一证不具。即当细审。况疫痧总属阳毒性多。阴毒性少。若忘其病之为毒。一见肢冷脉
伏。骤进以附姜丁桂之剂。恐多草率误人。盖因此等急证。往往脉候难凭。必须细查病
源。详审舌苔。按其胸腹。询其二便。汇参默察。则阴阳虚实之真假。庶可得其真谛也
。惟溪毒、砂虱、水弩、射工、短狐、蝈虾之类。俱能含沙射人。被其毒者。憎寒壮热
。百体分解。胸痞腹痛。状似伤寒兼痧。常用酒煨大黄滴入松节油拌捣极烂。用软帛包
裹。遍擦周身。其毒自解。再用地浆水调下太乙紫金丹。以整肃其痧毒。病自除根。或
用角筒按入皮肉极痛处。以口吸出其痧。外用煨蒜捣膏。封贴疮口而愈。或用 HT
鸟白毛 灰。用松节油调匀。搽擦周身。亦可拔毒外出而痊。此于恒痧疫痧外。另是一
种虫毒之病。必照此杀虫解毒。方能收效。
（一名寒疟俗称脾寒病）
【因】外因多风寒暑湿。内因多夹食夹痰。其病有日发间日发之殊。其证有经病腑
病脏病之异。且必寒热往来。确有定候。方谓之疟。与乍寒乍热。一日二三度发。寒热
无定候者迥异。其病新久轻重不一。全在临证者。细审病源。辨明病状之寒热虚实。病
所之经络腑脏。应以温凉补泻耳。先述 疟。
【证】 疟因风寒而发。初起恶寒无汗。头身俱痛。继即寒热往来。发有定期。深
者间日一发。极深者三日一发。发冷时形寒战栗。齿 然有声。面头手足皆冷。甚则
口唇指甲皆青。发冷过期。即发大热。皮肤壮热色赤。头甚痛。呼吸粗。渴欲饮冷。神倦
嗜睡。或心烦懊 。少则二三时。多则四五时。周身大汗。诸证若失。根据此反复而作。累
月经年。缠绵难愈。舌苔白滑而腻。甚或灰腻满布。
【脉】沉弦而迟。沉为在脏。弦迟者多寒。此内经所谓邪气内薄五脏。横连膜原。
其道远。其气深。故休数日乃作也。亦即后贤所谓三阴疟。俗称脾寒病。四日两头是也
。
【治】必先辨其胁下有块与否。无块者。脾脏积水与顽痰也。轻则清脾饮（浙茯苓
六钱、川桂枝一钱、炒冬术钱半、清炙草五分、姜半夏四钱、炒广皮二钱、川朴、草果
、柴胡、黄芩各一钱、小青皮八分、生姜二片、大红枣二枚、煎成、热退时服、忌酸
冷油腻）送下除疟胜金丸（酒炒透常山四两、草果、槟榔、制苍术各二两、共为细末
、水法小丸。外用半贝丸料为衣。每服二十丸、至三十丸）温利积水。消化顽痰。重则
补中益气汤加减。（别直参，炙
绵、炒冬术各钱半、清炙草八分、姜半夏三钱、炒广皮一钱、川柴胡六分、醋炒青
皮七分、生姜一钱、红枣二枚）。送下 疟除根丸（炼人言八毫、真绿豆细粉一钱、巴
霜九厘二毫、辰砂三分、须研极匀、至无声为度、用白蜜作二十丸、生甘草末为衣、
每服一粒）温补中气。吐下顽痰。有块者。脾脏败血与陈 也。先与十将平 汤。（酒
炒常山钱半、槟榔三钱、草果仁、春砂仁各八分、醋炒三棱、莪术、青皮、姜半夏、
炒广皮各一钱、乌梅肉三分。）送下鳖甲煎丸（炙鳖甲、牙硝各十二分、柴胡炒蜣
螂各六分、干姜、大黄、桂枝、石韦、川朴、紫葳、赤芍、丹皮、 虫、阿胶、姜半
夏各五分、炙蜂房四分、射干、黄芩、炒鼠妇各三分、桃仁、瞿麦各二分、葶苈、人
参各一分、以上二十三味为末、取 灶下灰一斗、清酒一斗五升浸灰、俟酒尽一半
入鳖甲于中、煮令如胶、绞取汁、纳诸药、煎为丸、如桐子大、空心服七丸、日三服
。）开豁痰结。攻利营血。以消疟母。疟母消。 自除。至若风寒变疟。多发于深秋初
冬。暑湿化疟。多发于夏末秋初。而痰食化疟。阴虚化疟。劳役化疟。及妇人郁疟。小儿
胎疟。四时皆有。惟疫疟不常有。爰将因证脉治。二条述如下。
【荣斋按】疟疾若无他种特殊症状的，则两三发后，可设法使它不再发，叫做“截
疟”。截疟必于两三发后者，因发过两三次后，病患之抗毒力已生出不少，得截疟的药
剂相助，可以遏止了。截早则抗毒力未足，不能得效的。截疟方剂，据陆渊雷先生经验
∶《外台》疗疟丸最效──知母、常山、甘草；此方本是丸方，作煎剂也好，须于疟发
前后四小时间各服一次，即不复发。
一 风寒疟（俗称伤寒变疟。一名正疟）
【因】浅者、先受风寒。继而变疟。随感随发。深者、夏伤于暑。久伏阴分。至深
秋重感冷风。新邪引动伏邪而
发疟。
【证】疟因风寒转变者。初起恶寒无汗。头疼身痛。继即邪传少阳。寒已而热。热
已而汗。寒长热短。确有定候。胸胁痞满。呕吐黄涎。舌苔白多黄少。或两边白滑。中
心灰腻。若伏暑重感冷风而发者。初起寒多热少。肢冷胁痛。渴喜热饮。饮即吐涎。继
则寒热并重。或寒轻热重。舌苔白滑。略兼黄色。或灰腻色。
【脉】右浮滑。左弦紧者。内经所谓先伤于寒。后伤于风。病以时作。名曰寒疟是
也。若右浮缓而滑。左沉弦而迟。《金匮》所谓寒多者名曰牡疟。外台改为牝疟是也。
【治】寒疟宜先与苏羌达表汤。发汗散寒。继与柴胡枳桔汤。轻剂以和解之。服一
二剂后。疟发寒热并重者。则以柴芩双解汤。重剂以和解之。俟病势转轻。则用小柴胡
汤。方中东参用常山（二钱）拌炒以截之。牝疟宜先与柴胡桂姜汤。和解温透。服后。
表寒去而伏暑外溃。热重寒轻者。则以新加木贼煎清泄之。或用蒿芩清胆汤凉解之。
【荣斋按】何廉臣先生在全国名医验案类编中曾说∶“疟疾因于风寒者多，初起无
汗，当用发散，如羌防苏葛之类；若在深秋初冬，寒重无汗，口不渴，脉弦缓者，当用
麻桂各半汤。又有一种寒疟发厥者，多由内伏寒饮，醒后多吐稀痰，是其明证；此为高
年所最忌，治宜镇逆温化。”特录于此，以资互阐。
二 暑湿疟（俗称暑湿化疟一名时疟。）
【因】内经谓夏伤于暑。秋必 疟。但暑必挟湿。当辨其暑重于湿者为暑疟。湿重
于暑者为湿疟。
【证】暑疟初起。寒轻热重。口渴引饮。心烦自汗。面垢齿燥。便闭溺热。或泻不
爽。舌苔黄而糙涩。甚或深黄
而腻。或起芒刺。或起裂纹。湿疟初起。寒热身重。四肢倦怠。肌肉烦疼。胸腹痞满。
胃钝善呕。便溏溺涩。舌苔白滑浓腻。甚则灰而滑腻。或灰而糙腻。舌边滑润。
【脉】右弦洪搏数。左弦数者。疟因于暑。金匮所谓弦数者多热是也。若右弦滞。
左沉弦细软者。疟因于湿。《金匮》所谓沉细者湿痹是也。
【治】暑疟。先与蒿芩清胆汤清其暑。暑热化燥者。则用柴胡白虎汤清其燥。
若兼肢节烦疼者。去柴芩加桂枝（五分）以达肢。兼胸痞身重者。去柴芩花粉。加苍术（
一钱）以化湿。肺中气液两亏者。去柴芩。加西洋参（钱半至二钱）以益气生津。
湿疟先与柴平汤燥其湿。湿去而热多寒少。胸膈满痛者。则以柴胡陷胸汤宽其胸。胸
宽而热透口燥。溺短赤涩者。则以桂苓甘露饮（川桂枝二分拌飞滑石六钱、赤苓、猪苓
各二钱、泽泻钱半、生晒术五分、生石膏、寒水石各研细四钱）。辛通以清化之。
