素问：刺疟篇第三十六

Suwen: Chapter 36 — Treatise on Needling Malaria

Overall Paraphrase

The Treatise on Needling Malaria primarily discusses the manifestations of malaria classified according to the six channels and five viscera, along with the corresponding needling approaches. All needling methods described herein represent ancient therapeutic concepts presented for scholarly study only and must not be self-administered.

I. Malaria of the Six Channels

• Foot-Taiyang Channel Malaria: Causes lower back pain and heaviness in the head, with chills beginning from the back. There is cold first, followed by heat; when fever arises it is intense, causing restless agitation as if scorched by fire. Sweating occurs after the fever subsides, and the condition is not easily cured. The ancients recommended needling Xizhong (near the popliteal fossa, around Weizhong point) to draw blood.
• Foot-Shaoyang Channel Malaria: Causes the body to feel languid and weary, with neither chills nor fever being severe. The person dislikes seeing others and feels anxious and unsettled when seeing people. There is relatively more fever and pronounced sweating. Needle the Foot-Shaoyang channel.
• Foot-Yangming Channel Malaria: Causes the person to feel cold first, with chills coming in waves like cold water being splashed on the body. The cold is pronounced and lasts a considerable time before fever develops. After the fever subsides, sweating occurs. The person enjoys seeing sunlight, moonlight, and firelight, and feels comfortable when seeing them. Needle the Foot-Yangming channel at the dorsalis pedis artery.
• Foot-Taiyin Channel Malaria: Causes the person to feel despondent and unhappy, given to sighing, and unwilling to eat. There are frequent alternating chills and fever with sweating. When the attack occurs, vomiting is likely; after vomiting, the condition slightly subsides. One may needle the Foot-Taiyin channel at this time.
• Foot-Shaoyin Channel Malaria: Causes severe vomiting, alternating chills and fever, with more heat and less cold. The person prefers to shut doors and windows and rest alone. This type of malaria is difficult to cure.
• Foot-Jueyin Channel Malaria: Causes lower back pain, distension and fullness in the lower abdomen, and difficult urination—resembling longbi (urinary retention) but not true retention. There is frequent urination, a tendency toward fear, shortness of breath and fatigue, and a sensation of stagnation and obstruction in the abdomen. Needle the Foot-Jueyin channel.

II. Malaria of the Five Viscera and Stomach Malaria

• Lung Malaria: Causes the heart to feel cold; after the severe cold, fever develops. During intermissions of the fever, the person is easily startled, as if seeing something. Needle the Hand-Taiyin and Hand-Yangming channels.
• Heart Malaria: Causes pronounced vexation and irritability. The person desires cold water to drink, yet paradoxically there is more cold and the fever is not severe. Needle the Hand-Shaoyin channel.
• Liver Malaria: Causes the complexion to appear greenish-cyan, with a tendency toward sighing. The demeanor resembles that of a gravely ill person, as if near death. Needle the Foot-Jueyin channel to draw blood.
• Spleen Malaria: Causes chills, abdominal pain, and during fever, audible intestinal rushing sounds. After the borborygmus, sweating occurs. Needle the Foot-Taiyin channel.
• Kidney Malaria: Causes waves of chills, pain in the lower back and spine, difficulty in turning the body, difficult bowel movements, dizziness and blurred vision, and cold hands and feet. Needle the Foot-Taiyang and Foot-Shaoyin channels.
• Stomach Malaria: Causes the person to feel hungry easily during an attack yet be unable to eat; after eating, there is a sensation of distension and fullness in the abdomen with abdominal enlargement. Needle the transverse vessels of the Foot-Yangming and Foot-Taiyin channels to draw blood.

III. General Principles for Needling Malaria

• When malaria attacks and the body has just begun to heat up, needle the dorsalis pedis artery, open the point, and release blood—the heat will subside immediately. When malaria is about to bring chills, needle the Hand-Yangming and Hand-Taiyin channels as well as the Foot-Yangming and Foot-Taiyin channels.
• When the malarial pulse is full, large, and rapid, needle the Back-Shu points using medium-sized needles. At each of the five viscera Shu points on the back, insert one needle beside each, adjusting the amount of blood released according to whether the patient is stout or thin.
• When the malarial pulse is small, firm, and rapid, moxa the points on the lower leg of the Foot-Shaoyin channel, and needle the Jing-Well points at the tips of the toes.
• When the malarial pulse is full, large, and rapid, needle the back Shu points, using one point each from the five viscera Shu points and the back Shu points, allowing appropriate bleeding.
• When the malarial pulse is slow, large, and vacuous, medicinal treatment is appropriate; needling should not be used. In all cases of treating malaria, treatment should be administered about the time it takes to eat one meal before the attack; missing this window forfeits the optimal opportunity.
• If in various malarial conditions the pulse is deep and hidden and cannot be felt, needle between the ten fingers to draw blood; after blood is released, the condition can resolve. One should also first examine the body for red spots resembling small beans in size, and needle all of them to draw blood.
• The twelve types of malaria have varying times of onset. One should observe the patterns of the disease to determine which channel's pathology is involved. Needle about one meal-time before the attack. The first needling will reduce the severity; the second needling will produce noticeable improvement; the third needling will bring recovery. If still not cured, needle the two vessels beneath the tongue to draw blood. If still not cured, needle the more engorged vessel in the popliteal fossa to draw blood, and then needle the points beside the spine below the nape—this will surely cure it. The two vessels beneath the tongue correspond to the area anciently known as Lianquan.
• When needling malaria, one must first ask the patient where the symptoms first begin, and needle the area of first onset first. For those with headache and head heaviness first, first needle the head, both temples, and between the eyebrows to draw blood. For those with neck and back pain first, first needle the neck and back. For those with lower back and spinal pain first, first needle Xizhong to draw blood. For those with arm pain first, first needle the points between the ten fingers of the Hand-Shaoyin and Hand-Yangming channels. For those with soreness in the lower legs and feet first, first needle the points between the toes of the Foot-Yangming channel to draw blood.

