病源夫温疟与寒疟安舍，温疟得之冬，中于风寒，寒气藏于骨髓之中，至春则阳气大发
，邪气不能出，因遇大暑，脑髓铄，肌肉消释，腠理发泄，因有所用力，邪气与汗偕出，此
邪气先藏于肾，其气先从内出之于外，如是则阴虚而阳盛，盛则病矣，阳衰则气复反入，入
则阳虚，阳虚则寒矣，故先热而后寒，名曰温疟，疟先寒而后热者，此由夏伤于大暑，汗大
出，腠理开发，因遇夏气凄沧之小寒，寒迫之，藏于腠理皮肤之中，秋伤于风，则病成矣，
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，病以时作，名曰寒疟，
先伤于风而后伤于寒，故先热而后寒，亦以时作，名曰温疟，夫病疟六七日但见热者，温疟
也。（出第十一卷中）
甲乙经黄帝曰夫疟皆生于风夏伤于暑，秋为 疟。黄帝问疟先寒而后热，何也。岐伯对
曰∶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，名曰寒疟。
又问曰∶先热而后寒者，何也？对曰∶先伤于风而后伤于寒，故先热而后寒也，名曰温
疟。
其但热而不寒者，阴气先（千金作孤）绝，阳气独发，即少气烦冤，手足热而欲呕，名
曰
瘅疟。
又曰温疟者得之冬，中于风寒，寒气藏于骨髓之中，至春即阳气大发，邪气不能出，因
遇大暑，脑髓铄肌肉消释。（腠理）理发泄因有所用力邪气与汗偕出，此邪气先藏于肾，其
气
先从内出之于外，如是者阴虚而阳盛，盛则病矣，阳衰则气复反入，入则阳虚，阳虚则复寒
矣，故先热而后寒，名曰温疟。
又曰，瘅疟者，肺素有热，气盛于身，厥气逆上，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，故但热不寒，热气内藏于心，外舍分肉之间，令人销铄脱肉，故名曰瘅疟。（出庚卷第
七千金同）
广济疗温疟渐渐羸瘦欲成骨蒸常山汤方。
常山（三两） 车前叶（一握） 甘草（二两炙） 猕猴骨（三两炙） 乌梅肉（二两）
天灵盖
（一两烧作灰末） 驴粪汁（三合）
上七味切，以水六升，煮五味，取三升，去滓，下粪汁天灵盖末分三服，微吐不利。
忌生葱生菜海藻菘菜面粘食等。
又疗温疟，常山丸方。
常山 乌梅肉（熬） 豉 天灵盖（烧各六分） 知母 朱砂 蜀漆 大黄（各四分）
上八味捣筛，蜜和丸如梧子，空肚以温酒下二十丸，至三十丸，日三服，并未发前服，
不吐利。忌生葱生菜生血等物。（并出第十卷中）
千金论曰，瘅疟者，阴气孤绝，阳气独发，其候也，少气烦满，手足热，欲呕，热而不
寒，气藏在心。
又曰，有温疟者，其脉如平人，无寒时热，其候骨节疼烦，时呕，朝发暮解，暮发朝解
，皆白虎加桂心汤主之方。
知母（六两） 甘草（二两炙） 石膏（碎一斤） 粳米（六合）
上四味切，以水一斗二升煮，取米烂，去滓，加桂心三两，煎取三升，分温三服，覆令
汗，先寒发热汗出者愈。忌海藻菘菜生葱。伤寒论云，用秕粳米，不熟稻米是也。（出第十
卷中）
备急竹叶常山汤疗温疟，壮热微寒温疟之候也，壮热后如觉微寒，或瘅疟依时手足冷，
少时便壮热，亦有手足烦热干呕者， 疟先大寒后大热者，并主之神效，尤宜乳下小儿亦瘥
方。
常山（三两切） 淡竹叶（一握） 小麦（一升）
上三味，以水五升渍一宿，明旦煮取二升，温分三服。忌生菜生葱。（支短剧文仲并同
出第三卷中）
延年疗温疟壮热不能食知母鳖甲汤方。
知母 鳖甲（炙） 地骨皮（各三两） 常山（二两） 竹叶（切一升） 石膏（四两
碎）
上六味切，以水七升，煮取二升五合，去滓，分三服。忌蒜猪肉苋菜生葱生菜。（出第
十七卷中）
【病因】温疟与寒疟的发病部位在哪里？温疟是由于冬季感受风寒，寒气潜伏在骨髓之中，到了春天阳气大发，邪气无法排出；又恰逢大暑天气，脑髓受热消融，肌肉消减，腠理（皮肤毛孔）开泄，此时如果有所用力劳作，邪气便随着汗液一起排出。这种邪气原先潜伏于肾，其气机先从体内出于体表，这样就会导致阴虚而阳盛，阳盛则发病；若阳气衰退，气机又会反向入里，入里则导致阳虚，阳虚则产生寒象，所以表现为先发热而后发冷，称为温疟。
如果是先发冷后发热的疟疾，这是由夏季受大暑所伤，大汗淋漓，腠理开发，又遇到夏季凄清寒冷的小寒之气，寒气逼迫身体，潜伏在腠理和皮肤之中，秋季再感受风邪，疾病就形成了。寒属于阴气，风属于阳气，先伤于寒而后伤于风，所以先冷后热，病证按时发作，称为寒疟；先伤于风而后伤于寒，所以先热后冷，也按时发作，称为温疟。凡是患疟疾六七天只见到发热症状的，属于温疟。（出自第十一卷中）
《甲乙经》黄帝说：疟疾都生于风邪，夏季伤于暑气，秋季发为疟疾。黄帝问：疟疾先发冷后发热，是什么原因？岐伯回答说：寒是阴气，风是阳气，先伤于寒而后伤于风，所以先冷后热，称为寒疟。
又问：先发热后发冷的原因是什么？回答说：先伤于风而后伤于寒，所以先热后冷，称为温疟。
那些只发热而不发冷的，是阴气先绝（《千金方》作“孤”），阳气独发，就会出现气短、烦闷冤屈感、手足发热且想呕吐的症状，称为瘅疟（dān nüè）。
又说：温疟是由于冬季感受风寒，寒气潜伏在骨髓之中，到了春天阳气大发，邪气无法排出，又恰逢大暑，脑髓受热消融，肌肉消减，腠理发泄，此时如果有所用力劳作，邪气便随汗而出。这种邪气原先潜伏于肾，其气机先从内出于外，这样就会阴虚而阳盛，阳盛则发病；阳气衰退，气机又反向入里，入里则阳虚，阳虚则再次感到寒冷，所以先热后冷，称为温疟。
又说：瘅疟是因为肺中素有热邪，气盛于全身，厥逆之气向上冲，中焦气实而不能向外宣泄，此时如果有所用力劳作，腠理开放，风寒停留在皮肤之内、分肉之间而发病。发病时阳气盛极，阳气盛极而不衰减，则发病。因为热气不及于阴分，所以只发热不发冷。热气内藏于心，外舍于分肉之间，使人消瘦脱肉，所以称为瘅疟。（出自庚卷第七，《千金方》相同）
