或问曰。经云夏伤于暑。秋必病疟。前人虽备言之。旨殊未畅。盍明示诸。曰不发于夏。而发于秋。此亢
则害承乃制。子来救母之义。盖暑令当权。君火用事。肺金必受伤克。火位之下。水气承之。肾水为肺之子。
因母受火伤。子来承之。以制火救母。于是水火相战。阴阳交争。大胜则大复。小胜则小复。此阴阳胜复之常
理。疟之所由作也。然而有病有不病者。盖邪之所凑。其气必虚。故其人元气不固者。暑邪得以乘之。所以
治疟。以扶元气为主。
发在夏至后处暑前者。此三阳受病。伤之浅者。近而暴也。发在处暑后冬至前者。此三阴受病。
伤之重者。远而深也。
发在子半之后午之前。是阳分受病。其病易愈。发于午后者。是阴分受病。其病难愈。
或问曰。有一日一发。有间日一发。有三日一发。何也。曰在阳则发早。在阴则发晏。浅则日作。深则
间日。夫人荣卫之气。一日一周。历五脏六腑十二经络之界分。每一界各有一舍。荣
卫之有舍。犹行人之传舍也。邪气客于荣卫之舍。与日行之卫气相接。则病作。离则病退。故一日一周。有止
发之定期。其间日而作者。气之舍深。内薄于阴。阳气独发。阴气内着。阴与阳争。不得出。故间日而作也。
三日一作者。邪入于三阴也。作于子午卯酉日者。少阴也。寅申已亥日者。厥阴也。辰戌丑未日者。太阴也。
凡治疟必先问其寒热多寡。而参之脉证。有寒多热少者。有热多寒少者。大抵寒热往来。皆属少阳经证。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。金匮
云。阴气孤绝。阳气独发。则热而少气烦冤。手足热而欲呕。名曰瘅疟。邪气内藏于心肺。外舍于分
肉之间。令人消烁脱肉。又云。温疟者。其脉如平。人身无寒但热。骨节疼烦。时时呕逆。以白虎加桂枝汤主
之。但寒者。名曰牡疟。蜀漆散主之。此寒热多寡之定法也。然亦有不可执者。当察其脉之虚实何如。若但寒
者。其脉或洪实或滑。当作实热治之。若但热者。其脉或空虚或微弱。当作虚寒治之。仲景云。疟脉
自弦。弦数者多热。弦迟者多寒。弦小紧者可下。弦迟者可温。弦紧者可发汗及针灸也。弦数者。风痰发也。
以饮食消息止之。
凡疟将发之时。与正发之际。慎勿施治。治亦无效。必待阴阳并极而退。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。
古今治疟证候。有风寒暑湿不同治疗。有汗吐下各异方术。无虑千百。不能尽述。独无痰不成疟。无食
不成疟。深得致疟之因。无汗要有汗。散邪为主。有汗要无汗。扶正气为主。深得治疟之法。以青皮饮一方。
治秋时正疟。随证加减。屡用屡效。若胃中有郁痰伏结者。以草果饮一服即愈。
服前方不应。当以补中益气汤。倍柴胡加半夏生姜。养正
而邪自除。薛立斋先生云。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。
仁斋云。有人脏腑久虚。大便常滑。忽得疟疾。呕吐异常。以二陈加人参白豆蔻。进一二服。病患自觉
气脉顿平。寒热不作。盖白豆蔻流行三焦。元气荣卫一转。寒热自平。继今遇有呕吐发疟之证。或其人素虚
者。慎勿用常山等药。以上专论秋时正疟之法也。世间似疟非疟者多。世人一见寒热往来。便以截
疟丹施治。一截不止则再截。再截而止。止而复发复截。以致委顿。甚或因而致毙者有之。是不可不辨也。
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
劳瘵等证。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。阳虚者补阳。
如理中汤。六君子汤。补中益气汤加姜桂。甚则加附子。诸方中必用升麻柴胡。以提出阴中之阳。水升火降而
愈。医书中有论及之者矣。至于阴虚者。其寒热亦与正疟无异。而阴疟中又有真阴真阳之分。人所不知。
经曰。昼见夜伏。夜见昼止。按时而发。是无水也。昼见夜伏。夜见昼止。倏忽往来。时作时止。是无火也。
无水者。壮水之主。以镇阳光。六味汤主之。无火者。益火之原。以消阴翳。八味汤主之。世人患久疟而不愈
者。非疟不可愈。乃治之不如法也。丹溪云。夜发者邪入阴分。宜用血药引出阳分。当归川芎红花生地黄柏
治之。亦未及真阴真阳之至理。遍考诸书疟论。并未能露其意。且余常试有神验。故特表而出焉。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。
以六味地黄加柴胡芍药肉桂五味。大剂一服便愈。
有渴甚者。每发时饮汤不绝。必得五六大壶方可。余以六
味丸一料。内肉桂一两。水十碗。作四砂锅。煎五六碗。以水探
冷。连进代茶。遂熟睡渴止而热愈。
又有恶寒恶热。如疟无异。面赤如脂。口渴不甚。吐痰如涌。身以上热如烙。膝以下自觉冷。此真阳泛
上。肾虚之极。急以附子八味地黄汤。大剂冷冻饮料而热退。继以人参建中汤调理。
