疟之不同于伤寒也∶疟为轻，伤寒为重；疟在经络，伤寒在气化。气化者，随六气而化病，有阴阳之传变
也。经络者，疟邪随经络而沉以内薄，由卫气应乃作也。应者，卫气外出，疟从之而发；卫气内入，疟从之而
休也。时行传染之疟，邪疟也，邪气相感，但在皮肤络
脉间，即不服药，三日亦愈。其先寒后热，热时烦渴，汗出即休，此三阳疟也，即不服药，六日亦愈。又日发而
早，其疟将愈；日发而晏，其疟难已。晏者，卫气虚而循经不入也。疟有阴阳轻重之不同，疟为阳，脾寒为阴；
疟为轻，脾寒为重。时俗一概混称，医家一概混治，岂知疟与脾寒之不同哉！疟不死人，脾寒能死人。若脾寒
病，而概以消散寒凉之药，昧昧以治，断未有不毙者也。夫病之发也，寒少热多，六脉均平，能食，而神气如常
者，疟也；寒多热少，六脉微虚，不能食而烦闷呕逆，神气消索者，脾寒也。夏月皮毛开发，经络外溢，风暑之
邪，易伤经络，故多疟病。伤络者，疟之轻者也；伤经者，疟之可轻可重者也。治疟之方，当调其气血，和其荣
卫，疏其络，通其经，察寒热之多少，辨脏腑之虚实，而施治之。欲调气血、和荣卫，如归、芍、红花、柴胡、桂枝
可用也；疏通经络，如续断、木通、秦艽、银花可用也。寒多者，姜、桂、曲、朴以温之；热多者，柴、芩、知、葛以
清之；实者，橘、半、枳、朴；虚者， 、术、甘、苓。此疟病通治之法也。
若干太阴脾脏，则为寒疟；寒疟，犹脾寒也。少阴心脏，则为心疟；心疟，犹瘅疟也。少阴肾脏，则为肾
疟；肾疟，犹牝疟也。厥阴肝脏，则为厥疟；厥疟，厥不知人也。此数疟者，当用参、 、术、姜、桂、附
以治之，惟心疟属手少阴，不宜温热，当用参、苓、归、芍、枸杞、枣仁、
远志、龙眼补心养血之法以治之。此五脏三阴疟，实可生而可死。凡此所以论疟病之重轻，及治疟之常法也。
而疟之方起、疟之变病、治之禁忌、药之流通，更当悉焉。夏月天暑地炎，无寒风之外感，然而沐浴水寒。
暮夜凉风，不能无也。人犯之者，不在皮肤，多伤经脉。人身卫气，夜入于阴，日出于阳，因卫气之出，而乍
然寒热，即疟病也。若昧昧以诊，见有寒热，不曰伤寒，即曰伤暑，不曰中暑，即曰内伤外感。夫其言如是，
而所用之药，无非发散、消食，及乎寒凉而已。嗟嗟！如是之病，不遭如是之药，虽然成疟，七日可愈。今也
发散虚其表，消食损其中，寒凉滞其经，而又绝其谷，必至疟不成疟，伤寒不成伤寒，汗虽出而身不凉，至日
晡而热更甚。须知日晡热甚，原病疟也；汗出不凉，表里皆虚也。无力之家，不延医，不服药，进以糜粥，
挨延时日而愈；有力之家，屡屡更医，察其根由，医必曰∶虚之极矣。先以人参少许，探而试之，试之相宜，
则重用之，然后进以糜粥，亦延挨时日而愈。如是之病，夏月颇多，明者视之，深为叹惜，而医与病家，总不
知也。然延挨而愈者，什之八九，其告殂者，岂无一二？言念及此，宁不悲哉！又有炎暑之时，其人卒然厥逆，
色苍苍如死状，人必骇曰∶此痧发也。放痧出血，以救一时之困，数日之后，转而为疟。讵知厥逆若死，非
痧也，乃邪盛于经，经脉一时不能交接，即疟之兆端始发也。徒刺其血，后必病
疟，疟亦不轻，然此疟乃发于经脉之阳者。更有一时暴厥，厥不知人，刺之无血，牙关紧急。医见之，不曰急
痧，即曰中风入脏，刺指无血，则用锋针刺曲池、委中，以出其血，牙关不开，则以铜箸撬齿，灌矾水而探吐，
时余始苏，精神委顿，六脉微虚，一日稍平，次日复厥，厥而无热，微微有汗。此疟从阴出，不得阳热之化，
乃厥疟也。余于夏日，曾治一二，其后亦愈。若既苏之后，投剂不宜，亦不能生。此疟之方起为然也。若疟之
变病，总由攻消太过，三焦内虚，或胀满，或浮肿，或泄泻，或咳嗽。病虽有变，更当温其中土，助其三焦；
若胀满者消之，浮肿者散之，泄泻者通之，咳嗽者清之，一时暂松，不能全愈，耽延时日，断未有不毙者也。
治疟禁忌∶一发散，二消食，三寒凉，前已言之矣。至药之流通，今人治疟，不用常山，以常山为截疟药，
截之早，其后必变臌胀。不观仲师治疟，每用蜀漆。蜀漆，常山苗也。苗不可得而用其根，亦何害焉？况常山
乃从阴出阳之药，若三阴疟、脾寒病，不使从阴出阳，何能即愈？既愈矣，又何臌胀之有？又疟病虚寒，久用
参、术、姜、桂，总不能愈者；参、术、姜、桂之内，须加常山，更须加穿山甲，使经络疏通，疟邪外出，
未有不愈者也。又阳热之疟，鳖甲可以攻散；心、肾之热疟，菖蒲、黑豆可以交通；邪入郛郭，槟榔、草果
可以泄之；邪入膀胱，车前、滑石
可以利之。若疟后发咳，乃初因疟病，地气不交于肺，今疟止病去，则地气上升，脾、肺始交，故咳。苟不助脾
气之上升，而反用泄肺之药以下泄，其咳断不能除，转为疟怯，至五年而必死。嗟嗟！医之为道，至精至微，
粗工凶凶，方技自逞，收一时之小效，至后死而弗计，哀哉！
