疟者，邪正纷争之病，邪乘正虚，寒热交攻，止而复作，最为炎威，故病名疟也。疟之为病，其证虽多，
然非外有所感必不发，且非内有可乘之机，则外邪亦无自而入。篇中所言，委曲周至，比之别篇论病为独详。
凡一十四段∶首段前半统论疟之寒热，后言日作之疟；二段言间日；三段言疟发有早晏之不同；四段又申解间
日；五段言疟发之故，初无一定；六段言邪留于内，必因卫气而作；七段言寒、温、瘅三疟之异；八段言疟
已发时，不可医治；九段又详论疟发之故，与首段同；十段言欲治疟，必于未发之时，与八段同；十一段言疟
之止作，因于卫气，与第六段同；十二段论三、四日疟；十三段言四时各有疟，不独夏秋；十四段又复解温、
瘅而略寒疟而不言。此内经论疟，专属外感。至于血、痰、食、瘴等项，又为疟中之兼证，医家所当详察者也。
黄帝问曰∶夫 疟皆生于风，其蓄作有时者，何也？（ 犹老也，亦瘦也。）岐伯对曰∶疟之始发也，先
起于毫毛，伸欠，乃作寒栗鼓颔，（栗谓战栗，鼓谓振动。按∶邪之入也，原由毫窍，故其发也，先令毫毛洒
淅。正虚不能胜邪，则神气倦怠，腰为之伸弛，而口为之呵欠。惟寒栗，故鼓颔也。）腰脊俱痛，寒去则内外
皆热，头痛如破，渴欲冷冻饮料。帝曰∶何气使然？愿闻其道。岐伯曰∶阴阳上下交争，虚实更作，阴阳相移也。
（阳气者，下行极而上，阴气者，上行极而下，故曰阴阳上下交争也。阳虚则外寒，阴虚则内热，阳盛则外热，
阴盛则内寒，由此寒去热生，则虚实更作，阴阳之气相移也。）阳并于阴
则阴实而阳虚，阳明虚则寒栗鼓颔也。巨阳虚，则腰背头项痛。（阳并于阴，言阳气入于阴分也。阳明，胃脉
也。胃之脉，自交承浆，却分行，循颐后下廉，出大迎。其支别者，从大迎前下人迎。故气不足，则恶寒战栗
而颐颔振动也。巨阳者，膀胱脉。其脉从头别下项，循肩 内，挟脊抵腰中，故气不足，则腰背头项痛也。）
三阳俱虚则阴气胜，阴气胜则骨寒而痛，寒生于内，故中外皆寒。（按∶阳主外，阴主内，邪在阳分则热，邪
在阴分则寒矣。今三阳并入于阴，阴盛之极，一身尽寒，内之寒也，其实由外而入也。）阳盛则外热，阴虚则
内热，外内皆热，则喘而渴，故欲冷冻饮料也。（按∶阴极于内，则复出之阳而阳又盛，是以内外皆热而渴，此又
由内出外，所谓更虚更实，疟之情状如是也。阳愈盛则阴愈虚，阳盛则外热，阴虚则内热，凡病皆然，不独疟
也。）此皆得之夏伤于暑，热气盛，藏于皮肤之内，肠胃之外，此荣气之所舍也。此令人汗空疏，（按∶空犹
孔也。）腠理开，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，内外相搏，是以日作。（按∶前言阴阳更胜则为寒为热，此则推原
疟之所以为病也。荣主血，卫主气。血属阴，舍于内；气属阳，行于外。灵枢经言∶“卫气者，所以温分肉，充
皮肤，肥腠理，司关阖者也。”邪气中人，必根据卫气而后发者，正以卫气运会夫一身，卫气循经外达，邪随之
而发也。此气，邪气也。卫气一日一夜营运于周身，邪气随之而出入，故每日一发。）
帝曰∶其间日而作者，何也？岐伯曰∶其气之舍深，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。（按∶邪入于阴愈深，则去阳愈远，及其返外而与卫气相应也，已多一日矣，故间日发也。）
帝曰∶善！其作日晏与其日早者，何气使然？岐伯曰∶邪气客于风府，循膂而下。（风府穴在项上，入发际
一寸，大筋内宛宛中。膂谓脊两旁。）卫气一日一夜大会于风府，其明日日下一节，故其作也晏。此先客于脊
背也，每至于风府则腠理开，腠理开则邪气入，邪气入则病作，以此日作稍益晏也。（节，脊骨之节。然邪
气远则逢会迟，故发暮也。按∶此言疟发早晏，似以骨节之上下为次。其实元气虚陷，发必日迟，是则日下一节
者，未必非正气渐虚之故也。）其出于风府，日下一节，二十五日下至 骨，二十六日入于脊内，注于伏膂之
脉，其气上行，九日出于缺盆之中，其气日高，故作日益早也。（项以下至尾 凡二十四节，故日下一节，二十
五日下至 骨，二十六日入于脊内，注于伏膂之脉也。伏膂之脉者，谓膂筋之间，肾脉之伏行者也。肾之脉
循股内后廉，贯脊属肾。其直行者，从肾上贯肝膈，入肺中。以其贯脊，又不正应行穴，但循膂伏行，故谓之
伏膂脉。以肾脉贯脊属肾，上入肺中。肺者，缺盆为之道。阴气之行速，故其气上行，九日出于缺盆之中。按∶脊
骨本二十一节，日下一节，止应二十二日，下至 骨止应二十三日，而王本各多三日者，盖连项骨三节而言也。
全元起及甲乙、太素并作二十一、二十二日，是止照脊骨本数而言，其实初非有异也。）
其间日发者，由邪气内薄于五脏，横连募原也，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。（按∶卫气一日一周，而邪入既深，故不能与卫俱行也。募原者，膈膜之原。邪之所入深而
且广，故曰横连也。募，全元起作膜，太素、巢元方并同，举痛论亦作膜原。）
帝曰∶夫子言卫气每至于风府，腠理乃发，发则邪气入，入则病作。今卫气日下一节，其气之发也，不
当风府，其日作者奈何？岐伯曰∶（按，新校正云∶“按全元起本及甲乙经、太素，自‘此邪气客于头项’
至下‘则病作故’，八十八字并无。”）此邪气客于头项，循膂而下者也。故虚实不同，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。（虚实不同，邪中异所，卫邪相合，病则发焉，不必悉当风府而发作也。）
帝曰∶善！夫风之与疟也，相似同类，而风独常在，疟得有时而休者，何也？岐伯曰∶风气留其处，故
常在。疟气随经络沉以内薄，故卫气应乃作。（按∶风与疟皆能寒热，故云相似。然风邪中人，每有定所，而疟
则有作止之不同。盖其气与卫合则作，与卫相失则止也。）
帝曰∶疟先寒而后热者，何也？岐伯曰∶夏伤于大暑，其汗大出，腠理开发，因遇夏气凄沧之水寒，藏
于腠理皮肤之中，秋伤于风，则病成矣。夫寒者阴气也，风者阳气也，先伤于寒而后伤于风，故先寒而后热也。
病以时作，名曰寒疟。（按∶夏应热而反凉，天时不正之气，多由阴雨连绵，故云凄沧之水寒也。阴寒既伏，
又遇秋风，寒因风发，病则为疟矣。时作者，疟发有时，谓每至其时则作也。疟起于寒，故即名寒。）帝曰∶
