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Malaria differs from Cold Damage (Shanghan): Malaria is mild, while Cold Damage is severe; Malaria involves the meridians and collaterals, whereas Cold Damage involves Qi transformation. Qi transformation refers to the disease transforming according to the Six Qi (Wind, Cold, Summerheat, Dampness, Dryness, Fire), with changes transmitted between Yin and Yang. The meridians and collaterals refer to the Malaria pathogen sinking inward along the meridians, occurring when Wei Qi (Defensive Qi) responds. "Responding" means that when Wei Qi moves outward to the exterior, the Malaria pathogen follows and manifests; when Wei Qi moves inward to the interior, the Malaria pathogen follows and rests. Epidemic infectious malaria is Evil Malaria (Xie Nue); the evil qi interacts, residing only between the skin and collateral vessels. Even without medication, it heals in three days. Preceded by chills followed by fever, with irritability and thirst during fever, stopping after sweating, this is Three-Yang Malaria; even without medication, it heals in six days. If the daily发作 occurs earlier, the malaria will heal; if it occurs later, the malaria is difficult to cure. "Later" (Yan) indicates that Wei Qi is deficient and fails to enter the meridians on time. Malaria varies in Yin/Yang and severity: Malaria is Yang, Spleen Cold is Yin; Malaria is mild, Spleen Cold is severe. Common people indiscriminately mix the terms, and physicians indiscriminately treat them, not knowing the difference between Malaria and Spleen Cold! Malaria does not kill, but Spleen Cold can kill. If Spleen Cold is treated indiscriminately with dispersing and cold/cooling herbs, foolishly managed, death is inevitable. When a disease manifests with less chills and more heat, uniform and level pulses, ability to eat, and normal spirit, it is Malaria; when there are more chills and less heat, slightly deficient and weak pulses, inability to eat, irritability, fullness, nausea, vomiting, and depleted spirit, it is Spleen Cold. In summer, pores open, meridian Qi overflows outward, making Wind and Summerheat pathogens easily injure the meridians, hence many cases of Malaria. Injury to collaterals is mild Malaria; injury to meridians is Malaria that can be mild or severe. Formulas for treating Malaria should regulate Qi and Blood, harmonize Ying (Nutritive) and Wei (Defensive) Qi, unblock collaterals, and unblock meridians. Observe the degree of chills and heat, differentiate the deficiency/excess of Zang-Fu organs, and then apply treatment. To regulate Qi and Blood, harmonize Ying and Wei Qi, Gui Zhi Tang (Cinnamon Twig Decoction) ingredients such as Dang Gui (Angelicae Sinensis Radix), Bai Shao (Paeoniae Radix Alba), Hong Hua (Carthami Flos), Chai Hu (Bupleuri Radix), and Gui Zhi (Cinnamomi Ramulus) can be used; to unblock meridians, Xu Duan (Dipsaci Radix), Mu Tong (Akebiae Caulis), Qin Jiao (Gentianae Macrophyllae Radix), and Yin Hua (Lonicerae Japonicae Flos) can be used. For more chills, use Gan Jiang (Zingiberis Rhizoma), Rou Gui (Cinnamomi Cortex), Shen Qu (Massa Medicata Fermentata), and Hou Po (Magnoliae Officinalis Cortex) to warm; for more heat, use Chai Hu, Huang Qin (Scutellariae Radix), Zhi Mu (Anemarrhenae Rhizoma), and Ge Gen (Puerariae Lobatae Radix) to clear; for Excess patterns, use Chen Pi (Citri Reticulatae Pericarpium), Ban Xia (Pinelliae Rhizoma), Zhi Shi (Aurantii Fructus Immaturus), and Hou Po; for Deficiency patterns, use Ren Shen (Ginseng Radix et Rhizoma), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Gan Cao (Glycyrrhizae Radix et Rhizoma), and Fu Ling (Poria). This is the general method for treating Malaria.

If the pathogen enters the Taiyin Spleen organ, it becomes Cold Malaria; Cold Malaria is similar to Spleen Cold. If it enters the Shaoyin Heart organ, it becomes Heart Malaria; Heart Malaria is similar to Dan Malaria (Febrile Malaria with heat only). If it enters the Shaoyin Kidney organ, it becomes Kidney Malaria; Kidney Malaria is similar to Pin Malaria (Chill-predominant Malaria). If it enters the Jueyin Liver organ, it becomes Jue Malaria; Jue Malaria presents with Jue syndrome (cold extremities) and loss of consciousness. These several types of Malaria should be treated with Ren Shen, [missing character, likely Huang Qi], Bai Zhu, Gan Jiang, Rou Gui, and Fu Zi (Aconiti Lateralis Radix Praeparata). Only Heart Malaria, belonging to the Hand-Shaoyin channel, is unsuitable for warm/hot therapies; instead, methods to tonify the Heart and nourish Blood using Ren Shen, Fu Ling, Dang Gui, Bai Shao, Gou Qi Zi (Lycii Fructus), Suan Zao Ren (Ziziphi Spinosae Semen), Yuan Zhi (Polygalae Radix), and Long Yan Rou (Longan Arillus) should be used. These Five-Zang and Three-Yin Malarias can indeed lead to life or death. This discusses the severity of Malaria and the standard methods of treatment. Regarding the onset of Malaria, its complications, treatment contraindications, and drug circulation, one must be thorough. In summer, the sky is hot and earth is scorching; although there is no external contraction of cold wind, bathing in cold water and cool night breezes cannot be avoided. If humans are affected, the pathogen does not stay in the skin but often injures the meridians. The body's Wei Qi enters Yin at night and emerges to Yang during the day; due to the emergence of Wei Qi, sudden chills and heat occur, which is Malaria. If diagnosed foolishly, seeing chills and heat, one might say it is Cold Damage or Summerheat injury; if not Summerheat, then internal