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Tidal fever (Chao Re) manifests with regular onset and cessation, much like the tide, occurring without missing its time, typically once a day. If it occurs three to five times a day, it is classified as fever (Fa Re), not tidal fever. Tidal fever can be of deficiency (Xu) or excess (Shi) nature. Only in Shang Han (Cold Damage) disease, fever occurring at the Ding-Shi hour (9 PM - 1 AM, though text implies afternoon/waning yang context often associated with Yangming, here specified as 'Ri Bu' which usually means 3-5 PM, i.e., Shen hour) belongs to Stomach Excess (Wei Shi), with no other deficiency patterns involved. For other cases of tidal fever, one must examine for deficiency or excess: if there is dry and constipated stool, preference for cold drinks, aversion to heat, epigastric fullness and discomfort (Xin Xia Man Ran), and restless sleep, these all indicate Qi excess, known as excess-type tidal fever. For mild cases, Can Su Yin (Ginseng and Perilla Decoction) is suitable; for severe cases, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is used. If there is Qi depletion and fatigue, mental exhaustion, reduced appetite, and gradual emaciation, although the acute illness may have temporarily subsided, the "five hearts" (palms, soles, and chest) remain hot, this belongs to deficiency syndrome. Suitable formulas include Fu Ling Bu Xin Tang (Poria Decoction to Tonify the Heart), Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction), or Yang Rong Tang (Nourishing the Blood Decoction). For post-illness lack of regulation, Ba Zhen San (Eight Treasure Powder) is the main treatment. In cases where tidal fever appears like deficiency but presents with chest and diaphragm stuffiness, back pain, and no response to tonifying medicines, this is due to fluid retention (Yin Zheng) moving with Qi, causing heat to fluctuate with the fluids; thus, one should seek treatment methods in the Phlegm-Fluids section. Additionally, some patients experience slight fever at night, which they do not perceive; upon waking and moving, they are fine, eating normally, with no other suspicious symptoms. This is merely blood deficiency failing to nourish Yang, requiring moistening and tonification. Use Fu Ling Bu Xin Tang. After the heat subsides slightly, continue with Yang Rong Tang or Shi Quan Da Bu Tang. A slippery pulse indicates retained food in the intestines; if there is evening fever that stops by morning, seek treatment in the Food Retention section. For night fever due to Damp Atrophy, use Huang Qin (Scutellariae Radix), Huang Bo (Phellodendri Cortex), Huang Lian (Coptidis Rhizoma), and Bai Shao Yao (Paeoniae Radix Alba) powdered and made into pills with porridge. For tidal fever, Huang Qin (Scutellariae Radix) and Sheng Gan Cao (Raw Glycyrrhizae Radix) are primary. Add Qiang Huo (Notopterygii Rhizoma et Radix) if it occurs at Chen or Xu hours; add Huang Lian (Coptidis Rhizoma) at Wu hour; add Shi Gao (Gypsum Fibrosum) at Wei hour; add Chai Hu (Bupleuri Radix) at Shen hour; add Sheng Ma (Cimicifugae Rhizoma) at You hour; add Dang Gui Shao (Radix Angelicae Sinensis Cauda) at night. If accompanied by aversion to cold, add Huang Qi (Astragali Radix), Ren Shen (Ginseng Radix), and Bai Zhu (Atractylodis Macrocephalae Rhizoma). The differentiation of day/night fever is detailed in the Fever section.

