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Malaria has stopped medication. There is a daily tendency towards recovery. Stomach distress leads to fullness and obstruction, with loss of appetite. Although food intake has not increased yet, the perception of sweetness in food indicates that the stomach Qi is gradually awakening. Children do not suffer from deficiency of the lower jiao. Pain in the urethra occurs when urination is attempted. This is primarily because the stomach fluids and lung juices have been depleted by the harsh, acrid, bitter, dry, and hot flavors, leaving the intestines unable to transport and transform. Quack doctors, seeing this condition, invariably use diuretic methods. This is akin to saying that when the source of the spring is exhausted, one should nourish its transforming source. Disharmony of the nine orifices all belongs to stomach disease.

Ophiopogonis Radix (Maidong), Sweet Water Pear Peel, Sweet Almond (Tao Ren), Sugarcane Juice (Zhe Jiang)

Rapid pulse, yellow eyes, dry center of the tongue with white-yellow coating, sticky sensation in the mouth, epigastric fullness, and anorexia. This is due to pathogenic wind-heat invading internally during travel, causing disharmony of Ying and Wei at the Mouyuan (semi-exterior semi-interior region), leading to malaria. Summerheat must be accompanied by dampness; both dampness and heat belong to the Qi level. When Qi battles with pathogens, clear and turbid Qi mix, obstructing ascending and descending functions. As ancients stated, when dampness suppresses, heat arises spontaneously. The Sage Emperor discussed diseases based on the four climatic factors and advocated drug flavors for prescriptions. The principle must involve bitter descent and acrid diffusion to open heat-fullness obstruction. Using aromatic-dry drugs for digestion and stagnation removal depletes Qi, leaving the cause of summerheat-pathogen disease untreated, which is inexplicable.

Coptidis Rhizoma (Huanglian), Scutellariae Radix (Huangqin), Trichosanthis Radix (Huafen), Platycodonis Radix (Jiegeng), Amomi Fructus Rotundus (Bai Kou Ren), Curcumae Radix (Yujin), Citri Reticulatae Pericarpium (Ju Hong), Liu Yi San

Prefers drinking hot soup when feeling cold, but no thirst after fever. Intermittent malaria has lasted forty days. Although it has stopped, there is no hunger or desire to eat, and tastes are distorted. Initially, the tongue was white with dry retching, indicating dampness attacking the Taiyin Spleen channel. Spleen collaterals were damp-stagnant with Qi blockage, hence the preference for hot drinks to temporarily unblock the stagnation. Pathogenic steaming generates heat within dampness, burning the six fu organs, preventing fluid transport, leading to hard constipation. This is Qi-damp bi-obstruction, requiring mild dietary regulation. Now that Qi is clear and descending, resembling Pi Yue (Spleen Confinement). However, Zhang Zhongjing treated both Qi and Blood, whereas this disease specifically damages the Qi level.

Pinelliae Rhizoma Praeparatum (Chao Ban Xia), Zingiberis Tuber (Sheng Yi Zhi Ren), Artemisiae Scopariae Herba (Mian Yin Chen), Citri Reticulatae Pericarpium (Guang Pi), Magnoliae Officinalis Cortex (Nou Pu), Poria (Fu Ling)

Damp-heat steams with food and drink, entirely affecting the Qi level. It is said that the Three Jiao requires separate dispersion and clearing. Since intermittent malaria has formed, with evil and righteous Qi struggling, originally there is no major harm. Initially misdiagnosed as Six Channels of Cold Damage, then erroneously treated with Ginseng and Atractylodes for tonification, causing pathogen diffusion, coma, panting, delirium, and convulsions. All result from pathogen having no exit; internal closure leads to external collapse. Seeking synergistic purgation with heat is now impossible. Pulse is fine and choppy; abdomen is distended upon palpation. Spleen fullness belongs to Qi; dryness-solidity belongs to Blood. After profuse diarrhea, abdominal fullness increases, indicating Qi knotting. Is this due to closure? The body is ruined and ruptured to this extent, rescue is unlikely.

