师曰疟脉自弦。弦数者多热。弦迟者多寒。弦小紧者下之瘥。弦迟者可温之。弦紧者可发汗针灸也。浮
大者可吐之。弦数者风发也。以饮食消息止之。（弦紧下。脉经有数字。风发。外台作风疾。）
〔程〕内经曰。 疟皆生于风。其蓄作有时者何也。岐伯曰。疟之始发也。先起于毫毛。伸欠乃作。寒
栗鼓颔。腰脊俱痛。寒去则内外皆热。渴欲饮水。方其寒。汤火不能温。及其热冰水不能寒。此阴阳交争。虚
实并作。邪舍于营卫之间。风寒之气不常。故休作有时。而作往来寒热也。木郁则发热。热则脉数。此邪气
微者。故以饮食消息止之。经曰。五脏病各有得者愈。五脏病各有所恶。各随其不喜者为病。
遂其喜恶。而消息之。则疟自止。上说如此。后并无汗吐下温针灸之法。去古既远。文多简略。不可考矣。
〔徐〕疟者。半表里病。而非骤发之外病也。故内经曰。夏伤于暑。秋必
疟。又曰。在皮肤之内。肠胃之外。唯其半表里。则脉必出于弦。弦者东方甲木之气。经属少阳。故曰疟脉
自弦。自者谓感有风寒。而脉唯自弦也。于是脉既有一定之象。而兼数为热。兼迟为寒。此其大纲也。
〔尤〕疟者。少阳之邪。弦者。少阳之脉。有是邪。则有是脉也。然疟之舍。固在半表半里之间。而疟之气。则有
偏多偏少之异。故其病有热多者。有寒多者。有里多而可下者。有表多而可汗可吐者。有风从热出。而不可以
药散者。当各随其脉而施治也。徐氏曰。脉大者为阳。小者为阴。紧虽寒脉。小紧则内入而为阴矣。阴
不可从表散。故曰下之愈。迟既为寒。温之无疑。弦紧不沉。为寒脉。而非阴脉。非阴故可发汗针灸也。疟
脉概弦。而忽浮大。知邪在高分。高者引而越之。故可吐。既云弦数者多热矣。而复申一义云。弦数者风发。
见多热不已。必至于极热。热极则生风。风生则肝木侮土。而传其热于胃。坐耗津液。此非徒求之药。须以饮
食消息。止其炽热。即梨汁蔗浆。生津止渴之属。正内经风淫于内。治以甘寒之旨也。
案风发以饮食消息止之。其义未清晰。姑举二氏之说。以备考。金鉴云。弦小紧者之小字。当是沉字。则
有可下之理。弦紧者。当是弦浮紧。则有可发汗之理。弦浮大者。当是弦滑大。则有可吐之理。且不遗本文疟
脉自弦之意。此说不必矣。徐尤之注。义自允当。
病疟。以月一日发。当以十五日愈。设不瘥。当月尽解。如其不瘥。当云何。师曰。此结为 瘕。名曰
疟母。急治之。宜鳖甲煎圆。（脉经。自病疟止师曰此三十字无。结上有疟疾二字。无急治之三字。
赵本圆作丸。下并同。）
〔程〕五日为一候。三候为一气。一气十五日也。夫人受
气于天。气节更移。营卫亦因之以易。故交一节气当愈。不
愈者。再易一气。故云月尽解也。
〔尤〕设更不愈。其邪必假血根据痰。结为 瘕。僻处胁下。将成负固不服
之势。故宜急治。鳖甲煎丸。行气逐血之药颇多。而不嫌其峻。一日三服。不嫌其急。所谓乘其未集而击之
也。
〔魏〕寒热杂合之邪。在少阳。而上下格阻之气结厥阴。聚肝下之血分。而实为疟病之母气。足于生疟而
不已。此所阴阳互盛。历月经年。而病不除也。盖有物以作患于里。如草树之有根 。必须急为拔去。不然旋
伐旋生。有母在焉。未有不滋蔓难图者矣。
案玉篇。HT 。莫浓切。病HT 癖也。乃疟母之母。从 者。
三因云。结为 癖。在腹胁。名曰老疟。亦名曰母疟。
鳖甲煎丸方（外台。作大鳖甲煎。引张仲景伤寒论。云出第十五卷中。）
鳖甲（十二分炙○千金作成死鳖注云要略作鳖甲三两） 乌扇（三分烧） 黄芩
（三分） 柴胡（六分） 鼠妇（三分熬） 干姜（三分） 大黄（三分） 芍药（五分） 桂
枝（三分） 葶苈（一分熬） 石韦（三分去毛） 浓朴（三分） 牡丹（五分去心） 瞿麦
（二分） 紫葳（三分） 半夏（一分） 人参（一分） 虫（五分熬） 阿胶（三分炙） 蜂
窠（四分炙） 赤硝（十二分） 蜣螂（六分熬） 桃仁（二分）
上二十三味。为末。取锻灶下灰一斗。清酒一斛。五斗浸灰。候酒尽一半。着鳖甲于中。煮令泛烂如
胶漆。绞取汁。纳诸药。煎为丸。如梧子大。空心服七丸。日三服。（〔原注〕千金方。用鳖甲十二片。又有海藻三分。
大戟一分。 虫五分。无鼠妇赤硝二味。以鳖甲煎
和诸药为丸。○案今考千金。无鼠妇紫葳赤硝。有虻虫紫菀海藻大戟。凡二十四味。分两
颇异。不繁引于此。浸灰候酒尽一半。作以酒浸灰去灰取酒。似是。）
〔程〕疟母者。邪气内搏于脏腑。血气羁留而不行息而成积。故内结 瘕。而外作往来寒热。内经曰。
坚者削之。结者行之。以鳖甲。主 瘕寒热。故以为君。邪结于血分者。用大黄芍药 虫桃仁赤硝牡丹鼠妇
紫葳。攻逐血结为臣。邪结于气分者。浓朴半夏石韦葶苈瞿麦乌羽蜂房蜣螂。下气利
小便。以为佐。调寒热和阴阳。则有黄芩干姜。通营卫。则有桂枝柴胡。和气血。则有阿胶人参。六味又
用之。以为使也。结得温即行。灶灰之温。清酒之热。所以制鳖甲。同诸
药而逐 瘕疟母。内经曰。治有缓急。方有大小。此急治之大方也。
案乌扇。即射干。见本经。千金作乌羽。赤硝。活人书云。硝石生于赤山。考本草。射干。散结气腹中
邪逆。鼠妇。治月闭血瘕寒热。石韦。治劳热邪气。利水道。紫葳。治 瘕血闭寒热。瞿麦。利小便。下
闭血。蜂窠。治寒热邪气。蜣螂。治腹胀寒热。利大小便。 虫。治血积 瘕破坚。
灶灰。即 铁灶中灰尔。亦主 瘕坚积。此方合小柴胡桂枝。大承气三汤。去甘草枳实。主以鳖甲。更用以
上数品。以攻半表之邪。半里之结。无所不至焉。然三因云。古方虽有鳖甲煎等。不特服不见效。抑亦药
料难备。此说殆有理焉。
师曰。阴气孤绝。阳气独发。则热而少气烦冤。手足热而欲呕。名曰瘅疟。若但热不寒者。邪气内
藏于心。外舍分肉之间。令人消铄肌肉。（肌。赵本作脱。案素问疟论曰。但热而不寒。气内
藏于心。而外舍于分肉之间。令人消铄脱肉。则赵本为是。）
〔程〕瘅。热也。内经曰。瘅疟者。肺素有热。气盛于身。厥逆上冲。中气实而不外泄。因有所用力。
腠理开。风寒客于皮肤之内。分肉之间而发。发则阳气盛。阳气盛而不衰。则病矣。其气不及于阴。故
但热而不寒。此肺素有热。而成瘅疟也。今所云阴气孤绝者。以热邪亢盛。热盛则气消。故
烦冤少气。表里俱病。今手足热而欲呕。心阳脏也。心恶热。邪气内藏于心。外舍于分肉之间。内外燔灼。
故令人消铄肌肉。此热藏于心。而为瘅疟也。然则瘅疟之所舍。属心肺两经者欤。
温疟者。其脉如平。身无寒但热。骨节疼烦。时呕。白虎加桂枝汤主之。（呕下。千金有朝发暮解。暮
发朝解名温疟十一字。）
〔程〕内经曰。温疟得之冬中于风寒。气藏于骨髓之中。至春则阳气大发。邪气不能自出。因遇大暑。
脑髓烁肌肉消。腠理发泄。或有所用力。邪气与汗皆出。此病藏之肾。其气先从内出之外也。如是者。阴虚
而阳盛。阳盛则热矣。衰则气复反入。入则阳虚。阳虚则寒矣。故先热而后寒。名曰温疟。今但热不寒。则
