再阅虚劳一证，《难经》独窥底蕴。曰：损脉之为病，奈何一损损于皮毛，皮聚而毛落，二损损于血脉，血脉虚少，不能荣于五脏六腑。三损损于肌肤，肌肤消瘦，饮食不能生肌肤。四损损于筋，筋缓不能自收持。五损损于骨，骨痿不能起于床。自上下者，过于胃则不可治，自下上者，过于脾则不可治。夫上下者，阴阳之根蒂也，脾胃者，上下之枢机也。且脾属己土，腑于离，胃为戊土，脏于坎。脾中有己土，故能降，胃中有戊土，故能升。然则脾胃者，非阴阳一大关钮乎观夫此，可知损于心则不特血脉不能荣于脏腑，而胃中之阴亦已暗耗矣。损于肾则不特骨痿不能起于床，而脾中之阳亦已暗伤矣。过胃过脾不易易哉。治者于未过之时，乘脾胃两经之合体未亏，犹可藉后天而培补先天，犹可藉饮食而充养精气。俾下入之邪未过脾者得专在补气，而为戊土立根。上入之邪未过胃者得专在固精，而己土筑基。中焦有主，上下有权，升降渐合其宜，精气日归于足，此越人深得《内经》玄旨，着着皆治病之先机也。即《金匮》所载诸方，亦不外乎是。
虚劳脉论
虚劳之脉专以胃气为本。《脉经》云：有胃气则生，无胃气则死。虽百病皆然，而实辨劳脉生死之吃紧关头也。观《内经》论重虚之脉，既以寸虚、尺虚定虚脉之大概矣，而又结之曰：如此者滑则生，涩则死。诚以上下皆虚之候，精气久伤，所赖后天之水谷入胃，犹可积味化精，积精生气。滑脉虽属血虚，然实系水谷之气充盛于中，故呈指下者觉往来流利，设反是而为涩，则先天精气既脱于上下，而后天水谷复竭于中州，生机灭矣。然此特揭出劳脉生死之机，决其可治不可治耳。而未滑未涩之先，其正有许多脉象可令人寻会者，仲景于此一条曰：劳之为病，其脉浮大。夫胃中水谷之气，别为营卫，营行脉中，卫行脉外，营充乎卫，卫充乎营，此平人之脉所以不浮不沉，不大不小也。惟劳伤其精血，则营亏不能充卫，卫为水谷之悍气，而无营以济之，故浮越于外，而见盛大之象。仲景即于卫气有余处反看出营气不足，以见虚劳之亡血失精多伤营分也。推而至于诸芤动微紧，为男子失精，女子梦交。极虚芤迟为清谷亡血失精，虚弱细微者，善盗汗，无非荣卫相失而见此种种偏陂之象。迨夫营行日迟，卫行日疾，一变而细数，再变而急促，则营亡而卫亦随之矣。有志生人者，可不体《内经》之意，遵《金匮》之法而急通其营卫，全其胃气也哉?
大黄廑虫丸合陈大夫百劳丸方论
《金匮》云：五劳虚极，羸瘦，腹满不能饮食，食伤、忧伤、房室伤、饥伤、劳伤、经络伤、营卫伤、伤气、伤内，有干血，肌肤甲错，面目黯黑，缓中补虚，大黄廑虫主之。此总结上七条病情之造于极点者而出其治法，后人不知立言之要，后于五劳之外又分出七伤，何其梦梦。况日食、曰忧、曰房室、曰饥、曰劳、曰经络、曰营卫、曰气，此八者不特可以该五劳，并可以该万病。仲景恐学者不能细心体认，千头万绪，何处寻踪，故总提五劳之下，自为注解，以见凡一切外入内生之病，延绵日久，皆足成劳。观许州陈大夫百劳丸之名，其义可知矣。方下云；治一切劳瘵积滞，未经药坏者宜服。仲景授而悟之，思人身精气游溢，则化梢化气，气血郁结则为滞为瘀，凡饮食起居，过时失节，皆能扰乱气血。气乱则卫在外而为固者反乘于营，而血为之溢。血乱则营在内而为守者反乘于卫，而气为之塞，各失其常道，阴日亏而阳日盛。经曰：阴虚则下脘不通，言气不能统之也。阳盛则上焦不通，言血不能濡之也。由是随其气血不通处成瘀成积，以致五脏失其滋养，征于外而羸瘦不能饮食，肌肤甲错，面目黯黑，枯槁之状非一端可拟，但未经药坏，胃气未为所乱，都作一服，大夫不嫌其过峻，已经药坏，胃气已为所乱，宜变当归乳没之油滞而妨胃者，改用甘草杏仁以和之，地黄芍药以润之。其蠕动啖血之品虽同，而缓急轻重大相径庭矣。仲景犹恐人虑其猛峻，置而不用，故复结一语曰；缓中补虚。岂非以此方为治痨之第一神药者耶?