先热而后寒者，何也？岐伯曰∶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。（按∶
疟起于寒，即名为寒，是也。疟起于风，亦宜名风，而更名温者，何也？风为阳邪，阳性温热也。寒温之别，
原于邪入之先后。
要之寒疟多而温疟少，辨之宜审也。）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。（瘅，热也。按∶先绝，非谓阴气败绝也，言火邪炽盛，纯阳独胜，若无阴然，如阳明之疟，宜用
白虎之类是也。）
帝曰∶夫经言有余者泻之，不足者补之。今热为有余，寒为不足。夫疟之寒，汤火不能温也，及其热，冰
水不能寒也，此皆有余不足之类。当此之时，良工不能止，必须其自衰乃刺之，其故何也？愿闻其说。岐伯曰∶
经言无刺 之热，无刺浑浑之脉，无刺漉漉之汗，故为其病逆，未可治也。（ ，盛热也。浑浑，言无
端绪也。漉漉，言汗大出也。按∶此一段言疟当发时，不可针刺，针既不宜，药可知矣，强饮之药，多致呕逆
也。 音郝。）
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。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，病极则复至。病之发也，如火之热，如风雨不可当也。（……阴盛则胃寒，故先寒栗，
阳盛则胃热，故先热欲饮也。复谓复旧也，言其气发至极，复还如旧。按∶人之无病也，阳卫外，阴守中。及
邪中于身而为病也，阴阳之气，随之而乱矣。是故邪入于阴，则阳气亦随之而并于阴，唯并于阴，于是阳在内
而不在外，故外无气。逆极，盛极也，极则必反，阴又与阳出而复并于外，即前所谓虚实更作，阴阳相移也。
夫疟气者以下六句，即是申解上文，前后一意。疟者，风寒之气不常，不言寒热者，以疟之寒热本于风寒也。
病极，即上逆极意，言阴极则寒，阳极则热，而疟又复来也。注解寒热并以胃言，误甚矣。）
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。帝曰∶善！攻之奈何？早晏何如？岐伯曰∶疟之且发
也，阴阳之且移也，必从四末始也。阳已伤，阴从之，故先其时，坚束其处，令邪气不得入，阴气不得出，审
候见之，在孙络盛坚而血者皆取之，此真往而未得并者也。（按∶此段言欲治疟，必于未发之时，与前第八段同
意。阳已伤二句，谓阳不能胜邪，而令邪入阴分也。真往未得并，言果能治之于未发之时，则真邪自去，不至
并入于内也。）
帝曰∶疟不发，其应何如？岐伯曰∶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。（按∶此一段，帝问疟若不发，应验何如。
伯以脉之静躁亦分于阴阳，而病之休复则随卫气而转也。极则阴阳俱衰者，谓病久则气血并虚，而尺寸之脉必
衰弱无力也。相离者，谓卫气日夜一周，而邪或深入于脏腑，故有时相离也。休，暂止也。集谓邪气复与卫合也。）
帝曰∶时有间二日或至数日发，或渴或不渴，其故何也？岐伯曰∶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。（按∶相失即前相离意，相离愈远，即相间日多也。）疟者，阴阳更胜
也，或甚或不甚，故或渴或不渴。（阳胜阴甚则渴，阳胜阴不甚则不渴也。胜谓强盛于彼之气也。）
帝曰∶论言夏伤于暑，秋必病疟，今疟不必应者，何也？（按∶不必应，言疟发不尽在秋也。）岐伯曰∶
此应四时
者也。其病异形者，反四时也。其以秋病者寒甚，以冬病者寒不甚，以春病者恶风，以夏病者多汗。（按∶应
四时，谓受病原有四时之异，故疟发不尽在于秋，而四时皆有疟也。异形谓证与常异，而与四时之令不合。
如秋气虽凉，而病则寒甚；冬时严肃，而病反不寒；春宜宣畅，而病反恶风；夏汗虽易，病则难得，而今直多
汗，是谓病异而与时反也。要而论之，疟之形固与时反，然其发也，总不出于秋冬春夏之外，是其反四时者，
即其应四时者也，疟不尽发于秋，宜矣。特以夏暑秋疟，其病为多，故古论言之如是耳。）
帝曰∶夫病温疟与寒疟而皆安舍？舍于何脏？岐伯曰∶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，其气先从内出之于外也。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。（按∶衰者，盛极而变也，与前病极逆极同意。注作病衰退解，是疟已愈，不当更言
阳虚则寒矣。）
帝曰∶瘅疟何如？岐伯曰∶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。其气不及于阴，故但热而不寒，
气内藏于心，而外舍于分肉之间，令人消烁脱肉，故命曰瘅疟。帝曰∶善！（按∶内本实热，外感风寒，乃
三阳之邪热，疟之有余者。其气，病气也。病尽在阳，故云不及于阴也。按寒、温、瘅三疟，岐伯虽解于前，
然尚有详略不同，故帝复再问，此对止有温、瘅而无寒疟，想系前已对，故后更不再言耳。）
疟疾，是邪气与正气相互争斗的疾病。邪气趁正气虚弱之时侵袭，导致寒热交替发作，症状停止后又再次出现，病情最为剧烈，因此病名叫做“疟”。疟疾这种病，虽然症状表现多样，但如果没有外感邪气的诱因，就一定不会发作；而且如果体内没有可供邪气乘虚而入的契机，那么外邪也无法侵入。《素问·疟论》篇中的论述，详尽周到，比其他篇章讨论疾病更为详细。全篇共分为十四段：第一段前半部分总论疟疾的寒热症状，后半部分论述每日发作一次的疟疾；第二段论述隔日发作的疟疾；第三段论述疟疾发作时间有早有晚的不同；第四段进一步解释隔日发作的原因；第五段论述疟疾发作的原因，起初并没有固定的规律；第六段论述邪气留滞于体内，必须依赖卫气的运行才会发病；第七段论述寒疟、温疟、瘅疟这三种疟疾的区别；第八段论述疟疾已经发作时，不宜进行治疗；第九段再次详细论述疟疾发作的原因，与第一段内容相同；第十段论述想要治疗疟疾，必须在未发作的时候进行，与第八段观点一致；第十一段论述疟疾的停止和发作，取决于卫气，与第六段内容相同；第十二段论述每隔三到四天发作一次的疟疾；第十三段论述四季都有疟疾，不仅仅局限于夏秋两季；第十四段再次解释温疟和瘅疟，而简略提及寒疟不再详述。《内经》中关于疟疾的论述，专门归属于外感病范畴。至于血疟、痰疟、食积疟、瘴疟等情况，又属于疟疾中的兼夹证候，是医生应当详细诊察的。
