Traditional Chinese Medicine (TCM) is an inseparable component of Chinese culture. It has gone through thousands of years and still played a significant role in modern time. TCM doctors collect patients’ information by Four Diagnostic Methods, and make the final diagnosis, namely syndrome differentiation, depending on the clinical manifestations. Right now we would like to introduce the method of interrogation which will magically offer you some light for the syndrome differentiations. It is one of the methods to collect clinical data within the four diagnostic methods so as to identify the causative factors, diseased location and the strength between the pathogenic factors and vital Qi.

 

Interrogation may cover a lot of content and we would like to talk about one after another, the first is the inquiry of aversion to cold and fever.

 

Inquiry of aversion to cold and fever means asking the patients’ sensation of fever and aversion to cold. They are two common symptoms seen in some diseases and are often taken as the evidences for differentiating the nature of pathogenic factors. These two symptoms appear simple, but their presence and severity may provide us significant information about the location, nature and strength between pathogenic factors and vital Qi.

 

In inquiring fever and aversion to cold, the doctor should make sure whether there is aversion to cold and fever or not, whether aversion to cold and fever appear simultaneously, whether fever and aversion to cold is serious or mild, when they appear and how they last as well as other symptoms and signs.

 

Generally speaking, there are four kinds of situation: coexistence of aversion to cold and fever, aversion to cold without the accompaniment of fever, fever without aversion to cold and alternation between aversion to cold and fever.

 

Ⅰ. Coexistence of aversion to cold and fever

In this case, aversion to cold and fever exist simultaneously. That means the patients are afraid of cold but at the same time feel hot. This situation often occurs in exterior syndrome, and is often the consequence of the conflict between pathogenic factors and vital Qi. As we know that the defensive qi stays in the superficial portion of the body and acts as a screen to keep the body away from the external pathogenic factors.

 

Coexistence of aversion to cold and fever is usually seen at the primary stage of exogenous disease, which is termed exterior syndrome, in which the invading pathogenic factors are in the superficial part. Because the pathogenic factors attack the superficial part of the body, the defensive yang looses the function of warming so that the body feels cold. And the fever is the consequence of the fighting between defensive qi and pathogenic factors.

 

The two symptoms appear at the same time but they are various in severity. This is caused by different invading pathogenic factors as well as the constitutional reaction toward the invading factors. Thereby analyzing the severity of the two symptoms will help us to understand the nature of the exterior syndrome.

 

In clinic there are usually three types:

⑴ Serious aversion to cold and mild fever: Serious aversion to cold and mild fever indicate exterior syndrome due to wind-cold. Cold is a pathogenic factor of yin nature. When pathogenic cold invades the superficial part, defensive yang is stagnated and the superficial part cannot be warmed, leading to serious aversion to cold. Mild fever is just caused by the conflict between the pathogenic factors and vital Qi.

 

⑵ Serious fever and mild aversion to cold: It indicates exterior syndrome due to wind-heat. Wind-heat is a pathogenic factor of yang nature. When pathogenic factors of yang nature cause diseases, yang usually becomes excessive. That is why fever is serious. When wind-heat invades the superficial part, the muscular interstices become loose. That is why aversion to cold is mild.

 

⑶ Mild fever and aversion to wind: It indicates exterior syndrome due to wind attack. Aversion to wind means that the patients are rather sensitive to wind and feel cold on exposure to wind. Pathogenic wind is featured by opening the skin pores. The muscular interstices become loose in case of wind attack. That is why there are mild fever and aversion to wind.

                                                   

Four Diagnostic Methods                     四诊（si zhen）

Pathogenic factors                              邪气(xie qi)

syndrome differentiations                    辨证论治(bian zheng lun zhi)

exterior syndrome                              表证(biao zheng)

exogenous disease                             外感病(wai gan bing)

defensive yang                                   卫阳(wei yang)

defensive qi                                        卫气(wei qi)

aversion to cold                                  恶寒(wu han)

muscular interstices                            腠理(cou li)

exogenous pathogenic wind                外风(waif eng)

( to be continued )

 

 

1. Lufen Wang, Zhaoguo Li, Bai Bao, Dianostics of Traditional Chinese Medicine, Publishing House of Shanghai University of Traditional Chinese Medicine.

 

2. Wenfeng Zhu, Diagnostics of Traditional Chinese Medicine, Shanghai Science and Technology Publishing House

 

3.Yanfu Zuo, The New Century Chinese-English Dictionary of Traditional Chinese Medicine, People’s Military Medical Press.

 

                         (The Translation Section, Yanting Guan)