For listeners who enjoy audiobooks, you can click below to listen to the audio.
The term “combining cold and heat” refers to the use of both cold and heat properties in medicinal substances. In the eight therapeutic methods, it belongs to the warming and clearing methods, also known as the warming-clearing method. Cold and heat, cool and warm, have completely opposite medicinal properties. If they belong to the same meridian and act on the same area, their cold and heat properties will be reduced when combined in the same formula; if they belong to different meridians and act on different areas, their cold and heat properties will not be reduced. As stated in the “Su Wen: The Great Treatise on True Essentials”: “Cold treats heat, and heat treats cold”; it further emphasizes: “Treat cold with heat, treat heat with cold, and the physician cannot abandon the rules and change the method.” This is a fundamental principle of TCM treatment.
Clinically, while there are certainly many cases of pure heat syndrome or pure cold syndrome, the combination of cold and heat, the mixing of cold and heat, the confusion of cold and heat with deficiency and excess, the true and false cold and heat, and the rejection of cold and heat are even more common. If one only clears heat, the heat may not be eliminated, or even worsen; if one only warms yang, the cold may not retreat, or even worsen. Only by using and adjusting both cold and heat can one achieve a combined treatment. As stated in the “Yi Zhi”: “The combination of cold and heat is due to the presence of both cold and heat evils mixed within the person, and one must use a mixture of cold and heat agents.” This is especially true when encountering cases of cold-heat rejection, where without counteracting assistance, harmony cannot be achieved.
The “Shang Han Lun” records 112 formulas, of which 53 formulas (47.32%) utilize the combination of cold and heat. The wide application of this method is evident. The combination of cold and heat includes the pairing of the strongly pungent and hot herbs like Fu Zi (Aconite) and Gan Jiang (Dried Ginger) with the extremely bitter and cold herbs like Huang Qin (Scutellaria) and Huang Lian (Coptis); it also includes the warm herb Gui Zhi (Cinnamon Twig) with the cool herb Ge Gen (Kudzu Root). There are combinations of the strongly hot Fu Zi with the mildly cold Bai Shao (White Peony), and the extremely cold Shi Gao (Gypsum) with the warm Ban Xia (Pinellia). Zhang Zhongjing not only pioneered the method of combining cold and heat in TCM but also created exquisite combinations. His applications are both flexible and diverse, yet follow inherent principles:
Taking properties and uses: “Properties” refer to the four properties of medicinal substances: cold, heat, warm, and cool. “Use” refers to the functions of the medicines. Some formulas in the “Shang Han Lun” that combine cold and heat select herbs based on both their properties and their uses. For example, the Zhi Zi Gan Jiang Tang (Gardenia and Dried Ginger Decoction) is used for upper heat and lower cold (heat disturbing the chest above, spleen and stomach deficiency and cold below) in cases of “cold damage, where the physician uses pills to purge heavily, and the body heat does not dissipate, with slight agitation.” In this formula, Zhi Zi (Gardenia) is cold in nature and functions to clear heat and eliminate agitation; Gan Jiang (Dried Ginger) is hot in nature and functions to return yang and warm the center. The use of Zhi Zi is based on its cold nature and its function to clear heat and eliminate agitation, addressing the evil heat above; the use of Gan Jiang is based on its warming nature and its function to return yang and warm the spleen and stomach’s yang qi below. Although the two herbs have opposite properties, their actions complement each other and do not contradict, and after their combination, Gan Jiang mitigates the damage Zhi Zi may cause to the spleen and stomach’s yang qi, while Zhi Zi counteracts Gan Jiang’s effect on the heat disturbing the chest.
