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The etiology and syndromes of malaria (Nüe, 疟) are recorded most comprehensively in the *Suwen: Malaria Chapter* (*Suwen Nuelun*) and the *Acupuncture for Malaria Chapter* (*Cimaelun*). Later generations, adhering to partial inheritances, caused the original meaning of the classics to be obscured, resulting in numerous errors and fallacies.

Those who investigate etiology often neglect syndromes, while those confined to syndromes fail to understand etiology; those who know the constant but do not reach the variable, and those who follow the variable but abandon the constant. Little do they know that only with a specific etiology does a corresponding syndrome arise. Once the etiology and syndrome are manifest, the constant methods are already established, and only then can one discuss adapting to changes. If someone is confused by constant methods and cannot distinguish etiology and syndrome, mistaking cold for heat, heat for cold; deficiency for excess, excess for deficiency; this causes mild conditions to become severe, and severe conditions to become critical. The transformation continues endlessly year after year, making it impossible to predict life and death. Mr. Fang Ruxian happened to ask about this matter, so I briefly record a few words for correction.

Malaria is generally called "Jie" (Jie, 痎). "Jie" refers to the simultaneous occurrence of cold and heat in autumn, which is when the "Jie" occurs and Metal Qi is latent. Sub-names include "Jie" and "Nüe". "Nüe" refers specifically to the cruel tyranny of Fire overcoming Metal, occurring daily and resting daily. "Jie" refers to发作 every other day or every few days, where the pathogen has deeply entered the Yin aspect. These all result from summer injury by summerheat (Shu, 暑), where hot Qi is abundant and hides within the skin, outside the stomach and intestines, between the Mu Yuan (Gates of the Original Qi) and the Six Fu organs. If the pathogen lodges in the head and neck, or shoulders, back, hands, and feet, it hides within the skin; if it lodges in the chest and hypochondrium, or abdomen, it also hides within the skin, or outside the stomach and intestines, or at the Mu Yuan, or between the Six Fu organs. These are all places where Ying Qi (Nutritive Qi) resides. This is because Summer Qi connects with the Heart, and the Heart governs the Qi of Ying and Blood. The Classic states: "Among those that nourish the body, none is more precious than the Jing Sui (Meridian Channels)." Therefore, the pathogen does not pour into the Jing Sui but flows into the She (Lodging Places). The She refers to the boundaries passed by the Jing Sui; wherever there is a boundary, there must be a She. It is like travelers having relay stations.

This summerheat causes sweat pores to be open and疏 (sparse), and Cou Li (interstices) to be open, because summerheat nature is warm and dispersing, causing the Cou Li to open but not close immediately. Those who do not get sick immediately are in the season when Summer Yang moves from inside to outside. Wei Qi (Defensive Qi) relies on this to defend against pathogens. When encountering Autumn Qi, the mechanism of balance has turned from outside to inside. The remaining summerheat keeps the sweat pores open and Cou Li open. Wind then follows and enters, or due to bathing, Water Qi lodges inside the skin, dwelling together with Wei Qi. Wei Qi travels through Yang during the day and Yin at night. Wind and Water Qi, following Wei Qi, go out with Yang and enter with Yin. Internal and external conflict results in daily attacks. Thus, when Wei Qi arrives, the Cou Li must open; when open, Wind and Water Qi pathogens enter, and upon entry, the disease manifests. When Wei Qi and the Qi of the Three Yang merge into Yin, at this time Yang is deficient and Yin is excessive, with no Qi on the exterior, hence chills occur first. When Wei Qi is deficient, hair stands erect and yawning occurs; when Yangming is deficient, chills cause jaw trembling; when Taiyang is deficient, pain occurs in the lower back, back, head, and neck; when the Three Yang are all deficient, Yin Qi prevails. When Yin Qi prevails, bones feel cold and painful, cold originates internally, so both interior and exterior are cold. In severe cases, boiling water or fire cannot warm, and the pulse is quiet and slow.

