风雨寒暑，皆为疟病。日作之疟，卫气应乃作，邪客脊背，循风府而日下一节，则发日晏。出于
风府，注伏膂而上出缺盆，则发日早。邪薄五脏，横连募原，则间日乃作。邪与卫气，客于六腑，
循行失度，则间二日，或休数日乃作。夏伤水寒，秋伤于风，则为先寒后热之寒疟。冬中风寒，藏于骨髓，夏
暑乃发，则为先热后寒之温疟。肺素有热，用力劳形，气不归阴，内藏于心，舍于分肉，则为但热不寒之瘅疟。
黄帝问曰∶夫 疟皆生于风，其蓄作有时者，何也？
疟，阴疟也。《生气通天论》云，夏伤于暑，秋为 疟。帝问 疟皆生于风，谓 疟不必尽生于
暑，而有生于风者。 ，阴疟也。疟，阳疟也。故曰皆也。蓄，犹藏也。作，犹发也有时，或日发或间日发也。
岐伯对曰∶疟之始发也，先起于毫毛，伸欠乃作寒栗鼓颌，腰
脊俱痛，寒去，则内外皆热，头痛如破，渴欲冷冻饮料。
伸欠，欲伸而欠不自如也。凡疟之始发也，先起于毫毛之伸欠，乃作寒栗鼓颌，而腰脊俱痛。始
则寒栗鼓颌，继则寒去，内外皆热，始渴，腰脊俱痛，继则头痛如破，内外皆热，则渴欲冷冻饮料。
帝曰∶何气使然？愿闻其道。
道，犹路也。寒热之作，何气使然？而愿闻其出入之道。
岐伯曰∶阴阳上下交争，虚实更作，阴阳相移也。
更，平声，下同。疟之发也，阴气不和于阳，阳气不和于阴，故阴阳上下交争。阳争于上，则阳实阴
虚；阴争于下，则阴实阳虚，上下交争，则虚实更作。交争更作，则阴阳相移也。
阳并于阴，则阴实而阳虚。
相移者，相并之义。如阳气相移而并于阴，则阴实而阳虚，须
知阴气相移而并于阳，则阳实而阴虚，不言者，省文也。
阳明虚，则寒栗鼓颌也。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。
所谓阴实阳虚者，如阳明虚则寒栗鼓颌也。阳明经脉，行身之前。颌，面下也。巨阳虚，则腰背头项
痛。巨阳经脉，行身之背，从头至腰，皆在背也。阳明太阳既虚，而少阳亦虚，则三阳俱虚，
俱虚则阴气胜，阴气胜则骨寒而痛。少阳属肾主骨，此寒生于内，故中外皆寒，少阳经脉，行身之侧，
枢转阴阳，司中外也。此申明阳并于阴，则阴实阳虚也。
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。
申明阳实阴虚者，阳主外，阳盛则外热；阴主内，阴虚则内热。外内皆热，阳气过盛，则喘而渴，故
欲冷冻饮料也。此申明阴并于阳，则阳实阴虚也。由此推之，则上文之寒栗鼓颌，腰背俱痛，内
外皆热，头痛如破，渴欲冷冻饮料，皆病三阳之气，亦阴实阳虚，阳实阴虚之所致也。
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。
藏，如字，空、孔通。通承上文之意，而言此三阳疟病，皆得之夏伤于暑，暑热气盛，藏于皮肤之内，肠
胃之外。夫皮肤之内，肠胃之外，此荣气之所舍也。暑热伤荣，则肌表不和，此令人汗孔
疏而腠理开也。汗孔疏，腠理开，暑月之时，因得秋凉之气，是汗
出遇风及得之以浴水气，风水之气舍于皮肤之内，则于卫气并居也。夫卫气者，昼日行于阳二十五周，夜
行于阴二十五周，疟之发也，必卫气应乃作。此卫气得日阳而外出，得夜阴而内薄。内外相
薄，遇邪则发，是以日作。此言暑风寒水之气，而有三阳之疟病也。
帝曰∶其间日而作者，何也？
间，去声，下间日之间同。承上文日作，而问间日之作也。
岐伯曰∶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。
此段，旧本在故作日益早也之下，今改正于此。其疟间日发者，由邪气内薄于五脏之阴，横连膏膜
之募原也。其道远，其气深，道远气深，其行于皮肤也迟。卫气夜行于阴，日行于阳，一日
乃出。五脏之气，三日乃出，不能与卫气俱行，一日不得皆出，故间日乃作，而交于三日之首也。
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。
此复申明上文之意，横连募原，则其气之舍深，薄于五脏，则内薄于阴，道远气深行迟，则阳气独发，
阴邪内着矣。不能与卫气俱行，不得皆出，则阴与阳争不得出矣，是以交三日之首，间日而作也。
帝曰∶善。其作日晏，与其日早者，何气使然？
间日之疟，其气舍深，日作之疟，气舍不深，帝故善之。其疟日作而早晏不同，则何气使然？
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。
疟邪随经，经气不足，病气下入，则疟作日晏。经气有余，病气上出，则疟作日早，故假邪气之
入于风府，出于风府者，以明之，邪气客于风府，经气不足，则循膂而下，卫气一日一夜常大会
于风府，卫气之行，其明日日下一节，周时至于风府，不与邪遇，必循膂而下乃遇，故其作也晏。此
从风府而下，乃邪气之先客于脊背也。
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。
申明邪气之所以客于风府者，以卫气每至于风府，则腠理开，
腠理开则邪气入，邪气入则疟病作，邪气循膂而下，以此日作稍益晏也。益者，渐次之谓。
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。
若其气不循膂而下，则出于风府。夫卫气之行，日下一节。二十一日，下至 骨。二十二日，入
于脊内，注于伏膂之脉，今病气不循膂而下，则其气上行，卫气循经，一月一周，故九日出于缺盆
之中，其气上行，则其气日高，故作日益早也。此假病气之入于风府，则从上而下，出于风府，则从下
而上，以明日作之疟，而有早晏之不同也。
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？
复举岐伯之言，而问卫气日下一节，其气之发，不当风府，其日作而不早晏者奈何？
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
至于足而病，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。
中，去声。此言卫气与邪相合之处，即为风府，邪中异所，无常府也。卫气日下一节，不当风府者，此
邪气客于头项，循膂而下者也。经气虚则循膂而下，经气实则其气上行，故虚实不同，有从
风府而入，有不从风府而入，是邪中异所，不得定当其风府也。故邪中于头项者，卫气至头项而病，中
于背者，卫气至背而病。中于腰脊者，卫气至腰脊而病。中于手足者，卫气至手足而病，此卫气
循行之所在，与邪气相合，则病乃作，故风无常府，卫气之所发，必开其腠理，与邪气之所合，则其
