Cold-heat Patterns Research Articles

Machine learning model for predicting the cold-heat pattern in Kampo medicine: a multicenter prospective observational study.

The purpose of this study was to predict the four cold-heat patterns in patients who have the subjective symptoms of the cold-heat pattern described in the International Classification of Diseases Traditional Medicine Conditions - Module 1 by applying a machine learning algorithm. Subjects were first-visit Kampo outpatients at six institutions who agreed to participate in this multicenter prospective observational study. The cold pattern model and the heat pattern model were created separately with 148 symptoms, body mass index, blood pressure (systolic and diastolic), age, and sex. Along with a single cold or heat pattern, the tangled heat/cold pattern is defined as being predicted by both cold and heat patterns, while the moderate (heat/cold) pattern is defined as being predicted by neither the cold pattern nor the heat pattern. We included 622 participants (mean age ±standard deviation, 54.4 ± 16.9; with female 501). The accuracy, macro-recall, precision, and F1-score of a combination of the two prediction models were 96.7%, 93.2%, 85.6%, and 88.5% respectively. The important items were compatible with the definitions of the cold-heat pattern. We developed a prediction model on cold-heat patterns with data from patients whose subjective cold/heat-related symptoms matched the cold-heat pattern diagnosis by the physician.

A Modern Interpretation of Cold-Heat Pattern in Traditional Medicine with a Focus on Thermo-Regulation

Cold-heat patterns (C-HPs) in Traditional East Asian Medicine are essential for individually diagnosing and treating patients. However, the concept of C-HPs and their biological mechanisms (thermoregulation) remains unclear. C-HPs studies published between January 2000 and May 2023 were retrieved from 5 databases (PubMed, Google Scholar, OASIS, Korean studies Information Service System, and Research Information Sharing Service). Among the 8,373 articles screened, 132 were included in the review and categorized. Nineteen articles were clinical studies related to traditional concept of C-HP identification, 14 studies investigated diseases affecting thermosensation or thermoregulation, and 99 studies identified candidate genes as potential markers for C-HP identification. Further analysis, including gene ontology, and gene set enrichment analysis of the candidate genes, revealed 3 primary biological processes closely associated with thermoregulation-related genes, including localization, responses to stimuli, and homeostatic processes. Notably there was a significant association between the candidate genes and inflammatory mediator regulation of transient receptor potential channels (<i>p</i> < 0.001). A significant association between C-HPs and inflammation-related pathways across thermosensation-related and thermoregulation-related clinical and preclinical studies was observed, suggesting that the traditional concept of C-HPs should be studied further from an immunological perspective.

A cross-sectional survey-based study of the cold and heat pattern of recovering patients after COVID-19 at the University medical center at Ho Chi Minh City branch 3 and students of the faculty of Traditional medicine, University of Medicine and Pharmacy at Ho Chi Minh City.

Due to the surge of the post-COIVD-19 patients, numerous publications were recently presented, including applying Traditional Chinese medicine (TCM) in accelerating recovering pace. However, most TCM studies mainly focused on interventions and their effect on the patients. In the general characteristic of the post-COVID-19 syndrome in TCM, this study identified the relationship between post-COVID-19 syndrome and cold–heat patterns, one of the essential principles of the Eight Principles in TCM. We established a cross-sectional study on 384 participants at University Medical Centre HCMC - branch No.3 and the faculty of Traditional medicine, UMP, from January 2022 to April 2022 (including outpatients, inpatients, and students). A questionnaire was built to collect data on socio–demography, post-COVID-19 status, and cold-heat patterns. Cold-heat patterns were gathered based on the “Cold and heat patterns identification questionnaire” developed by Yeo M et al. (2016). All eligible participants were free to choose a suitable interview method, including by phone, by URL link, or by face-to-face interview. We enrolled 384 eligible patients, and 17 samples were removed due to missing. The median age was 33 (24 - 42) and the median BMI was 21.97 (19.78 – 23.88), and females took up to 62%. We found the relationship between gender and cold-heat pattern with post-COVID-19 status (p<0.05). The relevance of post-COVID-19 status and cold–heat patterns took the first step in comprehensively observing general TCM characteristics of the post-COVID-19 syndrome.

