论
《内经》曰∶夏伤于暑，秋为 疟。又曰∶先寒而后热者，名曰寒疟。先热而后寒者，名曰温疟。其但热而不寒者，
名曰瘅疟。丹溪曰∶ 疟皆生于风， 疟者老疟也，以其隔二日一作，缠绵不去，古方多用峻剂，恐非禀受怯弱与居养
所移者所宜。始悟常山、乌梅、砒丹劫剂，或误投之，轻病变重，重者必危。夫三日一作者，邪入于三阴经也。作于子
午卯酉日者，少阴疟也。作于寅申巳亥日者，厥阴疟也。作于辰戌丑未日者，太阴疟也。疟得于暑，当以汗解。或因取
凉太过，汗郁成痰，其初感也，弱者即病，胃气强者伏而未动，至于再感，复因内伤，其病乃作，宜其难瘥。夫感暑与
风，皆外邪也，故非汗多不解。今之遘此疾者，已经再三劫试，胃气重伤，何由得愈。欲治此证，必先与参、术等补剂
为君，加柴、葛等发散药，渐而取汗，得汗而虚，又行补养。下体属阴，最难得汗，补药力到，汗出至足，方是佳兆。
又有感病极深，邪气必自脏传出至腑，其发无时。若发于午之后、寅之前者，血受病也，为难愈。须渐趱早，亦佳兆也。
治斯疾者，春夏为易，秋冬为难。大忌饱食，遇发日食饱，病愈加重。尤当以汗之难易，较轻重也。《内经》又曰∶疟之
且发也，阴阳之且移也，必从四末始，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（谓用三棱针刺孙络出血），此直往而未得并者也。故今人多以诸般草药，于臂膊内缚之，即此遗
意耳。外有阴虚证，每日午后恶寒发热，至晚亦得微汗而解，脉必虚濡而数。且疟脉弦，而虚脉不大弦为辨耳。若误作
疟治，而用常山、砒丹及柴胡、干葛等药，多至不救。医者宜以脉证参验其虚实而疗之，毋纵巨胆以杀人也。
脉法
《要略》曰∶疟脉自弦，弦数多热，弦迟多寒，弦而小紧者下之瘥，弦迟者宜温，弦紧者可发汗针灸，浮大者可吐
之，弦数者风发也，以饮食消息止之。
《脉经》云∶疟脉自弦，微则为虚，代散则死。
方法
丹溪曰∶有暑疟，有风疟，有湿疟，有痰疟，有食疟。三日一发者受病一年，间日一发者受病半年，一日一发者受
病一月。连发二日住一日者，气血俱受病。俗名脾寒，乃因名而迷其实也。苟因饮食所伤而得之，未必是寒，况其他乎。
暑疟，宜人参白虎汤之类。
有痰者，二陈汤加常山、草果、柴胡、黄芩。
不能食者，必于饮食上得之，当以食治。
虚者，必用参、术一、二帖，托住其气，不使下陷，后用他药。若无汗，要有汗，散邪为主，带补。若有汗，要无
汗，扶正气为主，带散邪。
数发之后，便宜截而除之。久发则中气虚弱，病邪已深而难治。世有砒丹等截药，有大毒，不可轻用。
大渴大热，用小柴胡去半夏，加知母、麦门冬、黄连、黄柏、栀子、天花粉。
疟渴，用生地黄、麦门冬、天花粉、牛膝、知母、炒黄柏、干葛、生甘草。
久疟，二陈汤加川芎、苍术、柴胡、葛根、白术，一补一发药也。
甚者发寒热，头痛如破，渴而饮水，多汁，可以参、 、芩、连、栀子、川芎、苍术、白术之类治之。
痰滞胸满，热多寒少，大便燥实，大柴胡利之愈。
久疟不得汗，以二陈汤倍加苍术、白术，少加槟榔。
小儿疟疾者，有痞块，生地黄、芍药各一钱半，陈皮、川芎、炒黄芩、半夏各一钱，甘草二分，加生姜煎，调醋炙
鳖甲末。
疟母，用丸药消导之，醋炙鳖甲为君，三棱、蓬术、香附、海粉、青皮、桃仁、红花、神曲、麦芽随证加减，为丸，
醋汤送下。
老疟系风暑入在阴分，宜用血药引出阳分而散，川芎、抚芎、当归、红花、苍白术、白芷、黄柏、甘草煎，露一宿
服之。
疟，老疟也，三日一发，阴经受病也。夫疟得于暑，当以汗解。或处凉冷，令汗不得泄，郁而成痰，又复嗜欲纵
饮，及轻试劫药，胃气大伤，其病难愈。必先与参、术、陈皮、芍药等剂，佐以本经引用之药，若得汗而体虚，又须重
补。俟汗通身，下过委中，方是佳兆。仍节饮食，避风寒，远房劳，无不愈者。
（以上丹溪方法凡十六条）
截疟常山饮（局方）
川常山 草果 槟榔 知母 炙甘草 乌梅 穿山甲（慢火煨脆）
上各等分，细切，每服五钱，水酒各半盏，煎至八分，露星月一宿，清晨冷服之，欲吐则顺之，忌热汤一日。然常
山性暴悍，善驱逐痰饮，大伤真气，病患稍虚弱者，戒勿轻用。
截疟七宝饮（局方）
常山（一钱） 浓朴 青皮 陈皮 炙甘草 槟榔 草果仁（各五分）
上细切，作一服，酒水各半盏，寒多加酒，热多加水，煎八分，露星月一宿，空心冷服，忌热茶汤一日，至午食温
粥。
东垣曰∶夏月天气上行，秋月天气下行，治者当顺天道。如先寒后热，太阳阳明病，白虎加桂也，此天气上行宜用
之。若天气下行，则不宜泻肺，宜泻命门相火则可矣。亦有内伤冷物而作者，当先调中，后定疟形，治随应见，乃得康
宁。亦有久而不瘥者，当求虚实，以脉为期，虚补实泻，可使却疾，此之谓也。
太阳证，令人腰痛头重，寒从背起，先寒后热， 然，热止汗出，难已，羌活加生地黄汤、小柴胡加桂汤。
阳明证，令人先寒洒淅，寒甚久乃热，热去汗出，喜日月光火气乃快然，桂枝二白虎一汤、黄芩芍药加桂汤。
少阳证，令人身体解 ，寒不甚，热不甚，恶见人，见人心惕惕然，热多汗出甚，小柴胡汤。
太阴证，令人不乐，好太息，不嗜食，多寒热汗出，病至则善呕，呕已乃衰，小建中汤、异功散。
少阴证，令人呕吐甚，多寒热，热多寒少，欲闭户牖而处，其病难已，小柴胡加半夏汤。
厥阴证，令人腰痛，小腹满，小便不利如癃伏，数便，意恐惧，气不足，腹中悒悒，四物玄胡苦楝附子汤。
白虎加桂枝汤（活人） 治温疟。
知母（四钱） 甘草（一钱） 石膏（五钱） 桂枝（一钱） 粳米（一合）
上以水三盏煎米，至二盏去米，入诸药，再煎至一盏，温服。三服，汗出愈。
温脾散（宝鉴） 治久疟不愈。
紫河车（俗名金线重楼） 绿豆（各一两） 甘草（五钱） 信砒（一钱五分，研细）
上为细末，入砒一处研匀，每服五分，新汲水少许调下。须于发日隔夜夜深服药，忌荤酒瓜果生冷鱼腥鸡肉等物三
日，孕妇勿服。但至诚合此药，与人并不吐。此虽有砒一味，而有河车、绿豆、甘草三味及新汲水皆能解毒，不妨。
按∶以上二方，劫病之捷胜于他方，但虚弱或久病羸瘦之人，终不可轻用。如服上药吐不止者，以生绿豆细研，新
汲水调饮，多即止。
（丹溪活套）云∶凡疟证，或连日或间日发作，恶寒发热，腰背头项俱痛，此属太阳经疟也，宜二陈汤加麻黄、羌
活、 本、防风之类。如连日或间日发作，先寒后热，或寒少热多，或但热不寒，目痛鼻孔燥，此属阳明经疟也，宜用
二陈汤加干葛、升麻、石膏、知母、白芷之类。如连日或间日发，或先寒后热，或寒热间作，胁痛口苦，或呕吐恶心，
