以先去其一为快，予以此方投之，一服而二病俱愈。外祖母虞太孺人，年八十余，
夏患疟，诸舅以年高不堪，惧其再发，议欲截之。予曰欲一剂而已亦甚易，何必截
乎。乃用柴胡、升麻、葛根、羌活、防风之甘辛气清以升阳气，使离于阴而寒自已，
以知母、石膏、黄芩之苦甘寒引阴气下降，使离于阳而热自已，以猪苓之淡渗分利
阴阳，使不得交并，以穿山甲引之，以甘草和之，果一剂而止。故赵以德云∶尝究
本草，知母、草果、常山、甘草、乌梅、槟榔、穿山甲，皆言治疟。集以成方者，
为知母性寒，入足阳明药，将用治阳明独盛之火热，使其退就太阴也。草果性温
燥，治足太阴独盛之寒，使其退就阳明也。二经合和，则无阴阳交错之变，是为君
药也。常山主寒热疟，吐胸中痰结，是为臣药也。甘草和诸药，乌梅去痰，槟榔除
痰癖、破滞气，是佐药也。穿山甲者，以其穴山而居，遇水而入，则是出阴入阳，
穿其经络于荣分，以破暑结之邪，为之使药也。然则此方，乃脾胃有郁痰伏涎者，
用之收效。若无痰，止于暑结荣分，独应是太阴血证而热者，当发唇疮而愈，于此
方则无功矣。（柴升等药，外因为宜。知母等药，内因为宜。）东南濒海，海风无常，所食鱼
盐，人多停饮，故风疟、食疟所由以盛，乌头、草果、陈皮、半夏施得其宜。西北高旷，
隆冬则水冰地裂，盛夏则烁石流金，人多中寒伏暑，故多暑疟、寒疟，柴胡、恒山
故应合用。东南西北往来其间，病在未分之际，可与藿香正气散、草果饮，是犹养
胃汤也。治北方疟，以马鞭草茎叶煎一盏，露一宿，早服。寒多加姜汁。戴云∶近
世因寒热发作，见其指甲青黑，遂名曰沙，或戛或挑，或灌以油茶，且禁其服药，
此病即是南方瘴气。生料平胃散加草果、槟榔，正其所宜，岂有病而无药者哉。按
南人不以患疟为意，北人则畏之，北人而在南方发者尤畏之。以此见治者，当知方
土之宜也，上三条姑引其端耳。《洁古家珍》治久疟不能食，胸中郁郁欲吐而不能吐
者，以雄黄散吐之。按此必上部脉浮滑有力，确知胸中有 而后可用，不然能无
虚虚之祸。杨仁斋云∶有中年人脏腑久虚，大便尝滑，忽得疟疾，呕吐异常，唯专
用人参，为能止呕，其他疟剂，并不可施，遂以茯苓二陈汤加人参、缩砂，而倍用
白豆蔻，进一二服，病患自觉气脉顿平，于是寒热不作。盖白豆蔻能消能磨，流行
三焦，荣卫一转，寒热自平。继今遇有呕吐发疟之症，或其人素呕而发疟，谨勿用
常山，惟以生莱菔、生姜各碾自然汁半盏，入蜜三四匙，乌梅二枚同煎，吞《局方》
雄黄丸三四粒，候其利下恶血痰水，即以人参、川芎、茯苓、半夏、砂仁、甘草调
之。万一呕不止，热不退，却用真料小柴胡汤，多加生姜主治。其或呕吐大作而又
发热，且先与治疟生熟饮，呕定以小柴胡汤继之。按仁斋论治虽悉，而用药不甚中
肯綮，若审知胸中有 而吐，不若以逆流水煎橘皮汤导而吐之。若吐不出，便可定
之，抑之使下，于随证药中加枇杷叶、芦根之属。大抵当审其所以吐之故，从其本
而药之，难以言尽也。仁斋又云∶疟家多蓄痰涎黄水，常山为能吐之利之，是固然
矣。其有纯热发疟，或蕴热内实之证，投以常山，大便点滴而下，似泄不泄，须用
北大黄为佐，大泄数下，然后获愈。又云∶凡疟皆因腹中停蓄黄水，惟水不行，所
以寒热不歇，此疟家受病之处也。治法，暑疟纯热，以香薷饮加青皮、北大黄、两
个乌梅同煎，侵晨温服。寒疟多寒，以二陈汤加青皮、良姜，多用姜同煎，侵晨吞
神保丸五粒，并欲取下毒水，则去其病根，寒热自解。又云∶疟有水有血，水即水
饮也，血即瘀血也。唯水饮所以作寒热，唯瘀血所以憎寒热。常山逐水利饮固也，
苟无行血药品佐助其间，何以收十全之效耶。继自今疟家，或衄血，或大便血丝，
或月候适来适去，皆是血证，当于疟药中加五灵脂、桃仁为佐，入生姜、蜜同煎以
治之。又云∶疟之经久而不歇，其故何耶？有根在也，根者何？曰饮、曰水、曰败
血是耳。惟癖为疟之母，惟败血为暑热之毒，惟饮与水皆生寒热，故暑之脉虚，水
饮之脉沉，癖之脉结。挟水饮者，为之逐水消饮；结癖者，胁必痛，为之攻癖；败
血暑毒，随证而疏利之。寒热不除，吾未之信。按仁斋之论固是矣，其于治未也。
大黄止能去有形之积，不能去水，其取瘀血，亦必醋制，及以桃仁之属引之而后行，
不然不行也。常山治疟，是其本性，虽善吐人，亦有蒸制得法而不吐者，疟更易愈，
其功不在吐痰明矣。亦非吐水之剂，但能败胃耳。内弟于中甫多留饮，善患疟，尝
一用常山截之，大吐，疟亦不止，反益重。今谈及之，犹兀兀欲呕也。甲午以多饮
茶过醉，且感时事愤懑于中，饮大积腹中，常辘辘有声。夏秋之交，病大发，始作
寒热，寒热已而病不衰。予见其呕恶，用瓜蒂散、人参芦煎汤导吐之，不得吐，因念
积饮非十枣汤不能取，乃用三药以黑豆煮制，晒干研为末，枣肉和丸如芥子大，
而以枣汤下之，初服五分后，见其不动，复加五分，无何腹痛甚，以枣汤饮之，大
便五六行，皆溏粪无水，时盖晡时也，夜半乃大下积水数斗而疾平。然当其下时，
瞑眩特甚，手足厥冷，绝而复苏，举家号泣，咸咎予之孟浪，嗟乎！药可轻试哉。
王海藏云∶水者，肺肾脾三经所主，有五脏六腑十二经之部分，上而头，中而四肢，
下而腰脚，外而皮毛，中而肌肉，内而筋骨。脉有尺寸之殊，浮沉之别，不可轻泻药。
当知病在何经何脏，方可用之，若误投之则害深矣。况仁斋所用，尤非治水之药，
其诛罚无过，不为小害。故愚谓病患果有积水瘀血，其实者，可用小胃丸行水，抵
当汤行血。其虚者，不若且以淡渗之剂加竹沥、姜汁以治痰，而于随证药中加桃仁、
韭汁之属以活血，疾亦当以渐而平。慎无急旦夕之功，而贻后悔也。疟发已多遍，
诸药未效，度无外邪及虚人患疟者，以人参、生姜各一两煎汤，于发前二时，或发
日五更，连进二服，无不愈者。愈后亦易康复，不烦调将。近因人参价高，难用济
贫，以白术代之，夜发则用当归，亦莫不应手而愈。《金匮》问曰∶疟以月一日发，
当十五日愈，设不瘥，当月尽日解也。如其不瘥，当云何？师曰∶此结为 瘕，
名曰疟母。急宜治之，可用鳖甲煎丸。疟母丸，鳖甲醋炙二两，三棱、莪术各醋煮
一两，香附醋制二两，阿魏醋化二钱，醋糊为丸服之，积消及半即止。诸久疟及处
暑后冬至前后疟，及非时之间日疟，并当用疟母法治之，以鳖甲为君。疟之间日而
作者，其气之舍深，内薄于阴，阳气独发，阴邪内着，阴与阳争不得出，故间日而
作也。其有间二日，或至数日发者，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。丹溪曰∶三日一作者，邪入于三阴经也。作于子午卯酉日者，少
阴疟也。作于寅申巳亥日者，厥阴疟也。作于辰戌丑未日者，太阴疟也。当更参之
证与脉，而后决其经以立治法。
【淹疾疟病】肝病面青，脉弦皮急，多青则痛，形盛，胸胁痛，耳聋口苦舌干，
往来寒热而呕，以上是形盛，当和之以小柴胡汤也。如形衰骨摇而不能安于地，此
乃膝筋，治之以羌活汤。本草云∶羌活为君也。疟证取以少阳，如久者发为瘅疟，
宜以 针刺绝骨穴，复以小柴胡汤治之。心病面赤，脉洪身热，赤多则热，暴病壮
热恶寒，麻黄加知母、石膏、黄芩汤主之。此证如不发汗，久不愈为疟也。淹疾
肿，面赤身热，脉洪紧而消瘦，妇人则亡血，男子则失精。脾病面黄，脉缓，皮肤
亦缓，黄多则热，形盛，根据伤寒说是为湿温，其脉阳浮而弱，阴小而急，治在太阴，
湿温自汗，白虎汤加苍术主之。如久不愈为温疟重 ，白虎加桂枝主之。淹疾肉消，
食少无力，故曰热消肌肉，宜以养血凉药。《内经》曰∶血生肉。肺病面白，皮涩，
脉亦涩，多白则寒，暴病涩痒，气虚，麻黄加桂枝，令少汗出也。《伤寒论》云∶夏伤
于暑，汗不得出为痒。若久不痊为风疟，形衰面白脉涩，皮肤亦涩，形羸气弱，
形淹卫气不足。肾病面黑，身凉，脉沉而滑，多黑则痹，暴病形冷恶寒，三焦伤也，
治之以姜附汤，或四逆汤。久不愈为疟，暴气冲上吐食，夜发，俗呼谓之夜疟。太
阳经桂枝证，形衰淹疾，黑瘅羸瘦，风痹痿厥，不能行也。外有伤寒，往来寒热如
疟，劳病往来寒热亦如疟，谓之如疟，非真疟也。然伤寒寒热如疟，初必恶风寒，
发热头痛体疼，自太阳经而来。劳病寒热如疟，初必五心烦热，倦怠咳嗽，久乃成
寒热，与正疟自不同。诸病皆有寒热，如失血痰饮， 瘕积聚，小肠 疝，风寒暑