Moxibustion for treating cancer-related fatigue: A multicenter, assessor-blinded, randomized controlled clinical trial.

Cancer‐related fatigue (CRF) is one of the most common chronic symptoms experienced by cancer patients. As moxibustion is a popular traditional therapy for managing fatigue, it can be an alternative strategy to treat CRF as well. Therefore, we rigorously designed a full‐scale, multicenter, assessor‐blinded, randomized controlled trial to evaluate the efficacy and safety of moxibustion treatment for CRF. Ninety‐six subjects suffering from CRF were recruited and randomly assigned to moxibustion group, sham moxibustion group, or usual care group. Both the moxibustion group and the sham group received moxibustion treatment for 8 weeks and the usual care group did not. Brief fatigue inventory (BFI) score and Functional Assessment of Cancer Therapy‐Fatigue score were used to assess CRF at baseline and weeks 5, 9, and 13. Questionnaires for the assessment of cognitive impairment, quality of life, and Cold–Heat and Deficiency–Excess patterns were also evaluated. BFI scores significantly decreased in moxibustion group compared to the usual care group (mean difference of −1.92, p < 0.001 at week 9 and mean difference of −2.36, p < 0.001 at week 13). Although the sham group also showed significant improvement during the treatment period, only the moxibustion group showed improvement after 4 weeks of follow‐up period (mean difference of −1.06, p < 0.001). There were no serious adverse events. Our findings confirmed the efficacy and safety of moxibustion for CRF compared to usual care. We also found that moxibustion has a prolonged treatment effect during 4 weeks of follow‐up period.

Discrimination of prediction models between cold-heat and deficiency-excess patterns

ObjectiveThe purpose of this study was to extract important patient questionnaire items by creating random forest models for predicting pattern diagnosis considering an interaction between deficiency-excess and cold-heat patterns. DesignA multi-centre prospective observational study. SettingParticipants visiting six Kampo speciality clinics in Japan from 2012 to 2015. Main outcome measureDeficiency–excess pattern diagnosis made by board-certified Kampo experts. MethodsWe used 153 items as independent variables including, age, sex, body mass index, systolic and diastolic blood pressures, and 148 subjective symptoms recorded through a questionnaire. We sampled training data with an equal number of the different patterns from a 2 × 2 factorial combination of deficiency–excess and cold–heat patterns. We constructed the prediction models of deficiency–excess and cold–heat patterns using the random forest algorithm, extracted the top 10 essential items, and calculated the discriminant ratio using this prediction model. ResultsBMI and blood pressure, and subjective symptoms of cold or heat sensations were the most important items in the prediction models of deficiency–excess pattern and of cold–heat patterns, respectively. The discriminant ratio was not inferior compared with the result ignoring the interaction between the diagnoses. ConclusionsWe revised deficiency–excess and cold–heat pattern prediction models, based on balanced training sample data obtained from six Kampo speciality clinics in Japan. The revised important items for diagnosing a deficiency–excess pattern and cold–heat pattern were compatible with the definition in the 11th version of international classification of diseases.

Disruption of Pathological Patterns in a Young Population with Dysfunctional Breathing.