府也。愚按上文风邪客于头项，行身之背，太阳经气之疟也。其气上行，出于缺盆之中，行身之前，
阳明经气之疟也。此邪中于头项背腰手足，无有定处，少阳经气之疟也。
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？
风邪合而为府，不必定当风府，帝故善之。复问风之与疟，风则善行数变，疟则寒热更移，相
似同类，而风伤经脉，风独常在，疟之发也，得有时而休，其故何也？
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。
处，去声，下同。风伤经脉则风气留其处，故常在，疟气外发，随经络而沉以内薄，则有时而休，
故明日卫气应乃复作。此一节，论阴阳寒热之疟，有日发间日之浅深，早晏经络之虚实也。
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。
藏，如字。先寒后热，名曰寒疟，夏暑无寒，有凄沧之水寒，至秋复伤于风。先伤寒，后伤风，
故先寒后热，病以时作者，发作有时，无早晏也。
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。
先热后寒，名曰温疟，乃先伤于风，后伤于寒，故先热后寒，亦以时作，无早晏也。
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。
承上文，温疟而言，其但热不寒者，名曰瘅疟，绝无阴寒之气，是阴气先绝，阴气先绝，故不寒，独
有阳气之发，是阳气独发，阳气独发，故但热。阴气先绝，水不济火则少气烦冤，阳气独发，火
热上炎，故手足热而欲呕。瘅症之外，更有牝疟，见《金匮要赂》中。
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。
疟必自衰乃刺，故引《灵枢·根结》论之言，而言当寒热之时，虽良工不能止，其故何也？
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。
为，去声，下同。《灵枢·逆顺》论云，刺法曰，无刺 之热，无刺漉漉之汗，无刺浑浑
之脉，无刺病与脉相逆者，故为其病逆，犹言其病与脉相逆也，此皆未可刺治也。引经言，而对帝之经言也。
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。
疟发有先寒栗者，故夫疟之始发也，阳气内并于阴，当阳气并
阴之时则阳虚而阴盛；阳主外，主气，阳虚故外无气，外无气而阴盛，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。
疟发有先热渴者，阴气虚而内逆，极则阴气复出之阳，是阳与
阴，复并于外，并于外则阴虚而阳实，阴虚则热，阳实则渴，故先热而渴也。
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。
疟发先寒则后热，先热则后寒。故夫疟气者，并于阳则阳胜而热，并于阴则阴胜而寒。风气为阳，阳胜
则热，寒气为阴，阴胜则寒。是症者，风寒之气不常也。寒极则热，热极则寒，故病极则复至。
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。
经言，《灵枢·逆顺》论之言也，毁，伤也。疟病之发也，热如火之热，寒如风雨不可当。故经言曰，
方其盛时而治之，正气必毁，因其衰也而治之，事必大昌，即此火热风雨不可当之谓也。
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。
自衰乃刺，不若因其未发而调治之，故夫疟之未发也。阴未并
阳，阳未并阴，因而调之，真气得安，邪气乃亡，疟之已发，虽良工不能治，为其气之逆乱也。
帝曰∶善。攻之奈何？早晏何如？
攻，治也。早谓治其未发。晏谓治其已衰，承上文治其未发，刺其已衰之意，而复问也。
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。
刺其已衰，上文已详言之，故此但言治其未发，且者，未定之辞，疟之将发未发也。阴阳之
将移未移也，必从手足之四末始也。盖三阴三阳之气，从手足之井荥而出入更移，如病在阳，而阳已伤，
则阴从之而亦伤，故当先其未发之时，坚束其四末之处，令邪气之在此经者，不得入于彼经，彼经
之阴气，不得出而并于此经，审候其脉，而见其证，见其在孙络盛坚而血者，皆取刺之，此真气自往
而未得交并之时也，此治未发之也道。
帝曰∶疟不发其应何如？
承上文治未发之意，问疟病不发之时，其脉候证候，何如而应。
岐伯曰∶疟气者，必更盛更虚，当气之所在与，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。
疟气者，寒热相胜，阴阳交极，故必更盛更虚，无有定也。由此言之，则疟不发，无所应矣。惟当疟
风雨寒暑，都会导致疟病。每天发作的疟疾，是卫气运行到邪气所在之处时才发作。邪气客居在脊背，沿着风府穴每日向下移动一节脊椎，那么发作时间就会一天比一天晚。如果邪气从风府穴出来，注入伏膂脉并向上行至缺盆穴，那么发作时间就会一天比一天早。邪气迫近五脏，横向连接募原（脏腑之间的膜原），就会隔日发作。邪气与卫气客居于六腑，循行失去常度，就会隔两天发作，或者休息几天才发作。夏天被水寒之气所伤，秋天感受风邪，就会形成先冷后热的寒疟。冬天感受风寒，邪气藏在骨髓中，到了夏天暑热时节才发作，就会形成先热后冷的温疟。肺脏原本有热，加上用力劳作使形体疲惫，气不能归于阴分，内藏于心，停留于分肉之间，就会形成只热不冷的瘅疟（dān nüè，一种但热不寒的疟疾）。
黄帝问道：疟病都生于风邪，但它们发作和停止都有定时，这是为什么呢？
疟，指阴疟。《生气通天论》说，夏天伤于暑气，秋天会得疟疾。黄帝问疟病都生于风，意思是疟病不一定全由暑气引起，也有由风邪引起的。这里的“疟”指阴疟，“疟”（此处指另一种疟疾，或泛指阳疟）指阳疟。所以说“皆”。蓄，就是藏的意思。作，就是发的意思。有时，指有的每天发作，有的隔日发作。
岐伯回答说：疟病刚开始发作时，先从毫毛竖起开始，接着打哈欠伸懒腰，然后出现寒战、牙齿打颤，腰部和脊柱都疼痛。寒气退去后，体内体外都发热，头痛得像要裂开一样，口渴想喝冷饮。
伸欠，是想伸展却不由自主地打哈欠。凡是疟病刚开始发作，先从毫毛处的伸欠开始，接着出现寒战、牙齿打颤，腰脊俱痛。起初是寒战、牙齿打颤，随后寒气退去，体内体外都发热，起初口渴，腰脊疼痛，随后头痛欲裂，体内体外都发热，于是想喝冷饮。
