瘅疟一证，在《内经》曰∶肺素有热，气盛于身，发则阳气盛而不衰，故致消烁脱肉者
，命曰瘅疟。盖此以阳脏而病阳证也，自与诸疟不同。而治此之法有三∶如热邪内蓄，而
表邪未解者，则当散以苦凉；如热因邪致，表虽解而火独盛者，则当清以苦寒，此皆治其有
余也。若邪火虽盛，而气血已衰，真阴日耗者，急宜壮水固元，若但知泻火，则阴日以亡，
必致不救。
瘴疟一证，惟岭南烟瘴之地有之。盖南方风湿不常，人受其邪而致病者，因名瘴疟。然
瘴出地气，疟由天气，但使内知调摄，而外不受邪，则虽居瘴地，何病之有？是可见瘴以地
言，而疟即风寒外感之病也。但其甚者，则或至迷困喑哑，乃与常疟为稍异耳。凡治此者，
亦总不离寒热虚实，及有邪无邪，如前治疟诸法而尽之矣。外如大梁李待诏瘴疟等证，既明
且确，详列瘴气门，不可不察。
仲景曰∶疟脉自弦。弦数者多热，弦迟者多寒。
《机要》曰∶疟有中三阳者，有中三阴者，其证各殊也。在太阳经谓之寒疟，治多汗之
；在阳明经谓之热疟，治多下之；在少阳经谓之风疟，治多和之。此三阳受病，谓之暴疟，
发在夏至后，处暑前，乃伤之浅者。在阴经则不分三经，总谓之湿疟，当从太阴经论之。发
在处暑后，冬至前，此乃伤之重者。
一、古法云∶以清脾饮治秋时正疟，随证加减，大效。若胃中有伏痰郁结者，以草果饮
，一服可愈。
丹溪曰∶邪气深入阴分、血分，而成久疟者，必当用升发药，自脏而出之于腑，然后自
表作汗而解。若用下药，则邪气愈陷而难出矣。
傅氏曰∶疟系外邪，当以汗解。或汗不得出，郁而成痰，宜养胃、化痰、发汗，邪气得
出，自然和也。
刘宗浓曰∶或问∶俗以疟为脾寒，何也？曰∶此亦有理。盖暑盛阳极，人以伏阴在内，脾
困体倦，腠理开发；或因纳凉于水阁木阴，及泉水澡浴，而微寒客于肌肉之间，经所谓遇夏
气凄沧之水寒迫之是也；或劳役饥饱内伤而即病作，故指肌肉属脾，发则恶寒战栗，乃谓之
脾寒耳。实由风寒暑湿之邪，郁于腠理，夏时毛窍疏通而不为病，至秋气收敛之际，表邪不
能发越，故往来寒热，进退不已，病势如凌疟人之状，所以名疟。即如四时伤寒，十二经皆
能为病。古方治法，多兼内伤取效，脾胃和而精气通，则阴阳和解，此实非脾病也。然古人
称疟不得为脾寒者，正恐人专于温脾之说，不明造化之源，而失病机气宜之要故也。
立斋曰∶大凡疟证，皆因先伤于暑，次感于风，客于营卫之间，腠理不密，复遇风寒，
闭而不出，舍于肠胃之外，与营卫并行，昼行于阳，夜行于阴，并则病作，离则病止。并于
阳则热，并于阴则寒。浅则日作，深则间日。在气则早，在血则晏。其病热多寒少，心烦少
睡者，属心，名曰瘟疟，用柴苓汤。但寒少热，腰疼足冷者，属肾，名曰寒疟，用桂附二陈
汤。先寒而后大热，咳嗽者，属肺，名曰瘅疟，用参苏饮。热长寒短，筋脉揪缩者，属肝，
名曰风疟，宜小柴胡加乌药、香附。寒热相停，呕吐痰沫者，属脾，名曰食疟，宜清脾饮。
若中气虚而间日发者，用补中益气汤。若寒热大作，不论先后，此太阳阳明合病。寒热作则
必战，经曰∶热胜则动也。发热则必汗泄。又曰∶汗出不愈，知内热也。
又曰∶凡日久虚疟，寒热不多，或无寒而微热者，若内因胃气虚，用四君加升麻、当归
。若脾血虚，用四君加川芎、当归。若中气下陷，用补中益气加茯苓、半夏。大凡久疟，多
属元气虚寒，盖气虚则寒，血虚则热，胃虚则恶寒，脾虚则发热，阴火下流，则寒热交作。
或吐涎不食，战栗泄泻，手足逆冷，皆脾胃虚弱，但补益中气，则诸证悉愈。凡人久疟，诸
药不效，以补中益气汤内加半夏，用人参一两，煨姜五钱，此不截之截也，一服即愈。若病
久者，须大补元气为主，盖养正邪自除也。
徐东皋曰∶疟疾多因风寒暑湿而得之，乃天之邪气所伤，当以汗解。故仲景、河间悉用
发表之药，但以寒热多少，分经络而治。
瘅疟这一证候，在《内经》中记载说：肺脏原本就有热邪，体内气机亢盛，发作时阳气极盛而衰退缓慢，因此导致身体消瘦、肌肉脱失的症状，这种病被称为瘅疟。这主要是因为患者属于阳热体质而患上了阳热性质的病证，自然与其他类型的疟疾不同。治疗此病的方法有三种：如果热邪内蕴蓄积，而表邪尚未解除的，应当用苦凉的药物来发散；如果是因邪气引发热象，虽然表邪已解但火热独盛的，应当用苦寒的药物来清泻，这两种情况都是治疗其有余之邪。如果邪火虽然旺盛，但气血已经衰弱，真阴日渐耗损的，急需壮水滋阴以固护元气，如果只知道泻火，那么阴气将日渐消亡，必定会导致无法救治的后果。
瘴疟这一证候，只有在岭南烟瘴之地才有。大概是因为南方风湿之气变化无常，人感受了这种邪气而致病，所以称为瘴疟。然而，瘴气源于地气，疟疾源于天气，只要内部懂得调养摄生，外部不受邪气侵袭，那么即使居住在瘴地，又有什么病可患呢？由此可见，瘴是指地理环境而言，而疟疾则是风寒外感类的疾病。只是病情严重的，可能会出现神志迷困、声音嘶哑等症状，这与普通疟疾稍有不同罢了。凡是治疗这类疾病，也不离寒热虚实以及有无邪气的原则，像前面论述治疗疟疾的各种方法都可以涵盖。另外如大梁李待诏所论的瘴疟等证候，既明确又确切，详细列在瘴气门中，不可不仔细考察。
张仲景说：疟疾的脉象自呈弦象。脉弦而数的多属热证，脉弦而迟的多属寒证。
《医学机要》说：疟疾有中三阳经的，有中三阴经的，其症状各不相同。在太阳经发病的称为寒疟，治疗多用发汗法；在阳明经发病的称为热疟，治疗多用攻下法；在少阳经发病的称为风疟，治疗多用和解法。这三阳经受病，称为暴疟，发作在夏至之后、处暑之前，这是邪气侵犯较浅的情况。在阴经发病则不分具体哪一经，总称为湿疟，应当从太阴经来论述。发作在处暑之后、冬至之前，这是邪气侵犯较重的情况。