【荣斋按】桂枝白虎汤为治暑疟的正方，叶天士谓此方二进必愈，确是实际经验。
湿疟治法，何廉臣先生在全国名医验案卷四第十页指出∶“湿疟之为病，当辨湿重于热
者，藿香正气散加减；热重于湿者，苍术白虎汤加减。”
三 痰疟
【因】或肺胃素有痰饮。或膜原积湿酿痰。或夏令乘凉饮冷。坐卧湿地。湿郁化痰
。皆能变疟。
【证】痰踞肺胃者。初起咳嗽痰多。胸痞呕吐。头目晕眩。寒从背起。热已微汗。
舌苔白滑。甚则白滑浓腻。痰阻膜原者。初起胸膈痞满。心烦懊 。头眩口腻。咯痰不
爽。间日发疟。舌苔粗如积粉。扪之糙涩。
【脉】弦而滑。此《金匮》所谓疟脉自弦也。滑则为痰。故俗称无痰不成疟。
【治】必以消痰为主。在肺胃、先与越婢加半夏汤。开肺和胃。继与柴胡枳桔汤加
炒川贝（三钱）炒常山（二钱）、劫而截之。在膜原、先与柴胡达原饮。和解三焦。继
与大柴胡汤。加槟榔（三钱）和解兼下。痰除则疟自止。惟肥人痰多者。寒战时。间有
痰迷清窍。昏厥不语者。最险。急与淡姜汤调下《局方》妙香丸。开窍导痰以救之。救
之稍缓。老年及小儿。每多痰壅气闭而死。
四 食疟
【因】饮食不节。饥饱不常。胃气受伤而成。恣食瓜果油腻者独多。
【证】胸满腹痛。嗳腐吞酸。噫气恶食。食即呕逆。寒热交作。舌苔白腻而浓。或
黄浓而腻。
【脉】右紧盛。或滑而有力。此《内经》所谓饮食自倍。肠胃乃伤。俗称无食不成疟是
也。
【治】当分缓急轻重。势缓而轻者。只须柴平汤加莱菔子（二钱）拌炒春砂仁（八
分）、小青皮（一钱）、和解兼消。不应。则求其属以消之。属于瓜果。加公丁香（七
支）、白蔻末（七分）、属于油腻。加芒硝（三分）、拌炒枳实（二钱）。炒山楂（四钱
）。若羊肉积。非毛栗壳灰不能消。牛肉积非稻草灰汁不能化。食消则疟自除。若挟湿
者。食虽消化。疟仍不止。则用大橘皮汤温化之。湿已化热者。则用增减黄连泻心汤清
泄之。热急而重。脘腹刺痛胀闷者。必先用备急丸（生川军末干姜末各一钱、巴豆霜
一分、共研极匀、蜜丸、如绿豆大、每服三丸、不知、更服三丸、腹鸣吐下、便愈）。
或吐或泻以逐之。继与小柴胡汤。益气以和解之。
五 阴虚疟（统称虚疟）
【因】或素体阴虚而病疟。或久疟不愈而阴虚。然有胃阴虚。脾阴虚。肝阴虚。肾
阴虚之别。当审其因而治之。
【证】胃阴虚者。申酉时寒热交作。寒轻热重。甚则但热不寒。少气烦郁。手
足热甚。气逆欲呕。肌肉消烁。口渴自汗。舌苔黄燥起刺。中有直裂。脾阴虚者。间日发
疟。寒热自汗。发于未时者。至丑时而热退。发于丑时者。至未时而热退。面白神馁。
声微气怯。心悸肢软。肌肉消瘦。口干不思饮。饮则呕水。腹痛肠鸣。舌质粗涩。苔灰
而干。或舌心虽灰。无甚苔垢。肝阴虚者。疟发间日。日暮时寒轻热重。发于申酉
时者。每至寅卯时微汗而热退。身体枯瘦。头目晕眩。肢节酸痛。筋脉拘挛。腰痛溺涩。
少腹胀满。舌紫而赤。甚或红如胭脂。肾阴虚者。间日发疟。先热后寒。寒短热长
。发于子时者。每至午时而热方退净。腰脊酸痛。心烦口燥。两颧微红。足后跟痛。甚
或梦泄遗精。两腿痿软。舌绛胖嫩。或舌黑燥而无刺。
【脉】右弦大而数者。《内经》所谓阴气先伤。阳气独发。名曰瘅疟是也。右弦软细弱
者。内经所谓病至善呕。呕已乃衰。足太阴之疟也。左关尺弦小搏数者。《内经》所谓腹中
悒悒。小便如癃。足厥阴之疟也。左关尺沉细虚数者。《内经》所谓病藏于肾。因遇大暑。
或有所用力。邪气与汗皆出。名曰温疟是也。
【治】胃阴虚疟。先与人参白虎汤。加鲜石斛（四钱）、蔗浆梨汁（各一瓢冲
）甘寒法以退其热。继与麦门冬汤加减。（原麦冬三钱、西洋参二钱、生甘草八分、
鲜官枣四枚、北秫米五钱、仙半夏一钱、建兰叶三钱、鲜
稻穗露一两冲）甘润法以救胃阴。脾阴虚疟。先与加味何人饮。（生首乌四钱、潞
党参三钱、生黄 二钱、归身钱半、新会皮、苏佩兰各一钱、煨生姜五分、大南枣二枚。
）敛补法以截其疟。继与补阴益气煎。滋补法以复其阴。肝阴虚疟。先与加减追疟饮
。（生首乌四钱、当归二钱、生白芍三钱、清炙草五分、青蒿脑钱半、生鳖甲五钱、
银胡钱半、地骨皮六钱、醋炒青皮八分、井水河水合煎）。清敛法以截其疟。继与四物
绛覆汤。加陈阿胶（二钱）、炙鳖甲（五钱）、清滋法以濡血络。肾阴虚疟。先与
阿胶黄连汤。加制首乌（四钱）炙鳖甲（五钱）。清敛法以截其疟。继与坎气潜龙汤。
滋潜法以复真阴。
【荣斋按】虚人久疟，或疟久虚弱者，可用《必读》截疟饮──黄 、人参、白术
、茯苓、砂仁、草果、橘红、五味子、乌梅、甘草。若前症多寒象者，宜补中益气汤加
姜附。至于首乌治虚疟，《本草纲目》不提及，而张景岳有“何人饮”，用首乌、人参
。恽铁樵先生治虚疟，常用小柴胡汤加鲜首乌，颇有疗效。
六 劳疟
【因】中气素虚。遇劳即发。或一二月而愈。或半年一年不愈。或由禁截太早。或
由口腹不慎。
【证】寒热往来。病以时作。轻则昼发。发时短而渐早。深则夜发。发时长而渐晏
。或间一日而发。或间二日而发。肢冷自汗。神倦嗜卧。寒重热轻。食少便溏。舌苔白
而嫩滑。或淡灰薄润。
【脉】右细软而弱。或虚大无力。多由劳役过度。饮食失节。内伤脾阳而发疟也。
【治】法当补气升阳以和解之。先与补中益气汤加减。继则健脾和胃以敛补之。
四兽饮为主（别直参、炒于术、浙茯苓、姜半夏各钱半、广皮一钱、炙草六分、草果
如果症状不齐全，就应当仔细审查。况且疫痧大多属于阳毒，少属于阴毒。如果忘记了这是毒邪致病，一见四肢冰冷、脉搏伏匿，就急忙使用附子、干姜、丁香、肉桂等温热药剂，恐怕会因草率而误人。因为这类急症，往往脉象难以作为凭据，必须仔细查考病源，详细审视舌苔，按压胸腹部，询问大小便情况，综合参考并默默观察，那么阴阳虚实真假的真谛，才可以探求得到。至于溪毒、砂虱、水弩、射工、短狐、蝈虾之类，都能含沙射人，被它们毒害的人，憎恶寒冷且高热，全身骨骼关节疼痛，胸膈痞闷腹痛，症状类似伤寒兼痧。常用酒煨大黄滴入松节油中拌匀捣烂至极软，用软布包裹，遍擦全身，其毒自然解除。再用地浆水调服太乙紫金丹，以整顿肃清痧毒，病根自除。或者用角筒按在皮肉极痛处，用口吸出其中的痧毒，外用煨蒜捣成膏状，封贴疮口而痊愈。或者用乌白毛灰，用松节油调匀，搽擦全身，也可以拔毒外出而痊愈。这是在普通痧疾和疫痧之外，另一种虫毒之病，必须按照这种方法杀虫解毒，才能收到疗效。
（一名寒疟，俗称脾寒病）
