疟疾不离少阳。少阳为半表半里，邪居表里之界。入与阴争则寒，出与阳争则热。争则
病作，息则痛止。止后其邪仍据于少阳之经。浅则一日一作，深则二日一作，更深则三日一
作。虽有别经，总以少阳为主。故仲景以弦字该本症之脉，盖于治法只一小柴胡汤。热多烦
渴，加知母、花粉；寒多身疼，加干姜、桂枝。治之得法。一二服可愈。
朱丹溪云∶无汗要有汗，散邪为主，带补正；有汗要无汗，补正为主，带散邪。大抵于
小柴胡汤中无汗，麻黄可加二钱，即三解汤意也。有汗，桂枝、酒芍可各加二钱，即柴胡桂
枝汤意也；如三五作不休，即于前方加常山三钱，一服即愈。俗谓常山截疟，用之太早，则
截住邪气而成他病。不知常山祛痰涌吐，从阴达阳之药，正所以鼓邪气外出，何截之有？
余每合穿山甲、金银花三味，取其通达经络，又以人参、当归、白术、何首乌之类，择
用一二两为君。于疟未出时，服之多愈。至于方书分定名色，多歧仅惑。而所应别者，如单
寒无热为牡疟，宜理中汤、理阴煎加柴胡主之；单热无寒为痹疟，或先热后寒为热疟，宜白
虎汤加桂枝主之；劳役饥饱过度为劳疟，宜补中益气汤加柴胡主之；受山岚瘴气为瘴疟，宜
藿香正气散、平胃散加柴胡主之；久疟心腹有块者，名疟母，以鳖甲饮主之。只此数症，略
宜分别，究亦不离少阳一经也。
若疟痢交作，只以小柴胡汤疏少阳之气，则陷者自举。加花粉三钱，滋阳明之液，则滞
者自通。或即以此汤送香连丸一钱五分，挟虚者，以补中益气汤倍柴胡煎，送香连丸二钱。
此薛立斋先生之心法也。
小柴胡汤（方见《伤寒》）
男元犀按∶凡服治疟药，宜疟未至前三时服，或煎两服。一服于疟期五鼓时服，留一服
于疟未至前二时服，最妙。凡治疟药，古法必露一宿，以疟为暑邪，暑气得露而消也。又近
医以初疟，忌用人参、白术、茯苓，此说本之嵩崖尊生。余虽不满，亦当从众。今即照嵩崖
，去人参加青皮一钱五分。寒多加干姜、桂枝各二钱；热多加知母、花粉各二钱，或加黄
连、石膏。本方去人参，加常山、草果、知母、槟榔、川贝母各二钱，名清中驱疟饮。大意
以无痰不成疟，此方为治症之总方也，然亦多效。
鳖甲饮
鳖甲（三钱，醋炙） 白术（炒） 黄 川芎 酒白芍 槟榔 草果（煨） 浓朴 陈皮 甘草（各一
钱） 生姜（三片） 枣肉（三枚） 乌梅（一枚）
水煎服。
又有久疟流连不愈，及三阴疟三日一作者，当分五脏之虚，而施温补。宜以景岳何人饮
、休疟饮常服。疟作之期，或加少阳药一二味，及常山、穿山甲、附子、金银花之类，以通
经络。或用人参一两、生姜一两，浓煎服之。此不截之截法也。家贫者，以冬白术一二两代
之；血虚者，以当归一两代之。
疟虽有五脏之分，而久疟证治法，只以补脾为主。盖以土为万物之母，五脏六腑皆受荫焉
。况疟为少阳之邪，戊己之土，久受甲木之克，扶弱抑强之法，权实操于医者，宜于六君子
汤、四君子汤、补中益气汤诸方，加之意焉。
何人饮
何首乌（一两，不见铁或生用） 人参（二三钱或一两） 陈皮（一二钱，虚者不用） 煨生姜（二三钱）
水煎服。
休疟饮
何首乌（四钱或一两） 人参（二三钱） 白术（三钱炒） 当归（三钱） 炙甘草（一钱）
阴阳水煎服。
又久疟不愈，必求之肾。如肾水不足，热多者以六味丸加味主之；肾火不足，寒多者以
八味丸加味主之。
《高鼓峰医案》云∶余治一人三阴疟不愈，令吞八味丸，服人参养荣汤，冬至日再加
附子一钱，至半夜汗出而愈。（汗出者阳回之兆，亦邪解之征也。愈于冬至日者以阳生而
阴退也。）
疟疾的病变离不开少阳经。少阳经位于半表半里之间，邪气盘踞在表与里的交界之处。邪气向内与阴气相争则出现寒战，向外与阳气相争则出现发热。正邪交争时疾病发作，交争停止时症状缓解。症状停止后，邪气仍然占据在少阳经。病邪较浅的，每天发作一次；病邪较深的，每两天发作一次；病邪更深的，每三天发作一次。虽然可能涉及其他经络，但总以少阳经为主。所以张仲景用“弦”字来概括本症典型的脉象（弦脉），在治疗上主要使用小柴胡汤。如果热象明显且伴有烦渴，加入知母、天花粉；如果寒象明显且身体疼痛，加入干姜、桂枝。治疗方法得当的话，服用一两剂即可痊愈。
朱丹溪说：无汗的情况要有汗，以发散邪气为主，兼以补益正气；有汗的情况要止汗，以补益正气为主，兼以发散邪气。大体上在小柴胡汤的基础上，若无汗，可加麻黄二钱，这符合三解汤的意思；若有汗，可加桂枝、酒白芍各二钱，这符合柴胡桂枝汤的意思；如果每隔三五天发作一次不停歇，就在前方中加入常山三钱，服用一剂即可痊愈。世俗认为常山能截断疟疾，如果过早使用，就会将邪气截留在体内从而引发其他疾病。他们不知道常山是祛除痰饮、涌吐痰涎、从阴达阳的药物，正是用来鼓动邪气外出，哪里有什么截留呢？我每次将穿山甲、金银花与常山三味药合用，取其通达经络的作用，又用人参、当归、白术、何首乌等药物，选择其中一二两作为君药。在疟疾发作前服用，大多能治愈。至于医书中分门别类定下的名称和颜色，往往分歧众多，令人困惑。而应当区分的类型，如只有寒战没有发热的称为牡疟，适宜用理中汤、理阴煎加柴胡主治；只有发热没有寒战的称为痹疟，或者先发热后发寒的称为热疟，适宜用白虎汤加桂枝主治；因劳累过度或饥饱失常引起的称为劳疟，适宜用补中益气汤加柴胡主治；感染山岚瘴气引起的称为瘴疟，适宜用藿香正气散、平胃散加柴胡主治；久疟导致心腹部有结块的，称为疟母，用鳖甲饮主治。仅这几类病症，略作区分，究其根本也不离少阳一经。
如果疟疾与痢疾同时发作，只用小柴胡汤疏解少阳经的气机，下陷的气机自然提升。加入天花粉三钱，滋养阳明经的津液，停滞的气血自然通畅。或者就用此汤送服香连丸一钱五分；对于夹杂虚证的，用补中益气汤倍量柴胡煎煮，送服香连丸二钱。这是薛立斋先生的核心治法。
小柴胡汤（方剂见《伤寒论》）