疟疾与伤寒不同：疟疾病情较轻，伤寒病情较重；疟疾病变在经络，伤寒病变在气化。所谓气化，是指病邪随着六气（风、寒、暑、湿、燥、火）的变化而转化，存在阴阳之间的传变规律。所谓经络，是指疟邪顺着经络深入体内，由卫气相应时发作。所谓“应”，是指卫气外出体表时，疟邪随之发作；卫气内入脏腑时，疟邪随之休止。属于时行传染的疟疾，是邪疟，邪气相互感应，仅在皮肤络脉之间，即使不服药，三天也能痊愈。先恶寒后发热，发热时烦躁口渴，出汗后即停止，这是三阳疟，即使不服药，六天也能痊愈。如果每天发作时间提前，说明疟疾即将痊愈；如果每天发作时间推迟，说明疟疾难以治愈。所谓“晏”（推迟），是因为卫气虚弱，循经运行不能按时进入体内。疟疾有阴阳轻重的不同，疟疾属阳，脾寒属阴；疟疾较轻，脾寒较重。世俗之人一概混称，医生们一概混治，哪里知道疟疾与脾寒的不同呢！疟疾不致死，脾寒能致死。如果是脾寒病，却一概用消散、寒凉的药物，糊涂地治疗，断然没有不死亡的。凡是发病时，寒少热多，六脉平和，能进食，且神气如常的，是疟疾；寒多热少，六脉微弱虚软，不能进食且烦躁闷乱、恶心呕吐，神气衰败消索的，是脾寒。夏季皮毛开泄，经络气血外溢，风暑之邪容易损伤经络，所以多发疟疾。伤及络脉的，是轻症的疟疾；伤及经脉的，是可轻可重的疟疾。治疗疟疾的方剂，应当调和气血，调和营卫，疏通络脉，通达经脉，观察寒热的多少，辨别脏腑的虚实，然后施治。想要调和气血、调和营卫，可以使用当归、白芍、红花、柴胡、桂枝等；想要疏通经络，可以使用续断、木通、秦艽、金银花等。寒多者，用干姜、肉桂、神曲、厚朴来温中；热多者，用柴胡、黄芩、知母、葛根来清热；实证者，用陈皮、半夏、枳实、厚朴；虚证者，用人参、白术、甘草、茯苓。这是治疗疟疾的通法。
如果邪气陷入太阴脾脏，就成为寒疟；寒疟，类似于脾寒。邪气陷入少阴心脏，就成为心疟；心疟，类似于瘅疟（但热不寒的疟疾）。邪气陷入少阴肾脏，就成为肾疟；肾疟，类似于牝疟（先寒后热的疟疾）。邪气陷入厥阴肝脏，就成为厥疟；厥疟，表现为四肢厥冷、神志不清。这几种疟疾，应当使用人参、[此处原文缺字，推测为黄芪或类似补气药]、白术、干姜、肉桂、附子来治疗。只有心疟属于手少阴经，不宜用温热药，应当用人参、茯苓、当归、白芍、枸杞、酸枣仁、远志、龙眼肉补心养血的方法治疗。这五脏三阴疟，实际上是既可生也可死的。以上这些是用来论述疟病的轻重，以及治疗疟疾的常规方法。至于疟疾的初起、疟疾的变证、治疗的禁忌、药物的运用，更应当详尽了解。夏季天气炎热，地面灼热，虽然没有寒风的外感，但是沐浴时的水寒、暮夜时的凉风，是不能避免的。人若触犯这些邪气，邪气不在皮肤，多伤及经脉。人身体的卫气，夜间进入阴分，白天出于阳分，因为卫气的出入，突然发生寒热交替，这就是疟疾。如果糊涂地诊断，见到有寒热症状，不是说是伤寒，就是说是伤暑；不是中暑，就是内伤兼外感。虽然说法如此，但所用的药物，无非是发散、消食，以及寒凉药罢了。唉！这样的病，如果不遭受这些药物的误治，虽然形成疟疾，七天也可以痊愈。现在发散药使表虚，消食药损伤中焦，寒凉药阻滞经脉，又断绝了谷气摄入，必然导致疟疾不像疟疾，伤寒不像伤寒，虽然出汗但身体不凉爽，到了傍晚时分热度反而更甚。须知傍晚热度甚重，原本就是疟疾；出汗后身体不凉爽，是因为表里都虚。无力请医的家庭，不延请医生，不服药，只进米粥，拖延时日而痊愈；有力请医的家庭，屡次更换医生，考察其根源，医生必定说：“虚损到极点了。”先用少许人参试探，如果试探相宜，就重用，然后进以米粥，也是拖延时日而痊愈。这样的病，夏季很多，明智的人看了，深为叹息，而医生和病人家属，总不知道原因。然而拖延而痊愈的，占十分之八九，那些死亡的，难道没有一两个吗？想到这些，怎能不悲伤呢！又有在炎热酷暑之时，其人突然四肢厥逆，面色青苍如同死状，人们一定惊恐地说：“这是痧症发作。”放痧出血，以救一时的困厄，数日之后，转变为疟疾。哪里知道这种厥逆像死一样的状态，不是痧症，而是邪气盛于经脉，经脉一时不能交接，这是疟疾征兆开始发出的表现。仅仅刺血，后来必然患疟疾，疟疾也不轻，然而这种疟疾是发于经脉之阳的。还有一种是一时暴厥，四肢厥冷、神志不清，刺之无血流出，牙关紧闭。医生见到这种情况，不是说是急痧，就是说是中风入脏，刺手指无血流出，就用锋针刺曲池、委中穴，放出血液，牙关不开，就用铜筷子撬开牙齿，灌入矾水催吐，此时我才苏醒，精神萎靡，六脉微弱虚软，一天稍平，第二天再次厥逆，厥逆而没有发热，微微有汗。这是疟疾从阴分出，得不到阳热的化育，是厥疟。我在夏季，曾治疗过一两个，后来也痊愈了。如果在苏醒之后，用药不当，也不能存活。这就是疟疾初起的情况。至于疟疾的变证，总归是由于攻伐消导太过，导致三焦内部空虚，或者出现胀满，或者浮肿，或者泄泻，或者咳嗽。病虽然有变化，更应当温补中土，助益三焦；如果胀满的用消导法，浮肿的用散法，泄泻的通利法，咳嗽的清解法，暂时得到缓解，不能全愈，拖延时日，断然没有不死亡的。
