平按∶此篇自篇首至末，见《素问》卷十第三十五《疟论》篇，与上编相接，又见
《甲乙经》卷七第五，又见《巢氏病源》卷十一《疟病诸候》，惟编次先后略异。
黄帝曰∶疟先寒后热何也？岐伯曰∶夏伤于大暑，汗大出，腠理开发，因遇夏凄沧
之小寒，寒迫之，（平按∶小寒寒迫之《素问》作水寒二字，新校正云；“《甲乙》
《太素》水寒作小寒迫之。”据此，则本书下寒字疑衍。）藏于腠理皮肤之中，秋伤于
风，病盛矣。夫寒者阴气也，风者阳气也，先伤于寒而后伤于风，故先寒而后热。（夏
遇小寒，藏于腠理皮肤之中，至秋复伤于风。先遇于寒，故先寒也。后伤于风，故后热。
此为寒疟也。平按∶病盛矣《素问》《甲乙》作则病成矣。后热下《素问》、《甲乙》
有“病以时作，名曰寒疟”八字。）黄帝曰∶先热而后寒何也？岐伯曰∶此先伤于风而
后伤于寒，故先热而后寒，亦以时作，名曰温疟。其但热而不寒，阴气绝，阳气独发，
则少气烦 ，手足热而欲欧，名曰瘅疟。（此二种疟，略示所由，广解在下。平按∶
《素问》、《甲乙》绝上有先字，欧作呕。《素问》烦
作烦冤。）黄帝曰∶夫经言有余者泻之，不足者补之。今热为有余，寒为不足。夫
疟之寒也，汤火不能温也，及其热也，冰水不能寒也，此皆有余不足之类也。当是时，
良工不能止也，必须其时自衰，（平按∶《素问》作必须其自衰，《甲乙》作必待其自
衰。）乃刺之，其故何也？愿闻其说。岐伯曰∶经言无刺 之气，无刺浑浑之脉，无
刺漉漉之汗，故其为病逆不可治。（此言病发盛时，不可取也。平按∶ 之气，气字
《素问》、《甲乙》作热，新校正云∶“全元起本及《太素》热作气。”）夫疟之始发
也，阳气并于阴，当是之时，阳虚而阴盛，外无气，故先寒 。阴气逆极，则复出之阳，
阳与阴复并于外，则阴虚而阳实，故热而渴。夫疟气者，并于阳而阳胜，并于阴则阴胜，
阴胜则寒，阳胜则热。疟，风寒气也，不常，病极则复至。（平按∶“疟，风寒气也，
不常，病极则复至。”《素问》作“疟者，风寒之气不常也，病极则复。”王注云∶
“复，谓复旧也。言其气发至极，还复如旧。”至字连下文病之发也作句。新校正云∶
“《甲乙》作疟者，寒风之暴气不常，病极则复至。全元起本及《太素》作疟，风寒
气也，不常，病极则复至。至字连上句，与王氏之意异。”）病之发也如火热，风雨不可
当也。故经言曰∶方其盛时，勿敢必毁，因其衰也，事必大昌。此之谓也。（此言取其
衰时有益者也。平按∶《素问》、《甲乙》热字上有之字，下有如字，盛时下无勿敢二
字。新校正云∶“《太素》作勿敢必毁。”与此同。）夫疟之未发也，阴未并阳，阳未
并阴，因而调之，真气得安，邪气乃已，故工不能治其已发，为其气逆也。（此言取其
未病之病，未盛之时也。平按∶《素问》、《甲乙》邪气乃已作邪气乃亡，别本亦作亡。）
黄帝曰∶
善。工之奈何？早晏何如？（晏，晚也。疗疟之要，取之早晚何如也？平按《素问》
任务攻。）岐伯曰∶疟之且发，阴阳之且移也，必从四末始，阳以伤，阴从之，故先其
时，坚束其处，令邪气不得入，阴气不得出，后见之在孙络，盛坚而血者皆取之，此直
往而取，未得并者也。（此言疗之在早，不在于晚也。夫疟之作也，必内阴外阳，相入
相并相移乃作。四肢为阳，脏腑为阴。疟之将作，阳从四肢而入，阴从脏腑而出，二气
交争，阴胜为寒，阳胜为热。疗之二气未并之前，以绳坚束四肢病所来处，使二气不得
相通，必邪见孙络，皆刺去血，此为要道也。阳以伤者，阳虚也。阴从之者，阴并也。
平按∶《素问》、《甲乙》阳以伤，以作已；后见之作审候见之。直往《素问》作真往，
新校正云∶“真往《甲乙》作其往，《太素》作直往。”）黄帝曰∶病不发，其应何如？
（疟病有休有作，其应何气也？平按∶《素问》、《甲乙》病作疟。）岐伯曰∶疟气者，
必更盛更虚，随气所在。病在阳则热，脉躁；在阴则寒，脉静；极则阴阳俱衰，卫气相
离，则病得休；卫气集，则复病。（疟气不与卫气聚，故得休止。若疟气居卫，与卫气
聚者，则其病复作。故病不发者，不与阴阳相并故也。平按∶随气所在《素问》作当气
之所在也。）黄帝曰∶时有间二日或至数日发，或渴或不渴，其故何也？（夫疟之作，
迟数不同。或不间日，谓一日一发也。或有间日，隔日而发也。或间二日，三日一发也。
或至数日一发，四日以去有一发也。诸间二日以去温疟，人多不识，不以为疟，宜审察
