经义
夏伤于暑，秋为 疟。○夏暑汗不出者，秋成风疟。（《素问》）
哲言
牡疟，但寒不热，无汗寒栗，头痛，病属太阳。瘅疟，但热不寒，烦热自汗，病属阳明。风疟，先热后
寒，恶风自汗，头痛，病属少阳。湿疟，先寒后热，身重呕逆，病属太阳。 疟，寒热间日一作，或三日一作，
缠绵不已，病属少阴、厥阴。（《医阶辨证》）
身后为太阳，太阳者，膀胱寒水也。身前为阳明，阳明者，大肠燥金也。少阳之邪在其中，近后膀胱寒
水则恶寒，近前阳明燥金则发热，故为寒热往来也。（李东垣）
疟病之寒战，乃内热将作，火冲其气，故凛凛而寒，非真冷也，不得以热药治之。（《己任编》）
疟发必有寒有热，有寒热之往来，适在少阳所主之界。偏阴则多寒，偏阳则多热，即其纯热无寒，而为
瘅疟、温疟；纯寒无热，而为牡疟。要皆自少阳而造其极偏，补偏救弊，亦必返还少阳之界，阴阳两协于和而
后愈也。疟邪如傀儡，少阳则提傀儡之线索，操纵进退，一惟少阳主张。（喻嘉言）
凡疟因于暑，人皆知之，不知夏令炎热，此自正气之宜，而人有畏热者，每多避暑贪凉，此因暑受寒，所
以致疟。《经》曰∶夏暑汗不出者，秋成风疟。义可知也。然又惟禀质薄弱，或劳倦过伤者，尤易感邪，此所
以受邪有浅深，而为病有轻重。第以病
因暑致，故曰受暑，而不知暑有阴阳，疟惟阴暑为病耳。至其病变，则有为寒证者，有为热证者，有宜散者，
有宜敛者，有宜温者，有宜清者，其要在标本虚实，因证制宜斯尽善矣。其有云伤暑，而认暑为火者；有云脾
寒，而执以为寒者，皆偏见也。○凡疟发在夏至后秋分前者，病在阳分，其病浅。发在秋分后冬至前者，病在阴
分，其病深。发在子后午前者，此阳分病也，易愈。发在午后子前者，此阴分病也，难愈。○凡疟自阴渐阳，自
迟渐早者，由重而轻也。自阳渐阴，自早渐迟者，由轻而重也。凡感邪深者，其发必迟，必使渐早渐近，方是
佳兆。故治此疾者，春夏为易，秋冬为难。（《景岳全书》）
疟有一日一发者，有间日一发者。昔人谓一日者轻，间日者重，以为卫气不胜邪，非积二日，不能逐出风
府也。然有间日一发而轻者，则邪微病微，必积二日，方能与卫气交争，迸出风府，不得以重论。○疟邪与瘟疫
相似，但疫重而疟轻耳。（《医参》）
谚云∶少不可弱，老不可疟。盖少年欲火正旺，阴水愈亏，老年气血衰微，不能任其寒热凌虐之状耳。（《见闻录》）
或问有疟发时而脉歇至，人事昏谵，疟退则神清而脉不歇至者，何也？答曰∶疟发之时，邪气阻滞，则正
气不能周流，故脉歇至。疟止邪散，正气复，则脉舒，故如常。疟发昏谵者，由热甚乱其神明故耳。（方星岩）
补编
疟疾有风、寒、暑、湿不同，治疗有汗、吐、下各异，方术百千，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，扶正为主，深得治疟之法。（《赵氏医贯》）
疟病一门，《巢氏病原》妄分五脏。后人谓其发明《内经》，深信不疑，而不知疟邪不从脏发。《内经》
所无之理，巢氏臆言之耳。陈无择三因之说韪矣。乃谓夏伤于暑，秋为 疟者，不可
专以此论，何其甘悖圣言耶？至论内因，抄袭巢氏心、肝、脾、肺、肾五疟立言，仍是巴人下里之音矣。张子
和治疟，喜用汗、吐、下三法，自夸本于长沙。讵知仲景所谓汗下者，但从少阳之和法而进退其间，不从伤寒
之汗下起见也。其可吐者，或用瓜蒂，或用常山苗，各有深义，亦岂漫然而吐之耶？且子和谓治平之时，其民
夷静，虽用砒石毒药，以热治热，亦能取效，是何言欤？至东垣、丹溪，确遵《内经》夏伤于暑，秋必 疟之
论，多所发明。而谓吴楚闽广之人，患疟甚多，阳气素盛之处，其地卑湿，长夏之时，人多患 疟霍乱泻痢，
伤湿热也，此语诚为聪明绝世矣。然于《内经》之旨，尚隔一层。《内经》运气，暑与湿同推，不分彼此，曾
何分南北乎？且丹溪所论十二经，皆能为病，固即《刺疟篇》之旨，曷不遵《金匮》推足少阳一经为主，坐令
多歧亡羊耶。方书俱以温疟为伤寒坏病，与风疟大同，此言出于何典？至于牡疟，总无其名，统括于寒疟之内，
误指寒疟为脏寒之极，故无热有寒，用姜、桂、附子温之。又有更其名为牝疟者，云久受寒湿，阴盛阳虚，不
能制阴，所以寒多不热，凄怆振振，亦行温热之法，直是杀人不转睫矣。又谓暑疟即瘅疟，呕者用缩脾等药，
从无有救少阳木火之邪如救焚者，适燕而南其指，抑何生民之不幸耶？○弦数者风发也，以饮食消息止之。仲景
既云弦数者多热矣，复申一义云，弦数者风发，见多热不已，必至于极热，热极则生风，风生则肝木侮土，而
传其热于胃，坐耗津液，阳愈偏而不返。此未可徒求之于药也，须以饮食消息而止其炽热，即梨汁、蔗浆生津止
渴之属，正《内经》风淫于内，治以甘寒之旨也。（喻嘉言）
凡治疟当知标本，有标则治标，无标则治本，此最为治疟之肯綮。盖标以邪气言，本以正气言，夫邪正相
争，所以病疟。凡疟之初起，本由邪盛，此当治邪，固无疑也。若或表散已过，久而不愈，则于邪正之间，有
不可不辨矣。盖有邪者，证必猖炽，
脉必弦紧，或头痛未除，或汗出未透。凡属形证有余者，即其病虽已久，亦必有邪未清，但觉有邪，犹宜兼标
为治。若汗出已多，邪解已透，别无实证实脉可据，而犹不愈者，必由正气全虚，或以质弱，或以年衰，此当
专治其本，但使元气恢复，则无不愈。设或不明标本，无论有邪、无邪，而但知攻疟，则害多矣！○治疟之法，
若其久而汗多，腠理开泄，阳不能固者，必补敛之。无汗则腠理致密，邪不能解，必发散之。故曰∶有汗要无
汗，扶正为主。无汗要有汗，散邪为主，此大法也。盖疟本外邪，非汗不解，若不知善解其邪，而妄用劫剂，
多致胃气受伤，宜以补剂为主，加减取汗。若邪在阴分，则下体最难得汗，补药力到，自然汗出至足，方是佳
兆。○凡寒邪之自外入者，得汗即解，如伤寒之类是也。而惟瘟疟之候，则病有深浅不同，如病瘟者，虽有大
汗，而热仍不退。病疟者，屡发屡汗，而疟犹不止。此其所感者深，故不能以一、二汗而即愈，或通身如洗而
邪犹不能透。若此者，但当察其强弱，仍渐次再汗之，方得邪解。故不可谓汗后必无邪也，此但当以脉之紧与
不紧，头身之痛与不痛，寒热之甚与不甚为辨耳。○古称治疟，凡将发之时，与正发之际，慎勿施治，必待阴阳
并极，势平之后，然后治之；或于未发之先，迎而夺之。此说殊似不然，予近治疟，每迎其锐而击之，最捷最
效。是可见古法之有不必泥者。（《景岳全书》）
疟由伏邪而成，当辨其六气中所伤何气，六经中病涉何经，若小柴胡专主少阳，岂能兼括哉？此证春冬间
有，惟夏秋暑湿为患者居多。暑必挟湿，专伤气分，须分别其上焦中焦暑湿二气，何者为重？若暑热重者，专
究上焦肺脏清气，疟发必热重寒微，唇舌绛赤，烦渴喜饮，其脉色自有阳胜之候，当宗桂枝白虎，及天水散加
辛凉之品为治。若湿邪重者，当议中焦脾胃阳气，疟发虽热势蒸燔，然舌必有腻苔，渴喜暖汤，胸脘痞胀，呕
恶，其脉色自有阳气不舒之状，当宗正气散及二陈汤去甘草加杏、蔻、生
姜之类主之。必要阳盛于阴，而后配和阳之剂，方无贻累。倘证象两兼，则两法兼之可也。大凡是证，若邪轻
正不甚虚者，寒热相等，而作止有时。若邪重正怯者，寒热模糊，来势必混而不分。邪浅则一日一发，稍深则
间日一发，最深则三日一发，古称为三阴大疟，以肝脾肾三脏之见证为要领。其补泻寒温，亦不离仲景治三阴
之法为根蒂，可知阳经轻浅之方，治之无益也。所云移早则邪达于阳，移晏则邪陷于阴，阴阳胜复，于此可参。
若久而不已，必有他虞。太阴之虚浮胀满，有通补之理中汤，开腑之五苓散。少阴之痿弱成劳，有滋阴之复脉
汤，温养之升奇法。厥阴之厥逆吐蛔，及邪结为疟母，有乌梅丸与鳖甲煎法。又如心经疟久，必动其营，则为
烦渴见红，肺经疟久，必伤其津，则为胃秘肠痹，一则滋阴为主，一则清降为宜。或暑湿格拒三焦，而呕逆不
纳者，宗半夏泻心法。秽浊蒙蔽膻中，而清灵昧甚者，用牛黄清心丸。心阳暴脱，有龙、蛎之救逆。胃虚呕呃，
有旋复、代赭之成方。至于表散和解，通阳补气，滋阴化营，搜邪入络，动药劫截，辛酸两和，营卫并补，及
阳疟之后养胃阴，阴疟之后理脾阳等法，已全备矣。○治疟用乌梅，以酸泄木安土之意。用常山、草果，乃
劫其太阴之寒，使二邪不相并也。用人参、生姜曰露姜饮，一以固元，一以散邪，取通神明去秽恶之气。疟邪
既久，深入血分，或结疟母，宜鳖甲煎丸煎方活血通络。（《临证指南》）
少阳证知可解者，寒热日不移时而作，邪未退也。若用柴胡而移其时，早移于晏，晏移于早，气移于血，
血移于气，是邪无可容之地，知可解也。（王好古）
疟者，阴阳交争，寒热互作，用药须半生、半熟，半冷、半热，乃收十全之功。（《得效方》）
治疟药煎好，须露一宿服。盖疟者暑气为病，暑得露即解。（缪仲淳）
疟病须待热退身凉，方可饮食，切勿带热饮食，恐停积不消，
而成痞成鼓者有之。（《万病回春》）
凡治疟不求邪之所在，辄行大汗、大下，伤人正气者，医之罪也。○凡用截疟之法，不俟疟势稍衰，辄求
速止者，医之罪也。○凡用吐法，妄施恶劣之药，并各种丸药，伤人脏腑者，医之罪也。（《医门法律》）
瘅疟
