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The symptom of alternating chills and fever refers to a condition where, after chills subside, fever arises, and after fever subsides, chills return, or it may occur two or three times a day. If it occurs only once daily, starting with chills followed by fever, and the onset is regular in timing, it is called "simulating malaria" (Simulating Malaria), rather than ordinary alternating chills and fever.

Symptoms of alternating chills and fever mostly belong to disorders of the Taiyang Channel (Taiyang Channel Disorder). Sometimes, chills occur because pathogenic heat from external pathogens is latent internally; sometimes, fever occurs because pathogenic heat from external pathogens is emerging externally. If exterior pathogenic factors are predominant, chills will be more frequent than fever, accompanied by anhidrosis (absence of sweating); Qianghuo Chaihu Tang (Notopterygium and Bupleurum Decoction) should be used to disperse exterior pathogens. If interior heat is predominant, fever will be more frequent than chills, accompanied by hyperhidrosis (excessive sweating); Xiao Chaihu Tang (Minor Bupleurum Decoction) should be used to harmonize the exterior and interior.

If chills are predominant and the pulse is floating and large, the dosage of Chai Hu (Bupleuri Radix) should be doubled. If the hands and feet are constantly cold, with aversion to cold and scanty sweating, additional diaphoretic agents should be added. If sweating is profuse and the pulse is deep and rapid, Huang Qin (Scutellariae Radix) should be included in the formula; if sweating is profuse, accompanied by thirst and a rapid pulse, additional interior-clearing agents should be added. When exterior cold is predominant, dispersing methods should be used, avoiding cooling agents; when interior heat is predominant, cooling methods should be used combined with dispersing methods. If there is profuse sweating with both cold and heat symptoms, it becomes necessary to use a compound formula combining dispersing and cooling properties to harmonize the exterior and interior. This is why Zhang Zhongjing used Xiao Chaihu Tang to treat alternating chills and fever caused by pathogens affecting the Shaoyang Channel (Shaoyang Channel Disorder). In this formula, Chai Hu (Bupleuri Radix) alone lifts and disperses exterior pathogens, resolving aversion to cold naturally; Huang Qin (Scutellariae Radix) alone clears and resolves interior heat, eliminating fever naturally. Additionally, Ren Shen (Ginseng Radix et Rhizoma), Guang Pi (Citri Reticulatae Pericarpium), and Gan Cao (Glycyrrhizae Radix et Rhizoma) are added to harmonize Stomach Qi (Stomach Energy), allowing Stomach Yang (Stomach Heat/Energy) to distribute throughout the body, thereby mastering the authority of harmonization. By analogy, if symptoms involve the Taiyang Channel, Qianghuo Chonghe Tang (Notopterygium Harmonizing Decoction) is used; if symptoms involve the Yangming Channel (Yangming Channel Disorder), Gange Shigao Tang (Pueraria and Gypsum Decoction) is used; if symptoms of all three Yang channels are present, Qiang Huo (Notopterygii Rhizoma et Radix), Ge Gen (Puerariae Lobatae Radix), and Chai Hu (Bupleuri Radix) are used to disperse exterior pathogens and treat aversion to cold; Huang Qin (Scutellariae Radix), Shi Gao (Gypsum Fibrosum), and Zhi Mu (Anemarrhenae Rhizoma) are used to clear heat and treat interior heat; Guang Pi (Citri Reticulatae Pericarpium) and Gan Cao (Glycyrrhizae Radix et Rhizoma) are used to harmonize Middle Jiao Qi (Middle Burner Energy). Thus, the alternating chills and fever, along with profuse sweating, involving the three Yang channels can be completely resolved through one method of harmonization. The book *Zhunsheng* records that this formula treats malaria with alternating chills and fever of the three Yang channels during summer and autumn, deeply grasping this principle.

In Shanghan disease (Cold Damage Disease), after more than ten days, if exterior heat condenses into the interior and recurrent alternating chills and fever reappear, Da Chaihu Tang (Major Bupleurum Decoction) is indicated.

