疟是风暑之邪。有一日一发，有二日一发，有三日一发，有间一日连二日发，有日与夜各发，有有
汗，有无汗，有上半日发，有下半日发，有发于夜者。治法∶邪从外入，宜发散之，然以扶持胃气为本，又
须分别阳分阴分而用药。邪疟及新发者，可散可截；虚疟及久者，宜补气血。若过服截药，致伤脾胃，则
必延绵不愈矣。
主方
柴胡 白术（各一钱半） 苍术（泔浸，一钱，以上三味疟疾必用之药） 干葛（一钱二分）
陈皮（七分） 甘草（炙，五分）
愚按前症皆因先伤于暑，次感于风，客于荣卫之间，腠理不密，复遇风寒，闭而不出，舍于肠胃之
外，与荣卫并行，昼行于阳，夜行于阴，并则病作，离则病止，并于阳则热，并于阴则寒，浅则日作，深
则间日，在气则早，在血则晏。按本经曰∶疟脉自弦，弦数者多热，弦迟者多寒，弦短者伤食，弦滑者多
痰。弦而紧者宜下，浮大者宜吐，弦迟者宜温，此治疟之大法。其病热多寒少，心烦少睡者，属心，名曰
温疟，用柴芩汤；但寒少热，腰疼足冷者，属肾，名曰寒疟，用桂附二陈汤；先寒而后大热，咳嗽者，属
肺，名曰瘅疟，用参苏饮；热长寒短，筋脉揪缩者，属肝，名曰风疟，用小柴胡加乌药、香附；寒热相停，
呕吐痰沫者，属脾，名曰食疟，用清脾饮。疟愈之后，阴阳两虚，梦遗，咳嗽，不善保养，遂成劳瘵。若能
清心养体，节食避风，如此调治，无不愈矣。
若一日一发及午前发者，邪在阳分，加枯芩、茯苓、半夏各一钱；热甚，头痛，再加川芎、软石膏
各一钱；口干，加石膏、知母、麦门冬各一钱。
愚按刘宗浓先生云∶从卯至午发者，邪在大肠、小肠也，宜大柴胡汤下之；从午至酉发者，邪亦在心
与肾也，宜大承汤下之。此皆邪入于内也。从酉至子发者，邪在心与胆也，或至寅发者，此邪在气在血
也，宜用桃仁承气汤微下之，更以小柴胡汤彻其余邪。若身热，目痛，热多寒少，其脉实长者，先以大
柴胡汤下之，余热不尽，再用白芷汤；若甚寒微热，或但寒不热者，名曰牝疟，用柴胡桂枝汤以解表。
若间日或三日发，或午后或夜发者，邪入阴分，加川芎、当归、芍药（酒炒）、熟地黄、
知母（酒炒）各一钱，红花（酒洗）、黄柏（酒炒）、升麻各四分，提起阳分，可截之。
愚按仲景先生云∶疟无他症，但隔日发而先寒后热，寒多热少，用桂枝石膏汤；发于夜，麻黄
黄芩汤。窃谓前症若中气虚而间日发者，用补中益气汤；
若气血俱虚，而三日一发者，用十全大补汤。大抵邪气在阳分者，浅而易治；邪气在阴分者，深而难治。
若间一日，连发二日，或日夜各发者，气血俱病，加人参、黄 、白茯苓各一钱以补气，川芎、当归、
芍药、熟地黄各一钱以补血。
愚按此条治法，当以前后论参看用药调治。
若阳疟多汗，用黄 、人参、白术以敛之；无汗，柴胡、苍术、白术、黄芩、干葛以发之。
愚按仲景云∶处暑以前疟发而头项痛，脉浮，恶风，有汗者，桂枝羌活汤；若恶风，无汗者，
麻黄羌活汤；若久而汗多，腠理开泄，阳不能固，必补敛之；无汗，则腠理致密，邪不能解，必
发散之；若属饮食所伤，用六君子汤为主；劳伤元气，用补中益气汤为主。
若阴疟多汗，用当归、白芍药、熟地、黄连、黄柏、黄 以敛之；无汗，柴胡、苍术、川芎、
红花、升麻以发之。故曰有汗者要无汗，扶正为主；无汗者要有汗，散邪为主。
愚按前症若寒热大作，不论先后，此太阳阳明合病，寒热作则必战。经曰∶热胜而动也，发热则必汗
泄。又曰∶汗出不愈，知内热也。阳盛阴虚之症，当内实外虚，不治，恐久而传阴经也，宜用桂枝芍药
汤。若病久，须大补脾胃为主。盖养正邪自除也。
若病患胃气弱，饮食少，或服截药伤脾胃而少食者，加人参一钱五分，芍药（酒炒）、大麦芽各一钱。
愚按前症若用寒凉止截，脾胃伤损，必致连绵不已，若非培养元气，决不能愈。然芍药、麦芽善损脾
肾，恐不宜多用。
洞庭马志卿母，疟后形体骨立，发热恶寒，自汗盗汗，胸膈痞满，日饮米饮盏许，服参、术药益胀，
卧床半年矣。余以为阳气虚寒，用大剂补中益气加附子一钱，二剂诸症渐退，饮食渐进，又二剂全愈。
若伤食痞闷，或有食积者，加神曲、麦芽、枳实（炒）各一钱，黄连（炒）五分。
愚按前症若脾胃无亏，饮食过多，而患暴怒胸膈痞闷者，宜用此方以消导宿滞；若饮食既消，而胸膈
痞闷者，宜用六君子汤以调补脾胃；若劳伤元气，兼停饮食，用补中益气加半夏、茯苓以升补脾胃；若感怒
兼食，用二陈、参、术、木香、香附、山栀以补脾平肝。
冬官朱省庵，停食感寒而患疟，自用清脾、截疟二药；食后腹胀，时或作痛，服二陈、黄连、枳实之
类，小腹重坠，腿足浮肿，加白术、山楂，吐食未化。余曰∶食后胀痛，脾虚不能克化也；小腹重坠，阳气
不能升举也；腿足浮肿，胃气不能营运也；吐食不消，脾胃虚寒也。治以补中益气汤加吴茱、姜、桂、木
香，不数服而痊。
一妇人饮食后患疟，呕吐，属内停饮食，外感风寒，用藿香正气散而愈。后因怒，吐痰甚多，狂言，热
