For TCM practitioners and TCM enthusiasts
Always Cold
The Cold pattern explained end to end — and what to send patients home with
Get the ebook — $19Clinical Acupuncture
Dr Michal Richter, MD
You have explained Cold to a patient forty times this year.
And you have watched the same thing happen after most of those conversations: the patient nods, goes home, and does none of it. Not because they did not believe you — because by Thursday they could not remember what you actually said, or why the soup mattered, or which part was the important one.
You do not have forty minutes per patient. You have twelve, and six of them go on the intake.
This is the explanation, written down once, in language your patient will accept — so you stop rebuilding it from scratch at every visit.
She came about her bladder. The answer was a wedding.
A woman of forty-seven, recurring cystitis. Nothing unusual in that — in my experience most recurrent bladder infections in women begin with external cold.
Her pulse said something else. Jing was deficient — the yin aspect missing. And where yin is missing, the body compensates with pathological yin. Jing is water, and the pathological energy of water is Cold.
The pulse also placed it in time: this had started about fifteen years ago.
So I asked the obvious question. Were you ill back then — respiratory infections, one chest problem after another, pneumonia?
Nothing.
She thought for a moment. Then she said that fifteen years earlier her sister had married a man who, she was certain, should never have been her husband. She had never got over it.
Yin is experience. Pathological yin is Cold. She could not live it through — could not digest it — and what stayed behind has behaved like Cold ever since. For fifteen years. In her bladder.
That is the entire book inside one appointment, and it is why the first chapter insists that Cold is not a temperature.
What this is
Always Cold is a 102-page ebook about how Chinese medicine describes Cold: the fresh kind that arrives with the weather, and the lingering kind that settles in and stops looking like Cold at all.
It is written in ordinary language, deliberately. Your patient can read it. That is the point.
Inside it, marked off in separate boxes, is the second layer — FOR PRACTITIONERS: the pattern reasoning, the differentials, the things you would not say to a patient out loud.
Two readers, one file.
What is in it
- How Cold is described in Chinese medicine, and why the description holds together
- Fresh Cold and lingering Cold — what separates them, and why the second one gets missed
- Yang as the force that warms and moves, and what it costs when it runs short
- The four quiet companions of Cold that patients never mention unless asked: cold exposure, stress, exhaustion, and stillness — including sleep
- A self-test your patient can fill in themselves
- The everyday measures a patient can actually carry out at home — food, warmth, timing, and what to stop doing
- A chapter almost nobody writes: “but my test results are normal”
- Contraindications and the situations that need a doctor, listed in full
Everything that is in the book
Seventeen chapters across six parts, plus the quick reference and the safety section. This is what each one gives you.
PART I. What Cold actually is — The mechanism the whole book stands on: what Cold is, and where it comes from.
- 1. Cold is not temperature — Why two people meet the same winter and only one falls ill, and why an unsolved problem counts as Cold.
- 2. Yang. The energy that warms you and sets you moving — Yang in four concrete words, the two reasons anyone falls ill, and why removing Cold and warming belong to different moments.
- 3. Cold's four quiet accomplices — Four everyday accomplices you almost certainly have in your week, and the one-energy rule that explains why they add up.
- 4. Self-check: are you carrying Cold? — A seven-point self-check, the table that tells fresh from lodged, and an honest answer for the reader whose bloodwork is normal.
PART II. Fresh Cold. The first seventy-two hours — What the first days are for, and why the window closes sooner than people think.
- 5. The window you would rather not sleep through — What being ill efficiently looks like, and what diaphoretic actually means, before anybody reaches for a remedy.
- 6. The first-hours protocol — Ten home measures, in the order I reach for them, and the time limit that decides when the aim changes.
- 7. Fever, saunas and the mistakes of day one — When a fever is doing its job, how the sauna fits during an infection, and six day-one mistakes.
PART III. The Cold that stayed — The part nobody connects with chill, and the three levels of work it needs.
- 8. “But it went away” — Why the symptoms going does not mean the Cold went, and why the target changes from the Cold to your own energy.
- 9. The three gates of Cold — Three places Cold gets in, and why the trouble then shows up at your weakest link rather than where it entered.
- 10. The core of immunity: the Lungs — Breath and movement as the engine of circulation, and the three measures that give most while needing no space or equipment.
- 11. The core of immunity: the Stomach — Food temperature, an uncluttered gut, three things worth supplying, and why unresolved emotion belongs in a chapter about digestion.
- 12. The core of immunity: the Kidneys — Your reserve energy, the daily balance it runs on, and why a weekend lie-in does not repay five sleepless nights.
- 13. Local work: what to do where it hurts — What to do where it hurts, the caveat that decides whether it works, and an honest answer on moxa.
PART IV. Cold as training — Where prevention ends and harm begins, in the subject people get wrong most often.
