Keywords: Chinese medicine, acupuncture-moxibustion,
In Chinese medicine, malaria is called
nue. This disease category covers true malaria (i.e., infection by
various species of Plasmodium
protozoa), as well as malaria-like conditions that resemble malaria
in their clinical presentation. Nue is defined as a recurrent disease
characterized by shivering, vigorous heat, and sweating and is classically
attributed to external contraction of summerheat evils during the hot
season, contact with so-called "mountain forest miasma," or
external contraction of cold and dampness. The relapsing-remittent
nature of malaria is explained as evil qi latent or deeply lying in
the half exterior-half interior stage. This means that some of the
externally contracted evil qi has remained in the exterior part of
the body (i.e., the skin and hair, muscles and flesh, and sinews and
bones), but some also invaded the interior or viscera and bowels. This
is equivalent to the shao yang aspect of a cold damage disorder.
the recurrent nature of nue conditions, the Yellow Emperor in the Huang
Ti Zhen Jiu Jia Yi Jing (Yellow Emperor's
Acupuncture-moxibustion Systematic Classic, circa 270 CE) says the following:
[Nue] is contracted in summer as a result of damage done by summerheat. The
heat qi, which is exuberant, is then hidden in the skin, outside the stomach
and the intestine [or more exactly] in the dwelling place of the constructive
qi. It causes people to perspire. This leaves a void behind and forces the
interstices to open. [Later, they] may contract autumn qi, be caught in wind
while sweating, or contract water qi while taking a bath. [These evil qi then]
lodge in the skin, residing in the defensive qi. Because the defensive qi moves
in the yang during the day and in the yin during the night, the [evil] qi emerges
during the yang [phase] and oppresses internally during the yin [phase]. Because
[the evil] oppresses [alternately] internally and externally, the nue episodes
occur once a day.1
The Jia Yi Jing (The Systematic Classic) similarly explains why some nue episodes
attack every other day or earlier or later than the preceding day. It also
clarifies why nue episodes present alternately cold and heat. At roughly the
same time, Wang Shu-he explained the bowstring pulse characteristic of malaria-like
The pulse of nue is typically bowstring. A bowstring and rapid pulse points
to abundant heat, while a bowstring and slow pulse points to abundant cold.
If the pulse is bowstring, small, and tight, precipitation [i.e., purgation]
is allowed. If the pulse is tight and rapid, diaphoresis, needling, or moxibustion
is allowed. If the pulse is floating and large, ejection [or vomiting] is allowed.
If the pulse is bowstring and rapid, [nue] has been started by wind and can
be checked by balancing the diet.2
In actuality, Chinese medicine identifies a number of different subtypes of
malaria or malaria-like diseases, with different authors giving different lists
ranging from seven to 12. For instance, wind malaria is distinguished by fever
and spontaneous perspiration; summerheat malaria is distinguished by high fever,
vexation, and thirst; damp malaria is distinguished by chest oppression, nausea,
and aching and heaviness in the body and limbs; cold malaria is distinguished
by severe aversion to cold, followed by mild fever; and warm malaria is characterized
by marked fever, followed by mild aversion to cold. Chinese medicine also recognizes
tertian malaria with attacks every third day and quartan malaria with attacks
every fourth day. Also, four other types of malaria-like disease are defined
by their triggering causes. These are taxation malaria, whose attacks are triggered
by fatigue; food malaria, whose attacks are triggered by dietary irregularities;
miasmic malaria caused by mountain forest miasmic qi; and epidemic malaria
caused by epidemic qi.