【病因】外因多为风寒暑湿，内因多夹杂饮食停滞和痰饮。这种病有每日发作或隔日发作的不同，证候有经病、腑病、脏病的差异。而且必定是寒热往来，且有固定的发作时间，这才称为疟疾。这与忽冷忽热、一天发作两三次、寒热没有固定时间的情况截然不同。这种病的新久轻重不一，全凭临证医生仔细审查病源，辨明病状的寒热虚实，以及病位在经络还是脏腑，应当采用温、凉、补、泻的方法治疗。先叙述牝疟。
【证候】牝疟因风寒而发作。初起时恶寒无汗，头身俱痛。随即出现寒热往来，发作有定期。病情深的隔日发作一次，极深的三日发作一次。发冷时身体寒冷战栗，牙齿格格作响，面部、头部、手足皆冷，甚至口唇指甲都发青。发冷的时间过后，即发大热，皮肤壮热色赤，头痛剧烈，呼吸粗重，口渴想喝冷饮，精神疲倦嗜睡，或者心烦懊恼。发作时间短则两三个时辰，长则四五个时辰，周身大汗淋漓，各种症状好像消失了一样。根据此反复发作，累月经年，缠绵难愈。舌苔白滑而腻，甚或灰腻满布。
【脉象】沉弦而迟。沉表示病在脏，弦迟者多属寒。这就是《内经》所说的邪气内迫五脏，横连膜原，病程远，病气深，所以休息几天才发作。也就是后世医家所说的三阴疟，俗称脾寒病，四天发作两次的那种。
【治法】必须先辨别胁下是否有痞块。没有痞块的，是脾脏积水与顽痰所致。轻的先用清脾饮（浙茯苓六钱、川桂枝一钱、炒冬术钱半、清炙草五分、姜半夏四钱、炒广皮二钱、川朴、草果、柴胡、黄芩各一钱、小青皮八分、生姜二片、大红枣二枚，煎成，热退时服用，忌酸冷油腻）送服除疟胜金丸（酒炒透常山四两、草果、槟榔、制苍术各二两，共为细末，用水泛为小丸，外用半贝丸料为衣，每服二十至三十丸），以温利积水，消化顽痰。重的用补中益气汤加减（别直参、炙绵芪、炒冬术各钱半、清炙草八分、姜半夏三钱、炒广皮一钱、川柴胡六分、醋炒青皮七分、生姜一钱、红枣二枚），送服疟除根丸（炼人言八毫、真绿豆细粉一钱、巴霜九厘二毫、辰砂三分，须研极匀，直到无声为止，用白蜜做成二十丸，生甘草末为衣，每服一粒），以温补中气，吐下顽痰。有痞块的，是脾脏败血与陈积瘀血所致。先用十将平胃汤（酒炒常山钱半、槟榔三钱、草果仁、春砂仁各八分、醋炒三棱、莪术、青皮、姜半夏、炒广皮各一钱、乌梅肉三分），送服鳖甲煎丸（炙鳖甲、牙硝各十二分、柴胡炒蜣螂各六分、干姜、大黄、桂枝、石韦、川朴、紫葳、赤芍、丹皮、䗪虫、阿胶、姜半夏各五分、炙蜂房四分、射干、黄芩、炒鼠妇各三分、桃仁、瞿麦各二分、葶苈、人参各一分，以上二十三味为末，取灶下灰一斗、清酒一斗五升浸灰，待酒去一半，放入鳖甲于其中，煮成胶状，绞取汁液，纳入诸药，煎为丸，如梧桐子大，空心服七丸，每日三次），以开豁痰结，攻利营血，以消除疟母。疟母消除，病自除。至于风寒变成的疟疾，多发于深秋初冬；暑湿化成的疟疾，多发于夏末秋初；而痰食化疟、阴虚化疟、劳役化疟，以及妇人郁疟、小儿胎疟，四季都有。只有疫疟不常有。现将因、证、脉、治四条叙述如下。
【荣斋按】疟疾如果没有其他特殊症状的，在两三次发作后，可以设法使其不再发作，叫做“截疟”。截疟必须在两三次发作之后进行，因为发作两三次后，患者的抗毒力已经产生不少，得到截疟药剂的帮助，可以遏制住。截得太早则抗毒力不足，不能见效。截疟方剂，据陆渊雷先生经验：《外台秘要》疗疟丸最效——知母、常山、甘草；此方本是丸方，作煎剂也可以，须在疟疾发作前后四小时内各服一次，即可不复发。
一 风寒疟（俗称伤寒变疟，一名正疟）
【病因】浅层的，先受风寒，继而变成疟疾，随感随发。深层的，夏天伤于暑气，久伏于阴分，到深秋再次感受冷风，新邪引动伏邪而发疟。
【证候】疟疾由风寒转变而来的，初起恶寒无汗，头疼身痛。随即邪传少阳，寒罢而热，热罢而汗出，寒长热短，确有固定时间。胸胁痞满，呕吐黄涎，舌苔白多黄少，或两边白滑，中心灰腻。如果是伏暑再次感受冷风而发的，初起寒多热少，肢冷胁痛，口渴喜欢热饮，喝了就吐涎。随后寒热并重，或寒轻热重，舌苔白滑，略兼黄色，或灰腻色。
【脉象】右脉浮滑，左脉弦紧的，《内经》所说先伤于寒，后伤于风，病按时发作，名叫寒疟。如果右脉浮缓而滑，左脉沉弦而迟，《金匮要略》所说寒多者名叫牡疟，《外台秘要》改为牝疟。
【治法】寒疟宜先用苏羌达表汤，发汗散寒。继用柴胡枳桔汤，轻剂以和解。服一二剂后，若疟发寒热并重，则以柴芩双解汤，重剂以和解。等到病势转轻，则用小柴胡汤，方中的党参改用常山（二钱）拌炒以截疟。牝疟宜先用柴胡桂姜汤，和解温透。服后，表寒去而伏暑外溃。热重寒轻的，则以新加木贼煎清泄。或用蒿芩清胆汤凉解。
【荣斋按】何廉臣先生在全国名医验案类编中曾说：“疟疾因于风寒的多，初起无汗，当用发散，如羌防苏葛之类；若在深秋初冬，寒重无汗，口不渴，脉弦缓者，当用麻桂各半汤。又有一种寒疟发厥的，多由内伏寒饮，醒后多吐稀痰，是其明证；此为高龄者所最忌，治宜镇逆温化。”特录于此，以资互相阐发。
二 暑湿疟（俗称暑湿化疟，一名时疟。）
【病因】《内经》说夏天伤于暑，秋天必患疟疾。但暑必挟湿，应当辨别暑重于湿的为暑疟，湿重于暑的为湿疟。
【证候】暑疟初起，寒轻热重，口渴引饮，心烦自汗，面垢齿燥，大便闭结小便热，或者泻而不爽。舌苔黄而糙涩，甚或深黄而腻，或起芒刺，或起裂纹。湿疟初起，寒热身重，四肢倦怠，肌肉烦疼，胸腹痞满，胃钝善呕，便溏溺涩。舌苔白滑浓腻，甚则灰而滑腻，或灰而糙腻，舌边滑润。
【脉象】右脉弦洪搏数，左脉弦数的，疟因于暑，《金匮要略》所谓弦数者多热。如果右脉弦滞，左脉沉弦细软的，疟因于湿，《金匮要略》所谓沉细者湿痹。
【治法】暑疟，先用蒿芩清胆汤清其暑。暑热化燥的，则用柴胡白虎汤清其燥。若兼肢节烦疼的，去柴芩加桂枝（五分）以通达肢节。兼胸痞身重的，去柴芩花粉，加苍术（一钱）以化湿。肺中气液两亏的，去柴芩，加西洋参（钱半至二钱）以益气生津。
湿疟先用柴平汤燥其湿。湿去而热多寒少，胸膈满痛的，则以柴胡陷胸汤宽其胸。胸宽而热透口燥，尿短赤涩的，则以桂苓甘露饮（川桂枝二分拌飞滑石六钱、赤苓、猪苓各二钱、泽泻钱半、生晒术五分、生石膏、寒水石各研细四钱），辛通以清化之。
【荣斋按】桂枝白虎汤为治暑疟的正方，叶天士说此方服两次必愈，确实是实际经验。湿疟治法，何廉臣先生在全国名医验案卷四第十页指出：“湿疟之为病，当辨湿重于热的，藿香正气散加减；热重于湿的，苍术白虎汤加减。”
三 痰疟
【病因】或者肺胃素有痰饮，或者膜原积湿酿痰，或者夏令乘凉饮冷，坐卧湿地，湿郁化痰，皆能变成疟疾。
