使肾水上连于肺，所以疟疾、咳嗽同时发作。用人参、白术、黄芩、黄连、升麻、柴胡调理中焦一两天，再服用黄柏丸两天，夜间梦见男女交合。这是肾热欲解的表现，所以从前阴精窍排出消散。无需担忧，次日疟疾、咳嗽顿时停止。
一位富家子弟，年轻力壮却患疟疾，从卯时足冷开始，到酉时才发热，到寅初才停止，一天一夜只清醒一个小时。我思考这必定是入房后感寒所致，询问得知：九月突发寒冷半夜，有盗贼急起，没穿内衣，当时脚立刻变冷，十日后疟疾发作。足阳明胃经与冲脉汇合于宗筋，交会于气街（腹股沟动脉搏动处），入房过度则足阳明与冲脉之气都被耗损，寒气乘虚而入，客居于这两条经脉；这两条经脉经过胫部，交会于足背，于是这两条经脉的阳气进一步受损，不能渗润滋养经络，所以疾病发作，最终无法停止。于是用人参、白术大补正气，附子通行经络，加散寒药以取汗。几天后仍不出汗，病情如前。我思考足背距离身体较远，药力难以到达，再用苍术、川芎、桃枝煎汤，盛在高桶里，扶坐浸泡双脚至膝盖，吃顿饭的功夫后，喝下之前服的药，全身出汗，病愈。先生遇到疑难杂症，则设立规矩，多方寻求曲折领会，施行权变之法。
The Materia Medica states that Rhizoma Anemarrhenae (Zhimu, 知母), Fructus Tsaoko (Caoguo, 草果), Fructus Mume (Wumei, 乌梅), and Squama Manis (Chuanshanjia, 穿山甲) are all indicated for the treatment of malaria. However, Rhizoma Anemarrhenae is cold in nature and treats the excessive fire of the Foot-Yangming Stomach Meridian, causing it to retreat and align with the Foot-Taiyang Bladder Meridian; Fructus Tsaoko is warm and drying, treating the excessive cold of the Foot-Taiyang Bladder Meridian, causing it to retreat and align with the Yangming Meridian. When these two herbs are combined, they prevent the alternation of Yin and Yang symptoms, thus serving as the Sovereign Drug (Jun Yao). Radix Dichroiae (Changshan, 常山) primarily treats cold-heat alternating malaria and expels phlegm knots from the chest, so it is used as the Minister Drug (Chen Yao). Radix Glycyrrhizae (Gancao, 甘草) harmonizes the various herbs, Fructus Mume eliminates phlegm, and Areca Seed (Binglang, 槟榔) removes phlegm accumulation and breaks stagnant Qi, so they are used as the Assistant Drugs (Zuo Yao). Squama Manis, due to its habit of dwelling in mountain burrows and entering water, symbolizes emerging from Yin into Yang; it penetrates the meridians to enter the Ying (Nutrient) level to break up pathogenic heat constrained by summerheat, thus serving as the Envoy Drug (Shi Yao). If the malaria is caused by phlegm-fluids stagnating in the Spleen and Stomach, this formula will be effective. However, if there is no phlegm, and the condition is merely summerheat constraining the Ying level, specifically corresponding to heat in the Blood level of the Foot-Taiyin Spleen Meridian manifesting as lip sores, this formula will be ineffective.
The *Neijing* discusses various diseases, but provides the most detailed account of malaria. Regarding pathogenic factors, Wind, Cold, Summerheat, and Dampness can all linger in the body and cause malaria. Regarding the location of pathogen invasion, there are distinctions between the Intestines and Stomach, the abodes of Ying and Wei (Defensive) Qi, the interspinous spaces, the membrane origins of the Five Zang Organs, and invasion into the Zang organs themselves, varying in depth. Regarding clinical manifestations, it distinguishes the sequence of cold and heat. Regarding the predominance of cold or heat, it relates to counter-seasonal illness responding to the growth, development, storage, and concealment of seasonal Qi. These are all caused by external pathogens. Dampness affecting the Zang organs results solely from Wind-Cold invading the Kidney. Dan Malaria (a type of malaria characterized by fever without chills) results solely from pre-existing heat in the Lung. However, if Winter Cold invades the Kidney, would the pathogenic Qi of the other four Zang organs not also invade their respective organs? Since heat in the Lung's intrinsic Qi can cause malaria, would heat generated by stagnation in the other four Zang organs not similarly cause malaria? This example illustrates the rest. Chen Wuyue stated that internal injuries from Seven Emotions, irregular diet, and sexual exhaustion can all lead to stagnation and accumulation of phlegm-fluids. When this pathogenic Qi combines with Wei Qi, malaria occurs. Essentially, both internal and external pathogenic factors reside in the abode of Ying Qi, which is why malaria has regular intervals of onset and remission. Ying Qi has its abode, much like travelers have relay stations. Ying and Wei Qi circulate once daily through the Five Zang Organs, Six Fu Organs, and Twelve Meridians, having distinct abodes. When the abode combines with the pathogen, Yin becomes excessive and Yang becomes deficient. Thus, Yin and Yang contend, and the disease manifests. During an attack, not only is the Wei Qi outside the vessels deficient and merging into Yin, but also the Foot-Yangming Stomach Meridian, which travels with Wei Qi as described in the *Lingshu*, becomes deficient. Deficiency of Yangming Qi leads to a temporary decline of Tianzhen (innate) Qi nourished by food and drink. Therefore, acupuncture is contraindicated during malaria attacks to avoid damaging Stomach Qi and True Qi. Treatment should wait until Yin and Yang extremes recede, and Ying, Wei, Tianzhen, and Stomach Qi recover, allowing the pathogen to remain in its location before intervening; or one may intercept the pathogen before the disease manifests. The