Library

Yang states: The onset and cessation of malaria symptoms occur at regular intervals, unlike the alternating chills and fever (alternating aversion to cold and fever) which may be sparse or frequent with no fixed timing for onset and cessation. In individuals who have contracted a common cold, if they suddenly feel cold hairs, trembling of the thighs, stiffness and spasm of muscles and joints, a sensation as if all bones are being shaken like a drum, nausea, vomiting, and loss of appetite, followed by an unbearable coldness that soon turns into fever, this is termed warm malaria (a type of malaria characterized by high fever accompanied by chills). One should not assume that only a wiry pulse indicates malaria; nor should one consider rapid and surging, tight and solid, deficient and slow, or rough and choppy pulses as definitive signs of malaria without differentiation. These are all manifestations of malaria, but they must be distinguished by external syndromes. Medication naturally follows specific guidelines, such as using Xiao Chai Hu Tang (Minor Bupleurum Decoction, the primary formula for harmonizing Shaoyang), which can be flexibly adjusted according to previous principles. Although blood deficiency can generate chills and fever, and stagnant blood (blood stasis obstruction) can also cause chills and fever, and although each syndrome of yin-yang imbalance has its own specific formula, Chuanxiong Rhizoma (Chuanxiong) should generally be used as an adjuvant herb in all cases.

In Taiyang disease (an early stage of exogenous cold-wind pathogen affecting the exterior), after eight or nine days, if the symptoms resemble malaria with more heat than cold, the patient does not vomit, bowel and bladder functions are relatively normal, and episodes occur two or three times a day, a slightly moderate pulse indicates impending recovery. If the pulse is faint with aversion to cold, this indicates deficiency of both yin and yang, and sweating, purgation, or emesis should not be induced. If the face appears flushed with heat, the pathogen has not been resolved because slight perspiration has not been achieved, leading to body itching; Guizhi Mahuang Ge Ban Tang (Cinnamon Twig and Ephedra Half-Dose Decoction) is appropriate to induce mild sweating.

After taking Guizhi Tang (Cinnamon Twig Decoction), if profuse sweating occurs and the pulse becomes surging, Guizhi Tang should still be administered according to the previous method. If symptoms resemble malaria occurring twice a day, resolution will follow sweating; Guizhi Er Mahuang Yi Tang (Cinnamon Twig Twice-Ephedra Once Decoction) is indicated. Cheng Wuji stated: If symptoms persist after one dose, the original decoction should be prepared again. A surging pulse after sweating from Guizhi Tang indicates the pathogen remains. If symptoms resemble malaria occurring twice daily, it signifies pathogenic factors lodged between Ying (Nutritive) and Wei (Defensive) levels; Guizhi Er Mahuang Yi Tang is used to dissipate these pathogens.

Formula for Guizhi Er Mahuang Yi Tang:
Guizhi (Cinnamomi Ramulus, 3 qian, remove coarse bark), Shaoyao (Paeoniae Radix Alba, 3 qian), Mahuang (Ephedrae Herba, 1.6 qian, remove nodes), Shengjiang (Zingiberis Rhizoma Recens, 3 qian, sliced), Gancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle, 1.6 qian, honey-fried), Xingren (Armeniacae Semen Amarum, 4 pieces, remove skin and pointed ends), Dazao (Ziziphi Jujubae Fructus, 2 pieces, split). The above seven ingredients are boiled in two zhong of water. First, boil Mahuang for one or two boils, skim off the foam, then add the remaining herbs. Boil until one zhong remains, strain, and divide into two doses.

If the patient’s head feels hot and sweating occurs, the condition resolves. If symptoms resemble malaria with fever occurring in the late afternoon (Ribu, approximately 3-5 PM), this belongs to Yangming disease (excess heat in the stomach and intestines). If the pulse is excess, purgation is indicated; if the pulse is deficient and floating, sweating is indicated. For purgation, Da Chengqi Tang (Major Order the Qi Decoction) is used; for sweating, Guizhi Tang is appropriate. Although Yangming syndrome patterns are present, internal excess cannot be assumed immediately; pulse and condition must be carefully examined to distinguish interior from exterior. An excess pulse indicates heat has entered the fu organs becoming excess, allowing for purgation with Da Chengqi Tang. A floating-deficient pulse indicates heat has not entered the fu organs but remains on the exterior, allowing for resolution via sweating with Guizhi Tang.

In women suffering from wind-stroke for seven or eight days, if chills and fever continue to occur at regular intervals and menstruation happens to cease, this is termed "heat entering the blood chamber" (heat invading the uterus/blood sea). Blood coagulation results, causing malaria-like periodic symptoms. Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the primary treatment. (For details, refer to the section on Cold Damage in Women.)