【证候】痰踞肺胃的，初起咳嗽痰多，胸痞呕吐，头目晕眩，寒从背起，热已微汗，舌苔白滑，甚则白滑浓腻。痰阻膜原的，初起胸膈痞满，心烦懊恼，头眩口腻，咯痰不爽，间日发疟，舌苔粗如积粉，扪之糙涩。
【脉象】弦而滑，这是《金匮要略》所谓疟脉自弦。滑则为痰，所以俗称无痰不成疟。
【治法】必须以消痰为主。在肺胃的，先用越婢加半夏汤，开肺和胃。继用柴胡枳桔汤加炒川贝（三钱）、炒常山（二钱），劫而截之。在膜原的，先用柴胡达原饮，和解三焦。继用大柴胡汤，加槟榔（三钱），和解兼下。痰除则疟自止。只是肥胖人多痰的，寒战时，间有痰迷清窍，昏厥不语的，最危险。急用淡姜汤调服《局方》妙香丸，开窍导痰以救之。救得稍慢，老年及小儿，多因痰壅气闭而死。
四 食疟
【病因】饮食不节，饥饱不常，胃气受伤而成。恣食瓜果油腻者独多。
【证候】胸满腹痛，嗳腐吞酸，噫气恶食，食即呕逆，寒热交作。舌苔白腻而浓，或黄浓而腻。
【脉象】右脉紧盛，或滑而有力，这是《内经》所谓饮食自倍，肠胃乃伤，俗称无食不成疟。
【治法】应当分缓急轻重。势缓而轻的，只须柴平汤加莱菔子（二钱）拌炒春砂仁（八分）、小青皮（一钱），和解兼消。无效，则求其所属以消之。属于瓜果积滞的，加公丁香（七支）、白蔻末（七分）；属于油腻积滞的，加芒硝（三分）、拌炒枳实（二钱）、炒山楂（四钱）。若是羊肉积，非毛栗壳灰不能消；牛肉积非稻草灰汁不能化。食消则疟自除。若挟湿的，食虽消化，疟仍不止，则用大橘皮汤温化之。湿已化热的，则用增减黄连泻心汤清泄之。热急而重，脘腹刺痛胀闷的，必先用备急丸（生川军末干姜末各一钱、巴豆霜一分，共研极匀，蜜丸，如绿豆大，每服三丸，不效，更服三丸，腹鸣吐下，便愈），或吐或泻以逐之。继用小柴胡汤，益气以和解之。
五 阴虚疟（统称虚疟）
【病因】或者素体阴虚而病疟，或者久疟不愈而阴虚。然有胃阴虚、脾阴虚、肝阴虚、肾阴虚的区别，应当审其因而治之。
【证候】胃阴虚的，申酉时寒热交作，寒轻热重，甚则但热不寒，少气烦郁，手足热甚，气逆欲呕，肌肉消烁，口渴自汗，舌苔黄燥起刺，中有直裂。脾阴虚的，间日发疟，寒热自汗，发于未时的，至丑时而热退；发于丑时的，至未时而热退。面白神馁，声微气怯，心悸肢软，肌肉消瘦，口干不思饮，饮则呕水，腹痛肠鸣，舌质粗涩，苔灰而干，或舌心虽灰，无甚苔垢。肝阴虚的，疟发间日，日暮时寒轻热重，发于申酉时的，每至寅卯时微汗而热退。身体枯瘦，头目晕眩，肢节酸痛，筋脉拘挛，腰痛溺涩，少腹胀满，舌紫而赤，甚或红如胭脂。肾阴虚的，间日发疟，先热后寒，寒短热长，发于子时的，每至午时而热方退净。腰脊酸痛，心烦口燥，两颧微红，足后跟痛，甚或梦泄遗精，两腿痿软，舌绛胖嫩，或舌黑燥而无刺。
【脉象】右脉弦大而数的，《内经》所谓阴气先伤，阳气独发，名叫瘅疟。右脉弦软细弱的，《内经》所谓病至善呕，呕已乃衰，足太阴之疟。左关尺弦小搏数的，《内经》所谓腹中悒悒，小便如癃，足厥阴之疟。左关尺沉细虚数的，《内经》所谓病藏于肾，因遇大暑，或有所用力，邪气与汗皆出，名叫温疟。
【治法】胃阴虚疟，先与人参白虎汤，加鲜石斛（四钱）、蔗浆梨汁（各一瓢冲），甘寒法以退其热。继用麦门冬汤加减（原麦冬三钱、西洋参二钱、生甘草八分、鲜官枣四枚、北秫米五钱、仙半夏一钱、建兰叶三钱、鲜稻穗露一两冲），甘润法以救胃阴。
脾阴虚疟，先与加味何人饮（生首乌四钱、潞党参三钱、生黄芪二钱、归身钱半、新会皮、苏佩兰各一钱、煨生姜五分、大南枣二枚），敛补法以截其疟。继用补阴益气煎，滋补法以复其阴。
肝阴虚疟，先与加减追疟饮（生首乌四钱、当归二钱、生白芍三钱、清炙草五分、青蒿脑钱半、生鳖甲五钱、银胡钱半、地骨皮六钱、醋炒青皮八分、井水河水合煎），清敛法以截其疟。继用四物绛覆汤，加陈阿胶（二钱）、炙鳖甲（五钱），清滋法以濡血络。
肾阴虚疟，先与阿胶黄连汤，加制首乌（四钱）、炙鳖甲（五钱），清敛法以截其疟。继用坎气潜龙汤，滋潜法以复真阴。
【荣斋按】虚人久疟，或疟久虚弱者，可用《必读》截疟饮——黄芪、人参、白术、茯苓、砂仁、草果、橘红、五味子、乌梅、甘草。若前症多寒象的，宜补中益气汤加姜附。至于首乌治虚疟，《本草纲目》不提及，而张景岳有“何人饮”，用首乌、人参。恽铁樵先生治虚疟，常用小柴胡汤加鲜首乌，颇有疗效。
六 劳疟
【病因】中气素虚，遇劳即发。或一二月而愈，或半年一年不愈。或由禁截太早，或由口腹不慎。
【证候】寒热往来，病以时作。轻则昼发，发时短而渐早；深则夜发，发时长而渐晏。或间一日而发，或间二日而发。肢冷自汗，神倦嗜卧，寒重热轻，食少便溏，舌苔白而嫩滑，或淡灰薄润。
【脉象】右脉细软而弱，或虚大无力，多由劳役过度，饮食失节，内伤脾阳而发疟也。
【治法】法当补气升阳以和解之。先用补中益气汤加减。继则健脾和胃以敛补之。以四兽饮为主（别直参、炒于术、浙茯苓、姜半夏各钱半、广皮一钱、炙草六分、草果
If the symptoms are not complete, careful examination must be conducted. Moreover, epidemic sha (epidemic toxic heat rash) mostly belongs to yang toxicity (yang pathogenic factor manifesting as heat and toxicity), and rarely to yin toxicity (yin pathogenic factor manifesting as cold and deficiency). If one forgets that this is a disease caused by toxin, and upon seeing cold limbs and hidden pulse (pulse felt only with heavy pressure), hastily administers decoctions containing Fuzi (Prepared Aconite Root), Ganjiang (Dried Ginger), Dingxiang (Clove), and Rougui (Cinnamon Bark), it may lead to errors due to carelessness. Because in such acute conditions, the pulse