解表之剂
仲景白虎加桂枝汤治温疟
知母(六两) 甘草(二两炙) 石膏(一斤碎) 桂枝(三两) 粳米(六合)
上咀以水一斗二升煮米熟去滓煎至三升温服一升日三服汗出愈
按此太阳阳明经药也
柴胡桂姜汤治寒多微有热或但寒不热名曰牝疟
柴胡(八两) 桂枝 黄芩(各二两) 栝蒌根(四两) 牡蛎 甘草(炙) 干姜(各二两)
上咀水煎服一升日三初烦汗出愈
按此少阳太阳经药也
机要桂枝羌活汤治疟处暑以前发头项痛脉浮恶风有汗
桂枝 羌活 防风 甘草(各半两)
上为粗末每服半两水一盏半煎至一盏温服清迎发而服之如吐加半夏曲
麻黄羌活汤活证如前恶风无汗
麻黄(去节) 羌活 防风 甘草(各半两)
上如前服加法同
按以上二方太阳经药也
治疟病身热目痛热多寒少脉长先以大柴胡下之微利为度后余热不尽者当服白芷汤以尽其
邪
白芷(一两) 知母(一两七钱) 石膏(四两)
上粗末根据前服
按此阳明经药也
桂枝芍药汤治疟寒热大作不论先后此太阳阳明合病也谓之大争寒热作则必战经曰热胜而
动也
发热则必汗泄经曰汗出不愈知内热也阳盛阴虚之证当内实外虚不治恐久而传阴经也此汤主之
桂(三钱) 黄 知母 石膏 芍药(各一两)
上粗末每服五钱加至一两水煎
按此太阳阳明经药也
桂枝黄芩汤如服前药转大者知三阳合病也宜此和之
柴胡(一两二钱) 黄芩 人参 甘草(各四钱半) 半夏(四钱) 石膏 知母(各五钱)
桂枝(二钱)
上为粗末根据前服之前服此药已如外邪已罢内邪未已再服下药从卯至午发者宜大柴胡下之
从午
至酉发者知其邪气在内也宜大承气下之从酉至子发者或至寅发者知其邪气在血也宜桃仁承气
下之微利后更以小柴胡彻其邪气可也
按此太阳阳明少阳经药也以上诸方并系发风寒暑热之气自外而入中于三阳之经者也
桂枝石膏汤治疟无他证隔日发先寒后热寒少热多
桂枝(五钱) 石膏(一两半) 知母(一两半) 黄芩(一两)
上为粗末分三服水煎服
按此太阳阳明经药也治隔日发则邪气所含深者也
麻黄黄芩汤治疟发如前证而夜发者
麻黄(一两去节) 甘草(炙三钱) 桃仁(三十个去皮尖) 桂(二钱) 黄芩(五钱)
上为细末根据前服桃仁味苦甘辛肝者血之海血骤则肝气燥经所谓肝苦急急食甘以缓之故桃
仁散血缓肝谓邪气深远而入血故夜发乃阴经有邪此汤发散血中风寒之剂
按此治风暑深入阴分而夜发乃血受病邪气所舍尤深者也麻黄桂枝桃仁等乃太阳经血药也
非三阴经药也
解表类方剂
张仲景的白虎加桂枝汤用于治疗温疟。
药物组成：知母（六两）、炙甘草（二两）、石膏（一斤，捣碎）、桂枝（三两）、粳米（六合）。
制法与服法：将药材切碎，用水一斗二升煎煮，待米熟后滤去药渣，继续煎至剩余三升，每次温服一升，每日服用三次，服药后汗出即愈。
按语：此方属于太阳经和阳明经的药物组合。
柴胡桂姜汤用于治疗寒多热少，或仅有寒而无热的疟疾，这种病证称为牝疟（阴疟）。
药物组成：柴胡（八两）、桂枝、黄芩（各二两）、天花粉（栝蒌根，四两）、牡蛎、炙甘草、干姜（各二两）。
制法与服法：将药材切碎，加水煎煮，每次服一升，每日三次。初服时感到烦渴，随后出汗即愈。
按语：此方属于少阳经和太阳经的药物组合。
《医学机要》中的桂枝羌活汤用于治疗在处暑节气之前发作的疟疾，症状表现为头项疼痛、脉浮、恶风、有汗。
药物组成：桂枝、羌活、防风、甘草（各半两）。
制法与服法：将药材制成粗末，每次取半两，加水一盏半，煎至一盏，趁温热在疟疾发作前服用。如果患者呕吐，加入半夏曲。
麻黄羌活汤适用于上述证候，但表现为恶风且无汗的情况。
药物组成：麻黄（去节）、羌活、防风、甘草（各半两）。
制法与服法：制法与服法同前。
