内经云夏伤于暑秋必 疟又云先寒后热者名曰寒疟先热而后寒名曰温疟其但热而不寒者
名曰瘅疟
按内经论疟谓阴阳相并之虚实发为寒热历叙四时及六经五脏与胃之疟以至连日间日发之
早晏最为详尽学人必通考全文以熟玩之
略要云师曰疟脉自弦弦数者多热弦迟者多寒弦小紧者下之差弦迟者可温之弦紧者可发汗
针灸也浮大者可吐之弦数者风发也以饮食消息止之
脉经云疟脉自弦微则为虚代散则死
陈无择云夫疟备三因外则感四气内则动七情饮食饥饱房室劳逸皆能致之经所谓夏伤暑秋
疟
节烦疼胀满自汗善呕因汗出复浴湿舍皮肤及冒雨湿有牝疟者寒多不热但惨戚HT 栗病以时作此
则多感阴湿阳不能制阴也五种疟疾以外感风寒暑湿与卫气相并而成除瘅疟独热温疟先热牝疟
无热外诸疟皆先寒后热内所因证病者以蓄怒伤肝气郁所致名曰肝疟以喜伤心心气耗散所致名
曰心疟以思伤脾气郁涎结所致名曰脾疟以忧伤肺肺气凝痰所致名曰肺疟以失志伤肾所致名曰
肾疟所致之证不同素问此五种疟疾以感气不和郁结痰饮所致不内外因有疫疟者一岁之间长
幼
相似有鬼疟者梦寐不祥多生恐怖有瘴疟者乍热乍寒乍有乍无南方多病有胃疟者饮食饥饱伤胃
而成世谓食疟有劳疟者经年不瘥前后复发微劳不任亦有数年不瘥结成 癖在腹胁名曰老疟亦
曰母疟以上诸证各有方治宜推而用之
按无择有七情感动郁气成疟之论可谓发千古之未发但所集随证施治之方皆是温热脾胃之
剂止
有四兽饮云治五脏气虚结聚涎饮夫以各脏君臣之药补虚泻实之法各各不同岂可以一方通治
七情之疟哉岂欲学人自求之与嗟夫医之为学宋三百年钱仲阳之下一人而已其集方者尚如是欲
使人据证捡方乌可得也
《内经》说：夏季感受暑邪，到了秋季必定发生疟疾。又说：先感到寒冷而后发热的，名叫寒疟；先发热而后感到寒冷的，名叫温疟；只有发热而没有寒感的，名叫瘅疟（但热不寒的疟疾）。
按：《内经》论述疟疾，认为它是阴阳之气相并合导致的虚实变化，从而引发寒热症状。文中详细叙述了四季以及六经、五脏和胃发生疟疾的情况，甚至连每日发作或隔日发作、发作时间早晚等细节都记载得最为详尽。学习中医的人必须通读全文以仔细研读。
《略要》说：老师讲，疟疾的脉象自然呈现弦脉。脉象弦而数的，多属热证；脉象弦而迟的，多属寒证；脉象弦小且紧的，用下法治疗较好；脉象弦迟的可以用温法治疗；脉象弦紧的可以用发汗法或针灸治疗；脉象浮大的可以用吐法治疗；脉象弦数且伴有风热表现的，可以通过饮食调养来止住病情。
《脉经》说：疟疾的脉象自然呈现弦脉。脉微细的表示正气虚弱；脉代（间歇）或散的表示病情危重，预后不良，主死。
陈无择说：疟疾具备三因致病的特点。外因则是感受风、寒、暑、湿四气；内因则是触动喜、怒、忧、思、悲、恐、惊七情。此外，饮食饥饱不均、房事过度、劳累与安逸失度都能导致疟疾。经文所说的“夏伤于暑，秋必疟”，还有节律性的烦疼、胀满、自汗、容易呕吐，是因为出汗后洗澡沾湿皮肤，或者冒雨受湿，湿气停留在皮肤所致。还有一种叫牝疟（寒多热少或但寒不热的疟疾），表现为寒多热少，神情凄惨战栗，按时发作，这多是感受阴湿之邪，阳气不能制约阴邪所致。五种疟疾中，除了瘅疟独热、温疟先热、牝疟无热之外，其他疟疾都是先寒后热，这是由外感风寒暑湿与卫气相并合而成的。内因所致的证候，病者因为暴怒伤肝，导致气机郁结，名叫肝疟；因为喜乐过度伤心，导致心气耗散，名叫心疟；因为思虑过度伤脾，导致脾气郁结、痰涎凝结，名叫脾疟；因为忧伤肺，导致肺气凝滞、生痰，名叫肺疟；因为失意伤肾，名叫肾疟。这些所致证候各不相同。《素问》认为这五种疟疾是由感受气候不和、气机郁结、痰饮内停所致。不属于内因也不属于外因的有：疫疟，一年内老少症状相似；鬼疟，梦境不祥，多产生恐怖感；瘴疟，忽冷忽热，时有时无，南方多见；胃疟，因为饮食饥饱损伤胃气而成，世人称为食疟；劳疟，经年不愈，前后复发，轻微劳作便无法承受；也有数年不愈，结成癖块在腹胁部的，名叫老疟，也叫母疟。以上各种证候各有方药治疗，应当推究其理而使用。
按：陈无择有关于七情扰动、郁气成疟的论述，可以说是发掘了千古以来未曾阐发的道理。但他所收集的随证施治的方剂，都是温热脾胃的药物，仅有四兽饮说是治疗五脏气虚、结聚痰饮的。既然各脏君臣配伍用药、补虚泻实的方法各不相同，怎么能用一个方子通治七情引起的疟疾呢？难道是想让学习者自己去寻求吗？唉！医学作为一门学问，宋朝三百年来，钱仲阳之后只有一人而已（指陈无择），他收集方剂尚且如此，想让人依据证候去查找方剂，怎么可能做到呢？
The *Neijing* (Inner Canon) states: If one is injured by summerheat in the summer, malaria will inevitably occur in autumn. It also states: Those who experience chills first and then fever are named *Han Nue* (Cold Malaria); those who experience fever first and then chills are named *Wen Nue* (Warm Malaria); those who have only fever without chills are named *Dan Nue* (Malaria with Intense Heat).