之，以行补泻也。）岐伯曰∶其间日者，邪气与卫气客于六腑，而时相失，不能相得，
故休数日乃作。（疟气卫气俱行，行至六腑，谷气有时盛衰，致令二气相失，数日乃得
一集，集时即发，故至数日乃作也。平按∶而时相失《素问》作而
有时相失，《甲乙》作而相失。）疟者，阴阳更胜，或甚或不甚，或渴或不渴。（阴盛
寒甚不渴，阳胜热甚故渴也。平按∶或渴上《素问》、《甲乙》有故字。）黄帝曰∶论
言夏伤于暑，秋必 疟，今疟不必应何也？（夏伤于暑，秋必 疟。今疟之发，不必要
在秋时，四时皆发，其故何也？平按∶《甲乙》无论言二字。 疟《素问》作病疟，新
校正云∶“按《生气通天论》并《阴阳应象大论》俱作 疟。”注不必要在秋时，要字
袁刻作应，亦通。）岐伯曰∶此应四时者也。其病异形者，反四时者也。（或夏伤于暑，
或冬伤于寒，以为疟者，至其发时，皆应四时，但病形异也。）其俱以秋病者寒甚，以
冬病者寒不甚，以春病者KT 风，以夏病者多汗。（KT ，于路反，畏KT 也。言同伤
寒暑，俱以四时为疟也。秋三月时，阴气得胜，故热少寒甚也。冬三月时，阳生阴衰，
故热多寒少也。春三月时风甚，故恶风也。夏三月时温热甚，故多汗也。平按∶《素问》、
《甲乙》无俱字，KT 均作恶。）黄帝曰∶夫温疟与寒疟各安舍？舍何脏？（问寒温二
疟所居之脏也。平按∶《素问》夫下有病字，各安舍舍何脏作而皆安舍舍于何脏，《甲
乙》作其在何脏。）岐伯曰∶温疟者，得之冬中风，寒气藏于骨髓之中，（平按∶寒下
《甲乙》、巢氏重寒字。）至春则阳气大发，邪气不得出，因遇大暑，脑髓铄，脉内销
泽，（平按∶邪气不得出《甲乙》作不能出，《素问》作不能自出。脉肉销泽《素问》、
《甲乙》作肌肉消，巢氏作脉肉消释。）腠理发泄，因有所用力，邪气与汗偕出，（平
按∶因《素问》、《甲乙》作或，偕作皆。）此病藏于肾，其气先从内出之于外，如是
则阴虚而阳盛，则病矣，衰则气复反入，入则阳虚，阳虚则寒矣，故先热而后寒，名曰
温疟。（此言温疟所舍之脏，谓冬三月时，因腠理开，得大寒气深入，至于骨
髓，藏于肾中，至春阳气虽发，亦不能出，在内销于脑髓，销泽脉肉，发泄腠理，有因
用力汗出，其寒气从内与汗俱出，是则阴虚，阴虚阳乘，内盛为热，故先热也；热极复
衰，反入于内，外阳复虚，阳虚阴乘为寒，所以后寒，故曰温疟也。平按∶则病矣《素
问》作阳盛则热矣，《甲乙》作阳盛则热衰矣。又注阳虚阴乘，别本无阳虚二字。）黄
帝曰∶瘅疟者何如？岐伯曰∶瘅疟者，肺之素有热气盛于身，厥逆上，中气实而不外泄，
因有所用力，腠理开，风寒舍于皮肤之内，分肉之间而发，发则阳气盛，气盛而不衰，
则病矣。（瘅，热也。素，先也。人之肺中，先有热气，发于内热，内热盛而不衰，以
成瘅疟之病也。平按∶肺之素有热，《素问》、《甲乙》无之字，巢氏素作系。厥逆上
《素问》作厥逆上冲，巢氏作上下。）其气不反之阴，故但热不寒，寒气内藏于心，而
外舍分肉之间，令人销铄脱肉，故命曰瘅疟。黄帝曰∶善哉。（为寒气所发热气，不反
之阴，故但热不寒。神引寒气藏心，而舍分肉之间，故能销铄脱肉，令人瘦瘠。然则无
寒独热，故曰瘅疟也。平按∶不反之阴《素问》作不及于阴，新校正云∶“全元起本及
《太素》作不反之阴，巢元方作不及之阴。”寒气，寒字《素问》、《甲乙》不重。销
铄《素问》作消烁，《甲乙》作消铄，巢氏同。）
【平按】：本篇从篇首到篇末，见于《素问》卷十第三十五《疟论》篇，与上编相接，又见于《甲乙经》卷七第五，又见于《巢氏病源》卷十一《疟病诸候》，只是编排顺序略有不同。
黄帝说：疟疾先出现寒战而后发热，这是为什么呢？岐伯回答说：夏季遭受大暑热之邪，汗液大量排出，腠理（皮肤毛孔）开放，此时如果遇到夏季清凉的小寒之气，寒气逼迫人体，（平按：小寒寒迫之，《素问》作“水寒”二字，新校正说：“《甲乙》《太素》中‘水寒’作‘小寒迫之’。”据此，则本书下文的“寒”字可能是衍文。）寒气藏匿于腠理和皮肤之中，秋季再感受风邪，病情就加重了。寒气属于阴气，风邪属于阳气，先受寒邪后受风邪，所以先寒战后发热。（夏季遇到小寒，藏匿于腠理皮肤之中，到了秋季又伤于风邪。先遇寒邪，所以先寒；后伤风邪，所以后热。这称为寒疟。平按：病盛矣，《素问》《甲乙》作“则病成矣”。后热之下，《素问》、《甲乙》有“病以时作，名曰寒疟”八个字。）
