寒战者，森然若寒，振振然摇动也。切牙者，上下片牙相磨而鸣也。经曰∶诸风振掉，皆属肝木。寒战而振振摇动，
风之众也，火气冲物亦然。钱氏曰∶肝主风，虚则切牙多欠。又曰∶上窜切牙，心热也。然则寒战切牙，心肝
二脏主之，或以寒战为气虚，切牙为血虚，或以切牙为齿槁，谓津液不足者，皆不知此意。痘疮所恶者寒战切牙，
或单见一证，或二证并见，若疮已坏，加之喘促闷乱者，死无日矣。凡病痘者，疮本稠密，转动之间，身体振摇者，此
一身被疮所困，不能支持，转动艰难之故，不可便作寒战，妄投热药也。有只切牙者，此心肝二经火旺也，盖肝虚
切牙，心热者亦切牙，勿便作不治论。
如疮初出而寒战者，此邪气将出，外与正争，故振振摇动，火之象也，疮出乃定，柴葛桂枝汤主之。疮已出，或
已成浆而寒战者，表气虚而不胜邪气之盛也，养卫化毒汤主之。如疮本稠密， 发肿痛，经脉动摇，时时振
动者，不可谓之寒战，待脓成痛去而解。收靥之时，痂皮圆净，但或时战栗者，此正气将复，不能
自持之兆，不必忧疑，须臾自定。有筋惕肉 者，经络之血为疮所耗，不能荣养肌肉，主持筋脉，故惕惕然而手足自
跳， 然而肤肉自动也，不可谓之寒战，但养其气血，十全大补汤（汗）主之。〔薛〕一小儿十四岁，痘将愈，忽
寒战手足并冷，脉微细而不及两寸。乃脾气虚热。用五味异功散、独参汤、十全大补汤而愈。一妇人，愈后寒战，
脉浮大，按之微细。此血气虚也，用十全大补汤三十余剂而愈。后因劳，寒热往来，寒时手足如水，热时手足如
炙，脉浮大，重按则细。此阳气虚甚也，朝用补中益气汤加桂、附各一钱，夕用八味丸料倍加桂、附，各五十余剂而安。
柴葛桂枝汤
柴胡 葛根 甘草 桂枝 防风 人参 白芍药（各等分）
上锉细。加生姜三片，水一盏，煎七分，去滓，温服，不拘时。
养卫化毒汤
人参 黄 （炙） 桂枝 甘草 当归
上，水煎服。
初虞世云∶憎寒困倦，或发寒战，能令痘子缩伏，宜用陈文中异功散（方见见形证治出不快条）。娄氏云∶
尝治痘疮寒战，用白术、 、归加芩治之愈。
〔袁氏〕独附汤 治寒战。
大附子（五钱，面裹煨）
用水一钟，灯草七根，煎服。
上方，加人参二钱、肉桂五分、黄 二钱、橘红一钱、甘草五分、当归一钱、则为附子振阴汤，治寒
战切牙捷效方也，但紫焦伏黑者不用。
切牙呵欠者，肝虚也，肝属木，临官于寅，寅为相火，火盗木之气，故肝虚之证形焉。阳引而上，阴引而下，
则开而欠也。阳上极而下，阴下极而上，则合而啮
也。十全大补汤主之。如发热之初，便切牙者，此与痒塌吐泻，脾胃弱者不同，须审形证分治之，若多欠切牙顿闷者，
肝藏风热也，羌活汤（痘发热）。目上窜切牙者，心脏热也，导赤散（心）。不可妄用陈氏辛热之剂。上窜切牙者，心热
也，诸疮皆属心火，上窜者，火炎上之象也，切牙者，火气动摇之象也，导赤散加酒炒黄连、牛蒡子主之。切牙兼面赤
作渴，至夜为甚者，宜地黄丸。〔薛〕一小儿痘疮切牙，面黄饮汤。此阳气虚弱也。用五味异功散加木香而愈。后仍切牙，
面赤作渴，至夜为甚。此脾肾阴虚也。用地黄丸、大补汤而愈。一小儿切牙作渴，面色忽白忽赤，脉洪数，按之无力，
左关尺为甚。此属肾虚也。用地黄丸、补中益气汤寻愈。后因惊面青目赤，呵欠切牙，手寻衣领。此肝经虚热。用加减
八味丸料煎与恣饮，顿安，又用补中益气汤而痊。一小儿切牙，作渴饮冷，大便微秘，寒战痘赤，多在身侧。此属
胆经虚热也。用小柴胡汤、柴胡麦门散各一剂，又用加味四物汤而痊。
清神化毒汤 治心肝火旺，其牙相戛而鸣者。
升麻 生地黄 木通 甘草 防风 麦门冬
上，用水煎服。
人参蝉蜕散 治切牙喘满，烦躁作渴（方见痘烦躁）。
〔钱氏〕百神丸 治戛齿甚妙。
如寒战、切牙并作者，则少阴专主之，观其疮本。如疮本溃烂，寒战切牙者，此手少阴心火也。经曰∶热胜
则肉腐。寒战切牙，火气动摇之象也。如疮本焦黑，寒战切牙者，此足少阴肾水也，肾色黑，为主蛰封藏之本，干
黑者真藏色见也。肾气寒，在变动为栗，寒战者，肾本病也。肾主骨，牙为骨余，寒战则鼓颔而两牙相
轧，切牙者，肾寒所发也。此二证者，在心热则清之，在肾寒则温之，其病已坏，治之何益。或因阳气亏损，切牙
寒战者，独参汤、参附汤甚效。若血气不荣，而不能靥，兼以闷乱不宁，卧则哽气，泄泻寒战切牙者，陈氏异功散（
见形出不快条）加木香、当归以救之。钱氏法，寒战切牙黑陷者，百祥丸下之（方见黑陷）。〔薛〕前证，若手足并冷，
渴饮热汤，大便泄泻者，阳气虚寒也，宜热补之。手足不冷，大便不利，渴饮温汤者，脾气虚热也，宜调补之。手
足不热，大便不利，渴饮热汤者，脾胃虚弱也，宜温补之。一小儿出痘，寒战切牙，四肢倦缩，大便自利，手足并
冷，喜饮热汤。此阳气虚寒也。用十二味异功散末二钱，诸证顿退，又用人参白术散、参
四圣散而靥。一小儿十四岁，面色忽赤忽黑，出痘寒战切牙，作渴烦热，喜饮热汤。此阳气虚寒也。用十全大补汤散，
烦渴顿止，乃以八珍倍加参、 。至脓灌，又作渴面赤，此脓成而血气虚也，用当归补血汤、八珍汤而靥。至月余，
面赤烦渴，或时昏愦，痘痕如赭，或时作痒，脉洪大，按之如无。此血脱也，用大剂当归补血汤而安。一小儿脓不
灌，兼寒战切牙，腹胀。属脾胃虚弱。用四君、肉桂、归、 、肉豆蔻，又用参 四圣散而痊，后用托里散、四君
子汤而靥。一小儿痒塌，寒战切牙，喜饮温汤，手足不热。属阳气虚弱也。用参 四圣散，诸证已退，用参 托
里散，其浆渐灌，用十全
大补汤，其痂顿靥。一产妇出痘，寒战切牙，腹胀作渴，足冷身热。此脾胃，内虚寒外假热也，大补汤加桂、附三四
