bubble_chart Concept

Aversion to wind and cold refers to the sensation of feeling cold, which is commonly seen in both external contraction and internal damage diseases. Historical literature has referred to it as "aversion to cold," "aversion to wind," and "fear of cold." Some believe that "aversion to wind" and "aversion to cold" are different. Those with "aversion to cold" feel cold even without wind exposure, remaining cold even in a sealed room, under blankets, or near a fire. On the other hand, those with "aversion to wind" only feel cold when exposed to wind. However, clinically, it is observed that most people with "aversion to cold" also have "aversion to wind," and those with "aversion to wind" often also experience "aversion to cold." Since "aversion to cold," "aversion to wind," and "fear of cold" present similarly, this text uses "aversion to wind and cold" to encompass these terms and collectively refers to them as "aversion to cold."

bubble_chart Pattern Analysis

1. External Contractionwind-cold︰Aversion to cold with fever, without sweating, headache and body pain, no thirst, thin white tongue coating, floating and tight pulse. Wind-cold fettering exterior aversion to cold is caused by the external constraint of wind-cold pathogens and the stagnation of defensive yang. The struggle between healthy qi and pathogenic qi leads to fever, and the inability of defensive yang to spread results in headache and body pain. Thin white tongue coating and floating-tight pulse are all signs of the pattern of common cold due to wind-cold. The treatment principle is to release the exterior with pungent-warm herbs and disperse wind-cold, and the prescription is selected as Ephedra Decoction with modifications.
2. Cold Invasion of Shaoyin︰Aversion to cold without fever, fatigue and cold limbs, listlessness, vomiting, diarrhea with undigested food, clear and abundant urine, pale tongue with white coating, deep and faint pulse. Cold invading the Shaoyin channel. Aversion to cold is caused by congenital heart and kidney yang deficiency, allowing cold pathogens to directly attack the Shaoyin channel. Heart and kidney yang deficiency leads to internal exuberance of pudendal coldness, where healthy qi cannot overcome pathogens, resulting in symptoms such as aversion to cold without fever, fatigue and cold limbs, and faint pulse. Treatment should focus on supporting yang and suppressing yin, with the representative formula being Cold-Extremities Decoction.
3. Deficiency of Yang with Exuberance of Yin︰Aversion to cold, cold limbs, fatigue and lack of strength, shortage of qi, reluctance to speak, bland taste in the mouth, absence of thirst, clear urine, loose stool, pale complexion and tongue, deep slow and weak pulse. deficiency of yang with exuberance of yin aversion to cold due to overstrain and internal damage, or prolonged illness leading to the gradual decline of healthy qi, causing the functional decline of the zang-fu organs in the body, weakness of yang qi, and failure of yang to restrain yin, resulting in internal generation of pudendal coldness. Therefore, there are both qi deficiency patterns such as fatigue, lack of strength, shortage of qi, and reluctance to speak, as well as yang deficiency patterns such as aversion to cold, cold limbs, clear urine, loose stool, pale tongue, and slow pulse. The treatment principle is to warm yang and dispel cold. For kidney yang deficiency, it is appropriate to warm and tonify kidney yang, with prescriptions such as Right-Restoring Decoction; for spleen yang deficiency, it is suitable to warm and activate spleen yang, with prescriptions like Aconite Middle-Regulating Pill; for heart yang deficiency, it is advisable to warm and tonify heart yang, with prescriptions such as Cinnamon Twig Liquorice Root Decoction with modifications.
4. Exuberant Yang Repelling Yin︰Aversion to cold, cold limbs, thirst with a preference for cold drinks, vexing heat in the chest, a burning sensation upon palpation of the abdomen, dry throat, fetid mouth odor, yellow urine, constipation, a red tongue with yellow coating, and a deep and hidden pulse. Exuberant yang repelling yin and aversion to cold are caused by pathogenic heat deeply lurking in the interior, with yang qi stagnated internally and unable to reach the exterior. The main manifestations are symptoms of extreme heat resembling cold. Although the patient exhibits signs such as aversion to cold, cold limbs, and a deep pulse, these are false cold symptoms. The true heat symptoms, such as thirst with a preference for cold drinks, a burning sensation upon palpation of the chest and abdomen, dark urine, constipation, a red tongue with yellow coating, are predominant. The essence of this condition is yang exuberance in the interior repelling yin to the exterior. Treatment should focus on clearing the interior and draining heat. The recommended formulas are White Tiger Decoction or modified Chengqi Decoction variants. Once the interior heat is resolved, the external cold will naturally dissipate.
5. Internal Retention of Water and Fluid︰Aversion to cold, heaviness of limbs, chest and abdominal distension and fullness, anorexia, thirst without desire to drink, greasy tongue coating, and slippery pulse. The disease is caused by phlegm-fluid retention stagnating in the body, either in the chest and hypochondrium, the gastrointestinal tract, or the limbs. Phlegm-fluid retention is a yin pathogen; when cold-fluid retention obstructs internally, yang qi cannot circulate freely, leading to symptoms such as aversion to cold. Clinically, the manifestations vary depending on the location of phlegm-fluid retention. For example, if it stagnates in the chest and diaphragm, the main symptoms are coughing and spitting phlegm-drool, wheezing, and shoulder lifting; if it stagnates in the hypochondrium, the main symptom is hypochondriac pain preventing turning the body; if it stagnates in the gastrointestinal tract, the main symptom is borborygmus with gurgling sounds; if it stagnates in the limbs, the main symptoms are body pain and heaviness, as well as swelling. The treatment principle is to unblock yang and resolve fluid retention. Prescriptions include Poria, Cinnamon Twig, Bighead Atractylodes and Licorice Decoction, Gansui and Pinellia Decoction, Minor Green-Blue Dragon Decoction, Cocculus Root Decoction, and others.
6. Sores and Ulcers︰Aversion to cold, even shivering, fever, sore and ulcer with localized swelling and pain, fever, dark urine, severe constipation, yellow tongue coating, wiry and rapid or surging and rapid pulse. Mostly caused by external contraction of fire-heat pathogens, excessive consumption of rich and greasy food, or external injuries, leading to disharmony between nutrient and defensive qi, accumulation of pathogenic heat, and obstruction of meridians and collaterals, thus triggering the disease. Aversion to cold indicates intense struggle between pathogens and healthy qi, as well as rampant virulent toxins, usually transient and soon followed by fever, with localized redness, swelling, and burning pain. Treatment should focus on clearing heat, purging fire, and removing toxins. Formulas such as Modified Antiphlogistic Decoction or Immortal Formula Life-Saving Decoction can be used.
7. Cold Malaria︰Aversion to cold without fever, or with more chills and less fever, occurring intermittently, mental fatigue and limb weariness, chest and hypochondriac stuffiness and fullness, white and greasy tongue coating, wiry and slow pulse. This syndrome is due to a constitution of yang deficiency with dampness encumbrance, further affected by malarial pathogen, with extreme interior cold and obstructed yang qi circulation, hence manifesting as chill without fever or more chills and less fever. Cold-dampness encumbering the spleen impairs transportation and transformation, leading to mental fatigue, limb weariness, and white greasy tongue coating; the failure of shaoyang qi circulation causes chest and hypochondriac stuffiness and fullness; the wiry and slow pulse indicates the lurking of malarial pathogen. The aversion to cold in this syndrome is characterized by intermittent occurrence, once daily or every other day, making it easily distinguishable from other syndromes. Treatment should focus on dispelling cold and preventing malaria, using Bupleurum, Cinnamon Twig and Dried Ginger Decoction with additions such as Dichroa and Caoguo.

