COLD

written by: Yejin Go, Heeyeon Shin, Dahye Jeong,
Wonkyung Moon, and Sunwoong Kim (in order of writing)
edited by: Wonkyung Moon

It is very easy to catch cold, but most people do not think of it as a big deal. However, it is difficult to define what a cold is, since it is very complicated. Even in some cases where people show symptoms that are often closely connected to cold, such as cough and runny nose, it often turns out that they do not have cold. Thus, we would like to find out how cold can be defined.
First, how is cold defined in Western Medicine? In WM, cold means inflammation in respiratory organs such as the nasal cavity, throat, bronchial tubes, or lung. It does not sound like a serious disease, buy its factors vary. However, its symptoms do not seem to vary as much as the factors, and they are cough, runny nose, hoarse throat, sore throat, fever, headache, and fatigue.
In Oriental Medicine, cold is a disease pattern(證) which includes secondary symptoms(症) that are presented when wind pathogen(風邪) or cold pathogen(寒邪) enters the exterior part(表部) of the body, and/or when the qi in the exterior part(表部) is weak.

CAUSES OF COLD

While viruses are the main cause of cold in Western Medicine, TKM(traditional Korean medicine) takes a different point of view. There are two ways cold can occur in the human body, and they are when pathogens enter the body, or when the body is weak. The former, when the cause is limited only to pathogenic qi(邪氣) such as wind or cold pathogens(風邪, 寒邪), is called external contraction of wind-cold syndrome(外感風寒證). The latter, when the body displays cold-like symptoms because the body, more specifically healthy qi(正氣), has become weak, is called external contraction caused by deficient body(體虛外感證).
To put it in a nutshell, causes of cold can be summarized as the following: 1) when outer pathogenic qi(邪氣), such as wind pathogen(風邪) or cold pathogen(寒邪) enter the body, and 2) when inner healthy qi(正氣) has become deficient.

SYMPTOMS OF COLD

The occurrence of the common cold can be divided into two major categories; one is external contraction of wind-cold syndrome(外感風寒證), and the other is external contraction caused by the deficiency of the human body(體虛外感證).
First, if the exterior part of the body is infected with the pathogenic wind and cold(風邪, 寒邪), characterized by their cool nature, the pathogenic qi(邪氣) enters and fetters the superficial part(表部), or the greater yang(太陽) part of the exterior(表部). It affects the Lung, which is in charge of breathing-qi, and the defensive qi(衛氣), which wards off external pathogens. Since the Lung governs the skin and hair and nose, the skin and hair then get tensed up and the sweat pores, or the interstices(腠理), are tightly closed; hence there is lack of sweating or anhydrosis(無汗). Moreover, the defense yang(衛陽) is not able to warm the flesh, hence there is an aversion to Cold or Wind(惡寒, 惡風).
The manifestations of external contraction of wind-cold syndrome(外感風寒證) include aversion to Cold or Wind(惡寒, 惡風), fever(發熱), headache and painful stiff nape(頭項强痛), body aches(身痛), nasal congestion, dyspnea and cough(咳逆上氣), tongue with thin whitish fur(舌苔薄白) and a floating and tense pulse(浮緊脈).
Aversion to cold and wind(惡寒, 惡風) occurs, since the pathogenic Wind and Cold(風邪, 寒邪), which intrude the exterior surface of the body(表部), inhibit the defense yang(衛陽) to reach the exterior and to warm the flesh. Fever(發熱) occurs as a result of the struggle between the healthy qi(正氣) and the pathogenic qi(邪氣) in the skin.
As mentioned above, external contraction of Wind-Cold syndrome(外感風寒證) is the greater yang disease pattern(太陽病). The corresponding channel, which is called the bladder meridian(足太陽膀胱經), arises at the inner canthus of the eye(目銳眥), runs up to the forehead and vertex(巓頂), down the neck and travels along the back of the body. Thus, when the greater yang channel(太陽經) qi contracts the pathogenic Cold and Wind(寒邪, 風邪), there is severe headache and painful stiff nape(頭項强痛). Body aches(身痛) commonly appear when the pathogenic Wind and Cold(風邪, 寒邪) violate the body in combination with the pathogenic Dampness(濕邪). Then, the Wind, Cold, and Dampness pathogens(風邪, 寒邪, 濕邪) become lodged in the channels and block the flow of the channel qi, hence there is pain in the joints.
The pathogenic qi(邪氣) entering the nose, which is an orifice through which the Lung breathes in the gathering-qi, leads to nasal congestion in the case of the cold pathogen(寒邪) and thin nasal discharge(鼻流淸涕) in the case of the wind pathogen(風邪). Dyspnea and cough(咳逆上氣) arises from the upward disturbance of the Lung qi, which occurs due to the invasion of the Wind-Cold pathogen(風寒邪) in the Lung. The lung qi fails to disperse and descend. Instead, it ascends, giving rise to cough and asthmatic breathing.
A floating pulse(浮脈) is a sign of the wind-cold pathogen(風寒邪) lodging in the exterior(表部) and loss of regulation between the nutrient qi(營氣) and defensive qi(衛氣). In order to resist the pathogenic qi(邪氣), the defensive qi(衛氣) collects in the exterior(表部), hence the pulse is floating. A thin white tongue fur(舌苔薄白) indicates the onset of an exterior syndrome(表證) and the presence of pathogenic factors on the surface of body. It denotes a syndrome of Cold(寒) or Cold-Dampness(寒濕).
On the other hand, the symptoms and pathogenesis of external contraction caused by the deficient body(體虛外感證) differ from those of external contraction of wind-cold syndrome(外感風寒證). Along with the symptoms of the latter, the former shows the signs of Qi deficiency(氣虛). Qi deficiency(氣虛) manifests as spontaneous sweating(汗出), distention and fullness in the chest, nasal congestion, deep and turbid voice, dry cough with phlegm, and a floating and forceless pulse.
The lack of the healthy Qi(正氣) leads to the lack of securing by the defense yang(衛陽), which manages the opening and closing of the sweat pores. Thus, the weak defensive Qi(正氣) that fails to appropriately control the opening and closing of the pores engenders spontaneous perspiration(汗出). Distention and fullness in the chest is a syndrome due to deficiency of Qi(氣虛), which results in the failure to expel the pathogenic Qi(邪氣). The pathogenic Qi(邪氣) transmuted to the interior causes the unwell feeling of stuffiness in the chest.
The patterns including nasal congestion, deep and turbid voice, and dry cough with phlegm are due to the dysfunction of the Lung in dispersing and descending(宣發肅降). A voice that is heavy and turbid, accompanied by nasal congestion, is developed by the pathogenic Qi(邪氣) entering through the nose and causing the Qi of the nose to become obstructed and not flow. The prolonged cough consumes the Lung qi. As a consequence, the deficiency of the Lung qi results in the impairment of the Lung in dominating qi and its function of descending.
A floating and forceless pulse is a manifestation of exterior deficiency syndrome. It indicates both deficiency of the healthy qi(正氣) and excessiveness of the pathogenic qi(邪氣). Specifically, a forceless pulse indicates deficiency of qi, blood, yin, yang and the viscera and bowels.

