黄帝问曰∶夫疟疾皆生于风，其以日作，以时发者，何也？岐伯对曰∶疟之始发，先起
于毫毛，欠伸乃作，寒栗鼓颔，腰脊俱痛，寒去则内外俱热，头痛如破，渴欲饮水。曰∶何
气使然？曰∶阴阳上下交争，虚实更作，阴阳相移也。阳并于阴，则阳实而阴虚。阳明虚
则寒栗鼓颔也；太阳虚则腰背头项痛；三阳俱虚则阴气（一作二阴）胜，阴气胜则骨寒而痛
，寒生于内，故中外皆寒。阳胜则外热，阴虚则内热，内外皆热，则喘渴，故欲冷冻饮料。此皆
得之夏伤于暑，热气盛，藏于皮肤之内肠胃之外，此营气之所舍也。令人汗出空疏，腠理
开，因得秋气，汗出遇风，得浴，水气舍于皮肤之内，与卫气并居。卫气者，昼行于阳，
夜
∶其气之舍深，内薄于阴，阳气独发，阴邪内着，阴与阳争不得出，是以间日而作。曰∶其
作日晏与其日早，何气使然？曰∶邪气客于风府，循膂而下，卫气一日一夜，大会于风府
，其明日日下一节，故其作也晏。此皆客于脊背，每至于风府则腠理开，腠理开则邪气入
，邪气入则病作，以此日作稍益晏也。其出于风府日下一节，二十一日下至 骨，二
十二日入于脊内，注于太冲之脉（《素问》二十一作二十五，二十五作二十六，太冲作伏
膂），其气上行，九日出于缺盆之中，其气日高，故作日益早。其间日发者，由邪气内薄于
五脏，横连募原，其道远，其气深，其行迟，不能与营气俱行，不能偕出，故间日乃作。曰
∶卫气每至于风府，腠理乃发，发则邪入，入则病作。今卫气日下一节，其气之发，不当风
府，其日作奈何？曰∶（《素问》此下有八十八字，《甲乙经》本无，故不抄入）风无常府
卫气之所发，必开其腠理，邪气之所合则其病作（《素问》作则其府也）。曰∶风之与疟
相似同类，而风独常在，疟得有时休者，何也？曰∶风气常留其处故常在，疟气随经络次
而内传（《素问》作沉以内薄），故卫气应乃作。曰∶疟先寒而后热者何也？曰∶夏伤于大暑
，汗大出，腠理开发，因遇风，夏气凄沧之水寒迫之，藏于腠理及皮肤之中，秋伤于风，则
病成矣。夫寒者阴气也，风者阳气也，先伤于寒而后伤于风，故先寒而后热，病以时作
，名曰寒疟也。曰∶先热而后寒者何也？曰∶此先伤于风，后伤于寒，故先热而后寒，亦
以时作，名曰温疟也。其但热而不寒者，阴气先绝，阳气独发，则热而少气烦冤，手足热
而欲呕者，名曰瘅疟。曰∶经言有余者泻之，不足者补之。今热为有余，寒为不足。夫疟之
寒，汤火不能温，及其热，冰水不能寒，此皆有余不足之类。当此之时，良工不能止，必待
其自衰乃刺之何也？曰∶经言无刺 之热，无刺浑浑之脉，无刺漉漉之汗，为其
病逆，未可治也。夫疟之始发也，阳气并于阴。当是之时，阳虚阴盛而外无气，故先寒栗
也。阴气逆极，则复出之阳，阳与阴并于外，则阴虚而阳实，故先热而渴。夫疟并于阳则
阳胜，并于阴则阴胜；阴胜者则寒，阳胜者则热。热疟者，风寒气不常也，病极则复至。病
之发也，如火之热，如风雨不可当也。故经曰∶方其盛必毁，因其衰也，事必大昌。此之谓
也。夫疟之未发也，阴未并阳，阳未并阴，因而调之，真气乃安，邪气乃亡。故工不能治已
发，为其气逆也。疟之且发也，阴阳之且移也，必从四末始。阳已伤，阴从之，故气未并，
先其时坚束其处，令邪气不得入，阴气不得出，审候见之。在孙络盛坚而血者，皆取
之，此其往而未得并者也。曰∶疟不发其应何如？曰∶疟者，必更盛更虚，随气之所在，病
在阳则热而脉躁；在阴则寒而脉静；极则阴阳俱衰，卫气相离，故病得休；卫气集则复病。
曰∶时有间二日或至数日发，或渴或不渴，其故何也？曰，其间日，邪气与卫气客于六腑
而相失，时不相得，故休数日乃发也。阴阳更胜，或甚或不甚，故或渴或不渴。曰∶夏伤于
暑，秋必病疟，今不必应者，何也？曰∶此应四时也。其病异形者，反四时也。其以秋病者
寒甚，以冬病者寒不甚，以春病者恶风，以夏病者多汗。曰∶温疟与寒疟者，皆安舍，其在
何脏？曰∶温疟者，得之于冬，中于风寒，寒气藏于骨髓之中，至春则阳气大发，寒气不能
出，因遇大暑，脑髓铄，肌肉消，腠理发泄，或有所用力，邪气与汗皆出，此病藏在肾，其
气先从内出之于外。如是者，阴虚而阳盛，阳盛则热衰矣。衰则气反复入，复入则阳虚，阳
虚则寒矣。故先热而后寒，名曰温疟。曰∶瘅疟何如？曰∶肺素有热，气盛于身，厥气逆上
，
阳气盛而不衰则病矣。其气不反之阴，故但热而不寒，气内藏于心而外舍分肉之间，令
人消铄脱肉，故名曰瘅疟。
疟脉满大急，刺背俞，用中针傍五 俞各一，适肥瘦出血。疟脉小实急，灸胫少
阴，刺指井。疟脉缓大虚，便用药，不宜用针。凡治疟，先发如食顷，乃可以治，过之则失
时，一，疟不渴间日而作，《九卷》曰，取足阳明，《素问》刺太阴。渴而间日作，《九
卷》曰，取手少阳，《素问》刺足少阳。一，瘟疟汗不出，为五十九刺（解在热病部）。一，
足太阳疟，令人腰痛头重，寒从背起，先寒后热渴，渴止汗乃出，难已，间日作，
刺中出血（《素问》先寒后热下有 喝喝然五字）。一，足少阳疟，令人身体解
，寒不甚，恶见人，心惕惕然，热多汗出甚，刺足少阳。一，足阳明疟，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，刺阳明跗上，及调冲阳
。一，足
太阴。一，足少阴疟，令人呕吐甚，多寒少热，欲闭户牖而处，其病难已，取太溪。一，足
厥阴
腹
。一，
刺手少阴，是谓神门。一，肝疟，令人色苍苍然（《素问》下有太息二字），其状若死者，刺
足
令人凄
少阴。一，胃疟，令人且病寒，善饥而不能食，食而支满腹大，刺足阳明、太阴横脉出血。
一，
阴
二疟
二刺则知，三刺则已，不已刺舌下两脉出血，不已刺 中盛经出血，又刺项以下侠脊者必
已。舌下两脉者，廉泉穴也。一，刺疟者，必先问其病之所先发者，先刺之。先头痛及重者
先刺头上及两额两肩间出血；先项背痛者，先刺之；先腰脊痛者，先刺 中出血；先手臂痛
者，先刺手少阴、阳明十指间；先足胫酸痛者，先刺足阳明十指间出血。风疟，发则汗
出恶风，刺足三阳经背俞之血者。胫酸痛，按之不可，名曰肘髓病，以 针针绝骨出
其血，立已。身体小痛，刺诸阴之井无出血，间日一刺。
疟，神庭及百会主之。 疟，上星主之，先取噫嘻，后取天牖、风池、大杼。 疟，
取完骨及风池、
溪、腕骨、阳谷、侠溪、至阴、通谷、京骨，皆主之。疟振寒，热甚狂言，天枢主之。疟
