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In late autumn, for malaria persisting for a long time, where there is no accumulation in the chest and no phlegm-fluid retention, but the abdomen is distended and high with reduced food intake, commonly referred to as "malaria qi entering the abdomen," Cangzhu Tang (Caulis Atractylodis Macrocephalae Decoction) is indicated.

Cangzhu (Atractylodis Macrocephalae Rhizoma, 4 liang), Caowutou (Aconiti Kusnezoffii Radix, 1 qian), Xingren (Armeniacae Semen Amarum, 30 pieces)

Grind the above into coarse powder. Take one dose at a time. Add three sheng of water, decoct until half remains, divide equally into three doses, and consume all within one day.

Malaria occurring postpartum is mostly caused by foul blood mixed with cold and heat pathogens. The general principle is to regulate it with Chaihu Siwu Tang (Bupleurum Four Substances Decoction). If heat predominates, Caoguo Yinzi (Tsaoko Fruit Infusion) is indicated.

Banxia (Pinelliae Rhizoma, soaked in hot water seven times), Chi Fuling (Poria with Red Wood, 1 qian 2 fen), Caoguo (Tsaokos Fructus, roasted and peeled, 1 qian 2 fen), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, 1 qian 2 fen), Chenpi (Citri Reticulatae Pericarpium, 1 qian 2 fen), Chuanxiong (Ligustici Chuanxiong Rhizoma, 1 qian 2 fen), Baizhi (Angelicae Dahuricae Radix, 1 qian 2 fen), Zisu (Perillae Folium, amount appropriate), Liangjiang (Alpiniae Officinarum Rhizoma, 6 fen), Qingpi (Citri Reticulatae Pericarpium Viride, 6 fen), Ganjiang (Zingiberis Rhizoma, 2 qian 4 fen)

Cut the above into small pieces, divide into two portions. Add two zhan of water, five slices of Shengjiang (Zingiberis Rhizoma Recens), and two dates. Decoct until eight parts remain. On the day of malaria onset, take three doses consecutively in the morning; this method is invariably effective.

If cold predominates, Shengshu Yinzi (Raw and Cooked Infusion) is indicated.

Roudoukou (Myristicae Semen, 2 qian 5 fen), Caoguoren (Tsaokos Fructus Seed, 2 qian 5 fen), Nongpu (Magnoliae Officinalis Cortex, 2 qian 5 fen), Banxia (Pinelliae Rhizoma, 2 qian 5 fen), Chenpi (Citri Reticulatae Pericarpium, 2 qian 5 fen), Gancao (Glycyrrhizae Radix et Rhizoma, 2 qian 5 fen), Dazao (Jujubae Fructus, pitted, 2 qian 5 fen), Shengjiang (Zingiberis Rhizoma Recens, 2 qian 5 fen)

Cut the above into small pieces, divide into two portions. Half is used raw, half is wrapped in wet paper and roasted until fragrant and cooked, then mixed evenly. Divide into two portions. Add two zhan of water, decoct until eight parts remain. Take one dose on an empty stomach, and one dose after meals. Combine the dregs from both decoctions and decoct again, taking one dose before noon.

[From *Lingshu*] The essence of minor needles is easy to state but difficult to master. (*Zhijie* says: Easy to state means easy words; difficult to master means difficult to implant in people.) Crude practitioners guard form, while superior practitioners guard spirit.