GENERAL METHODS OF TREATMENT

*The Method of Treatment of Six-Meridian Disease(六經病證)

In a word, the method of treatment(治則) of six-meridian disease, discussed in "Treatise on Cold Damage Diseases", is defeating the pathogenic qi and supporting the healthy qi. The fundamental is "developing the yang-qi" and "keeping the yin fluid", so we have to eliminating the pathogenic qi and to stabilizing the healthy qi.
The basis for method of treatment are eight methods(八法) - sweat[汗], vomiting[吐], purgation[下], harmonizing method[和], warming method[溫], clearing method[淸], wasting method[消], supplementation method[補]. In 'Damage by the Cold', the method of treatment - eight methods by eight principle pattern identification - for the cold is usually using those three methods : sweat[汗], vomiting[吐], purgation[下]. And the most important method is sweat.
- sweat : extract the pathogenic qi.
- vomiting : refuse the pathogenic qi, mainly in external contraction food accumulation.
- purgation : drain the pathogenic qi.
sweat method is mainly used in case of accumulation in exterior. In case of exterior pathogen, vomiting or purgation is also possible, but those are un-proper for sudden outer-pathogenic qi. Also purgation can cause side effect draining disorder from exterior to interior, and vomiting can draining blood and fluid, besides external contraction food accumulation, so it can cause deficiency of fluid. Therefore in case of exterior pathogen being excess, sweat method is apposite.

