（证二条方六首）
师曰。疟脉自弦。弦数者多热。弦迟者多寒。弦小紧者下之瘥。弦迟者可温之。弦紧
者可发汗针灸也。浮大者可吐之。弦数者风发也。以饮食消息止之。
〔衍义〕今观此篇。虽未尽内经诸篇论疟之详。然亦取其一二立方以明其治。此
条叙脉。固亦未尽疟脉之变。然举其自弦。则自之一字。已该其脉之要。何则。弦
者。少阳甲木之象也。疟邪客于荣气之间。与卫气合而病作。寒热者。正隶少阳
半表半里之分。所以少阳为疟之舍。故弦乃疟疾之本脉也。于是少阳引邪退
而就阴。阴则寒。寒则迟。进而就阳。阳则热。热则数。寒用温而热用凉可知矣。此
明表里进退。乘其虚实而调之者也。复言小紧与弦紧汗下之者。此又明表里
之有实邪而攻之者也。浮大者。以明病不在表里而在上者也。非若内经之谓
疟脉大虚者。斯因其浮而用吐也。弦数风发者。非前多热之所云。乃更论其热
之变。而木从火则风生。风得火则旺。旺则克土。火发木淫。必先实脾。实脾莫如
资以饮食消息寒凉之味以止之。此乃明其病在中者也。仲景凡一言一字皆立准绳。学人详之。
嘉言云。即梨汁蔗浆。生津止渴之属。
病疟以月一日发。当以十五日愈设不瘥。当月尽解。如其不瘥当云何。师曰。此结
为瘕。名曰疟母。急治之。宜鳖甲煎丸。
鳖甲煎丸方
鳖甲（十一分炙） 乌扇（三分烧） 黄芩（三分） 柴胡（六分） 鼠妇（三分熬）
干姜（三分） 大黄（三分） 芍药（五分） 桂枝（三分） 葶苈（一分熬） 石韦（三分
去毛） 浓朴（三分）
牡丹皮（五分） 瞿麦（二分） 紫葳（三分） 半夏（一分）
人参（一分） 虫（五分熬） 阿胶（三分炙） 蜂窠（四分炙）
赤硝（十二分） 蜣 （六分熬） 桃仁（二分）
上二十三味为末。取 灶下灰一斗。清酒一斛五斗。浸灰。候酒尽一半。着鳖甲
于中。煮令泛烂如胶漆。绞取汁。内诸药。煎为丸。如梧子大。空心服七丸。日三服。
千金方用鳖甲十二片。又有海藻三分。大戟一分。 虫五分。无鼠妇、赤硝二味。以鳖甲煎和诸药为丸。
〔衍义〕内经云。天度者。所以制日月之行也。气数者。所以纪化生之用也。五日为
一候。三候为一气。然人之三阴三阳。上奉之而为之应焉。是疟有发于月一日
者。至十五日则一气终。人气亦更。故疟气随变而散。设有未愈。则至月尽又历
第二气。终其天之月。以应人之血。月再生魄。血亦更新。邪当从其更新而解矣。
若又不愈。则是荣气内着。不得流行与日月度数相应。而肝藏血。血并其邪归
之于肝。是以疟母多结左胁下。由是用柴胡行气。鳖甲破血为君。余二十一味。
佐之行血、补血、散结、导滞而已。虽然。天人气候之相应者。大法如是。然人之禀
质有强弱。邪中有重轻。质弱邪重。虽不内结疟母。亦至连月者有之。质强邪轻。
不待一候即瘥者。亦有之。然仲景此论。补内经未言耳。（二钱五分为一分）
师曰。阴气孤绝。阳气独发。则热而少气烦冤。手足热而欲呕。名曰瘅疟。若但热不
寒者。邪气内藏于心。外舍分肉之间。令人消烁肌肉。
〔衍义〕内经云。但热而不寒者。阴气先绝。阳气独发。则热而少气烦冤。手足热而
欲呕。名曰瘅疟。又云。肺素有热。气盛于身。因又用力。风寒舍于分肉之间而发。
发则阳气盛。盛而不衰。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。令人消烁肌肉。故命曰瘅疟。此二者。一为先伤于风。一为肺素有热。
所感之邪虽不一。然病是阳盛。又内经之阳盛逢风。两阳相得而阴气虚少。少
水不能制盛火。而阳独治。此热如火。当烁肉也。由是观之。疟之寒热更作。因阴
阳之气。互为争并。若阴衰少。则离绝真阳。先自退处。不与之并。而阳亦不并于
阴。故阳独发。但热而已。此总论二者之瘅疟。其少气烦冤。肺主气。肺受火抑故
也。手足热者。阳主四肢。阳盛则四肢热也。欲呕者。火邪上冲。胃气逆也。内藏于
心者。心乃五脏阳火之主。故阳盛则直隶而藏之。外舍分肉之间也。消烁肌肉
者。消万物者莫甚于火。火甚则肌肉烁矣。然此条固无治法。自后条除温疟者
观之。亦可治此瘅疟也。何则。白虎汤。退热药也。分肉四肢。肉属脾胃。非切于其
所舍者乎。又泻肺火。非救其少气烦冤者乎。设其别有兼证。岂不可推加桂之
例以加别药乎。仲景于此。虽不言方治。盖可知矣。凡立一法。则足以比类用之。虽然。自其
阴气孤绝一语观之。又足有可论者。夫阴阳之在身者。血与气也。水
与火也。内属乎心与肾也。而寒本于阴。热本于阳以寒治热。固可退阳而回阴
也。然治病有轻重。岂一法而尽哉。小热之气。凉以取之。大热之气。泻之于内。或
反佐以取之。取之不衰。求其属以衰之。谓壮水之主。以消阳光也。
温疟者。其脉如平。身无寒。但热。骨节疼痛。时呕。白虎加桂枝汤主之。
白虎加桂枝汤方
知母（六两） 甘草（二两炙） 石膏（半斤） 粳米（二合） 桂枝（去皮三两）
上锉末。每五钱。水一盏半。煎至八分。去滓。温服汗出愈。
〔衍义〕内经名温疟。亦有二。一者谓先伤风。后伤寒。风、阳也。故先热后寒。一者为