辨用大黄廑虫法
虚劳治法，长沙以后干百年来名医迭起，议论愈多，治法愈杂。专用知柏四物滋阴者不足论矣，即用地黄、归脾、四君、八珍以补脾肾者，亦不过苟延岁月而已，余思仲景之法虽失传，然见今之幼科，治小儿疳积有得其旨者。夫小儿之疳积，多伤于饥饱，大人之虚劳多伤于精气。受病之因虽不同，而见证之情则一也。其眉疏发落与《难经》损于皮毛，毛聚而毛落者何异五液俱少，与《难经》损于肌肉，肌肉消瘦，饮食不为肌肉者何异行立时艰，与《难经》损于筋，筋缓不能自收持者何异手足瘫软，与《难经》损于骨，骨痿不能起于床者何异即皮肤枯槁，朝凉暮热，腹胀青筋，两目无光，与《金匮》羸瘦腹满，肌肤甲错，面目黑黯，亦无稍异也。倘用滋补之法，立见其毙。余每选古名家相传效方，尽以消积利气为主，投之辄应。盖积滞去则机关自利，营卫行则肌肉渐充。大人虚劳同此积滞，同此营卫，后学者何不因小儿所致疳积，推而知大人所致之虚劳，因先哲疳积之效力，推而用仲景之大黄廑虫丸也。
疟论大纲
疟之一症，余博览方书，议论纷纷，莫宗一是。求之《金匮》脉证治法，昭昭矣。更求之《内经》，益知疟之一症，或先伤于风，后伤于寒，先伤于寒，后伤于风，未有不从风寒所伤而得之者。盖惟寒故能时止，惟风故能时作。经云：疟生于风。又曰：风气留其处，故常在疟。气随经络，沉以内薄，卫气应，乃作同一气也，而分为风气疟气。可知仅伤于风而不伤于寒，则为风气。既伤于寒，又伤于风，则为疟气。观经之论疟，先热后寒，先寒后热，其义益昭然矣。夫风气之始入也，必伤卫气，卫气伤则风气弥沦于卫气所行之处而常在。在太阳则显头痛项强，在阳明则显目痛鼻干不眠，在少阳则显胁痛口苦呕吐等证。风气不去，卫气不复，必漫无止。其疟气之始入也，则兼伤营气，营气伤则气潜伏于营舍之空窍，随营气不复，漫无止期。疟气之始入也，则兼伤营气，营气伤则气潜伏于营，舍不空窍，随营气所行之经络转入转深，故必待卫冲行于营气之相应而始作。在太阳则亦显头项强，痛在阳明亦显目痛鼻干不眠，在少阳亦显胁痛口苦呕吐等证。卫气既过，疟仍止息，于是知疟气异于风气而时作时止者，此中有机在焉。机动则发，机静则止，机毁则愈。吾得而譬之于弩，弩之为物，有倚伏，有感触，有交会。倚伏者，即《内经》先伤于风，后伤于寒，如弩中之矢也。感触者，即《内经》先伤于寒，后伤于风，如弩上之弦也。交会者，即《内经》卫气并居，营气相合，如弦与矢相接之时也。其日作者，机近而发速，《内经》所谓风无常府，卫气之所发，邪气之所合，则其府也。其间日而作者，机远而发迟，《内经》所谓薄于五脏，横连募原，道远气深行迟也。其间二日而作者，机深以伏而发益迟，《内经》所谓阴邪内伏，阴与阳争不得出也。其日早日晏者，机或由上而渐下，或由下而渐上，《内经》所谓日下一节，其作也晏，日上一节，其作也早。其或休数日而作者，机深以固，与气俱并，《内经}所谓邪气与卫气客于六腑而有时相失，不能相得也，其有疟不应者，犹弓矢虽张，其机不动，《内经》所谓病异形者，反四时也。如刺疟篇云：足太阳之疟，刺郗中出血，足阳明之疟，刺足阳明跗上，足少阳之疟，刺足少阳，知机之所在而毁之也。足太阴之疟，呕已乃衰，即取之足少阴之疟，其病难已。足厥阴之疟，刺足厥阴，见血，脾疟之刺足太阴，肾疟之刺足太阳，少阴胃疟之刺足阳明，太阴横脉出血，以及脉满大急，刺背俞。脉小实急，刺指。并脉缓大虚，不宜用针。脉不见，刺十指间出血。虽刺法种种不同，其机则一也。《灵》《素》治疟大论，莫详于此，迨后世刺法置而不讲，长沙研求要领，随证立方，补《内经》之未逮，虽方药与刺法治各不同，而辨证搜根知机则一。观其论疟有云：弦数者，风发也，饮食消息止之。玩消息二字，机字显然意表，余故揭出一机字为治疟法之大纲云。
疟 脉 辨
世谓疟疾皆属少阳，嘉言先生发明《金匮》亦谓少阳而兼他经者有之，他经而不涉少阳者必无之。事是说不特与《内经》诸条刺谬，抑且与《金匮》诸方不合。后人悉宗其说，遂致弊端种种，遗流至今。皆立言之病也，余考仲景有云；疟脉自弦，弦数者多热，弦迟者多寒，弦小紧者下之瘥。弦迟者可温之，弦紧者可发汗、针灸也。弦数者，风发也，以饮食消息止之，此仲景揭出疟脉之总纲，示人扼要之大法。盖疟者，阴邪也，弦，阴脉也。其所以弦者，以少阳擅枢机之用，枢机利则开阖自如，枢机不利则出入窒碍。况人身脏腑经络各有枢机，如五脏之枢机少阴主之，六腑之枢机少阳主之，经络之枢机营舍主之。邪气客于枢机，欲退而之外不得则为寒，欲进而之内不得则为热，故邪在少阴。亦有脉弦寒热，邪在少阳，亦有脉弦寒热，邪在十二经之营舍。亦莫不有脉弦寒热，正以邪之所凑，必窒碍其枢机也。疟邪始终在枢机，则始终有寒热，则始终有弦脉，如以弦为少阳之一脉，少阳脉亦未尝本弦，弦不过少阳之病派也。即《内经》论春脉多弦，亦不过仿佛稚阳之初动，略见为弦，以应春生之令，而非若疟脉之弦也。《脉经》云：弦如始按弓弦状，试将三指初按弓弦，其意象如何苟心领神会，实有枢机窒绊坚涩，欲开不开，欲合不合之象，余故曰谓疟脉必弦则可，谓弦属少阳则断断不可也。