is often unreliable. One must carefully investigate the source of the disease, examine the tongue coating in detail, palpate the chest and abdomen, inquire about urination and defecation, and synthesize observations through silent contemplation. Only then can the true nature of the apparent and real aspects of yin and yang, excess and deficiency be grasped. As for toxins from streams, sand lice, water弩 (water bugs), shegong (water spiders), duanhu (short foxes), and guoxia (crayfish-like insects), they can all "shoot sand" at people. Those poisoned by them experience aversion to cold with high fever, severe body aches, chest oppression, and abdominal pain, resembling shanghan (cold damage) combined with sha. Commonly, Dahuang (Rhubarb Root and Rhizome) stir-fried with wine is dripped into pine resin oil, mixed and pounded until extremely soft, wrapped in soft cloth, and rubbed all over the body; the toxin will naturally dissipate. Then, Taiyi Zijin Dan (Great Unity Purple Gold Pill) is taken down with dilute earth water (Di Jiang Shui) to rectify and clear the sha toxin, and the root of the disease is removed. Alternatively, a horn tube is pressed onto the extremely painful skin and flesh areas, and the sha toxin is sucked out by mouth. Externally, garlic stir-fried until cooked is pounded into a paste and applied to seal the wound for healing. Or, ash from white feathers of Wu birds is mixed with pine resin oil and rubbed all over the body, which can also draw out the toxin and lead to recovery. This is a type of insect-toxin disease distinct from ordinary sha and epidemic sha. It is necessary to follow this method of killing insects and detoxifying to achieve efficacy.
(Also known as Han Nue, commonly called Spleen Cold Disease)
[Etiology] External causes are mostly wind-cold, summer-heat, and dampness; internal causes often involve food stagnation and phlegm-dampness. The disease varies in having daily or every-other-day attacks. The syndromes differ between meridian diseases, fu-organ diseases, and zang-organ diseases. Furthermore, there must be alternating chills and fever with a definite schedule to be classified as Nue (Malaria). This is distinctly different from cases where chills and fever occur irregularly, two or three times a day, without a fixed pattern. The duration and severity of the disease vary, relying entirely on the clinician to carefully examine the etiology, differentiate the cold/heat and excess/deficiency of the syndrome, and determine whether the pathology lies in the meridians or organs, thereby applying warming, cooling, tonifying, or purging methods. First, we discuss Pin Nue.