黄帝问道：疟疾都是由风邪引起的，但它们发作的时间却有定时，这是为什么呢？（岐伯注：蓄，通“蓄”，也有瘦弱之意。）岐伯回答说：疟疾刚开始发作时，首先感觉毫毛竖立，身体伸展打哈欠，接着开始发冷颤抖，下巴抖动。（颤抖是指战栗，鼓颔是指下巴振动。按：邪气入侵，原本是从毛孔进入的，所以发作时，首先会让毫毛感到凉飕飕的。正气虚弱不能战胜邪气，神气就会倦怠，腰部松弛伸展，嘴巴会打哈欠。因为寒冷颤抖，所以下巴会振动。）随后腰部和脊柱都疼痛，寒冷过去后，体内体外都发热，头痛得像要破裂一样，口渴想喝冰冷的饮料。黄帝说：是什么气造成这样的呢？我想听听其中的道理。岐伯说：阴阳上下相互交争，虚实交替变化，这是阴阳之气相互移易的结果。（阳气下行至极点则向上行，阴气上行至极点则向下行，所以说阴阳上下交争。阳虚则体表寒冷，阴虚则体内发热，阳盛则体表发热，阴盛则体内寒冷，由此寒冷退去热气产生，虚实交替变化，阴阳之气相互移易。）当阳气并入阴分时，阴分实而阳分虚，阳明经气虚就会出现发冷颤抖、下巴抖动的症状。太阳经气虚，就会出现腰背头项疼痛。（阳气并入阴分，是说阳气进入阴分。阳明，指胃脉。胃的经脉，从承浆穴交叉后，分别下行，沿着下颌角后方下廉，出于大迎穴。其分支，从大迎穴前方下行到人迎穴。所以经气不足，就会恶寒战栗且下巴抖动。巨阳，指膀胱脉。其经脉从头部分别下行至项部，沿着肩胛内侧，夹着脊柱抵达腰部，所以经气不足，就会腰背头项疼痛。）如果三阳经（太阳、阳明、少阳）都虚，则阴气胜，阴气胜则骨头寒冷疼痛，寒气生于内部，所以内外都寒冷。（按：阳主外，阴主内，邪在阳分则热，邪在阴分则寒。现在三阳并入阴分，阴盛到了极点，全身都寒冷，这是内部的寒，其实是由外部侵入的。）阳气盛则体表发热，阴虚则体内发热，内外都热，就会气喘且口渴，所以想喝冰冷的饮料。（按：阴气在内极盛，则复出为阳而阳气又盛，所以内外皆热且口渴，这又是从内出外，所谓虚实交替，疟疾的情状就是这样的。阳越盛则阴越虚，阳盛则外热，阴虚则内热，所有疾病都是这样，不仅仅是疟疾。）这些情况都是因为夏天被暑气所伤，热气旺盛，潜伏在皮肤之内、肠胃之外，这是营气停留的地方。这让人汗孔疏松，（按：空，同孔。）腠理开泄，因而受到秋气的侵袭，出汗时遇到风，或者洗澡时，水气停留在皮肤之内，与卫气并居。卫气，白天行于阳分，夜晚行于阴分，这种邪气遇到阳分就外出，遇到阴分就内迫，内外相搏，所以每天发作。（按：前面说阴阳更替胜负就会表现为寒或热，这里则是推究疟疾之所以成为疾病的根源。营主血，卫主气。血属阴，藏于内；气属阳，行于外。《灵枢经》说：“卫气，是用来温养肌肉，充实皮肤，肥厚腠理，主管毛孔开阖的。”邪气中人，必须依附卫气而后才发作，正是因为卫气周流一身，卫气循经外达，邪气随之而发。此处的“气”，指邪气。卫气一天一夜在周身运行，邪气随之出入，所以每天发作一次。）
黄帝说：那些隔日发作的，是什么原因呢？岐伯说：邪气潜伏的部位深，内迫于阴分，阳气单独发越，阴邪内着，阴与阳争斗而不能外出，所以隔日发作。（按：邪气进入阴分越深，则离阳分越远，等到它返回外部与卫气相应时，已经多过了一天，所以隔日发作。）
黄帝说：好！那些发作时间推迟或提前的，是什么气造成的呢？岐伯说：邪气客居于风府穴，沿着脊背向下行进。（风府穴在项上，入发际一寸，大筋内的凹陷处。膂，指脊柱两旁。）卫气一天一夜在风府穴大会合，第二天向下移动一节脊椎，所以它的发作时间就推迟了。这是因为邪气先客居于脊背，每次到达风府穴时腠理开泄，腠理开泄则邪气侵入，邪气侵入则疾病发作，因此每天发作的时间逐渐推迟。（节，指脊椎骨节。然而邪气距离远则逢会迟，所以发作晚。按：这里说疟疾发作早晚，似乎以骨节的上下为次序。其实元气虚陷，发作必然延迟，那么“日下一节”的说法，未必不是正气逐渐虚损的缘故。）邪气从风府出发，每天向下移动一节，二十五天下降到骶骨，第二十六天进入脊柱内部，注入伏膂之脉，这股气向上行，九天之后出于缺盆之中，这股气位置越来越高，所以发作时间日益提前。（项以下到尾骶共有二十四节，所以每天下一节，二十五天下至骶骨，二十六天进入脊内，注入伏膂之脉。伏膂之脉，指脊筋之间，肾脉伏行的部位。肾的经脉沿着大腿内侧后缘，贯穿脊柱，归属肾脏。其直行者，从肾脏向上贯穿肝膈，进入肺中。因为它贯穿脊柱，又不正对穴位，只是沿着脊筋伏行，所以叫作伏膂脉。因为肾脉贯脊属肾，上入肺中。肺，缺盆是其通道。阴气运行速度快，所以这股气上行，九天出于缺盆之中。按：脊骨本来二十一节，每天下一节，只应二十二日，下至骶骨止应二十三日，而王冰本各多三日，大概是连颈部三节一起算的。全元起本及《甲乙经》、《太素》都作二十一、二十二日，这只是照着脊骨本数而言，其实最初并没有不同。）
那些隔日发作的，是因为邪气内迫于五脏，横向连接募原，路径遥远，气机深隐，运行迟缓，不能与卫气一同运行，不能完全外出，所以隔天才发作。（按：卫气一天一周身，而邪气进入既深，所以不能与卫气同行。募原，即膈膜的原野。邪气进入得深而且广，所以说横连。募，全元起本作“膜”，《太素》、巢元方也同，举痛论也作膜原。）
黄帝说：先生曾说卫气每至于风府，腠理才开泄，开泄则邪气侵入，侵入则疾病发作。现在卫气每天下一节，它发作的时候，不一定在风府，那些每天发作的疟疾是怎么回事呢？岐伯说：（按：新校正说：“查全元起本及《甲乙经》、《太素》，从‘此邪气客于头项’到下‘则病作故’，这八十八字都没有。”）这是邪气客居于头项，沿着脊背向下行进。所以虚实不同，邪气侵犯的部位不同，就不一定正好在风府发作。所以邪气中于头项的，气至头项而病发；中于背部的，气至背部而病发；中于腰脊的，气至腰脊而病发；中于手足的，气至手足而病发。卫气所在之处，与邪气相合，疾病就发作。所以风邪没有固定的风府，卫气所发的地方，必定腠理开泄，邪气与之相合，那里就是它的“府”。（虚实不同，邪气侵犯部位各异，卫气与邪气相合，疾病就发作，不一定都在风府发作。）