治疟大法
按：疟症《内经》有十二经之分，寒温瘅之辨。仲景表章《内经》，述寒温瘅三证，增出一牝疟，而独无十二经之说，后人不深维其意，遂执定疟脉多弦一语，而有专主少阳一经之论。除少阳一经之外，别无治法。不知《内经》以经络为主，故于府舍上定早晏而分浅深。仲景则以营卫为主，故于寒热上别阴阳而分轻重，是以《内经》论刺全在腑舍求原，仲景立方尽在寒热起见。如先寒后热者，知其先伤于寒而后伤于风也，则以和营之剂兼以疏卫。先热后寒者，知其先伤于风而后伤于寒也，则以疏卫之剂兼以和营。寒多热少者，则以甘温之晶少佐辛凉，热多寒少者，则以辛凉之品少佐甘温。但寒不热者，寒伏于肾也，则以镇涩之剂少佐升发。但热不寒者，热客于心也，则以升发之剂佐以镇涩。仲景制方，一毫不苟，有如此者。
瘅 疟 论
治疟之法，专以一机字为主，前篇已露一斑。近代针刺不传，而欲以汤药补偏救弊，调营卫而和阴阳，舍《金匮》其奚从焉观其重引经文云：阴气孤绝，阳气独发，则热而少气烦冤。手足热而欲呕，名曰瘅疟。邪气内藏于心肺，外舍于分肉之间，令人消铄肌肉。此条文义虽以嘉言先生之敏悟，尚支离强合，未悉其旨。窃谓瘅者热也，心者阳也，两阳相合，几何不至心阴消灼，况又言肺素有热，厥气上逆，有所用力，又显三脏受伤之原，阴阳两脱之象。故岐伯独于瘅疟一证前后辨论，较他症尤详。仲景会《内经》之意，有一症即设一法，至稍涉心肾者，必郑重以出之。其独取《内经》前条阴气孤绝至名曰瘅疟一段，取后假邪气内藏于心肺至令人消铄肌肉一段，削去中间相续成文，以见下一段即是上一段之注解。谓邪气内藏心肺，肺气不得下通而金水断源，心阴不能下降而木火沸腾，所以不必再引厥气上逆而可知阴气孤绝矣，不必再引肺素有热而可知阳气独发矣。若外舍分肉之间，令人消灼肌肉，以脾主肌肉，又主四肢，邪之所凑，其经必虚，而况兼孤绝之阴、独发之阳，上下内外相为捍格乎!所以不必再引有所用力而可知少气烦冤，手足热而欲呕矣，噫，瘅疟之暴与阴毒之惨，初无少异，由此可见，疟气之留于皮毛肌肉筋骨六腑募原者犹浅，伤于五脏者深。疟气之行于阳而阳处，胜行于阴而阴胜，阴阳虽偏而胜复得以相乘者，犹浅。但寒不热，但热不寒，阴阳重复而上下各为一偏者深。疟气之连及他脏者犹浅，动关心肾者深，司命者使不于极寒极热之时，速为拔邪救正，延至日久，阴气下竭，阳气上脱，虽有善者亦无如之何矣。故仲景独揭瘅疟经文，冠于篇首，不立治法，其示后人之意微矣。
论《内经》《金匮》温疟治法
Re-examining the syndrome of Xu Lao (Consumptive Disease), *Nan Jing* (Classic of Difficult Issues) alone penetrates its underlying mechanism. It states: What are the diseases caused by Sun Mai (Damaging Pulse)? First, damage to the skin and hair, manifesting as condensed skin and falling hair; second, damage to the blood vessels, manifesting as deficient and scanty blood vessels unable to nourish the five zang organs and six fu organs; third, damage to the muscles and flesh, manifesting as emaciation where diet cannot generate muscle tissue; fourth, damage to the sinews, manifesting as flaccid sinews unable to self-support; fifth, damage to the bones, manifesting as bone atrophy unable to rise from bed. If the progression is from upper to lower, if