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The *Huangdi Neijing* (Yellow Emperor's Inner Canon) records: "Summer injury by heat, autumn must suffer from malaria." This means that malaria arises from injury by summer-heat causing sweating and opening of the Couli (skin pores). When exposed to wind or bathing in water, one is affected by the chilling cold of water. In autumn, when cool winds bind the exterior, the pathogenic factors inside cannot escape outward. They follow the meridians to invade internally, lodging between the Zang-Fu organs and the Mu-Yuan (membranous origin between the viscera and the peritoneum), where they encounter the daily circulating Wei Qi (Defensive Qi), thus triggering malaria. When pathogens and healthy Qi contend, if they merge into the Yin aspect, both interior and exterior feel cold; if they merge into the Yang aspect, both interior and exterior feel hot. At the extreme, both Yin and Yang Qi decline, and Wei Qi separates, so the patient's condition temporarily alleviates. When Wei Qi gathers again, the disease recurs. The practitioner should absolutely avoid treating during the onset or peak of the malaria attack, as doing so will worsen the illness. Treatment must be conducted two to three hours before the expected onset, intercepting and seizing the pathogen ("Ying Er Duo Zhi"), which is the correct method. For infants suffering from fetal malaria who cannot take oral medicine, use 5 qian of Minium (Dan), 3 qian of raw Alum, 2.5 qian of Pepper, and a small amount of Moschus (Musk). Grind them into powder, mix with good vinegar, and apply to the palm. Apply to the left hand for males and the right hand for females. Wrap the palm with silk gauze; the medicine induces sweating and cures the disease. If an infant has not yet consumed solid food and suffers from prolonged malaria, administer thickly decocted rock sugar soup orally, which is highly effective.

Food Malaria: Caused by irregular diet combined with exposure to wind and summer-heat, resulting in alternating chills and fever, abdominal distension and fullness, sallow complexion, and aversion to food. Internal treatment is primarily based on Yangwei Tang (Stomach-Nourishing Decoction) with Ginseng and Atractylodes removed.
Manual techniques: Fen Yin Yang (Divide Yin and Yang) (200 repetitions), Tui San Guan (Push Three Gates) (100 repetitions), Tui Liu Fu (Push Six Bowels) (100 repetitions), Qing Tian He Shui (Clear River Water) (200 repetitions), Tui Pi Tu (Push Earth of Spleen) (200 repetitions), Tui Shen Shui Bu Qing (Push Water of Kidney with Tonification and Clearing methods) (100 repetitions each), Rou Qi (Rub Umbilicus) (100 repetitions), Yun Ba Gua (Move Eight Trigrams) (20 repetitions). Use the Ironing Method (see Volume 2, page 45).

Phlegm Malaria: Infants who inherently have phlegm-fluid retention, compounded by external pathogens condensing in the Spleen and Stomach, present with chest tightness and urge to vomit. Signs include sallow complexion and swollen eyes. Internal treatment is primarily based on phlegm-resolving medicines.
Manual techniques: Fen Yin Yang (200 reps), Tui San Guan (100 reps), Tui Liu Fu (100 reps), Tui Qing Fei Jing (Push and Clear Lung Meridian) (200 reps), Tui Si Heng Wen (Push Four Horizontal Lines) (30 reps), Tui Pi Tu (Push Spleen Earth) (200 reps), Rou Qi (Rub Umbilicus) (120 reps), Rou Nei Lao Gong (Rub Inner Laogong) (30 reps), Yun Ba Gua (Move Eight Trigrams) (50 reps), An Xian Cuo Mo (Press Strings and Rub) (24 reps). Employ Sweating and Vomiting methods first. All pushing techniques should use Ginger Soup or Peach Leaf Juice as medium. Additionally, grind peach leaves into a cake and apply to Yongquan (KI1) acupoint. Use Opening/Closing methods (see Volume 2, page 39) and Phlegm-Guiding methods (see Volume 2, page 40).

Chronic Malaria: Pathogens knot in the blood collaterals, causing distension and fullness in the left hypochondrium radiating to the lower abdomen. This may also occur due to Kidney Deficiency or Spleen Deficiency.
Manual techniques: Fen Yin Yang (200 reps), Tui San Guan (200 reps), Tui Liu Fu (100 reps), Qing Tian He Shui (Clear River Water) (200 reps), Tui Bu Pi Tu (Tonify Push Spleen Earth) (200 reps), Yun Ba Gua (Move Eight Trigrams) (100 reps), Qia Er Ren Shang Ma (Pinch Two Men Mounting Horse) (20 reps). All pushing techniques use Ginger Water as medium. Pound peach leaves and apply to the sole of the foot.

Dan Malaria (Intense Heat Malaria): Fever without chills. Caused by prior injury to Yin Qi, leaving Yang Qi to flare alone. Symptoms include high fever, shortness of breath, mental restlessness/oppression, heat in hands and feet, nausea. Pathogens hide internally in the Heart and externally lodge in the muscles, causing emaciation. Internal treatment uses Sweet-Cold methods to generate fluids.
Manual techniques: Fen Yin Yang (200 reps), Tui San Guan (200 reps), Tui Pi Tu (Push Spleen Earth) (100 reps), Yun Ba Gua (Move Eight Trigrams) (50 reps), Tui Fei Jing (Push Lung Meridian) (50 reps), Tui Liu Fu (Push Six Bowels) (100 reps), Tui Jian Shi (PC5) and Nei Guan (PC6) (100 reps), Tian Men Ru Hu Kou (Heaven's Gate Entering Tiger's Mouth) (50 reps), Yao Dou Zhou (Shake Bucket Elbow) (50 reps). Use Clearing Interior methods (see Volume 2, page 37).

Commentary: The etiology of malaria involves internal injury from phlegm and food stagnation, and external contraction of wind, cold, summer-heat, and dampness. The depth of pathogen invasion determines the severity. The therapeutic principle is: warm for cold patterns, clear for heat patterns, digest for food stagnation, and guide/disperse for wind-phlegm. Treatment must be gradual; do not expect rapid results. Perform massage and other methods 3-5 times daily for 3-5 days, or 5-7 days. For infants, this suffices; for adults, increase frequency and duration. Do not seek quick success to avoid inducing other diseases. This is crucial. Do not rely solely on manual therapy while neglecting herbal prescriptions. (Ti Li Zi)