寒热者，证如疟状，阴阳相胜也，先寒而后热阳不足，先热而后寒阴不足，寒
多而热少，阴胜阳也，热多而寒少，阳胜阴也，寒热相半，阴阳交攻也，寒热隔日阴阳乍
离也，阳盛发热，阴盛发寒也。其有头疼汗出者，有呕吐不食者，有憎寒而饮水者，
壮热而饮汤者，有筋骨疼痛者，或泻或秘，或内寒而外热，或内热而外寒，又有寒
而腹中痛，热而腹中鸣，是有食积也。治法，因于食积者，当用白饼子下之，次行
补助，以钱氏白术散。寒多热少者小柴胡汤加桂。热多寒少者白虎汤加桂。寒热相
半者并用小柴胡汤主之。〔薛〕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，故寒热多主肝胆经证，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。其疟证寒热，详见
疟门。
白饼子（癖） 白术散（渴） 小柴胡汤（半表半里热） 白虎汤（表里俱热）
八珍汤（虚羸） 十全大补汤（虚羸） 保和丸（宿食） 六君子汤（脾） 人参理中丸（吐
泻） 异功散（吐泻）
Cold and heat disorders present symptoms resembling malaria, resulting from the mutual excess of Yin and Yang. Feeling cold first followed by fever indicates deficiency of Yang; feeling hot first followed by cold indicates deficiency of Yin. More cold than heat signifies excess of Yin over Yang; more heat than cold signifies excess of Yang over Yin. Equal amounts of cold and heat indicate a struggle between Yin and Yang. Cold and heat alternating every other day indicates a temporary separation of Yin and Yang Qi. Excess of Yang leads to fever; excess of Yin leads to chills.
Some patients present with headache and sweating; others with vomiting and anorexia; some feel aversion to cold yet desire water; some have high fever yet desire hot drinks; some suffer from bone and joint pain; some experience diarrhea or constipation; some have internal cold with external heat, or internal heat with external cold. Additionally, abdominal pain caused by cold or borborygmus (intestinal rumbling) caused by heat indicates food stagnation (accumulation of undigested food).
Treatment methods: If caused by food stagnation, one should use *Bai Bing Zi* (White Pill) to purge the accumulation, followed by tonification using *Qian Shi Baizhu San* (Dr. Qian's Atractylodes Macrocephala Powder). For cases with more cold than heat, use *Xiao Chai Hu Tang* (Minor Bupleurum Decoction) with added Cinnamon Twig (*Guizhi*). For cases with more heat than cold, use *Bai Hu Tang* (White Tiger Decoction) with added Cinnamon Twig (*Guizhi*). For equal amounts of cold and heat, primarily use *Xiao Chai Hu Tang*.
Xue Ji stated: The *Neijing* says, "Yang deficiency leads to external cold, Yin deficiency leads to internal heat, Yang excess leads to external heat, and Yin excess leads to internal cold." Alternating cold and heat is due to the mutual excess of Yin and Yang. When cold Qi merges with Yin, chills occur; when Yang Qi merges with Yang, fever occurs. A faint pulse at the Cun position indicates Yang deficiency, where Yin Qi enters the Yang region causing aversion to cold; a weak pulse at the Chi position indicates Yin deficiency, where Yang Qi descends into the Yin region causing fever. Yang deficiency leads to cold first then heat; Yin deficiency leads to heat first then cold. If Yin and Yang do not remain in their proper positions, cold and heat will struggle. Furthermore, excess in the upper Jiao causes fever, excess in the lower Jiao causes chills; Yang excess causes sudden fever, Yin excess causes sudden chills. Due to mutual excess of Yin and Yang and imbalance of deficiency and excess, pathogenic factors alternate, leading to alternating cold and heat or sudden fluctuations between 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 each other here; thus, cold and heat disorders are mostly related to the Liver and Gallbladder channels, treated with modifications of *Xiao Chai Hu Tang*. If only cold and heat are present while daily activities remain normal, and it persists for a long time without cure, or occurs after a severe illness when Yuan Qi has not recovered, these all belong to Yin deficiency generating heat and Yang deficiency generating cold. It is appropriate to use *Ba Zhen Tang* (Eight Treasures Decoction) for tonification, or *Shi Quan Da Bu Tang* (Complete Great Tonifying Decoction) for severe cases. Food stagnation can also cause cold and heat, treated with *Bao He Wan* (Preserve Harmony Pill) to resolve stagnation. If accompanied by vomiting and diarrhea, use *Liu Jun Zi Tang* (Six Gentlemen Decoction). For cold limbs with alternating preference for cold and hot drinks, use *Ren Shen Li Zhong Wan* (Ginseng and Poria Pill to Regulate the Middle). For unrelenting thirst, use *Qi Wei Bai Zhu San* (Seven-Ingredient Atractylodes Macrocephala Powder). If food stagnation has been resolved but cold and heat persist, it is Liver pathogen invading Spleen Earth, where the conquered element insults the unconquerable element; use *Yi Gong San* (Extraordinary Efficacy Powder) with added Bupleurum (*Chaihu*) and Gardenia (*Shanzhi*). Regarding the cold and heat of malaria patterns, see the Malaria section.
*Bai Bing Zi* (treats mass accumulation) *Baizhu San* (treats thirst) *Xiao Chai Hu Tang* (treats half-exterior half-interior heat) *Bai Hu Tang* (treats exterior and interior heat) *Ba Zhen Tang* (treats emaciation/weakness) *Shi Quan Da Bu Tang* (treats emaciation/weakness) *Bao He Wan* (treats retained food) *Liu Jun Zi Tang* (treats Spleen deficiency) *Ren Shen Li Zhong Wan* (treats vomiting and diarrhea) *Yi Gong San* (treats vomiting and diarrhea)