it exceeds the Stomach, it is incurable; if it is from lower to upper, if it exceeds the Spleen, it is incurable. The terms "upper and lower" refer to the root of Yin and Yang; the Spleen and Stomach are the pivot of this upper-lower movement. Moreover, the Spleen belongs to Ji Earth and resides in the Li position (Fire), while the Stomach belongs to Wu Earth and resides in the Kan position (Water). Because the Spleen contains Ji Earth, it can descend; because the Stomach contains Wu Earth, it can ascend. Thus, are not the Spleen and Stomach a major key to Yin and Yang? Observing this, one can understand that damage to the Heart means not only that blood vessels fail to nourish the zang-fu organs, but also that the Yin fluid in the Stomach has been secretly consumed; damage to the Kidney means not only bone atrophy preventing rising from bed, but also the Yang Qi of the Spleen has been secretly injured. To exceed the Stomach or the Spleen is not easy! When treating, before the disease exceeds the Stomach and Spleen, while the combined integrity of these two meridians is not yet depleted, one can still use the Post-Heaven (Spleen/Stomach) to cultivate the Pre-Heaven (Kidney Essence), and still use diet to replenish Jing-Qi. This allows pathogens entering from below, before exceeding the Spleen, to focus on tonifying Qi, establishing a root for Wu Earth; and pathogens entering from above, before exceeding the Stomach, to focus on securing Jing, laying a foundation for Ji Earth. With a master in the Middle Jiao and balance in the upper and lower, ascending and descending gradually become appropriate, and Jing-Qi daily returns to fullness. This shows that Yue Ren (Bian Que) deeply grasped the profound principles of *Nei Jing*, with every step seizing the initiative in treatment. Even the formulas recorded in *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) do not go beyond this principle.