师曰∶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。若但热不寒者，邪气内藏于心，
外舍分肉之间，令人销铄肌肉。（《金匮》）
瘅疟一证，在《内经》曰∶肺素有热，气盛于身，发则阳气盛，阳气盛而不衰，故致销铄肌肉者，命曰瘅
疟，自与诸疟不同。治法有三∶如热邪内蓄而表邪未解者，则当散以辛凉；如热因邪致，表虽解而火独盛者，
则当清以苦寒，此皆治其有余也。若邪火虽盛，而气血已衰，真阴自耗者，急宜壮水固元，若但知泻火，则阴
日亡，必致不救。（《景岳全书》）
温疟
温疟者，其脉如平，身无寒，但热，骨节疼烦，时呕，白虎加桂枝汤主之。（《金匮》）
《内经》所称先热后寒之温疟有二∶一者先伤于风，后伤于寒，风为阳邪，寒为阴邪，先阳后阴，故先热
后寒。此以风寒两伤营卫之法治之，初无难也。其一为冬感风寒，深藏骨髓，内舍于肾，至春夏时令大热而始
发。其发也，疟邪从肾出之于外而大热，俟其疟势外衰，复返于肾，而阴精与之相持，乃始为寒。设不知壮水
之主，急救其阴，十数发而阴精尽矣，阴精尽则真火自焚，洒洒时惊，目乱无精，顷之死矣。所以伤寒偏死下
虚人，谓邪入少阴，无阴精以御之也。而温疟之惨，岂有异哉！（喻嘉言）
温疟有三，总属阳盛，而浅深之邪不同。仲景所言于《金匮》者，温疟之一也。《素问》又有温疟二证，
证不同而因亦异。仲
景所言者二证，但热不寒之疟也，一曰瘅疟，一曰温疟。《内经》所言者二证，先热后寒之疟也，俱曰温疟，
此以寒热之有无、先后为分晰者也。仲景所名瘅疟，但热不寒之热，热根生于心，而热气舍于分肉；至于温疟
之但热不寒之热，则不渴，阳郁于表之热，故脉如平，此二证，其热大分浅深也。《内经》所言之第一种温疟，
其先热后寒之热，亦如仲景所言之温疟，不过阳郁于表之热，特寒热之次序，稍变于常疟耳，其发亦以时变，而
仍不失其常，亦热之浅者也。至《内经》所言第二种之温疟，则又似同于仲景所言之瘅疟矣。然先热后寒，与
瘅疟之但热不寒又不同。盖寒热之见于外不同，而积热生于里有同耳，何以谓之同于瘅疟？以仲景所言瘅疟有
夙热，而《内经》所言温疟，亦有夙热者也。仲景所言夙热藏于心脏，《内经》所言夙热藏于肾脏也。疟病原
非脏邪，以热在脏为疟之根，如疟母在肝脏，为疟之母，俱系于脏，而以脏言。而疟则究非脏病，故热藏于心，
即根于心；热藏于肾，即根于肾，此俱热之深者也。○《内经》言温疟有二，喻氏引以发明《金匮》之未备，但
未言方出治。予总以白虎汤主之，治心火于少阴，与治肾火于少阴，亦相去不远也。气虚加人参，津亡加生地，
血虚加归、芍，热甚在心加黄连，在肾加黄柏，俱不出阳盛救阴之法也。（魏荔彤）
牝疟
疟多寒者，名曰牝疟。蜀漆散主之。（《金匮》）
疟多寒者，寒多于热，如三七、二八之分，非纯寒无热也。若纯寒无热，则为阴证，而非疟证矣。（喻嘉言）
【经文释义】
夏季感受暑邪，到了秋季就会发生疟疾。○夏季暑热之时如果汗液排不出来，到了秋天就会形成风疟。（出自《素问》）
【哲人言论】
牡疟，表现为只有寒战而没有发热，无汗且寒冷颤抖，伴有头痛，病位属于太阳经。瘅疟，表现为只有发热而没有恶寒，心烦身热且自汗出，病位属于阳明经。风疟，先出现发热随后恶寒，怕风且自汗出，伴有头痛，病位属于少阳经。湿疟，先出现恶寒随后发热，身体沉重并伴有呕吐逆气，病位属于太阳经。三日疟（此处原文可能有误，通常指间日疟或三日疟，依文意译为间歇性发作的疟疾），寒热交替每隔一天发作一次，或者三天发作一次，缠绵难愈，病位属于少阴经和厥阴经。（出自《医阶辨证》）
人体的背部属太阳经，太阳经对应膀胱，其气为寒水。人体的胸腹部属阳明经，阳明经对应大肠，其气为燥金。少阳的邪气居于其中，靠近背部的膀胱寒水则感到恶寒，靠近胸腹的阳明燥金则感到发热，所以表现为寒热往来。（出自李东垣）
疟病发作时的寒战，是因为体内的热势将要发作，火热之气冲逆，所以使人凛冽寒冷，这并不是真正的体寒，因此不能用热药来治疗。（出自《己任编》）
疟疾发作必然既有寒又有热，且有寒热往来的特点，这正好处于少阳经所主司的范围。偏向阴分则寒多，偏向阳分则热多，即使是纯热无寒的瘅疟、温疟，或是纯寒无热的牡疟，都是病情从少阳发展至极端的偏颇状态。要纠正这种偏颇，必须使其回归到少阳的平衡界限，阴阳协调和谐后才能痊愈。疟邪就像傀儡戏中的木偶，少阳经则是提线木偶的线索，控制着进退，完全由少阳经的主宰来决定。（出自喻嘉言）
凡是疟疾因暑邪引起，人们都知道，但不知道夏令炎热本是正气适宜的状态，而有人怕热，常常避暑贪凉，这是因暑受寒，从而导致疟疾。《内经》说：夏季暑热之时如果汗液排不出来，到了秋天就会形成风疟。其中的道理可以由此推知。然而，只有那些体质薄弱，或者过度劳累损伤正气的人，更容易感受邪气，这就是为什么感受邪气有深浅不同，导致疾病有轻重的区别。虽然因为病因是暑邪所致，所以说“受暑”，但不知道暑邪有阴阳之分，疟疾唯独由阴暑致病罢了。至于病变的表现，有的表现为寒证，有的表现为热证，有的宜用发散法，有的宜用收敛法，有的宜用温法，有的宜用清法，关键在于辨别标本虚实，根据证候制定适宜的治疗方案才算完美。那些将伤暑认作火邪的；那些将脾寒固执地当作寒邪治疗的，都是偏见。○凡是疟疾在夏至后、秋分前发作的，病在阳分，病情较浅。在秋分后、冬至前发作的，病在阴分，病情较深。在半夜子时之后、中午午时之前发作的，这是阳分的病，容易治愈。在午后到半夜子时之前发作的，这是阴分的病，难以治愈。○凡是疟疾从阴分逐渐转向阳分，从间隔时间长逐渐变为间隔时间短（发作时间提前）的，是由重转轻的好现象。从阳分逐渐转向阴分，从发作时间提前逐渐变为延后的，是由轻转重的坏现象。凡是感受邪气深的，发作时间一定晚，必须使发作时间逐渐提前、接近正常，才是佳兆。所以治疗这种疾病，春夏季容易，秋冬季难。（出自《景岳全书》）
疟疾有一日发作一次的，也有隔日发作一次的。古人认为一日发作者病情轻，隔日发作者病情重，认为是卫气不能战胜邪气，必须积累两天，才能将邪气驱逐出风府穴。但是也有隔日发作一次而病情较轻的，这是因为邪气微弱、病情轻微，必须积累两天，才能与卫气交争，迸出风府穴，不能据此认定为重病。○疟邪与瘟疫相似，只是瘟疫重而疟疾轻罢了。（出自《医参》）
谚语说：年轻人不可虚弱，老年人不可患疟疾。大概是因为少年时期欲火正旺，阴液日益亏损；老年时期气血衰微，不能承受寒热交替凌虐的身体状况。（出自《见闻录》）
有人问：疟疾发作时脉搏间歇停跳，人事昏迷谵语，疟疾停止后神志清醒且脉搏不再间歇停跳，这是什么原因？回答说：疟疾发作的时候，邪气阻滞，导致正气不能周流全身，所以脉搏出现间歇停跳。疟疾停止后邪气消散，正气恢复，脉搏舒展，所以像平常一样。疟疾发作时昏迷谵语，是因为热势太甚扰乱了神明。（出自方星岩）
【补编】
疟疾有风、寒、暑、湿的不同，治疗方法有汗、吐、下法的差异，方术成千上万，无法全部叙述。唯独“无痰不成疟，无食不成疟”这句话，深得导致疟疾的原因。对于无汗的疟疾要有汗，以散邪为主；对于有汗的疟疾要止汗，以扶正为主，深得治疗疟疾的方法。（出自《赵氏医贯》）
关于疟病这一门类，《巢氏病源》胡乱将其分为五脏疟。后人认为它阐发了《内经》的道理，深信不疑，却不知道疟邪并非从脏腑发出。这是《内经》中没有的道理，是巢氏的主观臆断。陈无择的三因学说是对的。但他认为“夏伤于暑，秋为疟”不可以专门以此论断，这岂不是甘心违背圣人的言论吗？至于论述内因，抄袭巢氏的心、肝、脾、肺、肾五疟立论，仍然是粗俗不堪的言论。张子和治疗疟疾，喜欢用汗、吐、下三法，自夸本于张仲景。哪里知道仲景所说的汗法和下法，只是从少阳经的和法而在其间进退，并不是从伤寒病的汗下法来看待的。那些可以用吐法的，或者用瓜蒂，或者用常山苗，各有深意，难道是随意吐之吗？而且张子和说在太平盛世，百姓安宁，即使使用砒石毒药，以热治热，也能取效，这是什么话呢？至于李东垣、朱丹溪，确实遵循《内经》“夏伤于暑，秋必疟”的论点，多有发明。并且认为吴楚闽广地区的人，患疟疾很多，这些地方阳气素盛，地势低洼潮湿，长夏时节，人多患疟疾、霍乱、泻痢，这是伤了湿热，这话确实聪明绝世。然而对于《内经》的宗旨，还隔了一层。《内经》运气学说中，暑与湿是一同推演的，不分彼此，何曾区分南北呢？而且丹溪论述十二经都能致病，固然是《刺疟篇》的宗旨，为什么不遵循《金匮要略》推崇足少阳一经为主，反而让多种歧路导致迷失方向呢？方书都将温疟视为伤寒的坏病，与风疟大同小异，这话出于什么典籍？至于牡疟，根本没有这个名字，统括在寒疟之内，错误地将寒疟指为脏寒之极，所以无热有寒，用干姜、肉桂、附子温补。又有改名为牝疟的，说是久受寒湿，阴盛阳虚，不能制阴，所以寒多不热，凄怆振颤，也施行温热之法，简直是眨眼间就杀人了。又有人说暑疟就是瘅疟，呕吐的用缩脾饮等药，从来没有像救火一样去救治少阳木火之邪的，真是南辕北辙，是何等的百姓不幸啊！○脉弦数的是风热发作，通过饮食调理来制止它。仲景既然说弦数的脉象多热，又申述一个意思说，弦数是风热发作，见多热不已，必定发展到极热，热极则生风，风生则肝木克制脾土，并将热传给胃，坐视津液消耗，阳气更加偏亢而不返回。这不可以单纯求之于药物，必须通过饮食调理来制止炽热，比如梨汁、蔗浆生津止渴之类，正是《内经》“风淫于内，治以甘寒”的宗旨。（出自喻嘉言）
