此以针灸治疟法也。然经止言刺某经,而穴俞补泻之法,赖注言之甚详,启玄真足不朽矣。但前半既言足
六经疟,而后又出肝脾肾胃及心肺六疟,参错不齐,应缀集成篇者也。
足太阳之疟,令人腰痛头重,寒从背起,(足太阳脉,从巅入络脑,还出别下项,循肩 内,挟脊抵腰中。
其支别者,从 内左右,别下贯胂,过髀枢。故令腰痛头重,寒从背起。按∶三部九候论注与刺腰痛注贯胂俱
作贯臀,又厥论注及甲乙经与此注俱作贯胂。胂,脊肉也。臀,人身坐处肉也。臀与胂相去颇远,未知孰是。)
先寒后热, 然,( ,甚热状; ,亦热盛也。太阳不足,故先寒;寒极则生热,故后热也。
按∶ 音郝。 音渴,)热止汗出,难已,(热生是为气虚,热止则为气复,气复而汗反出,此为邪气盛而真
不胜,故难已。按∶新校正云∶“全元起本并甲乙、太素、巢元方并作先寒后热渴,渴止汗出,与此文异。”)
刺中出血。(太阳之 ,是谓金门。金门在足外踝下,一名曰关梁,阳维所别属也。刺三分,灸三壮。黄帝
中诰图经云委中主之,则古法以委中为 中也。委中在 中央,约文中动脉,足太阳之所入也。刺五分,留七
呼,灸三壮。按∶新校正云∶“详刺 中,甲乙经作 中,今王氏两注之,当以 中为正。”)足少阳之疟,
令人身体解 ,寒不甚,热不甚,恶见人,见人心惕惕然,(按,解 解已见前。少阳,胆也,合于肝而主筋,
病则筋不束骨,肢体为之懈惰也。少阳之病兼寒热,而其脉则主半表半里,故寒不甚热不甚也。胆虚则惊而恶
人,故又惕惕然也。注以寒热不甚为解 ,误矣。)热多,汗出甚,(按∶虽兼寒而热较多,邪乘虚也。邪入肝
胆则风动,故汗出甚也。)刺足少阳。(侠溪主之。侠溪在足小趾次趾岐骨间,本节前陷者中,少阳之荥。
刺三分,留三呼,灸三壮。)足阳明之疟,令人先寒,洒淅洒淅,寒甚,久乃热,热去汗出,喜见日月光火气,
乃快然,(阳虚则外先寒,阳虚极则复盛,故寒甚,久乃热也。热去汗已,阴又内强,阳不胜阴,故喜见日月
光火气乃快然也。按∶再言洒淅,状寒甚也。)刺足阳明跗上。(冲阳穴也。在足跗上五寸,骨间动脉上,
去陷谷三寸,阳明
之原。刺三分,留十呼,灸三壮。)足太阴之疟,令人不乐,好太息,(心气流于肺则喜,今脾脏受病,心母救
之,火气下入于脾,不上行于肺。又太阴脉支别者,从胃上膈注心中。故令人不乐,好太息也。按∶太读作叹。)
不嗜食,多寒热,汗出,(按∶脾主运化,今既受邪,则滞腻而不知味,惟不知味,是以不嗜也。多寒热,甲
乙经作多寒少热,与此文异。)病至则善呕,呕已乃衰,(呕,胃病也。胃与脾相配,邪既入脾,则气及于胃,
故善呕。呕则邪散,故衰也。注惟以经穴为解,未见发挥。)即取之。(言衰即取之井俞及公孙也。公孙在足大
趾本节后一寸,太阴络也。刺四分,留七呼,灸三壮。)足少阴之疟,令人呕吐甚,多寒热,热多寒少。(足
少阴脉,贯肝膈,入肺中,循喉咙,故呕甚,多寒热也。肾为阴脏,阴气生寒,今阴气不足,故热多寒少。
按∶新校正云∶“甲乙经云∶呕吐甚,多寒少热。”)欲闭户牖而处,其病难已,(胃阳明脉病,欲独闭户牖
而处,今胃证反见于肾水之中,土刑于水,故其病难已也,大钟太溪悉主之。大钟在足内踝后街中,少阴络也。
刺二分,留七呼,灸三壮。太溪在足内踝后跟骨上,动脉陷者中,少阴俞也。刺三分,留七呼,灸三壮。按∶
新校正云∶“甲乙经云∶其病难已,取太溪。又大钟穴甲乙经作跟后冲中,刺腰痛篇注作跟后街中,水穴注在内
踝后,此注云内踝后街中,诸注不同,当以甲乙经为正。”)足厥阴之疟,令人腰痛,少腹满,小便不利,如癃
