Always Cold, Cold Hands and Feet — Is It Yang Deficiency? Doctor Luo Dalun on the Four Types of Cold Intolerance in Women

Patient search terms: I am always cold / cold hands and feet / is feeling cold always yang deficiency / why do I get heat flushes when I try to warm myself / my whole arm feels cold / cold hands and feet when I am angry / blood deficiency and feeling cold / blood stasis and feeling cold / yang deficiency symptoms in women / moxibustion does not work for my coldness / what causes cold intolerance in women

Corresponding medical names: cold intolerance (pa leng) · blood deficiency (xue xu) · stagnant liver qi (gan qi bu shu) · the four inversions (si ni) · blood stasis (yu xue) · yang deficiency (yang xu) · insufficiency of the ming men fire (fire of life) · kidney essence (shen jing) depletion · phlegm-dampness (tan shi) · damp-heat versus cold-damp · dan yu mei (the desire to lie down and sleep) · Si Ni San (Frigid Extremities Powder) · warming the channels and freeing the vessels · gynecological inflammation

Opening: being cold is not that simple

Doctor Luo usually tells classical case records, but today he sets the cases aside and talks about something close to home — the problem of cold intolerance in women.

💬 Note from Doctor Luo: These days you will find that many women feel cold. But feeling cold actually comes in many kinds, with very different causes. People whose blood is deficient feel cold; people who are always angry feel cold; people with blood stasis feel cold too — and none of these is the same thing as genuine yang deficiency.

Many people, the moment they feel cold, label themselves: “I have yang deficiency — quick, warm me up!” Doctor Luo says, don’t jump to conclusions. He tells a case that stayed with him:

💬 Note from Doctor Luo: When I was studying, I read about a case of a woman who sought treatment in the United States. After moving to America she began to feel cold — so cold that she wore several pairs of socks and slept under several layers of blankets. She found a famous Chinese-medicine doctor in America. The doctor took one look and thought: warm the yang — so he used fu zi (aconite) and gan jiang (dried ginger). He treated her many times with absolutely no effect. She kept asking him: what is wrong with me? The doctor was puzzled too: “By all rights, with your constitution, you should have warmed up by now.”

Why couldn’t she be warmed up? Because her coldness was not yang deficiency at all. Today Doctor Luo lays out the different types of cold intolerance in women once and for all.

Cold type one: blood deficiency — it is not a lack of yang, the “blood” has run short

Blood carries warmth as it circulates through the body. Wherever the blood reaches, it delivers warmth, nourishing the limbs and the hundred bones.

💬 Note from Doctor Luo: When a woman’s blood is insufficient — blood deficiency (xue xu) — her body’s ability to warm and nourish the limbs and frame declines, because you are no longer carrying warmth there; the blood is insufficient. So many women who are blood-deficient feel cold.

This kind of cold has a very distinctive pattern:

💬 Note from Doctor Luo: When the weather outside is warm, you feel fine, because the outside temperature helps warm your body. But the moment it turns cool, you immediately feel your limbs and your body getting cold. In plain words: your body’s ability to regulate itself and adapt to falling outside temperatures has declined — it can no longer adjust itself as the weather changes.

Blood-deficiency cold is extremely common in women. How can you tell whether you are blood-deficient? Doctor Luo runs through the symptoms he has explained before:

💬 Note from Doctor Luo: Blood-deficient women have poor memory, a poor complexion — pale — they see black spots when standing up from a squat, and their periods are light in color and scanty in volume. If you have these symptoms, you are blood-deficient. Coming back to that American case — that was exactly her situation, yet she was treated as yang deficiency and warmed with fu zi and gan jiang, which of course did nothing. A woman like this needs her blood supplemented first.

