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[Symptoms of Wandering Malaria] Initially, malaria (malaria) occurs three times (Sanmalaria), followed by an additional episode. It continues for two days and stops for only one day. For instance, if malaria occurring on the Zi, Wu, Mao, or You days (associated with the Shaoyin Meridian) is followed by another episode on the Chen, Xu, Chou, or Wei days the next day, this is Shaoyin malaria, where residual pathogens wander into the Taiyin Meridian. Similarly, if malaria occurring on the Chen, Xu, Chou, or You days is followed by another episode on the Yin, Shen, Si, or Hai days the next day, this is Taiyin malaria, where residual pathogens wander into the Jueyin Meridian. Hence, it is called wandering malaria.

[Etiology of Wandering Malaria] Due to deficiency of Qi and Blood and insufficiency of Zang-Fu Qi, external pathogens lodge in the Yin meridians, leading to Sanmalaria. If the malaria pathogens are abundant, they wander and overflow into other meridians, causing episodes to occur consecutively for two days with a one-day interval, commonly known as wandering malaria.

[Pulse Signs of Wandering Malaria] The pulse is mostly fine and rapid (Xi Shu), or may appear deep and fine (Chen Xi), deficient and large (Xu Da), wiry and slippery (Xian Hua), or deep and hidden (Chen Fu).

[Treatment of Wandering Malaria] First, treat the symptoms manifesting in the primary meridian. For Jueyin malaria, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) with added Shengma (Rhizoma Cimicifugae) and Chaihu (Radix Bupleuri). For Shaoyin malaria, use Jiawei Dihuang Gao (Modified Rehmannia Paste) with added Shengma and Chaihu. For Taiyin malaria, use Jiawei Baizhu Gao (Modified Atractylodes Macrocephala Paste) with added Shengma and Chaihu. By drawing the pathogen back to its original meridian, the symptoms in the wandering meridians will naturally recede. Ancient prescriptions often failed to distinguish meridians and indiscriminately administered tonics, which was inappropriate. All these formulas are detailed in the preceding section on Sanmalaria.
Jiawei Xiaoyao San: See Sanmalaria section.
Jiawei Dihuang Gao: See Sanmalaria section.
Jiawei Baizhu Gao: See Sanmalaria section.

When humans are invaded by Wind-Cold, they experience aversion to cold and fever. If sweating occurs, the pathogen disperses, the body cools, and recovery ensues. In malaria, there is initially aversion to cold, followed by fever, then sweating, after which the body cools and the patient feels better. However, why does the disease recur after one day or every other day at the same time? This is because, unlike acute exogenous diseases that merely affect the muscle layer, malaria pathogens accumulate gradually. The interior has already been damaged, so a single episode of chills, fever, and sweating cannot resolve the entire condition. When external pathogens lie deep and latent, it becomes Sanmalaria. Regardless of the number of days, one must observe the nature of the pathogenic factor. For example, if chills and cold feet appear first during an attack, this indicates Taiyang pathogen lying latent in the Yin aspect. One should use Qiangduo Baidu San (Notopterygium and Angelica Dahurica Decoction to Overcome Toxins) with heavy doses of Danggui (Radix Angelicae Sinensis) and Shaoyao (Radix Paeoniae Alba) to draw out the latent pathogen from the Blood aspect and release it externally. If the patient has been ill for a long time and is deficient, add a small amount of Renshen (Radix Ginseng) to the Qiangduo formula to facilitate the dispersion of the pathogen. If chest fullness and oppression are observed, phlegm and food stagnation are involved; add Banxia (Rhizoma Pinelliae), Houpo (Cortex Magnoliae Officinalis), Qingpi (Pericarpium Citri Reticulatae Viride), Binglang (Semen Arecae), and Shanzha (Fructus Crataegi) to decoct together, taken early in the morning before the attack. If chest fullness, oppression, nausea, and vomiting appear first during an attack, it is named Phlegm Malaria; use Jiamicao Caoguo Yin (Secret Prescription of Caoguo Drink) to eliminate accumulation and transform phlegm. If chills are present, add Qianghuo (Rhizoma Notopterygii), Duhuo (Radix Angelicae Pubescentis), and Shengma to guide and extract the internal latent pathogen outward. This is the true principle of treating malaria, applicable not only to Sanmalaria. All malaria cases require dispelling the pathogen and removing the root cause. Failures in treating Sanmalaria historically stem from not mastering the method of treating latent pathogens and failing to uproot the disease, instead using tonics that close orifices, leading to dietary obstruction and resulting in swelling and distension. It is unknown that persistent malaria is due to phlegm knotting in the Middle Jiao, failure to avoid rich/fatty foods, and premature administration of tonics. I employ a sequence of dispelling pathogens, resolving stagnation, and tonifying deficiency to demonstrate the subtle art of treating malaria: first remove the pathogen, then tonify Yuan Qi. For example, chronic dysentery due to external contraction fails to heal either because tonification/closure was too early or because releasing the exterior pathogen was neglected; chronic dysentery due to internal injury fails to heal either because tonification/closure was too early or because rich/fatty and raw/cold foods were not avoided. Those who lose appetite and suffer from persistent malaria should have their phlegm and food resolved; once Stomach Qi is clear and harmonious, the heat will naturally subside—a fact known to all. However, those who can eat but suffer from persistent fever should restrict their diet to avoid aiding the heat pathogen, thereby reducing the heat—a fact unknown to many. This method applies not only to malaria but also to all febrile diseases and heat generated from excessive consumption of rich foods, including accumulated heat and childhood malnutrition fever (Gan Huo).