Discussion on the Pulse of Xu Lao
The pulse of Xu Lao specifically takes Stomach Qi as its root. *Mai Jing* (Pulse Classic) says: With Stomach Qi, there is life; without Stomach Qi, there is death. Although this applies to all hundred diseases, it is truly the critical juncture for distinguishing life and death in the pulses of consumptive diseases. Looking at *Nei Jing*'s discussion on the pulse of double deficiency, having already determined the general outline of deficiency pulses by Cun (Inch) deficiency and Chi (Cubit) deficiency, it concludes: In such cases, a Hua Mai (Slippery Pulse) indicates life, while a Se Mai (Choppy Pulse) indicates death. Indeed, in the condition where both upper and lower are deficient and Jing-Essence has been long injured, reliance is placed on post-heaven water and grain entering the Stomach, which can still accumulate flavor to transform into essence, and accumulate essence to generate Qi. Although a Slippery Pulse is associated with Blood deficiency, it actually reflects abundant water-grain Qi in the middle jiao, feeling smooth and flowing under the fingers. Conversely, if it is Choppy, then Pre-Heaven Jing-Essence has already escaped from the upper and lower, and Post-Heaven water-grain is exhausted in the center, extinguishing the vital spark. However, this merely reveals the mechanism of life and death in consumptive pulses, deciding treatability. Before the pulse becomes slippery or choppy, there are many pulse images to be understood. Zhongjing states in this context: For diseases of Lao, the pulse is Floating and Large. The water-grain Qi in the Stomach differentiates into Ying (Nutritive) and Wei (Defensive) Qi; Ying moves within the vessels, Wei moves outside. Ying fills Wei, and Wei fills Ying; this is why the pulse of a healthy person is neither floating nor sunken, neither large nor small. Only when Lao damages Jing-Blood does Ying deficiency fail to fill Wei. As Wei is the fierce Qi of water-grain, lacking Ying to assist it, it floats outward, presenting a large and vigorous image. Zhongjing sees Ying deficiency amidst apparent Wei excess, demonstrating that loss of blood and essence in Xu Lao mostly damages the Ying aspect. Extending this, various Kou (Hollow), Dong (Agitated), Wei (Fine), and Jin (Tight) pulses indicate loss of essence in men and dream intercourse in women. Extreme deficiency, Hollow, and Slow pulses indicate clear stool (undigested food), blood loss, and essence loss; Weak and Fine pulses indicate night sweats. These are all manifestations of Ying-Wei disharmony. When Ying movement slows and Wei movement accelerates, changing first to Fine-Rapid and then to Urgent pulses, Ying perishes and Wei follows. Those dedicated to saving lives should not fail to embody the intent of *Nei Jing* and follow the methods of *Jin Gui* to urgently unblock Ying-Wei and preserve Stomach Qi.
