师曰。（疟者。寒热往来之有定候也。虽有三阳三阴之异。而其舍总不外乎半表半里
之间。少阳主乎半表半里。其脉必弦。今为之提其大纲曰。）疟脉自弦。（而弦中之兼见者。）弦数者多热。弦迟者多寒。
（一隅可以三反也。至于因证施治。）弦小紧者。（以其小而知其在里。可）下之（
而）瘥。弦迟者。（多寒无有疑义。即）可温之。弦紧（而不小）者。（知其在表而不
在里。）可（以）发汗针灸也。（弦而）浮大者。（知其邪在高分）可（以）吐（而越
）之。弦数者（多热。治则宜清。而热极生风。当知其为）风发也。（若以上因脉施治
诸法。治之而犹不止。更当）以饮食消息止之。（即难经所谓损其脾者。调其饮食。适
其寒温之旨也。）
此言疟证不离少阳。以弦脉为主。随其兼见者而施治也。末一句言治之不愈。求之脾
胃。是为久疟虚疟者。立一大法也。徐忠可尤在泾诸家之解俱误。
男（元犀）按、素问疟论。言之甚详。大约邪气与卫气并居。合则病作。离则病休。
一日发者。正气不虚。易愈。间日与三日。正气虚。内薄于阴。难愈。仲景以内经之
旨深远。难与中人以下说法。另寻出阴阳出入大
冲要处。独取少阳为主。以补内经未言之旨。并示后人握要之图。开口即云疟脉自弦。
看一自字。大有深意。见疟证虽各不同。而少阳脉之真面目。自不可掩。
病疟。以月（计之。）一日（一）发。当十五日愈。（以五日为一候。三候为一气。一
气十五日也。人受气于天。天气更则人身之气亦更。更气旺则不受邪而愈也。）设不瘥。
当月尽解。（是又更一旺气也。）如其（更二气而）不瘥。当云何。师曰。此（疟邪
不衰。与气血痰饮。）结为 瘕。名曰疟母。当急治之。宜鳖甲煎丸。
此言疟邪因人正气之衰旺。以为消长也。上节以饮食消息止之。为治久疟之正法。
若有疟母。先急除其有形之 瘕。再培其无形之元气。医者切不可 言小心。酿成姑息
养奸之祸。如景岳方之何人饮休疟饮追疟饮。皆调停两可。走江湖之套技。
鳖甲煎丸方
鳖甲（十二分炙） 乌扇（三分烧即射干） 黄芩（三分） 柴胡（六分） 鼠妇
（三分熬） 干姜 大黄 桂枝 石苇（去毛） 浓朴 紫葳（即凌霄） 半夏 阿胶
芍药 牡丹 虫（各五分） 葶苈 人参（各一分） 瞿麦（二分） 蜂窠（四分
炙） 赤硝（十二分） 蜣螂（六分熬） 桃仁（二分）
上二十三味为末。取 灶下灰一斗。清酒一斛五升。浸灰。俟酒尽一半。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。无鼠妇赤硝二味。
师曰。阴气孤绝。阳气独发。（阳独发。气为火蚀。火无水济。）则热而少气烦冤。
（阴孤绝。无以濡外。无以守中。则）手足热而欲呕。名曰瘅疟。若（欲知其）但热不
寒（之所以然）者。（须知其）邪气内藏于心。外舍分肉之间。令人消烁肌肉。（肌肉
为阴。阳极则阴消也。）
按内经所论之瘅疟。撮其大略。以肺素有热。而偶受风寒。内藏于心。外舍分肉。
表则寒而里则热。缘阴气内虚。不能与阳相争。故但热而不作寒也。师不出方。余比例
而用白虎加桂枝汤。以白虎清心救肺。以除里热。加桂枝调和营卫。以驱外邪。诚一方
而两扼其要也。即先热后寒。名为热疟。亦以白虎清其先。桂枝却其后。极为对证。此
法外之法也。然此节与内经稍异。师又略节经文。不言及外感风寒。以阴气孤绝。阳气
独发二句为主。方内有桂枝。又未中的。师早已熟审矣。若明薛立斋张景岳赵养葵。用
六味地黄汤及玉女煎之说。反致滞邪生热而增剧。俗传疟痢三方。为害更速。师于此等
重证而不出方者。欲人寻绎而自得也。伤寒论自序云。若能寻余所集。思过半矣。此物此
志也。 男（元犀）按、下节白虎加桂枝汤。是内经所言之瘅疟。非师所云、云瘅疟之治
也。师未出方。似可借用竹叶石膏汤之类。而梨汁甘蔗汁。亦可以佐之。
（又有）温疟者。（冬不藏精。则水亏而火盛。火盛于内。外为寒气所格而不出。则火气
内郁。日盛一日。至春令感温气而发。夏令感热气而发。是病在伏气。与乍感不同。故）
其脉如平。（但此病当证书而不凭脉。难经云。温病之脉。行在诸经。不知何经之病。
即此意也。）身无寒。但热。骨节烦疼。时呕。（为热从肾出。外舍其合。而上并于阳
明也。）以白虎加桂枝汤主之。（盖于大凉肺胃之中。加一辛温之品。因其势而利导
之也。）
此言温疟与内经不同。而其义则相表里也。然余谓仲师书。读其正面。须知其对面。
须知其反面。须知
其旁面。则顺逆分合。如织锦回文。字字扣得着。上节言瘅疟。单主阴绝阳发。以补经
文之未尽。至于经文所云。肺热加以外感。为瘅疟之正证。亦包括在内。均一瘅疟。不
无毫厘千里之判。此所以不率尔而出方也。至此节论温疟。又与内经不同。意者伏气外
出之证。其始也。热为寒郁而内藏。其发也。寒因热盛而俯首。究竟酿此猖狂之热祸。
皆缘寒邪之格外为祸端。以白虎清其热势。加桂枝追其所由来。可谓面面周到。且所云
无寒但热疼呕之证。俱是内经瘅疟之正证。师于此补叙其正证。补出其正方。文法错综
变化。非细心人不能体会。虽然。篇首有弦数者风发一句。伤寒论有风温一证。于此可
以悟开大觉路。即可以普济无量苍生矣。
白虎加桂枝汤方
知母（六两） 石膏（一斤） 甘草（二两炙） 粳米（二合） 桂枝（三两）
上五味。以水一斗。煮米熟汤成。去滓温服一升。日三。
