夫 疟皆生于风，蓄作有时。（ ，皆也。疟，残虐之谓。疟症虽多，皆谓之疟，故曰“ 疟”。诸
解不一，皆未为得。观“ 疟皆生于风”，盖总诸疟为言，于此“皆”字，义可知矣。蓄，言邪蓄于经，有
时而伏也。作，言病见于外，不期而发也。 ，音皆。）其始发也，先起于毫毛，伸欠乃作，寒栗鼓颔，腰
脊俱痛，寒去则内外皆热，头痛如破，渴或冷冻饮料。（起于毫毛，憎寒而毛竖也。伸者，伸其四体，邪动于
经也。欠，呵欠也，阴阳争引而然也。）阴阳上下交争，虚实更作，阴阳相移也。（阳气者，下行极而上；
阴气者，上行极而下。邪气入之，则阴阳上下交争矣，阳虚则外寒，阴虚则内热，阳盛则外热，阴盛则内寒。
邪之所在，则邪实正虚，故入于阴则阴实阳虚，入于阳则阳实阴虚。虚实更作者，以阴阳相移易也。）
阳并于阴，则阴实而阳虚，阳明虚则寒栗鼓颔之，（阳并于阴，则阴邪胜，阴胜则寒也。阳明者，胃气之所出，
其主肌肉，其脉循颐颊，故阳明虚则为寒栗鼓颔。鼓者，振悚之谓。）巨阳虚则腰背头项痛，（腰背头项，皆
太阳经也。阳虚则寒邪居之，故为痛。）三阳俱虚则阴气胜，阴气胜则骨寒而痛。（三阳者，兼阳明、少阳
而言，阴气胜则阳气不行，血脉凝滞，故骨寒痛。）寒生于内，故中外皆寒。（表里阴邪皆胜也。）
阳盛则外热，阴虚则内热，外内皆热
则喘而渴，故欲冷冻饮料也（此邪自阴分而复并于阳分，并于阳则阳胜，阳胜则外内皆热而喘渴喜冷。）此皆得
之夏伤于暑，热气盛，藏于皮肤之内，肠胃之外，此营气之所舍也。（暑伤于夏，其时则热甚，
其邪则风寒也，故曰“ 疟皆生于风”，又曰“夏暑汗不出者，秋成风疟”。可知风寒在表，必郁而为热。其
藏于皮肤之内，肠胃之外，即经脉间耳。荣行脉中，故曰“此荣气之所舍”也。）令人汗空疏，腠理开。（暑
气能开肌表也。）因得秋气，汗出遏风，及得之以浴，水气舍于皮肤之内，与卫气并居。（暑邪内伏者，阴邪
也。秋气、水气，亦阴气也。新邪与卫气并居，则内合伏暑，故阴阳相薄而疟作矣。伤暑为疟，何谓阴
邪？盖阳暑伤气，其证多汗，感而即发，邪不能留，其留脏不去者，惟阴暑耳，以其无汗也。故凡患疟者，必
因于盛暑之时贪凉取快，不避风寒，或浴以凉水，或澡于河流，或过食生冷，壮者邪不能居，未必致病，怯者
蓄于荣卫，则所不免，但外感于寒者多为疟，内伤于寒者多为痢，使能慎此二者，则疟、痢何由来也？）卫气
者，昼日行于阳，夜行于阴，此气得阳而外出，得阴而内薄，内外相薄，是以日作。（风寒自
表而入，则与卫气并居，故必随卫气以为出入。卫气一日一周，是以新感之疟，亦一日一作。然则日作之疟，邪
在卫耳，其气浅，故其治亦易。）其间日而作者，气之舍深，内薄于阴，阳气独发，阴邪内者，阴与阳争不得
出，是以间日而作也。（其气之舍深，则邪居荣气之间，连乎脏也，荣为阴，卫为阳。阳气独发者，其行本
速，阴邪内着者，其行则迟，一迟一速，相拒而争，则阴邪不得与卫气俱出，故间日而作也。）
其作日晏与日早者，邪气客于风府，循膂而下。（风府，督脉穴。膂、吕同。脊骨曰膂，象形也；一曰挟脊
两旁之肉曰膂。下者，下行至尾 也。）卫气一日一夜大会于风府，其明日日下一节，故其作也晏。（卫气每至
明旦，则出于足太阳之精明穴而大会于风府，此一日一夜卫气周行之常度也，若邪气客于风府，心循膂
而下，其气渐深，则日下
一节，自阳就阴，其会渐迟，故其作渐晏也。）此先客于脊背也，每至于风府则腠理开，腠理开则邪气入，
邪气入则病作，以此日作稍益晏也。（此先客于脊背，言初感之伏邪也。每至于风府则腠理开，
言卫气、邪气之会也。会则病作，晏则因邪之日下也。）其出于风府，日下一节，二十五日下至 骨，二十
六日入于脊内，注于伏膂之内。（项骨三节，脊骨二十一节，共二十四节。邪气自风府日下一节，
故于二十五日下至尾 ，复自后而前，故于二十六日入于脊内，以注伏膂之脉。冲脉之循背者伏行脊膂之间，
故曰“伏膂”，也。）其气上行，九日出于缺盆之中，其气日高，故作日益早也。（邪在伏膂之脉，循脊
而上，无关节之窒，故九日而出缺盆。其气日高，则自阴就阳，其邪日退，故作渐早也。）其间日发者，由
邪气内薄于五脏，横连募原也。其道远，其气深，其行迟，不能与卫气俱行，不得皆出，故
间日乃作也。（此重申上文未尽之义也。诸经募原之气内连五脏，邪在阴分，故道远行迟而间日作也。）卫气
每至于风府，腠理乃发，发则邪气入，入则病作。今卫气日下一节，其气之发也，不当风府，又何所会而病日
作也？此邪气客于头项，循膂而下者也，故虚实不同，邪中异所，则不得当其风府也。（凡邪气客
于头项，则必循膂而下，此其常也。然邪之所中，亦但随虚实而异其处，不必尽当风府也。然则所谓日下者，
惟邪气耳。卫气周环，岂有日下之理？但气至而会，其病乃作，则邪气卫气，均为日下一节矣。）故邪中于
头项者，气至头项而病；中于背者，气至背而病；中于腰脊者，气至腰脊而病；中于手足者，气至手足而病。
（气至者，卫气之至也。至于邪合，然后病作，故其蓄作，则迟早有时。）卫气之所在，与邪气相合则病作，
故风无常府。卫气之所发，必开其腠理，邪气之所合，则其府也。（府者，所以聚物，故凡风之所居，即为风
府。卫气之至，与邪相合则腠理开，开则邪复入之，故无论乎上下左右，
皆可中邪。凡邪所中之处，亦皆可称为风府，故曰“风无常府”也。）夫风之与疟也，相似同类，而风独常在，
疟得有时而休者，风气留其处，故常在，疟气随经络，沉以内薄，故卫气应乃作。（此“风”字，指风证
为言。风之与疟，皆因于风，本为相似同类，然风则无休，疟有时止，当知所辨也。风气留其处，着而不移；
疟气随经络，流变不一。沉以内薄，言其深也，即上文“薄于五脏，横连募原”之谓，故必因
卫气之应而作也。）疟先寒而后热者，夏伤于大暑，其汗大出，腠理开发，因遇夏气凄沧之水寒，藏于腠理
皮肤之中，秋伤于风，则疾成矣。（凄沧之水寒，谓浴水乘凉之类也。因暑受寒，则腠理闭，汗不出，寒邪
先伏于皮肤之中，得清秋之气而风袭于外，则病发矣。）夫寒者，阴气也；风者，阳气也。先伤于寒而后伤
于风，故先寒而后热也。病以时作，名曰“寒疟”。（先受阴邪，后受阳邪，故先寒后热，人之患疟者多属
此症。）先热而后寒者，此先伤于风，而后伤于寒，故先热而后寒也。亦以时作，名曰“温疟”。
