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Malaria is all caused by wind pathogen, with pathogens accumulating in the meridians and attacks occurring at specific times. ("Jie" means all. "Nue" implies cruelty or torment. Although malaria presents with various symptoms, they are all collectively termed malaria, hence called "Jie Nue". Various interpretations vary, none capturing the essence. Observing "Malaria all arises from wind," this speaks generally of all malaria types; the meaning can be understood from the word "all." "Accumulate" refers to pathogens lodging in the meridians, lying dormant for periods. "Attack" refers to the disease manifesting externally, erupting unexpectedly. "Jie" is pronounced jie.)

When malaria first begins, it starts with goosebumps, followed by yawning and stretching, then chills with shivering and jaw quivering, pain in the waist and spine. After the cold subsides, both interior and exterior become hot, headache feels like splitting, thirst may arise with a desire for cold drinks. (Starting with goosebumps indicates aversion to cold causing hair erection. Stretching refers to extending limbs as pathogens move within meridians. Yawning occurs due to contention between Yin and Yang Qi.)

Yin and Yang contend above and below, alternating between deficiency and excess, representing the shifting of Yin and Yang. (Yang Qi descends to its extreme then ascends; Yin Qi ascends to its extreme then descends. When pathogens enter, Yin and Yang contend. Yang deficiency leads to external cold, Yin deficiency to internal heat, Yang excess to external heat, Yin excess to internal cold. Where pathogens reside, pathogen is excess and healthy Qi is deficient. Entering Yin makes Yin excess and Yang deficient; entering Yang makes Yang excess and Yin deficient. The alternation of deficiency and excess results from the mutual shifting of Yin and Yang.)

When Yang merges into Yin, Yin becomes excess and Yang deficient. Deficiency of the Yangming Meridian causes chills and jaw quivering. (When Yang merges into Yin, Yin pathogens prevail, prevailing Yin causes cold. The Yangming Meridian is where Stomach Qi originates, governs muscles, and its vessel circulates along the cheeks; thus, Yangming deficiency leads to chills and jaw quivering. "Gu" means trembling.) Deficiency of the Jueyin (Taiyang) Meridian causes pain in the lower back, back, head, and neck. (The lower back, back, head, and neck are all areas of the Taiyang Meridian. Yang deficiency allows cold pathogens to reside there, causing pain.) When the Three Yang Meridians are all deficient, Yin Qi prevails. Prevailing Yin Qi causes bone coldness and pain. (Three Yang refers to Yangming and Shaoyang combined. When Yin prevails, Yang Qi cannot flow, blood vessels stagnate, causing bone cold and pain.) Cold generates internally, so both interior and exterior are cold. (Yin pathogens prevail on both exterior and interior.)

Yang excess causes external heat, Yin deficiency causes internal heat. If both interior and exterior are hot, one will pant and feel thirsty, desiring cold drinks. (This occurs when pathogens re-merge from the Yin level to the Yang level. Merging into Yang causes Yang excess, leading to internal/external heat, panting, thirst, and preference for cold.) All these result from summer damage by summerheat, with intense heat qi hiding inside the skin but outside the stomach and intestines, which is the abode of Ying Qi (Nutritive Qi). (Summerheat injury occurs when heat is intense; the pathogen is actually wind-cold, hence "Malaria all arises from wind," and also "Those who do not sweat during summer heat will develop wind-malaria in autumn." This shows that wind-cold on the exterior must stagnate and transform into heat. Hiding inside skin but outside stomach/intestines means within the meridians. Ying Qi flows within vessels, hence "This is the abode of Ying Qi.") It causes pores to open and interstices to relax. (Summerheat opens the muscle surface.)

Then, encountering autumn air, wind enters while sweating, and bathing introduces water qi that lodges inside the skin, coexisting with Wei Qi (Defensive Qi). (Internal latent summerheat is Yin pathogen. Autumn air and water qi are also Yin. New pathogens coexisting with Wei Qi combine internally with latent summerheat, causing Yin-Yang conflict and malaria onset. Summerheat-induced malaria is considered Yin pathogen because Yang summerheat damages Qi, causing profuse sweating and immediate onset without retention; only Yin summerheat remains in organs due to lack of sweating. Thus, malaria sufferers often indulged in cooling activities during peak summer, exposed to wind-cold, bathed in cool water, swam in rivers, or ate raw/cold foods. Robust individuals resist pathogens, but frail ones accumulate them in Ying and Wei. External cold invasion tends toward malaria; internal cold injury tends toward dysentery. Cautioning against these prevents malaria and dysentery.)

