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When the climate is abnormal and there is qi contrary to the season, in winter, yang qi should be stored and conserved, but instead it leaks outward. Treatment should exclusively use tonifying medicines combined with exterior-releasing agents, such as those in Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction).

Prescription: Take a bamboo tube, retaining the nodes at both ends, and open a hole in the middle. Place crushed large licorice root (Gancao) inside, then seal the hole with bamboo or wooden pegs and oil paste. On the day of Start of Winter (Lidong), immerse it in a cesspit. Retrieve it on the day before Start of Spring (Lichun), and dry it for twenty-one days in a place with wind but no direct sunlight; the longer it is kept, the better. Then break the bamboo, retrieve the licorice, and grind it into a fine powder. This can effectively treat Yang-pattern epidemic toxins. Another claim is that it also treats swelling toxins and can be applied externally to traumatic injuries (Jinchuang) mixed with water. The pulse presents as the left Cun position larger than the right Cun position, floating, moderate, and vigorous, but weak upon deep pressure.

The etiologies of malaria include Wind, Summerheat, Food Stagnation, Phlegm-Fluid, chronic malaria (Lao Nue), and malaria mass (Nue Mu - subcostal mass formed after prolonged malaria). Chronic malaria patients suffer from Wind and Summerheat pathogens invading the Yin organs. Use blood-invigorating herbs to draw the pathogen out to the Yang level and dissipate it, employing a method of one tonification followed by one release. Herbs include Chuanxiong Honghua Danggui (Ligusticum, Safflower, Angelica Sinensis), added with Cangzhu Baizhu Baizhi Huangbai Gancao (Atractylodes Lancea, Atractylodes Macrocephala, Angelica Dahurica, Phellodendron, Licorice). Decoct and leave exposed overnight, taken early the next morning. For those without sweat, induce sweating; prioritize releasing pathogens while accompanying with tonification. For those with sweat, stop sweating; prioritize tonifying righteous qi while accompanying with releasing pathogens. To release pathogens and induce sweating, use Zisu Mahuang (Perilla Leaf, Ephedra). To tonify righteous qi, use Renshen Huangqi (Ginseng, Astragalus). Malaria masses are mostly located under the hypochondrium, causing excessive sweating and hypochondriac pain; treat with pill formulations for resolution and guidance. Use Vinegar-processed Turtle Shell (Biejia) as the sovereign herb, combined with Sanleng Ezhu (Burreed Rhizome, Curcuma Zedoaria), Haifen (Sea Sponge), Vinegar-processed Xiangfu Qingpi Taohong Honghua Shenqu Maidong (Cyperus, Tangerine Peel, Peach Kernel, Safflower, Medicated Leaven, Ophiopogon), adjusted according to symptoms. In another version, all herbs from Xiangfu upwards are vinegar-processed. Those attacking every three days have been ill for one year; those attacking every other day have been ill for half a year; those attacking daily have been ill for one month; those attacking two days and resting one day indicate both Qi and Blood are diseased. Those attacking one day and resting one day are treated with tonics accompanied by exterior-releasing drugs, subsequently using Jie Nue Dan (Malaria-Cutting Pill) to cut off the malaria. If the disease is in the Yin level, use medication to bring it up to the Yang level before it can be cut off.