冬感风寒。藏于骨髓之中。至春夏邪与汗出。故病藏于肾。先从内出之外。寒则
气复反入。是亦先热后寒。二者之温疟。则皆有阴阳往来寒热之证。而此之无
寒但热。亦谓之温疟。似与内经不侔。然绎其义。一皆以邪疟为重而名之。夫阴
不与阳争。故无寒。骨节皆痹。不与阳通。则疼痛。火气上逆则时呕。用白虎治其
阳盛也。加桂疗骨节痹痛。通血脉。散疟邪。和阴阳以取汗也。
疟多寒者。名曰牡疟。蜀漆散主之。
蜀漆散方
蜀漆（洗去腥） 云母（烧二日夜） 龙骨（等分）
上三味。杵为散。未发前以浆水服半钱匕。温疟加蜀漆半分。临发时服一钱匕。（
一方云母作云实）
〔衍义〕心者牡脏也。邪在心而成疟。故曰牡疟。何以言之。心肺居上。阳也。而心乃
阳中之阳。今邪气结伏心下。则心虚。内经曰。心虚者热收于内。则阳气不行于
外。故外寒。积聚津液以成痰。是以牡疟反多寒也。用蜀漆和浆水以吐所结痰
邪。龙骨以疗气伏心下者。云母安脏补虚。以除内收之热。若夫温疟亦用是。少
加蜀漆治者。亦为邪气结伏在心下。致伤气而不入于阴。反独盛在外。以成热
而不寒。故亦以此去其所结也。
牡蛎汤治牡疟方
牡蛎（四两熬） 麻黄（去节四两） 甘草（二两） 蜀漆（三两）
上四味。以水八升。先煮蜀漆、麻黄。去上沫。得六升。内诸药。煮取二升。温服一升。若吐则勿更服。
〔衍义〕此与前牡疟名同。故治亦同。略以有初感寒邪为异。牡蛎者。能软坚消结。
除滞血。今更佐之蜀漆。以理心下所结之邪。而甘草佐麻黄。非独散寒。且可发
越阳气而通于外。阳通结去。其病即瘥。
柴胡去半夏加栝蒌汤 治疟病发渴者。亦治劳疟。
柴胡（八两） 人参 黄芩 甘草（各三两） 栝蒌根（四两） 生姜（二两） 大枣（十二枚）
上七味。以水一斗二升。煮取六升。去滓。再煎。取三升。温服一升。日三服。
嘉言云。渴虽阳明津竭。而所以致阳明津竭者。全是少阳之邪。故即小柴胡去
半夏加栝蒌也。
〔衍义〕内经谓渴者刺足少阳。此证胃土被木火之伤。则津液涸而燥渴。故用柴
胡、黄芩治木火。人参、甘草补胃。栝蒌生津益燥。姜枣发越荣卫。若劳疟由木火
盛。荣卫衰。津液竭者。亦治以此。
柴胡桂姜汤 治疟寒多。微有热。或但寒不热。服一剂如神。
柴胡（半斤） 桂枝（三两去皮） 干姜（二两） 栝蒌根（四两）
黄芩（三两） 牡蛎（二两熬） 甘草（二两炙）
上七味。以水一斗二升。煮取六升。去滓。再煎。取三升。温服一升。日三服。初服微
烦。复服。汗出便愈。
〔衍义〕是疟也。以寒多言之。若与牡疟相类。以药论之。则非也。牡疟邪客心下。此
风寒湿痹于肌表。肌表行阳以温分肉。痹则阳气不得通于外。遂郁伏于荣血
之间。半表半里之分也。阳化气热。血滞成瘀。着于其处。遇卫气行阳二十五度
及之则病作。其邪之入荣者。既无外出之势。而荣之素痹者。亦不出而与阳争。
故少热或无热也。是用柴胡为君。发其郁伏之阳。佐以桂枝、干姜。散其肌表之
痹。栝蒌根、牡蛎为臣。除留热。消瘀血。佐以黄芩助柴胡。治半表里。甘草以和诸
药。调阴阳也。得汗则痹邪散。血热行而病瘥耳。
（证候两条，方剂六首）
老师说道：疟疾的脉象自然呈现弦脉。脉象弦而数的，多属热证；脉象弦而迟的，多属寒证。脉象弦小且紧的，可用下法治疗而痊愈；脉象弦而迟的，可用温法治疗；脉象弦而紧的，可用发汗或针灸治疗；脉象浮大的，可用吐法治疗。脉象弦而数的，属于风邪引发的发热，可以通过饮食调理来制止它。
〔衍义〕现在看这一篇，虽然未能详尽列举《内经》中关于疟疾论述的所有内容，但也选取了一两个方剂来阐明其治疗方法。这一条叙述脉象，固然没有穷尽疟疾病脉的变化，但提出“自弦”这一点，“自”字已经概括了脉象的要领。为什么呢？因为弦脉是少阳甲木的象征。疟邪客居在荣气之间，与卫气相合而发病。寒热交替的症状，正属于少阳半表半里的范畴，所以少阳是疟疾的居所，因此弦脉是疟疾的根本脉象。于是少阳引邪退而归于阴，阴则表现为寒，寒则脉迟；进而归向于阳，阳则表现为热，热则脉数。可知寒证用温法，热证用凉法。这是在阐明表里进退的关系，乘其虚实进行调理。又提到小紧与弦紧分别用下法和汗法，这是为了阐明表里有实邪时采用攻邪的方法。脉象浮大，是为了说明病不在表里而在上部。不像《内经》所说疟脉大虚那样，而是因其脉浮而使用吐法。所谓弦数风发，不是前面所说的多热，而是进一步论述热的变化，木从火化则生风，风得火势则旺盛，旺盛则克制脾土，火发木淫，必须先充实脾脏。充实脾脏不如通过饮食消息，食用寒凉味道来制止它。这是为了阐明病位在中焦。仲景的每一句话、每一个字都确立了准则，学习者应仔细研究。
嘉言说：就是指梨汁、蔗浆等生津止渴的药物。
患疟疾的人如果在农历初一发病，应当在十五天内痊愈；如果不好转，应当在当月月底解除。如果不好转，该怎么办呢？老师说：这是因为邪气结聚形成了瘕块，名叫疟母。应当紧急治疗，适宜使用鳖甲煎丸。
鳖甲煎丸方
鳖甲（十一分，炙） 乌扇（三分，烧） 黄芩（三分） 柴胡（六分） 鼠妇（三分，熬）
