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(Full text from "Ci Nie Pian" [Chapter on Acupuncture for Malaria] of *Suwen* [Basic Questions])

Malaria involving the Foot-Taiyang meridian causes lower back pain and a heavy head, with cold sensation arising from the back. It begins with chills followed by fever; after the fever subsides, sweating occurs but is difficult to stop. Bleeding should be induced at Weizhong (BL-40). (Here follows the discussion on acupuncture treatment for malaria of the six meridians of the foot. The head, back, and waist are pathways of the Foot-Taiyang meridian, hence these symptoms occur. "Xiao Xiao" and "Xi Xi" describe severe heat. Pathogens in the Three Yang meridians are abundant at the exterior. Sweat is hard to retain, hence "difficult to stop." Regarding "sticking at Zhong," Wang Bing notes: The Xi-Cleft point of the Taiyang meridian is Jinmen (BL-63). Also, *Huangdi Zhonggao Tu Jing* states it is governed by Weizhong (BL-40). Thus, ancient methods considered Weizhong as "Zhong." Therefore, Weizhong should be the target; both points belong to this meridian. "Xiao" is pronounced háo or xiāo by Hao and Xiao, or mù qiē. "Xi" is pronounced yè. "Xi" is synonymous with "xi" [gap].)

Malaria involving the Foot-Shaoyang meridian causes the body to feel weak and fatigued ("jie jie"), with mild chills and mild fever. Patients dislike seeing people and feel fearful upon seeing them. There is much heat and profuse sweating. Acupuncture should be applied to the Foot-Shaoyang meridian. ("Jie" means "xie" [weakness]; "ji" means "trace." "Body jie jie" refers to intolerance to labor and physical fatigue. Mild chills and mild fever indicate the disease is in the half-exterior, half-interior state. Fearfulness upon seeing people indicates pathogens in the Gallbladder. Shaoyang is a Wood-Fire meridian, so heat exceeds chills and sweating is profuse. One should needle the Foot-Shaoyang meridian; Wang Bing says Xiaoxi (GB-43) governs it. Note: Wang Bing interprets "jie" as mild chills and heat; however, careful examination suggests otherwise. Since the text states "body jie jie" and then "chills and heat not severe," they clearly refer to different things. In *Ci Yao Lun*, it is said: "If marrow is injured, it wastes away and becomes sore; the body feels weak and cannot rise." Is this not referring to weakness in movement? Examining the character, it is not in rhyme books; if read as "yi," it lacks meaning. It should follow the "ji" rhyme for appropriateness.)

Malaria involving the Foot-Yangming meridian causes initial chills, shivering severely, with intense cold that lasts for a long time before turning into fever. After the fever subsides, sweating occurs. Patients prefer sunlight, moonlight, or fire warmth, feeling comforted. Acupuncture should be applied to the dorsum of the foot of the Foot-Yangming meridian. Although the Yangming meridian has abundant blood and qi, when cold pathogens prevail, chills appear first. After a long time, heat appears; when heat subsides, pathogens resolve, causing sweating. *Jing Mai Pian* states: "In Yangming disease, patients abhor people and fire." Why do they now prefer sunlight/moonlight/fire? This is because Yangming receiving Yang pathogens represents Stomach excess, leading to aversion to heat; Yangming receiving Yin pathogens represents Stomach deficiency, leading to preference for warmth. "Fu shang" [dorsum of foot] refers to Chongyang (ST-42), a point of this meridian. "Xi" is pronounced xī.)

Malaria involving the Foot-Taiyin meridian causes dissatisfaction, frequent sighing, loss of appetite, and frequent chills, fever, and sweating. Upon onset, vomiting often occurs; the condition improves after vomiting. Treatment can then proceed. (Spleen is the child of Heart; Spleen disease leads to constrained Heart qi, causing dissatisfaction. If Spleen fails to transform, Upper Jiao becomes obstructed, causing sighing and anorexia. Taiyin governs the interior, where pathogens are hard to resolve, leading to frequent chills, fever, and sweating. The Spleen meridian connects to the Stomach, passes through the diaphragm, and flanks the throat, so vomiting occurs upon onset. However, one must wait until after vomiting when the pathogen declines before needling. Wang Bing says: Treat the Jing-River/Shu points and Gongsun (SP-4). These are all points of this meridian.)

