又有自内达外者。）故头项痛。腰脊强。（太阳脉从巅络脑下项。挟脊抵腰。）二日阳明受之。（传入阳明。为表之里。）阳
明主肉。其脉挟鼻。（起鼻 。循鼻外。）络于目。（经别篇。阳明系目系。）故身热目痛而鼻干。（金燥故干。）不得卧也。
（阳明主胃。胃不和则卧不安。）三日少阳受之。（传入少阳。为半表半里。）少阳主胆。其脉循胁。络于耳。故胸胁痛而
耳聋。三阳经络。皆受其病。而未入于脏者。故可汗而已。（邪在三阳之经。尚属表。故宜汗。此藏字非五脏。乃三阴经
也。马注以三阴属五脏。故亦谓之藏。）四日太阴受之。（阳邪传阴而入里。）太阴脉布胃中。络于嗌。故腹满而嗌干。五
日少阴受之。少阴脉贯肾。络于肺。系舌本。故口燥舌干而渴。（阳邪虽入里阴。而皆为热症。）六日厥阴受之。厥阴脉
循阴器而络于肝。故烦满而囊缩。（灵枢经筋篇。厥阴筋循阴股。结于阴器。伤于内则不起。伤于寒则阴缩入。伤于热则
挺纵不收。昂按。阴症忌用寒药。然舌卷囊缩。有寒极而缩者。宜用四逆吴茱火灸葱熨等法。又有阳明之热。陷入厥阴。
阳明主润宗筋。宗筋为热所攻。弗荣而急。亦致舌卷囊缩。此为热极。宜大承气以泻阳救阴。不可不知。）三阴三阳。五
脏六腑皆受病。荣卫不行。五脏不通。则死矣。（内经言伤寒分足经。而不列手经。仲景伤寒论宗之。遂有伤寒传足不传
手之说。昂按。仲景分经虽主于足。至其用药。亦未尝遗手经也。先正以麻黄桂枝皆肺经药。承气白虎亦三焦大肠之药。
至泻心汤则前言泻心矣。刘草窗曰。足太阳少阴属水。水得寒而冰。足阳明太阴属土。土得寒而坼。足少阳厥阴属木。
木得寒而凋。故寒喜阳之。手六经则属火与金。火得寒而愈烈。金得寒而愈刚。故寒不能伤。创论新异。世多奇之。一
阳子何东辨之曰。刘子将人身荣卫经络上下截断。下一段受病。上一段无干。失血气周流瞬息罔间之旨矣。内经云。五
脏六腑皆受病。谓五脏六腑而无手六经可乎。经又云。人之伤寒则为病热。既曰病热。则无水冰土坼木凋之说。而有金
烁火亢之征矣。且列手经受病甚晰。见医方集解。）其不两感于寒者。七日巨阳病衰。头痛少愈。（此亦七日来复之义。
马注曰。世有再传经之说。本篇及伤寒论。原无此义。乃成无己注释之谬也。阳表阴里。自太阳以至厥阴。犹入户升堂
以入室矣。厥阴复传太阳。尚有数经隔之。岂有遽出而传之之理。本篇衰字最妙。谓初感之邪。尚未尽衰则可。断非再
出而传太阳也。）八日阳明病衰。身热少愈。九日少阳病衰。耳聋微闻。十日太阴病衰。腹减如故。则思饮食。十一日少
阴病衰渴止。不满。舌干已而嚏。（嚏为阳气和利。）十二日厥阴病衰。囊纵。少腹微下。大气皆去。病日已矣。治之各
通其脏脉。病日衰已矣。其未满三日者。可汗而已。其满三日者。可泄而已。（此言表里之大凡也。伤寒有循经传者。有
越经传者。有表里传者。有传二三经而止者。有始终止在一经者。故有八九日而仍在表。有二三日即已传里。又有不由
表而直中里者。可汗可泄。当审症察脉。不可执泥。王注。虽日过多。但有表症。而脉大浮数。犹宜发汗。日数虽少。
即有里症。而脉沉细数。犹宜下之。）热病已愈。时有所遗者。（遗邪。）何也。热甚而强食之。故有所遗也。若此者。皆
病已衰。而热有所藏。（余热未尽。）因其谷气相薄。两热相合。故有所遗也。（脾胃尚弱。不能消谷。）病热少愈。食肉
则复。（肉甚于谷。故病复。）多食则遗。此其禁也。两感于寒者。病一日则巨阳与少阴俱病。则头痛口干而烦满。二日
则阳明与太阴俱病。则腹满身热不欲食。谵言。三日则少阳与厥阴俱病。则耳聋囊缩而厥。水浆不入。不知人。六日死。
五脏已伤。六腑不通。荣卫不行。如是之后。三日乃死。何也。曰阳明者。十二经脉之长也。其血气盛。（阳明多血多气。）
故不知人。三日其气乃尽。故死矣。（胃气绝乃死。）凡病伤寒而成温者。先夏至日者为病温。后夏至日者为病暑。暑当
与汗皆出。勿止。（热论）
【素】夫 疟皆生于风。（王注。 。犹老也。杨上善云。此经或云 疟。或但云疟。不必以日发间日以定 也。）
其畜作有时者何也。曰疟之始发也。先起于毫毛伸欠。（毫毛属表。伸欠为阴阳相引。）乃作寒栗鼓颔。腰脊俱痛。寒去
则内外皆热。头痛如破。渴欲冷冻饮料。何气使然。曰阴阳上下交争。虚实更作。阴阳相移也。（阳病者。上行极而下。阴病
者。下行极而上。阳虚生外寒。阴盛生内寒。阳盛生外热。阴虚生内热。故有交争更作相移之患。）阳并于阴。则阴实而
阳虚。阳明虚。则寒栗鼓颔也。（阳明胃脉。循颐出大迎。循颊车。）巨阳虚。则腰背头项痛。（太阳经脉所过。按疟邪居
半表半里。属少阳经。本篇言阳明太阳。而不及少阳。下文又曰三阳俱虚。盖太阳为开。阳明为阖。少阳为枢也。又说
太阳寒水。行身后为表。阳明燥金。行身前为表之里。邪在于中。近后膀胱水则寒。近前阳明燥则热也。）三阳俱虚。则
阴气胜。阴气胜。则骨寒而痛。（阴主骨。寒主痛。）寒生于内。故中外皆寒。（阳虚外寒。阴虚内寒。）阳盛则外热。阴
虚则内热。外内皆热。（阴寒既极。则复并出之阳。阳实阴虚。故外内皆热。）则喘而渴。（热伤气故喘。热伤津故渴。）
故欲冷冻饮料也。此皆得之夏伤于暑。（暑邪。）热气盛。藏于皮肤之内。肠胃之外。此营气之所舍也。（表之内。里之外。营
气之所居。热伤营气。遇卫气应乃作。）此（指暑气。）令人汗空（孔。）疏。腠理开。因得秋气。汗出遇风。（风邪。）及
得之以浴。水气（湿邪。）舍于皮肤之内。与卫气并居。（邪伤于卫。）卫气者昼日行于阳。（六阳经。）夜行于阴。（六阴
经。）此气得阳而外出。得阴而内薄。（外出故热。内薄故寒。）内外相薄。（疟邪居半表半里。故内外相薄。）是以日作。
（一日一发。）其气（邪气。）之舍深。内薄于阴。阳气独发。阴邪内着。阴与阳争不得出。是以间日而作也。（人有 悍
之气。行于大经之隧。为卫气。邪气感人。藏于分肉。不与大经之气会遇。则不发。邪气出于分肉。流于大经。邪正相
遇。不能兼容而交争。则发矣。邪入于阳。则感浅而道近。故日作。邪入于阴。则感深而道远。阴邪与卫气相争。不能
与卫气俱行。故间日作。）其作日晏。与其日早者。何气使然。曰邪气客于风府。循膂而下。（脊两旁为膂。挟脊而下行。
至尾 骨。）卫气一日一夜。大会于风府。（督脉穴。在项后。入发际一寸。项骨有三椎。其下乃是大椎。又名百劳。大
椎以下至尾 。有二十一节。共二十四节。云应二十四气。疟一日。行一节。）其明日。日下一节。故其作也晏。（阳邪
传入阴分。则作日晏。）此先客于脊背也。每至于风府。则腠理开。开则邪气入。入则病作。以此日作稍晏也。（日下一
节。则上会风府也。益迟。）其出于风府。日下一节。二十五日下至 骨。（脊骨尽处。）二十六日入于脊内。（复行上脊。）
注于伏膂之脉。（王注。谓膂筋之间。肾脉之伏行者也。甲乙经作太冲之脉。巢元方作伏冲。谓冲脉之上行者也。按冲脉
入肾之络。亦与肾脉并行。张注作伏冲膂筋二脉。）其气上行。九日出于缺盆之中。（足阳明穴。肩下横骨陷中。）其气日
高。故作日益早也。（阴分传出阳分。则作日早。病易愈矣。）其间日发者。由邪气内薄于五脏。（疟有经疟脏疟。邪深者
则入脏。）横连募原也。（膈膜之原。）其道远。其气深。其行迟。不能与卫气俱行。不得皆出。故间日乃作也。卫气日下
一节。其气之发也。不当风府。其日作者奈何。曰虚实不同。邪中异所。则不得当其风府也。故邪中于头项者。气至头
项而病。中于背者。气至背而病。中于腰脊者。气至腰脊而病。中于手足者。气至手足而病。卫气之所在。与邪气相合
则病作。故风无常府。卫气之所发。必开其腠理。邪气之所合。则其府也。夫风（风症。）之与疟也。相似同类。而风独
常在。疟得有时而休者何也。曰。风气留其处。故常在。疟气随经络。沉以内薄。故卫气应乃作。（昂按。卫为阳主表。
疟疾虽有陷入阴经者。然必待卫气应乃作。是为阴中有阳。故虽甚而不至于杀人也。灵枢岁露论。与此篇略同。）疟先寒
而后热者何也。夏伤于大暑。其汗大出。腠理开发。因遇夏气凄沧之水寒。（甲乙太素并作小寒。）藏于腠理皮肤之中。
秋伤于风。则病成矣。夫寒者。阴气也。（阴邪。）风者。阳气也。（阳邪。）先伤于寒。而后伤于风。故先寒而后热也。
病以时作。名曰寒疟。先热而后寒者何也。此先伤于风。而后伤于寒。故先热而后寒也。亦以时作。名曰温疟。其但热
而不寒者。阴气先绝。阳气独发。则少气烦冤。手足热而欲呕。名曰瘅疟。温疟者。得之冬中于风。寒气藏于骨髓之中。
至春则阳气大发。邪气不能自出。因遇大暑。脑髓烁。肌肉消。腠理发泄。或有所用力。邪气与汗皆出。此病藏于肾。
（经）
其气先从内出之于外也。（昂按。此即春温之症。寒气积久。自内达外。非犹伤寒之由表传里也。王安道曰。每见治温热
病。误攻其里。亦无大害。误发其表。变不可言。此足明其热之自内达外矣。）如是者。阴虚而阳盛。阳盛则热矣。衰则
气复反入。入则阳虚。阳虚则寒矣。故先热而后寒。名曰温疟。瘅疟者。肺素有热。气盛于身。厥逆上冲。中气实而不
外泄。因有所用力。腠理开。风寒舍于皮肤之内。分肉之间而发。发则阳气盛。阳气盛而不衰。则病矣。其气（邪气。）
不及于阴。故但热而不寒。气内藏于心。（昂按。此病当是肺瘅心瘅之类。与前脾瘅胆瘅同。瘅。热也。）而外舍于分肉
之间。令人消烁脱（一作肌。）肉。故命曰瘅疟。（李士材曰。温疟舍于肾。瘅疟舍于肺与心。温疟即伤寒也。故伤寒论
有温疟一症。瘅疟则火盛乘金。阴虚阳亢。二者皆非真疟也。）夫疟之始发也。阳气并于阴。当是之时。阳虚而阴盛。外
无气。故先寒栗也。阴气逆极。则复出之阳。阳与阴复并于外。则阴虚而阳实。故先热而渴。（王注。阴盛则胃寒。故战
栗。阳盛则胃热。故欲饮。）夫疟气者。并于阳则阳胜。并于阴则阴胜。阴胜则寒。阳胜则热。疟者。风寒之气不常也。
病极则复。（发已则复如平人。如后文极则阴阳俱衰也。）至病之发也。（至字有连上句读者。言寒热复至。今从王氏。）
如火之热。如风雨不可当也。故经言曰。方其盛时必毁。（方盛而泻之。必毁伤真气。）因其衰也。事必大昌。此之谓也。
夫疟之未发也。阴未并阳。阳未并阴。因而调之。真气得安。邪气乃亡。故工不能治其已发。为其气逆也。（疟正发时。
不可服药。若服药则寒药助寒。热药助热。反增其病。）疟气者。必更盛更虚。当气之所在也。病在阳则热而脉躁。在阴
则寒而脉静。
极则阴阳俱衰。卫气相离。故病得休。卫气集。则复病也。时有间二日或至数日发。或渴或不渴何也。其间日者。邪气
与卫气客于六腑。而有时相失。不能相得。故休数日乃作也。疟者阴阳更胜也。或甚或不甚。故或渴或不渴。（阳盛则渴。
阴盛则不渴。）疟之且发也。阴阳之且移也。必从四末始也。（手足十指。为三阴三阳经脉所从起。故后刺疟篇曰。诸疟
而脉不见。刺十指间出血。血出必已。）其以秋病者寒甚。（秋气栗烈。）以冬病者寒不甚。（阳气内藏。）以春病者恶风。
（阳方升而腠理开。）以夏病者多汗。（气热而津液外泄。〔疟论〕）
【素】足太阳之疟。令人腰痛头重。寒从背起。（经脉所过。）先寒后热。 （音谒。）然。（热貌。）热止汗出
难已。足少阳之疟。令人身体解 。寒不甚。热不甚。（即解 也。）恶见人。（胆木盛。则克胃土。胃热盛。则恶人。）
见人心惕惕然。（胆虚。）热多汗出甚。足阳明之疟。令人先寒洒淅。洒淅寒甚。（阳虚生外寒。）久乃热。热去汗出。喜
