Zhu Shengan, an official of the Ministry of Works (Dongguan), contracted malaria due to food stagnation and cold invasion. He self-medicated with Qingpi Yin (Clear the Spleen Decoction) and Jiemai drugs (antimalarial agents). Subsequently, he experienced abdominal distension after meals and intermittent pain. He then took Erchen Tang (Two-Cured Decoction), Huanglian (Coptidis Rhizoma), and Zhishi (Immature Bitter Orange), which led to a heavy bearing sensation in the lower abdomen and edema of the legs and feet. Adding Baizhu (Atractylodis Macrocephalae Rhizoma) and Shanzha (Crataegi Fructus) resulted in vomiting undigested food. He asked me, "Why is this?" I replied, "Abdominal distension and pain after eating indicate Spleen deficiency failing to transform and transport; the heavy bearing sensation in the lower abdomen indicates Spleen deficiency failing to raise the clear Yang; edema of the legs and feet indicates Spleen deficiency failing to circulate and transport fluids; vomiting undigested food indicates deficiency-cold of the Spleen and Stomach with insufficient Fire (Yang)." The treatment was Buyi Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Wuzhuyu (Evodiae Fructus), Paojiang (Prepared Ginger), Muxiang (Aucklandiae Radix), and Rougui (Cinnamon Bark). After one dose, all symptoms receded abruptly, dietary intake increased immediately, and recovery occurred within a few doses.

Generally, for conditions of food stagnation, Liu Jun Zi Tang (Six-Gentlemen Decoction), Zhishi (Immature Bitter Orange), and Houpo (Magnoliae Officinalis Cortex) are appropriate. If the food stagnation has resolved but the illness persists, use Liu Jun Zi Tang (Six-Gentlemen Decoction). For internal injury combined with external contraction, use Huoxiang Zhengqi San (Agaricus Powder for Rectifying the Qi). For internal injury predominant with slight external contraction, use Renshen Yangwei Tang (Ginseng Decoction for Nourishing the Stomach). For exhaustion damaging Yuan Qi (Primal Qi) with external contraction, use Buyi Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Chuanxiong (Ligustici Chuanxiong Rhizoma). For exhaustion damaging Yuan Qi (Primal Qi) with food stagnation, use Buyi Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Shenqu (Massa Medicata Fermentata) and Chenpi (Citri Reticulatae Pericarpium). For anger combined with food stagnation, use Liu Jun Zi Tang (Six-Gentlemen Decoction) added with Xiangfu (Cyperi Rhizoma) and Shanzhi (Gardeniae Fructus). If there is acid regurgitation or sour taste in the mouth after eating, diet should be regulated. During an attack, if there is intense heat, restlessness, and thirst, drink hot ginger soup while it is still hot; this is an excellent method for arresting malaria. I often see patients who consume raw and cold substances during attacks; although their condition may temporarily improve, it frequently leads to Spleen deficiency and Stomach damage, often resulting in untreatable cases. Generally, those with internal injury from diet will dislike food, whereas those with external contraction from wind-cold will not dislike food. Carefully ascertain if it is exhaustion damaging Yuan Qi (Primal Qi); even with a hundred symptoms, simply using Buyi Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) will lead to spontaneous recovery. For cases belonging to external contraction, prioritize nourishment and support with dispersing methods, so that the pathogenic factor naturally retreats. Once the external pathogen has retreated, use Buyi Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to solidify the exterior. If the pathogen is removed without consolidating the exterior, or if excessive diaphoretic methods are used, damaging the Spleen and Stomach, the disease will become chronic and difficult to treat. In all these cases, regardless of whether the malaria occurs day or night, or involves Yin or Yang patterns, Buyi Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) is suitable. This is what is called "arresting without arresting" (achieving arrest through tonification).

The human body relies on the Spleen and Stomach as the foundation. There are no cases of malaria or dysentery arising from excess patterns of the Spleen and Stomach. To focus solely on releasing the exterior, purging the interior, clearing fire, or guiding out phlegm is to treat the branch while forgetting the root. The above describes the general principles of malaria. If these do not apply, treatment should be differentiated according to the Six Channels (Taiyang, Yangming, Shaoyang, Taiyin, Shaoyin, Jueyin) and interior-exterior relationships, as detailed in the respective formula sections.

Cao Shiyong, a Dayin (Magistrate), suffered from alternating chills and fever of malaria. Using antimalarial arresters caused him to develop fever and aversion to cold, reduced appetite, and extreme mental fatigue. His pulse was sometimes floating and surging, sometimes faint and fine, indicating deficiency-cold of Yang Qi. I used Buyi Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), adding three qian each of Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix), Danggui (Angelicae Sinensis Radix), and Baizhu (Atractylodis Macrocephalae Rhizoma), one qian five fen of Gancao (Licorice Root), and one qian each of Paojiang (Prepared Ginger) and Fuzi (Aconiti Lateralis Radix Praeparata). After one dose, the chills and fever ceased; after several doses, Yuan Qi (Primal Qi) recovered.

