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Fever without chills refers to the symptom of having a fever but not an aversion to cold during the course of a sexually transmitted disease.

The causes of fever are numerous and are generally divided into two categories: external-contraction fever and internal damage fever. Typically, external-contraction fever has a sudden onset and high fever; internal damage fever has a gradual onset and is often characterized by low-grade fever. At the initial stage of external contraction fever, fever and chills or aversion to wind may occur simultaneously. When the exterior pathogen penetrates inward and transforms into heat, it often manifests as fever without chills. The "Treatise on Cold Damage Diseases: Differentiation of Taiyang Disease Pulse and Symptoms and Treatment" states: "No aversion to cold, but heat, is real." Later generations have followed this theory, using it as one of the markers for the inward penetration of pathogenic factors in the differentiation of external-contraction febrile diseases.

This article mainly discusses the symptom of fever without chills in external-contraction febrile diseases. As for internal damage fever, and the symptom of heat without aversion to cold seen in "warm malaria" and "dan malaria," they are respectively discussed in the relevant entries on "vexing heat in chest, palms and soles," "tidal fever," and "alternating chills and fever."

bubble_chart Pattern Analysis

1. Pathogenic Heat Accumulating in the Lung︰fever without aversion to cold, cough with chest pain, thick and sticky yellow or fishy sputum, flaring nostrils and coarse breathing, thirst and sore throat, red tongue with yellow dry or greasy coating, slippery and rapid pulse. Mostly caused by the upper attack of wind-heat pathogens, or external contraction of cold pathogens stagnating and transforming into heat, pathogenic heat invading the lungs, lung heat scorching fluids and condensing them into phlegm, phlegm-heat obstruction, and failure of lung qi in purification. Initially, aversion to cold with fever may be seen, followed by fever without chills, cough with chest pain, thick and sticky yellow or fishy sputum, flaring nostrils and coarse breathing. The key points of pattern identification are fever without aversion to cold, cough with coarse breathing, and yellow sticky sputum as characteristics. Treatment should focus on clearing the lungs and draining heat, resolving phlegm to stop cough. Prescriptions include Phragmites Stem Decoction combined with White-Draining Powder, or Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction with modifications.
2. Exuberant Heat in Yangming︰Aversion to cold, aversion to heat, high fever, flushed face, profuse sweating, severe thirst, scanty yellow urine, red tongue with yellow coating, and surging large pulse. The treatment should focus on clearing the qi aspect and draining heat, and the prescription is White Tiger Decoction with modifications. If interior heat scorches qi and fluids, the treatment should focus on clearing heat and draining fire, tonifying qi, and promoting fluid production, and the prescription is White Tiger Decoction Plus Ginseng.
3. Intestinal Heat Accumulation︰high fever without aversion to cold, worse in the afternoon, abdominal distension and fullness with hard pain, firm upon palpation, constipation or heat retention with watery discharge, and in severe cases unconsciousness, delirious speech, dysphoria and restlessness, yellow and dry or scorched black tongue coating, deep and strong pulse. Treatment should focus on draining heat and purging the bowels, attacking and removing dryness accumulation. Depending on the severity of heat accumulation, choose Major Purgative Decoction, Minor Purgative Decoction, or Stomach-Regulating Purgative Decoction.
4. Dampness-heat︰The fever fluctuates without aversion to cold, intensifies in the afternoon, and persists despite sweating. There is thirst without a desire to drink, chest stuffiness, gastric stuffiness, heavy body, anorexia, a yellow and greasy tongue coating, and a wiry, slippery, and rapid pulse. The condition often occurs during the transition between summer and autumn or in rainy and humid seasons, where dampness-heat combines as a pathogenic factor. Dampness, being a yin pathogen, is heavy, turbid, and sticky, and when coupled with heat, it leads to steaming and stagnation, resulting in a prolonged and stubborn course of illness. In the initial stage, fever is accompanied by aversion to cold, followed by pathogenic heat lingering in the qi aspect, manifesting as fever without chills. Xue Sheng-baiwarm febrile disease states: "In dampness-heat syndrome, there is initially aversion to cold, followed by fever without chills, sweating, chest stuffiness, a white tongue, and thirst without a desire to drink." The key points for diagnosis include hidden fever, worsening in the afternoon, along with symptoms of dampness obstructing qi movement such as chest stuffiness, anorexia, nausea, bitter taste in the mouth, and thirst without a desire to drink. Treatment should focus on dispersing qi and resolving dampness to clear heat and expel pathogens. Recommended formulas include Three-Kernel Decoction and Coptis and Magnolia Bark Decoction.
5. Summerheat Impairing Qi︰Fever without aversion to cold, headache, flushed face, coarse breathing, chest stuffiness, dysphoria, thirst with desire to drink, excessive sweating, red tongue with yellow and dry coating, surging and rapid pulse. The disease is mostly caused by summerheat injury in summer, or excessive sweating leading to damage to fluid and qi consumption; or due to sleeping outdoors and indulging in coolness, allowing summerheat pathogens to invade when the body is weakened. The key points of pattern identification are high fever, flushed face, polydipsia, and other symptoms of summerheat damaging the qi aspect. The treatment should focus on clearing summerheat and discharging heat, tonifying qi and promoting fluid production. The prescription of choice is Wang's Summerheat-Clearing Qi-Replenishing Decoction. In the initial stage [first stage], it can be combined with White Tiger Decoction, and in the late stage [third stage], it can be combined with Pulse-Reinforcing Powder.
6. Heat Entering the Nutrient-Blood Level︰The fever is particularly severe in the evening without aversion to cold, accompanied by dysphoria, insomnia, dry mouth, or even delirious speech, mania, unconsciousness, macula and papule eruptions, a crimson-red tongue texture with scant or peeled coating, and a thin, rapid pulse. This is mostly caused by pathogenic heat penetrating deeply into the nutrient-blood. Pathogenic heat scorches the nutrient-blood, leading to intense fever without chills. Ye Xiang-yanExternal Contraction Warm Heat Treatise states: "After the defensive aspect comes the qi aspect, and after the nutrient aspect comes the blood aspect." The nutrient aspect pattern further develops into the blood aspect pattern, and the two cannot be strictly separated. The key diagnostic points include fever without chills, fever that is mild during the day but severe at night, dysphoria, insomnia, unconsciousness, delirious speech, a crimson-red tongue texture, and, in cases of severe heat stirring blood, symptoms such as hematemesis, bloody stool, hematuria, and macule eruptions. Treatment should focus on clearing the nutrient aspect and cooling the blood to drain heat and remove toxins. Recommended formulas include Nutrient-Clearing Decoction or Rhinoceros Horn and Rehmannia Decoction with modifications.

