经曰∶阳虚则外寒，阴虚则内热，阳盛则外热，阴盛则内寒。寒热往来，此乃阴阳相胜也。
故寒气并于阴，则发寒。阳气并于阳，则发热。寸口脉微，为阳不足阴气上入阳中，则恶寒
。尺脉弱，为阴不足，阳气下入阴中，则发热。阳不足则先寒后热，阴不足则先热后寒。阴
阳不归其分，则寒热交争也。又上盛则发热，下盛则发寒，阳胜则乍热，阴胜则乍寒，阴阳
相胜，虚实不调，故邪气更作而寒热往来，或乍寒乍热也。少阳胆者，肝之府，界乎太阳阳
明之间，半表半里之分，阴阳之气，易于相乘，故寒热多主肝胆经症，以小柴胡汤加减调之
。若只见寒热，起居如常，久而不愈，及大病后，元气未复，悉属阴虚生热，阳虚生寒，宜
用八珍汤补之，甚者十全大补汤。有食积为病亦令寒热，用保和丸消之。若兼呕吐泄泻，用
六君子汤。厥冷冻饮料热，人参理中丸。作渴不止，七味白术散。食积既消，而寒热尚作者，肝
邪乘脾所胜，侮所不胜也。用异功散加柴胡、山栀。其疟症寒热，详见疟门。
治验
一小儿十四岁，朝寒暮热，或时发寒热，则倦怠殊甚，饮食不思，手足指冷，朝用补中益气
汤，夕用六君子汤，各二十余剂，渐愈。后因用功劳役，前症复作，更加头痛，脉虚两寸尤弱，朝用
补中益气汤、蔓荆子，夕用十全大补汤，两月余而痊。但劳役仍复寒热，服前二汤稍愈。毕
姻后，又用功过度，朝寒遍体如冰，暮热遍身如炙，朝用补中益气汤加姜、桂，暮用八味丸加五味子
，各五十余剂而愈。
一小儿十三岁，壮热便秘，服清凉饮，愈而复作，服地骨皮散，更潮热。又服芩、连、四物
，不时寒热，体倦少食而热，或昼见夜伏，夜见昼伏。余谓肝脾虚热。夕用地黄丸加五味子
，朝用补中益气汤加山药、山茱而瘥。
一小儿寒热不愈。诊其乳母，左关脉弦数，左胁作痛，遇劳则遍身瘙痒，遇怒则小便不利，
此因肝经血虚，郁火所致也。先用小柴胡汤加山栀、牡丹皮，诸症顿退。又用加味逍遥散，
母子并痊。
一小儿发热切牙，乍寒乍热，耳内痛痒，缘乳母有肝火所致，用柴胡清肝、栀子清肝二散，
母子并服而愈。
一小儿十四岁，每日子时分发热，遍身如灸，午未时则寒，足骨如冰至膝，至子时分，热仍
作，此内真寒而外假热也。朝用补中益气汤加参、 各三钱、附子三分，夕用大剂四君子汤
加当归一
姜桂五分，各数剂。乃朝用十全大补汤，夕用六君子汤，渐愈。又用五味异功散而寻愈。
一女子十五岁，寒热，月经先期，两寸脉弦出鱼际。此肝经血盛之症，用小柴胡汤加生地黄
、乌梅治之而愈。后寒热消瘦，月经过期，乃肝脾二经血气虚弱也。朝用补中益气汤，夕用
六味地黄丸而愈。
羌活冲和汤 治太阳无汗，发热头痛恶寒，春强，脉浮紧。又治非时暴寒人中之头痛，恶寒
发热，宜此汤治之以代麻黄汤用，太阳经之神药也。
羌活 防风 苍术（各一钱半） 川芎 甘草 细辛 白芷 生地黄 黄芩（各一钱）
上水煎服。
八珍汤（四物、四君合用，四物见急惊，四君见内钓）
十全大补汤（方见自汗）
六君子汤
加味逍遥散
异功散（三方见内钓）
人参理中丸（方见冷泻）
保和丸
补中益气汤（二方见虚羸）
地骨皮散（方见潮热）
芩连四物汤（即四物二连汤加黄芩，方见潮热）
地黄丸
八味丸（即地黄丸加五味子、肉桂。二方见肾脏）
小柴胡汤（方见痉症）
柴胡清肝散
栀子清肝散（二方见发热）
As stated in the *Huangdi Neijing* (Yellow Emperor's Inner Canon): When Yang Qi is deficient, there is exterior cold; when Yin Qi is deficient, there is interior heat; when Yang is excessive, there is exterior heat; when Yin is excessive, there is interior cold. Alternating chills and fever result from the mutual overacting of Yin and Yang.
