（扬俊）谓人之疟证。由外邪之入。每伏于半表半里。入而与阴争则寒。出而与阳
争则热。故寒热往来主少阳。谓兼他经证则有之。谓全不涉少阳。则无是理也。
仲景曰。脉自弦。正以或数或迟。或小紧。或浮大。皆未可定。要必兼弦。弦为少阳
脉也。夫邪犯少阳。与卫气并居。卫实昼行于阳。夜行于阴。故邪得阳而外出。得
阴而内搏。内外相搏。是以日作。若气之舍深。内搏于阴。阳气独发。阴气内着。阴
与阳争不得出。是以间日而作也。然则偏阴多寒。偏阳多热。其纯热无寒而为
瘅为温。纯寒无热而为牡。莫不自少阳而造其极偏。补偏救弊。必从少阳之界。
使邪去而阴阳适归于和而后愈也。盖补救之道。非药不可。乃仲景复云。弦数
者风发。以饮食消息之。抑又何耶。数为热。热极则风生。势必肝木侮土而传以
不胜。遂坐耗胃家之津。阳愈偏而不复。是未可徒求之药也。须以饮食消息而
止其热。即梨汁、蔗浆。生津止渴之属。正内经谓风淫于内。治以甘寒之旨耳。不
然。其热之移于胃者。必上熏心肺。少气烦冤而心肺病。手心热。欲呕。而胃亦自
病。人岂能堪之耶。故知消息以止入胃之邪。真圣法也。然仲景之法。亦不越内
经。经谓疟脉缓大虚。便宜用药。又谓虚者不宜用针。以甘药调之。即此意也。夫
温疟其脉平。无寒但热。骨节疼烦。时呕。白虎加桂枝。如内经言温疟有二。俱先
热后寒。非但热不寒。有似瘅疟而实不同也。瘅疟两阳合邪。上熏心肺。肺主气
者。少气烦冤。则心主脉者。阳盛脉促。津亏脉代。从可推矣。温疟脉如平人。则邪
未合而津未伤。其所以但热而不寒者。以其人素有瘅气。荣卫不调。故疟之发
于阳。不入于阴。即入而阴不受。所以骨节烦疼。时呕。邪气捍格之状。有如此者。
惟用桂枝加于白虎中。既有以去阳邪。复有以通荣卫。斯阴阳和。血脉通。得汗
而愈矣。然桂枝阳药也。何以用于只热不寒之证。不知用白虎以大清气分之
热。即少加桂枝以通荣卫。未为不可也。至若内经所称先热后寒之温疟。一者
先伤于风。后伤于寒。发时先阳后阴。故先热后寒也。其一为冬感风寒。深藏骨
髓。内舍于肾至春夏时令。大热而始发。邪从肾出之于外。俟热势少衰。复返于
肾。而阴精与之相持。乃始为寒。设不知壮水之主。以急救其阴。十数发而阴尽
矣。若多寒者曰牡疟。非纯寒无热也。多寒者。如十分之中七八分也。夫邪伏于
心下。适在膻中心包之位。心为阳。阳邪从之。则心经虚。曰心虚者。热收于内。既
收其邪。不易外出。此寒多之一因也。邪入心包。君主之官震恐。周身津液悉力
内助。遂使所受之邪。为外围而不得出。又多寒之一因也。心为牡脏。故以名疟。
治用蜀漆散。和浆水吐其心下结伏之邪。则内陷之邪与之俱出。一举而荡逐
无余矣。夫蜀漆常山苗也。常山善吐。何故不即用之。而必取意于其苗者何居。
苗性轻扬。入重阳之界。引拔其邪。合之龙骨镇心宁神。蠲除伏气。云母安脏补
虚。媚兹君主。仲景炼石补天之功也。乃温疟亦用此方。更加蜀漆。以取快吐者。
正以一吐则结伏之邪尽开。而周身之瘅者通。荣卫并可借以无忤。是又以吐
法为和法者也。岂牡与温证有相反。而必以方为异处耶。即如仲景治疟病发
渴。谓亦治劳疟。乃出柴胡去半夏加栝蒌方。明系小柴胡汤。渴者加栝蒌根。去
半夏。为一定之法。盖以弦为少阳之脉。寒热不外半表半里。故渴虽阳明津竭。
而所以致阳明津竭者。全是少阳之邪。且内经刺法篇云。渴者。取之少阳。非以
其木火之势劫夺胃津而然耶。夫疟邪进退于少阳。亦即以此方进退以施其
巧。诚如赵先生所注药性。故曰亦可以治劳疟也。假如寒多微有热者。又或但
寒少顷而不热者。又主柴胡桂姜汤。且云服之如神。观其证或有似于牡疟。而
微甚则大不同。故仲景不立论。且云如神。知其邪之轻且浅矣。诚以卫即表也。
荣即里也。胸中之阳散行于分肉之间。今因邪气痹之。则外卫之阳反郁伏于
内守之阴。而血之痹者。愈结而不散。遇卫气之行阳而病发。则其邪之入荣。既
无外出之势。而荣之素痹者。亦不出而与阳争。所以多寒少热。或但寒无热。有
如此也。小柴胡汤本随邪之进退以为进退者。加桂枝、干姜。则进而从阳。痹着
之邪。可以开已。况加牡蛎以攻其坚。以破其结。阴阳不可豁然而汗解乎。故曰
服一剂如神也。然则加芩连之寒。以退而从阴。不又可于兹悟耶。余本仲景之
义。并集嘉言之议。合而为论。以为善治疟者一助云尔。
