大意
发热恶寒者。发于阳也。无热恶寒者。发于阴也。（仲景）夜寒者。阴气旺于阴分。昼寒者。阴气上溢阳中。重阴
者。昼夜俱寒。（东垣）
内因
阳虚则外寒。阴盛则内寒。（内经）此第言阴阳正虚之病。他如风寒暑湿痰火郁瘀痈疮。一切邪气怫郁于
表。表中之阳气不能发越。皆令恶寒。（汇补）
外候
恶寒者。虽居密室帏幕之中。猛火近热之处。仍觉憎寒拘急。甚则毫毛毕直。鼓颔战栗。非若恶风之候。见
风则凛凛畏惧。无风则坦然自适也。（汇补）
阳虚恶寒
阳虚恶寒。以阳气能温分肉而充皮毛。肥腠理而司阖辟。（内经）内伤房欲。火衰恶寒。即热之不热。是无火
也。其症必兼蜷卧足冷。 自汗。两尺沉细。（汇补）
劳倦恶寒
劳倦恶寒。脉必缓弱。或气口虚大无力。兼见倦怠。手心独热。此劳倦过度。脾胃不足。卫阳下陷。宜补中益
气汤。甚加桂、附以行参、 之力。（东垣）
肺火恶寒
肺受火克。毛窍常疏。不能固腠理而洒淅恶寒者。必兼咳嗽咽干。治宜清金润肺。（汇补）
痰饮恶寒
痰饮恶寒。由痰滞上焦。荣卫阻滞。抑遏清道。不能固密腠理而恶寒。肥人多有此症。脉滑或沉。周身沉重。
胸满食减。肌肉如故。（汇补）
伤酒恶寒
伤酒恶寒。因饮酒太过。热郁在内。不得宣越而恶寒者。症兼口渴昏眩。（六要）
伤食恶寒
伤食恶寒。由饮食过度。宿食内停。或食冷物所致。脉必沉滑。恶心头痛。饱闷咽酸。宜从消导。食化而寒自
已。（六要）
疮毒恶寒
有背恶寒。脉弦数。寒热兼作。乃疮毒之候。审其有无痛处。随部分经用药。大抵恶寒之候。除气虚阳虚外。
均宜发越。以辛散之。（六要）
郁火恶寒
有素病虚热。忽觉恶寒。须臾战栗。如丧神守。此火郁清道。抑遏阳气于脾土。不得外越。故手足厥冷。乃火
极似水。热极反兼水化。自觉其寒。非真寒也。外症口苦溺赤脉数。宜升阳散火汤。（河间）
内外恶寒辨
外感恶寒。虽近烈火不除。内伤恶寒。稍就温暖即止。（东垣）
脉法
表虚者浮濡。火郁者沉数。阳衰者细迟。痰饮者滑数。大抵脉来无力而恶寒者虚症。脉来有力而恶寒者。
非外感。即内郁也。以见症参之。（汇补）
治法
阳虚者。益火之原。表虚者。固卫之失。脾虚者。补其中。火郁者。治其内。痰宜吐下。食宜消导。酒宜分越。（汇
补）
用药
卫不和而恶寒者。调中益气汤。脾胃弱。补中益气汤。阳虚。四君子加黄 、炮姜、肉桂、附子。表虚。黄 建中
汤。浊痰滞膈。先用姜茶探吐。后用通圣散加减。肺火。甘桔汤加酒芩、门冬、山栀。恶寒久不已。服诸药不效
者。亦宜解郁。大抵恶寒之症。种种不同。然世人以背恶寒属太阳经。此经气郁而不行。或浊痰阻滞经络。
药中必加羌活以散太阳之邪。
【附产后恶寒】
产后。气血两虚恶寒者。腹中不和。脉虚大无力。八珍汤。若小腹胀痛。是恶露。心下饱闷。是食滞。乳中胀痛。
是蒸乳。四者皆令恶寒。宜详辨之。（汇补）
【附呻欠】
足阳明之脉。是动则病振振寒。善伸数欠。欠者阳引而上。阴引而下。阴阳相引。俗名呵欠。（汇补）
恶寒选方
补中益气汤 四君子汤（二方俱见中风） 调中益气汤 黄 建中汤（二方俱见劳倦） 升阳散火汤（即火郁汤）
防风通圣散（二方俱见火症） 升麻葛根汤（方见伤暑）
甘桔汤 治肺受火克。洒淅恶寒。
甘草 桔梗
加酒芩、山栀、麦冬、五味、枣仁。水煎。
黄 葛根汤 治酒郁。内热恶寒。
黄 （一两） 葛根（五钱）
煎服。大汗而愈。
如痰湿恶寒。宜苦参、赤小豆各一钱。为末。蜜水调服探吐。吐后。以苍术、川芎、南星、黄芩糊丸。白汤下。冬
月去芩加姜汁为丸。
【大意】
发热且恶寒的，是病发于阳经。不发热而仅恶寒的，是病发于阴经。（引自张仲景）夜间感到寒冷的，是因为阴气在阴分旺盛；白天感到寒冷的，是因为阴气上溢至阳分；阴阳俱盛的，则是昼夜都感到寒冷。（引自李东垣）
【内因】
阳气虚弱则体表生寒，阴气亢盛则体内生寒。（引自《黄帝内经》）这里只论述了阴阳正气虚损导致的病症。其他的如风寒暑湿、痰火郁结、瘀血痈疮等，一切邪气郁闭于体表，导致体表的阳气不能宣发透达，都会引起恶寒。（引自本书）
【外候】
所谓恶寒，即使身处密室帷帐之中，靠近猛火热源之处，仍然觉得怕冷拘急，严重时毫毛竖立，下巴打颤，身体战栗。这与恶风不同，恶风是见到风就凛然畏惧，无风时则坦然舒适。（引自本书）
【阳虚恶寒】
阳气虚弱导致的恶寒，是因为阳气能温煦肌肉皮肤，充盈腠理并控制其开合。（引自《黄帝内经》）因房事过度损伤元气，命门火衰导致的恶寒，即使用热药治疗也不见效，这是“无火”的表现。此类症状必然伴有蜷缩卧睡、脚冷、自汗、两尺脉沉细。（引自本书）
【劳倦恶寒】
因劳累倦怠导致的恶寒，脉象必定缓弱，或者气口脉虚大无力，兼见疲倦乏力，手心单独发热。这是由于劳倦过度，脾胃不足，卫阳之气下陷所致。宜用补中益气汤治疗，严重者加桂枝、附子以辅助人参的作用。（引自李东垣）
【肺火恶寒】
肺受火邪克制，毛孔常处于疏松状态，不能固密腠理而出现洒淅般的恶寒，必然兼有咳嗽、咽干等症状。治疗宜清金润肺。（引自本书）
【痰饮恶寒】
痰饮导致的恶寒，是由于痰滞留在上焦，营卫之气阻滞，压抑了清阳之道，不能固密腠理而导致恶寒。肥胖的人多有此症，脉象滑或沉，周身沉重，胸满食少，但肌肉形态如故。（引自本书）
【伤酒恶寒】
饮酒过量导致的恶寒，是因为酒热郁结在内，不得宣散透达而引起恶寒，症状兼有口渴、昏眩。（引自《证治要诀》）
【伤食恶寒】
饮食过度导致的恶寒，是由于宿食停滞在内，或是食用生冷食物所致。脉象必定沉滑，伴有恶心、头痛、饱闷、咽酸等症状。宜采用消导法治疗，食积化解后寒冷自然消失。（引自《证治要诀》）
【疮毒恶寒】
出现背部恶寒，脉象弦数，寒热交替发作，这是疮毒的征候。需仔细审查是否有疼痛部位，根据病变所属经络用药。大抵而言，除气虚、阳虚引起的恶寒外，其他均宜宣发散越，使用辛散药物。（引自《证治要诀》）
【郁火恶寒】
素有虚热病史，忽然感觉恶寒，片刻后战栗，神志恍惚如失守，这是因为火郁闭塞清道，压抑阳气于脾土，不得向外宣越，所以手足厥冷。这是“火极似水”，热极反而兼有水化之象，自觉寒冷并非真寒。外在症状可见口苦、尿赤、脉数。宜用升阳散火汤治疗。（引自刘河间）
