Feeling of cold in interior conditions

In internal diseases, questions about feeling cold serve to establish the Cold nature of the presenting patterns. Cold may be Full or Empty. Whether it is Full or Empty, it always manifests with a feeling of cold.

If a person feels easily cold and experiences cold limbs, this clearly indicates either Full-Cold or Empty- Cold deriving from Yang deficiency. In patients with chronic diseases, Empty-Cold is more common than Full-Cold.

Full-Cold is characterized by an intense feeling of cold and shivers; the body also feels cold to the touch. Various parts of the body may feel particularly cold depending on the location of the Cold: if it is in the Stomach the limbs and epigastrium will feel cold, if in the Intestines the legs and lower abdomen are cold, if in the Uterus the lower abdomen feels cold. Full-Cold has usually a sudden onset and may last only a few months at the most because Cold will inevitably injure Yang and lead to Yang deficiency and therefore Empty-Cold.

Box 43.1 summarizes the clinical manifestations of Full-Cold.

Yang deficiency of any organ may cause a cold feeling or cold limbs, or both. It could be due especiallyto a deficiency of Yang of the Heart, Lungs, Spleen, Kidneys and Stomach. The cold feeling is both subjective and objective, that is, the patient feels easily and frequently cold and the limbs or other parts of the body will feel cold to the touch.

A deficiency of Yang of the Lungs or Heart, or both, will manifest especially with cold hands (Fig 43.2), a deficiency of Spleen-Yang with cold limbs and abdomen (Fig 43.3) and that of Kidney-Yang especially with cold legs, knees, feet and back (Fig 43.4). A deficiency of Stomach-Yang will manifest with cold epigastrium and cold limbs in a similar way to Spleen-Yang deficiency (Fig 43.3).

Box 43.2 summarizes the clinical manifestations of Empty-Cold.

There are however, other causes of cold limbs (as opposed to a general cold feeling). One is Qi stagnation: when Qi stagnates it may fail to reach the hands and feet and these become cold (Fig 43.5). This is called the ‘Four Rebellious Syndrome’, in which the ‘Four Rebellious’ indicate cold hands and feet; the famous formula Si Ni San Four Rebellious Powder is used for this pattern. An important difference between cold in the limbs due to Yang deficiency and that due to Qi stagnation is that in the former case the whole limb will be cold whereas in the latter case only the hands and feet, and especially the fingers, are cold.

Besides this, cold limbs may also derive in women from Blood deficiency; this is due to the deficient Blood not reaching the extremities. In cases of Heart-Blood deficiency only the hands and chest will be cold (Fig 43.6), whereas in cases of Liver-Blood deficiency the feet will be cold (Fig 43.7).

We should bear in mind that, even if patients feel cold in general, they may have a feeling of heat in a specific part of their body, (e.g the face) and we should therefore always remember to ask about specific parts of the body after we have asked about the generalfeeling. A very common example of this, especially in women, is a general cold feeling with occasional episodes of feeling hot in the face.

Box 43.3 summarizes the patterns underlying a cold feeling and cold limbs in interior conditions.

Feeling of cold in exterior conditions

How to distinguish between external and internal causes of feeling of cold

The distinction between a cold feeling from an invasion of external Wind and a cold feeling from internal Cold (which may be Full or Empty) is fairly easy as the accompanying symptoms are quite obvious. During an external invasion with the pathogenic factor still on the Exterior, the patient feels cold, dislikes the idea of going out, shivers, and may have a fever, and the dorsum of the hand feels hot; in addition, there will be sneezing, a cough, a nasal discharge, a sore throat, a headache, body aches and a Floating pulse.

When the patient suffers from interior Cold, there are none of the above symptoms. Another distinction between a cold feeling in exterior syndromes and one in interior syndromes is that in the former case the cold feeling is not alleviated by covering oneself, while in the latter case it is. In fact patients who feel cold and shiver from an invasion of exterior Wind will want to go to bed and cover up with blankets, but this will not alleviate the cold feeling and shivering. If a patient suffers from internal Cold, this will be alleviated by covering oneself. Table 43.1 summarizes the differentiation between external and internal Cold.