血上塞心窍，哑不能言，但噫噫作声，即哑瘴也。治此皆当散血，用黑神散（见血）立散。
（黑神散须慎用。）其或痰迷心窍而舌强者，不在此论。
又有似疟非疟者，如伤寒邪在少阳经，往来寒热，似疟而无定期，或一日二三
遍，且热已即寒，寒已即热，相继不息，不似疟之有定期，有息时也。又虚人亦有
往来寒热。《经》云∶阳虚则外寒，阴虚则内热，阴气上入阳中则恶寒，（本身下焦阴寒
之气，上干阳分则恶寒。）阳气下入阴中则发热。（上焦阳气下陷阴中，则发热。）故亦有往来寒
热，似疟而实非疟，病后产后多有之，必由积渐虚损而致，与疟之发于陡然者不同。
且亦忽作忽止，无有定期，与疟之不爽其期者又别也。（按瘴疟亦有无定期者，不可不知。）
治法∶无汗须发汗，散邪为主；（丹溪谓∶外邪必用汗解，惟足厥阴最难得汗，其汗至足方佳。大
率取汗非必用麻黄辈，但开郁通经，邪即散而为汗矣。）有汗当敛汗，扶正为先；新发邪实者，可汗、
吐、下；久病正虚者，宜补气血；稍久而正虚邪滞者，宜一补一发；若深入于阴分
者，宜先升后汗；至若邪乘虚入，则宜以发散祛其客邪，然后扶持胃气；痰、食、
气滞，则先以消导散其壅滞，然后渐补脾元。诸疟发过三五次，表里之邪皆清，即
宜截之。凡用药，病正发时，当避其锐气，于未发前二时服。
血液瘀滞阻塞心窍，导致失语不能说话，只能发出“噫噫”的声音，这就是哑瘴。治疗此症都应当散血，使用黑神散（见血证篇）来迅速消散瘀血。（黑神散必须谨慎使用。）如果是痰浊迷蔽心窍而导致舌体僵硬强直的情况，不在此讨论范围内。
又有类似疟疾而非疟疾的情况，例如伤寒邪气停留在少阳经，出现寒热往来，看似疟疾但没有固定的发作时间，或者一天发作两三次，并且热退后立即发冷，冷退后立即发热，相继不停息，不像疟疾那样有固定的发作时间和间歇期。此外，身体虚弱的人也会出现寒热往来的症状。《黄帝内经》说：阳气虚则体表恶寒，阴气虚则体内发热，阴气上入阳分则感到恶寒（指下焦本身的阴寒之气，上犯阳分则导致恶寒），阳气下陷阴分则发热（指上焦的阳气下陷于阴分，则导致发热）。因此也有寒热往来，看似疟疾实则不是疟疾的情况，多在病后或产后出现，必定是由逐渐积累的虚损所致，与突然发作的疟疾不同。而且这种寒热忽作忽止，没有固定时间，与疟疾发作时间准确无误的情况又有所区别。（按：瘴疟中也有没有固定时间的情况，不可不知道。）
治疗方法：无汗时需要发汗，以驱散邪气为主；（丹溪认为：外感邪气必须用发汗法解除，只有足厥阴肝经最难出汗，汗出至足部为佳。大致取汗不一定非要用麻黄之类的药物，只要开通郁结、疏通经络，邪气就会随汗而散。）有汗时应当收敛汗液，以扶助正气为先；新近发病且邪气实盛的，可以采用汗法、吐法、下法；久病正气虚弱的，适宜补益气血；病程稍长且正气虚弱、邪气滞留的，适宜一边补益一边发散；如果邪气深入阴分的，适宜先升提阳气然后发汗；至于邪气乘虚而入的，则适宜先用发散法祛除客邪，然后再扶持胃气；如果是痰饮、食积、气机阻滞导致的，则先用消导法疏散壅滞，然后再逐渐补益脾胃元气。各种疟疾发作过三五次之后，表里之邪都已清除，就应当采用截疟法。凡是用药，在疾病正发作的时候，应当避开其锐气，在未发作前两小时服用。
Blood stasis obstructing the orifices of the Heart leads to aphasia (loss of speech), where the patient cannot speak but only makes "yi yi" sounds; this is termed Ya Zhang (Mute Malaria). Treatment for this condition should always involve dispersing blood, using Hei Shen San (Black Divine Powder) [see Blood Disorders] to rapidly dissipate the stasis. (Hei Shen San must be used with caution.) If the tongue becomes stiff and rigid due to phlegm confusing the orifices of the Heart, this does not fall under this discussion.
There are also conditions that resemble malaria but are not malaria. For example, when pathogenic factors from Shang Han (Cold Damage) remain in the Shaoyang (Lesser Yang) meridian, there is alternating chills and fever. This resembles malaria but lacks a regular periodicity, occurring perhaps two or three times a day, with heat immediately followed by cold and cold by heat, continuously without cessation. This differs from true malaria, which has a fixed periodicity and intervals of remission. Furthermore, individuals with deficiency may also experience alternating chills and fever. The Classic states: "Yang deficiency leads to external cold, Yin deficiency leads to internal heat. When Yin qi ascends into the Yang region, it causes aversion to cold (referring to the inherent cold Yin qi of the lower Jiao invading the Yang region, causing aversion to cold); when Yang qi descends into the Yin region, it causes fever (referring to the Yang qi of the upper Jiao sinking into the Yin region, causing fever)." Therefore, there are cases of alternating chills and fever that resemble malaria but are not malaria. These often occur after illness or postpartum, resulting from gradual accumulation of deficiency and damage, differing from malaria which arises suddenly. Moreover, these episodes start and stop intermittently without a fixed schedule, distinct from the precise timing of malaria. (Note: Some types of Zhang Malaria also lack fixed timing, which must be known.)
Treatment methods: If there is no sweating, diaphoresis (sweating method) is required, primarily to disperse pathogens. (Danxi stated: External pathogens must be resolved through sweating. The Foot Jueyin Liver meridian is particularly difficult to induce sweating in; sweating reaching the feet is ideal. Generally, inducing sweat does not necessarily require herbs like Mahuang (Ephedrae Herba); simply resolving stagnation and unblocking meridians allows pathogens to scatter as sweat.) If there is sweating, one should consolidate sweat and prioritize supporting healthy Qi. For newly onset conditions with excess pathogens, sweating, emesis, or purgation methods may be used. For chronic conditions with deficient healthy Qi, tonifying Qi and Blood is appropriate. For conditions lasting some time with both deficiency and lingering pathogens, a combination of tonification and dispersion is suitable. If pathogens have penetrated deeply into the Yin aspect, raising Yang Qi followed by diaphoresis is indicated. If pathogens enter due to deficiency, dispersing methods should first be used to expel the exogenous pathogens, followed by supporting Stomach Qi. If caused by Phlegm, Food Retention, or Qi Stagnation, digestive and resolving methods should first be used to clear congestion, followed by gradual tonification of Spleen Yuan Qi. After various types of malaria have occurred three to five times, once pathogens in the exterior and interior are cleared, antimalarial interception methods should be employed. Regarding medication administration, during the peak of an attack, one should avoid the pathogen's sharp vigor; medicine should be taken two hours before the expected onset.