湿，食伤发劳，劳瘵、香港脚、疮毒，已各见本门，其余不能尽举，应有发寒热者，
须问其元有何病而生寒热，则随病施治。凡寒热发作有期者疟也。无期者诸病也。
先用一种方法去除其中一种病邪，效果显著。我用这个方子给他服用，一剂药后两种病都痊愈了。我的外祖母虞太孺人，八十多岁，夏天患疟疾，各位舅舅因为年事已高，担心她身体承受不住，害怕疟疾再次发作，商议想要强行截断疟疾（使用强力止疟药）。我说只要用一剂药就能解决，也非常容易，何必非要强行截断呢？于是使用柴胡、升麻、葛根、羌活、防风这些味甘辛、气清轻的药物来升发阳气，使阳气脱离阴邪而寒热自止；使用知母、石膏、黄芩这些味苦甘性寒的药物来引导阴气下降，使阴气脱离阳邪而热势自退；使用猪苓这种味甘淡、能渗湿利水的药物来分利阴阳，使阴阳不得交并；使用穿山甲作为引经药，使用甘草来调和诸药，果然一剂药就止住了疟疾。所以赵以德说：我曾研究本草，发现知母、草果、常山、甘草、乌梅、槟榔、穿山甲，都说可以治疗疟疾。将它们集合组成方剂，是因为知母性寒，入足阳明胃经，用来治疗阳明经独盛的火热，使其退避归于太阴；草果性温燥，治疗足太阴脾经独盛的寒邪，使其退避归于阳明。这两经调和，就没有阴阳错乱的变证，这两味药作为君药。常山主治寒热往来的疟疾，能吐出胸中的痰结，作为臣药。甘草调和诸药，乌梅去痰，槟榔消除痰癖、破滞气，作为佐药。穿山甲，因为它在山上打洞居住，遇到水就进入水中，这象征着出阴入阳，穿透经络到达营分，以破除暑邪凝结的邪气，作为使药。那么此方，对于脾胃中有郁结的痰饮伏留者，使用它能收到疗效。如果没有痰，仅仅是暑邪凝结在营分，只表现为太阴血分有热的证候，应当出现唇疮然后自愈，对此方则没有功效了。（柴胡、升麻等药，适合治疗外因引起的病。知母等药，适合治疗内因引起的病。）东南沿海地区，海风无常，人们吃的鱼盐多导致体内停聚水饮，所以风疟、食疟因此盛行，使用乌头、草果、陈皮、半夏，施用得当即可。西北地势高旷，隆冬时节水结冰地裂，盛夏时节石头烫手金子熔化，人们多中寒邪伏暑邪，所以多患暑疟、寒疟，柴胡、常山应当合用。在东南西北各地往来的人，病邪处于未完全分化的阶段，可以使用藿香正气散、草果饮，这类似于养胃汤。治疗北方的疟疾，用马鞭草的茎叶煎一盏，露天放置一夜，早晨服用。寒象加重加姜汁。戴云说：近代人因为寒热发作，看到患者指甲青黑，就命名为“沙”，有的用刀刮或挑刺，有的灌油茶，并且禁止服药，这种病就是南方的瘴气。使用生料平胃散加草果、槟榔，正是适宜的治法，哪里有病了却没有药可治的呢？按：南方人不把患疟疾当回事，北方人则畏惧它，北方人在南方发病的人尤其畏惧它。由此可以看出，治疗者应当知道因地制宜的道理，以上三条只是列举其开端罢了。《洁古家珍》治疗久疟不能进食，胸中郁郁想要呕吐却吐不出来的，用雄黄散催吐。按：这必须是上部脉象浮滑有力，确知胸中有实邪后才能使用，否则难道不会造成虚其虚的祸害吗？杨仁斋说：有中年人脏腑长期虚弱，大便经常滑泄，忽然得了疟疾，呕吐异常，只有专门用人参，才能止呕，其他治疟药剂，都不可以施用，于是用茯苓二陈汤加人参、缩砂，并且倍用白豆蔻，进服一二剂，病患自觉气脉顿时平和，于是寒热不再发作。大概白豆蔻能消能磨，流通三焦，营卫一转，寒热自然平息。从此以后遇到有呕吐并发疟疾的症状，或者其人平时易呕又发疟疾，千万不要用常山，只用生莱菔、生姜各碾取自然汁半盏，加入蜂蜜三四匙，乌梅两枚同煎，吞服《局方》雄黄丸三四粒，等待其排出恶血、痰水后，立即用人参、川芎、茯苓、半夏、砂仁、甘草来调理。万一呕吐不止，热不退，却要用真料小柴胡汤，多加生姜主治。如果呕吐大作而又发热，先给予治疟生熟饮，呕吐停止后用小柴胡汤接续治疗。按：杨仁斋论述治疗虽然详尽，但用药不太切中要害，如果审知胸中有实邪而需要催吐，不如用逆流水煎橘皮汤引导催吐。如果吐不出来，就可以确定病位，抑制病势使其下行，在随证治疗的药中加入枇杷叶、芦根之类的药物。大抵应当审察呕吐的原因，顺着根本原因用药，难以用言语尽述。杨仁斋又说：患疟疾的人多蓄积痰涎黄水，常山能够催吐利下，这是固然的情况。那些纯热发疟，或者蕴热内实的证候，投用常山，大便点滴而下，似泄非泄，必须用北大黄为佐药，大泻几次，然后才能痊愈。又说：凡是疟疾都是因为腹中停蓄黄水，只有水不行走，所以寒热不停歇，这是疟疾病患受病的部位。治疗方法，暑疟纯热，用香薷饮加青皮、北大黄、两个乌梅同煎，清晨温服。寒疟多寒，用二陈汤加青皮、良姜，多用生姜同煎，清晨吞服神保丸五粒，并且想要取下毒水，就能去除病根，寒热自然解除。又说：疟疾有水证和血证，水即水饮，血即瘀血。只有水饮所以产生寒热，只有瘀血所以憎恶寒热。常山驱逐水利下水饮固然有效，假如没有行血的药品辅助其间，怎么能收到十全的效果呢？从今以后患疟疾的人，如果出现鼻出血，或者大便带血丝，或者月经刚来刚去，都是血证，应当在疟药中加入五灵脂、桃仁作为佐药，加入生姜、蜜同煎来治疗。又说：疟疾经久不愈，是什么原因呢？是有病根存在。病根是什么？就是饮、水、败血罢了。只有癖积是疟疾的母亲，只有败血是暑热之毒，只有饮与水都能产生寒热，所以暑疟脉虚，水饮脉沉，癖积脉结。挟带水饮的，为之逐水消饮；结成癖积的，胁部必然疼痛，为之攻癖；败血暑毒，随证疏利。寒热不除，我是不相信的。按：杨仁斋的论述固然正确，但他对治法的阐述还不够完善。大黄只能去除有形的积滞，不能去除水饮，他取用瘀血，也必须醋制，以及用桃仁之类的药物引导才能运行，不然就不运行。常山治疗疟疾，是其本性，虽然善于使人呕吐，也有蒸制得法而不呕吐的，疟疾更容易痊愈，它的功效不在于吐痰是很明显的。也不是吐水的药剂，只会败坏胃气。内弟于中甫体内多有留饮，容易患疟疾，曾经一次用常山强行截疟，大吐，疟疾也不止，反而更加严重。现在谈及此事，还感到头晕想吐。甲午年因为多饮茶过度醉酒，并且感时事愤懑于心中，水饮大量积聚在腹中，常常辘辘有声。夏秋之交，病情大发，开始产生寒热，寒热过后病情并未衰退。我看见他恶心呕吐，用瓜蒂散、人参芦煎汤引导催吐，没能吐出来，于是想到积饮非十枣汤不能攻取，于是用这三种药以黑豆煮制，晒干研为末，枣肉和丸如芥子大小，并用枣汤送服，初服五分后，见其无反应，再加五分，不久腹痛剧烈，用枣汤饮用，大便五六次，都是溏粪无水，当时大约是傍晚时分，半夜才大下积水数斗而疾病平息。然而在下泻时，瞑眩反应特别严重，手足厥冷，气息微弱几近死亡而后复苏，全家号哭，都责怪我鲁莽，唉！药怎么可以轻易尝试呢？王海藏说：水，由肺、肾、脾三经所主，涉及五脏六腑十二经的部分，上至头部，中至四肢，下至腰脚，外至皮毛，中至肌肉，内至筋骨。脉象有尺寸的不同，浮沉的区别，不可轻易使用泻下药。应当知道病在何经何脏，方可使用，如果误用则危害很深。况且杨仁斋所用的，尤其不是治水之药，诛罚无罪之人，造成的伤害不小。所以我主张病患果真有积水瘀血，属于实证者，可用小胃丸行水，抵当汤行血。属于虚证者，不如暂且用淡渗的药剂加竹沥、姜汁来治痰，并在随证药中加入桃仁、韭汁之类的药物来活血，疾病也应当逐渐平息。千万不要急于求成，而留下后悔。疟疾发作已经多次，各种药物无效，推测没有外邪及虚人患疟的情况，用人参、生姜各一两煎汤，在发作前两小时，或发作日五更天，连进两服，没有不愈的。痊愈后也容易康复，不需要烦劳调养。近来因为人参价格高，难以用于救济贫困者，用白术代替，夜间发作则用当归，也没有不随手而愈的。《金匮要略》问：疟疾如果在初一那天发作，应当在十五天痊愈，假设没好，应当在月底那天解除。如果还没好，该怎么办？老师说：这会结为癥瘕，名叫疟母。应当紧急治疗，可用鳖甲煎丸。疟母丸，鳖甲醋炙二两，三棱、莪术各醋煮一两，香附醋制二两，阿魏醋化二钱，醋糊为丸服用，积滞消除一半就停药。各种久疟以及处暑后冬至前后的疟疾，以及非正常时间发作的间日疟，都应当用治疟母的方法治疗，以鳖甲为君药。疟疾每隔一天发作一次的，邪气潜伏较深，内迫于阴，阳气单独发动，阴邪内着，阴与阳争无法外出，所以隔天发作。如果有间隔两天，甚至几天发作的，邪气与卫气客居于六腑，有时失去联系，不能相得，所以休息几天才发作。丹溪说：三天发作一次的，邪气进入三阴经。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。应当再参考症状与脉象，然后决定所属经脉以确立治法。