The Classics state: "Aversion to cold and shivering all belong to Heat." It also states: "Shivering as if losing spiritual control all belongs to Fire." Aversion to cold manifests as, even in hot months, upon encountering wind and frost, wearing heavy cotton clothes, one still feels biting cold and shivers uncontrollably, as if losing spiritual control, indicating severe aversion to cold. *Yuan Bing Shi* says: "Having a heat syndrome but feeling cold internally indicates heat disease, not actual cold." One might ask: "Why do many cases recover after taking hot-natured medicines?" The answer is: "In heat diseases, Qi flares upward, condensing into phlegm-fluids, obstructing the clear pathways, preventing Yin Qi from ascending, worsening the condition. Accumulated phlegm, aided by heat, may temporarily recede, but heat exacerbates the pathogen, deepening the illness." Another asks: "If cold is so severe, who dares to use cold-natured medicines? Would that not kill them?" The reply is: "Ancients treated shivering syndromes by purging dry feces with Da Cheng Qi Tang (Major Order the Qi Decoction) and achieving cure. Aversion to cold and shivering are clearly heat syndromes, differing only in deficiency or excess." Daytime aversion to cold indicates Yin Qi overflowing into the Yang aspect; nighttime aversion to cold indicates Yin Blood flourishing in the Yin aspect. If Wei Qi (Defensive Qi) is deficient and weak, unable to secure the exterior and warm the muscles, leading to aversion to cold, Danxi used Ren Shen (Ginseng Radix) and Huang Qi (Astragali Radix); in severe cases, a small amount of Fu Zi (Aconiti Lateralis Radix Praeparata) was added to promote the movement of Ren Shen and Huang Qi. If pathogens in the Upper Jiao block Ying and Wei, preventing their emergence to the exterior, causing aversion to cold, Danxi treated a young woman by using Ku Shen (Sophorae Flavescentis Radix) and Chi Xiao Dou (Vigna Semen Rubrum) powdered, inducing vomiting with water, then administering Wan Xiong (Ligustici Chuanxiong Rhizoma), Cang Zhu (Atractylodis Rhizoma), Nan Xing (Arisaematis Rhizoma), Huang Qin (Scutellariae Radix), and Jiu Qu (Medicated Leaven) as honeyed pills. If internal stagnation of wine-heat causes aversion to cold, Danxi treated a thin, dark-complexioned man near fifty who loved drinking. He suddenly experienced severe aversion to cold and shivering, complained of thirst but could not drink. His pulse was large and weak, with the Right Guan position slightly solid and string-like, rough upon heavy pressure. He prescribed Huang Qi (Astragali Radix) alone, decocted with Ge Gen (Puerariae Lobatae Radix). After consuming two taels of Huang Qi and one tael of Ge Gen, the pulse became smaller, and he recovered the next day. In the intense heat of June, he contracted severe cold, with difficulty breathing, cool body, and slow pulse. How to treat? Disease has root (Ben) and branch (Biao). Heat is the root; severe cold is the branch. Using cold medicines follows the season but ignores the root; using hot medicines follows the root but ignores the season. Therefore, one does not follow root or branch, but treats via the "Middle Method." What is the Middle Method? It is using Warmth. However, if called "Warm," it cannot treat severe cold. Treating severe cold requires Jiang (Zingiberis Rhizoma) and Fu Zi (Aconiti Lateralis Radix Praeparata). Using them seems contrary to the "Warm" method. Yet, stopping when the pathogen is largely reduced, and the pulse returns to four beats per breath, suffices. Using Jiang and Fu Zi is also the Middle Method, effectively Warmth. The Classic says: "Avoid hot medicines during hot seasons." Although generally inappropriate, when pathogenic force is extreme, violation is permissible. Danxi treated a sixty-year-old woman with eye issues who felt severe aversion to cold and shivering in June, preferring fire and cotton, sweating profusely. She was obese with thick flesh, had taken over ten doses of Fu Zi, suffered severe itching, and had deep, choppy pulses that became larger upon heavy pressure. Recognizing severe heat and blood deficiency, he used Si Wu Tang (Four Substances Decoction) removing Chuan Xiong, doubling Di Huang (Rehmanniae Radix), adding Bai Zhu (Atractylodis Macrocephalae Rhizoma), Huang Qi (Astragali Radix), fried Huang Bo (Phellodendri Cortex), Sheng Gan Cao (Raw Glycyrrhizae Radix), and Ren Shen (Ginseng Radix), each dose weighing one tael. After one dose, she had severe diarrhea, blindness, and muteness. Recognizing deep pathology and lack of counter-agent in the prescription, he repeated the formula but served it hot, using heat as a guide. After one dose, diarrhea stopped; after four doses, spirit returned; after ten doses, full recovery. He also treated a thirty-something man, thin and dark, who preferred heat and feared cold in June. Pulses were deep and choppy, rapid upon heavy pressure. He purged him with San Huang Wan (Three Yellows Pill), administered with Ginger Decoction, thirty pills per dose. After twenty doses, mild sweating led to recovery. A woman initially had aversion to cold, cold limbs, no fever, pulse eight beats, slight hypochondriac pain. The physician treated it as Shaoyang disease. With Yang trapped in the marrow and Yin on the exterior causing cold, treatment should not focus on interior/exterior but on the Middle Method. Use Xiao Chai Hu Tang (Minor Bupleurum Decoction) with increased Ginger and Jujube. Spleen/Stomach deficiency leads to lethargy, desire to lie down, and limp limbs. During autumn dryness, as damp-heat recedes, heaviness and joint pain occur, mouth/throat dryness, tastelessness, irregular bowels, frequent urination, anorexia, indigestion, combined with Lung symptoms, chilliness, depression, and sallow complexion. This is due to Yang Qi failing to extend. Use Sheng Yang Yi Wei Tang (Raise Yang and Benefit Stomach Decoction). Back aversion to cold is due to phlegm-fluids. Zhongjing stated: "Retained fluids in the heart region cause back aversion to cold, cold as ice." Treat with Fu Ling Wan (Poria Pill). Anterior body cold belongs to the Stomach. The Classic states: "Deficiency of Foot-Yangming Stomach channel Qi causes cold and shivering of the anterior body." Treat with acupuncture, tonifying Zu San Li (ST36). Cold hands and feet indicate Jue (Cold Extremities). Cold palms indicate abdominal cold. Blue veins on the hypothenar eminence indicate Stomach cold. Treat with Li Zhong Tang (Regulate the Middle Decoction). Huang Qi Bu Wei Tang (Astragalus Decoction to Tonify the Stomach) treats exterior deficiency with aversion to thieving wind. Upper Jiao obstruction inhibits Yang Qi, preventing warming of skin and muscles, causing shivering. Dongyuan's Sheng Yang Yi Wei Tang uses ascending agents to open the Upper Jiao, extending Yangming Qi outward to warm. Danxi’s induction of vomiting for damp-phlegm also opens the Upper Jiao, allowing Yang Qi to rise and warm, curing shivering.