（先受阳邪，后受阴邪，故先热后寒而为温疟。）其但热而不寒者，阴气先竭，阳气独发，则少气烦冤，手
足热而欲呕，名曰“瘅疟”。（瘅，热也。阳气独亢，故但热不寒而烦冤少气；表里俱病，故手足热而欲
呕，以热邪及于胃也。）有余者泻之，不足者补之，今热为有余，寒为不足。夫疟者之寒，汤火不能温也；及
其热，冰水不能寒也。此皆有余、不足之类，当此之时，良工不能止，必须其自衰，乃刺之，故曰∶“无刺
之热，（ ，热正盛也。 ，赫、嚣二音，又呼木切。）无刺浑浑之脉，（浑浑之脉，阴阳虚实未定也。
不得其真，恐有所误。）无刺漉漉之汗”。（漉漉，汗大出也，其时邪正未定也。）故为其病逆，未可治也。
（于此三者而刺之，是逆其病气也。）凡为疟者，药法饮食皆然也。（当其时，避其锐。药，药饵；法，法
则，皆不可犯，至于饮食，尤所宜慎也。）夫疟之始发也，阳气并于
阴。当是之时，阳虚而阴盛，外无气，故先寒栗也。（此阴有余，阳不足也。卫气并于阴分则表虚，故曰“
外无气”。）阴气逆极，则复出之阳，阳与阴复并于外，则阴虚而阳实，故先热而渴。（气极于里，则复出于
外。阴虚阳实，故热病而渴。）夫疟气者，并于阳则阳胜，并于阴则阴胜。阴胜则寒，阳胜则热。（此疟证
或寒或热之故也。）疟者，风寒之气不常也，病极则复。（或阴或阳，疟本不常∶有先寒后热者，阴极则复
于阳也；有先热后寒者，阳极则复于阴也。）至病之发也，如火之热，如风雨之不可当也。（其暴如此，故名
为“疟”。）方其盛时必毁，因其衰也，事必大昌，此之谓也。（病邪方盛之时，真气正衰，辄加攻治，必
致毁伤，故当因其衰止而后取之，则邪气去而事大昌矣。天下凡事，何独不然？）夫疟之未发也，阴未并
阳，阳未并阴，因而调之，真气得安，邪气乃亡，故工不能治其已发，为其气逆也。（邪气正发，乃阴阳气逆
之时，故不可以强治。重言申之，至深切矣。）攻之早晏何如？疟之且发也，阴阳之且移也，必从四末始也。
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，此真往而未得并者也。（阴阳且移，必从四末始者，以十二经井原之气皆本于四肢也。故凡
疟之将发，则四肢先有寒意，此即其候。故治之者，当于先时未发之顷，坚束其处，谓四关之上也，使邪气
不得留行，乃察其孙络之坚盛者皆取之，今北人多行此法。砭出其血，谓之“放寒”，其义即此。故可令真
气自为往来，而邪则能无并也。）疟不发，其应何如？疟气者，必更盛更虚，当气之所在也。病在阳则
热而脉躁，病在阴则寒而脉静。（疟不发，谓其未作时也。欲察其应，当求气之所在，故但于证之寒热，脉
之躁静，可辨其病之阴阳也。）极则阴阳俱衰，卫气相离，故病得休，卫气集则复病也。（疟之或
在阴，或在阳，阴阳盛极，气必俱衰，故与卫气相离而病得休止，及卫气
再至则邪正分争，病复作矣。）时有间二日，或至数日发，或渴或不渴。其间日者，邪气与卫气客于六腑，
而有时相失，不能相得，故休数日乃作也。（客，犹言会也。邪在六腑则气远会希，故或间二日，或休数
日乃作也。此疟之间二日及数日发者，以邪气深客于腑，时与卫气相失而然。其理甚明。丹溪谓作于子、午、
卯、酉日为“少阴疟”，作于寅、申、巳、亥日为“厥阴疟”，作于辰、戌、丑、未日为“太阴
疟”，此不过以六气司天之义为言，然子、午虽曰少阴，而卯、酉则阳明矣；巳、亥虽曰厥阴，而寅、申则
少阳矣；丑、未虽曰太阴，而辰戌则太阳矣。如三日作者，犹可借此为言，若四日者，又将何以辨之？按此必
误学人，不可为训。）疟者，阴阳更胜也。或甚或不甚，故或渴或不渴。（阳胜则热甚，故渴。阴胜则否也。）
夏伤于暑，秋必病疟，此应四时者也。今疟有不必应，其病异形者，反四时也。（夏伤于暑，秋必病疟，此
应四时也。其于春夏冬而病疟者，则病形多异，正以四时之气，寒热各有相反，皆能为疟也。）其以秋病者
寒甚，（秋以盛热之后，而新凉束之，阴阳相激，故病为寒甚。）以冬病者寒不甚，（阳气伏藏于内，故冬
病者虽寒不甚。）以春病者恶风，（春时阳气外泄，腠理渐疏，余寒未去，故多病恶风。）以夏病者多汗。（
夏时热甚，熏蒸肌表。故病此者多汗。）温疟与寒疟，而皆安舍？舍于何脏？（安舍者，言
其何所居也。）温疟者，得之冬中于风寒，（风虽阳邪，其气则寒，故风寒可以并言。）气藏于骨髓之中，
至春则阳气大发，邪气不能自出，因遇大暑，脑髓烁，肌肉消，腠理发泄，或有所用力，邪气与汗皆出，此
病藏于肾，其气先从内出之于外也。（肾应冬，其主骨髓，故冬中风寒而不即病者，则邪气藏于骨髓之中，
或遇春温，或遇大暑，随触而发，故自内达外而为病也。）如是者阴虚而阳盛，阳盛则热矣。（自阴出阳，
则阴虚阳实也。）衰则气复反入，入则阳虚，阳虚则寒矣。故先热而后寒，名曰温疟。（阳极而衰，故复入于阴
分。此以冬中于寒，发为温疟，即伤寒之属，故伤寒有温疟一症，盖本诸此。）又有瘅疟者，肺素有热，
气盛于身，厥逆上冲，中气实而不外泄，因有所用力，腠理开，风寒舍于皮肤之内，分肉
之间而发，发则阳气盛，阳气盛而不衰，则病矣。其气不及于阴，故但热而不寒。（肺素有热者，阳盛气
实之人也，故邪中于外，亦但在阳分而不及于阴，则但热不寒也。）气内藏于心，而外舍于分
肉之间，令人消烁脱肉，故命曰瘅疟。（气藏于心，阳走脏也。热在肌肉之间，故令人消烁。然则瘅疟之所
舍者，在肺、心两经耳。）
足太阳之疟，令人腰痛头重，寒从背起，先寒后热， 然，热止汗出，难已，刺 中出血。（
此下言足六经之疟刺也，头、背、腰，皆足太阳经之所行，故为是病， ，皆热甚貌。
疟疾皆由风邪引起，邪气在经络中蓄积，发作有固定的时间。（“疟”字，意为残虐。虽然疟疾的症状多种多样，但都统称为疟，所以叫“疟”。各种解释不一，都没有抓住要点。看“疟皆生于风”，这是总括所有疟疾而言，从这个“皆”字，意思就可以知道了。“蓄”，是说邪气蓄积在经络中，有时潜伏。“作”，是说病症表现在外部，不期而发地发作。“疟”，读音为jiē。）
疟疾刚开始发作时，先感觉毫毛竖起，打哈欠伸展四肢后开始发作，出现恶寒战栗、下巴打颤，腰部和脊背都疼痛，寒冷过去后内外都发热，头痛得像要裂开一样，口渴想要喝冷饮。（“起于毫毛”，是憎恶寒冷而汗毛竖起。“伸”，是伸展四肢，邪气在经络中扰动。“欠”，是呵欠，阴阳之气相争牵引所致。）