炽、胸膈胀痛，手按少止，脉洪大无伦，按之微细。余谓肝脾二经血少火旺，用加味逍遥散加熟地、川芎，二
剂顿退，再用十全大补而安。
若痰盛，加半夏（姜制）、南星、枳实各一钱，黄芩（炒）、黄连各六分。
愚按前方非膏粱积热实火为痰者，不宜用。若中气虚而痰甚，用补中益气汤加茯苓、半夏；如未应，
用一味姜汁尤好。
若欲截之，加槟榔、黄芩、青皮、常山各一钱，乌梅肉三个。
愚按前症若血气俱虚，用人参、生姜各一两，煎服顿止，不问新久并效。若咽酸口酸，且节饮食，其病
潮作时虽大渴，只与姜汤，乘热饮之，此亦截疟之良法。每见饮啖生冷物者，病或少愈，多致脾虚胃损，反
为难治。若病势正炽，一、二发间，未宜遽截，恐邪气不去，正气反伤耳！此法有益无害。
一上舍，每至夏秋，非停食作泻，必疟、痢、霍乱，遇劳吐痰，头眩，体倦，发热恶寒。杂用
四物、二陈、芩、连之类。患疟服止截之药，前症益甚，时或遍身
如芒刺然。余谓中气虚热，用补中益气汤加茯苓、半夏，内参、 各用三钱，归、术各二钱，四十余剂全愈。
若日久虚疟，寒热不多，或无寒而微热者，邪气已无，只用四君子合四物汤加柴胡、黄芩、陈
皮，以滋补气血。
愚按前症若因胃气虚，用四君加升麻、当归；若脾血虚，用四君加川芎、当归；若因中气下陷，用补
中益气汤加茯苓、半夏。大凡久疟，多属元气虚寒。盖气虚则寒，血虚则热，胃虚则恶寒，脾虚则发热，
阴火下流则寒热交作，或吐涎不食，战栗泄泻，手足逆冷，皆脾胃虚弱，但补中益气，其诸症悉愈。
一妇人疟久不愈，发热，口干，倦甚。此脾胃虚热，用七味白术散加麦门、五味，作大剂煎与恣饮；
再发稍可，乃用补中益气汤加茯苓、半夏，十余剂而愈。
一妇人久疟寒热，服清脾饮之类，胸膈饱胀，饮食减少，用补中益气汤加茯苓、半夏、炮姜各一钱而痊。
疟疾是由风邪和暑邪引起的。有的每天发作一次，有的两天发作一次，有的三天发作一次，有的隔一天连续两天发作，有的白天和夜晚各发作一次，有的有汗，有的无汗，有的上午发作，有的下午发作，有的在夜间发作。治疗原则：病邪从外部侵入，应当使用发散的方法，但要以扶持胃气为根本，同时必须区分阳分和阴分来用药。实证疟疾和新发的疟疾，可以发散或截断；虚证疟疾和久病的疟疾，应当补益气血。如果过服截疟药物，导致损伤脾胃，那么病情必定拖延缠绵难以痊愈。
主方：柴胡、白术（各一钱半）、苍术（用淘米水浸泡，一钱，以上三味是治疗疟疾必用的药）、干葛（一钱二分）、陈皮（七分）、甘草（炙，五分）。
我按语：上述病症都是因为先受暑邪伤害，接着感受风邪，邪气客居在荣卫之间，腠理不致密，又遇到风寒，被闭塞而不能排出，停留在肠胃之外，与荣卫并行，白天行于阳分，夜晚行于阴分，两者相并则发病，分离则病止，并与阳分相并则发热，与阴分相并则发冷，病位浅则每日发作，病位深则隔日发作，病在气分则发作早，病在血分则发作晚。根据《本经》记载：疟疾的脉象自呈弦象，脉弦数者多热，脉弦迟者多寒，脉弦短者伤食，脉弦滑者多痰。脉弦紧者宜用下法，脉浮大者宜用吐法，脉弦迟者宜用温法，这是治疗疟疾的大法。如果病证热多寒少，心烦睡眠少，属于心，名为温疟，用柴芩汤；只觉寒冷少热，腰疼脚冷的，属于肾，名为寒疟，用桂附二陈汤；先恶寒而后大热，伴有咳嗽的，属于肺，名为瘅疟，用参苏饮；热长寒短，筋脉拘急收缩的，属于肝，名为风疟，用小柴胡汤加乌药、香附；寒热相等，呕吐痰沫的，属于脾，名为食疟，用清脾饮。疟疾痊愈之后，阴阳两虚，出现梦遗、咳嗽，如果不善于保养，就会形成劳瘵。如果能清心养体，节制饮食，避开风寒，这样调治，没有不能痊愈的。
如果每天发作一次及上午发作的，病邪在阳分，加枯黄芩、茯苓、半夏各一钱；热势严重，头痛，再加川芎、软石膏各一钱；口干，加石膏、知母、麦门冬各一钱。
我按语：刘宗浓先生说：从卯时到午时发作的，病邪在大肠、小肠，宜用大柴胡汤攻下；从午时到酉时发作的，病邪也在心与肾，宜用大承气汤攻下。这都是病邪入里的情况。从酉时到子时发作的，病邪在心与胆，或者到寅时发作的，这病邪在气在血，宜用桃仁承气汤轻微攻下，再用小柴胡汤清除残余病邪。如果身体发热，眼睛痛，热多寒少，脉象实而长的，先用大柴胡汤攻下，余热未尽，再用白芷汤；如果非常寒冷微热，或者只有寒冷不发热，名为牝疟，用柴胡桂枝汤解表。
如果隔日或三日发作，或者午后或夜间发作的，病邪入阴分，加川芎、当归、芍药（酒炒）、熟地黄、知母（酒炒）各一钱，红花（酒洗）、黄柏（酒炒）、升麻各四分，以提起阳分之气，可以截断疟疾。
我按语：张仲景先生说：疟疾没有其他症状，只是隔日发作且先寒后热，寒多热少，用桂枝石膏汤；夜间发作的用麻黄黄芩汤。我认为上述病症如果是中气虚弱而隔日发作的，用补中益气汤；如果是气血都虚弱而三日发作一次的，用十全大补汤。大致来说，邪气在阳分的，病位浅而易治；邪气在阴分的，病位深而难治。
