黄帝问曰∶夫 疟皆生于风，其蓄作有时者何也？岐伯对曰∶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，头痛如破，渴欲冷冻饮料。帝曰∶何气使然？愿闻其道。岐伯曰∶阴阳上下
交争，虚实更作，阴阳相移也。阳并于阴，则阴实而阳虚，阳明虚则寒栗鼓颔也；巨阳虚则腰背头项痛；三阳
俱虚则阴气胜，阴气胜则骨寒
而痛；寒生于内，故中外皆寒；阳盛则外热，阴虚则内热，外内皆热则喘而渴，故欲冷冻饮料也。此皆得之夏伤于
暑，热气盛，藏于皮肤之内，肠胃之外，此荣气之所舍也。此令人汗空疏，腠理开，因得秋气，汗出遇风，及
得之以浴，水气舍于皮肤之内，与卫气并居。卫气者，昼日行于阳，夜行于阴，此气得阳而外出，得阴而内薄，
内外相薄，是以日作。帝曰∶其间日而作者何也？岐伯曰∶其气之舍深，内薄于阴，阳气独发，阴邪内着，阴
与阳争不得出，是以间日而作也。帝曰∶善。其作日晏与其日早者，何气使然？岐伯曰∶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，此先客于脊背也，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，二十五日下至 骨，二十六日入
于脊内，注于伏
膂之脉，其气上行，九日出于缺盆之中，其气日高，故作日益早也。其间日发者，由邪气内薄于五脏，横
连募原也，其道远，其气深，其行迟，不能与卫气俱行，不得皆出，故间日乃作也。帝曰∶夫子言卫气每至于
风府，腠理乃发，发则邪气入，入则病作。今卫气日下一节，其气之发也不当风府，其日作者奈何？岐伯曰∶
此邪气客于头项循膂而下者也，故虚实不同，邪中异所，则不得当其风府也。故邪中于头项者，气至头项而病；
中于背者，气至背而病；中于腰脊者，气至腰脊而病；中于手足者，气至手足而病。卫气之所在，与邪气相合，
则病作。故风无常府，卫气之所发，必开其腠理，邪气之所合，则其府也。帝曰∶善。
夫风之与疟也，相似同类，而风独常在，疟得有时而休者何也？岐伯曰∶风气留其处，故常在；疟气随经络沉
以内薄，故卫气应乃作。帝曰∶疟先寒而后热者何也？岐伯曰∶夏伤于大暑，其汗大出，腠理开发，因遇夏
气凄沧之水寒，藏于腠理皮肤之中，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，
故先寒而后热也，病以时作，名曰寒疟。帝曰∶先热而后寒者何也？岐伯曰∶此先伤于风而后伤于寒，故先
热而后寒也，亦以时作，名曰温疟。其但热而不寒者，阴气先绝，阳气独发，则少气烦冤，手足热而欲呕，
名曰瘅疟。
帝曰∶夫经言有余者泻之，不足者补之。今热为有余，寒为不足。夫疟者之寒，汤火不能温也，及其热，
冰水不能寒也，此皆有余不足之类。当此之时，良工不能止，必须其自衰乃刺之，其故何也？愿闻其说。岐
伯曰∶经言无刺 之热，无刺浑浑之脉，
无刺漉漉之汗，故为其病逆未可治也。夫疟之始发也，阳气并于阴，当是之时，阳虚而阴盛，外无气，故
先寒栗也。阴气逆极，则复出之阳，阳与阴复并于外，则阴虚而阳实，故先热而渴。夫疟气者，并于阳则
阳胜，并于阴则阴胜，阴胜则寒，阳胜则热。疟者，风寒之气不常也，病极则复。至病之发也，如火之热，如
风雨不可当也。故经言曰∶方其盛时必毁，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，真气得安，邪气乃亡，故工不能治其已发，为其气逆也。帝曰∶善。攻之奈何？早晏何如？
岐伯曰∶疟之且发也，阴阳之且移也，必从四末始也，阳已伤，阴从之，故先其时坚束其处，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，此真往而未得并者也。帝曰∶疟不发，其应何如？岐伯曰∶疟气者，必更盛更虚，当
气之所在也，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
复病也。帝曰∶时有间二日或至数日发，或渴或不渴，其故何也？岐伯曰∶其间日者，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。疟者，阴阳更胜也，或甚或不甚，故或渴或不渴。帝曰∶论言夏伤
于暑，秋必病疟，今疟不必应者何也？岐伯曰∶此应四时者也。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。帝曰∶夫病温疟与寒疟而皆安舍？
舍于何脏？岐伯曰∶温疟者，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，此病藏于肾，其气先从内出之于外也。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。帝
曰∶瘅疟何如？岐伯曰∶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，
风寒舍于皮肤之内、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，
