3. Cold and Heat

3. Cold and Heat

Cold and Heat are two categories used to distinguish the nature of a disease. Cold syndromes are usually caused by cold pathogenic factors or by deficiencies in the zang-fu organs, meridians, muscles, or qi and blood. Heat syndromes are usually caused by heat pathogenic factors or by excesses in the zang-fu organs, meridians, muscles, or qi and blood. In TCM, the differentiation between Cold and Heat is often based on whether the patient feels thirsty, the characteristics of bowel movements, the warmth or coolness of the limbs, the pulse, and the tongue coating.

(1) Characteristics of Cold and Heat Syndromes

Clinical manifestations of Cold syndromes include cold hands and feet that are not warm, aversion to cold, pale complexion, lack of thirst but preference for hot drinks, clear and long urination, loose and odorless stools, thin white tongue coating, and a slow pulse. Clinical manifestations of Heat syndromes include fever and thirst, preference for cold drinks, flushed face, restlessness and irritability, dry and hard stools, sticky and burning anus, short and reddish urination, a red tongue with yellow coating, and a rapid, large pulse.

(2) Locations Where Cold and Heat Occur

The occurrence of Cold and Heat usually has specific locations, such as the zang-fu organs, meridians, qi and blood, the three jiao, and the superficial–deep relationship. Cold and Heat in the zang-fu organs are discussed in Zang-Fu differentiation, Cold and Heat in the meridians are discussed in Six Meridians differentiation, Cold and Heat in the three jiao are introduced in Three Jiao differentiation, and qi and blood are shared by all five zang organs and six fu organs, so their presence can also be inferred in Zang-Fu differentiation.

(3) True vs. False Cold and Heat

There are usually two situations: true heat and false cold, and true cold and false heat. In the case of true heat and false cold, the patient exhibits symptoms such as dry, hard stools, abdominal fullness and pain, thirst for cold drinks, and short, reddish urination—all signs of heat—while simultaneously displaying symptoms such as a pale face, cold limbs, and a faint pulse—all signs of cold. The hallmark of this syndrome is that, at first glance, many symptoms appear cold, but upon closer inspection, heat is actually at the core; this is often referred to as “yang flourishing internally, yin suppressed externally,” and is similar to what Western medicine calls “acute abdominal shock” or “heat shock”—both of which are examples of warm shock. In the case of true cold and false heat, the patient presents with body heat but does not want to remove clothing, thirst for water but does not want to swallow, a large, strong pulse that feels heavy when pressed, a flushed face but cold limbs, restless limbs but clear consciousness. The hallmark of this syndrome is that cold resides internally while yang floats outward; this is often called “yin flourishing internally, yang suppressed externally,” and some refer to it as “daiyang syndrome.” In Western medical pathology, this is often associated with autonomic nervous system and endocrine disorders.