见日月光火气。乃快然。（阳明多血多气。热盛则恶人与火。今反喜之者。胃虚故也。）足太阴之疟。令人不乐。好太息。
（脾不运而气不舒。）不嗜食。多寒热。（脾虚恶寒。胃虚恶热。故疟疾又谓之脾寒。）汗出。病至则善呕。（脾脉络胃。
挟咽。）呕已乃衰。足少阴之疟。令人呕吐甚。（肾脉贯鬲入肺。循喉咙。）多寒热。热多寒少。（水衰火旺。）欲闭户牖而
处。其病难已。（阳明胃脉病。欲独闭户牖而处。今胃病见肾中。为土刑于水。故难已。）足厥阴之疟。令人腰痛。少腹
满。小便不利。如癃状。（癃闭。厥阴脉环阴器。抵小腹。）非癃也。数便。意恐惧。气不足。（肝气有余则怒。不足则恐。）
又有病邪由体内向体表传变的。所以出现头项疼痛，腰脊僵硬。（足太阳膀胱经的脉气从头顶联络脑部，下行至项部，夹行于脊柱两侧直达腰部。）第二天，阳明经受邪。（病邪传入阳明经，这是表证之里的层次。）阳明经主管肌肉，其经脉夹行于鼻旁。（起于鼻翼旁，沿鼻外侧下行。）联络于目。（《灵枢·经别》篇记载，阳明经系连目系。）所以出现身体发热、眼睛疼痛且鼻子干燥。（肺金燥盛故鼻腔干燥。）不能安卧。（阳明经主属胃腑，胃气不和则睡眠不安。）第三天，少阳经受邪。（病邪传入少阳经，处于半表半里的层次。）少阳经主属胆腑，其经脉循行于胁肋部，联络于耳部。所以出现胸胁疼痛和耳聋。三阳经（太阳、阳明、少阳）的经络都受到病邪侵袭，但病邪尚未传入五脏，所以可以通过发汗的方法治愈。（病邪在三阳经，尚属于表证，所以适宜用发汗法。这里的“脏”字并非指五脏，而是指三阴经。马莳注将三阴归属于五脏，所以也称其为“藏”。）第四天，太阴经受邪。（阳热病邪传入阴经而深入体内。）太阴脾经的脉气散布于胃中，联络于咽喉。所以出现腹部胀满且咽喉干燥。第五天，少阴经受邪。少阴肾经的脉气贯穿肾脏，联络于肺，系连舌根。所以出现口燥、舌干且口渴。（阳热病邪虽然传入里阴，但表现均为热证。）第六天，厥阴经受邪。厥阴肝经的脉气循行于阴器并联络于肝脏。所以出现心中烦闷且阴囊收缩。（《灵枢·经筋》篇记载，厥阴经筋循行于大腿内侧，结聚于阴器。受内伤则勃起不起，受寒邪则阴囊内缩，受热邪则挺纵不收。汪昂按语：阴寒证忌用寒凉药物，然而舌卷阴缩，有因寒极导致的，适宜使用四逆汤、吴茱萸汤、艾灸、葱熨等方法。又有因阳明经的热邪陷入厥阴经，阳明经主润宗筋，宗筋被热邪攻伐，失于濡养而拘急，也会导致舌卷阴缩。这属于热极之证，适宜用大承气汤泻阳救阴，不可不知。）如果三阴三阳经以及五脏六腑都受到病邪侵袭，营卫之气运行阻滞，五脏气机不通，那么就会死亡。（《内经》论述伤寒只分足经，不列手经，张仲景《伤寒论》遵循这一原则，于是有了“伤寒传足不传手”的说法。汪昂按语：张仲景分经虽主要依据足经，但在用药上，也未曾遗漏手经药。先贤认为麻黄、桂枝都是肺经的药，承气汤、白虎汤也是三焦和大肠的药，至于泻心汤则是治疗心的。刘草窗说：足太阳、足少阴属水，水遇寒则结冰；足阳明、足太阴属土，土遇寒则开裂；足少阳、足厥阴属木，木遇寒则凋零。所以寒邪容易伤害阳气旺盛的经脉。手六经则属火与金，火遇寒则更烈，金遇寒则更刚硬，所以寒邪不能伤害它们。这种创论新奇怪异，世人多感到惊奇。一阳子何东辨析道：刘氏将人身营卫经络上下截断，认为下一段受病，上一段就无关，这违背了气血周流瞬息无间的宗旨。《内经》说：“五脏六腑皆受病”，难道只有五脏六腑而没有手六经吗？经文又说：“人受伤寒则为病热”，既然说是病热，就没有水冰、土坼、木凋的说法，而有金烁、火亢的征象了。况且对手经受病的描述非常清晰，见《医方集解》。）那些没有两感于寒（即表里两经同时受邪）的，第七天太阳病衰退，头痛减轻。（这也是七日来复的道理。马莳注说：世间有再传经的说法，《素问》本篇及《伤寒论》原文并没有这个意思，是成无己注释的错误。阳为表，阴为里，从太阳到厥阴，就像入户升堂进入内室一样。厥阴再传回太阳，中间还有好几经隔着，怎么会有突然出来又传给太阳的道理呢？本篇用“衰”字最妙，意思是初感的邪气尚未尽除，可以衰退，绝不是再次传出传给太阳。）第八天阳明病衰退，身体发热减轻。第九天少阳病衰退，耳聋稍微能听到声音。第十天太阴病衰退，腹部胀满消退恢复常态，开始想吃东西。第十一天少阴病衰退，口渴停止，腹不满，舌干已缓解并且打喷嚏。（打喷嚏说明阳气调和通畅。）第十二天厥阴病衰退，阴囊松弛，小腹轻微下坠，大气（正气）都已去除，病一天天好了。治疗应当分别疏通各脏腑的经脉，病就会一天天衰退痊愈。病程未满三天的，可以通过发汗治愈。病程已满三天的，可以通过泄下治愈。（这是阐述表里治法的大概原则。伤寒有循经传的，有越经传的，有表里传的，有传两三经而停止的，有始终只在一经的。所以有的八九日仍在表，有的二三日就已传里，又有不由表而直中里的。可汗可泄，应当审察症状和脉象，不可固执拘泥。王冰注：虽然日子多，但只要还有表证，且脉象大浮数，仍然适宜发汗；日子虽少，即使有里证，且脉象沉细数，仍然适宜攻下。）热病已经痊愈，但有时留有后遗症。（遗留邪气。）为什么呢？因为热势正盛时强行进食，所以留下后遗症。像这种情况，都是病邪已经衰退，但余热潜伏在内。（余热未尽。）因为食物谷气与体内余热相互搏结，两热相合，所以留下后遗症。（脾胃尚虚弱，不能消化谷物。）病热稍减时，吃肉就会复发。（肉比谷物更难消化，所以病会复发。）多吃就会遗留病邪，这是饮食禁忌。两感于寒的，第一天太阳与少阴两经同时发病，出现头痛、口干、烦闷。第二天阳明与太阴两经同时发病，出现腹部胀满、身体发热、不想吃饭、说胡话。第三天少阳与厥阴两经同时发病，出现耳聋、阴囊收缩且四肢厥冷、水浆不进、神志昏迷。第六天死亡。五脏已受伤，六腑不通畅，营卫之气不行，在此之后三天才死亡。为什么呢？回答说：阳明经是十二经脉之长，它的血气最旺盛。（阳明经多血多气。）所以神志昏迷，经过三天它的元气耗尽，所以死亡。（胃气绝则死。）凡是患伤寒而转化为温病的，在夏至日之前发病的叫温病，在夏至日之后发病的叫暑病。暑病应当随着汗液一起排出，不要止住。（出自《热论》）
【素问】所有疟疾都是由风邪引起的。（王冰注： 同“瘅”，意为老、久。杨上善说：这篇经文有的写“ 疟”，有的只写“疟”，不必以是否每日发作来定是否为 疟。）它发作有定时，为什么呢？回答说：疟疾刚开始发作时，先表现为毫毛竖立、呵欠伸腰。（毫毛属表证，呵欠伸腰是阴阳相互牵引的表现。）接着出现寒战鼓颔（牙齿打颤），腰脊俱痛。寒冷过去后，内外都发热，头痛得像要破裂一样，口渴想喝冷冻饮料。这是什么气造成的呢？回答说：这是阴阳上下交争，虚实交替变化，阴阳相互移易的结果。（阳病者，上行至极则下行；阴病者，下行至极则上行。阳虚生外寒，阴盛生内寒，阳盛生外热，阴虚生内热。所以有交争、交替、移易的病患。）阳气并入阴分，则阴实而阳虚。阳明经气虚，则出现寒战鼓颔。（足阳明胃经，循行于面颊出大迎穴，沿颊车穴。）巨阳（太阳）经气虚，则腰背头项疼痛。（太阳经脉所经过的部位。按：疟邪居于半表半里，属少阳经，本篇言阳明太阳而不及少阳，下文又说三阳俱虚，大概是因为太阳为开，阳明为阖，少阳为枢。又说太阳寒水，行于身后为表；阳明燥金，行于身前为表之里。邪气在于中，靠近后面的膀胱水则寒，靠近前面的阳明燥则热。）三阳经气都虚，则阴气胜。阴气胜，则骨头寒冷疼痛。（阴主骨，寒主痛。）寒生于内，所以内外都寒。（阳虚生外寒，阴虚生内寒。）阳盛则外热，阴虚则内热，所以内外都热。（阴寒到了极点，则复发的阳气并出，阳实阴虚，所以内外都热。）这就出现气喘且口渴。（热伤气故喘，热伤津故渴。）所以想喝冷冻饮料。这都是因为在夏天受了暑邪。（暑邪。）热气盛大，藏在皮肤之内、肠胃之外，这是营气居住的地方。（表之内，里之外，是营气所居之处。热伤营气，遇到卫气应时而作。）这（指暑气）使人汗孔疏开，腠理开放，因而得到秋天的风气。（风邪。）以及洗澡时，水气（湿邪）停留在皮肤之内，与卫气并居。（邪气伤于卫气。）卫气白天行于阳经（六阳经），夜晚行于阴经（六阴经）。这股邪气遇到阳气则外出，遇到阴气则内迫。（外出故发热，内迫故恶寒。）内外相互搏结。（疟邪居于半表半里，所以内外相搏。）因此每天发作。（一日一发。）如果邪气停留的部位深，内迫于阴分，阳气独发，阴邪内着，阴与阳争斗不得出，因此隔天发作。（人有剽悍之气，行于大经的隧道，称为卫气。邪气感人，藏在分肉之间，不与大经之气相遇，就不发作。邪气出于分肉，流入大经，邪正相遇，不能兼容而交争，就发作了。邪入于阳，则感受浅而路径近，所以每天发作。邪入于阴，则感受深而路径远，阴邪与卫气相争，不能与卫气同行，所以隔天发作。）如果发作时间一天比一天晚，或者一天比一天早，是什么气造成的呢？回答说：邪气客居在风府穴，沿着脊柱两旁向下。（脊骨两旁称为膂，夹脊下行至尾骶骨。）卫气一天一夜，大会于风府。（督脉穴位，在项后入发际一寸，颈骨有三椎，其下是大椎，又名百劳。大椎以下至尾骶，有二十一节，共二十四节，对应二十四节气。疟疾一日行一节。）第二天，日下一节。所以发作时间晚了。（阳邪传入阴分，则发作时间推迟。）这是因为邪气先客居在脊背。每次到达风府，则腠理开放，开放则邪气入内，入内则病发作。因此每天发作的时间稍微推迟。（每天下一节，则向上会合风府的时间益迟。）邪气出于风府，每天下一节，二十五天下至骶骨。（脊骨尽头处。）第二十六天进入脊内。（重新上行于脊背。）注入伏膂之脉。（王冰注：指膂筋之间，肾脉伏行的地方。《甲乙经》作太冲之脉，巢元方作伏冲，指冲脉的上行者。按：冲脉入肾之络，也与肾脉并行，张介宾注作伏冲、膂筋二脉。）邪气上行，九天出于缺盆之中。（足阳明胃经穴位，肩下横骨陷中。）邪气位置日益升高，所以发作时间日益提前。（阴分传出阳分，则发作时间提前，病容易痊愈。）那些隔天发作的，是因为邪气内迫于五脏。（疟疾有经疟、脏疟之分，邪气深的则入脏。）横向连及募原。（膈膜的原野。）路径远，邪气深，运行迟缓，不能与卫气同行，不能同时外出，所以隔天发作。卫气每天下一节，邪气发作的时候，不在风府。那每天发作的疟疾是怎么回事呢？回答说：虚实不同，邪中部位各异，就不能正好当在风府。所以邪气中于头项，气至头项而病发；中于背部，气至背部而病发；中于腰脊，气至腰脊而病发；中于手足，气至手足而病发。卫气所在之处，与邪气相合则病发作。所以风邪没有固定的风府，卫气所发之处，必定开启其腠理，邪气所合之处，就是它的“府”。风症与疟疾相似且同类，但风症常常持续存在，疟疾却有间歇休息的时候，为什么呢？回答说：风邪留滞在局部，所以常存。疟气随经络深入体内，所以卫气应时而作才发作。（汪昂按语：卫气属阳主表，疟疾虽然有陷入阴经的，但必须等待卫气应时而作，这是阴中有阳，所以虽然严重但不至于杀人。《灵枢·岁露论》与此篇大致相同。）疟疾先寒而后热的，为什么呢？夏天受了大暑，汗大出，腠理开发，因而遇到夏季凄沧的水寒之气。（《甲乙经》、《太素》并作小寒。）寒气藏在腠理皮肤之中，秋天伤了风邪，病就形成了。寒，是阴气。（阴邪。）风，是阳气。（阳邪。）先伤于寒，而后伤于风，所以先寒而后热。