In Traditional Chinese Medicine, cold-induced syndromes are a category of conditions caused by an external invasion of cold pathogens or an internal deficiency of yang qi. Typical symptoms include sensitivity to cold, pain that worsens with cold exposure, and relief upon warming. These syndromes are classified into superficial cold, internal cold, excess cold, and deficiency cold.
Typical Manifestations:
Cold: Sensitivity to wind and cold; cold hands and feet; preference for hot beverages.
Pain: Headaches, joint pain, stomach pain, and dysmenorrhea that worsen with cold and improve with warm compresses.
Pallor: Pale or bluish complexion; copious, thin, and white phlegm, nasal discharge, and vaginal discharge.
Sluggishness: Low energy, reluctance to move; a pale tongue with a white coating; and a deep or slow pulse.
The Story of a Frozen Water Pipe
One winter, the temperature was exceptionally low, and many households had their water pipes freeze and burst—my kitchen pipe was no exception. When I woke up that morning and saw the pipe completely frozen solid, my wife looked utterly helpless.
I brought over a bottle of hot water and slowly poured it over the frozen pipe. A few minutes later, water began to trickle out—first drop by drop, then as a thin stream—until the flow gradually became steady. But then I noticed the pipe had burst from the cold, and water was gushing out nonstop. There was no choice but to replace that section of pipe.
So I called a plumber. As he replaced the pipe, I struck up a conversation with him.
“I didn’t expect the freezing to be this severe this winter—it actually cracked a perfectly good pipe,” I remarked.
“That’s nothing. At many construction sites, because they don’t account for thermal expansion and contraction, buildings can be damaged by the cold. If this issue isn’t properly addressed during construction, even bridges can be frozen to the point of breaking…”
After the pipe was repaired and the plumber had left, I reflected on our conversation. The country suffers significant losses every year due to the cold, but as a practitioner of Traditional Chinese Medicine, I’m even more concerned about the harm “cold” inflicts on the human body. Traditional Chinese Medicine posits that disease is caused by the “Six Excesses,” and cold pathogens are one of them. Not only do they wreak such havoc on nature, but they are also the root cause of many diseases in the human body.
I. Cold Has a Contracting Nature; the Body Also Contracts When Exposed to Cold
From a TCM perspective, a frozen and burst pipe is caused by the “contracting nature of cold.”
The contracting nature of cold is a characteristic of cold pathogens. “Cold causes qi to contract.” When cold pathogens invade the body, they cause the flow of qi to contract, leading to the constriction and stiffness of the pores, meridians, and tendons. “For example, when cold pathogens attack the exterior, the pores and skin pores become blocked, and the defensive yang is suppressed and unable to disperse, resulting in chills, fever, and an absence of sweat; when cold lodges in the blood vessels, qi and blood stagnate, and the blood vessels constrict, leading to pain in the head and body and a tight pulse; when cold lodges in the meridians and joints, the meridians become stiff and contracted, resulting in difficulty bending or stretching the limbs, or coldness and numbness.”
The manifestation of “contraction and tightening” in the human body can be understood from two perspectives: horizontal contraction and vertical contraction.
“Horizontal contraction” is akin to a water pipe contracting and becoming narrower! When the body is exposed to cold, the meridians also contract and narrow, affecting the flow of qi and blood. This leads to local blockages in the meridians, resulting in pain—the principle that “where there is no free flow, there is pain,” which is quite easy to understand. As mentioned above, “When cold invades the blood vessels, qi and blood become stagnant, and the blood vessels constrict, leading to pain in the head and body and a tight pulse.”
“Longitudinal contraction” is like a piece of steel that shortens after being frozen! When the body’s meridians, tendons, bones, and muscles are invaded by cold pathogens, they also contract and shorten. As mentioned above, “When cold invades the meridians and joints, the meridians become stiff and contracted, leading to difficulty in flexing and extending the limbs, or coldness and numbness.”
II. Frostbite Is the Most Common Disease Caused by Cold Pathogens
Does cold pathogenic factor actually affect people in clinical practice? Are such patients common? Yes, and they are very common!
The most frequently observed condition in clinical practice is chilblains. Some patients develop chilblains every year, from childhood through adulthood, year after year. In fact, this is caused by the cold’s contracting effect and impaired blood circulation.
Some people may wonder: since everyone lives in the same place, why do some people get chilblains while others do not?