（周扬俊）认为，人的疟疾病证，是由于外邪侵入，往往潜伏在半表半里之间。邪气进入体内与阴气相争则表现为寒战，外出与阳气相争则表现为发热。因此，寒热往来是少阳病的主症。如果说兼有其他经络的症状那是有的，如果说完全与少阳无关，那是不合道理的。
张仲景说，脉象自当见弦脉，这是因为脉象或数或迟，或小紧，或浮大，都难以确定，但必须兼见弦脉。因为弦脉是少阳病的脉象。邪气侵犯少阳，与卫气并居。卫气白天行于阳分，夜晚行于阴分。所以邪气遇到阳气则外出，遇到阴气则内搏。内外邪气相搏结，所以每日发作。如果邪气潜伏较深，内搏于阴分，阳气独发，阴气内着，阴气与阳气相争而不能外出，所以隔日发作。
既然这样，偏于阴分的多寒，偏于阳分的多热。那些纯热无寒而称为瘅疟、温疟的，以及纯寒无热而称为牡疟的，没有不是从少阳发展到极端偏颇的。要补救这种偏颇，必须从少阳的界限入手，使邪气去除，阴阳重新归于和谐，然后才能痊愈。大概补救的方法，非药物不可。然而张仲景又说，脉弦数的属于风热发病，可以通过饮食来调治，这又是为什么呢？
数为热象，热极则生风，势必导致肝木克制脾土，从而传变至不胜之地，于是坐视消耗胃中的津液，阳气更加偏盛而无法恢复，这是不能单纯依靠药物治疗的。必须通过饮食调养来止住热势，比如梨汁、甘蔗浆等生津止渴的药物，这正是《内经》所说的“风淫于内，治以甘寒”的宗旨。
否则，热邪移入胃中，必然向上熏蒸心肺，导致少气、烦闷冤郁而引发心肺病变，手心发热，想呕吐，而胃本身也生病，人怎么能承受得了呢？所以知道通过饮食调养来阻止邪气入胃，真是圣明的方法啊。
然而张仲景的方法，也没有超出《内经》的范围。《内经》说，疟疾脉象缓大虚的，适宜用药治疗；又说虚证不宜用针，应用甘药调治，就是这个意思。
至于温疟，其脉象平和，无寒只有热，骨节疼痛烦扰，时常呕吐，用白虎加桂枝汤。正如《内经》所说温疟有两种情况，都是先热后寒，并非只有热没有寒，这与瘅疟相似但实际不同。瘅疟是两阳合邪，上熏心肺，肺主气，所以少气烦闷；心主脉，所以阳盛脉促，津亏脉代，由此可以推断。温疟脉象如平人，说明邪气未合而津液未伤，之所以只有热不寒，是因为患者素体有瘅气，营卫不调，所以疟疾发于阳分，不入阴分，即使进入阴分，阴分也不受纳，所以出现骨节烦疼、时常呕吐，邪气捍格不通的状态就是这样。
只有将桂枝加入白虎汤中，既能够祛除阳邪，又能够疏通营卫，这样阴阳调和，血脉通畅，出汗后就能痊愈。然而桂枝是阳药，为什么用于只热不寒的病证？不知道用白虎汤来大清气分之热，再少量加入桂枝来疏通营卫，也是可以的。
至于《内经》所称的先热后寒的温疟，一种是先伤于风，后伤于寒，发作时先阳后阴，所以先热后寒。另一种是冬天感受风寒，深藏于骨髓，内舍于肾，到了春夏时令，天气大热才发作，邪气从肾出于体表，等到热势稍衰，又返回到肾，阴精与之相持，才开始发冷。如果不知道壮水之主，以急救其阴，发作十几次后阴精就耗尽了。
如果寒多者称为牡疟，并不是纯寒无热。所谓多寒，是指十分之中有七八分是寒。邪气伏于心下，正好位于膻中、心包的位置。心为阳脏，阳邪随之，则心经虚，所谓心虚，就是热收于内，既然收住了邪气，就不容易外出，这是寒多的一个原因。邪气进入心包，君主之官震惊恐惧，周身津液全力向内协助，使得所受的邪气被外围包裹而不能外出，这也是寒多的另一个原因。心为牡脏，所以以此命名疟疾。治疗用蜀漆散，配合浆水吐出其心下结伏的邪气，那么内陷的邪气就随之而出，一举荡除无余。
蜀漆是常山的苗。常山善于催吐，为什么不直接用常山，而一定要取其苗的原因何在？苗的性质轻扬，进入重阳的界限，引拔邪气，配合龙骨镇心安神，蠲除伏气，云母安脏补虚，取悦君主，这是张仲景炼石补天的功夫啊。
温疟也用这个方子，再加蜀漆，是为了取快速催吐的效果，正是因为一吐则结伏的邪气全部开通，而全身的瘅热得以通利，营卫也可以借此不受干扰，这也是以吐法作为和法的手段。难道牡疟与温疟证候相反，而必须用不同的方剂吗？
就像张仲景治疗疟病发作口渴，说也可以治疗劳疟，于是提出柴胡去半夏加栝蒌方，这明显是小柴胡汤，口渴加栝蒌根，去掉半夏，这是一定的法则。因为弦脉是少阳的脉象，寒热不外乎半表半里，所以虽然口渴是阳明津液枯竭，但导致阳明津液枯竭的原因，完全是少阳的邪气。而且《内经·刺法篇》说：“口渴者，取之少阳”，不是因为它木火之势劫夺胃津而造成的吗？
疟邪在少阳进退，也就用这个方子进退来施展巧妙。确实像赵先生所注的药性那样，所以说也可以治疗劳疟。
