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Treatment for chronic malaria that does not resolve, with a wiry and deficient pulse.
Chai Hu (Bupleuri Radix) (3 qian), Huang Qin (Scutellariae Radix) (2 qian), Zhi Mu (Anemarrhenae Rhizoma) (3 qian), Lu Shen (Codonopsis Radix) (3 qian), Bie Jia (Testudinis Carapax et Plastrum) (3 qian, vinegar-fried), Qing Ban Xia (Pinelliae Rhizoma Praeparatum cum Alumine et Zingibere) (2 qian), Chang Shan (Dichroae Radix) (1.5 qian, wine-fried), Cao Guo (Tsaoko Fructus) (1 qian), Gan Cao (Glycyrrhizae Radix et Rhizoma) (1 qian), Jiu Qu (Zea Mays Fermentata) (3 qian), Sheng Jiang (Zingiberis Rhizoma Recens) (3 qian), Da Zao (Jujubae Fructus) (2 pieces, split open).
For early-stage malaria, reduce the dosage of Lu Shen and Bie Jia. For severe heat, add Sheng Shi Gao (Gypsum Fibrosum) 5-6 qian or up to 1 liang. For severe cold, add an additional 5 fen to 1 qian of Cao Guo. (Shen Qu is prone to mold, hence Jiu Qu is used in this formula.)

The pathogen of malaria is not exclusively located in the Shaoyang channel, but primarily resides there; thus, the six pulses often manifest a wiry quality. The initial chills result from the Shaoyang pathogen combining externally with the Taiyang channel; the subsequent fever results from the Shaoyang pathogen combining internally with the Yangming channel. Therefore, Chai Hu is used in the formula to ascend and disperse the Shaoyang pathogen; Cao Guo and Sheng Jiang are used to dispel the Taiyang cold; Huang Qin and Zhi Mu are used to clear the Yangming heat.
Furthermore, the formation of malaria often involves phlegm and food retention; thus, Ban Xia and Chang Shan are used to resolve phlegm, and Jiu Qu is used to digest food. Ren Shen (Ginseng Radix) is employed because prolonged malaria leads to Qi deficiency; supporting the righteous Qi serves to expel the pathogenic factor. Bie Jia is used because prolonged malaria leads to the formation of masses and accumulations under the hypochondrium (formulas refer to these as "Malaria Mother," actually caused by hepatosplenomegaly); resolving these masses allows for the eradication of the root cause of malaria. Gan Cao and Da Zao are used to mitigate the harsh nature of Chang Shan, preventing severe adverse reactions (mingxuan) upon ingestion.

A question was raised: In Ye Tianshi's medical cases, his formulas for treating malaria rarely use Chai Hu. His disciples also proposed the theory of "malaria transmission," stating that Chai Hu should not be used to treat malaria. Misusing it could indeed ruin the treatment. Is this claim credible? The answer is: Ye Tianshi had high prestige at the time. Malaria is a minor ailment, and in its early stages, few patients delay seeking medical attention. However, when malaria becomes chronic, various deficiency syndromes emerge. Often, the malaria pathogen becomes milder while other diseases worsen. If the more serious disease is cured, the malaria may also resolve spontaneously. This is a method of clinical flexibility, not the standard treatment for malaria. Regarding conditions in the Jueyin channel, there are cases presenting with initial chills followed by fever, slight improvement after sweating, and symptoms resembling malaria. This indicates extreme deficiency of Liver Qi nearing collapse. If misdiagnosed as malaria and treated with Chai Hu to ascend, danger will appear immediately. In such cases, Shan Yu Rou (Corni Fructus) should be heavily used to astringe and tonify. Thus, the *Shennong Bencao Jing* states that Shan Zhu Yu (Corni Fructus) also treats chills and fever. When Ye's disciples said that misusing Chai Hu ruins the case, they were likely referring to such scenarios.

