秦子曰∶疟疾者，先寒后热，发作有定期，大约巳午末三时者多。若一日一作，太阳少
阳也。间日而作，阳明少阳也。伸欠、恶寒、头痛，太阳也。发热口渴，阳明也。有寒有热
，呕而口苦，少阳也。日中三阳得令，其病即发。日夕三阳时令退而病解，不比寒热往来，
时寒时热，一日二三次发。亦不比暑热之症，热无停止。按《内经》但有巨阳、阳明二经，
而不及少阳，然有寒有热，乃是少阳所主，余故补注少阳之脉，少阳之治也。以上三阳经疟
易愈。若三日一发，名曰三阴经疟，难愈。今分别外感八条，内伤三条，又三疟三条，游疟一条。
（《内经》寒营名寒疟）
【寒疟之症】《内经》云∶先寒后热，腰背头项痛，脊膂强，呵欠呻吟，始则寒极而战
动，终则大热而汗解，发在午前者，此太阳经疟。若目痛鼻干，寒栗鼓颔，略寒即热，发在午
后者，此阳明经疟。以上二条，乃《内经》寒邪伤营，名寒疟之症也。
【寒疟之因】夏伤暑热之气，入于皮肤之内，肠胃之外，营气所舍之处。又值早晚寒冷
之邪，外束暑热，至日中阳旺之时，发泄不出，后感寒邪近表，是以先寒，先感暑热在里，是
以后热。此先寒后热之疟作矣。
【寒疟之脉】浮大而紧；太阳之邪；长大洪实，阳明之疟；弦大之脉，少阳之诊。
【寒疟之治】在太阳者，桂枝羌活汤。在阳明者，桂枝葛根汤。在少阳者，桂枝柴胡
汤。三经俱见症者，三方互用。
桂枝羌活汤 治寒伤太阳，寒多热少，无汗寒疟。
桂枝 羌活 防风 甘草
吐者加半曲，夏秋口渴引饮加石膏。
桂枝葛根汤 治寒伤阳明，寒多热少，有汗之疟。
葛根 白芍药 桂枝 生姜 甘草
无汗加防风。头痛加羌活。夏秋口渴消水加石膏。
桂枝柴胡汤 治寒伤少阳，寒多热少之疟。
桂枝 柴胡
桢按∶前三方，因寒伤之疟，寒多热少，故皆用桂枝。原文曰∶夏秋热令，必加石膏。
可见热多寒少，脉数口渴者，切不可误用也。
秦子说：疟疾这种病，特点是先出现寒战，随后发热，发作有固定的时间，大多在巳时、午时和未时这三个时辰发作。如果每天发作一次，属于太阳经和少阳经受邪；如果隔日发作一次，属于阳明经和少阳经受邪。出现伸懒腰、打哈欠、怕冷、头痛的症状，是太阳经受邪的表现；出现发热、口渴的症状，是阳明经受邪的表现；既有寒战又有发热，伴有呕吐、口苦的症状，是少阳经受邪的表现。中午时分，三阳经（太阳、阳明、少阳）之气当令，所以疾病在此时发作；傍晚时分，三阳经的时令之气衰退，病情随之缓解。这与寒热往来、忽冷忽热、一天发作两三次的情况不同；也不像暑热证那样，发热持续不停。查阅《黄帝内经》，只提到了巨阳（即太阳经）和阳明经，而没有提及少阳经，然而既有寒战又有发热的症状，正是少阳经所主，所以我补充注释了少阳经的脉象和治疗方法。以上三种阳经的疟疾容易治愈。如果三天发作一次，称为三阴经疟疾，难以治愈。现在分别列出外感疟疾八条，内伤疟疾三条，以及三日疟三条，游疟一条。
【寒疟的症状】《黄帝内经》说：先出现寒战，随后发热，腰背及头项部疼痛，脊柱僵硬，经常打哈欠并呻吟。起初寒冷至极而身体颤抖，最后高热并通过出汗而缓解。如果在午时之前发作，这是太阳经疟疾。如果出现眼睛疼痛、鼻子干燥、寒战且下巴抖动，稍微感到寒冷就立即发热，且在午时之后发作，这是阳明经疟疾。以上两条，是《黄帝内经》中所述寒邪损伤营气，称为寒疟的症状。
【寒疟的病因】夏季被暑热之气所伤，邪气侵入皮肤之内、肠胃之外，也就是营气居留的地方。此时又遇到早晚寒冷的邪气，从外部束缚住体内的暑热，到了中午阳气旺盛的时候，暑热无法发散出去，随后又感受了靠近体表的寒邪，因此先出现寒战；因为先前感受的暑热在体内，所以随后出现发热。这就是先寒后热的疟疾发作的原因。
【寒疟的脉象】脉象浮大而紧，是太阳经受邪的表现；脉象长大洪实，是阳明经疟疾的表现；脉象弦大，是少阳经的诊断依据。
【寒疟的治疗】病在太阳经的，使用桂枝羌活汤。病在阳明经的，使用桂枝葛根汤。病在少阳经的，使用桂枝柴胡汤。如果三经的症状同时出现，可以互用上述三方。
桂枝羌活汤：治疗寒邪伤害太阳经，表现为寒多热少、无汗的寒疟。
药物组成：桂枝、羌活、防风、甘草。
若患者呕吐，加半夏曲；夏秋季口渴想喝水的，加石膏。
桂枝葛根汤：治疗寒邪伤害阳明经，表现为寒多热少、有汗的疟疾。
药物组成：葛根、白芍药、桂枝、生姜、甘草。
若无汗，加防风。若头痛，加羌活。夏秋季口渴消水的，加石膏。
桂枝柴胡汤：治疗寒邪伤害少阳经，表现为寒多热少的疟疾。
药物组成：桂枝、柴胡。
桢按语：前三方，是因为寒邪伤害导致的疟疾，寒多热少，所以都使用了桂枝。原文说：夏秋炎热季节，必须加入石膏。由此可见，如果是热多寒少、脉数且口渴的患者，切不可误用这些方剂。
