平按∶此篇自篇首至末，见《素问》卷十第三十五《疟论》篇，又见《甲乙经》卷
七第五，又见《灵枢》卷十二第七十九《岁露论》，又见《巢氏病源》卷十一《疟病诸
候》，惟编次稍异。
黄帝问于岐伯曰∶夫 疟者，皆生于风，其蓄作有时何也？（ 者，有云二日一发
名疟，此经但夏伤于暑至秋为病，或云 疟，或但云疟，不必日发间日以定 也，俱
应四时其形有异以为 耳。因腠理开发，风入不泄，藏蓄合于四时，而发日之辰又异，
其故何也？平按∶ 《素问》巢氏作 。《素问》新校正云∶“按《甲乙经》云∶夫疟
疾皆生于风，其以日作以时发何也？与此文异。《太素》同今文。”并自 者有云至以
为耳，全引杨注，惟注中俱应四时作但应四时。又注 者下袁刻脱有云二字。巢氏作
“疟者，夏伤于暑也，其病秋则寒甚，冬则寒轻，春则恶风，夏则多汗者，然其蓄作
有时。”）岐伯曰∶疟之始发，先起于豪毛，伸欠乃作寒 ，寒 鼓颔，腰脊痛，寒去
则外内皆热，头如破，渴欲饮。（寒疟发状，凡有七别∶一起豪毛谓毛立，二为伸欠，
三为
寒，四腰脊痛，五内外热，六头痛甚，七渴饮水。寒疟之状，有斯七别也。平按∶豪
毛《素问》、《甲乙》作毫毛，巢氏作毫末，寒 二字俱不重。《素问》、《甲乙》脊
下有俱字。渴欲饮《素问》作渴欲冷冻饮料，《甲乙》作渴欲饮水，巢氏作头痛而渴欲饮。）
黄帝曰∶何气使然？愿闻其道。（请问寒疟发之所以也。）岐伯曰∶阴阳上下交争，虚
实更作，阴阳相移也。阳并于阴，则阴实而阳明虚，阳明虚则寒 鼓颔，巨阳虚则腰脊
头项痛，三阳俱虚，阴气胜，阴气胜则骨寒而痛，寒生于内，故中外皆寒。（寒气藏于
肠胃之外，皮肤之内，舍于营气，至于春时，阴阳交争，更胜更衰，故虚实相移也。三
阳俱并于阴，则三阳皆虚，虚为阴乘，故外寒。阴气强盛，盛故内寒。内外俱寒，汤火
不能温也。平按∶腰脊《素问》、巢氏作腰背。）阳盛则外热，阴虚则内热，外内皆热，
则喘而渴欲饮。（阴极则阳盛，阳盛则外热。阴极则阴虚，阴虚则阳乘，故内热。外内
俱热，甚于栗炭，冰水不能凉，故渴而欲饮也。平按∶欲饮《素问》、《甲乙》作故欲
冷冻饮料。）此得之夏伤于暑，热气盛，藏于皮肤之内，肠胃之外，此营气之所舍也。（此
言其日作所由也。皮肤之内，肠胃之外，脉中营气，是邪之舍也。平按∶此得之《素问》、
《甲乙》作此皆得之。）此令人汗出空疏，（平按∶汗出空疏，《素问》无出字，新校
正云∶“全元起本作汗出空疏，《甲乙》、《太素》并同。”）腠理开，因得秋气，汗
出遇风，乃得之以浴，（平按∶乃得之以浴，《素问》乃作及，《甲乙》作得浴二字。）
水气舍于皮肤之内，与卫气并居。卫气者，昼日行阳，此气得阳而出，得阴而内薄，是
以日作。（邪舍营气之中，令人汗出，开其腠理，因
得秋气，复藏皮肤之内，与卫气居。卫昼行于阳，夜行于阴，邪气与卫俱行，以日日而
作也。平按∶昼日行阳《素问》作昼日行于阳夜行于阴，《甲乙》同，惟昼下无日字。
而出《素问》、《甲乙》作而外出。是以上《素问》、《甲乙》有内外相薄四字。）黄
帝曰∶其间日而作何也？岐伯曰∶其气之舍泻，内薄于阴，阳气独发，阴邪内着，阴与
阳争不得出，是以间日而作。（其邪气因卫入内，内薄于阴，共阳交争，不得日日与卫
外出之阳，故间日而作也。平按∶泻《素问》、《甲乙》作深。注入内下原重内字，袁
刻脱。交争下袁刻有“不得出”三字。）黄帝曰∶善。其作日晏与其日早，何气使然？
岐伯曰∶邪气客于风府，循KT 而下，卫气一日一夜大会于风府，其明日，日下一节，
故其作也晏，此先客于脊背也，每至于风府则腠理开，开则邪入，邪入则病作，此以