加减地黄方 肾肝同治之法。
熟地（四钱） 山药（二钱） 山茱萸肉（二钱） 丹皮（钱半） 茯苓（钱半） 泽泻（一钱） 五
味子（一钱） 柴胡（一钱） 芍药（一钱） 肉桂（一钱） 水三钟。煎一钟服。
八味地黄方 即六味地黄分两。外加附子一钱。肉桂一钱。
补中益气汤加半夏方
人参 黄 甘草 当归 白术 柴胡 升麻 陈皮 半夏 加煨姜
六味丸方
熟地（八两） 山药（四两） 山萸肉（四两） 丹皮（三两） 茯苓（三两） 泽泻（三两） 加
肉桂（一两）
建中汤方
人参（一钱） 芍药（二钱） 甘草（一钱） 肉桂（七分） 大枣 饴糖
又有一等郁证似疟者。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。继以六味地黄。加柴胡芍药调理而安。
至于三阴疟者。惟太阴疟。当用理中汤。必加肉桂。若少阴厥阴。非八味地黄不效。
逍遥散 治郁疟。
柴胡（一钱） 芍药（一钱） 陈皮（一钱） 牡丹皮（一钱） 茯神（一钱） 当归（一钱） 白术（一
钱） 贝母（一钱） 薄荷（七分） 黄连（五分每一两用吴茱萸二钱水拌炒焦色合用）。
青皮饮
青皮 浓朴 白术 柴胡 草果仁 茯苓 黄芩 半夏 甘草 此方以柴胡为主。大抵寒热往来。属
少阳经证。故用以为君。草果浓朴所以化食。青皮半夏所以祛痰。寒多者。可加肉桂。热多者。可加黄连。
草果饮 治脾胃有郁痰伏涎者。元气壮强者可用。虚者莫用。
草果 常山 知母 乌梅 槟榔 甘草 穿山甲
赵以德云。知母性寒。入足阳明药。用治阳明独盛之火热。使其退就太阴也。草果性温药。治足太
阴独盛之寒。使其居于阳明也。二经合和。则无阴阳交错之变。是为君。常山主吐胸中痰结。是为臣。甘草和
诸药。乌梅去痰。槟榔除痰癖。破滞气。是佐药。穿山甲者。以其穿山而居。遇水而入。则是出阴入阳。穿其
经络于荣分。以破暑结之邪。为之使也。
白虎汤加桂方 治瘅疟。若脉虚弱不宜。
石膏（一斤） 知母（六两） 甘草（二两） 桂枝（去皮三两） 糯米（二合） 每服五钱。
蜀漆散 治牝疟。见金匮。
蜀漆（烧去腥） 云母（烧三夜） 龙骨（各等分） 上为散。未发前。以
浆水服半钱匕。如温疟加蜀漆一钱。临发时服一钱匕。
牡蛎汤 治牡疟。
牡蛎（四两熬） 麻黄（去节） 蜀漆（各三两） 甘草（二两） 水八升。先煮蜀漆麻黄去沫。
得六升。内诸药。煮取二升。温服一升。若吐则勿更服。
理中汤 此方专治大阴疟。必加肉桂一钱乃效。
人参（二钱） 白术（二钱） 干姜（钱半） 炙甘草（一钱）
有人问：《内经》说“夏季感受暑邪，秋季必定发生疟疾”。前人虽然详细论述过，但主旨尚未完全阐明。请您明示。
答：疟疾不在夏季发作，而在秋季发作，这是遵循“亢盛则害，承制乃平”以及“子来救母”的道理。暑热当令时，君火主事，肺金必然受到克制而受伤。在火位之下，水气会随之承接制约。肾水是肺金之子，因为母亲（肺）受火邪伤害，儿子（肾）前来承接制约火邪以拯救母亲。于是水火相互交战，阴阳相互争胜。大胜之后会有大的恢复，小胜之后会有小的恢复。这是阴阳胜复的常理，也是疟疾产生的原因。然而，有的人生病，有的人不生病，这是因为邪气聚集的地方，正气必然虚弱。所以那些元气不坚固的人，暑邪得以乘虚而入。因此治疗疟疾，应以扶助元气为主。
在夏至后、处暑前发作的，这是三阳经受病，邪气伤得浅，发病急骤且病程短。在处暑后、冬至前发作的，这是三阴经受病，邪气伤得重，发病缓慢且病程深长。
在半夜子时之后、中午午时之前发作的，是阳分受病，病情容易治愈；在午时之后发作的，是阴分受病，病情难以治愈。
又问：有的每天发作一次，有的隔日发作一次，有的三日发作一次，为什么呢？
答：邪在阳分则发作早，在阴分则发作晚。邪浅则每日发作，邪深则隔日发作。人的营卫之气，一天循环一周，经过五脏六腑和十二经络的分界。每一界各有一个停留之所。营卫有停留之所，就像行人有驿站一样。邪气客居在营卫的停留之所，与每日运行的卫气相遇，疾病就发作；分离了，疾病就退去。所以营卫一日一周，就有停止和发作的定期。那隔日发作的，是因为气的停留之所较深，邪气内迫于阴分，阳气单独发越，阴气内着不去，阴与阳相争，不能外出，所以隔日发作。三日一发的，是邪气进入三阴经。在子、午、卯、酉日发作的，属于少阴经；在寅、申、巳、亥日发作的，属于厥阴经；在辰、戌、丑、未日发作的，属于太阴经。
