bubble_chart Concept

Shivering, also known as chills or shiver. In the process of external-contraction febrile disease, the phenomenon of shivering followed by immediate sweating is called shiver sweating, which is a manifestation of the struggle between pathogenic factors and the body's resistance.

Shiver sweating is different from "shiver"; "shiver" refers to the subjective feeling of coldness and shivering throughout the body, while shiver sweating refers to the simultaneous occurrence of shivering and sweating.

bubble_chart Pattern Analysis

1. Taiyang Cold Damage Resolving︰Fever, aversion to cold, limb and joint pain, thin white tongue coating, floating and rapid pulse that feels weak upon pressure. If resolution is desired, there may be trembling and sweating, the body becomes calm, the pulse harmonizes, and the illness is cured with recovery. This is due to cold damaging the taiyang muscle exterior, hence symptoms of the taiyang exterior pattern appear (aversion to cold, fever, absence of sweating, floating pulse). The conflict between wind-cold pathogens and healthy qi stagnates in the taiyang meridian exterior. When healthy qi and pathogenic qi contend and healthy qi cannot overcome the pathogens, trembling occurs. Subsequently, when healthy qi becomes strong and pathogenic qi weakens, a burst of sweating drives the pathogens outward, so the body calms, the pulse harmonizes, and the exterior illness resolves naturally, potentially healing without medication. However, if there is shivering and sweating but the sweating is insufficient, and the exterior pattern persists, this may recur with shivering and sweating until recovery, or one may administer formulas that regulate the nutritive and defensive levels and release the flesh exterior. In such cases, Cinnamon Twig Decoction can be taken.
2. Epidemic Lingering in Qi Level Resolving︰Fever or even no aversion to cold, or conversely aversion to heat, restlessness and thirst or desire to drink, yellow tongue coating, and a surging pulse. If there is initial trembling and shivering, followed by sweating all over the body, and then a calm pulse with a cool body, this indicates the disease is about to resolve and be eliminated. This is when the pestilential pathogen transmits from the exterior to the interior, lingering in the qi aspect, manifesting qi-aspect symptoms (high fever, no aversion to cold, restlessness and thirst, surging pulse, etc.). If healthy qi is still vigorous, it may transform into shivering and sweating to expel the pathogen from the exterior. After shivering and sweating, if the pulse calms, the body cools, and the restlessness and thirst suddenly cease, the disease will naturally heal. If after shivering and sweating, "the fever has not subsided, and the pulse is nearly floating, this indicates pathogenic qi is congested in the channels, and the exterior has not yet resolved. It should be resolved by sweating. If sweating does not occur, use Bupleurum Dryness-Clearing Decoction to harmonize" (supplementary note from Wenyi Lun). If there is only shivering without sweating, and reversal cold of the limbs, "if the reversal cold subsides and sweating occurs, the patient will live; if the reversal cold does not subside and sweating does not occur, the patient will die. This is because healthy qi is depleted and cannot overcome the pathogen" (supplementary note from Wenyi Lun). This is a manifestation of the disease progressing toward deterioration.

The symptom of shiver sweating is a clinical manifestation of the struggle between healthy qi and pathogenic qi. Its outcome is limited to two paths: if the healthy qi overcomes the pathogenic qi, the illness will naturally heal; if the pathogenic qi is strong and the healthy qi is weak, and the healthy qi cannot overcome the pathogenic qi, the illness will worsen. When shiver sweating occurs, "it should not be disturbed, but can be kept warm; disturbance will cause the struggle to cease midway" (Wenyi Lun supplementary note). This is something that should be noted in clinical practice.

bubble_chart Documentation

1. Shiyi Dexiao Fang．"Cold-Damage Disease Anecdotes": "On the seventh day of the reversal of the Jueyin, if the pulse becomes slightly slow and slightly floating, it indicates the presence of the spleen and stomach pulse. Therefore, it is known that the spleen qi is complete, no longer being overcome, and the evil has nowhere to reside. When the extreme turns to peace, the defense and nourishment will be restored, water rises and fire descends, then cold and heat occur, and profuse sweating resolves."