Dysfunctional breathing (DB) is characterized by abnormal breathing patterns and often results from psychogenic causes in the absence of organic diseases. Although acupuncture and herbal treatments have been suggested as alternative therapies for DB, few studies have addressed the relationship between DB and pathological patterns from a diagnostic perspective. We asked 237 college students (130 men aged 21.4 ± 1.9 years; 107 women aged 21.4 ± 3.0 years) to complete the Korean version of the General Health Questionnaire-30 (K-GHQ-30) and four validated pathological pattern questionnaires regarding qi and yin deficiencies, phlegm, and cold-heat patterns. The Korean version of the Nijmegen Questionnaire was used to classify participants into DB and non-DB groups. Effects of age, gender, and DB on pathological patterns were examined using simple regression and two-way MANCOVA models. Age had an effect on all pattern scores except heat pattern scores (β: 0.154–0.098). DB group showed a moderate main effect (η2 = 0.167) on pathological patterns, while gender showed a minimal main effect (η2 = 0.096); qi and yin deficiencies, phlegm, and cold-heat pattern scores in DB and female groups were higher than those in non-DB and male groups. The K-GHQ-30 scores showed significant positive correlations with the pathological pattern scores (r: 0.243–0.533), indicating that disruption of pathological patterns could be associated with patients' psychological disturbance. In conclusion, these questionnaires may help to identify pathological patterns related to DB and determine individually tailored alternative therapies.

The Cohort Study Analysis of Correlation between Cold-Heat Patterns and Various Factors

The concept of aggressive pituitary tumor (APT) has been precisely defined in recent years. These tumors are characterized by morphological (radiological or histopathological) data of invasion, proliferative activity superior to that of typical adenomas and a clinical behavior characterized by resistance to standard therapies and frequent recurrences. The absence of cerebrospinal or distant metastases differentiates them from the pituitary carcinoma. APTs account for about 10% of all pituitary neoplasm. Proper diagnostic implies participation not only of radiological and hormonal investigation but also a thorough pathological assessment including proliferation markers and immunohistochemistry for hormones and transcription factors. Surgical resection, aiming gross total resection or tumor debulking, is the mainstay initial therapy in most patients. Most patients with APTs need more than one surgical intervention, pituitary radiation, sometimes on more than one occasion, and multiple sequential or combined medical treatments, to finally be doomed to unusual treatments, such as alkylating agents (temozolomide alone or in combination), molecular targeted therapies, or peptide receptor radionuclide therapy. Multimodal therapy, implemented by experts, preferably in specialized centers with high volume caseload, is the only way to improve the prognosis of patients with these uncommon tumors. The research needs in this area are multiple and include a greater knowledge of the molecular biology of these tumors, establishment of protocols for monitoring and sequencing of treatments, development of multicenter studies and international registries.El concepto de tumor hipofisario agresivo (THA) se ha definido con más precisión en los últimos años. Son tumores caracterizados por signos morfológicos (radiológicos o histopatológicos) de invasión, actividad proliferativa superior a la de los adenomas típicos y un comportamiento clínico caracterizado por resistencia a los tratamientos habituales y recidivas frecuentes. La ausencia de metástasis cefalorraquídeas o a distancia los diferencia del carcinoma hipofisario. Los THA suponen alrededor del 10% de todas las neoplasias hipofisarias. Un diagnóstico apropiado exige no solo investigación radiológica y hormonal, sino también una valoración histopatológica detenida que incluya marcadores de proliferación e inmunohistoquímica para hormonas y factores de transcripción. La resección quirúrgica encaminada a la resección total o la reducción del volumen tumoral es el tratamiento inicial clave en la mayoría de los pacientes. La mayoría de los pacientes con THA necesitan más de una intervención quirúrgica, irradiación hipofisaria, a veces en más de una ocasión, y diversos tratamientos médicos consecutivos o combinados, y están predestinados a terminar recibiendo tratamiento inhabituales como fármacos alquilantes (temozolomida sola o en combinación), tratamientos multidiana o tratamientos con péptidos radiomarcados. El tratamiento multimodal aplicado por expertos, preferiblemente en centros especializados con gran volume de pacientes, es el único modo de mejorar el pronóstico de los pacientes con estos tumores poco frecuentes. Las necesidades de investigación en este campo son enormes, e incluyen la de un mayor conocimiento de la biología molecular de estos tumores, el establecimiento de protocolos de vigilancia y secuenciación de los tratamientos, el desarrollo de estudios multicéntricos y registros internacionales.

