（《内经》名瘅疟仲景名温疟）
【瘅疟之症】但热不寒，少气烦冤，手足热而欲吐呕，面赤口渴，虽热已而六脉沉数大
者，《内经》名热伤阳明瘅疟之症。仲景发明《内经》阳明瘅疟，则曰身无寒，骨节疼痛，烦
冤时呕，更其名曰温疟是也。
【瘅疟之因】夏秋暑热之令，热气伤人，《内经》云∶阴气先绝，阳气独发，此暑热伤
于阳经，阳独用事，毫无阴寒，故名曰瘅热疟也。
【瘅疟之脉】六脉弦数，少阳有热。若见洪长，阳明有邪。若见沉数，里有热结。
【瘅疟之治】仲景以脉平者，用白虎加桂枝汤，治太阳阳明。家秘用桂枝黄芩汤，兼治
少阳阳明。《准绳》于风邪疟中，补出三阳和解汤。余于瘅疟中，亦补立三阳和解法也。
白虎加桂枝汤 治但热无寒，骨节疼痛，时呕之疟。
知母 甘草 石膏 粳米 桂枝
桂枝黄芩汤
柴胡 黄芩 人参 甘草 半夏 石膏 知母 桂枝 陈皮
南方热令，多用羌活以易桂枝。
按∶此二方，以但热，故用知母、石膏。以骨节烦疼，不得不用桂枝和营卫通其表里
，此治阳明经之疟。又借太阳经之桂枝，以治骨节烦疼。以桂枝与石膏同用，则桂枝藉石膏
之凉，不碍里热；石膏藉桂枝之辛温，亦不碍表寒矣。
（即暑疟）
【湿热疟之症】身体重痛，肢节烦疼，呕逆胀满，胸膈不舒，此湿热疟之症也。
【湿热疟之因】《内经》云∶因得秋气，汗出遇风，及得之以浴，水气舍于皮肤之内，
与卫气并居。卫气者，昼日行于阳，夜行于阴，此气得阳而外出，得阴而内薄，内外相薄，则
【湿热疟之脉】若见浮紧，表有寒湿。若见浮缓，乃是风湿。若见弦数，湿而兼热。
【湿热疟之治】《内经》有其论，仲景无其方，桢意身体重痛，肢节烦疼，脉浮紧者，
活败毒散。右脉弦长，呕逆胸满者，柴葛平胃散。六脉洪数，湿热者，加味香薷饮，调益元
羌活败毒散 治湿疟表邪多有者。
羌活 独活 柴胡 前胡 川芎 桔梗 枳壳 陈皮 甘草
柴葛平胃散 治湿疟胸次不平者。
苍术 浓朴 陈皮 甘草 柴胡 干葛
头痛身痛加羌活。无汗，加防风。
加味香薷饮 治暑湿之疟。
香茹 浓朴 扁豆 甘草 川黄连
【瘅疟的症状】只有发热而没有恶寒，气短且心中烦闷不适，手足发热并伴有想吐或呕吐的感觉，面色发红、口渴，即使热退之后，六脉仍呈现沉、数、大的特征。《黄帝内经》将这种症状命名为热邪损伤阳明经所致的瘅疟。张仲景阐发《黄帝内经》中关于阳明瘅疟的理论，指出身体无恶寒、骨节疼痛、心烦意乱时常呕吐，因此将其更名为温疟。
【瘅疟的病因】在夏秋季节暑热当令之时，热气伤害人体。《黄帝内经》说：“阴气先绝，阳气独发”，这是暑热邪气伤于阳经，导致阳气单独亢盛，完全没有阴寒之象，所以称之为瘅热疟。
【瘅疟的脉象】六脉弦而数，提示少阳经有热。如果脉象洪大且长，提示阳明经有邪气。如果脉象沉而数，提示体内有热结。
【瘅疟的治疗】张仲景认为若脉象平和者，使用白虎加桂枝汤，治疗太阳与阳明合病。家父（作者自称）秘传使用桂枝黄芩汤，兼治少阳与阳明合病。《医学准绳六要》在风邪疟疾中，补充了三阳和解汤。我在瘅疟治疗中，也补充确立了三阳和解法。
白虎加桂枝汤：治疗只有发热没有恶寒、骨节疼痛、时常呕吐的疟疾。
药材：知母、甘草、石膏、粳米、桂枝。
桂枝黄芩汤：
药材：柴胡、黄芩、人参、甘草、半夏、石膏、知母、桂枝、陈皮。
在南方炎热季节，多用羌活来替代桂枝。
按语：这两首方剂，因为患者只有发热，所以使用知母、石膏清热。因为骨节烦痛，不得不使用桂枝来调和营卫、疏通表里，这是治疗阳明经疟疾的方法。又借用太阳经的桂枝，来治疗骨节烦痛。将桂枝与石膏同用，则桂枝借助石膏的凉性，不会妨碍体内的热邪；石膏借助桂枝的辛温之性，也不会妨碍体表的寒邪。
（即暑疟）
【湿热疟的症状】身体沉重疼痛，肢节烦痛，恶心呕吐、腹胀满闷，胸膈部感觉不舒畅，这是湿热疟的症状。
【湿热疟的病因】《黄帝内经》说：“因得秋气，汗出遇风，及得之以浴，水气舍于皮肤之内，与卫气并居。”卫气，白天运行于阳分，夜晚运行于阴分，此邪气随卫气出于阳分则外出，进入阴分则内迫，内外相互搏结，则……
【湿热疟的脉象】如果脉象浮紧，表示体表有寒湿。如果脉象浮缓，表示是风湿。如果脉象弦数，表示湿邪兼夹热邪。
【湿热疟的治疗】《黄帝内经》有关于此病的论述，但张仲景没有提供相应的方剂。根据我的见解：身体沉重疼痛、肢节烦痛、脉象浮紧者，使用羌活败毒散。右脉弦长、恶心呕吐、胸满者，使用柴葛平胃散。六脉洪数、湿热重者，使用加味香薷饮，并配合益元散服用。
羌活败毒散：治疗湿疟表邪较多的情况。
药材：羌活、独活、柴胡、前胡、川芎、桔梗、枳壳、陈皮、甘草。
