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The alternation of chills and fever (Han Re Wang Lai) differs from simultaneous fever and aversion to cold (Fa Re E Han): simultaneous fever and aversion to cold occur at the same time; whereas in the alternation of chills and fever, one feels cold first, then becomes hot after the cold subsides, and feels cold again after the heat subsides. This also differs from malaria (Nue): malaria attacks have fixed times, and the duration of chills and fever are definite; this condition has no fixed attack times, and the duration of chills and fever is indefinite. Although different from malaria, the pathogenic factor resides in the half-exterior and half-interior region of the Shaoyang channel (Shaoyang Jing).

At the initial stage of disease transmission, the condition progresses from mild to severe: initially presenting as alternation of chills and fever, subsequently becoming more heat than cold, then evolving into only heat without cold, until continuous high fever throughout day and night, delirium (Chan Wang), restlessness, and excessive thirst manifest completely. After the stage of transmission, the condition recovers from severe to mild: continuous high fever gradually decreases to simple fever, sometimes stopping; further decreasing to alternation of chills and fever; further decreasing to battle sweat (Zhan Han); until the pulse becomes calm and the body cools down, leading to recovery.

Epidemic pathogens emerging from the interior to the exterior represent a mild condition, while those entering from the exterior to the interior represent a severe condition. The initial alternation of chills and fever indicates the pathogen moving from exterior to interior, invading the Shaoyang channel, where the interior righteous qi struggles against and rejects the pathogen. Subsequently, the pathogen penetrates deeply into the interior, causing both exterior and interior to generate heat, resulting in continuous high fever with an increasingly severe trend. The alternation of chills and fever after the transmission stage indicates that the pathogenic factor is declining and the righteous qi is recovering, with the pathogen moving from interior to exterior, passing through the Shaoyang channel. Previously, during continuous high fever, the pathogenic factor held dominance; now, as the righteous qi gradually harmonizes, the chills and fever occur at regular intervals. Previously, when pathogenic yang was exclusively flourishing and extreme without yin, manifesting as pure heat; now, as yin qi recovers, chills and fever contend with each other. Previously, when pathogenic factors combined in both exterior and interior, causing daily worsening of heat and thirst; now, as interior righteous qi drives out the exterior pathogen, battle sweat occurs.

For treatment before transmission, when the pathogen tends to move from exterior to interior, the primary method is to penetrate and guide out the pathogen to facilitate its transformation and resolution, using Da Yuan Yin (Reach the Origin Decoction). After transmission, when the pathogen tends to move from interior to exterior, the primary method is harmonization, using Xiao Chai Hu Tang (Minor Bupleurum Decoction). After repeated treatments with sweating and purging methods, if the pulse is deficient and faint, soft and weak, or knotted and intermittent; if there is palpitation; if mental spirit is lethargic and fatigued; if the physical form is excessively emaciated and weak, the primary method should be nourishing yin and replenishing qi, assisting the righteous qi to expel the pathogen, using Shen Hu San Bai Tang (Ginseng and Bupleurum Three Whites Decoction), Zhi Gan Cao Tang (Honey-Fried Licorice Decoction), Qing Zao Yang Rong Tang (Clear Dryness and Nourish Nutrient Decoction), and Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). ("Ru" is synonymous with "Ruan".)