假如寒多微有热的，或者只是短暂发寒而不发热的，又主治以柴胡桂姜汤，并且说服用后效果神奇。观察其症状或许类似于牡疟，但轻重程度大不相同，所以张仲景没有立论，只说如神，知道邪气轻浅了。确实因为卫即表，荣即里。胸中的阳气散布运行于分肉之间，现在因为邪气痹阻，导致外卫的阳气反而郁伏在内守的阴分中，而血液痹阻的，更加凝结不散，遇到卫气行于阳分时病发，那么邪气进入荣分，既没有外出的趋势，而荣分原本痹阻的，也不出来与阳气相争，所以多寒少热，或者只有寒没有热，情况就是这样。
小柴胡汤本是随着邪气的进退而进退的，加入桂枝、干姜，则是进而从阳，痹着的邪气可以开解，何况加入牡蛎来攻其坚硬，破除其结聚，阴阳岂能不豁然汗解呢？所以说服一剂如神。然而，加入黄芩、黄连的寒凉，以退而从阴，不也可以从这里领悟吗？
(Zhou Yangjun) holds that the pathogenesis of malaria in humans stems from the invasion of external pathogens, which often lie dormant between the exterior and interior (half-exterior half-interior). When the pathogen enters and contends with Yin, chills manifest; when it emerges and contends with Yang, fever manifests. Therefore, alternating chills and fever are the hallmark symptoms of Shaoyang disease (Disease of the Gallbladder and Sanjiao channels). While it is true that other channel symptoms may coexist, it is illogical to claim that the condition has absolutely nothing to do with Shaoyang.
Zhang Zhongjing stated that the pulse should naturally be wiry (Xian). This is because the pulse may be rapid or slow, small and tight, or floating and large, all of which are indeterminate; however, it must necessarily present a wiry quality. The wiry pulse is the pulse of Shaoyang. When pathogens invade Shaoyang and reside alongside Wei Qi (Defensive Qi), they interact with its cycle: Wei Qi travels through the Yang aspects during the day and the Yin aspects at night. Thus, the pathogen moves outward upon encountering Yang and presses inward upon encountering Yin. The contention between internal and external factors causes daily attacks. If the pathogen lodges deeply, pressing inward into Yin, while Yang Qi alone flares up and Yin adheres internally, the contention between Yin and Yang prevents exit, resulting in every-other-day attacks.