疟（少热）多寒者。（非真寒也。缘无形之寒气。挟有形之痰饮。伏于心间。阳气
不能外透于肌表。故多寒。甚则有寒无热。心为牡脏。因）名（之）曰牡疟。（以）蜀漆散主之。
（驱其心胸结伏之痰饮。则内陷之邪。亦转旋而外出。）
此言牡疟证也。方中云母无真。未能速效。且此方原是宣通心阳。使气行于肌表。
则不至偏阴用事。却不专在于涌吐也。故不注明吐之一字。余借用桂枝去芍药。加蜀漆
龙骨牡蛎救逆汤如神。
蜀漆散方
蜀漆（烧去腥） 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。
附外台秘要三方
牡蛎汤 治牡疟。
牡蛎 麻黄（各四两） 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。
尤在泾云、此系宋孙奇等所附。盖亦蜀漆散之意。而外攻之力较猛
矣。赵氏云、牡蛎软坚消结。麻黄非独散寒。且可发越阳气。使通于外。结散阳通。其
病自愈。
柴胡去半夏加栝蒌根汤 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（三两） 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。
徐忠可云、疟邪在半表半里之间。入与阴争则寒。出于阳争则热。此少阳之象也。是
谓少阳而兼他经之证则有之。谓他经而全不涉少阳。则不成其为疟矣。所以小柴胡为少
阳主方。渴易半夏加栝蒌根。亦治少阳成法也。攻补兼施。故亦主劳疟。
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） 干姜（三两） 栝蒌根（四两） 黄芩（三两）
甘草（二两炙） 牡蛎（二两）
上七味。以水一斗煮取六升。去滓再煎取三升。温服一升。日三。初服微烦。复服
汗出便愈。
赵氏曰、此与牡疟相类而实非。牡疟邪客心下。此风寒湿痹于肌表。肌表既痹。阳
气不得通于外。遂郁伏于荣血之中。阳气化热。血滞成瘀。着于其处。遇卫气行阳二十
五度及之则病作。其邪之入营者。既无外出之势。而营之素痹者。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。黄芩为佐。清其半里之热。桂枝干姜。
所以通肌表之痹。栝蒌根牡蛎。除留热。消瘀血。甘草。和诸药调阴阳也。得汗则痹邪
散。瘀热行。而病愈矣。
老师说：“疟疾，是指寒热交替发作且有固定时间的病证。虽然有三阳经和三阴经的区别，但其病位总在半表半里之间。少阳经主管半表半里，其脉象必然呈现弦脉。现在为您提纲挈领地总结说：”疟疾的脉象自当以弦脉为主。（而在弦脉中兼见的其他脉象。）弦而数的脉象，多表现为热证；弦而迟的脉象，多表现为寒证。
（通过这一隅可以推知其余三种情况。至于根据具体证候施治。）若脉象弦、小且紧，（因为脉小可知病邪在里，可）用下法（治疗即可痊愈）。若脉象弦而迟，（多属寒证，没有疑问，即）可用温法治疗。若脉象弦而紧（且不细小），（可知病邪在表而不在里。）可用发汗法或针灸治疗。（若脉象）浮大，（可知邪气在高处胸膈，可）用吐法（使邪气从上而出）。若脉象弦数（多属热证，治宜清热，但若热极生风，应当知道这是）风发（类型的疟疾）。（如果以上根据脉象施治的方法，治疗后仍然不止，更应当）通过饮食调养来缓解症状。（这符合《难经》所说的“损其脾者，调其饮食，适其寒温”的宗旨。）
这一段论述疟证离不开少阳经，以弦脉为主要特征，根据其兼见的脉象不同而施治。最后一句指出，若治疗不愈，应从脾胃求治，这是为久疟、虚疟确立的大法。徐忠可、尤在泾等医家的解释都是错误的。
弟子（陈元犀）按语：《素问·疟论》对此论述非常详尽。大致而言，邪气与卫气相搏则发病，分离则病休。每日发作一次的，正气不虚，容易治愈；隔日或三日发作一次的，正气虚弱，邪气内迫于阴分，难以治愈。张仲景认为《内经》旨意深远，难以向中等资质以下的人说明，于是另寻阴阳出入的关键之处，独取少阳经为主，以补充《内经》未言明的旨意，并向后人展示掌握要领的图谱。开篇就说“疟脉自弦”，看这个“自”字，大有深意，表明疟证虽然各不相同，但少阳脉的真实面目是不可掩盖的。
患疟疾，以一个月（来计算）。若一日（一）次发作，应当在十五日后痊愈。（以五日为一候，三候为一气，一气为十五日。人受气于天，天气变化则人身之气也随之变化，更替之气旺盛则不受邪气侵袭而痊愈。）如果未能痊愈，应当在当月结束时解除。（这是又经历了一个旺气周期。）如果（经历两个气周期而）仍未痊愈，该怎么办呢？老师说：这是因为（疟邪未衰，与气血痰饮）结聚成 瘕块，名叫疟母。应当紧急治疗，适宜使用鳖甲煎丸。
这一段论述疟邪随着人体正气的盛衰而消长。上一节提到的通过饮食调养来止疟，是治疗久疟的正法。如果有疟母，必须先紧急去除有形的 瘕块，再培补无形的元气。医者切不可过于“小心”，酿成姑息养奸的祸患。如张景岳方中的何人饮、休疟饮、追疟饮，都是调停两可、走江湖的套路技法。
鳖甲煎丸方
鳖甲（十二分，炙） 乌扇（三分，烧，即射干） 黄芩（三分） 柴胡（六分） 鼠妇（三分，熬） 干姜 大黄 桂枝 石苇（去毛） 浓朴 紫葳（即凌霄花） 半夏 阿胶 芍药 牡丹皮 䗪虫（各五分） 葶苈子 人参（各一分） 瞿麦（二分） 蜂窠（四分，炙） 赤硝（十二分） 蜣螂（六分，熬） 桃仁（二分）