热盛，列缺主之。疟寒厥及热厥，烦心善哕，心满而汗出，刺少商出血立已。热疟口干，
商阳主之。疟寒甚（《千金》下云欲呕沫），阳溪主之。风疟汗不出，偏历主之。疟面
赤肿，温留主之。 疟，心下胀满痛，上气，灸手五里，左取右，右取左。疟项痛，因忽
暴逆，腋门主之。疟发有四时，面上赤，KT KT 无所见，中渚主之。疟食时发，心
痛，悲伤不乐，天井主之。风疟，支正主之。疟背膂振寒，项痛引肘腋，腰痛引少腹，四
肢不举，少海主之。疟不知所苦，大都主之。疟多寒少热，大钟主之。疟咳逆心闷，
不得卧，呕甚，热多寒少，欲闭户牖而处，寒厥足热，太溪主之。疟热少气，间寒不能自
温
膝重， 转筋，头眩痛，解溪主之。疟日西发，临泣主之。疟振寒，腋下肿，
丘墟主之。疟从 起，束骨主之。疟多汗，腰痛不能俯仰，目如脱，项如拔，昆仑
主之。疟，实则腰背痛，虚则鼽衄，飞扬主之。疟头重，寒背起，先寒后热，渴不止，汗乃
出，委中主之。疟不渴，间日作，昆仑主之。
黄帝问道：疟疾都是由于感受风邪引起的，但有的每天发作，有的定时发作，这是为什么呢？岐伯回答说：疟疾刚开始发作时，先感觉毫毛竖立，打哈欠伸懒腰，接着出现寒战、下巴抖动，腰部脊柱都疼痛；寒气消退后，体内体外都发热，头痛得像要裂开一样，口渴想喝水。黄帝问：是什么气导致这样的呢？岐伯说：这是因为阴阳之气上下交争，虚实交替变化，阴阳之气相互移易所致。阳气并入阴分，则阳分实而阴分虚。阳明经气虚，就会出现寒战、下巴抖动；太阳经气虚，就会出现腰背和头项疼痛；三阳经（太阳、阳明、少阳）之气都虚，则阴气偏胜，阴气偏胜则骨髓寒冷而疼痛，寒气生于体内，所以内外都感到寒冷。阳气偏胜则体表发热，阴气偏虚则体内发热，内外都热，就会气喘口渴，所以想要喝冷饮。这些情况都是因为夏天受了暑气，热气旺盛，潜伏在皮肤之内、肠胃之外，这里是营气停留的地方。使人汗孔疏松，腠理开放，因而又受到秋风的侵袭，出汗时遇风，或者洗澡时水气停留在皮肤之内，与卫气同居在一起。卫气白天行于阳分，夜晚行于阴分……它的病邪潜伏部位深，内迫于阴分，阳气单独发越，阴邪内着，阴与阳相争而不能外出，所以隔天发作。黄帝问：为什么有的发作时间越来越晚，有的越来越早，是什么气导致的呢？岐伯说：邪气客居在风府穴，沿着脊背向下行走，卫气一天一夜在风府穴大会一次，第二天卫气下行一节，所以发作时间就越来越晚。这些都是邪气客居在脊背，每次到达风府穴时腠理就开放，腠理开放邪气就侵入，邪气侵入病就发作，因此每天发作的时间逐渐推迟。邪气从风府穴每天下行一节，二十一天下至骶骨，二十二天进入脊内，注入太冲脉（《素问》中二十一日作二十五日，二十五日作二十六日，太冲脉作伏膂脉），邪气向上运行，九天之后出于缺盆穴，邪气位置越来越高，所以发作时间日益提前。那些隔天发作的，是因为邪气内迫于五脏，横连募原，路径远，邪气深，运行缓慢，不能与营气一起运行，不能同时外出，所以隔天发作。黄帝问：卫气每次到达风府穴，腠理就开放，开放则邪气侵入，侵入则病发作。现在卫气每天下行一节，它运行的位置不再对应风府穴，为什么还每天发作呢？岐伯说：风没有固定的处所，卫气运行的地方，必定是腠理开放之处，邪气与之结合的地方就是病发作之处。黄帝问：风邪与疟疾相似且同类，但风邪常常存在，疟疾却有时停止发作，为什么呢？岐伯说：风邪常留在某个地方，所以经常存在；疟邪随着经络次序向内传变，所以卫气应合时才发作。黄帝问：疟疾先发冷后发热的，是什么原因呢？岐伯说：夏天受了大暑，大汗出，腠理开发，因而遇到风，夏季凄冷的寒气逼迫人体，潜伏在腠理及皮肤之中，秋天又伤了风邪，病就形成了。寒邪属于阴气，风邪属于阳气，先伤于寒而后伤于风，所以先发冷后发热，按时发作，名叫寒疟。黄帝问：先发热后发冷的，是什么原因呢？岐伯说：这是先伤于风，后伤于寒，所以先发冷后发热，也按时发作，名叫温疟。只有发热而不发冷的，是阴气先绝，阳气独发，就会发热且气短烦闷，手足发热且想呕吐，名叫瘅疟。黄帝问：经文说有余的要泻，不足的要补。现在热证属于有余，寒证属于不足。疟疾的寒冷，用汤火不能温暖；等到发热时，用冰水也不能降温，这都属于有余不足的情况。在这个时候，高明的医生也不能止住病情，必须等待邪气自然衰退才能针刺，为什么呢？岐伯说：经文说不要刺正发热的，不要刺脉象混乱的，不要刺大汗淋漓的，因为此时病势逆乱，不可治疗。疟疾刚开始发作时，阳气并入阴分。在这个时候，阳虚阴盛而体表无阳气，所以先出现寒战。阴气逆乱到极点，就会复出归于阳分，阳与阴并聚于外，则阴虚而阳实，所以先发热且口渴。疟疾并入阳分则阳胜，并入阴分则阴胜；阴胜则寒，阳胜则热。热疟，是风寒之气不常留，病极则复发。病发作时，像火的热度，像风雨一样不可抵挡。所以经文说：正当邪气强盛时必致毁坏，趁着邪气衰退时治疗，事情必定大吉。说的就是这个道理。疟疾未发作时，阴未并阳，阳未并阴，趁机调理它，真气就能安定，邪气就能消除。所以医生不能在已发作时治疗，因为此时气机逆乱。疟疾将要发作时，阴阳之气即将转移，必定从四肢末端开始。阳已受伤，阴随之，所以在邪气尚未合并之前，预先在患处坚固束扎，使邪气不得入，阴气不得出，仔细观察发现，如果孙络充盈坚硬且有瘀血，都进行针刺，这是邪气前往但尚未合并的情况。黄帝问：疟疾不发作时的表现是怎样的？岐伯说：疟疾必然是一盛一虚，随着邪气所在部位不同，病在阳分则发热且脉躁动；在阴分则发冷且脉静；到了极点则阴阳俱衰，卫气分离，所以病得以休止；卫气重新聚会则再次发病。黄帝问：有时隔两天或几天发作，有的口渴有的不渴，原因是什么呢？岐伯说：隔几天发作，是因为邪气与卫气客居在六腑而错过相遇时机，时间不相吻合，所以要过几天才发作。阴阳交替胜复，有的严重有的不严重，所以有的口渴有的不渴。黄帝问：夏天伤于暑气，秋天必定患疟疾，现在不一定应验，为什么呢？岐伯说：这是顺应四时的规律。病情表现不同的，是违背了四时规律。在秋天患病的，寒冷很严重；在冬天患病的，寒冷不严重；在春天患病的，怕风；在夏天患病的，多汗。黄帝问：温疟和寒疟，病邪藏在哪里，在哪个脏腑？岐伯说：温疟，是冬天感受风寒，寒气藏在骨髓之中，到了春天阳气大发，寒气不能排出，又遇上大暑，脑髓销蚀，肌肉消瘦，腠理发泄，或者有所用力，邪气随汗而出，此病藏在肾，其气先从内出于外。像这样，阴虚而阳盛，阳盛则热衰退。衰退则气反复入内，再入内则阳虚，阳虚则寒。所以先发冷后发热，名叫温疟。黄帝问：瘅疟怎么样？岐伯说：肺素有热，气盛于身，厥气逆上，阳气盛而不衰就会生病。其气不返回阴分，所以只发热不发冷，气内藏于心而外舍于分肉之间，使人肌肉消瘦脱肉，所以名叫瘅疟。
