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Entering the Yin aspect. (Note: This refers to Warm Malaria (Wen Nue) caused by contracting cold in winter, which belongs to the category of Cold Damage (Shang Han). Therefore, *The Treatise on Cold Damage* (Shang Han Lun) includes a syndrome of Warm Malaria, likely originating from this.) The Yellow Emperor asked: What is about Epidemic Fever Malaria (Dan Nue)? Qibo replied: In patients with Epidemic Fever Malaria, the lungs harbor heat internally, and Qi is abundant throughout the body. There is rebellious Qi rushing upward, the Middle Jiao Qi is full but fails to vent outward. Due to physical exertion, the interstices (Cou Li) open, allowing Wind-Cold pathogens to lodge between the skin and muscle layers, triggering the disease. Upon onset, Yang Qi becomes excessive; if this excess does not subside, illness ensues. The pathogenic Qi does not reach the Yin aspect, resulting in fever without chills. (Lungs harboring heat internally indicates a person with hyperactive Yang and substantial Qi. Thus, when external pathogens invade, they remain only in the Yang aspect and do not penetrate the Yin, causing fever without chills.) The pathogenic Qi resides internally within the Heart and externally lodges between the muscle layers, causing emaciation and flesh wasting; hence it is named Epidemic Fever Malaria. The Yellow Emperor said: Well said. (Qi resides in the Heart, the residence of Yang. Heat in the muscles causes emaciation. Thus, the location where Epidemic Fever Malaria lodges is in the Lung and Heart meridians.)

(From *Ling Shu: Sui Lu Pian*. The wording and meaning here overlap significantly with the previous chapter on Malaria, suggesting it might be redundant. However, since there are slight differences, it is preserved for cross-reference. Appendix: Treatment Methods for Malaria.)
The Yellow Emperor asked Qibo: The classics state that summer injury by Summerheat leads to autumn malaria, and malaria attacks at specific times. What is the reason? (Wherever the meaning overlaps with the previous chapter, no further explanation is given.) Qibo answered: The pathogen lodges in the Fengfu point (GV16), and the disease follows the spine downward. Wei Qi (Defensive Qi) convenes at the Fengfu point once every day and night. The next day, it descends one vertebral segment. Therefore, the daily attack occurs later. This is because the pathogen initially lodged in the back. Whenever Wei Qi reaches the Fengfu point, the interstices open; when the interstices open, the pathogen enters; when the pathogen enters, the disease manifests. This explains why the daily attacks occur progressively later. Wei Qi’s movement at Fengfu descends one segment daily. After twenty-one days, it reaches the base of the coccyx. On the twenty-second day, it enters the interior of the spine and pours into the Fu Chong Mai (Hidden Surging Vessel). (*The previous "Malaria Theory" states it reaches the bone on the twenty-fifth day and enters the spine interior on the twenty-sixth, differing from this text. That text likely refers to the cervical vertebrae combined with the skull, whereas this text refers solely to the spinal column. The Hidden Surging Vessel was written as the Hidden Spine Vessel in the previous text.*) Wei Qi travels for nine days, emerging from the Quepen area (ST12 region). Its Qi moves upward, so the condition gradually worsens. ("Zhi" [arrive] is an error; the previous text says "Yi Zao" [earlier] is correct.) The pathogen presses inward against the Zang organs and spreads horizontally to the Mu Yuan (Sea of Origin). The pathway is long, the Qi is deep, and its movement is slow, preventing daily attacks. Thus, it accumulates power and attacks on alternate days. (The previous text says it attacks on alternate days. "Xu" is pronounced Chang-Liu-Qie.) The Yellow Emperor said: When Wei Qi reaches the Fengfu point, the interstices open, and upon opening, the pathogen enters. If Wei Qi descends one segment daily, it would not always be at Fengfu. How should this be explained? Qibo said: Fengfu has no fixed location. Wherever Wei Qi responds, it opens the interstices. The segment where the pathogen lodges becomes its "Fu." (In the previous text, "Wei Qi responds" was written as "Wei Qi emits." "Suo She Jie" refers to the segment where the pathogen lodges.) The Yellow Emperor said: Well said. Wind and Malaria are of the same category, yet wind persists while malaria pauses intermittently. Why? Qibo said: Wind pathogen remains stationary, while Malaria Qi follows the meridians, sinking and pressing inward. Thus, it manifests only when Wei Qi arrives. The Yellow Emperor said: Well said. (The two instances of "Bo" [press/battle] in this chapter were written as "Bo" [approach/thin] in the previous *Malaria Theory*. My analysis: Chapters like *Sheng Qi Tong Tian Lun* state: Summer injury by Summerheat leads to autumn malaria. *Malaria Theory* states: All malaria arises from Wind. It also states: Malaria is due to irregular Wind-Cold. It further states: Sweating followed by exposure to wind, or bathing, allows Water Qi to lodge within the skin. These discussions all cite Wind, Cold, Summerheat, and Dampness as causes, encompassing the etiology of malaria. If we distinguish Yin and Yang based on this: Wind and Summerheat are Yang pathogens; Cold and Water are Yin pathogens. However, Wind is cool Qi within Yang; Summerheat is cold Qi within heat. Considering these four together, they essentially all belong to Cold. Hence, in Jiangnan, it is called Spleen Cold Disease, meaning Cold pathogen lodges in the muscles, and the Spleen governs the muscles. Before malaria attacks, there must be cold extremities because the Spleen governs the limbs. Thus, the name "Spleen Cold" is justified. However, Zhang Hezi opposed this, saying: Since *Nei Jing* attributes malaria to summer Summerheat injury, why do physicians treat it as Spleen Cold? Zhang