疟者，虐也。寒则汤火不能温，热则冰水不能寒，寒热令人难当，故曰∶疟也。凡人从未发疟者，
名为胎疟。自幼发者多轻，中年发者必重，老年发者多危。经言∶疟之始
发，必先毫毛竖立，伸欠，乃作寒栗鼓颔，腰脊俱痛。寒去则内外皆热，头痛如破，渴欲饮冷。或一日
一发，或间日，或三日而发。戴氏云∶寒热发作有期者，疟也，无期者，杂病也。不可不辨。经论∶此皆
得之夏伤于暑，汗出腠开，当风浴水，凄怆之寒，伏于皮肤，及遇秋风，新凉束之，表邪不能外越，阴
欲入而阳拒之，阳欲出而阴遏之，阴阳相搏，而疟作矣。故曰∶夏暑汗不出者，秋成风疟。又曰， 疟皆
生于风。言盛暑之时，贪凉取快，暑邪内郁，秋伤于风，则病成矣。浅者，病在三阳，随卫气以为出入，
而一日一作。经云∶卫气者，昼行于阳，夜行于阴。此气得阳而外出，得阴而内搏，内外相搏，是以日
作。深者病在三阴，邪气不能与卫气并出，或间日，或三、四日而作。经云∶由邪气内搏五脏，横连募
原，其道远，其气深，其行迟，不能与卫气并行，不得皆出，故间日乃作。作愈迟者，病愈甚也。其论先。
热后寒之温疟，一者因先伤于风，而后伤于寒，先受阳邪，后受阴邪，故先热后寒。一者因冬感风寒，深
藏骨髓，内舍于肾，或遇春温，或遇大暑，随触而发。其发也，邪气从肾出之于外而大热，内已如焚；俟
其势衰，复返于肾，而阴精与之相持，乃始为寒，故亦先热后寒。其但。热无寒之瘅疟，因肺素有热，阴
气先绝，阳气独发，则少气烦冤，而心肺病；手足热，欲呕，而胃自病。所以继之曰∶邪气内
藏于心，外舍于分肉之间，令人消灼脱肉。经之论疟，无漏义矣。而立斋、丹溪，又分痰，疟、食疟，
及饮水败血为疟等症。虽古人有无痰不成疟，无食不成疟之说，然不过疟疾之兼症耳，岂果因此而成疟
者哉！此外有谓瘴，疟者。惟岭南地方，天气炎，山气温，多有岚瘴之气，感之而病，乃湿热之外入
也。有谓牝疟者，但寒无热，以阳气不充，乃阴邪之胜也。有谓劳疟者，因劳即发，以里气虚，而感邪
之易也。凡邪自外入，当从汗解。然治法云∶有汗要使无汗，扶正为先；无汗要使有汗，散邪为急。
又热多者，凉药为君；寒多者，温药为主。至于痰食饮血，各随其甚者而兼理之。若冬感风寒藏肾，至
春夏发为先热后寒之温疟，宜壮水之主，以急救其阴，不然，则十数发，阴精尽而死矣。世俗又有鬼疟
之名，此为时行疫气，投平胃散，加桃仁、雄黄、无不截者。总之脉实症实者，攻邪以治标；脉虚症虚
者，养正以治本。久疟必虚，惟用人参一、二两，姜皮三、五钱，于未发二时之前，连投二服，莫不应
手取效，贫困者，则 、术、当归，亦可随宜择而用之。若阴虚水亏之人，则多用熟地，或少佐生姜。近
世不明表里虚实，辄用芩、连、栀、柏，若表未解而得者，寒凉则寒邪愈固；或用常山、草果，若正已虚
而得者，克伐则元气转虚。故夫缠绵不已者，皆医之咎也。
小柴胡汤〔见伤寒。〕治疟主方，加减用之。
渴者，去半夏加花粉，劳虚亦如之。热多者，合竹叶石
膏汤。寒多者，加姜皮，甚者或再加桂枝。有痰加花粉、橘红、竹沥。有食加枳实、青皮、豆蔻。若
多热而久不解者，〔必本阴虚。〕加鳖甲、牛膝。〔大剂益阴除热，自愈。〕若多寒而久不解者，〔必
本阳虚。〕合露姜饮，或再加 、术。〔益阳气则寒自止，邪自散。〕夜发者，〔邪在阴分。〕
合四物汤加红花。〔必用血药提起阳分，则易愈。〕妇人久疟，或产后亦如之。如强壮人欲截，必俟三、
四发后，疟势稍减，方可加常山。〔钱许，用酒炒透，则不发吐。其虚弱之人，始终不可截，误截，每
致腹胀。〕
此和解表里之剂，乃治少阳病，全体大用之一方也。嘉言谓∶外邪相干，每伏藏于半表半里，入而
与阴争则寒，出而与阳争则热，所以寒热往来，乃少阳所主。内经论疟，虽分五脏及足三阳、然少阳而
兼他经之症则有之，谓他经而全不涉少阳，则不成其为疟矣。所以仲景云∶疟脉自弦，弦数者，多热，
弦迟者、多寒。此不但初病之脉乃尔，即久疟正虚，脉不鼓指，而弦象亦隐然在中。故始之似疟非疟，
与后之经年不解，总一少阳主之。偏阴则多寒，偏阳则多热，即其纯热无寒而为瘅疟，纯寒无热而为牝
疟，要皆自少阳而造其极偏。补偏救弊，亦必返还少阳之界，阴阳协和，然后可愈，故以小柴胡汤为
主，热多者，加寒药，寒多者，加热药，乃天然不易之法也。
王太史治疟神方 主治加减，所投辄效。
柴胡〔少阳寒热往来之主药。〕羌活〔太阳发表之主
药，以头、项、腰、脊、背痛，太阳经也。〕葛根〔阳明解表之主药，寒栗鼓颔责之阳明，其脉循
颐领故也。〕防风〔风湿交攻，以 疟皆生于风也。〕升麻〔同柴、葛、羌、防，俱辛甘气
清，使阳气上升，离于阴而寒自己。咳家、呕家、血家忌之。无汁加藕叶。〕石膏〔烦渴者必
用。〕知母 黄芩〔三味俱性寒下行，引阴气下降，离于阳而热自己〕猪苓〔分利阴阳，使不
交并。〕穿山甲〔恐经络阴阳相阻，药力难入故也。此味最妙，孕妇忌之。〕浓朴〔下气消痰、
以无痰不成疟也。〕神曲〔下气消食，以无食不成疟也。隔夜先煎，露一宿。盖疟因暑邪，得露则
解。临发前一时，重汤炖温服，避其锐气也。然势将退，服二煎，击其惰懈也。若疟势正盛，服药与之混
战，徒自苦耳。〕
此治疟之神剂也。王宇泰云∶卫气与邪气相并则病作，与邪相离则病休。并于阴则寒，并于阳则热。
故寒多者宜升其阳，使不并于阴，则寒自己；热多者，宜降其阴，使不并于阳，则热自己，寒热交作者，