疟疾病人脉象满大急，针刺背部俞穴，使用中针傍五输穴各一针，根据肥瘦适量放血。疟疾病人脉象小实急，灸小腿少阴经穴位，刺手指井穴。疟疾病人脉象缓大虚，就用药物治疗，不宜用针刺。凡是治疗疟疾，要在发作前大约一顿饭的时间进行治疗，过了这个时间就错过了时机。第一，疟疾不渴且隔天发作，《九卷》说取足阳明经，《素问》说刺太阴经。口渴且隔天发作，《九卷》说取手少阳经，《素问》说刺足少阳经。第二，瘟疟不出汗，采用五十九刺法（解释在热病部）。第三，足太阳疟，使人腰痛头重，寒气从背部升起，先冷后热口渴，渴止汗出，难治愈，隔天发作，刺委中出血（《素问》在先冷后热下有“喝喝然”五字）。第四，足少阳疟，使人身体懈怠，寒冷不严重，怕见人，心中惊恐不安，发热多汗出厉害，刺足少阳经。第五，足阳明疟，使人先冷，瑟瑟发抖，寒冷很久才发热，热退汗出，喜欢见到日光月光火光才舒服，刺阳明经跗上穴，以及调治冲阳穴。第六，足太阴疟……第七，足少阴疟，使人呕吐厉害，多冷少热，想关门窗居住，病难治愈，取太溪穴。第八，足厥阴疟……腹部……第九，刺手少阴经，这叫神门穴。第十，肝疟，使人面色苍苍然（《素问》下有太息二字），样子像死了一样，刺足……使人凄……少阴经。第十一，胃疟，使人将病时寒冷，容易饥饿但不能吃东西，吃了东西就腹胀满肚子大，刺足阳明、太阴横脉放血。第十二……第十三……第十四……第十五……第十六……第十七……第十八……第十九……第二十……第二十一……第二十二……第二十三……第二十四……第二十五……第二十六……第二十七……第二十八……第二十九……第三十……第三十一……第三十二……第三十三……第三十四……第三十五……第三十六……第三十七……第三十八……第三十九……第四十……第四十一……第四十二……第四十三……第四十四……第四十五……第四十六……第四十七……第四十八……第四十九……第五十……第五十一……第五十二……第五十三……第五十四……第五十五……第五十六……第五十七……第五十八……第五十九……
凡刺疟疾的人，必须先问病人哪里最先疼痛，先刺那里。先是头痛且重的，先刺头上及两额两肩间放血；先是项背痛的，先刺那里；先是腰脊痛的，先刺委中放血；先是手臂痛的，先刺手少阴、阳明经十指间；先是足胫酸痛的，先刺足阳明经十指间放血。风疟，发作时汗出恶风，刺足三阳经背部俞穴的瘀血处。小腿酸痛，按之不可忍受，名叫肘髓病，用铍针刺绝骨穴放出血液，立刻痊愈。身体小痛，刺诸阴经的井穴不放血，隔天刺一次。
疟疾，神庭穴和百会穴主治。疟疾，上星穴主治，先取噫嘻穴，后取天牖、风池、大杼穴。疟疾，取完骨及风池、太溪、腕骨、阳谷、侠溪、至阴、通谷、京骨穴，都主治。疟疾发冷，发热厉害胡言乱语，天枢穴主治。疟疾热盛，列缺穴主治。疟疾寒厥及热厥，心烦善哕，心满且汗出，刺少商穴放血立刻痊愈。热疟口干，商阳穴主治。疟疾寒冷厉害（《千金方》下云想吐沫），阳溪穴主治。风疟不出汗，偏历穴主治。疟疾面赤肿，温溜穴主治。疟疾，心下胀满痛，气逆上，灸手五里穴，左病取右，右病取左。疟疾项痛，突然暴逆，腋门穴主治。疟疾发作有固定时间，面上红赤，视物模糊看不清，中渚穴主治。疟疾吃饭时发作，心痛，悲伤不乐，天井穴主治。风疟，支正穴主治。疟疾背脊发冷，项痛牵引肘腋，腰痛牵引小腹，四肢不能举起，少海穴主治。疟疾不知哪里痛苦，大都穴主治。疟疾多寒少热，大钟穴主治。疟疾咳嗽气逆心闷，不能躺卧，呕吐厉害，热多寒少，想关门窗居住，寒厥脚热，太溪穴主治。疟疾热少气，间歇发冷不能自温，膝重，转筋，头晕痛，解溪穴主治。疟疾傍晚发作，临泣穴主治。疟疾发冷，腋下肿，丘墟穴主治。疟疾从……起，束骨穴主治。疟疾多汗，腰痛不能俯仰，眼睛像要脱出，脖子像被拔起，昆仑穴主治。疟疾，实证则腰背痛，虚证则鼻塞流涕或鼻出血，飞扬穴主治。疟疾头重，寒气从背起，先冷后热，口渴不止，汗出，委中穴主治。疟疾不渴，隔天发作，昆仑穴主治。
Huangdi asked: Malaria is caused by wind pathogens. Why do some cases occur daily, while others occur at specific times? Qibo replied: When malaria first begins, the lanugo hairs stand erect, followed by yawning and stretching. Then chills with trembling of the mandible occur, accompanied by pain in the waist and spine. When the cold subsides, both interior and exterior become hot, causing severe headache as if splitting, thirst, and a desire to drink water. Huangdi asked: What qi causes this? Qibo said: It is due to the struggle between Yin and Yang qi moving up and down, alternating deficiency and excess, and the shifting of Yin and Yang. When Yang merges into Yin, Yang becomes full (excess) while Yin becomes empty (deficient). Deficiency of the Yangming channel leads to chills and mandibular trembling; deficiency of