干姜（三分） 大黄（三分） 芍药（五分） 桂枝（三分） 葶苈（一分，熬） 石韦（三分，去毛）
浓朴（三分） 牡丹皮（五分） 瞿麦（二分） 紫葳（三分） 半夏（一分）
人参（一分） 䗪虫（五分，熬） 阿胶（三分，炙） 蜂窠（四分，炙）
赤硝（十二分） 蜣螂（六分，熬） 桃仁（二分）
以上二十三味药研成末，取灶下灰一斗，清酒一斛五斗，浸泡灶下灰，等到酒剩下一半时，放入鳖甲在其中，煮至烂熟如胶漆状，过滤取汁，加入其他药物，煎煮制成丸药，大小如梧桐子。空腹服用七丸，每日三次。
《千金方》使用鳖甲十二片，另有海藻三分，大戟一分，䗪虫五分，没有鼠妇、赤硝两味药。以鳖甲煎液调和诸药为丸。
〔衍义〕《内经》说：天度，是用来制定日月运行的规律的；气数，是用来记录生化作用的。五天为一候，三候为一气。然而人体的三阴三阳，上奉天道而与之相应。所以疟疾有在农历初一发作的，到了十五日则一气终结，人气也随之更新，所以疟气随变化而消散。假使没有痊愈，那么到月底又经历第二气，终结这个天上的月份，以对应人体的血。月亮再生魄，血也更新，邪气应当随着更新而解除。如果仍然不愈，那就是荣气内着，不能流行，不与日月度数相应。而肝藏血，血连同邪气归于肝，所以疟母多结聚在左胁下。因此用柴胡行气，鳖甲破血作为君药。其余二十一味药，辅助行血、补血、散结、导滞罢了。虽然天人气候相应的法则如此，但人的禀赋体质有强弱之分，邪气有中重之异。体质弱而邪气重的，即使不内结成疟母，也有持续几个月的；体质强而邪气轻的，不到一候就痊愈的，也有这种情况。然而仲景的这一论述，补充了《内经》未曾提及的内容。（二钱五分为一分）
老师说道：阴气孤绝，阳气独发，就会出现发热、气短、烦闷冤屈感，手足发热且想呕吐的症状，名叫瘅疟（Dan Nue, Malaria with high fever）。如果只有热而没有寒，那是邪气内藏于心，外舍于分肉之间，使人肌肉消瘦枯槁。
〔衍义〕《内经》说：只有热而不寒的，是因为阴气先绝，阳气独发，所以发热、气短、烦闷冤屈，手足发热且想呕吐，名叫瘅疟。又说：肺素来有热，气盛于全身，又因用力过度，风寒客居于分肉之间而发病。发作时阳气盛，盛而不衰，其气不及于阴，所以只有热而不寒。气内藏于心，而外舍于分肉之间，使人肌肉消瘦枯槁，所以命名为瘅疟。这两种情况，一种是先伤于风，一种是肺素来有热。所感受的邪气虽然不同，但病机都是阳盛。又是《内经》所说的阳盛逢风，两阳相得而阴气虚少，少水不能制盛火，而阳独治。这种热如火，应当灼烧肌肉。由此看来，疟疾的寒热交替，是因为阴阳之气互为争并。如果阴衰少，则离绝真阳，先自行退处，不与阳相并，而阳也不并于阴，所以阳独发，只有热而已。这是总论两种瘅疟的情况。其中气短烦闷，是因为肺主气，肺受火抑制的缘故。手足发热，是因为阳主四肢，阳盛则四肢热。想呕吐，是因为火邪上冲，胃气逆乱。内藏于心，是因为心是五脏阳火之主，所以阳盛则直接隶属而藏于心。外舍于分肉之间。肌肉消瘦枯槁，是因为没有什么比火更能消亡万物了，火甚则肌肉被灼烧。然而这一条虽然没有治疗方法，但从后面的除温疟的条文来看，也可以治疗这种瘅疟。为什么呢？白虎汤是退热的药物。分肉和四肢，肉属于脾胃，这不正是切中其所舍之处吗？又能泻肺火，不正能救治气短烦闷吗？假使另有兼证，难道不可以参考加桂的范例来添加其他药物吗？仲景在这里，虽然没有说出方剂治疗，但可以推知了。凡是确立一种法则，就足以类比应用。虽然，从“阴气孤绝”这句话来看，又有可以讨论的地方。夫阴阳在人身，就是血与气，水与火。内属于心与肾。寒本于阴，热本于阳。以寒治热，固然可以退阳而回阴。然而治病有轻重，岂有一种方法就能穷尽的呢？小热之气，用凉法取之；大热之气，从内部泻之。或者反佐以取之。取之不衰，求其所属以衰减它。这就是所说的壮水之主，以消阳光。
温疟（Wen Nue, Warm Malaria），其脉象如同平常，身体无寒，只有热，骨节疼痛，时常呕吐，用白虎加桂枝汤主治。
白虎加桂枝汤方
知母（六两） 甘草（二两，炙） 石膏（半斤） 粳米（二合） 桂枝（去皮三两）
以上五味药切碎成末，每次取五钱，用水一盏半，煎至八分，去渣，温服，出汗即愈。
〔衍义〕《内经》名为温疟，也有两种。一种说是先伤风，后伤寒。风属阳，所以先热后寒。另一种是冬天感受风寒，藏于骨髓之中，到了春夏季节，邪气随汗出而发，所以病藏于肾，先从内出之外。寒则气复反入，这也是先热后寒。这两种温疟，都有阴阳往来寒热的症状，而这个只有热没有寒，也称为温疟，似乎与《内经》不符。然而推究其义，都是以邪疟为重而命名的。阴不与阳争，所以无寒。骨节皆痹，不与阳通，则疼痛。火气上逆则时常呕吐。用白虎汤治疗阳盛。加桂枝治疗骨节痹痛，通血脉，散疟邪，调和阴阳以取汗。
疟疾多寒的，名叫牡疟（Mu Nue, Malaria with chills predominating），用蜀漆散主治。