黄帝说：先发热而后寒战，这是为什么呢？岐伯回答说：这是先伤于风邪而后伤于寒邪，所以先发热而后寒战，也是按时发作，称为温疟。如果只有发热而没有寒战，说明阴气衰竭，阳气单独亢盛，就会出现气短、心中烦闷郁结、手足发热且想呕吐的症状，称为瘅疟（dān nüè，一种但热不寒的疟疾）。（这两种疟疾，简要说明了其成因，详细解释在下文。平按：《素问》、《甲乙》在“绝”字上有“先”字，“欧”作“呕”。《素问》中“烦”作“烦冤”。）
黄帝说：医经上说，有余的病证用泻法，不足的病证用补法。现在发热属于有余，寒战属于不足。疟疾发作时的寒战，用汤火也不能使其温暖；等到发热时，用冰水也不能使其寒冷，这些都属于有余和不足的情况。在这个时候，高明的医生也不能止住它，必须等待邪气自然衰退，（平按：《素问》作“必须其自衰”，《甲乙》作“必待其自衰”。）然后才能针刺治疗，这是什么原因呢？我想听听其中的道理。岐伯回答说：医经说不要针刺热气炽盛的时候，不要针刺脉象混乱无序的时候，不要针刺大汗淋漓的时候，所以这些病势逆乱的时候是不可治疗的。（这说明病发正盛时，不可取穴治疗。平按：“之气”，“气”字在《素问》、《甲乙》中作“热”，新校正说：“全元起本及《太素》中‘热’作‘气’。”）
疟疾刚开始发作时，阳气并入阴分，在这个时候，阳虚而阴盛，体表没有阳气护卫，所以先出现寒战。阴气逆乱至极，就会复出而归于阳，阳与阴再次合并于外，这时阴虚而阳实，所以出现发热和口渴。疟疾的邪气，并入阳分则阳胜，并入阴分则阴胜，阴胜则寒，阳胜则热。疟疾是风寒邪气，不恒定不变，病势极盛时就会反复。（平按：“疟，风寒气也，不常，病极则复至。”《素问》作“疟者，风寒之气不常也，病极则复。”王冰注说：“复，谓复旧也。言其气发至极，还复如旧。”“至”字连下文“病之发也”作一句。新校正说：“《甲乙》作‘疟者，寒风之暴气不常，病极则复至。’全元起本及《太素》作‘疟，风寒气也，不常，病极则复至。’‘至’字连上句，与王意不同。”）疟疾发作时如火热般猛烈，风雨都不能抵挡。所以医经说：当邪气正盛时，不敢强行攻伐，要趁着邪气衰退时治疗，事情必定大吉。说的就是这个意思。（这说明趁邪气衰退时治疗有益处。平按：《素问》、《甲乙》“热”字上有“之”字，“下”下有“如”字，“盛”时下无“勿敢”二字。新校正说：“《太素》作‘勿敢必毁’。”与此相同。）
疟疾未发作时，阴气未并入阳分，阳气未并入阴分，趁机调理身体，真气得以安宁，邪气就会消除，所以医生不能在疟疾已发作时治疗，因为那时气机逆乱。（这说明要在未发病之前、邪气未盛之时治疗。平按：《素问》、《甲乙》“邪气乃已”作“邪气乃亡”，别本也作“亡”。）
黄帝说：好。医生的治疗方法是怎样的？早晚时机如何把握？（晏，晚也。治疗疟疾的关键，在于选择早晚何时治疗？平按《素问》任务攻。）岐伯回答说：疟疾将要发作时，阴阳之气即将发生移位，一定从四肢末端开始，阳气受伤，阴气随之，所以在发作之前，坚固地束缚患处，使邪气不得进入，阴气不得外出，后来发现孙络（细小的络脉）中有充盈坚硬的血脉，都进行刺破放血，这是直接前往取穴，是在邪气尚未合并之时。（这说明治疗要在早，不在晚。疟疾发作，必然内阴外阳，相互入并移位才发作。四肢为阳，脏腑为阴。疟疾将作，阳从四肢而入，阴从脏腑而出，二气交争，阴胜为寒，阳胜为热。治疗在二气未合并之前，用绳子坚固束缚四肢病邪来处，使二气不得相通，必定邪气见于孙络，都刺去瘀血，这是关键之道。阳以伤者，即阳虚。阴从之者，即阴并。平按：《素问》、《甲乙》“阳以伤”，“以”作“已”；“后见之”作“审候见之”。直往，《素问》作“真往”，新校正说：“真往，《甲乙》作‘其往’，《太素》作‘直往’。”）
黄帝说：疾病不发作时，其表现如何？（疟病有休止也有发作，其对应的是什么气机变化？平按：《素问》、《甲乙》“病”作“疟”。）岐伯回答说：疟疾邪气，必然有时强盛有时虚弱，随着气所在的地方而变化。病在阳分则发热，脉象躁急；病在阴分则发冷，脉象平静；极盛时阴阳都衰弱，卫气分离，病就能休止；卫气聚集，病就复发。（疟气不与卫气相聚，所以能休止。如果疟气居留在卫气中，与卫气相聚，那么病就复发。所以病不发作时，是因为不与阴阳相合并。平按：随气所在，《素问》作“当气之所在也”。）