Malaria involving the Foot-Shaoyin meridian causes severe vomiting, frequent chills and fever, with more heat than chills. Patients desire to close doors and windows and stay alone. This disease is difficult to cure. (The Kidney meridian passes through the liver and diaphragm, enters the lungs, and follows the throat. Yin pathogens rushing upward cause severe vomiting. Kidney disease leads to Yin deficiency, resulting in more heat than chills. Diseases in the Yin aspect favor quietness, hence the desire to stay alone behind closed doors. The Kidney is the organ of Extreme Yin, and pathogens residing there make the disease deep and hard to cure. The absence of acupuncture instructions here implies a textual omission. Wang Bing says: Dazhong (KI-4) and Taixi (KI-3) both govern this. They are points of this meridian. "You" is pronounced yǒu.)

Malaria involving the Foot-Jueyin meridian causes lower back pain, fullness in the lower abdomen, and difficulty urinating resembling strangury (long), though it is not true strangury, but rather frequent urination. There is mental fear, Qi deficiency, and abdominal depression/distress. Acupuncture should be applied to the Foot-Jueyin meridian. (The Liver meridian passes through the genitalia, reaches the lower abdomen, and spreads over the hypochondrium, causing these lumbar, abdominal, and urinary symptoms. Difficulty in urination is called strangury; here it resembles strangury but is not, likely due to Liver pathogen sinking rather than water metabolism issues, causing urgency and frequency. Mental fear indicates Liver Qi deficiency. Abdominal "yi yi" describes a state of stagnation. All should be treated by needling the Foot-Jueyin meridian; Wang Bing says Taichong (LR-3) governs it. "Long" is pronounced lóng. "Yi" is pronounced yì.)

Lung malaria causes coldness in the heart/chest, with severe cold followed by heat. During intervals of heat, patients are prone to fright and hallucinations. Acupuncture should be applied to the Hand-Taiyin and Hand-Yangming meridians. (This section discusses acupuncture for Zang malaria, including the Stomach. Lung is the canopy of the Heart; cold pathogens attacking the unconquered element cause Lung malaria, leading to chest coldness. Severe cold followed by heat injures Heart qi, causing fright and visual disturbances. One should needle the exterior-interior pair meridians to drain Yangming excess and tonify Taiyin deficiency. Wang Bing says: Lieque (LU-7), the Luo-connecting point of Hand-Taiyin, and Hegu (LI-4), the Yuan-source point of Yangming, govern this.)

Heart malaria causes severe mental restlessness and a desire for cold water, but with excessive chills and mild heat. Acupuncture should be applied to the Hand-Shaoyin meridian. (Malaria pathogens in the Heart cause severe restlessness and desire for water to cool down. The Heart is a Yang organ; when occupied by pathogens, Yang becomes deficient and Yin abundant, leading to excessive chills and mild heat. Wang Bing says Shenmen (HT-7) governs it, which is a point of the Hand-Shaoyin meridian.)

Liver malaria causes a pale green complexion, frequent sighing, and a demeanor resembling death. Acupuncture should be applied to the Foot-Jueyin meridian to induce bleeding. (Liver belongs to Wood, hence the green complexion. Liver constraint causes Qi rebellion, leading to sighing. Wood disease causes stiffness, hence the death-like appearance. Needling Foot-Jueyin to bleed: Wang Bing says Zhongfeng (LR-4) governs it. Note: Foot-Jueyin malaria was mentioned earlier; this repetition clarifies Zang disease details versus the earlier Meridian disease description. The same logic applies to Spleen, Kidney, and Stomach below.)

Spleen malaria causes chills and abdominal pain. When heat appears, intestinal sounds are heard; sweating occurs after the sounds cease. Acupuncture should be applied to the Foot-Taiyin meridian. (As the organ of Extreme Yin, Spleen hosting malaria pathogens causes chills. The Spleen meridian enters the abdomen from the thigh, causing abdominal pain. After chills subside and heat appears, Spleen Qi moves, causing borborygmus. After borborygmus, Yang Qi reaches the exterior, causing sweating and resolution. Wang Bing says Shangqiu (SP-5) governs it.)

