（《素问·疟论》全）
黄帝问曰∶夫 疟皆生于风，其蓄作有时者何也？（ ，皆也。疟，残虐之谓，疟证虽多，皆谓之虐，故曰 疟。
自王氏而下，诸解不一，皆未为得。观 疟之下，曰皆生于风，盖总诸疟为言，于此皆字，义可知矣。蓄言邪蓄于经，
有时而伏也。作言病见于外，不期而发也。 音皆。）岐伯对曰∶疟之始发也，先起于毫毛，伸欠乃作，寒栗鼓颔，腰脊
俱痛，寒去则内外皆热，头痛如破，渴欲冷冻饮料。（起于毫毛，憎寒而毛竖也。伸者，伸其四体，邪动于经也。欠，呵欠也，
阴阳争引而然。诸义皆如下文。颔，何敢切，腮颔也。）帝曰∶何气使然？愿闻其道。岐伯曰∶阴阳上下交争，虚实更作，
阴阳相移也。（阳气者，下行极而上。阴气者，上行极而下。邪气入之，则阴阳上下交争矣。阳虚则外寒，阴虚则内热；
阳盛则外热，阴盛则内寒。邪之所在，则邪实正虚。故入于阴，则阴实阳虚；入于阳，则阳实阴虚。虚实更作者，以阴
阳相移易也。）阳并于阴，则阴实而阳虚，阳明虚则寒栗鼓颔也。（阳并于阴则阴邪胜，阴胜则寒也。阳明者胃气之所出，
其主肌肉，其脉循颐颊，故阳明虚则为寒栗鼓颔。鼓者，振悚之谓。）巨阳虚则腰背头项痛。（腰背头项，皆太阳经也。
阳虚则寒邪居之，故为痛。）三阳俱虚则阴气胜，阴气胜则骨寒而痛。（三阳者，兼阳明少阳而言。阴胜则阳气不行，血
脉凝滞，故骨寒而痛。《终始篇》曰∶病痛者阴也。）寒生于内，故中外皆寒。（表里阴邪皆胜也。）阳盛则外热，阴虚则
内热，外内皆热，则喘而渴，故欲冷冻饮料也。（此邪自阴分而复并于阳分，并于阳则阳胜，阳胜则外内皆热，而喘渴喜冷，）
此皆得之夏伤于暑，热气盛，藏于皮肤之内，肠胃之外，此荣气之所舍也。（暑伤于夏，其时则热盛，其邪则风寒也。如
上文曰∶ 疟皆生于风。《金匮真言论》曰∶夏暑汗不出者，秋成风疟。其义可知。风寒在表，必郁而为热，其藏于皮肤
之内，肠胃之外，盖即经脉间耳。荣行脉中，故曰此荣气之所舍也。暑有阴阳之辨，义详本类前五。荣、营通用。）此令
人汗空疏，腠理开。（暑气能开肌表也。）因得秋气，汗出遇风，及得之以浴，水气舍于皮肤之内，与卫气并居。（暑邪内
伏者，阴邪也。秋气，水气，亦阴气也。新邪与卫气并居，则内合伏暑，故阴阳相搏而疟作矣。按∶伤暑为疟，何谓阴
邪？盖阳暑伤气，其证多汗，感而即发，邪不能留。其留藏不去者，惟阴暑耳，以其无汗也。故凡患疟者，必因于盛暑
之时，贪凉取快，不避风寒，或浴以凉水，或澡以河流，或过食生冷，壮者邪不能居，未必致病，怯者蓄于营卫，则所
不免。但外感于寒者多为疟，内伤于寒者多为痢，使能慎此二者，则疟痢何由来也？）卫气者，昼日行于阳，夜行于阴，
此气得阳而外出，得阴而内薄，内外相薄，是以日作。（风寒自表而入，则与卫气并居，故必随卫气以为出入。卫气一日
一周，是以新感之疟，亦一日一作。然则日作之疟，邪在卫耳，其气浅，故其治亦易。）
帝曰∶其间日而作者何也？岐伯曰∶其气之舍深，内薄于阴，阳气独发，阴邪内着，阴与阳争不得出，是以间日而
作也。（其气之舍深，则邪居荣气之间，连乎藏矣。荣为阴，卫为阳，阳气独发者其行本速，阴邪内着者其行则迟，一迟
一速，相拒而争，则阴邪不得与卫气俱出，故间日而作也。）帝曰∶其作日晏与其日早者，何气使然？岐伯曰∶邪气客于
风府，循膂而下。（风府，督脉穴。膂，吕同，脊骨曰吕，象形也。一曰夹脊两旁之肉曰膂。下者，下行至尾 也。）卫
气一日一夜大会于风府，其明日日下一节，故其作也晏。（卫气每至明旦，则出于足太阳之睛明穴，而大会于风府，此一
日一夜卫气周行之常度也。若邪气客于风府，必循膂而下，其气渐深则日下一节，自阳就阴，其会渐迟，故其作渐晏也。）
此先客于脊背也，每至于风府则腠理开，腠理开则邪气入，邪气入则病作，以此日作稍益晏也。（风府不一，义如下文。
此先客于脊背，言初感之伏邪也。每至于风府则腠理开，言卫气邪气之会也。会则病作，晏则因邪之日下也。）其出于风
府，日下一节，二十五日下至 骨，二十六日入于脊内，注于伏膂之内，（项骨三节，脊骨二十一节，共二十四节。邪气
自风府日下一节，故于二十五日下至尾 。复自后而前，故于二十六日入于脊内，以注伏膂之脉。按《岁露篇》曰∶入
脊内，注于伏冲之脉。盖冲脉之循背者，伏行脊膂之间，故又曰伏膂也。冲脉详义见经络类二十七。 音底。）其气上行，
九日出于缺盆之中，其气日高，故作日益早也。（邪在伏膂之脉，循脊而上，无关节之窒，故九日而出缺盆。其气日高，
则自阴就阳，其邪日退，故作渐早也。）其间日发者，由邪气内薄于五脏，横连募原也，其道远，其气深，其行迟，不能
与卫气俱行，不得皆出，故间日乃作也。（此重申上文未尽之义也。诸经募原之气，内连五脏，邪在阴分，故道远行迟而
间日作也。募音暮。按《举痛论》及全元起本俱作膜原。）帝曰∶夫子言卫气每至于风府，腠理乃发，发则邪气入，入则
病作。今卫气日下一节，其气之发也，不当风府，其日作者奈何？（上文云邪气客于风府而与卫气日下一节，是卫气之
与风府，日相远矣，又何所会而病日作也？故致疑为问。）岐伯曰∶此邪气客于头项，循膂而下者也，故虚实不同，邪中
异所，则不得当其风府也。（凡邪气客于头项则必循膂而下，此其常也。然邪之所中，亦但随虚实而异其处，不必尽当风
府也。然则所谓日下者，惟邪气耳。卫气周环，岂有日下之理？但气至而会，其病乃作，则邪气卫气，均为日下一节矣。）
故邪中于头项者，气至头项而病；中于背者，气至背而病；中于腰脊者，气至腰脊而病；中于手足者，气至手足而病。（气
至者，卫气之至者。至与邪合，然后病作，故其蓄作则迟早有时。）卫气之所在，与邪气相合则病作，故风无常府，卫气
之所发，必开其腠理，邪气之所合，则其府也。（府者所以聚物，故凡风之所居，即为风府。卫气之至，与邪相合，则腠
理开，开则邪复入之，故无论乎上下左右，皆可中邪，凡邪所中之处，亦皆可称为风府，故曰风无常府也。）帝曰∶善。
夫风之与疟也，相似同类，而风独常在，疟得有时而休者何也？（此风字，指风证为言。风之与疟，皆因于风，本为相
似同类；然风则无休，疟有时止，故当知所辨也。）岐伯曰∶风气留其处，故常在；疟气随经络，沉以内薄，故卫气应乃
作。（风气留其处，着而不移者也。疟气随经络，流变不一者也。沉以内薄，言其深也，即上文薄于五脏，横连募原之谓，
故必因卫气之应而作也。）
帝曰∶疟先寒而后热者何也？岐伯曰∶夏伤于大暑，其汗大出，腠理开发，因遇夏气凄沧之水寒，藏于腠理皮肤之
中，秋伤于风，则病成矣。（凄沧之水寒，谓浴水乘凉之类也。因暑受寒则腠理闭，汗不出，寒邪先伏于皮肤之中，得清
秋之气而风袭于外，则病发矣。）夫寒者阴气也，风者阳气也，先伤于寒而后伤于风，故先寒而后热也，病以时作，名曰
寒疟。（先受阴邪，后受阳邪，故先寒后热。人之患疟者，多属此证。）
帝曰∶先热而后寒者何也？岐伯曰∶此先伤于风而后伤于寒，故先热而后寒也，亦以时作，名曰温疟。（先受阳邪，
后受阴邪，故先热后寒而为温疟。）
其但热而不寒者，阴气先绝，阳气独发，则少气烦冤，手足热而欲呕，名曰瘅疟。（瘅，热也。阳邪独亢，故但热不
