Heat and Cold Pathogens in TCM

Heat and Cold Pathogens over a hand filled with fire and a hand filled with cold water - Beachisde blog

Out of the Six Exogenous (exterior/coming from the environment) Pathogenic Factors in Traditional Chinese Medicine (TCM), the Heat and Cold pathogens are much easier to understand than others like Wind and Dampness as their symptoms are mostly what one would expect. Each pathogen also has attributes that may not stand out as clearly, though, so let's review them both just in case...

Heat Pathogen

The exogenous Heat pathogen is most likely to penetrate the body in the summer, but it can also sneak in during other times of the year. It can combine with the Wind and/or Dampness pathogens and invade through the mouth, nose, or skin. Depending on its route of invasion, it will cause symptoms such as common cold with sore throat and fever or joint pain with pronounced redness and heat. The Heat pathogen can also seep deeper into the body and turn into Fire if left untreated, causing more severe symptoms like bleeding, high fever, uncontrolled movements, and delirium. (Think of water as it boils, and keep in mind that Heat rises to the top, just as it does in physics.)


Just like with the other Pathogenic Factors, Heat can be generated internally in addition to attacking from the outside. Emotions are the most prevalent cause of internal disharmony, but patterns like Yin deficiency and Qi stagnation can also produce Heat.


If you think you are dealing with a Heat pathogen condition, limit your exposure to things that will heat you further, such as heating pads, hot showers, spicy foods, etc. Instead, help your body get back into balance with bitter foods, Peppermint essential oil, possibly ice (which can bring down inflammation but is not often recommended in TCM), and other cooling interventions.

Summer Heat Pathogen

The Summer Heat pathogen is the only pathogenic factor that occurs at just one time of the year. It is similar to heatstroke and heat exhaustion in Western medicine and is tied to spending extensive amounts of time in the blazing summer sun or in a hot, poorly ventilated area. Summer Heat likes to attack the head and upper body, causing profuse sweating and therefore depleting Body Fluid and Yin in general. Qi also escapes when the pores remain open too long, so in addition to obvious symptoms like thirst, hot skin, and dizziness, someone suffering from Summer Heat may also have fatigue and difficulty breathing or even fall into a coma.


Summer Heat issues are usually acute, so the primary treatment goal is to clear the heat and replenish fluids. Slowly sip water - drinking a lot at once would be too much for the body to handle - and move to a cool, shady location. Apply cold, wet towels to the body, and seek medical help if symptoms are severe.

Cold Pathogen

As you would expect, the exogenous Cold pathogen is most prevalent in winter, though it can also occur during other seasons. Imagine a machine not designed to handle cold weather: How easy will it be to operate? It will probably be stiff and creaky, very difficult to move. The Cold pathogen influences the body in the same way. It can penetrate through the skin, causing stiffness and severe pain, and a Wind-Cold invasion can produce a common cold with little sweating and slight chills.


This pathogen is unusual because it can also directly invade the Stomach, Intestines, or Uterus. Different from the Heat pathogen burrowing deeper if it's left untreated, a direct invasion by Cold means that this pathogen doesn't need to hang out on the exterior of the body first. This can lead to stomach pain and vomiting (Stomach), abdominal pain and diarrhea (Intestines), or acute cramping and possible fertility issues (Uterus). Interior cold can also be generated by an internal disharmony, such as Yang deficiency, which would involve a slower onset of symptoms with accompanying signs of deficiency like fatigue.


If you think you are struggling with the Cold pathogen, try to heat your body up! Use heating pads, eat warming foods, and consume hot drinks. Teas and essential oils based on warming herbs like ginger may be helpful, as can therapies like moxibustion.

Symptoms of the Heat and Cold Pathogens on the Beachside blog

As always, we are here to help if you need more support in getting your body back into balance! Diet and lifestyle adjustments can go a long way, but acupuncture and herbal formulas might be needed if you've been battling a pathogen for a long time or have severe symptoms.

Kathleen Ketola is a Licensed Acupuncturist and the owner of Beachside Community Acupuncture. She loves providing affordable acupuncture to the residents of Addison, Dallas, and Farmers Branch, Texas, and educating the general public on how acupuncture and Traditional Chinese Medicine can treat everything from pain to infertility to stress and beyond. Click "Book Now" at the top of this page to book an appointment or feel free to contact her at (214) 417-2260.