Traditional Chinese Medicine (TCM) is profound and intricate, with dialectical reasoning at its core. Understanding how to apply dialectics is both complex and straightforward. Starting today, I will explain this in detail.
First, let me introduce the “Ten Questions Song”:
Ten Questions Song
First ask about cold and heat, second ask about sweating,
Third ask about head and body, fourth ask about bowel movements,
Fifth ask about diet, sixth about chest and abdomen,
Seventh ask about deafness, eighth about thirst,
Ninth ask about old illnesses, tenth ask about causes,
Also consider medication and variations,
Women must especially ask about menstrual periods,
Delays, accelerations, and interruptions can all be seen,
Additionally, brief notes for pediatrics,
Measles and smallpox are all included.
When a patient consults, we should address the ten questions above; this is comprehensive. However, some experienced doctors can often identify the issue with just a glance, which is a separate discussion. Of course, as experience accumulates, one can also discern problems at a glance.
Today’s first lesson is about asking about cold and heat. There are recommended formulas, but diagnosis and treatment must be differentiated; TCM only offers personalized prescriptions, not one-size-fits-all solutions.
【1】The Meaning of Cold and Heat
“Cold” refers to the patient’s subjective feeling of being cold. Clinically, there are distinctions between aversion to wind, aversion to cold, and fear of cold. If a patient feels cold when encountering wind and can alleviate it by avoiding it, this is called aversion to wind; if a patient feels cold and cannot alleviate it by adding clothing or warming up, this is called fear of cold; if a patient feels cold but can warm up by adding clothing or getting close to a fire, this is called aversion to cold.
“Heat” refers to fever, including an elevated body temperature or a normal temperature with the patient feeling localized heat (such as in the palms or soles).
The generation of cold and heat mainly depends on the nature of the disease and the balance of yin and yang in the body. When pathogenic factors cause illness, cold is a yin pathogen, characterized by its cooling nature, thus cold pathogens lead to illness with prominent aversion to cold symptoms; heat is a yang pathogen, characterized by its heating nature, thus heat pathogens lead to illness with obvious fever symptoms. When the body’s yin and yang are imbalanced, excess yang leads to heat, excess yin leads to cold, yin deficiency leads to heat, and yang deficiency leads to cold.
【2】Common Types, Clinical Manifestations, and Significance of Cold and Heat Symptoms
1. Clinical Manifestations and Significance of Aversion to Cold with Fever
Aversion to cold with fever refers to the simultaneous occurrence of aversion to cold and elevated body temperature, which is a characteristic symptom of exterior syndrome. The cause of aversion to cold with fever is due to external pathogens attacking the exterior, affecting the function of wei yang (defensive yang) in “warming the flesh”; when the muscle surface loses warmth, aversion to cold occurs; when the righteous qi rises to resist the pathogen, yang qi moves towards the exterior, but due to the cold outside, the exterior is obstructed, and yang qi cannot properly emerge, leading to stagnation and fever. (Therefore, do not use antibiotics immediately when fever occurs, as this can lead to the loss of the body’s ability to resist external pathogens.)
Depending on the severity of aversion to cold and fever, it can be further divided into the following three types:
(1) Severe aversion to cold with mild fever: This is characteristic of wind-cold exterior syndrome. Since cold is a yin pathogen, it constrains the exterior and injures yang, hence the aversion to cold is prominent.
(2) Mild fever with aversion to wind: This is characteristic of wind-heat exterior syndrome. The nature of wind is to disperse, causing the exterior to open, hence spontaneous sweating and aversion to wind.
(3) Severe fever with mild aversion to cold: This is characteristic of wind-heat exterior syndrome. Since heat is a yang pathogen, it easily leads to excess yang, hence the fever is prominent.
The severity of exterior cold and heat symptoms is not only related to the nature of the external pathogen but also closely related to the severity of the pathogenic factor; generally speaking, if the pathogenic factor is mild, both aversion to cold and fever are mild; if the pathogenic factor is severe, both aversion to cold and fever are severe.
2. Clinical Manifestations and Significance of Cold without Heat
Cold without heat refers to the symptom where the patient only feels cold without fever, which is a characteristic of interior cold syndrome. Clinically, there are distinctions between new illness with aversion to cold and chronic illness with fear of cold.
(1) New illness with aversion to cold: This refers to the sudden feeling of cold in the patient, with no high body temperature. It is often accompanied by four not warm symptoms, or cold pain in the abdomen and limbs, vomiting, diarrhea, or cough with wheezing, and a deep tight pulse. This is mainly seen in interior excess cold syndrome. It is often due to a heavy invasion of cold pathogens, which directly enter the viscera and meridians, obstructing yang qi, leading to the body’s inability to warm itself.
(2) Chronic illness with fear of cold: This refers to the patient frequently feeling cold, with cold limbs, and symptoms that can be alleviated by warmth, often accompanied by a pale complexion, a pale and swollen tongue, and a weak pulse. This is mainly seen in interior deficiency cold syndrome. It is due to the deficiency of yang qi, leading to the body’s inability to warm itself.
