Shaking with Chills and Fever — How Do You Treat It with Needles? Doctor Luo Dalun Presents Doctor Ni Haixia’s Forty-Fourth Lecture on the Huang Di Nei Jing: the Ci Nue Lun (Needling Malaria Treatise, Chapter 36) — Six-Channel Malaria by Channel Differentiation with Bloodletting at Weizhong BL40, Warm Malaria and Dan Malaria, the Five-Zang Malarias Read from the Face, ‘The Kidneys Are the Gate of the Stomach’, Malaria Pulses and Which Needles to Choose, the Ah Shi Points, the Timing Rules, Tying Up the Fingers, the Two Sublingual Veins, Treating the First Place to Break Out, Wind Malaria and the Chan Needle at Juegu

Patient search words: the shakes / alternating chills and fever / shivering and shaking / teeth chattering / how to treat malaria / acupuncture for malaria / bloodletting therapy / low-back pain / heavy head / nausea and vomiting / vomiting with kidney trouble / vexation craving cold water / hungry but unable to eat / face turning blue-green / diarrhea / difficult urination / bloated belly with no urge to urinate / fever with hallucinations / sweating and fearing wind / shinbone pain / Weizhong BL40 / Back-Shu points / Ah Shi points / sublingual bloodletting / Jinjin and Yuye / Juegu point

Corresponding topics (medical terms): Su Wen · Ci Nue Lun (Needling Malaria Treatise, chapter 36): the acupuncture treatment of malaria · warm malaria (wen nue — winter wind-cold buried in the bone marrow; yin deficient and yang abundant, heat first then cold) · dan malaria (dan nue — overwork, the lungs habitually hot, heat only, never cold) · the six-channel malarias treated by channel differentiation (tai yang malaria — bloodletting at Weizhong BL40; shao yang malaria — Linqi GB41 / Yangfu GB38; yang ming malaria — Chongyang ST42; tai yin malaria — bloodletting at the extremities; kidney malaria — vomiting, more heat than cold; jue yin malaria — lower-abdominal fullness and difficult urination) · the kidneys are the gate of the stomach (the warning signs before kidney failure: severe dizziness, vomiting, nothing can enter the stomach) · the five-zang malarias (lung malaria — easily startled, seeing things; heart malaria — craving cold water; liver malaria — blue-green face, heavy sighing; spleen malaria — abdominal pain, chills, chattering teeth; kidney malaria — chills, urgent low-back pain, the kidneys govern the two excretions; stomach malaria — hungry but unable to eat) · malaria in the broad sense (a disease of the seasons and climate, not the plasmodium) · treatment timing (needle as the fever first rises; one bleed at Chongyang ST42 on the instep and the heat falls; treat before the attack, about a meal-time early; never needle during the attack) · malaria pulse differentiation (full, large, rapid — disease in the back, prick the Back-Shu points and let blood; small, hard, urgent — moxa the yin channels or needle the Jing-Well points; slow, large, empty — qi and blood both deficient, use decoctions, not needling) · the spirit of the Ah Shi points (Sun Simiao pressed and needled where it hurt; Ganshu BL18 is 1.5 cun lateral to the ninth thoracic vertebra) · the principles of treating malaria (treat before the attack; early treatment within about a meal-time; never needle during the attack) · bloodletting the collateral vessels at the extremities (tying up the fingers; green veins and red spots; malaria lives at the ends of the four limbs) · the two sublingual veins (Jinjin and Yuye EX-HN12) · treat the first place that breaks out first (headache — Baihui GV20, the forehead corners, Taiyang EX-HN5, Tongziliao GB1; low-back pain — Weizhong BL40; arm pain — the fingertips; sore shins — foot yang ming) · wind malaria — prick the tai yang Back-Shu points · fu sui bing — the chan needle at Juegu (Xuanzhong GB39) and bloodletting

Opening: last lecture described what malaria looks like — this lecture teaches where to put the needles

Last lecture, the Nue Lun (Malaria Treatise), explained the mechanism of malaria: wounded by summer heat, sick with malaria in autumn — the alternating chills and fever, shivering until the teeth chatter. This lecture is the Ci Nue Lun — chapter thirty-six of the Huang Di Nei Jing — devoted entirely to how malaria is treated with acupuncture. Doctor Ni Haixia says that before you pick up a needle, the first step is not needling at all — it is channel differentiation: figure out which channel the disease is sitting on.

