FEELING OF COLD, FEELING OF HEAT, FEVER

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Chapter 82

FEELING OF COLD, FEELING OF HEAT, FEVER

Chapter contents

FEELING OF COLD, SHIVERING

Interrogation, Chapter 43

Exterior

Interior

Internal Cold

Cold feeling, no fever, dorsum of the hands not hot, cold feet, cold limbs.

Deficiency of Yang of the Heart/Lungs

Cold hands, a feeling of cold, shortness of breath, palpitations, Weak pulse.

Yang deficiency of the Stomach and Spleen

Cold limbs and abdomen, poor appetite, tiredness, slight abdominal distension, bright-white complexion, loose stools, a feeling of cold, Pale and wet tongue, Deep-Weak pulse.

Kidney-Yang deficiency

Cold legs, knees, feet and back, lower backache, dizziness, tinnitus, a feeling of cold, weak knees, bright-white complexion, tiredness, abundant clear urination, Pale and wet tongue, Deep-Weak pulse.

Qi stagnation

Cold hands and feet (especially fingers and toes), irritability, depression, hypochondrial discomfort, sighing, Wiry pulse.

Heart-Blood deficiency

Cold hands, a feeling of cold, palpitations, dizziness, insomnia, poor memory, anxiety, dull-pale complexion, Pale tongue, Choppy or Fine pulse.

Liver-Blood deficiency

Cold feet and hands, a feeling of cold, dizziness, blurred vision, floaters, numbness/tingling of limbs, dull-pale complexion, Pale tongue, Choppy or Fine pulse.

Phlegm in the Interior

A feeling of cold, cold limbs, a feeling of heaviness of the limbs, a feeling of oppression of the chest, sputum in the throat, Slippery pulse.

Often Phlegm may cause a cold feeling and cold limbs because it may obstruct the circulation of the Defensive Qi; this may happen even in the case of Phlegm-Heat and may account for contradictory hot and cold signs.

Heat stagnating in the Interior (True Heat–False Cold)

A feeling of cold, cold limbs, thirst, mental restlessness, dry throat, dry stools, red tongue, deep pulse.

This is due to interior Heat blocking Yang Qi in the Interior so that it cannot extend towards the Exterior; however, this situation is quite rare.

Clinical note

• Apart from obvious differences in patterns, the cold feeling from exterior invasions manifests with typical ‘waves’ of feelings of cold and shivering.

FEVER

Interrogation, Chapter 43

Acute fever

In acute fevers the identification of patterns according to the Four Levels provides the best framework of interpretation. Within the Four Levels, the Defensive-Qi level is the only exterior one and therefore there is fever and shivering with a slight feeling of cold simultaneously. At the other three levels (Qi, Nutritive Qi and Blood), Heat is in the Interior and the fever is interior. The identification of patterns according to the Four Levels describes the symptomatology of invasions of Wind-Heat. However, fever, to a lesser degree, may be present also in invasions of Wind-Cold, for which the identification of patterns according to the Six Stages is used.

Invasion of external Wind-Heat in the Lungs Defensive-Qi portion

Fever with a slight aversion to cold, cough, sore throat, stuffed or runny nose with yellow discharge, headache, body aches, slight sweating, slight thirst, swollen tonsils, tongue slightly Red on the sides in the chest area or on the front part, Floating-Rapid pulse.

Invasion of external Wind-Cold

A slight fever with a pronounced cold feeling and possibly shivering, cough, itchy throat, slight breathlessness, stuffed or runny nose with clear watery discharge, sneezing, occipital headache, body aches, thin white tongue coating, Floating-Tight pulse.

Invasion of Summer-Heat

Fever, a slight feeling of cold, absence of sweating, headache, a feeling of heaviness, an uncomfortable feeling of the epigastrium, irritability, thirst, Red tongue, with white coating, Weak-Floating and Rapid pulse.

Heat in the Lungs (Qi level)

Fever, cough, slight breathlessness, a feeling of heat, chest ache, flaring of the nostrils, thirst, red face, Red tongue with yellow coating, Overflowing-Rapid pulse.