Acori Tatarinowii Rhizoma Juice (Xi Ye Chang Pu Gen Zhi), Tsaoko Fructus (Cao Guo Ren), Poria Cum Pinus (Fu Ling Pi), Magnoliae Officinalis Cortex (Zi Hou Po), Artemisiae Scopariae Herba (Mian Yin Chen), Cinnabaris Yi Yuan San, Forsythiae Fructum (Lian Qiao Xin), Lonicerae Japonicae Flos (Jin Yin Hua), Niuhuang Wan

Small and choppy pulse. Disease started after malaria, aggravated by improper diet and mental fatigue from reading. Left hypochondrium extends to the lower abdomen, with frequent rebellious Qi. Sometimes attacking the epigastrium, sometimes gathering in the abdomen, causing凝着 (fixed) distension. Ancients said: Distension involves Liver and Gallbladder, just as cough involves the Lung. When Liver receives pathogen aid, Wood energy flares, insulting Middle Earth. Root Qi becomes weak, losing transport and reception power. Clear Yang cannot expand, Turbid Yin occupies daily, gradually forming fullness. Last year, warming and nourishing with acrid-sweet drugs failed to cure. The method of treating the root likely cannot remove the disease. Self-reported worsening in stillness, slight relief with movement, indicates long-term Qi-Blood obstruction and depression. Propose collateral-unblocking method, as the root cause is long-standing malaria with pathogen lingering in collaterals.

Dalbergiae Odoriferae Lignum (Zi Xiang), Pruni Semen (Tao Ren), Cyperi Rhizoma (Xiao Xiang Fu), Ginger Dregs (Dan Jiang Zha), Massae Fermentatae Medicinales (Shen Qu), Gavis Crassus (Ji Zun Pi), Crataegi Fructus (Nan Shan Zha), Chinese Chive Root Juice (Jiu Gen Zhi) Wan

Previous discussion attributed injury to Yang Qi from overwork, understanding the principle of internal damage and pathogen sinking. In women after cessation of Tian Gui (menstruation), Yin channels are empty, not just suffering from Ying-Wei imbalance colds/fevers. Thus, warming Spleen/Stomach and using Dewed Ginger to treat Middle Palace Ying deficiency. Fear of cold without heat sensation indicates Pin Malaria (Yin Malaria). Pin represents Yin; heavy body is also a Yin sign. This uses acrid-sweet to regulate Yang. Deer Antler (Lu Rong) warms from Du Mai, unlike the harsh nature of Ginger/Aconite only moving Qi. Expelling pathogen and benefiting deficiency occurs in the Ying level. *Nan Jing* states Yang Wei Mai disease causes chills and fever.

Cornu Cervi Degelatinatum (Lu Rong), Cornu Cervi Pantotrichum (Lu Jiao Shuang), Ginseng Radix et Rhizoma (Ren Shen), Angelicae Sinensis Radix (Dang Gui), Cinnamomi Ramulus (Xun Gui), Poria (Fu Ling), Glycyrrhizae Radix et Rhizoma Praeparata (Zhi Cao)

Summerheat damages Qi level, Upper Jiao affected first. He Jian's methods are exquisite. Later physicians who haven't read his book cannot achieve efficacy. Deep pathogen causes delayed malaria onset; Qi knotting causes chest confusion like fullness. Formless heat gradually steams formless phlegm. These digestive and dispersing methods deplete fluids and fail to expel pathogens.

Gypsum Fibrosum (Shi Gao), Armeniacae Semen Amarum (Xing Ren), Pinelliae Rhizoma (Ban Xia), Magnoliae Officinalis Cortex (Nou Pu), Anemarrhenae Rhizoma (Zhi Mu), Phragmitis Rhizoma (Zhu Ye)

Deep pulse, white tongue, hiccups, frequent irritability. Originally Yang deficiency with phlegm-fluid retention. Malaria stopped after three attacks. This is pathogen obstruction preventing dissemination, not pathogen expulsion and disease resolution. Condition has changed to Yin freezing, phlegm-turbidity blocking the middle, disrupting upper-lower Qi mechanism. Critical condition. Only through unblocking Yang can a prescription be formulated. Must restore Middle Yang circulation; if malaria recurs, there may be hope for recovery.