【淹疾疟病】肝病面色青，脉弦且皮肤紧急，青色多则痛，形体壮盛，胸胁痛，耳聋口苦舌干，往来寒热而呕吐，以上是形盛，应当用小柴胡汤调和。如果形体衰弱骨摇而不能安立于地，这是膝筋的问题，用羌活汤治疗。本草说：羌活为君药。疟证取法少阳，如久病发展为瘅疟，适宜针刺绝骨穴，再用小柴胡汤治疗。心病面色赤，脉洪身热，红色多则热，突发壮热恶寒，用麻黄加知母、石膏、黄芩汤主治。此证如果不发汗，久不愈就会变成疟疾。淹疾肿，面色赤身热，脉洪紧而消瘦，妇人则是亡血，男子则是失精。脾病面色黄，脉缓，皮肤也缓，黄色多则热，形体壮盛，根据伤寒说是湿温，其脉阳浮而弱，阴小而急，治疗在太阴，湿温自汗，用白虎汤加苍术主治。如果久不愈变成温疟重证，用白虎加桂枝汤主治。淹疾肉消，食少无力，所以叫热消肌肉，适宜用养血凉药。《内经》说：血生肉。肺病面色白，皮肤涩，脉也涩，白色多则寒，突发病涩痒，气虚，用麻黄加桂枝，令其少量出汗。《伤寒论》说：夏伤于暑，汗不得出则为痒。如果久不痊愈变成风疟，形体衰弱面色白脉涩，皮肤也涩，形体羸弱气弱，形体淹滞卫气不足。肾病面色黑，身凉，脉沉而滑，黑色多则痹，突发病形冷恶寒，是三焦受伤，用姜附汤，或四逆汤治疗。久不愈变成疟疾，暴气冲上呕吐食物，夜间发作，俗呼称为夜疟。太阳经桂枝证，形体衰弱淹疾，黑疸羸瘦，风痹痿厥，不能行走。外有伤寒，往来寒热如疟，劳病往来寒热也像疟疾，叫做如疟，不是真正的疟疾。然而伤寒寒热如疟，起初必定恶风寒，发热头痛体疼，从太阳经而来。劳病寒热如疟，起初必定五心烦热，倦怠咳嗽，久了才成为寒热，与正疟自然不同。各种病都有寒热，如失血痰饮，癥瘕积聚，小肠疝，风寒暑湿，食伤发劳，劳瘵、香港脚、疮毒，已在各自门类中见到，其余不能全部列举，所有有发寒热的，必须询问原本有什么病而生寒热，则随病施治。凡寒热发作有定时的就是疟疾。无定时的就是各种病。
First, remove one of the pathogens to achieve quick relief. I administered this prescription to him, and after a single dose, both ailments were cured. My maternal grandmother, Lady Yu, was over eighty years old. In summer, she contracted malaria (Malaria). Her uncles, concerned about her advanced age and inability to endure further attacks, discussed forcibly stopping the malaria (using strong antimalarial drugs). I said that resolving it with just one dose would be very easy; why insist on forcibly stopping it? Thus, I used Chai Hu (Bupleuri Radix), Sheng Ma (Cimicifugae Rhizoma), Ge Gen (Puerariae Lobatae Radix), Qiang Huo (Notopterygii Rhizoma et Radix), and Fang Feng (Saposhnikoviae Radix)—medicinals with sweet and pungent flavors and clear, light qi—to raise Yang Qi (Yang Energy) so that it separates from Yin pathogen, causing the coldness to resolve spontaneously. I used Zhi Mu (Anemarrhenae Rhizoma), Shi Gao (Gypsum Fibrosum), and Huang Qin (Scutellariae Radix)—medicinals with bitter and sweet flavors and cold nature—to guide Yin Qi downward so that it separates from Yang pathogen, causing the heat to resolve spontaneously. I used Zhu Ling (Polyporus) with its bland and permeating properties to differentiate and drain Yin and Yang, preventing them from intertwining. I used Shan Jia Chuan Kong (Manis Squama) as an guiding agent, and Gan Cao (Glycyrrhizae Radix et Rhizoma) to harmonize the herbs. Indeed, a single dose stopped the malaria. Therefore, Zhao Yi De stated: "I have studied Materia Medica and found that Zhi Mu, Cao Guo (Tsaoko Fructus), Chang Shan (Dichroae Radix), Gan Cao, Wu Mei (Mume Fructus), Bing Lang (Arecae Semen), and Shan Jia Chuan Kong are all said to treat malaria." Combining them into a formula is because Zhi Mu is cold in nature and enters the Foot-Yangming Stomach Meridian; it is used to treat the excessive fire-heat of the Yangming, causing it to retreat towards the Taiyin. Cao Guo is warm and drying, treating the excessive cold of the Foot-Taiyin Spleen Meridian, causing it to retreat towards the Yangming. When these two meridians harmonize, there is no disorder of Yin and Yang intermixing; these two serve as the Sovereign (Jun) herbs. Chang Shan primarily treats chills and fever malaria, vomiting phlegm knots in the chest, serving as the Minister (Chen) herb. Gan Cao harmonizes the various herbs, Wu Mei removes phlegm, and Bing Lang