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Inquiry of fever and cold
Time:9/29/2008 12:02:28 PM
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TCM diagnosis, Traditional Chinesemedicine,theory,methods,introduction,achievement,literature.Inquiry of fever and cold means asking the patient whether he or she has the sensation of fever and aversion to cold. Fever and cold are the common symptoms seen in the course of a disease and are the evidences for differentiating the nature of pathogenic factors and the states of yin and yang in the body.

Aversion to cold is a subjective sensation, including disliking cold and fearing cold. If the patient feels cold and such sensation cannot be relieved after putting on more clothes and quilt or staying near fire, it is called disliking cold; if the patient feels cold and such sensation can be relieved after putting on more clothes and quilt or staying near fire, it is called fearing cold. Fever means that the body temperature is higher than usual, also including subjective sensation of general or local fever like feverish sensation over the five centers (palms, soles and chest) which does not necessarily mean the increase of body temperature. The occurrence of fever and cold lies in the nature of pathogenic factors as well as decline and predomination of yin and yang in the body, reflecting or signifying the result of the struggle between healthy qi and pathogenic factors as well as the changes of yin and yang. Generally speaking, in the disease due to pathogenic factors, pathogenic cold leads to disliking of cold and pathogenic heat leads to fever; in the cold and fever caused by the predomination and decline of yin and yang in the body, exuberance of yang leads to fever and superabundance of yin leads to cold, asthenia of yin brings about fever and asthenia of yang results in cold. So inquiry of cold and fever is helpful for understanding the nature of pathogenic factors and differentiating the states of yin and yang in the body.

In inquiring fever and cold, the doctor should make sure whether there is cold and fever or not, whether cold and fever appear simultaneously, whether fever and cold is serious or mild, what time it appears and how it lasts as well as other complications.

Clinically the types of cold and fever include aversion to cold and fever, cold sensation without fever, fever without cold sensation, and alternate cold and fever.

Aversion to cold and fever
 
Aversion to cold and fever means that the patient dislikes cold and the body temperature increases, usually seen at the primary stage of exogenous disease  which pertains to external syndrome due to retention of pathogenic factors in the superficies and struggle between defensive yang and pathogenic factors. Aversion to cold is caused by invasion of pathogenic factors in the skin which affects the function of defensive yang to warm the muscles~ fever is caused by pathogenic factors encumbering the superficies and resistance of defensive qi against pathogenic factors. When the pathogenic factors are in the superficies, there is difference in aversion to cold and fever due to the difference of pathogenic factors in nature. Generally there are three types of aversion to cold and fever according to their degree.

Serious aversion to cold and mild fever. Serious aversion to cold and mild fever indicate external syndrome due to wind-cold. Cold is a pathogenic factor of yin nature. When pathogenic cold invades the superficies, defensive yang is stagnated and the superficies lacks warmth, leading to serious aversion to cold. Cold tends to coagulate. So when defensive yang is stagnated and when pathogenic factors struggle with healthy qi, fever is caused. Serious fever and mild aversion to cold: Serious fever and mild aversion to cold indicate external syndrome due to wind-heat. Wind-heat is a pathogenic factor of yang nature. When pathogenic factor of yang nature causes disease, yang is usually superabundant. That is why fever is serious. When wind-heat invades the superficies, the muscular interstices become loose. That is why aversion to cold is mild.

Mild fever and aversion to wind: Mild fever and aversion to wind indicate external syndrome due to wind attack. Aversion to wind means sensation of cold in contact with wind and is relieved after avoiding wind, usually caused by exogenous pathogenic wind. Since wind tends to open, muscular interstices become loose when attacked by wind. That is why there are mild fever and aversion towind.

The degree of aversion to cold and fever in external syndrome is not only related to the nature of pathogenic factors, but also to the relation between pathogenic factors and healthy qi. For example, if both the pathogenic factors and healthy qi are in predomination, aversion to cold and fever are all serious, signifying drastic struggle between healthy qi and pathogenic factors. When both pathogenic factors and healthy qi are deficient, aversion to cold and fever are all mild, indicating slight struggle between healthy qi and pathogenic factors. When pathogenic factors are superabundant and healthy qi is deficient, aversion to cold is serious and fever is mild, suggesting failure of healthy qi to control pathogenic factors.

 Cold without fever
 
Cold without fever means that the patient only feels cold but there is no fever. It is usually caused by direct invasion of pathogenic cold into the interior which stagnates yangqi and prevents it from moving outwards; or by decline of yangqi and lack of warmth of the body. According to the onset, duration, cause and pathogenesis, cold without fever can be further divided into aversion to cold in new disease and fear of cold in chronic disease.

Aversion to cold in new disease: Aversion to cold in new disease is caused by serious invasion of cold directly into the viscera which stagnates yangqi and deprives the body of warmth. Sudden aversion to cold with cold limbs accompanied by cold abdominal pain or dyspnea with sputum rale pertains to cold syndrome of internal sthenia.

Fear of cold in chronic disease: Fear of cold in chronic disease is usually caused by decline of yangqi and lack of warmth of the body. The patient frequently fears cold

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