此少阳经疟也，宜二陈汤倍加柴胡，及黄芩、人参、青皮之类。如于子午卯酉日发，寒热呕吐，舌干口燥，此少阴经疟
也，宜二陈汤加川归、川芎、黄柏、黄连、柴胡之类。如于辰戌丑未日发，寒热呕吐，不嗜食，或腹满自利，此太阴经
疟也，宜二陈汤加苍白术、柴胡、芍药之类。如于寅申巳亥日发，恶寒发热，寒多热少，或腹痛引阴，如淋状，善恐，
此厥阴经疟也，宜用二陈汤加桂枝、附子、干姜之类。大抵疟属三阳，宜汗宜吐，麻黄、葛根、柴胡、常山、草果、乌
梅之属治之。疟属三阴，宜下宜温宜和，大柴胡汤、柴胡桂姜汤、柴胡四物汤、附子理中汤之类，选而用之。
（祖传方）
截法∶
木通 秦艽 常山 穿山甲（醋炙黄，各一钱） 辰砂（五分，另研） 乌梅（七个） 大枣（七枚）
上细切，以水三盏，煎至一盏，先以枣和辰砂末食，后服药。
一方 用常山、草果、知母、槟榔各一钱，酒一盏浸一日，临发日早服。
又方 治久疟不愈，一服便止，永不发，其效如神。
常山（一钱五分） 槟榔（一钱） 丁香（五分） 乌梅（一枚）
上细切，作一服，用好酒一盏浸一宿，临发日清晨饮之。
予壮年过杭，同舟有二男子，皆年逾四十，已各得 疟三年矣，俱发于寅申巳亥日，一人昼发于巳而退于申，一人
夜发于亥而退于寅。予曰∶但到杭，可买药俱与痊可。昼发者，乃阴中之阳病，宜补气解表，与小柴胡汤倍柴胡、人参，
加白术、川芎、葛根、陈皮、青皮、苍术。夜发者，为阴中之阴病，宜补血疏肝，用小柴胡合四物，加青皮。各与十帖，
教其加姜、枣煎，于未发前二时服，每日一帖。服至八帖，同日得大汗而愈，永不再发。
论
《黄帝内经》说：夏季感受暑邪，秋季就会发生疟疾。又说：先出现寒战而后发热的，称为寒疟；先发热而后出现寒战的，称为温疟；只有发热而没有寒战的，称为瘅疟（但热不寒的疟疾）。朱丹溪说：疟疾都是由风邪引起的。“老疟”是指病程迁延的疟疾，因为它每隔两天发作一次，缠绵难愈，古代方剂中多使用峻猛的药物，恐怕不适合体质虚弱或生活调养导致正气受损的人。这才明白常山、乌梅、砒丹等劫夺痰邪的猛药，如果误用，轻病会加重，重病则必然危险。凡是三天发作一次的，是邪气侵入三阴经。在子日、午日、卯日、酉日发作的，是少阴疟。在寅日、申日、巳日、亥日发作的，是厥阴疟。在辰日、戌日、丑日、未日发作的，是太阴疟。疟疾由暑邪引起，应当通过发汗来解除。或者因为贪凉过度，汗液郁结变成痰饮，初次感受时，体质弱的人立即发病，胃气强的人邪气潜伏而未动，等到再次感受外邪，又加上内伤，疾病才发作，所以难以痊愈。感受暑邪和风邪，都是外邪，所以不是大汗淋漓就不能解除。现在患这种病的人，已经经过多次猛药的攻伐试探，胃气受到严重损伤，怎么能痊愈呢？想要治疗这个病症，必须先用人参、白术等补益药物作为主药，加入柴胡、葛根等发散药物，逐渐使其出汗，出汗后身体虚弱，再进行补养。下半身属阴，最难出汗，当补药的力量到达，汗出直到脚部，这才是好的征兆。又有感受病邪极深，邪气必然从脏传至腑，发作没有固定时间。如果在午时之后、寅时之前发作，是血分受病，难以治愈。必须逐渐提前发作时间，也是好征兆。治疗这种疾病，春夏季节容易，秋冬季节困难。特别忌讳饱食，遇到发作的日子吃得太饱，病情会更加加重。尤其应当根据发汗的难易程度来判断病情的轻重。《黄帝内经》又说：疟疾将要发作的时候，阴阳之气将要转移，必定从四肢末端开始，阳气已受伤，阴气随之而来，所以在发作前紧紧束缚患处，使邪气不能进入，阴气不能外出，仔细诊察发现孙络（浅表小血管）充盈坚硬且有瘀血的，都进行针刺放血（即用三棱针刺破孙络出血），这是针对邪气独行而尚未与正气相搏的情况。所以现在的人多用各种草药绑缚在手臂内侧，就是沿袭这个遗意罢了。另外有阴虚证，每天午后恶寒发热，到了晚上也能微微出汗而缓解，脉象一定虚软而数。而且疟疾的脉象弦，而虚脉不像弦脉那样紧绷，以此作为辨别。如果误当作疟疾治疗，而使用常山、砒丹以及柴胡、干葛等药物，大多会导致无法挽救。医生应当结合脉象和症状来验证虚实进行治疗，不要凭借大胆的胆量去杀人。
脉法
《金匮要略》说：疟疾的脉象自然呈弦象，弦而数的多热，弦而迟的多寒，弦而小紧的用下法可愈，弦迟的用温法适宜，弦紧的可以用发汗或针灸治疗，浮大的可以用吐法，弦数的是风热所致，可以通过饮食调理来制止。
《脉经》说：疟疾的脉象自然呈弦象，微弱则为虚证，代脉或散脉则是死证。
方法
朱丹溪说：有暑疟，有风疟，有湿疟，有痰疟，有食疟。三天发作一次的，患病一年；隔日发作一次的，患病半年；每天发作一次的，患病一个月。连续发作两天停一天的，气血都受了病。俗称脾寒，这是因名而迷惑了其实质。如果是因饮食所伤而得的，未必是寒证，何况其他情况呢。暑疟，适宜用人参白虎汤之类的方剂。有痰的，用二陈汤加常山、草果、柴胡、黄芩。不能进食的，一定是从饮食上得来的，应当用食疗。虚证的，必须用人参、白术一二帖，托住其气，不让其下陷，然后再用其他药物。如果没有汗，要有汗，以发散邪气为主，兼带补益。如果有汗，要无汗，以扶助正气为主，兼带发散邪气。多次发作之后，就应当截断并除去病邪。久发则中气虚弱，病邪已深而难治。世间有砒丹等截疟药，有大毒，不可轻易使用。大渴大热的，用小柴胡汤去掉半夏，加知母、麦门冬、黄连、黄柏、栀子、天花粉。疟疾口渴，用生地黄、麦门冬、天花粉、牛膝、知母、炒黄柏、干葛、生甘草。久疟，用二陈汤加川芎、苍术、柴胡、葛根、白术，这是一补一发的方剂。严重的出现寒热，头痛如裂，口渴想喝水，汁水多，可以用人参、[缺字]、黄芩、黄连、栀子、川芎、苍术、白术之类的药物治疗。痰滞胸满，热多寒少，大便干燥结实，用大柴胡汤利之可愈。久疟不得汗，用二陈汤加倍苍术、白术，少加槟榔。小儿疟疾，有痞块的，用生地黄、芍药各一钱半，陈皮、川芎、炒黄芩、半夏各一钱，甘草二分，加生姜煎煮，调服醋炙鳖甲末。疟母（疟疾形成的痞块），用丸药消导，醋炙鳖甲为君药，三棱、蓬术、香附、海粉、青皮、桃仁、红花、神曲、麦芽随证加减，制成丸药，醋汤送服。老疟是风暑深入阴分，适宜用血分药引出阳分而消散，用川芎、抚芎、当归、红花、苍白术、白芷、黄柏、甘草煎煮，露天放置一夜后服用。疟疾，是老疟，三天发作一次，是阴经受病。疟疾得自暑邪，应当通过发汗解除。或者处于凉冷环境，让汗液不能排泄，郁结而成痰，又反复嗜欲纵饮，以及轻率尝试劫药，胃气大伤，其病难愈。必须先用人参、白术、陈皮、芍药等剂型，佐以本经引经药，如果出汗后身体虚弱，又须重补。等到汗通全身，下行过委中穴，才是好征兆。仍节制饮食，避风寒，远房事，没有不痊愈的。