eliminates phlegm-stagnation and breaks stagnant Qi, serving as the Assistant (Zuo) herbs. Shan Jia Chuan Kong, because it lives in holes in mountains and enters water when encountered, symbolizes exiting Yin and entering Yang, penetrating meridians to reach the Ying (Nutritive) level, thereby breaking the pathogenic evil condensed by summer-heat; it serves as the Envoy (Shi) herb. Thus, this formula is effective for those with stagnant phlegm and retained fluids in the Spleen and Stomach. If there is no phlegm, but only summer-heat condensed in the Ying level, manifesting solely as heat in the Taiyin Blood level, the patient should develop lip ulcers and heal spontaneously; this formula would be ineffective. (Chai Hu, Sheng Ma, etc., are suitable for external causes. Zhi Mu, etc., are suitable for internal causes.) In the southeast coastal regions, sea winds are unpredictable, and people's consumption of fish and salt often leads to retained fluids in the body; thus, Wind Malaria and Food Malaria prevail here. Using Wu Tou (Aconiti Lateralis Radix Praeparata), Cao Guo, Chen Pi (Citri Reticulatae Pericarpium), and Ban Xia (Pinelliae Rhizoma) is appropriate if applied correctly. In the northwest, the terrain is high and open; in deep winter, water freezes and earth cracks; in midsummer, stones scorch and gold melts. People often suffer from cold evil and latent summer-heat; thus, Summer-heat Malaria and Cold Malaria are common, and Chai Hu and Chang Shan should be used together. For those traveling between southeast and northwest, when the pathogen is not yet fully differentiated, Huo Xiang Zheng Qi San or Cao Guo Yin can be used, which is similar to Yang Wei Tang. To treat Northern malaria, decoct the stems and leaves of Ma Bian Cao (Verbena officinalis) in one cup, leave it exposed overnight, and take it early in the morning. Add Jiang Zhi (Ginger Juice) if cold symptoms are severe. Dai Yun said: "In recent times, due to chills and fever attacks, seeing patients' fingernails turn blue-black, they named it 'Sha'. Some scrape or pick at it, some feed them tea oil, and forbid medication. This disease is actually Southern Miasma Malaria. Using Sheng Liao Ping Wei San added with Cao Guo and Bing Lang is precisely suitable. How can there be a disease without medicine?" Note: Southerners do not take malaria seriously, while Northerners fear it. Northerners developing malaria in the South fear it even more. This shows that practitioners must know how to adapt to local conditions; the above three points merely introduce the topic. *Jie Gu Jia Zhen* treats long-standing malaria where the patient cannot eat and feels郁郁 (oppressed) in the chest, wanting to vomit but unable to do so, by using Xiong Huang San (Realgar Powder) to induce vomiting. Note: This is only applicable if the upper pulse is floating, slippery, and forceful, confirming the presence of excess pathogen in the chest; otherwise, it may cause the harm of "deficiencyizing deficiency." Yang Ren Zhai said: "Middle-aged individuals with long-term visceral deficiency and frequent loose stools who suddenly contract malaria and experience abnormal vomiting can only stop the vomiting by specifically using Ren Shen (Ginseng Radix); other antimalarial prescriptions are unsuitable. Thus, use Fu Ling Er Chen Tang added with Ren Shen and