寒而烦冤少气。表里俱病，故手足热而欲呕，以热邪及于胃也。瘅音丹，又上、去二声。）
帝曰∶夫经言有余者泻之，不足者补之。今热为有余，寒为不足。夫疟者之寒，汤火不能温也，及其热，冰水不能
寒也，此皆有余不足之类。当此之时，良工不能止，必须其自衰乃刺之，其故何也？愿闻其说。（此下言疟之诸变也。须
其自衰乃刺之，谓不可刺于病发之时。）岐伯曰∶经言无刺 之热，（经言，引《灵枢逆顺篇》也。 之势，热正盛
也。不可刺之，盖避其来锐之谓。 ，赫、嚣二音，又呼木切。）无刺浑浑之脉，（浑浑之脉，阴阳虚实未定也。不得其
真，恐有所误，故未可刺。）无刺漉漉之汗，（漉漉，汗大出也。其时邪正未分，故不可刺。漉音鹿。）故为其病逆，未可
治也。（于此三者而刺之，是逆其病气也。）夫疟之始发也，阳气并于阴，当是之时，阳虚而阴盛，外无气，故先寒栗也。
（此阴有余、阳不足也。卫气并于阴分则表虚，故曰外无气。）阴气逆极，则复出之阳，阳与阴复并于外，则阴虚而阳实，
故先热而渴。（气极于里，则复出于外，阴虚阳实，故病热而渴。）夫疟气者，并于阳则阳胜，并于阴则阴胜，阴胜则寒，
阳胜则热。（此疟证或寒或热之故也。）疟者，风寒之气不常也，病极则复。（或阴或阳，疟本不常，有先寒后热者，阴极
则复于阳也。有先热后寒者，阳极则复于阴也。）至病之发也，如火之热，如风雨不可当也。（其暴如此，故名为疟）故
经言曰∶方其盛时必毁，因其衰也，事必大昌。此之谓也。（病邪方盛之时，真气正衰，辄加以刺，必致毁伤，故当因其
衰止而后取之，则邪气去而事大昌矣。此即上文须其自衰乃刺之谓。）夫疟之未发也，阴未并阳，阳未并阴，因而调之，
真气得安，邪气乃亡，故工不能治其已发，为其气逆也。（邪气正发，乃阴阳气逆之时，故不可以强治。）帝曰∶善。攻
之奈何？早晏何如？岐伯曰∶疟之且发也，阴阳之且移也，必从四末始也，阳已伤，阴从之，故先其时坚束其处，令邪
气不得入，阴气不得出，审候见之，在孙络盛坚而血者皆取之，此真往而未得并者也。（阴阳且移，必从四末始者，以十
二经井原之气，皆本于四肢也。故凡疟之将发，则四肢先有寒意，此即其候。故治之者，当于先时未发之顷，坚束其处，
谓四关之上也，使邪气不得流行，乃察其孙络之坚盛者皆取之。今北人多行此法，砭出其血，谓之放寒，其义即此。故
可令真气自为往来，而邪则无能并也。）帝曰∶疟不发，其应何如？岐伯曰∶疟气者，必更盛更虚。当气之所在也，病在
阳则热而脉躁，在阴则寒而脉静。（疟不发，谓其未作时也。欲察其应，当求气之所在。故但于证之寒热，脉之躁静，可
辨其病之阴阳也。）极则阴阳俱衰，卫气相离，故病得休；卫气集，则复病也。（疟之或在阴，或在阳，阴阳盛极，气必
俱衰，故与卫气相离而病得休止。及卫气可至，则邪正分争，病复作矣。）帝曰∶时有间二日或至数日发，或渴或不渴，
其故何也？岐伯曰∶其间日者，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。（客，犹言会也。邪在
六腑则气远会希，故或间二日，或休数日乃作也。按∶本节言疟之间二日及数日发者，以邪气深客于腑时与卫气相失而
然，其理甚明。观丹溪曰∶作于子午卯酉日为少阴疟，作于寅申巳亥日为厥阴疟，作于辰戌丑未日为太阴疟。此不过以
六气司天之义为言，然子午虽曰少阴，而卯酉则阳明矣。巳亥虽曰厥阴，而寅申则少阳矣。丑未虽曰太阴，而辰戌则太
阳矣。如三日作者，犹可借此为言；若四日者，又将何以辨之？殊属牵强。倘按此施治，未必无误。学人不可执以为训。）
疟者，阴阳更胜也，或甚或不甚，故或渴或不渴。（阳胜则热甚，故渴也。）帝曰∶论言夏伤于暑，秋必病疟，今疟不必
应者何也？（论，即《生气通天》及《阴阳应象》二论。）岐伯曰∶此应四时者也。其病异形者，反四时也。（夏伤于暑，
秋必病疟，此应四时者也。其于春夏冬而病疟者，则病形多异。正以四时之气，寒热各有相反，皆能为疟也。）其以秋病
者寒甚，（秋以盛热之后，而新凉束之，阴阳相激，故病为寒甚。）以冬病者寒不甚，（阳气伏藏于内，故冬病者虽寒不甚。）
以春病者恶风，（春时阳气外泄，腠理渐疏，余寒未去，故病多恶风。）以夏病者多汗。（夏时热甚，熏蒸肌表，故病此者
多汗。）帝曰∶夫病温疟与寒疟而皆安舍？舍于何脏？（安舍者，言其何所居也。）岐伯曰∶温疟者，得之冬中于风寒，（风
虽阳邪，其气则寒，故风寒可以并言。）气藏于骨髓之中，至春则阳气大发，邪气不能自出，因遇大暑，脑髓烁，肌肉消，
腠理发泄，或有所用力，邪气与汗皆出，此病藏于肾，其气先从内，出之于外也。（肾应冬，其主骨髓，故冬中风寒而不
即病者，则邪气藏于骨髓之中，或遇春温，或遇大暑，随触而发，故自内达外而为病也。）如是者阴虚而阳盛，阳盛则热
矣；（自阴出阳，则阴虚阳实也。）衰则气复反入，入则阳虚，阳虚则寒矣。故先热而后寒，名曰温疟。（阳极而衰，故复
（《素问·疟论》全文）
黄帝问道：所有的疟病都是由风邪引起的，但它们的发作和休止都有固定的时间，这是为什么呢？（“疟”字，意为残虐。虽然疟病的种类很多，但都称为“虐”，所以叫“疟”。自王冰以下的各家注解都不一致，都没有得到真谛。看“疟皆生于风”这句话，是总括各种疟病而言，这个“皆”字的含义就可以知道了。“蓄”指邪气蓄积在经脉中，有时潜伏不发；“作”指病症表现于外，不期而发。“蓄”音同“皆”。）岐伯回答说：疟病刚开始发作时，先感到毫毛竖立，接着伸腰打哈欠，然后出现寒战、下巴抖动，腰部和脊柱都疼痛；寒气消退后，体内体外都发热，头痛得像要裂开一样，口渴想喝冷饮。（“起于毫毛”，是指怕冷而汗毛竖起。“伸”，是伸展四肢，说明邪气扰动经脉。“欠”，是呵欠，因为阴阳之气相争牵引所致。其他解释如下文所述。“颔”，读音为“何敢切”，指腮帮子。）黄帝说：是什么气导致这样的呢？我想听听其中的道理。岐伯说：这是因为阴阳之气上下交争，虚实交替变化，阴阳之气相互转移。（阳气下行到极点则向上行，阴气上行到极点则向下行。邪气侵入人体，阴阳之气就在上下交争。阳虚则体表发冷，阴虚则体内发热；阳盛则体表发热，阴盛则体内发冷。邪气所在之处，邪气实而正气虚。所以邪气进入阴分，则阴实阳虚；进入阳分，则阳实阴虚。所谓虚实交替，是因为阴阳相互移易。）当阳气并入阴分时，阴气实而阳气虚，阳明经气虚则会出现寒战、下巴抖动。（阳气并入阴分，则阴邪胜，阴胜则寒。阳明经是胃气发出的地方，主管肌肉，其经脉循行经过面颊，所以阳明经虚就会出现寒战、下巴抖动。“鼓”就是颤动惊恐的意思。）太阳经气虚则腰背头项疼痛。（腰背头项，都属于太阳经。阳虚则寒邪停留，所以疼痛。）三阳经（太阳、阳明、少阳）之气都虚，则阴气胜，阴气胜则骨头寒冷疼痛。（三阳，兼指阳明和少阳。阴胜则阳气不行，血脉凝滞，所以骨头寒冷疼痛。《终始篇》说：“病痛属于阴证。”）寒气生于体内，所以内外都冷。（表里的阴邪都胜了。）阳气盛则体表热，阴虚则体内热，内外都热，就会气喘且口渴，所以想喝冷饮。（这是邪气从阴分再次并入阳分，并入阳分则阳胜，阳胜则内外皆热，出现气喘、口渴、喜冷。）