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The Yellow Emperor asked: When pathogenic fire and heat reappear, causing aversion to cold and fever, resembling malaria, sometimes occurring daily or every few days, what is the reason for this? (Generally, alternating chills and fever are mostly caused by external contraction. However, there are cases not due to wind-cold, but rather excessive internal fire-heat, which also present with chills and fever. These episodes have a specific timing. Although the symptoms resemble malaria, they are essentially not malaria; thus, this question is raised for clarification.)

Qibo replied: The time of encounter between the victorious qi (Sheng) and the retaliatory qi (Fu) varies in intensity. If yin qi is abundant and yang qi is scarce, the interval between episodes is long; if yang qi is abundant and yin qi is scarce, the interval between episodes is short. This reflects the rhythm of victory and retaliation, and the fluctuation of excess and deficiency. Malaria follows the same principle. (Chills and fever represent the dynamics of yin and yang qi. The speed of onset reflects the nature of yin and yang. In the human body, yin and yang correspond to water and fire, as well as Ying (Nutrient) Qi and Wei (Defensive) Qi. A sensation of cold despite heat indicates extreme fire mimicking water; a sensation of heat despite cold indicates extreme yin mimicking yang. When yin and yang are harmonious, blood and qi are balanced, and the interior and exterior are regulated. When yin and yang are disharmonious, the encounter of Sheng and Fu qi involves varying degrees of abundance and scarcity. Thus, when yang enters yin, yin fails to control yang, resulting in heat; when yin emerges from yang, yang fails to control yin, resulting in cold. Furthermore, if yin is abundant and yang is scarce, the sluggish nature of yin delays their encounter, leading to longer intervals between episodes. If yang is abundant and yin is scarce, the rapid nature of yang accelerates their encounter, leading to shorter intervals. This rhythm of Sheng and Fu, though not necessarily malaria, often presents similarly, governed by the same logic of yin-yang entry and exit. The similarity lies in the principles of yin-yang movement. However, differences exist within these similarities, distinguishing true malaria from malaria-like conditions. The key distinction lies in the presence or absence of pathogenic factors. True malaria involves pathogens, where the meeting of Wei Qi determines cessation and onset. Malaria-like conditions without pathogens involve the struggle between water and fire determining excess and deficiency. The former is located in the exterior, treated by expelling pathogens; the latter is located in the interior, treated by supporting healthy qi. One should not assume that similar mechanisms imply identical treatments. The subtle distinction between similarity and difference is critical to life and death; students must examine this carefully.)