The differentiation of aversion to cold must distinguish between exterior and interior patterns. Among the seven common syndromes mentioned above, wind-cold fettering the exterior is an exterior pattern, cold malaria is a half-exterior half-interior pattern, and the other syndromes are all interior pattern. Generally, aversion to cold in exterior pattern is often accompanied by fever, and the aversion to cold does not diminish with warmth; it requires sweating to expel the pathogen before the aversion to cold subsides. Aversion to cold in half-exterior half-interior pattern is characterized by periodic occurrences. Although aversion to cold in sores and ulcers is seen alongside fever, it cannot be generalized as an exterior pattern. Aversion to cold in interior pattern is often not accompanied by fever and diminishes with warmth, commonly seen in yang deficiency.

bubble_chart Documentation

1. Shanghan Lun．"On the Differentiation and Treatment of Taiyang Disease by Pulse and Symptoms": "Taiyang disease, whether it has already developed a fever or not, must have an aversion to cold, body pain, nausea, and a pulse that is tight in both yin and yang aspects, is called cold-damage disease." "Diseases with fever and chills are caused by yang; those without fever but with an aversion to cold are caused by yin."
2. Yizong Bidu．"Cold-Damage Disease": "Aversion to cold, even without exposure to wind, and a reluctance to remove clothing or bedding despite body heat. Fever and chills indicate yang, treated with Notopterygium Peaceful Decoction. Aversion to cold without fever indicates yin, treated with Middle-Regulating Decoction. If all signs of a lower syndrome are present with slight aversion to cold, the exterior has not been resolved; first release the exterior before attacking the interior. If symptoms persist after purging, with fever, thirst, and aversion to cold, use White Tiger Decoction. Aversion to cold with nausea and epigastric stuffiness is treated with Five Ingredients with Poria Powder. Aversion to cold after sweating indicates deficiency, treated with Peony Root Aconite Lateral Root Liquorice Root Decoction. Back aversion to cold indicates the exterior has not been resolved, treated with Pueraria Decoction. Back aversion to cold with tidal fever is treated with Bupleurum and Cinnamon Decoction. Thirst, heart vexation, and slight back aversion to cold are treated with White Tiger Decoction Plus Ginseng. Back aversion to cold with tidal fever and abdominal distension and fullness is treated with Minor Purgative Decoction. Shaoyin disease with a normal sense of taste and back aversion to cold is treated with Aconite Decoction. If symptoms persist after sweating and there is back aversion to cold, it indicates deficiency, treated with Peony Root Liquorice and Aconite Decoction."