【内外恶寒辨】
外感引起的恶寒，即使靠近烈火也不能缓解；内伤引起的恶寒，稍微靠近温暖处即可停止。（引自李东垣）
【脉法】
表虚者脉浮濡，火郁者脉沉数，阳衰者脉细迟，痰饮者脉滑数。大抵脉来无力而恶寒的是虚证，脉来有力而恶寒的，不是外感就是内郁。需结合具体症状参详判断。（引自本书）
【治法】
阳虚者，益火之源；表虚者，固护卫气；脾虚者，补益中气；火郁者，调理内部；痰证宜吐下，食积宜消导，酒郁宜分消宣越。（引自本书）
【用药】
卫气不和而恶寒者，用调中益气汤；脾胃虚弱者，用补中益气汤；阳虚者，四君子汤加黄芪、炮姜、肉桂、附子；表虚者，黄芪建中汤；浊痰阻滞膈部，先用姜茶探吐，后用防风通圣散加减；肺火者，甘桔汤加酒炒黄芩、麦冬、山栀。恶寒久治不愈，服用各种药物无效者，也宜解郁。大抵世人认为背恶寒属于太阳经，这是经气郁结不行，或浊痰阻滞经络所致，用药中必加羌活以疏散太阳经之邪。
【附产后恶寒】
产后气血两虚导致恶寒者，腹中不适，脉虚大无力，用八珍汤。若小腹胀痛，是恶露不尽；心下饱闷，是食滞；乳房胀痛，是乳汁淤积（蒸乳）。这四种情况都会导致恶寒，宜详细辨别。（引自本书）
【附呻欠】
足阳明胃经发生变动，会生病振振恶寒，喜欢伸展，频繁打哈欠。“欠”是阳气向上牵引，阴气向下牵引，阴阳相互牵引，俗称呵欠。（引自本书）
【恶寒选方】
补中益气汤、四君子汤（以上二方均见于中风章节）、调中益气汤、黄芪建中汤（以上二方均见于劳倦章节）、升阳散火汤（即火郁汤）、防风通圣散（以上二方均见于火症章节）、升麻葛根汤（方见伤暑章节）。
甘桔汤：治疗肺受火邪克制，出现洒淅恶寒。
组成：甘草、桔梗。
加味：酒炒黄芩、山栀、麦冬、五味子、枣仁。水煎服。
黄芪葛根汤：治疗酒郁，内热恶寒。
组成：黄芪（一两）、葛根（五钱）。
煎服：大汗出而愈。
如属痰湿恶寒，宜用苦参、赤小豆各一钱，研为末，蜜水调服以探吐。吐后，以苍术、川芎、南星、黄芩糊丸，白开水送下。冬季去黄芩，加姜汁制丸。
[General Principles]
Fever accompanied by aversion to cold indicates disease originating in the Yang aspect. Aversion to cold without fever indicates disease originating in the Yin aspect. (Zhang Zhongjing) Chills occurring at night indicate that Yin Qi is flourishing in the Yin divisions; chills occurring during the day indicate that Yin Qi has overflowed into the Yang divisions; when both Yin and Yang are excessive, chills occur throughout the day and night. (Li Dongyuan)
[Internal Causes]
Yang deficiency leads to exterior cold, while Yin excess leads to interior cold. (Huangdi Neijing) This section discusses only diseases caused by the positive deficiency of Yin and Yang. Other conditions such as wind-cold, summer-heat, dampness, phlegm-fire stagnation, blood stasis, and carbuncles/cancers involve all pathogenic factors obstructing the exterior. When the Yang Qi in the exterior cannot be dispersed and vented, it results in aversion to cold. (Zhengzhi Huibu)
[External Manifestations]
Aversion to cold means that even when residing in a sealed room with curtains, or near intense heat sources like roaring fires, one still feels chilly and constrained. In severe cases, body hair stands on end, the jaw trembles, and the body shivers. This differs from aversion to wind (Wei Feng), where fear arises only upon exposure to wind, and comfort is felt when there is no wind. (Zhengzhi Huibu)
[Aversion to Cold due to Yang Deficiency]