Kidney malaria causes shivering chills ("sa sa"), painful lower back and spine with twisting movements, difficulty defecating, blurred vision, and cold hands and feet. Acupuncture should be applied to the Foot-Taiyang and Foot-Shaoyin meridians. ("Sa sa" describes shivering. The Kidney meridian penetrates the spine and belongs to the Kidney, opening into the two orifices, causing back/spine pain, twisting, and constipation. "Xuan" describes dizziness/blurred vision. Poor vision indicates Water/Kidney deficiency. Cold extremities indicate Yin reversal. Needle the exterior-interior pair of Foot-Taiyang and Foot-Shaoyin as previously described. "Xuan" is pronounced xuàn.)

Stomach malaria causes hunger pangs during onset, but inability to eat. Eating leads to distension and abdominal enlargement. Acupuncture should be applied to the Foot-Yangming and Foot-Taiyin meridians, inducing bleeding from transverse vessels. (Among the Six Fu organs, only Stomach is mentioned because it is the leader of the Six Fu. Pathogens in Yangming affect Stomach and Spleen, causing hunger without ability to eat, distension, and abdominal swelling. One should needle the exterior-interior pair of Yangming. Wang Bing says Lidui (ST-45), Jiexi (ST-41), and Zusanli (ST-36) govern the Foot-Yangming. For Foot-Taiyin, bleed the transverse vessel, referring to the large oblique vessel anterior to the medial malleolus, i.e., the Taiyin meridian, likely Shangqiu (SP-5).)

When malaria fever is just rising, needle the arterial pulse on the dorsum of the foot, open the aperture, and release blood to immediately reduce heat. (This section discusses general acupuncture for malaria. "Body just hot" refers to the pre-febrile phase. Malaria starting with heat is Warm Malaria. The arterial pulse on the dorsum is Chongyang (ST-42) of the Foot-Yangming meridian. As a meridian of abundant Qi and blood, releasing blood reduces heat pathogens.)

When malaria chills are about to start, needle the Hand-Yangming, Hand-Taiyin, Foot-Yangming, and Foot-Taiyin meridians. ("Chills about to start" means impending chills. Needling Yangming meridians drains heat; needling Taiyin meridians tonifies Yin. Wang Bing says: Needle the Jing-River/Shu points of these four meridians.)

If the malaria pulse is full, large, and urgent, needle the Back-Shu points using medium needles, one point each at the five Shu points beside the Back-Shu, adjusting bleeding according to body fat/thinness. (Full, large, urgent pulses indicate Yang pathogen excess. The back is the pathway of Yang meridians, so needle the five Shu points beside the Back-Shu. "Qu" means hypochondrium or side. *Shui Re Xue Lun* states: Five points beside the Five Zang Back-Shu drain Zang heat. These are Pohu (BL-42), Shentang (BL-44), Hunmen (BL-47), Yishe (BL-49), and Zhishi (BL-52), all Foot-Taiyang points. Adjust bleeding based on constitution: shallow/less for thin, deep/more for fat. "Qu" is pronounced qū.)

If the malaria pulse is small, solid, and urgent, moxa the Lower Limb Shaoyin meridian and needle the Digital Jing-Well points. (Small, solid, urgent pulses indicate Yin pathogen excess. Yin excess generates internal cold, so moxa Lower Shaoyin to disperse cold and needle Digital Jing-Well to tonify Yang. Wang Bing says: Moxa Lower Shaoyin refers to Fuliou (KI-7); needle Digital Jing-Well refers to Zhiyin (BL-67) of Foot-Taiyang.)

[Repeated section]: If the malaria pulse is full, large, and urgent, needle the Back-Shu points, using one point each from the five Shu points and Back-Shu points, adjusting flow until bleeding occurs.

If the malaria pulse is slow, large, and deficient, medication is suitable, but acupuncture is not. (Acupuncture drains but does not tonify; thus, it is unsuitable for deficient pulses. *Mai Du Pian* states: Excess is drained, deficiency is tonified with medicine. This refers to that principle.)