Is there a connection between blood deficiency and yang deficiency? Yes — but it is a connection “dragged out” over time:

💬 Note from Doctor Luo: When blood deficiency lasts a long time, the upright qi in the body is bound to become insufficient, and gradually the condition moves toward yang deficiency. For example, when attacked by cold, other people are fine, but in you the cold pathogen stays inside — people with blood deficiency catch cold more easily than others. Accumulated over the years, they eventually tend to enter a yang-deficient state too. So all of these are connected; there is no clean dividing line.

Cold type two: stagnant liver qi — the yang is trapped inside the torso (si ni)

The second kind of cold is born from anger. Chinese medicine calls it liver qi constraint (gan qi bu shu).

💬 Note from Doctor Luo: The liver governs free coursing — moving the qi and unblocking the channels are the liver’s jobs. Once liver qi is constrained and stagnant and the qi mechanism does not flow, what happens? The warmth gets sealed inside, and the four limbs turn cold — Chinese medicine calls this si ni (the four inversions).

This produces a strange phenomenon that puzzles many women:

💬 Note from Doctor Luo: Many women with cold hands and feet assume they have yang deficiency. But the moment they try to warm the yang, they get heat flushes and are completely confused — what is going on? This is si ni: the qi mechanism is blocked. The body is not short of yang qi — the yang qi is trapped inside the torso, the limbs’ qi cannot circulate, and so the limbs are cold.

How do you tell whether you are this type? The accompanying symptoms are very typical:

💬 Note from Doctor Luo: These people get angry easily, belch a lot, sigh a lot, feel dizzy, have a bitter taste in the mouth, suffer insomnia and excessive dreaming, distending pain in the chest and flanks, a fluttering racing heart, palpitations, chest oppression, and rib pain. If you have these symptoms, stagnant liver qi should be high on your list.

The tongue is also very characteristic:

💬 Note from Doctor Luo: The tongue of such a person is often swollen and enlarged, sluggish, lifeless — a normal tongue should be agile and lively, but theirs looks dull and puffy, like a lump of flesh without vitality. There is a lot of saliva on top, the coating covers the whole tongue, and especially along both edges of the tongue there are two saliva lines. Some people’s tongues come out pointed, then become plump as the condition progresses. Blood deficiency, by contrast, shows a tongue body that is pale in color — through the tongue you can tell which constitution you have.

Why are so many women cold in the hands and feet this way? Doctor Luo says it is tied to the female temperament:

💬 Note from Doctor Luo: Women are more sensitive by nature; when under pressure they bottle it up inside, and they feel things far more keenly than men do. A man lights a cigarette or has a drink and the feeling is gone. Women are more sensitive and get hurt more easily. So cold hands and feet from liver qi stagnation and a blocked qi mechanism are extremely common in women. But many people treat it as yang deficiency and do moxibustion every day — that is wrong; they have not distinguished what is actually going on.

So what to do? Smooth the qi mechanism and regulate the flow of qi:

💬 Note from Doctor Luo: Chinese medicine has a formula called Si Ni San (Frigid Extremities Powder). In daily life you can also brew rosebuds and China roses (yue ji hua) as tea — both are helpful; add a little chen pi (tangerine peel) to regulate qi. This type must not be confused with the others.

Cold type three: blood stasis — the blood is blocked, warmth cannot reach the limbs

The third kind is cold hands and feet from blood stasis (yu xue). The reasoning resembles blood deficiency — the qi and blood cannot circulate, the blood does not reach the limbs, and so the limbs cannot be warmed and nourished.

How do you tell blood stasis apart from stagnant liver qi? Doctor Luo teaches one trick:

💬 Note from Doctor Luo: Stagnant liver qi usually makes the hands and feet cold. In blood stasis, however, the whole arm feels cold — the entire arm is cold. When the weather turns cool, the arm takes on a bluish tint, and when you touch it, it is icy. Such people are especially affected by outside temperature, especially cold. When it is warm they feel comfortable; the moment it gets cold, the hands, feet and arms all turn cold.

