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This occurs because the pathogenic factor and the Wei Qi (Defensive Qi) travel together to the Fengfu acupoint (GV16), but at times they lose coordination and fail to move in sync. Consequently, the pathogenic factor internally assaults the Zang organs. Due to the long pathway and deep location of the disease, its movement is slow; it cannot exit simultaneously with the Wei Qi. This is why the condition manifests every other day.

Generally, all malaria arises from Wind pathogens. Wind belongs to Yang energy, and Yang governs heat. Therefore, whenever the Wei Qi reaches the Fengfu acupoint (GV16), the Couli (pores and interstices of the skin) open. When the Couli are open, pathogens enter; once pathogens enter, the disease manifests. Because the body was initially injured by Wind, fever appears first, followed by chills.

The so-called Dan Malaria (a type of malaria characterized by high fever) occurs because the lungs inherently possess accumulated heat, causing Qi to be excessive throughout the body. There is rebellious Qi rushing upward, and the Qi in the Middle Jiao is full but fails to vent outward. Due to physical exertion that causes the Couli to open, Cold-Wind pathogens lodge within the skin and between the muscles (Fenrou). Upon manifestation, Yang Qi becomes excessive. If this excessive Yang Qi does not decline, the disease persists. Since the pathogenic Qi does not reach the Yin aspect, there is only fever without chills. The hot Qi stores internally in the Heart and externally lodges between the muscles, causing emaciation and wasting of flesh; thus, it is named Dan Malaria. Its presentation involves only fever without chills; Yin Qi is exhausted first, while Yang Qi acts alone and excessively, resulting in shortness of breath, mental restlessness and vexation, heat in the hands and feet, and vomiting.

This disease originates in the Lingnan region, carrying the miasmic Qi of the mountains. Its symptoms include alternating chills and fever with regular intervals. This is caused by the damp-toxic vapors found in mountain streams and ridges. The severity of this illness exceeds that of malaria caused by summer-heat injury.

Tan Shi Malaria (Phlegm-Stasis Malaria) refers to a condition where the patient already has stagnant phlegm consolidated in the chest and diaphragm prior to onset. This leads to malaria, causing distension and fullness below the heart (epigastrium), rebellious Qi, mental irritability, and vomiting.

Generally, malaria is caused by Cold-Wind pathogens. When pathogens merge into the Yin aspect, cold manifests; when they merge into the Yang aspect, heat manifests. Therefore, attacks always involve both cold and heat.

This occurs because Cold Qi merging into Yin induces chills, while Wind Qi merging into Yang induces fever. The Yin and Yang Qi undergo alternating excess and deficiency, leading to the alternating recurrence of chills and fever.

This results from the mutual binding of Yin and Yang pathogens. When Yang is deficient, Yin prevails; when Yin prevails, cold generates. Cold emanates from the interior and merges with the exterior, causing both interior and exterior to be cold. Thus, during an attack, the patient experiences only shivering and clenching of the jaw.

For malaria that persists for a long time without resolution, both the exterior and interior become deficient. The invading pathogens have not dispersed, and the True Qi has not recovered. Therefore, although the disease may temporarily subside, any slight exertion will trigger a recurrence.