After more than ten days, if exterior heat has condensed into the interior, purgation is already indicated. However, due to the presence of recurrent alternating chills and fever, which are Shaoyang Channel symptoms, one should only use Chaihu Tang to disperse exterior pathogens, adding just one ingredient, Da Huang (Rhei Radix et Rhizoma), to remove interior heat.

In Shanghan disease lasting six or seven days, or following Wind Strike (Wind Attack), if there are recurrent alternating chills and fever, bitter fullness in the chest and hypochondrium, silence with loss of appetite, irritability and a tendency to vomit, or alternatively, irritability in the chest without vomiting, thirst, abdominal pain, hardness and stuffiness under the hypochondrium, palpitations in the epigastrium, difficulty in urination, absence of thirst, slight fever on the body, or cough, Xiao Chaihu Tang (Minor Bupleurum Decoction) is the primary treatment.
This clause is detailed in the Vomiting Section.

If a original Taiyang disease (Taiyang Disease) does not resolve and transitions into the Shaoyang channel, presenting with hypochondriac fullness, dry retching, and recurrent alternating chills and fever, without prior emesis or purgation, and with a deep and tight pulse, Xiao Chaihu Tang (Minor Bupleurum Decoction) is used.

When Taiyang disease transmits to the Shaoyang channel, presenting with hypochondriac fullness, dry retching, and recurrent alternating chills and fever, with a deep, tight, and wiry pulse, both the symptoms and pulse correspond to the Shaoyang channel; therefore, Xiao Chaihu Tang (Minor Bupleurum Decoction) is used.

In Shanghan disease lasting five or six days, after having undergone sweating or purging treatments, if there is slight knotting in the chest and hypochondrium, difficulty in urination, thirst without vomiting, sweating only on the head, recurrent alternating chills and fever, and irritability, the disease has not yet resolved; Chaihu Guizhi Ganjiang Tang (Bupleurum, Cinnamon Twig, and Dried Ginger Decoction) is appropriate.

After five or six days, following sweating and purging, if there is slight knotting in the chest and hypochondrium, difficulty in urination, thirst without vomiting, sweating only on the head, recurrent alternating chills and fever, and irritability, this indicates that the Taiyang exterior syndrome has not ceased, while the Shaoyang symptoms are urgent. Therefore, Chai Hu (Bupleuri Radix) and Gui Zhi (Cinnamomi Ramulus) are used in combination. Due to the post-sweating and purging state, Gan Jiang (Zingiberis Rhizoma) is slightly added to harmonize the Middle Jiao (Middle Burner).

Xiao Chaihu Tang (Minor Bupleurum Decoction)
Ingredients: Chai Hu (Bupleuri Radix), Huang Qin (Scutellariae Radix), Ren Shen (Ginseng Radix et Rhizoma), Shu Ban Xia (Prepared Pinelliae Tuber), Guang Pi (Citri Reticulatae Pericarpium), Gan Cao (Glycyrrhizae Radix et Rhizoma).
This is Zhang Zhongjing's formula for harmonizing the exterior and interior, and treating alternating chills and fever in the Shaoyang channel. If accompanied by Taiyang symptoms, add Qiang Huo (Notopterygii Rhizoma et Radix); if accompanied by Yangming symptoms, add Ge Gen (Puerariae Lobatae Radix) and Sheng Ma (Cimicifugae Rhizoma); if there is no sweat, add Fang Feng (Saposhnikoviae Radix); if thirsty, remove Ban Xia (Pinelliae Tuber) and add Tian Hua Fen (Trichosanthis Radix); if constipation with abdominal distension and pain, indicating urgent interior excess, add Da Huang (Rhei Radix et Rhizoma); if difficulty in urination, add Mu Tong (Akebiae Caulis); if loose stools, add Chi Fu Ling (Polyporus with Hostwood), named Chai Ling Tang (Bupleurum and Polyporus Decoction). For pain at the temples, add Chuan Xiong (Ligustici Chuanxiong Rhizoma).

Qianghuo Chonghe Tang (Notopterygium Harmonizing Decoction) - See Fever section.
This formula harmonizes alternating chills and fever of the Taiyang channel. Modifications are detailed in the Fever section.