Another question: When treating malaria in patients with Yin deficiency and dry heat, Ye Tianshi often substituted Qing Hao (Artemisiae Annuae Herba) for Chai Hu. Later commentators praised this medication choice as demonstrating skillful adaptation. Is it true that Qing Hao can truly replace Chai Hu? The answer is: The malaria pathogen lies dormant in the fatty tissue under the hypochondrium, which is the major hub of the Foot-Shaoyang channel. The power of Chai Hu can enter this area, ascending and lifting the malaria pathogen through the diaphragm to exit outward, whereas Qing Hao lacks this capability. For patients with Yin deficiency or heat entering the Blood level, one may appropriately add more herbs that nourish Yin and cool the blood. For those with dry heat or excess heat in the Qi level, one may appropriately add more herbs that clear dryness and dissipate fire. I once treated a patient with intermittent malaria occurring every other day. During febrile episodes, the heat felt like burning; even on days without malaria, he felt internal heat, dry tongue and mouth, and a wiry and long pulse (all malaria pulses are wiry), which was very solid upon heavy pressure. This indicated excessive Fire in the Yangming. I prescribed a large dose of Bai Hu Tang (White Tiger Decoction) with 3 qian of Chai Hu. After ingestion, he immediately felt refreshed in the heart region, and the next morning the malaria did not recur. He then took half the previous dose with an added 3 qian of Sheng Jiang, and was cured.

I also treated a patient suffering from warm disease, where heat entered the Fu organs of the Yangming, presenting with a thick yellow tongue coating and a surging, long pulse, along with alternating chills and fever every other day. This was warm disease complicated by malaria. However, the patient had a history of opium addiction; although the illness was excess in nature, his constitution was inherently deficient. I prescribed my own modified Bai Hu Jia Ren Shen Tang (White Tiger plus Ginseng Decoction), using Mai Dong (Ophiopogonis Radix) instead of Zhi Mu, and Shan Yao (Dioscoreae Rhizoma) instead of Jing Mi (Rice), with a small amount of Chai Hu added. He recovered after two doses.

Western medicine often uses Cinchona Bark Alkaloids (Jin Ji Na Shuang) to treat malaria. On days without fever, half a grain is taken at noon and evening with sugar water. Another dose is taken the following morning, after which the malaria resolves.
Medical texts state that cold winters lead to many warm diseases, and hot summers lead to many malaria cases. This means that if winter is excessively cold, latent cold remains in the body; in spring, following the warming of Spring Yang, it transforms into heat, resulting in warm diseases. If summer is excessively hot, latent summer-heat remains in the body; in autumn, triggered by mild cold, malaria arises. In the late summer of the Dingmao year, the heat was abnormal, causing many deaths in the Beijing-Tianjin area due to heat. Consequently, autumn saw many malaria cases. Taking Western medicine Cinchona Bark Alkaloids could cure the malaria, but relapses were common after recovery. A young man from my wife's family Wang, residing in Tianjin, suffered relapses after being cured three times by Cinchona Bark Alkaloids. Repeated doses proved ineffective. His pulse was wiry, long, and forceful on both sides. Wiry indicates malaria; long and forceful indicates latent summer-heat. I prescribed Bai Hu Tang (White Tiger Decoction), heavily using 2 liang of Sheng Shi Gao (Gypsum Fibrosum), plus 2 qian each of Chai Hu and He Shou Wu (Polygoni Multiflori Radix). The malaria resolved after one dose. Fearing incomplete eradication, he took another dose of the same formula, and the disease never relapsed again. This formula uses Bai Hu Tang to resolve latent summer-heat, and adds Chai Hu and He Shou Wu because any external contraction presenting with a wiry pulse must involve Shaoyang pathology, requiring Chai Hu to clear it; furthermore, since the exterior pathogen has lingered in the Shaoyang, the channel must be deficient, requiring He Shou Wu to tonify. The two herbs work together: one supports the righteous Qi, the other expels the pathogen. By treating both Shaoyang and Yangming, the latent summer-heat resolves, and the malaria follows suit.