黄帝说：是什么气造成这种情况的呢？我想听听其中的道理。
道，就是路径的意思。寒热发作，是什么气造成的呢？我想听听其出入的路径。
岐伯说：阴阳上下交争，虚实交替变化，这是阴阳相互移易的结果。
更，读平声，以下同。疟病发作时，阴气不和于阳，阳气不和于阴，所以阴阳上下交争。阳争于上，则阳实阴虚；阴争于下，则阴实阳虚。上下交争，虚实交替变化。交争交替变化，就是阴阳相互移易。
阳气并入阴分，则阴实而阳虚。
相移，就是相并的意思。如阳气相移而并入阴分，则阴实而阳虚。须知阴气相移而并入阳分，则阳实而阴虚，文中没说是为了省略文字。
阳明经气虚，就会出现寒战、牙齿打颤。太阳经气虚，会出现腰、背、头、项疼痛。三阳经气都虚，则阴气胜。阴气胜则骨头寒冷疼痛，寒气生于内部，所以内外都寒冷。
所谓阴实阳虚，比如阳明经气虚则寒战、牙齿打颤。阳明经脉，行走在身体前面。颌，指面下部。太阳经气虚，则腰背头项疼痛。太阳经脉，行走在身体后面，从头到腰都在背部。阳明、太阳既虚，少阳也虚，则三阳经气都虚。都虚则阴气胜，阴气胜则骨头寒冷疼痛。少阳属肾主骨，这寒气生于内部，所以内外都寒冷。少阳经脉，行走在身体侧面，枢转阴阳，主管内外。这是在阐明阳气并入阴分，则阴实阳虚。
阳气盛则体表发热，阴气虚则体内发热。体表体内都发热，就会气喘且口渴，所以想喝冷饮。
这是在阐明阳实阴虚的情况。阳主外，阳气盛则体表发热；阴主内，阴气虚则体内发热。体表体内都发热，阳气过盛，就会气喘且口渴，所以想喝冷饮。这是在阐明阴气并入阳分，则阳实阴虚。由此推断，上文提到的寒战、牙齿打颤，腰背俱痛，体内体外都发热，头痛欲裂，想喝冷饮，都是病在三阳之气，也是阴实阳虚、阳实阴虚所致。
这些疟病都是因为夏天伤于暑气，热气旺盛，藏在皮肤之内，肠胃之外，这是营气所居之处。这使得人的汗孔疏松，腠理开放，因此容易受到秋气的侵袭，出汗时遇风，以及洗澡时受水气侵袭，邪气停留在皮肤之内，与卫气同居。卫气，白天行于阳分，夜晚行于阴分。这种邪气遇到阳分就外出，遇到阴分就内迫；内外相搏，所以每天发作。
藏，读原音，空、孔相通。承接上文之意，说这三种阳疟病，都是因为夏天伤于暑气，暑热气盛，藏在皮肤之内，肠胃之外。皮肤之内，肠胃之外，是营气所居之处。暑热伤了营气，则肌表不和，这使得人汗孔疏、腠理开。汗孔疏，腠理开，在暑月之时，因受到秋凉之气的影响，是出汗遇风以及洗澡受水气侵袭，风水之气停留在皮肤之内，则与卫气同居。卫气，白天行于阳分二十五周，夜晚行于阴分二十五周。疟病发作，必须卫气运行到相应部位时才发作。这种卫气得到白天的阳气就外出，得到夜晚的阴气就内迫。内外相搏，遇到邪气就发作，所以每天发作。这是在说暑、风、寒、水之气，导致了三种阳疟病。
黄帝说：那些隔日发作的，是什么原因呢？
间，读去声，以下的“间日”之“间”同义。承接上文每天发作，而问隔日发作的原因。
岐伯说：那些隔日发作的，是因为邪气内迫于五脏，横向连接募原。它的路径远，气机深，运行迟缓，不能与卫气一起运行，不能完全外出，所以隔日才发作。
这段文字，旧版本在“故作日益早也”之下，现在改正到这里。疟病隔日发作，是因为邪气内迫于五脏之阴，横向连接膏膜的募原。它的路径远，气机深，路径远气机深，它在皮肤中的运行就迟缓。卫气夜晚行于阴分，白天行于阳分，一天才能出来。五脏之气，三天才能出来，不能与卫气一起运行，一天不能完全出来，所以隔日发作，而在第三天的开头交接。
邪气潜伏很深，内迫于阴分，阳气单独发作，阴邪内着，阴与阳争，不能外出，所以隔日发作。
这是在再次阐明上文的意思，横向连接募原，则邪气潜伏很深；内迫于五脏，则内迫于阴分；路径远、气机深、运行迟，则阳气单独发作，阴邪内着了。不能与卫气一起运行，不能完全外出，则阴与阳争而不能出，所以在第三天开头交接，隔日发作。
黄帝说：好。那些发作时间推迟和提前的，是什么气造成的呢？
隔日的疟疾，邪气潜伏深；每天的疟疾，邪气潜伏不深，黄帝因此称赞。那些每天发作但早晚不同的疟疾，是什么气造成的呢？
岐伯说：邪气客居在风府穴，沿着脊背向下，卫气一天一夜常在风府穴大会。第二天卫气向下移动一节，所以发作时间推迟，这是因为邪气先客居在脊背上。
疟邪随经络下行，经气不足，病气下入，则疟疾发作时间推迟。经气有余，病气上出，则疟疾发作时间提前。所以借邪气进入风府、出于风府来说明这个问题。邪气客居在风府，经气不足，则沿着脊背向下。卫气一天一夜常在风府穴大会。卫气的运行，第二天向下移动一节，直到到达风府，不与邪气相遇，必须沿着脊背向下走才能相遇，所以发作时间推迟。这是从风府向下，是邪气先客居在脊背上。
每次卫气到达风府，腠理就开放，腠理开放则邪气进入，邪气进入则疾病发作，因此每天发作的时间逐渐推迟。
阐明邪气之所以客居在风府，是因为卫气每次到达风府，腠理就开放，腠理开放则邪气进入，邪气进入则疟疾发作。邪气沿着脊背向下，因此每天发作的时间逐渐推迟。“益”，是逐渐的意思。
邪气从风府出来，每天向下移动一节，二十一天后，下行至骶骨。第二十二天，进入脊内，注入伏膂脉，邪气上行，九天之后出于缺盆穴。邪气位置越来越高，所以发作时间一天比一天早。
如果邪气不沿着脊背向下，而是从风府出来。卫气的运行，每天向下移动一节。二十一天后，下行至骶骨。第二十二天，进入脊内，注入伏膂脉。现在病气不沿着脊背向下，而是上行。卫气循经运行，一个月一周天，所以九天之后出于缺盆穴。邪气上行，位置越来越高，所以发作时间一天比一天早。这是假设病气进入风府，则从上而下；出于风府，则从下而上，以此说明每天发作的疟疾，会有早晚的不同。
黄帝说：先生曾说卫气每次到达风府，腠理才开放，开放则邪气进入，进入则疾病发作。现在卫气每天向下移动一节，卫气发作的地方，不再对应风府，那每天发作的疟疾是怎么回事呢？
再次引用岐伯的话，问卫气每天向下移动一节，卫气发作的地方，不对应风府，那每天发作且不涉及早晚变化的疟疾是怎么回事？
岐伯说：这是因为邪气客居在头项部，沿着脊背向下。所以虚实不同，邪气侵入的部位不同，就不一定对应风府了。所以邪气中于头项，气至头项而发病；中于背部，气至背部而发病；中于腰脊，气至腰脊而发病；中于手足，气至于足而发病。卫气所在之处，与邪气相合则疾病发作。所以风没有固定的风府，卫气所发之处，必定开启其腠理，邪气与之相合之处，就是它的“府”。