一升一降，而以渗利之药，从中分利之，使不交并则愈。其制此方，深得治疟之窍，学人能悟其旨，而善
为加减之，则不可胜用矣。
竹叶石膏汤〔见伤寒。〕治疟发热甚，渴甚，烦躁不眠。
汗多加人参，虚者亦用。〔一钱至一两。〕食滞加枳实、青皮。呕加竹茹、木瓜、枇杷叶。如三日疟，
热渴甚者，加首乌、鳖甲、牛膝。
此甘寒清暑之要剂，余谓以治瘅疟，亦至当不易之方也。仲淳治疟，每用此方，其言曰∶余年十
七时，为疟所苦，诸方不效。因读《内经》夏伤于暑，秋必 疟，乃知疟。疾暑邪所致，遂从暑治，
不旬日愈。后数以意消息，虽随症投药解散，必清暑益气，调理脾胃为主。痰多者，兼消痰，有食
者，兼消食，气虚者，补气，血虚者，补血，即经年久疟亦无不愈。又曰∶疟必由于中气虚弱，破
气，则中气愈伤，邪不得解，甚则中满。果系伤食者，不拘此例。误下则邪下陷。变为痢疾，或腹满
腹胀。故凡属破气下泄之药，慎误勿投。
仲淳治疟简服方 疟疾未发日服之。如一日一作者，亦乘其未发二时之前服之。
异功散去甘草，〔恐助脾家湿热。〕加白芍、扁豆、豆蔻、山楂、麦芽，如有肺火者，去参、术
加麦冬、石斛。
此开胃、健脾、消食、消痰之剂，佐以此方，使正旺则邪易除也。
仲淳方 久疟不已，似劳症者用之，三日疟在阴分者，亦效。
鲜首乌〔疗阴阳久疟。〕鳖甲〔益阴除热，而消散。为治疟要药。〕牛膝〔同鳖甲治
疟在阴分久不愈者。各五钱至一两。〕当归〔养血，三、五钱。〕贝母〔三钱至八钱。〕橘
红〔消痰，三、五钱。〕柴胡〔和解余
邪。〕姜皮〔各一、二钱，热甚及有汗者去之。〕加竹沥〔一大杯。〕虚极者，加人参。〔至
一两。〕
此滋阴养血，而兼消痰和解，乃阴虚久疟之剂也。
六味地黄汤〔见虚劳。〕
本方宜去萸肉，加柴胡、鳖甲、牛膝、麦冬、花粉。
此壮水之剂，赵氏云∶阴虚人发疟，见其面赤口渴，作肾中真阴虚治，用此无不立应。
补中益气汤〔见泄泻。〕久疟属阳虚者，〔必寒甚热少不渴。〕可用此方。
此补气、健脾、升阳之剂。立斋云∶凡人久疟，诸药不效，本方内加半夏，用参一两，加煨姜
五钱，此不截之截也，一服即愈。徐忠可谓∶余见贫人，无力服参，不论间日三日，令将黄 、白术、当
归、首乌、橘红等分，以生姜自然汁为丸，不问邪之清否，服三、四斤。百不失一。
露姜饮 亦治阳虚久疟。
人参〔一两。〕姜皮〔五钱。〕〔水煎露一宿，隔汤温服。〕
此扶正驱邪之剂。仲淳云∶余治一人三日疟，用原方不应，加参三两，加姜一两五钱，一剂即止。
截疟神方
白术〔四两。炒常山二两，煎浓汁，浸白术，焙干去常山，但用术。〕〔分作四服，煎饮立愈。〕
此补多攻少之剂，疟久不截者，可用此方。
鳖甲丸〔自制。〕《金匮》云∶以月一日发，当以十五日
愈，〔天之节气更。则人身之气亦更。〕设不愈，当月尽解，〔天人之气再更，疟势自衰。〕如其
不愈，当结为 瘕，名曰疟母。〔必少阳所主之胁肋，外邪相挟，痰血成形。〕急治之，宜鳖甲煎丸。
鳖甲〔下瘀血，破 瘕，为治疟母之要药。醋炙，四两。〕桃仁〔炒。〕 虫〔祛
血积，去足炒。〕瓦楞子〔消老痰， 。〕麦芽〔消谷积。〕青皮〔破滞气。〕香
附〔气郁血滞必用之药。〕三棱 莪术〔磨积削坚，必需之品。各二两。〕〔共九味，醋煮神曲糊
为丸。〕
此一派破瘀、消痰，削积之品，恐日久根深，牢不可破，所以祛邪为急，药不嫌其峻也。但虚人必
得参、术赞助。脾能营运，积可得去。此方师其法，而不泥用其药，投之其效。
疟疾之脉，代散者死。
疟疾，就是虐害的意思。发冷时，用汤火也无法温暖；发热时，用冰水也无法降温。寒热交替发作让人难以忍受，所以称为“疟”。从未患过疟疾的人，称为胎疟。自幼发病的通常较轻，中年发病的必然较重，老年发病的多有危险。医经说：疟疾刚开始发作时，必定先出现毫毛竖立、伸懒腰打哈欠，接着出现恶寒战栗、下巴打颤，腰部脊柱都疼痛。寒冷消退后，体内体外都发热，头痛得像要破裂一样，口渴想喝冷水。有的每天发作一次，有的隔一天发作，有的三天发作一次。戴氏说：寒热发作有固定时间的，是疟疾；没有固定时间的，是杂病。不能不加以辨别。医经论述：这些病症都是因为夏天被暑邪所伤，出汗时腠理（皮肤毛孔）张开，吹着风或洗冷水澡，受到凄冷的寒气侵袭，寒气潜伏在皮肤之间，等到秋天秋风起，新的凉气束缚体表，表邪不能向外发散，阴气想进入体内却被阳气拒绝，阳气想外出却被阴气遏制，阴阳相互搏结，疟疾就发作了。所以说：夏天中暑却不出汗的，秋天会形成风疟。又说，疟疾都是因风邪引起的。说的是在盛暑之时，贪图凉快取乐，导致暑邪内郁，到了秋天又受了风邪，疾病就形成了。病位浅的，病在三阳经，随着卫气的运行而出入，所以每天发作一次。医经说：卫气，白天行于阳分，夜晚行于阴分。此气遇到阳分就外出，遇到阴分就在体内搏结，内外相搏，所以每天发作。病位深的，病在三阴经，邪气不能与卫气同时外出，有的隔一天发作，有的三、四天发作。医经说：因为邪气内搏五脏，横连募原（脏腑间的膜原），路径远，气机深，运行迟缓，不能与卫气并行，不能每次都一起外出，所以隔一天才发作。发作间隔越迟，病情越严重。关于先热后寒的温疟，一种是因为先受风邪，后受寒邪，先感受阳邪，后感受阴邪，所以先热后寒。另一种是因为冬天感受风寒，深藏于骨髓，内舍于肾，或者遇到春季温热，或者遇到大暑天，随触动而发作。发作时，邪气从肾出于外而大热，体内已经像火烧一样；等到邪气势头衰退，又返回到肾，阴精与之相持，才开始发冷，所以也是先热后寒。