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(Zhou Yangjun) holds that the pathogenesis of malaria in humans stems from the invasion of external pathogens, which often lie dormant between the exterior and interior (half-exterior half-interior). When the pathogen enters and contends with Yin, chills manifest; when it emerges and contends with Yang, fever manifests. Therefore, alternating chills and fever are the hallmark symptoms of Shaoyang disease (Disease of the Gallbladder and Sanjiao channels). While it is true that other channel symptoms may coexist, it is illogical to claim that the condition has absolutely nothing to do with Shaoyang.

Zhang Zhongjing stated that the pulse should naturally be wiry (Xian). This is because the pulse may be rapid or slow, small and tight, or floating and large, all of which are indeterminate; however, it must necessarily present a wiry quality. The wiry pulse is the pulse of Shaoyang. When pathogens invade Shaoyang and reside alongside Wei Qi (Defensive Qi), they interact with its cycle: Wei Qi travels through the Yang aspects during the day and the Yin aspects at night. Thus, the pathogen moves outward upon encountering Yang and presses inward upon encountering Yin. The contention between internal and external factors causes daily attacks. If the pathogen lodges deeply, pressing inward into Yin, while Yang Qi alone flares up and Yin adheres internally, the contention between Yin and Yang prevents exit, resulting in every-other-day attacks.

Consequently, conditions leaning toward Yin exhibit more cold, while those leaning toward Yang exhibit more heat. Cases of pure heat without cold, termed Dan Malaria (Feverish Malaria) or Wen Malaria (Warm Malaria), and cases of pure cold without heat, termed Mu Malaria (Yin Malaria), all originate from an extreme deviation starting from Shaoyang. To remedy this deviation and correct the imbalance, one must address the boundary of Shaoyang, allowing the pathogen to depart so that Yin and Yang can return to harmony, leading to recovery. Generally, remediation requires herbal medicine. However, Zhang Zhongjing further stated that a wiry and rapid pulse indicates wind-heat onset, which can be managed through dietary adjustments. Why is this?

A rapid pulse indicates heat; extreme heat generates wind. This inevitably leads to Liver Wood overacting on Spleen Earth, transmitting to areas unable to withstand it, thereby consuming the fluids of the Stomach. Yang becomes increasingly excessive and fails to restore balance. In such cases, treatment cannot rely solely on herbs. One must use dietary regulation to curb the heat, employing substances like pear juice and sugarcane syrup that generate fluids and quench thirst. This aligns with the principle in the *Neijing* (Inner Canon): "When wind invades internally, treat it with sweet and cold agents." Otherwise, if heat transfers to the Stomach, it will surely steam upward to the Heart and Lungs, causing shortness of breath, vexation, and oppression, leading to Heart and Lung pathology, hot palms, nausea, and Stomach dysfunction. How could a person endure this? Therefore, using dietary regulation to stop the pathogen from entering the Stomach is indeed a sage method.

However, Zhang Zhongjing’s methods do not exceed the scope of the *Neijing*. The *Neijing* states that for malaria with a slow, large, and deficient pulse, medication is appropriate; it also states that deficiency patterns are unsuitable for acupuncture and should be regulated with sweet medicines. This reflects the same intent.

Regarding Warm Malaria (Wen Malaria), the pulse is normal, there is no chill but only fever, bone joints are painful and vexed, and vomiting occurs intermittently. Baibu Jia Guizhi Tang (White Tiger Decoction plus Cinnamon Twig) is used. As the *Neijing* mentions, there are two types of Warm Malaria, both characterized by fever preceding chills, not merely fever without chills. They resemble Dan Malaria but are distinct. Dan Malaria involves the combination of two Yang pathogens steaming upward to the Heart and Lungs. Since the Lung governs Qi, there is shortness of breath and vexation; since the Heart governs vessels, Yang excess causes a hurried pulse, and fluid deficiency causes an intermittent pulse, which can be deduced thus. In Warm Malaria, the pulse resembles that of a healthy person, indicating the pathogens have not combined and fluids are not yet damaged. The reason for fever without chills is that the patient inherently possesses Dan Qi (feverish energy), and Ying (Nutritive) and Wei (Defensive) Qi are unregulated. Thus, the malaria originates in Yang, does not enter Yin, or if it enters, Yin rejects it. Hence, bone joint pain and vomiting occur due to the obstruction of pathogenic qi.

By adding Guizhi (Cinnamon Twig) to Baishi Tang (White Tiger Decoction), one can dispel Yang pathogens and unblock Ying and Wei Qi. This harmonizes Yin and Yang, unblocks blood vessels, and leads to recovery through sweating. Although Guizhi is a Yang herb, why is it used for conditions with only heat and no chills? It is understood that Baishi Tang clears heat from the Qi level significantly, and adding a small amount of Guizhi to unblock Ying and Wei Qi is acceptable.