《广济方》治疗温疟逐渐消瘦欲成骨蒸劳热的常山汤方。
常山（三两） 车前叶（一握） 甘草（二两，炙） 猕猴骨（三两，炙） 乌梅肉（二两） 天灵盖（一两，烧成灰末） 驴粪汁（三合）
以上七味药切碎，用水六升，煮前五味药，取三升药液，去渣，加入驴粪汁和天灵盖末，分三次服用，以微微吐泻为度。忌食生葱、生菜、海藻、菘菜（白菜）、面食及粘性食物等。
又治疗温疟的常山丸方。
常山 乌梅肉（熬制） 豆豉 天灵盖（烧，各六分） 知母 朱砂 蜀漆 大黄（各四分）
以上八味药捣碎过筛，用蜂蜜调和制成梧桐子大小的丸剂，空腹时用温酒送服二十至三十丸，每日三次，均在未发作前服用，以不引起吐泻为宜。忌食生葱、生菜、生血类食物等。（均出自第十卷中）
《千金方》论述说：瘅疟是阴气孤绝，阳气独发，其症状表现为气短、烦满，手足发热，想呕吐，只发热不发冷，气机蕴结在心。
又说：有温疟患者，脉象如常人，没有发冷的时候只有发热，其症状表现为骨节疼痛烦扰，时常呕吐，早晨发作傍晚缓解，或傍晚发作早晨缓解，都用白虎加桂心汤主治。
知母（六两） 甘草（二两，炙） 石膏（打碎一斤） 粳米（六合）
以上四味药切碎，用水一斗二升煮，煮到米烂熟，去渣，加入桂心三两，煎取三升药液，分三次温服，服药后覆盖衣被令其出汗，先冷后热并出汗者痊愈。忌食海藻、菘菜、生葱。《伤寒论》中说，使用秕粳米，即未成熟稻米。（出自第十卷中）
《备急方》竹叶常山汤治疗温疟，壮热微寒是温疟的症状，壮热之后如果觉得微寒，或者瘅疟按时出现手足冰冷，片刻后又壮热，也有手足烦热干呕的，以及先大寒后大热的疟疾，此方均主之，神效，尤其适合哺乳期婴儿也能治愈。
常山（三两，切碎） 淡竹叶（一握） 小麦（一升）
以上三味药，用水五升浸泡一夜，第二天早上煮取二升药液，分三次温服。忌食生菜、生葱。（支道、短剧、文仲等人的记载相同，出自第三卷中）
《延年方》治疗温疟壮热不能进食的知母鳖甲汤方。
知母 鳖甲（炙） 地骨皮（各三两） 常山（二两） 竹叶（切碎一升） 石膏（四两，打碎）
以上六味药切碎，用水七升，煮取二升五合药液，去渣，分三次服用。忌食蒜、猪肉、苋菜、生葱、生菜。（出自第十七卷中）
[Pathogenesis] Where do warm malaria and cold malaria originate? Warm malaria arises from contracting wind-cold in winter, where cold qi hides within the bone marrow. By spring, when yang qi expands vigorously, the pathogenic qi cannot exit. If one then encounters intense summer heat, the brain marrow melts, muscles atrophy, and the cou li (skin pores) open. If physical exertion occurs at this time, the pathogenic qi exits along with sweat. This pathogenic qi originally hid in the Kidney; its qi moves from the interior to the exterior first. Consequently, yin deficiency and yang excess occur; excess leads to disease. If yang qi declines, the qi reverses and enters the interior; entering leads to yang deficiency, and yang deficiency results in cold. Thus, fever precedes chills, named "Warm Malaria" (Wen Nue).
If malaria presents with chills preceding fever, it is caused by summer injury from intense heat, leading to profuse sweating and open cou li. Subsequently, encountering the slight cold of a chilly summer day forces cold to hide within the cou li and skin. Autumn injury from wind completes the pathology. Cold belongs to Yin Qi, while wind belongs to Yang Qi. Injury from cold first, then wind, results in chills preceding fever, occurring at regular intervals, named "Cold Malaria" (Han Nue). Injury from wind first, then cold, results in fever preceding chills, also occurring at regular intervals, named "Warm Malaria." For those suffering from malaria for six or seven days exhibiting only heat, it is Warm Malaria. (From Volume 11)