Suo Sha (Amomi Fructus Rotundus), and significantly increase Bai Dou Kou (Cardamomi Fructus). After one or two doses, the patient feels their Qi and pulse instantly stabilize, and chills and fever cease. Generally, Bai Dou Kou can digest and grind, circulating through the Triple Burner; once Ying and Wei circulate, chills and fever naturally subside. From now on, for symptoms of vomiting accompanying malaria, or for those prone to vomiting who develop malaria, do not use Chang Shan. Instead, crush fresh Lai Fu (Radish) and Sheng Jiang (Fresh Ginger) to obtain half a cup of natural juice, add three or four spoons of honey, and two Wu Mei, decoct together, and swallow 3-4 pills of Ju Fang Xiong Huang Wan (Prescribed Form Realgar Pill). Wait for the discharge of foul blood, phlegm, and fluid, then regulate with Ren Shen, Chuan Xiong (Ligustici Chuanxiong Rhizoma), Fu Ling (Poria), Ban Xia, Sha Ren (Amomi Fructus), and Gan Cao. If vomiting persists and heat does not subside, use Zhen Liao Xiao Chai Hu Tang (Authentic Minor Bupleurum Decoction) with increased Sheng Jiang as the main treatment. If vomiting is severe accompanied by fever, first administer Zhi Mie Sheng Shu Yin (Antimalarial Raw and Cooked Drink); once vomiting stops, follow up with Xiao Chai Hu Tang. Note: Although Yang Ren Zhai's discussion on treatment is detailed, his medication choices are not always precise. If it is confirmed that there is excess pathogen in the chest requiring vomiting, it is better to use Ni Liu Shui (Reverse-flowing Water) to decoct Ju Pi Tang (Tangerine Peel Decoction) to guide vomiting. If vomiting cannot be induced, the location can be determined; suppress the pathogen to move it downward, adding Pi Pa Ye (Loquat Leaf) and Lu Gen (Reed Rhizome) to the symptomatic prescription. Generally, one must examine the cause of vomiting and treat according to the root; this cannot be fully explained in words. Yang Ren Zhai also said: "Malaria patients often accumulate phlegm-fluids and yellow water; Chang Shan can induce vomiting and promote drainage, which is true. However, for pure-heat malaria or cases with internal heat accumulation, administering Chang Shan results in scanty bowel movements, resembling diarrhea but not quite; one must use Bei Da Huang (Northern Rhubarb) as an assistant, inducing several large purgations before recovery. He also said: 'All malaria is due to retained yellow water in the abdomen; because the water does not flow, chills and fever do not cease. This is where the malaria pathogen resides.' Treatment method: For pure-heat Summer-heat Malaria, decoct Xiang Ru Yin (Elsholtzia Decoction) added with Qing Pi (Citri Reticulatae Pericarpium Viride), Bei Da Huang, and two Wu Mei; take warm in the early morning. For Cold Malaria with predominant cold, decoct Er Chen Tang (Two-Cured Decoction) added with Qing Pi and Liang Jiang (Galangal Rhizoma), using much Sheng Jiang; swallow five Shen Bao Wan (Divine Protection Pills) in the early morning. Also, to drain toxic water, the root of the disease can be removed, and chills and fever will naturally resolve. He also said: 'Malaria involves Water and Blood. Water refers to Fluid retention; Blood refers to Blood stasis. It is Fluid retention that causes chills and fever; it is Blood stasis that causes aversion to chills and