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Question: Some patients present with chills (sajie ehan) accompanied by fever. What is the cause?
Answer: This occurs when the Yin pulse is deficient and Yang Qi moves to follow it; or when the Yang pulse is deficient and Yin Qi moves to invade it.
Question: Why do you say Yang is deficient?
Answer: If the Cun position (Cunkou pulse) is faint (wei), this is called Yang deficiency. When Yin Qi enters the Yang region due to deficiency, chills occur.
Question: Why do you say Yin is deficient?
Answer: If the Chi position pulse is weak (ruo), this is called Yin deficiency. When Yang Qi sinks into the Yin region due to deficiency, fever occurs.

Chills accompanied by fever constitute a Taiyang disease (Taiyang bing). When the Yin pulse is deficient and Yang Qi follows it, fever results; when the Yang pulse is deficient and Yin Qi invades it, chills result. If the Cun position pulse is faint, it indicates Yang deficiency, and Yin Qi invading the Yang region causes chills. If the Chi position pulse is weak, it indicates Yin deficiency, and Yang Qi sinking into the Yin region causes fever. Generally, the Cun position governs Wei Qi (Defensive Qi), and the Chi position governs Ying Qi (Nutritive Qi). Ying Qi circulates within the vessels and is abundant in the lower part; Wei Qi circulates outside the vessels and is abundant in the upper part. This is a fixed principle. In disease, Wei Qi becomes closed and cannot reach the exterior, instead invading the Yin position, causing Yang to become deficient. Ying Qi becomes disturbed and cannot guard inwardly, instead invading the Yang position, causing Yin to become deficient. When the Yin position is deficient and Yang invades it, Yang stagnates internally leading to fever; when the Yang position is deficient and Yin invades it, Yin binds externally leading to chills. This is the reason for the reversal of Ying and Wei Qi positions.

If the Yang pulse is floating (fu) and the Yin pulse is weak (ruo), there is Blood deficiency. Blood deficiency leads to tendon tension. A sinking (chen) pulse indicates deficient Ying Qi. A floating pulse with sweating like flowing pearls indicates deficient Wei Qi. In cases of deficient Ying Qi, if moxibustion needles (shao zhen) are applied, blood flow will stagnate, resulting in increased fever and irritability.

The Cun position belongs to Yang, and the Chi position belongs to Yin. If the Yang pulse is floating and the Yin pulse is weak, there is Blood deficiency. Blood nourishes the tendons; thus, Blood deficiency causes tendon tension. The Yin pulse is described as "weak" rather than "floating," implying the pulse is sinking. A sinking pulse indicates deficient Ying Qi. When Ying Qi is deficient and Yang Qi invades, this is the origin of fever. The floating nature of the Yang pulse does not indicate Yang excess; rather, a floating pulse with profuse sweating indicates deficient Wei Qi. When Wei Qi is deficient and Yin Qi invades, this is the origin of chills. Deficient Ying Qi inevitably leads to fever. If burning needles are used to cauterize the blood, the flowing blood will dry and coagulate, stopping circulation. Wei Qi becomes obstructed and stagnant, causing further fever and increased irritability. This is the cause of fever. Yang deficiency in the upper part leads to a floating pulse because it lacks root in the lower part. Yin deficiency in the lower part leads to a sinking pulse because it lacks root in the upper part. When both Yin and Yang are excessive, the Cun position is not excessively floating, and the Guan position (Guan pulse) has a pulse to guide descent; the Chi position is not excessively sinking, and the Guan position has a pulse to guide ascent. Therefore, Yin and Yang are not excessive at the Cun and Chi positions but are excessive at the Guan position. The Guan position is the pivot of the middle Qi of Yin and Yang, serving as the axis for ascending, descending, floating, and sinking.