那种只有热没有寒的瘅疟，是因为肺素来有热，阴气先绝，阳气独发，就会少气烦闷冤屈，心肺生病；手足发热，想呕吐，胃自生病。所以接着说：邪气内藏于心，外舍于分肉之间，使人消瘦枯槁。医经对疟疾的论述，没有遗漏义理了。而立斋、丹溪，又分为痰疟、食疟，以及饮水败血为疟等症状。虽然古人有无痰不成疟、无食不成疟的说法，但这不过是疟疾的兼症罢了，难道真的是因此而成疟的吗！此外有称为瘴疟的。只在岭南地方，天气炎热，山气温湿，多有岚瘴之气，感之而病，这是湿热之外入。有称为牝疟的，只冷不热，是因为阳气不充盛，是阴邪胜出的表现。有称为劳疟的，因为劳累就发作，是因为里气虚弱，容易感邪。凡是邪气从外而入，应当通过发汗解除。但是治法说：有汗的要使无汗，以扶正为先；无汗的要使有汗，以散邪为急。又是热多者，以凉药为主；寒多者，以温药为主。至于痰、食、饮、血，各自根据严重的情况兼以调理。如果是冬天感受风寒藏于肾，到春夏季发作成为先热后寒的温疟，应当壮水之主，以急救其阴，不然的话，发作十几次，阴精耗尽就会死亡。世俗又有鬼疟的名称，这是时行疫气，投用平胃散，加桃仁、雄黄，没有不能截断的。总之脉实症实的，攻邪以治标；脉虚症虚的，养正以治本。久疟必定虚，只用参一两、二两，姜皮三钱、五钱，在未发作前两小时之前，连续服用两次，没有不随手见效的，贫困的人，则用黄芪、白术、当归，也可以随意选择使用。如果是阴虚水亏的人，则多用熟地，或少量佐以生姜。近代人不明表里虚实，就用黄芩、黄连、栀子、黄柏，如果表证未解而得的，用寒凉药则寒邪更加固结；或者用常山、草果，如果正气已虚而得的，用克伐药则元气更加虚弱。所以缠绵不已的，都是医生的过错。
小柴胡汤〔见伤寒论〕治疗疟疾的主方，加减使用。
口渴的，去掉半夏加天花粉，劳虚也这样处理。热多的，合用竹叶石膏汤。寒多的，加姜皮，严重的再加桂枝。有痰的加天花粉、橘红、竹沥。有食的加枳实、青皮、豆蔻。如果多热且长久不解的，〔必定本于阴虚。〕加鳖甲、牛膝。〔大剂量益阴除热，自然痊愈。〕如果多寒且长久不解的，〔必定本于阳虚。〕合用露姜饮，或者再加黄芪、白术。〔益阳气则寒自然停止，邪气自然消散。〕夜间发作的，〔邪在阴分。〕
合用四物汤加红花。〔必须用血药提起阳分，则容易痊愈。〕妇人久疟，或者产后也这样处理。如强壮人想要截断疟疾，必须等三、四次发作后，疟势稍减，才可以加常山。〔一钱许，用酒炒透，则不会引起呕吐。那些虚弱的人，始终不可截断，误用截断，往往导致腹胀。〕
这是和解表里的药剂，是治疗少阳病，全体大用的一个方子。嘉言说：外邪相干，常常潜伏在半表半里，进入体内与阴争则寒，出来与阳争则热，所以寒热往来，是少阳所主。内经论疟，虽然分五脏及足三阳经，但少阳兼及其他经的症状是有存在的，如果说其他经完全不涉及少阳，那就不成其为疟了。所以仲景说：疟脉自弦，弦数的，多热，弦迟的，多寒。这不仅是初病的脉象，就是久疟正虚，脉不鼓指，而弦象也隐约在中。所以开始的似疟非疟，与后来的经年不解，总归由少阳主治。偏阴则多寒，偏阳则多热，即使是纯热无寒而为瘅疟，纯寒无热而为牝疟，都要说是从少阳而造其极偏。补偏救弊，也必须返还到少阳的界限，阴阳协和，然后才能痊愈，所以以小柴胡汤为主，热多的，加寒药，寒多的，加热药，这是天然不易的方法。
王太史治疟神方 主治加减，所投辄效。
柴胡〔少阳寒热往来的主药。〕羌活〔太阳发表的主药，因为头、项、腰、脊、背痛，属于太阳经。〕葛根〔阳明解表的主药，寒栗鼓颔责之于阳明，其脉循行于颐领的缘故。〕防风〔风湿交攻，因为疟皆生于风。〕升麻〔同柴胡、葛根、羌活、防风，都是辛甘气清，使阳气上升，离开阴分而寒自然止。咳嗽家、呕吐家、出血家忌用。无汁加藕叶。〕石膏〔烦渴者必用。〕知母 黄芩〔这三味都性寒下行，引阴气下降，离开阳分而热自然止。〕猪苓〔分利阴阳，使不交并。〕穿山甲〔恐怕经络阴阳相阻，药力难入的缘故。此味最妙，孕妇忌用。〕浓朴〔下气消痰，因为无痰不成疟。〕神曲〔下气消食，因为无食不成疟。隔夜先煎，露一宿。盖疟因暑邪，得露则解。临发作前一小时，重汤炖温服，避其锐气。然而势将退时，服二煎，击其惰懈。如果疟势正盛，服药与之混战，徒然自苦罢了。〕
这是治疗疟疾的神剂。王宇泰说：卫气与邪气相并则病作，与邪相离则病休。并于阴则寒，并于阳则热。所以寒多的宜升其阳，使不并于阴，则寒自然止；热多的宜降其阴，使不并于阳，则热自然止，寒热交作的，一升一降，而以渗利之药，从中分利之，使不交并则愈。他制定这个方子，深得治疟的窍诀，学人能领悟其旨意，而善于加减运用，则不可胜用了。
竹叶石膏汤〔见伤寒论〕治疗疟疾发热甚，渴甚，烦躁不眠。
汗多加人参，虚者也用。〔一钱至一两。〕食滞加枳实、青皮。呕加竹茹、木瓜、枇杷叶。如三日疟，热渴甚重的，加首乌、鳖甲、牛膝。
这是甘寒清暑的要剂，我认为用来治疗瘅疟，也是至当不易的方子。仲淳治疟，每用此方，他说：我十七岁时，被疟疾所苦，诸方无效。于是读《内经》夏伤于暑，秋必疟，才知道疟疾是暑邪所致，遂从暑治，不到十天就好了。后来多次凭心意斟酌，虽然随症投药解散，必以清暑益气，调理脾胃为主。痰多的，兼消痰，有食的，兼消食，气虚的，补气，血虚的，补血，即使经年久疟也没有不愈的。又说：疟必由于中气虚弱，破气，则中气更伤，邪不得解，甚至中满。果系伤食的，不拘泥于此例。误下则邪下陷。变为痢疾，或腹满腹胀。所以凡是属破气下泄的药，慎误勿投。