男弟子元犀按语：凡是服用治疗疟疾的药物，应当在疟疾发作前三小时服用，或者煎煮两次服用。第一次在疟疾发作当天五更时分服用，留第二次在疟疾发作前两小时服用，最为巧妙。凡是治疗疟疾的药物，古法必定露置一夜，因为疟疾属于暑邪，暑气遇到露水就能消散。另外，近代医生认为初起疟疾忌用人参、白术、茯苓，这种说法源自嵩崖尊生。我虽然不完全赞同，但也应当顺应大众。现在即按照嵩崖的说法，去掉人参，加入青皮一钱五分。寒象多加干姜、桂枝各二钱；热象多加知母、天花粉各二钱，或者加入黄连、石膏。本方去掉人参，加入常山、草果、知母、槟榔、川贝母各二钱，名为清中驱疟饮。大意认为无痰不成疟，此方为治疗疟疾的总方，然而也多有疗效。
鳖甲饮
鳖甲（三钱，醋炙） 白术（炒） 黄芪 川芎 酒白芍 槟榔 草果（煨） 厚朴 陈皮 甘草（各一钱） 生姜（三片） 大枣肉（三枚） 乌梅（一枚）
水煎服。
又有久疟缠绵不愈，以及三阴疟三日发作一次的，应当分辨五脏的虚损情况，施行温补疗法。适宜长期服用景岳的何人饮、休疟饮。在疟疾发作期间，或者加入少阳经药物一二味，以及常山、穿山甲、附子、金银花等药物，以通达经络。或者用人参一两、生姜一两，浓煎服用。这是不强行截断却达到截断效果的方法。家境贫寒者，用冬白术一二两代替人参；血虚者，用当归一两代替人参。
疟疾虽然有五脏之分，但久疟证的治疗法则，只以补脾为主。因为土（脾）是万物的母亲，五脏六腑都受其荫庇。况且疟疾是少阳的邪气，戊己之土（脾胃）长久受到甲木（肝胆）的克制，扶弱抑强的方法，权变操作在于医者，应当在六君子汤、四君子汤、补中益气汤等方剂中，用心斟酌运用。
何人饮
何首乌（一两，不见铁器或生用） 人参（二三钱或一两） 陈皮（一二钱，虚证不用） 煨生姜（二三钱）
水煎服。
休疟饮
何首乌（四钱或一两） 人参（二三钱） 白术（三钱炒） 当归（三钱） 炙甘草（一钱）
阴阳水煎服。
另外久疟不愈，必须求之于肾。如果肾水不足，热象多的用六味丸加味主治；肾火不足，寒象多的用八味丸加味主治。
《高鼓峰医案》记载：我治疗一人患三阴疟疾不愈，令其吞服八味丸，服用人参养荣汤，冬至日再加附子一钱，到半夜出汗而痊愈。（出汗是阳气回复的征兆，也是邪气解除的标志。在冬至日痊愈是因为阳气生长而阴气消退。）
Malaria is inextricably linked to the Shaoyang (Lesser Yang) channel. The Shaoyang channel is located at the half-exterior and half-interior level, where pathogenic factors reside at the boundary between exterior and interior. When pathogens enter and contend with Yin, chills occur; when they emerge and contend with Yang, fever occurs. Disease manifests during contention and subsides when contention ceases. After symptoms subside, pathogens still occupy the Shaoyang channel. If the pathogen is shallow, attacks occur daily; if deeper, every two days; if even deeper, every three days. Although other channels may be involved, the Shaoyang channel remains primary. Therefore, Zhang Zhongjing used the term "wiry" (Xian Mai, Wiry Pulse) to characterize the typical pulse of this condition, and in treatment, primarily utilized Xiaochaihu Tang (Minor Bupleurum Decoction). If heat signs are prominent accompanied by irritability and thirst, add Zhi Mu (Anemarrhenae Rhizoma) and Hua Fen (Trichosanthis Radix); if cold signs are prominent accompanied by body pain, add Gan Jiang (Zingiberis Rhizoma) and Gui Zhi (Cinnamomi Ramulus). With appropriate treatment, recovery can be achieved after one or two doses.