日作稍益晏者也。其出于风府，日下一椎，二十一日下至 骨，（因卫气从风府日下，
故作也晏晚也。 ，丁礼反，尾穷骨也。平按∶《素问》、《甲乙》KT 作膂，一椎均
作一节。二十一日《素问》作二十五日。）二十二日入于脊内，注KT 之脉，其气上行
九日，出于缺盆之中，其气日高，故日益早。（邪与卫气下二十一椎，日日作晚，至二
十二日，邪与卫气注于督脉上行，气上高行，故其作也早。平按∶二十二日《素问》作
二十六日，注KT 之脉作注于伏膂之脉。《甲乙》、巢氏伏膂作伏冲。《素问》新校正
云∶全元起本二十五日作二十一日，二十六日作二十二日，《甲乙》、《太素》并同。）
其内薄于五脏，横连膜原也，其道远，其气深，其行迟，不能与卫气俱行偕出，故间日
乃作。（偕，俱也。膜原，五
脏皆有膜原。其邪气内着五脏之中，横连五脏膜原之输，不能与卫气日夜俱行阴阳，隔
日一至，故间日作也。平按∶膜原《素问》、《甲乙》作募原，《素问》新校正云∶
“全元起本募作膜。《太素》、巢元方并同，《举痛论》亦作膜原。”又《甲乙》卫气
作营气。《素问》偕出作皆出。）黄帝曰∶夫子言卫气每至于风府，腠理乃发，发则邪
入，邪入则病作。今卫气日下一节，其气之发也不当风府，其日作奈何？（项发际上风
府之空，卫气之行，日日而至。若下二十一节，复上方会风府，日作则不相当，通之奈
何也？平按∶注若下二十一节袁刻作若其下一节。）岐伯曰∶风无常府，卫气之所发也，
必开其腠理，气之所舍，即其府高已。黄帝曰∶善哉。（无常府者，言卫气发于腠理，
邪气舍之，即高同风府，不必常以项发际上以为府也。故卫气发腠理，邪舍之处，其病
日作也。平按∶《素问》岐伯曰下有“此邪气客于头项循膂而下者也，故虚实不同，邪
中异所，则不得当其风府也。故邪中于头项者，气至头项而病；中于背者，气至背而病；
中于腰脊者，气至腰脊而病；中于手足者，气至手足而病。卫气之所在，与邪气相合，
则病作。”故八十八字。新校正云∶“全元起本及《甲乙》、《太素》自此邪客于头项
至下则病作故八十八字并无。”气之所舍即其府高已《素问》作邪气之所合则其府也，
新校正云∶《甲乙》、巢元方则其府也作其病作。）
黄帝曰∶夫风之与疟也，相似同类，而风独常在，而疟得有休者，何也？（因腠理
开，风入脏内，至时而发，名之为疟。然则风之与疟，异名同类，其疟日有休时，风府
常在未愈，其意何也？平按∶有休者《素问》、《甲乙》作有时而休者。）岐伯曰∶经
留其处，卫气相顺，经络沉以内薄，故卫留乃作。（经络停
留之处，卫气过之，经脉与卫气相顺，故经脉内薄停处，卫气亦留，卫气与风留处发
动为疟，所以其风常在，疟有休作也。）
平按∶经留其处《素问》作风气留其处，《甲乙》作风气常留其处。卫气相顺《素
问》、《甲乙》作“故常在疟气随”六字。沉以内薄《甲乙》作次而内传。故卫留乃作
《素问》、《甲乙》作故卫气应乃作。袁刻留作气。
【平按】：本篇从开头到结尾，见于《素问》卷十第三十五《疟论》篇，又见于《甲乙经》卷七第五，又见于《灵枢》卷十二第七十九《岁露论》，又见于《巢氏病源》卷十一《疟病诸候》，只是编排次序稍有不同。
黄帝问岐伯说：凡是疟疾（一种以寒热往来为特征的疾病），都是由于风邪引起的，但它的发作和蓄积有时间规律，这是为什么呢？（注：关于“疟”字，有的说法是两天发作一次叫疟，此经文只说是夏季感受暑邪，到了秋季发病；有的说是“痎疟”，有的只说“疟”，不必拘泥于是否隔日发作来定义它。它们都顺应四时变化，只是表现形式不同罢了。这是因为腠理（皮肤毛孔）开发时，风邪侵入而不能排出，潜伏体内并与四时之气相合，导致每天发作的时间各不相同，这是什么原因呢？）
