经曰∶ 疟皆生于风。又曰∶夏伤于暑，秋必 疟。夫风与暑阳邪也，寒与水阴邪也。然风为阳中之凉气，
暑为热中之寒邪，合是四者而言，无非皆属乎寒，故俗号为脾寒，谓病邪客于肌肉之间，而脾应肉也。及疟之
将发，必先手足厥冷，以脾主四肢也。经言暑者，言时气也；寒者，言病气也。虽邪气自浅而深，郁寒成热，
然终不免寒为本，热为标耳。久而不解，纵实变虚，非大补真气，大健脾胃，莫能瘳也。
疟必有寒有热，盖外邪伏于半表半里，正在少阳所主之界。出与阳争，阴胜则寒；入与阴争，阳胜则热。
即纯热无寒为温疟，纯寒无热为牡疟，要皆自少阳而造其极偏，故补偏救弊，亦必还返少阳之界，使阴阳协和，
而后愈也。谓少阳而兼他经则有之，谓他经而不涉少阳，则不成其为疟矣。疟之不离乎少阳，如咳嗽之不离于肺
也。
凡小儿触冒风寒暑湿，客于皮肤，积于脏腑，邪正相攻，阴阳偏胜，发为寒热往来。阳不足则先寒后热，
阴不足则先热后寒。寒多热少者，阴胜阳也；热多寒少者，阳胜阴也；阴阳互攻，则寒热相半。其初也，必内
有痰食，致脏气不流，故发而为疟。
疟之正发有定期，其间有一日，间日、二三日者。此脏气有盛衰，邪之轻重不等也。发于夏至后处暑前者，
三阳受病，伤之浅而暴也；发于处暑后冬至前者，三阴受病，伤之远而深也。发在子后午前者，阳分受病易愈；
发在午后子前者，阴分受病难愈。尤当以寒热多寡，禀受强弱而参之，则得矣。
疟疾之证，始而呵欠，继而足冷，面色青黄，身体拘急战栗，头项腰脊俱痛，寒去未已，内外皆热，头痛
而渴，但欲饮水，呕恶烦满而不嗜食者，皆其候也。由小儿脾胃素弱，邪气得以乘之，虽有寒热虚实之不同，
然要不离乎脾胃。其证亦有五，乃风寒暑湿食也。治法之要，宜分国中末而治之。初则截之，谓邪气国中，正
气未伤，略与疏解，则驱之使去，不可养以为患也；中则和之，谓邪气渐入，正气渐伤，或于补中加截药，或
于截中加补药，务适其中，以平为期；末用补法，谓邪久不去，正气已衰，当补其脾胃为主，使正气复强，则邪
不攻自退矣。
一、风疟，因感风得之，恶风自汗，烦渴头疼。风，阳也，故先热后寒。初时宜发散，桂枝白术汤；不退，
小柴胡加常山、槟榔、乌梅截之；久而不退，补中益气汤多服自愈。
一、寒疟，因感寒得之，无汗恶寒，挛急面惨。寒，阴也，故先寒后热。宜发散寒邪，养胃汤加桂心；不
止，平胃散加槟榔、草果截之；久不止，六君子汤加姜、桂。
一、暑疟，因伤暑得之，阴气独微，阳气独发，但热不寒，烦渴少睡，呕恶时见，肌肉消烁。宜解暑毒，
柴胡白虎汤；不止，去石膏加贝母、常山、槟榔截之；久不止，补中益气汤。
一、湿疟，因冒袭雨湿，汗出澡浴，坐卧湿地得之。身体重痛，肢节烦疼，呕逆胀满，胃苓汤；不退，平
胃散加茯苓、槟榔、常山截之；久不止，参苓白术散。
一、食疟，一名痰疟，由饮食不节，饥饱有伤然也。凡食啖生冷鱼肉油腻之物，以致中脘停痰，皆为食疟。
其候饥不欲食，食则中满，呕逆腹痛，宜去其食，四兽饮；不止，以二陈汤送红丸子；久不止，六君子汤加青
皮、姜、桂。
有疟痢并作者，初用小柴胡加当归、白芍、槟榔以解表导滞；不已，六君子汤加桂枝。
疟后肿，此病极多。胃苓丸、五皮汤下；不消，六君子汤加姜、桂、砂仁，四肢冷者，加附子。
疟后食少黄瘦，不长肌肉者，将欲成疳，
但以平疟养脾丸调之，多服自愈。
有夜疟，此邪在血分，宜麻黄桂枝汤加地黄、红花。不止，以四物汤合小柴胡汤加升麻，提出阳分，用四
君汤加常山、乌梅、槟榔截之。
