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Question: There are diseases where chills precede fever, and others where fever precedes chills. Since the pathology indeed varies, do the methods of acupuncture also differ? Please explain.

Answer: In terms of the disease manifesting in humans, there are differences in the sequence of chills and fever. However, regarding treatment by the practitioner, there is a distinction to be made concerning similarity/difference and sequence. If one does not investigate the sequence of chills and fever, errors will occur with no proper measure, and how can one ascertain the source of the disease? If one does not understand the sequence of treating similarities and differences, efforts will be aimless without focus, and how can one achieve treatment tailored to the specific condition? These chills and fever syndromes, whether occurring as chills then fever or fever then chills, result from contracting pathogenic qi (unhealthy energy) that penetrates into the Couli (interstices of skin and muscle). To treat these conditions, one must follow the cause of their occurrence and apply tonification (Bu) or sedation (Xie) methods accordingly. This ensures that treating cold does not become excessively harsh, and treating heat does not become excessively burning, leading to the recovery of the illness. Is this not beneficial for humanity? Allow me to offer my humble insight to answer your profound question, however slight it may be.

I have sought to understand the origin of life in humans and all things, which stems from the Supreme Ultimate (Taiji) and divides into Yin and Yang Qi. When static, it manifests as Yin, yet contains Yang within; when active, it manifests as Yang, yet has Yin as its root. Because Yin is rooted in Yang, movement and stillness are endless, giving form to generation; because Yang is rooted in Yin, appearance and concealment have a basis, giving function to generation. However, the circulation of Qi inevitably has deviations from harmony, and humans suffering from external pathogens inevitably experience differences in cold and heat. Thus, some present with chills followed by fever, while others present with fever followed by chills. Chills preceding fever indicates Yang hidden within Yin; if treated solely by addressing Yin, it biases towards Yin, causing heat to intensify. Fever preceding chills indicates Yin hidden within Yang; if treated solely by addressing Yang, it biases towards Yang, causing cold to deepen. Intensified heat may transform into Shaoyang, Yangming, or Taiyang syndromes (Three Yang Syndromes); deepened cold may transmit to Jueyin, Shaoyin, or Taiyin syndromes (Three Yin Syndromes). What should the treatment method be? I have studied the *Tu Jing* and learned from my masters. For chills preceding fever, the "Yang Hidden within Yin" technique must be applied. During needling, insert the needle 5 cun (or fen, depending on context, here likely fen/0.1 cun units common in ancient texts, but strictly translating 'fen' as a unit), perform the Nine Yang numbers (tonifying manipulation count). If slight warmth is felt, advance the needle to 1 cun, then perform the Six Yin numbers (sedating manipulation count), aiming for Deqi (arrival of Qi sensation). In this way, the disease of chills preceding fever can be eliminated. For fever preceding chills, the "Yin Hidden within Yang" technique is used. Insert the needle 1 cun, perform the Six Yin numbers. If slight coolness is felt, withdraw the needle gradually by 5 fen, then perform the Nine Yang numbers, again aiming for Deqi. In this way, the disease of fever preceding chills can be cured. The terms "preceding" and "following" refer to differences in Ying (Nutritive) and Wei (Defensive) Qi involved; "cold" and "heat" refer to differences in affected meridians, specifically Yin or Yang meridians. If fever preceding chills is not treated with Yin Hidden within Yang, the origin of the disease is missed. How can one grasp the appropriateness of sequence? If chills preceding fever is not treated with Yang Hidden within Yin, the mechanism of the disease is not understood. How can one achieve the subtlety of adaptation? Furthermore, discussing the origin of cold and heat, it is not Heaven harming people, but people harming themselves. The Classics state: Where pathogenic factors gather, Zheng Qi (Upright Qi) must be deficient. When humans indulge their desires, Zhen Yuan (True Essence) becomes precarious; when ambition leads astray, purity becomes diluted; when distracted by material attachments, essence scatters; when enslaved by food and sex, integrity is compromised; when the body labors the spirit, solidity develops flaws. Yuan Yang (Primal Yang) is lost, Zheng Qi perishes, and Han Du (Cold Toxicity) attacks due to deficiency. If one could nurture the spiritual spring like water at the foot of a mountain, aligning with the profound Dao at sunrise and sunset, keeping desires shallow and Tian Ji (Heavenly Mechanism/Instinct) deep, the natural body of the Supreme Ultimate would be established. Although cold and heat toxins are powerful, they would find no gap to enter. It is like a solid wall; how can thieves act tyrannically? Therefore, the sages said: Is it not better to treat disease before it occurs than after it has occurred? This applies to cold and heat syndromes.