[Syndrome] Pin Nue arises from wind-cold. Initially, there is aversion to cold, absence of sweating, headache, and body pain. Subsequently, alternating chills and fever occur with a regular schedule. In deeper cases, it occurs every other day; in extreme cases, every three days. During the cold phase, the body is cold and trembling, teeth chatter, face, head, hands, and feet are cold, and even lips and fingernails turn cyanotic. After the cold phase passes, high fever ensues: skin is hot and red, headache is severe, breathing is coarse, thirst with desire for cold drinks, mental fatigue, drowsiness, or irritability and restlessness. The episode lasts two to four hours, or up to five to six hours. Profuse sweating follows all over the body, and symptoms seem to vanish. This repeats cyclically, persisting for months or years, difficult to cure. Tongue coating is white, slippery, and greasy, or even gray and fully coated.
[Pulse] Deep, wiry, and slow. Deep indicates the disease is in the zang organs. Wiry and slow indicate cold. This corresponds to the *Neijing* saying that pathogens invade the five zang internally and spread horizontally to the membrane source (Mo Yuan). The pathway is distant, and the qi is deep, hence the pause of several days before an attack. This is also what later scholars call San Yin Nue (Three Yin Malaria), commonly known as Spleen Cold Disease, occurring twice every four days.
[Treatment] First, distinguish whether there is a mass under the hypochondrium. If no mass, it is fluid retention in the spleen and stubborn phlegm. For mild cases, use Qing Pi Yin (Zhe Fuling [Poria], Chuan Guizhi [Cinnamon Twig], Chao Dongzhu [Atractylodes Macrocephala Rhizome], Qing Zhigancao [Licorice Root], Jiang Banxia [Pinellia Tuber], Chao Guangpi [Tangerine Peel], Chuan Houpo [Magnolia Bark], Caoguo [Black Cardamom Seed], Chaihu [Bupleurum Root], Huangqin [Scutellaria Root] each 1 qian, Xiao Qingpi [Green Tangerine Peel] 8 fen, Shengjiang [Fresh Ginger] 2 slices, Da Hongzao [Jujube] 2 pieces, decocted; take when fever subsides; avoid sour, cold, and greasy foods) to deliver Chu Nue Sheng Jin Wan (Changshan [Dichroa Root] stir-fried in wine 4 liang, Caoguo, Binglang [Areca Seed], Zhi Cangzhu [Atractylodes Rhizome] each 2 liang, ground into fine powder, formed into small pills with water, coated with Banbei Wan material; take 20-30 pills per dose) to warm and drain fluid retention and dissolve stubborn phlegm. For severe cases, use Bu Zhong Yi Qi Tang (modified) (Biezhishen [Codonopsis/Ginseng], Zhi Mian [Astragalus Root], Chao Dongzhu each 1.5 qian, Qing Zhigancao 8 fen, Jiang Banxia 3 qian, Chao Guangpi 1 qian, Chuan Chaihu 6 fen, Cu Chao Qingpi 7 fen, Shengjiang 1 qian, Hongzao 2 pieces) to deliver Nue Chugen Wan (Lian Renyan [Arsenic Trioxide] 8 hao, Zhen Lvdou Xifen [Mung Bean Powder] 1 qian, Bashuang [Croton Seed Frost] 9.2 hao, Chencha [Cinnabar] 3 fen, ground extremely uniformly until silent, formed into 20 pills with white honey, coated with raw Gancao powder; take 1 pill per dose) to warm and tonify middle qi and purge stubborn phlegm via vomiting and purging. If there is a mass, it is stale blood in the spleen and old blood stasis. First administer Shijiang Ping Wei Tang (Changshan stir-fried in wine 1.5 qian, Binglang 3 qian, Caoguoren [Black Cardamom Seed], Chun Sharen [Amomum Fruit] each 8 fen, Cu Chao Sanleng [Sparganium Rhizome], E Zhu [Curcuma Rhizome], Qingpi [Tangerine Peel], Jiang Banxia, Chao Guangpi each 1 qian, Wumei Rou [Mume Fruit Flesh] 3 fen) to deliver Biejia Jian Wan (Zhi Biejia [Turtle Shell], Yaxiao [Mirabilite] each 12 fen, Chaihu stir-fried with Changlang [Beetle] each 6 fen, Ganjiang [Dried Ginger], Dahuang [Rhubarb], Guizhi [Cinnamon Twig], Shiwei [Pyrosia Frond], Chuan Houpo, Ziwei [Bignonia Stem], Chishao [Red Peony Root], Danpi [Moutan Cortex], Jichong [Ground Beetle], Ejiao [Donkey-hide Gelatin], Jiang Banxia each 5 fen, Zhi Fengfang [Honeycomb] 4 fen, Shegan [Belamcanda Rhizome], Huangqin, Chao Shufu [Woodlouse] each 3 fen, Taoren [Peach Seed], Qumai [Persicaria Herba] each 2 fen, Tingli [Lepidium Seed], Renshen [Ginseng Root] each 1 fen. Grind the above 23 ingredients into powder. Take 1 dou of Zao Xia Hui (Ash from stove bottom) and 1.5 dou of Qingjiu [Clear Wine]. Soak the ash in wine. When half the wine has evaporated, add Biejia and boil until gelatinous. Strain the juice, add the medicinal powders, and decoct into pills the size of tung seeds. Take 7 pills on an empty stomach, three times a day.) To resolve phlegm nodules and attack blood stasis to eliminate Nuomu (Malaria Mass). Once Nuomu is eliminated, the disease is cured. Regarding malaria transformed from wind-cold, it mostly occurs in late autumn and early winter; malaria transformed from summer-heat and dampness mostly occurs in late summer and early autumn. Malaria transformed from phlegm-food, yin deficiency, labor injury, as well as women's Yu Nue and children's Tai Nue, occur in all seasons. Only Yi Nue (Epidemic Malaria) is uncommon. The following outlines the etiology, syndrome, pulse, and treatment.
[Rongzhai Note] If malaria presents without other special symptoms, after two or three attacks, measures can be taken to prevent further recurrence, termed "Jie Nue" (Intercepting Malaria). Intercepting must be done after two or three attacks because after these episodes, the patient's anti-toxic resistance has increased sufficiently. With the aid of intercepting agents, the disease can be halted. Intercepting too early results in insufficient resistance and ineffectiveness. According to Mr. Lu Yuanlei's experience, the most effective formula is Liao Nue Wan from *Waitai Mi Yao*: Zimu [Anemarrhena Rhizome], Changshan, Gancao [Licorice Root]. Although originally a pill formula, it can be used as a decoction. It should be taken once four hours before and once four hours after the malaria attack to prevent recurrence.
1 Wind-Cold Malaria (Commonly called Shanghan Bian Nue, also known as Zheng Nue)
[Etiology] Superficial cases: initially affected by wind-cold, which transforms into malaria, attacking immediately upon exposure. Deep cases: injured by summer-heat in summer, lying dormant in the yin level; triggered in late autumn by new cold wind acting on the latent pathogen.
[Syndrome] For malaria transforming from wind-cold: initially aversion to cold, no sweat, headache, and body pain. Subsequently, the pathogen transmits to Shaoyang. Chills cease then fever begins; fever ceases then sweating begins. Chills are longer than fever, with a definite schedule. Chest and hypochondriac fullness, vomiting of yellow saliva. Tongue coating is more white than yellow, or white and slippery on sides, gray and greasy in center. If triggered by latent summer-heat and new cold wind: initially more chills than fever, cold limbs, hypochondriac pain, thirst preferring hot drinks, vomiting saliva upon drinking. Subsequently, chills and fever are equal, or chills are light and fever heavy. Tongue coating is white and slippery, slightly yellow, or gray and greasy.