一、古法云：用清脾饮治疗秋季的正疟，随证加减，效果显著。如果胃中有伏痰郁结的，用草果饮，服一次即可痊愈。
朱丹溪说：邪气深入阴分、血分，形成久疟的，必须使用升发药物，使邪气从脏排出到腑，然后从体表作汗而解。如果使用下药，邪气就会更加深陷而难以排出。
傅氏说：疟疾属于外邪，应当通过发汗来解除。如果汗不得出，郁结而成痰，宜养胃、化痰、发汗，邪气得以排出，自然调和。
刘宗浓说：有人问：世俗认为疟疾是脾寒，为什么呢？回答说：这也是有道理的。大概因为夏季暑气盛大，阳极之时，人体内在伏藏阴气，脾土困顿，身体疲倦，腠理开发；或者因为在水阁木荫下纳凉，以及泉水洗澡，微寒客居于肌肉之间，这就是《内经》所说的遇到夏季凄沧的水寒逼迫所致；或者因为劳役、饥饱内伤而立即发病，所以指肌肉归属于脾，发作时恶寒战栗，就称之为脾寒。实际上是由风寒暑湿之邪，郁结于腠理，夏季毛窍疏通而不发病，到了秋气收敛之际，表邪不能发散，所以往来寒热，进退不已，病势如同凌虐疟疾患者的样子，所以命名为疟。就像四时伤寒一样，十二经都能致病。古方治法，多兼治内伤取效，脾胃调和而精气通畅，则阴阳和解，这实在不是脾本身的病。然而古人称疟疾不能说是脾寒，正是担心人们专注于温脾的说法，不明白造化之源，而失去病机与气候相宜的要领。
薛立斋说：大凡疟疾证候，都是因为先伤于暑，接着感受风邪，客居在营卫之间，腠理不致密，又遇风寒，闭阻而不能外出，停留于肠胃之外，与营卫并行，白天行于阳分，夜晚行于阴分，两者相并则发病，分离则病止。并与阳分则发热，并与阴分则发冷。病位浅则每日发作，病位深则隔日发作。病在气分则发作早，病在血分则发作晚。如果病症表现为热多寒少，心烦少睡的，属于心，名为瘟疟，用柴苓汤。如果仅觉寒冷少热，腰疼足冷的，属于肾，名为寒疟，用桂附二陈汤。先感到寒冷而后出现大热，伴有咳嗽的，属于肺，名为瘅疟，用参苏饮。热长寒短，筋脉拘急收缩的，属于肝，名为风疟，宜用小柴胡汤加乌药、香附。寒热程度相当，呕吐痰沫的，属于脾，名为食疟，宜用清脾饮。如果中气虚弱而隔日发作的，用补中益气汤。如果寒热剧烈发作，不论先后顺序，这是太阳阳明合病。寒热发作时必定寒战，经文说：热胜则动。发热则必定出汗。又说：汗出后病不愈，说明内有热邪。
薛立斋又说：凡是日久形成的虚疟，寒热不多，或者没有寒冷而仅有微热的，如果内因胃气虚弱，用四君子汤加升麻、当归。如果脾血虚弱，用四君子汤加川芎、当归。如果中气下陷，用补中益气汤加茯苓、半夏。大凡久疟，多属于元气虚寒，因为气虚则寒，血虚则热，胃虚则恶寒，脾虚则发热，阴火下流，则寒热交替发作。或者吐涎水不进食，战栗泄泻，手足逆冷，这都是脾胃虚弱，只要补益中气，各种症状都会痊愈。凡人患久疟，诸药无效，在补中益气汤内加半夏，用人参一两，煨姜五钱，这是不强行截断却达到截断效果的方法，服一次即愈。如果病程长久的，必须以大补元气为主，因为养护正气邪气自然消除。
徐东皋说：疟疾多因风寒暑湿而得病，乃天之邪气所伤，应当通过发汗来解除。所以张仲景、刘河间都使用发表的药物，只是根据寒热多少的不同，区分经络进行治疗。
Dan-malaria (Febrile Malaria) is a syndrome described in the *Neijing* (Classic of Internal Medicine): "The lungs possess heat by nature, and qi is abundant throughout the body. Upon onset, yang qi becomes excessive and fails to recede, leading to emaciation and wasting of flesh; this is termed Dan-malaria." This occurs because the patient has a yang-constituted body suffering from a yang-type disease, which differs from other types of malaria. There are three treatment methods for this condition: If heat pathogen is accumulated internally while exterior pathogen remains unresolved, bitter-cool herbs should be used to disperse it; if heat arises due to pathogenic influence, and although the exterior is resolved, fire alone is rampant, bitter-cold herbs should be used to clear it. Both these approaches treat excess conditions. However, if although evil-fire is strong, qi and blood have already declined, and true yin is daily consumed, urgent measures to nourish water (yin) and consolidate yuan (original qi) are required. If one only knows how to purge fire, yin will perish day by day, inevitably leading to untreatable conditions.
