《内经》论病诸篇，唯疟论最详，语邪则风寒暑湿四气，皆得留着而病疟。论邪入
客处所，则有肠胃之外，荣气之舍，脊骨之间，五脏募原，与入客于脏腑浅深不同。
语其病状，则分寒热先后，遇寒热之多寡，则因反时而病，以应令气生长化收藏之
变，此皆外邪所致者也。及乎语温疟在脏者，止以风寒中于肾。语瘅疟者，止以肺
素有热。然冬令之寒，既得以中于肾，则其余四脏令气之邪，又宁无入客于所属之
脏者乎。既肺本气之热为疟，则四脏之气郁而为热者，又宁不似肺之为疟乎。此殆
举一隅，可以三隅反也。故陈无择谓内伤七情，饥饱房劳，皆得郁而蕴积痰涎，其
病气与卫气并则作疟者，岂非用此例以推之欤。夫如是内外所伤之邪，皆因其客在
荣气之舍，故疟有止发之定期。荣气有舍，犹行人之有传舍也。故疟荣卫之气，日
行一周，历五脏六腑十二经络之界分，每有一界分，必有其舍，舍有随经络沉内薄
之疟邪，故与日行之卫气相集则病作，离则病休。其作也，不惟脉外之卫虚并入于
阴，《灵枢》所谓足阳明与荣俱行者，亦虚以从之。阳明之气虚，则天真因水谷而充
大者亦暂衰。所以疟作之际，禁勿治刺，恐伤胃气与天真也。必待阴阳并极而退，
其荣卫天真胃气离而复集，过此邪留所客之地，然后治之。或当其病未作之先，迎
而夺之。丹溪谓疟邪得于四气之初，弱者即病，胃气强者，伏而不得动，至于再感，
胃气重伤，其病乃作。此谓外邪必用汗解，虚者先以参术实胃，加药取汗，唯足厥
阴最难得汗，其汗至足方佳。大率取汗，非用麻黄辈，但开郁通经，其邪热即散为
汗矣。又云∶疟发于子半之后、午之前，是阳分受病，其病易愈。发于午之后、寅
之前，阴分受病，其病难愈。必分受病阴阳，气血药以佐之，观形察色以别之。盖
尝从是法，而治形壮色泽者，病在气分，则通经开郁以取汗。色稍夭者，则补虚取
汗。挟痰者，先实其胃一二日，方服劫剂。形弱色枯者，则不用取汗，亦不可劫，
但补养以通经调之。其形壮而色紫黑者，病在血分，则开其阻滞。色枯者，补血调
气。夫如是者，犹为寻常之用。至于取汗不得汗，理血而汗不足，若非更求药之切
中病情，直造邪所着处，何能愈之乎。经云∶夏伤于暑，秋必 疟。暑者、季夏也，
季夏者、湿土也，君火持权，不与之子，暑湿之令不行也。湿令不行，则土亏矣。
所胜妄行，木气太过，少阳旺也。所生者受病，则肺金不足。所不胜者侮之，故水
得以乘之土分。土者、坤也，坤土、申之分，申为相火，水入于土，则水火相干，
阴阳交争，故为寒热。兼木气终见三焦，是二少阳相合也。少阳在湿土之分，故为
寒热。肺金不足，洒淅寒热。此皆往来未定之气也，故为 疟久而不愈。疟不发于
夏，而发于秋者，以湿热在酉之分，方得其权，故发于大暑以后也。在气则发早，
在血则发晏，浅则日作，深则间日。或在头项，或在背中，或在腰脊，虽上下远近
之不同，在太阳一也。或在四肢者，风淫之所及，随所伤而作，不必尽当风府也。
先寒而后热者，谓之寒疟。先热而后寒者，谓之温疟。二者不当治水火，当从乎中
治，中治者，少阳也。渴者，燥胜也。不渴者，湿胜也。疟虽伤暑，遇秋而发，其
不应也。秋病寒甚，太阳多也。冬寒不甚，阳不争也。春病则恶风，夏病则多汗，
汗者、皆少阳虚也。其病随四时而作，异形如此。又有得之于冬，而发之于暑，邪
客于肾、足少阴也。有藏之于心，内热熏于肺，手太阴也。至于少气烦冤，手足热
而呕，但热而不寒，谓之瘅疟，足阳明也。治之奈何？方其盛也，勿敢必毁，因其
衰也，治法易老疟论备矣。易老云∶夏伤于暑，湿热闭藏而不能发泄于外，邪气内
行，至秋而发为疟也。初不知何经受病，随其受而取之。有中三阳者，有中三阴者，
经中邪气，其证各殊，同伤寒论之也。五脏皆有疟，其治各异。肺疟，令人心寒，
寒甚热，热间善惊，如有所见者，桂枝加芍药汤。心疟，令人烦心甚，欲得清水，
反寒多不甚热，桂枝黄芩汤。肝疟，令人色苍苍然，太息，其状若死者，四逆汤、
通脉四逆汤。脾疟，令人寒，腹中痛，热则肠中鸣，鸣已汗出，小建中汤、芍药甘
草汤。肾疟，令人洒洒然，腰脊痛宛转，大便难，目 然，手足寒，桂枝加当归
芍药汤。足太阳之疟，令人腰痛头重，寒从背起，先寒后热， 然，热止汗
出，难已，羌活加生地黄汤、小柴胡加桂汤。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，热多汗出甚，小柴胡汤。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，桂枝二白虎一，黄芩
芍药加桂汤。足太阴之疟，令人不乐，好太息，不嗜食，多寒热汗出，病至则善呕，
呕已乃衰，小建中汤、异功散。足少阴之疟，令人呕吐甚，多寒热，热多寒少，
欲闭户牖而处，其病难已，小柴胡加半夏汤。足厥阴之疟，令人腰痛，少腹满，小
便不利，如癃状，非癃也，数便，噫，恐惧，气不足，腹中悒悒，四物柴胡苦练附
子汤。在太阳经者，谓之风疟，治多汗之。在阳明经者，谓之热疟，治多下之。在
少阳经者，谓之风热疟，治多和之。此三阳受病，皆谓暴疟也。发在夏至后处暑前
者，此乃伤之浅者，近而暴也。在阴经者，则不分三经，皆谓之温疟，宜以太阴经
论之。其发处暑后冬至前者，此乃伤之重者，远而深也。 疟者、老疟也，故谓之
久疟。疟疾处暑前发，头痛项强，脉浮恶风有汗，桂枝羌活汤。疟疾头痛项强，脉
浮恶寒无汗，麻黄羌活汤。发疟如前证而夜发者，麻黄黄芩汤。（桃仁散血缓肝，夜发
乃阴经有邪，此汤散血中风寒也。）疟疾身热目痛，热多寒少，脉长，睡卧不安，先以大柴
胡汤下之，微利为度。如下过微邪未尽者，宜白芷汤以尽其邪。疟无他证，隔日发，先寒后热，
寒少热多，宜桂枝石膏汤。疟寒热大作，不论先后，此太阳阳明合病也，谓之大争。
寒作则必战动，经曰热胜则动也。发热则必汗泄，经曰汗出不愈，知为热也。阳盛
阴虚之证，当实内治外，不治，恐久而传入阴经也。桂枝芍药汤主之。如前药服之，
寒热转大者，知太阳、阳明、少阳、三阳合病也。宜桂枝黄芩汤和之。服药已，如
外邪已罢，内邪未已，再诠下药。从卯至午时发者，宜大柴胡汤下之。从午至酉发
者，知邪在内也，宜大承气汤下之。从酉至子发者，或至寅时发者，知邪在血也，
宜桃仁承气汤下之。前项下药，微利为度，更以小柴胡汤彻其微邪之气。大法先热
后寒者，小柴胡汤。先寒后热者，小柴胡加桂枝汤。多热、但热者，白虎加桂枝汤。
多寒、但寒者，柴胡桂姜汤。此以疟之寒热多少定治法也。若多寒而但有寒者，其
脉或洪实，或滑，当作实热治之，若便用桂枝误也。如或多热而但有热者，其脉或
空虚，或微弱，当作虚寒治之，若便用白虎亦误也。所以欲学人，必先问其寒热多
少，又诊脉以参之，百无一失矣。仲景云∶疟脉自弦，弦数者多热，弦迟者多寒，
弦小紧者可下之，弦迟者可温之，弦紧者可发汗及针灸也，浮大者可吐之，弦数者
风疾发也，以饮食消息止之。阴气孤绝，阳气独发，则热而少气烦冤，手足热而欲
呕，名曰痹疟。若但热不寒者，邪气五内于心肺，外舍于分肉之间，令人消烁脱肉。
又云∶温疟者，其脉如平，身无寒但热，骨节疼烦，时时呕逆，以白虎加桂枝汤主
之。疟多寒者，名曰牝疟，蜀漆散主之。《外台》牡蛎汤亦主之。予弱冠游乡校时，
校师蒋先生之内，患牝疟身痛，逾月不瘥，困甚。时予初知医，延予延医，告以医
欲用姜附温之，予曰溽暑未衰，明系热邪，安得寒而温之。经云∶阳并于阴则阴实
而阳虚，阳明虚则寒栗鼓颔也。巨阳虚则腰背头项痛，三阳俱虚则阴气胜，阴气胜
则骨寒而痛。寒生于内，故中外皆寒，此所云寒，乃阴阳交争互作之寒，非真寒也，
岂得用桂、附温之。乃处一方，以柴胡、升麻、葛根、羌活、防风补三阳之虚，
（升之也，何曰补，曰虚亦非真虚，以陷入阴分而谓之虚，故升之即补矣。）以桃仁、红
花引入阴分，而取阳以
出还于阳分，以猪苓分隔之，使不复下陷，一剂而病良已。疟病发渴，小柴胡去半
夏加栝蒌根汤。亦治劳疟。张子和法∶白虎加人参汤、小柴胡汤、五苓散、神 丸。
服前三服未动，次与之承气汤，甘露饮调之，人参柴胡饮子补之。在上者，常山饮
吐之。刘立之法∶先当化痰下气，调理荣卫。草果平胃散、理中汤加半夏、藿香正
气散、不换金正气散、对金饮子，皆要药也。俟荣卫正，方进疟药。杨仁斋法∶风
疟自感风而得，恶风自汗，烦躁头疼，转而为疟。风、阳气也，故先热后寒，可与
解散风邪，如川芎、白芷、青皮、紫苏之类，或细辛、槟榔佐之。温疟一证，亦先
热后寒，此为伤寒坏病，与风疟大略则同，热多寒少，小柴胡汤。热少寒多，小柴
胡汤内加官桂。寒疟自感寒而得，无汗恶寒，挛痛面惨，转而为疟。寒、阴气也，
故先寒后热，可与发散寒邪，生料五积散、增桂养胃汤、或良姜、干姜、官桂、草
果之类，甚则姜附汤，附子理中汤。暑疟者，暑胜热多得之，一名瘅疟。阴气独微，
阳气独发，但热不寒，里实不泄，烦渴且呕，肌肉消铄，用小柴胡汤、香薷散，呕
者缩脾饮加生姜温服，下消暑丸。热多燥甚者，少与竹叶汤、常山、柴胡，于暑证
最便。湿疟者，冒袭雨湿，汗出澡浴得之，身体痛重，肢节烦疼，呕逆胀满，用五