[Pulse] Right floating and slippery, left wiry and tight. This matches the *Neijing*: first injured by cold, then by wind, disease occurs at specific times, named Han Nue (Cold Malaria). If right floating and loose with slipperiness, left deep, wiry, and slow, this matches *Jingui Yaolue*: more chills named Mu Nue (Yang Malaria), changed to Pin Nue (Yin Malaria) in *Waitai*.
[Treatment] For Han Nue, first use Su Qiang Da Biao Tang to induce sweating and disperse cold. Then use Chaihu Zhiju Tang, a light formula to harmonize. After one or two doses, if chills and fever are both heavy, use Chai Qin Shuang Jie Tang, a heavy formula to harmonize. When the condition lightens, use Xiao Chaihu Tang, substitining Dangshen with Changshan (2 qian) stir-fried to intercept. For Pin Nue, first use Chaihu Guijin Tang to harmonize and warm/unblock. After taking it, exterior cold resolves and latent summer-heat dissipates outward. For heavy fever and light chills, use Xinjia Muzei Jian to clear and drain. Or use Haoqin Qingdan Tang to cool and resolve.
[Rongzhai Note] Mr. He Lianchen stated in *Quan Guo Ming Yi Yan An Lei Bian*: "Malaria caused by wind-cold is common; initially without sweat, dispersants like Qiangfang Sugge should be used. In late autumn/winter, with heavy cold, no sweat, no thirst, and wiry-loose pulse, Ma Gui Ge Ban Tang should be used. Another type is Han Nue with syncope, often due to latent cold-fluid inside, evidenced by vomiting thin phlegm upon waking; this is most contraindicated in the elderly, treating with calming rebellion and warming transformation." Recorded here for mutual elucidation.
2 Summer-Heat-Dampness Malaria (Commonly called Shushi Hua Nue, also known as Shi Nue)
[Etiology] *Neijing* states summer heat injury leads to autumn malaria. Summer-heat always carries dampness. Differentiate Shu Nue (Summer-Heat Malaria) when summer-heat exceeds dampness, and Shi Nue (Dampness Malaria) when dampness exceeds summer-heat.
[Syndrome] Shu Nue initially: light chills, heavy fever, thirst with desire to drink, irritability, spontaneous sweating, dirty face, dry teeth, constipation, hot urine, or incomplete diarrhea. Tongue coating is yellow, rough, and dry, or deep yellow and greasy, or with prickles/cracks. Shi Nue initially: chills with body heaviness, limb fatigue, muscle soreness, chest/abdominal fullness, gastric dullness with vomiting tendency, loose stools, difficult urination. Tongue coating is white, slippery, and thick/greasy, or gray/slippery-greasy, or gray/rough-greasy, with slippery edges.
[Pulse] Right wiry, surging, rapid, beating; left wiry and rapid. Malaria due to summer-heat, matching *Jingui*: wiry-rapid indicates heat. If right wiry and stagnant, left deep, wiry, fine, and soft, malaria due to dampness, matching *Jingui*: deep-fine indicates damp-bi.
[Treatment] For Shu Nue, first use Haoqin Qingdan Tang to clear summer-heat. If summer-heat transforms into dryness, use Chaihu Baizhu Tang to clear dryness. If accompanied by joint soreness, remove Chai/Qin, add Guizhi (5 fen) to reach limbs. If accompanied by chest oppression and body heaviness, remove Chai/Qin/Huafen, add Cangzhu (1 qian) to transform dampness. If lung qi and fluids are deficient, remove Chai/Qin, add Xiyangshen (1.5-2 qian) to tonify qi and generate fluids.
For Shi Nue, first use Chai Ping Tang to dry dampness. If dampness clears but heat remains dominant with chest/diaphragm fullness/pain, use Chaihu Xianxiong Tang to widen the chest. If chest widens, heat penetrates, mouth becomes dry, urine short/red/difficult, use Guiling Ganlu Yin (Guizhi 2 fen mixed with Fei Huashi 6 qian, Chifuling, Zhuling each 2 qian, Zexie 1.5 qian, Sheng Shai Zhu 5 fen, Sheng Shigao, Hanshuishi each finely ground 4 qian) to unblock and clear-transform.
[Rongzhai Note] Guizhi Baizhu Tang is the correct formula for Shu Nue; Ye Tianshi said two doses guarantee cure, based on practical experience. Regarding Shi Nue treatment, Mr. He Lianchen pointed out in *Quan Guo Ming Yi Yan An Juan Si*, page 10: "For Shi Nue, differentiate damp exceeding heat (Huoxiang Zhengqi San modified) vs. heat exceeding damp (Cangzhu Baizhu Tang modified)."
3 Phlegm Malaria
[Etiology] Pre-existing phlegm-fluid in lungs/stomach, or damp accumulating in Mo Yuan brewing phlegm, or cooling/drinking cold in summer, sitting/lying on wet ground causing damp-stagnation transforming into phlegm, can all transform into malaria.
[Syndrome] Phlegm lodging in lungs/stomach: initially cough with much phlegm, chest oppression/vomiting, dizziness, chills starting from back, slight sweating after fever, white slippery tongue coating, or thick/greasy white. Phlegm blocking Mo Yuan: initially chest/diaphragm fullness, irritability/restlessness, dizziness, greasy mouth, difficult expectoration, every-other-day malaria, tongue coating rough like accumulated powder, rough to touch.
[Pulse] Wiry and slippery. Matches *Jingui*: malaria pulse is naturally wiry. Slippery indicates phlegm, hence "no phlegm, no malaria."
[Treatment] Must focus on resolving phlegm. For lungs/stomach, first use Yebio Jia Banxia Tang to open lungs and harmonize stomach. Then use Chaihu Zhiju Tang plus Chao Chuanbei (3 qian), Chao Changshan (2 qian) to intercept. For Mo Yuan, first use Chaihu Dayin Tang to harmonize Sanjiao. Then use Da Chaihu Tang plus Binglang (3 qian) to harmonize and purge. Phlegm resolved, malaria stops. However, obese people with much phlegm may have phlegm confusing the clear orifices during chills, leading to coma and muteness, which is critical. Immediately use Danjiang Tang to administer Miaoxiang Wan from *Jufang* to open orifices and guide out phlegm. Delayed rescue often leads to death from phlegm obstruction and qi closure in elderly and children.
4 Food Malaria
[Etiology] Irregular diet, uneven hunger/fullness, damaging stomach qi. Mostly caused by excessive consumption of fruits, melons, and greasy foods.
[Syndrome] Chest fullness, abdominal pain, belching with rotting taste, acid regurgitation, hiccups, aversion to food, vomiting after eating, alternating chills/fever. Tongue coating is white, thick, and greasy, or yellow, thick, and greasy.
[Pulse] Right tight and vigorous, or slippery and forceful. Matches *Neijing*: doubling food intake damages intestines/stomach, hence "no food, no malaria."