Etiologies of the Relationships Among Body Mass Index and Cold-Heat Patterns: A Twin Study.

The phenotypic relationships between body mass index (BMI) and cold-heat patterns have been frequently reported, but the etiology of these relationships remains unknown. We previously demonstrated that the cold pattern (CP) and the heat pattern (HP) were heritable traits. In the present study, we explored underlying genetic and environmental structures of the relationships among BMI and the CP and the HP. Twins (N = 1,752) drawn from the South Korean twin registry completed a cold-heat pattern questionnaire via a telephone interview. The phenotypic correlations among the three phenotypes were moderate but significant. Cross-twin, cross-trait correlations among BMI and the CP and the HP were consistently greater in monozygotic than in dizygotic twins, suggesting the presence of genetic effects on the relationships between BMI and the two patterns. A trivariate Cholesky model was applied to the raw data. The results indicated that the phenotypic relationship between the HP and BMI was completely determined by common genetic influences, while the relationship between the CP and BMI was explained by both common genetic and common individual-specific environmental influences. The genetic correlation between the HP and the CP was not significant, suggesting that the two patterns may be genetically independent from each other. Genetic correlations were 0.31 between the HP and BMI, and -0.22 between the CP and BMI. The individual-specific environmental correlation was -0.22 between HP and CP, and between CP and BMI.

Heritability of Cold and Heat Patterns: A Twin Study.

In traditional East Asian medicine, cold-heat patterns have been widely used in the diagnosis and treatment of patients suffering from various diseases. The present study aimed to estimate the heritability of cold-heat patterns. Trained interviewers administered a cold-heat pattern questionnaire to 1,753 twins (mean age = 19.1 ± 3.1 years) recruited throughout South Korea. Correlations for the cold pattern (CP) were 0.42 (95% CI [0.28, 0.54]) for monozygotic (MZ) males, 0.16 (95% CI [-0.08, 0.39]) for dizygotic (DZ) males, 0.40 (95% CI [0.30, 0.49]) for MZ females, 0.30 (95% CI [0.12, 0.45]) for DZ females, and 0.07 (95% CI [-0.11, 0.25]) for opposite-sex DZ twins. The corresponding twin correlations for the heat pattern (HP) were 0.38 (95% CI [0.24, 0.51]), -0.22 (95% CI [-0.43, 0.02]), 0.34 (95% CI [0.24, 0.43]), 0.21 (95% CI [0.03, 0.37]), and 0.08 (95% CI [-0.10, 0.26]), respectively. These patterns of twin correlations suggested significant genetic effects on the HP and the CP. Model-fitting analysis revealed that heritability estimates in both sexes were 40% (95% CI [38, 42]) for the CP and 33% (95% CI [25, 42]) for the HP, with the remaining variances attributable to unique environmental variances. These estimates did not vary significantly with age during adolescence and young adulthood.

Association of Cold-Heat Patterns with Tongue Features, Body Composition, Anthropometric Indices, and Blood Parameters in Tae-Eum Type.

