Alternating Chills and Fever, Shivering Until Your Teeth Chatter? Doctor Luo Dalun Presents Doctor Ni Haixia’s Forty-Third Lecture on the Huang Di Nei Jing — the Nue Lun (Malaria Treatise, Chapter 35), Continued: Three Questions That Tell You Whether It’s Malaria, How to Tell It Apart from the Shao Yang Syndrome, Wounded by Summer Heat and Sick with Malaria in Autumn, Shallow or Deep — Daily Versus Every-Other-Day Attacks, Feng Fu in the Broad Sense and the Du Channel Descending One Segment a Day, Wind Disease Versus Malaria, the Three Kinds of Malaria, When to Treat and the Needling Method, Gui Zhi Tang the Great Harmonizer, the Yin-Yang Mechanism, Pulse Diagnosis, and the Exceptions to the Four Seasons

Patient search words: alternating chills and fever / the shakes / malaria / shivering until your teeth chatter / chills and shaking / fever with thirst / back and loin pain / chills and fever once a day / chills and fever every other day / fever coming earlier each day / fever coming later each day / cold first then heat / heat first then cold / fever only, no chills / recurring fever / catching wind and cold / headache and stiff neck from a draft / preventing colds

Corresponding topics (medical terms): Su Wen · Nue Lun (Malaria Treatise, chapter 35), continued: telling malaria by three questions (thirst during the fever, han li gu han — chattering teeth with the chill, pain in the loins and spine) · distinguishing the shao yang syndrome (alternating chills and fever with nausea — shao yang blocks the pivot, wood conquers earth and disturbs the stomach; without nausea it is tai yang — exterior cold never makes the teeth chatter; malaria’s cold comes from deep inside) · wounded by summer heat, sick with malaria in autumn (the summer heat injures fluids; the hot qi hides between skin, muscles and intestines — where the blood and qi dwell; the constitution that sweats easily; in autumn the killing metal qi arrives, sweating meets wind or cold-water washing, cold-wind dwells with the defensive qi; normal day-night exchange of yang and yin; ‘go out with yang, press in with yin’ produces the daily alternating chills and fever) · the Chinese and Western views of malaria (the mosquito theory of the West versus summer-heat injury of the Chinese school; the summer qi that never left; autumn wind-cold meeting the sweat) · shallow and deep disease qi (daily attacks — shallow, the qi near the intestines; every-other-day attacks — deep, pressing into yin, yin and yang fight and cannot get out; attacks days apart — the pathogen sometimes joins the six bowels and sometimes separates) · feng fu in the broad sense (wherever you catch wind becomes a feng fu; narrow sense — the feng fu point GV16 behind the head; the air-conditioner draft on the hand; the pathogen travels the Du (Governing) channel, one segment per day; twenty-five segments down to the sacrum; on day twenty-six it turns back and rises to the ninth vertebra — the diaphragm, the liver half above half below — and comes out at que pen ST12; attacks getting later — still on the Du channel; attacks getting earlier — it has turned back) · bonus: mother was always right (wind has no fixed home; the scarf covers feng chi GB20, feng fu GV16, feng men BL12 — then the knees catch the wind on the motorcycle; never sit facing an electric fan) · wind disease versus malaria (wind is constant — stiff neck all day; malaria is punctual — the attack ends and the patient is well; wind stays fixed, malaria moves with the channels; tai yang wind’s cold and heat can run twenty-four hours) · the three kinds of malaria (cold then heat — cold malaria, han nue, first wounded by cold then by wind, cold is yin wind is yang; heat then cold — warm malaria, wen nue, first wounded by wind then cold; heat only — dan malaria, yin qi exhausted first, yang qi alone bursts out, hot hands and feet with nausea, ‘dan’ per the Ci Hai dictionary means disease earned by overwork) · when to treat (drain the excess, tonify the deficiency; never treat at the peak of the disease qi — not in great heat, not with the jumping irregular pulse, not after heavy sweating; treat before the attack or after it ends; striking the peak injures the upright qi without removing the pathogen) · the needling method for malaria (every attack starts at the tips of the four limbs where yin and yang meet; tie up every finger and toe before the attack — the pathogen cannot enter, the yin cannot come out; let blood from every swollen superficial collateral, sun luo; intercept the disease at the yin-yang tips before it reaches the body; the blood vessels visibly swell just before the attack — that is where the pathogen sits) · why the limbs are tied first (when malaria is not attacking it hides in the tips of the limbs; when the attack begins it goes deep; several-day and every-other-day malaria are deep — the pathogen sometimes joins the six bowels and sometimes not) · Gui Zhi Tang (Cinnamon Twig Decoction) — the first formula for harmonizing yin and yang, the ancestor of every formula in the Shang Han Lun, better at preventing colds than any vaccine) · the yin-yang mechanism (yin in excess means cold, yang in excess means heat; yang qi merging into yin — yang deficient, yin in excess — brings the shivering; yin reaching its extreme and emerging into yang brings the fever; water qi meeting yang qi gives cold; hot qi meeting yin qi gives heat; whenever you see cold, yang is deficient) · pulse diagnosis (disease in yang — restless rapid cun pulse; disease in yin — cold slow pulse; the yin-yang seat is visible in the pulse) · running against the four seasons (the disease usually follows the seasonal calendar — wounded by summer heat, malaria in autumn; wounded by winter cold, warm disease in spring; but when the seasons themselves are out of order — an autumn colder than winter — the disease does not follow the usual pattern)