中，读去声。这是说卫气与邪气相合之处，即为风府，邪气侵入部位不同，没有固定的风府。卫气每天向下移动一节，不对应风府，是因为邪气客居在头项，沿着脊背向下。经气虚则沿着脊背向下，经气实则气机上行，所以虚实不同，有从风府而入的，有不从风府而入的，是邪气侵入部位不同，不一定定在风府。所以邪气中于头项，卫气至头项而发病；中于背部，卫气至背部而发病；中于腰脊，卫气至腰脊而发病；中于手足，卫气至手足而发病。这是卫气循行的所在，与邪气相合，疾病才发作。所以风没有固定的风府，卫气所发之处，必定开启其腠理，与邪气相合之处，就是它的“府”。我按：上文风邪客居在头项，行走在身体背部，是太阳经气的疟疾。其气上行，出于缺盆，行走在身体前面，是阳明经气的疟疾。此邪气中于头项、背、腰、手足，没有固定位置，是少阳经气的疟疾。
黄帝说：好。风邪与疟疾，相似且同类，但风邪常常存在，疟疾却有间歇期，这是为什么呢？
风邪结合成为“府”，不一定定在风府，黄帝因此称赞。又问风与疟，风善行数变，疟寒热更移，相似同类，但风伤经脉，风邪常常存在，疟疾发作时有间歇，这是什么原因？
岐伯说：风邪留在其处，所以常常存在；疟气随经络深入体内，所以卫气运行到相应部位时才发作。
处，读去声，以下同。风伤经脉则风邪留在其处，所以常常存在；疟气外发，随经络深入体内，则有间歇期，所以第二天卫气运行到相应部位时才再次发作。这一段，论述阴阳寒热的疟疾，有每天发作和隔日发作的浅深区别，有早晚发作的经络虚实区别。
黄帝说：疟疾先冷后热的，是什么原因呢？岐伯说：夏天伤于大暑，汗大量流出，腠理开发，因而遇到夏天凄冷的水寒之气，藏在腠理皮肤之中，秋天再伤于风邪，病就形成了。寒，是阴气。风，是阳气。先伤于寒，后伤于风，所以先冷后热。疾病按时发作，名叫寒疟。
藏，读原音。先冷后热，名叫寒疟。夏天暑热无寒，但有凄冷的水寒之气，到了秋天再伤于风。先伤寒，后伤风，所以先冷后热。疾病按时发作，发作有定时，没有早晚之分。
黄帝说：先热后冷的，是什么原因呢？岐伯说：这是先伤于风，后伤于寒，所以先热后冷。也按时发作，名叫温疟。
先热后冷，名叫温疟，是先伤于风，后伤于寒，所以先热后冷。也按时发作，没有早晚之分。
那种只热不冷的，是阴气先绝，阳气独发，就会气短、烦闷，手足发热且想呕吐，名叫瘅疟。
承接上文温疟而言，那种只热不冷的，名叫瘅疟，完全没有阴寒之气，是阴气先绝，阴气先绝所以不冷，只有阳气独发，阳气独发所以只热。阴气先绝，水不济火则气短烦闷，阳气独发，火热上炎，所以手足发热且想呕吐。除了瘅疟之外，还有牝疟，见《金匮要略》中。
黄帝说：经文说有余的泻它，不足的补它。现在热为有余，寒为不足。疟疾的寒冷，用汤火也不能温暖；等到发热时，用冰水也不能使其冷却。这都属于有余不足之类，在这个时候，高明的医生也不能制止，必须等它自行衰退才能针刺。这是什么原因呢？我想听听解释。
疟疾必须自行衰退才能针刺，所以引用《灵枢·根结》篇的话，说在寒热发作的时候，即使是高明医生也不能制止，这是什么原因？
岐伯说：经文说不要刺高热时的疟疾，不要刺脉象混乱的，不要刺大汗淋漓的，因为此时病情逆乱，不可治疗。
为，读去声，以下同。《灵枢·逆顺》篇说，刺法规定，不要刺高热时的疟疾，不要刺大汗淋漓的，不要刺脉象混乱的，不要刺病证与脉象相逆的，因为此时病情逆乱，犹言病证与脉象相逆，这些都不可针刺治疗。引用经文，是对答黄帝的经文提问。
疟病刚开始发作时，阳气并入阴分，这个时候，阳虚而阴盛，体表没有阳气，所以先出现寒战。
疟病发作有先寒战的，所以疟病刚开始发作时，阳气内并于阴分，当阳气并入阴分时，则阳虚而阴盛；阳主外、主气，阳虚故体表没有阳气，体表没有阳气而阴盛，所以先出现寒战。
阴气逆乱，极盛则复出至阳分，阳与阴复并于体表，则阴虚而阳实，所以先发热且口渴。
疟病发作有先热渴的，阴气虚而内逆，极盛则阴气复出至阳分，是阳与阴复并于体表，并于体表则阴虚而阳实，阴虚则热，阳实则渴，所以先发热且口渴。
疟气，并入阳分则阳胜，并入阴分则阴胜。阴胜则寒，阳胜则热。疟疾的风寒之气是不恒定的，病极则复发。
疟病发作先寒则后热，先热则后寒。所以疟气，并入阳分则阳胜而热，并入阴分则阴胜而寒。风气为阳，阳胜则热，寒气为阴，阴胜则寒。这个病症，风寒之气是不恒定的。寒极则热，热极则寒，所以病极则复发。
疾病发作时，像火的炎热，像风雨的猛烈，不可抵挡。所以经文说，当其盛时治疗，必伤正气；因其衰时治疗，事必大吉，说的就是这个道理。
经文，指《灵枢·逆顺》篇的话。毁，损伤。疟病发作，热如火热，寒如风雨不可抵挡。所以经文说，当其盛时而治之，正气必受损；因其衰时而治之，事情必大吉，即此火热风雨不可抵挡之意。
疟疾未发作时，阴未并入阳，阳未并入阴，趁机调治，真气得以安宁，邪气乃消亡，所以医生不能在已发作时治疗，因为此时气机逆乱。
待其衰退再针刺，不如趁其未发作时调治。所以疟疾未发作时，阴未并入阳，阳未并入阴，趁机调治，真气得以安宁，邪气乃消亡。疟疾已发作，虽高明医生也不能治，因为此时气机逆乱。
黄帝说：如何攻治？早晚如何把握？
攻，即治。早指治其未发。晏指治其已衰。承接上文治其未发、刺其已衰的意思，再次发问。
岐伯说：疟疾将要发作时，阴阳之气将要移易，必定从四肢末端开始。阳已受伤，阴随之受伤，所以在发作之前，牢固束缚患处，令邪气不得入，阴气不得出，仔细诊察，见到孙络盛大坚实且有瘀血者，都予以针刺，这是真气前往而尚未交并的时候。
刺其已衰，上文已详细说过，所以这里只说治其未发。“且”，是未定的词，指疟疾将发未发。阴阳之气将移未移，必定从手足的四末开始。大概三阴三阳之气，从手足的井穴、荥穴出入更移，如病在阳，而阳已伤，则阴随之也伤，所以当在未发之时，牢固束缚四肢末端，令在此经的邪气不得入彼经，彼经的阴气不得出而并于此经，仔细诊察脉象，见到孙络盛大坚实且有瘀血者，都予以针刺，这是真气自往而未得交并的时候，这是治未发的方法。
黄帝说：疟疾不发作时，有什么反应？
承接上文治未发的意思，问疟疾不发作时，其脉候证候，如何对应。
岐伯说：疟气，必然盛虚交替，当气所在之处，病在阳分，则发热而脉躁动；在阴分，则发冷而脉静止。极盛时阴阳俱衰，卫气分离，所以疾病得以休止，卫气聚集则疾病复发。
疟气，寒热相胜，阴阳交极，所以必然盛虚交替，没有定数。由此而言，则疟疾不发作时，无所对应了。惟当疟