大凡治疗疟疾，必须先询问其寒热症状的多寡，并结合脉证参详。有寒多热少的，有热多寒少的。大体上寒热往来，都属于少阳经证。治法应当以小柴胡汤为主。如果寒多者，用小柴胡汤加桂枝。有只热不寒的，名叫瘅疟（Dan Nue, Malaria with high fever）。有只寒不热的，名叫牝疟（Pin Nue, Malaria with chills predominating）。《金匮要略》说：“阴气孤绝，阳气独发，则出现发热、气短、烦闷冤屈感，手足发热且想呕吐，名叫瘅疟。”邪气内藏于心肺，外舍于肌肉腠理之间，使人消瘦脱肉。又说：“温疟（Wen Nue, Warm Malaria），其脉象如常人，身体没有恶寒只有发热，骨节疼痛烦扰，时常呕吐逆气，用白虎加桂枝汤主治。”只有寒的，名叫牡疟（Mu Nue, Malaria with cold predominating），用蜀漆散主治。这是根据寒热多寡的固定治法。然而也有不可拘泥的情况，应当观察脉象的虚实如何。如果只有寒症，其脉象或洪实或滑，当作实热证治疗。如果只有热症，其脉象或空虚或微弱，当作虚寒证治疗。张仲景说：“疟疾的脉象自然呈弦脉。弦数脉的多热，弦迟脉的多寒。弦小紧脉的可攻下，弦迟脉的可温补，弦紧脉的可发汗及针灸。”弦数脉，是风痰引起的，通过饮食调理即可止住。
大凡疟疾将要发作的时候，以及正在发作的期间，千万不要施治，即使治疗也无效。必须等到阴阳极度偏盛而衰退之后，邪气离开其所客居的地方，然后才能治疗。况且应当在发病前两三个小时之前，迎头痛击截断病势是可以的。
古今治疗疟疾的证候，有因风寒暑湿不同而导致的治疗差异，有汗、吐、下各异的方法方术，无虑千百种，不能全部叙述。唯独认为“无痰不成疟，无食不成疟”，深得导致疟疾的原因。“无汗要有汗”，以发散邪气为主；“有汗要无汗”，以扶助正气为主，深得治疗疟疾的方法。用青皮饮一方，治疗秋季的正疟，随证加减，屡用屡效。如果胃中有郁结的伏痰，服用草果饮一剂即可痊愈。
服用前方无效，应当用补中益气汤，加倍柴胡，加入半夏、生姜，养护正气而邪气自然除去。薛立斋先生说：“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。这是不直接截疟却达到截疟效果的方法。一服即愈。”
仁斋说：“有人脏腑长期虚弱，大便经常滑泄，忽然得了疟疾，呕吐异常。用二陈汤加人参、白豆蔻，进服一二剂，病人自觉气脉顿时平和，寒热不再发作。因为白豆蔻能通行三焦，使元气和营卫运转，寒热自然平息。今后遇到有呕吐并发疟疾的证候，或者其人素体虚弱者，千万不要用常山等药。以上专门论述秋季正疟的治疗方法。世间类似疟疾而非疟疾的情况很多，世人一见寒热往来，就用截疟丹治疗。一次截不住就再截，再截才止住，止住后又复发再截，以致身体委顿，甚至因此致死的都有。这是不可不辨别的。
《内经》说：“阳虚则恶寒，阴虚则恶热。阴气上入于阳分，则恶寒；阳气下陷于阴分，则恶热。”凡是伤寒后、大病后、产后、劳瘵等证，都有寒热往来，似疟非疟，或一天发作两三次，都当作虚证治疗，但有阳虚阴虚的区别。阳虚者补阳，如理中汤、六君子汤、补中益气汤加干姜、肉桂，严重时加附子。这些方中必须用升麻、柴胡，以提出阴中之阳，使水升火降而痊愈。医书中已有论及此点的。至于阴虚者，其寒热也与正疟无异，而阴疟中又有真阴、真阳之分，人们所不了解。
《内经》说：“白天发作晚上潜伏，晚上发作白天停止，按时而发，这是无水（肾阴亏虚）的表现。白天发作晚上潜伏，晚上发作白天停止，忽来忽往，时作时止，这是无火（肾阳亏虚）的表现。”无水的，壮水之主，以镇阳光，用六味地黄丸主治。无火的，益火之原，以消阴翳，用八味地黄丸主治。世人患久疟不愈的，不是疟疾不可愈，而是治疗不得法。朱丹溪说：“夜间发作的是邪入阴分，宜用血分药引出阳分，用当归、川芎、红花、生地黄、黄柏治疗。”这也未能触及真阴真阳的根本道理。遍考诸书疟论，并未能揭示其意。而且我常试用，有神效，所以特意表彰出来。我见到发疟疾有面赤口渴的，都当作肾中真阴虚治疗，无不立即见效。凡是见到患者寒来时像冰一样冷，热来时像烙铁一样烫，只有面色红如脂粉，口渴想喝水的，用六味地黄丸加柴胡、芍药、肉桂、五味子，大剂量一服便愈。
有渴得很厉害的，每次发作时饮水不断，必须喝五六壶才行。我用六味丸一料，内加肉桂一两，用水十碗，分成四个砂锅，煎至五六碗，探水温使其变冷，连进代替茶水饮用，于是熟睡后口渴停止而热退。
又有恶寒恶热，与疟疾无异，面色红如脂粉，口渴不甚，吐痰如涌，上半身热如烙铁，膝盖以下自觉寒冷，这是真阳泛上，肾虚到了极点。急用附子八味地黄汤，大剂量冷冻饮料服用而热退。继用人参建中汤调理。
【加减地黄方】肾肝同治之法。
熟地（四钱）、山药（二钱）、山茱萸肉（二钱）、丹皮（钱半）、茯苓（钱半）、泽泻（一钱）、五味子（一钱）、柴胡（一钱）、芍药（一钱）、肉桂（一钱）。水三钟，煎成一钟服用。
【补中益气汤加半夏方】
人参、黄芪、甘草、当归、白术、柴胡、升麻、陈皮、半夏，加煨姜。
【六味丸方】
熟地（八两）、山药（四两）、山萸肉（四两）、丹皮（三两）、茯苓（三两）、泽泻（三两），加肉桂（一两）。
【建中汤方】
人参（一钱）、芍药（二钱）、甘草（一钱）、肉桂（七分）、大枣、饴糖。