Blood-stasis constitutions in women have their own identifying marks:

💬 Note from Doctor Luo: The throat feels dry, and you always want to drink water to moisten it — but you are not truly thirsty; the skin tends to be dry and to peel in patches; you easily develop visible red capillaries; your memory is poor; and there are places in the abdomen that hurt when pressed. Blood stasis is common in women — all sorts of lumps may be blood stasis, for example thyroid nodules and breast nodules.

Blood stasis and yang deficiency are another pair that entangle each other:

💬 Note from Doctor Luo: When blood stasis reaches a certain degree, a person is more likely than others to slip into yang deficiency after exposure to cold; and when yang deficiency cannot warm the body and the blood cannot circulate, blood stasis also arises. So the two often mix together. For such women, the treatment must warm the channels and free the vessels — warm the body on one hand, invigorate blood and resolve stasis on the other, and only by treating both together can you recover. Resolving stasis alone will not work, because her body is extremely cold.

Cold type four: true yang deficiency — the ming men fire is running low

The first three types are not true yang deficiency — although if they drag on long enough, they can all turn into it. So what does true yang deficiency look like?

💬 Note from Doctor Luo: True yang deficiency really is insufficiency of yang qi — the ming men fire, the fire of life itself, is insufficient. Yang deficiency is a major factor harming women’s health, and women must learn to recognize it.

The first sign of yang deficiency is cold:

💬 Note from Doctor Luo: The limbs feel cold; you always feel cold. The complexion is pale — and when yang deficiency reaches a certain depth, the face can even turn dark. The urine is clear and copious — a large volume, but not yellow; especially when kidney yang is insufficient, night urination increases, and you get up frequently at night.

People with yang deficiency also have a hallmark state — dan yu mei (the desire to lie down and sleep):

💬 Note from Doctor Luo: People with yang deficiency are not spirited — always sleepy, listless and depressed, because the fire of life is low. During the day they are perpetually weary, want to lie down, and their head feels fuzzy and heavy. This is called dan yu mei — but it does not necessarily mean truly sleeping. Some people just crouch there; they are not asleep, they simply find that closing their eyes and thinking of nothing feels comfortable — their energy is insufficient.

Yang deficiency also makes the whole body “regress”:

💬 Note from Doctor Luo: All functions related to growth and development begin to decline. A yang-deficient child develops slowly; a yang-deficient elder ages early — especially when kidney yang is insufficient, people age very early. People with yang deficiency are also extremely sensitive to cold: sit on a cold bench and you immediately get diarrhea and have to run to the toilet; a cold morning wind blows on you and you immediately get diarrhea; drink something cold and the diarrhea pours out and your stomach immediately hurts.

For women, the effects of yang deficiency are even more direct:

💬 Note from Doctor Luo: Women have the uterus (bao gong) as their special organ. Yang-deficient women are more prone to infertility — difficulty conceiving — to painful periods, to abnormal vaginal discharge, and to all kinds of gynecological problems. So when people see gynecological inflammation, the automatic thought is “clear heat and resolve toxins” — do not make that mistake. A significant proportion of gynecological inflammation actually needs warming the yang and freeing the channels; warming resolves it. If you keep clearing heat and resolving toxins, the illness drags on endlessly and never heals.

Where does yang deficiency come from? Internal causes come first — check your “ammunition depot”

Having laid out the four types of cold, Doctor Luo asks a deeper question: how does yang deficiency actually arise?

💬 Note from Doctor Luo: Your yang qi becoming insufficient means first that your own organs have declined to a certain degree — only then does outside cold affect you. Some people say eating cold things causes yang deficiency — not necessarily. Some people can eat ice cream with no problem; others eat it and immediately get stomach pain, stomach ache and diarrhea. The internal cause is primary: either you are blood-deficient, or you have blood stasis, or liver qi constraint, or qi deficiency. Something inside your own body is wrong, is insufficient, dampness is gathering, all kinds of pathological factors are present — and then, on top of all that, you catch cold from outside, and you very quickly develop toward a yang-deficient state.