Zhu Danxi stated: In cases without sweating, induce sweating as the primary method to disperse pathogens, while simultaneously tonifying healthy Qi; in cases with sweating, stop sweating as the primary method to tonify healthy Qi, while simultaneously dispersing pathogens. Generally, based on Xiaochaihu Tang, if there is no sweating, add Ma Huang (Ephedrae Herba) two qian, which aligns with the principle of Sanjie Tang (Three-Resolving Decoction); if there is sweating, add Gui Zhi (Cinnamomi Ramulus) and Jiu Bai Shao (Paeoniae Radix Alba processed with wine) each two qian, which aligns with the principle of Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction); if attacks occur irregularly every three to five days without cessation, add Chang Shan (Dichroae Radix) three qian to the previous formula, and recovery follows one dose. It is commonly believed that Chang Shan (Dichroae Radix) can arrest malaria; using it too early traps pathogens and causes other diseases. They fail to realize that Chang Shan (Dichroae Radix) is a herb that expels phlegm, induces vomiting, and guides energy from Yin to Yang, precisely to urge pathogens outward, so how could it trap them? I often combine Chang Shan (Dichroae Radix), Chuan Shan Jia (Manis Squama), and Jin Yin Hua (Lonicerae Japonicae Flos), utilizing their ability to unblock collaterals, and select Ren Shen (Ginseng Radix et Rhizoma), Dang Gui (Angelicae Sinensis Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma), and He Shou Wu (Polygoni Multiflori Radix), choosing one or two liang as the sovereign drug. Administered before the onset of malaria, it cures most cases. As for the classifications and names defined in medical texts, there are many divergences causing confusion. However, distinct types should be differentiated: Mulinie (Male Malaria), characterized by chills only without fever, is treated with Lizhong Tang (Regulate the Middle Decoction) or Liyin Jian (Yin-Nourishing Decoction) plus Chai Hu (Bupleuri Radix); Bi Lanie (Bi Malaria), characterized by fever only without chills, or Re Lanie (Heat Malaria), characterized by fever preceding chills, is treated with Baihu Tang (White Tiger Decoction) plus Gui Zhi (Cinnamomi Ramulus); Laolie (Labor Malaria), caused by overexertion or irregular diet, is treated with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Chai Hu (Bupleuri Radix); Zhanlie (Miasma Malaria), contracted from mountain miasma, is treated with Huoxiang Zhengqi San (Agarwood Powder for Regulating Qi) or Pingwei San (Calm the Stomach Powder) plus Chai Hu (Bupleuri Radix); Jiulie (Chronic Malaria) resulting in masses in the heart and abdomen is called Mumai (Malaria Mother), treated with Biejia Yin (Softshell Turtle Decoction). These few categories require slight differentiation, yet fundamentally remain within the Shaoyang channel.
