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Epistaxis (nosebleed) caused by external pathogenic invasion and latent fire within. It manifests as malaria or simple fever, followed days later by sudden profuse epistaxis. This indicates the pathogen has entered the blood level, seeking to vent through blood, termed "red sweat" (Hong Han). This injures the blood level far more severely than venting through normal sweat; treatment requires clearing and dispersing with the addition of blood-cooling agents.

A young man fell ill due to a contusion, recurring whenever he exerted himself. He should be treated with Danggui Buxue Tang (Angelica Sinensis Decoction for Replenishing Blood), added with Tan Shengdi (Charred Rehmanniae Radix), Tan Niuxi (Charred Achyranthis Bidentatae Radix), Tan Jingjie (Charred Schizonepetae Spica), Chenpi (Citri Reticulatae Pericarpium), and Dangguishen (the root part of Angelicae Sinensis Radix). These herbs must also be charred black to achieve hemostasis and avoid aggravating fire. If there is flaming fire of the Heart and Lungs, Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) may also be used.

If this condition is chronic and recurs frequently, it is a precursor to consumptive disease. I often use Huanglian Liuwang Tang (Coptis Hexagenus Decoction) and Buxue Tang (Replenishing Blood Decoction), added with Hanliancao (Ecliptae Herba), Shengdi (Rehmanniae Radix), and Danpi (Moutan Cortex), which are mostly effective. There are also cases of external invasion with latent fire, where bleeding stops immediately after spitting out congealed blood; this is due to constrained fire. Medications such as Chaihu (Bupleuri Radix), Bohe (Menthae Haplocalycis Herba), Huanglian (Coptidis Rhizoma), Shanzhi (Gardeniae Fructus), Danpi (Moutan Cortex), and Chishao (Paeoniae Radix Rubra) are used, modified according to symptoms.

Malaria occurs most frequently in summer and autumn; although it appears at other times, it is never as prevalent as in these seasons. Generally, in summer, people consume rich and fatty foods and inhale summer-heat pathogens. External cold wind or exposure to dew causes initial closure of the skin pores, preventing the release of summer-heat. Internally, rich food transforms into phlegm. The pathogenic factors of wind and dew are on the exterior, while those of summer-heat and diet are in the interior. The location is half-exterior and half-interior, corresponding to the Foot-Shaoyang Gallbladder Meridian. When Wei Qi (Defensive Qi) sinks into Ying level (Nutritive level), chills occur; when Ying Qi does not interact with Wei Qi, fever occurs. Vomiting indicates accumulated phlegm in the Stomach; irritability and insomnia indicate disharmony of the Stomach; bitter taste in the mouth indicates Gallbladder heat. These are the origins of daily malaria and intermittent malaria. The treatment method should involve dispersing pathogens, clearing heat, purging phlegm, promoting Qi movement, and eliminating phlegm simultaneously. Common herbs include Chaihu (Bupleuri Radix), Qinghao (Artemisiae Annuae Herba), Banxia (Pinelliae Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Huangqin (Scutellariae Radix), Shenqu (Massae Fermentatae Medicae), and Gancao (Glycyrrhizae Radix et Rhizoma). (For daily malaria with mild chills, Bohe may be used instead of Chaihu.) Add Ziyeh (Perillae Folium) if there is no sweat; add Shigao (Gypsum Fibrosum), Zhimu (Anemarrhenae Rhizoma), and Zhuyeh (Phyllostachys Folium) if heat is severe; add Huafen (Trichosanthis Radix) if thirsty; add Chao Zhuru (Processed Bambusae Caulis in Taeniam) if vomiting is severe; add Huashi (Talcum) if urine is short and red; add Zhishi (Aurantii Fructus Immaturus) and Gualoupi (Benincasae Exocarpium) if chest fullness or oppression exists; add Zharon (Crataegi Fructus) if belching with sour regurgitation occurs; if the tongue coating is yellow or black, the pulse is wiry and excess, and bowel movements have been absent for several days, Dahuang (Rhei Radix et Rhizoma) can be added to purge. Add Xingren (Armeniacae Semen Amarum), Shegan (Belamcandae Rhizoma), and Qianhu (Peucedani Radix) if coughing occurs. Take the first dose one hour before the expected onset to suppress its inertia; take the second dose one hour before the expected onset to intercept and seize the pathogen.

In modern times, wealthy people fear taking Chaihu. Note: This herb is contraindicated only when the pathogen has not yet entered the Shaoyang stage; otherwise, it would be like "opening the door to invite thieves," drawing the pathogen inside. However, if symptoms such as alternating chills and fever, wiry pulse, bitter taste, irritability, and frequent vomiting—indicative of established Shaoyang syndrome—are present, Chaihu is essential to ascend and clear heat from the Liver and Gallbladder. What harm could it do? In cases of severe malaria chills, where shivering and rapid breathing occur, even multiple layers of cotton quilts in summer are insufficient to cover the patient. Unknowingly, patients often drink copious amounts of ginger soup or strong liquor during the chills. This fails to dispel the cold but exacerbates the subsequent fever, as it aids the fire. A theory in *Zhunsheng* is particularly brilliant: the chills in malaria are due to Yang Qi sinking into Yin, requiring lifting and raising. I have used this method with much success. One physician treated a patient with severe chills using Guizhi (Cinnamomi Ramulus) and Danggui (Angelicae Sinensis Radix), resulting in persistent high fever that nearly caused death. Alas! Treating malaria requires distinguishing between early, middle, and late stages, and whether the pathology is in Qi or Blood. The above treatments apply to the early stage and Qi level; the middle stage involves both Qi and Blood; the late stage involves the Blood level. One should combine dispersing with tonifying, and tonifying with clearing. There are no fixed formulas or unchanging methods; it is like embroidery, where the golden needle is hard to guide, depending entirely on the physician's intelligence and diligent study to understand profoundly. Furthermore, if malaria occurs while a woman's menstruation is just beginning, accompanied by high fever, delirium, and manic behavior resembling madness, this is heat entering the Blood Chamber. Use Xiaochaihu Tang (Minor Bupleurum Decoction) removing Renshen (Ginseng Radix), adding Shengdi (Rehmanniae Radix), Guixu (Angelicae Sinensis Radix filamentous root), and Danpi (Moutan Cortex); one dose can cure it. Regarding Sanri Nüe (tertian malaria), although my medical records contain a few cases, they were accidental successes, and I have not deeply investigated the major details, so I dare not speak rashly. The volume *Nüelun Shu* (Commentary on Malaria Theory) written by Lu Zhiyi of the Ming Dynasty is very detailed and worth reading.