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Malaria (Nue) derives its name from "cruelty" or "tyranny," resembling the suffering of being oppressed and abused; hence it is called Malaria. When the cold phase occurs, patients experience shivering and chattering teeth; even hot water or fire cannot warm them. When the heat phase follows, they feel vexation, oppression, and shortness of breath; even ice water cannot cool them. This is due to no other reason than the intermingling of Yin and Yang, and the struggle between healthy Qi (Zheng Qi) and pathogenic factors (Xie Qi). When Yin predominates, cold manifests; when Yang predominates, heat manifests. When healthy Qi is deficient, there is timidity; when pathogenic factors are excessive, they run rampant. Is there any part of the body that does not obey commands but instead allows itself to be devastated? So, which meridian governs this disease? What medicine controls it? It is said: Zhang Zhongjing, in the Shaoyang chapter of *Shanghan Lun* (Treatise on Cold Damage), mentions that for alternating chills and fever, Xiaochaihu Tang (Minor Bupleurum Decoction) can be used. In this formula, Chaihu (Bupleuri Radix) and Huangqin (Scutellariae Radix) clear heat from the exterior and interior; Shengjiang (Zingiberis Rhizoma Recens) and Banxia (Pinelliae Rhizoma) eliminate cold from the exterior and interior; Renshen (Ginseng Radix), Gancao (Glycyrrhizae Radix et Rhizoma), and Dazao (Jujubae Fructus) harmonize Yin and Yang and support healthy Qi. Is this not an appropriate formula for treating malaria? I have expanded upon it: If chills are more frequent than fever, add Huoxiang (Agastaches Herba); if fever is more frequent than chills, add Zhimu (Anemarrhenae Rhizoma); if there is only cold without fever, remove Huangqin; if there is only heat without cold, remove Banxia. If Qi is deficient, add Fuling (Poria) and Baizhu (Atractylodis Macrocephalae Rhizoma); if Blood is deficient, add Danggui (Angelicae Sinensis Radix) and Shaoyao (Paeoniae Radix Alba). Merely by modifying this base formula, few cases fail to respond promptly. From this, it is clear that malaria primarily belongs to the Shaoyang meridian.

The timing of malaria attacks varies (early or late). Why? The classics state: Wei Qi (Defensive Qi) gathers at Fengfu (GV16) once every twenty-four hours. The next day, it descends one vertebral segment; thus, the attack is delayed (Yan). This is because the pathogen resides in the spine and back muscles. After twenty-five days, it descends to the sacrum; on the twenty-sixth day, it ascends. Nine days later, it emerges from the Jianjing area (Qiepen), so the attacks occur progressively earlier. Pathogens in the Yang aspect indicate mild disease; those in the Yin aspect indicate severe disease. Guiding pathogens out through the Yang aspect disperses them. As for why some attacks occur daily while others occur every other day: The classics say, shallow invasion leads to daily attacks; deep invasion leads to intermittent attacks. Some occur every three days because the pathogen is stronger and healthy Qi is weaker. What about attacks occurring three or four times a day, or even ten times? This cannot be discussed solely as malaria but can be deduced from the principles of malaria. Yang deficiency generates cold; Yin deficiency generates heat; deficiency of both Yin and Yang leads to alternating cold and heat. Without significantly tonifying Qi and Blood, the cold and heat will not cease. However, the classics also mention: Taiyang malaria presents with lower back pain, heavy head, and cold starting from the back; Shaoyang malaria presents with mild chills and mild fever, palpitations, and sweating; Yangming malaria presents with initial aversion to cold and shivering, followed by heat after a long time, sweating after heat subsides, and a preference for sunlight or firelight; Taiyin malaria presents with frequent sighing, loss of appetite, alternating chills and fever, sweating, and vomiting; Shaoyin malaria presents with vomiting, predominant heat, a desire to stay in closed rooms, and difficulty in cure; Jueyin malaria presents with fullness in the lower abdomen, sensation of urinary difficulty, frequent urination, and fear. Thus, each of the Six Meridians has its own treatment methods. Nevertheless, when malaria erupts, it is like intense heat or violent wind and rain; stopping it at this stage is impossible, even for skilled physicians. One must regulate the body before the onset, when Yin has not yet merged with Yang and Yang has not yet merged with Yin. By doing so, True Qi becomes peaceful, and pathogenic factors are expelled. This is the rationale behind the formulation of Lujiang Yin (Dew and Ginger Drink), which can be understood through deduction. If one attempts to arrest malaria prematurely before pathogens are fully resolved, complications will arise. Is this not inferior to regulating Yin and Yang? Xue Lizhai treated persistent malaria by administering one liang of Renshen and five qian of Shengjiang before onset, stopping the malaria immediately. This demonstrates the superiority of supporting healthy Qi to overcome pathogens. How could one be trapped by malaria then?

