瘴疟之证，岭南地方为多也。乃因天气炎热，山气湿蒸，多有岚瘴之毒，人感之者，实时昏闷，一身
沉重，或寒甚热微，或寒微热甚，亦有迭日间日而作者，亦有狂言妄语者，亦有口喑不言者。揆其诸证，初
起之时，邪必郁于气分，甚则血瘀于心，涎聚于脾。先宜宣窍导痰法，探吐其痰，然后辨其轻重表
里为要。其轻者在表，宜用芳香化浊法加草果、槟榔；其重者在里，宜用和解兼攻法为治。
帝曰∶瘅疟何如？岐伯曰∶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。帝曰∶善。
《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。
丰按∶《素问》谓肺素有热；又谓气内藏于心。《金匮》亦谓邪气内藏于心而未及肺。合而论之，
似异而实同也。盖肺心皆居膈上，主乎阳位，阳气盛，故但热而不恶寒。石顽注《金匮》云∶少气烦冤者，
肺主气，肺受火邪也。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，阳盛则邪气内藏，而外舍分肉之间也。消烁肌肉者，火盛则肌肉烁也。治瘅疟惟宜白虎，盖白虎专于
退热，其分肉四肢，内属于胃，非切于所舍者乎？又泻肺火，非救其烦冤者乎？据此而观，不但病在肺心，亦
且兼之胃病。嘉言意用甘寒，亦属非谬，真所谓智谋之士，所见略同。窃思阳气盛则阴益伤，
拟用甘寒生津法，庶几针芥。
瘴疟这种病证，在岭南地区最为多见。这是因为天气炎热，山间湿气蒸腾，多有岚瘴之毒，人感染后，立刻出现昏闷，全身沉重，有的寒重热轻，有的寒轻热重，也有隔日或间日发作的，也有胡言乱语、神志狂乱的，也有口哑不能说话的。推究这些症状，初起时邪气必定郁结在气分，严重时则血瘀在心，涎沫聚积于脾。治疗上先宜用宣窍导痰法，通过探吐排出痰浊，然后再辨别病证的轻重以及表里属性作为关键。病证较轻的在表，宜用芳香化浊法加草果、槟榔；病证较重的在里，宜用和解兼攻法来治疗。
黄帝问：瘅疟是怎样的？岐伯回答：瘅疟患者，肺中素有热邪，体内气机亢盛，气逆向上冲撞，中焦之气充实而不能向外宣泄，因为用力劳作，腠理开泄，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，若阳气亢盛不衰则疾病形成。其气不及于阴分，所以只发热而不恶寒，气内藏于心，外舍于分肉之间，使人肌肉消瘦，所以命名为瘅疟。黄帝说：好。
《金匮要略》记载：老师说：阴气孤绝，阳气独发，则出现发热、少气、烦冤（烦闷不舒），手足发热且想呕吐，名为瘅疟。如果只发热不恶寒，邪气内藏于心，外舍于分肉之间，使人肌肉消瘦。
雷丰按语：《素问》说肺中素有热；又说气内藏于心。《金匮要略》也说邪气内藏于心而未涉及肺。综合论述来看，似乎不同实则相同。大概肺和心都居于膈上，主司阳位，阳气旺盛，所以只发热而不恶寒。石顽注释《金匮要略》说：少气烦冤，是因为肺主气，肺受火邪所致。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。内藏于心，是因为阳盛则邪气内藏，而外舍于分肉之间。肌肉消瘦，是因为火盛则肌肉被灼烧。治疗瘅疟只宜用白虎汤，因为白虎汤专门用于退热，其作用部位分肉四肢，内属于胃，这不正是切中病邪所舍之处吗？又清泻肺火，不是救治烦闷不舒的方法吗？据此看来，不仅病在肺心，而且兼及胃病。嘉言主张使用甘寒药物，也不属谬误，真所谓智谋之士，所见略同。我私下认为阳气盛则阴液更受损伤，拟用甘寒生津法，或许能像磁石吸针一样见效。
The syndrome of Zhang Malaria (Malaria caused by miasma) is most common in the Lingnan region. This is due to hot weather and steaming mountain humidity, where there is much toxic miasma. Upon infection, patients immediately experience dizziness and stuffiness, heaviness of the whole body, sometimes with severe chills and mild fever, or mild chills and severe fever. Some cases occur every other day or intermittently; some present with delirious speech and妄语 (wild talk); some are mute and unable to speak. Analyzing these symptoms, at the onset, the pathogenic factor must be stagnant in the Qi level (the functional level of the body). In severe cases, blood stasis occurs in the Heart, and phlegm-fluid accumulates in the Spleen. Initially, one should employ the method of Opening Orifices and Guiding Out Phlegm to induce vomiting and expel phlegm. Then, it is essential to differentiate the severity and whether the condition is exterior or interior. If the condition is mild and located in the exterior, the method of Aromatic Transformation of Turbidity added with Caoguo (Tsaoko Fruit) and Binglang (Areca Seed) should be used. If the condition is severe and located in the interior, the method of Harmonizing and Attacking simultaneously should be employed for treatment.