(Crude practitioners guarding form refers to guarding needling techniques. Superior practitioners guarding spirit refers to observing the person's Qi and Blood, determining sufficiency or deficiency for tonification or sedation.) Spirit! Spirit! The guest resides at the gate. (Spirit and guest refer to the convergence of righteous Qi and pathogenic Qi. Spirit denotes righteous Qi. Guest denotes pathogenic Qi. At the gate means the pathogen follows the pathways of righteous Qi's entry and exit.) Before perceiving the disease, how can one know its origin? (Before perceiving the disease means first knowing which meridian suffers from pathogenic or righteous Qi imbalance. Knowing the origin means first knowing which meridian is diseased and where to needle.) The subtlety of needling lies in speed and slowness. (Speed and slowness refer to rapid and slow movements.) Crude practitioners guard joints, while superior practitioners guard mechanisms. (Crude practitioners guarding joints refers to guarding the four limbs without knowing the coming and going of righteous Qi and pathogens. Superior practitioners guarding mechanisms refers to knowing how to guard Qi.) The movement of Qi does not depart from the acupoint void. (Knowing the emptiness or fullness of Qi, using rapid or slow needling techniques.) The mechanism within the void is pure, clear, and subtle. (After obtaining Deqi with the needle, mentally guard the Qi so as not to lose it.) When Qi arrives, do not meet it with tonification. (When Qi is abundant, do not use tonification.) When Qi departs, do not pursue it with sedation. (When Qi is deficient, do not use sedation.) Those who understand the way of Qi mechanisms cannot be delayed by even a hair. (Meaning Qi is easily lost.) Those who do not understand Qi mechanisms are like striking something that does not produce sound. (Meaning not knowing the intent of tonification and sedation, the Qi and Blood are exhausted, yet Qi does not descend.) Knowing its coming and going, aim for the right timing. (Knowing coming and going means knowing the reversals, smoothness, abundance, and deficiency of Qi. Aiming for timing means knowing when Qi can be accessed.) Crude practitioners are obscure, (Unaware of the subtleties of Qi.) while superior practitioners alone possess mastery. (Fully comprehending the meaning of needling.) What has gone is reversal, (Referring to deficient and small Qi. Small implies reversal.) what is coming is smoothness. (Referring to balanced Qi. Balanced implies smoothness.) Clearly knowing reversal and smoothness, proceed correctly without doubt. (Meaning knowing the points to select.) Meet it and seize it, how can it not become deficient? Pursue it and assist it, how can it not become full? Meeting and following, harmonize with intent, and the Dao of needling is complete. (Meeting and seizing is sedation; pursuing and assisting is tonification. *Nanjing* says: Regarding meeting and following, knowing the circulation of Ying and Wei and the flow of meridians, following their reversals and smoothness to select points is called meeting and following. It also says: Meeting and seizing sedates the son meridian; pursuing and assists the mother meridian. For example, in heart disease, sedating the Shu point of the Hand Jueyin Pericardium is meeting and seizing; tonifying the Jing-Well point of the Hand Jueyin Pericardium is following and assisting.) In all cases of using needles, if deficient, make it full. (If the pulse at the Cun Kou is deficient, tonify it. *Suwen* says: Heat under the needle indicates Qi fullness. Note: 'Under the needle' refers to after needling.) If full, drain it. (If the pulse at the Cun Kou is excess, sedate it. *Suwen* says: Cold under the needle indicates Qi deficiency.) If there are stasis and old blood, remove them. (Remove obstructed blood vessels. *Suwen* says: Expel evil blood.) If pathogenic Qi is excessive, make it deficient. (For any meridian with excess pathogenic Qi, sedate the pathogen. *Suwen* says: Do not press the needle hole upon withdrawal. *Da Yao* says: Slow insertion and rapid withdrawal result in fullness. (Slow insertion, rapid withdrawal. *Suwen* says: Withdraw the needle slowly and press quickly.) Rapid insertion and slow withdrawal result in emptiness. (Rapid insertion, slow withdrawal. *Suwen* says: Withdraw the needle rapidly and press slowly.) Discussing fullness and emptiness, it seems as if there is Qi or as if there is none. (Saying fullness has Qi sensation, emptiness has no Qi sensation. *Suwen* says: Discussing fullness and emptiness refers to the degree of cold or warm Qi. 'Seeming as if there is none' means the manipulation is imperceptible.) Observe the sequence, as if existing or perishing. (Referring to the emptiness or fullness of Qi, and the sequence of tonification and sedation. Observing whether Qi has descended or persists.) Treating emptiness and fullness, it feels as if gaining or losing. (Tonification feels as if gaining; sedation feels as if losing. *Nanjing* says: Qi not yet firm and solid is gaining; soft and deficient is losing. Hence, 'as if gaining or losing.' *Suwen* says: Regarding emptiness and fullness, doctors must not lose the method. 'As if gaining or losing' means deviating from the method.) The key to emptiness and fullness lies in the Nine Needles. (*Suwen* says: Because each has its specific suitability.) The timing of tonification and sedation is determined by the needle. (*Suwen* says: The timing of tonification and sedation corresponds with the opening and closing of Qi.) Sedation is called meeting; hold and insert, release and withdraw, push away Yang to obtain the needle position, allowing pathogenic Qi to escape. Press and guide the needle out; this is internal warming, preventing blood dispersion and Qi exit.