黄帝说：好！风邪与疟疾，相似且同类，但风邪常常持续存在，疟疾却有时休止，这是为什么呢？岐伯说：风邪留在它的处所，所以常存。疟气随着经络沉潜内迫，所以卫气应合时才发作。（按：风与疟都能引起寒热，所以说相似。然而风邪中人，往往有固定部位，而疟疾则有发作和休止的不同。大概是因为它的邪气与卫气相合就发作，与卫气分离就休止。）
黄帝说：疟疾先冷后热的，是什么原因呢？岐伯说：夏天遭受大暑，汗大量流出，腠理开发，因而遇到夏季清凉的水寒之气，潜伏在腠理皮肤之中，秋天又伤了风邪，病就形成了。寒，是阴气；风，是阳气。先伤于寒而后伤于风，所以先冷后热。疾病按时发作，名叫寒疟。（按：夏天应该热反而凉，天时不正之气，多由阴雨连绵所致，所以说凄沧之水寒。阴寒既已潜伏，又遇秋风，寒因风而发，病就成为疟疾了。时作者，指疟疾发作有定时，谓每到那个时间就发作。疟起于寒，所以即名为寒。）黄帝说：先热后冷的，是什么原因呢？岐伯说：这是先伤于风，而后伤于寒，所以先热后冷。也是按时发作，名叫温疟。（按：疟起于寒，即名为寒，是对的。疟起于风，也应该名为风，而改名为温，为什么呢？风为阳邪，阳性温热。寒与温的区别，源于邪气入侵的先后顺序。总之寒疟多而温疟少，辨别时应当审慎。）那种只有热而没有冷的，阴气先绝，阳气单独发越，就会气短烦闷，手足发热且想呕吐，名叫瘅疟。（瘅，意为热。按：先绝，不是说阴气败绝，而是说火邪炽盛，纯阳独胜，好像没有阴气一样，如阳明疟，宜用白虎汤之类。）
黄帝说：经书上说有余的用泻法，不足的用补法。现在热为有余，寒为不足。疟疾的寒冷，用汤火也不能温暖它；等到发热时，用冰水也不能冷却它，这都属于有余不足的情况。在这个时候，高明的医生也不能制止，必须等它自然衰退才能针刺，这是什么原因呢？我想听听您的说法。岐伯说：经书说不要刺盛热时的疟疾，不要刺混乱无绪的脉象，不要刺大汗淋漓时的疟疾，因为这些时候病气逆乱，不可治疗。（焮，指盛热。浑浑，指无端绪。漉漉，指汗大出。按：这一段说疟疾发作时，不可针刺，针刺都不适宜，用药可想而知，强行服药，多会导致呕吐逆乱。焮音郝。）
疟疾刚开始发作时，阳气并入阴分，这个时候，阳虚而阴盛，体表没有阳气护卫所以先冷颤。阴气逆乱到极点则复出归于阳，阳与阴又重新并聚于外，则阴虚而阳实，所以先热且渴。疟气，并入阳则阳胜，并入阴则阴胜，阴胜则寒，阳胜则热。疟疾，是风寒之气不恒定，病势极盛则会反复。疾病发作时，像火的炎热，像风雨一样不可抵挡。（……阴盛则胃寒，所以先冷颤，阳盛则胃热，所以先热想喝水。复，指恢复旧态，言其气发至极，又回复如旧。按：人没有病的时候，阳卫护于外，阴守持于中。等到邪气中身而为病，阴阳之气，随之而紊乱。所以邪入于阴，则阳气也随之外并于阴，唯并于阴，于是阳在内而不在外，所以体表无气。逆极，指盛极，极则必反，阴又与阳出而复并于外，即前文所说的虚实更作，阴阳相移。从“夫疟气者”以下六句，即是申解上文，前后意思一致。疟疾，是风寒之气不恒定，不说寒热，是因为疟的寒热本于风寒。病极，即上文的逆极意，言阴极则寒，阳极则热，而疟疾又复来了。注解寒热都以胃来说，错误很大。）
疟疾未发作时，阴未并阳，阳未并阴，趁机调理它，真气得以安宁，邪气乃除，所以医生不能治疗已经发作的疟疾，因为那时气机逆乱。黄帝说：好！如何攻治？早晚时机怎样？岐伯说：疟疾将要发作时，阴阳之气将要移易，必定从四肢末端开始。阳已受伤，阴随之，所以在发作之前，牢固地束缚患处，令邪气不得入，阴气不得出，仔细观察，发现孙络盛大坚胀且有瘀血的，都予以刺破，这是真气前往而尚未与邪气并合的时候。（按：这一段说想要治疗疟疾，必须在未发作之时，与前第八段意思相同。阳已伤两句，谓阳不能胜邪，而令邪入阴分。真往未得并，言果能治之于未发之时，则真邪自去，不至并入于内也。）
黄帝说：疟疾不发作时，有什么征象呢？岐伯说：疟气，必定虚实更替。当气所在之处，病在阳分则热而脉躁动，在阴分则寒而脉静，极盛时阴阳俱衰，卫气分离，所以病得以休止，卫气聚集则病复发。（按：这一段，黄帝问疟若不发，应验何如。伯回答以脉之静躁亦分于阴阳，而病之休复则随卫气而转也。极则阴阳俱衰者，谓病久则气血并虚，而尺寸之脉必衰弱无力也。相离者，谓卫气日夜一周，而邪或深入于脏腑，故有时相离也。休，暂止也。集谓邪气复与卫合也。）
黄帝说：有时隔两天或几天发作，有的口渴有的不口渴，是什么原因呢？岐伯说：那些隔日发作的，是因为邪气与卫气客居于六腑，而有时相失，不能相得，所以休息几天才发作。（按：相失即前相离意，相离愈远，即相间日多也。）疟疾，是阴阳更替胜负，有的厉害有的不厉害，所以有的口渴有的不口渴。（阳胜阴甚则渴，阳胜阴不甚则不渴也。胜谓强盛于彼之气也。）
黄帝说：论著说夏天伤于暑，秋天必定病疟，现在疟疾不一定对应这个规律，为什么呢？（按：不必应，言疟发不尽在秋也。）岐伯说：这是顺应四时的情况。病症形态不同的，是违背四时的。在秋天发病的寒冷严重，在冬天发病的寒冷不严重，在春天发病的怕风，在夏天发病的多汗。（按：应四时，谓受病原有四时之异，故疟发不尽在于秋，而四时皆有疟也。异形谓证与常异，而与四时之令不合。如秋气虽凉，而病则寒甚；冬时严肃，而病反不寒；春宜宣畅，而病反恶风；夏汗虽易，病则难得，而今直多汗，是谓病异而与时反也。要而论之，疟之形固与时反，然其发也，总不出于秋冬春夏之外，是其反四时者，即其应四时者也，疟不尽发于秋，宜矣。特以夏暑秋疟，其病为多，故古论言之如是耳。）
黄帝说：温疟与寒疟的病位在哪里？舍于哪个脏腑？岐伯说：温疟，是冬天感受风邪，寒气藏于骨髓之中，到春天阳气大发，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，或者有所用力劳作，邪气随汗而出，这种病藏于肾，其气先从内出于外。像这样，阴虚而阳盛，阳盛则热。衰退时气又反回入内，入内则阳虚，阳虚则寒。所以先热后冷，名叫温疟。（按：衰者，盛极而变也，与前病极逆极同意。注作病衰退解，是疟已愈，不当更言阳虚则寒矣。）
