（以下俱杂病，于五脏无所敷，故列于后）
〔娄〕治小儿疟疾，多与大人同法，以出汗为瘥，宜桂枝、柴胡、麻黄、参、苓
等辈，又视其病食、病痰，以意消息之，大抵多是饮食失节得之，须以消导为先可
也。〔曾〕《内经》疟论∶ 疟皆生于风，而发作有时何也？岐伯曰∶夏伤于暑，秋
必病疟。谓腠理开而汗出遇风，或得于澡浴，水气舍于皮肤，因卫气不守，邪气并
居。其疾始作，伸欠寒栗，腰背俱痛，骨节烦疼，寒去则内外皆热，头疼而渴，乃
阴阳二气交争，虚实更作而然。阴气独盛则阳虚，故先寒战栗，腰背头项骨节皆痛，
阳气独胜则阴虚，故先热，发时不嗜食，善呕，头疼腰痛，小便不利，阴盛阳虚则
内外皆寒，阳盛阴虚则内外俱热，此外感六淫或内伤七情，蕴积痰饮，病气与卫气并
居，故病日作，卫气昼行于阳，夜行于阴，得阳而外出，得阴而内薄，内薄五脏，病
气深入，不能与卫气俱出，则间日而作。当卫气所至，病气所在，则发在阳则热，
在阴则寒。经曰∶亢则害，极乃反，俟阴阳各衰，卫气与病气相杂则病休，阴阳相
搏，卫气与病气再集则病复，各随其卫气之所在，与所中邪气相合而然也。先寒后
热者，先伤寒而后伤风，名曰寒疟。先热后寒者，先伤风而后伤寒，名曰温疟。但
热不寒者，名曰瘅疟。身重寒热，骨节痛，腹胀满，自汗善呕，名曰湿疟。但寒不
热者，名曰牝疟。盖疟之为病，为证非一，故处方之制，随其阴阳虚实，脉病证治，
汗吐下温，对证施治，以平为期。然百病中人，必因其正气之虚，感受邪气，留而
不去，其病为实，自表传里，先汗后下，古今不易，故治疟之法，必须先表，用百
解散（惊）水姜葱煎投，次小柴胡汤（往来寒热）加桂、水姜枣煎服，以和解表里之邪，自然作
效。若表里实，用当归散（潮热）、五和汤（里热）或乌犀丸（积）、六圣丸（积）下之，匀气散（疝）止
补，后以藿香饮（不乳食）加草果、良姜、水姜枣煎投，正胃气，去寒邪，则自平复。如
解表后寒热往来，以二仙饮（本条）截之，寒热既除，用平胃散（不乳食）加茴香汤（腹痛）和匀，
盐汤空心调服，温胃燥脾，进美饮食，使中州之土既实，则外邪不战而自屈，此为
明论。有寒多热少，经久不愈，致脾胃弱，饮食减，神色变，二姜丸（本条）及清脾汤
（本条）为治。〔薛〕经曰∶夏伤于暑，秋必 疟。其证先起于毫毛伸欠，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，盖邪气并于阳则阳胜，并于阴
则阴胜，阴胜则寒，阳胜则热，阴阳上下交争，虚实更作，故寒热间发也。有一日
一发，二日一发，三日一发，有间一日连二日发，有日与夜各发，有上半日发，下
半日发，及发于夜者，有有汗，有无汗，此其略也。以详言之，当分六经五脏及痰、
食、劳、暑、鬼瘴之不同（六经五脏疟详见杂病准绳）。痰疟者，胸膈先有停痰，因而成疟，
令人心下胀满，气逆烦呕是也。食疟者，是饮食伤脾，其人噫气吞酸，胸膈不和是
也。劳疟者，久而不瘥，表里俱虚，客邪未散，真气不复，故疾虽间，遇劳即发是
也。暑疟者，其人面垢口渴，虽热已退，亦常有汗是也。鬼疟者，进退无时是也。
瘴疟者，感山岚瘴气，其状寒热休作有时是也。久而不愈，名曰 疟， 疟、老疟
也，老疟不愈，结癖于两胁之间，名曰疟母，此先失于解散，或复外感风寒，内伤
饮食，故缠绵不已也。治法，风暑之邪从外而入，宜解散之，解表后，即宜扶持胃