剂，去附，易干姜二三剂，仍用参 四圣散并五味异功散加归、 治之而痊。
诸书多以寒战切牙并作，为不治之证，然能善治之，多有生者，盖热毒不得尽发，内与正气相搏，则筋脉因
之而动摇，人之一身，惟手足能运动，口能开阖，皆虚境也，相搏之际，故手足战摇，而口齿相戛矣。
无忧散 治临危痘证，寒战切牙。
人牙（自落者、不拘多少，火 存性，淬入韭菜汁内，大牙三次，小牙二次，研极细末） 雄黄 珍珠（各五分）
上，俱研为末。每服三五分，多则一钱，用荔枝煎汤下。一方，有牛黄五分。
透骨解毒汤 治寒战切牙。
紫草 甘草 当归 防风 陈皮 赤芍药
上，各等分，水煎服。
催蛰丹 痘逾八九朝，脓浆虽不充裕，倏然寒战切牙，以此治之。
虎牙、人牙、各一枚，酥炙，研细，和人参、丁香末、乳、酒和服。
滴滴金 治寒战切牙。
狗头去肉留脑髓，酥炙脆，细研为末，浓煎酒，下。
Chanzhan (shivering with cold) refers to the sensation of severe cold accompanied by violent trembling and shaking. Qiya (teeth grinding/chattering) refers to the sound produced by the upper and lower teeth rubbing against each other. The Classics state: "All wind-induced tremors and convulsions belong to Liver Wood." Chanzhan with violent shaking is a manifestation of excessive Wind; similarly, the surging of Fire Qi can cause objects to vibrate. Qian Yi stated: "The Liver governs Wind; deficiency leads to teeth grinding and frequent yawning." He also said: "Upward deviation of the eyes with teeth grinding indicates Heart Heat." Therefore, chanzhan and qiya are primarily governed by the Heart and Liver organs. Some attribute chanzhan to Qi deficiency and qiya to Blood deficiency; others claim qiya results from withered teeth due to insufficient body fluids. These views fail to grasp the underlying pathology. In smallpox, chanzhan and qiya are ominous signs. Whether appearing singly or together, if the sores are already necrotic and accompanied by panting, distress, and confusion, death is imminent within days. In patients with smallpox, if the sores are originally dense and the body shakes during movement, this is due to the body being overwhelmed by the toxin, unable to support itself, making movement difficult. This should not be mistaken for chanzhan, nor should hot-natured herbs be administered recklessly. If only qiya occurs, it indicates hyperactivity of Fire in the Heart and Liver meridians. Since both Liver deficiency and Heart Heat can cause qiya, one should not hastily declare it incurable.