以上二十三味药研为末。取灶下灰一斗，清酒一斛五升，浸泡灶下灰，等到酒剩下一半时，将鳖甲放入其中，煮至烂熟如胶漆状，绞取汁液，加入诸药，煎制成丸，如梧桐子大。空腹服七丸，每日三次。《千金方》用鳖甲十二片，另有海藻三分，大戟一分，无鼠妇和赤硝两味药。
老师说：阴气孤绝，阳气独发。（阳气独发，气被火邪灼蚀，火无水制约。）则出现发热、气短、烦闷冤屈感。（阴气孤绝，无法濡润体表，无法固守体内，则）手足发热且想呕吐，名叫瘅疟。如果（想知道）只有热而无寒（的原因），（须知）邪气内藏于心，外留于分肉之间，使人肌肉消瘦。（肌肉属阴，阳极则阴消亡。）
按《内经》所论述的瘅疟，概括其大意，是因为肺素有热，偶然感受风寒，内藏于心，外留于分肉。表则有寒而里有热，由于阴气内虚，不能与阳气相争，所以只有热而不发冷。老师未出方剂，我参照比例使用白虎加桂枝汤。用白虎汤清心救肺，以除里热；加桂枝调和营卫，以驱外邪。诚可谓一方而同时扼住两个关键。即使是先热后寒，名为热疟，也用白虎汤清其先热，桂枝解其后寒，极为对症。这是此法之外的变通之法。然而本节内容与《内经》略有差异，老师略去了经文，不提外感风寒，而以“阴气孤绝，阳气独发”两句为主。方中有桂枝，又似乎未完全切中要害，老师早已仔细审察过了。如果像薛立斋、张景岳、赵养葵那样，使用六味地黄汤及玉女煎的说法，反而会导致滞留邪气、滋生热势而使病情加重。俗传的疟痢三方，危害更快。老师对这些重症不出方剂，是想让人细细寻绎而自行领悟。《伤寒论》自序说：“若能寻余所集，思过半矣。”这就是他的心意。弟子（陈元犀）按语：下一节的白虎加桂枝汤，是《内经》所言的瘅疟，并非老师所说的瘅疟治法。老师未出方，似乎可借用竹叶石膏汤之类，而梨汁、甘蔗汁，也可以辅助服用。
（又有）温疟。（冬季不藏精，则肾水亏而心火盛。火盛于内，外为寒气所格拒而不能外出，则火气内郁，日益增强，至春季感受温气而发，夏季感受热气而发。此病属于伏气致病，与突然感受不同，故）其脉象看似正常。（但这种病应当依据症状诊断而不单凭脉象，《难经》说：温病的脉象，行走在各经之中，不知是哪一经的病，就是这个意思。）身体无恶寒，只有发热，骨节烦痛，时而呕吐。（这是因为热从肾出，外留于合穴，而上并于阳明经。）用白虎加桂枝汤主治。（在大凉肺胃的药中加入一味辛温之品，顺应病势而引导它。）
这一段论述温疟与《内经》不同，而其义理则相互表里。然而我认为读仲景的书，读其正面，需知其反面；读其正面，需知其侧面。这样顺逆分合，就像织锦回文诗一样，字字扣得紧密。上一节讲瘅疟，单主阴绝阳发，以补充经文未尽之意。至于经文所说，肺热加上外感，作为瘅疟的正证，也包含在内。同样是瘅疟，却有无毫厘千里的差别。这就是老师不轻易出方的原因。至此节论温疟，又与《内经》不同。意思是伏气外出的证候，开始时，热被寒郁而内藏；发作时，寒因热盛而屈服。最终酿成如此猖狂的热祸，都源于寒邪格外格拒成为祸端。用白虎汤清其热势，加桂枝追踪其由来，可谓面面周到。且所说的无寒但热、疼呕等症状，俱是《内经》瘅疟的正证。老师在此补叙其正证，补出其正方，文法错综变化，不是细心人不能体会。虽然，篇首有“弦数者风发”一句，《伤寒论》有“风温”一证，于此可以悟开大道，普济无量苍生了。
白虎加桂枝汤方
知母（六两） 石膏（一斤） 甘草（二两，炙） 粳米（二合） 桂枝（三两）
以上五味药，用水一斗，煮至米熟汤成，去渣，温服一升，每日三次。
疟疾（少热）多寒者。（并非真寒。是由于无形之寒气，挟带形之痰饮，伏在心间，阳气不能外透于肌表，故多寒，甚至有寒无热。心为牡脏，因）名（之）曰牡疟。（用）蜀漆散主治。（驱除心胸结伏之痰饮，则内陷之邪，也会转旋而外出。）
这一段论述牡疟证。方中云母无真品，未能速效，且此方原是宣通心阳，使气行于肌表，则不至偏于阴盛，却不专在于涌吐。故不注明“吐”字。我借用桂枝去芍药加蜀漆龙骨牡蛎救逆汤，效果神奇。
以上三味药，捣碎为散。未发作前，用浆水送服半钱匕。
附《外台秘要》三方
牡蛎汤 治牡疟。
牡蛎 麻黄（各四两） 甘草（二两） 蜀漆（三两）
以上四味药，用水八升，先煮蜀漆、麻黄，去掉上面的泡沫，得六升，加入诸药，煮取二升，温服一升。若服药后呕吐，则不要继续服用。
尤在泾说：这是宋代孙奇等人所附，大概是蜀漆散的意思，但外攻之力较猛烈了。赵氏说：牡蛎软坚消结，麻黄不仅散寒，还可发越阳气，使其通达于外。结散阳通，病自然痊愈。
柴胡去半夏加栝蒌根汤 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（三两） 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。
徐忠可说：疟邪在半表半里之间，入与阴争则寒，出于阳争则热，这是少阳的象。所谓少阳而兼他经之证则有之，谓他经而全不涉少阳，则不成其为疟了。所以小柴胡汤为少阳主方，口渴易半夏加栝蒌根，也是治疗少阳的成法。攻补兼施，故也主治劳疟。