Aversion to cold due to Yang deficiency occurs because Yang Qi warms the muscles and skin, fills the interstices (Cou Li), and controls their opening and closing. (Huangdi Neijing) Damage from excessive sexual activity leading to fire decline causes aversion to cold; if heating treatments fail to produce warmth, this indicates "absence of Fire." Symptoms necessarily include curling up while lying, cold feet, spontaneous sweating, and deep, fine pulses at the Chi position. (Zhengzhi Huibu)
[Aversion to Cold due to Fatigue and Overexertion]
Aversion to cold due to fatigue and overexertion presents with a slow and weak pulse, or a deficient and large but powerless pulse at the Qi Kou position, accompanied by lassitude and distinct heat in the palms. This results from excessive labor causing Spleen-Stomach insufficiency and sinking of Defensive Yang Qi. Treatment should employ Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). In severe cases, add Cinnamon Twig (Guizhi) and Prepared Aconite Root (Pao Fuzi) to enhance the action of Ginseng Radix (Renshen). (Li Dongyuan)
[Aversion to Cold due to Lung Fire]
When the Lung is controlled by Fire, pores remain loose, failing to secure the interstices, resulting in aversion to cold with shivering. This is necessarily accompanied by cough and dry throat. Treatment should clear Metal and moisten the Lung. (Zhengzhi Huibu)
[Aversion to Cold due to Phlegm-Fluids]
Aversion to cold due to Phlegm-Fluids arises from phlegm stagnating in the Upper Jiao, obstructing Ying and Wei Qi, suppressing the Clear Orifices, and preventing the securing of interstices. Obese individuals often suffer from this. The pulse may be slippery or deep, with heaviness of the whole body, chest fullness, reduced appetite, while muscle mass remains unchanged. (Zhengzhi Huibu)
[Aversion to Cold due to Alcohol Injury]
Aversion to cold due to excessive alcohol consumption occurs because heat from alcohol stagnates internally and cannot be vented. Symptoms include thirst and dizziness. (Zhengzhi Yaojue)
[Aversion to Cold due to Food Injury]
Aversion to cold due to dietary excess results from retained food stagnating internally or consumption of cold foods. The pulse is necessarily deep and slippery, accompanied by nausea, headache, abdominal fullness, and sour regurgitation. Treatment should focus on digestion and elimination; once food stagnation resolves, the cold sensation disappears. (Zhengzhi Yaojue)
[Aversion to Cold due to Carbuncle Toxins]
Back aversion to cold, with a wiry and rapid pulse, alternating chills and fever, indicates signs of carbuncle toxins. One must carefully examine for painful areas and prescribe medication according to the affected meridian. Generally, except for aversion to cold caused by Qi or Yang deficiency, other forms should be dispersed and vented using acrid-dispersing herbs. (Zhengzhi Yaojue)