如果隔一天，连续两天发作，或者日夜各发作一次的，气血都受病，加人参、黄芪、白茯苓各一钱以补气，川芎、当归、芍药、熟地黄各一钱以补血。
我按语：这一条的治疗原则，应当结合前后的论述参考用药调治。
如果是阳疟多汗，用黄芪、人参、白术来收敛；无汗，用柴胡、苍术、白术、黄芩、干葛来发散。
我按语：张仲景说：处暑以前发作疟疾而头项痛，脉浮，恶风，有汗的，用桂枝羌活汤；如果恶风，无汗的，用麻黄羌活汤；如果日久汗多，腠理开泄，阳气不能固摄，必须补益收敛；无汗，则腠理致密，邪气不能解除，必须发散；如果属于饮食所伤，以六君子汤为主；劳伤元气，以补中益气汤为主。
如果是阴疟多汗，用当归、白芍药、熟地、黄连、黄柏、黄芪来收敛；无汗，用柴胡、苍术、川芎、红花、升麻来发散。所以说，有汗的要使其无汗，以扶正为主；无汗的要使其有汗，以散邪为主。
我按语：上述病症如果寒热大作，不论先后，这是太阳阳明合病，寒热发作时必定战栗。经文说：热胜则动，发热则必然汗出泄热。又说：汗出而不愈，说明内有热。阳盛阴虚的病症，应当内实外虚，如果不治疗，恐怕日久会传入阴经，宜用桂枝芍药汤。如果病久，必须以大补脾胃为主。因为养护正气，邪气自然除去。
如果患者胃气弱，饮食少，或者服用截疟药损伤脾胃而食欲不振的，加人参一钱五分，芍药（酒炒）、大麦芽各一钱。
我按语：上述病症如果使用寒凉药止截，损伤脾胃，必定导致病情连绵不断，如果不是培养元气，决不能痊愈。然而芍药、麦芽容易损伤脾肾，恐怕不宜多用。
洞庭马志卿的母亲，疟疾后形体消瘦如骨立，发热恶寒，自汗盗汗，胸膈痞满，每天只喝米汤一杯左右，服用参、术等药反而腹胀，卧床半年了。我认为这是阳气虚寒，用大剂量的补中益气汤加附子一钱，两剂后各种症状逐渐消退，饮食逐渐增加，又两剂后完全痊愈。
如果因伤食导致痞闷，或者有食积的，加神曲、麦芽、枳实（炒）各一钱，黄连（炒）五分。
我按语：上述病症如果脾胃没有亏损，是因为饮食过多，加上暴怒导致胸膈痞闷的，宜用此方来消导宿滞；如果饮食已经消化，而胸膈仍然痞闷的，宜用六君子汤来调补脾胃；如果劳伤元气，兼有停食，用补中益气汤加半夏、茯苓来升补脾胃；如果感怒兼有食积，用二陈汤加人参、白术、木香、香附、山栀来补脾平肝。
冬官朱省庵，因停食感寒而患疟疾，自行服用清脾、截疟两种药；饭后腹胀，有时疼痛，服用二陈汤、黄连、枳实之类，小腹重坠，腿足浮肿，加白术、山楂，呕吐未消化的食物。我说：饭后胀痛，是脾虚不能运化；小腹重坠，是阳气不能升举；腿足浮肿，是胃气不能营运；呕吐不消化的食物，是脾胃虚寒。治疗用补中益气汤加吴茱萸、生姜、肉桂、木香，没吃几副药就好了。
一位妇女在饮食后患疟疾，呕吐，属于内停饮食，外感风寒，用藿香正气散而痊愈。后来因为生气，呕吐很多痰，胡言乱语，热势炽盛，胸膈胀痛，用手按压稍缓解，脉象洪大无比，重按微细。我认为这是肝脾二经血少火旺，用加味逍遥散加熟地、川芎，两剂后症状顿退，再用十全大补汤而安定。
如果痰多，加半夏（姜制）、南星、枳实各一钱，黄芩（炒）、黄连各六分。
我按语：前面的方子如果不是膏粱厚味积热实火生痰者，不宜使用。如果是中气虚弱而痰多，用补中益气汤加茯苓、半夏；如果无效，单用姜汁也很好。
如果想要截断疟疾，加槟榔、黄芩、青皮、常山各一钱，乌梅肉三个。
我按语：上述病症如果气血都虚弱，用人参、生姜各一两，煎服可立即停止，无论新病久病都有效。如果咽酸口酸，并且节制饮食，其病潮作时虽然大渴，只给姜汤，趁热饮用，这也是截疟的好方法。常见喝冷饮吃生冷食物的人，病情或许稍减，大多导致脾虚胃损，反而难治。如果病势正猛烈，在一两次发作期间，不宜急于截断，恐怕邪气不去，正气反而受伤！这个方法有益无害。
一位上舍生，每到夏秋季节，不是停食作泻，就是疟疾、痢疾、霍乱，遇劳累则吐痰，头晕，身体疲倦，发热恶寒。杂乱使用四物汤、二陈汤、黄芩、黄连之类。患疟疾服用止截的药物，前面的症状更加严重，有时全身像有芒刺一样。我认为这是中气虚热，用补中益气汤加茯苓、半夏，其中人参、黄芪各用三钱，当归、白术各二钱，四十多剂后完全痊愈。
如果日久虚疟，寒热不多，或者无寒而微热的，邪气已无，只用四君子汤合四物汤加柴胡、黄芩、陈皮，来滋补气血。
我按语：上述病症如果是因胃气虚，用四君子汤加升麻、当归；如果是脾血虚，用四君子汤加川芎、当归；如果是因中气下陷，用补中益气汤加茯苓、半夏。大凡久疟，多属于元气虚寒。因为气虚则寒，血虚则热，胃虚则恶寒，脾虚则发热，阴火下流则寒热交作，或者吐涎不食，战栗泄泻，手足逆冷，都是脾胃虚弱，只要补中益气，各种症状全部痊愈。
