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Chills and shivering (Han Zhan) result from the deficiency of Qi within Yang. When Yang Qi is deficient, Yin encroaches upon it; as Yang cannot overcome Yin, coldness and trembling occur. Teeth grinding or clenching (Qie Ya) results from the deficiency of Qi within Yin. Deficiency of Yin Qi indicates exhaustion of the Kidney Yuan (Original Qi), leading to the depletion of Bone Qi, thus causing teeth to grind and make noise. In summary, when the deficiency lies in the Qi aspect, it is invariably a disease pattern of Excess Yin and Deficient Yang, which requires vigorous warming and tonification.

*Xin Jian* states: Chills appearing seven days prior indicate Exterior Deficiency; teeth grinding indicates Interior Deficiency. Chills appearing seven days later indicate extreme Qi deficiency; teeth grinding indicates extreme Blood deficiency. For Qi deficiency, Baoyuan Tang (Preserve the Origin Decoction) with doubled Rougui (Cinnamon Bark) should be used to warm the Yang aspect. For Blood deficiency, Baoyuan Tang with Xiong (Ligusticum Rhizome) and Gui (Angelica Sinensis Root) should be used to nourish the Yin aspect. I commonly use Liuqi Jian (Six Qi Decoction) or Liuwu Jian (Six Ingredients Decoction) added with Guizhi (Cinnamon Twig) and Fuzi (Prepared Aconite Root) to treat this, with immediate cessation of symptoms in all cases. Those presenting with isolated chills or isolated teeth grinding are treated similarly; combining with Erxian San (Two Immortals Powder) is also effective.

First, if pathogenic Cold remains in the Exterior, accompanied by high body heat, a tight and rapid pulse without sweating, and chills due to the struggle between Pathogen and Righteous Qi, this resembles malaria-like patterns. Dispersing the pathogen will naturally stop the chills; Chaige Guizhi Tang (Bupleurum and Kudzu and Cinnamon Twig Decoction) is appropriate.

Second, if pustules are grayish-white and ulcerated, accompanied by diarrhea, chills, and teeth grinding, this is a pattern of Pure Yin without Yang. Jiwei Yigong Jian (Nine-Ingredient Extraordinary Efficacy Decoction) or Chen's Shi'er Wei Yigong San (Twelve-Ingredient Extraordinary Efficacy Powder) may be used.

Third, if pustules are dry, purple-black, and sunken, accompanied by obstruction of urination and defecation, irritability, intense thirst, chills, and teeth grinding, this is a pattern of Pure Yang without Yin, where extreme Fire mimics Water. Shuangjie San (Double Release Powder) is indicated.

Fourth, during the stage of pus formation and scabbing, if there is red-purple swelling, constipation of urine and stool, irritability, and thirst preferring water, this is a pattern of Heat in both the Interior and Exterior. The body trembles due to pain, and teeth are ground while enduring pain; this does not belong to the category of chills and teeth grinding. If Heat is severe with constipation, Sishun Qingliang Yin (Four Smooth Cooling Beverage) added with Qiaofen (Forsythia Fruit), Mutong (Akebia Stem), and Jinyinhua (Honeysuckle Flower) is appropriate.

Fifth, muscle twitching (Jin Ti Rou Yu) resembling chills occurs because meridional Qi and Blood are depleted by sores, failing to nourish muscles and govern sinews. Consequently, muscles twitch involuntarily. This is fundamentally not a pattern of chills; Shiquan Dabu Tang (Comprehensive Great Tonifying Decoction) is appropriate.

Chen states: Teeth grinding indicates withered teeth, caused by Qi and Blood failing to nourish; it must not be mistakenly treated as Heat.

Sixth, if chills and teeth grinding are accompanied by panting, delirium, mental confusion, and cold feet, this indicates either internal collapse of the eruption or inversion of the scabs, and is untreatable.