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Chronic malaria refers to malaria where the attacks occur at intervals of two or three days, lingering and difficult to resolve.

[Zhu Danxi] Chronic malaria is caused by wind-heat and summer-heat pathogens invading the Yin aspect and the Zang organs. It is appropriate to use blood-nourishing herbs to draw the pathogen out to the Yang aspect for dispersion. The prescription consists of Chuanxiong Rhizoma (Chuanxiong), Fuxiong Rhizoma (Fuxiong), Safflower (Honghua), Angelicae Sinensis Radix (Danggui), Atractylodis Rhizoma Alba (Baizhu), Atractylodis Rhizoma (Cangzhu), Angelicae Dahuricae Radix (Baizhi), Phellodendri Cortex (Huangbai), and Glycyrrhizae Radix et Rhizoma (Gancao). Leave exposed overnight and take in the early morning. Ancient prescriptions often used harsh agents, which are likely unsuitable for those with weak constitutions or whose conditions were altered by improper living and care. Only then did I realize that drastic astringent or expelling agents such as Dichroa Radix (Changshan), Arsenic Trioxide (Pidan), and Mume Fructus (Wumei), if misused, can turn mild illness into severe, and severe illness into critical. Attacks occurring every third day indicate the pathogen has entered the Three Yin meridians. Attacks on Zi, Wu, Mao, and You days indicate Shaoyin meridian malaria. Attacks on Yin, Shen, Si, and Hai days indicate Jueyin meridian malaria. Attacks on Chen, Xu, Chou, and Wei days indicate Taiyin meridian malaria. Malaria acquired from summer-heat should be resolved through sweating. However, excessive cooling may cause sweat to stagnate and transform into phlegm. Upon initial infection, those with weak constitutions fall ill immediately, while those with strong Stomach Qi harbor the pathogen without symptoms until a subsequent infection combined with internal injury triggers the disease, making it difficult to cure. Both summer-heat and wind are external pathogens; thus, they cannot be resolved without profuse sweating. Patients suffering from this condition have already undergone multiple drastic treatments, severely damaging their Stomach Qi, so how can they recover? To treat this syndrome, one must first use tonifying agents like Ginseng Radix et Rhizoma (Renshen) and Atractylodis Macrocephalae Rhizoma (Baizhu) as the sovereign drugs, adding dispersing herbs like Bupleuri Radix (Chaihu) and Puerariae Radix (Gegen) to gradually induce sweating. If deficiency appears after sweating, tonification and nourishment should follow. The lower body belongs to Yin and is hardest to sweat; when the power of the tonifying herbs reaches the extremities and sweat emerges down to the feet, this is a favorable sign.

[Zhu Danxi] Treated a woman with malaria attacking every three days, poor appetite, and amenorrhea for three months. Her pulse was imperceptible. It was winter and cold, so there was discussion to treat it as deficiency-cold, but I suspected an error. On re-examination, seeing her grooming, speaking, and moving normally, I knew the diagnosis was indeed wrong. Amenorrhea does not mean lack of blood, but obstruction by phlegm. An imperceptible pulse does not mean Qi and Blood deficiency, but rather accumulated phlegm generating heat, knotting and hiding within the vessels, rendering the pulse invisible. It should be treated as excess-heat. Prescribed Sanhua Shenyao Wan. Ten days later, her appetite improved and her pulse emerged, slightly wiry. I stated that since Stomach Qi had recovered, even without medication, the malaria would self-resolve and menstruation would return. Advised a bland diet, which proved correct. (Sanhua Shenyao Wan, see "Water Swelling" section.)

A short-statured woman with a preference for rich flavors suffered from malaria for over a month, alternating-day attacks during Shen and You hours, headache and body pain, aversion to cold preferring extremely hot soups, sunken pulse, and sallow, dull complexion. Treated as excess-heat using Shizao Tang powdered, formed into pills with congee, size of broomcorn millet seeds. Administered ten pills per dose, taken with warm water, three times daily. Advised a bland diet. She recovered with profuse sweating after half a month.

