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[Pulse]
The *Mai Jue* (Pulse Mantra) states: The pulse of malaria naturally presents as a string-like (Xian) pulse. A string-like and slow pulse indicates excess cold; a string-like and rapid pulse indicates excess heat; a string-like, small, and tight pulse is suitable for purgation; a string-like and slow pulse is suitable for warming; a string-like and rapid pulse is suitable for diaphoresis; a floating, large, and slippery pulse is suitable for emesis; a洪 (Hong, surging) and rapid pulse that is forceless upon pressure indicates deficiency; a Dai (intermittent) or San (scattered) pulse portends death.

[Symptoms]
The *Neijing* (Inner Canon) states: Summer injury by summerheat leads to dysentery or malaria in autumn. If fever precedes chills, it is called Wen Nue (Warm Malaria); if there is only fever without chills, it is called Dan Nue (Fiery Malaria); if it persists for years and forms a mass, it is called Lao Nue (Old Malaria), also known as Nue Mu (Malaria Mass). If there are alternating chills and fever with heavy body, painful joints, abdominal distension, and spontaneous sweating, it is Shi Nue (Damp Malaria). If chills and fever do not cease, but there is only severe trembling and aversion to cold, with attacks occurring at regular times, it is Pin Nue (Yin Malaria). If caused by food stagnation, it is Shi Nue (Food Stagnation Malaria). If all ages in a year suffer similarly, it is Yi Nue (Epidemic Malaria).
My commentary: The *Neijing* explicitly states it is caused by summerheat injury in summer. Why do later physicians attribute it entirely to Spleen cold and use warming herbs? In fact, trembling and aversion to cold are manifestations of extreme heat resembling water; when hyperactivity reaches its limit, it causes harm, requiring a controlling force to regulate it.
Furthermore, according to Danxi: Malaria occurs when summerheat pathogens lodge between the Ying (Nutritive) and Wei (Defensive) levels. If the Couli (skin pores and interstices) are not dense, and wind-cold is encountered, they close up and cannot exit, lodging outside the stomach and intestines. They simmer and circulate with the Ying and Wei Qi. During the day, they travel in the Yang aspect; at night, in the Yin aspect. When they merge, disease arises; when they separate, disease ceases. Merging in Yang causes heat; merging in Yin causes cold. Shallow involvement leads to daily attacks; deep involvement leads to every-other-day attacks. Involvement in Qi results in early onset; involvement in Blood results in late onset. Thirst indicates dryness prevailing; no thirst indicates dampness prevailing.
The *Jiyao* states: Involvement of the Taiyang Channel manifests as Han Nue (Cold Malaria), treated mostly with diaphoresis; involvement of the Yangming Channel manifests as Re Nue (Heat Malaria), treated mostly with purgation; involvement of the Shaoyang Channel manifests as Han Re Nue (Cold-Heat Malaria), treated mostly with diaphoresis. Disease in these three Yang channels is called Bao Nue (Acute Malaria), occurring from after Summer Solstice to before End of Heat, indicating shallow pathogen invasion. Involvement of the three Yin channels is collectively called Wen Nue, occurring from after End of Heat to before Winter Solstice, indicating heavy pathogen invasion. This theory is sound. Among the three Yin channels: attacks on Zi, Wu, Mao, You days are Shaoyin Malaria; attacks on Yin, Shen, Si, Hai days are Jueyin Malaria; attacks on Chen, Xu, Chou, Wei days are Taiyin Malaria. Clinical differentiation should be detailed.

[Treatment Principles]
Danxi stated: Malaria acquired from summerheat should be resolved via diaphoresis. If sweat cannot be produced, stagnation transforms into phlegm; one should nourish the Stomach and resolve phlegm, prioritizing diaphoresis. Once the pathogen exits, harmony returns. For no sweat, promote sweating to scatter the pathogen, accompanied by tonification, using Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Chuanxiong, Cangzhu, Shengma, Ge Gen, etc. For excessive sweat, stop sweating by supporting the Righteous Qi, accompanied by scattering the pathogen, using Renshen, [missing character], Danggui, Baizhu, Shaoyao, Huangbai, Maidong, Wuweizi, etc., to tonify and astringe. For deficiency, Renshen and Baizhu must be used for one or two doses to support the Qi and prevent sinking, followed by other herbs based on symptoms. For extreme thirst, high fever, and headache like splitting, use Xiao Chai Hu Tang, remove Banxia, add Chuanxiong, Shigao, Zhimu. For Summerheat Malaria, use Renshen Baihu Tang (Ginseng White Tiger Decoction). For phlegm, use Er Chen Tang (Two-Cured Decoction) plus Changshan to induce vomiting. For anorexia, it stems from food; treat via digestion, using Pingwei San (Peaceful Stomach Powder) plus Shanzha, Shenqu, Caoguo, Qingpi.
For Nue Mu (Malaria Mass) under the left hypochondrium causing spontaneous sweating and pain, use Qinghao and Biejia as main herbs, assisted by Sanleng, Ezhu, Xiangfu, Qingpi, Taoren. After multiple malaria attacks, use Xiao Chai Hu Tang plus Changshan, Caoguo, Qingpi, Wumei to intercept the malaria. Prolonged duration weakens the Middle Qi, making the disease deeper and harder to treat.

