3. Cold and Heat

3. Cold and Heat

Cold and Heat are two categories used to distinguish the nature of 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 there is thirst, 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 urine, 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, while qi and blood are shared by all five zang organs and six fu organs and can also be glimpsed in Zang-Fu differentiation.

(3) True vs. False Cold and Heat

There are typically two scenarios: true heat and false cold, and true cold and false heat. In the case of "true heat and false cold," one might observe symptoms such as dry and hard stools, abdominal fullness and pain, thirst for cold drinks, and short, reddish urine—all characteristic of heat—while simultaneously seeing a pale face, cold limbs, and a faint pulse—all characteristic of cold. The hallmark of this syndrome is that it appears to have many cold-like symptoms at first glance, but upon closer inspection, heat is actually at its core. This is often referred to as "yang excess internally, yin suppression externally," and corresponds to what Western medicine calls "acute abdominal shock" or "heat shock"—both of which fall under the category of "warm shock." In the case of "true cold and false heat," clinical manifestations include body heat but reluctance to remove clothing, thirst for water but unwillingness to swallow, a large and heavy pulse that feels weak 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, often referred to as "yin excess internally, yang suppression externally." Some call this "daiyang syndrome," and in Western medical pathology, it is often associated with autonomic nervous system and endocrine disorders.