Alternating chills and fever refers to the alternating occurrence of aversion to cold and fever.

Alternating chills and fever is different from "aversion to cold with fever." In the latter, aversion to cold and fever occur simultaneously, whereas in alternating chills and fever, aversion to cold and fever appear alternately. During fever, there is no aversion to cold, and during aversion to cold, there is no fever. This distinction should be noted.

bubble_chart Pattern Analysis

1. Pathogenic Factor in the Shaoyang Meridian︰alternating chills and fever, vexation and vomiting, bitter taste in mouth, dry throat, dizzy vision, chest and hypochondriac fullness, red tongue edges, thin yellow tongue coating, wiry and rapid pulse. In cold-damage disease, when taiyang disease is not resolved, the pathogen transmits to shaoyang. Shaoyang lies between the exterior and interior. When external pathogens invade and contend with healthy qi, if healthy qi fails to overcome the pathogen, aversion to cold occurs; if healthy qi prevails over the pathogen, fever arises, hence alternating chills and fever manifest. The "Treatise on Cold-Damage Diseases: Differentiation of Shaoyang Disease Pulse Patterns and Treatment" states: "When taiyang disease is not resolved and progresses to shaoyang, there is hardness and fullness in the hypochondrium, retching and inability to eat, alternating chills and fever..." Clinically, besides alternating chills and fever, there are also shaoyang symptoms such as bitter taste in mouth, dry throat, chest and hypochondriac fullness, and wiry pulse. Treatment should focus on harmonizing shaoyang, with Minor Bupleurum Decoction as the representative formula.
2. External Contractionmalarial Pathogen︰Alternating chills and fever, recurring at regular intervals, often occurring every other day, or sometimes every three days. During an episode, it begins with aversion to cold, followed by high fever, and finally profuse sweating, after which the fever subsides and the body returns to normal. The tongue is red with a thin white or yellow greasy coating, and the pulse is wiry. The condition is caused by exposure to malarial pathogens and often occurs during summer and autumn. As stated in Yizong Bidu: "Malaria is mostly caused by wind, cold, summerheat, and dampness—pathogenic qi from the heavens." Its clinical manifestations are described in detail in Suwen.Nue Lun: "At the onset of malaria, it first arises from the fine hairs, then the acupoints become active, with chills causing chestnut-like trembling of the jaw and pain in the waist and spine. When the cold recedes, there is internal and external heat, headache as if splitting, and a thirst for cold drinks." The key diagnostic points are: alternating chills and fever occurring at fixed intervals, every other day or every three days (this is ordinary malaria); or more fever with less chills (called warm malaria), or more chills with less fever (called cold malaria). During episodes, there is aversion to cold, fever, and sweating, often recurring repeatedly. The difference between this syndrome and alternating chills and fever due to pathogens entering the Shaoyang channel is that the latter involves aversion to cold and fever without fixed timing, occurring several times a day, with a shorter course, and accompanied by Shaoyang symptoms such as chest and hypochondriac fullness, bitter taste in the mouth, and dry throat. For alternating chills and fever due to external contraction of malarial pathogens, the treatment should focus on expelling pathogens and preventing malaria attacks. The recommended formula is Malaria-Truncating Seven-Treasure Decoction. For debilitated individuals with recurrent episodes, Fleeceflower and Ginseng Decoction may be used.
3. Dampness-heat Stagnating in the Triple Energizer︰Alternating chills and fever, sweating without relief, chest tightness, abdominal distension and fullness, nausea, vertex pain, dysphoria, dry mouth with desire for cold drinks, scanty dark-yellow urine, red tongue edges, tongue coating that is greasy or white like accumulated powder, and soggy pulse. This syndrome is caused by dampness-warm disease with pathogenic heat and turbid phlegm lingering in the triple energizer, remaining unresolved, leading to dysfunction of triple energizer qi transformation. It manifests as alternating chills and fever, chest and gastric stuffiness, abdominal distension and fullness, dark-yellow scanty urine, greasy tongue coating, and other symptoms characteristic of dampness-heat obstructing the upper, middle, and lower triple energizer. The treatment should focus on separate elimination through urination and defecation and promoting qi movement. The recommended formula is Coptis RhizomeGallbladder-Warming Decoction with modifications. This syndrome differs from the previous two: in the case of pathogenic invasion of the Shaoyang, it is caused by cold pathogens and belongs to cold-damage disease; in external contraction of malarial pathogens, it is caused by malarial pathogens and belongs to malaria; whereas this syndrome is caused by dampness-heat and belongs to dampness-warm disease. The clinical manifestations are distinct: in pathogenic invasion of the Shaoyang, alternating chills and fever occur suddenly and irregularly; in external contraction of malarial pathogens, alternating chills and fever follow a regular pattern; in dampness-heat stagnation obstructing the triple energizer, alternating chills and fever persist, with sweating failing to relieve the condition. Additionally, differentiation can be made based on tongue coating, pulse, and accompanying symptoms.

bubble_chart Documentation

1. Yixue Gangmu．Malaria with chills and fever: "When the defensive qi merges with the pathogenic factor, the illness manifests; when it separates from the pathogenic factor, the illness subsides. If it merges with yin, there is cold; if it merges with yang, there is heat. When it separates from yin, the cold ceases; when it separates from yang, the heat ceases. The next day, if they gather and merge again, the illness recurs."
2. Leizheng Huorenshu："Alternating chills and fever are due to the struggle between yin and yang. If yang is insufficient, there is first cold and then heat; if yin is insufficient, there is first heat and then cold."