此承上章以记刺疟之法。故不曰论。
足太阳之疟。令人腰痛头重。寒从背起。先寒后热。 然。热止汗出难已。刺 中出血。（ 音谒。此论三阴
三阳经气之为病也。太阳是动病者。腰似折。冲头痛。太阳标阳而本寒。故先寒后热。背为阳。故寒从背起也。 、
如火之炽。 、暑热气也。太阳乃日中之阳火。故 然也。如热在气分者。热止汗出。其病则愈。此乃经气之
兼证。故病难全已。当刺 中出血。以泻在经之邪焉。按藏气法时论曰。心病者。胸中痛。取其经少阴太阳。舌下血者。
其变病。刺 中血者。谓取手少阴之阴 穴也。此所谓 中出血。是亦当取项上之络 。腰下之浮 矣。王氏曰。 中、
委中也。卢子繇曰。此但详足经而无手经者。经云风寒暑火。天之阴阳也。张兆璜曰。疟之足经。与伤寒同义。盖天之
六淫伤人三阴三阳之气。皆从足而起也。）足少阳之疟。令人身体解 。寒不甚。热不甚。恶见人。见人心惕惕然。热多
汗出甚。刺足少阳。（ 音亦。解 、懈惰也。少阳主初生之气。病则生阳不升。故身体懈惰。少阳主枢。寒不甚。热不
甚。枢象也。胆病者。心中 。恐人将捕之。少阳相火主气。故热多。少阳所生病者汗出。当取足少阳之侠溪。在足
小指次指歧骨间。本节前之中。刺入三分。留三呼。此足少阳之荣也。）足阳明之疟。令人先寒洒淅。洒淅寒甚。久乃热。
热去汗出。喜见日月光火气。乃快然。刺足阳明跗上。（阳明者。两阳合明。阳热光明之气也。病则反其本。而洒淅寒甚。
热去汗出。则病气去而喜见光明。复其阳明之本气也。本气复而仍取足阳明者。经邪未去也。故当取足跗上冲阳。刺入
三分。留十呼。此足阳明原也。按三阴三阳之病。论在六气。则不涉经络之有形。是以见太阳之先寒后热。少阳之寒热
从枢。如少阴之标寒本热。此病无形之六气也。又如胆病之恐人将捕。脾土之灌溉四旁。少阴之呕吐。厥阴之腰痛。是
又涉于有形之经。当知经不离乎气。气不离乎经。可分而可合者也。能明乎经气之理。进乎道矣。王芳侯曰。日月光、
明也。火气、阳热也。）足太阴之疟。一令人不乐。好太息。不嗜食。多寒热。一汗出。病至则善呕。呕已乃衰。即取
之。（足太阴脾土主气。主灌四脏。心肺居上为阳。肝肾居下为阴。脾为孤脏。中央土。间于阴阳之间。膻中者臣使之官。
喜乐出焉。膻中乃宗气之所居。上出于肺。以司呼吸。经云。心系急则气道约。约则不利。故太息以伸出之。一令人不
乐。好太息者。足太阴病疟而上及于心肺也。肾病者寝汗出。肝脉缓甚而善呕。所生病者为呕逆。一汗出。病至则善呕
者。下及于肝肾也。病至者。言病至于肝脏则善呕。呕已则肝脏之病已衰。而即当取之。盖言脾疟而病至于四脏。见四
脏之病已衰。而即当取之足太阴也。不嗜食。多寒热。太阴之本病也。脾病而不能转输。故不嗜食。太阴居中土。间于
阴阳之间。故多寒热也。）足少阴之疟。令人呕吐甚。多寒热。热多寒少。欲闭户牖而处。其病难已。（足少阴寒水主气。
故呕吐甚。少阴标阴而本热。故多寒热。热多寒少。本气胜也。大凡病热多而阳气胜者易愈。寒多而阴气胜者难已。欲
闭户牖而处者。阴寒甚也。故其病难已。本经曰。阳尽而阴盛。故欲独闭户牖而居。王芳侯曰。阳热甚者。宜刺泄其邪。阴盛故不言刺也。）足厥阴之疟。令人腰痛少腹满。小便不利如癃状。非癃也。数便。意恐惧。气不足。腹中悒悒。刺足
厥阴。（腰痛小腹满。厥阴之经证也。木乃水中之生阳。故肝主疏泄水液。如癃非癃。而小便频数不利者。厥阴之气不化
也。志意者。所以御精神。收魂魄。经云。肝气虚则恐。盖肝藏之神魂不足。故意恐惧也。木主春生之气。厥阴受邪。
故生气不足。木郁不达。故腹中悒悒也。宜刺足厥阴之太冲。在足趾本节后二寸陷者中。刺入三分。留一呼。朱圣公曰。
肝者将军之官。谋虑出焉。气虚则恐惧矣。）肺疟者。令人心寒。寒甚热。热间善惊。如有所见者。刺手太阴阳明。（肺
者心之盖。故令人心寒热。心气虚则善惊。如有所见。经云。心者。神之舍也。神精乱而不转。卒然见非常物。宜刺手
太阴之列缺。手阳明之合谷。列缺在手腕后寸半。刺入三分。留三呼。合谷在手大指次指歧骨间。刺入三分。留六呼。
卢之颐曰。邪不干脏。列脏证者。非真脏之藏。乃脏募之气化证也。莫仲超曰。邪入于五脏六腑募原之间。不干脏腑
之气。则为间日之疟。干脏腑之气。则为五脏六腑之疟。涉于三阴三阳。则为六经之疟。故曰疟者。风寒之气不常也。）
心疟者。令人烦心甚。欲得清水。反寒多。不甚热。刺手少阴。（心为火脏。心气热。故烦甚而欲得清水以自救。热极生
寒。故反寒多。寒久则真火气衰。故不甚热也。宜刺手少阴之神门。在掌后锐骨端陷者中。刺三分。留七呼。）肝疟者。
令人色苍苍然。太息。其状若死者。刺足厥阴见血。（苍乃东方之青色。肝主色。故令人色苍苍然。胆病者善太息。胆附
于肝。故肝病必及于胆。肝胆主春生之气。胆气升则脏腑之气皆升。生阳不升。故其状若死。刺足厥阴中封见血。在内
踝前一寸半陷者中。仰足取之。伸足得之。刺入四分。留七呼。）脾疟者。令人寒。腹中痛。热则肠中鸣。鸣已汗出。刺
足太阴。（脾为阴中之至阴。故令人寒。腹乃脾土之郛郭。故腹中痛。湿热下行则肠鸣。上蒸则汗出也。鸣已汗出者。下
行极而上也。宜刺足太阴之商丘。在足内踝下。微前三寸陷者中。刺入三分。留七呼。）肾疟者。令人洒洒然。腰脊痛宛
转。大便难。目 然。手足寒。刺足太阳少阴。（ 同旬。足少阴寒水主气。故令人洒洒然。腰乃肾之府。故腰脊痛而
欲其宛转也。肾开窍于二阴。故大便难。 目摇动而不明。骨之精为瞳子。故目 然也。肾主生气之原。手足为诸
阳之本。邪病则有伤生气。故手足寒也。宜取足太阳之委中。足少阴之大钟太溪。委中在 约横纹中央有动脉。大钟在
内踝后街中。刺入二分。留七呼。太溪在足内踝后跟骨上动脉陷者中。刺入三分。留七呼。）胃疟者。令人且病也。
善饥而不能食。食而支满腹大。刺足阳明太阴横脉出血。（胃主受纳水谷。故胃疟者。令人病饥而不能食。中焦受邪。不
能主化。故支满腹大。横脉、脾胃之横络脉也。）
疟发身方热。刺跗上动脉。开其空。出其血。立寒。（此言疟之寒热。乃病在阴阳之气分。当取于阳明太阴焉。夫三
阳主表。三阴主里。疟发身方热。是邪将出于表阳。阳明者。两阳合明。间于二阳之间。主行气于周身。阳盛之气也。
故当取阳明之冲阳。摇针以开其穴。泻出其血。则阳热去而立寒矣。）疟方欲寒。刺手阳明太阴。足阳明太阴。（夫身半
以上为天。身半以下为地。手太阴阳明主天。足太阴阳明主地。故从腰以上者。手太阴阳明皆主之。从腰以下者。足太
阴阳明皆主之。又阳者天气也。主外。阴者地气也。主内。疟方欲寒。是邪将入于里阴。故当刺手足阳明太阴。使天地
阴阳之气。上下外内和平。而无偏阴之患矣。）疟脉满大急。刺背俞。用中针。旁五 俞各一。适肥瘦出其血也。（旁