黄帝说：有时隔两天或几天发作一次，有时口渴有时不口渴，这是什么原因？（疟疾发作，迟速不同。或不间日，指一天一发。或有间日，隔日而发。或间二日，三日一发。或至数日一发，四日以上有一次发作。各种间隔两日以上的温疟，人们大多不认识，不认为是疟疾，应当仔细审查，以施行补泻疗法。）岐伯回答说：那些间隔日子发作的，是因为邪气与卫气客居于六腑，而时常失去同步，不能相遇，所以要过几天才发作。（疟气与卫气共同运行，行至六腑，谷气有时盛衰，导致二气失去同步，经过几天才能再次集合，集合时就发作，所以过几天才发作。平按：而时相失，《素问》作“而有时相失”，《甲乙》作“而相失”。）疟疾，是阴阳交替胜负，有的严重有的不严重，有的口渴有的不口渴。（阴盛寒重而不渴，阳胜热重故口渴。平按：或渴之上，《素问》、《甲乙》有“故”字。）
黄帝说：医论说夏季伤于暑气，秋季必定患疟疾，现在的疟疾不一定应验这个规律，为什么呢？（夏季伤于暑气，秋季必定患疟疾。现在疟疾的发作，不一定在秋季，四季都会发作，这是什么原因？平按：《甲乙》无“论言”二字。痎疟，《素问》作“病疟”，新校正说：“按《生气通天论》并《阴阳应象大论》俱作‘痎疟’。”注不必要在秋时，“要”字袁刻作“应”，也通。）岐伯回答说：这是顺应四时的情况。那些病情形态不同的，是违背四时规律的。（或夏季伤于暑，或冬季伤于寒，形成疟疾，到发作时，都应顺应四时，只是病情形态不同。）如果在秋季患病则寒重，在冬季患病则寒不重，在春季患病则恶风，在夏季患病则多汗。（KT，于路反，畏KT也。言同伤寒暑，俱以四时为疟也。秋三月时，阴气得胜，故热少寒甚也。冬三月时，阳生阴衰，故热多寒少也。春三月时风甚，故恶风也。夏三月时温热甚，故多汗也。平按：《素问》、《甲乙》无“俱”字，KT均作“恶”。）
黄帝说：温疟和寒疟各居住在哪个部位？舍居于哪一脏？（询问寒温二疟所居之脏。平按：《素问》夫下有“病”字，各安舍舍何脏作“而皆安舍舍于何脏”，《甲乙》作“其在何脏”。）岐伯回答说：温疟，是由于冬季感受风邪，寒气藏匿于骨髓之中，（平按：寒下，《甲乙》、巢氏重“寒”字。）到了春天阳气大发，邪气无法排出，如果遇到大暑天，脑髓被销铄，血脉肌肉消泽，（平按：邪气不得出，《甲乙》作“不能出”，《素问》作“不能自出”。脉肉销泽，《素问》、《甲乙》作“肌肉消”，巢氏作“脉肉消释”。），腠理发泄，因为有所用力劳作，邪气随着汗液一起排出，（平按：因，《素问》、《甲乙》作“或”，偕作“皆”。）这种病藏于肾，其气先从内部出于外部，这样就是阴虚而阳盛，于是发病，衰退时气又返回内部，进入内部则阳虚，阳虚则寒，所以先发热而后寒战，称为温疟。（这说明温疟所舍之脏，是指冬季三个月时，因腠理开，得大寒气深入，至于骨髓，藏于肾中，到了春天阳气虽发，也不能排出，在内销于脑髓，销泽脉肉，发泄腠理，有因用力汗出，其寒气从内与汗俱出，是则阴虚，阴虚阳乘，内盛为热，所以先热；热极复衰，反入于内，外阳复虚，阳虚阴乘为寒，所以后寒，故曰温疟。平按：则病矣，《素问》作“阳盛则热矣”，《甲乙》作“阳盛则热衰矣”。又注阳虚阴乘，别本无“阳虚”二字。）
黄帝说：瘅疟又是怎样的？岐伯回答说：瘅疟，是因为肺中素有热气盛于全身，厥逆之气上行，中气充实而不能外泄，因为有所用力劳作，腠理开放，风寒邪气舍居于皮肤之内，分肉之间而发作，发作时阳气盛，气盛而不衰，于是发病。（瘅，热也。素，先也。人之肺中，先有热气，发于内热，内热盛而不衰，以成瘅疟之病也。平按：肺之素有热，《素问》、《甲乙》无“之”字，巢氏“素”作“系”。厥逆上，《素问》作“厥逆上冲”，巢氏作“上下”。）其气不反过来并入阴分，所以只有发热而没有寒战，寒气内藏于心，而外舍于分肉之间，使人肌肉消瘦脱肉，所以命名为瘅疟。黄帝说：太好了。（为寒气所发热气，不反之阴，故但热不寒。神引寒气藏心，而舍分肉之间，故能销铄脱肉，令人瘦瘠。然则无寒独热，故曰瘅疟也。平按：不反之阴，《素问》作“不及于阴”，新校正说：“全元起本及《太素》作‘不反之阴’，巢元方作‘不及之阴’。”寒气，寒字《素问》、《甲乙》不重。销铄，《素问》作“消烁”，《甲乙》作“消铄”，巢氏同。）
