Femoral heat, sudden pain in the yin region, alternating chills and fever, soreness and heaviness of the knees: He Yang (BL56) is indicated. After the resolution of alternating chills and fever, (alternatively read as "ulceration"), body aching and weakness, soreness of the shins, heaviness and pain in the four limbs, shortness of breath and difficulty in speaking: Zhi Yang (GV9) is indicated.

Alternating chills and fever with low back pain as if broken: Shu Gu (BL65) is indicated. Alternating chills and fever with bone pain: Yu Zhen (GB9) is indicated.

[Huangdi asked:] How can one predict who is prone to diseases of alternating chills and fever? Shaoyu replied: Those with small bones and weak flesh are prone to such diseases. Huangdi asked: How can one assess the size of the bones, the firmness or fragility of the flesh, and the uniformity of the complexion? Shaoyu replied: The zygomatic bone is the root of the bones. A large zygoma indicates large bones; a small zygoma indicates small bones. If the skin is thin and the flesh lacks substance, and the arms appear flaccid and soft, and the facial complexion is dull and distinct from the natural sky-like hue, appearing dirty and abnormal, this is a sign of susceptibility. Furthermore, those with thin arms have insufficient marrow, and thus are prone to diseases of alternating chills and fever. (From *Wu Bian Pian*)

[Zhongjing] stated: Some patients experience initial aversion to cold with shivering, followed by fever. What is the cause? It is said: When the Yin pulse is deficient, Yang Qi moves to follow it. When the Yang pulse is deficient, Yin Qi moves to invade it. What is meant by Yang deficiency? For instance, if the Cun Kou pulse is faint, it is called Yang deficiency. When Yin Qi ascends into the Yang region, aversion to cold with shivering occurs. What is meant by Yin deficiency? For instance, if the Chi pulse is weak, it is called Yin deficiency. When Yang Qi sinks into the Yin region, fever occurs. (Full text see *Shanghan Lun* on Chills and Fever).

[Suwen] states: A Cun Kou pulse that is deep and accompanied by panting indicates alternating chills and fever. (From *Ping Ren Qi Xiang Lun*). A pulse that is deep, rapid, fine, and scattered indicates alternating chills and fever. (From *Mai Yao Jing Wei Lun*; note: deep and fine indicate Cold, rapid and scattered indicate Heat). A pulse that is choppy and surging-large indicates internal alternating chills and fever. If the skin of the Chi area feels hot initially but becomes cold upon prolonged palpation, it indicates alternating chills and fever. (Meaning: initially hot to touch, then cold after a while). If the Chi area feels cold initially but becomes hot upon prolonged palpation, it also indicates alternating chills and fever. (Meaning: initially cold to touch, then hot after a while). In alternating chills and fever, if the body form is emaciated and the pulse is firm and bounding, this is a contrary sign indicating poor prognosis. (Full text see *Zhen Sheng Si Men*). If the flesh of the Chi area is hot, with sweating and recumbency accompanied by muscle wasting, alternating chills and fever is difficult to treat. (Full text see *Zhen Sheng Si Men*). In diagnosing alternating chills and fever, if red vessels run vertically through the pupil, seeing one vessel predicts death in one year; one and a half vessels, death in one and a half years; two vessels, death in two years; two and a half vessels, death in two and a half years; three vessels, death in three years. (If the red vessels do not extend below the pupil, the condition is treatable. From *Han Re Pian*). Patients with alternating chills and fever die at dawn. (Full text see *Zhen Sheng Si Men*).