*Fundamentals of Method of Treatment

We have to treat, while pathogenic qi is in exterior. While pathogenic qi is in exterior, it's easy to treat but delaying can make it chronic disease. The cause of disease affected by heat is wind and cold, so it start at exterior. First of all this cases need sweating method. Anyway, whatever location of disease, it's good to sweat.
We have to check whether the patient have exterior deficiency or exterior cold, treat disease affected by heat with sweat. That's why untreated heat with sweat has usually exterior deficiency or exterior cold. The disease pattern untreated with sweat is not need purgation.
1) External Contraction of Wind-cold Syndrome(外感風寒證)
The fundamental of method of treatment is not difficult. We have to think the route of invasion of pathogenic qi in the reverse order. Thus, the fundamental is that draw out pathogenic qi, and main method is sweat. The main symptoms, affected by wind and cold pathogen, are non-sweat and goose bump caused by clogging of interstices. That's why defense yang-controlling interstices-is forced out by pathogenic qi and can't accomplishment it's function well. So, we need to use medicine to help defense yang to force out external pathogen. It's natural to sweat in this process. That's why defense yang restores it's function and heats fleshy. Thus interstices restore it's function, and pores open and sweat naturally.
2) External Contraction Caused by Deficient Body(體虛外減證)
Pattern of fleshy deficiency with external contraction means deficiency of healthy qi of fleshy. Also, this case needs to sweat to force pathogenic qi out of body. But in this case, already body has spontaneous sweating. We have to know differences between sweat and spontaneous sweating. In case of deficiency of fleshy and getting external pathogen, there is discord with nutrient yin - which nutrients body all the corners - and defense yang. Thus, differently from pattern of wind and cold excess with external contraction, which non-sweat and defense yang forced out from pathogenic qi, defense yang can't be controlled by nutrient yin and role it's function, thus interstices open and sweat. This sweat is "spontaneous sweating" which means lose of healthy qi and diseased sweating. That's why nutrient-defense disharmony, so damages healthy qi, but sweat fills a role to eliminate pathogenic qi by nutrient-defense harmony. In this case, also, we need to eliminate stagnated pathogenic qi with perspiration by sweating. The fundamental of method of treatment is that help healthy qi and accord nutrient and defense thus accord nutrient yin with defense yang, and draw out pathogenic qi at the same time.

*The Method of Treatment of Cold - Based on Six Meridian Disease by Treatise on Cold Damage Diseases

Oriental Medicine thinks that cold is caused by six excesses(六淫) which means un-normal weather condition - wind, cold, summer-heat, dampness, dryness, fire. From among these, wind and cold are regarded as most important factor. Thus cold is divided into cold-damage pattern and wind-damage pattern.
Greater yang(太陽) indicates bladder meridian(足太陽膀胱經) and small intestine meridian(手太陽小腸經). Bladder meridian(足太陽膀胱經) is assigned to bladder commencing from the inner canthus(BL-1), ascending to the forehead and joints its symmetrical channel at the vertex(GV-20), where a branch splits off running to the temple. The original channel enters into and communicates with the brain from the vertex, then re-emerges, bifurcating at the back of the neck and running downward along the medial side of the scapula, then parallel to the vertebral column to the lumbar region where it enters the body cavity through the para-vertebral muscles, communicating with the kidney and finally joining its pertaining organ, the urinary bladder. This meridian administers the exterior. Therefore, the disease named "greater yang" means the illness caused by external pathogen(外邪).
Greater yang disease is early stage of external contraction disease(外感病), which means healthy qi and pathogenic qi conflicting on the exterior point. The exterior(表) is the first bulwark defending pathogen and its function is controlled by ups and downs of defense qi(衛氣) and nutrient-defense harmony. Greater yang governs nutrient-defense, controls exterior of body, and defense body from pathogen. Several symptoms of cold are caused by those reasons that nutrient-defense disharmony, defense yang flourishing outwardly in opposing pathogen, and pathogen is so strong to greater yang meridian qi is overwhelmed.
Greater yang exterior pattern looks mild and unimportant. But, if missed the right time to treatment or got erroneous treatment, exterior pathogen could be left or get other symptoms. Therefore exterior pattern have to treated carefully at first time.