Wind, rain, cold, and heat all cause malaria. Malaria that occurs daily is triggered when the Wei Qi (Defensive Qi) reaches the location of the pathogen. If the pathogen lodges in the back along the Du Meridian, moving down one vertebral level daily from the Fengfu point (GV16), the onset of symptoms will be delayed each day. If the pathogen exits from Fengfu (GV16), enters the Fulu Mai (Hidden Spine Vessel), and ascends to the Quepen point (LI12), the onset of symptoms will occur earlier each day. If the pathogen presses against the Zang organs and spreads horizontally to the Mu Yuan (Master Source/Epigastrium), it will occur every other day. If the pathogen and Wei Qi lodge in the Six Fu organs, and their circulation loses its regular rhythm, it will occur every two days, or after resting for several days. Injury by cold water in summer and wind in autumn leads to Cold Malaria (Han Nue), characterized by chills preceding fever. Wind-cold injury in winter, with the pathogen hiding in the bone marrow and emerging during summer heat, leads to Warm Malaria (Wen Nue), characterized by fever preceding chills. If the Lungs already have heat, and strenuous labor prevents Qi from returning to the Yin, causing internal accumulation in the Heart and lodging in the muscle spaces, it leads to Dan Malaria (Dan Nue), characterized by heat without chills.
The Yellow Emperor asked: "Malaria arises from wind, yet its paroxysms have a fixed timing. Why is this?"
"Nue" here refers to Yin Malaria. The *Treatise on the Interaction of Vital Energy and Heaven* states: "Injury by summer heat in summer leads to malaria in autumn." When the Emperor asks if malaria arises from wind, he implies that malaria does not solely arise from heat but also from wind. Here, "Nue" refers to Yin Malaria, while the other form refers to Yang Malaria. Hence the term "all." "Xu" (accumulation) means storage; "Zuo" (onset) means emission. "You shi" (having a time) means occurring daily or every other day.
Qibo replied: "When malaria first begins, it starts with the erection of body hair, followed by yawning and stretching. Then chills and trembling of the jaw occur, accompanied by pain in the waist and spine. After the chills subside, both the interior and exterior become hot, leading to severe headache as if splitting, and thirst for cold drinks.
'Yawning and stretching' refers to the involuntary desire to stretch and yawn. In the initial stage of malaria, it starts with yawning and stretching at the body hair level, then progresses to chills, jaw trembling, and pain in the waist and spine. Initially, there are chills and jaw trembling; subsequently, the chills subside, and both interior and exterior become hot. Thirst and waist/spine pain occur initially; subsequently, the headache becomes severe, and both interior and exterior become hot, leading to a desire for cold drinks.
The Emperor said: "What Qi causes this? I wish to hear the principle."
