TCM Book ClubIssue 3402
One issue daily, accompanying the growth of TCM practitioners
IIntroduction：Symptoms observed in clinical practice are not always straightforward; they may present illusions. When a condition develops to extremes of cold or heat, there can sometimes be symptoms or signs that are contrary to their true nature, known as true heat with false cold or true cold with false heat. Today, we will learn how the experienced TCM practitioner Li Ke distinguishes between true and false cold and heat through two case studies.
Click the bottom right corner of the article to 【like】【view】to establish a deep reading (friendship) relationship
Li Ke on the True and False Nature of Cold and Heat, Discrimination Must Be CautiousAuthors/Zhang Cuntai, Zhuo Tongnian
Famous cold damage expert Chen Shenwu once said: “To understand yin and yang is to treat disease; to distinguish between true and false is essential for a physician.” This highlights the importance of discerning truth from falsehood for a medical practitioner. Li Ke realized through practice that: “Diseases, like people, are very cunning; what they present is not necessarily their true face, so one must think deeply and consider the underlying issues to avoid mistakes.”
Li Ke believed: “The physical constitution of individuals varies greatly, and the distinction between deficiency and excess, true and false, is not always clear. Especially in critical conditions, where there may be extreme deficiency yet signs of excess, a slight misjudgment can lead to misdiagnosis and mistreatment, resulting in life or death in an instant. Be cautious, be cautious! After treating a case of true cold with false heat, he wrote: ‘This condition is indeed perilous; although I was fortunate to cure it, I was already drenched in sweat.’ This left a deep impression. Thus, he proposed the principle of cautious discrimination between true and false cold and heat.
1. True Heat with False Cold, Excess with Deficiency Signs
Case: A famous physician, on December 26, 1964, just two days after the winter solstice, suddenly fell ill with a strange disease. Initially, the illness seemed like a minor external ailment, but three days later, he suddenly fell into a coma. His breath was weak, his complexion gray and dull, his hands cold past the elbows, his feet cold past the knees, his head was sweating profusely, and his consciousness was unclear, with the six pulses seeming to be present yet absent. A certain physician diagnosed it as “cold damage, lesser yin losing yang, already in a critical state, tentatively prescribing Shenfu Decoction to do what can be done.”
The hospital director invited Li Ke for a consultation to determine the course of action. Upon examination, the symptoms were as described. However, the foul odor in the room was quite puzzling. Moreover, the sudden change in condition, the pulse at the cun position was chaotic and unreliable, but upon checking the lower three positions of the foot yang, tai xi, and tai chong, the pulse was deep and strong, with more than six beats per breath. Wanting to observe the tongue, the patient was in a stupor, with clenched jaws, so he forcefully pricked the patient’s jaw point to pry open the mouth. Before he could examine the tongue, the foul odor from the mouth made him want to vomit; the tongue was covered with thick yellow and dry coating, and the root was already black. Inquiring about urination, it was like strong tea, also with a foul smell, and the patient had not defecated for five days. Upon palpating the lower abdomen, it was hard, and at this point, the truth was revealed.
It was known that the patient had been addicted to opium for over 20 years since the Opium War before the founding of New China, and still relied on camphor tincture to maintain energy, indicating that his organs were filled with toxins.
Moreover, the illness occurred after the winter solstice, in a body with yin deficiency and fluid depletion, coinciding with the return of yang, where the evil transformed into heat and dryness, having shifted from the tai yang to the yang ming organ. The coldness in the limbs was a transformation of deep heat; the confusion of consciousness was due to turbid qi obstructing the spirit; the profuse sweating was also due to the organ’s fullness steaming. All signs indicated heat obstructing the yang ming organ, rather than a loss of yang and withdrawal. Furthermore, true cold conditions would never present with a foul odor. It was learned that the previous physician had not examined the tongue due to the clenched jaws, and the loss of yang and withdrawal often presents with involuntary urination and an open mouth with closed eyes, while a clenched jaw is unique to real, heat, and obstructive conditions. Thus, it could be concluded that the previous physician had misdiagnosed.
Therefore, he prescribed Da Cheng Qi Decoction combined with Zeng Ye Decoction to urgently purge and preserve yin, clearing the obstruction, opening the closure, without the need for unnecessary additions: Da Huang 30g, Mang Xiao 20g (to be dissolved separately), Zhi Shi 15g, Hou Po, Sheng Di, Yuan Shen, Mai Dong each 30g, decocted and taken in two doses, every three hours.
The next day, upon re-examination, the patient had taken the medicine only once, and about two hours later, passed a foul-smelling stool, leaving the bedding in disarray, and after a while, his spirit was clear and he recovered. Upon re-examining the pulse, it was still fine and thin like a thread. It was realized that his pulse was a “six yin pulse”; although there were signs of fullness, the pulse did not change, thus making it difficult to reflect the truth. There is also a type of “six yang pulse” that is always large and strong, even with deficiency signs, the pulse does not change. If one relies solely on pulse diagnosis without further inquiry, how can one accurately diagnose the illness!
