bubble_chart Concept

Cold back refers to the self-perceived sensation of coldness in the back. This symptom is referred to as "back aversion to cold" in the Treatise on Cold Damage Diseases. The Jingui Yaolue names it "back coldness". The chapter on "Strong Pain and Aversion to Cold" in the Hejian Six Books calls it "back timidity to cold".

bubble_chart Pattern Analysis

1. External Contractionwind-cold︰aversion to cold, fever, headache and body pain, thin white tongue coating, floating and tight pulse. Often caused by external contraction in the initial stage [first stage], when wind-cold invades the body surface, and cold pathogens constrict the exterior, leading to symptoms such as aversion to cold, fever, and headache.
2. Deficiency of Yang with Exuberance of Yin︰Cold back with preference for warmth, bland taste in the mouth, absence of thirst, pale complexion, reversal cold of hands and feet, clear and profuse urine, loose stools, pale tongue with white and moist coating, deep and slow pulse. Often due to constitutional weakness, decline of yang qi, and internal generation of cold, thus manifesting symptoms of pudendal coldness such as cold back, cold limbs, and deep slow pulse. Key points for clinical differentiation: wind-cold invasion causing cold back and aversion to cold must be accompanied by exterior patterns such as fever, headache, body pain, and floating pulse. Whereas cold back due to yang deficiency with exuberance of cold, which prefers warmth and is relieved by heat, must present signs of deficiency of yang with exuberance of yin, such as cold limbs, clear and profuse urine, loose stools, white and slippery tongue coating, and deep slow pulse. For treatment: - Cold back due to wind-cold invasion primarily focuses on releasing the exterior and dispelling wind-cold. It is advisable to modify Nine-Ingredient Notopterygium Decoction. - Cold back due to yang deficiency with exuberance of cold should be treated by warming the meridians, assisting yang, and dispelling cold-dampness. Aconite Decoction is commonly selected. Cold back due to phlegm-fluid retention versus cold back due to yang deficiency with exuberance of cold: Both are interior patterns caused by yang deficiency, but one is due to phlegm-fluid retention, while the other is due to pathogenic cold. Cold back from phlegm-fluid retention often occurs in those with chronic illness, weak constitution, or elderly individuals with declining qi. Insufficiency of spleen and kidney yang leads to impaired transportation and retention of water-dampness, which congeals into phlegm-fluid. Where phlegm-fluid accumulates, yang qi is obstructed and unable to spread. Since the heart’s transport point is on the back, the retention of phlegm-fluid prevents yang qi from reaching, resulting in a cold pain in the center of the back. Its clinical characteristic is an aversion to cold in the back, as if icy. Jingui Yaolue states:
3. Internal Retention of Water and Fluid︰Back aversion to cold, cold as ice, cough or panting, copious thin white phlegm, head dizzy vision, no desire to drink or preference for hot drinks in small amounts, abdominal distension and fullness with poor appetite, general fatigue and lack of strength, or swelling of the limbs, tongue coating white and slippery, pulse deep and slippery. Often occurs in those with chronic illness and weak constitution, or the elderly with declining qi. Spleen-kidney yang qi deficiency, when spleen yang is deficient, its transportation and transformation functions fail, leading to water-damp retention that congeals into phlegm-fluid retention. Wherever phlegm-fluid accumulates, yang qi is obstructed and cannot spread. Since the heart's transport point is on the back, when fluid retention blocks yang qi from reaching, there appears a patch of cold pain on the back. Its clinical characteristic is back aversion to cold as cold as ice. Jingui Yaolue states: "When there is persistent fluid retention below the heart, the patient's back feels cold like a palm-sized area." It must be accompanied by spleen-kidney yang deficiency symptoms. The treatment focuses on strengthening the spleen and eliminating dampness, and Poria Decoction may be used.

The symptom of cold back can occur in both exterior pattern and interior pattern. In terms of its location, the acupoints of the five zang and six fu-organs are all located on the back, and the qi of the zang-fu organs and blood all flow into these acupoints. The back is also where the yang meridians are located, so regardless of the meridians, the zang-fu organs are all connected to the back. Cold back is often related to external contraction of wind-cold and the decline of yang qi in the zang-fu organs. Treatment requires careful examination of the disease to identify the cause and differentiate the syndrome for analysis, in order to achieve good therapeutic results.

bubble_chart Documentation

1. Danxi Xinfa．Phlegm: "A patch on the back often feels cold, ... all caused by phlegm-fluid retention. Those skilled in treating phlegm do not treat the phlegm but treat the qi. When the qi flows smoothly, the body fluids throughout the body also follow the qi and flow smoothly."