In terms of treatment, practitioners of Chinese medicine generally treat the
initial stage of malaria by harmonization. In this case, harmonizing means
harmonizing the exterior with the interior. Practically speaking, this means
dispelling those evils residing in the exterior at the same time as draining
or clearing any evils that have made it into the interior. In the middle stage
of the disease, the treatment principle is to interrupt the malaria: this means,
treat in order to prevent the occurrence of an imminent attack. If the attacks
are regular, needling is done with draining hand technique two to three hours
before the expected episode. If attacks are not so regular, acupuncture treatment
may be given two to three times per day in an attempt to break the cycle. In
the advanced stage, the emphasis is on supplementing the vacuity caused by
enduring disease with the understanding that if the righteous qi is exuberant,
it will automatically attack and negate any remaining deep-lying or latent
Up until the mid 20th century, most acu-moxa books discussed the treatment
of malaria primarily based on its Chinese medical disease diagnosis (i.e.,
nue). For instance, in the late 1500s, Yang Ji-zhou devoted a chapter to nue
in the therapeutics section of his famous Zhen Jiu
Da Cheng (Great Compendium
of Acupuncture & Moxibustion). The following is that pithy chapter in its
[For] nue, [use] Bai Hui (GV 20), Jing Gu (Lu 8), [and] Qian Gu (SI 2).
[For] warm nue, [use] Zhong Wan (CV 12) [and] Da Zhui (GV 14).
[For] quartan nue, [use] Yao Shu (GV 2).
[For] nue with cold [and] heat, [use] He Gu (LI 4), Ye Men (TB 2), [and] Shang
Yang (LI 1).
[For] phlegm nue with cold [and] heat, [use] Hou Xi
(SI 3) [and] He Gu (LI 4).
[For] nue with quivering with cold, [use] Shang Xing (GV 23) and Xian Gu (St
[For accompanying] headache, [use] Wan Gu (SI 4).
[For] cold nue, [use] San Jian (LI 3).
[For accompanying] heart vexation, [use] Shen Men (Ht 7).
[For] cold nue with inability to ingest, [use] Gong Sun (Sp 4), Nei Ting (St
44), [and] Li Dui (St 45).
[For] enduring nue, [use] Zhong Zhu (TB 3), Shang Yang (LI 1), [and] Qiu Xu
[For] more heat than cold, [use] Jian Shi (Per 5) [and Zu] San Li (St 36).
[For] nue initiated by spleen cold, [use] Da Zhui (GV 14), Jian Shi (Per 5),
and Ru Gen (St 18).3
However, in the mid-20th century, with the advent of provincial and metropolitan
colleges and universities of Chinese medicine, the methodology of treating
based primarily on pattern discrimination was extended to the practice of acupuncture
and moxibustion. Therefore, the following is a more detailed, contemporary
discussion of the disease causes and mechanisms of alternating cold and heat
and the acupuncture treatment of this main distinguishing feature of malaria.
Nevertheless, general malaria-terminating treatment is still based mainly on
points located on the governing vessel, pericardium, and small intestine channels.
Disease Causes & Mechanisms:
The shao yang is known as the pivot. In fact, a shao yang pattern describes
a situation where evils are in two places in the body at the same time. Half
the evils are located in the exterior, and half are located in the interior.
In other words, evils are neither entirely in the exterior nor entirely in
the interior. This pattern is frequently seen in a number of febrile diseases.
In the struggle between the righteous qi and evils, the battle may swing
back and forth. When evils are relatively victorious, the defensive qi will
be depressed and blocked. Hence, the exterior is deprived of warming, and
chills occur. When the righteous qi is relatively victorious, heat will form
leading to fever, since yang added to yang engenders heat. As a result, alternating
chills and fever are seen.
Treatment Based on Pattern Discrimination:
entering the shao yang
Symptoms: Alternating fever and chills, chest and rib-side distention and pain,
a bitter taste in the mouth, a dry throat, no desire to eat, heart vexation,
frequent retching, nausea, possible deafness and vertigo, white or yellow
tongue fur, and a bowstring pulse
Therapeutic principles: Harmonize the constructive and defensive and resolve
the shao yang.
Acupuncture & moxibustion:
Wai Guan (TB 5) Together, these points harmonize and resolve the shao yang
Qiu Xu (GB 40) with even supplementing and draining method.
Qi Men (Liv 14)
Jian Shi (Per 5) Together, these points clear heat and eliminate vexation when
needled with He Gu (LI 4) draining method.
Additions & subtractions:
For deafness and vertigo, add Jin Men (GB 25) and Ting Hui (GB 2).