There is a classic saying in Traditional Chinese Medicine: “When vital energy resides within, pathogenic factors cannot invade; where pathogenic factors gather, vital energy must be deficient.” Insufficient vital energy is the root cause of chilblains.
So what kind of vital energy deficiency is this?
“The heart governs the blood vessels.” When the heart’s yang energy is insufficient, blood circulation becomes obstructed. When the body is then invaded by cold pathogens—whose nature is to contract and constrict—it becomes prone to developing chilblains.
Therefore, the treatment of chilblains must begin with the “heart,” and “warming” and “unblocking” are key. There is a medicinal herb called Guizhi (Cinnamomum cassia twig), which is the dried young twig of the Cinnamomum cassia plant (family Lauraceae). It has the effects of warming and unblocking the meridians, as well as assisting yang and transforming qi, making it an indispensable herb for treating various types of chilblains.
The classical text of Traditional Chinese Medicine, *Treatise on Cold Damage*, records a formula for treating blood deficiency with cold-induced cold extremities—Dang Gui Si Ni Decoction. It is primarily used for individuals with cold hands and feet, a pale-white tongue coating, and a deep, fine pulse or a fine pulse that is nearly imperceptible. Its composition includes Dang Gui, Gui Zhi, Shao Yao, Xi Xin, Tong Cao, Da Zao, and Zhi Gan Cao.
In terms of its formulation, this decoction combines warming the yang with dispelling cold, and nourishing the blood with unblocking the meridians. It is warming without causing dryness and tonifying without causing stagnation, making it a classic prescription for treating chilblains. In the early stages of chilblains, due to the constricting and contracting effects of cold, the affected skin may appear pale, cold, numb, and painful; followed by swelling and cyanosis, itching and pain, or the formation of blisters, and even ulceration; over time, tissue necrosis may occur, making healing difficult. Since blood deficiency with cold stagnation is the indication for this formula, it can be modified as needed to treat chilblains of the hands and feet, regardless of whether ulceration is present in the early stages.
III. General Principle for Dispelling Cold—Warming and Tonifying Kidney Yang
Cold pathogens can cause many ailments besides chilblains, such as headaches, frozen shoulder, ankylosing spondylitis, intestinal spasms, and dysmenorrhea in women.
When treating these conditions, in addition to considering that the heart governs the blood vessels, we must also take kidney yang into account. This is because the heart and kidney yang are the sources of the body’s yang qi; a deficiency in either can lead to an insufficiency of vital energy, making it easier for cold pathogens to invade the body. One of the nineteen principles of pathogenesis in the *Huangdi Neijing* states, “All cold-induced contraction and constriction are attributed to the kidneys,” which illustrates this very principle.
Patients with kidney yang deficiency who are exposed to cold will experience cold pain in the lower back; some patients may even be unable to straighten their backs due to the pain. In fact, this is caused by the contracting nature of cold, and can be treated by taking herbs that warm and tonify kidney yang.
IV. Methods for Warming and Tonifying Kidney Yang—Taking Gui Fu Di Huang Wan, Moxibustion, or TDP (Specific Electromagnetic Wave) Irradiation
There are many herbs for warming and tonifying kidney yang, so which ones are appropriate?
Generally, patients with kidney yang deficiency will find Gui Fu Di Huang Wan effective. However, if dampness is also present—resulting in cold-damp lower back pain—it is necessary to combine yang-warming with dampness-removing treatments. In such cases, patients can take Du Huo Ji Sheng Wan, Tian Ma Wan, or Mu Gua Wan.
If you are unsure about which medication to choose, it is best to directly apply moxibustion with moxa sticks to the lower back affected by cold. Use the moxa fire to dispel the cold pathogen from the lower back; once the cold pathogen is completely dispelled, the lower back pain will naturally subside.
When performing moxibustion, you can use five to six moxa sticks at once, arranged in a row and secured with thin wire, then held in place with tongs. Lighting the entire row simultaneously will yield better results.
Although moxa stick therapy is effective, it has one drawback: the smoke produced during combustion is quite heavy. The room becomes filled with smoke during the treatment, so it’s best to find a place with an exhaust fan to draw the smoke away, making the experience more comfortable for the patient.