仲淳治疟简服方 疟疾未发日服之。如一日一发的，也乘其未发前两小时之前服之。
异功散去甘草，〔恐助脾家湿热。〕加白芍、扁豆、豆蔻、山楂、麦芽，如有肺火者，去参、术加麦冬、石斛。
这是开胃、健脾、消食、消痰的药剂，佐以此方，使正气旺盛则邪气易除。
仲淳方 久疟不已，似劳症者用之，三日疟在阴分者，也有效。
鲜首乌〔疗阴阳久疟。〕鳖甲〔益阴除热，而消散。为治疟要药。〕牛膝〔同鳖甲治疟在阴分久不愈者。各五钱至一两。〕当归〔养血，三、五钱。〕贝母〔三钱至八钱。〕橘红〔消痰，三、五钱。〕柴胡〔和解余邪。〕姜皮〔各一、二钱，热甚及有汗者去之。〕加竹沥〔一大杯。〕虚极者，加人参。〔至一两。〕
这是滋阴养血，而兼消痰和解，乃阴虚久疟的药剂。
六味地黄汤〔见虚劳〕
本方宜去萸肉，加柴胡、鳖甲、牛膝、麦冬、花粉。
这是壮水的药剂，赵氏说：阴虚人发疟，见其面赤口渴，作肾中真阴虚治，用此无不立应。
补中益气汤〔见泄泻〕久疟属阳虚的，〔必寒甚热少不渴。〕可用此方。
这是补气、健脾、升阳的药剂。立斋说：凡人久疟，诸药无效，本方内加半夏，用参一两，加煨姜五钱，这是不截之截，一服即愈。徐忠可谓：我看见贫人，无力服参，不论间日三日，令将黄芪、白术、当归、首乌、橘红等分，以生姜自然汁为丸，不问邪之清否，服三、四斤。百不失一。
露姜饮 亦治阳虚久疟。
人参〔一两。〕姜皮〔五钱。〕〔水煎露一宿，隔汤温服。〕
这是扶正驱邪的药剂。仲淳说：我治一人三日疟，用原方不应，加参三两，加姜一两五钱，一剂即止。
截疟神方
白术〔四两。炒常山二两，煎浓汁，浸白术，焙干去常山，但用术。〕〔分作四服，煎饮立愈。〕
这是补多攻少的药剂，疟久不截者，可用此方。
鳖甲丸〔自制。〕《金匮要略》说：以月一日发，当以十五日愈，〔天之节气更则人身之气亦更。〕设不愈，当月尽解，〔天人之气再更，疟势自衰。〕如其不愈，当结为瘕，名曰疟母。〔必少阳所主之胁肋，外邪相挟，痰血成形。〕急治之，宜鳖甲煎丸。
鳖甲〔下瘀血，破瘕，为治疟母之要药。醋炙，四两。〕桃仁〔炒。〕虻虫〔祛血积，去足炒。〕瓦楞子〔消老痰。〕麦芽〔消谷积。〕青皮〔破滞气。〕香附〔气郁血滞必用之药。〕三棱 莪术〔磨积削坚，必需之品。各二两。〕〔共九味，醋煮神曲糊为丸。〕
这是一派破瘀、消痰，削积之品，恐怕日久根深，牢不可破，所以祛邪为急，药不嫌其峻也。但虚人必得参、术赞助。脾能营运，积可得去。此方师其法，而不泥用其药，投之其效。
疟疾之脉，代散者死。
Malaria, also known as "nüe" (虐), refers to a condition where the body is tormented. During chills, hot water or fire cannot warm the body; during fever, ice or cold water cannot cool it. The alternating chills and heat are unbearable, hence the name "malaria". Individuals who have never contracted malaria are said to have "fetal malaria" (Tai Nüe). Those who develop it from childhood usually have mild cases, those in middle age have severe cases, and those in old age often face critical conditions. The classics state: When malaria first begins, hair stands on end, yawning and stretching occur, followed by shivering with chin quivering, and pain in the waist and spine. After the chills subside, both internal and external heat arise, causing headache as if splitting, and thirst for cold drinks. It may occur daily, every other day, or every three days. Dai Shi stated: Malaria has periodic chills and heat; non-periodic ones are miscellaneous diseases. They must be distinguished. The classics discuss: These ailments result from summer heat injury, where sweating opens the pores (Cou Li), exposure to wind or cold water bath invites chilling