状,非癃也,数噫,恐惧,气不足,腹中悒悒,(足厥阴脉,循股阴,入髦中,环阴器,抵少腹,故病如是。
癃谓不得小便也。悒悒,不畅之貌。按∶王本数便意,甲乙经作数噫二字,是也,今改从之。)刺足厥阴。(大
冲主之。在足大趾本节后二寸,陷者中,厥阴俞也。刺三分,留十呼,灸三壮。按∶刺腰痛篇注云∶“在本节
后内间动脉。”与此注异,未知孰是。)
肺疟者,令人心寒,寒甚热,热间善惊,如有所见
者,刺手太阴阳明。(列缺主之。列缺在手腕后一寸半,手太阴络也。刺三分,留三呼,灸五壮。阳明穴,合
谷主之。合谷在手大指次指岐骨间,手阳明脉所过也。刺三分,留六呼,灸三壮。按∶肺主皮毛,不能捍邪,
令得深入,故心寒也。寒甚热,谓寒甚于热,肺受邪,则皮毛洒淅而恶寒也。热间善惊者,邪盛木强,乘金之
虚而反侮之,故热少退,则善惊而如有所见,肺为邪伤故然也。)心疟者,令人烦心甚,欲得清水,反寒多不甚
热,刺手少阴。(神门主之。神门在掌后锐骨之端,陷者中,手少阴俞也。刺三分,留七呼,灸三壮。按∶心
藏火,得邪则火益炽,故烦甚而欲清水也。火内炽则外转寒,故不甚热而多寒,应热而寒,故曰反也。)肝疟者,
令人色苍苍然,大息,其状若死者,刺足厥阴见血。(中封主之。中封在足内踝前一寸半,陷者中,仰足而取之,
伸足乃得之,足厥阴经也。刺出血止,常刺者可入四分,留七呼,灸三壮。按∶前已言足六经之疟矣,兹又出肝
脾肾胃四疟,乃其证与前异,少胆与膀胱疟,更肺心二疟,居手经之二,不知何故。岂一经之证多端,前言之
未尽,后更变其文以畅之?抑本非同篇,古人或因其均为论疟,故合为一篇,是以文义参错欤?皆未可知也。
苍,青色,老瘁也,肝邪自病故色苍。人郁不乐则叹息,邪气抑肝,故叹息若死状也。)脾疟者,令人寒腹中
痛,热则肠中鸣,鸣已汗出,刺足太阴。(商丘主之。商丘在足内踝下微前,陷者中,足太阴经也。刺三分,
留七呼,灸三壮。按∶脾经内主肠腹,故寒则痛,热则鸣也。)肾疟者,令人洒洒然,腰脊痛宛转,大便难,目
然,手足寒,刺足太阳少阴。(大钟主之。取如前足少阴疟中法。按∶本篇论疟诸证,前后殊别,病本多
端,其不同宜也。乃王氏之注穴俞刺灸,亦皆差别,其相同者,惟此肾疟一则而已。详求其义,差别者是则相
同者非,盖后证既与前异,则穴俞自应不同,何得仍如前法也。)胃疟者,令人善饥而不能食,食而支满腹大,
胃热脾虚,故善饥而不能食,食则支满腹大也。
是以下文兼刺太阴。刺足阳明太阴横脉出血。(……厉兑、解溪、三里主之。厉兑在足大趾次趾之端,
去爪甲如韭叶,阳明井也。刺一分,留一呼,灸一壮。解溪在冲阳后三寸半,腕上陷者中,阳明经也。刺五分,
留五呼,灸三壮。三里在膝下三寸, 骨外廉,两筋肉分间,阳明合也。刺一寸,留七呼,灸三壮。然足阳明
取此三穴,足太阴刺其横脉出血也。横脉谓足内踝前斜过大脉,则太阴之经脉也。按∶此注云解溪在冲阳后三
寸半,气穴论注二寸半,甲乙经作一寸半,当以甲乙为正。)
疟脉缓大虚,便宜用药,不宜用针。(缓者中风,大为气实,虚者血虚。血虚气实,风又攻之,故宜药治
以遣其邪,不宜针泻而出血也。按∶注以大为气实,误矣。大而有力乃为实,今大而兼虚,其为无力可知,故宜
药以补正而祛邪,不宜用针泄气,更增其虚也。)凡治疟先发如食顷,乃可以治,过之则失时也。(……先其
发时,真邪异居,波陇不起,故可治。过时则真邪相合,攻之则反伤真气,故曰失时。)
这是用针灸治疗疟疾的方法。然而经文只提到刺某条经脉,而关于穴位的补泻方法,依靠王冰的注释讲得非常详细,启玄子(王冰)确实足以流传不朽了。只是前半部分既讲了足六经的疟疾,后面又列出肝、脾、肾、胃及心、肺六种疟疾,参差错落不整齐,应该连缀集成一篇才对。