去声。此言疟病在经络者。当取其背俞焉。盖经脉内合五脏五行之气。五脏之俞在背。故当取背俞以泻之。脉满大急者。
邪盛于经脉中也。 、胁也。旁、倚也。 俞者。五脏俞之旁。近于 胁。乃魄户、神堂、魂门、意舍、志室也。谓当
旁五 俞各刺其一。肥者深而留之。瘦者浅而疾之。各适其当。以出其血焉。）疟脉小实急。灸胫少阴。刺指井。（此言
经脉之气虚陷者。宜灸足少阴也。盖经脉之气。发原于少阴肾脏。脉小者。脉气虚也。经云诸急为寒。小实急者。脉气
虚寒而邪气实也。艾名冰台。能启陷气之阳。故当灸少阴胫下之太溪。以启经脉之生气。刺足小指之井穴。以泻经脉之
实邪。此论攻邪。又当审其正气也。）疟脉满大急。刺背俞五 俞背俞各一。适行至于血也。（俞俱音输各篇皆同。此复
申明背俞。与 俞之经气相通也。曰背俞五 俞背俞各一者。言背俞旁之五 俞。与背俞各刺其一也。背俞者。离脊骨
两旁。各一寸五分。乃五脏之俞也。 俞者。去脊骨两旁各三寸。近于 胁。乃五脏神气之所舍。故曰魄户者。谓肺藏
魄也。曰神堂者。谓心藏神也。曰魂门者。谓肝藏魂也。曰意舍者。谓脾藏意也。曰志室者。谓肾藏志也。此 俞与背
俞之气相通。故当各取之。适其肥瘦。以行其针而至于出血也。此盖言邪盛于血脉者。取五 俞。甚而及于五脏者。兼
取背俞。是以上节之灸胫。此下之用药。亦少有别焉。莫子晋曰。血者神气也。故病在经脉而邪伤血者。宜取脏神所
舍之俞。然经脉内合五脏。故又当兼取其背俞也。）疟脉缓大虚。便宜用药。不宜用针。（便平声。此承上文而言。五脏
之经气虚者。便于用药。而不宜用针也。脉缓大虚。血气两虚也。灵枢经云。少气者。则阴阳俱不足。补阳则阴竭。泻
阴则阳脱。如是者。可将以甘药。不可饮以至剂。如此者。弗灸。不已者。因而泻之。则五脏气坏矣。上节论经脉生始
之原。本于足少阴肾。此言经俞血气。又五脏五行之所生。然有邪有正。有实有虚。而灸刺用药。各有所宜也。）凡治
疟。先发如食顷。乃可以治。过之则失时也。（此论治疟母先后其时。先发如食顷者。谓疟未发前如一饭之顷。正气未乱。
因而调之。所谓无刺 之热。浑浑之脉也。若待其已发。邪方盛时而取之。则失其时矣。）诸疟而脉不见。刺十指间
出血。血去必已。先视身之赤如小豆者。尽取之。（此言邪在皮肤气分者。宜刺十指之井穴也。疟在气分。故不见于脉。
脉不见者。谓不见满大急之脉也。当刺十指之井穴出血。血去其病立已。盖所出为井。乃经气始相交会之处。故刺之可
泄气分之邪。身有赤如小豆者。邪在肤表气分。有伤淡渗皮肤之血。故赤如小豆。当先取而去之。此言邪在经脉之血。
与淡渗皮肤之血。所见脉证不同。而取刺亦各有别。）十二疟者。其发各不同时。察其病形。以知其何脉之病也。（此言
邪在脏腑经脉者。更有刺之之法也。十二疟者。谓六经五脏胃疟也。其发各不同者。言厥阴与肝疟。阳明与胃疟。太阴
与脾疟。少阴与肾疟。各有脏腑经气之不同也。故当时察其病形。或腰痛头重。或心寒善惊。以知其何脉之病。盖经脉
乃胃腑之所生。五脏之所主。故曰以知何脉之病。）先其发时如食顷而刺之。一刺则衰。二刺则知。三刺则已。（先其发
时如食顷者。先于未发之前而刺之也。刺之者。以足太阳之疟取 中。阳明之疟取足 。肺疟刺手太阴阳明。心疟刺手
少阴也。一刺则病衰。二刺则知。三刺则病已。按上古以小便利。腹中和为知。杨元如曰。邪在气分者。宜后其时以刺
之。盖气为阳。其性锐。故当避其来锐。邪在血分者。宜先其时以取之。盖血为阴。其性柔。故当迎而夺之。）不已。
刺舌下两脉出血。不已。刺 中盛经出血。又刺项以下挟脊者必已。舌下两脉者。廉泉也。（舌下两脉。任脉之廉泉穴也。
中、王氏谓委中也。盛经者。谓血气盛于此也。项以下挟脊者。 俞背俞也。盖任脉统任一身之阴。为经络之海。而
脏腑之经俞。皆属于太阳。故刺本经不愈。而复取任脉。及足太阳之 中背俞。其病立已也。）刺疟者。必先问其病之
所先发者。先刺之。（此言邪中于头项者。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。必先问其所先发者。先刺之。倪冲之曰。用三先字者。谓邪或舍于头项。而又兼中于腰背。或
舍于腰背。而又兼中于手足。卫气先至之处。其病先发。是一日之中。或又有两发之疟也。）先头痛及重者。先刺头上
及两额两眉间出血。先项背痛者。先刺之。先腰脊痛者。先刺 中出血。先手臂痛者。先刺手少阴阳明十指间。先足胫
痛者。先刺足阳明十指间出血。（头上、谓上星百会。两额、谓悬颅。两眉间为攒竹诸穴也。项背痛者。或刺风池风府。
或项背所痛之处。随其病而取之。 中、王氏谓委中也。手少阴阳明十指间者。谓十指间之少冲商阳也。足阳明十指间
者。足十指间之厉兑也。盖少阴心脏主血脉。而手足井荥之血气。皆阳明之所生。是以手足痛者。独取于少阴阳明。张
兆璜曰。惟项背之疟。见证不一。有邪入于风府。随卫气上下而日作早晏者。有邪留于项背。而遇卫气以日作晏者。有
邪留于项背之间。而不与卫气之日作晏者。故概而言之曰先刺之。）风疟。疟发则汗出恶风。刺三阳经背俞之血者。（此
言病风疟者。亦当取足太阳之经也。疟发则汗出恶风者。表阳之气虚也。三阳、太阳也。背俞、太阳之经俞也。盖太阳
承接上一章来记载针刺治疗疟疾的方法。所以不称为“论”。
足太阳经的疟疾，使人腰痛、头重，寒气从背部开始升起，先恶寒后发热，热势炽盛如烈火燃烧，又如暑天热气蒸腾。热退时出汗，但汗出后病难痊愈。应刺委中穴出血。（这是论述三阴三阳经气致病的情况。太阳经发生变动之病，表现为腰像要折断一样，冲头痛。太阳经标为阳而本为寒，所以先恶寒后发热。背部属阳，所以寒气从背部升起。焮焮（xìn xìn），像火那样炽热；暍暍（yē yē），是暑天热气。太阳经是日中的阳火，所以表现为焮焮之热。如果热在气分，热退汗出，病就会好。这是经气的兼证，所以病难以完全痊愈。应当刺委中穴出血，以泻除在经脉中的邪气。按《藏气法时论》说：心病的人，胸中痛，取手经和足经，舌下出血的是变病。刺委中穴出血的，是指取手少阴经的阴郄穴。这里所说的“刺委中出血”，也应当取项上的络脉和腰下的浮络。王冰说：委中就是委中穴。卢子繇说：这里只详细论述了足经而没有手经，经文说风寒暑火是天之阴阳。张兆璜说：疟疾涉及足经，与伤寒的意义相同。大概天之六淫伤害人三阴三阳之气，都是从足部开始的。）