又有一类郁证类似疟疾的，其寒热与正疟无异，但其人口苦，呕吐清水或苦水，面色青，胁痛，耳鸣，脉涩。须用逍遥散，加黄连、贝母，加倍柴胡，作一剂服用。继用六味地黄丸加柴胡、芍药调理而安。
至于三阴疟，只有太阴疟，当用理中汤，必须加肉桂。如果是少阴、厥阴疟，非八味地黄丸无效。
【逍遥散】治郁疟。
柴胡（一钱）、芍药（一钱）、陈皮（一钱）、牡丹皮（一钱）、茯神（一钱）、当归（一钱）、白术（一钱）、贝母（一钱）、薄荷（七分）、黄连（五分，每两用吴茱萸二钱水拌炒至焦色合用）。
【青皮饮】
青皮、浓朴、白术、柴胡、草果仁、茯苓、黄芩、半夏、甘草。此方以柴胡为主。大体上寒热往来，属少阳经证，故用以为君药。草果、浓朴用来化食，青皮、半夏用来祛痰。寒多者，可加肉桂；热多者，可加黄连。
【草果饮】治脾胃有郁痰伏涎者。元气壮强者可用，虚者莫用。
草果、常山、知母、乌梅、槟榔、甘草、穿山甲。
赵以德说：知母性寒，入足阳明经药，用于治疗阳明经独盛的火热，使其退回到太阴经。草果性温药，治疗足太阴经独盛的寒，使其居于阳明经。二经合和，就没有阴阳交错的病变，这为君药。常山主治吐出胸中的痰结，这为臣药。甘草调和诸药，乌梅去痰，槟榔除痰癖，破滞气，这是佐药。穿山甲，因为它穿山而居，遇水而入，则是出阴入阳，穿透经络到达营分，以破除暑结之邪，这为使药。
【白虎汤加桂方】治瘅疟。若脉虚弱不宜使用。
石膏（一斤）、知母（六两）、甘草（二两）、桂枝（去皮三两）、糯米（二合）。每服五钱。
【蜀漆散】治牝疟。见《金匮要略》。
蜀漆（烧去腥味）、云母（烧三夜）、龙骨（各等分）。上为散。未发作前，用浆水送服半钱匕。如果是温疟，加蜀漆一钱，临发作时服一钱匕。
【牡蛎汤】治牡疟。
牡蛎（四两熬）、麻黄（去节）、蜀漆（各三两）、甘草（二两）。水八升，先煮蜀漆、麻黄去沫，得六升，内诸药，煮取二升，温服一升。如果吐了就不要继续服用。
A question was asked: The *Classic of Internal Medicine* (*Huangdi Neijing*) states, "Summer injury by heat (Shu) leads to malaria in autumn." Although predecessors have discussed this extensively, the core principle has not been fully elucidated. Please explain clearly.
The answer is: Malaria does not manifest in summer but in autumn. This follows the principle that "excess causes harm, and control brings balance" as well as the concept of "the child coming to rescue the mother." When the heat of summer prevails, the Ministerial Fire (Jun Huo) is in charge, and Lung Metal is inevitably injured and constrained. Below the position of fire, Water Qi ascends to constrain it. Kidney Water is the child of Lung Metal. Because the mother (Lung) is injured by Fire, the child (Kidney) comes to constrain the Fire and save the mother. Thus, Water and Fire battle, and Yin and Yang contend. A great victory leads to a great recovery; a small victory leads to a small recovery. This is the normal law of Yin-Yang victory and recovery, which is the origin of malaria. However, some people get sick while others do not. This is because where pathogenic factors gather, Qi must be deficient. Therefore, those whose Yuan Qi (Original Qi) is not solid allow Summer-heat pathogens to take advantage. Hence, treating malaria should primarily focus on supporting Yuan Qi.