气，故丹溪曰∶无汗要有汗，散邪为主，有汗要无汗，固正气为主，骤发之疟宜解
表，久发之疟宜补脾，寒疟宜温，温疟宜和，瘅疟宜清，挟痰则行痰，兼食则消食，
劳疟宜安，暑疟宜解，鬼疟宜祛，瘴疟宜散，此亦其略也。更以详言之，则热多寒
少者小柴胡汤。寒多热少者清脾饮子。无汗者桂枝麻黄各半汤。有汗者柴胡桂枝汤。
汗多渴者白虎汤。渴而小便不利者五苓散。小便赤，热多而渴者，小柴胡汤。热多
汗出，腹满便 者，大柴胡汤，渴加葛根。痰疟者，二陈汤（痰涎）加柴胡、黄芩，甚者
加枳实。食疟者，先用大安丸（宿食），次用异功散（吐泻）。劳疟、 疟，并用补中益气汤
（虚热）。暑疟者，十味香薷饮。鬼疟者，鬼哭散。瘴疟者，四兽饮。疟母者，鳖甲饮。
凡脾胃虚而患疟者，不拘有汗无汗，三阴六经，悉以六君子汤为主，热多加柴胡、
山栀，寒多加干姜、肉桂，有汗加黄 、浮麦，无汗加苍术、葛根，元气下陷，及
肝木乘脾，并加升麻、柴胡、为善。若用青皮、草果、常山等药，以为攻截良法，
正气益虚，邪气益深，是多延绵不止，而为劳热者有矣。若乳母七情六欲，饮食不
调，或寒热似疟，肝火炽盛，致儿为患者，又当治其乳母，斯无误矣。
《全生指迷》论曰∶寒热之病，或寒已而热，或热已而寒。若寒热战栗，头痛如
破，身体拘急，数欠，渴欲饮冷，或先寒而后热，或先热而后寒，或 时而发，或
间日而作，至其时便发，发已如常，此谓之疟。疟脉自弦，弦数多热，弦迟多寒，
此皆得之于冬中风寒之气，藏于骨髓之中，至春阳气大发，邪气不能自出，因遇大
暑，而后与邪气相合而发，寒多者宜温之与姜桂汤，热多者宜解之与栝蒌汤，寒热
等者宜调之与鳖甲汤。大人小儿疟疾，若寒从背起，冷大如手，不甚战栗，似欲
发热而汗出，或即头痛，呕吐时作，其脉迟小，此由脾胃素弱，因气寒而收聚水谷，
不能克化，变而成痰，伏痰在内，阴上乘阳，阳为阴所乘，所以作寒，逼而成汗，
宜服旋复花丸、半硫丸。
（以下内容均属于杂病范畴，与五脏的常规论述无关，因此列在后面）
【娄全善】治疗小儿疟疾，大多采用与成人相同的方法，以出汗作为痊愈的标志，适宜使用桂枝、柴胡、麻黄、人参、茯苓等药物。此外，还要根据患儿是否因饮食或痰饮致病，灵活斟酌调整。大抵上多是因为饮食不节制而得病，必须把消食导滞放在首位即可。
【曾世荣】《黄帝内经·素问·疟论》记载：疟疾都产生于风邪，但为什么发作有固定的时间呢？岐伯回答说：夏季感受暑邪，秋季必定患疟疾。这是因为腠理（皮肤毛孔）张开时出汗，遇到风邪；或者洗澡时，水气停留在皮肤之间，因为卫气不能固守，邪气乘虚而入并与之相居。疾病刚开始发作时，表现为伸懒腰、打哈欠、怕冷颤抖，腰背都疼痛，骨节烦扰疼痛。寒气退去后，体内和体表都发热，头痛且口渴，这是阴阳二气相互交争，虚实交替变化所致。如果阴气单独偏盛则阳气虚弱，所以先出现寒战颤抖，腰背、头项、骨节都疼痛；如果阳气单独偏盛则阴气虚弱，所以先发热，发病时不想吃东西，容易呕吐，头痛腰痛，小便不通利。阴盛阳虚则内外都寒冷，阳盛阴虚则内外都发热。这些是由外感六淫（风、寒、暑、湿、燥、火）或内伤七情（喜、怒、忧、思、悲、恐、惊），蕴积成痰饮，病气与卫气并居在一起，所以每天发作。卫气白天行于阳分，夜晚行于阴分，遇到阳分就外出，遇到阴分就向内迫近。当病气深入五脏，不能与卫气一同外出时，就会隔日发作。