Though the Beijing Meteorological Bureau shouldn't dictate personal fashion, its warning about the start of the long underwear season issued on November 2 may get some residents' knickers in a twist.

In Northern Chinese tradition, qiuku, or long johns, are donned following the start of winter. Though TCM practitioners have long thought layering up fends off arthritis, a subset of the younger and fashion conscious is striving to showcase their shapely calves, sans qiuku.

With so many potential joints at risk limping around Beijing, Metro Beijing set out to explore the long john dilemma. We asked a TCM and traditional doctor and probed aesthetically concerned people for their take on joint health: Should long johns be kept on or off?

TCM perspective

"Qiuku are common in Northern China. Parents dress their children in layers of clothing and a variety of long underwear as soon as the temperature drops," said Zhang Jilan, a retired traditional Chinese medicine (TCM) doctor in Beijing.

A firm believer in qiuku's ability to prevent arthritis, Zhang advises everyone this winter to take short-term precautions to prevent long-term ailments.

"When you're young, you won't feel the effects [of wearing too little]. But with age, problems will begin surface," she said.

The Chinese word for rheumatoid arthritis, "fengshi," literally translates to "wind wet." Zhang recommends protecting lower limbs against not only the cold and wind, but also against damp air, as both humidity and cold cause achy joints.

"Some people are more predisposed to rheumatoid arthritis. If you are healthy, you can be less rigorous in following these guidelines. But if you're unhealthy at a young age, you're more at risk of developing arthritis in the future."  

Zhang said that the repercussions of not bundling up are already evident. From her experience, hospitals are seeing an increasing number of people in their 30s with joint-related problems, whereas 10 years ago, middle-aged patients would have been the norm.

"Signs of joint problems are increasing, because many Beijingers, particularly the younger generation, ignore traditional advice." 

But not everyone residing in chilly areas immediately reaches for the long johns. In the West, protecting the torso, rather than the bottom limbs is seen as more important. Zhang attributes the different circumstances between the East and West to upbringing, diets and environment. 

"Until recently, Westerners ate more protein and drank more dairy than their Eastern counterparts. This has had an impact on their bodies. Perhaps it's because of this, they don't have to wear qiuku," Zhang said.

Scientific angle

Luke Guo, medical director at Beijing's Vista Medical Center, gave his view on whether arthritis is caused by indecent exposure of the legs in the winter.

"Joint problems are usually caused by multiple factors. [Not wearing enough] is one factor. If you are always exposed [to] cold in the winter, the blood supply will not be good. Poor blood supply will cause hypo-immunity and higher morbidity. If you are physically active and stay in a warm office, that is a different thing," he told Metro Beijing by e-mail.

Various factors may indeed cause joint problems and arthritis is an umbrella term used to refer to hundreds of medical conditions affecting joints. 

Being overweight for example, can also cause arthritis, as the bones are put under too much pressure. The overuse of a joint can cause cartilage degeneration, and prior injuries damage joints as well. Cartilage also degenerates naturally with age.

The key to preventing arthritis and other possible winter ailments, such as the ubiquitous cold, is to have a well-balanced lifestyle. 

Guo lists basic principles to adhere to: getting enough sleep, being in ventilated and clean air (for Beijingers, this might require investing in an air purifier), staying hydrated, having a healthy diet, exercising and maintaining good hygiene.

Pedestrian approach

For the fashion conscious collective wishing to remain warm while not looking like an asexual abominable snowman, there are alternatives to the qiuku.

Tiffany Wang, a Beijing-based style writer said, "Long johns are a crucial item in our wardrobe, but decidedly unsexy, and better off left unseen. With that in mind, opt for something that offers full coverage yet is also as thin as possible, to avoid adding any extra bulk. You can also go the route of avoiding long johns altogether, but keep in mind, it will be a long winter."

As her personal favorites, Wang recommends wearing the Heattech series from Uniqlo, which according to the brand, uses super lightweight fabric to generate heat.

Others remain more blasé about layering up, much to the aghast of their elders. Chen Zhong, a 25-year-old Beijing resident, shies away from his grandmother during winter, as each time they meet, the elderly woman reprimands Chen for not wearing thick undergarments. 

"I can't fit my qiuku in my skinny jeans," he said. "And my pants would ride up because of the friction." Chen laments that though he is often cold, the qiuku look just doesn't work with his form-fitting clothes.

There are other modern day alternatives to the tragically unfashionable qiuku.

Nuanbaobao are popular heating pads and are available at any convenience store.  They can be stuck on areas that need attention. For women, knee-high boots may also provide much-needed protection.

Fashion faux pas or not, qiuku may always be around. Trending on Sina Weibo is "chill cool," the slang name for qiuku. The term conveys the coolness of wearing qiuku, with various netizens chiming in about their love-hate relationship with the thermal underwear.