Consequently, conditions leaning toward Yin exhibit more cold, while those leaning toward Yang exhibit more heat. Cases of pure heat without cold, termed Dan Malaria (Feverish Malaria) or Wen Malaria (Warm Malaria), and cases of pure cold without heat, termed Mu Malaria (Yin Malaria), all originate from an extreme deviation starting from Shaoyang. To remedy this deviation and correct the imbalance, one must address the boundary of Shaoyang, allowing the pathogen to depart so that Yin and Yang can return to harmony, leading to recovery. Generally, remediation requires herbal medicine. However, Zhang Zhongjing further stated that a wiry and rapid pulse indicates wind-heat onset, which can be managed through dietary adjustments. Why is this?
A rapid pulse indicates heat; extreme heat generates wind. This inevitably leads to Liver Wood overacting on Spleen Earth, transmitting to areas unable to withstand it, thereby consuming the fluids of the Stomach. Yang becomes increasingly excessive and fails to restore balance. In such cases, treatment cannot rely solely on herbs. One must use dietary regulation to curb the heat, employing substances like pear juice and sugarcane syrup that generate fluids and quench thirst. This aligns with the principle in the *Neijing* (Inner Canon): "When wind invades internally, treat it with sweet and cold agents." Otherwise, if heat transfers to the Stomach, it will surely steam upward to the Heart and Lungs, causing shortness of breath, vexation, and oppression, leading to Heart and Lung pathology, hot palms, nausea, and Stomach dysfunction. How could a person endure this? Therefore, using dietary regulation to stop the pathogen from entering the Stomach is indeed a sage method.
However, Zhang Zhongjing’s methods do not exceed the scope of the *Neijing*. The *Neijing* states that for malaria with a slow, large, and deficient pulse, medication is appropriate; it also states that deficiency patterns are unsuitable for acupuncture and should be regulated with sweet medicines. This reflects the same intent.
Regarding Warm Malaria (Wen Malaria), the pulse is normal, there is no chill but only fever, bone joints are painful and vexed, and vomiting occurs intermittently. Baibu Jia Guizhi Tang (White Tiger Decoction plus Cinnamon Twig) is used. As the *Neijing* mentions, there are two types of Warm Malaria, both characterized by fever preceding chills, not merely fever without chills. They resemble Dan Malaria but are distinct. Dan Malaria involves the combination of two Yang pathogens steaming upward to the Heart and Lungs. Since the Lung governs Qi, there is shortness of breath and vexation; since the Heart governs vessels, Yang excess causes a hurried pulse, and fluid deficiency causes an intermittent pulse, which can be deduced thus. In Warm Malaria, the pulse resembles that of a healthy person, indicating the pathogens have not combined and fluids are not yet damaged. The reason for fever without chills is that the patient inherently possesses Dan Qi (feverish energy), and Ying (Nutritive) and Wei (Defensive) Qi are unregulated. Thus, the malaria originates in Yang, does not enter Yin, or if it enters, Yin rejects it. Hence, bone joint pain and vomiting occur due to the obstruction of pathogenic qi.
By adding Guizhi (Cinnamon Twig) to Baishi Tang (White Tiger Decoction), one can dispel Yang pathogens and unblock Ying and Wei Qi. This harmonizes Yin and Yang, unblocks blood vessels, and leads to recovery through sweating. Although Guizhi is a Yang herb, why is it used for conditions with only heat and no chills? It is understood that Baishi Tang clears heat from the Qi level significantly, and adding a small amount of Guizhi to unblock Ying and Wei Qi is acceptable.
As for the Warm Malaria described in the *Neijing* featuring fever preceding chills: one type results from first being injured by Wind, then by Cold; during attack, Yang precedes Yin, hence fever precedes chills. The other type involves contracting Wind-Cold in winter, which hides deeply in the Marrow and resides internally in the Kidney. It erupts only when summer-heat arrives in spring and summer. The pathogen exits from the Kidney outward; as the heat subsides slightly, it returns to the Kidney, where Yin Essence contends with it, initiating chills. If one does not know to strengthen the master of Water to urgently rescue Yin, after ten or more attacks, Yin Essence will be exhausted.