当卫气运行到病气所在之处时，病在阳分就发热，在阴分就发冷。经书说：亢盛就会为害，极点就会返复。等到阴阳之气各自衰减，卫气与病气混杂则疾病休止；阴阳相互搏结，卫气与病气再次聚集则疾病复发，这都是随着卫气所在的位置，与所中的邪气相合而形成的。先冷后热的，是先受寒邪而后受风邪，名叫寒疟。先热后冷的，是先受风邪而后受寒邪，名叫温疟。只有热没有冷的，名叫瘅疟（dān nüè）。身体沉重、忽冷忽热、骨节痛、腹胀满、自汗且容易呕吐的，名叫湿疟。只有冷没有热的，名叫牝疟（pìn nüè）。大概疟疾这种病，证候不止一种，所以处方的制定，要依据其阴阳虚实、脉象病症，分别采用汗、吐、下、温等方法，对症施治，以达到平衡为止。然而各种疾病侵入人体，必然是因为正气虚弱，感受邪气，停留不去，导致病情属实，由表传里，先用汗法后用下法，古今不变。所以治疗疟疾的方法，必须先解表，用百解散（主治惊风）用水、生姜、葱白煎服，接着用小柴胡汤（主治往来寒热）加桂枝、生姜、大枣煎服，以和解表里的邪气，自然见效。如果表里俱实，用当归散（主治潮热）、五和汤（主治里热）或乌犀丸（主治积滞）、六圣丸（主治积滞）攻下，再用匀气散（主治疝气）止泻补虚，随后用藿香饮（主治食欲不振）加草果、良姜、生姜、大枣煎服，以正胃气，去除寒邪，则自然平复。如果解表后仍有寒热往来，用二仙饮（见本条）截断疟疾；寒热既除，用平胃散（主治食欲不振）加茴香汤（主治腹痛）调和均匀，空腹用盐汤调服，以温胃燥脾，增进饮食，使中焦脾胃之气充实，则外邪不战而自屈，这是明理的说法。如果有寒多热少，经久不愈，导致脾胃虚弱，饮食减少，神色改变，可用二姜丸（见本条）及清脾汤（见本条）治疗。
【薛己】经书说：夏季感受暑邪，秋季必定患疟疾。其症状先从毫毛竖起、伸懒腰开始，接着出现寒战咬牙，腰脊都疼痛，寒气退去后内外都发热，头痛剧烈如破裂感，想喝冷冻饮料。这是因为邪气并入阳分则阳胜，并入阴分则阴胜，阴胜则寒，阳胜则热，阴阳上下交争，虚实交替，所以寒热间歇发作。有一日一发，两日一发，三日一发，有隔一天连两天发作的，有白天黑夜各发作一次的，有上半日发作，下半日发作，以及夜间发作的，有有汗的，有无汗的，这只是大略情况。详细来说，应当分为六经、五脏以及痰、食、劳、暑、鬼瘴等不同类型（六经五脏疟详见《证治准绳·杂病》）。痰疟，是胸膈原本有停痰，因而形成疟疾，让人心下胀满，气逆烦闷呕吐。食疟，是饮食损伤脾胃，其人嗳气吞酸，胸膈不和。劳疟，是日久不愈，表里俱虚，客邪未散，真气不复，所以疾病虽然间歇，但遇到劳累就发作。暑疟，其人面色垢浊口渴，虽然热已退，也常有汗出。鬼疟，是发作时间进退无常。瘴疟，是感受山岚瘴气，其状寒热休作有时。日久不愈，名叫久疟、老疟。老疟不愈，结块在两胁之间，名叫疟母，这先是失于解散，或者又外感风寒，内伤饮食，所以缠绵不已。治疗方法，风暑之邪从外而入，宜解散之，解表后，即宜扶持胃气，所以丹溪说：无汗要有汗，以散邪为主；有汗要无汗，以固正气为主。骤发的疟疾宜解表，久发的疟疾宜补脾，寒疟宜温，温疟宜和，瘅疟宜清，挟痰则行痰，兼食则消食，劳疟宜安，暑疟宜解，鬼疟宜祛，瘴疟宜散，这也是大略说法。更详细地说，热多寒少的用小柴胡汤。寒多热少的用清脾饮子。无汗的用桂枝麻黄各半汤。有汗的用柴胡桂枝汤。汗多口渴的用白虎汤。