阴阳上下交争，虚实交替出现，这是阴阳相互转移的结果。（阳气，下行到极点则上行；阴气，上行到极点则下行。邪气侵入，阴阳上下就交争了。阳虚则体表发冷，阴虚则体内发热，阳盛则体表发热，阴盛则体内发冷。邪气所在之处，邪气实而正气虚，所以进入阴分则阴实阳虚，进入阳分则阳实阴虚。虚实交替出现，是因为阴阳相互移易。）
阳气并入阴分，则阴实而阳虚，阳明经虚弱就会恶寒战栗、下巴打颤，（阳气并入阴分，则阴邪胜，阴胜则寒。阳明经，是胃气发出的地方，主管肌肉，经脉循行经过面颊，所以阳明经虚弱就会出现恶寒战栗、下巴打颤。“鼓”，是振悚的意思。）太阳经虚弱就会腰背头项疼痛，（腰背头项，都是太阳经循行的部位。阳虚则寒邪停留，所以疼痛。）三阳经都虚弱则阴气胜，阴气胜则骨头寒冷疼痛。（三阳，兼指阳明、少阳而言，阴气胜则阳气不行，血脉凝滞，所以骨头寒冷疼痛。）寒气生于内部，所以内外都寒冷。（表里的阴邪都胜了。）
阳气盛则体表发热，阴虚则体内发热，内外都热就会气喘且口渴，所以想喝冷饮（这是邪气从阴分重新并入阳分，并入阳分则阳胜，阳胜则内外都热而喘渴喜冷。）这些都因为夏天被暑气所伤，热气旺盛，藏在皮肤之内，肠胃之外，这是营气居住的地方。（夏天受暑，那时天气很热，邪气则是风寒，所以说“疟皆生于风”，又说“夏天暑天不出汗的人，秋天会形成风疟”。可知风寒在体表，必然郁结化为热。它藏在皮肤之内，肠胃之外，就是在经脉之间。营气行于脉中，所以说“这是营气居住的地方”。）使人毛孔疏松，腠理开泄。（暑气能打开肌表。）
于是遇到秋气，出汗时受风，以及洗澡时，水气停留在皮肤之内，与卫气共同居住。（暑邪内伏，是阴邪。秋气、水气，也是阴气。新感邪气与卫气共同居住，则内合伏藏的暑邪，所以阴阳相搏而疟疾发作。伤暑成疟，为什么说是阴邪？大概阳暑伤气，症状多汗，感受后立即发作，邪气不能留滞，只有阴暑才会留滞在脏腑不去，因为它无汗。所以凡是患疟疾的人，必定是因为在大暑之时贪凉取快，不避风寒，或用凉水洗澡，或在河流中沐浴，或过食生冷，身体强壮的人邪气不能停留，未必致病，体弱的人邪气蓄积在荣卫之间，就不能避免，只是外感寒邪的多为疟疾，内伤寒邪的多为痢疾，如果能谨慎这两方面，那么疟疾、痢疾从哪里来呢？）
卫气，白天行于阳分，夜晚行于阴分，这种气得到阳分则外出，得到阴分则内迫，内外相搏，所以每天发作。（风寒从体表而入，则与卫气共同居住，所以必须随着卫气的出入而出入。卫气一天循环一周，所以新感的疟疾，也是一天发作一次。既然这样，每天发作的疟疾，邪气在卫分，气机浅，所以治疗也容易。）
其中隔日发作的，是因为邪气潜伏较深，内迫于阴分，阳气独自发动，阴邪在内，阴与阳争不得出，所以隔日发作。（邪气潜伏深，则邪气居住在荣气之间，连及脏腑。荣为阴，卫为阳。阳气独自发动，其运行本来快速，阴邪在内附着，其运行则缓慢，一迟一速，相互抗拒争斗，则阴邪不能与卫气一起出来，所以隔日发作。）
发作时间推迟和提前的，是因为邪气客居在风府穴，沿着脊柱向下。（风府，督脉穴位。膂，同吕。脊骨叫膂，象形字；一说夹在脊骨两旁肉叫膂。下，是下行到尾闾。）卫气一天一夜在风府大会，第二天每天下降一节，所以发作时间推迟。（卫气每到次日清晨，就从足太阳膀胱经的精明穴出来并在风府大会，这是一天一夜卫气周行的常规度数。如果邪气客居在风府，心顺着脊柱向下，气逐渐变深，则每天下降一节，从阳入阴，大会逐渐延迟，所以发作逐渐推迟。）
这先是邪气客居在脊背，每次到达风府则腠理开泄，腠理开泄则邪气进入，邪气进入则病发作，因此每天发作的时间逐渐推迟。（这先是邪气客居在脊背，说的是初感时潜伏的邪气。每次到达风府则腠理开泄，说的是卫气、邪气相会。相会则病发作，推迟是因为邪气每天下降。）
邪气从风府出发，每天下降一节，二十五天下降到尾闾骨，二十六天进入脊柱内部，注入伏膂脉之中。（颈骨三节，脊骨二十一节，共二十四节。邪气从风府每天下降一节，所以在第二十五天下降到尾闾，又从后面转到前面，所以在第二十六天进入脊柱内部，注入伏膂脉。冲脉循行背部者伏行在脊膂之间，所以叫“伏膂”。）
邪气向上行，九天出于缺盆穴中，邪气位置越来越高，所以发作时间日益提前。（邪气在伏膂脉中，顺着脊柱向上，没有关节阻滞，所以九天而出缺盆。邪气位置越来越高，则是从阴就阳，邪气日渐消退，所以发作逐渐提前。）
其中隔日发作的，是因为邪气内迫于五脏，横连募原。路径远，气机深，运行慢，不能与卫气同行，不能都出来，所以隔日才发作。（这是重申上文未尽的意思。各经募原之气内连五脏，邪在阴分，所以路远行迟而隔日发作。）
卫气每次到达风府，腠理才开泄，开泄则邪气进入，进入则病发作。现在卫气每天下降一节，它开泄的时候，不在风府，又在何处相会而每天发作呢？这是因为邪气客居在头项，顺着脊柱向下的缘故，所以虚实不同，邪气侵犯的部位不同，就不一定正当风府穴了。（凡是邪气客居在头项，则必顺着脊柱向下，这是常理。然而邪气所中的部位，也随虚实不同而改变，不一定都正当风府。既然这样，所谓每天下降的，只是邪气罢了。卫气周环运行，哪有每天下降的道理？只是气至而相会，病才发作，那么邪气和卫气，都算是每天下降一节了。）
所以邪气中于头项的，气至头项而病发；中于背部的，气至背部而病发；中于腰脊的，气至腰脊而病发；中于手足的，气至手足而病发。（气至，是指卫气之至。到了邪气结合处，然后病发作，所以它的蓄积和发作，就有迟早的时间。）卫气所在之处，与邪气相合则病发作，所以风没有固定的风府。卫气所发的地方，必然开泄其腠理，邪气所合的地方，就是它的府。（府，是用来聚物的，所以凡是风所停留的地方，就是风府。卫气之至，与邪相合则腠理开，开则邪复入之，所以无论上下左右，都可以中邪。凡是邪气所中的地方，也可以称为风府，所以说“风无常府”。）
风和疟疾，相似同类，但风邪常常存在，疟疾有时休止，是因为风气留在某处，所以常在；疟气随着经络，沉潜向内逼迫，所以卫气应时而发作。（这个“风”字，是指风证而言。风和疟，都因于风，本来相似同类，然而风没有休止，疟疾有时停止，应当知道辨别。风气留在某处，附着不移；疟气随着经络，流变不一。沉以内薄，说的是深，即上文“薄于五脏，横连募原”的意思，所以必须因卫气的应时而发作。）
