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[General Principle] Zhang Zhongjing stated: When the pulse is vigorous at both Yin and Yang positions (superficial and deep, or upper and lower), if the Yin pulse (Chi position) is more vigorous, it transforms into Warm Malaria.

[Detailed Discussion] Li said: After treatment of Cold Damage with sweating, vomiting, or purging, if residual heat remains uncleaned and is compounded by a new contraction of cold pathogen, malaria may result. Alternatively, after the disease has passed its meridian stage, if old heat is not resolved and new contraction of the Six Excesses (Wind, Cold, Summer-heat, Dampness, Dryness, Fire) occurs, malaria may also result. These are all termed Warm Malaria because they present with fever preceding chills. If chills predominate over fever, or if there are only chills without fever, this is a transformation of Shaoyang pathogen affecting the Taiyang channel; treat with Chaihu Guizhi Tang. If fever predominates over chills, or if there is only fever accompanied by severe bone joint pain, this is a transformation affecting the Yangming channel; treat with Baitu Tang plus Guizhi. If chills and fever are equal in intensity, or if fever precedes chills, this is a transformation affecting the Shaoyang channel; treat with Xiaochaihu Tang. If thirst is present, remove Banxia and add Huafen and Zhimu. If chills and fever are severe, with rigors and profuse sweating that does not stop, this is a combined disease of Taiyang and Yangming; treat with Guizhi Shigao Tang. If malaria worsens after taking this formula, it indicates a combined disease of the Three Yang channels, and there is fear of transmission to the Yin channels; immediately use Guizhi Huangqin Tang. If the pathogen transmits to the Yin aspect, and attacks occur between Mao hour (5-7 AM) and Wu hour (11 AM-1 PM) with vomiting and fecal impaction, purge with Dachaihu Tang. If attacks occur between Wu hour (11 AM-1 PM) and You hour (5-7 PM) with abdominal fullness and fecal impaction, purge with Dachengqi Tang. If attacks occur between You hour (5-7 PM) and Yin hour (3-5 AM) with mania, forgetfulness, and black stools, mildly purge with Tao Ren Chengqi Tang. For those who cannot tolerate purgation, use Zhizi Shengma Tang. The distinction between malaria caused by Cold Damage and that from miscellaneous diseases lies here. Occasionally, there are cases complicated by phlegm-dampness or food stagnation, causing vomiting and inability to eat; treat with Erchen Tang combined with Jinyinzi. For cases with difficult urination, irritability, thirst, due to miasma or acclimatization issues, use Wuling San, adding Chaihu and Huangqin. Such malaria differs little from miscellaneous diseases. If the condition persists for a long time and attacks become slightly less frequent, interception methods can be used. If phlegm-fluid retention is in the upper diaphragm, causing retching without successful emesis, powder equal parts of Goudi, Chi Xiaodou, and Xionghuang, mix with water and take 0.5 fen; induce vomiting until satisfied. Quxie Wan is also suitable. For chronic cases, use Shengjin Dan or Laonie Wan to resolve the pathogen.

Wang Kentang said: In any complicated disease resulting from Cold Damage, if previous heat is not eliminated and the pulse is vigorous at both Yin and Yang positions, compounding cold pathogen leads to Warm Malaria. If there is alternating chills and fever, bitter taste in the mouth, and chest/hypochondriac fullness, treat with Xiaochaihu Tang plus Shaoyao and a small amount of Guizhi. If heat predominates, double the dosage of Chaihu; if chills predominate, double the dosage of Guizhi. If heat is intense with irritability and thirst, use Renshen Baitu Tang with a small amount of Bo Gui. If there is only heat without chills, do not use Guizhi. However, if there is any chill, Guizhi must be slightly added as an assistant. If heat predominates, combine Xiaochaihu Tang with Baitu Tang. If there is much phlegm and heat, combine Xiaochaihu Tang with Erchen Tang. If appetite is poor and stomach Qi is weak, add Baizhu. If there is epigastric stuffiness, add Zhishi and Huanglian. If the pulse is deficient, double the dosage of Renshen. If thirsty, remove Banxia and add Huafen. If evil heat accumulates internally with dry stool and a slippery, large, and forceful pulse, purge with Dachaihu Tang. Once the malaria symptoms have corrected, seek treatment principles within the framework of miscellaneous diseases.