Hot and Cold Syndromes: are you empty or full?

Hot and Cold
Hot and Cold - Photo by Teddy Österblom on Unsplash

Hot and Cold? You’d think telling the difference would be easy!

Hot is Yang and Cold is Yin’ so where’s the problem?

This distinction often IS easy, but then again, often it’s not. The problem is that Yang and Yin take many forms.

You can have

In addition, when combined with four of the other 8 principles (internal/external and full/empty), you can end up with confusion.

Yet, for the sake of improving health and ameliorating disease, the distinction is vital.

By the way … For more about this important topic, you could look up the nature of Cold, and similarly of Heat. In Chinese medical theory Heat takes several forms, for instance Summer Heat, Heatwave and Sunstroke, which are serious causes of ill-health. Also, you assess the progress of a disease from where it’s got to in the Four Levels (for Hot diseases), or Six Stages (for Cold). As an example, Covid 19 is treated as a hot disease.

So we can have, by combining Hot or Cold with ‘internal/external’ and ‘full/empty’:

1/ ‘Full Internal’ Hot and Cold syndromes

This kind of Hot and Cold is the subject of THIS page.

Look at the tables further on down below to read about the usual symptoms and causes.

‘Internal’ means the disease process has penetrated to the inside and the body is trying to keep it from invading further. Your acupuncturist’s job is to help your body push this disease process outwards, away from the centre. Click here to read about the difference between Internal and External syndromes.

However, there are several other important categories, see 2/ and 3/ below.

2/ ‘Full External’ Hot and Cold syndromes

‘External’ means the disease is on the outside of the body, trying to get in, and the body is trying to keep it out. Click here to read about External Hot and Cold syndromes.

3/ ‘Empty’ Hot and Cold syndromes

This is a different kind of distinction between hot and cold. Whereas ‘Full’ means that the body has the energy to battle with an invasive energy such as a bug, ‘Empty’ means that symptoms arise not from ‘Fullness’ but from ‘Deficiency’ – a kind of Weakness.

Click here to read about Empty Heat and Cold.

This ‘deficiency’ may arise from weakness in one or more of the Organ-energies (zang-fu), or weakness in either or both Yin or Yang.

Put another way, Emptiness (ie arising from Deficiency) means that your body is under-functioning. It has been weakened by age or disease, and is producing symptoms not caused mainly by a bug or an external pathogenic factor. Click to read more about the difference between Full and Empty conditions.

(An example of emptiness? For instance when you sweat copiously without cause, when not exerting yourself and not because of high ambient temperature or fear.)


More about Hot and Cold: yet another attempt to explain them!

When you feel unwell, you’ll find you nearly always feel warmer or colder than normal, whatever the cause may be.

The Chinese analysed these different ways of feeling ill, and established the causes.

Disease can come from outside (as from a bug; an accident; or exposure to inclement conditions like a heatwave or cold). Your body reacts to this with either heat or cold symptoms. The Chinese described these as being External Heat or Cold syndromes.

Alternatively, the disease can be generated from internal factors. Sometimes this comes about because an external factor has overcome your body’s best attempts at dealing with it (via External Heat or External Cold syndromes) and the disease process has penetrated to the interior.

Sometimes internal disease comes about because you’ve been eating unwisely, or because of emotional factors. (Don’t underestimate the power of emotional factors in causing disease!) These internal hot and cold syndromes are the subject of this page.

So that covers ‘Full EXTERNAL Heat and Cold‘, and ‘Full INTERNAL Heat and Cold’, which you can read about below, on this page.

There’s another set of conditions, called EMPTY Heat or Empty Cold syndromes. Sometimes, from exhaustion or dissipation of its energy, your body is deficient in Yin or Yang energy. It lacks the power to mount a proper attack on the invading force, and in fact there needn’t even be an invading force. That’s when you get Empty Heat or Empty Cold syndromes, arising from a deficiency in either Yin or Yang factors.

Signs of Full Internal Heat and Full Internal Cold syndromes

In the table below you’ll see the distinction between full Hot and full Cold syndromes. What this means is that if your symptoms are like those on the left side, you will be diagnosed as suffering from a Full Internal Heat condition.

If your symptoms are like those in the right hand column, then the diagnosis would be Full Internal Cold.

If there are confused signals, the final decision might come down to diagnosis from inspection of pulse and tongue.


Tongue pale and moist suggesting a Cold condition.

The tongue, in particular, is often a strong pointer to whether a condition is hot or cold.

In the picture, the tongue is a bit pale and moist, suggesting a Cold condition.