足太阳经的疟疾,使人腰痛头重,寒气从背部升起,(足太阳经脉,从头顶入络于脑,复出别行下项,沿肩内侧,夹脊柱抵腰中。它的支脉,从腋下左右别行,向下贯穿臀肉,经过髀枢。所以导致腰痛头重,寒气从背部升起。按:《三部九候论》注与《刺腰痛》注将“贯胂”都写作“贯臀”,而《厥论》注及《甲乙经》与此注都写作“贯胂”。胂,是脊旁的肌肉;臀,是人身体坐着接触椅子的肉。臀与胂相距颇远,不知道哪个是正确的。)先冷后热,寒战剧烈,( ,形容非常热的样子; ,也是热势很盛的样子。太阳经气不足,所以先冷;寒冷至极则生热,所以后热。按: 音郝。 音渴,)热退汗出,难以痊愈,(热生是因为气虚,热退则是正气恢复,正气恢复却反而出汗,这是因为邪气盛而真气不胜,所以难以痊愈。按:新校正说:“全元起本以及《甲乙经》、《太素》、《巢元方》都作‘先寒后热渴’,渴止汗出,与本文不同。”)针刺金门穴出血。(太阳经的金门穴,叫做金门。金门在足外踝下方,一名关梁,是阳维脉别出的归属处。刺三分,灸三壮。黄帝《中诰图经》说委中主治它,那么古法是以委中为金门穴。委中在腘窝中央,约纹中的动脉处,是足太阳经所入的合穴。刺五分,留针七次呼吸的时间,灸三壮。按:新校正说:“详查刺金门,《甲乙经》作刺委中,现在王氏两注之,应当以刺委中为正。”)
足少阳经的疟疾,使人肢体懈惰无力,冷得不厉害,热得也不厉害,害怕见人,见到人就心里惊恐不安,(按,解㑊懈怠的意思前面已经见过。少阳,指胆,与肝相合而主筋,生病则筋不能约束骨骼,肢体因此懈怠懒惰。少阳的病兼有寒热,而其脉主半表半里,所以冷得不厉害热得也不厉害。胆虚则惊骇而恶人,所以又感到惊恐不安。注释把寒热不甚是解㑊,是错误的。)热多,出汗很多,(按:虽然兼有寒但热较多,是邪气乘虚而入。邪气侵入肝胆则风动,所以出汗很多。)针刺足少阳经。(侠溪穴主治它。侠溪在足小趾和次趾之间的骨缝间,本节前陷者中,是少阳经的荥穴。刺三分,留针三次呼吸的时间,灸三壮。)
足阳明经的疟疾,使人先冷,瑟瑟发抖,冷得很厉害,很久才发热,热退汗出,喜欢见到日光月光火气,才觉得舒服,(阳气虚则体表先冷,阳气虚极则复盛,所以冷得很厉害,很久才发热。热退汗出后,阴气又在体内强盛,阳不胜阴,所以喜欢见到日光月光火气才觉得舒服。按:再次说洒淅,是形容冷得很厉害。)针刺足阳明经跗上的穴位。(冲阳穴。在足背上方五寸,骨间动脉上,距离陷谷三寸,是阳明经的原穴。刺三分,留针十次呼吸的时间,灸三壮。)
足太阴经的疟疾,使人心情不乐,喜欢长叹气,(心气流行于肺则喜,现在脾脏受病,心母救之,火气下行进入脾,不上行于肺。另外太阴经脉的支脉,从胃上膈注入心中。所以使人心情不乐,喜欢长叹气。按:太读作叹。)不喜欢吃东西,多寒热,出汗,(按:脾主运化,现在既受邪气,则滞腻而不知味,正因为不知味,所以不喜欢吃。多寒热,《甲乙经》作多寒少热,与本文不同。)病发作时容易呕吐,吐完病情就减轻,(呕,是胃病。胃与脾相配,邪气既然进入脾,则气波及胃,所以容易呕吐。吐则邪气散,所以病情减轻。注释只以经穴来解释,没有发挥深意。)随即取穴治疗。(意思是病情减轻时就取井穴、俞穴及公孙穴。公孙在足大趾本节后一寸,是太阴经络穴。刺四分,留针七次呼吸的时间,灸三壮。)
