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At the time of sudden stroke (Zhong Feng), one must not panic or move/disturb the patient. One should only pinch the Renzhong (GV26) acupoint and slowly administer medicine.

*Rumen Shiqin* records a case of an elderly man suffering from headache with vomiting and diarrhea. After moxibustion, he went out and collapsed upon seeing sunlight. His family wanted to rub and pat him. Dai Yuanli immediately stopped them, saying: "Absolutely do not disturb. Because the patient is old and frail, having undergone emetic and purgative treatments, his blood vessels are prone to disorder. There is residual heat from moxibustion inside, and exposure to the sun outside, causing the collapse. If disturbed further, it will be incurable. Only calm the patient's spirit and wait in stillness. Stillness belongs to Water, and naturally, there will be no trouble."

Ancient physicians, when treating diseases, first examined the etiology, then distinguished the strength or weakness of the constitution, and then treated, just as archery aims at the target. How could ordinary artisans in the marketplace dream of such realms?

Note: Stroke is a major disease; is this brief description too simple? What the world calls stroke, characterized by deviation of the mouth and eyes and hemiplegia, is called *Piangu* (Hemiplegia) in the *Neijing*. Left paralysis and right flaccidity, as well as fear of wind in the legs, are manifestations of shallow pathogenic factors after sudden collapse. Tongue stiffness with inability to speak, and loose lips that cannot close, are called *Fei Bing* in classics, which corresponds to the syndrome of *Feng Yi* in *Qianjin Fang*, representing deep pathogenic factors after sudden collapse. Li Dongyuan believed that involvement of the Fu organs implies shallow pathogens and is easy to treat, while involvement of the Zang organs implies deep pathogens and is difficult to treat. Examining the methods of Lou Ying and Sun Yikui, their analysis is most thorough. They clarified the distinctions among Mao (minor invasion), Shang (injury), and Zhong (stroke), weighing severity to prescribe medication. Severe cases manifesting as Taiyang disease (Disease of the Taiyang channel), headache and neck pain, and stiffness of the waist and spine, are treated with Guizhi Tang (Cinnamon Twig Decoction), termed Wind Injury. Mild cases occur in all seasons, known as common cold or minor wind invasion, treated with Jiuwei Qianghuo Tang (Nine-Ingredient Notopterygia Decoction) plus Chaihu (Bupleuri Radix), which is a routine method for various channels. Extremely severe cases involve Cold invading the Three Yin channels or stroke involving the Six Channels, treated with pungent-hot warming methods.

