1 Inquiry of fever and cold
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.
1.3.3.1.1 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 to wind.
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.
1.3.3.1.2 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 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 and the limbs are not warm, usually relieved with warmth, with light-coloured and tender tongue as well as deep, slow and weak pulse. Such pathological conditions signify cold syndrome of internal asthenia.
1.3.3.1.3 Fever without cold
Fever without cold means that the patient only has fever and does not feel cold or, on the contrary,dislikes heat. Such a problem usually pertains to internal heat syndrome caused by exuberance of yang or asthenia of yin. According to the degree, time and features, fever can be further divided into high fever,tidal fever and mild fever.
High fever: High fever means that the patient suffers from serious high fever hard to be relieved with the symptoms of aversion to heat instead of to cold. It is usually caused by wind-cold invading into the interior and transforming into heat, or by transmission of wind-heat into the interior, struggle between pathogenic factors and healthy qi and internal exuberance of yang-heat, the steaming of which manifests externally. High fever is usually seen at the qi phase stage of exogenous febrile disease, pertaining to internal sthenia-heat syndrome, usually accompanied by flushed cheeks, profuse sweating, dysphoria, thirst and preference for cold drinks.
Tidal fever: Tidal fever is marked by regular OCcurrence or regular worsening. According to its cause and pathogenesis, it can be further divided into the following categories.Yangming afternoon fever: It is marked by continuous fever and severity in the afternoon (3 - 5 o'clock In the afternoon ) when qi in yangming meridian is superabundant, accompanied by constipation and unpres-sable abdominal hardness and pain due to invasion of pathogenic heat into yangming, retention of dry-heat in stomach and intestines as well as obstruction of intestinal qi.
Damp-warm tidal fever: Damp-warm tidal fever is marked by fever, worsening in the afternoon or evening and dull fever (that means that it does not feel feverish when the hand touches on the skin at first, but after a while the hand feels scorching hot), usually accompanied by epigastric and abdominal fullness and oppression, nausea and vomiting, heavy sensation of the head and body, loose stool and diarrhea as well as thick and greasy tongue fur, often caused by retention of damp-heat in the middle energizer, stagnation of dampness and latency of heat and failure of heat to get out of the body as well as stagnation of dampness and steaming of heat.
Yin-asthenia tidal fever: It is marked by fever in the afternoon or evening and feverish sensation over the five centers (palms, soles and chest) or steaming fever in the bones); usually accompanied by flushed cheeks, night sweating, dry mouth and throat as well as reddish tongue with scanty fluid, often caused by consumption of y in fluid, failure of yin to control Fang and endogenous asthenia-heat.
Besides, one of its major symptoms is worsening of fever in the night due to invasion of heat into nutrient phase and constumption of nutrient yin in febrile disease.
Mild fever: Mild fever, also known as low fever,means that the fever is slight or indistinct or subjective sensation of fever with normal temperature. Mild fever is marked by longer duration. The cause and disease involved are complicated. For example, internal heat due to yin asthenia leads to prolonged low fever; prolonged mild fever, also known as fever due to qi asthenia, is usually caused by asthenia of spleen qi, sinking of gastrosplenic qi and failure of lucid yang to rise which stagnate into heat; mild fever may be caused by emotional upsets and failure of the liver to disperse and convey, leading to fever due to qi stagnation.
1.3.3.1.4 Altemate cold and fever
Alternate cold and fever means that aversion to cold and fever occur alternately due to struggle between healthy qi and pathogenic factors, signifying development and abatement of cold and fever. Irregular alternate cold and fever is seen in shaoyang disease pertaining to semi-internal and semi-external syndrome due to struggle between healthy qi and pathogenic factors. The predomination of pathogenic factors leads to aversion to cold, while the predomination of the healthy qi leads to fever. If pathogenic factors and healthy qi predominate alternately, it leads to alternate cold and fever. Regular cold and fever, once a day or once two and three days, accompanied by severe headache, thirst and profuse sweating, pertains to malaria. When pathogenic factors invades the body, they stay in the semi-internal and semi-external region. When they get inside, they struggle with yin; and when they get out, they struggle with yang. That is why chills and high fever appear alternately and continually.
