疟疾之病形何如。曰。疟之为病。非经非络。非脏非腑。乃夏月汗出太多。肌表空疏。外感
暑邪。直入脏腑募原之间。待收藏二令一行。玄府闭密。则所藏之邪。无以泄其怒。而寒热作矣。
然其寒也。乃内热将作。火冲其气故凛凛而寒。非真冷也。故不得以热药治之也。然素问分六经
疟。岂募原足以尽之与。曰。非是之谓
也。凡脏与脏腑与腑。或脏与腑。彼此相接之处。中间盖有虚界之募原。而虚界中。复有刚柔筋
脉。其为某脏之筋。便为某脏之病。譬如胃与小肠相近。而邪入于胃与小肠之虚界。而彼筋脉属
胃。则为阳明经疟也。又如肝与脾相近。而邪入于肝脾之虚界。而筋脉或属脾。便为太阴经疟矣。
究之脏腑虽病。皆因募原之气迁移也。至于每日间二日者。疟之卫气。日行一周。历五脏十二经
之界分。每一界分。必有其舍。（营卫之有舍。犹行人之有传舍也。）舍有随经络浮沉内薄之外
邪。故与日行之卫气。相集则病作。离则病休也。间日间二日者。由其募原之远近也。（疟疾一
症。前人虽备言之。然于夏伤于暑。秋必病疟经旨。殊未透辟也。四明论本邯郸。而益阐其义。始
知向来医家。只于脏腑经络中求之。直是隔靴搔痒耳。）曰。古人言无痰不成疟。信乎。曰。痰
之所为。非热不生。今病患饮食入胃。而每日发热。则脾不能守其静化。一味外邪热化煎熬。并
饮食而化为痰邪矣。（此言因疟只以生痰也。）其有先伤饮食。而痰热内作。复挟外感之暑邪。
变而为疟者。有之矣。（此则由痰而作疟也。然必内伤饮食。而后生痰。外挟暑邪。而后作疟。
则痰与疟皆属标病。而所谓无痰不成疟者。非谓必因痰而致疟也。只是凡疟莫不兼痰耳。）无
痰不成疟。（此句须合上两条看。其理乃圆。）凡疟皆由脾虚。（如内伤饮食与外感暑邪。皆不出
脾虚二字范围。脾不虚则饮食不得而伤。暑邪无自而入矣。）此些二语乃透疟病之根。医家不可忽
诸。疟初发时。治法不论六经内外。只用清中驱疟饮。或清脾饮。三四发不应。以二妙丸与之立
除。若淹延岁月不愈者。一味六君子汤自愈。（立斋云。凡人久疟诸药不效。以补中益气汤加半
夏。用人参一两煨姜五钱。此不截之截也。一服即愈。）有发在酉时者。五发内。俱当用香红饮。
古人用升提法转出阳分。不过言道理当如是耳。时人执此法。愈
提则阴愈虚矣。且凡属夜病。若俱要见阳而愈。则亦不胜其升提矣。
间一日者。与每日发者。治法不甚相远。惟三日疟最难治。予于岁月未久者。用参汤下二妙
丸。服至半月一月自愈。如年深月久。 羸不堪者。大剂养荣汤。吞八味丸。仍于汤中加熟附子
一钱。十帖必除。（东庄云。久疟用补中益气不效者。八味丸有神应。予每得其力。然不若兼服
养荣。其效为尤速也。）疟痞初起。三妙丸加鳖甲久服自愈。（须治之于早。否则未有不成胀者。）
清中驱疟饮
柴胡 黄芩 半夏 山楂 枳实 浓朴 青皮
陈皮 草果 苍术 生姜
二妙丸
橘红 半夏（姜制）
上为末。神曲和丸。每发前三个时许。吞一二服。自然不发矣。凡有痰有食。误服补药。以
致不瘥者。用此立愈。或再用小柴胡汤加枳实桔梗二三剂。
香红饮
人参 益母 当归 香附 红花 生姜
按邯郸云。凡治疟必先问其寒热多寡。而参之脉症。有寒多热少者。有热多寒少者。大抵寒热往
来。皆属少阳经。治法当以小柴胡为主。若寒多者。小柴胡加桂枝。有但热不寒者。名曰瘅疟。
有但寒不热者。名曰牝疟。然亦有不可执者。当察脉之虚实何如。若但寒者。其脉或洪实或滑。
当作实热治。若但热者。其脉或空虚或微弱。当作虚寒治。凡疟将发之时与正发之际。慎勿施治
。治亦无效。必待阴阳升极而退。过此邪留所客之地。然后治之。且当病未发二三时前。迎而夺
之可也。经曰。阳虚则恶寒。阴虚则恶热。阴气上入于阳中则恶寒。阳气下陷于阴中则恶热。凡
伤寒后大病后产后劳瘵等症。俱有往来寒热。似疟非疟。或一日二三度发。并作虚治。但有阳虚阴虚
之别耳。余见发疟有面赤口渴者。俱作肾中真阴虚治。无不立应。凡见患者寒来如冰。热来如烙