与瘅疟无异。意者内经。以先热后寒为温疟。仲景以但热不寒。为温疟也。脉如平。非平也。其气
不及于阴。故但热无寒。邪气内藏于心。故时呕。外舍于肌肉。故骨节疼烦。今阳邪偏胜。但热无寒。加桂
枝于白虎汤中。引白虎辛寒。而出入营卫。制其阳邪之亢害。
〔尤〕脉如平者。病非乍感。故脉如其平时也。
骨节烦疼时呕者。热从肾出。外舍于其合。而上并于阳明也。白虎甘寒除热。桂枝则因其势。而达之耳。
白虎加桂枝汤方
知母（六两） 甘草（二两炙） 石膏（一斤） 粳米（二合○案千金作六合据伤寒
论作六合为是） 桂（去皮三两○俞本作桂枝是）
上锉每五钱。水一盏半。煎至八分。去滓温服。汗出愈。（
俞本出下。有即字。案徐沈作上五味以水一斗。煮米熟汤成。去滓。温服一升。日三服。
一云。上锉每五钱。水盏半。煎至八分。去滓温取。汗出愈。尤本根据前法。此盖古之煎法
其云钱云盏。系于宋人改定。千金云。上四味 咀。以水一斗二升。煮米烂。去滓。加桂
枝三两。煎取三升。分三服。覆令汗。先寒发热者愈。外台。引千金。方后。伤寒论云。
用粳米。不熟稻米是也。）
案圣济总录。知母汤。治温疟骨节疼痛。时呕朝发暮解。暮发朝解。（即本方。）
活人白虎加苍术汤 治湿温多汗。于白虎汤中。加苍术三两。（此方出伤寒微旨。亦仿金匮白虎加桂汤。）
疟多寒者。名曰牡疟。蜀漆散主之。（程作牝疟。金鉴同。）
〔尤〕疟多寒者。非真寒也。阳气为痰饮所遏。不得外出肌表。而但内伏心间。心牡脏也。故名牡疟。
蜀漆吐疟痰。痰去则阳伸。而寒愈。取云母龙骨者。以蜀漆上越之猛。恐并动心中之神与气也。
案尤注详备。第牡疟之解。本于喻氏法律。此恐非也。外台引本条云。张仲景伤寒论。疟多寒者。名
牝疟。吴氏医方考云。牝阴也。无阳之名。故多寒名牝疟。此说得之金鉴云。此言牝疟。其文脱简。内经
已详。不复释。今考内经。无牝疟证。亦误。（兰台轨范云。似当作牝字。诸本皆作牡。存考。）
蜀漆散方
蜀漆（洗去腥○案赵本洗作烧非） 云母（烧二日夜） 龙骨（等分）
上三味。杵为散。未发前以浆水服半钱。○温疟。加蜀漆半分。临发时。服一钱匕。（〔原注〕一方云
母。作云实。○浆水。千金。作酢浆。外台。作清浆水。尤本删温疟以下十四字。千金注云。要略不用云母。
用云实。）
〔程〕蜀漆。常山苗也。得浆水。能吐疟之顽痰。三阴者。其道远。故于未发之先服。令药入阴分。以
祛其邪。属心肺者。其道近。故于临发之时服。令药力入心肺。以祛其邪。
此方乃吐顽痰。和阴阳之剂。故牝疟温疟。俱可服。
医通云。方后有云。湿疟。加蜀漆半分。而坊本误作温疟。大谬。此条本以邪伏髓海。谓之牝疟。
赵以德不辨亥豕。注为邪在心而为牡。喻嘉言亦仍其误而述之。非智者之一失欤。案危氏得效方云。寒热
身重。烦疼胀满。名湿疟。丹溪纂要云。在三阴。总谓之湿疟。湿疟之称。古经方无所考。
仅见于此。则其言不可从。况邪伏髓海之说。未见所据。
仁斋直指云。凡疟方来与正发。不可服药。服药在于未
发两时之先。否则药病交争。转为深害。
案以未发前服之语观之。即是后世所谓截疟之药也。外台。载广济常山汤。常山三两。以浆水三升。浸
经一宿。煎取一升。欲发前顿服之。后微吐瘥止。与本方。其意殆同矣。
附外台秘要方（程本金鉴。并不载附方。以下各篇同。）
牡蛎汤 治牡疟。
牡蛎（四两熬） 麻黄（去节四两） 甘草（二两） 蜀漆（三两○外台云若无用常山代之）
上四味。以水八升。先煮蜀漆麻黄。去上沫。得六升。纳诸药。煮取二升。温服一升。若吐则勿更服。
〔尤〕案此系宋孙奇等所附。盖亦蜀漆散之意。而外攻之
力较猛矣。赵氏云。牡蛎。软坚消结。麻黄。非独散寒。且可发越阳气。使通于外。结散阳通。其病自愈。
外台云。仲景伤寒论。牝疟多寒者。名牝疟。牡蛎汤主之。根据此。则牡即牝之讹。
此方外台。列于蜀漆散前。云。并出第十五卷中。
柴胡去半夏加栝蒌汤 治疟病发渴者。亦治劳疟。
柴胡（八两） 人参 黄芩 甘草（各三两） 栝蒌根（四两） 生姜（二两） 大枣（十二枚）
上七味。以水一斗二升。煮取六升。去滓再煎。取三升。温服一升。日二服。
〔徐〕伤寒论。寒热往来。为少阳邪在半表里故也。疟邪亦在半表里。故入而与阴争则寒。出而与阳
争则热。此少阳之象也。是谓少阳而兼他经之证则有之。谓他经而全不涉少阳。则不成其为疟矣。所以
小柴胡。亦为治疟主方。渴易半夏加栝蒌根。亦治少阳成法也。攻补兼施。故亦主劳疟。
外台云。张仲景伤寒论。疟发渴者。与小柴胡去半夏加
栝蒌汤。经心录。疗劳疟。出第十五卷中。
案巢源劳疟候云。凡疟积久不瘥者。则表里俱虚。客邪未散。真气不复。故疾虽暂间。小劳便发。
柴胡桂姜汤 治疟寒多。微有热。或但寒不热。（〔原注〕服一剂如热○俞本姜作蒌非。）
柴胡（半斤） 桂枝（三两去皮） 干姜（二两） 栝蒌根（四两） 黄芩（三两） 牡蛎（二两熬）
甘草（二两炙）
上七味。以水一斗二升。煮取六升。去滓再煎。取三升。温服一升。日三服。初服微烦。复服汗出便愈。
〔徐〕胸中之阳气。散行于分肉之间。今以邪气痹之。则外卫之阳。郁伏于内守之阴。而血之痹者。既
老师（张仲景）说：疟疾的脉象自然呈现弦脉。脉象弦而数的，多属热证；脉象弦而迟的，多属寒证。脉象弦小且紧的，可用下法治疗以痊愈；脉象弦而迟的，可用温法治疗；脉象弦而紧的，可用发汗法和针灸治疗；脉象浮大的，可用吐法治疗。脉象弦而数的，属于风邪引发的发热，可以通过饮食调理来制止。（注：原文“弦紧下”处，《脉经》有若干文字缺失。“风发”，《外台秘要》作“风疾”。）
〔程林〕《内经》说：疟疾都生于风邪。为什么它的发作和休止有时间规律呢？岐伯说：疟疾刚开始发作时，先起于毫毛竖立，接着出现伸欠（打哈欠），然后开始寒战鼓颔（下巴颤抖），腰部和脊柱都疼痛。寒气消退后，体内体外都发热，口渴想喝水。在寒冷的时候，喝热水、用火烧也不能温暖身体；等到发热的时候，用冰水也不能降温。这是因为阴阳之气相互交争，虚实之邪同时发作，邪气潜伏在营卫之间。风寒之气变化无常，所以发作和休止都有定时，表现为往来寒热。木气郁结则发热，热盛则脉数。这是邪气轻微的情况，所以通过饮食调理来制止它。经文说：五脏的疾病各有适宜的食物能治愈，五脏的疾病各有厌恶的事物。随着它们不喜欢的东西致病，顺应它们的喜好与厌恶，进行饮食调理，那么疟疾自然停止。上面提到的方法如此，后面并没有提到无汗、吐、下、温、针灸等具体治法。由于距离古代久远，文字大多简略，无法考证了。
