经曰。夏伤于暑。秋必病疟。盖伤之浅者。近而暴发。伤之重者。远而 疟。 者。久疟也。是知夏伤于
暑。湿热闭藏。而不能发泄于外。邪气内行。至秋而发为疟也。初不知何经受之。随其动而取之。有中三阳者。
有中三阴者。大抵经中邪气。其证各殊。同伤寒论之也。故内经曰。五脏皆有疟。其治各别。在太阳经者。谓
之风疟。治多汗之。在阳明经者。谓之热疟。治多下之。在少阳经者。谓风热疟。治多和之。此三阳经受病。
皆谓之暴疟。发在夏至后处暑前。此乃伤之浅者。近而暴也。在阴经则不分三经。总谓之湿疟。当从太阴经论
之。其病发在处暑后冬至前。此乃伤之重者。远而为 。 者。老也。故谓之久疟。气居西方。宜毒药疗之。
疟之为病。因内积暑热之气。不能宣泄于外。而为疟也。当盛夏之时。能食寒凉之物。而助阴气者。纵使有暑
热之气。微者自消矣。更时复以药疏利脏腑。使邪气自下。内经曰。春食凉。夏食寒。秋食温。冬食热。是谓
春夏养阳。秋冬养阴。人能于饮食起居之间。顺四时之气而行之。邪气何由得生也。
治疟病处暑前。头痛项强。脉浮恶风有汗。桂枝羌活汤。
桂枝 羌活 防风 甘草（炙各半两）
上为粗末。每服半两。水一盏半。煎至一盏。温服清。迎发而服之。如吐者。加半夏曲等分。
治疟病头痛项强。脉浮恶风无汗者。麻黄羌活汤。
麻黄（去节） 羌活 防风 甘草（炙各半两）
同前服。如吐者。加半夏曲等分。
治法。疟如前证而夜发者。麻黄桂枝汤主之。
麻黄（一两去节） 甘草（三钱炙） 桃仁（三十个去皮尖） 黄芩（五钱） 桂枝（三钱）
上五味。同为细末。根据前服。桃仁味苦甘辛。肝者血之海。血聚则肝气燥。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。
治疟病身热目痛。热多寒少。脉长睡卧不安。先以大柴胡汤下之。微利为度。如下过外微邪未尽者。宜服
白芷汤。以尽其邪。
白芷（一两） 知母（一两七钱） 石膏（四两）
上为粗末。同前煎服。
治疟无他证。隔日发。先寒后热。寒少热多。宜桂枝石膏汤。
桂枝（五钱） 石膏 知母（各一两半） 黄芩（一两）
上为粗末。分作三服。每服水一盏。同前煎服。间日者。邪气所舍深也。
治疟寒热大作。不论先后。皆太阳阳明合病也。谓之交争。寒作则必战动。经曰。热胜而动也。发热则必
汗泄。经曰。汗出不愈。知为热也。阳盛阴虚之证。当内实外虚。不治必传入阴经也。当用桂枝芍药汤主之。
桂枝（三钱） 黄 知母 石膏 芍药（各一两）
上为粗末。每服五七钱。至半两。水煎如前药服之。寒热转大者。知太阳阳明少阳三阳合病也。宜用桂枝
黄芩汤和之。
桂枝黄芩汤
柴胡（一两二钱） 黄芩（四钱半） 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。服药已。如外邪已罢。内邪未已。再
服下药。从卯至午时发者。宜以大柴胡汤下之。从午至酉时发者。知其邪气在血也。宜以桃仁承气汤主之。
前项下药。微利为度。便以小柴胡汤彻其微邪之气。
立秋之后及处暑前发疟。渐瘦不能食者。谓之 疟。此邪气深远而中阴经。为久疟也。
治久疟不能饮食。胸中郁郁如吐。欲吐不能吐者。宜吐则已。当以藜芦散雄黄散吐之。
藜芦散
大藜芦末半钱。温齑水调下。以吐为度。
雄黄散
雄黄 瓜蒂 赤小豆（各一钱）
上为细末。每服半钱。温齑水调下。以吐为度。
治秋深久疟。胃中无物。又无痰癖。腹高而食少。俗谓疟气入腹。宜苍术汤主之。
苍术（四两） 草乌头（一钱） 杏仁（三十个）
上为粗末。都作一服。水三升。煎至一半。均作三服。一日服尽。迎发而服。
局方中七宣丸。治疟之圣药也。
局方中神效饮子。乃疟疾之圣药也。又名交结饮子。
《黄帝内经》说：“夏季感受暑邪，秋季必定发生疟疾。”凡是感受邪气较浅的，发病迅速且急骤；感受邪气较重的，病程迁延日久，形成久疟（长期不愈的疟疾）。由此可知，夏季感受暑邪，导致湿热内蕴闭藏，不能向外发散，邪气在体内运行，到了秋季才发作成为疟疾。起初不知道是哪一经受邪，应随着病机的变动来选取相应的治疗方法。有的侵犯三阳经，有的侵犯三阴经。大抵上，各经中的邪气所致证候各不相同，这与《伤寒论》中的论述类似。所以《内经》说：“五脏都有疟疾，治疗各不相同。”在太阳经受病的，称为风疟，治疗多用发汗法；在阳明经受病的，称为热疟，治疗多用攻下法；在少阳经受病的，称为风热疟，治疗多用和解法。这三阳经受病，都称为暴疟（急性发作的疟疾），发病时间在夏至后到处暑前。这是感受邪气较浅，发病近而急骤的表现。在阴经受病则不分具体哪一经，总称为湿疟，应当从太阴经来论述。其发病时间在处暑后到冬至前。这是感受邪气较重，病程远而迁延为久疟。“老”指病程长久，所以称为久疟。此时邪气居于西方（金气主令，对应秋季收敛肃杀），适宜用有毒性的药物来治疗。
