经言虚邪之中人也。洒洒动形。正邪之中人也。微见于色。不知其身。又曰。阳明所谓洒洒
振寒。阳明者。午也。五月盛阳之阴也。阳盛而阴气加之。故洒洒振寒。当泻阳者也。又云。阳气
客于皮肤。阴气盛。阳气虚。故振振寒栗。当补阳者
也。如六脉弦细而涩。按之空虚。此大寒证。亦伤精气。当温补者也。泻阳。白虎加人参汤、竹
叶石膏汤。补阳。黄 建中汤。若夫真阳虚证。但寒栗耳。不作振也。或兼风寒则振。桂枝加附子汤。
经云。肾之变动为栗。原病式曰。战栗动摇。火之象也。阳动阴静。而水火相反。故厥逆禁
固。屈伸不便。为病寒也。栗者寒冷也。或言寒战为脾寒者。未明变化之道也。此由心火热甚。
亢极而战。反兼水化制之。故寒栗也。寒栗由火盛似水。实非兼有寒气也。以大承气下之。多有
燥屎。下后热退。则寒栗愈矣。若阳虚则但畏寒。阳郁则振寒战栗。有火无火之分也。亦有暴感
寒邪。恶寒脉伏而战栗者。麻黄汤发散之。
经云。因于露风。乃生寒热。阳胜则热。阴胜则寒。重寒则热。重热则寒。风气客于皮肤之
间。内不得通。外不得泄。风者善行而数变。腠理开则洒然寒。闭则热而闷。其寒也则衰饮食。
其热也则消肌肉。故使人 栗而不能食。名曰寒热。
寒热如疟。表里不和者。小柴胡为主药。至夜转甚者。加丹皮、山栀。日久虚劳。寒热不除
者。柴胡四物汤、加味逍遥散。脾病则血气俱不宁。寒热往来。无有休息。故脾病如疟状也。元
气虚人。遇劳即发寒热。此元气下陷之故。或劳力
而发寒热。腿缝中结核作痛。谓之劳发。俱宜补中益气汤。病寒热间作。腕后有斑三五点。鼻中
微血。两脉沉涩。胸膈四肢按之殊无大热。此脾胃气虚而挟微邪。理中汤去人参。加茯苓、煨葛
根。郁怒而发寒热。逍遥散。内伤疟疾寒热。各具本门。伤寒寒热。不在此例。
外热内寒 外寒内热 皮寒而燥者。阳不足。皮热而燥者。阴不足。皮寒而寒者。阴盛也。
皮热而热者。阳盛也。仲景云。病患身大热反欲得近衣者。热在皮肤寒在骨髓也。黄 建中汤汗
之。病患身大寒反不欲近衣者。寒在皮肤热在骨髓也。越婢汤发之。若杂证外热内寒者。理中汤
敛之。外寒内热者。火郁汤散之。
上热下寒 上寒下热 热发于上。阳中之阳邪也。热发于下。阴中之阳邪也。寒起于上。阳
中之阴邪也。寒起于下。阴中之阴邪也。脉经云。阳乘阴者。腰以下至足热。腰以上寒。栀子豉
汤吐以升之。阴气上争。心腹满者死。阴乘阳者。腰以上至头热。腰以下寒。桂苓丸利以导之。
阳气上争。得汗者生。若杂证上热下寒。既济汤。兼大便秘。既济解毒汤。火不归源。八味丸。
上寒下热。五苓散送滋肾丸。虚阳下陷者。加减八味丸。
The classics state that when deficient pathogens (Xu Xie, pathogenic factors exploiting deficiency) invade the human body, the patient experiences shivering and bodily tremors. When normal pathogens (Zheng Xie, typical climatic pathogens) invade, symptoms are slight and manifest only in the complexion, with the patient feeling no discomfort internally. It is also said that what the Yangming channel refers to as "shivering cold" (Sasha Zhen Han) occurs because the Yangming channel corresponds to the Wu hour (noon) and represents Yin within the abundant Yang of the fifth lunar month. When Yang is abundant and Yin acts upon it, one feels shivering and cold; treatment should involve draining Yang heat. Furthermore, when Yang Qi lodges in the skin while Yin Qi is abundant and Yang Qi is deficient, generalized trembling and chills occur; treatment should involve tonifying Yang. If all six pulses are wiry, fine, and choppy, feeling empty upon deep pressure, this indicates a severe Cold syndrome that has also damaged Essence and Qi; treatment should involve warming and tonifying. To drain Yang heat, use Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) or Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction). To tonify Yang, use Huangqi Jianzhong Tang (Astragalus Decoction for Building the Middle). In cases of true Yang deficiency, there is merely coldness and trembling without bodily shaking. If complicated by Wind-Cold, shaking occurs, treated with Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Aconite Root).
