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The syndrome of Damp Malaria (Shi Nue) arises from prolonged exposure to yin-dampness, with dampness lying latent in the Taiyin Spleen meridian, and erupting upon occasional stimulation. Upon eruption, it manifests as aversion to cold without significant fever, a slow and dull pulse rather than a taut one, generalized body pain accompanied by sweating, heaviness in the hands and feet, nausea, vomiting, abdominal distension, and fullness. The common term "Spleen Cold" (Pi Han) generally refers to this syndrome. For this condition, the method of Ventilating and Permeating the Membrane Source (Xuan Tou Mo Yuan Fa) is appropriate to resolve the pathogen and eliminate the malaria. However, acrid and drying agents must be used with caution in patients with Yin deficiency and internal heat. In patients with Yang deficiency and a cold constitution, aged cardamom (Lao Kou) and dried ginger (Gan Jiang) may be added. Methods intended to abruptly arrest malaria attacks should not be employed prematurely; otherwise, they may lead to abdominal distension resembling drumming (Peng Gu) or the formation of a malaria mass (Nue Mu). There are many types of malaria, all of which should be treated according to specific differentiation.

Jiang Cheng stated: Cold Malaria (Han Nue) occurs because cold water lies latent in the muscle-cou li (skin and interstices), while Damp Malaria occurs because dampness lies latent in the Taiyin. These two types of malaria occur in both summer and autumn, unlike Summerheat Malaria (Shu Nue) and Wind Malaria (Feng Nue), which are contracted in summer but manifest in autumn.

The Classics state: Warm Malaria (Wen Nue) results from contracting wind-cold during winter, where the pathogen lies latent in the bone marrow. It does not erupt in spring. When summer arrives, Yang Qi dissipates significantly, the cou li become open, or physical exertion causes the latent pathogen to exit along with sweat. This pathogen, stored in the Kidney, moves from the interior to the exterior. Such cases involve Yin deficiency and Yang excess; Yang excess generates heat. When the Yang Qi declines, it re-enters the interior; interior entry leads to Yang deficiency, which generates external cold. It is also stated: Injury by wind first, followed by injury by cold, results in high fever first and then chills. This occurs at regular intervals and is named Warm Malaria. The syndrome of Warm Malaria features fever preceding chills. The pulse is floating on the Cun (superficial) position and weak on the Chi (deep) position. There may be profuse sweating or scanty sweating, thirst with a preference for cool drinks. The treatment principle is to clear heat and vent the pathogen using a cooling method (Qing Liang Tou Xie Fa). If sweating is profuse, remove Tan Dou Chi (Lightly Fermented Soybean) and add Mai Dong (Ophiopogon Root) and Hua Fen (Trichosanthes Root). If the tongue coating turns scorched black, the method of clearing heat and preserving fluids (Qing Re Bao Jin Fa) is indicated. Jiayan stated: In treating Warm Malaria, one must understand nourishing Water to rescue Yin. Otherwise, after numerous paroxysms, Yin Essence may be exhausted; if exhausted, True Fire will burn itself out, leading to death shortly. This aligns with Xiangyan’s theory on protecting Yin constantly when discussing Warm Diseases (Wen Bing). For any variant syndromes, one may refer to the methods found in the sections on Spring-Warmth (Chun Wen), Wind-Warmth (Feng Wen), Warm Disease (Wen Bing), and Warm Toxin (Wen Du).

A question was raised: Since Warm Malaria is contracted in winter and manifests in summer, why is it not listed under the category of Warm Diseases, or appended after Heat Diseases? What is the rationale for its current placement? The answer is: Regarding the character "Warm," it should be listed there; regarding the character "Malaria," it should be attached here. This is done to enable students to recognize that various malarial syndromes differ: some feature fever preceding chills, others chills preceding fever, some have more cold than heat, some have less cold than heat, and some present with fever only without chills. Another question arose: The *Jin Gui Yao Lue* discusses Warm Malaria, stating there is no cold, only heat. Yet your discussion mentions fever preceding chills. Does this contradict Zhang Zhongjing? The response is: Fever preceding chills follows the teaching of the *Huang Di Nei Jing*. The statement in the *Jin Gui Yao Lue* about "no cold, only heat" is likely a transcription error. One must not fail to distinguish that fever only without chills constitutes Dan Malaria (Dan Nue).