State broadcaster CCTV said at least 113 people were killed in northwestern Gansu province and 18 more in neighbouring Qinghai after a shallow tremor on Monday night damaged thousands of buildings.
Almost 1,000 were injured across the two provinces, according to state news agency Xinhua.
The quake was China's deadliest since 2014, when more than 600 people were killed in southwestern Yunnan province.
AFP reporters saw families sheltering in makeshift tents constructed from wooden poles and tarpaulins outside the local Majiahe mosque near the epicentre in Gansu's Jishishan county, with outdoor stoves and blankets salvaged from their homes their only sources of warmth.
Residents crowded around stoves in large tents set up by the local government on a basketball court in Liugou township.
One resident told AFP some tents had as many as 35 people huddling inside.
Children lay under blankets, playing on their phones, while adults attempted to prepare meals out of the limited supply of instant noodles provided by the authorities.
AFP saw rescue teams unloading large bundles of supplies, including more tents.
Nearly a thousand people who were injured have been sent to hospitals, with 87,000 people moved to "temporary shelters" in Gansu alone, CCTV said.
China's western hinterland carries the scars of frequent seismic activity. A huge quake in Sichuan province in 2008 left more than 87,000 people dead or missing, including 5,335 schoolchildren.
"Search and rescue work basically ended by 3 pm yesterday and the main work now is to treat the injured and resettle the affected population," an unidentified official from Gansu's Emergency Management Department told a news conference on Wednesday.
The US Geological Survey said Monday night's magnitude-5.9 quake struck at a shallow depth at 11:59 pm local time (1559 GMT) with its epicentre around 100 kilometres (60 miles) from Gansu's provincial capital, Lanzhou.
Dozens of smaller aftershocks followed and officials warned that tremors with a magnitude of more than 5.0 were possible in the next few days.
Fears are growing that survivors could succumb to the bitter cold, with temperatures in Jishishan expected to dip as low as -17 degrees Celsius (1.4 Fahrenheit) on Wednesday.
Thousands of firefighters and rescue personnel have been sent to the disaster zone and state media said 2,500 tents, 20,000 coats and 5,000 rollaway beds had been sent to Gansu.
Record-breaking cold hits northern China
Beijing (AFP) Dec 20, 2023 -
Temperatures in cities across northern China hit record lows on Wednesday, as authorities issued an alert for extreme cold across swathes of the country.
The national weather office said subzero temperatures smashed records at five stations in the provinces and regions of Shanxi, Hebei and Inner Mongolia in the early hours of Wednesday.
That included a drop to minus 33.2 degrees Celsius (minus 27.8 degrees Fahrenheit) in Shanxi's historic city of Datong and -27C in the nearby county of Yangqu.
In those areas, "notably, the records for all-time low temperatures had already been broken on December 17", the weather office said in a social media post.
The mercury also sank to a record -29.7C in Qingshuihe, Inner Mongolia; -23.3C in Baoding, Hebei; and -22C in Shunping, Hebei.
In Gansu province, where an earthquake late Monday caused the deaths of more than 130 people, groups of survivors spent a freezing Tuesday night huddled around outdoor fires.
Many of them had seen their homes destroyed or rendered unsafe by the magnitude-5.9 tremor, which struck remote villages near the provincial capital Lanzhou.
Authorities on Wednesday issued a three-day alert for low temperatures across a vast area of northern, eastern and southeastern China.
The brutal cold follows a summer of record heat and devastating floods across the north of the country.
Experts warn that global warming caused by greenhouse gas emissions makes extreme weather more likely.
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