Introduction The purpose of this study was to elucidate the relationship between cold-heat patterns and body composition, anthropometric indices, blood parameters, and tongue features in Tae-Eum type subjects. We also sought to determine whether significant indicators could be used as risk factors for predicting cold-heat patterns in a clinic. MethodsThis prospective, case-control pilot study was conducted at a single center. The subjects were males and females aged 19 years or older who had been analyzed as the Tae-Eum type. After screening, subject allocation was performed. The body composition, 11 anthropometric indices, blood parameters, and tongue features of the subjects were measured by well-trained practitioners. An independent t-test was conducted to compare the cold- and heat-pattern groups. Binary logistic regression was performed to determine significant differences between the two groups after adjusting for age, sex, and systolic blood pressure, with a focus on identifying significant indicators. ResultsEighty-nine participants were recruited, 39 of whom were excluded from the analysis. Ultimately, 20 cold-pattern and 30 heat-pattern subjects were included in the final analysis. We found that alanine aminotransferase and all anthropometric indices, except for neck and forehead circumference, were significant predictive factors in both groups according to the binary regression analysis. Additionally, the tongue body color in the cold-pattern group was significantly paler than that in the heat-pattern group. ConclusionsThis study found that cold and heat patterns were significantly associated with body composition, anthropometric indices, blood parameters, and tongue features. We suggest that these factors could thus be used as objective indicators and predictors of cold-heat patterns. Our findings provide fundamental but also applicable data that will be useful for diagnosing and monitoring cold-heat patterns in Tae-Eum type patients.

Relationship between Tongue Temperature Estimated by Infrared Thermography, Tongue Color, and Cold-Heat Pathological Patterns: A Retrospective Chart Review Study.

Tongue diagnosis is a technique used to determine cold-heat pathologic patterns (CHPPs). Herein, we reviewed electronic medical records of tongue temperature measured using infrared thermography (IRT), tongue color (luminance, green/red, and blue/yellow balance), cold-heat pattern questionnaires (CHPQ), and body temperature for 134 women with gynecological problems (age, 38.97 ± 11.49 years). The temperatures of seven tongue regions (root, center, tip, and both sides of the center and root) were determined, and the effects of age, regional differences, and their correlations with color parameters were examined. Factor analysis was conducted separately with the 10 cold pattern (CP) and 10 heat pattern (HP) items. Tongue temperature showed an age effect (β; -0.198 to -0.210) and regional differences (both sides of the root > center and root > tip). Tongue temperature was positively correlated with luminance (r: 0.236-0.246), indicating that a higher temperature was associated with a brighter color. The factor analysis extracted two factors (cold sensitivity-pain and discharge-complexion factors) from the CP items and three factors (heat sensation-pain, discharge-breath, and cold preference-thirst factors) from the HP items. Tongue temperature was negatively correlated with the discharge-complexion factor of CP and the discharge-breath factor of HP (r: -0.171 to -0.203), indicating that a lower tongue temperature may be a consequence of emission of excessive heat in HP and a lower blood perfusion in CP. Body temperature did not correlate with the CHPQ factor scores. In conclusion, tongue temperatures measured using IRT may be a partial indicator of CHPPs.

Cardiff Acne Disability Index: cross-cultural translation in Korean and its relationship with clinical acne severity, pathological patterns, and general quality of life

ObjectiveTo culturally translate the cardiff acne disability index (CADI) into Korean, and to examine its relationship with clinical acne severity, pathological patterns, and general quality of life (QoL). MethodsThe CADI was culturally and linguistically translated into Korean via translation, back-translation, and face validity test process. Two hundred and fifty-four Korean adolescents were asked to complete the Korean version of the CADI (K-CADI), the Phlegm Pattern, the Cold-Heat Pattern, and the Korean version of the General Health Questionnaires. A clinician estimated acne severity for the adolescents, using the Korean Acne Grading System. Finally, reliability and validity of the K-CADI was examined, and the relationships between acne severity, Phlegm, Cold, and Heat patterns, and QoL level were examined via pathway analysis. ResultsThe K-CADI had satisfactory internal consistency (α = 0.827). The examination of construct validity indicated that the K-CADI had one factor (explaining 59.6% of the total variance). Pathway analysis showed satisfactory model fit (NFI = 0.960 and CFI = 0.983), and acne-related QoL was determinant to Phlegm, Heat, and Cold patterns (0.13-0.27 of β), and Phlegm and Heat patterns lowered one's QoL level (0.17–0.34 of β). ConclusionThe K-CADI is a valid and reliable instrument. Phlegm and Heat patterns should be managed when treating acne since they have a moderating effect on general QoL aggravation.