[Ping An]: This chapter, from the beginning to the end, is found in *Suwen* (Basic Questions), Volume 10, Chapter 35 "Malaria Theory" (Nüe Lun), connected with the previous compilation. It also appears in *Jiayi Jing* (Systematic Classic of Acupuncture and Moxibustion), Volume 7, Chapter 5, and in *Chao Shi Bing Yuan* (Source of Diseases by Chao Yuanfang), Volume 11 "Various Syndromes of Malaria", with only slight differences in arrangement order.
Yellow Emperor said: Why does malaria present with chills first and fever later? Qibo replied: In summer, one is injured by intense heat (Shu), causing profuse sweating and the opening of Couli (skin pores). If one then encounters a slight cold (Xiao Han) characteristic of early autumn chill, the cold forces its way in, (Ping An: "Xiao Han han po zhi" in this text; *Suwen* reads "Shui Han". Xin Zheng Jiao says: "*Jiayi*" and "*Taisu*" read "Xiao Han po zhi" instead of "Shui Han". Based on this, the character "Han" below in this book may be superfluous.) The cold qi hides within the Couli and skin. In autumn, one is further injured by Wind, and the disease intensifies. Cold belongs to Yin Qi, while Wind belongs to Yang Qi. Being injured by cold first and wind later results in chills first and fever later. (Encountering slight cold in summer, it hides within the Couli and skin; encountering wind again in autumn. Since cold was encountered first, chills appear first; since wind was injured later, fever appears later. This is called Cold Malaria. Ping An: "Bing sheng yi" (*Disease becomes severe*) in *Suwen* and *Jiayi* reads "Ze bing cheng yi" (Then the disease is formed). Below "Hou re" (Later fever), *Suwen* and *Jiayi* have eight characters: "Bing yi shi zuo, ming yue Han Nüe" (The disease occurs at specific times, named Cold Malaria).)