足少阳经的疟疾，使人身体懈怠无力，恶寒不严重，发热也不严重，厌恶见人，见到人就感到心慌害怕，发热多且出汗厉害。应刺足少阳经。（解㑊（xiè tuǒ），即懈怠懒惰。少阳主初生的阳气，生病则生阳不能上升，所以身体懈怠。少阳主枢机，恶寒不重，发热不重，这是枢机的象。胆病的人，心中懊恼，怕别人抓捕他。少阳相火主气，所以发热多。少阳经所生的病会出汗，应当取足少阳经的荥穴侠溪，位于足小趾和第二趾歧骨间，本节前中间，刺入三分，留针三次呼吸的时间。这是足少阳经的荥穴。）
足阳明经的疟疾，使人先恶寒战栗，非常寒冷，很久才发热，热退后出汗，喜欢见日光月光或火光，觉得舒服。应刺足阳明经足背上的穴位。（阳明是两阳合明，是阳热光明的气。生病则违背本性，反而出现严重的战栗寒冷。热退汗出，病气离去而喜欢见光明，恢复了阳明经的本气。本气恢复但仍取足阳明经，是因为经邪未去。所以应当取足背上的冲阳穴，刺入三分，留针十次呼吸的时间。这是足阳明经的原穴。按三阴三阳的病，论述在六气，就不涉及经络的有形部分，所以见到太阳经的先寒后热，少阳经的寒热随枢机变化，如少阴经的标寒本热，这是无形之六气的病。又如胆病的人怕人抓捕，脾土灌溉四旁，少阴经的呕吐，厥阴经的腰痛，这又涉及到有形的经络。应当知道经络不离气，气不离经络，可分可合。能明白经气的道理，就接近道了。王芳侯说：日月光，是光明；火气，是阳热。）
足太阴经的疟疾，使人心情不愉快，喜欢长叹气，不想吃东西，多有寒热，有时出汗。病发作时就容易呕吐，吐完病情就减轻。应立即取足太阴经。（足太阴脾土主气，灌注四脏。心肺居上属阳，肝肾居下属阴。脾是孤脏，属中央土，介于阴阳之间。膻中是臣使之官，喜乐由此产生。膻中是宗气居住的地方，向上出于肺，主管呼吸。经文说：心脉紧急则气道约束，约束则不通利，所以通过长叹气来伸展它。使人心情不愉快，喜欢长叹气，是足太阴病疟疾而上及于心肺。肾病的人睡觉出汗，肝脉缓急过度则容易呕吐，所生的病是呕逆。有时出汗，病发作就容易呕吐，是下及于肝肾。病发作，是说病至于肝脏就容易呕吐，吐完肝脏的病就减轻，而立即应当取足太阴经。这是说脾疟而病至于四脏，见四脏的病已减轻，而立即当取足太阴经。不想吃东西，多有寒热，是太阴经的本病。脾病而不能转输，所以不想吃东西。太阴居中土，介于阴阳之间，所以多有寒热。）
足少阴经的疟疾，使人呕吐严重，多有寒热，发热多恶寒少，想关上门窗独处。这种病难痊愈。（足少阴寒水主气，所以呕吐严重。少阴标阴而本热，所以多有寒热，发热多恶寒少，是本气胜。大凡病发热多而阳气胜的容易痊愈，恶寒多而阴气胜的难痊愈。想关门窗独处的，是阴寒严重。所以病难痊愈。本经说：阳气尽而阴气盛，所以想独自关门而居。王芳侯说：阳热盛的，宜刺泄其邪，阴盛所以不说刺。）
足厥阴经的疟疾，使人腰痛，小腹满，小便不利像癃病的样子，其实不是癃病，而是频繁小便，心里恐惧，气不足，腹中郁闷。应刺足厥阴经。（腰痛小腹满是厥阴经的证候。木是水中之生阳，所以肝主疏泄水液。像癃非癃，而小便频数不利，是厥阴经的气化功能失常。志意，是用来驾驭精神，收敛魂魄的。经文说：肝气虚则恐惧。大概肝藏的神魂不足，所以心里恐惧。木主春生之气，厥阴受邪，所以生气不足。木气郁结不达，所以腹中郁闷。宜刺足厥阴经的太冲穴，在足趾本节后二寸凹陷处，刺入三分，留针一次呼吸的时间。朱圣公说：肝是将军之官，谋虑由此产生。气虚则恐惧。）
肺疟，使人心里发冷，冷极则发热，热间歇时容易惊恐，好像看到了什么东西。应刺手太阴和手阳明经。（肺是心的盖子，所以使人心里寒热。心气虚则容易惊恐，好像看到了东西。经文说：心是神的住所。神精混乱而不运转，突然看到不寻常的东西。宜刺手太阴经的列缺穴，手阳明经的合谷穴。列缺在手腕后一寸半处，刺入三分，留针三次呼吸的时间。合谷在手大指和第二指歧骨间，刺入三分，留针六次呼吸的时间。卢之颐说：邪气不侵犯脏腑，列出脏证候的，不是真脏的储藏，而是脏募的气化证候。莫仲超说：邪气进入五脏六腑募原之间，不侵犯脏腑之气，就成为间日疟；侵犯脏腑之气，就成为五脏六腑疟；涉及三阴三阳，就成为六经疟。所以说疟疾，是风寒之气不固定。）
心疟，使人烦闷严重，想要喝冷水，反而恶寒多，发热不严重。应刺手少阴经。（心是火脏，心气热，所以烦闷严重而想要喝冷水自救。热极生寒，所以反而恶寒多。寒久则真火气衰，所以发热不严重。宜刺手少阴经的神门穴，在掌后锐骨端凹陷处，刺三分，留七次呼吸的时间。）
肝疟，使人面色苍青，长叹气，样子像死了一样。应刺足厥阴经见血。（苍是东方的青色。肝主色，所以使人面色苍青。胆病的人喜欢长叹气，胆附于肝，所以肝病必波及胆。肝胆主春生之气，胆气升则脏腑之气都升。生阳不升，所以样子像死。刺足厥阴经的中封穴见血，在内踝前一寸半凹陷处，仰足取穴，伸足得穴，刺入四分，留七次呼吸的时间。）
脾疟，使人发冷，腹中痛，发热则肠鸣，鸣完出汗。应刺足太阴经。（脾是阴中之至阴，所以使人发冷。腹部是脾土的廓郭，所以腹中痛。湿热下行则肠鸣，上蒸则出汗。鸣完出汗，是下行至极而上行。宜刺足太阴经的商丘穴，在足内踝下，微前三寸凹陷处，刺入三分，留七次呼吸的时间。）
肾疟，使人洒洒然发抖，腰脊痛且辗转反侧，大便困难，眼睛昏花看不清，手足寒冷。应刺足太阳和足少阴经。（旬同洵。足少阴寒水主气，所以使人洒洒然发抖。腰是肾的府，所以腰脊痛而想辗转。肾开窍于二阴，所以大便困难。目摇动而不明，骨的精华是瞳孔，所以眼睛昏花。肾主生气的根源，手足是诸阳的根本，邪气生病则损伤生气，所以手足寒冷。宜取足太阳经的委中穴，足少阴经的大钟穴、太溪穴。委中在腘窝横纹中央有动脉处，大钟在内踝后跟骨中，刺入二分，留七次呼吸的时间。太溪在足内踝后跟骨上动脉凹陷处，刺入三分，留七次呼吸的时间。）
胃疟，使人既患病又饥饿，想吃却不能吃，吃了就腹胀满，肚子大。应刺足阳明和足太阴经的横脉出血。（胃主受纳水谷，所以胃疟使人患饥饿感却不能吃。中焦受邪，不能主运化，所以腹胀满肚子大。横脉，是脾胃的横络脉。）
疟疾发作身体刚发热，刺足背上的动脉，打开穴位，放出血液，立刻退烧。（这是说疟疾的寒热，是病在阴阳之气分，应当取阳明和太阴经。三阳主表，三阴主里。疟疾发作身体刚发热，是邪气将要出于表阳。阳明是两阳合明，介于二阳之间，主行气于周身，是阳盛之气。所以应当取阳明的冲阳穴，摇针以开通穴位，泻出其血，则阳热去除而立刻退烧。）
疟疾正要发冷，刺手阳明、手太阴、足阳明、足太阴经。（身半以上是天，身半以下是地。手太阴、手阳明主天，足太阴、足阳明主地。所以从腰以上，手太阴、手阳明都主管；从腰以下，足太阴、足阳明都主管。另外阳是天之气，主外；阴是地之气，主内。疟疾正要发冷，是邪气将要入于里阴。所以应当刺手足阳明和太阴经，使天地阴阳之气，上下内外和平，而没有偏阴的祸患。）
