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(Detailed information on Malaria Mother (Nue Mu) should be referred to alongside Accumulation and Mass (Ji Ju).)

General Summary: Yellowish complexion and erect hair indicate the causes of malaria; it arises from external contraction of Wind, Cold, Summerheat, and Dampness. Internally, it results from emotional stagnation or following hunger, thus causing alternating chills and fever.

Pulse Diagnosis: The pulse in malaria is typically Wiry (Xian). If the pulse is Fine (Wei), it indicates Deficiency. If the pulse is Intermittent (Dai) and Scattered (San), it indicates a fatal prognosis.

The *Neijing* states: Those who do not sweat during summer heat will develop Wind Malaria (Feng Nue) in autumn. It also states: Injury by Summerheat in summer leads to malaria in autumn. Zhu Danxi stated: All malaria originates from Wind pathogen. This represents the general understanding of previous scholars regarding malaria. However, they failed to realize that Wind, Cold, Summerheat, and Dampness pathogens enter from outside, while pathogens due to diet and lifestyle arise from within. It is not merely that injury by summer heat in summer inevitably leads to malaria in autumn! Generally, shallow injuries manifest quickly and acutely, while deep injuries manifest slowly and chronically; chronic cases are known as Long-term Malaria (Jiu Nue). One must understand that the alternating chills and fever in malaria result from the mutual struggle between Yin and Yang Qi. When pathogens congregate in the Greater Yang (Ju Yang) meridian, Yin becomes Excess and Yang becomes Deficient, hence chills occur first. When pathogens congregate in the Greater Yin (Ju Yin) meridian, Yang becomes Excess and Yin becomes Deficient, hence fever occurs. This is the shifting of Yin and Yang. Pathogenic qi resides in the skin and coexists with Defensive Qi (Wei Qi). Defensive Qi travels through Yang during the day and Yin at night. When this pathogen obtains Yang Qi, it moves outward causing an attack; when it obtains Yin Qi, it presses inward causing remission. Thus, daily attacks indicate shallow infection. When the pathogen resides deeply, affecting the Five Zang organs, Yang Qi flares up alone while Yin pathogen lingers inside. Yin and Yang struggle endlessly without exiting, resulting in every-other-day attacks, indicating deeper infection. When pathogenic qi and Defensive Qi lodge in the Six Fu organs but sometimes fail to interact, unable to struggle, remission lasts several days before an attack, indicating the deepest infection.

However, malaria symptoms vary:
Foot-Taiyang Malaria (Bladder Meridian) causes lower back pain and heavy head, cold sensation rising from the back, preceded by chills then fever, body stiffness, ending only after sweating ceases.
Foot-Shaoyang Malaria (Gallbladder Meridian) causes bodily laxity, mild chills and mild fever, aversion to people, trembling upon seeing others, abundant fever and sweating.
Foot-Yangming Malaria (Stomach Meridian) causes initial shivering cold, followed by fever after prolonged cold, ending with sweating and relief upon exposure to sunlight or moonlight.
Foot-Taiyin Malaria (Spleen Meridian) causes melancholy, frequent sighing, loss of appetite, alternating chills and fever, sweating, nausea upon onset, with improvement after vomiting.
Foot-Shaoyin Malaria (Kidney Meridian) causes severe vomiting, more fever than chills, desire to stay indoors with doors closed, and is difficult to treat.
Foot-Jueyin Malaria (Liver Meridian) causes lower back pain, abdominal fullness, difficulty urinating (resembling strangury but not quite), frequent urge to urinate, fearfulness, Qi deficiency, and abdominal depression. These are the six-meridian malarias.

Lung Malaria causes chills, severe cold then severe heat, fright during heat intervals, and visual hallucinations.
Heart Malaria causes extreme irritability, desire for cold water, yet more chills than heat.
Liver Malaria causes pale/greenish complexion, frequent sighing, and a state resembling death.
Spleen Malaria causes chills, abdominal pain, borborygmus during fever, and sweating after borborygmus.
Kidney Malaria causes aversive cold, lower back and spine pain, restlessness, difficulty defecating, dizziness, and blurred vision. These are the five-zang malarias.

Li Dongyuan stated: Cold Malaria belongs to Taiyin, Heat Malaria to Yangming, Wind Malaria to Shaoyin, and Warm Malaria to Jueyin. Attacks occurring on Zi, Wu, Mao, You days belong to Shaoyin; those on Yin, Shen, Si, Hai days belong to Jueyin; those on Chen, Xu, Chou, Wei days belong to Taiyin, due to the tri-day cycle.

Danxi also named Food Malaria, Phlegm Malaria, Wind Malaria, Summerheat Malaria, Old Malaria, and Malaria Mother. These do not exceed the domains of the Five Zang and Six Fu meridians, differing only in the specific pathogen contracted. They are named according to the accompanying pathogen. These are listed here for reference.

