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Nowadays, many things are difficult to distinguish between true and false, whether it’s food, drink, clothing, or daily necessities. Some people even mix falsehoods into love and family relationships 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 certain 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 encountering 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, as this can lead to misguided treatments, which has harmed many.
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 for health maintenance, when they or their family members fall ill, tend to observe complexion, sweating, and whether the body feels cold or hot, but often neglect to examine the tongue. For ordinary people, pulse diagnosis can be quite challenging, but tongue diagnosis is relatively easier to learn.
Generally speaking, if thetongue coating is white, it indicates that the personhas internal cold, and their illness is often related to cold. Even if there is fever, it is a false heat, as the body is too cold, and the remaining yang energy cannot stay warm, thus rising to the surface. In this case, you should administerwarm yang and expel cold.
If the person’stongue coating is thick and yellow, it indicates that the personhas internal heat, and their illness is a heat syndrome, requiring treatment toclear heat and expel 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 this can harm the righteous qi. This point has been repeatedly emphasized by Zhang Zhongjing in the “Shang Han Lun”.
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. Sometimes, there may be infrequent urination or difficulty and pain during 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. 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 have “excess yang and insufficient yin,” the fever must be a heat syndrome, so he prescribed some cold herbs for treatment. 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, he was persuaded by his family to invite Zhu Weijun.
Zhu Weijun, known as “Zhu Fuzhi,” was a representative figure in warm disease theory, particularly skilled in using Fuzi (Aconite) for treatment, often employing it in nine out of ten cases. When Zhu Weijun arrived, he indeed included Fuzi in the prescription for the child.
Xu Xiaopu was furious. The child was burning with fever, and he still prescribed such a hot herb. In anger, he retreated to his room.
Zhu Weijun stayed with the child, preparing and administering the medicine while observing the child’s condition. To Xu Xiaopu’s surprise, 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.
Xu Xiaopu rushed over and examined the child thoroughly. The child had indeed improved significantly, looking completely different from a few days prior. At that moment, Xu Xiaopu was thoroughly convinced of Zhu Weijun’s abilities and took down the plaque that read “Pediatric Expert,” realizing he was not as skilled and no longer deserved the title of “expert.” He earnestly sought to become Zhu Weijun’s disciple.
In the end, Zhu Weijun agreed to take his child as a student.
This example illustrates that Xu Xiaopu’s child’s illness was indeed true cold disguised as heat.
On the surface, the high fever seemed severe, but the child actually had internal cold. The internal cold had already set in, and using cold herbs to combat it would only exacerbate the cold and further deplete the yang energy, which is why Xu Xiaopu’s treatment was ineffective. In contrast, Fuzi is warming; using Fuzi aligns with the TCM principle of “treating cold with heat,” restoring the balance of yin and yang, leading to recovery.
Conversely, another situation is true heat disguised as false cold.
One might appear extremely cold, but in reality, they have a heat syndrome internally.
I once treated a patient who came to me in July, during a scorching summer. While many people were wearing tank tops and shorts, sweating profusely, this patient was dressed in 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 cold-expelling herbs. I was puzzled; these were medications for treating cold syndromes, so why had her condition not improved over such a long time?
As she spoke, I 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 some cold herbs like Sheng Shigao (Gypsum), Huashi (Talc), and Niubangzi (Water Buffalo Horn) for her to take. After one dose, she felt less cold. After a few 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 I initially did, 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 understand diseases better and gain more knowledge, which will provide us with a greater guarantee of health.
Source: The Theory of Innate System Medicine
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