一位妇女疟疾久不愈，发热，口干，极度疲倦。这是脾胃虚热，用七味白术散加麦门冬、五味子，做大剂量煎服让她随意饮用；再发时稍好，于是用补中益气汤加茯苓、半夏，十余剂后痊愈。
Malaria is caused by wind and summerheat pathogens. It may occur once daily, once every two days, or once every three days; some cases involve consecutive attacks on alternate days, some occur both day and night, some present with sweating, others without; some attack in the first half of the day, some in the second half, and some at night. Treatment principles: Since the pathogen enters from the exterior, dispersing methods should be used, but supporting Stomach Qi (Stomach Energy) must be the foundation. Medication must also be differentiated according to Yang divisions and Yin divisions. For excess-type malaria and newly onset cases, dispersing or intercepting methods are applicable; for deficiency-type malaria and chronic cases, tonifying Qi and Blood is appropriate. Overuse of intercepting medicines may damage the Spleen and Stomach, leading to a lingering and intractable course.
Main Formula: Chai Hu (Bupleuri Radix), Bai Zhu (Atractylodis Rhizoma) (each 1.5 qian), Cang Zhu (Atractylodis Rhizoma) (soaked in rice water, 1 qian; these three herbs are essential for treating malaria), Gan Ge (Puerariae Radix) (1.2 qian), Chen Pi (Citri Reticulatae Pericarpium) (0.7 qian), Gan Cao (Glycyrrhizae Radix et Rhizoma) (roasted, 0.5 qian).
My Commentary: The aforementioned symptoms arise primarily from initial injury by summerheat, followed by contraction of wind. The pathogen lodges between Ying (Nutritive) and Wei (Defensive) levels. When Cou Li (pores/skin texture) are not dense, exposure to wind-cold causes closure, trapping the pathogen outside the intestines and stomach. It travels alongside Ying and Wei, moving through Yang during the day and Yin at night. When the pathogen merges with Ying/Wei, disease manifests; when it separates, symptoms cease. Merging with Yang generates heat; merging with Yin generates cold. Shallow involvement leads