寒热往来有定候。一日一发者邪浅。二日一发者邪深。三日一发者邪更深。先寒后热者
为顺。先热后寒者为逆。自子至午发者为阳。自午至子发者为阴。单寒无热者名牡疟。为纯
阴病。单热无寒者为瘅疟。为纯阳病。疟病因劳而发者名劳疟。因食而发者名食疟。更有鬼
疟为祟病。瘴疟疾感岚气而成。种种不同。总以少阳一经为主。以少阳居阴阳之界。偏阴则
寒多。偏阳则热多。阴阳俱病。则寒热等。单寒单热。为阴阳偏造具极。即祟疟瘴疟。亦阳
气之虚。正虚不能胜邪。内虚不能御外。脾胃之阳虚。不能熟腐水谷。俱不离少阳一经。
疟脉自弦（浮弦表邪 沉弦里邪。 迟弦属寒。 数弦痰饮。 洪弦属热。 实弦食积。）
久疟之脉（渐缓则愈 弦紧则殆。 吐散双弦。 代散莫救。）
初起俱宜小柴胡汤。一日一服。五日必愈。方中柴胡一味。少则用四钱。多则用八钱。
切不可少。此一味。神农推为上品。久服延年益寿之药。自李东垣及李时珍之书行。此药之
真面目渐掩。张景岳新造五柴胡饮为散剂。更属无知妄作流毒非轻。○凡初起无汗。去人参
加桂枝三钱。服后食热粥温覆。微似汗则愈。未愈再服之。有利无弊。切勿惑于浅人之说。
○若发热甚。汗不出。可加麻黄三钱。如病家惑于邪说。牢不可破。即以杏仁紫苏防风各三
钱。代麻黄。服后温覆。微似汗。不用食粥。○上下午疟。不必过分。唯以寒多者属阴盛。
加桂枝三钱。生姜宜倍用之。或再加吴萸三钱。单寒无热者。亦用此法。或去黄芩。再加熟
附子二钱。○热多者属阳盛。加知母贝母各三钱。汗多而大热大渴者。加生石膏五钱。麦冬
三钱。粳米四钱。单热无寒者亦用此法。或再加知母三钱。先热后寒者名痹疟。治同。宜加
桂枝二钱。是从金匮白虎加桂枝汤中仿出。○鬼疟。脉乍大乍小。加藿香二钱。以香为天地
之正气。正能胜邪也。天麻三钱。以天麻之形如魁芋。有二十四子周环于外。其苗名赤箭。
取弧矢以示威之义也。○瘴疟。加苍术藿香各二钱。○食疟。以平胃散采入柴胡一味为君。
融合二方为一方。即前人复方法也。○劳疟。是虚人不能耐劳而病疟。宜小柴胡原方。去半
夏。加栝蒌根二钱。或佐以补中益气汤。○一切疟疾口渴。俱去半夏。加栝蒌根。以生津液。
凡一切疟疾。欲急于取效。俟三发之后。以小柴胡汤。加常山三钱。寅时服。渣再煎于辰时
再服如吐。任其吐去痰涎。自愈。○时医惑于俗传本草。谓常山是截疟猛药。邪未尽而强截
之。多变他病。此无稽之臆说也。盖常山从阴出阳。为透邪外出之良药。仲景用其苗名为蜀
漆。今人用其根。何尝是强截之药。
一久疟不愈。及三阴疟三日一发者。诸药不效。惟以白术一两或二两加生姜五七钱。水
煎一杯。于寅时服之渣再煎。于上午再服。如热多者。以当归一两余。代白术。○如脾肾两
虚。诸药不效者。用近效白术汤一日两服。服到十日必愈。（书成。友人自安徽回赠余医书
一帙。乃张心在新着附经也。中有三阳交于胆。三阴交于脾。三阳之疟治胆。三阴之疟治脾
句。真是名言可佩。此君若得名师益友而讲论之。将来为医中一巨擘。恨未悟其人。）
一初病疟。世称胎疟。缠绵难愈。与痘疹之症。本于胎毒无异。宜六君子汤。加草果乌
梅。或合小柴胡汤。
一久疟不愈。不必治疟。只以六君子汤。补中益气汤。兼吞桂附八味丸。调理半月无不
痊愈。今医俱遵景岳法。用何人饮休疟饮方中。以何首乌一味为主。据云中和之道。其实苦
涩之品不能食入。余屡见久服此药。多变出肿胀等病。学人不可不知。
寒热往来发作有固定的时间规律。每天发作一次的，病邪较浅；每两天发作一次的，病邪较深；每三天发作一次的，病邪更深。先感到寒冷随后发热的，属于顺证；先发热随后感到寒冷的，属于逆证。从子时到午时发作的，属于阳证；从午时到子时发作的，属于阴证。只有寒冷没有发热的，称为牡疟（Mǔ Nüe），属于纯阴病；只有发热没有寒冷的，称为瘅疟（Dān Nüe），属于纯阳病。因劳累而诱发的疟疾，称为劳疟（Láo Nüe）；因饮食不当而诱发的，称为食疟（Shí Nüe）。更有鬼疟（Guǐ Nüe）这种由祟气作怪的疾病，以及瘴疟（Zhàng Nüe）这种感受山岚瘴气而成的疾病，情况种种不同，但总以少阳经（Shaoyang Channel）的病机为主。因为少阳经位于阴阳交界之处，偏于阴则寒多，偏于阳则热多，阴阳俱病则寒热相等。单寒或单热，是阴阳偏盛到了极点。即使是祟疟和瘴疟，也是由于阳气虚弱，正气不足不能战胜邪气，内部虚弱不能抵御外邪，脾胃阳气虚弱不能腐熟水谷，这些都不脱离少阳经的范围。