The reason Shaoyang syndromes are not listed is that Taiyang is the Opening, Yangming is the Closing, and Shaoyang is the Pivot. The ability of the Opening to open and the Closing to close depends on the Pivot turning. If the Pivot is abandoned, there is no Opening or Closing. Without Opening and Closing, the Pivot cannot be found. Therefore, if Opening and Closing collapse, how can the Pivot remain alone? If the image of the Pivot appears, it means Opening and Closing are holding each other; thus, holding implies both hold, collapsing implies both collapse. When the Three Yang all collapse, Yin Qi rebels. When Yin Qi rebels to the extreme, it re-emerges into Yang. Yang and Yin both gather externally, leading to Yin deficiency and Yang excess. Yang excess causes external heat, Yin deficiency causes internal heat; both interior and exterior are hot, causing panting and thirst. In severe cases, cold water cannot cool, and the pulse is active and rapid. This is the mutual struggle of Yin and Yang above and below, alternating deficiency and excess, and the shifting of Yin and Yang. At the extreme, both Yin and Yang decline, and Wei Qi separates, so the disease rests. When Wei Qi gathers again, the disease recurs.

Variations in the timing of attacks (early or late) occur because the pathogen lodges in Fengfu (GV16). Wei Qi meets at Fengfu once a day and night, descending along the spine, moving down one segment daily, reaching the sacrum in twenty-one days. Thus, attacks occur progressively later. On the twenty-second day, it enters the spine, pours into Fulu, ascends, and emerges from Quepen (CV15) after nine days, rising higher, so attacks occur progressively earlier. Attacks not occurring at Fengfu are called "pathogen striking different locations," so they are not necessarily at Fengfu. For example, if struck in the head and neck, the attack occurs when Qi reaches the head and neck; if struck in the shoulders and back, when Qi reaches there; if in the waist and spine, when Qi reaches there; if in the hands and feet, when Qi reaches there; if in the chest and abdomen, when Qi reaches there. Thus, where Wei Qi is located and combines with the pathogen, the disease manifests. Therefore, Wind has no fixed Fengfu; the place where the pathogen combines is its Fengfu.

As for Jie occurring every other day or several days, the Qi lodging is deep. It presses inwardly on Yin, Yang Qi alone erupts, Yin Qi attaches internally. Yin and Yang struggle and cannot exit, hence occurring every other day or several days. Occurring every other day means the pathogen presses inwardly on the Five Zang organs and horizontally connects to the Mu Yuan. Occurring every several days means the pathogen and Wei Qi lodge in the Six Fu organs, sometimes losing contact and failing to interact, hence resting for several days before attacking. However, the Fu organ struck is the She of the Mu points of various meridians, and one should observe the syndromes of these Mu points. For example, if lodged in Foot Taiyang, it additionally causes heavy head, low back pain, cold starting from the back, chills followed by fever,翕翕 (warmth), and difficult-to-stop sweating after fever subsides. If lodged in Foot Yangming, it additionally causes shivering chills, severe cold, followed by heat after a long time, and comfort upon exposure to sunlight or fire when sweating. If lodged in Foot Shaoyang, it additionally causes flaccid body, mild chills and heat, aversion to people, palpitations, prolonged heat, and profuse sweating. If lodged in Foot Taiyin, it additionally causes unhappiness, frequent sighing, anorexia, alternating chills and heat, profuse sweating, nausea upon onset, and relief after vomiting. If lodged in Foot Shaoyin, it additionally causes severe vomiting, alternating chills and heat (more heat than chills), desire to stay behind closed doors, and difficulty in recovery. If lodged in Foot Jueyin, it additionally causes lumbar pain, fullness in the lower abdomen, frequent urination resembling strangury but not strangury, fear, Qi insufficiency, and oppression in the abdomen. If lodged in Lung Mu, it additionally causes cold heart, severe cold then heat, palpitations during heat intervals, and hallucinations. If lodged in Heart Mu, it additionally causes severe mental restlessness, desire for cold water, more chills, and mild heat. If lodged in Spleen Mu, it additionally causes cold, abdominal pain, bowel sounds during heat, and sweating after sounds cease. If lodged in Liver Mu, it additionally causes pale/greenish complexion, sighing, and a state resembling death. If lodged in Kidney Mu, it additionally causes shivering chills, lumbar and spinal pain, rolling over, difficult defecation, blurry vision, and cold hands and feet. If lodged in Stomach Mu, it additionally causes hunger but inability to eat, and abdominal distension after eating. This details only the Foot meridians, not the Hand meridians, because the Classic states: "Wind, cold, summerheat, and fire are the Yin and Yang of Heaven; the Three Yin and Three Yang receive them from above." Also, pathogens do not invade the Zang; listing Zang syndromes refers not to the true Zang storage but to the Qi transformation syndromes of the Zang Mu.