足少阴经的疟疾,使人呕吐严重,多寒热,热多寒少。(足少阴脉,贯穿肝膈,进入肺中,沿喉咙,所以呕吐严重,多寒热。肾为阴脏,阴气生寒,现在阴气不足,所以热多寒少。按:新校正说:“《甲乙经》说:‘呕吐甚,多寒少热。’”)想要关上门窗独处,这种病难以痊愈,(胃阳明经脉有病,想要独自关上门窗独处,现在胃的症状反而出现在肾水之中,土克水,所以这种病难以痊愈,大钟、太溪穴都主治它。大钟在足内踝后跟骨中,是少阴经络穴。刺二分,留针七次呼吸的时间,灸三壮。太溪在足内踝后跟骨上,动脉陷者中,是少阴经的俞穴。刺三分,留针七次呼吸的时间,灸三壮。按:新校正说:“《甲乙经》说:‘其病难已,取太溪。’另外大钟穴《甲乙经》作跟后冲中,《刺腰痛篇》注作跟后街中,《水穴注》在内踝后,此注云内踝后街中,各注不同,应当以《甲乙经》为正。”)
足厥阴经的疟疾,使人腰痛,小腹胀满,小便不利,像癃闭的样子,其实不是癃闭,频繁打嗝,恐惧,气不足,腹中郁闷不畅,(足厥阴脉,沿大腿内侧,入阴毛中,环绕生殖器,抵少腹,所以病成这样。癃谓不得小便。悒悒,是不畅快的样子。按:王本作数便意,《甲乙经》作数噫二字,是对的,现在改正依从它。)针刺足厥阴经。(大冲穴主治它。在足大趾本节后二寸,陷者中,是厥阴经的俞穴。刺三分,留针十次呼吸的时间,灸三壮。按:《刺腰痛篇》注说:“在本节后内间动脉。”与此注不同,不知道哪个正确。)
肺疟,使人心里发冷,冷得很厉害然后发热,热间歇时容易惊骇,好像看到了什么东西,针刺手太阴、手阳明经。(列缺穴主治它。列缺在手腕后一寸半,是手太阴经络穴。刺三分,留针三次呼吸的时间,灸五壮。阳明经穴,合谷穴主治它。合谷在手大指和次指之间的骨缝间,是手阳明经脉所经过的地方。刺三分,留针六次呼吸的时间,灸三壮。按:肺主皮毛,不能抵御邪气,使邪气深入,所以心里发冷。冷得很厉害然后发热,是说冷比热厉害,肺受邪,则皮毛洒淅恶寒。热间歇时容易惊骇,是因为邪盛木强,乘肺金之虚而反侮之,所以热稍退,则容易惊骇且好像看到了东西,肺被邪气伤害所以这样。)
心疟,使人心中烦乱严重,想要喝冷水,反而冷多热不厉害,针刺手少阴经。(神门穴主治它。神门在掌后锐骨之端,陷者中,是手少阴经的俞穴。刺三分,留针七次呼吸的时间,灸三壮。按:心藏火,得邪则火更炽盛,所以心烦严重且想喝冷水。火内炽则外表转寒,所以热不厉害而多寒,应热却寒,所以叫反。)
肝疟,使人面色苍苍然,长叹气,其状态像死人一样,针刺足厥阴经见血。(中封穴主治它。中封在足内踝前一寸半,陷者中,仰足取穴,伸足才能取到,是足厥阴经穴。刺出血即止,常刺者可入四分,留针七次呼吸的时间,灸三壮。按:前面已经讲了足六经的疟疾了,这里又列出肝、脾、肾、胃四种疟疾,乃是因为症状与前不同,少了胆与膀胱疟,加上肺心二疟,居于手经之二,不知道什么原因。难道是一条经的症状多方面,前面说得未尽,后面变换文辞来阐明它?还是本来不是同一篇,古人或许因为都是论述疟疾,所以合为一篇,因此文义参错不齐呢?都不可知。)
脾疟,使人怕冷腹中痛,发热则肠中鸣响,鸣响后出汗,针刺足太阴经。(商丘穴主治它。商丘在足内踝下微前,陷者中,是足太阴经穴。刺三分,留针七次呼吸的时间,灸三壮。按:脾经内部主肠腹,所以冷则痛,热则鸣。)
肾疟,使人洒洒然怕冷,腰脊痛辗转反侧,大便困难,眼睛昏花看不清,手足寒冷,针刺足太阳、足少阴经。(大钟穴主治它。取穴方法如前足少阴疟疾中的方法。按:本篇论述疟疾的各种症状,前后截然不同,病本多种多样,其不同是适宜的。然而王氏对穴位、腧穴、刺灸的注释,也都差别很大,相同的只有这肾疟一则而已。详细推求其义,差别的是对的,相同的是错的,因为后面的症状既然与前面不同,那么穴位腧穴自然应该不同,怎么能仍像前面的方法呢?)
