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True malaria often presents with headache. After the illness subsides and the patient rises, they feel as if they are not ill. Symptoms resembling malaria include mild chills, shallow fever, or cases where chills are slight and fever is extremely light. Some present with headache occurring once daily, loss of appetite, inability to taste food, fatigue and weakness, spontaneous sweating with body heat, body pain and distension, alternating chills and fever without excessive severity. Others may experience extreme fever followed by sweating that stops at the neck or half of the body. After the episode, the patient cannot rise from bed, speaks incoherently, and appears confused. There are many miscellaneous diseases involved, difficult to describe fully. If treated as true malaria, death can be avoided, but it may transform into *Lao* (consumptive disease), taking one to two years to heal, yet the affliction remains endless. True malaria has fixed times for onset and cessation, unlike Shaoyang Shanghan (Cold Damage affecting the Shaoyang channel) which comes and goes irregularly. Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the standard treatment formula. If there is no sweat, inducing sweat will stop the condition; if there is sweat, stopping sweat will cure it. This disease originates in winter, with pathogens lodging in the Kidney, storing in the Heart, and heat lingering in the Lung, involving the Taiyin (Spleen/Lung) channel. It manifests as shortness of breath, vexation and oppression, heat in the hands and feet, and vomiting, indicating Spleen involvement. Chills preceding fever is called Han Nue (Cold Malaria); fever preceding chills is called Wen Nue (Warm Malaria). These two differ, and treatment should follow the middle path, involving the Shaoyang channel. Thirst indicates Dryness prevailing; no thirst indicates Dampness prevailing. The classics state: "Summer injury by Summerheat leads to Autumn Malaria." Those who do not sweat during summer heat will develop malaria in autumn because summer damages Yang Qi, causing Shaoyang Yang Qi to fail to circulate freely, all pointing to Shaoyang Deficiency. Malaria in the four seasons should follow the seasonal timing: Summer Qi moves upward, Autumn Qi moves downward. Chills preceding fever belongs to Taiyang and Yangming channels; use Bai Hu Tang (White Tiger Decoction) plus Guizhi (Cinnamon Twig). Since Heaven's Qi moves upward, downward-moving methods are appropriate; one should not drain the Lung but rather drain Ministerial Fire. For headache, add Chuanxiong (Szechwan Lovage Rhizome); for back pain, add Guizhi; for waist pain, add Niuxi (Achyranthes Root); for foot pain, add Mugua (Chaenomeles Fruit) and Yiren (Coix Seed). Use Xiao Chai Hu Tang as the main formula, combined with Wu Ling San (Five-Ingredient Powder with Poria). For dietary injury, add Qingpi (Aurantii Fructus Pericarpium) and Caoguo (Tsaoko Cardamom); for body distension without sweat, use Renshen Baidu San (Ginseng Detoxification Powder); for generalized body pain with sweat, use Buzhong Yiqi Tang (Middle-Boosting Qi-Invigorating Decoction) plus Huangqi (Astragalus Root). For chronic illness unresponsive to tonification, treat as Xu Sun (Deficiency Injury). For cold pain in waist and feet, use Er Chen Tang (Two-Cured Decoction) plus Rougui (Cinnamon Bark) and Fuzi (Aconite Root). For daily episodes where pathogens transmit to the Yin aspect, use Bazhen Er Chen Tang (Eight-Treasure and Two-Cured Decoction) plus Chaihu (Bupleurum Root) for several doses. Wait until pathogens transmit to the Yang aspect to easily intercept them; otherwise, it transforms into Lao. For chronic daily persistent pathogenic heat, Buyi Tang (Benefit Qi Decoction) plus Fuzi, or Shiquan Dabu Tang (Perfect Ten Tonifying Decoction) are best. For abdominal distension and diarrhea, remember to regulate the Spleen and Stomach; add Sijunzi Tang (Four-Gentlemen Decoction). Taiyang channel disorders cause lower back pain and heavy head, cold rising from the back, chills preceding fever, shivering, and difficulty stopping sweat after fever ceases; use Qianghuo Shengdi Tang (Notopterygium and Rehmannia Decoction). Yangming channel disorders cause initial shivering and severe cold, followed by heat later, with relief upon exposure to sunlight, moonlight, or fire after sweating; use Bai Hu Tang plus Guizhi. Shaoyang channel disorders cause limb flaccidity, mild chills and fever, aversion to people, palpitations upon seeing people, abundant heat and sweat; use Xiao Chai Hu Tang. Taiyin channel disorders cause depression, frequent sighing, frequent chills and fever, sweating, nausea upon onset, and improvement after vomiting; use Sijunzi Tang plus Chenpi (Aged Tangerine Peel) and Beimu (Fritillaria Bulb). Shaoyin channel disorders cause severe vomiting, frequent chills and fever (more heat than cold), desire to stay indoors behind closed doors, and difficult treatment; use Xiao Chai Hu Tang plus Xixin (Asarum). Jueyin channel disorders cause lower back pain, lower abdominal fullness and pain, dysuria resembling Long (dysuria/retention) but not true Long, frequent urination, fear, Qi deficiency, and abdominal gloominess; use Yanhu Kulian Tang (Corydalis and Melia Decoction): Kubai 1 liang, Kulian 2 fen, Fuzi and Guixin (Cinnamon Heart) each 2 fen, Shudi (Prepared Rehmannia Root) 1 qian, taken on an empty stomach.