coldness, which lies latent in the skin. When autumn winds bring new coolness, the exterior pathogen cannot disperse outward. Yin desires to enter but Yang rejects it; Yang desires to exit but Yin obstructs it. The struggle between Yin and Yang causes malaria to manifest. Thus it is said: Summer heat without sweating leads to wind-malaria in autumn. Also, malaria arises from wind. In peak summer, seeking coolness allows heat pathogens to stagnate internally; autumn wind injury completes the illness. Superficial cases involve the Three Yang meridians, moving with Wei Qi (Defensive Qi), causing daily attacks. The classics say: Wei Qi travels through Yang during the day and Yin at night. Encountering Yang, it moves outward; encountering Yin, it struggles internally. This internal-external struggle causes daily attacks. Deep cases involve the Three Yin meridians, where pathogens cannot exit with Wei Qi, occurring every other day or every three to four days. The classics explain: Pathogens struggle internally with the Five Zang organs, spreading horizontally to the Mu Yuan (Membrane Source). The path is long, the qi is deep, movement is slow, preventing simultaneous exit with Wei Qi, thus occurring every other day. The later the onset, the more severe the disease. Regarding Warm Malaria (Wen Nüe) with heat preceding cold: One type results from prior wind injury followed by cold injury, receiving Yang pathogen then Yin pathogen, hence heat then cold. Another type involves winter wind-cold hiding deep in bone marrow, residing in Kidney, triggered by spring warmth or summer heat. Upon attack, pathogens emerge from Kidney causing intense heat, burning internally; as momentum fades, they return to Kidney, where Yin Essence resists, causing cold, hence heat then cold. For Dan Malaria (Dan Nüe) with heat only and no cold: Lung heat exists, Yin Qi is exhausted first, Yang Qi acts alone, causing shortness of breath, vexation, Heart-Lung pathology, hot hands and feet, and nausea due to Stomach pathology. Thus it follows: Pathogens hide in Heart, reside between muscle layers, causing emaciation. The classics' discussion on malaria covers all principles. Li Shizhao and Zhu Danxi further