胃疟,使人容易饥饿却不能进食,吃了食物则支撑胀满腹部膨大,(胃热脾虚,所以容易饥饿却不能进食,吃了食物则支撑胀满腹部膨大。)所以下文兼刺太阴经。针刺足阳明、足太阴经横脉出血。(……厉兑、解溪、三里穴主治它。厉兑在足大趾次趾的尖端,距离爪甲如韭菜叶宽,是阳明经井穴。刺一分,留针一次呼吸的时间,灸一壮。解溪在冲阳后三寸半,腕上陷者中,是阳明经穴。刺五分,留针五次呼吸的时间,灸三壮。三里在膝下三寸,胫骨外廉,两筋肉分间,是阳明经合穴。刺一寸,留针七次呼吸的时间,灸三壮。然而足阳明取这三个穴位,足太阴刺其横脉出血。横脉谓足内踝前斜过的大脉,则是太阴的经脉。按:此注说解溪在冲阳后三寸半,《气穴论》注二寸半,《甲乙经》作一寸半,应当以《甲乙经》为正。)
疟疾脉象缓大虚,适宜用药治疗,不宜用针。(缓者中风,大为气实,虚者血虚。血虚气实,风又攻之,所以宜药治以驱除邪气,不宜针泻而出血。按:注释把大为气实,是错误的。大而有力才是实,现在大而兼虚,其为无力可知,所以宜药以补正而祛邪,不宜用针泄气,更增加其虚。)凡是治疗疟疾,在发作前大约一顿饭的时间,才可以治疗,过了这个时间就失时机了。(……在发作之前,真气与邪气分居,波浪隆起不起,所以可治。过时则真气与邪气相合,攻之则反而伤真气,所以说失时。)
This section describes the method of treating malaria with acupuncture and moxibustion. However, the classic text only mentions needling specific meridians, while the methods of tonifying and reducing at acupoints are detailed in Wang Bing's commentary; Qixuanzi (Wang Bing) is indeed worthy of immortality. Yet, the first half discusses malaria of the six foot meridians, while the latter part lists malaria of the liver, spleen, kidney, stomach, heart, and lung meridians, appearing disjointed and irregular, which should have been integrated into a single chapter.