苓散除湿汤加苍术、茯苓辈。寒多者，术附汤最良。牝疟者，久受阴湿，阴盛阳虚，
阳不能制阴，所以寒多不热，气虚而泄，凄惨振振，柴胡桂姜汤，减半黄芩，加半
夏。食疟一名胃疟，饮食无节，饥饱有伤致然也。凡食啖生冷。咸藏，鱼盐肥腻，中
脘生痰，皆为食疟。其状苦饥而不能食，食则中满，呕逆腹痛，青皮、陈皮、半夏、
草果、缩砂、白豆蔻作剂，或四兽汤下红丸子。瘴疟，挟岚瘴溪源蒸毒之气致然也。
自岭以南，地毒苦炎，燥湿不常，人多瘴疟。其状∶血乘上焦，病欲来时，令人迷
困，甚则发躁狂妄，亦有哑不能言者。皆由败血瘀于心，毒涎聚于脾，坡仙指为脾
胃实热所致，又有甚于伤暑之疟耳。治之须用凉膈，疏通大肠；小柴胡加大黄，治
瘴木香丸，观音丸，皆为要药。戴复 法∶不问寒热多少，且用清脾饮，草果饮，
二陈汤加草果，生料平胃散加草果、前胡。初发之际，风寒在表，虽寒热过后而身
体常自疼，常自畏风，宜草果饮，或养胃汤，每服加川芎、草果各半钱。热少者进
取微汗，寒多者宜快脾汤，或养胃汤，每服更加草果半钱。服药后寒仍多者，养胃汤，
每服加熟附、官桂各半钱。独寒者尤宜。不效则七枣汤。热多者，宜驱疟饮，或参
苏饮，每服加草果半钱。大热不除，宜小柴胡汤，渴甚则佐以五苓散，入辰砂少许。
独热无寒，宜小柴胡汤。热虽剧不甚渴者，于本方加桂四分。热多而脾气怯者，柴
朴汤。寒热俱等者，常服宜如上项二陈汤、平胃散加料之法。发日进，柴胡桂姜汤，
候可截则截之。有独热用清脾饮效者，内烦增参作一钱。食疟，乃是饮食伤脾得之，
或疟已成而犹不忌口，或寒热正作时吃食，其人噫气吞酸，胸膈不利。宜生料平胃
散，每服加草果、砂仁各半钱，仍佐以红丸子、七香丸。暑疟，其人面垢口渴，虽
热已过后，无事之时，亦常有汗，宜养胃汤一帖，香薷饮一帖，和匀作二服。渴甚
汗出多者，加味香薷饮，间进辰砂五苓散。不问已发未发，其人呕吐，痰食俱出，
宜多服二陈汤，加草果半钱。又恐伏暑蕴结为痰，宜消暑丸。按戴院使处元末国初
大乱之后，草昧之初，故其用药多主温热，医者当更斟酌于天时方土物情之间，而
得其宜，以为取舍可也。仲景、易老治疟法晰矣，然用之外因暑邪，病在盛热之时
为宜，若深秋凄清之候，与七情痰食诸伤，未可泥也，故又备诸治法。然暑月之疟，
必脉浮有表证，始可用麻、桂、羌活等表药。脉洪数长实有热证，始可用白虎等药。
脉沉实有里证，始可用大柴胡、承气等药。若弦细芤迟，四肢倦怠，饮食少进，口
干，小便赤，虽得之伤暑，当以清暑益气汤，十味香薷饮投之，虽人参白虎非其治
也。至于内外俱热，烦渴引饮，自汗出而不衰，虽热退后脉长实自如，即处暑后进
白虎何害，是又不可泥矣。澹寮云∶用药多一冷一热，半熟半生，分利阴阳。按《局
方》交解饮子，即半熟半生之例也。东垣云∶秋暮暑气衰，病热疟，知其寒也，《局
方》用双解饮子是已。治瘴疟尤妙。邑令刘蓉川先生，深秋患疟而洞泄不止，问予
《黄帝内经》中论述疾病的各篇里，只有《疟论》最为详尽。在论述病邪时，指出风、寒、暑、湿四种气候之气，都能滞留体内而引发疟疾。在论述病邪侵入并停留的部位时，有在肠胃之外、营气所居之处、脊骨之间、五脏募原等不同位置，这与病邪侵入脏腑的深浅程度不同有关。在论述病症表现时，分为寒热出现的先后顺序；根据寒热症状的多寡，又因违背时令节气而发生疾病，以对应自然界生长化收藏的变化，这些都是由外邪引起的。至于论述脏疟（病位在脏的疟疾），只说是风寒侵袭肾脏；论述瘅疟（但热不寒的疟疾），只说是肺本身素有热邪。然而，冬季的寒气既然能侵袭肾脏，那么其余四脏对应时令的气邪，难道不会侵入它们所属的脏腑吗？既然肺本气的热邪能导致疟疾，那么其他四脏的气机郁结化为热邪，难道不会像肺那样导致疟疾吗？这大概是举一反三的道理吧。所以陈无择认为，内伤于七情（喜、怒、忧、思、悲、恐、惊）、饥饱失调、房劳过度，都能导致气机郁结，蕴积成痰涎，当这些病气与卫气相搏结时就发作疟疾，这难道不是运用上述例子来推演的吗？像这样，内外所伤的邪气，都因为客居于营气所居之处，所以疟疾有定期发作和停止的特点。营气有固定的居所，就像行人有驿站一样。因此，疟疾中的营卫之气，每天运行一周天，经过五脏六腑及十二经络的分界区域，每一分界区域必有其居所，居所中潜伏着随经络深入体内的疟邪，所以当每日运行的卫气与之相遇时就发病，分离时就休止。在发病时，不仅是脉外的卫气虚弱并入于阴分，《灵枢》所说的足阳明胃经与营气共同运行的情况，也会因虚弱而跟随进入。阳明经气虚弱，那么依靠水谷精微充养的天真元气也会暂时衰退。所以在疟疾发作之际，禁止进行针刺治疗，恐怕会损伤胃气和天真元气。必须等到阴阳之气都达到极点而消退，营卫、天真、胃气分离后重新聚集，越过病邪停留的地方之后，再进行调理。或者在疾病未发作之前，迎头痛击以祛除邪气。朱丹溪说，疟邪最初获得于四气（风寒暑湿）之中，体质弱者随即发病，胃气强者，邪气潜伏而不能发动，直到再次感受外邪，胃气受到严重损伤，疾病才发作。这说明外邪必须用发汗法解除，体虚者先用参术（人参、白术）充实胃气，加入药物取汗，只有足厥阴肝经的病最难出汗，汗出到达足部才算好。大抵取汗的方法，不一定非要用麻黄之类的药，只要开通郁结、疏通经络，邪热就会随着汗液散发出去。又说：疟疾在子时半之后、午时之前发作，是阳分受病，病情容易痊愈；在午时之后、寅时之前发作，是阴分受病，病情难愈。必须分辨受病的阴阳属性，配合气血药物辅助，观察形体色泽来辨别。我曾经遵循这种方法，治疗形体壮实、面色光泽的人，病在气分，就用疏通经络、开郁结的方法来取汗。面色稍显枯槁的人，就用补虚的方法来取汗。挟带痰湿的人，先充实胃气一两天，然后服用截疟猛剂。形体虚弱、面色枯黑的人，就不采用取汗法，也不可用截疟猛剂，只需补养身体以疏通经络来调理。形体壮实而面色紫黑的人，病在血分，就疏通阻滞。面色枯黑的人，补血调气。像这样的用法，还算是一般常规的应用。至于取汗不出，调理血液而汗源不足，如果不是进一步寻求切中病情的药物，直达邪气附着之处，怎么能治愈呢？经文说：夏季伤于暑气，秋季必定发生疟疾。暑气属于季夏（农历六月），季夏属于湿土，君火掌权，不给予子气（湿气），暑湿的政令不能施行。湿令不行，则土气亏损。所胜之气妄行，木气太过，少阳胆经旺盛。所生之气受病，则肺金不足。所不胜之气反侮，所以水气得以乘袭土分。土对应坤卦，坤土对应申地，申为相火，水进入土中，则水火相互干扰，阴阳交争，所以出现寒热交替。兼有木气最终影响三焦，这是二少阳（胆与三焦）相合。少阳位于湿土之分，所以出现寒热。肺金不足，出现洒淅恶寒发热。这些都是往来不定的气机变化，所以疟疾久而不愈。疟疾不在夏季发作，而在秋季发作，是因为湿热在酉地（农历八月）之时，方才得其权柄，所以在立秋以后发作。病在气分则发作早，在血分则发作晚，病位浅则每日发作，病位深则隔日发作。有的在头项，有的在背中，有的在腰脊，虽然上下远近不同，但都在太阳经。有的在四肢，是风邪淫溢所及，随受伤部位而发作，不一定都在风府穴。先冷后热的，称为寒疟。先热后冷的，称为温疟。这两种情况不应当直接治水火，而应当从中焦治疗，中焦治疗指的是少阳经。口渴的，是燥气胜；不渴的，是湿气胜。疟疾虽然伤于暑气，但在秋季发作，这是不合常理的。秋季病重且寒冷，多属太阳经病变。冬季寒冷不明显，阳气不争。春季发病则怕风，夏季发病则多汗，汗出都是由于少阳经虚弱所致。疾病随四季而变化，形态各异如此。又有在冬季得病，而在暑季发作的，邪气客居在肾脏，即足少阴肾经。有藏于心，内热熏蒸于肺，即手太阴肺经。至于气短烦闷，手足发热而呕吐，只有热而没有寒，称为瘅疟，属于足阳明胃经。如何治疗？在邪气盛的时候，不敢强行攻伐，趁着邪气衰退时治疗，易老（张元素）的疟论已经完备了。易老说：夏季伤于暑气，湿热闭藏而不能发泄于外，邪气内行，到秋季发作成为疟疾。起初不知道是哪条经脉受病，随其受病的经脉来选取治疗方法。有中三阳经的，有中三阴经的，经络中的邪气，证候各不相同，如同伤寒论所述的那样。五脏都有疟疾，治疗各不相同。肺疟，使人心中寒冷，寒冷严重时发热，热间歇时容易惊恐，好像看到了什么，用桂枝加芍药汤。心疟，使人心中非常烦躁，想喝冷水，反而怕冷多而发热轻，用桂枝黄芩汤。肝疟，使人面色苍苍然，经常叹气，样子像死了一样，用四逆汤、通脉四逆汤。脾疟，使人怕冷，腹中疼痛，发热时肠鸣，鸣响后出汗，用小建中汤、芍药甘草汤。肾疟，使人洒洒然怕冷，腰脊疼痛辗转不安，大便困难，眼睛昏花看不清，手脚冰凉，用桂枝加当归芍药汤。足太阳经疟，使人腰痛头重，寒气从背部升起，先冷后热，身体拘急，热退后出汗，难以治愈，用羌活加生地黄汤、小柴胡加桂枝汤。足少阳经疟，使人身体懈怠松弛，冷不重，热不重，害怕见人，见到人就心里恐惧，热多汗出多，用小柴胡汤。足阳明经疟，使人先冷，洒淅怕冷，冷很久才发热，热退后出汗，喜欢见日光月光火光才觉得舒服，用桂枝二白虎一方、黄芩芍药加桂汤。足太阴经疟，使人不快乐，喜欢叹气，不想吃东西，多寒热出汗，病发作时容易呕吐，吐完病情减轻，用小建中汤、异功散。