这些都是因为在夏天被暑邪所伤，热气旺盛，潜伏在皮肤之内、肠胃之外，这里是营气居留的地方。（夏天受暑，当时热气旺盛，邪气其实是风寒性质的。如上文所说：“疟皆生于风”。《金匮真言论》说：“夏天暑热汗不出的人，秋天会形成风疟。”道理就在这里。风寒在体表，必然郁结化为热，潜伏在皮肤之内、肠胃之外，大概就是在经脉之间。营气运行在脉中，所以说这是营气居留的地方。暑有阴暑和阳暑的区别，义理详见本类前五条。荣、营通用。）这使人毛孔疏松，腠理开放。（暑气能打开肌表。）于是遇到秋天的凉气，出汗时受风，或者洗澡时水气停留在皮肤之内，与卫气共同居住。（暑邪内伏，属于阴邪。秋气、水气，也是阴气。新感之邪与卫气并居，内合伏藏的暑邪，所以阴阳相搏而疟病发作。按：伤暑成疟，为什么说是阴邪？因为阳暑伤气，症状多汗，感邪后立即发病，邪气不能留藏。只有阴暑才会留藏不去，因为它无汗。所以凡是患疟病的人，必定是在盛夏之时，贪图凉快，不避风寒，或用凉水洗澡，或在河流中沐浴，或过食生冷。身体强壮的人，邪气不能停留，未必致病；体弱的人，邪气蓄积在营卫之间，就难免患病。只是外感寒邪的多为疟病，内伤寒邪的多为痢疾，如果能谨慎避免这两方面，那么疟疾和痢疾从哪里来呢？）卫气，白天运行于阳分，夜晚运行于阴分，这种气遇到阳分就外出，遇到阴分就内入，内外相搏，所以每天发作。（风寒从体表侵入，就与卫气并居，所以必定随着卫气的出入而发作。卫气一天一夜循环一周，所以新感受的疟病，也是一天发作一次。既然这样，每天发作的疟病，邪气在卫分，气机浅表，所以治疗也容易。）
黄帝说：隔一天发作一次的，是什么原因呢？岐伯说：邪气潜伏的部位深，内迫于阴分，阳气单独发动，阴邪内着，阴气与阳气相争而不能外出，所以隔一天发作一次。（邪气潜伏的部位深，则邪气居于营气之间，连及五脏。营属阴，卫属阳。阳气单独发动，它的运行本来迅速；阴邪内着，它的运行则迟缓。一迟一速，相互抗拒争斗，阴邪就不能与卫气一起外出，所以隔一天发作一次。）黄帝说：发作时间推迟或提前的，是什么气导致的呢？岐伯说：邪气客居在风府穴，沿着脊骨向下行。（风府，是督脉的穴位。膂，通“吕”，脊骨叫吕，是象形字。另一种说法，夹在脊骨两旁的肉叫膂。下，指下行到尾骶骨。）卫气一天一夜在风府穴大会，第二天卫气下行一节椎骨，所以发作时间推迟。（卫气每到次日清晨，就从足太阳膀胱经的睛明穴出发，在风府穴大会，这是一日一夜卫气周行的常规度数。如果邪气客居在风府，必定沿着脊骨向下行，邪气逐渐深入，每天下行一节，从阳分走向阴分，大会的时间逐渐推迟，所以发作逐渐推迟。）这是因为邪气先客居在脊背上，每次到达风府穴时腠理就开放，腠理开放则邪气侵入，邪气侵入则病发作，因此每天发作的时间稍微推迟。（风府不止一个，义理如下文所述。这里说“先客于脊背”，是指初感时潜伏的邪气。每次到达风府穴时腠理开放，是指卫气和邪气相会。相会则病发作，推迟是因为邪气每天下行。）邪气从风府出发，每天下行一节，二十五天后下行到尾骶骨，第二十六天进入脊骨内部，注入伏膂脉之中。（颈部有三节椎骨，背部有二十一节椎骨，共二十四节。邪气从风府每天下行一节，所以在第二十五天下行至尾骶骨。然后又从后向前，所以在第二十六天进入脊骨内部，注入伏膂脉。按《岁露篇》说：“进入脊内，注入伏冲脉。”大概冲脉循行于背部者，伏行在脊膂之间，所以又叫伏膂。冲脉的详细义理见经络类第二十七条。“底”音dǐ。）邪气沿此脉上行，九天后出于缺盆穴，邪气位置逐渐升高，所以发作时间日益提前。（邪气在伏膂脉中，沿脊骨上行，没有关节的阻滞，所以九天后出于缺盆。邪气位置逐渐升高，就是从阴分走向阳分，邪气日渐退却，所以发作逐渐提前。）那些隔一天发作的，是因为邪气内迫于五脏，横连募原，路径远，气机深，运行迟缓，不能与卫气同时运行，不能全部外出，所以隔一天才发作。（这是重申上文未尽的含义。各经募原的气，内连五脏，邪气在阴分，所以路径远、运行迟缓而隔一天发作。“募”音mù。按《举痛论》及全元起本都写作“膜原”。）
黄帝说：先生讲卫气每次到达风府穴，腠理才开放，开放则邪气侵入，侵入则病发作。现在卫气每天下行一节，它开放的时候，并不在风府穴，那为什么每天发作呢？（上文说邪气客居在风府并与卫气每天下行一节，这样卫气与风府的距离就一天天远了，又在哪里相会而每天发作呢？所以提出疑问。）岐伯说：这是邪气客居在头项，沿着脊骨向下行，所以虚实不同，邪气中伤的部位不同，就不一定正好在风府穴。（凡邪气客居在头项，必定沿着脊骨向下行，这是常理。然而邪气中伤的部位，也随人体虚实的不同而异，不一定都在风府穴。那么所谓的“日下一节”，只指邪气而言。卫气周身循环，哪里有每天下行的道理？只是气至而相会，病才发作，那么邪气和卫气，都可以说是每天下行一节。）所以邪气中伤在头项的，卫气到达头项而病发作；中伤在背部的，卫气到达背部而病发作；中伤在腰脊的，卫气到达腰脊而病发作；中伤在手足的，卫气到达手足而病发作。（气至，是指卫气到达。卫气到达与邪气相合，然后病发作，所以发作和休止都有定时。）卫气所在的位置，与邪气相合则病发作，所以风邪没有固定的风府穴，卫气所发的地方，必定开放其腠理，邪气所相合的地方，就是它的“府”。（“府”是用来聚物的，所以凡是风邪停留的地方，就是风府。卫气到达，与邪气相合，则腠理开放，开放则邪气再次侵入，所以无论上下左右，都可能中邪，凡是邪气中伤的地方，也可以称为风府，所以说风邪没有固定的风府穴。）黄帝说：好。风邪与疟病，相似且同类，但风邪常常持续存在，疟病却有休止的时候，为什么呢？（这里的“风”字，指风病而言。风与疟，都是因为风邪引起，本来相似同类；但风病没有休止，疟病有时停止，所以应当知道辨别。）岐伯说：风邪留在局部，所以常在；疟邪顺着经络，深沉地内迫，所以卫气应时而发作。（风邪留在局部，附着而不移动。疟邪顺着经络，流变不一。深沉地内迫，是说它很深，即上文所说的内迫于五脏，横连募原，所以必须等待卫气应时而发作。）
黄帝说：疟病先冷后热的，是什么原因呢？岐伯说：夏天受到大暑伤害，大汗淋漓，腠理开发，于是遇到夏季清凉的水寒之气，潜伏在腠理皮肤之中，秋天再受风邪，病就形成了。（清凉的水寒，指洗澡乘凉之类。因为中暑受寒，腠理闭合，汗出不来，寒邪先潜伏在皮肤之中，等到清肃的秋气到来，风邪袭击外部，病就发作了。）寒是阴气，风是阳气，先受寒邪后受风邪，所以先冷后热，按时发作，名叫寒疟。（先受阴邪，后受阳邪，所以先冷后热。得疟病的人，大多属于这种证型。）
黄帝说：先热后冷的，是什么原因呢？岐伯说：这是先受风邪后受寒邪，所以先热后冷，也按时发作，名叫温疟。（先受阳邪，后受阴邪，所以先热后冷而成温疟。）
只有热而没有冷的，是阴气先绝，阳气独发，就会气短、烦闷，手足发热且想呕吐，名叫瘅疟。（瘅，就是热。阳邪独亢，所以只有热没有冷而且烦闷气短。表里都生病，所以手足发热且想呕吐，因为热邪波及胃腑。“瘅”音dān，又读上声、去声。）
