Alternating cold and heat is a type of fever characterized by the alternating appearance of fever and chills, where during fever, the patient feels hot without feeling cold, and during chills, the patient feels cold without feeling hot. This differs from simultaneous chills and fever. According to the “Lai Zheng Huo Ren Shu”: “Alternating cold and heat indicates a struggle between yin and yang. When yang is insufficient, chills precede fever; when yin is insufficient, fever precedes chills. The pathogenesis is due to the invasion of pathogenic factors that are half exterior and half interior, leading to dysfunction.
Symptoms
(1) Pathogenic invasion of Shaoyang: alternating cold and heat, irritability, preference for vomiting, dry throat, bitter mouth, dizziness, chest and hypochondriac fullness, red edges of the tongue, thin yellow coating, wiry and rapid pulse.
(2) External malarial pathogen: alternating cold and heat, recurrent episodes, with fever occurring at specific times, often seen as once every two days, or every three days. During episodes, there is first a chill, followed by high fever, and finally profuse sweating, with the heat subsiding and the body feeling comfortable. The tongue is red with a thin white or yellow greasy coating, and the pulse is wiry.
(3) Damp-heat obstructing the Sanjiao: alternating cold and heat, sweating that does not clear, chest fullness, abdominal distension, nausea, headache, irritability, dry mouth and thirst, disliking drinking, short yellow and red urine, red edges of the tongue, white greasy coating, and a slippery pulse.
Etiology
(1) Pathogenic invasion of Shaoyang leading to alternating cold and heat: In cases of typhoid fever that do not resolve, the pathogen transmits to Shaoyang, where the righteous and evil contend; if the righteous cannot overcome the evil, chills occur; if the righteous overcomes the evil, fever occurs, hence the presentation of alternating cold and heat. Clinically, in addition to alternating cold and heat, there may also be bitter mouth and throat, fullness in the chest and hypochondria, and wiry pulse, which are symptoms of Shaoyang.
(2) External malarial pathogen causing alternating cold and heat: This condition arises from the invasion of malarial pathogens, often occurring in summer and autumn. Key diagnostic points include: alternating cold and heat, episodes occurring at intervals, either every two days or every three days; during episodes, there may be more heat than cold, or more cold than heat, with chills, fever, and sweating, often recurring.
(3) Damp-heat obstructing the Sanjiao causing alternating cold and heat: This condition is due to damp-warm diseases, with evil heat and phlegm-turbidity lingering in the Sanjiao, leading to alternating cold and heat, chest and abdominal fullness, yellow and short urine, and greasy coating, which are characteristics of damp-heat obstructing the upper, middle, and lower Sanjiao.
(4) Alternating cold and heat differs from “simultaneous chills and fever”: the latter presents with chills and fever occurring simultaneously, while alternating cold and heat presents with alternating symptoms, meaning during fever there is no chill, and during chill there is no fever, making it easy to distinguish.
Moxibustion Points
Day One
Da Zhui (Dazhui) (GV14) (Reference temperature 52 degrees, Reference time 40 minutes)
Qu Chi (Quchi) (LI11) (Reference temperature 48 degrees, Reference time 30 minutes)
Hou Xi (Houx) (SI3) (Reference temperature 48 degrees, Reference time 30 minutes)
Shen Que (Shenque) (CV8) (Reference temperature 54 degrees, Reference time 60 minutes)
Day Two
Pi Yu (Pishu) (BL20) (Reference temperature 54 degrees, Reference time 50 minutes)
Gong Sun (Gongsun) (SP4) (Reference temperature 48 degrees, Reference time 30 minutes)
Jian Shi (Jianshi) (PC5) (Reference temperature 48 degrees, Reference time 30 minutes)
Shen Que (Shenque) (CV8) (Reference temperature 54 degrees, Reference time 60 minutes)
Day Three
Tao Dao (Taodao) (Reference temperature 52 degrees, Reference time 50 minutes)
He Gu (Hegu) (LI4) (Reference temperature 48 degrees, Reference time 30 minutes)
Nei Guan (Neiguan) (PC6) (Reference temperature 48 degrees, Reference time 30 minutes)
Shen Que (Shenque) (CV8) (Reference temperature 54 degrees, Reference time 60 minutes)
Day Four
Zhong Wan (Zhongwan) (CV12) (Reference temperature 54 degrees, Reference time 50 minutes)
Zu San Li (Zusanli) (ST36) (Reference temperature 48 degrees, Reference time 40 minutes)
Tian Shu (Tianshu) (ST25) (Reference temperature 54 degrees, Reference time 50 minutes)
Shen Que (Shenque) (CV8) (Reference temperature 54 degrees, Reference time 60 minutes)
Day Five
Qi Men (Qimen) (LR14) (Reference temperature 52 degrees, Reference time 40 minutes)
Tai Chong (Taichong) (LR3) (Reference temperature 48 degrees, Reference time 30 minutes)
Zhang Men (Zhangmen) (LR13) (Reference temperature 52 degrees, Reference time 40 minutes)
Shen Que (Shenque) (CV8) (Reference temperature 54 degrees, Reference time 60 minutes)
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