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） 干姜（三两） 栝蒌根（四两） 黄芩（三两）
甘草（二两，炙） 牡蛎（二两）
以上七味药，用水一斗煮取六升，去渣再煎取三升，温服一升，每日三次。初服微烦，复服汗出便愈。
赵氏说：此证与牡疟相似而实非。牡疟邪客于心下，此证是风寒湿痹阻于肌表。肌表既已痹阻，阳气不得通达于外，遂郁伏于营血之中。阳气化热，血滞成瘀，附着于该处，遇到卫气行阳二十五度经过此处则发病。其邪入营者，既无外出之势，而营气素来痹阻者，也不出来与阳争，故少热或无热。因此用柴胡为君药，发散其郁伏之阳；黄芩为佐药，清其半里之热；桂枝、干姜，用来通肌表之痹；栝蒌根、牡蛎，清除余热，消散瘀血；甘草，调和诸药，调理阴阳。得汗则痹邪散，瘀热行，病就好了。
The Master said, "Malaria (Nue Bing) is characterized by alternating chills and fever with a fixed schedule. Although there are differences among the Three Yang and Three Yin meridians, its location is always between the exterior and interior (Ban Biao Ban Li). The Shaoyang meridian governs this region, so its pulse must be wiry (Xian Mai). Now, to summarize the main principle: 'The pulse of malaria is naturally wiry.' (Among the wiry pulses, those with accompanying characteristics.) A wiry and rapid (Xian Shu) pulse indicates mostly heat; a wiry and slow (Xian Chi) pulse indicates mostly cold.
(From one corner, one can infer the others. As for treatment based on symptoms.) If the pulse is wiry, small, and tight (Xian Xiao Jin), (because it is small, we know the pathogen is in the interior, and we may) use purgation (to achieve recovery). If the pulse is wiry and slow (Xian Chi), (it is mostly cold without doubt, so we may) use warming methods. If the pulse is wiry and tight (Xian Jin) (and not small), (we know the pathogen is in the exterior and not in the interior.) we may use diaphoresis or acupuncture/moxibustion. If the pulse is floating and large (Fu Da), (we know the pathogen is in the high position [chest/diaphragm], and we may) use emesis (to expel it upwards). If the pulse is wiry and rapid (Xian Shu) (mostly heat, treatment should clear heat, but if extreme heat generates wind, one should know this is) Wind-Fa Malaria (Feng Fa). (If the above treatments based on pulse do not stop the disease, one should further) use dietary management to resolve it. (This aligns with the principle in the *Nan Jing* that 'for damage to the Spleen, regulate diet and adjust warmth and cold.')