黄帝说：经文说有余的要泻，不足的要补。现在热是有余，寒是不足。疟病人的寒冷，用汤火不能温暖；到了发热的时候，用冰水也不能降温，这都属于有余不足的情况。在这个时候，高明的医生也不能止住病情，必须等它自然衰退才能针刺，这是什么原因呢？我想听听其中的道理。（这部分以下讲疟病的各种变化。必须等它自然衰退才能针刺，意思是不能在病发作的时候针刺。）岐伯说：经文说不要刺那种热势正盛的（经文引用的是《灵枢·逆顺篇》。“熇”之势，热势正盛。不可刺，是为了避开它锐利的势头。“熇”音hè、xiāo，又读hū mù qiē），不要刺那种脉象浑浊不明的（浑浊的脉象，阴阳虚实尚未确定。得不到真实的脉象，恐怕有误，所以不可刺），不要刺那种大汗淋漓的（漉漉，是大汗出。这个时候邪正未分，所以不可刺。“漉”音lù）。所以对于这三种情况针刺，是违背病气，不可治疗。（在这三种情况下针刺，是逆其病气。）疟病刚开始发作时，阳气并入阴分，在这个时候，阳虚而阴盛，体表没有阳气，所以先出现寒战。（这是阴有余、阳不足。卫气并入阴分则表虚，所以说体表没有阳气。）阴气逆乱到极点，就会复出到阳分，阳与阴再次合并于外，则阴虚而阳实，所以先发热且口渴。（气极于里，就会复出到外，阴虚阳实，所以病热且口渴。）疟气，并入阳分则阳胜，并入阴分则阴胜，阴胜则冷，阳胜则热。（这是疟病或冷或热的原因。）疟病，风寒之气是不固定的，病极则反复。（或阴或阳，疟病本来不固定，有先冷后热的，是阴极复归于阳；有先热后冷的，是阳极复归于阴。）等到病发作时，像火一样热，像风雨一样猛烈，不可抵挡。（其暴烈如此，所以名叫疟。）所以经文说：正当邪气盛的时候针刺必致损伤，趁着邪气衰退的时候治疗，事情必然大吉。说的就是这个意思。（病邪正盛的时候，真气正衰，如果立即加以针刺，必致损伤，所以应当趁着邪气衰退时再施治，这样邪气去除而治疗大吉。这就是上文说的必须等它自然衰退才能针刺。）疟病未发作时，阴气未并入阳分，阳气未并入阴分，趁机调理它，真气得以安宁，邪气乃除，所以医生不能治疗已经发作的病，因为那是气机逆乱的时候。（邪气正发作，正是阴阳气机逆乱的时候，所以不可以强行治疗。）
黄帝说：好。如何攻治呢？早晚时机怎样？岐伯说：疟病将要发作时，阴阳之气将要转移，必定从四肢末端开始，阳气已伤，阴气随之，所以要在发作前坚固束缚患处，使邪气不得入内，阴气不得外出，仔细观察发现，在孙络盛大坚满且有瘀血的地方都进行针刺，这是真气前往而邪气尚未合并的状态。（阴阳将要转移，必定从四肢末端开始，因为十二经井穴和原穴的气，都源于四肢。所以凡是疟病将要发作，四肢先有寒意，这就是征兆。所以治疗者，应当在先时未发作之际，坚固束缚患处，即在四关之上，使邪气不得流行，然后观察其孙络坚盛的地方都予以针刺。现在北方人常施行这种方法，砭刺出血，叫做放寒，其义理就在这里。所以可以让真气自行往来，而邪气就无法合并。）
黄帝说：疟病不发作时，有什么反应呢？岐伯说：疟气，必定盛衰交替。当气在某个部位时，病在阳分则发热且脉躁动，在阴分则发冷且脉静。（疟病不发作，指未发作的时候。想要察知反应，应当寻求气的所在。所以只要根据证的寒热、脉的躁静，就可以辨别病在阴还是阳。）极盛之后阴阳都衰弱，卫气分离，所以病得以休止；卫气聚集，则病又发作。（疟病或在阴分，或在阳分，阴阳盛极，气必俱衰，所以与卫气分离而病休止。等到卫气可至，则邪正分争，病又发作了。）
黄帝说：有时隔两天或几天发作一次，有的口渴有的不口渴，是什么原因呢？岐伯说：隔一天发作的，是因为邪气与卫气客居在六腑，有时错过，不能相得，所以休息几天才发作。（“客”，犹言相会。邪在六腑则气远会稀，所以或隔两天，或休息几天才发作。按：本节讲疟病隔两天及几天发作，是因为邪气深深客居在腑时与卫气错过所致，道理很清楚。看朱丹溪说：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。这不过是借用六气司天的意义来说，然而子午虽曰少阴，而卯酉则是阳明；巳亥虽曰厥阴，而寅申则是少阳；丑未虽曰太阴，而辰戌则是太阳。如果是三天发作的，还可以借此来说；如果是四天发作的，又将怎么辨别呢？实在牵强。如果按照这个来治疗，未必无误。学习者不可固执以此为训。）疟病，是阴阳交替胜复，有的严重有的不严重，所以有的口渴有的不口渴。（阳胜则热甚，所以口渴。）
黄帝说：经文说夏天伤于暑，秋天必定得疟病，现在疟病不一定对应这种情况，为什么呢？（“论”，指《生气通天论》及《阴阳应象大论》两篇。）岐伯说：这是顺应四时的。病形不同的，是反于四时的。（夏天伤于暑，秋天必定得疟病，这是顺应四时。如果在春夏冬三季得疟病，则病形多有不同。正因为四时之气，寒热各有相反，都能导致疟病。）在秋天得的，寒邪很重（秋天在盛热之后，新凉束之，阴阳相激，所以病表现为寒重），在冬天得的，寒邪不重（阳气伏藏于内，所以冬天得的病虽然冷但不重），在春天得的，怕风（春季阳气外泄，腠理渐疏，余寒未去，所以病多怕风），在夏天得的，多汗（夏季热甚，熏蒸肌表，所以得这种病的人多汗）。
黄帝说：温疟和寒疟，病邪安身于何处？舍于哪个脏腑？（“安舍”，是说它居住在何处。）岐伯说：温疟，是冬天中了风寒（风虽然是阳邪，但其气则寒，所以风寒可以并言），邪气藏在骨髓之中，到了春天阳气大发，邪气不能自己排出，于是遇到大暑，脑髓被灼烧，肌肉消瘦，腠理发泄，或者有所用力，邪气随着汗液一起排出，这种病邪藏在肾，其气先从内部，发出到外部。（肾应冬季，主骨髓，所以冬天中风寒而不立即发病的，邪气就藏在骨髓之中，或者遇到春温，或者遇到大暑，随触动而发作，所以自内达外而成为病。）像这样的人阴虚而阳盛，阳盛则热；（从阴出阳，则阴虚阳实；）衰退时气又反过来入内，入内则阳虚，阳虚则冷。所以先热后冷，名叫温疟。（阳极而衰，所以又复归于阴，故先热而后寒……
(Full text of *Suwen: Lun Nue* [Treatise on Malaria from the Basic Questions])