疟疾先冷后热的，是因为夏天受了大暑，大汗淋漓，腠理开发，于是遇到夏天清凉的水寒之气，藏在腠理皮肤之中，秋天伤了风，就迅速形成了。（清凉的水寒，指的是洗澡乘凉之类。因为暑而受寒，则腠理闭，汗不出，寒邪先伏于皮肤之中，得到清秋之气而风袭于外，则病发了。）
寒，是阴气；风，是阳气。先伤于寒而后伤于风，所以先冷后热。病按时发作，名叫“寒疟”。（先受阴邪，后受阳邪，所以先寒后热，人患疟疾的多属于此症。）
先热后冷的，是先伤于风，而后伤于寒，所以先热后冷。也按时发作，名叫“温疟”。（先受阳邪，后受阴邪，所以先热后寒而为温疟。）
只有热而不冷的，是阴气先竭，阳气独发，则气短烦闷，手足热而想呕吐，名叫“瘅疟”。（瘅，热也。阳气独亢，所以只热不寒而烦闷气短；表里都病，所以手足热而想呕吐，因为热邪波及胃腑。）
有余的用泻法，不足的用补法，现在热为有余，寒为不足。疟疾患者的寒冷，用汤火也不能温暖；等到发热时，用冰水也不能使其冷却。这都是有余、不足的情况，在这个时候，高明的医生也不能制止，必须等它自然衰退，才能针刺，所以说：“不要刺热势正盛的，（ ，热正盛也。 ，赫、嚣二音，又呼木切。）不要刺脉象浑乱的，（浑浑之脉，阴阳虚实未定也。得不到真象，恐怕有误。）不要刺大汗淋漓的”。（漉漉，汗大出也，此时邪正未定。）所以因为病情逆乱，不可治疗。（在这三种情况下针刺，是逆其病气。）
凡是治疟疾，用药法则和饮食都要注意。（当此时，避开其锐气。药，药饵；法，法则，都不可触犯，至于饮食，尤其应该谨慎。）
疟疾刚开始发作时，阳气并入阴分。在这个时候，阳虚而阴盛，体表没有阳气，所以先恶寒战栗。（这是阴有余，阳不足。卫气并入阴分则表虚，所以说“外无气”。）
阴气逆极，则复出到阳分，阳与阴再次并合于外，则阴虚而阳实，所以先热而渴。（气极于里，则复出于外。阴虚阳实，所以热病而渴。）
疟气，并入阳分则阳胜，并入阴分则阴胜。阴胜则寒，阳胜则热。（这是疟证或寒或热的原因。）
疟疾，是风寒之气不固定，病极则反复。（或阴或阳，疟本不固定：有先寒后热的，是阴极则复于阳；有先热后寒的，是阳极则复于阴。）
到了病发作的时候，像火的热，像风雨的不可抵挡。（其暴烈如此，所以名叫“疟”。）当邪气正盛时必定毁坏（真气），趁着它衰退时，事情必定大昌，说的就是这个道理。（病邪正盛之时，真气正衰，立即加以攻治，必致毁伤，所以应当趁其衰退止息后而取之，则邪气去而事大昌。天下的凡事，何尝不是这样？）
疟疾未发作时，阴未并阳，阳未并阴，因而调理它，真气得以安宁，邪气乃亡，所以医生不能在已发作时治疗，因为此时气机逆乱。（邪气正发作，正是阴阳气逆之时，所以不可以强治。重复说明，非常深切。）
攻治早晚如何？疟疾将要发作时，阴阳将要转移，必定从四肢末端开始。阳已伤，阴随之，所以在发作前坚固束扎患处，令邪气不得入，阴气不得出，仔细观察，在孙络盛大坚满且有血的都取之，这是真气前往而尚未被邪气并合的时候。（阴阳将要转移，必定从四肢末端开始，因为十二经井原之气都本于四肢。所以凡是疟疾将要发作，则四肢先有寒意，这就是征兆。所以治疗者，应当在先前未发作之际，坚固束扎患处，谓四关之上，使邪气不得留行，然后察其孙络坚盛者都取之，现在北方人多行此法。砭石刺出血，叫做“放寒”，意义就在这里。所以可令真气自为往来，而邪气则能不被并合。）
疟疾不发作时，有什么反应？疟气，必定更盛更虚，取决于气所在的位置。病在阳分则热而脉躁动，病在阴分则寒而脉静止。（疟疾不发作，说的是未作时。欲察其反应，应当求气之所在，所以只看证的寒热，脉的躁静，可辨病之阴阳。）
极则阴阳俱衰，卫气分离，所以病得休止，卫气聚集则又发病。（疟疾或在阴，或在阳，阴阳盛极，气必俱衰，所以与卫气分离而病得休止，及卫气再至则邪正分争，病又发作了。）
有时隔两天，或者到几天发作，有的口渴，有的不渴。其中隔日发作的，是因为邪气与卫气客居在六腑，而有时相失，不能相得，所以休息几天才发作。（客，犹言会也。邪在六腑则气远会稀，所以或隔两天，或休息几天才发作。这疟疾隔两天及数日发，是因为邪气深客于腑，时常与卫气相失而然。这道理很清楚。丹溪说在子、午、卯、酉日发作的叫“少阴疟”，在寅、申、巳、亥日发作的叫“厥阴疟”，在辰、戌、丑、未日发作的叫“太阴疟”，这不过是以六气司天的意义来说，然而子、午虽曰少阴，而卯、酉则阳明矣；巳、亥虽曰厥阴，而寅、申则少阳矣；丑、未虽曰太阴，而辰戌则太阳矣。如果是三日发作，还可以借此来说，如果是四日发作，又将怎么辨别呢？按此必定误导学人，不可作为准则。）
疟疾，是阴阳更替胜复。有的严重，有的不严重，所以有的口渴，有的不渴。（阳胜则热甚，所以渴。阴胜则不渴。）
夏天伤于暑，秋天必定病疟，这是顺应四时的。现在疟疾有不必应时的，其病形不同的，反而违背四时。（夏天伤于暑，秋天必定病疟，这是顺应四时。其在春夏冬而病疟的，则病形多异，正因为四时之气，寒热各有相反，都能导致疟疾。）
在秋天病的，寒冷严重，（秋天在盛热之后，而新凉束缚之，阴阳相激，所以病为寒甚。）在冬天病的，寒冷不严重，（阳气伏藏于内，所以冬天病的虽寒不严重。）在春天病的，怕风，（春时阳气外泄，腠理渐疏，余寒未去，所以多病怕风。）在夏天病的，多汗。（夏时热甚，熏蒸肌表。所以病此者多汗。）
温疟，得之于冬天中了风寒，（风虽阳邪，其气则寒，所以风寒可以并言。）气藏于骨髓之中，到春天则阳气大发，邪气不能自己出来，于是遇到大暑，脑髓被烤干，肌肉消瘦，腠理发泄，或者有所用力，邪气与汗都出来，这病藏于肾，其气先从内出之于外。（肾应冬，主骨髓，所以冬天中风寒而不即病的，则邪气藏于骨髓之中，或遇春温，或遇大暑，随触而发，所以自内达外而为病。）
像这样阴虚而阳盛，阳盛则热。（自阴出阳，则阴虚阳实。）衰退则气复反入，入则阳虚，阳虚则寒。所以先热后冷，名叫温疟。（阳极而衰，所以复入于阴分。这是以冬天中寒，发为温疟，即伤寒之属，所以伤寒有温疟一症，盖本于此。）
又有瘅疟，肺素来有热，气盛于身，厥逆上冲，中气实而不外泄，于是有所用力，腠理开，风寒舍于皮肤之内，分肉之间而发，发则阳气盛，阳气盛而不衰，则病了。其气不及于阴，所以只热不冷。（肺素来有热，是阳盛气实之人，所以邪中于外，亦但在阳分而不及于阴，则只热不冷。）