to daily attacks; deep involvement leads to alternate-day attacks. Involvement of Qi results in earlier onset; involvement of Blood results in later onset. According to the *Ben Jing* (Divine Farmer's Materia Medica): The pulse in malaria is naturally wiry (Xian). A wiry and rapid pulse indicates much heat; a wiry and slow pulse indicates much cold; a wiry and short pulse suggests food retention; a wiry and slippery pulse indicates much phlegm. A wiry and tight pulse warrants purgation; a floating and large pulse warrants emesis; a wiry and slow pulse warrants warming. These are the general principles for treating malaria. If heat predominates over cold, with irritability and poor sleep, the pathology belongs to the Heart, named Wen Malaria (Warm Malaria), treated with Chai Qin Tang (Scutellaria and Bupleurum Decoction). If cold predominates over heat, with lower back pain and cold feet, the pathology belongs to the Kidney, named Han Malaria (Cold Malaria), treated with Gui Fu Er Chen Tang (Cinnamon Twig, Aconite, and Two-Chen Decoction). If chills precede high fever accompanied by cough, the pathology belongs to the Lung, named Dan Malaria (Fever Malaria), treated with Shen Su Yin (Ginseng and Perilla Drink). If heat lasts longer than cold, with tendon contraction, the pathology belongs to the Liver, named Feng Malaria (Wind Malaria), treated with Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Wu Yao (Linderae Radix) and Xiang Fu (Cyperi Rhizoma). If chills and heat are equal, with vomiting of phlegm-saliva, the pathology belongs to the Spleen, named Shi Malaria (Food Malaria), treated with Qing Pi Yin (Clearing Spleen Drink). After malaria subsides, if both Yin and Yang are deficient, manifesting as nocturnal emission and cough, failure to maintain health properly may lead to Lao Zhai (Consumption Disease). If one can clear the Heart, nourish the body, regulate diet, and avoid wind, such regulation ensures recovery.
