Winter Warmth

 

Among the many types of “common cold” described in Chinese medicine, there is one type–called “winter warmth (dongwen 冬温), that I have often invoked in treating patients. In particular, it is the type of cold my daughter is most prone to catching.

“Winter warmth” is a bit of an oxymoron in Chinese medical thought. “Colds” from our perspective are most frequently the result of external climatic factors–cold, heat, damp, etc.–invading the body. Winter, being a time of cold weather, is naturally also the time for “colds” caused by the invasion of external cold. We call such illnesses “cold damage (shanghan 伤寒).” Nevertheless, it has been recognized for over 1800 years that illnesses caused by–or at least manifesting as–warmth do occur in winter.

The usual explanation for these unseasonable diseases is that periods of unnaturally warm weather occur in winter and give rise to winter warmth illnesses. Since changes in the weather were responsible, it was expected that large numbers of patients would contract winter warmth in such warm-spells. This explanation fits very nicely with Chinese medical theory, but unfortunately doesn’t always jive so well with what we actually see clinically. Living in New York City for seven years (before we moved to Chengdu), I saw plenty of winter warmth cases when the weather had not warmed up and was, in fact, frigid. I also saw lots of cold damage cases during the same periods of time. The treatments described for winter warmth in the old books were highly effective, but the description of its epidemiology seemed incorrect to me.

I have an explanation for all of this, but I won’t bore you with the technical details. My point is simply that in my clinical experience, winter warmth is related to neither unseasonable warmth nor large numbers of similar cases. It is simply one of the “common colds” that is common in winter. So you can imagine my interest when I saw an outbreak of winter warmth here in Chengdu that followed the classical description perfectly.

About a week ago, the weather here suddenly turned warm. I was–as I mentioned in a previous post–overjoyed. I really don’t like cold weather. But then lots of people I knew started getting sick–including my daughter. She was the only patient I treated personally; her illness was clearly winter warmth. I treated it appropriately, and she recovered quickly. In talking to my friends who came down “colds,” it seemed clear that all of them also had winter warmth. Then I developed a sore throat–a classic first sign of winter warmth. I treated myself and the sore throat went away. Sadly, it returned as a sinus infection–another illness due to warmth–and I treated that as well. Regardless, the pattern was clearly that described in the old books: unseasonable warmth leads to widespread winter warmth illness.

The obvious question is whether there is a reason that the pattern holds here in China but didn’t hold in the U.S. I can think of one good explanation. Here in Chengdu we don’t have central heating. In fact most families, and almost all businesses, don’t bother heating during the winter. Chengdu is not that cold–it almost never drops below freezing–but it’s cold enough that you feel it. People dress in layers: a jacket over two wool sweaters over a shirt over thermal underwear (we all look vaguely like the Pillsbury Doughboy as a result), but you are definitely more exposed to the elements. Even our house, which we heat using a combination of oil radiators and an an air-con that can heat, is still colder than any of our U.S. homes. You feel the environment more directly here, and I think that leaves us more exposed to changes in the weather. But I may be wrong.

In spite of the possibility that it made me sick, I rather enjoy being able to live this way. I remember when I came back from Chengdu to the U.S. the first time, in 1997, that I had to leave my windows open well into November to feel comfortable. You quickly get used to knowing the weather without stepping outside. Although I suspect it is part of why we are more vulnerable to things like winter warmth, I also suspect it has long-term health benefits. Though proving that would be rather difficult. At any rate, I like being part of the world and weather outside my window. Not that I would mind if there happened to be a tropical island outside that window …

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