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Journal of Integrative Medicine ›› 2016, Vol. 14 ›› Issue (1): 36-43.doi: 10.1016/S2095-4964(16)60232-7

• Research Article • Previous Articles     Next Articles

Extraction of items identifying hiesho (cold disorder) and their utility in young males and females

ShunjiSakaguchia, HiroshiKugeb,c, HidetoshiMoric, JunjiMiyazakid, Tim HideakiTanakac, KazuyoHanyuc,e, TaroTakedaf, KazuroSasakig   

  1. a Research Division of Acupuncture and Moxibustion, Kansai University of Health Sciences, Osaka, 590- 0482, Japan 
    b Department of Anesthesiology, Osaka Medical College Hospital, Osaka, 569-8686, Japan 
    c Faculty of Health Sciences, Course of Acupuncture and Moxibustion, Tsukuba University of Technology, Tsukuba, 305-0821, Japan
    d Takarazuka University of Medical and Health Care, Takarazuka, 666-0162, Japan
    e Graduate School of Life and Environmental Sciences, University of Tsukuba, Tsukuba, 305-8572, Japan 
    f Department of Clinical Acupuncture and Moxibustion, Meiji University of Integrative Medicine, Kyoto, 629-0301, Japan 
    g Department of Acupuncture Medicine, Faculty of Oriental Medicine, Suzuka University of Medical Science, Suzuka, 510-0293, Japan
  • Received:2015-07-29 Accepted:2015-10-23 Online:2016-01-15 Published:2016-01-15
  • Contact: Tim Hideaki Tanaka, PhD; Tel: +1-416-929-6958; E-mail:


Hie (cold sensation) is one of the most common health complaints in Japan. Those who suffer from severe hie are considered as having hiesho (cold disorder). However, exact hiesho symptoms have not been defined clearly and the decision as to whether a person suffers from hiesho is subjective and based on self-awareness. The study was conducted in attempt to develop a standardized hiesho diagnostic scale.


Subjects comprised 1 146 students. From the self-awareness of hiesho symptoms, males and females were divided into hiesho and non-hiesho groups. Physical, behavioral and adaptive characteristics were compared using the 24-item questionnaire (four-grade survey) and indicators for hiesho symptoms were extracted. Based on the scores, a receiver operating characteristic curve was drawn for the total ordinal scale score of the extracted items in relation to the presence and absence of hiesho symptoms, and an optimal cutoff value was determined.


The self-awareness of having hiesho was found in 23.2% males and in 55.6% females. The sensitivity was 84.5% for males and 83.3% for females in the hiesho groups, and the specificity was 86.0% for males and 85.2% for females in the non-hiesho groups.


A questionnaire consisting of the extracted items may be useful to identify hiesho in young males and females with a high level of accuracy.