Yellow Emperor said: Why does malaria present with fever first and chills later? Qibo replied: This is due to being injured by Wind first and Cold later, resulting in fever first and chills later. It also occurs at specific times and is named Warm Malaria (Wen Nüe). If there is only fever without chills, it indicates the exhaustion of Yin Qi and the solitary flare-up of Yang Qi. Symptoms include shortness of breath, vexation and oppression (Fan Yuan), heat in the hands and feet, and a desire to vomit (Ou). This is named Dan Nüe (Crimson/Heat Malaria). (These two types of malaria briefly indicate their origins; extensive explanations follow below. Ping An: In *Suwen* and *Jiayi*, there is a "Xian" (First) character before "Jue" (Exhaustion); "Ou" is written as "Ou" (Vomit). In *Suwen*, "Fan" is written as "Fan Yuan".)
Yellow Emperor said: The classics state that excess conditions are treated with draining methods, and deficiency conditions with tonifying methods. Now, fever represents excess, and chills represent deficiency. During the chills of malaria, boiling water or fire cannot warm the body; during the fever, ice or water cannot cool it. These belong to categories of excess and deficiency. At such times, even skilled physicians cannot stop it immediately; one must wait for the pathogenic factor to naturally decline, (Ping An: *Suwen* reads "Bi xu qi zi shuai", *Jiayi* reads "Bi dai qi zi shuai".) before applying acupuncture. What is the reason? I wish to hear the explanation. Qibo replied: The classics say: Do not puncture when Qi is chaotic (Re Qi), do not puncture when the pulse is confused (Hun Hun Zhi Mai), and do not puncture when sweat is dripping profusely (Lu Lu Zhi Han). Therefore, these rebellious pathological states are untreatable at that moment. (This means treatment should not be attempted when the disease is at its peak. Ping An: For "Zhi Qi", the character "Qi" in *Suwen* and *Jiayi* is "Re" (Heat). Xin Zheng Jiao says: "Quan Yuanqi's edition and *Taisu* read 'Qi' instead of 'Re'.")
When malaria first begins to manifest, Yang Qi merges into Yin. At this time, Yang is deficient and Yin is excessive, leading to a lack of defensive Qi on the exterior, hence chills appear first. When Yin Qi reverses to an extreme, it emerges back into Yang. Yang and Yin merge again on the exterior, resulting in Yin deficiency and Yang excess, hence fever and thirst occur. The Malaria Qi, when merging into Yang, causes Yang to prevail; when merging into Yin, Yin prevails. Yin prevalence causes chills; Yang prevalence causes fever. Malaria is caused by Wind-Cold Qi, which is not constant; when the pathology reaches its extremity, it recurs. (Ping An: "'Ma, Feng Han Qi Ye, Bu Chang, Bing Ji Ze Fu Zhi.' *Suwen* reads 'Nué zhě, fēng hán zhī qì bù cháng yě, bìng jí zé fù.' Wang Bing's commentary states: 'Fu means returning to the original state. It means when the qi erupts to its extreme, it returns to how it was.' The character 'Zhi' connects to the following sentence 'Bing zhi fa ye' as one sentence. Xin Zheng Jiao says: '*Jiayi* reads 'Nué zhě, hán fēng zhī bào qì bù cháng, bìng jí zé fù zhì.' Quan Yuanqi's edition and *Taisu* read 'Nué, fēng hán qì yě, bù cháng, bìng jí zé fù zhì.' The character 'Zhi' connects to the preceding sentence, differing from Wang's meaning.") The onset of malaria is fierce like fire and heat, impervious to wind and rain. Thus, the classics say: When the pathogen is at its peak, do not attempt to destroy it forcibly; treat it when it is declining, and success is assured. This is what is meant. (This indicates the benefit of treating during the declining phase. Ping An: In *Suwen* and *Jiayi*, there is a "Zhi" character before "Re"; a "Ru" character after "Xia"; no "Wu Gan" characters after "Sheng". Xin Zheng Jiao says: "*Taisu* reads 'Wu Gan Bi Hui'." This matches here.)
Before malaria manifests, Yin has not merged into Yang, and Yang has not merged into Yin. Regulating the body at this time allows the True Qi to settle and the Pathogenic Qi to dissipate. Hence, physicians cannot treat the disease once it has manifested, because the Qi is rebellious at that stage. (This indicates targeting the disease before onset, when it is not yet severe. Ping An: In *Suwen* and *Jiayi*, "Xie Qi Nai Yi" reads "Xie Qi Nai Wang"; other editions also read "Wang".)