[Aversion to Cold due to Stagnant Fire]
In patients with chronic deficiency-heat who suddenly feel aversion to cold followed by shivering and mental confusion, this is due to Fire stagnation blocking the Clear Orifices and suppressing Yang Qi in the Spleen-Earth, preventing external venting, thus causing cold extremities. This is "Fire extreme resembling Water," where extreme heat mimics water transformation; the perceived cold is not true cold. External symptoms include bitter taste, dark urine, and rapid pulse. Treatment should employ Shengyang Sanhuo Tang (Raise Yang and Disperse Fire Decoction). (Liu Wansu)
[Differentiation of Internal vs. External Aversion to Cold]
Exterior contraction aversion to cold persists even near intense fire; Interior injury aversion to cold ceases slightly upon seeking warmth. (Li Dongyuan)
[Pulse Diagnosis]
Exterior deficiency presents with floating and soggy pulses; Fire stagnation presents with deep and rapid pulses; Yang decline presents with fine and slow pulses; Phlegm-fluids present with slippery and rapid pulses. Generally, a powerless pulse with aversion to cold indicates a deficiency syndrome; a powerful pulse with aversion to cold indicates either exterior contraction or internal stagnation. Correlate with clinical manifestations. (Zhengzhi Huibu)
[Therapeutic Methods]
For Yang deficiency, benefit the source of Fire; for exterior deficiency, secure the loss of Defensive Qi; for Spleen deficiency, tonify the Middle; for Fire stagnation, treat the interior; for Phlegm, induce vomiting or purging; for Food stagnation, promote digestion; for Alcohol stagnation, separate and vent. (Zhengzhi Huibu)
[Medication Selection]
For aversion to cold due to Disharmony of Defensive Qi, use Tiaozhong Yiqi Tang; for weak Spleen-Stomach, use Buzhong Yiqi Tang; for Yang deficiency, use Sijunzi Tang added with Astragali Radix (Huangqi), Roasted Ginger (Pao Jiang), Cinnamon Bark (Rougui), and Prepared Aconite Root (Fuzi); for exterior deficiency, use Huangqi Jianzhong Tang; for turbid phlegm obstructing the diaphragm, first induce vomiting with ginger-tea, then modify Fangfeng Tongsheng San; for Lung Fire, use Ganjie Tang added with Wine-fried Scutellariae Radix (Jiu Huangqin), Ophiopogonis Radix (Maidong), and Gardeniae Fructus (Shanzhi). For prolonged aversion to cold unresponsive to various medicines, resolving stagnation is also appropriate. Generally, people attribute back aversion to cold to the Taiyang Meridian, indicating stagnation of meridian Qi or obstruction by turbid phlegm; medications must include Notopterygii Rhizoma et Radix (Qianghuo) to disperse Taiyang pathogens.