治疗疟疾的禁忌：一是发散，二是消食，三是寒凉，前面已经说过了。至于药物的运用，现在人治疗疟疾，不用常山，认为常山是截疟药，截断得太早，其后必然变成臌胀病。没看仲景治疗疟疾，每用蜀漆。蜀漆，是常山的嫩苗。苗不可得而用其根，又有什么害处呢？况且常山是从阴出阳的药，如果是三阴疟、脾寒病，不让它从阴出阳，怎么能立即痊愈？既然痊愈了，又怎么会有臌胀呢？另外，对于疟病虚寒，久用参、术、姜、桂，总不能痊愈的；在参、术、姜、桂之内，必须加入常山，更须加入穿山甲，使经络疏通，疟邪外出，没有不痊愈的。还有阳热之疟，鳖甲可以攻散；心、肾之热疟，菖蒲、黑豆可以交通；邪气侵入郛郭（指较深的部位），槟榔、草果可以泄之；邪气侵入膀胱，车前子、滑石可以利之。如果在疟疾后发生咳嗽，是因为起初因疟病，地气（脾土之气）不交于肺，现在疟止病去，则地气上升，脾、肺始交，所以咳嗽。如果不助脾气之上升，反而用泄肺的药以下泄，其咳嗽断然不能消除，转为疟疾后的虚劳羸弱，到五年时必然死亡。唉！医学之道，极其精微，粗劣的医生凶狠急躁，凭借方技自我炫耀，收取一时的微小疗效，至于后来的死亡却不加考虑，可悲啊！
Malaria differs from Cold Damage (Shanghan): Malaria is mild, while Cold Damage is severe; Malaria involves the meridians and collaterals, whereas Cold Damage involves Qi transformation. Qi transformation refers to the disease transforming according to the Six Qi (Wind, Cold, Summerheat, Dampness, Dryness, Fire), with changes transmitted between Yin and Yang. The meridians and collaterals refer to the Malaria pathogen sinking inward along the meridians, occurring when Wei Qi (Defensive Qi) responds. "Responding" means that when Wei Qi moves outward to the exterior, the Malaria pathogen follows and manifests; when Wei Qi moves inward to the interior, the Malaria pathogen follows and rests. Epidemic infectious malaria is Evil Malaria (Xie Nue); the evil qi interacts, residing only between the skin and collateral vessels. Even without medication, it heals in three days. Preceded by chills followed by fever, with irritability and thirst during fever, stopping after sweating, this is Three-Yang Malaria; even without medication, it heals in six days. If the daily发作 occurs earlier, the malaria will heal; if it occurs later, the malaria is difficult to cure. "Later" (Yan) indicates that Wei Qi is deficient and fails to enter the meridians on time. Malaria varies in Yin/Yang and severity: Malaria is Yang, Spleen Cold is Yin; Malaria is mild, Spleen Cold is severe. Common people indiscriminately mix the terms, and physicians indiscriminately treat them, not knowing the difference between Malaria and Spleen Cold! Malaria does not kill, but Spleen Cold can kill. If Spleen Cold is treated indiscriminately