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The pulse of malaria naturally presents as a *Xian* (Wiry) pulse. A pulse that is Xian and Shu (Rapid) indicates heat; a pulse that is Xian and Chi (Slow) indicates cold; a pulse that is Dai (Intermittent) and San (Scattered) indicates a critical condition leading to death.

The *Su Wen* (Basic Questions), chapter "Malaria Theory," states: All malaria arises from wind pathogen, because wind belongs to Wood and corresponds to Spring. The Wiry pulse is the intrinsic pulse of wind; since the disease originates from wind, its pulse resembles wind, thus naturally presenting as Wiry. Furthermore, during the onset of malaria, pathogenic factors and healthy Qi contend with each other, alternating between chills and fever. This alternation of chills and heat reflects the entry and exit of healthy Qi and pathogens, with the pivot mechanism governed by the Shaoyang channel. The classics state: "Shaoyang serves as the pivot." Shaoyang also corresponds to Spring, therefore the pulse should also be Wiry. If the pulse is Wiry and accompanied by Rapidness, Rapidness indicates heat, from which it can be known that malaria often manifests as heat syndromes. (If there is excessive heat and sweating, *Xiao Chai Hu Tang* (Minor Bupleurum Decoction) is suitable, or one may add herbs such as *Zhi Mu* (Anemarrhenae Rhizoma), *Shi Gao* (Gypsum Fibrosum), and *Huang Lian* (Coptidis Rhizoma). In severe cases where the patient craves frozen drinks and the pulse is Rapid and Large, *Bai Hu Tang* (White Tiger Decoction) or similar formulas are suitable.) If the pulse is Wiry and accompanied by Slowness, Slowness indicates cold, from which it can be known that malaria often manifests as cold syndromes. (If there is little heat and much cold, progressing to cold extremities and vomiting/regurgitation, *Er Chen Tang* (Two-Cured Decoction) added with *Sheng Jiang* (Zingiberis Rhizoma Recens), *Rou Gui* (Cinnamomi Cortex), *Chai Hu* (Bupleuri Radix), *Bai Zhu* (Atractylodis Macrocephalae Rhizoma), and *Cao Guo* (Tsao-ko Fruit) is suitable. Even the use of *Fu Zi* (Aconiti Lateralis Radix Praeparata) is permissible, provided the syndrome is carefully examined, ensuring efficacy in every instance.) If the pulse is Intermittent, stopping and then Scattered, this is a sign of healthy Qi deficiency and collapse, unable to continue or gather. Pathogenic factors are abundant while healthy Qi is depleted, definitely indicating a fatal outcome. (This belongs to critical conditions. If medication is desired for rescue, only major tonification of Qi and Blood using herbs such as *Ren Shen* (Ginseng Radix et Rhizoma), Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma), *Bai Zhu*, *Fu Zi*, *Sheng Jiang*, and *Rou Gui* can salvage even a fraction of hope.)

Zhang Zhongjing's *Xiao Chai Hu Tang* (Minor Bupleurum Decoction): The *Shang Han Lun* (Treatise on Cold Damage) states: After five or six days of cold damage, or wind strike, presenting with alternating chills and heat, fullness and distress in the chest and hypochondrium, silence with lack of desire for food, irritability, and frequent vomiting. Or if there is irritability in the chest without vomiting, thirst, abdominal pain, hardness and fullness under the ribs, palpitations in the epigastrium, difficult urination, absence of thirst, slight fever on the body, or cough, *Xiao Chai Hu Tang* is the primary treatment. This is a formula for treating half-exterior half-interior conditions with alternating chills and heat. Currently, it is effective in treating the alternating chills and heat caused by malaria.
Ingredients: *Chai Hu* (Bupleuri Radix) (half jin), *Huang Qin* (Scutellariae Radix), *Ren Shen* (Ginseng Radix et Rhizoma), Gan Cao (Licorice Radix et Rhizoma) (prepared), *Sheng Jiang* (Zingiberis Rhizoma Recens) (each three liang), *Ban Xia* (Pinelliae Tuber), Da Zao (Jujubae Fructus) (twelve pieces).
Take these seven ingredients, boil in ten dou two sheng of water, reduce to six sheng. Remove the dregs, decoct again to obtain three sheng. Take one sheng warm, three times daily.
If there is irritability in the chest without vomiting, remove Ban Xia and Ren Shen, add one Gua Lou Shi (Trichosanthis Fructus). If there is thirst, remove Ban Xia, increase Ren Shen to four liang and half, add four liang of Gua Lou Gen (Trichosanthis Radix). If there is abdominal pain, remove Huang Qin, add three liang of Shao Yao (Paeoniae Radix Alba). If there is hardness and fullness under the ribs, remove Da Zao, add four liang of Mu Li (Ostreae Concha). If there are palpitations in the epigastrium and difficult urination, remove Huang Qin, add four liang of Fu Ling (Poria). If there is no thirst and slight external fever, remove Ren Shen, add three liang of Gui Zhi (Cinnamomi Ramulus), cover with blankets to induce slight sweating for cure. If there is cough, remove Ren Shen, Da Zao, and Sheng Jiang, add half sheng of Wu Wei Zi (Schisandrae Chinensis Fructus) and three liang of Gan Jiang (Zingiberis Rhizoma).

Zhang Zhongjing's *Bai Hu Tang* (White Tiger Decoction) (adding Ren Shen makes it *Ren Shen Bai Hu Tang*): The *Shang Han Lun* states: Cold damage with a floating and slippery pulse, indicating exterior heat and interior cold, is treated with *Bai Hu Tang*. It also states: After emesis and purgation, if the disease persists for seven or eight days, heat is bound internally, with heat in both exterior and interior, occasional aversion to wind, extreme thirst, dryness and irritation on the tongue, desiring to drink several sheng of water, *Ren Shen Bai Hu Tang* (White Tiger Decoction with Ginseng) is the primary treatment. Generally speaking, when both exterior and interior are hot, the exterior presents with much sweat, not heat due to closure and stagnation; the interior presents with thirst and irritation, not heat due to solid accumulation in the fu organs. This is a formula for the transition from summer to autumn.
Ingredients: *Zhi Mu* (Anemarrhenae Rhizoma) (six liang), *Shi Gao* (Gypsum Fibrosum) (one jin), Gan Cao (Licorice Radix et Rhizoma) (prepared, two liang), Jing Mi (Oryza Sativa var. glutinosa).
Take these four ingredients, boil in ten dou of water until the rice is cooked and the decoction is ready. Remove the dregs, take one sheng warm. Three times daily.