【脉】 疟脉自弦，弦数多热，弦迟多寒。弦小紧者，可下之；弦迟者，可温之
；弦数者，可汗，灸之；浮大者，可吐之；弦数者，风发也，以饮食消息止之。
【因】 夏暑舍于营卫之间，腠理不密，遇秋之风，玄府受之。惨怆之水，寒气
气闭而不出
，舍于肠胃之外，与营卫并行。昼行于阳，夜行于阴，并则病作，离则病止。并于阳则热，
并于阴则寒。浅则日作，深则间日。在气则早，在血则晏。因汗郁成痰，因虚弱阴阳相乘。
外因从六淫，有寒、湿、瘅、湿、牝。寒则先寒后热；温则先热后寒；瘅则但热不寒；
湿则
身骨节疼；牝则寒多不热。内因，有脏气不和，郁结痰饮所致。有肝、心、脾、肺、肾之说
。说见后。不内外因，疫疟，一岁之内，大小相似；鬼疟梦寐不详；瘅疟乍有乍已；食疟因
饮食得之；劳疟因劳得之；母疟有母传染者也。
李论 夏伤于暑，秋为 疟。暑者，季夏湿土。湿令不行则土亏矣，所胜妄行，
木气太
过，少阳主也。所生者受病，则肺金不足，不胜者侮之。水胜土之分，土者坤，坤在申，申
为相火。水入土，则水火相干，则阴阳交作，肺金不足，洒淅恶寒。土虚少阳乘之，则为寒
热。发于秋者，湿热则卯酉之分也。
【证治】 先寒而热，谓之寒疟；先热而寒，谓之温疟；治之宜乎中也。中者，
少阳也
。渴者，燥胜也。不渴者，湿胜也。又有得之于冬，而发于暑，邪舍于肾，足少阴也。有藏
之于心，内热蓄于肺，手太阴也。但热而不寒，谓之瘅疟，足阳明也。在太阳经谓之风疟，
宜汗之；在阳明经谓之热疟，宜下之；少阳经谓之风热，宜和之。此伤之浅也。在阴经则不
分三经，谓之温疟，宜从太阴经论之。此伤之重也。
太阳经，头痛腰痛，寒从背起，先寒后热，宜小柴胡、羌活地黄汤。
少阳经，心体解 ，寒热不甚，恶见人，多汗出甚，小柴胡汤。
阳明经，先寒久乃热，热大汗，喜见火乃快，宜桂枝二白虎一汤。
少阴经，呕吐烦闷，热多寒少，欲闭户而处，病难已，小柴胡加半夏汤。
太阴经，好太息，不嗜食，多寒热汗出，病至喜呕乃衰，理中汤。
厥阴经，小腹腰痛，小便不利，意恐惧，四物玄明苦楝附子汤。
心疟，烦心，甚欲得清水，反寒多不甚热，宜桂枝黄芩汤。
肺疟，心寒甚，热间善惊，如有见者，桂枝加芍药汤。
肝疟，色苍苍然太息，甚伏若死，通脉四逆汤。
脾疟，寒则腹痛，热则肠鸣，鸣已汗出，小建中汤、芍药甘草汤。
肾疟，腰脊痛宛转便难，目 然，手足寒，桂枝加当归芍药汤。
胃疟，将病也，善饥不能食，能食而支满腹胀，理中汤、丸主之。
劳疟，经年不瘥，后复发作，微劳力不任，名曰劳疟。
母疟，百药不瘥，结成 癖在腹胁，名疟母。
治虽不同，疟得于暑，当以汗解。或汗不彻，郁而成痰，宜以养胃化痰发汗，邪气得出
，自然和也。虚则补之，脉洪数无力者是也。
羌活汤 治邪气浅在表。
羌活 防风 甘草 恶寒有汗，加桂枝；恶风无汗，加麻黄；吐，加半夏。
麻黄桂枝汤 治夜疟。此散血中风寒。
麻黄（一两） 桂枝（二钱） 甘草（炙，三钱） 黄芩（五钱） 桃仁（三十粒，去皮尖） 邪
气深而入血，故夜。以桃仁缓肝，散血中邪。
桂枝石膏汤 治邪深间日。
桂枝 石膏 知母 黄芩 汗出不愈，为内实外虚，寒热大作，必传入阴。太阳阳明，
、芍；寒热传入，太阳阳明少阳合病，加柴胡、半夏、人参、甘草。
藜芦散 治久疟欲吐不能吐，宜吐之。
藜芦为末，温齑水调下半钱，以吐为度。
张法 白虎加参汤、小柴胡合五苓散、神祜丸治之。
服前三方未动，次与之承气汤治。甚者，甘露饮调之，人参柴胡饮子补之，常山饮吐之
。
老疟丹 治老疟，风暑入阴在脏，凝血气。
川芎 桃仁 红花 当归 苍术 白术 白芷 黄柏 甘草
上水煎，露一宿，次早服之。
疟母丸 治疟母、食疟。
鳖甲（醋炙，君） 三棱 莪术（醋炙） 香附子 阿魏（食积加醋化）
截疟丸 先补药、表药，彻起阳分，方可截。
川常山 草果 知母 槟榔 乌梅 穿山甲（炒） 甘草（炙）
用水一大碗，煎半碗，露一宿，临发时温服之，宜吐。
