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The condition of *Hanre* (alternating chills and fever) refers to the symptom of alternating chills and fever. The Classics state: "When blood is deficient and Qi is weak, the Couli (pores and interstices) are invaded by pathogenic factors; Yin and Yang contend with each other, and the struggle between pathogenic factors and healthy Qi gives rise to the disease." If pathogenic factors invade but healthy Qi does not contend with them, there will be only fever without chills. Now, when both fever and chills occur, it is because healthy Qi and pathogenic factors are contending separately, thus generating alternating chills and fever. During this contention, Qi becomes stagnant and fails to disperse outward, leading to a struggle of chills and fever. When the contention is severe, it becomes intense and results in fever; therefore, after the chills subside, external heat manifests. This is the mechanism of alternating chills and fever. Some argue that alternating chills and fever result from the contention between Yin and Yang, as excess Yang leads to heat and excess Yin leads to cold; this is the contention of Yin and Yang. Why? Because cold is Yin and heat is Yang, while the interior is Yin and the exterior is Yang. When pathogenic factors lodge in the exterior, they manifest as chills; when pathogens contend with Yang, chills occur. When pathogenic factors enter the interior, they manifest as heat; when pathogens contend with Yin, heat occurs. If the pathogen is half in the exterior and half in the interior, contending outwardly with Yang produces chills, and contending inwardly with Yin produces heat. Thus, the boundaries of exterior and interior are not fixed, and the location of inside and outside is unstable; the pathogen moves in and out, causing alternating chills and fever to occur intermittently. Therefore, alternating chills and fever mostly belong to the Shaoyang syndrome (half-exterior, half-interior). Another view holds: if Yang is insufficient, Yin pathogenic factors emerge to the exterior and contend with it, resulting in excess Yin and thus chills; if Yin is insufficient, Yang pathogenic factors enter the interior and contend with it, resulting in excess Yang and thus fever. If pathogens reside mostly in the exterior, chills predominate; if pathogens reside mostly in the interior, heat predominates; if pathogens are in the half-exterior/half-interior region, chills and heat are balanced. By carefully examining the degree of chills and heat, and observing the depth of the pathogenic factors, Xiaochaihu Tang (Minor Bupleurum Decoction) is used to harmonize. If chills are predominant, add Guizhi (Cinnamon Twig); if heat is predominant, add Dahuang (Rhubarb Root); this is the fundamental principle.

"Si Nue" (malaria-like) refers to symptoms that resemble fever with aversion to cold and alternating chills and fever, but are essentially different. In malaria-like chills and fever, the onset and cessation have a regular timing; whereas in true alternating chills and fever, the onset and cessation are irregular. It may occur or recur, happening three to five times a day, and in severe cases, more than ten times, with intense manifestations. As for simultaneous fever and aversion to cold, it means that during fever, aversion to cold is not present, and during aversion to cold, fever is not present, unlike the alternation of chills followed by heat, or heat followed by chills. However, there are Taiyang syndrome resembling malaria, Yangming syndrome resembling malaria, Jueyin syndrome resembling malaria, and women's syndrome of heat entering the Blood Chamber resembling malaria. Although the symptoms are similar, the medicinal prescriptions differ.