足少阴经疟，使人呕吐严重，多寒热，热多寒少，想关上门窗独处，病情难愈，用小柴胡加半夏汤。足厥阴经疟，使人腰痛，小腹满，小便不利，像尿潴留的样子，其实不是尿潴留，频繁小便，打嗝，恐惧，气不足，心中郁闷，用四物柴胡苦练附子汤。在太阳经的，称为风疟，治疗多用发汗法。在阳明经的，称为热疟，治疗多用泻下法。在少阳经的，称为风热疟，治疗多用和解法。这三阳经受病，都称为暴疟。在夏至后处暑前发作的，这是受伤较浅，近而突然发作的。在阴经的，则不分三条经，都称为温疟，宜按太阴经论治。在处暑后冬至前发作的，这是受伤较重，远而深入的。久疟，是老疟疾，所以称为久疟。疟疾在处暑前发作，头痛项强，脉浮怕风有汗，用桂枝羌活汤。疟疾头痛项强，脉浮怕冷无汗，用麻黄羌活汤。发作如前述证状而在夜间发作的，用麻黄黄芩汤。（桃仁散血缓肝，夜间发作乃是阴经有邪，此汤疏散血中风寒。）疟疾身热目痛，热多寒少，脉长，睡卧不安，先用大柴胡汤泻下，轻微腹泻为度。如果泻下后微邪未尽，宜用白芷汤以清除余邪。疟疾没有其他证状，隔日发作，先冷后热，冷少热多，宜用桂枝石膏汤。疟疾寒热剧烈发作，不论先后，这是太阳阳明合病，称为大争。寒作时必然战栗抖动，经文说热胜则动。发热时必然汗出泄越，经文说汗出不愈，知道是热证。阳盛阴虚的证状，应当充实内部治疗外部，如果不治，恐怕日久传入阴经。用桂枝芍药汤主治。如果服前药后，寒热转剧，知道是太阳、阳明、少阳三阳合病。宜用桂枝黄芩汤和解。服药后，如果外邪已罢，内邪未除，再选用下药。从卯时至午时发作的，宜用大柴胡汤泻下。从午时至酉时发作的，知道邪气在内，宜用大承气汤泻下。从酉时至子时发作的，或至寅时发作的，知道邪气在血分，宜用桃仁承气汤泻下。前述下药，以轻微腹泻为度，再用小柴胡汤清除微邪之气。大法：先热后寒的，用小柴胡汤。先寒后热的，用小柴胡加桂枝汤。多热、但热的，用白虎加桂枝汤。多寒、但寒的，用柴胡桂姜汤。这是根据疟疾寒热的多少来确定治法。如果多寒而只有寒的，其脉或洪实，或滑，当作实热治疗，如果直接用桂枝就错了。如果多热而只有热的，其脉或空虚，或微弱，当作虚寒治疗，如果直接用白虎也错了。所以想学医的人，必须先问寒热多少，又诊脉来参考，百无一失。仲景说：疟脉自弦，弦数者多热，弦迟者多寒，弦小紧者可下之，弦迟者可温之，弦紧者可发汗及针灸，浮大者可吐之，弦数者风疾发作，以饮食调养来止住。阴气孤绝，阳气独发，则热而少气烦闷，手足发热而想呕吐，名叫痹疟。如果只有热没有寒，邪气内在于心肺，外舍于分肉之间，使人消瘦脱肉。又说：温疟，其脉象如常人，身体不冷只热，骨节疼痛烦扰，时时呕吐，用白虎加桂枝汤主治。疟疾多寒的，名叫牝疟，用蜀漆散主治。《外台秘要》的牡蛎汤也主治。我二十岁在乡校求学时，校师蒋先生的内人，患牝疟身痛，超过一个月不好，非常困顿。当时我刚懂医术，请我去看病，告诉我说医生想用姜附温热之法治疗，我说溽暑未衰，明系热邪，怎么能用寒证来温热治疗。经文说：阳并于阴则阴实而阳虚，阳明虚则寒栗鼓颔（下巴发抖）。巨阳虚则腰背头项痛，三阳俱虚则阴气胜，阴气胜则骨寒而痛。寒生于内，所以中外皆寒，这里所说的寒，乃是阴阳交争互作的寒，并非真寒，怎么能用桂枝、附子温热治疗。于是开一方，用柴胡、升麻、葛根、羌活、防风补三阳之虚，（这是升提之意，为什么说补？曰：虚也不是真虚，因为陷入阴分而谓之虚，所以升提就是补了。）用桃仁、红花引入阴分，而使阳气出来回到阳分，用猪苓分隔，使不再下陷，一剂病就好了。疟病发作口渴，用小柴胡去半夏加栝蒌根汤。也治疗劳疟。张子和的法子：白虎加人参汤、小柴胡汤、五苓散、神祐丸。服前三剂未见效，接着给他承气汤，用甘露饮调理，用人参柴胡饮子补益。病在上部的，用常山饮催吐。刘立的法子：先当化痰下气，调理营卫。草果平胃散、理中汤加半夏、藿香正气散、不换金正气散、对金饮子，都是重要药物。等营卫正气恢复，才进服疟药。杨仁斋的法子：风疟自然感风而得，怕风自汗，烦躁头疼，转而为疟。风，是阳气，所以先热后寒，可与解散风邪的药物，如川芎、白芷、青皮、紫苏之类，或用细辛、槟榔辅助。温疟一证，也是先热后寒，这是伤寒坏病，与风疟大致相同，热多寒少，用小柴胡汤。热少寒多，在小柴胡汤内加官桂。寒疟自然感寒而得，无汗恶寒，挛痛面惨，转而为疟。寒，是阴气，所以先寒后热，可与发散寒邪的药物，生料五积散、增桂养胃汤、或良姜、干姜、官桂、草果之类，严重的用姜附汤，附子理中汤。暑疟者，暑胜热多得之，一名瘅疟。阴气独微，阳气独发，但热不寒，里实不泄，烦渴且呕，肌肉消铄，用小柴胡汤、香薷散，呕吐的用缩脾饮加生姜温服，下消暑丸。热多燥甚的，少量给竹叶汤、常山、柴胡，对于暑证最方便。湿疟者，冒袭雨湿，汗出澡浴得之，身体痛重，肢节烦疼，呕逆胀满，用五苓散除湿汤加苍术、茯苓辈。寒多的，术附汤最好。牝疟者，久受阴湿，阴盛阳虚，阳不能制阴，所以寒多不热，气虚而泄，凄惨振颤，用柴胡桂姜汤，减半黄芩，加半夏。食疟一名胃疟，饮食无节制，饥饱损伤导致。凡是吃生冷、咸菜、鱼盐肥腻之物，中脘生痰，都成为食疟。其状苦于饥饿却不能进食，进食则中满，呕逆腹痛，用青皮、陈皮、半夏、草果、缩砂、白豆蔻作剂，或用四兽汤送服红丸子。瘴疟，挟带岚瘴溪源蒸毒之气导致。自岭南以南，地方毒苦炎热，燥湿无常，人多患瘴疟。其状：血乘上焦，病欲来时，使人迷困，甚至发躁狂妄，也有哑巴不能说话的。都是由败血瘀于心，毒涎聚于脾，坡仙（苏轼）指为脾胃实热所致，又有甚于伤暑的疟疾罢了。治疗须用凉膈散，疏通大肠；小柴胡加大黄，治瘴木香丸，观音丸，都是重要药物。戴复庵的法子：不问寒热多少，暂且用清脾饮，草果饮，二陈汤加草果，生料平胃散加草果、前胡。初发之际，风寒在表，虽寒热过后而身体常自疼，常自畏风，宜用草果饮，或养胃汤，每服加川芎、草果各半钱。热少的进取微汗，寒多的宜快脾汤，或养胃汤，每服更加草果半钱。服药后寒仍多的，用养胃汤，每服加熟附、官桂各半钱。独寒的尤其适宜。无效则用七枣汤。热多的，宜驱疟饮，或参苏饮，每服加草果半钱。大热不除，宜小柴胡汤，渴甚则佐以五苓散，入辰砂少许。独热无寒，宜小柴胡汤。热虽剧不甚渴的，于本方加桂四分。热多而脾气怯的，用柴朴汤。寒热俱等的，常服宜如上项二陈汤、平胃散加料之法。发日进，用柴胡桂姜汤，候可截则截之。有独热用清脾饮有效的，内烦增人参作一钱。食疟，乃是饮食伤脾得之，或疟已成而犹不忌口，或寒热正作时吃食，其人噫气吞酸，胸膈不利。宜生料平胃散，每服加草果、砂仁各半钱，仍佐以红丸子、七香丸。暑疟，其人面垢口渴，虽热已过后，无事之时，亦常有汗，宜养胃汤一帖，香薷饮一帖，和匀作二服。渴甚汗出多的，加味香薷饮，间进辰砂五苓散。不问已发未发，其人呕吐，痰食俱出，宜多服二陈汤，加草果半钱。又恐伏暑蕴结为痰，宜消暑丸。按戴院使处在元末国初大乱之后，草昧之初，故其用药多主温热，医者当更斟酌于天时方土物情之间，而得其宜，以为取舍可也。仲景、易老治疟法晰矣，然用之外因暑邪，病在盛热之时为宜，若深秋凄清之候，与七情痰食诸伤，未可泥也，故又备诸治法。然暑月之疟，必脉浮有表证，始可用麻、桂、羌活等表药。脉洪数长实有热证，始可用白虎等药。脉沉实有里证，始可用大柴胡、承气等药。若弦细芤迟，四肢倦怠，饮食少进，口干，小便赤，虽得之伤暑，当以清暑益气汤，十味香薷饮投之，虽人参白虎非其治也。至于内外俱热，烦渴引饮，自汗出而不衰，虽热退后脉长实自如，即处暑后进白虎何害，是又不可泥矣。澹寮云：用药多一冷一热，半熟半生，分利阴阳。按《局方》交解饮子，即半熟半生之例也。东垣云：秋暮暑气衰，病热疟，知其寒也，《局方》用双解饮子是已。治瘴疟尤妙。邑令刘蓉川先生，深秋患疟而洞泄不止，问予
