bubble_chart Concept

Aversion to cold with fever refers to the simultaneous occurrence of aversion to cold and fever. This symptom can be observed in Taiyang disease within the six-meridian pattern identification, defense aspect pattern within the defense-qi-nutrient-blood pattern identification, and upper energizer pattern within the triple-energizer pattern identification. It is a primary symptom of external contraction exterior pattern.

Suwen．Cire records, "In cases of lung heat disease... there is aversion to wind and cold, a yellow coating on the tongue, and body heat." The "Treatise on Cold-Damage Disease: Differentiation of Taiyang Disease Pulse and Symptoms and Treatment (Part 1)" states, "Diseases with fever and chills arise from yang, while those without fever but with aversion to cold arise from yin," summarizing the mechanism of disease characteristics of this condition, which serves as an important basis for clinical pattern identification. Jingyue Quanshu also refers to it as "aversion to cold with fever" or "fear of cold fever," different names but the same essence.

Simple aversion to cold, such as "aversion to cold without fever" when pathogenic factors enter the three yin; or simple fever, such as "fever without chills" when pathogenic factors enter the yangming; or internal damage aversion to cold with fever, as well as aversion to cold with fever at the onset of surgical diseases, are not within the scope of this discussion.

bubble_chart Pattern Analysis

1. Wind-cold Attacking the Exterior︰aversion to cold with fever, aversion to cold is severe, fever is mild, headache and body pain, without sweating, nasal congestion and runny nose, cough with heavy sound, tongue coating thin and white, pulse floating and tight. Cold nature congeals and stagnates, wind-cold externally binds, invades the taiyang, striae and interstices become obstructed, defensive yang is impeded, qi pathway is unfavorable, hence aversion to cold is severe, fever is mild and without sweating, accompanied by cough with heavy body, nasal congestion and runny nose, headache and body pain, tongue coating thin and white, pulse floating and tight. Treatment should focus on releasing the exterior with pungent-warm. For mild cases, use Fistular Onion Stalk, Fermented Soybean Decoction; for severe cases, use Ephedra Decoction or Schizonepeta and Saposhnikovia Toxin-Vanquishing Powder with modifications.
2. Wind-heat Invading the Lung︰aversion to cold with fever, fever is severe, aversion to cold is mild, slight sweating, headache, red throat, dry mouth, cough, tongue coating thin and yellow, floating and rapid pulse. Wind-heat upper attack, defensive exterior disharmony, lung failing to diffuse and descend, hence fever is severe and aversion to cold is mild with slight sweating. Accompanied by headache and red throat. Dry mouth and cough, tongue coating thin and yellow, floating and rapid pulse. Treatment should focus on releasing the exterior with pungent-cool herbs, using Lonicera and Forsythia Powder or Mulberry Leaf and Chrysanthemum Decoction with modifications.
3. External Contractionwind-dampness︰aversion to cold with fever, heavy sensation in the body, distending headache as if being tightly wrapped, joint pain, white and greasy tongue coating, soggy and rapid pulse. The invasion of wind-dampness into the muscles and interstices, with the dampness being sticky and stagnant, obstructs the clear yang, leading to aversion to cold with fever, accompanied by heavy sensation in the body, joint pain, white and greasy tongue coating, soggy and rapid pulse. The treatment should focus on dispersing wind and eliminating dampness, using Notopterygium Overcoming Dampness Decoction.
4. Summerheat-dampness Intermingling︰aversion to cold with fever, aversion to cold is mild, fever is severe, head distension, chest tightness with nausea and vomiting, sweating, thirst, scanty dark urine, yellow greasy tongue coating, soggy and rapid pulse. In summer, summerheat injury occurs, summerheat as a yang pathogen often combines with dampness, summerheat and dampness obstruct each other, qi movement is less smooth, hence aversion to cold is mild, fever is severe, sweating and thirst, accompanied by head distension, chest tightness, nausea and vomiting, white greasy tongue coating, soggy and rapid pulse. Treatment should focus on clearing summerheat, using Newly Supplemented Mosla Decoction.

Aversion to cold with fever, as it belongs to the exterior pattern, always requires releasing the exterior to dispel pathogens. However, the pathogens can vary, such as wind-cold, warm-heat, summerheat, and dampness. Clinical diagnosis should differentiate these accordingly.

bubble_chart Documentation

1. Suwen-Feng Lun: "Wind qi is hidden between the skin and flesh, internally it cannot circulate, externally it cannot be discharged; wind is adept at moving and frequently changes, when the striae and interstice open, it causes a sudden chill, when they close, it causes heat and stifling; when it is cold, it diminishes appetite; when it is hot, it consumes the muscles, thus causing people to shiver and be unable to eat, this is called cold-heat."
2. Neiwaishang Bianhuo Lun．On Differentiating Cold and Heat: "The symptoms of external cold-damage disease, along with the illness from improper diet and physical labor, and internal damage from diet, all have cold and heat.… External cold-damage disease, fever and chills, cold and heat occur together, the heat is a gentle fever, also a fluttering fever, occurring on the skin and hair, like the brushing of feathers, indicating that the heat is on the exterior.… Internal damage from improper diet or injury from labor, also has headache, stiff neck, lumbago, slightly similar to the taiyang exterior pattern, but the rest are different…."