Library

Without phlegm and food retention, malaria cannot form; however, external contraction of wind-cold can still induce it. Only when fire pathogen interacts with autumn metal (lung qi), the evil pathogen penetrates deeply, causing spleen cold and exhaustion of kidney qi. After malaria subsides, dysentery may follow; repeated relapses sink into the spring yang phase, resulting in dimmed vision and reduced luster of the eyes.

This chapter discusses eye diseases caused by malaria, and malaria occurring in patients with eye diseases, describing their mutual transformation and recurrent changes. The *Classic* states: "Injury by summer-heat in summer leads to malaria in autumn." This is because exposure to summer-heat causes lung dryness-thirst, prompting water intake for self-rescue. Excessive drinking leads to dampness affecting the Yangming channel, where heat pathogen fears dampness and dares not disperse, lying dormant to cause disaster. When autumn metal qi takes command, summer-warmth emerges riding on dryness. If blown by cool wind at this time, both summer-dampness and dryness-heat become constrained again. Once constrained, they inevitably weaken the middle jiao and insult the cold water (kidney), resulting in a combined disease of three channels. Thus, yin and yang clash chaotically, presenting alternating chills and fever, occurring at regular intervals. Upon onset, there is headache, irritability, soreness and pain in bone joints, vomiting or thirst, and unsettled spirit and soul. Although symptoms gradually cease after sweating, muscles have secretly wasted away. Hence, the condition is named according to malaria.

Regarding cases with more chills than fever, more fever than chills, daily attacks, every-other-day attacks, or twice-daily attacks; occurring before noon or after noon, before midnight or after midnight; starting with chills then fever, starting with fever then chills; only chills without fever (Pin Malaria); or only fever without chills (Dan Malaria)—these represent distinctions between involvement of yin or yang, and deep or shallow pathogenic levels. Although the principles are profound and subtle, they are not difficult to understand. A physician equipped with the four diagnostic methods will naturally grasp the beginning and end of the disease.

Treatment methods: For absence of sweat, induce sweating, prioritizing dispersion of pathogenic factors. For presence of sweat, stop sweating, prioritizing support of healthy qi. Use Qingpi Yin (Green Peel Decoction) or Magui Yin (Cinnamon Twig and Ephedra Decoction) with modifications based on syndrome. If there is stagnant phlegm knotting in the stomach, use Caoguo Yin (Tsaiko Rhizome Decoction). If ineffective, employ Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with doubled Chaihu (Bupleuri Radix), plus Banxia (Pinelliae Rhizoma) and Shengjiang (Zingiberis Rhizoma Recens), or alternatively Jianzhong Tang (Establish the Middle Decoction) or Guipi Tang (Restore the Spleen Decoction). If heat is abundant and chills are few, add Mudan Pi (Moutan Cortex) and Zhizi (Gardeniae Fructus). For chronic malaria unresponsive to previous formulas, Bawei Wan (Eight-Ton Pill) and Jiuzhuan Dan (Nine-Cycle Pill) indeed show miraculous efficacy. However, medication must generally be administered two to three hours before the expected onset to intercept the pathogen; while malaria will not retreat spontaneously, the condition will slightly alleviate.

There exists a condition resembling malaria but not being true malaria. In conditions following exogenous cold damage, severe illness, postpartum state, or consumptive disease, there are often alternating chills and fever, or occurring two to three times a day. This corresponds to what the *Classic* describes as: "Yang deficiency leads to aversion to cold, yin deficiency leads to aversion to heat; when yin qi ascends into yang, there is aversion to cold; when yang qi sinks into yin, there is aversion to heat." Furthermore, there are cases of dysentery following malaria, or malaria following dysentery. In the case of post-malarial dysentery, since evacuation has been extreme, there should be no residual summer-heat toxin causing dysentery anew; rather, this is due to invasion by other pathogens, where spleen and lung primordial qi are deficient and unable to ascend, manifesting as something resembling dysentery but not truly dysentery. In the case of post-dysenteric malaria, excessive downward discharge leads to loss of blood, and qi scatters with the dysentery, subsequently transforming into malaria. This represents dual failure of yin and yang, manifesting as resembling malaria but not true malaria. All such cases are treated as deficiency syndromes, using previous formulas with careful adjustment, leading to immediate recovery.

Incompetent physicians, without distinguishing between true malaria and malaria-like conditions, seeing the aforementioned symptoms, indiscriminately administer drugs like Changshan (Dichroae Radix) and Xianglian (Coptidis Rhizoma mixed with Cinnamomi Cortex) to forcibly cut off the disease, termed "Jiejiang Nao" (River-Cutting Oar), resulting in many wrongful deaths. They remain unrepentant and unenlightened, which is truly lamentable! Therefore, these distinctions are presented here for reference by future authors.