Commentary: The *Neijing* discusses malaria, stating that it arises from the intermingling of Yin and Yang Qi, leading to deficiency and excess conditions, which manifest as alternating chills and fever. It comprehensively narrates malaria occurring in the four seasons, the Six Channels (Taiyang, Yangming, Shaoyang, Taiyin, Shaoyin, Jueyin), the Five Zang Organs, and the Stomach, down to details such as daily or every-other-day onset, and early or late timing of attacks, which is the most detailed account. Students must study the full text thoroughly to master it.
The *Lüeyao* (Essentials) states: The Master said, "The pulse of malaria is naturally *Xian* (Wiry). A wiry and rapid pulse indicates much heat; a wiry and slow pulse indicates much cold; a wiry, small, and tight pulse suggests that purgation may be appropriate; a wiry and slow pulse can be treated with warming methods; a wiry and tight pulse can be treated with diaphoresis or acupuncture; a floating and large pulse can be treated with emesis; for a wiry and rapid pulse indicating wind-heat, one should use dietary management to resolve it."
The *Maijing* (Pulse Classic) states: "The pulse of malaria is naturally wiry. A faint pulse indicates deficiency; an intermittent or scattered pulse indicates death."
Chen Wuyue stated: "Malaria involves all three categories of etiology. Externally, it results from contracting the Four Qi (Wind, Cold, Summerheat, Dampness); internally, it stems from disturbing the Seven Emotions (Joy, Anger, Worry, Thought, Sorrow, Fear, Fright). Additionally, irregular diet, excessive sexual activity, overwork, or lack of exercise can all cause malaria. The scripture mentions 'summer injury by summerheat leads to autumn malaria.' There are also cases of periodic pain, distension, spontaneous sweating, and frequent vomiting, caused by bathing while sweaty, allowing dampness to remain on the skin, or being caught in rain and dampness. Another type is *Pin Nue* (Yin Malaria/Cold-predominant Malaria), characterized by severe chills with little or no fever, a desolate and shivering state, occurring at regular times. This is mostly due to contracting Yin-dampness, where Yang Qi cannot control Yin. Among the five types of malaria, except for *Dan Nue* (pure heat), *Wen Nue* (fever precedes chills), and *Pin Nue* (no heat), all others present with chills preceding fever. This is caused by external contraction of Wind, Cold, Summerheat, and Dampness merging with Wei Qi (Defensive Qi). Regarding internal causes: anger injuring the Liver causing Qi stagnation is called *Gan Nue* (Liver Malaria); excessive joy injuring the Heart causing Heart Qi dispersion is called *Xin Nue* (Heart Malaria); excessive thinking injuring the Spleen causing Spleen Qi stagnation and phlegm-saliva accumulation is called *Pi Nue* (Spleen Malaria); sorrow injuring the Lung causing Lung Qi condensation and phlegm formation is called *Fei Nue* (Lung Malaria); loss of aspiration injuring the Kidney is called *Shen Nue* (Kidney Malaria). These manifestations differ. The *Suwen* (Plain Questions) attributes these five types to climatic disharmony, Qi stagnation, and phlegm-fluid retention. Not falling into internal or external causes are: *Yi Nue* (Epidemic Malaria), where symptoms are similar among young and old within a year; *Gui Nue* (Ghost Malaria), involving ominous dreams and fear; *Zhang Nue* (Miasma Malaria), with fluctuating hot and cold spells, common in the South; *Wei Nue* (Stomach Malaria), caused by dietary irregularity damaging the Stomach, known as Food Malaria; and *Lao Nue* (Labor Malaria), persisting for years with recurrent episodes, intolerable even to slight labor. Some cases persist for years, forming masses in the abdomen and hypochondrium, called *Lao Nue* or *Mu Nue*. All the above conditions have specific treatments and should be applied after careful deduction.
Commentary: Chen Wuyue’s theory that the Seven Emotions disturb Qi and cause malaria is indeed an unprecedented insight. However, the formulas he collected for treating based on symptoms are all warm-tonifying formulas for the Spleen and Stomach, with only *Si Shou Yin* (Four Beasts Decoction) mentioned for treating Qi deficiency of the Five Zang Organs and accumulated phlegm-fluids. Since the method of tonifying deficiency and draining excess varies according to the minister and sovereign herbs of each organ, how can one formula treat malaria caused by the Seven Emotions? Does he expect students to figure it out themselves? Alas! In three hundred years of Song Dynasty medicine, following Qian Zhongyang, there was only one figure like him. Even his collection of formulas is so limited; expecting practitioners to find formulas based solely on symptoms is impossible.