[Treatment] Differentiate urgency and severity. For mild/slow cases, use Chai Ping Tang plus Laifuzi (2 qian) stir-fried with Chun Sharen (8 fen), Xiao Qingpi (1 qian) to harmonize and digest. If ineffective, treat according to cause. For fruit accumulation, add Gong Dingxiang (7 cloves), Baikou Mo (7 fen). For grease accumulation, add Mangxiao (3 fen), stir-fried Zhishi (2 qian), Chao Shanzha (4 qian). For mutton accumulation, only Maoli Ke Hui (ash of hazel shell) can dissolve it; for beef accumulation, only Daocao Hui Zhi (rice straw ash juice) can transform it. Food digested, malaria removes. If complicated by dampness, even if food digests, malaria persists; use Dajupi Tang to warm-transform. If damp transforms to heat, use Zengjian Huanglian Xiexin Tang to clear-drain. For urgent/severe heat with stabbing abdominal pain/distension, first use Beiji Wan (Sheng Chuanjun Mo, Ganjiang Mo each 1 qian, Bashuang 1 fen, ground uniformly, honey pills, bean-sized, take 3 pills, if no effect take 3 more, bowel sounds/vomit/diarrhea indicate cure) to purge via vomiting or diarrhea. Then use Xiao Chaihu Tang to tonify qi and harmonize.
5 Yin Deficiency Malaria (Collectively called Xu Nue)
[Etiology] Constitutionally yin-deficient contracting malaria, or prolonged malaria causing yin deficiency. Distinctions exist among Stomach, Spleen, Liver, and Kidney yin deficiency; treat according to cause.
[Syndrome] Stomach yin deficiency: alternating chills/fever at Shen/You hours (3-7 PM), light chills/heavy fever, or only fever/no chills, shortness of breath, irritability, hot hands/feet, rebellious qi with nausea, emaciation, thirst, spontaneous sweating. Tongue coating yellow, dry, prickle-covered, with vertical cracks. Spleen yin deficiency: every-other-day malaria, chills/fever with sweating. Attacks at Wei hour (1-3 PM) end at Chou hour (1-3 AM); attacks at Chou hour end at Wei hour. Pale face, weak spirit, faint voice, timidity, palpitations, weak limbs, emaciation, dry mouth without desire to drink, vomiting water upon drinking, abdominal pain/borborygmus. Tongue body rough/rough, coating gray/dry, or gray center with little coating. Liver yin deficiency: every-other-day malaria, light chills/heavy fever at dusk. Attacks at Shen/You hours end with slight sweating/fever reduction at Yin/Mao hours (3-7 AM). Emaciated, dizzy, joint soreness, tendon spasms, lower back pain, difficult urination, lower abdominal fullness. Tongue purple-red, or crimson like carmine. Kidney yin deficiency: every-other-day malaria, fever first then chills, short chills/long fever. Attacks at Zi hour (11 PM-1 AM) end with complete fever resolution at Wu hour (11 AM-1 PM). Lower back/spine soreness, irritability, dry mouth, malar flush, heel pain, nocturnal emission, weak legs. Tongue crimson/swollen/tender, or black/dry without prickles.
[Pulse] Right wiry-large-rapid: *Neijing* says yin qi injured first, yang qi alone erupts, named Dan Nue. Right wiry-soft-fine-weak: *Neijing* says disease brings vomiting, subsides after vomiting, Taiyin Malaria. Left Guan/Chi wiry-small-rapid-beating: *Neijing* says abdominal depression, urinary difficulty like strangury, Jueyin Malaria. Left Guan/Chi deep-fine-empty-rapid: *Neijing* says disease lodged in Kidney, encountering great heat or exertion, pathogen and sweat exit together, named Wen Malaria.
[Treatment] Stomach yin deficiency malaria: first Ren Shen Baihu Tang plus Xian Shihu (4 qian), Zhejiang/Lizhi (one ladle each mixed in), sweet-cold method to reduce fever. Then Maidong Tang modified (Maodong 3 qian, Xiyangshen 2 qian, Sheng Gancao 8 fen, Xian Guanzao 4 pieces, Beishumi 5 qian, Xian Banxia 1 qian, Jianlan Ye 3 qian, Xian Dao Sui Lu 1 liang mixed in), sweet-moist method to save stomach yin.
Spleen yin deficiency malaria: first Jiawei Heren Yin (Sheng Shouwu 4 qian, Lushen 3 qian, Sheng Huangqi 2 qian, Guishen 1.5 qian, Xinhui Pi, Supelan each 1 qian, Wei Shengjiang 5 fen, Da Nanzao 2 pieces), astringent-tonic method to intercept malaria. Then Buyin Yiqi Jian, tonic method to restore yin.
Liver yin deficiency malaria: first Jiiazhi Zhuimie Yin (Sheng Shouwu 4 qian, Danggui 2 qian, Sheng Baishao 3 qian, Qing Zhigancao 5 fen, Qinghao Nao 1.5 qian, Sheng Biejia 5 qian, Yinhú 1.5 qian, Digupi 6 qian, Cu Chao Qingpi 8 fen, well/river water decocted), clear-astringent method to intercept. Then Siwu Jiangfu Tang plus Chen Ejiao (2 qian), Zhi Biejia (5 qian), clear-nourishing method to moisten blood collaterals.
Kidney yin deficiency malaria: first Ejiao Huanglian Tang plus Zhi Shouwu (4 qian), Zhi Biejia (5 qian), clear-astringent method to intercept. Then Kanqi Qianlong Tang, nourish-submerge method to restore true yin.
[Rongzhai Note] For deficient persons with long-term malaria or weakness from malaria, use *Bidu* Zhu Mie Yin: Huangqi, Renshen, Baizhu, Fuling, Sharen, Caoguo, Juhong, Wuweizi, Wumei, Gancao. If many cold signs, use Bu Zhong Yi Qi Tang plus Jiang/Fu. Regarding Shouwu for deficiency malaria, *Bencao Gangmu* does not mention it, but Zhang Jingyue has "Heren Yin" using Shouwu/Renshen. Mr. Yun Tieqiao treats deficiency malaria with Xiao Chaihu Tang plus fresh Shouwu, showing good efficacy.
6 Labor Malaria
[Etiology] Middle qi inherently weak, triggered by labor. May heal in 1-2 months, or persist for half a year to a year. Due to premature interception or dietary indiscretion.
[Syndrome] Alternating chills/fever, occurring at specific times. Mild: daytime attacks, short duration, occurring earlier gradually. Severe: nighttime attacks, long duration, occurring later gradually. Or every other day, or every two days. Cold limbs, spontaneous sweating, mental fatigue, drowsiness, heavy chills/light fever, poor appetite, loose stools. Tongue coating white, tender-slippery, or pale-gray thin-moist.
[Pulse] Right fine-soft-weak, or empty-large-powerless. Mostly due to excessive labor, irregular diet, injuring spleen yang internally causing malaria.
[Treatment] Method: tonify qi and raise yang to harmonize. First use Bu Zhong Yi Qi Tang modified. Then strengthen spleen and harmonize stomach to astringe and tonify. Main formula: Si Shou Yin (Biezhishen, Chao Yuzhu, Zhe Fuling, Jiang Banxia each 1.5 qian, Guangpi 1 qian, Zhigancao 6 fen, Caoguo