凡疟经年不愈者，谓之老疟。或食积，或痰涎，或瘀血，皆能结成痞块，藏于腹胁，作胀而痛，令人多
汗，谓之疟母。亦有因调治失宜，营卫俱虚，或截疟太早，邪伏肝经胁下，而成痞块者。丰历见之，其痞居左
胁者为多。盖左胁属肝，当补虚之中，兼以疏肝为治。宜用调中畅气法去 、术、甘、荷，加青皮、
鳖甲、牡蛎、半夏治之。如形气未衰，块痛甚者，蓬、棱、肉桂，并可加入。倘偏用攻破剥削，以治其块，
而罔顾其正者，延为中满，遂不可医，可不谨欤！
三日疟，又名三阴疟，间两日而发者是也。丹溪曰∶发于子午卯酉日者为少阴疟，寅申巳亥日者为厥
阴疟，辰戌丑未日者为太阴疟。其说似乎近理，然介宾、路玉皆驳为非，悉以轩
岐之训为准则也。经曰∶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。李念莪释云∶客，犹言会也。邪在六腑，则气远会稀，故间二日，或休数日也。由是观之，丹溪
之言，不足为训。盖间二日而作者，以邪气深客于腑，是与卫气相失而然，宜以双甲搜邪法治之。如阴虚之
体，益以首乌、当归；阳虚之体，益以鹿霜、潞党。至间数日而作者，其邪愈深，不待言矣。凡邪深陷者，
必因正气空虚，当用补气升阳法，助其既虚之正，提其已陷之邪，使正气复旺，邪气自出，则疟不驱自遁矣。
或问∶先生论疟，既及三阴，而不及三阳者何也？答曰∶丹溪分别三阴，前贤已驳之矣。今既问及三阳，
不得不略言之。大概疟在太阳则寒重，法当汗之。在阳明则热重，法当清之。在少阳则寒热往来，法当和之。
又问∶诸疟悉详，何独遗胎疟一证？究竟何如？曰∶胎疟今之俗名也。有谓襁褓小儿患疟为胎疟，有谓从未患
疟为胎疟，又以母年之多寡，与疟期相应，此未尽然。总之，无论其襁褓壮年，而未曾患疟者，悉称
为胎疟也。仍当分暑、风、寒、湿等疟而治。历尝见之，较诸疟逾格缠绵，最难速愈，必俟其势衰微，方可断截耳。
凡是疟疾经过多年不愈的，称为老疟。或者因为饮食积滞，或者因为痰涎停滞，或者因为瘀血阻滞，都能结成痞块，藏在腹部和胁部，引起胀满疼痛，使人多汗，这叫做疟母。也有因为调理治疗不当，导致营气和卫气都虚弱，或者截断疟疾太早，邪气潜伏在肝经的胁下，从而形成痞块的。雷丰历次见到这种情况，痞块位于左胁部的比较多。大概左胁属于肝脏，应当在补虚的同时，兼用疏肝的方法进行治疗。适宜使用调中畅气法，去掉原方中的白芍、白术、甘草、荷叶，加入青皮、鳖甲、牡蛎、半夏来治疗。如果形体和气力还没有衰弱，痞块疼痛严重的，蓬莪术、三棱、肉桂，都可以加入药方中。倘若片面地使用攻破消削的药物来治疗痞块，而不顾护正气，会导致发展为中满证（腹部胀满），那时就不可医治了，能不谨慎吗！
三日疟，又名三阴疟，就是每隔两天发作一次的疟疾。朱丹溪说：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。这种说法似乎接近事理，但是戴元礼（介宾）、路玉都驳斥它是不对的，都以《黄帝内经》（轩岐）的训示作为准则。《内经》说：有时隔两天，或者到几天才发作一次，是因为邪气与卫气客居在六腑，而有时候不能相遇，不能相互感应，所以休息几天才发作。李念莪解释说：客，就是会合的意思。邪气在六腑，那么气机就会远隔，会合的机会稀少，所以间隔两天，或者休息几天才发作。由此看来，丹溪的说法，不值得作为准则。大概间隔两天发作的，是因为邪气深深客居于腑，是与卫气不相遇而造成的，适宜用双甲搜邪法来治疗。如果是阴虚体质，加上何首乌、当归；如果是阳虚体质，加上鹿角霜、潞党参。至于间隔几天才发作的，邪气就更深了，不用多说。凡是邪气深陷的，必定是因为正气空虚，应当使用补气升阳法，帮助其已经虚弱的正气，提升其已经陷入的邪气，使正气恢复旺盛，邪气自然排出，那么疟疾不驱赶也会自行消退了。有人问：先生论述疟疾，既然涉及了三阴疟，为什么不提三阳疟呢？回答说：丹溪区分三阴疟，前贤已经驳斥过了。现在既然问到三阳疟，不得不简略地说一下。大抵疟疾在太阳经则恶寒重，治法应当发汗；在阳明经则发热重，治法应当清热；在少阳经则寒热往来，治法应当和解。又问：各种疟疾都讲详细了，为什么唯独遗漏了胎疟这一证候？究竟是怎么回事？回答说：胎疟是现在的俗名。有人说襁褓中的小儿患疟疾叫胎疟，有人说从未患过疟疾的人叫胎疟，又说母亲的年龄多少与疟疾发作周期相应，这些都不完全正确。总之，无论是襁褓婴儿还是壮年人，只要未曾患过疟疾的，都称为胎疟。仍然应当分暑疟、风疟、寒疟、湿疟等类型来治疗。雷丰曾经见过，比一般的疟疾更加缠绵难愈，最难快速治愈，必须等到病势衰微之后，才可以截断疟疾。
When malaria persists for years without resolution, it is referred to as *Lao Nue* (Old Malaria). Whether due to food stagnation (*Shi Ji*), phlegm-fluid retention (*Tan Xian*), or blood stasis (*Yu Xue*), these pathogenic factors can coalesce into a palpable mass (*Pi Kuai*) hidden in the abdomen and hypochondrium, causing distension and pain, accompanied by excessive sweating. This condition is termed *Nue Mu* (Malaria Mother). There are also cases where improper regulation and treatment lead to deficiency of both Ying Qi (Nutritive Qi) and Wei Qi (Defensive Qi), or where antimalarial measures are taken too early, allowing pathogens to lie latent in the hypochondrium of the Liver Meridian, thereby forming a mass. Lei Feng has observed that such masses are more frequently located in the left hypochondrium. Since the left hypochondrium belongs to the Liver, treatment should involve tonifying deficiency while simultaneously soothing the Liver. The appropriate formula is *Tiao Zhong Chang Qi Fa* (Regulate Middle and Unblock Qi Method), removing Bai Shao (White Peony Root), Bai Zhu (Atractylodes Rhizome), Gan Cao (Licorice Root), and He Ye (Lotus Leaf), and adding Qing Pi (Green Tangerine Peel), Bie Jia (Turtle Shell), Mu Li (Oyster Shell), and Ban Xia (Pinellia Tuber). If the patient's constitution and Qi strength have not yet declined, but the mass causes severe pain, Peng Zhi (Rhizoma Curcumae Phaeocaulis), San Leng (Rhizoma Sparganii), and Rou Gui (Cinnamon Bark) may be added. However, if one exclusively uses harsh attacking and reducing drugs to treat the mass without considering the Righteous Qi (Zheng Qi), it may progress to *Zhong Man* (Abdominal Fullness), at which point it becomes incurable. Can one not be cautious?