If chanzhan occurs when the sores first emerge, it signifies that pathogenic factors are attempting to exit and are contending with righteous Qi, causing trembling—a sign of Fire. Once the sores erupt, the symptom will subside. The governing formula is Chaige Guizhi Tang (Bupleurum and Kudzu Decoction with Cinnamon Twig). If chanzhan occurs after the sores have erupted or formed pus, it indicates deficiency of Wei Qi (Defensive Qi), which cannot withstand the excess pathogenic factor. The governing formula is Yangwei Huadu Tang (Nourish Defense and Transform Toxin Decoction). If the sores are originally dense, accompanied by swelling, pain, meridian instability, and constant trembling, this is not chanzhan but a reaction to the eruption; it will resolve once pus forms and pain subsides. During the scabbing stage, if the scabs are neat but occasional shivering occurs, it signals the recovery of righteous Qi, which is temporarily unable to maintain control. There is no need for worry; it will stabilize shortly. If there is jingtirou (muscle twitching/fasciculation), it is because blood in the meridians has been depleted by the sores, failing to nourish muscles and tendons, causing involuntary jumping of the limbs and automatic contraction of skin and flesh. This is not chanzhan; treatment should focus on nourishing Qi and Blood using Shiquan Dabu Tang (Perfect Ten Tonifying Decoction). [Xue Ji] recorded a case of a 14-year-old boy whose smallpox was nearly cured when he suddenly developed chanzhan and cold extremities, with a faint, thin pulse undetectable at the cun position. This was Spleen Qi deficiency with heat. He was cured using Wumei Yigong San (Five-Ingredient Extraordinary Work Powder), Dushen Tang (Single Ginseng Decoction), and Shiquan Dabu Tang. A woman developed chanzhan after smallpox recovery, with a floating, large pulse that became faint upon deep pressure, indicating Qi and Blood deficiency. She was cured after more than thirty doses of Shiquan Dabu Tang. Later, due to overwork, she experienced alternating chills and fever; her extremities were cold as water during chills and hot as fire during fevers, with a floating, large pulse that became thin upon deep pressure. This indicated severe Yang Qi deficiency. She took Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with Guizhi (Cinnamon Twig) and Fuzi (Aconite Root) in the morning, and Bawei Wan (Eight-Ingredient Pill) with increased Guizhi and Fuzi in the evening, taking over fifty doses of each to achieve stability.