Manifestation after the Summer Solstice but before the End of Heat (Chushu) indicates disease in the Three Yang meridians; the injury is shallow, so onset is near and sudden. Manifestation after the End of Heat but before the Winter Solstice indicates disease in the Three Yin meridians; the injury is severe, so onset is distant and deep.
Manifestation between midnight (Zi hour) and noon (Wu hour) indicates disease in the Yang aspect; the illness is easy to cure. Manifestation after noon indicates disease in the Yin aspect; the illness is difficult to cure.
Another question: Why does some malaria occur daily, some every other day, and some every three days?
The answer is: Pathogens in the Yang aspect cause early onset; those in the Yin aspect cause late onset. Shallow pathogens cause daily attacks; deep pathogens cause alternate-day attacks. The Ying (Nutritive) and Wei (Defensive) Qi circulate once daily through the boundaries of the Five Zang organs, Six Fu organs, and Twelve Meridians. Each boundary has a specific station. The stations of Ying and Wei are like rest stops for travelers. When pathogens lodge in these stations and meet the daily circulating Wei Qi, the disease manifests; when they separate, the disease recedes. Thus, the daily circulation results in regular intervals of cessation and manifestation. In alternate-day attacks, the station of Qi is deep, pressing internally into the Yin. Yang Qi alone flares up, while Yin Qi adheres internally. Yin and Yang contend but cannot exit, hence the alternate-day manifestation. Every-three-day attacks indicate pathogens entering the Three Yin meridians. Attacks occurring on Zi, Wu, Mao, You days belong to Shaoyin (Lesser Yin); those on Yin, Shen, Si, Hai days belong to Jueyin (Terminal Yin); those on Chen, Xu, Chou, Wei days belong to Taiyin (Greater Yin).