Huangdi asked: All malaria diseases arise from wind pathogenic factors, yet their accumulation and manifestation occur at specific times. Why is this? ("Nue" implies cruelty and tyranny. Although there are many types of malaria, they are all referred to as "Nue," hence the name. Since Wang Bing, various interpretations have differed, none having grasped the true meaning. Observing the phrase "All malaria arises from wind," it speaks generally of all malaria types; the meaning of the word "all" here is clear. "Xu" refers to pathogens accumulating in the meridians, lying dormant for a time. "Zuo" refers to the disease manifesting externally, erupting without prior warning. "Xu" is pronounced like "Jie".) Qibo replied: When malaria first begins to manifest, it starts with the erection of fine body hairs (Haomao), followed by stretching and yawning. Then chills and trembling of the jaw (Hanli Guhan) occur, accompanied by pain in the waist and spine. After the cold subsides, both the interior and exterior become hot, causing severe headache as if splitting, thirst, and a desire for cold drinks. ("Starting from Haomao" indicates aversion to cold with hair standing erect. "Stretching" refers to extending the limbs, indicating pathogenic disturbance in the meridians. "Yawning" is due to the struggle and traction between Yin and Yang Qi. Other explanations follow below. "Han" refers to the cheeks/jaw, pronounced 'he gan qie'.) Huangdi said: What Qi causes this? I wish to hear the principle. Qibo said: It is because Yin and Yang Qi struggle above and below, alternating between deficiency and excess, as Yin and Yang shift positions. (Yang Qi descends to its extreme then ascends; Yin Qi ascends to its extreme then descends. When pathogenic Qi enters, Yin and Yang struggle above and below. Yang deficiency leads to external cold; Yin deficiency leads to internal heat. Yang excess leads to external heat; Yin excess leads to internal cold. Wherever the pathogen resides, it is excess while Zheng Qi is deficient. Thus, entering Yin results in Yin excess and Yang deficiency; entering Yang results in Yang excess and Yin deficiency. The alternation of deficiency and excess is due to the mutual shifting of Yin and Yang.) When Yang merges into Yin, Yin becomes excess and Yang deficient. Deficiency of Yangming Qi leads to chills and jaw trembling. (When Yang merges into Yin, Yin pathogens prevail, leading to cold. Yangming is the source of Stomach Qi, governs muscles, and its meridian circulates around the cheeks; thus, Yangming deficiency causes chills and jaw trembling. "Gu" means trembling or fright.) Deficiency of Juyang (Taiyang) leads to pain in the lower back, back, head, and neck. (The lower back, back, head, and neck belong to the Taiyang meridian. Yang deficiency allows cold pathogens to reside there, causing pain.) When the Three Yang meridians (Taiyang, Yangming, Shaoyang) are all deficient, Yin Qi prevails. Prevailing Yin leads to cold bones and pain. (Three Yang includes Yangming and Shaoyang. Yin excess obstructs Yang Qi, causing blood vessel stagnation, leading to cold bones and pain. The *Zhongshi Pian* states: "Painful conditions belong to Yin.") Cold generates internally, so both interior and exterior are cold. (Both exterior and interior Yin pathogens prevail.) Yang excess leads to external