气内藏于心，而外舍于分肉之间，令人消烁脱肉，故命曰瘅疟。帝曰∶善。
黄帝问道：疟疾都是由于感受风邪引起的，但它的发作和休止都有固定的时间规律，这是为什么呢？岐伯回答说：疟疾刚开始发作时，先表现为毫毛竖立，接着出现伸腰打哈欠的症状，然后开始发冷颤抖、下巴鼓动，腰部脊柱都感到疼痛；等到寒冷过去之后，体内体外都会发热，头痛得像要裂开一样，口渴想喝冷饮。黄帝说：是什么气导致这种情况的呢？我想听听其中的道理。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，则阴分实而阳分虚，阳明经气虚则出现发冷颤抖、下巴鼓动的症状；太阳经气虚则出现腰背头项部的疼痛；三阳经气都虚则阴气偏胜，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；阳气盛则体表发热，阴气虚则体内发热，内外皆热则气喘且口渴，所以想喝冷饮。这些情况都是因为夏天受了暑气的伤害，暑热之气旺盛，潜伏在皮肤之内、肠胃之外，这里是营气停留的地方。这使得人的汗孔疏松，腠理开放，因此容易受到秋风的侵袭，出汗时遇风，或者洗澡时水气侵入停留在皮肤之内，与卫气共同居住在一起。卫气白天行于阳分，夜晚行于阴分，这种邪气随着卫气出于阳分则向外发散，进入阴分则向内迫近，内外邪气相搏结，所以每天发作。黄帝说：为什么有的疟疾每隔一天发作一次呢？岐伯说：因为邪气潜伏的部位较深，内迫于阴分，阳气单独外发，阴邪内着，阴气与阳气相争而不能外出，所以每隔一天发作一次。黄帝说：好。为什么有的疟疾发作时间越来越晚，有的却越来越早呢？是什么气导致的呢？岐伯说：邪气客居在风府穴，沿着脊柱向下移动，卫气一天一夜在风府穴大会一次，第二天卫气下行一节，所以发作时间就推迟了，这是因为邪气先客居于脊背的缘故。每当卫气到达风府穴时，腠理就开放，腠理开放则邪气乘虚而入，邪气入内则疾病发作，因此每天的发作时间逐渐推迟。邪气从风府穴出发，每天下行一节，二十五天后下行至骶骨，第二十六天进入脊柱内部，注入伏膂之脉，其气上行，九天后出于缺盆穴，邪气位置日益升高，所以发作时间日益提前。至于每隔一天发作的疟疾，是因为邪气内迫于五脏，横连募原，路径遥远，邪气深沉，运行迟缓，不能与卫气同时运行，也不能同时外出，所以要隔天才发作。黄帝说：您说卫气每次到达风府穴，腠理就开放，开放后邪气就进入，进入后疾病就发作。现在卫气每天下行一节，邪气发作的位置不再对应风府穴，为什么还是每天发作呢？岐伯说：这是因为邪气客居在头项部，沿着脊柱向下走，所以虚实不同，邪气中伤的部位不同，就不一定正好对应风府穴。因此，邪气中伤头项部，卫气到达头项部则发病；中伤背部，卫气到达背部则发病；中伤腰脊，卫气到达腰脊则发病；中伤手足，卫气到达手足则发病。卫气所在之处，与邪气相合，疾病就会发作。所以风邪没有固定的处所，卫气所发的部位，必然是腠理开泄之处，邪气与之相合，那里就是邪气的处所。黄帝说：好。
风邪与疟疾相似且同类，但风邪常常持续存在，而疟疾却有定时休止的时候，这是为什么呢？岐伯说：风邪停留在它所侵犯的部位，所以常存不去；疟气则随经络深入体内，所以只有当卫气与之相会时才发作。黄帝说：为什么有的疟疾先恶寒而后发热呢？岐伯说：这是因为夏天受了大暑的伤害，大汗淋漓，腠理开发，又遇到夏季凄冷的寒水之气，寒邪潜伏在腠理和皮肤之中，秋天又伤了风邪，于是疾病就形成了。寒邪属于阴气，风邪属于阳气，先伤于寒而后伤于风，所以先恶寒而后发热，疾病按时发作，名叫寒疟。黄帝说：为什么有的疟疾先发热而后恶寒呢？岐伯说：这是因为先伤于风而后伤于寒，所以先发热而后恶寒，也是按时发作，名叫温疟。如果只发热而不恶寒，是因为阴气先竭绝，阳气独发，就会出现气短、心中烦闷冤屈、手足发热且想呕吐的症状，名叫瘅疟（dān nüè）。
黄帝说：医经上说，有余的病证用泻法，不足的病证用补法。现在发热属于有余，恶寒属于不足。患疟疾的人，恶寒时喝热水烤火都不能温暖，发热时喝冰水也不能降温，这都属于有余和不足的情况。在这个时候，即使是高明的医生也不能止住病情，必须等邪气衰退后才能针刺治疗，这是什么原因呢？我想听听您的解释。岐伯说：医经上说不要在高热时针刺，不要在脉象混乱时针刺，不要在大汗淋漓时针刺，因为这些时候病势逆乱，不可治疗。疟疾刚开始发作时，阳气并入阴分，这个时候，阳分虚而阴分盛，体表没有阳气护卫，所以先出现恶寒颤抖。阴气逆乱到极点，就会复出而归于阳分，阳与阴再次并聚于体表，则阴分虚而阳分实，所以先发热且口渴。疟疾的邪气，并入阳分则阳胜，并入阴分则阴胜，阴胜则恶寒，阳胜则发热。疟疾的风寒之气不是恒定的，病情发展到极点就会反复。到了疟疾发作的时候，热度之高就像烈火，猛烈得像风雨一样不可抵挡。所以医经上说：当邪气正盛时强行治疗必然损伤正气，趁着邪气衰退时治疗，事情一定能成功。说的就是这个道理。在疟疾未发作的时候，阴气未并入阳分，阳气未并入阴分，此时进行调理，真气得以安宁，邪气自然消散，所以医生不能在疟疾已发作时治疗，因为那时气机逆乱。黄帝说：好。那么如何攻治呢？应该在什么时候治疗呢？岐伯说：疟疾将要发作的时候，阴阳之气即将发生转移，必定从四肢末端开始。