（以上丹溪的方法共十六条）
截疟常山饮（出自《局方》）
川常山 草果 槟榔 知母 炙甘草 乌梅 穿山甲（慢火煨脆）
以上各等分，细切，每次服用五钱，水和酒各半盏，煎至八分，露天星月下一夜，清晨冷服，想吐就顺其势吐出，忌喝热汤一天。然而常山性烈，善于驱逐痰饮，大伤真气，病患稍虚弱者，告诫不要轻用。
截疟七宝饮（出自《局方》）
常山（一钱） 浓朴 青皮 陈皮 炙甘草 槟榔 草果仁（各五分）
以上细切，作一服，酒水各半盏，寒多加酒，热多加水，煎至八分，露天星月下一夜，空腹冷服，忌热茶汤一天，到中午吃温粥。
李东垣说：夏天天气上行，秋天天气下行，治疗者应当顺应天道。如先寒后热，是太阳阳明病，用白虎加桂枝汤，这是天气上行时适宜用的。如果天气下行，则不宜泻肺，宜泻命门相火才可以。也有因内伤冷物而发作的，应当先调中焦，后定疟疾形态，治疗随证见效，才能安康。也有久而不愈的，应当求虚实，以脉象为准期，虚则补实则泻，可以使疾病退去，说的就是这个道理。
太阳证，使人腰痛头重，寒从背起，先寒后热，[缺字]然，热止汗出，难愈，用羌活加生地黄汤、小柴胡加桂汤。
阳明证，使人先寒战栗，寒甚久后才热，热去汗出，喜欢日光月光火气才舒服，用桂枝二白虎一汤、黄芩芍药加桂汤。
少阳证，使人身体懈怠，寒不甚，热不甚，怕见人，见人心惊惕，热多汗出甚，用小柴胡汤。
太阴证，使人心情不乐，喜欢叹气，不想吃东西，多寒热汗出，病发作时容易呕吐，吐完病情衰退，用小建中汤、异功散。
少阴证，使人呕吐严重，多寒热，热多寒少，想关窗闭户独处，其病难愈，用小柴胡加半夏汤。
厥阴证，使人腰痛，小腹满，小便不利像癃闭伏匿，频繁小便，心里恐惧，气不足，腹中郁闷，用四物玄胡苦楝附子汤。
白虎加桂枝汤（出自《活人书》） 治疗温疟。
知母（四钱） 甘草（一钱） 石膏（五钱） 桂枝（一钱） 粳米（一合）
以上用水三盏煎米，至二盏去米，入诸药，再煎至一盏，温服。三服，出汗即愈。
温脾散（出自《宝鉴》） 治疗久疟不愈。
紫河车（俗名金线重楼） 绿豆（各一两） 甘草（五钱） 信砒（一钱五分，研细）
以上为细末，入砒一处研匀，每次服五分，新汲水少许调下。必须在发作日前一晚深夜服药，忌荤酒瓜果生冷鱼腥鸡肉等物三日，孕妇勿服。只要诚心配制此药，给人服用并不呕吐。这虽然有砒一味，但有河车、绿豆、甘草三味及新汲水都能解毒，不妨碍。
按：以上两个方子，截断病邪的捷效胜过其他方子，但虚弱或久病羸瘦之人，终究不可轻用。如果服用上述药物呕吐不止，用生绿豆细研，新汲水调饮，多了就能停止。
（丹溪活套）说：凡是疟疾，或连日或间日发作，恶寒发热，腰背头项俱痛，这属于太阳经疟，适宜二陈汤加麻黄、羌活、[缺字]本、防风之类。如连日或间日发作，先寒后热，或寒少热多，或但热不寒，目痛鼻孔燥，这属于阳明经疟，适宜用二陈汤加干葛、升麻、石膏、知母、白芷之类。如连日或间日发，或先寒后热，或寒热间作，胁痛口苦，或呕吐恶心，这属于少阳经疟，适宜二陈汤倍加柴胡，及黄芩、人参、青皮之类。如在子午卯酉日发，寒热呕吐，舌干口燥，这属于少阴经疟，适宜二陈汤加川归、川芎、黄柏、黄连、柴胡之类。如在辰戌丑未日发，寒热呕吐，不嗜食，或腹满自利，这属于太阴经疟，适宜二陈汤加苍白术、柴胡、芍药之类。如在寅申巳亥日发，恶寒发热，寒多热少，或腹痛引阴，像淋状，善恐，这属于厥阴经疟，适宜用二陈汤加桂枝、附子、干姜之类。大抵疟疾属于三阳，宜汗宜吐，用麻黄、葛根、柴胡、常山、草果、乌梅之类治疗。疟疾属于三阴，宜下宜温宜和，选大柴胡汤、柴胡桂姜汤、柴胡四物汤、附子理中汤之类使用。
（祖传方）
截法：
木通 秦艽 常山 穿山甲（醋炙黄，各一钱） 辰砂（五分，另研） 乌梅（七个） 大枣（七枚）
以上细切，用水三盏，煎至一盏，先用枣和辰砂末吃，后服药。
一方 用常山、草果、知母、槟榔各一钱，酒一盏浸一日，临发作日早服。
又方 治疗久疟不愈，一服便止，永不复发，其效如神。
常山（一钱五分） 槟榔（一钱） 丁香（五分） 乌梅（一枚）
以上细切，作一服，用好酒一盏浸一宿，临发作日清晨饮之。
我壮年路过杭州，同船有两个男子，都年过四十，都已患疟疾三年了，都在寅申巳亥日发作，一人白天在巳时发作而在申时退去，一人夜晚在亥时发作而在寅时退去。我说：只要到了杭州，可以买药一起治愈。白天发作的，是阴中之阳病，宜补气解表，用小柴胡汤倍加柴胡、人参，加白术、川芎、葛根、陈皮、青皮、苍术。夜晚发作的，是阴中之阴病，宜补血疏肝，用小柴胡合四物汤，加青皮。各给十帖，教他们加姜、枣煎煮，在未发作前两小时服用，每日一帖。服至八帖，同日得大汗而愈，永不再发。
Discussion
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: Summer injury by heat-evil leads to malaria in autumn. It also says: Those who experience chills first and then fever are named cold malaria (Han Nue). Those who experience fever first and then chills are named warm malaria (Wen Nue). Those who have only fever without chills are named dan malaria (Dan Nue). Zhu Danxi said: Malaria all arises from wind-evil. "Old malaria" refers to chronic malaria, as it occurs every two days, lingering and refusing to depart. Ancient prescriptions often used harsh agents, which is likely unsuitable for those with weak constitutions or whose health has been altered by improper living care. I then realized that harsh agents like Changshan (Dichroa Radix), Wumei (Mume Fructus), and Pidans (Arsenic Pills) could, if mistakenly administered, turn mild illness into severe cases, and severe cases into critical ones. When the disease occurs every three days, the evil has entered the Three Yin meridians. Occurrences on Zi, Wu, Mao, You days indicate Shaoyin malaria. Occurrences on Yin, Shen, Si, Hai days indicate Jueyin malaria. Occurrences on Chen, Xu, Chou, Wei days indicate Taiyin malaria. Malaria acquired from summer-heat should be resolved through sweating. However, if one cools off excessively, sweat becomes trapped and transforms into phlegm. Upon initial infection, those with weak constitutions fall ill immediately, while those with strong Stomach Qi remain latent until a secondary infection combined with internal injury triggers the disease, making it difficult to cure. Both summer-heat and wind are external evils, thus they cannot be resolved without profuse sweating. Patients suffering from this ailment now have already undergone multiple harsh purgative trials, severely damaging their Stomach Qi; how can they recover? To treat this condition, one must first use tonifying agents such as Renshen (Ginseng Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma) as the sovereign drug, adding dispersing herbs like Chaihu (Bupleuri Radix) and Gegen (Puerariae Lobatae Radix) to gradually induce sweating. After sweating, if deficiency persists, further nourishment is required. The lower body belongs to Yin and is hardest to sweat; when the power of tonifying drugs reaches its destination and sweat flows down to the feet, this is a favorable sign. In cases where the pathogenic factor is extremely deep, the evil must transmit from the Zang organs to the Fu organs, with irregular onset. If onset occurs after Wu hour and before Yin hour, the Blood is affected, making it difficult to cure. A gradual shift to earlier onset is also a favorable sign. Treating this disease is easier in Spring and Summer but difficult in Autumn and Winter. One must strictly avoid overeating; eating too full on onset days worsens the illness. One should judge severity by the ease or difficulty of sweating. The *Neijing* further states: When malaria is about to attack, Yin and Yang are shifting, starting from the four extremities. Since Yang is injured and Yin follows, bind the area firmly before onset to prevent evil entry and Yin exit. Observe carefully; if Sunluo (collateral vessels) are full, hard, and bloody, puncture them to bleed (using a three-edged needle). This targets the evil traveling alone before merging with healthy Qi. Hence, people today tie various herbal remedies inside the