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I have examined various Materia Medica texts, all of which state that Changshan (Dichroa Radix) is bitter, cold, and toxic, serving as a key herb for treating malaria. However, this herb most easily damages the body's True Qi (vital energy). If the malaria pathogen has not yet been resolved, and one hastily uses antimalarial drugs to stop the attack, although it may bring temporary relief, the condition will recur shortly thereafter, or other symptoms may develop, such as swelling, often leading to death. I have witnessed many such cases with my own eyes. Nevertheless, it might be used temporarily only in those with robust Yuan Qi (original qi) and sturdy constitutions, such as rough laborers in rural areas.

Wang Shishan stated: The Materia Medica records that Zhi Mu (Anemarrhenae Rhizoma), Caoguo (Tsaoko Fructus), Wumei (Mume Fructus), and Chuanshanjia (Pangolin Scales) can all treat malaria. Among them, Zhi Mu is cold in nature and enters the Foot-Yangming channel, specifically clearing excessive fire, causing it to retreat to the Taiyang channel. Caoguo is warm and drying, treating excessive cold in the Foot-Taiyin channel, causing it to retreat to the Yangming channel. When these two herbs are combined and harmonized, there will be no adverse changes from the interaction of Yin and Yang; thus, they serve as the Sovereign (Jun) herbs. Changshan primarily treats chills and fever in malaria, vomiting, and phlegm accumulation in the chest, so it is used as the Minister (Chen) herb. Gancao (Licorice Root) harmonizes the various herbs, Wumei removes phlegm, and Binglang (Areca Seed) eliminates phlegm-related stagnation and breaks stagnant Qi, so they are used as the Assistant (Zuo) herbs. Chuanshanjia, because it lives by burrowing through mountains and entering water, symbolizes moving out of Yin into Yang, penetrating the meridians to enter the Ying (Nutritive) level, thereby breaking the congealed summer-heat pathogen; thus, it serves as the Envoy (Shi) herb. This formula is certainly effective if the cause is phlegm-fluid retention due to depression in the Spleen and Stomach. However, if there is no phlegm, but only summer-heat congealing in the Ying level, corresponding solely to heat in the Blood level of the Foot-Taiyin, where lip sores should appear, this formula will be ineffective.

Danxi stated: Changshan has a violent and aggressive nature, good at expelling pathogens, but it can damage True Qi. It should not be used for patients who are slightly deficient or frail.

Zhang Tongyi said: In reviewing prescriptions for malaria, many do not distinguish between exterior/interior conditions or the sequence of treatment, indiscriminately using cold and cooling herbs like Huangqin (Scutellariae Radix), Lianzi (Coptidis Rhizoma), Zhi Mu, Dahuang (Rhei Radix et Rhizoma), and Shigao (Gypsum Fibrosum). Since the exterior pathogen is unresolved, using these cold herbs causes the cold pathogen to sink deeper. Alternatively, arbitrarily using harsh and drastic antimalarial agents like Changshan and Caoguo, or strong purgatives, when the healthy Qi is already injured by the pathogen, further depletes the Yuan Qi. Consequently, the disease often becomes chronic, light cases become severe, and severe cases become critical. All these errors stem from failing to grasp the root cause. Grasping the root makes treatment as easy as turning over a hand; it lies merely in investigating the origin.

I believe that the method for treating malaria should focus on the essentials, covering only six aspects: new vs. old, deficiency vs. excess, and root vs. branch. For new-onset malaria with prominent branch symptoms and robust Yuan Qi, one should use Zhang Zhongjing’s methods, observing the speed of onset during day and night to guide treatment. Liu Zongnong stated: Attacks occurring from Mao hour to Wu hour should be treated with Da Chai Hu Tang (Major Bupleurum Decoction) to purge; attacks from Wu hour to You hour should be treated with Da Cheng Qi Tang (Major Order the Qi Decoction) to purge; attacks from You hour to Zi hour or Yin hour should be treated with Tao Ren Cheng Qi Tang (Peach Kernel Order the Qi Decoction) to purge. Subsequently, Xiao Chai Hu Tang (Minor Bupleurum Decoction) should be used to eliminate residual pathogens. If the pulse is excess and long, start with Da Chai Hu Tang to purge; if residual heat remains, use Baizhi Tang (Angelica Dahurica Decoction). If chills are heavy and fever is slight, or if there is only chills without fever, it is called Pin Malaria (Female Malaria); treat with Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) to release the exterior. These are all methods for treating excess patterns.

