【纲】仲景曰。脉阴阳俱盛。重于阴者。变为温疟。
【目】李 曰。伤寒汗吐下后。余热未净。重感于寒而变疟。过经。旧热未解。新感六淫之气
而变疟。皆曰温疟者。俱先热后寒故也。寒多热少。或单寒者。太阳邪变也。柴胡桂枝汤。热多寒
少。或单热。骨节烦疼者。阳明邪变也。白虎汤加桂枝。寒热相等。或先热者。少阳邪变也。小柴
胡汤。渴者去半夏加花粉、知母。寒热大作。战栗汗出不散。太阳阳明合病也。桂枝石膏汤。服此
后。疟愈甚者。三阳合病也。恐传入阴经。急用桂枝黄芩汤。如传入阴分。从卯至午发。而呕吐大
便闭者。大柴胡汤下之。从午至酉发。而腹满便闭者。大承气汤下之。从酉至寅发。而欲狂喜忘便黑
者。桃仁承气汤微利之。不敢下者。栀子升麻汤。伤寒杂病疟不同在此。间有挟痰食积。呕吐不食
者。二陈汤对金饮子。尿涩烦渴或因瘴气。不伏水土者。五苓散。俱加柴、芩。此等疟与杂病无大
异。日久势发稍缓。则截之。痰饮在上膈。欲吐不吐者。瓜蒂、赤小豆、雄黄等分为末。水调五分服
之。以吐为度。或祛邪丸亦好。久不愈者。胜金丹、老疟丸以消之。
王肯堂曰。凡伤寒坏病。前热未除。其脉阴阳俱盛。重感寒邪。变为温疟也。寒热往来。口苦
胸胁满者。小柴胡汤加芍药。少加桂枝主之。热多者。倍用柴胡。寒多者。倍用桂枝。热盛而烦渴。
人参白虎汤。少加薄桂主之。单热无寒者。不用桂枝也。但有寒。必少佐之。如热多者。小柴胡
合白虎汤。痰多而热者。小柴胡合二陈汤。若食少胃弱者。加白术。心下
痞。加枳实、黄连。脉虚者。倍人参。口渴者。去半夏加花粉。邪热蕴结于里。大便秘实。脉滑大
有力者。大柴胡汤下之。若变疟已正。宜与杂病中求之。
【纲】张仲景说：脉象寸关尺三部都盛大，如果阴脉（尺脉）更为盛实，就会演变为温疟。
【目】李氏说：伤寒经过发汗、催吐或泻下治疗后，余热尚未清除，再次感受寒邪而转变为疟疾；或者病已过经（离开原发病阶段），旧有的热邪未解，又新感六淫（风、寒、暑、湿、燥、火）之气而转变为疟疾。这些都称为温疟，都是因为先发热后恶寒的缘故。如果是恶寒多发热少，或者只有恶寒没有发热的，属于太阳经受邪变异所致，用柴胡桂枝汤治疗。如果是发热多恶寒少，或者只有发热，且骨节烦痛剧烈的，属于阳明经受邪变异所致，用白虎汤加桂枝治疗。如果寒热程度相等，或者先发热的，属于少阳经受邪变异所致，用小柴胡汤治疗；若伴有口渴症状，则去掉半夏，加入天花粉和知母。如果寒热发作剧烈，战栗出汗后汗出不止的，属于太阳与阳明合病，用桂枝石膏汤治疗。服用此方后，如果疟疾反而加重，说明是三阳合病，恐怕病邪传入阴经，应立即使用桂枝黄芩汤。如果病邪传入阴分，在卯时到午时之间发作，并伴有呕吐和大便闭塞的，用大柴胡汤攻下；在午时到酉时之间发作，并伴有腹部胀满和大便闭塞的，用大承气汤攻下；在酉时到寅时之间发作，并出现狂躁、喜忘、大便黑色的，用桃仁承气汤轻微通下；不敢用攻下法的，用栀子升麻汤治疗。伤寒引起的疟疾与杂病引起的疟疾不同之处就在这里。间或有夹杂痰饮、食积，导致呕吐不能进食的，用二陈汤配合金饮子治疗；小便涩痛、心烦口渴，或因瘴气、不服水土引起的，用五苓散治疗，均加入柴胡和黄芩。这类疟疾与杂病没有太大区别，如果日久病情发作稍缓，则可以采取截疟的方法。如果痰饮停留在上膈，想要呕吐却吐不出的，将瓜蒂、赤小豆、雄黄等分为末，用水调服五分，以吐出为度。或者使用祛邪丸也很好。久治不愈的，用胜金丹、老疟丸来消除病邪。
王肯堂说：凡是伤寒坏病（病情恶化或误治后的复杂病症），之前的热邪未除，脉象阴阳俱盛，再次感受寒邪，就会转变为温疟。如果出现寒热往来、口苦、胸胁胀满的症状，用小柴胡汤加芍药，少量加入桂枝主治。发热多的，加倍使用柴胡；恶寒多的，加倍使用桂枝。如果热盛且烦躁口渴，用人参白虎汤，少量加入薄桂主治。只有发热没有恶寒的，不使用桂枝。但只要有寒象，必须稍微佐以桂枝。如果热多者，可用小柴胡汤合白虎汤；痰多且热者，可用小柴胡汤合二陈汤。如果饮食减少、胃气虚弱者，加入白术；心下痞塞者，加入枳实和黄连；脉虚者，加倍使用人参；口渴者，去掉半夏加入天花粉。如果邪热蕴结于体内，大便秘结坚实，脉象滑大有力者，用大柴胡汤攻下。如果疟疾症状已经纠正，应当在治疗杂病的原则中寻求方法。
[General Principle] Zhang Zhongjing stated: When the pulse is vigorous at both Yin and Yang positions (superficial and deep, or upper and lower), if the Yin pulse (Chi position) is more vigorous, it transforms into Warm Malaria.
