典藏书目

Danxi stated: The *Neijing* (Inner Canon) mentions "summer injury by heat, manifesting as malaria in autumn," and also says "all malaria arises from wind." The so-called "chronic malaria" or "malaria mother" refers to a condition that occurs every other day, lingering and difficult to eradicate.

Former sages sometimes used harsh medications, but one must fear that the patient's constitution is weak or altered by living conditions and care. Therefore, it is appropriate to use agents with astringent or interruptive properties such as Changshan (Dichroa Root), Wumei (Mume Fruit), and Pi (Arsenic). If these are mistakenly administered, mild diseases may become severe, and severe diseases may become critical.

Those who experience attacks every three days have disease in the Yin meridians. Attacks occurring on Zi, Wu, Mao, and You days indicate Shaoyin Malaria; those on Yin, Shen, Si, and Hai days indicate Jueyin Malaria; and those on Chen, Xu, Chou, and Wei days indicate Taiyin Malaria.

Malaria acquired from heat should be resolved through sweating. However, excessive cooling can cause sweat to stagnate and transform into phlegm. Upon initial infection, those with weak Zheng Qi (Upright Qi) fall ill immediately, while those with strong Stomach Qi remain latent without symptoms. The illness only manifests upon secondary infection combined with internal injury, which explains why it is difficult to cure.

Both heat and wind are external pathogens that cannot be resolved without profuse sweating. Patients seeking treatment have often already tried interruptive therapies, severely damaging their Stomach Qi, making rapid recovery unlikely. One must first administer modified tonifying formulas containing Renshen (Ginseng Root) and Baizhu (Atractylodes Rhizome) to induce sweating. After sweating, if deficiency persists, further nourishment is required. The lower body belongs to Yin and is hardest to sweat; it is a good omen only when the medicinal force drives sweat out to the feet.

Furthermore, when the pathogenic factor is extremely deep, it must transmit from the Zang organs to the Fu organs, resulting in irregular attack times. If attacks occur after Wu hour and before Yin hour, the Blood is affected, making it difficult to cure. A good omen appears only when the attack time gradually advances earlier. Therefore, treating this disease is easier in spring and summer but difficult in autumn and winter. It is strictly forbidden to induce sweating after a full meal; the ease or difficulty of sweating determines the quality of the treatment.

Commissioner Zhan contracted malaria in spring. After repeatedly trying interruptive drugs, the condition lingered until winter when he sought my treatment. Knowing he had not sweated for a long time and his Stomach Qi was incomplete, I determined that tonification was essential. I prescribed a powder of single-ingredient Baizhu (Atractylodes Rhizome) mixed with congee and formed into pills, instructing him to consume two jin (approx. 1 kg). He sweated profusely and recovered. Such cases are common, differing only slightly in modification, so they need not all be detailed.

According to the *Neijing*, malaria arises from wind, cold, and heat, which are heavenly pathogenic factors affecting the body and should be resolved through sweating. Zhang Zhongjing and Liu Hejian both used exterior-releasing medicines, differentiating treatment based on the degree of cold and heat to identify the meridian involved. However, there are differences between the Three Yin and Three Yang meridians. Generally, injury in the Yang meridians presents late but violently; injury in the Yin meridians is distant and deep. Injury in the Qi level manifests early; injury in the Blood level manifests late. Superficial disease causes daily attacks, while deep disease causes intermittent attacks. Although divided into Yin and Yang, this essentially refers to depth, and all should be resolved through sweating.

The *Jiyao* (Essentials) states that for the Three Yang meridians, the methods of sweating, purging, and harmonizing are the same as treating exogenous pathogens in Shanghan (Cold Damage). If the exterior pathogen is resolved but the interior remains unharmonized, one uses medicines like Daxiehu Tang (Major Bupleurum Decoction), Dachengqi Tang (Major Order the Qi Decoction), or Taoren Chengqi Tang (Peach Kernel Order the Qi Decoction) based on morning/evening differentiation of Qi and Blood. For chronic malaria patients with chest oppression, desire to vomit but inability to do so, one should use Lili San (Veratrum Powder) or Xionghuang San (Realgar Powder) to induce vomiting. This is established for acute diseases with excess Qi.

My master, Danxi, discussed chronic malaria caused by pathogens deeply entering the Yin and Blood levels. One should use ascending and dispersing medicines to move the pathogen from the Zang organs to the Fu organs, and then resolve it through sweating from the exterior. Using purgatives would cause the pathogen to sink deeper and become harder to expel.

Moreover, in chronic malaria patients with deficient Zheng Qi, interruptive drugs should not be used as they damage Stomach Qi. If interrupted several times without success, and the condition does not change, one must wait for spring. As Qi ascends in spring, the malaria pathogen will ascend and disperse with it, leading to resolution. In such cases, tonification is necessary.

For example, a woman suffered from chronic dysentery. Her son died of dysentery, and she wept bitterly. Several days later, her dysentery stopped, and malaria began. Physicians administered Sishou Yin (Four Beasts Drink) for two months. I was summoned to examine her. She experienced five or six attacks per day, sweating like rain without rest, unable to rise or lie down, eating little, speaking lazily, with a faint and rapid pulse. I reasoned that post-dysentery Yin deficiency and grief damaged Qi, and the administration of damp-heat clearing drugs exacerbated fire, further depleting Zheng Qi. With profuse sweating and no pathogen left to treat, Yin is deficient and Yang is scattering; death is imminent within a day or two. Small doses cannot suffice. I prescribed Renshen (Ginseng Root) 2 liang, Baizhu (Atractylodes Rhizome) 2 liang, Shaoyao (Peony Root) 1 liang, Huangqin (Scutellaria Root) 0.5 liang, and a small amount of Gancao (Licorice Root) as one dose, decocted strongly. She took this four to five times daily. After two days, the chills and fever ceased.

Another case involved two women with malaria. One had a lustrous complexion; I diagnosed dampness in the Qi level, requiring sweating. Two sweating treatments cured her. The other had a red-black complexion; I diagnosed heat injuring the Blood level. I used Siwu Tang (Four Substances Decoction) added with bitter, acrid, and cold herbs. After two days, sores appeared on her lips, indicating recovery. When treating diseases, how can one adhere rigidly to one method?

Previous discussions also mentioned Food Malaria, Phlegm Malaria, Epidemic Malaria, and Miasma Malaria. Their formulas are incomplete, and scholars must consider the treatment principles according to specific syndromes.