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The *Yellow Emperor's Inner Canon* states: Malaria all originates from wind pathogens. It also states: If one is injured by summer heat in summer, malaria will inevitably occur in autumn. Wind and summer heat are yang pathogens, while cold and water are yin pathogens. However, wind is the cool qi within yang, and summer heat is the cold pathogen within heat (referring to the accumulation of cold-dampness or internal cold due to excessive cooling). Considering these four factors together, they all belong to the category of cold. Therefore, it is commonly known as "Spleen Cold," meaning the pathogen resides between the muscles, and since the Spleen governs the muscles, this is the reason. When malaria is about to erupt, there must first be cold extremities, because the Spleen governs the four limbs. The scripture mentions "summer heat" to refer to the seasonal climate; it mentions "cold" to refer to the nature of the disease. Although the pathogen moves from superficial to deep levels, and stagnant cold transforms into heat, ultimately, cold remains the root and heat is the branch. If the condition persists unresolved, even if excess transforms into deficiency, without greatly tonifying true qi and vigorously strengthening the Spleen and Stomach, it cannot be cured.

Malaria must involve both chills and fever, because external pathogens lie dormant at the half-exterior and half-interior level, which is precisely the domain governed by the Shaoyang (Lesser Yang) channel. When the pathogen emerges and contends with yang, yin prevails and causes chills; when it enters and contends with yin, yang prevails and causes fever. Even in Warm Malaria (Wen Nue), characterized by pure heat without chills, or in Male Malaria (Mu Nue), characterized by pure cold without fever, all originate from the Shaoyang channel and reach an extreme deviation. Therefore, to correct the deviation and remedy the defect, one must return to the balance of the Shaoyang channel, harmonizing yin and yang, before recovery can occur. It is possible for Shaoyang to involve other channels, but if other channels are involved without touching Shaoyang, it cannot be considered malaria. Malaria's inseparability from Shaoyang is like cough's inseparability from the Lung.

Whenever children are exposed to wind, cold, summer heat, and dampness, the pathogen lodges in the skin and accumulates in the zang-fu organs. Pathogenic factors and healthy qi attack each other, causing an imbalance of yin and yang, leading to alternating chills and fever. If yang is insufficient, chills precede fever; if yin is insufficient, fever precedes chills. More chills than fever indicates yin prevailing over yang; more fever than chills indicates yang prevailing over yin; if yin and yang attack each other mutually, chills and fever are equal. In the initial stage, there is invariably phlegm and food stagnation internally, causing the qi of the zang-fu organs to fail to circulate freely, thus manifesting as malaria.

The timing of malaria attacks is regular, occurring daily, every other day, or every two to three days. This depends on the flourishing or declining state of the zang-fu qi and the severity of the pathogen. Attacks occurring after the Summer Solstice and before the End of Heat (Chushu) indicate disease in the Three Yang channels, representing a shallow and acute injury. Attacks occurring after the End of Heat and before the Winter Solstice indicate disease in the Three Yin channels, representing a distant and deep injury. Attacks occurring after Zi hour (11 PM-1 AM) and before Wu hour (11 AM-1 PM) indicate disease in the yang aspect, which is easier to cure. Attacks occurring after Wu hour and before Zi hour indicate disease in the yin aspect, which is difficult to cure. One must especially consider the proportion of chills and fever, as well as the strength of the constitution, to grasp the essence.

The symptoms of malaria begin with yawning, followed by cold feet, a bluish-yellow complexion, stiff and spasmodic body with shivering, pain in the head, neck, waist, and spine. As the chills subside but have not fully ceased, both interior and exterior become hot, accompanied by headache, thirst, desire only to drink water, nausea, vomiting, vexation, abdominal fullness, and loss of appetite. These are all signs. Because children's Spleen and Stomach are inherently weak, pathogens take advantage of this. Although manifestations vary among cold, heat, excess, and deficiency, they fundamentally do not depart from the Spleen and Stomach. There are five types of syndromes: those caused by wind, cold, summer heat, dampness, and food. The key to treatment lies in addressing the early, middle, and late stages separately. In the early stage, intercept the pathogen: when the pathogen is in the middle jiao and healthy qi is unharmed, slight dispersal allows expulsion of the pathogen; do not nourish it to allow harm. In the middle stage, harmonize: as the pathogen gradually enters and healthy qi gradually declines, either add anti-malarial herbs to tonifying formulas or add tonifying herbs to anti-malarial formulas, aiming for balance. In the late stage, use tonification: when the pathogen lingers and healthy qi is depleted, focus on tonifying the Spleen and Stomach so that when healthy qi recovers strongly, the pathogen retreats spontaneously.