以上三味药捣碎为散。未发作前用浆水送服半钱匕。温疟加蜀漆半分，临发作时服一钱匕。（一方说云母作云实）
〔衍义〕心是牡脏（Yang Organ）。邪气在心而成疟，所以叫牡疟。为什么这么说？心肺居上，属阳，而心是阳中之阳。现在邪气结伏在心下，则心虚。《内经》说：心虚者热收于内，则阳气不行于外，所以外寒。积聚津液以成痰，所以牡疟反而多寒。用蜀漆配合浆水来吐出所结的痰邪，龙骨来治疗气伏在心下的病症，云母安脏补虚，以除去内收的热。至于温疟也用这个方子，少加蜀漆治疗的，也是因为邪气结伏在心下，导致伤气而不入于阴，反而独盛在外，形成热而不寒，所以也用此法去除所结之邪。
牡蛎汤治疗牡疟方
牡蛎（四两，熬） 麻黄（去节四两） 甘草（二两） 蜀漆（三两）
以上四味药，用水八升，先煮蜀漆、麻黄，去掉上面的沫，得到六升，加入其他药物，煮取二升，温服一升。如果呕吐了就不要再服。
〔衍义〕这与前面的牡疟名称相同，所以治疗也相同，略微有所不同的是初感寒邪。牡蛎，能软坚消结，除滞血。现在更佐以蜀漆，来理心下所结之邪，而甘草佐助麻黄，不仅散寒，还可发越阳气而通于外。阳通则结去，病即痊愈。
柴胡去半夏加栝蒌汤，治疗疟病发作时口渴的，也治疗劳疟（Lao Nue, Chronic/Consumptive Malaria）。
柴胡（八两） 人参 黄芩 甘草（各三两） 栝蒌根（四两） 生姜（二两） 大枣（十二枚）
以上七味药，用水一斗二升，煮取六升，去渣，再煎，取三升，温服一升，每日三次。
嘉言说：口渴虽然是阳明津液枯竭，而导致阳明津液枯竭的原因，完全是少阳之邪，所以就在小柴胡汤中去掉半夏，加上栝蒌根。
〔衍义〕《内经》说口渴要刺足少阳。此证胃土被木火所伤，则津液涸竭而燥渴，所以用柴胡、黄芩治木火，人参、甘草补胃，栝蒌生津益燥，姜枣发越荣卫。如果是劳疟由木火盛，荣卫衰，津液竭者，也用此方治疗。
柴胡桂姜汤，治疗疟疾寒多，微有热，或者但寒不热，服一剂如神效。
柴胡（半斤） 桂枝（三两，去皮） 干姜（二两） 栝蒌根（四两）
黄芩（三两） 牡蛎（二两，熬） 甘草（二两，炙）
以上七味药，用水一斗二升，煮取六升，去渣，再煎，取三升，温服一升，每日三次。初服微烦，再服，汗出便愈。
〔衍义〕这种疟疾，从寒多来说，若与牡疟相似，但从药物分析，则不相同。牡疟邪客心下，此证风寒湿痹阻于肌表。肌表行阳以温分肉，痹则阳气不得通于外，遂郁伏于荣血之间，处于半表半里的位置。阳化气热，血滞成瘀，附着于该处，遇到卫气行阳二十五度及之则病发作。其邪进入荣分的，既无外出之势，而荣分素来痹阻的，也不出来与阳相争，所以少热或无热。因此用柴胡为君药，发散其郁伏之阳，佐以桂枝、干姜，散发其肌表之痹。栝蒌根、牡蛎为臣药，清除留热，消除瘀血，佐以黄芩助柴胡，治疗半表里，甘草调和诸药，调阴阳。得汗则痹邪散，血热行而病愈。
(Two types of syndromes, six prescriptions)
The Master said: The pulse of malaria naturally presents as a string-like (Xian) pulse. A string-like and rapid (Shu) pulse indicates mostly heat; a string-like and slow (Chi) pulse indicates mostly cold. A string-like, small, and tight (Jin) pulse can be treated with purgation to achieve recovery; a string-like and slow pulse can be treated with warming methods; a string-like and tight pulse can be treated with sweating or acupuncture; a floating (Fu) and large (Da) pulse can be treated with emesis. A string-like and rapid pulse indicates wind-induced fever, which can be stopped by dietary management.