Discussion on Da Huang Zhe Chong Wan Combined with Chen Dafu's Bai Lao Wan
*Jin Gui* states: Five types of Lao leading to extreme deficiency, emaciation, abdominal fullness, inability to eat; injuries from diet, sorrow, sexual activity, hunger, labor, meridians, Ying-Wei, Qi, and interior. With dry blood, skin like scales, and dark complexion, one should soothe the middle and tonify deficiency, using Da Huang Zhe Chong Wan. This summarizes the treatment for conditions reaching the extreme of the aforementioned seven categories. Later generations did not grasp the essence of this statement, dividing Seven Injuries beyond the Five Lao, which is confused. Moreover, Diet, Sorrow, Sex, Hunger, Labor, Meridians, Ying-Wei, and Qi—these eight can cover not only the Five Lao but all diseases. Zhongjing feared scholars could not carefully recognize the myriad threads, so he provided annotations under the summary of Five Lao to show that any external or internal disease lingering for a long time can become Lao. The name "Bai Lao Wan" (Hundred Lao Pill) by Dr. Chen of Xuzhou reveals this meaning. The formula description says: Treat all kinds of Lao tuberculosis and stagnation, suitable for those whose stomach qi has not yet been damaged by medication. Zhongjing transmitted and comprehended this, thinking that when human Jing-Qi flows freely, it transforms into fluids and Qi; when Qi-Blood stagnates, it becomes obstruction and stasis. Any irregularity in diet and起居 can disturb Qi-Blood. Qi disturbance causes Wei (external guardian) to attack Ying, causing blood to overflow. Blood disturbance causes Ying (internal keeper) to attack Wei, causing Qi to block. Each loses its normal path, Yin declines daily while Yang surges daily. The classic says: Yin deficiency leads to blockage of the lower epigastrium, meaning Qi cannot control it. Yang excess leads to blockage of the upper jiao, meaning Blood cannot moisten it. Thus, stasis and accumulation form where Qi-Blood is blocked, causing the five zang organs to lose nourishment. Externally manifesting as emaciation, inability to eat, skin like scales, and dark face, the withered state is manifold. As long as medication has not damaged the Stomach Qi, it can be taken as a single dose. Dr. Chen did not fear the harshness. If medication has already damaged the Stomach Qi, one should change from oily/stagnating herbs like Dang Gui, Ru Xiang, and Mo Yao to Gan Cao and Xing Ren to harmonize, and Di Huang and Shao Yao to moisten. Although the blood-eating creatures are the same, the speed and severity differ greatly. Zhongjing feared people would avoid it due to its harshness, so he concluded with "soothe the middle and tonify deficiency." Is this not treating this formula as the first divine medicine for Lao?
Differentiating the Use of Da Huang Zhe Chong Wan
Treatment methods for Xu Lao have seen numerous famous doctors arise since Changsha (Zhongjing) over a thousand years, with more debates and mixed methods. Using solely Zhi Bai Si Wu Tang to nourish Yin is not worth discussing. Even using Di Huang Tang, Gui Pi Tang, Si Jun Zi Tang, or Ba Zhen Tang to tonify Spleen and Kidney only prolongs life temporarily. I reflect that although Zhongjing's method is lost, modern pediatrics treating Xiao Er Gan Ji (Childhood Malnutrition/Accumulation) has grasped its essence. Childhood Gan Ji is mostly injured by irregular eating, while adult Xu Lao is mostly injured by Jing-Essence depletion. Although the cause differs, the manifestation is the same. Sparse eyebrows and falling hair are no different from *Nan Jing*'s damage to skin/hair. Scarcity of five fluids is no different from damage to muscles. Difficulty walking is no different from damage to sinews. Flaccid limbs are no different from bone atrophy. Dry skin, morning chills/evening fevers, abdominal distension with visible veins, and dull eyes are no different from *Jin Gui*'s emaciation, abdominal fullness, skin like scales, and dark face. Using tonification methods will lead to immediate death. I often select effective ancient formulas focusing on resolving accumulation and promoting Qi, which always work. Once accumulation is removed, joints move freely; once Ying-Wei circulates, muscles fill. Adults with Xu Lao have the same accumulation and Ying-Wei issues. Why should later generations not deduce the treatment for adult Xu Lao from childhood Gan Ji, and apply Zhongjing's Da Huang Zhe Chong Wan based on the efficacy of ancient Gan Ji treatments?