凡是治疗疟疾应当知道标本，有标证就治标，无标证就治本，这是治疗疟疾的关键所在。所谓标是指邪气，本是指正气，邪正相争，所以生病成疟。凡是疟疾初起，本来是由于邪气盛，此时应当治邪，这毫无疑问。如果表散已经做过，久而不愈，那么在邪正之间，就有不可不辨别的了。如果有邪气的，症状必定猖獗，脉象必定弦紧，或者头痛未除，或者汗出未透。凡是属于形证有余的，即使病很久，也一定有邪气未清，只要觉得有邪气，仍然应该兼治标证。如果汗出已多，邪气已解透，没有其他实证实脉可依据，而仍然不愈的，必定是由于正气全虚，或者因为体质弱，或者因为年老，此时应当专治其本，只要使元气恢复，就没有治不好的。假若不明白标本，无论有无邪气，只知道攻伐疟疾，那么危害就大了！○治疗疟疾的方法，如果病久汗多，腠理开泄，阳气不能固摄的，必须补益收敛。无汗则腠理致密，邪气不能解散，必须发散。所以说：有汗的要止汗，以扶正为主；无汗的要发汗，以散邪为主，这是大法。大概疟疾本是外邪，非汗不解，如果不懂得善于解散邪气，而妄用劫夺之剂，大多导致胃气受伤，应当以补剂为主，加减取汗。如果邪气在阴分，那么下半身最难得汗，补药力到达，自然汗出至足，这才是佳兆。○凡是寒邪从外侵入的，得汗即解，如伤寒之类是这样。而只有瘟疟的症状，则病情有深浅不同，如患瘟病的人，即使有大汗，而热仍不退。患疟疾的人，屡次发作屡次出汗，而疟疾仍不止。这是所感的邪气深，所以不能靠一两次汗法就痊愈，或者通身大汗如洗而邪气仍然不能透出。像这种情况，只应当观察病人的强弱，仍然逐渐再次发汗，才能得到邪气解散。所以不能说发汗后一定没有邪气，这应当以脉象紧或不紧，头身痛或不痛，寒热甚或不甚来辨别而已。○古时候称治疗疟疾，凡是将要发作的时候，和正在发作之际，千万不要施治，必须等到阴阳都达到极点，气势平定之后，然后治疗；或者在未发作之前，迎击而夺取邪气。这种说法似乎不太对，我最近治疗疟疾，每每迎着邪气锐气而攻击它，最快最有效。这可见古法中有不必拘泥的地方。（出自《景岳全书》）
疟疾由伏邪而成，应当辨别是在六气中受了哪一种气，在六经中病涉哪一经，如果小柴胡汤专门主治少阳，怎么能兼括其他经呢？这个证候春冬季有，但夏秋季节因暑湿为患者居多。暑必挟湿，专门伤害气分，须分别其上焦和中焦的暑湿二气，哪一个为重？如果暑热重者，专门研究上焦肺脏的清气，疟疾发作必然热重寒微，嘴唇舌头红赤，心烦口渴喜饮水，其脉色自然有阳胜的征候，应当宗法桂枝白虎汤，以及天水散加辛凉的药物来治疗。如果湿邪重者，应当议从中焦脾胃阳气入手，疟疾发作虽然热势蒸腾燔灼，但是舌头上必有腻苔，口渴喜欢喝热汤，胸脘痞闷胀满，呕吐恶心，其脉色自然有阳气不舒的状态，应当宗法正气散及二陈汤去掉甘草加杏仁、豆蔻、生姜之类为主治疗。一定要等到阳气盛于阴气，然后配合调和阳气的药剂，才不会留下祸害。如果证候象两兼，则两种方法兼用即可。大凡这个证候，如果邪气轻正气不甚虚的，寒热相等，而有固定的发作时间。如果邪气重正气怯弱的，寒热模糊不清，来势混杂不分。邪气浅则一日发作一次，稍深则隔日发作一次，最深则三日发作一次，古时候称为三阴大疟，以肝脾肾三脏的见证为主要要领。其补泻寒温，也不离张仲景治疗三阴法为根基，可知阳经轻浅的方剂，治疗它没有益处。所说的“移早则邪达于阳，移晏则邪陷于阴”，阴阳胜复，于此可以参悟。如果久而不愈，必定有其他变端。太阴的虚浮胀满，有用通补理中汤，开通腑气的五苓散。少阴的痿弱成劳，有用滋阴的复脉汤，温养的升奇法。厥阴的厥逆吐蛔，以及邪结为疟母，有用乌梅丸与鳖甲煎法。又如心经疟疾日久，必定扰动营血，则为烦渴见红；肺经疟疾日久，必定损伤津液，则为胃秘肠痹，一则以滋阴为主，一则以清降为宜。或者暑湿格拒三焦，而呕吐逆气不能纳食的，宗法半夏泻心汤。秽浊蒙蔽膻中，而神志昏昧严重的，用牛黄清心丸。心阳暴脱，有龙骨、牡蛎的救逆法。胃虚呕呃，有旋覆花、代赭石的成方。至于表散和解，通阳补气，滋阴化营，搜邪入络，动用药物劫截，辛酸两和，营卫并补，以及阳疟之后养胃阴，阴疟之后理脾阳等方法，已经完备了。○治疗疟疾用乌梅，是以酸味泄木安土的意思。用常山、草果，乃是劫夺太阴的寒邪，使这两种邪气不相兼并。用人参、生姜叫露姜饮，一是为了固护元气，一是为了疏散邪气，取通达神明去除秽恶之气。疟邪既久，深入血分，或者结成疟母，宜用鳖甲煎丸煎方活血通络。（出自《临证指南》）
少阳证知道可以解除的，是寒热每天在同一时间发作，说明邪气尚未退去。如果使用柴胡而改变了发作时间，早的变得晚，晚的变得早，气机转移至血，血机转移至气，这是邪气无处容身的表现，知道可以解除了。（出自王好古）
疟疾，是阴阳交争，寒热互作，用药须半生半熟，半冷半热，才能收到十全的效果。（出自《得效方》）
治疗疟疾的药煎好后，须露天放置一夜再服用。大概疟疾是暑气致病，暑气遇到露水就能解散。（出自缪仲淳）
疟疾病人须等到热退身凉，才可以饮食，切勿带热饮食，恐怕停滞积聚不消化，从而形成痞块或鼓胀的病例。（出自《万病回春》）
凡是治疗疟疾不寻求邪气所在的部位，就进行大汗、大下，伤害人体正气的，是医生的罪过。○凡是使用截疟的方法，不等待疟疾势头稍衰，就追求快速止住的，是医生的罪过。○凡是使用吐法，妄施恶劣的药物，以及各种丸药，伤害人体脏腑的，是医生的罪过。（出自《医门法律》）
【瘅疟】
老师说：阴气孤立绝灭，阳气独自发动，则发热且气短烦冤，手足发热且想呕吐，名叫瘅疟。如果只有发热没有恶寒的，邪气内藏于心，外舍于分肉之间，使人肌肉消瘦枯槁。（出自《金匮要略》）
瘅疟这一证候，在《内经》中说：肺素有热，气盛于身，发作时阳气盛，阳气盛而不衰，所以导致肌肉消瘦枯槁的，名叫瘅疟，自然与其他疟疾不同。治疗方法有三种：如热邪内蓄而表邪未解的，则当用辛凉散发；如因热致邪，表虽解而火独盛的，则当用苦寒清泄，这都是治疗其有余的部分。如果邪火虽盛，而气血已衰，真阴自耗的，急宜壮水固元，如果只知道泻火，则阴气日渐消亡，必定导致无法救治。（出自《景岳全书》）
【温疟】
温疟，其脉象如常人平和，身体不恶寒，只有发热，骨节疼痛烦扰，时时呕吐，用白虎加桂枝汤主治。（出自《金匮要略》）
《内经》所称的先热后寒的温疟有两种：一种是先伤于风，后伤于寒，风为阳邪，寒为阴邪，先阳后阴，所以先热后寒。对此以风寒两伤营卫的方法治疗，起初并不难。另一种是冬天感受风寒，深藏于骨髓，内舍于肾，到了春夏时令大热时才发作。其发作时，疟邪从肾出于外而大热，等到疟势向外衰退，又返回于肾，阴精与之相持，才开始出现寒战。假如不知道壮水之主，急救其阴，十几次发作后阴精就耗尽了，阴精尽则真火自焚，洒洒然时常惊悸，目光混乱无神采，顷刻间就死了。所以伤寒偏死于下虚之人，是说邪气进入少阴，没有阴精来抵御它。而温疟的惨状，难道有什么不同吗！（出自喻嘉言）
温疟有三种，总属阳盛，而邪气的浅深不同。仲景在《金匮》中所说的，是温疟的一种。《素问》又有温疟二证，证候不同而病因也异。仲景所说的二证，是只有发热没有恶寒的疟疾，一种叫瘅疟，一种叫温疟。《内经》所说的二证，是先热后寒的疟疾，都叫温疟，这是以寒热的有无、先后为分辨标准。仲景所名的瘅疟，只有发热没有恶寒的热，热根生于心，而热气舍于分肉；至于温疟的只有发热没有恶寒的热，则不口渴，是阳气郁于表的热，所以脉象如平，这两证，其热大有浅深之分。《内经》所言的第一种温疟，其先热后寒的热，也像仲景所言的温疟，不过是阳气郁于表的热，只是寒热的次序，稍微不同于常疟罢了，其发作也以时辰变化，而仍不失其常态，也是热之浅者也。至于《内经》所言第二种温疟，则又似乎同于仲景所言的瘅疟了。然而先热后寒，与瘅疟的只有发热没有恶寒又不同。大概寒热见于外在表现不同，而积热生于里有相同之处，为什么说同于瘅疟？因为仲景所言瘅疟有夙热，而《内经》所言温疟，也有夙热。仲景所言夙热藏于心脏，《内经》所言夙热藏于肾脏。疟疾本源并非脏邪，以热在脏为疟之根，如疟母在肝脏，为疟之母，都系于脏，而以脏而言。而疟疾则究非脏病，所以热藏于心，即根于心；热藏于肾，即根于肾，这都是热之深者也。○《内经》言温疟有二，喻氏引用以发明《金匮》的未备之处，但未说出方剂出来治疗。我总以白虎汤主治，治心火于少阴，与治肾火于少阴，也相去不远。气虚加人参，津液亡失加生地，血虚加当归、芍药，热甚在心加黄连，在肾加黄柏，都不超出阳盛救阴的方法。（出自魏荔彤）
【牝疟】
[Scriptural Interpretation]