Zhang-malaria (Miasma Malaria) occurs only in the miasma-prone regions of Lingnan. This is likely because wind-dampness in the south is irregular; when people contract this pathogen and become ill, it is named Zhang-malaria. However, miasma originates from earth qi, while malaria originates from heaven qi. If one knows internal regulation and prevention, and avoids external pathogens, what illness could there be even living in miasma regions? Thus, "zhang" refers to geography, whereas "malaria" is a disease of external contraction of wind-cold. Only in severe cases might confusion or aphonia occur, slightly differing from common malaria. Treatment generally adheres to principles of cold/heat, deficiency/excess, and presence/absence of pathogen, utilizing previous methods for treating malaria. For instance, Li Daizhao's detailed account of Zhang-malaria in the "Gate of Miasma" chapter must be carefully examined.
Zhang Zhongjing stated: "The pulse of malaria is naturally wiry (Xian). A wiry and rapid pulse indicates much heat; a wiry and slow pulse indicates much cold."
The *Jiyao* (Essentials of Mechanism) states: "Malaria can affect the Three Yang meridians or the Three Yin meridians, presenting distinct symptoms. When affecting the Taiyang meridian, it is called Han-malaria (Cold Malaria), treated mostly with sweating methods; when affecting the Yangming meridian, it is called Re-malaria (Heat Malaria), treated mostly with purgative methods; when affecting the Shaoyang meridian, it is called Feng-malaria (Wind Malaria), treated mostly with harmonizing methods. Disease in these Three Yang meridians is called Bao-malaria (Acute Malaria), occurring after Summer Solstice and before End of Heat, indicating shallow invasion. Disease in Yin meridians is collectively called Shi-malaria (Damp Malaria), discussed under the Taoyin meridian. It occurs after End of Heat and before Winter Solstice, indicating heavy invasion."
1. Ancient methods state: Use Qingpi Yin (Clear the Spleen Decoction) to treat regular autumn malaria, modifying according to symptoms, yielding great efficacy. If latent phlegm stagnates in the stomach, Caoguo Yin (Tsaiko Fruit Decoction) cures it in one dose.