💬 Note from Doctor Ni: If it is tai yang malaria, it makes the patient’s low back hurt and the head heavy, the cold rises from the back, cold first then heat. Just look at the channel — how does the foot tai yang bladder channel travel? The low back, the head, the back — right? So seeing these symptoms you know it is tai yang, and then you needle Weizhong BL40 — let blood from Weizhong.

Why does warm malaria come on with heat first, then cold? — Frozen to the bone in winter, breaking out in summer

Before the needling methods proper, Qi Bo finishes the origin stories of warm malaria (wen nue) and dan malaria. The root of warm malaria lies in winter.

💬 Note from Doctor Ni: What is called warm malaria — it is contracted from wind-cold in winter, and the cold qi hides inside the bone marrow. When you are struck by cold in winter, the strike is deep; winter is the season of the bones, and the kidneys govern them, so the moment you are struck, it reaches the bones. In spring the yang qi flourishes greatly, but that yang only rises on the surface of the muscles and skin — the disease in the bones has not yet come out. Then in summer you meet the great heat, the summer heat is at its fiercest, hot and dry — and if you labor or exert yourself, this pathogen comes out together with the sweat — the disease qi moves from the inside outward; yin deficient and yang abundant, yang abundant means heat — that is warm malaria.

So warm malaria looks like fever first, then chills, with more cold than heat — yet the true origin is cold. The cold hides very deep, rides from winter all the way to summer, and is pulled out by the heat of the hot season.

Dan malaria (dan nue, sometimes written “shan nue”) is different — it is earned by overwork:

💬 Note from Doctor Ni: Dan malaria is caused by too much labor. People who do physical work, always moving — plowing the fields, construction, cement work — sweat a great deal, so the lungs run comparatively hot. The lungs love cold; the lungs are like the heaven-yang above, and inside them it should be a little cooler. Now, because of everyday work, fluids are lost a lot, and the fluids of the lungs are lost from above. When the disease breaks out, yang is abundant without decline, it cannot reach the yin places — so there is heat only, no chills. You only see heat signs, never cold signs. When we do see cold signs, most of the time they come out of the bones — that is when the patient shakes until the teeth chatter; what comes in from outside is mostly heat.

Treating malaria by channel (1): the shao yang malaria that hides from people, and the yang ming malaria that loves the sun

The six-channel malarias, differentiated one by one. Shao yang malaria and yang ming malaria each have their own temper.

💬 Note from Doctor Ni: Foot shao yang malaria makes the body tired and weary; the cold and heat are both mild — shao yang sits between half-exterior and half-interior. The patient does not want to see people — that is a shao yang symptom, the patient simply does not want to look at anyone. Needle the Shu point of the shao yang channel — Linqi (GB41). If you say, teacher, can I choose Yangfu instead? Of course you can — if the disease has been there less than a week, it is still an excess, and you may needle Yangfu (GB38), which is the Shu point of the shao yang channel.

💬 Note from Doctor Ni: Yang ming malaria begins with gusts of aversion to cold; after the disease has lasted long, you keep seeing heat signs. But the yang ming cold is different from the tai yang cold: the tai yang cold feels very cold — tai yang itself is cold water, cold on top of cold, extremely cold, and it sits on the back. The yang ming cold sits all on the front of the body — you feel gusts of cold on the front, never on the back. Yang ming itself is pure yang, abundant in both qi and blood; when it is injured it likes to see yang — like attracts like — the patient likes to see sunlight and firelight. Treat yang ming malaria on the front — needle the Shu point of the yang ming channel, Chongyang (ST42).

Treating malaria by channel (2): spleen malaria — no appetite, only sighing, let blood from the extremities

In tai yin spleen malaria, all the symptoms sit on the spleen and stomach: low mood, no appetite, and nothing but sighing.