Generally, treat malaria approximately one meal's duration before onset. Missing this timing loses efficacy. (Before onset, pathogen and healthy Qi have not yet combined, allowing effective treatment. Treating after combination confuses pathogen and Qi, damaging healthy Qi.)

For various malaria cases where the pulse is imperceptible, needle the spaces between the ten fingers to release blood; the disease will surely cease. First, observe any red spots like small beans on the body and needle them all. (Imperceptible pulse indicates pathogen excess and Qi reversal causing pulse hiding. Needling finger webs drains excess.)

The twelve types of malaria have different onset times. Observe symptoms to determine the affected meridian. (The twelve types refer to the six meridians and five zang organs discussed above. Different timings require identifying the meridian based on signs.)

Needle approximately one meal's duration before onset. One needle reduces pathogen Qi; two needles show effect; three needles cure. (One needle reduces Qi but patient may not feel it; second needle shows effect; third cures.)

If not cured, needle the two vessels under the tongue to release blood.

If not cured, needle the abundant vessels at Weizhong (BL-40) to release blood. (Weizhong is on Foot-Taiyang, hence "abundant vessel".)

Also needle the points below the neck flanking the spine; the disease will surely cease. (Dazhu (BL-11) and Fengmen (BL-12) of Foot-Taiyang.)

The two vessels under the tongue are Lianquan (CV-23), a Ren meridian point.

When treating malaria, first ask where symptoms started, and needle that area first. (Attack the root first.)

If headache and heaviness start first, needle the top of the head, temples, and glabella to release blood. (Top: Shangxing (GV-23), Baihui (GV-20), Governing Vessel. Temples: Xuanlu (GB-5), Foot-Shaoyang. Glabella: Zanzhu (BL-1), Foot-Taiyang.)

If neck and back pain start first, needle those areas. (Neck: Fengchi (GB-20), Fengfu (GV-16). Back: Dazhu (BL-11), Shendao (GV-11). Fengfu/Shendao are Governing Vessel; Fengchi is Foot-Shaoyang; Dazhu is Foot-Taiyang.)

If lower back and spine pain start first, needle Weizhong (BL-40) to release blood. (Waist and back belong to Taiyang.)

If arm pain starts first, needle the spaces between the ten fingers of Hand-Shaoyin and Hand-Yangming. (Refers to Jing-Well points. Needling finger webs treats the specific meridian involved.)

If lower leg pain starts first, needle the spaces between the ten toes of Foot-Yangming to release blood. (Releasing blood from toe webs drains Jing-Well points where pathogens reside.)

Wind malaria, characterized by sweating and aversion to wind upon onset, should be treated by bleeding the Back-Shu points of the Three Yang meridians. (Refers to Bladder, Stomach, and Gallbladder Back-Shu points, all on Foot-Taiyang.)

If bone pain is severe and worsens on pressure, it is called Marrow Disease. Needle Juegu (GB-39, formerly Xuanzhong) to release blood; it cures immediately. ("Gong" refers to tibia. Worsening on pressure indicates deep pathogens. "Zhen" is the first type of needle. Juegu is Foot-Shaoyang. Pronunciations: gōng/háng, suān, fù, chán.)

For slight body pain, needle Zhiyin (BL-67), a Foot-Taiyang point.

Do not bleed the Jing-Well points of Yin meridians; needle every other day. (承接上文: Do not bleed Yin Jing-Well points; alternate-day needling allows pathogen drainage. Only Yang Jing-Well points may be bled to protect True Yin.)

For malaria without thirst, occurring every other day, needle the Foot-Taiyang meridian. (No thirst indicates no internal pathogen, only exterior; hence Foot-Taiyang.)

For malaria with thirst, occurring every other day, needle the Foot-Shaoyang meridian. (Thirst indicates pathogen in half-exterior/half-interior; hence Foot-Shaoyang. *Zabing Pian* differs: No thirst/every other day -> Foot-Yangming; Thirst/daily -> Hand-Yangming. See Ci Lei 53.)

For Warm Malaria without sweating, use the Fifty-Nine Points method. (See Ci Lei 39-40.)