Shivering, Chills Then Fever at Regular Times (Malaria)? Doctor Miao Xiyong Stops It Overnight — Three Formulas, Five Doses in One Day and Night

Searched by patients: shaking fits (da bai zi) / chills then fever / alternating cold and hot / fever at the same time every day / fever every other day / great sweat after the fever breaks / thirsty / too weak to stand Medical terms for this case: malaria · summer-heat malaria · warm disease · pathogen lingering with deficiency · qi and yin both injured

The opening: external contractions are on the rise again — a word of warning first

Lately, external contraction illnesses have started to climb again. Doctor Luo Dalun says he has heard of many friends up north coming down with fever again — some catching COVID a second time, others who were fine back then and are only now getting infected. The situation is not reassuring. The symptoms may not be severe, but this must never be taken lightly, because external contraction can throw all kinds of systems in the body into disorder — some people developed heart problems and ended up in serious trouble. So please be careful, keep learning, and protect yourselves well.

The disease in today’s story also belongs to the external contraction family — and it is an old, notorious one: malaria.

💬 Note from Doctor Luo: Lately I’ve been talking about external contraction diseases, and it’s good for everyone to listen in. Malaria — in the old days people called it “da bai zi” (the shaking fits). In China today it is extremely well controlled, and many young people have never even heard of it. But only a few decades ago, in the old society, it was everywhere: a little cold, then hot; a fever, then chills all over — and it attacked in rhythm: some people every other day, some every two days. It really is a hateful disease. In Africa today, malaria still kills an enormous number of people every year — it remains one of the biggest problems on the planet.

What is “da bai zi”? Chills and fever that strike on schedule

Malaria has very distinctive symptoms: sudden chills, then fever, always on schedule. When an attack comes, you first shake with cold and shiver all over, then a high fever comes on and you sweat; after a while the fever breaks and you feel fine — but two days later, on schedule again, the cold and the fever come back. It torments people in that relentless rhythm.

How frightening are the numbers? In 2021 alone, there were about 249 million malaria cases worldwide — close to a quarter of a billion people — and about 610,000 deaths. Six hundred and ten thousand people in a single year — that is malaria, and even today the whole world has not brought it under control.

💬 Note from Doctor Luo: Think about it: modern medicine has developed to its present level, and malaria is still not controlled globally. That shows how complex this disease is. So in today’s story, when the patient demands “stop it for me right now,” Doctor Miao Xiyong’s answer is: “Talk of ease!” He wasn’t being modest — he genuinely knew how stubborn this disease is.

Why did Doctor Miao Xiyong study medicine? At 17, malaria forced him into it

So who are we talking about today? Doctor Miao Xiyong (缪希雍), courtesy name Zhongchun, a native of Changshu in Jiangsu — a celebrated physician of the late Ming, author of Xian Xing Zhai Medical Notes (《先醒斋医学广笔记》) and Shen Nong Ben Cao Jing Shu (Commentary on the Divine Farmer’s Classic of Materia Medica), and one of the founders of the warm disease (wen bing) school. And the starting point of his medical studies is quite the legend — at the age of 17 he caught malaria himself, and managed to cure himself all on his own.

Back then, he tried every method for his malaria: drinking herbal decoctions, even summoning shamans for “zhu you” incantation healing — nothing worked. Seeing that this was going nowhere, Miao Xiyong shut himself away and studied: he read the Huangdi Neijing (Yellow Emperor’s Classic of Internal Medicine), read the books of famous physicians, and combed through the formularies. Eventually he understood: his own disease came from summer-heat evil (shu xie). The Neijing says, “Shang shang yu shu, qiu bi jie nue” — injured by summer heat in summer, you will get malaria in autumn. The body’s disharmony comes first; only then do the malaria parasites multiply inside. Of course, he knew nothing back then about plasmodium, or about transmission through mosquito bites — but he treated from the angle of “the body’s external contraction is out of balance,” and in less than ten days he cured the malaria that had plagued him for years.