If cold predominates, it is called Mu Malaria. It is not purely cold without heat. "Predominant cold" means seven or eight parts out of ten are cold. The pathogen lies dormant below the Heart, precisely in the position of Danzhong (Conception Vessel 17) and Pericardium. The Heart is Yang; Yang pathogens follow it, causing Heart Meridian deficiency. "Heart deficiency" means heat is retained internally. Once the pathogen is contained, it is difficult to expel outward, which is one cause of predominant cold. When the pathogen enters the Pericardium, the Ruler (Heart) is alarmed, and bodily fluids exert themselves to assist internally. This causes the acquired pathogen to be surrounded externally and unable to exit, which is another cause of predominant cold. Since the Heart is a Yang (Mu) organ, the malaria is named accordingly. Treatment uses Shuqi San (Chinese Tansy Powder) combined with fermented grain liquid to induce vomiting, expelling the knotted and latent pathogens below the Heart. The sunken pathogens exit together with them, clearing everything in one stroke.
Shuqi is the sprout of Changshan (Dichroa Root). Changshan induces vomiting effectively; why not use it directly instead of its sprout? The sprout has a light and ascending nature, entering the realm of extreme Yang to draw out pathogens. Combined with Longgu (Dragon Bone) to calm the Heart and Spirit, eliminate latent Qi, and Yunmu (Mica) to settle the Zang organs and tonify deficiency, pleasing the Ruler, this represents Zhang Zhongjing’s skill akin to mending the sky with colored stones.
Warm Malaria also uses this formula, adding extra Shuqi to achieve rapid vomiting. This is because one vomiting episode opens all knotted pathogens, unblocking the systemic feverishness, allowing Ying and Wei Qi to function without interference. Thus, vomiting therapy serves as a harmonizing method. Do Mu Malaria and Warm Malaria have contradictory natures requiring different formulas?
Consider Zhang Zhongjing’s treatment for malaria with thirst, stating it also treats Lao Malaria (Consumptive Malaria), proposing Chaihu Qu Banxia Gua Lou Tang (Bupleurum Decoction minus Pinellia plus Trichosanthes Root). This is clearly Xiao Chaihu Tang (Minor Bupleurum Decoction). For thirst, add Gua Lou Gen (Trichosanthes Root); remove Banxia (Pinellia). This is a fixed rule. Since the wiry pulse indicates Shaoyang, and chills/fever pertain to the half-exterior/half-interior, although thirst indicates exhaustion of Stomach fluids in the Yangming stage, the cause of this exhaustion is entirely the Shaoyang pathogen. Furthermore, the *Neijing* Chapter on Acupuncture Methods states: "For thirst, treat Shaoyang." Is this not because the Wood-Fire tendency of Shaoyang robs the Stomach of fluids?
The malaria pathogen advances and retreats within Shaoyang; thus, this formula advances and retreats to apply its efficacy. As noted by Mr. Zhao regarding herb properties, it is said to treat Lao Malaria.
If cold predominates with slight heat, or only brief chills without heat, Chaihu Guijiang Tang (Bupleurum, Cinnamon Twig, and Ginger Decoction) is indicated, with the note that it works miraculously. Observing the symptoms, they may resemble Mu Malaria, but the severity differs greatly. Zhang Zhongjing did not elaborate, only saying it works miraculously, implying the pathogen is light and superficial. Indeed, Wei corresponds to the Exterior, and Ying corresponds to the Interior. Yang Qi in the chest disperses among the muscle intervals. Now, due to pathogenic bi-syndrome (obstruction), the external Wei Yang is depressed and trapped within the internal守 (defensive) Yin. Blood stasis becomes more condensed. When Wei Qi travels to the Yang aspect and the disease flares, the pathogen entering Ying lacks momentum to exit, and the previously obstructed Ying does not emerge to contend with Yang. Hence, predominant cold with slight heat, or only cold without heat, occurs as described.
Xiao Chaihu Tang originally advances and retreats with the pathogen. Adding Guizhi and Ganjiang (Dried Ginger) shifts it toward Yang, resolving the obstructed pathogen. Moreover, adding Muli (Oyster Shell) attacks hardness and breaks stagnation. Can Yin and Yang not resolve suddenly through sweating? Hence, "one dose works miraculously." Conversely, adding Huangqin (Scutellaria) and Huanglian (Coptis) for their cold nature to retreat toward Yin, can we not learn from this?
I base this discussion on Zhang Zhongjing’s principles and compile Jiayan’s (Chen Shiduo’s) discussions, offering this treatise as assistance for those skilled in treating malaria.