Opening: the patient alternates chills and fever — ask three questions, and you know whether it’s the shakes

Last lecture described what a malaria attack looks like: first the hair stands on end, yawning and stretching, shivering with chattering teeth, the loins and spine aching together — then heat inside and out, a headache as if the skull would split. In this lecture Doctor Ni Haixia teaches you how to recognize malaria at the bedside — no pulse-taking needed. Just ask three questions.

💬 Note from Doctor Ni: We just ask the patient: when you have the fever, are you thirsty? The mouth is parched, very dry. And when the chill comes on, after the shaking fit — what happens then? You are cold until your teeth go kaka-kaka-kaka, chattering, and your back and loins ache — that is textbook malaria. That’s all there is to it. So you ask, and you let the patient tell you. Chinese medicine doesn’t depend on taking the pulse; don’t just look at the treatment — ask.

The shao yang syndrome also has chills and fever — how do you tell them apart? Ask one question: “Do you feel nauseous?”

A patient who catches wind-cold outside can also have alternating chills and fever; the shao yang syndrome has its alternating chills and fever too. How do you separate them from malaria? Doctor Ni says there is a key watershed in the middle.

💬 Note from Doctor Ni: When the tai yang syndrome appears, it’s either heat or cold — though sometimes both, mixed and intertwined. When the shao yang syndrome appears, the pathogen has entered from the exterior and gone into shao yang — at the half-exterior, half-interior stage — and you get the alternating chills and fever. Teacher, what about shao yang versus tai yang? Tai yang can also be heat-more-cold-less or cold-more-heat-less, and we prescribe differently; shao yang is the true alternating chills and fever — so how do you tell them apart? Shao yang has one extra feature: vomiting, because shao yang blocks the opening and closing of the pivot; where wood conquers earth and drainage fails, the stomach is affected. So alternating chills and fever plus nausea — that’s shao yang.

💬 Note from Doctor Ni: If there is alternating chills and fever but no nausea, that is tai yang — the disease sits on the exterior, and this cold and heat is not emitted from the interior. The cold that chills you until your teeth chatter — I tell you, when we catch cold damage, when we have the Ma Huang Tang (Ephedra Decoction) pattern and are wounded by cold, the teeth still don’t chatter; that is only exterior cold, the teeth never chatter. Malaria’s cold comes from deep inside the body, cold enough to make the teeth chatter and the back ache; and in the hot phase, the mouth is dying of thirst. Don’t mix them up — that is malaria.