The *Jia Yi Jing* states: Huangdi said, "Malaria all originates from Wind; Summer injury from Heat leads to Malaria in Autumn." Huangdi asked, "Why does malaria present with chills preceding fever?" Qibo replied, "Cold is Yin Qi, Wind is Yang Qi. Injury from cold first, then wind, results in chills preceding fever, named 'Cold Malaria.'"
He further asked, "Why does it present with fever preceding chills?" The reply was, "Injury from wind first, then cold, results in fever preceding chills, named 'Warm Malaria.'"
Those who exhibit only heat without chills have their Yin Qi severed first (the *Qian Jin Fang* reads 'isolated'), while Yang Qi acts alone. Symptoms include shortness of breath, vexation and oppression, heat in the hands and feet, and a desire to vomit. This is named "Dan Malaria" (Dan Nue).
It is also stated: Warm malaria arises from winter contraction of wind-cold, with cold qi hiding in the bone marrow. By spring, when yang qi expands, the pathogen cannot exit. Encountering great summer heat causes brain marrow to melt and muscles to atrophy. With open cou li and physical exertion, the pathogen exits with sweat. Originally hiding in the Kidney, the qi moves from interior to exterior, causing yin deficiency and yang excess, leading to disease. When yang declines, qi returns inward, causing yang deficiency and subsequent cold, resulting in fever preceding chills, named "Warm Malaria."
Furthermore, Dan Malaria occurs because the Lungs harbor latent heat, making qi abundant throughout the body. Rebellious Qi ascends, middle jiao Qi is full but fails to vent outward. Upon physical exertion, cou li opens, allowing wind-cold to lodge between the skin and muscle layers. Upon onset, Yang Qi becomes excessive and does not decline, causing disease. Because the heat does not reach the Yin aspect, there is only heat without chills. The hot qi hides internally in the Heart and externally in the muscle layers, causing emaciation and flesh wasting, hence named "Dan Malaria." (From Geng Volume 7, same as *Qian Jin Fang*)
The *Guang Ji* formula for treating Warm Malaria progressing to emaciation and impending Bone Steaming Consumption: Changshan Tang (Dichroa Decoction).