(Referred to as Dan Nue in the *Huangdi Neijing* [Yellow Emperor's Inner Canon], and Wen Nue by Zhang Zhongjing.)
[Symptoms of Dan Nue] There is fever without chills, shortness of breath accompanied by mental restlessness and oppression, heat in the hands and feet with a desire to vomit or actual vomiting, a red face, and thirst. Even after the fever subsides, the six pulses remain deep (Chen), rapid (Shu), and large (Da). The *Neijing* names this condition "Dan Nue caused by Heat damaging the Yangming Meridian." Zhang Zhongjing elaborated on the *Neijing*'s theory of Yangming Dan Nue, stating that when there is no chills, pain in the bone joints, mental distress, and occasional vomiting, it should be renamed "Wen Nue."
[Etiology of Dan Nue] During the summer and autumn seasons when summer-heat and dryness prevail, heat qi injures the human body. The *Neijing* states: "Yin qi is exhausted first, while Yang qi acts alone." This indicates that summer-heat pathogenic factors have injured the Yang meridians, causing Yang qi to dominate exclusively without any Yin cold, hence named "Dan Re Nue" (Hot Malaria).
[Pulse of Dan Nue] The six pulses are wiry (Xian) and rapid (Shu), indicating Heat in the Shaoyang Meridian. If the pulse appears surging (Hong) and long, it indicates pathogenic factors in the Yangming Meridian. If the pulse is deep and rapid, it indicates internal heat accumulation.
[Treatment of Dan Nue] Zhang Zhongjing prescribed Baihu Jia Guizhi Tang for cases where the pulse is peaceful, treating concurrent Taiyang and Yangming syndromes. My family secret method uses Guizhi Huangqin Tang to concurrently treat Shaoyang and Yangming syndromes. The *Zhunsheng* [Medical Standards] supplemented the Sanyang Hejie Tang within the context of wind-pathogen malaria. I have also established the Sanyang Hejie Method for treating Dan Nue.
Baihu Jia Guizhi Tang: Treats malaria characterized by fever without chills, bone joint pain, and occasional vomiting.