The various chapters in the *Huangdi Neijing* (Yellow Emperor's Inner Canon) discussing diseases are most detailed in the *Malaria Treatise* (Nue Lun). Regarding pathogenic factors, it states that wind, cold, summerheat, and dampness can all linger in the body and cause malaria. Regarding the sites where pathogens enter and lodge, there are locations outside the intestines and stomach, within the abodes of Ying (Nutritive) Qi, between the spinal bones, and at the Mu-Yuan (Alarm and Source) points of the Zang organs; these differ according to the depth of pathogen invasion into the Zang-Fu organs. Regarding clinical manifestations, it distinguishes the sequence of chills and fever; based on the predominance of chills or fever, illness may occur contrary to the seasonal climate, responding to the variations of growth, transformation, and storage in nature. These are all caused by external pathogens. As for discussing Zang malaria (malaria located in the Zang organs), it attributes it solely to wind-cold invading the Kidney. As for discussing Dan malaria (malaria with only heat and no chills), it attributes it solely to pre-existing heat in the Lung. However, if winter cold can invade the Kidney, why would the climatic pathogens corresponding to the other four seasons not invade their respective Zang organs? Since heat in the Lung's own Qi can cause malaria, why would heat generated by Qi stagnation in the other four Zang organs not similarly cause malaria? This is likely a principle of inferring three corners from one corner. Thus, Chen Wuyue stated that internal injuries from the Seven Emotions (joy, anger, worry, thought, grief, fear, fright), irregular diet, and sexual excess can all lead to Qi stagnation and the accumulation of phlegm-fluids. When this pathological Qi combines with Wei (Defensive) Qi, malaria occurs. Is this not an application of such reasoning? In this way, both internal and external pathogenic factors lodge in the abode of Ying Qi, which is why malaria has regular periods of onset and remission. Ying Qi has its abode, just as travelers have relay stations. Therefore, the Ying and Wei Qi in malaria circulate through the body once daily, passing through the boundaries of the five Zang organs, six Fu organs, and twelve meridians. At each boundary, there must be an abode containing malaria pathogens that have sunk inward along the meridians. When these encounter the daily circulating Wei Qi, the disease manifests; when they separate, the disease rests. During onset, not only does the Wei Qi outside the vessels weaken and merge into the Yin, but also, as mentioned in the *Lingshu* (Spiritual Pivot), the Foot-Yangming Stomach Meridian, which normally travels with Ying Qi, also weakens and follows suit. When Yangming Qi is deficient, the Tianzhen (innate) Yuan Qi, nourished by food and drink, also temporarily declines. Therefore, during malaria attacks, acupuncture should be prohibited to avoid damaging Stomach Qi and Tianzhen Qi. One must wait until Yin and Yang reach their extremes and recede, until Ying, Wei, Tianzhen, and Stomach Qi separate and then reassemble, and after passing the location where the pathogen resides, treatment can proceed. Alternatively, attack the pathogen before the disease manifests. Zhu Danxi said that malaria pathogens are acquired initially from the four climatic factors; those with weak constitutions fall ill immediately, while those with strong Stomach Qi allow the pathogen to lie dormant until a secondary infection severely damages the Stomach Qi, triggering the disease. This indicates that external pathogens must be resolved via sweating. For the deficient, first strengthen the Stomach with Renshen (Ginseng Root) and Baizhu (Atractylodis Rhizoma), then add herbs to induce sweating. Only in cases involving the Foot-Jueyin Liver Meridian is sweating difficult to achieve; sweating reaching the feet is ideal. Generally, inducing sweating does not necessarily require herbs like Mahuang (Ephedrae Herba); simply opening stagnation and unblocking meridians allows pathogenic heat to dissipate as sweat. It is also said: Malaria occurring between half past Zi hour and Wu hour involves the Yang aspect and is easier to cure. Occurring between half past Wu