'Dao' (Way/Path) refers to the pathway. What Qi causes the cold and heat? I wish to hear the pathway of their entry and exit.
Qibo said: "It is the struggle between Yin and Yang above and below, the alternating excess and deficiency, and the shifting of Yin and Yang.
'Geng' (alternate/change) is pronounced with the falling tone. During a malaria attack, Yin is not harmonious with Yang, and Yang is not harmonious with Yin, causing a struggle between Yin and Yang above and below. If Yang struggles above, Yang becomes excessive and Yin deficient; if Yin struggles below, Yin becomes excessive and Yang deficient. This mutual struggle and alternation constitute the shifting of Yin and Yang.
When Yang merges into Yin, Yin becomes excessive and Yang deficient.
'Shifting' implies merging. If Yang shifts and merges into Yin, Yin becomes excessive and Yang deficient. Note that if Yin shifts and merges into Yang, Yang becomes excessive and Yin deficient. This was omitted for brevity.
When the Yangming Meridian is deficient, chills and jaw trembling occur. When the Taiyang Meridian is deficient, pain occurs in the waist, back, head, and neck. If all three Yang meridians are deficient, Yin Qi prevails. When Yin prevails, the bones become cold and painful. Since the cold originates internally, both interior and exterior feel cold.
The so-called 'Yin excessive and Yang deficient' is exemplified by Yangming deficiency causing chills and jaw trembling. The Yangming Meridian runs along the anterior aspect of the body. The mandible is the lower part of the face. Taiyang deficiency causes pain in the waist, back, head, and neck. The Taiyang Meridian runs along the posterior aspect of the body, from head to waist. When Yangming and Taiyang are deficient, and Shaoyang is also deficient, all three Yang meridians are deficient. Deficiency allows Yin to prevail; when Yin prevails, bones become cold and painful. Shaoyang is associated with the Kidneys and governs the bones. This cold originates internally, hence the sensation of cold inside and out. The Shaoyang Meridian runs along the lateral aspect of the body, pivoting Yin and Yang, and governing the interior and exterior. This clarifies that when Yang merges into Yin, Yin becomes excessive and Yang deficient.
When Yang is excessive, there is external heat; when Yin is deficient, there is internal heat. If both interior and exterior are hot, there is panting and thirst, hence the desire for cold drinks.
This clarifies 'Yang excessive and Yin deficient.' Yang governs the exterior; Yang excess causes external heat. Yin governs the interior; Yin deficiency causes internal heat. If both interior and exterior are hot, Yang Qi is overly abundant, causing panting and thirst, hence the desire for cold drinks. This clarifies that when Yin merges into Yang, Yang becomes excessive and Yin deficient. From this, we can infer that the previously mentioned chills, jaw trembling, waist/back pain, internal/external heat, severe headache, and desire for cold drinks are all due to pathology in the Three Yang meridians, resulting from Yin excess/Yang deficiency and Yang excess/Yin deficiency.
These conditions result from summer heat injury. The intense heat qi hides within the skin but outside the stomach and intestines, which is where Ying Qi (Nutritive Qi) resides. This causes sweat pores to open and interstices (Cou Li) to relax. Consequently, autumn air, wind encountered during sweating, and water vapor from bathing allow the pathogen to lodge in the skin, coexisting with Wei Qi. Wei Qi travels through the Yang aspects during the day and the Yin aspects at night. This pathogen moves outward upon encountering Yang and inward upon encountering Yin. The interaction between interior and exterior causes daily attacks.
'Hides' is read as written; 'kong' and 'dong' are interchangeable. Continuing the previous meaning, these three types of Yang malaria result from summer heat injury. The intense heat qi hides within the skin but outside the stomach and intestines, where Ying Qi resides. Summer heat injures Ying Qi, disrupting the muscle surface, causing open sweat pores and relaxed interstices. With open pores and relaxed interstices, during summer months, exposure to autumn coolness, wind during sweating, and water vapor from bathing allows wind-water qi to lodge in the skin, coexisting with Wei Qi. Wei Qi travels 25 circuits in Yang during the day and 25 circuits in Yin at night. Malaria attacks only when Wei Qi arrives. This Wei Qi moves outward with daytime Yang and inward with nighttime Yin. The interaction between interior and exterior, meeting the pathogen, causes daily attacks. This discusses how summer heat, wind, cold, and water qi lead to the three types of Yang malaria.
The Emperor asked: "Why do some cases occur every other day?"
'Jian' (interval) is pronounced with the falling tone. Continuing from daily attacks, asking about every-other-day attacks.
Qibo said: "Every-other-day attacks occur because the pathogen presses inward against the Zang organs and spreads horizontally to the Mu Yuan. The pathway is long, the qi is deep, and its movement is slow. It cannot travel together with Wei Qi nor fully emerge, hence the every-other-day onset.
This section was originally placed under 'therefore the onset becomes progressively earlier' in old editions; it is now corrected here. Every-other-day malaria occurs because the pathogen presses inward against the Yin of the Zang organs and spreads horizontally to the Mu Yuan of the fatty membranes. The pathway is long and the qi is deep; thus, its movement in the skin is slow. Wei Qi travels in Yin at night and Yang during the day, emerging once a day. The Qi of the Zang organs takes three days to emerge. Unable to travel with Wei Qi and unable to fully emerge daily, it attacks every other day, intersecting at the beginning of the third day.
Because the pathogen's lodging is deep, pressing inward against Yin, Yang Qi alone erupts, while Yin pathogen lingers internally. Yin and Yang struggle, unable to exit, hence the every-other-day onset.
This reiterates the previous point: spreading horizontally to Mu Yuan means deep lodging; pressing against Zang organs means pressing against Yin. Long pathway, deep qi, and slow movement mean Yang Qi erupts alone and Yin pathogen lingers internally. Unable to travel with Wei Qi or fully emerge, Yin and Yang struggle and cannot exit, hence the intersection at the start of the third day and every-other-day onset.
The Emperor asked: "Excellent. Regarding the delayed and early onsets of daily attacks, what Qi causes this?"
For every-other-day malaria, the pathogen lodges deeply; for daily malaria, the pathogen lodges shallowly. The Emperor praised this. For daily attacks with varying times, what Qi causes this?