[Commentary] Observing this chapter, although it does not exhaustively list all discussions on malaria from the *Nei Jing* (Inner Canon), it selects one or two prescriptions to clarify its treatment principles. This section on pulse diagnosis, while not enumerating all variations of malaria pulses, highlights "naturally string-like." The word "naturally" encompasses the essence of the pulse. Why? Because the string-like pulse is the image of Shaoyang (Lesser Yang) Jia Wood. The malaria pathogen lodges between Ying (Nutrient) Qi and Wei (Defensive) Qi, causing disease when they combine. The alternating chills and fever belong to the half-exterior, half-interior aspect of Shaoyang; thus, Shaoyang is the abode of malaria, making the string-like pulse the fundamental pulse of malaria. Consequently, Shaoyang draws the pathogen back into Yin; Yin manifests as cold, hence the slow pulse. Advancing into Yang; Yang manifests as heat, hence the rapid pulse. It is known that cold conditions use warming methods, and heat conditions use cooling methods. This clarifies the advance and retreat of exterior and interior, adjusting based on deficiency and excess. Mentioning small-tight and string-like-tight pulses for purgation and sweating further clarifies attacking excess pathogens in the exterior and interior. A floating and large pulse indicates the disease is not in the exterior or interior but in the upper jiao. Unlike the *Nei Jing*'s description of a large and deficient malaria pulse, here emesis is used due to the floating nature. "String-like and rapid wind-induced fever" refers not merely to the previously mentioned heat, but discusses the transformation of heat: Wood following Fire generates Wind; Wind strengthened by Fire overacts on Earth (Spleen). One must first strengthen the Spleen. Strengthening the Spleen is best achieved through dietary management, consuming cool flavors to stop the condition. This clarifies that the pathology lies in the middle jiao. Every word and phrase of Zhang Zhongjing sets a standard; students should study it carefully.
Jiayan stated: This refers to substances like pear juice and sugarcane syrup that generate fluids and quench thirst.