arms, following this ancient intent. Additionally, there is Yin deficiency syndrome: daily afternoon chills and fever, resolving with slight sweating at night, with a pulse that is deficient, soft, and rapid. Differentiate this from malaria pulse (wiry); the deficient pulse is not wiry. Mistaking this for malaria and using Changshan, Pidans, Chaihu, or Gegen often leads to untreatable conditions. Physicians must verify deficiency and excess via pulse and symptoms, avoiding reckless treatment that may cause death.
Pulse Methods
The *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) states: Malaria pulses are naturally wiry. Wiry and rapid indicates much heat; wiry and slow indicates much cold. Wiry, small, and tight suggests purging will help; wiry and slow suggests warming; wiry and tight suggests sweating or acupuncture; floating and large suggests emesis; wiry and rapid indicates wind-fire, which can be managed through dietary adjustments.
The *Maijing* (Pulse Classic) states: Malaria pulses are naturally wiry. Micro indicates deficiency; intermitting or scattered pulses indicate death.
Methods
Zhu Danxi said: There is summer-heat malaria, wind malaria, dampness malaria, phlegm malaria, and food stagnation malaria. Every-three-day attacks imply one year of illness; every-other-day attacks imply six months; daily attacks imply one month. Two consecutive days of attack followed by one day rest implies both Qi and Blood are diseased. Commonly called Spleen Cold, this name confuses the reality. If caused by dietary injury, it is not necessarily cold, let alone other causes. For summer-heat malaria, Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction) is suitable. For phlegm, Er Chen Tang (Two-Cured Decoction) plus Changshan, Caoguo (Tsaiko Fructus), Chaihu, Huangqin (Scutellariae Radix). For inability to eat, address diet directly. For deficiency, use Renshen and Baizhu for one or two doses to support Qi and prevent sinking, then use other drugs. If no sweat, focus on dispersing evil with some tonification. If sweating, focus on supporting righteous Qi with some dispersal. After frequent attacks, it is timely to intercept and remove the pathogen. Long-term attacks weaken Middle Qi, making deep-seated pathogens hard to treat. Arsenic-based interception drugs are highly toxic and should not be used lightly. For extreme thirst and heat, use Xiao Chai Hu Tang (Minor Bupleurum Decoction) removing Banxia (Pinelliae Rhizoma), adding Zhimu (Anemarrhenae Rhizoma), Maidong (Ophiopogonis Radix), Huanglian (Coptidis Rhizoma), Huangbai (Phellodendri Cortex), Zhizi (Gardeniae Fructus), and Tianhuafen (Trichosanthis Radix). For