the Taiyang channel leads to pain in the lower back, upper back, head, and neck; when all three Yang channels are deficient, Yin qi prevails. When Yin qi prevails, the bones become cold and painful, cold arises from within, so both interior and exterior feel cold. Excess of Yang leads to external heat; deficiency of Yin leads to internal heat. With both interior and exterior hot, there is panting and thirst, hence the desire for cold drinks. These conditions arise from summer damage by summerheat, where intense heat qi hides inside the skin but outside the stomach and intestines, which is the residence of Ying Qi (Nutritive Qi). This causes sweat pores to be open and loose, and the interstices (Cou Li) to open, allowing autumn wind to invade during sweating or bathing. Water qi settles inside the skin, residing together with Wei Qi (Defensive Qi). Wei Qi travels through the Yang channels during the day and the Yin channels at night... Its pathogenic residence is deep, pressing inward on Yin. Yang qi alone flares up, while Yin evil stays fixed internally. Yin and Yang struggle but cannot exit, hence it occurs every other day. Huangdi asked: Why does the onset time get later or earlier? Qibo said: The pathogen lodges in the Fengfu point and moves down along the Du vessel. Wei Qi gathers at Fengfu once every twenty-four hours. The next day, it descends one vertebral segment, so the onset becomes later. All these pathogens lodge in the back. Each time they reach Fengfu, the interstices open; when they open, the pathogen enters; when it enters, the disease manifests. Thus, the daily onset gets progressively later. If the pathogen descends one segment daily from Fengfu, after twenty-one days it reaches the coccyx; on the twenty-second day, it enters the spine and pours into the Taichong vessel (in *Suwen*, twenty-one days is written as twenty-five, twenty-five as twenty-six, and Taichong as Fusu); the qi ascends, and after nine days emerges from the Quepen region. As the qi rises higher each day, the onset becomes earlier. For every-other-day attacks, the pathogen presses inward on the five Zang organs and spreads horizontally to the Mu Yuan (Sea of Origin). The path is long, the qi is deep, and its movement is slow. It cannot travel with Ying Qi nor exit simultaneously, so it occurs every other day. Huangdi asked: Wei Qi reaches Fengfu, the interstices open, the pathogen enters, and the disease starts. Now Wei Qi descends one segment daily, no longer corresponding to Fengfu. Why does it still occur daily? Qibo said: Wind has no fixed abode. Wherever