Cold Disease: Pulses, Manifestations, and Treatment — Chapter Twelve

Cold Disease: Pulses, Manifestations, and Treatment — Chapter Twelve

Holistic Paraphrase

General Introduction

When cold pathogens cause disease, the Kidney is the first to be afflicted. When cold pathogens invade between the five viscera, the channels and vessels are tugged and pulled, causing pain; if they invade the Eight Hollows (the two elbows, two armpits, two hip joints, and two popliteal fossae—the flexed recesses of the joints), they cause stagnant blood (vicious blood that fails to circulate) to remain and accumulate, and if it accumulates for a long time without dispersing, it turns into Fixed Disease (a condition of stubborn, localizing pain). This cannot be taken lightly!

Cold Pathogen Assailing the Kidney

Cold disease may manifest as bone pain, yin bi (bi-pain caused by cold-damp yin pathogenic factors), abdominal distension, lower back pain, difficulty with defecation, and pulling pain in the shoulders, back, neck, and nape, with a deep and slow pulse (deep pulse position, slow beat rate). This is cold pathogen assailing the Kidney. The ancients advocated treating it primarily with Cinnamon Twig plus Kudzu Root Decoction. If it develops into Fixed Disease, there will be pain in both popliteal fossae (behind the knees), treated primarily with Licorice, Ginger, Poria, and White Atractylodes Decoction.

Cold Pathogen Taking Advantage of the Liver

Cold disease may manifest as pain in both hypochondriac regions. When cold pathogen strikes the channels and vessels, it easily causes tugging and cramping in the joints during walking; when cold attacks upward, there will be headache and deafness, with a wiry, deep, and slow pulse. This is cold pathogen taking advantage of the Liver. The ancients treated it primarily with Minor Bupleurum Decoction. If it develops into Fixed Disease, there will be cramping pain in both armpits, inability to turn or lie on one's side, treated primarily with Bupleurum, Scutellaria, Peony, Pinellia, and Licorice Decoction.

Cold Pathogen Taking Advantage of the Heart

Cold disease may manifest as a feeling of fullness and distension in the chest and hypochondrium, pain between the sternum, back, and scapulae; in severe cases, a tendency to be easily grieved, frequent dizziness, or even collapse and loss of consciousness. This is cold pathogen taking advantage of the Heart. The ancients treated it primarily with Cardiodermal Meridian Activation Counterflow Decoction (Tongmai Sini Tang). If it develops into Fixed Disease, there will be pain on the outside of the elbows and inability of the arms to extend, treated primarily with Licorice Draining the Heart Decoction.

Cold Pathogen Taking Advantage of the Spleen

Cold disease may manifest as abdominal distension, borborygmus, undigested food in the stool, sunsun (thin, loose stool with undigested food), and in severe cases, flaccidity and weakness of the lower limbs that is difficult to control, with a slow and choppy pulse. This is cold pathogen taking advantage of the Spleen. The ancients treated it primarily with Regulating the Middle Decoction (Li Zhong Tang). If it develops into Fixed Disease, there will be stiffness and pain in the hip joint (pi shu), with difficulty flexing and extending, treated primarily with Immature Bitter Orange, White Atractylodes, Poria, and Licorice Decoction.

Cold Pathogen Taking Advantage of the Lung

Cold disease may manifest as wheezing, coughing, shortness of breath, respiration that cannot continue smoothly, salivation with drooling, deafness, dry throat, with a deep and slow pulse. This is cold pathogen taking advantage of the Lung. The ancients treated it primarily with Licorice and Dried Ginger Decoction. If it develops into Fixed Disease, there will be pain on the inner side of the elbow and difficulty turning the body, treated primarily with Immature Bitter Orange, Tangerine Peel, Platycodon, Pinellia, Fresh Ginger, and Licorice Decoction.