Zhu Danxi said: "When pathogen penetrates deep into yin and blood levels, forming chronic malaria, uplifting and dispersing herbs must be used to move pathogen from zang to fu, then release via sweating. Using purgatives causes pathogen to sink deeper and become difficult to expel."
Fu Shi said: "Malaria is an external pathogen, to be resolved by sweating. If sweat cannot emerge, stagnation creates phlegm; one should nourish the stomach, resolve phlegm, and induce sweating. Once pathogen exits, harmony returns naturally."
Liu Zongnong said: "Someone asked: Why do common people consider malaria as 'Spleen Cold'? I replied: There is logic here. During summer, extreme heat prevails; humans harbor latent yin internally. The spleen becomes sluggish, the body weary, and pores open. Or, cooling off in pavilions or bathing in springs allows slight cold to lodge in muscles, as described in the classics regarding cold water oppression in summer. Or, labor and dietary injury trigger immediate onset. Since muscles belong to the spleen, chills and rigors upon onset lead to the name 'Spleen Cold.' Actually, wind-cold-damp-heat pathogens stagnate in the interstices. In summer, pores are open so no disease occurs; in autumn, when qi converges, exterior pathogens cannot vent, causing alternating chills and fever. The severity mimics tormenting parasites, hence the name 'Malaria.' Just as four-season cold injuries affect all twelve meridians, ancient formulas often address internal injury simultaneously. Harmonizing spleen and stomach unblocks essence and qi, reconciling yin and yang; this is truly not a spleen disease. However, ancients denied 'Spleen Cold' to prevent exclusive focus on warming the spleen, ignoring the source of creation and the importance of matching pathology with climatic appropriateness."
Xue Lizhai said: "Generally, malaria arises from initial summer-heat injury followed by wind contraction, lodging between Ying and Wei levels. With loose interstices, wind-cold closes pathways, preventing exit, settling outside the intestines and stomach, moving with Ying and Wei—daytime in Yang, nighttime in Yin. Conjunction causes illness; separation stops it. Joining Yang causes heat; joining Yin causes cold. Shallow involvement leads to daily attacks; deep involvement leads to alternate-day attacks. Qi-level onset is early; Blood-level onset is late. Symptoms of more heat than cold, irritability, and insomnia belong to the Heart, named Wen-malaria (Plague Malaria), treated with Chai Ling Tang. Symptoms of slight cold, less heat, lower back pain, and cold feet belong to the Kidney, named Han-malaria (Cold Malaria), treated with Guifu Erchen Tang. Initial chills followed by high fever and cough belong to the Lung, named Dan-malaria (Febrile Malaria), treated with Rensu Yin. Prolonged heat, short chills, and muscle spasms belong to the Liver, named Feng-malaria (Wind Malaria), treated with Xiao Chai Hu Tang plus Wuyao and Xiangfu. Equal chills and heat with vomiting of phlegm belong to the Spleen, named Shi-malaria (Food Malaria), treated with Qingpi Yin. If Middle Qi is deficient causing alternate-day attacks, use Buzhong Yiqi Tang. Severe chills and heat regardless of sequence indicate combined Taiyang-Yangming disease. Rigors during attacks confirm 'Heat dominance causes movement.' Fever causes sweating. If sweating fails to cure, internal heat is confirmed."
He further stated: "For chronic deficiency malaria with mild or absent chills and slight fever: if Stomach Qi is deficient, use Sijunzi Tang plus Shengma and Danggui; if Spleen Blood is deficient, use Sijunzi Tang plus Chuanxiong and Danggui; if Middle Qi sinks, use Buzhong Yiqi Tang plus Fuling and Banxia. Chronic malaria usually involves Yuan Qi deficiency and cold. Qi deficiency causes cold; Blood deficiency causes heat; Stomach deficiency causes aversion to cold; Spleen deficiency causes fever; descending Yin fire causes alternating chills and heat. Saliva spitting, anorexia, rigors, diarrhea, and cold extremities indicate Spleen-Stomach weakness; tonifying Middle Qi resolves all symptoms. For chronic malaria unresponsive to other drugs, add Banxia to Buzhong Yiqi Tang, using 1 liang of Renshen and 5 qian of roasted ginger. This achieves interception without forceful suppression, curing in one dose. For long-standing illness, major tonification of Yuan Qi is primary, as nurturing righteousness eliminates pathogen."
Xu Donggao said: "Malaria is mostly caused by wind-cold-summer-heat-dampness, injuring Heaven's pathogenic qi, requiring resolution through sweating. Thus, Zhang Zhongjing and Liu Hejian all used releasing-surface herbs, differentiating treatment based on channel involvement determined by the degree of cold and heat."