💬 Note from Doctor Ni: Foot tai yin malaria makes one unhappy, fond of deep sighing, and without desire for food — no appetite, liking to sigh — this is the spleen, the foot tai yin damp-earth. There is much cold and heat, and sweating; when the disease breaks out the patient feels nauseated, because the spleen and stomach are connected — when the spleen damp is very abundant it presses on the stomach. When the vomiting stops, you know the disease qi has declined — that is the time to begin treatment. When we treat malaria, we always treat when the disease qi has declined or before it has broken out.

Where do you needle? Still at the extremities:

💬 Note from Doctor Ni: For foot tai yin malaria, look on the foot tai yin channel itself. At the ends of the four limbs — for instance around Dadu (SP2), Taibai (SP3), Gongsun (SP4) — wherever you see green veins, congested vessels, let a little blood right there.

Kidney malaria is the fiercest: vomiting until the sky spins — “the kidneys are the gate of the stomach”

Among the six-channel malarias, Doctor Ni spends the most effort on kidney malaria — because its vomiting hides the great secret of what Western medicine calls kidney failure.

💬 Note from Doctor Ni: Foot shao yin (kidney) malaria makes one vomit severely, with much cold and heat — more heat than cold. Why more heat than cold? Because the kidney yang is inside — the heaven-yang descends from the lungs, and the kidney yang lives inside, the ming men fire sits right here; the kidneys are the source of water and fire together, the fountainhead of human life, holding very strong yang within. When the kidneys are struck by malaria, by disease, the yang scatters outward — the yang comes out robust, so of course you see more heat and less cold.

Why is vomiting connected to the kidneys? Doctor Ni points to an old saying of Chinese medicine — “the kidneys are the gate of the stomach”:

💬 Note from Doctor Ni: Chinese medicine has a saying: the kidneys are the gate of the stomach. What does it mean? The lungs are above, the heart in the middle, the stomach below, and the kidneys below that. In the normal person, the lung qi descends — no problem. When the kidneys have a problem, the upright qi below is yin and cold; the lung qi comes down and cannot get through — cold blocks it, the waste qi turns back and pushes against the stomach, and the stomach easily vomits. So when we see very severe vomiting, we know the kidneys have gone wrong.

💬 Note from Doctor Ni: In the clinic, when a patient’s kidneys are failing and they are about to begin dialysis, beforehand they are always dizzy — extremely severe vertigo — and vomiting, vomiting again and again; food and drink simply cannot enter the stomach; the vertigo is terrible — dizzy even lying in bed, turning upside down, however you lie, always vomiting. Because the kidneys are about to fail. So you see — the stomach is the official of the kidneys.

Kidney disease contracted in winter waits for spring to turn around — with an aside: the sage who hides in the wardrobe

When does kidney malaria get better? Qi Bo gives a forecast based on the seasons.

💬 Note from Doctor Ni: The kidneys govern winter; winter is when the disease starts. If you treat it in winter it will not get up — it is hard to stop. At the next season, spring is the season that nourishes it, and it should recover in spring. When the patient comes in winter, tell him: the time you came is not ideal — it will actually take about three months; only after three months does it slowly begin to turn around. The real turn for the better begins around the winter solstice — yang is born at the winter solstice — and by next spring the kidneys will be well. But if your prescription is excellent, you can bring it about sooner, and the seasons will not bind you.

As for the demeanor of a kidney-malaria patient, Doctor Ni tells a wonderfully vivid detail:

💬 Note from Doctor Ni: The sage seeks like with like — he likes to shut the door. Look at the patient — say the family is large, he shuts the door but there are still people around, right? So he hides in the wardrobe, closing himself inside the wardrobe. Kidney malaria — you know it: he wants to find a place to hide.

Jue yin malaria: urine blocked, and a fearful heart — “qi that cannot be drawn in is the kidneys’ business”

Foot jue yin (liver channel) malaria also has very typical symptoms: low-back pain, lower-abdominal fullness, difficult urination — and an unusual tendency to fear.