Summer injury by summer-heat, autumn becomes malaria. ○ If sweat does not come out during the summer heat, wind-malaria will form in autumn. (From *Su Wen*)
[Philosophical Remarks]
Mu-malaria (Cold-predominant Malaria) presents with chills but no fever, anhidrosis, cold shivering, and headache; the disease location belongs to the Taiyang (Greater Yang) channel. Dan-malaria (Hot-predominant Malaria) presents with fever but no chills, mental restlessness, spontaneous heat, and sweating; the disease location belongs to the Yangming (Bright Yang) channel. Feng-malaria (Wind-malaria) presents with fever first followed by chills, aversion to wind, spontaneous sweating, and headache; the disease location belongs to the Shaoyang (Lesser Yang) channel. Shi-malaria (Dampness-malaria) presents with chills first followed by fever, heavy body, nausea, and vomiting; the disease location belongs to the Taiyang channel. Intermittent malaria (Sanri-nie) alternates between chills and fever, occurring every other day or every three days, lingering endlessly; the disease location belongs to the Shaoyin (Lesser Yin) and Jueyin (Terminal Yin) channels. (From *Yi Jie Bian Zheng*)
The back of the body belongs to Taiyang, which corresponds to the Bladder and its Qi is Cold Water. The front of the body belongs to Yangming, which corresponds to the Large Intestine and its Qi is Dry Metal. The pathogen of Shaoyang resides within; when it approaches the posterior Bladder Cold Water, there is aversion to cold; when it approaches the anterior Yangming Dry Metal, there is fever. Hence, it manifests as alternating chills and fever. (Li Dongyuan)
The chills in malaria are caused by internal heat about to arise; Fire rushes its Qi, causing a chilling sensation, which is not true cold. Therefore, hot medicines should not be used for treatment. (From *Ji Ren Bian*)
Malaria attacks must involve both chills and fever, with alternating chills and heat, fitting precisely within the domain governed by Shaoyang. Bias towards Yin results in more chills; bias towards Yang results in more heat. Even pure heat without chills (Dan-malaria, Wen-malaria) or pure chills without heat (Mu-malaria) are all extremes deviating from Shaoyang. To correct this deviation and remedy the flaw, one must return to the boundary of Shaoyang; only when Yin and Yang coordinate harmoniously can recovery occur. The malaria pathogen is like a puppet; Shaoyang holds the strings, controlling advance and retreat, entirely subject to Shaoyang's dominance. (Yu Jiayan)
Everyone knows that malaria is caused by summer-heat, but few realize that while summer heat is naturally suitable for righteous Qi, those who fear heat often seek coolness and avoid heat. This leads to contracting cold due to summer-heat, resulting in malaria. The Classics state: "If sweat does not come out during summer heat, wind-malaria forms in autumn." The meaning is clear here. However, only those with weak constitutions or excessive fatigue and injury are prone to pathogenic invasion. This explains why pathogenic invasion varies in depth, leading to varying severity of illness. Although the cause is summer-heat, termed "contracting summer-heat," one must understand that summer-heat has Yin and Yang aspects; malaria is specifically caused by Yin summer-heat. Regarding pathological changes, some present as cold syndromes, some as heat syndromes; some require dispersing methods, some requiring astringent methods, some warming methods, and some clearing methods. The key lies in distinguishing root and branch, excess and deficiency, and adapting treatment to the syndrome. Those who mistake summer-heat injury for Fire, or stubbornly treat Spleen-cold as mere cold, hold biased views. ○ Malaria occurring after Summer Solstice and before Autumn Equinox is in the Yang aspect, indicating shallow disease. Malaria occurring after Autumn Equinox and before Winter Solstice is in the Yin aspect, indicating deep disease. Malaria occurring after Zi hour (11 PM–1 AM) and before Wu hour (11 AM–1 PM) is a Yang aspect disease, easy to cure. Malaria occurring after Wu hour and before Zi hour is a Yin aspect disease, difficult to cure. ○ Malaria shifting from Yin to Yang, and from long intervals to short intervals (earlier onset), indicates progression from severe to mild. Shifting from Yang to Yin, and from earlier to later onset, indicates progression from mild to severe. Deep pathogenic invasion causes late onset; if the onset gradually becomes earlier and closer to normal, it is a good sign. Thus, treating this disease is easier in Spring and Summer, and harder in Autumn and Winter. (From *Jing Yue Quan Shu*)
Malaria may occur daily or every other day. Ancients believed daily occurrence is mild, while every-other-day occurrence is severe, attributing this to Wei Qi (Defensive Qi) failing to overcome the pathogen, requiring two days' accumulation to expel the pathogen from Fengfu. However, some every-other-day cases are mild because the pathogen and disease are slight, requiring two days to accumulate before Wei Qi can contend and expel the pathogen from Fengfu; thus, they cannot be deemed severe. ○ Malaria pathogens resemble epidemic toxins, but epidemics are severe while malaria is mild. (From *Yi Can*)
The proverb says: "Youth should not be weak, elders should not have malaria." This is because youth have vigorous desire-fire and declining Yin-water; elders have declining Qi and Blood, unable to endure the torment of alternating chills and fever. (From *Jian Wen Lu*)
Question: Why does the pulse skip beats and consciousness become confused/delirious during malaria attacks, but clarity and normal pulse return after the attack? Answer: During the attack, pathogenic obstruction prevents righteous Qi from circulating freely, causing skipped pulses. After the attack, the pathogen dissipates, righteous Qi recovers, and the pulse relaxes, returning to normal. Delirium during attacks is due to extreme heat disturbing the Spirit. (Fang Xingyan)
[Supplement]
Malaria differs by Wind, Cold, Summer-heat, and Dampness; treatments vary by Sweating, Vomiting, and Purging methods. Thousands of formulas exist, impossible to list fully. Only "No phlegm, no malaria; no food stagnation, no malaria" captures the etiology well. For anhidrotic malaria, induce sweating to disperse pathogens; for diaphoretic malaria, stop sweating to support righteousness. This captures the essence of malaria treatment. (From *Zhao Shi Yi Guan*)
The chapter on malaria in *Chao Shi Bing Yuan* arbitrarily divides it into Five Zang organs. Later scholars believed it elucidated *Nei Jing*, trusting it implicitly, unaware that malaria pathogens do not originate from the Zang organs. This concept absent in *Nei Jing* is merely Chao's speculation. Chen Wuyue's Three Causes theory is correct. However, claiming "Summer injury by summer-heat, autumn becomes malaria" cannot be solely relied upon is contrary to sage words. Regarding internal causes, copying Chao's Five Zang malaria theories remains vulgar. Zhang Hezi treated malaria favoring Sweating, Vomiting, and Purging, boasting of following Zhang Zhongjing. Unaware that Zhongjing's sweating/purging referred to adjusting the Harmonizing method of Shaoyang, not Taoyang sweating/purging. Those suitable for vomiting used Geng Ti or Chang Shan, each with deep meaning, not arbitrary. Zhang claimed that in peaceful times, even