一补一发丹 治久疟内伤挟外邪。内发必主痰，外以汗解。
半夏 茯苓 陈皮 柴胡 黄芩 苍术
川常山 葛根 虚加参、术补气，甚加芩、连。有一人夏感，脉沉细，服之愈。
常山汤 治妇胎疟。
常山（二两） 黄芩（三两） 石膏（八钱，另研） 乌梅（十四个） 甘草（一两）
煎服之。
不二散 白面（二两） 砒（一钱）
和匀，以香油一斤煎之，色黄，用草纸压之，去油为末，入江茶三两，每服一字。
神妙绝疟 木通（川者） 秦艽（去芦） 穿山甲（炙） 常山（各等分） 辰砂（半钱
，另研） 乌梅（七个） 大枣（七个）
上以水三盏，煎至半，入酒一盏，再至半。先刮砂，枣服，次服药。
【脉象】疟疾的脉象自然呈现弦脉，脉弦而数者多属热证，脉弦而迟者多属寒证。脉弦小且紧的，可用攻下法；脉弦迟的，可用温法；脉弦数的，可用发汗法或灸法；脉浮大的，可用吐法；脉弦数的，属于风邪引发的发热（风发），可通过饮食调理来止住病情。
【病因】夏季的暑气潜伏在营卫之间，若腠理（皮肤纹理及毛孔）不致密，遇到秋季的风邪，玄府（汗孔）受邪侵袭。凛冽的寒气闭塞而不能外出，停留在肠胃之外，与营卫之气并行运行。白天行于阳分，夜晚行于阴分，阴阳相并则发病，分离则病止。邪气并入阳分则发热，并入阴分则发冷。病位浅则每日发作，病位深则隔日发作。邪在气分则发作较早，在血分则发作较晚。因汗液郁结而成痰，或因身体虚弱导致阴阳相互乘袭。外因包括六淫（风、寒、暑、湿、燥、火六种外感病邪），有寒疟、湿疟、瘅疟、牝疟等。寒疟表现为先恶寒后发热；温疟表现为先发热后恶寒；瘅疟表现为只有发热没有恶寒；湿疟表现为身体骨节疼痛；牝疟表现为寒冷多而发热少。内因方面，有脏气不和、郁结痰饮所致者，涉及肝、心、脾、肺、肾五脏的说法，详见后文。不内外因方面，有疫疟，一年内大小患者症状相似；鬼疟表现为梦中惊扰不安；瘅疟表现为时发时止；食疟由饮食不当引起；劳疟由劳累引起；母疟是由母亲传染而来的。
李中梓论述：夏季伤于暑气，秋季发为疟疾。暑气属于季夏的湿土之气。若湿气令行不畅则土气亏虚，所胜之气（木）妄行，导致木气太过，这是少阳经主令。所生之气（火）受病，则肺金不足，不胜者（水）来侮之。水胜土之分，土对应坤卦，坤位于申位，申位属相火。水入土中，则水火相干，导致阴阳交替发作，肺金不足，出现洒淅恶寒的症状。土虚则少阳邪气乘之，从而产生寒热往来。发于秋季的，是湿热在卯酉之分（指时间或方位）。
【证治】先恶寒后发热，称为寒疟；先发热后恶寒，称为温疟；治疗应当适中。所谓“中”，指的是少阳经。口渴的，是燥气胜；不口渴的，是湿气胜。又有冬季受邪，而在暑天发作的，邪气潜伏在肾，属于足少阴经。有邪气藏于心，内热蓄积于肺，属于手太阴经。只有发热而没有恶寒的，称为瘅疟，属于足阳明经。在太阳经的称为风疟，宜用发汗法；在阳明经的称为热疟，宜用攻下法；在少阳经的称为风热，宜用和解法。这是病邪较浅的情况。在阴经的则不分三经，称为温疟，宜从太阴经论治。这是病邪较重的情况。
太阳经受病，头痛腰痛，寒气从背部升起，先恶寒后发热，宜用小柴胡汤、羌活地黄汤。
少阳经受病，身体懈怠无力，寒热不甚严重，厌恶见人，出汗很多，宜用小柴胡汤。
阳明经受病，先恶寒很久才发热，发热时大汗出，喜欢靠近火源才感觉舒服，宜用桂枝二白虎一汤。
少阴经受病，呕吐烦闷，热多寒少，想关上门独处，病情难愈，宜用小柴胡加半夏汤。
太阴经受病，喜欢叹气，食欲不振，寒热往来且多汗，病势到来时喜欢呕吐，之后病情衰退，宜用理中汤。
厥阴经受病，小腹腰痛，小便不利，心中恐惧，宜用四物玄明苦楝附子汤。
心疟，心烦意乱，极度想要喝冷水，反而恶寒多而发热轻，宜用桂枝黄芩汤。
肺疟，心中寒冷严重，发热间隙容易惊恐，好像看到了什么，宜用桂枝加芍药汤。
肝疟，面色青苍，经常叹气，严重时身体蜷缩像死了一样，宜用通脉四逆汤。
脾疟，发冷时腹痛，发热时肠鸣，鸣响后出汗，宜用小建中汤、芍药甘草汤。
