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The Materia Medica states that Rhizoma Anemarrhenae (Zhimu, 知母), Fructus Tsaoko (Caoguo, 草果), Fructus Mume (Wumei, 乌梅), and Squama Manis (Chuanshanjia, 穿山甲) are all indicated for the treatment of malaria. However, Rhizoma Anemarrhenae is cold in nature and treats the excessive fire of the Foot-Yangming Stomach Meridian, causing it to retreat and align with the Foot-Taiyang Bladder Meridian; Fructus Tsaoko is warm and drying, treating the excessive cold of the Foot-Taiyang Bladder Meridian, causing it to retreat and align with the Yangming Meridian. When these two herbs are combined, they prevent the alternation of Yin and Yang symptoms, thus serving as the Sovereign Drug (Jun Yao). Radix Dichroiae (Changshan, 常山) primarily treats cold-heat alternating malaria and expels phlegm knots from the chest, so it is used as the Minister Drug (Chen Yao). Radix Glycyrrhizae (Gancao, 甘草) harmonizes the various herbs, Fructus Mume eliminates phlegm, and Areca Seed (Binglang, 槟榔) removes phlegm accumulation and breaks stagnant Qi, so they are used as the Assistant Drugs (Zuo Yao). Squama Manis, due to its habit of dwelling in mountain burrows and entering water, symbolizes emerging from Yin into Yang; it penetrates the meridians to enter the Ying (Nutrient) level to break up pathogenic heat constrained by summerheat, thus serving as the Envoy Drug (Shi Yao). If the malaria is caused by phlegm-fluids stagnating in the Spleen and Stomach, this formula will be effective. However, if there is no phlegm, and the condition is merely summerheat constraining the Ying level, specifically corresponding to heat in the Blood level of the Foot-Taiyin Spleen Meridian manifesting as lip sores, this formula will be ineffective.

The *Neijing* discusses various diseases, but provides the most detailed account of malaria. Regarding pathogenic factors, Wind, Cold, Summerheat, and Dampness can all linger in the body and cause malaria. Regarding the location of pathogen invasion, there are distinctions between the Intestines and Stomach, the abodes of Ying and Wei (Defensive) Qi, the interspinous spaces, the membrane origins of the Five Zang Organs, and invasion into the Zang organs themselves, varying in depth. Regarding clinical manifestations, it distinguishes the sequence of cold and heat. Regarding the predominance of cold or heat, it relates to counter-seasonal illness responding to the growth, development, storage, and concealment of seasonal Qi. These are all caused by external pathogens. Dampness affecting the Zang organs results solely from Wind-Cold invading the Kidney. Dan Malaria (a type of malaria characterized by fever without chills) results solely from pre-existing heat in the Lung. However, if Winter Cold invades the Kidney, would the pathogenic Qi of the other four Zang organs not also invade their respective organs? Since heat in the Lung's intrinsic Qi can cause malaria, would heat generated by stagnation in the other four Zang organs not similarly cause malaria? This example illustrates the rest. Chen Wuyue stated that internal injuries from Seven Emotions, irregular diet, and sexual exhaustion can all lead to stagnation and accumulation of phlegm-fluids. When this pathogenic Qi combines with Wei Qi, malaria occurs. Essentially, both internal and external pathogenic factors reside in the abode of Ying Qi, which is why malaria has regular intervals of onset and remission. Ying Qi has its abode, much like travelers have relay stations. Ying and Wei Qi circulate once daily through the Five Zang Organs, Six Fu Organs, and Twelve Meridians, having distinct abodes. When the abode combines with the pathogen, Yin becomes excessive and Yang becomes deficient. Thus, Yin and Yang contend, and the disease manifests. During an attack, not only is the Wei Qi outside the vessels deficient and merging into Yin, but also the Foot-Yangming Stomach Meridian, which travels with Wei Qi as described in the *Lingshu*, becomes deficient. Deficiency of Yangming Qi leads to a temporary decline of Tianzhen (innate) Qi nourished by food and drink. Therefore, acupuncture is contraindicated during malaria attacks to avoid damaging Stomach Qi and True Qi. Treatment should wait until Yin and Yang extremes recede, and Ying, Wei, Tianzhen, and Stomach Qi recover, allowing the pathogen to remain in its location before intervening; or one may intercept the pathogen before the disease manifests. The Master said: When contracting the Four Pathogens initially, those with weak Stomach Qi fall ill immediately, while those with strong Stomach Qi harbor the pathogen without manifestation. Upon re-infection, severe damage to Stomach Qi triggers the disease. As an external pathogen, it must be resolved via sweating. For deficiency patterns, first strengthen the Stomach with Ginseng Radix (Renshen, 人参) and Atractylodis Macrocephalae Rhizome (Baizhu, 白术), then add herbs to induce sweating. Sweating is difficult in the lower extremities as they belong to Yin; sweating reaching the feet is ideal. Inducing sweat does not rely solely on Ephedrae Herba (Mahuang, 麻黄); any method that opens stagnation and unblocks meridians will dissipate pathogenic heat as sweat. Furthermore, malaria occurring after Zi hour and before Wu hour affects the Yang aspect and is easier to cure; occurring after Wu hour and before Hai hour affects the Yin aspect and is harder to cure. One must differentiate Yin and Yang, Qi and Blood to guide medication, and observe form and complexion. In my practice, I have followed this method. For robust patients with good complexion, the disease is in the Qi level; unblock meridians and open stagnation to induce sweat. For those with slightly sallow complexion, tonify deficiency to induce sweat. For cases with phlegm, first strengthen the Stomach for one to two days, then administer antimalarial drugs. For frail patients with withered complexion, do not induce sweat nor forcibly arrest malaria; instead, tonify and nourish, regulating through meridian unblocking. For robust patients with purple-black complexion, the disease is in the Blood level; resolve stagnation. For those with withered complexion, tonify Blood and regulate Qi. This is the general rule. However, if sweating fails to produce sweat, or blood regulation fails to open blood stasis, unless one seeks new medications that precisely address the pathology and reach the exact site of pathogen attachment, how can recovery be achieved?

