《金匮》云∶疟多寒者，名曰牝疟。赵以德不辨鱼鲁，注为邪在心而为牡。喻嘉言亦为邪伏于心，
心为牡脏，即以寒多热少之疟，名为牡疟。二公皆以牝疟为牡，又皆谓邪藏于心。石
顽已正其非，堪为来学之圭臬也。乃曰∶若系邪气内藏于心，
则但热而不寒，是为瘅疟。此则邪气伏藏于肾，故多寒而少热，则为牝疟。以邪气伏结，则阳气不行于外，
故作外寒。患斯证者，真阳素虚之体为多，缘当盛夏之时，乘凉饮冷，感受阴寒，或受阴湿，其阳不能制阴邪
之胜。故疟发时，寒盛热微，惨戚振栗，病以时作，其脉必沉而迟，面色必淡而白。宜以宣阳
透伏法治之，因寒者姜、附为君，因湿者苍、果为主，日久不愈，温补之法为宜。
痰疟者，因夏月多食瓜果油腻，郁结成痰；或素系痰体，其痰据于太阴脾脏，伏而不发，一旦外感凉风，
痰随风起，变为疟病矣。初发之时，头痛而眩，痰气呕逆，寒热交作，脉来弦滑之象。古谚云∶无痰不作疟，
岂不然乎？宜以化痰顺气法，加草果、藿香治之。如昏迷卒倒者，宜以宣窍导痰法，加浓朴、草
果、苏合香丸治之。肥盛之人，痰药更宜多用。
食疟者，即胃疟也。因于饮食失节，饥饱不常，谷气乖乱，营卫失和，一有不谨，则外邪冒之，遂成疟
疾矣。其证寒已复热，热已复寒，寒热交并，噫气恶食，食则吐逆，胸满腹胀，脉滑有力，或气口紧盛者，宜
以楂曲平胃法，加藿香、草果治之。如脉迟滞，必兼寒也，可加干姜、白蔻。如脉缓钝者，必兼湿也，
可加半夏、茯苓。食疟之证，兼寒兼湿为多，法当分治。
或问曰∶介宾之书，谓疟疾之作，无非外邪为之本，岂果因食因痰有能成疟者耶？据此而论，痰食是为兼
证，今先生专列痰疟、食疟之门何也？丰曰∶素来痰体，加感凉风而致疟者，以痰为本，故曰痰疟。饮食
停积，加受外邪而致疟者，以食
为本，故曰食疟。如前所论暑、风、寒、湿、温、瘴、瘅、牝等疟，倘有头眩呕逆脉滑者，是痰为兼证也；
噫气恶食脉紧者，是食为兼证也，遂不能以痰疟、食疟名之。本证兼证，讵可以不辨哉！
《金匮要略》中说：疟疾中怕冷症状较多的，称为牝疟（以寒为主的疟疾）。赵以德没有分辨清楚文字差异，将其注释为邪气在心而称为牡疟。喻嘉言也认为是邪气伏藏于心，心属于阳脏（牡脏），因此也将寒多热少的疟疾称为牡疟。这两位先生都将牝疟误作牡疟，并且都认为邪气藏于心脏。石顽已经纠正了他们的错误，可以作为后学者的准则。他说：如果确实是邪气内藏于心，那么应该只有发热而没有恶寒，这叫做瘅疟（但热不寒的疟疾）。而这里的病机是邪气伏藏于肾，所以表现为怕冷多而发热少，这才称为牝疟。由于邪气伏结，导致阳气不能运行于体表，所以出现体表发冷的症状。患这种病症的人，大多是真阳素来虚弱的体质，因为在盛夏时节，贪凉饮冷，感受了阴寒之气，或者受了阴湿之邪，体内的阳气不能制约阴邪的亢盛。所以在疟疾发作时，寒冷剧烈而发热轻微，神情凄惨、身体颤抖，疾病按时发作，脉象必定沉而迟，面色必定淡白。治疗应当采用宣通阳气、透达伏邪的方法，如果是因寒邪所致，以干姜、附子为主药；如果是因湿邪所致，以苍术、草果为主药；如果病程日久不愈，则适宜采用温补的方法。
痰疟，是因为夏季多吃瓜果油腻食物，郁结形成痰浊；或者是素来就是痰湿体质，痰浊占据太阴脾脏，潜伏而不发作，一旦外感凉风，痰随风气而动，转变为疟病。刚开始发作时，头痛且眩晕，痰气上逆引起呕吐，寒热交替发作，脉象呈现弦滑之象。古谚语说：“无痰不作疟”，难道不是这样吗？治疗应当采用化痰顺气的方法，加用草果、藿香进行治疗。如果出现昏迷突然跌倒的症状，应当采用开窍导痰的方法，加用厚朴、草果、苏合香丸进行治疗。体型肥胖的人，使用化痰药物更应多用。
食疟，也就是胃疟。是由于饮食不节制，饥饱无常，谷气紊乱，营卫失调，稍有不慎，外邪便乘虚而入，于是形成了疟疾。其症状表现为先冷后热，热退后又变冷，寒热交错，嗳气厌恶进食，进食后则呕吐逆反，胸脘痞满、腹部胀大，脉象滑而有力，或者人迎脉紧盛者，应当采用山楂、神曲平胃散的方法，加用藿香、草果进行治疗。如果脉象迟缓涩滞，必定兼有寒邪，可以加用干姜、白豆蔻。如果脉象缓钝，必定兼有湿邪，可以加用半夏、茯苓。食疟的证候，兼夹寒邪和湿邪的情况较多，治疗方法应当区分对待。
有人问道：“介宾的书里说，疟疾的发生，无非是外邪作为根本原因，难道真的会因为饮食或痰浊而形成疟疾吗？根据这个理论来看，痰和食只是兼夹证候，现在先生专门列出痰疟、食疟的门类，这是为什么呢？”雷丰回答说：“素来就有痰湿体质，加上感受凉风而导致疟疾的，以痰为本源，所以叫痰疟。饮食停积，加上感受外邪而导致疟疾的，以食为本源，所以叫食疟。如前面所论述的暑疟、风疟、寒疟、湿疟、温疟、瘴疟、瘅疟、牝疟等，如果有头晕、呕吐、脉滑等症状的，这是痰作为兼夹证候；如果有嗳气、厌食、脉紧等症状的，这是食作为兼夹证候，就不能称之为痰疟或食疟了。本证与兼证，怎么可以不加以辨别呢！”
