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Chronic malaria caused by latent summerheat lingers for a long time, with the pathogenic factor having no outlet. A mass forms under the hypochondrium, known as "Mamo" (Malaria Mother). It is appropriate to use Biejia Yinzi (Turtle Shell Decoction) and Biejia Jianwan (Turtle Shell Pill for Reducing Stagnation) to dissipate the stagnation and treat malaria.

This refers to the malaria pathogen deeply lodged in the Jueyin Liver Meridian, forming a mass under the hypochondrium, which constitutes Mamo. Since the hypochondrium is the pathway of the Shaoyang Gallbladder Meridian, when the malaria pathogen first invades, it must gradually transmit from Shaoyang to Jueyin. Over time, it inevitably enters the collaterals, where it condenses with phlegm and qi, forming a tangible mass. Without using ascending and descending, penetrating and circulating herbs such as Biejiaruo (Turtle Shell), Dibiechong (Ground Beetle), Jiangcan (Bombyx Batryticatus), and Shanjiachuan (Pangolin Scales), it may be impossible to search out and eliminate the hidden pathogens and ascend/release the lurking evil. Furthermore, combining Chaihu (Bupleurum Root), Chuanxiong (Sichuan Lovage Rhizome), Guixu (Angelica Sinensis Root Tip), Shegan (Belamcanda Rhizome), and Taoren (Peach Seed) provides methods of ascending, descending, diffusing, and purging. With these four methods fully employed, the pathogen has no place to reside and will inevitably emerge outward. The above discussions all arise from latent summerheat, so they are collected together. Scholars should also refer to the section on Malaria Syndrome for comprehensive reference.

Dysentery with accumulation caused by latent summerheat presents with white stool, abdominal pain, tenesmus, white tongue coating, and nausea/vomiting. This indicates the pathogen is latent in the Spleen and Stomach. It is appropriate to use Huoxiang Zhengqi San (Agaricus Powder for Rectifying the Qi) added with Shanzha (Hawthorn Fruit), Muxiang (Aucklandiae Radix), Binglang (Areca Seed), Cheqianzi (Plantago Seed), etc., to regulate the Spleen and expel dampness.

Whenever summerheat lies dormant in the Moyuan (Sea of Origin) and erupts due to external invading pathogens, it is called Malaria Syndrome; if it arises from internal injury caused by cold and raw food, it is called Dysentery. As the sages said, "Summerheat pathogen in the Spleen results either in malaria or dysentery, but not both simultaneously." Currently, the passage of white accumulation in stool, accompanied by abdominal pain, white tongue coating, and nausea/vomiting, indicates that cold-dampness has injured the Spleen. Although there is tenesmus, one should first regulate the Qi aspect to dissipate the pathogen. Therefore, Zhengqi San is used with additions of Shanzha, Muxiang, Binglang, and Cheqian to warm the Spleen, regulate dampness, and separate fluids via the Bladder, preventing the pathogen from spreading into the Blood aspect and turning into bloody dysentery.

Dysentery with accumulation caused by latent summerheat presents with red stool, abdominal pain, and tenesmus. This occurs because the Qi aspect is injured and subsequently affects the Blood aspect. It is appropriate to use Jiegou Shaoyao Tang (Jiegu's Peony Decoction) to harmonize Qi and nourish Blood.

The previous case of white accumulation in stool specifically injures the Qi aspect and only requires regulating Qi; this case involves red stool, indicating injury to the Blood aspect, where merely regulating Qi is ineffective. Thus, Jiegou Shaoyao Tang is used. Huangqin (Scutellaria Root) and Huanglian (Coptis Rhizome) use their bitter-cold nature to clear stagnant heat; Binglang and Muxiang use their acrid-warm nature to move Qi stagnation; Danggui (Angelica Sinensis Root), Shaoyao (Peony Root), and Taoren (Peach Seed) harmonize Ying (Nutritive) level and stop bleeding; Dahuang (Rhubarb Root) and Rougui (Cinnamon Bark) provide warmth and unblock to resolve accumulation. This is what is meant by "harmonizing the Blood stops dysentery naturally, regulating the Qi eliminates tenesmus." Furthermore, Dysentery was anciently called "Zhixia" (Stagnant Downward Flow) or "Changpi" (Intestinal Diarrhea). It is caused by summerheat-dampness injuring the Spleen during summer and autumn, obstructing Qi mechanism, steaming and fermenting, leading to failure of Qi transformation and lack of pathogen outlet. The pathogens rush to the Large Intestine, causing binding and stagnation. Hence, initially, the stool often contains intestinal mucus and turbid matter mixed together, regardless of color (red or white), always presenting with tenesmus, abdominal pain, and even rectal prolapse. However, within abdominal pain, one must distinguish between Excess and Deficiency. Pain that alleviates after defecation is Excess, suitable for purgative methods; pain that does not alleviate after defecation is Deficiency, suitable for tonifying methods. Tenesmus also has Excess and Deficiency types. "Tenesmus" refers to the sensation of heaviness and drooping in the abdomen before the urge to defecate. If the urgency alleviates with defecation, it is Excess, primarily treated with dredging methods; if the urgency persists despite defecation, it is Deficiency, primarily treated with consolidating and tonifying methods. "Heaviness in the anus" (Houzhang) also has Excess and Deficiency types. "Houzhang" refers to the feeling of incomplete evacuation and anal heaviness after defecation. In Excess cases, caused by pathogenic fire constraining the bowels, bitter-cold herbs should be used to clear heat; in Deficiency cases, caused by fluid depletion and Qi sinking, sweet-warm herbs should be used to tonify. Scholars must carefully examine the exact pathology regarding Qi/Blood and Excess/Deficiency. The appropriate application of warming, clearing, tonifying, and purging methods, along with flexible adaptation, depends entirely on the practitioner.