Traditional Chinese Medicine (TCM), as a treasure of the Chinese nation, has a long history and profound depth. In the diagnostic system of TCM, the inquiry of cold and heat is regarded as an extremely important aspect, embodying profound medical wisdom and philosophical thought.The changes in all things on Earth follow the laws of spring growth, summer flourishing, autumn harvest, and winter storage. The root of all these changes lies in the alternation of climate, which is essentially the interplay of cold and heat. The occurrence and development of diseases are also closely related to cold and heat. Any disease begins with abnormalities in cell morphology and function, and tracing back, the abnormalities in the internal environment can be summarized with the terms “cold” and “heat.” Therefore, cold and heat are the root of all diseases, and understanding the details of a disease must start with the inquiry of cold and heat.1. Fear of Cold: A Signal of Internal ColdFear of cold refers to the aversion to cold. When others wear light clothing, those who fear cold need to wear a jacket; when others wear jackets, they need to switch to sweaters. In winter, their limbs are cold, and at night, it takes a long time for their bedding to warm up. Fear of cold is a manifestation of an excessively low internal environment temperature (internal cold). In a state of internal cold, the body lacks sufficient heat energy to resist external cold, and the growth, activity, metabolism, and reproduction of cells are suppressed, leading to organ function decline. Patients who fear cold often experience symptoms such as fatigue, poor appetite, susceptibility to colds, indigestion, and decreased sexual function. In TCM, this condition caused by internal cold is referred to as “Yang Deficiency (Yang Xu).”2. Fever: A Manifestation of Internal Environmental Temperature ImbalanceFever can occur in various situations, and its causes are the opposite of fear of cold, resulting from an excessively high internal environmental temperature (either systemic or localized). There are mainly three types of fever:(1) Fever Caused by Excessive Heat ProductionThis type of fever is often caused by hypermetabolism in the body, such as hyperthyroidism or external factors like Japanese encephalitis virus infection. Its characteristics include high fever (often above 39°C), often accompanied by profuse sweating, thirst for cold drinks, restlessness, and a strong pulse. At this time, the body dissipates heat through sweating; if the internal environment is overheated, sweating cannot completely dissipate the excess heat, leading to persistent high fever. The best treatment for this type of fever is to “drain fire,” with Bai Hu Tang (White Tiger Decoction) being a commonly used formula.(2) Fever Caused by Insufficient Heat DispersionThis is often caused by cold pathogens invading the body. Fever coexists with aversion to cold, often accompanied by no sweating, headache, lower back pain, and joint pain. The aversion to cold is different from fear of cold; even wearing more clothes, covering with more blankets, or using heating cannot alleviate it. This is because the cold pathogen invades the body’s surface, slowing blood flow and constricting blood vessels, preventing heat energy from reaching the surface, while sweat gland secretion is obstructed, leading to heat accumulation and fever. For such diseases, Western medicine’s antibacterial and anti-inflammatory treatments are often ineffective, while TCM employs methods to induce sweating and dispel cold. For example, Ma Huang Tang (Ephedra Decoction) is a classic formula for inducing sweating and dispelling cold. If the patient’s pulse is not only tight but also weak, it indicates insufficient Yang Qi in the body; thus, in addition to inducing sweating and dispelling cold, Yang Qi must also be tonified.(3) Fever Caused by Insufficient Temperature RegulationIn TCM, this is referred to as “Xu Re” (Deficiency Heat), often caused by weakness in the body, leading to decreased temperature regulation ability. Characteristics include subjective feelings of heat without an actual increase in body temperature, or low-grade fever (often below 38°C), with heat sensation being lighter in the morning and heavier in the afternoon or evening, alleviating with rest and worsening with exertion, accompanied by hot palms and soles, skin heat, fatigue, decreased appetite, and lack of energy. For this type of fever, Western medicine often finds it difficult to identify the cause, while TCM can effectively reduce the fever through methods that tonify Yuan Qi, such as using Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), often achieving the effect of resolving heat naturally.3. Tidal Fever: Abnormalities in Body Rhythm and Internal EnvironmentTidal fever occurs at specific times, often in the afternoon or at night, with the heat subsiding after a period, resembling the regular rise and fall of tides. There are mainly three types:(1) Damp-Heat Tidal FeverThis is caused by the characteristics of “dampness.” Dampness has a sticky nature, which can absorb a lot of heat and hinder heat dissipation. When the internal environment of the body is filled with “dampness,” tidal fever will occur. Its characteristics include regular occurrence in the afternoon or evening, and “body heat not rising,” meaning the skin initially feels cool but becomes hot upon prolonged contact, often accompanied by a yellow greasy tongue coating.(2) Floating Yang Tidal FeverThis is common in women during menopause. Traditionally, TCM believed this was due to “Yin Deficiency with Excess Fire,” but many patients find little relief from Yin-nourishing and fire-reducing medications. In reality, this is due to weak Yang Qi in the body, which cannot remain stable internally and instead “floats” outward and upward, causing excess heat wherever it goes, resulting in tidal fever, sweating, flushed cheeks, and irritability. Unlike true internal heat, floating Yang tidal fever presents with characteristics of fear of cold and lack of energy. Treatment for floating Yang tidal fever can include Si Ni Tang (Frigid Extremities Decoction) to rescue the Yang and Long Gu (Dragon Bone) and Duan Mu Li (Calcined Oyster Shell) to restrain floating Yang.(3) Yangming Tidal FeverThis is caused by heat pathogens invading the large intestine, forming dry stools that block the intestines, characterized by fever occurring between 3-5 PM, sweating of hands and feet, abdominal hardness and pain, and constipation. Treatment involves using Da Cheng Qi Tang (Major Order the Qi Decoction) to purge and relieve constipation, allowing the dry stools to be expelled, thus naturally resolving tidal fever.4. Alternating Cold and Heat: A Manifestation of Special ConditionsAlternating cold and heat refers to the alternating occurrence of cold and heat, commonly seen in malaria and in Shaoyang diseases caused by cold pathogens invading the body between the surface and interior. During chills, there is shivering, and warming does not alleviate it, followed by fever, which cannot be relieved even by soaking in ice water.The inquiry of cold and heat is a key aspect of TCM diagnosis. By carefully inquiring about the different manifestations of cold and heat, we can roughly understand the state of the internal environment of the body, laying the foundation for accurate diagnosis and effective treatment of diseases. The wisdom of TCM lies in exploring the roots of diseases from these seemingly ordinary symptoms, using unique methods to adjust the balance of Yin and Yang in the body, achieving the goal of curing diseases and restoring health. Next, we will continue to delve into the world of TCM inquiry, exploring the mysteries of sweating (to be continued).
