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Tidal fever (Chao Re) is like the tide, regular and punctual. It presents with fever only, without chills, unlike malaria which has alternating chills and fever, or conditions where exterior symptoms still exist. Its onset occurs at specific times, unlike general fever, severe fever, vexatious fever, or constant unremitting fever. Tidal fever in miscellaneous diseases can be either excess or deficiency. In external contraction diseases, tidal fever is solely caused by accumulated heat and dry fecal impaction in the Yangming Stomach and Intestines. Therefore, tidal fever is mostly treated with clearing heat (Qing Re) and purging (Xia) methods, as it is predominantly an interior syndrome. However, distinctions must be made: Onset during Yin and Mao hours (3 AM - 7 AM), preceded by slight chills then fever, indicates Shaoyang tidal fever. With no sweat and a floating pulse, use Chaihu Fangfeng Tang (Bupleurum and Saposhnikovia Decoction); with sweat and a wiry pulse, use Xiaochaihu Tang (Minor Bupleurum Decoction); with constipation and signs indicating purgation is indicated, use Dachaohu Tang (Greater Bupleurum Decoction); for deficient constitution, use Chaihu Yinzi (Bupleurum Drink). Onset during Si and Wu hours (9 AM - 1 PM), or occurring once daily, indicates Taiyang tidal fever. With a floating pulse and no sweat, use Qianghuo Chonghe Tang (Notopterygium and Harmonizing Decoction); with heat binding the Bladder, use Daochi Gehan Tang (Guide Out Redness Half-Decoction), heavily augmented with Qianghuo. Onset during Shen and Wei hours (1 PM - 7 PM), or occurring every other day, indicates Yangming Stomach and Intestine accumulated heat; use Chuanlian Zhike Tang (Coptis and Aurantium Decoction); however, if there is a floating pulse and no sweat, Ganjie Jiemo Tang (Pueraria Muscle-Releasing Decoction) is still appropriate; if there is sweat, a large pulse, and thirst, use Gegen Baihu Tang (Kudzu and White Tiger Decoction); if there is fullness and oppression in the chest, and a wiry-slippery right pulse, use Baohe San (Preserve Harmony Powder), heavily augmented with digestive agents; if stool is dry and signs of purgation are present, use Da Ganjie Tang (Great Pueraria Decoction) to purge; if abdominal distension and pain occur, inability to pass stool, and excessive sweating on hands and feet, use Sanyi Chengqi Tang (Three Yi Chengqi Decoction). Formulas for releasing the exterior are not used for tidal fever because tidal fever lacks exterior symptoms. If exterior pathogens have not dissipated, dispersing methods should still be used. Thus, tidal fever can also be cured using Shuangjie San (Double Release Powder) or Xiaochaihu Tang to harmonize; one cannot rely solely on clearing and purging methods. In summary, for tidal fever with spontaneous sweating and a deep-rapid pulse, lacking exterior pathogens, clearing the interior is appropriate, and releasing the exterior is unnecessary. For tidal fever with no sweat and a floating-large pulse, having exterior symptoms, releasing the exterior is appropriate. Even if interior pathogens exist, only simultaneous release of exterior and interior is suitable; one should not solely clear interior heat, as this may hinder the expulsion of exterior pathogens. Even if exterior pathogens are completely resolved and interior tidal fever appears, if there are no signs of purgation, immediate purging should not be performed. The above discusses tidal fever with both exterior and interior symptoms. There is another type: usually not frequently feverish, but feeling vexatious heat starting at Wugeng (3 AM - 5 AM), rising to internal fire attacking upwards during Chen-Si or Wu-Wei-Shen hours, accompanied by vomiting, distension, pain, or burning sensation in the chest and hypochondrium. Fever becomes intense like fire at these specific times, occurring once daily without missing the schedule. This is tidal fever originating from the interior due to accumulated heat and phlegm-fire lurking inside. Use Shengma Qingwei Tang (Cimicifuga Stomach-Clearing Decoction) combined with Zhike Chuanlian Tang (Aurium and Coptis Decoction), Zhilian Erchen Tang (Gardenia and Coptis Two-Chen Decoction), augmented with Haishi (Sea Stone) and Gualou (Trichosanthes Fruit) to clear accumulated heat and transform phlegm-fluids. If abdominal pain occurs with signs of purgation, use Daotan Tang (Great Phlegm Decoction) augmented with Dahuang (Rhubarb) and Xuanmingfen (Mirabilite) to purge. If food stagnation remains and cold/cold-natured suppression is contraindicated, use Baohe Pingwei San (Preserve Harmony and Harmonize Stomach Powder) to digest food accumulation. If phlegm and food are cleared but accumulated heat persists, the family secret method uses Ganjie (Kudzu Root) to resolve heat via the exterior, Chuanlian combined with Zhike to drain the large intestine, and Chuanlian combined with Mutong (Akebia Caulis) to clear the small intestine, achieving the method of internal and external dispersion. This discusses tidal fever with interior accumulated heat. After a febrile disease, slight tidal fever occurs during Shen-You hours (3 PM - 7 PM), named "evening mild vexation." This indicates Yangming Stomach and Intestine accumulated heat is not yet cleared, bowel and bladder movements are not smooth, and food was consumed too early. Zhang Zhongjing said: "Reducing food intake leads to recovery." This advises restricting grain consumption, using cold-natured herbs, mildly purging the large intestine, reducing food in the abdomen, and clearing residual heat. Use Zhike, Mutong, Chuanlian, Dahuang, Huangqin (Scutellaria Root), and Shanzhi (Gardenia Fruit) for treatment; or Zizhi Douchi Tang (Gardenia and Fermented Soybean Decoction) augmented with Zhishi (Immature Bitter Orange) and Dahuang, combined with dietary therapy for recovery.

