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Huangdi asked: Malaria is caused by wind pathogens. Why do some cases occur daily, while others occur at specific times? Qibo replied: When malaria first begins, the lanugo hairs stand erect, followed by yawning and stretching. Then chills with trembling of the mandible occur, accompanied by pain in the waist and spine. When the cold subsides, both interior and exterior become hot, causing severe headache as if splitting, thirst, and a desire to drink water. Huangdi asked: What qi causes this? Qibo said: It is due to the struggle between Yin and Yang qi moving up and down, alternating deficiency and excess, and the shifting of Yin and Yang. When Yang merges into Yin, Yang becomes full (excess) while Yin becomes empty (deficient). Deficiency of the Yangming channel leads to chills and mandibular trembling; deficiency of the Taiyang channel leads to pain in the lower back, upper back, head, and neck; when all three Yang channels are deficient, Yin qi prevails. When Yin qi prevails, the bones become cold and painful, cold arises from within, so both interior and exterior feel cold. Excess of Yang leads to external heat; deficiency of Yin leads to internal heat. With both interior and exterior hot, there is panting and thirst, hence the desire for cold drinks. These conditions arise from summer damage by summerheat, where intense heat qi hides inside the skin but outside the stomach and intestines, which is the residence of Ying Qi (Nutritive Qi). This causes sweat pores to be open and loose, and the interstices (Cou Li) to open, allowing autumn wind to invade during sweating or bathing. Water qi settles inside the skin, residing together with Wei Qi (Defensive Qi). Wei Qi travels through the Yang channels during the day and the Yin channels at night... Its pathogenic residence is deep, pressing inward on Yin. Yang qi alone flares up, while Yin evil stays fixed internally. Yin and Yang struggle but cannot exit, hence it occurs every other day. Huangdi asked: Why does the onset time get later or earlier? Qibo said: The pathogen lodges in the Fengfu point and moves down along the Du vessel. Wei Qi gathers at Fengfu once every twenty-four hours. The next day, it descends one vertebral segment, so the onset becomes later. All these pathogens lodge in the back. Each time they reach Fengfu, the interstices open; when they open, the pathogen enters; when it enters, the disease manifests. Thus, the daily onset gets progressively later. If the pathogen descends one segment daily from Fengfu, after twenty-one days it reaches the coccyx; on the twenty-second day, it enters the spine and pours into the Taichong vessel (in *Suwen*, twenty-one days is written as twenty-five, twenty-five as twenty-six, and Taichong as Fusu); the qi ascends, and after nine days emerges from the Quepen region. As the qi rises higher each day, the onset becomes earlier. For every-other-day attacks, the pathogen presses inward on the five Zang organs and spreads horizontally to the Mu Yuan (Sea of Origin). The path is long, the qi is deep, and its movement is slow. It cannot travel with Ying Qi nor exit simultaneously, so it occurs every other day. Huangdi asked: Wei Qi reaches Fengfu, the interstices open, the pathogen enters, and the disease starts. Now Wei Qi descends one segment daily, no longer corresponding to Fengfu. Why does it still occur daily? Qibo said: Wind has no fixed abode. Wherever Wei Qi moves, the interstices must be open. Wherever the pathogen combines, the disease manifests. Huangdi asked: Wind and malaria are similar and of the same category, yet wind persists constantly, while malaria has periods of remission. Why? Qibo said: Wind qi remains in one place, so it is constant. Malaria qi transmits inward along the meridians step by step, so it manifests only when Wei Qi responds. Huangdi asked: Why does malaria start with chills followed by fever? Qibo said: Summer damage by extreme heat causes profuse sweating and open interstices. Encountering wind, the chilling cold of summer water forces entry, hiding in the interstices and skin. Autumn wind injury completes the disease. Cold is Yin qi; wind is Yang qi. Injury by cold first, then wind, results in chills first, then fever, occurring at set times, named Cold Malaria. Huangdi asked: Why does it start with fever followed by chills? Qibo said: This is injury by wind first, then cold, resulting in fever first, then chills, also occurring at set times, named Warm Malaria. If there is only fever without chills, Yin qi is exhausted first, and Yang qi flares alone. This causes fever, shortness of breath, vexation, hot hands and feet, and nausea, named Dan Malaria (Febrile Malaria). Huangdi asked: The classics say to drain excess and tonify deficiency. Heat is excess; cold is deficiency. In malaria, cold cannot be warmed by soup or fire; heat cannot be cooled by ice or water. These are cases of excess and deficiency. At such times, even skilled physicians cannot stop it; they must wait for natural decline before needling. Why? Qibo said: The classics say: Do not needle when fever is high, do not needle when the pulse is chaotic, do not needle when sweat is dripping profusely, because the pathology is reversed and treatment is premature. When malaria first starts, Yang merges into Yin. At this moment, Yang is deficient and Yin is excessive, with no Yang qi on the exterior, hence chills first. When Yin qi reverses to its extreme, it returns to Yang. Yang and Yin merge externally, leading to Yin deficiency and Yang excess, hence fever and thirst