The classics state that the movement associated with the Kidney manifests as trembling/chills. The *Yuan Bing Shi* states that trembling and shaking are manifestations of Fire. Yang moves, Yin is still, and Water and Fire are opposite; thus, when Jue Ni (reversal of Qi flow) and rigid confinement occur, causing difficulty in flexion and extension, it presents as a Cold disease. "Li" (trembling/shivering) means cold. Some say that cold shivering is due to Spleen Cold, failing to understand the principles of pathological transformation. This actually arises from excessive Heart Fire; when Fire becomes hyperactive, it shakes, and contrary to its nature, it adopts Water characteristics to restrain itself, resulting in cold shivering. Thus, cold shivering results from Fire abundance resembling Water, not from an actual presence of Cold pathogen. Using Dachengqi Tang (Major Order the Yellow Decoction) to purge often expels dry feces; after purging, when heat recedes, the cold shilling resolves. If Yang is deficient, there is merely aversion to cold; if Yang is constrained, there is shivering and chills; this distinguishes between conditions with Fire and those without. There are also cases of sudden invasion by Cold pathogen, presenting with aversion to cold, hidden pulse, and chills, treated with Mahuang Tang (Ephedra Decoction) to disperse.
The classics state that exposure to wind and dew generates alternating chills and fever. Yang excess leads to heat, Yin excess leads to cold; extreme cold transforms into heat, extreme heat transforms into cold. When Wind pathogen lodges between the skin layers, unable to circulate inward or diffuse outward, and since Wind is agile and changes frequently, open pores cause a sensation of shivering cold, while closed pores cause heat and chest stuffiness. This cold diminishes appetite, and this heat consumes muscle mass, causing trembling and inability to eat, named "Han Re" (alternating chills and fever).
For alternating chills and fever resembling malaria due to disharmony between Exterior and Interior, Xiaochaihu Tang (Minor Bupleurum Decoction) is the primary formula; if worsening at night, add Mudan Pi (Moutan Cortex) and Shanzhi (Gardeniae Fructus). For chronic deficiency consumption where alternating chills and fever persist, Chaihu Siwu Tang (Bupleurum Four Substances Decoction) or Jiawei Xiaoyao San (Modified Free Wanderer Powder) are used. Spleen disease causes both Qi and Blood to be unsettled, leading to alternating chills and fever without respite, so Spleen disease resembles malaria. In individuals with deficient Yuan Qi (Primal Qi), exertion triggers alternating chills and fever due to sinking of Yuan Qi. Alternatively, labor-induced alternating chills and fever accompanied by painful nodules in the leg creases is called "Lao Fa" (exertion-triggered attack); Bu Zhong Yi Qi Tang (Decoction to Supplement the Middle and Augment Qi) is suitable for both. For intermittent chills and fever with three to five macules on the wrist, slight epistaxis, deep and choppy pulses, and no significant heat upon palpation of the chest, diaphragm, and limbs, this indicates Spleen-Stomach Qi deficiency with slight pathogenic retention; Lizhong Tang (Regulate the Middle Decoction) minus Renshen (Ginseng Root), plus Fuling (Poria) and Wei Gegen (Calcined Puerariae Radix), is used. Alternating chills and fever triggered by anger/stress are treated with Xiaoyao San (Free Wanderer Powder). Internal injury malaria with chills and fever is discussed in its respective section. Alternating chills and fever due to Shanghan (Cold Damage) are excluded here.
Exterior Heat/Interior Cold and Exterior Cold/Interior Heat: Skin that is cold and dry indicates insufficient Yang; skin that is hot and dry indicates insufficient Yin; skin that is cold and feels cold indicates abundant Yin; skin that is hot and feels hot indicates abundant Yang. Zhang Zhongjing stated: "If a patient has high body temperature but desires to wrap themselves in clothes, the heat is in the skin/flesh and the cold is in the bone/marrow," treated with Huangqi Jianzhong Tang to induce sweating. "If a patient has low body temperature but does not desire to wrap themselves in clothes, the cold is in the skin/flesh and the heat is in the bone/marrow," treated with Yuespi Tang (Yuebi Decoction) to induce sweating. For miscellaneous diseases presenting with exterior heat and interior cold, Lizhong Tang is used to consolidate; for exterior cold and interior heat, Huoyu Tang (Fire Stagnation Decoction) is used to disperse.
Upper Heat/Lower Cold and Upper Cold/Lower Heat: Heat arising in the upper part is Yang-Yang pathogen; heat arising in the lower part is Yin-Yang pathogen; cold arising in the upper part is Yang-Yin pathogen; cold arising in the lower part is Yin-Yin pathogen. The *Mai Jing* (Pulse Classic) states: "When Yang invades Yin," heat is felt from the waist down to the feet, while the upper body is cold; Zhiizi Chi Tang (Gardenia and Fermented Soybean Decoction) is used to induce vomiting and raise Yang Qi. If Yin Qi contends upward causing abdominal fullness, the prognosis is fatal. "When Yin invades Yang," heat is felt from the waist up to the head, while the lower body is cold; Guiling Wan (Cinnamon and Polyporus Pill) is used to promote urination and guide Yin downward. If Yang Qi contends upward and sweating occurs, the prognosis is favorable. For miscellaneous diseases with upper heat and lower cold, Jiji Tang (Ji Ji Decoction) is used; if accompanied by constipation, Jiji Jiedu Tang (Ji Ji Detoxification Decoction) is used; for Fire not returning to its source (deficient Mingmen fire with floating deflected fire), Bawei Wan (Eight-Ingredient Pill) is used. For upper cold and lower heat, Wuling San (Five-Ingredient Powder) is administered with Zishen Wan (Kidney-Nourishing Pill); for sinking of deficient Yang, Jiaban Bawei Wan (Modified Eight-Ingredient Pill) is used.