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Cold Jue (Cold Extremities) with a deep, rapid, and forceful pulse often indicates internal heat. Li Dongyuan treated a Secretary of the Secretariat, Tiehe Gong, who suffered from coldness in his feet, knees, sacrum, buttocks, and back, yet his pulse was deep, rapid, and forceful. He prescribed Huangbai Zishen Wan (Phellodendron Kidney-Nourishing Pill), after which the patient recovered upon further administration. He also treated Yao Gongmao, Left Vice-Director of the Secretariat, who presented with upper heat and lower cold, prescribing Jiji Jiedu Tang (Ji Ji Detoxifying Decoction), resulting in excellent recovery. Zhu Danxi treated Lu Zongxin, who had abdominal masses and coldness extending to the knees in both legs. He used Da Chengqi Tang (Major Order the Qi Decoction) with modifications to purge the interior, leading to recovery. These cases all demonstrate that Cold Jue may be accompanied by heat pathogens.

Luo Tianyi (styled Datemu'er, Deputy Marshal of the Southern Expedition), aged sixty, went on campaign in the seventh month of autumn. I accompanied him. After traveling a thousand li past Yangzhou, during mid-winter, he developed diarrhea with undigested food in the stool, cold pain in the umbilical and abdominal regions, and coldness in the feet so severe that scratching them with hands did not elicit any sensation of pain or itch. He frequently burned stones to warm himself, but could not get warm. Upon examination, his pulse was deep, fine, and faint. I reasoned that due to his advanced age and weak constitution, combined with penetrating into enemy territory, heavy military duties, exposure to cold day and night, irregular diet, excessive consumption of milk and cheese, and walking in damp, low-lying areas, his Yang Qi failed to secure the exterior. Consequently, clear-damp pathogens invaded the deficiency, causing disease to arise from below, resulting in cold reversal. The *Neijing* states: "Contracting cold leads to disease; mild cases result in cough, severe cases in diarrhea or pain." This is a disease caused by the combination of cold and dampness. The treatment method should urgently dispel the cold-damp pathogen and vigorously tonify Yang Qi; only moxibustion can cure this condition. First, apply large moxa cones to Qihai (CV6) for one hundred burns to tonify Lower Jiao Yang deficiency; next, treat each leg's Zusanli (ST36) with twenty-one burns to address cold reversal and guide Yang Qi downward; additionally, moxa Sanyinjiao (SP6) to disperse cold-damp pathogens affecting the feet. Thus, the prescription rationale was stated as follows: When cold excess prevails, treat with acrid-hot herbs; when dampness invades the exterior, level it with bitter-hot herbs, and use bitter flavors to induce dispersal. Use Fuzi (Aconiti Lateralis Radix Praeparata), extremely acrid and hot, to assist Yang and retreat Yin, warming meridians and dispelling cold as the Sovereign herb. Ganjiang (Zingiberis Rhizoma) and Guigui (Cinnamomi Cortex), being extremely hot and acrid-sweet, also dispel cold and dampness; Baizhu (Atractylodis Macrocephalae Rhizoma) and Banxia (Pinelliae Rhizoma), bitter, acrid, and warm, dry Spleen dampness, thus serving as Ministers. Renshen (Ginseng Radix), Caodoukou (Cardamomi Fructus), and Gancao (Glycyrrhizae Radix et Rhizoma) are extremely warm, tonifying the Middle and benefiting Qi; Shengjiang (Zingiberis Rhizoma Recens), extremely acrid and warm, disperses clear-damp pathogens; Congbai (Allii Fistulosi Bulbus), acrid and warm, unblocks Upper Jiao Yang Qi, thus serving as Assistants. It is also stated: To tonify the lower and treat the lower, the preparation should be urgent; urgency implies strong flavor and potency, hence prepare a large dose for administration. After several doses, diarrhea ceased, pain decreased, and the feet gradually warmed. With dietary regulation, full recovery occurred within ten days. The following autumn, passing through Xiangyang amidst continuous rain for over ten days, the previous symptoms recurred. Again, following the previous moxibustion protocol, adding two sets of seven burns to Yangfu (GB38) on each side, and administering the previous herbal formula again, recovery was achieved after several doses.

Modified Baitong Tang: Treats cold exposure and cold drinks, spontaneous diarrhea, undigested food in stool, cold pain in the umbilical/abdominal region, and cold, reversed extremities.
Fuzi (Pao, peeled) 1 liang, Ganjiang (Pao) 1 liang, Guigui (peeled), Gancao (Zhi), Caodoukou (wrapped in flour and baked), Banxia (soaked in boiling water, seven times), Renshen, Baizhu (each 0.5 liang).
Crush the above ingredients. For each dose, take 5 qian, add 2.5 zhan of water, 5 slices of Shengjiang, and 5 stalks of Congbai. Decoct until 1.3 zhan remains, strain, and take warm on an empty stomach after residual food has digested.