气内藏于心，而外舍于分肉之间，令人消烁脱肉，所以名叫瘅疟。（气藏于心，阳走脏也。热在肌肉之间，所以令人消烁。然而瘅疟之所舍者，在肺、心两经耳。）
足太阳经的疟疾，使人腰痛头重，寒从背起，先冷后热，烦躁不安，热止汗出，难愈，刺委中穴出血。（此下言足六经之疟刺也，头、背、腰，皆足太阳经之所行，故为是病， ，皆热甚貌。）
Malaria is all caused by wind pathogen, with pathogens accumulating in the meridians and attacks occurring at specific times. ("Jie" means all. "Nue" implies cruelty or torment. Although malaria presents with various symptoms, they are all collectively termed malaria, hence called "Jie Nue". Various interpretations vary, none capturing the essence. Observing "Malaria all arises from wind," this speaks generally of all malaria types; the meaning can be understood from the word "all." "Accumulate" refers to pathogens lodging in the meridians, lying dormant for periods. "Attack" refers to the disease manifesting externally, erupting unexpectedly. "Jie" is pronounced jie.)
When malaria first begins, it starts with goosebumps, followed by yawning and stretching, then chills with shivering and jaw quivering, pain in the waist and spine. After the cold subsides, both interior and exterior become hot, headache feels like splitting, thirst may arise with a desire for cold drinks. (Starting with goosebumps indicates aversion to cold causing hair erection. Stretching refers to extending limbs as pathogens move within meridians. Yawning occurs due to contention between Yin and Yang Qi.)
Yin and Yang contend above and below, alternating between deficiency and excess, representing the shifting of Yin and Yang. (Yang Qi descends to its extreme then ascends; Yin Qi ascends to its extreme then descends. When pathogens enter, Yin and Yang contend. Yang deficiency leads to external cold, Yin deficiency to internal heat, Yang excess to external heat, Yin excess to internal cold. Where pathogens reside, pathogen is excess and healthy Qi is deficient. Entering Yin makes Yin excess and Yang deficient; entering Yang makes Yang excess and Yin deficient. The alternation of deficiency and excess results from the mutual shifting of Yin and Yang.)
When Yang merges into Yin, Yin becomes excess and Yang deficient. Deficiency of the Yangming Meridian causes chills and jaw quivering. (When Yang merges into Yin, Yin pathogens prevail, prevailing Yin causes cold. The Yangming Meridian is where Stomach Qi originates, governs muscles, and its vessel circulates along the cheeks; thus, Yangming deficiency leads to chills and jaw quivering. "Gu" means trembling.) Deficiency of the Jueyin (Taiyang) Meridian causes pain in the lower back, back, head, and neck. (The