💬 Note from Doctor Luo: Imagine if this happened to you — could you do it? A person gets malaria and runs to the hospital, weeping and wailing — so many doctors couldn’t cure it, what do you do? He read the Huangdi Neijing himself, prescribed for himself, and cured a disease he’d had for years in about ten days. So I believe Miao Xiyong had real talent — this is no small feat. From curing his own malaria he was greatly encouraged: Chinese medicine really works! And so he began to study medicine in earnest — and studied his way into becoming one of the great physicians of the late Ming.

Later, when treating malaria, Miao Xiyong developed a distinctive insight — besides expelling the pathogen, he specifically nourished stomach qi and the spleen and stomach, and differentiated by organ and channel, each following its own kind. Many people whose malaria had dragged on for a long time without healing were, once he looked at them, quickly restored. This insight of his resembles that of the later Doctor Wang Mengying — Wang himself had also suffered malaria, treated it well all his life, and said “I’ve never met one that was hard to treat,” using the same approach of pattern differentiation on external contraction.

The patient arrives: Shen Shaoqing, depleted by chronic malaria until he could barely stand, weeping and begging “stop it at once”

The patient who came to see Miao Xiyong that day was Shen Shaoqing — a man who had served as an official. In those days many of Miao Xiyong’s patients were local gentry and officials, and Shen Shaoqing was one of them; according to the records he was a Donglin partisan who had returned from the court.

Shen Shaoqing had been tormented terribly by malaria. As soon as he saw Miao Xiyong he said: Sir, please help me — malaria has tormented me terribly!

Miao Xiyong took one look: the man was exhausted to the extreme (the original text says “bei shen” — gravely worn out), his upright qi severely insufficient, depleted beyond words. Shen Shaoqing himself said: “If it attacks one more time, I think I’m done for!” Every attack nearly killed him. The disease came every other day or every two days, and before each attack he knew “it’s time” — the fever would start, unbearable; it would break, and two days later it came again, like a bad cold with high fever that simply would not clear. His spirit was broken. He said: Sir, do you have some wonderful formula? Can you stop it for me in one go? I can’t take it anymore — one more attack and my life is over!

💬 Note from Doctor Luo: The most tormenting thing about malaria is precisely this “attack on schedule” — you know when it’s coming, you wait for fate to arrive, the fever starts, it’s awful; it breaks, and two days later it’s back. So the psychological pressure on the patient is enormous. When Shen Shaoqing said “one more attack and I’ll die,” that wasn’t exaggeration — the disease had genuinely broken him.

Doctor Miao Xiyong’s reply: “Talk of ease!” You underestimate malaria

The patient begged for it to “stop at once,” but Miao Xiyong said: “He yi yan zhi yi ye?” — How can you speak of it so easily!

He said: You make it sound simple — one formula and it stops? You really underestimate malaria. This disease — the entire world of medicine has developed to its present level, and malaria is still not controlled. In 2021: 249 million patients, 610,000 deaths. You say it in one breath, but I must point out to you: you underestimate this disease. It is complicated!

So how did he treat it? Miao Xiyong opened three formulas — not one! Don’t underestimate the disease — the three formulas together came to five doses, and he ordered them all drunk within one day and one night. What happened? “Ci zao nue zhi” — the next morning, the malaria stopped! And the record adds “jin ji er yu” — after finishing the doses, he was truly cured.

💬 Note from Doctor Luo: Friends, in treating illness today we rarely see this practice — who prescribes three formulas at once and tells you to drink them all in one day and night? Very few. Why did Miao Xiyong do it this way? Because this patient was in too much pain; his spirit had collapsed; he couldn’t bear it. He said “Can you stop it for me in one go — I can’t take it, one more attack and I’m dead.” The man was shattered. An ordinary doctor wouldn’t bother treating it this way; letting it attack a couple more times, treating over a few more days, would also do. But Miao Xiyong had the confidence: if you are determined, I will cure it in one go. And “one go” meant five doses, three formulas, in one day and night. From this single sequence you can see how genuinely extraordinary Miao Xiyong was at treating illness.