[Zhèn Hán] Refers to cold with trembling. The Classic states: "Yangming refers to 'shivering cold.' Yangming corresponds to Noon, May is Yin within abundant Yang. Abundant Yang plus Yin causes shivering cold." This requires draining Yang. It also states: "Cold qi lodging in the skin, with excess Yin and deficient Yang, causes shivering cold." This requires tonifying Yang. It further states: "Jueyin in the lower position, wind dominance causes shivering cold; treat with pungent-cool." And: "Yangming governing heaven, cooling qi holds at the qi intersection, people suffer shivering cold. Fourth Qi, cold rain falls, suffering shivering chills." Treatment depends on severity. Lower part of six pulses shows string-taut, fine, and choppy, powerless upon pressure, intermittent abdominal pain, heart/stomach pain radiating to testicles, loose stools, anosmia, runny nose, tearing, wheezing cough with white foam, heavy sore waist, pain in neck/back/chest/flanks, burning eyes, aversion to cold in mouth/nose, headache/dizziness, persistent shivering, cough/vomit/hiccups, followed by restlessness and steaming heat, sitting in a steamer, needing to undress and sit in cold places or drink cold water for relief. Recurring shivering, shortness of breath, chest fullness/pain, sensation of blocked throat, nearly dying. Severe cases: mouth open, eyes staring, loud voice, profuse tears/snot/phlegm. Restlessness passes, shivering returns. Pale face indicates blood loss. Sadness/depression, forgetfulness, sneezing indicates wind-heat damaging Kidney Water and Dryness Metal rebound. Fine, string-taut, choppy pulses, empty upon pressure, indicate severe cold damaging essence/qi. Treat with pungent-sweet-warm-moistening agents, draining Northwest energies to cure.

[Hán Bì] Emperor asked: "Body is not cold from clothing, nor is there external cold invasion, why does cold arise internally?" Qibo answered: "This person has much Bi Qi (Obstruction Qi), little Yang Qi, much Yin Qi, hence body cold as if emerging from water." Emperor asked: "Someone is cold, soup/fire cannot warm, thick clothes cannot heat, yet does not shiver, what disease is this?" Qibo answered: "This person has strong Kidney Qi, engages in water-related work, Taiyang Qi declines, Kidney marrow dries up. One Water cannot overcome Two Fires. Kidney is Water, generates bone. If Kidney fails, marrow is insufficient, hence cold reaches bone. Why no shivering? Liver is one Yang, Heart is two Yangs, Kidney is solitary organ. One Water cannot overcome Two Fires, hence no shivering. Named Bone Bi, prone to joint contraction." Treat according to Bi section.