Chaige Guizhi Tang (Bupleurum and Kudzu Decoction with Cinnamon Twig)
Ingredients: Chaihu (Bupleuri Radix), Gegen (Puerariae Lobatae Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Guizhi (Cinnamomi Ramulus), Fangfeng (Saposhnikoviae Radix), Renshen (Panacis Ginseng Radix), Baishaoyao (Paeoniae Radix Alba) in equal parts.
Preparation: Coarsely powder. Add three slices of Shengjiang (Zingiberis Rhizoma Recens), one cup of water, decoct to seven-tenths volume, remove dregs, and take warm at any time.
Yangwei Huadu Tang (Nourish Defense and Transform Toxin Decoction)
Ingredients: Renshen (Panacis Ginseng Radix), Huangqi (Astragali Radix, honey-fried), Guizhi (Cinnamomi Ramulus), Gancao (Glycyrrhizae Radix et Rhizoma), Danggui (Angelicae Sinensis Radix).
Preparation: Decoct in water and take.
Chu Yushi stated: Chills, fatigue, or chanzhan can cause smallpox to retract. Use Chen Zhongwen's Yigong San (Extraordinary Work Powder). Lou Shi stated: He treated smallpox chanzhan using Baizhu (Atractylodis Macrocephalae Rhizoma), [missing character], Danggui (Angelicae Sinensis Radix), and Huangqin (Scutellariae Radix) with success.
[Yuan Shi] Dufu Tang (Single Aconite Decoction) treats chanzhan.
Ingredients: Dafu Zi (Aconiti Lateralis Radix Preparata, five qian, wrapped in flour and baked).
Preparation: Use one zhong of water and seven stalks of Dengcao (Junci Medulla), decoct and take.
Adding Renshen (Panacis Ginseng Radix, two qian), Rougui (Cinnamomi Cortex, five fen), Huangqi (Astragali Radix, two qian), Juhong (Citri Reticulatae Pericarpium Rubrum, one qian), Gancao (Glycyrrhizae Radix et Rhizoma, five fen), and Danggui (Angelicae Sinensis Radix, one qian) to the above formula creates Fuzi Zhenyin Tang (Aconite Shaking Yin Decoction), a highly effective formula for chanzhan and qiya, except for cases with purple-black necrotic sores.
Qiya with yawning indicates Liver deficiency. The Liver belongs to Wood and governs the Yin hour. Yin corresponds to Xiang Huo (Ministerial Fire). Fire stealing Wood's Qi manifests as Liver deficiency symptoms. Yang pulls upward, Yin pulls downward, resulting in yawning. When Yang reaches its peak and descends, and Yin reaches its peak and ascends, the mouth closes and teeth grind. Treat with Shiquan Dabu Tang (Perfect Ten Tonifying Decoction). If qiya occurs at the onset of fever, it differs from cases of itching, collapse, vomiting, diarrhea, and Spleen/Stomach weakness; differentiate and treat accordingly. Frequent yawning, qiya, and sudden oppression indicate Liver storing Wind-Heat; treat with Qianghuo Tang (Notopterygii Rhizoma et Radix Decoction). Upward eye deviation with qiya indicates Heart Heat; treat with Daochi San (Guide Out Red Powder). Do not recklessly use Chen's acrid-hot formulas. Upward eye deviation with qiya indicates Heart Heat; all sores relate to Heart Fire. Upward deviation is the image of Fire flaring up; qiya is the image of Fire Qi shaking. Treat with Daochi San (Guide Out Red Powder) plus Jiuhuanglian (Alcohol-fried Scutellariae Radix) and Niubangzi (Arctii Fructus). If qiya accompanies red face and thirst, worsening at night, use Dihuang Wan (Rehmannia Pill). [Xue Ji] recorded a child with smallpox qiya, yellow face, and desire for soup, indicating weak Yang Qi. He was cured using Wumei Yigong San (Five-Ingredient Extraordinary Work Powder) with Muxiang (Aucklandiae Radix). Later, qiya recurred with red face, thirst, and nighttime worsening, indicating Spleen-Kidney Yin deficiency. He was cured using Dihuang Wan (Rehmannia Pill) and Dabu Tang (Great Tonifying Decoction). Another child had qiya and thirst, fluctuating pale/red complexion, flooding-numerous pulse, weak upon pressure, especially at the left Guan and Chi positions, indicating Kidney deficiency. He was cured using Dihuang Wan (Rehmannia Pill) and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). Later, after fright, he had a blue face, red eyes, yawning, qiya, and hand-groping, indicating Liver Meridian deficiency-heat. He was given Jianba Weiwang Pian (Modified Eight-Ingredient Pill) decoction to drink freely, achieving instant calm, followed by Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) for full recovery. Another child had qiya, thirst for cold drinks, slight constipation, chanzhan with red sores mainly on the sides, indicating Gallbladder Meridian deficiency-heat. He was treated with Xiaochaihu Tang (Minor Bupleurum Decoction) and Chaihu Maimen San (Bupleurum and Ophiopogon Powder), one dose each, followed by Jiawei Siwu Tang (Modified Four Substances Decoction) for recovery.