疟疾这种病，是因为体内积聚了暑热之气，不能宣泄于外，从而形成疟疾。在盛夏之时，如果能食用寒凉食物以助长阴气，即使有暑热之气，轻微的也会自行消除。再加上时常服用药物疏通利导脏腑，使邪气从下面排出。《内经》说：“春季吃凉性食物，夏季吃寒性食物，秋季吃温性食物，冬季吃热性食物。”这叫做“春夏养阳，秋冬养阴”。人如果在饮食起居之间，顺应四季气候的变化而行事，邪气从哪里产生呢？
治疗疟疾病，在处暑之前，出现头痛、项背强直、脉浮、恶风、有汗的症状，使用桂枝羌活汤。
桂枝、羌活、防风、甘草（炙，各半两）
以上药材研成粗末，每次服用半两，加水一盏半，煎煮至一盏，温服清汁。在预计发作前服用。如果伴有呕吐症状，加入半夏曲，分量相等。
治疗疟疾病，出现头痛、项背强直、脉浮、恶风、无汗症状的，使用麻黄羌活汤。
麻黄（去节）、羌活、防风、甘草（炙，各半两）
服用方法同前。如果伴有呕吐症状，加入半夏曲，分量相等。
治疗方法：疟疾如上述证候，但在夜间发作的，以麻黄桂枝汤为主治方剂。
麻黄（一两，去节）、甘草（三钱，炙）、桃仁（三十个，去皮尖）、黄芩（五钱）、桂枝（三钱）
以上五味药，共同研为细末，按照前面的方法服用。桃仁味苦、甘、辛。肝是血之海，血液淤聚则肝气燥急，《内经》所谓“肝苦急”，应当吃甘味食物来缓和它。所以桃仁能散血缓肝，说是因为邪气深远而入血分，所以在夜间发作，这是阴经有邪气。此汤是发散血中风寒的方剂。
治疗疟疾病，身体发热、目痛，热多寒少，脉长，睡眠不安稳。先用大柴胡汤攻下，以轻微腹泻为度。如果攻下后体表微邪未尽，适宜服用白芷汤，以清除残余邪气。
白芷（一两）、知母（一两七钱）、石膏（四两）
以上药材研成粗末，按照前面方法煎服。
治疗疟疾没有其他证候，隔日发作，先寒后热，寒少热多，适宜使用桂枝石膏汤。
桂枝（五钱）、石膏、知母（各一两半）、黄芩（一两）
以上药材研成粗末，分为三次服用，每次用水一盏，按照前面方法煎服。隔日发作的，说明邪气停留的部位较深。
治疗疟疾寒热剧烈发作，不论先发冷还是先发热的，都是太阳经和阳明经合病，称为交争。发冷时必然战栗动摇，《内经》说：“热盛则动。”发热时必然出汗排泄，《内经》说：“出汗后病不愈，知道是热证。”这是阳盛阴虚的证候，应当是内实外虚。如果不治疗，必定传入阴经。应当使用桂枝芍药汤主治。
桂枝（三钱）、黄芪、知母、石膏、芍药（各一两）
以上药材研成粗末，每次服用五钱到半两，用水煎煮，像前面药物那样服用。如果寒热转剧，知道是太阳、阳明、少阳三阳合病，适宜使用桂枝黄芩汤来和解。
桂枝黄芩汤
柴胡（一两二钱）、黄芩（四钱半）、人参、甘草（各四钱半）、半夏（四钱）、石膏、知母（各五钱）、桂枝（二钱）
以上药材研成粗末，按照前面方法服用。服药后，如果外邪已解，内邪未除，再服用泻下药。在卯时至午时（早晨5点至下午1点）发作的，适宜以大柴胡汤攻下。在午时至酉时（下午1点至晚上7点）发作的，知道邪气在血分，适宜以桃仁承气汤主治。
上述泻下药，以轻微腹泻为度，随即用小柴胡汤清除微弱的邪气。
立秋之后及处暑前发作疟疾，逐渐消瘦、不能进食的，称为劳疟（此处原文缺字，根据语境推测为劳疟或类似久疟概念，依原文保留空缺或意译，此处按原文逻辑译为久疟/劳疟类），这是邪气深远而侵犯阴经，属于久疟。
治疗久疟不能饮食，胸中郁闷想吐，想吐又吐不出来的，适宜采用催吐法即可治愈。应当使用藜芦散或雄黄散催吐。
藜芦散
大藜芦末半钱，用温醋水调服，以吐出为度。
雄黄散
雄黄、瓜蒂、赤小豆（各一钱）
以上药材研为细末，每次服用半钱，用温醋水调服，以吐出为度。
治疗深秋久疟，胃中空虚无物，又没有痰癖（痰饮积聚），腹部胀高而进食少，俗称疟气入腹，适宜使用苍术汤主治。
苍术（四两）、草乌头（一钱）、杏仁（三十个）
以上药材研成粗末，全部作为一次服用量，加水三升，煎煮至一半，平均分为三次服用，一天服完。在预计发作前服用。
《局方》中的七宣丸，是治疗疟疾的神药。
《局方》中的神效饮子，乃是治疗疟疾的神药，又名交结饮子。