lower back, back, head, and neck are all areas of the Taiyang Meridian. Yang deficiency allows cold pathogens to reside there, causing pain.) When the Three Yang Meridians are all deficient, Yin Qi prevails. Prevailing Yin Qi causes bone coldness and pain. (Three Yang refers to Yangming and Shaoyang combined. When Yin prevails, Yang Qi cannot flow, blood vessels stagnate, causing bone cold and pain.) Cold generates internally, so both interior and exterior are cold. (Yin pathogens prevail on both exterior and interior.)
Yang excess causes external heat, Yin deficiency causes internal heat. If both interior and exterior are hot, one will pant and feel thirsty, desiring cold drinks. (This occurs when pathogens re-merge from the Yin level to the Yang level. Merging into Yang causes Yang excess, leading to internal/external heat, panting, thirst, and preference for cold.) All these result from summer damage by summerheat, with intense heat qi hiding inside the skin but outside the stomach and intestines, which is the abode of Ying Qi (Nutritive Qi). (Summerheat injury occurs when heat is intense; the pathogen is actually wind-cold, hence "Malaria all arises from wind," and also "Those who do not sweat during summer heat will develop wind-malaria in autumn." This shows that wind-cold on the exterior must stagnate and transform into heat. Hiding inside skin but outside stomach/intestines means within the meridians. Ying Qi flows within vessels, hence "This is the abode of Ying Qi.") It causes pores to open and interstices to relax. (Summerheat opens the muscle surface.)
Then, encountering autumn air, wind enters while sweating, and bathing introduces water qi that lodges inside the skin, coexisting with Wei Qi (Defensive Qi). (Internal latent summerheat is Yin pathogen. Autumn air and water qi are also Yin. New pathogens coexisting with Wei Qi combine internally with latent summerheat, causing Yin-Yang conflict and malaria onset. Summerheat-induced malaria is considered Yin pathogen because Yang summerheat damages Qi, causing profuse sweating and immediate onset without retention; only Yin summerheat remains in organs due to lack of sweating. Thus, malaria sufferers often indulged in cooling activities during peak summer, exposed to wind-cold, bathed in cool water, swam in rivers, or ate raw/cold foods. Robust individuals resist pathogens, but frail ones accumulate them in Ying and Wei. External cold invasion tends toward malaria; internal cold injury tends toward dysentery. Cautioning against these prevents malaria and dysentery.)