If malaria and dysentery occur simultaneously, use Xiaochaihu Tang (Minor Bupleurum Decoction) to soothe the Qi of the Shaoyang channel, thereby lifting sunken Qi. Add Hua Fen (Trichosanthis Radix) three qian to nourish the fluids of the Yangming channel, thereby unblocking stagnation. Alternatively, administer Xianglian Wan (Fringeflower and Coptis Pill) one qian five fen with this decoction; for cases with deficiency, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with doubled Chai Hu (Bupleuri Radix) decocted, administering Xianglian Wan (Fringeflower and Coptis Pill) two qian. This is the core method of Mr. Xue Lizhai.
Xiaochaihu Tang (Formula see *Shanghan Lun*)
Disciple Yuan Xi notes: Medications for treating malaria should ideally be taken three hours before the onset of the attack, or decocted into two doses. Take one dose at wugeng (5-7 AM) on the day of the attack, and reserve the second dose for two hours before the anticipated onset, which is optimal. Ancient methods required exposing malaria medications overnight because malaria is attributed to summerheat pathogens, and exposure to dew dissipates summerheat energy. Furthermore, contemporary physicians prohibit the use of Ren Shen (Ginseng Radix et Rhizoma), Bai Zhu (Atractylodis Macrocephalae Rhizoma), and Fu Ling (Poria) for initial malaria, a view originating from Songya Zunsheng. Although I do not fully agree, I shall follow the majority. Thus, following Songya, remove Ren Shen (Ginseng Radix et Rhizoma) and add Qing Pi (Citri Reticulatae Pericarpium Viride) one qian five fen. Increase Gan Jiang (Zingiberis Rhizoma) and Gui Zhi (Cinnamomi Ramulus) by two qian each for excess cold; increase Zhi Mu (Anemarrhenae Rhizoma) and Hua Fen (Trichosanthis Radix) by two qian each for excess heat, or add Huang Lian (Coptidis Rhizoma) and Shi Gao (Gypsum Fibrosum). Removing Ren Shen (Ginseng Radix et Rhizoma) from this base formula and adding Chang Shan (Dichroae Radix), Cao Guo (Tsaoko Fructus), Zhi Mu (Anemarrhenae Rhizoma), Bing Lang (Arecae Semen), and Chuan Bei Mu (Fritillariae Cirrhosae Bulbus) each two qian creates Qingzhong Qumai Yin (Clear the Middle and Drive Out Malaria Decoction). The general idea is that "no phlegm, no malaria," making this the master formula for treating the condition, and it is indeed effective.