Generally, treating malaria requires first asking about the proportion of chills and fever, combined with pulse and symptom analysis. There are cases with more chills than fever, and more fever than chills. Broadly speaking, alternating chills and fever belong to Shaoyang (Lesser Yang) meridian patterns. The treatment method should prioritize Xiaochaihu Tang (Minor Bupleurum Decoction). If chills predominate, add Guizhi (Cinnamon Twig) to Xiaochaihu Tang. Cases with only fever and no chills are named Dan Nue (Malaria with High Fever). Cases with only chills and no fever are named Pin Nue (Malaria with Predominant Chills). The *Jingui Yaolue* states: "When Yin Qi is isolated and extinct, and Yang Qi flares up alone, there is fever, shortness of breath, and a sense of grievance or oppression, with hot hands and feet and nausea; this is called Dan Nue." Pathogens hide internally in the Heart and Lungs and lodge externally in the muscle spaces, causing emaciation. It also states: "In Wen Nue (Warm Malaria), the pulse is normal, the body has no chills but only fever, joint pain and irritability, and frequent vomiting; treat with Baihu Jia Guizhi Tang (White Tiger Plus Cinnamon Twig Decoction)." Cases with only chills are named Mu Nue (Malaria with Predominant Cold), treated with Shuqi San (Shuqi Powder). These are fixed methods based on the ratio of chills and fever. However, one must not be rigid; one must observe whether the pulse is Deficient or Excess. If there are only chills, the pulse may be洪 (Surging) or 滑 (Slippery), indicating treatment as an Excess Heat pattern. If there are only fevers, the pulse may be Empty or Weak, indicating treatment as a Deficiency Cold pattern. Zhang Zhongjing said: "The pulse of malaria is naturally Wiry (Xian). Wiry and Rapid pulses indicate much heat; Wiry and Slow pulses indicate much cold. Wiry, Small, and Tight pulses can be treated with purgatives; Wiry and Slow pulses with warming methods; Wiry and Tight pulses with sweating techniques and acupuncture/moxibustion." Wiry and Rapid pulses are caused by Wind-Phlegm and can be resolved through dietary management.
During the time just before malaria begins and during its active phase, one must strictly avoid treatment, as intervention will be ineffective. One must wait until the extreme excess of Yin and Yang subsides, and the pathogen leaves its lodging place, before treating. Ideally, treatment should begin two to three hours before onset to intercept the pathogenic force.
Throughout history, treatments for malaria have varied according to Wind-Cold, Summer-heat, and Dampness, employing sweating, vomiting, or purging methods, numbering in the thousands. However, it is understood that "no phlegm, no malaria; no food stagnation, no malaria," grasping the etiology. "For those without sweat, induce sweat" to disperse pathogens; "for those with sweat, stop sweat" to support Zheng Qi (Upright Qi). Qingpi Yin (Green Peel Drink) is used for typical autumn malaria, modified according to symptoms, proving effective repeatedly. For stomachal latent phlegm stagnation, Caoguo Yin (Tsaiko Fruit Drink) cures it in one dose.
If previous formulas fail, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with doubled Chaihu (Bupleurum), plus Banxia (Pinellia) and Shengjiang (Fresh Ginger), to nourish Zheng Qi so pathogens self-resolve. Mr. Xue Lizhai stated: "For chronic malaria unresponsive to various drugs, use Buzhong Yiqi Tang plus Banxia, with Ren Shen (Ginseng) 1 liang and Wei Jiang (Roasted Ginger) 5 qian. This is 'interception without direct interception.' It cures in one dose."
Ren Zhai stated: "For someone with long-term visceral deficiency and loose stools who suddenly contracts malaria with severe vomiting, use Erchen Tang plus Ren Shen and Ba Dou Kou (Cardamom). After one or two doses, the patient feels immediate relief of Qi and pulse, and chills/fever cease. This is because Cardamom circulates through the Triple Burner, turning Yuan Qi and Ying/Wei Qi, thus calming chills and fever. Henceforth, for vomiting with malaria or constitutionally weak patients, avoid drugs like Changshan (Polygala root). The above discusses methods for typical autumn malaria. Many conditions resemble malaria but are not. People often see alternating chills and fever and immediately apply Jiemie Dan (Malaria Interception Pill). If one application fails, they repeat it. This leads to exhaustion and sometimes death. This must be distinguished.
