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Common cold and heat symptoms in clinical practice include four types: aversion to cold with fever, aversion to cold without fever, aversion to heat without cold, and alternating cold and heat.1. Aversion to Cold with FeverRefers to the simultaneous occurrence of aversion to cold and fever in patients, commonly seen in the exterior syndrome stage of exogenous diseases. The mechanism involves the invasion of external pathogens into the muscle surface, where the righteous qi and pathogenic qi struggle against each other, leading to abnormal dissemination of defensive qi. When external pathogens invade the surface, the defensive yang is restrained, and the muscles lose warmth, resulting in aversion to cold; when the pathogenic qi binds externally, the struggle between righteous and pathogenic qi leads to stagnation and fever. Due to the different natures of the external pathogens, the cold and heat symptoms can vary in severity. The following three types are commonly seen in clinical practice:(1) Severe Aversion to Cold with Mild Fever indicates that the patient feels significantly cold with only mild fever. This is characteristic of wind-cold exterior syndrome caused by the invasion of wind-cold pathogens. Since cold is a yin pathogen, its nature is to constrict; when the cold pathogen invades the surface, the struggle between righteous and pathogenic qi leads to blockage of the muscles, causing the defensive yang to be trapped inside, resulting in severe aversion to cold and mild fever.(2) Severe Fever with Mild Aversion to Cold indicates that the patient feels a significant fever while also experiencing mild aversion to cold. This is characteristic of wind-heat exterior syndrome caused by the invasion of wind-heat pathogens. Since wind-heat is a yang pathogen, it causes the yang to flourish, leading to significant fever; the invasion of wind-heat opens the pores, resulting in mild aversion to cold. The severity of cold and heat symptoms in exterior syndromes is closely related to the nature of the pathogenic factors and the strength of the righteous and pathogenic qi. Generally, if the pathogenic factor is mild, both cold and heat symptoms are mild; if the pathogenic factor is severe, both symptoms are severe; if both righteous and pathogenic qi are strong, both symptoms are severe; if the pathogenic qi is strong and the righteous qi is weak, there will be severe aversion to cold and mild fever.In the early stage of exogenous diseases, some patients may only feel aversion to cold without feeling feverish. As the condition progresses, they will quickly experience simultaneous fever, thus the presence of both aversion to cold and fever is an important diagnostic criterion for exterior syndrome. Particularly, the symptom of aversion to cold is essential for diagnosing exterior syndrome, as it is considered a precursor to fever; the invasion of external pathogens into the muscle surface will always result in aversion to cold, regardless of whether the patient feels feverish or not. Hence, there is an ancient saying: “For every degree of aversion to cold, there is a degree of exterior syndrome.”(3) Mild Fever with Aversion to Wind indicates that the patient feels mild fever and experiences cold when encountering wind, which can be alleviated by avoiding it. This is characteristic of wind-cold exterior syndrome caused by the invasion of wind pathogens. Due to the dispersing nature of wind, the pores are relaxed, and the stagnation of yang qi is not severe; thus, the struggle between righteous and pathogenic qi is not intense, resulting in mild fever and aversion to wind. Some patients may only feel aversion to wind without (or not yet having) a fever, which is generally due to the invasion of wind pathogens or a deficiency of lung defensive qi, leading to an unstable exterior.2. Aversion to Cold without FeverIndicates that the patient only feels cold without fever. This is a characteristic of interior cold syndrome. The aversion to cold often arises from the invasion of cold pathogens or from insufficient yang qi leading to internal cold. Based on the urgency of onset and the duration of the illness, the following two types are commonly seen in clinical practice:(1) New Illness with Aversion to Cold indicates that the patient suddenly feels cold, with cold extremities, or has abdominal pain, vomiting, diarrhea, or cough with wheezing, and a deep, tight pulse. This is often due to a heavy invasion of cold pathogens, which directly affect the internal organs and meridians, obstructing yang qi and causing the body to lose warmth, thus resulting in sudden aversion to cold, often seen in interior excess cold syndrome. Some wind-cold exterior syndromes may initially present only with the sensation of cold without fever, but this aversion to cold often precedes fever, and as the condition progresses, the patient’s temperature will rise, presenting with aversion to cold and fever.