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[Luoti Yiyi] Clinical Case of Treating Upper Heat and Lower Cold: Yao Gongmao, Left Vice Director of the Secretariat, aged sixty-seven, had a history of latent wind pathogen. At the end of the Wushen year of the Zhiyuan era, he fell ill due to alcohol consumption. His head and face were red, swollen, and painful, with swelling particularly severe around the ears. He experienced chest oppression and throat discomfort. The lower half of his body was cold, especially the calves. Consequently, he connected beds to form a pit, lying on the upper part, with reduced appetite, mental fatigue, and body pain. I was summoned to treat him. The pulse was floating and rapid, but deep pressure revealed it to be wiry and thin, clearly indicating upper heat and lower cold. The *Neijing* states: "Excess heat causes swelling." It also says: "Diseases caused by spring qi often affect the head." The *Nanjing* states: "Accumulation leads to swelling and heat, which can be treated by bloodletting with a bi stone." Aiming for easy dispersion, I performed approximately fifty pricks on the swollen areas, extracting about one cup of dark purple-black blood. Pain subsided almost immediately. I then applied moxibustion at Qihai (CV6) for one hundred cones to assist yang deficiency in the lower jiao and dispel yin cold. Next, I moxaed the bilateral Zusanli (ST36) points, thirty-seven cones each, to treat coldness in the feet and guide yang qi downward. Thus, I formulated a prescription named Jiji Jiedu Tang (Both Crossing Detoxification Decoction), employing the method of "treating heat with cold." However, diseases vary in location and treatment in distance; this principle does not exceed these bounds. Huangqin (Scutellariae Radix) and Huanglian (Coptidis Rhizoma) are bitter and cold, prepared with wine as a guide to purge upper heat. Jiegeng (Platycodonis Radix) and Gancao (Glycyrrhizae Radix et Rhizoma) are acrid, sweet, and warm, ascending to assist the bitter herbs in treating heat. Chaihu (Bupleuri Radix) and Shengma (Cimicifugae Rhizoma) are bitter, neutral, and light in flavor, belonging to yang within yang, dispersing upper heat. Lianqiao (Forsythiae Fructus) is acrid, bitter, and neutral, resolving nodules and reducing swelling. Danggui (Angelicae Sinensis Radix) is acrid and warm, harmonizing blood and relieving pain. Dahuang (Rhei Radix et Rhizoma) stir-fried with wine is bitter and cold, guiding the bitter nature upward to relieve irritability and heat. After administration, swelling dispersed, pain decreased, and bowel movements became smooth. Upon re-administration, the dosage of Dahuang was reduced. With careful speech and dietary restrictions, he recovered fully within ten days.

Jiji Jiedu Tang (Both Crossing Detoxification Decoction): Treats upper jiao head and eyes red, swollen, and painful, chest and diaphragm oppression preventing sleep, coldness in the lower half of the body, especially the feet, and dark, constipated stools.
Dahuang (Rhei Radix et Rhizoma) (stir-fried with wine; omit if stool is loose), Lianqiao (Forsythiae Fructus) (prepared with wine, stir-fried), Huangqin (Scutellariae Radix) (stir-fried with wine), Gancao (Glycyrrhizae Radix et Rhizoma) (roasted), Huanglian (Coptidis Rhizoma) (stir-fried with wine).
Jiegeng (Platycodonis Radix) (2 qian each), Chaihu (Bupleuri Radix), Danggui (Angelicae Sinensis Radix), Shengma (Cimicifugae Rhizoma) (1 qian each).

[Maijue] In febrile diseases, "Yang attaching to Yin" refers to heat from the waist down to the feet, with cold above the waist. If yin qi struggles downward and returns causing fullness in the heart and abdomen, death ensues. "Yin attaching to Yang" refers to heat from the waist up to the head, with cold below the waist. If yin qi struggles upward and sweating occurs, survival is indicated.

[Lingshu] For upper cold and lower heat, first needle the Taiyang points at the neck, retaining the needles for a long time. After needling, apply moxibustion or heat therapy to the neck and scapula until warmth descends and merges, stopping only then. This is called "pushing upwards." (From *Cijie Zhenxie Lun*, same follows) For upper heat and lower cold, observe deficient pulses sinking into the collaterals; extract qi until it descends, then stop. This is called "drawing downwards."

[Li Gao] There is another presentation of upper heat and lower cold. The classic states: "Yin disease affecting yang should draw yin from yang," requiring treatment via blood in the collaterals and meridians. If fire within yin flares up to heaven, causing the six yang channels to remain hyperactive and fill the upper body, one must first drain blood from the collateral vessels of the five zang organs to guide it downward. When heavenly qi descends, the lower cold pathology resolves naturally. Do not solely purge the six yang channels. This condition involves yang hyperactivity fueled by yin fire; only remove the yin fire and the pathogenic factors in the blood collaterals and meridians.

The Sages view upper heat and lower cold as having spring and summer without autumn and winter. One must draw yang from outside heaven down into the earth. This syndrome involves excessive yin fire in the upper heaven assisting the six yang, preventing their decline. First, pierce blood collaterals in the six yang to bleed, allowing qi to descend to the three yin. Though weak, this can drive the six yang downward because yin blood naturally descends. This can be described as old yang transforming into yin. Thus, the classic says: "For upper heat and lower cold, take those with deficient pulses sinking into the collaterals; this is drawing downwards." All mention of collaterals applies here. For severe cases, use a three-edged needle to bleed, removing heat from yang. Heat lingering in the Hand Taiyang Small Intestine channel prevents old yang from transforming into yin and descending. Therefore, first drain the hot blood from the Hand Taiyang channel, allowing the three yin to function timely, descending to execute autumnal functions, receiving and storing within the earth. This purges old yang refusing to transform and follow the yin pathway. In the spring of the Wuchen year of Zhiyuan, Yang Zhengqing, Vice Director of the Secretariat, over seventy years old, suffered from facial depression and redness resembling drunkenness, thick sticky phlegm, and occasional vertigo as if in a wind fog. One day at an assembly, this symptom suddenly appeared, accompanied by blurred vision, so he returned home. I examined him: both cun positions were flooding and large, while chi positions were wiry, thin, and powerless, clearly indicating upper heat and lower cold. Medication was considered, but given his advanced age and weak qi, he could not tolerate it. Recalling my master's discussion: upper heat is like a bird's nest high atop; shoot and remove it. I used a three-edged needle to rapidly prick more than twenty times at the anterior hairline of the vertex, extracting about two he of dark purple-black blood. Immediately, the head and eyes felt clear, all suffering ceased, and it never recurred. (Needling upper heat/lower cold differs from the classic intent. The classic blames deficiency at the cold site, treating it to draw upper heat down. Yuan [Li Gao] obtains blood at the heat site, waiting for heat to retreat from within and descend.)

[Zhenjiu Miyu] For upper cold and lower heat, or upper heat and lower cold, select Xuanzhong (GB39). (Depth 2.5 cun. For upper cold/lower heat, tonify first then sedate; for upper heat/lower cold, sedate first then tonify. Alternatively, tonify Xuanzhong (GB39) by 0.5 cun for upper cold, and sedate Quchi (LI11) by 1.5 cun for lower heat.)