The three formulas — how the “layering” worked

Three formulas, five doses, drunk in one day and night — how were they put together? There is great learning here.

• First two doses: a large dose of Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) with gui zhi (cassia twig);
• Middle two doses: a spleen-strengthening, food-resolving formula;
• Last dose: ren shen (Asian ginseng) and sheng jiang pi (fresh ginger peel), 1 liang each.

Fight the battle first, then replenish the ammunition, and finally greatly boost the yuan qi — that is Miao Xiyong’s sense of “layering.”

💬 Note from Doctor Luo: Look at the clarity of his thinking: he judged you to be suffering from warm-heat pathogen, so first he fought a great battle with a large dose of Zhuye Shigao Tang to clear heat and push the pathogen outward; but you had been sick a long time and were severely depleted, so ginseng was added into the battle to support upright qi. Yet that wasn’t enough — the next two doses strengthened the spleen and resolved stagnation, clearing out the accumulations and reviving the spleen-stomach qi so your upright qi would have a source; and finally the largest dose, ginseng paired with ginger peel, borrowed the rising yang of the morning to lift the yuan qi all at once. Once upright qi is lifted, the pathogen can no longer attack. This is the Chinese-medicine way of treating malaria — and the way it treats every external contraction disease.

Group one: large-dose Zhuye Shigao Tang with guizhi — clear the heat out first

The first group was a large dose of Zhuye Shigao Tang with gui zhi. Why add gui zhi? Because the patient was thirsty and sweating profusely — thirsty, much sweat — so a bit of gui zhi was added to harmonize qi and blood, to harmonize ying and wei (nutritive and defensive qi), something in the spirit of Guizhi Tang, though the main body remained Zhuye Shigao Tang.

And this Zhuye Shigao Tang was Miao Xiyong’s specialty. Flip through his case records and you will see — Zhuye Shigao Tang appears again and again in his cases. Why? Because this formula clears warm epidemic heat, clears warm heat, exceptionally well. It can fairly be said that Miao Xiyong was the pioneer who opened the way for warm disease theory — what later warm disease specialists studied was precisely his method of clearing warm heat with this approach.

Let’s review the formula (it is Zhang Zhongjing’s): sheng shi gao (gypsum), zhu ye (bamboo leaf), ban xia (pinellia), mai men dong (ophiopogon root), ren shen (Asian ginseng), gan cao (licorice), jing mi (non-glutinous rice).

• Zhu ye (two handfuls) — clears heat, vents qi;
• Sheng shi gao — in a very large dose. Today we use 30 g; Miao Xiyong used large doses, likely 2 liang (60 g) and up — the commanding general holding the line, pushing the heat outward;
• Ban xia — regulates qi, resolves phlegm, sends rebellious qi downward. When fluids are insufficient and the body is weak, one tends to vomit upward; ban xia sends the qi downward;
• Mai men dong — nourishes jin ye (fluids) — note: the character for fluids here is jin with the water radical next to the ye for night; it means body fluids, not “jing ye” (semen)! Doctor Luo emphasizes this after every lecture, because whenever the talks are written up, people keep typing the wrong word — it is completely wrong;
• Ren shen — supports upright qi, tonifies qi, and also generates fluids. This formula treats the late stage of heat disease with qi and yin both injured: qi damaged and fluids insufficient — ginseng both tonifies qi and generates fluids;
• Gan cao — harmonizes the herbs;
• Jing mi — protects the stomach qi so the stomach isn’t hurt; moreover, the rice water made by boiling jing mi lets the medicinal qi linger longer in the upper and middle jiao, strengthening its power to clear lung heat and stomach heat.

💬 Note from Doctor Luo: Zhang Zhongjing composed this formula beautifully — few ingredients, but every angle is covered, each herb representing a direction: bamboo leaf clears heat and vents the pathogen, gypsum holds the line and pushes heat outward, pinellia sends qi down, ophiopogon replenishes fluids, ginseng supports upright qi and generates fluids, licorice harmonizes, rice protects the stomach. One pot of this medicine, and the heat is cleared, the fluids preserved, and the upright qi has its root — that is Miao Xiyong’s first axe for clearing warm heat.