。惟面赤如脂。渴欲饮水者。以六味加柴胡芍药肉桂五味大剂。一服便愈。又有一等郁症似疟者。
其寒热与正疟无异。但其人口苦呕吐清水。或苦水。面青胁痛。耳鸣脉涩。须以逍遥散加茱连贝
母倍柴胡。作一服。继以六味加柴胡芍药调理。
疟疾这种疾病的症状表现是怎样的呢？回答说：疟疾这种疾病，既不在经络，也不在脏腑，而是由于夏季出汗过多，导致肌表空疏（皮肤毛孔开泄），外感暑邪，直接侵入脏腑募原（脏腑之间的间隙）之间。等到收藏二令（指秋季的收敛之气）一运行，玄府（汗孔）闭密，那么所潜伏的邪气，无法宣泄其暴烈之势，于是寒热发作了。然而它的寒冷，其实是内热将要发作，火热冲逆其气，所以感到凛冽寒冷，并非真正的寒冷。因此不能用热药来治疗它。然而《素问》将疟疾分为六经疟，难道仅用募原就足以概括了吗？回答说：不是这个意思。凡是脏与腑、脏与脏、腑与腑，彼此相接的地方，中间都有虚界的募原，而在虚界之中，又有刚柔筋脉。如果是某脏的筋脉，就是某脏的病。例如胃与小肠相近，而邪气侵入胃与小肠的虚界，如果那里的筋脉属于胃，就是阳明经疟。又如肝与脾相近，而邪气侵入肝脾的虚界，如果筋脉属于脾，就是太阴经疟了。究其根本，虽然脏腑生病，都是因为募原之气的迁移所致。至于每隔一天或两天发作一次的，是因为疟疾的卫气，每天运行一周，经过五脏十二经的分界处。每一分界处，必定有其舍（营卫有舍，就像行人有驿站一样）。舍中有随着经络浮沉、内迫于内的外邪，所以当每日运行的卫气与之相聚会时，病就发作；分离时，病就休止。隔一日或隔两日发作，是由募原位置的远近决定的。（对于疟疾这一病症，前人虽然详尽论述过，但对于“夏伤于暑，秋必病疟”的经典旨意，并没有透彻阐明。四明人根据邯郸人的理论，进一步阐发其义，才知道以往的医家只在脏腑经络中寻求病因，简直是隔靴搔痒。）有人说：古人说无痰不成疟，是真的吗？回答说：痰的产生，不是因为热就不会生成。现在病人饮食入胃，却每天发热，脾就不能保持其静化的功能，一味地受外邪热化煎熬，连同饮食一起化为痰邪。（这是说因为疟疾才产生痰。）也有先损伤饮食，导致痰热内生，又夹杂外感的暑邪，变而为疟的，这种情况是有的。（这是由痰而产生疟疾。但是必须内伤饮食，然后生痰，外挟暑邪，然后作疟，那么痰和疟都属于标病，所谓“无痰不成疟”，并不是说一定因痰而导致疟疾，只是说凡疟疾无不兼夹痰邪罢了。）无痰不成疟。（这句话需要结合上面两条来看，道理才圆满。）凡疟疾都是由脾虚引起的。（如内伤饮食和外感暑邪，都不出脾虚二字范围。脾不虚，则饮食不得被损伤，暑邪也无从进入。）这两句话是透辟疟疾病根的关键，医家不可忽视。疟疾初发时，治疗方法不论六经内外，只用清中驱疟饮，或者清脾饮。三四次发作如果不奏效，给予二妙丸，立刻就能消除。如果拖延岁月不愈的，单用六君子汤就能自愈。（立斋说：凡人久患疟疾，各种药物无效，用补中益气汤加半夏，用人参一两，煨姜五钱，这是不截断疟疾却达到截断效果的方法。一服即愈。）有在酉时（下午5-7点）发作的，五次以内，都应当用香红饮。古人使用升提法将其转出阳分，不过是说道理应当如此而已。时下的人拘执于此法，越升提则阴越虚。而且凡是属于夜间的病，如果都要见到阳气才能痊愈，那也就受不了过多的升提了。
隔一日发作的，与每日发作的，治疗方法不太远。只有三日疟最难治疗。我在病程未久的情况下，用参汤送服二妙丸，服用到半个月或一个月就能自愈。如果是年深月久，身体羸弱不堪的，用大剂量的养荣汤，吞服八味丸，仍在汤剂中加入熟附子一钱，十帖必定消除。（东庄说：久疟用补中益气汤无效的，八味丸有神奇疗效。我每每感受到它的力量，然而不如兼服养荣汤，其效果更为迅速。）疟痞初起，三妙丸加鳖甲久服就能自愈。（必须在早期治疗，否则没有不变成胀病的。）
清中驱疟饮