Note: Some claim malaria is a Spleen disease, caused by summer-heat injury in late summer, constrained by early autumn coolness, leading to malaria. Thus, attacks have specific timings, and treatment should focus on regulating the Spleen, using formulas such as Pingwei San (Calm the Stomach Powder), Liujunzi Tang (Six Gentlemen Decoction), or Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), depending on excess or deficiency. However, one must know that the Spleen fears Liver Wood. Is Chaihu not a Liver-soothing herb? The Spleen favors sweet flavors; are Renshen and Gancao not tonifying the Middle Jiao? The Spleen dislikes dampness; is Banxia not a damp-drying herb? The Spleen fears heat; is Huangqin not a heat-clearing herb? If the cause is wind or food stagnation, disperse and digest it. If caused by cold or heat, warm or clear it. For deficiency, tonify it; for sinking, lift it. If practitioners can master these principles flexibly, how could they remain rigid and inflexible?

Case Records:
A scholar developed malaria in late autumn. He had tried various exterior-releasing and purgative herbs without effect. After forty days, his limbs were cold, he sweated profusely like rain, and he covered himself tightly, fearing wind. Upon diagnosis, all six pulses were weak. I administered Guipi Tang (Restore the Spleen Decoction) with doubled Renshen and added Wuzhuyu (Evodiae Fructus) or here specified as Shufuzi (Prepared Aconite Lateralis Radix Preparata) 5 fen. After several doses, he recovered. Subsequently, he was regulated with Liujunzi Tang for over a month.

A young woman suffered from malaria with vexatious heat, vomiting, dry mouth, and thirst, presenting with heat but no chills. Previous harmonizing treatments failed. Her pulse was rapid and hurried. This was Dan Nue (Febrile Malaria), caused by pre-existing lung heat. I used Maidong (Ophiopogonis Radix), Zhimu, Huangqin, Zhizi (Gardeniae Fructus), Huafen (Trichosanthis Radix), Houpo (Magnoliae Officinalis Cortex), Chenpi (Citri Reticulatae Pericarpium), and Gancao. Symptoms reduced after one dose and resolved after two.

A man over fifty years old suffered from dysentery for half a month. After dysentery ceased, malaria began. During attacks, he became confused and unable to support himself. His pulse was empty, large, and forceless. I used Buzhong Yiqi Tang with doubled Renshen and added Banxia. He recovered after two doses.

Xiaochaihu Tang (Minor Bupleurum Decoction)
Chaihu (2 qian), Huangqin, Renshen, Banxia (each 1 qian), Gancao (0.5 qian).
Decoct with Shengjiang and Dazao. If thirsty, add Gegen (Puerariae Lobatae Radix) 1 qian. If the right Guan pulse is forceful and chest/epigastrium feels tight, add Houpo and Laifuzi (Raphani Semen) each 1 qian. If vexed and thirsty, remove Banxia. If pulse is not rapid, remove Huangqin. If Qi deficient, combine with Sijunzi Tang (Four Gentlemen Decoction) or Buzhong Yiqi Tang. If Yin deficient, follow with Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia).