š”ļø Feeling of Cold vs. Feeling of Heat in Traditional Chinese Medicine
Feeling of Cold vs. Feeling of Heat
Understanding the body's internal dialogue through observation
Let's break down what each pattern means, using the Boncho Friends Diagnosis Deck as our guide.
š§ Feeling of Cold
When a patient complains of feeling cold or chills, the practitioner's first step is to determine where the Cold is acting ā and why the body cannot warm itself.
š¹ 1. Full Cold
Symptoms:
- Intense feeling of cold and shivers
- Body is cold to touch
- Pain with a tight, full pulse
- Sudden onset
Pattern explanation:
This points to an Excess Cold pattern, often caused by external Cold invading the body or by internal Cold due to stagnation. In modern understanding, this can feel like acute chills when the body reacts strongly to an invading pathogen ā similar to how the immune system constricts surface circulation to conserve internal warmth.
š¹ 2. Empty Cold
Symptoms:
- Persistent, mild sensation of cold
- Body mildly cold to touch
- No pain
- Weak pulse
- Gradual onset
Pattern explanation:
This is a Deficiency Cold ā typically from Yang Deficiency. The body simply lacks the energy (Yang Qi) to warm itself. Think of it like the body's "metabolic fire" burning low ā the patient feels cold even in warm environments.
š¹ 3. External Wind
Symptoms:
- Fever and aversion to cold
Pattern explanation:
Here, the body is fighting off an external pathogenic factor, like Wind-Cold. The chills and mild fever reflect the immune system's early defensive stage ā a classic "common cold" presentation in TCM.
š¹ 4. Pathogenic Factor in the Interior
Symptoms:
- Patient feels cold, but body is hot to the touch
Pattern explanation:
This occurs when the pathogen has penetrated deeper into the body's interior. Even though the patient feels cold, the body is actually generating heat internally to fight back ā similar to how a fever develops during infection. In this case, the "cold feeling" is subjective, while the heat on the body surface is objective evidence of internal battle.
š¹ 5. Shao (Lesser) Yang Pattern
Symptoms:
- Alternating sensations of heat and cold
Pattern explanation:
This represents a half-exterior, half-interior pattern, often seen in the Shao Yang stage of disease (per Shang Han Lun). The pathogenic factor oscillates between the exterior and interior, leading to fluctuating symptoms ā a hallmark of imbalance between the body's defense and the invading factor.
š„ Feeling of Heat
Now, let's look at the opposite sensation ā feeling hot. Just as Cold can arise from Full or Empty conditions, so can Heat.
šø 1. Empty Heat
Symptoms:
- Feeling of heat in the afternoon or evening
- Low-grade fever worse in the afternoon
Pattern explanation:
This is a Yin Deficiency type of Heat. Because Yin (cooling, nourishing aspect) is insufficient, Yang appears in relative excess ā leading to sensations of heat, dryness, and restlessness. In modern physiology, this resembles hypermetabolic states from chronic deficiency or hormonal imbalance (e.g., menopause).
šø 2. Damp Heat
Symptoms:
- Constant low-grade fever, often with a heavy sensation or sticky feeling in the body
Pattern explanation:
Here, Heat combines with Dampness, trapping warmth in the interior. The fever is usually mild but persistent, and the patient often feels sluggish or has digestive discomfort. A common example is low-grade inflammation in the digestive or urinary tract.
šø 3. Yin Deficiency and Food Retention
Symptoms:
- Fever during the night (adults: Yin Deficiency; children: Food Retention)
Pattern explanation:
Nighttime fever in adults signals that Yin is too weak to anchor Yang at night, causing rising internal Heat. In children, night fevers often come from Food Retention, which produces internal Heat as digestion stagnates.
š©ŗ Diagnostic Summary
| Patient Sensation | Body Condition | Pattern Type | Example Cause |
|---|---|---|---|
| Feels cold, body cold | Full pulse, sudden onset | Full Cold | External Cold invasion |
| Feels cold, body mildly cold | Weak pulse, gradual onset | Empty Cold | Yang Deficiency |
| Fever + aversion to cold | Body alternating warm/cold | External Wind | Wind-Cold invasion |
| Feels cold, body hot | Heat fighting inside | Interior Pathogen | Internal battle, fever onset |
| Feels hot, body hot | Full pulse, red tongue | Full Heat | Excess Yang or Heat pathogen |
| Feels hot, mild fever (PM) | Thin body, night sweat | Empty Heat | Yin Deficiency |
| Constant mild fever | Heaviness, sticky tongue coat | Damp Heat | Damp stagnation |
| Night fever | Adults: Yin Xu / Children: Food Retention | Deficiency or Excess Heat | Yin Xu or Food Stagnation |
šæ Clinical Application
When differentiating Cold and Heat patterns:
- Always assess subjective feeling (what the patient feels) vs. objective signs (what the practitioner observes).
- Combine findings from pulse and tongue diagnosis to confirm whether the pattern is Full, Empty, or Mixed.
- Remember that Cold and Heat are not opposites ā they are dynamic indicators of how Qi and Blood are flowing (or not flowing) through the body.
š¬ Final Thoughts
The sensations of feeling cold and feeling hot are not just simple temperature experiences ā they are reflections of the body's ongoing dialogue with its internal and external environment.
Through observation, TCM practitioners can tell whether the body's Qi is trapped, exhausted, or rising in defense ā and tailor treatment accordingly.
So next time a patient says, "I feel cold," you'll know there's much more to that statement than meets the eye.
šŖ· Continue Learning
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Explore these concepts in detail with the Diagnosis Deck and Foundations Deck by Boncho Friends. Each card is designed to make classical diagnosis visual, simple, and memorable ā bridging ancient wisdom with modern study practice.
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