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The clinical manifestations of malaria-like diseases (Nue Ji) are as follows. It is said that this disease does not reside in the meridians or collaterals, nor in the zang or fu organs. Rather, it arises from excessive sweating during summer, which leaves the body surface loose and open. External pathogenic heat (Shu Xie) directly enters the moo-yuan (the space between the zang and fu organs). When the qi of storage and collection (associated with autumn) begins to function, the xu-fu (sweat pores) become closed and tight. Consequently, the latent pathogens cannot vent their violent nature, leading to the onset of alternating chills and fever. However, the chills experienced are actually due to internal heat about to erupt; the fire rushes upward against the qi, causing a sensation of severe coldness, rather than true cold. Therefore, hot-natured medicines should not be used for treatment.

However, the *Suwen* classifies malaria into six meridian types. Is the moo-yuan sufficient to explain all cases? The answer is no. Wherever zang meets fu, or zang meets zang, or fu meets fu, there exists a boundary zone known as the moo-yuan. Within this void boundary, there are gang-rigid tendons and vessels. If these tendons belong to a specific zang organ, the disease manifests in that zang. For example, the stomach and small intestine are close; if pathogens enter the void boundary between them and the tendons therein belong to the stomach, it is Yangming Meridian Malaria. Similarly, the liver and spleen are close; if pathogens enter their void boundary and the tendons belong to the spleen, it is Taiyin Meridian Malaria. Ultimately, although the zang and fu appear diseased, it is due to the migration of qi in the moo-yuan.

Regarding cases occurring every other day or every two days: the Wei Qi (Defensive Qi) circulates once daily through the boundaries of the five zang and twelve meridians. Each boundary has its "abode" (just as travelers have relay stations). Pathogens floating along the meridians and pressing inward reside in these abodes. When the circulating Wei Qi gathers with these pathogens, the disease flares up; when they separate, the disease rests. The interval of one or two days depends on the distance of the moo-yuan location. (Although predecessors discussed malaria extensively, they did not thoroughly elucidate the classic principle that "summer injury by heat leads to malaria in autumn." Siming, building upon Handan's theory, clarified this, revealing that previous physicians seeking causes solely within zang-fu and meridians were like scratching an itch through a boot.)

It is said that "no phlegm, no malaria." Is this true? Phlegm is generated by heat. When patients eat and drink, but suffer daily fever, the Spleen loses its ability to maintain quiet transformation. Instead, it is constantly scorched by external pathogenic heat, transforming food and drink into phlegm-pathogens. This implies malaria generates phlegm. Conversely, there are cases where dietary injury first causes internal phlegm-heat, which then combines with external summer heat to transform into malaria. In such cases, both phlegm and malaria are branch symptoms (Biao). Thus, "no phlegm, no malaria" means that while malaria is not necessarily caused *by* phlegm, malaria invariably involves phlegm. Both statements highlight that all malaria stems from Spleen Deficiency (Pi Xu). If the Spleen were not deficient, dietary injury would not occur, and summer heat would not easily invade. These insights reveal the root of malaria, which physicians must not ignore.

For initial attacks, regardless of the meridian involved, use Qingzhong Qumai Yin (Clear Middle and Expel Malaria Decoction) or Qingpi Yin (Clear Spleen Decoction). If ineffective after three or four attacks, administer Ermiao Wan (Two Marvels Pill), which will quickly resolve it. For chronic cases lasting years, Liu Junzi Tang (Six Gentlemen Decoction) alone can cure it. (Lizhai stated: For chronic malaria unresponsive to other drugs, use Buzhong Yiqi Tang with Banxia, Ren Shen 1 liang, and Wei Jiang 5 qian. This is a method of stopping malaria without using antimalarial herbs; one dose brings cure.) For attacks occurring at You hour (5-7 PM), within five attacks, use Xianghong Yin (Fragrant Red Decoction). Ancients used lifting methods to move pathogens to the Yang level, stating this was the theoretical approach. Modern practitioners who rigidly apply this cause further Yin deficiency. Nighttime illnesses generally do not require excessive lifting to reach Yang.

Treatment for every-other-day or daily attacks is similar. Only Sanri Nue (Three-Day Malaria) is difficult to treat. For recent onset, administer Ermiao Wan with Ginseng Decoction; half a month to one month of treatment yields self-cure. For long-standing cases with severe emaciation, use large doses of Yangrong Tang (Nourish Ying Decoction) with Babai Wan (Eight-Treasure Pill), adding Shu Fu Zi 1 qian to the decoction. Ten doses ensure elimination. (Dongzhuang noted: When Buzhong Yiqi Tang fails for chronic malaria, Babai Wan shows miraculous effects. I find it effective, but combining it with Yangrong Tang yields faster results.) For early-stage Napie (Malaria Mass), Sanmiao Wan with Biejia (Turtle Shell) taken long-term cures it. Early treatment is crucial; otherwise, distension develops.

**Qingzhong Qumai Yin**
Chai Hu, Huang Qin, Ban Xia, Shan Zha, Zhi Shi, Hou Po, Qing Pi, Chen Pi, Cao Guo, Cang Zhu, Sheng Jiang.

**Ermiao Wan**
Ju Hong, Ban Xia (processed with Ginger).
Grind into powder, form pills with Shen Qu. Take 1-2 doses orally three hours before each attack to prevent occurrence. Effective for cases with phlegm and food stagnation worsened by mistaken tonic use. Alternatively, follow with Xiao Chai Hu Tang plus Zhi Shi and Jie Geng for 2-3 doses.

**Xianghong Yin**
Ren Shen, Yi Mu, Dang Gui, Xiang Fu, Hong Hua, Sheng Jiang.

Handan advised: Always inquire about the ratio of chills to fever and correlate with pulse and symptoms. Cases with more chills than fever, or more fever than chills, generally involve the Shaoyang Meridian, treated primarily with Xiao Chai Hu Tang. Add Gui Zhi for more chills. Pure fever without chills is called Dan Nue (Febrile Malaria); pure chills without fever is called Pin Nue (Yin Malaria). However, one must not be rigid; observe the pulse. Pure chills with a洪 (Surging) or 滑 (Slippery) pulse indicate excess heat; treat accordingly. Pure fever with a 空虚 (Empty) or 微弱 (Weak) pulse indicates deficiency cold; treat accordingly. Do not treat during the onset or peak of an attack, as it is ineffective. Wait until the extreme of Yin-Yang shifts and pathogens settle in their location, then treat. Ideally, intervene 2-3 hours before the expected onset to intercept the pathogen. The Classic states: Yang deficiency causes aversion to cold; Yin deficiency causes aversion to heat. Yin entering Yang causes cold; Yang sinking into Yin causes heat. Post-typhoid, post-major illness, postpartum, and consumptive diseases may present with alternating chills and fever resembling malaria but are not true malaria. Treat as deficiency, distinguishing between Yang and Yin deficiency. I have seen malaria patients with red faces and thirst, treating them as Kidney True Yin Deficiency, yielding immediate results. For patients with chills like ice, heat like branding iron, yet with a ruddy face and thirst for water, use Liuwei Dihuang Wan plus Chai Hu, Shao Yao, Rou Gui, and Wu Wei Zi in large doses; one dose cures. Another type resembles malaria but is actually Liver Qi Stagnation (Yu Zheng), with bitter taste, vomiting clear or bitter fluid, blue complexion, hypochondriac pain, tinnitus, and choppy pulse. Treat with Xiaoyao San plus Zhu Yu, Huang Lian, Bei Mu, doubling Chai Hu for one dose, followed by Liuwei Dihuang Wan plus Chai Hu and Shao Yao for regulation.