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The Yellow Emperor, continuing from the previous chapter "Treatise on Malaria," further elucidates the methods of acupuncture for treating malaria. It lists malaria affecting the three Yang meridians, the three Yin meridians, and the five Zang organs and six Fu organs, as well as Wind Malaria and Warm Malaria, each with specific acupuncture treatments, hence the name "Chapter on Acupuncture for Malaria."

Malaria of the Foot-Taiyang (Bladder) meridian causes lower back pain and a heavy sensation in the head. Coldness arises from the back, starting with chills followed by fever. When the fever subsides, sweating occurs but is difficult to stop. One should puncture Weizhong (BL-32) to release blood.

The Foot-Taiyang meridian descends from the head, passes down the back along both sides of the spine, and reaches the waist. Therefore, malaria of the Foot-Taiyang meridian causes lower back pain and a heavy sensation in the head. Coldness arising from the back indicates pathology in the fundamental Qi (Cold-Water) of Taiyang, hence chills first; pathology in the marked Qi (Ministerial Fire) of Taiyang results in fever later. During the fever, it is intense like burning fire or steaming summer heat. When the fever stops, profuse sweating occurs that is hard to cease.

Weizhong (BL-32) is located in the center of the popliteal fossa. Puncturing Weizhong to release blood treats malaria of the Foot-Taiyang meridian.

Malaria of the Foot-Shaoyang (Gallbladder) meridian causes the body to feel flaccid and weak. The chills are not severe, nor is the fever severe. The patient dislikes seeing people and feels fearful upon seeing them. There is much fever and profuse sweating. One should puncture points on the Foot-Shaoyang meridian.

"E" (dislike) is pronounced with the departing tone, same as below. "Xie Jie" means flaccidity and laziness, indicating weak pivot function. The Foot-Shaoyang meridian runs along the side of the body, governing pivot transport. In malaria, the pivot function is weak, causing bodily flaccidity. The pivot is central, governing opening and closing; opening is Yang, closing is Yin. Since both Yin and Yang are deficient, chills and fever are not severe. Deficiency of Shaoyang Yang Qi causes dislike of people; seeing people induces fear. This fear leads to increased fever and profuse sweating. One should puncture the Foot-Shaoyang meridian to treat Shaoyang malaria.

Malaria of the Foot-Yangming (Stomach) meridian causes initial aversion to cold with shivering, which is severe. After a long time, fever ensues. When the fever subsides, sweating occurs. The patient likes sunlight, moonlight, or firelight, feeling comfortable. One should puncture Chongyang (ST-42) on the dorsum of the foot of the Foot-Yangming meridian.

The "Meridians" chapter states: When the Foot-Yangming meridian undergoes change, the disease manifests as shivering aversion to cold. Thus, Foot-Yangming malaria causes initial shivering aversion to cold, which is severe. After the cold persists, fever follows. When the fever subsides, Yin and Yang harmonize, leading to sweating. Yangming deficiency causes preference for light sources. "Likes seeing" means feeling comforted by them. One should puncture Chongyang (ST-42) on the dorsum of the foot of the Foot-Yangming meridian to treat Yangming malaria.

Malaria of the Foot-Taiyin (Spleen) meridian causes unhappiness, frequent sighing, loss of appetite, frequent chills and fever, and sweating. When the disease strikes, vomiting often occurs; after vomiting, the condition subsides, and one should then stop or consolidate treatment.

"Hao" (likes/frequent) is pronounced with the departing tone. In Foot-Taiyin malaria, Spleen Qi fails to ascend to the Heart, causing unhappiness. Spleen Qi fails to communicate with the Lung, causing frequent sighing. Disharmony between Spleen and Stomach causes loss of appetite. Failure of Spleen Qi to fill muscles and interstices causes frequent chills and fever. Internal deficiency of Spleen Earth allows fluid metabolism to leak outward, causing sweating. When malaria strikes, Zheng Qi cannot ascend or reach the exterior, leading to vomiting. Vomiting allows Taiyin Qi to move upward from below, so the condition subsides after vomiting. When the disease wanes, one should immediately puncture Taiyin meridian points for treatment.