黄帝说：瘅疟怎么样？岐伯说：瘅疟，是肺素有热，气盛于身，厥逆上冲，中气实而不外泄，因有所用力劳作，腠理开泄，风寒舍于皮肤之内、分肉之间而发，发作时阳气盛，阳气盛而不衰则病已成。其气不及于阴分，所以只有热而没有冷，气内藏于心，而外舍于分肉之间，使人消烁脱肉，所以名叫瘅疟。黄帝说：好！（按：内本实热，外感风寒，乃三阳之邪热，疟之有余者。其气，病气也。病尽在阳，故云不及于阴也。按寒、温、瘅三疟，岐伯虽解于前，然尚有详略不同，故帝复再问，此对止有温、瘅而无寒疟，想系前已对，故后更不再言耳。）
Malaria is a disease characterized by the struggle between pathogenic factors and healthy qi. When pathogenic factors take advantage of the deficiency of healthy qi, cold and heat attack each other alternately; symptoms cease and then recur, making it the most severe in its manifestations, hence named "malaria." Although malaria presents with various symptoms, it will not occur without external pathogenic invasion, nor can external pathogens enter if there is no internal opportunity for them to exploit. The discussion in this chapter of the *Suwen* (Basic Questions) is thorough and detailed, more so than in other chapters discussing diseases. The chapter consists of fourteen sections: the first section generally discusses the cold and heat of malaria in its first half, and daily malaria in its second half; the second section discusses every-other-day malaria; the third section discusses the variation in the timing of malaria onset (early or late); the fourth section further explains every-other-day malaria; the fifth section discusses the causes of malaria onset, which initially have no fixed pattern; the sixth section discusses how pathogenic factors retained internally must rely on the movement of Wei Qi (Defensive Qi) to cause illness; the seventh section discusses the differences between Cold Malaria, Warm Malaria, and Dan Malaria; the eighth section states that treatment should not be attempted once malaria has already manifested; the ninth section reiterates the causes of malaria onset, similar to the first section; the tenth section states that to treat malaria, one must act before onset, consistent with the eighth section; the eleventh section discusses how the cessation and recurrence of malaria depend on Wei Qi, consistent with the sixth section; the twelfth section discusses malaria occurring every three or four days; the thirteenth section states that malaria occurs in all four seasons, not just summer and autumn; the fourteenth section re-explains Warm Malaria and Dan Malaria, briefly mentioning Cold Malaria without detail. The *Neijing* (Inner Canon) classifies malaria specifically under exogenous diseases. Conditions such as Blood Malaria, Phlegm Malaria, Food Stagnation Malaria, and Miasma Malaria are considered concurrent syndromes within malaria, which physicians must carefully examine.
