无痰无食不成疟，风寒外感仍能作，惟火 秋金，邪魔入却深，脾寒肾气瘁，疟住还下痢，反复陷春阳，阴
霾目减光。
此章指病疟目病，病目疟病，反复变迁而言。《经》曰∶夏伤于暑，秋必病疟。盖冒暑，肺渴引水自救，过
饮则阳明受湿，而热邪畏不敢发，伏而成祸。至秋金令行，暑温乘燥而出，此时被凉风一吹，二者复为所郁，既
为所郁，必虚中而侮寒水，三经合病矣。故阴阳混战，寒热往来，按期而发。发则头痛心烦，骨节酸痛，或呕或
渴，神魂无主，虽汗过渐止，而肌肉已暗暗销脱尔。故从疟而名症云。其寒多
热少、热多寒少，一日一发、间日一发、一日两发，与夫子后午前、午后子前，先寒后热，先热后寒，但寒不热
之牝疟，但热不寒之瘅疟，此在阴在阳、邪深邪浅之分，理虽渊微，不甚费解，医如四诊具备，自能得其巅末。
治法∶无汗要有汗，散邪为主。有汗要无汗，扶正为主。以青皮饮、麻桂饮随证加减。若胃中有郁痰伏结，用草
果饮。不效，当补中益气倍柴胡加半夏、生姜，或建中、归脾。热盛寒少，加丹皮、栀子亦可。久疟并前方俱不
效者，八味丸、九转丹确有神应。然总须病未来二三时迎而夺之，疟不自退，病自稍减。有一种似疟非疟，凡伤
寒后、大病后、产后、痨瘵等症俱有往来寒热，或一日二三度发，此《经》所谓阳虚则恶寒，阴虚则恶热，阴气
上入于阳中则恶寒，阳气下陷于阴中则恶热是也。又有一种疟后痢，痢后疟者，夫即疟后，发泄已极，必无暑热
之毒，复为痢疾，此客感别邪，脾肺元虚不能升发，而变似痢非痢也，既为痢后。下多亡血，气又随痢散，复为
疟疾，此阴阳两败，似疟非疟也。并作虚论，一用前药消息之，立愈。粗工不问正疟、似疟，但见病候如前，辄
用常山、香连等物斗病而进，谓之截江桡，枉夭颇多，不悔不悟，伤哉！因并辨别于此，以俟作者参考焉。
没有痰饮和食积就不会形成疟疾，但外感风寒也能引发此病。只有火邪与秋金之气相搏，邪气深入体内，导致脾寒肾气衰竭。疟疾停止后反而出现痢疾，病情反复陷入春阳升发之季，致使视力模糊、目光减退。
本章论述的是疟疾引发的眼病，以及眼病患者患疟疾，两者相互转化、反复变化的情况。《黄帝内经》说：“夏季感受暑邪，秋季必然发生疟疾。”这是因为冒犯暑热，肺脏因燥渴而引水自救，如果饮水过量，则阳明经受湿邪困扰，热邪畏惧湿气而不敢发散，潜伏体内酿成祸患。等到秋季金气当令，暑温之气乘着燥气而出，此时若被凉风一吹，暑湿与燥热二者再次被郁遏。既然被郁遏，必然导致中气虚弱并反侮寒水（肾），这就形成了三经合病的局面。因此阴阳之气混战，出现寒热往来的症状，按时发作。发作时头痛心烦，骨节酸痛，或呕吐或口渴，神魂不安。虽然出汗后症状逐渐停止，但肌肉已经暗中消瘦脱失。所以根据疟疾来命名这种病症。
至于寒多热少、热多寒少，一日一发、隔日一发、一日两发，以及早晨前或早晨后、下午前或下午后发作，先寒后热、先热后热、只寒不热的牝疟，只热不寒的瘅疟，这些属于病在阴分或阳分、邪气深或浅的区别。道理虽然深奥微妙，但并不难以理解。医生如果四诊具备，自然能掌握疾病的始末。
治疗方法：无汗时要使其出汗，以疏散邪气为主；有汗时要止汗，以扶助正气为主。使用青皮饮、麻桂饮根据证候加减。如果胃中有郁结的伏痰，使用草果饮。如果无效，应当用补中益气汤加倍柴胡，加入半夏、生姜，或者使用建中汤、归脾汤。如果热盛寒少，也可以加入牡丹皮、栀子。对于久疟并且上述方剂都无效的情况，八味丸、九转丹确实有神奇疗效。然而总须在疾病发作前两三个小时提前服药以截断病势，疟疾不会自行消退，但病情会稍微减轻。
有一种类似疟疾而非疟疾的情况，凡是在伤寒后、大病后、产后、虚劳等病症中，都有寒热往来的表现，或者一天发作两三次，这就是《内经》所说的“阳虚则恶寒，阴虚则恶热，阴气上入于阳分则恶寒，阳气下陷于阴分则恶热”的道理。又有一种疟疾之后转为痢疾，或者痢疾之后转为疟疾的情况。如果是疟疾之后，发泄已经极度严重，必然不会有暑热毒邪再引起痢疾，这是客感了别的邪气，由于脾肺元气虚弱不能升发，从而变得像痢疾又不是痢疾。既然是痢疾之后，泻下过多导致亡血，气也随着痢疾散失，又转为疟疾，这是阴阳两败，表现为似疟非疟。这些都作为虚证来论治，使用前方的药物斟酌调理，即可立即痊愈。
粗劣的医生不问是正疟还是似疟，只要见到前面的病候，就随意使用常山、香连等药物强行截断，称之为“截江桡”，枉死的人很多，他们却不后悔不醒悟，真是可悲啊！因此一并加以辨别，留给后来的作者参考。
Without phlegm and food retention, malaria cannot form; however, external contraction of wind-cold can still induce it. Only when fire pathogen interacts with autumn metal (lung qi), the evil pathogen penetrates deeply, causing spleen cold and exhaustion of kidney qi. After malaria subsides, dysentery may follow; repeated relapses sink into the spring yang phase, resulting in dimmed vision and reduced luster of the eyes.