病按时发作，名叫寒疟。先热而后寒的，为什么呢？这是先伤于风，而后伤于寒，所以先热而后寒。也按时发作，名叫温疟。只有热而不寒的，阴气先绝，阳气独发，则少气烦冤，手足热且想呕吐，名叫瘅疟。温疟，是冬天中了风邪，寒气藏在骨髓之中，到了春天阳气大发，邪气不能自行排出，因而遇到大暑，脑髓被灼烧，肌肉消瘦，腠理发泄，或者有所用力，邪气随汗而出。此病藏于肾。（经）邪气先从内出到外。（汪昂按语：这就是春温的病证，寒气积久，自内达外，不像伤寒那样由表传里。王安道说：常见治疗温热病，误用攻里法，也无大害；误用发汗法，变证不可言说。这足以证明热是自内达外的。）像这样，阴虚而阳盛，阳盛则热。衰退时气又反入，入内则阳虚，阳虚则寒。所以先热而后寒，名叫温疟。瘅疟，是肺素有热，气盛于身，厥逆上冲，中气实而不外泄，因而有所用力，腠理开，风寒舍于皮肤之内、分肉之间而发作。发作时阳气盛，阳气盛而不衰，则病了。邪气不及于阴分，所以只有热而不寒。气内藏于心。（汪昂按语：此病应当是肺瘅、心瘅之类，与前文脾瘅、胆瘅相同。瘅，即热也。）而外舍于分肉之间，令人消瘦脱肉，所以名叫瘅疟。（李士材说：温疟舍于肾，瘅疟舍于肺与心。温疟即伤寒，所以《伤寒论》有温疟一症。瘅疟则是火盛乘金，阴虚阳亢，二者都不是真疟。）疟疾刚开始发作时，阳气并入阴分，这个时候，阳虚而阴盛，外无阳气，所以先寒战。阴气逆乱至极，则复出归于阳，阳与阴复并于外，则阴虚而阳实，所以先热且渴。（王冰注：阴盛则胃寒，所以战栗；阳盛则胃热，所以想喝水。）疟气，并入阳则阳胜，并入阴则阴胜。阴胜则寒，阳胜则热。疟疾，是风寒之气不常所致。病极则复。（发作完就像正常人一样，如后文所说极则阴阳俱衰也。）到了病发作的时候，（“至”字有连上句读的，言寒热复至，今从王氏说法。）像火一样热，像风雨一样不可抵挡。所以经文说：当其邪气盛时必毁伤真气。（邪气正盛时泻之，必毁伤真气。）趁着邪气衰退时治疗，事情必然大吉。说的就是这个道理。疟疾未发作时，阴未并阳，阳未并阴，因而调理它，真气得以安宁，邪气乃亡。所以医生不能在疟疾已发作时治疗，因为此时气机逆乱。（疟疾正在发作时，不可服药，若服药则寒药助寒，热药助热，反而增加病情。）疟气，必然更盛更虚，当气所在之处。病在阳则热而脉躁，病在阴则寒而脉静。极则阴阳俱衰，卫气分离，所以病得休息。卫气聚集，则病又发作。有时隔两天或至几天发作，有时口渴有时不口渴，为什么呢？那些隔几天发作的，是因为邪气与卫气客居在六腑，有时相失，不能相得，所以休息几天才发作。疟疾是阴阳更胜。有时甚有时不甚，所以有时渴有时不渴。（阳盛则渴，阴盛则不渴。）疟疾将要发作时，阴阳即将移易，必定从四肢末端开始。（手足十指，是三阴三阳经脉所起始的地方，所以后文《刺疟篇》说：诸疟而脉不见，刺十指间出血，血出必愈。）在秋天得的疟疾寒甚。（秋气肃杀凛冽。）在冬天得的疟疾寒不甚。（阳气内藏。）在春天得的疟疾怕风。（阳气方升而腠理开。）在夏天得的疟疾多汗。（气热而津液外泄。〔出自《疟论》〕）
【素问】足太阳经的疟疾，使人腰痛头重，寒从背部开始。（经脉所过之处。）先寒后热， （音谒，形容热貌。）热退后汗出难止。足少阳经的疟疾，使人身体懈怠无力，寒不甚，热不甚。（即懈惰之意。）怕见人。（胆木气盛，则克伐胃土，胃热盛，则恶人。）见到人心里恐惧惕惕然。（胆气虚。）热多汗出甚。足阳明经的疟疾，使人先寒战洒淅，寒甚。（阳虚生外寒。）很久才发热，热退汗出，喜欢见到日光月光火气，才觉得舒服。（阳明经多血多气，热盛则恶人与火，现在反而喜欢，是因为胃虚的缘故。）足太阴经的疟疾，使人心情不乐，喜欢长叹气。（脾不运化而气机不舒。）不喜欢吃东西，多寒热。（脾虚恶寒，胃虚恶热，所以疟疾又叫脾寒。）汗出，病发作时善于呕吐。（脾脉络胃，挟咽。）吐完病势才衰退。足少阴经的疟疾，使人呕吐严重。（肾脉贯膈入肺，循喉咙。）多寒热，热多寒少。（水衰火旺。）想关上门窗独处。病难治愈。（阳明胃经病，想独闭户牖而处，现在胃病见于肾中，为土刑于水，所以难治。）足厥阴经的疟疾，使人腰痛，少腹胀满，小便不利，像癃闭状。（癃闭，厥阴经脉环阴器，抵小腹。）并不是癃闭，而是频繁小便。心里恐惧，气不足。（肝气有余则怒，不足则恐。）
There are cases where pathogenic factors spread from the interior to the exterior. Thus, headache and stiffness of the neck and spine occur. (The meridians of Taiyang [Greater Yang] originate from the vertex, connect with the brain, descend to the nape, run alongside the spine, and reach the waist.) On the second day, the Yangming [Yang Brightness] meridian is affected. (The pathogen transmits to the Yangming meridian, representing the level of the interior relative to the exterior.) Yangming governs the flesh, and its meridian runs alongside the nose. (Originating beside the nose, it follows the lateral aspect of the nose.) It connects with the eyes. (According to the *Jingbie* chapter of the *Lingshu*, the Yangming meridian is connected to the eye system.) Therefore, fever, eye pain, and dryness of the nose occur. (Dryness results from the desiccating nature of Metal/Lung.) The patient cannot sleep. (Yangming corresponds to the Stomach; disharmony of the Stomach leads to restlessness in sleep.) On the third day, the Shaoyang [Lesser Yang] meridian is affected. (The pathogen transmits to the Shaoyang meridian, representing the half-exterior, half-interior level.) Shaoyang governs the Gallbladder, its meridian courses along the flanks, and connects with the ears. Therefore, pain in the chest and hypochondrium, and deafness occur. When the meridians of the Three Yang meridians are all affected by disease, but the pathogen has not yet entered the Zang organs, it can be cured by inducing sweating. (The pathogen in the Three Yang meridians still belongs to the exterior level, so diaphoresis is appropriate. Here, the term "Zang" does not refer to the Five Zang organs, but to the Three Yin meridians. Ma Shi's commentary associates the Three Yin with the Five Zang organs, hence calling them "Zang".) On the fourth day, the Taiyin [Greater Yin] meridian is affected. (Yang pathogenic factors transmit to the Yin meridians and enter the interior.) The Taiyin Spleen meridian spreads into the stomach and connects with the throat. Therefore, abdominal fullness and dryness of the throat occur. On the fifth day, the Shaoyin [Lesser Yin] meridian is affected. The Shaoyin Kidney meridian penetrates the Kidneys, connects with the Lungs, and attaches to the root of the tongue. Therefore, dry mouth, dry tongue, and thirst occur. (Although Yang pathogenic factors have entered the interior Yin, they manifest as heat syndromes.) On the sixth day, the Jueyin [Terminal Yin] meridian is affected. The Juevin Liver meridian courses around the genitalia and connects with the Liver. Therefore, irritability, fullness, and retraction of the scrotum occur. (The *Jingsi* chapter of the *Lingshu* states that the Jueyin tendon channel courses along the inner thigh and knots at the genitalia. Internal injury causes inability