肾疟，腰脊疼痛，翻身困难，大便艰难，眼睛昏花看不清，手足寒冷，宜用桂枝加当归芍药汤。
胃疟，将要发病时，容易饥饿但不能进食，能进食则胸胁胀满腹胀，宜用理中汤或理中丸主治。
劳疟，经过一年不愈，后来再次发作，轻微劳作便无法承受，名叫劳疟。
母疟，百药不效，结成癖块在腹胁部位，名叫疟母。
治疗方法虽不同，但疟疾得自暑邪，应当以发汗解表为主。如果发汗不彻底，郁结而成痰，宜用养胃化痰发汗的方法，使邪气排出，自然调和。虚证则补益，脉象洪大数而无力就是虚证的表现。
羌活汤 治疗邪气浅表在肌表。
羌活、防风、甘草。恶寒有汗，加桂枝；恶风无汗，加麻黄；呕吐，加半夏。
麻黄桂枝汤 治疗夜间发作的疟疾。此方发散血中的风寒。
麻黄（一两）、桂枝（二钱）、甘草（炙，三钱）、黄芩（五钱）、桃仁（三十粒，去皮尖）。邪气深入血分，所以夜间发作。用桃仁舒缓肝气，散除血中的邪气。
桂枝石膏汤 治疗邪气深重、隔日发作的疟疾。
桂枝、石膏、知母、黄芩。出汗后病未愈，属于内实外虚，寒热大作，必然传入阴经。若是太阳阳明合病，加芍药；若是寒热传入，太阳阳明少阳合病，加柴胡、半夏、人参、甘草。
藜芦散 治疗久疟想吐却吐不出来的情况，宜用吐法。
将藜芦研为末，用温醋水调服半钱，以吐出为度。
张氏方法 用白虎加人参汤、小柴胡汤合五苓散、神祐丸治疗。
服用前三方无效后，接着给予承气汤治疗。严重的，用甘露饮调理，用人参柴胡饮子补益，用常山饮催吐。
老疟丹 治疗陈年疟疾，风暑侵入阴分并在脏腑，凝结气血。
川芎、桃仁、红花、当归、苍术、白术、白芷、黄柏、甘草。
以上药材用水煎煮，露天放置一夜，次日早晨服用。
疟母丸 治疗疟母、食疟。
鳖甲（醋炙，为君药）、三棱、莪术（醋炙）、香附子、阿魏（若有食积加醋化开）。
截疟丸 先用补益药、解表药，提升阳气至阳分，才可以截断疟疾。
川常山、草果、知母、槟榔、乌梅、穿山甲（炒）、甘草（炙）。
用水一大碗，煎至半碗，露天放置一夜，发作前温服，宜引起呕吐。
一补一发丹 治疗久疟内伤兼夹外邪。内发必然主痰，外邪以发汗解除。
半夏、茯苓、陈皮、柴胡、黄芩、苍术、川常山、葛根。虚证加人参、白术补气，重症加黄芩、黄连。有一人夏季感受邪气，脉沉细，服用此方痊愈。
常山汤 治疗孕妇患疟。
常山（二两）、黄芩（三两）、石膏（八钱，另研）、乌梅（十四个）、甘草（一两）。
煎服。
不二散 白面（二两）、砒（一钱）。
混合均匀，用香油一斤煎炸，颜色变黄，用草纸压去油分，研为末，加入江茶三两，每次服用一字量。
神妙绝疟 木通（四川产者）、秦艽（去芦头）、穿山甲（炙）、常山（各等分）、辰砂（半钱，另研）、乌梅（七个）、大枣（七个）。
以上用水三盏，煎至半盏，加入酒一盏，再煎至半盏。先刮下辰砂和大枣服用，再服药。
[Pulse] The pulse of malaria naturally presents as a *Xian* (Wiry) pulse. A wiry and rapid (*Shu*) pulse indicates excess heat, while a wiry and slow (*Chi*) pulse indicates excess cold. If the pulse is wiry, small, and tight, purgation may be used; if wiry and slow, warming methods may be applied; if wiry and rapid, diaphoresis or moxibustion may be used; if floating and large, emesis may be induced; if wiry and rapid, it is termed "Wind-Fire" (*Feng Fa*, fever caused by wind pathogen), which can be resolved through dietary regulation.