Changshan (*Dichroae Radix*, 3 liang), Cheqian Ye (*Plantaginis Leaf*, 1 handful), Gancao (*Glycyrrhizae Radix et Rhizoma*, 2 liang, honey-fried), Mihou Gu (*Simiae Os*, 3 liang, honey-fried), Wumei Rou (*Mume Fructus Flesh*, 2 liang), Tianlinggai (*Cranii Os*, 1 liang, burned to ash), Lv Fen Zhi (*Asini Feces Juice*, 3 he).
Cut the seven ingredients. Boil the first five in 6 sheng of water to obtain 3 sheng. Remove dregs, add the Asini Feces Juice and Cranii Os ash. Divide into three doses. Aim for mild vomiting or purgation. Avoid raw green onions, raw vegetables, seaweed, Chinese cabbage, wheat products, and sticky foods.
Another formula for Warm Malaria: Changshan Wan (Dichroa Pill).
Changshan (*Dichroae Radix*), Wumei Rou (*Mume Fructus Flesh*, roasted), Chishao (*Sojae Preparata*, i.e., fermented soybean), Tianlinggai (*Cranii Os*, burned, each 6 fen), Zhimu (*Anemarrhenae Rhizoma*, 4 fen), Zhusha (*Cinnabaris*, 4 fen), Shuqi (*Perillae Folium*, i.e., Perilla leaf, 4 fen), Dahuang (*Rhei Radix et Rhizoma*, 4 fen).
Pulverize the eight ingredients, mix with honey to form pills the size of wu zi (wu berry). Take 20-30 pills on an empty stomach with warm wine, three times daily. Administer before the onset of symptoms. Aim to avoid vomiting or purgation. Avoid raw green onions, raw vegetables, and raw blood products. (All from Volume 10)
The *Qian Jin Fang* discusses: Dan Malaria involves isolated Yin Qi and independent Yang Qi emission. Symptoms include shortness of breath, fullness and vexation, heat in hands and feet, desire to vomit, heat without chills, and qi stagnating in the Heart.
It also states: For Warm Malaria patients whose pulse resembles that of a healthy person, with no chills—only heat—the symptoms include painful and vexed joints, occasional vomiting, resolution in the morning if onset was in the evening, or resolution in the evening if onset was in the morning. These are treated with Baihu Jia Guixin Tang (White Tiger Decoction plus Cinnamon Twig).
Zhimu (*Anemarrhenae Rhizoma*, 6 liang), Gancao (*Glycyrrhizae Radix et Rhizoma*, 2 liang, honey-fried), Shigao (*Gypsum Fibrosum*, crushed, 1 jin), Jingmi (*Oryza Sativa Var. Glutinosa*, 6 he).
Cut the four ingredients. Boil in 12 dou of water until the rice is soft. Remove dregs, add Guixin (*Cinnamomi Ramulus*, 3 liang), and decoct to obtain 3 sheng. Divide into three warm doses. Cover the patient to induce sweating. Those who experience chills followed by heat and sweating will be cured. Avoid seaweed, Chinese cabbage, and raw green onions. The *Shanghan Lun* specifies using bi jingmi, which refers to immature rice grains. (From Volume 10)
The *Beiji* formula: Zhuye Changshan Tang (Bamboo Leaf and Dichroa Decoction) treats Warm Malaria characterized by high fever and slight chills. If after high fever one feels slight chills, or if Dan Malaria presents with cold hands and feet at specific times followed quickly by high fever, or if there are hot hands/feet and dry retching, or if there is severe chills followed by severe heat, this formula is effective and especially suitable for nursing infants.
Changshan (*Dichroae Radix*, 3 liang, cut), Danye Zhu (*Phyllostachys Pubescens Leaf*, 1 handful), Xiaomai (*Tritici Semen*, 1 sheng).
Soak the three ingredients in 5 sheng of water overnight. Boil the next morning to obtain 2 sheng. Divide into three warm doses. Avoid raw vegetables and raw green onions. (Records by Zhi Dao, Duan Ju, and Wen Zhong are identical; From Volume 3)
The *Yannian* formula for treating Warm Malaria with high fever and inability to eat: Zhimu Biejia Tang (Anemarrhena and Turtle Shell Decoction).
Zhimu (*Anemarrhenae Rhizoma*), Biejia (*Testudinis Carapax et Plastrum*, honey-fried), Digupi (*Lycii Cortex*, each 3 liang), Changshan (*Dichroae Radix*, 2 liang), Zhuye (*Bamboo Leaf*, cut, 1 sheng), Shigao (*Gypsum Fibrosum*, crushed, 4 liang).
Cut the six ingredients. Boil in 7 sheng of water to obtain 2.5 sheng. Remove dregs. Divide into three doses. Avoid garlic, pork, amaranth, raw green onions, and raw vegetables. (From Volume 17)