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Cold and heat nature of diseases are the reflections* of the conditions of yin and yang in the body. Yang pathogens usually damage yin; damaged yin can result in yang hyperactivity which can transform into heat, and then heat patterns occur. Yin pathogens usually damage yang and lead to yin exuberance, and then cold patterns appear. Therefore, there is a saying that "Yang exuberance leads to heat and yin exuberance leads to cold."

Cold pattern is a general term for patterns caused either by external cold pathogen or by insufficient yang within the body, commonly manifested by aversion to cold or fear of cold, cold pain with preference for heat, absence of thirst, thin clear sputum and nasal mucus*, long voidings of clear urine, loose bowels, white facial complexion, pale tongue with white coating, and tight or slow pulse.

Cold pattern can arise when cold pathogen attacks the body, causing excess cold pattern, or body yang is deficient, leading to deficiency cold pattern.

When cold attacks the body it can damage body yang qi from warming the body, resulting in excess cold pattern; when body yang is deficient, interior cold will be generated, leading to deficiency cold pattern. Exterior cold pattern may arise when cold pathogen attacks the body surface; while interior cold pattern may occur when cold pathogen directly attacks the interior, or cold pathogens enter the interior after attacking the exterior, or yin cold generates inside the body.

Heat pattern is a general term for patterns resulting either from attack of external heat or from prevalence of yang qi, usually manifested by fever, aversion to heat and liking for cold, thirst, flushed face, irritability and vexation, thick yellow sputum and nasal mucus, short voidings of dark-colored urine, constipation, reddened tongue with yellow coating, and rapid pulse.

Yang exuberance can transform into heat, and yin deficiency can lead to yang hyperactivity which also transforms into heat. Therefore, heat patterns can be further divided into excess heat (yang exuberance) and deficiency heat (yin deficiency) patterns. External heat pathogen contraction or excess intake of spicy and warm-heat food can cause yang heat exuberance in the body, giving rise to excess heat patterns; chronic disease may consume* yin and result in yin deficiency and yang hyperactivity, leading to deficiency heat pattern. Heat patterns can also be divided into exterior and interior. When heat pathogens invade the body surface, they usually cause exterior heat pattern. Interior heat can be caused by direct interior attack of external heat pathogen, or heat pathogen entering the interior after attacking the exterior, or exterior cold entering the interior and transforming into heat, or yang heat generating inside the body due to body yin deficiency.

Cold and heat patterns reflect the condition of body yin and yang. Cold patterns pertain to yin and heat patterns pertain to yang. The main points of differentiating cold and heat patterns are listed in Table 9-2.

Table 9-2 Cold and heat pattern differentiation