The Yellow Emperor asked: Malaria is caused by wind pathogens, yet why do they manifest at specific times? (Qi Bo's note: "Xu" implies accumulation or emaciation.) Qi Bo replied: At the initial stage of malaria, it begins with goosebumps, stretching, and yawning, followed by chills and trembling of the jaw. (Trembling refers to shivering; "Gu Han" refers to jaw vibration. Note: Pathogens enter through hair follicles, so onset first causes a chilly sensation in the hairs. Due to healthy qi deficiency failing to overcome pathogens, spirit energy becomes fatigued, the waist relaxes, and yawning occurs. Because of the chills, the jaw trembles.) Subsequently, pain affects the waist and spine. After the cold subsides, both interior and exterior become hot, causing severe headache as if splitting, and thirst for cold drinks. The Yellow Emperor asked: What qi causes this? I wish to hear the principle. Qi Bo said: It is the mutual contention of Yin and Yang above and below, alternating deficiency and excess, resulting from the shifting of Yin and Yang qi. (Yang qi descends to its extreme and then rises; Yin qi ascends to its extreme and then descends, hence "mutual contention." Deficiency of Yang leads to exterior cold; deficiency of Yin leads to interior heat; excess of Yang leads to exterior heat; excess of Yin leads to interior cold. Thus, as cold recedes and heat arises, deficiency and excess alternate, and Yin-Yang qi shift.) When Yang merges into Yin, Yin becomes full and Yang becomes deficient. Deficiency of the Yangming channel leads to chills and jaw trembling. Deficiency of the Juyang (Taiyang) channel leads to pain in the lower back, back, head, and neck. (Yang merging into Yin means Yang entering the Yin aspect. Yangming refers to the Stomach meridian. Its pathway crosses Chengjiang, descends along the mandible, emerges at Daying. Branches descend to Renying. Insufficiency causes aversion to cold, shivering, and jaw vibration. Juyang refers to the Bladder meridian. It descends from the head through the neck, along the shoulder medial to the spine, to the waist. Insufficiency causes pain in the waist, back, head, and neck.) If all three Yang channels are deficient, Yin qi prevails. Prevailing Yin causes bone coldness and pain; cold originates internally, causing both interior and exterior cold. (Note: Yang governs the exterior, Yin the interior. Pathogens in Yang lead to heat; in Yin, to cold. Now, with all three Yang merging into Yin, Yin excess is extreme, causing whole-body coldness—internal cold actually originating externally.) Excess Yang causes exterior heat; deficiency of Yin causes interior heat. Heat in both interior and exterior leads to panting and thirst, hence the desire for cold drinks. (Note: When Yin is extreme internally, Yang emerges again and becomes excessive, causing heat in both interior and exterior and thirst. This represents movement from inside out, illustrating alternating deficiency and excess. The more Yang exceeds, the more Yin is deficient. Yang excess causes exterior heat, Yin deficiency causes interior heat. This applies to all diseases, not just malaria.) These conditions arise from summer injury by heat, where intense heat lingers inside the skin but outside the intestines and stomach, residing where Ying Qi (Nutritive Qi) dwells. This causes porous sweat apertures and open cou-li (interstices), allowing autumn qi to invade. Sweat combined with wind exposure, or bathing, allows water qi to lodge in the skin, coexisting with Wei Qi. Wei Qi travels through Yang during the day and Yin at night. This pathogen moves outward when encountering Yang and inward when encountering Yin. Their conflict results in daily attacks. (Note: Earlier, alternating Yin-Yang victory explained cold and heat; here, the root cause of malaria is explored. Ying governs blood, Wei governs qi. Blood is Yin, stored internally; Qi is Yang, moving externally. The *Ling Shu* states: "Wei Qi warms muscles, fills skin, thickens interstices, and controls aperture opening/closing." Pathogens attacking humans must attach to Wei Qi to manifest because Wei Qi circulates the body. As Wei Qi moves meridians outward, pathogens follow. Here, "qi" refers to pathogenic qi. Wei Qi circulates the body daily; pathogens follow, causing daily attacks.)
The Yellow Emperor asked: Why does some malaria occur every other day? Qi Bo said: The pathogen lodges deeply, pressing inward on Yin. Yang alone flares up, while Yin pathogen adheres internally. Yin and Yang contend but cannot exit, resulting in every-other-day onset. (Note: The deeper the pathogen enters Yin, the farther it is from Yang. By the time it returns externally to align with Wei Qi, a day has passed, hence every-other-day onset.)
