问∶病有先寒后热者，先热后寒者，然病固有不同，而针刺之法，其亦有异乎？请试言
对曰∶病之在天人也，有寒热先后之殊，而治之在吾人也，有同异后先之辨。盖不究夫
寒热之先后，则谬焉无措，而何以得其受病之源；不知同异之后先，则漫焉无要，而何以达
其因病之治。此寒热之症，得之有先后者，感于不正之气，而适投于腠理之中，治寒热之症
，得之有后先者，乘其所致之由，而随加以补泻之法，此则以寒不失之惨，以热则不过于
灼，而疾以之而愈矣。是于人也，宁不有济矣乎？请以一得之愚，以对扬明问之万一，何如？
盖尝求夫人物之所以生也，本之于太极，分之为二气，其静而阴也，而复有阳以藏于其中；
其动而阳也，而复有阴以根于其内，惟阴而根乎阳也，则往来不穷，而化生有体；惟阳而根
乎阴也，则显藏有本，而化生有用。然而气之营运也，不能无愆和之异，而人之罹之也，不
能无寒热之殊，是故有先寒后热者，有先热后寒者。先寒后热者，是阳隐于阴也，苟徒以阴
治之，则偏于阴，而热以之益炽矣。其先热后寒者，是阴隐于阳也，使一以阳治之，则偏于
阳，而寒以之益惨矣。夫热而益炽，则变而为三阳之症，未可知也。夫寒而益惨，则传而为
三阴之症，未可知也。而治之法，当何如哉？吾尝考之《图经》，受之父师，而先寒后热者
，须施以阳中隐阴之法焉。于用针之时，先入五分，使行九阳之数，如觉稍热，更进针令入
一寸，方行六阴之数，以得气为应。夫如是，则先寒后热之病可除矣。其先热后寒者，用以
阴中隐阳之法焉。于用针之时，先入一寸，使行六阴之数，如觉微凉，即退针，渐出五分，
却行九阳之数，亦以得气为应。夫如是，则先热后寒之疾瘳矣。夫曰先曰后者，而所中有荣
有卫之殊；曰寒曰热者，而所感有阳经阴经之异。使先热后寒者，不行阴中隐阳之法，则失
夫病之由来矣。是何以得其先后之宜乎？如先寒后热者，不行阳中隐阴之法，则不达夫疾之
所致矣。其何以得夫化裁之妙乎？抑论寒热之原，非天之伤人，乃人之自伤耳。经曰∶邪之
所凑，其气必虚。自人之荡真于情窦也，而真者危；丧志于外华也，而醇者漓；眩心于物牵
也，而萃者涣； 情于食色也，而完者缺；劳神于形役也，而坚者瑕。元阳丧，正气亡，寒
毒之气，乘虚而袭。苟能养灵泉于山下，出泉之时，契妙道于日落，万川之中，嗜欲浅而天
机深，太极自然之体立矣。寒热之毒虽威，将无隙之可投也。譬如墙壁固，贼人乌得而肆其
虐哉？故先贤有言曰∶夫人与其治病于已病之后，孰若治病于未病之先，其寒热之谓欤？
问：疾病有先出现寒战随后发热的，也有先发热随后出现寒战的。既然病情确实存在不同，那么针刺的方法是否也有区别呢？请试着讲讲。
答：疾病在人体上的表现，有寒热发作先后顺序的不同；而治疗在于医者手中，有辨别同异、先后次序的关键。如果不探究寒热发作的先后顺序，就会谬误而无从着手，又怎能找到致病之源？如果不明白同异治疗的先后次序，就会漫无重点，又怎能达到因病施治的目的？这种寒热病症，有的是先寒后热，有的是先热后寒，这是由于感受了不正之气，恰好侵入腠理（皮肤肌肉的间隙）之中。治疗这类寒热病症，需要根据其发病的先后缘由，随之采用补法或泻法。这样，处理寒证就不会过于惨烈，处理热证就不会过于灼热，疾病就能痊愈了。这对于人来说，难道不是很有帮助吗？请允许我用这浅陋的一得之见，来回答您高明问题的万一，怎么样？
我曾经探究过人和万物之所以生存的道理，本源在于太极，分化出阴阳二气。当它静止时表现为阴，但其中又藏着阳；当它运动时表现为阳，但内部又以阴为根基。正因为阴以阳为根，所以往来无穷，化生有了实体；正因为阳以阴为根，所以显隐有本，化生有了功用。然而气的运行，不可能没有失调的差异，人遭受邪气侵袭，也不可能没有寒热的不同。因此，有的先寒后热，有的先热后寒。先寒后热，是阳气隐匿于阴分之中；如果只用治阴的方法，就会偏于阴，导致热势更加炽盛。先热后寒，是阴气隐匿于阳分之中；如果只用治阳的方法，就会偏于阳，导致寒势更加严重。热势更加炽盛，可能会转变为三阳病证，这是不可预知的。寒势更加严重，可能会传变为三阴病证，这也是不可预知的。那么治疗方法应当如何呢？我曾经考证《图经》，并师承父辈老师，认为先寒后热的病症，必须施用“阳中隐阴”的针法。在使用针具时，先刺入五分深，施行九阳之数（指捻转补法的操作次数），如果感觉稍微发热，再进针使深度达到一寸，然后施行六阴之数（指捻转泻法的操作次数），以得到“得气”的感觉作为应验。像这样，先寒后热的病就可以消除了。对于先热后寒的病症，则使用“阴中隐阳”的针法。在使用针具时，先刺入一寸深，施行六阴之数，如果感觉微微发凉，就退针，逐渐拔出五分深，然后再施行九阳之数，同样以得到“得气”的感觉作为应验。像这样，先热后寒的疾病就能痊愈了。所谓先和后，是因为所作用的营卫之气有所不同；所谓寒和热，是因为所感受的经络有阳经和阴经的区别。如果先热后寒的病，不施行阴中隐阳的方法，就失去了对病因来源的判断。怎么能掌握先后的适宜时机呢？如果先寒后热的病，不施行阳中隐阴的方法，就不能通达疾病产生的机理。怎么能获得灵活变通的妙处呢？再者论述寒热的根源，并非天灾伤人，而是人自我伤害所致。医经说：邪气聚集的地方，正气必然虚弱。由于人在情欲窦开之时放纵真情，导致真元危险；在外表繁华丧志，导致醇厚变得淡薄；被物欲迷惑心神，导致精粹涣散；沉溺于饮食男女，导致完整变得残缺；因形体役使劳神，导致坚固产生瑕疵。元阳丧失，正气消亡，寒毒之气便乘虚而入。如果能够像山间泉水一样涵养灵泉，在日出之时契合妙道，在日落万川之中保持嗜欲浅薄而天机深远，那么太极自然的本体就确立了。虽然寒热毒气威力很大，也将找不到可乘之机。这就好比墙壁坚固，盗贼怎么能肆意肆虐呢？所以先贤有句话说：与其在已经生病后治病，不如在未病之前预防疾病，说的就是寒热这类情况吧？
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.