水，即水饮也；血，即淤血也。惟水饮，所以作寒热；惟淤血，所以增寒热。常山逐水
利饮固也，苟无行血药品佐助其间，何以收十全之郊耶？继自今疟家，或衄血，或唾血，或
大便血丝，或月候适来适去，皆是血证，当以常山、草果、槟榔、青皮、乌梅、甘草作剂
，于内加五灵脂、桃仁为佐，入生姜、浓蜜同煎，以主治之。
凡疟，固当以风寒暑湿别而治之，或汗、或下、或吐、或温，《活人书》之格法，虽卢
扁不能违矣。然尝见疟之经久而不歇，其故何耶？有根在也。根者何？曰饮、曰水、曰败血
是尔。惟癖为疟之母，惟败血为暑热之毒，惟饮与水皆生寒热。故暑之脉虚，水与饮之脉沉
结，癖之脉结。聚挟水饮者，为之逐水消饮。结癖者，胁必痛，为之攻癖。若败血、暑毒随
证而疏利之，寒热不除，吾未之信。
疟家多蓄痰涎黄水，常山为能吐之利之，是固然尔。其有纯热发疟或蕴热内实之证，
投以常山，大便点滴而下，似泄不泄，须用北大黄为佐，大泄数行，然后获愈。或曰巴豆丸
子相依而行，亦能泄也，是又不然，巴豆攻于下积，苟欲荡涤血热，不可以无大黄。凡疟方
来于正发，不可服药，服药在于未发两时之先。否则药病交争，转为深害。
此伤寒一证，而实非瘴疟也。其人肝脉浮盛，头痛怯风，大抵小柴胡东加青皮、紫苏主
之。呕者多用生姜，渴者多加乌梅，其或伤暑，兼之小柴胡东加香薷，入生姜、乌梅同煎可
也。抑犹有说焉，寒热之根，非通利不能除也。万一其根未锄，又当以麻仁丸、神保丸辈与
之，是亦先解后攻之意。
水，即水饮（体内停聚的病理水液）；血，即淤血（血液运行不畅或停滞）。正因为有水饮，所以导致寒热发作；正因为有淤血，所以加重寒热症状。常山具有驱逐水饮、通利水湿的作用，这是肯定的，但如果缺少行血药物在其中辅助，怎么能达到十全十美的疗效呢？从今以后，对于疟疾病人，如果出现鼻出血、咳血、大便带血丝，或者月经刚来刚去等情况，这些都是血证的表现，应当使用常山、草果、槟榔、青皮、乌梅、甘草作为主药，在此基础上加入五灵脂、桃仁作为佐药，放入生姜、浓蜜共同煎煮，用来主治这些病症。
凡是疟疾，本来应当根据风、寒、暑、湿的不同性质分别治疗，采用发汗、攻下、催吐或温补的方法，《活人书》中的规范法则，即使是卢医和扁鹊也不能违背。然而我曾经见到疟疾经久不愈的情况，这是什么原因呢？是因为病根存在。病根是什么呢？就是痰饮、水湿、败血。正因为癖积是疟疾的母亲，败血是暑热之毒的来源，痰饮与水湿都会产生寒热症状。所以暑邪导致的脉象虚浮，水与饮导致的脉象沉结，癖积导致的脉象结滞。对于夹杂水饮的积聚，采用逐水消饮的方法；形成癖积的，胁部必然疼痛，采用攻逐癖积的方法。如果是败血、暑毒，则根据证候进行疏泄通利，如果这样寒热还不能消除，我是不相信的。
患疟疾的人体内多蓄积痰涎和黄水，常山能够使其吐出并通利，这确实是这样的。对于那些纯热型疟疾或内蕴实热的证候，投用常山后，大便点滴而下，似泻非泻，必须用北大黄作为佐药，使其大量排泄数次，然后才能痊愈。有人说巴豆丸子和常山配合使用也能起到泻下的作用，这又不对了，巴豆主要攻逐下焦的积滞，如果想要荡涤血分的热邪，不能没有大黄。凡是疟疾方将要发作时，不可服药，服药应当在未发作前的两个时辰之前。否则药物与病邪相互争斗，反而转为更深的危害。
这是伤寒的一种证候，但实际上不是瘴疟。这个人的肝脉浮盛，头痛且怕风，大致用小柴胡汤加上青皮、紫苏来主治。呕吐的人多用生姜，口渴的人多加乌梅，如果是伤暑，兼用小柴胡汤加上香薷，放入生姜、乌梅共同煎煮即可。还有进一步的说法，寒热的病根，如果不通过通利的方法是不能消除的。万一病根未被铲除，又应当给予麻仁丸、神保丸之类的药物，这也是先解表后攻里的意思。
Water refers to *Yin* (pathological accumulation of fluid in the body); blood refers to *Yu Xue* (stagnant or stagnant blood). It is precisely because of *Yin* that chills and fever occur; it is precisely because of *Yu Xue* that chills and fever are exacerbated. *Changshan* (Dichroa Radix) expels water and promotes diuresis, which is indeed correct. However, if there are no blood-invigorating herbs to assist in between, how can one achieve a perfect cure? From now on, for patients with malaria, if they present with epistaxis, hemoptysis, blood streaks in the stool, or irregular menstruation, these are all manifestations of blood disorders. One should use *Changshan* (Dichroa Radix), *Caoguo* (Tsaoko Fructus), *Binglang* (Arecae Semen), *Qingpi* (Aurantii Fructus Pericarpium Viride), *Wumei* (Mume Fructus), and *Gancao* (Glycyrrhizae Radix et Rhizoma) as the principal formula. To this, add *Wulingzhi* (Trogopterori Faeces) and *Taoren* (Persicae Semen) as adjuvants. Decoct them together with *Shengjiang* (Zingiberis Rhizoma Recens) and thick honey to treat these conditions.