As for the proportion of cold and heat herbs, the “Shang Han Lun” has specific guidelines. In principle, it is determined based on the primary and secondary roles of cold and heat, as well as their intensity. Generally, for the primary and heavier herbs, more varieties and larger quantities are selected; for the secondary and lighter herbs, fewer varieties and smaller quantities are chosen. For example, in the Xiao Feng San (Minor Wind Powder), three strongly bitter and cold herbs Da Huang (Rhubarb), Huang Qin (Scutellaria), and Huang Lian (Coptis) are used to purge heat and eliminate fullness, while one strongly pungent and hot herb Fu Zi (Aconite) is used to warm yang and dispel cold. Huang Lian Tang (Coptis Decoction) uses one strongly bitter and cold herb Huang Lian to clear and drain upper heat, while four warm and sweet herbs Ban Xia (Pinellia), Gui Zhi (Cinnamon Twig), Ren Shen (Ginseng), and Zhi Gan Cao (Honey-Fried Licorice) are used to harmonize and warm the lower cold. The Da Qing Long Tang (Major Blue Dragon Decoction) primarily uses the warm herbs Ma Huang (Ephedra) and Gui Zhi, with a small addition of the cold herb Shi Gao to primarily release exterior cold and secondarily clear internal heat. The Tao He Cheng Qi Tang (Peach Kernel Decoction) uses the bitter, salty, and cold herbs Da Huang (Rhubarb), Mang Xiao (Mirabilite), and Tao Ren (Peach Kernel) to drain heat and eliminate stasis, with a small addition of the warm herb Gui Zhi to assist Da Huang and Tao Ren in promoting blood flow. The application is very flexible.
Removing properties and taking uses: In some formulas of the “Shang Han Lun” that combine cold and heat, the purpose of the combination is to remove the properties and take the uses. The method of removing properties is through the changes in combinations that restrict their properties. For example, the Ma Huang Xing Ren Gan Cao Shi Gao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) treats exterior evils transforming into heat entering the interior, obstructing the lungs. In this formula, the warming property of Ma Huang is restricted by the cold and bitter Shi Gao, removing its warming nature while preserving its function to stop cough and relieve wheezing. Therefore, although Ma Huang, a strong warming and sweating herb, is used in the formula, it does not belong to the category of warming sweating agents but is classified as a strong cooling agent. Huang Qin Jia Ban Xia Sheng Jiang Tang (Huang Qin with Ban Xia and Fresh Ginger Decoction) treats Shao Yang heat evils pressing on Yang Ming causing vomiting and diarrhea. In this formula, the warming properties of Ban Xia and Sheng Jiang are restricted by the heavily used bitter and cold Huang Qin, removing their warming nature while preserving their functions to harmonize the stomach, descend counterflow, and stop vomiting. Thus, Huang Qin Jia Ban Xia Sheng Jiang Tang is classified as a clearing heat agent. Dang Gui Si Ni Tang (Tangkuei Decoction for Cold Extremities) treats blood deficiency and cold stagnation causing cold hands and feet; in this formula, the sweet and cold Tong Cao (Rice Paper Plant) is restricted by the warming properties of Gui Zhi and Xi Xin, removing its cold nature while preserving its function to open the meridians, and so on.
Counteracting combinations: This refers to the effective use of two opposing medicinal substances in the formulas of the “Shang Han Lun”. These two substances may appear in multiple formulas within the “Shang Han Lun”, in other formulas from the “Jin Kui Yao Lue”, or in famous formulas created by later physicians. After counteracting combinations, some enhance efficacy, some expand functions, and some restrict tendencies. The “Shang Han Lun” contains many cold and heat counteracting drugs, with over 20 pairs still commonly used today. For example, Gui Zhi and Bai Shao (Cinnamon Twig and White Peony) (Gui Zhi Tang, Xiao Qing Long Tang, Xiao Jian Zhong Tang) are one warm and one cold, one dispersing and one gathering, harmonizing Ying and Wei, balancing Yin and Yang, alleviating pain. Gui Zhi and Da Huang (Cinnamon Twig and Rhubarb) (Tao