If attacks occur once daily or before noon, the pathogen is in the Yang division. Add Ku Huang Qin (Scutellariae Radix), Fu Ling (Poria), and Ban Xia (Pinelliae Rhizoma) (each 1 qian). If heat is severe with headache, add Chuan Xiong (Ligustici Chuanxiong Rhizoma) and Ruan Shi Gao (Gypsum Fibrosum) (each 1 qian). If dry mouth occurs, add Shi Gao (Gypsum Fibrosum), Zhi Mu (Anemarrhenae Rhizoma), and Mai Men Dong (Ophiopogonis Radix) (each 1 qian).
My Commentary: Mr. Liu Zongnong stated: Attacks from Mao hour to Wu hour indicate pathogen in the Large Intestine and Small Intestine, suitable for Da Chai Hu Tang (Major Bupleurum Decoction) for purgation. Attacks from Wu hour to You hour indicate pathogen in the Heart and Kidney, suitable for Da Cheng Qi Tang (Major Order the Qi Decoction) for purgation. These represent interior pathogen invasion. Attacks from You hour to Zi hour indicate pathogen in the Heart and Gallbladder; attacks extending to Yin hour indicate pathogen in Qi and Blood, suitable for Tao Ren Cheng Qi Tang (Peach Kernel Order the Qi Decoction) for mild purgation, followed by Xiao Chai Hu Tang to eliminate residual pathogen. If body heat, eye pain, heat predominating over cold, and a wiry, long, and solid pulse are present, use Da Chai Hu Tang first for purgation; if residual heat remains, use Bai Zhi Tang (Angelica Dahurica Decoction). If severe cold with slight heat, or only cold without heat, named Pin Malaria (Yin Malaria), use Chai Hu Gui Zhi Tang (Bupleurum and Cinnamon Twig Decoction) to release the exterior.
If attacks occur on alternate days or every three days, or in the afternoon or at night, the pathogen has entered the Yin division. Add Chuan Xiong, Dang Gui (Angelicae Sinensis Radix), Shao Yao (Paeoniae Radix Alba) (wine-fried), Shu Di Huang (Rehmanniae Radix Preparata), and Zhi Mu (each 1 qian); Hong Hua (Carthami Flos) (wine-washed), Huang Bo (Phellodendri Cortex) (wine-fried), and Sheng Ma (Cimicifugae Rhizoma) (each 0.4 qian) to raise Yang Qi, allowing interception of the malaria.
My Commentary: Zhang Zhongjing stated: Malaria with no other symptoms, presenting as alternate-day attacks with chills preceding heat, where chills predominate over heat, is treated with Gui Zhi Shi Gao Tang (Cinnamon Twig and Gypsum Decoction); nighttime attacks are treated with Ma Huang Huang Qin Tang (Ephedra and Scutellaria Decoction). I believe that if the above symptoms result from Middle Jiao Qi deficiency with alternate-day attacks, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). If Qi and Blood are both deficient with attacks every three days, use Shi Quan Da Bu Tang (Ten Great Tonics Decoction). Generally, pathogen in the Yang division is shallow and easy to treat; pathogen in the Yin division is deep and difficult to treat.
If attacks occur on alternate days with consecutive two-day attacks, or daily and nightly attacks, both Qi and Blood are affected. Add Ren Shen (Ginseng Radix et Rhizoma), Huang Qi (Astragali Radix), and Bai Fu Ling (Poria) (each 1 qian) to tonify Qi; Chuan Xiong, Dang Gui, Shao Yao, and Shu Di Huang (each 1 qian) to tonify Blood.
My Commentary: This treatment principle should be cross-referenced with previous discussions for medication adjustment.
For Yang malaria with excessive sweating, use Huang Qi, Ren Shen, and Bai Zhu to consolidate. For absence of sweating, use Chai Hu, Cang Zhu, Bai Zhu, Huang Qin, and Gan Ge to disperse.
My Commentary: Zhang Zhongjing said: Malaria occurring before the End of Heat solar term, with head and neck pain, floating pulse, aversion to wind, and sweating, is treated with Gui Zhi Qiang Huo Tang (Cinnamon Twig and Notopterygium Decoction). If aversion to wind exists without sweating, use Ma Huang Qiang Huo Tang (Ephedra and Notopterygium Decoction). If prolonged sweating leads to open Cou Li and inability of Yang to secure, supplementation and consolidation are required. If there is no sweating, Cou Li are dense, preventing pathogen resolution, requiring dispersal. If caused by dietary injury, Six Gentlemen Decoction (Liu Jun Zi Tang) is primary. If caused by labor injuring Yuan Qi, Bu Zhong Yi Qi Tang is primary.
