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Regarding the ancient methods for treating malaria (Malaria), if the disease has persisted for a long time with excessive sweating, leading to open pores (Couli) and an inability of Yang Qi to consolidate, tonification and astringency must be employed; if there is no sweating, it indicates that the pores are dense and the pathogenic factor cannot be resolved, so dispersing methods must be used. Therefore, it is said: For those with sweating, the goal is to stop sweating, focusing on supporting healthy Qi; for those without sweating, the goal is to induce sweating, focusing on dissipating pathogens. This is the general principle. Since malaria originates from external pathogens, it cannot be resolved without sweating. If one does not understand how to disperse and resolve the pathogen, but recklessly uses agents to forcibly arrest the malaria, it often results in injury to Stomach Qi, failure to resolve the pathogen, and consequently, difficulty in recovery. In such cases, tonifying formulas should be the primary treatment, adjusted to induce sweating, followed by nourishing supplementation after sweating occurs. If the pathogen resides in the Yin aspect, sweating is hardest to achieve in the lower body; when the power of the tonifying medicine reaches its destination, sweating naturally extends to the feet, which is a favorable sign. For those suffering from this condition where the pathogen remains unresolved, overeating is strictly contraindicated, as the ease or difficulty of sweating determines the quality of the outcome. When cold pathogens enter from the exterior, resolution occurs immediately upon sweating, as seen in conditions like Cold Damage (Shanghan). However, in epidemic febrile diseases (Wen Bing) and epidemic malaria, the depth of illness varies. For instance, in patients with epidemic febrile diseases, fever may persist despite profuse sweating. In malaria patients, repeated episodes and sweating may occur without cessation of the malaria, because the contracted pathogen is deep-seated, preventing immediate cure with just one or two instances of sweating, or even when the whole body is soaked with sweat, the pathogen may still not be fully expelled. In such cases, one must assess the patient's strength and weakness, and gradually induce sweating again to resolve the pathogen. Thus, one cannot assume that no pathogen remains after sweating. Differentiation should rely on whether the pulse is tight or not, and whether there is pain in the head and body, as well as the severity of chills and fever. Furthermore, there are cases where, although sweating has occurred and the pathogen is about to be resolved, non-compliance with dietary and lifestyle taboos—such as fatigue, sexual excess, exposure to cold/raw foods or mild pathogens, unclear Stomach Qi, or overeating—leads to immediate recurrence upon contact with triggers. This represents lingering old pathogens combined with new ones, resulting in chronic, entrenched, and persistent conditions. Such cases must still be treated via sweating, but the decision between consolidating and dispersing depends primarily on assessing deficiency and excess.

In treating malaria, one must understand the concepts of Root (Ben) and Branch (Biao). I have stated: treat the Branch if present, otherwise treat the Root; this is the crux of treating malaria. Why? The Branch refers to the pathogenic factor, while the Root refers to the healthy Qi. The struggle between pathogen and healthy Qi causes malaria. At the initial stage of malaria, the condition is due to excess pathogen, so treating the pathogen is undoubtedly correct. However, if exterior-dispersing treatments have already been applied, or if the disease persists chronically, differentiation between pathogen and healthy Qi becomes crucial. If pathogen is present, symptoms will be fierce and the pulse string-tight; headache may persist, or sweating may be incomplete. Any condition showing signs of excess indicates that exterior pathogen remains unresolved, regardless of duration. Even slight residual pathogen warrants concurrent treatment of the Branch. If sweating has been profuse, the pathogen is resolved and dispersed, and there are no signs or pulses of excess, yet the disease persists, it must be due to complete deficiency of healthy Qi, either from weak constitution or advanced age, leaving residual qi unexpelled and True Yin unsettled. In this case, one should focus exclusively on treating the Root; once Yuan Qi recovers, recovery is inevitable. Failure to distinguish Root and Branch, blindly attacking malaria regardless of the presence of pathogen, leads to significant harm. Although this discussion arises from malaria, the same principles apply to all diseases; the wise should keep this in mind.