[Appendix: Postpartum Aversion to Cold]
Postpartum aversion to cold due to dual deficiency of Qi and Blood presents with abdominal discomfort and a large, powerless, deficient pulse; use Bazhen Tang. If lower abdominal distension and pain occur, it is lochia retention; if epigastric fullness occurs, it is food stagnation; if breast distension and pain occur, it is milk engorgement. All four conditions cause aversion to cold and require detailed differentiation. (Zhengzhi Huibu)
[Appendix: Yawning]
When the Foot-Yangming Meridian undergoes change, it causes trembling chills, a desire to stretch, and frequent yawning. "Yawning" involves Yang Qi pulling upward and Yin Qi pulling downward, with Yin and Yang pulling each other, commonly known as yawning. (Zhengzhi Huibu)
[Selected Formulas for Aversion to Cold]
Buzhong Yiqi Tang, Sijunzi Tang (both see Stroke chapter), Tiaozhong Yiqi Tang, Huangqi Jianzhong Tang (both see Fatigue chapter), Shengyang Sanhuo Tang (i.e., Huoyu Tang), Fangfeng Tongsheng San (both see Fire Syndrome chapter), Shengma Gegen Tang (see Summerheat chapter).
Ganjie Tang: Treats aversion to cold with shivering due to Lung controlled by Fire.
Ingredients: Licorice Root (Gancao), Platycodon Root (Jiegeng).
Additions: Wine-fried Scutellariae Radix (Jiu Huangqin), Gardeniae Fructus (Shanzhi), Ophiopogonis Radix (Maidong), Schisandrae Fructus (Wuweizi), Ziziphus Jujuba Seed (Suanzaoren). Decoct in water.
Huangqi Gegen Tang: Treats alcohol stagnation with interior heat and aversion to cold.
Ingredients: Astragali Radix (Huangqi, 1 liang), Puerariae Lobatae Radix (Gegen, 5 qian).
Decoct and take. Recovery follows profuse sweating.
For aversion to cold due to Phlegm-Dampness, use Sophorae Flavescentis Radix (Kushen) and Adzuki Bean (Chixiaodou), 1 qian each, powdered, mixed with honey-water to induce vomiting. After vomiting, formulate pills with Atractylodis Macrocephalae Rhizoma (Cangzhu), Ligusticum Chuanxiong Rhizoma (Chuanxiong), Pinelliae Tuber (Nanxing), and Scutellariae Radix (Huangqin) using paste. Take with warm water. In winter, remove Scutellariae Radix and add Ginger Juice for pill formulation.