💬 Note from Doctor Ni: Foot jue yin malaria makes one’s low back hurt, the lower abdomen full, urination difficult like lin (retention) — lin means the urine cannot come out, the belly distends, as if urine were blocked inside — but in fact urine is not blocked inside. The patient can feel fear; the qi is insufficient. Why is the qi insufficient? Because inhaling is managed by the kidneys — our qi enters the kidneys and the liver; exhaling is managed by the heart and lungs. If you call the heart and lungs the upper burner, they manage exhaling; the liver and kidneys manage the lower burner, they manage inhaling.

The needling: needle the foot jue yin liver channel, all around the five Shu points.

💬 Note from Doctor Ni: When needling the liver channel, we stay around the five Shu points. Most of our malaria needling — especially malaria — is at the sides of the five toes and fingers, at the joints, from below the wrists and ankles down to the toes — those are all the places we needle for malaria.

When malaria runs into the five zang organs: read the face — lung malaria sees ghosts, heart malaria craves cold water

After the channel malarias, Qi Bo moves on to malaria entering the five zang organs. Each organ has one signature symptom — Doctor Ni says, “remember one symptom per organ and you are done.”

💬 Note from Doctor Ni: The lungs themselves govern cold, and everyone likes warmth, so when we treat lung disease, generally the patient must stay warm — I have always stressed this. When malaria runs into the lungs, it chills the heart, chills the upper burner; when the cold is extreme it turns to heat, and between the bouts of heat the patient is easily startled, seeing things — seeing what should not be seen: for example, you open the door in daylight and there is a person standing there — but there is no one. Lung patients are always easily startled, always seeing strange things. Needle the hand tai yin lung channel and the hand yang ming channel — because they are interior-exterior paired.

💬 Note from Doctor Ni: If malaria runs into the heart, it makes one vexed — when the heart has a problem there is always oppression and irritability, the mood turns bad. The patient craves cold water — yu de qing shui — and on the contrary there is much cold, not much heat. Why does he crave cold water? Because the heart itself is fiery — the heart is struck by malaria, the heat scatters outward, and the patient wants to drink some cold water. Needle the hand shao yin channel.

Liver malaria and spleen malaria — one is read from the face, the other from the teeth:

💬 Note from Doctor Ni: When malaria hits the liver, it makes the face turn blue — the complexion becomes blue-black — with heavy sighing, the condition as if dead. Needle the foot jue yin liver channel. One organ, one symptom — that is all you need to remember. Spleen malaria makes one cold, with pain in the abdomen, then changing to fever with aversion to cold. Malaria’s cold is different from ordinary cold-damage chill: cold-damage chill is just cold on the surface of the skin; malaria’s cold makes the teeth chatter — ge-ge-ge, ge-ge-ge, the teeth rattle. Never forget — chattering teeth means malaria.

Kidney malaria loses control of both excretions; stomach malaria is hungry but cannot eat — treat by differentiation, aim at the target

The most wonderful thing about kidney malaria is that you can read the disease’s location from urination and defecation.

💬 Note from Doctor Ni: Kidney malaria makes one sa sa ran — the character sa with the water radical — that means chills. The low back aches urgently — you all know the kidneys sit in the low back. If the stool becomes difficult and the bowels bind (wan zhuan da bian nan), and the eyes turn dizzy (mu xuan xuan ran) — the eyeballs rotate — and the hands and feet are ice cold. Chinese medicine holds that the kidneys govern the two excretions — both your urine and your stool are managed on behalf of the kidneys. A person says: doctor, what is wrong with me? I used to feel the urge to urinate; lately the urge is gone, I don’t want to urinate, my belly is very bloated, I know there is urine inside, but I have no urge at all; and the stool does not come either — and I am vomiting to death. When you hear that list of symptoms, you know the target has already run into the kidneys. That is how Chinese medicine treats by pattern differentiation.

The stomach malaria patient almost seems to be “deliberately making trouble”:

💬 Note from Doctor Ni: When malaria sits in the stomach — hungry yet unable to eat: the stomach is very hungry, but the patient cannot get food down; the moment he eats, the whole abdomen distends. You ask him: why are you hungry yet unwilling to eat? He says, every time I eat, my whole stomach distends, painfully full; but if I don’t eat, the stomach is tight with hunger; eat and it distends, and it cannot digest. You see this all the time. Needle the foot yang ming and foot tai yin channels, and let blood.

