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Although malaria is a minor disease, it is discussed in the greatest detail in the *Neijing* (Classic of Internal Medicine). It first states that summer-heat pathogen injures the body in summer and hides inside the skin but outside the stomach and intestines. When autumn qi arrives, sweat is produced and wind is encountered; the internal and external pathogens struggle with each other, causing daily attacks. This indicates that malaria arises from the struggle between summer-heat and wind. However, summer-heat must be accompanied by dampness; without dampness, if there is only dry heat, it is not summer-heat. From this, we can infer that although malaria is formed by the struggle of summer-heat and wind, it must also be caused by the brewing action of dampness pathogen.

Specifically, the six exogenous pathogens are distributed across the four seasons. Although summer-heat and dampness differ in nature, their etiological origins share similarities, implying both separable and inseparable aspects. This year, Taiyin (Great Yin) governs the heavenly qi, and wet earth is in charge. The changes are sudden and heavy rainfall occurs like flooding. Humans exist within the intersection of heaven and earth qi; those who contract the pathogen and fall ill immediately suffer from cholera, vomiting and diarrhea, swelling, and fullness. Those who do not fall ill immediately have the pathogen latent in the Mo Yuan (Membrane Source); moving inward toward the Large Intestine results in dysentery, while moving outward to the Shaoyang (Lesser Yang) channel results in malaria. Thus, the alternating chills and fever of malaria are similar to the red and white sticky discharge in dysentery. After more than ten days, the malaria has attacked five times. The patient experiences chest and abdominal fullness, nausea and vomiting without thirst, and a deep, wiry, and slow pulse. This clearly indicates dampness stagnating in the Middle Jiao (Middle Burner), causing the Fu Yang (Yang of the Bowels) to lose its transformative function. Fortunately, the pathogen is able to reach the exterior via the pivot mechanism, preventing stagnation in the lower jiao as dysentery or jaundice and distension. Once the pathogen is cleared, recovery will occur naturally, requiring no excessive worry.

Multiple pregnancies have depleted the Chong Mai (Penetrating Vessel) and Ren Mai (Conception Vessel). Additionally, breastfeeding further consumes yin blood. Having suffered for many years, the patient experiences stabbing pain in the waist and spine, making turning difficult. There is hematuria with painful dribbling, and pain radiating to the lower abdomen. Speculating on the cause, this is not merely an injury to qi and blood, but also damage to the Eight Extraordinary Vessels. Therefore, using Gui Di (Angelicae Sinensis Radix and Rehmanniae Radix Praeparata) to nourish yin and Shen (Ginseng) to tonify qi yields no effective results. The Chong Mai originates at Qichuan (ST30), and the Ren Mai originates below Zhongji (CV3). Conditions such as painful dribbling are necessarily related to these vessels; even the symptom of chills and fever is a disease of the Yang Wei Mai (Yang Linking Vessel). The illness stems from emptiness of the Blood Sea, damaging the Eight Extraordinary Vessels. Ordinary herbal medicines are unlikely to achieve success. Following the *Neijing*'s treatment for "Blood Withered" (Xue Ku), the formula Si Wu Ju Gu Xu Ru Wan (Four Cuttlebone and Asparagus Pill) is adopted. An Bo notes: Ancient texts state that long-standing diseases enter the eight extraordinary vessels.

Previously suffering from Fei Feng (a condition characterized by flaccidity and paralysis), slight improvement was achieved through regulation. However, mental labor from official duties has left the primordial qi deficient and unrecovered. Although the waist and spine can now turn, the feet and knees still feel weak. This indicates a deficiency of the true yuan (primordial essence) of the Liver and Kidneys in the lower part, and the Eight Extraordinary Vessels fail to provide constraint. Shen (Ginseng), Gui (Angelicae Sinensis Radix), and Di (Rehmanniae Radix Praeparata) can only benefit qi and blood, failing to penetrate the Eight Extraordinary Vessels. Ancients treating injuries to the essence and marrow of the extraordinary vessels all used "blood and flesh sentient substances" (animal-derived medicines). How can mere plant roots and herbs be compared to them? Extending this logic, the waist is the mansion of the Kidney, and the knees are the mansion of the sinews. If rotation and shaking are impossible, and walking causes trembling, without seeking self-strengthening efforts, it will be difficult to mend these deficiencies. Maintaining tranquility and emptiness, and guarding the spirit to preserve fullness, one might retain the posture of pine and cypress, becoming stronger with age.

The proposed prescription includes He Che Da Zao (Placenta Hominis), Lu Rong (Cervi Cornu Pantotrichum), Hu Jing Gu (Tigris Ossis Tibialis), Hu Xi Gu (Tigris Ossis Fibularis), Niu Su Sui (Bovis Medulla), Zhu Su Sui (Suis Medulla), Yang Su Sui (Ovis Medulla), E Jiao (Colla Corii Asini), and Hai Shen (Holothuria).