2. True Cold with False Heat, Extreme Deficiency with Excess Signs
Case: Wu, 57 years old. On December 23, 1979, he suddenly developed sores in the mouth, tongue, and lips, with symptoms that were quite strange and urgent. The illness began at 10 AM, and by 11 AM, his mouth and tongue were in excruciating pain as if burned by fire. In a hurry, he sought treatment from an old friend, who said: “Sores in the mouth and tongue are a minor issue, heat accumulation in the heart and spleen, no need to panic.” Without examining the pulse or asking about the illness, he hastily prescribed a combination of Chi San and Liang Ge San. The prescription was very light, with Sheng Di and Lian Qiao 10g, and the rest 3-5g. The patient took the first decoction at 11:30 AM, and after covering the cup, he immediately felt heat surging from the lower abdomen to his head, his lips swollen like peaches, and his tongue even more swollen and painful, along with feelings of anxiety and distress.
By around 12:30 PM, his son invited a consultation. Upon seeing the patient, his face was red as if intoxicated, his tongue was swollen and blocking his mouth, and he could not clearly express his symptoms. He showed the prescription he had taken, and his wife reported the changes after taking the medicine. The pulse was large and chaotic, and upon pressing harder, it felt like a floating thread, 120 beats per minute. Observing his tongue, it had numerous teeth marks along the edges, with white ulcers covering the edges and tips. His lips were swollen and cracked, bleeding, and upon inquiring about his bowel and bladder movements, the stool was dry, and he had not paid attention to urination. There was also no foul odor in the mouth.
Inquiring about the cause of the illness, his wife said: “End-of-year summary, continuous late nights for three nights before falling ill.” When asked if he felt thirsty, the patient shook his head. This condition was quite perplexing, and none of the four diagnostic methods yielded clear insights. Upon careful observation, it was difficult to overturn the previous physician’s diagnosis. The “Huang Di Nei Jing” clearly states: “All painful sores and ulcers belong to the heart.” Moreover, acute illnesses are often due to excess, and this illness was acute with a tendency towards toxicity; was the previous treatment too light for a serious condition, like a drop in the bucket?
In the midst of doubt, he suddenly saw the patient waving his hands and feet, in a state of indescribable agitation. Upon entering, he hastily noticed his face was red as if intoxicated, and upon closer inspection, it was bright and shiny, like an actor with painted makeup. Suddenly realizing this was synonymous with the “red face like makeup” seen in the Dai Yang syndrome, which often occurs in critical external conditions, this was instead due to internal injury. Upon palpating the lower limbs, he found them cold past the knees. This indicated that the lower source was severely depleted, coinciding with the day of the winter solstice when yang is born, and yin does not support yang, causing the dragon fire to surge uncontrollably. The previous physician mistakenly diagnosed it as excess fire and recklessly used bitter cold herbs, leading to an uncontrollable situation.
He urgently prescribed high-dose Fu Gui Ba Wei Decoction with oil of cinnamon to rectify the medication error and harmonize yin and yang: Fu Zi, Shu Di, Sheng Shan Yao, Shan Yao Rou each 30g, Yun Ling, Ze Xie each 12g, Wu Wei Zi 10g, oil of cinnamon 1.5g (to be dissolved), decocted and taken cold.
The patient took the medicine once, and after a quarter of an hour, he peacefully fell asleep. After about two hours, the swelling and pain subsided, leaving no trace.
Upon re-examination the next day, the mouth still felt numb and spicy, the tongue was bright red without coating, indicating damage to the yin aspect. The fire did not return to its origin, and it was not appropriate to use high doses of Fu Zi to break yin and restore yang; however, due to the previous medication error, it had to be used. Although the perilous condition had receded, the yin damage had not yet recovered, so he prescribed a high dose of Yin Huo Decoction, and after two doses, the patient was cured. In retrospect, this condition was indeed perilous; although it was fortuitously cured, I was already drenched in sweat.
3. Commentary
Analyzing Li Ke’s recognition of the true and false cold and heat in these two cases, the main confirmations were made through tongue coating, pulse patterns, and the pulses at the foot yang, tai xi, and tai chong.
Additionally, both cases noted the onset occurring around the winter solstice, which has significant diagnostic implications for the development of cold and heat, emphasizing the role of yin and yang rhythms in discerning yin and yang. Li Ke summarized: “Following the rhythms of yin and yang throughout the year and daily, the phenomena of heaven and man correspond, such as when yang is born at the winter solstice, illness occurs; in spring, yang rises and becomes heavy; in summer, yin is born and gradually slows; illness occurs at sunrise, worsens at noon, eases at sunset, and resolves at night.”
—END—
Summary of Li Ke’s experience in treating “oral ulcers”: cured over 120 cases, most in one consultationLi Ke: Fu Qingzhu’s formula for treating severe shoulder periarthritis—Copyright Statement—
- This article is excerpted from “The Great Doctor: Li Ke” 丨Authors/Zhang Cuntai, Zhuo Tongnian丨Editor/Xu Jingru, Ju Ye
- This article is copyrighted by the rights holder. For educational exchange only, please do not use medications indiscriminately.
Download the 【Linglan TCM App】Freewith nearly 200 ancient TCM texts available
Scroll up and down to see more
Click here to download the Linglan TCM APP for more exciting articles
Give a