For listeners who enjoy audiobooks, you can click below to listen.
When we face the dilemma of treating cold with heat or heat with cold, and it does not yield results, or when the symptoms do not align strictly with either cold or heat, the treatment should not rely solely on either cold or heat herbs. Instead, we must combine both cold and heat herbs, which is known as the mutual use of cold and heat.
The mutual use of cold and heat is the most extensive and variable method in herbal formulations. It can be said that without understanding the mutual use of cold and heat, one cannot be a good doctor.
To discuss the method of mutual use of cold and heat, we must first understand the syndrome of mixed cold and heat. This syndrome, where cold and heat are intertwined, can be illustrated with several common clinical examples:
1. Cold in the abdomen and heat in the intestines: The patient experiences coldness in the abdomen, with symptoms of fullness, poor appetite, painful lumps upon palpation, dry mouth, constipation, a dry red tongue, and a yellow dry coating. The pulse shows a strong force at the guan and cun positions, while the chi positions are weak. Taking cold herbs exacerbates abdominal pain, while heat herbs lead to mouth sores and abdominal pain. The treatment should include warming herbs such as Gan Jiang (Dried Ginger), Rou Gui (Cinnamon), Fu Zi (Aconite), Ma Ti Xiang (Atractylodes), Sha Ren (Cardamom), and Chang Pu (Acorus), to dispel cold, combined with Huang Qin (Scutellaria), Long Dan Cao (Gentian), and Da Huang (Rhubarb) to purge the heat in the intestines and stomach. Since these herbs are all drying, we also add Bai Shao (White Peony), Sheng Di (Rehmannia), Xuan Shen (Scrophularia), and Hua Fen (Pollen) to moisten the intestines and stomach. Given that prolonged illness leads to a struggle between pathogenic cold and the body’s righteous qi, we must also include Qi-tonifying herbs like Dang Shen (Codonopsis) and Huang Qi (Astragalus) in the formula. Other herbs that promote circulation and resolve stasis can be added as needed, making the treatment of this condition manageable.
2. Bladder heat and kidney yang deficiency: The patient experiences burning urination, frequent and urgent urination, lower abdominal pain radiating to the waist, and a heavy sensation in the lower abdomen. The pulse is weak and soft at the chi positions, with a thin and wiry pulse at the guan and cun positions. The tongue is tender red, or the tip is red, with a pale tender body and a thin yellow coating. We should use Xiao Hui Xiang (Fennel), Sha Ren (Cardamom), Du Zhong (Eucommia), Huo Xiang (Agastache), Gan Song (Dried Pine), and Wu Yao (Lindera) to warm and promote kidney qi, combined with Che Qian Zi (Plantago), Hua Shi (Talc), Huang Bai (Phellodendron), Wei Zi (Mulberry), Zhi Mu (Anemarrhena), and Shi Wei (Pyrrosia) to clear the heat from the bladder and promote the smooth flow of the San Jiao (Triple Burner). If the dispersing power is insufficient, we can add Hou Po (Magnolia Bark) and Ji Zi (Jujube) to resolve fullness. Since the pathogenic heat has long obstructed the yin, we can use Bai He (Lily), Shi Hu (Dendrobium), and Bai Shao (White Peony) to nourish yin, and add Chai Hu (Bupleurum) and Yu Jin (Curcuma) to help clear and disperse the stagnation. Adding Tai Zi Shen (Pseudostellaria) and Gan Cao (Licorice) will tonify qi to overcome the pathogen. Thus, we know that this condition requires the mutual use of cold and heat for the formula to be appropriate for the symptoms.
3. Lung and stomach heat with liver and kidney yang deficiency: The patient presents with exterior heat, moist skin, lower abdominal pain radiating to the waist, and severe back pain that restricts movement. Due to dryness and heat in the lung and stomach, there is a dry cough with little sticky phlegm, dry mouth, and constipation. The tongue is dry and red or crimson, and the pulse is floating and weak. The patient may also experience sore throat, sweating, or black slippery stools (indicating gastric bleeding). The treatment should follow the method of Wu Mei Wan (Mume Pill) from the “Shang Han Lun” (Treatise on Cold Damage), which emphasizes the mutual use of cold and heat. We can consider using Chuan Wu (Chuan Aconite) and Cao Wu (Aconite) to warm the kidney and dispel cold, along with Gan Jiang (Dried Ginger), Wu Zhu Yu (Evodia), Chang Pu (Acorus), Xi Xin (Asarum), and Ma Ti Xiang (Atractylodes) to warm and disperse cold from the exterior, allowing the body’s qi to circulate without obstruction. We can also use large doses of Huang Bai (Phellodendron) or Da Huang (Rhubarb) to purge heat, combined with Bai Shao (White Peony), Wu Mei (Mume), Xuan Shen (Scrophularia), and Hua Fen (Pollen) with Gan Cao (Licorice) to bitterly sweeten and moisten dryness. If there is sweating, we can add Mu Guo (Papaya), and for sore throat, we can add Jie Geng (Platycodon). If there are black stools, we can add Zi Di Yu (Rehmannia), San Qi (Notoginseng), and Xian He Cao (Agrimonia) to treat this condition effectively.