Another inconvenience of moxa stick therapy is that it requires assistance from another person; it cannot be performed alone. Some elderly people have limited dexterity in their hands and feet; if they attempt to treat their spouse’s lower back, they may easily cause burns. Therefore, for patients who have difficulty performing the procedure themselves, I recommend using an electric heating method. There is a type of TDP (Specific Electromagnetic Wave) therapy device, also known as the “Divine Lamp” therapy device, which is now widely used in many hospitals. It is simple to operate—a single person can use it independently—and produces no pollution. Using it to warm the lower back and dispel cold and dampness from that area is also highly effective.
When the lower back is exposed to cold, the contracting nature of cold causes pain. Once this principle is understood, treatment becomes straightforward. Treat cold with heat; apply heat to the affected area, and the lower back pain will naturally resolve.
V. Symptoms of Cold Affecting the Spleen and Stomach: Abdominal Pain, Diarrhea
People with spleen and stomach yang deficiency will experience abdominal pain and diarrhea after consuming cold or cooling foods. If they visit a hospital, the doctor will likely tell them this is intestinal spasm. In reality, it is also caused by “cold’s contracting nature,” only manifested in the intestines. The treatment principle remains “treat cold with heat”; taking medications that dispel cold, such as Fuzi Lizhong Pills, can resolve the issue. If you prefer not to take medication, applying moxibustion with a moxa stick to the Shenque acupoint—located at the navel—until the area feels warm to the touch will be equally effective. If you prefer not to use moxibustion, warming the area with a heating lamp works on the same principle.
VI. Symptoms of Neck Exposure to Cold: Neck Stiffness
Some patients with cervical spondylosis experience a “cracking” sound when moving their necks. After exposure to cold, their necks become stiff and painful, as if they had a stiff neck. Some patients even describe it as if the tendons in their backs have shortened, causing tightness and pain. In fact, this is a manifestation of cold-induced contraction.
When a water pipe freezes and bursts, we clearly understand that it is caused by extremely cold weather and cold pathogens. Yet when the body’s tendons and bones contract and become painful, people rarely attribute it to cold pathogens. Some mistakenly believe it is due to degenerative cervical spine disease and treat it with neck traction. However, this often results in increasing pain and greater neck stiffness. Such counterproductive treatment does not resolve the issue; dispelling the cold from the neck is the key to treatment.
Treating such patients is actually quite simple. Ge Gen Tang (Kudzu Root Decoction) from the *Treatise on Cold Damage* can be considered a highly effective formula for treating pain and discomfort caused by cold in the neck. The formula consists of kudzu root (Ge Gen), ephedra (Ma Huang), cinnamon twig (Gui Zhi), peony root (Shao Yao), licorice root (Gan Cao), fresh ginger (Sheng Jiang), and jujube (Da Zao).
Ma Huang in this formula can raise blood pressure and increase heart rate; therefore, patients with hypertension or heart disease should omit Ma Huang when using this formula. If the patient is averse to wind and exhibits an absence of sweating, Ma Huang can be replaced with Jing Jie. This substitution maintains the formula’s ability to release the exterior without the side effects of elevated blood pressure or increased heart rate.
VII. Symptoms of Cold in the Shoulders and Back: Frozen Shoulder
Clinically, some individuals with a tendency toward cold in the small intestine have impaired circulation in the Small Intestine Meridian. Since the Hand-Taiyang Small Intestine Meridian runs around the shoulders and back, even slight exposure to cold can cause the meridians to contract due to the cold, obstructing the flow of qi and blood. The person will first experience pain in the shoulders and back, particularly on the outer and posterior sides of the arms; however, movements such as abduction, elevation, and adduction of the shoulder joint remain unrestricted. This represents the initial stage of the condition. If the condition persists for a long time, with prolonged local meridian blockage combined with reduced shoulder joint mobility and lack of exercise, it can lead to muscle adhesions and ultimately result in frozen shoulder (also known as shoulder stiffness), causing restricted joint movement.
Pain in the shoulders and back is merely a symptom; the underlying causes—deficiency of qi and blood, a predominance of cold pathogens in the intestines, and blocked meridians—are the key factors in the onset of the disease.
For treatment, one can first take Ma Huang Tang or two tablets of compound aspirin (not recommended for those with stomach conditions) to induce sweating, dispel cold from the body surface, and unblock the meridians. Once symptoms have subsided, treatment should focus on the Small Intestine Meridian to dispel cold pathogens from the intestines (by taking Fu Zi Li Zhong Wan); this is the key to a complete cure.