疟疾的脉象自然呈现弦脉（Xian Pulse，端直以长，如按琴弦）：浮弦表示表邪，沉弦表示里邪，迟弦属寒，数弦属痰饮，洪弦属热，实弦属食积。久疟的脉象：逐渐缓和则痊愈，弦紧则危险，吐散双弦，代散则不可救药。
初起时都适宜服用小柴胡汤（Xiaochaihu Decoction），一天服用一剂，五天必定痊愈。方中的柴胡一味药，最少用四钱，最多用八钱，切不可用量过少。这一味药，神农将其推为上品，是久服能延年益寿的药物。自从李东垣和李时珍的书籍流传后，这味药的真面目才逐渐被掩盖。张景岳新创制的五柴胡饮作为散剂，更是无知妄作，流毒非轻。○凡是初起无汗的，去掉人参，加入桂枝三钱，服药后喝热粥并温覆取微汗即可痊愈，未愈再服，只有好处没有坏处，切勿被浅薄之人的言论所迷惑。○如果发热严重，不出汗，可以加麻黄三钱。如果病人家属受邪说迷惑，固执己见，就用杏仁、紫苏、防风各三钱代替麻黄，服药后温覆取微汗，不需要喝热粥。○上下午都发作的疟疾，不必过分治疗，只是对于寒多者，属于阴盛，加桂枝三钱，生姜宜加倍使用，或者再加吴茱萸三钱。单寒无热的，也用此法，或者去掉黄芩，再加熟附子二钱。○热多者属于阳盛，加知母、贝母各三钱。出汗多且大热大渴的，加生石膏五钱，麦冬三钱，粳米四钱。单热无寒的也用此法，或者再加知母三钱。先热后寒的称为痹疟（Bi Nüe），治疗方法相同，宜加桂枝二钱，这是从《金匮要略》的白虎加桂枝汤（Baihu Jia Guizhi Decoction）中仿效出来的。○鬼疟，脉象忽大忽小，加藿香二钱，因为香气是天地间的正气，正气能战胜邪气。加天麻三钱，因为天麻的形状像魁芋，周围有二十四个子环抱，其苗名叫赤箭，取弧矢以示威严的意思。○瘴疟，加苍术、藿香各二钱。○食疟，以平胃散（Pingwei San）为基础，采入柴胡一味作为君药，融合两方为一一方，这就是前人所说的复方法。○劳疟，是体虚之人不能耐受劳累而患疟疾，适宜用小柴胡汤原方，去掉半夏，加栝蒌根二钱，或者佐以补中益气汤（Buzhong Yiqi Decoction）。○一切疟疾出现口渴症状的，都去掉半夏，加栝蒌根，以生津液。
凡是一切疟疾，想要急于见效，等发作三次之后，用小柴胡汤加常山三钱，在寅时服用，药渣再煎，在辰时再服。如果发生呕吐，任其吐出痰涎，自然会痊愈。○当时的医生受世俗流传的本草书迷惑，认为常山是截疟的猛药，邪气未尽而强行截断，容易变生其他疾病，这是毫无根据的臆说。其实常山从阴出阳，是透邪外出的良药，张仲景用它的花蕾名为蜀漆（Shuqi），现在人用它的根，何尝不是强截之药？
对于久疟不愈，以及三阴疟（Sanyin Malaria，三日一发者），各种药物无效的情况，只用白术一两或二两，加生姜五七钱，水煎一杯，在寅时服用，药渣再煎，在上午再服。如果热多者，用当归一两余代替白术。○如果是脾肾两虚，各种药物无效的，用近效白术汤（Jinxiao Baizhu Decoction），一天服用两次，服到十天必定痊愈。（书稿完成时，朋友从安徽回来赠送我一批医书，是张心在新著的《附经》，其中有“三阳交于胆，三阴交于脾”、“三阳之疟治胆，三阴之疟治脾”的句子，真是值得钦佩的名言。此人如果有名师益友与之讲论，将来必成为医学界的巨擘，可惜我不认识他。）
初病疟疾，世人称为胎疟（Tai Nüe），缠绵难愈，与痘疹病症，本源于胎毒无异，适宜六君子汤（Liujunzi Decoction），加草果、乌梅，或者合用小柴胡汤。
久疟不愈，不必专门治疟，只用六君子汤、补中益气汤，兼吞桂附八味丸（Guifu Bawei Wan），调理半月无不痊愈。现在的医生都遵循张景岳的方法，使用何人饮（Heren Yin）、休疟饮（Xiunüe Yin），方中以何首乌一味为主，据说是中和之道，其实是苦涩之品难以入口。我多次见到长期服用此药，反而变生出肿胀等疾病，学习者不可不知道。