Malaria of the Foot-Shaoyin (Kidney) meridian causes severe vomiting, frequent chills and fever, with more fever than chills. The patient desires to stay behind closed doors and windows. This disease is difficult to cure.

In Foot-Shaoyin malaria, Yin-Cold rebels upward, causing severe vomiting. As pathogenic Qi moves from Yin to Yang, involving Water and Fire, chills and fever are frequent. Qi escaping to the exterior results in excess Yang and deficiency Yin, hence more fever than chills. The Shen Spirit of Shaoyin is weakened by excessive heat, causing the desire to stay secluded. With pathology in Yin, Yang, Water, and Fire, and repeated deficiency of the Shen Spirit, the disease is difficult to cure. Due to its difficulty, no acupuncture method is mentioned here.

Malaria of the Foot-Jueyin (Liver) meridian causes lower back pain, fullness in the lower abdomen, and difficulty urinating. It resembles Gong (strangury/urinary retention) but is not true Gong; there is frequent urge to urinate, mental fear, Qi deficiency, and a depressed feeling in the abdomen. One should puncture the Foot-Jueyin meridian.

"Shuo" (frequent) is pronounced 'shuo'. The Foot-Jueyin meridian merges with the Du Mai and ascends, causing lower back pain in malaria. Its pathway passes through the genitalia to the lower abdomen, causing lower abdominal fullness. Fullness leads to urinary difficulty. Difficulty resembles Gong but is not true Gong; frequent urination implies scanty flow. Sheng Yang Qi originates in Jueyin; extreme Yin prevents Yang generation, causing fear. Fear leads to Qi deficiency. Deficient Qi cannot ascend to Yang, causing abdominal depression. "Yi Yi" means stifled and unrelieved. One should puncture the Foot-Jueyin meridian to treat Jueyin malaria.

Lung Malaria causes a cold sensation in the heart, followed by intense heat. Between attacks, the patient is easily startled, as if seeing things. One should puncture Hand-Taiyin (Lung) and Hand-Yangming (Large Intestine) meridians.

"Jian" (interval) is pronounced with the departing tone, similar to "jian ri" (every other day). Lung represents Heaven; Heart represents Sun. Lung Malaria causes coldness in the heart, representing deficiency-cold of Heaven and Sun. Heaven and Sun are Yang, so after cold, heat is intense. During intervals, Qi and Blood are deficient, causing startles. The startles feel like hallucinations. One should puncture Hand-Taiyin Lung meridian, involving Hand-Yangming Large Intestine, to treat Lung Malaria.

Heart Malaria causes severe mental restlessness, desire for cold water, but actually presents with more chills and less fever. One should puncture the Hand-Shaoyin (Heart) meridian.

Heart belongs to Fire. Heat causes restlessness, so Heart Malaria causes severe mental distress. Severe distress leads to desiring cold water to cool the heat. Receiving water suppresses True Fire, resulting in more chills and less fever. One should puncture Hand-Shaoyin Heart meridian to treat Heart Malaria.

Liver Malaria causes a pale greenish complexion, frequent sighing, and a demeanor resembling death. One should puncture the Foot-Jueyin (Liver) meridian until bleeding occurs.

"Cang" refers to green. Liver Wood corresponds to green, so Liver Malaria causes a greenish complexion. Liver meridian ascends to the Lung; failure of Liver Qi to ascend causes sighing. Greenish complexion and sighing make the patient look like death. One should puncture Foot-Jueyin Liver meridian until bleeding to treat Liver Malaria.

Spleen Malaria causes chills and abdominal pain. During fever, intestinal borborygmus occurs, followed by sweating. One should puncture the Foot-Taiyin (Spleen) meridian.

