湿疟之证，因于久受阴湿，湿气伏于太阴，偶有所触而发。发则恶寒而不甚热，脉象缓钝而不弦，一身
尽痛而有汗，手足沉重，呕逆胀满者是也。俗谓脾寒，大概指是证耳。此宜宣透膜原法，使其邪化疟除，但
辛燥之剂，于阴亏热体者，须酌用之。阳虚寒体者，更可加老蔻、干姜。所有断截之法，不宜早
用，用之非变膨鼓，即成疟母之 。疟证殊多，总宜分别而治。
江诚曰∶寒疟因寒水伏于肌腠，湿疟因湿气伏于太阴，斯
二疟夏秋皆有，非比暑疟、风疟，受于夏天，发于秋令也。
经谓∶温疟由冬令感受风寒，伏藏于骨髓之中，至春不发，交夏阳气大泄，腠理不致，或有所用力，
伏邪与汗并出，此邪藏于肾，自内而达于外。如是者，阴虚而阳盛，阳盛则热矣。
衰则其气复入，入则阳虚，阳虚生外寒矣。又谓∶先伤于风，后伤于寒，故先热而后寒也，亦以时作，名曰
温疟。温疟之证，先热后寒，其脉阳浮阴弱，或汗多，或汗少，口渴喜凉，宜清凉透邪法治之。如汗多者去
淡豉，加麦冬、花粉。如舌苔化为焦黑者，宜清热保津法治之。嘉言云∶治温疟，当知壮水以救其
阴，恐十数发而阴精尽，尽则真火自焚，顷之死矣。此与香岩论温病，当刻刻护阴之说，不相悖也。凡
有变证，仿春温、风温、温病、温毒门中之法可也。
或问∶温疟得之于冬，发之于夏，何不列于温病之门，或附于热病之后，今列如斯，其意何也？答曰∶
就温字而言，当列于彼，就疟字而论，当附于此，欲使学人，知诸疟有先热后寒，有先寒后热，有寒多热少，
有寒少热多，有独热不寒之各异也。又问∶《金匮》论温疟，谓身无寒但热，今先生论中谓先热
后寒，得毋有违仲景乎？曰∶先热后寒者，遵《内经》之训也。《金匮》谓无寒但热，定系传写之讹。殊
不知但热无寒，乃瘅疟也，不可不为分辨。
湿疟的证候，是由于长期遭受阴湿之气侵袭，湿气潜伏在太阴脾经，偶尔受到触动而发作。发作时表现为怕冷而不怎么发热，脉象缓钝而不弦，全身疼痛且伴有出汗，手足沉重，恶心呕吐、腹胀满闷等。民间所说的“脾寒”，大致指的就是这种病证。对此适宜采用宣透膜原法，使邪气化解、疟疾消除。但是，辛温燥烈的药剂，对于阴液亏损、体内有热的人，必须斟酌使用。对于阳气虚弱、体质偏寒的人，则可以额外加入白豆蔻、干姜。所有用于强行截断疟疾发作的方法，不宜过早使用，否则要么导致腹部胀大如鼓（膨鼓），要么形成疟疾病根形成的包块（疟母）。疟疾的种类很多，总应当辨别清楚后分别治疗。
江诚说：寒疟是因为寒水潜伏在肌肤腠理之间，湿疟是因为湿气潜伏在太阴脾经，这两种疟疾在夏秋两季都会出现，不像暑疟、风疟那样，是在夏天感受病邪，到秋天才发作。
经典医籍记载：温疟是由于冬季感受风寒，邪气潜伏藏匿于骨髓之中，到了春天没有发作，进入夏天后阳气大量外泄，腠理开疏，或者因为用力劳作，潜伏的邪气随着汗液一起排出。这种邪气藏于肾中，从体内达于体表。像这样的情况，属于阴虚而阳盛，阳盛就会发热。当阳气衰退时，其气重新内入，内入则导致阳虚，阳虚就会产生外寒。又记载：先被风邪所伤，后被寒邪所伤，所以先发高热而后发冷，也是按时发作，称为温疟。温疟的证候，是先发热后发冷，脉象寸部浮、尺部弱，或者出汗多，或者出汗少，口渴喜欢喝凉水，适宜用清凉透邪法治之。如果出汗多的，去掉淡豆豉，加入麦冬、天花粉。如果舌苔变成焦黑色的，适宜用清热保津法治之。嘉言说：治疗温疟，应当知道通过滋补肾水来救阴，恐怕经过十几次发作后阴精耗尽，耗尽了真火就会自焚，顷刻间就会死亡。这与香岩论述温病时要时刻保护阴液的说法，并不矛盾。凡是出现变证，可以参照春温、风温、温病、温毒章节中的方法处理。
有人问：温疟是冬天得的病，夏天发的病，为什么不列在温病的门类里，或者附在热病之后，现在这样排列，是什么意思？回答说：就“温”字来说，应当列在那里；就“疟”字来说，应当附在这里，是为了让学习的人知道，各种疟疾有先热后寒的，有先寒后热的，有寒多热少的，有寒少热多的，有只发热不恶寒的，各不相同。又问：《金匮要略》论述温疟，说身体没有寒冷只有发热，现在先生的论述中说先热后寒，难道与张仲景的观点违背吗？回答说：先热后寒，是遵循《黄帝内经》的教诲。《金匮要略》说的无寒但热，肯定是传抄书写时的错误。殊不知只有发热没有恶寒，那是瘅疟，不能不加以分辨。
The syndrome of Damp Malaria (Shi Nue) arises from prolonged exposure to yin-dampness, with dampness lying latent in the Taiyin Spleen meridian, and erupting upon occasional stimulation. Upon eruption, it manifests as aversion to cold without significant fever, a slow and dull pulse rather than a taut one, generalized body pain accompanied by sweating, heaviness in the hands and feet, nausea, vomiting, abdominal distension, and fullness. The common term "Spleen Cold" (Pi Han) generally refers to this syndrome. For this condition, the method of Ventilating and Permeating the Membrane Source (Xuan Tou Mo Yuan Fa) is appropriate to resolve the pathogen and eliminate the malaria. However, acrid and drying agents must be used with caution in patients with Yin deficiency and internal heat. In patients with Yang deficiency and a cold constitution, aged cardamom (Lao Kou) and dried ginger (Gan Jiang) may be added. Methods intended to abruptly arrest malaria attacks should not be employed prematurely; otherwise, they may lead to abdominal distension resembling drumming (Peng Gu) or the formation of a malaria mass (Nue Mu). There are many types of malaria, all of which should be treated according to specific differentiation.
Jiang Cheng stated: Cold Malaria (Han Nue) occurs because cold water lies latent in the muscle-cou li (skin and interstices), while Damp Malaria occurs because dampness lies latent in the Taiyin. These two types of malaria occur in both summer and autumn, unlike Summerheat Malaria (Shu Nue) and Wind Malaria (Feng Nue), which are contracted in summer but manifest in autumn.