There are also Wen Nüe (Warm Malaria), Han Nüe (Cold Malaria), Dan Nüe (Fever Malaria), and Pin Nüe (Yin Malaria). Wen Nüe is the type with heat preceding chills. It divides into two types. First, summer injury by summerheat, autumn injury by wind, followed by winter injury by cold. Summerheat is internal, wind is middle, cold is external. Thus, wind and cold alternate up and down. It does not involve the summerheat in the Ying She because the situation is bifurcated, making tri-directional movement difficult. The initial heat is because wind is a Yang pathogen, so it exits outward and follows cold upward, winning externally, hence heat first. Reversing, it re-enters inward and follows wind downward, losing externally, hence cold later. Second, syndromes involving brain marrow consumption and muscle wasting, also heat preceding chills, named Wen Nüe. This is winter injury by cold wind, hiding in bone marrow. Winter Qi connects with Kidney, and Kidney stores bone marrow Qi. In spring, Yang Qi erupts greatly, but the pathogen cannot exit itself. Encountering great summerheat, Cou Li opens, or due to exertion, pathogen and sweat exit together, moving from inside to outside. This leads to Yin deficiency and Yang excess, hence heat first. As Qi declines, it re-enters, leading to Yang deficiency, hence cold later.

Han Nüe is the type with chills preceding heat. It is also summer injury by great summerheat, profuse sweating, open Cou Li. Encountering cold water of autumn chill, it hides in Cou Li and skin. Autumn injury by wind completes the disease. Injury by cold water first, then wind, hence chills first, then heat. Summerheat is internal, situation is bifurcated, only this one type exists.

Dan Nüe is the type with heat only, no chills. It also divides into two types, both internal causes. First, Yin Qi is exhausted first, Yang Qi erupts alone, causing shortness of breath, vexation, hot hands and feet, and nausea. Because Yang is heat, requiring no external pathogen, resembling summerheat, hence no chills. Second, Lungs have inherent heat, Qi is abundant in the body, rebellious Qi rushes upward, Middle Qi is full but does not vent outward. Due to exertion, Cou Li opens, wind and cold lodge in skin and muscle layers. Upon eruption, Yang Qi becomes abundant. If Yang Qi remains abundant without declining, disease occurs. It does not reach Yin, hence heat only, no chills. Its Qi hides internally in the Heart and externally in muscle layers, causing muscle wasting. This uses lung heat resembling summerheat as internal cause, and wind/cold as external cause.

Pin Nüe is the type with cold only, no heat. Summer injury by summerheat, autumn injury by wind. But Yang Qi sinks alone, unable to lift Yin from below to above. Yang is effectively empty/deficient, Yin remains full. This supplements the omissions in Zhang Zhongjing's Malaria Treatise, based on the principle that where there is Dan, there must be Pin.

For those attacking according to the four seasons, syndromes differ slightly from constant methods. Autumn attacks have severe chills; winter attacks have mild chills; spring attacks have aversion to wind; summer attacks have profuse sweating. If contracted in winter but manifesting in summer, hidden in Heart but showing in Lungs, although similar to seasonal variation, this transcends constant methods regarding internal/external differentiation of Wen and Dan. Above roughly discusses the constants of the two treatises, arranged in order.