柴胡 黄芩 半夏 山楂 枳实 浓朴 青皮
陈皮 草果 苍术 生姜
二妙丸
橘红 半夏（姜制）
以上研为末，神曲和丸。每次发作前三个时辰左右，吞服一二服，自然就不发作了。凡是有痰有食积，误服补药，导致不愈的，用此方立刻痊愈。或者再用小柴胡汤加枳实桔梗二三剂。
按邯郸人说：凡是治疗疟疾，必须先询问其寒热的多少，并参考脉症。有寒多热少的，有热多寒少的。大抵寒热往来，都属于少阳经，治疗方法应当以小柴胡汤为主。如果寒多的，小柴胡汤加桂枝。有只热不寒的，名叫瘅疟。有只寒不热的，名叫牝疟。然而也有不可拘执的情况，应当观察脉象的虚实如何。如果只寒的，其脉或洪实或滑，当作实热治疗。如果只热的，其脉或空虚或微弱，当作虚寒治疗。凡是疟疾将要发作的时候与正在发作之际，千万不要施治。施治也无效。必须等待阴阳升极而退，过了这个时间，邪气留在其所客居的地方，然后再治疗它。而且在病未发作前两三个时辰前，迎而夺之是可以的。经文说：阳虚则恶寒，阴虚则恶热。阴气上入于阳中则恶寒，阳气下陷于阴中则恶热。凡是伤寒后、大病后、产后、劳瘵等症，都有往来寒热，似疟非疟，或者一天发作两三次，都作为虚证治疗，只是有阳虚阴虚的区别罢了。我见过发疟疾有面赤口渴的，都作为肾中真阴虚治疗，没有不立刻见效的。凡是见到患者寒来时像冰一样冷，热来时像烙铁一样烫，只有面色红如脂膏，口渴想喝水的，用六味地黄丸加柴胡、芍药、肉桂、五味子大剂量服用，一服便愈。又有一类郁症似疟的，其寒热与正疟无异，但是其人口苦呕吐清水，或者苦水，面青胁痛，耳鸣脉涩，须以逍遥散加茱萸、黄连、贝母，倍用柴胡，作一服服用，继以六味地黄丸加柴胡、芍药调理。
The clinical manifestations of malaria-like diseases (Nue Ji) are as follows. It is said that this disease does not reside in the meridians or collaterals, nor in the zang or fu organs. Rather, it arises from excessive sweating during summer, which leaves the body surface loose and open. External pathogenic heat (Shu Xie) directly enters the moo-yuan (the space between the zang and fu organs). When the qi of storage and collection (associated with autumn) begins to function, the xu-fu (sweat pores) become closed and tight. Consequently, the latent pathogens cannot vent their violent nature, leading to the onset of alternating chills and fever. However, the chills experienced are actually due to internal heat about to erupt; the fire rushes upward against the qi, causing a sensation of severe coldness, rather than true cold. Therefore, hot-natured medicines should not be used for treatment.