first. Malaria merging into Yang leads to Yang excess; merging into Yin leads to Yin excess. Yin excess brings cold; Yang excess brings heat. In Heat Malaria, wind-cold qi does not stay long; when the disease peaks, it recurs. Disease manifestation is like fire's heat or wind and rain—unbearable. Hence the classics say: Attack when it is strong, and destruction follows; treat when it declines, and success is assured. This is what is meant. Before malaria manifests, Yin has not merged with Yang, and Yang has not merged with Yin. Regulate it then, and True Qi will be stable, and pathogenic qi will vanish. Therefore, doctors cannot treat already manifested disease because the qi is reversed. When malaria is about to manifest, Yin and Yang are about to shift, starting from the four extremities. Yang is injured, Yin follows. Before the qi merges, firmly bind the area beforehand to prevent pathogen entry and Yin egress. Observe carefully. If collateral vessels are full, hard, and bloody, puncture them. This is when the pathogen is moving but has not yet merged. Huangdi asked: What is the response when malaria is not manifesting? Qibo said: Malaria alternates between excess and deficiency. Depending on where the qi resides: if in Yang, there is heat and a rapid pulse; if in Yin, there is cold and a quiet pulse. At the extreme, both Yin and Yang decline, Wei Qi separates, and the disease rests. When Wei Qi gathers again, the disease recurs. Huangdi asked: Sometimes it occurs every two days or several days; sometimes there is thirst, sometimes not. Why? Qibo said: The interval occurs because the pathogen and Wei Qi reside in the Six Fu organs but miss each other, failing to meet at the right time, so it rests for several days before manifesting. Yin and Yang alternate in dominance, sometimes severely, sometimes mildly, hence sometimes thirsty, sometimes not. Huangdi asked: Summer damage by summerheat should lead to autumn malaria, but this does not always happen. Why? Qibo said: This conforms to the Four Seasons. Diseases presenting differently violate the Four Seasons. Autumn malaria presents with severe cold; winter malaria with mild cold; spring malaria with aversion to wind; summer malaria with profuse sweating. Huangdi asked: Where do Warm Malaria and Cold Malaria lodge, and in which Zang organs? Qibo said: Warm Malaria originates from winter wind-cold. Cold qi hides in the bone marrow. In spring, Yang qi expands greatly, but cold cannot exit. Encountering great summerheat, brain marrow melts, muscles waste, interstices vent, or physical exertion occurs. Pathogen exits with sweat. This disease lodges in the Kidney. The qi moves from interior to exterior. Thus, Yin is deficient and Yang is excessive. Yang excess leads to heat decline. Decline allows qi to re-enter. Re-entry leads to Yang deficiency, and Yang deficiency leads to cold. Hence chills first, then fever, named Warm Malaria. Huangdi asked: What about Dan Malaria? Qibo said: The Lungs have prior heat, qi is abundant in the body, Jue Qi reverses upward. Yang qi is excessive and does not decline, causing disease. The qi does not return to Yin, so there is only heat without cold. The qi lodges internally in the Heart and externally in the muscle interspaces, causing emaciation, hence named Dan Malaria.

For malaria with a full, large, and urgent pulse, needle the Back-Shu points on the back. Use medium needles at the five Shu points beside the midline, one on each side, bleeding according to fatness or thinness. For malaria with a small, solid, and urgent pulse, moxa the lower leg Shaoyin points, and needle the finger Jing-Well points. For malaria with a slow, large, and deficient pulse, use herbal medicine; acupuncture is unsuitable. Generally, treat malaria about the time it takes to eat a meal before onset. If missed, the timing is lost. 1. For non-thirsty, every-other-day malaria: *Jiujuan* says take Foot-Yangming; *Suwen* says needle Taiyin. 2. For thirsty, every-other-day malaria: *Jiujuan* says take Hand-Shaoyang; *Suwen* says take Foot-Shaoyang. 3. For Wen Malaria with no sweat: perform the Fifty-Nine Needles method (explained in the Heat Disease section). 4. Foot-Taiyang Malaria: causes lower back pain, heavy head, cold rising from the back, chills then fever/thirst, sweat after thirst stops, difficult to cure, every-other-day onset. Bleed Weizhong (BL57) (*Suwen* adds "he he ran" after chills/fever). 5. Foot-Shaoyang Malaria: causes body laxity, mild cold, aversion to people, palpitations, much heat and sweat. Needle Foot-Shaoyang. 6. Foot-Yangming Malaria: causes initial chills, shivering, prolonged cold then heat, sweat after heat leaves, relief upon seeing light/fire. Needle Yangming dorsum and regulate Chongyang (ST42). 7. Foot-Taiyin Malaria... 8. Foot-Shaoyin Malaria: causes severe vomiting, much cold little heat, desire to close doors/windows. Difficult to cure. Take Taixi (KI3). 9. Foot-Jueyin Malaria... Abdomen... 10. Needle Hand-Shaoyin, called Shenmen (HT7). 11. Liver Malaria: face appears pale/greenish (*Suwen* adds sighing), appearance like death. Needle foot... makes one shiver... Shaoyin. 12. Stomach Malaria: feels cold before illness, good appetite but cannot eat, abdominal distension/fullness after eating. Bleed horizontal vessels of Foot-Yangming and Taiyin. 13... 14... 15... 16... 17... 18... 19... 20... 21... 22... 23... 24... 25... 26... 27... 28... 29... 30... 31... 32... 33... 34... 35... 36... 37... 38... 39... 40... 41... 42... 43... 44... 45... 46... 47... 48... 49... 50... 51... 52... 53... 54... 55... 56... 57... 58... 59...