〔徐大椿〕疟疾是半表半里的病，而不是突然发作的外感病。所以《内经》说：夏天被暑邪所伤，秋天必定患疟疾。又说：病位在皮肤之内，肠胃之外。正因为处于半表半里，所以脉象必然呈现弦象。弦脉对应东方甲木之气，经脉归属于少阳，所以说疟疾的脉象自然呈现弦脉。“自”的意思是，虽然感受了风寒，但脉象唯独呈现弦象。既然脉象有一定的形态，兼见数脉即为热，兼见迟脉即为寒，这是总纲。
〔尤在泾〕疟疾是少阳的邪气，弦脉是少阳的脉象。有了这种邪气，就有这种脉象。然而疟疾的病位固然在半表半里之间，但疟疾的气机却有偏多偏少的差异。所以有的病热多，有的病寒多，有的病位偏里可以用下法，有的病位偏表可以用汗法或吐法，有的风从热出，不能用药物发散。应当各自根据脉象来施治。徐氏说：脉大为阳，脉小为阴。紧虽然是寒脉，但小紧则内入成为阴脉。阴脉不可从表散发，所以说下法可愈。迟既然是寒，用温法无疑。弦紧而不沉，是寒脉而非阴脉。不是阴脉，所以可以发汗和针灸治疗。疟疾的脉概略都是弦脉，如果忽然出现浮大，知道邪气在高处，高处的邪气引导其向上越出，所以可以用吐法。既然说了弦数者多热，又补充一个观点说：弦数者属于风发，说明多热不止，必至于极热。热极则生风，风生则肝木克制脾土，并将热传给胃，坐耗津液。这不仅仅是依靠药物，必须通过饮食调理，来制止炽热的火势。像梨汁、蔗浆这类生津止渴的东西，正是符合《内经》“风淫于内，治以甘寒”的宗旨。
按语：关于“风发以饮食消息止之”的含义尚不清晰，暂举两家之说，以备参考。《医宗金鉴》说：“弦小紧”中的“小”字，应当是“沉”字，这样才有可下的道理。“弦紧”者，应当是“弦浮紧”，这样才有可发的道理。“弦浮大”者，应当是“弦滑大”，这样才有可吐的道理。而且不违背本文“疟脉自弦”的意思。这种说法不必采纳。徐氏和尤氏的注释，义理恰当。
患疟疾，如果在农历初一发病，应当在十五天痊愈。假如没有痊愈，应当在当月月底解除。如果还是没有痊愈，该怎么办？老师说：这会结聚成瘕块，名叫疟母。必须紧急治疗。宜用鳖甲煎丸。（《脉经》中，从“病疟”到“师曰此”这三十字没有。在“结”字上有“疟疾”二字。没有“急治之”三字。赵本将“圆”写作“丸”，下文相同。）
〔程林〕五天为一候，三候为一气，一气是十五天。人禀受天气，节气更替，营卫之气也随之改变。所以经过一个节气应当痊愈。如果不愈，再经历一个节气。所以说当月月底解除。
〔尤在泾〕假如仍然不愈，邪气必定借由血液和痰饮，结聚成瘕块，偏僻地处在胁下，将要形成顽固不服之势。所以应该紧急治疗。鳖甲煎丸中含有许多行气逐血的药物，但不嫌其峻猛。一天服用三次，不嫌其急切。这就是所谓趁邪气尚未集结而成势时攻击它。
〔魏荔彤〕寒热夹杂的邪气，在少阳经，而上下格阻的气机结聚于厥阴经，聚集在肝下的血分中，实为疟病的母气。足以导致疟疾发作不止。这是阴阳互相偏盛，历经数月甚至经年，而病不能消除。大概是有实物在体内作祟，如同草木有根一样，必须紧急拔除。不然的话，砍伐之后又生长，因为有“母”存在，没有不蔓延难以处理的。
按语：《玉篇》解释“HT”字，读音为莫浓切。病名“HT癖”，就是疟母的“母”。从“疒”部。《三因极一病证方论》说：结聚成“HT癖”，在腹胁部位，名叫老疟，也名叫母疟。
鳖甲煎丸方（《外台秘要》作大鳖甲煎，引用张仲景《伤寒论》，说出自第十五卷中。）
药材：鳖甲（十二分，炙制。《千金方》作成死鳖，注解说《要略》作鳖甲三两）、乌扇（三分，烧制）、黄芩（三分）、柴胡（六分）、鼠妇（三分，熬制）、干姜（三分）、大黄（三分）、芍药（五分）、桂枝（三分）、葶苈（一分，熬制）、石韦（三分，去毛）、厚朴（三分）、牡丹（五分，去心）、瞿麦（二分）、紫葳（三分）、半夏（一分）、人参（一分）、虻虫（五分，熬制）、阿胶（三分，炙制）、蜂窠（四分，炙制）、赤硝（十二分）、蜣螂（六分，熬制）、桃仁（二分）。
以上二十三味药，研为细末。取锻铁炉底下的灰一斗，清酒一斛，用五斗酒浸泡炉灰，等到酒剩下一半时，放入鳖甲在其中，煮至烂熟如胶漆状，绞取汁液，纳入诸药，煎煮成丸，如梧桐子大小。空腹服用七丸，每日三次。（〔原注〕《千金方》用鳖甲十二片，又有海藻三分、大戟一分、虻虫五分，没有鼠妇、赤硝两味药，用鳖甲煎煮和诸药为丸。○按：今考《千金方》，没有鼠妇、紫葳、赤硝，有虻虫、紫菀、海藻、大戟，共二十四味。分量颇有差异，此处不繁琐引用。浸灰等待酒尽一半，意思是先用酒浸灰，去掉灰取酒，似乎是这样。）
〔程林〕疟母，是邪气内搏于脏腑，气血羁留不行息而成积，所以内结瘕块，而外作往来寒热。《内经》说：坚硬的要用削法，结聚的要行散。用鳖甲为主药，主治瘕块、寒热，所以作为君药。邪气结在血分的，用大黄、芍药、虻虫、桃仁、赤硝、牡丹、鼠妇、紫葳，攻逐血结，作为臣药。邪气结在气分的，用厚朴、半夏、石韦、葶苈、瞿麦、乌扇、蜂房、蜣螂，下气利小便，作为佐药。调和寒热、和阴阳的，则有黄芩、干姜；通营卫的，则有桂枝、柴胡；和气血的，则有阿胶、人参。这六味药又用来作为使药。结聚得温即行，灶灰的温热，清酒的火热，是用来制约鳖甲，同诸药一起驱逐瘕块和疟母。《内经》说：治疗有缓急，方剂有大小的区别。这是紧急治疗的大方。
按语：乌扇，就是射干，见于《神农本草经》。《千金方》作乌羽。赤硝，《活人书》说硝石生于赤山。考《本草》，射干散结气、腹中邪逆；鼠妇治月闭、血瘕、寒热；石韦治劳热、邪气，利水道；紫葳治瘕、血闭、寒热；瞿麦利小便，下闭血；蜂窠治寒热、邪气；蜣螂治腹胀、寒热，利大小便；虻虫治血积、瘕、破坚。灶灰，就是锻铁炉中的灰，也主瘕坚积。此方合了小柴胡汤、桂枝汤、大承气汤三方的意思，去掉甘草、枳实，主以鳖甲，再加上上述几味药，以攻半表之邪，半里之结，无所不到。然而《三因方》说：古方虽有鳖甲煎等，不仅服用不见效，而且药料难备。这种说法大概有理。
老师说：阴气孤绝，阳气独发，则发热而气短烦冤，手足发热且想呕吐，名叫瘅疟。如果只有热没有寒，邪气内藏于心，外舍于分肉之间，使人肌肉消瘦。（“肌”字，赵本作“脱”。按：《素问·疟论》说：但热而不寒，气内藏于心，而外舍于分肉之间，令人消铄脱肉，则赵本是正确的。）
〔程林〕瘅，就是热。《内经》说：瘅疟，是因为肺素有热，气盛于身，厥逆上冲，中气实而不外泄，因为有所用力，腠理开，风寒客于皮肤之内，分肉之间而发。发作时阳气盛，阳气盛而不衰，就病了。其气不及于阴，所以只有热而没有寒。这是肺素有热，而成瘅疟。现在所说的阴气孤绝，是因为热邪亢盛，热盛则气消，所以烦冤少气。表里俱病，现在手足热而想呕吐，心是阳脏。心恶热，邪气内藏于心，外舍于分肉之间，内外燔灼，所以使人肌肉消瘦。这是热藏于心，而为瘅疟。那么，瘅疟之所舍，属于心肺两经吗？