If malaria begins on the first day of the lunar month, it should resolve within fifteen days. If it does not improve, it should resolve by the end of the month. If it still does not resolve, what should be done? The Master said: This is because the pathogen has coagulated into a mass, named "Malaria Mother" (Nuomu). It requires urgent treatment. The appropriate prescription is Biejia Jian Wan (Turtle Shell Decoction Pill).
Biejia Jian Wan Prescription
Bie Jia (Scutellum Testudinis, 11 parts, prepared by stir-frying); Wushan (Iris Tectorii Rhizome, 3 parts, roasted); Huang Qin (Scutellariae Radix, 3 parts); Chai Hu (Bupleuri Radix, 6 parts); Shufu (Kermes Scale, 3 parts, prepared by stir-frying); Gan Jiang (Zingiberis Rhizoma, 3 parts); Da Huang (Rhei Radix et Rhizoma, 3 parts); Shao Yao (Paeoniae Radix Alba, 5 parts); Gui Zhi (Cinnamomi Ramulus, 3 parts); Ting Li (Lepidii Semen, 1 part, prepared by stir-frying); Shi Wei (Pyrrosiae Folium, 3 parts, hairs removed); Hou Po (Magnoliae Officinalis Cortex, 3 parts); Mu Dan Pi (Moutan Cortex, 5 parts); Qu Mai (Polygoni Avicularis Herba, 2 parts); Zi Wei (Lagerstroemiae Flos, 3 parts); Ban Xia (Pinelliae Rhizoma, 1 part); Ren Shen (Ginseng Radix, 1 part); E Chong (Eupolyphaga Steleophaga, 5 parts, prepared by stir-frying); E Jiao (Colla Corii Asini, 3 parts, prepared by stir-frying); Feng Ke (Apis Nido, 4 parts, prepared by stir-frying); Chi Xiao (Natrii Sulfas, 12 parts); Qiang Lang (Scarabaeus, 6 parts, prepared by stir-frying); Tao Ren (Persicae Semen, 2 parts).
Grind the above twenty-three herbs into powder. Take one dou (unit of volume) of ash from the kitchen stove and one hu (unit of volume) of clear wine. Soak the ash in the wine. When half the wine has been absorbed, add the Bie Jia and boil until it dissolves into a glue-like consistency. Strain to obtain the juice, add the other medicines, and decoct to form pills the size of wu zi (smartweed seeds). Take seven pills on an empty stomach, three times a day.
The *Qianjin Fang* uses twelve pieces of Bie Jia, plus 3 parts of Hai Zao (Sargassum Herba), 1 part of Da Ji (Euphorbiae Pekinensis Radix), and 5 parts of E Chong. It lacks Shufu and Chi Xiao. The pills are formed using the Bie Jia decoction to bind the herbs.
[Commentary] The *Nei Jing* states: Tian Du (Heavenly Degree) regulates the movement of the sun and moon; Qi Shu (Qi Number) records the function of generation and transformation. Five days constitute one Hou (pentad); three Hou constitute one Qi (term). The human body's Three Yin and Three Yang correspond to these heavenly rhythms. Thus, malaria starting on the first day of the month resolves by the fifteenth day when one Qi cycle ends and human Qi renews, causing the malaria pathogen to dissipate with the change. If not cured, by the end of the month, a second Qi cycle completes, corresponding to the lunar month and human blood. As the moon regenerates, blood renews, and the pathogen should resolve with this renewal. If it persists, Ying Qi is internally stagnated and fails to circulate in accordance with celestial degrees. Since the Liver stores blood, the blood carrying the pathogen returns to the Liver. Hence, Nuomu often forms under the left hypochondrium. Therefore, Chai Hu moves Qi, and Bie Jia breaks blood stasis as the sovereign herb. The remaining twenty-one herbs assist in moving blood, nourishing blood, resolving masses, and guiding out stagnation. Although the principle of correspondence between heaven and human climate is as described, individual constitution varies in strength, and pathogenic factors vary in severity. Those with weak constitutions and severe pathogens may suffer for months even without forming Nuomu. Those with strong constitutions and mild pathogens may recover before one Hou. However, Zhongjing's discussion supplements what the *Nei Jing* omitted.
The Master said: When Yin Qi is isolated and exhausted, and Yang Qi acts alone, there will be fever, shortness of breath, and a feeling of oppression and grievance, along with hot hands and feet and a desire to vomit. This is called Dan Nue (Malaria with High Fever). If there is only heat without chills, the pathogen is internally stored in the Heart and externally lodged in the intermuscular spaces, causing the muscles to waste away.