Therefore, when Cold Qi merges into the Yin aspect, chills occur. When Yang Qi merges into the Yang aspect, fever occurs. A faint pulse at the Cun position indicates insufficient Yang, where Yin Qi ascends into the Yang region, resulting in aversion to cold. A weak pulse at the Chi position indicates insufficient Yin, where Yang Qi descends into the Yin region, resulting in fever. Insufficiency of Yang typically presents with chills preceding fever, while insufficiency of Yin typically presents with fever preceding chills. If Yin and Yang fail to remain in their respective domains, alternating chills and fever ensue. Furthermore, excess in the upper body causes fever, while excess in the lower body causes chills. Excess Yang causes sudden heat, and excess Yin causes sudden cold. Due to the mutual overacting of Yin and Yang and the disharmony of deficiency and excess, pathogenic factors alternate, causing alternating chills and fever or intermittent cold and heat. The Shaoyang Gallbladder channel is the fu-organ of the Liver, situated between the Taiyang and Yangming channels, in the half-exterior half-interior region. The Qi of Yin and Yang easily invades one another here; thus, chills and fever are predominantly symptoms of the Liver and Gallbladder channels, treated by modifying Xiao Chai Hu Tang (Minor Bupleurum Decoction). If only chills and fever are present, with normal daily activities, persisting for a long time without cure, or occurring after a major illness when Yuan Qi has not yet recovered, these belong to heat generated by Yin deficiency and cold generated by Yang deficiency. It is appropriate to use Ba Zhen Tang (Eight Treasure Decoction) for tonification, or Shi Quan Da Bu Tang (Ten Significant Great Tonifying Decoction) for severe cases. Food stagnation can also cause chills and fever, treated with Bao He Wan (Preserve Harmony Pill) to resolve stagnation. If accompanied by vomiting and diarrhea, Liu Jun Zi Tang (Six Gentlemen Decoction) is used. For cold limbs and a preference for hot drinks, Ren Shen Li Zhong Wan (Ginseng Regulate the Middle Pill) is indicated. For unrelenting thirst, Qi Wei Bai Zhu San (Seven-Ingredient Atractylodes Macrocephala Powder) is used. If food stagnation has been resolved but chills and fever persist, it is due to Liver pathogen overacting on Spleen (the controlled element) and insulting Lung (the controlling element). Yi Gong San (Yi Gong’s Powder) modified with Chai Hu (Bupleuri Radix) and Shan Zhi (Gardeniae Fructus) is used. Regarding malaria-induced chills and fever, see the Malaria section.
Clinical Cases
A fourteen-year-old boy experienced morning chills and evening fevers. During episodes of alternating chills and fever, he was extremely fatigued, had no appetite, and his finger tips were cold. In the morning, he took Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), and in the evening, Liu Jun Zi Tang (Six Gentlemen Decoction). After taking each prescription for more than twenty doses, he gradually recovered. Later, due to overexertion, the previous symptoms recurred, accompanied by headache. His pulse was deficient, particularly weak at both Cun positions. In the morning, he took Bu Zhong Yi Qi Tang plus Jing Jie (Schizonepetae Herba) [Note: Text says Man Jing Zi, likely Scutellariae Barbatae or similar, but strictly translating as Man Jing Zi/Cacumen Viticis], and in the evening, Shi Quan Da Bu Tang (Ten Significant Great Tonifying Decoction). He recovered after more than two months. However, whenever he exerted himself, chills and fever returned, improving slightly with the previous two decoctions. After marriage, due to excessive sexual activity, his whole body felt like ice in the morning and like being roasted by fire in the evening. In the morning, he took Bu Zhong Yi Qi Tang plus Sheng Jiang (Zingiberis Rhizoma Recens) and Rou Gui (Cinnamomi Cortex), and in the evening, Ba Wei Wan (Eight-Ingredient Pill) plus Wu Wei Zi (Schisandrae Fructus). After taking each for more than fifty doses, he recovered.
A thirteen-year-old boy suffered from high fever and constipation. After taking Qing Liang Yin (Cooling Drink), the condition improved but relapsed. After taking Di Gu Pi San (Lycium Bark Powder), tidal fever developed. Subsequently, taking Huang Qin (Scutellariae Radix), Lian Zi (Coptidis Rhizoma), and Si Wu Tang (Four Substances Decoction) led to intermittent chills and fever, fatigue, reduced appetite, and heat. Sometimes symptoms appeared during the day and vanished at night, or vice versa. I diagnosed this as deficiency-heat of the Liver and Spleen. In the evening, he took Di Huang Wan (Rehmannia Pill) plus Wu Wei Zi (Schisandrae Fructus), and in the morning, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Shan Yao (Dioscoreae Rhizoma) and Shan Zhu Yu (Corni Fructus), leading to recovery.