温疟，其脉象像平时正常人的脉象，身体没有寒只有热，骨节疼烦，有时呕吐。用白虎加桂枝汤主治。（“呕”字下，《千金方》有“朝发暮解，暮发朝解名温疟”十一字。）
〔程林〕《内经》说：温疟得之于冬天中于风寒，气藏于骨髓之中，到了春天阳气大发，邪气不能自己出来，因为遇到大暑，脑髓烁，肌肉消，腠理发泄，或者有所用力，邪气与汗皆出。此病藏在肾，其气先从内出之外。像这样，阴虚而阳盛，阳盛则热了。衰则气复反入，入则阳虚，阳虚则寒了。所以先热而后寒，名叫温疟。现在只有热没有寒，则与瘅疟无异。猜想《内经》以先热后寒为温疟，仲景以但热不寒为温疟。脉象像平时，并非真的平，其气不及于阴，所以只有热没有寒。邪气内藏于心，所以时呕。外舍于肌肉，所以骨节疼烦。现在阳邪偏胜，只有热没有寒，在白虎汤中加入桂枝，引白虎辛寒之性，出入营卫，制约阳邪的亢害。
〔尤在泾〕脉象像平时，是因为病非乍感，所以脉象如其平时。
骨节烦疼、时呕，是因为热从肾出，外舍于其合，而上并于阳明。白虎甘寒除热，桂枝则是因其势而达之罢了。
白虎加桂枝汤方
知母（六两）、甘草（二两，炙）、石膏（一斤）、粳米（二合。按：《千金方》作六合，据《伤寒论》作六合是正确的）、桂（去皮三两。俞本作桂枝是对的）。
以上五味药，锉碎，每服五钱，用水一盏半，煎至八分，去滓，温服。汗出即愈。（俞本在“出”下有“即”字。按：徐沈本作上五味以水一斗，煮米熟汤成，去滓，温服一升，日三服。一说：上锉每五钱，水盏半，煎至八分，去滓温取，汗出愈。尤本根据前法。这大概是古代的煎法，其云钱、云盏，系于宋人改定。《千金方》说：上四味咀，以水一斗二升，煮米烂，去滓，加桂枝三两，煎取三升，分三服，覆令汗。先寒发热者愈。《外台》引用《千金方》方后，《伤寒论》说：用粳米，是不熟的稻米。）
按语：《圣济总录》知母汤，治温疟骨节疼痛，时呕，朝发暮解，暮发朝解。（即本方。）
《活人书》白虎加苍术汤，治湿温多汗，于白虎汤中，加苍术三两。（此方出《伤寒微旨》，也是仿照《金匮》白虎加桂枝汤。）
疟疾多寒的，名叫牡疟。用蜀漆散主治。（程林作牝疟，《医宗金鉴》同。）
〔尤在泾〕疟疾多寒，不是真寒。阳气被痰饮所遏，不得外出肌表，而但内伏心间。心是牡脏（阳脏），所以名叫牡疟。蜀漆吐疟痰，痰去则阳伸，而寒愈。取云母、龙骨，是因为蜀漆上越之力猛烈，恐怕并动心中之神与气。
按语：尤注详备。只是牡疟的解释，本于喻嘉言《法律》，这恐怕不对。《外台秘要》引用本条说：张仲景《伤寒论》，疟多寒者，名叫牝疟。吴氏《医方考》说：牝是阴也，无阳之名，所以多寒名叫牝疟。这种说法正确。《医宗金鉴》说：此言牝疟，其文脱简，《内经》已详，不复释。今考《内经》，无牝疟证，也是错误的。（《兰台轨范》说：似当作牝字。诸本皆作牡，存疑考察。）
蜀漆散方
蜀漆（洗去腥。按：赵本洗作烧，非）、云母（烧二日夜）、龙骨（等分）。
以上三味药，杵为散。未发前以浆水服半钱。○温疟，加蜀漆半分，临发时，服一钱匕。（〔原注〕一方云母，作云实。○浆水，《千金方》作酢浆，《外台》作清浆水。尤本删温疟以下十四字。《千金方》注云：《要略》不用云母，用云实。）
〔程林〕蜀漆，是常山的苗。得浆水，能吐疟之顽痰。三阴经的病，其道远，所以在未发之前服，令药入阴分，以祛其邪。属心肺的病，其道近，所以在临发之时服，令药力入心肺，以祛其邪。
此方乃吐顽痰、和阴阳的药剂，所以牝疟、温疟，都可服用。
《医宗金鉴》说：方后有云，湿疟，加蜀漆半分，而坊本误作温疟，大谬。此条本以邪伏髓海，谓之牝疟。赵以德不辨亥豕，注为邪在心而为牡。喻嘉言亦仍其误而述之，非智者之一失欤？按：危氏《得效方》说：寒热身重，烦疼胀满，名叫湿疟。丹溪《纂要》说：在三阴，总谓之湿疟。湿疟之称，古经方无所考，仅见于此，则其言不可从。况邪伏髓海之说，未见所据。
仁斋《直指方》说：凡疟方来与正发，不可服药。服药在于未发两时之先，否则药病交争，转为深害。
按：以未发前服之语观之，即是后世所谓截疟之药。《外台》载《广济》常山汤：常山三两，以浆水三升，浸经一宿，煎取一升，欲发前顿服之，后微吐瘥止。与本方，其意殆同矣。
附《外台秘要》方（程林、《医宗金鉴》并不载附方，以下各篇同。）
牡蛎汤 治牡疟。
牡蛎（四两，熬）、麻黄（去节四两）、甘草（二两）、蜀漆（三两。○《外台》云若无用常山代之）。
以上四味药，以水八升，先煮蜀漆、麻黄，去上沫，得六升，纳诸药，煮取二升，温服一升。若吐则勿更服。
〔尤在泾〕按：此系宋孙奇等所附，盖亦蜀漆散之意，而外攻之力较猛矣。赵氏说：牡蛎软坚消结，麻黄非独散寒，且可发越阳气，使通于外。结散阳通，其病自愈。《外台》说：仲景《伤寒论》，牝疟多寒者，名叫牝疟，牡蛎汤主之。根据此，则牡即牝之讹。
此方《外台》列于蜀漆散前，云：并出第十五卷中。
柴胡去半夏加栝蒌汤 治疟病发渴者，亦治劳疟。
柴胡（八两）、人参、黄芩、甘草（各三两）、栝蒌根（四两）、生姜（二两）、大枣（十二枚）。
以上七味药，以水一斗二升，煮取六升，去滓再煎，取三升，温服一升，日二服。
〔徐大椿〕《伤寒论》说：寒热往来，为少阳邪在半表里故也。疟邪亦在半表里，故入而与阴争则寒，出而与阳争则热。此少阳之象也。是谓少阳而兼他经之证则有之，谓他经而全不涉少阳，则不成其为疟矣。所以小柴胡汤，亦为治疟主方。渴易半夏加栝蒌根，亦治少阳成法也。攻补兼施，故亦主劳疟。
《外台》说：张仲景《伤寒论》，疟发渴者，与小柴胡去半夏加栝蒌汤。《经心录》，疗劳疟，出第十五卷中。
按：巢元方《诸病源候论》劳疟候说：凡疟积久不瘥者，则表里俱虚，客邪未散，真气不复，故疾虽暂间，小劳便发。
柴胡桂姜汤 治疟寒多，微有热，或但寒不热。（〔原注〕服一剂如热。○俞本姜作蒌，非。）
柴胡（半斤）、桂枝（三两，去皮）、干姜（二两）、栝蒌根（四两）、黄芩（三两）、牡蛎（二两，熬）、甘草（二两，炙）。
以上七味药，以水一斗二升，煮取六升，去滓再煎，取三升，温服一升，日三服。初服微烦，复服汗出便愈。