The Yellow Emperor asked: Good! Why do some cases start later or earlier each day? What qi causes this? Qi Bo said: Pathogens reside at Fengfu acupoint, descending along the Du meridian/spine. Wei Qi converges at Fengfu once daily and nightly. Each subsequent day, it descends one vertebral segment, delaying onset. This is because pathogens initially reside in the back. Whenever they reach Fengfu, cou-li opens, allowing pathogen entry and disease manifestation, progressively delaying daily onset. (Segment refers to vertebrae. Distant pathogens meet convergence late, causing late onset. Note: This explanation links onset timing to vertebral levels. However, underlying healthy qi deficiency causes delay; thus, "descending one segment daily" may reflect gradual healthy qi decline.) From Fengfu, descending one segment daily, after twenty-five days it reaches the sacrum. On the twenty-sixth day, it enters the spine, injecting into the Fulu muscle-vein. This qi ascends, emerging in the Quepen region after nine days. As the qi rises higher, onset occurs progressively earlier. (From neck to sacrum are twenty-four segments. Twenty-five days to sacrum, twenty-sixth day into spine/Fulu vein. Fulu vein lies between spinal muscles where Kidney meridian runs deep. Kidney meridian runs along posterior thigh, through spine, connecting to Kidneys. Direct branch ascends through Liver/Diaphragm to Lungs. Connecting to spine but not following standard acupoints, running deep along muscles, it is called Fulu vein. Since Kidney meridian connects to Lungs via Quepen, and Yin qi moves fast, this qi ascends, emerging in Quepen after nine days. Note: Spine has twenty-one segments. Descending one daily should take twenty-two days to sacrum (twenty-three including sacrum). Wang Bing's text adds three days, likely counting cervical segments. Quan Yuanqi, *Jia Yi Jing*, and *Tai Su* cite twenty-one/twenty-two days, strictly following vertebral count, implying no fundamental difference.)
Every-other-day malaria occurs because pathogens press inward on the Five Zang organs, spreading horizontally to the Mu Yuan (Sea of Origin/Mo Yuan). The path is long, qi is deep, and movement is slow, preventing synchronization with Wei Qi, causing delayed onset. (Note: Wei Qi completes one circuit daily. Deeply lodged pathogens cannot keep pace. Mu Yuan refers to the diaphragmatic origin. Pathogens penetrate deeply and broadly, hence "horizontal connection." "Mu" is written as "Mo" in Quan Yuanqi's version, *Tai Su*, and *Chou Yuan Fang*, also in *Ju Tong Lun*.)
The Yellow Emperor asked: You stated Wei Qi reaches Fengfu, opening cou-li for pathogen entry and disease. Now Wei Qi descends one segment daily; if onset doesn't happen at Fengfu, why does daily malaria occur? Qi Bo said: (New Correction notes: Quan Yuanqi, *Jia Yi Jing*, and *Tai Su* lack 88 characters from "This pathogen resides in head/neck" to "then disease manifests.") This pathogen resides in the head and neck, descending along the spine. Variations in deficiency/excess and different invasion sites mean onset need not coincide exactly with Fengfu. Thus, pathogens striking the head/neck cause disease when qi reaches there; striking the back causes disease when qi reaches the back; striking the waist/spine causes disease when qi reaches the waist/spine; striking limbs causes disease when qi reaches limbs. Disease manifests when Wei Qi location coincides with pathogen location. Therefore, there is no fixed "Fengfu"; wherever Wei Qi acts and cou-li opens, and pathogens combine, that is their "Fengfu." (Different deficiency/excess and invasion sites mean disease manifests upon Wei-pathogen combination, not necessarily at Fengfu.)
The Yellow Emperor asked: Good! Wind and malaria are similar and same-category, yet wind persists constantly while malaria has remissions. Why? Qi Bo said: Wind pathogens remain in their location, hence constant. Malaria qi sinks and presses inward along meridians, manifesting only when responding to Wei Qi. (Note: Both wind and malaria cause chills/heat, hence similarity. Wind pathogens usually have fixed locations; malaria has variable onset/remission. Manifestation depends on alignment with Wei Qi; cessation depends on separation.)
The Yellow Emperor asked: Why does some malaria begin with chills followed by heat? Qi Bo said: Summer injury by severe heat causes profuse sweating and open cou-li. Encountering cool/cold water qi in summer, it lodges in cou-li/skin. Autumn wind injury completes the pathology. Cold is Yin qi; wind is Yang qi. Injury by cold first, then wind, causes chills first, then heat. Regular onset defines Cold Malaria. (Note: Summer should be hot but is cool due to continuous rain ("Qicang" cold water). Latent Yin-cold triggers via autumn wind, forming malaria. "Regular onset" means predictable timing. Named Cold Malaria because it starts with cold.) The Yellow Emperor asked: Why does some begin with heat followed by chills? Qi Bo said: Injury by wind first, then cold, causes heat first, then chills. Regular onset defines Warm Malaria. (Note: Naming based on initial symptom is correct. Wind is Yang/Warm, hence "Warm Malaria." Distinction lies in sequence of invasion. Generally, Cold Malaria is more common than Warm Malaria; differentiation requires care.) Pure heat without chills indicates prior Yin exhaustion and isolated Yang flare-up, causing shortness of breath, vexation, hot hands/feet, and nausea. This is Dan Malaria. ("Dan" means heat. Note: "Prior exhaustion" does not mean Yin collapse, but rather rampant fire/pathogenic heat, pure Yang dominance resembling Yin-deficiency, e.g., Yangming malaria treated with Baihu Tang.)
The Yellow Emperor asked: Classics state excess is drained, deficiency is tonified. Heat is excess, cold is deficiency. Malaria cold cannot be warmed by fire/water; malaria heat cannot be cooled by ice/water. These are excess/deficiency types. At this time, even skilled doctors cannot stop it; treatment must wait for natural decline. Why? Qi Bo said: Classics advise against puncturing high fever, chaotic pulses, or profuse sweating, as pathogenic qi is rebellious and untreatable at these stages. ("Xin" means intense heat; "Hunhun" means chaotic/unstructured; "Lulu" means dripping sweat. Note: This section warns against acupuncture during active malaria; medication is similarly risky, often causing vomiting/rebellion. "Xin" sounds like "He".)