Tonification is called following; mentally forget, moving or pressing as if walking, like a mosquito bite lingering, staying or returning, withdrawing like a breaking bowstring, causing Left to belong to Right, stopping Qi naturally, closing the external gate, filling the central Qi, ensuring no retained blood, urgently applying punitive methods. The way of holding the needle values firmness. Point straight and needle vertically, avoiding left-right deviation. Focus spirit on the haomao (fine hairs/skin level), attend to the patient. Examine blood vessels; needling will then be safe. During needling, focus on Xuanyang (suspended Yang) and the Two Weis (Wei Qi), keeping spirit attached without departing, knowing the survival or demise of the disease. Blood vessels lie horizontally beneath the skin; they appear distinctly clear to the eye and feel distinctively firm to touch.
If Qi does not arrive after needling, do not ask about the number of manipulations. If Qi arrives, remove the needle and do not needle again. Each needle has its specific indications and different shapes, each performing its designated function. The essence of needling is that efficacy occurs when Qi arrives. The certainty of efficacy is like wind blowing away clouds, clearly revealing the blue sky; thus, the Dao of needling is complete. Pathogenic Qi arrives tight and rapid; Gu Qi (Grain Qi/Righteous Qi) arrives slow and harmonious. (Both seen in *Jiuzhen Shier Yuan* and *Xiaozhen Jie*.)
Among all types of needling, three insertions reach Gu Qi. When pathogenic deviations combine wrongly, Yin and Yang exchange places, reversals and smoothness oppose, floating and sinking differ in location, and the four seasons fail to align, with Qi stagnating and overflowing, needles are required to remove it.
Thus, the first insertion expels Yang pathogens; the second expulsion expels Yin pathogens; the third insertion brings Gu Qi. Stop when Gu Qi arrives. What is meant by Gu Qi arriving is that after tonification, fullness is achieved; after sedation, emptiness is achieved. Thus, we know Gu Qi has arrived. What is meant by three insertions yielding Gu Qi is: first, shallow insertion piercing the skin to expel Yang pathogens; second, slightly deeper insertion piercing the skin to reach muscle, but not entering the intermuscular spaces; once entering the intermuscular spaces, Gu Qi emerges. Therefore, the needling method states: Start with shallow insertion to drive out pathogenic Qi and attract Blood and Qi. Then insert deeply to draw out Yin-pathogenic Qi. Finally, insert extremely deeply to bring down Gu Qi. This is what is meant. Thus, those who use needles, without knowing the annual influences, the prosperity and decline of Qi, and the origins of emptiness and fullness, cannot be skilled practitioners. (Both seen in *Zhongshi* and *Guanzhen* chapters.)
Above, awaiting Qi involves two types: one is Pathogenic Qi, the other is Gu Qi. Whenever Qi arrives during needling, await until Pathogenic Qi is exhausted; when exhausted, Gu Qi arrives; when it arrives, stop needling. Pathogenic Qi is described as tight and rapid, where tonification fails to create fullness and sedation fails to create emptiness. Gu Qi is described as slow and harmonious, where tonification achieves fullness and sedation achieves emptiness.
Observe the complexion, examine the eyes, know the dispersion, restore unity of form, listen to movement and stillness. (Superior physicians know the five colors in the eyes, and know how to adjust the Cun Kou and Chi Kou pulses—small/large, slow/fast, slippery/rough—to diagnose diseases.) Knowing pathogenic and righteous Qi, (Understanding the discussion of Deficient Pathogens and Righteous Pathogens winds.) Push forward with the right hand, hold and defend with the left. (Referring to inserting and withdrawing the needle.) Remove the needle when Qi arrives.
(Referring to removing the needle after Qi is harmonized through tonification and sedation.)
The above is from *Zhijie*. In all cases of preparing to use needles, one must first diagnose the severity or ease of the pulse Qi before treatment can proceed.
