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The *Shanghan Lun* (Treatise on Cold Damage) records Yang Jue (Yang Reversal, a condition characterized by initial heat followed by cold extremities) where fever precedes the onset of cold limbs, and Yin Jue (Yin Reversal, a condition characterized by cold extremities without initial fever) where cold limbs appear at the onset without fever; this is known to everyone. However, in febrile conditions where exterior pathogens are internally trapped, there is heat in the upper body but only the feet are cold. When Sha (Sha disease/toxin, often referring to toxic heat or eruptive diseases) is internally trapped, there is heat in the upper body accompanied by vomiting and cold feet. Even if the body is hot with profuse sweating, the pulse is deep and rapid, the tongue has coating, yet only the feet are cold—these scenarios were not recorded in previous medical texts. It is unknown that when cold pathogen initially injures the body before fever occurs, cold feet may present. If the upper body is already hot, how could it be that within one person's body, only the two feet are exclusively cold? Moreover, during winter cold, even healthy people often have cold feet. If one has contracted Shanghan (Cold Damage) and already has fever, even in winter months, hands and feet should be warm. If the feet remain cold, it indicates that the exterior pathogen has not been extended/dispersed, and the heat pathogen has not been able to vent outward. Furthermore, during hot seasons, people's hands and feet are all warm; how could there be heat in the upper body while only the feet are cold? My family secret formula uses Qianghuo Duhuo Baidu San (Notopterygium and Angelica Pubescens Decoction for Resolving Exterior and Expelling Toxins) to resolve the exterior, because for the exterior pathogen causing cold feet, only Duhuo (Angelicae Pubescentis Radix) can resolve it. If Duhuo is omitted, although exterior-resolving herbs are used, the pathogen in the lower part will ultimately not disperse; severe cases will transform into complicated syndromes, mild cases will linger, and even if cured later, one must fear complications like Wei Bi (Atrophy Syndrome with Obstruction) or loss of vitality in the feet. Therefore, whenever sweating occurs but body heat does not resolve, it is either interior heat or unresolved exterior pathogen. If there is knotted heat in the interior causing fever without feeling cold, there must be sweat appearing intermittently over the whole body. If the body is very hot, restless, and feet are cold, it is definitely not interior heat, but rather unresolved exterior pathogen or un-erupted Sha toxin. If it were a case of "heat deep, reversal deep" (Re Shen Jue Shen), indicating interior heat syndrome, the entire body would necessarily be cold. Now, since the body is hot but only the feet are cold, it must be that the exterior syndrome is unresolved. Thus, whenever there is irritability, distension, panting, vomiting, body heat, and cold feet, these are signs of Sha eruption. In treating febrile diseases during hot seasons, regardless of whether there is sweating or not, and whether the pulse is floating or deep, once I see body heat with cold feet—a deviation from normal severe condition—I follow the principle of "treating based on symptoms rather than pulse." With such treatment, some recover after sweating. Some, previously suppressed by cold-cooling agents, require multiple rounds of sweating (three or four times) to fully resolve. Only when Sha toxin is long-suppressed is prognosis poor (more ominous than auspicious). However, if the Sha color is bright and clear, survival is possible. But if heavy consumption of meat/fish suppresses the Sha and exterior sweating, survival is unlikely. I commonly see patients in summer and autumn with internal accumulated heat and external exterior pathogen, whose Stomach Yang is further suppressed by cold dietary intake, preventing the Yangming heat pathogen from venting outward; they exhibit sweating only on the head with no sweating on the rest of the body. Similarly, Sha epidemic toxins suppressing Stomach Yang also fail to promote outward eruption. I frequently use Zhiqiao (Aurantii Fructus), Houpo (Magnoliae Officinalis Cortex), and Guangpi (Citri Reticulatae Pericarpium) to loosen and regulate Stomach Qi, and Chaihu (Bupleuri Radix), Gegen (Puerariae Lobatae Radix), and Fangfeng (Saposhnikoviae Radix) to disseminate exterior pathogens. Where there is an exterior pathogen, sweating will occur; where there is Sha toxin, Sha eruptions will manifest. From this, I realized that for conditions with sweating only on the head and none on the body, medical books treat them primarily as Water Retention, Blood Stasis, or failure of the Middle Jiao to circulate freely. For example: for dampness condensation, use Cangzhu (Atractylodis Rhizoma), Houpo, Gegen, Fangfeng; for cold condensation, use Shengjiang (Zingiberis Rhizoma), Qianghuo (Notopterygii Rhizoma et Radix); for heat condensation, use Huanglian (Coptidis Rhizoma), Zhiqiao; for food stagnation condensation, use Maiya (Hordei Fructus Germinatus), Doukou (Amomi Fructus Rotundus); for phlegm-fluid condensation, use Banxia (Pinelliae Rhizoma), Shichangpu (Acori Tatarinowii Rhizoma). One must know that Zhiqiao, Doukou, Xiangfu (Cyperi Rhizoma), and Sharen (Amomi Fructus) are the key regulators for the chest area, while Gegen and Shengma (Cimicifugae Rhizoma) promote the dissemination of Stomach Qi, warming hands and feet, dispersing heat throughout the body, inducing sweating to resolve the exterior. Thus, promoting Stomach Qi dissemination is a subtle method for inducing sweating. Note: Both cold feet and red face belong to exterior pathogens. Red face appears in the upper part, which everyone knows. Cold feet appear in the lower part, which many ignore; hence I specifically supplement this discussion. However, treating cold feet requires referencing methods for Sha eruption and Food Stagnation. Therefore, my universally applied secret formula is Shengma Jiexiao Tang (Cimicifuga Exterior-Resolving Decoction).

Duhuo Tang (Angelica Pubescens Decoction)
Ingredients: Duhuo, Fangfeng, Chaihu, Gegen, Guangpi, Gancao.
Modifications: Add Qianghuo for body pain; add Zhiqiao for chest fullness; add Banxia, Houpo, Baiddoukou, and Chuanhuanglian for nausea/vomiting.

Hewei Touji Tang (Harmonize Stomach and Penetrate Muscle Decoction)
Ingredients: Houpo, Zhiqiao, Guangpi, Chaihu, Gegen, Fangfeng.
Explanation: Cold feet are all due to exterior pathogens, but the distinction between exterior sweating and Sha eruption was unclear; thus, this formula achieves two goals with one action.

Shengma Jiexiao Tang See entry under "Food Stagnation".