A Study on the Difference of Cold-heat Patterns between Health and Mibyeong Group

A Study on the Difference of Cold-heat Patterns between Health and Mibyeong Group

Study on the Difference of Cold-heat Patterns According to Sasang Cinstitution

Study on the Difference of Cold-heat Patterns According to Sasang Cinstitution

Bodily differences between Cold- and Heat-prescription groups in Sasang medicine

BackgroundIn Sasang medicine, patients are treated with herbal prescriptions based on Cold-Heat patterns induced by conditions of physiological equilibrium among internal organs, which also induce differences in body circumferences. The objective of the current study was to elucidate the relationship between Cold- and Heat-prescription types and body circumferences. MethodsData from suitable subjects (115 males and 222 females) were collected, and the body circumferences were compared according to their Cold- and Heat-prescription grouping. For male subjects with significant body circumference differences between the Cold- and Heat-prescription groups, the body circumference ratios were analyzed by comparing the differences between these groups using ranked analysis of covariance (ANCOVA). ResultsIn men, consistent differences were observed in the body circumference measures and ratios between the Cold- and Heat-prescription groups. The Heat-prescription groups showed greater abdominal circumferences, notably demonstrated by a higher rib-to-pelvic circumference ratio in the Tae-Eum (TE) type (p=0.041) and a higher chest-to-hip circumference ratio in the So-Yang (SY) type (p=0.087). ConclusionIn the SY-type men, the chest circumference was significantly greater in the Heat-prescription group compared to the Cold-prescription group. In the TE-type men, the rib-to-pelvic circumference ratio was significantly higher in the Heat-prescription group than in the Cold-prescription group.

Relationship of the Cold-Heat Sensation of the Limbs and Abdomen with Physiological Biomarkers.

The present study explored the relationship between the regional Cold-Heat sensation, the key indicator of the Cold-Heat patterns in traditional East Asian medicine (TEAM), and various biomarkers in Korean population. 734 apparently healthy volunteers aged 20 years and older were enrolled. Three scale self-report questions on the general thermal feel in hands, legs, and abdomen were examined. We found that 65% of women tended to perceive their body, particularly their hands and legs, to be cold, versus 25% of men. Energy expenditure and temperature load at resting state were lower in women, independently of body mass index (BMI). Those with warm hands and warm legs had a 0.74 and 0.52 kg/m2 higher BMI than those with cold hands and cold legs, respectively, regardless of age, gender, and body weight. Norepinephrine was higher, whereas the dynamic changes in glucose and insulin during an oral glucose tolerance test were lower in those with cold extremities, particularly hands. No consistent differences in biomarkers were found for the abdominal dimension. These results suggest that gender, BMI, the sympathetic nervous system, and glucose metabolism are potential determinants of the Cold-Heat sensation in the hands and legs, but not the abdomen.

Relationships between pathological patterns and vocal qualities estimated by acoustic parameters