classified Phlegm-Malaria, Food-Stagnation Malaria, and Malaria from water retention/blood stasis. Although ancients said "no phlegm, no malaria; no food, no malaria," these are merely accompanying symptoms, not the root cause. Additionally, there is "Zhang Malaria" (Miasma Malaria), specific to Lingnan where hot weather and mountain humidity create miasma; infection here is external damp-heat. There is "Pin Malaria" (Female Malaria), characterized by cold only without heat, due to insufficient Yang Qi and dominance of Yin pathogens. There is "Lao Malaria" (Labor Malaria), triggered by fatigue due to deficient interior Qi making one susceptible to pathogens. All external pathogens should be resolved via sweating. However, treatment dictates: If sweating exists, stop it by supporting Righteous Qi first; if no sweating, induce it by dispersing pathogens urgently. If heat predominates, use cooling herbs as sovereign; if cold predominates, use warming herbs as sovereign. Address phlegm, food, fluid, and blood stasis according to severity. If winter wind-cold hides in Kidney and manifests in spring/summer as Warm Malaria, tonify Water (Kidney Yin) to rescue Yin urgently, otherwise death ensues after numerous attacks depleting Yin Essence. Secularly called "Ghost Malaria," caused by epidemic qi, treated with Pingwei San plus Tao Ren and Xiong Huang can always arrest it. Generally, excess pulse/symptoms require attacking pathogens to treat branch; deficiency pulse/symptoms require nourishing Zheng to treat root. Chronic malaria leads to deficiency; using Ren Shen (1-2 liang) and Jiang Pi (3-5 qian) two hours before onset, taken twice, yields immediate effect. Poor patients may substitute Huang Qi, Bai Zhu, Dang Gui. For Yin deficiency/water depletion, use Shu Di heavily or add small amounts of Sheng Jiang. Modern physicians ignoring exterior-interior/excess-deficiency often use Huang Qin, Huang Lian, Zhi Zi, Huang Bo. If exterior unresolved, cooling herbs fixate cold pathogens; using Chang Shan, Cao Guo in deficient patients depletes Yuan Qi. Thus, lingering cases are physician errors.
Xiao Chai Hu Tang [See Shang Han Lun] is the main formula for malaria, used with modifications.