The alternating chills and fever occur at fixed intervals. When it occurs once a day, the pathogenic factor is shallow; when it occurs once every two days, the pathogenic factor is deep; when it occurs once every three days, the pathogenic factor is even deeper. Chills preceding fever is a favorable pattern (Shun); fever preceding chills is an unfavorable pattern (Ni). Occurrence from Zi hour to Wu hour belongs to Yang; occurrence from Wu hour to Zi hour belongs to Yin. Only chills without fever is named Mu Nüe (Male Malaria), which is a pure Yin disease; only fever without chills is named Dan Nüe (Fever Malaria), which is a pure Yang disease. Malaria induced by fatigue is named Lao Nüe (Labor Malaria); that induced by improper diet is named Shi Nüe (Food Malaria). Furthermore, there is Gui Nüe (Ghost Malaria) caused by malevolent influences, and Zhang Nüe (Miasma Malaria) contracted from mountain miasma. These conditions vary greatly but are primarily governed by the Shaoyang channel (Shaoyang Jing). Since Shaoyang resides at the boundary of Yin and Yang, bias towards Yin results in more chills, while bias towards Yang results in more fever. If both Yin and Yang are diseased, chills and fever are equal. Pure chills or pure fever indicate extreme deviation of Yin or Yang. Even Gui Nüe and Zhang Nüe stem from deficiency of Yang Qi, where righteous Qi is insufficient to overcome pathogenic factors, internal deficiency fails to resist external invasion, and deficiency of Spleen and Stomach Yang fails to ripen and transform food and fluids. All these do not depart from the Shaoyang channel.