疟疾病人脉象满大急，刺背部的俞穴，用中等粗细的针，旁边五腧穴各刺一个，根据肥瘦决定出血量。（旁读去声。这是说疟病在经络的，应当取背部的俞穴。因为经脉内合五脏五行之气，五脏的俞在背部，所以应当取背俞以泻之。脉满大急，是邪气盛于经脉中。胁也。旁，倚靠。腧穴，是五脏俞的旁边，靠近胁肋，是魄户、神堂、魂门、意舍、志室。谓应当旁侧的五腧穴各刺一个，肥胖者深刺并留针，消瘦者浅刺快出，各自适当，以放出血液。）
疟疾病人脉象小实急，灸胫部的少阴经，刺手指井穴。（这是说经脉之气虚陷的，宜灸足少阴经。因为经脉之气，发源于少阴肾脏。脉小，是脉气虚。经文说各种急促为寒。小实急，是脉气虚寒而邪气实。艾名叫冰台，能启陷下的阳气，所以应当灸少阴胫下的太溪穴，以启经脉的生气。刺足小趾的井穴，以泻经脉的实邪。这是论攻邪，又应当审察正气。）
疟疾病人脉象满大急，刺背俞和五腧穴，背俞和五腧穴各刺一个，操作直到出血。（俞俱音输，各篇皆同。这是再次申明背俞与五腧穴的经气相通。说“背俞五腧，背俞各一”，是说背俞旁边的五腧穴，与背俞各刺一个。背俞，离脊骨两旁各一寸五分，是五脏的俞穴。腧穴，去脊骨两旁各三寸，靠近胁肋，是五脏神气所舍的地方。所以叫魄户，是说肺藏魄；叫神堂，是说心藏神；叫魂门，是说肝藏魂；叫意舍，是说脾藏意；叫志室，是说肾藏志。这些腧穴与背俞的气相通，所以应当各取它们。适当其肥瘦，行针直到出血。这是说邪盛于血脉的，取五腧穴；甚而至于五脏的，兼取背俞。所以上一节论灸胫，这一节论用药，也有少许不同。莫子晋说：血是神气。所以病在经脉而邪伤血的，宜取脏神所舍的俞穴。然而经脉内合五脏，所以又应当兼取背俞。）
疟疾病人脉象缓大虚，适宜用药，不适宜用针。（便读平声。这是承接上文而言，五脏的经气虚的，便于用药，而不适宜用针。脉缓大虚，是血气两虚。《灵枢经》说：少气的，则阴阳都不足。补阳则阴竭，泻阴则阳脱。像这样，可以用甘药，不可饮用峻剂。像这样的人，不要灸，如果不愈，因而泻之，则五脏气败坏。）
凡是治疗疟疾，在发作前大约一顿饭的时间，才可以治疗。过了这个时间就失时机了。（这是论治疟母先后时机。发作前一顿饭的时间，是说疟疾未发前如一顿饭的功夫，正气未乱，趁机调理。所谓不要刺浑浑的热，不要刺浑浑的脉。如果等它已经发作，邪气正盛时再取穴，就失去时机了。）
各种疟疾而脉象不见（摸不到明显的脉象），刺十个手指间出血，血去病一定好。先观察身上有红点像小豆一样的，全部刺破。（这是说邪在皮肤气分的，宜刺十个手指的井穴。疟在气分，所以脉象不见。脉不见，是说不见满大急的脉。应当刺十个手指的井穴出血，血去病立刻好。因为所出为井，是经气始相交会的地方，所以刺它可以泄气分之邪。身上有红点像小豆的，是邪在肤表气分，有伤淡渗皮肤的血液，所以红像小豆。应当先取而去掉。这是说邪在经脉的血，与淡渗皮肤的血液，所见脉证不同，而取刺也各有区别。）
十二种疟疾，它们的发作时间各不相同，观察病形，就知道是哪条经脉的病。（这是说邪在脏腑经脉的，更有刺的方法。十二种疟疾，是指六经、五脏、胃疟。它们的发作各不相同，是说厥阴与肝疟，阳明与胃疟，太阴与脾疟，少阴与肾疟，各有脏腑经气的不同。所以当时观察病形，或腰痛头重，或心寒善惊，以此知道是哪条经脉的病。大概经脉是胃腑所生，五脏所主，所以说以知何脉之病。）
在发作前大约一顿饭的时间刺之。刺一次病衰退，刺两次病好转，刺三次病痊愈。（发作前一顿饭的时间，是在未发之前刺。刺的方法，比如足太阳疟取委中，阳明疟取足跗上，肺疟刺手太阴和阳明，心疟刺手少阴。刺一次病衰退，刺两次病好转，刺三次病痊愈。按上古时期以小便利、腹中和为好转。杨元如说：邪在气分的，宜后其时刺。因为气为阳，其性锐，所以应当避开它的来势锐利。邪在血分的，宜先其时取。因为血为阴，其性柔，所以应当迎而夺之。）
如果不好，刺舌下两条脉络出血。如果还不好，刺委中盛经出血。又刺项部以下挟脊的穴位，一定好。舌下两脉，是廉泉穴。（舌下两脉，是任脉的廉泉穴。委中，王冰说是委中穴。盛经，是说气血盛于此。项以下挟脊的，是腧穴和背俞。大概任脉统任一身之阴，是经络之海，而脏腑的经俞，都属于太阳。所以刺本经不愈，而复取任脉，及足太阳的委中和背俞，病立刻好。）
刺疟疾的人，必须先问病人哪里先发病，先刺那里。（这是说邪中于头项的，气至头项而病；中于背的，气至背而病；中于腰脊的，气至腰脊而病；中于手足的，气至手足而病。必须先问哪里先发，先刺那里。倪冲之说：用三个“先”字，是说邪或者停留在头项，而又兼中于腰背；或者停留在腰背，而又兼中于手足。卫气先到的地方，病先发。是一天之中，或者又有两次发作的疟疾。）
先头痛且重的，先刺头上及两额、两眉间出血。先项背痛的，先刺那里。先腰脊痛的，先刺委中出血。先手臂痛的，先刺手少阴、手阳明经十个手指间。先足胫痛的，先刺足阳明经十个手指间出血。（头上，指上星、百会。两额，指悬颅。两眉间为攒竹等穴。项背痛，或者刺风池、风府，或者项背所痛之处，随病取穴。委中，王冰说是委中穴。手少阴、手阳明十个手指间，指十指间的少冲、商阳。足阳明十个手指间，指足十指间的厉兑。大概少阴心脏主血脉，而手足井荥的血气，都生于阳明。所以手足痛，独取少阴和阳明。张兆璜说：只有项背的疟疾，见证不一，有邪入于风府，随卫气上下而每天发作早晚不同的；有邪留在项背，而遇卫气而每天发作晚的；有邪留在项背之间，而不与卫气每天发作早晚相应的。所以概而言之曰先刺。）
风疟，疟疾发作则出汗恶风，刺三阳经背俞的出血。（这是说病风疟的，也当取足太阳经。疟疾发作则出汗恶风，是表阳之气虚。三阳，指太阳。背俞，是太阳的经俞。大概太阳……）
This section continues from the previous chapter to record the methods of acupuncture for treating malaria. Therefore, it is not called "Treatise".