At malaria onset, Yang merges into Yin. Yang is deficient, Yin is excess; lack of exterior Yang causes initial chills. Extreme Yin rebellion forces return to Yang; Yang and Yin merge externally again. Yin becomes deficient, Yang becomes excess, causing initial heat and thirst. Malaria qi: merging into Yang causes Yang excess; merging into Yin causes Yin excess. Yin excess brings cold; Yang excess brings heat. Malaria involves fluctuating wind-cold qi; extreme pathology recurs. Onset is like fire heat or storm winds, unstoppable. (...Yin excess causes Stomach cold/chills; Yang excess causes Stomach heat/thirst. "Fu" means returning to normal state. Note: Healthy state: Yang guards exterior, Yin guards interior. Pathogens disrupt Yin-Yang balance. Yin invasion drags Yang inward, leaving exterior void. "Extreme rebellion" means peak intensity leading to reversal. Yin/Yang emerge externally again, mirroring alternating deficiency/excess. The six lines starting "Malaria qi..." explain previous text. Malaria involves unstable wind-cold; cold/heat stem from wind-cold. "Extreme pathology" mirrors "extreme rebellion": Yin extreme brings cold, Yang extreme brings heat, then malaria recurs. Explaining cold/heat solely via Stomach is erroneous.)
Before malaria onset, Yin has not merged into Yang, Yang has not merged into Yin. Regulating at this time allows Healthy Qi to settle and Pathogens to vanish. Hence, doctors cannot treat active malaria due to rebellious qi. The Yellow Emperor asked: How to attack it? Timing? Qi Bo said: Before onset, Yin-Yang are shifting, starting from extremities. Yang is injured, Yin follows. Bind the area firmly before onset to block pathogen entry and Yin exit. Observe carefully; if Sun Luo (branch vessels) are swollen/hard with blood, puncture them. This targets Healthy Qi before merging with pathogens. (Note: Treat before onset, consistent with Section 8. "Yang injured" means Yang fails to resist, allowing pathogen into Yin. "Healthy Qi proceeds without merging" means treating early prevents internal merger.)
The Yellow Emperor asked: What are signs when malaria is not active? Qi Bo said: Malaria qi alternates excess/deficiency. Wherever qi resides: Yang location causes heat/restless pulse; Yin location causes cold/still pulse. At extremes, both Yin and Yang decline, Wei Qi separates, causing remission. Wei Qi gathering causes recurrence. (Note: Question asks about inactive phase signs. Answer: Pulse stillness/restlessness reflects Yin/Yang; remission/recurrence follows Wei Qi cycles. "Both decline" means prolonged illness depletes Qi/Blood, weakening radial/cubital pulses. "Separation" means Wei Qi's daily cycle diverges from deep-seated pathogens. "Remission" is temporary pause. "Gathering" is pathogen re-aligning with Wei Qi.)
The Yellow Emperor asked: Why does some malaria occur every two days or several days, with varying thirst? Qi Bo said: Every-other-day cases involve pathogens and Wei Qi residing in Six Fu organs, occasionally missing each other, causing multi-day rests. (Note: "Missing" equals previous "separation"; greater distance means longer intervals.) Malaria involves Yin-Yang alternation; severity varies, causing variable thirst. (Yang excess over Yin causes thirst; mild Yang excess causes no thirst. "Excess" means overpowering strength.)
The Yellow Emperor asked: Classics say summer heat injury leads to autumn malaria. Why don't all cases follow this? (Note: "Not necessarily corresponding" means not all occur in autumn.) Qi Bo said: This refers to seasonal correspondence. Atypical forms contradict seasons. Autumn onset: severe cold. Winter onset: mild cold. Spring onset: aversion to wind. Summer onset: profuse sweating. (Note: Seasonal correspondence means etiology varies by season, explaining non-autumn onset. "Atypical" means symptoms contradict seasonal norms. E.g., Autumn is cool but disease causes severe cold; Winter is strict but disease lacks cold; Spring promotes flow but disease causes wind aversion; Summer promotes sweating but disease causes excessive sweating. Essentially, malaria form contradicts season, yet onset always falls within seasonal cycles; contradiction is itself correspondence. Non-autumn onset is logical. Ancient texts emphasize summer heat/autumn malaria due to prevalence.)
The Yellow Emperor asked: Where do Warm Malaria and Cold Malaria reside? Which Zang organ? Qi Bo said: Warm Malaria originates from winter wind injury, cold lodging in Marrow. Spring Yang expansion fails to expel pathogen. Summer heat scorches brain marrow, consumes muscles, opens cou-li. Physical exertion releases pathogen with sweat. Disease resides in Kidney; qi moves from interior to exterior. Yin deficiency, Yang excess causes heat. Decline allows qi to re-enter, causing Yang deficiency and cold. Heat first, then cold defines Warm Malaria. (Note: "Decline" means peak transformation, consistent with "extreme pathology." Interpreting as recovery is incorrect, as Yang deficiency/cold would not follow cure.)
The Yellow Emperor asked: And Dan Malaria? Qi Bo said: Dan Malaria stems from pre-existing Lung heat, abundant body qi, rebellious upward rush, solid interior Qi failing to vent. Physical exertion opens cou-li; wind-cold lodges in skin/muscle layers. Onset causes Yang excess; persistent Yang excess sustains disease. Qi does not reach Yin, causing pure heat without cold. Qi stores in Heart, resides in muscle layers, wasting flesh, hence named Dan Malaria. The Yellow Emperor said: Good! (Note: Internal heat plus external wind-cold constitutes Three Yang pathogenic heat, an excess type of malaria. "Qi" refers to pathogenic qi. Disease entirely in Yang, hence "not reaching Yin." Qi Bo previously explained Cold/Warm/Dan malaria with varying detail; Emperor re-asks, receiving only Warm/Dan answers, likely because Cold was addressed earlier.)