Patients with this condition should avoid consuming cold foods in their daily diet and eat more warming foods. When sleeping, be sure to keep the shoulders and back warm. If joint mobility is already restricted, it is even more important to increase exercise to stretch the adhered muscles; only then can frozen shoulder be completely cured.
VIII. Symptoms of Lower Abdominal Cold in Women: Gynecological Disorders
During menstruation, if a woman’s lower abdomen is exposed to cold, affecting the circulation of qi and blood, it will manifest as dysmenorrhea. This is also an example of “cold causing contraction,” but it manifests specifically in the lower abdomen and the uterus. How should it be treated?
Women who suffer from dysmenorrhea know that applying a hot water bottle during an episode brings significant relief. This is the simplest practical application of the principle “treat cold with heat.” A hot water bottle is effective; moxibustion is naturally effective; and electric therapy using a treatment device is naturally effective as well! What about taking warming herbs?
Many women with dysmenorrhea seek treatment from TCM practitioners, who often prescribe variations of the Taohong Siwu Decoction. Is this effective? It works! Herbs like peach kernel and safflower, which promote blood circulation and dispel blood stasis, help unblock the blood vessels, naturally alleviating the pain. However, if the cold pathogen isn’t completely eliminated, the pain will return with the next menstrual cycle. Moreover, a persistent accumulation of cold pathogens in the uterus can increase the risk of developing uterine fibroids. In fact, the best herbs for treating dysmenorrhea aren’t those that promote blood circulation, but rather those that warm the meridians. When warming herbs are used to eliminate the cold pathogen from the uterus, the dysmenorrhea will naturally resolve.
There is a proprietary Chinese medicine called Ai Fu Nuan Gong Wan, formulated with mugwort (charred), cyperus (vinegar-processed), evodia (processed), cinnamon, angelica, ligusticum, white peony (wine-fried), rehmannia, astragalus (honey-fried), and续断. Its primary functions are to regulate qi and nourish blood, as well as warm the uterus and regulate menstruation. It is used to treat irregular menstruation and dysmenorrhea caused by blood deficiency and qi stagnation, as well as deficiency-cold in the lower jiao. It is most effective for symptoms such as delayed menstruation, scanty menstrual flow, blood clots, lower abdominal pain, cold pain in the lower abdomen during menstruation that is relieved by warmth, and aching in the lower back and knees. Taking this medicine regularly for a period of time can cure most cases of dysmenorrhea.
Some people, after their lower abdomen has been exposed to cold, experience abdominal bloating and a constant urge to urinate, yet pass only small amounts each time. An ultrasound examination at the hospital may reveal a small amount of fluid in the pelvic cavity. Some doctors believe this is an inflammation requiring antibiotic treatment. In my view, however, this is actually due to the cold-induced contracting effect manifesting in the Sanjiao.
The Triple Burner is the body’s “oil network” outside the intestines, connecting the five zang organs and six fu organs from top to bottom—a concept discussed in detail in *Medicine: Integrating Chinese and Western Insights*. The Triple Burner governs the water channels; the metabolism of bodily fluids is most closely related to it. When the lower abdomen is exposed to cold, the “oil network” surrounding the bladder contracts due to the cold, obstructing the flow of water channels, causing fluid to accumulate. This is why a small amount of fluid is visible in the pelvic cavity on an ultrasound. What we see is fluid; what we cannot see is the cold! The root cause of the patient’s discomfort is the pathogenic cold; due to its contracting nature, the illness arises.
Treatment simply involves dispelling the cold. For such patients, it suffices to decoct about 30 grams of fennel seeds in water, take the decoction in two divided doses to dispel cold and regulate qi, and the condition can be cured within a few hours.
Earlier, through the story of releasing sky lanterns, we learned that “fire rises upward.” In this chapter, through the story of the frozen water pipe, we’ve learned that “cold contracts and constricts.” Some might ask, “I always feel a burning sensation in my chest and a ‘heat’ in my head and face—I know this is fire rising upward—but I also feel cold below the waist. Why is that? Does cold actually tend to descend?”
This is a case of “heat above, cold below,” a condition commonly seen in clinical practice. To illustrate this point, let’s look at another story: the story of air conditioning.