Malaria involving the Foot-Taiyang meridian causes lower back pain and a heavy head. Coldness begins to rise from the back. There is initial chills followed by fever. The heat is intense like blazing fire (Xin Xin) and steaming like summer heat (Ye Ye). When the heat subsides, sweating occurs, but the disease is difficult to cure. One should puncture the Weizhong (BL-40) acupoint to bleed. (This discusses diseases caused by the Qi of the Three Yin and Three Yang meridians. The moving disease of the Taiyang meridian presents with waist pain as if broken and headache striking upwards. Taiyang is marked by Yang but rooted in Cold, hence initial chills followed by fever. The back belongs to Yang, hence coldness rises from the back. Xin Xin refers to heat like fire; Ye Ye refers to summer heat. Taiyang is the Yang Fire of midday, hence the Xin Xin heat. If the heat is in the Qi level, and the disease resolves with sweating upon heat subsiding, it heals. This is an accompanying syndrome of meridian Qi, hence the difficulty in complete resolution. One should puncture Weizhong to bleed, thereby draining the pathogenic factors in the meridian. According to the *Ling Shu: Zang Qi Fa Shi Lun*: For heart disease with chest pain, one selects the Hand and Foot meridians; for tongue bleeding, it is a transformed disease. Bleeding at Weizhong refers to selecting the Yin Xi (HT-6) point of the Hand-Shaoyin meridian. Here, "bleeding at Weizhong" also implies selecting collateral vessels on the neck and floating collaterals below the waist. Wang Bing states: Weizhong is the Weizhong acupoint. Lu Ziyao notes that this section details only the Foot meridians, not the Hand meridians, stating that Wind, Cold, Summer-heat, and Fire are the Heaven's Yin and Yang. Zhang Zhaohuang states that malaria involving the Foot meridians shares the same meaning as Shanghan. Generally, the Six Excesses of Heaven damage the Qi of the Three Yin and Three Yang meridians, all starting from the feet.)
Malaria involving the Foot-Shaoyang meridian causes the body to feel flaccid and weak (Xie Tuo). Chills are not severe, and fever is not severe. The patient dislikes seeing people and feels fearful upon seeing them. There is much fever and profuse sweating. One should puncture the Foot-Shaoyang meridian. (Xie Tuo means laxity and laziness. Shaoyang governs the nascent Qi. Disease causes this nascent Yang to fail to ascend, resulting in bodily flaccidity. Shaoyang governs the Pivot. Mild chills and mild fever reflect the Pivot mechanism. Gallbladder disease involves mental restlessness and fear of being captured. Shaoyang Ministerial Fire governs Qi, hence much fever. Diseases generated by Shaoyang involve sweating. One should select Xiaxi (GB-43), the Ying-Spring point of the Foot-Shaoyang meridian, located between the second and fifth toes, proximal to the metatarsophalangeal joint. Puncture 3 cun deep, retain for three breaths. This is the Ying-Spring point of the Foot-Shaoyang meridian.)