The Classic only lists acupuncture methods, treating before malaria onset, when Yang has not merged with Yin and Yin has not merged with Yang, thereby regulating. True Qi recovers, pathogen vanishes. Therefore, bind the area firmly before onset to prevent pathogen entry and Yin egress. Observe carefully; take all Sun Luo (Branch Collaterals) that are full, hard, and bloody. If lodged in Foot Taiyang, puncture Jinmen (BL64). Jinmen is in the lateral malleolus, insert 3 cun (same-body inch), this is the divergent branch of Yang Wei Mai. If lodged in Foot Yangming, puncture Chongyang (ST42), on the dorsal pedal artery, 3 cun from Xangu (ST43), insert 3 cun, retain 10 breaths, this is the Yuan Source point of Foot Yangming. If lodged in Foot Shaoyang, puncture Xiaxi (GB43), between the metatarsals of the second and third toes, midpoint of the proximal phalanx, insert 3 cun, retain 3 breaths, this is the Ying Spring point of Foot Shaoyang. If lodged in Foot Taiyin, puncture Gongsun (SP4), 1 cun posterior to the base of the big toe, insert 4 cun, retain 7 breaths, this is the Luo Connecting point of Foot Taiyin. If lodged in Foot Shaoyin, puncture Taizhong (KI4) or Taixi (KI3). Taizhong is posterior to the medial malleolus, insert 2 cun, retain 7 breaths, this is the Luo point of Foot Shaoyin; Taixi is posterior to the medial malleolus on the heel bone, in the depression of the artery, insert 3 cun, retain 7 breaths, this is the Shu Stream point of Foot Shaoyin. If lodged in Foot Jueyin, puncture Taichong (LR3), 2 cun posterior to the base of the big toe in the depression, insert 3 cun, retain 1 breath, this is the Shu Stream point of Foot Jueyin. If lodged in Lung Mu, puncture Lieque (LU7) and Hegu (LI4). Lieque is 1.5 cun posterior to the wrist crease, insert 3 cun, retain 3 breaths, this is the Luo point of Hand Taiyin; Hegu is between the metacarpals of the thumb and index finger, insert 3 cun, retain 6 breaths, this is the Jing-River point of Hand Yangming. If lodged in Heart Mu, puncture Shenmen (HT7), in the depression at the radial end of the pisiform, insert 3 cun, retain 7 breaths, this is the Shu Stream point of Hand Shaoyin. If lodged in Spleen Mu, puncture Shangqiu (SP5), in the depression anterior and inferior to the medial malleolus, insert 3 cun, retain 7 breaths, this is the Jing-River point of Foot Taiyin. If lodged in Liver Mu, puncture Zhongfeng (LR4) until bleeding, 1.5 cun anterior to the medial malleolus in the depression, take with foot dorsiflexed or plantarflexed, insert 4 cun, retain 7 breaths, this is the Jing-River point of Foot Jueyin. If lodged in Kidney Mu, puncture Taizhong and Taixi, method as Foot Shaoyin example. If lodged in Stomach Mu, bleed the transverse vessels of Foot Yangming and Taiyin; Lidui (ST45), Jiexi (ST41), and Zusanli (ST36) all govern. Lidui is at the tip of the second toe, remove nail like leek leaf, insert 1 cun, retain 1 breath, this is the Jing Well point of Foot Yangming; Jiexi is 3.5 cun posterior to Chongyang, in the depression of the ankle, insert 5 cun, retain 5 breaths, this is the Jing-River point of Foot Yangming; Zusanli is 3 cun below the knee, lateral to the tibia, between the tendons, insert 1 cun, retain 7 breaths, this is the He-Sea point of Foot Yangming. These twelve malarias attack at different times. Observe the syndrome form to know the lodging place, then know when Wei Qi gathers. Puncture as if a meal has passed before onset. One puncture reduces, two punctures show effect, three punctures cure. If not cured, bleed the two vessels under the tongue; if still not cured, bleed the full vessels at Jinmen; if still not cured, puncture the vessels below the neck flanking the spine, must cure. The two vessels under the tongue are Lianquan (CV23). If no time to examine lodging, first ask where the disease started and puncture there. If headache and heaviness start first, puncture Shangxing (GV23), Baihui (GV20), Xuanlu (GB5) at temples, and Cuanzhu (BL2) between eyebrows until bleeding. If neck/back pain starts first, puncture Fengchi (GB20), Fengfu (GV16), Dazhu (BL11), Shendao (GV11) until bleeding. If low back/spine pain starts first, puncture Jinmen until bleeding. If arm/hand pain starts first, puncture Hand Shaoyin and Yangming, bleed between ten fingers. If sweating and aversion to wind start first, it is Wind Malaria, bleed the Back-Shu points of the Three Yang meridians. If marrow soreness/pain is severe and unpressable, it is Marrow Disease, use a Jian needle (镵针) to puncture Jiegu (GB39), bleed to stop immediately. Or at the start of malaria, when body feels cold, first puncture Jing and Shu points of Hand Yangming/Taiyin and Foot Taiyin/Yangming. When body feels hot, puncture the dorsal pedal artery, open the aperture, bleed, this is the Yangming vessel. If malaria pulse is full, large, and urgent, puncture Back-Shu and Wu Shu (Wei Zhong BL40), use medium needle, one each, adjust for fat/thinness, bleed. Back-Shu refers to Dazhu; Wu Shu refers to Weizhong. If pulse is small, solid, and urgent, moxa Fuliu (KI7) on the leg, 2 cun above medial malleolus in depression, 5 moxa cones, this is Foot Shaoyin vessel; also puncture Zhiyin (BL67) on the little toe, lateral side, remove nail like leek leaf, insert 1 cun, retain 5 breaths, this is Foot Taiyang Jing Well. If pulse is slow, large, and deficient, medication is suitable, acupuncture is not. If puncturing Jing Wells of all Yin vessels, do not bleed, puncture every other day. Malaria without thirst, every other day attack, puncture Foot Taiyang. Thirsty and every other day attack, puncture Foot Shaoyang. Warm Malaria without sweating, use Fifty-Nine Acupoints (Wujiusi), all achieving their combination. Passing this time loses the opportunity. When malaria is about to attack, Yin and Yang are about to shift, called Qi rebellion, do not treat. Hence Classic says: Do not puncture when heat is blazing (Hehe), do not puncture when pulse is chaotic (Hunhun), do not puncture when sweat is dripping (Lulu). Treating at peak strength destroys, treating at decline promotes prosperity. This is what is meant.

