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Yang qi is concealed, while yin qi protrudes outward; the failure of yin and yang to connect smoothly results in cold extremities (Jue). If fever occurs first followed by cold extremities, it indicates heat pathogen concealed within. If cold extremities occur first followed by fever, it signifies the retreat of yin and the restoration of yang.

If cold extremities appear immediately upon onset of illness, it is due to deficiency of yang and excess of yin. In cases where heat is concealed within, the pulse is deep and rapid, accompanied by delirium, thirst, extending arms and throwing off clothes, restlessness with inability to sleep, or constipation. In cases where cold extremities appear initially, the pulse is deep, slow, and weak; the patient remains clear-headed and quiet, fears cold and pulls clothes to cover themselves, or experiences diarrhea with undigested food. Cases involving fear of cold with curling up, restlessness with diarrhea, and unconsciousness are all adverse prognoses, hence termed "reverse" (Ni).

In cases of initial fever followed by cold extremities, symptoms include waving hands and kicking feet, irritability with desire for water, aversion to heat with sweating on the head, constipation, dark urine, oppression, dizziness, and palpitations. This occurs because purgation was indicated but not administered, leading to obstruction of qi and blood. This is what is meant by "the deeper the heat, the deeper the cold extremities." Da Chai Hu Tang (Major Bupleurum Decoction) or Xiao Cheng Qi Tang (Minor Order the Qi Decoction) should be selected for use.

In cases where cold extremities appear at the very beginning of illness, symptoms include cramping of the feet, aversion to cold, pulling clothes to cover oneself, absence of thirst, normal urination and defecation, silence mixed with anxiety. Various Si Ni Tang variants (Four Counterflow Decoctions) should be selected.

In Shaoyin disease presenting with cold extremities and epigastric palpitations, treat the palpitations first with Fu Ling Gui Gan Tang (Poria, Cinnamon Twig, and Licorice Decoction); subsequently treat the cold extremities with Si Ni Tang (Four Counterflow Decoction). For vomiting, diarrhea, cold extremities, and severe irritability as if dying, use Wu Zhu Yu Tang (Evodia Decoction) or Dang Gui Si Ni Tang (Angelica Four Counterflow Decoction), and moxa the Taixi (KI-3) acupoint.

Constipation refers to difficulty in defecation. It often arises from sweating or diuresis depleting body fluids, causing dryness of the intestines and stomach, frequently transforming into Yangming interior syndrome. If urination is frequent, fluids are diverted to the bladder, making defecation difficult. If purgation or sweating leads to frequent urination and hard stool, administer Cheng Qi Tang formulas to harmonize, indicating depletion of internal fluids. There are cases unsuitable for immediate purgation, such as floating pulse, deficient pulse, or aversion to cold, which indicate exterior pathogen retention and contraindicate purgation. Vomiting suggests the pathogen has not entered the fu organs; even with Yangming signs, attack is contraindicated. Clear urine indicates the pathogen remains in the exterior, not the interior. Difficulty in defecation with scanty urine and no flatus indicates no dry feces in the interior, only hard stool at the beginning and loose stool later. In Yangming disease with a floating pulse, or after sweating with spontaneous urination and constipation, it is also due to fluid depletion; honey suppositories (Mi Dao Jian) should be used to promote passage. The Classic states: A floating and rapid pulse, ability to eat, and constipation constitute an excess pattern named Yang Jie (Yang Binding), treated with Da Chai Hu Tang. If symptoms persist, relief comes after passing stool. A deep and slow pulse, inability to eat, heavy body, and difficult defecation constitute Yin Jie (Yin Binding), treated with Jin Ye Dan (Golden Liquid Pill).

In Shaoyang disease, if constipation persists for six to seven days with headache and fever, use Xiao Cheng Qi Tang.
If a patient has had constipation for six to seven days with periumbilical irritability occurring at specific times, this indicates hard feces preventing passage; use Xiao Cheng Qi Tang.

For Yangming disease, purgation may cause hardness; excessive sweating followed by further sweating also causes hardness; both may be managed with Xiao Chai Hu Tang (Minor Bupleurum Decoction).
In Yangming disease with hardness and fullness in the hypochondrium, constipation, vomiting, and a white coating on the tongue, use Xiao Chai Hu Tang.
In Shaoyin disease lasting six to seven days with abdominal distension and constipation, urgent purgation is required using Da Cheng Qi Tang (Major Order the Qi Decoction).

If sweating or diuresis depletes internal fluids causing natural difficulty in defecation, do not purge. Without clear yin-yang differentiation, forcibly purging will lead to diarrhea with undigested food and abdominal distension; in such cases, use honey suppositories.