Group two: strengthen the spleen and resolve stagnation — replenish the ammunition right after the battle

What were the middle two doses for? Strengthening the spleen and removing accumulation. The formula: ju hong (red tangerine peel), bai dou kou (white cardamom), bai zhu (atractylodes), fu ling (poria), gu ya (rice sprout), wu mei (smoked plum), bai bian dou (white hyacinth bean), shan zha (hawthorn), mai ya (malt).

• Ju hong — regulates qi, and also disperses external pathogen and opens the lung qi;
• Bai dou kou — aromatic, revives the spleen-stomach qi;
• Bai zhu — tonifies the spleen;
• Fu ling — removes dampness;
• Gu ya — generates stomach qi;
• Wu mei — sour-sweet to transform yin, supplements fluids, and has an astringent, contracting action;
• Bai bian dou — tonifies the spleen and stops diarrhea;
• Shan zha and mai ya — resolve food stagnation.

Why prescribe it this way? Because at this point the patient’s spleen and stomach were very weak — his upright qi severely insufficient; had it been sufficient, the external pathogen could not have failed to be pushed out. First the Zhuye Shigao Tang cleared the heat; now, immediately, strengthen the spleen — resolve the stagnation so the spleen and stomach can travel light and run properly, digest and absorb, and produce upright qi. The front line fights; the rear immediately replenishes the ammunition.

💬 Note from Doctor Luo: This line of thinking is worth pondering deeply for modern people. Miao Xiyong was especially good at resolving food stagnation and strengthening the spleen — the famous Zi Sheng Wan (Nourishing Life Pill, the celebrated formula for digestion and spleen strengthening) was his creation. The ancients were very clever: tonify the spleen and stomach, remove stagnation, let the spleen and stomach run well and absorb nourishment — then upright qi has a source. I genuinely believe that people researching gut microbiota today should seriously study these Chinese formulas — some fecal transplants don’t survive, and half a year later the patient needs another transplant; how do you make them survive? These spleen-strengthening, stagnation-resolving formulas of Chinese medicine, taken slowly in small amounts to revive the spleen-stomach qi, make an absolutely different world of difference. This was Miao Xiyong’s thinking of treating malaria from the spleen and stomach — and you see, when he cured himself, he also expelled the pathogen first and immediately tonified the spleen and stomach afterwards.

Group three: ren shen and sheng jiang pi, 1 liang each, taken warm at the fifth watch — Doctor Miao Xiyong’s special move

The last dose: ren shen and sheng jiang pi, 1 liang each — both in large amounts; 1 liang is 30 g. How was it taken? Decocted in water, then left out overnight (exposed to the dew), and taken warm at the fifth watch — just before dawn.

Why all this fuss? Because just before dawn, yang qi is about to rise. Drink the medicine at that moment and, borrowing the momentum of rising yang, lift the great tonifying power of ginseng all at once — when the yuan qi is full and upright qi is lifted, the pathogen can no longer attack.

The most unusual element here is sheng jiang pi (fresh ginger peel). With ginger, we usually say the flesh is warming — it disperses, regulates qi, harmonizes the middle, sends rebellious qi downward and stops vomiting; the peel is generally regarded as cool — flesh hot, peel cool, that’s the usual teaching. But Miao Xiyong clearly had his own view: he considered ginger peel warming. Notice that whenever he used ginger peel in his formulas, the patient was especially cold, with yang qi insufficient. Why peel rather than flesh? Because ginger peel has the function of “xing shui” (activating the water) — when there is dampness at the body surface, ginger peel regulates qi and transforms and expels that surface dampness. So in treating malaria, when he met a patient with insufficient upright qi, prominent cold pathogen, and yang deficiency, he tended to use ren shen paired with sheng jiang pi — and he specifically noted that when cold signs are pronounced, one should use ginger peel with ginseng. In his malaria formulas, ginseng is often paired with ginger peel.