to erect; cold injury causes retraction; heat injury causes protrusion and inability to retract. Wang Ang notes: Cold syndromes contraindicate cold-natured herbs. However, curled tongue and retracted scrotum can result from extreme cold, requiring formulas like Sini Tang or Wuzhuyu Tang, moxibustion, or ginger-warming methods. Alternatively, heat from Yangming sinking into Jueyin may attack the Zongjin [major tendons], causing them to contract due to lack of nourishment, leading to curled tongue and retracted scrotum. This is an extreme heat syndrome, requiring Dachengqi Tang to purge Yang and save Yin. This must be understood.) If the Three Yin and Three Yang meridians, as well as the Five Zang and Six Fu organs, are all affected, and the Ying [Nutritive] and Wei [Defensive] Qi cease to circulate, and the Qi of the Five Zang becomes blocked, death will ensue. (*Neijing* discusses Shanghan [Cold Damage] primarily in terms of Foot meridians, excluding Hand meridians. Zhang Zhongjing's *Shanghan Lun* followed this, leading to the theory that "Shanghan transmits through Foot meridians but not Hand meridians." Wang Ang notes: Although Zhang Zhongjing categorized meridians mainly by the Foot meridians, his herbal prescriptions did not omit Hand meridians. Ancients considered Mahuang and Guizhi as Lung meridian herbs, Chengqi and Baihu formulas as Sanjiao and Large Intestine meridian herbs, and Xiexin Tang as treating the Heart. Liu Caochuang stated: The Foot Taiyang and Shaoyin belong to Water, which freezes in cold; Foot Yangming and Taiyin belong to Earth, which cracks in cold; Foot Shaoyang and Jueyin belong to Wood, which withers in cold. Thus, cold favors damaging Yang. The Hand Six Meridians belong to Fire and Metal; Fire burns fiercer in cold, Metal becomes harder in cold, so cold cannot harm them. This novel theory was met with surprise. He Dong of Yiyangzi refuted this: Liu severed the body's Ying-Wei and meridians into upper and lower segments, implying that if the lower segment is diseased, the upper is unaffected, violating the principle of continuous Qi circulation. *Neijing* says "Five Zang and Six Fu organs are all affected"; how could there be no Hand Six Meridians? The classic also states "When humans contract cold, they develop heat diseases." Since it is a heat disease, there is no freezing water, cracking earth, or withering wood, but rather signs of scorched Metal and hyperactive Fire. Moreover, the involvement of Hand meridians is clearly described in *Yifang Jijie*.) In cases not suffering from Lianggan [Simultaneous contraction of Exterior and Interior meridians], on the seventh day, the Taiyang disease declines, and the headache lessens. (This reflects the principle of recovery after seven days. Ma Shi notes: The theory of "re-transmission" exists in popular belief, but neither this chapter nor *Shanghan Lun* supports it; it is an error in Cheng Wuji's commentary. Exterior is Yang, Interior is Yin; transmission from Taiyang to Jueyin is like entering a house and ascending to the inner room. For Jueyin to transmit back to Taiyang, several meridians lie in between; it is illogical for it to suddenly exit and transmit to Taiyang. The word "decline" in this chapter is apt: it means the initial pathogen has not fully dissipated but is receding, not that it re-emerges to transmit to Taiyang.) On the eighth day, Yangming disease declines, and body heat lessens. On the ninth day, Shaoyang disease declines, and hearing slightly improves. On the tenth day, Taiyin disease declines, abdominal fullness subsides to normal, and appetite returns. On the eleventh day, Shaoyin disease declines, thirst stops, abdominal distension resolves, tongue dryness ceases, and sneezing occurs. (Sneezing indicates harmonious and smooth Yang Qi.) On the twelfth day, Jueyin disease declines, the scrotum relaxes, slight lower abdominal heaviness subsides, and the Great Qi [vital energy] is expelled; the illness heals day by day. Treatment requires unblocking the meridians of each affected Zang-Fu organ, and the disease will decline daily. If the duration is less than three days, diaphoresis can cure it. If the duration exceeds three days, purgation can cure it. (This outlines the general principles of treating exterior and interior conditions. Shanghan may transmit along the meridians, skip meridians, transmit between exterior and interior, stop after affecting two or three meridians, or remain confined to one meridian. Thus, some cases remain in the exterior after eight or nine days, while others transmit to