Differentiation of cold and heat patterns: ambiguities in diagnosis

Cold and heat are two fundamental principles in the differentiation of the nature of disease. They are the two characteristic patterns of exterior manifestations of internal imbalances of yı̄n and yáng. Clinically, only after a clear differentiation of the cold or hot nature of a disease or pattern can there be a correct treatment that follows with satisfactory curative results. However, in clinical realities, neither cold nor heat patterns typically manifest externally through classical patterns and signs. For instance, if the symptoms of cold or heat are not obvious externally, or they are not substantial enough to be included in [the diagnosis of] the true nature of the illness, or, even more frequently, if the actual pattern manifests itself externally with a false ‘mask’, all these are frequent causes for mistakes in pattern identification. The focus of this paper is to analyze the causes for such mistakes in cold and heat pattern identification. This paper addresses three main causes of such problems. First is the rather easily confused relationship between the manifestations, on the one hand, and the patterns, on the other hand, of cold and heat. Second is the unclear understanding and poor grasp of the concepts and clinical manifestations of cold and heat patterns. Third is non-discrimination of the complex interrelationships between cold patterns and heat patterns, particularly with respect to so-called true and false cold and heat. Below is a close examination of these three causes of these problems in diagnosis.