Hezi considered Summerheat as Heat pathogen, leading to this view. Did he not read the scripture: Summer injury by intense Summerheat causes profuse sweating and open interstices. If one encounters cold water in summer, it hides in the interstices and skin. Autumn injury by Wind then completes the illness. This shows that "Summerheat" refers to the seasonal climate, while "Cold" refers to the pathogenic nature. As the pathogen changes from superficial to deep, stagnant Cold transforms into Heat, but ultimately Cold remains the root and Heat the branch. How can it not be considered Cold? Initially, Cold pathogen lies dormant in the interstices. When autumn coolness arrives, it constricts the exterior, preventing the exterior pathogen from venting. Yin desires to enter but is rejected by Yang; Yang desires to exit but is blocked by Yin. Yin and Yang battle, and the disease manifests. Superficial cases involve the Three Yang meridians, following Wei Qi’s entry and exit, causing daily attacks. Deep cases involve the Three Yin meridians; the pathogen cannot exit with Wei Qi, causing attacks every other day or every three to four days. The later the attack, the more severe the disease. Thus, the severity of malaria depends on the depth of Yin and Yang. Hence, in the classic, there are classifications of Cold Malaria, Warm Malaria, Epidemic Fever Malaria, and Six Meridian/Six Zang Malaria syndromes, all falling under this principle. Later, from Yang Renzhai and Zhu Danxi onwards, distinctions were made for Phlegm Malaria, Food Stagnation Malaria, and Malaria due to Fluid Retention or Blood Stasis. These are merely concurrent syndromes of malaria, not the primary cause of malaria itself. Additionally, there is Zang Malaria, found only in the miasma-prone regions of Lingnan, caused by external Dampness. There is Pin Malaria, characterized by chills without fever, due to insufficient Yang Qi and excess Yin pathogen. There is Labor Malaria, triggered by exertion, due to deficiency of exterior and interior Qi making one susceptible to pathogens. There is Ghost Malaria, where no ghost exists, but the Spirit is disturbed by pathogen. Thus, all are essentially Cold pathogen. External pathogens should be resolved through sweating. Scripture states: Those who do not sweat during summer heat will develop Wind Malaria in autumn. Also: Summerheat should be expelled with sweat; do not stop it. Also: If the body burns like charcoal, sweating dissipates the heat. These illustrate the principle. Therefore, treating malaria requires observing the depth of the pathogen and the Yin-Yang nature of the syndrome. One must guide the pathogen from Zang to Fu, from interior to exterior, drawing it out and dispersing it, lifting and raising it, so the pathogen exits and harmony is restored. Treatment principle: For those with sweat, aim to stop it by supporting Right Qi and dispersing pathogen; for those without sweat, aim to induce it by dispersing pathogen and supporting Right Qi. This is correct. However, inducing sweat is easier for pathogen in Yang meridians than in Yin meridians; thus, spring/summer cases are easier to treat than autumn/winter cases; upper body cases are easier than lower body cases. One must unblock Yin Qi to induce sweat in the lower body. Ideally, the condition shifts from Yin to Yang, and from late to early onset, indicating a good prognosis. Sweat difficulty indicates severity. If external Wind-Cold and internal injury by raw/cold foods cause simultaneous exterior and interior pathology, Malaria and Dysentery may occur together. Malaria stems from meridians; Dysentery stems from Zang organs. By addressing both exterior and interior and removing the root of Cold-Dampness, both will heal. Conditions like Phlegm-Food, Blood-Qi imbalance, Internal Cold, or Internal Heat should be treated concurrently based on severity, not as the primary focus. This is the general method for treating malaria. Although methods vary, the key lies in Root/Branch and Deficiency/Excess. Branch refers to Pathogen; Excess means strong pathogen. Root refers to Right Qi; Deficiency means depleted Right Qi. If Excess Syndrome and Pulse are present, target the location directly to expel the pathogen, and other symptoms will resolve. This is treating the Branch. If no Excess signs exist but illness persists, it is due to Qi deficiency. One must warm and tonify True Yuan, cultivate the root, strengthen Middle Qi, and force the pathogen outward. This is treating the Root. Treat the Branch if present; treat the Root if absent. This captures the essence. For chronic malaria where exterior pathogen has weakened and drugs fail, use Ren Shen (Ginseng Radix) and Sheng Jiang (Zingiberis Rhizoma Recens), each 1 liang, decocted. Take two doses before the predicted onset time or at dawn on the day of attack. Recovery is assured. If Ginseng is too expensive, Bai Zhu (Atractylodis Macrocephalae Rhizoma) and Dang Gui (Angelicae Sinensis Radix) may substitute. For Yin deficiency with fluid depletion, increase Shu Di Huang (Rehmanniae Radix Praeparata) and Sheng Jiang. Effects are immediate. However, one must diagnose internally via pulse and externally via syndrome, understanding the urgency of Root/Branch. Then, what fear is there of malaria? I have reviewed formulas for malaria, many ignoring exterior/interior sequence, indiscriminately using Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), Zhi Mu (Anemarrhenae Rhizoma), Da Huang (Rhei Radix et Rhizoma), and Shi Gao (Gypsum Fibrosum). Using such cold-cooling herbs when exterior pathogen is unresolved drives Cold deeper. Alternatively, overusing Chang Shan (Dichroae Radix), Cao Guo (Tsao-ko Fructus), or harsh interceptive agents damages already compromised Right Qi, leading to chronicity, worsening severity, and danger. This results from missing the root. Grasping the root makes treatment easy as turning a hand; it depends on investigating the cause.)