So Doctor Luo gives a special warning: do not think yang deficiency can be cured by doing moxibustion every day.

💬 Note from Doctor Luo: I have seen many yang-deficient people who did moxibustion every day and never got better. Warming the yang alone is not enough — actually you need to build up (bu). Your material foundation, your ammunition depot, must have something in it — you need gunpowder. If you have no gunpowder, no matter how many matches I strike, nothing catches fire. The decline of the organs is the important foundation of yang deficiency.

The core of this “ammunition depot” is kidney essence (shen jing):

💬 Note from Doctor Luo: Kidney essence is the fundamental substance of the body. Kidney essence transforms into kidney yin and kidney yang, and the yin and yang of all five organs come from it. If you stay up late night after night, overthink constantly, or indulge excesses, you consume a great deal of kidney essence, and the person easily becomes deficient in both yin and yang. Then if you are suddenly exposed to cold — ice cream, iced beer, cold air-conditioning, clothes leaving the belly exposed — yang deficiency can take shape. So the decline and loss of the organs comes first; warming the yang is only the final act of lighting the fire. Keeping the ammunition depot well stocked with gunpowder is the real key.

Phlegm-dampness and environment: why do some people get damp-heat and others cold-damp?

On top of organ decline, phlegm-dampness (tan shi) also develops. Once dampness is heavy, it moves in completely different directions depending on the environment:

💬 Note from Doctor Luo: Dampness is a yin pathogen; by nature it is heavy and turbid. If you are spleen-deficient with heavy dampness and you live in Sanya, where it is over thirty degrees all year round, it easily becomes damp-heat — many people with rheumatoid arthritis have red, swollen joints; that is damp-heat. If you are in the northeast, where the outside environment is cool, the water-dampness inside your body tends to develop toward cold-damp — wind, cold and dampness arrive together and combine into bi (painful obstruction); this kind of rheumatism fears cold and loves warmth — warm and it is comfortable, cold and it hurts.

💬 Note from Doctor Luo: So every constitutional pattern is the result of internal and external factors working together. Blood stasis, dampness, qi stagnation — these are all obstacles inside the body, obstacles to the movement of qi and blood. They exist, and then the outside cold attacks you on top of that, and your body very likely moves in the cold direction, toward yang deficiency — this is the combination of internal and external causes.

Emotion and outlook on life: why does talking about yang deficiency lead to talking about being a person?

The last piece of the internal cause is emotion.

💬 Note from Doctor Luo: People who are depressed and inactive more easily enter a yang-deficient state — of course this is mutual causation: yang deficiency in turn makes it easier to fall into low spirits. While people who laugh “hahaha” every day, who are spirited and happy, rarely become yang-deficient.

Doctor Luo gives a very vivid example — the neighbor’s child taking the college entrance exam and getting into a top university; different women react completely differently:

💬 Note from Doctor Luo: Some people think: “Hmph — he got into that university? The city has so many cars — what if he gets hit by one?” There are actually quite a few people like this in life; when they see another person’s good fortune, they are furious inside. Everywhere they are cold and spiteful — if they can spoil someone else’s business they will, if they can say a cutting word they will, they look at people sideways, and when someone needs help, “why should I help?” Can a person like this have vigorous yang qi? Often their face is pale and twisted, and they are thin and small — they very easily enter a yang-deficient state.

The other kind of person:

💬 Note from Doctor Luo: Others think: “That kid is really impressive — I saw it coming. I happen to have relatives in Beijing; let me introduce them, have everyone meet.” That is a warm heart. Why is it called a warm heart? Because the yang qi is vigorous. Can a person like this enter a yang-deficient state? Very hard.

