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Summer heat injures the Ying (Nutritive) level and resides within; in autumn, cold wind is contracted and dwells with the Wei (Defensive) level. At that time, if bound by external pathogens, summer sweat cannot exit, resulting in malaria.

[Note] The Classics state: "All malaria arises from wind." This refers to malaria occurring in all four seasons, none of which occur without external binding by wind-cold and internal retention of summer-heat pathogen. It also states: "Malaria is due to the irregularity of wind-cold qi." This speaks of malaria contracted during specific seasonal transitions. It further states: "Summer injury by summer-heat leads to malaria in autumn." And: "Those who suffer summer-heat in summer but do not sweat will develop wind-malaria in autumn." This means: Summer injury by summer-heat—if the pathogen is severe, it causes immediate summer-heat disease; if mild, it resides in the Ying level. Upon re-contracting autumn cold wind, it combines with the Wei level. Thus, summer-heat and wind-cold combine to form malaria. Those who do not immediately contract cold damage do so because summer-heat pathogen was pre-retained in the Ying level. Generally, wind alone causes wind disease; summer-heat alone causes summer-heat disease. Only when wind and summer-heat combine does malaria occur.

The malaria pathogen follows the meridians and lies hidden in the spine and back muscles, penetrating deeply into the interior of the spine and injecting into the Fu Chong vessel. It extends horizontally to connect with the Mo Yuan (Membrane Source) and presses against the Zang-Fu organs. When the Wei Qi arrives at this point, righteous Qi and pathogenic Qi contend. When the pathogen receives Yin Qi's internal containment, chills are generated; when it receives Yang Qi's outward movement, steaming heat occurs. If the pathogen is shallow, it manifests daily as it meets the Wei Qi; if deep, it manifests intermittently because the meeting with the sluggish Wei Qi is delayed.

[Note] The malaria pathogen hides within the Ying level. Following the meridians, it descends along the exterior of the spine and back muscles. This is the initial stage where the pathogen is shallow, marking the sequence of transmission and residence. If the pathogen is deep, it enters the interior of the spine and back muscles, lying hidden and injecting into the Chong Mai (Penetrating Vessel), extending horizontally to connect with the origin of the fat membranes of various meridians and the Zang-Fu organs. This marks the progression where the pathogen becomes deeper, another sequence of transmission and residence. The Wei Qi circulates through the body once every day and night. Each morning at dawn, it emerges from Jingming (BL1) of the Foot-Taiyang Bladder Meridian and gathers at Fengfu (DU16). The Cou Li (pores/skin texture) then open. Once open, the pathogen residing in the Ying and Wei levels enters. Upon entering, if contained internally by Yin, cold is generated; if moving outwardly by Yang, heat is generated. Internal and external contending, pathogen and righteous Qi engaging, the disease manifests. In early stages with shallow pathogen, Wei Qi circulation remains normal, so the pathogen meets the Wei Qi daily, causing daily attacks. In prolonged illness with deep pathogen, Wei Qi circulation becomes sluggish and abnormal, so the pathogen cannot meet the Wei Qi daily, causing intermittent attacks. Sometimes attacks occur after two or three days, or even several days, because the Wei Qi circulation becomes increasingly sluggish, the meeting becomes increasingly delayed, and thus the attack interval lengthens.