For thirst, remove Ban Xia, add Hua Fen; apply similarly for labor-deficiency. For excessive heat, combine with Zhu Ye Shi Gao Tang. For excessive cold, add Jiang Pi; if severe, add Gui Zhi. For phlegm, add Hua Fen, Ju Hong, Zhu Li. For food stagnation, add Zhi Shi, Qing Pi, Dou Kou. For prolonged heat, [rooted in Yin deficiency], add Bie Jia, Niu Xi. [Large doses nourish Yin and clear heat, leading to natural recovery.] For prolonged cold, [rooted in Yang deficiency], combine with Lu Jiang Yin, or add Huang Qi, Bai Zhu. [Tonifying Yang stops cold and disperses pathogens.] For nighttime attacks, [pathogen in Yin division], combine with Si Wu Tang plus Hong Hua. [Blood-invigorating herbs lift Yang division, facilitating cure.] Women with chronic malaria or postpartum cases follow this. Strong individuals seeking to arrest malaria must wait until after 3-4 attacks when intensity subsides, then add Chang Shan. [1 qian, wine-fried to prevent vomiting. Weak patients should never attempt arrest; mistaken arrest often causes abdominal distension.]
This is a harmonizing exterior-interior formula, a major application for Shaoyang disease. Jiayan stated: Exterior pathogens often hide in half-exterior half-interior. Entering and struggling with Yin causes cold; exiting and struggling with Yang causes heat. Hence alternating chills and heat are governed by Shaoyang. Nei Jing classifies malaria by Five Zang and Foot Three Yang meridians, but Shaoyang often accompanies other meridians. If other meridians do not involve Shaoyang, it is not malaria. Thus Zhongjing said: Malaria pulse is naturally Wiry (Xian). Wiry-rapid indicates much heat; Wiry-slow indicates much cold. This applies to initial stages and chronic deficiency where pulse is weak but Wiry quality remains. Whether initially resembling malaria or persisting for years, Shaoyang governs. Yin bias causes much cold; Yang bias causes much heat. Even pure heat Dan Malaria or pure cold Pin Malaria stem from extreme deviation from Shaoyang. Correcting deviations requires returning to Shaoyang balance, harmonizing Yin-Yang for cure. Hence Xiao Chai Hu Tang is primary: add cooling herbs for heat, warming herbs for cold, an immutable natural method.
Wang Taishi's Divine Formula for Malaria: Effective with modifications.
Chai Hu [Sovereign herb for Shaoyang alternating chills/heat.] Qiang Huo [Sovereign herb for Taiyang exterior release, for head/neck/back/spine pain, Taiyang meridian territory.] Ge Gen [Sovereign herb for Yangming exterior release, chills/chin quivering relate to Yangming, whose meridian passes jaw/cheek.] Fang Feng [For wind-damp interaction, as malaria arises from wind.] Sheng Ma [Together with Chai, Ge, Qiang, Fang, all acrid-sweet and clear, raising Yang Qi away from Yin to stop cold. Contraindicated in cough, vomiting, bleeding disorders. Add Ouye if juice unavailable.] Shi Gao [Essential for vexation/thirst.] Zhi Mu, Huang Qin [All three cold and descending, drawing Yin down away from Yang to stop heat.] Zhu Ling [Separates and benefits Yin/Yang, preventing entanglement.] Chuanshan Jia [Prevents meridian Yin-Yang obstruction hindering drug entry. Excellent, contraindicated in pregnancy.] Hou Po [Descends Qi, resolves phlegm, as no phlegm no malaria.] Shen Qu [Descends Qi, aids digestion, as no food no malaria. Decoct overnight, expose to dew. Malaria stems from summer heat; dew resolves it. Take warm one hour before onset to avoid peak pathogen energy. Take second decoction as pathogen wanes to strike weakness. Do not take during peak intensity, futile.]
This is a divine agent for malaria. Wang Yutai said: Disease flares when Wei Qi joins pathogens; rests when separated. Joining Yin causes cold; joining Yang causes heat. For much cold, raise Yang to prevent joining Yin; for much heat, lower Yin to prevent joining Yang. For alternating chills/heat, raise and lower simultaneously, using diuretics to separate them mid-way, preventing entanglement for cure. His formulation grasps the essence of treating malaria. Understanding and modifying it yields infinite utility.
Zhu Ye Shi Gao Tang [See Shang Han Lun]: Treats malaria with high fever, severe thirst, restlessness, insomnia.
Add Ren Shen for profuse sweating or deficiency. [1 qian to 1 liang.] Add Zhi Shi, Qing Pi for food stagnation. Add Zhu Ru, Mu Gua, Pi Pa Ye for vomiting. For tertian malaria with severe heat/thirst, add Shou Wu, Bie Jia, Niu Xi.
This is a key sweet-cold summer-clearing formula. I consider it ideal for Dan Malaria. Zhong Chun used this frequently, stating: At seventeen, suffering from malaria unresponsive to other formulas, reading Nei Jing's "Summer heat injury leads to autumn malaria," I realized malaria stems from summer heat, treated accordingly, cured within ten days. Later, I refined it: while resolving symptoms, always prioritize clearing summer heat, boosting Qi, regulating Spleen/Stomach. Add phlegm-resolving for phlegm, food-resolving for food, Qi-tonifying for Qi deficiency, Blood-nourishing for Blood deficiency. Even chronic malaria cures. He added: Malaria stems from Middle Qi deficiency. Qi-breaking herbs injure Middle Qi further, trapping pathogens, causing fullness. Unless food injury, avoid this. Mistaken purgatives sink pathogens, causing dysentery or abdominal fullness. Avoid all Qi-breaking/purgative herbs.
