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In Taiyang disease (Taiyang Disease), what is meant by "Zhen" (Trembling/Shivering)? "Zhen" refers to a state where the body feels intensely cold and trembles or quivers. The occurrence of "Zhen" in Taiyang disease is attributed to deficiency-cold (Xu Han).

When sweating is about to occur, the patient must be deficient. There will inevitably be a sensation of steaming heat accompanied by trembling ("Zheng Zheng Er Zhen"), followed by fever, sweating, and resolution of the disease. "Zhen" is close to "Zhan" (Shivering/Chattering), but the milder form is called "Zhen". "Zhan" represents the struggle between righteous Qi (Zheng Qi) and pathogenic factors (Xie Qi); this struggle manifests as shivering with chattering teeth. "Zhen", however, arises merely from deficiency without reaching the stage of struggle, thus manifesting only as quivering and trembling.

After purgation followed by diaphoresis, if chills and trembling occur, it indicates that both the exterior and interior are deficient. If a patient who has lost blood undergoes diaphoresis and experiences cold chattering and trembling, it indicates that both blood and Qi are deficient. In such cases, there is only quivering and trembling. However, in cases where the patient trembles violently as if wanting to fall to the ground ("Zhen Zhen Yu Pi Di") or where the body trembles and sways ("Shen Wei Zhen Zhen Yao"), these result from excessive diaphoresis leading to Yang collapse and deficiency of the meridians, causing the body to lose autonomous control and tremble. This differs from "Zhen Li" (Shivering and Chattering). The Classic states: "If after emesis or purgation, there is fullness and counterflow of Qi below the heart, Qi rushing up to the chest, dizziness upon standing, and subsequent diaphoresis disturbs the meridians causing the body to tremble and sway, Poria, Cinnamon Twig, Atractylodes Macrocephala and Licorice Decoction (Fuling Guizhi Baizhu Gancao Tang) should be administered." In Taiyang disease, if diaphoresis fails to resolve the condition, and the patient still has fever, palpitations below the heart, dizziness, body movement, and trembles violently as if wanting to fall to the ground, Asarum and Prepared Aconite Decoction (Zhenwu Tang) should be administered. Both of these formulas are agents that warm the meridians, benefit Yang, nourish blood, and assist Qi. For those with meridian deficiency and weak Yang, their use invariably leads to complete recovery.

What is meant by "Zhan Li" (Shivering and Chattering) in Taiyang disease? Although "Zhan" and "Li" appear similar, they are essentially different. Collectively referred to as "Zhan Li," they constitute one concept; analytically distinguished, they have differences between interior and exterior. "Zhan" refers to the physical shaking of the body. "Li" refers to internal trembling or fear (often manifesting as chattering teeth or inner dread). "Zhan" and "Li" serve as diagnostic indicators for exterior and interior conditions. Ignorant practitioners conflate them into "Zhan Li," unaware of the distinction between favorable (Shun) and unfavorable (Ni) patterns. The Classic states: "When the Stomach lacks Grain Qi and the Spleen is stagnant and blocked, the mouth becomes tight and speech is impaired, resulting in shivering and chattering." From this, we see that "Zhan" and "Li" are indeed distinct. Comparing "Zhan" and "Zhen," "Zhen" is mild and "Zhan" is severe. Comparing "Zhan" and "Li," "Zhan" is exterior while "Li" is interior.

"Zhan Li" represents the struggle between Yin and Yang. When Taiyang disease is about to resolve and sweating is imminent, if the Righteous Qi is internally solid, Pathogenic Factors cannot struggle with it, and sweating occurs directly without shivering. If Pathogenic Factors attempt to exit but the patient is originally deficient, Pathogenic Factors and Righteous Qi struggle. Mild struggle manifests as "Zhen"; severe struggle manifests as "Zhan". After the struggle subsides, Righteous Qi prevails, and the disease resolves. The Classic states: "Why do some patients resolve through shivering followed by sweating? It is because the patient was originally deficient, hence shivering occurs." When Pathogenic Factors struggle with Righteous Qi externally, it manifests as "Zhan"; "Zhan" indicates healing. When Pathogenic Factors struggle with Righteous Qi internally, it manifests as "Li"; "Li" indicates a more severe condition. The Classic states: "When Yin is attacked by pathogens, internal chattering (Li) necessarily occurs." This is because exterior Qi is slightly deficient and interior Qi does not hold fast, allowing pathogens to enter Yin. When interior Qi fails to hold and pathogens attack the Righteous Qi, the Righteous Qi becomes timid, forming "Li". "Zhan" signifies Righteous Qi prevailing; "Li" signifies Pathogenic Factors prevailing.

In Taiyang disease, on the sixth or seventh day, when resolution is expected, shivering followed by sweating should occur. If there is only internal chattering and chattering of the jaw, without body shivering, it will subsequently develop into Cold Reversal (Han Ni). Such patterns rarely resolve spontaneously. Why? Because Yin Qi is abundant internally and Righteous Qi is too deficient to overcome the pathogens, instead being overcome by them. Unless large hot-decoctions are used, or moxibustion is applied, how can this be countered?