Malaria of the Foot-Taiyang meridian causes lower back pain and heaviness of the head, with cold sensations arising from the back. (The Foot-Taiyang meridian enters the brain from the vertex, emerges to descend the nape, runs along the medial shoulder, and夹 the spine to the waist. Its branch descends through the gluteal muscles from the axilla, passing the hip joint. Hence, it causes lower back pain, head heaviness, and coldness from the back. Note: The commentaries on *Sanbu Jiuhou Lun* and *Ci Yaotong Lun* write "guan tun" (penetrate buttocks), whereas the commentary on *Jue Lun*, *Jia Yi Jing*, and this commentary write "guan shen" (penetrate paraspinal muscles). Shen refers to the muscles alongside the spine; Tun refers to the fleshy part of the buttocks where one sits. These are quite different; it is unknown which is correct.) It presents with chills preceding fever, severe rigors, ( , indicates intense heat; , also indicates excessive heat. Deficiency of Taiyang qi leads to initial chills; extreme cold generates heat, hence subsequent fever. Note: Pronounced Hao. Pronounced Ke,) followed by cessation of fever and sweating, making it difficult to cure. (The generation of heat indicates Qi deficiency; the cessation of heat indicates the recovery of Qi. If sweating occurs upon Qi recovery, it signifies that pathogenic factors are abundant and true Qi is insufficient, hence difficult to cure. Note: Xin Zhengjiao states: "Quanyuan Qi's edition, along with *Jia Yi Jing*, *Tai Su*, and *Chao Yuanfang*, read 'chills then fever with thirst', thirst ceases then sweating, differing from this text.") Needling Jinmen (Jinmen) to bleed. (Jinmen is the Xi-Cleft point of the Taiyang meridian. Located below the lateral malleolus, also known as Guanliang, it is where the Yang Wei vessel branches off. Needle 3 cun deep, moxa 3 cones. Huangdi's *Zhonggao Tu Jing* states Weizhong treats it, implying ancient methods considered Weizhong as Jinmen. Weizhong is in the center of the popliteal crease, over the arterial pulse, the He-Sea point of the Foot-Taiyang meridian. Needle 5 cun deep, retain for 7 breaths, moxa 3 cones. Note: Xin Zhengjiao states: "Upon detailed examination, *Jia Yi Jing* reads 'needling Weizhong'. Wang Bing provides two notes; 'Weizhong' should be considered correct.")
Malaria of the Foot-Shaoyang meridian causes flaccidity and weakness of the body, with mild chills and mild fever, aversion to seeing people, and palpitations/anxiety upon contact. (Note: Xieji (flaccidity/weakness) was explained previously. Shaoyang corresponds to the Gallbladder, harmonizes with the Liver, and governs the sinews. Disease causes sinews to fail to bind the bones, leading to limb flaccidity. Shaoyang disease involves both chills and fever, and its pulse governs the Half-Exterior/Half-Interior level, hence mild chills and mild fever. Gallbladder deficiency causes fright and aversion to people, hence anxiety. The commentary incorrectly interprets mild chills/fever as flaccidity.) Fever predominates, with profuse sweating. (Note: Although chills are present, fever is more prominent, indicating pathogenic factors exploiting deficiency. Pathogens entering the Liver and Gallbladder stir wind, causing profuse sweating.) Needling the Foot-Shaoyang meridian. (Xiaxi treats it. Xiaxi is between the metatarsals of the second and fifth toes, in the depression proximal to the metatarsophalangeal joint, the Ying-Spring point of Shaoyang. Needle 3 cun deep, retain for 3 breaths, moxa 3 cones.)
Malaria of the Foot-Yangming meridian causes initial chills, shivering severely, intense cold, which lasts a long time before turning to fever. After the fever subsides and sweating occurs, the patient prefers sunlight, moonlight, or fire warmth to feel comfortable. (Yang deficiency causes initial exterior cold; extreme Yang deficiency leads to rebound excess, hence intense cold lasting long before fever. After fever subsides and sweating stops, Yin becomes strong internally, and Yang cannot overcome Yin, hence preference for external heat sources to feel comfortable. Note: Repeated mention of Shaxe (shivering) indicates severe cold.) Needling the dorsum of the Foot-Yangming meridian. (Chongyang acupoint. Located 5 cun above the dorsum of the foot, on the arterial pulse between the bones, 3 cun from Xangu, the Yuan-Source point of Yangming. Needle 3 cun deep, retain for 10 breaths, moxa 3 cones.)
Malaria of the Foot-Taiyin meridian causes dysphoria and frequent sighing. (Heart Qi flowing to the Lung brings joy; now the Spleen is diseased, and the Heart Mother rescues it, sending Fire Qi down to the Spleen instead of up to the Lung. Additionally, the branch of the Taiyin meridian ascends from the Stomach through the diaphragm to the Heart. Hence, dysphoria and sighing. Note: Tai is pronounced Tan.) Anorexia, alternating chills and fever, sweating. (Note: The Spleen governs transformation and transportation. Disease causes stagnation and loss of taste, hence anorexia. Alternating chills and fever: *Jia Yi Jing* reads "more chills, less fever," differing from this text.) Upon onset, frequent vomiting occurs; the condition improves after vomiting. (Vomiting is a Stomach disorder. The Stomach and Spleen are paired; pathogens entering the Spleen affect the Stomach Qi, hence vomiting. Vomiting disperses pathogens, hence improvement. The commentary only explains via meridians/acupoints without deeper elaboration.) Treat immediately upon improvement. (Refers to taking the Jing-Well and Shu points, plus Gongsun. Gongsun is 1 cun distal to the base of the big toe, the Luo-Connecting point of Taiyin. Needle 4 cun deep, retain for 7 breaths, moxa 3 cones.)
