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Cold sensation in the back is due to insufficiency of Yang Qi (Yang energy). Insufficiency of Yang Qi leads to excess Yin Qi (Yin energy). When Yin Qi is in excess, the mouth feels normal (not bitter or dry), and Fuzi Tang (Aconite Decoction) is indicated. If Yang Qi sinks inward, causing dryness of the mouth and throat, Baihu Tang (White Tiger Decoction) is indicated. Although both conditions present with cold sensation in the back, they must be carefully differentiated before treatment.

Alternating chills and fever (alternating cold and heat) results from the mutual overcoming of Yin and Yang, and the contention between pathogenic factors and healthy Qi; it belongs to the Shaoyang (Lesser Yang) half-exterior half-interior syndrome. Generally, when Yang is insufficient, Yin pathogens emerge to the exterior to contend with it, leading to Yin excess manifesting as chills. When Yin is insufficient, Yang pathogens enter the interior to contend with it, leading to Yang excess manifesting as fever. If pathogens reside more in the exterior, chills predominate; if pathogens reside more in the interior, fever predominates. If pathogens are in the half-exterior half-interior region, chills and fever are equal, appearing intermittently and alternating. Xiaochaihu Tang (Minor Bupleurum Decoction) specifically treats alternating chills and fever: add Guizhi (Cinnamon Twig) if chills are predominant; add Dahuang (Rhubarb) if fever is predominant. This is the general principle. In Taiyang (Greater Yang) disease lasting eight or nine days, resembling malaria with two or three episodes per day, no vomiting, normal urination and defecation, and a floating-slow pulse, indicates spontaneous recovery; if the pulse is not floating-slow, it indicates non-recovery, and Chaihu Guijiang Tang (Bupleurum, Cinnamon, and Gypsum Decoction) is used. After ten-plus days, if heat is consolidated in the interior, accompanied by severe thirst, solid stool, and alternating chills and fever, Da Chaihu Tang (Major Bupleurum Decoction) is indicated. If there are alternating chills and fever with chest and hypochondriac fullness but no pain, it is a half-exterior half-interior syndrome where pathogens have not yet entered the Fu organs; Xiaochaihu Tang plus Zhishi (Immature Bitter Orange) and Jiegeng (Platycodon Root) is used. In women suffering from Wind Strike for seven or eight days, if subsequent alternating chills and fever occur at regular intervals coinciding with the sudden cessation of menstruation, this is Heat entering the Blood Chamber (Xue Shi); Xiaochaihu Tang is also used.

Tidal fever (fever that rises like the tide at regular times) belongs to the proper Yangming Stomach Fu organ syndrome, peaking during the Wei (13:00-15:00) and Shen (15:00-17:00) hours. It occurs once daily, starting in the late afternoon, reliable as the tide, and specifically treats excess heat in the stomach caused by dry feces; purgative therapy should be employed. If the fever is not tidal, the stool is loose, and the pulse is floating, indicating that exterior symptoms persist, Chengqi Tang formulas should not be given prematurely. Once the stool becomes hard and dry, accompanied by thirst, spontaneous sweating, delirium, and tidal fever, immediate purgation is undoubtedly required.

Symptoms resembling malaria, also called "malaria-like," have regular onset and cessation, unlike the irregular nature of alternating chills and fever. In Taiyang disease resembling malaria with a floating-vigorous pulse, Guizhi Tang (Cinnamon Twig Decoction) is used. If there is no vomiting, normal urination and defecation, two or three episodes per day, belonging to Jueyin (Terminal Yin) disease, with a floating-slow pulse and no retraction of the testicles, it indicates spontaneous recovery. If the pulse is not floating, and the face is red with heat, due to the inability to obtain slight sweating, the body will likely itch; Guizhi Mahuang Ge Ban Tang (Half-and-Half Decoction of Cinnamon Twig and Ephedra) is used. In Yangming disease resembling malaria, with irritability, heat, sweating, evening fever, and a floating pulse, Guizhi Tang is used; if the pulse is excessive/solid, Chengqi Tang is used. For Heat entering the Blood Chamber causing blood coagulation with malaria-like symptoms, Xiaochaihu Tang is used; if heat is predominant over chills and the Chi (cun-guan-chi) pulse is slow, Jianzhong Tang (Establish the Middle Decoction) is used; once the Chi pulse is no longer slow, Xiaochaihu Tang is used to harmonize. In damp malaria with a peaceful pulse, only fever without chills, painful joints, and occasional vomiting, Baihu Tang plus Guizhi is used; if thirsty, Xiaochaihu Tang plus Gualougen (Trichosanthes Root) is used. The treatments vary accordingly.