The *Classic* says: "Yang deficiency causes aversion to cold; Yin deficiency causes aversion to heat. When Yin Qi enters Yang, there is aversion to cold; when Yang Qi sinks into Yin, there is aversion to heat." Conditions such as post-typhoid, post-major illness, postpartum, and consumptive diseases all present with alternating chills and fever, resembling malaria but not being true malaria, sometimes occurring twice or thrice daily. These should be treated as Deficiency patterns, distinguishing between Yang and Yin deficiency. Yang deficiency requires tonifying Yang, e.g., Lizhong Tang (Regulate the Middle Decoction), Liujunzi Tang (Six Gentlemen Decoction), or Buzhong Yiqi Tang plus Ganjiang (Dried Ginger) and Rougui (Cinnamon Bark), even adding Fuzi (Aconite Root) if severe. These formulas must include Shengma (Cimicifuga) and Chaihu to raise Yang from within Yin, allowing Water to ascend and Fire to descend for cure. Medical texts discuss this. For Yin deficiency, chills and fever resemble typical malaria, but Yin malaria distinguishes between True Yin and True Yang deficiency, a concept unknown to many.
The *Classic* states: "Manifesting by day and hiding by night, occurring at fixed times, indicates lack of Water (Kidney Yin). Manifesting by day and hiding by night, appearing suddenly and intermittently, indicates lack of Fire (Kidney Yang)." Lack of Water requires strengthening the master of Water to suppress excessive Yang, treated with Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill). Lack of Fire requires benefiting the source of Fire to dissipate Yin shadows, treated with Bawei Dihuang Wan (Eight-Ingredient Rehmannia Pill). Those suffering from chronic malaria that does not resolve do so not because malaria is incurable, but due to improper treatment. Zhu Danxi said: "Nighttime onset means pathogens entered the Yin aspect; use Blood-invigorating drugs to draw them out to the Yang aspect," prescribing Dang Gui (Angelica Sinensis), Chuanxiong (Sichuan Lovage Rhizome), Honghua (Safflower), Sheng Di Huang (Rehmannia Root), and Huang Bo (Phellodendron Bark). This misses the profound truth of True Yin and True Yang. I have tested this personally with miraculous results and thus highlight it. I have seen malaria patients with red faces and thirst, treating them as Kidney True Yin deficiency, always with immediate effect. For patients with chills like ice and fever like branding irons, with a face red as grease and thirst for water, use Liuwei Dihuang Wan plus Chaihu, Shaoyao (Peony Root), Rougui, and Wuweizi (Schisandra Berry) in large doses; one dose cures.
For severe thirst requiring continuous drinking (5-6 pots per episode), I used one portion of Liuwei Wan with 1 liang of Rougui, boiled in 10 bowls of water across four clay pots to yield 5-6 bowls. Cooled and drunk as tea, the patient fell into a deep sleep, thirst stopped, and fever resolved.
For those with chills and fever indistinguishable from malaria, red face, mild thirst, profuse sputum, upper body burning hot, and cold knees/lower legs, this is True Yang floating upward due to extreme Kidney deficiency. Urgently treat with Fuzi Bawei Dihuang Tang (Aconite Eight-Ingredient Rehmannia Decoction) served cold in large doses to reduce fever, followed by Renshen Jianzhong Tang (Ginseng Regulate the Middle Decoction) for regulation.
[Modified Dihuang Formula] Method for simultaneous treatment of Kidney and Liver.
Shu Di Huang (Prepared Rehmannia Root) 4 qian, Shan Yao (Chinese Yam) 2 qian, Shan Zhu Yu (Cornus Fruit) 2 qian, Dan Pi (Moutan Bark) 1.5 qian, Fu Ling (Poria) 1.5 qian, Ze Xie (Alisma Rhizome) 1 qian, Wu Wei Zi (Schisandra Berry) 1 qian, Chaihu (Bupleurum Root) 1 qian, Shaoyao (Peony Root) 1 qian, Rougui (Cinnamon Bark) 1 qian. Boil 3 zhong of water to 1 zhong and take.
[Bawei Dihuang Formula] Same dosage as Liuwei Dihuang Wan, plus Fuzi (Aconite Root) 1 qian and Rougui (Cinnamon Bark) 1 qian.
[Buzhong Yiqi Tang Plus Banxia Formula]
Ren Shen (Ginseng), Huang Qi (Astragalus Root), Gan Cao (Licorice Root), Dang Gui (Angelica Sinensis), Bai Zhu (Atractylodes Macrocephala Rhizome), Chaihu (Bupleurum Root), Sheng Ma (Cimicifuga Rhizome), Chen Pi (Citrus Reticulata Peel), Banxia (Pinellia Tuber), plus Wei Jiang (Roasted Ginger).
[Liuwei Wan Formula]
Shu Di Huang 8 liang, Shan Yao 4 liang, Shan Yu Rou (Cornus Fruit) 4 liang, Dan Pi 3 liang, Fu Ling 3 liang, Ze Xie 3 liang, plus Rougui 1 liang.