The Master said: The pulse of malaria naturally presents as a string-like (Xian) pulse. A string-like and rapid pulse indicates mostly heat; a string-like and slow pulse indicates mostly cold. A string-like, small, and tight pulse can be treated with purgation to achieve recovery; a string-like and slow pulse can be treated with warming methods; a string-like and tight pulse can be treated with sweating methods and acupuncture; a floating and large pulse can be treated with emesis. A string-like and rapid pulse indicates wind-induced fever, which can be stopped by dietary regulation. (Note: In the phrase "string-like, tight, [purgation]", several characters are missing in *Mai Jing*. "Wind-induced" is written as "wind disease" in *Wai Tai Mi Yao*.)
[Cheng Lin] *Nei Jing* states that malaria arises from wind pathogens. Why do its paroxysms have a specific timing? Qibo said: When malaria first begins, it starts with goosebumps, followed by yawning, then chills with jaw quivering, and pain in the waist and spine. After the cold subsides, both interior and exterior become hot, accompanied by thirst and desire to drink water. During the chills, neither hot soup nor fire can warm the body; during the fever, neither ice nor cold water can cool it. This is due to the conflict between Yin and Yang, with deficiency and excess pathogens occurring simultaneously. The pathogen lodges between Ying (Nutritive) and Wei (Defensive) levels. Because the wind-cold qi fluctuates irregularly, the paroxysms and remissions occur at regular intervals, manifesting as alternating chills and fever. Liver Qi stagnation generates heat, and heat causes a rapid pulse. This represents a mild pathogenic factor, so dietary regulation is used to stop it. The classic says: Each of the five Zang organs has foods that aid recovery and substances they dislike. By following their dislikes to avoid aggravating the disease and accommodating their preferences through dietary adjustment, malaria will naturally cease. The above methods are described thus, but subsequent texts lack detailed explanations of sweating, emesis, purgation, warming, and acupuncture. Due to the great distance from antiquity, the text is often abbreviated and cannot be verified.
[Xu Dacun] Malaria is a disease of the half-exterior and half-interior, not an acute external contraction. Thus, *Nei Jing* states: Summerheat injured in summer leads to malaria in autumn. It also states: The location is inside the skin but outside the stomach and intestines. Precisely because it is in the half-exterior and half-interior, the pulse must be string-like. The string-like pulse corresponds to the Wood Qi of East Jia, belonging to the Shaoyang channel. Hence, it is said that the malaria pulse is naturally string-like. "Naturally" means that although wind-cold is contracted, the pulse specifically appears string-like. Since the pulse has a definite form, combined with rapidness indicates heat, and combined with slowness indicates cold; this is the general principle.
