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(Yan Yonghe) Treats *Dan Nue* (Cachectic Malaria), characterized by a wiry and rapid pulse, fever without chills. Or, more heat than cold, chest fullness with anorexia, bitter taste in the mouth, dry tongue with restlessness and thirst, red and scanty urine, and difficult defecation.

Qingpi (Green Tangerine Peel), Houpo (Magnolia Bark, vinegar-fried), Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix, stir-fried), Banxia (Pinelliae Rhizoma, ginger-processed), Fuling (Poria), Baizhu (Atractylodis Macrocephalae Rhizoma, soil-stir-fried), Gancao (Licorice Root, honey-roasted), Caoguo (Tsaoko Fructus).

(Commentary:) *Nue* (Malaria) is caused by pathogenic factors of the Liver and Gallbladder, yet it often arises due to injury to the Spleen and Stomach. The Spleen belongs to Wet Earth; when heavily affected by Summerheat-Dampness, the aforementioned symptoms appear. Once the Spleen is diseased, Wood overacts on Earth (Liver Qi invades Spleen); therefore, Fuling (Poria) is used to leach out Dampness, and Huangqin (Scutellariae Radix) to clear Heat. Caoguo (Tsaoko Fructus) is pungent and hot; it can disperse accumulated Cold in the Taiyin (Spleen) channel, eliminate Phlegm, and arrest malaria. (It can clear Phlegm generated from rich dietary intake.) This implies first removing the factor harming the Spleen, and then using Baizhu (Atractylodis Macrocephalae Rhizoma) and Gancao (Licorice Root) to regulate and tonify it. [This formula is a modification of Xiao Chai Hu Tang (Minor Bupleurum Decoction), representing a shift from formulas that warm the Spleen. Zhang Zihe said: "Physicians of the world consider malaria as Spleen Cold; severe cases are attributed to demonic influence, which is truly laughable." Liu Zongnong said: "In the height of summer when Yang is at its peak, Yin lies hidden within. If people seek coolness or bathe, Cold pathogens lodge between the muscles; or if there is irregular eating or overexertion, internal injury occurs and disease manifests. Muscles belong to the Spleen; upon onset, there is aversion to cold and shivering, hence it is called 'Spleen Cold.' In reality, it is due to Wind-Cold-Damp pathogens stagnating in the cou-li (interstices). In summer, when pores are open, no disease occurs. But in autumn, when Qi converges, exterior pathogens cannot be vented, leading to alternating progression and regression, with alternating chills and fever, resembling the torment of malaria patients, thus named 'Malaria.' Ancient formulas often address internal injury simultaneously, aiming for harmony of the Spleen and Stomach, unobstructed Jing-Qi, reconciliation of Yin and Yang, and dispersion of all pathogens; this is actually not a disease of the Spleen itself. People use methods such as releasing the exterior and resolving the muscle layer, warming meridians and dispersing Cold, often sticking rigidly to drying-Spleen and expelling-Phlegm agents. Wu Hegao said: 'Qing Pi' does not mean cooling; rather, it means attacking and removing pathogens so that the Spleen region becomes clear. He ridiculed this formula because of the pungent-hot nature of Caoguo. This shows he did not grasp the subtlety of Yan's prescription. Gao Gugeng said: 'There are many methods for treating malaria, none hitting the mark, except this formula, which is perfectly balanced. I use this formula with modifications every time, and there is never a failure. Generally, the chills and fever of malaria originate in Shaoyang (Lesser Yang), half-exterior and half-interior. A wiry and rapid pulse indicates... Houpo (Magnolia Bark) widens and eliminates stagnation in the Stomach; Caoguo (Tsaoko Fructus) transforms Phlegm and removes obstruction; Fuling (Poria) and Baizhu (Atractylodis Macrocephalae Rhizoma) strengthen the Spleen Qi.']

Although malaria is indeed caused by external contraction, it must involve internal injury before the external pathogen can invade; this is the profound insight of Li Dongyuan. In Yan's original formula, I often substitute Cangzhu (Atractylodis Rhizoma) for Baizhu (Atractylodis Macrocephalae Rhizoma) and add Chenpi (Citri Reticulatae Pericarpium) to align with the intent of Pingwei San (Regularize the Stomach Powder). For cases with more heat than cold, adding slightly Qianhu (Peucedani Radix) to vent latent Heat yields immediate results. By examining these details and adjusting accordingly, how could one err? For those who have taken decoctions incorrectly and suffered long-term illness, one should not rigidly adhere to this as an immutable method; this requires practitioners to understand it spiritually and clearly. Use Renshen Yangwei Tang (Ginseng Decoction to Nourish the Stomach) to nourish them. For those who have taken too many hot medicines, still use Xiao Chai Hu Tang (Minor Bupleurum Decoction) with added Huanglian (Coptidis Rhizoma) and Danpi (Moutan Cortex) to rescue them. For malaria manifesting at night, use Yimucao Yin (Motherwort Decoction) to assist it. (Yimucao Yin, also known as...) [The text contains gaps/typos here, logical completion based on context]. The purport must not be detached.]