Heat in Bright Yang – channel pattern

Fever, sweating, intense thirst, burning epigastric pain, thirst, sour regurgitation, nausea, excessive hunger, foul breath, a feeling of heat, Red tongue with a yellow coating, Overflowing-Rapid pulse.

This corresponds to Heat in the Stomach channel and is described by the Stomach-Heat level within the Four Levels or the Bright-Yang channel pattern within the Six Stages.

Heat in Bright Yang – organ pattern

Fever, burning epigastric pain, intense thirst with a desire to drink cold liquids, mental restlessness, bleeding gums, dry stools, abdominal pain, tongue Red with a thick, dry dark-yellow coating, Deep-Full-Rapid pulse.

This is Dry-Heat in the Intestines level within the Four Levels and is the same as the Bright-Yang organ pattern within the Six Stages.

Damp-Heat in the Stomach and Intestines

Low-grade fever, sweating which does not relieve the fever and does not lead to the clearing of Heat, a feeling of fullness of the epigastrium/abdomen, epigastric/abdominal pain, poor appetite, sticky taste, a feeling of heaviness of the body, thirst without a desire to drink, nausea, vomiting, loose stools with offensive odour, burning sensation of the anus, a feeling of heat, scanty dark urine, headache with a feeling of heaviness of the head, dull-yellow complexion like tangerine peel, yellow sclera of the eyes, oily sweat, bitter taste, Red tongue with sticky yellow coating, Slippery-Rapid pulse.

Heat at Nutritive-Qi level

Fever at night, thirst, dry mouth with no desire to drink, mental restlessness.

This is Heat at the Nutritive-Qi level within the Four Levels.

Heat at Blood level

Fever at night, thirst, mental restlessness, macular rash, bleeding.

This is Heat in the Blood level within the Four Levels.

Chronic fever

Empty-Heat from Yin deficiency

Low-grade fever or feeling of heat in the afternoon or evening, five-palm heat, malar flush, thirst with a desire to drink in small sips, dry mouth and throat at night, mental restlessness, night sweating, insomnia, dream-disturbed sleep, dry stools, scanty dark urination, a thin red line on the inside of the lower eyelid, Red tongue without coating and with cracks, Fine-Rapid pulse.

These are the general symptoms of Empty-Heat deriving from Yin deficiency; they may arise from the Lungs, Heart, Stomach, Spleen, Liver or Kidneys.

Qi deficiency

Low-grade fever or feeling of heat that is aggravated by overwork, dizziness, tiredness, depression, muscular weakness, spontaneous sweating, shortness of breath, loose stools, poor appetite, weak voice, Pale tongue, Weak or Empty pulse.

Blood deficiency

Low-grade fever or feeling of heat in the afternoon, dizziness, blurred vision, floaters, numbness/tingling of limbs, scanty menstruation, dull-pale complexion, Pale tongue, Choppy or Fine pulse.

Stagnant Liver-Qi turned into Heat rebelling upwards

Chronic low-grade fever or feeling of heat that comes and goes according to the emotional state (it comes when the person is upset), volatile mood, irritability, a feeling of distension of the chest and hypochondrium, moodiness, a feeling of a lump in the throat, premenstrual tension, a bitter taste, tongue Red on the sides and thin yellow coating, Rapid-Wiry pulse.

Blood stasis

Low-grade fever or feeling of heat in the afternoon or evening, abdominal pain, dry skin and nails, dark complexion, purple lips, Purple tongue, Choppy or Firm pulse.

Tidal fever

Tidal fever is a fever that rises and decreases at regular intervals. It is usually seen only in interior patterns.

Yin deficiency

Fever that is higher in the afternoon or only in the afternoon, hot palms and soles, night sweating, dry mouth with a desire to drink in small sips, dry throat in the evening, scanty dark urine, dry stools, normal-coloured tongue without coating, Floating-Empty pulse.

Stomach- and Spleen-Qi deficiency

Fever in the mornings, decreasing in the afternoon, poor appetite, slight abdominal distension after eating, an uncomfortable sensation of the epigastrium, tiredness, lassitude, pale complexion, weakness of the limbs, loose stools, Pale tongue, Empty pulse.