[You Zaijing] Malaria is Shaoyang pathogen; the string-like pulse is the Shaoyang pulse. With this pathogen comes this pulse. However, while the seat of malaria is indeed between half-exterior and half-interior, the Qi of malaria varies in degree. Thus, some cases have more heat, some more cold, some predominantly interior allowing purgation, some predominantly exterior allowing sweating or emesis, and some where wind emerges from heat, which cannot be dispersed by medicine alone. Treatment should follow the pulse. Xu stated: Large pulse is Yang, small pulse is Yin. Tight is a cold pulse, but small-tight enters inward becoming Yin. Yin cannot be dispersed from the exterior, hence purgation heals. Slow indicates cold, so warming is unquestionable. String-like and tight without sinking is a cold pulse, not a Yin pulse. Not being Yin allows for sweating and acupuncture. Generally, malaria pulses are string-like; if suddenly floating and large, the pathogen is high. High pathogens are guided upward and outward via emesis. Having stated that string-like and rapid indicates much heat, another point is added: string-like and rapid indicates wind-induced fever, meaning excessive heat reaches extreme heat. Extreme heat generates wind; wind generation causes Liver Wood to overact on Spleen Earth, transmitting heat to the Stomach, consuming fluids. This requires not just medicine but dietary regulation to curb the blazing heat. Items like pear juice and sugarcane syrup, which generate fluids and quench thirst, align with the principle of *Nei Jing*: "Wind rampant within, treat with sweet-cold."
Commentary: The meaning of "stopping wind-induced fever by dietary regulation" is unclear. I cite these two scholars' views for reference. *Yi Zong Jin Jian* states that the "small" in "string-like, small, tight" should be "deep," providing rationale for purgation. "String-like, tight" should be "string-like, floating, tight," providing rationale for sweating. "String-like, floating, large" should be "string-like, slippery, large," providing rationale for emesis. This preserves the original meaning of "malaria pulse is naturally string-like." Such interpretations are unnecessary. The annotations by Xu and You are reasonable.
In malaria, if onset occurs on the first day of the lunar month, it should heal in fifteen days. If not healed, it should resolve by the end of the month. If still not healed, what should be done? The Master said: This condenses into a mass called "Malaria Mother" (Nuomu). It must be treated urgently. Use Biejia Jian Wan (Turtle Shell Decoction Pill). (*Mai Jing* omits thirty characters from "Bing Nue" to "Shi Yue Ci". Two characters "Nue Ji" appear before "Jie". Three characters "Ji Zhi Zhi" are absent. Zhao edition writes "Yuan" as "Wan", same below.)
[Cheng Lin] Five days constitute one Hou (decad); three Hous make one Qi (term/season), which is fifteen days. Humans receive Qi from Heaven; as solar terms shift, Ying and Wei Qi change accordingly. Thus, after one solar term, it should heal. If not, after changing another term, it resolves. Hence, "resolve by month's end."
[You Zaijing] If it still does not heal, the pathogen likely borrows blood and phlegm to form a mass, lodging eccentrically in the hypochondrium, threatening stubborn resistance. Therefore, urgent treatment is needed. Biejia Jian Wan contains many Qi-moving and blood-draining herbs, yet their harshness is acceptable. Taken three times daily, the urgency is acceptable. This is attacking while the pathogen has not fully gathered.
[Wei Litong] Cold-heat mixed pathogens reside in Shaoyang, while obstructed Qi knots in Jueyin, gathering blood in the liver area, truly forming the mother Qi of malaria, causing continuous attacks. This involves Yin-Yang mutual excess, lasting months or years without resolution. Essentially, a physical entity acts as a nuisance internally, like roots of grass and trees, requiring urgent removal. Otherwise, cutting leads to regrowth because the "mother" remains, leading to uncontrollable spread.
Commentary: *Yu Pian* defines "HT" (Pi) with pronunciation Mo Nong Qie. Disease "HT Pi" refers to the "Mother" of Malaria Mother. From the disease radical. *San Yin Fang* states: Knotting forms "HT Pi" in abdomen/hypochondrium, named Old Malaria or Mother Malaria.
Biejia Jian Wan Formula (*Wai Tai Mi Yao* calls it Da Biejia Jian, citing Zhang Zhongjing's *Shang Han Lun*, Vol 15):
Biejia (Turtle Shell) (12 fen, roasted. *Qian Jin* makes dead turtle, note says *Yao Lue* uses 3 liang Biejia), Wushan (Black Cuscuta Seed/Shexiang) (3 fen, burned), Huangqin (Scutellaria Root) (3 fen), Chaihu (Bupleurum Root) (6 fen), Shufu (Jersey Devil Crab) (3 fen, roasted), Ganjiang (Dried Ginger) (3 fen), Dahuang (Rhubarb Rhizome) (3 fen), Shaoyao (Peony Root) (5 fen), Guizhi (Cinnamon Twig) (3 fen), Tingli (Perilla Seed) (1 fen, roasted), Shiwei (Pyrrosia Leaf) (3 fen, de-haired), Houpo (Magnolia Bark) (3 fen), Mudan (Moutan Cortex) (5 fen, heart removed), Qumai (Dianthus Herb) (2 fen), Ziwei (Cornus Flower) (3 fen), Banxia (Pinellia Tuber) (1 fen), Renshen (Ginseng Root) (1 fen), Mengchong (Blister Beetle) (5 fen, roasted), Ejiao (Donkey-hide Gelatin) (3 fen, roasted), Fengke (Honeycomb) (4 fen, roasted), Chixiao (Red Niter) (12 fen), Qianglang (Dung Beetle) (6 fen, roasted), Taoren (Peach Kernel) (2 fen).
These twenty-three ingredients are powdered. Take one dou of ash from a forged iron stove, one hu of clear wine, soak the ash in five dou of wine. Wait until half the wine is absorbed. Add Biejia, boil until soft like glue. Strain the juice, add all medicines, decoct into pills the size of wutong seeds. Take seven pills on an empty stomach, three times daily. ([Original Note] *Qian Jin Fang* uses 12 pieces of Biejia, plus Haizao 3 fen, Daji 1 fen, Mengchong 5 fen, lacking Shufu and Chixiao. Uses Biejia decoction to bind other herbs. ○ Commentary: Current *Qian Jin* lacks Shufu, Ziwei, Chixiao, but has Mengchong, Ziwan, Haizao, Daji, totaling 24 ingredients. Dosages differ significantly; not cited here. Soaking ash waiting for half wine absorption implies soaking ash in wine, removing ash to get wine, which seems plausible.)
[Cheng Lin] Malaria Mother is pathogen internal binding to Zang-Fu, Qi and Blood stagnating to form accumulation. Internally knots as mass, externally causes alternating chills/fever. *Nei Jing* says: Hardness requires削 (scraping/reducing), knotting requires moving. Biejia treats masses and chills/fever, serving as Sovereign herb. Pathogens knotting in Blood level use Dahuang, Shaoyao, Mengchong, Taoren, Chixiao, Mudan, Shufu, Ziwei to attack blood stasis, serving as Minister. Pathogens knotting in Qi level use Houpo, Banxia, Shiwei, Tingli, Qumai, Wushan, Fengke, Qianglang to descend Qi and promote urination, serving as Assistant. To harmonize cold/heat and Yin/Yang, use Huangqin, Ganjiang; to unblock Ying/Wei, use Guizhi, Chaihu; to harmonize Qi/Blood, use Ejiao, Renshen. These six serve as Envoy. Knots move when warmed; stove ash warmth and clear wine heat constrain Biejia, working with other herbs to drive out mass and Malaria Mother. *Nei Jing* says: Treatment has urgency, formulas have sizes. This is a large formula for urgent treatment.