Yellow Emperor said: Excellent. How should the physician proceed? What about the timing (early vs. late)? (Yan means late. The key to treating malaria lies in whether to treat early or late? Ping An *Suwen* task Gong.) Qibo replied: When malaria is about to manifest, Yin and Yang Qi are about to shift. This shift always begins at the four limbs. Yang is injured, and Yin follows. Therefore, before the onset, firmly bind the affected area to prevent the pathogen from entering and the healthy Qi from exiting. Later, observe if the Sun Luo (fine collateral vessels) show fullness and hardness with blood; puncture all such vessels. This is a direct approach taken before the pathogens merge. (This indicates treatment should be early, not late. When malaria arises, internal Yin and external Yang interact, merge, and shift to cause the disease. The four limbs belong to Yang, and the Zang-Fu organs to Yin. Before malaria manifests, Yang enters from the limbs, and Yin exits from the Zang-Fu. The two Qi compete; Yin prevalence causes chills, Yang prevalence causes fever. Before the two Qi merge, tie the limbs firmly where the disease comes from, preventing communication between the two Qi. Once the pathogen appears in the Sun Luo, puncture to remove blood; this is the essential method. "Yang yi shang" means Yang deficiency. "Yin cong zhi" means Yin merging. Ping An: In *Suwen* and *Jiayi*, "Yang yi shang" reads "Yang yi shang" (with "yi" as "yi" [already]); "Hou jian zhi" reads "Shen hou jian zhi". "Zhi wang" in *Suwen* is "Zhen wang"; Xin Zheng Jiao says: "'Zhen wang' in *Jiayi* is 'Qi wang', in *Taisu* is 'Zhi wang'.")
Yellow Emperor said: What are the manifestations when the disease is not active? (Malaria has periods of remission and attack; what Qi corresponds to this? Ping An: In *Suwen* and *Jiayi*, "Bing" reads "Nué".) Qibo replied: Malaria Qi alternates between excess and deficiency, depending on where the Qi resides. If the disease is in Yang, there is fever and a rapid pulse; if in Yin, there is chills and a quiet pulse. At the extreme, both Yin and Yang decline, Wei Qi separates, and the disease rests; when Wei Qi gathers, the disease recurs. (Malaria Qi does not gather with Wei Qi, so it can rest. If Malaria Qi stays with Wei Qi and gathers, the disease recurs. Thus, when the disease is inactive, it is because it does not merge with Yin and Yang. Ping An: "Sui Qi suo zai" in *Suwen* reads "Dang qi zhi suo zai ye".)
Yellow Emperor said: Sometimes attacks occur every two days or several days apart; sometimes there is thirst, sometimes not. What is the reason? (Malaria attacks vary in frequency. "Not every other day" means daily attacks. "Every other day" means bi-daily attacks. "Interval of two days" means tri-daily attacks. "Up to several days" means attacks after four or more days. People often fail to recognize Warm Malaria occurring at intervals greater than two days and do not identify it as malaria; careful examination is needed to apply tonification or drainage. Ping An: *Jiayi* lacks "Lun Yan" (The theory says). "Jie Nué" in *Suwen* reads "Bing Nué"; Xin Zheng Jiao says: "According to *Sheng Qi Tong Tian Lun* and *Yin Yang Ying Xiang Da Lun*, it is written as 'Jie Nué'.") Qibo replied: In cases with interval days, the pathogenic Qi and Wei Qi reside in the Six Fu Organs but lose synchronization, failing to meet, hence the pause of several days before recurrence. (Malaria Qi and Wei Qi travel together. Upon reaching the Six Fu Organs, the fluctuation of Gu Qi (Grain Qi) causes the two Qi to lose sync, requiring several days to reconverge. Convergence triggers the attack, hence the multi-day interval. Ping An: "Er shi xiang shi" in *Suwen* reads "Er you shi xiang shi"; *Jiayi* reads "Er xiang shi".) Malaria involves alternating dominance of Yin and Yang; severity varies, as does the presence of thirst. (Yin excess causes severe chills without thirst; Yang excess causes severe fever with thirst. Ping An: Above "Huo ke" (Or thirsty), *Suwen* and *Jiayi* have "Gu" (Therefore).)
Yellow Emperor said: Theories state that summer injury by Heat leads to autumn malaria. Why does current malaria not always follow this rule? (Summer injury by Heat should lead to autumn malaria. However, malaria now occurs in all seasons, not just autumn. Why? Ping An: *Jiayi* lacks "Lun Yan". "Jie Nué" in *Suwen* reads "Bing Nué"; Xin Zheng Jiao says: "According to *Sheng Qi Tong Tian Lun* and *Yin Yang Ying Xiang Da Lun*, it is written as 'Jie Nué'.") Qibo replied: This conforms to the Four Seasons. Those with atypical presentations violate the seasonal patterns. (Whether injured by Heat in summer or Cold in winter, forming malaria, the onset corresponds to the Four Seasons, though the clinical presentation differs.) If contracted in Autumn, chills are severe; if in Winter, chills are mild; if in Spring, there is aversion to wind; if in Summer, there is profuse sweating. (KT, pronounced Yu Lu fan, means fear of KT. Speaking of contracting cold/heat equally and developing malaria across all seasons. In Autumn, Yin Qi prevails, so heat is less and chills are severe. In Winter, Yang generates and Yin declines, so heat is more and chills are less. In Spring, Wind is strong, causing aversion to wind. In Summer, Heat is intense, causing profuse sweating. Ping An: *Suwen* and *Jiayi* lack "Ju" (All); KT is written as "E" (Aversion/Fear).)