[Etiology] Summer-heat lingers between the Ying (Nutritive) and Wei (Defensive) levels. If the Cou Li (skin pores and interstices) are not dense, autumn wind pathogens invade the Xuan Fu (sweat pores). The biting cold closes off and cannot exit, lodging outside the intestines and stomach, running parallel with Ying and Wei. During the day, it travels in Yang; at night, in Yin. When they merge, disease manifests; when they separate, disease ceases. Merging in Yang causes heat; merging in Yin causes cold. Shallow involvement leads to daily attacks; deep involvement leads to every-other-day attacks. Involvement in Qi results in earlier onset; involvement in Blood results in later onset. Pathogenesis arises from sweat retention transforming into phlegm, or from deficiency causing Yin and Yang to attack each other. External causes include the Six Excesses (Wind, Cold, Summer-Heat, Dampness, Dryness, Fire), manifesting as Cold Malaria (chills precede fever), Warm Malaria (fever precedes chills), Dan Malaria (fever without chills), Damp Malaria (body and joint pain), and Pin Malaria (more chills than fever). Internal causes involve disharmony of Zang organs, stagnation, and fluid retention, involving the Liver, Heart, Spleen, Lung, and Kidney (see below). Non-internal/external causes include Epidemic Malaria (similar symptoms among all patients in a year), Ghost Malaria (disturbing dreams), Dan Malaria (intermittent onset), Food Malaria (caused by diet), Labor Malaria (caused by overexertion), and Mother Malaria (transmitted from mother).