Commentary: Wushan is Shegan (Belamcanda Rhizome), seen in *Ben Jing*. *Qian Jin* writes Wu Yu. Chixiao: *Huoren Shu* says Niter grows in Red Mountain. *Ben Cao* notes: Shegan disperses knotting Qi and abdominal rebellion; Shufu treats amenorrhea, blood masses, chills/fever; Shiwei treats labor fever, pathogenic Qi, promotes waterways; Ziwei treats masses, blood closure, chills/fever; Qumai promotes urination, passes closed blood; Fengke treats chills/fever, pathogenic Qi; Qianglang treats abdominal distension, chills/fever, promotes bowel/bladder movement; Mengchong treats blood accumulation, breaks masses. Stove ash is ash from iron forging, also treating hard masses. This formula combines Xiao Chai Hu Tang, Gui Zhi Tang, and Da Cheng Qi Tang, removing Gancao and Zhishi, prioritizing Biejia, adding aforementioned items to attack half-exterior pathogens and half-interior knots, reaching everywhere. However, *San Yin Fang* states ancient formulas like Biejia Jian are ineffective and hard to prepare. This view has merit.
The Master said: When Yin Qi is isolated and extinct, and Yang Qi fires alone, there is fever, shortness of breath, oppression, hot hands/feet, and desire to vomit. This is named Dan Nue (Cancer Malaria/Hot Malaria). If only heat without cold, the pathogen hides internally in the Heart, externally in the flesh spaces, causing muscle wasting. ("Muscle" in Zhao edition is "Tuò" (wasting). Commentary: *Su Wen · Nue Lun* says: Only heat no cold, Qi hides in Heart, externally in flesh spaces, causing muscle wasting. Thus Zhao edition is correct.)
[Cheng Lin] Dan means heat. *Nei Jing* says: Dan Nue arises because Lung has prior heat, Qi is abundant in body, rebellious rising upward, Middle Qi full but not escaping externally. Due to exertion, pores open, wind-cold enters skin/flesh spaces. Onset makes Yang Qi abundant. Abundant Yang without decline causes disease. Its Qi does not reach Yin, so only heat, no cold. This is Lung prior heat forming Dan Nue. What is now called "Yin Qi isolated/extinct" is because Heat pathogen is hyperactive. Heat excess consumes Qi, causing oppression and shortness of breath. Exterior/Interior diseased. Now hot hands/feet and vomiting indicate Heart (Yang organ). Heart dislikes heat. Pathogen hides in Heart, externally in flesh spaces, burning inside/outside, causing muscle wasting. This is Heat hiding in Heart, forming Dan Nue. Thus, Dan Nue resides in Lung and Heart meridians?
Wen Nue (Warm Malaria) has a pulse like normal. Body has no cold, only heat, joint pain/distress, occasional vomiting. Treat with Baihu Jia Guizhi Tang (White Tiger Plus Cinnamon Twig Decoction). (Below "Vomit", *Qian Jin* adds "Morning onset evening resolve, evening onset morning resolve named Wen Nue" - 11 chars.)
[Cheng Lin] *Nei Jing* says: Wen Nue results from wind-cold in winter, Qi hidden in bone marrow. Spring Yang expands, pathogen cannot exit. Encountering intense summer heat, brain marrow melts, muscles waste, pores open. Exertion causes pathogen and sweat to exit. Disease hides in Kidney, Qi moves from interior to exterior. Thus, Yin deficiency and Yang excess. Yang excess brings heat. Decline allows Qi to re-enter. Re-entry causes Yang deficiency, bringing cold. Hence, heat first, then cold, named Wen Nue. Now only heat no cold is similar to Dan Nue. Hypothesis: *Nei Jing* defines Wen Nue as heat-then-cold; Zhongjing defines it as heat-only-no-cold. Pulse like normal is not truly normal; Qi fails to reach Yin, so only heat no cold. Pathogen hides in Heart, causing vomiting. Externally in muscles, causing joint pain. Yang pathogen dominates, only heat no cold. Adding Guizhi to Baihu Tang guides Baihu's acrid-cold nature into Ying/Wei, restraining Yang pathogen's hyperactivity.
[You Zaijing] Pulse like normal means disease is not sudden, so pulse resembles normal state.
Joint distress and vomiting occur because heat exits Kidney, lodges in its opening, and merges with Yangming. Baihu's sweet-cold removes heat; Guizhi follows the trend to guide it out.
Baihu Jia Guizhi Tang Formula
Zhimu (Anemarrhena Rhizome) (6 liang), Gancao (Licorice Root) (2 liang, roasted), Shigao (Gypsum Fibrosum) (1 jin), Jingmi (Rice Grain) (2 he. Commentary: *Qian Jin* says 6 he, consistent with *Shang Han Lun*). Gui (Cinnamon) (3 liang, bark removed. Yu edition says Guizhi is correct).
Five ingredients. Coarsely crush. Every 5 qian, add 1.5 cups water, decoct to 0.8 cup, strain, take warm. Sweating indicates cure. (Yu edition adds "Ji" after "Chu". Commentary: Xu/Shen version: 5 ingredients, 1 dou water, boil rice until cooked, strain, take 1 sheng warm, 3x daily. Another version: Crush 5 qian, 1.5 cup water, decoct to 0.8 cup, strain, take warm, sweat cures. You edition follows previous method. Ancient decoction methods using "qian" and "cup" were Song dynasty modifications. *Qian Jin*: 4 ingredients coarse crush, 1.2 dou water, boil rice soft, strain, add Guizhi 3 liang, decoct to 3 sheng, divide 3 doses, cover to sweat. Chills-then-fever cures. *Wai Tai* cites *Qian Jin*. *Shang Han Lun*: Uses Jingmi, unripe rice.)
Commentary: *Sheng Ji Zong Lu* Zhimu Tang treats Wen Nue joint pain, vomiting, morning/evening onset-resolve. (Same formula.)
*Huoren Shu* Baihu Jia Cangzhu Tang treats damp-warmth with profuse sweating, adding Cangzhu 3 liang to Baihu Tang. (From *Shang Han Wei Zhi*, imitating *Jin Gui* Baihu Jia Guizhi Tang.)
Malaria with much cold is named Mu Nue (Male Malaria/Yang Malaria). Treat with Shuqi San (Patrinia Powder). (Cheng Lin writes Pin Nue, same as *Jin Jian*.)
[You Zaijing] Much cold in malaria is not true cold. Yang Qi is suppressed by Phlegm-Fluid, unable to exit to muscle surface, hiding internally in Heart. Heart is Yang (Mu) organ, hence named Mu Nue. Shuqi induces vomiting of malaria phlegm. Phlegm gone, Yang extends, cold heals. Yunmu and Longgu are used because Shuqi's ascending force is fierce, fearing it disturbs Heart Spirit and Qi.