3. Clinical Manifestations and Significance of Heat without Cold
Heat without cold refers to the symptom where the patient only has fever without feeling cold, which is a characteristic of interior heat syndrome. Depending on the different clinical manifestations of fever, it can be categorized into strong fever, tidal fever, and low fever.
(1) Strong fever: This refers to the patient having high fever that persists (body temperature exceeds 39°C), belonging to interior excess heat syndrome. It can be seen with a flushed face, thirst for cold drinks, profuse sweating, and a surging pulse, indicating that the wind-cold pathogen has entered the interior and transformed into heat, or that wind-heat has transmitted internally, with the righteous qi being strong and the pathogen being real, leading to a fierce struggle, resulting in excessive internal heat. This is often seen in the yangming channel syndrome of typhoid fever and the qi stage of warm diseases.
(2) Tidal fever: This refers to the patient having fever at specific times or with a certain pattern, like the tides.
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① Tidal fever in the afternoon: Its characteristics include higher fever, more severe in the afternoon, often accompanied by abdominal distension and constipation, belonging to yangming organ excess syndrome. This is due to heat being constrained in the yangming stomach and large intestine, with the afternoon (the time of shen, i.e., 3-5 PM) being when the yangming qi is most vigorous, thus the yangming qi is strong and combined with excess heat, leading to more severe afternoon fever. (This requires dialectical treatment.)
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② Bone steaming tidal fever: Afternoon or nighttime tidal fever, characterized by low fever in the afternoon and at night. If there is a feeling of heat emanating from the bones, it is called bone steaming fever, often caused by yin deficiency and excess fire. Due to the deficiency of yin fluids, yang cannot be restrained, 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 excessive, resulting in internal heat. (Can be treated with Qinggu San.)
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③ Damp-heat tidal fever: Afternoon fever is particularly noticeable, characterized by body heat that does not feel very high at first touch, but after a while, it feels hot to the touch, indicating damp-heat, which is a manifestation of dampness obstructing heat. (Can be treated with San Ren Tang.)
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④ Stasis-heat tidal fever: Afternoon and nighttime low fever, often accompanied by skin rashes, and a tongue with stasis spots, indicating that long-standing blood stasis has transformed into heat. (Can be treated with Xuefu Zhuyu Tang.)
(3) Low fever: Refers to a mild fever, with body temperature generally between 37°C-38°C, or only a subjective feeling of heat. This often occurs in certain internal injuries and in the later stages of warm diseases. According to the pathogenesis, it can be due to qi deficiency fever, blood deficiency fever, yin deficiency fever, qi stagnation fever, and summer heat in children due to both qi and yin deficiency.
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① Qi deficiency fever: Long-term low fever, worsened by exertion, often accompanied by slight shortness of breath, spontaneous sweating, fatigue, and weakness. (Can be treated with Si Junzi Tang or Bu Zhong Yi Qi Tang.)
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② Blood deficiency fever: Occasional low fever, often accompanied by a pale face, dizziness, pale tongue, and thin pulse. (Can be treated with Si Wu Tang or Danggui Bu Xue Tang.)
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③ Yin deficiency fever: Long-term low fever, often accompanied by red cheeks and five hearts feeling hot. (Can be treated with Liu Wei Di Huang Tang.)
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④ Qi stagnation fever: Occasional low fever due to emotional distress, often accompanied by chest tightness, irritability, and anger. (Can be treated with Yue Ju Wan.)
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⑤ Summer heat in children: Children experiencing prolonged fever during the summer, often accompanied by irritability, thirst, little sweating, and frequent urination, which resolves naturally in autumn, is due to insufficient qi and yin in children, making them unable to adapt to the hot summer climate.
4. Clinical Manifestations and Significance of Alternating Cold and Heat
Alternating cold and heat refers to the symptom where the patient feels alternating aversion to cold and fever, which is a pathological response of the struggle between the righteous and the evil, characteristic of half-exterior half-interior syndrome. Clinically, there are two types:
(1) Alternating cold and heat without a fixed time: The patient feels cold and hot at different times, with multiple occurrences throughout the day without a regular pattern, often seen in lesser yang disease. Accompanied by bitter mouth, dry throat, dizziness, fullness in the chest and hypochondria, loss of appetite, and wiry pulse, this indicates that the external pathogenic factor has not yet reached the interior, and the pathogenic qi is stagnating between half-exterior and half-interior. As the evil and righteous struggle between half-exterior and half-interior, if the evil prevails, there is cold; if the righteous prevails, there is fever, hence the alternating occurrence of aversion to cold and fever. (Can be treated with Xiao Chai Hu Tang.)
(2) Alternating cold and heat with a fixed time: The patient experiences alternating chills and high fever at specific times, occurring once a day or every two to three days, often accompanied by severe headache, thirst, and profuse sweating, commonly seen in malaria. This is due to the malarial pathogen invading the body, lurking in the half-exterior half-interior membrane, with the malarial pathogen entering and contending with yin, leading to chills and shivering, while going outside contends with yang, resulting in alternating chills and fever. (Can be treated with Da Yuan Yin.)
Today’s lesson ends here.