按语：以上两个方剂均属于太阳经的药物组合。
治疗疟疾病症，若身体发热、目痛、热多寒少、脉长，应先使用大柴胡汤进行攻下，以轻微腹泻为度。若之后余热未尽，应当服用白芷汤以清除残余邪气。
药物组成：白芷（一两）、知母（一两七钱）、石膏（四两）。
制法与服法：将药材制成粗末，按照前述方法煎服。
按语：此方属于阳明经的药物组合。
桂枝芍药汤用于治疗寒热发作剧烈的疟疾，不论发病先后，这属于太阳经和阳明经合病，称为“大争”。寒热发作时必然伴有战栗，《内经》说：“热胜则动。”
发热必然导致汗出，《内经》说：“汗出而不愈，说明体内有热。”这是阳盛阴虚的证候，当表现为内实外虚。若不治疗，恐怕日久会传入阴经。此汤主治此证。
药物组成：桂枝（三钱）、黄芪、知母、石膏、芍药（各一两）。
制法与服法：将药材制成粗末，每次服用五钱，可增至一两，加水煎煮。
按语：此方属于太阳经和阳明经的药物组合。
桂枝黄芩汤：如果服用前面的药物后病情加重，说明是三阳经合病，适宜用此方调和。
药物组成：柴胡（一两二钱）、黄芩、人参、甘草（各四钱半）、半夏（四钱）、石膏、知母（各五钱）、桂枝（二钱）。
制法与服法：将药材制成粗末，按照前述方法煎服。
此前服用此药，若认为外邪已解而内邪未除，再服用攻下药。若在卯时至午时之间发作，适宜用大柴胡汤攻下；若在午时至酉时之间发作，可知邪气在内，适宜用大承气汤攻下；若在酉时至子时之间发作，甚至到寅时发作，可知邪气在血分，适宜用桃仁承气汤攻下，使轻微腹泻后，再用小柴胡汤彻底清除邪气。
按语：此方属于太阳经、阳明经、少阳经的药物组合。以上各方，都是针对风寒暑热等邪气从外部侵入，中伤三阳经的情况。
桂枝石膏汤用于治疗疟疾，无其他兼证，隔日发作，先恶寒后发热，寒少热多。
药物组成：桂枝（五钱）、石膏（一两半）、知母（一两半）、黄芩（一两）。
制法与服法：将药材制成粗末，分三次服用，加水煎煮。
按语：此方属于太阳经和阳明经的药物组合。治疗隔日发作的疟疾，是因为邪气潜伏较深。
麻黄黄芩汤用于治疗疟疾，证候如前所述，但在夜间发作。
药物组成：麻黄（一两，去节）、炙甘草（三钱）、桃仁（三十个，去皮尖）、桂枝（二钱）、黄芩（五钱）。
制法与服法：将药材制成细末，按照前述方法煎服。桃仁味苦、甘、辛，肝为血之海，血液躁动则肝气燥，《内经》所谓“肝苦急，急食甘以缓之”，所以桃仁能散血缓肝。这是因为邪气深远而入血分，故在夜间发作，乃阴经有邪。此汤是发散血中风寒的方剂。
按语：此方用于治疗风暑深入阴分而在夜间发作的疟疾，此时血受病邪，邪气所舍之处尤为深沉。麻黄、桂枝、桃仁等乃是太阳经的血分药，并非三阴经的药物。
Formulas for Resolving the Exterior
Zhang Zhongjing's Baihu Jia Guizhi Tang (White Tiger plus Cinnamon Twig Decoction) is used to treat Warm Malaria (Wen Nue).
Ingredients: Zhi Mu (Anemarrhenae Rhizoma, 6 liang), Zhi Gancao (Prepared Glycyrrhizae Radix et Rhizoma, 2 liang), Shigao (Gypsum Fibrosum, 1 jin, crushed), Guizhi (Cinnamomi Ramulus, 3 liang), Jingmi (Oryzae Sativa Semen, 6 he).
