The Back Burns and the Hands Feel Cold: Reconstructing Cold–Heat from a Single Score into a Spatiotemporal Phenotype
When one person reports heat in the back and a deep chill in the hands at the same time, placing the experience on a single “cold or heat” axis erases its most clinically informative features: distribution and simultaneity. Replacing that experience with one thermographic image erases sensory coding, temporal delay, adaptation, and context. This problem-led critical synthesis reads Korean-medicine cold–heat questionnaires; Korean and Japanese work on cold hypersensitivity; thermosensory physiology; quantitative sensory testing; vascular provocation; objective–subjective discordance in hot flushes; neuropathic burning; and the regional, depth, and temporal distinctions preserved in the Donguibogam. Three recurrent reductions emerge: spatial reduction of whole-body cold–heat into a sum score; temporal reduction of a fluctuating event to resting skin temperature; and criterion circularity when groups defined by expert judgment or self-report are reclassified using closely related questions or images. We propose a “local thermal field” that records, for location l and time t, perceived quality and intensity P(l,t), skin temperature and its rate of change T(l,t), cold and warm detection Q(l,t), perfusion and rewarming V(l,t), provoking and relieving context C(t), and functional effect F(t). This is not a new diagnosis but a measurement grammar for separating competing explanations. The first study should not train an AI to guess disease or test treatment effectiveness. It should combine cognitive interviews, 14-day event-based body maps, ambient temperature, and standardized rest–provocation–recovery observations to test repeatability, added information, and feasibility. The contribution of Korean-medicine observation is not to replace biomedical measurement, but to preserve experiences in which different regions move in different directions and to make any added prognostic, functional, or treatment-selection value falsifiable.