Heat: an external cause of disease

Jonathan Clogstoun-Willmott

March 29, 2022

Key Learning Points

What are the symptoms of Heat?
How your body deals with Heat
Ways people get Heat
Long-term dangers of Heat

What is Heat?

In Chinese medicine Heat is an External Cause of Disease, that becomes internalised. It can occur on its own, or when one of the other syndromes (eg Wind, Cold, Damp etc) turns into Heat in the interior of your body. Here it often combines with an pre-existing Yin deficiency if there is one.

With global warming and our propensity to sit on hot beaches, or to get tanned before we sit on warm beaches, this syndrome is becoming more common. That means we’ll probably see more people with heat exhaustion, heat cramps, heat stress in the workplace, heat stroke and general signs of heat intolerance.

In fact, for heatstroke and sunstroke we’ve got a special page.

So what are the usual symptoms of Heat?

Where it affects the body there is redness and inflammation
Areas affected, (eg a joint) feel hot to the touch
Area may be swollen if it combines with Damp
The place affected may be sore to touch
Skin often has a raised, hot, rash
Movement is restricted
Pain can be severe
Often thirst, especially in acute cases
Any fever continues despite sweating
If your body has this Heat syndrome, you may find yourself getting a huge range of other ills. For example, you become sensitive to foods and situations that previously did not trouble you. These may range from catching ‘colds’ from the ‘air-conditioning’ in the plane on the way home, to going down with a fever some time after your return, for no obvious reason, or getting a much more severe illness than your friends.
Pulse: rapid, slippery
Tongue: red, may be swollen

Clearing Heat

As with Summer-Heat, one of the main ways the body has of clearing this syndrome is by purging. What does that mean?

Well, first a warning!

Suppression of this natural process is potentially dangerous from the point of view of Chinese medicine, and it needs careful treatment.

Purging means diarrhoea: the ‘shits’!

Holiday-makers returning from hot places who report that their offensive and urgent diarrhoea was successfully suppressed by Imodium (the brand name for Loperamide HCl and Simethicone) tend to worry practitioners of Chinese medicine.

This is not that we don’t want them to get better, but that the Heat that their bodies were purging, if suppressed by Imodium or similar, doesn’t just disappear. It goes somewhere else, sometimes into the Blood, meaning they get a rash, or into their Stomach, making them much hungrier and thirstier, indefinitely, probably with resultant weight-gain.

Or it goes and disturbs their Shen (roughly translatable as their personality), making them prone to signs of mental ‘inflammation’.

This causes a whole range of problems including mental instability, irritability and increasing intolerance. Few of these symptoms are attributed to the original hot beach. Indeed – in my experience – none of them are ever connected to that hot beach holiday!

But you need to get that Heat out of you or it can cause many kinds of long term problems.

Purging

Purging in this context does not mean that suggested by Wikipedia where purging is now often associated with Binge-eating and Bulaemia. (Of course, another meaning of purging is to eliminate political opposition or socially ‘undesirable’ elements. So purging here is more like that – getting rid of unwanted energies in your body!)

In the context of Chinese medicine, it means encouraging the body to eliminate unwanted matter, almost always by evacuating the bowels.

What is the benefit of purging? Purges clears out the offensive material taking heat with it. Your diarrhoea’s offensive smell comes from its heat. If you like, your body is doing its best to evacuate this, but not quite succeeding.

Purging, done right, helps it do the job better.

In effect, it means using methods in Chinese medicine/acupuncture that have a laxative effect. Various Chinese herbs have been found to do this but, as with everything in Chinese herbal medicine, they are seldom given alone. That’s because additional herbs are included to balance the primary herbs’ effects.

For instance a primary herb’s effect might be to clear the excess warmth, but at least one other herb would be added to tonify Qi. Then there would be another to balance the moisture levels in the body.

Why all this, you ask? Because in their absence a strong laxative effect can be weakening and drying.

Of course, with purging you’ll need to take in fluids and balance your sugar-salt balance, as Western medicine now appreciates.

(Here is a picture of the famous Roman aqueduct in Segovia, Spain. Well worth a visit! – Segovia has much more to offer than just an aqueduct. There’s a huge palace not far away and an old town and Disney-like castle you should not miss. Aqueducts brought water to the town from the nearby hills.)

How your body deals with purging

The body has its own ways of clearing Heat and some of these are used by bulaemics, for instance vomiting. Diarrhoea – the hot smelly urgent kind – is another: the body knows how to do this!

Bleeding is another. Some children and teenagers (and others) get nose-bleeds for no obvious reason, though on questioning they may later admit to having felt recent dryness (a mild sign of Heat from lack of moisture) in their noses.

Some women get vaginal blood-spots or small haemorrhages at unexpected times of the month. Whilst these can be due to a variety of causes, if the blood is fresh and red, then one possible cause is Heat.

Unless they become frequent and heavy, they pose no great problem.

Of course if they do become frequent, persistent or heavy, the cause should be diagnosed and treated. Chinese medicine and acupuncture have an honourable reputation here.

Causes of Heat

Any prolonged or repeated exposure to hot conditions can produce this syndrome. For example, it can occur from

sunbathing for too long
over-use of sun tanning studios
standing next to, or sitting on something hot for too long – eg hot radiators in cold private schools in winter. In the past, stokers on board ship or in steam engines suffered from it, as some bakers and chefs still do.

Another major contributing factor is diet: eating too many foods that are heating, such as spicy food or red meats, roasted, and alcohol. Read more about balancing diet under Nutrition.
In some people, stress is a cause.
As mentioned, young people who are growing rapidly sometimes display signs of this syndrome, particularly at puberty, often also appearing as increased libido.