Malaria involving the Foot-Yangming meridian causes initial aversion to cold and shivering (Sa Xi), which becomes very severe. After a long time, fever develops. Upon heat subsiding, sweating occurs. The patient desires sunlight, moonlight, or firelight to feel comfortable. One should puncture the acupoint on the dorsum of the Foot-Yangming meridian. (Yangming is the convergence of two Yangs, representing the bright Qi of Yang and Heat. Disease causes a reversal to its root, resulting in severe shivering. Upon heat subsiding and sweating, the pathogenic Qi departs, and the patient desires brightness, restoring the original Qi of Yangming. Although the original Qi is restored, one still selects the Foot-Yangming meridian because meridian pathogens remain. Thus, one should select Chongyang (ST-42) on the dorsum of the foot. Puncture 3 cun deep, retain for ten breaths. This is the Yuan-Source point of the Foot-Yangming meridian. Regarding diseases of the Three Yin and Three Yang, when discussed in terms of the Six Qi, it does not involve the有形 (tangible) aspects of meridians. Thus, we see Taiyang's initial chills and subsequent fever, Shaoyang's chills and fever following the Pivot, and Shaoyin's marked Cold and rooted Heat; these are diseases of the intangible Six Qi. Conversely, gallbladder disease causing fear, Spleen Earth irrigating the four directions, Shaoyin vomiting, and Jueyin lower back pain involve tangible meridians. One must understand that meridians do not separate from Qi, and Qi does not separate from meridians; they can be divided yet united. Understanding the principle of Meridian-Qi leads one closer to the Dao. Wang Fanghou states: Sunlight and moonlight represent brightness; Fire Qi represents Yang Heat.)
Malaria involving the Foot-Taiyin meridian causes unhappiness, frequent sighing, loss of appetite, frequent chills and fever, and occasional sweating. Upon onset, the patient tends to vomit; after vomiting, the condition improves. One should immediately select the Foot-Taiyin meridian. (Foot-Taiyin Spleen Earth governs Qi and irrigates the four zang organs. Heart and Lung reside above and belong to Yang; Liver and Kidney reside below and belong to Yin. Spleen is the solitary organ, belonging to Central Earth, situated between Yin and Yang. Danzhong is the official of the minister, from where joy arises. Danzhong is the residence of Zong Qi (Gathering Qi), which emerges upward from the Lung to govern respiration. The Classic states: When the Heart vessel is tense, the airway is constricted; constriction leads to obstruction, hence sighing to relieve it. Unhappiness and frequent sighing indicate that Foot-Taiyin malaria affects the Heart and Lung. Kidney disease involves nocturnal sweating; rapid Liver pulse indicates tendency to vomit; diseases generated include regurgitation. Occasional sweating and vomiting upon onset indicate involvement of the Liver and Kidney. "Onset" refers to the disease reaching the Liver, causing vomiting; after vomiting, the Liver disease subsides, and one should then select the Foot-Taiyin meridian. This describes Spleen malaria affecting the four zang organs; once the zang diseases subside, one selects the Foot-Taiyin meridian. Loss of appetite and frequent chills/fever are the primary diseases of Taiyin. Spleen disease fails to transport and transform, hence loss of appetite. Taiyin resides in Central Earth, between Yin and Yang, hence frequent chills and fever.)
Malaria involving the Foot-Shaoyin meridian causes severe vomiting, frequent chills and fever, with more fever than chills. The patient desires to close doors and windows and stay alone. This disease is difficult to cure. (Foot-Shaoyin Cold Water governs Qi, hence severe vomiting. Shaoyin is marked by Yin but rooted in Heat, hence frequent chills and fever, with more fever than chills, indicating dominance of the Root Qi. Generally, diseases with more fever and dominant Yang Qi are easier to cure; those with more chills and dominant Yin Qi are difficult to cure. Desiring to close doors and windows indicates severe Yin Cold. Hence, the disease is difficult to cure. The Classic states: When Yang is exhausted and Yin is abundant, one desires to stay alone behind closed doors. Wang Fanghou states: For excessive Yang Heat, one should puncture to drain the pathogen; for Yin abundance, puncturing is not mentioned.)
Malaria involving the Foot-Jueyin meridian causes lower back pain, abdominal fullness, and difficulty urinating resembling strangury (Long), though it is not true strangury, but rather frequent urination. The patient feels fearful, lacks Qi, and feels depressed in the abdomen. One should puncture the Foot-Jueyin meridian. (Lower back pain and abdominal fullness are Jueyin meridian syndromes. Wood is the nascent Yang within Water; thus, the Liver governs the discharge of fluids. Resembling strangury but not true strangury, with frequent and difficult urination, indicates failure of Jueyin Qi transformation. Zhi Yi (Will and Intent) controls spirit and gathers soul and hun. The Classic states: Deficiency of Liver Qi causes fear. Since the Liver stores Shen Hun, deficiency leads to fear. Wood governs Spring Nascent Qi; Jueyin pathogenic invasion causes deficiency of Nascent Qi. Stagnant Wood fails to reach outward, causing abdominal depression. One should puncture Taichong (LR-3) of the Foot-Jueyin meridian, located 2 cun posterior to the interphalangeal joint of the big toe, in the depression. Puncture 3 cun deep, retain for one breath. Zhu Shenggong states: The Liver is the general, from where strategy arises. Qi deficiency causes fear.)
Lung Malaria causes coldness in the heart region. Severe cold precedes fever. During fever intervals, the patient is prone to fright and hallucinations, as if seeing things. One should puncture the Hand-Taiyin and Hand-Yangming meridians. (The Lung is the canopy of the Heart, hence causing coldness and heat in the heart region. Heart Qi deficiency causes fright and hallucinations. The Classic states: The Heart is the residence of Shen. When Shen Jing (Spiritual Essence) is chaotic and unrotating, one suddenly sees extraordinary objects. One should puncture Lieque (LU-7) of the Hand-Taiyin meridian and Hegu (LI-4) of the Hand-Yangming meridian. Lieque is 1.5 cun distal to the wrist crease; puncture 3 cun deep, retain for three breaths. Hegu is between the first and second metacarpal bones; puncture 3 cun deep, retain for six breaths. Lu Zhiyi states: Pathogens not invading the Zang organs present with Zang syndromes that are not true Zang storage issues, but rather气化 (Qi transformation) syndromes of the Zang Mu points. Mo Zhongchao states: When pathogens enter the Mu Yuan between the five Zang and six Fu organs without affecting their Qi, it results in intermittent malaria. Affecting Zang/Fu Qi results in Five Zang/Six Fu malaria. Involving Three Yin/Three Yang results in Six Meridian malaria. Thus, malaria is due to irregular Wind-Cold Qi.)
Heart Malaria causes severe mental distress. The patient desires cold water but has excessive chills and mild fever. One should puncture the Hand-Shaoyin meridian. (The Heart is a Fire organ. Heart Qi Heat causes severe distress and desire for cold water to self-rescue. Extreme Heat generates Cold, hence excessive chills. Prolonged Cold depletes True Fire Qi, hence mild fever. One should puncture Shenmen (HT-7) of the Hand-Shaoyin meridian, in the depression at the end of the ulnar styloid process of the wrist. Puncture 3 cun deep, retain for seven breaths.)