Qingshen Huadu Tang (Clear Spirit and Transform Toxin Decoction) treats Heart-Liver Fire hyperactivity causing teeth grinding.
Ingredients: Shengma (Cimicifugae Rhizoma), Shengdihuang (Rehmanniae Radix), Mutong (Akebiae Caulis), Gancao (Glycyrrhizae Radix et Rhizoma), Fangfeng (Saposhnikoviae Radix), Maimendong (Ophiopogonis Radix).
Preparation: Decoct in water and take.
Renshen Chantui San (Ginseng and Cicada Slough Powder) treats qiya, wheezing, fullness, irritability, and thirst (see "Smallpox Irritability").
[Qian Shi] Baishen Wan (Hundred Spirits Pill) is excellent for treating teeth grinding.
If chanzhan and qiya occur together, the Shaoyin channel specifically governs them; observe the nature of the sores. If the sores are ulcerated with chanzhan and qiya, it is Hand-Shaoyin Heart Fire. The Classics state: "Excess heat causes flesh to rot." Chanzhan and qiya are images of Fire Qi shaking. If the sores are blackened/necrotic with chanzhan and qiya, it is Foot-Shaoyin Kidney Water. The Kidney color is black; it is the root of storage and sealing. Dry blackness reveals the true Zang color. Cold Kidney Qi manifests as shivering; chanzhan is a primary Kidney disease. The Kidney governs bones; teeth are the surplus of bones. Chanzhan causes jaw quivering and teeth grinding; qiya is caused by Kidney cold. For these two conditions, clear Heat if in the Heart, warm Cold if in the Kidney. If the disease is already ruined, what benefit is treatment? If qiya and chanzhan result from Yang Qi depletion, Dushen Tang (Single Ginseng Decoction) and Shenfu Tang (Ginseng and Aconite Decoction) are very effective. If Blood and Qi fail to nourish, preventing scabbing, accompanied by distress, restlessness, choking sensations when lying down, diarrhea, chanzhan, and qiya, use Chen's Yigong San (Extraordinary Work Powder) with Muxiang (Aucklandiae Radix) and Danggui (Angelicae Sinensis Radix) to rescue. Qian's method for chanzhan, qiya, and black depression is Baixiang Wan (Hundred Auspicious Pills). [Xue Ji] stated: For the aforementioned conditions, if extremities are cold, thirsty for hot drinks, and having diarrhea, it is Yang Qi deficiency-cold; use hot tonification. If extremities are not cold, constipated, and thirsty for warm drinks, it is Spleen Qi deficiency-heat; use regulating tonification. If extremities are not hot, constipated, and thirsty for hot drinks, it is Spleen-Stomach weakness; use warm tonification. A child with smallpox had chanzhan, qiya, tired/curled limbs, spontaneous loose stools, cold extremities, and preference for hot drinks, indicating Yang Qi deficiency-cold. Two qian of Shierwei Yigong San (Twelve-Ingredient Extraordinary Work Powder) powder rapidly alleviated symptoms, followed by Renshen Baizhu San (Ginseng and Atractylodes Macrocephala Powder) and Shensi Sixiao San (Four Sages Powder) for scabbing. A 14-year-old with fluctuating red/black face, smallpox chanzhan/qiya, thirst, irritability, and preference for hot drinks had Yang Qi deficiency-cold. Shiquan Dabu Tang (Perfect Ten Tonifying Decoction) powder stopped irritability/thirst immediately; then Bazhen Tang (Eight Treasures Decoction) with increased Renshen (Panacis Ginseng Radix) and Huangqi (Astragali Radix) was used. At the pus stage, recurrence of thirst/red face indicated Blood/Qi deficiency after pus formation; Danggui Buxue Tang (Dong Quai Tonify Blood Decoction) and Bazhen Tang (Eight