malaria-induced thirst, use Shengdihuang (Rehmanniae Radix), Maidong, Tianhuafen, Niuxi (Achyranthis Bidentatae Radix), Zhimu, fried Huangbai, Gan Ge (Puerariae Radix), and Sheng Gancao (Licorice Radix). For chronic malaria, Er Chen Tang plus Chuanxiong (Ligustici Chuanxiong Rhizoma), Cangzhu (Atractylodis Rhizoma), Chaihu, Gegen, Baizhu serves as a tonic-dispersing formula. For severe cases with chills/fever, splitting headache, thirst, and copious fluids, use Renshen, [missing character], Huangqin, Huanglian, Zhizi, Chuanxiong, Cangzhu, Baizhu. For phlegm stagnation with chest fullness, more heat than cold, and dry stool, Da Chai Hu Tang (Major Bupleurum Decoction) resolves it. For chronic malaria without sweat, double Cangzhu and Baizhu in Er Chen Tang, add少量 Binlang (Arecae Semen). For pediatric malaria with masses, use Shengdihuang and Shaoyao (Paeoniae Radix Alba) 1.5 qian each, Chenpi (Citri Reticulatae Pericarpium), Chuanxiong, fried Huangqin, Banxia 1 qian each, Gancao 2 fen, decoct with fresh ginger, mix with vinegar-fried Biejia (Testudinis Carapax et Plastrum) powder. For Nuomu (malaria mass), use pills for digestion: Biejia as sovereign, plus Sanleng (Sparganii Rhizoma), Pengzhi (Curcumae Radix), Xiangfu (Cyperi Rhizoma), Haifen (Sepiae Endoconcha), Qingpi (Citri Reticulatae Pericarpium Viride), Taoren (Persicae Semen), Honghua (Carthami Flos), Shenqu (Massae Fermentatae Medicamentosa), Maiya (Hordei Fructus Germinatus) adjusted by syndrome, formed into pills, taken with vinegar water. Old malaria involves wind-heat entering Yin levels; use blood-invigorating herbs to draw evil to Yang level for dispersal: Chuanxiong, Fujxiong, Danggui (Angelicae Sinensis Radix), Honghua, Cang/Bai Zhu, Baizhi (Angelicae Dahuricae Radix), Huangbai, Gancao, decoct and leave exposed overnight before taking. Malaria, specifically old malaria occurring every three days, affects Yin meridians. Acquired from summer-heat, it requires sweating. Cooling environments trap sweat into phlegm; indulgence in desires/drinks and rash use of harsh drugs damage Stomach Qi, making recovery hard. Start with Renshen, Baizhu, Chenpi, Shaoyao, assisted by meridian-guiding herbs. If sweating occurs and body is weak, heavily tonify. When sweat covers the whole body and reaches Weizhong (BL40), it is a good sign. Regulate diet, avoid wind/cold, abstain from sexual activity; recovery is assured.
(Above are sixteen methods from Danxi.)
Jie Nue Changshan Yin (Intercept Malaria Changshan Drink - *Ju Fang*)
Chuan Changshan, Caoguo, Binlang, Zhimu, Zhi Gancao, Wumei, Chuanshanjia (slow-fire roasted crisp).