《黄帝内经》说：疟疾都是由风邪引起的。又说：夏天被暑气所伤，到了秋天必定会患疟疾。风和暑属于阳邪，寒和水属于阴邪。然而，风是阳气中的凉气，暑是热邪中的寒邪（注：此处指暑季多雨湿或贪凉饮冷致寒），综合这四种因素而言，无不归属于寒的范畴，所以民间俗称其为“脾寒”，意思是病邪停留在肌肉之间，而脾主肌肉的缘故。等到疟疾将要发作时，一定先出现手脚冰凉，这是因为脾主四肢的缘故。经文所说的“暑”，是指当时的气候；所说的“寒”，是指疾病的性质。虽然病邪由浅入深，郁结的寒气化为热象，但最终仍然免不寒为本、热为标。如果病情迁延不愈，即使实证转为虚证，如果不是大补真气、大力健运脾胃，是不能治愈的。
疟疾一定有寒战和发热，这是因为外邪潜伏在半表半里之间，正是少阳经所主的区域。邪气外出与阳气相争，阴气胜则发冷；邪气内入与阴气相争，阳气胜则发热。即使是纯热无寒的温疟，或纯寒无热的牡疟，也都是从少阳经发展至极偏的状态，所以要纠正偏颇、补救弊端，也必须使其回归少阳经的平衡状态，使阴阳和谐，然后才能痊愈。可以说少阳经兼及其他经络的情况是有的，但如果说其他经络发病而不涉及少阳经，那就不能称之为疟疾了。疟疾离不开少阳经，就像咳嗽离不开肺脏一样。
凡是小儿触犯风寒暑湿，邪气客居在皮肤，积聚在脏腑，邪气与正气相互攻伐，导致阴阳偏盛，从而引发寒热往来。阳气不足则先冷后热，阴气不足则先热后寒。寒多热少的，是阴胜阳衰；热多寒少的，是阳胜阴衰；阴阳互相攻伐，则寒热各占一半。在初期，必然体内有痰食停滞，导致脏腑之气运行不畅，所以发作成为疟疾。
疟疾的正发时间有规律，间隔有一天、一天或两天、两三天不等。这是脏腑之气有盛有衰，邪气轻重不同的缘故。在夏至后、处暑前发作的，是三阳经受病，受伤浅且急暴；在处暑后、冬至前发作的，是三阴经受病，受伤远且深沉。在子时后、午时前发作的，是阳分受病，容易治愈；在午时后、子时前发作的，是阴分受病，难以治愈。尤其应当结合寒热多少、患儿体质强弱来综合分析，就能掌握要领了。
疟疾的症状，开始时打哈欠，接着脚发冷，面色青黄，身体拘挛紧急并战栗，头项腰脊都疼痛，寒冷感未退尽，内外都发热，头痛且口渴，只想喝水，呕吐恶心、心烦腹满且不思饮食的，都是其征候。由于小儿脾胃素来虚弱，邪气得以乘虚而入，虽然有寒热虚实等不同表现，但总归离不开脾胃。其证候也有五种，即风、寒、暑、湿、食所致。治疗的关键，应当分为初、中、末三个阶段来治疗。初期要截断病势，意思是邪气尚在中焦，正气未受损，稍微给予疏解，就能驱除邪气，不可留养它成为祸患；中期要调和，意思是邪气逐渐深入，正气逐渐受损，或者在补益中加入截疟药，或者在截疟中加入补益药，务必适中，以平衡为标准；末期用补法，意思是邪气久留不去，正气已经衰弱，应当以补益脾胃为主，使正气恢复强大，那么邪气不攻自退了。
一、风疟，因感受风邪所致，怕风自汗，烦躁口渴头疼。风属阳，所以先热后寒。初期宜发散，用桂枝白术汤；如果不退，用小柴胡汤加常山、槟榔、乌梅来截断病势；如果久而不退，服用补中益气汤，多服即可自愈。
一、寒疟，因感受寒邪所致，无汗怕冷，肢体拘挛紧急面色惨白。寒属阴，所以先寒后热。宜发散寒邪，用养胃汤加桂心；如果不止，用平胃散加槟榔、草果来截断病势；如果久不止，用六君子汤加生姜、肉桂。
一、暑疟，因伤暑所致，阴气单独微弱，阳气单独亢盛，只发热不恶寒，烦躁口渴睡眠少，偶尔呕吐恶心，肌肉消瘦。宜解除暑毒，用柴胡白虎汤；如果不止，去掉石膏加贝母、常山、槟榔来截断病势；如果久不止，用补中益气汤。
一、湿疟，因冒雨涉水、出汗后洗澡、坐卧湿地所致。身体沉重疼痛，关节烦疼，呕吐逆气腹胀，用胃苓汤；如果不退，用平胃散加茯苓、槟榔、常山来截断病势；如果久不止，用参苓白术散。
一、食疟，又名痰疟，是由于饮食不节制，饥饱失调造成的。凡是吃了生冷鱼肉油腻之物，导致中脘停聚痰湿，都称为食疟。其症状是饥饿但不想吃东西，吃了就胃脘胀满，呕吐逆气腹痛，宜消导食积，用四兽饮；如果不止，用二陈汤送服红丸子；如果久不止，用六君子汤加青皮、生姜、肉桂。