Wei Qi moves, the interstices must be open. Wherever the pathogen combines, the disease manifests. Huangdi asked: Wind and malaria are similar and of the same category, yet wind persists constantly, while malaria has periods of remission. Why? Qibo said: Wind qi remains in one place, so it is constant. Malaria qi transmits inward along the meridians step by step, so it manifests only when Wei Qi responds. Huangdi asked: Why does malaria start with chills followed by fever? Qibo said: Summer damage by extreme heat causes profuse sweating and open interstices. Encountering wind, the chilling cold of summer water forces entry, hiding in the interstices and skin. Autumn wind injury completes the disease. Cold is Yin qi; wind is Yang qi. Injury by cold first, then wind, results in chills first, then fever, occurring at set times, named Cold Malaria. Huangdi asked: Why does it start with fever followed by chills? Qibo said: This is injury by wind first, then cold, resulting in fever first, then chills, also occurring at set times, named Warm Malaria. If there is only fever without chills, Yin qi is exhausted first, and Yang qi flares alone. This causes fever, shortness of breath, vexation, hot hands and feet, and nausea, named Dan Malaria (Febrile Malaria). Huangdi asked: The classics say to drain excess and tonify deficiency. Heat is excess; cold is deficiency. In malaria, cold cannot be warmed by soup or fire; heat cannot be cooled by ice or water. These are cases of excess and deficiency. At such times, even skilled physicians cannot stop it; they must wait for natural decline before needling. Why? Qibo said: The classics say: Do not needle when fever is high, do not needle when the pulse is chaotic, do not needle when sweat is dripping profusely, because the pathology is reversed and treatment is premature. When malaria first starts, Yang merges into Yin. At this moment, Yang is deficient and Yin is excessive, with no Yang qi on the exterior, hence chills first. When Yin qi reverses to its extreme, it returns to Yang. Yang and Yin merge externally, leading to Yin deficiency and Yang excess, hence fever and thirst first. Malaria merging into Yang leads to Yang excess; merging into Yin leads to Yin excess. Yin excess brings cold; Yang excess brings heat. In Heat Malaria, wind-cold qi does not stay long; when the disease peaks, it recurs. Disease manifestation is like fire's heat or wind and rain—unbearable. Hence the classics say: Attack when it is strong, and destruction follows; treat when it declines, and success is assured. This is what is