using arsenic poison to treat heat with heat could work—what nonsense! Li Dongyuan and Zhu Danxi strictly followed *Nei Jing*'s "Summer injury by summer-heat, autumn must have malaria," making many discoveries. They noted people in Wu, Chu, Min, Guang suffer much malaria due to abundant Yang, low damp terrain, and long summer damp-heat causing malaria, cholera, and dysentery—a wise observation. Yet regarding *Nei Jing*'s intent, it falls short. *Nei Jing* treats Summer-heat and Dampness together,不分南北 (distinguishing North/South). Danxi discussed twelve channels causing disease, aligning with *Ci Nie Pian*, yet why not follow *Jin Gui* focusing on Foot Shaoyang, leading to confusion? Formulas classify Wen-malaria as a complication of Cold Damage, similar to Wind-malaria; source unknown. Mu-malaria lacks a specific name, grouped under Cold-malaria, mistakenly identified as extreme organ cold, hence no heat, treated with Ginger, Cinnamon, Aconite. Some renamed it Pin-malaria, citing chronic cold-damp, Yin excess/Yang deficiency, treating with warming methods, effectively killing patients instantly. Others equated Summer-malaria with Dan-malaria, using She Pi for vomiting, never saving Shaoyang Wood-Fire like saving a fire—truly misguided and unfortunate for the people. ○ String-numerous pulse indicates Wind-Heat; stop it with dietary adjustments. Zhongjing stated string-numerous implies heat, adding that string-numerous indicates Wind-Heat progressing to extreme heat, generating Wind, where Liver Wood insults Spleen Earth, transmitting heat to Stomach, consuming fluids, causing Yang excess. This requires dietary management (Pear juice, Sugarcane syrup) per *Nei Jing*'s "Wind rampant inside, treat with Sweet-Cold." (Yu Jiayan)
Treating malaria requires knowing Root and Branch. Treat Branch if present, Root if not; this is crucial. Branch refers to Pathogen, Root to Righteous Qi. Pathogen-Righteous contention causes malaria. Initial malaria involves strong Pathogen, so treat Pathogen. If dispersing has been done and it persists, distinguish Pathogen vs. Righteous Qi. Pathogenic presence shows fierce symptoms, string-tight pulse, unrelieved headache, or incomplete sweating. If signs indicate excess, even if chronic, pathogen remains; treat both. If sweating is profuse, pathogen resolved, no excess signs, yet persistent, it is Righteous Qi deficiency (weak constitution or old age); treat Root exclusively. Restoring Yuan Qi ensures cure. Ignoring Root/Branch and attacking malaria blindly causes harm. ○ Treatment: Chronic malaria with profuse sweating and open pores (Yang insecurity) requires tonifying and astringing. Anhidrosis with closed pores (pathogen unresolved) requires dispersing. Thus: Diaphoresis needs astringency/supporting Righteous Qi; Anhidrosis needs sweating/dispatching Pathogens. Malaria is external pathogen, resolved by sweating. Without proper dispersal, using coercive agents damages Stomach Qi; use tonics with modifications to induce sweating. If pathogen is in Yin aspect, lower body resists sweating; tonic efficacy reaching feet induces sweating to toes, a good sign. ○ External Cold resolves with sweating (e.g., Cold Damage). Plague-malaria varies in depth; plague persists despite sweating. Malaria recurs despite sweating. Deep invasion requires gradual sweating based on strength. Do not assume pathogen absence post-sweat; judge by pulse tightness, pain, and heat intensity. Ancients advised against treating during impending or active attacks, waiting for peak Yin/Yang balance or striking before onset. I find striking at peak effectiveness fastest. Ancient methods need not be rigid. (From *Jing Yue Quan Shu*)