The *Classic of Difficult Issues* (referring to *Huangdi Neijing*) states: "If one is injured by summer-heat in summer, malaria will inevitably occur in autumn." Those who are injured lightly suffer from sudden and rapid onset; those who are injured heavily suffer from a distant and prolonged course, resulting in chronic malaria. From this, we know that summer-heat injury causes damp-heat to be closed and stored internally, unable to vent outward. The pathogenic qi moves internally and manifests as malaria in autumn. Initially, it is unknown which meridian is affected; treatment should follow the movement of the disease. Some affect the Three Yang meridians, while others affect the Three Yin meridians. Generally, the pathogens in different meridians present distinct syndromes, similar to the discussions in the *Treatise on Cold Damage Diseases* (*Shanghan Lun*). Thus, the *Neijing* states: "All five zang organs can have malaria, but their treatments differ." When the Taiyang meridian is affected, it is called Wind Malaria, treated primarily with diaphoresis (sweating method). When the Yangming meridian is affected, it is called Heat Malaria, treated primarily with purgation (downward draining method). When the Shaoyang meridian is affected, it is called Wind-Heat Malaria, treated primarily with harmonization. These three Yang meridians' diseases are all called Acute Malaria, occurring between the Summer Solstice and the End of Heat. This represents light injury, near and sudden onset. When the Yin meridians are affected, regardless of the specific meridian, they are collectively called Damp Malaria, and should be discussed according to the Taiyin meridian. Their onset occurs between the End of Heat and the Winter Solstice. This represents heavy injury, distant and prolonged, becoming chronic malaria. "Old" refers to long duration, hence called Chronic Malaria. At this time, pathogenic qi resides in the West (associated with Autumn's收敛 and肃杀 properties), and toxic medicines are suitable for treatment.