[Formulas]
Chai Ling Er Chen Tang treats various malarias, suitable for those with more heat than cold.
Chaihu, Baizhu, Cangzhu (each 1.5 qian), Renshen, Banxia (processed with ginger), Huangqin (each 1 qian), Huoxiang, Chuanxiong, Fuling, Chenpi, Qingpi (each 0.8 qian), Gancao (0.3 qian), Nongpo (0.7 qian).
Take as one dose, add three slices of Shengjiang, one Zao, 1.5 zhong of water, decoct to 0.8 zhong, take far after meals.
At initial onset when Yin and Yang are undifferentiated, add Zhuling, Zexie (each 0.8 qian), Guizhi (0.4 qian).
If once daily, attacking before noon, the pathogen is in the Yang aspect; add Huangqi (1 qian), increase Fuling, Banxia (each 0.5 qian).
For intense heat and headache, add Shigao (1.5 qian), Congbai juice (2 chi).
For thirst, add Shigao (1.5 qian), Zhimu (1 qian), Mendumdong (1 qian).
For every-other-day or third-day attacks, or afternoon/night attacks, add Danggui, Shaoyao, Dihuang, Zhimu (each 1 qian), Jiu Honghua, Jiu Bai, Shengma (each 0.4 qian); this indicates pathogen in the Yin aspect, lift to the Yang aspect to intercept.
If skipping one day, then two consecutive days, or attacking once day and once night, both Qi and Blood are diseased; add Huangqi (1 qian), increase Renshen, Fuling (each 0.5 qian) to tonify Qi; add Danggui, Shaoyao, Dihuang (each 1.5 qian) to tonify Blood.
For Yang Malaria with excessive sweat, add Huangqi (1.5 qian) to astringe. For no sweat, add Gegen (1.5 qian) to induce sweat.
For Yin Malaria with excessive sweat, add Danggui, Shaoyao, Dihuang, Huangbai, Zhimu (each 2 qian) to astringe.
For no sweat, double Chaihu, Cangzhu, add Shengma (0.7 qian), Gegen (1.5 qian) to induce sweat.
For weak Stomach and poor appetite, or damage to Spleen/Stomach by interception drugs, adding Renshen (0.5 qian), Shaoyao (wine-fried), Maiya (each 1 qian), Sharen (0.5 qian), Bidou (0.8 qian).
For food accumulation, add Shanzha, Shenqu, Zhishi, Caoguo (each 1 qian), Huanglian (0.4 qian).
For Zhang Nue (Miasmic Malaria), add Binglang, Zhimu, Gegen, Baizhi (each 1 qian), Wumei (3 pieces).
If malaria transforms into dysentery, prioritize tonifying deficiency and clearing heat; add Renshen (0.5 qian), add Sharen (0.7 qian), Bidou, Huanglian (each 1 qian), Muxiang (0.7 qian), Danggui (1.2 qian), Shaoyao (1.5 qian), Binglang (0.7 qian), Wumei (2 pieces).
To intercept, add Changshan (1.5 qian), Binglang, Caoguo (each 1 qian), Wumei (7 pieces), decoct in 2 zhong of water, take on empty stomach.
For prolonged deficiency malaria, or [missing character] malaria persisting for years, use this formula, remove Nongpo, Cangzhu, Chuanxiong, Huoxiang, Qingpi; halve Chaihu, Huangqin. Add Huangqi, Danggui (each 1.5 qian), Baishaoyao, Zhimu, Qinghao, Digupi (each 1 qian), Biejia (roasted 2 qian, nine-pronged or seven-pronged).
For more heat and less sweat, or extreme thirst, add Shigao (1.5 qian), Zhimu, Gegen (each 1 qian), Maidong, Shanzhi (each 0.8 qian), increase Huangqin (0.5 qian).
For more cold and less heat, or only cold without heat, add Dingxiang (0.7 qian), Guanzi (1 qian), Ganjiang (1 qian), Caoguo (1 qian); for severe cases, add Fuzi (1 qian), halve Chaihu, Huangqin.
For Spring Malaria, add Fangfeng, Gange, Baizhi (each 1 qian).
For Summer Malaria, add Huanglian, Bidou (each 1 qian), Xiangru (1 qian).
For Autumn Malaria, add Zhimu, Guishen, Beimu, Xingren, Maidong (each 1 qian).
For Winter Malaria, add Xingren (1 qian), Guizhi (0.8 qian), Ganjiang (0.7 qian); for more cold, add Dingxiang (0.5 qian).
If long-term mild chills/fever or only slight heat without cold, the pathogen is exhausted. In summer, use Qingshu Yiqi Tang (Clear Summerheat and Boost Qi Decoction). In other months, use Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction), add Maidong, Huangbai, Zhimu (each 0.8 qian) to tonify Qi and Blood. Post-interception regulation follows this principle.
Another Formula: Jie Nue Dan (Malaria-Intercepting Pill) is miraculous for all malarias, proven effective.
Renshen (2 liang, remove rhizome), Xionghuang (1.6 liang, ground separately), Chensha (6 qian, ground separately).
Grind the three ingredients into powder, weigh accurately. On the fifth day of the fifth month, make pills from Zong rice of five families, size of beans. Adults: 10 pills; Children: 5 pills. On the attack day, at dawn, take on empty stomach, delivered with Qinghao decoction made with Wugen water (rainwater/snowwater). Avoid raw/cold foods, chicken, and fish for one month.