Malaria arises from latent pathogens; distinguish which of Six Qi injured which channel. Xiao Chai Hu Tang targets Shaoyang only. Occurs in Spring/Winter, mostly Summer/Autumn Summer-heat/Dampness. Summer-heat carries Dampness, injuring Qi aspect. Differentiate Upper/Middle Jiao burden. Heavy Summer-heat: Focus on Lung Qi; fever > chills, red lips/tongue, thirst/desire for drinks, Yang-excess pulse/color. Use Gui Zhi Bai Hu Tang or Tian Shui San plus Acrid-Cool herbs. Heavy Dampness: Focus on Spleen/Stomach Yang; steaming fever, greasy tongue coating, desire for warm drinks, chest/epigastric fullness, nausea. Use Zheng Qi San or Er Chen Tang minus Gan Cao plus Xing Ren, Dou Kou, Sheng Jiang. Balance Yang over Yin before harmonizing. Combined syndromes use combined methods. Mild pathogen/moderate Righteous Qi: Equal chills/fever, regular timing. Severe pathogen/weak Righteous Qi: Blurred chills/fever, chaotic onset. Shallow pathogen: Daily. Deeper: Every other day. Deepest: Every three days (Three Yin Great Malaria), involving Liver/Spleen/Kidney signs. Tonify/Clear/Warm/Cool follow Zhongjing's Three Yin methods; Yang channel formulas ineffective. "Earlier onset reaches Yang, later onset sinks to Yin"; Yin/Yang fluctuation observable. Chronic cases risk complications. Taiyin deficiency/bloating: Li Zhong Tang (Tonify/Pass), Wu Ling San (Open Fu). Shaoyin emaciation/labor: Fu Mai Tang (Nourish Yin), Sheng Qi Fa (Warm/Nourish). Jueyin reversal/vomiting roundworms/malaria mass: Wu Mei Wan, Bie Jia Jian Wan. Heart channel chronic: Disturbs Ying, causes thirst/redness; nourish Yin. Lung channel chronic: Damages Jin Ye, causes constipation/obstruction; clear/descend. Summer-heat/Dampness blocking San Jiao, vomiting/refusal: Ban Xia Xie Xin Tang. Turbid misting Dan Zhong, dull spirit: Niu Huang Qing Xin Wan. Heart Yang sudden collapse: Long Gu, Mu Li rescue. Stomach deficiency retching: Xuan Fu Dai Zhe Tang. Methods include dispersing/harmonizing, unblocking Yang/tonifying Qi, nourishing Yin/resolving Ying, searching pathogen into collaterals, coercive interception, Sour/Pungent harmony, Ying/Wei tonification, Stomach Yin nourishment post-Yang malaria, Spleen Yang regulation post-Yin malaria—all complete. ○ Wu Mei uses sourness to drain Wood/peace Earth. Chang Shan, Cao Guo coerce Taiyin Cold, preventing pathogen merger. Ren Shen, Sheng Jiang (Lu Jiang Yin) secure Origin/scatter pathogen, clearing turbidity. Chronic pathogen entering Blood/mass: Bie Jia Jian Wan activates blood/unblocks collaterals. (From *Lin Zheng Zhi Nan*)
Shaoyang syndrome resolution indicated by consistent timing; unchanged timing means pathogen remains. Using Chai Hu to shift timing (early to late, late to early) moves Qi to Blood, Blood to Qi, leaving no room for pathogen, indicating resolution. (Wang Haogu)
Malaria involves Yin/Yang contention, alternating chills/fever; medicine should be half raw/half cooked, half cold/half hot for perfect results. (From *De Xiao Fang*)
Malaria decoctions should be exposed overnight before taking. Malaria is caused by Summer-heat; Summer-heat dissolves with dew. (Miu Zhongchun)
Malaria patients must wait for fever to subside and body to cool before eating. Avoid hot food/drink to prevent stagnation forming masses or drum-like distension. (From *Wan Bing Hui Chun*)
Doctors sin by treating malaria without locating the pathogen, using excessive sweating/purging, damaging Righteous Qi. Doctors sin by using intercepting methods before malaria wanes, seeking quick cessation. Doctors sin by using vomiting methods with harsh drugs/pills, damaging Zang/Fu organs. (From *Yi Men Fa Lv*)
[Dan Malaria]