However, the tongue coating isn’t thick enough to confirm Full Internal Cold so this is more likely a condition of Heart and Spleen Blood deficiency and possibly Yang deficiency. The front of the tongue is also a little darker than the rest, suggesting a tendency towards Heart Qi deficiency.

So this a rather deficient tongue, indicating a deficiency of Heat.


Full-Heat: common symptoms Full-Cold: common symptoms
Feeling hot, possibly fever, averse heatSensationFeels cold, limbs cold and pale or bluish
ThirstyThirst levelNo thirst, but if drinks, wants warm fluids
Red faceComplexionBright White, or pallid or even bluish face
Stools dryBowel movementsStools loose
 After bowel actionFeels better
Dark, scanty, may burnUrineUrine copious, clear
Raised, red eruptionsSkinNo skin eruptions from Full-Cold
BurningPainSharp, piercing, worse if pressed
Mania, restlessnessMindAnxiety, low spirits, may prefer company nearby
RedTongue BodyPale or blue-purple
YellowTongue CoatingThick, white
Rapid and full, may be floodingPulse qualityDeep, tight, full

Usual Causes of Full Internal Heat and Full Internal Cold Syndromes

How do you acquire these Hot and Cold syndromes?

In the table you’ll see the reasons, on left for Hot and on right for Cold syndromes.

Usual Causes of Internal HeatNormal Causes of Internal Heat and ColdUsual Causes of Internal Cold
Eating too much hot-energy food (eg spicy, alcoholic or red meat)FoodToo much cold-type foods, ie foods that cause the body to cool down or run ‘cold’
Emotional stress causing Qi stagnation that turns to Interior HeatEmotions(Your emotions are not a cause of Full-Cold)
From an external pathogenic factor that penetrates (often via mouth or nose, but there are other factors) to the interior where it is turned into HeatInvasion by an external pathogenic factorExternal cold invasion (invades the channels first through the skin, then subsequently enters the zang-fu organs – causing interior cold)

What to do about ‘Full Internal’ Hot syndromes?

Full Internal Hot conditions can be helped by what you do, depending on how severe they are, and what caused them.


Diet too Heating

If they arise from  eating foods that are too ‘heat’ producing, then over time you may improve your health by avoiding many such foods. Eating just COLD-type foods would probably be a bad idea, however, as it’s hard to judge how much is enough:

  • Would you use a single bucket of cold water to put out a forest fire?
  • Would you use an iceberg to quench a cigarette? 


Emotional Stress

If caused by emotional stress, especially continuing emotional stress, you cannot really expect that even good treatment purely to clear Internal Heat syndromes will work for long.

This is because if you live on top of a volcano and huge chunks of flaming rock keep sailing through your windows, just sitting in a cool bath isn’t really going to cure your problem.

You will need some kind of help to resolve your emotional stress. This could be a shoulder to cry on, but more likely some kind of therapy, counselling, and/or a change in your life situation or direction.

Do not underestimate the power of Chinese medicine to help. Some parts of its huge body of theory and practice are very appropriate for treating emotional stress. You can read more about it under Qi Stagnation, but it’s such a big subject that eventually I wrote a book about it, see below.


A pathogenic factor invades you causing Internal Full Heat

Chinese medicine has plenty of experience of treating this, using a range of therapies including acupuncture and herbs. Probably you will need professional help. However, avoiding emotional stress and avoiding hot foods will help a bit, but on their own they won’t cure it.


What to do about ‘Full Internal’ Cold syndromes?

Diet too Cooling

So have you been eating too much ‘cold’-type food? You can probably make a huge difference quite fast by avoiding cold-type foods and changing your diet to eat more ‘warming’-type foods. I’ve seen many patients who cured themselves without doing anything else than this!

Even if changing your diet does not cure your condition completely, you’ll almost certainly start to feel better. What’s more, you’ll find that treatment by your acupuncturist, perhaps using moxibustion (picture below), will speed things up.

Also, there are many herbal recipes in Chinese medicine to assist – but see someone experienced who can assess your condition properly, including taking your pulse and assessing your tongue.

Of course, you should also keep warm and wear plenty of clothes etc.


Invasion by an External Pathogenic Factor, causing Full Internal Cold

You will WANT to keep warm. Although warm baths will help you feel a bit better and might have helped your body get rid of the problem when it was still at the ‘exterior’ level, it is now too late to expect a warm bath to solve the problem.

Moxa Cone in Situ

You need one or more of the following

  • moxibustion, (see the picture above for one type of moxibustion, but there are other ways of doing it too)
  • acupuncture to help clear and smooth the channels and
  • Chinese herbs to warm and chase out the invader.
  • to see someone experienced.


Return from Hot and Cold to 8 Principles.

Jonathan Brand colours

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