Where does malaria come from? — Wounded by summer heat, and a gust of wind in autumn sets it off

The Yellow Emperor asks: why does malaria break out in autumn? Qi Bo lays out the whole chain — the source is summer.

💬 Note from Doctor Ni: This disease comes from being wounded by summer heat, from excessive hot qi: the summer days are scorching, you run around outside, the hot qi is fierce, and this hot qi hides within the skin and outside the intestines — between the muscles, skin and intestines. That spot is precisely where the blood and qi dwell. If the heat stays there and never leaves, it normally makes you sweat easily, the skin opens readily; but this heat has not reached the intestines — if it reached the intestines and turned hot, you’d get constipation, the fluids of the intestines all dried up.

The heat stays in the middle and doesn’t leave. Then autumn turns cool, and things happen:

💬 Note from Doctor Ni: In autumn you also meet the metal’s killing, descending qi: you sweat and meet wind; or you wash in cold water, and the water stays within the skin and dwells with the defensive qi (wei qi). In the normal person, yang moves on the surface by day and over the yin by night — yang and yin exchange: by day yang is outside, yin inside; at night, when you sleep, yang goes in and yin comes out, so at night you cover yourself with a blanket — that is the normal state. Now there is summer heat inside and wind-cold outside, and this produces “go out with yang, press in with yin” — the phenomenon of alternating chills and fever — once a day.

Western medicine says a mosquito bit you; Chinese medicine says summer heat wounded you — the pathogen hides in different places

When it comes to the cause of malaria, Chinese and Western medicine disagree completely, and Doctor Ni puts both accounts on the table.

💬 Note from Doctor Ni: Long ago they said malaria mosquitoes — bitten by a mosquito and you get malaria — that is the Western theory. Chinese medicine doesn’t talk about mosquitoes: the summer is too hot, you are wounded by summer heat, the fluids (jin ye) are injured, and the summer qi has not left; it stops inside the body — right between the skin, muscles and intestines, where the blood and qi ordinarily travel. There is already heat inside, and it shows easily in daily life: you move a little, and sweat pours off you — strange, why so hot and restless? That constitution means the heat was never removed. We said earlier: when summer-heat disease comes, one sweat resolves it — it’s gone. Have you ever met a classical-formula doctor who prescribed a Warm Disease school formula instead, and you ate cooling herbs for a long time while the heat still sat right there? Then in autumn a wind-cold blows on you and you are still sweating — because you sweat in summer and you still sweat in autumn — and as soon as the sweat meets wind-cold, or you wash in cold water, that too is wind-cold, and it produces the alternating chills and fever.

Once a day versus every other day — the difference between shallow and deep disease qi

Both cases are malaria, so why does one person attack daily and another every other day? Qi Bo says it is not random — it is a pointer to the depth of the disease qi.

💬 Note from Doctor Ni: Attacking with chills and fever once a day — the disease qi is still relatively shallow: it sits in the intestines, close to the intestines. When the disease qi approaches the internal organs, pressing into yin, then yang qi alone bursts out while the yin pathogen sits within — yin and yang fight and cannot get out; because its pace is slower and the disease is deeper, it attacks every other day. So attacking every other day means the disease is deeper. Wait — I mean, the once-a-day attack is shallower, and the every-other-day attack is deeper.

Why do some people’s attacks drift later and later, and some earlier? — The story of feng fu (the wind palace)

The Yellow Emperor asks again: some people used to attack every morning, then it became noon, then afternoon — and some attacks come earlier. Why? Qi Bo’s explanation, Doctor Ni says, hinges on the two characters “feng fu” — and here they must be understood in the broad sense.