To needle malaria, first ask where the pain started, and needle that area first. If headache and heaviness start first, bleed the top of the head, temples, and shoulders. If neck/back pain starts first, needle there. If lower back/spine pain starts first, bleed Weizhong (BL57). If arm/hand pain starts first, needle the spaces between fingers of Hand-Shaoyin and Yangming. If lower leg soreness starts first, bleed the spaces between toes of Foot-Yangming. For Wind Malaria with sweating and aversion to wind, bleed the Back-Shu points of the Three Foot-Yang channels. Lower leg soreness unrelieved by pressure is called Zhou Sui Bing; needle Juegu (GB39) with a bi needle to bleed, immediate relief. Minor body pain: needle Jing-Well points of all Yin channels without bleeding, once every other day.

Malaria: Shenting (GV24) and Baihui (GV20) govern it. Malaria: Shangxing (GV23) governs it; first take Yixi (BL53), then Tianyou (TE16), Fengchi (GB20), Dazhu (BL11). Malaria: Quangu (GB12) and Fengchi (GB20), Taixi (KI3), Wanggu (SI4), Yanggu (SI5), Xiaxi (GB43), Zhiyin (BL67), Tonggu (BL43), Jinggu (BL64) all govern it. Malaria with chills, high fever, delirium: Tianshu (ST25) governs it. Malaria with high heat: Lieque (LU7) governs it. Malaria with cold/heat jue, vexation, hiccups, chest fullness, sweating: Bleed Shaoshang (LU11) for immediate relief. Heat Malaria with dry mouth: Shangyang (LI1) governs it. Malaria with severe cold (wants to vomit foam): Yangxi (LI5) governs it. Wind Malaria with no sweat: Pianli (TE5) governs it. Malaria with red/swollen face: Wenliu (ST44) governs it. Malaria with epigastric distension/pain, rebellious qi: Moxa Wuli (ST30), left for right, right for left. Malaria with neck pain, sudden rebellion: Yimen (GB2) governs it. Malaria with fixed timing, red face, blurred vision: Zhongzhu (TE3) governs it. Malaria occurring at mealtime, heart pain, sadness: Tianjing (TE10) governs it. Wind Malaria: Zhizheng (SI7) governs it. Malaria with back/chill, neck pain radiating to elbow/armpit, lower back pain radiating to abdomen, inability to lift limbs: Shaohai (HT3) governs it. Malaria with unknown discomfort: Dadu (SP4) governs it. Malaria with much cold/little heat: Dazhong (KI4) governs it. Malaria with cough/rebellious qi, chest stuffiness, insomnia, severe vomiting, much heat/little cold, desire to close doors/windows, cold jue/hot feet: Taixi (KI3) governs it. Malaria with heat/shortness of breath, intermittent cold unable to self-warm, heavy knees, spasms, dizziness/headache: Jiexi (ST41) governs it. Malaria occurring at dusk: Linqi (GB34) governs it. Malaria with chills, axillary swelling: Qiuxu (GB40) governs it. Malaria starting from...: Shugu (BL65) governs it. Malaria with much sweat, lower back pain limiting flexion/extension, eyes feeling like popping out, neck feeling like pulling: Kunlun (BL60) governs it. Malaria: Excess causes lower back/upper back pain; deficiency causes nasal congestion/epistaxis. Feiyang (BL58) governs it. Malaria with heavy head, cold from back, chills then fever, unquenchable thirst, sweat: Weizhong (BL57) governs it. Malaria with no thirst, every-other-day onset: Kunlun (BL60) governs it.