有疟疾与痢疾同时发作的，初期用小柴胡汤加当归、白芍、槟榔以解表导滞；如果不愈，用六君子汤加桂枝。
疟疾后出现浮肿，这种病非常多见。用胃苓丸、五皮汤服用；如果不消退，用六君子汤加生姜、肉桂、砂仁，四肢冷的，加附子。
疟疾后食欲减退、面色萎黄消瘦，不长肌肉的，即将形成疳积，只用平疟养脾丸调理，多服即可自愈。
有夜疟，这是邪气在血分，宜用麻黄桂枝汤加地黄、红花。如果不止，用四物汤合小柴胡汤加升麻，将邪气提出到阳分，再用四君子汤加常山、乌梅、槟榔来截断病势。
The *Yellow Emperor's Inner Canon* states: Malaria all originates from wind pathogens. It also states: If one is injured by summer heat in summer, malaria will inevitably occur in autumn. Wind and summer heat are yang pathogens, while cold and water are yin pathogens. However, wind is the cool qi within yang, and summer heat is the cold pathogen within heat (referring to the accumulation of cold-dampness or internal cold due to excessive cooling). Considering these four factors together, they all belong to the category of cold. Therefore, it is commonly known as "Spleen Cold," meaning the pathogen resides between the muscles, and since the Spleen governs the muscles, this is the reason. When malaria is about to erupt, there must first be cold extremities, because the Spleen governs the four limbs. The scripture mentions "summer heat" to refer to the seasonal climate; it mentions "cold" to refer to the nature of the disease. Although the pathogen moves from superficial to deep levels, and stagnant cold transforms into heat, ultimately, cold remains the root and heat is the branch. If the condition persists unresolved, even if excess transforms into deficiency, without greatly tonifying true qi and vigorously strengthening the Spleen and Stomach, it cannot be cured.