hour and Yin hour involves the Yin aspect and is harder to cure. One must distinguish the Yin-Yang nature of the disease, assist with Qi-Blood regulating herbs, and differentiate by observing form and complexion. I have followed this method: for patients with robust forms and lustrous complexions, where the disease is in the Qi level, I use methods to unblock meridians and open stagnation to induce sweating. For those with slightly sallow complexions, I use tonification to induce sweating. For those with phlegm-dampness, I first strengthen the Stomach for one to two days, then administer potent antimalarial agents. For those with weak forms and withered complexions, I do not use sweating methods nor potent agents, but instead tonify and nourish to unblock meridians and regulate. For those with robust forms but purple-black complexions, the disease is in the Blood level, so I unblock obstructions. For those with withered complexions, I tonify blood and regulate Qi. Such applications are considered standard. However, if sweating fails to produce sweat, and blood regulation fails to generate sufficient sweat, unless one seeks herbs that precisely target the pathology and reach the site of pathogen attachment, how can the disease be cured? The Classic states: "Summer injury by summerheat leads to autumn malaria." Summerheat belongs to late summer (the sixth lunar month), which corresponds to wet earth. With Sovereign Fire holding power, it does not generate the sub-element (wetness), so the command of summerheat and dampness does not operate. If dampness does not operate, Earth becomes deficient. The overcoming element acts recklessly, Wood Qi becomes excessive, and Shaoyang (Gallbladder) prospers. The generating element suffers, so Lung Metal becomes insufficient. The non-overcoming element insults, allowing Water to invade the Earth sector. Earth corresponds to Kun; Kun Earth corresponds to Shen. Shen represents Ministerial Fire. When Water enters Earth, Water and Fire interfere, causing Yin-Yang conflict, resulting in alternating chills and fever. Additionally, Wood Qi ultimately affects the Sanjiao (Triple Burner), combining the two Shaoyangs. Shaoyang in the wet Earth sector causes chills and fever. Insufficient Lung Metal causes shivering chills and fever. These are all fluctuating Qi dynamics, hence malaria persists. Malaria does not manifest in summer but in autumn because damp-heat gains power in You (the eighth lunar month), thus appearing after Major Heat. Disease in Qi manifests early; in Blood, late. Superficial disease manifests daily; deep disease manifests every other day. Symptoms may appear in the head and neck, back, or waist and spine. Although locations vary, they all relate to the Taiyang (Greater Yang) meridian. Symptoms in the limbs result from Wind dispersal, manifesting where injured, not necessarily at Fengfu (GV16). Chills preceding fever is called Han Nue (Cold Malaria). Fever preceding chills is called Wen Nue (Warm Malaria). These two should not be treated directly targeting Water or Fire, but rather through the Middle Jiao, which refers to Shaoyang. Thirst indicates Dryness predominance; lack of thirst indicates Dampness predominance. Although malaria originates from summerheat injury, its manifestation in autumn is abnormal. Severe cold in autumn suggests Taiyang involvement. Mild cold in winter indicates Yang does not contend. Spring onset implies aversion to wind; summer onset implies profuse sweating, all due to Shaoyang deficiency. The disease varies with seasons, presenting differently. Some contracted in winter manifest in summer, with pathogens lodging in the Kidney (Foot-Shaoyin). Some stored in the Heart, with