General Outline of Malaria Theory
Regarding Malaria, I have read many medical books with conflicting opinions, none adhering to a single correct view. Seeking in *Jin Gui*, the pulse, symptoms, and treatment are clear. Seeking further in *Nei Jing*, I know Malaria arises either from wind then cold, or cold then wind; none are not caused by wind-cold injury. Only Cold causes periodic cessation; only Wind causes periodic onset. The classic says: Malaria originates from Wind. Also: Wind Qi remains in its place, hence constant malaria. Qi follows meridians, sinking inward; when Wei Qi responds, it occurs. It is the same Qi, divided into Wind Qi and Malaria Qi. Knowing that injury only to Wind (not Cold) results in Wind Qi, while injury to both Cold and Wind results in Malaria Qi, the classic's discussion of Malaria—first heat then cold, or first cold then heat—becomes clear. When Wind Qi first enters, it injures Wei Qi. Damaged Wei Qi allows Wind Qi to permeate wherever Wei Qi travels, remaining constant. In Tai Yang, it manifests as headache and stiff neck; in Yang Ming, eye pain, dry nose, insomnia; in Shao Yang, hypochondriac pain, bitter taste, vomiting. If Wind Qi does not leave and Wei Qi does not recover, it will continue endlessly. When Malaria Qi first enters, it injures Ying Qi. Damaged Ying Qi allows the pathogen to hide in the empty spaces of the Ying residence, waiting for Ying Qi to return, with no end in sight. The pathogen hides in the Ying, moving deeper along the meridians Ying Qi travels. It must wait for Wei Qi to rush into the Ying Qi's corresponding phase to onset. In Tai Yang, it also shows head/neck stiffness; in Yang Ming, eye pain/nose dryness/insomnia; in Shao Yang, hypochondriac pain/bitter taste/vomiting. After Wei Qi passes, Malaria stops. Thus, Malaria Qi differs from Wind Qi in its periodic onset and cessation due to an internal mechanism. Mechanism moves = onset; Mechanism still = cessation; Mechanism destroyed = cure. I compare it to a crossbow: The crossbow has tension (Yi Fu), contact (Gan Chu), and intersection (Jiao Hui). Yi Fu corresponds to *Nei Jing*'s "Wind then Cold," like the arrow. Gan Chu corresponds to "Cold then Wind," like the bowstring. Jiao Hui corresponds to "Wei Qi and Ying Qi combining," like string meeting arrow. Daily onset means the mechanism is close and fast ("Wind has no fixed abode..."). Intermittent (every other day) onset means the mechanism is far and slow ("Thin on five zang, connecting to Mu Yuan..."). Every two days means the mechanism is deep and hidden ("Yin pathogen hidden inside, Yin fighting Yang..."). Varying times of onset mean the mechanism moves up or down ("Moving down one node, onset is late; moving up one node, onset is early"). Resting for several days means the mechanism is solid and merged with Qi ("Pathogen and Wei Qi lodge in six fu, sometimes missing each other"). Irregular Malaria is like a drawn bow with a stuck trigger ("Disease resembling others, contrary to four seasons"). Acupuncture points for Malaria vary by meridian (Tai Yang, Yang Ming, Shao Yang, etc.), but the principle of targeting the mechanism is one. *Ling Shu* and *Su Wen* discuss Malaria acupuncture in detail here. Later generations neglected acupuncture, but Changsha studied the essentials, prescribing formulas according to symptoms, supplementing *Nei Jing*. Though methods differ, the differentiation and understanding of the mechanism are the same. He states: "Xuan Shu (String-Rapid) indicates Wind Fever, stop it by dietary adjustment." Pondering "adjustment" (Xiao Xi), the concept of "Mechanism" (Ji) is evident. Hence, I propose "Mechanism" as the general outline for treating Malaria.
Differentiation of Malaria Pulses
The world says Malaria belongs to Shao Yang. Mr. Jiayan, elucidating *Jin Gui*, also said Shao Yang involves other meridians, but other meridians never involve Shao Yang. This theory contradicts *Nei Jing* and *Jin Gui*. Later generations followed this, causing errors. Examining Zhongjing: "Malaria pulse is naturally Xuan (String-like). Xuan-Shu indicates Heat; Xuan-Chi indicates Cold; Xuan-Xiao-Jin indicates purgation cures; Xuan-Chi indicates warming; Xuan-Jin indicates sweating/acupuncture. Xuan-Shu is Wind Fever, stop with diet." This is Zhongjing's general outline for Malaria pulses. Malaria is Yin Pathogen; Xuan is Yin Pulse. Why Xuan? Because Shao Yang governs the Pivot. If the Pivot is free, opening/closing is natural; if obstructed, entry/exit is blocked. All zang-fu and meridians have pivots: Shao Yin governs Zang pivots, Shao Yang governs Fu pivots, Ying Residence governs Meridian pivots. Pathogens lodging in the pivot cause Cold if unable to exit, Heat if unable to enter. Thus, Shao Yin, Shao Yang, and Twelve Meridians all show Xuan pulses with Chills/Fever because pathogens obstruct the pivot. Since Malaria pathogen stays in the pivot, it always has Chills/Fever and Xuan pulse. If Xuan is seen only as a Shao Yang pulse, it is wrong; Shao Yang pulse is not inherently Xuan; Xuan is merely a pathological branch of Shao Yang. Even *Nei Jing*'s Spring pulse being Xuan is just the initial movement of young Yang, unlike the Malaria pulse. *Mai Jing* says: Xuan feels like pressing a bowstring. Concentrating on this, one feels the pivot obstructed, stiff and rough, wanting to open but not, wanting to close but not. Thus, saying Malaria pulse must be Xuan is correct; saying Xuan belongs only to Shao Yang is absolutely incorrect.
