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4. The Wei Qi (Defensive Qi) converges at Fengfu (GV16) in the early morning, while the pathogenic factor transmits downward by one vertebral segment each day. Because the pathogen follows a downward course from the head, the onset of symptoms is delayed progressively; when the pathogen reaches its lowest point and then ascends again, this is the reason for the progressive advancement of the onset time.

[Annotation] The Wei Qi circulates and meets at Fengfu (GV16) every day in the early morning. When pathogenic factors invade the human body, they travel from the head and neck through Fengfu (GV16), descending along the back and waist, transmitting downward by one vertebral segment of the spine each day. As the pathogen meets the Wei Qi later each day, the malaria attacks are delayed progressively. When the pathogen transmits to the lowest limit (Chong Mai), its qi ascends again, causing the pathogen to meet the Wei Qi earlier each day, thus the malaria attacks occur progressively earlier.

5. In the initial stage of malaria, if the Zheng Qi (Upright Qi) is substantial, sweating, vomiting, or purging methods may be used. If both exterior and interior patterns are cleared, harmonizing formulas should be employed. If clearing and harmonizing fail, antimalarial drugs may be used. For chronic malaria resulting in physical debility, tonification is appropriate.

[Annotation] In the initial stage of malaria with substantial Zheng Qi, sweating, vomiting, and purging methods are all suitable. For exterior and interior syndromes, sweating and purging are applied. For chest fullness, vomiting, and retching due to fluid retention, vomiting is induced. When exterior and interior patterns are cleared, harmonization is indicated. If clearing and harmonizing are ineffective and no exterior or interior patterns exist, antimalarial medications can be used to stop the attack. For chronic malaria leading to emaciation and Qi deficiency, tonifying agents are naturally appropriate.

Guizhi Mahuang Ge Ban Tang (Cinnamon Twig and Ephedra Half-Dose Decoction)

6. For malaria in the initial stage where chills and fever are balanced, Guizhi Mahuang Ge Ban Tang (Cinnamon Twig and Ephedra Half-Dose Decoction) is used to induce sweating. If there is little sweat and more chills, double the dose of Mahuang (Ephedra); if there is much sweat and more heat, double the dose of Guizhi (Cinnamon Twig) and add Shigao (Gypsum).

[Annotation] At the onset of malaria, when chills and fever are neither excessive nor deficient but balanced, Guizhi Mahuang Ge Ban Tang (Cinnamon Twig and Ephedra Half-Dose Decoction) should be used to induce sweating. If there is little sweat, more chills, and less heat, double the dose of Mahuang Huang Tang (Ephedra Decoction) to induce sweating. If there is much sweat, less chills, and balanced heat, double the dose of Guizhi Tang (Cinnamon Twig Decoction) to induce sweating; if heat is predominant, add Gypsum.

Mahuang Qianghuo Tang (Ephedra and Notopterygium Decoction), Guizhi Qianghuo Tang (Cinnamon Twig and Notopterygium Decoction), Mahuang Qianghuo Jia Banxia Tang (Ephedra and Notopterygium Decoction with Pinellia), Baihu Tang (White Tiger Decoction), Baihu Guizhi Tang (White Tiger and Cinnamon Twig Decoction), Chaihu Baihu Tang (Bupleurum and White Tiger Decoction), Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction)

7. For cold-predominant cold malaria without sweat, seek Mahuang (Ephedra), Qianghuo (Notopterygium), Gancao (Licorice), and Fangfeng (Saposhnikovia). For heat-predominant wind malaria with sweat, reduce Mahuang (Ephedra), increase Guizhi (Cinnamon Twig), and add Banxia (Pinellia) equally for vomiting. Preceding heat followed by cold is named Wen Malaria (Warm Malaria); combine Baihu Tang (White Tiger Decoction) with Guizhi Tang (Cinnamon Twig Decoction) if sweat is profuse. Dan Malaria (Blazing Malaria) presents with heat only; use Chaihu Baihu Tang (Bupleurum and White Tiger Decoction). Pin Malaria (Yin Malaria) presents with cold only; use Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction).

[Annotation] These are all sweating methods for the initial stage of various types of malaria. Injury by cold first, then by wind, preceding cold followed by heat, with more cold than heat and no sweat, is called Cold Malaria (Han Malaria). It is suitable for Mahuang Qianghuo Tang (Ephedra and Notopterygium Decoction), composed of Mahuang (Ephedrae Herba), Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), and Gancao (Glycyrrhizae Radix et Rhizoma). Injury by cold first, then by wind, preceding cold followed by heat, with more heat than cold and with sweat, is called Wind Malaria (Feng Malaria). It is suitable for Guizhi Qianghuo Tang (Cinnamon Twig and Notopterygium Decoction), composed of Guizhi (Cinnamomi Ramulus), Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), and Gancao (Glycyrrhizae Radix et Rhizoma). For either syndrome with vomiting, add Banxia (Pinelliae Rhizoma). Injury by wind first, then by cold, preceding heat followed by cold, is called Warm Malaria (Wen Malaria). It is suitable for Baihu Tang (White Tiger Decoction); if sweat is profuse, combine with Guizhi Tang (Cinnamon Twig Decoction). When Yang Qi is abundant and Yang acts alone, there is heat only without cold, called Blazing Malaria (Dan Malaria). It is suitable for Chaihu Baihu Tang (Bupleurum and White Tiger Decoction), which is Xiao Chaihu Tang (Minor Bupleurum Decoction) combined with Baihu Tang (White Tiger Decoction). When Yin Qi is abundant and Yin acts alone, there is cold only without heat, called Yin Malaria (Pin Malaria). It is suitable for Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction), which is Xiao Chaihu Tang (Minor Bupleurum Decoction) combined with Guizhi Tang (Cinnamon Twig Decoction).

Caoguo Chai Ping Tang (Tsaoko and Bupleurum Harmonizing Decoction), Da Chaihu Tang (Major Bupleurum Decoction)

8. For food-stagnation malaria presenting with epigastric fullness, belching, and aversion to food, Caoguo (Tsaoko Fructus) combined with Xiao Chaihu Tang (Minor Bupleurum Decoction) and Pingwei San (Powder for Maintaining Uprightness) is appropriate. For malaria with internal hardness of stool, Da Chaihu Tang (Major Bupleurum Decoction) is used for purging, adding Mangxiao (Mirabilite), Binglang (Areca Seed), Caoguo (Tsaoko Fructus), and Houpo (Magnolia Bark) according to dosage.

[Annotation] For malaria caused by food stagnation, presenting with epigastric fullness, belching, and aversion to food, it is suitable to clear the condition using Xiao Chaihu Tang (Minor Bupleurum Decoction) combined with Pingwei San (Powder for Maintaining Uprightness) plus Caoguo (Tsaoko Fructus). For any malaria with unclear interior patterns and hard stools, Da Chaihu Tang (Major Bupleurum Decoction) should be used with Mangxiao (Natrii Sulfas), Houpo (Magnoliae Officinalis Cortex), Caoguo (Tsaoko Fructus), and Binglang (Arecae Semen) to purge the interior.