Malaria must involve both chills and fever, because external pathogens lie dormant at the half-exterior and half-interior level, which is precisely the domain governed by the Shaoyang (Lesser Yang) channel. When the pathogen emerges and contends with yang, yin prevails and causes chills; when it enters and contends with yin, yang prevails and causes fever. Even in Warm Malaria (Wen Nue), characterized by pure heat without chills, or in Male Malaria (Mu Nue), characterized by pure cold without fever, all originate from the Shaoyang channel and reach an extreme deviation. Therefore, to correct the deviation and remedy the defect, one must return to the balance of the Shaoyang channel, harmonizing yin and yang, before recovery can occur. It is possible for Shaoyang to involve other channels, but if other channels are involved without touching Shaoyang, it cannot be considered malaria. Malaria's inseparability from Shaoyang is like cough's inseparability from the Lung.
Whenever children are exposed to wind, cold, summer heat, and dampness, the pathogen lodges in the skin and accumulates in the zang-fu organs. Pathogenic factors and healthy qi attack each other, causing an imbalance of yin and yang, leading to alternating chills and fever. If yang is insufficient, chills precede fever; if yin is insufficient, fever precedes chills. More chills than fever indicates yin prevailing over yang; more fever than chills indicates yang prevailing over yin; if yin and yang attack each other mutually, chills and fever are equal. In the initial stage, there is invariably phlegm and food stagnation internally, causing the qi of the zang-fu organs to fail to circulate freely, thus manifesting as malaria.
The timing of malaria attacks is regular, occurring daily, every other day, or every two to three days. This depends on the flourishing or declining state of the zang-fu qi and the severity of the pathogen. Attacks occurring after the Summer Solstice and before the End of Heat (Chushu) indicate disease in the Three Yang channels, representing a shallow and acute injury. Attacks occurring after the End of Heat and before the Winter Solstice indicate disease in the Three Yin channels, representing a distant and deep injury. Attacks occurring after Zi hour (11 PM-1 AM) and before Wu hour (11 AM-1 PM) indicate disease in the yang aspect, which is easier to cure. Attacks occurring after Wu hour and before Zi hour indicate disease in the yin aspect, which is difficult to cure. One must especially consider the proportion of chills and fever, as well as the strength of the constitution, to grasp the essence.
The symptoms of malaria begin with yawning, followed by cold feet, a bluish-yellow complexion, stiff and spasmodic body with shivering, pain in the head, neck, waist, and spine. As the chills subside but have not fully ceased, both interior and exterior become hot, accompanied by headache, thirst, desire only to drink water, nausea, vomiting, vexation, abdominal fullness, and loss of appetite. These are all signs. Because children's Spleen and Stomach are inherently weak, pathogens take advantage of this. Although manifestations vary among cold, heat, excess, and deficiency, they fundamentally do not depart from the Spleen and Stomach. There are five types of syndromes: those caused by wind, cold, summer heat, dampness, and food. The key to treatment lies in addressing the early, middle, and late stages separately. In the early stage, intercept the pathogen: when the pathogen is in the middle jiao and healthy qi is unharmed, slight dispersal allows expulsion of the pathogen; do not nourish it to allow harm. In the middle stage, harmonize: as the pathogen gradually enters and healthy qi gradually declines, either add anti-malarial herbs to tonifying formulas or add tonifying herbs to anti-malarial formulas, aiming for balance. In the late stage, use tonification: when the pathogen lingers and healthy qi is depleted, focus on tonifying the Spleen and Stomach so that when healthy qi recovers strongly, the pathogen retreats spontaneously.
1. Wind Malaria: Caused by contracting wind, presenting with aversion to wind, spontaneous sweating, vexation, thirst, and headache. Wind is yang, so fever precedes chills. Initially, use dispersing methods: Guizhi Baizhu Tang (Cinnamon Twig and Atractylodes Macrocephala Decoction). If unresolved, use Xiaochaihu Tang (Minor Bupleurum Decoction) plus Changshan (Polygala Root), Binglang (Areca Seed), and Wumei (Mume Fruit) to intercept. If persistent long-term, consume Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) frequently until self-healed.