heat; Yin deficiency leads to internal heat. When both interior and exterior are hot, there is panting and thirst, hence the desire for cold drinks. (This occurs when pathogens move from the Yin aspect to merge into the Yang aspect. Merging into Yang causes Yang excess, leading to internal and external heat, panting, thirst, and preference for cold.) These conditions result from summer injury by summer-heat, where intense heat lingers inside the skin but outside the stomach and intestines, which is the abode of Ying Qi (Nutritive Qi). (Summer heat injury occurs when heat is intense; the pathogen is actually wind-cold in nature. As stated above: "All malaria arises from wind." The *Jingui Zhenyan Lun* says: "Those who do not sweat during summer heat will develop wind-malaria in autumn." This clarifies the meaning. Wind-cold on the exterior must stagnate and transform into heat. Lurking inside the skin but outside the stomach and intestines, it resides within the meridians. Ying Qi circulates within the vessels, hence it is called the abode of Ying Qi. Summer-heat has Yin and Yang distinctions, detailed in the preceding sections of this category. Rong and Ying are interchangeable.) This causes pores to open and Cou Li (skin texture) to relax. (Summer-heat opens the muscle surface.) Subsequently, encountering autumn Qi, sweating while exposed to wind, or bathing allows water Qi to settle inside the skin, residing together with Wei Qi (Defensive Qi). (Lurking summer-heat is a Yin pathogen. Autumn Qi and water Qi are also Yin. New pathogens residing with Wei Qi combine internally with latent summer-heat, causing Yin-Yang conflict and malaria onset. Note: Summer-heat injury causing malaria is considered a Yin pathogen because Yang summer-heat damages Qi, causing profuse sweating and immediate onset, preventing pathogen retention. Only Yin summer-heat remains latent due to lack of sweating. Therefore, those contracting malaria usually indulge in cooling behaviors during peak summer, avoiding wind and cold, using cool water for bathing, swimming in rivers, or eating raw/cold foods. Robust individuals may not retain the pathogen, but frail individuals accumulate it in Ying and Wei, inevitably becoming ill. External cold injury often leads to malaria, while internal cold injury often leads to dysentery. If one avoids these two, how would malaria and dysentery arise?) Wei Qi travels through Yang during the day and Yin at night. This Qi moves outward upon encountering Yang and inward upon encountering Yin. The interaction between interior and exterior causes daily attacks. (Wind-cold enters from the exterior, residing with Wei Qi, thus following Wei Qi's entry and exit. Wei Qi completes one cycle per day and night; therefore, newly contracted malaria attacks once daily. Thus, daily malaria involves pathogens in the Wei level, which is superficial and easier to treat.)