Aconiti Lateralis Radix Praeparata (Dan Fu Zi), Tsaoko Fructus (Sheng Cao Guo Ren), Paeoniae Radix Alba (Sheng Bai Shao), Poria (Fu Ling), Magnoliae Officinalis Cortex (Sheng Hou Po), Ginger Juice (Jiang Zhi)

Latent summerheat with cold invasion caused malaria. Used Qiang Huo, Fang Feng, Su Ye, Cong Bai for acrid-warm profuse sweating. Profuse sweat severely damaged Wei Yang and stolen Stomach fluids, causing thirst, irritability, and insomnia. Pulse: left weak, right rapid, slightly yellow eyes. Alcoholism causes Middle deficiency and low grain intake, prone to damp-heat accumulation. Do not hastily tonify Yang injury. Following *Nei Jing*, excessive acrid dispersion requires sweet foods to moderate.

Hordei Fructus Germinatus (Da Mai Ren), Glycyrrhizae Radix et Rhizoma Praeparata (Zhi Cao), Ophiopogonis Radix Praeparata (Chao Mai Dong), Paeoniae Radix Alba (Sheng Bai Shao), Poria Cum Parapluia (Fu Shen), Jujubae Fructus (Nan Zao)

Malaria pathogen disturbs the center from the four extremities, involving Yangming and Jueyin domains. Yangming decline allows Jueyin to invade. Fluid deficiency triggers internal wind. Ancients attributed malaria to Qi deficiency, actually damp-phlegm and bad blood. Current frequent heat in Xu-Hai hours, walking with sweat, clearly indicates fluid deficiency and Yang-moving wind generation. Lipids fail to irrigate extremities; this is not a damp-phlegm Qi-level ailment.

Mori Folium (Dong Sang Ye), Polygoni Multiflori Preparata Radix (Shou Wu Pian), Sesami Nigris Semen (Hei Ma Zi), Placenta Humana (Bai Zi Ren - *Note: Text says Bai Zi Ren, usually Seed*), Poria Cum Parapluia (Fu Shen), Angelicae Sinensis Radix (Dang Gui), Lycii Fructus (Qi Zi), Chrysanthemi Flos Carbonis (Ju Hua Tan) Honey Pill

Malaria relapsed. Turid urine with painful dribbling. Childhood spleen malaria, careless diet, yellow complexion, abdominal distension, stagnation. Spleen-Stomach further declined. Dong Yuan said: Insufficient Middle Qi causes urinary/stool changes. Early autumn to winter, repeated exacerbations, eventually leading to five types of malnutrition and consumption. Must be cautious with diet to make Spleen-Stomach Qi agile. Follow *Pi Wei Lun* ascending-descending, draining-tonifying method.

Ginseng Radix et Rhizoma (Ren Shen), Poria (Fu Ling), Glycyrrhizae Radix et Rhizoma Praeparata (Zhi Cao), Citri Reticulatae Pericarpium (Guang Pi), Quisqualis Fructus (Shi Jun Zi), Massae Fermentatae Medicinales (Shen Qu), Crataegi Fructus (Zha Rou), Malto (Mai Ya), Alismatis Rhizoma (Ze Xie)

Fujian production has biased Yang leakage. Long-term heat this year injured Yuan Qi. Initial malaria dispersion failed to cure, further stealing Stomach Yang, causing pathogen to enter Jueyin, coma, profuse sweat. Liver and Kidney share Lower Jiao. Rebellious Yang carries internal wind causing fainting, vomiting saliva and thick phlegm. Yangming Stomach, disturbed by cold-heat, is empty like a valley, wind generates internally. Reviewing medical records shows lack of meridian differentiation, merely calling deficiency excess, hence little efficacy. Use Zhang Zhongjing's method of calming Stomach and draining Liver.

Ginseng Radix et Rhizoma (Ren Shen), Zanthoxyli Fructus (Chuan Jiao), Mume Fructus (Wu Mei), Aconiti Radix Praeparata (Fu Zi), Zingiberis Rhizoma (Gan Jiang), Cinnamomi Ramulus (Gui Zhi), Coptidis Rhizoma (Chuan Lian), Ostrei Concha (Sheng Mu Li), Paeoniae Radix Alba (Sheng Bai Shao)

White tongue, no significant thirst, chills followed by fever, mental agitation approaching coma, worse chest/epigastric fullness. Malaria is exogenous pathogen, disturbing center from extremities. Phlegm-saliva and vomiting indicate Lung-Stomach deficiency, pathogen aggregation blocking flow, causing coma and irritability. Steaming sweat provides temporary relief. Ying-Wei pathogens not cleared, chills/fever persist. Harmonizing and tonifying may not hit the mark; following meridians is appropriate.