In Taiyang Disease, after heavy sweating and subsequent purging, leading to constipation, dry tongue with thirst, slight tidal fever at Dubu (3 PM - 5 PM), hardness, fullness, and pain from the epigastrium down to the lower abdomen, intolerable to touch, use Daxiexiong Tang (Major Great Chest-Piercing Decoction).
This clause does not treat tidal fever but treats Jie Xiong (Chest Binding), hence the detailed annotation of Jie Xiong symptoms.

Yangming tidal fever with hard stool may be treated with Chengqi Tang. If there is no passing of flatus (Zhuan Shi Qi), this indicates only the beginning of the stool is hard, while the rest will be loose; purging will inevitably cause distension and anorexia.
This clarifies that the Chengqi method requires the passage of flatus as confirmation of hardened stool. If flatus is not passed, although the initial part of the stool is hard, the remainder is loose. Misguided purging will cause abdominal distension and anorexia.

In Yangming Disease, with a slow pulse, sweating, and no aversion to cold, the body will feel heavy. Shortness of breath, abdominal fullness, and wheezing, accompanied by tidal fever, indicate the exterior is resolving, and interior purging is now permissible. Sweating on hands and feet indicates the stool has hardened; use Dachengqi Tang (Major Chengqi Decoction). If there is slight fever and aversion to cold, the exterior is not yet resolved. If the fever is not tidal, Chengqi Tang should not be given. If there is significant abdominal fullness and obstruction, Xiaochengqi Tang (Minor Chengqi Decoction) may be given to gently harmonize stomach qi, avoiding drastic purgation.

In Yangming Disease, if the pulse is not floating and large, but slow, with sweating and no aversion to cold, plus abdominal fullness, tidal fever, and sweating on hands and feet, indicating hardened stool, interior purging is permissible. If fever and aversion to cold persist, and there are no tidal fever or interior signs, Chengqi Tang is contraindicated. Even with significant abdominal fullness and constipation, only Xiaochengqi Tang should be used to gently harmonize stomach qi, avoiding drastic purging.

In Yangming Disease, delirium, tidal fever, and inability to eat indicate the presence of five or six pieces of dry feces in the stomach/intestines. If the patient can eat, the stool is merely hard; Dachengqi Tang is the primary formula.
The inability to eat indicates dry fecal impaction. The ability to eat suggests no dry fecal impaction. Yangming heat typically allows for eating; the current inability to eat implies the gastrointestinal tract is filled and solid, leaving no room for food (synonymous with major excess and fullness). Thus, it is concluded that five or six pieces of dry feces exist, and Dachengqi Tang is indicated. If the patient can eat, the stool is only hard, likely without dry impaction, so Dachengqi Tang is not appropriate.

In Yangming Disease, delirium with tidal fever and a slippery-rapid pulse is treated with Xiaochengqi Tang. Administer one sheng of decoction. If flatus passes in the abdomen, administer another sheng. If flatus does not pass, do not administer further. If there is no bowel movement the next day and the pulse becomes faint and choppy, interior qi is deficient; this is difficult to treat, and Chengqi Tang should not be administered again.
In Yangming Disease, delirium and tidal fever with a deep-rapid pulse constitute the indication for purging. A slippery-rapid pulse currently indicates floating exterior pathogen. After administering Xiaochengqi Tang, observe for flatus; if present, administer another dose. If absent, do not administer. If no bowel movement occurs the next day and the pulse becomes faint and choppy, interior qi is deficient, making it difficult to treat; thus, Chengqi Tang should not be given again.