He Cheng Qi Tang, Gui Zhi Jia Da Huang Tang) are one warm and one cold, promoting circulation and eliminating stasis, harmonizing and alleviating pain. Fu Zi and Bai Shao (Aconite and White Peony) (Zhen Wu Tang, Shao Yao Gan Cao Fu Zi Tang, Gui Zhi Jia Fu Zi Tang, Fu Zi Tang) are one hot and one mildly cold, one drying and one softening, balancing rigidity and flexibility, warming without drying, warming yang and benefiting yin, relieving pain and dispelling obstruction. Ma Huang and Shi Gao (Ephedra and Gypsum) (Ma Huang Xing Ren Gan Cao Shi Gao Tang, Da Qing Long Tang, Yue Bi Tang) are one warm and one cold, one dispersing and one clearing, dispersing lung and relieving wheezing, clearing heat and eliminating agitation, promoting water metabolism. Huang Qin and Ban Xia (Scutellaria and Pinellia) (Xiao Chai Hu Tang, Da Chai Hu Tang, Huang Qin Jia Ban Xia Sheng Jiang Tang) are one cold and one warm, one opening and one descending, clearing and transforming damp-heat, dispersing and eliminating fullness. Gan Jiang and Huang Lian (Dried Ginger and Coptis) (Gan Jiang Huang Qin Huang Lian Ren Shen Tang, Ban Xia Xie Xin Tang, Gan Cao Xie Xin Tang, Sheng Jiang Xie Xin Tang, Huang Lian Tang, Wu Mei Wan) are one hot and one cold, one opening and one descending, balancing yin and yang, dispersing and eliminating fullness. Xuan Fu Hua and Dai Zhe Shi (Inula and Hematite) (Xuan Fu Dai Zhe Tang) are one mildly warm and one cold, one dispersing and one descending, calming counterflow and stopping vomiting, transforming phlegm and eliminating fullness. Gan Sui and Yuan Hua (Kusso and Genkwa) (Shi Zao Tang) are one warm and one cold, attacking and expelling water retention, draining chest and hypochondriac water accumulation. Ban Xia and Gua Lou (Pinellia and Trichosanthes) (Xiao Xian Xiong Tang) are one warm and one cold, transforming phlegm and dispersing fullness, broadening the chest and eliminating fullness. Ban Xia and Mai Dong (Pinellia and Ophiopogon) (Zhu Ye Shi Gao Tang) are one warm and one mildly cold, one drying and one moistening, nourishing yin and benefiting the stomach, descending counterflow and stopping vomiting, etc.
Counteracting treatment: The “Su Wen: The Great Treatise on True Essentials” states: “If the odd does not leave, the even remains, this is called a heavy formula. If the even does not leave, then counteracting assistance is used to obtain it. The so-called cold, heat, warm, and cool, counteract according to the disease.” Counteracting assistance is a method of counter-treatment in TCM, originating from the “Huang Di Nei Jing”. The counteracting method used in the “Shang Han Lun” has two components: one is to assist heat medicines with cold medicines to treat heat syndromes; the other is to assist cold medicines with heat medicines to treat cold syndromes. This is the counteracting combination; the second is “treat heat with cold, warm and act; treat cold with heat, cool and act.” This is the counteracting administration of the medicine. The counteracting used in the “Shang Han Lun” is the counteracting combination. For example, in the Tong Mai Si Ni Jia Zhu Gan Zhi Tang (Four Reversal Decoction with Pig Gallbladder), the pig gallbladder, Bai Tong (White Tong), and pig gallbladder all belong to counteracting medicines, which are added to the strongly pungent and hot warming medicines to counteract with salty, cold, and bitter descending agents, taking the meaning of “the extreme should follow”. This has the effect of adapting to the situation, eliminating cold and heat rejection, and is used in special stages where the primary treatment is ineffective, or when there is a rejection of the medicine, or when true and false cold and heat appear. If used appropriately, it can often yield significant results. As stated in the “Su Wen: The Great Treatise on True Essentials”: “Counter-treatment… heat uses heat, cold uses cold, blockage uses blockage, and passage uses passage, must follow its master and precede its cause; the beginning is the same, the end is different, which can break accumulation, dissolve hardness, harmonize qi, and ensure completion.”