Huangdi asked: Why does some malaria attack every other day? Qibo replied: The pathogen resides deeply, pressing inward on Yin. Yang Qi alone activates, while Yin pathogens remain fixed internally. Yin and Yang struggle but cannot exit together, resulting in every-other-day attacks. (Deep residence places the pathogen between Ying Qi and the Zang organs. Ying is Yin, Wei is Yang. Yang activation is fast; Yin pathogen fixation is slow. The disparity in speed causes resistance and struggle, preventing Yin pathogens from exiting with Wei Qi, hence every-other-day attacks.) Huangdi asked: Why do some attacks occur later or earlier each day? Qibo replied: Pathogens lodge at Fengfu (Governor Vessel Acupoint), descending along the Lu (spine/muscles between spine and shoulder). (Fengfu is an acupoint on the Du Meridian. "Lu" refers to the spine or muscles flanking the spine. "Descending" means moving down to the coccyx.) Wei Qi gathers at Fengfu once every day and night. The next day, it descends one vertebral segment. Thus, attacks are delayed. (Wei Qi emerges from Jingming (BL1) of the Bladder Meridian at dawn and gathers at Fengfu, completing its daily cycle. If pathogens lodge at Fengfu and descend along the spine, deepening daily by one segment, moving from Yang to Yin, the gathering time delays, causing progressively later attacks.) This is because pathogens initially lodge in the back. Each time they reach Fengfu, Cou Li opens; opening allows pathogen entry; entry triggers the attack, causing progressively later daily attacks. (Fengfu is not singular; see below. "Initially lodging in the back" refers to latent pathogens from initial infection. Reaching Fengfu opens Cou Li, signifying the meeting of Wei Qi and pathogens. Meeting triggers the attack; delay is due to daily pathogen descent.) From Fengfu, descending one segment daily, after twenty-five days it reaches the coccyx. On the twenty-sixth day, it enters the spine interior, injecting into the Fulu Meridian. (Three cervical vertebrae, twenty-one thoracic/lumbar vertebrae, totaling twenty-four segments. Descending one segment daily from Fengfu, it reaches the coccyx on day 25. Moving posteriorly to anteriorly, it enters the spine interior on day 26, injecting into the Fulu Meridian. According to the *Suilu Pian*: "Enters spine interior, injects into Fuchong Meridian." The Chong Meridian running along the back lies hidden between the spine and muscles, hence called Fulu. See Meridians Category 27 for Chong details. "Di" is pronounced dǐ.) The Qi ascends, emerging from Quepen (ST12) after nine days. As the Qi rises, attacks occur increasingly earlier. (Pathogens in Fulu ascend along the spine without joint obstruction, emerging from Quepen in nine days. Rising Qi indicates moving from Yin to Yang, retreating pathogens, causing earlier attacks.) Every-other-day attacks occur because pathogens press inward on the Five Zang organs and connect horizontally to Muyuan (Moyuan/Epigastric Region). The path is long, the Qi is deep, movement is slow, unable to travel with Wei Qi or exit fully, hence every-other-day attacks. (Reiterating previous points. Muyuan Qi connects internally to Zang organs; pathogens in Yin cause long paths and slow movement, resulting in every-other-day attacks. "Mu" is pronounced mù. *Jutong Lun* and Quan Yuanqi's version write "Moyuan".)
Huangdi asked: You stated Wei Qi reaches Fengfu, opening Cou Li, allowing pathogen entry and attack. Now Wei Qi descends one segment daily, so its opening is no longer at Fengfu. Why do attacks still occur daily? (Previous text said pathogens lodge at Fengfu and descend with Wei Qi, increasing distance from Fengfu daily. How can they meet to cause daily attacks? Hence the doubt.) Qibo replied: Pathogens lodge in the head and neck, descending along the spine. Thus, deficiency/excess differs, and pathogen location varies, not necessarily coinciding with Fengfu. (Pathogens in head/neck always descend along the spine. However, invasion sites vary based on body deficiency/excess, not strictly Fengfu. Thus, "daily descent" applies only to pathogens. Wei Qi circulates globally; it does not descend daily. But when Qi arrives and meets, the attack occurs, so both pathogens and Wei Qi appear to descend one segment daily.) Therefore, if pathogens strike the head/neck, the attack occurs when Wei Qi reaches the head/neck; if striking the back, when it reaches the back; if striking the waist/spine, when it reaches the waist/spine; if striking hands/feet, when it reaches hands/feet. (Qi arrival refers to Wei Qi arrival. Attack occurs upon combination with pathogens, ensuring timed accumulation and eruption.) Wherever Wei Qi is located, if it combines with pathogens, an attack occurs. Thus, Wind has no fixed Fengfu. Wherever Wei Qi activates, it opens Cou Li; wherever pathogens combine, that is their "Fu" (Abode). ("Fu" gathers substances; thus, wherever Wind resides is Fengfu. Wei Qi arrival opens Cou Li, allowing pathogen re-entry. Thus, regardless of direction, pathogens can invade anywhere, and any invasion site can be called Fengfu, hence "Wind has no fixed Fengfu".) Huangdi said: Excellent. Wind and malaria are similar and of the same category, yet wind persists constantly while malaria has remissions. Why? (Here, "Wind" refers to Wind diseases. Both arise from Wind, appearing similar; however, Wind is continuous, while Malaria has pauses, requiring differentiation.) Qibo replied: Wind Qi remains in its location, hence constant; Malaria Qi follows meridians, sinking and pressing inward, hence triggered by Wei Qi response. (Wind stays fixed; Malaria flows and changes. "Sinking and pressing inward" denotes depth, i.e., pressing Zang organs and connecting to Muyuan, requiring Wei Qi response to trigger attacks.)
Huangdi asked: Why does some malaria present with cold first, then heat? Qibo replied: Summer injury by intense heat causes profuse sweating and open Cou Li. Encountering cool/cold water in summer, pathogens hide in Cou Li and skin. Autumn wind injury completes the disease. (Cool/cold water refers to bathing/cooling. Heatstroke combined with cold closes Cou Li, stops sweating, hiding cold pathogens in skin. Autumn clear air brings external wind, triggering disease.) Cold is Yin Qi; Wind is Yang Qi. Injury by cold first, then wind, causes cold first, then heat, occurring at set times, named Cold Malaria (Han Nue). (First Yin, then Yang pathogen; hence cold then heat. Most malaria cases fall into this type.)
