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What is the distinction between Warm Malaria (Wen Nue) and Cold Malaria (Han Nue)? Warm Malaria arises from contracting Wind-Cold in winter; the pathogenic Cold hides within the Marrow. By spring, when Yang Qi expands vigorously, the pathogen cannot exit. If accompanied by intense summer heat, the brain marrow is scorched, vessels and flesh are depleted, and Cou Li (pores/skin texture) open and sweat is released. If physical exertion occurs at this time, the pathogen exits along with the sweat. This disease resides in the Kidney. Its Qi first moves from the interior to the exterior, resulting in Yin deficiency and Yang excess, which generates Heat. When the Heat declines, the Qi reverses and returns inward; inward movement leads to Yang deficiency, and Yang deficiency results in Cold. Thus, it presents as fever followed by chills, named Warm Malaria.

Malaria that begins with chills followed by fever occurs because of Summer-Heat injury in summer. Profuse sweating opens the Cou Li, and one encounters cold water or cold air (associated with summer's chilling nature), causing Cold to hide within the Cou Li and skin. In autumn, Wind injury exacerbates the condition. Cold belongs to Yin Qi; Wind belongs to Yang Qi. Injury by Cold first, then by Wind, results in initial chills followed by fever, occurring at regular intervals, named Cold Malaria. Conversely, injury by Wind first, then by Cold, results in initial fever followed by chills, also occurring at regular intervals, named Warm Malaria.

If malaria persists for six or seven days and only fever is observed, it is classified as Warm Malaria.

Regarding Malaria, it originates from Summer-Heat injury in summer. The symptoms manifest as severe chills in autumn, mild chills in winter, aversion to Wind in spring, and profuse sweating in summer, yet its paroxysms occur at fixed times. At the onset of a malaria attack, hair stands on end, yawning and stretching occur, followed by shivering with mandibular clattering, and pain in the lower back and spine. After the chills subside, both interior and exterior become hot, accompanied by headache and thirst requiring drinking. What Qi causes this? It is due to the contention between Yin and Yang above and below, alternating deficiency and excess, and the shifting of Yin and Yang. When Yang merges into Yin, Yin becomes full and Yang becomes deficient. Deficiency of Yang Ming leads to shivering and mandibular clattering; deficiency of Ju Yang (Tai Yang) leads to pain in the waist, back, head, and neck. If all three Yang channels are deficient, Yin Qi prevails; Yin prevalence causes bone cold and pain, with cold generating from within, resulting in coldness both inside and outside. Yang excess causes external heat; Yin deficiency causes internal heat. Internal and external heat together lead to panting and thirst requiring drinking. This results from Summer-Heat injury in summer, where excessive Heat Qi hides between the skin and the intestines/stomach, the residence of Ying Qi (Nutritive Qi). This causes sparse sweating and open Cou Li, allowing Autumn Qi to enter; sweating combined with Wind exposure causes the disease, or bathing allows Water Qi to reside within the skin, coexisting with Wei Qi (Defensive Qi). Wei Qi travels through the Yang channels during the day and the Yin channels at night. This pathogen follows Wei Qi outward to the Yang level to cause heat, and inward to contend with Yin to cause cold. The contention between interior and exterior causes daily paroxysms.

When paroxysms occur every other day, it indicates the pathogen resides deeply, contending internally with Yin. Yang Qi alone erupts, while Yin pathogen adheres internally. Yin and Yang contend but cannot exit, resulting in every-other-day paroxysms.