Qibo said: "The pathogen lodges at Fengfu (GV16) and moves down along the spine. Wei Qi gathers at Fengfu once daily and nightly. The next day, it moves down one vertebral level. Thus, the onset is delayed. This is because the pathogen first lodged in the spine.
If the malaria pathogen follows the meridian downward due to insufficient meridian Qi, the disease onset is delayed. If meridian Qi is sufficient and the pathogenic qi moves upward, the onset is early. Thus, using the entry and exit of the pathogen at Fengfu illustrates this. If the pathogen lodges at Fengfu and meridian Qi is insufficient, it moves down along the spine. Wei Qi gathers at Fengfu daily. Wei Qi moves down one level the next day. It reaches Fengfu without encountering the pathogen, must move down along the spine to meet it, hence the delayed onset. This downward movement from Fengfu indicates the pathogen first lodged in the spine.
Whenever Wei Qi reaches Fengfu, the interstices open. When interstices open, the pathogen enters. When the pathogen enters, the disease manifests. Thus, the daily onset is gradually delayed.
This explains why the pathogen lodges at Fengfu: whenever Wei Qi reaches Fengfu, interstices open. When they open, the pathogen enters. When it enters, malaria manifests. As the pathogen moves down along the spine, the daily onset is gradually delayed. 'Yi' (increase/gradual) means progressive.
If the pathogen exits from Fengfu, moving down one level daily, after twenty-one days it reaches the sacrum. On the twenty-second day, it enters the spine,注入 the Fulu Mai, and ascends. After nine days, it emerges at Quepen (LI12). As the pathogen rises higher, the onset becomes progressively earlier.
If the pathogen does not move down along the spine but exits from Fengfu: Wei Qi moves down one level daily. After twenty-one days, it reaches the sacrum. On the twenty-second day, it enters the spine and注入 the Fulu Mai. Now, since the pathogenic qi does not move down along the spine but ascends, and Wei Qi circulates once monthly, it emerges at Quepen after nine days. As the pathogen rises, the onset becomes progressively earlier. This hypothetical scenario—pathogen entering Fengfu (moving down) versus exiting Fengfu (moving up)—explains the variation in early and late onsets in daily malaria.
The Emperor asked: "You stated that whenever Wei Qi reaches Fengfu, interstices open, allowing pathogen entry and disease manifestation. Now, since Wei Qi moves down one level daily, its arrival no longer corresponds to Fengfu. How does daily malaria occur without this variation?"
Repeating Qibo's words, asking: If Wei Qi moves down one level daily and its arrival does not correspond to Fengfu, how does daily malaria occur without early/late variations?
Qibo said: "This is because the pathogen lodges in the head and neck and moves down along the spine. Therefore, depending on deficiency or excess, and the different sites of invasion, it does not necessarily correspond to Fengfu. If the pathogen strikes the head and neck, disease occurs when Qi reaches the head and neck; if it strikes the back, disease occurs when Qi reaches the back; if it strikes the waist and spine, disease occurs when Qi reaches the waist and spine; if it strikes the hands and feet, disease occurs when Qi reaches the hands and feet. Disease manifests when Wei Qi meets the pathogen. Thus, there is no fixed 'Fengfu'; wherever Wei Qi arrives and opens the interstices, and where the pathogen combines, that is its 'Fu' (station).
'Zhong' (strike/injure) is pronounced with the falling tone. This means the site where Wei Qi and the pathogen combine is the Fengfu. Since the pathogen invades different sites, there is no fixed Fengfu. Wei Qi moves down one level daily, not corresponding to Fengfu, because the pathogen lodges in the head and neck and moves down along the spine. Insufficient meridian Qi causes downward movement; sufficient meridian Qi causes upward movement. Thus, due to deficiency/excess differences, some enter via Fengfu, others do not. The pathogen invades different sites, not necessarily fixing on Fengfu. If the pathogen strikes the head and neck, disease occurs when Wei Qi reaches the head and neck; if it strikes the back, disease occurs when Wei Qi reaches the back; if it strikes the waist and spine, disease occurs when Wei Qi reaches the waist and spine; if it strikes the hands and feet, disease occurs when Wei Qi reaches the hands and feet. Wherever Wei Qi circulates and combines with the pathogen, disease manifests. Thus, there is no fixed Fengfu; wherever Wei Qi arrives and opens interstices, and where the pathogen combines, that is its station. My commentary: Previously, wind pathogen lodging in the head and neck, moving along the back, refers to Taiyang meridian malaria. Its qi ascending to Quepen, moving along the front, refers to Yangming meridian malaria. This pathogen striking various sites without fixation refers to Shaoyang meridian malaria.
The Emperor asked: "Excellent. Wind and malaria are similar and of the same category, yet wind persists constantly, while malaria has intervals. Why?"
Wind combines to form a 'Fu' without fixing on Fengfu; the Emperor praised this. He further asked: Wind and malaria are similar, but wind changes rapidly and persists, while malaria alternates cold and heat and has intervals. Wind injures meridians and persists, while malaria has remissions. Why?
Qibo said: "Wind qi remains in its place, hence it persists constantly. Malaria qi follows the meridians, sinking inward, hence it only manifests when Wei Qi arrives."
'Chu' (place) is pronounced with the falling tone. Wind injuring meridians leaves wind qi in its place, hence it persists. Malaria qi erupts externally, follows meridians, and sinks inward, hence it has intervals. Thus, the next day, when Wei Qi arrives, it recurs. This section discusses the depth of Yin/Yang cold-heat malaria (daily vs. every-other-day) and the deficiency/excess of meridians regarding early/late onset.
The Emperor asked: "Why does malaria present with chills first, then fever?" Qibo said: "Summer injury by intense heat causes profuse sweating and open interstices. Encountering cold water vapor in summer, the pathogen hides in the interstices and skin. Autumn injury by wind 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 fixed times, it is named Cold Malaria (Han Nue)."
'Hides' is read as written. Chills first, then fever is Cold Malaria. Summer heat is not cold, but there is cold water vapor. Autumn wind injury follows. Cold injury first, wind injury second, results in chills first, then fever. Fixed-time occurrence means regular onset without early/late variation.
The Emperor asked: "Why does malaria present with fever first, then chills?" Qibo said: "This is due to wind injury first, then cold injury, resulting in fever first, then chills. It also occurs at fixed times and is named Warm Malaria (Wen Nue)."