Since Zhang Zhongjing established the method of combining cold and heat, it has had a significant impact on later generations. Later physicians have created many famous formulas using this method. Examples include Yin Qiao San (Honeysuckle and Forsythia Powder) (Jing Jie and Bo He), Jing Fang Bai Du San (Jing Jie and Chai Hu), Shen Su Yin (Perilla Leaf and Kudzu), Huang Long Tang (Angelica and Rhubarb), Wen Pi Tang (Aconite and Rhubarb), Hao Qing Qing Dan Tang (Ban Xia and Bamboo Shavings), Xiao Yao Wan (Angelica and White Peony), Bai Zhu Shao Yao San (Atractylodes and White Peony), Si Miao Yong An Tang (Honeysuckle and Angelica), Zuo Jin Wan (Huang Lian and Wu Zhu Yu), Xiang Lian Wan (Huang Lian and Mu Xiang), Hu Qian Wan (Huang Bai and Suo Yang), Mu Li San (Oyster and Astragalus), An Gong Niu Huang Wan (Musk and Niu Huang), Yue Ju Wan (Chuan Xiong and Zhi Zi), Ju Pi Zhu Ru Tang (Tangerine Peel and Bamboo Shavings), Dan Shen Yin (Salvia and Sandalwood), Jian Pi Wan (Nutmeg and Huang Lian), San Ren Tang (White Cardamom and Job’s Tears), Er Miao San (Huang Bai and Cang Zhu), Liu Mei Di Huang Wan (Shan Yao and Dan Pi), and many more.
As an important therapeutic principle in TCM, “combining cold and heat” continues to effectively guide clinical practice in TCM today. This principle can be applied not only to common and frequently occurring diseases but is also frequently used for various difficult and complicated diseases, as well as critical illnesses. In recent years, I have been engaged in clinical work for kidney diseases, and in the clinical process, I often use the method of “combining cold and heat” to treat kidney diseases, which has been greatly beneficial.
Highlights from Previous Articles
Thoughts on Yin-Yang Ascending and Descending in TCM (Upper and Lower Deficiency and Excess, Cold and Heat) | Yu Hao
Root Treatment of All Diseases 2 (Cold, Heat, Muscles, and Bones) | Yu Hao and Zheng Li
Both Deficiency and Excess of Cold and Heat Can Lead to Agitation; How Did Zhang Zhongjing Treat It?
Essential Understanding: The Yin-Yang Cold and Heat Properties of Food
There Are No Absolute Cold and Heat Deficiencies and Excesses in Disease – Flexible TCM
This Article Only Discusses Two Words: Cold and Heat
Medical Insights: Differentiating Cold and Heat, Deficiency and Excess, Yin and Yang
The Correct Eight Principles: Interior and Exterior, Deficiency and Excess, Cold and Heat + Ascending and Descending (Including Eight Principles Differentiation Key)
Yin-Yang, Interior and Exterior, Deficiency and Excess, Cold and Heat – An In-Depth Explanation of Ancient TCM
Liuzhou: Discussing the Confusion of Yin-Yang and the Mixing of Cold and Heat in Disease
Shen Shao Gong’s General Treatment Essentials – 2 – Not Being Able to Differentiate Cold and Heat, Not Being Able to Differentiate Deficiency and Excess, Difficult to Use Medicine
Cold and Heat Pairing Does Not Harm the Spleen and Stomach | Liang Dong in Conversation with Xu Wenbing
Essential Understanding of Formulas: Wu Mei Wan (Because Cold and Heat Mixing is Common)
Self-Learning Pulse Diagnosis (Pulse Diagnosis), Start with Differentiating Strength and Weakness to Identify Deficiency and Excess, Start with Differentiating Speed to Identify Cold and Heat
Let’s Read the “Huang Di Nei Jing” – Ling Shu: Cold and Heat, Chapter Seventy
Let’s Read the “Huang Di Nei Jing”: Ling Shu: Cold and Heat Disease, Chapter Twenty-One
Decreased Sense of Smell and Taste, Supplementing Qi and Benefiting the Middle with Cang Er Zi San; Oral Ulcers Must Be Treated Differently for Cold and Heat
It Turns Out That TCM’s Inquiry into Cold and Heat Can Reveal So Much
Learning from a Master: Daily Insights from the Medical Sea – 153 – The Wedding Chamber and the Medium of Cold and Heat
Essential to Master: The Classical Formulas of Combining Cold and Heat