A scholar suffered from alternating chills and fever in autumn, which persisted into spring, accompanied by chest stuffiness and abdominal distension. I prescribed two liang of Renshen (Ginseng Radix et Rhizoma) and two liang of Shengjiang (Zingiberis Rhizoma Recens), baked until ripe, decocted and taken in one dose. The chills and fever stopped immediately. Then, using Tiaozhong Yiqi Tang (Regulate the Middle and Augment the Qi Decoction) added with Banxia (Pinelliae Rhizoma), Fuling (Poria), and Paojiang (Prepared Ginger), his Yuan Qi (Primal Qi) recovered rapidly after several doses. Later, when serving as a County Magistrate, whenever his illness was triggered by improper diet or labor fatigue, taking the previous medicine cured him.

Generally, prolonged malaria belongs to deficiency of Yuan Qi (Primal Qi). Qi deficiency generates cold, blood deficiency generates heat, Stomach deficiency causes aversion to cold, and Spleen deficiency causes fever. Downward flow of deficient fire leads to alternating chills and fever, or vomiting saliva, inability to eat, diarrhea, abdominal pain, cold extremities, and severe shivering like trembling millet. Misusing Qingpi Yin (Clear the Spleen Decoction) or Jiemai Yin (Antimalarial Decoction) often leads to death.

A Shangshe (Student at the Imperial Academy), every summer and autumn, would suffer either from diarrhea due to food stagnation or from malaria, dysentery, or cholera. Upon exertion, he vomited phlegm, felt dizzy and fatigued, with fever and aversion to cold. He had previously used Siwu Tang (Four-Substance Decoction), Erchen Tang (Two-Cured Decoction), Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Zhishi (Immature Bitter Orange), and Shanzhi (Gardeniae Fructus). When contracting malaria, he took antimalarial arresters, causing his previous symptoms to worsen, with occasional sensations of prickling all over his body like thorns. I used Buyi Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Fuling (Poria) and Banxia (Pinelliae Rhizoma), using three qian each of Renshen (Ginseng Radix et Rhizoma) and Huangqi (Astragali Radix), and two qian each of Danggui (Angelicae Sinensis Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma). After more than ten doses, he improved slightly. If the medication was interrupted, the illnesses returned. After continuous administration for over thirty doses, he fully recovered. He then took Hushao Dan (Preserve Youth Pill) for half a year, becoming physically robust.

A woman suffered from prolonged malaria that did not resolve. After attacks, she experienced dry mouth and extreme fatigue. I used Qiwu Baizhu San (Seven-Ingredient Atractylodes Powder) added with Maidong (Ophiopogonis Radix) and Wuweizi (Schisandrae Fructus), prepared in a large dosage for her to drink freely. Her subsequent attacks were milder. Then, using Buyi Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Fuling (Poria) and Banxia (Pinelliae Rhizoma), she recovered after more than ten doses.

Regarding arresting malaria, I often use one liang each of Renshen (Ginseng Radix et Rhizoma) and Baizhu (Atractylodis Macrocephalae Rhizoma), and four liang of Shengjiang (Zingiberis Rhizoma Recens), baked and decocted, which stops the malaria. Alternatively, using a large dose of Buyi Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with baked ginger is particularly effective; using only Shengjiang (Zingiberis Rhizoma Recens) alone is also effective.

Ma Zhiqing from Dongting East suffered from emaciation (body resembling bones), fever, aversion to cold, reduced appetite, and fatigue after malaria. I used Buyi Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), adding three qian each of Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix), Danggui (Angelicae Sinensis Radix), and Baizhu (Atractylodis Macrocephalae Rhizoma), one qian five fen of Gancao (Licorice Root), and two qian of Paojiang (Prepared Ginger). After one dose, the chills and fever ceased; after several doses, Yuan Qi (Primal Qi) recovered.

A woman suffered from prolonged alternating chills and fever. After taking Qingpi Yin (Clear the Spleen Decoction) and similar formulas, she experienced fullness and distension in the chest and diaphragm, and reduced appetite. I used Tiaozhong Yiqi Tang (Regulate the Middle and Augment the Qi Decoction) added with one qian each of Fuling (Poria), Banxia (Pinelliae Rhizoma), and Paojiang (Prepared Ginger). She recovered after two doses.

A woman contracted malaria due to labor and food stagnation. Others used digestive and antimalarial arresters, leading to reduced appetite, emaciation, and abdominal distension. I used Buyi Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), doubling the dosage of Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix), Danggui (Angelicae Sinensis Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), and Gancao (Licorice Root), adding one qian five fen each of Fuling (Poria) and Banxia (Pinelliae Rhizoma), and five qian of Paojiang (Prepared Ginger). After one dose, she was instantly relieved. Then, using the same prescription but reducing Paojiang (Prepared Ginger) to one qian, she recovered her Yuan Qi (Primal Qi) and healed after a few doses.

Postpartum malaria is discussed in *Nuke Cuoyao* (Essentials of Gynecology).