fever. Chang Shan drives out water and drains fluids, which is correct. But without blood-moving medicines to assist, how can perfect efficacy be achieved?' From now on, for malaria patients presenting with epistaxis, blood streaks in stool, or menstruation just starting or ending, these are Blood syndromes. Add Wu Ling Zhi (Trogopteri Dung) and Tao Ren (Persicae Semen) as assistants to the malaria prescription, decoct with Sheng Jiang and Honey to treat. He also said: 'Why does malaria persist and not cease? Because there is a root. What is the root? It is Fluid, Water, and Defeated Blood. Only Phlegm-Stagnation (Pi Ji) is the mother of malaria; only Defeated Blood is the toxin of summer-heat; only Fluid and Water generate chills and fever. Thus, Summer-heat pulse is deficient, Fluid pulse is deep, and Phlegm-Stagnation pulse is knotted. For those with Fluid/Water, drain water and dissipate fluids; for those with Phlegm-Stagnation, the hypochondrium must hurt, so attack the stagnation; for Defeated Blood and Summer-heat toxin, disperse and drain according to symptoms. If chills and fever are not eliminated, I do not believe it.' Note: Yang Ren Zhai's theory is correct, but his treatment explanation is incomplete. Da Huang can only remove有形 (tangible) accumulations, not Water. His extraction of Blood stasis must be vinegar-processed and guided by Tao Ren etc., otherwise it will not move. Chang Shan's nature is to treat malaria; although it induces vomiting, if steamed properly to avoid vomiting, malaria heals more easily. Its merit lies not in vomiting phlegm, clearly. It is not a drug for vomiting water, but only damages the Stomach Qi. My brother-in-law Yu Zhongfu had much retained fluid and was prone to malaria. Once, he used Chang Shan to forcibly stop malaria, vomited heavily, but the malaria did not stop and worsened. Even now, discussing it makes him feel nauseous. In the year Jia Wu, due to excessive tea drinking leading to intoxication, and feeling resentful about current events, large amounts of fluid accumulated in his abdomen, making gurgling sounds. At the transition of summer and autumn, the illness flared up, beginning with chills and fever. After the chills and fever subsided, the illness did not improve. Seeing his nausea, I used Gua Di San (Melon Seed Powder) and Ren Shen Lu (Ginseng Stalk) decocted to guide vomiting, but he could not vomit. I thought that retained fluid requires Shi Zao Tang (Ten Jujube Decoction) to drain, so I used these three medicines boiled with black beans, dried, powdered, mixed with jujube paste into pills the size of mustard seeds, and administered with jujube decoction. Initially taking 0.5 fen, seeing no effect, I increased by another 0.5 fen. Soon, severe abdominal pain occurred; I gave him jujube decoction to drink. He had five or six bowel movements, all loose stool without water. It was around dusk. At midnight, he passed several dou of accumulated water, and the illness subsided. However, during the purgation, the Ming Xuan reaction (herxheimer-like reaction) was severe; his limbs were cold, he nearly died and revived. The whole family wept, blaming my recklessness. Alas! Can medicines be tested lightly? Wang Hai Zang said: 'Water is governed by the Lung, Kidney, and Spleen meridians, involving parts of the five Zang and six Fu