Chinese medicine’s malaria is not the mosquito’s plasmodium — malaria in the broad sense

Here Doctor Ni pauses deliberately to draw a clear line between Chinese medicine’s “malaria” and Western medicine’s plasmodium.

💬 Note from Doctor Ni: When you read the Huang Di Nei Jing to this point, we have defined malaria — it is not necessarily the plasmodium brought by mosquitoes. Chinese medicine’s malaria is malaria in the broad sense, not the narrow sense — it speaks of a disease caused by changes in the external seasons and climate. What relation does stomach malaria or kidney malaria have to plasmodium? What we see in these cases is all cold patterns. So we extinguish malaria with evidence — that is the broad-sense malaria we are talking about.

The transverse vessels: the congested veins between two straight channels — let them out and it is done

There is one more very concrete needling method — bleeding the transverse vessels, specially for malaria.

💬 Note from Doctor Ni: Bleeding the transverse vessels — you see, between the stomach channel and the spleen channel — both are straight: the stomach channel and the spleen channel, one on the outer side of the shinbone, one on the inner — between the two channels there are some transverse congested veins, clear and quiet; just let the blood out of them. Let the blood out and that is it — that is the needling method for malaria.

Treatment timing: needle the moment the fever rises — one bleed and the heat falls

Treating malaria is all about timing. When do you put the needle in? Qi Bo is very precise.

💬 Note from Doctor Ni: When the malaria attack is underway and the body has just begun to heat up — that is the moment to treat. If you prick the artery on the top of the foot — Chongyang (ST42) — the moment blood comes out, the patient is no longer hot, and the cold begins; it is very fast. If the malaria is about to turn cold — you know the heat has passed and the cold is coming — then prick the hand yang ming and tai yin, or the foot yang ming and tai yin. Choose the side to needle according to the cold and heat.

The malaria pulse is full, large and urgent? The disease sits on the back — prick the Back-Shu points and let blood

How does the pulse decide the treatment? Qi Bo gives one clear rule.

💬 Note from Doctor Ni: If the malaria pulse is full, large and urgent — the pulse is swollen, big and racing — we know the disease sits on the back, so we prick the Back-Shu points (bei shu xue). When you needle the back, you want bleeding, but do not use our ordinary 32-gauge needles — use direct spot-pricking to let blood. For example, 1.5 cun lateral to the Du (Governing) channel — Xinshu BL15, Pishu BL20 and so on — that is how we generally let blood. The Back-Shu points are the places where the five zang and six bowels communicate with the yang outside — the portals — and the gatekeeper of these portals is shao yang.

How do you know which Shu point holds the disease? Doctor Ni brings out the spirit of Sun Simiao’s Ah Shi points:

💬 Note from Doctor Ni: How do we know where the disease is? We use the Ah Shi points. Sun Simiao’s original spirit of the Ah Shi points was to press along each of the Shu points — whichever one hurts, bleed that one; where it hurts is where the disease lives. Later this path degenerated: shoulder hurts, smash the shoulder; eye hurts, smash the eye; heart hurts, smash the heart — that is wrong! When we treat malaria, we search over the lungs and press everywhere — nothing; but at the Ganshu point (BL18), 1.5 cun lateral to the ninth thoracic vertebra, it hurts — we know it is Ganshu, so let blood right there.

The bladder channel has little qi and much blood — it can spare blood, but do not overdo it

The foot tai yang bladder channel has a special trait: little qi, much blood — it can afford bloodletting.

💬 Note from Doctor Ni: The foot tai yang bladder channel has little qi and much blood — you may let blood freely. But when I say that, do not take it to excess — always “let freely,” and then draw a bowl out of every spot — that is too much! If the malaria pulse is full, large and urgent, and we let blood on the back along the bladder channel, the amount depends on whether the patient is fat or thin — generally not much, a few drops suffice.