This chapter discusses eye diseases caused by malaria, and malaria occurring in patients with eye diseases, describing their mutual transformation and recurrent changes. The *Classic* states: "Injury by summer-heat in summer leads to malaria in autumn." This is because exposure to summer-heat causes lung dryness-thirst, prompting water intake for self-rescue. Excessive drinking leads to dampness affecting the Yangming channel, where heat pathogen fears dampness and dares not disperse, lying dormant to cause disaster. When autumn metal qi takes command, summer-warmth emerges riding on dryness. If blown by cool wind at this time, both summer-dampness and dryness-heat become constrained again. Once constrained, they inevitably weaken the middle jiao and insult the cold water (kidney), resulting in a combined disease of three channels. Thus, yin and yang clash chaotically, presenting alternating chills and fever, occurring at regular intervals. Upon onset, there is headache, irritability, soreness and pain in bone joints, vomiting or thirst, and unsettled spirit and soul. Although symptoms gradually cease after sweating, muscles have secretly wasted away. Hence, the condition is named according to malaria.
Regarding cases with more chills than fever, more fever than chills, daily attacks, every-other-day attacks, or twice-daily attacks; occurring before noon or after noon, before midnight or after midnight; starting with chills then fever, starting with fever then chills; only chills without fever (Pin Malaria); or only fever without chills (Dan Malaria)—these represent distinctions between involvement of yin or yang, and deep or shallow pathogenic levels. Although the principles are profound and subtle, they are not difficult to understand. A physician equipped with the four diagnostic methods will naturally grasp the beginning and end of the disease.
Treatment methods: For absence of sweat, induce sweating, prioritizing dispersion of pathogenic factors. For presence of sweat, stop sweating, prioritizing support of healthy qi. Use Qingpi Yin (Green Peel Decoction) or Magui Yin (Cinnamon Twig and Ephedra Decoction) with modifications based on syndrome. If there is stagnant phlegm knotting in the stomach, use Caoguo Yin (Tsaiko Rhizome Decoction). If ineffective, employ Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with doubled Chaihu (Bupleuri Radix), plus Banxia (Pinelliae Rhizoma) and Shengjiang (Zingiberis Rhizoma Recens), or alternatively Jianzhong Tang (Establish the Middle Decoction) or Guipi Tang (Restore the Spleen Decoction). If heat is abundant and chills are few, add Mudan Pi (Moutan Cortex) and Zhizi (Gardeniae Fructus). For chronic malaria unresponsive to previous formulas, Bawei Wan (Eight-Ton Pill) and Jiuzhuan Dan (Nine-Cycle Pill) indeed show miraculous efficacy. However, medication must generally be administered two to three hours before the expected onset to intercept the pathogen; while malaria will not retreat spontaneously, the condition will slightly alleviate.
There exists a condition resembling malaria but not being true malaria. In conditions following exogenous cold damage, severe illness, postpartum state, or consumptive disease, there are often alternating chills and fever, or occurring two to three times a day. This corresponds to what the *Classic* describes as: "Yang deficiency leads to aversion to cold, yin deficiency leads to aversion to heat; when yin qi ascends into yang, there is aversion to cold; when yang qi sinks into yin, there is aversion to heat." Furthermore, there are cases of dysentery following malaria, or malaria following dysentery. In the case of post-malarial dysentery, since evacuation has been extreme, there should be no residual summer-heat toxin causing dysentery anew; rather, this is due to invasion by other pathogens, where spleen and lung primordial qi are deficient and unable to ascend, manifesting as something resembling dysentery but not truly dysentery. In the case of post-dysenteric malaria, excessive downward discharge leads to loss of blood, and qi scatters with the dysentery, subsequently transforming into malaria. This represents dual failure of yin and yang, manifesting as resembling malaria but not true malaria. All such cases are treated as deficiency syndromes, using previous formulas with careful adjustment, leading to immediate recovery.
Incompetent physicians, without distinguishing between true malaria and malaria-like conditions, seeing the aforementioned symptoms, indiscriminately administer drugs like Changshan (Dichroae Radix) and Xianglian (Coptidis Rhizoma mixed with Cinnamomi Cortex) to forcibly cut off the disease, termed "Jiejiang Nao" (River-Cutting Oar), resulting in many wrongful deaths. They remain unrepentant and unenlightened, which is truly lamentable! Therefore, these distinctions are presented here for reference by future authors.