4. Heart stasis heat and spleen stomach cold: The patient experiences palpitations, cyanosis of the lips, fullness and pain in the epigastric region and hypochondrium, and constipation. The tongue is dry and red with many stasis spots, and the pulse is floating and slippery at the guan and cun positions, while the chi positions are weak. This condition may sometimes be accompanied by phlegm and wheezing, or numbness and pain in the limbs. The treatment should include Gui Zhi (Cinnamon Twig), Gan Jiang (Dried Ginger), Ma Ti Xiang (Atractylodes), and Wei Ling Xian (Clematis) to warm the middle and disperse the obstruction, while also promoting heart yang. Da Huang (Rhubarb) and Da Huang (Rhubarb) should be used to purge heat and resolve stasis, while Bai Shao (White Peony), Sheng Di (Rehmannia) should moisten dryness, and Dang Shen (Codonopsis) and Huang Qi (Astragalus) should tonify qi. Since there is stasis, we must include Dang Gui (Angelica), Dan Shen (Salvia), Ru Xiang (Frankincense), Mo Yao (Myrrh), Wu Gong (Centipede), Di Bie Chuang (Earthworm), and Hong Hua (Safflower). If the exterior is not dispersing, we can add Fang Feng (Saposhnikovia), Qin Jiao (Gentiana), Fang Ji (Stephania), and Du Huo (Angelica) to assist. For phlegm and wheezing, we can add Ma Huang (Ephedra), Xing Ren (Apricot Kernel), Sheng Shi Gao (Gypsum), Bai Tou Weng (Pulsatilla), and Bei Mu (Fritillaria) to clear lung heat and transform phlegm (Bai Tou Weng is particularly effective for lung heat phlegm cough). We should harmonize the properties of the herbs with Gan Cao (Licorice). If wheezing is severe, we can add Hou Po (Magnolia Bark) and Ting Li Zi (Descurainia). For limb numbness, we can add Wu Shao She (Snake) and Si Gua Luo (Luffa). To prevent excessive purging, we should add an appropriate amount of Xue Jie (Dragon’s Blood) to moderate the purging effect of Bai Shao and Da Huang, while also enhancing the formula’s ability to resolve stasis and stasis.
5. Wind-cold obstructing the exterior, lung and stomach heat accumulation, and kidney yang deficiency: The patient frequently catches colds and suffers from prolonged illness, experiencing chills and fever, coughing and sneezing, with a red tongue and yellow coating. The pulse is floating and slippery at the guan and cun positions, while the chi positions are weak. The patient has lower back pain and cold extremities. We can use Hu Zhang (Polygonum) and Da Huang (Rhubarb) to purge the heat accumulation in the lung and stomach, while Fu Zi (Aconite) warms and strengthens kidney yang. We can also add herbs that disperse the exterior and clear cold, such as Jing Jie (Schizonepeta) and Fang Feng (Saposhnikovia) to disperse the exterior, and Tou Gu Cao (Dichroa) and Qing Feng Teng (Clematis) to clear the channels. Due to lower back weakness, Guo Guo (Euphorbia) and Gou Ji (Cibotium) can strengthen the kidney and bones. Alcohol is a strong aid for warming and dispersing, and using the above herbs in a medicinal wine can combat stubborn conditions that have persisted for years. However, it is crucial to note that the Aconite slices used for medicinal wine must be stir-fried with sand or salt until yellow, and the resulting wine should be consumed in small doses. Following this method, recovery from the illness is not difficult.
In summary, the syndrome of mixed cold and heat reflects a wide variety of symptoms. Regardless of how complex the symptoms may be, as long as the patient presents with symptoms that differ from pure cold or pure heat, and both types of symptoms are present, or if the condition worsens after taking either a predominantly hot or predominantly cold formula, it is likely that a mixed cold and heat syndrome is present. In such cases, we should use cold herbs to treat heat and heat herbs to warm cold, combining both to reflect the essence of syndrome differentiation and treatment.
Regarding the mutual use of cold and heat in herbs, it is not only applicable to mixed cold and heat syndromes but is also widely used in various formulations.