💬 Note from Doctor Ni: The narrow definition of feng fu is the feng fu point (GV16) at the back of the head. The broad definition: wherever you catch wind becomes a feng fu. For example: you sit in a car, the air conditioner comes on, and you put your hand into the draft — the place that takes the wind is your feng fu. That is feng fu in the broad sense. In one day and one night, the defensive qi (wei qi) completes one circuit; no matter where you catch the wind, the place that took the wind serves as the endpoint — it is centered there.

After the pathogen enters the feng fu, it follows a fixed route — the Du (Governing) channel:

💬 Note from Doctor Ni: This pathogen lodges on the tai yang bladder channel and then travels down the Du channel. The disease never heals, it keeps entering deeper, moving one Du-channel segment a day — so the attack gets later and later: because the pathogen is wounding the Du channel. Down one segment a day; the Du channel has twenty-five segments, so after twenty-five days it reaches the sacrum; on day twenty-six it turns back, rises from the coccyx and walks up again to the ninth vertebra — the ninth vertebra is exactly the level of the diaphragm, the liver half above the diaphragm and half below — and then continues up and comes out at que pen (ST12, the supraclavicular fossa).

So the shifting of attack time is a live broadcast of the pathogen’s position:

💬 Note from Doctor Ni: If the attack comes later every day, the pathogen is on the Du channel, walking one segment a day. If the attack comes earlier, that means the disease has reached the end and turned back — it has walked from this side to that side and is coming home. So some people with the shakes — chills and fever coming earlier every day — the disease has already turned back; attacks coming later every day — the disease is still on the Du channel.

Bonus: Mother was always right — never sit in the draft

Talking about “feng fu in the broad sense” brings Doctor Ni a story from America — full of laughs, and the principle is completely real.

💬 Note from Doctor Ni: Wind has no viscera — no home to hide in. Today you walk out into the cold, you wrap your neck up well: feng chi (GB20), feng fu (GV16), feng men (BL12) all covered — scarf, hat, the whole body wrapped — and then down below you’re wearing shorts, riding a motorcycle, and both knees take the wind: the knees are the feng fu! In Taiwan you rarely see this kind of lunatic; in America there are lunatics like this — they don’t have that concept. Do you remember when you were little, Mother always said: “Don’t sit facing the electric fan!” — everything Mother said was right. Remember: Mother is always right.

Wind disease and malaria — how do you tell them apart? One is the clingy one, the other the punctual guest

The Yellow Emperor asks: wind disease and malaria look alike in many ways — how do you distinguish them? Doctor Ni gives a summary that is easy to remember.

💬 Note from Doctor Ni: Wind disease is constant: for example, you catch wind — tai yang wind — stiff neck, rigid nape; the neck stays stiff and rigid all day long — the symptoms continue without stopping. Malaria is different: when the attack comes there is alternating chills and fever, and when it finishes, the patient is fine. When wind pathogen strikes, it is fixed and does not move; malaria qi is different — it moves with the channels, with the depth, so the time of the attack changes. Tai yang wind also has cold and heat, but that cold and heat is twenty-four hours of alternating chills and fever — not like malaria: malaria finishes its one attack a day and then there is nothing until the next.

Cold then heat is cold malaria, heat then cold is warm malaria, heat with no cold is dan malaria

Malaria has even finer subdivisions. Qi Bo divides it into three types by the order of cold and heat, each with its own name.

💬 Note from Doctor Ni: In summer you are wounded by the great heat, the summer heat injures the fluids (jin ye), you sweat heavily and labor hard — rowing a boat, say, very hard, sweating profusely; then at night you meet the cool, chilly water of the summer season, you sleep on the water, and the cold hides in the interstices (cou li) of the skin. During the day you sweat a lot; at night the wind-cold closes the pores, and the summer heat inside cannot get out. By autumn the wind arrives, the skin contracts again, and now the disease begins — wounded by summer heat, sick with malaria in autumn: that is how it comes about. Cold is yin qi, wind is yang qi — first wounded by cold, then by wind, so cold comes first and heat after: this is called cold malaria (han nue).