For chronic malaria with urge to vomit but inability to do so, emesis is indicated. Use Liliu San or Xionghuang San.

For malaria patients who can eat but have latent phlegm, use Xiaowei Dan. (See "Internal Injury due to Diet" section.)

A man with an impatient temperament, fond of alcohol and sex, and rich dietary habits, suffered from chronic malaria after excessive worry and anger. He suddenly developed high fever, passed foul fecal accumulation, and experienced painful sinking of the anus. This indicates severe deficiency. His pulse was wiry, large, and floating. I ground a tile into a coin shape, heated it red-hot, dipped it in child's urine, and quickly wrapped it in paper to apply to the painful area, fearing external cold might invade the deficiency. Prescribed a decoction of Renshen, Danggui, and Chenpi. He stabilized after half a month of a bland diet.

A woman with chronic dysentery transformed into malaria due to weeping for her deceased son. She had five to six attacks per day, sweating profusely like rain, with a faint and rapid pulse, extreme fatigue, no pathogenic factor to treat, Yin deficiency with Yang scattering, facing imminent death. Temporarily administered Si Shou Yin and other warming agents. Then prescribed a large dose containing Renshen and Baizhu (2 liang each), Bai Shaoyao (1 liang), Huangqin (0.5 liang), and Zhi Gancao (2 qian). She recovered after four to five doses.

A man developed cough due to overwork, contracted malaria, and took dispersing herbs, which transformed into fever, shortened tongue, slurred speech, and loud phlegm rales. His pulse was surging, solid, and seemingly slippery. First used Dushen Tang added with Zhuli and Geke. After one dose, he expectorated gelatinous phlegm, and his tongue returned to normal. Subsequently used Huangqin Renshen Tang, recovering after half a month.

Liliu San
Da Liliu powder (5 fen). Mix with warm vinegar water and administer. Stop when vomiting occurs.

Xionghuang San
Xionghuang, Gouti, Chi Xiaodou (each 1 qian).
Grind into fine powder. Take 0.5 qian per dose with warm water. Stop when vomiting occurs.

Biejia Jian Wan Treats Mamo (Malaria Mass).
Biejia (12 parts, roasted), Wushan (3 parts, burned), Huangqin, Shufu (stir-fried), Dahuang, Guizhi, Shiwei (de-haired), Houpo, Ziwei, Ejiao (each 3 parts), Ganjiang, Renshen, Taoren (each 2 parts), Chaihu, Qianglang (stir-fried, each 6 parts), Shaoyao, Mudanpi, Chan (fried, each 5 parts), Fengke (roasted, 4 parts), Qumai (2 parts), Tingli (fried), Banxia (each 1 part), Chixiao (12 parts).
Grind the above twenty-three ingredients into powder. Take one dou of ash from a forge furnace and one hu five dou of clear wine. Soak the ash in the wine. When half the wine has evaporated, add Biejia and boil until it dissolves into a glue-like consistency. Strain the juice, add the herbal powders, and decoct into pills the size of tung tree seeds. Take seven pills on an empty stomach, three times daily.

Maomu Wan
Qingpi, Taoren, Honghua, Shenqu, Maiya, Biejia (boiled in vinegar, as sovereign), Sanleng, Pengze, Haifen, Xiangfu (all boiled in vinegar).
Grind into powder, bind with Shenqu paste into pills the size of tung tree seeds. Take 50-70 pills per dose with plain warm water.

For pediatric malaria with masses, use Dihuang and Shaoyao (1.5 qian each), Chenpi, Chuanxiong, Huangqin, Banxia (1 qian each), Gancao (2 fen). Decoct with ginger water and mix with Biejia powder for administration.

Shizao Tang
Yuanhua (soaked in vinegar and boiled), Daji, Gansui (processed, equal parts).
Grind into powder. Take 0.5 qian per dose with one cup of water and ten dates. Decoct together to half a cup and administer.