Treasures Decoction) led to scabbing. Over a month later, red face, irritability, occasional confusion, ochre-colored scars, itching, and flooding pulse (weak on pressure) indicated Blood exhaustion; large doses of Danggui Buxue Tang (Dong Quai Tonify Blood Decoction) brought stability. A child with non-pus-forming sores, chanzhan, qiya, and abdominal distension had Spleen-Stomach weakness. Sijunzi Tang (Four Gentlemen Decoction), Rougui (Cinnamomi Cortex), Danggui (Angelicae Sinensis Radix), Huangqi (Astragali Radix), and Roudoukou (Myristicae Semen) were used, followed by Shensi Sixiao San (Four Sages Powder) for recovery, and Tuoli San (Support Interior Powder) and Sijunzi Tang (Four Gentlemen Decoction) for scabbing. A child with itching/collapse, chanzhan, qiya, preference for warm drinks, and non-hot extremities had Yang Qi deficiency. Shensi Sixiao San (Four Sages Powder) alleviated symptoms; Tuoli San (Support Interior Powder) promoted pus formation; Shiquan Dabu Tang (Perfect Ten Tonifying Decoction) induced rapid scabbing. A postpartum woman with smallpox had chanzhan, qiya, abdominal distension/thirst, cold feet, and hot body, indicating Spleen-Stomach internal deficiency-cold with external false-heat. Dabu Tang (Great Tonifying Decoction) with Guizhi (Cinnamon Twig) and Fuzi (Aconite Root) for three to four doses, then removing Fuzi and adding Ganjiang (Zingiberis Rhizoma) for two to three doses, followed by Shensi Sixiao San (Four Sages Powder) and Wumei Yigong San (Five-Ingredient Extraordinary Work Powder) with Danggui (Angelicae Sinensis Radix) and Huangqi (Astragali Radix) resulted in recovery.
Many books list chanzhan and qiya together as incurable. However, with proper treatment, many survive. Generally, if heat-toxins cannot fully express and contend internally with righteous Qi, tendons and vessels shake. The hands, feet, and mouth are the most vulnerable areas for movement and opening/closing. During contention, limbs shake and teeth grind.
Wuyou San (Carefree Powder) treats critical smallpox with chanzhan and qiya.
Ingredients: Renya (Human Teeth, naturally fallen, amount unspecified, calcined to preserve nature, quenched in Jiucai juice—large teeth three times, small teeth twice, ground to fine powder), Xionghuang (Realgar), Zhenzhu (Pearl) (each five fen).
Preparation: Grind all into powder. Take three to five fen, or up to one qian, washed down with Lizhi decoction (Lychee decoction). Another prescription includes Niuhuang (Bovis Calculus, five fen).
Togu Jiedu Tang (Bone-Penetrating Toxin-Resolving Decoction) treats chanzhan and qiya.
Ingredients: Zicao (Arnebiae Radix seu Lithospermi Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Danggui (Angelicae Sinensis Radix), Fangfeng (Saposhnikoviae Radix), Chenpi (Citri Reticulatae Pericarpium), Chishao (Paeoniae Radix Rubra).
Preparation: Equal parts, decoct in water and take.
Cuizhe Dan (Stimulate Hibernation Pill) treats smallpox beyond eight or nine days where pus is insufficient but sudden chanzhan and qiya occur.
Ingredients: Huya (Tiger Tooth), Renya (Human Tooth), one each, roasted in butter, ground fine, mixed with Renshen (Panacis Ginseng Radix) and Dingxiang (Caryophylli Flos) powders, milk, and wine, taken together.
Didijin (Dripping Gold) treats chanzhan and qiya.
Ingredients: Dog head, meat removed leaving brain marrow, roasted crisp in butter, ground fine, taken with strong wine decoction.