Wei Qi travels through Yang during the day and Yin at night. This Qi moves outward upon encountering Yang and inward upon encountering Yin. Their mutual conflict causes daily attacks. (Wind-cold enters from the exterior, coexisting with Wei Qi, thus following Wei Qi's entry and exit. Wei Qi completes one cycle daily, so newly contracted malaria attacks daily. Therefore, daily malaria indicates pathogens in Wei Qi, shallow depth, and easier treatment.)

Intermittent attacks (every other day) occur because pathogens lodge deeply, pressing inward on Yin. Yang Qi alone activates, but Yin pathogens remain inside. Yin and Yang contend but cannot exit together, causing every-other-day attacks. (Deep lodging places pathogens between Ying Qi and Zang organs. Ying is Yin, Wei is Yang. Yang Qi moves fast; internal Yin pathogens move slow. Speed difference causes resistance, preventing Yin pathogens from exiting with Wei Qi, resulting in intermittent attacks.)

Delayed or early attacks occur because pathogens lodge at Fengfu Point, descending along the Du Meridian (Spine). (Fengfu is a Du Meridian acupoint. "Lv" refers to the flesh beside the spine. Descending means moving down to the coccyx.) Wei Qi gathers at Fengfu once daily and nightly. Each subsequent day, it descends one vertebral segment, delaying attack time. (Wei Qi emerges from Jingming Point of Bladder Meridian at dawn and gathers at Fengfu, completing a daily cycle. If pathogens lodge at Fengfu and descend along the spine, depth increases daily, shifting from Yang to Yin, delaying gathering and thus attack time.)

Initially, pathogens lodge in the back. Upon reaching Fengfu, interstices open, allowing pathogen entry and disease onset, progressively delaying daily attacks. (Initial lodging in back refers to latent pathogens from initial infection. Reaching Fengfu opens interstices, signifying Wei-Qi/pathogen convergence. Convergence triggers attack; delay results from daily pathogen descent.)

Pathogens start at Fengfu, descending one segment daily. In 25 days, they reach the coccyx; on day 26, they enter the spine interior, injecting into the Fulu Meridian. (Neck has 3 vertebrae, spine has 21, totaling 24. Pathogens descend one segment daily from Fengfu, reaching coccyx on day 25, then turning frontward, entering spine interior on day 26 into Fulu Meridian. Chong Meridian runs secretly along the spine, hence "Fulu".)

Qi ascends, emerging from Qumen area after 9 days. As Qi rises higher, attacks occur earlier. (Pathogens in Fulu Meridian ascend along spine without joint obstruction, emerging at Qumen in 9 days. Rising Qi shifts from Yin to Yang, retreating pathogens cause earlier attacks.)

Intermittent attacks occur because pathogens press inward on the Five Zang Organs, connecting horizontally to Mu Yuan (Diaphragm). The path is long, depth deep, movement slow, unable to travel with Wei Qi or exit fully, causing every-other-day attacks. (Reiterating previous points: Mu Yuan Qi connects to Zang organs; pathogens in Yin level mean long path/slow movement, causing intermittent attacks.)

Wei Qi reaches Fengfu, opening interstices, allowing pathogen entry and attack. Now Wei Qi descends one segment daily; when it opens, it is no longer at Fengfu. Where does it converge to cause daily attacks? Because pathogens lodged in head/neck, descending along spine. Thus, deficiency/excess varies, pathogen location varies, not necessarily aligning with Fengfu. (Pathogens in head/neck descend along spine normally. However, pathogen entry sites vary by deficiency/excess, not always Fengfu. Thus, "daily descent" applies only to pathogens. Wei Qi cycles uniformly; why descend? Only when Qi arrives and converges does disease occur, making both pathogen and Wei Qi appear to descend one segment daily.)