HERBAL TREATMENT

As mentioned above, there can be two reasons as to how cold can occur in the human body; One, where wind pathogen(風邪) or cold pathogen(寒邪) invades the outermost part of the body because pathogenic qi(邪氣) is excessive(external contraction of wind-cold syndrome, 外感風寒證), and two, where the body displays cold-like symptoms because internal healthy qi(正氣) has become deficient(external contraction caused by deficient body, 體虛外感證). Herbal treatment differs according to each circumstance, but even though there exist two different methods to treating cold, this writer would like to focus on the treatment of external contraction of wind-cold syndrome(外感風寒證), because it is considered a more general way of treating cold. The ground for taking external contraction of wind-cold syndrome(外感風寒證) more seriously than external contraction caused by deficient body(體虛外感證) is mentioned in 'The Causes of Cold' part.
First, wind-cold-dispersing medicinal(發散風寒藥), which is a kind of exterior-releasing medicinal(解表藥), is used in order to treat external contraction of wind-cold syndrome(外感風寒證). Exterior-releasing medicinal(解表藥) acts by dispersing the pathogenic qi(邪氣) impeded in the exterior part of the human body, and it enters the lung and bladder meridians. It treats symptoms such as aversion to cold(惡寒), fever(發熱), headache(頭痛), and generalized pain(身痛). It comprises of two categories: wind-cold-dispersing medicinal(發散風寒藥) and wind-heat-dispersing medicinal(發散風熱藥). Because external contraction of wind-cold syndrome(外感風寒證) is a syndrome caused by wind and cold pathogens, the former(wind-cold-dispersing medicinal, 發散風寒藥) is used to treat its symptoms. Wind-cold-dispersing medicinal(發散風寒藥) has pungent and warm properties, dispersing qi with its pungency and driving out cold pathogen with its warmness. Many kinds of materia medica such as Ephedrae Herba(麻黃), Cinnamomi Ramulus(桂枝), Osterici Radix(羌活), Angelicae Dahuricae Radix(白芷), Angelicae Tenuissimae Radix(藁本), and Saposhnikoviae Radix(防風) are used as wind-cold-dispersing medicinal(發散風寒藥), but among these, only Ephedrae Herba(麻黃), Cinnamomi Ramulus(桂枝), and Osterici Radix(羌活) will be introduced in this part. Effects of each on external contraction of wind-cold syndrome(外感風寒證) can be summarized as the following respectively: promoting sweating to release the exterior(發汗解表), releasing the flesh and promoting sweating, and relieving pain caused by stagnation of wind-cold-dampness.
Ephedrae Herba(麻黃) is the stem of Ephedra sinica Stapf(草麻黃), which is a perennial herb that belongs to Family Ephetraceae(麻黃科). It has pungent and warm properties, and it enters the lung and bladder meridians. Because the skin and hair pertain to the lung and exterior part of body to the bladder, Ephedrae Herba(麻黃) is effective in promoting sweating to release the exterior(發汗解表) and dissipating cold(散寒). Thus, it treats excessive pathogenic qi in the exterior and absence of sweating(無汗) caused by external contraction of wind-cold pathogen(外感風寒). It also diffuses lung to calm panting(宣肺平喘) and induces diuresis to alleviate edema(利水消腫), and it treats cold caused by wind-cold pathogen(風寒感冒), oppression in the chest(胸悶), wind edema(風水浮腫), and wheezing and dyspnea in the bronchi(氣管支哮喘).
Cinnamomi Ramulus(桂枝) is the young branch of Cinnamomum cassia Blume(肉桂), which is an evergreen arbor that belongs to Family Lauraceae(樟科). It has pungent, sweet, and warm properties, and it enters the heart, lung and bladder meridians. Its pungent taste disperses qi and its warm property disperses wind-cold pathogen in the exterior, thus having the effect of releasing the interstices(腠理). Its effects are promoting sweating to release the exterior(發汗解表), warming the meridian(溫經), and assisting yang(助陽). It also treats cold caused by wind-cold pathogen(風寒感冒), cold pain in the abdomen(脘腹冷痛), numb pain in the joints(關節痹痛), phlegm(痰飮), edema(水腫), and palpitations(心悸).
Osterici Radix(羌活) is the root of Ostericum koreanum Maximowicz(羌活), which is a perennial herb that belongs to Family Umbelliferae(繖形科). It has pungent and bitter taste and warm property, and it enters the bladder and kidney meridians. Because Osterici Radix(羌活) has ascending and dispersing effects, it disperses cold-dampness pathogen in the exterior part of the body and relieves pain in the joints. Thus, it is strongly effective in treating headache and generalized pain(頭身疼痛) caused by external contraction of wind-cold pathogen(外感風寒) and pain in the joints(關節疼痛) caused by wind-cold-dampness pathogen. Osterici Radix(羌活) is effective in dissipating cold(散寒), dispelling wind(祛風), eliminating dampness(除濕), and alleviating pain(止痛), and it can treat numb pain caused by wind-dampness pathogen(風濕痺痛) and aching pain in the shoulders and back(肩背痠痛). Major prescriptions that contain the above materia medica include Mahwangtang, Gyejitang, Gumiganghwaltang, and Socheongnyongtang.
Next, qi-tonifying medicinal(補氣藥) is used with above-mentioned exterior-releasing medicinal(解表藥) in order to treat external contraction caused by deficient body(體虛外感證). This is to help healthy qi(正氣) before driving out pathogenic qi(邪氣) in the exterior part when healthy qi(正氣) is deficient in the body. Qi-tonifying medicinal(補氣藥) is a kind of tonifying and replenishing medicinal(補益藥), and its original purpose is to treat symptoms related to deficient qi(氣虛), but harmonizing nutrient qi and defense qi(調和營衛) is considered as the main efficacy in this text. Herbs such as Ginseng Radix(人蔘), Astragali Radix(黃芪), and Glycyrrhizae Radix(甘草) are used as qi-tonifying medicinal(補氣藥). They usually have sweet and warm properties, and they enter the spleen and lung meridians, assisting the spleen and lung so healthy qi(正氣) can become stronger. The spleen creates acquired qi(後天之氣) by receiving water and food(水穀), and the lung plays an important role in creating qi by gathering breathing qi(天氣). Therefore, helping these two meridians result in replenishment of healthy qi(正氣) in the body, which in turn leads to expulsion of pathogenic qi(邪氣). Paedoksan and Samsoeum are examples of such prescriptions.