Yellow Emperor said: Where do Warm Malaria and Cold Malaria reside? Which Zang Organ do they lodge in? (Asking about the Zang organs housing Cold and Warm Malaria. Ping An: *Suwen* has "Bing" after "Fu"; "Ge an she she he zang" reads "Er jie an she she yu he zang"; *Jiayi* reads "Qi zai he zang".) Qibo replied: Warm Malaria originates from Wind injury in Winter. Cold Qi hides in the Marrow. (Ping An: After "Han", *Jiayi* and Chao Shi repeat "Han".) By Spring, Yang Qi expands vigorously, but the pathogen cannot exit. If one encounters intense Summer Heat, the brain marrow is depleted, and vessels/muscles waste away, (Ping An: "Xie qi bu de chu" in *Jiayi* reads "Bu neng chu"; *Suwen* reads "Bu neng zi chu". "Mai rou xiao ze" in *Suwen* and *Jiayi* reads "Ji rou xiao"; Chao Shi reads "Mai rou xiao shi".), the Couli open and sweat flows out. Due to physical exertion, the pathogen exits along with the sweat, (Ping An: "Yin" in *Suwen* and *Jiayi* reads "Huo"; "Xie" reads "Jie".) this disease lodges in the Kidney. Its Qi first moves from interior to exterior. Thus, Yin becomes deficient and Yang becomes excessive, causing illness. As it declines, Qi returns inward; entering inward causes Yang deficiency, and Yang deficiency leads to chills. Hence, fever precedes chills, named Warm Malaria. (This explains the organ housed in Warm Malaria: In Winter, Couli open, allowing deep Cold Qi to enter the marrow and lodge in the Kidney. In Spring, although Yang Qi expands, it cannot expel the pathogen. It depletes brain marrow and wastes vessels/muscles internally, opens Couli externally. Physical exertion causes sweat, carrying Cold Qi out from inside. This results in Yin deficiency; Yin deficiency allows Yang to invade, causing internal excess and heat, hence fever first. When heat peaks and declines, it returns inward, causing external Yang deficiency; Yang deficiency allows Yin to invade, causing chills, hence chills later. Thus, Warm Malaria. Ping An: "Ze bing yi" in *Suwen* reads "Yang sheng ze re yi"; *Jiayi* reads "Yang sheng ze re shuai yi". Also, in the note "Yang xu yin cheng", other editions lack "Yang xu".)
Yellow Emperor said: What about Dan Malaria? Qibo replied: Dan Malaria arises because the Lungs inherently possess excessive Heat throughout the body. Rebellious Qi ascends, Middle Qi is full but cannot vent outward. Due to physical exertion, Couli open, and Wind-Cold Qi lodges within the skin and between the muscle layers, triggering onset. At onset, Yang Qi becomes excessive; if Qi remains excessive without declining, illness occurs. (Dan means Heat. Su means inherent/prior. The lungs inherently possess prior Heat, manifesting as internal heat. Internal heat is excessive and does not decline, forming Dan Malaria. Ping An: "Fei zhi su you re" in *Suwen* and *Jiayi* lacks "Zhi"; Chao Shi writes "Su" as "Xi". "Jue ni shang" in *Suwen* reads "Jue ni shang chong"; Chao Shi reads "Shang xia".) The Qi does not revert to Yin, hence only fever without chills. Cold Qi lodges internally in the Heart and externally between the muscle layers, causing emaciation and wasting. Thus, it is named Dan Malaria. Yellow Emperor said: Excellent. (Due to Heat generated by Cold, not reverting to Yin, hence only fever without chills. Spirit draws Cold Qi to lodge in the Heart and between muscles, causing wasting and emaciation. Thus, no chills, only heat, hence Dan Malaria. Ping An: "Bu fan zhi yin" in *Suwen* reads "Bu ji yu yin"; Xin Zheng Jiao says: "Quan Yuanqi's edition and *Taisu* read 'Bu fan zhi yin'; Chao Yuanfang reads 'Bu ji zhi yin'. 'Han Qi', the character 'Han' is not repeated in *Suwen* and *Jiayi*. Xiao Shuo in *Suwen* reads "Xiao Shuo"; *Jiayi* reads "Xiao Shuo"; Chao Shi agrees.)