Prescription: Chuan Changshan Cao Guo Zhimu Binglang Wumei Chao Chuanshanjia Zhi Gancao (Changshan, Tsaoko Cardamom, Anemarrhena, Areca Seed, Mume Fruit, Processed Pangolin Scale, Processed Licorice). Decoct in one large bowl of water until half remains, leave exposed overnight. On the morning of the attack, or two hours before the attack, take warm. If vomiting occurs, follow the trend. The general principle is that Summerheat-Wind malaria must be treated by inducing sweating. In summer, resting in cool breezy places causes pores to close and prevents excretion; aversion to food indicates the disease originated from diet. For malaria with deficiency, first use Renshen Baizhu (Ginseng, Atractylodes Macrocephala) for one or two doses to support the Qi and prevent sinking, then treat with other medications. When internal injury combines with external pathogens, phlegm inevitably forms internally, and the exterior must be resolved through sweating. Use Er Chen Tang plus Caoguo Changshan Chaihu Huangqin (Tsaoko Cardamom, Changshan, Bupleurum, Scutellaria). For severe malaria presenting with alternating chills and fever, headache as if splitting, thirst with desire to drink, and spontaneous sweating, use Renshen Huangqi Baizhu Huangqin Huanglian Zhizi Chuanxiong Cangzhu Banxia Tianhuafen (Ginseng, Astragalus, Atractylodes Macrocephala, Scutellaria, Coptis, Gardenia, Ligusticum, Atractylodes Lancea, Pinellia, Trichosanthes Root). For chronic malaria, use Er Chen Tang plus Chuanxiong Cangzhu Chaihu Baizhu Genge (Ligusticum, Atractylodes Lancea, Bupleurum, Atractylodes Macrocephala, Pueraria). One tonification and one release: for attacks near midday; for attacks near midday with excessive sweating, irritability, and thirst, use Huangqi Sanbai Tang plus Qinlian (Astragalus Three Whites Decoction plus Scutellaria and Coptis). For chills predominating, weak pulse, fatigue, and poor appetite, use Ju Fang Renshen Yangwei Tang (Official Formula Ginseng Stomach-Nourishing Decoction). Malaria caused by overwork or worry, with excessive sweating, poor appetite, severe fatigue, and reluctance to speak, is treated with Bu Zhong Yi Qi Tang. For phlegm stagnation in the chest with fullness, more heat than cold, and dry hard stool, use Da Chai Hu Tang (Major Bupleurum Decoction). For malaria where the patient can eat but phlegm is latent, use Xiao Wei Dan (Minor Stomach Pill). For severe malaria with extreme thirst and heat, use Xiao Chai Hu Tang removing Banxia, adding Zhimu Maidong Huanglian (Anemarrhena, Ophiopogon, Coptis). Generally, Summerheat malaria uses Xiao Chai Hu Tang and Renshen Baihu Tang (Ginseng White Tiger Decoction). For malaria thirst, use Shengdiye Maidong Tianhuafen Chuan Niuxi Zhimu Chao Bai Genge Sheng Gancao (Rehmannia, Ophiopogon, Trichosanthes Root, Cyathula, Anemarrhena, Processed Phellodendron, Pueraria, Raw Licorice). Post-malaria, use Baizhu Banxia (each 1 liang), Huanglian (5 qian), Shaoyao (3 qian), Chenpi (5 qian), grind to powder, and form pills with congee. For chronic malaria without sweat, use Er Chen Tang plus Binglang, doubling Cangzhu and Baizhu. One patient had hand tremors after malaria; this was due to phlegm stagnation blocking saliva, improving after expectoration.

Jie Nue Qinghao Wan (Malaria-Cutting Artemisia Pill): Qinghao (1 jin), Donggua Ye (2 liang), Guanzi Gui (2 liang), Mabiancao (2 liang). Dry the first three leaves by roasting, grind to powder, make pills like paulownia seeds. Divide one liang into four doses, finish taking them one hour before the expected attack. Another formula: Binglang, Chenpi, Baizhu, Changshan (each 2 qian), Fuling, Wumei, Houpo (each 1 qian). Make two doses. Each dose decocted with one cup of wine and one cup of water until half remains. Take one dose the day before the attack, and one dose on the day of the attack. Sleep briefly after taking; effect follows. It is best to use cutting medicine after several attacks to remove the pathogen. If the attack depletes Middle Qi and the pathogen goes deeper, lasting months or years, even a divine physician cannot cure it. Although treatment may provide temporary relief, recurrence due to diet or external pathogens is common in modern times. Use good quality Changshan (1 liang) and Binglang (5 qian), grind to powder, make pills with wheat paste like paulownia seeds. Take two pills the day before the attack; effective immediately. Or use Changshan Yinzi. For cutting methods, use Mr. Shouzhen's pills: Xionghuang (1 liang), Renshen (5 qian). On the fifth day of the fifth lunar month, make pills using the tip of a zongzi (sticky rice dumpling), size of paulownia seeds. Take one pill early before the attack, facing East, swallowed well-water. Avoid all hot-natured foods. (Renshen is sometimes said to be Renyan/Arsenic). Another formula: Daheidou (7 qian), Xionghuang (1 qian), Qingfen (5 fen), Renshen (1 qian), Bohe (5 fen), Gancao (1 qian). Grind to powder, make pills with drops of water like small beans. Swallow one pill at cockcrow, facing East, with fresh well-water. (Renshen is sometimes said to be Renyan/Arsenic). Another formula by Luo Qianfu, Zijieche Wan: Zijieche (1 liang), Sheng Gancao (5 qian), Ludou (1 liang), Renyan (Arsenic, 1 qian, separately ground). Grind to fine powder. Take 5 fen each time, swallowed with a little fresh well-water. If attacking every other day, take at night; if frequent attacks, take during deep sleep. Avoid meat, fruits, alcohol, noodles, fish, chicken, and raw/cold items. For attacks every three days or deeply infected pathogens, only one dose is needed. Over ten years old take one zi character dose, three years old take half zi character dose. Pregnant women should not take it.