Spleen governs Cold-Dampness, so Spleen Malaria causes chills. The abdomen is the domain of Spleen; Spleen Cold causes abdominal pain. Spleen Earth has Cold-Damp and Damp-Heat pathogens. Heat causes intestinal borborygmus; after borborygmus, Damp-Heat moves outward, causing sweating. One should puncture Foot-Taiyin Spleen meridian to treat Spleen Malaria.

Kidney Malaria causes shivering cold, lower back and spine pain, inability to turn over, difficulty defecating, blurry vision, and cold hands and feet. One should puncture Foot-Taiyang (Bladder) and Foot-Shaoyin (Kidney) meridians.

Kidney is the organ of Cold-Water, so Kidney Malaria causes shivering cold. The waist is the mansion of the Kidney. Kidney disease causes lower back and spine pain. Pain impedes transport, causing inability to turn over. *Ling Shu: Five Evils* states: Pathogen in Kidney causes bone pain and Yin Bi, and difficulty defecating. *Su Wen: Zhi Zhen Yao Da Lun* states: Difficulty defecating is due to non-function of Yin Qi. Thus, Kidney Malaria involves difficulty defecating. The essence of bone manifests in the pupils; Kidney governs bone, so vision becomes blurry. "Wang Wang" describes shaking and unclear vision. Sheng Yang Qi of the Lower Jiao fails to fill the limbs, causing cold hands and feet. One should puncture Foot-Shaoyin Kidney meridian, involving Foot-Taiyang Bladder meridian, to treat Kidney Malaria.

Stomach Malaria causes the illness to be near resolution but not fully cured. The patient feels hungry but cannot eat. Eating causes distension and fullness, with an enlarged abdomen. One should puncture Foot-Yangming (Stomach) and Foot-Taiyin (Spleen) meridians, releasing blood from transverse collaterals.

"Qie" means temporarily. "Qie Bing" implies the illness is about to resolve. Transverse vessels refer to collaterals, contrasting with straight meridians. When Zang organ malaria reaches the Fu organs, it moves from Yin to Yang, indicating impending recovery. Thus, Stomach Malaria presents as near-recovery. Near-recovery causes hunger without ability to eat. Disharmony of Spleen-Stomach collaterals causes postprandial distension and abdominal enlargement. One should puncture Foot-Yangming Stomach meridian, involving transverse collaterals of Foot-Taiyin Spleen meridian, to release blood.

When malaria is just erupting with body heat, puncture the arterial pulse on the dorsum of the foot (Chongyang), open the aperture, release blood, and the body will instantly cool. When malaria is just about to present with chills, puncture Hand-Yangming (Large Intestine), Hand-Taiyin (Lung), Foot-Yangming (Stomach), and Foot-Taiyin (Spleen) meridians.

"Kong" is synonymous with "Kou" (aperture). This reiterates the meaning for Stomach Malaria. The arterial pulse on the dorsum of the foot is the Chongyang pulse of Foot-Yangming Stomach meridian. When Stomach Malaria erupts with heat, puncture the Chongyang arterial pulse on the dorsum of the foot. Rock the needle to open the acupoint, drain blood, and the body cools instantly. When Stomach Malaria erupts with impending chills, it is because Yangming Qi internally combines with Taiyin. Thus, puncture Hand-Yangming combined with Hand-Taiyin, and Foot-Yangming combined with Foot-Taiyin.

If the malaria pulse is full, large, and urgent, puncture the Back-Shu points. Use a medium-sized needle. Puncture one point at each of the five Xi-Cleft points adjacent to the back, adjusting depth according to the patient's fatness or thinness, and release blood. If the malaria pulse is small, solid, and urgent, moxa the lower leg Shaoyin points and puncture the Jing-Well points of the fingers.