Qin Zi said: Malaria (Nue Ji) is characterized by chills preceding fever, with paroxysms occurring at regular intervals, mostly during the Si, Wu, and Wei hours. If it occurs once a day, it involves the Taiyang (Greater Yang) and Shaoyang (Lesser Yang) meridians. If it occurs every other day, it involves the Yangming (Bright Yang) and Shaoyang meridians. Symptoms such as yawning, aversion to cold, and headache indicate involvement of the Taiyang meridian. Fever and thirst indicate involvement of the Yangming meridian. The presence of both chills and fever, accompanied by vomiting and bitter taste in the mouth, indicates involvement of the Shaoyang meridian. At noon, when the Qi of the three Yang meridians is dominant, the disease manifests. In the evening, as the timing of the three Yang meridians recedes, the illness resolves. This differs from alternating chills and fever (Han Re Wang Lai), where one feels cold and hot intermittently, occurring two or three times a day. It also differs from summerheat-heat syndromes (Shu Re), where fever persists without cessation. According to the *Huangdi Neijing* (Yellow Emperor's Inner Canon), only the Juyang (another name for Taiyang) and Yangming meridians are mentioned, omitting the Shaoyang meridian. However, the combination of chills and fever is primarily governed by the Shaoyang meridian; therefore, I have supplemented notes on the pulse diagnosis and treatment methods for the Shaoyang meridian. Malaria involving the aforementioned three Yang meridians is relatively easy to cure. If it occurs once every three days, it is called San Yin Jing Nue (Malaria of the Three Yin Meridians), which is difficult to cure. Here, eight categories of exogenous malaria, three categories of endogenous injury malaria, three categories of tertian malaria (San Nue), and one category of wandering malaria (You Nue) are distinguished.