Commentary: You's annotation is detailed. However, the explanation of Mu Nue originates from Yu Jia Yan's *Fa Lü*, which is likely incorrect. *Wai Tai Mi Yao* cites this clause: Zhang Zhongjing *Shang Han Lun*, Malaria much cold named Pin Nue. Wu Shi *Yi Fang Kao* says: Pin is Yin, no Yang name, hence much cold named Pin Nue. This view is correct. *Yi Zong Jin Jian* says: Text regarding Pin Nue has missing slips; *Nei Jing* details it, no need to explain. Examining *Nei Jing*, there is no Pin Nue syndrome, also an error. (*Lan Tai Gui Fan* says: Should probably be Pin character. All editions write Mu, preserve for study.)
Shuqi San Formula
Shuqi (Patrinia Herba) (wash to remove fishy smell. Commentary: Zhao edition washes as burns, incorrect), Yunmu (Cloud Mother/Mica) (burn for two nights), Longgu (Fossilized Bone) (equal parts).
Three ingredients, pound into powder. Take half a qian with Jiangshui (fermented grain water) before onset. ○ For Wen Nue, add Shuqi half a qian, take one qian-bi at onset. ([Original Note] One formula uses Yunshi instead of Yunmu. ○ Jiangshui: *Qian Jin* writes Cujiang, *Wai Tai* writes Qingjiangshui. You edition deletes 14 characters below Wen Nue. *Qian Jin* note: *Yao Lue* does not use Yunmu, uses Yunshi.)
[Cheng Lin] Shuqi is the sprout of Changshan (Dichroa Root). With Jiangshui, it can vomit stubborn malaria phlegm. Diseases of the Three Yin channels are distant, so taken before onset to enter Yin level and dispel pathogen. Diseases of Lung/Heart are close, so taken at onset to enter Lung/Heart and dispel pathogen.
This formula vomits stubborn phlegm and harmonizes Yin/Yang, suitable for both Pin Nue and Wen Nue.
*Yi Tong* states: Formula postscript mentions Wet Malaria, add Shuqi half qian, but market editions mistakenly write Warm Malaria, a major error. This clause originally refers to pathogen hiding in Marrow Sea, called Pin Nue. Zhao Yi De failed to distinguish characters, annotating as pathogen in Heart as Mu. Yu Jiayan repeated this error. Is this not a slip of the wise? Commentary: Wei Shi *De Xiao Fang* says: Chills/fever, heavy body, painful distension named Wet Malaria. Danxi *Zuan Yao* says: In Three Yin, collectively Wet Malaria. Wet Malaria term found nowhere in ancient classics/formulas, only here, so its words cannot be followed. Moreover, pathogen hiding in Marrow Sea lacks basis.
Ren Zhai *Zhi Zhi Fang* states: When malaria is coming or fully erupting, do not administer medicine. Medication must be given before the pre-onset period. Otherwise, medicine and disease contend, causing deeper harm.
Commentary: Taking medicine before onset implies later "intercepting malaria" drugs. *Wai Tai* records Guangji Changshan Tang: Changshan 3 liang, soaked in 3 sheng Jiangshui overnight, decoct to 1 sheng, take all before onset, slight vomiting stops disease. Similar intent to this formula.
Append *Wai Tai Mi Yao* Formulas (Cheng Lin and *Jin Jian* do not record appendices, same for following chapters.)
Muli Tang (Oyster Shell Decoction) treats Mu Nue.
Muli (Oyster Shell) (4 liang, roasted), Mahuang (Ephedra Stem) (4 liang, nodes removed), Gancao (Licorice Root) (2 liang), Shuqi (Patrinia Herba) (3 liang. ○ *Wai Tai* says if unavailable, replace with Changshan).
Four ingredients. 8 sheng water. First decoct Shuqi and Mahuang, remove foam, obtain 6 sheng. Add remaining herbs, decoct to 2 sheng. Take 1 sheng warm. If vomiting occurs, do not take further.
[You Zaijing] Commentary: This was appended by Song dynasty Sun Qi et al., sharing the intent of Shuqi San but with stronger exterior-attacking power. Zhao Shi says: Muli softens hardness and dissipates knots; Mahuang not only disperses cold but also vents Yang Qi outward. Knots scatter, Yang connects, disease heals. *Wai Tai* says: Zhongjing *Shang Han Lun*, Pin Nue much cold, named Pin Nue, Muli Tang treats it. Based on this, Mu is a corruption of Pin.
*Wai Tai* lists this before Shuqi San, stating both come from Vol 15.
Chaihu Qu Banxia Jia Gualou Tang (Bupleurum Decoction minus Pinellia plus Trichosanthes Root) treats Malaria with thirst, also treats Lao Nue (Consumptive Malaria).
Chaihu (Bupleurum Root) (8 liang), Renshen (Ginseng Root), Huangqin (Scutellaria Root), Gancao (Licorice Root) (3 liang each), Gualougen (Trichosanthes Root) (4 liang), Shengjiang (Fresh Ginger) (2 liang), Dazao (Jujube) (12 pieces).
Seven ingredients. 1.2 dou water, decoct to 6 sheng, strain, decoct again to 3 sheng. Take 1 sheng warm, twice daily.
[Xu Dacun] *Shang Han Lun* states: Alternating chills/fever indicates Shaoyang pathogen in half-exterior/half-interior. Malaria pathogen is also in half-exterior/half-interior. Entering contests with Yin causing cold; exiting contests with Yang causing heat. This is Shaoyang image. Shaoyang combining other meridians exists; other meridals entirely unrelated to Shaoyang do not constitute malaria. Thus Xiao Chai Hu Tang is a main formula for malaria. Thirst replaces Banxia with Gualougen, a standard Shaoyang method. Attacking and tonifying combined, thus treats Lao Nue.
*Wai Tai* says: Zhang Zhongjing *Shang Han Lun*, Malaria with thirst, give Chaihu Qu Banxia Jia Gualou Tang. *Jing Xin Lu* treats Lao Nue, from Vol 15.
Commentary: Chao Yuanfang *Zhu Bing Yuan Hou Lun* Lao Nue section states: Malaria lingering long causes exterior/interior deficiency, guest pathogen not scattered, true Qi not restored. Disease temporarily pauses, minor exertion triggers recurrence.
Chaihu Guijiang Tang (Bupleurum, Cinnamon, and Dried Ginger Decoction) treats Malaria with much cold, slight heat, or only cold no heat. ([Original Note] After one dose feels like heat. ○ Yu edition writes Jiang as Lou, incorrect.)
Chaihu (Bupleurum Root) (0.5 jin), Guizhi (Cinnamon Twig) (3 liang, bark removed), Ganjiang (Dried Ginger) (2 liang), Gualougen (Trichosanthes Root) (4 liang), Huangqin (Scutellaria Root) (3 liang), Muli (Oyster Shell) (2 liang, roasted), Gancao (Licorice Root) (2 liang, roasted).
Seven ingredients. 1.2 dou water, decoct to 6 sheng, strain, decoct again to 3 sheng. Take 1 sheng warm, three times daily. Initial dose causes slight irritability; subsequent doses cause sweating and cure.
[Xu Dacun] Yang Qi in chest scatters between flesh spaces. Now blocked by pathogen, exterior defensive Yang is depressed within interior-storing Yin, and blood stasis...