This section states that malaria syndromes are inseparable from the Shaoyang meridian, with the wiry pulse as the primary indicator, and treatment varies according to accompanying pulse features. The last sentence indicates that if treatment fails, one should seek the cause in the Spleen and Stomach, establishing a general method for chronic and deficiency-type malaria. The interpretations by Xu Zhongke, You Zaijing, and others are erroneous.
Disciple (Chen Yuanxi) notes: The *Su Wen: Malaria Chapter* discusses this in detail. Generally, when pathogenic qi combines with Defensive Qi (Wei Qi), the disease manifests; when they separate, the disease rests. Daily attacks indicate righteous qi is not deficient and will heal easily. Intermittent (every other day or every third day) attacks indicate deficient righteous qi, with pathogens invading the Yin internally, making healing difficult. Zhang Zhongjing considered the profound intent of the *Nei Jing* difficult to explain to those of average or lower capacity, so he sought the critical point of Yin-Yang entry and exit, focusing solely on the Shaoyang meridian to supplement what the *Nei Jing* did not explicitly state, and providing future generations with a map to grasp the essentials. Opening with "The pulse of malaria is naturally wiry," the word "naturally" (Zi) holds deep meaning, showing that although malaria syndromes vary, the true nature of the Shaoyang pulse cannot be concealed.
In malaria, calculated by month. If it occurs once a day, it should heal within fifteen days. (Five days constitute one Hou; three Hous make one Qi period; one Qi period is fifteen days. Humans receive Qi from Heaven; when Heavenly Qi changes, human Qi also changes. When the changing Qi is prosperous, it resists pathogens and heals.) If it does not recover, it should resolve by the end of the month. (This represents another cycle of prosperous Qi.) If it does not recover after two Qi periods, what should be done? The Master said: This is because (the malaria pathogen has not declined and) condenses with Blood, Qi, Phlegm, and Fluids into a mass (Jia), named Malaria Mother (Nue Mu). It must be treated urgently, preferably with Biejia Jian Wan (Turtle Shell Decoction for Reducing Masses).
