Library

Whenever malaria first occurs, there is invariably chills and fever alternating. Generally, it belongs to the Shaoyang (Lesser Yang) channel disease. In the initial stage, treatment should focus primarily on dispersing pathogenic factors. If the patient's physical constitution and vital energy are undamaged, and the pulse and symptoms show no other abnormalities, only Zheng Chaihu Yin (Correct Bupleurum Decoction) or San Chaihu Yin (Three Bupleurum Decoction) should be used. For mild cases, one or two doses suffice; for severe cases, three or four doses will cure it without exception. If the patient's constitution was originally weak and contracted malaria due to pathogenic invasion, Si Chaihu Yin (Four Bupleurum Decoction) is excellent; do not refrain from using it simply because it is the initial stage.

1. When treating malaria, one must distinguish between chills and heat. Predominance of chills indicates a Yin syndrome (Yin Syndrome), while predominance of heat indicates a Yang syndrome (Yang Syndrome). There are differences in innate constitutional cold/heat and those acquired through external infection. However, only when both exterior and interior have heat pathogens is it considered a Fire syndrome (Fire Syndrome). If fever occurs only during the malaria attack and subsides when it stops, without internal symptoms such as irritability or constipation, it cannot be treated as a Fire syndrome. If there are Fire syndromes both internally and externally, yet the pathogen remains unresolved, Yi Chaihu Yin (One Bupleurum Decoction) should be used. If the pathogen has entered the Yangming (Yang Brightness) channel with severe internal heat but remains unresolved, Chaihu Baihu Jian (Bupleurum and White Tiger Decoction) is appropriate. If the pathogen has entered the Liver and Kidney channels, causing extreme heat that disturbs the blood, Chai Qin Jian (Bupleurum and Scutellaria Decoction) is indicated.

1. Malaria can present with Cold syndromes. If there is no deficiency pathogen, but merely cold pathogen that fails to disperse, or if there is significant middle-jiao cold, Er Chaihu Yin (Two Bupleurum Decoction) is suitable. If cold predominance is accompanied by Qi deficiency and the pathogen remains unresolved, Si Chaihu Yin (Four Bupleurum Decoction) or Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Ganjiang (Dried Ginger) and Guigui (Cinnamon Twig) should be used. If chills are severe with little heat, the pulse is slow, and there is aversion to cold on the back, or frequent vomiting, nausea, and diarrhea, Magui Yin (Ephedra and Cinnamon Decoction) or Da Wenzhong Yin (Great Warm the Middle Decoction) must be used.

1. If Spleen and Stomach Qi is weak and unable to overcome the pathogen, resulting in unresolved illness, the pathology lies in the Qi aspect of the Spleen and Lung. Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) or Wu Chaihu Yin (Five Bupleurum Decoction) is indicated. If Yin deficiency leads to insufficient Blood, preventing pathogen resolution, the pathology lies in the Essence aspect of the Liver and Kidney. Buyin Yiqi Jian (Nourish Yin and Augment Qi Decoction) or Guichai Yin (Angelica and Bupleurum Decoction) is indicated. This type of case is very common and responds particularly quickly. If during an attack the body feels as cold as ice and as hot as a branding iron, the face is red like grease, thirst exists with desire to drink water, but thirst ceases when the fever breaks, Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) added with Chaihu (Bupleurum Root), Shaoyao (Peony Root), and Rougui (Cinnamon Bark) in a large single dose can effect a cure. If Yuanqi (Original Qi) is extremely deficient and cold, with Yang unable to overcome Yin, Da Wenzhong Yin (Great Warm the Middle Decoction) is used. If Yuanqi is severely deficient, or in cases of old age and chronic debility, attacking the pathogen should be avoided; instead, tonifying healthy Qi is paramount. As long as Yuanqi does not collapse, the pathogen will submit. Dabu Yuanyuan Jian (Great Tonify Original Source Decoction) or Shiquan Dabu Tang (Ten Complete Great Tonification Decoction) are indicated. Among these, Xiumie Yin (Malaria-Restoring Decoction) is the most excellent.

1. After repeated dispersing treatments for malaria, excessive sweating occurs, yet the disease persists. This is due to over-damage of healthy Qi, where healthy Qi cannot overcome the pathogen. Even minor pathogens remain active. If the deficient Yuanqi is revitalized and dispersed Qi is gathered, immediate recovery is assured. Sanyin Jian (Three Yin Decoction), Wufu Yin (Five Blessings Decoction), Xiaoying Jian (Small Nourishing Decoction), or Xiumie Yin (Malaria-Restoring Decoction) are indicated. If there is slight cold, Daying Jian (Great Nourishing Decoction) or Lizhong Tang (Regulate the Middle Decoction) is suitable. If there is slight heat, Yiyin Jian (One Yin Decoction) is suitable. If sweating is profuse and uncontrolled, Wuyin Jian (Five Yin Decoction) is indicated.

1. Malaria that persists for a long time is due to dual deficiency of the Spleen and Kidney and failure of Yuanqi (Original Qi) to recover. If pulse and symptoms indicate minor unresolved pathogens, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) should be the primary treatment. If pathogens are cleared but malaria continues, pure tonification of Yuanqi is required, using Bazhen Tang (Eight Treasures Decoction), Shiquan Dabu Tang (Ten Complete Great Tonification Decoction), or Dabu Yuanyuan Jian (Great Tonify Original Source Decoction). If Kidney Yin is insufficient and Essence fails to transform into Qi, Liyin Jian (Regulate Yin Decoction) is most effective. If Yin pathogens are stagnant and persistent, add Jiang (Ginger), Gui (Cinnamon), and Fuzi (Prepared Aconite Root) to the previous formulas.