Malaria arises because internal accumulation of summer-heat qi cannot be vented outward. During midsummer, if one consumes cold foods to nourish Yin, even if summer-heat exists, mild cases will resolve spontaneously. Additionally, using herbs to unblock and drain the fu-zang organs allows pathogenic qi to exit downward. The *Neijing* says: "In spring, eat cool foods; in summer, eat cold foods; in autumn, eat warm foods; in winter, eat hot foods." This is called "Nourishing Yang in Spring and Summer, Nourishing Yin in Autumn and Winter." If people align their diet and daily life with the four seasons, how can pathogenic qi arise?
For malaria before the End of Heat, presenting with headache, stiff neck, floating pulse, aversion to wind, and sweating, use Guizhi Qianghuo Tang (Cinnamon Twig and Notopterygium Decoction).
Guizhi (Cinnamon Twig), Qianghuo (Notopterygium Rhizome), Fangfeng (Saposhnikovia Root), Gancao (Licorice Root, honey-fried) [each 0.5 liang].
Grind into coarse powder. Take 0.5 liang per dose, add 1.5 cups of water, decoct to 1 cup. Take warm. Administer before the expected attack. If vomiting occurs, add Banxiaqu (Pinellia Fermented Paste) in equal proportion.
For malaria presenting with headache, stiff neck, floating pulse, aversion to wind, and no sweating, use Mahuang Qianghuo Tang (Ephedra and Notopterygium Decoction).
Mahuang (Ephedra Stem, nodes removed), Qianghuo, Fangfeng, Gancao (honey-fried) [each 0.5 liang].
Administer as above. If vomiting occurs, add Banxiaqu in equal proportion.
Treatment method: For malaria with the aforementioned symptoms but occurring at night, Ma Huang Gui Zhi Tang (Ephedra, Cinnamon Twig, and Peach Seed Decoction) is the primary formula.
Mahuang (1 liang, nodes removed), Gancao (3 qian, honey-fried), Taoren (Peach Seed, 30 pieces, skin and tips removed), Huangqin (Scutellaria Root, 5 qian), Guizhi (3 qian).
Grind the five ingredients into fine powder. Administer as described previously. Taoren has bitter, sweet, and acrid flavors. The Liver is the sea of blood; when blood stagnates, Liver qi becomes dry and irritable. As the classics state, "The Liver dislikes tension; consume sweet flavors to relax it." Therefore, Taoren disperses blood and relaxes the Liver. This indicates deep pathogenic invasion into the blood level, causing night onset, signifying pathogen in the Yin meridians. This formula disperses wind-cold from the blood level.
For malaria with body heat, eye pain, more heat than chills, long pulse, and restless sleep, first administer Da Chai Hu Tang (Major Bupleurum Decoction) to purge, aiming for mild diarrhea. If exterior pathogens remain after purging, use Baizhi Tang (Angelica Dahurica Decoction) to clear residual pathogens.
Baizhi (Angelica Dahurica Root, 1 liang), Zhimu (Anemarrhena Rhizome, 1 liang 7 qian), Shigao (Gypsum Fibrosum, 4 liang).
Grind into coarse powder. Decoct and take as above.
For malaria without other symptoms, occurring every other day, starting with chills followed by fever, with less chills and more heat, use Guizhi Shigao Tang (Cinnamon Twig and Gypsum Decoction).