2. Cold Malaria: Caused by contracting cold, presenting with no sweat, aversion to cold, spasms, and pale face. Cold is yin, so chills precede fever. Use methods to disperse cold pathogens: Yangwei Tang (Nourish the Stomach Decoction) plus Guixin (Cinnamon Heart). If persistent, use Pingwei San (Level the Stomach Powder) plus Binglang (Areca Seed) and CaoGuo (Tsaoko Cardamom) to intercept. If long-term persistent, use Liujunzi Tang (Six Gentlemen Decoction) plus Shengjiang (Fresh Ginger) and Rgui (Aconite Lateral Root).
3. Summer Heat Malaria: Caused by summer heat injury, where yin qi is alone weak and yang qi alone flares, presenting with only heat without chills, vexation, thirst, poor sleep, occasional nausea/vomiting, and muscle wasting. Resolve summer heat toxicity: Chaihu Baihu Tang (Bupleurum and White Tiger Decoction). If persistent, remove Shigao (Gypsum Fibrosum), add Beimu (Fritillaria Bulb), Changshan (Polygala Root), and Binglang (Areca Seed) to intercept. If long-term persistent, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction).
4. Damp Malaria: Caused by exposure to rain/dampness, bathing after sweating, or sitting/lying on wet ground. Presents with heavy and painful body, vexatious joint pain, vomiting, regurgitation, and abdominal distension. Use Weiling Tang (Stomach and Lingzhi Decoction). If unresolved, use Pingwei San (Level the Stomach Powder) plus Fuling (Poria), Binglang (Areca Seed), and Changshan (Polygala Root) to intercept. If long-term persistent, use Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder).
5. Food Malaria: Also called Phlegm Malaria, caused by irregular diet and damage from hunger/fullness. Consuming raw/cold foods, fish/meat, or greasy substances leads to phlegm retention in the Zhongwan (Middle Jiao), constituting Food Malaria. Symptoms include hunger without desire to eat, abdominal fullness after eating, vomiting, regurgitation, and abdominal pain. Eliminate food stagnation: Six Beasts Drink (Sishou Yin). If persistent, administer Hongwanzi (Red Pill) delivered by Erchen Tang (Two Aged Substances Decoction). If long-term persistent, use Liujunzi Tang (Six Gentlemen Decoction) plus Qingpi (Aurantii Fructus Pericarpium), Shengjiang (Fresh Ginger), and Rgui (Aconite Lateral Root).
When malaria and dysentery occur simultaneously, initially use Xiaochaihu Tang (Minor Bupleurum Decoction) plus Danggui (Angelica Sinensis), Baishao (White Peony Root), and Binglang (Areca Seed) to release the exterior and guide out stagnation. If unresolved, use Liujunzi Tang (Six Gentlemen Decoction) plus Guizhi (Cinnamon Twig).
Post-malaria edema is very common. Treat with Weiling Wan (Stomach and Lingzhi Pills) or Wupi Tang (Five Peel Decoction). If swelling does not resolve, use Liujunzi Tang (Six Gentlemen Decoction) plus Shengjiang (Fresh Ginger), Rgui (Aconite Lateral Root), and Sharen (Amomum Fruit); if limbs are cold, add Fuzi (Prepared Aconite Lateral Root).
Post-malaria poor appetite, yellow sallow complexion, emaciation, and failure to gain muscle indicate impending consumption syndrome (Gan Ji). Regulate with Pingmaiyang Pi Wan (Stop Malaria and Nourish Spleen Pills); frequent administration leads to self-healing.
Night Malaria: The pathogen is in the blood aspect. Use Mahuang Guizhi Tang (Ephedra and Cinnamon Twig Decoction) plus Dihuang (Rehmannia Root) and Honghua (Carthamus Flower). If unresolved, combine Siwu Tang (Four Substances Decoction) with Xiaochaihu Tang (Minor Bupleurum Decoction) plus Shengma (Cimicifuga Rhizome) to raise the pathogen to the yang aspect. Then use Sijunzi Tang (Four Gentlemen Decoction) plus Changshan (Polygala Root), Wumei (Mume Fruit), and Binglang (Areca Seed) to intercept.