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The Inner Canon of Huangdi Health Preservation
Nowadays, many things are difficult to distinguish between true and false, whether it’s food, drink, clothing, or daily necessities. Some people even mix in falsehoods in love and family for money and profit.Thus, a song sings, “Lend me, lend me a pair of wise eyes, so I can see through this confusion clearly and distinctly.” In our discussion of Traditional Chinese Medicine (TCM), I want to talk about a condition that sometimes plays tricks on you: what appears to be a cold syndrome may disguise itself as a heat syndrome; or what seems to be a heat syndrome may present with signs of cold. When faced with such situations, we need to have discerning eyes to clearly identify whether it is true cold or true heat. Understanding the essence of the illness is crucial; one must not be misled by appearances, or else the treatment may go awry, leading to many being harmed in the process.So how do we distinguish between the true and false?
The most direct and effective method is to observe the tongue. It is straightforward and convenient.Many friends studying TCM health preservation, when they or their family members fall ill, look at complexion, sweating, and whether the body feels cold or hot, but they often neglect to examine the tongue. For ordinary people, pulse diagnosis can be quite challenging, but tongue diagnosis is relatively easy to learn.Generally speaking, if the tongue coating is white, it indicates that the person has internal cold, and their illness is often related to cold. Even if there is fever, it is a false heat because the body is too cold, and the remaining bit of yang energy cannot stay warm, thus rising to the surface. At this time, you should administer warm yang and dispel cold.If the person’s tongue coating is thick and yellow, it indicates that the person has internal heat, and their illness is a heat syndrome, requiring treatment with clearing heat and dispelling fire.In addition, observing bowel movements is often an effective way to distinguish between cold and heat.If it is a heat syndrome, the stool will definitely be dry and hard; in severe cases, it may resemble sheep droppings. If the stool is not dry, one should not recklessly use cold purgatives, as it can harm the righteous qi. This point was repeatedly emphasized by Zhang Zhongjing in the “Treatise on Cold Damage.” 
Urination can also be observed at any time when going to the restroom.If the urine is particularly yellow and has a strong odor, it indicates that there is fire in the body, and sometimes there may be infrequent urination or painful urination. Conversely, if it is a cold syndrome, the urine will be relatively clear and abundant.True cold and false heat, true heat and false cold—these deceptive symptoms can sometimes confuse not only ordinary people but also renowned doctors, who may also be misled by these appearances. Let me share a story about true cold and false heat.Xu Xiaopu was a famous pediatrician in Shanghai during the 1930s. One summer, his young son contracted typhoid fever and developed a high fever. Xu Xiaopu thought that since children often have excess yang and insufficient yin, a fever must be a heat syndrome, so he prescribed some cooling medicines. However, after taking the medicine, the fever did not subside; instead, the child’s condition worsened.Xu Xiaopu tried every possible method, but nothing worked. In desperation, at the urging of his family, he invited Zhu Weiju.Who is Zhu Weiju? He is known as “Zhu Fuzhi,” a representative figure in warm disease theory, particularly skilled in using Aconite (Fu Zi) for treatment, often employing it in nine out of ten cases. When Zhu Weiju arrived, he indeed prescribed Aconite for the child.Xu Xiaopu was furious. The child was already burning with fever, and he still prescribed such a hot herb. In anger, he retreated to his room.Zhu Weiju stayed with the child, preparing and administering the medicine while observing the child’s condition. Unexpectedly, by the next morning, the child’s fever gradually subsided, and he even began to drink rice soup. This was great news, and Mrs. Xu hurried to inform Xu Xiaopu.Upon hearing the news, Xu Xiaopu rushed to examine the child thoroughly. The child had indeed improved significantly, looking completely different from a few days prior. At this point, Xu Xiaopu was thoroughly convinced of Zhu Weiju’s skills and immediately removed the plaque reading “Pediatric Expert” from his door, acknowledging that he was not as skilled and no longer deserved the title of “expert,” and earnestly sought to become Zhu Weiju’s disciple.In this example, we can see that Xu Xiaopu’s child’s illness was actually true cold disguised as false heat.
On the surface, the high fever persisted, appearing extremely hot, but in reality, it was an internal cold syndrome. The interior was already affected by cold, and using cooling medicines would only exacerbate the cold and further deplete the yang energy, which is why Xu Xiaopu’s treatment was ineffective. In contrast, Aconite is warming; using Aconite aligns with the TCM principle of “treating cold with heat,” and once the yin-yang balance is restored, the illness naturally resolves.Correspondingly, another situation is true heat disguised as false cold.One might perceive a person as being extremely cold, but in reality, they are experiencing a heat syndrome internally.I once treated a patient like this. It was July, a very hot month, and many people were wearing tank tops and shorts, sweating profusely, but this patient came in wearing a wool sweater, hunched over, and claimed to feel cold. She said this “cold illness” had troubled her for several years, and she had seen many doctors without improvement.I reviewed her previous prescriptions, which were all warming and dispelling cold medicines. At that moment, I was puzzled; these were indeed medicines for treating cold syndromes, so why had the patient’s condition not improved over such a long time? While she spoke, I occasionally noticed her breath was quite heavy, and suddenly the term “cold trapping fire” popped into my mind. Upon examining her tongue coating, it was not the white expected in a cold syndrome but rather thick and yellow, indicating a clear heat syndrome.
Thus, I quickly prescribed gypsum (Sheng Shi Gao), talc (Hua Shi), and water buffalo horn (Shui Niu Jiao), among other cooling herbs, for her to take. As a result, after one dose, she no longer felt as cold. After a few more doses, she was able to wear clothes similar to those of normal people. Eventually, her condition gradually improved.Looking back, I suspect that the doctors she had seen before, like myself at first, were misled by her apparent cold symptoms.Therefore, distinguishing between true and false, clearing the fog, is a very important task for a doctor. Of course, not everyone can become a doctor, nor does everyone need to be one.Most of us simply hope for health and longevity for ourselves and our families. However, even so, we need to have a better understanding and awareness of diseases, which will provide us with greater health security.
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