[Commentary] The *Nei Jing* states: Only heat without chills occurs when Yin Qi is exhausted first, and Yang Qi acts alone, resulting in fever, shortness of breath, oppression, hot extremities, and nausea, named Dan Nue. It also states: If the Lungs have pre-existing heat, Qi is excessive in the body, and exertion causes wind-cold to lodge in the intermuscular spaces, triggering the disease. Upon onset, Yang becomes excessive and does not decline. Its influence does not reach Yin, so there is only heat without chills. The pathogen internally resides in the Heart and externally lodges in the intermuscular spaces, wasting the muscles, hence named Dan Nue. These two scenarios involve either prior wind injury or pre-existing lung heat. Although the pathogenic factors differ, the pathology is Yang Excess. As the *Nei Jing* notes, Yang Excess meeting Wind creates a dual Yang condition where Yin is deficient. Little water cannot control abundant fire, allowing Yang to dominate exclusively. This heat is like fire, burning flesh. Thus, the alternating chills and fever in malaria result from the contention between Yin and Yang. If Yin is deficient, it withdraws from True Yang, refusing to contend, and Yang does not merge with Yin, so Yang acts alone, producing only heat. This summarizes the two types of Dan Nue. Shortness of breath and oppression occur because the Lung governs Qi and is suppressed by fire. Hot extremities occur because Yang governs the four limbs, and Yang excess causes limb heat. Nausea occurs because fire pathogen rushes upward, reversing Stomach Qi. Internal residence in the Heart is because the Heart is the master of Yang Fire in the five zang organs; thus, Yang excess directly resides in the Heart. External lodging in intermuscular spaces leads to muscle wasting because nothing consumes things more than fire; intense fire scorches muscles. Although this section lacks a specific treatment, observing subsequent sections on Wen Nue suggests Dan Nue can be treated similarly. For instance, Baihu Tang (White Tiger Decoction) clears heat. Intermuscular spaces and limbs relate to the Spleen and Stomach, targeting the site of lodging. It also clears Lung Fire, addressing shortness of breath and oppression. If other symptoms exist, one could extrapolate adding Gui Zhi (Cinnamon Twig) or other herbs. Zhongjing implies the treatment method here. Establishing one principle allows for analogical application. From the phrase "Yin Qi isolated and exhausted," we can discuss further. Yin and Yang in the body are Blood and Qi, Water and Fire, internally belonging to the Heart and Kidney. Cold originates from Yin, Heat from Yang. Using cold to treat heat can subdue Yang and restore Yin. However, treatments vary in intensity; no single method suffices for all. Mild heat is treated with cooling; severe heat is purged internally. Sometimes counter-agents are used. If reduction fails, seek the root cause to reduce it. This is "strengthening the master of Water to extinguish the sunlight."
Wen Nue (Warm Malaria) presents with a pulse similar to normal, no chills, only heat, joint pain, and occasional vomiting. It is primarily treated with Baihu Jia Guizhi Tang (White Tiger Plus Cinnamon Twig Decoction).
Baihu Jia Guizhi Tang Prescription
Zhi Mu (Anemarrhenae Rhizoma, 6 liang); Gan Cao (Glycyrrhizae Radix et Rhizoma, 2 liang, prepared by stir-frying); Shi Gao (Gypsum Fibrosum, 0.5 jin); Geng Mi (Oryza Sativa, 2 he); Gui Zhi (Cinnamomi Ramulus, peeled, 3 liang).
Crush the above five ingredients into coarse powder. Take 5 qian per dose, add 1.5 cups of water, decoct to 0.8 cup, strain, and take warm. Sweating indicates cure.
[Commentary] The *Nei Jing* mentions two types of Wen Nue. One is prior wind injury followed by cold injury. Wind is Yang, so heat precedes chills. The other is winter wind-cold lodging in bone marrow, emerging with sweat in spring/summer, residing in the Kidney, emerging from interior to exterior. Chills cause Qi to reverse inward, also resulting in heat preceding chills. Both types exhibit alternating chills and fever. This type, having only heat without chills, is also called Wen Nue, seemingly differing from the *Nei Jing*. However, examining the meaning, both are named based on the dominance of the pathogen. Yin does not contend with Yang, hence no chills. Joint blockage prevents Yang circulation, causing pain. Fire Qi rushing upward causes vomiting. Baihu Tang treats Yang Excess. Adding Gui Zhi treats joint blockage, unblocks vessels, disperses malaria pathogen, harmonizes Yin and Yang to induce sweating.
Malaria with predominant chills is called Mu Nue (Malaria with Chills Predominating), primarily treated with Shuqi San (Shuqi Powder).
Shuqi San Prescription
Shu Qi (Perillae Folium, washed to remove fishy odor); Yun Mu (Muscovite, roasted for two days and nights); Long Gu (Fossilia Ossis Mastodi, equal parts).
Grind the above three herbs into powder. Take half a qian bi (coin-sized measure) with Jiang Shui (fermented grain water) before onset. For Wen Nue, add half a qian of Shu Qi; take one qian bi at onset. (Another version uses Yun Shi instead of Yun Mu).
[Commentary] The Heart is a Yang organ (Mu Zang). Pathogen lodging in the Heart causes malaria, hence Mu Nue. Why? Heart and Lungs are superior and Yang, but the Heart is Yang within Yang. Pathogen stagnating below the Heart causes Heart Deficiency. The *Nei Jing* states: Heart Deficiency leads to internal heat retention, preventing Yang Qi from reaching the exterior, causing external chills. Fluids accumulate into phlegm, explaining why Mu Nue features prominent chills. Shu Qi with Jiang Shui expels stagnant phlegm; Long Gu treats Qi stagnation below the Heart; Yun Mu calms the viscera, tonifies deficiency, and clears internal heat. Wen Nue also uses this formula with less Shu Qi because pathogen stagnation below the Heart damages Qi, preventing entry into Yin, causing Yang to dominate externally, creating heat without chills. Thus, this method removes the stagnation.