Li Zhongzi's Discussion: Summer injury by summer-heat leads to autumn malaria. Summer-heat belongs to the damp earth of late summer. If dampness fails to circulate, Earth Qi is deficient, allowing Wood Qi to overact, governed by Shaoyang. The generated element suffers, leading to insufficient Lung Metal, which allows Water to insult. Water overcoming Earth corresponds to Kun trigram, located at Shen, associated with Ministerial Fire. Water entering Earth causes water-fire conflict, leading to alternating Yin-Yang fluctuations. Insufficient Lung Metal causes shivering chills. Deficient Earth allows Shaoyang to invade, causing alternating chills and fever. Autumn onset relates to damp-heat at Mao-You positions.
[Syndrome Differentiation and Treatment] Chills preceding fever is Cold Malaria; fever preceding chills is Warm Malaria; treatment should be moderate, targeting Shaoyang. Thirst indicates dryness predominance; no thirst indicates dampness predominance. Some contract pathogens in winter but manifest in summer, with pathogens lodging in the Kidney (Foot Shaoyin). Some lodge in the Heart, with internal heat accumulating in the Lung (Hand Taiyin). Fever without chills is Dan Malaria, related to Foot Yangming. Involvement of Taiyang channel is Wind Malaria, treated by diaphoresis; Yangming channel is Heat Malaria, treated by purgation; Shaoyang channel is Wind-Heat, treated by harmonization. This represents shallow invasion. Involvement of Yin channels is called Warm Malaria, treated via Taiyin channel theory, representing severe invasion.
Taiyang Channel: Headache, lower back pain, cold starting from the back, chills then fever. Use Xiao Chai Hu Tang (Minor Bupleurum Decoction) or Qiang Huo Di Huang Tang.
Shaoyang Channel: Body lethargy, mild chills and fever, aversion to people, profuse sweating. Use Xiao Chai Hu Tang.
Yangming Channel: Prolonged chills followed by fever, profuse sweating during fever, preference for warmth/fire. Use Gui Zhi Er Bai Hu Yi Tang (Cinnamon Twig Twice, Gypsum Decoction One Part).
Shaoyin Channel: Vomiting, oppression, more heat than chills, desire to stay behind closed doors, difficult to cure. Use Xiao Chai Hu Tang plus Ban Xia (Pinellia).
Taiyin Channel: Frequent sighing, poor appetite, alternating chills/fever with sweating, vomiting marks decline. Use Li Zhong Tang (Regulate the Middle Decoction).
Jueyin Channel: Lower abdominal and lower back pain, dysuria, fearfulness. Use Si Wu Xuan Ming Ku Lian Fu Zi Tang.
Heart Malaria: Mental restlessness, intense desire for cold water, more chills than mild fever. Use Gui Zhi Huang Qin Tang.
Lung Malaria: Severe mental coldness, palpitations during fever intervals, hallucinations. Use Gui Zhi Jia Shao Yao Tang.
Liver Malaria: Pale/greenish complexion, frequent sighing, severe cases curled up like death. Use Tong Mai Si Ni Tang.
Spleen Malaria: Abdominal pain during chills, borborygmus during fever, sweating after borborygmus. Use Xiao Jian Zhong Tang or Shao Yao Gan Cao Tang.
Kidney Malaria: Lower back/spine pain, difficulty turning, difficult defecation, blurred vision, cold extremities. Use Gui Zhi Jia Dang Gui Shao Yao Tang.
Stomach Malaria: Hunger before onset but inability to eat; if eating, chest/flank fullness and abdominal distension. Use Li Zhong Tang or Wan.
Labor Malaria: Persisting for a year, recurring, intolerance to slight exertion.
Mother Malaria: Refractory to medicines, forming masses in abdomen/flanks, termed Nu Malaria Mass.
Although treatments vary, malaria originates from summer-heat and should primarily be resolved by diaphoresis. If sweating is incomplete, phlegm forms from retention; treat by nourishing stomach, resolving phlegm, and inducing sweating to expel pathogens. For deficiency (pulse large, rapid, forceless), tonify.