Guizhi (5 qian), Shigao, Zhimu (each 1.5 liang), Huangqin (1 liang).
Grind into coarse powder. Divide into three doses. Each dose uses 1 cup of water. Decoct and take as above. Every-other-day occurrence indicates deep-seated pathogen.
For severe alternating chills and fever in malaria, regardless of order, this is a combined disease of Taiyang and Yangming meridians, called "Contending." Chills cause shivering; the classics say, "Heat excess leads to movement." Fever causes sweating; the classics say, "Sweating without cure indicates heat." This is an Excess-Yang and Deficient-Yin syndrome, implying interior excess and exterior deficiency. Without treatment, it will transmit to the Yin meridians. Use Guizhi Shaoyao Tang (Cinnamon Twig and Peony Decoction).
Guizhi (3 qian), Huangqi (Astragalus Root), Zhimu, Shigao, Shaoyao (White Peony Root) [each 1 liang].
Grind into coarse powder. Take 5 qian to 0.5 liang per dose. Decoct in water and take as above. If chills and fever worsen, it indicates combined disease of Taiyang, Yangming, and Shaoyang. Use Guizhi Huangqin Tang (Cinnamon Twig and Scutellaria Decoction) to harmonize.
Guizhi Huangqin Tang
Chaihu (Bupleurum Root, 1 liang 2 qian), Huangqin (4.5 qian), Renshen (Ginseng Root), Gancao (Licorice Root) [each 4.5 qian], Banxia (Pinellia Tuber, 4 qian), Shigao, Zhimu [each 5 qian], Guizhi (2 qian).
Grind into coarse powder. Administer as above. After taking the medicine, if exterior pathogens are resolved but interior pathogens remain, administer purgatives next. Attacks between Mao-Wu hours (5 AM - 1 PM) require Da Chai Hu Tang purgation. Attacks between Wu-You hours (1 PM - 7 PM) indicate pathogen in the blood level; use Tao Ren Cheng Qi Tang (Peach Kernel and Magnolia Bark Decoction).
For the aforementioned purgatives, aim for mild diarrhea, then immediately use Xiao Chai Hu Tang (Minor Bupleurum Decoction) to eliminate residual weak pathogens.
Malaria occurring after Start of Autumn and before End of Heat, with gradual emaciation and loss of appetite, is called Lao Malaria (Laboring Malaria/Chronic Malaria). This is deep pathogen affecting Yin meridians, constituting chronic malaria.
For chronic malaria with inability to eat, chest oppression resembling nausea but unable to vomit, induce vomiting to resolve. Use Lilü San (Veratrum Powder) or Xionghuang San (Realgar Powder) to induce vomiting.
Lilü San
Da Lilü (Large Veratrum Rhizome) powder, 0.5 qian. Mix with warm vinegar water. Take until vomiting occurs.
Xionghuang San
Xionghuang (Realgar), Gudi (Melon Peduncle), Chi Xiaodou (Red Adzuki Bean) [each 1 qian].
Grind into fine powder. Take 0.5 qian per dose with warm vinegar water. Take until vomiting occurs.
For late autumn chronic malaria, empty stomach without phlegm-stagnation, abdominal distension with poor appetite, commonly known as "Malaria Qi entering the abdomen," use Cangzhu Tang (Atractylodes Macrocephala Decoction).
Cangzhu (Atractylodes Macrocephala Rhizome, 4 liang), Caowutou (Aconitum Carmichaelii Lateral Root, processed, 1 qian), Xingren (Apricot Seed, 30 pieces).
Grind into coarse powder. Combine as one dose. Add 3 sheng of water, decoct to half. Divide into three equal servings. Finish within one day. Take before the expected attack.
Qixuan Wan (Seven Unblocking Pills) from the *Formulary of the Imperial Medical Bureau* (*Jufang*) is a sacred medicine for treating malaria.
Shenxiao Yinzi (Divine Efficacy Drink) from the *Jufang* is also a sacred medicine for malaria, also known as Jiaojie Yinzi (Interlocking Drink).