Regarding children, if they are held improperly, exposed to Wind and Cold, or suffer Summerheat and Dampness, pathogens lodge in the skin, and Phlegm-Fluids, Milk, and Food stagnate in the Zang-Fu. Initially, resolution and guidance methods may be used, but protecting Stomach Qi is fundamental. Subsequent treatment should follow the cause. For acute or transient malaria, dispersal or interception can be used. For deficient or chronic malaria, tonifying Qi and Blood is appropriate. Overuse of intercepting drugs damages Spleen and Stomach, leading to lingering illness.
For Heat-dominant, Cold-minimal, anhidrosis: Guizhi Mahuang Ban Ge Tang (Cinnamon Twig and Ephedra Half-Dose Decoction).
For hyperhidrosis: Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction).
For hyperhidrosis with thirst: Baihu Jia Guizhi Tang (White Tiger plus Cinnamon Twig Decoction).
For red urine, Heat-dominant, Cold-minimal: Xiaochaihu Tang (Minor Bupleurum Decoction).
For Cold-dominant, Heat-minimal: Qingpi Yin (Clear the Spleen Drink) or Yangwei Tang (Nourish the Stomach Decoction).
For chronic non-resolving cases: Gui Ku San (Ghost Cry Powder).
For Heat-dominant, sweating, abdominal pain, thirst: Daxiehu Tang (Major Bupleurum Decoction) to purge.
For chronic malaria with intestinal masses: Biejia Yin (Turtle Shell Drink).
For malaria with Spleen Deficiency, regardless of meridian involvement, Liu Junzi Tang (Six Gentlemen Decoction) is primary. Add Chaihu, Zhizi, Huangqin for heat; add Zhimu, Digupi, Biejia for severe heat. Add Ganjiang, Rougui for cold. Add Huangqi, Fumai for sweating. Add Cangzhu, Gegen for no sweating. For sinking Yuan Qi or Liver Wood overacting on Spleen, add Shengma, Chaihu. Avoid Qipi, Changshan, Caoguo, as they further deplete Zheng Qi and deepen pathogens, causing myriad complications.

Some pediatric malaria transforms into deficiency edema or scrotal swelling, or dietary injury to Spleen/Stomach causes edema. Edema reflects Spleen pathology; treat with Dafupi Tang (Areca Peel Decoction) or Caoguo Yin (Caoguo Drink). Follow with Spleen-fortifying tonics.
If the nursing mother has emotional/dietary imbalance, presenting with malaria-like chills/fever and blazing Liver Fire affecting the infant, treat the mother instead.

Yin Deficiency syndrome presents with afternoon chills and fever resembling malaria, resolving with evening sweat. Treating as malaria with Changshan/Caoguo is erroneous. Differentiate by pulse: Yin Deficiency shows Empty, Soft, Rapid pulse; Malaria shows Wiry, Rapid pulse.
Masses (Pi Pi) causing malaria-like chills/fever should not be treated as malaria.

(Note: Chronic malaria depletes Yuan Qi. Misusing Qingpi Yin often proves fatal; use caution. Jiemai Yin is also unsuitable. Post-malaria poor appetite, weakness, yellow face, and frailty: Use Sijunzi Tang combined with Erchen Tang, Ginger-processed Huanglian, and Zhishi. Caoguo and Changshan are harsh and draining; avoid in slightly deficient patients.)

Malaria with Wiry-Rapid pulse indicates Kidney/Stomach Deficiency, common in both external and internal injuries. Use Guixiong Renshen Biejia Yin (Angelica, Ligusticum, Ginseng, Turtle Shell Decoction): Banxia, Houpo, Binglang, Qingpi, Gancao, Baizhu, Cangzhu, Wumei, Shengjiang, Heidou. Decoct with Peach Branch wine dew. Add Guizhi for severe cold; add Chaihu, Lingzhi (fried in wine) for severe heat. Add Zhimu, Tianhuafen for thirst; add Shengma for insufficient Yuan Qi. For night attacks, add Shengma, Jiegeng. For chronic malaria, adjust Changshan, Caoguo.
Interception method: Changshan, Cangzhu, Houpo, Chenpi, Huanglian, Binglang, Caoguo. Seven ingredients plus Wumei decocted in water/wine. Plus Heshouwu, Fuling (3-4 liang). Erchen Tang and Houpo omitted. Gancao (10 parts) decocted in overnight dew. Take on empty stomach.

[Attached Formulas]
Guizhi Mahuang Ban Ge Tang: Guizhi, Baishao, Mahuang, Gancao, Xingren, Shengjiang, Dazao.
Chaihu Guizhi Tang: Chaihu, Guizhi, Huangqin, Banxia, Renshen, Gancao.
Baihu Jia Guizhi Tang: Shigao, Zhimu, Guizhi, Gancao.
Xiaochaihu Tang: See Vomiting Syndromes (remove Bohe).
Qingpi Yin (Suitable for early stage): Cangzhu, Banxia, Caoguo, Qingpi, Huangqin, Chaihu, Houpo, Chenpi, Fuling, Zhiqiao, Zisu, Gancao.
Yangwei Tang (Suitable for deficiency): Huoxiang, Cangzhu, Houpo, Banxia, Chenpi, Caoguo, Fuling, Renshen, Gancao.
Gui Ku San: Dafupi, Changshan, Fuling, Biejia.
Daxiehu Tang: Chaihu, Huangqin, Banxia, Shaoyao, Zhishi, Gancao, Dahuang (wine-processed).
Biejia Yin (Li Zicai uses equal parts Red/White Heshouwu, decocted in wine): Baizhu, Chenpi, Caoguo, Chuanxiong, Shaoyao, Binglang, Huangqin, Houpo, Biejia, Gancao.
Liu Junzi Tang: Renshen, Baizhu, Fuling, Gancao, Chenpi, Banxia.
Dafupi Tang: Zhiqiao, Cangzhu, Binglang, Gancao, Sanleng, Pengze, Dafupi.
Caoguo Yin: Houpo, Qingpi, Caoguo, Huoxiang, Banxia, Dingxiang, Gancao, Ganjiang, Shenqu.