Liver Malaria causes the complexion to appear bluish-green (Cang Cang). The patient sighs frequently and appears as if dead. One should puncture the Foot-Jueyin meridian until blood appears. (Cang refers to the green color of the East. The Liver governs color, hence the bluish-green complexion. Gallbladder disease causes frequent sighing; since the Gallbladder attaches to the Liver, Liver disease inevitably affects the Gallbladder. Liver and Gallbladder govern Spring Nascent Qi. When Gallbladder Qi ascends, all Zang-Fu Qi ascend. Failure of Nascent Yang to ascend makes the patient appear as if dead. Puncture Zhongfeng (LR-4) of the Foot-Jueyin meridian until blood appears, located 1.5 cun anterior to the medial malleolus in the depression. Take the position with the foot extended or dorsiflexed. Puncture 4 cun deep, retain for seven breaths.)
Spleen Malaria causes chills and abdominal pain. Upon fever, there is borborygmus (intestinal rumbling); after rumbling, sweating occurs. One should puncture the Foot-Taiyin meridian. (Spleen is the Ultimate Yin within Yin, hence causing chills. The abdomen is the outer wall of Spleen Earth, hence abdominal pain. Damp-Heat descending causes borborygmus; ascending causes sweating. Rumbling followed by sweating indicates descent reaching extremity and then ascent. One should select Shangqiu (SP-5) of the Foot-Taiyin meridian, below the medial malleolus, slightly 3 cun anterior, in the depression. Puncture 3 cun deep, retain for seven breaths.)
Kidney Malaria causes shivering (Sa Sa), lower back and spine pain with rolling/restlessness, difficulty defecating, blurred vision, and cold hands and feet. One should puncture the Foot-Taiyang and Foot-Shaoyin meridians. (Xun is synonymous with Xun. Foot-Shaoyin Cold Water governs Qi, hence shivering. The lower back is the mansion of the Kidney, hence pain and desire to roll. The Kidney opens into the two orifices, hence difficulty defecating. Eyes shaking and unclear vision relate to Bone Essence forming the pupil. The Kidney governs the source of generating Qi; hands and feet are the root of all Yang meridians. Pathogenic disease damages generating Qi, hence cold hands and feet. One should select Weizhong (BL-40) of the Foot-Taiyang meridian, and Dazhong (KI-4) and Taixi (KI-3) of the Foot-Shaoyin meridian. Weizhong is in the center of the popliteal crease where the artery pulses. Dazhong is behind the medial malleolus; puncture 2 cun deep, retain for seven breaths. Taixi is behind the medial malleolus in the depression over the arterial pulse; puncture 3 cun deep, retain for seven breaths.)
Stomach Malaria causes the patient to feel ill and hungry, yet unable to eat. Upon eating, there is distension and abdominal enlargement. One should puncture the transverse vessels of the Foot-Yangming and Foot-Taiyin meridians to bleed. (The Stomach governs reception of water and grain, hence the sensation of hunger without ability to eat. Middle Jiao pathogenic invasion prevents transformation, hence distension and abdominal enlargement. Transverse vessels refer to the transverse collaterals of the Spleen and Stomach.)
When malaria fever is just beginning, puncture the arterial pulse on the dorsum of the foot. Open the acupoint and release blood; the fever will cease immediately. (This states that malaria chills and fever involve the Qi level of Yin and Yang, so one should select the Yangming and Taiyin meridians. Three Yang govern the exterior; Three Yin govern the interior. Malaria fever just beginning indicates pathogen exiting to Exterior Yang. Yangming is the convergence of two Yangs, situated between the two Yangs, governing Qi circulation throughout the body, representing abundant Yang Qi. Thus, one should select Chongyang (ST-42) of Yangming, shake the needle to open the acupoint, and drain blood, so Yang Heat leaves and coolness returns immediately.)
When malaria chills are about to begin, puncture the Hand-Yangming, Hand-Taiyin, Foot-Yangming, and Foot-Taiyin meridians. (The upper half of the body is Heaven; the lower half is Earth. Hand-Taiyin and Hand-Yangming govern Heaven; Foot-Taiyin and Foot-Yangming govern Earth. Thus, above the waist, Hand-Taiyin and Hand-Yangming govern; below the waist, Foot-Taiyin and Foot-Yangming govern. Furthermore, Yang is Heaven's Qi, governing the exterior; Yin is Earth's Qi, governing the interior. Malaria chills about to begin indicate pathogen entering Interior Yin. Thus, one should puncture Hand and Foot Yangming and Taiyin meridians, harmonizing Heaven and Earth, Yin and Yang, Upper and Lower, Exterior and Interior, preventing Yin excess.)
If the malaria pulse is full, large, and urgent, puncture the Back-Shu points. Use a medium needle. Puncture one point each from the five Shu points adjacent to the Back-Shu points, adjusting depth based on fatness or thinness to release blood. (Pang reads as qù shēng. This states that for malaria in meridians, one should select Back-Shu points. Meridians internally connect with the Qi of the Five Zang and Five Elements. The Back-Shu of the Five Zang are on the back, so one should select Back-Shu to drain. Full, large, and urgent pulse indicates pathogen abundance in meridians. Xie refers to the hypochondrium. Pang means adjacent. Shu points here refer to the five Shu points adjacent to the Back-Shu, near the hypochondrium: Pohu (BL-42), Shentang (BL-44), Hunmen (BL-47), Yishe (BL-49), and Zhishi (BL-52). One should puncture one point from each of these five adjacent Shu points. For fat patients, puncture deeply and retain; for thin patients, puncture shallowly and quickly, appropriately releasing blood.)
If the malaria pulse is small, solid, and urgent, moxa the lower leg Shaoyin meridian and puncture the Jing-Well points of the fingers/toes. (This states that for sinking of meridian Qi, one should moxa the Foot-Shaoyin meridian. Meridian Qi originates from the Kidney of Foot-Shaoyin. Small pulse indicates deficient Qi. The Classic states: All urgency indicates Cold. Small, solid, and urgent pulse indicates deficient Cold Qi and abundant Pathogenic Qi. Mugwort, named Bing Tai, can raise sunken Yang Qi. Thus, one should moxa Taixi (KI-3) below the lower leg of Shaoyin to raise generating Qi of the meridian. Puncture the Jing-Well point of the little toe to drain solid pathogen. This discusses attacking pathogens, but one must also assess healthy Qi.)
If the malaria pulse is full, large, and urgent, puncture the Back-Shu and the five Shu points adjacent to them, one point each. Operate until blood appears. (Shu is pronounced Shū in all chapters. This reiterates that Back-Shu and the adjacent Shu points have connected meridian Qi. "Back-Shu and five Shu, one each" means puncturing one point from the five Shu points adjacent to the Back-Shu, and one Back-Shu point. Back-Shu points are 1.5 cun lateral to the spine, corresponding to the Five Zang. The adjacent Shu points are 3 cun lateral to the spine, near the hypochondrium, where the Spirit Qi of the Five Zang resides. Pohu (Lung stores Po), Shentang (Heart stores Shen), Hunmen (Liver stores Hun), Yishe (Spleen stores Yi), Zhishi (Kidney stores Zhi). These Shu points connect with Back-Shu Qi, so select both. Adjust for fat/thin, manipulate needle until bleeding. This addresses pathogen abundance in blood vessels; if severe and affecting Zang, combine with Back-Shu. Thus, the previous section on moxa legs and this section on medication differ slightly. Mo Zijin states: Blood is Shen Qi. For disease in meridians damaging blood, select Shu points where Zang Spirits reside. Since meridians internally connect with Zang, also select Back-Shu.)