[From *Suwen*] Once the Five Zang organs are determined and the Nine Probes are prepared, then consider the needle. (Wang Bing's commentary: First determine the pulses of the Five Zang, then follow the diagnosis of the Nine Probes, and only then focus intention on the method of using needles.) Yellow Emperor asked: The classics speak of the prosperity and decline of Qi, shifting left and right, regulating below by above, regulating right by left, surplus and insufficiency, tonifying and sedating at Ying and Shu points. I understand this. These are shifts of Ying and Wei, arising from emptiness and fullness, not pathogenic Qi entering from outside into the meridians. I wish to hear about pathogenic Qi residing in the meridians; what are its pathological manifestations? How should it be treated? Qibo replied: The sage establishes measures, responding to Heaven and Earth. Thus, Heaven has stellar degrees, Earth has rivers and waters, and humans have meridians. When Heaven and Earth are mild and warm, river waters are calm. When Heaven is cold and Earth frozen, river waters congeal and flow sluggishly. When Heaven is hot and Earth warm, river waters boil and overflow. When sudden storms arise, river waters surge and rise in waves. When pathogenic Qi enters the vessels, cold causes blood to congeal and flow sluggishly; heat makes Qi fluid and moist. Deficient pathogens take advantage to invade, just as river waters react to wind. The arterial pulses of meridians also rise in waves at times; they move steadily within the vessels. Their arrival at the Cun Kou feels sometimes large, sometimes small. Large indicates pathogen arrival; small indicates peace. Their movement has no fixed location, alternating between Yin and Yang, defying fixed measurement. Following and examining them, across the Three Regions and Nine Probes, if suddenly encountered, block their path early. The Emperor asked: How to await Qi? Qibo said: When pathogenic Qi moves from collaterals into meridians, it lodges in blood vessels. Its cold and warmth have not yet interacted, like rising waves, coming and going, thus not constant. Therefore, when it comes, press and stop it, then treat it. Do not meet its peak surge to sedate. True Qi is Meridian Qi. If Meridian Qi is too deficient, it is said 'do not meet its arrival,' which is what this means. (*Lingshu* says: 'Do not meet its arrival' means when Qi is abundant, do not tonify.) Therefore, it is said: If awaiting pathogens is unexamined, and the major Qi has already passed, sedating will cause True Qi to escape; if it escapes, it cannot recover. Pathogenic Qi returns, and the disease accumulates further. Therefore, it is said 'do not pursue its departure,' which is what this means. (*Lingshu* says: 'Do not pursue its departure' means when Qi is deficient, do not sedate.) 'Cannot be delayed by a hair' means waiting for the pathogen to arrive before issuing the needle for sedation. ('Cannot be delayed by a hair' means Qi is easily lost.) If treating before or after improperly, Blood and Qi are exhausted, and the disease cannot be cured. Therefore, knowing the correct moment is like triggering a crossbow; not knowing it is like striking a cone. Therefore, those who know the Dao of mechanisms cannot be delayed by a hair; those who do not know, though struck, do not respond. This is what is meant. The Emperor asked: How to tonify and sedate? Qibo said: This is attacking pathogens. Withdraw rapidly to remove excess blood, thereby restoring True Qi. This applies when pathogens have newly invaded, flowing freely without fixed location. Pushing advances them; pulling stops them. Pricking against their flow extracts warm blood. Extracting the blood cures the disease immediately. When pathogens have newly invaded and arrived, without fixed location, pushing advances them, pulling stops them. Meeting them and sedating them cures the disease immediately. (All from *Lihe Zhenxie Lun*.)
The above describes the method of awaiting newly invaded pathogenic Qi in meridians and selecting points. It states that when pathogens first invade meridians, their cold and warmth have not yet clashed, like rising waves, coming and going, thus not constant. To treat them, one must examine between the Three Regions and Nine Probes and wait. If in one region or probe, one sees them coming like waves, press and stop them, then treat. Do not sedate merely because they surge forth. Hence, 'do not meet its arrival.' Or if awaiting Qi is unexamined, and the wave-like major pathogenic Qi has already passed, sedating causes True Qi to escape, pathogens return, and disease accumulates. Hence, 'do not pursue its departure.' In all cases of diagnosing the Three Regions and Nine Probes to await the opportunity of pathogen arrival for needling, one must concentrate fully. Hence, 'those who know the Dao of mechanisms cannot be delayed by a hair.' What is meant by waves is a floating and large pulse. The Three Regions and Nine Probes do not refer only to Cun, Guan, Chi, but rather three regions on the face, three on the hands, and three on the feet, combining to nine regions.