Preparation and Administration: Coarsely crush the herbs. Boil in 12 sheng of water until the rice is cooked, then strain. Continue boiling until 3 sheng remain. Take 1 sheng warm per dose, three times daily. Recovery occurs with sweating.
Commentary: This formula consists of herbs belonging to the Taiyang (Greater Yang) and Yangming (Yang Brightness) meridians.
Chaihu Guijiang Tang (Bupleurum, Cinnamon Twig, and Ginger Decoction) is used to treat malaria characterized by abundant cold and slight heat, or only cold without heat, known as Pin Nue (Yin Malaria).
Ingredients: Chaihu (Bupleuri Radix, 8 liang), Guizhi (Cinnamomi Ramulus), Huangqin (Scutellariae Radix) (each 2 liang), Gualougen (Trichosanthis Radix, 4 liang), Muli (Ostreae Concha), Zhi Gancao (Prepared Glycyrrhizae Radix et Rhizoma), Ganjiang (Zingiberis Rhizoma) (each 2 liang).
Preparation and Administration: Coarsely crush the herbs. Decoct in water. Take 1 sheng per dose, three times daily. Initial administration may cause irritability, followed by sweating indicates recovery.
Commentary: This formula consists of herbs belonging to the Shaoyang (Lesser Yang) and Taiyang (Greater Yang) meridians.
Guizhi Qianghuo Tang (Cinnamon Twig and Notopterygii Rhizoma Decoction) from *Jingyue Quanshu* (Essential Principles) is used for malaria occurring before the End of Heat solar term, presenting with headache and stiff neck, floating pulse, aversion to wind, and sweating.
Ingredients: Guizhi (Cinnamomi Ramulus), Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), Gancao (Glycyrrhizae Radix et Rhizoma) (each half liang).
Preparation and Administration: Make into coarse powder. Take half liang per dose, decoct in 1.5 zhan of water until 1 zhan remains. Take warm before the onset of fever. If vomiting occurs, add Banxia Qu (Fermented Pinelliae Mass).
Mahuang Qianghuo Tang (Ephedra and Notopterygii Rhizoma Decoction) applies to the above syndrome but presents with aversion to wind and absence of sweating.
Ingredients: Mahuang (Ephedrae Herba, de-stemmed), Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), Gancao (Glycyrrhizae Radix et Rhizoma) (each half liang).
Preparation and Administration: Same as above.
Commentary: Both of the above formulas consist of herbs belonging to the Taiyang (Greater Yang) meridian.
For treating malaria with body heat, eye pain, abundant heat and scanty cold, and a long pulse, first administer Da Chaihu Tang (Major Bupleurum Decoction) to purge, aiming for mild diarrhea. If residual heat remains, administer Baizhi Tang (Angelica Dahurica Decoction) to eliminate remaining pathogenic factors.
Ingredients: Baizhi (Angelicae Dahuricae Radix, 1 liang), Zhi Mu (Anemarrhenae Rhizoma, 1 liang 7 qian), Shigao (Gypsum Fibrosum, 4 liang).
Preparation and Administration: Make into coarse powder. Decoct according to previous methods.
Commentary: This formula consists of herbs belonging to the Yangming (Yang Brightness) meridian.
Guizhi Shaoyao Tang (Cinnamon Twig and Peony Decoction) is used for malaria with severe chills and fever, regardless of sequence. This is a combined disease of the Taiyang (Greater Yang) and Yangming (Yang Brightness) meridians, termed "Da Zheng" (Great Struggle). During chills and fever, there is necessarily trembling. The *Classic* states: "When heat prevails, movement occurs."
Fever inevitably leads to sweating. The *Classic* states: "If sweating does not lead to cure, it indicates internal heat." This is a syndrome of Excess Yang and Deficiency Yin, manifesting as Internal Excess and External Deficiency. If untreated, it may transmit to the Yin meridians over time. This formula governs this syndrome.
Ingredients: Guizhi (Cinnamomi Ramulus, 3 qian), Huangqi (Astragali Radix), Zhi Mu (Anemarrhenae Rhizoma), Shigao (Gypsum Fibrosum), Shaoyao (Paeoniae Radix Alba) (each 1 liang).