In Er Yang Bing (Dual Yang Pathology), when Taiyang symptoms cease and only tidal fever remains, with sweating on hands and feet, difficulty in defecation, and delirium, purging will lead to recovery; Dachengqi Tang is the primary formula.
With Taiyang symptoms ceased and only tidal fever present, exterior syndrome is gone. Sweating, difficulty in defecation, and delirium are all indications for purging; hence, Dachengqi Tang is used.

In Yangming Disease, a floating and tight pulse indicates tidal fever occurring at specific times; a merely floating pulse indicates night sweats.
In Yangming Disease, if the pulse is floating and tight, causing tidal fever at specific times, premature purging should be avoided; treatment should follow Taiyang protocols. "Occurring at specific times" does not mean a fixed schedule, but rather that the onset coincides with Taiyang hours. For example, tidal fever during Chen-Si hours belongs to Taiyang time; tidal fever in the first half of the day belongs to exterior pathogen time. Even if the pulse is merely floating without tightness, indicating light exterior pathogens, night sweats may appear, which is still a Chaihu pattern. This illustrates that regardless of pulse and symptoms, if signs of exterior pathogens appear, treatment should target the exterior.

Chaihu Fangfeng Tang (Bupleurum and Saposhnikovia Decoction)
Chaihu (Bupleuri Radix), Fangfeng (Saposhnikoviae Radix), Ganjie (Puerariae Radix), Gancao (Glycyrrhizae Radix et Rhizoma).
This formula disperses exterior pathogens of Shaoyang and Yangming. If chills and body pain are present, add Qianghuo (Notopterygii Rhizoma et Radix). For fullness and oppression, add Zhike (Aurantii Fructus) and Nongpo (Magnoliae Officinalis Cortex); for vomiting, add Banxia (Pinelliae Rhizoma) and Nongpo.

Xiaochaihu Tang (Minor Bupleurum Decoction)
Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), Guangpi (Citri Reticulatae Pericarpium), Gancao (Glycyrrhizae Radix et Rhizoma), Banxia (Pinelliae Rhizoma), Renshen (Ginseng Radix).
This formula harmonizes Shaoyang. If chills and body pain are present, add Qianghuo and Fangfeng; for thirst, remove Banxia and add Tianhuafen (Trichosanthis Radix); for fullness and oppression, remove Renshen and add Zhike and Nongpo; for difficult urination, add Mutong (Akebiae Caulis).

Dachaohu Tang (Greater Bupleurum Decoction)
Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), Guangpi (Citri Reticulatae Pericarpium), Gancao (Glycyrrhizae Radix et Rhizoma), Banxia (Pinelliae Rhizoma), Dahuang (Rhei Radix et Rhizoma).
Used when Shaoyang exterior symptoms are unresolved and interior symptoms are urgent, this formula simultaneously releases exterior and interior. For dry mouth and thirst, remove Banxia; for abdominal distension, add Zhike; for astringent urination, add Mutong.

Chaihu Yinzi (Bupleurum Drink)
This is Xiaochaihu Tang augmented with Dahuang, or Dachaohu Tang augmented with Renshen. The family secret method uses this for tidal fever with constipation in patients with deficient Yuan Qi. Remove Banxia, add Danggui (Angelicae Sinensis Radix) and Baishao (Paeoniae Radix Alba) to treat blood-deficiency tidal fever with constipation.

Qianghuo Chonghe Tang (Notopterygium and Harmonizing Decoction) See Fever.
Daochi Gehan Tang (Guide Out Redness Half-Decoction) See Abdominal Pain.
Baihu Tang (White Tiger Decoction) See Thirst.
When using this formula, the first step is to distinguish between sweating and no sweating, retention and non-retention of fluids, and scorched lips/mouth versus normal, which are key principles for intervention.

Da Ganjie Tang (Great Pueraria Decoction)
Derived from the dual-release method of Dachaohu Tang for Shaoyang exterior and interior, this formula simultaneously releases Yangming exterior pathogens and addresses Yangming interior heat with purgation indications.

Sanyi Chengqi Tang (Three Yi Chengqi Decoction)
Zhike (Aurantii Fructus), Nongpo (Magnoliae Officinalis Cortex), Dahuang (Rhei Radix et Rhizoma), Mangxiao (Natrii Sulfas), Gancao (Glycyrrhizae Radix et Rhizoma).
Tidal fever is an interior syndrome. Therefore, upon seeing purgation indications, purging methods should be applied immediately.

Daxiexiong Tang (Major Great Chest-Piercing Decoction) See detailed notes on Jie Xiong (Chest Binding).