For Yin malaria with excessive sweating, use Dang Gui, Bai Shao Yao (White Peony Root), Shu Di, Huang Lian (Coptidis Rhizoma), Huang Bo, and Huang Qi to consolidate. For absence of sweating, use Chai Hu, Cang Zhu, Chuan Xiong, Hong Hua, and Sheng Ma to disperse. Thus, for those with sweating, the goal is to stop sweating, prioritizing support of Zheng Qi (Upright Qi); for those without sweating, the goal is to induce sweating, prioritizing dispersion of Xie Qi (Pathogenic Qi).
My Commentary: If chills and heat are severe regardless of sequence, this is a combined syndrome of Tai Yang (Greater Yang) and Yang Ming (Yang Brightness). Severe chills and heat cause shivering. The Classics state: Excess heat causes movement; fever leads to sweating. Also: Sweating without cure indicates internal heat. In syndromes of Yang excess and Yin deficiency, there is internal excess and external deficiency. Without treatment, it may transmit to Yin meridians over time; Gui Zhi Shao Yao Tang (Cinnamon Twig and Peony Decoction) is indicated. For chronic illness, major tonification of Spleen and Stomach is primary, as nourishing Zheng Qi eliminates Xie Qi.
If the patient has weak Stomach Qi, poor appetite, or reduced intake due to damaging the Spleen and Stomach with intercepting medicines, add Ren Shen (1.5 qian), Shao Yao (wine-fried, 1 qian), and Da Mai Ya (Hordei Fructus Germinatus, 1 qian).
My Commentary: Using cold and cooling medicines to stop malaria damages the Spleen and Stomach, leading to a lingering course. Recovery is impossible without cultivating Yuan Qi. However, Shao Yao and Mai Ya may damage Spleen and Kidney, so they should not be overused.
The mother of Ma Zhiqing from Dongting suffered from emaciation after malaria, with fever, aversion to cold, spontaneous and night sweats, chest and diaphragm fullness, drinking only about a cup of rice water daily. Taking Ren Shen and Bai Zhu increased bloating, leaving her bedridden for half a year. I diagnosed Yang Qi deficiency and cold, prescribing a large dose of Bu Zhong Yi Qi Tang plus 1 qian of Fu Zi (Aconiti Lateralis Radix Preparata). After two doses, symptoms gradually receded and appetite improved; after two more doses, she fully recovered.
For food stagnation causing fullness or existing food accumulation, add Shen Qu (Massa Medicata Fermentata), Mai Ya, and Zhi Shi (Immature Bitter Orange) (roasted, each 1 qian), and Huang Lian (roasted, 0.5 qian).
My Commentary: If Spleen and Stomach are intact but symptoms arise from overeating combined with sudden anger causing chest fullness, this formula aids digestion of retained stagnation. If food has digested but fullness persists, Liu Jun Zi Tang regulates and tonifies Spleen and Stomach. If labor injures Yuan Qi with retained food, Bu Zhong Yi Qi Tang plus Ban Xia and Fu Ling raises and tonifies Spleen and Stomach. If anger combines with food stagnation, Er Chen Tang plus Ren Shen, Bai Zhu, Mu Xiang (Aucklandiae Radix), Xiang Fu, and Shan Zhi (Gardeniae Fructus) tonifies Spleen and soothes Liver.
Zhu Shengan, an official in the Ministry of Works, contracted malaria from retained food and cold. Self-medicating with Qing Pi and jie nue (intercept malaria) drugs led to postprandial abdominal distension and pain. Taking Er Chen Tang, Huang Lian, and Zhi Shi resulted in heavy sensation in the lower abdomen and edema of legs and feet. Adding Bai Zhu and Shan Zha (Crataegi Fructus) failed to stop vomiting of undigested food. I stated: Postprandial distension and pain indicate Spleen deficiency failing to transform; heavy lower abdomen indicates Yang Qi failing to ascend; leg edema indicates Stomach Qi failing to circulate; vomiting undigested food indicates Spleen-Stomach deficiency cold. Treatment with Bu Zhong Yi Qi Tang plus Wu Zhu Yu (Evodiae Fructus), Sheng Jiang (Zingiberis Rhizoma Freshum), Rou Gui (Cinnamomi Cortex), and Mu Xiang cured him in few doses.