Herbs: Zhi Mu (Anemarrhenae Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), Shigao (Gypsum Fibrosum), Jingmi (Oryzae Fructus Germinatus), Guizhi (Cinnamomi Ramulus).
Guizhi Huangqin Tang:
Herbs: Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), Renshen (Ginseng Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Banxia (Pinelliae Rhizoma Preparatum), Shigao (Gypsum Fibrosum), Zhi Mu (Anemarrhenae Rhizoma), Guizhi (Cinnamomi Ramulus), Chenpi (Citri Reticulatae Pericarpium).
In the hot regions of the South, Qianghuo (Notopterygii Rhizoma et Radix) is often used to replace Guizhi.
Note: These two formulas utilize Zhi Mu and Shigao because the primary symptom is fever. Guizhi is indispensable for relieving painful stiffness in the bone joints by harmonizing Ying and Wei Qi and unblocking the interior and exterior; this treats malaria of the Yangming Meridian. Furthermore, Guizhi from the Taiyang Meridian is borrowed to treat painful stiffness in the joints. When Guizhi and Shigao are used together, Guizhi relies on the cooling nature of Shigao so as not to aggravate internal heat; conversely, Shigao relies on the acrid-warm nature of Guizhi so as not to obstruct external cold.
(Also known as Shu Nue [Summer-heat Malaria])
[Symptoms of Shire Nue] Heavy and painful body, painful stiffness in limbs and joints, nausea/vomiting, abdominal distension and fullness, and discomfort in the chest and diaphragm. These are the symptoms of Shire Nue.
[Etiology of Shire Nue] The *Neijing* states: "Acquired during autumn, when sweating occurs and one encounters wind, or after bathing, water qi resides within the skin and dwells together with Wei Qi." Wei Qi travels through the Yang aspects during the day and the Yin aspects at night. This pathogenic factor moves outward when it enters the Yang aspect and presses inward when it enters the Yin aspect. The mutual struggle between the interior and exterior leads to...
[Pulse of Shire Nue] If the pulse is floating and tight (Fu Jin), it indicates Cold-Dampness on the exterior. If the pulse is floating and moderate/slow (Fu Huan), it indicates Wind-Dampness. If the pulse is wiry and rapid (Xian Shu), it indicates Dampness combined with Heat.
[Treatment of Shire Nue] The *Neijing* discusses this pathology, but Zhang Zhongjing did not provide specific formulas. Based on my clinical judgment: For cases with heavy/painful body, painful joints, and a floating-tight pulse, use Huoqi Baidu San. For cases with a wiry-long right pulse, nausea/vomiting, and chest fullness, use Chaige Pingwei San. For cases with surging-rapid six pulses and significant Damp-Heat, use Jiawei Xiangru Yin, administered with Yiyuan San.
Huoqi Baidu San: Treats damp malaria with abundant exterior pathogenic factors.
Herbs: Qianghuo (Notopterygii Rhizoma et Radix), Duhuo (Angelicae Pubescentis Radix), Chaihu (Bupleuri Radix), Qianhu (Peucedani Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Jiegeng (Platycodonis Radix), Zhike (Aurantii Fructus Immaturus), Chenpi (Citri Reticulatae Pericarpium), Gancao (Glycyrrhizae Radix et Rhizoma).
Chaige Pingwei San: Treats damp malaria with disharmony in the chest/epigastrium.
Herbs: Cangzhu (Atractylodis Rhizoma), Houpo (Magnoliae Officinalis Cortex), Chenpi (Citri Reticulatae Pericarpium), Gancao (Glycyrrhizae Radix et Rhizoma), Chaihu (Bupleuri Radix), Gange (Puerariae Lobatae Radix).
Add Qianghuo for headache and body pain. Add Fangfeng for absence of sweating.
Jiawei Xiangru Yin: Treats summer-damp malaria.
Herbs: Xiangru (Elsholtziae Herba), Houpo (Magnoliae Officinalis Cortex), Biandou (Dolichoris Semen), Gancao (Glycyrrhizae Radix et Rhizoma), Chuanlianzhong (Coptidis Rhizoma).