Library

Dan-malaria (Febrile Malaria) is a syndrome described in the *Neijing* (Classic of Internal Medicine): "The lungs possess heat by nature, and qi is abundant throughout the body. Upon onset, yang qi becomes excessive and fails to recede, leading to emaciation and wasting of flesh; this is termed Dan-malaria." This occurs because the patient has a yang-constituted body suffering from a yang-type disease, which differs from other types of malaria. There are three treatment methods for this condition: If heat pathogen is accumulated internally while exterior pathogen remains unresolved, bitter-cool herbs should be used to disperse it; if heat arises due to pathogenic influence, and although the exterior is resolved, fire alone is rampant, bitter-cold herbs should be used to clear it. Both these approaches treat excess conditions. However, if although evil-fire is strong, qi and blood have already declined, and true yin is daily consumed, urgent measures to nourish water (yin) and consolidate yuan (original qi) are required. If one only knows how to purge fire, yin will perish day by day, inevitably leading to untreatable conditions.

Zhang-malaria (Miasma Malaria) occurs only in the miasma-prone regions of Lingnan. This is likely because wind-dampness in the south is irregular; when people contract this pathogen and become ill, it is named Zhang-malaria. However, miasma originates from earth qi, while malaria originates from heaven qi. If one knows internal regulation and prevention, and avoids external pathogens, what illness could there be even living in miasma regions? Thus, "zhang" refers to geography, whereas "malaria" is a disease of external contraction of wind-cold. Only in severe cases might confusion or aphonia occur, slightly differing from common malaria. Treatment generally adheres to principles of cold/heat, deficiency/excess, and presence/absence of pathogen, utilizing previous methods for treating malaria. For instance, Li Daizhao's detailed account of Zhang-malaria in the "Gate of Miasma" chapter must be carefully examined.

Zhang Zhongjing stated: "The pulse of malaria is naturally wiry (Xian). A wiry and rapid pulse indicates much heat; a wiry and slow pulse indicates much cold."

The *Jiyao* (Essentials of Mechanism) states: "Malaria can affect the Three Yang meridians or the Three Yin meridians, presenting distinct symptoms. When affecting the Taiyang meridian, it is called Han-malaria (Cold Malaria), treated mostly with sweating methods; when affecting the Yangming meridian, it is called Re-malaria (Heat Malaria), treated mostly with purgative methods; when affecting the Shaoyang meridian, it is called Feng-malaria (Wind Malaria), treated mostly with harmonizing methods. Disease in these Three Yang meridians is called Bao-malaria (Acute Malaria), occurring after Summer Solstice and before End of Heat, indicating shallow invasion. Disease in Yin meridians is collectively called Shi-malaria (Damp Malaria), discussed under the Taoyin meridian. It occurs after End of Heat and before Winter Solstice, indicating heavy invasion."

1. Ancient methods state: Use Qingpi Yin (Clear the Spleen Decoction) to treat regular autumn malaria, modifying according to symptoms, yielding great efficacy. If latent phlegm stagnates in the stomach, Caoguo Yin (Tsaiko Fruit Decoction) cures it in one dose.

Zhu Danxi said: "When pathogen penetrates deep into yin and blood levels, forming chronic malaria, uplifting and dispersing herbs must be used to move pathogen from zang to fu, then release via sweating. Using purgatives causes pathogen to sink deeper and become difficult to expel."

Fu Shi said: "Malaria is an external pathogen, to be resolved by sweating. If sweat cannot emerge, stagnation creates phlegm; one should nourish the stomach, resolve phlegm, and induce sweating. Once pathogen exits, harmony returns naturally."