For chronic malaria with few branch symptoms and deficient Yuan Qi, if attacks occur every other day, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). If Qi and Blood are both deficient and attacks occur every three to four days, indicating deep internal involvement, use Shiquan Dabu Tang (Ten Substance Great Tonifying Decoction). If caused by dietary injury, base the treatment on Liujunzi Tang (Six Gentlemen Decoction). If caused by overwork injuring Middle Qi, also base the treatment on Buzhong Yiqi Tang. For cases persisting for a long time, use 1–2 liang of Renshen (Ginseng Radix et Rhizoma) and half the amount of Shengjiang (Zingiberis Rhizoma Recens), decocted into a concentrated soup, administered one to two hours before the anticipated onset. A few doses will bring immediate cessation. There are also cases where the disease is chronic but branch symptoms remain and Yuan Qi is not yet depleted, requiring simultaneous tonification and purging. Furthermore, in new-onset cases presenting with sudden deficiency, urgent rescue of the root is required; one must not refrain from using strong tonics simply because the pathogenic factor is currently vigorous.

The general principle is: If there is sweating, aim to stop it by supporting the righteous Qi; since the Couli (pores) are open and Yang cannot consolidate, tonification and astringency are necessary. If there is no sweating, aim to induce it by dispersing the pathogen; since the Couli are tight and the pathogen cannot resolve, dispersion is necessary. Although sweating indicates a need for tonification, dispersion should also be considered; although lack of sweating indicates a need for dispersion, tonification should also be considered. This is because when pathogenic factors are abundant, it manifests as excess and must be attacked; when essence and Qi are depleted, it manifests as deficiency and must be tonified. Therefore, diseases in the Yang levels are superficial and easier to treat; diseases in the Yin levels are deep and harder to treat. Treatments in Spring and Summer are easier; in Autumn and Winter, harder. Diseases in the upper body are easier; in the lower body, harder. In youth and prime, easier; in old age, harder. Especially difficult are women during pregnancy and postpartum. Treatment must strive to transform Yin to Yang, late onset to early onset, lower body to upper body, or change from more chills than fever to alternating daily, indicating transmission from Zang (organs) to Fu (bowels). Sweating from the head down to the feet indicates ease of recovery.

Lizhai stated: Whenever a patient presents with high fever, dryness, and thirst, drinking Ginger Soup while hot is an excellent method for arresting malaria. I often see patients consuming raw or cold foods during an attack; while the illness may seem to improve slightly, it often leads to Spleen deficiency and Stomach damage, becoming incurable. He also said: I frequently use 1 liang each of Renshen and Baizhu (Atractylodis Macrocephalae Rhizoma), along with 4 liang of Shengjiang, stewed and decocted for administration, which stops the malaria immediately. Using a large dose of Buzhong Yiqi Tang with stewed ginger is even more effective. Using Shengjiang alone is also effective. Alas, this method is extremely sound; why seek erratic prescriptions? Qingpi Yin (Clear the Spleen Drink) and Jiemie Yin (Arrest Malaria Drink) should absolutely not be taken lightly. Nourishing the righteous Qi naturally eliminates the pathogen; how could one risk life for the sake of a fleeting quick cure?

There are also symptoms resembling malaria. True malaria arises from external contraction of Wind-Cold, Summer-Heat, and Dampness, whereas malaria-like conditions arise from the decline of Zang-Fu organs and Qi-Blood. One type depends on the entry and exit of Ying and Wei (Defensive) Qi to determine onset and cessation; another depends on the conflict between Water and Fire to determine excess and deficiency. One focuses on the exterior, one on the interior; one attacks the pathogen, one supports the righteous Qi. There are Yang deficiency cases presenting with chills and fever resembling malaria, and Yin deficiency cases presenting similarly. Generally, malaria-like conditions are not true malaria; between these distinctions lie differences in pathogen vs. righteous Qi and deficiency vs. excess. A slight error in treatment can lead to life or death instantly; students of medicine must be particularly aware of this.