Last time we talked about the coexistence of aversion to cold and fever. In that situation, aversion to cold and fever exist simultaneously and are usually seen in exterior syndrome. This time let’s discuss a different situation in which fever exists alone without accompaniment of aversion to cold.

 

Fever without accompaniment of aversion to cold refers to the situation that the patients only have fever and do not have aversion to cold, sometimes even dislike of heat. This is often seen in interior heat syndrome caused by excess of yang or deficiency of yin. According to the body temperature, occurring time and other clinical features, fever can be further divided into high fever, tidal fever and mild fever.

 

Generally speaking, there is a struggle between the vital qi and pathogenic factors in case of exogenous pathogenic invasion. Fever is often the manifestation of this fighting and it is also considered as a kind of self protection of the body. If this battle occurs on the exterior, fever is often seen together with aversion to cold. But if the pathogens moved interiorly, aversion to cold may disappear gradually, leaving fever alone.

 

⑴ High fever: It means that the patients suffer from serious high fever to be relieved with the symptoms of aversion to heat instead of to cold. It is usually caused by wind-cold invading the interior and transforming into heat. Another possibility is the exterior wind-heat moving into the interior. The wind-heat either directly from the exterior to the interior or transformed from wind-cold while moving interiorly, will also arose a fierce conflict between the two sides, which usually manifests very high fever and commonly seen in epidemic febrile diseases involving the qi stage, in TCM, it is known as Yangming syndrome. It is an interior heat syndrome of excess type and it is usually accompanied by flushed face, profuse sweating, dysphoria and thirst with preference for cold drinks.

 

⑵ Tidal fever: This kind of fever is very interesting. Just like the tide coming on time, the fever is marked by regular occurrence or regular worsening. According to its cause and pathogenesis, it can be further divided into four kinds as following.

 

①    Tidal fever of Yangming type: Qi of Yangming meridians is usually becoming abundant in the afternoon around 3:00¬5:00 o’clock, which is the time of sunset and called RiBu in Chinese). Tidal fever of Yangming type tends to occur at this time, thereby it is also known as RiBu hectic fever. It’s caused by qi and heat stagnation in Yangming meridian, which further consumes body fluid, leading to retention of dry-heat in stomach and intestines and impairment of the normal function of fu organs. This type of fever is often seen in obstruction of qi of the fu organs.

 

②    Tidal fever of damp-warm type: Dampness is a yin evil, so this fever always occurs in the afternoon or evening, in which yin is becoming abundant. Although the warm is a kind of yang evil, when mixed with dampness, its moving temper, as well as hot nature, and high body temperature it causes, are all blocked by dampness. So this kind of fever has a special feature, the patient’s skin feels relatively cool at the beginning and gradually turns scorching hot if the hand remains on the skin for some time. Besides fever, we can expect 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 coating. They symptoms are caused by retention of damp-heat in the middle energizer.

 

 

③    Tidal fever of yin-deficient type: This fever always occurs in the afternoon or evening also at the time of yin with a day cycle. When yin is deficient, yang will become excessive, manifesting as hot symptoms and signs, such as feverish sensation over the five centres or steaming fever in the bones. In clinic, we can see flushed cheeks, night sweating, dry mouth and throat, which are the consequence of deficiency of yin failing to control yang, generating endogenous heat.

 

⑶ Mild fever: Actually there are three types: qi deficiency, qi stagnation and yin deficiency.

①    Qi deficiency: This type is often seen in spleen qi deficiency, which may further cause the sinking and stagnation of qi, giving rise to fever.

②    Qi stagnation: This is usually seen in liver qi stagnation, in a long run, stagnation of qi generates fire and leads to mild fever.

③    Yin deficiency: Chronic diseases exhaust yin gradually and yang becomes relatively excessive. This type of fever is not high in temperature, but may last for long if it is not treated properly.

 

                                                     (to be continued…)

 

Interior heat syndrome                          内热证（nei re zheng）

Exterior wind-heat                                 外感风热( wai gan feng re)                                   

Wind-cold                                             风寒(feng han)

Epidemic febrile diseases                         温热病(wen re bing)

The qi stage                                           气分(qi fen)

Yangming syndrome                                阳明证(yang ming zheng)

RiBu hectic fever                                      日晡潮热(ri bu chao re)

Obstruction of qi of fu organs                                     腑气不通(fu qi bu tong)

Epigastric and abdominal fullness and oppression         脘腹痞闷(wan fu pi men)

Middle energizer                                                         中焦(zhong jiao)

Feverish sensation over the five centres                      五心烦热(wu xin fan re)

Steaming fever in the bones                                       骨蒸潮热(gu zheng chao re)

 

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.

                                  

 

  (Translation Section: Yanting Guan)