For vexatious pain in the joints, add Yang Fu (GB 38) and Da Shu (Bl 11).
For vomiting, add Zhong Wan (CV 12).
For constipation, add Zhi Gou (TB 6) and Shang Ju Xu (St 37).
For predominant fever, replace Wai Guan with Zi Lin Qi (GB 41).
2. External contraction of malaria evils
Symptoms: Alternating fever and chills that occur at a fixed times, possibly
once a day, every other day, or every third day. At the beginning, there
are chills that cannot be relieved even with double quilts. Then there is
high fever, vexatious thirst with a desire for lots of drinking, red lips
and face, and, finally, sweating followed by a normal body temperature. The
pulse is deep and bowstring during the shivering, and surging, large, and
rapid when there is fever. The pulse becomes normal again after sweating.
Therapeutic principles: Dispel evils and eliminate malaria.
Acupuncture & moxibustion:
Da Zhui (GV 14) Together, these points arouse the yang and eliminate the evils
Hou Xi (SI 3) with draining method.
Zhong Zhu (TB 3) Together, these points harmonize the constructive and
Jian Shi (Per 5) defensive when needled with even supplementing and draining
Note: Da Zhui, Hou Xi, and Jian Shi are all traditional points for the treatment
of malaria-like conditions.
Additions & subtractions:
For splitting headache, add Feng Chi (GB 20) and Tai Yang (M-HN 5).
For profuse sweating and thirst, add Fu Liu (Ki 7).
For nausea and vomiting, add Zhong Wan (CV 12).
For high fever, prick Shi Xuan (M-UE-1) to bleed.
For enduring malaria, add Pi Shu (Bl 21) and Zu San Li (St 36).
3. Deep-lying summerheat & dampness
invading the shao yang
Symptoms: Alternating fever and chills, sweating that does not abate the fever,
thirst but drinking just a little, heart vexation, possible headache, possible
sour vomiting, chest and stomach glomus and oppression, possible rib-side
and abdominal distention, short voidings of dark-colored urine, red tongue
edges with slimy, white fur, and a bowstring pulse
Therapeutic principles: Clear heat, transform dampness, and disinhibit the
Acupuncture & moxibustion:
Da Zhui (GV 14) Together, these points clear heat when needled with draining
Tao Dao (GV 13)
Qu Chi (LI 11) Together, these points clear heat and prevent contrary shifting
of evils to the
Hou Xi (SI 3) pericardium when needled with draining method.
Zhi Gou (TB 6) Together, these points transform dampness and disinhibit the
Zhong Wan (CV 12) when needled with draining method.
Additions & subtractions:
For nausea and vomiting, add Nei Guan (Per 6).
For inhibited defecation, add Tian Shu (St 25).
For loose stools, add Gong Sun (Sp 4).
While most people who become infected with malaria in developed countries will
seek the care of a Western medical doctor, malaria has become resistant to
some standard Western drug treatments. And, although there are also Chinese
herbal treatments for all the patterns listed above, some people prefer acupuncture
therapy because it does not involve ingesting another substance that has
to be processed by an already sensitive digestive system. In either the case
of Chinese herbal or Western medical treatment, acupuncture therapy can be
an important and effective adjunct. In Third World populations of patients,
acupuncture is an inexpensive and low-tech option that might be useful where
drugs may not be available.
Honora Lee Wolfe, DiplAc, LicAc, FNAAOM
c/o Blue Poppy Press
5441 Western Ave. #2, Boulder, Colorado 80301 USA
1. Huang-fu Mi. (Yang Shou-zhong, Charles Chace, translators). The
Systematic Classic of Acupuncture & Moxibustion. Boulder, Colorado:
Blue Poppy Press, 2004, p. 263.
2. Wang Shu-he. (Yang Shou-zhong, translator). The
Pulse Classic. Boulder, Colorado: Blue Poppy Press, 1997, p.291.
3. Yang Ji-zhou. (Yang Shou-zhong, Liu Feng-ting, translators). The
Divinely Responding Classic. Boulder, Colorado: Blue Poppy Press, 1994,