Equal parts, finely cut. Take 5 qian per dose, half cup water and half cup wine, decoct to 8/10 volume. Expose under stars/moon overnight. Take cold in the morning. If vomiting occurs, allow it. Avoid hot soup for one day. Changshan is aggressive, expelling phlegm-fluids but greatly damaging True Qi. Do not use lightly in slightly weak patients.
Jie Nue Qibao Yin (Intercept Malaria Seven-Treasure Drink - *Ju Fang*)
Changshan (1 qian), Houpo (Magnoliae Officinalis Cortex), Qingpi, Chenpi, Zhi Gancao, Binlang, Caoguoren (each 5 fen).
Finely cut, one dose. Half cup water, half cup wine (more wine for cold, more water for heat). Decoct to 8/10 volume. Expose overnight. Take cold on empty stomach. Avoid hot tea/soup for one day; eat warm congee at noon.
Li Dongyuan said: In summer, Heaven's Qi ascends; in autumn, it descends. Treaters must follow this Heavenly Dao. For chills first then fever (Taiyang-Yangming syndrome), Baihu Jia Guizhi Tang (White Tiger plus Cinnamon Twig Decoction) is appropriate for ascending Qi. For descending Qi, do not purge Lung; instead purge Minister Fire of Mingmen. Some arise from internal injury by cold foods; regulate the Middle first, then define the malaria pattern. Treatment responds accordingly, leading to health. For chronic non-resolving cases, determine deficiency/excess based on pulse. Tonify deficiency, purge excess; this drives away disease.
Taiyang Syndrome: Causes lower back pain, heavy head, cold rising from back, chills first then fever, [missing char], sweating stops fever but is hard to cure. Use Qianghuo plus Shengdihuang Decoction or Xiao Chai Hu Tang plus Guizhi.
Yangming Syndrome: Causes initial shivering chills, long-lasting severe cold then fever, sweating upon fever cessation. Relief comes from sunlight/moonlight/fire warmth. Use Gui Zhi Er Bai Hu Yi Tang (two parts Gui Zhi, one part Baihu) or Huangqin Shaoyao plus Guizhi Tang.
Shaoyang Syndrome: Causes flaccid body, mild chills/fever, aversion to people, palpitations upon seeing people, much heat and sweating. Use Xiao Chai Hu Tang.
Taiyin Syndrome: Causes low mood, frequent sighing, anorexia, mixed chills/fever/sweating. Vomiting at onset subsides the disease. Use Xiao Jian Zhong Tang or Yi Gong San.
Shaoyin Syndrome: Causes severe vomiting, mixed chills/fever (more heat), desire to close doors/windows and stay alone. Hard to cure. Use Xiao Chai Hu Tang plus Banxia.
Jueyin Syndrome: Causes lower back pain, abdominal fullness, urinary difficulty resembling strangury/frequency, fear, Qi insufficiency, abdominal depression. Use Siwu Xuanhu Kulian Fuzi Tang.
Baihu Jia Guizhi Tang (*Huoren Shu*): Treats Wen Nue.
Zhimu (4 qian), Gancao (1 qian), Shigao (5 qian), Guizhi (1 qian), Jingmi (1 he).