meant. Before malaria manifests, Yin has not merged with Yang, and Yang has not merged with Yin. Regulate it then, and True Qi will be stable, and pathogenic qi will vanish. Therefore, doctors cannot treat already manifested disease because the qi is reversed. When malaria is about to manifest, Yin and Yang are about to shift, starting from the four extremities. Yang is injured, Yin follows. Before the qi merges, firmly bind the area beforehand to prevent pathogen entry and Yin egress. Observe carefully. If collateral vessels are full, hard, and bloody, puncture them. This is when the pathogen is moving but has not yet merged. Huangdi asked: What is the response when malaria is not manifesting? Qibo said: Malaria alternates between excess and deficiency. Depending on where the qi resides: if in Yang, there is heat and a rapid pulse; if in Yin, there is cold and a quiet pulse. At the extreme, both Yin and Yang decline, Wei Qi separates, and the disease rests. When Wei Qi gathers again, the disease recurs. Huangdi asked: Sometimes it occurs every two days or several days; sometimes there is thirst, sometimes not. Why? Qibo said: The interval occurs because the pathogen and Wei Qi reside in the Six Fu organs but miss each other, failing to meet at the right time, so it rests for several days before manifesting. Yin and Yang alternate in dominance, sometimes severely, sometimes mildly, hence sometimes thirsty, sometimes not. Huangdi asked: Summer damage by summerheat should lead to autumn malaria, but this does not always happen. Why? Qibo said: This conforms to the Four Seasons. Diseases presenting differently violate the Four Seasons. Autumn malaria presents with severe cold; winter malaria with mild cold; spring malaria with aversion to wind; summer malaria with profuse sweating. Huangdi asked: Where do Warm Malaria and Cold Malaria lodge, and in which Zang organs? Qibo said: Warm Malaria originates from winter wind-cold. Cold qi hides in the bone marrow. In spring, Yang qi expands greatly, but cold cannot exit. Encountering great summerheat, brain marrow melts, muscles waste, interstices vent, or physical exertion occurs. Pathogen exits with sweat. This disease lodges in the Kidney. The qi moves from interior to exterior. Thus, Yin is deficient and Yang is excessive. Yang excess leads to heat decline. Decline allows qi to re-enter. Re-entry leads to Yang deficiency, and Yang deficiency leads to cold. Hence chills first, then fever, named Warm Malaria. Huangdi asked: What about Dan Malaria? Qibo said: The Lungs have prior heat, qi is abundant in the body, Jue Qi reverses upward. Yang qi is excessive and does not decline, causing disease. The qi does not return to Yin, so there is only heat without cold. The qi lodges internally in the Heart and externally in the muscle interspaces, causing emaciation, hence named Dan Malaria.