The Emperor said: Good. However, when True and Pathogenic Qi have merged, and waves do not rise, how to await? Qibo said: Carefully palpate the Three Regions and Nine Probes for excess and deficiency to regulate them. Observe losses and reductions between left/right and upper/lower. Examine the affected Zang organ to anticipate recovery. Not knowing the Three Regions means failing to distinguish Yin and Yang, Heaven and Earth. Earth probes the lower, Heaven probes the upper, Humanity probes the middle. Regulate the Central Palace to define the Three Regions. Therefore, it is said: If needling ignores the locations of the Three Regions and Nine Probes disease pulses, even if great excesses approach, the physician cannot prevent them. Punishing the innocent is called great confusion. Reversing the great meridians makes True Qi irrecoverable. Treating fullness as emptiness, mistaking pathogen for truth. Using needles without righteousness becomes a thief of Qi. Depriving people of righteous Qi, treating compliance as rebellion. Ying and Wei scatter and disorder, True Qi is lost. Pathogen alone lodges internally, cutting off long life, bringing premature disaster. Not knowing the Three Regions and Nine Probes prevents longevity, because one does not integrate them with the Four Seasons and Five Elements, adding mutual overcoming, releasing pathogen to attack Zheng, cutting off long life. (*Lihe Zhenxie Lun*)
The above describes the method of treating when pathogens have resided long, and True and Pathogenic Qi have merged. It states that for newly encountered pathogens, one only awaits the wave-like pulse to locate and treat. Now that pathogens have merged and waves do not rise, and the location of pathogen invasion is unknown, one must palpate the Three Regions and Nine Probes for excess and deficiency, sedating excess areas and tonifying deficient areas. If left and right are mismatched, with left larger and right finer, sedate left and tonify right. If upper and lower are mismatched, with upper larger and lower smaller, sedate upper and tonify lower. If upper smaller and lower larger, tonify upper and sedate lower. If left, right, upper, and lower are all diminished and fine, examine which Zang is diminished. Tonify the meridian of the diminished Zang according to its time of decline, and sedate the meridian it overcomes according to its time of prosperity. Wait until pathogens leave and True Qi recovers to stop. Therefore, it is said: If needling ignores the locations of the Three Regions and Nine Probes disease pulses, one punishes the innocent, reverses the great meridians, treats fullness as emptiness, mistakes pathogen for truth, loses True Qi, allows pathogen to lodge internally, and cuts off long life.
Superior physicians intervene at the sprouting stage. They must see the Qi of the Three Regions and Nine Probes, ensure it is fully regulated and not defeated, then intervene. Hence, they are called superior. Inferior physicians intervene at the formed stage, intervening at the defeated stage. Intervening at the formed stage means not knowing the mismatch of the Three Regions and Nine Probes, leading to defeat due to disease. Knowing the location means knowing where to diagnose the disease pulses of the Three Regions and Nine Probes to treat. Hence, guarding the gates, others do not know the condition, yet one sees the pathogenic form. (*Bazheng Shenming Lun*)
[From *Nanjing*] Speaking of superior physicians treating disease before it arises, and medium physicians treating disease after it arises, what does this mean? Answer: Treating disease before it arises means seeing liver disease, knowing the liver will transmit to the spleen, thus first strengthening Spleen Qi so it does not receive Liver pathogens. Hence, treating disease before it arises. Medium physicians see liver disease, do not understand transmission, and focus solely on treating the liver. Hence, treating disease after it arises. (Chapter 77) From the beginning of this section to here lies the essential purport of examining disease and using needles. Students should ponder and recognize this deeply. Medicine without knowing this is not skilled practice. Alas, in today's world, those who slightly know acupoint methods become arrogant and complacent, due to ignorance of the discourse on crude practitioners guarding form and superior practitioners guarding spirit. How lamentable.