Fever without chills is a symptom indicating that the pathogenic factor has entered the interior and transformed into heat. At this stage, the pathogenic factor is vigorous, and the healthy qi is resisting it, leading to intense conflict between the pathogen and the healthy qi. This condition is mostly classified as an excess pattern and represents a critical moment in the Rebing process that determines the progression of the disease. Clinically, it is essential to carefully observe the changes in pathogenic heat in the qi, nutrient, and blood levels to grasp the mechanism of disease. The fundamental principle of treatment is to eliminate the pathogen and drain the heat. The Jingyue Quanshu states in the chapter on difficult syndromes: "The method for treating heat is as follows: for mild fever in the qi level, coolness should be used to harmonize it; for intense heat, cold should be applied to control it; for stagnant heat in the meridians and collaterals, it should be dispersed by expelling the pathogen from the exterior; for accumulated heat in the zang-fu organs, it should be expelled and purged..." This concise yet profound statement provides significant insights into the pattern differentiation and treatment of this condition, particularly emphasizing the importance of expelling the pathogen from the exterior.

bubble_chart Documentation

1. Jingyue Quanshu．Miscellaneous Syndrome Discussion: "All Rebing occurrences also have internal and external distinctions. For example, when wind-cold is transmitted and transformed into heat, or when seasonal epidemics cause excessive fire leading to heat, these are all external sources of heat, such as cold-damage disease, pestilence, seasonal toxin, and malaria. As for internally generated heat, it can be caused by diet, overstrain, indulgence in alcohol and sex, seven emotions, medication, excessive warmth, yin deficiency, occasional exposure, or accumulation. Although the causes differ, the disease manifestations affect both the exterior and interior. Therefore, for external conditions, one should examine the depth of the meridians and collaterals; for internal conditions, one should examine the yin-yang of the zang-fu organs."
2. Zabing Extensive Essentials．Internal Causes Category．Aversion to Cold with Fever: "Fever is the manifestation of heat on the body surface. Most illnesses involve fever, as heat arises from fire, and fire originates from qi. The principle revolves around two main aspects: qi disharmony and qi depression. Qi disharmony has three forms: yang hyperactivity fever, yin-deficiency fever, and yang-deficiency fever. Qi depression has seven forms: wind-cold stagnation heat, dietary stagnation heat, phlegm-fluid retention stagnation heat, static blood stagnation heat, dampness stagnation heat, liver qi stagnation heat, and spleen qi stagnation heat."