(The condition named "Cold Malaria" in the *Huangdi Neijing*, where cold pathogenic factors injure Ying Qi [Nutritive Qi])
[Symptoms of Cold Malaria] The *Huangdi Neijing* states: There are chills preceding fever, pain in the waist, back, head, and neck, and stiffness of the spine. The patient frequently yawns and groans. Initially, the cold is extreme, causing tremors; finally, high fever occurs, resolving through sweating. If onset occurs before noon, it is Taiyang meridian malaria. If there is eye pain, nasal dryness, shivering with trembling of the jaw, and heat follows immediately after slight cold, occurring after noon, it is Yangming meridian malaria. The above two descriptions refer to the symptoms of Cold Malaria caused by cold pathogenic factors injuring Ying Qi, as described in the *Huangdi Neijing*.
[Etiology of Cold Malaria] In summer, the body is injured by summerheat-qi. The pathogen enters between the skin and the intestines/stomach, the residence of Ying Qi. Simultaneously, cold pathogens from the morning and evening externally bind the summerheat within. When Yang Qi becomes vigorous at noon, the summerheat cannot be vented out. Subsequently, external cold pathogenic factors near the surface are contracted, leading to initial chills. Because the previously contracted summerheat resides internally, fever follows. Thus, malaria with chills preceding fever arises.
[Pulse Diagnosis of Cold Malaria] A floating, large, and tight pulse indicates Taiyang pathogenic invasion. A long, large, surging, and solid pulse indicates Yangming malaria. A wiry and large pulse is the diagnostic sign for Shaoyang.
[Treatment of Cold Malaria] For cases in the Taiyang meridian, use Guizhi Qianghuo Tang (Cinnamon Twig and Notopterygium Decoction). For cases in the Yangming meridian, use Guizhi Gegen Tang (Cinnamon Twig and Kudzu Root Decoction). For cases in the Shaoyang meridian, use Guizhi Chaihu Tang (Cinnamon Twig and Bupleurum Decoction). If symptoms of all three meridians appear simultaneously, these three formulas may be used interchangeably or combined.
Guizhi Qianghuo Tang: Treats cold injuring the Taiyang meridian, characterized by more chills than fever and anhidrosis in cold malaria.
Ingredients: Ephedrae Herba? No, Cinnamomi Ramulus (Guizhi), Notopterygii Rhizoma et Radix (Qianghuo), Saposhnikoviae Radix (Fangfeng), Glycyrrhizae Radix et Rhizoma (Gancao).
If vomiting occurs, add Banxia Qu (Pinellia Fermented Paste); if thirsty and drinking water in summer/autumn, add Gypsum Fibrosum (Shigao).
Guizhi Gegen Tang: Treats cold injuring the Yangming meridian, characterized by more chills than fever and diaphoresis in malaria.
Ingredients: Puerariae Lobatae Radix (Gegen), Paeoniae Radix Alba (Baishao), Cinnamomi Ramulus (Guizhi), Zingiberis Recens Rhizoma (Shengjiang), Glycyrrhizae Radix et Rhizoma (Gancao).
If anhidrosis occurs, add Saposhnikoviae Radix (Fangfeng). If headache occurs, add Notopterygii Rhizoma et Radix (Qianghu). If thirsty and consuming water in summer/autumn, add Gypsum Fibrosum (Shigao).
Guizhi Chaihu Tang: Treats cold injuring the Shaoyang meridian, characterized by more chills than fever in malaria.
Ingredients: Cinnamomi Ramulus (Guizhi), Bupleuri Radix (Chaihu).
Commentary by Zhen: The previous three formulas are used because the malaria is caused by cold injury, presenting with more chills than fever; thus, Cinnamomi Ramulus (Guizhi) is employed in all. The original text states that in the hot seasons of summer and autumn, Gypsum Fibrosum (Shigao) must be added. This demonstrates that for patients with more heat than chills, rapid pulse, and thirst, these formulas must not be mistakenly used.