Malaria of the Foot-Shaoyin meridian causes severe vomiting, frequent chills and fever, with fever predominating over chills. (The Foot-Shaoyin meridian passes through the Liver and Diaphragm, enters the Lungs, and follows the throat, hence severe vomiting and frequent chills/fever. The Kidney is a Yin organ; Yin generates cold. Now Yin Qi is deficient, hence more fever than chills. Note: Xin Zhengjiao states: "*Jia Yi Jing* says: 'Severe vomiting, more chills, less fever.'") Desire to stay indoors with doors and windows closed; the disease is difficult to cure. (Disease of the Stomach-Yangming meridian causes desire to stay alone behind closed doors; now Stomach symptoms appear in Kidney Water, Earth overcoming Water, hence difficult to cure. Datong and Taixi treat it. Datong is posterior to the medial malleolus, the Luo-Connecting point of Shaoyin. Needle 2 cun deep, retain for 7 breaths, moxa 3 cones. Taixi is posterior to the medial malleolus on the heel bone, in the depression of the arterial pulse, the Shu-Stream point of Shaoyin. Needle 3 cun deep, retain for 7 breaths, moxa 3 cones. Note: Xin Zhengjiao states: "*Jia Yi Jing* says: 'Difficult to cure, take Taixi.' Also, *Jia Yi Jing* writes Datong as 'posterior to the heel Chongzhong,' *Ci Yaotong Lun* commentary writes 'posterior street,' *Shui Xue Zhu* writes 'posterior to medial malleolus,' this commentary writes 'posterior street'; discrepancies exist, follow *Jia Yi Jing*.")
Malaria of the Foot-Jueyin meridian causes lower back pain, abdominal fullness, difficulty urinating resembling strangury but not strangury, frequent belching, fear, Qi deficiency, and inner oppression/gloom. (Foot-Jueyin meridian runs along the medial thigh, enters the pubic region, circles the genitals, and reaches the lower abdomen, hence these symptoms. Long refers to inability to urinate. Yiyi refers to a state of obstruction/discomfort. Note: Wang Ben reads "frequent urination intent," *Jia Yi Jing* reads "frequent belching," which is correct; corrected here.) Needling the Foot-Jueyin meridian. (Dachong treats it. Located 2 cun proximal to the base of the big toe, in the depression, the Shu-Stream point of Jueyin. Needle 3 cun deep, retain for 10 breaths, moxa 3 cones. Note: *Ci Yaotong Lun* commentary says "medial arterial pulse behind the joint base," differing from this note; correctness unknown.)
Lung Malaria causes coldness in the heart/chest, severe cold followed by fever, and fright during fever intervals, with visual hallucinations. Needling Hand-Taiyin and Hand-Yangming meridians. (Lieque treats it. Lieque is 1.5 cun distal to the wrist crease, the Luo-Connecting point of Hand-Taiyin. Needle 3 cun deep, retain for 3 breaths, moxa 5 cones. Yangming point, Hegu treats it. Hegu is between the metacarpals of the thumb and index finger, where the Hand-Yangming meridian passes. Needle 3 cun deep, retain for 6 breaths, moxa 3 cones. Note: The Lung governs skin and hair; inability to defend against pathogens allows deep invasion, causing chest cold. Severe cold then fever means cold exceeds fever; Lung pathology causes shivering and aversion to cold. Fright during fever intervals occurs because pathogenic factors are strong and Wood overacts on weak Metal, counter-rebelling; when fever subsides slightly, fright and hallucinations occur due to Lung injury.)
Heart Malaria causes severe mental restlessness, desire for cold water, but predominantly chills with mild fever. Needling the Hand-Shaoyin meridian. (Shenmen treats it. Shenmen is at the end of the radial styloid process, in the depression, the Shu-Stream point of Hand-Shaoyin. Needle 3 cun deep, retain for 7 breaths, moxa 3 cones. Note: The Heart houses Fire; pathogen intensifies Fire, causing severe restlessness and desire for cold water. Internal Fire blazing causes external cold, hence mild fever and predominant chills; fever expected but cold appears, hence termed "reverse".)