One patient, sixty years old, robust constitution and rich diet, contracted malaria in spring. Mr. Zhu advised abstinence from sexual activity and bland diet, but he did not listen. Physicians gave "robbery" (harsh/expelling) medicines for three to five doses, bringing relief, but it recurred ten days later. This continued until winter when he sought treatment again. Mr. Zhu knew he had sweated profusely long ago, but his Stomach Qi was not yet restored. Due to severe cold weather and exposure to cold causing chills and fever, tonification was necessary. He used only Baizhu (Atractylodes Macrocephala) ground to powder, made into pills with congee, giving two jin. Instructed to take it when hungry, without prior food intake, swallowing 100-200 pills with hot water, and maintaining diet with thin congee. After finishing the medicine, profuse sweating occurred and he recovered. Many cases followed this pattern, with slight variations in herbs. One patient had chronic malaria with abdominal distension. Pulse was not rapid but slightly wiry; heavy pressure felt unsmooth, light pressure felt weak. Thus, San He Tang (Suo Shi version) was given at triple dosage, added with Baizhu and ginger juice. After several doses, urination increased by one or two times, and abdominal distension decreased slightly. As urine became scanty, it was treated as Qi and Blood deficiency. Added Renshen, Niuxi, Dangguishen (Ginseng, Achyranthes, Angelica Sinensis root body) in large doses. After forty-plus doses, he recovered.

One woman suffered from malaria attacking every two days, ate very little, and menstruation had stopped for three months. Her pulse was absent in both hands. However, she dressed normally, spoke and walked without fatigue. Realizing that amenorrhea was not due to lack of blood but obstruction by phlegm, and absence of pulse was not due to blood depletion but blockage by accumulated phlegm generating heat, he treated it as Excess Heat. He gave Sanhua Shenyu Wan (Three Flowers Divine Expulsion Pill). Ten days later, appetite improved and pulse appeared slightly. After one month, all six pulses were palpable, though slightly wiry. Malaria had not yet ceased. Since Stomach Qi was restored, deep spring energy would naturally strengthen the menses, so recovery would occur without further medication. He taught her to eat bland flavors and regulate diet. Half a month later, malaria ceased and menstruation resumed.

An elderly man suffered from malaria for half a year. His Chi positions were rapid and forceful, complexion slightly withered. This was because he had taken Si Shou Yin (Four Beasts Decoction) and similar formulas, causing damp-heat in the Middle Jiao to flow downward and settle in the Kidney. Consequently, Kidney Fire rose to the Lung, causing both malaria and cough. He was treated with Renshen, Baizhu, Huangqin, Huanglian, Shengma, Chaihu to harmonize the center. After one or two days, he took Huangbai Wan (Phellodendron Pills). He experienced nocturnal emissions for two nights, indicating Kidney heat was resolved and there was no cause for worry. The next day, malaria and cough stopped abruptly.

A wealthy young man suffered from malaria. Chills started at Mao hour (5-7 AM), heat started at You hour (5-7 PM), and subsided at Yin hour (3-5 AM). He was awake for only one hour in a full day-night cycle. He deduced it was caused by sexual activity followed by cold invasion. He used Renshen and Baizhu for major tonification, Fuzi to circulate channels, and cold-dispelling herbs to induce sweating. After several days, no sweat occurred, and the condition remained unchanged. Because he mistakenly traveled far via foot paths, the medicinal power could not reach the extremities. He decocted Cangzhu, Chuanxiong, and Taozhi (Peach Twig) in a vessel, sat and immersed his feet to the knees. Within the time of one meal, he drank the previously prepared medicine. Profuse whole-body sweating ensued, and the disease was cured. For chronic diseases, direct cutting is not advisable; one must use one tonification and one release. Arsenic and other toxic drugs should not be taken lightly due to their toxicity. Disease in the Yin level is difficult to treat; disease in the Yang level is easy to treat. Malaria mass must be dissolved with toxic drugs, prioritizing Qi-moving and hardness-reducing actions. Dong Yuan stated: Cold malaria belongs to Taiyang and should be treated by sweating; Heat malaria belongs to Yangming and should be treated by purging; Alternating chills and fever malaria belongs to Shaoyang and should be treated by harmonizing. In the Three Yin levels, they are not distinguished and are collectively called Warm Malaria; this statement is correct. However, the theory of Three Yin meridians is unclear. Malaria occurring on Zi, Wu, Mao, You days is Shaoyin Malaria; on Yin, Shen, Si, Hai days is Jueyin Malaria; on Chen, Xu, Chou, Wei days is Taiyin Malaria. The pulse is wiry; if heat, wiry and rapid; if cold, wiry and slow. There are also cases of chronic illness where the pulse is extremely deficient, faint, and weak, seemingly not wiry. However, within the deficiency and faintness, a wiry quality must be seen, though it does not strike the finger forcefully. Careful observation can reveal it.