Are you “Hot” or not?

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(Next time you reach out for a cooling drink to quench your heatiness, think again. Dr Clement Ng explains how TCM classifies and interprets the relativity of “heatiness” in our bodies, and their respective symptoms and treatments.)

Living so near the equator, in Singapore, along with having a tropical rainforest climate to boot makes most of our days warm and humid, and hence leaving many of us hot and bothered. We instinctively reach for that cooling drink (chrysanthemum tea or “liangteh” 凉茶 – cooling tea in local hokkian) in a bid to cool down and feel less heaty inside. Yet, is this “heatiness” really attributed to external temperatures, or is there an underlying state of nutritional deficiency within our bodies that need to be addressed.

What is Hot?

“Hot” is defined as having a high degree of heat or a high temperature. “Heat” can be defined as a measure of warmth or coldness of an object or substance with reference to some standard value. From the perspective of a human body, “heatiness” is a sense of the body feeling warm. Such a symptom has become one of the key observations, which both modern and TCM medicinal practitioners use to determine whether a person is suffering from an illness.

From a TCM perspective, heat has a dual effect in the human body. It is the source of energy for all activities in the body and is responsible for an effective rate of metabolism. TCM practitioners use it to classify the syndromes associated with the body, when conducting a “Syndrome Differentiation” diagnostic analysis, due to a yin and yang imbalance. A healthy individual cannot survive without heat; and at the same time, too much heat is not desirable. It is the universal goal of TCM treatment to correct imbalance and resume harmony of the body.

Relative Heat?

As discussed in the previous articles, TCM dictates that all substances-energies in the body strive to achieve constant balance relative to one another, in order to determine the health and vitality of the body. This balance is expounded through the adoption of “Yin-Yang Theory” which forms a basic guideline of TCM holistic approach. The transformation between yin and yang occur in a natural and seamless process when we are in balance. As you can observe in the yin-yang symbol, you’ll see the largest part of the dark yin ball starting to flip over into the smallest part of the yang tail, and vice versa, as one changes into the other.Yin_and_Yang.svg

In the dynamic equilibrium state, the yin (substances or reserve) must be balanced with the yang (energies or action), the visceral organ systems must harmoniously work in unison, and the Shen (emotions) must be calm to truly be well. This can be achieved through an observed routine of rest, work and a regular diet regime. However, as we journey through life, with all the activities presented to us in our modern lifestyles, such dynamic balance is difficult to achieve. Moreover as we age, we will start to experience syndromes, which are associated with changes in the yin and yang balance. When this imbalance occurs, one of the symptoms will be the different degree and nature of “hotness” experienced by the individual.

Let me illustrate this development of heatiness brought on by lifestyle. In Picture 1, you will notice that both the yin and yang columns align with one another at the “balance” line. This is an equilibrium state.

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Picture 1

When an individual consumes a spicy and oily diet such as curry mutton and fried chicken respectively, the scenario in picture 2 will take place. One will feel “heatiness” due to an absolute excess of yang, and display symptoms such as redness of face, extreme restlessness, agitation, a thirst for cold beverages, a dry mouth and throat sensation, hotness all over the body throughout the day, and a rapid and full pulse.

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Picture 2

When an individual is staying up late on many nights working on a big project, a scenario such as picture 3 will be observed. One will feel “heatiness” due to yin deficiency, a situation when the body’s reserves are depleted below the balance line. Symptoms displayed are red or malar hot flush, an emotional state of restlessness, tired and fidgety, a dry mouth and throat sensation at night, mild heat mainly in the afternoon or evening, red line inside eyelid, and a rapid and thin pulse.

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Picture 3

It was also observed and documented in the TCM classic text Huangdi’s Inner Classic of Medicine(黄帝内经), that as we age, we will naturally start to have low gender-related yin or yang energy. For example, in women, their yin declines as they go through menopause. Yin deficiency symptoms include malar hot flushes, night sweats and frequent waking. Some will grow less submissive, that is, going out, doing more and standing up for themselves. If the situation becomes pathological, they may become restless, easily agitated and more demanding. This is all relative based on one’s personal observation or proximity to the person.

In men, their yang decreases as they mellow with age. They become more yin, that is, easy going, less confrontational and less combative. Yang deficiency symptoms include sexual impotence (enter the multibillion dollar market for aphrodisiac supplements), frequent waking at night to go to the bathroom, feeling cold and lower back pain. If the situation becomes pathological, they may become too mellow, to the point of losing confidence, becoming listless and apathetic.

Symptoms of heatiness

Comparison of Yin Deficiency and Yang Excess
Yin Deficiency Yang Excess
Hotness Relative Absolute
Complexion Red cheeks/malar flush Whole face red
Mental state Mentally restless but tired, vague anxiety, fidgety Extreme restlessness, agitation or manic behaviour
Sleep pattern Frequent waking during night Dream-disturbed or restless sleep
Thirst Thirsty, with no desire to drink Thirst for cold beverages
Mouth Dry mouth and throat at night Constant dry mouth and throat
Bowel Dry stools, no pain Constipation, pain
Eyes Red line inside eyelid Red eyes
Tongue Red with little coating, or peeled Red with yellow coating
Pulse Rapid, thin Rapid, full

Treatment for Heatiness

From what we’ve learnt so far, emotionally speaking, heat causes restlessness. However, there exist differences in whether the heatiness is due to yin deficiency or yang-excess. A yin-deficient individual will experience vague anxiety without the ability to pinpoint why and what causes this edginess. A yang-excess individual is obviously more agitated, and sometimes arrogant; and any heatiness sensation will cause difficulty falling and staying asleep, sleep is extremely restless and dream disturbed. But a yin-deficiency heat keeps people waking frequently during the night or early morning.

A correct diagnostic and appropriate treatment protocol needs to be administered to correct the imbalance and resume harmony of the body. In general, we nourish yin when there is yin deficiency, and clear heat when there is excess. However, in the event of misdiagnosis or the individual decides to self-medicate with limited knowledge, the following scenarios will occur.

In picture 4, instead of clearing the heat during a yang-excess situation, yin-nourishing treatment was administered. For example, instead of consuming cooling tea like chrysanthemum tea, one chooses to drink a soup prepared with an ingredient such as Polygonatum Odoratum(玉竹: yuzhu)which is typically used for nourishing the yin. A situation of damp-heatiness will occur.

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Picture 4

On the other hand, to nourish yin deficiency due to over exertion and age-related scenarios, we adopt a purging protocol instead of nourishing yin, a situation in Picture 4 will occur. While the individual may feel relief from the reduction of heatiness, such mistreatment actually results in a weaker body constitution, which is undesirable in the long run.

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Picture 5

From a TCM perspective, there are five common types of yin deficiencies, and three types of yang excess, all of which result in different degrees of heatiness. These will be discussed further in subsequent articles. The objective of this article is to familiarise yourself with the general symptoms associated with heatiness.

Next time, when you experience heatiness, while it is alright to reach out for your favourite cooling beverage, you may want to go a little deeper to address the underlying state of your body. Are you hot or not?

This article written by Dr Clement Ng first appeared in Raffles Marina’s Magazine – Nautique Jul-Aug 2016.


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