Wei Qi travels through Yang during the day and Yin at night. This Qi moves outward upon encountering Yang and inward upon encountering Yin. Their mutual conflict causes daily attacks. (Wind-cold enters from the exterior, coexisting with Wei Qi, thus following Wei Qi's entry and exit. Wei Qi completes one cycle daily, so newly contracted malaria attacks daily. Therefore, daily malaria indicates pathogens in Wei Qi, shallow depth, and easier treatment.)
Intermittent attacks (every other day) occur because pathogens lodge deeply, pressing inward on Yin. Yang Qi alone activates, but Yin pathogens remain inside. Yin and Yang contend but cannot exit together, causing every-other-day attacks. (Deep lodging places pathogens between Ying Qi and Zang organs. Ying is Yin, Wei is Yang. Yang Qi moves fast; internal Yin pathogens move slow. Speed difference causes resistance, preventing Yin pathogens from exiting with Wei Qi, resulting in intermittent attacks.)
Delayed or early attacks occur because pathogens lodge at Fengfu Point, descending along the Du Meridian (Spine). (Fengfu is a Du Meridian acupoint. "Lv" refers to the flesh beside the spine. Descending means moving down to the coccyx.) Wei Qi gathers at Fengfu once daily and nightly. Each subsequent day, it descends one vertebral segment, delaying attack time. (Wei Qi emerges from Jingming Point of Bladder Meridian at dawn and gathers at Fengfu, completing a daily cycle. If pathogens lodge at Fengfu and descend along the spine, depth increases daily, shifting from Yang to Yin, delaying gathering and thus attack time.)
Initially, pathogens lodge in the back. Upon reaching Fengfu, interstices open, allowing pathogen entry and disease onset, progressively delaying daily attacks. (Initial lodging in back refers to latent pathogens from initial infection. Reaching Fengfu opens interstices, signifying Wei-Qi/pathogen convergence. Convergence triggers attack; delay results from daily pathogen descent.)
Pathogens start at Fengfu, descending one segment daily. In 25 days, they reach the coccyx; on day 26, they enter the spine interior, injecting into the Fulu Meridian. (Neck has 3 vertebrae, spine has 21, totaling 24. Pathogens descend one segment daily from Fengfu, reaching coccyx on day 25, then turning frontward, entering spine interior on day 26 into Fulu Meridian. Chong Meridian runs secretly along the spine, hence "Fulu".)
Qi ascends, emerging from Qumen area after 9 days. As Qi rises higher, attacks occur earlier. (Pathogens in Fulu Meridian ascend along spine without joint obstruction, emerging at Qumen in 9 days. Rising Qi shifts from Yin to Yang, retreating pathogens cause earlier attacks.)
Intermittent attacks occur because pathogens press inward on the Five Zang Organs, connecting horizontally to Mu Yuan (Diaphragm). The path is long, depth deep, movement slow, unable to travel with Wei Qi or exit fully, causing every-other-day attacks. (Reiterating previous points: Mu Yuan Qi connects to Zang organs; pathogens in Yin level mean long path/slow movement, causing intermittent attacks.)
Wei Qi reaches Fengfu, opening interstices, allowing pathogen entry and attack. Now Wei Qi descends one segment daily; when it opens, it is no longer at Fengfu. Where does it converge to cause daily attacks? Because pathogens lodged in head/neck, descending along spine. Thus, deficiency/excess varies, pathogen location varies, not necessarily aligning with Fengfu. (Pathogens in head/neck descend along spine normally. However, pathogen entry sites vary by deficiency/excess, not always Fengfu. Thus, "daily descent" applies only to pathogens. Wei Qi cycles uniformly; why descend? Only when Qi arrives and converges does disease occur, making both pathogen and Wei Qi appear to descend one segment daily.)
Therefore, if pathogens strike head/neck, disease occurs when Qi reaches head/neck; if back, when Qi reaches back; if waist/spine, when Qi reaches waist/spine; if extremities, when Qi reaches extremities. (Qi arrival refers to Wei Qi arrival. Disease occurs upon pathogen-Qi combination, determining timing of accumulation and attack.) Disease occurs where Wei Qi meets pathogens; thus, Wind has no fixed "Fengfu" (Abode). Wherever Wei Qi activates, interstices open; wherever pathogens meet, that is their abode. (Abode gathers things; wherever Wind resides is Fengfu. Wei Qi arrival opens interstices, allowing pathogen re-entry. Thus, anywhere can be struck by pathogens, termed Fengfu, hence "Wind has no fixed abode.")
Wind and malaria are similar/same category, yet wind persists while malaria rests. Wind stays in place, persisting; malaria follows meridians, sinking inward, attacking only when Wei Qi responds. ("Wind" here refers to Wind Syndrome. Both stem from Wind, appearing similar, but Wind is continuous while Malaria is intermittent. Wind lingers fixedly; Malaria flows variably. Sinking inward implies depth, linking to "pressing Zang organs/connecting Mu Yuan," requiring Wei Qi response to attack.)
Malaria starting with cold then heat results from summer severe heat causing profuse sweating and open interstices, followed by exposure to cool water/cold, hiding in skin/interstices, then autumn wind triggering rapid onset. (Cool water/cold refers to bathing/cooling. Summerheat plus cold closes interstices, stops sweating, hiding cold pathogens in skin. Autumn wind strikes externally, triggering disease.)
Cold is Yin Qi; Wind is Yang Qi. Injury by cold first, then wind, causes cold then heat. Timely attacks name it "Cold Malaria." (Yin pathogen first, Yang second, causing cold then heat. Most malaria cases fit this.)
Starting with heat then cold results from wind injury first, then cold, causing heat then cold. Timely attacks name it "Warm Malaria." (Yang pathogen first, Yin second, causing heat then cold.)
Heat only, no cold, results from prior Yin exhaustion, solitary Yang activation. Symptoms include shortness of breath, irritability, hot hands/feet, nausea. Named "Dan Malaria" (Febrile Malaria). (Dan means heat. Solitary Yang hyperactivity causes heat-only, irritability, shortness of breath. Interior/exterior involvement causes hot extremities and nausea due to heat affecting Stomach.)