1. Vomiting and food aversion during malaria attacks are often attributed to Shaoyang (Lesser Yang) pathogens affecting the Stomach, but actually result from Wood (Liver) pathogens invading the Stomach. Resolving the exterior pathogen usually stops the vomiting spontaneously. Chaichen Jian (Bupleurum and Chenpi Decoction) or Zheng Chaihu Yin (Correct Bupleurum Decoction) added with Banxia (Pinellia Tuber) is indicated. If Spleen and Stomach Qi deficiency allows Cold pathogens to invade, leading to frequent vomiting and nausea, Wenwei Yin (Warm the Stomach Decoction), Lizhong Tang (Regulate the Middle Decoction), or Yangzhong Jian (Nourish the Middle Decoction) are indicated. If deficiency-cold extends to the Mingmen (Gate of Life), with Fire failing to generate Earth (Spleen/Stomach), causing vomiting, Liyin Jian (Regulate Yin Decoction) or Yougui Yin (Right Restoration Decoction) are indicated. If accompanied by food stagnation causing vomiting, abdominal fullness is likely; add Chenpi (Tangerine Peel), Sharen (Amomum Fruit), Shanzha (Hawthorn Fruit), and Houpo (Magnolia Bark) as assistants. If accompanied by Fire pathogens, heat-thirst, restlessness, and constipation occur; add Huangqin (Scutellaria Root) and Huanglian (Coptis Rhizome) as assistants. If Fire is severe in the Yangming (Yang Brightness) channel, add Shigao (Gypsum). If accompanied by Cold, cold sensation in the stomach region, acid regurgitation, belching of rotten smells, or nausea occur. Relief with warmth suggests adding Jiang (Ginger), Gui (Cinnamon), Fuzi (Prepared Aconite Root), and Wuzhuyu (Evodia Fruit) as assistants.

1. Malaria recurring immediately after exertion and persisting continuously indicates Spleen and Kidney deficiency. The Kidney governs bones, the Liver governs sinews, and the Spleen governs the four limbs. Weak Qi cannot withstand labor, triggering recurrence. Tonifying the Spleen, Liver, and Kidneys strengthens Qi and cures the disease. Shiquan Dabu Tang (Ten Complete Great Tonification Decoction), Bazhen Tang (Eight Treasures Decoction), and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) may be used酌情ly.

1. Excessive dispersing treatments for malaria often lead to Yin deficiency and fluid depletion, causing irritability, heat, and thirst. Watermelon juice, Xini Jiang (Sydney Pulp - *Note: Likely a specific local remedy or textual variant*), or Lengshen Tang (Cold Ginseng Decoction) can nourish Yin and arrest malaria. They should not be forced upon patients without heat signs.

1. When malaria and dysentery occur together with harmonious viscera and shallow pathogens, Weiling Tang (Stomach and Ping Decoction) added with 1-2 qian of Chaihu (Bupleurum Root) is indicated. If Cold-Dampness injures the Spleen causing simultaneous malaria and dysentery, Wenwei Yin (Warm the Stomach Decoction) added with Chaihu (Bupleurum Root), or Weiguan Jian (Stomach Gate Decoction) added with Chaihu (Bupleurum Root) is excellent. If Damp-Heat injures the Spleen, descending to the Liver and Kidney, causing acute watery diarrhea, heat-thirst, or passage of pure bright red blood, Chai Qin Jian (Bupleurum and Scutellaria Decoction) is indicated.

1. If malaria pathogens are not cleared and overeating injures the Spleen, causing persistent epigastric fullness and obstruction, Da Xiao Hezhong Yin (Large and Small Harmonize the Middle Decoctions) added with Chaihu (Bupleurum Root) is indicated. If food-induced malaria obstruction occurs, Shaoyao Zhizhu Wan (Peony and Immortelle Pill) and Da Xiao Hezhong Yin (Large and Small Harmonize the Middle Decoctions) are used for regulation. If the obstruction is formed and difficult to dissipate, moxibustion at Zhangmen (LR13) and Shuidao (ST28) acupoints is necessary. The moxa cones should be slightly larger, applied frequently, or continued for two to three sessions for complete recovery.

1. Ancient texts state: Regarding malaria treatment, when symptoms are about to start or are actively occurring, one must not forcibly apply treatment; even if done, it is ineffective. One must wait until Yin and Yang extremes pass, the situation stabilizes, and Qi recedes, then observe and treat. Alternatively, intercepting the pathogen two to three hours before onset is acceptable. The Classics say: "Before malaria starts, Yin has not merged with Yang, and Yang has not merged with Yin. Therefore, regulating it then allows True Qi to settle and Pathogens to perish." Thus, skilled physicians cannot treat already-onset malaria because Qi is reversed. According to this ancient method, it seems incorrect. In my recent practice, I intercept the pathogen while it is at its peak, which is fastest and most effective. This shows that ancient methods need not be rigidly adhered to.