阳气已经受伤，阴气随之而来，所以在发作前先牢固地束扎患处，使邪气不得进入，阴气不得外出，仔细诊察发现孙络中充盈坚硬且有瘀血的地方，都可以刺破放血，这是在真气前往而尚未被邪气并扰的时候进行的。黄帝说：疟疾不发作的时候，脉象反应是怎样的？岐伯说：疟疾的邪气，总是盛衰交替的，根据邪气所在的位置而定：病在阳分，则发热且脉象躁急；病在阴分，则恶寒且脉象平静；到了极点则阴阳俱衰，卫气分离，所以疾病得以休止；卫气重新聚集，则疾病复发。黄帝说：有时疟疾间隔两天或几天才发作一次，有的口渴，有的不口渴，这是什么原因呢？岐伯说：那些间隔几天发作的，是因为邪气与卫气客居在六腑，有时不能相遇，不能相得，所以要休息几天才发作。疟疾是阴阳之气交替偏胜的结果，偏胜程度有深有浅，所以有的口渴，有的不口渴。黄帝说：医论中说夏天伤于暑气，秋天必定患疟疾，现在的疟疾不一定符合这个规律，为什么呢？岐伯说：这也是顺应四时变化的。病情表现不同的，是违背了四时规律的。在秋天患病的，恶寒严重；在冬天患病的，恶寒较轻；在春天患病的，怕风；在夏天患病的，多汗。黄帝说：温疟和寒疟的病邪分别藏在哪里？藏在哪个脏腑？岐伯说：温疟，是冬天中了风邪，寒气潜伏在骨髓之中，到了春天阳气大发，邪气不能自行排出，又遇到大暑天气，脑髓受热煎熬，肌肉消瘦，腠理开泄，或者有所用力劳作，邪气随着汗水一起排出，这种病邪藏在肾中，其气先从体内发出到体表。像这样的情况，阴虚而阳盛，阳盛则发热，衰退时气又反回体内，入内则阳虚，阳虚则恶寒，所以先发热而后恶寒，名叫温疟。黄帝说：瘅疟又是怎样的呢？岐伯说：瘅疟患者，肺中素有热气，热气充斥全身，气机厥逆上冲，中焦气实而不能外泄，又因有所用力劳作，腠理开泄，风寒邪气停留在皮肤之内、分肉之间而发病，发病时阳气亢盛，阳气亢盛不衰则生病。其气不及于阴分，所以只发热而不恶寒，气内藏于心，外舍于分肉之间，使人肌肉消烁脱失，所以名叫瘅疟。黄帝说：好。
Huangdi asked, "Malaria is all caused by wind pathogen. Why does it have a specific time for its accumulation and recurrence?" Qibo replied, "When malaria first begins to manifest, it starts with the erection of fine hairs, followed by stretching and yawning. Then chills occur, with trembling of the jaw, and pain in the waist and spine. When the cold subsides, both the interior and exterior become hot, causing severe headache as if splitting, and thirst for cold drinks." The Emperor said, "What qi causes this? I wish to hear the principle." Qibo said, "It is due to the contention between Yin and Yang above and below, the alternation of deficiency and excess, and the shifting of Yin and Yang. When Yang merges into Yin, Yin becomes full and Yang becomes deficient. Deficiency of the Yangming meridian leads to chills and jaw trembling; deficiency of the Greater Yang (Taiyang) meridian leads to pain in the back, head, and neck; when all three Yang meridians are deficient, Yin qi prevails. Prevailing Yin qi causes bone coldness and pain. Cold generated internally results in coldness inside and out. Excess Yang causes external heat, while Yin deficiency causes internal heat. When both interior and exterior are hot, panting and thirst occur, hence the desire for cold drinks. All these result from summer damage by summer-heat. The