*San Ri Nue* (Three-Day Malaria), also known as *San Yin Nue* (Three-Yin Malaria), refers to malaria that occurs every other day. Zhu Danxi stated: Malaria occurring on Zi, Wu, Mao, You days is Shaoyin Malaria; on Yin, Shen, Si, Hai days is Jueyin Malaria; on Chen, Xu, Chou, Wei days is Taiyin Malaria. While this theory seems plausible, Dai Yuanli (Jiebin) and Lu Yu refuted it, adhering strictly to the teachings of Huangdi Neijing (Xuanqi). The Classic states: "Sometimes there is an interval of two days, or even several days before onset, because the pathogen and Wei Qi reside in the Six Fu Organs, and sometimes they fail to meet or interact, thus remaining dormant for several days before manifesting." Li Nian'e explained: "Reside" implies meeting. When the pathogen is in the Six Fu Organs, the Qi interaction is distant and infrequent, hence the two-day interval or multi-day dormancy. From this perspective, Zhu Danxi's theory is not authoritative. Generally, malaria with a two-day interval indicates the pathogen has deeply lodged in the Fu Organs, failing to interact with Wei Qi. It should be treated with *Shuang Jia Sou Xie Fa* (Double Shell Search-and-Expel Pathogen Method). For patients with Yin deficiency constitution, add Shou Wu (Polygonum Multiflorum Radix Preparata) and Dang Gui (Angelica Sinensis Radix); for those with Yang deficiency, add Lu Jiao Shuang (Deer Antler Glue) and Lu Dang Shen (Codonopsis Pilosula). In cases with intervals of several days, the pathogen is even deeper, which goes without saying. Whenever pathogens sink deeply, it is invariably due to deficiency of Righteous Qi. One should employ *Bu Qi Sheng Yang Fa* (Tonify Qi and Raise Yang Method) to support the deficient Righteous Qi and lift the sunk pathogen. Once Righteous Qi recovers its vigor, the pathogen will exit naturally, and the malaria will recede without direct expulsion.
One might ask: Why does your discussion on malaria cover the Three Yin meridians but omit the Three Yang meridians? I reply: Zhu Danxi's differentiation of the Three Yins has already been refuted by earlier scholars. Since you ask about the Three Yangs, I shall briefly address them. Generally, malaria affecting the Taiyang meridian presents with severe chills, requiring diaphoresis (sweating method); affecting the Yangming meridian presents with severe heat, requiring clearing heat; affecting the Shaoyang meridian presents with alternating chills and fever, requiring harmonization.
Another question arises: You have detailed various types of malaria, why did you omit *Tai Nue* (Fetal Malaria)? What exactly is it? I answer: *Tai Nue* is a common folk term today. Some refer to malaria in infants as *Tai Nue*; others define it as malaria contracted by someone who has never had malaria before. Some even correlate the mother's age with the malaria cycle, but these views are not entirely accurate. In summary, whether in infancy or adulthood, anyone who has never suffered from malaria is called *Tai Nue*. Treatment must still differentiate between Summerheat, Wind, Cold, and Dampness types. I have observed that *Tai Nue* is more persistent and difficult to cure quickly than ordinary malaria. One must wait until the pathogenic force weakens before attempting to arrest the malaria.