Huangdi asked: Why does some malaria present with heat first, then cold? Qibo replied: Injury by wind first, then cold, causes heat first, then cold, occurring at set times, named Warm Malaria (Wen Nue). (First Yang, then Yin pathogen; hence heat then cold.)
Only heat without cold occurs when Yin Qi is exhausted and Yang Qi acts alone. Symptoms include shortness of breath, oppression, hot hands/feet, and nausea, named Dan Malaria (Damp/Hot Malaria). ("Dan" means heat. Solitary Yang excess causes heat without cold and oppression. Interior/exterior involvement causes hot extremities and nausea due to heat affecting the Stomach. "Dan" is pronounced dān, also shǎng/qù tones.)
Huangdi asked: Classics state: Excess requires draining, deficiency requires tonifying. Heat is excess; cold is deficiency. In malaria, cold cannot be warmed by fire/water; heat cannot be cooled by ice/water. These are excess/deficiency patterns. At such times, even skilled physicians cannot stop the condition; treatment must wait for natural decline before acupuncture. Why? I wish to understand. (This section discusses malaria variations. Waiting for natural decline means not treating during active attack.) Qibo replied: Classics say: Do not needle when heat is blazing (citing *Lingshu: Nishun Pian*. "He" indicates peak heat. Avoiding needling prevents confronting sharp pathogenic force. "He" is pronounced hè/xiāo/hū mù). Do not needle when pulse is turbid (turbid pulse indicates indeterminate Yin/Yang deficiency/excess; uncertainty risks error). Do not needle when sweating profusely (Lulu indicates heavy sweating; pathogen/Zheng distinction unclear). Treating these three ways opposes pathogenic Qi and is untreatable. (At malaria onset, Yang merges into Yin; Yang is deficient, Yin excess, exterior lacks Qi, causing chills. This is Yin excess/Yang deficiency. Wei Qi merging into Yin causes exterior deficiency. Extreme Yin reversal exits to Yang; Yang/Yin merge externally, causing Yin deficiency/Yang excess, leading to heat/thirst. Qi extreme internally returns externally; Yin deficiency/Yang excess causes heat/thirst. Malaria Qi: merging Yang causes Yang excess; merging Yin causes Yin excess. Yin excess = cold; Yang excess = heat. This explains cold/heat variations. Malaria wind-cold is irregular; extreme conditions reverse. Yin/Yang fluctuate; cold-then-heat is Yin extreme returning to Yang; heat-then-cold is Yang extreme returning to Yin. Attacks are fierce like fire/storms. Hence classics say: Needling during peak causes damage; treating during decline ensures success. This means waiting for decline before needling. Before attack, Yin hasn't merged into Yang, Yang hasn't merged into Yin; regulating then allows Zheng Qi to rest and pathogens to vanish. Physicians cannot treat active attacks due to Qi reversal.) Huangdi asked: How to treat? Timing? Qibo replied: Before attack, Yin/Yang shift begins at four extremities. Yang injured, Yin follows. Bind firmly before onset to block pathogen entry and Yin exit. Observe Sun Luo (collateral vessels); needle those full, hard, and bloody. This preserves Zheng Qi before pathogen merger. (Shift begins at extremities because Jing-Yuan Qi of twelve meridians originates there. Pre-attack chill in limbs is the sign. Binding at Four Gates prevents pathogen flow. Needle full Sun Luo collaterals. Northern people practice this, bleeding to release cold, aligning with this principle. Allows Zheng Qi circulation, blocking pathogen merger.) Huangdi asked: What are signs when malaria is not attacking? Qibo replied: Malaria Qi alternates excess/deficiency. Where Qi resides: Yang location = heat/restless pulse; Yin location = cold/quiet pulse. (Non-attack phase requires observing Qi location. Cold/heat and pulse restlessness/quietness distinguish Yin/Yang pathology.) At extremes, Yin/Yang both decline, Wei Qi separates, disease rests; Wei Qi gathers, disease recurs. (Whether in Yin or Yang, extreme excess leads to mutual decline, separating from Wei Qi, causing rest. When Wei Qi arrives, pathogen/Zheng struggle resumes disease.) Huangdi asked: Why some attack every two days or several days, some thirsty, some not? Qibo replied: Every-other-day attacks occur because pathogens and Wei Qi reside in Six Fu organs, sometimes missing each other, causing multi-day rests. ("Ke" means meeting. Pathogens in Fu organs are distant/rare meetings, causing 2-day or multi-day intervals. Note: Zhu Danxi linked attack days to Yin meridians (Zi/Wu/Mao/You = Shaoyin; Yin/Shen/Si/Hai = Jueyin; Chen/Xu/Chou/Wei = Taiyin). This uses Six Qi theory but is flawed (e.g., Mao/You are Yangming, not Shaoyin). Applying this rigidly is erroneous. Learners should not follow blindly.) Malaria involves Yin/Yang alternation; severity varies, hence thirst variation. (Yang excess = severe heat = thirst.) Huangdi asked: Classics say summer heat leads to autumn malaria. Why not always? (Referring to *Shengqi Tongtian Lun* and *Yinyang Yingxiang Dalun*.) Qibo replied: This follows seasons. Atypical forms oppose seasons. (Summer heat -> autumn malaria follows seasons. Malaria in spring/summer/winter has different forms because seasonal Qi (cold/heat) varies and can cause malaria.) Autumn malaria: severe cold (post-summer heat, new coolness binds, Yin/Yang clash). Winter malaria: mild cold (Yang hides internally). Spring malaria: aversion to wind (Yang escapes, Cou Li opens, residual cold remains). Summer malaria: profuse sweating (intense heat steams surface). Huangdi asked: Where do Warm Malaria and Cold Malaria lodge? Which Zang? ("An she" asks for location.) Qibo replied: Warm Malaria arises from winter wind-cold. (Wind is Yang but has cold nature; wind-cold are grouped.) Pathogens hide in bone marrow. Spring Yang expansion traps pathogens. Summer heat scorches brain/marrow, consumes muscles, opens Cou Li, or exertion forces pathogens out with sweat. Disease lodges in Kidney, emerging from interior to exterior. (Kidney corresponds to winter/bone marrow. Winter wind-cold latent in marrow triggers in spring warmth or summer heat, emerging internally to externally.) Such cases have Yin deficiency/Yang excess, causing heat. (Emerging Yin to Yang creates Yin deficiency/Yang excess.) Decline causes Qi to return inward; inward return causes Yang deficiency, leading to cold. Hence heat first, then cold, named Warm Malaria. (Yang extreme declines, returning to Yin, hence heat then cold...