Amomi Fructus Rotundus (Bai Kou Ren), Armeniacae Semen Amarum (Da Xing Ren), Pinelliae Rhizoma焦 (Jiao Ban Xia), Ginger Juice (Jiang Zhi), Scutellariae Radix (Huang Qin), Phragmitis Rhizoma (Dan Zhu Ye)

Weak and fine pulse, nose tip bright, daytime cold sweat, no hunger, poor intake, constant epigastric-abdominal fullness, relief after passing gas. Yang Qi loses protection, causing chills/sweat; Yang fails to drive, Spleen-Stomach Qi dull. Previous nourishing-Ying treatments focused on Middle Palace, likely because blood tonics are soft/moistening, preventing sudden Yang recovery. Initial dose effective, subsequent doses ineffective. Dislikes drinking soup, tongue moist, not pathogen-heat knotting. Propose Lizhong Tang method, focusing on regulating Spleen-Stomach Yang Qi, not just curing disease but transporting previous medicines. Ancients called malaria Spleen Cold, emphasizing regenerating Yang to let Middle State operate silently, a key treatment principle.

Ginseng Radix et Rhizoma (Ren Shen), Paeoniae Radix Alba (Sheng Shao), Atractylodis Macrocephalae Rhizoma (Bai Zhu), Aconiti Radix Praeparata (Fu Zi), Poria (Fu Ling), Zingiberis Rhizoma (Gan Jiang)

Malaria involves twelve meridians but mainly Shaoyang and Jueyin. This discusses exogenous pathogen injury. If accompanied by depression/anger, causing rebellious Liver Qi horizontal invasion, the force is sharp. Classics state Liver channel passes through diaphragm into Stomach, up throat. Malaria pathogen also disturbs center from extremities, causing anorexia, Stomach distress. Treating disease requires distinguishing Qi/Blood first. Long-term/frequent attacks damage collaterals. Collaterals gather blood; chronic disease leads to stasis/blockage. Acrid-dry blood-breaking and stagnating-nourishing-blood drugs are contraindications. Must be vigilant.

Artemisiae Annuae Herba (Qing Hao), Testudinis Carapax et Plastrum (Sheng Bie Jia), Pruni Semen (Chao Tao Ren), Angelicae Sinensis Radix Tail (Dang Gui Wei), Curcumae Radix (Yu Jin), Citri Reticulatae Pericarpium (Ju Hong), Poria (Fu Ling)

Post-malaria ear discharge indicates orifice closure and deafness, residual pathogens tangled with Qi-Blood. For 7-8 years, clearing/dispersing yields no quick effect. Avoid meat/alcohol/turbid flavors. Take Cha Tiao San (1 qian) before bed. Insert sharpened Kansui (Gan Sui) into affected ear, holding Licorice (Gan Cao) half cun. Two years ago morning diarrhea, vomiting after eating. Not age-related Spleen-Kidney deficiency diarrhea treatable with Er Shen Si Shen. Rather, childhood Yang deficiency is rare. Now diarrhea persists, chills/fever/cough/hemoptysis, amenorrhea, string-rapid pulse, emaciated appearance. Entirely due to Yin failing to grow in youth, severe consumption. No simple disease-treatment logic. Protect stomach appetite to hope for menstruation return. Emphasize emotional openness, do not rely solely on medicine.

Rehmanniae Radix Preparata (Shu Di Tan), Angelicae Sinensis Radix (Chao Dang Gui), Glycyrrhizae Radix et Rhizoma Praeparata (Zhi Gan Cao), Paeoniae Radix Alba (Chao Bai Shao), Scutellariae Radix (Dan Huang Qin), Mume Fructus (Wu Mei Rou), Crataegi Fructus (Hei Zha Rou)