💬 Note from Doctor Ni: The other kind: heat comes first, then cold — first wounded by wind, then by cold; wind is yang, so heat comes first and cold after: this is called warm malaria (wen nue). And there is a third kind — heat only, no cold at all: yin qi is exhausted first, yang qi alone bursts out; only heat symptoms appear, and at that point the yin seems to have vanished; hands and feet hot, with the urge to vomit — this is called dan malaria. According to the Ci Hai dictionary, the character “dan” means a disease earned through overwork — yin worn down by labor, and so the illness.

When can you treat? — When the disease qi is at its strongest, do not touch it

How do you treat malaria? The Yellow Emperor asks: “drain the excess, tonify the deficiency” — but during an attack, the cold is too deep for hot water or hot moxa to warm, and the heat too fierce for ice water to cool; excess and deficiency both occupy the field. What do you do? Qi Bo lays down the great principle of timing.

💬 Note from Doctor Ni: In treating malaria, we do not treat during the attack; we wait until the disease retreats, or we treat before the attack begins. Actually, treating malaria is very simple — the treatment rule fixed later in the text is very simple. Do not needle during great heat; when the pulse qi is bad — jumping, stopping, skipping at irregular times — do not needle; after heavy sweating, do not needle either. These are all moments when the disease qi is at its strongest. The time to treat is before the disease has started to attack; after the attack finishes we move in. Because while the disease qi is attacking it is very strong, and if you treat it then, the disease qi is not removed and the upright qi is wounded instead; wait until the attack has passed and the upright qi slowly returns — that is the best moment. When the disease qi is at its peak, it cannot be treated.

Why does malaria go cold first, then hot? — Yang qi merges into yin: shivering; yin reaches its extreme and emerges into yang: fever

Qi Bo also explains the yin-yang contention of the attack thoroughly, and Doctor Ni adds a memory device that “can never be wrong.”

💬 Note from Doctor Ni: When malaria attacks, yang qi merges into yin — at this moment yang is deficient and yin is in excess; as soon as yang is deficient, yin must be in excess, so first comes the shivering. When yang qi merges into yin, the patient shows shivering, the chattering cold. Then if yin qi reaches its extreme, it turns back and emerges into yang — yin gives birth to yang — at this point yang merges outward, yin is deficient and yang in excess, and the fever comes. Use a simple symbol to remember: when water qi and yang qi merge together, the symptom that appears is cold — because the exterior is cold; when hot qi meets yin qi, what is produced is heat. So whenever you see cold, yang is deficient — yang is heat. In malaria: when the disease sits in yang, yang is in excess; when it merges into yin, yin is in excess; yin in excess means cold, yang in excess means heat — that is the definition.

How does the pulse show malaria? — Disease arising in yang: the cun pulse is rapid; disease arising in yin: the pulse is cold and slow

This lecture also covers the great yin-yang principle of pulse diagnosis.

💬 Note from Doctor Ni: Chinese medicine doesn’t care whether your disease is on the exterior or in the interior: as long as the disease is in yang, the yang pulses are all restless and hot; if the disease is in yin, the yin pulses are all deep and slow. So when we take the pulse — whether malaria or anything else — we can always see the seat of yin and yang in the pulse. Simple summary: disease arising in yang shows on the yang pulses; disease arising in yin shows on the yin pulses. When the disease arises in yang, the yang pulses are more restless and rapid — the cun pulse is fast; when it arises in yin, the yin pulses look cold — the pulse is slower. That’s it in a nutshell.

The needling method for malaria: before the attack, tie up the fingers and toes — then let blood from the superficial collaterals

The Yellow Emperor asks about the specific needling method. This set of techniques from Qi Bo, Doctor Ni says, is the most practical substance in the whole treatment of malaria.