injury with external contraction. Although the terminology is thus, the drugs used are nothing but diaphoretics, food-dispersing agents, and cold/cooling herbs. Alas! Such a disease, if not subjected to such drugs, although becoming Malaria, would heal in seven days. Now, diaphoretics make the exterior deficient, food-dispersing agents damage the middle, cold/cooling agents stagnate the meridians, and grain intake is cut off. This inevitably leads to Malaria not resembling Malaria, Cold Damage not resembling Cold Damage; although sweat is produced, the body does not cool, and by late afternoon (Ri Bu), the heat is even worse. Know that heat worsening in the late afternoon originates from Malaria; sweating without cooling indicates both exterior and interior are deficient. Poor families who do not hire doctors or take medicine, consuming only millet porridge, drag out the days and recover; wealthy families who change doctors repeatedly, upon investigating the root cause, the doctor will surely say: "Extremely deficient." First, test with a small amount of Ren Shen; if suitable, use a heavy dose, then feed millet porridge, also recovering after dragging out the days. Such diseases are common in summer. Wise people sigh deeply, yet doctors and patients' families know nothing. Of those who recover by dragging out the illness, nine or ten out of ten do so; among those who die, are there not one or two? Thinking of this, is it not sorrowful! There are also times in intense summer heat when a person suddenly suffers from Jue Ni (reversal of Qi/cold extremities), complexion pale/greenish like death. People are horrified, saying: "This is Sha (sand/heat stroke) eruption." Bleeding via Sha therapy saves temporary distress, but days later, it transforms into Malaria. Who knows that this Jue Ni resembling death is not Sha, but excessive evil Qi in the meridians causing a temporary failure of meridian connection, marking the beginning of Malaria onset. Merely pricking blood will later result in Malaria, which is not mild; however, this Malaria arises from the Yang aspect of the meridians. Another case is sudden Jue, unconsciousness, no blood from pricking, tight jaw. Doctors seeing this say either acute Sha or Stroke entering the Zang. With no blood from finger pricking, they use sharp needles to prick Qu Chi (LI11) and Wei Zhong (BL40) to release blood; if the jaw remains closed, they pry teeth open with chopsticks, pour alum water to induce vomiting, and only then do I regain consciousness. Spirit is depressed, pulses are slightly deficient and weak. One day slightly stable, next day recurrent Jue, Jue without heat, slight sweating. This is Malaria emerging from Yin, lacking Yang-heat transformation, i.e., Jue Malaria. I treated one or two cases in summer, which later recovered. If post-recovery medication is inappropriate, survival is impossible. This describes the initial onset of Malaria. As for Malaria complications, they generally result from excessive attacking and dispersing, leading to internal emptiness of the San Jiao (Triple Burner), manifesting as distension/fullness, edema, diarrhea, or cough. Although the disease changes, one must warm the Middle Earth (Spleen/Stomach) and assist the San Jiao; if distended, disperse; if edematous, scatter; if diarrheal, drain; if coughing, clear. Temporary relief may occur, but without complete cure, dragging out the days inevitably leads to death.

Contraindications for treating Malaria: first, diaphoretics; second, food-dispersing agents; third, cold/cooling herbs, as mentioned before. Regarding drug circulation: modern physicians do not use Chang Shan (Daphne genkwa Root Bark), considering it a malaria-arresting herb; arresting too early inevitably leads to abdominal distension (Gu Zhang) later. Have you not seen Master Zhongjing treating Malaria, always using Shu Qi? Shu Qi is the young shoot of Chang Shan. If the shoot is unavailable and the root is used, what harm is there? Moreover, Chang Shan is a herb that moves from Yin to Yang. For Three-Yin Malaria or Spleen Cold, if one does not allow it to move from Yin to Yang, how can it heal immediately? Having healed, how could Gu Zhang occur? Furthermore, for Malaria with deficiency-cold, if long-term use of Ren Shen, Bai Zhu, Gan Jiang, and Rou Gui fails to cure; within these formulas, one must add Chang Shan, and further add Shan Zha Jia (Pangolin Scales), to unblock meridians and expel the Malaria pathogen outward, ensuring recovery. For Yang-heat Malaria, Bie Jia (Testudinis Carapax et Plastrum) can attack and disperse; for Heart/Kidney heat Malaria, Shi Chang Pu (Acori Tatarinowii Rhizoma) and Hei Dou (Sojae Semen Nigrum) can facilitate communication; if evil enters deep layers (Fu Guo), Bing Lang (Arecae Semen) and Cao Guo (Tsaoko Fructus) can drain; if evil enters the Bladder, Che Qian Zi (Plantaginis Semen) and Hua Shi (Talcum) can promote urination. If cough develops after Malaria, it is because initially, due to Malaria, Earth Qi (Spleen Qi) did not communicate with Lung; now that Malaria stops and disease leaves, Earth Qi rises, allowing Spleen and Lung to communicate, hence cough. If one does not assist the rising of Spleen Qi, but instead uses herbs that drain Lung Qi downward, the cough will certainly not cease, turning into post-Malaria consumptive weakness, leading to death within five years. Alas! The Way of Medicine is extremely profound and subtle. Crude physicians are fierce and hasty, boasting of their techniques, seeking momentary small effects, disregarding subsequent death. How tragic!