Decoct Jingmi in 3 cups water to 2 cups, remove rice. Add other herbs, decoct to 1 cup. Take warm. After 3 doses, sweating cures.
Wen Pi San (Warm Splene Powder - *Baojian*): Treats chronic malaria.
Ziheche (Placenta Human), Lv Dou (Mung Bean) (each 1 liang), Gancao (5 qian), Xin Pi (Arsenic Trioxide) (1.5 qian, finely ground).
Grind together uniformly. Take 5 fen per dose, mixed with a little fresh drawn water. Must take late at night before onset day. Avoid meat, alcohol, fruits, raw/cold, fish, chicken for 3 days. Pregnant women forbidden. Sincere preparation prevents vomiting despite arsenic content, as Heche, Lv Dou, Gancao, and fresh water detoxify.
Note: These two formulas are potent interceptors but unsafe for weak or emaciated chronic patients. If vomiting persists after taking, grind fresh Lv Dou, mix with fresh water, drink to stop vomiting.
(Danxi Flexible Patterns) states: For any malaria, whether daily or intermittent, with chills/fever and pain in waist/back/head/neck, it belongs to Taiyang Malaria. Use Er Chen Tang plus Mahuang (Ephedrae Herba), Qianghuo, [missing char] Ben (Ligustici Wallichii Rhizoma), Fangfeng (Saposhnikoviae Radix). If daily/intermittent, chills first then fever, or less chills/more heat, or only heat without chills, with eye pain and dry nostrils, it belongs to Yangming Malaria. Use Er Chen Tang plus Gan Ge, Shengma (Cimicifugae Rhizoma), Shigao, Zhimu, Baizhi. If daily/intermittent, chills/fever alternating, hypochondriac pain, bitter taste, nausea/vomiting, it belongs to Shaoyang Malaria. Use Er Chen Tang doubling Chaihu, plus Huangqin, Renshen, Qingpi. If onset on Zi/Wu/Mao/You days with chills/fever/vomiting, dry tongue/mouth, it belongs to Shaoyin Malaria. Use Er Chen Tang plus Chuan Gui, Chuanxiong, Huangbai, Huanglian, Chaihu. If onset on Chen/Xu/Chou/Wei days with chills/fever/vomiting, anorexia, abdominal fullness/diarrhea, it belongs to Taiyin Malaria. Use Er Chen Tang plus Cang/Bai Zhu, Chaihu, Shaoyao. If onset on Yin/Shen/Si/Hai days with chills/fever (more chills), abdominal pain radiating to genitals, stranguria-like sensation, fear, it belongs to Jueyin Malaria. Use Er Chen Tang plus Guizhi, Fuzii (Aconiti Lateralis Radix Praeparata), Ganjiang (Zingiberis Rhizoma). Generally, Yang-level malaria requires sweating/emesis; use Mahuang, Gegen, Chaihu, Changshan, Caoguo, Wumein. Yin-level malaria requires purging/warming/harmonizing; select Da Chai Hu Tang, Chaihu Gui Jiang Tang, Chaihu Siwu Tang, Fuzi Lizhong Tang.
(Ancestral Formula)
Interception Method:
Mutong (Akebiae Caulis), Qin Jiao (Gentianae Macrophyllae Radix), Changshan, Chuanshanjia (vinegar-fried yellow, each 1 qian), Chen Sha (Cinnabar) (5 fen, separately ground), Wumei (7 pieces), Dazao (Jujubae Fructus) (7 pieces).
Finely cut. Decoct in 3 cups water to 1 cup. First eat dates with Chen Sha powder, then take medicine.
Another Prescription: Changshan, Caoguo, Zhimu, Binlang (each 1 qian), soak in 1 cup wine for one day. Take early on onset day.
Another Prescription: Treats chronic malaria, stops after one dose, never recurs, miraculous effect.
Changshan (1.5 qian), Binlang (1 qian), Dingxiang (Caryophylli Flos) (5 fen), Wumei (1 piece).
Finely cut, one dose. Soak in 1 cup good wine overnight. Drink early morning on onset day.
In my youth, passing Hangzhou, two men on the same boat, both over forty, had suffered from malaria for three years, always on Yin/Shen/Si/Hai days. One attacked during the day at Si hour and subsided at Shen hour; the other at night at Hai hour and subsided at Yin hour. I said: Upon reaching Hangzhou, buy medicine and both will recover. Daytime attack is Yang within Yin; tonify Qi and release exterior. Use Xiao Chai Hu Tang doubling Chaihu and Renshen, plus Baizhu, Chuanxiong, Gegen, Chenpi, Qingpi, Cangzhu. Nighttime attack is Yin within Yin; tonify Blood and soothe Liver. Use Xiao Chai Hu Tang combined with Siwu Tang, plus Qingpi. Gave each ten doses, instructed to decoct with ginger and jujube, take two hours before onset, one dose daily. After eight doses, both sweated profusely on the same day and recovered permanently.