Generally, diseases often cause alternating chills and fever. Those with regular intervals are Malaria (Nüe). Those without regular intervals are other diseases. In malaria, if the pathogen is shallow, it attacks once daily; if deep, every other day or every two to three days. If the pathogen is at the boundary of Yin and Yang, it attacks both day and night; if in Yang, it attacks in the first half of the day; if in Yin, in the second half. Cases with chills preceding fever are caused by initial Cold injury followed by Wind injury, named Han Nüe (Cold Malaria). Cases with fever preceding chills are caused by initial Wind injury followed by Cold injury, named Wen Nüe (Warm Malaria). Cases with only fever and no chills result from Yin deficiency failing to control Yang, leading to isolated Yang hyperactivity, named Dan Nüe (Blazing Malaria). Cases with only chills and no fever result from Yang deficiency failing to control Yin, leading to isolated Yin excess, named Pin Nüe (Female Malaria). The pulse in malaria is naturally Wiry (Xian). A Wiry-Rapid pulse indicates more heat; a Wiry-Slow pulse indicates more cold. A Wiry-Small-Tight pulse requires purgation; a Wiry-Slow pulse requires warming; a Wiry-Tight-Rapid pulse requires clearing; a Floating-Large pulse requires emesis; a Floating-Wiry-Rapid pulse indicates Wind origin, resolved through dietary management. A weak and powerless pulse indicates chronic illness; a Full-Rapid powerless pulse or a Minute pulse both indicate deficiency. (A powerless, minute pulse, barely palpable even with heavy pressure, indicates deficiency of healthy Qi and excess of pathogenic factors.) Summerheat malaria presents with only heat or more heat than cold, greasy complexion, thirst, persistent sweating even after fever subsides, heart heat with irritability, and a Full-Void pulse. Wind malaria presents with aversion to wind, spontaneous sweating, irritability, headache, progressing to malaria. Wind is Yang energy, hence fever precedes chills. Cold malaria presents with aversion to cold, no sweating, spasmodic pain, pale face, progressing to malaria. Cold is Yin energy, hence chills precede fever. At the onset of these two syndromes, Wind-Cold is in the exterior. Even after chills and fever pass, the body often aches and fears wind; treatment should focus on dispersing. Dampness malaria presents with heavy body, joint pain, belching, nausea, and fullness, caused by exposure to rain/dampness or bathing while sweating. Food stagnation malaria presents with hunger but inability to eat, abdominal fullness after eating, nausea, and abdominal pain, caused by irregular diet and damage from over/under-eating. Phlegm malaria presents with phlegm-saliva obstructing upwards during attacks, nausea, or dizziness; for those with chronic phlegm, resolving phlegm is primary when malaria occurs. As ancients said, "No phlegm, no malaria." Deficiency malaria occurs after long-term malaria where interior and exterior are deficient, true Yuan Qi is unrepaid, malaria temporarily stops but recurs with slight exertion, named Lao Nüe (Labor Malaria). Generally, alternate-day attacks are common, daily attacks are rare. Accumulation leads to chronic non-resolving malaria, where pathogens hide between the hypochondrium, forming masses called Nuomu (Malaria Mother). Generally, Summerheat pathogens are common. When Wei Qi combines with pathogens, disease acts; when separated, disease rests. Combining with Yin causes chills to cease; separating from Yang causes heat to stop. On the next day, they gather again, causing recurrence. Alternate-day attacks occur because pathogens press inward on the Five Zang, connecting to the Mu Yuan (Assemblage Origins); the path is distant, qi is deep, movement is slow, unable to travel with Wei Qi simultaneously, thus occurring every other day. For excessive chills, raise Yang so it does not combine with Yin, and chills cease. For excessive heat, lower Yin so it does not combine with Yang, and heat ceases. For alternating chills and heat, use one raising and one lowering method, combined with diuretic herbs to separate them in the middle, preventing combination—this is the secret. Clear Summerheat, disperse Wind-Cold, dry Dampness, digest food stagnation, resolve phlegm, tonify deficiency, and slowly dissipate masses. Do not attack urgently.

The differentiation is precise, adjusting based on the six Qi injuries, offering profound enlightenment to successors. Studying these methods carefully reveals the source of disease.

Main Formula: Chaihu (Bupleuri Radix) 1.5 qian, Shengma (Cimicifugae Rhizoma), Gegen (Puerariae Lobatae Radix), Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix) each 0.5 qian. These five herbs have sweet-pungent and clear qualities, capable of raising Yang Qi to separate from Yin, thus stopping chills. Zhimu (Anemarrhenae Rhizoma) 1 qian, Shigao (Gypsum Fibrosum) 3 qian, Huangqin (Scutellariae Radix, dried/floating pieces) 0.5 qian. These three herbs: Zhimu and Huangqin are bitter, Shigao is heavy; all are cold and descending, thus guiding Yin Qi downward to separate from Yang, thus stopping heat. Zhu Ling (Polypori Umbellati Sclerotium) 1.5 qian separates and benefits Yin and Yang, preventing combination. Chuanshanjia (Manis Squama) 1 qian (This substance can live in water and land, borrowing its qi to guide other herbs from Yin to Yang, penetrating meridians without obstruction.) Gancao (Glycyrrhizae Radix et Rhizoma) 0.5 qian harmonizes the herbs. (I once heard a practitioner say malaria contraindicates Gancao as it aids damp-heat in the Spleen channel.) This is my formula created 5-6 years ago. Usually, one dose stops recurrence, expelling pathogens from interior and exterior, leaving no place for them to stay, so chills and heat cease immediately. Others using this formula may be bound by it, lacking flexibility, sometimes ineffective. The reason is latent summerheat steaming, stagnating into Qi, condensing into Phlegm, which are roots of chills/heat; this formula lacks Qi-moving and Phlegm-resolving herbs. Now, I propose adding Jiangzhi Houpo (Magnoliae Officinalis Cortex processed with ginger) 1 qian to move Qi, Sanhequ (Sanhe Qu) 1.5 qian to move Phlegm. Further modification rules follow; this covers malaria treatment.