[Qi Fen Han] Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Prepared Aconite Root), Guizhi Jia Shaoyao Renshen Xinjia Tang (Cinnamon Twig Decoction plus Peony and New Ginseng Formula).

[Xue Fen Han] Bajie Wan (Morinda Pill), Shenzhu Wan (Divine Pearl Pill).

[San Jiao Han] Upper Jiao Cold: Chen Pi (Citri Reticulatae Pericarpium), Hou Po (Magnoliae Officinalis Cortex), Huo Xiang (Agastaches Herba), Hu Jiao (Piperis Longi Fructus), Lizhong Wan (Regulate the Middle Pill), Tie Shua Tang (Iron Brush Decoction), Gui Fu Wan (Cinnamon and Aconite Pill). Middle Jiao Cold: Bai Zhu (Atractylodis Macrocephalae Rhizoma), Gan Jiang (Zingiberis Rhizoma), Ding Xiang (Eugeniae Flos), Da Jian Zhong Tang (Great Establish the Middle Decoction), Er Qi Dan (Two Qi Elixir), Fuzi Lizhong Wan (Aconite Regulate the Middle Pill). Lower Jiao Cold: Rou Gui (Cinnamomi Cortex), Fu Zi (Aconiti Lateralis Radix Praeparata), Chen Xiang (Aquilariae Lignum Resinatum), Bawei Wan (Eight Ingredients Pill), Huan Shao Dan (Return to Youth Elixir), Tianzhen Dan (Heavenly Innocence Elixir). Haizang said: "Lower Jiao cold follows Si Ni Tang (Frigid Extremities Decoction) pattern." Gan Jiang (Zingiberis Rhizoma) is bitter, stops but does not move; Fu Zi (Aconiti Lateralis Radix Praeparata) is acrid, moves but does not retain, used for urinary obstruction. Both are Yang, promoting Qi transformation to produce urine. Adding Fu Ling (Poria) to Jiang, Fu, and Zhu aids separation and drainage. Raw Fu Zi lacks fire power; if heated, it moves uncontrollably. With more water and less decoction, heat enters Lower Jiao directly.

[Wu Zang Han] Formulas for Five Zang Cold: Liver Cold, Shuang He Tang (Double Harmony Decoction). Heart Cold, Ding Zhi Wan (Settle Spirit Pill), Chang Pu Wan (Acorus Pill). Spleen Cold, Yi Huang San (Benefit Yellow Powder). Lung Cold, Xiao Qing Long Tang (Minor Green Dragon Decoction). Kidney Cold, Bawei Wan (Eight Ingredients Pill). General treatment for severe cold, Si Ni Tang (Frigid Extremities Decoction), Da Yi Han Wan (Great Eliminate Cold Pill), Chen Xiang Gui Fu Wan (Aquilaria, Cinnamon, and Aconite Pill). Wang Taipu said: "Minor cold is harmonized with warmth. Major cold is taken with heat. Severe cold is drained downward. If draining fails, suppress it inversely. If suppression fails, seek its affiliation to weaken it." Dongyuan said: "Treating cold with heat, administered cool, has three reasons. Northerners injured by severe cold have swollen calves; cold excess causes floating, naturally so. Moxibustion/baths would cause hair loss/exposed bone; must bathe in fresh water first for recovery. Severe cold freezing face/ears requires bathing in cool rooms before warming to prevent skin peeling/sores. This is 'administering cool' to remove severe cold, reason one. Severe cold requires strengthening the Mother element. Earth moves left to Lung, reverses Heaven. Cool medicines make Heaven move right, following Heavenly commands, curing diseases, reason two. Severe cold outside hides great heat underground, root of San Jiao/Bao Luo true Qi. Heat hidden damages Yuan Qi (Stomach). Cool medicines harmonize, enriching Yuan Qi without damage, reason three."