For malaria with a full, large, and urgent pulse, needle the Back-Shu points on the back. Use medium needles at the five Shu points beside the midline, one on each side, bleeding according to fatness or thinness. For malaria with a small, solid, and urgent pulse, moxa the lower leg Shaoyin points, and needle the finger Jing-Well points. For malaria with a slow, large, and deficient pulse, use herbal medicine; acupuncture is unsuitable. Generally, treat malaria about the time it takes to eat a meal before onset. If missed, the timing is lost. 1. For non-thirsty, every-other-day malaria: *Jiujuan* says take Foot-Yangming; *Suwen* says needle Taiyin. 2. For thirsty, every-other-day malaria: *Jiujuan* says take Hand-Shaoyang; *Suwen* says take Foot-Shaoyang. 3. For Wen Malaria with no sweat: perform the Fifty-Nine Needles method (explained in the Heat Disease section). 4. Foot-Taiyang Malaria: causes lower back pain, heavy head, cold rising from the back, chills then fever/thirst, sweat after thirst stops, difficult to cure, every-other-day onset. Bleed Weizhong (BL57) (*Suwen* adds "he he ran" after chills/fever). 5. Foot-Shaoyang Malaria: causes body laxity, mild cold, aversion to people, palpitations, much heat and sweat. Needle Foot-Shaoyang. 6. Foot-Yangming Malaria: causes initial chills, shivering, prolonged cold then heat, sweat after heat leaves, relief upon seeing light/fire. Needle Yangming dorsum and regulate Chongyang (ST42). 7. Foot-Taiyin Malaria... 8. Foot-Shaoyin Malaria: causes severe vomiting, much cold little heat, desire to close doors/windows. Difficult to cure. Take Taixi (KI3). 9. Foot-Jueyin Malaria... Abdomen... 10. Needle Hand-Shaoyin, called Shenmen (HT7). 11. Liver Malaria: face appears pale/greenish (*Suwen* adds sighing), appearance like death. Needle foot... makes one shiver... Shaoyin. 12. Stomach Malaria: feels cold before illness, good appetite but cannot eat, abdominal distension/fullness after eating. Bleed horizontal vessels of Foot-Yangming and Taiyin. 13... 14... 15... 16... 17... 18... 19... 20... 21... 22... 23... 24... 25... 26... 27... 28... 29... 30... 31... 32... 33... 34... 35... 36... 37... 38... 39... 40... 41... 42... 43... 44... 45... 46... 47... 48... 49... 50... 51... 52... 53... 54... 55... 56... 57... 58... 59...