Preparation and Administration: Make into coarse powder. Take 5 qian per dose, increasing to 1 liang if necessary. Decoct in water.
Commentary: This formula consists of herbs belonging to the Taiyang (Greater Yang) and Yangming (Yang Brightness) meridians.
Guizhi Huangqin Tang (Cinnamon Twig and Scutellaria Decoction): If symptoms worsen after taking previous formulas, it indicates a combined disease of the Three Yang meridians. It is appropriate to use this formula to harmonize.
Ingredients: Chaihu (Bupleuri Radix, 1 liang 2 qian), Huangqin (Scutellariae Radix), Renshen (Ginseng Radix et Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma) (each 4 qian 5 fen), Banxia (Pinelliae Rhizoma, 4 qian), Shigao (Gypsum Fibrosum), Zhi Mu (Anemarrhenae Rhizoma) (each 5 qian), Guizhi (Cinnamomi Ramulus, 2 qian).
Preparation and Administration: Make into coarse powder. Decoct according to previous methods.
Regarding previous treatments: If external pathogens are resolved but internal pathogens remain, proceed with purging formulas. If onset occurs between Mao (05:00-07:00) and Wu (11:00-13:00 hours), Da Chaihu Tang (Major Bupleurum Decoction) is suitable for purging. If onset occurs between Wu (11:00-13:00) and You (17:00-19:00) hours, the pathogen is internal; Dachengqi Tang (Major Order the Qi Decoction) is suitable for purging. If onset occurs between You (17:00-19:00) and Zi (23:00-01:00) hours, or even Yin (03:00-05:00) hours, the pathogen is in the Blood level; Taoren Chengqi Tang (Peach Kernel Order the Qi Decoction) is suitable for purging with mild diarrhea, followed by Xiaochaihu Tang (Minor Bupleurum Decoction) to thoroughly resolve the pathogen.
Commentary: This formula consists of herbs belonging to the Taiyang (Greater Yang), Yangming (Yang Brightness), and Shaoyang (Lesser Yang) meridians. All the above formulas address Wind, Cold, Summerheat, and Heat pathogens entering from the exterior and affecting the Three Yang meridians.
Guizhi Shigao Tang (Cinnamon Twig and Gypsum Decoction) is used for malaria with no other accompanying symptoms, occurring every other day, starting with chills followed by fever, with scanty cold and abundant heat.
Ingredients: Guizhi (Cinnamomi Ramulus, 5 qian), Shigao (Gypsum Fibrosum, 1 liang 5 qian), Zhi Mu (Anemarrhenae Rhizoma, 1 liang 5 qian), Huangqin (Scutellariae Radix, 1 liang).
Preparation and Administration: Make into coarse powder. Divide into three doses. Decoct in water.
Commentary: This formula consists of herbs belonging to the Taiyang (Greater Yang) and Yangming (Yang Brightness) meridians. Treating every-other-day malaria addresses pathogens that have penetrated deeply.
Mahuang Huangqin Tang (Ephedra and Scutellaria Decoction) is used for malaria presenting as described above but occurring at night.
Ingredients: Mahuang (Ephedrae Herba, 1 liang, de-stemmed), Zhi Gancao (Prepared Glycyrrhizae Radix et Rhizoma, 3 qian), Taoren (Persicae Semen, 30 pieces, skin and tip removed), Guizhi (Cinnamomi Ramulus, 2 qian), Huangqin (Scutellariae Radix, 5 qian).
Preparation and Administration: Make into fine powder. Decoct according to previous methods. Taoren has bitter, sweet, and acrid flavors. The Liver is the sea of blood; when blood becomes agitated, Liver Qi becomes dry. As stated in the *Classic*: "The Liver dislikes constraint; urgently consume sweet flavors to relax it." Therefore, Taoren disperses blood and relaxes the Liver. This indicates the pathogen has entered deeply into the Blood level, hence the nocturnal onset, signifying pathology in the Yin meridians. This formula disperses Wind-Cold from the Blood level.
Commentary: This formula treats Wind-Summerheat penetrating deeply into the Yin sub-system causing nocturnal onset, where the Blood is affected by pathogens, and the location of the pathogen is particularly deep. Mahuang, Guizhi, Taoren, etc., are Blood-level herbs of the Taiyang (Greater Yang) meridian, not herbs of the Three Yin meridians.