Malaria arises from external contraction of Wind-Cold or Summerheat-Dampness, and internal injury from diet or overwork. Irregular eating, sexual excess, etc., lead to Spleen-Stomach disharmony and Phlegm obstruction; indeed, "no Phlegm, no Malaria." The Spleen and Stomach belong to Earth and are trustworthy, arriving and departing on time. If the timing shifts early or late, it means the pathogen has no place to reside and will self-resolve. Daily attacks indicate shallow disease, easy to treat; every-other-day attacks, or two days on one day off, or every three days, are difficult to treat. For early-stage malaria with more chills than heat, or only chills without heat, use Guifu Erchen Tang (Cinnamon-Aconite Two-Cured Decoction): Rougui (Cinnamon Bark), Dingxiang (Clove), Chenpi, Banxia (Pinellia Tuber), Chaihu, Huangqin (Scutellaria Root). Add Paojiang (Roasted Ginger) for thirst, Fuzi for cold. For more heat than chills, or only heat without chills, use Bai Hu Tang plus Guizhi: Gancao (Licorice Root) 8 fen, Shigao (Gypsum) 8 qian, Zhimu (Anemarrhena Rhizome) 1.5 qian, Guizhi 4 fen, Yuanmi (Rice grain) a pinch. One to two doses should be effective. If previous medicines fail, use Liujunzi Tang (Six-Gentlemen Decoction) plus Chaihu and Huangqin; add Danggui (Angelica Sinensis) and Baishao (White Peony Root) for Blood Deficiency.

Malaria generally requires separation, draining, and harmonization using Chaihu, Banxia, Huangqin, and Gancao. Add Renshen (Ginseng) for deficiency, Huangqi for sweating, Wu Ling San for severe heat-dampness, Zhimu for bone-steaming fever. Four to five doses should cure it. For farmers with miasma-induced malaria, use Changshan Yin (Dichroa Decoction) to induce vomiting. If vomiting fails, treat as internal injury. Changshan Yin: Changshan (Dichroa Root), Binglang (Areca Seed), Zhimu, Beimu. Decoct in water, leave exposed overnight, warm and take next morning.

For malaria starting at night or lasting one to two months, use Shouwu (Polygonum Multiflorum) 5 qian, Qingpi 2 qian, Dingxiang 1-2 qian to intercept. If ineffective, use Renshen, Baizhu (Atractylodes Macrocephala Rhizome), Fuling (Poria), Gancao, Chenpi, Banxia, Chaihu (avoid if exterior deficiency), Huangqin, Dangguishen (Angelica Sinensis root heart; avoid if diarrhea), Baishao. Add Shenqu (Medicated Leaven) for belching, Dingxiang for nose/mouth bleeding, Paojiang for abdominal pain.

Regarding Malaria Qi: merging with Yang leads to Yang excess (Heat); merging with Yin leads to Yin excess (Cold). Malaria is caused by Summerheat injury, where Heat Qi merges with the Qi aspect of the meridians. Merging with Yin involves Cold pathogens in the Wei (Defensive) level descending to merge with the Blood aspect of the meridians. Qi is Yang and Hot; when Ying (Nutritive) Heat merges with it, two heats combine causing fever. Blood is Yin and Cold; when Wei Cold merges with it, two colds combine causing chills. Although termed Yang/Yin excess, it is essentially the struggle of Yin and Yang within the meridian, driven by Qi.

Treatment methods for malaria involve raising Yang so it does not merge with Yin, thus stopping chills. Raising Yang means dispersing Cold in Yang, using Chaihu, Gegen (Kudzu Root), Qianghuo (Notopterygium Rhizome), Zhimu, Shouwu, etc., which are heat-draining agents. Separation cures what merging causes.

Chronic malaria indicates Yuan Qi (Original Qi) deficiency and Cold. Qi deficiency causes Cold; Blood deficiency causes Heat. Stomach deficiency causes aversion to cold; Spleen deficiency causes fever. Downward flow of Minster Fire causes alternating chills and fever. Vomiting phlegm, anorexia, tremors, diarrhea, and cold extremities all indicate Spleen-Stomach deficiency. Buzhong Yiqi Tang with modifications will self-cure.

