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The *Classic of Difficult Issues* (Jing Yun) states: "If injured by summerheat in summer, malaria will inevitably occur in autumn." This refers to contracting summerheat pathogen during the summer months. If severe, one immediately suffers from summerheat disease; if mild, the pathogen resides in the Ying (Nutrient) level. Upon re-exposure to the cool wind of autumn, the pathogen dwells together with the Wei (Defensive) Qi. Thus, summerheat combines with wind-cold pathogens, resulting in malaria. Zhang Jingyue stated: "Nue" (Malaria) is synonymous with "Nüe" (Tyrannical), a general term for all types of malaria; "Nüe" implies the meaning of bullying or tormenting. Malaria is not a single entity but comprises various types that must be differentiated and treated. Ancient texts mention names such as Shu Nue (Summerheat Malaria), Feng Nue (Wind Malaria), Han Nue (Cold Malaria), Shi Nue (Dampness Malaria), Wen Nue (Warmth Malaria), Zhang Nue (Miasma Malaria), Dan Nue (Intense Heat Malaria), Pin Nue (Yin Malaria), Tan Nue (Phlegm Malaria), Shi Nue (Food Stagnation Malaria), Yi Nue (Epidemic Malaria), Gui Nue (Ghost Malaria), Xu Nue (Deficiency Malaria), Lao Nue (Exhaustion Malaria), Nu Mu (Malarial Mass), and San Ri Nue (Every-Third-Day Malaria). These must be distinguished and treated clinically.

Shu Nue (Summerheat Malaria) presents with aversion to cold and high fever, irritability, thirst, and a desire to drink. Feng Nue (Wind Malaria) presents with less aversion to cold and more heat, headache, and spontaneous sweating. Han Nue (Cold Malaria) presents with a longer duration of cold and shorter duration of heat, headache, and absence of sweating. Shi Nue (Dampness Malaria) presents with heavy cold and light heat, and generalized body pain. Wen Nue (Warmth Malaria) presents with heat preceding cold, caused by latent pathogens from winter. Zhang Nue (Miasma Malaria) presents with confusion and drowsiness upon onset, caused by inhaling mountain miasma. Dan Nue (Intense Heat Malaria) presents with isolated heat without cold. Pin Nue (Yin Malaria) presents with more cold than heat. Additionally, headache with vertigo and coma during attacks are termed Tan Nue (Phlegm Malaria). Alternating cold and heat with belching and anorexia are termed Shi Nue (Food Stagnation Malaria). Epidemics affecting households and regions with similar symptoms are termed Yi Nue (Epidemic Malaria). Daily alternating cold and heat accompanied by fear are termed Gui Nue (Ghost Malaria). Malaria contracted due to underlying Yuan Qi deficiency is termed Xu Nue (Deficiency Malaria). Malaria recurring upon exertion after long illness is termed Lao Nue (Exhaustion Malaria). A mass forming in the hypochondrium and abdomen after years of non-healing is termed Nu Mu (Malarial Mass). Malaria occurring every other day due to pathogen lodging in the Fu organs amidst underlying Zheng Qi deficiency is termed San Ri Nue (Every-Third-Day Malaria). Furthermore, there is "Fu Shu" (Latent Summerheat), which resembles malaria but is not it; it occurs in autumn due to summerheat contracted in summer and is difficult to cure quickly. If autumn is hot like summer but there is no latent pathogen internally, and symptoms resemble Yang Shu (Yang Summerheat), it is named Qiu Shu (Autumn Summerheat). These two conditions occur in autumn and are discussed here to prevent misdiagnosis as malaria.

Shu Nue (Summerheat Malaria) often arises from seeking coolness during late summer, contracting Yin Shu (Yin Summerheat). When summerheat sweat does not emerge, the pathogen lies latent within. It remains until autumn, when exposure to cool air triggers its manifestation. Ancients stated: The latent summerheat is Yin Qi; the external binding of autumn coolness is Yin Pathogen. The new pathogen dwells with Wei Qi, combining internally with latent summerheat, causing Yin and Yang to contend and malaria to arise. Symptoms include aversion to cold and high fever, thirst with desire to drink, a wiry pulse, or surging or soft pulses. Patients may feel irritable when clothed and shiver when unclothed. The skin has no sweat; fever subsides only after profuse sweating. Treatment should employ methods to clear the Ying level and intercept malaria. For severe thirst, add Maidong (Ophiopogonis Radix) and Huafen (Trichosanthis Radix). Malaria occurring on consecutive days indicates shallow disease; every other day indicates deeper disease; every third day indicates even deeper disease. Attacks occurring progressively earlier indicate mildness, as Zheng Qi overcomes and expels the pathogen outward; attacks occurring progressively later indicate severity, as the pathogen overcomes and moves inward. Initial stages are mostly excess patterns, prioritizing pathogen expulsion; chronic stages are mostly deficiency patterns, prioritizing nourishing Zheng Qi. Physicians must differentiate depth, severity, excess/deficiency, and acuity/chronicity to ensure effective treatment.

Zhang Jingyue said: Regarding malaria caused by summerheat injury, what is meant by Yin Pathogen? Generally, Yang Shu (Yang Summerheat) damages Qi, presenting with sweating, immediate onset upon contraction, and inability of the pathogen to remain. What remains lodged is only Yin Shu (Yin Summerheat), because it involves absence of sweating. Therefore, those suffering from malaria invariably do so because, during peak summer, they sought coolness recklessly, failed to avoid wind and cold, bathed in cold water, swam in rivers, or consumed excessive raw/cold foods. Robust individuals cannot harbor the pathogen and may not become ill; frail individuals harbor it in Ying and Wei levels and inevitably suffer. However, exogenous cold invasion typically causes malaria, while endogenous cold injury typically causes dysentery. If one guards against these two factors, how would malaria and dysentery arise?