To needle malaria, first ask where the pain started, and needle that area first. If headache and heaviness start first, bleed the top of the head, temples, and shoulders. If neck/back pain starts first, needle there. If lower back/spine pain starts first, bleed Weizhong (BL57). If arm/hand pain starts first, needle the spaces between fingers of Hand-Shaoyin and Yangming. If lower leg soreness starts first, bleed the spaces between toes of Foot-Yangming. For Wind Malaria with sweating and aversion to wind, bleed the Back-Shu points of the Three Foot-Yang channels. Lower leg soreness unrelieved by pressure is called Zhou Sui Bing; needle Juegu (GB39) with a bi needle to bleed, immediate relief. Minor body pain: needle Jing-Well points of all Yin channels without bleeding, once every other day.
Malaria: Shenting (GV24) and Baihui (GV20) govern it. Malaria: Shangxing (GV23) governs it; first take Yixi (BL53), then Tianyou (TE16), Fengchi (GB20), Dazhu (BL11). Malaria: Quangu (GB12) and Fengchi (GB20), Taixi (KI3), Wanggu (SI4), Yanggu (SI5), Xiaxi (GB43), Zhiyin (BL67), Tonggu (BL43), Jinggu (BL64) all govern it. Malaria with chills, high fever, delirium: Tianshu (ST25) governs it. Malaria with high heat: Lieque (LU7) governs it. Malaria with cold/heat jue, vexation, hiccups, chest fullness, sweating: Bleed Shaoshang (LU11) for immediate relief. Heat Malaria with dry mouth: Shangyang (LI1) governs it. Malaria with severe cold (wants to vomit foam): Yangxi (LI5) governs it. Wind Malaria with no sweat: Pianli (TE5) governs it. Malaria with red/swollen face: Wenliu (ST44) governs it. Malaria with epigastric distension/pain, rebellious qi: Moxa Wuli (ST30), left for right, right for left. Malaria with neck pain, sudden rebellion: Yimen (GB2) governs it. Malaria with fixed timing, red face, blurred vision: Zhongzhu (TE3) governs it. Malaria occurring at mealtime, heart pain, sadness: Tianjing (TE10) governs it. Wind Malaria: Zhizheng (SI7) governs it. Malaria with back/chill, neck pain radiating to elbow/armpit, lower back pain radiating to abdomen, inability to lift limbs: Shaohai (HT3) governs it. Malaria with unknown discomfort: Dadu (SP4) governs it. Malaria with much cold/little heat: Dazhong (KI4) governs it. Malaria with cough/rebellious qi, chest stuffiness, insomnia, severe vomiting, much heat/little cold, desire to close doors/windows, cold jue/hot feet: Taixi (KI3) governs it. Malaria with heat/shortness of breath, intermittent cold unable to self-warm, heavy knees, spasms, dizziness/headache: Jiexi (ST41) governs it. Malaria occurring at dusk: Linqi (GB34) governs it. Malaria with chills, axillary swelling: Qiuxu (GB40) governs it. Malaria starting from...: Shugu (BL65) governs it. Malaria with much sweat, lower back pain limiting flexion/extension, eyes feeling like popping out, neck feeling like pulling: Kunlun (BL60) governs it. Malaria: Excess causes lower back/upper back pain; deficiency causes nasal congestion/epistaxis. Feiyang (BL58) governs it. Malaria with heavy head, cold from back, chills then fever, unquenchable thirst, sweat: Weizhong (BL57) governs it. Malaria with no thirst, every-other-day onset: Kunlun (BL60) governs it.