💬 Note from Doctor Luo: Using large doses of ginger peel to treat malaria — this should be one of Miao Xiyong’s special moves; ginger peel appears in many of his formulas, which is very distinctive. Look at the dosage: ginger peel increased little by little, from a few qian up to 1 liang — 30 g of ginger peel, that’s a very large amount; ginseng likewise, increased gradually up to 1 liang. In this case it was ginseng and ginger peel at 1 liang each: warm the person up, supplement upright qi fully, then clear the pathogen at the surface. Drink ginseng 30 g and ginger peel 30 g — try it and see — it lifts the yuan qi up all at once. Some people today call this “tiao yuan” (regulating the origin) — suspending the yuan qi up high; then the disease resolves, and the pathogen dares not attack again — because upright qi is sufficient, your own body can control these external pathogens.

The layering: clear the pathogen, strengthen the spleen, then greatly boost the yuan qi

After these five doses and three formulas, Shen Shaoqing’s malaria never attacked again — the next day it stopped, and with gradual recuperation he recovered.

The most brilliant part of this case is Miao Xiyong’s sense of layering:

• Layer one: large-dose Zhuye Shigao Tang with gui zhi — judge it as warm-heat pathogen, clear the heat first and push the pathogen outward; because you are depleted, ginseng is added to support upright qi;
• Layer two: strengthen the spleen and resolve stagnation — replenish the ammunition right after the battle, clear the accumulations from the spleen and stomach, revive their qi, and give upright qi a source;
• Layer three: ren shen and sheng jiang pi, 1 liang each, taken warm at the fifth watch — borrow the timing of heaven, lift the yuan qi all at once; upright qi sufficient, the pathogen naturally retreats.

💬 Note from Doctor Luo: Look at this small case — he deploys his troops in layers: different troops, different tactics; what comes first and what comes after, he knows perfectly. The patient begged “stop it quickly,” but this disease cannot be pounded with one mixed formula — he worked in layers, letting the body do different work in different time periods; every detail mattered. In literally one day, he stopped the malaria attacks. Friends, learning this way of thinking is enough: treatment must have layers — clear the pathogen first, then support upright qi, step by step.

What this case teaches us

Doctor Luo Dalun closes the case with several points:

• Malaria is an external contraction disease, but a very complex one — chills then fever, attacks on schedule, still uncontrolled globally; yet Chinese medicine, approaching it from external contraction and from “injured by summer heat” (the Neijing saying), can treat it;
• Treatment must have layers — first clear heat and vent the pathogen, then strengthen the spleen and resolve stagnation so upright qi has a source, and finally greatly boost the yuan qi. One day and one night, three layers — this is Miao Xiyong’s thinking for malaria (and for all external contraction diseases);
• Miao Xiyong’s special moves — large-dose Zhuye Shigao Tang for clearing warm heat (he was a pioneer of warm disease theory), ginseng paired with ginger peel for yang-deficient malaria, and Zi Sheng Wan for strengthening the spleen and resolving stagnation — these were his signature skills;
• Behind the case stands real history — patients like Shen Shaoqing, a Donglin partisan and former official, were recorded by the people of their own time; the case record is entirely authentic.

💬 Note from Doctor Luo: Miao Xiyong, from the age of 17 when he cured his own malaria by reading the Huangdi Neijing, practiced medicine all his life with that spirit of “bold in judgment, fine in care”: a great bushy beard, a voice that shook the room — yet his prescriptions were layered and orderly, not a thread out of place. Curing a collapsed malaria patient in one day and one night was a miniature portrait of his skill. Friends, when you are looking after your own health, you too can learn this way of thinking — when the body goes wrong, first clear the pathogen, then strengthen the spleen, and finally support upright qi; step by step, don’t rush. Every day I tell you a little story of an ancient doctor treating a patient, hoping it helps you protect your own health.

Case compiled from Doctor Luo Dalun’s commentary on Doctor Miao Xiyong’s medical cases; the case originates from Xian Xing Zhai Medical Notes (《先醒斋医学广笔记》) by Doctor Miao Xiyong, Ming dynasty.