[Detailed Discussion] Li said: After treatment of Cold Damage with sweating, vomiting, or purging, if residual heat remains uncleaned and is compounded by a new contraction of cold pathogen, malaria may result. Alternatively, after the disease has passed its meridian stage, if old heat is not resolved and new contraction of the Six Excesses (Wind, Cold, Summer-heat, Dampness, Dryness, Fire) occurs, malaria may also result. These are all termed Warm Malaria because they present with fever preceding chills. If chills predominate over fever, or if there are only chills without fever, this is a transformation of Shaoyang pathogen affecting the Taiyang channel; treat with Chaihu Guizhi Tang. If fever predominates over chills, or if there is only fever accompanied by severe bone joint pain, this is a transformation affecting the Yangming channel; treat with Baitu Tang plus Guizhi. If chills and fever are equal in intensity, or if fever precedes chills, this is a transformation affecting the Shaoyang channel; treat with Xiaochaihu Tang. If thirst is present, remove Banxia and add Huafen and Zhimu. If chills and fever are severe, with rigors and profuse sweating that does not stop, this is a combined disease of Taiyang and Yangming; treat with Guizhi Shigao Tang. If malaria worsens after taking this formula, it indicates a combined disease of the Three Yang channels, and there is fear of transmission to the Yin channels; immediately use Guizhi Huangqin Tang. If the pathogen transmits to the Yin aspect, and attacks occur between Mao hour (5-7 AM) and Wu hour (11 AM-1 PM) with vomiting and fecal impaction, purge with Dachaihu Tang. If attacks occur between Wu hour (11 AM-1 PM) and You hour (5-7 PM) with abdominal fullness and fecal impaction, purge with Dachengqi Tang. If attacks occur between You hour (5-7 PM) and Yin hour (3-5 AM) with mania, forgetfulness, and black stools, mildly purge with Tao Ren Chengqi Tang. For those who cannot tolerate purgation, use Zhizi Shengma Tang. The distinction between malaria caused by Cold Damage and that from miscellaneous diseases lies here. Occasionally, there are cases complicated by phlegm-dampness or food stagnation, causing vomiting and inability to eat; treat with Erchen Tang combined with Jinyinzi. For cases with difficult urination, irritability, thirst, due to miasma or acclimatization issues, use Wuling San, adding Chaihu and Huangqin. Such malaria differs little from miscellaneous diseases. If the condition persists for a long time and attacks become slightly less frequent, interception methods can be used. If phlegm-fluid retention is in the upper diaphragm, causing retching without successful emesis, powder equal parts of Goudi, Chi Xiaodou, and Xionghuang, mix with water and take 0.5 fen; induce vomiting until satisfied. Quxie Wan is also suitable. For chronic cases, use Shengjin Dan or Laonie Wan to resolve the pathogen.
Wang Kentang said: In any complicated disease resulting from Cold Damage, if previous heat is not eliminated and the pulse is vigorous at both Yin and Yang positions, compounding cold pathogen leads to Warm Malaria. If there is alternating chills and fever, bitter taste in the mouth, and chest/hypochondriac fullness, treat with Xiaochaihu Tang plus Shaoyao and a small amount of Guizhi. If heat predominates, double the dosage of Chaihu; if chills predominate, double the dosage of Guizhi. If heat is intense with irritability and thirst, use Renshen Baitu Tang with a small amount of Bo Gui. If there is only heat without chills, do not use Guizhi. However, if there is any chill, Guizhi must be slightly added as an assistant. If heat predominates, combine Xiaochaihu Tang with Baitu Tang. If there is much phlegm and heat, combine Xiaochaihu Tang with Erchen Tang. If appetite is poor and stomach Qi is weak, add Baizhu. If there is epigastric stuffiness, add Zhishi and Huanglian. If the pulse is deficient, double the dosage of Renshen. If thirsty, remove Banxia and add Huafen. If evil heat accumulates internally with dry stool and a slippery, large, and forceful pulse, purge with Dachaihu Tang. Once the malaria symptoms have corrected, seek treatment principles within the framework of miscellaneous diseases.