According to the *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet): "In malaria where chills are predominant, it is called Pin Malaria (malaria characterized by predominance of cold)." Zhao Yi-de failed to distinguish between similar characters and annotated it as "Mu Malaria" caused by pathogenic factors in the Heart. Yu Jiayan also believed that the pathogen was latent in the Heart; since the Heart is a Yang organ (Mu Zang), he likewise named malaria with more chills than fever as Mu Malaria. Both gentlemen mistakenly identified Pin Malaria as Mu Malaria and both asserted that the pathogen resides in the Heart. Shi Wen has corrected their errors, providing a standard for future students. He stated: "If the pathogenic factor were indeed stored internally in the Heart, there would be only fever without chills, which is termed Dan Malaria (malaria with fever but no chills). In this case, however, the pathogen is latent in the Kidney, hence there are more chills and less fever, thus it is called Pin Malaria. Because the pathogen is latent and bound, Yang Qi cannot circulate to the exterior, resulting in external cold. Patients suffering from this condition mostly have constitutions deficient in True Yang. This is because during midsummer, they indulged in cooling off and drinking cold beverages, contracting Yin-Cold or Yin-Dampness, such that their Yang Qi could not control the dominance of Yin pathogens. Therefore, when the malaria attacks, the cold is severe while the fever is slight, accompanied by a miserable demeanor and trembling/shivering. The illness occurs at regular intervals, the pulse must be deep and slow, and the complexion pale and white. Treatment should employ methods to diffuse Yang Qi and penetrate latent pathogens. If due to Cold, Ginger (*Zingiberis Rhizoma*) and Aconite (*Aconiti Lateralis Radix Praeparata*) are used as chief herbs; if due to Dampness, Atractylodes (*Atractylodis Macrocephalae Rhizoma*) and Tsaoko (*Amomi Fructus*) are used as principal herbs. If the disease persists for a long time without resolution, warming and tonifying methods are appropriate."