Zhong Chun's Simple Malaria Formula: Taken on non-attack days. For daily malaria, take two hours before onset.
Yi Gong San minus Gan Cao [Fear of aiding Spleen damp-heat.] Add Bai Shao, Bian Dou, Dou Kou, Shan Zha, Mai Ya. For Lung Fire, remove Ren Shen, Bai Zhu, add Mai Dong, Shi Hu.
This opens stomach, strengthens Spleen, resolves food/phlegm. Adjunct therapy boosts Righteous Qi to easily expel pathogens.
Zhong Chun's Formula: For chronic malaria resembling consumption, or tertian malaria in Yin division.
Xian Shou Wu [Treats chronic Yin/Yang malaria.] Bie Jia [Nourishes Yin, clears heat, dissipates nodules. Key malaria herb.] Niu Xi [With Bie Jia treats chronic Yin-division malaria. Each 5 qian to 1 liang.] Dang Gui [Nourishes Blood, 3-5 qian.] Bei Mu [3-8 qian.] Ju Hong [Resolves phlegm, 3-5 qian.] Chai Hu [Harmonizes residual pathogens.] Jiang Pi [1-2 qian each, remove if severe heat/sweating.] Add Zhu Li [1 large cup.] For extreme deficiency, add Ren Shen [up to 1 liang.]
This nourishes Yin/Blood, resolves phlegm, harmonizes; a formula for chronic Yin-deficiency malaria.
Liu Wei Di Huang Tang [See Xu Lao]
Remove Yu Rou, add Chai Hu, Bie Jia, Niu Xi, Mai Dong, Hua Fen.
This strengthens Water. Zhao Shi said: For Yin-deficient malaria with red face/thirst, treat as Kidney True Yin deficiency; this formula works instantly.
Bu Zhong Yi Qi Tang [See Xie Xie] For chronic Yang-deficiency malaria [severe cold, little heat, no thirst].
This tonifies Qi, strengthens Spleen, raises Yang. Li Zhai said: For chronic malaria unresponsive to drugs, add Ban Xia to this formula, use Ren Shen 1 liang, Wei Jiang 5 qian. This is "arrest without arresting"; one dose cures. Xu Zhongke said: I saw poor patients unable to afford Ren Shen. Regardless of intermittent/tertan, equal parts Huang Qi, Bai Zhu, Dang Gui, Shou Wu, Ju Hong made into pills with fresh Ginger juice. Take 3-4 jin regardless of pathogen nature. Success rate near 100%.
Lu Jiang Yin: Also treats chronic Yang-deficiency malaria.
Ren Shen [1 liang.] Jiang Pi [5 qian.] [Decoct in water, expose overnight, warm in double boiler.]
This supports Righteous Qi, drives out pathogens. Zhong Chun said: Treating a tertian malaria case, original formula failed. Added Ren Shen 3 liang, Jiang 1.5 liang; one dose stopped it.
Jie Nüe Shen Fang (Arrest Malaria Divine Formula)
Bai Zhu [4 liang. Stir-fry Chang Shan 2 liang, decoct thick liquid, soak Bai Zhu, dry, discard Chang Shan, use only Bai Zhu.] [Divide into four doses, decoct and drink for immediate cure.]
This emphasizes tonification over attack. Use for stubborn malaria.
Bie Jia Wan (Self-made). Jin Gui says: If starting on month's first day, should heal by fifteenth [Heavenly solar terms shift, human Qi shifts too.] If not healed, resolve by month's end [Heaven-Human Qi shifts again, malaria wanes.] If still not healed, forms mass called "Malaria Mother" [Must be Shaoyang-governed hypochondrium, exterior pathogens挟phlegm-blood forming mass.] Treat urgently with Bie Jia Jian Wan.
Bie Jia [Drains blood stasis, breaks masses. Key for Malaria Mother. Vinegar-fried, 4 liang.] Tao Ren [Stir-fried.] Meng Chong [Removes blood accumulation, remove feet, stir-fried.] Wa Leng Zi [Resolves old phlegm.] Mai Ya [Resolves grain stagnation.] Qing Pi [Breaks Qi stagnation.] Xiang Fu [Essential for Qi stagnation/Blood stasis.] San Leng, E Zhu [Grind accumulations, soften hardness. Essential. Each 2 liang.] [Nine ingredients, vinegar-boiled Shen Qu paste for pills.]
These are blood-breaking, phlegm-resolving, accumulation-reducing herbs. Fear deep-rooted persistence, so urgent pathogen removal justifies harsh drugs. Deficient patients need Ren Shen, Bai Zhu support. Spleen transport removes accumulations. This formula adopts the method without rigidly using all herbs, yet effective.
Malaria pulse: Dai (intermittent) and San (scattered) indicate death.