Heat and Its Many Forms in Chinese Medicine

By Toby Helmstetter, LAc

In some parts of the country, summer is nearing its end, although out here in North Carolina, we could continue to see some hot days through September. Every day I’m at work, with practically every patient I see, we all start out by discussing how unbelievably hot it’s been. In honor of all this hot weather, since all of us are sweating at some point lately, I’m going to talk about heat and the various forms it takes in Chinese medicine.

Much like modern medicine, Chinese medicine has seen its share of change over its thousands of years in existence. Theories and practices popular during the rule of one emperor would be discarded and replaced during the rule of the next. At one point, during its earliest practices, illness was thought to be a problem of inhabitation by ghosts. Doctors were like Shamans who would use needles to let the ghosts out of the body, believe it or not. Obviously the art of Chinese medicine has evolved to be much more scientific, and the idea of ghosts was abolished in favor of more “modern” theories. Later in Chinese medicine, external influences were thought to cause and perpetuate disease. Before the Chinese knew about bacteria and viruses, the weather was assumed to be what caused illness. The wisdom is there, if not the science—no one goes outside in the cold and snow in their bare feet, and if they do, they’re sure to catch cold. With patients working out in damp weather in rice paddies up to their knees in water, Chinese doctors developed systems of diagnosis and treatment whereby weather—wind, cold, damp and heat—“invaded” the body and caused both acute and chronic diseases. Later, the awareness of what the Chinese called “pestilent qi” formed another important era of the medicine. Diseases were being caused by infection, spread from person to person, and a whole other system to address these problems came into being. Still using the metaphors of heat and cold, Chinese medicine categorized infectious diseases into different conditions, treatable by such means as eliminating cold, or cooling heat in the body. We can think of all kinds of diseases of old that wiped out vast numbers of people in China, and even more recently, the help of Traditional Chinese Medicine was enlisted during the SARS epidemic for this very reason.

If we think about how we experience certain conditions internally, without knowing anything else about them either from a western or eastern medical perspective, we can think of several that would fall into the category of ‘heat.’ Think: a fever; that’s easy. However, to make things complicated, Chinese medicine also separates heat into two different types: excess heat and deficient heat. An excess heat condition is one that is caused by too much of something in the body: too many bacteria (causing a fever), too much inflammation (causing a red, swollen ankle after a sprain), too many spicy peppers in your gut (causing heartburn). While a little harder to conceptualize, a deficient heat condition still causes the sensation of heat in the body but is caused by not enough of something: not enough hormones (causing hot flashes), not enough fluids (causing dehydration), not enough hydrochloric acid in the stomach (also causing heartburn). Heat conditions can also be internally generated. According to Chinese medicine, emotions that go unexpressed find a place to reside in the body. Once there, they can fester, creating an internal heat that makes itself known in other ways. Internal, emotionally-generated heat can cause symptoms like outbursts of anger, restlessness or agitation, in addition to the myriad physical symptoms that manifest as heat. Regardless of their origin, all of these conditions have one thing in common: they make us feel hot, either systemically or locally where the heat is occurring.

The Chinese calendar has five seasons, instead of our usual four. We are right now in the midst of this fifth season, late summer (also known as Indian summer). It’s typically a time when the blossoms hang heavy on the trees, the heat is particularly stifling, and everyone eagerly awaits the final transition into autumn. If it feels intuitively like an in-between time, your body-clock is right. It’s a kind of seasonal limbo, where everything feels heavy, a little sluggish and, well, hot. How Chinese medicine categorizes disease into manifestations of heat (or cold or dampness…) demonstrates how much we are a reflection of nature, and how nature at times reflects our own internal climate.

But if you think that all conditions that make us feel hot need to be treated by introducing something cold, think again. Not all sore throats that feel hot inside require the use of cold beverages or cold-natured herbs. Most do, but that’s why you go to your acupuncturist to help distinguish the difference (and find the quickest way to relieve the problem!). Next time you find yourself struggling with your own condition of heat—a fever, a sore throat; a sprained ankle, hot flashes, or even a little restlessness or agitation—remember that the way Chinese medicine views the body provides adequate metaphors for understanding these conditions, and effective ways to treat them.