1. Wind Malaria: Caused by contracting wind, presenting with aversion to wind, spontaneous sweating, vexation, thirst, and headache. Wind is yang, so fever precedes chills. Initially, use dispersing methods: Guizhi Baizhu Tang (Cinnamon Twig and Atractylodes Macrocephala Decoction). If unresolved, use Xiaochaihu Tang (Minor Bupleurum Decoction) plus Changshan (Polygala Root), Binglang (Areca Seed), and Wumei (Mume Fruit) to intercept. If persistent long-term, consume Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) frequently until self-healed.

2. Cold Malaria: Caused by contracting cold, presenting with no sweat, aversion to cold, spasms, and pale face. Cold is yin, so chills precede fever. Use methods to disperse cold pathogens: Yangwei Tang (Nourish the Stomach Decoction) plus Guixin (Cinnamon Heart). If persistent, use Pingwei San (Level the Stomach Powder) plus Binglang (Areca Seed) and CaoGuo (Tsaoko Cardamom) to intercept. If long-term persistent, use Liujunzi Tang (Six Gentlemen Decoction) plus Shengjiang (Fresh Ginger) and Rgui (Aconite Lateral Root).

3. Summer Heat Malaria: Caused by summer heat injury, where yin qi is alone weak and yang qi alone flares, presenting with only heat without chills, vexation, thirst, poor sleep, occasional nausea/vomiting, and muscle wasting. Resolve summer heat toxicity: Chaihu Baihu Tang (Bupleurum and White Tiger Decoction). If persistent, remove Shigao (Gypsum Fibrosum), add Beimu (Fritillaria Bulb), Changshan (Polygala Root), and Binglang (Areca Seed) to intercept. If long-term persistent, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction).

4. Damp Malaria: Caused by exposure to rain/dampness, bathing after sweating, or sitting/lying on wet ground. Presents with heavy and painful body, vexatious joint pain, vomiting, regurgitation, and abdominal distension. Use Weiling Tang (Stomach and Lingzhi Decoction). If unresolved, use Pingwei San (Level the Stomach Powder) plus Fuling (Poria), Binglang (Areca Seed), and Changshan (Polygala Root) to intercept. If long-term persistent, use Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder).

5. Food Malaria: Also called Phlegm Malaria, caused by irregular diet and damage from hunger/fullness. Consuming raw/cold foods, fish/meat, or greasy substances leads to phlegm retention in the Zhongwan (Middle Jiao), constituting Food Malaria. Symptoms include hunger without desire to eat, abdominal fullness after eating, vomiting, regurgitation, and abdominal pain. Eliminate food stagnation: Six Beasts Drink (Sishou Yin). If persistent, administer Hongwanzi (Red Pill) delivered by Erchen Tang (Two Aged Substances Decoction). If long-term persistent, use Liujunzi Tang (Six Gentlemen Decoction) plus Qingpi (Aurantii Fructus Pericarpium), Shengjiang (Fresh Ginger), and Rgui (Aconite Lateral Root).

When malaria and dysentery occur simultaneously, initially use Xiaochaihu Tang (Minor Bupleurum Decoction) plus Danggui (Angelica Sinensis), Baishao (White Peony Root), and Binglang (Areca Seed) to release the exterior and guide out stagnation. If unresolved, use Liujunzi Tang (Six Gentlemen Decoction) plus Guizhi (Cinnamon Twig).

Post-malaria edema is very common. Treat with Weiling Wan (Stomach and Lingzhi Pills) or Wupi Tang (Five Peel Decoction). If swelling does not resolve, use Liujunzi Tang (Six Gentlemen Decoction) plus Shengjiang (Fresh Ginger), Rgui (Aconite Lateral Root), and Sharen (Amomum Fruit); if limbs are cold, add Fuzi (Prepared Aconite Lateral Root).

Post-malaria poor appetite, yellow sallow complexion, emaciation, and failure to gain muscle indicate impending consumption syndrome (Gan Ji). Regulate with Pingmaiyang Pi Wan (Stop Malaria and Nourish Spleen Pills); frequent administration leads to self-healing.

Night Malaria: The pathogen is in the blood aspect. Use Mahuang Guizhi Tang (Ephedra and Cinnamon Twig Decoction) plus Dihuang (Rehmannia Root) and Honghua (Carthamus Flower). If unresolved, combine Siwu Tang (Four Substances Decoction) with Xiaochaihu Tang (Minor Bupleurum Decoction) plus Shengma (Cimicifuga Rhizome) to raise the pathogen to the yang aspect. Then use Sijunzi Tang (Four Gentlemen Decoction) plus Changshan (Polygala Root), Wumei (Mume Fruit), and Binglang (Areca Seed) to intercept.