organs and twelve meridians. It affects the head above, limbs in the middle, waist and feet below, skin and hair outside, muscles in the middle, and bones and sinews inside. Pulses differ in Cun/Cun positions and Floating/Sinking qualities; one must not lightly use purgative drugs. One must know which meridian and Zang organ the disease is in before using them; misuse causes deep harm. Moreover, what Yang Ren Zhai used was especially not a drug for treating Water. Punishing the innocent causes significant harm. Therefore, I suggest that if patients truly have accumulated water and blood stasis, and are Excess type, Xiao Wei Wan (Minor Stomach Pill) can be used to move water, and Di Dang Tang (Di Dang Decoction) to move blood. If Deficient type, it is better to temporarily use bland-draining agents added with Zhu Li (Bamboo Sap) and Jiang Zhi to treat phlegm, and add Tao Ren and Jiu Zhi (Leek Juice) to the symptomatic prescription to invigorate blood. The illness will gradually subside. Do not seek immediate results and regret later.' For malaria that has recurred many times with no effect from various medicines, assuming no external pathogen and not a Deficient person suffering malaria, decoct Ren Shen and Sheng Jiang (1 liang each) in water. Take two doses consecutively two hours before the attack, or at Wugeng (3-5 AM) on the day of the attack. There will be no failure to cure. Recovery is easy afterward, without needing extensive recuperation. Recently, due to high Ginseng prices, difficult to use for helping the poor, replace with Bai Zhu (Atractylodis Macrocephalae Rhizoma). For night attacks, use Dang Gui (Angelicae Sinensis Radix). All respond promptly. *Jin Gui Yao Lue* asks: 'If malaria starts on the first day of the month, it should heal by the fifteenth day. If not healed, it should resolve by the end of the month. If not, what then?' The Master said: 'This forms a mass called Nue Mu (Malaria Mother). Treat it urgently. Bi Jia Jian Wan (Softshell Turtle Pill) can be used. Nue Mu Wan: Bi Jia (Testudinis Carapax et Plastrum) vinegar-fried 2 liang, San Leng (Sparganii Rhizoma) and E Zhu (Curcumae Rhizoma) each vinegar-boiled 1 liang, Xiang Fu (Cyperi Rhizoma) vinegar-processed 2 liang, A Wei (Ferulae Resina) vinegar-melted 2 qian. Make pills with vinegar paste. Stop when the accumulation is half resolved. All long-standing malaria, malaria around Chu Shu (End of Heat) to Dong Zhi (Winter Solstice), and irregular intermittent malaria should be treated using the Nue Mu method, with Bi Jia as the Sovereign herb. Malaria occurring every other day indicates the pathogen is deep, invading Yin internally. Yang Qi alone erupts, Yin pathogen adheres internally. Yin and Yang struggle but cannot exit, hence the interval. If occurring every two days or several days, the pathogen and Wei Qi reside in the Six Fu organs, sometimes losing contact, unable to interact, hence resting for several days before attacking. Dan Xi said: 'Attacking every three days means the pathogen has entered the Three Yin meridians. Attacking on Zi, Wu, Mao, You days is Shao Yin Malaria. Attacking on Yin, Shen, Si, Hai days is Jue Yin Malaria. Attacking on Chen, Xu, Chou, Wei days is Tai Yin Malaria. Further reference to symptoms and pulses is needed to determine the meridian and establish treatment.'"