with dispersing and cold/cooling herbs, foolishly managed, death is inevitable. When a disease manifests with less chills and more heat, uniform and level pulses, ability to eat, and normal spirit, it is Malaria; when there are more chills and less heat, slightly deficient and weak pulses, inability to eat, irritability, fullness, nausea, vomiting, and depleted spirit, it is Spleen Cold. In summer, pores open, meridian Qi overflows outward, making Wind and Summerheat pathogens easily injure the meridians, hence many cases of Malaria. Injury to collaterals is mild Malaria; injury to meridians is Malaria that can be mild or severe. Formulas for treating Malaria should regulate Qi and Blood, harmonize Ying (Nutritive) and Wei (Defensive) Qi, unblock collaterals, and unblock meridians. Observe the degree of chills and heat, differentiate the deficiency/excess of Zang-Fu organs, and then apply treatment. To regulate Qi and Blood, harmonize Ying and Wei Qi, Gui Zhi Tang (Cinnamon Twig Decoction) ingredients such as Dang Gui (Angelicae Sinensis Radix), Bai Shao (Paeoniae Radix Alba), Hong Hua (Carthami Flos), Chai Hu (Bupleuri Radix), and Gui Zhi (Cinnamomi Ramulus) can be used; to unblock meridians, Xu Duan (Dipsaci Radix), Mu Tong (Akebiae Caulis), Qin Jiao (Gentianae Macrophyllae Radix), and Yin Hua (Lonicerae Japonicae Flos) can be used. For more chills, use Gan Jiang (Zingiberis Rhizoma), Rou Gui (Cinnamomi Cortex), Shen Qu (Massa Medicata Fermentata), and Hou Po (Magnoliae Officinalis Cortex) to warm; for more heat, use Chai Hu, Huang Qin (Scutellariae Radix), Zhi Mu (Anemarrhenae Rhizoma), and Ge Gen (Puerariae Lobatae Radix) to clear; for Excess patterns, use Chen Pi (Citri Reticulatae Pericarpium), Ban Xia (Pinelliae Rhizoma), Zhi Shi (Aurantii Fructus Immaturus), and Hou Po; for Deficiency patterns, use Ren Shen (Ginseng Radix et Rhizoma), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Gan Cao (Glycyrrhizae Radix et Rhizoma), and Fu Ling (Poria). This is the general method for treating Malaria.