This section discusses how malaria pathogens wax and wane according to the strength of the body's righteous Qi. The previous section's dietary management is the correct method for treating chronic malaria. If there is a Malaria Mother, one must first urgently remove the有形 (tangible) mass, then nourish the intangible Original Qi. Physicians must not be overly 'cautious,' causing disaster through indulgence. Formulas like Heren Yin, Xiu Nue Yin, and Zhui Nue Yin from Zhang Jingyue's works are merely compromise tactics and quackery.
Biejia Jian Wan Formula
Bie Jia (Turtle Shell, 12 fen, prepared) Wu Shan (Iris Tectorii Rhizome/Shexiang, 3 fen, burnt, i.e., She Gan) Huang Qin (Scutellaria Root, 3 fen) Chai Hu (Bupleurum Root, 6 fen) Shu Fu (Kerria Glabra Fruit, 3 fen, processed) Gan Jiang (Dried Ginger) Da Huang (Rhubarb Root) Gui Zhi (Cinnamon Twig) Shi Wei (Pyrrosia Leaf, de-haired) Hou Po (Magnolia Bark) Zi Wei (Lonicera Japonica Flower/Lingxiao) Ban Xia (Pinellia Tuber) E Jiao (Donkey-Hide Gelatin) Shao Yao (Peony Root) Mu Dan Pi (Moutan Cortex) Chan Chong (Ground Beetle, each 5 fen) Ting Li (Perilla Seed) Ren Shen (Ginseng Root, each 1 fen) Qu Mai (Polygonum Aviculare Herb) Feng Ke (Honeycomb, 4 fen, prepared) Chi Xiao (Red Nitre/Chihun, 12 fen) Qiang Lang (Dung Beetle, 6 fen, processed) Tao Ren (Peach Kernel, 2 fen)
Grind the above twenty-three ingredients into powder. Take one dou of ash from the kitchen stove and one hu five sheng of clear wine. Soak the ash in the wine. When half the wine has been absorbed, place the Bie Jia in it. Boil until it becomes gelatinous like lacquer. Strain to obtain the juice. Add the other medicines and decoct into pills the size of Wuzi (wu-tzu seeds). Take seven pills on an empty stomach, three times daily. The *Qianjin Fang* uses twelve slices of Bie Jia, plus San Fen of Hai Zao (Sargassum Herb) and Yi Fen of Da Ji (Euphorbia Root), omitting Shu Fu and Chi Xiao.
The Master said: "When Yin Qi is isolated and exhausted, and Yang Qi erupts alone." (Yang erupting alone means Qi is scorched by Fire, which lacks Water to moderate it.) Then there is fever, shortness of breath, and vexation/oppression. (Yin being isolated means it cannot moisten the exterior or guard the interior,) leading to hot hands and feet and desire to vomit. This is named Dan Nue (Febrile Malaria). If (one wishes to know) why there is only heat without chills, (one must understand that) the pathogen hides internally in the Heart and resides externally between the muscle layers, causing muscles to waste away. (Muscles belong to Yin; when Yang is extreme, Yin is consumed.)
According to the *Nei Jing*, summarizing the rough outline of Dan Nue: The Lungs have inherent heat, and upon accidental exposure to Wind-Cold, the pathogen hides in the Heart and resides in the muscle layers. The exterior presents chills while the interior presents heat. Because internal Yin Qi is deficient and cannot contend with Yang, there is only heat without chills. The Master did not provide a formula. I refer to the ratio and use Baihu Jia Guizhi Tang (White Tiger Plus Cinnamon Twig Decoction). Baihu Qing clears the Heart and saves the Lungs to remove interior heat; adding Gui Zhi harmonizes Ying and Wei to drive out exterior pathogens. Truly, one formula grasps both essentials. Even if it is heat followed by chills, named Re Nue (Hot Malaria), using Baihu Qing to address the initial heat and Gui Zhi to address the subsequent chills is highly appropriate. This is a variation of the method. However, this section differs slightly from the *Nei Jing*. The Master abbreviated the scripture, omitting external Wind-Cold exposure, focusing instead on "Yin Qi isolated, Yang Qi erupting alone." The formula contains Gui Zhi, which might seem not fully targeted, but the Master had already examined this carefully. If one follows Xue Lizhai, Zhang Jingyue, and Zhao Yangkui in using Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) and Yvü Jian (Jade Woman Decoction), it would instead trap pathogens and generate heat, worsening the condition. Popular formulas for malaria and dysentery cause harm even faster. The Master omitted formulas for these severe cases to encourage seekers to ponder and realize the truth themselves. In the preface to *Shanghan Lun*, it says: "If you can search my collected works, you will understand more than half." This is his intent. Disciple (Chen Yuanxi) notes: The following Baihu Jia Guizhi Tang corresponds to the Dan Nue mentioned in the *Nei Jing*, not the treatment of Dan Nue described by the Master. Since the Master provided no formula, one might borrow Zhuyeshigao Tang (Bamboo Leaf and Gypsum Decoction) or assist with Pear Juice and Sugarcane Juice.
