赵养葵曰∶世间似疟非疟者,世人一见寒热往来,便以截疟丹施治,以致委顿。经曰∶阳虚则恶寒,
阴虚则发热。阴气上入阳中则恶寒,阳气下陷入阴中则恶热。凡伤寒后、大病后、产后,劳瘵等症,俱有寒热
往来,似疟非疟,或一日二三度发,并作疟治,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,医者有论及之者
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,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,六味汤主之;无火者益火,八味汤主之。世人患久疟而不愈,
亦治之不如法故耳。丹溪云∶邪入阴分,宜用血药引出阳分,芎、归、地、红花、黄柏治之。亦未及真阴真
阳之至理。
夫发疟有面赤口渴者,俱作肾中真阴虚治,治之无不立愈。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。
又有一种郁症似疟者,其寒热与正疟无异,但其口苦,呕吐清水或苦水,面清胁痛,耳鸣脉涩。须以逍
遥散加茱萸、黄连、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。
赵养葵说:世间有一种症状类似疟疾但并非真正疟疾的病证,世人一见患者出现寒热往来的症状,就使用截疟丹进行治疗,导致患者身体更加虚弱疲惫。《内经》说:阳气虚则怕冷,阴气虚则发热。当阴气侵入阳分之中时就会感到恶寒,当阳气下陷进入阴分之中时就会感到恶热。凡是伤寒病后、大病之后、产后以及劳瘵等病症,都可能出现寒热往来、似疟非疟的症状,或者一天发作两三次。如果把这些症状都当作疟疾来治疗,其实只是有阳虚和阴虚的区别罢了。对于阳虚者应当补阳,可以使用理中汤、六君子汤、补中益气汤并加入生姜和肉桂,严重时甚至加入附子。在这些方剂中必须使用升麻和柴胡,以将阴中之阳气提举出来,使水升火降,疾病即可痊愈,对此医家已有论述。至于阴虚者,其寒热症状也与真正的疟疾没有不同。
而在阴疟之中又有真阴亏损和真阳亏损的区分。《内经》说:症状白天显现夜间潜伏,夜间显现白天停止,按时发作,这是“无水”(肾阴亏虚)的表现;症状白天显现夜间潜伏,夜间显现白天停止,忽隐忽现,时作时止,这是“无火”(肾阳亏虚)的表现。“无水”者应当壮水滋阴,以六味地黄丸为主治方;“无火”者应当益火助阳,以八味地黄丸(金匮肾气丸)为主治方。世人患久疟不愈,也是因为治疗方法不当的缘故。朱丹溪说:邪气深入阴分,应当用血分药将其引出到阳分,可用川芎、当归、地黄、红花、黄柏来治疗。但这也没有触及真阴真阳的根本道理。
凡是发疟疾伴有面色红赤、口渴症状的,都应当作为肾中真阴虚损来治疗,治疗无不立即见效。凡是见到患者感觉寒冷如冰,发热如火烙,唯独面色红赤如油脂,口渴想喝水的,使用六味地黄丸加入柴胡、芍药、肉桂、五味子,大剂量服用一次即可痊愈。
又有一种郁证表现为类似疟疾的症状,其寒热表现与正疟无异,但伴有口苦、呕吐清水或苦水、面色青白、胁肋疼痛、耳鸣、脉涩等症状。需要用逍遥散加入吴茱萸、黄连、贝母,加倍柴胡用量,一次性服用。随后再用六味地黄丸加入柴胡、芍药进行调理,病情即可安定。
Zhao Yangkui stated: In the world, there are conditions that resemble malaria but are not true malaria. When people see patients experiencing alternating chills and fever (Han Re Wang Lai), they immediately administer Jiemie Dan (Malaria-Intercepting Pill) for treatment, resulting in the patient becoming prostrate and exhausted. The Classic says: "Yang deficiency leads to aversion to cold; Yin deficiency leads to fever." When Yin Qi invades the Yang region, aversion to cold occurs; when Yang Qi sinks into the Yin region, heat sensation occurs. Following Shanghan (Cold Damage) illness, after severe diseases, postpartum states, and conditions like Laozai (Consumption/Tuberculosis), all may present with alternating chills and fever, resembling malaria but not being it, or occurring two or three times a day. Treating these as malaria without distinguishing between Yang deficiency and Yin deficiency is incorrect. For Yang deficiency, one should tonify Yang, using Lizhong Tang (Regulate the Middle Decoction), Liujunzi Tang (Six Gentlemen Decoction), or Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Shengjiang (Fresh Ginger Rhizome) and Rougui (Cinnamon Bark); in severe cases, Fuzi (Prepared Aconite Root) may be added. In these formulas, Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix) must be used to lift the Yang within the Yin, allowing Water to ascend and Fire to descend, leading to recovery; physicians have discussed this theory. As for Yin deficiency, their chills and fevers are no different from true malaria.
Furthermore, within Yin malaria, there is a distinction between True Yin deficiency and True Yang deficiency. The Classic says: Symptoms appearing by day and hiding by night, appearing by night and stopping by day, occurring at fixed times, indicate "Water Deficiency" (lack of Kidney Yin); symptoms appearing by day and hiding by night, appearing by night and stopping by day, coming and going suddenly, starting and stopping intermittently, indicate "Fire Deficiency" (lack of Kidney Yang). For "Water Deficiency," one should strengthen Water (nourish Yin), primarily using Liuwei Tang (Six-Ingredient Pill with Rehmannia); for "Fire Deficiency," one should benefit Fire (tonify Yang), primarily using Bawei Tang (Eight-Ingredient Pill with Rehmannia). People suffering from chronic malaria that does not heal do so because the treatment was not performed according to proper methods. Danxi said: "When pathogenic factors enter the Yin aspect, blood-invigorating herbs should be used to draw them out to the Yang aspect," treating with Xiong (Chuanxiong Rhizome), Gui (Angelicae Sinensis Radix), Di (Rehmanniae Radix), Honghua (Carthami Flos), and Huangbai (Phellodendri Cortex). However, this does not address the profound principles of True Yin and True Yang.
Whenever malaria presents with red face and thirst, it should be treated as True Yin deficiency in the Kidney, and treatment will invariably lead to immediate recovery. Whenever a patient presents with chills feeling like ice, heat feeling like a hot iron, yet specifically having a red face like grease and a desire to drink water, use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) added with Chaihu, Shaoyao (Paeoniae Radix Alba), Rougui, and Wuweizi (Schisandrae Fructus), administered in a large dose once, which will result in cure.
There is also a type of Yu Zheng (Depression Syndrome) that resembles malaria. Its chills and fevers are identical to true malaria, but accompanied by bitter taste in the mouth, vomiting clear fluid or bitter fluid, pale/greenish complexion, hypochondriac pain, tinnitus, and a choppy pulse. One must use Xiaoyao San (Free and Easy Wanderer Powder) added with Zhuyu (Evodiae Fructus), Huanglian (Coptidis Rhizoma), and Beimu (Fritillariae Thunbergii Bulbus), doubling the dosage of Chaihu, taken in one dose. Subsequently, regulate with Liuwei Dihuang Wan added with Chaihu and Shaoyao to restore peace.
As for Sanyin Malaria (Malaria involving the Three Yin meridians), only Taiyin Malaria should use Lizhong Tang, and it must be added with Rougui. If it involves Shaoyin or Jueyin, only Bawei Dihuang Wan (Eight-Ingredient Rehmannia Pill) will be effective.