A child suffered from persistent chills and fever. Upon examining his wet nurse, her Zuo Guan (Left Cuneiform) pulse was wiry and rapid, with pain in the left hypochondrium. She experienced generalized itching upon exertion and difficulty urinating upon anger. This was caused by blood deficiency in the Liver channel and stagnant fire. Initially, Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Shan Zhi (Gardeniae Fructus) and Mu Dan Pi (Moutan Cortex) was administered, causing all symptoms to subside immediately. Then, Jia Wei Xiao Yao San (Modified Free Wanderer Powder) was used, curing both mother and child.
A child exhibited fever, teeth grinding, intermittent chills and fever, and painful, itchy ears. This was caused by Liver fire in the wet nurse. Both mother and child took Chai Hu Qing Gan San (Bupleurum Clearing Liver Powder) and Zhi Zi Qing Gan San (Gardenia Clearing Liver Powder) and recovered.
A fourteen-year-old boy experienced fever every day at Zi hour (11 PM–1 AM), feeling as if roasted all over. At Wu and Wei hours (11 AM–3 PM), he felt cold, with coldness in the leg bones extending to the knees. At Zi hour, the fever would recur. This was true interior cold with false exterior heat. In the morning, he took Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Ren Shen (Ginseng Radix) and [missing character, likely Huang Qi/Astragali Radix] each 3 qian, and Fu Zi (Aconiti Lateralis Radix Praeparata) 0.3 qian. In the evening, he took a large dose of Si Jun Zi Tang (Four Gentlemen Decoction) plus Dang Gui (Angelicae Sinensis Radix) 1 liang, and Jiang (Zingiberis Rhizoma) and Gui (Cinnamomi Ramulus/Cortex) 0.5 fen. After several doses, he switched to morning Shi Quan Da Bu Tang (Ten Significant Great Tonifying Decoction) and evening Liu Jun Zi Tang (Six Gentlemen Decoction), gradually recovering. Finally, using Wu Wei Yi Gong San (Five-Ingredient Yi Gong’s Powder), he quickly recovered.
A fifteen-year-old girl presented with chills and fever, early menstruation, and wiry pulses at both Cun positions extending beyond the fish-mouth area. This was a syndrome of abundant blood in the Liver channel, treated with Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Sheng Di Huang (Rehmanniae Radix) and Wu Mei (Mume Fructus), leading to recovery. Later, she experienced chills, fever, emaciation, and delayed menstruation, indicating deficiency of Qi and Blood in the Liver and Spleen channels. Morning administration of Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) and evening administration of Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) resulted in recovery.
Qiang Huo Chong He Tang (Notopterygium Harmonizing Decoction) treats Taiyang channel conditions with no sweat, fever, headache, and aversion to cold, especially in spring with a floating-tight pulse. It also treats headaches, aversion to cold, and fever caused by sudden cold invading the body out of season. This decoction is suitable as a substitute for Ma Huang Tang (Ephedra Decoction) and is considered a divine medicine for the Taiyang channel.
Ingredients: Qiang Huo (Notopterygii Rhizoma et Radix), Fang Feng (Saposhnikoviae Radix), Cang Zhu (Atractylodis Rhizoma) (each 1.5 qian); Chuan Xiong (Chuanxiong Rhizoma), Gan Cao (Glycyrrhizae Radix et Rhizoma), Xi Xin (Asari Radix et Rhizoma), Bai Zhi (Angelicae Dahuricae Radix), Sheng Di Huang (Rehmanniae Radix), Huang Qin (Scutellariae Radix) (each 1 qian). Decoct in water and take orally.
Ba Zhen Tang (Eight Treasure Decoction) (Combination of Si Wu Tang and Si Jun Zi Tang; Si Wu Tang see Acute Convulsion section, Si Jun Zi Tang see Internal Hook section).
Shi Quan Da Bu Tang (Ten Significant Great Tonifying Decoction) (Formula see Sweating section).
Liu Jun Zi Tang (Six Gentlemen Decoction).
Jia Wei Xiao Yao San (Modified Free Wanderer Powder).
Yi Gong San (Yi Gong’s Powder) (Three formulas see Internal Hook section).
Ren Shen Li Zhong Wan (Ginseng Regulate the Middle Pill) (Formula see Cold Diarrhea section).
Bao He Wan (Preserve Harmony Pill).
Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) (Two formulas see Emaciation section).
Di Gu Pi San (Lycium Bark Powder) (Formula see Tidal Fever section).
Qin Lian Si Wu Tang (Scutellaria-Coptis Four Substances Decoction) (Also known as Si Wu Er Lian Tang plus Huang Qin; Formula see Tidal Fever section).
Di Huang Wan (Rehmannia Pill).
Ba Wei Wan (Eight-Ingredient Pill) (Also Di Huang Wan plus Wu Wei Zi and Rou Gui; Two formulas see Kidney section).
Xiao Chai Hu Tang (Minor Bupleurum Decoction) (Formula see Spasm section).
Chai Hu Qing Gan San (Bupleurum Clearing Liver Powder).
Zhi Zi Qing Gan San (Gardenia Clearing Liver Powder) (Two formulas see Fever section).