Library

Malaria (Nue, 疟) is akin to the severe form of malaria. It arises from summer-heat injury during the summer season, accompanied by the accumulation of pathogenic factors. This accumulation typically occurs below the left hypochondrium, resembling an inverted cup, which constitutes "malaria." Since it results from summer-heat injury leading to malaria, why do later physicians treat it as spleen-cold? Ignorant physicians fail to recognize that deep accumulation of pathogenic heat causes chills (Han Zhan, 寒战), thus being confused by this symptom; they also fail to comprehend that after pathogenic heat enters deeply and then emerges to the exterior, causing dryness and thirst (Zao Ke, 燥渴), they are misled by the struggle between righteous qi and pathogens. They pass down treatments using dried ginger (Ganjiang, 干姜), prepared aconite (Fuzi, 附子), sulfur (Liuhuang, 硫黄), Pingwei San (Stomach Harmonizing Powder), Yigong San (Extraordinary Efficacy Powder), and Jiaoxie Yinzi (Interacting Decoction). Among thousands of cases, one might occasionally succeed. Clinging to this as correct, fathers and sons, brothers, pass it down through generations. When malaria becomes severe, they attribute it to malevolent spirits, which is truly laughable. The *Neijing* states: "One who is bound by ghosts and spirits cannot be spoken to regarding the highest virtues." How foolish and unteachable the common people are! Some attribute it to excessive consumption of cold drinks in summer or damage from raw, hard foods like melons, pears, and dates, calling it "food malaria," which is also incorrect. Does one not know that the *Neijing* does not argue this way? Summer-heat injury, combined with autumn wind, sweating due to exertion, wind entering the xuankou (sweat pores, Xuanfu, 玄府), and subsequent exposure to chilling water, causes wind closure preventing expulsion. The pathogen resides outside the intestines and stomach, moving alongside Ying and Wei qi, traveling through Yang during the day and Yin at night. If pathogenic heat is shallow, it manifests daily; if deep, every other day. If it merges inward, there is fever; if outward, chills. Thus discussed, it has nothing to do with the spleen.

Later discussions on medicine contain such significant errors. Temporally, in times of peace, ordinary malaria cases are few; in turbulent times, they are many. In peaceful eras, even toxic drugs like realgar (Pishi, 砒石) and cinnabar (Chensha, 辰砂) can be effective because the populace is tranquil, so treating heat with heat rarely causes aftermath issues. In turbulent times, when people suffer labor and hardship, one must not abruptly use highly toxic or hot drugs. Using heat to treat heat may exacerbate heat, leading to hematemesis, hematochezia, carbuncles, sores, vomiting, etc. Turbulent times feature chaotic governance, heavy corvée, constant warfare, leaving no rest. Internal fire and external fire activate simultaneously, especially among nobles and officials. How can they be treated the same as tranquil people? I witnessed in the Bingyin year of Taihe 6th year, when southern campaigns were launched, returning the next year. That year, pestilence killed countless people, many dying of dizziness and oppression, nine out of ten deaths caused by fire transformation. The following year, malaria erupted widely among nobles and officials, lasting weeks for mild cases, over a year for severe ones. Wealthy individuals, straining their minds, should not suddenly use highly toxic drugs like realgar. Instead, start with Baihu Tang plus Ginseng, Xiaochaihu Tang, or Wuling San, taken in one dose for immediate relief. If ineffective, try Shenyu Wan reduced dosage or Shenxiong Wan. For severe cases, use Dachengqi Tang or Xiaochengqi Tang to purge, resulting in five to seven or more bowel movements, vigorously draining summer accumulated heat and toxicity. These purgatives drain without damaging zang-fu organs, thereby stabilizing them. Subsequently, use Guiling Ganlu San, Shigao Zhimu Tang, Da Chaihu Tang, Xiao Chaihu Tang, or Renshen Chaihu Yinzi, adjusted for deficiency or excess. These treat alternating chills and fever, afternoon exacerbations, similar to shaoyang syndrome treatment in Cold Damage. If still ineffective, induce vomiting with Changshan San, which invariably succeeds.

I have used Zhang Zhongjing’s methods of sweating, purging, and vomiting to cure many malaria cases. One must strictly avoid misdiagnosing it as spleen-cold and using violent hot drugs. Even if cured, carbuncles or bleeding disorders will likely follow, endangering life. My family has transmitted medical prescriptions for over fifty years. Without thorough mastery, how dare I make such definitive judgments? I also studied the Fifty-Nine Acupoints for Malaria from the *Needling Malaria* chapter: one needling reduces severity, two removes the pathogen, three cures it. A patient in Chenxia suffered from malaria for two years, taking only warm herbs until emaciated. Seeing his weakness, I hesitated to use cold/cool herbs immediately. Consulting the *Neijing*, I noted: "For persistent malaria, prick the ten fingers to bleed." At the onset of attack, I pricked his ten fingers. Bleeding stopped, and chills/fever ceased instantly. People marveled at the efficacy, but I merely applied technique. I see young scholars ignoring classics, blaming ghosts, seeking talismans, praying, and using unorthodox methods, prolonging patients' suffering. Except for specific miasma types where death is inevitable after one or two attacks, most organ-related malaria is curable; deaths are usually due to physician error. Someone asked: "If malaria stems from summer-heat, what about spring-onset malaria?" I replied: "This is the deepest type. Summer-heat lies dormant in autumn/winter, manifesting in spring." The *Neijing·Qi Jiao Bian Da Lun* states: "Excessive fire leads to widespread heat, injuring lung metal." Qixuanzi commented: "Fire lacking virtue harms lung metal." Thus lung disease precedes due to metal deficiency. Also: "Excessive fire causes early great heat, leading to malaria, shortness of breath, cough, asthma, bleeding, throat dryness, deafness, internal heat, shoulder/back heat." This corresponds to the Mars star (Yinghuo, 荧惑); its appearance brings drought and fire. Annotations explain: Fire harming metal triggers water counteracting heart fire, causing heart pathology. Mars appearing signifies harsh laws; thus malaria parallels cruel governance. Either cruel policy precedes malaria, or vice versa. Ancient poetry says: "Great heat drives away cruel officials." Though not medical, it aligns with medical principles. Previous authors omitted this, so I elucidate it. The sage's naming of malaria implies profound meaning.