岐伯回答说：疟疾刚开始发作时，先起于毫毛（体表的汗毛），出现伸腰打哈欠的症状，接着开始发冷，冷得上下牙齿打颤，腰部脊柱疼痛；寒冷过去之后，内外都发热，头痛得像要破裂一样，口渴想喝水。（注：寒疟发作的状态，共有七种表现：一是毫毛竖立，二是伸腰打哈欠，三是恶寒战栗，四是腰脊痛，五是内外皆热，六是头痛剧烈，七是口渴想喝水。寒疟的症状，就是这七种。）
黄帝说：是什么气导致这样的呢？我想听听其中的道理。（注：请问寒疟发作的原因。）
岐伯说：阴阳之气上下交争，虚实交替变化，这是阴阳之气相互移易的结果。阳气并入阴分，则阴气实而阳明经虚，阳明经虚就会引起恶寒战栗、上下牙齿打颤；太阳经虚就会引起腰、脊、头项疼痛；如果三阳经（太阳、阳明、少阳）都虚，阴气胜，阴气胜则骨头寒冷而疼痛，寒气生于体内，所以内外都感到寒冷。（注：寒气潜伏在肠胃之外，皮肤之内，寄居在营气之中。到了春季，阴阳交争，更替胜负，所以虚实相互转移。三阳经之气都并入阴分，则三阳经都虚，虚则被阴气乘袭，所以外寒。阴气强盛，所以内寒。内外俱寒，即使喝汤水或烤火也不能温暖身体。）
阳气盛则体表发热，阴气虚则体内发热，内外都热，就会气喘且口渴想喝水。（注：阴气极盛则阳气亢盛，阳气亢盛则体表发热。阴气极则阴液亏虚，阴液亏虚则阳气乘虚而入，所以体内发热。内外俱热，比烧红的木炭还要热，连冰水都不能降温，所以口渴想喝水。）
这种病是由于夏季感受暑邪，热气旺盛，潜伏在皮肤之内，肠胃之外，这里是营气所居住的地方。（注：这是说明每日发作的原因。皮肤之内，肠胃之外，脉中的营气，是邪气寄居的地方。）
这使人汗出，腠理疏松开放，（注：汗出空疏，《素问》无“出”字，新校正说：“全元起本作‘汗出空疏’，《甲乙经》、《太素》都相同。”）遇到秋凉之气，出汗时受风，或者洗澡时沾了水气，（注：洗澡，《素问》作“及”，《甲乙经》作“得浴”二字。）水气就停留在皮肤之内，与卫气共同居住。卫气白天行于阳分，这种邪气随着卫气出于阳分，随着卫气入于阴分而迫近内脏，所以每天发作。（注：邪气寄居在营气中，使人出汗，使腠理开泄，遇到秋气，又藏于皮肤之内，与卫气同居。卫气白天行于阳分，夜晚行于阴分，邪气与卫气一起运行，所以每天发作。）
岐伯说：邪气寄居的部位较深，向内迫近阴分，阳气单独发越，阴邪内伏，阴气与阳气交争但不能外出，所以隔一天发作一次。（注：邪气随着卫气进入体内，向内迫近阴分，与阳气交争，不能每天都随卫气出于阳分，所以隔一天发作一次。）
黄帝说：好。为什么有的疟疾发作时间越来越晚，有的却越来越早，是什么气导致的呢？
岐伯说：邪气客居于风府穴，沿着脊柱向下移动，卫气一天一夜在风府穴大会一次，第二天，卫气下行一节椎骨，所以发作时间越来越晚，这是因为邪气先客居于脊背。每当卫气到达风府穴时，腠理就开放，腠理一开，邪气就侵入，邪气侵入则病发作，这就是发作时间一天天推迟的原因。邪气从风府出发，每天下行一节脊椎，二十一天下行到尾骶骨，（注：尾骶骨，读音同“底”。《素问》、《甲乙经》将“膂”写作“膂”，一节均作“一节”。《素问》作二十五日。）第二十二天进入脊柱内部，注入夹脊的脉络，邪气向上运行九天，出于缺盆穴，邪气位置日益升高，所以发作时间一天天提前。（注：邪气与卫气下行二十一节椎骨，每天发作变晚，到第二十二天，邪气与卫气注入督脉上行，气位上升，所以发作变早。《素问》作二十六日，注入夹脊之脉作注入伏膂之脉。《甲乙经》、《巢氏病源》伏膂作伏冲。《素问》新校正说：全元起本二十五日作二十一日，二十六日作二十二日，《甲乙经》、《太素》都相同。）
