3. Cold-Heat

3. Cold-Heat

Cold-heat is the dual criterion for determining the nature of a disease. Cold syndromes are usually caused by cold pathogens or arise from deficiency in the zang-fu organs, meridians, muscles, or qi and blood; heat syndromes are typically caused by heat pathogens or result from excess 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 urination and defecation, the warmth or coolness of the limbs, the pulse condition, and the tongue appearance.

(1) Clinical Features of Cold and Heat Syndromes

Cold syndromes clinically manifest as cold and unwarmed hands and feet, aversion to cold, pale complexion, no thirst but preference for hot drinks, clear and long urination, loose and odorless stools, thin white coating on the tongue, and a slow pulse. Heat syndromes clinically present as fever and thirst, preference for cold drinks, flushed face, irritability, dry and hard stools, sticky and burning anus, short and red urine, red tongue with yellow coating, and a large, rapid pulse.

(2) Location of Cold and Heat Syndromes

The occurrence of cold and heat usually has specific locations, such as the zang-fu organs, meridians, qi and blood, triple burner, and exterior-interior. The cold and heat of the zang-fu organs are discussed in zang-fu pattern differentiation; the cold and heat of the meridians are covered in six-channel pattern differentiation; the cold and heat of the triple burner are introduced in triple-burner pattern differentiation; qi and blood are shared by all five zang and six fu organs and can also be glimpsed in zang-fu pattern differentiation.

(3) True vs. False Cold and Heat

There are usually two situations: true heat with false cold and true cold with false heat. In "true heat with false cold," one observes symptoms such as dry and hard stools, abdominal distension with severe pain, intense thirst for cold drinks, and short, red urine—clear signs of heat—while simultaneously seeing a pale face, cold limbs, and a weak, fine pulse—clear signs of cold. The characteristic of this syndrome is that at first glance there appear many cold signs, but upon closer examination, heat is found at its core. It is often referred to as yang excess internally and yin rejection externally; in Western medicine, conditions like acute abdominal shock and febrile shock—commonly known as "warm shock"—often fall into this category. In "true cold with false heat," the clinical presentation includes body heat without desire to remove clothing, thirst for water without desire to swallow, a large and strong pulse that feels weak when pressed, a flushed face with cold limbs, restless limbs but clear consciousness. The characteristic of this syndrome is that cold resides internally while deficient yang floats outward; it is often called "yin excess internally and yang rejection externally," sometimes referred to as the "daiyang" syndrome. In Western medical pathology, this often corresponds to autonomic nervous system and endocrine disorders.