Therefore, if pathogens strike head/neck, disease occurs when Qi reaches head/neck; if back, when Qi reaches back; if waist/spine, when Qi reaches waist/spine; if extremities, when Qi reaches extremities. (Qi arrival refers to Wei Qi arrival. Disease occurs upon pathogen-Qi combination, determining timing of accumulation and attack.) Disease occurs where Wei Qi meets pathogens; thus, Wind has no fixed "Fengfu" (Abode). Wherever Wei Qi activates, interstices open; wherever pathogens meet, that is their abode. (Abode gathers things; wherever Wind resides is Fengfu. Wei Qi arrival opens interstices, allowing pathogen re-entry. Thus, anywhere can be struck by pathogens, termed Fengfu, hence "Wind has no fixed abode.")

Wind and malaria are similar/same category, yet wind persists while malaria rests. Wind stays in place, persisting; malaria follows meridians, sinking inward, attacking only when Wei Qi responds. ("Wind" here refers to Wind Syndrome. Both stem from Wind, appearing similar, but Wind is continuous while Malaria is intermittent. Wind lingers fixedly; Malaria flows variably. Sinking inward implies depth, linking to "pressing Zang organs/connecting Mu Yuan," requiring Wei Qi response to attack.)

Malaria starting with cold then heat results from summer severe heat causing profuse sweating and open interstices, followed by exposure to cool water/cold, hiding in skin/interstices, then autumn wind triggering rapid onset. (Cool water/cold refers to bathing/cooling. Summerheat plus cold closes interstices, stops sweating, hiding cold pathogens in skin. Autumn wind strikes externally, triggering disease.)

Cold is Yin Qi; Wind is Yang Qi. Injury by cold first, then wind, causes cold then heat. Timely attacks name it "Cold Malaria." (Yin pathogen first, Yang second, causing cold then heat. Most malaria cases fit this.)

Starting with heat then cold results from wind injury first, then cold, causing heat then cold. Timely attacks name it "Warm Malaria." (Yang pathogen first, Yin second, causing heat then cold.)

Heat only, no cold, results from prior Yin exhaustion, solitary Yang activation. Symptoms include shortness of breath, irritability, hot hands/feet, nausea. Named "Dan Malaria" (Febrile Malaria). (Dan means heat. Solitary Yang hyperactivity causes heat-only, irritability, shortness of breath. Interior/exterior involvement causes hot extremities and nausea due to heat affecting Stomach.)

Excess treated by draining, deficiency by tonifying. Heat is excess, cold is deficiency. Malaria chills cannot be warmed by fire/water; fever cannot be cooled by ice/water. These are excess/deficiency states. At such times, even skilled doctors cannot stop them; must wait for natural decline before needling. Hence: "Do not needle when heat is raging," "Do not needle chaotic pulse," "Do not needle profuse sweating." (Raging heat, chaotic pulse indicates undetermined Yin/Yang deficiency/excess; profuse sweating indicates unsettled pathogen/healthy Qi. Needling now opposes disease Qi, making treatment impossible.)

General malaria treatment requires caution with herbs/diet. Avoid peak virulence. Herbs/methods must not be violated; diet especially需谨慎. (Avoid sharpness when present.)

At malaria onset, Yang merges into Yin. Yang deficient, Yin excess, exterior lacks Qi, causing initial chills. (Yin excess, Yang deficient. Wei Qi merging into Yin causes exterior deficiency, hence "no exterior Qi".)

Extreme Yin reversal returns to Yang. Yang and Yin merge externally again, causing Yin deficiency and Yang excess, leading to initial heat and thirst. (Qi extreme inside returns outside. Yin deficient, Yang excess causes heat/thirst.)

Malaria Qi merging into Yang causes Yang excess; merging into Yin causes Yin excess. Yin excess brings cold; Yang excess brings heat. (Cause of alternating cold/heat in malaria.)

Malaria involves irregular Wind-Cold Qi, reversing when extreme. (Alternating Yin/Yang: Cold-then-Heat is Yin extreme returning to Yang; Heat-then-Cold is Yang extreme returning to Yin.)

At attack, intensity resembles fire or storm. (Violence earns name "Malaria".) Attacking at peak strength destroys healthy Qi; treating at decline ensures success. (Treating at peak harms healthy Qi; waiting for decline removes pathogens successfully.)