internal heat steaming the Lung (Hand-Taiyin). Shortness of breath, vexation, hot hands and feet, vomiting, and fever without chills constitute Dan Nue, belonging to Foot-Yangming. How to treat? Do not attack during peak intensity; treat during decline. Yilao’s treatise on malaria is comprehensive. Yilao stated: Summer heat and dampness close internally and cannot vent outward; pathogens move inward and manifest as malaria in autumn. Initially, identify the affected meridian and treat accordingly. Pathogens may affect the Three Yang or Three Yin meridians; symptoms vary like in Shanghan (Cold Damage) theory. All five Zang organs can suffer malaria, with distinct treatments. Fei Nue (Lung Malaria) causes cold heart, severe chills followed by fever, anxiety during remission, and hallucinations; treat with Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction plus Peony). Xin Nue (Heart Malaria) causes severe mental restlessness, desire for cold water, more chills than fever; treat with Guizhi Huangqin Tang (Cinnamon Twig and Scutellaria Decoction). Gan Nue (Liver Malaria) causes pale complexion, sighing, and a corpse-like state; treat with Sini Tang (Frigid Extremities Decoction) or Tongmai Sini Tang (Pulse-Reviving Frigid Extremities Decoction). Pi Nue (Spleen Malaria) causes chills, abdominal pain, intestinal borborygmi during fever, and sweating after borborygmi; treat with Xiaojianzhong Tang (Minor Construct the Middle Decoction) or Shaoyao Gancao Tang (Peony and Licorice Decoction). Shen Nue (Kidney Malaria) causes shivering chills, lower back and spine pain, difficulty defecating, blurred vision, and cold extremities; treat with Guizhi Jiang Danggui Shaoyao Tang (Cinnamon Twig plus Angelica and Peony Decoction). Foot-Taiyang Malaria causes lower back pain, heavy head, chills starting from the back, chills then fever, stiffness, and difficult-to-cure sweating upon fever resolution; treat with Qianghuo Shengdihuang Tang (Notopterygium and Rehmannia Decoction) or Xiaochaihu Jia Guizhi Tang (Minor Bupleurum plus Cinnamon Twig Decoction). Foot-Shaoyang Malaria causes flaccidity, mild chills and fever, aversion to people, and palpitations; treat with Xiaochaihu Tang (Minor Bupleurum Decoction). Foot-Yangming Malaria causes initial chills, shivering, prolonged chills before fever, and relief upon seeing light/fire after sweating; treat with Guizhi Er Baihu Yi (Two parts Cinnamon Twig to one part White Tiger Decoction) or Huangqin Shaoyao Jia Guizhi Tang (Scutellaria, Peony, and Cinnamon Twig Decoction). Foot-Taiyin Malaria causes unhappiness, sighing, anorexia, chills/fever/sweating, vomiting upon onset, and improvement after vomiting; treat with Xiaojianzhong Tang or Yigong San (Yi Gong Powder). Foot-Shaoyin Malaria causes severe vomiting, mixed chills/fever (more heat), desire to stay indoors, and difficult cure; treat with Xiaochaihu Jia Banxia Tang (Minor Bupleurum plus Pinellia Decoction). Foot-Jueyin Malaria causes lower back pain, abdominal fullness, urinary difficulty resembling strangury but frequent urination, belching, fear, Qi deficiency, and inner oppression; treat with Siwu Chaihu Kunlian Fuzi Tang (Four Substances, Bupleurum, Coptis, and Aconite Decoction). Taiyang malaria is called Feng Nue (Wind Malaria), treated with diaphoresis. Yangming malaria is called Re Nue (Heat Malaria), treated with purgation. Shaoyang malaria is called Feng-Re Nue (Wind-Heat Malaria), treated with harmonization. These three Yang acute malarias occur between Summer Solstice and End of Heat, indicating shallow/recent injury. Yin meridian malarias are all called Wen Nue, treated per Taiyin principles. Onset between End of Heat and Winter Solstice indicates