Hot and Cold describe the nature of a pattern, and their associated symptoms depend on whether they are combined with a Excess or Deficient condition.
The main symptoms are feeling cold, cold limbs, absence of thirst, pale face, abdominal pain aggravated on pressure, desire to drink warm liquids, loose stools, clear abundant urination, Deep-Full-Tight pulse and a Pale tongue with thick white coating.
Cold also often causes pain, especially abdominal pain, which is a frequent manifestation of Full Cold. Also, anything that is pale or bluish-purple may indicate Cold. For example, a pale face or pale tongue, a white tongue coating, a bluish-purple tongue and bluish lips or fingers and toes.
Exterior Cold can sometimes penetrate into the Interior directly. In particular, Exterior Cold can invade the Stomach (causing vomiting and epigastric pain), the Small and Large Intestines (causing diarrhoea and abdominal pain), the Uterus (causing acute dysmenorrhoea) as well as the Liver Channel (causing swelling and pain of the scrotum).
Interior Full Cold may be caused by the excessive consumption of cold-energy foods (such as salads, fruit and iced drinks) or by external Cold. When external Cold invades the body, it will invade the Channels first and then the Organs. For example, invasion of external Cold in the Spleen is common: when in the Channel, it is still exterior Cold, when in the Spleen it is internal Cold.
The main symptoms are intolerance to cold, cold extremities, a phobia of coldness and a preference for warm climates, warm food and drinks. Lack of Yang will also cause symptoms of pale complexion, impotence, frigidity, lack of appetite, a weakened immune system, slowness of speech and slow movements. The tongue will appear pale with a white coat, possibly with scalloped edges. The pulse is slow (60 beats per minute or slower).
Empty Cold develops when Yang Qi is weak and fails to warm the body. It is mostly related to Spleen Yang and/or Kidney Yang Deficiency. The most common cause is Spleen Yang Deficiency. When this is Deficient, the Spleen fails to warm the muscles, hence the feeling of cold. The Spleen needs Heat for its function of transformation of food, and when Yang is Deficient, food is not transformed properly and loose stools result.
The cause of Empty Cold is Yang Deficiency. The main causes of Yang Deficiency are:
The most common situation in which there are manifestations of both Heat and Cold is when these patterns simply coexist. This is an extremely common situation in practice. For example, it is common for a person to suffer from Kidney Yang Deficiency (hence Empty Cold in the Kidneys) and Damp Heat in the Bladder, or Spleen Yang Deficiency and Liver Fire.
We should therefore not be surprised when we observe contradictory Hot and Cold symptoms in practice: in most cases, they are due to the coexistence of Heat and Cold patterns. To return to the above example, if a patient suffers from Spleen Yang Deficiency, he or she may feel generally cold but have a red face and thirst.
In some cases there may be contradictory Hot and Cold signs and symptoms, one of them being due to a ‘false’ appearance. This usually only happens in extreme conditions and is quite rare. It is important not to confuse this phenomenon with common situations when Heat and Cold are simply combined, as described right above.
For example, it is perfectly possible for someone to have a condition of Damp Heat in the Bladder and Cold in the Spleen. This is simply a combination of Hot and Cold signs in two different Organs, and does not fall under the category of False Heat and True Cold or vice versa.
In cases of False Heat and False Cold, tongue diagnosis shows its most useful aspect as the tongue-body colour nearly always reflects the true condition. If the tongue-body color is Red it indicates Heat, if it is Pale it indicates Cold.
In some cases there is Heat above (as Heat tends to rise) and Cold below. The manifestations of this situation might be thirst, irritability, sour regurgitation, bitter taste, mouth ulcers (manifestations of Heat above), loose stools, stomach rumbles and profuse pale urine (manifestations of Cold below).
The symptoms and signs would include a fever with aversion to cold, no sweating, a headache and stiff neck, aches throughout the body (manifestations of exterior Cold), irritability and thirst (manifestations of interior Heat).
This situation also occurs in attacks of Latent Heat combined with a new invasion of Wind-Cold. According to the theory of Warm diseases a person can be attacked by Cold in wintertime without developing any manifestations of it. The Cold can lie dormant in the Interior and change into Heat. In the Spring, with the rising of Yang energy, the interior Heat may be pulled towards the Exterior, especially in combination with a new attack of Wind-Cold. Because of this, the person would have symptoms and signs of an attack of Wind-Cold, but also signs of Interior Heat such as a thirst, irritability and a rapid pulse.
This situation simply occurs when a person with a Interior Cold condition is attacked by Exterior Wind Heat evil. There will therefore be some symptoms of Exterior invasion of Wind-Heat (such as a fever with aversion to cold, a sore throat, thirst, a headache and a Floating-Rapid pulse) and some symptoms of Interior Cold (such as loose stools, chilliness and profuse pale urine).