Cold Jue all belongs to Kidney deficiency. The Classics state: "The Kidney stores Zhi (Will); insufficiency of Zhi leads to Jue." It also states: "Kidney deficiency leads to Qing Jue (clear/cold Jue) and lack of joy." It further states: "Lower deficiency leads to Jue." And: "All types of Jue, constipation, or diarrhea belong to the Lower Jiao."

In the *Lingshu*, Yellow Emperor asked: "Why does the Shaoyin meridian descend alone?" Qibo replied: "Not so. The Chong Mai (Penetrating Vessel) is the Sea of the Five Zang and Six Fu organs; all organs receive its influence. Its ascending branch emerges at the pharynx, permeates the Yang meridians, and irrigates essence; its descending branch pours into the large collateral of Shaoyin, emerges at Qichong (ST30), follows the medial aspect of the thigh, enters the popliteal fossa, runs deep within the bone, descends behind the medial malleolus, and branches off. Its lower part joins the Shaoyin meridian and permeates the Three Yin meridians; its anterior part runs deep, emerges at the dorsum of the foot, descends along the dorsum, enters between the great toe, permeates various collaterals, and warms the muscles. Therefore, if the collateral collides/stagnates, the dorsum becomes immobile; immobility leads to Jue, and Jue leads to cold. (The *Ni Shun Fei Shu Pian* states: If meridians and collaterals are firm and tight, treat with fire therapy, i.e., moxibustion, or soaking in decoctions/wine.)"

There are two types of Cold Jue according to Yunqi (Five Movements and Six Qi):
First is Cold Jue. The Classics state: "Water movement qi is called Jing Shun (Quiet and Smooth). In the Jing Shun pattern, the disease is Jue." It also states: "When Water year is excessive, cold qi spreads, pathogenic factors harm Heart Fire, leading to dryness, palpitations, and Yin Jue." It also states: "When Metal year is deficient, flame/fire moves; the rebound effect causes Yin Jue and obstruction."
Second is Cold-Damp Jue. The Classics state: "When Taiyin governs Heaven, Heaven Qi descends, Earth Qi ascends, and people suffer from alternating cold and fever."

From *Qianjin Fang*: A prescription for men suffering from cold and numbness in the feet and waist, unable to walk. Take 3 dou of pure wine and 3 dou of water, mix in a jar, and soak warmly up to the knees for three days. If it cools, keep ashes/fire under the jar to prevent cooling.

From the *Lingshu*: "In Jue with severe cold, depression below the tibial border, cold exceeding the knee, select Zusanli (ST36), where Yin collaterals pass, and where pathogenic factors remain. Cold entering the interior, push and move it. For sunken meridians, fire therapy is indicated; for firm and tight meridians, fire therapy treats them. If the location of pain is unknown, at the base of the Two Qi vessels, for males select Yin Qi, for females select Yang Qi; skilled physicians prohibit needling here. The discussion on needles concludes. (Note in *Guan Neng Pian*: Base of Two Qi refers to Zhaohai (KI6) and Shenmai (BL62).) For Cold Jue, select Foot Yangming and Shaoyin points, retaining the needle. (*Han Re Bing Pian*)"

The aforementioned moxibustion and acupuncture methods for treating Cold Jue belong to tonifying deficiency. The Classics state: "The branch of Foot Shaoyang is named Guangming (GB37), five cun above the ankle, diverging to Jueyin, connecting downwards to the foot dorsum. In excess patterns causing Jue, select the divergence point; this method drains excess." Another Classic states: "Disordered Qi in the arm leads to Four Jue (extremity coldness); select points by first addressing blood vessels, then selecting Ying-Spring and Shu-Stream points of Foot Yangming and Shaoyang; this method treats disordered Qi without tonifying or draining, merely guiding Qi through slow insertion and withdrawal."

Li Dongyuan stated: "When Jue is located in the feet, Zong Qi fails to descend, blood in the pulses stagnates and stops; only fire therapy can resolve it."

Wang Jiegu stated: "Body heat like fire, feet cold as ice; moxa Yangfu (GB38)." Also: "Soreness and coldness in the lower leg; select Jiegu (GB39)."

From the *Jia Yi Jing*: "For severe Jue, select active meridians of Foot Taiyin and Yangming. For Foot Jueyin wheezing/reversal, coldness from sole to knee, Yongquan (KI1) is the main point. For Cold Jue and Heat Jue, vexation, scanty Qi, insufficient respiration, Yin dampness with itching/pain, inability to eat/drink, elbow contracture with chest fullness, dry throat with thirst, Yuji (LU10) is the main point. Coldness and numbness from below knee to foot, inability to sit/rise, inability to lift the sacrum, Yaoshu (BL23) is the main point."