口渴且小便不利的用五苓散。小便赤，热多而口渴的，用小柴胡汤。热多汗出，腹满便溏的，用大柴胡汤，口渴加葛根。痰疟的，用二陈汤（主治痰涎）加柴胡、黄芩，严重的加枳实。食疟的，先用大安丸（主治宿食），次用异功散（主治吐泻）。劳疟、久疟，都用补中益气汤（主治虚热）。暑疟的，用十味香薷饮。鬼疟的，用鬼哭散。瘴疟的，用四兽饮。疟母的，用鳖甲饮。凡是脾胃虚弱而患疟疾的，不管有汗无汗，三阴六经，都以六君子汤为主，热多加柴胡、山栀，寒多加干姜、肉桂，有汗加黄芪、浮小麦，无汗加苍术、葛根，元气下陷，及肝木乘脾，并加升麻、柴胡，为好。如果用青皮、草果、常山等药，以为攻截良法，会导致正气更虚，邪气更深，多是拖延不止，而变成劳热的就有这种情况了。如果乳母因七情六欲、饮食不调，或寒热似疟，肝火炽盛，导致婴儿患病，又应当治疗乳母，这样才不会出错。
《全生指迷》论述说：寒热病，有的寒退后热，有的热退后寒。如果寒战颤抖，头痛剧烈如破，身体拘急，频繁打哈欠，想喝冷水，或先冷后热，或先热后冷，或定时发作，或隔日发作，到了时候就发作，发作后像常人一样，这叫疟疾。疟疾的脉象自弦，弦数脉多热，弦迟脉多寒，这都是因为冬天感受风寒之气，藏在骨髓之中，到了春天阳气大发，邪气不能自行排出，如果遇到大暑天，然后与邪气相合而发作。寒多的宜温之，用姜桂汤；热多的宜解之，用栝蒌汤；寒热相等的宜调之，用鳖甲汤。大人小儿疟疾，如果寒从背部起，冷感大如手掌，不太战栗，好像要发热而出汗，或者随即头痛，呕吐不时发作，其脉迟小，这是由脾胃素来虚弱，因气寒而收聚水谷，不能消化，变而成痰，伏痰在内，阴上乘阳，阳被阴所乘，所以作寒，逼而成汗，宜服用旋复花丸、半硫丸。
(Below are miscellaneous diseases, unrelated to the standard discussions of the five zang organs, thus listed hereafter.)
[Lou Quanshan] Treating pediatric malaria generally follows the same methods as for adults, with sweating regarded as the sign of recovery. It is appropriate to use herbs such as Guizhi (Cinnamon Twig), Chaihu (Bupleurum Root), Mahuang (Ephedra Herb), Renshen (Ginseng Root), and Fuling (Poria) among others. Furthermore, one must flexibly adjust based on whether the disease stems from dietary issues or phlegm accumulation. Generally, it arises mostly from irregular diet, so prioritizing digestion-promoting and stagnation-resolving methods is advisable.