The Classics state: Warm Malaria (Wen Nue) results from contracting wind-cold during winter, where the pathogen lies latent in the bone marrow. It does not erupt in spring. When summer arrives, Yang Qi dissipates significantly, the cou li become open, or physical exertion causes the latent pathogen to exit along with sweat. This pathogen, stored in the Kidney, moves from the interior to the exterior. Such cases involve Yin deficiency and Yang excess; Yang excess generates heat. When the Yang Qi declines, it re-enters the interior; interior entry leads to Yang deficiency, which generates external cold. It is also stated: Injury by wind first, followed by injury by cold, results in high fever first and then chills. This occurs at regular intervals and is named Warm Malaria. The syndrome of Warm Malaria features fever preceding chills. The pulse is floating on the Cun (superficial) position and weak on the Chi (deep) position. There may be profuse sweating or scanty sweating, thirst with a preference for cool drinks. The treatment principle is to clear heat and vent the pathogen using a cooling method (Qing Liang Tou Xie Fa). If sweating is profuse, remove Tan Dou Chi (Lightly Fermented Soybean) and add Mai Dong (Ophiopogon Root) and Hua Fen (Trichosanthes Root). If the tongue coating turns scorched black, the method of clearing heat and preserving fluids (Qing Re Bao Jin Fa) is indicated. Jiayan stated: In treating Warm Malaria, one must understand nourishing Water to rescue Yin. Otherwise, after numerous paroxysms, Yin Essence may be exhausted; if exhausted, True Fire will burn itself out, leading to death shortly. This aligns with Xiangyan’s theory on protecting Yin constantly when discussing Warm Diseases (Wen Bing). For any variant syndromes, one may refer to the methods found in the sections on Spring-Warmth (Chun Wen), Wind-Warmth (Feng Wen), Warm Disease (Wen Bing), and Warm Toxin (Wen Du).
A question was raised: Since Warm Malaria is contracted in winter and manifests in summer, why is it not listed under the category of Warm Diseases, or appended after Heat Diseases? What is the rationale for its current placement? The answer is: Regarding the character "Warm," it should be listed there; regarding the character "Malaria," it should be attached here. This is done to enable students to recognize that various malarial syndromes differ: some feature fever preceding chills, others chills preceding fever, some have more cold than heat, some have less cold than heat, and some present with fever only without chills. Another question arose: The *Jin Gui Yao Lue* discusses Warm Malaria, stating there is no cold, only heat. Yet your discussion mentions fever preceding chills. Does this contradict Zhang Zhongjing? The response is: Fever preceding chills follows the teaching of the *Huang Di Nei Jing*. The statement in the *Jin Gui Yao Lue* about "no cold, only heat" is likely a transcription error. One must not fail to distinguish that fever only without chills constitutes Dan Malaria (Dan Nue).