- 14. Cold plunging, Wim Hof, saunas, bare feet — Who cold exposure is for, who it is not for, and a decision table covering four different states you might be in.
PART V. The plan — Everything in the book put into an order you can actually follow.
- 15. Eight weeks before the season — Eight weeks, one addition a week, nothing dropped, and what to do if you catch an infection halfway through.
- 16. Five situations I see most often — Five situations I see most often, each one traced from where the Cold got in to what I would do.
PART VI. For practitioners — The treatment-room half: what to ask, what to send home, what the pulse says.
- 17. What this means in the treatment room — The one decision that sets the season's strategy, three things patients say in passing, and why home advice outweighs your single hour.
And at the back — Two pages I expect you to use more than any chapter: the method table and the safety list.
- Quick reference: every method in one place — Every method in the book on one grid, marked for fresh Cold, lodged Cold and prevention, so you can see what applies.
- Contraindications, and when a consultation comes first — Who should speak to a doctor first, which measures need particular care, and the symptoms that mean stop reading and get help.
Why the plain language is the feature, not a compromise
You already know this material. What you do not have is forty minutes per patient to lay it out, and a patient who remembers it on Thursday.
So the book does the explaining. You keep the clinical reasoning — it is in the practitioner boxes, and it is the part the patient never sees.
What I hear back from practitioners working this way is not “my patients got better”. It is “I stopped repeating myself”. That is the honest claim and it is the one I will make.
"But will my patient actually read it?"
Fair question. It is written in ordinary language on purpose, there is a self-test chapter the patient fills in themselves — usually the first page they turn to — and the measures in it are ordinary things: what to eat, when to sleep, a ten-minute walk on the way home. Nothing in it asks them to believe anything first.
And if they never open it, you are out nineteen dollars. Not a treatment.
What changes in your room
You will be able to tell the patient why they keep getting ill — not "you have Cold", but the mechanism, in words they accept and still remember on Thursday.
You will be able to give home advice that fits this patient instead of the one from the internet. A brisk walk, a sauna, a cold shower, Wim Hof, bare feet on grass — the book says what each is for, when it helps, and who should leave it alone this week. We harden what is healthy. Someone in an acute or a chronic state gets thermal comfort, not another dose of Cold.
And you will hold the result you already produced. The treatment supplies something; what the patient does between two visits decides whether it stays. Targeted recommendations are not an addition to the treatment — they are what makes it last.
Or you hand them the book and let it do the explaining.
What "targeted" actually means — one recommendation, taken apart
A brisk walk on the way home from work. Ten minutes, between leaving the workplace and opening your own front door. It sounds like nothing. Here is what it is doing, and this is the level the whole book works at.
- It moves yang. Walking sends energy down into the legs, and circulation follows it.
- It starts the muscle pump. Most of your patients did not spend the day being stressed — they spent it in one position, at a screen or behind a counter. Tension from holding a single posture does not release by resting; it releases by moving. And fatigue itself — qi deficiency, or a shortage of ATP if you prefer it that way — produces tension of its own. The pump improves blood flow, the blood brings oxygen and nutrients, and it clears the tissue.
- It puts a wall between work and home. Ten minutes of pause, so the stress of the day does not get carried through the front door — neither to the people waiting behind it, nor into the rest of the evening.
Two birds with one stone, at a very small energy cost for what it gives back. Now multiply that by every measure in the book — food, warmth, timing, sauna, cold water, bare feet, and the things to stop doing.
Who this is for
TCM practitioners, acupuncturists, herbalists and students who work with these patterns and want the patient-facing explanation already written.
Who this is not for
Anyone looking for a needling protocol — there is none in this book. Anyone wanting a promise of results. And it is a book, not an examination — a reader with a complaint nobody has assessed still needs to be assessed.
April: yes. October: he could not walk a straight line.
A man of sixty, textbook yang deficiency — tired, cold all the time, knees and lower back aching, his drive gone. By April the picture was clearing. He asked whether he could take up ice swimming, because his friends said it was excellent.
I said yes.
He had his energy back, and we harden what is healthy — a body that has energy can learn to answer a load. One minute in the lake. Once a week.
He kept to it, and through the summer it went well.
In October he came back with dizziness, nystagmus, a marked drop in vitality and sleeping through the day. He had walked into the trap of our whole civilisation: faster, harder, more, longer. He had gone up to several minutes at a time, and far more often than we had agreed.
He had only just got his yang back, and he spent it past his own limit. Pathological yin — Cold — moved in, and this time it reached Jing.
That is why the chapter on cold exposure opens with a warning box, and why "for whom, and when" is not a disclaimer in this book. It is the content.
Read it before you buy
The whole book stands on one sentence, and it is in the first chapter. Read that chapter here, in full, and decide afterwards whether the rest is worth nineteen dollars.
Chapter 1 — Cold is not temperature (full text)
Chapter 1. Cold is not temperature
Let's start with the sentence that turns this whole subject upside down.