Muli Tang (Oyster Shell Decoction) treats Mu Nue.
Muli (Ostreae Concha, prepared by stir-frying, 4 liang); Ma Huang (Ephedrae Herba, nodes removed, 4 liang); Gan Cao (Glycyrrhizae Radix et Rhizoma, 2 liang); Shu Qi (Perillae Folium, 3 liang).
Decoct the above four herbs in 8 sheng of water. First decoct Shu Qi and Ma Huang, removing surface foam, until 6 sheng remain. Add other herbs and decoct to 2 sheng. Take 1 sheng warm. If vomiting occurs, do not administer further.
[Commentary] This shares the name Mu Nue with the previous section, hence similar treatment, differing slightly in initial cold pathogen acquisition. Muli softens hardness and resolves masses, removing blood stasis. Combined with Shu Qi, it addresses pathogen stagnation below the Heart. Gan Cao assists Ma Huang not only to disperse cold but also to vent Yang Qi outward. Once Yang flows and stagnation resolves, the disease cures.
Chaihu Qu Banxia Gua Lou Tang (Bupleurum Decoction Without Pinellia Plus Trichosanthes Root) treats malaria with thirst during attacks, and also consumptive malaria (Lao Nue).
Chai Hu (Bupleuri Radix, 8 liang); Ren Shen (Ginseng Radix); Huang Qin (Scutellariae Radix); Gan Cao (Glycyrrhizae Radix et Rhizoma, 3 liang each); Gua Lou Gen (Trichosanthis Radix, 4 liang); Sheng Jiang (Zingiberis Rhizoma Recens, 2 liang); Da Zao (Jujubae Fructus, 12 pieces).
Decoct the above seven herbs in 12 dou of water until 6 dou remain. Strain, then decoct again to 3 dou. Take 1 dou warm, three times daily.
Jiayan stated: Thirst indicates exhaustion of Yangming fluids, caused entirely by Shaoyang pathogen. Thus, modify Xiao Chaihu Tang by removing Banxia and adding Gua Lou Gen.
[Commentary] The *Nei Jing* advises puncturing Foot Shaoyang for thirst. Here, Stomach Earth is injured by Wood-Fire, depleting fluids and causing dry thirst. Chai Hu and Huang Qin treat Wood-Fire; Ren Shen and Gan Cao tonify Stomach; Gua Lou generates fluids and moistens dryness; Ginger and Jujube vent Ying and Wei. Consumptive malaria due to Wood-Fire excess, Ying-Wei deficiency, and fluid depletion is also treated with this.
Chaihu Guijiang Tang (Bupleurum Plus Cinnamon Twig and Dried Ginger Decoction) treats malaria with predominant chills, slight heat, or only chills without heat. One dose is miraculous.
Chai Hu (Bupleuri Radix, 0.5 jin); Gui Zhi (Cinnamomi Ramulus, peeled, 3 liang); Gan Jiang (Zingiberis Rhizoma, 2 liang); Gua Lou Gen (Trichosanthis Radix, 4 liang); Huang Qin (Scutellariae Radix, 3 liang); Muli (Ostreae Concha, prepared by stir-frying, 2 liang); Gan Cao (Glycyrrhizae Radix et Rhizoma, prepared by stir-frying, 2 liang).
Decoct the above seven herbs in 12 dou of water until 6 dou remain. Strain, then decoct again to 3 dou. Take 1 dou warm, three times daily. Initial administration may cause slight irritability; subsequent doses induce sweating and cure.
[Commentary] This malaria, characterized by predominant chills, resembles Mu Nue, but pharmacologically differs. Mu Nue involves pathogen lodging below the Heart; this case involves Bi syndrome of wind-cold-dampness in the muscle layer. Muscle layer Yang warms intermuscular spaces; Bi blocks Yang from reaching exterior, causing it to stagnate in Ying Blood, located at the half-exterior/half-interior level. Yang transforms into Qi and Heat; Blood stagnates into stasis, adhering there. Disease occurs when Wei Qi circulates Yang twenty-five times and reaches this point. Pathogens entering Ying lack outward momentum, and already Bi-stagnated Ying does not emerge to contend with Yang, resulting in slight or no heat. Thus, Chai Hu is sovereign to vent stagnant Yang. Gui Zhi and Gan Jiang assist to disperse exterior Bi. Gua Lou Gen and Muli are ministerial to clear residual heat and resolve stasis. Huang Qin assists Chai Hu in treating half-exterior/half-interior. Gan Cao harmonizes herbs and balances Yin-Yang. Sweating disperses Bi pathogen, circulates blood heat, and cures the disease.