As for the Warm Malaria described in the *Neijing* featuring fever preceding chills: one type results from first being injured by Wind, then by Cold; during attack, Yang precedes Yin, hence fever precedes chills. The other type involves contracting Wind-Cold in winter, which hides deeply in the Marrow and resides internally in the Kidney. It erupts only when summer-heat arrives in spring and summer. The pathogen exits from the Kidney outward; as the heat subsides slightly, it returns to the Kidney, where Yin Essence contends with it, initiating chills. If one does not know to strengthen the master of Water to urgently rescue Yin, after ten or more attacks, Yin Essence will be exhausted.

If cold predominates, it is called Mu Malaria. It is not purely cold without heat. "Predominant cold" means seven or eight parts out of ten are cold. The pathogen lies dormant below the Heart, precisely in the position of Danzhong (Conception Vessel 17) and Pericardium. The Heart is Yang; Yang pathogens follow it, causing Heart Meridian deficiency. "Heart deficiency" means heat is retained internally. Once the pathogen is contained, it is difficult to expel outward, which is one cause of predominant cold. When the pathogen enters the Pericardium, the Ruler (Heart) is alarmed, and bodily fluids exert themselves to assist internally. This causes the acquired pathogen to be surrounded externally and unable to exit, which is another cause of predominant cold. Since the Heart is a Yang (Mu) organ, the malaria is named accordingly. Treatment uses Shuqi San (Chinese Tansy Powder) combined with fermented grain liquid to induce vomiting, expelling the knotted and latent pathogens below the Heart. The sunken pathogens exit together with them, clearing everything in one stroke.

Shuqi is the sprout of Changshan (Dichroa Root). Changshan induces vomiting effectively; why not use it directly instead of its sprout? The sprout has a light and ascending nature, entering the realm of extreme Yang to draw out pathogens. Combined with Longgu (Dragon Bone) to calm the Heart and Spirit, eliminate latent Qi, and Yunmu (Mica) to settle the Zang organs and tonify deficiency, pleasing the Ruler, this represents Zhang Zhongjing’s skill akin to mending the sky with colored stones.

Warm Malaria also uses this formula, adding extra Shuqi to achieve rapid vomiting. This is because one vomiting episode opens all knotted pathogens, unblocking the systemic feverishness, allowing Ying and Wei Qi to function without interference. Thus, vomiting therapy serves as a harmonizing method. Do Mu Malaria and Warm Malaria have contradictory natures requiring different formulas?

Consider Zhang Zhongjing’s treatment for malaria with thirst, stating it also treats Lao Malaria (Consumptive Malaria), proposing Chaihu Qu Banxia Gua Lou Tang (Bupleurum Decoction minus Pinellia plus Trichosanthes Root). This is clearly Xiao Chaihu Tang (Minor Bupleurum Decoction). For thirst, add Gua Lou Gen (Trichosanthes Root); remove Banxia (Pinellia). This is a fixed rule. Since the wiry pulse indicates Shaoyang, and chills/fever pertain to the half-exterior/half-interior, although thirst indicates exhaustion of Stomach fluids in the Yangming stage, the cause of this exhaustion is entirely the Shaoyang pathogen. Furthermore, the *Neijing* Chapter on Acupuncture Methods states: "For thirst, treat Shaoyang." Is this not because the Wood-Fire tendency of Shaoyang robs the Stomach of fluids?

The malaria pathogen advances and retreats within Shaoyang; thus, this formula advances and retreats to apply its efficacy. As noted by Mr. Zhao regarding herb properties, it is said to treat Lao Malaria.

If cold predominates with slight heat, or only brief chills without heat, Chaihu Guijiang Tang (Bupleurum, Cinnamon Twig, and Ginger Decoction) is indicated, with the note that it works miraculously. Observing the symptoms, they may resemble Mu Malaria, but the severity differs greatly. Zhang Zhongjing did not elaborate, only saying it works miraculously, implying the pathogen is light and superficial. Indeed, Wei corresponds to the Exterior, and Ying corresponds to the Interior. Yang Qi in the chest disperses among the muscle intervals. Now, due to pathogenic bi-syndrome (obstruction), the external Wei Yang is depressed and trapped within the internal守 (defensive) Yin. Blood stasis becomes more condensed. When Wei Qi travels to the Yang aspect and the disease flares, the pathogen entering Ying lacks momentum to exit, and the previously obstructed Ying does not emerge to contend with Yang. Hence, predominant cold with slight heat, or only cold without heat, occurs as described.

Xiao Chaihu Tang originally advances and retreats with the pathogen. Adding Guizhi and Ganjiang (Dried Ginger) shifts it toward Yang, resolving the obstructed pathogen. Moreover, adding Muli (Oyster Shell) attacks hardness and breaks stagnation. Can Yin and Yang not resolve suddenly through sweating? Hence, "one dose works miraculously." Conversely, adding Huangqin (Scutellaria) and Huanglian (Coptis) for their cold nature to retreat toward Yin, can we not learn from this?

I base this discussion on Zhang Zhongjing’s principles and compile Jiayan’s (Chen Shiduo’s) discussions, offering this treatise as assistance for those skilled in treating malaria.