💬 Note from Doctor Ni: Any malaria — the alternating chills and fever of the shakes — always begins at the tips of the four limbs; the tips of the four limbs are exactly where yin and yang meet. Say this patient’s attack begins at nine in the morning; before it starts, at eight o’clock, tie up each of his fingers and toes — every one of them — so the pathogen cannot enter and the yin cannot come out; it is stopped right there. Now look carefully: at the ends of the superficial collaterals (sun luo), wherever you see blood vessels swelling and bulging, let the blood from all of them — one by one. This is the method for treating malaria. Because the attack always happens at the yin-yang tips — intercept it there, don’t let it reach the body.

💬 Note from Doctor Ni: Watch closely: when the attack is about to come, just before it, you will see the blood vessels circling up and standing out — that is where the pathogen sits; let the blood out and the pathogen is gone. As for letting a few malaria parasites out with the blood — we don’t worry about that. Western medicine says there are malaria parasites in the blood — so what. When the attack is already underway you cannot tie anymore — the disease has already erupted, and once you tie you can’t see the vessels. This is the needling method for preventing the attack, performed before the attack.

Why tie the tips first? — When malaria is not attacking, the pathogen hides in the tips of the limbs

When malaria is not attacking, where does the pathogen hide? Doctor Ni says this explains the rationale of the whole method.

💬 Note from Doctor Ni: Malaria is amusing: when it is not attacking — no alternating chills and fever, no shakes — the malaria pathogen is always in the tips of the four limbs; when the attack begins, the malaria goes deep. So while it is not attacking, we resolve it in the tips of the limbs. Also: several-day malaria and every-other-day malaria mean the disease is deeper; the pathogen sometimes joins the six bowels and sometimes does not, so it only attacks once every few days.

Gui Zhi Tang: the first formula for harmonizing yin and yang — better at preventing colds than any vaccine

Speaking of the meeting and harmonizing of yin and yang, Doctor Ni brings up Gui Zhi Tang (Cinnamon Twig Decoction) — the treasure he returns to again and again.

💬 Note from Doctor Ni: We haven’t introduced the Shang Han Lun yet, but I often tell everyone to take Gui Zhi Tang — why? Because from beginning to end, Gui Zhi Tang is the ancestor of every formula in the Shang Han Lun — all the formulas are additions and subtractions from it. Gui Zhi Tang is the master formula among all the ancient formulas for harmonizing yin and yang; when yin and yang are out of harmony, you use Gui Zhi Tang to adjust them. So I keep telling everyone: take Gui Zhi Tang to prevent colds — it is absolutely more effective than any cold vaccine you can get. That cold vaccine is a deception — it truly harms people.

Closing: wounded by summer heat, sick with malaria in autumn — and there are also cases that don’t follow the seasons

Finally, the Yellow Emperor asks: the canon says “wounded by summer heat, sick with malaria in autumn,” but some people are not like that at all. Why? Qi Bo’s answer, Doctor Ni says, is what we call “running against the four seasons” (fan si shi).

💬 Note from Doctor Ni: In spring, summer, autumn and winter, the disease must travel easily — that is the one who “runs against the four seasons.” Generally speaking, wounded by summer heat, sick with malaria in autumn — that is the normal course following the seasonal qi of the four seasons; wounded by winter cold, warm disease in spring — that too follows the four seasons. But some people do not follow the seasonal qi — it is not guaranteed. For example, autumn is the season of killing and descending — but in some years, autumn is unusually cold, and winter turns out not as cold as autumn — the seasonal qi of the four seasons differs from the norm. If a disease arises in winter and the winter is not so cold — only a slight wound of cold, not a great cold — then in spring the disease is only wind-aversion, without the phenomenon of warm disease; and summer disease tends to sweat a lot.

Based on Doctor Ni Haixia’s Ren Ji (Human Records) Huang Di Nei Jing lecture series (Lecture 43)