Master said: When contracting the Four Pathogens initially, those with weak Stomach Qi fall ill immediately, while those with strong Stomach Qi harbor the pathogen without manifestation. Upon re-infection, severe damage to Stomach Qi triggers the disease. As an external pathogen, it must be resolved via sweating. For deficiency patterns, first strengthen the Stomach with Ginseng Radix (Renshen, 人参) and Atractylodis Macrocephalae Rhizome (Baizhu, 白术), then add herbs to induce sweating. Sweating is difficult in the lower extremities as they belong to Yin; sweating reaching the feet is ideal. Inducing sweat does not rely solely on Ephedrae Herba (Mahuang, 麻黄); any method that opens stagnation and unblocks meridians will dissipate pathogenic heat as sweat. Furthermore, malaria occurring after Zi hour and before Wu hour affects the Yang aspect and is easier to cure; occurring after Wu hour and before Hai hour affects the Yin aspect and is harder to cure. One must differentiate Yin and Yang, Qi and Blood to guide medication, and observe form and complexion. In my practice, I have followed this method. For robust patients with good complexion, the disease is in the Qi level; unblock meridians and open stagnation to induce sweat. For those with slightly sallow complexion, tonify deficiency to induce sweat. For cases with phlegm, first strengthen the Stomach for one to two days, then administer antimalarial drugs. For frail patients with withered complexion, do not induce sweat nor forcibly arrest malaria; instead, tonify and nourish, regulating through meridian unblocking. For robust patients with purple-black complexion, the disease is in the Blood level; resolve stagnation. For those with withered complexion, tonify Blood and regulate Qi. This is the general rule. However, if sweating fails to produce sweat, or blood regulation fails to open blood stasis, unless one seeks new medications that precisely address the pathology and reach the exact site of pathogen attachment, how can recovery be achieved?
An elderly man suffered from malaria and cough for half a year. His Chi pulses at both wrists were rapid and forceful, and his complexion was slightly sallow. He had previously taken Si Shou Yin (Four Beast Decoction) and similar formulas, leading to damp-heat in the Middle Jiao flowing downward and binding in the Kidney, causing Kidney Water to ascend to the Lung, resulting in simultaneous malaria and cough. After regulating the Middle Jiao with Ginseng Radix, Atractylodis Macrocephalae Rhizome, Scutellariae Radix (Huangqin, 黄芩), Coptidis Rhizoma (Huanglian, 黄连), Rhizoma Cimicifugae (Shengma, 升麻), and Bupleuri Radix (Chaihu, 柴hu) for one to two days, followed by Huangbai Wan (Phellodendron Pill) for two days, he dreamed of sexual intercourse. This indicated that Kidney Heat was resolving and dispersing through the anterior essence orifice. There was no need for worry; the next day, malaria and cough ceased abruptly.
A wealthy young man, strong in youth, suffered from malaria. His feet became cold from Mao hour, he developed fever by You hour, and it subsided at Yin hour, leaving him conscious for only one hour in a twenty-four-hour cycle. I reasoned this must be due to cold contraction after sexual activity. Inquiry revealed that in September, during a sudden cold snap at midnight, he rose hastily to catch a thief without wearing inner garments, causing his feet to turn cold immediately. Ten days later, malaria began. The Foot-Yangming Stomach Meridian and Chong Mai (Penetrating Vessel) converge at the Zongjin (major tendons) and intersect at Qichuan (the groin region). Excessive sexual activity depletes the Qi of both the Foot-Yangming and Chong Mai. Cold entered through this deficiency and lodged in these two meridians. These meridians pass through the shins and intersect at the dorsum of the foot. Consequently, Yang Qi in these meridians was further damaged and could not moisten and nourish the meridians, causing the disease to persist. I prescribed large doses of Ginseng Radix and Atractylodis Macrocephalae Rhizome to strongly tonify, along with Aconiti Lateralis Radix Praeparata (Fuzi, 附子) to promote meridian circulation and herbs to dispel cold and induce sweating. After several days, no sweat occurred, and the condition remained unchanged. I reasoned that the distance to the dorsum of the foot made it difficult for medicinal power to reach. I prepared a decoction of Atractylodis Rhizoma (Cangzhu, 苍术), Ligusticum Chuanxiong Rhizome (Chuanxiong, 川芎), and Peach Twig (Taozhi, 桃枝) in a high tub. Having him sit and soak his feet to the knees for the time it takes to eat a meal, he then drank the previously prepared medicine. Full-body sweating ensued, and the disease was cured. When encountering complex cases, the Master established principles, sought understanding through diverse approaches, and applied flexible strategies.