the interior within two or three days. Some bypass the exterior and directly strike the interior. Whether to use diaphoresis or purgation depends on careful examination of symptoms and pulse; one must not be rigid. Wang Bing's commentary: Even if many days have passed, if exterior symptoms persist and the pulse is large, floating, and rapid, diaphoresis is still indicated. Conversely, even if few days have passed, if interior symptoms exist and the pulse is deep, fine, and rapid, purgation is indicated.) After a heat disease has healed, residual symptoms may occasionally persist. (Residual pathogenic factors.) Why? Because eating strongly when the heat is intense causes these residuals. In such cases, the main pathogen has declined, but residual heat remains hidden. (Residual heat has not fully cleared.) The Qi of food grains clashes with this residual heat, and the two heats combine, causing residual symptoms. (The Spleen and Stomach are still weak and cannot digest food properly.) Eating meat when the feverish condition slightly improves causes recurrence. (Meat is harder to digest than grains, so the disease recurs.) Overeating leads to lingering pathogens; this is a dietary prohibition. In cases of Lianggan (simultaneous contraction), on the first day, both Taiyang and Shaoyin meridians are affected, causing headache, dry mouth, and irritability/fullness. On the second day, both Yangming and Taiyin meridians are affected, causing abdominal fullness, body heat, anorexia, and delirious speech. On the third day, both Shaoyang and Jueyin meridians are affected, causing deafness, scrotal retraction, and cold limbs, inability to drink fluids, and unconsciousness. Death occurs on the sixth day. The Five Zang are injured, the Six Fu are blocked, and Ying-Wei Qi do not circulate; death occurs three days later. Why? The answer is: Yangming is the leader of the Twelve Meridians, and its Blood and Qi are abundant. (Yangming has abundant Blood and Qi.) Thus, unconsciousness occurs. After three days, its Qi is exhausted, leading to death. (Death occurs when Stomach Qi perishes.) Any disease contracted as Shanghan that transforms into Wen [Warmth] disease manifests as Wenbing if it occurs before the Summer Solstice, and as Shu [Summerheat] disease if it occurs after the Summer Solstice. Shu disease should be expelled with sweat; do not suppress sweating. (From *Re Lun*)
[Suwen] All malaria originates from Wind. (Wang Bing's note: The character denotes chronicity. Yang Shangshan states: This text uses either "malaria" or "chronic malaria"; one should not define it solely by whether it occurs daily.) Why does it发作 [attack] at regular intervals? The answer is: When malaria first attacks, it begins with goosebumps and yawning/stretching. (Goosebumps indicate the exterior; yawning indicates the interaction of Yin and Yang.) Then chills with teeth chattering occur, accompanied by pain in the lower back and spine. When the cold passes, both interior and exterior become hot, with severe headache as if splitting, and thirst for cold drinks. What Qi causes this? The answer is: This is due to the struggle between Upper and Lower Yin and Yang, alternating deficiency and excess, and the shifting of Yin and Yang. (Yang diseases ascend to the extreme then descend; Yin diseases descend to the extreme then ascend. Yang deficiency generates exterior cold; Yin excess generates interior cold; Yang excess generates exterior heat; Yin deficiency generates interior heat. Hence, struggles, alternations, and shifts occur.) When Yang merges into Yin, Yin becomes excessive and Yang deficient. Deficiency of Yangming Qi causes chills and teeth chattering. (The Foot Yangming Stomach meridian runs along the jaw, out to Daying, and along Jiache.) Deficiency of Juyang (Taiyang) Qi causes pain in the lower back, back, head, and neck. (Along the course of the Taiyang meridian. Note: Malaria pathogen resides in the half-exterior, half-interior, belonging to Shaoyang. This chapter mentions Yangming and Taiyang but not Shaoyang, and later states "Three Yang are all deficient," likely because Taiyang is the Opening, Yangming is the Closing, and Shaoyang is the Pivot. Also, Taiyang Cold Water runs along the posterior exterior, while Yangming Dry Metal runs along the anterior exterior-interior. Pathogens in the middle near the Bladder Water cause cold, while those near Yangming Dry cause heat.) When the Three Yang meridians are all deficient, Yin Qi prevails. When Yin Qi prevails, bones become cold and painful. (Yin governs bones; cold governs pain.) Cold