However, the *Suwen* classifies malaria into six meridian types. Is the moo-yuan sufficient to explain all cases? The answer is no. Wherever zang meets fu, or zang meets zang, or fu meets fu, there exists a boundary zone known as the moo-yuan. Within this void boundary, there are gang-rigid tendons and vessels. If these tendons belong to a specific zang organ, the disease manifests in that zang. For example, the stomach and small intestine are close; if pathogens enter the void boundary between them and the tendons therein belong to the stomach, it is Yangming Meridian Malaria. Similarly, the liver and spleen are close; if pathogens enter their void boundary and the tendons belong to the spleen, it is Taiyin Meridian Malaria. Ultimately, although the zang and fu appear diseased, it is due to the migration of qi in the moo-yuan.
Regarding cases occurring every other day or every two days: the Wei Qi (Defensive Qi) circulates once daily through the boundaries of the five zang and twelve meridians. Each boundary has its "abode" (just as travelers have relay stations). Pathogens floating along the meridians and pressing inward reside in these abodes. When the circulating Wei Qi gathers with these pathogens, the disease flares up; when they separate, the disease rests. The interval of one or two days depends on the distance of the moo-yuan location. (Although predecessors discussed malaria extensively, they did not thoroughly elucidate the classic principle that "summer injury by heat leads to malaria in autumn." Siming, building upon Handan's theory, clarified this, revealing that previous physicians seeking causes solely within zang-fu and meridians were like scratching an itch through a boot.)
It is said that "no phlegm, no malaria." Is this true? Phlegm is generated by heat. When patients eat and drink, but suffer daily fever, the Spleen loses its ability to maintain quiet transformation. Instead, it is constantly scorched by external pathogenic heat, transforming food and drink into phlegm-pathogens. This implies malaria generates phlegm. Conversely, there are cases where dietary injury first causes internal phlegm-heat, which then combines with external summer heat to transform into malaria. In such cases, both phlegm and malaria are branch symptoms (Biao). Thus, "no phlegm, no malaria" means that while malaria is not necessarily caused *by* phlegm, malaria invariably involves phlegm. Both statements highlight that all malaria stems from Spleen Deficiency (Pi Xu). If the Spleen were not deficient, dietary injury would not occur, and summer heat would not easily invade. These insights reveal the root of malaria, which physicians must not ignore.
For initial attacks, regardless of the meridian involved, use Qingzhong Qumai Yin (Clear Middle and Expel Malaria Decoction) or Qingpi Yin (Clear Spleen Decoction). If ineffective after three or four attacks, administer Ermiao Wan (Two Marvels Pill), which will quickly resolve it. For chronic cases lasting years, Liu Junzi Tang (Six Gentlemen Decoction) alone can cure it. (Lizhai stated: For chronic malaria unresponsive to other drugs, use Buzhong Yiqi Tang with Banxia, Ren Shen 1 liang, and Wei Jiang 5 qian. This is a method of stopping malaria without using antimalarial herbs; one dose brings cure.) For attacks occurring at You hour (5-7 PM), within five attacks, use Xianghong Yin (Fragrant Red Decoction). Ancients used lifting methods to move pathogens to the Yang level, stating this was the theoretical approach. Modern practitioners who rigidly apply this cause further Yin deficiency. Nighttime illnesses generally do not require excessive lifting to reach Yang.