So, although technically an external cause of disease, this syndrome can be internalised or emerge from internal factors.

For a fuller understanding, read up on Internal or External.

Examples of Heat

Bakers often get this, perhaps because they work in warm kitchens and are always peering into hot ovens. I might expect people who work in fish-and-chip shops, or who make pizzas or kebabs, or work with meat turning over hot coals or fires to suffer too.

I might expect people who receive hot stone treatments too often also to be affected.

Although not specifically listed above, Heat does also affect the Mind, making people more impulsive, more prone to angry outbursts, more restless and often a bit manic.

You often notice this in children, whose small bodies are not sufficiently Yin to absorb Heat comfortably but whose Yang nature makes them quickly volatile when over-stimulated.

When someone is already Yin-deficient, as mentioned above, it can be hard to clear Heat. They have the worst of both worlds, being, like small children, unable to balance Yang effectively.

Sometimes they are also somewhat Yang deficient and often feel cold, which inclines them to seek warmth but this makes their Heat symptoms (eg rash or skin condition) worse.

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What to do about Heat?

Usually, your body tells you what to do!

Avoid hot places and exposure to heat
Keep cool, but take care not to get cold
Drink fluids – but Chinese medical experience would council against iced drinks. Better drink luke-warm or slightly cool liquids. Avoid ice and ices if you are badly affected. (Why? Because heat symptoms rise to the surface, meaning that inside you may actually not have much warmth. To digest anything your stomach needs warmth and energy but when you are suffering from heat, most of your energy goes into cooling you, leaving little left over for digestion. So a big ice-cream just sits there inside you, making you feel even more uncomfortable, and not giving you the energy you crave. With luck, your body will eject it – upwards and out the same way it entered. But don’t count on it!)
Eat some fruit containing plenty of water, eg melons, and if your energy is low, consider fruits that grow in hot climates, such as bananas and dates, both of which are moisturising and cooling in action, but provide energy. (But don’t take these daily if you are in a cold climate! They have the wrong kind of energy for you.) Chew all fruit well before swallowing it.
Bathe affected areas in cool water. If you are very hot or feverish AND feeling hot, bathe behind your knees, your neck and elbow creases in cool water.
Apply moisturising emollients
Seek urgent advice from a professional if your symptoms include continuing/persistent offensive diarrhoea or heavy bleeding, high fever, or your mind is affected, for example. (Ask a trusted friend: if you are mentally unstable, you may be the last person to notice!)
If you have taken a diarrhoea suppressant, and you then get other symptoms as mentioned on this page, see an acupuncturist or Chinese herbalist who may help you dissipate this syndrome (if so diagnosed) without further endangering your health.
As mentioned, once internalised this can remain a cause of ill-health for years. I’ve seen patients still suffering from its effects 20 years after the event that caused it.

Guarding against it: heat illness prevention

Woman on the beach — Image by Hans Braxmeier from Pixabay

Can you do anything to reduce your susceptibility? What about heat illness prevention? This page contains plenty of suggestions for what to do. Here are more.

During the week immediately before your departure for the hot climate, try to regulate your diet so that you eat very little or no sweet, chilled or iced or raw food/drinks.
Chew what you eat well, and if chilled or iced food is unavoidable – again, during the week before you depart – take a warm drink (ordinary Indian tea will do) immediately before and preferably after eating it. (Ginger tea is even better.) (Taking things steadily like this helps your Spleen energy work better, and it is your Spleen and Stomach energies that take the brunt of your dietary adventures on holiday.)
To regulate the stress of organising your job or occupation so that your business or work doesn’t crumble in your absence, begin preparations in good time.
Lessen the last-minute rush and stress by packing well beforehand so that you have just a short list of things to do on your final day at home. (Stress leads to Qi Stagnation which often leads to Heat.)
Avoid alcohol during the trip. Alcohol is heating and if you arrive full of it you’ll be asking for trouble as your body tries to grapple with both the internal source of Heat (the alcohol) and its new hot external environment.
Now comes the hardest bit. During the first three days in your new environment, avoid spicy, very fatty, oily and very rich food – and too much alcohol. These are ‘hot’ foods. Also avoid very chilled or icy food and drink, and, if you are sensible, seafood (including crustaceans etc that live on the sea-floor.) Make it four days if possible. Keep chewing well.

Time to Adapt to Avoid Heat Symptoms

These three or four days are what your body needs to rest from the journey and begin to adapt to its new surroundings. Take more than three days if possible.

If you have been very stressed and exhausted by work, it may take you seven days to relax properly and start to benefit from your holiday. (Hint: see an acupuncturist before you go: they can usually help you relax even before you go!)

Also, during those first few days, bare your skin to the full sun only briefly daily, and never at midday. Use the shade. Gradually increase sun exposure. Use sensible skin protection. (You know all this!)

After that, well, don’t go crazy! Eat some of the wonderful foods that you find, but remember, better to eat cooked foods that are still hot. And be very careful with hand and utensil hygiene when eating or drinking.

Also avoid fluids and foods from opened bottles or street vendors.

If, in spite of all this, you get the runs, drink plenty of warm water, try using warm ginger tea to help regulate your digestion, and rest, but not in full sun. Often, fasting for a couple of days helps your body repair itself. Take a very weak mixture of warm water with a little salt and some sugar in it. Both that sugar and salt are purely for medicinal reasons: don’t think I’m encouraging you to eat spoonfuls of it! Wash fruit with soap and rinse it with clean water if you intend to eat its skin, and even if you don’t.