Liu Zongnong said: "Someone asked: Why do common people consider malaria as 'Spleen Cold'? I replied: There is logic here. During summer, extreme heat prevails; humans harbor latent yin internally. The spleen becomes sluggish, the body weary, and pores open. Or, cooling off in pavilions or bathing in springs allows slight cold to lodge in muscles, as described in the classics regarding cold water oppression in summer. Or, labor and dietary injury trigger immediate onset. Since muscles belong to the spleen, chills and rigors upon onset lead to the name 'Spleen Cold.' Actually, wind-cold-damp-heat pathogens stagnate in the interstices. In summer, pores are open so no disease occurs; in autumn, when qi converges, exterior pathogens cannot vent, causing alternating chills and fever. The severity mimics tormenting parasites, hence the name 'Malaria.' Just as four-season cold injuries affect all twelve meridians, ancient formulas often address internal injury simultaneously. Harmonizing spleen and stomach unblocks essence and qi, reconciling yin and yang; this is truly not a spleen disease. However, ancients denied 'Spleen Cold' to prevent exclusive focus on warming the spleen, ignoring the source of creation and the importance of matching pathology with climatic appropriateness."

Xue Lizhai said: "Generally, malaria arises from initial summer-heat injury followed by wind contraction, lodging between Ying and Wei levels. With loose interstices, wind-cold closes pathways, preventing exit, settling outside the intestines and stomach, moving with Ying and Wei—daytime in Yang, nighttime in Yin. Conjunction causes illness; separation stops it. Joining Yang causes heat; joining Yin causes cold. Shallow involvement leads to daily attacks; deep involvement leads to alternate-day attacks. Qi-level onset is early; Blood-level onset is late. Symptoms of more heat than cold, irritability, and insomnia belong to the Heart, named Wen-malaria (Plague Malaria), treated with Chai Ling Tang. Symptoms of slight cold, less heat, lower back pain, and cold feet belong to the Kidney, named Han-malaria (Cold Malaria), treated with Guifu Erchen Tang. Initial chills followed by high fever and cough belong to the Lung, named Dan-malaria (Febrile Malaria), treated with Rensu Yin. Prolonged heat, short chills, and muscle spasms belong to the Liver, named Feng-malaria (Wind Malaria), treated with Xiao Chai Hu Tang plus Wuyao and Xiangfu. Equal chills and heat with vomiting of phlegm belong to the Spleen, named Shi-malaria (Food Malaria), treated with Qingpi Yin. If Middle Qi is deficient causing alternate-day attacks, use Buzhong Yiqi Tang. Severe chills and heat regardless of sequence indicate combined Taiyang-Yangming disease. Rigors during attacks confirm 'Heat dominance causes movement.' Fever causes sweating. If sweating fails to cure, internal heat is confirmed."

He further stated: "For chronic deficiency malaria with mild or absent chills and slight fever: if Stomach Qi is deficient, use Sijunzi Tang plus Shengma and Danggui; if Spleen Blood is deficient, use Sijunzi Tang plus Chuanxiong and Danggui; if Middle Qi sinks, use Buzhong Yiqi Tang plus Fuling and Banxia. Chronic malaria usually involves Yuan Qi deficiency and cold. Qi deficiency causes cold; Blood deficiency causes heat; Stomach deficiency causes aversion to cold; Spleen deficiency causes fever; descending Yin fire causes alternating chills and heat. Saliva spitting, anorexia, rigors, diarrhea, and cold extremities indicate Spleen-Stomach weakness; tonifying Middle Qi resolves all symptoms. For chronic malaria unresponsive to other drugs, add Banxia to Buzhong Yiqi Tang, using 1 liang of Renshen and 5 qian of roasted ginger. This achieves interception without forceful suppression, curing in one dose. For long-standing illness, major tonification of Yuan Qi is primary, as nurturing righteousness eliminates pathogen."

Xu Donggao said: "Malaria is mostly caused by wind-cold-summer-heat-dampness, injuring Heaven's pathogenic qi, requiring resolution through sweating. Thus, Zhang Zhongjing and Liu Hejian all used releasing-surface herbs, differentiating treatment based on channel involvement determined by the degree of cold and heat."