如果邪气内迫五脏，横向连接膜原（脏腑之间的间隙组织），因为路径远，邪气深，运行缓慢，不能与卫气一同运行并外出，所以隔一天才发作。（注：偕，就是俱、一起的意思。膜原，五脏都有膜原。邪气内着于五脏之中，横向连接五脏膜原的输注之处，不能与卫气日夜一起在阴阳中运行，隔日才至一次，所以隔日发作。《素问》、《甲乙经》膜原作募原。《素问》新校正说：全元起本募作膜。《太素》、巢元方都相同，《举痛论》也作膜原。又《甲乙经》卫气作营气。《素问》偕作出作皆出。）
黄帝说：先生您说卫气每次到达风府穴，腠理才发散，发散则邪气侵入，邪气侵入则病发作。现在卫气每天下行一节椎骨，邪气的发散不在风府穴，那每天的发作是怎么回事呢？（注：项后发际上的风府穴位，卫气每天运行都会到达。如果下行二十一节，再回到上方会合风府，如果是每日发作，就不相对应了，通融起来怎么解释呢？）
岐伯说：风邪没有固定的风府穴，卫气在哪里发散，哪里就是风府。只要腠理开泄，邪气寄居的地方，就是所谓的“府”了。（注：无常府，是说卫气发于腠理，邪气寄居于此，这里的高度就等同于风府，不必一定以项后发际上作为风府。所以卫气发于腠理，邪气寄居之处，病就每日发作。）
黄帝说：太好了。（注：《素问》在岐伯曰下有八十八个字：“此邪气客于头项循膂而下者也，故虚实不同，邪中异所，则不得当其风府也。故邪中于头项者，气至头项而病；中于背者，气至背而病；中于腰脊者，气至腰脊而病；中于手足者，气至手足而病。卫气之所在，与邪气相合，则病作。”新校正说：全元起本及《甲乙经》、《太素》从“此邪客于头项”到下句“则病作”共八十八字都没有。）邪气所寄居之处即为病发之府，《素问》作“邪气之所合则其府也”，新校正说：《甲乙经》、巢元方作“其病作”。
黄帝说：风邪与疟疾，相似且同类，但风邪常常持续存在，而疟疾却有休止的时候，这是为什么呢？（注：因为腠理开泄，风邪进入脏腑内部，到一定时候发作，名叫疟疾。既然风与疟异名同类，疟疾每天有休止的时候，而风邪在风府处常未痊愈，这是什么意思呢？）
岐伯说：邪气停留在经络之处，卫气与之相顺，经络沉潜向内迫近，所以卫气停留时才发作。（注：经络停留之处，卫气经过，经脉与卫气相顺，所以经脉内迫停留之处，卫气也停留，卫气与风邪停留之处发动成为疟疾，所以风邪常在，疟疾有休止和发作。）
[Ping An]: This chapter, from beginning to end, is found in *Suwen* (Plain Questions), Volume 10, Chapter 35 "Treatise on Malaria"; also in *Jiayi Jing* (Systematic Classic of Acupuncture and Moxibustion), Volume 7, Section 5; also in *Ling Shu* (Spiritual Pivot), Volume 12, Chapter 79 "Treatise on Sui Lu"; and also in *Chao Shi Bing Yuan* (Source of Diseases by Master Chao), Volume 11 "Various Syndromes of Malaria", with only slight differences in arrangement.