[Zeng Shirong] The *Neijing* (Yellow Emperor's Inner Canon) chapter on Malaria states: "Malaria all originates from wind pathogen, yet why does it manifest at specific times?" Qibo replied: "Summer injury by summerheat leads to autumn malaria." This implies that when pores are open and sweating occurs, encountering wind; or during bathing, water qi lodges in the skin. Because Wei Qi (Defensive Qi) fails to guard, the pathogen enters and resides there. When the disease first manifests, it presents with yawning, shivering chills, pain in the waist and back, and vexing pain in bone joints. After the cold subsides, both interior and exterior become hot, accompanied by headache and thirst. This results from the contention between Yin and Yang Qi, alternating deficiency and excess. If Yin Qi alone prevails causing Yang deficiency, chills occur first, with pain in the waist, back, head, neck, and joints. If Yang Qi alone prevails causing Yin deficiency, heat occurs first, with anorexia, frequent vomiting, headache, lower back pain, and dysuria. Yin excess and Yang deficiency lead to coldness inside and out; Yang excess and Yin deficiency lead to heat inside and out. These stem from external contraction of the Six Excesses (Wind, Cold, Summerheat, Dampness, Dryness, Fire) or internal injury by the Seven Emotions (Joy, Anger, Worry, Pensiveness, Sorrow, Fear, Fright), accumulating into phlegm and fluid retention. Pathogenic Qi and Wei Qi reside together, causing daily attacks. Wei Qi travels through Yang meridians during the day and Yin meridians at night; it moves outward upon encountering Yang and inward upon encountering Yin. When pathogenic Qi penetrates deeply into the five zang organs and cannot exit with Wei Qi, it manifests every other day. When Wei Qi reaches the location of the pathogen, manifestation in Yang causes heat, while in Yin causes cold. The classics state: "Exuberance brings harm, extremity reverses." When Yin and Yang Qi decline, and Wei Qi mixes with pathogenic Qi, the disease rests; when Yin and Yang contend again, and Wei Qi gathers with pathogenic Qi, the disease recurs. This depends on the location of Wei Qi combining with the contracted pathogen. Cold followed by heat indicates initial cold injury then wind injury, named Cold Malaria. Heat followed by cold indicates initial wind injury then cold injury, named Warm Malaria. Heat without cold is named Dan Malaria (Febrile Malaria). Heavy body, alternating chills and fever, joint pain, abdominal fullness, spontaneous sweating, and easy vomiting constitute Damp Malaria. Cold without heat is named Pin Malaria (Yin Malaria). Since malaria presents various syndromes, prescriptions must be formulated according to Yin-Yang, deficiency-excess, pulse, and symptoms, utilizing sweating, vomiting, purging, or warming methods to restore balance. All diseases invade due to righteous Qi deficiency allowing pathogens to linger, creating excess conditions that move from exterior to interior, requiring sweating first then purging, a principle unchanged since antiquity. Thus, treating malaria requires first resolving the exterior, using Baijie San (for fright) decocted with water, ginger, and scallion, followed by Xiaochaihu Tang (for alternating chills and fever) added with Guizhi, ginger, and jujube to harmonize the exterior and interior, naturally yielding effects. If both exterior and interior are excess, use Danggui San (for tidal fever), Wuhe Tang (for interior heat), or Wuxi Wan (for accumulation), Liusheng Wan (for accumulation) to purge, then Yunqi San (for hernia) to stop diarrhea and tonify, followed by Huoxiang Yin (for poor feeding) added with Caoguo (Black Cardamom), Liangjiang (Galangal), ginger, and jujube to rectify Stomach Qi and dispel cold, leading to natural recovery. If alternating chills and fever persist after resolving the exterior, use Erxian Yin (see this section) to intercept the malaria. Once chills and fever cease, use Pingwei San (for poor feeding) added with Huixiang Tang (for abdominal pain), mixed evenly, taken empty-stomach with salt water to warm the stomach, dry the spleen, and improve appetite. When the central earth (Spleen/Stomach) is solidified, external pathogens retreat spontaneously, which is a sound theory. For cases with more cold than heat, chronic and unhealed, leading to weak spleen/stomach, reduced intake, and changed complexion, use Erjiang Wan (see this section) and Qingspi Tang (see this section).