Biejia Yin (Softshell Turtle Decoction)
Biejia (Softshell Turtle Carapace, three qian, vinegar-fried) Bai Zhu (Atractylodis Macrocephalae Rhizoma, stir-fried) Huang Qi (Astragali Radix) Chuan Xiong (Ligustici Chuanxiong Rhizoma) Jiu Bai Shao (Paeoniae Radix Alba, wine-processed) Bing Lang (Arecae Semen) Cao Guo (Tsaoko Fructus, baked) Hou Po (Magnoliae Officinalis Cortex) Chen Pi (Citri Reticulatae Pericarpium) Gan Cao (Glycyrrhizae Radix et Rhizoma) (each one qian) Sheng Jiang (Zingiberis Recens Rhizoma, three slices) Zao Rou (Jujubae Fructus pulp, three pieces) Wumei (Mume Fructus, one piece)
Decoct in water and take orally.
For chronic malaria lingering without resolution, or San Yin Malaria (Three-Yin Malaria) attacking every three days, differentiate the deficiency of the Five Zang organs and apply warming tonification. Regularly consume Jingyue's Heren Yin (Hereu Decoction) or Xiumai Yin (Rest Malaria Decoction). During the period of malaria attack, add one or two Shaoyang herbs, such as Chang Shan (Dichroae Radix), Chuan Shan Jia (Manis Squama), Fu Zi (Aconiti Lateralis Radix Preparata), or Jin Yin Hua (Lonicerae Japonicae Flos), to unblock collaterals. Alternatively, use Ren Shen (Ginseng Radix et Rhizoma) one liang and Sheng Jiang (Zingiberis Recens Rhizoma) one liang, decoct strongly and take orally. This is the method of arresting malaria without forcibly stopping it. For those with poor financial means, replace Ren Shen (Ginseng Radix et Rhizoma) with Dong Bai Zhu (Winter Atractylodis Macrocephalae Rhizoma) one to two liang; for blood deficiency, replace it with Dang Gui (Angelicae Sinensis Radix) one liang.
Although malaria is divided among the Five Zang organs, the treatment principle for chronic malaria focuses primarily on tonifying the Spleen. Earth (Spleen/Stomach) is the mother of all things, shading the Five Zang and Six Fu organs. Moreover, malaria is a Shaoyang pathogen; the Earth of Wu and Ji (Spleen/Stomach) suffers long-term overcoming by the Wood of Jia and Yi (Liver/Gallbladder). The method of supporting weakness and suppressing strength lies in the hands of the physician, who should carefully consider formulas such as Liu Junzi Tang (Six Gentlemen Decoction), Si Junzi Tang (Four Gentlemen Decoction), and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction).
Heren Yin (Hereu Decoction)
He Shou Wu (Polygoni Multiflori Radix, one liang, avoid iron or use raw) Ren Shen (Ginseng Radix et Rhizoma, two to three qian or one liang) Chen Pi (Citri Reticulatae Pericarpium, one to two qian, omit in deficiency) Wei Sheng Jiang (Zingiberis Recens Rhizoma, baked, two to three qian)
Decoct in water and take orally.
Xiumai Yin (Rest Malaria Decoction)
He Shou Wu (Polygoni Multiflori Radix, four qian or one liang) Ren Shen (Ginseng Radix et Rhizoma, two to three qian) Bai Zhu (Atractylodis Macrocephalae Rhizoma, three qian, stir-fried) Dang Gui (Angelicae Sinensis Radix, three qian) Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried, one qian)
Decoct in Yin-Yang Water and take orally.
Furthermore, for chronic malaria that does not resolve, seek the cause in the Kidney. If Kidney Water is insufficient with prominent heat, treat with Liuwei Wan (Six-Ingredient Pill with Rehmannia) modified; if Kidney Fire is insufficient with prominent cold, treat with Bawei Wan (Eight-Ingredient Pill with Rehmannia) modified.
*Gao Gufeng Medical Cases* records: I treated a patient with persistent San Yin Malaria, instructing him to swallow Bawei Wan (Eight-Ingredient Pill with Rehmannia) and take Ren Shen Yangrong Tang (Ginseng Nourishing Courage Decoction). On the Winter Solstice day, add Fu Zi (Aconiti Lateralis Radix Preparata) one qian. By midnight, he sweated and recovered. (Sweating is a sign of Yang returning and pathogens resolving. Recovery on the Winter Solstice occurs because Yang grows and Yin recedes.)