The Yellow Emperor asked Qibo: All cases of malaria (a disease characterized by alternating chills and fever) arise from wind pathogen, yet their accumulation and发作 (onset) occur at specific times. Why is this? (Note: Regarding the term "malaria," some say it refers to a condition occurring every two days. This text states that summer-heat injury leads to autumn illness. Some refer to it as "Jie Malaria" or simply "Malaria," not necessarily defined by bi-daily onset. They all follow the four seasons but present different forms. When pores open, wind enters and cannot escape, accumulating internally and harmonizing with seasonal qi, causing daily onset times to vary. What is the reason?)
Qibo replied: At the initial onset of malaria, symptoms begin at the hair follicles, followed by stretching and yawning, then chills, leading to rattling of the teeth, pain in the waist and spine. After the cold subsides, both interior and exterior become hot, the head feels as if bursting, and there is thirst with a desire to drink. (Note: The presentation of cold malaria includes seven signs: 1. Hair erection, 2. Stretching and yawning, 3. Chills/shivering, 4. Waist and spine pain, 5. Interior/exterior heat, 6. Severe headache, 7. Thirst and desire to drink.)
The Yellow Emperor said: What qi causes this? I wish to hear the principle.
Qibo said: There is a struggle between Yin and Yang qi moving up and down, with deficiency and excess alternating due to the shifting of Yin and Yang. When Yang merges into Yin, Yin becomes full while the Yangming channel becomes deficient. Deficiency of Yangming leads to chills and rattling of the teeth. Deficiency of the Taiyang channel leads to pain in the waist, spine, head, and neck. If all three Yang channels are deficient, Yin qi prevails. Prevailing Yin qi causes bone coldness and pain, with cold generating from within, resulting in coldness throughout the body. (Note: Cold qi hides outside the intestines and stomach, inside the skin, residing in Ying Qi. In spring, Yin and Yang struggle, alternating victory and defeat, causing shifts in deficiency and excess. When all three Yang merge into Yin, they become deficient and are overcome by Yin, causing external cold. Strong Yin causes internal cold. Both interior and exterior cold cannot be warmed by soup or fire.)
When Yang is excessive, there is external heat; when Yin is deficient, there is internal heat. With both interior and exterior heat, there is panting and thirst with a desire to drink. (Note: Extreme Yin leads to Yang excess, causing external heat. Extreme Yin leads to Yin deficiency, allowing Yang to invade, causing internal heat. Intense heat exceeds burning charcoal, uncooled by ice water, causing thirst.)
This results from summer-heat injury, where intense heat hides inside the skin but outside the intestines and stomach, which is the residence of Ying Qi. (Note: This explains the daily onset. The area inside the skin and outside the intestines/stomach, where Ying Qi flows in the vessels, is the abode of the pathogen.)
This causes sweating and loose pores. (Note: Sweating with loose pores. *Suwen* omits "sweating." New Correction notes Quan Qiyuan's version matches *Jiayi Jing* and *Taisu*.) Encountering autumn coolness, sweating while exposed to wind, or bathing exposes one to water qi. (Note: Bathing. *Suwen* uses "and," *Jiayi Jing* uses "obtains bath.") Water qi settles inside the skin, dwelling together with Wei Qi. Wei Qi travels through the Yang aspects during the day; this pathogen exits with Wei Qi into Yang and penetrates inward with Wei Qi into Yin, hence the daily onset. (Note: Pathogen resides in Ying Qi, causing sweating and opening pores. Encountering autumn air, it hides in the skin with Wei Qi. Wei Qi moves Yang by day, Yin by night. Pathogen moves with Wei Qi, causing daily onset.)