IV. Sites of First Onset and Special Types of Malaria

• Wind Malaria: When malaria attacks, there is sweating and aversion to wind. Needle the blood collaterals of the three Yang channels at their back Shu points.
• When there is severe soreness in the lower legs that is so tender it cannot be touched, this is called fusuí disease (marrow disease of the shin). Use a chán needle (lance needle) to bleed the Juegu point, which may bring immediate relief.
• For mild body pain, needle Zhiyin point. Do not draw blood from the Jing-Well points of the Yin channels; needle every other day.
• For malaria without thirst that attacks every other day, needle the Foot-Taiyang channel. For malaria with thirst that attacks every other day, needle the Foot-Shaoyang channel. For warm malaria with no sweating, use the method of fifty-nine needling points.

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🧠 Deep Understanding

Core Principles 💡

1. Classification of Malaria by Channels and Viscera as the Framework
   This chapter does not treat malaria as a single entity but classifies it into the six channels and five viscera based on the order of chills and fever, the degree of sweating, emotional changes, urination and defecation, and sites of pain. For example, lower back pain and head heaviness with cold starting from the back are attributed to Foot-Taiyang; body languor and aversion to seeing people are attributed to Foot-Shaoyang; vomiting, sighing, and poor appetite are attributed to Foot-Taiyin. This reflects early Chinese medicine's approach of "identifying disease location" and "differentiating patterns."

2. Attacks Occur at Set Times; Treatment Should Precede the Attack
   The chapter repeatedly emphasizes "needle about one meal-time before the attack," meaning treatment should be administered approximately one meal before the malarial paroxysm. The ancients believed that at this time the pathogenic qi was not yet at its height and the righteous qi could still be mobilized; early intervention could cut off the disease momentum, embodying the principle of "treating according to timing."

3. Bloodletting to Drain Pathogenic Qi as the Primary Approach
   Throughout the chapter, phrases such as "to draw blood" and "bleed [the point]" appear frequently, indicating the ancient belief that malarial pathogens stagnate in the channels and blood level. By releasing blood, pathogenic heat could be drained along with it. This bloodletting approach was common in the Huangdi Neijing period but cannot be directly applied in modern times.

4. Ask Where Symptoms First Appear and Needle That Site First
   "One must first ask where the disease first manifests, and needle that area first" embodies the diagnostic attitude of "seeking the root of the disease" and "guiding according to the momentum"—addressing the earliest and most critical site rather than needling indiscriminately.

Modern Understanding 🌟

• This chapter is one of the earliest extant acupuncture texts devoted to malaria in Chinese medicine, systematically organizing the six-channel malaria, five-viscera malaria, and stomach malaria. It holds significant value for acupuncture literature and the historical study of channel-based pattern differentiation.
• The ancients observed periodic features of malaria such as "attacks every other day," "alternating chills and fever," and "more heat with less cold," which share superficial similarities to the intermittent fever of modern malaria, indicating the ancients' careful observation of febrile diseases.
• However, it must be recognized that modern malaria is definitively understood as an infectious disease caused by Plasmodium parasites transmitted through Anopheles mosquitoes. The ancients had no concept of pathogenic microorganisms and could only attribute malaria to external pathogens invading the channels and viscera. Acupuncture, bloodletting, and moxibustion cannot kill Plasmodium parasites nor replace standard antimalarial treatment.
• Descriptions such as "severe fever," "cold starting from the back," and "sweating with aversion to wind" may serve as references for ancient symptomatology and pattern-differentiation thinking but cannot serve as modern diagnostic criteria. Procedures such as bloodletting also carry risks of infection and injury and must never be self-attempted in modern times.

Health Insights ⚡

• Shelter from wind in daily life: Keep the nape, back, and lower back warm, avoid prolonged exposure to dampness and wind, and reduce invasion by external pathogens.
• Moderation in diet: Avoid overeating and excessive consumption of raw, cold, greasy, or sweet foods to prevent spleen-stomach discomfort such as "hunger without ability to eat" or "fullness after eating."
• Emotional balance: Avoid prolonged fear, depression, and habitual sighing. Maintaining emotional calm helps the liver qi flow freely and harmonizes qi and blood.
• Regular daily routine: Balance work and rest, avoid excessive fatigue, and keep the righteous qi sufficient. During damp and hot summer-autumn seasons, pay attention to environmental hygiene, prevent mosquito bites by using screens, mosquito nets, and eliminating standing water to reduce the risk of infectious diseases.

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📚 Related Knowledge

• Related Concepts
  Three Yin and Three Yang channels, five-viscera malaria, stomach malaria, Jing-Well points, Back-Shu points, Xizhong, Lianquan, Juegu, fifty-nine needling points, chán needle, time-based treatment, bloodletting therapy, wind malaria, warm malaria.

• Further Reading
  Suwen·Treatise on Malaria (Chapter 35)
  Lingshu·Channels and Vessels
  Zhenjiu Jiayi Jing (The Systematic Classic of Acupuncture and Moxibustion), Volume 7, related needling sections
  Leijing·Malaria Diseases, related annotations

— Compiled by Bu Gua
This content is based on classical Chinese medicine texts and is provided solely for traditional cultural study and scholarly reading. It does not constitute any medical diagnosis, medication, or treatment advice. If you feel unwell, please seek medical attention promptly.