arises from within, so both interior and exterior are cold. (Yang deficiency causes exterior cold; Yin deficiency causes interior cold.) Yang excess causes exterior heat; Yin deficiency causes interior heat, resulting in heat throughout. (When Yin cold reaches extremity, the emerging Yang merges outward, making Yang excess and Yin deficiency, hence heat inside and out.) This leads to panting and thirst. (Heat damages Qi causing panting; heat damages fluids causing thirst.) Hence, the desire for cold drinks. All these result from Summerheat injury in summer. (Summerheat pathogen.) Heat Qi is vigorous, hiding inside the skin and outside the intestines/stomach, which is the abode of Ying Qi. (Inside the exterior, outside the interior, where Ying Qi resides. Heat damages Ying Qi; it acts when Wei Qi responds.) This (Summerheat) causes pores to open and interstices to relax, allowing Autumn Wind to enter when sweating. (Wind pathogen.) And bathing allows Water Qi (Dampness pathogen) to lodge in the skin, residing with Wei Qi. (Pathogen damages Wei Qi.) Wei Qi travels through the Yang meridians (Six Yang meridians) during the day and through the Yin meridians (Six Yin meridians) at night. This pathogen moves outward when encountering Yang Qi and presses inward when encountering Yin Qi. (Outward movement causes heat; inward pressing causes cold.) They clash internally and externally. (Malaria pathogen resides in the half-exterior, half-interior, hence internal-external clash.) Thus, it occurs daily. (Once a day.) If the pathogen lodges deeply, pressing inward on Yin, Yang Qi alone erupts, while Yin pathogen stays fixed inside. Yin and Yang struggle but cannot exit together, thus it occurs every other day. (Humans have Piao Han Qi [vigorous Qi] traveling in the great meridians' tunnels, called Wei Qi. When pathogen enters, it hides in Fenrou [muscle spaces]. If it does not meet the Qi of the great meridians, it does not attack. When it flows from Fenrou into the great meridians, Zheng [Upright] and Xie [Pathogenic] Qi meet, cannot coexist, and struggle, causing attack. Pathogen entering Yang is shallow and close, so it attacks daily. Pathogen entering Yin is deep and distant; Yin pathogen struggles with Wei Qi and cannot travel with it, so it attacks every other day.) Why does the onset time vary, sometimes later and sometimes earlier? The answer is: Pathogen lodges in Fengfu acupoint and descends along the Lumbar muscles. (The sides of the spine are called Lu, descending alongside the spine to the coccyx.) Wei Qi gathers at Fengfu once a day and night. (Du Meridian acupoint, one cun below the hairline at the nape, below the third cervical vertebra, is Dazhui, also known as Bailao. From Dazhui to the coccyx are 21 segments, totaling 24, corresponding to 24 solar terms. Malaria progresses one segment per day.) The next day, it descends one segment. Thus, the onset is delayed. (Yang pathogen transmitting to Yin causes delayed onset.) This is because the pathogen first lodged in the spine. Each time it reaches Fengfu, the interstices open, allowing pathogen entry and disease onset. Thus, onset is progressively delayed. (Descending one segment daily means meeting Fengfu later.) Exiting Fengfu, it descends one segment daily. After 25 days, it reaches the coccyx. (End of spinal column.) On the 26th day, it enters the spine. (Ascending again along the spine.) It injects into the Fulu Meridian. (Wang Bing notes: Between the Lu tendons, where the Kidney meridian runs deeply. *Jiayi Jing* calls it Taichong Meridian; Chao Yuanfang calls it Fuchong, referring to the ascending Chong Meridian. Note: Chong Meridian enters Kidney collaterals and runs parallel to Kidney meridian; Zhang Jiebin notes both Fuchong and Lu tendons.) The Qi ascends. After nine days, it emerges at Quepen. (Foot Yangming acupoint, in the depression below the clavicle.) As the Qi rises daily, onset becomes progressively earlier. (Transmitting from Yin to Yang causes earlier onset; the disease is easier to cure.) Cases occurring every other day occur because the pathogen presses inward on the Five Zang. (Malaria includes Meridian Malaria and Zang Malaria; deep pathogens enter the Zang.) Connecting horizontally to the Muyuan [Mu-Source/Original Source]. (The origin of the diaphragm.) The path is long, the pathogen is deep, and its movement is slow. It cannot travel with Wei Qi and cannot exit together, hence it occurs every other day. Wei Qi descends one segment daily. When the pathogen attacks, it is not at Fengfu. How does the daily attacking malaria