Key words: Cold hypersensitivity!, Questionnaires, ROC curve

1 Nakamura S, Ichisato SM, Horiuchi S, Mori T, Momoi M.Pregnant women’s awareness of sensitivity to cold (hiesho) and body temperature observational study: A comparison of Japanese and Brazilian women.BMC Res Notes. 2011; 4: 278.
2 Yamada N, Bekku N, Yoshimura H. Determinants for discriminating young women with and without chilliness. Nihon Shinkei Seishin Yakurigaku Zasshi.2007; 27(5-6): 191-199. Japanese with abstract in English.
3 Yoshino T, Katayama K, Munakata K, Horiba Y, Yamaguchi R, Imoto S, Miyano S, Watanabe K.Statistical analysis of hie (cold sensation) and hiesho (cold disorder) in Kampo clinic.Evid Based Complement Alternat Med. 2013; 2013: 398458.
4 Sakaguchi S.Concerning hiesho.Biomed Thermol. 2001; 21: 60-63.
5 Miura T, Katano Y, Sumimoto K, Kanayama N.Awareness of hiesho among adult woman and research into its causes.Matern Health. 2001; 4: 784-789.
6 Terasawa K. On recognizing and treating hiesho in traditional Kampo medicine. Shoyakugaku Zasshi.1987; 41: 85-96. Japanese.
7 Nakamura S.Skin temperature characteristics of pregnant women with hiesho, and their connection to daily life.J Jpn Acad Nursing Sci. 2008; 28: 3-11.
8 Shibata Y, Wu J.Kampo treatment for climacteric disorders. Brookline, MA: Paradigm Publications. 1997.
9 Tokunaga H, Munakata K, Katayama K, Yamaguchi R, Imoto S, Miyano S, Watanabe K.Clinical data mining related to the Japanese Kampo concept “hie” (oversensitivity to coldness) in men and pre- and postmenopausal women.Evid Based Complement Alternat Med. 2014; 2014: 832824.
10 Nagashima K, Yoda T, Yagishita T, Taniguchi A, Hosono T, Kanosue K.Thermal regulation and comfort during a mild-cold exposure in young Japanese women complaining of unusual coldness.J Appl Physiol (1985). 2002; 92(3): 1029-1035.
11 Kokubu T. Immunoserological study of so-called sensation of cold syndrome (Hiesho). (9). Nihon Sanka Fujinka Gakkai Zasshi.1968; 20(4): 393-402. Japanese.
12 Sato F, Matsushita S, Hyodo K, Akishima S, Imazuru T, Tokunaga C, Enomoto Y, Kanemoto S, Hiramatsu Y, Sakakibara Y.Sex difference in peripheral arterial response to cold exposure.Circ J. 2008; 72(8): 1367-1372.
13 Ushiroyama N. Chill sensation: Pathological findings and its therapeutic approach. Igaku No Ayumi.2005; 215: 925-929. Japanese.
14 Kondo M, Okamura T. Cold constitution: analysis of the questionnaire. Acta Obst Gynaec Jpn.1987; 39(11): 2000- 2004. Japanese.
15 Shibahara N, Itoh T.Hiesho (coldness) and peripheral circulatory disturbance.Kampo Newest Ther. 1999; 8(4): 317-323.
16 Watanabe K, Plotnikoff GA, Sakiyama T, Reissenweber- Hewel H.Collaboration of Japanese Kampo medicine and modern biomedicine.Evid Based Complement Alternat Med. 2014; 2014: 646947.
17 Nakamura S, Horiuchi S.Relationship between advanced maternal age, hiesho (sensitivity to cold) and abnormal delivery in Japan.Open Nurs J. 2013; 7: 142-148.
18 Kanehisa T, Fukamachi K.The Cornell medical index. Kyoto: Sankyobo Co. Ltd. 1988.
19 Sakaguchi S, Kawamoto M, Fujikawa O. Delineation of definition of “Hiesho”—utility of Terasawa’s modification questionnaire for “Hiesho”. Ann Rep Kansai Coll Orient Med.1997; 13: 58-63. Japanese.
20 Kawagoe H, Takahashi K, Kawashima A, Ishikawa T. Investigation into the actual conditions of Hiesho—the basic data and frequency of Hiesho according to diseases. Diagn Treat.2003; 91(12): 139-142. Japanese.
21 Mori H, Sakaguchi S, Nishijo K.Thermographic guideline of hiesho.Biomed Thermol. 2006; 26(2): 48-51.
22 Sakaguchi S, Kuge H, Kojima Y, Takeda T, Miyazaki J, Sasaki K, Mori H.Effects of acupuncture electrotherapy t o l o w e r l i m b s o n h i e s y m p t o m ( v a s o m o t o r dysfunction).J Jpn Soc Balneol Climatol Phys Med. 2010; 73(4): 231-240.
23 Falconer IR, Jacks F.Response of the thyroid and adrenal glands of sheep to cold and fear.J Physiol. 1972; 222(1): 86P-87P.
24 Frank SM, Higgins MS, Fleisher LA, Sitzmann JV, Raff H, Breslow MJ.Adrenergic, respiratory, and cardiovascular effects of core cooling in humans.Am J Physiol. 1997; 272(2 Pt 2): R557-R562.
25 Gordon CJ, Becker P, Padnos B.Comparison of heat and cold stress to assess thermoregulatory dysfunction in hypothyroid rats.Am J Physiol Regul Integr Comp Physiol. 2000; 279(6): R2066-R2071.
26 Wilson O, Hedner P, Laurell S, Nosslin B, Rerup C, Rosengren E.Thyroid and adrenal response to acute cold exposure in man. [J] Appl Physiol. 1970; 28(5): 543-548.
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