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Qin Zi said: Malaria (Nue Ji) is characterized by chills preceding fever, with paroxysms occurring at regular intervals, mostly during the Si, Wu, and Wei hours. If it occurs once a day, it involves the Taiyang (Greater Yang) and Shaoyang (Lesser Yang) meridians. If it occurs every other day, it involves the Yangming (Bright Yang) and Shaoyang meridians. Symptoms such as yawning, aversion to cold, and headache indicate involvement of the Taiyang meridian. Fever and thirst indicate involvement of the Yangming meridian. The presence of both chills and fever, accompanied by vomiting and bitter taste in the mouth, indicates involvement of the Shaoyang meridian. At noon, when the Qi of the three Yang meridians is dominant, the disease manifests. In the evening, as the timing of the three Yang meridians recedes, the illness resolves. This differs from alternating chills and fever (Han Re Wang Lai), where one feels cold and hot intermittently, occurring two or three times a day. It also differs from summerheat-heat syndromes (Shu Re), where fever persists without cessation. According to the *Huangdi Neijing* (Yellow Emperor's Inner Canon), only the Juyang (another name for Taiyang) and Yangming meridians are mentioned, omitting the Shaoyang meridian. However, the combination of chills and fever is primarily governed by the Shaoyang meridian; therefore, I have supplemented notes on the pulse diagnosis and treatment methods for the Shaoyang meridian. Malaria involving the aforementioned three Yang meridians is relatively easy to cure. If it occurs once every three days, it is called San Yin Jing Nue (Malaria of the Three Yin Meridians), which is difficult to cure. Here, eight categories of exogenous malaria, three categories of endogenous injury malaria, three categories of tertian malaria (San Nue), and one category of wandering malaria (You Nue) are distinguished.

(The condition named "Cold Malaria" in the *Huangdi Neijing*, where cold pathogenic factors injure Ying Qi [Nutritive Qi])

[Symptoms of Cold Malaria] The *Huangdi Neijing* states: There are chills preceding fever, pain in the waist, back, head, and neck, and stiffness of the spine. The patient frequently yawns and groans. Initially, the cold is extreme, causing tremors; finally, high fever occurs, resolving through sweating. If onset occurs before noon, it is Taiyang meridian malaria. If there is eye pain, nasal dryness, shivering with trembling of the jaw, and heat follows immediately after slight cold, occurring after noon, it is Yangming meridian malaria. The above two descriptions refer to the symptoms of Cold Malaria caused by cold pathogenic factors injuring Ying Qi, as described in the *Huangdi Neijing*.

[Etiology of Cold Malaria] In summer, the body is injured by summerheat-qi. The pathogen enters between the skin and the intestines/stomach, the residence of Ying Qi. Simultaneously, cold pathogens from the morning and evening externally bind the summerheat within. When Yang Qi becomes vigorous at noon, the summerheat cannot be vented out. Subsequently, external cold pathogenic factors near the surface are contracted, leading to initial chills. Because the previously contracted summerheat resides internally, fever follows. Thus, malaria with chills preceding fever arises.

[Pulse Diagnosis of Cold Malaria] A floating, large, and tight pulse indicates Taiyang pathogenic invasion. A long, large, surging, and solid pulse indicates Yangming malaria. A wiry and large pulse is the diagnostic sign for Shaoyang.

[Treatment of Cold Malaria] For cases in the Taiyang meridian, use Guizhi Qianghuo Tang (Cinnamon Twig and Notopterygium Decoction). For cases in the Yangming meridian, use Guizhi Gegen Tang (Cinnamon Twig and Kudzu Root Decoction). For cases in the Shaoyang meridian, use Guizhi Chaihu Tang (Cinnamon Twig and Bupleurum Decoction). If symptoms of all three meridians appear simultaneously, these three formulas may be used interchangeably or combined.

Guizhi Qianghuo Tang: Treats cold injuring the Taiyang meridian, characterized by more chills than fever and anhidrosis in cold malaria.
Ingredients: Ephedrae Herba? No, Cinnamomi Ramulus (Guizhi), Notopterygii Rhizoma et Radix (Qianghuo), Saposhnikoviae Radix (Fangfeng), Glycyrrhizae Radix et Rhizoma (Gancao).
If vomiting occurs, add Banxia Qu (Pinellia Fermented Paste); if thirsty and drinking water in summer/autumn, add Gypsum Fibrosum (Shigao).

Guizhi Gegen Tang: Treats cold injuring the Yangming meridian, characterized by more chills than fever and diaphoresis in malaria.
Ingredients: Puerariae Lobatae Radix (Gegen), Paeoniae Radix Alba (Baishao), Cinnamomi Ramulus (Guizhi), Zingiberis Recens Rhizoma (Shengjiang), Glycyrrhizae Radix et Rhizoma (Gancao).
If anhidrosis occurs, add Saposhnikoviae Radix (Fangfeng). If headache occurs, add Notopterygii Rhizoma et Radix (Qianghu). If thirsty and consuming water in summer/autumn, add Gypsum Fibrosum (Shigao).

Guizhi Chaihu Tang: Treats cold injuring the Shaoyang meridian, characterized by more chills than fever in malaria.
Ingredients: Cinnamomi Ramulus (Guizhi), Bupleuri Radix (Chaihu).

Commentary by Zhen: The previous three formulas are used because the malaria is caused by cold injury, presenting with more chills than fever; thus, Cinnamomi Ramulus (Guizhi) is employed in all. The original text states that in the hot seasons of summer and autumn, Gypsum Fibrosum (Shigao) must be added. This demonstrates that for patients with more heat than chills, rapid pulse, and thirst, these formulas must not be mistakenly used.