This discusses the Five-Shu point acupuncture methods for meridian malaria. A medium needle is neither large nor small. "Xi" refers to the area connecting the flank and back. A full, large, and urgent pulse indicates excess Qi in the meridians. The Back-Shu points of the five Zang organs are located on the back, so puncture the Back-Shu points. The Back-Shu points are in two rows on the back. Outside these two rows, there are two more rows, known as the "Xi" areas. They are: Po Hu (Lung), Shen Tang (Heart), Hun Men (Liver), Yi She (Spleen), and Zhi Shi (Kidney). Use a medium needle to puncture one point at each of the five Xi-Cleft points and Back-Shu points. For fat patients, insert deeply; for thin patients, insert shallowly. Adjust based on body type to release blood, draining excess meridian Qi. A small, solid, and urgent pulse indicates deficient meridian Qi. Excess is drained, deficiency is tonified. A small pulse indicates deficiency of Zheng Qi, so moxa Taixi (KI-3) on the Foot-Shaoyin meridian to stimulate Sheng Yang Qi. Solid and urgent indicates excess pathogen; puncture the Jing-Well point Zhiyin (BL-67) on the little toe. Moxa first, then puncture, to support Zheng Qi and scatter pathogens.

If the malaria pulse is full, large, and urgent, puncture the Back-Shu points. Use one point each from the five Xi-Cleft points and Back-Shu points, adjusting needle movement until bleeding occurs. If the malaria pulse is slow, large, and deficient, medication is suitable, but acupuncture is not.

The previous text mentions puncturing Back-Shu points and one point each of the five Xi-Cleft points, implying simultaneous puncture of Back-Shu and Xi-Cleft points. Here it clarifies: For full, large, and urgent pulses, use a medium needle to puncture one point each of the five Xi-Cleft points and Back-Shu points. Adjust needle depth based on fatness/thinness until bleeding occurs. A slow, large, and deficient pulse follows the discussion of small, solid, and urgent pulses. It means the pulse is not urgent but slow, not small but large, not solid but deficient. Such cases require tonification, not drainage. Hence, medication is suitable, acupuncture is not, extending beyond just moxa before acupuncture. This clarifies the preceding text.

Generally, for treating malaria, treatment should begin approximately the time it takes to eat a meal before the attack. If missed, the timing is lost.

Treating malaria generally follows the acupuncture methods above. Treating before the attack by the duration of a meal is appropriate because treatment should precede the onset. Missing this window is losing the timing; treating out of timing yields no benefit.

For various malaria cases where the pulse is imperceptible, puncture the ten fingertips to release blood. Once blood flows, the disease will surely resolve. Observe the body beforehand for red spots the size of mung beans and puncture all of them.

"Various malaria" summarizes the malaria diseases discussed. Imperceptible pulse means the full-large-urgent, small-solid-urgent, or slow-large-deficient pulses are not felt. The pathology is not in the main meridians; thus, puncture the Jing-Well points at the tips of the ten fingers to release blood. Releasing blood removes Heart pathogen. Before the attack, observe skin for red spots like mung beans and puncture them all. Jing-Well points are outlets; skin governs the exterior. Since pathology is not in the meridians, this method is used.

The twelve types of malaria have different eruption times. Observe the symptoms to determine which meridian is affected. Puncture approximately the time it takes to eat a meal before the attack. One puncture reduces the pathogen; two punctures bring improvement; three punctures result in cure. If not cured, puncture the two vessels under the tongue to release blood. If still not cured, puncture the abundant vessels at Weizhong (BL-32) to release blood. Also puncture points below the neck along the spine; the disease will surely resolve. The two vessels under the tongue are Lianquan (CV-23). When treating malaria, first ask where the symptoms started, and puncture there first. If headache and heaviness start first, puncture the head, including both temples and between the eyebrows, to release blood. If neck and back pain start first, puncture there. If lower back and spine pain start first, puncture Weizhong (BL-32) to release blood. If arm pain starts first, puncture Hand-Shaoyin (Heart) and Hand-Yangming (Large Intestine) at the ten fingertips. If lower leg pain starts first, puncture Foot-Yangming (Stomach) at the ten fingertips to release blood.