Before malaria onset, Yin hasn't merged into Yang, Yang hasn't merged into Yin. Regulating then stabilizes healthy Qi, eliminating pathogens. Doctors cannot treat active attacks because Qi is rebellious. (Active attack is Yin-Yang rebellion; forced treatment fails. Emphasized deeply.)

Timing of treatment? Before onset, Yin-Yang shift begins at extremities. Yang injured, Yin follows. Bind site firmly before attack to block pathogen entry/Yin exit. Observe Sun Luo (Branch Collaterals); take those full/bloody. This preserves healthy Qi before pathogen merger. (Twelve Jingyuan origins root in limbs. Pre-attack limb chill is sign. Binding four gates prevents pathogen stagnation. Pricking full branch collaterals releases blood ("releasing cold"), allowing healthy Qi circulation, blocking pathogen merger.)

When malaria is inactive, what is the response? Malaria Qi fluctuates between excess/deficiency depending on location. Yang location causes heat/restless pulse; Yin location causes cold/still pulse. (Inactive means pre-attack. Assess Qi location via cold/heat signs and pulse restlessness/stillness to determine Yin/Yang pathology.)

Extremes cause Yin/Yang depletion, Wei Qi separation, allowing rest. Wei Qi return restarts disease. (Yin/Yang extremes deplete Qi, separating from Wei Qi, causing rest. Wei Qi return triggers pathogen-healthy Qi conflict, restarting disease.)

Intervals of two days or more, with/without thirst. Every-other-day attacks involve pathogens/Wei Qi in Six Fu Organs, missing each other, resting days before attack. (Meeting in Fu Organs is distant/rare, causing multi-day intervals. Deep Fu lodging causes missed meetings. Danxi’s theory linking days to Shao-Yin/Jue-Yin/Tai-Yin based on Six Qi is flawed; e.g., Mao/You are Yangming, not Shao-Yin. Such theories mislead learners.)

Malaria is Yin-Yang alternating victory. Severity varies, causing thirst/no thirst. (Yang excess causes heat/thirst; Yin excess does not.)

Summer heat injury guarantees autumn malaria, aligning with seasons. Some malaria defies seasons, showing varied forms. (Seasonal alignment is normal. Non-seasonal malaria shows varied forms due to seasonal cold/heat variations causing malaria.)

Autumn malaria: severe cold (post-summer heat, new coolness stimulates Yin-Yang conflict). Winter malaria: mild cold (Yang hidden internally). Spring malaria: aversion to wind (Yang leaking, pores loosening, residual cold). Summer malaria: profuse sweating (Heat steaming muscle surface).

Where do Warm Malaria and Cold Malaria lodge? Which Zang?

Warm Malaria originates from winter wind-cold lodging in bone marrow. Spring Yang expansion traps pathogens. Summer heat dries marrow, melts muscle, opens pores. Effort forces pathogens out with sweat. Pathogen lodges in Kidney, emerging internally to externally. (Kidney corresponds to Winter, governs bone marrow. Winter wind-cold latent in marrow triggers in Spring warmth or Summer heat, emerging internally to externally.)

This causes Yin deficiency, Yang excess, leading to heat. Decline reverses Qi inward, causing Yang deficiency and cold. Heat-then-cold names Warm Malaria. (Yang extreme declines, returning to Yin. Winter cold inducing Warm Malaria belongs to Cold Damage category.)

Dan Malaria: Lung has prior heat, Qi excess in body, counterflow upward, middle Qi solid but not leaking. Effort opens pores, wind-cold lodges in skin/muscle. Attack causes Yang excess, persistent without decline, causing disease. Qi doesn't reach Yin, so heat only, no cold. (Prior Lung heat indicates Yang excess/Qi solidity. External strike stays in Yang, not Yin, causing heat-only.)

Qi lodges internally in Heart, externally in muscle/flesh, wasting body, named Dan Malaria. (Qi in Heart, Yang traveling to Zang. Heat in muscle wastes body. Dan Malaria abodes are Lung and Heart meridians.)

Foot Taiyang Malaria: Waist pain, heavy head, cold starting from back, cold-then-heat, irritability, sweating after heat cessation, difficult to cure. Needle Weizhong (BL40) to bleed. (Below discusses Foot Six Meridian malaria needling. Head/back/waist are Foot Taiyang pathways, causing these symptoms. Symbols indicate severe heat.)