Liver Malaria causes a pale/greenish complexion, frequent sighing, and a state resembling death. Needling the Foot-Jueyin meridian until bleeding occurs. (Zhongfeng treats it. Zhongfeng is 1.5 cun anterior to the medial malleolus, in the depression; take with foot dorsiflexed, extend foot to locate, Foot-Jueyin meridian. Bleed upon needling; for routine needling, insert 4 cun, retain for 7 breaths, moxa 3 cones. Note: Previously discussed Foot Six Meridian malaria; now listing Liver, Spleen, Kidney, Stomach malaria again because symptoms differ. Missing Gallbladder and Bladder malaria, adding Lung and Heart malaria (Hand meridians). Reason unknown? Perhaps one meridian has diverse manifestations, previously unexplained, now clarified? Or were they originally separate chapters combined because all discuss malaria, causing textual irregularity? Uncertain. Cang refers to green/pale color, signifying decay; Liver pathology causes this color. Depression causes sighing; pathogenic factors suppress Liver, causing sighing resembling death.)
Spleen Malaria causes chills and abdominal pain; upon fever, borborygmus (intestinal rumbling) occurs, followed by sweating. Needling the Foot-Taiyin meridian. (Shangqiu treats it. Shangqiu is slightly anterior to the inferior aspect of the medial malleolus, in the depression, Foot-Taiyin meridian. Needle 3 cun deep, retain for 7 breaths, moxa 3 cones. Note: Spleen meridian governs intestines and abdomen; hence pain with cold, rumbling with heat.)
Kidney Malaria causes shivering, low back and spine pain with rolling/restlessness, difficulty defecating, blurred vision, and cold hands and feet. Needling Foot-Taiyang and Foot-Shaoyin meridians. (Datong treats it. Use method as described in Foot-Shaoyin malaria above. Note: Symptoms in this chapter vary greatly; pathology is diverse, so differences are appropriate. However, Wang Bing's commentary on acupoints and needling/moxibustion also varies significantly; only Kidney Malaria remains consistent. Analyzing the logic, the varying ones are correct, and the consistent one is wrong. Since later symptoms differ from earlier ones, acupoints should naturally differ; why stick to previous methods?)
Stomach Malaria causes frequent hunger but inability to eat; upon eating, epigastric distension and abdominal enlargement occur. (Stomach Heat and Spleen Deficiency cause hunger without appetite; eating causes distension and abdominal enlargement.) Therefore, the following text combines needling of the Taiyin meridian. Needling transverse vessels of Foot-Yangming and Foot-Taiyin to bleed. (...Lidui, Jiexi, Zusanli treat it. Lidui is at the tip of the second toe, distance from nail like a leek leaf, Yangming Jing-Well point. Needle 1 cun deep, retain for 1 breath, moxa 1 cone. Jiexi is 3.5 cun posterior to Chongyang, in the depression above the ankle, Yangming meridian. Needle 5 cun deep, retain for 5 breaths, moxa 3 cones. Zusanli is 3 cun below the knee, lateral to the tibia, between muscle bellies, Yangming He-Sea point. Needle 1 cun deep, retain for 7 breaths, moxa 3 cones. Foot-Yangming takes these three points; Foot-Taiyin needs its transverse vessel to be bled. Transverse vessel refers to the large oblique vessel anterior to the medial malleolus, i.e., the Taiyin meridian. Note: This commentary says Jiexi is 3.5 cun posterior to Chongyang; *Qixue Lun* commentary says 2.5 cun; *Jia Yi Jing* says 1.5 cun; follow *Jia Yi Jing*.)
If the malaria pulse is slow, large, and deficient, medication is suitable; acupuncture is not. (Slow indicates Wind-strike; Large indicates Qi excess; Deficient indicates Blood deficiency. Blood deficiency with Qi excess, attacked by Wind, requires medication to dispel pathogens; needle reduction and bleeding are contraindicated. Note: Commentary interpreting Large as Qi excess is incorrect. Large and forceful indicates excess; Large and deficient indicates lack of force. Hence, medication to tonify Righteous Qi and expel pathogens is suitable; needle use to drain Qi would worsen deficiency.) Generally, treat malaria about the time it takes to eat a meal before onset; otherwise, it is mistimed. (...Before onset, True Qi and Pathogen are separated, waves do not rise, hence treatable. After onset, True Qi and Pathogen merge; attacking them harms True Qi, hence termed mistimed.)