deep/profound injury. Jiu Nue (Chronic Malaria) is old malaria. Malaria with headache, stiff neck, floating pulse, aversion to wind, and sweating before End of Heat is treated with Guizhi Qianghuo Tang (Cinnamon Twig and Notopterygium Decoction). Malaria with headache, stiff neck, floating pulse, aversion to cold, and no sweating is treated with Mahuang Qianghuo Tang (Ephedra and Notopterygium Decoction). Malaria with prior symptoms but nocturnal onset is treated with Mahuang Huangqin Tang (Ephedra and Scutellaria Decoction) to disperse blood and wind-cold in Yin meridians. Malaria with fever, eye pain, more heat than chills, long pulse, and insomnia is first treated with Daxiehu Tang (Major Bupleurum Decoction) to purge lightly. If pathogens remain, use Baizhi Tang (Angelica Dahurica Decoction). Malaria without other symptoms, every-other-day onset, chills then fever, less chills more heat, is treated with Guizhi Shigao Tang (Cinnamon Twig and Gypsum Decoction). Severe alternating chills/fever regardless of order indicates Taiyang-Yangming combined disease (Da Zheng), characterized by rigors (heat dominance causes movement) and sweating (heat dominance). For Yang excess/Yin deficiency, tonify interior and release exterior using Guizhi Shaoyao Tang (Cinnamon Twig and Peony Decoction) to prevent transmission to Yin. If symptoms worsen post-medication, it indicates Triple Yang combination; treat with Guizhi Huangqin Tang. If exterior pathogens resolve but interior remain, use purgatives. Onset Mao-Wu hours: Daxiehu Tang. Onset Wu-You hours: Da Chengqi Tang (Major Order the Qi Decoction). Onset You-Zi or Yin hours: Tao Ren Chengqi Tang (Peach Kernel and Major Order the Qi Decoction) for blood-level pathogens. Purges should be mild, followed by Xiaochaihu Tang. General rules: Heat-then-chills: Xiaochaihu Tang. Chills-then-heat: Xiaochaihu Jia Guizhi Tang. More heat/only heat: Baihu Jia Guizhi Tang (White Tiger plus Cinnamon Twig Decoction). More chills/only chills: Chaihu Guijiang Tang (Bupleurum, Cinnamon, and Ginger Decoction). Determine treatment by chill/heat ratio. Pure chills with surging/slipping pulse: treat as excess heat (Guizhi error). Pure heat with empty/weak pulse: treat as deficiency cold (Baihu error). Always ask about chill/heat ratio and check pulse. Zhang Zhongjing stated: Malaria pulse is naturally wiry. Wiry-rapid: more heat. Wiry-slow: more chills. Wiry-small-tight: purgation. Wiry-slow: warming. Wiry-tight: diaphoresis/acupuncture. Floating-large: emesis. Wiry-rapid: wind disease, manage with diet. Yin isolation/Yang eruption causes Bi Nue (Obstruction Malaria): heat, shortness of breath, vexation, hot extremities, vomiting. Only heat/no chills with wasting indicates pathogens in Heart/Lung affecting flesh. Wen Nue: normal pulse, fever without chills, bone/joint pain, vomiting; treat with Baihu Jia Guizhi Tang. Excessive chills: Pin Nue (Yin Malaria), treat with Shuqi San (Alisma Powder) or Waitai Musli Tang (Oyster Shell Decoction). Case: Teacher Jiang’s wife had Pin Nue with body pain for a month. Young physician suggested ginger/aconite warmth. I argued against it in summer heat, citing Yang merging into Yin causing false cold. Prescribed Chaihu, Shengma, Gegen, Qianghuo, Fangfeng to lift Yang from Yin, Taoren, Honghua to guide into Yin, and Zhuling to prevent sinking. One dose cured. Malaria with thirst: Xiaochaihu Qu Banxia Jua Gualou Gen Tang (Minor Bupleurum minus Pinellia plus Trichosanthes Root Decoction), also for Lao Nue (Labor Malaria). Zhang Zhizi’s method: Baihu Jia Renshen Tang, Xiaochaihu Tang, Wuling San, Shenyao Wan. If ineffective, use Chengqi Tang, Ganlu Yin, Renshen Chaihu Yinzi. Upper jiao: Changshan Yin (Emetic). Liu Li’s method: Resolve phlegm/Qi, regulate Ying/Wei. Caoguo Pingwei San, Lizhong Tang + Banxia, Huoxiang Zhengqi San, Buhuanjin Zhengqi San, Duijin Yinzi. Wait for Ying/Wei recovery before antimalarials. Yang Renzhai’s method: Feng Nue (wind-induced, aversion to wind, sweating, headache, heat-then-chills) uses Jiebiao herbs (Chuanxiong, Baizhi, Qingpi, Zisu, Xixin, Binglang). Wen Nue (cold damage complication, heat-then-chills, more heat) uses Xiaochaihu Tang (+ Guirou for more chills). Han Nue (cold-induced, no sweat, aversion to cold, spasms, chills-then-heat) uses Sanfa herbs (Shengliao Wuji San, Zenggui Yangwei Tang, Liangjiang, Ganjiang, Guirou, Caoguo; severe: Jiangfu Tang, Fuzi Lizhong Tang). Shu Nue (summerheat/Dan Nue, only heat, dryness, vomiting, wasting) uses Xiaochaihu Tang, Xiangru San, Suopi Yin (+ ginger for vomiting), Xiaoshu Wan. Dryness/heat: Zhuye Tang, Changshan, Chaihu. Shi Nue (dampness/rain exposure, heaviness, pain, vomiting) uses Wuling San Chushi Tang + Cangzhu, Fuling. Cold-predominant: Shufu Tang. Pin Nue (chronic damp/Yin excess/Yang deficiency, chills/shaking) uses Chaihu Guijiang Tang (- Huangqin, + Banxia). Shi Nue (food/stomach, irregular diet, phlegm from cold/fatty foods, hunger but inability to eat, fullness, vomiting) uses Qingpi, Chenpi, Banxia, Caoguo, Suosha, Baixiandou, or Sibao Tang + Hongwanzi. Zhang Nue (miasma/toxic qi, Lingnan region, confusion, mania, aphasia, blood stasis/phlegm in Heart/Spleen, spleen-stomach excess heat) uses Liangge San, Xiaochaihu Jia Huangqi, Zhizhang Muxiang Wan, Guanyin Wan. Dai Fu’an’s method: Regardless of chill/heat, use Qingpi Yin, Caoguo Yin, Erchen Tang + Caoguo, Shengliao Pingwei San + Caoguo, Qianhu. Initial stage (wind-cold exterior, body ache, aversion to wind): Caoguo Yin or Yangwei Tang + Chuanxiong/Caoguo. Less heat: induce slight sweat. More chills: Kuaipi Tang or Yangwei Tang + Caoguo. Post-medication persistent chills: Yangwei Tang + Shufu/Guirou. Unique cold: especially suitable. Ineffective: Qizao Tang. More heat: Qumie Yin or Renshen Su Yin + Caoguo. High fever: Xiaochaihu Tang + Wuling San + Chen Sha. Unique heat: Xiaochaihu Tang. High heat/thirst: add Guizhi. Heat/mild spleen: Chaipo Tang. Equal chill/heat: Erchen/Pingwei modifications. Daily progression: Chaihu Guijiang Tang, stop when possible. Unique heat responsive to Qingpi Yin: add Renshen. Food malaria (dietary spleen injury, eating during fever, acid regurgitation): Shengliao Pingwei San + Caoguo/Sharen, Hongwanzi, Qixiang Wan. Summerheat malaria (dirty face/thirst, sweating after fever): Yangwei Tang + Xiangru Yin. Thirst/sweat: Jiawei Xiangru Yin, Chen Sha Wuling San. Vomiting/phlegm-food: Erchen Tang + Caoguo. Latent summerheat-phlegm: Xiaoshu Wan. Note: Dai Fu’an practiced post-Yuan chaos, favoring warm herbs; physicians must adapt to time/place. Zhang Zhongjing/Yilao methods suit summer heat/exterior pathogens. Deep autumn/emotional/dietary injuries require different approaches. Summer malaria requires floating pulse/exterior signs for Mahuang/Guizhi/Qianghuo. Surging-rapid-long-excess pulse/heat signs for Baihu. Deep-excess/internal signs for Daxiehu/Chengqi. Wiry-thin-hollow-slow pulse, fatigue, poor appetite, dry mouth, red urine: Qingxu Yiqi Tang or Shiwei Xiangru Yin, even if summerheat origin. Internal/external heat, thirst, sweating: Baihu acceptable even post-End of Heat if pulse remains strong. Danliao noted cold/heat, raw/cooked herb combinations to balance Yin/Yang (Jiejie Yinzi example). Dongyuan noted late autumn heat malaria requires cold resolution (Shuangjie Yinzi), excellent for Zhang Nue. Case: Magistrate Liu Rongchuan, late autumn malaria with diarrhea, asked me...