intense heat qi hides within the skin but outside the stomach and intestines, where Ying Qi resides. This causes sweat pores to be open and interstices to relax. Consequently, autumn air can invade; sweat exposed to wind, or bathing water entering the skin, allows water qi to reside within the skin, coexisting with Wei Qi. Wei Qi travels through Yang during the day and Yin at night. This pathogen moves outward when encountering Yang and presses inward when encountering Yin. The mutual pressing of interior and exterior pathogens results in daily attacks." The Emperor said, "Why do some cases attack every other day?" Qibo said, "Because the pathogen resides deeply, pressing inward on Yin. Yang Qi alone erupts externally, while Yin pathogen adheres internally. Yin and Yang contend but cannot exit together, hence the every-other-day attack." The Emperor said, "Good. Why do some attacks occur later each day, while others occur earlier? What qi causes this?" Qibo said, "The pathogen lodges in Fengfu (GV16) and descends along the Du meridian. Wei Qi gathers at Fengfu once every day and night. The next day, it descends one vertebral level. Thus, the attack is delayed. This is because the pathogen first lodged in the back. Whenever it reaches Fengfu, the interstices open. When interstices open, the pathogen enters. When the pathogen enters, the disease manifests. Therefore, the attack time gradually delays. From Fengfu, descending one level daily, after twenty-five days it reaches the sacrum. On the twenty-sixth day, it enters the spine, pouring into the Fu Lü vessel. Its qi ascends, emerging from Quepen (ST12) after nine days. As the qi rises daily, the attack occurs earlier each day. For every-other-day attacks, the pathogen presses inward on the Zang organs and connects horizontally to the Mu Yuan (sea of origin). The path is long, the qi is deep, and its movement is slow. It cannot move with Wei Qi nor exit together, so it manifests only every other day." The Emperor said, "You stated that whenever Wei Qi reaches Fengfu, the interstices open, allowing the pathogen to enter and cause disease. Now, since Wei Qi descends one level