Cold in Chinese medicine is not low temperature.
Low temperature is one of the ways Cold can show up in you. It is neither the only one nor the most common one. Cold is something else, and until you see that, you will keep fighting the thermostat instead of the cause.
Yin and yang in two sentences
Chinese medicine describes the world with two terms: yang and yin. There are many definitions, but the simplest is this: yang is the presence of energy, yin is its absence.
The image those terms grew out of is very concrete: a hillside. The sunlit slope — there is sun, there is energy, that is yang. The shaded slope — no sun, that is yin.
Yang is our activity. Yin is our experience.
We collect experience through contact with all sorts of factors: dietary, emotional, climatic, chemical. Everything that happens to us does something to us.
And here is the sentence the rest of the book stands on:
If we can adapt to that experience, we collect the experience and build life wisdom. When the same factor turns up again, we already know how to respond. That is what immunity is.
You meet a virus. You meet the same virus six months later — you already know it, you can deal with it. That is physiology. That is how it is supposed to work.
When adaptation fails
So what happens when the body is weakened? When it is short of energy, or has no competence — does not know how to handle something, is simply not immune? Adaptation fails. And what forms then is what we call Cold.
Cold is stagnation of energy. Stagnation means the energy is not circulating. By implication: energy that has not been transformed. An experience the body never digested.
Remember this sentence, because we will keep coming back to it:
Pathological Cold is a factor the body failed to transform properly. The body did not adapt to what showed up.
The best proof is right in front of you. Not everyone who walks out into winter catches a cold. The person who has the energy and knows how to adjust to cold will not get sick. The person who cannot experience it will produce qi stagnation — pathological Cold.
The temperature was the same for both of them. The difference was on the inside.
What Cold does in the body
Cold produces one thing you know perfectly well: tension.
Step outside in your underwear in freezing weather. What do you feel in the first second? Tension. You clench. Even when we mime "it's cold" with our hands, we make a clenching gesture. It is a natural protective mechanism.
A moment later something else appears: shivering. Trembling. That is your yang energy trying to shift the stagnation. The same way you move a boulder — first you rock it, then you push.
Tension, then trembling, then a rise in temperature. The body is trying to deal with Cold.
Cold that has nothing to do with the weather
Here we reach the part that changes the most in clinic.
The same mechanism runs on the intellectual level. You have a problem to solve and you cannot find the solution. What forms? Stagnation of energy. Cold on the intellectual level.
And on the emotional level. If we cannot live through something, that experience stays. It carries a charge nobody discharged. That is Cold as well.
Which is why a man who has been carrying an unsolved problem at work for three months is more likely to catch a cold than the same man was six months earlier. Not because "stress lowers immunity" — that is a slogan. Because he already has one stagnation and has nothing left to handle a second one.
In this book we will mostly talk about Cold in its physical, climatic form. But keep in mind that this is one manifestation of something broader.
For practitioners
This distinction translates directly into intake. When a patient reports a recurring complaint that "just started on its own," it is worth asking not only about exposure to cold, but about what was happening in their life at the time. An unsolved problem and a chill act synergistically and add up inside the same mechanism — stagnation.
In practice this means the treatment alone is often not enough while the second source of stagnation is still running. Which is why home advice is not an add-on to therapy. It is part of it.
That is one of seventeen chapters. The rest of the book is what the patient does at home between your treatments.
The honest part
I promise no result. Nothing here works for everyone and nothing works every time. No method — natural or conventional — is one hundred per cent effective, and nobody can guarantee an outcome. When I write that something “works”, I am describing what I have seen in some patients over twenty years of practice, not a rule.
The book carries its own disclaimer at the front, before the content, so that any patient you hand it to reads it first.
This is educational material, not medical advice. It does not diagnose, treat, cure or prevent any disease, and it does not replace examination, investigation or conventional care.
Your clinical judgement about your own patient is yours, and this book does not substitute for it.
If it is the patient who needs it, send them the link
You do not have to buy copies and you do not have to carry the file around. This page works just as well for the person sitting in your treatment room: they read the whole first chapter, and they decide for themselves. What stays yours is the practitioner layer, which they never see.
There is a second book, built the same way, for a different patient — the one who starts everything and finishes nothing, and has decided that makes them lazy: Why You Never Finish. Read its first two chapters free →
Who wrote it
Michal Richter, MD is a physician and acupuncturist. He has been in practice since 2006 and first worked with acupuncture in 2001. He practises in Katowice, Poland, sees twenty to thirty patients a day, and has been teaching practitioners for fifteen years.
This book is the part he hands over: what a person can do for themselves, at home, between visits. What happens with a needle stays in the treatment room.
Always Cold
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A decent hot dog by the bridge at the London Eye — except you will still have this one in five years, and so will every patient you send it to.
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