If the pathogen enters the Taiyin Spleen organ, it becomes Cold Malaria; Cold Malaria is similar to Spleen Cold. If it enters the Shaoyin Heart organ, it becomes Heart Malaria; Heart Malaria is similar to Dan Malaria (Febrile Malaria with heat only). If it enters the Shaoyin Kidney organ, it becomes Kidney Malaria; Kidney Malaria is similar to Pin Malaria (Chill-predominant Malaria). If it enters the Jueyin Liver organ, it becomes Jue Malaria; Jue Malaria presents with Jue syndrome (cold extremities) and loss of consciousness. These several types of Malaria should be treated with Ren Shen, [missing character, likely Huang Qi], Bai Zhu, Gan Jiang, Rou Gui, and Fu Zi (Aconiti Lateralis Radix Praeparata). Only Heart Malaria, belonging to the Hand-Shaoyin channel, is unsuitable for warm/hot therapies; instead, methods to tonify the Heart and nourish Blood using Ren Shen, Fu Ling, Dang Gui, Bai Shao, Gou Qi Zi (Lycii Fructus), Suan Zao Ren (Ziziphi Spinosae Semen), Yuan Zhi (Polygalae Radix), and Long Yan Rou (Longan Arillus) should be used. These Five-Zang and Three-Yin Malarias can indeed lead to life or death. This discusses the severity of Malaria and the standard methods of treatment. Regarding the onset of Malaria, its complications, treatment contraindications, and drug circulation, one must be thorough. In summer, the sky is hot and earth is scorching; although there is no external contraction of cold wind, bathing in cold water and cool night breezes cannot be avoided. If humans are affected, the pathogen does not stay in the skin but often injures the meridians. The body's Wei Qi enters Yin at night and emerges to Yang during the day; due to the emergence of Wei Qi, sudden chills and heat occur, which is Malaria. If diagnosed foolishly, seeing chills and heat, one might say it is Cold Damage or Summerheat injury; if not Summerheat, then internal injury with external contraction. Although the terminology is thus, the drugs used are nothing but diaphoretics, food-dispersing agents, and cold/cooling herbs. Alas! Such a disease, if not subjected to such drugs, although becoming Malaria, would heal in seven days. Now, diaphoretics make the exterior deficient, food-dispersing agents damage the middle, cold/cooling agents stagnate the meridians, and grain intake is cut off. This inevitably leads to Malaria not resembling Malaria, Cold Damage not resembling Cold Damage; although sweat is produced, the body does not cool, and by late afternoon (Ri Bu), the heat is even worse. Know that heat worsening in the late afternoon originates from Malaria; sweating without cooling indicates both exterior and interior are deficient. Poor families who do not hire doctors or take medicine, consuming only millet porridge, drag out the days and recover; wealthy families who change doctors repeatedly, upon investigating the root cause, the doctor will surely say: "Extremely deficient." First, test with a small amount of Ren Shen; if suitable, use a heavy dose, then feed millet porridge, also recovering after dragging out the days. Such diseases are common in summer. Wise people sigh deeply, yet doctors and patients' families know nothing. Of those who recover by dragging out the illness, nine or ten out of ten do so; among those who die, are there not one or two? Thinking of this, is it not sorrowful! There are also times in intense summer heat when a person suddenly suffers from Jue Ni (reversal of Qi/cold extremities), complexion pale/greenish like death. People are horrified, saying: "This is Sha (sand/heat stroke) eruption." Bleeding via Sha therapy saves temporary distress, but days later, it transforms into Malaria. Who knows that this Jue Ni resembling death is not Sha, but excessive