For example, in cases of injury, whether due to cold transforming into heat or heat toxins obstructing the body, leading to redness, heat, and pain in the limbs, we can refer to ancient formulas such as Tao Zhi Tang (Peach Branch Decoction) and Bai Hu Jia Gui Zhi Tang (White Tiger Decoction with Cinnamon Twig) to use heat herbs to open obstructions and cold herbs to resolve heat toxins. Since heat promotes circulation and cold can cause stagnation, we can add a small amount of Gui Zhi (Cinnamon Twig), Chuan Wu (Chuan Aconite), Cao Wu (Aconite), Gan Jiang (Dried Ginger), and Hua Jiao (Sichuan Pepper) to disperse obstructions. Large doses of cold herbs such as Da Huang (Rhubarb), Huang Bai (Phellodendron), Huang Qin (Scutellaria), and Sheng Shi Gao (Gypsum) can clear heat toxins. If cold herbs are not supported by heat herbs, the formula will lack the ability to promote circulation and may easily damage the spleen yang, leading to cold accumulation. Only by incorporating a small amount of heat herbs into a large dose of cold herbs can we ensure that the heat herbs do not contribute to heat toxins while allowing the cold herbs to effectively promote circulation and resolve obstructions, which is the brilliance of the formulation.
Additionally, in cases of spleen and stomach deficiency cold, where prolonged illness may lead to yin deficiency and floating heat, the clinical presentation includes fullness and discomfort in the epigastric region, persistent pain, preference for warmth and pressure, poor appetite, possible vomiting, or loose stools, fatigue, and weakness. The pulse is thin and wiry, the tongue is tender red with little coating, and there may be symptoms of heat in the eyes and mouth sores. The treatment should focus on Xiang Sha Liu Jun Tang (Fragrant Sand Six Gentlemen Decoction) to address the deficiency cold, with a small addition of Bai Shao (White Peony), Shi Hu (Dendrobium), Mai Dong (Ophiopogon), and Sha Shen (Glehnia) to moisten and soften yin, while also using a small amount of Long Dan Cao (Gentian) and Huang Qin (Scutellaria) to control the cold that has long been obstructed and accumulated, leading to deficiency heat. This is another example of the mutual use of cold and heat.
Furthermore, in cases of spleen and stomach heat accumulation, the patient presents with a slippery and rapid pulse, dry and hard stools, abdominal distension and pain, dry mouth, and a red tongue with a yellow dry coating. The treatment should include Da Huang (Rhubarb), Shi Gao (Gypsum), Bai Shao (White Peony), Huang Qin (Scutellaria), Wei Zi (Mulberry), and Long Dan Cao (Gentian) to clear heat toxins, but we must also add Mu Xiang (Costus) and Sha Ren (Cardamom) to disperse obstructions. This way, the heat toxins can be purged without excessive cold herbs causing abdominal cold or obstructing the flow of qi and blood. The key to effective treatment lies in ensuring that the evil is expelled while maintaining smooth qi flow. Only by harmonizing the mutual use of cold and heat can we align with clinical realities.
In the formulas passed down by our predecessors, the mutual use of cold and heat is evident everywhere. For instance, Zhang Zhongjing’s classic formulas include Ban Xia Xie Xin Tang (Pinellia Decoction to Drain the Heart), Fu Zi Xie Xin Tang (Aconite Decoction to Drain the Heart), Wei Zi, Gan Jiang Shi Tang (Mulberry and Dried Ginger Decoction), Wu Mei Wan (Mume Pill), Huang Lian Tang (Coptis Decoction), and Da Huang Fu Zi Tang (Rhubarb and Aconite Decoction), among many others, all of which combine cold and heat herbs according to the balance of cold and heat in the disease, whether leaning more towards cold, heat, or an equal combination. This ensures that the cold and heat in the formula counteract the disease’s cold and heat, making formulation straightforward.
By learning from the experiences of our predecessors and utilizing the rich variety of herbal combinations available today, we can create effective remedies! Those who do not understand the true meaning of herbal formulations and are busy searching for miraculous herbs will find it difficult to succeed! Each herb has its own tendencies, and if the formulation loses the mutual use of cold and heat, we will be helpless against the adverse effects of herbs that are unsuitable for the disease. This will also diminish the subjective initiative of the formulation, inevitably reverting to the primitive stage of direct sensory recognition of herbs.
Highlights from Previous Articles
Practical Skills: Discussing the Mutual Use of Cold and Heat
The Method of Using Cold and Heat in the “Shang Han Lun”
TCM Yin-Yang Ascending and Descending Thought Process (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 Cold and Heat Can Lead to Irritability; How Did Zhang Zhongjing Treat It?