work? The answer is: Deficiency and excess differ, and pathogen invasion sites vary, so it does not always coincide with Fengfu. Thus, if pathogen invades the head/neck, disease occurs when Qi reaches the head/neck; if it invades the back, disease occurs when Qi reaches the back; if it invades the waist/spine, disease occurs when Qi reaches the waist/spine; if it invades the hands/feet, disease occurs when Qi reaches the hands/feet. Disease occurs where Wei Qi meets the pathogen. Thus, Wind has no fixed Fengfu. Wherever Wei Qi emerges, it opens the interstices; wherever the pathogen combines, that is its "Fu." Wind and Malaria are similar and of the same category, yet Wind persists constantly, while Malaria has periods of remission. Why? The answer is: Wind Qi stays in its location, so it persists. Malaria Qi follows the meridians and sinks inward, so it acts only when Wei Qi responds. (Wang Ang notes: Wei is Yang and governs the exterior. Although Malaria can sink into Yin meridians, it must wait for Wei Qi response, indicating Yang within Yin. Thus, even severe cases do not kill. *Lingshu: Suilu Lun* is similar to this chapter.) Why does Malaria start with chills and then fever? Summerheat injury in summer causes profuse sweating and open interstices. Encountering cold water/air in summer, Cold Qi hides in the skin and interstices. Autumn Wind injury completes the disease. Cold is Yin Qi. (Yin pathogen.) Wind is Yang Qi. (Yang pathogen.) Injury to Cold first, then Wind, causes chills first, then fever. Attacking at regular times, it is named Han Malaria [Cold Malaria]. Why does it start with fever and then chills? This is Wind injury first, then Cold injury, causing fever first, then chills. Attacking at regular times, it is named Wen Malaria [Warm Malaria]. Only heat without chills occurs when Yin Qi is exhausted first, and Yang Qi erupts alone. This causes shortness of breath, oppression, heat in hands and feet, and nausea, named Dan Malaria [Fever Malaria]. Wen Malaria results from Winter Wind injury, with Cold Qi hiding in the bone marrow. In Spring, Yang Qi erupts vigorously, but the pathogen cannot exit. Encountering Summerheat, brain marrow is scorched, muscles waste, interstices open, or physical exertion forces the pathogen out with sweat. This disease hides in the Kidney. (Classic) The Qi moves from interior to exterior. (Wang Ang notes: This is Chunwen [Spring Warmth]; accumulated Cold exits from interior to exterior, unlike Shanghan which transmits from exterior to interior. Wang Andao said: Treating Warm diseases, mistaken purgation causes little harm, but mistaken diaphoresis leads to untold changes. This proves heat originates from within.) Such cases involve Yin deficiency and Yang excess. Yang excess causes heat. When declining, Qi returns inward, causing Yang deficiency and cold. Thus, fever first, then chills, named Wen Malaria. Dan Malaria occurs when the Lungs harbor heat, Qi is vigorous in the body, rebellious Qi rushes upward, Middle Qi is full but does not vent outward. Physical exertion opens interstices, and Wind-Cold lodge in the skin and muscle spaces. Upon attack, Yang Qi becomes excessive. If Yang Qi remains excessive and does not decline, disease occurs. The pathogen does not reach Yin, so there is only heat without chills. The Qi hides in the Heart. (Wang Ang notes: This disease is likely Lung Dan or Heart Dan, similar to Spleen Dan and Gallbladder Dan mentioned earlier. Dan means heat.) It lodges externally in the muscle spaces, causing emaciation, hence named Dan Malaria. (Li Shicai said: Wen Malaria lodges in the Kidney; Dan Malaria lodges in the Lungs and Heart. Wen Malaria is Shanghan, hence included in *Shanghan Lun*. Dan Malaria is Fire overwhelming Metal, with Yin deficiency and Yang hyperactivity; neither is true Malaria.) When Malaria first attacks, Yang merges into Yin. At this time, Yang is deficient and Yin is excessive, with no Yang Qi on the exterior, hence chills first. When Yin Qi reverses to the extreme, it returns to Yang. Yang and Yin merge outward again, causing Yin deficiency and Yang excess, hence fever and thirst first. (Wang Bing notes: Yin excess causes Stomach cold, hence shivering; Yang excess causes Stomach heat, hence desire for drinks.) Malaria Qi, merging with Yang makes Yang prevail; merging with Yin makes Yin prevail. Yin prevailing causes cold; Yang prevailing causes heat. Malaria is caused by irregular Wind-Cold Qi. Extreme disease leads to reversal. (After attack, the person returns to normal, as stated later: "extreme leads to