When the pulse changes, the treatment changes with it:

💬 Note from Doctor Ni: If with malaria you feel a pulse that is small yet hard and urgent — a small pulse, we know the disease sits in the yin; the full-large-urgent pulse sits in the bowels, in the yang — that is the organs. When the pulse is small, we may needle the yin channel with moxa, or needle its Jing-Well point. As for whether what comes out is plasmodium — I make no claim either way; as long as the heat falls when you let blood and the patient recovers, that is enough.

Malaria with deficient qi and blood: pulse slow, large, empty — put the needles away and go home to decoctions

Not every malaria suits bloodletting. Once the pulse turns deficient, the whole treatment reverses.

💬 Note from Doctor Ni: Malaria alternates chills and fever; if the pulse is slow, large and empty — slow, and showing great emptiness — that means qi and blood are both deficient. When qi and blood are both deficient, the pulse becomes very large yet empty — without force; you feel a big pulse that is hollow in the middle, like squeezing a scallion at the market — the green scallion, hollow and empty. When qi and blood are both deficient, acupuncture and moxibustion are not appropriate. You say, teacher, let me give him more bloodletting on the back — too much, no need. When we are sure the pulse is floating, flooding, very large, we know the disease is on the surface — that is when we let blood; when the patient has qi and blood both deficient, decoctions are the right medicine. The Shang Han Lun and the Jin Gui Yao Lue both have formulas for it.

The iron rule of malaria: treat before the attack; if it is attacking, wait until it finishes

Qi Bo states the principle of treating malaria in one sentence — and later generations misunderstand it most easily. Doctor Ni also tells a story from his own lineage: back in the days of the Nationalist government, the old family-lineage physicians were drafted to form the “Malaria Eradication Brigade” and treated malaria along the Yangtze — treating precisely this broad-sense malaria:

💬 Note from Doctor Ni: Back then the Nationalist government drafted all these old family-lineage physicians to serve as army doctors, forming the Malaria Eradication Brigade, eradicating malaria with evidence. When they treated all the malaria cases along the Yangtze, you could not always arrive exactly when the disease had not yet broken out — right? Sometimes the malaria was attacking at that moment, and you stood beside him — wait, let me check whether it has begun to prepare yet — so it was very hard to catch the timing. That is why you must all know how we treat it.

💬 Note from Doctor Ni: In all malaria treatment, treating early — within about the space of a meal — is still treatable. This “early” does not mean “treat as soon as possible”; it means before the attack — when it is about to break out, hurry and treat it. That is seizing the moment, and recovery is very fast. So treating before the attack is best; if you encounter a patient who is currently attacking, do not treat. Are you in a hurry to meet your girlfriend? Then go out first, and come back tomorrow morning. First ask him: what time did you break out today? Nine o’clock. Fine — come back tomorrow at eight o’clock. You can adjust it this way.

Tie up the fingers and toes — one let of the green veins, and the chills and fever vanish

There is another situation: during the shaking fit, the pulse cannot even be felt — the pulse is perfectly normal. Where do you needle then?

💬 Note from Doctor Ni: In all malarias, when the patient shakes and chills and the pulse is invisible, the pulse normal — in this case, let blood from the middle of the index finger. Malaria always lives at the ends of the four limbs. Wherever you see congested blood — green veins, congested vessels — prick and let blood, any of them works. Why did people in the past tie up the fingers, bind them with cloth or cord? Because before the attack, the vessels swell and bulge, and you can see very clearly — the malaria was about to travel up the body, but it is bound, cannot get in, so it stops and tries to push through — and then you see it clearly, one by one, and let them all out. The moment you let them out — originally it was cold first then heat; the cold is gone. Or heat first then cold; the heat is gone. Very powerful, very simple — the qi and blood are certain to recover.

💬 Note from Doctor Ni: If you see many little red pimples on the patient, one grain at a time, let blood on them too — those are the malaria’s dwelling, the malaria’s nest. Is the plasmodium coming out here? I make no claim either way — as long as the disease recovers, that is enough. The twelve months all break out at different times; we watch the patient’s condition.