[From *Lingshu*] Qi in the vessels: Pathogenic Qi is in the upper. (*Zhijie* says: Pathogens strike humans from high positions, hence Pathogenic Qi is in the upper.) Turbid Qi is in the middle. (Water and grain enter the Stomach; their essence ascends to the Lungs, while turbidity lingers in the intestines and stomach. If exposed to inappropriate cold or heat, or irregular diet, disease arises in the intestines and stomach, hence called Turbid Qi in the middle.) Clear Qi is in the lower. (Damp and cold earthy Qi strikes humans, necessarily starting from the feet, hence Clear Qi is in the lower.) Needling Xian Mai expels Pathogenic Qi. (Select upper points.) Needling Zhong Mai expels Pathogenic Qi. (Select Yangming He-Sea points.) Deep needling causes Pathogenic Qi to sink反而. (Shallow diseases should not be needled deeply; deep needling allows Pathogenic Qi to enter, hence 'sink instead'.) Skin, flesh, sinews, and vessels each have their locations. (Meridians and collaterals each govern specific areas.) Diseases each have their appropriateness. (*Jiayi Jing* reads 'Yi' as 'He'.) Each differs in shape, each assumes its appropriate function. (See *Xiaozhen Jie* and *Jiuzhen Shier Yuan*.)
[From *Suwen*] Diseases have floating and sunken levels; needling has shallow and deep depths. Each must reach its proper principle, exceeding the path is wrong. Exceeding causes internal injury; falling short causes external obstruction. Obstruction allows pathogens to enter. Incorrect depth becomes a great thief, disturbing the Five Zang internally, later generating serious disease. Therefore, it is said: Diseases may reside in hair follicles and couli, in the skin, in the muscles, in the vessels, in the sinews, in the bones, in the marrow, etc. (*Ciyao Lun*) Disease in vessels regulates Blood; disease in Blood regulates Collaterals; disease in Qi regulates Wei Qi; disease in flesh regulates Fenrou (intermuscular spaces); disease in sinews regulates Sinews; disease in bones regulates Bones. Burning needles and劫刺 (seizing/stabbing) below and in acute conditions. (Wang Bing commentary: Method for regulating sinews.) Disease in bones, use needle and medicinal moxibustion/warming. (Method for regulating bones.) Disease with unknown pain location, use Du Mai and Ren Mai (Two Qiao) as primary. (Needle collateral vessels.) Pain on the left but disease in the right pulse, use Ju Ci. (Needle main meridians. See *Tiaojing Lun* chapter.)
[From *Lingshu*] Hand flexed but unable to extend: disease in sinews. Extended but unable to flex: disease in bones. In bone, guard bone; in sinew, guard sinew. (*Zhongshi* chapter.)
[From *Nanjing*] Speaking of needling Ying without injuring Wei, and needling Wei without injuring Ying, what does this mean? Answer: For needling Yang, insert the needle horizontally. For needling Yin, first use the left hand to press and stabilize the Ying-Shu point area; once Qi disperses, insert the needle. This is called needling Ying without injuring Wei, and needling Wei without injuring Ying. (See Chapter 71.)
[From *Suwen*] Needling bone should not injure sinew; needling sinew should not injure flesh; needling flesh should not injure vessel; needling vessel should not injure skin; needling skin should not injure flesh; needling flesh should not injure sinew; needling sinew should not injure bone. 'Needling bone without injuring sinew' means the needle reaches the sinew and is withdrawn, not penetrating to the bone. 'Needling sinew without injuring flesh' means reaching the flesh and withdrawing, not penetrating to the sinew. 'Needling flesh without injuring vessel' means reaching the vessel and withdrawing, not penetrating to the flesh. 'Needling vessel without injuring skin' means reaching the skin and withdrawing, not penetrating to the vessel. (Lin Yi commentary: This refers to not reaching the intended depth of needling.) 'Needling skin without injuring flesh' means disease is in the skin; insert needle into the skin without injuring flesh. 'Needling flesh without injuring sinew' means passing through the flesh into the sinew. 'Needling sinew without injuring bone' means passing through the sinew into the bone. This is called reverse needling. (Warning against being too deep. *Ciqi Lun*.)