(2) Chronic Illness with Aversion to Cold indicates that the patient frequently feels cold, with cool extremities that can be alleviated by warmth. This is often accompanied by a pale complexion, a pale, swollen tongue, and a deep, slow, weak pulse, commonly seen in interior deficiency cold syndrome. This is due to the deficiency of yang qi, leading to the body losing warmth.3. Aversion to Heat without ColdIndicates that the patient only has fever without aversion to cold. This is often due to excess yang or yin deficiency, characteristic of interior heat syndrome. Based on the severity, duration, and characteristics of the fever, the following three types are commonly seen in clinical practice:(1) High Fever indicates that the patient has a strong fever that persists without aversion to cold, only aversion to heat. This is often accompanied by a flushed face, thirst, profuse sweating, and a rapid pulse. This is usually due to the internal transmission of wind-heat or the transformation of wind-cold into heat, where the righteous and pathogenic qi clash, leading to intense yang heat that reaches the exterior. This is commonly seen in the yangming channel syndrome of typhoid fever and in the qi stage of warm diseases, classified as interior excess heat syndrome.(2) Tidal Fever indicates that the fever occurs at specific times or intensifies at certain times, resembling the ebb and flow of tides. There are distinctions such as afternoon tidal fever, damp-warm tidal fever, and yin deficiency tidal fever. ① Afternoon Tidal Fever: The patient experiences a higher fever, particularly noticeable in the afternoon (3-5 PM), known as afternoon tidal fever, commonly seen in yangming organ excess syndrome, hence also referred to as yangming tidal fever. This is due to the dryness and heat in the stomach and intestines, with the yangming channel qi being vigorous in the late afternoon, leading to intense clashes between righteous and pathogenic qi, thus exacerbating the fever at this time.② Damp-Warm Tidal Fever: The patient has a fever that is not pronounced (the skin does not feel hot upon initial touch, but feels hot after prolonged contact), with significant fever in the afternoon, known as damp-warm tidal fever, commonly seen in damp-warm diseases. This is often due to damp pathogens obstructing the heat from reaching the surface, leading to dampness and heat stagnation, thus the body temperature is not pronounced; as the afternoon progresses, yang qi declines and yin qi increases, exacerbating the dampness and heat, resulting in a more pronounced fever.③ Yin Deficiency Tidal Fever: The patient experiences low-grade fever in the afternoon and at night, known as yin deficiency tidal fever, commonly seen in yin deficiency with internal heat syndrome. This is often due to the deficiency of yin fluids, which cannot restrain yang, leading to an excess of yang qi; in the afternoon, the defensive yang gradually enters the interior, and at night, the defensive yang moves within, causing the already excessive yang qi to become even more pronounced, resulting in low-grade fever in the afternoon and at night.(3) Low-Grade Fever indicates a fever that is not high, generally below 38°C, or only a subjective feeling of fever, referred to as low-grade fever. The duration of the fever is generally long, and the etiology and pathogenesis are more complex. Long-term low-grade fever, exacerbated by fatigue, accompanied by fatigue, shortness of breath, and spontaneous sweating, often indicates qi deficiency fever. Long-term low-grade fever, accompanied by redness in the cheeks and five hearts feeling hot, often indicates yin deficiency fever. If the low-grade fever occurs intermittently due to emotional distress, accompanied by chest tightness, irritability, and anger, it often indicates qi stagnation fever, also known as stagnation heat.4. Alternating Cold and HeatIndicates that the patient experiences alternating aversion to cold and fever. This reflects the pathological interaction between righteous and pathogenic qi, characteristic of half-exterior half-interior syndrome. The following two types are commonly seen in clinical practice:(1) Alternating Cold and Heat without Fixed Timing indicates that the patient experiences alternating aversion to cold and fever without a regular pattern. This is commonly seen in shaoyang disease, representing half-exterior half-interior syndrome. This occurs when external pathogenic factors reach the half-exterior half-interior stage, where the righteous and pathogenic qi struggle; when the righteous prevails, fever occurs, and when the pathogenic prevails, aversion to cold occurs, thus alternating symptoms without fixed timing.(2) Alternating Cold and Heat with Fixed Timing indicates that the patient experiences alternating aversion to cold and fever with a regular pattern, occurring daily or every few days, often accompanied by severe headache, thirst, and sweating. This is commonly seen in malaria. The malarial pathogen invades the body, lurking in the half-exterior half-interior membrane region, where it competes with yin to cause cold and with yang to cause heat, thus alternating aversion to cold and fever occurs with regular intervals.
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