Chills and Fever

Apart from confirming the presence of chills and fever, we need to ask such questions as which is more severe, when they occur and what symptoms and signs accompany them, for this information is necessary for further differentiation of syndromes

• Chills accompanied by fever. Simultaneous occurrence of chills and fever at the beginning of the disease indicates exogenous exterior syndrome. It is the manifestation of invasion of the body surface by the pathogenic factor and its contending with the antipathogenic qi. Exterior syndromes resulting from exposure to pathogenic wind cold usually manifest as severe chills and mild fever with the accompanying symptoms and signs such as absence of sweating, headache and general aching, and a superficial, and tense pulse. Exterior syndromes due to invasion by pathogenic wind heat are characterized by mild chills and severe fever ; the patient also reveals thirst, sweating and a superficial and rapid pulse.
• Alternate chills and fever. The patient may notice alternate attacks of chills and fever. This is the representative symptom of intermediate syndromes. The patient may also complain of a bitter taste in the mouth, thirst and fullness and stuffiness in the chest and hypochondrium. High fever following chills occurring at a definite time of the day suggests malaria.
• Fever without chills. Fever may occur without chills. Persistent high fever with aversion to heat instead suggests interior heat syndromes of excess type due to transmission of the pathogenic factors from the exterior to the interior with excessive heat in the interior. The accompanying symptoms and signs are profuse sweating, severe thirst and a surging pulse. If fever occurs or becomes worse at a fixed hour of the day just like the sea waves, it is known as tidal fever. Tidal fever in the afternoon or evening, accompanied by night sweating and a red tongue with little moisture indicates deficiency of yin ; afternoon fever with constipation and fullness and pain in the abdomen suggests excess heat of the Yangming Meridian.
• Chills without fever. The subjective feeling of chills without fever indicates interior cold syndrome of deficiency type. The patient may also have chilled appearance, cold limbs and a deep, slow and weak pulse.