Historically, herbal treatments have many formulas, lacking a global view. Only Mr. Wang Kentang from Jintan, in *Zhengzhi Zhunsheng*, established two formulas. One: Shengma, Chaihu, Gegen, Qianghuo, Fangfeng, Gancao. Two: Shigao, Zhimu, Jingmi, Taoren, Honghua, Zhuling, Lingli (Pangolin scales).

Adapting constants to variables, transform and apply, divinely understood, depending on the person.

Jie and Nüe are Wind and Summerheat combining to cause disease, should be treated doubly. But Qi pathology has distances, directions, and new/old/severity differences. Adapt to the location, and formulas vary in odd/even repetition and assisting/reversing counter-agents. First explain main formula basics for analysis. Initially injured by summerheat, summerheat is fire/heat, must obstruct Lung Metal dryness transformation. Transitioning from Summer to Autumn, humid summerheat ceases, so drugs follow Yi-Geng (Wood-Metal) combined transformation method. In the transition of Fire/Earth transmission, facing the extreme Summer Fire trend, transforming into Autumn Metal descending command, this is igniting fire to create metal, without needing another seed. Although creating Metal, Metal does not generate Water, allowing biological transformation. Even if Summer Fire is removed, it merely lies dormant temporarily. Use Zhimu's yin-moistening water to restore the mother's revenge, i.e., Yin excess suppressing Yu Fu method. If Metal is obstructed, vent it; releasing exterior and promoting urination, wind herbs like Zhuling are used. Further injured by wind, wind is Wood, must move Spleen Earth dampness transformation. Spleen Earth transport, wind ceases. So drugs follow Jia-Ji (Wood-Earth) combined transformation method. Using five wind herbs as Jia (Wood), Gancao as Ji (Earth). Jingmi and Shigao as Metal, Earth generates Metal, driving away Wind Wood. If Earth is obstructed, purge it; using Earth, Earth generates Wood for function, wind herbs belong to Wood, exactly functioning Earth. Wind merges with Wei Qi, must treat wind. Five wind herbs are wind-treating agents. Wei Qi sinks into Ying, causing Three Yang to sink, only by lifting Three Yang can Wei Qi hold. Qianghuo lifts Taiyang; Gegen lifts Yangming; Chaihu, Shengma, Fangfeng lift Shaoyang. Focusing on Shaoyang is because the Pivot maintains Opening/Closing. Summerheat hides in Ying She, must treat summerheat; Baihu Quanfang is the summerheat-treating agent. Hiding in Ying She, must treat Ying, Taoren, Honghua etc. Pangolin lives in mountains, enters water, exiting Yin entering Yang, piercing meridians in Ying She. If She collapses, where can summerheat reside? Bathing water qi lodging in skin, Zhuling clears it. Cold water invading muscle layers, Zhuling drains, assisted by acrid-warm to face cold, Qianghuo, Chaihu etc. Thus Wind/Summerheat combine, initially syndromes bias toward wind. Because heat is not yet brewed, prioritize wind over summerheat, do not use full formula, releasing exterior and promoting urination suffices. Later summerheat burns fiercely, wind brews heat, two Qi average, syndromes balanced, then use full formula combined treatment. This refers to Wind/Summerheat in balance, neither biased.

If Summerheat exceeds Wind, syndromes bias toward summerheat, treat summerheat carrying wind. If Wind exceeds Summerheat, syndromes bias toward wind, treat wind carrying summerheat. Even if Summerheat burns alone, showing only summerheat signs, no wind signs, treat only summerheat, no need for wind. People calling this "Zhongshu" (Heat Stroke) is wrong. Summerheat shows constantly without rest; Malaria comes and goes, intensifying periodically. Even without interval, it must worsen at specific times; or seven...