This pattern is relatively rare and is due to a severe deficiency of Stomach and Spleen Qi occurring after a febrile disease. It was described by Li Dong Yuan in his ‘Discussion of Stomach and Spleen’ (see Bibliography) and for which he used the famous prescription Bu Zhong Yi Qi Tang Tonifying the Centre and Benefiting Qi Decoction. This condition is what he called Yin Fire, which is not Full-Heat nor Empty-Heat from Yin deficiency but a kind of Empty-Heat from Qi deficiency.

Blood stasis

Fever in the afternoon or night, dry throat, abdominal pain, dry skin and nails, dark rings under the eyes, Purple tongue, Choppy or Wiry pulse.

This is unusual and it is more likely to occur in the elderly; it is often seen in the late stages of cancer due to Blood stasis.

Bright-Yang organ pattern

Fever that is higher in the afternoon, sweating of the hands and feet, abdominal pain and fullness, constipation, Red tongue and black tongue coating, Deep-Full pulse.

This is the Bright-Yang organ pattern within the Six Stages identification of patterns.

Summer-Heat

Fever in the morning, cold feeling at dusk or vice versa, thirst, irritability.

This corresponds to invasion of Summer-Heat injuring Qi. This occurs only in children and is relatively rare.

Fever in cancer

Fever in cancer may present with symptoms that are different from the norm and may also be caused by patterns that do not normally cause fever such as Liver-Qi stagnation and Yang deficiency.

Blood stasis

Fever, cancer characterized by pain and a mass, dark complexion, Purple tongue, Wiry pulse.

This may be cancer of the stomach, lung, intestines, uterus or breast.

Phlegm

Fever in the afternoon, cancer characterized by relatively soft masses, a feeling of oppression of the chest, Swollen tongue with sticky coating, Slippery pulse.

This may be cancer of the breast, lymphoma, Hodgkin’s disease or thyroid cancer.

Damp-Heat

Afternoon fever, which may be high with delirium, headache, night sweating, mental restlessness, a feeling of oppression of the chest, oedema, nausea, Red tongue with sticky yellow coating, Slippery-Rapid pulse.

This may be cancer of the bladder, intestines, prostate or skin.

Toxic Heat

High fever, shivers, whole body hot to touch, cancer mass growing rapidly, purulent discharges, dark complexion, Red tongue with red points and thick, sticky, dry brown coating, Overflowing-Rapid pulse.

This may be cancer of oesophagus, lungs, stomach, intestines, breast or uterus.

Yin deficiency with Empty-Heat

Low-grade afternoon fever, late stage of cancer, five-palm heat, night sweating, malar flush, Red tongue without coating, Fine-Rapid pulse.

Stagnant Liver-Qi turned into Heat rebelling upwards

Low-grade afternoon fever, breast cancer, irritability, hypochondrial distension, sighing, Wiry pulse, tongue with Red sides.

Heat in Nutritive-Qi level

High fever, delirium, stage of rapid deterioration, mental confusion, maculae, dark-Red tongue without coating, Fine-Rapid pulse.

Yang deficiency

Midday low-grade fever, late stage of cancer, tiredness, chilliness, Pale tongue, Weak pulse.

Fever after chemotherapy

Stagnation of Qi and stasis of Blood

Low-grade fever, with no sweating, starts 3–5 days after the end of chemotherapy, Purple tongue, Wiry-Slow pulse.

Deficiency of Qi and Blood

Low-grade fever in the afternoon, poor appetite, loose stools, weak voice, palpitations, tiredness, blurred vision, dull-pale complexion, dizziness, Pale tongue, Weak or Choppy pulse.

Blood-Heat

Low-grade fever, thirst, mouth ulcers, blood in urine, red complexion, Red tongue, Rapid pulse.

FIVE-PALM HEAT

This is a feeling of heat in the palms, soles and chest, which is also sometimes called five-centre heat or five-heart heat. It may or may not be accompanied by an actual fever. It is usually accompanied by mental restlessness, night sweating and insomnia. This is frequently seen in practice; however, it may sometimes manifest only in the soles and palms, or in the palms and chest.