Essential Knowledge: Understanding the Yin-Yang Cold and Heat Properties of Food
There Are No Absolute Cold and Heat Deficiencies or 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: Exterior and Interior, Deficiency and Excess, Cold and Heat + Ascending and Descending (Including Eight Principles Differentiation Insights)
Yin-Yang, Exterior and Interior, Deficiency and Excess, Cold and Heat – Ancient TCM Explained
Liu Duozhou: Discussing the Mixed Yin-Yang and Cold-Heat of Jue Yin Disease
Shen Shaogong’s Comprehensive Treatment Essentials – 2 – Unable to Differentiate Cold and Heat, Deficiency and Excess, Difficult to Use Herbs
Cold and Heat Pairing Does Not Harm the Spleen and Stomach | Liang Dong in Dialogue with Xu Wenbing
Essential Understanding of Formulas: Wu Mei Wan (Due to the Prevalence of Mixed Cold and Heat)
Self-Learning Pulse Diagnosis (Pulse Diagnosis), Start by Differentiating Strength and Weakness to Identify Deficiency and Excess, Begin with Speed to Differentiate Cold and Heat
Let’s Read the “Huangdi Neijing” – Ling Shu – Cold and Heat Chapter Seventy
Let’s Read the “Huangdi Neijing”: 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, Cold Sores Must Be Treated Separately
It Turns Out That TCM’s Inquiry into Cold and Heat Can Reveal So Many Insights
Daily Insights from Mentorship – 153 – The Bedroom and the Medium of Cold and Heat
Essential to Master: The Classic Formulas of Cold and Heat
Uncle JT Slowly Teaches – 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 Key Principles: Direct Methods for Using Cold and Heat in Mixed Syndromes
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 Cold and Heat Imbalance | Yu Hao
Did You Know This? Yin-Yang Cold and Heat 88 Formulas
Comprehensive Guide to Cold and Heat Inquiry in TCM | Zhu Wenfeng
The Correct Eight Principles: Exterior and Interior, Deficiency and Excess, Cold and Heat + Ascending and Descending (Including Eight Principles Differentiation Insights)
What Is the Basis for Classifying Herbs and Foods as Cold or Hot? A Comprehensive Overview of Cold and Heat Classification in Daily Life~
Classifying Foods as Cold or Hot Based on Constitution for Optimal Health! Three Simple Sentences to Distinguish Cold and Hot Foods, Easy to Understand!
Da Huang Fu Zi Zeng Wei Tang, Cold and Heat Mutual Aid to Open Obstructions (Hernia/Women’s Lower Jiao Disorders)
Understanding the “Shang Han Lun” in Differentiating Cold and Heat
Liu Duozhou: Seven Mixed Cold and Heat Formulas in the “Shang Han Lun”
Da Huang Fu Zi Zeng Wei Tang Cold and Heat Mutual Aid to Open Obstructions
Yin-Yang, Exterior and Interior, Cold and Heat, Deficiency and Excess, Are the Eight Principles Equally Important? How Does the Classic Formula Expert Kong Bohua View It?
How to Solve the Ancient Dilemma of Cold and Heat Accumulation with Original Points
Classifying Foods as Cold or Hot Based on Constitution for Optimal Health! Three Simple Sentences to Distinguish Cold and Hot Foods, Easy to Understand!
========== END ==========
Warning Notice:All articles published on this platform are for the purpose of popularizing TCM knowledge and are intended for reference and learning by professional TCM practitioners. They do not serve as prescriptions and do not constitute any advice, recommendations, or guidance. Please do not blindly self-medicate; this platform does not bear any responsibility for any consequences arising from such actions! If necessary, please use under the guidance of a physician. All articles published on this platform represent the author’s views.
⊙ 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 violent games, as they are fundamentally similar to actual killing; do not read pornographic articles, as immorality is the root of reincarnation and disaster. Cause and effect are inseparable. Remember!
It is better to let the medicine gather dust on the shelf than to wish for a world without suffering!
As a parent, not knowing medicine is unkind! As a child, not knowing medicine is 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. Everyone is welcome to learn.
Learning Ancient TCM, Inheriting the Classic Formulas of the “Shang Han Lun”
With great virtue comes great responsibility! Herbs and minerals can only treat physical ailments; cultivating oneself and nurturing virtue is the way to dispel inner demons!
Prayer: May the world be harmonious, the sun and moon be clear; may the wind and rain come at the right time, and disasters not arise; may the nation 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 oppress the weak, and everyone gets their due; may no one suffer from illness or misfortune, and may all be rich, healthy, and peaceful; may all live long and virtuous lives, starting and ending well.
Long press for 2 seconds to follow Qibo Youdao
We welcome you to share the content of this account widely.