Tan Malaria (Phlegm Malaria) arises from excessive consumption of melons, fruits, and greasy foods during summer, leading to stagnation and formation of Phlegm; or it stems from a constitution inherently prone to Phlegm, where Phlegm occupies the Taiyin Spleen, lying latent and dormant. Once exposed to cool wind externally, the Phlegm rises with the wind, transforming into malaria. At the initial onset, symptoms include headache and dizziness, nausea and vomiting due to Phlegm-Qi rebellion, alternating chills and fever, and a string-taut and slippery pulse. An ancient proverb states: "No Phlegm, No Malaria," is this not true? Treatment should utilize methods to resolve Phlegm and regulate Qi, adding Tsaoko (*Amomi Fructus*) and Agastache (*Agastachis Herba*). If coma or sudden collapse occurs, methods to open orifices and guide out Phlegm should be employed, adding Magnolia Bark (*Magnoliae Officinalis Cortex*), Tsaoko (*Amomi Fructus*), and Suhexiang Wan (Styrax Pill). For obese individuals, phlegm-resolving medicines should be used in higher doses.
Shi Malaria (Food Malaria) is also known as Wei Malaria (Stomach Malaria). It results from irregular diet, inconsistent hunger and fullness, disorder of Grain Qi, and disharmony of Ying and Wei (Nutritive and Defensive Qi). With even slight negligence, external pathogens invade, resulting in malaria. Symptoms include alternating chills and fever, belching, aversion to food, vomiting after eating, chest fullness, abdominal distension, a slippery and forceful pulse, or a prominent pulse at the Qi Kou (Radial Artery). Treatment should employ Zhacha Qu Pingwei Method (Hawthorn and Fermented Rice Pill Formula to Calm the Stomach), adding Agastache (*Agastachis Herba*) and Tsaoko (*Amomi Fructus*). If the pulse is slow and stagnant, Cold is likely concurrent; add Dried Ginger (*Zingiberis Rhizoma*) and White Cardamom (*Amomi Rotundus Fructus*). If the pulse is slow and dull, Dampness is likely concurrent; add Pinellia (*Pinelliae Rhizoma*) and Poria (*Poria*). In cases of Food Malaria, concurrent Cold and Dampness are common; treatment methods must differentiate and address them separately.
One might ask: "Mr. Jiabin's book states that the origin of malaria lies solely in external pathogens. Can one truly develop malaria due to food or phlegm? Based on this argument, Phlegm and Food are merely concurrent syndromes. Why does Mr. Lei specifically categorize Tan Malaria and Shi Malaria?" Lei Feng replied: "When a person with an inherent Phlegm constitution contracts cool wind leading to malaria, Phlegm is the root cause, hence it is called Tan Malaria. When food stagnation combined with external pathogen invasion leads to malaria, Food is the root cause, hence it is called Shi Malaria. Regarding the previously discussed Summerheat, Wind, Cold, Dampness, Warmth, Miasma, Dan, and Pin malaria, if symptoms such as dizziness, vomiting, and a slippery pulse appear, Phlegm is a concurrent syndrome; if belching, food aversion, and a tight pulse appear, Food is a concurrent syndrome. In these instances, they cannot be named Tan Malaria or Shi Malaria. One must certainly distinguish between primary syndromes and concurrent syndromes!"