Treatment for every-other-day or daily attacks is similar. Only Sanri Nue (Three-Day Malaria) is difficult to treat. For recent onset, administer Ermiao Wan with Ginseng Decoction; half a month to one month of treatment yields self-cure. For long-standing cases with severe emaciation, use large doses of Yangrong Tang (Nourish Ying Decoction) with Babai Wan (Eight-Treasure Pill), adding Shu Fu Zi 1 qian to the decoction. Ten doses ensure elimination. (Dongzhuang noted: When Buzhong Yiqi Tang fails for chronic malaria, Babai Wan shows miraculous effects. I find it effective, but combining it with Yangrong Tang yields faster results.) For early-stage Napie (Malaria Mass), Sanmiao Wan with Biejia (Turtle Shell) taken long-term cures it. Early treatment is crucial; otherwise, distension develops.
**Qingzhong Qumai Yin**
Chai Hu, Huang Qin, Ban Xia, Shan Zha, Zhi Shi, Hou Po, Qing Pi, Chen Pi, Cao Guo, Cang Zhu, Sheng Jiang.
**Ermiao Wan**
Ju Hong, Ban Xia (processed with Ginger).
Grind into powder, form pills with Shen Qu. Take 1-2 doses orally three hours before each attack to prevent occurrence. Effective for cases with phlegm and food stagnation worsened by mistaken tonic use. Alternatively, follow with Xiao Chai Hu Tang plus Zhi Shi and Jie Geng for 2-3 doses.
**Xianghong Yin**
Ren Shen, Yi Mu, Dang Gui, Xiang Fu, Hong Hua, Sheng Jiang.
Handan advised: Always inquire about the ratio of chills to fever and correlate with pulse and symptoms. Cases with more chills than fever, or more fever than chills, generally involve the Shaoyang Meridian, treated primarily with Xiao Chai Hu Tang. Add Gui Zhi for more chills. Pure fever without chills is called Dan Nue (Febrile Malaria); pure chills without fever is called Pin Nue (Yin Malaria). However, one must not be rigid; observe the pulse. Pure chills with a洪 (Surging) or 滑 (Slippery) pulse indicate excess heat; treat accordingly. Pure fever with a 空虚 (Empty) or 微弱 (Weak) pulse indicates deficiency cold; treat accordingly. Do not treat during the onset or peak of an attack, as it is ineffective. Wait until the extreme of Yin-Yang shifts and pathogens settle in their location, then treat. Ideally, intervene 2-3 hours before the expected onset to intercept the pathogen. The Classic states: Yang deficiency causes aversion to cold; Yin deficiency causes aversion to heat. Yin entering Yang causes cold; Yang sinking into Yin causes heat. Post-typhoid, post-major illness, postpartum, and consumptive diseases may present with alternating chills and fever resembling malaria but are not true malaria. Treat as deficiency, distinguishing between Yang and Yin deficiency. I have seen malaria patients with red faces and thirst, treating them as Kidney True Yin Deficiency, yielding immediate results. For patients with chills like ice, heat like branding iron, yet with a ruddy face and thirst for water, use Liuwei Dihuang Wan plus Chai Hu, Shao Yao, Rou Gui, and Wu Wei Zi in large doses; one dose cures. Another type resembles malaria but is actually Liver Qi Stagnation (Yu Zheng), with bitter taste, vomiting clear or bitter fluid, blue complexion, hypochondriac pain, tinnitus, and choppy pulse. Treat with Xiaoyao San plus Zhu Yu, Huang Lian, Bei Mu, doubling Chai Hu for one dose, followed by Liuwei Dihuang Wan plus Chai Hu and Shao Yao for regulation.