[Xue Ji] The classics state: "Summer injury by summerheat leads to autumn malaria." Symptoms begin with hair standing on end and yawning, followed by shivering chills and jaw quivering, waist and spine pain. After cold subsides, interior and exterior become hot, severe headache like bursting, desire for cold drinks. This is because pathogen merging into Yang makes Yang prevail, merging into Yin makes Yin prevail; Yin prevailing causes cold, Yang prevailing causes heat. Upper and lower Yin-Yang contend, alternating deficiency and excess, hence intermittent chills and fever. Patterns include once daily, every two days, every three days, skipping one day then two consecutive days, day and night each, upper half-day, lower half-day, night only, with or without sweat. Detailed classification involves Six Meridians, Five Zang Organs, and distinctions among Phlegm, Food, Labor, Summerheat, Ghost, and Miasma malaria (Six Meridians and Five Zang malaria detailed in *Zhengzhi Zhunsheng·Zabing*). Phlegm Malaria: pre-existing phlegm in chest/diaphragm forms malaria, causing subcostal fullness, rebellious Qi, vexation, and vomiting. Food Malaria: diet injures Spleen, causing belching, acid regurgitation, and diaphragmatic discomfort. Labor Malaria: chronic unresolved, exterior/interior deficient, guest pathogen not dispersed, true Qi not restored; though intermittent, it triggers upon exertion. Summerheat Malaria: greasy face, thirst, persistent sweating even after fever subsides. Ghost Malaria: unpredictable onset and offset. Miasma Malaria: contracted mountain miasma, presenting with timed intermittent chills and fever. Chronic non-resolution is called Long-term or Old Malaria. If Old Malaria persists, a mass forms between the hypochondrium, called Malaria Mother (Pi Mass). This results from failed resolution, or re-contracting wind-cold externally and injuring diet internally, leading to lingering illness. Treatment: Wind-summerheat entering from outside requires resolution; after resolving exterior, support Stomach Qi. As Danxi said: "No sweat needs inducing sweat, focusing on dispersing pathogen; existing sweat needs stopping sweat, focusing on consolidating righteous Qi." Acute malaria requires exterior resolution; chronic malaria requires Spleen tonification. Cold malaria requires warming; Warm malaria requires harmonizing; Dan malaria requires clearing; Phlegm-involved requires moving phlegm; Food-involved requires digesting food; Labor malaria requires calming; Summerheat malaria requires resolving; Ghost malaria requires expelling; Miasma malaria requires dispersing. More specifically: Heat > Cold uses Xiaochaihu Tang. Cold > Heat uses Qingspi Yinzi. No sweat uses Guizhi Mahuang Ban Tang. Sweat uses Chaihu Guizhi Tang. Sweating + Thirst uses Baihu Tang. Thirst + Dysuria uses Wuling San. Red urine + Heat + Thirst uses Xiaochaihu Tang. Heat + Sweating + Abdominal Fullness + Loose Stool uses Dachaihu Tang (+ Gegen if thirsty). Phlegm Malaria uses Erchen Tang (+ Chaihu, Huangqin; add Zhishi if severe). Food Malaria uses Da'an Wan first, then Yigong San. Labor/Old Malaria uses Buzhong Yiqi Tang. Summerheat Malaria uses Shiwei Xiangru Yin. Ghost Malaria uses Guiku San. Miasma Malaria uses Sishou Yin. Malaria Mother uses Biejia Yin. For all malaria with Spleen/Stomach deficiency, regardless of sweat status or meridian involvement, Liu Junzi Tang is primary. Add Chaihu, Zhizi for heat; Ganjiang, Rougui for cold; Huangqi, Fumai for sweat; Cangzhu, Gegen for no sweat; Shengma, Chaihu for sinking Yuan Qi or Liver Wood overacting on Spleen. Using Qingpi, Caoguo, Changshan as aggressive interception methods depletes righteous Qi and deepens pathogen, often prolonging illness into labor-fever. If the nursing mother suffers from emotional disturbance, dietary imbalance, or malaria-like chills/fever with blazing Liver Fire affecting the infant, treat the mother to avoid error.
*Quansheng Zhimi* discusses: Cold-heat diseases may have heat following cold, or cold following heat. If shivering chills, severe headache, body stiffness, frequent yawning, desire for cold drinks, or alternating cold-heat, timed or every-other-day attacks occurring precisely at time, returning to normal after attack, this is Malaria. Malaria pulse is naturally wiry (Xuan); wiry-rapid indicates heat, wiry-slow indicates cold. These result from winter wind-cold hiding in marrow, emerging in spring when Yang Qi expands but pathogen cannot exit, combining with summerheat to manifest. Cold-dominant: warm with Jianggui Tang. Heat-dominant: resolve with Gualou Tang. Equal cold-heat: regulate with Biejia Tang. In adults/children, if cold starts from back, cold sensation palm-sized, mild chills, feeling like fever with sweat, or sudden headache, occasional vomiting, with slow-small pulse, this is due to inherent weak Spleen/Stomach, cold Qi gathering grain/water, failing to transform, becoming phlegm. Hidden phlegm inside, Yin rises over Yang, Yang oppressed by Yin causes cold, forced sweating ensues. Use Xuanfuhua Wan, Banshu Wan.