For Summerheat Malaria with more heat than cold, reduce the first five herbs by two-thirds; double the dosage of Zhimu, Huangqin, and Shigao. For fever without chills, remove the first five herbs, Chuanshanjia, and Zhu Ling (since there is no combination of cold/heat, focus on reducing heat). Add Jingmi (Oryza Sativa Germen) 1 spoon, Renshen (Ginseng Radix) 1.5 qian. (Shigao drains Stomach Qi, so Jingmi protects it; Renshen also serves this purpose. Heat damages Qi, so tonifying Qi is primary.) This is Baihu Tang (White Tiger Decoction) plus Renshen. Outside decoction, take Xiaoshu Dan (Summerheat Relieving Pill) 100-200 pills to vent latent summerheat and move accumulated phlegm. (See Summerheat chapter.) Summerheat disease必然 has spontaneous sweating; if absent, it is due to cooling in the wind closing pores; use Xiong Su San (Ligusticum and Perilla Powder) to induce sweat. (See Cold Damage chapter.) Do not use Baihu Tang. For Wind Malaria, use Xiong Su San; do not cover warmly, wait for natural slight sweating, then adjust the main formula based on chills/heat ratio and timing. Since sweating already exists, do not induce heavy sweating; only slightly release Wind-Cold. For Cold Malaria, use Xiong Su San to induce sweat; if no sweat, add Mahuang (Ephedrae Herba) 1-2 qian. If unresolved after sweating, adjust main formula. For Damp Malaria, use Chushi Tang (Dampness Removing Decoction) once, then adjust main formula. (See Dampness chapter.) For Food Malaria, use digestion methods from Food Injury chapter, combined with Chenping Yin, Ju Fang Shuang Yin Zi, or Qingpi Yin. Chenping Yin is Erchen Tang combined with Pingwei San. For deficient patients with chronic malaria, weak pulse, and inability to eat, avoid malaria drugs. At 5 AM during attacks, decoct Renshen 1 liang and Shengjiang (Fresh Ginger) 1 liang together, take two doses consecutively to stop immediately.

Malaria treatment is detailed in *Neijing*. Currently discussing Summer/Autumn malaria without detailing pulse/symptoms, using only 5 ascending/dispersing herbs and 3 bitter-cold herbs. Although Wang Jin Tan's masterpiece, I have reservations, fearing successors may misunderstand, fail to examine etiology, and use blindly, likely ineffective. Diseases vary infinitely; one cannot stick to one method. Proverb: "Treating disease with fixed formulas endangers the patient." If Healthy Qi cannot overcome pathogens, ascending/dispersing is dangerous. This formula works in early stages to expel pathogens and regulate Yin/Yang. For deficiency chronic malaria, it worsens condition. I often replace Chuanshanjia with Baokouren (Amomi Fructus Rotundus) 1 qian for its pungent-aromatic quality to open diaphragm obstruction and circulate Ying/Wei, more effective than original. Using ancient formulas lies in modification, not rigidity. I treat chronic malaria by examining etiology, modifying Liuwei Dihuang Wan, using Heren Xie Nüe as assistant, detailed in clinical records. Learn the method, do not cling to the formula.