Lesson 2: Balance TEMPERATURE in a herbal combination

This is the most basic of the herb properties, and failure to match the temperature of a single herb or herb combination to the patient’s temperature grade can result in the patient becoming worse instead of better.

Treatment temperature
Then a herb or acupuncture treatment can be chosen to correct the temperature imbalance of the patient.

Differential questions
The differential questions to separate the 5 temperature grades are shown in the following video. This video is part of our Online Course “How To Determine a Chinese  Syndrome Diagnosis – quickly and accurately”.

Common mistakes

The temperature correspondences in the Temperature Balancing Table seem obvious.
But failure to match correctly herb temperature with patient temperature is one of the commonest causes of adverse effects.

Hot herbs    Herbs graded ‘hot’ should be used with caution, since if used in too high a dose, or for too long, the patient may become too hot, even if they were initially too cold.

Cold herbs   Even more caution should be used with cold herbs, since too high a dose or for too long, the patient may become not only too cold, but exhausted and depressed, even if they were initially too hot.

If in doubt   Use a warm herb rather than a hot herb, or a cool herb rather than a cold herb, until you know how the patient will respond. The key is a correct diagnosis. But this does not always happen!

Mistake example: Menopause
Patient has menopausal hot flushes, so the practitioner assumed her temperature grade is hot, and asked no further questions about temperature. This was a mistake!
The practitioner prescribed cold herbs for menopausal hot flushes, such as Anemone and Salvia miltiorrhiza. At her next appointment the patient complained that now she felt too cold.

Missed question   The practitioner should have asked: “What was your temperature before the menopause?” She would have said: “Before the menopause, I was always cold, especially my hands and feet.”

Cool, not cold   The practitioner should have prescribed cool herbs for menopausal hot flushes, rather than cold ones, or, at least ensured that the overall temperature of the combination was cool rather than cold.

Dropper bottle of warming herb   Or, he should have said: “Here is a dropper bottle of Zanthoxylum tincture, which is warming. If you get too cold with the hot flushes prescription, add between 1 and 5 drops of the warming Zanthoxylum, until your temperature is neither too warm or too cold.”

Overall temperature of the herb combination
The overall temperature of a herb combination is the sum of all the temperatures of the herbs in the combination. So, if a combination had one cold herb and one hot herb, in equal amounts, the overall temperature would be approximately neutral.

In all the descriptions of herb combinations in the database, there is a section ‘Temperature’ where it states the overall temperature of the combination.

Example:  Lobelia 2

The ‘Temperature’ section states: “The overall temperature of the combination is slightly warm, and can be used for cool to warm conditions, with suitable modification.”

Importance of overall temperature

The Temperature Balancing Table shows the temperature of the single herb or herb combination that is required to bring the patient’s temperature back to approximately normal (neutral). In the case of a combination this refers to the overall temperature.

Modify to change overall temperature

The importance of matching the overall combo temperature to the patient temperature cannot be over-emphasized. If the overall temperature of a preset combination in the database does not match the patient’s temperature, then the combination can be modified to make a better match.

Example: Lobelia 2
The overall temperature of Lobelia 2 is slightly warm. But what if the patient is cold?
Then Lobelia 2 can be modified by the addition of a suitable amount of dried Zingiber.

A Ratio of 0.5 to 1 dried Zingiberr can be added to the combination, depending on how cold the patient is.

Variable temperature herbs

Most herbs have one main temperature effect.
For example, Asclepias is cold, Cinnamomum bark is hot, and Agrimonia is neutral.

Variable temperature herbs can have two, or even three, potential temperature effects.
Which of the potential temperature effects manifests in a specific situation depends on:

• the condition of the patient
• the method of dispensing
• the temperatures of the other herbs in the combination
• climate

Achillea as an example   Achillea is classified here as a warm-cool variable temperature herb, since it has the potential to be warm, neutral, or cool, depending on the situation.

warm

• patient: cool condition, eg. influenza with chills associated with exposure to cold wind (Lung Wind Cold)
• especially Achillea taken as a hot infusion with warming diaphoretics eg. Zingiber

neutral

• patient: neutral condition, no heat or cold, eg. weak digestion (Spleen Deficient Qi)
• especially, Achillea as a tincture in water at body temperature, combined with neutral bitter digestive tonics such as Marrubium

cool

• patient: warm or hot condition, eg. influenza with fever (Wind Heat)
• especially, Achillea as a hot infusion, with cooling diaphoretics, eg. Sambucus