Bloodletting the two sublingual veins: Jinjin and Yuye — hold the tongue with cotton

If both channels are struck at once, there is a procedure of “prick in sequence” — and the finale is the sublingual bloodletting.

💬 Note from Doctor Ni: Shao yin means two channels struck together; here it is introduced that when it first breaks out, we prick them in sequence, pricking them all in an instant: once — the disease declines; twice — it recovers; three times — it is done. If it is still not cured, turn the tongue over and prick the two veins under the tongue. You say, teacher, the tongue is slippery, there is a lot of saliva, I grab it and it slips away, the patient is very nervous — what then? We are not so foolish — we generally grab the tongue wearing gloves; or take two wads of cotton, one in each finger, clamp the tongue with the cotton so it cannot slip — turn it over, and it cannot escape either. The tougher ones are not afraid — they turn the tongue over and prick it just like that. Sometimes it is a child, and he will bite you — what then? Pull his tongue out; he cannot bite — one bite and he bites his own tongue. Even so, treatment cannot proceed. The two sublingual veins are Lianquan (CV23) — actually the two sublingual veins (Jinjin and Yuye EX-HN12) sit behind Lianquan.

If the sublingual bloodletting is not enough, there is a backup plan:

💬 Note from Doctor Ni: If the sublingual bloodletting does not cure it, then prick around Weizhong — wherever there are green veins and blood-streaked vessels — and let them out. Add the Jiaji (EX-B2) points: find the tender spots 0.5 cun lateral to the Du (Governing) channel and let blood there — let it early.

Wherever it breaks out first, needle there: headache — needle the head; low-back pain — needle Weizhong

The last principle, and the handiest in clinical work — ask the patient where it broke out first, and needle that place first.

💬 Note from Doctor Ni: When we treat malaria with needles, we always first ask: the place where the disease first broke out gets needled first (bing suo xian fa zhe xian ci zhi). Where did yours break out first? Oh, at the start I had a stiff neck — fine, first treat the stiff neck. Just ask the patient and you know. If the headache comes first and the head is heavy, first needle the head and the two forehead corners — the crown, for instance Baihui (GV20); the forehead corners, Taiyang (EX-HN5), Tongziliao (GB1). If the low back and spine ache first, treat the low back — the patient says, it is not my head, my low back started aching and then the shaking began — then you go to Weizhong (BL40). When the arms start aching, needle the fingertips of the hand shao yin and hand yang ming channels. When the shins are sore, follow yang ming — needle the foot yang ming channel.

Wind malaria fears the draft; shinbone pain too sore to touch — the last two moves

To close, two special malarias: wind malaria and fu sui bing (marrow attachment disease).

💬 Note from Doctor Ni: When wind malaria breaks out, there is sweating with aversion to wind; during the attack, alternating cold and heat, the body keeps sweating, and the patient is miserable when the wind blows on him — he does not like drafts. For this wind malaria, let blood from the Shu points on the back along the tai yang and yang channels. There is another one — the cold ache is extreme: on the shinbone of the foot you cannot even press it — this is called fu sui bing (marrow attachment disease). For this we use the chan needle — the chan needle is coarse, like a knife — to prick Juegu (Xuanzhong GB39) and let blood.

Closing: differentiate channel by channel — and malaria is needled exactly in these places

From the six-channel malarias to the five-zang malarias to the needling methods for every pulse, Qi Bo has drawn the acupuncture map of malaria clearly: the extremities, Weizhong, the Back-Shu points, under the tongue, Juegu… it all lives in the two characters “differentiate the pattern.”

💬 Note from Doctor Ni: These are the principles of needling malaria — just look at the channels and you will understand. If you have an acupuncture foundation, follow the acupuncture channels: how the foot tai yang bladder channel travels, how the shao yang channel travels — one look and everything is clear. If you have no acupuncture foundation, and you cannot tell what foot tai yang or foot yang ming is — then go home and study acupuncture. After you finish learning acupuncture, come back to the Huang Di Nei Jing — now one look and it all becomes perfectly clear.

Based on Doctor Ni Haixia’s Ren Ji (Human Records) Huang Di Nei Jing lecture series (Lecture 44)