Excess treated by draining, deficiency by tonifying. Heat is excess, cold is deficiency. Malaria chills cannot be warmed by fire/water; fever cannot be cooled by ice/water. These are excess/deficiency states. At such times, even skilled doctors cannot stop them; must wait for natural decline before needling. Hence: "Do not needle when heat is raging," "Do not needle chaotic pulse," "Do not needle profuse sweating." (Raging heat, chaotic pulse indicates undetermined Yin/Yang deficiency/excess; profuse sweating indicates unsettled pathogen/healthy Qi. Needling now opposes disease Qi, making treatment impossible.)
General malaria treatment requires caution with herbs/diet. Avoid peak virulence. Herbs/methods must not be violated; diet especially需谨慎. (Avoid sharpness when present.)
At malaria onset, Yang merges into Yin. Yang deficient, Yin excess, exterior lacks Qi, causing initial chills. (Yin excess, Yang deficient. Wei Qi merging into Yin causes exterior deficiency, hence "no exterior Qi".)
Extreme Yin reversal returns to Yang. Yang and Yin merge externally again, causing Yin deficiency and Yang excess, leading to initial heat and thirst. (Qi extreme inside returns outside. Yin deficient, Yang excess causes heat/thirst.)
Malaria Qi merging into Yang causes Yang excess; merging into Yin causes Yin excess. Yin excess brings cold; Yang excess brings heat. (Cause of alternating cold/heat in malaria.)
Malaria involves irregular Wind-Cold Qi, reversing when extreme. (Alternating Yin/Yang: Cold-then-Heat is Yin extreme returning to Yang; Heat-then-Cold is Yang extreme returning to Yin.)
At attack, intensity resembles fire or storm. (Violence earns name "Malaria".) Attacking at peak strength destroys healthy Qi; treating at decline ensures success. (Treating at peak harms healthy Qi; waiting for decline removes pathogens successfully.)
Before malaria onset, Yin hasn't merged into Yang, Yang hasn't merged into Yin. Regulating then stabilizes healthy Qi, eliminating pathogens. Doctors cannot treat active attacks because Qi is rebellious. (Active attack is Yin-Yang rebellion; forced treatment fails. Emphasized deeply.)
Timing of treatment? Before onset, Yin-Yang shift begins at extremities. Yang injured, Yin follows. Bind site firmly before attack to block pathogen entry/Yin exit. Observe Sun Luo (Branch Collaterals); take those full/bloody. This preserves healthy Qi before pathogen merger. (Twelve Jingyuan origins root in limbs. Pre-attack limb chill is sign. Binding four gates prevents pathogen stagnation. Pricking full branch collaterals releases blood ("releasing cold"), allowing healthy Qi circulation, blocking pathogen merger.)
When malaria is inactive, what is the response? Malaria Qi fluctuates between excess/deficiency depending on location. Yang location causes heat/restless pulse; Yin location causes cold/still pulse. (Inactive means pre-attack. Assess Qi location via cold/heat signs and pulse restlessness/stillness to determine Yin/Yang pathology.)
Extremes cause Yin/Yang depletion, Wei Qi separation, allowing rest. Wei Qi return restarts disease. (Yin/Yang extremes deplete Qi, separating from Wei Qi, causing rest. Wei Qi return triggers pathogen-healthy Qi conflict, restarting disease.)
Intervals of two days or more, with/without thirst. Every-other-day attacks involve pathogens/Wei Qi in Six Fu Organs, missing each other, resting days before attack. (Meeting in Fu Organs is distant/rare, causing multi-day intervals. Deep Fu lodging causes missed meetings. Danxi’s theory linking days to Shao-Yin/Jue-Yin/Tai-Yin based on Six Qi is flawed; e.g., Mao/You are Yangming, not Shao-Yin. Such theories mislead learners.)
Malaria is Yin-Yang alternating victory. Severity varies, causing thirst/no thirst. (Yang excess causes heat/thirst; Yin excess does not.)
Summer heat injury guarantees autumn malaria, aligning with seasons. Some malaria defies seasons, showing varied forms. (Seasonal alignment is normal. Non-seasonal malaria shows varied forms due to seasonal cold/heat variations causing malaria.)
Autumn malaria: severe cold (post-summer heat, new coolness stimulates Yin-Yang conflict). Winter malaria: mild cold (Yang hidden internally). Spring malaria: aversion to wind (Yang leaking, pores loosening, residual cold). Summer malaria: profuse sweating (Heat steaming muscle surface).
Where do Warm Malaria and Cold Malaria lodge? Which Zang?
Warm Malaria originates from winter wind-cold lodging in bone marrow. Spring Yang expansion traps pathogens. Summer heat dries marrow, melts muscle, opens pores. Effort forces pathogens out with sweat. Pathogen lodges in Kidney, emerging internally to externally. (Kidney corresponds to Winter, governs bone marrow. Winter wind-cold latent in marrow triggers in Spring warmth or Summer heat, emerging internally to externally.)
This causes Yin deficiency, Yang excess, leading to heat. Decline reverses Qi inward, causing Yang deficiency and cold. Heat-then-cold names Warm Malaria. (Yang extreme declines, returning to Yin. Winter cold inducing Warm Malaria belongs to Cold Damage category.)
Dan Malaria: Lung has prior heat, Qi excess in body, counterflow upward, middle Qi solid but not leaking. Effort opens pores, wind-cold lodges in skin/muscle. Attack causes Yang excess, persistent without decline, causing disease. Qi doesn't reach Yin, so heat only, no cold. (Prior Lung heat indicates Yang excess/Qi solidity. External strike stays in Yang, not Yin, causing heat-only.)
Qi lodges internally in Heart, externally in muscle/flesh, wasting body, named Dan Malaria. (Qi in Heart, Yang traveling to Zang. Heat in muscle wastes body. Dan Malaria abodes are Lung and Heart meridians.)
Foot Taiyang Malaria: Waist pain, heavy head, cold starting from back, cold-then-heat, irritability, sweating after heat cessation, difficult to cure. Needle Weizhong (BL40) to bleed. (Below discusses Foot Six Meridian malaria needling. Head/back/waist are Foot Taiyang pathways, causing these symptoms. Symbols indicate severe heat.)