A woman developed malaria after eating, with vomiting, indicating internal retained food and external wind-cold. She recovered using Huo Xiang Zheng Qi San (Patchouli Powder to Rectify the Qi). Later, due to anger, she vomited copious phlegm, spoke deliriously, had intense heat, chest/diaphragm distending pain relieved by pressure, and a surging pulse that was minute upon deep palpation. I diagnosed Liver and Spleen meridian blood deficiency with fire hyperactivity, prescribing Jia Wei Xiao Yao San (Modified Free Wanderer Powder) plus Shu Di and Chuan Xiong. Symptoms retreated after two doses; stability was achieved with Shi Quan Da Bu Tang.
For excessive phlegm, add Ban Xia (prepared with ginger juice), Nan Xing (Arisaematis Rhizoma), and Zhi Shi (each 1 qian); Huang Qin (roasted) and Huang Lian (each 0.6 fen).
My Commentary: The previous formulas are unsuitable for phlegm generated by rich food and accumulated heat/excess fire. For phlegm due to Middle Qi deficiency, use Bu Zhong Yi Qi Tang plus Fu Ling and Ban Xia. If ineffective, fresh Ginger Juice alone is beneficial.
To intercept malaria, add Bing Lang (Arecae Semen), Huang Qin, Qing Pi (Citri Reticulatae Pericarpium Viride), and Chang Shan (Dichroae Radix) (each 1 qian), plus three Wumei Rou (Mume Fructus flesh).
My Commentary: For Qi and Blood deficiency, taking 1 liang each of Ren Shen and Sheng Jiang decocted stops attacks immediately, effective for both new and chronic cases. If sour taste in throat/mouth occurs, and diet is regulated, even with intense thirst during paroxysms, hot Ginger Water is effective for interception. Consuming raw/cold foods often reduces symptoms temporarily but damages Spleen/Stomach, making treatment difficult. If the pathogen is vigorous, do not hastily intercept within the first one or two attacks, lest the pathogen remain while Zheng Qi is injured. This method is beneficial and harmless.
A scholar experienced diarrhea from food retention, or malaria, dysentery, or cholera every summer/autumn. Labor induced phlegm expectoration, dizziness, fatigue, fever, and aversion to cold. He indiscriminately used Si Wu Tang (Four Substances Decoction), Er Chen Tang, Huang Qin, and Huang Lian. Taking anti-intercept medicines for malaria worsened prior symptoms, sometimes causing whole-body prickling sensations. I diagnosed Middle Qi deficiency with heat, prescribing Bu Zhong Yi Qi Tang plus Fu Ling and Ban Xia, with Ren Shen and Huang Qi at 3 qian each, Dang Gui and Bai Zhu at 2 qian each. After forty-plus doses, he fully recovered.
For chronic deficiency malaria with mild chills/heat, or slight heat without chills, where pathogen is absent, use Si Jun Zi Tang (Four Gentlemen Decoction) combined with Si Wu Tang plus Chai Hu, Huang Qin, and Chen Pi to tonify Qi and Blood.
My Commentary: For Stomach Qi deficiency, use Si Jun Zi Tang plus Sheng Ma and Dang Gui. For Spleen Blood deficiency, use Si Jun Zi Tang plus Chuan Xiong and Dang Gui. For sinking of Middle Qi, use Bu Zhong Yi Qi Tang plus Fu Ling and Ban Xia. Chronic malaria generally involves Yuan Qi deficiency and cold. Qi deficiency causes cold; Blood deficiency causes heat; Stomach deficiency causes aversion to cold; Spleen deficiency causes fever. Downward flow of Yin Fire causes alternating chills and heat; spitting saliva, anorexia, shivering, diarrhea, and cold extremities all stem from Spleen-Stomach weakness. Tonifying the Middle with Qi resolves all symptoms.
A woman with chronic malaria had fever, dry mouth, and extreme fatigue. This was Spleen-Stomach deficiency heat. She drank large doses of Qi Wei Bai Zhu San (Seven-Ingredient White Atractylodes Powder) plus Mai Men Dong and Wu Wei Zi (Schisandrae Fructus). Upon recurrence, symptoms were milder; she then took Bu Zhong Yi Qi Tang plus Fu Ling and Ban Xia, recovering after ten-plus doses.
Another woman with chronic malaria chills/heat took Qing Pi Yin, resulting in chest/diaphragm fullness and reduced appetite. She recovered using Bu Zhong Yi Qi Tang plus Fu Ling, Ban Xia, and Pao Jiang (Prepared Ginger) (each 1 qian).