To examine whether vocal characteristics estimated by acoustic parameters were associated with phlegm, yin deficiency, or cold-heat patterns. A total of 75 college students (males:females = 53:22) aged 19-24 years were enrolled in this study. Each subject was asked to complete the phlegm pattern questionnaire (PPQ), yin deficiency questionnaire (YDQ) and cold-heat questionnaire (CHQ). For the acoustic analysis, each subject was asked to produce a sustained vowel sound (/a/) for 3 s to be used to calculate acoustic parameters. Then, habitual fundamental frequency (F0), jitter, shimmer, F0tremor, mean F0, standard deviation of F0, maximum F0, minimum F0, normalized noise energy, harmonic-to-noise ratio, signal-to-noise ratio, amplitude tremor, and power ratio were calculated using the Dr. Speech software. Finally, four hierarchical regression models with pattern questionnaire scores as dependent variables were formed to examine which factors among acoustic parameters, sex, and age were predictive of those pattern scores. PPQ, YDQ, heat, and cold pattern scores all formed significant regression model equations and the adjusted R2 values were 0.281, 0.164, 0.156, and 0.170, respectively. There were aging effects in the PPQ and YDQ models (standardized β=0.199, 0.271, respectively). Vocal tremor-related F0 tremor and vocal ringing-related power ratio parameters were associated with PPQ and YDQ scores. Gender was directly predictive of PPQ and indirectly moderated the relationship between power ratio and YDQ score. Vocal pitch-related habitual F0 and mean F0 were associated with heat and cold scores. These results indicate that the vocal qualities of phlegm- and yin deficiency-susceptible subjects tend to be ringing and less tremorous, and those of heat- and cold-susceptible subjects tend to be high-pitched. Our study results suggest that vocal characteristics estimated by acoustic parameters are partially predictive of phlegm, yin deficiency, heat, and cold patterns. In terms of phlegm and yin deficiency patterns, there were direct or moderating effects of sex and age.

Development and Validation of the Yin Deficiency Scale

Yin Deficiency (YD) is a pathophysiologic pattern that manifests with emaciation, dry mouth, tidal fever, Five Center Heat, night sweats, and malar flushing. The purpose of the present study was to develop and validate a new YD metric, the Yin Deficiency Scale (YDS), to define an optimum cutoff point for the YDS, and to examine the relationships between YD and Cold-Heat patterns. A total of 169 outpatients and 83 college students were asked to complete the YDS. The college students were also asked to complete the Yin Deficiency Questionnaire (YDQ) and Cold-Heat Questionnaire (CHQ). Twelve clinicians determined whether or not the 169 outpatients had YD. YDS and YDQ data were used to estimate the internal consistency, construct validity, and concurrent validity of the YDS. CHQ data were used to examine the relationships between YDS and CHQ subscale scores. Total YDS scores and the clinicians' diagnoses of the outpatients were used to define an optimum cutoff score for the YDS. The 27-item YDS had satisfactory internal consistency (α=0.885) and concurrent validity, with correlations between the YDS and YDQ subscale scores. A total of eight factors were extracted in the test of construct validity, using principal component analysis, and the overall variance explained by all factors was 63.1%. Among the eight factors, cough, fever, and skin-related factors were associated only with Heat pattern, whereas pain, urine, and fatigue-related factors were associated with both Cold and Heat patterns. In the receiver operating characteristic curve analysis, the sensitivity, specificity, and area under the curve of the YDS were 73.7%, 84.8%, and 0.875, respectively. The optimum cutoff score was defined as 10 points. The results of this study suggest that the YDS is a reliable and valid instrument for evaluating YD.

Differentiation of cold and heat patterns: ambiguities in diagnosis

Cold and heat are two fundamental principles in the differentiation of the nature of disease. They are the two characteristic patterns of exterior manifestations of internal imbalances of yı̄n and yáng. Clinically, only after a clear differentiation of the cold or hot nature of a disease or pattern can there be a correct treatment that follows with satisfactory curative results. However, in clinical realities, neither cold nor heat patterns typically manifest externally through classical patterns and signs. For instance, if the symptoms of cold or heat are not obvious externally, or they are not substantial enough to be included in [the diagnosis of] the true nature of the illness, or, even more frequently, if the actual pattern manifests itself externally with a false ‘mask’, all these are frequent causes for mistakes in pattern identification. The focus of this paper is to analyze the causes for such mistakes in cold and heat pattern identification. This paper addresses three main causes of such problems. First is the rather easily confused relationship between the manifestations, on the one hand, and the patterns, on the other hand, of cold and heat. Second is the unclear understanding and poor grasp of the concepts and clinical manifestations of cold and heat patterns. Third is non-discrimination of the complex interrelationships between cold patterns and heat patterns, particularly with respect to so-called true and false cold and heat. Below is a close examination of these three causes of these problems in diagnosis.