Uncle JT Teaches Slowly – 215 – Cold and Heat of the San Jiao vs. Cold and Heat of the Large and Small Intestines
Cold and Heat Differentiation Table (All Organs)
Zhang Zhongjing’s Heart Method: Direct Principles for Using Medicines in Cold and Heat Mixing
The Color and Temperature of the Nose Can Reflect the Body’s Cold and Heat | Xu Wenbing
How to Determine Disease Cold and Heat Through Phlegm and Nasal Discharge? | Luo Dalun
Health or Illness, Cold and Heat Take the Lead | Luo Dalun
The Story of Air Conditioning – Discussing the Imbalance of Cold and Heat | Yu Hao
Did You Know This? Yin-Yang Cold and Heat 88 Formula Syndromes
Comprehensive Inquiry into Cold and Heat in TCM | Zhu Wenfeng
The Correct Eight Principles: Interior and Exterior, Deficiency and Excess, Cold and Heat + Ascending and Descending (Including Eight Principles Differentiation Key)
What is the Basis for Classifying Foods as “Cold” and “Heat” in TCM? A Comprehensive Overview of Food Classification by Cold and Heat in Daily Life~
Foods Classified as Cold and Heat Should Be Eaten According to Body Type for Optimal Health! Three Sentences to Distinguish Cold and Heat Foods, Easy to Understand!
Da Huang Fu Zi Zeng Wei Tang, Cold and Heat Mutual Assistance to Open Stagnation (Hernia/Women’s Lower Jiao Disorders)
Understanding the “Shang Han Lun” in Differentiating Cold and Heat
Liuzhou: Seven Cold and Heat Mixing Formulas in the “Shang Han Lun”
Da Huang Fu Zi Zeng Wei Tang, Cold and Heat Mutual Assistance to Open Stagnation
Yin-Yang, Interior and Exterior, Cold and Heat, Deficiency and Excess, Eight Principles in Balance? See What the Classical Master Kong Bo Hua Has to Say!
How the Original Point Solves the Ancient Problem of Cold and Heat Combination
Foods Classified as Cold and Heat Should Be Eaten According to Body Type for Optimal Health! Three Sentences to Teach You to Distinguish Them Clearly
========== END ==========
Warm Reminder:
This platform shares health-related graphic and textual information for reference and learning purposes only and is not intended as a basis for medical diagnosis. If needed, please use under the guidance of a physician.
⊙ Copyright Statement: The article is sourced from the internet; if there is any infringement, please contact us for removal.
Advertisements are randomly distributed by the system, and we cannot control or select them in detail. Please do not purchase any animal products or meat. Do not buy fishing or hunting equipment, refuse to kill. Do not play killing games; the consequences of killing games are similar to actual killing; do not read pornographic articles; all evil comes from lust, and sexual misconduct is the root of reincarnation and disaster. Cause and effect follow closely. Remember!
It is better to let the medicine gather dust on the shelf than to wish for no illness and suffering in the world!
Parents who do not know medicine are unkind! Children who do not know medicine are unfilial!
Can’t find a good TCM practitioner? Why not learn TCM yourself!
In the menu of this account, there is a complete introductory series and video series. Welcome everyone to learn.
Learning Ancient TCM, Inheriting the Formulas of the “Shang Han Lun”
Virtue carries all things! Herbs and stones only remove physical ailments; cultivating virtue is the way to eliminate inner demons!
Prayer: May the world be harmonious, the sun and moon be clear; may the wind and rain come timely, and disasters not arise; may the country be prosperous and the people safe, and weapons be useless; may virtue be exalted and kindness be practiced; may there be no thieves or grievances; may the strong not bully the weak, and everyone gets their due; may no one suffer from illness or misfortune, and may they enjoy wealth and health; may they live long and be virtuous, and have a good beginning and end.
Long press for 2 seconds to follow Qibo Youdao
Welcome to share the content of this account widely