[Jianzhong Tang Formula]
Ren Shen 1 qian, Shaoyao 2 qian, Gan Cao 1 qian, Rougui 0.7 qian, Da Zao (Jujube), Yi Tang (Maltose).
There is another category of Stagnation patterns resembling malaria. Chills and fever are identical to typical malaria, but the patient has a bitter taste, vomits clear or bitter fluid, has a blue-green complexion, hypochondriac pain, tinnitus, and a choppy pulse. Use Xiaoyao San (Free and Easy Wanderer Powder) plus Huang Lian (Coptis Rhizome) and Bei Mu (Fritillaria Bulb), with doubled Chaihu, as a single dose. Follow with Liuwei Dihuang Wan plus Chaihu and Shaoyao for regulation and peace.
For Three Yin malaria, only Taiyin malaria uses Lizhong Tang, which must include Rougui. For Shaoyin and Jueyin malaria, only Bawei Dihuang Wan is effective.
[Xiaoyao San] Treats Stagnation Malaria.
Chaihu 1 qian, Shaoyao 1 qian, Chen Pi 1 qian, Mu Dan Pi 1 qian, Fu Shen (Poria with Wood) 1 qian, Dang Gui 1 qian, Bai Zhu 1 qian, Bei Mu 1 qian, Bo He (Mint) 0.7 qian, Huang Lian 0.5 qian (stir-fried with 2 qian Evodia Fruit soaked in water until charred, then combined).
[Qingpi Yin]
Qing Pi (Green Tangerine Peel), Hou Po (Magnolia Bark), Bai Zhu, Chaihu, Cao Guo Ren (Tsaiko Fruit Seed), Fu Ling, Huang Qin (Scutellaria Root), Banxia, Gan Cao. This formula prioritizes Chaihu. Generally, alternating chills and fever belong to Shaoyang patterns, so Chaihu is the Sovereign herb. Cao Guo and Hou Po transform food stagnation; Qing Pi and Banxia dispel phlegm. For more chills, add Rougui; for more fever, add Huang Lian.
[Caoguo Yin] Treats latent phlegm/fluid in Spleen/Stomach. Suitable for strong Yuan Qi; avoid in deficiency.
Cao Guo, Changshan (Polygala Root), Zhi Mu (Anemarrhena Rhizome), Wu Mei (Mume Fruit), Bing Lang (Areca Seed), Gan Cao, Chuan Shan Jia (Pangolin Scales).
Zhao Yi-de stated: Zhi Mu is cold and enters the Foot Yangming channel, treating excessive Yangming fire, returning it to Taiyin. Cao Guo is warm and treats excessive Taiyin cold, keeping it in Yangming. Harmonizing these two channels prevents Yin-Yang disorder; thus, they are Sovereign herbs. Changshan induces vomiting of chest phlegm knots; it is the Minister herb. Gan Cao harmonizes herbs; Wu Mei removes phlegm; Bing Lang removes phlegm癖 (accumulation) and breaks stagnant Qi; they are Assistant herbs. Chuan Shan Jia, dwelling in mountains and entering water, moves from Yin to Yang, penetrating meridians to the Ying level to break Summer-heat knot pathogens; it is the Envoy herb.
[Baihu Tang Plus Guizhi Formula] Treats Dan Nue. Contraindicated if pulse is weak.
Shi Gao (Gypsum) 1 jin, Zhi Mu 6 liang, Gan Cao 2 liang, Guizhi (Cinnamon Twig, peeled) 3 liang, Mi (Rice) 2 he. Take 5 qian per dose.
[Shuqi San] Treats Pin Nue. See *Jingui Yaolue*.
Shuqi (Burned to remove fishy smell), Yun Mu (Cloud Mother/Mica), Long Gu (Dragon Bone/Fossilized Bones) in equal parts. Powder form. Take half a qian bi with Jiang Shui (Fermented Rice Water) before onset. For Wen Nue, add 1 qian Shuqi; take 1 qian bi at onset.
[Muli Tang] Treats Mu Nue.
Mu Li (Oyster Shell, calcined) 4 liang, Ma Huang (Ephedra Stem, nodes removed), Shuqi (each 3 liang), Gan Cao 2 liang. Boil 8 sheng of water. First boil Shuqi and Ma Huang, skim foam, reduce to 6 sheng. Add remaining herbs, boil to 2 sheng. Take 1 sheng warm. If vomiting occurs, do not continue.
[Lizhong Tang] Specifically treats Taiyin malaria. Must add 1 qian Rougui for efficacy.
Ren Shen 2 qian, Bai Zhu 2 qian, Gan Jiang (Dried Ginger) 1.5 qian, Zhi Gan Cao (Honey-fried Licorice) 1 qian.