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The *Neijing · Malaria Chapter* states: "All malaria arises from wind, yet why does it occur at specific times?" Qibo replied: "Summer injury by summer-heat leads to malaria in autumn."

This is because when the couli (skin pores) are open and sweating occurs, exposure to wind, or obtaining water qi during bathing which lodges in the skin, combined with the failure of Wei Qi (Defensive Qi) to guard, allows pathogenic factors to occupy the body, causing the disease to begin.

Manifestations include yawning, chills, pain in the waist and back, vexing pain in bone joints. After the cold subsides, both interior and exterior become hot, accompanied by headache and thirst. This results from the contention between Yin and Yang Qi, alternating deficiency and excess. When Yin Qi alone prevails, Yang becomes deficient; thus, chills and tremors occur first, with pain in the waist, back, head, neck, and joints. When Yang Qi alone prevails, Yin becomes deficient; thus, heat appears first. During attacks, there is loss of appetite, propensity to vomit, headache, lower back pain, and difficult urination. If Yin is excessive and Yang deficient, both interior and exterior are cold. If Yang is excessive and Yin deficient, both interior and exterior are hot. These conditions stem from external contraction of the Six Excesses (Wind, Cold, Summer-Heat, Dampness, Dryness, Fire), or internal injury from the Seven Emotions (Joy, Anger, Worry, Pensiveness, Sorrow, Fear, Fright), leading to accumulation of phlegm-fluids. Pathogenic Qi and Wei Qi coexist, causing daily recurrence. Wei Qi travels through the Yang aspect during the day and the Yin aspect at night; encountering Yang, it moves outward to the surface; encountering Yin, it presses inward toward the five zang organs. When the six qi penetrate deeply and cannot exit with Wei Qi, the disease manifests every other day. When Wei Qi reaches the location of the pathogen, the disease flares up. In the Yang aspect, there is heat; in the Yin aspect, there is cold. The classics state: "Exuberance causes harm; extremity reverses." When Yin and Yang Qi decline separately, and Wei Qi separates from Pathogenic Qi, the disease rests. When Yin and Yang contend again, and Wei Qi gathers with Pathogenic Qi, the disease recurs. This depends on the location of Wei Qi combining with the contracted pathogen.

Cold preceding heat indicates injury by Cold followed by Wind, named Cold Malaria. Heat preceding cold indicates injury by Wind followed by Cold, named Warm Malaria. Heat without cold is named Dan Malaria (Febrile Malaria). Heavy body, alternating cold and heat, joint pain, abdominal distension, spontaneous sweating, and vomiting characterize Damp Malaria. Cold without heat is named Pin Malaria (Yin Malaria). Generally, malaria presents with various symptoms. Therefore, prescription formulation must follow Yin-Yang, deficiency-excess, pulse-disease patterns, employing diaphoresis, emesis, purgation, or warming methods, matching symptoms to balance the body. All diseases invade due to righteous Qi deficiency, allowing pathogens to linger and transform into excess, moving from exterior to interior, utilizing diaphoresis then purgation, an unchanging principle since antiquity.

Treating malaria requires first resolving the exterior using Baijie San (Hundred-Resolution Powder) decocted with water, ginger, and scallion. Next, use Xiaochaihu Tang (Minor Bupleurum Decoction) with added Guizhi (Cinnamon Twig), decocted with water, ginger, and jujube, to harmonize and resolve exterior-interior pathogens, naturally yielding effects. If exterior and interior are both excess, use Danggui San (Angelica Powder), Wuhe Tang (Five-Harmony Decoction), Wuxi Wan (Black Rhinoceros Pill), or Liusheng Wan (Six-Sages Pill) for purgation. Use Yunqi San (Qi-Balancing Powder) to stop vomiting and tonify; subsequently use Huoxiang Yin (Agastache Drink) with Caoguo (Tsaoko Fruit) and Liangjiang (Galangal), decocted with water, ginger, and jujube, to rectify Stomach Qi and dispel cold, restoring balance. If after resolving the exterior, alternating cold and heat persist, use Erxian Yin (Two-Immortals Drink) or Sansheng Wan (Three-Sages Pill) to intercept the attack. Once cold and heat are eliminated, use Pingwei San (Stomach-Calming Powder) with Huixiang (Fennel) decoction, mixed evenly, taken with salt water on an empty stomach. This warms the stomach, dries the spleen, promotes appetite, and strengthens the Middle Jiao Earth, causing external pathogens to yield without struggle, a sound theoretical approach. For cases with much cold and little heat persisting long-term, leading to weak spleen-stomach, reduced diet, and lethargy, treat with Erjiang Wan (Two-Ginger Pills) and Qingpi Tang (Clear Spleen Decoction).

I often observe practitioners treating malaria without understanding principles, resorting to herbal remedies crushed and taken with cold water, or exposed to dew before administration. This damages the spleen-stomach, depletes true Yuan Qi, and generates myriad complications: edema, kan diarrhea (infantile malnutrition with diarrhea), or cold dysentery, leading to spleen-stomach weakness, reduced intake, and sometimes death. Infants are delicate and fragile; how can they endure such herbal ingestion? Physicians and parents must strictly beware of this.