Gange Shigao Tang (Pueraria and Gypsum Decoction)
Ingredients: Ge Gen (Puerariae Lobatae Radix), Chai Hu (Bupleuri Radix), Huang Qin (Scutellariae Radix), Shi Gao (Gypsum Fibrosum), Guang Pi (Citri Reticulatae Pericarpium), Gan Cao (Glycyrrhizae Radix et Rhizoma).
This formula combines Sanfang (three formulas): Chaige Jieli Tang (Bupleurum and Pueraria Decoction to Release the Muscle Layer), Gange Shigao Tang (Pueraria and Gypsum Decoction), and Xiao Chaihu Tang (Minor Bupleurum Decoction), to simultaneously resolve the exterior and interior of the Yangming and Shaoyang channels.

Da Chaihu Tang (Major Bupleurum Decoction)
Ingredients: Chai Hu (Bupleuri Radix), Huang Qin (Scutellariae Radix), Guang Pi (Citri Reticulatae Pericarpium), Gan Cao (Glycyrrhizae Radix et Rhizoma), Da Huang (Rhei Radix et Rhizoma).
This formula is derived from Xiao Chaihu Tang (Minor Bupleurum Decoction) by removing Ren Shen (Ginseng Radix et Rhizoma) and adding Da Huang (Rhei Radix et Rhizoma), named Da Chaihu Tang (Major Bupleurum Decoction). It treats cases where the Shaoyang exterior syndrome has not ceased, but the interior excess syndrome is urgent, thus using this decoction to simultaneously resolve the exterior and interior.

Chaihu Guizhi Ganjiang Tang (Bupleurum, Cinnamon Twig, and Dried Ginger Decoction)
Ingredients: Chai Hu (Bupleuri Radix), Gui Zhi (Cinnamomi Ramulus), Huang Qin (Scutellariae Radix), Guang Pi (Citri Reticulatae Pericarpium), Gan Cao (Glycyrrhizae Radix et Rhizoma), Ren Shen (Ginseng Radix et Rhizoma), Shao Yao (Paeoniae Radix), Gan Jiang (Zingiberis Rhizoma), Ban Xia (Pinelliae Tuber).
This is essentially the combination of Xiao Chaihu Tang (Minor Bupleurum Decoction) and Guizhi Tang (Cinnamon Twig Decoction), treating Wind Strike of the Taiyang channel complicated by alternating chills and fever of the Shaoyang channel. Extending this logic, Zhang Zhongjing treated stiff neck symptoms with Guizhi Jia Gegen Tang (Cinnamon Twig Decoction plus Pueraria) and Mahuang Jia Gegen Tang (Ephedra Decoction plus Puerara), following the same principle.

For symptoms of intermittent chills and fever, laypeople commonly use Xiao Chaihu Tang (Minor Bupleurum Decoction) to harmonize the Shaoyang channel, yet often see no effect. I now advance to seek precision in diagnosis and treatment, realizing that fever and aversion to cold are both Taiyang exterior syndromes. "Intermittent chills" indicate that exterior pathogens desire to emerge but cannot extend fully; "intermittent fever" indicates that pathogenic heat temporarily manifests externally. "Intermittent chills and fever" means pathogenic heat desires to emerge but fails to do so, leading to a struggle between pathogenic factors and healthy Qi, where exterior pathogens have not transcended the surface and perspiration is not thorough. How can the single method of harmonization via Xiao Chaihu Tang (Minor Bupleurum Decoction) treat this! For symptoms simulating malaria, each episode must end with sweating and cooling of the body; the treatment focuses exclusively on dispersing pathogens, avoiding cold-cooling agents that might suppress them, lest aversion-to-cold exterior symptoms persist until the next cycle. How much less applicable is this to cases of alternating chills and fever without cooling! Lifei Fabiao Tang (Lung-Regulating Exterior-Dispersing Decoction) and Pingwei Fabiao Tang (Spleen-Pacifying Exterior-Dispersing Decoction) are most effective for treating intermittent chills and fever. Formulas are found in the Body Pain section.