The pulse in malaria is naturally Xian (String-like). Floating Xian indicates exterior pathogen; sunken Xian indicates interior pathogen; slow Xian indicates Cold; rapid Xian indicates Phlegm-Fluid; surging Xian indicates Heat; full Xian indicates Food Retention. The pulse in chronic malaria: gradual slowing indicates recovery; string-tight indicates danger; vomiting with scattered double string-pulse; intermittent with scattered pulse indicates incurability.
At the onset, Xiaochaihu Tang (Minor Bupleurum Decoction) is suitable for all cases. One dose per day, cure is expected within five days. In this formula, Chai Hu (Bupleuri Radix) should be used in doses ranging from four qian to eight qian; it must not be underdosed. This single herb was ranked as a superior grade by Shennong, believed to prolong life and enhance vitality when taken long-term. Since the works of Li Dongyuan and Li Shizhen circulated, the true nature of this herb has been obscured. Zhang Jingyue's newly created Wuchaihu Yin (Five Bupleurum Drink) as a powder is considered ignorant and reckless, causing significant harm. ○ For cases with no sweat at onset, remove Ren Shen (Ginseng Radix et Rhizoma) and add Guizhi (Cinnamomi Ramulus) 3 qian. After ingestion, consume hot porridge and cover warmly to induce slight sweating for cure. If not cured, administer again. This approach is beneficial and harmless; do not be misled by superficial opinions. ○ If fever is severe with no sweat, add Mahuang (Ephedrae Herba) 3 qian. If the patient's family is stubbornly influenced by erroneous theories, substitute Mahuang with Xingren (Armeniacae Semen Amarum), Zisu Ye (Perillae Folium), and Fangfeng (Saposhnikoviae Radix), each 3 qian. Cover warmly after ingestion to induce slight sweating; hot porridge is not required. ○ For malaria occurring in both morning and afternoon, excessive treatment is unnecessary. However, for cases with more chills indicating excess Yin, add Guizhi (Cinnamomi Ramulus) 3 qian, use twice the amount of Shengjiang (Zingiberis Rhizoma Recens), or additionally add Wuzhuyu (Evodiae Fructus) 3 qian. For pure chills without fever, apply this method, or remove Huangqin (Scutellariae Radix) and add Shu Fuzi (Aconiti Lateralis Radix Praeparata) 2 qian. ○ For cases with more heat indicating excess Yang, add Zhimu (Anemarrhenae Rhizoma) and Beimu (Fritillariae Cirrhosae Bulbus), each 3 qian. For those with profuse sweating, high fever, and intense thirst, add Sheng Shigao (Gypsum Fibrosum) 5 qian, Maidong (Ophiopogonis Radix) 3 qian, and Jingmi (Oryza Sativa) 4 qian. For pure fever without chills, apply this method, or additionally add Zhimu (Anemarrhenae Rhizoma) 3 qian. Fever preceding chills is named Bi Nüe (Obstruction Malaria), treated similarly, adding Guizhi (Cinnamomi Ramulus) 2 qian, derived from Baihu Jia Guizhi Tang (White Tiger plus Cinnamon Twig Decoction) in the *Jin Gui Yao Lue*. ○ For Gui Nüe, where the pulse fluctuates between large and small, add Huoxiang (Agastaches Herba) 2 qian, as fragrance represents the upright Qi of Heaven and Earth, which overcomes pathogens. Add Tianma (Gastrodiae Rhizoma) 3 qian; its shape resembles a tuber with twenty-four offshoots surrounding it, and its sprout is called Chijian. This symbolizes the display of authority like bow and arrow. ○ For Zhang Nüe, add Cangzhu (Atractylodis Rhizoma) and Huoxiang (Agastaches Herba), each 2 qian. ○ For Shi Nüe, use Pingwei San (Calm the Stomach Powder) as the base, incorporating Chai Hu (Bupleuri Radix) as the sovereign herb, merging the two formulas into one, following the ancient method of compound prescriptions. ○ Lao Nüe occurs in deficient individuals unable to withstand labor; use the original Xiaochaihu Tang (Minor Bupleurum Decoction), remove Banxia (Pinelliae Rhizoma), add Gualougen (Trichosanthis Radix) 2 qian, or assist with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). ○ For all malaria cases presenting with thirst, remove Banxia (Pinelliae Rhizoma) and add Gualougen (Trichosanthis Radix) to generate body fluids.