The Yellow Emperor asked: What is Dan Malaria (Febrile Malaria)? Qibo replied: In Dan Malaria, the Lungs have pre-existing heat, Qi is abundant throughout the body, and rebellious Qi rushes upward. The Qi in the Middle Jiao is full but does not vent outward. Due to physical exertion, the Cou Li (pores and interstices) open, allowing Wind-Cold to lodge between the skin and the Fen Rou (muscle intervals), causing the disease to manifest. When the disease manifests, Yang Qi becomes excessive. If this excess Yang Qi does not decline, the disease persists. Because the pathogenic influence does not reach the Yin, there is only fever without chills. The Qi internally resides in the Heart and externally lodges in the muscle intervals, causing emaciation of the muscles; hence it is named Dan Malaria. The Yellow Emperor said: Excellent.
The *Jin Gui Yao Lue* states: The Master said: When Yin Qi is isolated and exhausted, and Yang Qi alone flares up, it results in fever, shortness of breath, and deep vexation (fanyuan), along with heat in the hands and feet and a desire to vomit. This is called Dan Malaria. If there is only fever without chills, the pathogenic factor internally lodges in the Heart and externally occupies the muscle intervals, causing emaciation of the muscles.
Lei Feng's commentary: The *Su Wen* states that the Lungs have pre-existing heat and that Qi internally resides in the Heart. The *Jin Gui Yao Lue* also states that the pathogenic factor internally lodges in the Heart without involving the Lungs. Synthesizing these discussions, they appear different but are essentially the same. Both the Lungs and the Heart reside above the diaphragm, governing the Yang positions. Since Yang Qi is abundant, there is only fever without aversion to cold. Shiwang, annotating the *Jin Gui Yao Lue*, stated: "Shortness of breath and deep vexation" occur because the Lungs govern Qi and are affected by Fire pathogens. "Heat in the hands and feet" occurs because Yang governs the four limbs; when Yang is excessive, the limbs become hot. "Desire to vomit" occurs because Fire pathogens rush upward, causing Stomach Qi to rebel. "Internally lodging in the Heart" means that when Yang is excessive, the pathogenic factor internally lodges and externally occupies the muscle intervals. "Emaciation of muscles" occurs because excessive Fire scorches the muscles. To treat Dan Malaria, only Baihu Tang (White Tiger Decoction) is suitable, as Baihu Tang specializes in reducing fever. Its action on the muscle intervals and limbs, which internally belong to the Stomach, precisely targets the location where the pathogen lodges? Furthermore, clearing Lung Fire serves to relieve the deep vexation? Based on this observation, the disease involves not only the Lungs and Heart but also the Stomach. Jiayan’s intention to use Sweet-Cold herbs is not erroneous; it is truly said that wise strategists share similar insights. I privately consider that when Yang Qi is excessive, Yin is further damaged. Therefore, I propose using the method of Sweet-Cold Generation of Fluids, which may prove effective like a magnet attracting a needle.