Fever first, then chills is Warm Malaria. Wind injury first, cold injury second, results in fever first, then chills. Fixed-time occurrence means regular onset without early/late variation.
Cases with heat only and no chills occur when Yin Qi is exhausted first, and Yang Qi erupts alone. Symptoms include shortness of breath, vexation, heat in the hands and feet, and nausea. This is named Dan Malaria (Dan Nue).
Continuing from Warm Malaria: Heat only, no chills, is Dan Malaria. There is absolutely no Yin-cold qi; Yin Qi is exhausted first, hence no chills. Only Yang Qi erupts, hence heat only. Exhausted Yin Qi fails to control Fire, causing shortness of breath and vexation. Erupting Yang Qi causes Fire to flare upward, causing heat in extremities and nausea. Besides Dan Malaria, there is Pin Malaria, described in *Jin Gui Yao Lue*.
The Emperor asked: "The classics state: Excess should be drained, deficiency should be tonified. Heat is excess, cold is deficiency. In malaria, cold is so intense that fire cannot warm it; heat is so intense that ice cannot cool it. These are cases of excess and deficiency. At such times, even skilled physicians cannot stop them; treatment must wait until they subside spontaneously. Why?"
Malaria must subside before needling, hence citing *Ling Shu: Gen Jie*, stating that during cold/heat paroxysms, even skilled physicians cannot intervene. Why?
Qibo said: "The classics say: Do not needle malaria with high fever, do not needle chaotic pulses, do not needle profuse sweating. Because the pathology is adverse, treatment is not yet possible.
'Wei' (because) is pronounced with the falling tone. *Ling Shu: Ni Shun* states: Needling rules say, do not needle high fever, do not needle profuse sweating, do not needle chaotic pulses, do not needle when disease and pulse are adverse. Thus, because the pathology is adverse (disease and pulse mismatch), needling is contraindicated. Quoting classics to answer the Emperor's reference to classics.
When malaria first begins, Yang merges into Yin. At this time, Yang is deficient and Yin is excessive. There is no Qi on the exterior, hence chills occur first.
Malaria with initial chills: When Yang merges inward into Yin, Yang is deficient and Yin is excessive. Yang governs the exterior and Qi; Yang deficiency means no exterior Qi. No exterior Qi plus Yin excess causes initial chills.
When Yin Qi rebels and reaches extremity, it re-emerges to Yang. Yang and Yin merge again on the exterior, causing Yin deficiency and Yang excess. Hence, fever and thirst occur first.
Malaria with initial fever/thirst: Yin Qi is deficient and rebels inward. At extremity, Yin re-emerges to Yang. Yang and Yin merge on the exterior, causing Yin deficiency and Yang excess. Yin deficiency causes heat; Yang excess causes thirst. Hence, fever and thirst occur first.
Malaria Qi, merging into Yang causes Yang excess; merging into Yin causes Yin excess. Yin excess causes cold; Yang excess causes heat. The wind-cold qi of malaria is not constant; extreme pathology reverses.
Malaria alternates cold then heat, or heat then cold. Merging into Yang causes Yang excess and heat; merging into Yin causes Yin excess and cold. Wind is Yang; Yang excess causes heat. Cold is Yin; Yin excess causes cold. This pathology involves non-constant wind-cold qi. Extreme cold turns to heat; extreme heat turns to cold. Hence, extreme pathology reverses.
Disease onset is like the heat of fire or the force of wind and rain, unstoppable. Thus, the classics say: Treating during peak strength damages healthy Qi; treating during decline ensures great success. This is the principle.
Classics refer to *Ling Shu: Ni Shun*. 'Hui' means damage. Malaria onset, heat like fire, cold like wind/rain, is unstoppable. Classics say: Treating at peak strength damages healthy Qi; treating at decline ensures success. This refers to the unstoppable nature of fire/wind/rain.
Before malaria onset, Yin has not merged into Yang, and Yang has not merged into Yin. Regulating at this time allows Healthy Qi to rest and Pathogenic Qi to vanish. Hence, physicians cannot treat active attacks because the Qi is adverse.
Waiting for subsidence is inferior to regulating before onset. Before onset, Yin has not merged into Yang, and Yang has not merged into Yin. Regulating then allows Healthy Qi to rest and Pathogenic Qi to vanish. Active attacks cannot be treated by skilled physicians because the Qi is disordered.
The Emperor asked: "How to treat? When to treat?"
'Gong' (attack/treat) means treatment. 'Early' means treating before onset. 'Late' means treating after subsidence. Continuing the previous discussion on pre-onset treatment and post-subsidence needling, he asks again.
Qibo said: "When malaria is about to manifest, Yin and Yang are about to shift. This shift always begins at the four extremities. If Yang is injured, Yin follows. Therefore, before the time of onset, firmly bind the area to prevent pathogen entry and Yin Qi exit. Carefully observe; if Sun Luo (Branch Collaterals) are full, hard, and bloody, needle them. This is when True Qi goes forth but has not yet merged.
Needling after subsidence was detailed previously; here, only pre-onset treatment is discussed. 'Qie' (about to) indicates uncertainty, i.e., impending onset. Yin and Yang are about to shift, always starting at the four extremities. The Qi of the Three Yin and Three Yang meridians enters and exits via Jing-River points of hands and feet. If disease is in Yang and Yang is injured, Yin is also injured. Therefore, before onset, firmly bind the four extremities to prevent pathogen entry into the affected meridian and Yin Qi exit from the other meridian to merge here. Observe pulses and signs; needle any Sun Luo that is full, hard, and bloody. This is when True Qi moves forth but has not yet merged. This is the method of treating before onset.
The Emperor asked: "What are the responses when malaria is not attacking?"
Continuing the theme of pre-onset treatment, asking about pulse and symptom patterns during remission.
Qibo said: "Malaria Qi alternates between excess and deficiency. Wherever the Qi is located: if in Yang, there is heat and rapid pulse; if in Yin, there is cold and quiet pulse. At extremity, both Yin and Yang decline, Wei Qi separates, hence the disease rests. When Wei Qi gathers, the disease recurs.
Malaria Qi, with alternating cold and heat and extreme Yin-Yang interaction, inevitably alternates excess and deficiency without fixity. Thus, during remission, there is no specific response. Only when malaria..."