For all malaria cases seeking rapid efficacy, after three episodes, administer Xiaochaihu Tang (Minor Bupleurum Decoction) with Changshan (Dichroae Radix) 3 qian at Yin hour. Decoct the dregs again and administer at Chen hour. If vomiting occurs, allow the expulsion of phlegm-fluid; spontaneous recovery will follow. ○ Contemporary physicians, misled by popular materia medica, claim Changshan (Dichroae Radix) is a harsh antimalarial drug. They argue that forcibly cutting off malaria before pathogenic factors are exhausted leads to other diseases. This is baseless speculation. Changshan (Dichroae Radix) moves from Yin to Yang, serving as an excellent herb to vent pathogens outward. Zhang Zhongjing used its sprout, named Shuqi (Dichroae Caulis), while modern practitioners use its root. How can it be considered a harsh cutting agent?
For chronic malaria unresponsive to various drugs, and for Sanyin Malaria (Three-Yin Malaria) occurring every three days, use Baizhu (Atractylodis Macrocephalae Rhizoma) 1 liang or 2 liang, added with Shengjiang (Zingiberis Rhizoma Recens) 5-7 qian. Decoct in water to yield one cup, administer at Yin hour. Decoct dregs again and administer in the morning. For heat-dominant cases, substitute Baizhu (Atractylodis Macrocephalae Rhizoma) with Danggui (Angelicae Sinensis Radix) slightly over 1 liang. ○ For Spleen and Kidney dual deficiency unresponsive to other treatments, use Jinxiao Baizhu Tang (Near-Efficacy Atractylodes Decoction), administered twice daily. Cure is expected within ten days. (Upon completion of this manuscript, a friend returned from Anhui and gifted me a collection of medical books authored by Zhang Xin, titled *Fu Jing*. It contains the aphorisms "Three Yang intersect with Gallbladder, Three Yin intersect with Spleen" and "Treat Gallbladder for Three Yang Malaria, Treat Spleen for Three Yin Malaria." These are truly admirable insights. If this gentleman engages in discussion with master teachers and good friends, he will surely become a giant in medicine. I regret not knowing him personally.)
Acute malaria, known in the world as Tai Nüe (Fetal Malaria), is lingering and difficult to cure. Similar to vaccine pox symptoms originating from fetal toxins, treat with Liujunzi Tang (Six Gentlemen Decoction), adding Cao Guo (Tsaoko Fructus) and Wumei (Mume Fructus), or combine with Xiaochaihu Tang (Minor Bupleurum Decoction).
For chronic malaria unresponsive to treatment, there is no need to specifically target malaria. Instead, regulate with Liujunzi Tang (Six Gentlemen Decoction) and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), swallowing Guifu Bawei Wan (Cinnamon and Aconite Eight-Ingredient Pill) concurrently. Regulation for half a month ensures complete recovery. Current physicians follow Zhang Jingyue's methods, using Heren Yin (He Ren Drink) and Xiunüe Yin (Stop Malaria Drink), focusing on Heshouwu (Polygoni Multiflori Radix) as the main ingredient, claiming it embodies the doctrine of neutrality. However, its bitter and astringent nature makes it unpalatable. I have frequently observed that long-term use of this medication induces swelling and other diseases. Students of medicine must be aware of this.