ACUPUNCTURE TREATMENT

In Oriental Medicine, Cold is interpreted as external contraction of wind-cold syndrome in a broad sense. So, the treatment of acupuncture and moxibustion for cold is described according to the factors — wind-pathogen(風邪) or cold pathogen(寒邪) — in several medical books.
Thus, this chapter explains the treatments about wind(風) and cold(寒) section. The source of the following sentences is Dong-ui-bo-gam(東醫寶鑑) which is Traditional Korean medical book.
First, Cold Chapter(寒門) in the volume of various diseases(雜病篇) in Dong-ui-bo-gam is described cold that place under the external contraction of cold syndrome category in detail than Wind Chapter(風門) in the volume of various diseases(雜病篇) in Dong-ui-bo-gam. Especially, in the first stage which is caught a cold, if you got a headache and fever, you should cauterize the CV14(巨闕), CV13(上脘), CV12(中脘) with moxa. In addition, when you caught a cold, Dong-ui-bo-gam describes several prescription of acupuncture and moxibustion in each symptom which is accompanied with cold.
1. When you get an obstinate fever, you should apply acupuncture at LI11(曲池) for eliminate(瀉) and at Jeol-Gol(絶骨) for strengthen and at ST43(陷谷) or and at Pal-Gwan(between fingers;interdigital) for blood-letting.
2. When you get a headache which is because of cold, you should apply acupuncture at BL2(攢竹) or LI4(合谷).
3. When you don`t sweat, you should apply acupuncture at LI4(合谷) and KI7(復溜), SP5(商丘), GB12(脘骨), SI5(陽谷), GB43(俠谿), ST45(厲兌), PC8(勞宮), GB20(風池), LU10(魚際), LU8(經渠), ST44(內庭), and 12 honor acupuncture points(榮穴).
4. When you have a lot of sweat, and don`t stop it, you should apply acupuncture at ST44(內庭), LI4(合谷), KI7(復溜) for eliminate(瀉).
5. When you have chest pain, you should apply acupuncture at LR14(期門), PC7(大陵).
6. When your sides hurt, you should apply acupuncture at TE6(支溝), GB34(陽陵泉).
7. When your hands and feet are cold, you should apply acupuncture at SP2(大都穴).
8. When your fever lessens and then strengthens again, you should apply acupuncture at BL12(風門), LI4(合谷), LR2(行間).
But, there are just 9 taboos about applying acupunctures in cold.
First, No sweat and when you have a pink glow or get the hiccups.
Second, When you have a diarrhea, and have a abdominal dropsy.
Third, When you have blurry vision or your fever does not lessen.
Fourth, When the elderly and young have fever and have tympanites.
Fifth, When you can't sweat, have nausea, and discharge blood.
Sixth, When your root of the tongue becomes ulcerated and don`t stop fever.
Seventh, When you caught and have a nosebleed and don`t stop blood.
Eighth, When you have a fever in marrow.
Ninth, When you have a fever and bend the body and get cramps in your legs or hands.
Especially in the sinus cold, Nose Chapter(鼻部) in the volume of appearance(外形篇) in Dong-ui-bo-gam describes the treatment of runny nose.
1. When you have clear discharge, you should apply acupuncture at GV23(上星), and GV16(風府), GV20(百會), GB20(風池), BL12(風門), GV14(大椎)
2. When you can`y scent, you should apply acupuncture at LI20(大椎), GV23(上星), LI4(合谷), GV16(風府), SI2(前谷)
3. When you have dirty and yellow discharge, GV23(上星), BL4(曲差), LI4(合谷), LI20(迎香).
4. In all kinds of runny noses, you should apply acupuncture at GV22(顖會), GV21(前頂), LI20(迎香).