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Shengma (Rhizoma Cimicifugae) two liang, Danggui (Radix Angelicae Sinensis) one liang, Shujiao (Fructus Zanthoxyli) (stir-fried, remove sweat) one liang, Gancao (Radix Glycyrrhizae) two liang, Biejia (Carapax et Plastrum Testudinis) (roasted) the size of a palm, Xionghuang (Realgar) (ground) half a liang.
The above six herbs, with four sheng of water, boil to obtain one sheng, take in one dose; for the elderly and children, take another dose, aiming for sweating.

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The Master said: The pulse of malaria naturally presents as a Xian (Wiry) pulse. A Xian-Shu (Wiry-Rapid) pulse indicates mostly heat; a Xian-Chi (Wiry-Slow) pulse indicates mostly cold. A Xian-Xiao-Jin (Wiry-Small-Tight) pulse can be improved by purgation; a Xian-Chi (Wiry-Slow) pulse can be treated with warming methods; a Xian-Jin (Wiry-Tight) pulse can be treated with diaphoresis or acupuncture; a Xian-Fu-Da (Wiry-Float-Large) pulse can be treated with emesis. A Xian-Shu (Wiry-Rapid) pulse indicates Wind-Heat attack, which can be stopped by dietary regulation.
[Commentary]
The character "Xiao" (Small) in "Xian-Xiao-Jin" should be "Chen" (Deep), which provides the rationale for using purgation. "Xian-Jin" should be "Xian-Fu-Jin" (Wiry-Float-Tight), providing the rationale for using diaphoresis. "Xian-Fu-Da" should be "Xian-Hua-Da" (Wiry-Slippery-Large), providing the rationale for using emesis. This does not contradict the original meaning that "the pulse of malaria is naturally Xian."
[Annotation]
Malaria is a disease characterized by alternating chills and fever, occurring in all three Yin and three Yang meridians. Because the pathogen lies hidden between the exterior and interior, it belongs to Shaoyang (Lesser Yang), and the pulse is naturally Xian (Wiry). Xian-Shu (Wiry-Rapid) pulses indicate mostly heat, and Xian-Chi (Wiry-Slow) pulses indicate mostly cold, referring to the fact that during attacks, excessive heat signifies Yang excess, and excessive cold signifies Yin excess. In Taiyang-Shaoyang disease (Shaoyang syndrome in Cold Damage), there are prohibitions against diaphoresis, emesis, and purgation. However, since malaria also belongs to Shaoyang, why are diaphoresis, emesis, and purgation appropriate? This is because malaria is considered a miscellaneous disease, a point that must be understood. When first attacking, if the pulse is Xian combined with Chen-Jin (Deep-Tight), it indicates pathology in the interior, and purgation can be used; if combined with Chi (Slow), it indicates cold, and warming can be used; if combined with Fu-Jin (Float-Tight), it indicates pathology in the exterior, and diaphoresis can be used; if combined with Hua-Da (Slippery-Large), it indicates phlegm-fluid retention, and emesis can be used; if combined with Shu (Rapid), it indicates Wind-Heat attack, i.e., wind-heat, and clearing methods can be used. If the disease persists for a long time without stopping, these methods cannot be used; instead, dietary restraint and regulatory measures should be employed to stop the condition. Generally, acute illness prioritizes eliminating pathogens, while chronic illness prioritizes nourishing Zheng Qi (Upright Qi). Other types include Dan-Nue (Grave Malaria), which is the "only heat without chills" described in Neijing; Wen-Nue (Warm Malaria), which is "wind injury followed by cold injury, more heat than cold" described in Neijing; Pin-Nue (Female Malaria), which is "cold injury followed by wind injury, more cold than heat" described in Neijing. Only Nuomu (Malarial Mass) is not recorded in the classics. However, no text discusses various malarias more comprehensively than Neijing. Although the wording differs slightly, it is likely due to lost bamboo slips. Nevertheless, the therapeutic methods proposed do not exceed those of Zhang Zhongjing.
[Collected Annotations]
Xu Bin said: The word "Zi" (naturally) means that after contracting wind-cold, the pulse is exclusively Xian (Wiry). Since the pulse has a definite form, combined Shu (Rapid) indicates heat, and combined Chi (Slow) indicates cold; this is the general principle.
You Yi said: The seat of malaria is firmly located between the exterior and interior, but people's zang-fu organs have differences in excess or deficiency. Thus, some cases have more heat, some have more cold, some have more interior pathology treatable by purgation, and some have more exterior pathology treatable by diaphoresis or emesis. Treatment should be administered according to each pulse pattern.
Zhou Yangjun said: Human malaria cases, caused by external pathogens entering, often lie dormant between the exterior and interior. Entering and fighting with Yin causes chills; exiting and fighting with Yang causes fever. Hence, alternating chills and fever primarily belong to Shaoyang. While other meridian symptoms may coexist, it is impossible for malaria to completely exclude Shaoyang. Zhang Zhongjing said: "The pulse of malaria is naturally Xian," precisely because among Shu, Chi, Xiao, Jin, Fu, and Da, nothing is fixed; one must always see the Xian pulse, which is the pulse of Shaoyang. When pathogens invade Shaoyang and reside with Wei Qi (Defensive Qi), Wei Qi travels through Yang during the day and Yin at night. Thus, pathogens exit with Yang and penetrate inward with Yin. The internal and external struggle results in daily attacks. If the qi stays deep, penetrating Yin, Yang Qi alone erupts while Yin Qi adheres internally. The struggle between Yin and Yang prevents exit, resulting in every-other-day attacks. Therefore,偏向 Yin leads to more cold, and偏向 Yang leads to more heat. Whether Dan-Nue, Wen-Nue, or Pin-Nue, all originate from Shaoyang and reach their extreme. To correct imbalance and remedy deficiency, one must act from the boundary of Shaoyang, allowing pathogens to leave so Yin and Yang harmonize, returning to balance before recovery.
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Patients with malaria who develop on the first day of the lunar month should recover within fifteen days; if they do not improve, they should resolve by the end of the month. If they still do not improve, what should be done? The Master said: This condenses into a mass called Nuomu (Malarial Mass); it must be treated urgently, preferably with Biejia Jian Wan (Turtle Shell Decoction Pills).
[Annotation]
For patients with malaria, calculated by months: if onset is on the first day, recovery should occur by the fifteenth day, as fifteen days mark the change of a Jieqi (Solar Term). Humans receive Qi from Heaven; when Heavenly Qi changes, human Qi also changes. When the new Qi is prosperous, the body is not affected by Malaria pathogens, hence recovery. If improvement does not occur, resolution should happen by the end of the month, marking another cycle of prosperous Qi. If two cycles pass without improvement, the Malaria pathogen remains strong, combining with the patient's Blood, Qi, Phlegm, and Fluids to form a mass called Nuomu (Malarial Mass). It must be treated urgently, preferably with Biejia Jian Wan (Turtle Shell Decoction Pills) to attack it.
[Collected Annotations]
Cheng Lin said: Five days constitute one Hou (Decad), three Hous make one Jieqi (Solar Term), totaling fifteen days. Humans receive Qi from Heaven; as solar terms shift, Ying-Qi (Nutritive Qi) and Wei-Qi (Defensive Qi) also change accordingly.