🧠 Deep Understanding

Core Principles and Methods 💡

• Cold is a yin pathogen, apt to damage yang qi, with a nature of constricting and congealing: Cold pathogens cause the channels and vessels to constrict, slowing qi and blood circulation, thus giving rise to manifestations such as pain, cramping, and cold pain.
• The Kidney is the first to be afflicted: The Kidney is the organ of cold water, and similar qi attract each other; kidney yang is also the root of the yang qi of the entire body, so external contraction of cold often first disturbs the Kidney.
• Differentiation by the Five Viscera and Meridian Pathways: This text describes cold pathogen attack according to the Kidney, Liver, Heart, Spleen, and Lung, following where each viscera governs, its functions, and meridian pathways: The Kidney governs bones, lower back, defecation and urination; the Liver governs the hypochondrium, sinews, eyes, and ears; the Heart governs the chest, spirit; the Spleen governs the abdomen, limbs, transformation and transportation; the Lung governs qi, respiration, and the throat.
• The terms "Take Advantage of" (cheng) versus "Fixed" (zhuo) reflect depth and progression of disease: at the onset, the cold pathogen "takes advantage of" a viscus, with disease in the qi aspect and channels and vessels; over time it moves from qi into blood, as stagnant blood accumulates in the Eight Hollows, forming "Fixed Disease," which is deeper and more stationary. Treatment for "taking advantage" (cheng) emphasizes warming and dispersing, activating yang, and harmonizing; treatment for "fixed" (zhuo) focuses on moving qi, quickening blood, transforming dampness, and resolving phlegm.

Contemporary Understanding 🌟

• Cold stimulation can cause vasoconstriction, muscle spasm, and local circulation impairment; long-term cold and damp environments can easily trigger or aggravate joint and soft tissue discomfort.
• "Stagnant blood accumulation" roughly corresponds, on a shallow level, to impaired microcirculation, chronic strain, local inflammatory exudation, and fibrosis—yet should not be simply equated with those conditions.
• Differentiation by the five viscera is a traditional diagnostic model, not a distinction based on modern anatomical concepts of disease of the heart, liver, spleen, lungs, or kidneys. "Cold assailing the Heart" cannot be simply equated with heart disease, and "cold assailing the Kidney" cannot be seen as equivalent to kidney disease.
• Most of the listed formulas belong to the categories of warming yang, dispersing cold, moving qi, and dissolving dampness. Modern research suggests some of them carry anti-inflammatory, analgesic, circulation-improving, and gastrointestinal-regulating effects, but they cannot yet replace modern medical diagnosis and treatment.
• Aconite (Fuzi) used raw (sheng yong) in these formulas is toxic; pinellia, aconite, and other substances require standardized processing and decoction methods. Dosages listed in ancient formulas follow Han dynasty units and must not be employed directly at modern equivalents.

Health Preservation Insights ⚡

• Avoid cold in daily life: pay attention to keeping the lower back, abdomen, joints, nape, and feet warm; do not dwell in damp, cold, and drafty places; and avoid being caught in rain or chilled.
• Combine movement with rest: choose moderate gentle exercise to promote the circulation of qi and blood; avoid long periods of sitting or lying down. In cold seasons, avoid being out in the wind or chilled after heavy sweating.
• Moderate eating and drinking: reduce intake of raw-cold and chilled food and drink; consume mild warm foods; protect spleen and stomach yang qi. It is inadvisable to self-medicate with acrid-hot herbs to "expel cold."
• Harmonize emotions: refrain from prolonged fear, tension, or suppression, since emotional strain may disrupt the movement of qi.
• Seasonal rest patterns in winter: sleep early, rise late, and engage in daytime activity once the sunlight appears—this helps secure and protect yang qi.

📚 Related Knowledge

• Associated concepts: Eight Hollows, Fixed Disease, Kidney fixed(shen zhuo), cold constricts, prolonged disease enters the network vessels, return yang to rescue from counterflow.
• Further reading: Su Wen · Ju Tong Lun discusses pain due to cold; Ling Shu · Xie Ke discusses the Eight Hollows; Jin Gui Yao Lue · Five Viscera Wind-Cold Accumulation covers the Kidney fixed condition; correlated formulas from Shang Han Lun.

📜 Appendix: Original Formula Compositions and Preparation Points

The following dosages follow Han dynasty units and are to serve only for scholarly textual study, not as medicinal guidance. Do not follow them literally.

Kidney-System Formulas

• Cinnamomum Twig Plus Kudzu Root Decoction: Ramulus Cinnamomi (Guizhi) 3 liang (peeled), Paeonia (Shaoyao) 3 liang, Glycyrrhiza (Gancao) 2 liang (honey-fried), Fresh Ginger (Shengjiang) 3 liang (sliced), 12 pieces of Fructus Jujubae (Dazao) (split), Pueraria (Gegen) 4 liang. Decoction and Administration: First cook the Pueraria in seven sheng of water, skim the foam from top, then add the rest of the herbs and cook down to three sheng. Remove the dregs. Take one sheng warm, three times a day. Porridge is not needed; other aspects of care and contraindications followed those for Cinnamon Twig Decoction.