General Principles of Treating Malaria
Note: *Nei Jing* divides Malaria by twelve meridians and distinguishes Han (Cold), Wen (Warm), and Dan (Fever). Zhongjing expounded *Nei Jing*, describing Han, Wen, and Dan, adding Pin Malaria, but omitted the twelve meridians. Later generations, not deeply considering this, fixated on "Malaria pulse is mostly Xuan," arguing exclusively for Shao Yang treatment. They ignored that *Nei Jing* focuses on meridians (determining timing/shallow-deep by Fu residence), while Zhongjing focuses on Ying-Wei (distinguishing Yin-Yang/severity by Chills/Fever). Thus, *Nei Jing* acupuncture seeks origin in Fu residences, while Zhongjing's formulas address Chills/Fever. For example: Chills then Heat implies Cold then Wind injury; use Ying-harmonizing agents with Wei-dispersing agents. Heat then Chills implies Wind then Cold injury; use Wei-dispersing agents with Ying-harmonizing agents. More Chills than Heat: add slight Cool agents to Warm agents. More Heat than Chills: add slight Warm agents to Cool agents. Chills only: Cold hidden in Kidney; use Astringent agents with slight Ascending agents. Heat only: Heat lodged in Heart; use Ascending agents with slight Astringent agents. Zhongjing's prescription precision is thus demonstrated.
Discussion on Dan Malaria
Treating Malaria focuses on the "Mechanism" (Ji), hinted at in previous chapters. Modern acupuncture is lost; to correct imbalances with decoctions, regulating Ying-Wei and harmonizing Yin-Yang, one must turn to *Jin Gui*. Citing the classic: "Yin Qi isolated and extinct, Yang Qi alone erupts, resulting in Heat, shortness of breath, and oppression. Hands/feet hot, desire to vomit, named Dan Malaria. Pathogen hides internally in Heart/Lung, externally in muscle intervals, causing muscle wasting." Even Mr. Jiayan's sharp mind found this fragmented. I believe Dan means Heat, Heart means Yang. Two Yangs combining inevitably consume Heart Yin. Mentioning Lung heat, rebellious Qi, and exertion shows injury to three organs and dual exhaustion of Yin/Yang. Qibo discussed Dan Malaria extensively. Zhongjing, understanding *Nei Jing*, sets a method for each symptom. Regarding Heart/Kidney involvement, he is solemn. He quotes *Nei Jing*: "Yin extinct... Dan Malaria" and "Pathogen in Heart/Lung... muscle wasting," removing intermediate text to show the latter explains the former. Pathogen in Heart/Lung blocks Lung Qi descent (breaking Metal-Water source) and prevents Heart Yin descent (causing Wood-Fire boiling). Thus, rebellious Qi and Lung heat are implied by Yin extinction and Yang eruption. External lodging in muscles wastes them; Spleen governs muscles/limbs. Where pathogen gathers, meridians are deficient. Coupled with extinct Yin and erupting Yang, internal/external conflict ensues. Thus, exertion, shortness of breath, and vomiting are implied. Alas, the suddenness of Dan Malaria matches the severity of Yin Toxicity. Pathogens in skin/muscles/fascia/Mu Yuan are shallow; injury to five zang is deep. Pathogens in Yang/Yin with partial victory are shallow; exclusive Chills or exclusive Heat (Yin/Yang separated) is deep. Involvement of other zang is shallow; affecting Heart/Kidney is deep. Physicians must extract pathogens and save righteousness during extreme Heat/Cold. Delay leads to Yin exhaustion below and Yang collapse above, incurable even by experts. Thus, Zhongjing places Dan Malaria scripture at the start without a formula, implying subtle instructions to later generations.