An elderly man suffered from malaria and cough for half a year. His Chi pulses at both wrists were rapid and forceful, and his complexion was slightly sallow. He had previously taken Si Shou Yin (Four Beast Decoction) and similar formulas, leading to damp-heat in the Middle Jiao flowing downward and binding in the Kidney, causing Kidney Water to ascend to the Lung, resulting in simultaneous malaria and cough. After regulating the Middle Jiao with Ginseng Radix, Atractylodis Macrocephalae Rhizome, Scutellariae Radix (Huangqin, 黄芩), Coptidis Rhizoma (Huanglian, 黄连), Rhizoma Cimicifugae (Shengma, 升麻), and Bupleuri Radix (Chaihu, 柴hu) for one to two days, followed by Huangbai Wan (Phellodendron Pill) for two days, he dreamed of sexual intercourse. This indicated that Kidney Heat was resolving and dispersing through the anterior essence orifice. There was no need for worry; the next day, malaria and cough ceased abruptly.

A wealthy young man, strong in youth, suffered from malaria. His feet became cold from Mao hour, he developed fever by You hour, and it subsided at Yin hour, leaving him conscious for only one hour in a twenty-four-hour cycle. I reasoned this must be due to cold contraction after sexual activity. Inquiry revealed that in September, during a sudden cold snap at midnight, he rose hastily to catch a thief without wearing inner garments, causing his feet to turn cold immediately. Ten days later, malaria began. The Foot-Yangming Stomach Meridian and Chong Mai (Penetrating Vessel) converge at the Zongjin (major tendons) and intersect at Qichuan (the groin region). Excessive sexual activity depletes the Qi of both the Foot-Yangming and Chong Mai. Cold entered through this deficiency and lodged in these two meridians. These meridians pass through the shins and intersect at the dorsum of the foot. Consequently, Yang Qi in these meridians was further damaged and could not moisten and nourish the meridians, causing the disease to persist. I prescribed large doses of Ginseng Radix and Atractylodis Macrocephalae Rhizome to strongly tonify, along with Aconiti Lateralis Radix Praeparata (Fuzi, 附子) to promote meridian circulation and herbs to dispel cold and induce sweating. After several days, no sweat occurred, and the condition remained unchanged. I reasoned that the distance to the dorsum of the foot made it difficult for medicinal power to reach. I prepared a decoction of Atractylodis Rhizoma (Cangzhu, 苍术), Ligusticum Chuanxiong Rhizome (Chuanxiong, 川芎), and Peach Twig (Taozhi, 桃枝) in a high tub. Having him sit and soak his feet to the knees for the time it takes to eat a meal, he then drank the previously prepared medicine. Full-body sweating ensued, and the disease was cured. When encountering complex cases, the Master established principles, sought understanding through diverse approaches, and applied flexible strategies.