Here Doctor Luo carefully distinguishes two concepts — personality and outlook on life:

💬 Note from Doctor Luo: Personality and body influence each other; different physical states such as yang deficiency produce different personalities. But outlook on life has little to do with the body — it comes from your education and environment. If your outlook on life is positive, sunny, upward, helpful, compassionate and kind, your body more easily enters a balanced, healthy yin-yang state. If your outlook is cold and spiteful, always hoping others fail, your personality will not be good either, and your body will not be healthy. Outlook on life determines bodily health.

So Doctor Luo reflects: when studying Chinese medicine, what should you learn first?

💬 Note from Doctor Luo: First get your outlook on life right — first learn compassion, learn benevolence, learn kindness. Once your outlook is established, learning the techniques is no problem. Otherwise everyone treasures technique, learning one trick after another — but if your outlook heads in the wrong direction, all those tricks are useless. The same trick, used by people with different outlooks, may produce different results. First learn to be a person; get your moral direction straight, and then the techniques can work.

This also explains why some constitutions are so hard to adjust:

💬 Note from Doctor Luo: Some patients can never be changed, however you treat them, because their outlook will not change and their personality will not change — so their constitution is extremely difficult to adjust. Adjusting the body with medicine is actually simple, but if the root cause is not resolved, the body is not easy to turn around. So when a Chinese-medicine doctor adjusts a person’s body, he chats with them for a few minutes and collects the diagnostic information and the personality information at once — Chinese medicine analyzes a person by positioning you in all dimensions, analyzing both the branch and the root.

Ending: tomorrow we continue — how to actually regulate yang deficiency

After all this, Doctor Luo wraps up:

💬 Note from Doctor Luo: Today I first share with you the knowledge of cold intolerance in women — blood deficiency, stagnant liver qi, blood stasis, and yang deficiency: you must match yourself to the right type. Today we have covered half; tomorrow we continue with how yang deficiency arises in women’s bodies and how to regulate it. I spend a little time every day chatting; you listen — perhaps it will help you.

Being cold cannot be explained in one sentence. Distinguishing the type is the first step of regulation. See you in the next installment.

What to take away: match your coldness to one of the four types before you “warm the yang”

Blood deficiency (xue xu): the blood is insufficient, so warmth cannot be carried to the limbs. You feel fine while it is warm and instantly cold when the weather turns; add poor memory, a pale face, dark vision when standing up, light scanty periods. Treat by supplementing the blood — warming the yang with fu zi and gan jiang will not help.
Stagnant liver qi (gan qi bu shu): the yang is trapped in the torso — the hands and feet are cold, but warming treatments cause heat flushes. Add easy anger, belching, sighing, a bitter mouth, insomnia, chest and rib distension; the tongue is swollen with saliva lines on the edges. Treat by smoothing the qi mechanism — Si Ni San, rose tea, chen pi.
Blood stasis (yu xue): the whole arm feels cold and turns bluish in cool weather; add dry peeling skin, red capillaries, poor memory, painful abdominal spots, nodules. Treat by warming the channels and invigorating blood together — resolving stasis alone fails because the body is too cold.
True yang deficiency (yang xu): the ming men fire is low — cold limbs, a pale or even dark face, clear copious urine, night urination, dan yu mei (always wanting to lie down), sensitivity to cold (diarrhea from cold seats, wind or drinks), and infertility and gynecological problems in women. Treatment needs building up, not just warming — the ammunition depot (kidney essence) must be restocked.
Remember the entanglements: blood deficiency, blood stasis, liver qi constraint and qi deficiency are all foundations; left long enough, they all drag toward yang deficiency. Dampness plus a cold environment pushes in the same direction. The real ammunition depot is kidney essence — protect it from staying up late, overthinking and excess.
And the deepest root: outlook on life. A warm, compassionate, generous person’s yang qi is vigorous; a cold, spiteful person easily declines into yang deficiency. Learn to be a person before learning technique.

Compiled from Doctor Luo Dalun’s lecture series on cold intolerance in women (this installment: the general classification of the four types of cold; the next installment will cover the specific methods for regulating yang deficiency in women).