Yin deficiency with Empty-Heat

Five-palm heat in the afternoon, a desire to grasp cold objects, a desire to stretch hands and feet out of the blankets, dry throat at night, a feeling of heat in the evening, night sweating, malar flush, insomnia, anxiety, dry mouth with a desire to drink in small sips, Red tongue without coating, Floating-Empty and Rapid pulse.

This can be Yin deficiency of the Lungs, Heart, Liver, Kidneys, Stomach or Spleen.

Blood deficiency

Five-palm heat in the afternoon which is worse when tense or tired, dizziness, blurred vision, floaters, numbness/tingling of limbs, scanty menstruation, dull-pale complexion, Pale tongue, Choppy or Fine pulse.

Blood deficiency, like Yin deficiency, may also cause Empty-Heat and it usually occurs only in women, especially after the age of 40.

Liver-Fire

Five-palm heat, headaches, dizziness, tinnitus, irritability, propensity to outbursts of anger, red face, thirst, bitter taste, constipation, dark urine, Red tongue with redder sides and dry yellow coating, Wiry-Rapid pulse.

Although five-palm heat is nearly always associated with Yin deficiency, it may also be caused by Liver-Fire, but this is not common.

Latent Heat in Lesser Yin

Five-palm heat, low-grade fever, cold in the morning and hot at dusk, mental restlessness, insomnia, Red tongue without coating.

Clinical note

• Although five-palm heat involves three areas (the chest, the palms and the soles), the clinical significance would be the same if only two areas are involved, e.g. chest and palms, or chest and soles, or palms and soles.

CONTRADICTORY FEELINGS OF COLD AND HEAT

Simultaneous deficiency of Kidney-Yin and Kidney-Yang with prevalence of Kidney-Yin

Dizziness, tinnitus, night sweating, malar flush, a feeling of heat in the evening, but possibly also cold feet.

Simultaneous deficiency of Kidney-Yin and Kidney-Yang with prevalence of Kidney-Yang

Dizziness, backache, tinnitus, frequent urination, a pronounced feeling of cold, cold feet, but possibly also a feeling of heat in the afternoon.

Blood deficiency

Cold hands or feet, a feeling of cold, blurred vision, dizziness, tingling, dull ache in hands and feet, a feeling of heat in the face.

Disharmony of the Penetrating Vessel

Cold feet, a feeling of heat in the face, palpitations, anxiety, a feeling of tightness of the chest, a feeling of energy rising from the abdomen, irregular periods, painful period, Firm pulse.

Coexistence of a Heat and a Cold pattern in different organs

Example:

Kidney-Yang deficiency with Heart-Heat Lower backache, a feeling of cold in the back or generally, cold feet, frequent pale urination, dizziness, anxiety, red face, a feeling of heat in the face, insomnia, palpitations, Pale tongue but with a Red tip, Deep-Weak pulse.

This is just an example of a coexistence of a Cold and Heat pattern. This situation may arise in connection with many other organs, for example Kidney-Yang deficiency with Liver-Yang rising, Spleen-Yang deficiency with Heart-Heat, Kidney-Yang deficiency with Damp-Heat in the Bladder, Spleen-Yang deficiency with Liver-Fire, Spleen- and Kidney-Yang deficiency with Phlegm-Heat, etc.

Lesser-Yang pattern (Six Stages)

Alternation of aversion to cold and fever, bitter taste, dry throat, blurred vision, hypochondrial fullness and distension, absence of desire to eat or drink, irritability, nausea, vomiting, unilateral thin white tongue coating, Wiry-Fine pulse.

Gall-Bladder Heat (Four Levels)

Alternating hot and cold feeling with a prevalence of heat, bitter taste, thirst, dry throat, hypochondrial pain, nausea, a feeling of fullness in the epigastrium, Red tongue with unilateral sticky yellow coating, Wiry-Rapid pulse.

Clinical note

• In women over the age of 45, a simultaneous deficiency of Kidney-Yin and Kidney-Yang is more the rule than the exception.

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FEELING OF COLD, FEELING OF HEAT, FEVER

FEELING OF COLD, FEELING OF HEAT, FEVER

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