For chronic malaria without sweat, use Renshen 1 liang, Shengjiang (Fresh Ginger) 4 liang, decoct and drink. Or Dingxiang 1 qian, Renshen 3 qian; this is a good prescription for interception without forced suppression. For blood-heat malaria lasting a month, use Shouwu 5 qian, Qingpi 2 qian, decoct and take first thing next day. For deficiency, add Renshen, Shouwu 1.5 qian, Chenpi 5 fen, Gancao 3 fen, Fuling 1 qian, Zhimu 1 qian, Wumei (Dark Plum) 3 pieces.

For chronic malaria with Stomach deficiency, use Renshen and Dingxiang each 2 qian, Gancao and Baizhu each 1 qian, decoct and drink. For Spleen deficiency with fullness, anorexia, phlegm vomiting, and tidal fever, use Buzhong Yiqi Tang plus Fuzi. Add Huangbai (Phellodendron Bark) for difficult urination, Biejia (Turtle Shell) for Labor Malaria.

For chronic malaria lasting 3-5 months or half a year, use Er Chen Tang plus Dingxiang and Renshen. If malaria presents with only cold, no heat, and slow pulse, use one piece of Fuzi. If exterior is deficient, better to use Shenqu. Generally, malaria involves both Qi and Blood deficiency; regulate with Bazhen Tang or Shiquan Dabu Tang, but Er Chen Tang should never be omitted. For slippery-small malaria pulse, use Chaihu plus Changshan, Binglang, Qingpi, Caoguo to intercept; tight pulse adds Gegen and Ziye (Perilla Leaf); rapid pulse adds Huangqin and Huashi (Talc); slow pulse adds Fuzi. All fall within modifications of Xiao Chai Hu Tang. For chronic vomiting and nausea, use Renshen, Chenpi, Banxia, Dingxiang decocted. If tonification fails and it persists, it is Damp-Heat harm; use Pingwei San (Stomach-Calming Powder).

For three-day malaria lasting half a year, use Zhusha (Cinnabar), Xuanshen (Scrophularia Root) each 1 liang, Cangzhu (Atractylodes Rhizome), Houpo (Magnolia Bark) each 4 liang, Changshan, Caoguo each 1 liang. For children unable to take medicine, use Huangdan (Lead Oxide) 5 qian, Shengfan (Alum) 3 qian, Hujiao (Pepper) 2.5 qian, Shexiang (Musk) 0.5 li. Grind to powder, mix with good vinegar, apply to left palm for males, right palm for females, wrap hand in silk. When medicine warms and induces sweat, it heals. One dose works for three people.

For persistent malaria, use dates to intercept. Formula: Dingxiang, Changshan each 1 liang, Zisu (Perilla Leaf) 2 liang, Quanxie (Scorpion) 30, Dates 100. Boil together. Strong adults eat 5-6, weak adults 3, children 1-2. Chew and take just before onset for effect.

For chronic malaria forming a mass, mash Garlic, add little Musk, apply to mass for effect in one day. Internally, boil Ma Liaodou (Horse Bean) one dou frequently.

For symptoms resembling malaria coming daily with body distension and urge to hit, it belongs to Spleen deficiency. Use Liujunzi Tang. Add Shenqu for food stagnation/belching, Danggui/Baishao for Blood deficiency (0.5 fen), Huangqi for excessive sweat (0.7 fen), Wumei/Rougui for clear phlegm vomiting (0.3 fen each), Paojiang for nausea (0.3 fen).

For non-malaria resembling malaria persisting long, or chronic dysentery with Middle Qi deficiency, use Paojiang, Fuzi, Baizhu for dozens of doses. Only when Middle Qi is sufficient will pathogens not return. If effective in 1-2 doses and stopped, the disease will relapse.

Internal injury resembling malaria, daily occurrence: Baizhu 5 qian, Dangguishen 3 qian, Chenpi 2 qian, Wumei 2 pieces, Dingxiang (male/female) 3 grains each. For deficiency, add Renshen 5 qian. Soak in one bowl cold water overnight, expose to dew until dawn, strain and warm drink.

Another formula: Baizhu 5 qian, Qingpi, Chenpi each 3 qian. Soak in cold water and expose, decoct next morning.

Case Record
One person had early-stage malaria, drank alcohol and slept, then developed fever, even becoming confused, resolving at night. Urine was red and scanty, every other day attack, chills preceding fever, vomiting phlegm-saliva, anorexia, gastric discomfort, nausea after eating, thin body, numb hands, thirst preferring hot drinks. Formula: Chaihu 0.7 fen, Yizhi (Alpinia Oxyphylla Fruit) 0.5 fen, Gancao 0.3 fen, Renshen, Guizhi, Banxia, Fuling, Qianshi (Euryale Seed) each 1 qian. Decoct and drink; effective.

One person had severe malaria for over a year, large and forceful pulse, indicating stubborn Phlegm in the Spleen. When Spirit is vigorous, Righteous Qi circulates and disease heals; when Spirit declines, Pathogenic Qi prevails and disease acts. Combine Er Chen Tang and Xiao Chai Hu Tang.