daily, its eruption no longer corresponds to Fengfu. Why does it still attack daily?" Qibo said, "This is because the pathogen lodged in the head and neck and descended along the Du meridian. Thus, deficiency and excess differ, and the site of pathogen invasion differs, so it does not necessarily correspond to Fengfu. Therefore, if the pathogen invades the head and neck, disease manifests when Qi reaches the head and neck; if it invades the back, disease manifests when Qi reaches the back; if it invades the waist and spine, disease manifests when Qi reaches the waist and spine; if it invades the hands and feet, disease manifests when Qi reaches the hands and feet. Wherever Wei Qi is located, if it combines with the pathogen, disease manifests. Thus, Wind has no fixed abode. Wherever Wei Qi erupts, opening the interstices, and where the pathogen combines, there lies its abode." The Emperor said, "Good. Wind and Malaria are similar and of the same category, yet Wind persists constantly, while Malaria has periods of rest. Why?" Qibo said, "Wind pathogen remains in its location, thus persisting. Malaria pathogen follows the collaterals and sinks inward, thus manifesting only when Wei Qi responds." The Emperor said, "Why does some Malaria begin with chills followed by fever?" Qibo said, "Summer damage by extreme heat causes profuse sweating and open interstices. Encountering cold water qi from summer, cold pathogen hides in the interstices and skin. Autumn damage by wind completes the disease. Cold is Yin Qi; Wind is Yang Qi. Injury by cold first, then by wind, results in chills first, then fever. Manifesting at regular times, it is named Han Nüe (Cold Malaria)." The Emperor said, "Why does some Malaria begin with fever followed by chills?" Qibo said, "Injury by wind first, then by cold, results in fever first, then chills. Manifesting at regular times, it is named Wen Nüe (Warm Malaria). If there is only fever without chills, it is because Yin Qi is exhausted first, and Yang Qi erupts alone. This causes shortness of breath, vexation, heat in the hands and feet, and desire to vomit. It is named Dan Nüe (Intense Heat Malaria)."