If the malaria pulse is slow, large, and deficient, medication is suitable; acupuncture is not. (Bian reads as píng shēng. This follows the previous text: for deficiency of Five Zang meridian Qi, medication is suitable, not acupuncture. Slow, large, and deficient pulse indicates dual deficiency of Blood and Qi. The *Ling Shu* states: For Qi deficiency, both Yin and Yang are insufficient. Tonifying Yang exhausts Yin; draining Yin causes Yang collapse. In such cases, use Sweet Medicine; do not use potent formulas. Such patients should not be moxa'd. If not cured, draining would ruin the Five Zang Qi. The previous section discussed the origin of meridian generation rooted in Foot-Shaoyin Kidney. This section discusses meridian Shu and Blood/Qi generated by Five Zang and Five Elements. With pathogen and healthy Qi, excess and deficiency, moxa, acupuncture, and medication each have their indications.)
Generally, treat malaria approximately one meal's duration before onset. Treating after this time misses the opportunity. (This discusses timing treatment relative to malaria onset. "One meal's duration before onset" means before the malaria starts, during a brief period. Healthy Qi is not yet disturbed; regulate it then. Do not puncture turbulent heat or turbulent pulses. If waiting until onset when pathogen is strong, the timing is missed.)
For various malaria cases where the pulse is imperceptible, puncture the spaces between the ten fingers to bleed. Once blood is released, the disease will certainly resolve. First, observe any red spots on the body resembling small beans and puncture them all. (This states that for pathogen in skin and Qi level, puncture Jing-Well points of the ten fingers. Malaria in Qi level is not reflected in the pulse. Imperceptible pulse means absence of full, large, urgent pulse. Puncture Jing-Well points of ten fingers to bleed; upon blood release, disease resolves immediately. Jing points are where meridian Qi initially converges, so puncturing drains Qi-level pathogen. Red spots like small beans indicate pathogen in superficial Qi level damaging light penetrating skin blood. Select and remove them first. This distinguishes pathogen in meridian blood from superficial skin blood; observed symptoms and puncture methods differ.)
There are twelve types of malaria, each with different onset times. Observe the syndrome to determine which meridian is affected. (This states that for pathogen in Zang organs and meridians, there are specific puncture methods. Twelve types refer to Six Meridians, Five Zang, and Stomach malaria. Different onset times mean Jueyin and Liver Malaria, Yangming and Stomach Malaria, Taiyin and Spleen Malaria, Shaoyin and Kidney Malaria each have distinct Zang-Meridian Qi differences. Observe syndromes like lower back pain/head heaviness or heart cold/fright to identify the affected meridian. Meridians are generated by the Stomach and governed by the Five Zang; thus, identify the meridian disease.)
Puncture approximately one meal's duration before onset. One puncture reduces the disease; two punctures improve it; three punctures cure it. ("One meal's duration before onset" means puncturing before symptoms start. Methods include: Foot-Taiyang malaria selects Weizhong; Yangming malaria selects dorsum of foot; Lung Malaria punctures Hand-Taiyin/Yangming; Heart Malaria punctures Hand-Shaoyin. One puncture reduces disease; two improve; three cure. Ancient texts consider relief of urination and harmony of abdomen as improvement. Yang Yuanru states: For pathogen in Qi level, delay puncturing. Qi is Yang, sharp in nature, so avoid its sharp arrival. For pathogen in Blood level, puncture early. Blood is Yin, soft in nature, so intercept and drain.)
If not cured, puncture the two vessels under the tongue to bleed. If still not cured, puncture the full vessels at Weizhong to bleed. Also puncture the areas below the neck along the spine; the disease will certainly resolve. The two vessels under the tongue are Lianquan (CV-23). Weizhong is identified by Wang Bing as Weizhong (BL-40). Full vessels refer to areas of abundant Blood and Qi. Areas below neck along spine refer to Shu and Back-Shu points. Ren Mai governs all Yin meridians and is the Sea of Meridians; Zang-Fu meridian Shu points belong to Taiyang. If puncturing the primary meridian fails, select Ren Mai, Foot-Taiyang Weizhong, and Back-Shu; the disease resolves immediately.)
To puncture malaria, first ask where the symptoms started, and puncture that area first. (This states: Pathogen entering Head/Neck causes symptoms in Head/Neck; entering Back causes symptoms in Back; entering Waist/Spine causes symptoms in Waist/Spine; entering Hands/Feet causes symptoms in Hands/Feet. Ask where symptoms started first, and puncture there. Ni Chongzhi states: Using "first" three times means pathogen may lodge in Head/Neck and simultaneously affect Waist/Back, or lodge in Waist/Back and simultaneously affect Hands/Feet. Where Wei Qi arrives first, symptoms appear first. Within a day, there may be multiple malaria attacks.)
If headache and heaviness occur first, puncture the top of the head, temples, and between eyebrows to bleed. If neck/back pain occurs first, puncture that area. If lower back/spine pain occurs first, puncture Weizhong to bleed. If arm/hand pain occurs first, puncture the spaces between ten fingers of Hand-Shaoyin and Hand-Yangming. If lower leg pain occurs first, puncture the spaces between ten fingers of Foot-Yangming to bleed. (Top of head refers to Shangxing (GV-23) and Baihui (GV-20). Temples refer to Xuanlu (GB-7). Between eyebrows refers to Cuanzhu (BL-2) etc. Neck/back pain: puncture Fengchi (GB-20), Fengfu (GV-16), or tender points. Weizhong is BL-40. Hand-Shaoyin/Yangming ten finger spaces refer to Shaochong (HT-9) and Shangyang (LI-1). Foot-Yangming ten finger spaces refer to Luidui (ST-45). Heart of Shaoyin governs Blood vessels; Jing-Ying Blood/Qi of hands and feet are generated by Yangming. Thus, hand/foot pain uniquely selects Shaoyin and Yangming. Zhang Zhaohuang states: Only neck/back malaria has varied syndromes. Some have pathogen entering Fengfu, moving with Wei Qi causing daily variation in onset time. Some have pathogen lingering in neck/back, causing delayed onset with Wei Qi. Some have pathogen between neck/back, unrelated to Wei Qi daily cycles. Hence, generally stated as "puncture first.")
Wind Malaria: Onset involves sweating and aversion to wind. Puncture the blood of the Back-Shu points of the Three Yang meridians. (This states that for Wind Malaria, select Foot-Taiyang meridian. Sweating and aversion to wind on onset indicate deficiency of Exterior Yang Qi. Three Yang refers to Taiyang. Back-Shu refers to Taiyang meridian Shu points. Taiyang...)