The Yellow Emperor said: Why does some malaria occur every other day?
Qibo said: The pathogen resides deeply, pressing inward toward Yin. Yang qi erupts alone, while Yin pathogen stays fixed inside. The struggle between Yin and Yang prevents outward movement, resulting in every-other-day onset. (Note: Pathogen enters with Wei Qi, presses into Yin, struggles with Yang, unable to exit daily with Wei Qi, hence every other day.)
The Yellow Emperor said: Excellent. Why do some cases start later each day, while others start earlier? What qi causes this?
Qibo said: The pathogen lodges at Fengfu (GV16) and descends along the spine. Wei Qi convenes at Fengfu once every day and night. The next day, it descends one vertebral segment, so onset is delayed. This is because the pathogen first lodged in the back. Whenever Wei Qi reaches Fengfu, pores open; when open, pathogen enters; when entered, disease manifests. Thus, onset delays progressively. From Fengfu, descending one vertebra daily for twenty-one days reaches the coccyx. (Note: Coccyx. *Suwen* and *Jiayi Jing* use "Lu." *Suwen* says 25 days.) On the twenty-second day, it enters the spine interior, flowing into the paravertebral vessels, ascending for nine days, emerging at Quepen (ST12). As the pathogen's position rises daily, onset occurs earlier. (Note: Descending 21 segments delays onset. On day 22, entering Du Mai ascends, raising position, advancing onset. *Suwen* says 26 days. Paravertebral vessels. *Jiayi Jing/Chao Shi* say Fuchong. New Correction notes Quan Qiyuan's versions match *Taisu*.)
If the pathogen presses inward to the Zang organs, connecting horizontally to Mo Yuan (membrane source), the path is long, the qi is deep, and movement is slow. It cannot travel with Wei Qi and exit together, hence every-other-day onset. (Note: Mo Yuan exists in all Zang organs. Pathogen attaches to Zang, connects to Mo Yuan acupoints, cannot move with Wei Qi daily, thus every other day. *Suwen/Jiayi Jing* use Mu Yuan. *Suwen* says "Jie Chu" instead of "Xie Chu.")
The Yellow Emperor said: You said Wei Qi reaching Fengfu opens pores, allowing pathogen entry and disease onset. Now Wei Qi descends one vertebra daily, so its emergence is not at Fengfu. How does daily onset occur? (Note: Fengfu is at the nape hairline. Wei Qi reaches it daily. If descending 21 segments then returning to Fengfu, how does daily onset align?)
Qibo said: Wind has no fixed Fengfu. Wherever Wei Qi emerges, that is the site. Once pores open and pathogen lodges, that location serves as the "Fengfu." (Note: No fixed Fengfu means wherever Wei Qi opens pores and pathogen lodges, it acts as Fengfu, not just the nape. Disease occurs daily where pathogen lodges.)
The Yellow Emperor said: Wonderful. (Note: *Suwen* adds 88 characters explaining pathogen lodging at head, back, waist, limbs depending on Wei Qi convergence. New Correction notes these are absent in Quan Qiyuan, *Jiayi*, and *Taisu*. *Suwen* phrases it as "Where pathogen combines, that is the site.")
The Yellow Emperor said: Wind and malaria are similar and of the same category, yet wind persists constantly while malaria has periods of remission. Why? (Note: Wind enters Zang when pores open, manifesting as malaria. Though similar, malaria has rest periods while wind remains.)
Qibo said: The pathogen remains in the meridians. Wei Qi follows smoothly. Meridians sink and press inward, so Wei Qi lingers before manifestation. (Note: Pathogen stays in meridians. Wei Qi passes smoothly. Meridian and Wei Qi align, causing Wei Qi to linger at the stagnation point. Disease arises when Wei Qi and wind activate together, explaining why wind persists while malaria alternates.)