[Protracted Illness Malaria] Liver disease: face green, pulse wiry and skin tight. More green indicates pain. Robust constitution, chest/hypochondriac pain, deafness, bitter taste, dry tongue, alternating chills/fever, vomiting. Above describes robust constitution; harmonize with Xiao Chai Hu Tang (Minor Bupleurum Decoction). If constitution is weak, bones shake, unable to stand firmly, this concerns knee sinews; treat with Qiang Huo Tang. Materia Medica states: Qiang Huo is the Sovereign herb. For malaria involving Shaoyang, if long-standing it develops into Dan Malaria (Fever Malaria), puncture Jue Gu acupoint, then treat with Xiao Chai Hu Tang. Heart disease: face red, pulse surging, body hot. More red indicates heat. Sudden severe heat with chills; treat with Ma Huang Jia Zhi Mu, Shi Gao, Huang Qin Tang (Ephedra Added with Anemarrhena, Gypsum, Scutellaria Decoction). If this syndrome does not induce sweating, long non-resolution becomes malaria. Protracted swelling: face red, body hot, pulse surging/tight, emaciation. Women: blood loss; Men: essence loss. Spleen disease: face yellow, pulse slow, skin relaxed. More yellow indicates heat. Robust constitution. According to Shang Han Lun, this is Shi Wen (Damp-Warmth). Pulse: Yang floating/weak, Yin small/urgent. Treatment targets Taiyin. Damp-Warmth with spontaneous sweating: Bai Hu Tang (White Tiger Decoction) added with Cang Zhu (Atractylodis Rhizoma). If long non-resolution becomes heavy Wen Malaria (Warm Malaria): Bai Hu Jia Gui Zhi Tang (White Tiger Added with Cinnamon Twig Decoction). Protracted flesh wasting: little appetite, weakness. Hence called "Heat wasting flesh"; treat with blood-nourishing cooling herbs. *Nei Jing* says: "Blood generates flesh." Lung disease: face white, skin rough, pulse choppy. More white indicates cold. Sudden rough/itchy sensation, Qi deficiency. Ma Huang Jia Gui Zhi Tang (Ephedra Added with Cinnamon Twig Decoction) to induce slight sweating. *Shang Han Lun* says: "Summer injury by summer-heat, sweat cannot exit, causes itching." If long non-resolution becomes Feng Malaria (Wind Malaria): weak constitution, white face, choppy pulse, rough skin, emaciated, weak Qi, protracted Wei Qi insufficiency. Kidney disease: face black, body cool, pulse deep/slippery. More black indicates Bi (Obstruction). Sudden cold body with aversion to cold: San Jiao (Triple Burner) injury. Treat with Jiang Fu Tang (Ginger and Aconite Decoction) or Si Ni Tang (Four Counterflow Decoction). Long non-resolution becomes malaria. Violent Qi rushing up, vomiting food, night attacks: commonly called Night Malaria. Taiyang Meridian Gui Zhi Syndrome: weak constitution, protracted illness, black jaundice, emaciation, Wind-Bi, Wei Jue (Paralysis/Cold Limbs), inability to walk. External Shang Han (Cold Damage): alternating chills/fever like malaria. Lao Bing (Consumption/Fatigue Disease): alternating chills/fever like malaria. Called "Like Malaria," not true malaria. However, Shang Han chills/fever like malaria initially presents with aversion to wind/cold, fever, headache, body ache, originating from Taiyang. Lao Bing chills/fever like malaria initially presents with five-palm heat, fatigue, cough, eventually becoming chills/fever, different from true malaria. Various diseases have chills/fever: e.g., blood loss, phlegm-fluid, masses, intestinal hernia, wind/cold/summer-heat/dampness, food injury/fatigue, tuberculosis, beriberi, toxicity. These are covered in respective sections. Others cannot be listed. All with chills/fever must ask what original disease caused the chills/fever, then treat accordingly. Any chills/fever with regular timing is Malaria. Irregular timing is various diseases.