• Licorice, Ginger, Poria, and White Atractylodes Decoction: Glycyrrhiza (Gancao) 2 liang (honey-fried), Atractylodes macrocephala (Baizhu) 2 liang, Dried Ginger (Ganjiang) 4 liang, Poria (Fuling) 4 liang. Decoction and Administration: Cook in five sheng of water, reduce to three sheng, remove dregs, take one sheng warm, three times a day.

Liver-System Formulas

• Minor Bupleurum Decoction: As seen previously in the chapter on "Wind-Strike".
• Bupleurum, Scutellaria, Peony, Pinellia, and Licorice Decoction: Bupleurum (Chaihu) 4 liang, Scutellaria (Huangqin) 3 liang, Paeonia (Shaoyao) 2 liang, Glycyrrhiza (Gancao) 2 liang (honey-fried), Pinellia (Banxia) 2 liang. Decoction and Administration: Cook in five sheng of water down to three sheng, remove dregs, take divided warmly in three servings.

Heart-System Formulas

• Cardiodermal Meridian Activation Counterflow Decoction (Tongmai Sini Tang): Glycyrrhiza (Gancao) 2 liang (honey-fried), one large Aconiti Radix lateralis (Fuzi) (used raw, broken open), Dried Ginger (Ganjiang) 3 liang, Ginseng (Renshen) 2 liang. Decoction and Administration: Cook in three sheng of water (original text says "three Ecology" [san shengtai]; likely a corruption for "three sheng" [san sheng]) reduce to one sheng and two ge, remove dregs, take warm in two divided portions.

• Licorice Draining the Heart Decoction: Glycyrrhiza (Gancao) 4 liang (honey-fried), Scutellaria (Huangqin) 3 liang, Dried Ginger (Ganjiang) 3 liang, Pinellia (Banxia) 1 sheng (washed), Ginseng (Renshen) 3 liang, Coptis (Huanglian) 1 liang, Fructus Jujubae (Dazao) 12 pieces (split). Decoction and Administration: Cook in one dou of water, reduce to six sheng, remove dregs, then further cook it down to three sheng; take one sheng warm, three times a day.

Spleen-System Formulas

• Regulating the Middle Decoction: Ginseng (Renshen) 3 liang, Dried Ginger (Ganjiang) 3 liang, Glycyrrhiza (Gancao) 3 liang, Atractylodes macrocephala (Baizhu) 3 liang. Decoction and Administration: Cook in eight sheng of water down to three sheng, remove dregs, take warmly in three equally divided servings.

• Immature Bitter Orange, White Atractylodes, Poria, and Licorice Decoction: Immature Bitter Orange (Zhishi) 4 pieces, Atractylodes macrocephala (Baizhu) 3 liang, Poria (Fuling) 3 liang, Glycyrrhiza (Gancao) 1 liang (honey-fried). Decoction and Administration: Cook in six sheng of water down to three sheng, remove dregs, take warmly in three equally divided servings.

Lung-System Formulas

• Licorice and Dried Ginger Decoction: Glycyrrhiza (Gancao) 4 liang (honey-fried), Dried Ginger (Ganjiang) 2 liang (blast-fried). Decoction and Administration: Cook in three sheng of water down to one sheng and five ge, remove dregs, take warm in two divided portions.

• Immature Bitter Orange, Tangerine Peel, Platycodon, Pinellia, Fresh Ginger, and Licorice Decoction: Immature Bitter Orange (Zhishi) 4 pieces, Tangerine Peel (Jupi) 2 liang, Platycodon (Jiegeng) 3 liang, Pinellia (Banxia) 1 sheng (washed), Fresh Ginger (Shengjiang) 3 liang (sliced), Glycyrrhiza (Gancao) 2 liang (honey-fried). Decoction and Administration: Cook in eight sheng of water down to three sheng, remove dregs, take one sheng warm, three times per day.

Note from Bu Gua (Cucurbita): This content is based on the classical medical canon of traditional Chinese medicine and is offered solely for cultural learning and close reading. It does not in any way constitute medical diagnosis, therapeutic or pharmacological guidance, or health advice. If you feel unwell, promptly seek medical attention.