decline of both Yin and Yang.") When the disease attacks, (The character "Zhi" can link to the previous sentence, meaning cold and heat recur; following Wang's interpretation,) it is like fire's heat or wind and rain, unstoppable. Hence the classic says: "When it is盛 [prosperous/excessive], it must destroy." (Purging when pathogen is strong destroys True Qi.) "Because it is declining, the treatment will prosper." This is what is meant. Before Malaria attacks, Yin has not merged with Yang, and Yang has not merged with Yin. Regulating at this time allows True Qi to settle and Pathogen to perish. Thus, physicians cannot treat Malaria after it has started, because the Qi is reversed. (During active Malaria attack, medication should not be taken; cold herbs would aid cold, heat herbs would aid heat, worsening the condition.) Malaria Qi alternates between excess and deficiency. Wherever the Qi is located: if in Yang, there is heat and rapid pulse; if in Yin, there is cold and quiet pulse. At the extreme, both Yin and Yang decline, and Wei Qi separates, so the disease rests. When Wei Qi gathers, the disease recurs. Sometimes it occurs every two days or several days; sometimes with thirst, sometimes without. Why? In cases occurring every few days, the pathogen and Wei Qi reside in the Six Fu organs but sometimes miss each other and cannot interact, hence resting for several days before attacking. Malaria involves alternating Yin and Yang prevalence. Sometimes severe, sometimes mild, hence sometimes thirsty, sometimes not. (Yang excess causes thirst; Yin excess causes no thirst.) When Malaria is about to attack, Yin and Yang are about to shift, necessarily starting from the four extremities. (The ten fingers are the origins of the Three Yin and Three Yang meridians; hence the *Cimian* chapter states: For all malaria where pulse is not visible, prick the ten fingers to bleed; bleeding ensures cure.) Malaria contracted in Autumn has severe chills. (Autumn air is piercing.) Malaria contracted in Winter has mild chills. (Yang Qi is stored internally.) Malaria contracted in Spring features aversion to wind. (Yang Qi is rising and interstices are open.) Malaria contracted in Summer features profuse sweating. (Qi is hot, and body fluids leak outward. [From *Malun*])
[Suwen] Malaria of the Foot Taiyang meridian causes lower back pain, heavy head, and cold starting from the back. (Along the meridian course.) Chills precede fever. (Sound: ye, describing heat.) After fever subsides, sweating occurs but is difficult to stop. Malaria of the Foot Shaoyang meridian causes bodily laxity and weakness. Chills are mild, and fever is mild. (Meaning laxity.) Aversion to people. (Gallbladder Wood excess overacts on Stomach Earth; Stomach heat excess causes aversion to people.) Fearfulness upon seeing people. (Gallbladder deficiency.) Fever is prominent with profuse sweating. Malaria of the Foot Yangming meridian causes initial chills and shivering, with severe cold. (Yang deficiency generates exterior cold.) After a long time, fever develops. After fever subsides, sweating occurs. The patient likes sunlight, moonlight, and fire, feeling comfortable. (Yangming has abundant Blood and Qi; heat excess usually causes aversion to people and fire. Preferring them now indicates Stomach deficiency.) Malaria of the Foot Taiyin meridian causes unhappiness and frequent sighing. (Spleen fails to transform, Qi stagnates.) Anorexia, alternating chills and fever. (Spleen deficiency causes cold aversion; Stomach deficiency causes heat aversion, hence Malaria is called Spleen Cold.) Sweating. Upon attack, vomiting occurs. (Spleen meridian connects to Stomach and flanks the throat.) Vomiting leads to decline of the disease. Malaria of the Foot Shaoyin meridian causes severe vomiting. (Kidney meridian pierces the diaphragm, enters the Lungs, and follows the throat.) Alternating chills and fever, with more fever than chills. (Water deficiency, Fire hyperactivity.) Desire to stay behind closed doors and windows. The disease is difficult to cure. (Yangming Stomach meridian disease desires solitude; here Stomach disease appears in the Kidney, representing Earth overcoming Water, hence difficult to cure.) Malaria of the Foot Jueyin meridian causes lower back pain, lower abdominal fullness, and difficulty urinating, resembling Gongbi [strangury]. (Gongbi, Jueyin meridian circles the genitalia and reaches the lower abdomen.) It is not Gongbi, but frequent urination. Mental fearfulness and Qi insufficiency. (Liver Qi excess causes anger; deficiency causes fear.)