(There is also) Wen Nue (Warm Malaria). (Failure to store essence in winter leads to Water deficiency and Fire excess. Excess Fire inside is constrained by Cold outside, preventing outward release, causing Fire to stagnate internally, increasing day by day. Upon feeling Warm Qi in Spring or Hot Qi in Summer, it manifests. This disease involves latent pathogens, differing from sudden contraction, hence) the pulse appears normal. (But this disease should be diagnosed by symptoms rather than relying solely on pulse. The *Nan Jing* states: 'The pulse of warm diseases travels through the meridians; one does not know which meridian is affected.' This is the meaning.) The body has no chills, only heat, bone joints are painful and vexed, and there is occasional vomiting. (This is because heat originates from the Kidney, resides externally at the He-Sea points, and merges upward with the Yangming meridian.) Treat with Baihu Jia Guizhi Tang. (Adding one acrid-warm herb to the great cooling of Lung and Stomach guides the pathogen along its course.)
This section discusses Wen Nue, differing from the *Nei Jing* yet sharing related principles. However, I believe reading Zhang Zhongjing's work requires understanding the front, back, opposite, and side aspects. Thus, favorable and adverse, separating and combining, fit together like a brocade palindrome. The previous section on Dan Nue focused on Yin exhaustion and Yang eruption to supplement the scripture. The scripture's mention of Lung Heat plus external contraction as the standard Dan Nue is also included. Although both are Dan Nue, there is a difference of miles. This is why the Master did not readily provide a formula. Regarding Wen Nue here, it differs from the *Nei Jing*. The implication is that latent pathogens emerging outward initially have heat constrained by cold; upon manifestation, cold submits to heat. Ultimately, this rampant heat disaster stems from cold constriction. Baihu Qing clears the heat trend; Gui Zhi traces its origin. This is comprehensive. The symptoms of no chills, only heat, pain, and vomiting are all standard Dan Nue symptoms from the *Nei Jing*. The Master supplements the standard symptoms and provides the standard formula here. The literary structure is complex and varied, understandable only to careful readers. Although the opening mentions "wiry-rapid pulse indicates Wind-Fa," and *Shanghan Lun* mentions "Wind-Warmth," one can awaken to the great path here and save countless beings.
Baihu Jia Guizhi Tang Formula
Zhi Mu (Anemarrhena Rhizome, 6 liang) Shi Gao (Gypsum Fibrosum, 1 jin) Gan Cao (Licorice Root, 2 liang, prepared) Jing Mi (Oryza Sativa Grain, 2 he) Gui Zhi (Cinnamon Twig, 3 liang)
Decoct the above five ingredients in one dou of water until the rice is cooked and the soup is ready. Strain. Take one sheng warm, three times daily.
Malaria with (less heat and) more chills. (This is not true cold. It is due to formless Cold Qi carrying tangible Phlegm-Fluids, hiding in the Heart area. Yang Qi cannot penetrate to the muscle surface, hence more chills, even to the point of only chills without heat. The Heart is a Yang organ, therefore) it is named Mu Nue (Yang Malaria). (Treat with) Shuqi San (Chinese Perilla Powder). (Expelling the phlegm-fluids knotted in the chest and heart causes the internalized pathogen to rotate and move outward.)
This section discusses Mu Nue syndrome. The Yunmu (Cloud Mother stone) in the formula lacks authenticity and yields slow results. Moreover, this formula originally aims to diffuse Heart Yang, allowing Qi to move to the muscle surface, preventing excessive Yin dominance, rather than specifically inducing vomiting. Hence, "vomiting" is not noted. I borrow Guizhi Qu Shaoyao Jia Shuqi Longgu Muli Niuj Tang (Cinnamon Twig Decoction Removing Peony plus Chinese Perilla, Dragon Bone, and Oyster Shell Decoction for Saving from Collapse) with miraculous effect.