Qiang Huo Tang: Treats superficial pathogen.
Ingredients: Qiang Huo, Fang Feng, Gan Cao. Add Gui Zhi for chills with sweating; add Ma Huang for aversion to wind without sweating; add Ban Xia for vomiting.
Ma Huang Gui Zhi Tang: Treats nocturnal malaria. Disperses wind-cold in blood.
Ingredients: Ma Huang (1 liang), Gui Zhi (2 qian), Zhi Gan Cao (3 qian), Huang Qin (5 qian), Tao Ren (30 pits, peeled). Pathogen deep in blood causes nocturnal onset. Tao Ren soothes Liver and disperses blood pathogens.
Gui Zhi Shi Gao Tang: Treats deep pathogen with every-other-day attacks.
Ingredients: Gui Zhi, Shi Gao, Zhi Mu, Huang Qin. If sweating fails, indicating interior excess/exterior deficiency with severe chills/fever transitioning to Yin, add Shao Yao for Taiyang-Yangming combination. For Taiyang-Yangming-Shaoyang combined disease, add Chai Hu, Ban Xia, Ren Shen, Gan Cao.
Li Lu San: Treats chronic malaria with urge to vomit but inability. Induce emesis.
Preparation: Li Lu powder mixed with warm vinegar water, half qian dose, until vomited.
Zhang's Method: Use Bai Hu Jia Shen Tang, Xiao Chai Hu Tang combined with Wu Ling San, Shen You Wan.
If ineffective, use Cheng Qi Tang. Severe cases: Gan Lu Yin for regulation, Ren Shen Chai Hu Yin Zi for tonification, Chang Shan Yin for emesis.
Lao Nue Dan: Treats chronic malaria where wind-heat enters Yin/Zang, coagulating Qi/Blood.
Ingredients: Chuan Xiong, Tao Ren, Hong Hua, Dang Gui, Cang Zhu, Bai Zhu, Bai Zhi, Huang Bo, Gan Cao.
Decoct in water, expose overnight, take next morning.
Nu Malaria Pill: Treats Nu Malaria Mass, Food Malaria.
Ingredients: Bie Jia (vinegar-fried, Sovereign), San Leng, E Zhu (vinegar-fried), Xiang Fu Zi, A Wei (add vinegar for food stagnation).
Jie Nue Wan: First use tonics and exterior-releasing agents to raise Yang Qi to Yang level, then intercept malaria.
Ingredients: Chuan Chang Shan, Cao Guo, Zhi Mu, Bing Lang, Wu Mei, Chuan Shan Jia (fried), Zhi Gan Cao.
Decoct in one bowl water to half bowl, expose overnight, take warm before onset, induce vomiting.
Yi Bu Yi Fa Dan: Treats chronic malaria with internal injury and external pathogens. Internal phlegm must be addressed; external pathogens resolved by sweating.
Ingredients: Ban Xia, Fu Ling, Chen Pi, Chai Hu, Huang Qin, Cang Zhu, Chuan Chang Shan, Ge Gen. Add Ren Shen, Bai Zhu for deficiency; add Huang Qin, Huang Lian for severity. Case: Summer pathogen, deep/thin pulse, cured.
Chang Shan Tang: Treats pregnancy malaria.
Ingredients: Chang Shan (2 liang), Huang Qin (3 liang), Shi Gao (8 qian, separately ground), Wu Mei (14), Gan Cao (1 liang).
Decoct and take.
Bu Er San: Bai Mian (2 liang), Pi (1 qian).
Mix, fry in sesame oil (1 jin) until yellow, press with grass paper to remove oil, grind to powder, mix with Jiang Cha (3 liang). Dosage: one character measure.
Shen Miao Jue Nue: Mu Tong (Sichuan), Qin Jiao (de-rhizome), Chuan Shan Jia (fried), Chang Shan (equal parts), Chen Sha (half qian, separately ground), Wu Mei (7), Da Zao (7).
Decoct in three cups water to half cup, add one cup wine, reduce to half cup. Scrape Chen Sha and Da Zao first, then take medicine.