Master said: Yin Qi isolated/extinct, Yang Qi alone erupts, causing fever, shortness of breath, mental oppression, hot hands/feet, nausea; named Dan Malaria. If only fever without chills, pathogen hides in Heart, resides in Fen Rou (muscle interspaces), causing muscle wasting. (From *Jin Gui Yao Lue*)
Dan Malaria in *Nei Jing*: Lung previously hot, Qi abundant in body; eruption causes Yang abundance, unceasing, leading to muscle wasting. Named Dan Malaria, distinct from others. Three treatments: 1. Heat internal/stagnant, exterior unresolved: Disperse with Acrid-Cool. 2. Heat caused by pathogen, exterior resolved, Fire alone strong: Clear with Bitter-Cold. These treat excess. 3. Fire strong but Qi/Blood depleted, True Yin consumed: Urgently strengthen Water/secure Origin. Knowing only to purge Fire leads to Yin loss and death. (From *Jing Yue Quan Shu*)
[Wen Malaria]
Wen Malaria: Pulse like normal, no chills, only fever, bone/joint pain/annoyance, occasional vomiting; treated with Bai Hu Jia Gui Zhi Tang. (From *Jin Gui Yao Lue*)
*Nei Jing* describes two types of Wen Malaria (fever then chills): 1. Wind injury first, Cold second. Wind is Yang, Cold is Yin; Yang then Yin causes fever then chills. Treat with methods for Wind-Cold injuring Ying/Wei; simple. 2. Winter Wind-Cold hides deep in Marrow/Kidney; erupts in Spring/Summer heat. Pathogen exits Kidney externally causing high fever; as momentum fades, returns to Kidney, Yin essence contends, causing chills. If not strengthening Water/Emergency Yin, dozens of attacks exhaust Yin essence; Essence exhausted leads to True Fire self-immolation, trembling/fright, blurred vision, death quickly. Cold damage kills deficient persons because pathogen enters Shaoyin without Yin defense. Wen malaria is equally cruel! (Yu Jiayan)
Three types of Wen Malaria, all Yang excess, differing depth. Zhongjing's *Jin Gui* type is one. *Su Wen* has two Wen Malaria types, different symptoms/causes. Zhongjing's two types (Dan, Wen) are fever-only. *Nei Jing*'s two types are fever-then-chills, both called Wen Malaria, distinguished by presence/order of chills/fever. Zhongjing's Dan Malaria: Fever-only, root in Heart, heat in Fen Rou. Zhongjing's Wen Malaria: Fever-only, no thirst, Yang trapped in exterior, pulse normal. These differ in heat depth. *Nei Jing* Type 1 Wen Malaria: Fever-then-chills, like Zhongjing's Wen Malaria (Yang trapped in exterior), just order differs slightly from common malaria, timing variable but constant, shallow heat. *Nei Jing* Type 2 Wen Malaria: Similar to Zhongjing's Dan Malaria. But fever-then-chills differs from Dan's fever-only. External chills/fever differ, internal accumulated heat same. Why similar to Dan? Both have "Suo Re" (Pre-existing Heat). Zhongjing: Suo Re in Heart. *Nei Jing*: Suo Re in Kidney. Malaria not originally Zang pathogen; heat in Zang is root. Malaria mass in Liver is mother of malaria, associated with Zang. Malaria is not Zang disease. Heat in Heart = root in Heart; Heat in Kidney = root in Kidney. These are deep heat. ○ *Nei Jing* mentions two Wen Malarias; Yu cites them to supplement *Jin Gui*, but omits formulas. I generally use Bai Hu Tang. Treating Heart Fire in Shaoyin vs. Kidney Fire in Shaoyin is similar. Qi deficiency add Ren Shen; Fluid loss add Sheng Di; Blood deficiency add Dang Gui, Bai Shao; Heat in Heart add Huang Lian; Heat in Kidney add Huang Bo. All fall under Yang Excess Saving Yin method. (Wei Litong)
[Pin Malaria]
Malaria with more chills is named Pin Malaria. Treated with Shu Qi San. (From *Jin Gui Yao Lue*)
Malaria with more chills means chills exceed heat (e.g., 30% heat, 70% chills), not pure chills without heat. Pure chills without heat is Yin syndrome, not malaria. (Yu Jiayan)