Shuqi San Formula
Shuqi (Chinese Perilla Herb, burnt to remove fishy smell) Yunmu (Cloud Mother Stone, burnt for two days and nights) Longgu (Dragon Bone, equal parts)
Crush the above three ingredients into powder. Before the attack begins, take half a qianbi dose with Jiangshui (fermented grain water).
Attached: Three Formulas from *Waitai Miyao*
Muli Tang (Oyster Shell Decoction) Treats Mu Nue.
Muli (Oyster Shell) Mahuang (Ephedra Herb, each 4 liang) Gan Cao (Licorice Root, 2 liang) Shuqi (Chinese Perilla Herb, 3 liang)
Decoct the above four ingredients in eight sheng of water. First boil Shuqi and Mahuang, removing the foam. Obtain six sheng. Add remaining herbs. Boil to obtain two sheng. Take one sheng warm. If vomiting occurs, do not continue administration.
You Zaijing comments: This was attached by Sun Qi et al. in the Song Dynasty. It shares the intent of Shuqi San but has stronger exterior-attacking power. Mr. Zhao says: Muli softens hardness and resolves masses; Mahuang not only disperses cold but also vents Yang Qi, allowing it to reach the exterior. When masses disperse and Yang flows, the disease heals spontaneously.
Chaihu Qu Banxia Jia Gualougen Tang (Bupleurum Decoction Removing Pinellia plus Trichosanthes Root) Treats malaria with thirst, and also treats Lao Nue (Consumptive Malaria).
Chai Hu (Bupleurum Root, 8 liang) Ren Shen (Ginseng Root) Huang Qin (Scutellaria Root) Gan Cao (Licorice Root, each 3 liang) Gua Lou Gen (Trichosanthes Root, 4 liang) Sheng Jiang (Fresh Ginger, 3 liang) Da Zao (Jujube, 12 pieces)
Decoct the above seven ingredients in one dou two sheng of water. Obtain six sheng. Strain. Decoct again to obtain three sheng. Take one sheng warm, three times daily.
Xu Zhongke comments: Malaria pathogens reside between the exterior and interior. Entering to contend with Yin causes chills; exiting to contend with Yang causes heat. This is the image of Shaoyang. While Shaoyang combined with other meridians exists, a meridian entirely unrelated to Shaoyang cannot constitute malaria. Therefore, Xiaochaihu Tang (Minor Bupleurum Decoction) is the master formula for Shaoyang. For thirst, replacing Banxia with Gualougen is a established method for Shaoyang. It combines attacking and tonifying, thus also treating Lao Nue.
Chaihu Guijiang Tang (Bupleurum and Cinnamon Twig Decoction) Treats malaria with much chills and slight heat, or only chills without heat. One dose works miraculously.
Chai Hu (Bupleurum Root, half jin) Gui Zhi (Cinnamon Twig, 3 liang) Gan Jiang (Dried Ginger, 3 liang) Gua Lou Gen (Trichosanthes Root, 4 liang) Huang Qin (Scutellaria Root, 3 liang)
Gan Cao (Licorice Root, 2 liang, prepared) Mu Li (Oyster Shell, 2 liang)
Decoct the above seven ingredients in one dou of water to obtain six sheng. Strain and decoct again to obtain three sheng. Take one sheng warm, three times daily. Initial administration causes slight restlessness; subsequent administration induces sweating and cure.
Mr. Zhao says: This resembles Mu Nue but is distinct. In Mu Nue, pathogens lodge in the epigastrium; here, Wind-Cold-Dampness bi obstructs the muscle surface. Once the surface is bi-blocked, Yang Qi cannot flow outward, becoming stagnant in the Ying-Blood. Yang Qi transforms into heat, blood stasis forms, and attaches to the site. When Wei Qi circulates through the Yang stages twenty-five times and reaches this spot, the disease manifests. The pathogen entering Ying has no tendency to exit, and the Ying Qi, inherently bi-blocked, does not emerge to contend with Yang, hence slight or no heat. Therefore, Chai Hu is used as the sovereign herb to vent stagnant Yang; Huang Qin as the assistant to clear semi-interior heat; Gui Zhi and Gan Jiang to unblock muscle-surface bi; Gua Lou Gen and Mu Li to remove residual heat and resolve blood stasis; Gan Cao to harmonize herbs and balance Yin-Yang. Sweating disperses bi-pathogens and moves stasis-heat, curing the disease.