evil Qi in the meridians causing a temporary failure of meridian connection, marking the beginning of Malaria onset. Merely pricking blood will later result in Malaria, which is not mild; however, this Malaria arises from the Yang aspect of the meridians. Another case is sudden Jue, unconsciousness, no blood from pricking, tight jaw. Doctors seeing this say either acute Sha or Stroke entering the Zang. With no blood from finger pricking, they use sharp needles to prick Qu Chi (LI11) and Wei Zhong (BL40) to release blood; if the jaw remains closed, they pry teeth open with chopsticks, pour alum water to induce vomiting, and only then do I regain consciousness. Spirit is depressed, pulses are slightly deficient and weak. One day slightly stable, next day recurrent Jue, Jue without heat, slight sweating. This is Malaria emerging from Yin, lacking Yang-heat transformation, i.e., Jue Malaria. I treated one or two cases in summer, which later recovered. If post-recovery medication is inappropriate, survival is impossible. This describes the initial onset of Malaria. As for Malaria complications, they generally result from excessive attacking and dispersing, leading to internal emptiness of the San Jiao (Triple Burner), manifesting as distension/fullness, edema, diarrhea, or cough. Although the disease changes, one must warm the Middle Earth (Spleen/Stomach) and assist the San Jiao; if distended, disperse; if edematous, scatter; if diarrheal, drain; if coughing, clear. Temporary relief may occur, but without complete cure, dragging out the days inevitably leads to death.
Contraindications for treating Malaria: first, diaphoretics; second, food-dispersing agents; third, cold/cooling herbs, as mentioned before. Regarding drug circulation: modern physicians do not use Chang Shan (Daphne genkwa Root Bark), considering it a malaria-arresting herb; arresting too early inevitably leads to abdominal distension (Gu Zhang) later. Have you not seen Master Zhongjing treating Malaria, always using Shu Qi? Shu Qi is the young shoot of Chang Shan. If the shoot is unavailable and the root is used, what harm is there? Moreover, Chang Shan is a herb that moves from Yin to Yang. For Three-Yin Malaria or Spleen Cold, if one does not allow it to move from Yin to Yang, how can it heal immediately? Having healed, how could Gu Zhang occur? Furthermore, for Malaria with deficiency-cold, if long-term use of Ren Shen, Bai Zhu, Gan Jiang, and Rou Gui fails to cure; within these formulas, one must add Chang Shan, and further add Shan Zha Jia (Pangolin Scales), to unblock meridians and expel the Malaria pathogen outward, ensuring recovery. For Yang-heat Malaria, Bie Jia (Testudinis Carapax et Plastrum) can attack and disperse; for Heart/Kidney heat Malaria, Shi Chang Pu (Acori Tatarinowii Rhizoma) and Hei Dou (Sojae Semen Nigrum) can facilitate communication; if evil enters deep layers (Fu Guo), Bing Lang (Arecae Semen) and Cao Guo (Tsaoko Fructus) can drain; if evil enters the Bladder, Che Qian Zi (Plantaginis Semen) and Hua Shi (Talcum) can promote urination. If cough develops after Malaria, it is because initially, due to Malaria, Earth Qi (Spleen Qi) did not communicate with Lung; now that Malaria stops and disease leaves, Earth Qi rises, allowing Spleen and Lung to communicate, hence cough. If one does not assist the rising of Spleen Qi, but instead uses herbs that drain Lung Qi downward, the cough will certainly not cease, turning into post-Malaria consumptive weakness, leading to death within five years. Alas! The Way of Medicine is extremely profound and subtle. Crude physicians are fierce and hasty, boasting of their techniques, seeking momentary small effects, disregarding subsequent death. How tragic!