The Emperor said, "The Classics state: excess is drained, deficiency is tonified. Now, heat is excess, and cold is deficiency. In Malaria, chills are such that soup and fire cannot warm them; fever is such that ice and water cannot cool them. These belong to excess and deficiency. At such times, even skilled physicians cannot stop it; they must wait for spontaneous decline before needling. Why? I wish to hear the explanation." Qibo said, "The Classics state: Do not needle when heat is high; do not needle when the pulse is chaotic; do not needle when sweat is dripping. Because the disease pattern is reversed, treatment is not possible. When Malaria first manifests, Yang merges into Yin. At this time, Yang is deficient and Yin is abundant. There is no Qi on the exterior, hence chills and trembling occur first. When Yin Qi reverses to its extreme, it returns to Yang. Yang and Yin merge again on the exterior, resulting in Yin deficiency and Yang excess. Hence, fever and thirst occur first. The Malaria pathogen, merging into Yang, makes Yang prevail; merging into Yin, makes Yin prevail. Yin prevailing causes cold; Yang prevailing causes heat. The wind-cold qi of Malaria is not constant; when the disease reaches extremity, it recurs. When Malaria manifests, the heat is like fire, fierce like wind and rain. Thus, the Classics say: 'When the pathogen is strong, attacking will destroy [the patient]; when it is weak, treating will prosper.' This refers to this situation. Before Malaria manifests, Yin has not merged into Yang, and Yang has not merged into Yin. Regulating at this time allows True Qi to settle and Pathogenic Qi to perish. Thus, skilled physicians cannot treat after manifestation because the Qi is reversed." The Emperor said, "Good. How should it be attacked? When should it be treated?" Qibo said, "When Malaria is about to manifest, Yin and Yang are about to shift. It must start from the four extremities. Yang is already injured, and Yin follows. Therefore, bind the area firmly before the onset, preventing pathogen entry and Yin Qi exit. Carefully observe and take any Sun Luo (collaterals) that are full, hard, and bloody. This is when True Qi goes forth but has not yet been merged by the pathogen." The Emperor said, "What is the response when Malaria is not manifesting?" Qibo said, "Malaria pathogen alternates between abundance and deficiency. Depending on its location: if in Yang, there is heat and a restless pulse; if in Yin, there is cold and a quiet pulse. At the extreme, both Yin and Yang decline, and Wei Qi separates, so the disease rests. When Wei Qi gathers, the disease recurs." The Emperor said, "Sometimes Malaria occurs after two days or several days, sometimes with thirst, sometimes without. Why?" Qibo said, "For those occurring after intervals, the pathogen and Wei Qi reside in the Six Fu organs but sometimes miss each other, unable to interact, hence resting for several days before manifesting. Malaria is the alternating prevalence of Yin and Yang. Sometimes it is severe, sometimes not, hence sometimes thirsty, sometimes not." The Emperor said, "Discourses state: Summer damage by summer-heat leads to Autumn Malaria. Why do current cases not always correspond?" Qibo said, "This corresponds to the Four Seasons. Cases with different manifestations go against the seasons. Those manifesting in Autumn have severe cold; those in Winter have mild cold; those in Spring fear wind; those in Summer sweat profusely." The Emperor said, "Where do the pathogens of Wen Nüe and Han Nüe lodge? Which Zang organ?" Qibo said, "Wen Nüe originates from winter wind injury. Cold qi hides in the bone marrow. By spring, Yang Qi erupts greatly, but the pathogen cannot exit spontaneously. Encountering great summer heat, the brain marrow melts, muscles waste, interstices vent, or due to exertion, the pathogen exits with sweat. This disease lodges in the Kidney. Its Qi first emerges from the interior to the exterior. In such cases, Yin is deficient and Yang is excessive. Yang excess causes heat. When it declines, Qi returns inward. Inward return causes Yang deficiency, leading to cold. Hence, fever first, then chills, named Wen Nüe." The Emperor said, "What about Dan Nüe?" Qibo said, "Dan Nüe patients have pre-existing heat in the Lungs, with heat filling the body. Rebellious Qi rushes upward, Middle Jiao Qi is full but does not vent outward. Due to exertion, interstices open, and wind-cold lodges between the skin and muscle layers. Upon manifestation, Yang Qi becomes excessive. If Yang excess does not decline, disease occurs. Its Qi does not reach Yin, hence only fever without chills. The Qi lodges internally in the Heart and externally in the muscle layers, causing wasting and emaciation. Hence named Dan Nüe." The Emperor said, "Good."