Why are my hands and feet always cold?

The tradition thinks of warmth as something made in the middle and sent outward, and it is not surprised that the hands and feet, the furthest points from the middle, are where a shortfall is felt first. The question a Chinese physician asks is not why the hands are cold but why the warmth is not arriving, and there are three usual answers: there is not enough of it, there is not enough carrying it, or something is holding it back.

The three feel different. The person short of yang is cold all over, hands and feet worst, and loves the sun, the bath and the warm drink. The person short of qi and blood has pale, cold ends, gets dizzy standing up and tired on the stairs. The person whose qi is bound has icy hands on a body that is perfectly warm, worse on a stressful day, and finds they thaw the moment they go for a walk. The tongue tells them apart in a minute.

The Suwen’s fifth chapter is where the tradition explains how the body distributes what it makes from food: the clear, light part rises and goes outward to the limbs, the heavy part goes down to the bowels. Cold hands are a shortfall in the first half of that sentence.

Two other lines carry the rest of the reasoning. The chapter on regulating the channels gives the rule that yang deficiency shows as cold on the outside, and the chapter on the yang qi and heaven says what yang is: the sun, without which nothing is bright. The Shanghan Lun of the second century gives the condition its name, reversal cold of the hands and feet, in a line about a pulse so thin it is about to vanish; the formula it names is a physician’s formula and not a recipe, and we do not give it here.

Three pictures, and a fourth that is cold with heaviness. They are given different food and different advice.

• A basin of hot water for the feet every night for ten minutes, then socks and bed. The tradition has done this for two thousand years and it is the single most reliable thing on this page.
• Cover the lower back, the belly and the ankles. The body warms the ends last; it will not send warmth out while the middle is losing it.
• Move. Clear yang rises with movement, and the cold-hands-warm-body person thaws within ten minutes of walking. A brisk walk before lunch, daily.
• A warm breakfast, and no iced drinks with meals in any season. The four limbs receive their qi from the stomach; a cold stomach sends nothing.
• No raw salad or fruit straight from the fridge from October to March, for the first two pictures.
• For the wound-tight picture: shake the hands out, roll the shoulders, breathe out longer than in, and take the argument outside for a walk.

None of that is a promise, and we make none. It is the floor.

• Ginger 生姜, fresh, sliced into the morning cup, for the cold-all-over and the cold-and-pale. Mornings only; it is a rising, scattering food.
• Cinnamon 肉桂, a pinch in the morning congee, for the cold-all-over picture, and in winter.
• Jujube 大枣 and astragalus 黄芪 simmered in a soup, for the cold-and-pale: the one builds blood, the other raises the qi that carries it.
• Tangerine peel 陈皮 in hot water after meals, for the wound-tight and the cold-and-heavy; it moves what is stuck rather than heating it.
• Lamb, in the tradition’s winter kitchen, for the cold-all-over person, and nothing cooling: no chrysanthemum, no mung bean, no watermelon.

Four finger-widths below the kneecap, a thumb’s width outside the shin bone, is Zusanli, Stomach 36, 足三里: the point the tradition presses to raise the qi of the middle and send it outward. Thumb pressure, a minute each side, after the morning walk. It is not a needle and it is not a claim about outcomes.