Generally, malaria should be treated differently according to wind, cold, summerheat, and dampness, employing methods such as sweating, purging, vomiting, or warming. The standard protocols in *Huoren Shu* (Book of Living Persons) are so fundamental that even Lu Dan and Bian Que could not deviate from them. Yet, I have observed cases where malaria persists for a long time without ceasing. What is the reason? There is a root cause. What is this root? It is *Yin*, water, and *Bai Xue* (decayed blood). Precisely because *Pi Ji* (accumulation due to stagnation) is the mother of malaria, *Bai Xue* is the toxin of summerheat, and both *Yin* and water generate chills and fever. Therefore, the pulse in summerheat is deficient; the pulse in water and *Yin* is deep and knotted; the pulse in *Pi Ji* is knotted. For accumulations accompanied by water and *Yin*, employ methods to expel water and resolve *Yin*. For formed *Pi Ji*, the hypochondrium must be painful, so employ methods to attack *Pi Ji*. If *Bai Xue* and summerheat toxins are addressed according to the syndrome with draining and promoting methods, and yet chills and fever do not cease, I would not believe it.
Patients with malaria often retain phlegm-rheum and yellow fluids. That *Changshan* (Dichroa Radix) can induce vomiting and promote drainage is indeed true. However, in cases of pure heat-type malaria or internal excess heat, administering *Changshan* may result in only scanty stools, resembling diarrhea but not fully evacuating. In such instances, *Da Huang* (Rhei Radix et Rhizoma) must be used as an adjuvant to induce significant purgation several times before recovery can be achieved. Some argue that *Baidu* (Crotonis Fructus) pills work in conjunction with *Changshan* to also induce purgation; this is incorrect. *Baidu* attacks lower-joint accumulations, but to cleanse blood-heat, *Da Huang* (Rhei Radix et Rhizoma) is indispensable. When a malaria attack is imminent, medication should not be taken; it should be administered two hours prior to the onset. Otherwise, the medicine and the pathogen will contend with each other, leading to deeper harm.
This is a syndrome of *Shanghan* (Cold Damage), but it is actually not *Zhang Nue* (Miasmic Malaria). The patient’s liver pulse is floating and vigorous, accompanied by headache and aversion to wind. Generally, *Xiao Chaihu Tang* (Minor Bupleurum Decoction) combined with *Qingpi* (Aurantii Fructus Pericarpium Viride) and *Zisu* (Perillae Folium) is used as the main treatment. For those with vomiting, increase the amount of *Shengjiang* (Zingiberis Rhizoma Recens); for those with thirst, add more *Wumei* (Mume Fructus). If it is caused by summerheat, combine *Xiao Chaihu Tang* (Minor Bupleurum Decoction) with *Xiangru* (Elsholtziae Herba), decocted together with *Shengjiang* (Zingiberis Rhizoma Recens) and *Wumei* (Mume Fructus). Furthermore, there is another point: the root of chills and fever cannot be eliminated without promoting free flow and drainage. If the root has not been eradicated, one should administer formulas such as *Maren Wan* (Hemp Seed Pill) or *Shenbao Wan* (Divine Preservation Pill). This also reflects the principle of resolving the exterior first and then attacking the interior.