The previous text covers three Yang, three Yin, five Zang, and six Fu organs, combining twelve meridians, hence "twelve types of malaria." Their eruptions differ. Observe timing and symptoms to identify the affected meridian. Knowing the location, puncture before the attack by the duration of a meal. Proper puncture reduces the pathogen with one session. "Reduce" means pathogen decreases. Two sessions bring improvement ("Zhi"), meaning smooth urination and harmony in the abdomen. Three sessions cure ("Yi"), meaning pathogen is gone and Zheng Qi recovers. If three sessions fail, puncture the two vessels under the tongue (Lianquan CV-23) to release blood. If that fails, puncture abundant vessels at Weizhong (BL-32) to release blood, and points below the neck along the spine. The disease will resolve. Clarifying: For one, two, or three punctures, first ask where symptoms began. For headache/heaviness, puncture head/temples/between eyebrows to release blood. For neck/back pain, puncture there. For lower back/spine pain, puncture Taiyang Weizhong (BL-32) to release blood. For arm pain, puncture Hand-Shaoyin/Yangming at fingertips (Shaochong HT-9, Shangyang LI-1). For lower leg pain, puncture Foot-Yangming at fingertip (Lidui ST-45) to release blood. This summarizes the twelve meridians' malaria, emphasizing the principle of prioritizing treatment based on symptom onset.

Wind Malaria: Upon eruption, the patient sweats and fears wind. Puncture the Back-Shu points of the three Yang meridians to release blood.

Wind Malaria is caused by Wind pathogen. Eruption causes sweating and aversion to wind, as Wind damages Taiyang muscle layer. Taiyang is the chief of the three Yang. Puncturing Back-Shu points of the three Yang meridians to release blood treats Taiyang Wind Malaria.

Severe pain in the marrow bones, unpressable, is called Fu Sui Bing (Bone-Marrow Disease). Use a Chan needle to puncture Juegu (GB-39), releasing blood, and the condition resolves instantly.

"Fu" was an error in old texts, corrected here. Severe bone-marrow pain is due to Wind. Unpressable pain indicates pathology in the bone. Marrow resides in bone, hence the name. *Meridians* chapter states: Foot-Shaoyang Gallbladder meridian descends to the end of Juegu, governing bone diseases. Thus, use a Chan needle to puncture Juegu (GB-39) of Shaoyang, releasing blood, for instant resolution.

For mild body pain, puncture Zhiyin (BL-67). For Jing-Well points of Yin meridians, do not release blood; puncture every other day.

Mild body pain is not as severe as bone-marrow pain. Pain is not in the bone but in the general Taiyang distribution. Thus, puncture Zhiyin (BL-67) of Taiyang. No mention of bleeding because Jing-Well points of Yin meridians do not bleed. Zhiyin connects to Yongquan (KI-1), confirming its Yin nature. Puncture every other day.

If malaria presents without thirst and occurs every other day, puncture Foot-Taiyang (Bladder) meridian. If accompanied by thirst and occurring every other day, puncture Foot-Shaoyang (Gallbladder) meridian.

Puncturing every other day aligns with every-other-day eruption. Taiyang is governed by Cold-Qi, so malaria without thirst and every other day is treated by puncturing Foot-Taiyang. Shaoyang is governed by Fire-Qi, so malaria with thirst and every other day is treated by puncturing Foot-Shaoyang.

For Warm Malaria with no sweating, apply the Fifty-Nine Acupoints needling method.

The Fifty-Nine Acupoints are described in *Shui Re Xue Lun*. Warm Malaria with no sweating indicates pathogen hidden in Kidney, unable to exit to Yang. Apply the Fifty-Nine Acupoints to drain Heat from Shaoyin Kidney and vent it outward. These are all methods for acupuncture in malaria, continuing and clarifying the previous treatise.