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Malaria is a disease where pathogenic heat resides in the Ying (Nutrient) level, and pathogenic cold dwells in the Wei (Defensive) level. When cold dwells in the Wei level, it binds the heat of the Ying level, preventing it from dispersing outward; when heat resides in the Ying level, it obstructs the cold of the Wei level, preventing it from invading inward. The Qi mutually suppresses each other and remains in a stalemate; therefore, Shanghan (Cold Damage) tends to change frequently, whereas malaria remains relatively fixed in its location. Malaria pathogens cannot manifest spontaneously but must rely on the body's Zheng Qi (Upright Qi) to trigger the disease. Thus, it is said that when the Wei Qi reaches a certain area and combines with the pathogenic factor, the illness arises.

The malaria pathogen is neither on the exterior at the skin level nor on the interior within the Zang-Fu organs. Therefore, diaphoresis (sweating therapy) does not expel it from the exterior, and purgation (draining therapy) does not eliminate it from the interior. Wind pathogens are often present, but malaria has periods of remission. The ever-present wind Qi is gentle, while the accumulated malaria Qi is violent; thus, physicians find it difficult to treat the disease during its acute attack phase.

If, after an attack, the pathogen becomes shallower, the next attack occurs earlier; if, after an attack, the pathogen retreats deeper, the next attack occurs later. Attacks occurring earlier are easier to cure, while those occurring later are harder to cure.

If the onset time initially delays but eventually advances, it indicates that the pathogen has descended to its extreme and is now moving upward. Hence, when malaria is about to heal, it may occur two or three times in one day because the pathogen has become shallow and frequently clashes with the Wei Qi.

Malaria involves a struggle between pathogenic factors and upright Qi, characterized by continuous alternation, akin to battle. Treatment must first assist the Zheng Qi or rapidly eliminate the pathogenic factors. When Zheng Qi is robust, the pathogen resolves itself; when the pathogen is removed, the Zheng Qi remains secure. Now, consider a person with weak constitution suffering from malaria: within a few days, the attacks occur progressively later, the condition weakens, yet the spirit becomes confused and beyond salvation. Is this not due to deficiency of Zheng Qi leading to the sinking of the pathogen?

The disease known as Yin-Yang Jiao (Intermingling of Yin and Yang) existed in ancient texts with its name, but no one could fully elucidate its meaning. I believe "Jiao" does not mean communication or interaction, but rather disorder or confusion. When Yin and Yang are disordered and cannot be restored to order, attacking the Yin allows the Yang to resist, preventing entry; attacking the Yang allows the Yin to hold back, preventing passage. Thus, it is said that "Jiao" implies death. Guo Baiyun stated that this is essentially the same as Liang Gan (Double Exposure/Simultaneous Affection of Exterior and Interior), likely deduced from observing cases where fever persists despite sweating. However, Liang Gan ultimately refers to simultaneous disease of both Yin and Yang meridians, not the specific pathology of Yin-Yang Jiao. Therefore, treatments such as treating the exterior first then the interior, or treating both simultaneously, can be applied, as they have not yet merged into a single indistinguishable entity.